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+text,language
+"As already said, I'm a wife, a mother, and a full-time finance professionals with a daily three-hour round-trip commute. I'm an ME/CFS patient and I am one of the lucky ones.",English
+"I was diagnosed in 1995 after recovering from Epstein-Barr virus. A few weeks of resting and dancing the try hourly Tylenol,",English
+"advil shovel and I was okay and then one day I wasn't. So contact in 1995, I was 12 years old.",English
+More people were familiar with the term yuppie flu and then the diagnosis or even the veracity of chronic fatigue syndrome. There was no Google and I couldn't ask you.,English
+"In 1995, during the late night hours that I was too tired to sleep, which is the most frustrating contradiction of all ME/CFS symptoms.",English
+"I learned that I wasn't dying from watching midnight reruns on the Golden Girls. Season 5 Episodes 2 was titled, Sick and Tired.",English
+"By repeatedly receiving a clean bill of health after months of physical and cognitive impairments, so debilitating, so you had to stop working,",English
+"start these warn Act was diagnosed with chronic fatigue syndrome, and I could have written the episode myself. If brain fog didn't make it too hard to find the word and it's",English
+pain and didn't keep me from grasping a pen tightly enough to write. On the days that I couldn't even lift my arm. I have made the episode more exciting by adding a painting cell from,English
+"intermittent hypoglycemia and I complicated it with doctoral orthostatic tachycardia. I am lucky that this rheumatologists didn't dismiss my symptoms and growing pains or puberty or anxiety,",English
+which happens more than once. I'm lucky I didn't wait months or years for a diagnosis and I'm lucky to have the opportunity to speak with you today.,English
+"I have two vials of injectable acts our gel in the fridge is the last resort. Last resort because it's $30,000 a vial. The financial assistance program is so administratively burdensome,",English
+"it causes post exertional malaise. Also in my fridge is cassette decks for the psoriatic arthritis, I was diagnosed with it H33.",English
+Do rheumatologists that I need classic fiber okay. Until he noticed the scars from the bilateral total knee replacement had 25 for what the surgeon calls total side compartmental,English
+degeneration is that rivaled a retired football player. I started taking a low dose of the immunosuppressants to their limits in November of 22 and the fog started listing.,English
+"There's a difference between fog and fatigue. Half the time I can put through this again with Modafinil, but then I crashed and I need a few days to recover.",English
+"I couldn't find the toilet paper, which was on a roll on the toilet paper holder, I'd have the roll where it's always been. My fourth day on Carolinas,",English
+I realized it was working when I got home and didn't meet my husband help to pack the dinner on my plate. I bet in most any CFS patients gravitate,English
+towards finger goods over anything that requires a fork and knife. Microwaveable pizza pocket doesn't require strength or energy or dexterity and it's less likely to cause post exertional malaise.,English
+It's also a lot easier to navigate from inside the fog. Lucky because my recent progress is not short-lived but there are two sides to every coin.,English
+"I spent three decades to fog, to comprehend this pain. Life outside the Bosnians, I am acutely,",English
+"profoundly aware of my pain and chronic pain causes chronic fatigue. I'm lucky, 30 years of trial and error has taught me and most of my family,",English
+"because it takes most of my family, including my children who still don't have the mother they deserved how to balance my symptoms with the rest of my life.",English
+"As painful as it is, I'm lucky now, more so than ever to apply what I've learned about CNS symptom management from outside the fog.",English
+"Please make this your compass when defining the ME/CFS research roadmap. Symptom management in a vacuum is not working. I'm not discounting, it's important.",English
+"But we must treat and prevent the higher cascade of central nervous system disruptions to regain any quality of life. I am by no means healthy,",English
+"but I'm the healthiest ever been and 40 years old, a wife, a mother and since 1995, a full-time ME/CFS patient.",English
+"I'm one of the lucky ones. Thank you. Jarred Younger: Thank you, Trisha. I don't know if everyone can hear me,",English
+"I heard that my Zoom was not working very well. I hope it is working better now. If not, I will figure out what to do about that,",English
+"but it looks better so far. Thank you very much. I want to introduce the next speaker Gudrun Lange, and Gudrun is a clinical neuropsychologist.",English
+"She's at the Pain of Fatigue Study Center in New York. There is so much clinical and scientific confusion, and misconception when it comes to cognition in",English
+fibromyalgia or go for illness or ME/CFS or long COVID. Cognition is a core part of these conditions for sure. But sometimes it seems to me that it's the least understood and so I'm,English
+very glad that Gudrun can be the light in all the confusion. Every time I stumble upon a group starting to haphazardly incorporate cognitive measures into what they're doing.,English
+"I can just gently say, hold on a second, there's somebody you should speak to first, and that is Gudrun Lange. It's all yours.",English
+"Gudrun Lange: Thank you very much Jarred, and thank you very much, Trisha, for your report of the lived experience because it taps",English
+"right into what I'm actually going to be talking about today. John, I'm just going to say next slide, and go on to the next slide.",English
+What I'll be talking about today is the status of current knowledge about cognitive function in s and the gaps in knowledge.,English
+But it turned out that I'm going to be talking mostly about inclusion of cognitive assessment in clinical trial design.,English
+"Then finally, I'm going to focus on what we can do to make it better as we go forward. Next slide, please.",English
+"Not a rich history of neuropsychological research, Cordova for about 40 years, but 25 of those have been around,,",English
+and we know at this point pretty much that it's there. We know its nature. It is mostly focused on,English
+a complex information processing and efficient information processing as Trisha was so well describing before.,English
+"It is perceived as severe as disabling. In fact, very early on, Lenny Jason, already estimated that cognitive function to receive by about 89% of ME/CFS patients.",English
+The deficits they perceive most commonly are described as memory and concentration problems. I'll go into that a little bit.,English
+"Next slide, please. When I reviewed the literature, it quickly occurred to me that I had bitten off a lot for this presentation.",English
+I was surprised by the fact that cognitive assessments are not very often used in clinical trial design.,English
+"Despite the fact that we know that they are real, that they are not manifestations of depressive disorder,",English
+"even though it's present disorder can be comorbid, and make sure to also put that they're not manifestation of somatic symptoms. They are real.",English
+"They are not due to war effort, no motivation to do well on cognitive tasks. They are a real deficit and impact life.",English
+"Next slide, please. I'm going to briefly talk about patient reported measures of cognitive dysfunction and emit the best.",English
+"Most managers addressing cognitive functioning, ME/CFS studies and trials trying not to be patient reported outcome measures, also called PROs.",English
+I have a little list here of patient reported outcome measures that are often used clinical trials.,English
+"The first three are specific to any ME/CFS and the rest is not specific to ME/CFS. With the SF-36 pretty much used in most clinical trials,",English
+but not as the primary outcome measure. But somewhere in the secondary outcome major list. What's missing on this list are questionnaires that are specific to function.,English
+"It's not that they're not available, they are than normed and standardized. Next slide please.",English
+"If you are interested in finding out more information about the use and efficacy parameters of the tools that I just presented,",English
+"this is a really good resource. It's the management of myalgias, encephalomyelitis, chronic fatigue syndrome report,",English
+updated review that was prepared for the CDC by Pacific Northwest Evidence-based Practice Center and published in April 22.,English
+"It gives you before and after treatment group comparisons of patient reported outcome measures that have shown to have not only statistical significance,",English
+"but also estimates of clinical meaningfulness, which is a measure that has to be taken into",English
+account when you report data of clinical trials and that is often lacking. Assessment of cognitive function is not commonly used as a,English
+primary or even co-primary efficacy outcome measure or function. By function what is often meant are categories of mental fatigue.,English
+"In general, the attention, concentration, memory problems, but not specifically addressing the processes that underlie cognitive dysfunction in Emmys first.",English
+"Now the next slide, please. There is no doubt that the use of patient reported outcome measures in clinical trials is appropriate.",English
+"If the research question is false, what is an individual's perception or experience of cognitive dysfunction in comparison to a previous time point?",English
+This question reflects inquiry into a person's interpretation of what cognitive dysfunction needs to know. Cognitive dysfunction is often,English
+"perceived as catastrophic as was so well-described by Tricia this morning. As complex cognitive processes are affected,",English
+"that previously runs in the background automatically. Now, all of a sudden they have",English
+"risen to consciousness and the person has to attend to them. To make this experience a little bit more real life,",English
+"a lot of our patients describe the changes in the driving it. Since you were 18 years old,",English
+"most of us learned how to drive so we get in the car, run the car, get out of the driveway and do what we have to do to get to where we need to get.",English
+Not so for ME/CFS patients or persons with ME/CFS. They have to now think about every little step of driving a car.,English
+The environment becomes much more stressful and impactful on cognitive function. But also the person in the car,English
+"sometimes describes that they're talking to themselves saying, I have to now turn the blinker out. Boy, where's the lights which fully in this car,",English
+even though they've had this car for a long time? Some people are missing the exits. that they use every day. Some people even drive by their homes or end up,English
+in a different street in a neighborhood that they lived in for a long time. This is highly disturbing and it's really sad.,English
+"Next slide, please. Now I will turn to the objective assessment of cognitive function in ME/CFS events. Importantly, cognitive function, rather the processes underlying cognitive function.",English
+"But cognitive dysfunction is one of the few symptoms of ME/CFS that can be objectively quantified, psychometrically with valid, and reliable measures.",English
+How come we don't see it more often? I reviewed Kim et al's recent systematic review of primary outcome measures for ME/CFS in randomized controlled trials.,English
+"They considered 500 trials, but only 52 passed eligibility criteria for review. About 60% of the RCTs in the analysis was the single primary outcome measure,",English
+the rest used two or more co-primary outcome measures. My review of these 52 trials revealed that only 11 RCTs use an objective cognitive measure,English
+"administered in clinic face-to-face as one of the primary outcome measures and majority of the remaining 41 trials employed patient reported outcomes,",English
+most of them nonspecific to ME/CFS. The objective neuropsychological measures used,English
+included brief measures that are often not sensitive enough. For statistical significance never mind clinical meaningfulness. The topic that I'll address in the next few slides.,English
+"The outcome measures that were used were Digit Span, forward and backward Symbol Digit Modalities, which is actually a robust as trails A and B,",English
+"not so much a Stroop, yes and the computerized arithmetic task, which I don t know what the norms are. It's one of those lab specific things that I use to evaluate cognitive function.",English
+"Next slide please. The recent systematic review and meta-analysis by Sebaiti et al, makes some very important points.",English
+"They looked at original case control research studies using objective cognitive measures, published between January 1988, February 2019.",English
+All studies included in the analysis evaluated ME/CFS adults that were clinically diagnosed with ME/CFS and had known,English
+neurological or psychiatric comorbidities and could get them to healthy adults. The group applied rigorous statistical criteria,English
+that I was happy to see that include the following. Measures under investigation had to have been used at least two studies. Important because it's hard to compare,English
+assessment tools across studies if they are used in a non standardized way. The group differences between ME/CFS and controls needed to be of,English
+"statistical significance at the P 0.05 level and had to be accompanied, at least with a moderate waited effect size of 0.5.",English
+Here I'm going to briefly address why it's important to include an effect size as recommended by the American Psychological Association by the way.,English
+"A P-value of 0.05, simply infers that a comparison between group means is applicable to 95% of the sample under study.",English
+The calculated effect size between groups as defined by Cohen informs about the magnitude or size of the effect as the difference,English
+"between group means actually have practical or clinical significance. In order to determine that, Cohen defines the effect size in the following way,",English
+"0.2 is a small negligible effect size, 0.5 is a medium effect size and",English
+"often considered the minimum threshold in treatment trials. An effect size of 0.8 or greater is considered large and really robust. Since calculated effect sizes are standardized measures, for instance,",English
+and effect size of 0.5 equals half a standard deviation independent of sample size. Comparison of effect sizes across trials is possible.,English
+"There are criticisms of Cohen's effect sizes, but in my book, at least they provide some framework of evaluating clinical meaning.",English
+"Next slide, please. In the interest of time,",English
+I will focus on the gist of the information provided in the next three slides. They all address with a clinically meaningful changes were obtained with,English
+traditional neuropsychological measures listed on each of the slides in domains relevant to cognitive dysfunction and ME/CFS. The Bahitian co-workers found no differences in performance,English
+"between ME/CFS and controls on tasks, tapping in the domains of overall intellectual function as measured by NAART",English
+"and also WAIS R sub-tests that tap into verbal comprehension. In the executive functions with a focus on impulsivity,",English
+"ability to conceptualize and strategize without time constraints and then what we call instrumental functions focusing on language skills, visual functions, and computational abilities.",English
+"In my opinion, these are important negative findings as they affirm that especially intellectual functions without dynamic sub-components,",English
+but acquired over a lifetime is likely to be normal in ME/CFS. Does not signal the likelihood that it signals a neurodegenerative process is fairly low.,English
+"It is important to know about cognitive strengths does it helps to highlight cognitive weakness. In my opinion, an estimate of overall intellectual function should be included",English
+"in every clinical trial RCT addressing cognitive function. These tests are quick. Take maybe five minutes of research time, no breakfast,",English
+"and can be administered remotely. Next slide, please. Now stepping into simpler, even complex reaction time and speed of motor movement coordination",English
+"provide inconsistent results across studies due to variable effect sizes across study. Unfortunately, some of the simple tasks are used",English
+"as trial outcome measures and then not very informative, so I would not recommend using any of them especially as a primary outcome measure. Next slide, please.",English
+Gudrun Lange: Thank you. The Bahitian co-workers reported robust findings that these moderate effect sizes and,English
+"a low variability across studies in the following domains, sustained and divided attention with working memory and speed components, reflecting multi-tasking.",English
+Number 1 problem or patients or persons with ME/CFS. The tests used here are the Continuous Performance,English
+Test and the conditions were the numbers for them without distraction as well as the Paced Auditory Serial Attention Tests.,English
+There are several versions of that test. The one with four conditions going from very quick inter-stimulus intervals to longer inter-stimulus interval,English
+is the one that we'll give you a medium effect size. Another area of robust findings is,English
+"another area that is of interests and it's affected in ME/CFS, which is processing speed, Symbol Digital Modalities Test or the WAIS Coding Test,",English
+is the most commonly used for that. Then we go to the area of that memory deficit is proceed.,English
+Memory demonstrate in ME/CFS up this is most commonly due to difficulties with encoding and learning of novel information and is,English
+"not the memory problem that we generally see in patients with dementia. When patients report that they have a memory problem,",English
+they report it because they cannot remember the entire information that they were supposed to absorb but didn't. But you can only recall that information that you encode it.,English
+"If you didn't encode it, you won't recall it. But they do not forget information. That's enough about this.",English
+"Can you please switch to the next slide? I've already alluded to some gaps in knowledge that could be possible reasons to accomplish hesitancy between objective neuropsychological measures,",English
+in ME/CFS based RCT clinical trial design. Two methodological issues are really obvious.,English
+"First one is that, traditional neuropsychological measures use that. The subjects need to come into the office last week well enough to travel.",English
+Supervision is necessary to ascertain proper test administration and completion. The problem associated with a travel issue is,English
+that potential participants may already be exhausted just from the experience of traveling to the study site. We don't know how will that impact on,English
+cognitive function that's measured after their arrival. The second big deal is that investigators often,English
+"focus on the use of brief measures that may only have small negligible effect sizes, such as the WAIS IV Digit Span Forward and Backward and thus may not be",English
+"robust indicators sensitive to clinically meaningful changes in group means due to an intervention or treatment. Therefore, I recommend that investigators shy",English
+"away from Madras as primary or co-primary evidence, even though they are perceived as weak, easy, and not tapping in a lot of research time.",English
+"Next slide, please. At this time, I would like to shine a special light on the participant recruitment issue that I alluded to in the previous slide.",English
+"Due to the predominance of clinic administered neuropsychological measures, researchers are often not able to include patient groups that cannot travel to the research design.",English
+"Those are homebound or even bedbound ME/CFS as patients. An estimated about 840,000-2.5 million Americans suffer from",English
+"ME/CFS and about 10-25% of these are estimated to be either homebound or bedbound. Patients are rarely, if ever,",English
+participating in studies employing objective cognitive evaluation. Even though home and bedbound persons with ME/CFS might be,English
+"the important beneficiaries of pharmacological or non-pharmacological treatment and thus need to be captured in first. Next slide, please.",English
+So how can we move forward to integrate cognitive assessment in clinical trial design? How much better is now exist that can be administered remotely?,English
+"They more and more often include practice trials and easy to understand instructions, possibly reducing the workload on study personnel, facilitating use of in-home test administration as well.",English
+The COVID pandemic helped us to accelerate development in this area. An increasing number of studies show face-to-face and remote income test administration produces,English
+equivalent results even final neuropsychological measures that have shown to produce robust group differences between ME/CFS and healthy controls.,English
+Those traditional neuro-psychological measures I mentioned earlier. Next slide please. Some of them remotely administered batteries that have been,English
+used in ME/CFS samples are listed here. They include the NIH toolbox that has the flanker test that we evaluated.,English
+"The flanker test is a little bit difficult to administer. The Cambridge Neuropsychological Tests Automated Battery, Computerized reaction time measure,",English
+"the continuous performance test version, and the Cogstate Brief Battery. Next slide please.",English
+"Under the leadership of Dr. Hunger, the CDC has tried to address some of the questions I pose with the multi-site clinical assessment of ME/CFS,",English
+"also called MCAM cognitive substudy of 261 ME/CFS, and 165 healthy controls.",English
+We are currently preparing the findings for journal submission. The goals of this sub study were to evaluate the brief computerized neuropsychological screening battery that can be,English
+administered reliably and repeatedly in clinic and remotely at home after an exercise challenge. Needed a brief computerized cognitive battery that had been created and used in,English
+populations with similar cognitive dysfunction as seen in ME/CFS. That was a sample of patients with mild traumatic brain injury.,English
+The battery also needed to be able to be administered in clinic as well as remotely at home. It needed to be sensitive to cognitive deficits shown to exist between,English
+"ME/CFS versus healthy control and had to have good test, retest reliability to assess cognitive function following an exercise challenge over time.",English
+"Next slide please. Based on our review of the peer reviewed data in the early 2010s, when we conceptualize that study,",English
+we decided to use the computerized cognitive Brief battery developed by Cogstate. The battery include six standardized short tasks,English
+"psychometrically appropriate for detecting cognitive change in, within subject designs. Administration in short 17 minutes plus or minus one or two.",English
+"Our outcome measures were accuracy, performance accuracy, and speed of performance. Next slide, please.",English
+"I will not go into the details of the study at this time, and we will report on it soon in our upcoming paper. The important point I want to make here is that there was no difference in performance,",English
+"accuracy on any of the CBSB tasks, confirming previous observations by our group and others. We found significant statistical differences though on all speeded outcome measures.",English
+"The take home point right here is, speeded outcome measures most likely give you a result of group differences while accuracy outcome measures do not.",English
+"see a graph showing the mean latency of a simple reaction time task. The observed small but statistically significant group differences and simple reaction time,",English
+"and use it as a covariate for the other tasks. On the right side of the slide, you see the growth of maze learning tasks,",English
+"which showed to be very effective in finding differences across groups. Slower is lower, and the blue line is the healthy controls.",English
+"They're doing significantly better to a clinically meaningfully. Next slide, please. Here's the task.",English
+"I'm not going to go into it in the interest of time. Next slide, please. At this time, the Cogstate Batteries validated for unsupervised at",English
+"home using cognitively normal as well as mild cognitive individuals, and it's not perceived as overly stressful or tiresome. Cogstate also has been used in other ME/CFS as studies",English
+"with large sample sizes at this point. Next slide, please. I'm not going to go over all of these points because of time issues.",English
+But we know which areas are affected in ME/CFS in terms of cognitive dysfunction. We have standardized tool sensitive to differences and changes in,English
+"cognitive dysfunction and meet them appropriately. Next slide, please. ME/CFS,",English
+"cognitive dysfunctional can be assessed remotely. It's cost-effective, and we can reach people that we haven't been able to reach with traditional methods. At this point.",English
+"I'm going to wrap this up with the last slide. Next slide, please. I would like to direct your attention to",English
+the NINDS Common Data Elements that is available on the Internet and has a compendium of neuropsychological measures in there that have,English
+"shown to be sensitive to differences between groups,and ME/CFS. And with this, I'm finishing up. Thank you for your attention.",English
+I hope this was informative. Jarred Younger: Thank you. Awesome. I really appreciate it and we're going to move right along.,English
+"We had a little bit time for Q&A, but I know everyone has so much to talk about, so we're just going to keep on with the talks. I want to introduce Dr. Rowe,",English
+so Peter's Professor of Pediatrics at Johns Hopkins. He's director of the clinic at The Children's Center for Chronic Fatigue. He's going to be talking about dysautonomia.,English
+"There are lots of ways I can introduce Peter, but I will say that there are very few people that are willing to tackle ME/CFS and Ehlers-Danlos syndrome and mast cell activation syndrome.",English
+"Then when you take that group and the, reduce it down to the people who are willing to tackle those things in children. That is a rarefied and a heartbreakingly small group,",English
+"and so Peter is essential. He quite simply does the things clinically and scientifically that must be done, but no one else does them.",English
+"Every time I hear of a new interesting research direction, I say, wow, someone is pursuing this. Peter's name always comes up attached to it.",English
+"I'm really excited to hear from Peter. Peter Rowe: Thank you very much, Jarred. Thanks to you, and Vicky for the invitation to present today.",English
+"I think I can make these slides go ahead. I wanted to start off with Jarred's direction, which was, what do we know about dysautonomia in ME/CFS,",English
+what do we need to know? Then how do we move forward with clinical trials? We've known for a long time that,English
+"orthostatic stress can provoke the cardinal symptoms of this illness, including fatigue, but also including exercise intolerance, cognitive dysfunction, and PEM.",English
+"characterized by an excessive acceleration of the heart when the patient has changed from the recumbent to the erect posture, orthostatic exhaustion, blurring of vision,",English
+"weakness on exercise, and syncopal episodes may occur. They said this is a syndrome which seems identical with effort syndrome, irritable heart or neurocirculatory asthenia,",English
+which were the names at the time for what we now call ME/CFS. All they had available to treat patients was a high intake of sodium chloride up to 16 grams a day.,English
+Then this elevation of the head of the bed that you see in the upper right. They went on four years later to publish another paper subtitled Defects in the Return of Venous Blood to the Heart.,English
+They understood in 1944 what we now call preload failure or inadequate venous return to the heart as being a key feature in the pathophysiology of these symptoms.,English
+"Unfortunately, this work was essentially buried or ignored. We didn't know about it, but when we found out about it afterwards,",English
+"we started looking at patients with ME/CFS in the mid or early 1990s. In one of our studies, we had 23 ME/CFS patients who are a mix of adolescents and adults, 14 controls.",English
+"This was a pilot study that was intended to help us estimate the sample size for a randomized trial of Florida. But what we found was striking that is,",English
+"all of the patients who we put on a 70 degree head up tilt had an increase in their fatigue and lightheadedness. They had warmth and nausea,",English
+whereas the controls are simply bored. We also learned very quickly that patients were unwell for several days after the tilt test.,English
+But we introduced an intervention which was to give them two liters of normal saline intravenously. That prevented the posterior tilt exacerbation of,English
+symptoms and made them leave the clinic feeling better than when they came in. This work has been extended,English
+"and done more elegantly by a number of other groups since then. This is a slide from Julian and Newton's group in the United Kingdom, showing that if you measure a variety of",English
+"autonomic symptoms using the compass questionnaire, ME/CFS patients are clearly and significantly different than controls. Not only that, the degree of autonomic dysfunction on",English
+the compass correlates with the fatigue impact scale. Peter Rowe: We know that orthostatic stress can impair neurocognitive function.,English
+"One of the studies that help really bring this out was done by Marvin Medow and Julian Steward, who had been important investigators in orthostatic intolerance.",English
+"They showed that as you gradually increase the angle of the tilt test, ME/CFS patients had different problems on the n-back tests.",English
+"As you increase the complexity of the n-back test, they made more errors and had slower reaction time. We often hear about cognitive dysfunction as an independent symptom,",English
+but it clearly can also be aggravated by orthostatic stress. I want to highlight a few papers from Linda Van Camp and in France visitor's data in the Netherlands.,English
+"I've helped with some of the writing of these papers, but the data are entirely theirs and they deserve the bulk of the credit for this. But they looked at the influence of the tilt test",English
+"on cognitive scores using a two back and a three back-test. As you can see here, after the tilt test, immediately afterwards, patients had worse scores on their cognitive studies.",English
+They also looked at what happened seven days after the tilt test. You can see that ME/CFS patients had worse scores on numeric rating scales for concentration.,English
+This is suggestive of orthostatic intolerance being capable of provoking PEM. The symptoms of orthostatic intolerance are largely due to reductions,English
+in blood volume and venous return to the heart when people are upright. That leads importantly to under perfusion of the cerebral circulation.,English
+"If we look at this slide, it summarizes the main pathophysiologic influences on patients. They have an increase in the amount of pooling",English
+possibly due to a defect in vasoconstriction. There's about a 10% reduction in intravascular volume in people with orthostatic intolerance.,English
+"These two things combined, so that when they stand in upright tilt position, they get a marked reduction in cerebral blood flow.",English
+"As David Goldstein at the NIH has termed it, they get an increase in the sympathetic adrenal response, a big increase in catecholamines and adrenal release.",English
+"That can lead to a variety of different phenotypes of orthostatic intolerance at the bottom. One is classical orthostatic hypotension, delayed orthostatic hypotension that occurs beyond the three-minute point.",English
+"What we term neurally mediated or reflex hypotension, postural tachycardia syndrome. Then some people can have low orthostatic intolerance with a normal heart rate and blood pressure response.",English
+"When we tried to measure the cerebral blood flow differences, we initially began with transcranial Doppler, but could not identify differences between",English
+"healthy controls and patients during a head-up tilt test. I know that Dr. Novak, who will be speaking later, has had better success with this technique.",English
+"But Van Campen and Visser came up with a method of measuring brain blood flow by putting their Doppler probe on each internal carotid artery for about 20 or 30 seconds,",English
+"and then each vertebral artery for the same amount of time. So that over a two or three minute timespan, they can tell you by adding the flow through those vessels,",English
+"the total cerebral blood inflow. We obviously don't know what is happening within the brain, but that's the amount of blood that is pumped to the brain.",English
+Studies have shown that you don't really need to be an ultrasonographer to see the difference between the flow through each vessel when,English
+the person is supine and then when they're standing. I want to show you the data from their very large study of adults with ME/CFS during head-up tilt testing using this technique.,English
+"This study enrolled 429 adults, which was almost as many as the cumulative published research",English
+that we had summarized in the Institute of Medicine report. This is a very large study. Notice that 28% of these patients after 30 minutes upright met,English
+"criteria for POTS,14 had delayed orthostatic hypotension. But the vast majority of adults had a normal heart rate and blood pressure response, 58%.",English
+"They might have been at risk for being told there's nothing wrong. But when you employ the cerebral blood flow measures, here are the key findings from that paper.",English
+"Healthy controls have a 7% reduction in brain blood flow compared to their supine values after they'd been up for 30 minutes. In contrast, the entire group of ME/CFS patients had a 26% reduction in brain blood flow.",English
+So I think you could reasonably conclude that it's no wonder that these patients have difficulty with processing as Vergheut was talking about thinking of the right words and concentrating.,English
+"When you break that group of all patients down, 90% of them had objectively measured reductions in brain blood flow,",English
+"significantly different than controls. The ones with POTS or delayed orthostatic hypotension were worse. But the group that could have been dismissed as normal,",English
+the ones who had a normal blood pressure and heart rate response nonetheless had a 24% reduction in brain blood flow over threefold greater than what you'd see in healthy controls.,English
+"When these patients were all measured supine, the ME/CFS and healthy control groups did not differ with regard to their brain blood flow.",English
+"This slide from that paper shows that midway through the tilt at the 10th minute, the degree of cerebral blood flow reduction was correlating",English
+"well with the number of orthostatic symptoms that patients reported. This paper is more recent from their work, they looked at a group of people with",English
+"normal heart rate and blood pressure responses to the tilt. They were interested in looking at the relationship between heart rate and stroke volume. That relationship should mean that if stroke volume goes down,",English
+"we compensate with an increase in heart rate. In healthy controls, you see the 95th percentile prediction interval here with the blue line of the slope of",English
+"the change in stroke volume and the change in heart rate. What you see in the gray area is that close to 40% of adults with ME/CFS,",English
+"typically the ones with more severe symptoms, were unable to elevate their heart rate during the tilt test in accordance with the drop in stroke volume.",English
+"Suggesting and consistent with what's called chronotropic incompetence, something that had previously been identified during exercise testing of people with",English
+ME/CFS but we think this was the first demonstration of this during orthostatic testing. What else do we know? We know that the risk factors for orthostatic intolerance,English
+"can include seemingly disparate conditions. Trisha was talking about a number of other co-morbid problems. I think we have come to appreciate that mass cell activation, joint hypermobility,",English
+"vascular compression syndromes, and in a small subset, neuroanatomic problems can accompany the autonomic nervous system dysfunctions. Here's an example of one of the large studies comparing",English
+the hyper mobile Dutch ME CFS patients with the ones who didn't have hypermobility. Notice that the ones who are hypermobile had a far greater reduction in,English
+brain blood flow regardless of the type of hemodynamic response they had to the tilt test. This slide is meant to illustrate some of these other conditions,English
+we know from the work at Vanderbilt by Cyndya Shibao and Italo Biaggioni that postural tachycardia syndrome can occur in people with mast cell activation disorders.,English
+"In the Theohirades a review paper in the New England Journal, you can see I think here that many people with mast cell activation have cardiovascular problems and many of the other symptoms",English
+of mast cell activation can mimic those of ME/CFS. On the bottom left is a patient we had cared for Johns Hopkins who had some rather refractory symptoms of PO and ME/CFS.,English
+"We found later when her reflexes became abnormal, that she had congenital narrowing of the cervical spinal canal and a disc bulge at C67,",English
+"which her spine surgeon replaced, and within less than six months, her ME/CFS symptoms have resolved,",English
+"her POTS had disappeared, and she's now well into her eighth year of follow-up, having had previously refractory ME/CFS symptoms, now entirely healthy.",English
+"On the bottom right is some work from Stephen Smith and his colleagues pointing out that abnormalities that involve vascular compression in this case May–Thurner syndrome,",English
+"where you get the right iliac artery compressing the left common iliac vein, that these problems are associated with POTS and treatment of these pelvic venus abnormalities can be associated",English
+"with a nice improvement in overall symptoms, including the chronic pelvic pain. We also know from the past that",English
+"orthostatic intolerance is one of the most treatable components of ME/CFS. This was a slide from one of our earlier papers showing that with open treatment, not blinded therapy,",English
+"but open treatment of orthostatic intolerance with floor and FMI, migraine, and Beta-blockers and others, the patients who had volunteered for",English
+"this study came in with a wellness score of 35 out of 100, where 100 means optimal health, zero means dying,",English
+"and over four months of therapy, they increased to a mean of 70. This is, in many ways, still the data that we find clinically,",English
+"perhaps a little bit better now that we have medications like ivabradine and a couple of others that can be used to treat orthostatic intolerance. Well, what do we still need to know about dysautonomia in ME/CFS?",English
+"Well, we need better diagnostic tools, including as the Common Data Elements Committee concluded that we'd have to have",English
+"better questionnaires that focus on orthostatic intolerance. We need, as anyone who's had a tilt test knows more easily available, less taxing and less expensive orthostatic tests.",English
+"I think it's important to have a better ability to identify both for clinical care and for research studies, the patients who have refractory dysautonomia as a result of",English
+"other structural problems that probably would not respond to medication intervention. These include cervical stenosis, crania cervical instability, and some of these vascular compression problems.",English
+We need to know more about mechanisms. We don't know what initiates the circulatory dysfunction and whether it's one thing or multiple hits.,English
+"It could be that the autonomic nervous system disturbance is a consequence of something else at a more central level with downstream, autonomic, and circulatory control dysfunction.",English
+We don't know how infection triggers dysautonomia. We need to look at the genetic factors that influence its development since there's a heritable component to ME/CFS.,English
+It may be that the dysautonomia is triggered by a peripheral phenomenon. This is a slide on the mechanisms of POTS from a paper that was published after an NIH meeting.,English
+Connective tissue laxity may play a role in POT by making the vessels more compliant and allowing more blood to pool when the venous hydrostatic pressure is higher.,English
+There is interest in what role small fiber neuropathy plays in leading to excessive pooling. There's been a lot of interests in whether auto-immune antibodies that can block,English
+the ability to vasoconstrict or can activate cardiac receptors increasing tachycardia. There might be a variety of reasons for,English
+It's been thought to be the case as the part of the pathophysiology for ME/CFS in the past. But there's nice work from Van Camp and investors,English
+suggesting that the CPEC results have nothing to do with the cerebral blood flow raising the question of whether deconditioning plays a big role or not.,English
+Then we know there is an inadequate aldosterone response to standing that's clearly understood. These are among the mechanisms that need to be looked at.,English
+"I think we also need to ask what other symptoms are impacted by the circulatory dysfunction? There's a lot of interests in neuro inflammation,",English
+"but could it be the result of this sub-optimal blood flow that we see in ME/CFS patients, when they're upright? Is there some reperfusion injury that is taking place?",English
+"Then separately, we often think about immune dysfunction in this illness independently, but anything that elevates catecholamines and",English
+"orthostatic intolerance will provoke adverse sympathetic immune interactions. We know that each of the lymph nodes, it has sympathetic innervation and could",English
+"these problems be secondary to the orthostatic intolerance, but nonetheless effect viral reactivation or responses to infection. Along those lines, I wanted to show two models for how symptoms might occur.",English
+"This is from Klaus Wirth and Carmen Scheibenbogen in Germany. With upright posture you get a reduced pre-load, orthostatic stress, increased sympathetic activity,",English
+"which leads to tachycardia but also to vasoconstriction, and they pause it that this leads to under perfusion of skeletal muscles and a variety of vasodilators spilling out of there.",English
+Also reducing renal function and leading to various pain and other symptoms. Then this slide is a reminder that a variety of problems with,English
+"increased sympathetic activation can have immediate impact on a variety of immune functions, including factors that might affect the enteric nervous system.",English
+We have a number of treatments that have been available in treating orthostatic intolerance. But very few studies that have looked at these comprehensively in people with ME/CFS.,English
+"This includes vasoconstrictors, volume expanders and drugs that control heart rate or catecholamine release or effect. But in addition, I think we need to think about: whether you",English
+"can address the dysautonomia using therapies used, for example, for mass cell activation syndrome, notably famotidine or chromolyn.",English
+"I mentioned chromolyn because we've been treating a young man from Maine who has been refractory to all of the medications on the previous slide, but had a lot of facial erythema and cutaneous erythema,",English
+"and when we put them on chromolyn, he started being able to sit upright rather than being forced to lie down all day. My colleagues at Hopkins,",English
+"to mention another example, Malcolm Brock and his Belgian colleague Frank Boltzmann's, are looking at the combination of hyperhidrosis in POTS.",English
+"They've found that a proportion of these patients have a defect in a mutation in one of the sodium channels. When they use sodium channel blockers like guanfacine,",English
+they can see improvements in symptoms and overall function. This leads to some mechanism based treatments that might be fruitful. I want to end with a couple of points about the challenge of heterogeneity in ME/CFS.,English
+"Originally I had presented this at the FDA conference, I think 10 years ago. But it's important to recognize that flares in co-morbid illnesses can occur during",English
+"randomized trials and they have the potential to obscure the treatment effect of the drug under study. That heterogeneity can be reduced by careful subject selection, clear case definitions,",English
+"eligibility criteria, especially for these subsets, and studies have single agents for ME/CFS and orthostatic intelligible need large sample sizes.",English
+"I think ultimately that's going to necessitate a much greater devotion of resources to clinical trials, including support for clinical trial networks so that we can do",English
+these studies efficiently and in a timely manner for the people who are desperate for help. Some of the strategies that can be employed,English
+"include stratification to address duration of illness, since that seems to be a factor in at least the chronotropic incompetence, different pathophysiologic subsets.",English
+"One thought is that we should have run in periods for treating some of the co-morbid disorders and controlling them as much as we can. Or, another strategy is to identify the people who respond to the drug under study,",English
+then remove people from that medication and only randomize the responders. People have thought about randomized trials of,English
+"withdrawing the extensively effective therapies, crossover designs might be effective for some conditions and as N-of-1 trials. I'm going to stop there and thank those who've made our work",English
+"possible over the last three decades, including a number of philanthropic groups for whom we're quite grateful. I'll stop there Jarred,",English
+and hopefully we've recaptured some time. Jarred Younger: Thank you very much. Excellent. We're going to continue on and see all the questions that are being asked.,English
+"I know we're keeping notes and so I imagine there's a couple of different venues. Maybe the discussion at the end or maybe offline, get a chance to answer these questions.",English
+"Thanks, Dr. Rowe. I want to go right on and introduce Dr. Bergquist. Jonas is a full chair professor at Uppsala University in Sweden.",English
+He's in the Department of analytic chemistry and neurochemistry. I had a hard time and I always have a hard time trying to mentally encapsulate Jonas' work.,English
+"He has a remarkably diverse expertise set, he does basic science and clinical science and clinical practice, body, brain, there's really no place that's off limits.",English
+"There's no level of magnification that's off limits. I think any research modality is considered, and so the field is very fortunate,",English
+he's decided to bring all that to bear on battling ME/CFS. He might talk about this more spinal elements to the central nervous system contributions to ME/CFS.,English
+"Jonas Bergquist: Thank you, Jarred. Can you hear me? Jarred Younger: Yes, sounds good. Jonas Bergquist: Yes, okay, great. Can I control my slides or is it John who is controlling them?",English
+"I don't know, I can maybe, try to hit the bottom right. Okay, now I know how to do that. Great. I'm very happy to be with you this morning.",English
+"Yes, Jarred said, I've been working with quite many different applications, mostly in neurodegenerative diseases, in urology, and also trying to find out",English
+"But then 10 years ago approximately, I got really interested in working with ME/CFS, and I've been since then focusing really",English
+"on trying to help as much as we can do it from Uppsala in Sweden, and together with our colleagues down around the world with different centers or collaboration.",English
+"What I'm going to speak about today is the neuroinflammatory role of ME/CFS that we are focusing on in Uppsala and together with colleagues,",English
+"and I will give you a brief update on where we are there. But just to get started, as the questions were sent out from Jarred and was to address some things,",English
+"but quite often Epstein Barr Virus infection, mononucleosis, or influenza type of infections. Whether we have most women are affected by disease,",English
+"about 60-70% are women. In our patient cohorts, we know that there are demonstrated changes both in",English
+"the central but also in the autonomic nervous system. We know that the metabolism and especially the energy metabolism, more effected with, for instance,",English
+"elevated lactate levels, already often mild exertion, and right now we're using that as part of the diagnostic tools. We ask our patients when we see them to perform a mild exertion,",English
+"that could be a step test or it can be also mild or gone bad test for them, or a mental test even.",English
+Then we measure lactate levels and we can see that they are elevated and they stay elevated in most patients for a longer time than in our healthy controls. We also see that there is immune phenotype differences and also on the functional part.,English
+"We know that there are incidences of autoimmunity or over-representation, generally auto-immune disorders in these patients, but we have also monitored",English
+autoantibodies following what Cameron Shotgun Balkan in Berlin is doing. We see also the same type of autoantibodies against Beta rhinorrhea can muscarinic receptors for instance.,English
+"Then there are many reports I haven't worked so much on this myself, but gut microbiome changes and problems with intestinal tract co-morbidities and so on.",English
+"It's quite commonly reported on us, you all know. Then nowadays also we see that they're quite strong evidence on gene expression, the changes and epigenetic changes also.",English
+"For instance, after provocation you can see that they are variabilities in expression. Unfortunately, there's a lot of things we still don't know.",English
+I hope I can move my slide. Yeah. What is the exact mechanism that causes all these symptoms? Still a mystery.,English
+What leads to all the change that we see in all these different organs? It's a really a multi-system disorder as you know. What links those changes and what is the initial triggers?,English
+"We are focusing on the post viral idea, but we know also that trauma and other incidences could well be initiator or trigger. Of course, we would like to know if there is",English
+"a common explanatory model for all these symptoms, so we could target that with therapy of some kind. I will maybe if I have time just end up with what",English
+"we're doing right now on the therapy side. Of course, one of my tasks is to find good biomarkers, diagnostic, predictive, or even preventive if possible.",English
+"Because that would of course be in the end of the day what we are really searching for to make sure that people are not affected by this disease. We are focusing with my background in neurology on the brain,",English
+"and the human brain is of course extremely complex. We think, of course, the brain is the most important target when it comes to studies on these neurological diseases,",English
+"but as you already heard this morning and so of course, all the other systems and organs in the body are affected to a large extent. Of course, we need to compliment of competencies and we need to collaborate a lot",English
+"around this multi-system organ disease. One of our favorite targets when it comes to studying the neurological system,",English
+"central nervous system, is of course, to look at the cerebrospinal fluid, and although it's an invasive sampling technique, we really see a lot of specific biochemical markers",English
+"and differences in this liquid that surrounds the central nervous system. I think many of you know, but I just want to say that the liquid is produced in",English
+"the central part here of the brain in a region called choroid plexus. We produce about 5,600 milliliters per day in an adult person, and that volume is reserved several times.",English
+"We actually replace a volume of about 20,30 milliliters per hour during our day.",English
+"This liquid, of course, has mechanical function. It protects the brain from bouncing around in the skull, but also it flushes the brain and transports",English
+"away products that is released from the central nervous system. Of course, if we can measure the molecules that are present in this liquid, we could also get a chemical picture of",English
+"the central nervous system without going in and taking a biopsy of the older brain tissue. It's a liquid biopsy,",English
+"you could say in some sense. Yes, I think you also know that you draw this liquid through a lumbar puncture in the lower back region with the patient in a recumbent position.",English
+"You can also at some point take cerebrospinal fluid from the ventricles and the neck region, but the most common one is the lumbar puncture way.",English
+"As you see on the slide here you go enter between the spines and you'd enter the dorsal sac, which is a region where you can",English
+"penetrate into the tissue without harming any nervous tissue, so you didn't have a possibility to draw this liquid. In human adult, we take approximately 10 milliliters per sampling,",English
+"and in younger individuals we taken about three milliliters. The reason for that we draw this volume is not that we really need that big volume for our analysis,",English
+"for some analysis we can take 10 microliters, but we want to make sure that we get a representative sample of the volume. There is a gradient from the central part of the brain into the lower back region.",English
+"In order to cover that gradient, we typically take 10 milliliters dung. See if I can move my slides here.",English
+"Yes. You get some local anesthesia and sometimes you have to put a blood patch to stop leaking here,",English
+but it's not nothing really dramatic about the lumbar puncture. We have a very nicely standardized procedure for drawing our samples.,English
+There is a very few patients that have any complications afterwards is less than 1% of the patients that report on slight headache or post puncture issues.,English
+"We are pretty confident with this sampling. Well, looking at cerebral spinal fluid is not nothing new.",English
+"One person who have done that early on was this fellow Jons Jacob Berzelius he was actually a student from Uppsala at some point, but he moved to Stockholm and was also very much active in creating",English
+"the Royal Academy of Science and Stockholm as they are responsible for heading or for giving out the Nobel price every year, but Jons was also a very key in Clinical Chemists, you could say.",English
+He wrote the first clinical chemistry book that we had in Sweden one of the earliest ones in the world actually it's called Lectures in Animal Chemistry.,English
+"In that book, you can actually get an idea of what analysis they did on cerebral spinal fluid. They called it brain water at that time.",English
+"Unfortunately, this is an old Swedish, but in the blue box here it says in Swedish that this liquid is typically clear or a bit yellowish.",English
+"Sometimes it could even be a bit green. I have not seen any patient giving us green cerebrospinal fluid. It has a sweet, salty taste.",English
+"They were not using the sophisticated analytical instruments that we do today. We typically use mass spectrometry instead, but he also declared that there is the content of biomolecules, for instance, proteins.",English
+"He was actually the person in the world who actually gave the molecule protein its name protein from the Greek. He tells here that if you can treat this volume or liquid,",English
+"with alcohol, for instance, you can have precipitation of these molecules that are proteins, and you can analyze them further.",English
+"Why we think it's very important to look at cerebrospinal fluid typically when it comes to ME/CFS is of course that, as we know in many other neurological diseases,",English
+"that could be patterns of interest from biomolecules, like antibodies. Let's say in multiple sclerosis, we know there is oligoclonal antibodies produced centrally in",English
+"the brain and that we can measure them as oligoclonal bands in the cerebral spinal fluid, but also looking at specific molecules like",English
+immune related molecules like cytokines or other inflammatory markers. Of course then that could give us an insight and if,English
+"there is a newer inflammation going on in the disease. As I mentioned, this is one way of looking at the central nervous system without getting a biopsy.",English
+"It's a good compliment to what we can measure in circulation in blood and also what we can see with imaging techniques for instance. All in all, we think this is one way to look at ME/CFS patients and",English
+"hopefully then find the underlying mechanisms related to the pathogenesis. One target that we're looking at this time,",English
+"the neuroinflammation, and as you may know, central nervous system, like a few other organs in the body, are so-called immune privileged.",English
+"They are normally have a grade of low immune activation. The reason for that is that we don't really want that inflammation or big immunological reactions in certain organs like the brain,",English
+"because that causes also damages and scar tissue formation. But when there is an inflammation going on, we get an activation of the innate immune system,",English
+"we get activation of astrocytes, microglia. They get actually immune competent, and they can start producing some of",English
+"these signal molecules that we see in the immune system like cytokines. Of course, if we are unlucky, and we have neuroinflammation,",English
+"we will have done damage on the neurons and the degradation of the neurons on the myelin sheets around the neurons, for instance, that leads to neuronal loss in the end.",English
+"In ME/CFS patients specifically, we don't think the new inflammation activity is very high as compared to many other diseases,",English
+as I will go into a bit. But we know based on our findings that there is a low-grade activation of the immune system in many of our patients.,English
+"That may lead to some of the consequences and also lead to symptoms like brain fog or headache, and pain related disorders.",English
+"What do we do typically with our patients? We withdraw blood samples, of course, most available and also well established",English
+"detection for different molecules that are activated in circulation. We try to draw as many lumbar punctures as possible from our patients,",English
+"we do sample clean up and preparation, and then we typically use high resolution mass spectrometry doing proteomics and metabolomics in",English
+"connection with rather advanced bioinformatics on pathway analysis, etc., to decipher what is the difference between",English
+"healthy contrast groups and our patients of interest, in this case, ME/CFS. During the last years, we have been working quite a lot with",English
+"related diseases also just to get some comparison or contrast groups. For instance, post COVID patients and in this case,",English
+"a paper we published a few years ago in 2020, where we actually could detect that the virus went all the way into the central part of the brain and could be detected in cerebral spinal fluid.",English
+"We monitored then, ongoing inflammation, and we also measured quite a lot of brain inflammation related damage molecules in circulation and in service spinal fluid.",English
+"Luckily, these severe infections that happen in the brain are very rare when it comes to COVID infections,",English
+"so we haven't seen that many patients with this dramatic inflammation, luckily. But it can apparently happen in a few patients.",English
+"Just to let you know, this patient survived this infection, took a long time and now is in rehab.",English
+"But since a few years, he's doing pretty well actually after even this dramatic inflammation as you see on this MRI picture.",English
+Another paper that too It's just published. We have looked at herpes simplex encephalitis patients. As you may know is herpes virus type 1 that causes in a few cases,English
+"infections that go into the central nervous system and also causes inflammation and the brain damages in patients. In this study, we had the opportunity to collect around in Sweden,",English
+"together with many of our infection clinics, patients managed to follow them over time. Well, for us there are other large cohort",English
+"about 50 patients just to show some of the data, we had the opportunity to collect patients over time. We had three lumbar punctures done,",English
+"an acute phase in after 20 days on approximately after 100, 120 days. What we saw were correlations with",English
+"the inflammatory protein molecules with some of the more important things, for instance, treatment related phenomenon lesions: we found",English
+"on the MRT and also activity of anti NMDAR receptor IgG molecules, so autoantibodies against NMDA receptors.",English
+"As one of the examples of the findings, we found that apolipoprotein A1, for instance, correlates with this acute seropositiveness of auto antibodies against NMDA receptors.",English
+We know that the presence of these antibodies are also related to neural cognitive issues and problems and could lead to longterm consequences for the patients.,English
+"When it comes to our ME/CFS patients, we started looking at patients with ME about 10 years ago now.",English
+This was first collaboration with Steve Schweitzer and Ben Natelson that many of you know. We then collected cerebral spinal fluid from,English
+ME patients and compared them with post-treatment Lyme disease patients. Then we'd healthy controls from me. We can then see that there was a general up regulation of inflammatory markers.,English
+We saw differences and similarities between ME patients on the post-treatment Lyme disease patients. We just recently had a follow up paper accepted in,English
+"Annals medicine also with Steven with a comparison of CSF, cerebrospinal fluid proteome in ME/CFS patients on fibromyalgia patients.",English
+"As you know, many ME patients have comorbidity with fibromyalgia. Maybe to our surprise,",English
+"I'm not sure what we thought from the beginning, but we did not see any big differences between ME/CFS and fibromyalgia patients when it comes to the CSF proteome,",English
+we think that maybe the fibromyalgia have more inflammatory reactions in the periphery while the ME/CFS patients have this low grade inflammation centrally,English
+"and maybe that is reflecting the datum. If you have ME or if you have ME with fibromyalgia, there's not that big difference when it comes to the proteome in cerebrospinal fluid.",English
+"An ongoing study, this is unpublished data. This is a collaboration that we've done now is Sweden together with the Bragée clinic, it'd be on Bragée and get around them and others at the clinic,",English
+we have now done finished the collection of the samples actually. So we have done lumbar punctures. We have done pressure measurements during puncture and we have done sampling of blood and,English
+saliva in ME patients and matching a healthy controls. That this has also been followed up with MRI and the analysis,English
+"of the brain structures in the neck region and centrally. As you see on this picture here,",English
+"you see that one thing that we also looked at was the intracranial pressure and you can do that in different ways. You can do it during the lumbar puncture,",English
+but you can also use Owens SDO with the ultrasound measures. You can look at the optic nerve dimension and you can see,English
+"if a bit compressed that could also be related to elevated CSF pressure, intracranial pressure. Actually there was a rather high incidence of",English
+elevated CSF pressure measures in our ME patients. That is an interesting finding that we are following up on. Say I'm doing some time here.,English
+"We have now done the proteome of our patients sets. This is just one picture or one example of how the data looks like in 61 ME patients,",English
+"we have added on our post COVID patients around 40 and healthy controls. As you can see, when it comes to the proteome in CSF,",English
+we have a rather big overlap between our ME group and our COVID group. While we then have separate clustering of our controls.,English
+I think this is something that we are very keen on understanding and also see what is going on with the inflammatory markers specifically in COVID on ME/CFS group.,English
+Jonas Bergquist: Pilot clinical trials. As I mentioned is started and ongoing and we are now setting up a trial together with David [inaudible] group at Harvard.,English
+"This is going to be a combination of low dose naltrexone and mestonon in combination. They've got very excited and this will be launched very soon now,",English
+about 160 patients will be included. We also have some other trials in pipeline. We're now waiting for funding and setting up the practicalities around it.,English
+But there will be some more anti inflammatory treatment trials and there will also be some antiviral treatment trials starting soon.,English
+"We'll just end with the medical imaging ideas that we are also conducting, I won't give any details here,",English
+but we are now setting up another method also for measuring activation of immune cells in the central nervous system. This is going to be a very good complement to,English
+"our lumbar puncture measurements on our bimolecular screening. I think this is something we really look forward to getting going. By that I think my time is out,",English
+so I want to thank our patients and our controls that I'm very altruistic basis are volunteering to help us with our studies.,English
+"We are so happy that we have this tight connection and collaboration with patients. Of course, our funders, Open Medicine Foundation and Linda Tannenbaum,",English
+"I want to mention her specifically, fantastic person to work with and all the other supporters of our research. By that, thank you for your interest and",English
+We're going to take a break but there are some very interesting questions in the Q&A section of Zoom. I'm going to encourage all the speakers up to this point to check that and look for,English
+the questions that were directed to you and see if you can give an answer via the Q&A window. Let me know if you can't find that. But thank you very much.,English
+"We're going to go right into the break and let's do a 10 minute break and then I'll talk after the break and Dr. Mountain will talk as well, and then we'll have another break so we've got some chances for future breaks.",English
+"That's a little bit over 10 minutes. Let's do 11:50, so about 13 minutes and we will",English
+The RLA team will need to do a little editing of the recording and to develop a transcript that needs to be 508 compliant.,English
+allow more time for each speaker so that there's time after each one for specific questions for that speaker. We're very sorry that that has not happened.,English
+"But with that, I would like to introduce Dr. Younger Jarred who has been a really excellent partner working with us on many fronts in ME/CFS will alone for tackling his own research projects.",English
+He's really lead our effort together with Beth Sullivan in the development of the ME/CFS common data elements and we are in the process of finalizing a revision of the core common data elements.,English
+"I don't have a pointer, so I'm going to verbally direct you around these slides. The cumulative neuroimaging work supports the idea that ME/CFS involves abnormal inflammation in the brain.",English
+"you can see they have a resting state, that's their normal state, but they can be pushed into an active pro-inflammatory state that's in red where they're pumping up pro-inflammatory cytokines and these make you feel sick.",English
+"changing from one form to another in less than 30 seconds, so it's very fast. They do this all the time,",English
+We don't know all the reasons why we know that a massive viral or bacterial hit can do that. Particularly if the virus or bacteria invaded,English
+and we use a radio ligand called DPA-714 and it's a ligand for receptors with a radio isotope,English
+"only if they're in the pro-inflammatory activated state. If we inject a ligand for that, it will only stay where the microglia are pro-inflammatory and activated.",English
+"This technique, it works really well. It's been used in Alzheimer's and multiple sclerosis and traumatic brain injury. Very informative.",English
+chronic fatigue syndrome criteria and so there's definitely going to be some overlap between what we saw in fibromyalgia and what we see in ME/CFS. There are many similarities between fibromyalgia and ME/CFS.,English
+"There's fibro flares and there's fibro fog instead of brain fog, but there's a lot of overlap.",English
+"We don't know that they're 100% for sure the same thing, I wouldn't say that, but there's clearly some overlap. We published this study.",English
+"This was funded by the American Fibromyalgia Syndrome Association and the primary author is Christina Miller. Basically, we found that about half of the brain in fibromyalgia,",English
+individuals with pain and fatigue shows this microglia activation. There's inflammation happening all throughout the brain. These checkmarks on the left are the brain regions where,English
+"the microglia were abnormally activated in the patients. Just to show you, this is a program called,",English
+"I think it's pronounced neurotron or neurotorion, but as program, you can actually access and it just allows you to drive through the brain.",English
+"This is a top view, looking to the left where that arrow is pointed. We did not see any abnormal microglial activation in the front parts of the brain. The prefrontal cortex here,",English
+"which is where your personality is and your thinking, no evidence of inflammation there, no evidence in the premotor cortex,",English
+"that's where you plan your motor response, that looked fine and the precentral or the precentral gyrus where you execute your movements,",English
+"we did not see any evidence of microglia activation there. But after that point, everything was inflamed,",English
+everything had microglia activation. It started with the somatosensory cortices and this is where you perceive all your body sensations.,English
+"It's where they come in for you to actually feel them, all the information throughout the body, all the different sensations. There was lots of microglia activation in that region.",English
+"Then in the parietal lobe, huge section right behind that also lots of activated microglia. This is where pain and touch and everything else is integrated,",English
+"all your body senses. It makes a lot of sense that this would be activated. I do want to note real quick that our colleagues at Griffith University, they released a paper not too long ago showing",English
+"these exact same regions had brain volume increase, which means there was more matter in the somatosensory cortex and the parietal lobe.",English
+"That volume increase was associated with greater fatigue severity. I think a lot of people think that's counter-intuitive. They think, well, it's got to be hurting your neurons,",English
+if you have ME/CFS or killing off the neurons and so there should be less. Why is there more? I think one reason that may be the case is because,English
+"the MRI that detects brain matter cannot distinguish between microglia and neurons, they look exactly the same on MRI scans.",English
+"This is a microglia in green that's holding on to two neurons. They had actually grabs onto them, so they're right next to each other.",English
+"When you do a volumetric scan, you don't know if you're looking at neurons or microglia. The fact that there's more brain matter in these regions",English
+where we're finding microglia activation could suggest that the microglia are aggregating in those regions or they're proliferating and they're actually multiplying.,English
+We know that interleukin-1 beta and tumor necrosis factor alpha can make microglia proliferate. We know that ME/CFS multiple studies have shown the MEC,English
+best involves interleukin-1 beta and TNF-alpha. I think this is a very interesting possibility in why we're seeing these results with PET or with MRI.,English
+"I've got to move on to some other things. It just continues, it goes back to the occipital lobe. The occipital lobe had huge amounts of activated microglia.",English
+"The precuneus, which is a really important site for the emotional response to body sensations and pain, all of them showed microglia activation.",English
+"There's just again, about half of the brain showing inflammation. I just want to mention that my colleague Mark Loggia, he did a study very much like this with a different PET radio ligand and",English
+"found very similar results to what we found and somatosensory cortex, precuneus so I just want to say that there is convergence among the different groups.",English
+"The question now is, what does it look like in pure ME/CFS, not fibromyalgia, who may also meet ME/CFS criteria.",English
+"When we run this or when we finish running this, it's going to be, is the pattern the same as fibromyalgia? That's going to be incredibly informative.",English
+"Is it a different pattern that will also be informative or do we not find any differences between ME/CFS and healthy? That will be incredibly informative, as well.",English
+"I do need to note that a Dutch group in 2021 found no differences between ME/CFS and healthy controls in a small pilot, I think it was like 10 in10 people when they looked at TSPO.",English
+"But they used a radio ligand called PK-11195. That is an older, less specific radio ligand. I'm really glad they ran that study,",English
+"I think it's important to look at. However, to answer the question definitively, we need to use one of the second-generation radio ligands like DPA 714 or PBR",English
+28 and it needs to involve more people before we can say there's no difference between the two. We will be talking more about that closer to the end of the year.,English
+"Let's shift over quickly to a different imaging approach. MRI and magnetic resonance spectroscopy, probably the most repeated neuroimaging finding in",English
+ME/CFS in the history of research using your imaging and ME/CFS is elevated lactate. There are several papers showing lactate all throughout the brain in ME/CFS.,English
+"Some of these papers were done by Benjamin Natelson, who's on the panel today. This uses spectroscopy that can measure different chemicals in the brain.",English
+"We use a technique that allows us to measure it throughout the brain. Again, I can't point to it, but you can see it says lactate. Lactate is usually small to non-measurable.",English
+"That's generally what you want with you have lactate that's measurable in your brain. It suggests that something is wrong, that the cells are not getting the energy that they need.",English
+"The same thing happens in your muscles when you overwork them. They're going to demand more energy than your oxygen, than your blood supply can provide and so you get an increase of lactate.",English
+"Same thing in the brain. It could be that there's extreme hyperactivity such as neuroinflammation. It could be a mitochondrial dysfunction,",English
+"could be an oxygen perfusion problem. It could be oxidative stress, insufficient glucose. There's a lot of potential causes,",English
+"but it's telling us something is arrived in the brain and it's generally seen as part of the neuro-inflammatory response. This picture here, the top is a group of healthy individuals and the bottom",English
+"is ME/CFS with just a lot more lactate throughout the brain. My graduate student, Indonesia Jordan,",English
+"provided some first analysis this week and with our NINDS trial, using the scan where we can get lactate and other things.",English
+I have not had enough time to scrutinize everything and look at everything. I just wanted to show one quick slide from these analyses. I'll be looking at these more in depth over the next week.,English
+"All I wanted to say is that we've previously reported that ME/CFS involves lots of lactate. This really shows this again,",English
+the zero group to the left are healthy controls and on the right are ME/CFS participants. What I want to point out here is that while there are,English
+"lots of ME/CFS individuals who do not have abnormal lactate, you do clearly see that group extending higher on the one column where there is significantly higher lactate and this is",English
+about 20 or so percent of the MEC of a sample. These individuals have clearly abnormal lactate that is almost definitely going to be driving symptoms.,English
+It's all looking very good and I really look forward to digging into these data and preparing your first reports from this. Let's get into the roadmap questions,English
+"and we'll talk more about these things in the discussion. The first thing is, what do we know with neuroimaging? I'm just going to pop them all up so it's faster.",English
+"Here's what we know. There has been neuroimaging work in ME/CFS for about 20 years, MRI and FMRI. We know that the structure and function of the ME/CFS brain is abnormal.",English
+"But for most of the time, we didn't know why. Number 2, more recently, we have the tools to show us how and that indicates brain inflammation.",English
+"Number 3, not all individuals with ME/CFS show this neuroinflammation. There are critical subgroups and it may be that treating them will require different medicines, different approaches.",English
+"There's high lactate is probably the most consistent indicator fatigue and ME/CFS. Number 5, I want to note that the inflammation",English
+"we see while it can be completely debilitating, there's no evidence that it is high-level emergent neuroinflammation like",English
+bacterial meningitis which can kill you or sepsis which can kill you. It does not look like that. The levels are not high enough.,English
+"I think I've only one time seen severe neuroinflammation and that was somebody with traumatic brain injury. It's not again,",English
+"emergency issue level inflammation. It's more of a low to moderate level, it just never goes away is the issue. Then also, I've seen no evidence that there's neurodegeneration.",English
+"It's not like multiple sclerosis or Alzheimer's or Parkinson's disease, where there's something negative happening to the neurons themselves.",English
+"Other questions, what do we need to know? Big thing I need to know is, what is the origin of the inflammation?",English
+"We know, we can see that the brain is inflamed. We don't know exactly why. Is there a virus in there, a bacterium? Is this a problem with the vasculature?",English
+"Is it an auto-immune problem? And you can see this list, there are multiple things. My research leads me to believe that it is an abnormality in the microglia themselves,",English
+"but unless we rule out these other things, there might be other reasons why the brain is inflamed. And that leads into the next question we need to know.",English
+"The answer to is, is the brain inflammation we're looking at, is that the enemy, or is that actually trying to help us?",English
+"We know there's inflammation. It's very likely that that inflammation is the cause of the symptoms, because the microglia that are producing these pro-inflammatory cytokines are",English
+"literally hanging on to the neurons that drive your perception of fatigue. They're right there. So they're probably what's causing the symptoms. But is the inflammation,",English
+is that microglia the problem? Is something wrong with them? Or are they trying to deal with a problem? Is there an infection somewhere or,English
+"an abnormality that the inflammation is trying to correct? Or is it like a misguided friend? But it's trying to help, but it's causing more problems than helping.",English
+"It would be really nice to figure that out. How do we move forward, particularly with clinical trials,",English
+"and then I will be done. I'm really big in clinical trials now, I think it is where we should be putting most of our resources now.",English
+"We have enough evidence to show that there's brain inflammation in ME/CFS, so we need to get forward with the clinical trials.",English
+"We're not 100% sure, but we have enough evidence to go on to the next step. It's true we see microglia activation, we see lactate.",English
+"I can think of alternative explanations for what we see and you heard one of them today. It's possible that there's an oxygen profusion problem, and because there's not enough oxygen getting to the brain,",English
+"the microglia are freaking out, and then you have a buildup of lactate. That is possible. We test cerebral perfusion, but everyone's lying down, in a scanner,",English
+"and that could be a condition where we don't see the perfusion problems. Yes, we could try to get a sitting or a standing MRI to see if we see perfusion problems or try to do",English
+"a tilt test provocation like what Dr. Rowe would use and that would be super informative, but that can take about five years to run.",English
+And I think we really need to drive forward with clinical trials in parallel with the interesting things like that. We got to move forward with the clinical trials.,English
+"We need to focus on re-purposed medications, we need to do parallel testing, we need to test multiple,",English
+"high-priority drugs in parallel and then advance the ones that look the most promising to the next level and try to quickly get to the things that work. We need to have consensus criteria for all these clinical trials,",English
+"so they all use the same criteria so we can directly compare the results. And again, I hope we'll talk about this in the discussion. Got a couple more slides and I'm done.",English
+"In terms of what to try, I have a massive list of things I would love to see tested in ME/CFS, this is only a fraction of that list.",English
+I just filled up one slide. I started this a few years ago and now it's grown huge. The white compounds are prescription for humans.,English
+"The blue are not available for human use yet, and the green are botanicals which anyone can pick up. I do want to say very clearly that I'm not suggesting any of these things for ME/CFS.",English
+"Right now or for anything else, these are candidates or researchers to consider for future clinical trials. There's just so many that have great basic science evidence.",English
+"It would take a lifetime to test even a fraction of these, but we need to prioritize these and then just start testing them, if we want to come up with the answer.",English
+"There's so many of these I would love to talk about, but maybe they'll come up later in the discussion. But there's no shortage of really good options to test.",English
+"Last thing, in terms of prioritizing the treatments, I believe I've got four criteria to rank how their priority is for me testing,",English
+they have to be available for human use now. They have to have shown evidence for modulating microglia activity. They have to have shown a study where there was clinical benefit either to a human or,English
+to an animal model and there can't be any evidence of serious adverse events. I don't want to cause more problems. There are plenty of agents that meet those criteria.,English
+"Very last thing, in terms of neuroimaging in ME/CFS, I really want to see neuroimaging incorporated with clinical trials, especially if they're targeting the immune system and brain inflammation,",English
+"that was mentioned earlier today. It's so nice, this is just a random example from the literature. This is somebody with ME/CFS,",English
+"who did hyperbaric oxygen treatment and they had all this hypo metabolism, that's all that activity on the left. But after 50 sessions of the hyperbaric treatment,",English
+"the symptoms were resolved as was the hypermetabolism in the brain. This is just an N of one study, I just wanted to show how helpful it is when you can show someone improves,",English
+but you can also do the brain scans to show why they improved. And I think that's really important. I better end it there.,English
+"The questions, I think to keep on time, we'll just roll along with the presentations. I will keep an eye. This is my mascot by the way,",English
+"this is from our leukocyte tracking study, infiltrating the blood-brain barrier that I will be talking about at some other point in the future when we collect more data.",English
+"But I will look in the Q&A window and I'll answer any questions that are thrown my way, and I appreciate everyone. Jarred Younger: With our progression of events,",English
+"I'm actually introducing the next speaker. If everything's good with the Zoom, I will just go right into introducing Dr. Mullington.",English
+"Janet Mullington, PhD is a deep sleep expert. She's at Harvard University's Division of Sleep Medicine, professor of neurology.",English
+And the work she does is critically important in this field. She's looking at sleep and health and psychological states and,English
+the really complex relationships between these things and probing into the physiological substrates of healthy and unhealthy sleep. And more recently she's used this expertise to help our understanding of long COVID.,English
+I believe that sleep is one of the most underappreciated areas of improvement and it's unfortunate that so few people get a chance to see a sleep expert.,English
+"I wish we could take Janet's knowledge and just put it in everyone's brain and it would be so helpful. But until we can do that, we will settle for these really good webinar talks.",English
+"I want to turn it over to Janet. Janet Mullington: Thank you very much, Jarred. And thank you for all the work you did in organizing this,",English
+"along with Vicky and others. Thank you very much. I'm very delighted to be here. I can advance my slides, let me do so.",English
+"As Jarred said, Janet Mullington. Non-restorative sleep is an important part",English
+"of ME/CFS and it's a bit of an oxymoron, isn't it?",English
+"Sleep should be restorative. I'm going to begin with talking a little bit about the problem, the challenge that we faced in understanding",English
+"non restorative sleep and then I'm going to talk about some studies that have been particularly inspirational for me and for my group and show you a little bit of preliminary data,",English
+talk about a new study that we're starting and then move to what I think are opportunities and gaps needed to better,English
+understand the role of non-restorative sleep in ME/CFS. Non-restorative sleep as I mentioned it's a hallmark.,English
+"Sleep deficiency though we know causes performance and cognitive impairment, this has been known for decades and based on",English
+"research initially in healthy volunteers under controlled experimental conditions, where we can really carefully select participants who are healthy sleepers and then",English
+"we can deprive them of different amounts of sleep and different timing of sleep and wakefulness and really look at the effects on performance and mood outcomes, and we see that there's a really clear effect of insufficient sleep on performance.",English
+"As you stay awake, what this is showing here in the center of the screen, sleep pressure increases throughout the day and if you stay",English
+up later there's more sleep pressure that. If you stay up very late you actually may not be able to sleep as long as if you go to bed at your regular time because of circadian factors.,English
+These are diurnal 24 hour factors that also have an influence on your wake and sleep. When we experimentally sleep deprived people they,English
+experience brain fog or at times and or cognitive impairments that involves some of what we've heard about in terms of slowed reaction time,English
+and difficulty in functioning at optimal levels. We would like to get,English
+to markers of non-restorative sleep. Marker of non-restorative sleep can really help us,English
+track the progression and evaluate treatment efficacy. EEG is really an established method for looking at brain function.,English
+"Newer methods are incorporating EEG and including often transcranial magnetic stimulation,",English
+"direct current stimulation, and sometimes as we've heard elegantly MR imaging as well.",English
+"One of the questions is, can we come up with a brain signature of fatigue that can be extracted from the EEG? I just wanted to take a moment and explain what it is we're looking",English
+at when we monitor this sleep of individuals. There's EEG electrodes that are applied prior to sleep and then the individual sleeps while somebody else is monitoring the EEG.,English
+The gold cup electrodes typically are applied to the scalp by the eyes so that we can monitor rapid eye movements,English
+"during REM sleep and EMG which muscle tone typically on the chin electrodes,",English
+"and it is shown here, to decrease during the night and particularly during REM sleep which is marked by muscle atonia.",English
+"Here you can see the cycling through the night with individuals dropping into Stage 1, Stage 2, Stage 3, and Stage 3 and 4 are what we now call NREM,",English
+"non-REM sleep, a deep non-REM sleep. These cycles typically in healthy individuals cycle four or five times through the night seven or eight hours of sleep.",English
+EEG is also measured of course clinically during the day and EEG spectral coherence data has been analyzed from patients with ME/CFS.,English
+"This is an inspirational study for me because they were able, these investigators, Tony Komaroff and other collaborators,",English
+"that children's hospital, analyzed EEG data from hundreds of patients and found that they were able to discriminate using discriminant function analysis of",English
+the EEG coherence which is essentially looking at the correlation between different regions and the correspondence of the electrical activity coming from different regions of the brain.,English
+They were able to investigate the patterns and differences between people who had no ME/ CFS and had healthy function and people who had ME/CFS.,English
+"I think this is very promising, I think it is one area that really should be followed up with. Another area that was particularly inspirational for us was looking",English
+"at the EEG during awake again but before night of sleep and after a night of sleep. This group from Mexico led by Maria Corsi-Cabera,",English
+looked at the EEG in evening before bed and then compared it to the morning EEG in healthy controls that you see,English
+"on the left and then people with primary insomnia. It's not ME/CFS, it's insomnia, but insomnia as you know as severe sleep deficiency.",English
+"Well, they looked at all of the spectrum, but found in Beta and Gamma, a real difference between people who had",English
+"healthy sleep and people who were suffering from chronic insomnia in terms of their ability to dampen Beta activity and Gamma activity,",English
+these are fast frequency electrical activity patterns. The sleep period helped people to decrease this activity.,English
+"Those who had trouble sleeping, were not able to decrease. So this is comparing pre and post bed EEG.",English
+"What about ME/CFS? Well, this is probably my favorite study. This is a twin study.",English
+"These investigators studied twins who are discordant for ME/CFS, and looked at their ability to reverse the slow wave,",English
+"or sleep pressure that is experienced before bed in the night, in the evening. The healthy twin was able to do what we expect to reduce this slow-wave activity,",English
+"this Delta power across the night, so that they are discharging all of that sleep pressure, if you will, for the slow-wave sleep.",English
+But the chronic fatigue twin was not able to do so. They started out with a lower level of accumulated pressure in,English
+slow-wave activity and they were not able to get it down to the level that it was supposed to be out in the morning. This implies a real problem with the homeostatic function of sleep.,English
+"This is just to remind you, sleep pressure builds up with wakefulness, and then this curve here that I didn't speak about before",English
+"really is modeling what we see here, the decrease of sleep pressure across the night, and so there's something wrong with",English
+the homeostatic function in ME/CFS because what I think. We think that the post viral hypothesis,English
+"is very fueling one from many perspectives, and currently we have an opportunity to learn a lot.",English
+"This is showing you just some data from the clinic, and these are three people who are studied, who have severe hypersomnia.",English
+"That means that they're very tired, they also can complain of insomnia at the same time, and sometimes these may alternate,",English
+"and here what you see is the gray is showing you wakefulness, and this is showing you light though. It's taking a while to fall asleep.",English
+"If you look at the third row here of data, you see a lot of back-and-forth trying to get to sleep, and then what you see is finally consolidated sleep.",English
+"Then this isn't met multiple sleep latency test. Following it where we examine what is going on in the sleep pressure across the day,",English
+"and I can look for things like REM onset, which you see right in the middle panel. Here you see again a lot of fragmentation of sleep,",English
+"and then in the naps you actually see REM onset in two naps, you can see it over here as well. In the top, his histogram panel,",English
+"you see again, a lot of fragmentation of sleep, and less sleep onset actually is only occurring in two of the naps in the final one.",English
+"These patterns help us to understand what's going on with sleep fragmentation, and sleep pressure. But particularly surprising is the presence of REM onset,",English
+which is which is a characteristic of narcolepsy. But REM onset during daytime sleep can also be seen in some city or sleep deprivation.,English
+"Following story severe restriction of sleep over a long period of time, I misspoke. Not deprivation perse,",English
+"not in an experimental way. We have been studying long COVID participants, and we have a database in collaboration with",English
+"colleagues at Mass General Hospital Donna Felsenstein, and can sauce over, and we have been looking at the EEG of these three different groups,",English
+"and one of the things in terms of the clinical co-morbidities that stands out really is the prevalence of sleep,",English
+"and circadian desert disturbances in the ME/ CFS patients. We also see them in long COVID, and we have also been looking at the sleep architecture in these different groups.",English
+"The control, and long COVID or from an experimental study or research protocol, and the ME/CFS from clinical cases,",English
+"so they're not exactly identical conditions, and we also know that REM sleep latency here is showing a difference.",English
+"But the long sleep rate. REM, sleep onset latency is often associated with medication. Antidepressant medication can reduce REM sleep amount,",English
+"and we also found fragmentation, and arousal increased in the long COVID,",English
+"and any CFS patients. Another area that I think warrants further investigation is the finding of cortisol in morning fasting cortisol,",English
+a group has recently reported in.,English
+"Janet Mullington: Okay. Great. Sorry about that. So there's been a report that in long COVID, there's a lower morning cortisol level",English
+"and there have been inconsistent results in ME/CFS. I think that one of the things we need to do is compare by looking at 24 hour cortisol,",English
+because cortisol has a strong circadian effect. So I think that's an interesting area that needs to be pursued.,English
+Another area of inspiration or another inspirational study was that of Davidson College colleagues.,English
+"They characterize carefully the symptoms and the timing of the onset of symptoms in long COVID. Fatigue, of course,",English
+comes out early and stays persistently in long COVID. But other sleeping symptoms also show up early and stay prevalent.,English
+"One of the other things that was quite interesting that came out of this or sleep researchers was to see reports of vivid dreams,",English
+nightmares and lucid dreams. These phenomenon may give a clue about REM sleep. We have seen a couple of reports coming out looking at REM without atonia.,English
+"This can be a precursor to REM behavior disorder, which may be prodromal for neurodegenerative disease.",English
+So I think this is also an important place to focus some attention in the research on EEG looking at the fragmentation or the maintenance of atonia during REM sleep.,English
+We are currently doing a study looking at ME/CFS and long COVID patients. We are getting this study and,English
+"examining cortisol and melatonin as well as some inflammatory mediators, cytokines and resolving mediators that dampen inflammation.",English
+"This is just showing you the protocol that we're beginning. We have EEG here, a sample, so we'll be able to look at,",English
+"as [inaudible] did here, look at the EEG before sleep and after sleep, to investigate the homeostatic process through the night.",English
+"Then we will begin hourly blood draws. We're doing that, as I said, we will measure melatonin,",English
+"not to look at the circadian integrity of the system, but also the cortisol. So we'll be able to see if there are amplitude and phase differences.",English
+"Then we will do multiple sleep latency tests so we can look at sleep pressure during the day. Then after another night of sleep,",English
+the hourly blood draw ends. There will be cerebral spinal fluid sample in the morning so that we can look at,English
+"mediators in the cerebral spinal fluid, including orexin. Orexin-A is a peptide",English
+used in the brain and it is really important for state boundary control. So we will be able to look at that as well.,English
+That's never been investigated in Emmy's DFS or long COVID. So we're also looking at the spectral qualities in the EEG.,English
+Spectral qualities have been looked at in ME/CFS and there hasn't been a lot found. That's I think because the methods were limited.,English
+"This is an example in long COVID, but we're going to be looking at ME/CFS and long COVID in our preliminary data and in our currently enrolling study.",English
+"This allows us to look across the night and to look really at the disruption. So we'll be able to look at the fragmentation and spindle quality,",English
+"as well as alpha, delta and other patterns in the EEG that may help us to understand the sleep deficiency.",English
+I think it's really important to understand the switching between states and particularly the switching that occurs to move the brain from,English
+"a deep restful state into a brief and quick arousal and wakefulness. In this histogram up above,",English
+"you can see a lot of switching between these states. This shows you wake, REM, N1, N2 and N3,",English
+"N3 being the deep sleep. Then wake, you can see the amount of wakefulness that occurs here. Most of it's brief and very often people aren't",English
+"even aware of the fact that they're waking up at night. But this process of going back and forth, I think it's important to understand the burden of that on the homeostatic process.",English
+"Gudrun Lange: Thank you. Janet, we have just about 1 minute. Janet Mullington: Okay, I'm almost finished. This is how [OVERLAPPING] work.",English
+This shows just big data and how it can help us understand the individuals within a broader context. So we're looking at the ME/CFS and,English
+long COVID EEG in a broader context that's defined by this big data. I think we really have an opportunity to move beyond,English
+this deep architecture with some of these big data and machine learning methods. I think that twin studies of long COVID would also be,English
+helpful to understand and to be able to help us compare with genetic control and,English
+really understand the biology. I think we need to also follow long COVID cohorts for a longer period of,English
+"time and be able to look at the interventions. I think we have to share the data so that,",English
+"I think if there are data that are collected, we really need registries so that we can mine the data for future purposes.",English
+"With that, I would just like to acknowledge and thank our collaborators in ME/CFS and long COVID,",English
+"and acknowledge the patient led research collaborative, the Open Medicine Foundation, grateful for participation. Also all of our patient collaborators at Pollack and Letitia Soares,",English
+and also collaborators at MGH and across the country as well.,English
+"Thank you very much. Jarred Younger: Thank you, Janet. I saw some interesting questions coming through the Q&A window,",English
+"so take a look and take a crack at those. Let's do another little break, 10 minutes. Let's come back at 12:50, 10 minutes from now,",English
+"and then we're going to have Novak speak, and then we're going to do our panel discussion to wrap things up. Still some good things coming up.",English
+are you? Jarred Younger: Hello. We are at twelve fifty. Peter Novak: I will share my screen or I will use your screen?,English
+"Jarred Younger: I think they're going to set that up in a second. I'll introduce you and I bet everything will magically pop up, but if it doesn't, we will figure it out.",English
+So we have Peter Novak. He's going to be talking about peripheral nervous system in the CFS and maybe a couple of other things.,English
+"He's from Brigham and Women's Hospital, department of neurology. Dr. Novak does decidedly integrative clinical research.",English
+"He ties together these really dispersed elements that don't reveal their story until they're brought together. He has one of my top 10 papers from last year,",English
+"which is that mass cell disorders are associated with decreased cerebral blood flow in small fiber neuropathy. You've got mast cell disorder,",English
+"you've got cerebral blood flow, you've got small fiber neuropathy, that was one of the best titles I've ever seen in how you get three such exciting things tied together so",English
+cohesively so I think it's really a testament to his visionary scientific approach. I'm really looking forward to this one. I'll let Novak take it away and let's see if the technical aspect works.,English
+There should be a little gray box somewhere where you can advance your slides appearing up somehow. Jarred Younger: I think you got it.,English
+"Peter Novak: Can I start? Well, thank you",English
+"giving opportunity to share our experience with you about chronic fatigue syndrome, this very complicated intermingled topic.",English
+"I will talk about a very small part of the chronic fatigue syndrome. I've already asked at the peripheral nervous system,",English
+"now we're talking about small fibers and related dysautonomia then I will talk about associations of chronic fatigue syndrome with small fiber neuropathy, POTS, long COVID, and at the end,",English
+a few implications for chronic fatigue. I will try to be concise and mentioned already a lot of interesting autonomic issues.,English
+"I would try to avoid the overlap. So first, peripheral nervous system consists of the large and the small fibers. Large fibers are typical myelinated more than 50 microns.",English
+"They control the movement of muscles. Well, small fibers they are small because they're typical less than five microns and they are",English
+one ordinary for conducting. They might be affected in chronic fatigue syndrome although the implication of this involvement.,English
+"Small fibers, they are divided into autonomic or proper and sensory afferent. Sensory afferent fibers they modulate such chronic pain typical is burning sensation with",English
+"the modulation which is transmitted by small fibers but autonomic fibers they motor, they are efferent. So typical characteristic of autonomic fibers is that you don't",English
+"feel them and autonomic fibers manifest as an end organ dysfunction, so we call it enteric autonomic.",English
+"For example then just autonomic fiber is going to here a system abnormalities in motivating the heart, called the [inaudible].",English
+Autonomic fibers are divided in sympathetic parasympathetic immensely. Atomic system can also can be divided into the central and peripheral.,English
+Or central part is mainly from the brainstem reticular formation or Endo Hypothalamus. Hypothalamus is very important because it is called as,English
+"a sub ganglion which controls the autonomic nervous system. According to one study, all theory. Hypothalamus is the cause why people with",English
+"chronic fatigue syndrome or steel or brainstorming, they don't feel good if it's like having constant flu-like symptoms and they go to",English
+the one-third power is the last century hypothalamus. You'll switch to the street malls and maintain this feeling of the sickness. But this is one of the very interesting theory.,English
+"Snippets of system is so widespread it's modular, the peripheral organs, but probably the most important from the context of",English
+"chronic fatigue syndrome is parasympathetic system because the parasympathetic system, we'll talk a bit later is the inference portion of the auto immunity flex it mediates",English
+autoimmunity and cholinergic fibers by this function of the parasympathetic nerves to normality and autoimmunity.,English
+"Small fibers are very easy to detect or smaller than zero, but the diagnosis is established. It is easy using skin biopsy with",English
+"minimal invasive procedure that's two or three millimeter above C is typically done is telling by legs. They are simply counting the number of fibers, sensory and autonomic.",English
+So how is small fiber neuropathy related to chronic fatigue syndrome? So the prevalence is very high.,English
+"According to one study after this study you mentioned before one-third patients with chronic fatigue syndrome, diagnosis, having more fiber neuropathy, nothing simpler,",English
+"extending for neural motor. The prevalence is very similar, for example, in fibromyalgia or postural tachycardia syndrome.",English
+"However, the table until the chronic fatigue syndrome and small fiber neuropathy might be much harder one to one, which involves just do it on in peripheral spots,",English
+"so it gets a good reason to assume that here first, autoimmune inflammatory conditions,",English
+"so in this situation we see frequently on the largest also proximal, not only this side. For example, this canal dyspnea or shortness",English
+"of breath is extremely common in chronic fatigue syndrome, altering the physical phenomena. Those patients because it's now they have normal lung function and",English
+"distinct small fiber neuropathy actually the underlying pathological substrates for this chronic fatigue syndrome, and also in long call it standard form alone COVID,",English
+"so implications of small fiber neuropathy and CFS. Unknown, but in theory, based on the physiological studies,",English
+"dysautonomia, due to small fiber neuropathy can contribute to orthostatic intolerance and cerebral hypoperfusion. I will show an example of it later.",English
+"Then dysregulation of parasympathetic small fibers which mediate inflammatory efferent reflex may contribute to autoimmunity. Now, a few words about the POTS is overlapping,",English
+"both a small fiber neuropathy because small fiber neuropathy controls the POTS and vice versa. Historically, both studies were separated from the small fiber neuropathy studies, but nevertheless,",English
+"up to 20% in general adult, the Chronic Fatigue Syndrome bear POTS. Stewart showed that this person might be even much higher in",English
+"adults and up to 50% of patients with Chronic Fatigue Syndrome they do as well. It's like criteria for the POTS. If you ask about POTS, what it is, so it's currently",English
+"intolerant condition affecting mainly woman of age less than 50. Very common, affecting up to three million people in United States.",English
+"It is heterogeneous condition, so it is my neuropathic metabolic seconds after the conditioning or psychological problems. But we think about 20-50% of faults could be due to neuropathy.",English
+It's transmitted frequently by infection so also immunity still might play a role. Diagnostic criteria includes combination of,English
+"chronic orthostatic intolerance and excessive tachycardia. POTS is easy to diagnose by simply standing up and measure the heart rate. The best place is of course, the filter,",English
+which also gives you more details about the torque. This is how torque looks on the filters. On the left side you'll see the control rights are these reports from the top-down.,English
+"You can see the heart rate, continued pulse rate, and blood pressure inside of CO_2 and blood flows from the middle cerebral artery is obtained by outer sounds.",English
+This is classic textbook example for the folks. The blood pressure is stable burden the fields and the extrinsic pathway called the onboarding detail to more than 30 minutes.,English
+"The same time, just a person is hard for them to see the decrease of the entitle, CO_2 and hickories of the blood flow. It's important to note that decrease of blood flow",English
+"in more people do to hyperventilation by hypercapnia, causing vasoconstriction of the cerebral artery.",English
+Vicky Whittemore: Thank you. Peter Novak: Better now? Vicky Whittemore: Try it. We'll see. Thank you. Peter Novak: Sorry for that. Patient reports and they experience,English
+"orthostatic intolerance because they are hypoperfusing the brain and they are hypoperfusing the brain not because of the tachycardia,",English
+"but because of decreased blood flow due to hyperventilation, because hypercapnia, it can induce a cerebral vasoconstriction. Also our Stewart compares Chronic Fatigue Syndrome with the POTS in adolescence.",English
+"He again found depressed baroreflex which means that: decreased parasympathetic function or normal approximation functions, as I mentioned before.",English
+Parasympathetic functions goes into abnormal or abnormal autoimmune responses. Also what was very interesting that these orthonormal in,English
+orthostatic intolerance impulse and in chronic fatigue was similar. Going back to both patient because they do have orthostatic intolerance and mild but widespread dysautonomia often only on,English
+"the lateral pterygoid restrictive dysautonomia. Few words about the Long COVID. Long COVID, post-infection disorder and possibly it become free from the beginning.",English
+There are extensive similarities between Long COVID and Chronic Fatigue Syndrome. We just hope that we can extrapolate knowing from Long COVID to Chronic Fatigue Syndrome.,English
+Long COVID it is probably the most studied infection of humankind. Looking at the multiple similar to the Long COVID and CSF.,English
+"For example, 10% of COVID-19 patients develop chronic illness causes Chronic Fatigue Syndrome. The same 10% of patients with acute infection,",English
+they will develop a Long COVID. From these patients half of Long COVID patients develop symptoms consistent with Chronic Fatigue Syndrome going on objective testing.,English
+"It is reasonable to assume that there are some common mechanisms leading to Long COVID as well as the Chronic Fatigue Syndrome. Now multiple similar to the Long COVID and the Chronic Fatigue Syndrome, for example,",English
+"duration of the disease, chronic fatigue, post exertional malaise, very characteristic for CDSS. Those authentically in Long COVID patients.",English
+"There are similarities in neurocognitive psychiatric domains and nodal endocrine goes in autonomic manifestation or immune. Some autonomic manifestation is orthostatic intolerance,",English
+"cardiovascular abnormalities, chest pain. Also I like to mention this now, respiratory abnormalities are extremely common in",English
+both Long COVID and the Chronic Fatigue Syndrome. Even most people have normal lung function and we believe this now is due to small fiber neuropathy as mentioned before.,English
+"However, with Long COVID, it's not a simple condition which is really multi-system syndrome affecting",English
+"the vascular small fiber neuropathy dysautonomia hypocalcemia, this male, and about 20% Long COVID patients satisfied criteria for the book. When we use our study,",English
+"we did compare both readout, Long COVID or fist questions. They're really similar attempts of the day,",English
+"widespread, but the mouth dysatonomia. I would spend some time over here because the row mentioned that Chronic Fatigue Syndrome is associated with decreased liver blood flow.",English
+"There are two or three very nice studies common. Dr. Rose on both the corridor, show that patients with Chronic Fatigue Syndrome,",English
+"they do have decreased blood flow. There are three conditions in decreased blood flow and stable blood pressure, it is both post-operative cardiac syndrome.",English
+Again blood flow is caused by hyperventilation. There is hypocalcemic cerebral hypoperfusion gives the same consonant thoughts. The middle of the picture.,English
+"In this convention of patients are hyperventilating, causing decreased blood flow. But tarchychadia.",English
+"We think this meat and poultry are spectrum of the same disorder. What is very interesting in most of the Long COVID patients, they still decrease of the cerebral blood flow.",English
+"But those patients, they don't hyperventilate and they are not guarded and they don't have orthostatic hypotension. In other words, they have decreased cerebral blood flow because they are: vessels.",English
+"On the outstanding job, you have to have this compensatory vasodilation to keep the stables. This compensatory response is missing in them.",English
+"Some of the Long COVID. Again, it is an overlap with Long COVID and the Chronic Fatigue Syndrome. Most, about 20% will have this pop up on the autonomic testing.",English
+"Long COVID it is heterogeneous condition and there are different theories about what's causing long COVID,",English
+including auto immunity and persistent virus activation might be probably the most studied. But clinically we know that long COVID is heterogeneous.,English
+"Some patients have predominant tone, trouble or some dysautonomia or some chronic fatigue. It was very interesting data recent study actually",English
+"confirms a long COVID heterogeneity on more drug levels. For example, these studies, for some groups did show that based on the proteomics profiling,",English
+there are five clusters of the long COVID and only two clusters are auto-immune or inflammatory. It's a very consistent with our clinical observations.,English
+"Even like long COVID patients, they vary. Again, there's heterogeneity within the long COVID. How is dysautonomia and small fiber neuropathy relevant to chronic fatigue syndrome?",English
+Pro-inflammatory responses are controlled by evolutionary a very old neural circuit. We call them inflammatory reflex.,English
+The autonomic nervous system is the important part of inflammatory reflex. This is a short summary of this sensory fibers.,English
+"They detect molecular products of inflammation, injury or infection. They send information to the brain, to hypothalamus and to the brainstem and efferent motor neuron arc,",English
+which transmit from parasympathetic system modulate immune response. Very interesting that the main transmitter is acetylcholine called also cholinergic system and the most or highest concentration,English
+of acetylcholine is in the spleen. Spleen plays important role in autoimmunity [inaudible]. What does it mean?,English
+"The cholinergic anti-inflammatory pathways transmitted by the vagus or parasympathetic nervous system then modulates inflammatory responses mainly by influencing TNF,",English
+"IL-1b or IL-6 to the main inflammatory markers. There are plenty of others. In summary, first of all,",English
+"our peripheral nervous system is related to chronic fatigue syndrome. Small fibers, particularly autonomic fibers are frequently involved in chronic fatigue.",English
+They can cause a variety of the manifestation including Post Othorstatic Tarchycadia Syndrome or simply autonomic neuropathy. Parasympathetic dysfunction.,English
+This is frequently seen in chronic fatigue syndrome. Can mediate autoimmunity. Then POTS-like syndrome can result in,English
+cerebral hypoperfusion because there is a decreased blood flow. I would like to stress that the observed decreased blood flow which is indirect marker of hypoperfusion.,English
+"We don't have any good tester with laser type of hypoperfusion directly. Also based on these studies or based on how it is easy to get small fiber neuropathy diagnosis, or dysautonomia,",English
+"those variables can be used as a biomarker in some studies, but only [inaudible] chronic fatigue syndrome. Thank you.",English
+"Jarred Younger: Thank you, Dr. Novak. Our next session, we've got some time set aside to do a discussion and address these questions,",English
+"things that have come up in a larger level or higher level. I believe, Vicky, if you take things over,",English
+"I think this is going to be open to all the speakers and all the work group members to go through these major questions. Vicky, I will let you have it.",English
+Vicky Whittemore: Thank you. I'd ask all the speakers and anyone who would like to turn their cameras on to participate in this conversation. I believe we have some slides with questions.,English
+All LA if they could please put those up. Vicky Whittemore: Our three questions back to what do we know?,English
+What do we still need to know? How do we move forward with clinical trials? I think are the overarching questions. I think there was a second slide.,English
+The next slide. That really are additional discussion questions for us to ask. Really thinking about all of the excellent talks we've heard this morning.,English
+"Thank you, everyone. It's a lot of information and a lot to think about and put together. I saw a comment in the Q&A about how do we begin to put this all together.",English
+"I think that that is what makes ME/CFS so complex, is that we don't necessarily understand the underlying pathophysiology,",English
+and it impacts so many different systems. But I think if we can begin to think about what are the critical studies that we need,English
+to do now to be able to move to clinical trials. I'll start there and see if any of the panelists or the speakers or any of the other members who are on would like to comment on that.,English
+Jarred Younger: Hey Vicky. Question I see all the speakers. I don't see any one else. Are they actually on here and I can't see them?,English
+"Vicky Whittemore: Yes. Jarred Younger: Great. Cool. Peter Novak: I think the most important thing is to serve a biomarker. If you do any clinical trials,",English
+you have to add some way how to measure the response. IDL is the major. It's a quantitative full objective way.,English
+"Vicky Whittemore: It's still a little difficult to hear you. Peter Novak: Very hard. I might try to switch to another computer,",English
+but I'm very close to microphone over here. Can you hear me now better? Vicky Whittemore: That's better. Yes. Peter Novak: The main issue is they're trying to figure out though,English
+"they have a very similar clinical trials. The most important thing is to define the biomarkers, which would be IDL is fully quantified objective because we want to measure the response.",English
+"In our studies, we are, instead of using clinical definition, for example, postural tachycardia syndrome or chronic fatigue or long COVID,",English
+"which are wide definition and heterogeneous. We are narrowing the abnormalities. For example, for long COVID subset,",English
+"some of these is actually such like at your upper curl chronic fatigue, but let's say we're looking for the abnormal skin biopsy with abnormal inflammatory markers.",English
+"We call it inflammatory neuropathy. We can trace the progression or regression over the time. One of the example,",English
+"let's call this patient also, for example, satisfied criteria for long COVID or chronic fatigue or for mild cognitive deficit. By that way, we'll be avoiding the controversies with how to measure the response.",English
+"Vicky Whittemore: Thank you. Anyone else want to comment? Yeah, go ahead Janet",English
+Janet Mullington: I think there's a lot of data out that has been collected that we could benefit from,English
+making sure that we have really good harmonization and repositories available because just looking at that twin study for instance getting a hold of,English
+that EEG that's a treasure and being able to apply new data analytics methods to old data can be really cost saving,English
+and very informative and provide a shortcut because then we can move on to validating instead of collecting data from the beginning.,English
+I think those are really important to include going forward. Vicky Whittemore: Just to comment there so the data management coordinating,English
+center that we have funded for now going into the sixth year has developed a data repository called mapMECFS where data can be shared.,English
+It started out with data being curated from publications and now investigators can also upload data to that data platform.,English
+They're currently aren't EEG's stored there but I know of EEG data platforms where the data could be shared and clinical data could be shared in map,English
+Vicky Whittemore: Anyone else want to comment? Lenny Jason: Vicky just a couple of quick comments if you can hear me okay? Vicky Whittemore: Yes.,English
+so I think that's a paradigm shifting idea that probably we're going to need to have large enough samples so that we can really begin to parse the subgroups that might be,English
+effective and not and the other thing that I come away with is where we're recruiting the patients might be critical. Because in a sense,English
+co-morbidities or based on symptom presentation regardless of co-morbidity? Lenny Jason: I think they're both important. Vicky Whittemore: I know those are both excellent points,English
+very high lactate are they different and how are they different from the individuals who do not and would why would you treat the two groups of,English
+"But I think the other point you make also Lenny is also really quite important about where you collect, where you recruit the study participants from and we actually have",English
+provided some biospecimens to a researcher in Switzerland who is looking at chemokines and he has very different results depending on two of the site we initially because,English
+provided biospecimens from two sites that were involved in the CFI ME/CFS study and he got very different results based on where those individuals were recruited from.,English
+"You've got the same virus but just an incredible range of pathologies. People would just respiratory damage peripherally, some people that look like they have blood-brain barrier infiltration and",English
+"central immune system problems and everything in-between and you would treat those people differently. Sometimes you've got to target the virus,",English
+"sometimes it's other peripheral stuff, sometimes it's not the virus it's some long-lasting issue. You all know there are so many different things just with",English
+this one virus and so something like ME/CFS that's not due to a particular virus. There can be all levels of problems and pathologies under that and so yes we would treat those very,English
+what does it do for me? I think all these talks today were fantastic but where's the behavioral indication of what it actually does?,English
+"given to people with other ME/CFS symptoms in addition to let's say in my case cognitive dysfunction, that needs to captured because it could be possible that I'm not making this up",English
+"a Norwegian group presented a new instrument, that is designed specifically for individuals with ME/CFS to measure and look at impact on function of daily living.",English
+"That looks to me it's going to be an excellent tool. It doesn't really get at cognition, I don't think, but really how do your symptoms impact your function?",English
+That then could be used in a clinical trial to look at improvement in those functions of daily living. But I think those are critically important points absolutely.,English
+"I again, I use the COVID-19 response as a model. Just the way everyone just started running these impromptu clinical trials everywhere, probably a lot of them without IRB approval and stuff.",English
+"Just physicians and clinics, just running clinical trials, getting that information up to the next level and then testing those and coming up with best practices.",English
+"The serial stuff that we've been doing where you spent ten years testing one treatment and then if bombs then you just wasted ten years and you start another one, we just don't have time for that anymore.",English
+"We really have to make things more parallel and get multiple things tested simultaneously. Vicky Whittemore: No absolutely and this really requires, I think,",English
+"a lot of careful thought because I think we need a way to really carefully phenotype the patients, so we're putting them into the right trials.",English
+"Otherwise we're going to continue to have failed trials simply because you're putting people, potentially the wrong sub-group into a trial.",English
+"I think those things need to be put in place before I think we can do that, but is where we need to start absolutely.",English
+"Gudrun, you've had your hand up. Then I see Benjamin. Gudrun go ahead. Gudrun Lange: I couldn't agree more with Jarred. I think time has run out with respect to fiddle around with",English
+"these long protracted initiatives that take years and years, actually decades.",English
+This is my third decade in the field. Do I need to say more? Patients are suffering and so maybe we can just,English
+start like Jarred was suggesting in an informal way. What do we already have? Are there any measures in all of these 540 studies that some people have,English
+identified in the systematic review that we can harmonize with and do it in a more informal fashion just to get started.,English
+"Because if we don't get started, we don't get finished so that's $0.05. Vicky Whittemore: No, I absolutely agree.",English
+I think you're going to hear some really interesting things that could be potential biomarkers in some of the upcoming webinars.,English
+"I think coming full circle once we've heard from the metabolomics and the immune system groups, or it's going to be really important to bring",English
+"this discussion all back together to really say, okay, here's what we've heard, and that's what this research roadmap is intended to do, is to say,",English
+"okay, here's what we have, here's how we can move this forward in the best and most efficient way. Benjamin, you've had your hand up.",English
+Benjamin Natelson: One of the problems we've going to have to keep in mind with any therapeutic trials is that patients are on medicines. Most of the drug-related therapeutic trials in fibromyalgia require,English
+patients to come off medicines that in and of itself is a problem. But we're going to have to try to come up with treatments that can be done while,English
+"I have been aware of it, I recently put in for a device trial where I'm going to be using heart rate variability as a dependent variable",English
+for improvement but I certainly would have included the Groton. I think we need to think about including that in future studies. Vicky Whittemore: Thank you.,English
+"Trisha, I see you have your hand up. Trisha Fisher: [inaudible] data collection [inaudible] She maybe had a phenotype and group people together.",English
+"Vicky Whittemore: Your audio is a little lowkey. Can you say that again, Trisha? Sorry. No, maybe it was just on my end.",English
+and I forgot it today and I'm in trouble now. Things like that. Very easy things that are measurable that do exist.,English
+"I mean, we're talking about maybe some really cool technology that already exists. Patients don't have access to it. But they do have smartwatches.",English
+"They do have schedules. They do have Google calendars. Because if they don't, their families wouldn't know when to drive them to the doctor. Things like that.",English
+"I checked that out when I was preparing for this talk. There is only one tool, and that's the PROMIS fatigue toolkit.",English
+We have a lot of really season smart people who are working in the questionnaire development and so on and so forth.,English
+"Gudrun Lange: Exactly. Vicky Whittemore: When I was recently at the IEEE CFS conference and talked about the common data elements and that we were using the PROMIS,",English
+"someone stood up and said that they found that that was not at all helpful actually for their clinical trial that they were conducting, and that actually the Chalder was much more effective.",English
+"I think, again, thinking about validating these tools and having data in the population before you then go into a clinical trial is really valuable.",English
+"I don't know, Jarred, if you want to comment on that. Jarred Younger: Yeah. With those tools in particular,",English
+"but not really good for ME/CFS longitudinal clinical trial works. If you want to do a pre-post, that is probably not the tool I would choose.",English
+I would much rather pick something like the Chalder fatigue scale for a pre-post. I think there'll be a core one-time assessment and then there,English
+"should be a suite of established tools specifically for clinical trials, so you get baseline in at one or more points after the treatment.",English
+"That's hard to put together. A lot of these cognitive scales, there's one form or maybe two forms, but you can't get the same cognitive tests,",English
+"a lot of them again and again, or there's practice effect to people used to them. It's very tough, but it's something important we need to do. Gudrun Lange: But it's doable. Efforts are moving forward",English
+"of especially validating remotely used tools. Whether you use them on laptops, iPads, there are differences and similarities across populations.",English
+"But, I mean, it can be done, but it's an effort, and that's an effort that needs to be funded somehow, but it can be done, hopefully,",English
+without so much red tape that it's never going to get there. We using a million tools that we can compare over the studies that we all do and it's getting us nowhere.,English
+"Vicky Whittemore: I absolutely agree with that. Cindy, you had a comment in the chats. Cindy Bateman, you want to turn your camera on and unmute your audio?",English
+"Cindy Bateman: Sure. This is a little bit of a follow-up to a peer's comment about low diagnosis rate, which makes it really hard to do clinical trials.",English
+"I think if we could have an effort to provide basic diagnostic tools to clinicians broadly, then the number of patients would go up,",English
+"complex tissue, it has brown adipocytes. It has various immune populations, including macrophages, their cell autonomous mechanisms have been identified in both the Dipa",English
+"sites and in the macrophages that are assaut thought to confer resistance to norepinephrine, the main signal of the sympathetic nervous system. There's also evidence",English
+"that both the innervating fibres as sympathetic nervous system fibres, as well as the vasculature also remodel in",English
+"response to obesity, and that the density of the fibres and the and the vascularization is decreased. There is also",English
+"evidence that sympathetic tone coming from the brain is also decreased. And some of these, it's possible that some of these",English
+"mechanisms may be acting in concert or in different circumstances, although some of the mechanisms are also mutually exclusive. And part of the reason why we really can't",English
+understand what the relationship is stems from the approaches that are currently available to interrogate this issue in rodents. And so first one classical example is when either,English
+"the nerve innervating coming in innervating, the brown adipose tissue, I don't think this works, but the ones that are",English
+"coming in at the side. So those nerves, either you can deactivate those nerves, or you can stimulate those nerves. A lot of people have done that. And when you do that, the",English
+"problem is is that both sympathetic and sensory nerves are innervating, the brown adipose tissue through that mixed nerve population, and because those two cell types are",English
+"thought to have opposing effects, if you're either D intervening both or stimulating both, it's obviously complicated to interpret.",English
+"So other types of approaches So that are that have been used to study this issue. A classic one is to use a pharmacological stimulators, so either to inject peripheral injections of either",English
+"norepinephrine or various beta adrenergic receptors. And what you can see an example on the left is if you inject either norepinephrine or the beta three adrenergic receptor, you nicely",English
+"induce bat thermogenesis measured with a temperature transponder. You can also on the right side, inject a beta agonist and also induce glucose uptake, specifically in brown",English
+"adipose tissue and not in liver. And so these are the types of assays that are very typically used in rodents. But the problem is, is if you actually want to understand where this resistance",English
+"to the sympathetic tone is coming from, if you just come in with the agonist, you've now ignored all of the central circuits, all of even the peripheral circuits and you go",English
+"in, you directly activate the dip asides, and the endothelial cells and other cells within the depot. And so you're really sort of shortcutting any regulation that can happen. So it's hard to",English
+"understand what's happening and dodge honestly. So another approach that's often taken is so instead of jumping right in and attacking the addict, besides directly, so now, you",English
+"expose animals to cold for a while. And here's an example of mice put in four degrees into a cold challenge. And now we're measuring brown adipose tissue, heat production directly with",English
+"thermal imaging. And you can see again, if you move mice into the cold, you can get this night induction nice induction of bat thermogenesis. But the problem is, again, when you are moving",English
+"mouse mice into the cold, you're inducing a systemic response. So yes, you're inducing changes to brown adipose tissue, but you're inducing changes to white adipose tissue to the general",English
+"circulation. And again, you can't really study and isolate what's happening at the level of brown adipose tissue. And finally, the last approach that people use is to look at",English
+"tyrosine hydroxylase. So tyrosine hydroxylase is the rate limiting enzyme for the production of norepinephrine again, the major neurotransmitter of the",English
+"sympathetic nervous system. And what people do is they either do like a western blot in black and bat for tyrosine hydroxylase expression, or they could also do what's shown here is I disco",English
+immuno labelling in an intact depot in conjunction with whole Oregon imaging to get a reconstruction of what the,English
+"fibres look like. And so you can see here really nicely, the big nerves that are coming in, out and the lateral edges of the depot, and then sort of branching inwards, so people",English
+"characterise that density. But again, if you're looking at just a neuro anatomical organisation, or even more, so you're looking at a single point, at a western blot of tyrosine hydroxylase",English
+"expression, it's just not clear exactly how that correlates with activity. And today, neuroscientists have much more precise tools to measure these activities in real time. And so,",English
+"when I set out to study this problem, I decided that I wanted to build a toolkit to study sympathetic regulation of brown adipose tissue activity. And the key is, is that it's easy to",English
+"use, because right now, there are some labs out there that have very specialised techniques, but but those techniques are either not broadly available or are too",English
+expensive. And so there's a high barrier to entry. And so I really wanted to develop tools that could be readily adopted anywhere so that we could all start studying the same things,English
+and start comparing comparing notes. So the key items I wanted to develop is one in assay to really precisely measure bat,English
+"function in vivo in real time, and the other was to get genetic access to specifically modulate neuronal innervation or brown adipose tissue. And so with the first on the first developing",English
+"the in vivo assay, I decided to start with an anaesthetised prep, just so there would be more control over over the temperature and more consistent outcomes. But I was well aware",English
+"and I'm sure again, maybe many people know from the work of Barbara cannon and Dr. Anita guard that Eisah fluorine, which is the anaesthetic most commonly used for these types of",English
+"surgeries in animals, suppresses brown adipose tissue activity, so I compared various anaesthetics and all of this is just To direct temperature recordings from brown adipose",English
+"tissue, in response to stay lean in blue versus the various anaesthetic and you can see with Eisah fluorine, that brown adipose temperature is reduced, in contrast in ketamine",English
+"xylazine, which is Columbia University's second line anaesthetic of choice, so I had to show them what would happen when I use this. And you can see conversely, that we get",English
+"increased brown adipose tissue thermogenesis. And what we did find after screening a number of anaesthetics, that if we deliver abberton through a constant infusion through the tail vein",English
+IV that were able to maintain a very consistent level of playing of anaesthesia for about two hours. This consistency is also,English
+"important is because if you have mice waking up, and then you're putting them back down and waking up, of course, bred adipose tissue temperature and body temperature is going to",English
+"fluctuate. So really maintaining a stable plan of anaesthesia is critical. And so just to introduce you briefly to the sort of setup that we use, we have mice that are on a",English
+"platform, again, anaesthetise with average head, we have a probe, a rectal probe measuring core body temperature, then we have another probe, measuring low lower back body temperature",English
+"and a third pluck probe, measuring bat temperature. And what we do the calculation that I'll show very often is this delta bat minus lower back, and that is what we call brown",English
+"adipose tissue thermogenesis. And so this is just to show you what happens in this system when we add in norepinephrine. So you can see in the first box, looking down in the baseline",English
+"condition, nothing happens, then we inject pre warmed saline, again, nothing happens to the recording. When we inject norepinephrine, you see this big spike, and you see an increase",English
+"in actually both the core body temperature, the lower back and the brown adipose tissue. This is just to remind you again, that when you're adding in norepinephrine, you're affecting",English
+the entire body. But when we put when we then follow up with a beta blocker propellant all then we're able to completely block,English
+this the thermogenesis. So that's great. We can measure this with norepinephrine. But I already argued before that what,English
+"norepinephrine is really a sledgehammer and acts through everywhere. And so we wanted to develop, we wanted to make sure that this system is actually sensitive enough to detect",English
+"endogenous and physiological changes in body temperature. And so now what we did was we took remember, the mice are kept on this platform, the platform is warmed to 3035 degrees, and we",English
+"get a baseline recording, then we just shut off the heat, and let the temperature naturally fall down so that the platform temperature hits about 31. Then we do another series of",English
+"recordings, and then we turn the platform back on. And so what happens when we do this is and you look at core body temperature, not surprising when you turn the heat off the core",English
+"body temperature falls. And when you turn the heat on, then the core body temperature comes back, the lower back temperature exactly follows the same pattern as core body temperature, but",English
+"the brown adipose tissue does not it maintains a constant temperature. So when you look at this delta bat minus lower back, you can see that we turn just the natural cooling of the body,",English
+or is associated with increased brat bathroom agenesis. And this turns off when the heat on the platform is turned on. And what you can see is this doesn't happen immediately with the heat,English
+"with the change in the platform, but rather, it requires a drop of about about point eight degrees before we see brown adipose tissue",English
+"coming on. And then on the flip side, when we turn the heat on, it's there it seems to be more sensitive. Even within less than a half a degree of an increase in core body temperature we",English
+already see bout brown adipose tissue thermogenesis turning off. And so this system really reflects the very tight body temperature regulation that is normally exists in all,English
+"organisms. So until we felt confident that we had this system with it's in play, we not only looked at thermogenesis, but we also looked at blood flow with the Doppler imager and the",English
+"blood flow follows exactly the same pattern. Now in the blue, as we saw with the thermogenesis is when you inject norepinephrine you get this big spike and I I'm in blood flow",English
+"and that is completely blocked, or mostly blocked, I should say using the beta blocker. So we were happy with this assay, we have something to start with. We're also working on in vivo",English
+systems to measure norepinephrine and also nutrient uptake. But then we decided to move with this assay in hand over to get genetic access to specifically modulate,English
+"innervation of bat. And so this is just a diagram of the sympathetic nervous system. So the sympathetic nervous system, all of the ganglia basically lie parallel and adjacent to the",English
+"spinal cord. And the sympathetic ganglia, the neurons project out to the various organs. And it's really organised very much in a sort of rostrocaudal map. And so we want to just target not all",English
+"of the sympathetic predictions, we want to only target those projections that go to brown adipose tissue. And so this is just showing you in vivo data from a postdoc in my lab, when",English
+"she was back, Maria Francois when she was back in Heiko months Brookes lab, but what you can see in the th stain, so that this is a th reporter line. So this is actually a sympathetic",English
+"chain, again, lining the whole spinal cord. And if you inject a GFP labelled pseudorabies virus, you're able to retrogradely that goes from the brown adipose tissue into the ganglion. And",English
+"you can see that only a few of the ganglia are labelled that in fact, quantifying it out more than 50% of the sympathetic innervation, or brown adipose tissue comes from the stellate",English
+ganglion. So now we use two different strategies to try to isolate and activate only those projections to brown adipose,English
+"tissue. So we used an optogenetic approach and a chemo genetic approach. And so because this is a diverse audience, I'm",English
+"just going to give a brief overview about what optogenetics and chemo genetics are. And so basically, they're both very similar, conceptually, which is, if you focus on the middle, what",English
+you do in both cases is you're able to achieve targeted expression of a receptor that doesn't have any endogenous ligand in the mouse. And then what you're able to do is you,English
+"then activate in the case of chemo genetics with the ligand in the case of optogenetics, with light, and you're able to activate just that circuit. So in the case of chemo genetics,",English
+"there's a genetically altered muscarinic receptor, also called the dread receptor. And what you're able to do, it's coupled",English
+"to a GQ, in this case for stimulation. And if you just express this dread receptor on its own, absolutely nothing happens, because there are no endogenous ligands again, in the",English
+"mouse, but you if you inject with CNO, then you're able to stimulate just those neurons that express the dread receptor. And optogenetics is basically the same idea is except instead",English
+"of expressing a receptor, you actually express a channel rhodopsin, that senses blue light. And so in the absence of blue light, this is completely inert. But if you shine blue",English
+"light, you're now able to activate just those neurons. And so we started with an optogenetic approach, because what you would you're able to do is to just take a th Cree mouse",English
+"line, and Dr. Cree dependent expression of the channel rhodopsin. And so now you would be driving channel rhodopsin expression in all of this sympathetic nervous system. And",English
+in order to target just the fibres going to brown adipose tissue. So we worked with the sun lab to develop these sorts,English
+"of blue, these small blue light adapt adapters that would shine light just on these nerves as they're entering brown adipose",English
+"tissue and activate them. And so Sango Park, again from Texas a&m is the one who developed this system, and he had already used",English
+"on the blue light, basically, we saw absolutely nothing. And so if, if anyone's interested, I can speculate about why that happened. But we decided after working on trying to optimise it",English
+"a fair amount we've moved on, we had moved, move onto Kima genetics, which is a little bit trickier. So with Kima genetics, again, we want to express this jet dread receptor. And now what",English
+"we needed to express it, the advantage of the optogenetics is you could just target the light on bat. So here with chemo genetics, we had another problem, we want to just target",English
+"the sympathetic neurons that are innervating. Bat. So we wanted to use a retrograde tracing approach. So, the first thing we did is so I had showed you before, see if I can go",English
+backwards. That when you injected when re injected the PRV labelled GFP into brown adipose tissue that you can very,English
+"specifically retrograde Lee trace to some parts of the sympathetic chain and not all of it. So that's really key because we want to make sure that if we're tracing back, we're not",English
+"hitting projections to the white adipose tissue to the pancreas, all of these other matters metabolically relevant Oregon. So that's really important. But the next thing that we needed to",English
+"make sure of is the simple the stellate ganglion, which is the ganglion that sends the majority of the innervation to brown adipose tissue, we needed to make sure that the stellate",English
+"itself projects to a lot of different organs and projects to brown adipose tissue to forelimb. To Heart to lung, we needed to make sure that if we're targeting a neuron with a",English
+"retrograde injection from bat, that we're only hitting the projections to bat and not to the heart or to the forelimb. And so what we did, I'm just going to show you one example",English
+"here, we injected another retrograde trace colour toxin be conjugated to a fluorophore. So we conjugated it, the red",English
+"fluorophore, we inject it into brown adipose tissue, the green fluorophore, we inject it into the forelimb. And you can see that the neurons innervating, brown, adipose tissue and",English
+"forelimb are completely non overlapping. They're also non overlapping from the neurons that project to the heart. And so that now with this information, we're pretty",English
+"confident that at least with the retrograde approach, we will be able to inject a retrograde virus into the brown adipose tissue and that it would go into an only affect those neurons",English
+"sympathetic neurons are projecting Tibet. So that was the plan. But when we injected and we tried a number of the standard retrograde viruses that are available, various serotypes",English
+"and including most of the ones that we use in the brain without a problem, what I want you to see the comparison here is the injection of the colour toxin B versus the retrograde trace, and",English
+"the retrograde trace with existing serotypes, we're just not good. And we just could not get enough infection in order to really get decent expression and begin functional assays. So we",English
+"worked with Viviana Gratton Oros lab at Caltech, who's developed who developed a series of new serotypes that work better in",English
+"the peripheral nervous system. And we tested her serotype. And in fact, you can see on the right that now we get really nice robust expression in the, in the stellate ganglion in the",English
+"sympathetic nervous system. So this is great, but there's now another issue that cropped up, which is that I told you way back in that diagram of brown adipose tissue that brown",English
+adipose tissue is innervated by the sympathetic nervous system and the sensory nervous system. And it's thought that they have opposing functions. And so we needed to make sure we were not,English
+"hitting the, when we were doing our retrograde injection. If you just inject the retrograde virus here conjugated to GFP, you can see that not only are you labelling the stellate ganglion,",English
+"but you're also labelling the sensory neurons, you're labelling the neurons in the GRG is at the C five nd T one level. And so this type of stimulation is not going to work because",English
+"again, you're going to hit the opposing populations. So we next added in a cre dependent step. So now we had the th Cree",English
+"neurons, the driver that it's expressed in the sympathetic nervous system, we added a cre dependent retrograde virus with the grounded arrow serotype. And now you can see that we're able",English
+to get really nice expression in the stellate and not in the sensory ganglion. And just to say that the distribution cellular distribution is a little different here because,English
+this is actually the expression of the dread and the dread is a decoupled protein receptor. So let's actually localise to the,English
+"cell membrane. Okay, so finally we get to do our experiment. We now have the expression where we want, we inject CNO. And now I'm",English
+"just showing you core body temperature, blood flow and bat thermogenesis. And so we inject that again, the baseline baseline and see saline are really nice and flat, we inject",English
+CNO were able to see a robust and increase in both bat thermogenesis and blood flow that is blocked by propellant,English
+"all the beta blocker. And this is just to show you if you take a virus that expresses just the GFP and not the dread, and you inject siendo and propellant all you have absolutely no effect.",English
+"So this is very specific now for just the sympathetic innervation of brown adipose tissue. We did the same experiment with an alpha blocker. So alpha blockers, the bat thermogenesis",English
+is thought to be regulated primarily by beta adrenergic signalling. So we add in that alpha blocker now phentolamine you see that the effect on thermogenesis is really not,English
+"blunted. But if you look at blood flow, now, you can see that the blood flow is decreased by about 50%. And so again, just comparing things this can fits with what has already been known",English
+"in the literature about regulation of blood flow, which has alpha and beta adrenergic components, while the bat thermogenesis is only beta. So all of this has been in this",English
+"anaesthetised prep, we're now in the process of moving to in vivo in awake animals to see whether we can also impact systemic homeostasis. And so this is an example of a mouse now that has",English
+where we inject the CNO into mice that now in conjunction with an oral GTT. And you can see that chemo genetic,English
+activation of only sympathetic innervation of brown adipose tissue is able to improve glucose tolerance. And we've also the data is a little bit too fresh to to show. But we've,English
+done the same thing now in the context of indirect calorimetry. And we show that we can get increases in energy expenditure and also changes in our Q also induced by this type of thing.,English
+And so we are we are again feel good about the fact that we now have a system where we can get access to key to genetically,English
+"stimulate both brown adipose tissue thermogenesis and blood flow. And now we're again starting to work on more of the endpoints in awake mice. And in the long term, we're now that we",English
+"have all of this sort of almost nailed down, we really want to understand how the question I posed in the very beginning, which is how our responses to sympathetic signals altered in",English
+"the context of obesity, diabetes and ageing. And with that, I will thank my lab. I'm Danieli, who was the Daniela Nari, the PhD student who really spearheaded all of this work and",English
+"funding organisations as well. And as well as my collaborators from both Caltech and Texas a&m, I'll take any questions. Thanks. Thank Thank you, Laurie, fantastic presentation on trying",English
+"Over here. Yes, hi, Haley. burm. Really nice talk. I was just curious with the chemo genetics. Did you ever or do you plan to do any",English
+"continuous dosing of CNO to see if viewers any, like desensitisation? Or if you can, you know, keep that activation going for longer periods or even with like DC Z and like,",English
+"right, so we're working with so we're working with DC Z right now, because DC Z, all of our initial studies we had done with CNO DC Z works at about at least 100 fold lower concentrations,",English
+and it's so it's easier to do those types of dosing experiments. And so we're going to check we're going to look into using DCC in the context of like a mini pump or something,English
+"where you get more continuous, a low level infusion and we're going to see if we get that tap type of tacky for Laxus or not, but that's in the offing as well.",English
+"More questions in the front, if you don't mind passing down the microphone. Fantastic. Presentation I've already got some ideas. And do",English
+"you intend to somehow evaluate the mitochondrial function of this blog post tissue, like, in real time, because it's thermogenic, and so on.",English
+"So we're starting to work. So there are a number of tools that are coming online. We weren't originally, I mean, the mitochondrial function wasn't on the on the first thing, but it",English
+"will be one of them. But one of the things I had sort of met alluded to, and just the summary slides, we want to look at actually, norepinephrine release is actually one of the very top",English
+things that we want to look at. There are various grabbed fluorescent sensors that have been used in the brain in order to measure and visualise norepinephrine release. And the,English
+"problem, which we're working with some collaborators to overcome in the periphery, is that in the brain, they have these, you know, they mount these little mini scopes, or",English
+"fibre optics right onto the skull. And this has the real advantage that the fibre optics moves with the animal because it's mounted to the skull in brown adipose tissue, especially",English
+"because it's like right over the heart, and in the part of the body where the animal is, and the lungs where the the, you know, the animal is breathing. So doing those measurements,",English
+"where you have all of that movement is the issue that we're trying to overcome right now. And hopefully, we'll be able to get there. But if that can be overcome, technically, then it",English
+"opens up really the door to a lot of things, not only things like norepinephrine sensors, but also some of the fluorescent mitochondrial sensors, raw sensors, I mean, there's, there",English
+"are tonne of tools out there that have now have genetically encoded sensors that we could use, but we need to overcome that obstacle of the vibration.",English
+"More questions from the audience? Maybe Meanwhile, I'll I'll briefly ask if ever given up on the optogenetic approach,",English
+"you mentioned a little bit that you had some reasons for why you thought that didn't pan out, but maybe elaborate? Well, we had played around with a lot of different stimulation",English
+"protocols and intensities. And for one thing, if you turn down the intensity too high, you just heated up the red adipose tissue on its own. So that really didn't work. brown adipose",English
+"tissue also expresses some options. So you need to keep the stimulation pretty low. It's possible now looking back on it, that there are reports that tyrosine hydroxylase is",English
+transiently expressed during development in some of the sensory neurons. And it may be because we generated those mice by a cross. So it would be a developmental expression. And so,English
+"it's possible. At the time, we were really focusing on just validating, and looking at the stellate to make sure it was expressed. We weren't really looking back at the DRGs back",English
+"then. But it's possible that what we had is, is an issue of expression with the sensory nerves as well that are that are acting in opposition. And so we have we're in the process of",English
+developed to a process of validating another line that is th that is not th that would be able to target just the sympathetic innervation. And so we're hoping that it may be if,English
+"if that is validated, we may revisit the optogenetics. Because going back to the issue that was asked before about getting continuous stimulation, it's really if you have an",English
+optogenetic they have LEDs in there that you can implant and you can programme the LEDs to stimulate with different time courses. And that would be much nicer than just using a mini,English
+pump with you know DCC coming out all the time. We have time for one final question. I Laurie a couple of years ago for completely different,English
+"reasons. We did RNA seek on brown fat following cold exposure. And in that paper, we reported that FGF 21 and gdF 15. Those transcripts just go through the roof. And then the",English
+protein levels also go through the roof. And I was just wondering if this is certainly not an area that we focus on. But does that make sense as a feedback loop? Can you just,English
+"comment so yeah, so this is something that we're very much interested again, which is why timecourse matters here is because a lot of the stimulation that stimulations that have been",English
+"And if you do that, you can claim a special offer. They'll give you five free travel packs, which make it very easy to mix up Athletic Greens, whether you're in the car, or on a plane, or on the move,",English
+and they'll give you a year supply of vitamin D3K2. There is now a lot of data showing that vitamin D3 is important for many biological functions,English
+"that impact our immediate and long-term health. And most people do not get enough vitamin D3, even if they're getting a lot of sunshine. And K2 is also important or has been shown to be important",English
+"for heart health and for blood lipid function, et cetera. So, again, if you'd like to try Athletic Greens, you can go to athleticgreens.com/Huberman",English
+"to get the Athletic Greens, the five free travel packs, and the year supply of vitamin D3K2. Today's episode is also brought to us by InsideTracker.",English
+InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better meet your immediate and long-term health goals.,English
+I've long been a fan of getting regular blood work done for the simple reason that many of the things that impact your immediate and long-term health,English
+"can only be analyzed from a quality blood test. There's just simply no other body surface marker that you can look at somebody or yourself and say,",English
+"""Ah, I know that my blood lipids or my cholesterol are good, or that my hormone levels are X, Y, or Z."" We really need numbers on those things",English
+"to know where they sit. The problem with a lot of blood tests, however, is you get all those numbers back, you don't know what to do with that information.",English
+"InsideTracker has solved that problem, and they have a very easy to use dashboard where when you get your numbers back, it can tell you for instance,",English
+"where your numbers are high or low or on target. And they can suggest very specific dietary intervention, supplemental interventions, and behavioral interventions",English
+"that can allow you to bring those numbers to where you would like them to be. So they've simplified the whole process. And in terms of getting the blood tests,",English
+"you can go to a local center to get the blood drawn, or they can even send somebody to your house. So, they've made the whole thing very, very easy from start to finish.",English
+"If you'd like to try InsideTracker, you can visit InsideTracker.com/Huberman to get 25% off any of InsideTracker's plans.",English
+"You just use the code ""Huberman"" at checkout. Okay, let's talk about the immune system, and the nervous system, and how the two interact,",English
+"and how you can control your immune system to serve you better. We are going to talk a lot of mechanistic science,",English
+"a little bit of detail, you'll learn some new language around the immune system; names of the different cell types and so forth, but I promised to make it all very clear,",English
+regardless of your background. We are also going to discuss a lot of tools. And I think many of you are probably here because you want to know what you can do in order to boost,English
+or enhance the function of your immune system. That's a very reasonable question to ask. I want to begin by just acknowledging that if one were,English
+"to put that question into the internet, you would get back a lot of answers. And there is now a sort of generic form of that answer that deserves our respect,",English
+"but is not going to be the topic of conversation today. I just want to tip my hat to it, however, and list off a few of the things that we know",English
+"set us up to be healthier than we would be if we didn't do these things. So the first of course is the foundation of all mental and physical health, which is to get adequate sleep.",English
+"Meaning enough sleep, whatever it is for you that you require, to get deep sleep, so it's got to be of high quality, and to time that sleep correctly.",English
+"Meaning you can't sleep during the day one day, and at night the next day, and expect your system to function well. I've talked a lot about that before on this podcast. You need a relatively consistent sleep schedule",English
+"most of the time, about 80% of the time, or even better would be 90% of the time. But the realities of life make it that we can't always",English
+"go to bed at the same time and wake up at the exact same time. Okay, so we need sleep. We do need sunshine. Why do we need sunshine?",English
+Because it sets our rhythm into a regular state where the genes in all of our cells can be expressed at the correct times.,English
+"We're sort of a factory of cells, if you will, and that factory can only run properly if it knows when certain things should be active and when certain cells should not be active.",English
+"And the best way to coordinate all of those activities of all the cells is to get sunshine in your eyes in the morning and again in the evening,",English
+and not to get too much bright light in your eyes in the middle of the night. That's just foundational. And then any lists that you'll find,English
+"on any number of websites on the internet would say, ""Okay, get good sleep, get sun, get exercise."" How much exercise?",English
+"We should all be getting 150 to 180 minutes of zone two cardio. That's cardiovascular exercise where we can just barely hold a conversation or maybe not, per week.",English
+We should be eating well. We're always told we have to get good nutrition. What good nutrition means to you is going to be different than what it means to somebody else.,English
+"But we acknowledge that food intake and quality of food in particular, avoiding processed foods, that's going to be important.",English
+"Social connection is important. Hydration is important. You're starting to get the picture. We can take all that, acknowledge it as useful",English
+"and foundational for mental and physical health. But of course there are many people who still struggle with getting ill too often,",English
+"or with not being able to heal from physical injuries and wounds, or from various bacterial and viral infections",English
+"quickly enough or deal with chronic disease. And so, today's really about how you can take all of that information, acknowledge it, and follow it. But in addition to that,",English
+there are things that you can do to leverage your nervous system in order to enhance the function of your immune system in very robust ways.,English
+So that's where I'd like to shift the conversation to. The first topic we have to attack is the question of what is the immune system and how does it work?,English
+"I think many of you have heard of antibodies or killer cells or the various organs of the body that are involved in the immune system,",English
+"like the bone marrow, the spleen, the thymus, and the lymph nodes. I'd like to just take a moment and do a sort of brief immune system 101; really simple,",English
+cover the basic elements of the immune system so that everyone listening or watching this can get a clear sense of how the immune system functions,English
+"and what its basic parts are. For some of you, this might be too basic. It might be a little bit of background that you already know.",English
+"I think for most of you, this information will be new. And I promise you, you don't need a biology or medicine background in order to understand this.",English
+It's actually really simple because it is truly elegant in design. You have three main layers of defense for your health.,English
+"These are the three things that are constantly at work to protect you from invasion and illness from bacteria, from viruses, and from parasites.",English
+"And the first of those three is a physical barrier that we call your skin. And that might seem kind of obvious,",English
+but everything about you is contained in this compartment that is boundaried by your skin. And your skin is a very important aspect,English
+"of your immune system. If you've ever had a cut, you essentially have a breach of the boundary that is your immune system,",English
+"and you would notice a number of things would happen. You might get some swelling around that cut. You might get a scab, likely you would get a scab over time.",English
+"If it got dirty, there were some bacteria that got in there, you might see some accumulation of white blood cells, what's called puss. I know it's kind of gross, but that's what that is.",English
+It might take on a yellow tint because of the accumulation of some dead cells there. But basically your skin is the primary barrier,English
+"through which you keep things from the outside that could harm you from getting to the inside. Now, still in category one,",English
+"your body and your external surface, you have openings to that surface, right? You're not just a round or a body shaped",English
+"completely covered up with skin. You have openings, what are those openings? Well, let's start at the top and work our way down. A primary site of potential infection are your eyes.",English
+"You have your ears, you have your nostrils, you have your mouth. Okay, those are going to be the primary sites by which things can get into your system.",English
+"And you need to put things into your system; you need to drink and eat, and you need to get light into your system. That's why you have those openings, but bad things, meaning things that can harm you,",English
+"can get into those systems. And then of course, along the back of your throat, all the way down to your stomach and your digestive system,",English
+"and through your intestines and out your rectum, you have a tube, that you are basically a series of tubes. I've said that before on this podcast,",English
+"and this is one such tube by which you extract nutrients from the outside environment. But all along that tube, including your nose and your mouth, it's lined with mucus.",English
+"And while mucus might seem kind of gross to some of you, the more you learn about mucus, the more you realize that mucus is really, really cool because mucus essentially acts as a filter,",English
+as a trap for bacteria and viruses. And it has certain ways of scrubbing or killing those bacteria and viruses.,English
+"Now, the mucus is constantly being turned over, as we'll talk about later, the chemistry of that mucus is really important in order to make sure that certain things",English
+"don't make it into your system, and other things are allowed to move through your system and you can extract nutrients from them. So the reason I'm talking about this first category",English
+"of barrier for immune system in such detail is I'd like you to envision yourself as a human, of course, but as a human that is a clear entity from everything else.",English
+"And you have to bring in the right things and you have to keep out the wrong things or kill them. Now, inevitably, bacteria, viruses, and parasitic infections are going to make their way",English
+"into our body, but whether or not they are killed off or whether or not they take over and cause us harm is going to be determined by layers two and three.",English
+"So, layers two and three are the so-called innate immune system and the adaptive immune system. So the innate immune system is what I would call",English
+"the second layer of defense. It's very fast. So whether or not it's bacteria, virus, or parasite, what happens when you have something enter your body,",English
+"And I've talked about on this podcast before, very soon after we meet another person, usually within 30 seconds, believe it or not, most people wipe that person's chemicals",English
+"somewhere on their face or on their body's surface. This has been demonstrated over and over again. If you want to learn more about that, we did an episode all about chemical signaling,",English
+"where you can learn about it. I know it sounds weird and you might say, ""I don't do that,"" but indeed you do, most of the time most everybody does. Okay, so, this innate immune system is this rapid response",English
+"when something enters our system and our body doesn't recognize it. It's not food, it's not clean air, it's something that's either a bacteria, virus or parasite.",English
+"And the innate immune system involves the release of particular cells that are waiting dormant, ready to attack whatever this invader is.",English
+"And some of these cell types you've heard of before. The most typical one are the so-called white blood cells. So, the white blood cells will actively go to the site",English
+of invasion and will start to encapsulate or try and surround that given invader. The other names of these different cell types,English
+"are things like neutrophils, macrophages, natural killer cells are just a few of the many types of immune cells. So there's kind of like an ambulance system,",English
+"but rather than go and try and heal something like a paramedic would, they go there and they try and surround and kill whatever this invader is. They work in concert with two other assistants,",English
+"and those assistants are called the compliment proteins. Compliment proteins exist in the blood, and what they do is they travel to sites",English
+"where there's an invasion and they mark certain things for being engulfed and eaten. So they sort of put an ""eat me"" tag on it.",English
+"They basically put a chemical tag onto invaders that then allows those white blood cells, neutrophils, macrophages, natural killer cells to say,",English
+"And I'm using the analogy of the body bag, but in the sense it's the right one rather because these cells that come in and kill things,",English
+"the way they do that is actually to engulf the invading bacteria, virus or parasite. So they actually surround it. And when you see puss or you see infection",English
+"in maybe a cut on the skin or something like that, or even in an ingrown hair that gets some bacteria in it, that puss and the white part,",English
+"I know it's kind of gross to talk about, but those are the white blood cells, oftentimes it's dead cells, and that's the dead invader sitting there.",English
+"So it's trying to create an isolated compartment 'cause it wants to keep it in that part of the body. Okay, so you've got the innate immune system, the compliment comes through blood and helps it",English
+"by tagging certain things with an ""eat me"" signal. And then there are the cells that are either damaged from the injury or from the parasite,",English
+"or are suffering because of the bacteria or the virus itself, and the cells of your body will also release an alarm signal,",English
+"which is not an ""eat me"" signal, but a ""help me"" signal. And those ""help me"" signals come in the form of what we call cytokines. And the cytokines are things like interleukin-1,",English
+"interleukin-6, tumor necrosis factor alpha. You may have heard of these things if you are at all curious about or have been learning about the health space,",English
+"online health space, especially in the last few years, inflammation is all the buzz word now. Everyone's talking about inflammation, inflammation, inflammation.",English
+"What do we mean when we say inflammation? Well, inflammation is a physical response, but it's also a chemical response. And many times the markers of inflammation that are measured",English
+"in people or in animal models where this research is done, are things like interleukin-1, interleukin-6, tumor necrosis factor alpha.",English
+"So when those go up in the blood, it's a sign that somewhere there's a cell that's saying ""help me, help me."" And is secreting these things which calls in",English
+"those neutrophils, macrophages, natural killer cells, and white blood cells, okay? And it might help to remember all this, by just telling people that what interleukin means",English
+"is to communicate, right? So the interleukin is shouting out ""help me,"" the compliment proteins are coming in and saying, ""eat this"" and tagging the invader with an ""eat me"" signal.",English
+"And then the killer cells and the white blood cells are doing the job of trying to kill off that thing. That's the innate immune system. So, your skin and your mucus lining",English
+plus your innate immune system are a beautiful two-layered set of defenses against various kinds of invaders and infections.,English
+"And then there's the third type, which is the adaptive immune system. And you'll notice that leading up until now, I haven't said the word antibody at all,",English
+"and that's because it is the job not of the skin or the mucus or the microbiome or the innate immune system to produce antibodies that can recognize specific invaders,",English
+"but rather it is the job of the adaptive immune system to create antibodies against bacteria, viruses, and even parasites and even physical intruders",English
+"to your system. So, the adaptive immune system has this incredible ability to show up at the site of invasion",English
+"or infection or inflammation. It's called there by various cues, including the cytokines that we talked about earlier. And what it does is it actually attaches to",English
+and creates a sort of an imprint of the shape of whatever invader happens to be there. So if that particular invading bacteria or virus,English
+"has a contour that's kind of rippled or kind of spiky or whatever shape it happens to have, it creates an imprint of that.",English
+"And then, using that imprint in concert with some other cells, creates antibodies that are specific to recognize that invader should the body",English
+"ever have that invader inside of it again. Now, that's why it's called the adaptive immune system. And in many ways it creates a memory of a prior infection",English
+"so that these antibodies can be made anytime that same invader comes back again, all right? And so, this is the basis of what we call immunity.",English
+"This is the basis of what we call an enhanced ability to combat certain types of infections. And it's really a wonderful, and I mean,",English
+"I can't even state how incredible this really is, that all of our bodies have this capacity, right? We have something called leukocytes.",English
+"These are essentially white blood cells. We have red blood cells and white blood cells, and they both are derived from the same type of origin cell.",English
+"It's a stem cell. When you hear stem cell, a stem cell just means a cell that can become many different types of other cells. We sometimes hear about stem cells in terms of people",English
+"that are getting injections of stem cells or the potential therapeutic effects or potential of stem cells. But we all harbor certain stem cells within us as well,",English
+"that can become lots of different cell types. And there's one particular type of stem cell, which is the hematopoietic stem cell, which can give rise to red blood cells",English
+"and white blood cells. And in general, these reside in the marrow, at least in adults. So, in our bone marrow,",English
+"we have this ability to make certain cells that can go out when they are called out chemically, they get called out to sites of infection",English
+"and create antibodies, and then maintain those antibodies in our system, or have a memory of that particular infection so that if the infection comes back again,",English
+"we can kill it off immediately. And it doesn't have to pass through these multiple stages of first, the innate response, then the adaptive response, taking some time.",English
+"Now, there are a lot more details to the adaptive immune system, but I just want to emphasize a few points that might be relevant.",English
+"First of all, the name of the antibodies that are created sometimes come in the form of IgM and IgG, things of that sort.",English
+"This isn't a full deep dive immunology class, but Ig stands for immunoglobulin, okay? So the immunoglobulins are a part of",English
+"the adaptive immune response in creating antibodies. If you hear IgM, the IgM is the first of the adaptive immune responses,",English
+"and it tends to come on earlier. So if somebody is immunopositive for IgM for a particular type of viral or bacterial invader, that means that it was a fairly recent infection.",English
+"Later, one creates... The adaptive immune system, I should say, creates an IgG, which is the more stable form of the specific antibody",English
+"that's going to recognize a given invader. So IgG tends to come up a little bit later. So, just to recap, something gets into your system through your eyes,",English
+"through some hole in your skin, a cut, through your mouth, sexually transmitted diseases come in through the mucus membranes that are on the genitalia",English
+"or in the genitalia, sexually transmitted disease, airborne disease, gets into the mucus, somehow gets into the bloodstream.",English
+"Then there's the innate response, which is a more general response of trying to contain and combat the infection or invader. And then the adaptive response is the one",English
+"that generates the antibodies. First, the IgM response, the immunoglobulin-M response, and then the immunoglobulin-G response, IgG response.",English
+"So, how do we keep these three barriers or these three defense systems to infection tuned up? Well, leaving aside the list of things",English
+"that I mentioned before that generally enhances their function, things like sleep and sunlight and good nutrition, et cetera, the sort of generic things for good health,",English
+"one of the key ways we can do that is to keep that mucus lining in really good shape. And what does that mean? Well, the mucus lining needs to turn over quite often",English
+"and it needs to be the correct chemistry to be a trap for the bad stuff and for it to be permeable to the good stuff, to the nutrients that we need.",English
+"And it is now very clear from hundreds, if not thousands of studies that the best way to do that is to maintain a healthy so-called microbiome.",English
+The microbiome being these little bacterial organisms that are good for us that live all along our mucus pathways and even in our eyes.,English
+"Now, just to be really clear, it's not just about the gut microbiome; we actually have a microbiome in our eyes, we have one that's specific to our mouth,",English
+"we have a nasal specific microbiome, there's one all along the gut and the species of microbiota that live all along the digestive tract",English
+"differ from the mouth, to the throat, to the stomach, intestines, into the rectum. It's well-established that there are healthy microbiota",English
+"that live all along that length, and that they differ along that length. There's also a urethral microbiota, and there's a vaginal microbiota that promotes health",English
+"of that environment as well. So how is it that one can maintain the healthy microbiota and not favor growth of harmful bacteria,",English
+"or allow that mucus lining to become too permeable to the bad stuff that can come in from the environment? Well, as far as we know,",English
+"there are three main ways to do that. The first two are purely structural and mechanical. It's very clear now from work,",English
+"some of which was done at Stanford, but elsewhere as well, that the nasal microbiome is particularly good at scrubbing bacteria,",English
+"at preventing certain types of infections. So, this is a reminder that whenever possible, unless eating or speaking, you want to be nasal breathing,",English
+"not breathing through your mouth. Your nose is a much better filter for viruses and bacteria than is your mouth. The mouth contains certain structural features,",English
+"even organs and cell types that can protect against incoming infection, but you don't want to be a mouth breather",English
+"for a variety of reasons. And there's a terrific book called ""Jaws: A Hidden Epidemic,"" which was written by my colleagues, Sandra Kahn and Paul Ehrlich at Stanford,",English
+and Stanford Medicine with a foreword by Jared Diamond and Robert Sapolsky. So it's really a lot of heavy hitters on that book that talks about the increase in infection,English
+"that one gets when breathing through the mouth, as opposed to the nose. Now, of course, during hard exercise, one breathes through the mouth,",English
+"that's not necessarily bad. When one is eating or speaking, that's not necessarily bad at all. I guess it depends on what you're saying.",English
+"That was a joke. But in general, when possible you want to be breathing through your nose. Many people have trouble breathing through their nose",English
+because of so-called deviated septums or chronically collapsed sinuses. The best way to dilate those sinuses is actually to breathe through your nose.,English
+"So it can take a little bit of time, but there is some plasticity to the sinuses. And so, be a nose breather, not a mouth breather, you will combat more of the infections",English
+"that you are constantly confronted with. I should mention that we are always bombarded with different types of bacteria, viruses, and parasites in our environment.",English
+"And the goal of course, is to reinforce your immune system, so you can keep these things at bay and not get sick. There's actually a paper that was published",English
+"in Cell Reports, ""Cell Press Journal,"" excellent journal that showed that the nasal microbiome, it has particular species of microbiota that are good at fighting off infection.",English
+"There has not been a direct link between particular patterns of nasal breathing and the nasal microbiome yet, but oxygenation of that environment",English
+"by breathing through your nose, turns out to be quite important overall for enhancing it as a filter. So don't just think of your nose as something",English
+to smell foods and to bring in air. It's also an active filter for things that could invade you. The other way to try and keep out bad things,English
+"and to avoid getting sick is the advice that your mother, and certainly my mother gave me, which is to not touch your eyes after touching other people",English
+"or touching other surfaces. And as I mentioned earlier, we tend to do this subconsciously. But the reason to avoid doing that is the eyes",English
+"are a primary entry point for a lot of bacteria and viruses. You're constantly lubricating the surface of your eyes with the so-called lacrimal glands,",English
+"and tears and things of that sort. If you've ever noticed when you wake up in the morning, you have some sleep in your eyes, you know the kind of crusty stuff",English
+"in the corners of your eyes or on your eyelashes, that sleep, that crust are actually dead bacteria that you've successfully battled during the night.",English
+"Okay, that's what that is. It's not the accumulation of some healthy tissue. It's the accumulation of that your healthy mucus membranes and tears and other things that are specifically",English
+"combating those bacteria. So, I know that sounds a little bit gross, but that's what that is. So you're wiping away the casualties of a battle",English
+"that you fought at night. So during the daytime, you don't want to introduce viruses and things to your eyes as much as possible. It is a primary site of entry.",English
+"This is why people wear goggles in surgical units and things of that sort, to try and avoid getting things into their eyes.",English
+"Very, very important. And then the third way to keep a healthy line of defense for your entire mucus tract is to enhance",English
+the proliferation of good gut microbiota. The best way to enhance the quality of your gut microbiome and the mucus lining that serves as this protective layer,English
+"all along your body is to ingest two to four servings a day of fermented foods, low sugar fermented foods. I've talked about this before a bunch of times",English
+"on the podcast, but these are data from my colleague, Justin Sonnenburg's lab at Stanford Med. And there, I just wiped my eyes. Yep, you got me.",English
+"But a paper published in the journal ""Cell,"" which is a absolutely spectacular journal, really points to the fact that when",English
+"people eat fermented foods, two to four servings per day, it helps reduce the activity of certain cytokines. Now, you know what those are, right?",English
+"Cells make cytokines to call out, ""help me, help me."" To reduce the amount of cytokines, the so-called inflammatom.",English
+"Now that doesn't render those cells more vulnerable. The reason they saw a reduction in IL-6 and IL-1, and some of these other cytokines is because when people have a healthy gut microbiome,",English
+"there are fewer cells in the body being infected from outside infections and therefore less of a reason for cells to be crying out, ""help,""",English
+"because they are thriving, not suffering. So, don't wipe your eyes, keep your hands clean, everyone tells you that, right?",English
+"But keep your hands clean, don't wipe your eyes, be a nasal breather, not a mouth breather, unless you're speaking, exercising or eating, and keep a healthy gut microbiome",English
+"by eating two to four servings a day of quality, low sugar, fermented foods, things like sauerkraut, things like natto if you can access that.",English
+"I've tried it before, it's interesting. It's sort of an acquired taste, kimchi, pickles, again, low sugar sources are going to be the sources",English
+"that are going to be most effective for this. So now you're armed with three ways to enhance the function of your immune system and combat infection that is,",English
+"I like to think separate from the typical type of information that you get such as get good sleep, good nutrition, good social connection, et cetera. All of that stuff still holds true,",English
+"but these three other points I think can really make a substantial difference in terms of bolstering the immune system, your immune system.",English
+"I do want to mention, because these names are going to come up several times during this episode, that while interleukins like IL-6 and IL-1",English
+"encourage inflammation, they are these ""help me"" signals that call in cells to gobble up invaders. There are some interleukins that are anti-inflammatory.",English
+"And the one that I'd like to highlight in particular, because it will come up again in a little bit is interleukin-10. So not all of the IL, insert number,",English
+"not all of the interleukins are inflammatory, some are anti-inflammatory. So that's an important point to keep in mind as we go forward.",English
+"Next, I'd like to talk about what's called sickness behavior. And indeed there is a category of behavior that we call sickness behavior that is very informative",English
+"as to the things that we can do to avoid getting sick. Now, this notion of sickness behavior goes back several decades or more.",English
+"And it's a very interesting way of looking at the function of the immune system, because what it does is it bridges us from this thing",English
+"that we're calling the immune system where it's T-cells, and B-cells, and cytokines and leukocytes, and it starts taking us into the realm",English
+"of the nervous system, because of course the nervous system controls behavior. So sickness behavior is a suite of responses that we tend to all undergo when we are feeling sick.",English
+"So this is going to vary from person to person, but there's some general categories of things that we all do and that happen to all of us",English
+"after we are wounded or sick or dealing with an infection of any kind. And by examining sickness behavior in some detail, it can be really informative as to routes",English
+that we can take to health. So the main thing about sickness behavior is that it tends to involve a slowing of our usual levels of activity.,English
+"People start to feel lethargic, or they feel like the activities that previously they could do with relative ease are very difficult for them or somewhat overwhelming.",English
+"The other thing you start to see is that people and animals, by the way, stop grooming, they stop taking care of themselves. Not necessarily stopped showering,",English
+"although oftentimes that's the case, but they will stop doing their hair, they'll stop putting on makeup, depending on whether or not they did that before,",English
+they might stop. Animals will stop licking and grooming themselves. People will stop taking care of their cosmetic appearance. Now it's not just because they don't care,English
+"how they look when they're sick, it's because there's this overall suppression of certain kinds of activities and an enhancement of other kinds of activities.",English
+And this is really important. Sickness behavior is actually a motivated state. It's a state that's designed to accomplish certain things.,English
+"One of the other features of sickness behavior in addition to being lethargic, loss of grooming, will be a loss of appetite, right?",English
+Oftentimes people who have a great appetite normally just won't feel hungry at all. And there are several theories as to why this would be. One prominent idea in the literature is that,English
+"it's to discourage vomiting and diarrhea, which of course can be infectious to other people. So, that's a theory.",English
+"I don't know that that's ever been tested directly, but that's one idea. The other idea is that it's simply to harbor more resources for sake of repair.",English
+And I want to talk about that because we are all told to get extra sleep when we aren't feeling well or to rest. But just like any good two or three-year-old,English
+"constantly asks, ""why, why?"" Good scientists, good people who are interested in health information should always be asking why.",English
+Why should I get more sleep? What happens in sleep that I should get more sleep when I'm sick? Why shouldn't I just push through this? And there are a couple of reasons for this,English
+that have been established in the literature. The first is that there does seem to be something useful about slowing circulation when we are ill.,English
+"One idea that has some data to support it is that when we slow our circulation, our blood circulation, so not running around so much or running it all,",English
+"but rather lying down, getting extra rest, maybe sleeping, maybe even just remaining still, is that the lymphatic system,",English
+"which carries a lot of the immune-related cells and fluids, is able to ramp up its levels of activity. So, this is interesting, right?",English
+"So reducing circulation of the blood, but increasing circulation of the lymphatic system. You've all probably been familiar with the lymphatic system",English
+"when you're combating an infection, your lymph nodes can get sore. You've got lymph nodes behind your ears, in your groin, your armpits, around your throat,",English
+"around near your thyroid, in your throat, et cetera. So, that's the other reason. Now, some people, when they get sick,",English
+"psychologically go into a very vulnerable state where they really, really want people, other people to take care of them.",English
+"You've probably witnessed this, or you feel this way yourself. About 50% of people have that response. They really want to be taken care of.",English
+to the other members of their species to take care of them. And of course this will be especially apparent in cases where people are young enough or incapacitated enough,English
+"that they can't actually get resources on their own. If you've ever been really sick, just getting up and going to the fridge or to the restroom can feel like a monumental task.",English
+So about 50% of people report or describe seeking of help and support when they are sick. But you could also imagine how this would be,English
+a very non-adaptive response because it increases the opportunity to spread infection to the caretaker.,English
+So that's an interesting consideration. Another 50% of people seem to have the opposite response when they're sick.,English
+"So, somehow, regardless of how they were prior to getting ill, the sickness behavior that's engaged by these neural circuits in the brain,",English
+"they are indeed neural circuits in the brain, create a stay away from me. I don't want to be bothered. I want to be left alone.",English
+When he was sick I always knew because he would go around the back of the house and he would just hide there. He would just take himself away from everybody else. He did not want to be taken care of.,English
+"Regardless of what species they are, it's about 50/50. And again, this sickness behavior is a motivated state. It's designed to slow circulation of the blood,",English
+"increase circulation of the lymph, and the other killer cells in the body, reduce the probability of infecting others by reducing,",English
+"that I don't know how it got propagated. You have lots of different pathways in the vagus Usually vagal stimulation actually creates more arousal and alertness, although it does have multiple pathways,",English
+"but there have now been many studies of the vagus in various contexts, including in sickness behavior. And it's very clear that the vagus nerve is the fast pathway",English
+"by which an infection in the body is signaled to the brain, to a particular location in the brain called the hypothalamus, which harbors a lot of different types of neurons.",English
+"Neurons, for instance, in the preoptic area that increase body temperature and fever, right? That's one of the most important things is to increase body temperature,",English
+it's the body's attempt to kill off this invader because many viruses and many bacteria don't survive well at elevated heat.,English
+"That's the function of a fever. A fever actually has a functional role. So, in biology, we like complicated words, so we call anything that increases body temperature",English
+"or creates a fever, a pyrogen. Many years ago, in my undergraduate years, I was working on pyrogens,",English
+"injecting something called lipopolysaccharide into the belly, which then gives you a fever. The way it does that is LPS causes",English
+"an inflammation response in the gut. The gut doesn't know what is happening. The stomach cells don't know what's happening. So they just start secreting the IL-6, the IL-1,",English
+"all those cytokines, the killer cells migrate into the gut. That's why you sometimes get a stomach ache when you don't feel well, you have a flu, or something like it.",English
+"A neural signal, electrical signals get sent up to the hypothalamus. The hypothalamus says, oh, I don't know what's going on out there, but there's a signal something's going on.",English
+Let's just heat up the body. Let's just start cooking whatever it is out there. And of course you don't want fever to go too high because you can kill brain cells.,English
+"But within a particular range the fever is a functional and adaptive response, okay? So if you're taking drugs to try and lower the fever",English
+"that might make you feel more comfortable, but actually that's limiting the response that your body is creating in order to try and kill off that invader. And again, you don't want fever to go too high.",English
+This is going to vary depending on age. You can look up online what the tolerable ranges are for fever. But when you're trying to lower body temperature,English
+"when you have a fever, unless you're heading into dangerous levels of heating up, that's actually the wrong way to take your system if you do indeed want to kill off that invader.",English
+"Okay, so the vagus nerve is the quick response. It also sends input to areas of the brain that change your perception of the outside world.",English
+"One of the most obvious of these, obvious once I tell it to you, is photophobia, right? I love bright sunshine.",English
+"I love bright lights when I want to be alert. We all have different levels of light sensitivity, but most people when they are sick,",English
+"when there's an inflammation response in the body, they feel like bright lights are kind of aversive. They get a well-described kind of classical photophobia,",English
+"and that's mediated by a pathway that goes from your eye to an area of your thalamus, called the anterior nucleus of the thalamus.",English
+"This is work that was done by Clifford Saper at Harvard Medical School. It's really beautiful work. And then from there up to the outer lining of the brain,",English
+which is the meninges just sort of on the outside of the brain where the brain starts to interface with some of the other connective tissues. We'll talk more about these later.,English
+"It can actually create a photophobia and a headache when one is ill. So, here's the pathway: Some invader gets into your system",English
+'cause you wiped your eyes or it got in through your mouth. You didn't listen to your mother and got in through your eyes. You're feeling sick.,English
+"Something's going on there. You have a stomach ache because of all the inflammation there, the signal goes up from your vagus nerve. You're heating up with a fever.",English
+"You've got photophobia because you've activated this pathway by which what would normally be tolerable light is triggering this thalamic nucleus, the anterior thalamus,",English
+"that's projecting up to the meninges. You got a headache in response to looking at light. It's basically triggering an overall pathway to get you to go into a quiet, dark place and rest.",English
+"And the last element I'd like to talk about is the rest. There's something that gets triggered from the body to the brain, to the hypothalamus,",English
+"and we think we know which hypothalamic area it is. It's the supraoptic nucleus, we think. Supraoptic 'cause it's right above your so-called optic chiasm,",English
+"If you want to look up where that is, it's right above the roof of your mouth. And there are nuclei there that promote the desire to sleep even during the daytime, what would normally be",English
+"the active phase of your circadian cycle. Now, that is really interesting because what's happening here is you've got multiple",English
+"pathways that are saying avoid light, reduce your amount of behavior, heat up, all the things that are making you sick.",English
+"This is sickness behavior, and it's going from your body to your mind to make you do the right thing. Now there's also a slow pathway",English
+"that's purely mediated by the blood, so-called humoral factors. Not 'cause they're funny, but humoral factors are factors of the blood.",English
+"As you have an infection for many hours or days, the amount of IL-6 and IL-1 and tumor necrosis factor and other inflammatory cytokines",English
+is starting to increase such that the total amount in your circulation gets high enough and is communicated to the brain.,English
+"And it tends to enter the brain through a particular type of tissue that's really interesting called choroid, C-H-O-R-O-I-D.",English
+"Choroid is really interesting. It's kind of this fluffy tissue that sits in your ventricles. The ventricles are the spaces in your brain,",English
+"and the spaces in your brain have what's called cerebral spinal fluid in them. The cerebral spinal fluid contains a number of important things,",English
+"but the choroid starts releasing and responding to these cytokines, the inflammatory cytokines, and then the brain actually starts to experience",English
+"all sorts of changes in terms of inflammation to neurons, your memory tends to get poor, your cognition tends to get poor.",English
+"These are transient things most often. Eventually these things will pass, but this is deep into sickness when you're really feeling lousy.",English
+"You can't read, you can't watch a movie, you can't do anything. So if you ever get sick and you just can't be bothered by anything, it's probably because you've had that fast response",English
+from the body and you've also had the slower response where you literally have a set of tissues in your brain that are sending out these inflammatory signals.,English
+"And now your whole brain is starting to cope, or is trying to cope with this infection. So you've got a slow pathway and a fast pathway. That all sounds really terrible.",English
+"So, now, I'd like to talk about what you can do to reduce the probability of getting sick. And there are actually things that one can do",English
+"as you start to get sick and once you're sick, to accelerate the healing process by flipping the equation. Up until now we've been talking about how the body",English
+activates certain areas in the brain to create sickness behavior that's very much like depression. You're probably all familiar with this from anytime you've had a cold or a flu or something really lousy,English
+"or an injury. Now, let's flip the equation and ask what can we do with our nervous system in order to enhance",English
+the function of our immune system in order to be able to heal and recover from illness and injury more quickly. So let's say you are in that unfortunate circumstance,English
+"of waking up one day or coming home, and you've got that tickle in your throat, or when you breathe,",English
+your nasal passages don't feel the same way. You've got a little bit of a headache. You're feeling kind of off. We all know what we should do.,English
+"We should all hydrate, drink some water and go to sleep. Right, that's we are all told, but there are actually things that you can actively do",English
+in order to get your immune system to deploy a more robust response at that early phase of potential infection. Let's focus first on the rest component.,English
+"Yes, of course we are all told that we should take a hot shower and go to sleep, and get nine or 10 hours of sleep. But there's an interesting way of looking at sleep,",English
+"specifically for its role in enhancing the immune system. And there's a wonderful review, I'll put the review in the captions that looked specifically",English
+"at the literature surrounding sleep that is different because it occurs in support of the immune system. So normally when we go to sleep,",English
+"we have slow-wave sleep predominantly in the early phase of the night, and then over time as we sleep longer and longer, we get more so-called REM, rapid eye movement sleep.",English
+"I talked all about this on the episodes on sleep. Of course you have slow-wave sleep and REM sleep throughout the night always, but it's the fraction of slow-wave sleep",English
+"to REM sleep that shifts, and they have different functions, et cetera. There is some evidence that the sleep associated with an infection, in particular, early stage of infection,",English
+"is associated with elevated levels of serotonin in the brain that either through an adaptive mechanism or for whatever reason, the neurons in the brain",English
+of the so-called raphe nucleus start releasing more serotonin. And that serotonin and its related pathways can help enhance some of the immune system function,English
+"that could combat the infection. There is starting to be some data, and I emphasize starting because it's not",English
+"a very robust literature yet, looking at whether or not supplementing precursors to serotonin like 5-HTP, which can be taken in a supplement form",English
+or consuming foods that increase serotonin naturally. So these would be any foods that contain high levels of tryptophan.,English
+"You can look up what those are. So, white meat turkey, for instance, certain complex carbohydrates can often be rich with tryptophan.",English
+That consuming those foods can enhance the amount of serotonin that's available in the brain and blood and thereby lead to the particular quality of sleep that allows for more deep healing,English
+"or for when I say deep healing, I mean for a more robust immune response. Now, again, those are still emerging data. What is very clear, however,",English
+"is that during sleep and in particular, during sleep that's associated with the early stage of any kind of viral or bacterial infection, the so-called glymphatic system is much more active",English
+"than it would be normally. What's the glymphatic system? The glymphatic system is actually a relatively recent discovery. I mentioned lymph and the lymphatic system earlier,",English
+"the glymphatic system with a G, is a system in the brain by which debris that accumulates throughout the day, but in particular, debris that accumulates under conditions",English
+"of neuroinflammation and inflammation of the body, is cleared out or is washed out of the brain. And the activity of this glymphatic system",English
+"is extremely important for the recovery from infection of any kind. And it's now becoming clear, is important for recovery",English
+"from traumatic head injury, and maybe even from psychological trauma. So, the glymphatic system can be thought of more or less as a plumbing system that runs through the ventricles,",English
+but also mainly through the lining that sits between the brain and the skull and some of the other tissues and things of that sort.,English
+The choroid is involved as well. Brain imaging reveals the glymphatic system is very active during deep sleep. And there's this kind of wash out of the glymphatic system.,English
+And I am aware of some studies that are ongoing now where augmenting the serotonin system through either supplementation of tryptophan or 5-HTP,English
+"or even serotonin itself, these are laboratory studies, is being looked at for its capacity to increase the amount of circulation in the glymphatic system.",English
+"And the idea is that it might, and I want to underscore might, potentially lead to more rapid recovery from injury and illness and potentially ramp up, if you will,",English
+"the activity of the immune system. So, it essentially is a ramping up of the activity of the immune system. Now, regardless of whether or not you decide to,",English
+"for instance, supplement with 5-HTP before sleep or not, I'll talk about what that might look like in a moment, there is a way that you can increase the activity",English
+"of your glymphatic system under normal circumstances. Because of the mechanics of the glymphatic system, it turns out that if you elevate your heels",English
+"by about 12 degrees, it doesn't have to be exactly 12, as you sleep by putting maybe a rolled pillow or two pillows underneath your feet,",English
+by having the head below your legs. It seems that there's more glymphatic washout or clearance during sleep.,English
+"And this is without taking any compound to adjust the serotonin system. So I would say if you're not feeling well, yes, take the hot shower.",English
+"Yes, get into bed and go to sleep, but elevate your feet to try and increase the activity of the glymphatic system. Some might even consider that if you have to be awake,",English
+"that you might want to be awake with your feet elevated above your head. Now that might not be practical for the workplace, but it might be practical for a short nap during the day",English
+"or something of that sort. The glymphatic system is not just active during sleep. It's also active during certain phases of waking, in particular when we are in a deep state of relaxation.",English
+So as many of you probably know I'm a big proponent of self-hypnosis because of the quality scientific literature on this.,English
+"If you're interested in self-hypnosis, you can go to Reverie, R-E-V-E-R-I.com. Reverie is a cost-free app for Apple and Android that was developed by my colleague, David Spiegel,",English
+"and others at the Stanford University School of Medicine, based on quality studies and peer reviewed data, showing that deep states of relaxation can be used",English
+"to improve pain management, improve transition time to sleep, and a number of other things. You can select the various sort of outcomes",English
+"that you're seeking using Reverie. It's a great thing especially for people that are challenged with meditation could use, because you just listened to the script.",English
+"It involves deep relaxation. I would suggest using that script, or the script for sleep, but with feet elevated to increase activity of the glymphatic system.",English
+"Now, if you do decide that you want to test out this serotonin hypothesis on your own, obviously check with a doctor.",English
+"I'm not a doctor, I'm a professor. So, I'm professing things, not suggesting things, but 5-HTP is a supplement that I've talked about before on this podcast that I actually do not recommend",English
+"for most people for sake of sleep, because it can disrupt the normal architecture of sleep and create a deep sleep early in the night,",English
+and then a spontaneous waking with some trouble to get back to sleep. And that's because of the way that the serotonin system and the melatonin system interact.,English
+"However, under conditions where one is feeling like they might have an infection or an early stage of illness, in that case, 5-HTP might be a useful supplement",English
+in order to access these states of sleep that are not typical. They're not the typical deep sleep that you would achieve when you're feeling healthy.,English
+These are states of sleep that are specifically there in order to try and repair some of the immune system related inflammation that's occurring.,English
+"Not incidentally, increasing serotonin is also one typical approach for the treatment of major depression. This is the basis for things like SSRIs,",English
+"than prescription drug, of course, but will allow more serotonin to be synthesized and/or released.",English
+"Now, for those of you that are interested in learning more about the glymphatic system, it's a fascinating system, and you might want to do a deep dive there",English
+"This is a scientific article. The first author is Jessen is the last name, J-E-S-S-E-N. If you put in ""Jessen, The Glymphatic System:",English
+"A Beginner's Guide,"" you can access the full length manuscript easily online. It'll show up immediately in your search. And in a really interesting way,",English
+"the glymphatic system has now also been tied to the iron deposition system. Earlier we were talking about iron and how,",English
+"of course, getting enough dietary iron is important, but if levels of iron are too high it isn't good for a number of reasons.",English
+"There's a very interesting article that just came out last year called ""Dysfunction of the glymphatic system might be related to iron deposition in the normal aging brain.""",English
+"So, we're starting to see these links between iron levels being too high, the glymphatic system not being active enough and so forth,",English
+"leading to sickness behavior, inflammation, and maybe even damage to neurons associated with aging. We can flip that on its head and say that increasing",English
+"the activity of the glymphatic system, feet elevated during deep sleep, maybe even feet elevated above the head while awake,",English
+"during a nap or doing a Reverie script once a day or something of that sort, could increase the activity of the glymphatic system, lowering iron to a point that's probably below",English
+"the typical intake during periods of infection, perhaps, I should say, can enhance the glymphatic system and vice versa.",English
+And then you've got this specialized sleep that's related to sickness behavior that seems to have heightened levels of serotonin,English
+"that increase serotonin unless it's prescribed to you for depression or something, but not doing by supplement with tryptophan or 5-HTP on a regular basis, but only under conditions",English
+"the glymphatic and the serotonin system. What about the take a hot shower part? Is that good advice? Well, it turns out it is,",English
+which is kind of nice. This involves taking athletes and non-athletes and exposing them to sauna.,English
+"It wasn't particularly hot. It was 96 degrees, which isn't cool, but it's not really hot. Nowadays you hear about people doing very, very hot sauna.",English
+"The humidity of the sauna, if you want to know, is 15 plus or minus 3%. But basically what they found was that just one 15 minutes sauna session could really increase",English
+white blood cell profiles and could adjust cortisol levels in ways that were beneficial for combating infection. And now there are many other studies like this.,English
+"to the episodes on temperature, what you probably know is that when you get into a sauna or any kind of hot environment, your body is also going to be actively",English
+"pushing to cool itself off. So, there's probably an increase in heat, there is an increase in heating, but then afterwards your body will cool off,",English
+"maybe even with a dip below baseline. I do want to provide a cautionary note that if you are already running a fever, getting into a sauna could take your body temperature",English
+So this is kind of a ramping up or a super protocol of the typical advice of take a hot shower and get into bed. That is good advice.,English
+"Now we're talking about a hot sauna, probably showering off and then getting into bed, maybe augmenting serotonin.",English
+"I know many people don't have access to sauna. So, in that case, a very hot bath or shower, don't scald yourself, of course, but as hot as you can comfortably tolerate",English
+or right at that edge of what you can tolerate would be a good idea. Some people I've heard are creating saunas in their bathrooms by running hot water,English
+"and creating a ton of steam. Anything that really heats you up, but not to dangerously high levels is going to be beneficial.",English
+"If you have access to a sauna, terrific. This again was only 15 minutes. They'd had a cool off session.",English
+"However, if you are interested in maximizing the effects of sauna, it is clear that a cool off period is important. So it's not that a 15 minute sauna is good,",English
+"the areas of the hypothalamus, that is, that generate increases in body heat, the activation of those neurons occurs as you heat up and then were you to just stay in that heated environment,",English
+"of these cortisol lowering and white cell stimulating signals to the body. Some of you have probably heard the phrase,",English
+"And we can speculate that the reason that phrase, ""feed a fever, starve a cold"" came to be is because of the adaptive function of fever,",English
+"that increases in body temperature make it challenging for intruding viruses and bacteria to survive. Even though, of course, highly elevated body temperatures",English
+"pose a danger to the host organism, to you. Feeding, eating does cause an increase in body temperature through the so-called thermogenic effect of food.",English
+"So I can understand the logic of feed a fever. It would mean that when you have a fever, it's your body's natural attempt to heat up",English
+"and kill some invading thing. And by eating, you would further increase your body temperature. Why you would want to starve a cold, I don't know, however.",English
+"Maybe it's because when your nasal passages are congested, it's uncomfortable to eat or something of that sort. So the feet of fever part makes sense to me,",English
+the starve a cold part is still mysterious to me. I couldn't find any logical reason why that would be good. There are communities out there that believe that fasting,English
+"is a viable way to combat certain types of infection. Fasting, in particular, prolonged fasts, do increase the amount of adrenaline,",English
+"also called epinephrin, in the brain and body. And as we'll next explain, epinephrin, adrenaline does have a powerful effect on",English
+"the various inflammatory cytokines and on the immune system in general. So, let's talk about a behavioral protocol that anyone can use; it doesn't involve any equipment,",English
+"you don't need a sauna, you don't need anything at all, that has been demonstrated in excellent peer reviewed research to enhance the function of the immune system",English
+"and actually allow people to combat infection in very dramatic ways. Next, I'd like to do an in-depth analysis of a study",English
+"that has achieved some prominence out there, not just in the scientific literature, but on the internet, because it relates to how particular types of breathing",English
+"can impact the immune system and the ability to combat infection. The title of this paper is ""Voluntary activation of the sympathetic nervous system",English
+"and attenuation of the innate immune response in humans."" This is a paper that was published in PNAS, which is the Proceedings of the National Academy",English
+"of Sciences, USA. It's a very prestigious journal. For those of you that know PNAS, you know that there are certain papers published in PNAS,",English
+"or there used to be that were not peer reviewed. In recent years, I think all of them have moved to peer reviewed papers. So this is a peer reviewed, very high quality study.",English
+"And I just want to describe the basic contour of the study. I'll explain the findings, and then I want to go in-depth and explain the mechanistic basis for these findings",English
+"and the protocol that we can all export from these findings. So, here we go. First of all, a couple of terms so that everybody",English
+is on the same page. The sympathetic nervous system is one division of our nervous system. It's a set of neurons down the middle of our spinal cord,English
+and in our brain that generally lead to a heightened state of arousal and alertness. It's associated with epinephrin release in the brain,English
+"and adrenaline release in the body. It's the so-called fight or flight system when it's really active, but it's the system that's active when we are wide awake.",English
+"And we already talked about the innate immune system. That's that first line of defense after the skin barrier, of course, whereby some infection comes into the body",English
+"and there's this rapid response of increasing inflammation. And that's also about the time that you first feel lousy. So when you start to feel like,",English
+"""ugh, I think I've got something. I don't feel right, a headache. I feel nauseous. I'm heating up. I don't feel good.""",English
+"That's the innate immune system kicking in. So what they did in this study, and by the way, I should say they,",English
+"this first author is Kox, K-O-X, last author, last name Pickkers, P-I-C-K-K-E-R-S. What they did was they exposed human subjects",English
+"to an endotoxin. In other words, they injected people with E. coli, which is a bacteria which makes people,",English
+"all people feel terrible. Makes you nauseous, fever, vomiting, diarrhea, it's very unpleasant, okay? These people voluntarily signed up for this study.",English
+"However, some of the subjects in this study performed a behavioral protocol that can best be described as cyclic hyperventilation.",English
+"My lab works on these types of breathing protocols. This is not work that my lab did, but basically subjects hyperventilate, followed by breath retention, by breath holds,",English
+"and I'll explain exactly what they did. They also looked at other forms of behavioral protocols, but let's focus on that one. So, they're comparing controls that do just sort",English
+"of a basic meditation versus people that do this intense breathing followed by some breath holds. I'm just paraphrasing here, in the intervention group,",English
+"the breathing group, plasma levels of anti-inflammatory cytokine IL-10, so this is a cytokine that is lowers inflammation, increased after endotoxin administration.",English
+"And that was triggered by an increase in epinephrin and adrenaline. So, in other words, doing a particular pattern of breathing allowed",English
+"an anti-inflammatory cytokine to be turned on, whereas that was not the case in the subjects that did not do this particular breathing protocol.",English
+"And they discovered that levels of proinflammatory TNF-alpha, tumor necrosis factor alpha, IL-6, interleukin-6 and interleukin-8,",English
+"which you should all be familiar with now, as proinflammatory cytokines were lower in the intervention group. Whereas these IL-10 levels",English
+"that are anti-inflammatory went up. Finally, flu-like symptoms were lower in the intervention group. So this is an amazing finding, right?",English
+These are human subjects. One group of subjects is doing this breathing protocol. The other group of subjects is just meditating. Both sets of subjects have been injected with E. coli.,English
+"So, you know everyone's getting the same amount placed into their system. This is very, very interesting.",English
+"And it leads to the question that every good scientist, two year old or health information seeker asks, which is why?",English
+"How? How in the world does this work? Why does this work? Well to make a long story shortish, because I am going to go into depth here,",English
+"the reason it works is because the sympathetic nervous system, the so-called stress part of our nervous system, it's not really called that,",English
+"but the part of our nervous system that triggers stress from mild stress, to severe stress, even to panic, causes the release of adrenaline and epinephrin",English
+"in the brain and body. And under normal circumstances, when we have some sort of invading infection, our body is able to push back on that,",English
+"to resist it by engaging the stress response. So what's happening here is there's a behavioral protocol involving the nervous system, 'cause all behaviors",English
+"are generated from the nervous system of course. A behavioral protocol that people are deliberately employing that allows them to activate the sympathetic nervous system,",English
+which in turn allows them to activate the normal pathways by which immune system function is enhanced. Okay?,English
+"Now, the reason I'm underscoring this is that the common interpretation of this study is that somehow it blocks the normal immune response,",English
+"but that's not really what's happening here. Yes, there's a reduction in inflammatory cytokines and there's an increase in anti-inflammatory cytokines,",English
+"but that's not really the same thing as blocking the immune response. This could just as easily be viewed as enhancing the immune response and combating the intruder,",English
+"in this case, E. coli. So, let's parse this study a little bit more closely. First of all, what is this magical pattern of breathing?",English
+"Some of you may recognize this as so-called Wim Hof breathing. Wim, of course the Dutchman. I think his occupation online used to be",English
+"listed as daredevil, believe it or not, on Wikipedia. That's a pretty cool occupation. Wim is best known for his activities with cold exposure,",English
+"he holds multiple world records for that, swimming under icebergs and other incredible feats, that you definitely don't want to try unless",English
+"you're extremely skilled and really know what you're doing, as he does, but also for the use of breath work. The breathing that is so-called Wim Hof breathing",English
+"is very similar, not exactly the same, but very similar to Tummo breathing, as it's been described historically. In the science and physiology community",English
+"and in my laboratory, 'cause I run a university laboratory, we refer to it as cyclic hyperventilation, which just means repeated deep breaths in and out.",English
+"And then there are these retentions. So, because I'm here in the hot seat anyway, I might as well demonstrate it for you so you know what this looks like.",English
+"There are variations on this, so with respect to Wim, with respect to Tummo practitioners, with respect to the cyclic hyperventilators everywhere,",English
+"this is one general theme of it. It involves 20 to 30 deep inhales and then exhales through the mouth,",English
+"followed by a exhale of all one's air and a breath hold, that's the retention. And then at some point, 15 to 60 seconds later,",English
+"repeating the 25 or 30 breaths. And then again, a breath hold with lungs empty. There are variations on this,",English
+"but in our laboratory and in this particular study, it looks something like this. Okay, I'm not going to do the whole thing right now,",English
+"but it goes something like this. [Andrew deeply breathing] Okay, so let's assume I did that for 30 breaths.",English
+"I can already feel myself perspiring a little bit. You're heating up, that's the release of adrenaline. It's caused by that breathing pattern, and then exhaling all of one's air,",English
+no speaking in between like I'm doing. [Andrew deeply exhaling] And then sitting lungs empty until one feels the impulse,English
+"to breathe and then repeating for several rounds, two or three or even four rounds. Now some people will also introduce a big inhale and breath hold at the end",English
+and find that indeed they can hold their breath much longer than they normally would be able to. Because the trigger to breathe is normally activated,English
+"by increases in carbon dioxide in our blood. We have neurons in our brain stem and in our various regions of our brain, actually,",English
+"that respond to when carbon dioxide is too high and trigger the reflex to breathe. But when we exhale deeply, we blow off a lot of carbon dioxide",English
+"so we don't feel that impulse to breathe come quite as soon. Basically this study looked at people doing these cyclic hyperventilation with retention,",English
+"25 or 30 breaths, then the retention, 25 or 30 breaths, then retention, 25 or 30 breaths, then the retention. So, three rounds of 25 to 30 breaths followed by exhale,",English
+"hold in between of various duration. But in general, 15 to 60 seconds is typical. What happened physiologically?",English
+"This is one of the reasons I like this study. What happened physiologically? Well, a couple of things. Of course, blood oxygenation drops.",English
+"You would expect that based on hyperventilation and especially based on the exhale of so much carbon dioxide. We could explain why that is,",English
+"If you look up this paper, you can look at Figure One, Panel C, the pH goes way up. People become alkaline. You've heard before of alkaline water.",English
+"I hate to say this, I'll probably lose some friends for this, but yeah, don't waste your money on drinking alkaline water. You can't really shift the alkalinity of your body.",English
+"There are cases where some compartment in your body needs to be more alkaline than the rest. Your gut is a different alkalinity than other areas of your body, et cetera, but ingesting high alkaline water",English
+isn't going to shift your overall alkalinity. If someone can send me a quality reference that shows different than I'm happy to revise that statement.,English
+"But in any case, doing that pattern of breathing that I just described greatly increases the pH. Greatly, I should say, it doesn't send it off",English
+"into dangerous levels. It takes it from 7.4 to 7.6, which is a significant increase in alkalinity. So, as pH levels, for those you remember high school",English
+"or college chemistry, as the numbers on the pH go down, you're becoming more acidic, as they go up, you're becoming more alkaline,",English
+"okay or more basic. So, these subjects went from 7.4 to 7.6 during the breathing, and then afterwards it returned to normal.",English
+"But that shift in alkalinity is thought to be important here. So, what's going on here? How is the breathing leading to the shifts in...",English
+Or I should say reduction in inflammatory cytokines and an increase in the liberation of these anti-inflammatory cytokines.,English
+"Well, the authors make some good arguments as to why it's not the shift in pH per se, or the shift in carbon dioxide levels in the blood,",English
+"but rather it's the release of epinephrin. And there's some good reason to believe why that's the case. It's beyond the scope of this discussion,",English
+"but that it's actually the release of epinephrin, AKA adrenaline, that's causing this reduction in inflammation.",English
+"And that's actually supported by something that you've probably experienced before, which is if you've ever worked, worked, worked, worked,",English
+"worked really hard, or you've been a caretaker for somebody else or studying for exams, and people around you are getting sick and you're just powering through it",English
+"and you're not getting sick, but then you stop, you turn in your final exam, you stopped taking care of somebody else, or you finally stop and rest or you go on vacation,",English
+"and then you get sick. Well, you've just experienced the effect that adrenaline, epinephrin can have in activating your immune system",English
+"by way of the nervous system, in order to keep fighting and combating infection. And that brings us to a larger theme,",English
+which is that stress and combating infection or a wound is not one unique system. It's the same stress system that you use,English
+"to combat psychological stress. So when you're very, very stressed, at least in the short term, because you release so much adrenaline and epinephrin,",English
+"you're actually better able to combat infections and you reduce inflammation and the whole feeling lousy response, right? Remember reduced flu-like symptoms here.",English
+"So this pattern of breathing is actually a very useful tool. And I confess, I use this pattern of breathing anytime I am at the initial stages of getting some sort of bug.",English
+"If I feel like I've been running myself ragged, or if I somehow, for whatever reason, have a tickle in my throat, or I have that kind of sensation in my nose,",English
+"like I might've caught a bug of some sort, I will do this pattern of breathing. I've been doing it consistently,",English
+"gosh, for the last four years or more. Now this is just anecdotal reports, but I find that it allows me indeed to either",English
+"exposure to infections. Obviously you don't want to infect other people, nor do you want to crash and suddenly get a massive illness of some sort because you stopped doing this breathing.",English
+"But I do think it's a useful tool. It's a purely behavioral intervention that has been shown here and now there are additional studies on the way,",English
+"to enhance the function of your immune system and to reduce inflammation. And this is to me, one of the most concrete examples",English
+of a zero cost tool that bridges the activation of the nervous system through breathing with the immune system by way of releasing adrenaline,English
+"and thereby reducing the terrible effects or feelings of lousiness from, in this case, an E. coli infection.",English
+"Now, I'd like to focus on a couple of important points that I haven't heard discussed broadly elsewhere, which is that the hyperventilation",English
+and the breath retention are both important. So you can't simply hyperventilate to get this effect at the level of epinephrin release,English
+"and reduction in inflammatory cytokines. It's been shown before that the hyperventilation phase and the hypoxia, which is a low oxygen saturation",English
+"due to the breath retention, they both combine to increase epinephrin adrenaline levels. So, you have to do the 25 or 30 breaths,",English
+"and then the retention. 25 or 30 breaths then the retention, meaning that the exhale with the breath hold, in order to get the full effect.",English
+with breath hold retentions in between was the ideal protocol. There's one last very interesting feature of this study that I want to emphasize.,English
+"And that was that they actually measured the so-called catecholamine concentrations. Catecholamines are things like dopamine, epinephrin, norepinephrine.",English
+"These are chemicals in your nervous system and body that promote states of alertness, dopamine, of course, part of the reward and motivation pathways.",English
+"They explored the levels of these molecules in blood, in plasma during and after this breathing protocol. And it was interesting, as I mentioned before,",English
+"epinephrin showed robust increases compared to the control group, norepinephrine, significant increases occurred in the breathing group,",English
+"in the cyclic hyperventilation retention breathing group, of course, but less so. And dopamine levels actually dropped somewhat.",English
+"But this is very interesting because there's a new and emerging literature largely from Asya, A-Y-S-A Rolls' lab in Israel.",English
+What her laboratory has shown is that motivational state and mindset has a powerful impact on various aspects,English
+"at the very beginning of this episode, which is that 20, 30 years ago, the idea that you could heal the body with the mind was considered kind of quackery.",English
+"I think that there was an intervening period up until now where people might've said, ""sure, if you're stressed out, it's going to make things worse.""",English
+"I mean, I think everyone agrees that stress makes every thing worse at some level, outcomes to neurodegeneration, performance in a physical endeavors and mental endeavors.",English
+"If stress is too high for too long people experience different challenges and essentially every major psychiatric disorder,",English
+"everything suffers, but in the short term, stress can actually be beneficial in the ways that we just described. And stress, if we break it down",English
+"is really a neurochemical state, right? It's the release of these catacholamines. And what Asya Rolls' laboratory has shown",English
+"is that when the so-called dopamine system and at several episodes, I described there are multiple dopamine systems, but the so-called mesolimbic reward pathway",English
+"involving areas like the nucleus accumbens, et cetera. When the reward system that's associated with dopamine and norepinephrine is activated,",English
+"you see incredible effects, including for instance, highly significant reduction in tumor size in cancers. Now, why would that be?",English
+"How is it that mindset, dopamine and tumors, and tumor growth are somehow linked? We now know how this occurs largely through",English
+"the incredible work of Asya Rolls and others. So, now I'd like to turn our focus to how it is specifically that certain mindsets impact the immune system",English
+in ways that we can actually point to specific biological pathways and also specific protocols related to mindset. I guess a simple way to frame all this would be to say,English
+"that most of us are aware that yes, indeed, you can worry yourself sick. We've been told that, you're going to worry yourself sick. And actually there was a paper published in ""Science,""",English
+"again, one of the top three journals out there, the top three really being ""Nature,"" ""Science,"" and ""Cell."" And then other of course, excellent journals exist,",English
+"but this was a paper that came out in ""Science"" last year. First author is Kataoka, K-A-T-A-O-K-A, describing psychogenic stress and fever.",English
+"And they discovered a new pathway and they were able to both activate this pathway independent of worry and stress and see illness occur,",English
+"and they were able to inhibit this pathway, block activity in this neural pathway and prevent psychogenic fever and the worrying of oneself sick.",English
+"So, they were able to do this in a very controlled way. I'll just mention the pathway in case you want to look it up in more detail.",English
+"This is a corticolimbic pathway. So, just to orient us, the cortex is more or less the outer shell of the brain.",English
+It's involved in thinking and sensation and perceptions and learning and maintenance of a lot of memories are stored there.,English
+"We all hear that you learn and remember in the hippocampus, that's the initial site of learning and memory, but then that information, believe it or not,",English
+is passed off to the cortex where it's stored in kind of a long-term hard drive type storage. So the corticolimbic pathway is one in which,English
+"your thoughts, your prior experiences can literally in a structure way, feed down onto the areas of the brain that control very basal processes,",English
+including temperature regulation. So this is a corticolimbic hypothalamic pathway. We talked earlier about the hypothalamus as controlling temperature and a lot of sickness,English
+"related behavior, right? Remember vagus up to the hypothalamus and all the sleep more, less appetite, fever. Okay, that's all in the hypothalamus.",English
+"This is a top-down corticolimbic hypothalamic pathway, and it has a fancy name. It's the dorsal peduncular cortex, dorsal tinea tecta.",English
+"The short of that is the DP/DTT. Let's just call it the DP/DTT, to the dorsomedial hypothalamus. A lot of D's.",English
+It shouldn't mean anything. It doesn't really matter what we call it. But what's important is conceptually it's a pathway that originates insights to the brain,English
+"that are associated with thinking, with emotion and with prior history, and feeds directly into an area of the brain that's involved in basic physiological",English
+"subconsciously controlled processes. So, that's incredible, right? And it points to a physical pathway by which the way we think about something changes something core",English
+"about our physiology. Now, in some ways that shouldn't be surprising, right? If you think about something that excites you, your heart rate can increase.",English
+"You think about something that terrifies you, your heart rate can increase. So the idea that thinking controls our physiology is not a new concept at all, but somehow human beings,",English
+we have been challenged with the idea that we could actually think ourselves into being sick. But this paper from Kataoka shows that if you expose,English
+"somebody to a psychological stress, you can actually activate this pathway and create a fever. And how do they do that?",English
+"Well, you can do this by exposing subjects to a very stressful real event, and you cue it through our associative learning.",English
+"Then you take away the horrible experience, you give me the PILOT V5, and I start to experience a lot of the symptoms associated with that terrible event.",English
+"They were able to do this using sickness inducing stimuli and so forth. They did all the various derivations and identified this pathway that when activated,",English
+"even in the absence of some horrible event, could create fever and illness-like behavior and so forth. And if they blocked certain stations",English
+"along this neural pathway, they could block that effect. So this is really concrete evidence, proof, if you will, that there are dedicated pathways in the mammalian brain,",English
+"your brain and mine, that allow us to turn thoughts into illness. That's kind of a depressing idea. What about the inverse?",English
+"What about turning thoughts into health? Well, that's the work of Asya Rolls. They explored the well-established psychological phenomenon",English
+"that when cancer patients or very ill people or people who are suffering from very debilitating injuries, when people had a reported a sense of hope,",English
+"their rates of recovery were much higher, right? Sounds very subjective. But what is a sense of hope?",English
+"A sense of hope is a sense of the future. A sense of the future is tightly associated with the dopamine system. Dopamine, again, being this molecule of reward",English
+"and motivation and movement, but movement and motivation are about things that are beyond the confines of our skin and are about the future.",English
+"And so what they've discovered and through other studies from other groups have discovered is that stimulation of the dopamine pathway,",English
+"either simply by thinking about a future, ideally a positive future, but thinking about a positive future leads to activation",English
+"of the so-called mesolimbic reward pathway and could reduce the size of tumors, could accelerate wound healing, could greatly accelerate the passage from a state of illness",English
+"to a state of health and wellbeing. So there are many, many studies now starting to wick out related to this.",English
+"There's also the idea that augmenting the dopamine system can increase the rate of healing. And so, there are individuals out there who opt,",English
+"for instance, to take things that increase dopamine. Now, obviously drugs of abuse would not be a good idea in this context, even though they increase dopamine,",English
+"they lead to big crashes, they have addictive properties, et cetera. I've talked before on this podcast about things like L-tyrosine, taking anywhere from 500 to 750 milligrams",English
+"can increase dopamine because tyrosine is a dopamine precursor, of course. Things like Mucuna pruriens, which are L-dopa, the immediate precursor to dopamine.",English
+"Some of these will lead to somewhat of a crash in certain individuals. Other people tolerate them a little bit better. Again, you have to talk to your doctor,",English
+"you have to figure out what's right for you. If you have bipolar or mania or schizophrenia, these things, I would not recommend them at all. I'm not recommending them at all,",English
+"I'm just mentioning them for potential exploration if it's safe and right for you. But the point is this: the dopamine system, when activated can accelerate healing,",English
+it can accelerate the recovery from injury of all kinds. And that shouldn't come as a mystery or surprise result to us.,English
+It's because this reward pathway and the fact that it's related to a sense of the future seems to liberate entire systems within the body,English
+"that make inflammatory cytokines go down, and anti-inflammatory cytokines go up. Exactly as was demonstrated in the beautiful PNAS study",English
+"where breathing, cyclic hyperventilation, was used to increase epinephrin, increase norepinephrine, and to augment the catecholamine system.",English
+"So, I think that the bridges between these studies are really relevant. In one case, I'm talking about potentially taking an over-the-counter compound to increase dopamine",English
+"to accelerate healing. In another case, we're talking about using breathing. There's also the use of cold water exposure to increase dopamine.",English
+"I talked about this several episodes ago, but it's been shown that immersing oneself in cold water up to the neck or so. How cold?",English
+"Well, it depends on what you can tolerate, but uncomfortably cold, but not so cold that you become hypothermic, but where it's challenging to get in,",English
+"but you can stay there for three to 10 minutes or so, has been shown to lead to very significant, up to doubling or more of baseline dopamine levels",English
+and epinephrin levels that go on for several hours. This may be the basis for why people will do cold showers or ice baths and then get into a sauna.,English
+"So, what's called cold-heat contrast therapy, as a way to augment these neurotransmitters. Today, we've been talking about how these neurotransmitters",English
+"can be used to enhance the function of the immune system. And so just keep in mind that anytime you're talking about increasing neurotransmitter levels,",English
+"that can be done pharmacologically through supplementation, or the can be done behaviorally through exposure to cold water, for instance,",English
+"or it can be done even just simply by breathing in a particular way, cyclic hyperventilation followed by retention. The catacholamines, noradrenaline, dopamine,",English
+and norepinephrine are the bridge of activation for the immune system and the nervous system. They are the way that the nervous system calls out,English
+"to the immune system, ""Aha, we have a problem. We need to counter this."" So you can think of them, them meaning dopamine,",English
+"epinephrine, and norepinephrine, as being able to deploy larger amounts of immune cells, all the types of immune cells that we talked about",English
+"at the beginning of the episode. Okay, so thus far, we've been discussing how one can prevent getting sick or when one starts to feel ill,",English
+how one might be able to shorten the course of that infection by ramping up the activity of the immune system. But what about when you're already experiencing symptoms?,English
+"The runny nose, stuffed up nose, congestion, headache, et cetera. Well, there are many ways to address that",English
+"at the symptom level. You're probably aware of all the over the counter medications, many of which focus on the epinephrin system.",English
+"Things that are of the Sudafed variety prevent or reduce congestion because of the way that they cause release of epinephrin,",English
+and some of the effects on dilating the bronchioles and dilating the nasal passages and so forth. I'm not going to speak to whether or not,English
+"those are good or bad choices. They do have a couple of effects that are not so great for the course of treating the underlying cause, which are first of all they can cause dehydration.",English
+"So you have to make sure that you're hydrating well, both fluids and electrolytes, and they also can interfere with sleep because as I've talked about in the episodes on sleep,",English
+"one of the hallmarks of deep sleep and in particular REM sleep is that epinephrin, adrenaline levels are low. This is what allows you to have intense,",English
+"often very emotionally-laden dreams during REM sleep and not act those out. And low adrenaline, epinephrin during REM sleep",English
+"is basically a signature, a neurochemical signature of the REM sleep state, which is so vital for emotional and physical repair and so forth.",English
+"So, the fact that they can inhibit sleep, the fact that can cause dehydration, the fact that they can make people feel kind of lightheaded and jittery makes them not terrific choices",English
+"which is actually a form of algae. Years ago, I think when I first heard about spirulina, it sounded very much of the kind of 1970s,",English
+"80s health food store variety. It seemed really kind of mystical and wacky, but actually now there are some really nice studies and some data, and also an understanding of the mechanism",English
+"by which spirulina can have potent effects in reducing what's called rhinitis, which is a fancy word for congestion of the nose",English
+"and an inflammation of the nose. Basically, anytime you hear a word that includes ""itis,"" at least if it's in the medical or health context,",English
+"it generally means inflammation of some tissue. So rhinitis just being inflammation of the nasal passages, but that's one of the most uncomfortable symptoms",English
+of any kind of infection. So there are two studies I'd like to highlight just very quickly. One is the effects of spirulina on allergic rhinitis.,English
+"And the other is a clinical comparison to the efficacy of spirulina platensis, that's a technical name, and cetirizine for the treatment of allergic rhinitis.",English
+"These looked at humans, so this is not a mouse study, this is a study on humans. Both sexes, so males and females.",English
+"In one case, looking at 100 plus subjects, 129 subjects. The other, 65 subjects, so decent number of subjects, randomized trial, double blind.",English
+"Both cases saw significant decreases in nasal obstruction, improved ability to smell, improved sleep, daily working inflammatory cytokines were reduced as well,",English
+"reduction in nasal itching, all the stuff that you'd like to experience, I can imagine, after taking two grams, two grams, not milligrams, but two grams of spirulina.",English
+"Sometimes had to be taken for a short while before the effect kicked in. So, that's pretty impressive, I would say, but it doesn't really speak to mechanism,",English
+"but in exploring the underlying mechanisms for spirulina's effects on reducing rhinitis, it's interesting to find that spirulina actually can inhibit",English
+"the formation and/or activity of so-called histaminergic mast cells, M-A-S-T, mast cells. We haven't talked a lot about mast cells,",English
+"but they are a very interesting cell type in the immune response. Essentially what they are, are little packets of histamine. And when we have some sort of injury or irritant rather",English
+"to the skin, so a mosquito bite, for instance, or poison oak or poison ivy, something that causes an itch",English
+"or something that causes inflammation internally, doesn't just have to be on the skin, these mast are these little bubbles that contain histamine that go to that site [hissing],",English
+and release their histaminergic contents and cause swelling and inflammation of whatever cells are affected locally.,English
+"You might think, well, why would I want to have a mechanism in my body that would cause swelling and inflammation? Ah, well then those cells in turn send out cytokine signals that recruit the very cell types that we were talking about",English
+"way back at the beginning of the episode, the cells that are characteristics of the innate immune system that come in, the macrophages and the other types of cells",English
+"that will come in and gobble up the foreign invaders or will help sequester and move away, say the poison from a bite or from whatever irritant.",English
+"Again, it doesn't just have to be at the skin surface. I'm describing an example of at the skin, for instance, if you've ever had hives of any kind,",English
+"that almost certainly involved mast cells. So, and when you take an anti-histamine in order to deal with seasonal allergies, for instance,",English
+you're taking a compound that's reducing histamines in mast cells. And spirulina has also been used quite effectively as a way to treat seasonal allergies and some of the symptomatology.,English
+"Equally on par with some of the major prescription and over the counter drugs for that. One cautionary note, spirulina can carry some side effects",English
+for people that have a genetic mutation leading to something called PKU. These people know who they are. They're very sensitive to phenylalanine.,English
+"These same people cannot drink any sort of NutraSweet or diet soda for reasons that they understand. It can be quite dangerous. It's a rare genetic disorder, but nonetheless,",English
+"spirulina can be an issue for those people. For most people, the side effect profile is pretty minimal. And just to be clear, I don't have any relationship",English
+"to spirulina company or anything. I just find it interesting that there are these compounds that sound rather, forgive the phrase, but rather new-agey because they come from",English
+"a algae, from a plant. But when you look at the underlying mechanism, it makes perfect sense. So that's often what we like to point out here",English
+"is that if there are these so-called alternative therapies, alternative because most people haven't heard of them, it's always nice if they map to a specific logical mechanism",English
+"correlates with what we saw in the RNA, again, with about a 50% reduction. What about in vivo? Fortunately for us, William Yang made an HD mouse model that contains a full length",English
+"human gene with an expanded polyglutamine repeat, and it turns out this particular allele also has many of the SNPs that we were interested in assessing. And so we took our candidate",English
+guides and Cas 9 and packaged into recombinant RNA viruses and injected into one side of the mouse brain and then compared the level of editing on the treated side of the brain,English
+compared to the untreated side. What I'm showing in this first panel here on the lower left is editing as evidence by the in the splicing assay you can see that the right striatum,English
+"injected with the virus, you can see a very obvious editing here, whereas we're not seeing that in the left striatum, and tail DNA which the virus does not travel you can see as a",English
+"negative control. The consequence of this was a 50% reduction in the levels of human Huntington mRNA from this single infusion into the right striatum, so this is very encouraging.",English
+"So this data and additional data that I didn't present here show, I think very effectively, that you can take cells that expressing both the normal and mutant protein, selectively",English
+edit the mutant protein to give you a cell that now only contains normal Huntington. And we know from others' work that 50% of normal Huntington is well tolerated in the,English
+"brain and will not cause any deleterious sequence of events down the road. So this would be an ideal situation. But where are we going to where are we going to go with this? So,",English
+"there are several things that I want to spend the rest of seminar on showing you, how we're kind of thinking about advancing this into the clinic. One is to improve AAV targeting.",English
+"I'll talk about that in a minute. The other is phasing of this SNPs, the highly prevalent single nucleotide polymorphisms on the mutant versus the normal alleles. And I'm not going",English
+"to have time to show you that data today. And the other is improving the safety of AAV delivered editing machinery. Why do we think that's important? Well, cas9 is a bacterial",English
+protein. It's not a human protein. We only need to edit for a short period of time. We don't need it on forever. And so it would be ideal if we had a pulsive editing that,English
+then waned and then essentially the AAV machinery would be silent in cells when we didn't need it anymore. So how are we going to achieve that? I'm going to kind of step back and tell,English
+"you how we got to being able to do regulated editing. So, for this, I want to introduce you, for those who are not familiar, with spinal muscular",English
+"atrophy. And the fact that the severity of spinal muscular atrophy has to do with the dosing in the number of SMN2 pseudogenes. Humans have an SMN1 gene and SMN2 gene, and",English
+SMN patients have mutations in SMN1. And if you have multiple pseudogenes of SMN2 it can functionally complement for the SMN1 because a small portion of the pseudogene is correctly,English
+"spliced. And, in fact, there are drugs that are approved and some in clinical testing that can improve the level of splicing to include exon 7 and shows efficacy in SMNA",English
+"patients. In fact, these two drugs are orally bioavailable. Patients take them orally. Some of the dosing is more frequent than others. You know, maybe a couple times a week. So,",English
+"the idea here is that if these drugs can promote exon 7 inclusion and allow for the expression of full length SMN2, what if we take advantage of this and instead of driving SMN2 expression",English
+"we drive our gene of interest. In this case, Cas 9. So in our first examples of developing what we're calling a splicing switch for regulated control of gene therapy, we took this SMN2",English
+"mini gene, E6, E7, E8, fused it upstream in our gene of interest, and the first slides I'm just going to show you a lot of reporter data. And the idea here is when the exon is",English
+"not include, it's out of frame, there's no expression. In the presence of drug, it's in frame, and there's protein synthesis. And, in fact, we can alter the levels of inclusion",English
+"from not the wild type levels of 10% in the baseline, but to the level of 1%. So we asked, okay, what does this do for regulating gene expression?",English
+"So, we cloned a reporter downstream of our splicing switch, and in the absence of drug, you can see this baseline level, there is some baseline level of reporter expression.",English
+"But in the presence of drug, this drug here is LMI070, and you can see about a tenfold induction in the levels of gene expression. This also not only this works with Branaplam",English
+"but also the other drug I showed in another slide. Well, this was fine tenfold increase in expression, but our concern was that this baseline level of expression was too high.",English
+"We wanted something that was a lot more off, if you will. And also this required a fairly high dose of drug that probably would not be translatable to human therapies.",English
+So we went back to the drawing board and exposed human cells to a low dose drug and then did an RNA seq analysis to identify novel exons that we may be able to incorporate into the,English
+"splicing exon system. This work is not only done by Alex, but also Paul Ranum who did all of the computational work for these studies. So one of the candidates listed here shows",English
+"you the difference in the absence of drug in red, and the presence of drug in blue. Again, this is low dose drug that would be more translatable. And you can see the inclusion",English
+of a novel exon by this yellow bar in the presence of drug. And we can also confirm this by looking at the amount of inclusion as assessed by a splicing assay. And so here,English
+"is our top five candidates that we found. And you can see in the absence and presence of drug that there's another PCR product, suggesting the inclusion of the exon. How",English
+"responsive are these new non SMN2 mini gene candidates? So it's essentially the same structure here. However, we did one more trick, we moved the beginning codon into the included upstream",English
+"exon. Absence of drug, no exon inclusion and no protein expression. And in the presence of drug, there's exon inclusion and protein expression. And I hope you can appreciate",English
+"now these are really very much off. Each of these candidates. And our level of induction now is 200, not 10. And we think this gives us a finer control because now we can play",English
+with doses of drug and we can play with different promoters and all kinds of things I'll show you in a minute. Is this really off? Here is another example that is a little easier,English
+"to see visually than Luciferase, and I think you can appreciate in the lower right panels in the absence of drug, you have no GFP expression in the presence of drug. Again, this is a",English
+single pulse of drug. You see robust GFP expression. What about looking at different promoters to control dose as well as different doses,English
+"of the drug? Here is just a list of three that we're showing here, RSV, PGK, and mCMV. And you can see at different doses and with different promoters, you have different levels",English
+"of protein expression, which could be useful if the levels of expression you need for the experiments that you're doing are very modest, alternatively you can need very, very high",English
+"fold induction for a short period of time and need a more robust promoter. And this is the splicing assay that shows you, with the different promoters and at different",English
+"dose es, you have different levels of splicing in of that novel pseudoexon. So I want to come back to the GFP study. We had such nice GFP data in vitro, and we wanted",English
+"to move in vivo, so we packaged this system which we're calling Exxon, shh a single transgene into AAV and we injected this into mice. This is an IV injection. And then we analyzed tissues",English
+"and I'm just going to show you a smattering of the tissues today. So, we did the AAV injection and waited a few weeks and then gave a single oral dose of the LMI070 at these doses here.",English
+"You can see 5mg/kg and 50mg/kg. And I think you can appreciate in the vehicle treated animals there's no GFP expression, and the GFP expression with the low and high dose",English
+"is commensurate with the dose of the drug. Just to convince you of that, here is a western blot where you can see the levels of EGFP in a dose responsive way, and to convince",English
+"you this is truly off, we overexposed this western blot tremendously. And I think you can appreciate there is no GFP expression in these animals in the absence of the drug.",English
+"Well, what about the tissue we're actually interested in here, which happens to be the brain? We repackaged the same exon e GFP cassette into AAV/PHV, which is high grain tropism.",English
+"We injected these retro orbitally into mice, and I think you can appreciate two panel series in the hippocampus and cortex and you can see both at the 5 and 50 milligram doses we",English
+"have a robust turning on of our e GFP expression that was really exciting. And when we look at a splicing assay, you can see that in the vehicle treated animals there's essentially",English
+no splicing in of that ATG containing exon with the low dose and high dose. We have varying levels of splicing. And below that is the fold induction as assessed by quantitative,English
+"PCR, which is relevant here. So, again, we get 180 fold induction with 5 milligrams per kilogram, and over 1,000 fold induction based on transcript levels at the high dose. And",English
+"this is, again, a single oral dose given to these animals, and then the animals were euthanized a few days about a day later.",English
+"So why did we develop the system? It wasn't to, you know, treat people with eGFP. Instead it was to control the levels of Cas9 that was expressed and to be able to have a pulse",English
+of that. So I'm just going to show you one of the a little bit of that data here. We essentially replaced the eGFP with the cas9. And what we wanted to know is whether or not we got induction of cas9 to a level that was sufficient for editing similar to a con constitutively,English
+on system. First we assessed by western blot either the constitutive levels of expression or the switch varying doses of drug. This is all in vitro. You can see in the absence,English
+"of drug, this is truly off. There is no cas9 expression. And as we increase the dose of drug, we can get up to the levels of constitutive expression. And when we use this to control",English
+"cas9 in the presence of our allele specific guide RNAs, our hope is we get the level of silencing that we saw with the constitutive system. And so here are the transcript levels",English
+when we assess the ability of the exon driving cas9 to silence Huntington in an allele specific way. And I think you can appreciate here that so on the left is a control with control guides,English
+"and no drug, and then the next gray bar are the guides, but no drug, but that's with a constitutive system, those left two bars. The orange bars are controls. Control guides.",English
+"And the green bars are the Huntington specific guides, plus minus and plus the LMI070. And I think you can appreciate that the level of reduction at about 50% is consistent whether",English
+we use the exon system or a constitutive system. So this is very exciting and something we want to move forward for safety reasons.,English
+"The challenges for moving forward are regulation, which I feel that we're getting there. Again, fine control of gene expression with a brain penetrable orally bioavailable drug. For AAVs,",English
+"it's the capsid. So we have several efforts in the lab where we're doing ongoing engineering for improved potency. And this can have several positive impacts. One, it can reduce the needs",English
+"for extensive manufacturing, so reduced costs. The other is it gets us to the right cells and not just a whole bunch of cells that we really don't want. And it also, together with",English
+"the regulated system, can provide for the right level of expression in the right cells. So how are we going about engineering the right capsids? Our strategy depends on the",English
+application. In some cases we want AAVs that go everywhere because the entire brain is degenerating. And so for this we have created AAV libraries based on a number of different,English
+serotypes. Each serotype library is around 10 to the 7th or so distinct capsid variance. We infuse these into the CSF. And these are in non human primates. We infuse these into,English
+"the CSF and we go through a couple rounds of evolution, collect those tissues, and then subject the capsids that we recover to next generation sequencing. I'm just going to show",English
+"you a few examples because this could probably take up 15 figures, but just to kind of highlight for you how we might be able to use this to identify capsids that are more appropriate",English
+for what we intend. So this is just an example for one of those AAV serotypes that went through a validation. And each one of these rows is a different capsid variant. And what you can,English
+see by the density of the purple is the fold enrichment relative to that input. And this is the input after the last round of maybe about 150 different capsids. And you can see,English
+"some variants seem very good for the limbic system, some for the hindbrain, some for sensory systems, etc. And for each of these we can go in and validate them as we move along.",English
+"So, how do the best of the best peptide modified AAVs, which is what we call these, compare to the state of the art? For all practical purposes in humans and in other large animals,",English
+"it's known as AAV9. So here is an example of a peptide modified AAV, which you can't see the data for yet, and a wild type AAV9. After injection into the CSF. I'm showing",English
+you a region of the hippocampus. It's a strong promoter driving the transgene M ruby. This is four weeks after delivery into the CSF of a non human primate. I think you can see,English
+"a smattering of red cells here, but what is really impressive is you compare the peptide modified AAV within the hippocampus with the robust transduction within this region. And",English
+so we're very excited about this sort of broad spectrum peptide modified AAV that may provide enhanced transduction and thereby allow us to do gene therapy with much lower doses.,English
+What about engineering vectors for network level expression? And this can become important when you want to control a network that may impart changes in behavior or may impart or,English
+"maybe impact specifically in neurodegenerative diseases or other mental health disorders. And so, again, it's the same starting approach with the AAV peptide libraries. And here we",English
+do a parenchymal injection into the network node and then do our essential evolution here again through two rounds with next generation sequencing. And I'm just showing you the mid,English
+"level validation experiment from about 150 capsid variants that came out of that second round library. And these are three different libraries, AAV, AAB and AAVC on the left,",English
+and you can see the relative fold enrichment for these different kinds of libraries. And this is also represented in the regions of the network which are little a through little,English
+"f, where we are hoping to get coverage within this network so that we can do one infusion and then impact the and then get the virus to all of those regions of interest. And so",English
+"each of these highlighted with the arrow here are now moving forward in final validation studies, and it will be very interesting to see these properties again from a single stereotactic",English
+"infusion and then follow where they go. So the challenges moving forward is regulation. We are getting there. Fine control of gene expression, again, with this oral drug, and",English
+for AAVs I think we're making a lot of progress. We're in the state of merging our ongoing evolution studies with single cell methodologies to get at the cell level and not just regional,English
+"levels. And then we pioneered some work in developing better ways to evaluate tropism, at least in small animal models, which helps give us some indication of not only are we",English
+"getting where we want to go, but are we not going where we don't want to go. And I think you'll be surprised by some of the experiments I'm going to show you. Now, most of this is not in the brain. There's a little bit in the brain, but it's relevant nonetheless.",English
+"So the conventional way that we look at where A AV goes is to have them express a reporter, put them in an animal, and then look and see where it is. And so conventionally if we're",English
+"looking for something that transduces the liver, for example, you take an AAV vector and express e GFP, and you can use it to express cree to flip on sequences, but what we did",English
+here is took this Cre infused eGFP and we did what Jon Lang who did this work is calling a revised screen. You have an A14 mouse which has a floxed stop upstream TD tomato and you,English
+"infuse that same virus and now you'll be able to tag every cell that got the virus, whether it's a stable transduction event or a transient transduction event. How does this work in",English
+practicality? Here is what we would see a dose dependent increase in GFP expression when we infuse IV Cre eGFP and just look for GFP. And this is just normal black sick mice.,English
+"If we use the AI14 mice, I think you can appreciate that every liver cell is red. And, in fact, if you quantify this, the percent transduced from your standard transduction in the gray",English
+"bars you can see at best, you know, you get about 20% of the liver, but, in fact, what we're seeing is almost 100% of hepatocytes are transduced and we would have completely",English
+"missed it using standard screening methods. We kind of asked, well, is it possible that we're getting more AAV genomes into the cells? And that turned out not to be the case. So",English
+"how relevant is this as we look all the way across tissues, particularly for IV injections? And you know that for some brain gene therapies, there are IV injections being done with brain",English
+"tropic viruses and we think most of the viruses are going there, and what is getting peripherally, you know, is largely shed, or we understand it to some degree. So here we are again with",English
+"our AV8 expressing e GFP views to Cre in standard mouse model. You can see nothing in the brain, a little bit in the heart, nothing in the lung, same amount that we expect in the liver.",English
+"Nothing in any of the other tissues down below, kidney, spleen, skeletal muscle or testis. Yet when we use the Ai14 mice, I think you can appreciate we're getting vessels in the",English
+"brain, we're getting quite a few cardiomyocytes and certainly hitting cells in the lung. Again, our liver is 100%. 100% of the hepatocytes took up the virus. We see glomeruli in the",English
+"kidney. Spleen positive which may help explain some of the immune responses we see. Skeletal muscle is positive, and support cells in the testis are positive.",English
+"What about using the same system for editing? Because remember I came at this talk from the beginning, thinking about advancing DNA editing approaches for dominant gain of function",English
+"disorders similar to Huntington disease. And so we used another mouse here, the Ai14 mouse again that expressed SPS cas9 and came back with our virus that expressed guides and said,",English
+"where is editing possible? And it was really quite surprising. Again, we see editing in the brain in the cerebellum, heart, lung, really all the tissues we assayed, we saw",English
+"evidence of editing. We even saw evidence of editing or expression when we drove the Cre in the first experiment from a liver specific promoter. So, you know, I think what this",English
+study highlights for us is how unusual and how much gene transfer we're really getting in these tissues that we probably didn't realize using conventional screening methods. And,English
+"interestingly enough, if we're thinking about allele specific editing, we can also use this technology to see how effectively are we actually editing both alleles? And it turns out we're",English
+"not so good for hitting both alleles. So this is an example using AAV 9 in the heart and some other peripheral tissues, and AAVB in the brain, throughout, the cortex, striatum,",English
+hippocampus and cerebellum. And you can see there's very few double edited cells but mostly a single edit where you have either red or green. And I think this will be important,English
+"in informing how efficient we are in editing mutant alleles in vivo. So just to summarize and I hope I left plenty of time for questions, allele specific editing of disease alleles",English
+"can be accomplished in cells and animals. We've advanced approaches for regulating knock down, essentially creating a rheostat that can be used with an orally bioavailable drug",English
+"that's been in people, it's in children, and this gives us a method for drug based regulation. We're also devising ways where the state of the cell regulates expression. And we have",English
+"been able to identify novel vectors for focused or widespread or even network level transduction. And I think as these emerge, we'll go back to our lower animal models and assess the",English
+"footprint of transduction. And thus far, anything that we have found in the non human primate, actually has translated down quite well. Which is interesting, because as the evolution work happened in mice, it didn't translate up to larger animal models.",English
+"I'd like to thank the members of my lab and, of course, the funding for this work is both the NIH and the Children's Hospital of Philadelphia Research Institute as well as foundations",English
+"such as the Herd Disease Found days and Hopi's Hope. And I think here is a happy moment after we heard some good news. And this was obviously pre COVID when we could get together, very",English
+"high density, probably over the population of the room. So with that, I am happy to take any questions. I can see the questions here, and I can start to go through them. I'll start",English
+"at the top. Ryan says, I'm confused by the translational viability of small molecule regulated splicing that uses a small molecule. Does it also modulate endogenous genes? Seems",English
+"the system likely will have off target effects. Ryan, that's a really great question. So this small molecule, obviously, it will regulate or it will induce the splicing of a handful",English
+"of genes at this low dose in which we screened. Again, there's only a handful of genes that for which there is a suicide exon incorporated. And it's pretty short lived in cells. So the",English
+"idea is that we're using a dose to control gene expression that is not going to cause side effects in humans. And we know a lot of the human data, quite frankly, because",English
+this has been used for several years in kids. Jim Bloss asked why the therapies were canceled. And I think he's referring to the Roche studies,English
+"for the allele nonspecific Roche studies for Huntington's disease and the wave studies for Huntington's disease. The Roche studies failed to meet their end points, to my knowledge.",English
+"And the Wave studies showed no evidence again, this is all on the website. So, that's all I know is what I see. And for Wave there was no evidence of Huntington lowering or target",English
+"engagement after the infusions. Jim also goes on to ask, can you provide a little more detail about why 50% of Huntington in the brain was tolerable? This is from knock out experiments",English
+"in mice, and from other knock down experiments using other approaches. So 50% reduction of the total levels of Huntington doesn't appear to be deleterious, and if you have a Huntington",English
+"deficient animal for which that is a heterozygous animal, they're fine. Samuel says, at what age will the genetic intervention be implemented? Will existing neurodegeneration reverse itself",English
+"as a result of the intervention? That's a great question. For Huntington's disease, we think we have to go early. There is a progression of disease in which you go from modest degeneration",English
+"or modest atrophy to profound, and it would probably be right around the modest atrophy stage. I think similar to the studies that were set up by both Roche and Wave in terms",English
+"of early on either just write it onset or even a little earlier. Kurt... any comments Kurt Fishbeck hi, Kurt. Any comments on AAV toxicity?",English
+"Yeah, so one of the things we're working in our AAV evolution systems is not only to evolve things where we want them to go, but also evolve them to not go where we don't want",English
+them. And in this case I think you might be referring to the dorsal root ganglion cells where there seems to be some toxicity for AAV9 particularly in adults. And I think using,English
+"the methodology I used here you can deselect for any of those capsids that tend to like that area. Jim asked again, are you aware of any other studies that may be looking into",English
+use of CRISPR research in studying SMIs such as schizophrenia? If so could you identify the research and perhaps some results of their work? I am not. But I've been in conversations,English
+"with several investigators in the mental health arena, and, you know, the question is, will it be a single gene or a host of genes that you would try and regulate to have an impact.",English
+"Jonathan asks, in the revised AAV screening, if so many cells are transduced and able to express Cre and then RP, why don't those same cells express GFP? That's a great question.",English
+"The reason they don't express GFP is because this is transient. And that is what is relevant for editing, particularly nuclear editing with CRISPR. So it turns out that not all",English
+"transduction events are stable, but yet this data shows us that there are a number of transduction events that are occurring that we had no idea were happening, and it's really relevant for",English
+"editing. And he goes on to say, is the copy number of AAV too low to see GFP expression? Exactly.",English
+"And that is the beauty, because what that means is that we don't need those super high doses for gene therapy in the liver for stable transduction when we are going to employ an",English
+"editing strategy for something. We may be able to go in an order of magnitude or lower to have an effect. And I think this is, you know, relevant as we move the systems forward",English
+"to humans. Ryan asks, have you tested the exon transcriptional control system using the Ai 14 model assay? No, we have not. And that's a good suggestion. Thank you. And I",English
+I congratulate the signers as well. >> ALEXANDER DENKER: Thank you so much for an excellent talk. And I concur about our,English
+"signers' ability, and I recruit the great team of sign interpreters who can deal with all of our jargon y things. I want to ask, we have more time for questions if anyone",English
+"else wants to write into the Q&A box, but I want to ask if you can comment a little bit about some of the business y side of your work and what goes into making the decisions",English
+"on when to move forward with the specific gene therapy or not. >> BEVERLY DAVIDSON: Yeah. Money. So, as an academic, yeah, we have to make very... we",English
+"have to make tough... you know, companies do too, but we have smaller purses. And what we what is required is that the data really needs to be compelling. And then we go out",English
+"and we raise money to do the I&D enabling studies. And if the I&D enabling studies support moving to the next step, then that is what we try and do, either collaborating with biotech",English
+or pharma or trying to move it forward in house. We're very fortunate here at CHOP to have a GFP manufacturing facility that allows us to get through the I&D enabling phase and,English
+"also to first in human. However, we still have to raise the money to pay for all of the product and the clinical trial. And part of what I what we have worked toward with",English
+"funding from NIDMS is advance a couple of gene therapies towards the clinic, taken about ten years.",English
+"expressing to families and explaining these experimental therapies to them and going through the risks and why it might be, you know, worth it for their kids and families?",English
+">> BEVERLY DAVIDSON: Sure. As a non physician, I don't see these patients, but I work closely with physician scientists and physicians that do take care of these patients. And I think we need to be 100% upfront about the risk of these therapies. We can't over promise.",English
+"You know, these are experimental therapies at this stage and we hope to have a positive impact and reduce the disease burden in these individuals. I think gene therapy has very",English
+"has a lot of promise. We have been able to, you know, make headway into some very severe diseases with great success. You know, I think the SMA story is an example of that. But there's",English
+"a lot of disorders that may not be minimal to the current suite vectors that we have available and we have to be smart about what we do, and really understand fundamentally",English
+"and convince ourselves that, you know, we can make a positive impact on these patients before we would move into kids. >> ALEXANDER DENKER: Thank you. We do have another question that came into the box. A",English
+"couple questions now. >> BEVERLY DAVIDSON: Yeah. Anthony... yeah, I can read it if you want. >> ALEXANDER DENKER: Sure. >> BEVERLY DAVIDSON: Anthony asks if the approach has been assessed in larger animal models",English
+"or plan in the near future, would similar coverage of transduction be expected? I'll answer that. So all of the work that we're doing in the evolution experiments is in large",English
+"animal models. It's not in small animal models. However, we don't have a way to assess that footprint of transduction in large animal models yet because we don't have any Cre expressing",English
+"large animal models. But we could do that with Cas and then evaluate editing. With the fail of Roche's study, due to insufficient transduction resulting in insufficient suppression?",English
+"Roche's study is tin fusion of oligo nucleotides into the CSF via the lumbar puncture. It's given repetitively, I think monthly or every other month. And there's evidence of Huntington",English
+"lowering in the CSF from the therapy, so one would assume there would be benefit. What we don't understand is where that Huntington is coming, where that mutant Huntington is",English
+"coming from, what part of the brain or what even what part of the, you know, the spinal column, and whether or not that is reflecting where the ASOs are going. So I think there's",English
+"we need this situation where the tumor shows greater sensitivity to the radiation than the surrounding normal tissue. Because if that's not the case,",English
+"we can end up hurting normal tissue in a much more significant fashion than controlling or damaging tumors,",English
+"and end up with the situation on the right. What you see on the left is, as we increase dose, we start to get tumor cell killing. At some high enough dose,",English
+we'll start to get injury to normal tissue as well. We want to stay in this window here where we're getting a fair amount of tumor cell death,English
+"and not damage to normal tissue. In some situations, depending on the particular area of the body, the particular type of tumor,",English
+"we can have the reverse situation, the unfavorable window. Much of what we do in radiation science is to augment the favorable window,",English
+"and then convert the unfavorable picture to something more favorable. We can do this through various mechanisms, and I'm going to talk about some of them today.",English
+"I also think this is pretty striking, which is a plot of how radiation kill cells, and what this plot is showing,",English
+"again, on the bottom, the x-axis is dose going from low dose to high dose and the unit of dose that we use in medical radiotherapy is gray.",English
+"On the y-axis is surviving fraction or cell kill and it's shown in a logarithmic fashion. For a given dose,",English
+"you're going to kill cells. These are cells you can imagine that are done in experimental fashion. You put them on a plastic plate,",English
+"and you subject them to radiation, and then you see how many cells survive and how many cells die. Well, the interesting thing about",English
+that therapeutic window that I described is that both tumors and normal cells are sensitive to radiation.,English
+"We know that and we see that. It's evident in radiation accidents, it's evident in some of the side effects we see when we",English
+"give high dose radiotherapy. But what I think is very striking, and these were based on experiments that were done in the 20th century,",English
+"in 1950s, 1960s, is that, that actual therapeutic window can be pretty small. This window of opportunity for a given dose of radiation,",English
+"we can selectively kill more tumor cells in normal tissue, injure them. But that doesn't hold true as we increase dose.",English
+"We get to a point when we deliver single fraction of doses where we can overwhelm the cells. We can kill lots of tumor cells,",English
+"but we can also kill normal cells. This means that we need to treat at these lower doses, where normal cells will sustain some damage.",English
+"But as I noted, the mechanism of action is that they will disrupt or injure DNA. Well, normal cells as part of",English
+"their normal processes of homeostasis, is that they undergo a process called genomic surveillance. Before they go off and do",English
+"their business and carry out their normal functions, they are constantly surveilling their genetic complement, their DNA, and if they see that there's",English
+"an injury personifying these cells, then they will invest resources to repair that injury before they go about their business.",English
+"Whereas tumor cells, a very clear characteristic of them is that they don't invest the energy in repairing that damage, they are very much focused on dividing.",English
+"Because of that, you're able to, at low doses, cause an injury to the DNA of normal cells, cause injury to the DNA of tumor cells.",English
+"But the normal cells then can repair that injury where the tumor cells cannot. However, if you give a big enough dose, you can overwhelm the capacity of",English
+"normal cells to repair damage, and they will die. They may even die with greater potency than cancer cells,",English
+"because cancer cells can limp along in a very aberrant fashion, and continue to grow to some capacity without having normal cellular homeostatic processes intact.",English
+This is so important to the actual medical therapeutic delivery of radiotherapy. Because what we do is we harness,English
+"that beginning part of the sensitivity curve. We take that initial radiation, those first two gray or so,",English
+"and we give that dose and we hurt cells, we hurt normal cells in the field, we hurt tumor cells in the field, and then we stop and we wait.",English
+"Then we do that same process again at a later time, usually at another day. This is called fractionation.",English
+"We recreate that early part of the radiation kill curve over and over again, where we more selectively kill or",English
+injure tumor cells versus normal cells. That is the nature by which we deliver most radiotherapy. That can be altered by various things.,English
+"It can be altered by addition of drugs, by oxygen concentration, by where the cells are in their division cycle,",English
+"so there's many things that influence the shape of these curves. The other thing, and this is another technical leap here. It talked about how tumor cells",English
+"have various sensitivities to radiation. Different tissues can also demonstrate different sensitivities to radiation, and that's shown here on this plot where",English
+you see tissues of various origins plotted all over the curve showing different sensitivities,English
+"because the curves aren't overlapping. But I want to make a point that there is something called an isoeffect,",English
+"and what that means, it's a way to describe the relationship between the dose and those fractions, how many sessions you give.",English
+"I'm headed somewhere with this to really understand what I think isn't the important, the currency of radiation. It's not just the total dose.",English
+"We can throw numbers around and say I give two gray, I give four gray. But what I want to impress upon you is that a particular effect,",English
+"usually that effect is cell killing, is a function of both the dose and how quickly we give it. Again, diving a little bit deeper into",English
+"a technical aspect is this idea of biologic effective dose. That is what is meaningful as a radiation biologist,",English
+"as a radiation physician. It is a way to describe not just the total dose, but as a function of",English
+"the dose that we give and how quickly we give it, how biologically potent it is. It can be described through this particular equation,",English
+"which is a simplified equation. But I just want to be able to expose this to the audience, and then make the point that,",English
+"what that means for a given tissue, a given tumor or a given type of normal tissue, which may have a characteristic we call Alpha-Beta,",English
+that varies and describes the way that these particular tissues respond to the radiation. It's a function somewhat of their sensitivity.,English
+"For a given total dose, depending upon how you give it, the number of fractions, you can have a very powerful effect",English
+"on both tumor and normal tissue. But often it's the case that the more quickly you give it, and again, this hearkens back to what I",English
+"said just a few moments ago. That the bigger the dose per session, the more likely you are to cause an effect or injury to normal tissue.",English
+"Ultimately, that is how we arrived at what is modern radiotherapy delivery, which uses, what I call",English
+"and many call, conventional or standard fractionation, which is just from what I showed you in the kill curve in the beginning.",English
+"Those very low doses, 1.8-2 gray per day. We give that as a fraction several times over several weeks towards",English
+"a total dose that will more selectively kill tumor cells over regional normal tissue, and that's how we're able to",English
+"maintain that very favorable therapeutic window. Now, in some cases, based upon a location on the nature of what",English
+"we're treating and some of the technology, you can deliver bigger doses of radiation, and biologically, that may be more",English
+potent and that may be a good thing for tumor. You've likely heard a bit about this in the session on prostate cancer radiation.,English
+"You can get a more powerful effect. But if you can deliver that very precisely and not treat regional normal tissue,",English
+it can be very safe and also very convenient in the sense that it's given logistically over shorter course. Then we have extreme hypofractionation.,English
+"Hypo, meaning short and fractionation describing the fractionation. I'm going to talk a little bit about that later. Which is when you're giving",English
+"the radiation, in many cases, in a single dose, so very high doses in a single dose, 16, 24, 30 gray in a single session.",English
+"To do this effectively, we really have to harness the newer modern technology that allows us to just treat the tumor target and bestow little,",English
+"if any, dose to regional tissues, and we have technologies that are able to do that. For most of what we do in radiation therapy,",English
+"we use the modern linear accelerator, also known as the LINAC. Essentially, this is radiation that comes from electricity.",English
+"You have these machines that literally plug into the wall. Now, there's transformers involved in step-up voltage. But what these machines are able to do",English
+is to generate that therapeutic radiation. What they do is they energize electrons. For those of you who,English
+"are maybe slightly older in the audience, the older TVs, the cathode ray tubes would energize electrons onto phosphor fluorescence surface. It's somewhat similar.",English
+"Although much higher energy, we accelerate electrons very, very high speeds and energies. Then they are collimated or",English
+shaped as they exit the machine. They come out with a variety of energy as the process entails in,English
+"the generation, and that's filtered, sometimes called flattened, into a homogeneous energy that can be used meaningfully in a medical fashion, and that is what is shown in these diagrams.",English
+"What's interesting is that unlike other forms of radiation, we do the shaping of the radiation by using collimation.",English
+"It's like an aperture of a camera collimation, and that shaping happens within the machine itself. When you go to the dentist office and",English
+"you're going to get panorama x-rays, of course, you'll wear lead shield because you want to shield your thyroid and the rest of your body.",English
+"The shielding for the radiation actually happens in the head or gantry of the linear accelerator, and there's the small leaflets,",English
+"they're called multileaf collimators, and I show a figure of that looking into the head of the machine on the right that can create",English
+various shapes and actually shapes the radiation. Patients undergoing radiotherapy don't wear lead apparatus because all,English
+"of the shielding or collimation, the shaping of the radiation happens within the head of the machine. These little leaflets or collimators can move in and out.",English
+"They're controlled with servos, and they can do this in a very sophisticated, computer driven way to create these highly, highly nuanced sophisticated radiotherapy plans,",English
+"and I'm going to show you some of that in a moment. The last point I want to make in the Radiation 101 or review is the fact that,",English
+"again, unlike a laser that's entering tissue and causing thermal damage as a function of the depth,",English
+"so the most damage happens on the surface. The nature of radiation, as it interacts with tissue is such that it enters tissue at a lower modest dose and then",English
+builds up within a few centimeters within the surface and then deposits it's dose at some depth.,English
+It's a function of the energy that's used. It's a function of what tissue the radiation is penetrating. But what that means is that we're,English
+able to effectively deliver radiation treatment and dose anywhere in a patient in a way where possible. That can frequently spare,English
+"the superficial tissues that stand between the radiation machine and the target, and that's what gives us also",English
+"a very powerful tool to maintain a positive therapeutic window. Having said and review that for you,",English
+we can move on to radiation therapy and management of central nervous system disease. I say disease because much of,English
+"what radiation is used is to treat tumors, but I'm going to say a few things about use of radiation to treat other conditions that are not tumors.",English
+But I started the talk by showing the phrenology diagram and making a point about the historical understanding and,English
+"relevance of the various subdomains of cognition. Well, radiation therapy is actually a very well established treatment for central nervous system tumors and here, not as old.",English
+But back in 1950s diagram or paper that was showing its utility in treating metastasis.,English
+"Primary tumors that shed metastases that find themselves into the brain. Radiation was very commonly you used to various doses,",English
+"and actually was associated with improvements as compared to folks who did not have this treatment. It's a meaningful treatment even 75 years ago,",English
+"and what's shown on the left here is what is a very elementary isodose diagram. Understanding that as radiation is coming through,",English
+"the various sides of a patient, this is likely a patient lying down. Showing the top of their head looking down towards their feet.",English
+"Through the presentation, you have the interior, the far ahead, essentially posterior to the back of their head and in the sides,",English
+you can have radiation coming from all sides to try to create a dose wash or homogeneous dose through this area to reach all aspects of the brain.,English
+"What's the role of radiotherapy management of central nervous system disease? Certainly it's evolved over the past several decades. We do commonly use radiation to treat metastatic tumors,",English
+"both in the brain and spine. But we also use this to treat primary disease. Gliomas, which are very",English
+"common, both low-grade, high-grade, other central nervous system tumors known as ependymoma, germ cell tumors, medulloblastoma, and some lymphomas and leukemias",English
+"can also be present in the central nervous system. But in addition to that, we can treat benign tumors in condition,",English
+"meningiomas which are generally benign tumor of the covering of the brain. Hemangiomas, which are a benign vascular type tumor.",English
+"Schwannomas which are benign tumor covering nerves as well as other conditions like trigeminal neuralgia, which is abnormal nerve activity,",English
+which can cause pain in the face. There's many conditions in the modern era that we can employ,English
+"radiation treatment. What is the utility? Why is this such a great tool? Well, I would say for three principle reasons.",English
+"One is that most diseases that are treated in the modern era are approached with a interdisciplinary- Which is to say, we think about the therapeutic ratio,",English
+"we think about the tools that we have. Generally, those tools can be placed into three categories for treatment largely of tumors, surgery, chemotherapy or systemic therapy, and radiation.",English
+Those are the three pillars of most modern allopathic treatments. So what's the role of radiotherapy?,English
+"Why is it such a powerful modality? Well, one is that with regard to drugs, chemotherapy, the brain and the spine are",English
+"encased within a compartment that is generally shielded to most chemotherapeutic agents. That shielding is wonderful in the sense that it's able,",English
+"for most of us in our lives, keep various toxins, microbes out of these critical structures.",English
+But it also can prevent drugs from having access to these areas as compared to other parts of the body like the lungs or the liver.,English
+"Surgery, as an approach undertaken by gifted practitioners, can be very effective.",English
+"But there's limitations in the extent of resections that we can do and what are, in many cases, very eloquent",English
+"substructures of the brain and the spine. There's also what is otherwise a intrinsic, therapeutic, favorable window in that brain tissue",English
+"tends to be less sensitive to radiation and brain tumors. Now, we're going to step through these things just a bit. So I mentioned that chemotherapies,",English
+"conventional chemotherapies generally do not penetrate the blood-brain barrier very well and that's depicted here, and you can see on the left,",English
+"a cross-section of a vessel, a blood vessel, and it's surrounded by various nerve cells, as well as glial cells,",English
+"supportive cells in the environment. Then shown on the right, essentially a close-up of that. Between the blood vessel and those nerves,",English
+"and we call it the parenchyma, the substance of the brain, is a barrier that's barriers comprised of cells that are lining the blood vessels on a very sub-structural level.",English
+"There's these junctions that essentially form a very tight barrier, making it difficult for small molecules to even move between those cells.",English
+"There's transporters present that are important to transport things like nutrition, glucose, amino acids, nucleotides. There are also pumps, efflux pumps,",English
+"and so some drug that can get through this junction can be pushed out back into the blood. So it creates this balance and ultimately,",English
+"we understand that it's very difficult for many conventional, traditional chemotherapy.",English
+"Things like etoposide cisplatin, bilirubin to cross through. It's not as though these agents aren't able to penetrate at all,",English
+but their relative level on pharmacologic pharmacokinetic studies is far inferior to what would be,English
+"achieved in terms of an IV medication, IV cisplatin given, it would have significant uptake, say, in a liver lesion,",English
+"but very limited uptake into the brain. Again, we have our phonology diagram. So over the past 200 or so years,",English
+we've refined our understanding of the substructures of the brain through functional mapping studies and there are functional maps that describe,English
+"the regional anatomy and we understand the relationship between this anatomy, the various connections, and functional domains.",English
+"One of the challenges is that while surgery can be very, very effective in most instances, there are limitations. So most of us know the story of",English
+Phineas Gage or the railroad spike through the frontal lobe. Yet was able to live some semblance of a life thereafter. It is true that one can undergo resection or,English
+"injury to many components of an otherwise normal, healthy brain, but there are some components, some very critical structures.",English
+"Sometimes they're called eloquent in that they have very specific functions where if there is an anatomic disruption, that function could be irrevocably affected.",English
+"That really cannot withstand a surgical resection. Additionally, there are not just eloquent but critical sub-structures.",English
+"So parts of the central part of the brain, embryologically known as the diencephalon, mesencephalon. This is the thalamus,",English
+"the pons, the brain stem. We understand very critical functions that these have in terms of basic vital functions of breathing,",English
+"respiration, and movement, where any injury to this area could end up sustaining a significant functional or lethal compromise.",English
+"Not only that, but there are connections, very sophisticated connections, sometimes known as fascicles or tracks.",English
+"Shown here is a three-dimensional rendering of a brain, left side and right side. Rendering of these tracks,",English
+"we're able to see these connections, connections between the part of the brain that receives and interprets words, and then the part of the brain that",English
+"then generates words to evoke. Disruption, almost like a serial circuit, anywhere along that pathway can lead",English
+"to substantial functional deficits. So surgeons, good surgeons, are very hesitant and very thoughtful about their approach to",English
+"avoid injury to these eloquent and critical substructures. In contrast, with radiation, every anatomic compartment is accessible to radiotherapy.",English
+"So we can reach and we can treat and direct therapy to any part of the body. Of course, the focus here is on the brain tonight. But what you've seen is that we can use",English
+this as an adjuvant or complements a surgery. But in some cases where you have involvement of tumor in a very critical component,English
+"here shown in the brainstem in our cross section. So you can see the patient's eyes and their brain, their temporal lobes, and then their brainstem right in the middle.",English
+"This is not an area that would be amenable to a surgical procedure, but with radiation, with a technique of radiation called radiosurgery, again,",English
+"that extreme fractionated, very-ultra focal radiation, we can treat this safely and we can see shrinkage and in many cases,",English
+"resolution of those lesions. So this is part of the power of radiotherapy. Not only that, we can treat, in some cases, comprehensively.",English
+"So shown here is treatment comprehensively to both the brain and the spine, something known as cranial-spinal radiation therapy.",English
+"So there are some patients who have disease that's more disseminated. It's not a focal lesion, not a single spot or single spots that you can approach.",English
+"CNS, leukemia, and lymphoma are examples of that, where the brain and the spine exists in this space that is surrounded by the blood-brain barrier,",English
+"and in that space is fluid, cerebral spinal fluid, or CSF, that keeps the buoyancy of the brain and also acts as a protective buffer.",English
+"That's also a route for tumor to potentially spread and for some tumor types, they have a great propensity to spread within this compartment.",English
+"There's an indication to treat that entire compartment. Shown here are pictures of a patient, what we call sagittal section from the side. Split in the middle, and you can see the bones of",English
+"the vertebral column as well as the bones of the skull. Through various techniques, we're able to access and",English
+"treat the entirety of that compartments. This can be very, very important and efficacious in eradicating various types of malignancies.",English
+"There are some, for example, pediatric malignancies like medulla blastoma that shows a great tropism propensity to disseminate through the brain and the spine.",English
+"It's a very aggressive, high-grade malignancy that can be cured with combinations of cranial spinal radiation therapy,",English
+"surgery and chemotherapy. As a small hint or window into what I'm going to show you later,",English
+"there's different techniques that we can use and some techniques are a little bit more refined than others. So as you appreciate this particular figure,",English
+"you can see with the photon-based radiation plan, it's a nice plan to start to understand how we approach treatment planning because of its simplicity,",English
+"where there's beams of radiation that are coming through the back of the patients and exiting through the front. As they come through, just like a flashlight, those beams diverge.",English
+"So you can see almost like a flashlight, the beams coming through the spine, two beams actually on the left.",English
+"But you can see that with photon-based radiation, some of that radiation dose, which is really trying to target the spinal cord,",English
+"goes beyond the spinal cord and goes into the tissues of the chest and the tissues of the abdomen. Whereas with some proton therapy techniques,",English
+"we can actually minimize that dose. Sometimes we call it the exit dose. There's an entrance dose as the beam enters a patient,",English
+"the target dose, and then the exit dose. You can see here that one of the potential advantages was a proton radiotherapy and certain types of",English
+"treatments is to reduce that exit dose. As I'm going to show you, when we talk about toxicity,",English
+"a big part of toxicity is a function of both the dose and the volume of tissue that's being treated. So you can see with proton radiation,",English
+"there is that capacity to limit that exit dose, limit that volume of uninvolved tissue that's treated, and thereby reduce toxicity.",English
+"I noted that brain tumors show greater sensitivity to radiation as compared to intact brain tissue,",English
+"and that's very complex. I don't expect to go through all the aspects of this figure, but this just shows various signaling",English
+"homeostatic pathways within a cell. The cell wall on top, the cytosol in the middle, and then the nucleus of the cell and",English
+the DNA in the very center. All that's to say is that radiation sensitivity is a function of,English
+"a multitude of processes that are happening within a cell. Small variations in the particular compliments of enzymes of lipids,",English
+of other small factors and perturbations and signaling pathways can have a substantial impact on,English
+"the sensitivity of tissue to radiation. We're very fortunate that as is the case with most tumors,",English
+"the tumors show greater sensitivity to radiation than normal tissues at low doses, and that's something that we harness. So just by way of an example,",English
+"a practical clinical example, I want to step through the treatment of a very common central nervous system tumors. It's an uncommon tumor overall as compared to say,",English
+"prostate cancer, breast cancer. But glioblastoma. So just to get a sense of how we think about this and lead towards",English
+"both augmenting that therapeutic ratio to kill more tumor and reduce toxicity. So glioblastoma, this is",English
+"the most common malignant brain tumor in adults. They're highly infiltrative tumors. The standard of care therapy is multimodal interdisciplinary,",English
+"consisting of a maximum safe resection that avoids those eloquence and critical regions, followed by radiation and chemotherapy.",English
+"Despite our best efforts, even with these very aggressive regimen, that's associated with poor overall survival for some reasons that we understand",English
+"a seizure or a headache, loss of sensation, etc, the patient presents to a medical team and they'll get imaging,",English
+"and this is an MRI. So you can see when we do an MRI, we have various sequences that tell us slightly different things.",English
+What this MRI ultimately indicates when we're looking at this is that there is a cystic necrotic looking tumor associated with inflammation that's,English
+"present in the frontal lobe. So this is the front of the patient, this is the back on the right side. So it's flipped. This is",English
+the right side of the patient and this is the left. You can see that it's present on these various sequences that tell us that the tumor is there and then there's some inflammation present as well.,English
+"It's not so mystical on how we approach the treatment. Based upon a decades of research, we have come to what we call standard approaches.",English
+"I'm just going to send you a snapshot of what this looks like. There are some nuances here, but there's guidelines that we use in",English
+"the treatment approach for any type of tumor. We recognize that using this fractionated radiotherapy is of merit,",English
+that it's better than just doing surgery or just chemotherapy alone. I don't want you to pay attention to the details of this slide.,English
+"This will be present in the syllabus, but I just want to point out that there is a recognition in this standard approach that if it's possible to limit the target volume",English
+to allow less radiation to be delivered at normal brain that may be associated with reduced toxicity. But this is still an active area,English
+of research even in this day and age. I showed this slide just to speak to some of the complexity of how we approach,English
+"Which is to say a patient, that patient who presented, and now I have flipped it so that the tumor is now on the other side, the left side.",English
+"But that patient who presents with a tumor in the left frontal lobe can undergo a resection. It's actually amazing the frontal lobe is certainly,",English
+"in some aspects is not the most eloquent areas and so patients can undergo vast resections, often at the frontal lobe.",English
+"So the patient may have a complete resection, what we call gross total resection. But we know with this tumor type that there may be microscopic infiltrated disease beyond",English
+"what a surgeon may appreciate in the operating room, beyond what imaging, even advanced sophisticated imaging can resolve. We know this from studies in the past.",English
+"After a patient would have otherwise a complete resection, they would present to the medical oncologist and radiation oncologists.",English
+"includes essentially the tumor is gone, but the surgical site, so it's the surgical cavity. That's where there may be the highest concentration",English
+of residual tumor cells that weren't appreciated. But then on top of that is this clinical target volume. What that entails is the area,English
+beyond that surgical cavity where those infiltrate of tentacle-like invasive islands of tumor are likely present in highest concentration.,English
+"They may be at some distance from that cavity, or maybe a centimeter or two. Then on top of that,",English
+"there's another volume that we make. That's an expansion of these volumes. That's called the planning target volume, recognizing that there may be",English
+some uncertainty even with modern technology and modern setup. We add a little bit of margin on top of everything. But what you can see here is that we don't do it,English
+exactly in an equivocal or I call isotropic way. We have to understand how tumors grow and that's important,English
+"when we think about toxicity as well. What I show here is the volume. What I want to point out is that even in the presence of a tumor that's completely resected,",English
+"you may end up with a substantial volume of tissue that's being treated. Now, remember, in this instance, most of that tissue is",English
+normal brain tissue just admixed with some islands of tumor. But you have to treat those islands of tumor because it's an aggressive malignancy that,English
+"can come back pretty quickly. But ultimately, this is the challenges that we're going to be treating both tumor as well as normal tissue with this technique.",English
+"Not only that, I just showed you that this is part of the artistry of the technique is to think about the actual functional pathways,",English
+"and if we do these types of studies where we have different expert radiation oncologists delineate the target volumes, you'll get certainly different volumes",English
+"that are delineated by these overlapping lines. But again, just appreciate in this picture of the brain how large these volumes may be. They could be quite substantial.",English
+"So just historically, how did we get here? Radiation is very much in empirical science. I don't want to undermine",English
+"some of which were done here, we would give various doses from, in this case, 45 gray, 50 gray, 55, and 60 gray,",English
+"and then look at patient outcomes. We see as a function of dose, more's better, patients do better. Okay, so if more is better,",English
+"let's give a little bit more. At some point, we reach a ceiling, a threshold where we're not seeing any more benefit, but then we get into problems with toxicity.",English
+"That Goldilocks approach, again, done in the latter half, largely of the 20th century is how we have arrived at our current dosing strategies.",English
+Here's our seminal sinus is 15 years old and there's been some advances. But we understand now that 60 gray is the magic number that confers,English
+the most reasonable control of tumor without causing unacceptable toxicity. We've also found that if you,English
+"add some systemic therapy in the form of a chemotherapy called temozolomide it can augment, in most cases, the efficacy of radiation.",English
+What about the complications of that? It's wonderful that we're able to effectively treat and destroy tumor. But the complications can exist along a continuum.,English
+"They're a function of all of that biology that I touched upon earlier, which is disruption of both normal tissues as well as tumor.",English
+"So we think about this usually in three segments or temporarily, acute which is during that time course of treatment. So for glioblastoma 60 gray would be given over",English
+"six weeks at two grade per day and there can be the following. There can be hair loss, there can be some skin irritation, some fatigue,",English
+"nausea, some flair of symptoms, radiation itself, there's pro-inflammatory. Sub-acute, which can be",English
+just the protracted prolongation of those symptoms and some vascular issues. Then later are things that happen often months or years later.,English
+"There can be vascular issues, there can be effects on neurocognition if measured, will talk a little bit about that. Effects on hormones, as",English
+"well as risks of secondary cancers. Now many of these things are present in relatively limited risk and many are reversible, but not everything is reversible.",English
+"But a takeaway here is for all of these effects are a function of the dose that we're using, the volume. The particular nature of the tissue that we're treating,",English
+"patient age is very important. Generally, pediatric patients developing tissues are more sensitive than adult tissues, but then also interactions with",English
+extrinsic factors and we'll touch upon that also. Among some of the most severe sequelae of radiation can be white matter injury.,English
+"White matter, the tracks of the nerves being injured that's shown here on the left with edema. So leukoencephalopathy, edema, You can see necrosis,",English
+"which is essentially brain death, not the entire brain, but very limited pockets, as well as vascular injury and vascular malformations,",English
+"assistive degeneration can see. Now, this is in extreme cases. In the current modern practice, this is not something that is commonly observed.",English
+"Of course, we're always thinking about the therapeutic window and we're thinking about the benefit over the risk. Until most cases where radiations indicated,",English
+the small risk of these toxicities is far out shown by the benefit of the radiation. But we do see things historically.,English
+"We can see in pediatric patients who are receiving brain radiation, decrease in IQ over time. We can see as a function of",English
+"various components of the neuroendocrine axis, the pituitary, and the hypothalamus can be affected and we can cause",English
+loss of normal hormonal function over time. There's a risk of stroke that can happen. Much of this is done in,English
+"pediatric patients where you follow them for a long time because I'm focusing on what I call late or long-term effects. It's a small risk overall,",English
+"but if you follow enough patients over time, this can be an issue. Not only these very what I call firmer medical issues, some of the software issues can manifest as well.",English
+"Patients getting cranial radiation, we can see issues with psycho-social function late. Again, speaking to the nuance of integrative cranial function,",English
+"patients getting central nervous system radiotherapy, having less marriage or successful marriages, having issues with employment, and just",English
+"having a diminished psychological well-being. But we've established the sensitivities in patients, so we understand where are",English
+"the safer regions to avoid these injuries, and this is what's a big part of our practice. We understand that if we deliver in most cases with conventional fractionation,",English
+"be it slowly, that we're able to mitigate most of these toxicities. I wanted to say a few things about the spine as well. High dose radiation to the spine can also cause injury,",English
+"and it can be paramount because in some cases, it can be irreversible, but we've established doses that we know and we're treating at this lower end that",English
+"the probability of any type of significant injury myelopathy being a severe catastrophic effect on spinal cord function that can lead to paralysis,",English
+"we will avoid this at almost all costs, but it's remarkable, the biology, in that tissues can have",English
+"a substantive ability to take on a fair amount of radiation, and recover to some degree, so there are patients when we",English
+"treat relatively small volumes of these sensitive areas, and they can withstand that, and we can successfully",English
+"destroy tumor and preserve normal tissue, but it's a function again of both dose and volume. In some cases, there's also recovery,",English
+"and this is quite remarkable, that over time, there are some patients, who, during the course of disease, may benefit from",English
+"having multiple courses of radiation. Again, patients in many cases now living longer with significant burden of disease and",English
+"more chronic metastatic disease, they may have indications for radiotherapy along that disease course, and what we're finding is in some cases,",English
+"even for patients who've had fare amounts of radiation delivered, they can recover and they can withstand successfully second courses of",English
+"radiation without substantial toxicity, so radiation can be continued to be used as a powerful tool in many different settings.",English
+"Let's talk a little bit more granularly about the pathophysiology of radiation induced injury, specifically, brain injury.",English
+"This is something that has been studied in various capacities and we're still learning quite a bit,",English
+"but what we understand at a very fundamental level is that the biological effects of radiation, they're very pro-inflammatory.",English
+They create reactive oxygen species. They create signaling pathways that can engender cytokines. Those cytokines can undergo signaling that can,English
+"have a variety of pleiotropic effects on the cell. They can cause signaling that tells cells to stop growing,",English
+"to stop their function. In some instances even indicate that self-destruction pathway, apoptosis necrosis. They can cause leaky blood vessels",English
+"and loss of that blood-brain barrier, so that inflammation can propagate itself, because inflammation can portend greater inflammation,",English
+"infiltration of the immune compartment which in some cases may be a good thing as we learn to harness the power of the immune system in combination with radiation,",English
+"but in other instances, a very powerful inflammatory signaling, you heard about it in COVID.",English
+"to virus can do quite a bit of harm. Same thing can happen in other processes as well, and too much inflammatory infiltrate",English
+"can cause some of these damage, so what we understand is that in most cases, the pathophysiology, the mechanism of injury has to do",English
+"with a very powerful and sustained inflammation, and this is characterized by the presence of these reactive oxygen species",English
+"which are pro-inflammatory and irritating. One of the things that we understand and I focus on this, because most of the work",English
+"in the last I'd say decade or so, two decades, has been in understanding some of the more eloquent or sensitive areas of the brain.",English
+"To understand even within the brain tissue itself, differential regions have different sensitivities. One area that we understand",English
+"shows particular sensitivity to radiation is the hippocampus, and this is also understood to be the short-term memory center of the person.",English
+"We've recognized that the hippocampus in itself shows a sensitivity because it's an area where we think of the brain as not actively dividing,",English
+"but there is a compartment of cells. Sometimes they're called neural stem cells for those of you who have fore-read into neurosciences, that help replenish the brain overtime.",English
+"Vast oversimplification of the sophistication of those pathways, but neurogenesis, the formation of new hippocampal cells is happening as we",English
+understand it on a fairly continuous basis. Impairments of that which may be facilitated by radiation can subsequently lead to cognitive impairment.,English
+"There are various models that have demonstrated this. We know that this can happen as a function of dose, and so we can look at the readout",English
+"of impact on memory and see that as a function of dose to the hippocampus during various radiation procedures for tumor. There can be increasingly substantial impacts on memory,",English
+"but it's not limited to the hippocampus. It's not that simple. Other parts of the brain, parts that are involved,",English
+"we call the region the corpus colloquium which really is the areas that connect the two halves of the brain. They also seem to be particularly sensitive. They're very dense white matter tracts,",English
+"and that significant dose to those areas, the fornices, may be associated with more profound effects on neurocognition.",English
+"Again, much of this data frankly relatively new in the past five years and so this is a very exciting and interesting area of inquiry as we understand",English
+"the mechanisms and then can intervene, and I'm heading towards that very quickly. We also see, again, this differential effects. We can see cortical thinning, thinning of the brain.",English
+"You can see as a function of age, as a function of other issues; hypertension, etc, diabetes. We often can see thinning of the cortex [inaudible] ,",English
+"loss of the substance of the cortical matter. That happens as well in patients who have been treated with radiation,",English
+"more so than people who are of similar ages in these positions. We're also beginning to understand that there can be very small hemorrhages,",English
+micro bleeds following radiation and maybe that can have a consequence in terms of our original function.,English
+"A lot of areas of active inquiry, and as we understand these more than we can design interventions to potentially mitigate them, but ultimately,",English
+"assessment of neurocognition is very challenging because it's an integration of many different domains, many different things that are both",English
+"intrinsic and extrinsic to a person. Just going around the wheel of neurocognition, and if we start at the top,",English
+"certainly, tumor treatment we understand, radiation therapy can influence neurocognition, but we have to be mindful of other comorbidities, other illnesses, a patient's age,",English
+"a patient's education, what's their baseline, their prior medical history to fatigue. Fatigue is phenomenally interesting and confounding,",English
+is that it can impact various domains of cognition. Everything from perception and attention to integration of pathways. Medications; the particular location,English
+"as well as environmental influences, stress can certainly impact all of this, and so teasing out all of these in patients is very difficult.",English
+We actively interrogate this through very rigorous neurocognitive functional assessment to try to break,English
+"down these various domains of cognition through different tests, but ultimately, some of this remains elusive to really understand those nuanced pathways",English
+"that connect things in a person, but these are generally this robust neurocognitive assessments is how we study this. But just to point out",English
+"that in many cases, when we're thinking about understanding the effects attribute to radiation or neurocognition, is that many patients who come to",English
+"the clinic already have high rates of impairment due to their actual disease and disease disruption on those pathways, so it's very challenging to study.",English
+"Just before I move on to the next section which will be the last and I think most exciting section, I just want to recap radiation related injury.",English
+"Takeaways are the toxicities of function of the volume of irradiated normal tissue, the total dose, how much dose you're giving per fraction. The intrinsic sensitivity of the tissue.",English
+"Sensitizers which may be other drugs or agents. A patient's age and their medical comorbidities, and it's really important in",English
+"medical practice that we don't underestimate that sensitivity of the therapeutic ratio that every patient is different, and you really need to take a personalized,",English
+"individualized approach to thinking about the patient as a whole, and all these factors that will affect their sensitivity. Let's talk about where we stand now.",English
+"This is really the heart of the talk in the last 20 minutes or so, improving this therapeutic ratio. How do we improve the therapeutic ratio?",English
+"We have no shortage of potential avenues to do that. I'm going to step through all of these. We have technological advances in radiotherapy delivery,",English
+"the actual machinery, the way in which we target. We have improved target delineation with better imaging. In the same way, radiation therapy has advanced in",English
+"terms of its ability to deliver the radiation, so much of that delivery is based upon more sophisticated diagnostic medical imaging",English
+"as CT scans, MRIs, nuclear scans, PET scans have gotten better over time, we've been able to more specifically understand our targets",English
+"and more selectively target. At the same time, we've refined our clinical targets. By that, I mean,",English
+"we continued that Goldilocks approach. We are understanding what is essentially the minimum that we need to treat effectively as we move ahead,",English
+"and we have more sophisticated integrative therapies, we have better systemic therapies, better chemotherapies, we can scale back in dose in some cases,",English
+"we also have better molecular stratification. We understand who might respond to a lower dose of radiotherapy than another, and by who I mean a tumor.",English
+"We have treatment de-escalation for select tumor types as we understand and refine our different categories of tumors and we certainly know now,",English
+not all breast cancers are the same. There are subgroups and subgroups within those subgroups and they all now can,English
+"have differential personalized approaches, just same thing with chemotherapies, radiation as well. In some cases, we may be",English
+"able to de-escalate or avoid radiation altogether with newer therapies that actually are able to penetrate that blood-brain barrier. We have pharmacologic modifiers of radiation toxicity,",English
+ways maybe to reduce that inflammatory response in a way that doesn't compromise the anti-tumor effects. We also have post-treatment rehabilitative interventions.,English
+I'm going to step through all of these for you. Let's talk about the technologic advances. It's all about delivering dose.,English
+"Delivering dose where we want to deliver it within the target tissues and not within normal tissues. As the actual linear accelerators,",English
+"the machines essentially have gotten better, technologies have gotten better. We've been able to do that with more selectivity. This is depiction of a patient lying on the treatments,",English
+we call it the couch or bed. They have an immobilization mask on because it's still very basic principles. We don't want folks to move during their treatment.,English
+"In the past, we would do things with very simple beam arrangements. Maybe a beam coming from the left, from the right, from the top, from the bottom.",English
+But now we can have these machine move in arcs and not just in arc. This would be a depiction of a machine moving around a patient.,English
+"We can have it move essentially in almost 360 degrees, not through the table, but close to that. By doing that, we can have",English
+"all these little beam paths that converge at the target, and that creates much more sophisticated dose deposition plans",English
+"and that's shown here. With newer techniques, if we're going to treat a tumor that's situated here in the right temporal lobe, we're able to",English
+deliver dose more specifically to that area with these newer techniques. These are all new techniques that I'm showing you and I'm showing,English
+"you what they call a dose wash, which is almost like a topographic map, where areas that are red are showing, you call it hot, again, it's not thermal,",English
+"but the great regions of greater dose and then these bluer region are cooler areas of less dose. You can see with different newer techniques, we're able, in some cases, to significantly spare",English
+"altogether some of the brain tissue. But if nothing else, we're able to limit a lot of that dose to uninvolved parts of the brain.",English
+"Let's talk about a higher level of sophistication with regard to dose deposition, so radiosurgery.",English
+"What I was showing you before using that larger machine, we call it linear accelerator external beam techniques, was delivering beams that",English
+"were of some substance to treat, targets that were of substance or some size. But for very small targets, we can get even more sophisticated in our dose delivery",English
+"and treat with radio surgery techniques. The reason that it's called radiosurgery, there's no surgery involved in any of this.",English
+"But it has the precision of a surgical procedure and the power so in so much as you would undertake a surgery, you are resecting tumor,",English
+"you're removing it from the body, it is ablative in nature. The same is true of radiosurgery. It is an ablative form of radiation,",English
+"very small targets to very high dose. By doing that, you can essentially obliterate most small targets, most small tumors.",English
+"Historically, the Gamma Knife, which is a technology that we use commonly here, was developed to do just that. I show an older version of",English
+"that on the left and a new version on the right. The older version, it was designed in part by neurosurgeons, were trying to mitigate the toxicity and side effects of",English
+"undertaking very heroic surgeries. In this case, the patient would have a stereotactic head frame or frame mobilization frame",English
+"placed on their head to keep their head very still. Then you have 200 or so small radiation sources that are generating or emitting high-energy radiation,",English
+"case gamma radiation, that's collimated or focused into a single point in space. There's this big lead helmet here where all these radiation sources would",English
+"reside and they can be turned on or off. When they're turned on, they would all converge at a single point in space and we would put that target in that space.",English
+"Now, we have more sophisticated technologies now that can do this more readily. It's computer-driven.",English
+A patient could lie down on a bed and have just the frame on but a mask on in some cases and go into a machine. This machine can move in and out with,English
+different size collimators to very precisely deliver this type of radiation. It can be used for a variety of tumors and,English
+"even some benign conditions like arteriovenous malformation. Abnormal blood vessels can be targeted with this. Schwannoma, as I mentioned before, Trigeminal neuralgia,",English
+"treating small vessels or nerves that are causing irritation of those nerves and pain syndromes. But certainly, for brain metastases, malignant gliomas,",English
+"meningiomas that are close to these eloquent or critical structures, pituitary tumors. We can use all of these techniques with radiosurgery.",English
+"It's not appropriate for every situation, but it can be used. The real power of it is its ability to give ultra focal targeting.",English
+There's very little dose to regional normal tissues and that's how we can treat effectively to high ablative doses. But Gamma Knife isn't the only machine that can do that.,English
+"CyberKnife, maybe in your lexicon as well. This is another technique where you have a linear accelerator that's compact",English
+"mounted on a robotic arm and the patients lying down here and the arm moves around and it can replicate all those little beamlets,",English
+all those little sources converging on a single point in space to make very sophisticated ultra focused delivery of radiation.,English
+I mentioned proton radiotherapy before I'm going to mentioned in again here. Proton radiotherapy by nature of,English
+"the intrinsic physical properties of the particle. Photons and protons, are different in nature, both are forms, can be",English
+"used therapeutically as forms of radiation. They both have that same biologic potency. It's not as though one is more powerful than the other,",English
+"but the difference is in the way in which they enter tissue and exit tissue. What I showed you before, the power of radiation or a power radiation is",English
+that it doesn't deliver all the dose at the surface. It gradually delivers dose as a function of depth and penetration into tissue and then it exits out.,English
+"Well, protons are able to do that too, except the shape of that curve is a little bit different and it's a little bit steeper. There's less entrance and there's less exit dose.",English
+"What that leads to, this is two-photon techniques, a less sophisticated form and a more sophisticated form. But you can see that there's dose that will",English
+"be distributed to the anterior structures the mediastinum, the chest and abdomen. Somewhat more limited with",English
+"a more sophisticated photon technique, but nothing as good as a proton technique. Essentially, the beam that's coming from the back just stops within the spinal cord.",English
+That's great because that's your target. These types of techniques can significantly reduce unneeded dose to,English
+"those other organs and reduce some of the toxicity. Something else that's really exciting and cutting edge in the last two years,",English
+is different ways to deliver that radiation. There's something we call ultra high dose radiotherapy or flash-based radiotherapy.,English
+"That for reasons that we're coming to understand, are able to deliver high dose to tumor but be sparing of normal tissues.",English
+"It may be related to the fact that this form of higher dose rates radiotherapy, and by higher dose rate, I mean on the order of 10 or even a hundred folds,",English
+"even up to a thousand fold. In some cases, it seems to reduce the formation of these harmful reactive oxygen species. There's more to understand here for sure,",English
+"but the technology continues to improve and we need to harness that. In addition to that, there's improved target delineation. So we use more sophisticated imaging",English
+to understand areas in the brain for a given tumor type that may or may not be associated with disease.,English
+"We're getting better with being able to understand what needs to be our target. Not just that, we're understanding that tumor,",English
+"for example, for a glioblastoma, GBM, we know that has that microscopic front of tumor, outside of the main tumor,",English
+migrates away and infiltrates. We know that it doesn't happen randomly in any direction and happens along particular pathways.,English
+"Some of those tracks actually that I pointed out, those white matter tracks. We're able to image those tracks with what's called DTI or diffusion tensor imaging tractography,",English
+"and we can selectively target those tracks instead of treating all normal brain tissue. By doing that, we can actually reduce",English
+"the unnecessary radiation delivery to otherwise normal, healthy brain that likely does not have those microscopic tumor cells.",English
+"So we've come a long way from in our techniques, but we continue to refine them. Shown here, I didn't show this picture,",English
+"treats brain metastasis, for example, patients who have multiple spots in the brain. The technique that was used once",English
+"upon a time was whole-brain radiation therapy. You treat the entirety of the brain. You would block out the face,",English
+"you might block out the back of the neck, and that's shown here, but you would treat with a beam coming from the left beam, coming from the right. I mentioned we now understand that",English
+"the hippocampus is a particularly sensitive area. Studies have been done that show using these more sophisticated techniques, again, a dose was shown here,",English
+"we can selectively reduce dose to the hippocampus. When we do that, we can actually see better cognitive outcomes",English
+without coming at the expense of tumor control. This is also very exciting. We've also learned that in,English
+"some cases, we can shrink what we're treating. Pediatric patients with ependymomas, these are tumors that often involve the ventricles of the brain, the cerebellum.",English
+"We used to treat bigger volumes, now we can treat smaller volumes, and we don't see such significant declines in IQ with that technique.",English
+"Moving along, I mentioned that we are getting better with our approaches in terms of chemotherapy or targeted therapies, immunotherapies.",English
+"In fact, we now recognize that many of these therapies are able to cross the blood-brain barrier and have efficacy within the brain substance itself.",English
+"Tumors that are situated in the brain substance now can be, in some cases, effectively managed with these types of therapies.",English
+"There's a variety of therapies that we recognize across the blood-brain barrier and different malignancies. For metastatic breast cancer,",English
+"targeting the HER2 receptor, for some lung cancers, targeting ALK epidermal growth factor receptor,",English
+"and then for melanomas, targeting other signaling pathways as well. Immunotherapies and recent trials have shown very good response rates.",English
+"These are not yet, I would say, slam dunks in the sense that they completely obviate the need for radiation,",English
+"but in some cases, they worked really well, and this is evidence again, a very recent showing efficacy of this agent, tucatinib,",English
+"that targets HER2 in patients with metastatic breast cancer or brain metastases, and those patients were actually seeing improvements in control within the brain that",English
+"has an effect on overall survival. This is very, very powerful and very provocative and needs to be pursued further.",English
+"Of course, at the same time, we need to be mindful that same thing when you are taking multiple agents, multiple medical therapies, you",English
+"take one thing for nausea, it causes constipation. Well, sometimes when we combine things, combining immunotherapy or these targeted therapies with brain radiation",English
+"in some cases can also synergize toxicity. We need to be mindful of that as well. We also understand the targets, again,",English
+"I mentioned that pro-inflammatory pathway in the different parts of the brain. Inflammation can cause vascular damage,",English
+"inhibition of neurogenesis in the hippocampus, altered function of neurons and inflammation. There's a variety of medications,",English
+"things as simple as anti-inflammatory medications, to medications that are used in the treatment in other types of cognitive diseases.",English
+"For example, amantadine or donepezil for patients with Alzheimer's. They've been applied to patients who are undergoing",English
+radiation with radiotherapy and they may mitigate some of that toxicity. This is also very interesting. Amantadine Alzheimer's drug used in combination with,English
+"whole-brain radiotherapy for patients with brain metastasis, we see reduction in cognitive effects. If you take that and combine that",English
+"with that hippocampal avoidance, an even more profound effect. Combining these different techniques may be very powerful.",English
+"Now on the other side, after radiation therapy, we're beginning to understand that there are sophisticated rehabilitation interventions",English
+"that can be undertaken. They're very personalized to understand how patients can learn to be aware of these deficits,",English
+"to exercise these deficits and in some cases, to compensate for these deficits. These studies are an active investigation within UCSF.",English
+"We can actually see positive effects with patients who have undergone treatment for brain tumors, surgery and radiation undergoing",English
+"this type of cognitive rehabilitation. We can see and select domains, executive function, verbal learning, improvements over time. This is very meaningful.",English
+"Even after the fact, after the potential injury, we can see improvements. In summary, I've talked",English
+"about central nervous system directed radiation therapy, tried to impress upon you that it's potent, that it can be durable in some cases,",English
+"and largely safe for a variety of malignant, benign diseases. When it comes to the secrets of the brain, many of them still remain a secret,",English
+"and that really just speaks to the complexity of the various interacting pathways and neurocognition, but as we use more comprehensive interrogation",English
+"and really exploring individual domains and the synthesis of those domains, we're going to be able to more precisely target them both in terms of mitigating toxicity up-front,",English
+but also in terms of rehabilitation after treatments. More important than anything else is the importance of the therapeutic ratio.,English
+"Hopefully I've shown you how critical it is and that it can be optimized with a combination of very thoughtful interventions,",English
+"technological in nature, pharmacologic, as well as other interventions. With that, I will pause. I thank you for your attention.",English
+"I'm happy to facilitate discussion and take any questions. Sorry, if I missed it, but I was thinking it might be interesting to talk about",English
+"drugs that we sometimes use to help mitigate the side effects of whole-brain radiation in particular,",English
+"as that often comes up in our clinical practice. Yeah, absolutely. This is an area that is a really great example",English
+of what I would consider to be modern translational science. What I've impressed hopefully upon the group is many of,English
+these side effects are related to the pro-inflammatory nature of radiation. Now that information can be productive in so much as that inflammation represents destruction of tumor cells.,English
+"Again, the immune system has a role in this. The inflammation associated with tumor cell destruction that ultimately manifests",English
+signaling for immune cell infiltrate that can be productive. Radiation can act like an in situ vaccine in some cases as it destroys tumor cells.,English
+"You have these tumor cells that look abnormal. They are tumor cell antigens, in the same way there can be",English
+"viral or bacterial antigens that look foreign, that can manifest an immune response. That's a big part of what we",English
+"understand to be immunotherapy, and radiation potentially augment that. Well, that's good radiation, good inflammation. The concerning pro-inflammatory radiation when it's in",English
+"excess to the point that it's causing swelling and irritation of regional structures, that can be in part mitigated with anti-inflammatories,",English
+"and those anti-inflammatories can be very simple. Over-the-counter medications, non-steroidal anti-inflammatories.",English
+"Things like Acetaminophen Ibuprofen, but very commonly, we'll use a corticosteroids as well, and those can temporarily mitigate some of",English
+that inflammation in a way that we don't think comes at the expense of actual tumor control. But what I was mentioning is this really exciting translational work.,English
+"Coupling the understanding that hippocampal neurogenesis is impaired with radiation, understanding that to be a particularly sensitive area",English
+"that's very exquisitely tied to memory, and then focusing efforts on mitigating dose to that area, because it's just a small substructure of the brain and",English
+"an area that doesn't frequently harbor metastatic disease. This idea of hippocampal sparing was used initially to reduce those effects,",English
+"but at the same time, we were doing studies using this drug memantine, which has been shown to have cognitive preservation effects in patients with dementia.",English
+"But you can see that you can translate one pathophysiology to another situation. In this case, it's not as though",English
+"our patients were treated with radiation therapy, suffer from dementia, but there are some similarities. That drug that memantine has been shown to",English
+"show some efficacy in very specific domains. Thank you. There are a few questions in the Q&A box. David Fisher asks, ""For proton radiation therapy how are",English
+"the protons delivered or what chemical are the protons derived from?"" Great question. This is",English
+"much more involved than external beam techniques. The protons are actually generated through cyclotrons,",English
+there's no increase in heart rate so this isn't  pots this is rather orthostatic hypotension and   down below is what we call cardio vagal functions  so this is where we ask people to breathe in and,English
+out at a rate of six breaths per minute and then  we look at how fat or how well the heart rate   modulates itself and in this case it's reduced so  the heart rate doesn't vary as much as it ought,English
+to with inspiration and expiration and so that's  reflective of an autonomic neuropathy this slide   I like because it demonstrates a couple of things  so first of all the most obvious thing is is this,English
+in red which is sweating in the forearm so that's  a huge amount of sweating in the forearm and in   yellow is wetting in the foot which is reduced  so this slide actually demonstrates two things,English
+the primary abnormality is actually reduce  sweating in the foot so that's the autonomic   neuropathy that the increase in sweating and  the forearm is something called compensatory,English
+hyperhidrosis so sometimes when I hear you know  I sweat too much my first question when I hear   that is where do you sweat too much at because  sometimes that sweating too much results from,English
+sweating too little in certain places and so  that that this demonstrates something called   compensatory hyperhidrosis so it's not uncommon  for people with an autonomic disorder to sweat,English
+too little on the leg and in the feet but then  sweat much more than they ought to on the head   and the trunk so here's an example of orthostatic  hypotension this is one of our definitely our,English
+lowest recording ever in our autonomic laboratory  I have written down here oops pardon me with with   tilt this patient developed a blood pressure of  44 over 30 amazingly they were able to maintain,English
+consciousness with the blood pressure of 44  over 30 so this is an abnormal decrease in   blood pressure with tilt table testing really  important to talk about GI dysmotility I think,English
+that this is really under emphasized particularly  in the pots and the dissident Omiya realm we don't   talk about this enough important to recognize that  any component of the GI tract can be involved it,English
+can be esophagus it can be stomach it can be  small intestine it can be large intestine the   stomach may empty too rapidly or it may empty  too slowly when it's too slow that's what we've,English
+referred to as gastroparesis esophageal dismal  'ti is extremely common under recognized and so   this may result in difficulties with swallowing  so doctors don't do a good job of recognizing,English
+esophageal dismal Atilla tea in the context of  pots and dissident Omiya so important I sort of   think about GI dysmotility when it's significant  the way that I think about it is this actually,English
+may be a form of autonomic fail so in people who  have dismal 'ti from from a testing standpoint   from a disorder standpoint this may be a form of  autonomic failure and when present this should,English
+definitely be studied and attempts should be made  to treat it so one of the tremendous difficulties   with with pots with or with dissident oh me a--  is knowing whether its primary or secondary so,English
+what do you mean by that so I'll just give you  an example if somebody saw I'm a neurologist if   somebody comes to me with a headache they say  well a month ago I developed a headache my job,English
+as a neurologist is to determine whether there's a  secondary cause for their headache or whether this   is tension type headache or migraine which are  primary headache disorders so the way that I might,English
+do that is I might order an MRI scan of the brain  to make sure that that person doesn't have a brain   tumor or some other secondary cause of headache if  I've excluded a secondary cause then most likely,English
+that's a primary headache disorder either migraine  or tension type headache so one of the problems   with pots is we really don't know whether pots  is primary is a primary autonomic disorder that,English
+is it's a condition in its own right or whether  there's always something underlying it or whether   it's some combination so pots as I'm sure you know  at this point is a very heterogeneous condition,English
+people have you know various symptoms pots may  begin in a post infectious a post concussive   way but pots also may be a manifestation we think  of Sjogren's syndrome so this is just an example,English
+this is actually a pots patient who actually about  four years after I first diagnosed her with pots   we diagnosed her with Children syndrome so she was  16 she had an infection developed hot symptoms she,English
+also developed a new daily persistent headache  ND ph new daily persistent headache is a really   nasty headache type extremely difficult to treat  it's not uncommon in pots patients and so this,English
+was how her autonomic testing looked initially  and the same same person about four years later   ultimately she tested positive for Sjogren's but  pots can also begin following traumatic brain,English
+injury this was a professional hockey player who's  got in multiple fights and the last fight resulted   in pretty significant brain injury and this  demonstrates the not only in green that increase,English
+in heart rate but you see blood pressure is all  over the place very unstable and so pot skin   began following a concussion or traumatic brain  injury his his brain MRI was also a little bit,English
+abnormal as well probably as a result of multiple  head injuries so what is the evidence for pots as   an autoimmune condition well interestingly dating  back to the early 19th early 1900s pots has been,English
+reported in the ballpark of 30 to 40 percent of  the time to follow an infection and the neurology   world whether it's pots or neuropathy or other  things when we have a neurological condition,English
+that follows an infection will often hypothesize  that that neurological condition is an autoimmune   phenomenon so what we mean by that is it's the job  of the immune system to fight infection so instead,English
+of just fighting that infection the immune system  gets activated and affects autonomic pathways in   an abnormal way and so interestingly studies  over time have replicated the same finding 32,English
+forty percent of the people that we see in clinic  will report this antecedent history of infection   which may in and of itself be an indication that  pots at least can begin as an autoimmune process,English
+I had four years wondered well what if I saw a  patient with pots very very acutely now we're   told we're not supposed to diagnose pots acutely  I'm supposed to wait three to six months before I,English
+email and said you know had all of these symptoms  and wanted to come to the states and be evaluated   so this was a 36 year old female who reported  fatigue and lightheadedness and feeling faint,English
+she had urinary symptoms constipation she had  pain across her thorax so she flew 30 ish hours   from South Africa to our hospital we admitted her  MRI scanned everything tons of bloodwork spinal,English
+fluid etc and she was diagnosed by our neurology  hospital services having an adjustment disorder so   thought perhaps resulting from her her miscarriage  so they said well Goodman sent us this patient to,English
+the hospital so he can deal with it so she came  to my she came to my clinic and we did autonomic   testing and so this was about three weeks in and  she had an abnormal tilt table study showing in,English
+green again that increase in heart rate and  so because she was so we saw her so acutely   and because this came on in the around the time  of an infection maybe the miscarriage I thought,English
+and is still normal to this day so what she have  gotten better on her own without seeing me perhaps   should I have waited three to six months to  diagnose her with pots I would argue not but again,English
+perhaps some evidence of an autoimmune process  causing pots so another case just to demonstrate   how severe the autonomic nervous system can be an  association with Sjogren's this was a person I saw,English
+back in 2014 she had been hospitalized following  the abrupt onset of fainting she basically was   bed bound in a hospital in Albuquerque New Mexico  and she reported every time she would even sit up,English
+she would feel like she was going to pass out she  reported sensory symptoms with burning across her   distal extremities she had lost a bunch of weight  she reported pain around her abdomen she had some,English
+other GI symptoms and she had been diagnosed with  orthostatic hypotension this is her tilt table   testing showing horrible orthostatic hypotension  and she didn't sweat at all so you may remember,English
+from the other pictures we see the the the  sweat output in this case she didn't sweat   it also indicating horrible autonomic failure  and her laboratory studies showed an abnormal,English
+SSA which is one of the primary blood tests for  childrens so Sjogren's syndrome can result in   autonomic failure here's another case that proved  to be very vexing and actually was battleground,English
+for for Rheumatology where with Rheumatology  at Mayo so this was a woman who was referred   for numbness and weakness she had a urinary tract  infection then developed sensory symptoms and her,English
+extremities and then she developed a weak left arm  and then she began fainting she had a number of   symptoms lightheadedness GI symptoms she reported  some bladder symptoms she had been diagnosed with,English
+guillain barre a syndrome which is a nasty  neuromuscular condition that can be associated   autonomic dysfunction but we treat it with IVIG  or plasma exchange and so she had orthostatic,English
+hypotension and on autonomic testing she again  had orthostatic hypotension drop in blood pressure   very little sweating except she actually sweated  in the foot so this is a pattern of what we call a,English
+non length dependent pattern of neuropathy which  is actually what we look for in Sjogren's so we   had some inkling that she might have Sjogren's  based upon the autonomic testing actually so this,English
+person did not have dry eyes in dry mouth some of  the hallmark clinical features of Sjogren's she   developed acutely this autonomic failure and so  her laboratory studies for Sjogren's were negative,English
+we went ahead and did a minor salivary gland  biopsy which showed an abnormal infiltrate so   this is a lip biopsy where we take out a piece of  the lip look at it under the microscope and look,English
+for evidence of inflammation so she met criteria  for Sjogren's based upon those findings it took I   don't think the rheumatologists believed us which  I didn't really care we treated the patient as we,English
+would someone with Sjogren's syndrome with  autonomic failure so some examples of how   Sjogren's can affect the autonomic nervous system  Sjogren's syndrome is under-recognized it affects,English
+up to 3 3.1 million Americans probably more than  that it's recognized as the second most common   autoimmune disease it can result in neurological  symptoms rarely pulmonary symptoms and,English
+gastrointestinal symptoms are quite common with  Sjogren's now what's not been fully appreciated   is the degree to which autonomic nervous system  impairment can occur in relation to Sjogren's,English
+syndrome but actually you know it's interesting  we have these battles with the rheumatologist   I don't even send my patients to rheumatologists  anymore I don't really care what they have to say sorry if there are rheumatologists in the room  but that's that's reality the interesting thing,English
+is is I'll go through some of the data it's in  rheumatology literature that autonomic nervous   system impairment occurs in Sjogren's it is  unfortunate that Sjogren's is considered a,English
+rheumatologic condition in my opinion because you  know if you think about the primary manifestations   of childrens they're actually neurological so  it should really be a neurological disorder,English
+anyway but unfortunately about the only ones  who are decent at identifying Sjogren's are   the ophthalmologists or evaluating patients with  dry eyes maybe they may be a sharp dentist who's,English
+evaluating symptoms of dry mouth but childrens  can affect just about any part of the body so any   organ system can be involved and of course if the  autonomic nervous system is involved secondarily,English
+just about any organ system can be affected  by the autonomic impairment thirdly mass cell   activation which there was just a talk on in this  room is very common in Sjogren's syndrome and just,English
+about anything can be affected by mast cells  so all of these things can result in multiple   systems being involved so it's interesting if  you look at the epidemiology of Sjogren's it's,English
+actually very similar to pots in terms of the  agender propensity so this is 90 plus percent   in females so this is a female predominant  condition the so it's it's not common at all,English
+in males and why is that I have no idea the it's  been suggested that the age of onset is in the   fourth to fifth decade I'm skeptical of that  I think that may mean that patients are more,English
+likely to get diagnosed in the fourth to fifth  decade but onset of symptoms may be much earlier   it may be that it takes 15 years for laboratory  studies which are horribly insensitive to begin,English
+with to become abnormal it's unclear it may be  more common in in Caucasian women but I don't   think the data I don't really trust some of this  data in terms of of diagnosis there have been a,English
+number of studies looking at the prevalence of  of Sjogren's syndrome across the world you have   to take that with a grain of salt given what  I've said about how difficult it actually is,English
+to diagnose Sjogren's so what do we rely on rely  on Auto antibodies SSA is the primary one that we   look at we're interested in symptoms of dry eyes  and dry mouth and then we use the minor salivary,English
+gland biopsy to make the diagnosis the criteria  for establishing a diagnosis of Sjogren's it looks   horribly complicated on this slide it's actually  not all that complicated so these days folks have,English
+to have dry eyes and dry mouth they have to not  have a condition or be on a medication that is   the cause of that dry eyes and dry mouth and then  what we're looking for is something abnormal on,English
+testing so minor salivary gland biopsy abnormal  lab so something quote-unquote objective is what   we're looking for so what's the problem with  this well in Neurology it's actually well known,English
+I have a slide on this in a little bit that the  dry eyes and the dry mouth may not occur right   away in people with Sjogren's it may occur later  so as a neurologist it's my job to a cause for a,English
+person's condition I should not be relying on dry  eyes and dry mouth necessarily when attributing autonomic dysfunction or neuropathy to Sjogren's  it's been suggested that ssa antibodies may be 50,English
+to 70 percent sensitive I'm pretty skeptical  of that number I'll show some data here in a   second but other ant other Auto antibodies  may be seen with Sjogren's as well when you,English
+have any autoimmune condition you may see other  antibodies present with that autoimmune condition   so for example it's not uncommon for people with  Sjogren's to have an antiphospholipid antibody,English
+also present that does not necessarily mean that  somebody has antiphospholipid antibody syndrome   so so so with any autoimmune condition you can  see other antibodies present and often do there,English
+are novel antibodies or what's been called the  early show panel so this is sp1 CA 6 and PSP so   these are proteins that have been reported to  be abnormal in a very small cohort of people,English
+with pots so I get asked about this a fair bit  these may have utility in in Sjogren's syndrome   unfortunately the data is not great in terms of  there haven't been a lot of patients studied other,English
+antibodies have been reported in conjunction with  Sjogren's also there likely are other antibodies   that haven't even been demonstrated yet that may  be more sensitive and may be pathogenic so you,English
+might imagine an antibody against a salivary  gland tissue it's possible that that could   correlate with dry mouth right but is that going  to correlate with autonomic dysfunction see I,English
+would be more interested in an antibody against  say nerve or nerve receptor or something along   those lines so I tell our I tell our neurology  residents at Mayo that Sjogren's syndrome you can,English
+put it on your list of things that can literally  do anything to the nervous system and Sjogren's   syndrome can do anything to the nervous system so  we we torture our residents sometimes we say all,English
+right well what's the differential diagnosis  for a particular condition and Sjogren's you   can put actually in the differential diagnosis  it's a diagnostic possibility for just about,English
+anything within Neurology a really important  paper from the Mayo Clinic really highlights   the limited diagnostic utility sensitivity of  the testing for Sjogren's and this was a paper,English
+looking at peripheral neuropathy and Sjogren's  syndrome patients so these are people who had   typically sensory symptoms a sensory neuropathy  numbness tingling sometimes pain and this really,English
+demonstrates the challenge in diagnosing Sjogren's  syndrome and many of our patients so this is a   reqtest retrospective study dry eyes or dry mouth  ultimately occurred in most patients but were,English
+the initial symptoms and only 11% so dry eyes  and dry mouth which we think of as sort of the   hallmark and is used in the diagnostic criteria  for childrens may not be an initial symptom and,English
+in fact at least when present with neuropathy is  often typically not the initial symptom in this   study ssa so at Mayo we have this ena antibody  that we checked and if it's abnormal we break,English
+it down into other antibodies but and that  can include SSA SSA was abnormal in only 10%   of this cohort patience and this in fact is in my  opinion just an opinion in my opinion is probably,English
+the sensitivity of SSA in diagnosing Sjogren's  so if it's abnormal that's helpful but if it's   not abnormal if it's normal we literally may be  missing 90% of people minor salivary gland biopsy,English
+they reported that 73% those 33 folks were tested  so minor salivary gland biopsy at least going by   this data we may be missing Sjogren's in a quarter  of patients or more I can tell you we haven't,English
+looked at the data yet we've done 180 ish minor  salivary gland biopsies now looking for Sjogren's   and in my experience this is when I really  think somebody you know has Sjogren's it's the,English
+the frequency of this being abnormal and somebody  that I think actually has Sjogren's is seems to be   quite a bit less than 73% so again in this case  that really important to recognize dry eyes dry,English
+mouth occurred after neuropathy in most patients  so in some patients it'll occur at the same time   but the dry eyes and dry mouth which again we  think is of the hallmark of the condition may,English
+occur later so they looked at autonomic testing  and only one of this cohort had significant   autonomic symptoms so does it correlate to  dissident Omiya and what we're talking about,English
+here today perhaps not but in Sjogren's syndrome  with an associated autonomic neuropathy with pots   it might it might so one of the classic papers  from Japan though looked at autonomic dysfunction,English
+and a very large cohort of patients and found that  that autonomic dysfunction was actually common and   as I said earlier that autonomic failure where the  autonomic nervous system is failing can't occur,English
+the they did pathological studies and found  that in patients with Sjogren's the Sjogren's,English
+could affect the autonomic ganglia so there are  autonomic nerves and their autonomic ganglia the   ganglia are you can think of it as the cell body  it's the control structure of the autonomic nerves,English
+so Sjogren's seems to have a predilection for  affecting autonomic ganglia and so they seem to   be particularly vulnerable to immune mediated  attack in folks with Sjogren's so the other,English
+points made actually by my colleagues from from  the Mayo Clinic in Rochester suggests that the   abnormalities that are associated with dry eyes  and dry mouth may not be particularly relevant,English
+with respect to the development of a neuropathy  and in such patients we should look at targeting   the autonomic neuropathy that that may be a  manifestation of Sjogren's the other really,English
+challenging thing about Sjogren's is if you look  at any autoimmune condition autoimmune conditions   have a tendency to wax and wane they get better  they get worse they get better they get worse and,English
+this is particularly true and children syndrome  and so when we treat Sjogren's syndrome when   we think about clinical trials hopefully in the  future with children syndrome that really needs,English
+to be kept in mind I'll speak to that here shortly  so I mentioned earlier it's been well recognized   perhaps not well recognized it's been described  that autonomic dysfunction is common in children's,English
+this was a large Korean cohort and they found  on autonomic testing a high frequency of having   autonomic dysfunction this was just people in  a Sjogren's clinic without particular autonomic,English
+complaints again another study demonstrating  that autonomic involvement in Sjogren's was   common another study demonstrating that autonomic  impairment in childrens is common this is all in,English
+the Rheumatology literature a really important  study looking at 317 patients with Sjogren's   demonstrated that patients had higher disease  index scores when they had autonomic symptoms,English
+the autonomic system seems to be vulnerable  and may correlate with disease activity in   in children's we looked at we wanted to report  that not only autonomic failure and autonomic,English
+neuropathy can occur with Sjogren's that pots can  occur in association with Sjogren's as well and   now at this point we're up to somewhere between  70 to 80 people which is a pretty large cohort who,English
+we've diagnosed or to a lesser extent others have  diagnosed with with Sjogren's so almost everybody   so this is the data that we've looked at so far  almost everybody's female as I mentioned earlier,English
+the mean symptom duration prior to the diagnosis  of Sjogren's was 11 years one person who was 58   at the time that I saw her had gone forty two  years before being diagnosed with Sjogren's,English
+Sjogren's was diagnosed after Potts and 46 of  the 60th at the same time in nine of 60 and not   everybody had dry eyes and dry mouth GI symptoms  GI dysmotility is common in Sjogren's syndrome in,English
+terms of subtyping the pots the neuropathic which  I referred to earlier as pots with an autonomic   neuropathy was most common GI dysmotility wasn't  looked at in everyone formally at least it at our,English
+institution but when it was tested some part of  the GI system had abnormal motility and you can   see that SSA was abnormal in this group and about  half and the rest had an abnormality on the minor,English
+salivary gland biopsy most of the patients  the majority of the patients we had diagnosed   clinically with the mass cell activation disorder  so one of the things that often comes up I,English
+struggle with this pretty much on a daily basis is  when to do a minor salivary gland biopsy so I'll   consider it in people who have chronic refractory  symptoms if people have very significant dry eyes,English
+and dry mouth if the eye doctor if the dentist  has commented on it if someone has significant   GI dysmotility and it smells like shell burns I  may do a minor salivary gland biopsy if there's a,English
+family history of Sjogren's it's highly likely  that this is going to be Sjogren's and we may   pursue a minor salivary gland biopsy one of the  one of the interesting things to me is so if you,English
+think about the most common autoimmune condition  is Hashimoto's why is that perhaps because   the thyroid sits right here and is exposed to  everything that we smell eat drink environmental,English
+exposures if you think about Sjogren's dries in  dry mouth are exposed to the environment perhaps   there's a trigger there that's important perhaps  there's an environmental component but essentially,English
+Auto antibodies we think get stirred up by this  inflammatory soup of mediators I think ultimately   how will diagnose Sjogren's is by identifying  people who have a genetic susceptibility and then,English
+looking at cytokine profiles and hopefully better  Auto antibodies and I'm out of time but I'm going   to just quickly talk about treatment so how I  treat Sjogren's so as hard as children's is to,English
+"can see that the overwhelming majority caused a  reduction in current density with only two causing   a significant increase. Critically variants  associated with benign epilepsy cases, marked",English
+"in blue, do not seem to strongly segregate away  from variants associated with severe epileptic   encephalopathy cases marked in red. One potential  interpretation of this analysis is that the",English
+primary effect of the mutation on current density  is not a major determinant of clinical severity.   A critical question that we can  only address with iPSC technology,English
+is what are the functional ramifications of  these channels on patient neurons where we   can rely on the neurons themselves to assemble  the channel. To address this we've been using,English
+the classification of the from the heterologous  expression model that I described to you before   to select representative variants and analyze  their effects in iPSC patient-derived neurons.,English
+in collaboration with John Millichap and other  clinicians at Laurie Children's Hospital in   Chicago we have set up an IRB approved  protocol that has allowed us to enroll,English
+20 children with KCNQ2 associated epilepsy.   We've made induced pluripotent stem  cell lines from all of these cases   and have successfully corrected their mutation by  CRISPR/Cas9 in approximately half of them so far.,English
+For the next few slides I will present to you data  from one such patient as a case study. This was a   female individual with no known family history who  was clinically diagnosed with epileptic seizures,English
+within one month after she was born. At the time  at which she was recruited in our program she   was already 13 years old and she had significant  neurodevelopmental delay. Clinical genetic panel,English
+testing revealed a single de novo heterozygous  variant in the KCNQ2 gene which resulted in an   R2581Q amino acid change. At the bottom left  I'm showing you the sequencing chromatographs,English
+"depicting the heterozygous mutation in  the middle, in the case of the patient,   and one of the isogenic control corrected  clones that we used in our study.   At the bottom right I'm showing you some basic  characterization of the differentiated Ngn2 based",English
+cortical excitatory neurons all of which are  glutamatergic and all of which are earmarked   with GFP so we can identify them in culture.  One of the platforms we used to interrogate,English
+the excitatory neurons derived from this patient  was the multi-electrode array which allows us to   record spontaneous activity from populations  of neurons across a period of time in vitro,English
+during which the neurons are continuously  maturing and developing a functional network. This is some of the primary data. Critically  I'm showing you here in the top left,English
+that we compared a similar number of plated  patient and isogenic control neurons.   One of the first observations that we made  was that the patient neurons exhibited an   earlier initiation of spontaneous activity shown  here at the bottom with this raster plots for,English
+"days 12, 13, and 15, and quantified up here  as the rel as the number of active electrodes   in patient neurons shown in red and  isogenetic control neurons shown in blue",English
+"as well as the mean firing rate for each one  of the different genotypes. Most importantly   when we evaluated the activity of these neurons  across several weeks in culture, we observed a",English
+"robust shift in their firing behavior in the case  of the patient cells. We specifically found that   the mutant neurons exhibited a high number of  bursts, an increased number of spikes per burst,",English
+as well as an increased percentage of  all spikes that occur within bursts.   This is shown here in the raster plots on the  top left as well as this in in these quantitative,English
+measurements across time at the  bottom. Collectively these metrics   are telling us that the patient neurons exhibit  significantly enhance spontaneous burst firing.,English
+We are excited about this  findings because children   diagnosed with KCNQ2 associated epilepsy exhibit  a characteristic pattern in their brain EEGs   known as a burst suppression activity pattern.  They specifically show highly synchronized firing,English
+i.e. bursting followed by intermittent  periods of very little activity.   In fact when we represented the iPSC-derived  neural data in a raster plot within the same,English
+"20 second interval as the EEG pattern shown here  we highlighted a burst suppression firing pattern   which was highly reminiscent of the one seen  in the patient EEG, essentially recapitulating",English
+epilepsy in a dish. This provides us  with one phenotypic platform that can   be used to interrogate disease mechanism  as well as to assess therapeutic options.,English
+To better understand what is the mechanism  that drives this shift in firing behavior   we use single cell patch clamp analysis. In fact  when we analyzed on average 50 to 60 neurons,English
+per genotype across independent differentiation  cohorts we found that the patient cells exhibited   an enhancement of action potential repolarization  with faster action potential half-widths,English
+and enhanced fast after hyperpolization  potentials. Most strikingly the post-burst AHPs   were larger in patient neurons throughout  the timeline of our recorded experiments.,English
+Using transcriptional and pharmacological  approaches we identified a set of dishomeostatic   changes driven by the functional upregulation of  potassium currents mediated by BK and SK channels.,English
+On the left is quantitative real-time PCR analysis  showing the up regulation of several potassium   channel and other associated genes in the patient  neurons after weeks 3 and week 5 in culture. On,English
+"the right I'm showing you that in fact treatment  of patient neurons with the SK and BK channel   inhibitors Apamin and Paxilline rescued the phasic  bursting, while the zinc treatment had no effect",English
+on isogenic control neurons. We next wanted to  ensure that these rather unexpected changes were   identified were indeed driven by the primary  defect of the mutation on M-current itself.,English
+"To test this idea we chronically treated control  neurons with a specific M-current blocker known   as XE991 and assessed neural activity by single  cell patch clamp, multi-electrode arrays, as well",English
+as by quantitative real-time PCR. We found that  chronic inhibition of M-current in control neurons   phenocopies the alterations seen in  mutant KCNQ2 patient-specific neurons.,English
+"Interestingly the effects of chronic inhibition  were in some cases more dramatic than the ones   seen on patient neurons, moreover while the  transcriptional changes were not a hundred",English
+percent overlapping between the patient neurons  and the chronically treated control neurons.   The um overall dishomeostatic mechanisms  were concordant with our initial hypothesis.,English
+Everything that I've shown you so far concerns  one particular individual. Critically we have to   determine whether these phenotypic alterations  as well as this dishomeostatic mechanism that,English
+we identified are more broadly relevant across  other KCNQ2 patients. Using the same approaches   that I described earlier we're finding  that multiple patients harboring distinct,English
+mutations in the KCNQ2 gene share the same  enhanced spontaneous phasic bursting phenotype   as measured on a multi-electrode array.  Specifically I'm showing you here two additional,English
+cases next to the R581Q individual shown here in  the five on the far right. Critically these three   cases have dissimilar levels of loss of function  effects on M-current density are shown here based,English
+on the heterologous expression system I described  earlier. This raises several intriguing questions   related to the origin as well as to the mechanism  of this homeostatic adaptation in each case,English
+and we're currently focused on  addressing these critical questions. In summary I've shown you that KCNQ2 channelopathy  is an important cause of monogenic epilepsy.,English
+Many KCNQ2 variants have unknown clinical  significance. Automated patch clamp can categorize   KCNQ2 variants. KCNQ2 iPSC-derived neurons  exhibit spontaneous burst suppression firing,English
+that is reminiscent of the EEG pattern for  KCNQ2 patients. This homeostatic functional   upper regulation of BK and SK currents is driving  the bursting that we discovered in patient neurons,English
+and the question we're currently focused  on is whether these KCNQ2 iPSC-based models   can indeed be used to assess the efficacy of  small molecules targeting potassium channels.,English
+Thank you for your attention and time.  Thank you also to Dina Simkin who's been   spearheading this work in my lab as  well as to our invaluable collaborators,English
+"particularly Carlos Vanoye and Al George,   as well as our funding agencies the NIH which has  been supporting this work through a U-54 center   without walls grant as well as the New York Stem  Cell foundation that has been supporting my lab.",English
+Thank you Dr Kiskinis for that really interesting  and informative presentation. Our next speaker is   Dr David Belair. David performed the work he's  showing here while employed by Bristol Meyer,English
+"Squibb, formerly Celgene, in Summit, New Jersey.  He is currently a Senior Scientist at Abbvie in   North Chicago, Illinois. Today he will discuss  his previous work titled: Modeling peripheral",English
+neuropathy with stem cell-derived peripheral  neurons on multi-electrode arrays. Thank you   for the introduction and thank you to Axion for  the invitation to present on our research. Here,English
+we used an approach to model peripheral neuropathy  using stem cell derived peripheral neurons   and one of the tools that we used to do that was  multi-electrode array the Axion Maestro system.,English
+"Just a quick disclaimer, this work was performed  while I was employed by Bristol Meyer Squibb,   formerly Celgene, in Summit New Jersey.  I am currently an employee of Abbvie Inc.   The views here are my own.",English
+"This is some background information  on peripheral neuropathy which is a   common and debilitating adverse event  often associated with chemotherapy.   The sensory symptoms develop first in the most  distal parts of the body, the hands and feet,",English
+"manifesting as numbness, tingling, paresthesia,  dysesthesia, painful sensations like shooting   or electric shock-like pain, and in severe cases  can lead to loss of sensory perception altogether.",English
+"Sometimes this is also associated with  motor symptoms like distal weakness,   gait disturbance, fine motor impairment,  and rarely with autonomic symptoms as well.   Diagnosis of peripheral neuropathy can be made  from a blood test to rule out a nutritional",English
+"deficiency or underlying condition  like diabetes or immune dysfunction.   Imaging to rule out abnormalities, structural  abnormalities, like a herniated disc or a tumor.   Importantly in what I'll get to later are nerve  function test, electromyography, nerve conduction",English
+"velocity ,functional screens looking at reflexes,  sweat tests, sensory tests, and the most invasive   would be a nerve or a skin biopsy to look  for structural or nerve abnormalities.",English
+"Peripheral neuropathy is most commonly  associated with anti-neoplastic drugs   that act through various mechanisms shown  here on the left are a few examples. In   the mitochondria oxidative stress associated  with Bortezomib, Paclataxyl and oxaloplatin",English
+can induce reactive oxygen species production  which can damage mitochondrial DNA.   Cisplatin and oxaliplatin can also  produce mitochondrial DNA adducts,English
+and vincristine and oxaliplatin can also influence  or affect mitochondrial calcium homeostasis.   In the microtubules vincristine and other  vinka alkaloids bind the beta subunit of,English
+tubulin and inhibit microtubule formation and  paclitaxel and dosataxal belonging to the family   of taxans inhibit disassembly of tubulin resulting  in cell cycle arrest and disrupted microtubules,English
+can affect retrograde and anterior grade transport  along the axon and affect membrane remodeling   resulting in length dependent degeneration of  axonal distal segments. Other mechanisms include,English
+neural inflammation and myelin degeneration  which is often secondary to axonal degeneration   but can also be characteristic of Guillain-barre  syndrome which is an immune disease affecting,English
+the myelin sheath of peripheral nerves. An  underappreciated class of compounds that are   associated with neuropathy are receptor tyrosine  kinase inhibitors. Shown here on the right is a,English
+statistical analysis of clinical trials showing  that patients taking the jeff receptor inhibitors   are at increased risk of developing neuropathy in  the clinic and an analysis of 62 of the approved,English
+kinase inhibitors to date reveals that 30 of them  are associated with neuropathies in the clinic. A case study is presented here for CC-90003  which is a compound that was developed by Celgene,English
+a covalent ERK1/2 inhibitor investigated as  a therapy for solid tumors. So shown up top   is the crystal structure of CC-90003 as well as  a graph showing that it is relatively selective,English
+at least in this publication for ERK and  a few other off-target kinase families   which I'll get into later. This compound had  efficacy in mouse patient derived xenograft models,English
+and specifically in k-ras mutant models  however when this molecule went into the clinic   after 19 patients were treated  in the phase 1a clinical trial.,English
+The clinical trial was halted and development  of CC-90003 was discontinued in part due to   neurotoxic effects that were observed in  the clinical trial manifesting in a few,English
+"different ways. Here is showing the incidence  of dizziness, ataxia which is gate disturbance,   and dysesthesia that I mentioned previously  is a tell-tale sign of peripheral neuropathy.",English
+Putting the clinical trial results in context we  look back at the non-clinical CC-90003 data the   pivotal studies used in the filing prior to the  clinical trial included a 28-day GLP study in mice,English
+where no signs of neuropathy were observed and a  28-day GLP study in dogs with a 28-day recovery   which had standard endpoints as well as  nerve conduction velocity measurements,English
+which were added due to clinical science  of neuropathy in the non-GLP exploratory   study. In the GLP study the same clinical signs  showed up after one week of dosing with compound,English
+at the dose level of 16 mg/kg/day and in addition  to the clinical size the nerve conduction velocity   of the sensory and the motor nerve at that dose  level were significantly decreased during week,English
+one of dosing and week three of dosing. Notably  after dosing cessation the animals did recover   and the nerve conduction velocity returned  to normal levels during study week six.,English
+Further putting the non-clinical data into  context we compared the CC-90003 exposures   that produce neuropathy in dogs and humans.  We use two pharmacokinetic parameters,English
+the maximum plasma concentration or cmax as well  as the area under the curve or AUC of exposure   during the first 24 hours post dose at  these time points and what we saw is that,English
+the exposures producing neuropathy in the dogs  overlap significantly with exposures producing   neuropathy in the clinical  trial by both c-max and AUC,English
+suggesting that 90003 elicited neuropathy  at similar exposures in humans and dogs. Our research question asked whether CC-9003  induced neuropathy in dogs and humans,English
+was on target dependent on Ras-Raf-MEK-ERK  pathway inhibition or was it off-target. To ask   this mechanistic question we needed an in vitro  model. Luckily for us there are several published,English
+reports of models of peripheral neuropathy in  vitro. This is just one example of an assay   looking at neurite outgrowth. In this study the  authors derived human dorsal root ganglion-like,English
+neurons from pluripotent stem cells cultured  them for a period of time in the presence of   a dose response of chemicals and compared effects  on neurite outgrowth with effects on viability in,English
+the dorsal root ganglion neurite assay as well as  a similar assay using a central neuron from LUHMES   and they classified the compounds by effects  on either the peripheral or the central or,English
+both neurons with similar potency.  This is a very useful approach   but these cell types are not commercially  available which limited its applicability to us.,English
+There are a couple sources of commercially  available peripheral neurons. This is one of them   published in 2017. This is the human induced  pluripotent stem cell-derived peripheral neuron,English
+from Ncardia called the Peri.4U cells and using  a very similar approach as on the previous slide   looking at neurite outgrowth. The authors  were able to show sensitivity of a couple,English
+different classes of peripheral neurotoxicants  taxans and microtubule and interfering agents   however they did not show sensitivity to platinum  containing compounds like cisplatin or a model,English
+protein kinase inhibitor which led us to question  the usefulness of the neurite outgrowth assay for   identifying effects of kinase inhibitors.  So our hypothesis was that a functional,English
+readout of neuronal activity may be more  sensitive to a wider range of peripheral neurotoxicants. The assay that we developed  internally used the Peri.4U cells in the Axion,English
+Maestro system so here we use the MEA plates  48-well with 16 independent electrodes per well   and here are just some immunofluorescence  images from the published literature,English
+showing that these cells express MAP2  which is a neuronal marker as well as   Peripherin which is a specific  marker for peripheral neurons.,English
+This is a workflow of our experimental design. We  do coat the plates with PEI which is standard for   neurons we plate on day zero and we culture the  cells for a total of 14 days on the MEA plates,English
+taking readings throughout and I should point out  an important aspect of our experimental design   is that we start adding compound to our cells  starting on day two and we replenish compound,English
+each time we change the medium and so the cells  are in contact with the compound for 12 out of   the 14 days of culture. This is an important  aspect of our experimental design because,English
+peripheral neuropathy often manifests weeks  or months after the initiation of dosing. These are our initial validation  results of the model with known,English
+"peripheral neurotoxicants. We used four Colchicine  which is a microtubule inhibitor, Cisplatin which   is a platinum containing compound, Sunitinib  which is a receptor tyrosine kinase inhibitor,",English
+"and Thalidomide. We looked at three main  metrics: mean firing rate over time and culture,   the number of active electrodes in each well in  culture over time, and the weighted mean firing",English
+rate which is essentially the mean firing rate  normalized to the number of active electrodes.   We did see an effect of three out of the  four compounds at a single concentration   however with two of the compounds in  particular Colchicine and Cisplatin,English
+we saw a significant decrease in cell viability  over the 14-day culture 12 days in contact with   chemical. We did see that the effective Sunitinib  on mean firing rate and weighted mean firing rate,English
+was a specific effect on electrophysiology  with no corresponding cytotoxic effect. Importantly the model system was sensitive  to effects of CC-90003. We did perform a,English
+dose response characterization and at this point  I'd like to point out that throughout the 14-day   culture we see effects over time and the easiest  way to quantify those effects in time is to,English
+calculate an area under the curve of each metric  over time at each concentration of chemical.   So on the right I'm showing the area under  the curve for the weighted mean firing rate,English
+metric for CC-90003 on the top as well as another  inhibitor of the same pathway UO126 which is a   mech one two inhibitor and both compounds potently  inhibited weighted mean firing rate in this assay.,English
+"The approach that we took to  examine the ERK dependence   of our in vitro findings was to evaluate the  kinase selectivity of CC-9003, sunitinib, as well",English
+as 12 structural analogues of CC-9003. We screened  many more than 12 in this kinase selectivity assay   but we selected 12 of them for downstream and  vitro screening based on their varied selectivity,English
+of other off-target kinases. So you can see on  the panel on the right all of the compounds with   the exception of sunitinib potently inhibited  ERK1 and 2 activity as well as BRAF activity,English
+however they exhibited a range of specificities  against these other off-target kinases. We performed a dose response characterization  of all 14 compounds through the in vitro assay,English
+and compared our results to internal ERK  IC50 biochemical data as well as the kinase   selectivity data from the z prime light acid that  I showed you on the previous slide and what we,English
+found were three things: one that the effect  of the compounds on electrophysiology was not   correlated with ERK inhibitory activity although  we can't rule out ERK dependence just yet.,English
+It was not correlated with cytotoxicity either  suggesting that the effects of the compounds on   neuronal electrophysiology were independent of  cell cytotoxicity but the effect was correlated,English
+with kinase selectivity using this metric  of comparison called the Gini Score which   is a metric used to compare selectivity of kinase  inhibitors where the lower the score the lower the,English
+selectivity the higher the score the higher the  selectivity and you can see now why we chose the   12 structural analogs of CC-90003 they had  lower and higher selectivity than CC-90003,English
+and notably sunitinib had the lowest selectivity  of all the compounds that we tested. With our   in vitro data in hand as well as our z prime  light kinase selectivity data we had a tool set,English
+available to evaluate potential off-target effects  on kinases besides ERK that may be correlated with   in vitro activity of these compounds and may then  also be associated with neuropathy. These are just,English
+a few of the correlations that we pulled out the  first example is FER activity was significantly   correlated with potency of inhibition of  the number of active electrodes in vitro.,English
+IGF1R inhibitory activity was correlated with the  potency of inhibition of weighted mean firing rate   and PDGFRA activity was significantly  correlated with viability IC50 suggesting,English
+that these kinases inhibition of these kinases  may be associated with these in vitro outcomes. We further interrogated the  role of FER kinase and IGF1R,English
+on peripheral neurons using a literature search.  FER kinase is known to phosphorylate tubulin   is involved in microtubule dynamics and regulates  axonal retraction in dorsal root ganglia,English
+therefore there is a plausible association  between off-target fur inhibition and the   potency of inhibition of number of active  electrodes that we saw in our in vitro assay   assuming that number of active electrodes is a  metric of how far the neurites extend in vitro.,English
+"There's significantly more information available  on IGF1R signaling in neurons. IGF1R signaling is   known to promote motility, neurite outgrowth  and survival of peripheral neurons and IGF1R",English
+there were sort of two separate prior sections that they've now Consolidated into one update that hopefully will sort of get continually updated about every,English
+year or so as we move forward I don't think we really have time to to dig into this too much I did want to point out that there is a new edition of table 2,English
+which compiles the clsi breakpoints for NRA back to rallies pseudomonas asnetobacter and Cena which is a really cool resource,English
+um so I hope people have this bookmarked I did get to meet the uh pretty sadama this week and I was super excited um in our next two febrile episodes are,English
+actually going to be about a approaching multi-drug resistant gram-negative infection so hopefully people can use that as a resource as well,English
+okay a good plug for febrile and I will make sure to tweet that out there that's especially acceptable all right the article evaluating antimicrobial,English
+duration for gram negative bacteremia in patients with neutropenia due to hematologic malignancy for hematopoietic stem cell transplantation was published,English
+in transplant infectious disease so these are the results of a retrospective cohort study that was conducted on nutrific patients with mono microbial,English
+gram-negative bloodstream infections between 2018 and 2022 the primary outcome was a composite of all-cause mortality and microbiological relapse,English
+within 90 days after therapy completion so the secondary outcome was a composite of 90-day CDI and the development of mdrgnr bacteria oh these telas are,English
+killing me well they investigated outcomes of short that's less than equal to 10 days intermediate that's 11 to 14 and log to greater than equal to 15 days,English
+so we've got let's see two carpool units we've got two Constantine units and then we've got three or more carpal units all right no significant difference in the,English
+primary composite endpoint was observed for intermediate versus short or prolonged and no significant difference in the secondary endpoint so let's see,English
+it looks like two carpool units wins um this next paper is I think a really uh really good one and uh Daniel you can,English
+jump in at any point for any of these oh it's it's the best ever actually but just to raise expectations um so in CID there was a publication,English
+called antibiotic myths for the ID clinicians uh so this is a really great collection of eight myths related to quote nuanced prescribing of,English
+antimicrobial agents so hopefully everyone's ready I'm gonna just read off the myths and give some sort of initial Impressions but it's it's a really great,English
+kind of quick read that covers a lot of things that come up uh frequently so the first one myth so fastlin should be avoided for CNS infections,English
+um I actually just talked about this last week when I was on service related to a patient who had mssa bacteremia and what I presumed was probably pre-treated,English
+sterilized CSF um in the setting of an EVD on cefazolin and so even though is not seen as something that,English
+we use for CNS infection I don't think I don't think it's that it truly doesn't get into CSF so that was the first one yeah yeah I mean I'm I'm not quite old,English
+enough to have been around when this myth was created but it was last century and it just it just it's there I mean people measure the levels of their,English
+Excellency in its penetration but oh my gosh this is one of those quote-unquote pearls that are actually not true yeah yeah,English
+um all right number two lanae's lid must be avoided in patients receiving ssris which I think we've done a pretty good job when we see articles on this we do,English
+cover them on past Gas how serotonin syndrome is very very rare even when lacelet is used with other serotonergic agents so I think that many ID and uh ID,English
+Physicians and ID pharmacists try to work with teams to suggest that Wellness still is a good option for patients um even if they're on like a very very,English
+low dose SSRI but still I think this is something everyone is still working on yeah I have to say this one kills me we discussed it on rounds again today it's,English
+one of those pearls that is not true that keeps getting passed down and down another myth yeah it causes a lot of fear,English
+um okay number three uh no dose adjustment is needed for Lane's lid and patients with renal insufficiency so this actually was helpful for me I I,English
+have not really adjusted the nasal dosing in adults and I definitely have never used therapeutic drug monitoring um we have to adjust this dose the the,English
+frequency of lenasolin in children by age but um it was interesting to read about this because,English
+I I'm not really cons not really thought about it hadn't really come up before I have to say yeah I thank my clinical pharmacist for,English
+teaching me this I have to say and helping me manage this so thank you yeah okay our next myth clindamycin is a first-line drug for prevention of,English
+surgical site infections and patients with reported penicillin allergies um this one's easy I think many of us have tried to decrease clindamycin use,English
+but um just as a reminder you can use a structurally dissimilar cephalosporin and those with the history of penicillin anaphylaxis rather than using clindamycin,English
+all right the next one is uh trim sofa does not have in vitro activity against strep pyogenes uh this one I thought it's really nice they discussed some of,English
+the micro and clinical studies that show that monotherapy with trim sofa is an option for infection including those with strep,English
+any thoughts Daniel yes no this this is I have to say great what is really well the problem is so so many people are get getting thrown those uh those Z packs,English
+and you know what a z-pack is not good monotherapy for best biogens yeah yeah yeah um all right the next one oral fossomycin is an excellent drug for,English
+uncomplicated cystitis and I wrote gasp the author's point to the most recent randomized clinical data from women with uncomplicated cystitis that suggests,English
+that nitrofurantoin treatment resulted in greater clinical and micro resolution at 28 days than phosphomycin I have to admit I do really love fast for my sin,English
+for uncomplicated cystitis um so maybe I'll just put you know put that little Caution sign up now in my brain,English
+um yeah when did uncomplicated cystitis become so challenging I mean it really has I mean one of the the tough things is sort of the confirmation bias right,English
+ninety percent it's going to get better on its own so you think you're doing the right thing but you're really not yeah um all right and then we're down to the,English
+last two Rifampin and Gentamicin are essential for treatment of Staff species prosthetic valve endocarditis which I think we've talked about this maybe once,English
+or twice um on presscast before but how the data for these adjunctive agents is limited I will say or or really just not,English
+there but but you know this is that what they call the Delphi consensus where you get a bunch of old white confident guys in a,English
+room together and they're like yeah we think it's a good idea let's put that in the guidelines yes let's really start having evidence-based guidelines not on,English
+the Oracle of Delphi consensus guidance all right and our last one was doxycycline is contraindicated in pregnancy and pediatric patients less,English
+than eight years of age so just another great reminder that if you have a serious infection and doxy is the best choice you should use doxy,English
+um that's it I don't have anything else to add for that one all right I'm just cueing it up for all the hate now from the old white guys okay um the article Dal bevanson for the,English
+treatment of acute bacterial skin and skin structure infection and patients with obesity or diabetes a subgroup analysis of pooled phase three clinical,English
+trials recently published in both bed and I like to think of Dalma banson as a long-acting formulation of Vancomycin so ideally instead of giving that,English
+Vancomycin twice a day one would just give the bank the dalba Manson one time per week in the in the office of the infusion center and perhaps avoid the,English
+hospitalization in this publication data from two phase three Trials of dalva vanson and we've got a thousand milligrams intravenous on day one 500,English
+milligrams IV on day eight and they've got a comparator group with a one-phase trial of single dose just 1500 milligrams on day one versus a two dose,English
+1000 milligrams IV day one hit that at 500 milligrams on day eight and double dancing in adults these were pulled summarized separately by Baseline BMI,English
+diabetes status we get clinical success at 48 to 72 hours greater than a 20 reduction in they say lesion size end of treatment eot day 14,English
+and day 28 were evaluated in the intent to treat so in the valve advance and intent to treat population at 48 to 72 hours clinical success was achieved in,English
+89.3 percent of patients with normal BMI and 79 to 88 of patients with elevated BMI clinical success after Double vacancy treatment was achieved in 82.4,English
+percent of patients with diabetes 86 percent of patients without diabetes and similar Trends were observed for infections due to Mass cylinder,English
+resistance staph aureus or am I still unsusceptible staph Aquarius so couple thoughts um kind of nice to have the option of a,English
+single 1.5 gram dose of gabavencin that can run in over about 30 minutes uh still a reminder for that idsa Paradigm of purulent versus non-preillent,English
+cellulitis but here we have this one-time dose to achieve IV levels so would we think about this in non-perial cellulitis,English
+safer for Merino toxicity perspective and a lot less monitoring than that the ID vancomyosin now that sticker shock of only six thousand dollars a dose,English
+yeah I know I always stop a band someone's a little bit easier to get for patients oh sorry uh well ncid I've pulled a,English
+paper Global differences and the management of stapharios bacteremia no International standard of care so this was a survey which was,English
+impressive because they were able to get input from over 2000 Physicians from 71 different countries on six continents over a three week period,English
+and it showed a large variation and practice patterns for staphras bacteremia management throughout the world as reflected in the title,English
+um and showing that there really isn't any necessarily International standard of care uh just for details on the survey it wasn't English a targeted adult and pediatric,English
+clinicians and was distributed through social media email list serves Twitter and WeChat uh so I pulled out some of their main takeaways for mssa safazlin,English
+was the first choice in North America as far as agent versus it seemed like anti-staff penicillins were preferred in other continents and then for MRSA Bank,English
+was generally preferred all over but there was a kind of a broad range of what agents people were selecting the practice of adding adjunctive Rifampin,English
+with sapphire spectrumia associated with infected prosthetic material was more frequently reported in Europe and then the lowest percentage of oral,English
+switch therapy was in the U.S where three quarters of respondents indicated that they never or uncommonly used this plan to do the oral switch and then,English
+the higher highest acceptance excuse me was in Europe where 55 indicated that they use this approach frequently there did there did seem to be some,English
+consensus as far as treatment duration which I think is noteworthy meaning we all are nervous and kind of treat for similar periods of time,English
+um and then they did look a little bit at the use of pet scan as a diagnostic tool which was quite variable that I think likely is related to availability,English
+depending on where the survey respondents are practicing and then lastly there is disagreement about the definition of persistent Sapphire,English
+spectrumia throughout the world I guess not too surprisingly but it seemed like many people use that three to four days of persistent possible cultures but it,English
+of course varied um so there's a lot they have a couple nice figures that um I added in here to look more at the details of as they,English
+broke it up by different regions but I think a really interesting paper to see how something so common that we deal with all the time that we don't always,English
+that there's so much that we don't know or haven't kind of unified our practice on all right well back to UTIs the article,English
+of clinical risk scores to predict tribethaprin sulfa methoxazole fluoroquinolone nitrofurantoin and third generation cephalosphoric,English
+non-susceptibility among outpatient episodes of complicated urinary tract infections among adults was recently published and yes open form infectious,English
+disease all the obvious historical factors such as prior antibiotics interaction with the health care system or being in a facility male sex and,English
+comorbidities drove a higher likelihood of drug resistant bugs but in general lots of antimicrobial resistance being seen even at Baseline so reinforcing the,English
+importance of knowing your local antibiogram resistance rates this next one is from Jama it's entitled continuous versus intermittent mirror,English
+penum Administration and critically ill patients with sepsis the mercy randomized clinical trial and I feel like this one has opened up,English
+Croatia Italy Kazakhstan and Russia the authors concluded that continuous Administration Amir PanAm compared to intermittent does not improve clinically,English
+relevant outcomes and he's I see patients that they took care of with sepsis this is based on 607 patients with sepsis or septic shock based on,English
+um the composite of all cause mortality and emergence of pan drug resistant or extensively drug-resistant bacteria at,English
+day 28. so that composite outcome was present and 47 in the continuous administration of mere penum and 49 in the intermittent group relative risk was,English
+0.96 with a 95 confidence interval 0.81 to 1.13 with a p-value of 0.6 um in general the patients were 60 plus zero white men with fairly low,English
+prevalence of diabetes CKD malignancy they were quite ill 61 were reported as septic shock the infection site was identified in about 70 percent of,English
+patients in the continuous group and 64 in the intermittent with the most common side being respiratory tract and the most common gram-negative,English
+organisms that were isolated are klebsiella pseudomonas E coli and acetobacter they had a couple secondary outcomes,English
+that there were no significant difference in those including 90-day mortality which is about 42 in both groups all cause mortality at 28 days 30,English
+versus 33 percent and the continuous versus intermittent and then emergence of resistant bacteria at day 28 which was 24 versus 25 percent,English
+they had some sensitivity analyzes that didn't identify a specific subgroup and who in whom the primary outcome differed so including patients who specifically,English
+had gram-negative organisms with high mics to carbopenum antibiotics or looking at sort of um High versus low severity of illness,English
+so I you know I put a couple notes patients were Housewives for about nine days and then the ICU for about five days in the continuous group before,English
+randomization meaning patients were generally on antibiotics before this and you know must have had either new or Progressive,English
+infection that triggered their team to prescribe miropenum which certainly could contribute to the fact that these patients may be in a place with,English
+uh poor prognosis particularly compared to trials where patients are sort of enrolled from a community onset sepsis type setting,English
+um so maybe that could explain why antibiotics are less likely to have impact although the patients were quite sick only 10 percent had a confirm bloodstream infection,English
+uh it might be that we can't really extrapolate this to other beta-lock dams like maybe there is something specific to agents like piptazo that are you know,English
+not doesn't carry over to carbopenums um and then I I I would need help I think from a pharmacist to to know about this but just thinking about the dosing,English
+that they use in the trial and and the stability I had sort of thought of mirror penum as not particularly stable for continuous infusion but in the study,English
+they it looks like they changed out the bags every four to six hours which I think is doable and probably not an issue in an ICU setting but just,English
+something to to think about if you were trying to translate it so I don't really know that this is going to change people's minds necessarily to consider,English
+adjusting a clinical pathway or guideline if they already have one that uses continuous infusion because it didn't seem like there were signs of,English
+harm and there were other prior meta-analyzes that showed reduction in mortality with continuous infusion um but I did learn that there is an,English
+upcoming trial called beta lactam infusion group study or blink three which is an excellent Name by the way which compared continuous piptazo or,English
+mirror penum versus intermittent infusion on 90 day all-cause mortality so that may be more of a sort of definitive trial or definitive,English
+um answer for people yeah it's such a tough right I understand the concept and I understand the expectation but yeah here we have a,English
+randomized control trial of not showing the benefit so all right I am talking a lot about UTIs by the way today current pyuria cutoffs promote inappropriate,English
+urijract infection diagnosis and older women was published in CID and they start by writing that the presence of pyria remains for many the Cornerstone,English
+of UTI diagnosis however greater than 90 percent of a symptomatic bacteria patients have pyuria prompting unnecessary treatment so uh the,English
+investors here Quantified pyria by automated microscopy and fluocytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for,English
+UTI and older women now they say the commonly used cutoff of 10 leukocytes for microliter has a poor sensitivity 36 percent,English
+um specifically 36 percent I apologize sensitivity of a hundred well while at a cutoff of 264 that's going to be a hard,English
+one to remember sensitivity and specificity were 88 uh positive negative likelihood ratios of 7.2 and 0.1 so yes using a higher,English
+cutoff for those leukocytes might make a little more sense boy 10 seems really low um and what do I have next ncid I I pulled this because I had not heard of,English
+this before neonatal Pena bacilliosis p-a-e-n-i-b-a-c-i-l-l-i-o -s-i-s so Pena bacillus infection as a novel cause of sepsis and term neonates,English
+with high-risk high risk of sequelae and Uganda this was a prospective cohort of 800 full-term neonates with sepsis,English
+presenting to two Ugandan hospitals and they found that six percent of the 631 patients were testing available had a positive Quant PCR for Pena bacilliosis,English
+thiaminolyticus or penabacillus in blood or CSF so most of these patients had a positive CSF PCR so I was 35 of the 37 reported possible cases and three,English
+percent had a positive blood PCR the infants with the uh presumed penobacilliosis were more likely to be born at home six versus 22 percent and,English
+to have received non-recommended cord stump care 19 versus 38 percent they frequently presented with fever and 92 percent of cases and seizures were,English
+present and half of these patients although I would give the caveat that it sounds like EEG was not available so you're probably missing some subclinical,English
+seizures and there's probably some seizure-like movements that are counting towards seizures that may not be actual seizures but that said you know there,English
+were five of the cases that had presence of another pathogen I would say importantly staph aureus but that was only two of the cases,English
+um and they had a composite outcome of infant death post-infectious hydrocephalus neurodevelopmental impairment which was more common in,English
+neonates with penobacilliosis and 11 of these children died in their original admission I I think there's some question of it,English
+you know where does it really come from it doesn't seem like it's present in the vaginal microbiome at least some people have looked so far uh it has been seen,English
+in some gut microbiomes but potentially just could be from an environmental Source I learned that it's been identified in fish from like Michigan,English
+and soil and India um and so most of the children in the study were placed on empiric AMP gent but it does seem that resistance to amp,English
+vanc and klinda is common for this organism so another reason for concern and the last thing I learned is that this organism produces thiaminase which,English
+would reduce thymine levels so there's this question of whether thymine supplementation with help with neurodevelopmental outcomes but I I'd,English
+never really heard of this bug so this was a really interesting read for me all right so everyone who's heard of this bug before raised their hands yeah,English
+and you can correct how I pronounce it okay so my last article for this section is again a UTI one anti-microbial for seven or 14 days for febrile your,English
+attract infection in many multi-center non-inferiority double flying placebo-controlled randomized clinical trial published in CID and I need to,English
+keep reminding myself that CIS man and CIS women are different when it comes to treatment for their UTIs here 240 participants were randomly assigned,English
+to receive antibiotic therapy for seven days or 14 days in the intention to treat analysis treatment success occurred I'm going to say in only 55.7,English
+in the seven day group and was up at 77.6 in the 14-day Groove demonstrating inferiority with that seven days so one of our few uh articles that Buck's the,English
+trend here it looks like longer is required search all right fungal the research letter candida Orris,English
+Associated hospitalizations United States 2017 through 2022 was published in emerging infectious diseases and here the authors reviewed 192 C or,English
+hospitalizations 20 with BSI bloodstream infection that occurred in 42 hospitals among hospitalizations without bloodstream C or it's the most common,English
+positive specimen types were the axilla 30 you're in 34 percent now most 75.5 percent of the hospitalizations involved an intensive care unit stay mechanical,English
+ventilations was used in 43 percent of ICU cases median hospitalization length was 13 days but a big range from 1 to 209 days in hospital mortality rate was,English
+21 discharge locations included hospice 13 Skilled Nursing Facility 28 and law long-term acute care 15 percent,English
+estimated crude mortality rates were 47 for bloodstream C Horus versus 31 for non-bloodstream infections it's really interesting my paper was,English
+also from emerging infectious disease the fungal one that I pulled a fatal invasive mold infections after transplantation of organs recovered from,English
+drowned donors U.S 2011 to 2021 in this 10-year period 4136 organs from 1272 drowned donors were transplated so I thought that,English
+statistic in and of its own was um interesting so this described four rapidly fatal cases of potentially donor derived invasive mold infection with,English
+"like vector-borne disease. It may be waterborne diseases and these indirect pathways. Whether it's through CO2, through population migrations, we heard a lot about that earlier.",English
+It's very hard to deal with infectious disease outbreaks in places like refugee camps. We've seen this already and the like. So that's a maybe as short as I can overview of the window,English
+"into climate infectious diseases. SARAH FORTUNE: Perfect. So Marcia and Caroline, I'm now going to ask each of you",English
+"but also to climate. So if we take deforestation in the Amazon biome, for example, from an infectious disease perspective, there are two aspects.",English
+"First, the deforestation process is directly connected to an increase in transmission of malaria. And this is documented.",English
+"That's not a hypothesis. That's highly documented. But also, as deforestation happens, humans get closer to this huge reservoir",English
+of viruses that are in the forest in different kinds of animal species. And the possibility of a new zoonosis emerging,English
+"is also very high. In fact, I think we lucked out that nothing has emerged in a greater problem so far. From a point of view of climate, deforestation",English
+"produces less rainfall. And in fact, if you take the entire southern portion of the Brazilian Amazon known as the arch of deforestation,",English
+"it's already receiving less rainfall. So the drier season is longer by about a month on average. And by speeding up this process, then we",English
+"can have all the things that I just mentioned. So if you take deforestation as one example, you increase the transmission of diseases right now.",English
+"It can facilitate the emergence of new zoonoses. And it speeds up the process of climate change that, in itself, can also lead to more transmission.",English
+"So no matter from which angle you look, it's a bad thing. SARAH FORTUNE: And just my job here is going to be to just provide the dictionary aspect of this.",English
+"So the arboviruses are things like dengue, chikungunya, Zika-- things you hear about all the time.",English
+"Those are that set of zoonotic well, arboviral diseases that are being pushed into human populations.",English
+"MARCIA CASTRO: And many others. SARAH FORTUNE: And many others, yeah. Caroline. CAROLINE BUCKEE: So I guess building on what Marcia is saying, I think a lot about livelihoods.",English
+And there are also plant pathogens that we can't forget that are very important for farms and agricultural systems.,English
+"And when we think about what happens when we have either extreme weather events or shifts in seasonality, if you're already living on the edge of poverty, then",English
+"often that means that you have to leave the land. So when we think about climate migration, which is something I think about a lot,",English
+"it's not just climate refugees, which is a huge problem for sure. It's also disruptions to seasonal labor migrants",English
+and the increasing rural to urban migration that we see as a result of changing patterns of the feasibility of different agricultural systems.,English
+"And what that does is it not only connects us even more through mobility patterns, it also pushes people into urban and peri-urban environments",English
+"where we have very high density of population. And so if you were going to design a perfect system upon which to spread a pandemic, you",English
+would put everybody in very close proximity in cities and then you would connect them by global travel as much as you can. And that's exactly what we have.,English
+"And in fact, we're now seeing that problem exacerbated. So it's exacerbated by climate, as Marcia pointed out, because we have people in closer proximity with environments",English
+"where we have a huge diversity of potentially zoonotic emergence events. We've created a system that is not only driven by climate,",English
+"it's also setting us up for increasing and worse pandemics. So that's something I think about a lot. SARAH FORTUNE: And Ari, do you have--",English
+do you want to add to that sort of painting that picture beyond the landscape? Do you have more specific examples you'd like to us,English
+"to think about? ARI BERNSTEIN: Well, one thing I would point out-- and it's always great being with Marcia and Caroline because I'm learning something new every time.",English
+"At this juncture, and having heard everything we've heard today, I think it's really apparent how critical it is we start to think about multi solving.",English
+So deforestation-- big problem for climate change. So maybe 20% of all emissions are coming from chopping down forests.,English
+"Also a big problem for emerging infectious diseases. But when we think about the value of protecting forests, I can tell you that in policy debates,",English
+"we're typically only talking about them as, like, literally carbon vacuums. I don't even know if we get to the deforestation as infectious disease risk.",English
+But the point is that we really need to think about intersectionality in the environmental movement. And I think we've seen that a lot of the conversation has been focused on youth influence that is clearly,English
+an influence of people who are a lot younger and smarter than me having an influence for the better. And I think the good news is that we can actually do things that provide huge benefits both to potentially,English
+"infectious disease risk and also to climate. SARAH FORTUNE: Yeah, actually, so we had a prep session in anticipation of this panel.",English
+"We are doing this entirely spontaneously. No script here. No, and actually this leads really to one of the points that Marcia made in the prep session.",English
+And do you want to expand on what Ari was discussing in terms of deforestation and the complexity both of deforestation but solutions that have emerged?,English
+"MARCIA CASTRO: Yeah, so there's a lot that can be done with regulation. And we know, again, that there's plenty of data showing that the Indigenous",English
+"territories in the Amazon are the most preserved and are the ones that really contribute, by about 27%, in absorbing PM 2.5 in the forest.",English
+So having new lands in the Amazon demarcated as Indigenous territories is a big step forward in preventing areas,English
+"from being deforested. By law, there is nothing like deforestation mining, logging that should happen in those areas.",English
+"And you can see in some satellite images, you can almost see where the boundaries are. However, and I mentioned, legislation is not enough.",English
+And what we've seen in the last four years in Brazil is that those areas have been invaded by miners. And I think everything really exploded end of January,English
+"with a humanitarian crisis among the Yanomami that we had malaria, undernutrition, diarrhea, violence and several diseases associated",English
+"to mercury contamination. So it's way more than just the role of disease, as we mentioned here.",English
+"There is a study published last week mentioning that if we actually preserve the Indigenous territories, we can save about 15 million cases",English
+of respiratory diseases and cardiovascular diseases and save about $2 million from the health system just by protecting this.,English
+"And we publish a study last week showing that although Indigenous lands have very little fires, they are not the ones producing the fires,",English
+"they have twice the risk of having a mortality because of exposure to the smoke. So regulation is necessary, but it's not sufficient.",English
+"We need measures of accountability. We need measures of enforcement so people that actually violate those laws can be held accountable. And then, there's not a message as we had in the past four",English
+"years, go there and nothing is going to happen if you just cut down the trees. SARAH FORTUNE: And actually, can you say just a little bit more about measures of accountability and enforcement?",English
+"At what level are those most effective? MARCIA CASTRO: Yeah, so in 2004, I think it was the peak of deforestation,",English
+"Brazil was completely out of control, then that's the first term of President Lula. And then they had several measures,",English
+"first in protecting land, and again now there have been already three Indigenous lands that have been demarcated, none in the past government.",English
+"In fact, some were removed in the past government. So legislation is one. But there were an entire network of surveillance that",English
+was put together on the Amazon. And people were-- actually they had to pay fines. They were being held accountable.,English
+There was the entire satellite system that put together. Now we have daily alerts of deforestation every single day. We know where things are happening.,English
+But knowing is not enough. You have to take action. So we had about 10 years of those things really happening in an effective way.,English
+"And it was the most drastic decline in deforestation. In the past four years, everything reversed. And how did this happen?",English
+"So a lot of the legislation was relaxed. A major legislation we had in the past, the Senate is trying to reverse this now.",English
+"But they basically said every single Indigenous land that has not been demarcated until '88, that's the year of the Constitution,",English
+they're going to lose it. They were the owners of everything. So pretty much every step forward that were made in terms of holding,English
+people accountable in piece of legislation in the past four years were put down. So it's going to take some time to bring those back.,English
+But you know. SARAH FORTUNE: So I'm going to go a little off script here because actually what you just said about data and its being important in terms of holding governments holding,English
+"us all accountable seems resonant to actually, Caroline, a lot of your work. And I was wondering if you wanted",English
+"to expand on that-- the importance of data. CAROLINE BUCKEE: Sure, I'm happy to do that. So I work a lot in infectious disease surveillance,",English
+"and I work with control programs a lot to try and identify hotspots of transmission for resource allocation questions. What I would say is that on this topic,",English
+"we have massive data gaps. And we-- not just that we're not collecting data in a way that's integrated into health systems, which",English
+"would be a first step, right, environmental data and health system data in one place so that we can start to ask some of these questions.",English
+But I also think the types of data that we have available reflect certain global priorities that may not be local and regional priorities.,English
+"So we may not be going after the right thing. And I also think there's a major problem with mechanistic data. So at the moment, we have a lot of beautiful maps,",English
+"and we have a lot of associations, for example, between the length of time it takes a parasite to develop in a mosquito at different temperatures.",English
+"And so what often happens is we get beautiful models where we take that sometimes nonlinear relationship, we tack it onto a beautiful map like this,",English
+"and we get a projection of where we think dengue risk is going to be in 30 years or something like this. That-- those maps are useful for advocacy,",English
+"but they are not useful data for control programs. And they're not mechanistic in the sense that we don't understand many of the social aspects,",English
+the economic drivers. These are not multidisciplinary efforts. And so I think there are two types of gaps on the data in terms of what we need to do.,English
+"The first is that we need to start collecting environmental data as a matter of course, within our health systems. And the second is we need to start building up",English
+"mechanistic relationships in the context of some of the behavioral and social realities in places most affected, and that's still a huge gap.",English
+"SARAH FORTUNE: So Ari, the other sort of data we have is our own learnings. And we just went through a pandemic. Is there anything that we can take",English
+"And this is-- to the faculty at the Chan School was the pivoting on a dime to address this global health crisis, right. So you saw people of all backgrounds trying",English
+"to figure out how we as a scholarly community could contribute. And I only get three lines, but one of the things that I think really",English
+"spoke loudly to me was the work of Francesca Dominici, who was here and may still be here, and her team that underscored that when we think about air quality improvements,",English
+"we tend to think about lungs, which is important. We think about mortality. So we know from the Six Cities study that, among others, that air pollution",English
+is really bad for people living to their expected age. But also turns out that even small amounts of difference in the air we breathe over a decade,English
+"can have profound effects on whether people lived or died from the pandemic. And that is a huge environmental justice piece. And so when we heard from EPA about these rules,",English
+"when they talk about these benefits, whether it's from the mercury rule or the fuel economy rules, the air pollution rules from trucks,",English
+"we haven't even included those yet. And so I think it's extraordinary that from this disaster, we can see the greater",English
+"benefits of these actions we're doing on climate, particularly from an environmental justice standpoint. And I think that was one point that struck with me.",English
+"SARAH FORTUNE: I'm going to take this moment to just take a brief time here and clarify my timing instructions. Because oh, and I have 10 minutes until the 20 minutes.",English
+"Cue your questions up. This is actually I think all of the issues that you were discussing are reflective of the themes that you've heard through the day,",English
+and this would be a great time to have a broader conversation. So I was wondering actually I wanted to come back to this question of equity and climate,English
+And I was wondering if you could expound on the problems of migration and how that's going to-- forced migration and how that plays out.,English
+"there's so many axes that we can talk about. There's, of course, large global inequalities between countries. And we saw that play out, both in mortality but also vaccine",English
+allocation and the frankly immoral distribution of vaccines around the world to different countries. And in the context of these intersecting health risks.,English
+"So the problem with the climate and health intersection is that if you are already vulnerable, then any stress on the system is going",English
+"to make you even more so, which we know from many different crises. But what it means on a global scale is that we have,",English
+"if you look at South Asia, we have millions and millions of people who are already affected and have been dealing with extreme weather events and gradual increases",English
+"in temperature for a long time who are going to be the ones that are already feeling the effects now, and that",English
+"will get worse into the future. And in terms of the mobility data that my group works on and some of the migration issues that we've seen,",English
+"that has certainly been getting worse over time. With regards to solutions, I don't-- I think we here in the global North",English
+"have a lot to learn from our partners in the global South who have already been facing some of these challenges. If you look at Bangladesh, they do a great job",English
+of responding to cyclones because they've been dealing with it for many years. And I think we will continue to see innovation from our global South partners when,English
+it comes to some of the challenges of heat adaptation and figuring out how to respond in the wake of natural disasters.,English
+"And so, I think meaningful academic partnerships that reflect where climate change is having the most impact, which populations are most affected and really trying to understand",English
+"and listen to some of the researchers there on the ground is going to help us not just prioritize, but also come up with some of the innovations that we need.",English
+"Because I think, if you look at what happened with COVID, the same epidemic was not the same in different communities in terms of mortality,",English
+"in terms of response, and in terms of how policies were enforced. And so, I hope that in the wake of the pandemic,",English
+we will have a kind of re-imagination of global health partnerships in the context of the climate emergency as well. So I've given you no solutions.,English
+But I think the way forward has to be a major global effort to think in an integrated way about some of these challenges and not assume that we know people's realities.,English
+"in terms of equity really come from a predatory model of the so-called development that is just based on exploitation of resources,",English
+"ignoring local people, their culture, their knowledge, their needs, everything. So to me, if we really want to address equity,",English
+"it really starts from listening, understanding and working together. So anyone that comes here and say they have the solutions for the Amazon",English
+"and they've never been in the Amazon and they don't practice the listening, understanding and working together, it's wrong from the get go. So we have, thanks to a program that was put together",English
+"when President Lula was president the other term, a lot of energetic and really bright young Indigenous leaders made it to the university,",English
+"and they are now really leading their communities in fighting for their rights, in improving education, in improving community health.",English
+"They use drones to fight for environmental justice. And we recently, now, in this new term of President Lula, for the first time ever in our history, our meeting in Brazil,",English
+we have a minister of the Indigenous Peoples. So this is an incredible opportunity to give voice to the unheard.,English
+"And that's how you address equity. It's bringing those people to the table, sharing their knowledge. They have solutions we never thought about.",English
+"And I think this is one of the clear examples of if there is a will, there's a way. Where I think we're finding a way,",English
+and we hope we can continue on this path to address some of the issues on equity that we have. SARAH FORTUNE: So this is the time,English
+"when people who have questions should start making their way around. And Ari, yes?",English
+"ARI BERNSTEIN: I was thinking, if I can get one more shot at the solution speak, because we need solutions. So I was listening to Marcia and Caroline.",English
+"You know, I think for many of us, there's an unprecedented awareness to the divergent paths of the richer countries in the world and the low and middle income countries of the world",English
+"that the pandemic showed us. I mean pandemics show us in the most painful way what we need to fix in the world. And in the aftermath, I think one of the things",English
+"that many of us realized is that our foundational approach to dealing with infectious disease, and I'm mindful I'm going to the CDC, so be careful here,",English
+"is frankly a reactionary approach. It's let's wait for people to get sick and then try and fix it after the fact with tests, drugs, vaccines. Now, we're always going to need that.",English
+"They're always going to be infectious outbreaks. I mean, for heaven's sakes, we have this huge population. We're interconnected. I like to think of that as sort of the lighter",English
+"fuel of global pandemic risk. But the kindling for it is actually how we're doing business with nature. If you look at most of, and certainly the pandemics,",English
+"but most of the major emerging infectious diseases they're coming from other animals, sometimes livestock, sometimes wild animals. And we have enormous opportunities",English
+"to prevent the movement of those diseases into people. We do it to a certain extent now, but when we looked at how much we're",English
+"investing in what I would call these primary prevention strategies. So I'm a pediatrician. We're all about-- pediatricians, we're",English
+"all about preventing people from getting sick. And most of the people I talked to, we tend to like to just not get the cancer first, not get treated for the cancer.",English
+"Not get the heart attack, prefer not to get the heart attack. I think all of us prefer to just not have as many of these emerging infections from things spilling",English
+"from animals into people. And when we look at this, it is the best buy on the planet. Especially when you look at the reality that some of these strategies involve conservation of nature",English
+"potentially. So the other thing we always got critiqued about in this work was well, how do you know this stuff's going to work? And I said, I don't know that we do.",English
+"Because we don't have the data we need. We don't have trackers. There's more paradigms, but they're very small. But then we said, well, how ineffective can these things",English
+be to still make them cost effective? And they can be radically ineffective. Why? Because the value of doing these things,English
+"creates benefits to health equity. So think about this, folks. Most of the emerging infectious disease crises happen in low- and middle-income countries.",English
+"The resources that get deployed are in rich countries. So whether it's the vaccines, the tests the drugs that aren't getting there and need to,",English
+the profits are going to rich countries and their corporations. The damages are greatest in low-wealth countries. But when you prevent.,English
+"at the source, when you stop these events from happening the first place, the benefits accrue greatest in these communities. So there's work from Matt Bonds, who's at HMS,",English
+"and Andy Dobson looking at data out of Rwanda where they show this fascinating interplay between infectious disease burden, economic development,",English
+which is nothing new. That's been known for a long time that infectious disease burdens create poverty traps. But the ecological substrate of the community.,English
+"So there's this interplay. If you are poor, what are you going to do? You're going to rely more on nature. Chris Golden's work-- Chris was here.",English
+"His work in Madagascar has shown this. The people who are most at risk in many places for iron deficiency anemia in Madagascar, they need to have wild animals to provide food.",English
+"And if you take that away from them, they're likely to have nutritional deficiencies. So we see this globally. So you have infectious disease burdens.",English
+"That drives poverty. It drives greater destruction of nature. And what happens when you destroy nature, you risk having more infectious disease outbreaks.",English
+"So the point here is you can get a win for equity, a win for climate, and you can protect communities that are where these diseases tend to erupt.",English
+"SARAH FORTUNE: Fabulous. I see-- I just I'm so mindful that people haven't had the time to have questions, and so it's all you. AUDIENCE: Hi, my name is Erika Arteaga, and I am from Ecuador",English
+"and it's great to be here, but also, I was telling people that in climate change, you need to have hope.",English
+And I'm totally here disheartened because my country is living a huge violent wage with narco traffic and narco drug dealers. So my question is regarding prevention and prevention,English
+"low-income countries, middle-income countries and Brazil. I'm just going to quote an Uruguayan journalist his name is Raul Zibechi.",English
+And Raul Zibechi wrote something regarding Peru. I'm tackling all the region because I think narco trafficking and narco warlords are,English
+"a problem of Latin America. And I'm going to tell you the link between climate change. So Raul Zibechi was interviewing Brazilian Rocio Silva-Santisteban, a former Congressman, a leftist,",English
+and human rights activist. And she said that an emerging voice that is anchored in the illegal economy often linked to drug trafficking and that has,English
+"its representatives in all parties from the extreme right to the host of the post Pedro Castillo. This neoliberal sector rejects the legal rules,",English
+but embeds itself in the power apparatus because it needs to have a protective umbrella for its business and interest. Then he goes on and saying 27% of all imported mercury,English
+"goes to illegal mining from Peru and Bolivia, a trade that follows the Amazon Route from Puerto Rico, the Puerto Maldonado to Lake Titicaca.",English
+"And about half of the 1,100 tons of mercury that arrived in Bolivia between 2014 and 2022 come from Mexico, exported by Mexican businessmen with Peruvian intermediaries",English
+and small- and medium-sized containers. The Amazon regions of Peru and Bolivia are the main producers of gold and he goes on and on with more data saying,English
+"these businesses in our region are super hard to follow because Pandora papers. There's a scandal of paradises, fiscal paradises",English
+"and everything. And so we now have in the region a very intermingled situation between narco traffic warlords, mining, illegal mining,",English
+"extractivism, territories devastated by violence. We have beheaded people every day in Ecuador all day in the main cities.",English
+"And then he was treated, which a five-year-old being treated for Lyme meningitis was like so complicated, and I'm still traumatized.",English
+"system, the training of health professionals because ultimately I feel like I'm being failed as a parent or I don't have the partners that I need to help",English
+"we can now say that in the Harvard Medical School curriculum, every Harvard Medical student that graduates Harvard Medical is going to have to confront this. But it's not just Harvard Medical School there's",English
+and he always gets cut off. [LAUGHTER] ARI BERNSTEIN: That's Josh. MARCIA CASTRO: He's an alumni--,English
+and especially in the context of emerging pandemics in sometimes in low- and middle-income countries where we may not be familiar with the biology,English
+"and transmission of pathogens that emerge, and we will need to be ready. So there's going to be a shift in what's rare everywhere",English
+"that we will need to learn about. But right now there's CEPI, which is trying to make vaccines against some pandemic-prone",English
+"but now rare infectious diseases, but the funding models have to change. Also for research to reflect pathogens",English
+"that have pandemic potential and are important already in parts of the Global South, but have not yet become common enough here for people to be well versed",English
+"in them. And so I think again, we have to shift our whole mindset about what it means to be rare, what might be rare now but will not be rare in the future,",English
+"and have a much more adaptive system of research funding allocation and focus, frankly, when it comes to pandemic preparedness as well.",English
+AUDIENCE: Thank you. So I'm an alumni of the school and now work on these issues in the federal government. And I'm wondering if you all could talk about how you walk the boundary between these issues,English
+aren't so simple. They are complex. But not so complex that we just throw up our hands and give up. SARAH FORTUNE: Caroline.,English
+"CAROLINE BUCKEE: I do think that some fields are due for a major reckoning. And I think that for those of us in infectious disease,",English
+"I think we all need to think very seriously about the research, what the important research priorities are.",English
+"And how we can stop paying lip service to saying the word interdisciplinary and actually doing interdisciplinary work. And I don't just mean oh, I collaborated with a physicist,",English
+"so it counts. I mean like cross-university, cross-country, real collaborative conversations. At the moment, one of the things that's hard",English
+"is that we're all scrambling for time. It's very hard to have long, deep, thoughtful conversations and read the scientific literature across fields",English
+"and speak each other's languages. I think we have to really prioritize truly multidisciplinary research. Because when you do, I think extraordinary things",English
+can happen. And we start seeing innovation flourish. But we can't do it without really re-examining research priorities and our abilities to break down silos.,English
+"Because universities kind of create silos by mistake over time, and we need to find real ways to come together",English
+"on some of those issues. SARAH FORTUNE: Actually-- Oh, sorry. MARCIA CASTRO: A very quick answer. Josh, we can't give up because we don't have another planet",English
+to live. It's everyone's responsibilities here. So it's challenging. It's frustrating. But we've got to keep moving.,English
+CAROLINE BUCKEE: I also think there is some low-hanging fruit. There are some really basic things we just need to go out and measure and measure,English
+"well and start doing the work. SARAH FORTUNE: Well, and a lot of room for innovation, right? Actually, just in thinking of the infectious disease diagnostic question actually new technologies,",English
+AI is going to be our friend in terms of thinking about how to practice medicine adaptively. CAROLINE BUCKEE: Right.,English
+"SARAH FORTUNE: And so there's a lot of room for really radically rethinking how we do business. CAROLINE BUCKEE: Yeah, we have now",English
+"like paper-based multiplexed assays so you can tell more than one disease on, and it's heat stable, and you can get it out into different places.",English
+"There's a ton of things happening. It's just about translation, I think. SARAH FORTUNE: OK, Kari, I feel like there is a person standing behind you.",English
+"You should have the last word anyway, so you go. AUDIENCE: Hi my name is Anna Makris. I work as a public health epidemiologist,",English
+"and I want to speak to two points that you raised earlier. Sorry, speaking to Caroline, in particular, but curious to hear anyone's thoughts about data",English
+"and thinking about some of the gaps that you identified in our current data systems. So one thinking about, as you said, the need for data on the environmental side",English
+and the human health side to be combined in a way that can be usable and operationalized. So I'm wondering at what level you,English
+"foresee that being able to have the greatest effect. And what feasibly, given our politicalized often public health system in our country,",English
+"where that can happen most effectively. If that needs to happen at the state level, at the federal level, more locally. That's one question.",English
+And then another question was thinking about you mentioned having the need for data to be driven not only by the sort of global,English
+"or sort of predominant priorities but by local priorities. And I'm wondering there whether, or if you could describe some examples of places where maybe qualitative research has",English
+"helped to inform the way that data systems are collected. And then sort of again, with that and thinking about the silos in which we work, whether it be like the academic, public silos,",English
+"or within either of those two spheres, how you see opportunities for bridging those silos through this type of restructuring",English
+"of how we collect data. CAROLINE BUCKEE: OK, I'll try. So as far-- well, actually, parts of your questions",English
+"are, I think, together. So I think the local prioritization is also the data prioritization. And so I think, partly because the spatial and temporal scales",English
+"of the climate world and the health systems world are slightly different in a lot of places, it's hard to bring data sets together quite often.",English
+"So I think we need more granular data. And I really-- during the pandemic, I think what we saw a lot of was the collection of surveillance",English
+"data for the sake of collecting surveillance data, as opposed to collecting data in order to make a decision differently. And so what I would like to see is local prioritization",English
+"that is actionable. So I think, in this country, I'm not an expert in the US health system, but I think my experience during COVID",English
+suggested that state-level and even more local collection of data that could drive decision making at that scale is something that would be really great.,English
+"Because quite often, and this happens in many countries where I work, the environmental data available is available on huge spatial scales",English
+or it's from climate models. And the resolution of the data isn't fine enough in order to be able to link it meaningfully with health data.,English
+"And so creating those mechanistic, as it were, links between some of the variables that we have in climate models in larger scale and health",English
+"systems and your actual patient data is going to be very important. So and then, what was the second part?",English
+"AUDIENCE: So thinking about qualitative data-- CAROLINE BUCKEE: Oh, right. So about halfway through the pan-- the first year of the pandemic, I think I wrote a paper",English
+about how important human behavior was in drive-- in models getting it wrong. I think there has been a certain arrogance in academia,English
+in general that places quantitative methods above qualitative methods somehow. So we had a lot of people making SIR models,English
+because they knew math with no sense of local context and the impact of social contact patterns and the importance of human behavior and trust,English
+and all of those things or the nature of epidemiological data and how it's collected. So I think we need to be much more systematic about bringing,English
+qualitative data into our modeling frameworks and into the way that we think about infectious disease epi data in general.,English
+"The ways to do that-- I mean, again, I think it's partly a mindset of making sure that you have collaborative teams that",English
+come from different aspects of the problem. And I think we need to readjust our biases and recognize how key local context is to informing,English
+some of our methods. And a lot of that is qualitative data and local expertise. So it's essential.,English
+It's not always easy to do. I think it's easier to publish papers that don't do that than it is to actually do translational science that has to take that into account.,English
+But it's a very important goal. SARAH FORTUNE: So thank you. And then Kari. You get to close us out here.,English
+"AUDIENCE: Well first of all, thank you so much and we're looking forward to our next keynote speaker at 5 PM or around there.",English
+"But I wanted to really leave this discussion with a catalytic ask. And I know Sarah, you had mentioned",English
+"that you'd like perhaps these questions to be more general because we've seen throughout the day sessions that discuss heat stress, sessions that discuss",English
+"environmental justice, sessions that discuss how the government can play a role in working with us. But now I want to get back to we as public health officials",English
+"and public health researchers and also individual health practitioners. With that in mind, as you think about the future",English
+"Which, very impressive, but no way to confirm it pre-microscopy. I want to pause here to note a defining feature of humans, which is that we like to know why things happen,",English
+"especially why really bad things happen. And if a reason is not immediately apparent, we will find one. I'm reminded of a short poem by Kurt Vonnegut:",English
+"“Tiger got to hunt, bird got to fly; Man got to sit and wonder ‘why, why, why? Tiger got to sleep, bird got to land;",English
+Man got to tell himself he understand.” And this brings us to an important facet of understanding human responses to illness: stigma.,English
+"As part of our desire to answer the question “why why why” by telling ourselves we understand, humans commonly construct moral and ethical narratives around illness.",English
+"Like, my dad had cancer twice when I was a kid, and I saw some of this firsthand. People kept their distance from us.",English
+"Some said he got cancer because his parents smoked, or because he didn’t exercise enough, or because he didn’t eat broccoli, or whatever.",English
+"[contemplative music swells] And it’s true that second-hand smoke and poor diet are risk factors for cancer, but it’s also true that the vast majority of people",English
+"whose parents smoked do not get cancer when they are a 32-year-old father of two young kids. We do not want to reckon with a world that is merely unfair,",English
+"where some people get sick not because they did something wrong, but because the world is unjust— and insofar as it is just, it’s random. And so we tell ourselves we understand,",English
+"which too often means creating explanations that blame the sufferer. Stigma is a way of saying, “You deserved this to happen,” but implied within the stigma is also,",English
+"“And I don’t deserve it, and so I don’t need to worry about it happening to me.” Stigma can become a kind of double burden for the sick–",English
+"in addition to living with the physical and psychological challenges of illness, there’s the additional challenge of having their humanity discounted. Think of the word, universally used in English, to describe tuberculosis patients",English
+"in the 18th and 19th centuries: They were called invalids. They were, literally, invalid. People living with TB today have told me that fighting the disease was hard,",English
+"but fighting the stigma of their communities was even harder. Now stigma is very complex, of course, but researchers have identified certain hallmarks of highly stigmatized illnesses.",English
+"Chronic illnesses are more likely to be stigmatized than acute ones, for instance, as are illnesses with high levels of perceived peril. And critically for understanding tuberculosis,",English
+"stigma can be compounded if a disease is understood to be infectious. Finally, the origin–or perceived origin– of a disease also matters.",English
+"If an illness is seen to be a result of choice, it is much more likely to be stigmatized. So for instance, people with major depression are often told to just choose to be happier,",English
+just as those with substance abuse disorders are told to just choose to quit drinking. And some cancers and heart diseases are stigmatized for resulting from purported choice as well.,English
+"Of course, this is not how biology works– illness has no moral compass. It does not punish the evil and reward the good. It doesn’t know about evil and good.",English
+"But we want life to be a story that makes sense– which is why, for example, it was commonly believed up until the middle of the 20th century that cancer was caused by things like social isolation.",English
+"Parents were actually told their kids got leukemia because they hadn’t been adequately loved as infants. If a clear cause and effect isn’t present, we will invent one, even if it’s cruel–",English
+"because tigers gotta sleep, and birds gotta land, and man gotta tell himself he understand. TB occupies an interesting place in this conversation:",English
+"It’s a chronic disease with high levels of perceived peril, but it wasn’t always understood to be infectious and, in much of the world, it wasn’t seen as a choice.",English
+"And yet, TB was a highly stigmatized disease– it was often associated with demon possession or excessive alcohol consumption or moral frailty.",English
+"But in Northern Europe, beginning in the mid-18th century, it became untenable to understand the disease then known as consumption through only a stigmatic lens. [music intensifies]",English
+"The disease had exploded — especially in Britain’s cities and North American colonies. Stigmatizing away an illness becomes harder when everyone seems to be getting it,",English
+"not just the poor or the vulnerable but even the rich. I mean, the richest individual of the 19th century died of TB at the age of 56. It killed presidents and kings and poets and actresses.",English
+"And so suddenly, consumption became a romanticized disease–a disease of beauty, and refinement, and intellectual sophistication. “Death and decay are often beautiful,” Henry David Thoreau wrote,",English
+“like the pearly tear of the shellfish or the hectic glow of consumption.” [contemplative piano],English
+"So it may be tempting to think that romanticizing a disease would be better than stigmatizing it. But, as somebody who suffers from mental illness,",English
+"I understand firsthand that the two aren’t entirely separable. Like, both strategies ultimately other the sufferer, imagining them as somehow removed from the social order.",English
+Mental illness is often romanticized as unwellness that brings on creative genius or other superpowers. [Scientist laughs maniacally],English
+"But of course, mental illness is also heavily stigmatized in our culture. And so romanticization and stigmatization are essentially, like, complementary strategies for casting people out of society and finding a story that makes sense",English
+"for why “those people” ended up sick. In the case of consumption, this romanticization goes deep...and wide. Like, once you start noticing the impacts of this story on contemporary culture,",English
+"you start to wonder if there’s anything in our lives today that’s not connected to TB. So classically, consumption was viewed as a disease of the air.",English
+"It was an illness of the breath, of the place where the body interacts with the atmosphere. Consider many of our words for the human soul:",English
+"The Hebrew ruach, the Chinese chi, the English spirit, and the Inuit sila all derive from words meaning breath or breathing.",English
+Breath is life– to be inspired is literally to breathe in; to be expired is literally to breathe all the way out.,English
+"And so it was easy to make this disease of breath into a disease of the spirit, the chi, the sila, and the ruach. So much so that at times consumptives were seen as paragons of brilliance and beauty.",English
+"In men, consumption was believed to bring creative powers to new levels. Scholars pointed to the fact that everyone from Stephen Crane to Frederic Chopin to the sculptor of the Statue of Liberty died of consumption.",English
+"(Less attention was paid to the fact that, in a world where roughly 30% of all northern Europeans were dying of a disease, it shouldn’t be particularly surprising that many northern European",English
+"artists and writers were dying of it.) But like one magazine at the time linked TB to authors in particular, writing that an author’s “waywardness, peevishness, irascibility, misanthropy,",English
+"[and] murky passions … are referable to their constitutional peculiarities and condition"" In simple words, that their mental eccentricities result from the derangement of bodily health.",English
+"And that's precisely what I mean when I say that romanticization is not a kind or generous way of treating the ill. I am an author, and I for one am deeply offended by the notion that my waywardness, peevishness,",English
+"irascibility, misanthropy, and murky passions are caused by a derangement of bodily health, even as I am impressed by a 19th-century magazine’s ability to absolutely nail my personality.",English
+"It’s hard to overstate how profound the link between consumption and male creative genius was believed to be. It is said that Victor Hugo’s friends, for instance, joked with him that",English
+"with rosy cheeks and wide sunken eyes due to the low blood oxygenation and fevers that accompany the disease. Like the English actor Eliza Poe, whose beauty was widely admired,",English
+"when she was 23 or 24 and her son, Edgar, was two. Edgar Allen Poe would go on to describe many of the women in his stories and poems",English
+"as similarly wispy, pale, and large-eyed. By the time of Eliza’s death, so-called “consumptive chic” had taken over European beauty standards.",English
+American and European magazines encouraged women to apply the poison belladonna to their eyelids to dilate their pupils so they could have that wide-eyed consumptive look—,English
+"—and offered instructions for how to apply red paint to the lips and cheeks to capture the hectic glow of consumptive fevers. I probably do not need to point out that from runway shows to fashion magazines,",English
+"these standards of beauty are still molding what is considered to be feminine beauty. But TB shaped not only the makeup and beauty standards of the era but also fashion, which, for women, sought to emphasize the visible symptoms of illness.",English
+"The most glaring such clothing was the pointed corset, which emphasized the narrowness of women’s waists (the similarity by the way between “waste” and “waist” is an",English
+"etymological coincidence in English, but a telling one). These corsets were so restrictive that women were limited in the kinds of physical activities they could accomplish,",English
+"and struggled to get full breaths of air, both of which mirrored the experience of actual consumption. And so consumption had become fully glamorous, and idealized.",English
+that the spirit grows light and sanguine with its lightening load.” Dickens did not name the disease– nor did his readers need him to. Everyone knew of the disease that shrank the body and enlarged the soul.,English
+"But of course, this belied the true violence of consumption. Perhaps the most famous 19th-century victim of tuberculosis was the English poet John Keats.",English
+"When Keats’ body was autopsied a couple days after his death at the age of 25, the doctor wrote, “The lungs were completely gone.” This was–and is–the truth of death by tuberculosis.",English
+"The afflicted often drown as blood and pus fill their lungs. They die starved of oxygen, in agony. Here is where the romanticization of tuberculosis becomes–believe it or not–even more insidious.",English
+"Because underlying all these shifts was a feeling that consumption was, as some 18th-century observers put it, a disease of civilization. People at the time knew that city-dwellers were far more likely to develop consumption",English
+"than those in rural communities, and this concept of consumption as a civilized disease also meant that it could not be a disease of uncivilized people,",English
+"which led to a racialization of the illness. In Europe and the U.S., most white doctors believed that TB could only infect white people, and it was sometimes known as “The White Man’s Plague.”",English
+"One American doctor, for instance, called it, “a disease of the master race not of the slave race.” As Frank Snowden writes,",English
+"“In the United States, the prevailing wisdom was that African Americans contracted a different disease. This phenomenon also extended to other colonial empires.",English
+"Many European colonialists believed that TB was either rare or nonexistent among people of color. In reality, there was extensive illness and death",English
+"from consumption in colonial South Asia and Africa, and many local healthcare providers sought to bring attention to the crisis. But it went undetected and uncounted by colonial authorities",English
+"because the entire premise of colonialism relied on white supremacy, and the genetic understanding of consumption relied upon the idea that only supreme people could contract it.",English
+"Acknowledging that consumption was common among enslaved, colonized, and marginalized people would’ve undermined not just the theory of consumption,",English
+"but the project of colonialism itself. Toward the end of the 19th century, the romanticization of consumption began to decline",English
+as it became increasingly obvious that the illness was not exclusively or even primarily a disease of the rich and brilliant. Scholars had begun to turn their eyes,English
+"“away from the languorous, fainting young women and their romantic lovers,” write René and Jean Dubos. “They noticed instead the miserable humanity living in the dreary tenements",English
+"born of the Industrial Revolution. In the ‘tentacular cities’ they saw hosts of men, women and children, pale too,",English
+"often cold and starving, working long hours in dark and crowded shops, breathing smoke and coal dust. Tuberculosis was there, breeding suffering and misery without romance.”",English
+"Still, arguments raged over what caused the disease until 1882, when a “vexatious little organism” called m. tuberculosis,",English
+"was first identified by the physician Robert Koch. Over the next few years, the replication and acceptance of Koch’s research meant that the era of consumption–",English
+as an inherited condition that grew the soul by shrinking the body –slowly faded away. No longer could consumption be understood as an inherited condition shaped by sad passions,English
+"and wondrously translucent skin. Now, it was a germ disease– an illness of filth and overcrowding and poverty. The era of tuberculosis had begun.",English
+[old-timey orchestral music swells] [NEWS ANCHOR] From your local tuberculosis association... [orchestral music swells],English
+"Today, we understand the explosion of TB in the 19th century to have been primarily a result of the Industrial Revolution, which led to cramped living conditions in cities",English
+"where workers could easily spread TB to one another, and where widespread malnutrition– an important risk factor for developing active disease–",English
+"made people especially vulnerable. And so, just as Britain was Ground Zero for the Industrial Revolution, it was Ground Zero for the rise of tuberculosis.",English
+"And we’ve seen TB grow with industrialization in other communities as well, from India to Nigeria. “TB’s parallel journey with capital,” as Vidya Krishnan puts it,",English
+"has been seen in outbreak after outbreak. But at the time, industrialization was not seen as the culprit. Instead, as understandings of TB shifted to being about poverty rather than romance,",English
+racialized stigma did a 180. Where before Black and brown people were seen as incapable of getting such a beautiful disease;,English
+"now, they were blamed for it. “The negro race suffers from tuberculosis, tainting the country,” one American official wrote.",English
+"Racialized medicine no longer maintained that high rates of consumption among white people was a sign of white superiority; instead, racialized medicine now maintained that",English
+"high rates of consumption among Black people was a sign of white superiority. But of course, none of that was true. Black people were not more susceptible to TB",English
+"because of factors inherent to race; they were more susceptible to tuberculosis because of racism. TB especially preys on those who are marginalized not because of their choices or habits,",English
+"but because they are marginalized. It’s important to note that all this racialized medicine was challenged– it was obvious hogwash from the beginning,",English
+"a Black physician wrote a response arguing that this kind of racialized medicine “smacked more of the cheap politician seeking notoriety and office by playing to passion and prejudice than a doctor discussing, philosophically,",English
+"a scientific subject for the diffusion of knowledge.” Which is the doctor version of an extraordinarily sick burn. And in fact, this bias against marginalized people",English
+"and the healthcare workers serving them has proven to be one of the great facilitators of tuberculosis over the last century. Even after establishing that tuberculosis was an infectious disease caused by a bacterium,",English
+"nobody was quite sure how this disease spread. But man got to tell himself he understand, and so attention came to focus on the kinds of places and environments",English
+that seemed to foster outbreaks of tuberculosis –crowded housing tenements and dirty factories. Some public health efforts did made a significant impact:,English
+"Covering one’s cough or sneeze with a handkerchief which really did lessen the risk of spreading TB, as did discouraging spitting in public places like trolley cars and sidewalks,",English
+which was common in the U.S. at the time. People were also told not to kiss babies. Or… kiss at all. Another obsession was with dirt and dust.,English
+"Which again changed fashion, grooming, and social habits. “There is no way of computing the number of bacteria and noxious germs that may lurk in the Amazonian jungles of a well-whiskered face,",English
+"but their numbers must be legion,” argued Dr. Edwin Bowers in 1916. Fear of TB germs getting caught in beards led to what Harper’s Weekly called “the revolt against the whisker,” ushering in an era of clean shaves.",English
+"For women, hemlines grew shorter as anxiety rose that floor-length dresses might pick up TB germs off dirty floors. Vidya Krishnan points out that “as women’s hemlines rose a few inches",English
+"at the beginning of the 1900s, shoes became an important feature of women’s fashion.” By the early 20th century, entire industries had grown up in the U.S. to try to treat tuberculosis.",English
+"[MALE VOCALIST sings ""You Can Lick TB""] I got the blues, the TB blues I got the heeby-jeeby TB blues...",English
+"[Blues music continues] [JOHN] Dry air, sunshine, and rest were believed to be the best available treatments, and so sanitariums where consumptives could rest and breathe fresh air",English
+"popped up around the world. [MALE VOCALIST] ...when the doc can say ""Be on your way""... Southern California came to be known as “the land of new lungs.”",English
+"In a mass migration that rivaled the Gold Rush, consumptive patients traveled west, and–if they survived–began families, reshaping the landscape of the United States.",English
+"By 1920, around 10% of all people living in New Mexico were TB patients living in sanitariums, where the dry air and open spaces were said to heal the lungs.",English
+"[MALE SINGER] Blue and low down, way, way, way down, low down Aimin' for that doc at showdown. Buildin' to that special day When the doc can say ""Be on your way""...",English
+"[JOHN] Life in these sanitariums could be excruciatingly dull for the sufferer. The job of the so-called “invalid,” was to improve their health by lying very still.",English
+"Like, one sanitarium patient, Elizabeth Mooney, wrote ""I do nothing all day except lie here staring at the mountains. I wish they would rearrange them a bit.""",English
+"Family members were discouraged from visiting the sick, not only because visits risked spreading infection but also because visits were seen as detrimental to health.",English
+People might get excited and you couldn’t be excited because you had to rest. Often you were discouraged even from reading books,English
+and there was no YouTube. Many patients did recover in sanitariums– rest and adequate nutrition are much better for the body than malnourishment and stress–,English
+but recovery rates don’t seem to have been much higher for those taking the so-called “traveling cure” than for those who lived at home as invalids.,English
+"Nonetheless, separating millions of the ill from their homes did decrease the spread of the disease within families, and combined with better overall nutrition, safer housing, and lower rates of poverty,",English
+"tuberculosis declined around the world. Between 1882 and 1930, overall mortality from the disease in the U.S. fell by around 80%. But those improvements were not evenly distributed in the American population–",English
+"the declines for African Americans and Chinese Americans were much lower, and for Indigenous people, there was very little decline at all. Even as we developed better tools to diagnose and treat tuberculosis–",English
+"including the stethoscope, the X-ray machine, and chest drains– the illness was still fundamentally incurable. But then between 1940 and 1965,",English
+"eight different classes of drugs that kill m. tuberculosis were discovered and synthesized. But there was, however, of course, a catch.",English
+"Because the tuberculosis bacteria with its waxy coating is uncommonly hard to kill, each of these drugs needed to be administered long-term in order to be effective. And that meant the bacteria had more time to develop resistance to drugs.",English
+"On top of that, no single drug was capable of treating TB on its own. So, it wasn’t until the mid-1950s that a combination treatment involving three different drugs was tested and approved,",English
+"and for the first time in human history, tuberculosis became curable. As treatment, case-finding, and contact-tracing improved, new cases of TB were able to be identified and treated.",English
+"But in impoverished communities, which had for so long been believed by the rich world to be immune to TB, the illness continued to kill millions every year.",English
+"Attempts to get combination therapy to colonized regions were haphazard and inconsistent, forcing many people in poor communities to find whatever antibiotics they could,",English
+"regardless of their effectiveness against TB. In 2000, the Ugandan physician Dr. Peter Mugyenyi gave a speech about the global failure to get HIV drugs into impoverished communities.",English
+“Where are the drugs?” he asked. “The drugs are where the disease is not. And where is the disease?,English
+"The disease is where the drugs are not.” So, too, was the case with tuberculosis. By the mid-1960s, curative therapy for TB was available everywhere–",English
+"except for where it was most needed. I mentioned earlier that in the 25 years between 1940 and 1965,",English
+"eight different classes of drugs were developed to treat tuberculosis. And then in the 47 years between 1965 and 2012, no new drugs were synthesized to treat tuberculosis.",English
+"The reason for this is straightforward– as TB declined in rich countries, the profit incentive for researching new drugs went away, and as a result, funding dried up.",English
+"When TB ceased to be a problem of rich people, it not only ceased to be romanticized; it also ceased to exist in the minds of many.",English
+"But a system of pharmaceutical research driven exclusively by profit incentive is of course not the only way to develop drugs. As Dr. Carole Mitnick has told me,",English
+"the failure to develop drugs for illnesses that are not seen as profitable is “a human-manufactured problem that needs a human solution. … If medications were a public good,",English
+"the burden of disease would drive the priorities of the industry and TB treatment would be varied and plentiful.” In short, there is nothing inevitable about living in a world where developing drugs",English
+that lengthen eyelashes is more highly rewarded than developing drugs that treat tuberculosis. So all of this combined to keep the rates of TB death steady,English
+"in much of the developing world even as it declined precipitously in rich nations. [foreboding music plays] And then, beginning in the early 1980s, physicians and activists in the Global South",English
+"began to sound the alarm about an explosion in uncommonly swift and severe tuberculosis deaths that seemed to be associated with a new pandemic, that of HIV/AIDS.",English
+"Because untreated HIV lowers resistance to infection, TB infections are far more likely to progress to active disease as the immune system weakens. And although many were pointing out this connection in the mid-1980s,",English
+far too little was done to expand access to either TB or HIV medications. This inaction contributed to tens of millions of deaths,English
+"from the intertwining pandemics of HIV and TB. In fact, between 1982, when the term AIDS was first used, and 2005, when HIV deaths in poor countries finally started to decline",English
+"thanks to increased access to treatment, roughly as many people died of tuberculosis as died in World War I and World War II combined. At a TB conference not long ago,",English
+"I met a young South African woman named Phumeza Tisile, who was diagnosed with TB as a teenager. She had just received a full scholarship to university,",English
+"but from the start of her freshman year, something felt off. She had lost weight and was experiencing shortness of breath, eventually struggling just to walk up stairs.",English
+"“So I went to the clinic and coughed into a cup,” she explained to me. Although we now have extremely accurate molecular tests for TB,",English
+"they remain unnecessarily expensive, and so TB is still most commonly diagnosed via a person looking at a sputum sample through a microscope and trying to identify TB bacteria in that sample,",English
+"which is exactly how Robert Koch diagnosed TB in 1882. Unfortunately, microscopy misses about 50% of positive cases,",English
+and Phumeza was told–catastrophically– that she was negative for TB. But she kept getting sicker. She had to drop out of school.,English
+"Her weight dropped to 70 pounds. “I was really struggling to breathe,” she remembered, and then finally, she received a chest X-Ray, whereupon it was obvious",English
+that tuberculosis was everywhere in her lungs. She started on a standard TB treatment immediately. Now I have to take a little detour here to explain a protocol that’s been around,English
+"since the late 70s, called Directly Observed Therapy (short course). The thing to understand about DOTs is that it really only exists",English
+"because of a lack of trust that certain patients will take their medications consistently. You might recall that TB is particularly susceptible to developing antibiotic resistance,",English
+"which is worsened by haphazard treatment. So, the idea behind DOTs is to have a healthcare professional directly observe patients taking their medicine every day.",English
+"And in the beginning, this protocol did help because any regular access to adequate supplies of appropriate antibiotics was good news. But requiring patients to find their way to a clinic or doctor every day for months,",English
+"or else live in inpatient facilities to receive their daily medications, creates extreme challenges for many with TB. As Dr. Jennifer Furin put it to me, tuberculosis “is the only disease I know",English
+"where the core of therapy is based on fundamental mistrust.” Now it has long been argued that antibiotic resistance is driven by so-called “patient noncompliance,”",English
+"which is to say, patients failing to take their medication. And it is true that many TB patients fail to complete their full regimen. But the concept of “compliance” turns out to be really complicated",English
+"when you zoom into the level of individual patient experience. [contemplative piano music] By the time she was finally diagnosed, Phumeza could not walk to the clinic by herself.",English
+"She was simply too sick. And public transport was expensive, not to mention the potential to spread the illness. Did her inability to access daily treatment make her noncompliant?",English
+"Fortunately, Phumeza was able to avoid DOTs because South Africa had recently begun allowing seriously ill people to take home two weeks of treatment.",English
+"But after two weeks, she had to return to the hospital for more medicine, and it was clear she was getting no better. Eventually, Phumeza was hospitalized and after months of treatment,",English
+"it was discovered that the drugs were failing because Phumeza had multidrug resistant tuberculosis, also called MDR-TB. When she learned of her diagnosis, she told me,",English
+"“I was searching stuff online, and it was really really scary to see because on Google so many of the people on images were already dead. Their ribs were exposed and I thought I was gonna be like that, too.",English
+"I thought I was likely going to die.” At this point, the only treatment regimen available to Phumeza involved painful injections and dozens of pills taken each day–",English
+"and the injections came with a very high risk of permanent hearing loss. One day, as Phumeza put it, “I just woke up and everything was quiet.” [sharp humming sound]",English
+"As it turned out, Phumeza didn’t have MDR-TB; her particular strain of tuberculosis was resistant to even more drugs, making it pre-XDR TB or pre-extensively drug resistant tuberculosis.",English
+The painful injection she received that caused permanent and total hearing loss for four years until she received a cochlear implant? That drug didn’t help her at all.,English
+"If Phumeza had been able to access molecular testing, or if her TB had been correctly identified from the beginning, she could’ve been saved her hearing and so much suffering.",English
+"Instead, she was in treatment for tuberculosis for three years and eight months– during which time she took between 20- and 30,000 pills",English
+"before finally being cured. For many patients, this is still the reality in 2024, even though we now have treatment protocols",English
+"that can cure patients with drug-resistant TB within just six to nine months, with five to seven pills per day.",English
+"These drugs and protocols are only beginning to reach those who need them most. But each year more people are accessing these better treatments, albeit belatedly– and this is due, in no small part, to Phumeza herself.",English
+"[inspiring marimba music] Today, she’s a college graduate, a sociologist, and a leading voice in the fight against tuberculosis, whose efforts have helped increase access to life-saving drugs.",English
+"[PHUMEZA] But I ask you to act now. I ask you for change. Thank you. [JOHN] Bedaquiline, first released in rich countries in 2013,",English
+"is a critical medication for treating drug-resistant tuberculosis, but for years the price had been artificially high due to a lack of competition. With support from the organization Doctors without Borders,",English
+Phumeza and her friend Nandita Venkatesan filed a lawsuit in India to prevent the pharmaceutical company Johnson & Johnson from extending its patent on the drug past its initial 2023 expiration date.,English
+"Phumeza and Nandita succeeded in convincing Indian courts that J&J shouldn’t have a forever patent on this critical drug, which eventually allowed for generic competition and far less expensive bedaquiline.",English
+"Experts estimate that over 50,000 people with MDR-TB will receive treatment every year who otherwise would have had little if any chance of being cured.",English
+"Many people with TB have survived because of Phumeza’s work expanding access to diagnosis and treatment. And at the same time, she herself only survived",English
+"because of activism and innovation that preceded her. Until quite recently, the World Health Organization’s recommendations for people like Phumeza with drug resistant TB was “supportive care,”",English
+which Dr. Carole Mitnick summarized to me as “put people in a hut by the side of the road and wait for them to die.”,English
+"But in the late 1990s, Partners in Health, known as Socios en Salud in Peru, proved via a study that similar cure rates for MDR-TB could be achieved in poor communities",English
+"as were achieved at the world’s finest hospitals. Still, many of the drugs that effectively treat highly resistant tuberculosis remain very expensive, not because they are made of gold or platinum,",English
+"or because we have to fly to the moon to find them. They are expensive because 1) prices are kept artificially high by pharmaceutical companies,",English
+"and 2) We are afraid that making these drugs less rare will lead to further antibiotic resistance. And listen, I understand the fear of antibiotic resistance.",English
+This isn’t just about TB: the idea of a world where we cannot treat bacterial infections is indeed terrifying. But that should never mean that we reserve the most powerful,English
+and efficacious drugs for the rich. I would not accept my child being denied the best available treatment for TB. How can I ask Phumeza’s family to accept such a world?,English
+antibiotic-resistant pathogens. So let me tell you what an antibiotic is. An antibiotic is a small compound either made in a laboratory or made by some living creature and when,English
+"this compound is made, what it does is kill the pathogen. It kills the bacterial pathogen. Perhaps I should just remind you",English
+of the difference between a bacterial pathogen and a viral pathogen. A virus is not a living cell. A virus just has a protein coat and the genetic material sits inside this coat. And it,English
+"cannot make more of itself. The only way it can make more of itself is if it infects a host cell--one of our cells, one of the cells that are",English
+"of a rat, or a monkey, or some other animal. And then it gets in there co-opts the machinery of that cell and makes many more of itself. That's a virus. A bacterial cell is this little tiny living cell that can grow",English
+"and divide and respond to its environment and figure out if it's a pathogen how to get into a host cell and make you very ill. So that's a bacterial cell. Antibiotics are specific for bacterial cells,",English
+"not viral infections. And what has happened is that we have had a history of various kinds of antibiotics, which were first discovered",English
+"in 1946 with penicillin. Then soon after that, we had strep and staph infections that would be very sensitive to penicillin. Today, 80%",English
+of all strains of staph--staphylococcus--are resistant to penicillin. This was quite a shock to us. In 1950 we had more antibiotics that,English
+"would infect multiple bugs--streptomycin, chloramphenicol, tetracycline. Then in 1953 there was a Shigella outbreak in Japan",English
+and it resulted in the appearance of a strain of dysentery bacillus that was resistant not just to one antibiotic but to many. And that was a red flag. And people started becoming somewhat concerned.,English
+"Up now to 1982, when we had the last new class of antibiotics--the quinolones-- resistance is rising, really, in a frightening manner. Cipro, to which",English
+"we were eating like candy when there was an anthrax scare in the United States, has caused enormous resistance to that particular drug. In 1998, vancomycin, which is considered by many an antibiotic of",English
+"last resort for staph infections and other kinds of pathogens, we are now seeing the emergence of resistance to Vancomycin as well. Now what happens when something becomes resistant to an antibiotic",English
+"is that it turns out that these bugs are very, very smart and what they have learned how to do is if they see a drug coming towards",English
+"it, like arithrimycin, it figures out how to spit it out. Or if the antibiotic manages to get into the bug, the bacteria have figured out",English
+a way of chemically modifying that antibiotic so that it's no longer working. And they also have figured out how to change the target of that antibiotic in that particular cell so it doesn't work any longer.,English
+So these bugs are very smart and we're in a war with them and the bugs are winning. And what we need is to understand how to make,English
+"new and better antibiotics. If I just look at staph infections in the United States, in 1957 100% sensitive to penicillin. 1982-- fewer",English
+"than 10% of all staph cases could be cured by penicillin. 1993-- only vancomycin survived as an effective antibiotic. And today, as I",English
+"told you, there are strains that are resistant to everything. So one of the questions is, ""Why is antibiotic resistance growing so rapidly?"" And in fact, what we're seeing is that antibiotics are put into animal",English
+"feed, into aerosols for fruits and vegetables. Of the 50 million pounds of antibiotics produced annually in the U.S., 40% go into",English
+livestock. So how does this resistance arise? Let's say you have 10 to the ninth (10^9) bacterial cells all resistant to a particular antibiotic.,English
+"One of those 10^9 cells has a mutation that makes it resistant. All the others will be killed by that antibiotic, but that one",English
+will happily grow and divide and then you have a bloom of an antibiotic-resistant pathogen. By feeding antibiotics in huge quantities,English
+"to all of our livestock, we are increasing the chances of that one guy to develop antibiotic resistance. Another reason that things--",English
+this resistance--is growing so rapidly is that there are growing numbers of immunocompromised people. And this is really partly due to the wonders of medicine and also to new infectious diseases.,English
+"Chemotherapy patients have very, very low immunity. They're infected by many different bacteria and they grow and divide and develop resistance. Transplant patients, AIDS patients, even just aging populations--",English
+"if you're over 65, your immune system is going to hell in a handbasket. And so you have to really realize that you are particular sensitive to",English
+"bacterial infections and again you become a reservoir for increased antibiotic resistance. There's also the excessive use of antibiotics, over-prescription and then unregulated over-the-counter sales. So these",English
+"are all very serious problems. Of course, as I told you before, international travel has us all over the place. And so if you get a multi-drug-resistant strain of streptomycin in Spain, you wind up",English
+with it in South Africa in four days if somebody is traveling rapidly. So we have complete and rapid dissemination. Now what I'm going to turn to is the story of where new bugs come from.,English
+Where do new pathogens come from? And the story I'm going to tell you is one of E. coli 0157. It's a new and pervasive pathogen. It's a food,English
+contaminant that is now the leading cause of kidney failure in children. Now the first time I told this story was in a very unusual scenario. It was during Bill Clinton's administration.,English
+"And he became very worried about genetic engineering-- in other words, what we can do in the lab now in building new groups of genes and perhaps altering a pathogen or altering some other",English
+normal process. And he was worried. He wanted to know how worried we should be about malevolent forces actually creating new pathogens. And he wanted to understand what was happening.,English
+"And I was part of a group of six people who were invited to speak with President Clinton and his whole cabinet. And the story I told them really was that genetic engineering, yes we can do",English
+"in the lab, but the bugs and the various kinds of critters in the natural world are much better genetic engineers than we are and",English
+"the example is E. coli 0157. Now, this is a picture of a virus and I'm going to show you and tell you how this figured in",English
+to the genetic engineering that was carried out by E. coli 0157. So where did it come from? E. coli 0157 was first isolated,English
+"from a 50-year-old woman in California, who came down with severe gastric distress and bloody diarrhea. She survived but",English
+"she was quite ill. Then in 1980, 14 children were admitted to a Toronto hospital with the same symptoms. Of these, two children died",English
+"and the rest were left with severe kidney damage. Again the bug, the bacterium, isolated from one of these kids was the same as that found in that 50-year-old woman and",English
+"upon analysis, the very surprising development was that this E. coli cell, which is a bug that grows in all of our gastric system",English
+"and is quite harmless, had picked up a gene--a particular gene-- from another bug, a pathogen called Shigella that coded for a toxin.",English
+"So now we had taken an E. coli cell and put in a gene that made it a pathogen. That is genetic engineering. In 1981, in White City,",English
+California 12 people eating at a local hamburger place became ill with the same symptoms. 1982 in Michigan--again a local hamburger place--E. coli 0157 was found in its meat patties. 1993--Jack-in-the-box,English
+restaurants in the Northwest--hundreds became ill. Four kids died. And this continues on and on. It was found in 1996 in contaminated,English
+"apple juice and lettuce. And that turned out because the E. coli cell picked up not only your gene for the toxin but a gene that makes it resistant to acid. So it could grow in an acidic environment,",English
+"which normal E. coli does not. 1997--there was again a huge recall of contaminated hamburger meat. And in 2007, just a couple",English
+"months ago, contaminated spinach was found. And that came from the runoff from livestock, which were not too far away.",English
+"So it turns out that now, there are 25 to 30 outbreaks per year in the United States alone of E. coli 0157 contamination",English
+and 5% of our dairy cows carry this pathogen. So how did this happen? How do we think that this occurred? So what I'm showing you,English
+"here is a bacterial virus. Remember I told you that a virus has a protein head, and that's shown here. That's the head. This is its tail, and there's DNA in this head. And this over here",English
+"shows you what the virus looks like. This over hear shows you a diagram of this virus. Looks like a moon lander, doesn't it? And what this moon lander does is it lands on a bacterial cell",English
+"and it injects the DNA, the genetic material, right into the bacterial cell that it hits. And this is how we believe this happened.",English
+Okay. In this diagram I show you a Shigella bacterial cell. The blue circle indicates the chromosome--the single chromosome.,English
+"And the little moon lander up there indicates the virus. So the virus injects its DNA, and that's that little circle in the center of the head, into the cell. Once that DNA gets into the",English
+"cell, it codes for things that chop up that blue chromosome. You chop up that blue chromosome and the little piece that contains that Shigella gene, then gets put into the head",English
+of a new virus. And so this new bacterial virus contains its own DNA and a little bit of that Shigella DNA. And that little bit,English
+contains the gene that causes a toxin. Now what happens is that that same virus hits an E. coli cell. And we believe this,English
+happened during an epidemic of dysentery in Central America when both E. coli and Shigella were mixed. And this virus injected,English
+"its DNA into the harmless E. coli. And this piece of DNA got incorporated into the DNA of this E. coli, creating E. coli 0157.",English
+"That, folks, is genetic engineering. That happens naturally. So now let me tell you a second story. And the second story deals with why it's so difficult when we're first faced with something",English
+that we haven't seen before in a given country to decide whether this is a natural outbreak. Is it a malevolent deed? Where is it coming from? And this is an interesting story. Now West Nile virus,English
+causes an encephalitis-type disease. But it had never been found in the Western hemisphere. And this is several years ago now.,English
+And the way it started was that birds in the Bronx zoo started to die. And they had an encephalitis-type infection. And a vet in the Bronx zoo,English
+sent her tissue samples to the CDC--Center for Disease Control-- and they were pretty overwhelmed because the CDC never has enough money to do everything they have to do and they sort of,English
+"said, ""Yeah, we'll get to this. Birds are dying."" Well, at the same time there was an increasing number of human patients in New York City, which were exhibiting and dying from an encephalitis-type disease.",English
+People thought it was the mosquito-born St. Louis encephalitis virus. They didn't really know. Then the chief of Emergency Management,English
+"in New York City managed to co-opt the entire supply of ""Off."" ""Off"" is something that kills mosquitoes and flying bugs, and he",English
+"just sprayed ""Off"" all over the city and he stopped the epidemic cold. Meanwhile, the lady vet at the Bronx Zoo was still trying desperately to find out why her birds were dying. Waiting to hear",English
+"something from the CDC, and the weeks were going on and she happened to go to a wedding on the West Coast and sitting next to her at this wedding was a virologist. And not particularly",English
+"interested in dancing, they started talking about this odd thing that was happening to her birds at the zoo. And he said, ""Look, why don't you send me some of her tissues, and I'll try to figure out what",English
+"you've got."" And that's what happened. He very rapidly identified this as West Nile Virus. Now everyone's initial reaction was,",English
+"""This couldn't be. We don't have West Nile Virus in the Western hemisphere!"" But at about that time, in Fort Collins, the CDC had in fact identified this as well as West Nile Virus. It just took too long.",English
+"And this was our first experience with trying to rapidly identify something new. Now, interestingly, concurrently while all of this was going on, an Iraqi defector had reported that Saddam Hussein",English
+was developing a strain of West Nile Virus as a biological warfare agent and was preparing to release it. This was never confirmed. Was this a BW event? We don't know. Did this come into the United,English
+"States on a 747 that a mosquito happened to crawl into? We don't know. We don't know the answer, but what's important--what one",English
+has to remember--is anything we do to identify a new outbreak will be relevant no matter what the source is--malevolent or natural.,English
+"The problem is to understand what we've got and to rapidly understand how we can analyze these things and identify the agents. Now, this is changing. And this is changing particularly because",English
+"of what we found with SARs. Now that's happened fairly recently. SARs is Severe Acute Respiratory Syndrome. It's caused by a corona virus, which is an RNA virus. It's similar to the viruses that",English
+cause the common cold. It has a very high potential for natural evolution so it can change itself a lot. Now with SARs--it's an interesting story,English
+because this is an infection that first started predominantly in Hong Kong and Beijing and Guangdong Province in China. But very rapidly appeared in Toronto. And what happened there,English
+is that we had a highly infectious agent that exemplifies this global village we live in. There was a scientific meeting in Hong Kong. Someone got sick. They wound up in Toronto and it was all,English
+over the place. But SARs is an example in which we were much better at identifying the agent rapidly by sequencing. We were also able to realize that the only thing that would be effective,English
+"was quarantine. And this is interesting because in fact Singapore was very effective in quarantine. They said, ""This is",English
+"what we have to do to stop this."" Whereas Hong Kong and Toronto were not. Ultimately it stopped. The dealing with this was very effective.",English
+And actually there were very few deaths if you look at it in a global way. But the effect on the economy was enormous. And so this tells us that even a minor outbreak is going to have severe economic,English
+"implications globally. And what it did do though was help the World Health Organization build a network of reporting, of understanding, of",English
+diagnosing outbreaks of diseases everywhere in the world. So that we would know how to respond and deal rapidly with them. Now what I'm going to do is end this talk with a discussion of something,English
+"that's facing us all right now. And that's Asian bird flu H5N1. This causes influenza. Influenza is with us all the time, various",English
+"different kinds of strains. This is a particularly frightening one. However, there is no strong evidence as yet of human- to-human transmission. Right now, this is a disease of birds--",English
+"local fowl, poultry, wild birds. Our concern is that H5N1, which mutates rapidly, will ultimately go from person to person.",English
+"Now, let me tell you a little bit about this virus because it's relevant. Each virus has a single strand of RNA containing 8 genes.",English
+"Each gene encodes a single protein. This very high mutagenicity rate, in other words changing the kind of protein that's made",English
+"from each gene, can happen by reassorting the genes by single-base mutations. And it just changes rapidly. That's why we get flu shots every year. And basically at this time",English
+"we know that the transmission of H5N1 goes from ducks to either wild birds or to some cats, tigers, lions, leopards, house pets",English
+"with a fairly easy transmission. However, from wild birds to humans does occur. It's not easy. You need very personal contact.",English
+And humans to humans--there's not strong evidence of that yet. Our concern is that it might happen. And so what is H5N1 mean,English
+"anyway? ""H ""stands for hemaglutinin and that is a protein that sits on top of that cage that the RNA sits into. The function of",English
+"that hemaglutinin is to allow the virus to bind to the host cell and allow entry of the RNA to do its bad stuff. ""N"" stands for",English
+neuraminidase. Neuraminidase is another kind of protein that's also sitting on the surface of the cell and it allows newly formed viruses to escape and infect other cells. We have,English
+"two anti-virals out there now. One is called Tamiflu. The other is Relenza. And the neuraminidase is the target for both of these. And in fact, the best way to use something like Tamiflu",English
+"is if you've not been infected yet, it will give you 80% protection for awhile. If you've been infected, it will drop the viral load so that",English
+"you're not as contagious. You'll still get sick but you won't be as sick. Now if we look at the history of flu viruses, the most serious",English
+flu pandemic occurred in 1918 and that influenza was H1N1. It killed 40 million people worldwide and H1N1 means a particular,English
+derivative of the hemaglutinin and the neuraminidase. 1957 flu was H2N2--killed about 2 million people. 1968--H3N2 killed about,English
+a million. I know that one very well because I caught that one. And let me tell you--a real flu infection is no fun. Their current Asian bird flu is H5N1 as I've said. Scary thing about this guy,English
+"is that right now it has a 50% kill rate, which is enormous. And humans have no immunity against H5, whereas we have some against H1, H2, and H3, which has been around for awhile.",English
+So what needs to be done? How are we going to deal with this? Let me just tell you first that using something like Tamiflu,English
+is best done in my opinion not by sprinkling Tamiflu amongst the 30 million people in the world but rather using it where there's,English
+"a hot spot. Now that we have an entire network of reporting coming all over the world, keeping their eyes out for hot spots",English
+"of sudden break outs of H5N1, possibly being passed from human to human, then our Tamiflu has to get there immediately. And then",English
+"what you do, is you cordon off the area, quarantine, treat with Tamiflu, and start vaccines. Now clearly the vaccine we have now is to the H5N1 that only goes between birds and possibly cats.",English
+What we will ultimately need--if this happens--if it mutates to human-to-human is that we then have to get a new vaccine,English
+that will be against that particular variant. And a lot of work is going on right now by many small companies and many large pharmaceutical houses to be ready to make this as quickly as,English
+possible. Now one thing that is important to realize is that vaccines are made in eggs. I mean zillions of eggs. If you go to one of these,English
+"vaccine production places, it's astonishing. It's like a football field of eggs. And virus gets injected into these eggs and then a high titer of more viruses made that's impaired. You kill it. You then make",English
+the vaccine. The reason that we use eggs is that you get a very high titer. One thing that I can't stress too strongly is that in fact,English
+you can't get flu from a flu shot. It's dead. But you certainly can get immunity. But people seem to think that vaccines are an,English
+absolute panacea. It's not true. Flu vaccines are 70-90% effective in young healthy people and only 40-60% effective in people over,English
+65. So that the flu alone is not going to save us. But there are many things that we can do to help ourselves. One of the things,English
+"we have to do is that we have to stockpile face masks--the kind you buy in the hardware store for painters--syringes, medical supplies, food, and water. Currently we do not have in the United States",English
+enough ventilators if we were to have a pandemic. So it's extremely important that we learn how to deal with large amounts of people becoming ill. So what if we do get a pandemic? What does a,English
+country do? And what I'm going to do is end with sort of an economic part and that is in ordinary times economic logic does not dictate pandemic preparedness. We all keep low inventories.,English
+We don't want redundancy in reserves. We have lots of offshore drug production because it's cheaper. We don't guarantee the,English
+purchase of flu drug as we do with other kinds of weapons. In fact we have just in-time delivery with no surge capacity. Now what does this mean if you have a pandemic? The supply,English
+"chain is very thin. Every hospital contains only 30 days of drugs. We have, in a pandemic, workers becoming ill. Drug company",English
+"workers, the production of new vaccines and new drugs will become less. And in fact, we'll have borders closed and embargos. They can't get in. Truck drivers get sick. Things can't be delivered.",English
+"We then have to say, ""Alright, what do we need to do to deal with this?"" We need scaled-up manufacturing and stockpiling of",English
+"vaccines and anti-viral drugs, as well as antibiotics because many people die of flu infection by a secondary bacterial infection. So we need antibiotics. There's a pneumococcal vaccine that is",English
+"It causes leaking us in the GI tract and really, really serious diarrheal disease. So those are the bad boys there. But once again, there are many others.",English
+"Tuberculosis is yet another really serious infectious disease caused by Mycobacterium tuberculosis, that's the main one of the mycobacteria that is a threat.",English
+"It used to be called consumption in the old days, because people almost looked consumed by the disease. They would just get thinner and thinner.",English
+"Literally it was a wasting disease. People would be sent up into the mountains of Switzerland to try to recover from consumption,",English
+"to where the air is clearer and cleaner, and maybe hope that they can recuperate. But TB-- look at these numbers.",English
+In 2015 there were almost 10 million new cases. There are about 1.2 million deaths from TB. A serious situation with TB is that it's often,English
+"found co-infecting with the HIV virus, where you just can't fight the TB. So eventually, if you're infected with the HIV virus,",English
+it's the TB that gets you due to the weakening caused by the infection with TB. So these numbers are shocking in light,English
+"of the numbers I showed you on the previous slide, right. Look at these numbers if you go to snakes and things like that. They're meaningless numbers compared",English
+"to infectious diseases. So now, and I'm going to talk to you about the origins of this,",English
+"many, many infectious agents that we thought we had conquered-- we thought we could take care of it.",English
+"You just take this course of antibiotics and you're off, you're set. But now, because of the rapid mutation rates",English
+"in bacteria and viruses, certain pathogens have completely worked out mechanisms to escape therapeutic agent.",English
+"And I'm going to talk to you about those mechanisms towards the end of this class. So basically you can dose a person one day with a normal dose of an antibiotic agent,",English
+and then 10 months later that normal dose or 10 times or 100 times that dose stops working. Why is that?,English
+"It's due to resistance acquisition due to rapid cell division and mistakes made on replication and transcription, that then may one in a million times",English
+confer an advantage on the microorganism. All of a sudden the drugs don't work anymore. The WHO and various community notice boards,English
+"call this set of infectious agents the escape pathogens. It helps us remember which ones these are, because these are pathogens that escape treatment,",English
+"because they've developed resistance to multiple drug cocktails. So commonly, when someone has a particular disease",English
+"they don't take one drug, they take two or three to hit lots of pathways at once in the hope that resistance won't develop fast.",English
+"But the escape pathogens have collectively acquired resistance to several antibiotics, meaning there's no good treatment.",English
+"So the letters of escape stand for Enterococcus faecium, Staph aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and some",English
+of the Enterobacter species. Some of these infectious agents are what result from-- I always say this wrong--,English
+nosocomial infections. Does anyone know what those are? These are infections that people get in hospitals.,English
+"So Tom Brady had a knee operation. He got an infection in his knee that came from the surgery, right.",English
+"These are hospital acquired infections, because you can't sometimes clear an area enough, and there's infectious agents around.",English
+"So Acinetobacter baumannii was dubbed the Iraqi Bug for many, many years, because the vets coming back from Iraq were going to military hospitals,",English
+and these were abundant with cases of Acinetobacter baumannii. So that moved on to the escape pathogen list.,English
+"So these are things to watch out for. It's the reason that nosocomial infections-- I hope I'm saying it right, otherwise you're going to go off and Google it and realize",English
+I said it wrong. It's the reason why old school physicians wore bow ties and not ties. Can you imagine why?,English
+"So if you're wearing a tie, which I seldom wear to be honest, and you're working over a patient, the tie can be the thing that carries the infection,",English
+"because it gets closer to infected areas. This is old school stuff. And so originally the physicians wore bow ties in order to distinguish themselves as important people,",English
+"but not to wear ties that might carry infectious agents. That's sort of a scary thing. So with all this said, let me just",English
+lead you in to talk about bacteria antibiotics and resistance development. So we often name bacteria somewhat by their shape.,English
+"So the long rod shaped ones are cocci. The round ones are cocci. The rod ones, whatever they are, come on one of you.",English
+And then what did the rod shape ones? Bacilli. I had a blank moment. So the rod shaped ones are bacilli.,English
+"And then there's some others that have a different morphology like Campylobacter jejuni that have kind of a corkscrew shape. And that's thought to be important in their motility,",English
+"digging through the mucous layers in the epithelial layers. So here I show you several shapes of bacteria. And I'm just going to, once again,",English
+"reinforce what diseases some are associated with and some other diseases that you might be surprised by. So yes, we know about salmonella and the E.",English
+"coli and food poisoning. But Helicobacter pylori, which is one of these flagellated bacteria, can infect the stomach.",English
+"It's often the cause of ulcers. So it's a causative agent of stomach ulcers, but that has in turn led to a considerable risk",English
+"factor in stomach cancer. So what we thought was just an infection causes a constellation of other problems, including cancers.",English
+"And more and more microbial agents are now associated with cancers, in particular the viruses. Neisseria, these come along with the sexually",English
+"transmitted diseases such as gonorrhea. Neisseria meningitidis is the one that causes meningitis. It is a very, very often fatal infection of the meninges.",English
+"Staph aureus lots of infections around the body, just gruesome things like cellulitis, wound infections, toxic shock.",English
+"Streptococcal bacteria, I've already mentioned-- the pneumonias, and then Campylobacter. And now another complicated factor of infection--",English
+so I talked to you about stomach ulcers and stomach cancer. Another thing that seems to be coming along with infections,English
+"is autoimmunity. So in the last section of the class you heard about immunity and you also heard about tolerance,",English
+"that we don't react to things that are ourselves, otherwise we'd be in deep trouble. Autoimmunity can suddenly pop up from",English
+"certain bacterial infections, because bacteria tend to cloak themselves with unusual sugar polymers and other kinds of structures",English
+that the body doesn't really know what to do with. And in some cases they kind of mimic things that are in the human body. So they they are mimetics of normal structures,English
+in the human body. And the body just doesn't notice them at all. And then there are incidences where certain bacterial infections later on,English
+"cause autoimmune disease. So a bacteria may come along. It may have something that looks kind of like something human, but not quite.",English
+"The human body responds, develops antibodies, and then they cross talk back to aspects of our physiology. So Campylobacter jejuni is often a contaminant in poultry.",English
+"It's a severe GI infection. But later on people get diseases such as Guillain-Barre, which is a neuropathy where the ends of your limbs",English
+"become numb and non-functional. So there was a famous football player, the one they called ""The Refrigerator,"" who",English
+"had a serious case of Guillain-Barre resulting from very much an infectious disease, which converted into autoimmunity.",English
+"So let's now look at antibiotic targets. And to look at antibiotic targets, I think the first clear place to look",English
+"is at the bacterial cell wall. Now when we first started talking about prokaryotes,",English
+"things that include bacteria, we talked about the fact that these single celled organisms have to have a robust cell wall to prevent osmotic shock.",English
+They have to have some kind of thing to keep them from taking up too much water and basically exploding because of osmosis.,English
+"Water floods in to balance the salt concentrations. So they have a complex cell wall, which is made of a macro molecule called peptidoglycan",English
+"And it's usually one word, but I want to just underline peptidoglycan because it's a fascinating polymer that's made up of peptides and linear carbohydrate polymers.",English
+"So if you look at this typical bacterium, this is just a cartoon of the peptidoglycan. So it's a cross-linked polymer, we",English
+in one direction it has repeating carbohydrate units. I'm not drawing those complex hexose structures there. I'm just drawing it in cartoon form.,English
+And those are carbohydrates known as NAG and NAN. NAG is N-Acetyl Glucosamine.,English
+"It's a hexose sugar. NAN is N-AcetylMuramic acid. It's another modified sugar. And on the one of those sugars, there",English
+is a reactive site that allows you to basically cross-link these polymers into a mesh work.,English
+"So it's a feat of engineering to build this amazing polymer. It starts being built on the inside, on the cytoplasm. And then the components get flipped onto the other side",English
+of the cytoplasm of bacteria. Then they get polymerized in place to make this complex mesh work of a polymer,English
+that creates the rigidity of the bacterial cell wall. It's generically known as a peptidoglycan. Different bacteria have different peptidoglycans.,English
+"There are several modifications that might be specific to particular bacterial sera But this is the generic structure,",English
+where you have a polymer that's built of sugars. You can recognize the sugar structure there going in one direction and the peptide component that,English
+"cross-links across in order to make this mesh. And bacterial wall have different amounts of this, but it'll build up to a really strong, rigid mesh",English
+"work that's permeable to things, small molecules and water. There is holes, and so on. But it creates a mechanical rigidity",English
+"so that osmotic shock doesn't occur on the bacteria. Any questions about that? Does that makes sense? So that, in a sense, it's their exoskeleton,",English
+"if you want to think about it like that. So the properties are rigid. Without it, the bacteria would suffer osmotic shock.",English
+And it's plenty permeable to allow 2-nanometer type pores in order for nutrients and water to go into the structure.,English
+[VIDEO PLAYBACK] - --have E. coli growing here. And it's living. You can see it start to grow. Here we add penicillin. We're going to see these bacteria--,English
+"PROFESSOR: These are bacteria, rod-shaped bacteria. - There wasn't any microphone on this, so-- PROFESSOR: And I'm going to ask you to just keep watching",English
+"this kind of carefully. - There goes another one, boop, boop. [LAUGHTER] - Poking holes in the cell wall, boom, bacteria is dead. PROFESSOR: Look at some of the bacteria disappearing.",English
+"All right, I guess [INTERPOSING VOICES] OK, then we're going to-- [INTERPOSING VOICES]",English
+"So we're going to leave it. [END PLAYBACK] Let's go back one. OK, now what was that?",English
+"OK, so I've told you bacteria would suffer osmotic shock without peptidoglycan. Those are bacteria that you see popping,",English
+"as the person who was talking said, because the peptidoglycan cannot be made. There is an antibiotic that's added.",English
+"It is penicillin that's added to the bacteria. And it stops-- as bacteria grow, they have to make a bunch more peptidoglycan, because if you're doubling,",English
+"you've got to make twice as much peptido-- you've got to double the amount of peptidoglycan. If you have something that inhibits the peptidoglycan being made, you",English
+"have a bacterium that's trying to stretch out what it has, it's not resistant to osmotic shock. And what you saw was the bacteria basically undergoing",English
+"cell death via osmotic shock, pretty graphic, pretty visual. So penicillin was one of the first antibiotics that was described for the treatment",English
+"of bacterial infections. And we'll go to the timeline of that in a moment. So when we talk about bacteria, the original definition",English
+"of bacteria is in three different subtypes, gram-negative, gram-positive, and mycobacterial.",English
+This is actually the first way that people would take a look at your cell-- at the bacterial cells and diagnose roughly what kind of bacteria they were.,English
+Did they fall-- which of these broad families did they fall into? Because it would help in defining how you would treat the infectious disease.,English
+So I want to show you the difference between the cell wall of these various types of bacteria.,English
+"And the truth is, if you have an infectious disease, your wish is, if you had to pick one of the three, that you have a gram-positive disease.",English
+"And I'll explain why that is in a moment, because it's all to do with how drugs can get into the bacteria to inhibit vital functions in order that they die",English
+and they don't take over your system. So let's look first at gram-positive bacteria. They're shown here.,English
+This is a section of a bacterium. Gram-positive have a single cell wall. And they also have a thick layer of peptidoglycan.,English
+So they gain rigidity by basically having an extracellular thick layer of peptidoglycan coating them.,English
+"There is a schematic of it here. So here would be the inner cell wall. And here would be the peptidoglycan, shown in orange and pale, buff-colored circles.",English
+So that would be where their peptidoglycan is. And then there are some other glyco conjugates that actually stick out beyond that.,English
+"But there is only one cytoplasmic membrane. That's the standard double bilayer. And the peptidoglycan is quite thick, relatively,",English
+"20 to 80 nanometers across. So that's how wide it is. And you can, if you've got a-- if you've",English
+"stain a bacterium under a microscope, you would see that, the thickness of that wall, but the absence of a double wall.",English
+The gram-negative bacteria have a double wall. The inner membrane is pretty standard.,English
+It's just typical phospholipids. It looks like the inner cytoplasmic membrane of the gram-positive bacteria.,English
+And then it has an outer wall. So the inner membrane is typical. And then the outer wall has one leaflet,English
+"that looks kind of normal. And then it has a second leaflet that's sort of decorated, honestly, like a Christmas tree. There is all kinds of things sticking out",English
+"there that interact with hosts that they infect, and so on. And the space between the two walls is called the periplasmic space, because it's between.",English
+"It's not the cytoplasm. It's what's called the periplasm. Now, what's interesting about these, the gram-negative bacteria, is they have quite a bit",English
+"less peptidoglycan, only about 7 to 8 nanometers. So that's pretty interesting.",English
+"But they sort of gain robustness from that second wall structure that's coating on the outside. Now, their challenge with gram-negative bacteria relative",English
+"to gram-positive bacteria is any drugs you develop have to make a pretty-- if they're targeted at intracellular sites,",English
+"they have to get through two walls, not just one wall. So they are harder to treat. And they also have a lot of characteristics",English
+"that make them more prone to resistance development. So I want to point out to you, on this electron micrograph, you can actually see the double wall, the dark band of space",English
+"and then another dark band, whereas here you see a thin single wall, but you see a lot of junk on the outside.",English
+"Is everyone seeing the differences just to look at them? OK, so what's this gram thing about?",English
+What does this stand for? It simply stands for a chemical dye that stains peptidoglycan.,English
+"And it was invented or discovered by Professor Gram. That was his name. So when someone says you got a gram-positive infection,",English
+"gram-negative infection, it's how those cells look when they've been treated with this stain. Gram positives show up very positive to the stain",English
+"because there is a lot of peptidoglycan on the outside that absorbs the dye and shows a strong color. The gram-negatives don't show very well with a Gram stain,",English
+"because the peptidoglycan is tucked in the periplasm, not on the outside of the cell. So if someone does a quick check on a bacterial streak",English
+"or an infection that you have, they might treat it with the Gram stain and say gram-positive or gram-negative just based on that simple color analysis.",English
+"And so in one case, the peptidoglycan is abundant and accessible. In the other case, it's very, very much thinner and less",English
+"accessible to the dyes. Now, this probably looks like stone-age stuff to you, because how much can you learn by these simple colorimetric stains?",English
+"We're certainly moving in very, very different directions. But let me just finish off with the third type of bacteria, the mycobacteria, which include Mycobacterium tuberculosis.",English
+"And they have a different kind of wall, again. And they're pretty unusual. And they are really, really hard to treat, because it's almost impossible to get therapeutic agents",English
+"into mycobacteria. I used to work on a team with Novartis in Singapore. And they said, doing anything with mycobacteria",English
+"was like trying to do biochemistry on a wax candle, literally. You just can't work with it, because they have a thick additional wall that's kind of different again.",English
+"Did you have a question? No. Sorry, I thought I saw your hand up. So what they have is a typical cell",English
+"wall then some peptidoglycan, but then they have this thick mycobacterial layer which comprises what are known as mycolic acids, which",English
+basically add this thick layer of greasy hydrophobic material on the outside of the mycobacteria that's pretty impenetrable.,English
+The cell wall is quite different. It doesn't have an outer coat. It's like gram-positives in that respect. But it doesn't stain very strongly.,English
+"So it has a weak, what's known as Gram stain. So sometimes if you've got something",English
+"that gives a sort a so-so response to the Gram stain, you might say, oh, it looks like a mycobacterium because of what's happening.",English
+"Now, mycobacteria TB is a huge threat, because its treatment, its current treatment-- and it's the same treatment that's been around for, like, 30",English
+years or something-- is a treatment with four different antibacterial agents that hit a bunch of different sites in the lifecycle,English
+"of the bacteria. It includes these compounds shown here which are isoniazid, rifampicin, ethambutol, and pyrazinamide.",English
+"And it's a six-month treatment with those medications, so handful, four different medications for six months. So what they were realizing in the developing world",English
+"is that there was terrible compliance. The drugs are cheap, but there was no compliance. People just were not taking the pills, because they're like,",English
+Is anyone interested in infectious disease? It was a situation where it was a social system set up in order to make sure people took,English
+these drugs every day for six months in order to comply. So social workers would go to the villages in remote areas and watch people take the medications.,English
+"So it's directly observed treatment to make sure they followed through, because if they had regular TB, not very resistant TB, you could overcome it,",English
+"provided that you took these medications. But still, it's a hugely debilitating thing to have to deal with these treatments. Now, there are two strains of TB.",English
+One is called MDR-TB. And the other ones called XMDR-TB You'll occasionally hear of these on TV programs.,English
+"MDR is resistant to three of the four medications. And XMDR, which stands for extremely MultiDrug Resistant, is resistant to every single one of those medications.",English
+"New medications, different mechanisms of action are sorely needed. All right, this is just what things look like with the Gram stains.",English
+So here you see gram-positive Bacillus anthracis. That's the deep purple rods. You know that's a gram-positive because it's,English
+a deep purple stain. The other cells in this picture are white cells. So you can really pick out the gram-positive.,English
+This is the structure of the chemical dye that stains peptidoglycan through absorbing into the peptidoglycan.,English
+"It's a very sort of physical interaction of the dye with the polymer. And over on this slide, it's a mixture of gram-positive and gram-negative.",English
+"And you can pick up the gram-positive and differentiate them from the gram-negative, which just stains sort of kind of weakly pink.",English
+"And then mycobacteria, which are formerly gram-positive, don't stain very well because of that thick mycolic acid hydrophobic wall.",English
+So what would you do nowadays? Would you pull out a stain and drop it on bacteria and get some vague response?,English
+What's open to you now in the 21st century? You have a tiny sample of a bacterium. Grow it up.,English
+"What would you do? You could tell exactly what it is. AUDIENCE: PCR. PROFESSOR: Yeah, you'd PCR up the genomic DNA",English
+"and then go match it, because the thing that we, in addition to the human genome, there are thousands of pathogenic bacteria sequences that are completely annotated,",English
+known. The [INAUDIBLE] has a massive compilation of these sequences. And you just go and you find out what the bacterium is based on the sequence.,English
+So now rapid sequencing efforts-- maybe they're just a few number of key places in a genome that you would go towards and just do a really fast array,English
+"and figure out what's there and within what bacterium it is, which gives you a much better clue as to how to treat it than the vague, ambiguous stains.",English
+"So even though stains keep going, there is now other ways. Unfortunately, not everyone has the instrumentation to do rapid sequencing.",English
+"So nowadays, there is a lot, lot, lot of interest in faster dipstick sorts of tests that can distinguish between different bacterial strains",English
+"by, for example, interrogating that coat of glyco-conjugates that's on the outside of the bacteria, dipstick paper tests that can give you",English
+an idea of what organism and what serotype so you can move forward and do a much more rational treatment of those organisms.,English
+"was a pretty smart guy, because he contributed in a lot of different areas. He discovered that some bacteria tend to release substances",English
+"that kill other bacteria. That was in the 1870s. Then later on, there was another sort",English
+of spread of antibiotic agents. And it came with the discovery that we had things like arsenic derivatives actually,English
+showed some value in treating the organism that causes syphilis. So talk about the treatment being--,English
+"the cure being worse than the infection. People were being treated, seriously, with these arsenic derivatives in the hope of wiping out",English
+"the infectious agent that caused syphilis. But you know, sometimes it was a mixed bag. But where things started to get a lot more interesting was that",English
+"in 1928, there was this sort of famous historic story of Fleming discovering that some bacteria seemed",English
+to be inhibited by a particular agent that came from a fungus. And this was the origin of penicillin.,English
+"So he would have a Petri dish where he was growing bacteria. And he noticed that in some of his samples, there was inhibition of bacterial growth",English
+"due to an exogenous agent that had somehow contaminated the plates. So in that story, that was the substance",English
+that was named as penicillin. The mold from the-- mold is the fungus-- actually inhibited the growth of staphylococcus bacteria.,English
+"And it was called penicillin. And then a lot more time went by. But in the 1940s, the active ingredient was discovered.",English
+"So 1940s is sort of slap bang about, I would say, a couple of years into the Second World War.",English
+"And they were able to mobilize the production of this agent. Towards the later end of the war, people had penicillin available to them.",English
+"And it's basically pretty well believed that, if it wasn't for the antibiotic agents that emerged--",English
+"you know, the war ended in 1945. If it wasn't for those agents that emerged, there would have been way way, way more deaths from the war.",English
+"As it was, there were way too many. So penicillin was the first antibiotic that was discovered with a discreet mechanism of action.",English
+"And it was discovered at a very, very important time. So that was all great news. Penicillin was produced widely.",English
+Some of you may be allergic to penicillin. There are other options nowadays. But it's the cheapest and most viable of the first-line antibiotics.,English
+"Here we go. And this thing, this pointer has a mind of its own. It sort of changed its mind. But the problem was the bacterial species",English
+"started to survive treatment due to development of resistance. And all of a sudden, something that worked really well wasn't working anymore.",English
+"So let's try and think about peptidoglycan, what penicillin looks like and what it does, and how penicillin resistance emerges.",English
+"Those are the three things I'm going to cover here. OK, so what does penicillin do? Penicillin stops the formation of this big macromolecular",English
+"peptidoglycan polymer by stopping the last cross-link, stopping the chemistry that happens to join the peptide chains to make a cross-linked polymer.",English
+And anyone who is in the mechanical engineering area will know that polymers that are just strands are much weaker than polymers that,English
+are crossed-linked structures which have tensile strength in both directions. So the uncross-linked peptidoglycan was weak. And what penicillin specifically did,English
+was inhibit forming that cross-link. What does penicillin look like? Here it is. It's a cool structure.,English
+"It's what's known as a natural product, five ring, four ring, an interesting structure. And what it would do is it would interact with the enzyme",English
+the cross-linked the peptidoglycan and basically stop it dead in its tracks. What did the bacteria do?,English
+The key part of this structure is this four-membered ring within amide bond in it. The bacteria evolved an enzyme to chop it open basically,English
+making it completely inactive. So beta lactamase was evolved in the bacterial populations. It was probably derived from some other enzyme that,English
+"did some useful function, but not targeted to the penicillins. But the bacteria started to survive",English
+"because they made a ton of an enzyme called beta lactamase. And then it completely stopped working. So the chemists came up with other options,",English
+"because they said, well, you know, if that doesn't work, we've got other antibiotics in our arsenal. And there is a compound that was used",English
+"for years as a last line of resort antibiotic known as vancomycin. It was very, very important, so very serious infections,",English
+and really preserved for that use. And they thought that vancomycin might be a drug that just couldn't be defeated.,English
+This big molecule here is vancomycin. This little piece of peptide is actually the peptide that's in that cross-link.,English
+"And vancomycin basically, like a glove, sat on that piece of peptide and stopped it being cross-linked. And what did the bacteria do?",English
+"They evolved a set of enzymes to completely change that little piece of peptide into something that bound more poorly, giving you resistance",English
+"to vancomycin as well. So when there is one drug involved, it's pretty easy to get resistance quite quickly.",English
+You just mutate one enzyme and you get a resistant strain. And the enzyme that can beat the antibiotic will win. If you've got a compound that takes five different enzymes,English
+"or an antibiotic that has a very complex mechanism of action, you might say, well, this is never going to be defeated.",English
+"It took five additional enzymes to evolve to make the peptidoglycan a different structure. And it's not that within every bacterium,",English
+you mutate five different enzymes and get them all working as a team. What was happening in these infections is that a plasmid with the set of enzymes,English
+"was being passed around amongst bacteria. So a new bacterium could acquire resistance to this compound without evolving a whole bunch of new enzymes,",English
+but rather by lateral transfer of plasmids encoding the genes that it took to make the vancomycin inactive.,English
+"So currently, when we inhibit bacteria with antibiotics, there are a number of essential processes that are targeted with common antibiotics.",English
+"and many people know, bacteria are the ones that will respond to antibiotics, whereas viruses, until recently, we really didn't have any treatments.",English
+"Now we have some antivirals. But even for physicians, it can be very difficult to tell is this patient infected",English
+"by a bacteria or a virus. And yet, that has a huge difference in how they're gonna manage it. And the reason I mentioned parents is,",English
+"when your kid has an ear infection and you take 'em to the doctor, the thing that the doctor's trying to figure out is, does this child need antibiotics",English
+"because this looks bacterial, or is this gonna be a virus? It'll be self-limited, it'll get better. So tell me, using that as an example,",English
+"tell me how... In the old days, I know, we would just try to culture the bacteria out of the ear and say, ""What's growing?""",English
+"You have a different approach. Can you take us through that? - For differentiating bacteria and viruses, right? - Yes.",English
+"So imagine, bacteria and virus. Usually, bacteria are not inside the cell, usually they're outside the cell,",English
+"and viruses usually go inside the cell. And the reason for this, evolutionary speaking, is, bacteria has all the machinery",English
+"it needs to replicate itself, whereas virus doesn't. It uses the host machinery, our cell replication machinery",English
+"to replicate itself. And this is gross simplification, but let's put that on a side. So immune system over the evolution learned that",English
+"there are two types of danger signal, one that is outside the cell and one that is inside the cell. And depending on whether it's inside or the outside,",English
+"it learn what host responds to generate, to get rid of that danger. And we analyzed large amount of data",English
+where we had different bacterial and viral infections. And we figured out what is it that immune system did not change,English
+"during the evolution that no matter what kind of bacteria or virus it was, it always generated that response. And that's what we are now starting to rate.",English
+are there indeed signals that are very reliable? - They are extremely reliable. We've now shown that,English
+"whether what country or continent you were born and raised in, what your race and ethnic background is,",English
+"what strain of a pathogen you are infected with, whether you have some comorbidities or not, like the obesity, autoimmune diseases, immunosuppression.",English
+"Irrespective of these, or you have even both bacterial and viral infections together. Because that also happens.",English
+You can always see that there are these conserved immune responses to this types of pathogen,English
+- So I'll answer the second question. Doctors are definitely excited. I've heard repeatedly and I still hear it,English
+that they can't wait to try this out in their clinics. So that's really exciting. That wasn't the case,English
+"about seven, eight years ago, but now it is definitely. And the reason that they're excited is, because we are...",English
+I want to say less than a year into this actually becoming clinically available with a point of care machine,English
+"that you could use as a single blood draw, less than 40 minute turnaround time from sample to answer.",English
+"- So that's very exciting. And that will happen definitely, even in the lifetime of those of us who are getting older rapidly.",English
+"So, okay, so that's great. So did you have to... I think I know this. I know the answer.",English
+"I believe you had to combine both development of devices as you just described, and also computational analysis.",English
+"How do these algorithms work that try to pick up these signals? - So, it's not fancy AI. To be really honest,",English
+"the stuff that we are using now was developed sometime in mid seventies. The difference is,",English
+"there are two differences. One, we have so much data available that we are now make better use of the methods that were developed years ago, decades ago.",English
+"And then the second thing is, we changed a few things in this 50 year old algorithm that what was the fundamental guideline for using it,",English
+"we are ignoring it. So instead of making sure that the data sets are comparable to each other, we make sure that they are",English
+"as disjointed from each other as possible. And what that has allowed us to do... And then the reason for doing that was,",English
+"we wanted to find solution that is not biased. And in today's AI, that's a continuous discussion",English
+"of avoiding biases. And if you want to truly help patients, you need to make sure that",English
+"there are no hidden biases, and your solution has to be broadly applicable to large number of patient population",English
+"across the globe. So what we've been doing, that the methods that we developed are to account for these biases implicitly.",English
+"We are not accounting for them explicitly, but implicitly making sure that there is biological, clinical, and technical heterogeneity",English
+that we can represent in our data. And that allows us to make sure that when we go to real-world patient population,English
+"be it in Africa, or Europe, or Asia, or North America, it's the single solution",English
+"that continues to work across the globe. - Yeah, so that really does make sense. And in fact, earlier in your comments",English
+"where it still works. And so clearly that all, your ability to make those statements comes from this approach.",English
+"And in fact, I know that on the internet I can find talks that you've given about dirty data, and I'm suspecting that",English
+"this is what you mean is that, not that it's bad data, but that by having it be real world and from multiple sources,",English
+you can really check to make sure that this technology that is promising in the lab remains promising when it's deployed into the real world.,English
+"through lab experiments or whatever. We know that it does not immediately go to patients because the first thing we get asked is,",English
+"""Can you show that it works in another cohort?"" And what we are implicitly saying is, I know your patient population was not representative",English
+of the real-world patient population. Show me that if you were to now go out and do the same thing in a different patient population,English
+"to avoid that pitfall. We wanted to make sure that our a priority odds of success in real world were better than 70, 80%.",English
+"And that's why instead of starting with homogeneous one cohort, we decided to start with heterogeneous multiple cohort.",English
+"And you asked me earlier about AI. As we ask more sophisticated questions using this, we do realize that",English
+"we are now starting to include more neural network based approaches because now from the same set of variables,",English
+"was just trying to differentiate whether the patient has bacterial infection or a viral infection. But there is even a bigger problem which is,",English
+"many times we don't even know whether the patient is infected or not. Before we can ask a question, is this bacterial or a viral infection?",English
+"or it's going to turn into sepsis and I need to admit them to ICU?"" So there are three questions that we need to answer.",English
+"Presence, type, and severity of infection. And we need to be able to do in under an hour, let's say, but much earlier if we could.",English
+"So now with the small number of variables that we have identified that generalized the rest of the entire world's population,",English
+"we need to come up with better classification models. And that's where we are starting to use like multi-layer perceptrons, support vector machines,",English
+"neural networks, depending on the question. So that using a very small number of variables that you can measure in under an hour,",English
+"Now immune system, you can imagine is the trigger for the symptoms that you are going to see an hour later,",English
+"from Stanford University. In the last segment, Purvesh described how he can use the immune system to understand",English
+"how best to treat patients using precision medicine. So Purvesh, I know you've been working on tuberculosis,",English
+"and some of it is progressing to the clinic pretty rapidly. So what are the challenges with tuberculosis? Many of us hear about it,",English
+"we all get our little tests at the doctor every few years. Sometimes we have to take medications. Where are we with tuberculosis,",English
+"and what's the promise here? - So, tuberculosis, just to set the stage, it has killed 1 billion people in the history of mankind.",English
+"And that is every pandemic in the known history combined, plus all the world wars combined times two, right? Nobody, nothing has killed",English
+"as many people as tuberculosis. And in 21st century, as of 2020, we are still not able to diagnose",English
+"40% of the patients across the world. - Wow! So that's the severity of the disease. It still kills,",English
+used to be among the top 10. It is back in top five reasons for mortality worldwide.,English
+"And WHO has set this guideline, setting a goal for ending TB by 2035. And what they've asked is,",English
+they want a non-sputum-based test because the current test requires that patient cough off his sputum,English
+"and then culture it, which takes anywhere from one to three weeks. So they want something that is fast, and is as good",English
+"as the current standard of care. - It's also very unpleasant to get sputum up and some patients just can't do it. - Yes, especially like children",English
+"and patients with HIV co-infection. - Right. - So they can't even generate sputum. So we set out to do this about 2016,",English
+so about six years ago. And we found that there is a 3-gene signature in peripheral blood that would now diagnose,English
+"whether you have active tuberculosis disease or not, compared to healthy controls, those who have latent infection",English
+"or any other lung disease. That was 2016. - So, wait a minute. When you say 3-gene signature help decode,",English
+what does that mean to somebody who's not a scientist? - So every cell expresses or has a certain number of genes,English
+"that come from our genome. And depending on what kind of immune response you have, different genes are expressed.",English
+So not all genes are present in a cell at every time. It depends on what condition you are in. So these 3-genes,English
+"are only present in immune cells when you actually have tuberculosis. That's what we found. - Okay, okay. - And then a company in Sunnyvale",English
+"licensed this from us, from Stanford, created a cartridge. And two years ago,",English
+a group of scientists across two continents in four countries showed that they could now measure,English
+"this 3-gene signature using a finger stick. So looks like Theranos, right? But what they showed is as the...",English
+"- But it worked. - It's a ""Thera-yes."" (Russ laughs) - Yes. - But they could show that",English
+"in a truly prospective trial at point of care in clinic across four countries, this 3-gene signature measured on a cartridge",English
+"diagnosed TB in 45 minutes. Before the sputum left the clinic for culture, they knew what the patients had",English
+"and they could send them home with the treatment. The problem is, getting it adopted broadly.",English
+"This is, as you said in the beginning, this is an entirely new kind of diagnostic tool. We haven't used this.",English
+"We've been using host responses for almost 150 years. It started with lactate. But the problem is,",English
+"it's been not a problem. But they've been protein-based biomarkers, not gene expression based biomarkers. - Yeah. - So we haven't had",English
+"many of those, or actually none in the clinic. So raising awareness, showing that they are as good,",English
+"if not better than the current diagnostics that we have. So that's the challenge that we are going to go. - Yeah, so you raised an important point",English
+because I know that lots of the tuberculosis is occurring in the developing world where they're very resource constrained.,English
+"And so, is there efforts to try to make this like super robust? A lot of these tests have to be conducted in like, tents,",English
+or like temporary hospitals that also have other services. So is that one of the pushes of the work is to try to figure out,English
+how to get this to be robust and cheap? - Exactly. So I would speak for the robust part. Cheap part is where the...,English
+"Given that the technology itself is new and there isn't a market, - Yeah. - one could argue that the cost would be high, but as it gets more adopted,",English
+"production scales up, prices are going to come down dramatically. 20 years ago it took a few hundred",English
+"or a few million dollars to sequence a genome, and now we are sequencing it at $100, $200, right? So the same thing's going to happen,",English
+"but I think it's going to happen faster than the 20 year as the usage increases. - Yes, and that seems to be how things can go.",English
+"When you show initial that it works, then all of a sudden that creates a whole ecosystem for different people",English
+"who are good at engineering, and reduction of technology to figure out how do we get this to cost pennies, so we can deploy it broadly",English
+"in places that really need it. - Exactly, so my goal has been to demonstrate repeatedly over and over in different patient population,",English
+"in different countries that this works. It is clinically useful, it can be translated in clinic, and then that would bring more people in",English
+"and just move the field forward. - Right. So in the last few minutes, I know you were also doing work in precision medicine,",English
+"that is to say, you know, predicting what drugs would be best for patients. So could you set that up, what's the challenge here",English
+"and how are you addressing it? - Yeah, so there are two kind of things we could imagine. One, and I'll speak for one and that is,",English
+"most drugs don't work across all the patients, only a subset of the patients respond. And given that I've been very interested",English
+"in infectious diseases, that particular problem is very evident in sepsis. Just to put some numbers on the table,",English
+"every sepsis patient in state of California cost one day in ICU is $19,000 a day. And that's a median price.",English
+"It could be much higher, right? So the problem has been, if you look in the literature,",English
+"about 150 drugs have been tried and they've all failed, there is no single drug that works. There was Xigris that was approved.",English
+"And then post-marketing, it failed because it didn't work for everybody. - And this is for sepsis. This is very bad infections in the ICU.",English
+"- Right, it's about 45% mortality in ICU is because of sepsis. And what we have started to now learn is,",English
+"immune system itself is very heterogeneous, and the responses within sepsis patients are also heterogeneous. So we could,",English
+"Rachel Sare and Jean Tiong-Koehler who basically organized the event. Thank you, Rahul, and the whole NIA team for the excellent technical support.",English
+"A couple of housekeeping remarks. Please use the chat feature to ask presenters a question. Identify yourself in order to minimize disruption,",English
+"those who are not presenting do not have access to the microphone or camera. However, in exceptional cases or in some cases,",English
+"you can elevate people to the panelists. You have any technical questions Raul is the person to ask, and speakers have 15 minutes for their talk.",English
+"I will remind speakers two minutes before the time is overdue. That time is over,",English
+"it's two minutes left. The session will be followed by panel discussion guided by presentation. Again, we encourage a question from audience and scientific writer is present",English
+and in the call with the objective to document the event and know that the meeting is recorded. We ask all session chairs and presenters to briefly introduce themselves.,English
+"Again, the goal of the workshop is to discuss whether microbial pathogens may represent a causal component of Alzheimer disease. We would like to review gaps, knowledge gaps,",English
+"established some scientific priorities for research and think a little bit how to address those gaps. Again, we value your opinion and we would appreciate your comments in",English
+the chat box about the gaps and those priorities and how to move the field forward. We hope to present white paper from the workshop and your input is really invaluable.,English
+"We would like to stimulate a collegial conversation between those who postulated, there is a link between pathogens and AD.",English
+"Those who do not think that there is a strong enough proof that's such a link exists. We structured the first six presentation from epidemiology, computational in biology,",English
+"virology expert who asked similar question, had comparable experimental design yet draw opposite conclusion. One can say obviously that science progresses that way and that is true.",English
+"However, if you were to design and run these studies again and we are to support them, it would be great to hear from you how this study should be designed.",English
+"We are still building the program on infectious etiology of AD. Let me take this opportunity to say to those who applied recently to RFA on Infectious Etiology of AD and were not supported,",English
+"please do not give up. Many applications, we could not support but they were very meritorious application. We certainly hope that you will resubmit",English
+your proposal and you will give us a chance to consider it for funding. This is my brief remarks. Any questions or comments?,English
+"Rudolph Tanzi: All right. I just wanted to make sure you know that for the keynote I'll be using my own slides, not the ones that I sent.",English
+If that's okay. Mack Mackiewicz: Great. We finish a little bit earlier. I don't know whether we would like to start with,English
+the keynote presentation or wait five minutes. I think perhaps we can start.,English
+"It is a great pleasure to introduce our keynote speaker, Dr. Rudolph Tanzi. Doctor Tanzi is the Joseph P. and Rose",English
+"F. Kennedy Professor of Neurology at Harvard University, Vice chair of Neurology, Director of the Genetics and Aging Research unit and",English
+"Co-director of the Center for Brain Health and Mass General Hospital. Dr. Tanzi has published over 600 scientific papers, including several of the most cited papers in the field of Alzheimer's disease research.",English
+"Dr. Tanzi discovered the amyloid precursor protein gene, the first Alzheimer disease gene and co-discovered the two other early onset familial AD genes known as presenilin.",English
+"Dr. Tanzi and his team also discovered the amyloid beta, the main component of the senile plaque, plays a key role in innate immune system of the brain,",English
+"operating as antimicrobial peptide, suggesting a possible route for infection in driving AD pathology.",English
+"Dr. Tanzi, welcome and please go ahead with your presentation. Thank you so much. Rudolph Tanzi: Thank you, Mack. I'm just going to get",English
+"my slides up and make sure you can see them, okay? You can hear me and see my slides okay? Mack Mackiewicz: Yes.",English
+"Rudolph Tanzi: Okay. Great. Well. Thank you so much. It's such an honor to give a keynote at such an important meeting. I really want to start today by just thanking the committee,",English
+"Mack, Eliezer, Jean, Rachel for having the foresight to see how important it is to study the role of infection in a microbes in Alzheimer's disease.",English
+I think speaking for many on this panel and many who are listening in it's tough road for us who are trying to study this new idea. Many have study sections and reviewers of papers have,English
+"philosophical objections to this idea and it makes it even more difficult for us. To have the NIH behind us, have the NIH putting out our phase and having meetings",English
+"like this to support new ideas and be open-minded, I think on behalf of all of our suggests, I'd say thank you for allowing this opportunity to promote",English
+"these ideas and to explore this interesting area of etiology and pathogenesis for Alzheimer's. I wanted to just begin just to show my disclosures,",English
+these are accompanies in which I've served as a consultant. I've had financial interests over the last five years. Some of them I might mention during my talk.,English
+"Now, just to give you a preview of what I'm going to say in my talk, I am going to talk about an extension of the antimicrobial protection hypothesis of Alzheimer's that was first",English
+"really promoted by one of my dearest friends and colleagues, Rob Moir, who I think many of you know, who tragically passed away a couple of years",English
+"ago after a very short battle with glioblastoma. If you knew Rob, one of the friendliest, nicest, and smartest guys you could ever meet and we're so proud in my lab to continue his work.",English
+"Later you'll hear from Will Eimer who's now a member of my lab that was a member of Rob's lab, who will present some new idea that I'll just touch upon regarding also the rule",English
+of tangles as an antimicrobial protection. Let me just state what I would say is a new iteration of the original antimicrobial protection hypothesis that Rob and I had developed.,English
+"In our hypothesis, we're not saying that infection is directly causing all of Alzheimer's and the pathology of Alzheimer's is along for the ride.",English
+"What we're saying and I'm not saying that's not the case, that could be the case. In our hypothesis we put forward were saying that infection drives Alzheimer's pathology and that",English
+"Alzheimer's pathology evolved as a way to protect the brain. We call this an orchestrated innate immune response. The idea is that, Alzheimer's pathology plaques, tangles,",English
+and mirror inflammation evolved as an orchestrated innate immune response in the brain together with evolutionarily conserved AD susceptibility gene variance that,English
+"promote this pathology to protect the brain against microbial infection. Now today, it's possible that most of the pathology we're seeing, much of it is due to genetics.",English
+But we're making the argument that the gene variants that predisposed to AD may have been conserved because they promoted pathology that was protective as part of,English
+"the innate immune system over the last tens of thousands of years. One of the big task today will be to understand the relative roles of genetics, infection,",English
+and other environmental exposure factors and driving this disease in terms of etiology and pathogenesis. These are the first four Alzheimer genes that you all know.,English
+"I show this slide to make the point that all four of the first Alzheimer's genes that have the strongest effects on risk where they're fully penetrant,",English
+"early onset mutations, and APP, PSEN1, PSEN2 or APOE-e4, all of these get us to A-beta.",English
+"The majority of mutations here increase the ratio of A-beta 42 to 40, it drives aggregation of A-beta. The APOE-e4 effects the clearance of A-beta from the brain and deposition of A-beta.",English
+There is great genetic evidence to support the amyloid hypothesis and this continues. These are a number of different papers that we published alone on,English
+new Alzheimer genes with rare variants or common variants that continue to support the amyloid hypothesis. From Ataxin-1 controlling base activity,English
+"to ADAM10 the alpha secretase with mutations in the prodomain. Gga3 which has a rare African-American mutation that controls base trafficking, ace entertaining converting as an mutation that affects A-beta,",English
+"induce neurodegeneration and most recently essential sodium, a new mutation on APP in the ectodomain at S198P that affects APP trafficking A-beta deposition.",English
+"Although the majority of genes that we see today from GWAS are bringing us to microglia, I want to make a very interesting observation. The earliest onset genes that lead to",English
+amyloid deposition seem to tell us about the earliest events in the disease and this is true in heart disease too. The early onset fully penetrant mutations in the LDL receptor brought us to,English
+cholesterol while cholesterol occurs very early in heart disease and you have to hit it early. I think it's analogous for amyloid and now we're seeing,English
+late onset mutations and innate immune genes and neuroinflammation genes and they're telling us I think about later events and this seems to be a trend towards genetic diseases that early onset mutation is telling you about the earliest events.,English
+"You have to hit as early as possible, preferably pre-symptomatically so I just want to get back to that theme. It's showing here that I think based on what we are seeing that we can say that",English
+Alzheimer's disease is the most common tauopathy induced by A-beta oligomers. The idea is that A-beta oligomers induce neurofibrillary tangles where you need,English
+"an equal representation of three repeat and four repeat tau, as neurons die and amyloid accumulates this induces neuroinflammation and based on resilient brain studies without",English
+"neuroinflammation it would appear that plaques and tangles are not sufficient to lead to enough cell death to cause symptoms. These are initiating pathologies that occur very early,",English
+"perhaps two or three decades, at least a decade before symptoms and overtime they induce neuroinflammation. There are other tauopathies that can be induced by head bangs like CTE,",English
+genetics like FTLD and PSP or environmental triggers and you're going to hear later from Will Eimer that viruses can also induce tauopathy.,English
+"I want to make the point that with CTE, those bangs to the head come when folks are playing football, brilliant life, and it takes decades of tangle",English
+spreading and neuroinflammation before you see symptoms. It could be the same thing when amyloid acts as the match so to speak to induce tauopathy.,English
+"This is a very simplistic idea that amyloid could be like a match. Tangles are like brush fires that are spreading but you don't have the forest fire yet, neuroinflammation is the forest fire but you could also have matches",English
+"like head bangs or genetics of FTLD and I want to argue microbes. The big question is if not genetics, what is striking the match?",English
+"I'm going to make the argument, could it be microbes? Now, and could that have caused the reason for these gene mutations to be",English
+"evolutionarily conserved over the last tens of thousands of years? Now, one thing we know is that amyloid targeted trials have failed to improve cognition even at your canyon map which was recently approved,",English
+"was approved for removing amyloid but it did not have a substantial effect, minimal to no effect on cognition, so it was approved for AD to reduce amyloid levels as a way to affect",English
+"the pathogenesis of this disease and we'll see how this bears out over the next several years, maybe 10 years before the next trials adjourn.",English
+"But of course I would argue based on this and I think many would argue that you need to hit the amyloid as early as possible, perhaps before symptoms, pre-symptomatically.",English
+"I think the expense of Aduhelm at $56,000 a year plus imaging costs for safety might preclude using the pre-symptomatic way of course, it's estimated there may be 38 million people",English
+"in the US who have amyloid in their brain without symptoms. Although this approval is controversial, I want to say that there's a silver lining,",English
+"it opens the door for now testing other cheaper and safer therapies. Repurpose drugs, natural products, existing drugs, or new drugs like gamma secretase modulators.",English
+Steve Wagner and I have been developing for 20 years with the help of the NIH neuro-therapeutics blueprint. I think that this has opened a new era in Alzheimer's,English
+where we will see perhaps cheaper safer drugs to hit the amyloid that we could talk to the FDA about using when they should be used which is secondary prevention pre-symptomatically.,English
+"If they are cheap enough and safe enough that can happen, so I look forward to seeing how to solve the valves. Now, to get to such drugs that hit amyloid,",English
+"just before I get into the antimicrobial stuff, we've been working with 3D cell culture models that do Doo Yeon Kim and others have developed in our group for drug screening purposes.",English
+"In fact, two of the re-purpose drugs that came out of these screens have already been used in ALS trial in a company that I co-founded with Justin Klee and Josh Cohen called Amylyx.",English
+"ALS trial carried out by Merit Cudkowicz's groups and the HEALEY center worked, we published a paper in the England Journal of Medicine and now the company Amylyx is in conversations with the FDA",English
+"and Canadian and European agencies for approval of this for ALS, while we also wrote about it we're also testing it in a phase II trial for Alzheimer's and I think",English
+"those top-line results will be released soon. These are two drugs that protect neurons basically from dying in response to oxidative stress brought on by neuroinflammation,",English
+"so they can be tried to cause neurodegenerative diseases. But this is the map of how we're testing all the other drugs to see with the 3D systems, the 3D cell culture systems,",English
+it's really made drug screening literally tend to 100 times faster and cheaper. These are all of the intervention points that red testing in our lab way too many to go through from,English
+"A-beta production and aggregation all the way to tau spreading and reactive gliosis and microglial activation. Rudolph Tanzi: For today's purposes,",English
+"I'm just going to show you this and that is in our 3D model, we were able to show unlike mice, the amyloid doesn't use tangles.",English
+In mice you don't get tangles from amyloid because they don't have the right 3 repeat 4 repeat tau ratio. You have to have equal amounts of,English
+"these 4 repeat 3 repeat tau and that's not the case in mice. But in ReN VM derived neuroprogenitors, human embryonic stem cell derived ReN VM cells.",English
+If they grown in 3D you get this ratio and then amyloid which occurs in addition four weeks and about a week later you see bonafide paired helical filaments and tangles.,English
+"A warning with IPS derived neurons, these are too immature to get this 4 repeat 3 repeat tau ratio and so they don't make tangles. If you want to make tangles from the amyloid you need",English
+"to use the RenVM neuro progenitor cells. Then in a follow-up paper we showed that it's A-beta 42/40 that matters. The more A-beta oligomers you have driven by the greater 42/40 ratio,",English
+"the more endogenous human tau is turned into tangles. Importantly in this experiment that was published this last year, these are naïve neurons,",English
+"they're not over-expressing A-beta, they're naïve neurons. The A-beta is being fed from the bottom here and as A-beta oligomers feed in and hit the naïve neurons,",English
+"they still make paired helical filaments and tangles from endogenous tau saying that is A-beta 42, A-beta 40 ratio oligomers that matter in this gel,",English
+"the driving tauopathy as opposed to other pieces of APP or other functions of PSEN1 and PSEN1 mutations. Based on this, Steve Wagner and I are developing",English
+"Gamma secretase modulators that are now, with the help of the NIH Blueprint and the Cure Alzheimer's Fund, we're talking to the FDA now about IND.",English
+"Our pre IND went in, we're hoping to get into phase I clinical trials. Gamma secretase modulators are not inhibitors. They have no effect on Gamma secretase cleavage of notch or other side effects.",English
+"All they do is allosterically modulate the docking site of Gamma secretase to open it up. As a result of opening it up, APP can fit in further into the mouth,",English
+"and so you make more A-Beta 38, let's say A-Beta 42, and that shift from long to short A-Beta would drive down A-Beta oligomers and P-Tau.",English
+"Even at very high micromolar concentrations, these modulators, unlike Gamma secretase inhibitors, will not block notch cleavage or have your off-target effects",English
+"that former had drop problems with Gamma secretase inhibitors. Now, of course, there is also a role for neuroinflammation in this disease.",English
+"We had discovered CD33 is an Alzheimer's gene back in 2008, but was confirmed in 2011. TREM2 was found by decode and also by John Hardy's group, INPP5D.",English
+These all seem to modulate microglia function either toward neuroinflammation or more toward a janitorial function clearing A-Beta phagocytosis. This is just a summary of some of the results on some of these genes,English
+shown in this slide that I modified from a figure from Beth Stevens' paper. It's based on studies from Arnold Gricuc on neuron and a recent paper had Gricuc with McAlpine and Swirski.,English
+"Since there is a growing role of neuro inflammation, not new 3D model occlusion or inflammation as well as plaques and tangles. I want to show you is that in this model,",English
+"these are neurons in 3D peacefully coexisting with microglia, the little blue dots from microglia. But if those same neurons are making plaques and tangles,",English
+you can see the microglial cells rush in and they destroyed a neurons rapidly. They are also causing oxidative damage. This is neuro inflammation induced by neuronal cell death,English
+brought on by amyloid causing telepathy in this cell culture model and we can then screen for drugs. This just summarizes what we found.,English
+"We have now about 44 repurposed drugs and natural products that either block A-Beta production or induce microglial clearance of A-Beta that we add to home dose but these are drugs in natural products,",English
+"31 drugs that prevent amyloid from inducing telepathy in this model. We have about 42 drugs and natural products that either stop neuro inflammation or protect neurons from dying during the neuro-inflammation,",English
+"including those of black microglial activation. We're now planning with Howard Fellman and the ADCS to start doing trials, also with Stephen Arnold,",English
+"on many of these relatively safely purpose drugs and natural products to see if we can get them to hit these different pathways. Of course, with the approval of Aduhelm,",English
+"we're focusing on ones to clear A-Beta from the brain or lower A-Beta levels in the brain. But I want to ask as I introduce Rob Moir's work,",English
+"do we really want to wipe out A-Beta in the brain or just dial it down? I would say you don't want to right off A-Beta because as Rob Mouir showed during his brief tenure as a scientist,",English
+"he was in our group actually for over 20 years, but died way too young at 58 years old. What Rob showed in his papers is that A-Beta is a bona fide antimicrobial peptide.",English
+"In an immunity, your first defense against infection is antimicrobial peptides. These are sticky little peptides, the LL-37 and others,",English
+that bind microbes and rapidly agglutinate them into a trap to protect host cells by trapping them. He showed that A-Beta deposits actually do this and that,English
+"these microbes rapidly drive A-Beta aggregation and deposition. Refresh show this in vitro, just the A-Beta could hit various clinical pathogens.",English
+"This was a paper in 2010 and then papers by Will Eimer and Deepak Kumar and others. We showed that this happens in vivo. Specifically if you infect mice with salmonella in the brain,",English
+"which you will see is that the mice die quite quickly over here in blue, but if it's overexpressing A-Beta due to FAD mutations, they survive longer, significantly longer.",English
+"Same thing for HSV-1 and realignments paper. You saw neurons dying with herpes infection encephalitis in the mouse's brain, but if that mouse is expressing high levels of A-Beta 5XFAD mice, they survive longer.",English
+"Conversely, if they're APP knockout mice, they don't survive as long in the absence of A-Beta. This suggests in vivo evidence that A-Beta is an antimicrobial peptide.",English
+"But what A-Beta does, as I said, is it rapidly binds to microbes and it starts to form fibrils around them to track them. Whether that salmonella, which is shown here up top,",English
+"or herpes virus shown here, you're going to see more of this in Will Eimer's talk. But this is what really struck me and this is the paper from 2016.",English
+"This really changed my view of amyloid, and that what we saw was that, when we introduce salmonella into the brain,",English
+"it was able to induce A-Beta plaque formation in just 48 hours. If you look down here,",English
+"the yellow shows the fluorescent labeled Salmonella in the middle of the green, which are plaques which you can see is when you have heat kill bacteria, you get no plaques.",English
+"This is the wild-type mouse here when the bacteria going into wild-type mouse, the 5XFAD mice where A-beta's overproduced, which we can see is that within 48 hours, you're getting plaque.",English
+"Even one bacterium in some cases can induce a whole plaque overnight. This says that amyloids, I remember the popcorn plaque story from Brad Hyman and it",English
+"says that if you want popcorn plaques to form and see rapidly, a microbe will do that almost overnight. This is also true in the dish model where we could use HSV-1 or other herpes viruses.",English
+"In this dish model, as I told you earlier, the 3D model, it takes about four weeks to make a plaque in this model. But if you add a herpes virus into the dish,",English
+"you get it quite quickly. This is showing here actually I have, I'm so sorry, I have the wrong slide here. This is the mouse slide.",English
+"I thought I had the dish slide, but I've just mentioned that you'd get plaques very rapidly in the dish overnight when your herpes virus is versus four weeks. This is just showing HSV-1 and Eimer's 5XFAD mice.",English
+"These are one and half month old mice that don't have plaques yet. But if you put HSV-1 right in, you start to see diffused deposits in 36 hours,",English
+"and then you see full-blown neuritic plaques in just 21 days. By this point, these mice are about two months old, and normally as you know,",English
+"for those of you who work with 5XFAD mice, you don't usually get plaques at this point. You're rapidly inducing plaques with herpes virus and these mice.",English
+"Now the caveat here is that in the 5XFAD model and in the 3D models, we're overproducing A-Beta. So we have lots of A-Beta present.",English
+"The big question is, in physiological levels of A-Beta we have in our brains, is there enough A-Beta for the microbes to still promote the amyloid deposition?",English
+"This is something we're just tapping now, we just got the knock-in mice where you're making human A-Beta at physiological levels knocked into mice and realignment in the group.",English
+"We'll be looking now at the knock-in mice from some cyto to see if we also get this effect when there's physiological levels of A-Beta. This shows proof of concept with increased A-Beta,",English
+you do get this rapid promotion of plaque deposition driven by microbes. That's summarized here. Already A-Beta is binding to the outer wall of candida in,English
+"this case or to the carbohydrate domains on herpes virus shown down here. What will happen is that the A-Beta will start to fibrilize around the microbe,",English
+"and then the next thing you know, you have an animal trap, in this case it's a plaque. A-Beta fibril is trapping either at candida or HSV-1 or Salmonella.",English
+"Like I said, we've shown proof of concept for this an A-Beta over producing models. We still need to show it now for models where we have physiological levels may be like in the human brain and that's where I'm going.",English
+"Now I want to come on to extend into unpublished data and some of you guys see a more detailed and rely on this talk. But one of the things we saw is that A-Beta has a dual activity,",English
+"not only binds and kills microbes, but we can show here is that if neurons are infected, plus you have A-Beta, you get much more neuronal cell death.",English
+"So whether it's HSV-1 or Salmonella or even inducing inflammation inducing salmonella LPS, if there's A-Beta present,",English
+"what we could see is that by treating cells with A-Beta after viral infection, you get dramatically more so depth. But if you have an infected cell,",English
+it's not encountering A-Beta. Almost like A-Beta is binding into these infected cells and then taking them out selectively. What you're going to see also and rely on this talk is that,English
+"both HSV-1 and A-Beta can directly induce tangles. This is pretty amazing that HSV-1 can induce phosphatidyl,",English
+"you could see a nice colocalization of P-Tau and HSV-1 and effective neurons. When you have A-Beta plus HSV-1, you see even more tangled formation in the dishes or classic feeds on a string.",English
+"So the idea here, and this is unpublished data, is it possible that when HSV-1 gets passed A-Beta, and it's not trapped, and now it's infecting a neuron,",English
+"one thing that will happen is A-Beta will kill that neuron more readily, but the other thing that happens is HSV-1 plus A-Beta oligomers induce tangles. What tangles might be doing is blocking neurotropic virus spread.",English
+"In other words, with a tangle, you put up a roadblock in the highway. Normally HSV-1 will block by neurotropic spread down the axon for synapses neuron to neuron.",English
+Is it possible that tangles are blocking this? You're going to hear and this is just showing some of the punk take p-Tau and the human pneumococcus following HSV-1 infection in this slide here.,English
+"You're going to hear more about that from well. But the big question, I think it's going to be a big part of this meeting, is do we have a smoking gun?",English
+Is there really a microbe and infection that we can blame Alzheimer's on? I think we'll hear about all of these fungal infections have been implicated.,English
+"Herpes virus, we'll hear from Ben Readhead about his work on HSV-1. Chlamydia, HIV, certain you see amyloid deposition in many HIV patients,",English
+"especially those with AIDS-related dementia. Toxoplasma, hepatitis, cytomegalovirus, you'll hear more from Manolis Kellis about that later in collaboration with our group.",English
+But I think we're still waiting for a true smoking gun. We've been looking really hard. We did metagenomic sequencing of our own at Mass General.,English
+"We also collected the Mount Sinai and Mayo datasets. This is work of Nanda Kumar, Deepak Kumar, Will Eimer.",English
+"Deep sequencing, 120 million reads per sample. The QC cutoff was we had to have a sea of species present and greater than 10 or more samples with at least greater than two map reads per species,",English
+"and we use Kraken and viromescan algorithms for this purpose. So far, I've emphasized so far, we have not found significant differences in levels of",English
+any virus in AD versus control brain. We did see small but significant increases in three different periodontal bacterial species.,English
+"Not P. gingivalis in this case, these are other periodontal bacteria species, but it promotes this idea that perhaps our gum disease is leaking periodontal bugs into the brain that are causing problems.",English
+"But I want to make a point, that even though we've come up empty for a smoking gun. I think we have to consider football players in CTE.",English
+"Think about the fact that football players are boxers, they're competing in their teens and 20s. Those bangs to the ahead that are inducing",English
+"those first tangles that are going to propagate and spread like brush fires, well, they take decades before you see CTE. I mentioned before the match and the brush fires,",English
+"well, who knows, maybe if a virus or amyloid is also the match here or a microbe driving amyloid is the match,",English
+"that might also be occurring decades before you get symptoms. It takes decades just like CTE for those tangles to spread and neuroinflammation. Maybe by the time we're looking in these brains for microbes, it's too late.",English
+"It's like taking a person with CTE and you're looking for evidence that he played football yesterday. Well, no, he played football 20, 30, 40 years ago.",English
+I just want to put that caveat in. What we're doing now is we're laser capturing plaques. This is record Will Eimer and Brad Hyman's group.,English
+"We're laser capturing plaques, and looking inside of plaques for historical evidence of microbial RNA and DNA. Because the idea would be if a microbe drove the amyloid",English
+"decades ago and a microbe was striking the match, an amyloid is the match and tangles are the brush fires, maybe we'll find evidence for",English
+"that microbial RNA/DNA inside of the plaque by laser capture. That's ongoing. Before I end, I just want to point out one more thing.",English
+"That is that there's increasing evidence that vaccines offer protection against AD. These are the some of the papers of bladder cancer immunotherapy where BCG,",English
+"the tuberculosis vaccine is associated with significantly reduced risk. Two different papers showing that. Influenza vaccine has been associated with the reduced incidence of Alzheimer's,",English
+"Now, one possibility is that these are the most common pathogens that are leaking into the brain and then driving Alzheimer's pathology over time.",English
+"I think we have to explore that. But we did a recent performed a study that gave a surprising result that may suggest an alternate hypothesis,",English
+"and that is, could it just be that these vaccines are priming the peripheral immune system. That's good for the brain.",English
+"Could it be that just priming the peripheral immune system is good for the brain in terms of these data? The reason I say it is that recently we carried out a study with Reisa Sperling,",English
+"The Harvard Aging Brain Study. These are 300 normal elderlies. These are normal elderly, 300 people,",English
+"they've been followed for six years. Neuropsych exams, blood draws, many of them had been imaged for amyloid or image for tau.",English
+"We're asking what predicts cognitive path? What predicts cognitive trajectory in normal elderly in this study? The hypothesis ones that peripheral inflammation,",English
+"pro-inflammatory cytokines in the periphery, in the plasma will drive greater amounts of neurodegeneration and would worsen cognitive trajectory.",English
+"Well, the answer was the opposite, but exactly the opposite result. What we found, if you look here on the left, in red dashed line going down,",English
+"these are folks who have amyloid in their brain, and this is cognitive path or cognitive trajectory over six years. This is work with Hyun-Sik Yang,",English
+"and Reisa Sperling, and Jas Chhatwal. You are seeing the normal trajectory downward in cognition six years for those who have amyloid in the brain.",English
+"But for those who have high plasma levels of interleukin-12, a pro-inflammatory cytokine, well, they don't do so badly.",English
+"They do much better in this solid red line shown here. Now if you look at interferon Gamma, another proinflammatory cytokine,",English
+"this is the overall group. Here, it depended on amyloid. Here, the overall group of 300 people, this is the cognitive trajectory over six years for all of the normal elderly,",English
+"300 in this study. But if you have high interferon Gamma, another proinflammatory cytokine, no, you do much better; in fact,",English
+"you even get a tiny bit of elevation. What did these two proinflammatory cytokines do? Well, they modulate the interaction between effector T cells and macrophages.",English
+"A macrophages produce interleukin-12 that induces Th1 cells to produce interferon Gamma, which then activates macrophages into an M1 like",English
+"state to prime the innate immune system peripherally and fight infection. One possibility is just by being able to fight infection better, by priming this system,",English
+"you have a better cognitive trajectory, and that could be just simply due to hitting infection directly or it could be that we're simply priming the immune system",English
+"is good for the brain regardless of infection, and this is a very important path that we're taking in the lab to study this phenomenon, both based on the vaccines that protect and this idea",English
+that greater protection against infection by proinflammatory cytokines in this pathway of macrophages to affect the T cells may afford protection to the brain,English
+"directly regarding peripheral immunity and defense against infection. This is my summary, what I've told you,",English
+"and the extension of the antimicrobial protection hypothesis. A-Beta is a major antimicrobial peptide in the brain. Microbes in the brain rapidly seed Beta-amyloid,",English
+which then traps the microbes. This is in models overproducing A-Beta. Next we have to ask whether this happens with physiological levels of A-Beta in knockin mice.,English
+"I didn't mention this but we also know A-Beta oligomers block out long-term potentiation, induce vasoconstriction. This another way in which A-Beta as",English
+"an antimicrobial peptide shuts down infected area of the brain. A-Beta potentiates neuronal cell death in the presence of vital infection. A-Beta induces neuroinflammation in microglia as an innate immune defense,",English
+"and then you're going to hear from Will Eimer more data on A-Beta and herpes virus inducing tangles, perhaps to block neurotropic viral spread.",English
+"These all orchestrated in the immune response, and we have to ask whether AD-associated genetic risk variants may have been genetically conserved.",English
+"This is further summarized here. This is in the first slide I showed you, that Alzheimer's pathology, and this hypothesis. Is it possible that Alzheimer's pathology, plaques, tangles,",English
+"and neuroinflammation evolved as an orchestrated innate immune response together with evolutionary conserved AD susceptibility gene variants,",English
+"whether it's APOE or early onset genes or CD33, that promote AD pathology, be it plaques, tangles or neuroinflammation,",English
+"and protected the brain against microbial infections? I'm saying today, certainly genetics can handle it alone. Genetics can get you to the disease alone,",English
+"that these genetics evolve because this pathology was protective, and today is this pathology still being driven by microbes. I think we're going to hear in this symposium the evidence for",English
+"infection driving directly cell death, neuroinflammation or plaques or tangles as part of this orchestrated innate immune response,",English
+"where AD pathology in this hypothesis started with Rob Moir, evolved to protect the brain, and today we're dealing with the consequences of",English
+"the conservation of the genetics that came along for the ride. I'm going to stop there. This is Rob Moir who inspired this work, inspires us today. This is our genetics nature of research unit who do this work.",English
+"We're funded and is recommended by the Cure Alzheimer's Fund, NIA, and the Open Philanthropy Project and Good Ventures. I'll stop there and happy to take any questions now or later. Thank you very much.",English
+"but here's one more, and someone cut me off. Mack Mackiewicz: Liz, we have roughly three minutes. Elizabeth Newman: Just cut me off. There are a lot of questions.",English
+"During the recent talk at Duke's infection and inflammation meeting, a member of the audience indicated he had data suggesting APOE4 is an antimicrobial peptide,",English
+"similar to the findings from Rob, Will, and yourself regarding amyloid beta and phosphatidyl. Have you are well absorbed these results in your own hands? If so, have you observed different binding affinities between different APOE variance?",English
+"Rudolph Tanzi: Well, I don't think we've looked at it directly, but I wouldn't. Another paper Rob Moyer published with us, it must have been the late '90s when we first started with us,",English
+was that APOE4 drives A-Beta aggregation in the presence of trace metals of copper and zinc. This goes back to work that Ashley Bush and I did together.,English
+"Whereas APOE3 hardly did so at all, so he showed a difference in E3 interacting with A-Beta plus metals where you didn't get much aggregation,",English
+"whereas E4 plus metals and A-Beta, you've got more aggregations. I could see how perhaps, if the APOE being an anti-microbial protein,",English
+"or maybe APOE4 versus E3 is driving and seeding more A-Beta aggregation in the presence of metals, so you're driving more antimicrobial peptide activity by driving more ligament.",English
+I could see APOE4 being a partner or a conduit for A-Beta as an amp or E4 would do that more than E3. We don't have any direct evidence because we haven't looked.,English
+"I read the APOE itself is an antimicrobial. You'd have to say protein in that case, because APOE is not a peptide. I would guess it's more of a partner of A-Beta driving the ligament.",English
+"Mack Mackiewicz: Liz, one more question to ask. Rudolph Tanzi: You're muted, Liz. Elizabeth Newman: Hi. In the human plasma studies, do you have evidence that A-Beta Tau is found in the periphery and trapping pathogens?",English
+"Rudolph Tanzi: Well, we're looking at, of course, everybody, we're looking at A-Beta. In plasma, I think C2N, we need C2N's help for that.",English
+"I couldn't expect to get a good idea. They bet in plasma with the Tom plasma. What we are looking at right now is if in those normal elderly,",English
+"where they had increased amounts of interleukin 12 or interferon gamma, and that lead to a better cognitive trajectory. What we're looking at now is the amount of microbes in their blood.",English
+"You can look for microbes in plasma using various techniques right now. We need to do a metagenomic analysis of the plasma itself to see if there's a difference in bacterial, or viral,",English
+or even fungal load in the plasma as a result of having higher levels of those prong-inflammatory cytokines that protected the brain and led for Beta cognitive trajectories.,English
+That's something that's ongoing. Mack Mackiewicz: Perhaps last question. Elizabeth Newman: There are two questions that are related.,English
+Can you comment on gut microbiomes and microbiome endotoxins leaky gut and also reports that microbes are established in Parkinson's.,English
+"Has there's been anything similar with Alzheimer's disease? Rudolph Tanzi: Yeah. Nanda and Kumar, our group and others, Deepak Kumar,",English
+"they're doing gut microbiome work and we can see that we can profoundly affect amyloid levels in the brain. In fact, Sam and I have another paper,",English
+"I'm pressing JEM coming out soon, where we can profoundly affect amyloid levels in the brain and the amount of activated microglia in the brain by changing the gut.",English
+"Sam does antibiotic cocktails and unpublished data from our group. We used a probiotic plus prebiotic mix, a symbiotic on 5xFAD mice.",English
+"This is work from Nanda and Deepak Kumar where we showed that the gut microbiome just by giving it a symbiotic probiotic as prebiotic was able to reduce the amyloid in the brain, reduce inflammation.",English
+"It looks like the gut microbiome, when it's balanced it's good for the brain. Now whether there's dysbiosis and opportunistic microbes in the gut that are driving AD pathology, I don't think we know yet.",English
+"I think it's a very important question to address in the future. Mack Mackiewicz: Thank you so much, Dr. Tanzi. Thank you all for your questions.",English
+"I'm sorry, we cannot answer all of them. We will take perhaps four minutes break. Again, thank you so much, Dr. Tanzi,",English
+"fantastic talk, fantastic questions. For those in the audience, obviously, if you ask a question,",English
+"we cannot address those questions, obviously, there's not enough time. We would appreciate if you post your question perhaps in the form of comment,",English
+"we will take those comments, we will look at them, evaluate, organize them, and those comments could help us with thinking how to move the science forward.",English
+"Obviously, question the presenters trying to clarify their talk, but also your thoughts. Where are the gaps?",English
+What are the opportunities? How we should move the science forward? We would appreciate those comments too. Thank you so much. We will reconvene in three minutes at 11 o'clock.,English
+"Again, thank you, Dr. Tanzi. Rudolph Tanzi: Thank you. Mack Mackiewicz: It's one minute before 11:00 on East Coast of US.",English
+"Let me just quickly comment. We structured the next six presentation again, from epidemiology, computational and biology,",English
+"virology expert, and who ask similar question, had comparable experimental design. He had to draw opposite conclusion about infectious agents and Alzheimer's disease.",English
+"Again, it seems to me, at least my opinion, we would need to design and run those studies again. If we had to support those studies and you ran them,",English
+it would be great to hear from you how this status should be designed. Welcome to our next session and Dr.,English
+"Steven Jacobson from NIH will moderate this session. Dr. Jacobson? Steven Jacobson: Thank you so much, Mack. I really appreciate.",English
+"Could you hear me? We good? Mack Mackiewicz: Yes, we can hear you, we can see you. Steven Jacobson: Thanks. Hi. Thank you again. By way of introduction, I'm Steve Jacobson.",English
+I'm a Chief of the Viral Immunology section here in the Neurology Institute at NIH. We've spent quite a long time thinking about particularly how viruses are,English
+"associated with actually another chronic neurologic disease is multiple sclerosis. We've done a lot of work on that. Where a lot of our energy has moved to the herpes viruses,",English
+"both Epstein-Barr virus and HHV-6. I've been asked to chair this session, present some of our data.",English
+"But again, hopefully, we get some good interactions and discussion in this important topic on herpes viruses and Alzheimer's disease.",English
+"To begin with, let me introduce Hugo Lovheim from Umea, in Sweden. He'll be talking about herpes virus infections, antiviral treatment and Alzheimer's disease.",English
+Thank you. Hugo? Hugo Lovhelm: Yes. Thank you very much. Could you please show my first slide?,English
+I'm Hugo Lovheim from Umea in Northern Sweden. I will present some data from our work on this topic from the epidemiological perspective.,English
+"Next slide, please. As Professor Tanzi showed, there is much evidence now that amyloid Beta is a potent antimicrobial peptide.",English
+"While this antimicrobial peptide seems to have a broad antimicrobial effect against different virus and bacteria, not all pathogens have the potential to establish",English
+persistent infections within the brain and persist over a long time. But herpes simplex is one infection with these properties.,English
+"It can persist for a long time, cannot be eliminated by the immune system, and it also has a route to the brain through the trigeminal nerve.",English
+We know from encephalitis case that it has a predilection for the medial temporal lobe. It can induce Alzheimer's disease plaques,English
+"in animals and cell cultures as Professor Tanzi showed. Next slide, please. This is a model we have worked on.",English
+"It's not only that we carry herpes simplex virus, but in fact most people do, but also a lack of control over the infection.",English
+"The immune system loses control, leading to frequent reactivations, and at some point, the type of simplex is entering into the brain.",English
+"We think this leads, over many years, to a chronic low-grade infection and antimicrobial response,",English
+"leading to a slow accumulation of Alzheimer's disease pathology and later symptomatic Alzheimer's disease. Next slide, please. I come from",English
+"clinical geriatrics and geriatric epidemiology, and when I got interested in this, we identified the lack of sufficiently large, high-quality epidemiological studies.",English
+"We wanted to answer to the question, if individuals that carry herpes simplex virus have an increased risk of later developing Alzheimer's disease.",English
+"Which means that it's not only that herpes simplex can induce these changes, but also that it does so on the population level that is has a significant impact.",English
+"We wanted to investigate that. We have used two main cohort materials. The Betula cohort material,",English
+"which is 3,500 individuals followed for many years, with the mean follow-up time of 11.3 years and 245 incident Alzheimer's disease cases,",English
+"and another material from the Northern Sweden Health and Disease Study, where we have 360 well-defined Alzheimer's disease cases and an equal number of closely matched controls,",English
+"where we have plasma samples taken around 10 years before diagnosis. Next slide, please. In the second study we could for",English
+the first time see an association with herpes simplex carriage and an increased risk of Alzheimer's disease as published a few years ago.,English
+"Next slide, please. In the Betula cohort study, we didn't see an effect of carrying herpes virus, but see an effect of recent reactivations as measured by IgM antibodies in serum.",English
+"IgM antibodies is a sign of a recent herpes simplex reactivation, and that associated with that about doubled risk of later Alzheimer's disease.",English
+"This is a similar result to what was previously reported from a French cohort. In both these population-based cohort,",English
+"you could possibly see as I see, that the increased risk associated with IgM antibodies is delayed with about 8-10 years.",English
+"My interpretation is that at the event of significant reactivation, then the herpes virus could enter the brain and then start this slow,",English
+"persistent infection and process leading to symptomatic Alzheimer's disease 10 years later. Next slide, please. We then",English
+"looked at the combination of genetic factors and herpes virus. Because most people carry herpes virus and all doesn't develop Alzheimer's disease,",English
+"so there must be additional factors to explain this. When we look at herpes simplex virus and genetic factors together,",English
+then the solution becomes much clearer. We find that the combination of APOE4 and herpes simplex virus is associated with,English
+"largely increased risk for development of cognitive impairment. Next slide. In our other material,",English
+"the Northern Sweden health and disease study, we also saw an interaction effect with a greatly increased risk of Alzheimer's disease with the combination of APOE4 and herpes simplex type 1.",English
+"Next slide. In the same material, we also looked at the genetic risk score of nine other previously known Alzheimer's disease risk genes and saw an interaction also",English
+"between these scenes and herpes simplex. Again, indicating that it's not only herpes simplex per see but the combination of having the virus and having",English
+genetic factors that meant the immune system doesn't control the virus. Many of these gene has been linked to immune function in different ways. Next slide.,English
+"Then interestingly, or importantly, we do have drugs for herpes virus. Since mid-'80s, we have drugs like acyclovir.",English
+These drugs are specific for herpes viruses used for shingles and simplex reactivations. It's well-tolerated drugs with few side effects and they could,English
+efficiently hold backup herpes reactivations at time or reactivation.,English
+A very interesting question is whether these drugs could also affect the risk of later Alzheimer's disease development. Next slide. We wanted to look at this in the Swedish registries and included,English
+"265,000 subjects aged more than 50 with a diagnosis of varicella-zoster virus or herpes simplex virus or prescribed an antiviral drugs.",English
+"We matched controls from the general population by sex and birth year, and we followed for 12 years for dementia incidence.",English
+"Next slide, please. Here you see that those with herpes virus diagnosis and no treatment had an increased risk of dementia development in",English
+"the Swedish registries and those with herpes diagnosis and treatment did have a decreased risk. This supports an increased risk of infections of course,",English
+"but also modifying effect of treating with antivirals. Next slide, please. The problem with register-based studies is that there are so",English
+"much unknown about the individuals, and importantly, individuals are basically samples from different populations; those with diagnosis and the controls.",English
+"Therefore, in a second study, we wanted to look at this in one of our population-based cohort where we know herpes simplex virus carriage,",English
+"we know their APOE4 genotype. In this material, we could match those with Alzheimer's disease and controls for APOE4 and herpes simplex virus and then go",English
+"back into electronic medical records to see if individuals had been prescribed antivirals or not. We could reach back until 1995 in our region,",English
+"and we identified 262 matched pairs with 11.4 years follow-up. Next slide, please. This is the result,",English
+"and we saw that those who had been prescribed an antiviral drug during follow-up, had a 70 percent lower risk of developing Alzheimer's disease.",English
+"Again, supporting that antiviral drugs given at the time of reactivation could prevent or lower the risk of later Alzheimer's disease development.",English
+a profound effect on the risk of Alzheimer's disease even if we give a rather short treatment for two or four weeks at the time of reactivation.,English
+Next slide. This is the total use of antiviral drugs in Sweden from 1994 until now.,English
+"You see a linear increase in the use, and these drugs are used more and more over time. Next slide, please. In the bachelor cohort again,",English
+at different time points we have measured the proportion of individuals having IgM antibodies as a sign of recent reactivation. Here we see a clearly declining trend and a shift to,English
+"a much lower prevalence of IgM antibodies as a sign of recent reactivation from about 2,000 and onboard. We have two-time points really from 2003-2005 and 2008-2010,",English
+"where about 1.5 percent only have IgM antibodies. As you did remember from the original cohorts I showed,",English
+"reactivations measured as IgM antibodies increase the risk of Alzheimer's disease with 8-10 years delay. Next slide, please.",English
+Here you could see unsuspected and very interesting trend break in 2010 from where dementia incidence again has started to decline after,English
+"steadily increase with increasing age in the population. Whether this could be related to improved immunological control,",English
+"as I showed in the last slide or anything else, we could not know at this stage. Next slide, please. To sum this up,",English
+"herpes simplex virus, together with certain genes, appears to increase the risk of later development of Alzheimer's disease. This increased risk could potentially be",English
+"modified by use of antiviral drugs at the time of reactivation. To move forward in this area, I strongly believe placebo-controlled trials are needed both in",English
+"pre-symptomatic settings and in symptomatic Alzheimer's disease. Thank you. Steven Jacobson: Great. Thank you so much, Dr. Lovheim.",English
+That was a wonderful talk and I think we'll be handling questions probably at the end during the moderated discussion. I think it's time we'll just run right into Dr. Schnier from the University of Edinburgh.,English
+"We'll be talking about the association of herpes virus diagnosis, antiherpetic medication, herpes vaccinations associated with dementia. Please, Dr. Schnier. Thank you.",English
+"Christian Schnier: Yes, hello. Thank you very much for inviting me to give this talk. It's rather cold and wet and windy here.",English
+"Good morning to America. I'm presenting this study on behalf of myself, of Janet Janbek, Richard Lathe,",English
+"and Jurgen Haas, who are all sitting somewhere in the audience at the moment and throwing things at me. Can I see the second?",English
+"Yes, there we go. Sorry, I'm just getting organized here, this is not very good. Mastan Narne: Do you want to share your screen? You stayed up.",English
+"Christian Schnier: Can I share the screen? Yes, that could be easier. Mastan Narne: Yeah, go ahead and share your screen.",English
+Christian Schnier: Share screen. Can you watch this now? That's a shared screen?,English
+Mastan Narne: Nothing yet. You need to click Share button. Christian Schnier: Doing that again. Sorry for that. It's supposed to work.,English
+"Steven Jacobson: We see a nice pig in the background. Christian Schnier: No, that's not what it's supposed to do. Share screen, not the dog. Sharing.",English
+Mastan Narne: Yeah. Mack Mackiewicz: Perfect. Steven Jacobson: We see it now. Christian Schnier: Just get this thing over there.,English
+Totally unprepared here. Are you still there?,English
+"very recently emerging studies we've been conducting. The first, association of antiherpetic medication, and the other one is association of antiherpetic vaccination with dementia.",English
+Those studies that I'm going to present follow the same broad idea that Lovhelm just introduced. We routinely collected electronic health records to follow-up large populations of,English
+a substantial periods of time to test those different associations. There we go.,English
+"For the first study, we used electronic health records from Denmark, Germany, Wales, and Scotland to enforce separate observation of cohort studies.",English
+"The idea that we had was if chronic herpes infection that often is not clinically manifested was associated with dementia then clinically manifested herpes infection,",English
+"which often is shingles in the elderly, should also somehow be associated. Exposure to antiherpetic medication often given to reduce the risk of",English
+"post-hepatic complication might then ultimately mediate that association. But now that might be type dependent,",English
+"dependent on the type of herpes infection, type of medication, type of dementia. But think about it, there's a lot of conditional language that I'm using here.",English
+"There's a lot of maybe and stuff like this. Maybe it's suppression of the immune system that allows space. The sub-clinical herpes infection can cause the clinical manifestation but also,",English
+"in the same time, causing a higher risk of dementia, so not the herpes directly infecting the risk of dementia. There's some literature to support the association,",English
+and Hugo Lovhelm has just shown an almost 50 percent increase hazard of people with clinical herpes that were not treated compared to those free of clinical herpes.,English
+These are forest plot of different models we have run in the data from different nations. What you can see is estimate hazard ratios with reasonably short confidence intervals.,English
+"This is quite typical for this large population status. We just get a very small confidence intervals, so we have to be a bit careful when we interpret them.",English
+"Almost all the estimates for almost any of the outcomes are very close to one, which would indicate that there's very little, if any association between the treatment,",English
+"exposure to the drugs and subsequent dementia. This is repeated for different nations, so for Wales, Scotland, Denmark, and Germany.",English
+"It's repeated for different exposures, up to three different exposures to the drug. It's repeated for different dementia types.",English
+"There is no difference between Alzheimer's and vascular dementia. It's not different between different herpes types or between different drug types,",English
+The disease etiology of vascular dementia is quite different from Alzheimer's. How is it that both are not really much differently affected by exposure to drugs?,English
+"Similarly, can herpes substitute is quite different than herpes simplex and still we didn't see any difference. There's no effect of",English
+"any of the different drugs, dementia types, and herpes types and exposure, so I'm getting a bit worried about the whole thing.",English
+"Can I see the next slide please? In slide contrast to Hugo's and other national studies, we did not see any clear association between exposure to drugs and dementia.",English
+"However, I think the difference is more between the studies from Taiwan which show huge associations between those from Taiwan and others,",English
+"I was included, which showed that if there was a true association, it's not substantial. Comparing a Swedish results, the most striking difference for me is the higher risk of people with",English
+"herpes diagnosis but without exposure to antiherpetic drugs, you could see in the Swedish study. But I wonder, in all of our studies,",English
+"who are these people? Who is diagnosed with a herpes infection, a shingles, but is not exposed to any antiherpetic medication?",English
+"It must be very heterogeneous group I think, including people either with very low symptoms or very late in the disease progress,",English
+"or people where the treatment was contraindicated for some reason, or finally, people might have actually been exposed to the drug,",English
+but we haven't gotten a recording for exposure to the drugs. This is something that might have happened in our Wales study at least,English
+where people in old folks homes have a low recording of drugs exposure because they changed GPs.,English
+Maybe we just don't see that they are actually exposed to the drugs and the higher risk of dementia is basically coming from the fact,English
+"that they are in an old folks home, nursing homes. Can I get our next slide please. Now if herpes infection was associated with dementia,",English
+surely vaccination against shingles should then also be associated. Can I get the next slide please? This is something that Tanzi has just been mentioning.,English
+"I want to go into a bit more detail which is one of several recent vaccine efficacy studies that we have been doing and other people have been doing,",English
+"the idea of us to find out if shingles vaccination must associated with dementia, if that association is different for Alzheimer's and vascular dementia, again looking for some different patterns which we couldn't",English
+"explain and to determine if the association we see is caused by a reduced incidence of shingles in the vaccinated population because surely,",English
+"that would be the way how it goes. To get vaccinated, you've got lower exposure or lower shingles diagnosis and therefore,",English
+you've got less dementia. That is what we were trying to find out. Can I get the next slide please. Vaccination in the UK is mostly driven by public health policy.,English
+"Zostavax, which is the vaccine that we're looking at, was introduced in 2013 for 70 year olds and if you were already over the age of 70 in 2013,",English
+they had to catch-up vaccination at age 78 for everybody. This is why you see this bimodal distribution of vaccinations there.,English
+"Zostavax, if you don't know, it's life attenuated vaccine. It's given once and it's given to people independent of exposure status.",English
+"Even if people have had a shingles diagnosis, they might still be getting vaccinated.",English
+"Can I get the next slide please? With our study population we're about 330,000 people",English
+"and we have in total about 2.3 million person years of follow-up time. Of the population about half were born after 1943,",English
+"so they were vaccinated at later ages, than 70, half of them were male. During follow-up, bounded by 50 percent again we're exposed to the vaccine,",English
+"16 percent died and five-and-a-half percent so 18,000 people were diagnosed with dementia. For an epidemiology study, this is fantastic.",English
+"We've got plenty of exposure, plenty of controls, and plenty of outcomes. The next slide, please again.",English
+"Thank you. Here at the results. In figure A, on the left side, you can see that people vaccinated against shingles had",English
+"substantially almost 40 percent lower risk of getting diagnosed with dementia. Interestingly, you can also see that the association is clearly",English
+"stronger for vascular dementia than it is for Alzheimer's. Then the figure on the right-hand side, you can see that the association of vaccination with",English
+dementia is independent of the Shingle stages. That's the last row that you can see and of the V plus S plus X people who have been vaccinated and afterwards still got,English
+the Shingle diagnosis and they still had a lower risk of dementia even though they develop shingles after they had been vaccinated.,English
+"It's not a large group so therefore the confidence intervals of that estimate is quite wide. But still, the main estimate is bang on similar",English
+"to people vaccinated who did not subsequently develop shingles. The next slide, please. Thank you.",English
+"We then had to look at the association of shingles vaccination with other outcomes. You can see that vaccination was associated with lower shingles risk,",English
+"which is the first one, which is what we would expect. But it's also associated with lower mortality, but lower risk of stroke,",English
+"lower risk of getting myocardial infarct, and even with a lower risk of having a hip fracture. It was not associated with cancer. The next slide, please.",English
+"But lower mortality was interested. We analyzed the underlying cause of mortality, which is taken from the death certificate of anybody who dies.",English
+"We thought that if vaccination was substantially associated with lower dementia risk, surely the proportion of people dying with dementia, which somewhere have,",English
+"either a code of F or G in the graph should be lower for vaccination to people. But again, we could not see it.",English
+We couldn't see a slight difference if you really want to and the mortality due to respiratory system problems.,English
+That might again be associated with dementia because lots of people with dementia die of respiratory disease. But that difference is marginal.,English
+"Again, does not support our idea. Next slide, please. Mack Mackiewicz: Dr. Schnier.",English
+"We added five minutes extra time to you and you've two more minutes. Thank you. Christian Schnier: I'm almost there. Thank you very much. Summary, vaccination associated would reduce dementia incidence.",English
+"There is no question. This is something that we've seen and it's also being seen in the US, in veteran database and the market scans and in research",English
+"thought the association we've seen has also been shown for flu vaccination and for TDAP vaccination. Again, coming back to the US.",English
+"It's stronger for vascular dementia, like we've seen and it's not mediated by the shingles outbreak. Our capital conclusion is people getting vaccinated",English
+"have at that point a higher healthy life expectancy, which in epidemiology we call frailty-bias. However, what we cannot exclude is that,",English
+"there are non-specific vaccine effects. Tansy has probably mentioned them in the by-passing. I'm connecting the last slide, please.",English
+"In summary, I think in most of our study we could not find any evidence in either of the studies that herpes virus infection is causing dementia. However, what we did find is some evidence for",English
+an association of the state of the immune system with incident dementia. Thank you very much. Apologize for the chaos caused. Steven Jacobson: Thank you. Went through this chaos as well.,English
+"We have some interesting folder for later discussion, but let's move on to Ben redhead.",English
+"Actually, Ben was one of the reasons that I got a little bit into this field. It's a pleasure to have Ben talk about the new integrates",English
+"interrogating the brain microbiome and Alzheimer's disease. Thank you. Ben Benjamin Readhead: Thank you very much, Professor Jacobson,",English
+and thanks everyone for your time and attention. I'm really grateful for the opportunity to share with you some of the work that we're doing trying to understand the role of the brain microbiome in,English
+"Alzheimer's disease and some of the challenges and opportunities that go along with that. Next slide, please. I'll briefly touch on some of the diverse approaches",English
+"the different investigators are taking to investigate this problem. Talk about some of the real challenges and opportunities, why is it this is a formidable problem,",English
+"and what might be done about it. Then share with you some of the work that we're doing, trying to integrate brain metagenomics and antibody repertoire data with a host or mixed to help try and advance the field.",English
+"Next slide, please. It wouldn't be any surprise to anyone in this workshop that there's a rich storied history from hundreds of investigators",English
+"connecting the activity of different source of pathogens, not just viruses with different aspects of Alzheimer's disease public physiology. This is by no means meant to be exhaustive,",English
+"but just to touch on a few themes. Next slide, please. We had our own fore into this field a few years ago when we published a study in neurons,",English
+"a big data next-gen sequencing study where we took some publicly available data. Thought we were seeing an increase in abundance of several human herpes viruses,",English
+"many HSV-6A, HSV-7, and HSV-1 in cases compared with controls. Next slide, please. As you heard from Professor Tansy,",English
+"it's just really pioneering work showing that not just herpes, but also there are quite a broad set of pathogens capable of rapidly exceeding A-Beta fibrillation.",English
+"Next slide, please. A slew of epidemiological studies are really interesting here. Dr. Schnier's report previous to this,",English
+but a bunch of different studies showing that a history of clinically evident herpes virus infection seems to be associated with an increased rate of eventual progression to dementia in,English
+the following decades that seems to be at least partially mitigated by antivirals. Next slide. Benjamin Readhead: Series of work from Professor Lovheim and others.,English
+"Steven Jacobson: Slides are not moving, Ben. Sorry. Benjamin Readhead: It's actually just graying out different subsets of this slide here. From Professor Lovheim showing different interactions",English
+"between the risk-associated E4 alleles and the IgG burden, as well as HSV-1 carriage. Next slide.",English
+"Then more recently, links connecting protective PILRA variance with alternate adaptive immunity in HSV-1. Next slide. Anyone who",English
+"spends time with this literature you get the sensors rapidly evolving, it's discording. Certainly, it doesn't give the impression of being settled science yet there's still a lot more good science to do.",English
+"It's not just a series of positive confirmatory studies. Next slide. One great example is a study published by Professor Jacobson,",English
+"who you'll be hearing from shortly, who earlier last year published a study examining its ostensible connection between Herpes 6 and Alzheimer's disease. Professor Jacobson and his team,",English
+"they did some digital droplet PCR based detection of Herpes 6 in some stored DNA samples from a couple of different cohorts. In parallel to that, they also did some computational approach for",English
+the detection of microbial sequences from existing RNAseq datasets. What they saw on aggregate didn't support an association between Herpes 6 and Alzheimer's disease.,English
+"I'm mindful that Professor Jacobson is speaking up today. I'm certainly not wanting to preempt what he'd want to talk about, but it does help set the stage for some of the things I wanted to talk about up to this.",English
+"Next slide, please. One thing I would say about this study is that the detection rate of Herpes 6 that the authors",English
+reported was about an order of magnitude lower than what might be expected based on maybe half a dozen previous studies looking at Herpes 6 prevalence in control tissues. Next slide. The authors,English
+"saw Herpes 6 in none of the mouse on a brain bank control samples, they saw it unless than one percent of rows map control samples. Didn't seem to see any instances of",English
+"other common viruses that you might expect to see, such as HSV-1. When you look at the literature, previous to this really wide ranging estimates",English
+"in terms of prevalence even just in control brain tissue, ranging anywhere run about 25-35 percent seems to be about the median, right up to 88 percent: This varies depending on the CNS side that was being reported.",English
+"Next slide, please. It seems likely there's probably important differences in assay sensitivity and possibly specificity that could be relevant to some of these previous estimates.",English
+"Maybe there's interesting interactions between space for choices in sampling, interacting with focal infections. Next slide.",English
+"What I would say is that overall, I think it's probably tough to draw lessons about disease association until we understand what is it that's really driving the variance in these prevalence estimates.",English
+"Next slide, please. The reason why I mentioned all this is to set a pretext for laying out, what I think is some of their large challenges for investigation in this field.",English
+"This isn't comprehensive, but breaking them down broadly in terms of measurement challenges and interpretive challenges. By measurement, what I mean is you will go",English
+"to these choices about what it is we want to measure. We can look at sequences, we could look at peptides or proteins or antibodies or non microbial intermediate. There may be generated in the gut and then traveled to the CNS.",English
+We've got all sorts of choices about which tissues exactly to look at. What I think is probably critically important is the question about when to sample. I think what Professor Tanzi was alluding to previously may well be that to,English
+the extent that at any given microbial perturbation is relevant in driving Alzheimer's disease. Maybe by the time a patient comes to,English
+"the clinic and he's enrolled in the study and comes to autopsy to the point where we can look at pathogens in that person's brain, it may well be the most relevant microbial perturbation",English
+"is no longer available to be seen in. What may be most important is exactly what's missing that stage. Then sitting over the top of that,",English
+"I think is even a more formidable set of interpretive challenges, which is to say, how is it you can place an observation within the landscape of the causal evolution of Alzheimer's disease?",English
+"Next slide, please. You can imagine a case where maybe some perturbation is a cause of dry breath disease. Or you could imagine, maybe it's not capable of driving disease,",English
+but maybe it's capable of accelerating established disease. Or you could also imagine a situation in which space is opened up in the immune system within the CNS for opportunistic pathogens to,English
+"flourish in the slip stream of neurodegeneration that's being driven by other factors. Next slide, please. All of this, of course, is hampered by the long pre-disease course and difficulty in of course,",English
+sampling the primary tissue throughout life. One of the ways that we're trying to contribute to advance some of these questions in our own work is through data generation.,English
+"Really over the last couple of years, we really have a head down trying to generate a large amount of data that we think would be helpful for resolving some of these ambiguities. One of our big focuses is degeneration of a large amount of",English
+"shotgun metagenomics from a range of different brain tissue contexts. Notice straightforward shotgun metagenomics, but actually using a custom pen viral sequence in Richmond panel,",English
+"which we've designed to be able to very sensitively detect it in low abundances of all known viruses as well as a handful of bacteria and fungi,",English
+and the goal being to build up much higher resolution picture of microbial populations and what's available in the RNAseq to be used in our original study several years ago.,English
+"Looking at Alzheimer's, but we're also looking at earlier Alzheimer's related into phenotype. Mild cognitive impairment. Pre-clinical Alzheimer's disease,",English
+"where subjects might have high neuropathology but no dementia, as well as looking at some known Alzheimer's neuro-degenerative controls.",English
+"We're looking across a range of endophenotypes and a range of different brain tissue regions. Really, we've selected subjects for this.",English
+"Really top two minus four. Subjects also have a lot of existing multiomics. Many of these subjects will also have genetics. They'll also have brain RNAseq and proteomics,",English
+each of which gives us an opportunity to be able to contextualize any observation that we make. We can look at ways to stratify and associate different observations that we make and we hope to,English
+create a richer biological contexts for any given observation. Part of this work is going to include the kind of a careful reconciliation of the HHV-6 prevalence estimates that we see in,English
+this data: compared with what we reported previously. We're mindful of this been several critiques against the ways that we were quantifying and,English
+classifying the presence of Herpes 6 and other viruses in our study. We really take those critics seriously and think one of the most productive ways that we can try and advance the conversation around.,English
+"This is through, this data generation. This data will be available as we generate it through the AD Knowledge Portal for any interest investigated to look into.",English
+"Just now starting to ramp up production. Next slide, please. Next slide again. Just quickly, this is just some pilot data to we",English
+generated where we were interested in seeing whether or not this pen viral sequence enrichment panel that we're using to enrich the microbial signal within samples just to,English
+see whether or not it will be capable of helping us distinguish between highly homologous viruses like Herpes 6A and 6B and 7. What you see here are three different samples in the rows.,English
+The middle sample is a sample that we predicted to be HHV-6 positive based on the RNAseq. What you can see is this nice even coverage across almost the whole genome for Herpes 6B. We found this encouraging that,English
+"the approach that we're using is going to give us a nice ability to be able to discriminate between homologous species. Next slide, please. Next slide again.",English
+One of the other data generation directions that we're excited about is the generation of antimicrobial antibody repertoires from the cerebrospinal fluid.,English
+"We've generated data from 300 subjects, 200 cases, and 100 controls. Next slide. It uses a modified approach,",English
+"something called Serum Epitope Repertoire Analysis, which was an approach pioneered by a group called Serimmune. Essentially, you take a bio specimen that contain some antibody repertoire,",English
+"you expose it to a bacterial display peptide library, and then the bound bacteria, which are just each displaying random 12mer.",English
+"Those get drawn down and then amplified and sequenced. Essentially, you're enumerating this antibody epitope repertoire for each sample. Each one of these epitopes can then be mapped into a pathogen sequence database,",English
+"so like a viral sequence database. Then from there, you can do all sorts of interesting downstream analyses. The next slide, please. What I want to share with you is,",English
+"this is unpublished work, but this is a human herpes virus centric analysis within that data set. Next slide, please. Where essentially we took all nine species of human herpes viruses,",English
+"concatenated all of the individual proteins, which collectively numbers about 1,000 unique proteins and collectively encoded by the nine human herpes viruses.",English
+"Then simply looking for an enrichment for antibodies signal that targets any of these proteins. What we saw in the 280 versus 100 control subjects of all things,",English
+"was an enrichment against two HHV-6A antigens, protein U79, and protein U10, enrichment against an HSV-1 antigen,",English
+"UL4, and HSV-2 antigen, and HCMV antigen, all being at increased abundantly in cases compared with controls. Next slide, please.",English
+"potential to lock into specific epitopes within a certain protein. You can actually localize where the antibody signal is most strong. I'll point out this example here for HSV-1,",English
+"this nuclear protein UL4. It's a late protein, it's not structural, hasn't been studied extensively. It's classified as a nuclear protein,",English
+"it seems to localize to the cytoplasm where it conforms into this granular like pattern. What's really interesting is, next slide please, we see this concentration of signaling the final 20 amino acids of",English
+"the antibodies that are targeting this particular protein. What's really interesting about this protein is that this is actually where the nuclear export signal is located. Next slide, please.",English
+"In work that was published almost 10 years ago by Weiwei Pan, they discovered that these final 20 amino acids are necessary for normal export from the nucleus to the cytoplasm,",English
+as well as for this protein to conform to a normal granular formation. We really don't know what this means yet. We don't know whether or not this particular protein is telling us something specific.,English
+Is this specific protein functionally relevant to Alzheimer's disease or is it maybe tagging a certain infection state? This isn't a membrane associated protein.,English
+"Why there should be this particular immunogenic signal at this particular point? Well, we've got ongoing experiments. But if anyone has any ideas,",English
+"please reach out. Next slide, please. Next slide, again. That's right.",English
+One other quick example. This was actually the most strongly implicated antigen to come out of the herpes virus analysis.,English
+Each one of these dots is a patient or a sample. The red dots are cases and the teal dots are controls. This is an immediate early gene.,English
+"It's essential for viral DNA replication and it sits in the nucleus in this punctate pattern next to ND10 bodies. It seems to be encoded in multiple isoforms,",English
+"vary depending on the infection context. Next slide, please. The reason why I bring it up is, I think it illustrates an interesting opportunity",English
+"to integrate these data with other omics. We've these fantastic collaborators at Mount Sinai, Professor Michelle Ehrlich and Sam Gandy whose lab have been generating omics data from",English
+HHV-6A infection studies in cell and animal model systems. They generated some infection studies in a neuroblastomas derived cell line doing time-series infections.,English
+"We're doing RNA-seq at 1, 3, and 7 days post-infection. The idea was to do some dynamic and comparative transcriptomics. We thought maybe the antibody data could be",English
+"a unique opportunity to direct our focus within this transcriptomics. Maybe we could see which host genes are correlated with U79/U80 expression. Next slide, please. What you see",English
+"down here in Panel C is a snapshot of some of those genes, which includes some fairly fundamental kinases like JAK1 and MAP-Kinase 1 that are strongly correlated with the expression of U79 expression in these cell cultures.",English
+"The next slide. Also ABCA7, which of course is an Alzheimer's disease risk loci containing gene. When we will look at",English
+"the expression QTLs that are collectively associated with these genes, we see that as a group they're actually enriched for AD risk diagnosis variance and neurofibrillary tangle density variance using a SCAT analysis. Next slide, please.",English
+"Benjamin Readhead: It's a big complex here to cover in a short amount of time. Thanks for sticking with me on this. Hopefully, you get the sense that this is a rapidly evolving space.",English
+"There's much more good science to be done, I think. There's challenges in measurement that I think at least partially are being met by improvements in technology and data availability.",English
+"We've really been focused on the generation of new microbial readouts where we think there's a real opportunity for the integration of these with genetics and longitudinal clinical records,",English
+which I think could be helpful for better contextualizing any given observation and helping to advance some of these interpretive challenges.,English
+"Then final slide, please. I'm really grateful to a fantastic group of friends and collaborators without whose expertise and energy and data,",English
+"I wouldn't be able to report on this. Really grateful to the National Institutes of Health, the Benter Foundation, the Global Lyme Alliance and the Arizona Alzheimer's",English
+"some of the work we've done. Again, it's been alluded to on HHV-6 and dementia, detection of the virus in Alzheimer's disease and controls, and some new data on the integration of",English
+"HHV-6 in whole genome sequences of dementia cohorts. Again, you might know this about HHV-6,",English
+We're all seropositive. It is T-cell tropic virus that we find predominantly in CD4 T-cells. We also see it in monocytes.,English
+I'll keep your attention here to these direct repeats on the five-prime to the three-prime later. One of the unique features of HHV-6 is its stability,English
+"to chromosomally integrate into the host genome. I think it's, to our knowledge, the only human herpes virus known to integrate and establish latency in this way.",English
+"Roughly 0.5 to almost one percent of the world's population contain full-length HHV-6 in their genome, and we'll come up to that later.",English
+"You can see here the virus, particularly through the direct repeats and always seems to integrate somewhere on the telomere. It maintains the integration into these telomeres.",English
+"Again, no episodes are detected in these latently infected cells. Again, you heard we do a lot of work, particularly in digital droplet PCR.",English
+"We've established the system, it's highly sensitive, highly reproducible. This is an example of just looking with ddPCR looking for the ciHHV-6, both variants can be found.",English
+"Again, it's million copies per million cells. Every cell contains HHV-6. This is a 6A.",English
+"It's a brain that actually has 6A and this is a brain that actually has HHV-6B, and we'll talk about that. Again, about one percent of the general population.",English
+"We found an increased 6B DNA, particularly in those resections. There's some suggestions that it's fact that this early childhood infection that",English
+may set up some association later in life. But the majority of our work here at the NIH are interested in our group is looking at,English
+the association of a virus like HHV6 in the CNS demyelinating disease in multiple sclerosis. I think our experience in looking at virus in MS clearly might have,English
+"Again, you hear about the clinical correlates, the effect of MS exacerbations or remissions or effective therapies, whether antiviral therapies, immune-modulatory therapies,",English
+"and those that have an effect on the virus and subsequently an effect on the disease. Now we're hearing so much on the bioinformatical approach, looking at these large datasets to look for evidence in the virus.",English
+"Again, this is the space that we've lived in. Now we'll talk a little bit about HHV6 and its role in Alzheimer's.",English
+"I always like to give, when I get a lecture on the viruses in multiple sclerosis, you can see there are many viruses that have been associated also for many years in MS.",English
+"I thought this was an extraordinary paper that really got us started. We saw at least what they saw using large cohorts. Again, this is really high, large numbers,",English
+"We heard from Rudy Tanzi the work again. Moir was also at this HHV6 meeting that is presented. Again, giving a mechanistic framework.",English
+"whether it's the virus or even the viral proteins or viral peptides that might be able to do this. Based on this data, and again,",English
+"I just say flat out, I'm not an Alzheimer researcher. We work, I said, in multiple sclerosis, but there were reasons to investigate this,",English
+"we thought, based on some of, again, the work that was presented. There was a reasonable mechanism. There appeared to be a little bit of levels of viruses of the disease.",English
+"What's great about the Alzheimer field, the space is these large sample sizes. We have a very large clinic in MS,",English
+but the availability of samples is quite extraordinary for those of us not really in the field to gain access to it. What I liked about the neurons paper was really,English
+"that agnostic approach which identified HHV6 out of all possible pathogens. As I said, they had no skill in the game of HHV6. That clearly kept us of interest.",English
+"Again, large publicly available sequence data, and really, one of the reasons is Walter Koroshetz, who you may know is our institute director,",English
+"really asked me to look into this because we have a large footprint in the virus, in HHV6. Then obviously the interest in AD,",English
+"and we thought that would be a good way to look at it. Again, then presented our neuron paper. We looked at really the same sample sets that the Redhead and Dudley group looked at.",English
+"Because these available sequences, they're all easily available over 900 sequence, again, from the Mount Sinai Brain bank and the Ross MAP as well.",English
+"When I always told Walter is that I really was not looking forward to looking at 1,000 brains to do PCR because that's the way the virologists will look at it. But we did pair, we were able to obtain,",English
+"maybe not a 1,000, over 700 brain samples. Again, this was from the ROSMAP cohort and the Johns Hopkins brain bank as well. This was in collaboration with Philip De Jager you guys may know from Columbia and",English
+"Sonja Scholz here in our institute we were able to actually get the brain samples. Again, we could look at a bioinformatical approach as well as a PCR-based approach.",English
+"We use the PathSeq. Sonja has been involved in the Johns Hopkins Brain Bank, 1,000 samples, lots of different cases within the brain bank.",English
+"But we went through this PathSeq RNA sequence analysis. Again, the sequences were available. This was done through our bioinformatic score with Kory Johnson.",English
+"It's a way the geneticists, they looked at the host genes. We throw all the host genes out to see what's left. This could interrogate over 25,000 microbes,",English
+"including over 100 human virus families. Now, I think I had to prove to myself that this PathSeq actually works. This is just two examples of a case that we knew what the virus was.",English
+"This was an example of a transplant recipient who suffered complications, passed away a few months later. Autopsy showed JC virus VP1 staining in the brain.",English
+"We were able to look by PCR, brain was loaded with JC virus and by PathSeq, sure enough, we could find high scores,",English
+"high read number of reads for the virus, 500,000 reads to the polyoma virus JC. In addition, here's a case we did not know.",English
+"Five-year history of the progressive dementia with undiagnosed cause. That was a brain biopsy. There are microglial nodules,",English
+"inflammatory CD8 positive cells. He's passed away, we got some of the brain material. In fact, to their surprise,",English
+"there was dengue virus. So it was 5,000 reads associated with dengue, never thought, sure enough, this patient had dengue.",English
+"When we apply this PathSeq now to the 900 brains that could be analyzed, that we had available to us. At least this was the way we looked at this and that of the brains",English
+"that were available to us that we have the PathSeq are the RNA seek data, how many were actually positive for HHV6?",English
+"Again, when we looked at that, whether it's the Mount Sinai Brain Bank or ROSMAP brains, only six brains that we could detect that that had",English
+"a PathSeq score most of those scores when there, they were on the low side. Some were high, but some were typically low and that they were above zero.",English
+"Obviously most of them are zero. Then there were some A and some B. But again and again, as you heard, the statistical analysis of this really showed no difference",English
+between the Alzheimer disease and the non AD controls. There was really no statistical difference between them. When we looked at a correlation between the PathSeq scores,English
+"and Alzheimer disease severity on this disease severity score, you could see where they lie, and really not particularly in a high range here.",English
+"This is just a smattering. We look at other viruses, looked at detection in these controls again, by PathSeq really no evidence that any particular virus came up.",English
+"Like I said, we didn't want to do 1,000 brains, Mary Alice did over 700 brains by PCR. Again, this would be looked for 6A and this is a multiplex assay looked for 6B.",English
+"When she did that, really did not at least by PCR now to one region of the virus. We found maybe one brain was positive,",English
+"most of them were not, and 6B, we found more virus, but again, no evidence, at least the way we would look at it between",English
+"HHV-6 detection in the Alzheimer disease brains in the controls. While there was no difference with a the difference in loads. A few minutes, yeah. almost done. Two minutes, all right.",English
+"Then you could see that in fact, we could see increased, this is about viral loads again, no statistical difference. But again, as Ben pointed out, yeah,",English
+"there did seem to be some spattering more in AD brains, although it just didn't reach significance. Also for ciHHV-6,",English
+"obviously, we have these large numbers. They were ciHHV-6, again at the same rate, about one percent and no difference between controls.",English
+"Overall we can detect HHV-6, but at low levels, but there were no significant difference in the frequencies between the controls in AD brains.",English
+"I think it's difficult to take virus in autopsy samples and we'll talk about that, and no detect differences in the frequency of ciHHV-6. This leads again to what is the role of these virus in Alzheimer disease.",English
+"There's lot of evidence, a lot of suggestions, while some of these studies are actually complicated to interpret and I totally agree with what they're saying.",English
+"But I want to share with you some data on looking at whole genomes that Ben was alluding to. Here again with Sonja and Bryan Traynor at the NIH and the NIA,",English
+"they have access to over 8,000, a whole genome sequences from within these cohorts. Together we'd been looking here now over 6,000 samples,",English
+"2,000 control samples with Lewy Body dementia and Frontotemporal dementia. We look for HHV-6, this example of a chromosomal integrated.",English
+"You can see one brains with just complete relating to the virus, and again, no difference in between controls and disease.",English
+"Then there's number of copies per cell, one copy of a cell, I'm not going to go into that.",English
+But then we found lower path seat stores that corresponded to some of these viral genome segments. These are non chromosomal integrated.,English
+"This is an example of one brain and this happens to be the direct repeat I was telling you about. Remember, thousands of brains we have no viral sequences at all,",English
+"but occasionally we do find these brains that do have some sequence related to HHV-6. When we looked at that, this is what the controls",English
+"versus the frontal temporal dimension, no difference, but interesting in Lewy body dementia, there was a statistically increased amount of",English
+those sequences in individuals with Lewy body. I ended this with what I call my level of enthusiasm. I've been doing this for a long time looking at viruses and disease.,English
+"Should we be testing more brain samples, to different genes? I didn't know I gave that modest. I really believe in the more bioinformatic analysis because there's lots of data-sets.",English
+"There's an animal model, you can infect the non-human primate with HHV-6. I was moderate about that. We have some new data to suggest that might be a better way to go.",English
+"I really love the mechanistic studies that we heard about the idea of the nucleation around viruses, and probably right now,",English
+"I'm not that intrigued about looking at interventional anti-viral trials. Just to tell you a little bit about our animal model. Again, this is looking at the Pittsburgh Compound,",English
+"A-Beta, this was humans, this is a young monkey, and compare it to the old monkey. Sure enough, the old monkeys have A Beta.",English
+"I don't know if they have Alzheimer's, but they do have A Beta, and we can see nice neurofibrillary tangles, tau accumulation. In fact, this is all worked on by Afonso Silva at University of Pittsburgh,",English
+"who made a transgenic animal. Now, here's a young monkey, 18 months old monkey, transgenic with the PSEN-1 L and G,",English
+"making lots of A Beta. It's ultimately how do you demonstrate an association? We have great fellows that worked with you, and this just a number of the people directly involved in the study.",English
+"Particularly, Stacy, is doing a lot of work on the whole genomes, and again, thank the entire group that we work with in NIH. That's it for me, I think.",English
+"Now we have a time for discussion, and again, we can answer some question and all people from today and tomorrow can unmute themselves and ask and contribute.",English
+"Steven Jacobson: We could read this, Maria. Maria, you've been asking a lot of questions orally. It's really interesting again,",English
+"you see the virologists view of this. I think it's interesting and you have such experience, particularly VZV and the herpes viruses.",English
+that I'd like to thank the NIA for putting this together because it's really important to bring all of us together because we come from different backgrounds where multi-disciplinary.,English
+"will bring us together into potential collaborations. I really believe that it's important like what's come out in many of the studies that we've discussed,",English
+is to identify early risk factors that we can then modify to halt or slow the progression to actual clinical dementia because we know that Alzheimer's is a decades long disease.,English
+"for instance, against HHV-6 that can help progression. I just wanted to comment that this is just an amazing get-together for all of us, and again, thank you to the NIA for this.",English
+"Steven Jacobson: One of the things I think that's coming up dramatically and I think really, Tansy suggested this as, how do we go about looking for the smoking gun?",English
+"But would we ever find a smoking gun 70, 80 years later? When that gun might've happened, someone got shot when they were young or even at birth, or for example.",English
+"Again, for someone who has been looking at this, I just like to go on some records here saying, while I don't want to be put in the camp",English
+"that I don't think viruses are associated with Alzheimer's disease, my inability to show a PCR amplification does not really mean that that is not the case.",English
+"I think there are lots. I'm looking at one small region, I think this idea of seating is just a fantastic mechanistic approach. Again, the large-scale bioinformatics,",English
+"looking at these whole genomes with the ability to get samples, was just going to help all of us to move forward on that. Really, I think you thought we published something together.",English
+"Rudolph Tanzi: I agree with you. I think that, and Ben said this too, looking for the smoking gun and post-mortem brain,",English
+"if it was just the infection causing the disease on the spot in someone older, you might find it. But if you look at the data of how early amyloid comes in this disease,",English
+that's why I tell people amyloid clinical trials don't work because it's like giving someone who needs a bypass Lipitor. The brain is already burning.,English
+"You can't blow with a match. You can ask what lift match? If amyloid is one match to crosstalk tangles and we show it into 3D models unlike mice, amyloid causes tangos directly.",English
+"Well, microbe seating amyloid could be the initiator. But if we already know the amyloid is coming two or three decades before symptoms, well,",English
+"in our model and the microbes coming before that, it's actually sitting the amylase. That's why I think which exactly,",English
+a long time ago showed by in-site hybridization herpes RNA and the plaque. Now we can actually laser capture plaques and do RNA seek and meditate with 600 plaques themselves.,English
+"We have to look for historical evidence. We can look in plaza for historical evidence of antibodies, we can also look for pathogens that might still be in",English
+"the blood in a normal elderly, hovered aging brain study. But I think we have to move away from this narrow view that the microbes right there causing the disease within five years of death.",English
+"Now it's going to be in the brain. I think this is going to be self-defeating if you only think that way. We've got to look back at historical, bio-archaeological evidence and say.",English
+"Steven Jacobson: Along that lines it's not necessary to suggest to one agent. It could be multiple agents. It could be bacterial, it could be fungal.",English
+"I mean, it's not infinite numbers of hits, but it will be selected. There might be some rules that come out of this of what proteins.",English
+"For example, I'll go back to Ben. Ben, just because I can't PCR amplify it, that doesn't mean there might not be a protein or peptide that could be in",English
+"there that could have seated for years and years ago. I mean, as really said, I always look at this like HIV,",English
+"screw this up for everybody because there was an age and the cause of the disease. There was a car lift. You never had AIDS, you never had HIV.",English
+"We don't see that. That's not typically how viruses work. Many of us are exposed to this. Again, Maria would know this particularly in the herpes field.",English
+"We're all exposed and particularly I work on EBV or VCP? How do you show that as a real association? Ultimately I believe, and I'll go to Christian and Hugo now,",English
+"that clinical trials is our best way to go acts. That if I had a drug that I could do it and again, I think it's important to have a discussion.",English
+"Why were there epidemiological differences over the same drugs? I see in the chat, there's lots of reasons for that action. You can have lots of reasons,",English
+but particularly in Taiwan study is such a convincing study frankly on the use. I'm looking at it right now.,English
+That's a great clinical approach. They gave antivirals and did it prevent AD? I don't know. Rudy would probably think it shouldn't prevent AD because it's pretty given way too late.,English
+"But I'm interested. Mack Mackiewicz: Dr. Jacobson, this is Mack Mackiewicz and this is perhaps question Hugo and Christian. Your last point, you are not terribly supportive of",English
+"clinical trial yet Hugo suggested that perhaps this is the way forward. Christian and you,",English
+"do you agree that the way forward would be well-designed placebo control, a trial, and I believe Dr. Itzhaki, we discussed this also seem to support the idea.",English
+"Steven Jacobson: Yeah. Hugo Lovheim: I think related to the Taiwanese paper, I think it's not a good epidemiology paper.",English
+I think it's heavily inflated by a skew selection or a selection bias because they select people with several diagnosis but with no treatment.,English
+Hugo Lovheim: It's also shows sign or residual confounding and reverse causality. They have a large proportion of the cases are actually happening in the first year.,English
+"That is not what we would expect for slowly developing disorder like Alzheimer's disease. I think in general,",English
+"register-based studies are very hard to do because we are sampling from different populations, we always get residual confounding and bias skewing the results.",English
+"I think register-based studies could be very interesting, but has quite low evidence value because",English
+of all these inherited problems with the design. I think the population-based cohorts are much better to answer to the question if,English
+"individuals carrying a specific pathogen really hasn't increased risk of later developing Alzheimer's disease. Of course, that would not be possible for those very common diseases like EBV and HHV 6.",English
+"But for all others, we could ask the question to these population-based cohorts. If individuals carry this pathogen,",English
+"do they have an increased risk of actually developing Alzheimer's disease? In fact, it has only been showed for herpes simplex that is actually the case.",English
+That the only pathogen shown in prospective epidemiological trials or studies to actually increase the risk of,English
+"Alzheimer's disease on a population level is herpes simplex. For the second question on clinical trials,",English
+"I think could very well be the way forward, but I think it's will be important to carefully select participants to",English
+"such a trial to get only those with a high probability of say, herpes simplex associated Alzheimer's disease.",English
+Because I think different pathogen could be driving the process in different individuals. We would like to have a very selected population,English
+"for the clinical trials to get a good result. Steven Jacobson: Hugo, what would your inclusion criteria be of a select cohort? Mack would be very interested to know how would you select a 1,000 patients?",English
+"Would they be HSV-1 high positive, HSV antigen positive? What would you look for? Hugo Lovheim: I would select individuals with herpes simplex type I IgG positive,",English
+"so carriers of herpes simplex type I. In addition, having some of those genes we have shown to interact with herpes simplex type I for an increased risk.",English
+"APOE4 carriers and some other specific risk genes. Those with that particular combination,",English
+"Christian Schnier: I'm mostly agreeing with Hugo. However, I've got slight problems with the clinical trials because they just take",English
+"such a very long time and because we've got all these exposures even before people joining the clinical trials, which will be really hard to control.",English
+I'm much more on the side of looking at the data that we have and that we are generating and see what we can make of those.,English
+A lot of stuff that we can do with things like the Biobank data when we observe them for a lot longer than we have at the moment. But at least we've got a snapshot of,English
+"a very good interrogated population at some stage before they probably develop Alzheimer's. I think that like you said,",English
+"if you've got a 1,000 people, but like you want to follow up. Following up a 1,000 people is incredibly hard if you don't do it passively. Very few of them will actually develop dementia within the next five, 10 years.",English
+Even then you don't know if there has been some exposure before that with different pathogens. But we at the moment did not think about.,English
+It's nice to look now at herpes virus. But if we look at HHV 6 suddenly and decide that one is a lot more interesting than the one that is associated with shingles.,English
+We basically have to start a new trial. I think the problems with the data that we have at the moment is simply that at the moment we still haven't gotten them for long enough.,English
+"All the data that people with electronic health records are working with going back maybe 10, 15, years and that's not enough to find out whether or not people have been exposed",English
+"while they're young to stuff that would be incredibly interesting, but we can't measure it. Hugo Lovheim: Unless we have a biobank sample.",English
+"Christian Schnier: Unless we have biobank samples, yes, but even the biobank samples are just a snapshot in time of, whenever it's 50-ish or 60-ish,",English
+"and still not entirely sure what this means. Benjamin Readhead: Just wanted to jump into really quickly,",English
+"and just lay out what I think is a complementary strategy to the intervention trial, which is Mendelian randomization or causal modeling type of",English
+"approach where you can take large populations as subjects that we've got genetics, you've got some microbial readout do you think is informative, and then you've got some readouts of Alzheimer's relevant clinical traits.",English
+"What you can do there is you can take associations, let's say it's between the E4 alleles, and HSV-1 antibody titer or something like that.",English
+"You use that as an instrumental variable to see if it's upstream or downstream of the clinical traits to be carrying about. Now if you get a positive result from a statistical test like that,",English
+"that's not going to really convince anyone, but it might help refine their thinking when it comes to designing at trial what your inclusion criteria it might be, what microbial readouts you want to be tagging in your clinical population.",English
+"I think these things can inform one another. Rudolph Tanzi: If we believe there's two pathways where the one case microbes can directly induce inflammation,",English
+"and cause anything from delirium to dementia, and the other pathway is long-term chronic, that's the acute path radio chronic pathway.",English
+"The pathogen initiated seated amyloid and onward to the cascade of tangos neuroinflammation starting 20, 30 years ago. Of course, it's tough then to think about a trial,",English
+"but I think in terms of monitoring and detection, I wonder whether we should be routinely looking for evidence of active pathogen infections before there's any signs or symptoms as folks get older,",English
+basically looking for pathogens that might acutely drive infection. We may not be able to right away stop what happened 30 years ago. We might have to go in there and,English
+"think about early prevention there would have future strategy, early detection, and prevention. But maybe we should start just routinely monitoring for",English
+"pathogens that endoplasmic might be getting through a leaky BBB, as many people mentioned in the chat, and stop monitoring for this as part of",English
+"normal elderly healthcare or even middle-aged elderly healthcare. Because that will at least take care of the acute question, and maybe two things going on here or IgG titers like Irene just said.",English
+"Steven Jacobion: Maria, you got a question? Maria Nagel: Going back to the smoking gun, I think that there is a lot of resistance in exploring infectious contributors because there's",English
+this incorrect assumption that the pathogen we've all encountered has to be there at end-stage disease and these post-mortem AD brains.,English
+"I was drawing parallels with us with a dear colleague, Dr. Rinehart who's here. He was a former director of the National Center for Toxicology Research.",English
+"In a way this is parallel and that you're exposed to a carcinogen, decades later, you get a tumor, but you don't see that carcinogen present then.",English
+"But there were perhaps epigenetic changes and alterations in cascades that were induced in that environment. For us, I think it would be interesting",English
+"to fill in that knowledge gap like what can be happening. We were looking at end-stage, is there some epigenetic changes are things that are specific markers",English
+"for specific pathogens that are starting to occur in that decade's long gap? Then is there another type of biomarker that we can look at, the very end stage,",English
+"rather than just nucleic acids when we get post-mortem brain. Under the concepts that we thought about is that amyloid merely represents a footprint, of various infections,",English
+"and depending upon the host's ability to clear it and some other genetic environmental factors, that's when you'll develop disease.",English
+"We know that many pathogens actually have amyloidogenic regions that will self aggregate VZV, HSV-1, HIV. They're also catalytic and can induce aggregation of Ab42.",English
+"Could we potentially look end-stage at the amyloid and was there some way we could tease out, is there a fragment of an HIV protein in that aggregate, for instance?",English
+"again, this is your field. Are there biobanks that have longitudinal serum from healthy to MCI to AD? Hugo Lovheim: Yes. We do have that in some of our cohorts.",English
+"Rudolph Tanzi: It doesn't go back far enough. You're going to go back 20, 30 years. Steven Jacobion: What about, so we have used in the MS field,",English
+"there's the military database of serum. You know that all military get blood drawn when they enter the military. They gather their 20-year-olds and it's banked actually in Silver Spring, Maryland.",English
+"There's tens of millions of samples, and then they follow them for the rest of their life. How many go on to have cancer? How many go on to have MS?",English
+"How many go on to ALS? You have a pre-serum essentially, at least clinically, they didn't have anything when they joined and they follow them periodically,",English
+"so there are access to that. Mark, are you aware of biobanks that have that? Again, looking at those triggers early on,",English
+that then you might see later. Mack Mackiewicz: That's very interesting point. I would need to look at this. I wanted to point out that we have very interesting questions in the chatbox.,English
+"Perhaps we can ask, a couple of them. We are running a little bit behind. We'll shorten our lunch break by 10 minutes.",English
+Steven Jacobion: You can eat lunch at the Zoom. Mack Mackiewicz: Question from audience Alice or Jean. Jean Tiong-Koehler: There's a question for Dr. Redhead on,English
+"how exhaustive is the repertoire? What is the representation of primary and tertiary epitope and in relation to that, based on latest readouts,",English
+"Benjamin Readhead: Sure. A great question about the epitopes. Really the bias for this particular modality is really what is capturing the linear epitopes,",English
+so there's a primary epitope. There may be three-dimensional conformations that are relevant for antibody binding the we're blind too.,English
+"We're picking up the linear epitopes, and so really it's the first part invalidating any one of these case. One of the things we're doing is seeing if any of",English
+"these antigen hits replicate in an independent cohort. But we also need to follow up with things like ELISA where we express the full protein and check that in fact,",English
+"there are antibodies within those samples that are binding a three-dimensional version of the protein. Whether or not HHV-6 is a trigger,",English
+"look I'm so agnostic to that. I guess it's possible. We're waiting to see how our additional metagenomics come in and then,",English
+"how this antibody hits, how they validate an additional cohort. It's in my nature to be agnostic about that for now.",English
+I think it's interesting that the genes that are transcribed within the RNA seek that we shared those are Alzheimer's relevant genes that are,English
+"associating with the viral genes that we see the antibody hits against, which is all indirect. But it is helping to enrich that picture.",English
+"I'd say myself, I'm agnostic. Mack Mackiewicz: Any other questions?",English
+"Steven Jacobson: There are so many in the chat. Mack Mackiewicz: Yeah, I don't know how we can answer them. Steven Jacobson: There are so many and they're great questions, too.",English
+There's a lot of work. Rudolph Tanzi: Fred Volinsky mentioned reactivation. I think that's a great point.,English
+"HSV-1 reactivation rates and Fred's made a lot of comments. Fred, maybe you should speak up. He's not a panelist. I guess he can't talk,.",English
+Mack Mackiewicz: But we can elevate a person to panelist. Just need to point out who. Rudolph Tanzi: Fred Volinsky because he's made a lot of interesting comments.,English
+"Mack Mackiewicz: What's the last name? Rudolph Tanzi: Volinsky, V as in Victor, O-L-I-N-S-K-Y. Steven Jacobson: Fred is known to many of us, actually.",English
+"Mastan Narne: I promoted David. Steven Jacobson: I think it's hard to do this. Rudolph Tanzi: Well, the same points out the ADNI began",English
+"15 years ago collecting 200 normal age for an MCI. Sam, like this military guy, I think we need to see what's going on in the brain in 1821,",English
+"30 years old, we need to go way back. I think we overlook the CTE model that this is a tall apathy that spreads, that causes inflammation,",English
+"and then enough cell death to get dementia, but it starts with bangs to the head in your teens and 20s, maybe your 30s or if you're Tom Brady, in your 40s.",English
+"That propagation is occurring for decades and it's a tauopathy. Well, the amyloid induces tauopathy. Infection, induces tauopathy.",English
+"Why can't it be the same here? Why do we have to insist these things are all acting acutely. Going back to Maria's point, we need to have better ways to look for historical,",English
+"archaeological evidence of these infections, including entrapment of plaques. Hand out, you can look in plaques, we're looking in plaques,",English
+"we're looking IgG, but this is something we just don't talk enough about. Steven Jacobson: Is there any evidence in CTE that they may have had prior viral infections?",English
+"Not every one that gets smacked in the head is going to have a CTE. Maybe they have a predisposition. They had increased herpes viruses, particularly their young.",English
+HH V6 we see in young people. They didn't clear it. Rudolph Tanzi: Or genetic susceptibility APOE4 CNI offers a good gene to look at there because,English
+"ex-football players have protection against most neurodegenerative diseases because they have such a great neurovascular shape, but they have increased risk for ALS and ALS/FTLD.",English
+You probably should look at those risk factors in CTE as driving the pathology as well. Steven Jacobson: But I think the numbers you were talking about ADNI. At least what we're learning is numbers now are a much bigger game these days.,English
+"You need hundreds and hundreds, if not thousands of samples to see these. Again, that's the agnostic approach. I'm not sure what I'd find if I looked at 200 MS patients.",English
+"I need 2,000 MS patients these days. Again, because it's a very heterogeneous disease. I do like what Ben's doing.",English
+"We're also looking at cerebrospinal fluid. Again, I don't know how often CSF is taken in AD patients. I don't think that's routine, so biobank back,",English
+"but I know Ben, you're doing it from Colombia. There are some CSF that can be obtained from the De Jager's group.",English
+There's some quite amazing multi tissue mixed resources like GTEx looking across 30 different tissues and several brain regions with pair genetics.,English
+There may well be ways to cast a systematic net across tissues outside of the brain to at least prioritizing in a rational way as best you,English
+"well, what about amyloid? What about this idea that amyloid may be an anti-microbial peptide, not just a byproduct of the brain and something that causes problems,",English
+"but that much like anything we find in the human body, it typically serves a purpose. The hypothesis that he developed and we grew out was",English
+"the idea that amyloid is capable of acting as an antimicrobial peptide, it's part of the innate immune system.",English
+"We first looked at bacterium and yeast, Candida and Salmonella specifically. The idea that amyloid would bind to the glycoproteins on the surface of these pathogens,",English
+"isolate them from being able to infect a host cell, and then eventually agglutinate them into acidic mechanism that resulted in amyloid plaques with these pathogens permanently trapped in there.",English
+"Well, starting with Candida and Salmonella was great but we're talking about viruses here because viruses have a known track record of getting into the central nervous system.",English
+We're focused on HSV1. We've heard from researchers looking at HHV6. Shingles has been mentioned.,English
+CMV will be talked about later. Epstein-Barr can't be ignored but all of these share the important similarity in commonality,English
+with what we saw initially with the bacterium in that they have the envelope viruses. They have these surface proteins that we,English
+observed amyloid interacting within the other pathogens. We wanted to shift those gears to look at HSV1 and we included a little bit of HHV6 in the previous publication that I will go over a little bit.,English
+"Here, we're modifying our model system to mirror what we had seen in the bacterium. Between Dr. Deepak Kumar and group, and myself,",English
+we were able to show in five different animal models that the overexpression of A-Beta 42 in these animal models,English
+in beauty protective effect when they were challenged with different pathogens. You can see in the first three graphs here we're looking at Candida or Salmonella in cells in nematodes that over-expressed amyloid.,English
+"In flies that over-expressed amyloid. With mouse models, we examined the 5XFAD, which produces massive amounts of A-Beta 42.",English
+We saw both with direct challenge of Salmonella and HSV1 that imbued a protective effect that increased amyloid slowed down the mortality.,English
+"But also equally important when Dr. Kumar looked at the APP knockouts with Salmonella, the wild types which still produced some amyloid survived longer.",English
+"When we took the amyloid away, it resulted in a worse prognosis. Some additional work that he has produced looks at both SEM and TEM images.",English
+"We found agglutination of the bacteria very quickly, within two hours it was already starting to form what looked like seeds and plaques. Additionally, you can see from this false-colored SEM image that it really captures",English
+the bacterium and importantly looks like it starts to kill the bacteria that are trapped in these amyloid fibrils. We found similar results with the HSV1.,English
+At the bottom here you can see even HHV6 A and B. We saw this very quick ability functioning about two to three times as fast with virus as it did with bacterium.,English
+Its ability start to attach to the envelope of the viruses and then agglutinate them into these large chunks of amyloid fibril and viral particles.,English
+As you've seen a couple of these images already. The crux of our publication revolved around the use of three culture models of human pluripotent neurons that we had in the 3D matrix.,English
+"Using that 3D matrix, we were able to show that we could form plaques with amyloid relatively quickly. Importantly, another group, Dr. Cameron who originated this 3D plaque idea,",English
+"found that if you let it go long enough, it'll form plaques by itself. Yes, amyloid can form plaques without the presence of virus or without the presence of any pathogen.",English
+"I think we are well aware of that with the FAD, the familial Alzheimer's disease in humans that when we have genetic mutations that really ramp up the production of amyloid,",English
+"it can form plaques and progress the disease but in this particular case, we were able to use the presence of a pathogen to accelerate it. Usually, it was taking up to eight weeks.",English
+"In this case, we could do it in 3-4 weeks. Actually, within 48 hours after the presence of pathogen we were already seeing the development of these plaques.",English
+"In the video that you can see on the Right when we take the cells completely out of the question even with just virus and amyloid in a 3D matrix, it's capable of developing this massive 50-micron plaque inside the 3D matrix,",English
+"but without the presence of the viral particles, the same concentration of amyloid did not form any aggregated forms or plaques.",English
+William Eimer: This is where our foundation for what we had looked at with amyloid as an antimicrobial peptide but there are other antimicrobial peptides.,English
+This is not a unique situation in the human body. Two very well-known and documented ones are Beta-defensins and LL-37. Much of our early analysis used LL-37 as a model organism.,English
+"Importantly, not only can these known pathogens form different, either net or tangles or aggregates, but they're potent modulators of the immune system.",English
+"They don't just act as an exterior capturing mechanism. They interact with cells,",English
+they interact with the immune system and alter it in a way to progress. Battle against the pathogens.,English
+"We wanted to look at amyloid in the same light. To start off, the simplest experiment was going back to the 3D cultures and seeing",English
+"where the amyloid was binding and interacting with. What we found was that even in the same culture, the comparing cells that were infected with HSV-1 versus adjacent cells,",English
+"that were not infected with HSV-1, amyloid was preferentially present on the cells that were infected. We saw significance for this in over-express amyloid cells but even in our control cells,",English
+we started to see a trend. They do have physiological levels of amyloid in those cells. Looking at these cell cultures in terms of amyloid,English
+"added to the situation in the presence of HSV-1. With only exogenous added amyloid, we didn't really see any advancement of cytotoxicity,",English
+"so these cells weren't naturally dying. When we added infection HSV-1, we started to see increased cytotoxicity,",English
+but the presence of amyloid and the HSV-1 actually advanced the cell death over a very short period of time. We investigated into a possible mechanism behind this.,English
+"We know that there's a lot of documented evidence in AD, of mitochondrial dysfunction, and breakdown, and we looked at the presence of potential mitophagy.",English
+"While we didn't find significance, we did see a consistent trend both with synthetic and cell originated A-Beta 42 that when we combine that with the infection of the virus,",English
+it seemed to be advancing a mitophagy-based response that could be resulting in cell death. We created a 3D cell culture microfluidic model,English
+"because with the idea that the amyloid is acting both on the cells themselves and exterior, we wanted to look at the movement of HSV-1 across the system.",English
+"Would amyloid be effective at preventing or slowing down spread? In this three-channel microfluidic device, we infected the left channel and then had center channel being populated by either naïve",English
+or amyloid over-expressing ReN VM cell lines with another naïve cell system on the third channel. Indeed we did see that within the first 24 hours and out into 48 hours that the virus,English
+"trying to progress from the left to right was inhibited by the presence of amyloid in that center channel. Whether this was amyloid interacting with the exterior virus,",English
+"moving in the fluid between the microfluidics, or whether this was retrograde axonal transport from the interneuronal viral movement and amyloid's ability to",English
+"potentially interact with that we haven't quite deciphered that information yet. But unexpectedly, there was a significant increase in",English
+the presence of phosphorylated tau in these channels that separated the initial infection chamber from that central chamber. This was independent of whether it was,English
+an amyloid overexpressing line or a naïve expressing line. Looking a little bit deeper into that idea of tau also being part of this story.,English
+"We see that where there are viral replication centers, which you can see these red-on-take dots inside the neurons, we see this increase in punctate pTau staining.",English
+"Additionally, in this lower left-hand image, you can see dystrophies in neurites of a neuron, and in these dystrophies,",English
+"you see an aggregation of both HSV-1 and phosphatase tau. That adds another interesting layer to this idea that amyloid may be involved not just as an exterior antimicrobial peptide,",English
+but as an integral part as Dr. Tanzi's you talked about earlier in terms of altering the progression of a immune response to a pathogen.,English
+"While we focused on HSV-1, we've seen interactions with bacteria, with other viruses, with yeast,",English
+and this hypothesis provides a bit of a bridge between the elements of a pathogenic etiology and what,English
+"many researchers have been doing further down the spectrum in terms of the development of the AD disease that we're getting a lot of this cross interaction between infection,",English
+"amyloid tau, neuroinflammation, and it's all underneath the guise of the genetics. Mack Mackiewicz: Dr. Eimer,",English
+you have two more minutes. William Eimer: Great. I'm just about done. That as Dr. Tanzi mentioned before that this seems to be a conserved process.,English
+"The coelacanth fish, which separated from us evolutionarily about 400 million years ago, has the exact same sequence of the A-Beta 42 peptide as we do.",English
+This idea that we used the amyloid and potentially used the tau very early on as a method for us to fight infection and get through,English
+"pandemics very early on in our evolutionary early history, and that we have conserved these and now they're potentially working against us a little bit as we get into these advanced ages.",English
+"As a model, we think this could have an important connection bridging pathogens, amyloid and the disease.",English
+"I want to thank Cure Alzheimer's Fund, NIH, Open Philanthropy Project, and the Helmsley Trust for helping support this research.",English
+"My former mentor, Dr. Robert Moir, for starting this process and these ideas and sending me down this path. Then Dr. Tanzi for his mentorship,",English
+"and then Dr. Kim, Dr. Choi, and Dr. Breakefield for their continued support in this research. Thank you. Maria Nagel: Thank you, Dr. Eimer.",English
+Our next speaker is Dr. Adam Spira from the Johns Hopkins School of Medicine. Adam Spira: Hi there. I'm actually from the Johns Hopkins School of Public Health,English
+"that I do hold employment as well in in the School of Medicine. Maria Nagel: Sorry I didn't see that. Adam Spira: No, that's fine. Full disclosure here. Can everybody see my slides and hear me?",English
+"Dr. Nagel, can you see my slides? Maria Nagel: Yes. Adam Spira: Okay. Great. Thank you. First of all, I want to thank everybody",English
+"for being here today and thank the organizers for inviting me. I'm really honored to be part of this discussion. As you can see here, my talk is entitled Exposure to Infectious Agents and",English
+Cognitive Function: The Baltimore epidemiologic catchment area of study follow-up. I'll be doing something a bit different from the two prior talks in this session because I'll be focusing,English
+exclusively on humans and looking at cognition rather than any markers of Alzheimer's disease per se. A couple of disclosures here.,English
+Here we go. I won't believe at this point. I think everybody on the call is aware that US population is aging.,English
+"And of course, you know that this will have important implications for Alzheimer's disease, or AD and AD-related dementias, or ADRD.",English
+"The absence of effective AD treatments and as others have referred to previously, the failure of AD drug trials has really led many of us to focus on prevention.",English
+"I'm sure you're all aware, a range of modifiable risk factors for Alzheimer's disease have been identified, including hypertension, diabetes, depression, smoking, etc.",English
+I mentioned sleep disturbance though because that's close to my heart. That's what I studied. But it could very well be that we are neglecting,English
+"an important set of ADRD risk factors, namely common infections. Herpes simplex virus or HSV types 1 and 2, Cytomegalovirus, CMV,",English
+"Epstein-Barr virus EBV, and Toxoplasma gondii, the protozoan, all of these are common in older adults. In addition to the studies that have been presented previously,",English
+"a range of research links exposure to these infections to cognitive outcomes. People with amnestic mild cognitive impairment or Alzheimer's disease,",English
+"have higher HSV antibody levels compared to controls, cytomegalovirus has been tied to faster cognitive decline and twice the risk of AD diagnosis,",English
+"and Epstein-Barr virus antibody levels have been tied to incident MCI. And with respect to TOXO, it has been linked to poorer cognition in",English
+older adult populations and is more common in AD patients compared to controls. We sought to move this literature forward by addressing the following questions.,English
+"First of all, how is exposure to common infectious agents associated with cognitive performance: in a population-based cohort of older adults? Is there a dose-response effect such that exposure to",English
+"a greater number of agents is associated with lower cognitive performance? And then in some exploratory analyses, do associations differ by age, sex,",English
+and the the APOE e4 allele carrier status? We did this research in participants in the Baltimore Epidemiologic Catchment Area or ECA study follow-up.,English
+"This is a population-based cohort representative of East Baltimore, MD that has been followed since 1981. Baltimore's one site of",English
+"the National Institute of Mental Health Epidemiologic Catchment Area of study program, which provided the first population-based estimates of the prevalence and incidence of Diagnostic and Statistical Manual of Mental Disorders or DSM diagnosis.",English
+"Now, in the ECA, at wave four, which was in 2004-2005, all participants were asked to donate blood or buccal samples.",English
+I'm currently along with Dr. Bill Eaton wrapping up wave five of the Baltimore ECA in which we're studying stress exposures over 35 years in,English
+"relation to cognitive and functional decline in cellular aging, among other things. But we got as part of that grant, by the way, that led is funded by NIA. Thank you, NIA.",English
+"As part of that grant, we received an administrative supplement from NIA to perform assays on stored bloods from Wave 4 to investigate levels of IgG antibodies to HSV-1,",English
+"CMV, Epstein-Barr virus, VZV, and TOXO. Antibody positivity in this study was defined by",English
+"reactivity compared to standard samples that were run in each assay. Our cognitive outcomes were the Mini-Mental State Examination with which most, if not all of you will be familiar.",English
+A 30 item test of global cognitive function. We also used a wordless memory test that was administered at this 2004 wave along with the MMSE,English
+"from the Iowa EPESE or established populations for epidemiologic studies of the elderly. The ECA research staff read 20 common words aloud to participants,",English
+"and they were asked to recall as many as they could, and there was a delayed recall task about 20 minutes later when they were asked to recall them again.",English
+"We're focusing on the delayed recall task here because that's the most relevant to Alzheimer's disease versus immediate recall. The other measures that were collected were demographic data on age,",English
+"sex, years of education, race, which we categorized here as white versus non-white, and ApoE e4 allele carrier status.",English
+"We computed descriptive statistics and then based on the distribution of the Mini-Mental State Exam, and the wordless memory delayed recall task,",English
+"we used a Poisson regression, multivariable adjusted to investigate links of exposures with performance of these measures.",English
+"Our outcomes were the items, the number of items missed on the MMSE, or the number of words correctly recalled for the wordless memory based on that Poisson distribution.",English
+"These were counts. The predictors were positivity for the different antibodies individually, but then we took a different perspective and thought,",English
+"what is the link between the number of positive tests within a given participant and performance on these cognitive measures? Our analyses were adjusted for age, sex, race,",English
+"education, and the ApoE e4 alleles status. In terms of results, we suddenly 575 participants who had data on antibodies, cognitive tests, and covariance,",English
+"they had a mean age of 59 years, they were 63 percent female, 36 percent non-white, they had a mean of 12 years of education, on average,",English
+"they missed 1.7 Mini-Mental State Exam items and recalled an average of 5.5 words, 20 minutes or so after they were first exposed to them.",English
+Now here you can see the distribution of participant characteristics as a function of the number of positive antibody tests.,English
+You can see that age increases as the number of positive tests increases. The proportion of participants who were,English
+"female increases as the number of positive antibody tests increases, as does the proportion of participants who were not white as the number of positive tests increased.",English
+Years of education decreased as the number of positive tests increased and there was no association with ApoE e4 carriers status.,English
+"Now, here you can see a visual depiction that we thought was quite striking. The number of items missed on the Mini-Mental State Exam as a function of the number of positive antibody tests.",English
+"Just as a reminder here, because of the distribution we use the Poisson regression, and higher scores indicate poorer performance on the Mini-Mental State Exam.",English
+"So as you can see here, as you go up with a number of tests for which you were positive, you can see that the number of items missed on the MMSE, at least it's jumps out at you.",English
+"That that number goes up to. When we looked at the number of items that we're correct on the delayed recall, a component of the EPESE were",English
+"this memory test on which higher scores indicate better performance, you can see that as the number of positive antibody tests goes up, the performance on the number of correctly recalled goes down.",English
+"These were quite impressive to us when we first saw them. We then looked at the adjusted association, adjusted for age, sex, race education,",English
+and ApoE e4 allele carrier status of positivity for each of these different agent with cognitive performance. The only one that we saw that was statistically,English
+"significantly associated with performance, in this case, it was the MMSE was positive cytomegalovirus. What we noted though when even in adjusted analyses,",English
+is that a greater number of positive tests was associated with a greater number of items missed on Mini-Mental State Exam.,English
+"It's in gray hair because it did not quite reach statistical significance, but we see that there is, whereas we saw nothing like this in terms of significance.",English
+"On the left side, there's a hint that there might be something going on in terms of the total number of positive tests with respect to the number of words correctly recalled.",English
+"Here you can see something. We did look at interactions of age, sex and ApoE before status. Age and sex we didn't see anything interesting.",English
+"This one I'm presenting to you because we thought it was worth looking at despite this interaction, p-value. Keep in mind this is exploratory.",English
+"This is the interaction of ApoE4 carrier status with past infection with on performance on the MMSE. Again, remember that the higher the MMSE is born, the more numbers mixed.",English
+"This is looking in the whole sample. This is looking in ApoE4 negatives. You can see that in the folks who are negative,",English
+"you see pretty much what you would see here. In the folks who were ApoE4 positive, however, you can see that you don't see this in quite the same way,",English
+"this dose-response association, and there are various things that could be going on here. Let me go back. One of the things that we should consider is that selective attrition by",English
+"people who were both E4 positive and had a greater number of infections, meaning that it caused them to be sufficiently impaired and weren't able to stay in the study,",English
+"and so they dropped out that's why we don't see them here. Another possibility, however, is that there's some potential protective effect of",English
+"the E4 alleles on the negative effects of infection on cognition. It's an intriguing possibility that others, including Dr. Kenzie in his keynote",English
+"presented and that's something we have to consider, definitely bears replication. In summary, in a population-based cohort of middle aged and older adults,",English
+"we found that a greater number of infections with individual herpes viruses and TOXO was associated with poorer global cognitive function on the mini-mental, and a trend toward a lower delayed verbal recall.",English
+"Cytomegalovirus was the only individual infection that was associated with poorer global cognitive performance, and associations here were independent of age,",English
+"sex, race, education, and E4 allele status. There's a hint that there could be something going on with respect to an E4 and the infection interaction on global cognitive function,",English
+"but let's not make too much of it. In terms of future directions, well, prospective studies with serial samples, with measurement of a broader range of infectious agents,",English
+"including perhaps coronaviruses, are needed to examine how the accumulation and reactivation of infections could affect cognitive decline and dementia risk.",English
+"Others have already spoken to the importance of examining a potential role of anti-microbial interventions. In terms of mechanisms,",English
+"that is something that we still have to examine whether it be inflammation, epigenetic change, as someone mentioned earlier,",English
+"I think Dr. Nagel perhaps, cellular aging, senescence and AD pathology. We've seen controversial things in relation to AD pathology today.",English
+"Then I'm biased because this study, the Baltimore ECA, is really focused on stress-related exposures in relation to cognitive and functional decline.",English
+"But given we know that stress and stress responses can modulate the immune system, I think that it's important that we investigate interactions of infectious agents with stress and",English
+distress on cognitive and AD biomarker trajectories. I'd like to thank the NIA for providing the support to do the work that we've done in the ECA.,English
+"I'd like to thank the Stanley Medical Research Institute who supports our collaborator, Dr. Bob Yolken. I'd like to thank my co-authors,",English
+"Doctors Brion Maher, Bob Yolken, Jill Rabinovitz, Calliope Holingue and Bill Eaton, and the participants in the Baltimore epidemiologic catchment area of",English
+study without whom this research would not have been possible. Thank you. Maria Nagel: Thank you so much Dr. Spira.,English
+Our next speaker today is Dr. Laura Cox from Harvard. Laura Cox: Hi. Good afternoon everybody.,English
+"Can you confirm if you can see the slides? Maria Nagel: Yes, I can see the slides. Laura Cox: Okay, fantastic.",English
+We're going to shift gears a little bit and talk about bacteria. Today I'll be telling you about the potential role for bacteroides in Alzheimer's disease.,English
+"As we're starting to shift into a new type of infectious trigger, I just wanted to discuss how we might consider an anaerobic etiology in Alzheimer's disease and how that",English
+might differ from other bacterial infectious agents as well as viral yeast infectious agents as well. One thing is classic anaerobic bacteriology.,English
+"We know that the majority of anaerobic infections are really of endogenous origin, which means the bacteria are coming from the normal microbiota and they",English
+cause infections when there's compromised host defenses. We also know that advanced age represents a time with increased susceptibility to anaerobic infections.,English
+"This is driven by immune senescence as well as physiologic changes. This could be the weakening of the gut barrier function, the blood-brain barrier function,",English
+reduced blood circulation as well. Given the fact that the gut microbiome can affect the brain through,English
+"What I'll share with you today is some data-driven approaches that led us to backdrop these, and what we see is the big gaps in the future of our research.",English
+"We know that the gut microbiota changes throughout the aging process, we require it at birth and matures and stabilizes in early adulthood and in aging it can become destabilized and change.",English
+"Furthermore, these changes can have functional consequences on our immune system. We know in aging that there's two seemingly diametrically opposed processes of both",English
+"implementing an immunosenescence where there may be high circulating inflammatory cytokines, but yet there's also a decreased ability to kill pathogens.",English
+"We see this resistance in response to it, a constant stressor in many other things. We see this with insulin insensitivity,",English
+"leptin resistance, and obesity. You can think of this as a resistance to a constant alarm. What this beautiful study showed back in",English
+"2017 is that the aging gut microbiota can actually regulate this dual inflammation and immune senescence process in which if you transfer old microbiota to a young mouse,",English
+"you can increase TNF-Alpha and IL-6 and decrease phagocytosis obstruct. If you transfer young microbiota to aged mice, you can partially reverse this process.",English
+"We really care about Alzheimer's disease and we were wondering, how does the microbiome change with aging? How can we control that?",English
+"We know a number of factors shape our gut microbiome, including antibiotics, lifestyle, diet, and hygiene and some really beautiful studies coming out of Ireland,",English
+we're showing that the gut microbiota composition correlates with diet and health in the elderly. It's also been shown that calorie restriction can,English
+have a beneficial effects in Alzheimer's disease. That led us to initially ask are some of the protective effects seen with calorie restriction actually linked to changes in the gut microbiome.,English
+This was a wonderful collaboration that I had as a graduate student NYU. What we found is that if you lower the calorie content just from carbohydrate fraction by,English
+"30 percent it can protect plaques in female TG 2576 months. Then we looked at changes in the gut microbiome over time,",English
+and what we found is that bacteroides nearly tripled in our aging Alzheimer's females but these levels were stabilized by our diet. Out of all the changes in the gut microbiome we also found that Bacteroides was,English
+the strongest microbe to correlate with A-Beta 40 and A Beta-42 in the brain. This was really interesting to us because we found,English
+some translational relevance in the human population. One study has reported that just as our mice Bacteroides also goes up in aging humans. Then a recent study shows that there may be functional consequences of this.,English
+"In individuals over 85, those with the highest levels of Bacteroides have a increase likelihood of mortality in a four-year follow-up study.",English
+"In addition, two additional papers, one from Vogt and another from Heran et al, have found elevated Bacteroides in Alzheimer's patients.",English
+Given our connections in mice and also in the human population we next wanted to test this in experimental models. Working with a fantastic master's student we,English
+"administered Bacteroides to the APP/PS1 euchre mice, starting at about 2.5 months of age, about when black onset is just starting in these animals.",English
+This confirmed that actually administering Bacteroides can contribute to plaque production. This was very exciting for us at the time.,English
+We next look at changes in peripheral immunity and we looked at splenic immune responses. We really didn't see signs of peripheral inflammation induced by Bacteroides.,English
+"In fact, what we found in normal animals, the Alzheimer's mice have elevated levels of GM-CSF. Then our mice treated with factories fragilis,",English
+we were suppressing these peripheral immune responses with GM-CSF. This is really interesting to us because GM-CSF may actually have,English
+"beneficial effects in Alzheimer's disease to activate the peripheral immune system to aid in a plaque clearance. In fact, this is actually being looked at in clinical trials.",English
+"We want only to see what was happening in the brain. Does B. fragilis administration change what's going on in the brain? As we looked at gene expression by B. fragilis,",English
+"we found a number of genes that were altered. These were related to many different processes important for Alzheimer's disease including a neuronal cell death,",English
+"response to A-Beta, cell aging, and learning in memory. There was a few genes that in particular really stood out to us,",English
+one was that Bacteroides fragilis increased cdk5. This is one of the initiating events that phosphorylates APP and can promote it towards the pro amyloidogenic pathway.,English
+"We saw a decrease in Gga1 which is the Golgi gene and protein that get a clearance, and we saw an increase in Parp1 which is a gene that promotes",English
+"a neurotoxic microglial phenotype that may contribute to neuronal cell death. From that we wanted to look at microglia, and these cells play a very important role in Alzheimer's disease.",English
+"Early on with their homeostatic functions, they can play a role in clearing plaques and can be protective, but later on they can become neurotoxic and contribute to disease.",English
+"Now many studies have found that depleting the gut microbiome can ameliorate disease including improve Alzheimer's disease and in fact improve the microglial phenotype,",English
+but what's not known is really the effect of a specific pathogen or a specific microbe on microglia and Alzheimer's disease. We sorted microglia and we looked at the gene expression.,English
+"Surprisingly many of the genes that were altering were involved in protein homeostasis, including Fc gamma, mediated phagocytosis,",English
+"but also in the autophagolysosome and autophagy and even genes that interact with A-Beta. The surprise to us is that most of these genes were downregulated, not upregulated.",English
+"This is suggesting that B. fragilis is actually impairing some of them normal microglia functions and aging. To see if we had a functional effect just beyond gene expression,",English
+"we then administered Bacteroides to age a wild-type mice, and then inject it for us an A-Beta into the hippocampus 16 hours later,",English
+analyzed the uptake by flow cytometry. What Caroline Wasen found is that Bacteroides fragilis could impair A-Beta clearance by peripherally recruiting,English
+"monocytes and also to some extent by microglia as well, and so all of this together is suggesting that B. Fragilis is impairing this very important repair process in the brain.",English
+"To summarize some of our data findings, we found that B. fragilis can alter genes involved in A-Beta phosphorylation, trafficking, degradation,",English
+and modulates pathways in microglia related to protein homeostasis and neuronal cell death. It can inhibit A-Beta uptake by a peripherally recruited macrophages.,English
+I'll just spend the last couple of minutes talking about where we see the big gaps and where we want to go from here. I'll tell you that Bacteroides is incredibly ubiquitous and functionally diverse.,English
+"People in the world over have Bacteroides, and not all Bacteroides are causing Alzheimer's disease. We know that this is one of the most common bacteria that lives in our gut.",English
+"It outnumbers the E. coli 1,000:1. There's many beneficial functions of Bacteroides including helping us digest our food, and protecting us from pathogens that educate our immune system.",English
+"The Bacteroides can also contain pathogenicity factors and can contribute to serious infectious disease, but also contribute to chronic non-infectious diseases like colon cancer.",English
+"It has potential roles and in neurologic diseases. For instance, it can produce GABA, and it has beneficial association with",English
+"depression as seen by fMRI measurements in a human study. It also produces polysaccharide A which is the cell wall component that induces Tregs,",English
+"puts out the fire and dampens inflammation, and this might have benefits for diseases like multiple sclerosis. What's also interesting is it can package these proteins into",English
+"outer membrane vesicles which can enter the circulation and end up in distant tissues. Finally, other strings of Bacteroides can make a fragilysin toxin which is matrix metallic protease,",English
+"which can weaken tight junctions by cleaving E-cadherin, and it also interacts with PSEN 1 and Alzheimer's risk genes. One of our goals is to really",English
+"understand the molecular diversity of B. fragilis strains and AD. We know that different strains of the same species can have vastly different functions. To just really make this hit home these are all species; Canis lupus,",English
+but you can understand that they have vastly different functional effects and also roles within their ecosystems. We have started a project which has just recently been,English
+funded by the National Institutes of Aging to really dive into the genetic and molecular epidemiology of Bacteroides in AD. We're starting a strain collection.,English
+We will then be measuring their abilities to modulate A-Beta uptake using in vitro screening assays,English
+"and also a number of other in vitro screening assays. We'll be looking at Bacteroides strains in the Alzheimer's population versus healthy controls,",English
+"and using whole genome comparison to try to identify specific pathogenicity factors linked with Alzheimer's disease. Then finally we'll be investigating these strains specific effect in animal models,",English
+"and looking at their effects on behavioral analysis, AD pathology, signaling pathways, and even determining whether or not we can detect any Bacteroides in the brain,",English
+"or if it's simply works through modulating immune cells and metabolites through peripheral circulation. I think for these studies, the implications,",English
+"challenges, and hopefully the path forward, our data suggests that rather than inducing inflammation Bacteroides may contribute to Alzheimer's disease by altering MLA processing and actually impairing,",English
+inhibiting central and peripheral immune responses to A-beta. We can think that this likely mediated by secreted factors. We think that there are important disease-specific microbiota implications,English
+"where Bacteroides might be beneficial for something like a MS. It might be detrimental at a certain level for Alzheimer's disease. We think it's critical to study strain-specific interactions,",English
+"and it's likely that only some strains of Bacteroides could contribute to AD. This is exciting for us because if we can identify these factors, there's a clear path forward to molecular diagnostics that can be employed in",English
+a point of care setting and provide rapid information to the clinicians. Once we do have this information we think that there's going to be a number of translational challenges.,English
+"I do not believe that depleting all Bacteroides is a realistic approach. We don't want to put everyone on metronidazole, but we can start to think about targeted ways forward to shape the microbiome",English
+and start to eliminate certain pathological interactions. With that I would love to just acknowledge all of the people involved in this work.,English
+"Seth Gale is a clinician that's helping categorize our patients and really leading the charge for recruiting our subjects. I've mentioned a number of people involved in the work throughout,",English
+and I just want to say thank you to our funders and thank you for your attention. Maria Nagel: Thank you Dr. Laura Cox. Well that was an amazing session.,English
+It really raised our awareness that there are multiple pathogens that can be contributing singly or together in some type of network accelerating,English
+"the pathologies of Alzheimer's disease thereby accelerating disease. I'm going to go through, there are several questions both in the chat boxes and also in the Questions area.",English
+"Mack Mackiewicz: Maria? Maria Nagel: Yes. Mack Mackiewicz: Hi, this is Mack. Obviously this is our last talk, so thank you so much for all the presenters.",English
+"I see obviously we have our people monitoring chat boxes and they will be happy to provide questions. I see that there are still presenters from the morning session,",English
+"so I believe we perhaps could open discussion across all session. Again, I would like to remind that all presenters",English
+"and session moderators have full access, they can unmute themselves and comment. I would like to appeal to all those listening to us,",English
+"there are over 200 people. Please add your comment, please add your suggestion about gaps. In knowledge, research direction it will be incredibly helpful to us.",English
+"Again, this is our last talk. Thank you so much for all the presenters and we can now chat until midnight I guess.",English
+"No, I'm just joking. Maria Nagel: Mack, do you want me to go through some of the questions or should I just open it to our panelists first in the comments?",English
+"Mack Mackiewicz: Maria, I believe Liz, and Jane, and Rachel perhaps are monitoring, so we can open to all presenters and we can ask Liz and",English
+"Jane to pose the question because they should be looking at those questions, but it's up to you Maria. Go ahead.",English
+The podium is and it's your decision. Maria Nagel: Let's start with listening Jane. If you can go through some of those questions and we can pose them to our presenters and,English
+people feel free to raise your hand and to make some comments. Elizabeth Newman: We have one general question from,English
+"earlier today that would be good to probably start us off. To those that are new to the field of infection and CNS tissues, what if any possible artifacts of",English
+infectious-related antigens and postpartum genus tissues are there? Should their integrity be controlled for an individual subject level?,English
+"With regards to potential artifacts, I think we just need to be aware when we are looking at analyzing",English
+"brains that if there are certain peripheral inflammatory cells that have been there, that some of those cells may have latent cytomegalovirus, for instance.",English
+Areas of the brain do have latent HSV-1. It's just important to know that some of the cells that we're looking at just naturally have latent viruses and we just need to consider that.,English
+"Rudolph Tanzi: Can I ask a question? Elizabeth Newman: Yes, please go forward. Rudolph Tanzi: I wanted to address Dr. Baskakov.",English
+"Obviously we had opposite results and I have put quite a few comments in the chat about the differences in our study and role. Might want to comment as well,",English
+"but I'm not sure if you saw the exchange on outs forum from a while back, Dr. Baskakov, but we had used 10^8 titer.",English
+"You would use 10^4 titer of herpes virus, a different strain and in fact, to look for protective effects of a-beta,",English
+"and you saw a trend, a 10^4 and we would think that if you'd gone beyond 10^4, with higher titer toward what we use 10^8, you might have seen significance in just wondering why you didn't do that.",English
+"My second question is, in terms of seeing herpes from plaque, you only used trypsin antibodies and there was no control for whether you could actually see those epitopes with a-beta bound to the herpes.",English
+"We actually use fluorescent virus and we saw its specifically the virus around the plaque so it was pretty clear. I think that since you're stating a refutation that might have significant consequences,",English
+"I'd like one of you could address those two issues. Ilia Baskakov: Yeah, sure. Thank you for this question, of course we read very careful your comments on outs forum.",English
+"In our opinion, we use much more physiological concentration of doses of the virus. In fact, my opinion of NIH study section, we still went too high because",English
+"the lethal dose in humans seems to be much lower. It's only 10 PFU. Some we use thousands to 10,000 to sometimes a little bit more than thousand. In our opinion there's quite a lot of artifacts in my face when you",English
+use very high concentrations such as 10^8. It's not just absolutely not physiological. Human would never face this concentration and I'm not quite sure,English
+how this concentration would relate to the chances of developing or increasing Alzheimer's. But also it's very hard to claim that based on these concentrations that,English
+virus has intrinsic affinity to I-beam or a-beta plaques. It's overwhelms the brains. Brains loaded with the virus.,English
+How can you claim that it's actually binds to the plaque with affinity or just everywhere including plaques. Regarding how protocol for detecting,English
+"the virus in the brain we were very cautious not just to select antibody bit, we also use the protocols for epitopes exposure.",English
+"We test this protocol and we've been using this for a couple of decades to expose a prion plaques which are extremely dense plaques. Otherwise they would result these protocols,",English
+"will not expose epitopes. We started with as a starting point, but we also tested our reagents against all the FADs.",English
+"Because plaques has a lot of a-beta peptide and APP neurons. We do see that these neurons get infected with the virus. We do see a virus inside of this neurons,",English
+"which has a lot of Beta, meaning that a-beta does not seclude this epitopes. In addition to the data that I presented just with one antibody,",English
+we actually use panel of three different antibodies. All three antibodies showed us the same results that we do see. Virus inside of cells that express high level of APP anti-beta.,English
+"We also see virus in the extracellular space, but we don't see virus in plaques or trapped with the plaques. When you're working with plaques,",English
+you have to also be aware of the certain artifacts related to imaging of plaques such as auto-fluorescence of plaques. I'm not sure if you looked at the negative controls of,English
+"plaques.If you looked at the negative controls of autofluorescence. Rudolph Tanzi: The render plaques we induced these were young mice and the HSV-1 induced plaques,",English
+"mice that were months away from normally having plaques. We induce plaques with HSV-1. The other thing is the HSV-1 is not a mouse virus, it is a human virus.",English
+"You can't take human physiological values and think you can model that in mice. The mice you have to use higher levels of HSV-1 to test these systems. I said in my talk several times,",English
+"we need to see if at physiological levels of a-beta we will still see the same effect. I think if you see a trend in your experiment of 10^4, and you stop there before you to higher titer.",English
+I don't know if that's a fair comparison because you already on your way to seeing the same effect. That's all I'm trying to say. Ilia Baskakov: Don't really see a trend.,English
+"Rudolph Tanzi: On your trend, the p-value is published. Ilia Baskakov: One experiment shows a little bit protective effect which is not statistically significant.",English
+"Those other shows actually opposite effect and if you sum up all the experiments and all the animals that we use, I don't think there is any trend.",English
+There is pretty much lack of any effect. I think that's the difference that you use to construct of virus which was expressing red fluorescent protein.,English
+"I'm not sure if you have any controls that might be a plaques maybe virus binds to the plaques because it has additional extra parts,",English
+"red fluorescent proteins that might by itself bind plaques. Rudolph Tanzi: Like i said, the virus was inducing the plaque. It's not binding the plaque.",English
+It's inducing new plaques in young mice that wouldn't have plaques. Ilia Baskakov: But young mice also develop. If you look at the original data of this FAD model.,English
+"Rudolph Tanzi: I know this model very well and believe me, we've been using it for years. Ilia Baskakov: When are developing plaques right at the time point where you start absorbing zones,",English
+"they start developing plaques at certain brain areas. Certain brain areas,if you look carefully, you start seeing this plaques at very young mice.",English
+Rudolph Tanzi: As many as we saw at 1.5 month-old. We've been using these mice since Bob Vasser even before Bob Vasser published them. We're very familiar with the timing and profile of the plaques and bring region.,English
+"We're inducing plaques that shouldn't be there with HSV-1. I don't want to hold up this whole discussion for this, we can take it offline,",English
+but I just think it's important to point out that what you did was not a fair replication attempt at out of study. I just want to make that no.,English
+Ilia Baskakov: Not have in mind to replicating your study. We started before you're study was published and actually independently pursuing very similar strategy.,English
+"We did not have in mind at all replicating your study. Rudolph Tanzi: No. Mack Mackiewicz: Great. Thank you so much, Dr.Tanzi, Dr.Baskakov.",English
+"Maria, can you actually comment on you work or you try to develop some of the animal models. I mean, what is your thinking?",English
+What best models can we use? Or maybe you will be talking tomorrow about this so you can skip it.,English
+"Maria Nagel: Yeah, I don't talk too much on models. But with regards to HSV and bend the mouse model and the amyloid deposition, it would be really interesting and I don't know if anyone's already",English
+done this is to look at human samples if there's biopsies of cold sores or HSV encephalitis brain and then just do an immunohistochemical analysis for amyloid deposition around,English
+"active HSV replication in actual clinical samples. With regards to animal models, Mack, for us,",English
+we're trying to establish a VZV guinea pig model because VZV is an exclusively human virus. It's very hard to study that in vivo.,English
+"But I think one of the promising models is the non-human primates. We have early work where we show that Simian varicella virus,",English
+"which is recapitulates the disease you see with VZV, with chickenpox and then immune suppression and reactivation with zoster that we see in the serum during the viremia,",English
+"increased amyloid, and we also see where virus is deposited specifically, we looked at the pancreas. With SVD that we actually see amyloid deposition in areas in this natural animal models.",English
+"I think that the non-human primates, while very expensive. Particularly like also doing behavioral studies and",English
+"then can be challenging is a very promising model. Mack Mackiewicz: I wonder if someone can comment on organoids. Not only for HSV,",English
+but perhaps for bacterial infections. Would this be a reasonable model? Maybe. I know that Dr. Tanzi is probably doing this and perhaps others.,English
+"Rudolph Tanzi: I'll wrote comment, but I actually presented some organoid data where we used 3D culture models. I should mention that it talks Karnes et al from the capital lab,",English
+"replicated our findings showing herpes also was a Beta is protective against herpes and our 3D model, different 3D model than ours.",English
+"The HHV-6 where you can't infect mice unless they're transgenically altered to accept it. HHV-6, we had to show into 3D model because we couldn't use it in mice.",English
+Even HSV-1 is not perfectly adopted for mice. 3D models with human neurons and glia comes in very handy for that purpose. William you have a comment on that?,English
+William Eimer: Yeah. It's allowed us to expand the degree of control in terms of monitoring exactly what's going on in a small area.,English
+"A lot of what we're looking at, particularly looking at the amyloid is an anti-microbial peptide. We're looking at very focused, potentially high regions of concentration of both the pathogen and",English
+the antimicrobial peptide that on a global scale across a whole mouse brain may not present itself like that. It's allowed us to really basically pick it,English
+"apart and look on refined scale and be adaptive. We've used it for both HSV-1, HHV-6, if you've used it for Salmonella,",English
+a little bit for Candida. We've been able to bounce around and really look at it from a lot of different angles and,English
+"manipulations that we couldn't do inside the mouse model. Jean Tiong-Koehler: Dr. Eimer, there's also a question in relation to your presentation earlier.",English
+"Will there be pathogen associated A-Beta and tau be cleared after infection? William Eimer: With the model that we have presented and looked at so far,",English
+we were taking an approach that was more of a snapshot in time. It would be that initial contact between an anti-microbial peptide and,English
+"a pathogen and what happens in the near time-frame immediately during and after that. In that snapshot, we were able to see aggregation of the amyloid.",English
+"In this case, as I presented today, we saw the phosphorylation of Tau and the presence of the infection progressing through the microfluidic devices.",English
+"In terms of its ability to clear, the one disadvantage of our organoid models is that they don't present a full immune system.",English
+"It's not a mouse, it's not a human immune system. Not every single one of the players are there. We have more advanced organized models that incorporate microglia into the whole system.",English
+"But again, there's a lot of additional players that are not necessarily there to see, from start to finish, an infection is seating of plaques, development of plaques,",English
+"and then a clearance of plaques, that tends to be a little bit of a limitation of the organoid model. We are exploring the roles of microglia in the 3D organoids systems and the interaction.",English
+But that's more along the lines of communication and alteration of a microglia rather than necessarily being able to fulfill a whole cycle.,English
+"Rudolph Tanzi: Well, I think it's important to note also in our 3D model, you don't get plaques until about four weeks. But when you drop in either HSV-1 or HHV-6,",English
+"even after one week, you get plaques overnight. You get a very rapid seating of amyloid due to the herpes virus. That was replicated by David Kaplan's group at Tufts,",English
+but at different 3D model as well. Jean Tiong-Koehler: There's a question for Dr. Cox. What is the role of diet?,English
+"Could food hypersensitivity reaction play a role? Laura Cox: That's, really great. Question about dietary microbiome interactions in Alzheimer's disease.",English
+We haven't looked specifically at hypersensitivity or any allergic interactions. We can think about microbe diet interactions in two ways for Alzheimer's disease.,English
+"One is using the diet to control the microbiome and aging. We found that at 30 percent calorie restriction just in carbohydrates, protected plaques only female mice.",English
+"I would really exercise caution when we're thinking about calorie restriction, especially in an aging population that's at risk for frailty muscle loss.",English
+"We can think about controlling your microbiome with diet, with prebiotics, dietary fibers, and that sort of thing.",English
+"There's another area of dietary interaction with the gut microbiome in Alzheimer's disease, which is the contribution of microbial metabolites that could actually worsen disease.",English
+There's some really great work from Nick vote that showed that the same TMAO pathway that drives the cardiovascular disease in response to trimethylamine.,English
+This is why red meat gives you a heart attacks. It's actually a microbial metabolic process. They're finding elevated microbial enzymes for,English
+"this trimethylamine oxides also linked to Alzheimer's disease. We think that there could be some important microbial dietary interactions that could drive the disease,",English
+"and then conversely, you could control the microbiome with a healthy diet, potentially. Mack Mackiewicz: I have a quick question for Adam if Adam is still here.",English
+"Yes, Adam is still here, and I see that Dr. Melissa Lodoen, is also here. Adam, did I hear you correctly that you seem to see the toxoplasma actually, in my mind,",English
+toxoplasma protects against amyloid and perhaps Dr. Lodoen will tell us more tomorrow.,English
+"Am I wrong? Adam Spira: Well, it's a good question. We actually didn't see associations of toxoplasma with cognitive performance when we looked on its own.",English
+"But when we included it in a sum of positive tests, we saw this association. It's an interesting point because everything",English
+"else was a herpes virus that we included in that model. We should look and potentially, we can come up with some other protozoans to examine separately,",English
+but we didn't see a bivariate association. What wasn't even bivariate? Most bivariate are just association with toxoplasma per se.,English
+"It was cytomegalovirus that on its own was associated with lower performance. Melissa Lodoen: I'll just add, sorry, I can't seem to unmute my video.",English
+"This is Melissa Lodoen. Really lovely talk that you gave today, Adam. The work map that you're thinking about has largely been done on mouse models of Alzheimer's disease with toxoplasma infection being protective.",English
+I'll talk a bit more about that in my presentation tomorrow. Adam Spira: Terrific. Melissa Lodoen: Thanks. Mack Mackiewicz: Thank you.,English
+"Eliezer Masliah: Mack, if I may ask a question, just was wondering a little bit about the specificity issue, especially with the amyloid antimicrobial effects.",English
+"Rudy or somebody else could comment. I'm sure you guys have tried five rows of other amyloid, like seeing nuclei in Tau, etc.",English
+"We also know that in Parkinson's disease, there has been the idea that there might be a bacteria, maybe an enteroviral hypotheses.",English
+"Is there any specificity of these amyloids with different types of pathogens or is it fairly non-specific, the effects? Rudolph Tanzi: There's a little bit of specific like amylin.",English
+"We have a paper where submitting now, and amylin is also a pretty potent antimicrobial peptide. It's much more potent against E. faecalis,",English
+which goes up into pancreas where amylin is more or so than A-Beta. There have been others who published some antimicrobial peptide properties for alpha-synuclein for prion as well.,English
+I just learned today about my vitex ApoE has peptides that I didn't know about ApoE3 peptide so that acted as antimicrobial peptides. I think they're pretty promiscuous.,English
+"A-Beta's pretty promiscuous, but you do see a rank order of potency. At least, we see differences for amyloid versus A-Beta versus LL-37. Eliezer Masliah: It has to be in a similar form to the antimicrobial?",English
+"Rudolph Tanzi: No, oligomeric. It starts as a monomer and it binds to that carbohydrate proteoglycan, and then the A-Beta is then starts to oligomerize and then from a protofibril,",English
+"and then fibrilize around the microbe to entrap it. The fibers themselves, Will can correct me. I think the fibers themselves,",English
+"once they're formed separate of a microbe are not useful. You have to actually form a fibril around the microbial traffic. Is that correct, Will?",English
+"William Eimer: Yes. Once you get to the protofibril fibril stage, it's not nearly or it's not effective at all at trapping the microbe. Those are the walls that are built around it after you've had",English
+"the oligomer bind to the glycoprotein. Rudolph Tanzi: Somebody mentioned in the chat about copper. Just before Rob passed away, Rob Moyer,",English
+"he was putting together data showing that from copper interacts with oligomers around microbes that generates free radicals. All of the data republished were actually bush long ago,",English
+and those free radicals punch holes in the microbe to kill it. Copper and iron is reactive metals can interact with A-Beta to help them to killing process after it's trapped.,English
+William Eimer: Thank you. Mack Mackiewicz: Any other question in chat room or from our presenters?,English
+Jean Tiong-Koehler: Yeah. There's actually a question for Dr. Salinas. This is with regards to differential gene expression between males and females. Could you please comment on that.,English
+"Is sex-linked in the genes related? Thank you. Irene Salinas: Yeah. What I show on my presentation remember, is one month later,",English
+and that analysis was done within non-antibiotic treatment. You guys saw that there were a lot more genes differentially expressed in female versus male.,English
+"That match a lot with our either data. Females had a lot more antibody titers. If you look at notes in terms of,",English
+"is there a difference in the invasion, we don't see more CDL line mating females versus males. The invasion or the bacteria loads are similar.",English
+"It seems that females we respond better, we mount better titers, there were more responses in the brain.",English
+"But because we analyze a month after the infection, we didn't really see a lot of immune genes. At that time point, everything already toned down in terms of inflammation by then.",English
+"Mostly everything that we picked up was neuron all related, so there was nothing like microglia related. There were a lot of G protein-coupled receptors,",English
+"a lot of sensory related genes, and then the CDK pipe pathway that really jumped up. But then they were also a lot of AV related genes in there.",English
+"But there was nothing there that will be like, ""Oh, this is an anti-microbial response, but perhaps because it is not the super high dose."" Another thing that I want to say is that the other paper that has been published,",English
+"the only other paper on a CDL infection in mice, they use 10^4 more that we did use. We chose a much lower of those because like I told you,",English
+"in theory, you only need 10 to 100 colony forming units to get disease. The other paper was using 10^10 per halves, and we were using 10^5, 10^6.",English
+"Our's probably should be a lot more similar to what is found in nature rather than the really high doses. But anyway, in terms of the gene expression,",English
+I think doing it with the antibiotic plasma CGL will be really interesting and perhaps checking earlier time points. Just in case we missed a lot of the immune genes is probably a good idea as well.,English
+Jean Tiong-Koehler: There's one more general question. This is in relation to viral replication kinetics. Did anybody look into,English
+the kinetics in relation to any of the models that are any studies you guys have done? Ilia Baskakov: I can tell what we done.,English
+"We didn't look very precisely at kinetics of viral replication in the the brain, but we found that all animals that infected this HSV1 regardless of the root.",English
+"If they go through acute viral infection and die, we can detect virus very well. If they survive infection and if they manage to survive,",English
+"then it's very difficult to detect the virus. It's pretty much neutralized, and we think it's neutralized by effective microglia,",English
+either directly or through phagocytosis of infected neurons. Mack Mackiewicz: This is Mack again.,English
+"I would like to return to a conversation or discussion between Dr. Jacobson and Dr. Tanzi and Readhead. I believe Dr. Tanzi introduced something that I wrote in my little notebook,",English
+"historical evidence of infectious diseases in AD. Again, let me introduce suggest to let's say after",English
+"the storage of samples, or any collection of brain tissue",English
+"and do what Dr. Jacobson suggested let's say do PCR on them, or do antibodies,",English
+or can you just a little bit comment on the historical evidence. Rudolph Tanzi: If we believe that physiological levels of A-Beta,English
+with physiological levels of herpes virus activation in the brain. That this induces amyloid deposition the way we've,English
+"shown in modal systems where we have high amounts of A-Beta, we have high amounts of virus. The onus is upon us to show this knock-in mice where it just has wild-type APP,",English
+they can get Beta at normal levels. Let's say that turns out that amyloid is trapping microbes to way extracellular traps of any antimicrobial peptide would.,English
+"We'd expect to see remnants of those microbes in the plaque. Now Ruth Itzhaki had shown by in-situ hybridization, there was herpes RNA around the plaque.",English
+"Right now with Brad Hymen enrolled doing this, release of capturing plaques from parenchyma of post-mortem AD brain. Then the plaque is then basically broken open,",English
+then we're doing PCR metagenomic sequencing to look for evidence of microbial RNA or DNA inside the plaque. I think that's one thing we have to do in the brain.,English
+"For immune records, we can look at T-cell receptors, memory B-cells. Just have to be more inventive, but I think getting the hold of",English
+younger blood if we have it from folks who were attract longitudinally to see which ones went on to have dementia and then asking if there was viral infection there early on.,English
+"That would be also powerful. We can look at the Spanish flu, the high incidence of Parkinson's and Alzheimer's in the generations that came after the Spanish flu.",English
+These are the types of studies we have to be more inventive and innovative about and more serious about to get to these historical evidence for viruses and microbes,English
+"starting off the disease process decades before symptoms, and not necessarily thinking that we can see these microbes postmortem in a person who just died of Alzheimer's disease.",English
+"Steven Jacobson: I don't know, could you guys hear me? Jean Tiong-Koehler: Yes. Steven Jacobson: Can anyone hear me? Rudolph Tanzi: Yeah, we can hear you.",English
+"Steven Jacobson: Like Rudy did, we also did a laser capture micro dissection in MS brakes. That's originally how we started.",English
+"I'm in my car, so it's getting weird. But we also are doing single-cell RNA seek from both lie material. We actually doing an in blood CSF and you could even do it from fresh brains as well,",English
+"to look for TCR receptors, BCR receptors, and whole transcriptomics. Yeah, Mack, there's lots of ways to do it on brain material,",English
+"but getting fresh brain there are challenges, I think, obviously. Jean Tiong-Koehler: I see Dr. Itzhaki's hand is up,",English
+"and Dr. Noble, and Dr. Spira. Maybe we'll start with Dr. Noble because he started his hand first. James Noble: Thank you. I'm talking to more about",English
+periodontal disease and I just wanted to underscore its epidemiology. It starts very young. There's evidence of IgA for various periodontal organisms less than H5.,English
+"It becomes quite common with a very high frequency in the general population. Over 75 percent among seniors in the population, and in the 20s and 30s even in young healthy adults.",English
+"The other fascinating part I find about it is that transient bacteremia is very common in periodontally healthy and ill individuals, such that somewhere between 10 and 25 percent of people have",English
+"transient bacteremia after just brushing their teeth or routine dental care, and it gets higher with teeth extractions. The challenge that's really going to become as",English
+an archive of plasma actually that helpful if these events are relatively transient. What is the really gold standard exposure variable we're,English
+"looking at when we're looking at something that's an episodic but chronic infection, but maybe only transiently detectable. It's a fascinating challenge that we have and it's worth pursuing nonetheless.",English
+"Rudolph Tanzi: That's a good point. It's a great point. Jean Tiong-Koehler: Dr. Spira? Adam Spira: Hi, someone mentioned in the chat that they were curious about sharing of specimens and so on.",English
+"I just wanted to encourage people, we're following up the cohort of people who have been followed since 1981. They're now older adults.",English
+"We have blood samples from 2004, we're in the field now collecting blood samples and we fortunately received a recent grant to go back",English
+in the field to collect blood samples again. This is a community-based cohort. It started out as population-based.,English
+"I doubt that it's representative of East Baltimore anymore, but it was 35 years ago. Please be in touch if you have thoughts about",English
+"studies that could be done prospectively in this cohort. Some of it will likely overlap with what we're planning to do, but we can discuss that.",English
+"Just wanted to put that out there. Jean Tiong-Koehler: Thank you. Dr. Itzhaki. Dr. Itzhaki, it's your turn.",English
+"You're muted, you can unmute yourself please. Ruth Itzhaki: Can you hear me? Adam Spira: Yes. Ruth Itzhaki: It's just a minor technical point.",English
+"Rudy mentioned our work looking for whether or not viral DNA was present in flogs. We did it by in situ PCR, which is a very much more sensitive methods than in",English
+"situ hybridization which was never used. Rudolph Tanzi: Sorry. Ruth Itzhaki: No, it's okay. I just also mentioned it really is very sensitive indeed.",English
+"What we found, of course, was that far more blocks with viral DNA in them in Alzheimer's disease brain than in elderly normal brain. That's really all I want you to just say. Thank you.",English
+"Mack Mackiewicz: Dr. Itzhaki, this is Mack Mackiewicz, since we have you, we had a conversation at some point about clinical trial, and I felt that you were strong proponent",English
+"of placebo-controlled clinical trial to resolve some of the issue, and obviously, Dr. Jacobson was, perhaps,",English
+"Yes, it would be expensive? Yes, would require a lot of people, but would that such a trial resolve some of our existential issues? Ruth Itzhaki: I'm sure it would, yes.",English
+"I'd be very keen to have a trial rather like the present one going on by Devanand. Since using not just valacyclovir,",English
+"but also fucoidan because there they work in a completely different way from its active here. These block viral entry into cells,",English
+"and I think the combination of the two will be very very effective. We tried it in cell culture on infected cells, and they do have a synergistic effect.",English
+"I think that will be the main thing. I think, in agreement with somebody who said that one should select people who are HSV-1 seropositive and who also carrying APOE4 allele.",English
+"I'd be extremely keen on saying this. I'm sure it was sought out of a lot of questions. Steven Jacobson: But Mack, can I make a suggestion, though?",English
+"It's not a trial design to me. It's not that if it works. The question is, what would you do with it doesn't work?",English
+"Would you throw out the hypothesis? I would say, that's not what you'd want to do. If he did a big trial and it didn't work, would you say that the pathogen hypothesis is wrong?",English
+"I don't think that's correct. If it works, of course, everyone's happy. Mack Mackiewicz: Now, you have. Steven Jacobson: If you did an antiviral, and they get better,",English
+"they don't get worse, they don't go on to dementia or Alzheimer's, sure you found it. But if you don't, that's the issue we're running into a mess. Where how would you do the trial design?",English
+"Where either hypothesis, the null hypothesis really does work, we'll say, yes, you're actually found something or you actually didn't found something.",English
+It's not finding something that is really the issue for money. Ruth Itzhaki: Is very important then because I don't know what to say then.,English
+"Steven Jacobson: Yeah, exactly. Fred Volinsky: May I say something, Steve. Steven Jacobson: Yes. Fred Volinsky: You could use that argument.",English
+"This is Fred Volinsky, and I wrote an article, I was co-authored, and Pascal Goldschmidt read it, where collaborating with Hugo,",English
+"and also Margaret Pericak-Vance as a coauthor of this paper, review of herpes host genetics as AD. Everybody else's discuss things,",English
+"has much more detailed information about the basic science of AD. No one knows more than Dr. Tanzi on this topic, and that's not my comment.",English
+"But my comment is more as an ex-ER doc, and just logical making decisions when you have to include information. The first thing I want to say,",English
+so the surgeon requirement was at least eight  open rpl these in one year or 24 and three years   uh the surgeon template uh we said at least a  modified template uh but really it was uh up,English
+to the surgeon uh in terms of uh choosing the  template uh intraoperative photographs that   had to be taken just like the suag s1011 trial  just to make sure we have some quality control,English
+uh for the for the surgeries and all  were done to be uh to be done open   the reason being you don't want to add another  variable uh this is such a tight uh uh statistical,English
+um trial that you know one one or two recurrences  on one side will shift it so you want to minimize   all the uh variables around the trial it opened in  various sites uh around the country as you can see,English
+here but there were several that were high volume  um uh accruers like you can see here obviously us   and in indiana university uh but many contributed  to the trial and you can see the accrual that,English
+accrued uh quite well and closed about uh uh  eight months uh earlier than uh anticipated   uh which as josh can tell you from running  clinical trials um is is a as a major um uh,English
+uh success for for a trial so it was it was great  i mean we're all urologists we like to do surgery   so it's good to have a clinical trial it involves  surgery uh here's a basic uh characteristics of,English
+the patient importantly um uh 25 had stage  one who then had a recurrence and then uh 75   of them were stage two a or b at presentation and  median follow-up was 24 months but obviously we,English
+have patients who are far out from that uh for the  for the manuscript i will have minimum follow-up   at 24 months for all patients so um nothing's  changed so uh at usc and i'll get into this a,English
+little bit later the patients are undergoing a  midline extra peritoneal rpl indeed the hospital   stay is is one day uh at usc um and this is  the typical scar now they don't all look like,English
+this but this is uh you know obviously nerve  sparing uh technique but but i'll show you the   um uh technique a little bit uh later as we talk  about the surgical techniques but the overall,English
+recurrence rate was uh 20 with a median time to  recurrence of eight months so these are happening   early uh in the uh during the uh follow-up and  the two-year recurrence-free survival was uh 84,English
+and here's the uh breakdown of the secondary  treatment so nine patients uh uh had chemotherapy   uh seven of them were bep times three one was ep  times four one patient got carbohytomycid and two,English
+patients had repeat rpl indies um one of them was  what my patient um who after three years three and   a half years actually had a recurrence uh that was  in field i was very slow indolent and i thought uh,English
+well this guy really wants to avoid chemotherapy  we went in and re-resected him uh um again so one   patient received adjuvant carbo but but then we  made a strong push uh uh during follow-up for,English
+patients not to have uh uh any adjuvant treatment  because the whole point of of this is to uh uh   have surgery as your only curative modality so  here are the complications there were there were,English
+five uh short-term complications um uh i'm sorry  seven short-term complications five of them were   clavian dindo one two two and you can see these  were really minor complications one of them,English
+had an ileus requiring ng tube uh one was listed  as emesis or pain and two were craving three one   patient developed kyla societies and one patient  developed uh pulmonary embolism uh so you can see,English
+in you know in a surgical trial it's not all uh  uh uh walk in the park uh always there's there's   gonna be surgical complications but fortunately  the long-term complications uh were none meaning,English
+uh that uh fortunately integrated ejaculation  and all the patients who underwent nerve sparing   techniques had antigrade ejaculations with no  hernias no gi symptoms or anything else seen thus,English
+far so short term so far so good and certainly  long-term uh it's it's not not too bad um   so in conclusion you know we think that the  sems trial actually establishes rpl india as,English
+a treatment alternative uh for these patients  with isolated retroperitoneal lymphadenopathy   up to what three centimeters uh two-year median  follow-up as a systemic treatment free survival,English
+of 85 percent overall survival obviously 100  so it is an attractive option it's hard to do a   phase three trial if you think you know it is the  next step of phase three you can't really compare,English
+this modality with radiation or chemotherapy you'd  have to wait decades to see the difference in   complication rates obviously chemo would outdo the  surgery in terms of recurrence-free uh survival,English
+there is a sort of a brother trial or  sister trial to to the sams uh my good   colleague in germany peter albers is running  a trial called prime test very very similar,English
+he is looking you can see the differences  there basically looking at uh quality of life   complication rates um and things like that he is  still accruing to his trial um he recently just uh,English
+expanded it to multiple centers in  germany so hopefully in the future   um we will uh combine our our results and there's  a third trial in in london uh dave nicholl in   london is running but but that those patients  are all getting adjuvant treatment which which uh,English
+obviously we didn't want to do we want  to so so patients are getting rpl and d   then getting adjuvant carboplatin  which really defeats the purpose of   these patients not getting systemic therapy  so um i'm going to move on to management of,English
+post chemotherapy test as cancer i do want to save  some time at the end for a question and answer and   discussion so uh if i move uh too quickly uh let  me let me know um i i find uh surgical history,English
+fascinating and i think it's really interesting  that in the early 1900s they thought about doing   this i mean look at this picture first of all it's  very low quality but in 1906 here's a picture of   the testicle being taken out the cord and then  leading to whatever lymph nodes were there at the,English
+time no ct scans uh you know they were probably  doing some lymphangiograms or something like this   um to to see these uh nodes really fascinating uh  here's another uh uh depiction of this uh incision,English
+that's that's pretty wild but it was probably  extra peritoneal right given the laterality   of this and i gave pretty good exposure to the  retroperitoneum and all the areas of interest,English
+probably fairly morbid so we'll we'll get into  other incisions in in in a little bit uh but   basically one third of the patients at least one  third who undergo chemotherapy for metastatic,English
+germ cell tumors have some form of residual  retropregnal disease so the current indication   for uh post schema or plnd would be um we'll  go through this for non-seminomas and seminomas,English
+uh talk a little bit about imaging adjuvant  procedures uh and then the the newer approaches   to to treatment so you know this is a rare disease  and i'm i'm giving you fractions of fractions so,English
+so basically uh you the no the volume of disease  seen at any one center is not going to be quite   limited right so there's plenty of evidence that  supporting experience is an important component of,English
+improved outcomes in germ cell tumors um and and  you can see this uh here and you can see a famous   uh uh author here who documented the number of  rpl indies uh done by uh um uh uh practicing uh,English
+urologists around the country and and josh i don't  know if anyone's updated this but i don't think   it looks any different today than it did back  then when you when you published this but really,English
+interesting you see that the number of urologists  performing one rpl nd sharply drops if you do two   and basically there are a handful of surgeons in  the country doing more than you know ten a year uh,English
+and and i learned this when i was trying to do  the vetting of the surgeons for the sentence   trial and people said oh yeah i do 30 of these  a year and then you know we would ask for their   app reports and and their pass reports and and  it quickly whittles down to well it's actually,English
+you know six last year so um these are tough  cases these are uh long cases and we tend to   when we do one we think we've done four of them  so um but you can see the mean median number of,English
+rpl indies done around the country is one and the  very few uh do more than that so uh surgery uh the   histology really hasn't changed a lot over the  past few decades uh 40 to 45 post chemotherapy,English
+have teratoma uh same number or distribution uh  have uh fibrosis in the retroperitoneum and uh   10 to 15 percent have uh residual uh germ cell  tumor it's still not really possible to predict,English
+retroperitoneal histology based on imaging uh and  there have been a number of studies trying to to   establish some form of imaging or or radiomics  or other to to try to determine because that's,English
+really what we want to know uh right if  we can predict this ahead of time then   it would help us um so the real issue is we  can't really differentiate necrosis fibrosis from,English
+teratoma or even viable cancer following induction  chemotherapy this is really a microscopic   diagnosis what about pet scans it's my pet's peeve  that so many pet scans are done in testosterone,English
+it's absolutely worthless except for one setting  the false negative rates are 40 in nonsense all   serotonins are negative and it's really really  not helpful there are significant limitations in,English
+detecting very small microscopic disease so you  know it's it's basically extra radiation without   any um additional information and seminomas uh  it does help sometimes determine the viability of,English
+residual masses greater than three centimeters but  again we have this issue of a lot of inflammatory   uh cells uh uh that are in their retropregnal  uh masses what we use pet for in seminomas is,English
+the negative predictive value of 95 so if it's  negative it helps us but when it's positive   the positive predictive value unfortunately is  somewhere in the 50 to 69 percent so what are,English
+the current indications for post chemo rpl and e  any patient who has a residual mass greater than   one centimeter on ct following adequate primary  chemotherapy with normal serum tumor markers uh,English
+we don't do dissections on patients  with sub-centimeter masses there is some   controversy mostly for memorial where everybody  gets a post-chemorpmd but most most of us around   the world believe that those patients are are  cured uh without with the chemotherapy alone,English
+um if you undergo salvage chemotherapy almost  certainly uh most of the time you you need   uh postkey marker indeed the rates of viable  disease and those residuals are much much higher,English
+and chemo resistant disease if you have a growing  mass on chemotherapy and i'll show you a few cases   at the end with normal tumor markers resectable  masses with elevated markers that have you know,English
+had adequate chemotherapy and late recurrence  and late recurrences is is uh um defined as   any recurrence that happens two years uh uh after  diagnosis of tesla's cancer they tend to be chemo,English
+resistant uh particularly if they've been treated  with um uh uh rplnd or chemotherapy to begin with   so most of the and again you'll there's an  abstract being presented at uh asco um where,English
+uh the indiana university experience is being  updated on late recurrence and again you can see   the same theme the surgery should be the mainstay  of treatment for those patients some special,English
+situations um sometimes you have post chemotherapy  you have a patient who has elevated markers but   they're plateaued markers and that happens  when you have a sort of a cystic mass that's,English
+a teratoma that's harboring some elevated markers  within it that leaks slowly into the bloodstream   so if you have low but stable markers in  this situation we recommend the postgame rpl,English
+you don't have to wait for that to completely  normalize and you have to follow it you know   we don't make decisions based on one  marker but rather follow the patient   uh and and do several markers to kind of see  the pattern you certainly don't want to do,English
+surgery on anyone who has rising uh markers and  also patients who have a very high hcg levels   to begin with prior to initiation of chemotherapy  often fail to normalize their markers at the end,English
+of chemotherapy so don't be looking for that you  know perfect undetectable uh uh uh tumor marker   before doing a post chemorpmnd that the trend and  the plateau uh at low levels is what's important,English
+now we talked about management of patients who  have have had a complete response these patients   do really quite well this is one report when i  was at ohsu with 276 patients combined with the,English
+experience at university of british columbia there  were 161 patients who had a complete response or   partial response with less than one centimeter  lymph node most of these patients were good,English
+risk as as expected they would have the good good  response uh complete response was 115 the partial   response now 46 but 100 percent disease specific  survival for the patients who were managed with um,English
+surveillance uh only and  did not undergo a dissection   there was a accompanying article in that issue  of jco from indiana university and basically they,English
+have very very similar outcomes uh here you can  see uh the the world literature on on this topic   uh the the bigger series you can see the number of  patients the princess margaret hospital experience,English
+was was presented but actually never published  as far as i know but here you see the recurrence   free survival the cancer-specific survival and the  handful of patients who died of disease now many,English
+the the indiana patients uh two of them uh rapidly  recurred after chemotherapy so the thought was   that they would not have been cured with a post  chemorplnd anyway this isn't juxtaposition to the,English
+memorial data um that that shows that up to a 25  uh teratoma uh finding at a time of positive rpmd   in patients with sub centimeter masses but  you know indiana has a 15-year follow-up on,English
+these patients and they're doing quite well  so this notion of this late recurrence or   residual teratoma uh that um uh may at some point  uh show up we're just not seeing that we're not,English
+seeing the 25 relapse rates uh with long-term  follow-up in these patients so again i think   those patients uh often even don't make it to us  because they see the oncologist the ct scans clean,English
+and and they don't even get sent to us except  for some centers what about um adjuvant therapy   in patients who have viable carcinoma so you do  your postmark lnd and you find you know a little,English
+bit of residual viable germ cell tumor should you  give the patient adjuvant additional chemotherapy   um so like i said we find it in about 12 percent  of post chemorp lnd specimens but but following,English
+salvage chemotherapy increases to up to 50 percent  so so patients with good prognosis with complete   heat resection and have less than 10 percent  of viable tumor they have pretty good favorable,English
+outcome without any further adjuvant chemotherapy  that's what the surgery is for to remove any   residual microscopic disease now if you have a  lot of viable disease then that patient really,English
+probably needs a salvage therapy rather than the  two cycles of adjuvant further you know bep those   patients recur very rapidly and move on to other  treatments so again it's safe to watch patients,English
+who have very little residual volume of viable  disease following post chemotherapy and this is   uh supported by by data from indiana university uh  as well um a little bit about nerve sparing um i,English
+think this is something that you need to learn if  you're going to go into this business and you need   to learn it really well these nerves are tiny  they're anatomically uh very very distinct in,English
+in their location and and course um obviously  preservation of fertility is a major concern   for this patient population um and it you know the  extra effort in the operating room is really worth,English
+the the outcome um the this is a non-nurse bearing  operation uh this the patient had a huge mass uh a   this would be a template type that um dissection  uh sparing the nerves on that side but,English
+you you know one of the things that joel  scheinfeld says is you know is it a nerve   sparing or a nerve avoiding operation um if  you completely clean out a patient like this   and just preserve the left-sided postganglionic  nerves you may or may not preserve that one single,English
+l3o4 postganglionic on the left but really what  you should be doing is a prospective nerve sparing   approach where you identify and actually  spare the nerves on both sides if you can,English
+so that you have some insurance this would be  a left-sided template this is sort of a left   extended template at iu they sort of stop at the  middle of the aorta and some some folks don't do,English
+an interior cable no dissection when the disease  is only on the left side we have always tended to   do the interior cable and some retro cable as well  i don't think it takes that much more effort to do,English
+uh once you once you clean out uh this site this  would be a full bilateral template uh and taking   the ima sort of your your classic uh post chemo  rpl nd but this is a nerf sparing approach this,English
+is sparing a single l3 l4 fiber going down into  the hypogastric plexus this is really all you need   um to preserve your your function it's amazing  uh that the one single nerve can can do that,English
+now um many patients require adjuvant surgery  what we mean adjuvant is is you know additional   surgical procedures and this was just uh uh uh our  experience uh a number of years ago with 85 post,English
+american ads with 30 of patients requiring  adjuvant procedures and this is very similar   in the literature with with other series most of  these are vascular renal vein uh but aorta and,English
+cabin in several cases as you know nephrectomies  are interesting because most of them are on the   left side and it makes perfect sense doesn't it  um the patients who have left-sided tumors the,English
+lymphatics and the masses follow the  left gonadal vein and so the tumors tend   to be wrapped around the renal vessels  making it very difficult to to dissect   and you can see other sort of adjuvant procedures  that are needed on occasion we need we do a neck,English
+dissection um i do those in conjunction with the  post chemor plenty if needed with the neck surgeon   so we do it concurrently at the same time  with two separate scrubs uh their part is,English
+is really quite easy compared to what we do so  in order in order to minimize the patient's um   uh sort of time under anesthesia and things like  that is done concurrently and it's it's worked out,English
+really well i've got a nice picture of how the two  teams are are you know positioned to so that we're   not in each other's way uh but typically their  their part takes less than two hours while we're,English
+working uh the left renal vein uh is interesting  you can resect the left renal vein and have it   drain through its various um uh tributaries  but generally if that's what's happening,English
+the tumors wrapped around the renal vessels um  and and you can't really dissect just the renal   vein it's it's it's unusual but it can be and in  some cases i have just resected the renal vein,English
+and have it drain through its various  tributaries and at least give the kidney a chance   i don't graft the left renal vein i've never done  it um i think most of the time it's either the   whole kidney is going or or um you can just tie  off the vein and have it drain through its various,English
+tributaries vena cava can be involved in in a  number of cases and this needs to be recognized   this is a patient who underwent four cycles of bep  and it has obviously a cystic teratoma but if you,English
+look carefully the cava is actually on the left  side and it it contains something intraluminally   and again if you look very carefully it's the  teratoma that's actually entering the vena cava,English
+that happens to be on the left so the radiologist  read this as a left-sided mass with a clot in the   cava that is being pushed over to the left well  that's not true this is an actual left-sided cava,English
+and unfortunately the patient was undergoing uh  uh warfarin therapy for three months before he   came and saw me and they were wondering why this  mask keeps growing so so the the patient so this,English
+is a 20 centimeter mass but what it is is really  an ibc tumor thrombus uh within uh the uh uh   cava that's a that's a that's a tumor thrombus so  the patient's taken to the uh operating room and,English
+and you can see the left side of cable there and  there's a tumor within the cable you get control   and and you can see where the tumor actually  entered uh through the left common uh sorry   the right common iliac vein and here is uh we're  pulling out the uh the teratoma and all left side,English
+cave caves eventually go to the right but there's  the branch where the tumor actually entered   uh the cava so these patients do extremely well  it's it's a teratoma and and uh uh obviously,English
+it was completely resected the patient remained  disease free without any uh further uh treatment   so uh here's an another case this is a  non-seminoma this this looks really quite,English
+nasty it's a it's a big big tumor the patient's  had four cycles of bep uh there's again another   teratoma within the vena cava uh the kidneys being  pushed to aorta and the cava are almost nowhere,English
+to be found as this thing is completely elevated  uh but this was deemed unresectable and i always   say before you deem something unresectable you  really should have another expert surgeon sort,English
+of take a look at this and see whether this is  doable because some of these are it's a tough   case no question but is it unresectable i don't  really see it going into the you know uh spinal,English
+foramini that the bone is not this this is all  teratoma it's a tough case no question um but look   this these kids are um you know in their 20s and  they deserve you know the very best uh chance at,English
+survival so um we barely got the cave out after  hours of dissection and the proximal aorta and   this is one of those cases where everything has  to go down to the spine the aorta gave a kidney,English
+and then you know graft graft the aorta but this  as suspected was all teratoma markers were very   low but not not completely normal and this is a  teratoma within the within the cava again so these,English
+things can enter the vena cava and go up and i've  actually seen one uh in the heart as well uh so so   years ago i started scoping the cava looking for  these things when when there was suspicion and you,English
+can see here here's being a caboscopy and we're  seeing a tumor within the lumen of the of the   uh cava helps us decide uh whether or not to take  uh take the cava obviously you have proximal and,English
+distal control and this is really quite easy to  do this is a tumor adherent to the to the uh cable   wall and uh and you can see me sort of pushing up  to orient myself this you know anterior posterior,English
+and you can either partially resect this but  but honestly you'll end up with a very small   lumen and grafts and things like that so  so we generally just do a cable resection   in these series that's that's very very well um  tolerated and they're tolerated because of this,English
+um we published this in uh ju a number of years  ago uh showing the venus uh system uh mainly uh   being drained through the aziz and the hemiazigous  uh back to the heart and patients tolerate,English
+cavectomy uh extremely well particularly because  the reasons you're doing of cave ectomy to begin   with have to do with obstruction and these  collaterals forming from the beginning so,English
+uh i don't graft uh cabas i never have um and  again patients do extremely well there is swelling   uh for sure that happens uh in the in the  beginning uh but it almost always goes away and,English
+there's of course no risk of uh pulmonary embolism  uh aorta's on occasion and iliacs need to be   grafted at times uh of course we ask the vascular  surgeons for to come in to help with these,English
+uh but the cable work and things  like that we generally manage uh   on our own um on occasion you know we get these  very thin ureters and uh you know you could either   wrap some momentum around it and hope for the  best or uh you know i was very uncomfortable,English
+with the blood supply you can get strictures and  and so the appendix was nearby we thought maybe   we should bring it over and uh do that i guess i  guess you know buccal mucosal graft or something,English
+like that might be useful but i think this was  completely stripped and i didn't want to use a   complete uh ileal ureter so um getting to sort of  the the back to that extraperitoneal technique uh,English
+this is something um that i started working on  about uh ten years ago we used to do these huge   thorough abdominal incisions that were actually  extrapolated but obviously extremely morbid uh,English
+back in training and i thought well why do we need  the thoric abdominal incision i started making it   smaller and smaller and finally doing the opposite  of what we used to do from a thorough abdominal   approach approaching it from the chest down i  thought well why don't we start at the bottom,English
+up just like you do in transplant for instance  um and keep developing the pericle envelope   and i think most of us are very very comfortable  with with uh the anatomy of the peritoneum gerotos,English
+fascia duodenum liver and so on and so forth  so um initially i was making these larger   incisions to get and the exposure is identical  there's no way you can walk into the or and,English
+know whether i'm intrapaired near extra bird and  eventually these are these are uh these kind of   exposures so um uh this is a so so the exposure  is based on the side of the disease if you have,English
+right-sided disease i approach it from the right  if you have left-sided disease from the left   and not both you only do one approach um  so people ask me oh do you do one side and   then you get extra neutral exposure on the other  side no no this is this is the kind of exposure,English
+you get from the right side and you can see um  there's the inner ear cable we spare the l3 l4   nerve you get excellent exposure to even the  para aortic areas it's all about these sequential,English
+sort of placement of of um the retractors  and doing some dissection there's the crews   of the diaphragm and there's this sort of a super  hilar dissection and and you can do a retro cruel,English
+dissection there as well um so you can you can  get pretty high and and the incision doesn't   have to be huge for you to do that of course  this is now a left-sided exposure again you,English
+can see that we can easily get retro cable the  left is more difficult because the duodenum and   the valves don't quite you know get all the way  over but you don't need to get all the way over,English
+and see the right renal vein all you need to do is  get this exposure basically that you're seeing uh   uh right here and and you know at the end this is  the most satisfying where you put the peritoneum,English
+back um and and don't you wish surgery was like  that you could just just peel this back and   and end up in the retroperitoneum and do your work  but again this is sort of a picture where you know,English
+at a case where easily we're getting all the way  over to the para aortic area from the right side   and then the peritoneal envelope goes back it's  amazing the the pain discomfort nausea all that,English
+stuff is so much related to to what you do with  the bowels intra-operatively so i almost feel bad   when i'm in tropical these days and i did enough  for yuri directed me yesterday on a horseshoe,English
+kidney and we did that extra bird nearly midline  and it's amazing how different the patients look   the next day so this was just our updated series  published a few years ago we do all of the rpl,English
+ds except for the absolutely massive ones  uh ep now uh the all the residents are we   call them epr plnds and you can see that most of  these were post chem rpl nds they were not small,English
+antigrade ejaculation and 30 of 31 post dmr plnds  retrograde in in one and the tumor masses are   here you can see that we had 19 cases with tumor  masses greater than 10 centimeters uh and a return,English
+of bowel function one to two days length of state  three to four median of three but like i said uh   over the past three to four years we've actually  realized you know we can feed them that night,English
+they have clear liquids regular food the next day  and and if they're comfortable they go home that   next day here's a good picture of sort of the  peritoneal envelope being developed you can see   the bowels through the peritoneum here and this  is the liver basically back here so this is what,English
+i mean by the sequential sort of trade this is a  large mass in the retroperitoneum we've peeled the   the the peritoneal envelope over the  mass and pulled it over to the other side   and then sequentially you you keep the the the  liver and the colon are basically being retracted,English
+upwards while the duodenum and the rest of the  bowels are being retracted laterally so we're not   completely mobilizing the liver off the diaphragm  or things like that it's all intraperitoneal we,English
+just need a retractor up there and then to deliver  the kidney out of that mask to be able to get your   exposure it's uh we do have some videos but  it's really difficult to capture these um in,English
+open surgery but there is a video in european  urology but this is what that patient looked   like afterwards the pathology was 18 centimeter  mature teratoma he went home uh in in two days,English
+um so postgamer plenty here's another growing  teratoma syndrome uh with a nerve sparing approach   uh done extra permeability that's what he looked  like afterwards for a 15 centimeter mass length,English
+of stay was one day for this uh for this large  mass um so nowadays again the hospital stays most   likely most of them are our next day discharges  if you're wondering what these are if you haven't,English
+seen them these are on cue catheters um these  are sub fascial uh catheters uh placed between   the posterior rectus sheath and the rectus muscle  and they infuse rhopivocane uh continually and,English
+just recently over the past one and a half years  or so i've started sending patients home with it   um because i learned that the orthopedic surgeons  sent patients home with these on-cue catheters and,English
+thought well why not um this is just infusing  it's in a pump and and they can take not take   them out themselves so it's been very uh useful to  decrease the opioids and and medications at home,English
+a few more um uh instant uh uh topics here one's  extra retroperitoneal disease i get asked this   question a lot about how when and how would you  manage this as a patient who underwent a cavectomy,English
+has significant retro cruel disease that's just  continuous with the um with the retroperineal   stuff but required a cavectomy and i promise we  don't we don't we keep a good number of canvas,English
+but this patient we we you can approach most  of this uh trans abdominally all the way up   into the posterior mediastinum and then come  back and do do the rest through the chest um,English
+sometimes you get this picture where it looks  unresectable again because it looks like it's just   invading the mesentery but what this is is these  are cystic teratomas and they can actually be,English
+dissected out uh here's a mesenteric lymph node  dissection that we did shelling out all of these   uh little teratomas um out of the mesentery now  this is a view that you don't often see which is,English
+the the superior mesenteric vein and the branches  of the sma but just like you you know we're all   used to working around vessels we know the bowel  very well so there's nothing really special to,English
+this just don't damage these vessels they supply  a major portion of the small bowel but this can be   done and the patient could be cured from this as  well well in the same token periportal lymph nodes,English
+are sometimes involved for for various reasons but  you can do a periportal lymph node dissection as   well if you're comfortable with the anatomy here  um but you know again you need to know where the,English
+portal triad is and you can pull this down and do  a completed completed lymph node dissection around   these things and these are usually teratomas look  if they're viable disease we're not going there,English
+the patient needs additional chemotherapy this is  if i see a cystic mass along with a lot of other   cystic masses in the retroperidium i think these  can be done all at the same same time going back,English
+to the retrocrural lymph node dissection i try to  do as much as i can transabdominally and not have   to go through the chest or do these i used to do  them through a thoracic abdominal incision and get,English
+to the posterior chest but but nowadays i try to  really split the crews and and try to grab them um   it's amazing how far you can get uh just from  the abdomen and we presented this as an abstract,English
+a few years ago but here's a retro cruel uh mass  on the left on the uh this is on the right side   we've split the cruise and you can see uh it's  like a little egg that is uh uh sort of crowning,English
+here and these things shell out quite well you  can literally put your finger there there's no   major vessels there uh and and you can pull these  out uh uh and not if you don't burst them you can,English
+you can take them out completely uh intact so  that's my approach as much as i can i try to   do these um through uh trans abdominally  but occasionally there's more disease you,English
+you can go through the chest and do a posterior  mediastinal um dissection um if you're familiar   with the anatomy that this is a pheniketo  through a eighth ninth rib inner space here,English
+we're pulling down the diaphragm the patient has  this large cystic teratoma mass and the posterior   mediastinum once it gets to the esophagus level  and stuff i think those are best approached uh,English
+with the thoracic surgeons um making sure there's  no damage to those very vital structures but these   there's really not much there other than the  aorta the spine and the diaphragm it's sort   of an extension of of the anatomy that you're  familiar with um if you do thorough abdominal,English
+incisions um a few words about gts these are can  become absolutely massive this is a patient who   was 28 had a massive abdominal tumor had underwent  one cycle of bep and the tumor started to to grow,English
+and the oncologist recommended hospice uh for the  patient because there's nothing else you could do   well the markers were going down and the the  tumor was growing uh that's classic that's,English
+classic for gts and you can see this goes very  very quickly but he has a huge volume of tumor   within the abdomen just involving every  compartment uh so i can't slow down that,English
+video for support whatever reason but you  the point is just to see you know obviously   this requires a major incision stem to sternum um  and a lot of work as we work compartment through,English
+compartment and and get you know the pelvic and  this is what you uh uh hopefully end up with uh um   we i actually was planning on doing a  nephrectomy uh but then realize the kidney,English
+is sort of just free standing and all these  teratoma masses came off the kidney so i i   re-implanted the kidney i did an auto transplant  with the artery and vein uh but and and the kidney,English
+actually survived um surprisingly so um this  patient went on to have several other recurrences   one in the posterior chest but this was the  major mass all teratoma uh here he is um uh,English
+three years later i've done two other operations  on him he had an intra-abdominal mesenteric tumor   mask that was very easy to remove i went there  i did a retro cruel mass and then i did a a,English
+thoracotomy on one side and took out uh another  growing uh three four centimeter uh teratoma   from his left chest so he's doing really well so i  think you know in his post chemo in these growing,English
+teratoma syndromes um you should do make every  effort to to resect all these as much as possible   uh very few words about post chemo seminomas uh  we talked about pet scans there's no role for pet,English
+except for this if you have a three centimeter  mass again we talked about the negative predictive   value this was based on the seven pets trial uh  with 127 uh patients with metastatic seminoma,English
+the sensitivity was 82 specificity 90 but really  it was a negative predictive value that that is   of most uh use in this setting if the mass is  less than three centimeters um look at this you,English
+have no viable disease so so there's no point in  getting a pet scan when the masses the residual   mass is less than three centimeters uh so only if  it's over three centimeters and so the indications,English
+are someone who has a growing residual mass  after chemotherapy without marker elevation or   if you have a solitary resectable tissue following  salvage chemotherapy to exclude any non-seminoma,English
+elements if you're unsure about the initial  diagnosis because the patient went straight to   straight to chemotherapy here's a patient who  underwent salvage chemotherapy and has this,English
+a small residual mass there that's pet positive  we waited and waited uh and on one of the pets   they said definite increase in the size and  the suv of the mass we thought okay well,English
+um you know this is an indication to go back  in you know unfortunately you end up losing the   kidney uh this is the estimated dissection and  and you know it turns out to be all fibrosis so,English
+really disappointing that you know with with  everything we had we couldn't predict this and   we thought we're going in there to resect residual  disease we could have easily just watched him and,English
+he would have been fine uh he is okay he's very  grateful obviously but oftentimes it turns into   this now there's a very different picture than  the other ones i was showing you it's a mess uh,English
+you're resecting cave and aorta and it turns  out you know at the end it'll be fibrosis so   be careful with taking seminomas um uh after  chemotherapy uh you do want some indication,English
+that it's growing or you're doing this for  viable disease intense desmoplastic reaction   often requiring some vascular reconstruction  and most of these are are necrosis and and,English
+fibrosis so this is not a micro rna lecture and  but i just want to say this is going to change   everything i think uh the micro rnas um  are incredibly um useful in in germ cell,English
+tumors they're very very specific and you  can see the auc here at the specificity   of marker rna versus ct versus tumor markers um  you just you don't see curves like this at all,English
+so incredibly specific and there's currently a  swat trial swag s1823 that is that is capturing   um basically all newly diagnosed uh  uh test cancers um getting their serum,English
+measuring their micro rna but we're not acting  on it this is essentially a registration trial   and and we are looking to um validate basically  the the utility of these markers in in testless,English
+cancer so that's a biomarker-based uh care  but we are working on uh future studies we   are currently working on an mri mrna uh microrna  directed management of clinical stage two um in,English
+the sems trial we learned that about 20 of the  patients who we thought had disease had a lymph   node that was two to three centimeters on our  planet turn out to be completely negative so we,English
+do have these negative rpmds as well and we'd like  to further sort of personalize their management so   we're working on those trials right now hopefully  we'll get some funding soon and uh roll those out,English
+uh so that we can uh personalize our management  so in conclusion i i think we will need   aggressive treatment in post chemo setting  adjunctive surgery is often required the,English
+extraperitoneal approach i think really offers an  advantage in terms of morbidity for these patients   try to do nerve sparing as much as possible and  very very judicious use of of pet scans in that,English
+post chemo seminoma setting so with that i'll stop  and uh answer any uh questions that you may have   thank you very much that was really outstanding  sia can can i ask you about the the sense trial,English
+um what was your sense from the patients  that that were enrolled as far as their   you know we talk we're talking to patients  about their choices and and what to do   i had a couple people that went to chicago that  you know to enroll in the trial of scott um and,English
+they were all very happy to go you know have an  rpl d versus radiation or chemotherapy as options   what was your sense from the patients as they were  going through this i mean i think that's what's,English
+ultimately probably going to drive a lot of the  decision making is you know the the patients that   are diagnosed what will they choose to do going  forward yeah uh great uh question josh and i think,English
+that's a major point what are patients going to  do i showed you that's why i showed you that that   study with nick cosa like are patients willing  to enroll in clinical trials the answer is yes   it really doesn't take much i  think it's it's one as you know i,English
+i i i'm very interested in clinical trials and try  to accrue um and and this was one of the easiest   to accrue to and i had patients just coming  to us saying we've heard you have a clinical,English
+trial for this we don't want to have chemo so  the way i presented it was uh look these are   the guidelines the national and the international  guidelines for management of stage two seminomas,English
+this is what we are doing we're hoping it's  curative in this many patients and just basically   a a pared-down version of a uh lay language  version of the presentation you heard that,English
+that surgery will offer uh hopefully 70 to 80 i  was quoting them at the time uh curate and if you   relapse we can salvage you with with additional  chemotherapy it was not a difficult sell um if you,English
+"and that is what cancer and cancer metastasis is, an emergent system. And this approach of putting things together",English
+"is one which is very natural to physicists and engineers, because engineers are the one who put together this car.",English
+"So, can we put together different genes or proteins in the way that they interact in a cell in order to get a better understanding of metastasis",English
+"as a system, as an emergent, complex system? Let me give you an example: weather forecast. Today, we can predict weather very accurately...",English
+"well, what is going to happen in the next 7 days or even further? When are we going to get thunderstorms? When are we going to get good sunlight?",English
+"And based on that we actually make our travel plans, which means that we trust it so much. Well, it took at least a century to get here.",English
+"Climate scientists, physicists, and engineers, they collected all different factors that contributed to the weather of a particular place,",English
+"the climate of a particular place, and then put them together in the way that they actually interact, including how strongly they interact with one another.",English
+"And this is just a 'primitive' set of equations that actually controls this, there's a lot of math that went behind it,",English
+"and that is where we are today, after having undergone this validation and calculation of the model. So, can we, today, begin this journey of",English
+"putting together various genes and proteins that interact with each other to control metastasis and, not necessarily today, but some years down the line,",English
+"can we build a model which can actually predict metastasis? Can we have that amount of trust in it, just as we have in the weather forecast today?",English
+"So, today I'm going to take you on the first few steps of that journey that I have latched onto. Alright... so, metastasis...",English
+"when cancer cells leave the primary tumor, they can do it in two different ways: they can either leave as single cells or they can form a cluster",English
+before the enter the freeway and then leave together. It is like whether... is there a set of cars leaving at different times,English
+or is there a set of cars that are together on a ramp just waiting to get on the freeway? Experiments have shown that there are,English
+30 times more single cells that are shed off the tumor as compared to only clusters. But the clusters form,English
+"50 times more secondary tumors, or metastases, than single cells. And these clusters are not too large,",English
+"they are 2-7 cells large, so you can do the math and realize that there is indeed something",English
+"to cancer cells staying together and that is what leads to much more metastasis. There is a value in staying together; united they stand, divided they fall.",English
+"So, what exactly is this value and how do cancer cells utilize it? Let's go through that. So, if these are the real villains of metastasis,",English
+"these clusters, then let's try to understand, how do cancer cells form these clusters? How can we break these clusters, what target can we use?",English
+"And, eventually, why do these clusters form much more metastases? Let's go to the first part: ow do cancer cells form these clusters?",English
+"Before we go into the details, let me give you a relatively detailed understanding of how metastasis actually happens. So, let's consider that",English
+"these primary lung cancer cells, now, they do not have the innate property to move, as we discussed earlier,",English
+"so in order to move, in order to get on the freeway, they need to do two things: they need to break their bonds with their neighbors, the tight cell-cell adhesion that they have;",English
+"and at the same time, they need to gain the property to migrate and invade. Now, this property of staying together and not moving",English
+"is the property of epithelial cells in our body, such as the skin, and the cells that line multiple organs, such as breast, prostrate, and lung.",English
+"On the other hand, the property of not adhering and migrating is the property of mesenchymal cells in our body,",English
+"such as red blood cells. So, when cancer cells have to get on the freeway, they need to take on these properties of mesenchymal cells.",English
+"I'm not saying that they have to convert to mesenchymal cells, they don't have to become red blood cells, but they have to take on these properties.",English
+"And this transition is what is called as epithelial-to-mesenchymal transition, which is usually the first step in the metastatic cascade.",English
+"Now, once they on the freeway, once they're in the blood circulation and they survive and they get out at a different organ, take an exit,",English
+"now what they need to do is that... grow an entire new tumor, for which they need to shed their migration",English
+and invasion properties and regain their property of adhering to their neighbors. And this is the exact opposite transition,English
+"that we just talked about, mesenchymal-to-epithelial transition, which is usually the last step in this metastatic cycle, and the cycle can continue, go on and on,",English
+"forming multiple secondary or tertiary tumors at multiple different organs in the body. Now, EMT or MET,",English
+"as I'll refer to them throughout the talk, are not some new processes invented by cancer.",English
+These are normal physiological processes that happen during embryonic development and even wound healing and these processes are co-opted by cancer,English
+"to metastasize. Let's talk about wound healing for a bit. So, when you get a wound on your skin, you see the cells move together",English
+"and actually close that wound, and once the wound is filled, they stop moving and settle down. So, this is exactly what EMT and MET is going on.",English
+"But those cells typically move collectively, so... which is not really epithelial and not really mesenchymal. So, is there a state somewhere in between",English
+"where cells can both adhere and migrate, which can close the wound and, in the case of cancer, it can form much more clusters...",English
+"is there a stable state, a hybrid state, in between? So, recent studies have observed that in circulating tumor cells in patients,",English
+"those cells can co-express epithelial and mesenchymal proteins, suggesting that they're somewhere hybrid in nature. More importantly, what they observed",English
+"based on the biopsies of primary tumors, is that the more aggressive the cancer is, the more the number of such cells.",English
+"Of course, this is just a correlation, not a causal effect, but it definitely points to some correlation... it definitely points to some",English
+"connection between how hybrid cells... how many hybrid cells are out there and how aggressive the tumor is. But despite this,",English
+"the feeling in the field has been that, well, this is just a transient nature; cells cannot actually maintain this state for a very long time",English
+"and this is just a snapshot that got captured when cells were in route at EMT. So, that is the question that got me most excited:",English
+"is this a stable state or is it just a transient, intermediate, unstable state? So, here are the three states we have been talking about:",English
+"epithelial, to the very left, where cells adhere very strongly and do not move; mesenchymal to the extreme right, where cells migrate but they do not adhere;",English
+"and in between is this hybrid state where cells both adhere and migrate, therefore leading to this collective cell migration",English
+"or clustered cell migration. Now, how do we understand how cells can attain this state, whether hybrid is a stable state at all or not?",English
+"Again, going back to the approach of putting the car parts together... so, what I did was scan through literature of multiple different cell lines belonging",English
+"to multiple different cancers and try to identify, well, is there some core unit, is there some core set of proteins, genes, microRNAs,",English
+"that interact with each other and control EMT in multiple different contexts? And this is the network I came up with,",English
+"where there are four different players, which are connected to each other in a relatively complicated manner, the details of which I am not going into.",English
+"And there... two of which are transcription factors and two of which are microRNAs. The numbers you see here represent some kind of a quantitative relationship between them,",English
+"but, again, I'll not bore you with the details. The only thing I want you to remember is that what we know experimentally is that the amount... if the amount of SNAIL is ZEB are high,",English
+"then cells are mesenchymal, and if the amount of SNAIL and ZEB is low, then cells are epithelial. Alright.",English
+"So then, after finding these interactions, I wrote down mathematical equations which actually represent these interactions and, after doing calculations with these equations,",English
+"let's see what exactly the model predicts. So, here is the prediction of the model, where there are three solid lines,",English
+"each of which represents a stable state, which is a phenotype that cells can attain. The dotted red lines represent unable states. So, going back to standard high school physics,",English
+"we know that if the unstable state is perturbed, it exits that state, so cells cannot actually stay in that state, so therefore we are going to focus only on the unstable states",English
+"in this context. Now, let me break down this graph for you. So, out of the four players that we've discussed, I've here taken only two players, just for the purpose of representation,",English
+"to see what exactly the model says. So, at very low levels of ZEB, which is the y axis,",English
+"you see there is only one state, which is epithelial, and that is what we know from experiments. At very high levels of ZEB,",English
+"again, there is only one state, which is mesenchymal. And in between, you see this... another solid blue line,",English
+"which corresponds to intermediate ZEB levels, ZEB levels which are higher than those seen in epithelial",English
+"and lower than those seen in mesenchymal, and this intermediate state corresponds to a stable hybrid state. So, a prediction of the model is that,",English
+"yes, there is stable hybrid state that cells can achieve. Alright. Let me walk you through another facet of this graph. So, if you see, the very left part of the graph...",English
+"now let's look... we have already looked horizontally, now let's look vertical... so here, what you see is that",English
+"if the amount of SNAIL protein is less than 180,000 molecules and if you walk vertically upwards, there is only one blue solid line that you cross,",English
+"which means that there is only one state that cells in this region of parameters, or in this region of conditions, can attain, and that state, as you can see from ZEB levels,",English
+"is the epithelial state. Going to the very right, there is another region in which, again, there is only one state,",English
+"but that particular state is not epithelial, but the state with highest ZEB levels, which is mesenchymal, actually. And in between we see this interesting region.",English
+"For example, let's draw a vertical line from 200,000 molecules of SNAIL, and you see it will cross three distinct blue curves,",English
+"and each of those blue curves corresponds to a stable state, as I've already mentioned, and these three stable states are epithelial, mesenchymal, and hybrid.",English
+"So, again, what the model predicts is that there can be some conditions under which these three states can coexist with each other,",English
+"so if... there might be experimental cases, some cell lines, in which you can see that all these different,",English
+"three kinds of cell or phenotypes are present in the cells with the same genetic background, which is what a cell line is. So, once we made this model,",English
+"we wrote to a couple of experimental biologists working on EMT, trying to see, well, how do they react to this? Do they react in a very similar way",English
+"that my master's experimental biologists did, or they are actually supportive of this? So, one group is Seattle actually wrote back, among other groups as well,",English
+"and said, well, we have two pieces of good news for you. One is that we have been looking at a cohort of 40 different lung cancer cell lines",English
+"and we actually see that many of them lie somewhere in between epithelial and mesenchymal. And the other good news is that we are moving to Houston,",English
+"right across the street from Rice University at MD Anderson Cancer Center, so why don't you come over and we can discuss. And this was indeed the turning point.",English
+"So, once we discussed with them, they had these intermediate cell lines which were lying somewhere in between epithelial and mesenchymal, and how did they identify that these were intermediate?",English
+"Because they took measurements of several epithelial and mesenchymal proteins and their mRNA levels. But beware, all these measurements",English
+"were taken on a population level: they took 1000 or more cells of this and then crushed them and see, what was the amount of RNA present in them?",English
+"And this is the problem with taking population-level measurements, that you actually do not see what is going on at the single cell level.",English
+"So, when we looked at those cell lines, what we observed was that there were some cell lines in which there were some epithelial cells",English
+"and some mesenchymal cells, but not hybrid cells. So, here is a cell line, as shown here, where red is marking an epithelial protein",English
+"and green is marking a mesenchymal protein in these immunofluorescence images, so you see cells have only red or only green, which means they're only epithelial or only mesenchymal.",English
+"Another cell line where you see that cells actually co-express red and green at a single cell level, so these are indeed hybrid cells,",English
+"which is different from a mixture. So, a mixture is different than a hybrid cell. Its characterization is different, its migration traits are expected to be different,",English
+"and so on and so forth. Again, this is a snapshot. What is a stable state? If it is perturbed, it comes back,",English
+"or, in other words, it retains itself if not perturbed. So, in order to see whether this hybrid cell line which got us so excited",English
+"was indeed a stable state, we... our experimental collaborators, they actually cultured this cell line for multiple passages",English
+"and saw that, even after two months, they were actually coexpressing red and green, which is what is suggesting that, yes, can they be indeed stably present",English
+"in that hybrid state. Now, another thing that I've been talking about is that these hybrid cells are likely to move collectively.",English
+"Now, let's see if that is shown in the experiments, also, because eventually the proof of the pudding is in the eating, right?",English
+"So, here we take a mesenchymal cell line and a hybrid cell line and what you do... our experimental collaborators did is a scratch assay,",English
+"where you actually grow cells until they are confluent on a plate and then you just mark a scratch using a needle, and the way cells move to fill in that gap",English
+"is what is used to characterize their migration properties. Now, let's see how mesenchymal cells moved. So, the rightmost column",English
+"is just showing a zoomed in image of the middle column, as you can see these cells are flying out as single cells -- they just don't have any direct physical connection to each other.",English
+"However, the hybrid cells are moving more collectively -- they have not yet broken the bonds with their neighbors, they're actually moving collectively --",English
+"therefore leading to these finger-like projections as pointed out by these white arrows. So, indeed, these cells are hybrid, because it's a stable state",English
+"and of course they move collectively. Now, we were very intrigued with this hybrid cell line, because in our diagram, in our model,",English
+"we did not have a parameter region in which the only state was hybrid, so that's what got us thinking that,",English
+"well, what... how can we tweak the model, how can we add or delete components from it so that we can get a region in which the only state",English
+"is hybrid? And also, at the same time, we wanted to identify, well, what targets can break these clusters? So, if we can identify",English
+"what can give us a stable hybrid state, only a stable hybrid state, deleting that can destabilize the hybrid",English
+"and potentially lead to disrupted collective cell migration. Alright, so let's go back to the math.",English
+"So, this is the diagram that I showed you earlier and I would, again, like to highlight here that there is no parameter region in which the only state is hybrid.",English
+"There is a parameter region in which the only state is epithelial, there is a parameter region in which the only state is mesenchymal, but not a region in which the only state is hybrid.",English
+So then I went back to the wound healing and developmental EMT literature to see if they are talking about some players which can either disrupt or maintain,English
+"collective cell migration and, once I had a list of players from that literature, I looked at, well, do we know how exactly they couple to the players that we have here?",English
+And once we had a list of players which were implicated in collective cell migration as well as we had enough quantitative information,English
+"about that to couple to this model, I actually incorporated that into our model and, as you will see, the diagram changes. So, this is just one example that I'm showing you, here,",English
+"this particular protein called GRHL2, which connects with ZEB -- it inhibits ZEB and is inhibited by ZEB -- and you see the diagram changes",English
+"and if you look at approximately 400,000 molecules of SNAIL and go vertically upwards, as shown in this region highlighted by this dotted rectangle,",English
+"you see the only state is hybrid. So, adding this single factor stabilized the hybrid state.",English
+"Again, let's go to the inverse -- deleting this should destabilize the hybrid state. Again, let's go back to the experiments",English
+"and see if it actually holds true. So, we went back to the same cell line, which was stably hybrid and, as you can see",English
+"again, they're moving collectively, as you can see in the left column. On the right column, what we did was we deleted that particular protein from the cell line, and you see that their migration",English
+"is not completely collective now -- it has been disrupted and they start to begin moving more as single cells. Also, when we looked for the presence of red and green,",English
+"or epithelial and mesenchymal proteins that we have been talking about, this intermediate cell line, as I showed you earlier, this hybrid cell line,",English
+"co-expresses red and green in the same cells, but with the knockdown of this single protein, as predicted by the mathematical model,",English
+you see that the red just goes away and the cells are only mesenchymal. And that is consistent with the idea that they're moving more as single cells,English
+"rather than as collective cells. So we predicted this from the model and then we got it eventually validated, but I should remind you that",English
+"the whole idea about this project came from... that there is a stable hybrid cell line, so this is a wonderful example of how biology can inform math and math can inform biology,",English
+"and we can iteratively go forward to have a better understanding of the system. Now, once we had done this in vitro validation, we wanted to go to some clinical data",English
+"and see if it supports our hypothesis. So, a high amount of this protein, GRHL2, will potentially lead to more collective migration,",English
+"more clusters, and more clusters will decrease the survival period. So, what I did was look at a cohort of approximately 1000 lung cancer patients,",English
+"which were divided into high and how amounts of this protein, and then we looked at their 5-year and 10-year survival probabilities. As you can see, the patients that have",English
+"high amounts of this protein have a lower probability of progression-free survival, which means that the disease has actually progressed, in more cases,",English
+"as compared to the percentage of cases in which there is a lower amount of this particular protein, and that is what is shown in the graph here. The red line shows the cases where the protein...",English
+"where the patients have high amounts of this protein and the black graph shows that... the black curve shows the cases where the patients have low amounts of this protein,",English
+"and there is a difference, a stark difference in both the 5-year and 10-year survival probabilities, which is consistently with our hypothesis. Alright, so we have talked about these two aspects,",English
+"both of which are connected to how cancer cells get on the freeway. Now, let's talk about the last aspect,",English
+"that is, once they have survived the circulation and gotten off the freeway to a secondary organ, to a distant organ,",English
+"how exactly do they form secondary tumors. So, why do clusters form more metastases? Again, a very similar approach to what we have been talking about,",English
+"putting together parts of a car. Take the EMT network that we have been studying and take the tumor initiation network, as reported in published experimental data,",English
+"and see how they're connected to each other, again, as published in the data. And then simulate this and",English
+"see what the model predicts. Now, why this project was most exciting to me was because there were three different papers comparing the tumor initiation abilities",English
+"of epithelial and mesenchymal cells -- the cells that do not move and the cells that move as single cells, individually -- and they said three completely different things.",English
+"One... the first paper said that when cells undergo EMT to become mesenchymal, they form much more tumors. A couple of years later, another paper saying that,",English
+"well, when cells become mesenchymal, their tumor initiation ability goes down and the cells that are epithelial are the ones that form more tumors.",English
+"And the last one saying that, well, they are almost comparable -- epithelial and mesenchymal can initiate almost equal numbers of tumors, there is not a stark difference in that ability.",English
+"Now, this is conflicting, hugely confounding, and one of the reason why I thought that this paradox is being reported is that...",English
+"because all these studies actually categorized cells into two categories, either epithelial or mesenchymal.",English
+"So they completely missed out on these hybrid, stable cells, which were miscategorized as either epithelial or mesenchymal,",English
+"and it can be different in different studies, therefore leading to these potentially different results. So, then when I simulated this model",English
+"of EMT and the tumor initiation network together, the model predicted that the cells in the hybrid... the cells that are hybrid actually form",English
+"much more tumors than cells that are only epithelial or only mesenchymal. Now, one year later, after we published this, there was an experimental study,",English
+"which, to the best of my knowledge, is the first study that categorizes cells into three different categories -- these are also breast cancer cells --",English
+"epithelial, hybrid, and mesenchymal, segregates them, and then looks at their tumor initiation ability and, as you can see,",English
+"tumor initiation ability of the hybrid cells is ten times more than the tumor initiation ability of only epithelial or only mesenchymal,",English
+"which is, again, very consistent with what the model predicted. Of course, we didn't have this ten times number, but it's qualitatively the same result.",English
+"So, just summarizing... so, I've taken you through a journey of how theoretical physics or mathematics can be coupled with experimental biology",English
+"to get insights into this entire process of tumor progression and metastasis. So, the first part was, well, how do cancer cells form these clusters,",English
+"where we made a network of EMT and MET, and predicted that, indeed, the hybrid state is a stable state,",English
+"which is what is in contradiction to the current existing framework, where people believe it's just a transient state. Then the next part was, well,",English
+"how can we break these clusters? Where, again, based on mathematical modeling, then in vitro experimental validation, and then based on some clinical data,",English
+we concluded that GRHL2 might be an important player to break that clustered migration.,English
+"And then in the last part, we tried to offer an explanation of why clusters might be forming more metastasis, because clusters are the ones that are",English
+"usually corresponding to a hybrid state, and the hybrid state is the one that has much more tumor initiation ability than either mesenchymal or epithelial.",English
+"So, just concluding, as I already indicated, the existing framework has been that this hybrid state is just transient, cells can not maintain it for a very long time,",English
+"but what we showed, first based on mathematical modeling and then based on experimental validation, that, indeed, it can be a stable state,",English
+"in some scenarios, and it can move collectively. Therefore, this state might be the reason behind why clusters form much more metastases,",English
+"because it enables the formation of clusters of circulating tumor cells, or CTCs. Now, what are the clinical implications of this work?",English
+"So, these days, there's a lot of talk about liquid biopsy. Now, what is liquid biopsy? How is it different from solid biopsy? So, solid biopsy is when you take",English
+"a chunk of mass from a tumor, from a patient, and then try to characterize it. Liquid biopsy is that, instead of taking that chunk of solid tumor mass,",English
+"we wanted to see what percentage came  and showed up for their appointments   versus who didn't come. And what we found  is that first of all, physical distance,   so living far away. But being non-English  speaking or being older at diagnosis were",English
+"some factors that frequently resulted in children  not coming to their neuropsychology appointment.   We had a few that actually just refused to  schedule, some that scheduled and no showed,",English
+"but those were the trends that we saw. And  interestingly, if we break it up by diagnosis,   for medulloblastoma many more in terms  of percentage-wise, we had a much higher",English
+"percentage who actually showed up for  testing. As opposed to low-grade glioma,   which includes pilocytic astrocytoma, about 50%  showed up, and others did not. And one theory we",English
+"have for this is that medulloblastoma  is a much more aggressive tumor, and   the prognosis is a little bit more grim in terms  of just medical prognosis. And so, we feel like",English
+"these families maybe get a slightly different  message in terms of what we're telling them   and what they need to do and follow up. So, this  information gave us some good data in terms of how",English
+"to improve our messaging in clinic, how to improve  our triage for neuropsychology, things like that.   So, all of that is just kind of context  for the broader picture of pediatric cancer",English
+and some factors that relate to  survival and also to follow-up. But I’m going to jump into  brain tumors now. Let me see.,English
+"And we’re talking about some  just some important terms   when we’re talking about brain tumors. So,  most of brain tumors in pediatric cancer   in the pediatric population are 60-70%  percent of them are infratentorial,",English
+"which means that they are below the tentorium.  And the tentorium you see there in that image;   it’s part of the dura mater that covers the upper surface of the cerebellum. And it   essentially divides the posterior fossa, which  is this posterior being back, fossa being bone;",English
+"the backbone region of the brain it divides  it from the rest of the cranial vault.   So, the majority of the tumors we see in  kids occur in that region of the brain. So,",English
+"that’s one thing to know; you’ll see that term  a lot when you’re working with this population. Some other terms. So, anaplastic is a term that  you’ll see sometimes which refers to poor cellular",English
+"differentiation. Essentially, it’s kind of a messy  tumor, it looks messy. That image is actually an   anaplastic ependymoma. And as a result of it  being kind of messy and poorly differentiated,",English
+"it ends up being harder to treat, harder to  resect, harder to basically get it all. So,   anaplastic is always a higher-risk tumor. And  then degrees of resection is also important",English
+"to kind of understand these terms. So, gross total  is what you’ll see surgeons refer to as ‘we got it   all out.’ It actually doesn’t always mean that  they got it all out, but it means that about 99%",English
+"was removed. Near total is 91 to 98%, subtotal  is 50-90%, and then partial is less than 50%.   And what you see being the most common factor in  terms of how much they can remove is the location",English
+"of the tumor. Oftentimes, the tumor being in  the back of the brain can be invasive into   the brain stem. And so, if that happens, obviously  there’s parts that you just can’t risk taking out.",English
+"So, here’s an image that shows gross total versus  near total versus subtotal. And basically, the   white…gross total you really don’t see anything.  The white dots and sort of the blurry white spot",English
+in those other two images show residual tumor.  And so that gives you kind of a visual of   what we’re talking about when  we’re talking about these terms. Another way to talk about brain tumors  is looking at pathology. So many brain,English
+"tumors arise from glial cells, and the most  common are the astrocytoma’s, ependymomas, and   oligodendrogliomas. Arising from neuronal cells,  we have medulloblastomas and a tumor called PENT,",English
+which is primitive neuroectodermal tumor. And  that’s actually the image that you see there.   PNETs and medulloblastomas used  to be clumped as one category.,English
+"And currently, we don’t really view them as  similar at all; we very much make a distinction.   So, you’ll see in if you’re reading older  research, you’ll often see medullo and PNET",English
+"lumped together. In more recent  research, you’ll see this separated out. So, I’ve referenced medulloblastoma  a bunch; what is this exactly?   It’s the most common malignant pediatric brain  tumor, as I mentioned, formally associated",English
+with PNETs. And it’s thought to arise from  cerebellar stem cells; hence you often see   it in the posterior fossa region of the brain.  That is not necessarily always the case. Sometimes,English
+"the cancer cells can migrate into the cerebrum.  So, you occasionally do you get tumors, you   know medulloblastomas and pilocytic astrocytoma,  that are in the main cerebrum area of the brain;",English
+"however, typically originates  still from the cerebellar region.   So, pilocytic astrocytoma is the other brain  tumor that’s fairly common in pediatrics. And",English
+"it’s the most common benign pediatric brain tumor.  So, benign being non-aggressive, non-invasive,   but obviously, any tumor in the brain is going  to be a problem because it’s taking up space and",English
+"causing mass effect, pressure; the bigger it is  that the worse it is, obviously. So, these tumors,   both these types of tumors and brain tumors in  general, often first get diagnosed when kids start",English
+"having symptoms of mass effect such as nausea,  vomiting, balance issues, things like that.   So pilocytic astrocytoma is actually a  type of glioma; it’s a glial cell tumor.",English
+"And specifically, it arises from astrocytes,  as you might expect from the name.   So, these two tumors they’re very different, but  they’re also very commonly located in the same",English
+"area, and that’s in that posterior fossa area  of the brain. So as a result, they form a nice   comparison group between the two diagnoses.  Medulloblastoma is typically treated with,",English
+"they both are treated with surgical  resection. Medulloblastoma, you’ll   also get chemo and radiation. Pilocytic  astrocytoma almost never gets radiation.   So, it can be, in that way, sort of a control for  what are the effects of radiation in particular.",English
+"In terms of severities, the World Health  Organization grading, grades one to four   are sometimes used, not always used.  Really what we’re using more these days",English
+"are pathogenesis classifications and genotyping.  So, in terms of pathogenesis, an example of that   is in medulloblastoma. And this really has come  out of research done in the last 10-15 years",English
+"that we’ve really kind of categorized  medulloblastoma based on their cellular origin.   So based on looking at the pathology  of the tumor itself, even within",English
+"the category of medulloblastoma, we can  get a better sense of their prognosis. So, I’m going to compare  medulloblastomas and pilocytic",English
+"astrocytoma a little bit more just because, you know, if you’re working in this population,   these are two tumors that you’ll see all the  time. They are, while being the most common,",English
+"they’re still, you know, 18-20%; there’s a  lot of other brain tumors that children get   but by far these are the two most common. As I  mentioned previously, the peak age of diagnosis",English
+"for both is age five. But for medullo, you  see this diagnosed more commonly before age   10. Pilocytic astrocytoma, sometimes you can  see that diagnosed in the early teen years.",English
+"For both tumors, we see more males diagnosed  than females. And that’s an interesting finding;   there’s a lot of theories about that  which I’ll get into in a minute. But",English
+"you’ll often see more males than females and that  results in some difficulties with our research   because we often have populations that are skewed  very male, and it’s harder to generalize research",English
+"to female findings to know whether or not females  really experience the same sort of late effects.   So, it’s one thing that we have to take into  account when we’re looking at research on these",English
+"brain tumors. And let me see, I think actually,  I took out the next slide. Let me go ahead and   talk about in terms of males versus females, it’s  really actually not related to sex hormones. So,",English
+"sometimes that’s the theory that comes up. But  what research has shown is that one major factor   is a protein called retinoblastoma protein, it’s  referred to as pRb. And this protein is known to",English
+"reduce cancer risk and it’s also significantly  less active in male neurons than female neurons.   This was identified in 2014, so this is  pretty new knowledge. But it’s giving us",English
+"more information about why we see more  males with brain tumors than females.   So, I talked about the treatment differences.  Survival rates are not super different,",English
+"but medullo’s have slightly  less/lower survival rates. So, this is an image of medulloblastoma. This is  the same child, and these are pre- and post-op,",English
+"before and after surgical resection. This  is an eight-year-old boy and so you’ll see   it’s a pretty drastic difference when they go  in and take that out. But then, there is also   just kind of a mess left behind. And really what  we found is that surgical resection is not so much",English
+"a risk factor as the subsequent  treatments. So, chemo and radiation   are really much more devastating than actually  going in and removing the tumor itself.   This is an image of pilocytic astrocytoma. These  are two different patients and this just shows",English
+"that again, it’s in that same region of the  brain. You can see some mass effect issues,   especially on the one on the left. And these  patients are both obviously pre-surgery.",English
+"So, when we’re talking  about pediatric brain tumors   some prognostic factors include age at diagnosis.  So, prior to age three there’s a greater risk for   worse survival outcomes and worse  late effects/neurocognitive outcomes,",English
+"especially prior to 12 months but certainly prior  to age three. Tumor location of course is another   factor; if the tumor is in a place where it can  be resected or not. Histology, so some tumors",English
+"are more aggressive than others. Subtyping,  as we talked about, can make a difference.   For gender, there’s mixed findings and again  that’s related somewhat to the fact that we   have fewer females to study. But generally, we  found that females have higher survival rates",English
+"in some age groups as opposed to males. And again,  there’s still evolving research as to why that is.   In terms of ethnicity, we talked  about African Americans and Hispanics",English
+in particular having lower cure rates  and we talked about before some factors   regarding access to care that may contribute to  that. But it’s still not fully understood why,English
+"some ethnicities, some ethnic  groups have lower survival rates.   Metastatic disease obviously is another factor.  If the tumor has become invasive in other parts   of the brain or other areas of the body that  is a worse risk factor. Genetic factors,",English
+"here I’m talking about actually, differences  in response to treatment. So, we’ve found that   certain genes respond better to or indicate that  the body will respond better to chemo than other",English
+"types of genes. And I won’t get into too much  detail about that, that’s sort of a talk on   itself. And then response to treatment is the last  prognostic factor that’s important to know about.",English
+"So, typically remission should be achieved within  about one or two weeks. And that means that   there’s essentially just a substantial decrease in  the signs and symptoms, blood counts, things like",English
+"that. And many people are surprised to hear that  one to two weeks sounds very fast. But typically,   that is what you want to see and there’s a better  prognosis for survival if that is achieved.",English
+"So, some potential treatment complications  that are important to know about just because   of how they relate to the testing  that we do as neuropsychologists.   So first, you’ll want to if you’re if  you’re seeing a child with a brain tumor",English
+"or post-brain tumor; you want to know did they  go through a normal treatment protocol or did   their treatment protocol have to be modified  in some way. So, if they have allergic reaction to certain drugs, they may  need to modify the protocol.",English
+You may have a pretty standard protocol  for medulloblastoma but there may be some   deviations from that if there  was an allergic reaction.   So you just want to not assume that every kid  you see with medulloblastoma got the same chemo.,English
+"Infections almost always require hospitalization,  obviously these kids are immunocompromised. And   the important thing to be aware of is that  obviously when a child is hospitalized",English
+"there’s disruption to schooling and educational  instruction. So, it’s important to know, to get a   sense from the team or from the patient’s chart to  get a sense of how often were they hospitalized?",English
+"I mentioned while hospitalized, school can be  disrupted. And you’ll want to interview the   patient to kind of find out to what extent  did they still stay engaged in school.",English
+"Was work sent home? Were they actually doing  the work? You’ll often see that it’s reported   that they get school services at the home, so  something like homebound services, and that’s",English
+"regulated by state law. So, in Texas, I  have Dallas ISD listed here as an example.   First of all, you have to be out for four  weeks. And then in terms of regulations,",English
+"there aren’t actually very many beyond  that in Texas. So, the teacher may come   for an hour a day, an hour every other day. And  you really want to interview the patient and the",English
+family to get more information about how often  was homebound instruction actually taking place.   And be familiar too with your state law  about homebound instruction. And then,English
+"Section 504 and IEP. Many of you may be familiar  with these terms, but essentially, we’re looking   at the degree to which a child has accommodations  and modifications in school. Section 504 is more",English
+"accommodation-focused, and IEPs include  modifications to the actual curriculum.   So, getting more information about that and also,  not only to know their history but also to know",English
+"is the parent aware of this? Do we need to educate  on their options in terms of school supports? Alright, so I’m going to jump into neurocognitive  late effects of pediatric brain tumors.",English
+"As I mentioned, there’s typically not many  significant effects related to surgical resection   itself. So, some exceptions to that; one is  cerebellar mutism, this also is referred to as",English
+"posterior fossa syndrome. And essentially, it  is a period of mutism following surgery for a   tumor in the cerebellar region. And you see this  for a number of reasons. Sometimes it’s random.",English
+"If the cerebellar vermis is affected, it  tends to be more common (the vermis is   basically the area connecting the two lobes of  the cerebellum). And the incidence ranges widely",English
+"in terms of studies reporting how frequent  this is ranges from about 8% to about 39%;   it’s very rare, but it does happen essentially.  So, the syndrome itself, in addition to mutism,",English
+"can also be associated with ataxia, hypotonia,  irritability. Basically, emotional issues,   motor issues, and mutism. And most kids resolve  pretty quickly, within a couple weeks at most. But",English
+"we sometimes see kids who, even a year after  surgery, are still having issues with ataxia   and may not have total mutism but may have  some speech issues as well that are lingering.",English
+"So, that’s an important factor to know in  terms of your patient’s medical history.   Other surgical resection factors. We see worse  outcomes obviously with multiple surgeries",English
+"and with subtotal resection. Multiple surgeries   and subtitle resection both typically  just mean that it’s a more invasive tumor,   it’s harder to get all of it, it may be  in a very difficult region of the brain.",English
+"So, it’s not so much again the act of going in and  doing surgery, but it’s more that’s a measure of   something else about the tumor that makes it more  likely to have negative effects on the brain.",English
+"Many, you know, as we as we talk about mass  effect, many of our patients with brain tumors   also present with hydrocephalus. As you all may  know, hydrocephalus is commonly associated with   processing speed and attention deficits. And  then these kids, that can linger even after",English
+"hydrocephalus is resolved. One thing to look at  in a patient's medical history is shunt surgery,   and we see typically worse neurocognitive  outcomes associated with multiple shunt surgeries",English
+"and with complications, like shunt infections.  So that's another thing to look at.   And again, the factor here is not so much  the surgeries but the fact that if a shunt's",English
+"not working, it means that something's being  blocked, there's things changing in the brain,   there may be increased hydrocephalus. So,  there may be other factors essentially   that are pointing to worse outcomes  that then shunt surgery is a marker for.",English
+"In terms of chemo, we've talked about Cisplatin  and Vincristine, or I’m sorry, we talked about   Vincristine we didn’t talk about Cisplatin.  Cisplatin is a platinum-based chemotherapy",English
+"agent that is commonly associated with auditory  hearing loss issues, typically high frequency   hearing loss. Not always, but it is a risk factor  for that. And then Vincristine, we talked about",English
+"that being a risk factor for peripheral neuropathy  and then as a result fine motor deficits.   So, triples refers to intrathecal, which  means injected into the spinal cord. So,",English
+"triples is intrathecal methotrexate, intrathecal  hydrocortisone, and intrathecal cytarabine.   So, if you see triples in the chart or  you may see them listed out separately,",English
+"those are definitely together a major risk factor  for processing speed deficits, and attention   problems, and executive dysfunction. If we see  intrathecal methotrexate alone, it’s actually",English
+"sometimes has worse processing speed than  triples. There was a study that looked at this   and found that there may be some protective  factor of the other agents, especially the",English
+"hydrocortisone steroid, that research is still  kind of digging into what exactly explains that.   But to know that if you see a history of  intrathecal methotrexate, that's certainly",English
+"a red flag for issues, potential issues  with processing speed, attention, and EF. Late effects related to radiation. We see  progressive “declines” in a number of areas.",English
+"And I put declines in quotation marks because  it’s not necessarily a decline so much as it is   that they are not developing along the expected  growth curve. So, you see that they gradually,",English
+"the score being lower doesn’t mean that your  child has lost IQ or lost academic skills.   More so, it means that they’re not really meeting  those developmental expectations. Risk factors",English
+"for worse side effects related to radiation  include younger age at diagnosis and treatment.   The extent of radiation, so partial radiation  versus whole brain radiation. And then the",English
+"dose of radiation as well. And this is one area  where our research has really developed a lot of   advances in terms of minimizing the dose,  maximizing survival while minimizing",English
+cognitive late effects is essentially  the goal. So things like proton radiation   have been developed within the last 10-20 years  and tend to be more targeted and have less,English
+"peripheral spread of damage than some  of our older radiation techniques. So, when we talk about underlying mechanisms for  damage, certainly surgical resection, there can be",English
+"some degree of physical damage to the neuronal  connections. But if you look at the mechanisms   of other factors involved in brain tumors,  you’ll see kind of why they’re so much more",English
+"relevant than surgical resection; because these  are factors that often affect the brain in a   larger, more systemic way. So hydrocephalus,  as you know, if you’ve studied hydrocephalus,",English
+"we see interruption of synaptic  connections, which can change   dendritic structure, interruption of blood flow,  and we see hypoxia/ischemia related to that.   And essentially, all this together results  in subcortical white matter damage,",English
+"which of course, associates with processing  speed, attention, this sorts of functions.   And radiation, the effects of that in the first  one to six months after radiation you primarily",English
+"see some demyelination. And then after six months,  you still see progressive damage. So, you’ll see   increasing vascular damage, demyelination, areas  of gliosis, and broad white matter necrosis.",English
+"you may see not as much in terms of late  effects as you might see six months and beyond. Chemo is a very complicated process, obviously.  There are many mechanisms by which chemo can",English
+"affect the brain; it is essentially  injecting poison into the body. So you know,   it can damage the blood-brain barrier, you can see  DNA damage, neurotoxicity related to inflammation,",English
+"And certainly, oral chemo is less of a direct risk  to the brain than intrathecal, which is injected   into the spinal cord and then circulates through  the CNS. But both forms can have implications for",English
+"neurocognitive late effects. And you’ll see some  genetic variations in terms of, again, how these   certain chemotherapy agents affect certain  children based on everything from their genes for",English
+"DNA repair, their rate of telomere shortening,  genetic factors driving neuronal repair.   There’s many, many factors that we honestly still  need to research and learn more about, and we’re",English
+"learning more about every day. So, rather than  going into preliminary data, I’ll just tell you   that this is kind of an area of developing  research. And we’re hoping to understand",English
+"more about what genetic factors make certain  kids more at risk for neurocognitive outcomes,   as opposed to some other kids who get the same  treatment but really end up doing much better.",English
+"of real-world functioning. We know that the  majority of them require long-term special   ed. services and tend to be less likely  to finish high school than their peers.   Based on that knowledge, you would think  that their academic skills would be",English
+"sort of tanked. However, we found that multiple  studies have shown that they actually have   average academic skill development. So,  those studies are just a few examples of",English
+"the research really not matching the  reality. And so, we took this, at Children's,   and kind of took an approach looking at, okay,  what else could explain this? And we know that",English
+"into our study of academic skills we added  measures of academic fluency. And sure enough,   that's where you saw the major discrepancy.  If you look at that table four, you'll see",English
+"that fluency in both reading and math was  significantly different and significantly worse   than the basic skill development. So essentially,  saying that these kids have reasonably developed",English
+"skills, you know, broadly average for  both reading and math, but their fluency,   so their rate at which they're able to put out the  information and finish tests on time, for example,",English
+"is what's really holding them back and  causing them to have a lot of trouble.   So, we were kind of excited to identify that. You  know, it wasn't anything we didn't expect to find,   I would say. But it was good to actually  kind of quantify that, like quantify,",English
+"there is a reason for the real-world struggles  that we're seeing, and this kind of relates   back to what we see in terms of the  neurobiology of brain tumors and late effects.",English
+"Then going beyond neurobiology,  another thing we’ve looked at is what   influences these kids’ ability to do well in terms  of academic performance. Because certainly, many",English
+"And so, one thing we looked at, we looked  at academic fluency. So, taking that   what we knew about academic fluency being an area  of weakness for these kids, and we wanted to see",English
+"if an external incentive would improve their  performance. And what we found is that actually,   regardless of the processing speed deficits that  they showed, they did do better under a highly",English
+"motivating condition as opposed to the randomized  group that did not receive the motivation.   And you know, there’s more details about the  study that I don’t quite have time to go into",English
+"here, but the big takeaway is so first, it showed  the importance of looking at factors other than   the scores that we generally produce in any  neuropsych evaluation. So, beyond looking at",English
+"processing speed, and academic skills, and working memory, and executive functioning,   you know, it’s important to consider other  factors for these kids. And doing a comprehensive",English
+"neuropsychological evaluation means taking into  account things like personality, motivation,   intrinsic motivation. And the interesting  thing about what this showed is that",English
+"fairly disappointing scores, but in  the context of a child’s personality,   a child’s sort of hard-working nature,  those can be mitigated to some extent. So again, this is the chart that shows,  essentially, our no incentive group",English
+"versus the incentive group. The bar on math  fluency is oddly vanished because there’s   absolutely no change in the  mean, which was just a fluke. But   you see that there’s a significant improvement in  both reading and math fluency under motivation,",English
+"under a motivating condition. Again, while it  was still a deficit, so that shows that it’s a   true deficit, it also points to the importance  of providing accommodations for these kids.",English
+"And then, in terms of later follow-up studies  that I think we’d like to do, would be to look at   considering motivation in the design of  academic supports and services for these kids.",English
+"The big takeaway picture here  is that neuropsych testing,   even under optimal conditions, may not reflect  optimal performance. And that’s something that we   all inherently know, but I think this study did a  nice job of illustrating that, and it’s important",English
+"to keep in mind certainly when working with brain  tumor patients but also with other populations.   So with that, I think we have about 14 minutes",English
+"wiggle room here for questions.  So happy to take any questions! Thank you so much, Dr. Holland. We do have  a few questions. So, the first question",English
+"is, to what degree is anesthesia related  to long-term neurocognitive outcomes? That's a great question. That's actually one I get  from a lot of parents, especially parents who are",English
+"thinking about not necessarily even brain tumors  but optional surgeries and things; putting their   kids under it's a concern. The issue is that we  often, especially in brain tumors, we often don't",English
+"have a control, a good control group for that.  You know, it's hard to; I don't know if there's   any studies that have just allowed children to  go under anesthesia for no indicated reason.",English
+"So that said, we know in elderly populations,  we can see delirium and things like that. So we   know that anesthesia has the potential to affect  cognitive functioning. In pediatric populations,",English
+"and especially in brain tumor populations, we're  not totally sure to what extent that's a factor. Alright, next question. Is there an  age, for example in later adolescence",English
+"versus young childhood, is there an age at which  long-term developmental effects may not be as   pronounced as they are for children that are  younger with similar types of cancer I assume?",English
+"So, that's a great question. Actually,  the term that I was using, late effects,   is basically the term that we kind of use in the  oncology world and other worlds to talk about",English
+"neurocognitive issues that develop sort of down  the road. So oftentimes, actually, what we see   is that it may be somewhat counterintuitive, but  we sometimes see worse effects further out from",English
+"treatment. The reason for that being that a lot  of these kids are diagnosed at a very early age,   and they're treated at a very early age. And  we don't expect as much of a 5-year-old as we",English
+"do of an 18-year-old. And so, as expectations  increase, it more becomes evident in terms of   what deficits they have. Certainly, we can see  you know, significant effects in 5-year-olds,",English
+"but on the whole, the pattern tends to be more  that they start out more or less on track,   they may have some acute deficits here and there,  but then as they get older, you see you get a",English
+"better picture, a fuller picture of the extent  to which that may have affected their brain. Okay thank you, that’s helpful. Next question,  given that survival rates have improved, are there",English
+"any longitudinal studies following children as  they continue to develop over time in remission? Yes, that’s a great question. There definitely;  you know, this kind of relates back to the",English
+"question I just answered. But in terms of  long-term follow-up, we do see, again, just an   increasing evidence because we’re testing more  functions, and we have higher expectations.",English
+"And also, I wish I could draw for you guys, but  if you think about an axis, like an x-y axis,   and think about developmental chart. Like, say  that you’ve got a line going out from that axis",English
+"at a steady upward angle and say that’s normal  development. And then, say you’ve got a brain   tumor patient survivor who may have been  on that same track, along that same line,",English
+"but then they go through the brain  tumor treatment process, and their line   gets sort of offset. So, they continue to develop,  you know, that line still keeps going up but it’s   going up at a less sharp rate. So, if you  draw that out kind of visually in your mind",English
+"at first, the difference is not that big; you  know, it’s just a small gap between the two lines.   But as those lines go further and further out, you  see that gap widen. And so that’s what we see in a",English
+"lot of these longitudinal studies is that they  do, again, show that sort of decline in quotes   because it’s not really a decline, but they’re  not doing as well the further out they get.",English
+"Gotcha. Similarly related to outcomes, one  person asked, are there academic results   or the academic results you mentioned, like  being less likely to finish high school,",English
+"perhaps due to parental effects? So for  example, having a child with special needs,   having the parent having a hard time  stepping out of a caregiver role.   Or I guess what extent do parental  effects have on these outcomes?",English
+"all over the world and Madeline's was unusual. It was not normal. When people say, ""I have a big tumor,""",English
+"they mean like seven, eight centimeters. They mean something the size of like, you know, a grapefruit. That's big.",English
+"They're not talking about, you know, a cantaloupe or a small melon of some sort. Madeline's was straight out of a,",English
+"straight out of a book. I mean, it's a picture. Someone takes it and they show you this picture and say, ""Look at this is how bad it can get.""",English
+"But you know you're never actually gonna see that unless you're watching a movie or a documentary or something and here it is, living and breathing, it's like right there.",English
+"It's like you saw a unicorn or something. I mean, not something you ever expect to see. Not something I had seen. So it was definitely a career moment for me.",English
+- At the end of the meeting I was pretty sure we'd never see her again. I was absolutely sure of it. And I was probably gonna be okay with that.,English
+"- I didn't put out an ad in the paper saying I wanna see the biggest, baddest tumors in the world. No, I didn't.",English
+"But one is definitely sitting right here in front of me so I have to make a decision. And the decision, to me, was already made.",English
+"This is, this is probably gonna be my career. This is probably gonna be what I'm gonna be doing in life is dealing with situations",English
+that people don't wanna deal with. - We felt that her case was so dire and no one was gonna help her. - [Madeline] I needed them a lot more than they needed me.,English
+And I knew it. I knew it. So all the doubt just went away. - At that point in time we had seen,English
+very large tumors and had been successful at removing them without paralysis. So there was no real need to show anymore,English
+talent or skill. He had proven himself that he could remove those tumors successfully. So you would have to ask him what made him,English
+"decide to take it. - You have to always ask yourself, what is your purpose. Like why are you, why do you exist?",English
+I think everyone's trying to figure that out. Why am I on this planet? What am I here to do? I'm here to do this.,English
+I'm here to try to be there in the situation where some might need to and there doesn't seem to be nobody willing to stand up.,English
+"That is my purpose. - The day of surgery we blocked out the whole day. We normally block maybe three hours, four hours, we do other cases the same day.",English
+"But for that day, everything was down. - I woke up that morning pretty sure that there was only a 50/50 chance",English
+"that we'd be doing the surgery that day so I was really relaxed, actually. And then when they said, ""Hey, she actually showed up.""",English
+"I was like, wow, we're really gonna do this. - Okay, wow. She has actually taken that first step.",English
+"- I think, ultimately, what brought her to make that decision to move forward, it was the love for her daughter and the trust that she had in Dr. Osborne,",English
+"that she wasn't able to have with other surgeons. I think that combination, even Sandra being on board with Dr. Osborne,",English
+"all that probably added and made it happen for her. - The picture taking in the office, I was with my fiance.",English
+And he had never seen the tumor in its entirety from every angle and he was blown away.,English
+"And I, as was I. - It didn't look like a tumor. It almost looked like it was a second head. It was extended all the way down",English
+below her jawline into her neck. It had blood vessels and running over the top of it that were the size of your jugular vein.,English
+"a sense of this is routine. It wasn't routine, I knew that. And they knew it.",English
+(peaceful music) - It's game time.,English
+"And I remember thinking okay, I've got my whole team locked into this surgery. I dragged them into this. I gotta step up to the plate here.",English
+"You know, for sure. There's no two ways about this. (uplifting music) I don't even remember exactly how long",English
+"that surgery was. I know people had to take breaks, use the bathroom, so it probably was long. But in my head, I have no concept of time.",English
+"I just know that it was, it was an intense day that day. - All we could think of all day was Dr. Osborne and Dr. Hamilton are in this case",English
+"and where are they and how far are they getting right now and it's this time, are they almost done?",English
+"How is she doing? You know, everybody was very alert to see like, where are we in the surgery and we knew it was a defining point for Dr. Osborne.",English
+"We wanted, we wanted a successful surgery. We all wanted that for her, for him. It was a huge day. - When the tumor came out,",English
+"it was like a baby was born. - People were very happy. Everyone was excited because, you know, we had achieved that the tumor was out.",English
+"- It was, you know, the biggest tumor I'd ever had the opportunity or the pleasure to remove from a patient.",English
+(camera shuttering) - When we take a tumor out,English
+we put it in a specimen cup that goes to pathology. This was not gonna fit in a cup.,English
+So we had to get a specimen bucket. (camera shuttering) - And then we quickly went to work on,English
+"closing her up and reconstructing her face so that, to get her back to as normal as possible at the end of the case.",English
+"(camera shuttering) And when we were done, she looked really, really good. All we gotta see now when she wake up is,",English
+"is her face gonna move? - So for me, the surgery wasn't over at that point. I was waiting for her to completely wake up",English
+and I needed to see if she was gonna move her face. - When she woke up her face moved and it was a miracle.,English
+It was fantastic. - I really cared about her. I wanted to see her smile and see how she was after surgery and she was great.,English
+"You know, she had her wrap around her head and she smiled and I was like, I almost cried because it's like, you see her smiling, you see that all of her fears",English
+"are gone, this is behind her. She just like recovered years of her life and that, that was very rewarding. Like, aside from anything that it could have meant",English
+"for the practice and for the doctor and everything, there's such a human component to it. You know, that just makes you feel like",English
+"you helped out, you know, you made a difference. You helped this person move forward and move on with their life.",English
+(horn honking) (upbeat music) - There's no denying that our actions,English
+of the past affect the landscape of our future. The decision to help Madeline five years ago put us in a position where we have become,English
+"an international referral service for others just like Madeline. This tiny lady, from a small town in New Jersey, became the gateway for us to have the honor",English
+of helping patients around the world. I recently accepted a gracious invitation to Madeline's home for breakfast. A unique opportunity to tie together,English
+"but they don't save us from judgment. Only our results do. When I met Madeline, I was forced to accept this. With the complexity of her case and her age,",English
+"the possibility of her life ending on the operating table, it had to be taken into consideration. If that would have occurred,",English
+"my entire team would have been scrutinized. However, I felt her life had already ended decades ago.",English
+The tumor had caused her to become withdrawn and reclusive. We were simply trying to resuscitate her life and bring her back.,English
+There's something unique about being a doctor. No other profession can truly capture it. I think it's the human element,English
+"of a patient giving their life over to another. People like Madeline, they look at me like I'm more than a man.",English
+"The confidence and the safety they feel with me, it's a privilege but it weighs heavy sometimes because I actually know I am just a man.",English
+"So I pray. In those moments I pray for guidance, for direction and for courage. I can never get my eggs that color.",English
+"- Some more? - No that's good. Good stuff, good stuff. (peaceful music) (birds chirping)",English
+"- It is just surreal and it was almost like a nightmare that you've woke up from and you can, you can't believe that you lived",English
+"that way for so long. And it was just unbelievable. - I felt like my self esteem,",English
+"it just took a major hit. It, it was so many instances that you know, you just wanna crawl into a hole.",English
+"If I were having company, I would go into the bathroom and I would need that bathroom for three hours.",English
+"So two and a half to three hours where I'd wash my hair, blow it dry, set it and then comb it out and carefully comb it down and underneath the tumor",English
+and then I would even glue it. A woman actually stopped her car to have a good look at me.,English
+"You know, I had to say to her, didn't your parents ever teach you not to stare? And she very nervously scattered off.",English
+Strangers come in and they wanna know what's this all about. I was not going to start up a conversation,English
+"with somebody that was curious as to what was underneath that clump of hair. And, of course, I don't blame them.",English
+"But I don't wanna spend my time there. You know, I got out of the house talking about what I'm doing about this,",English
+"because nobody's gonna like the answer that I'm giving. I'm doing nothing. It was very difficult time because when Sandra was,",English
+"from the time she was nine, until she was 12, she was dancing for New York City Ballet in children's productions.",English
+The Nutcracker and others. And I had to be there. People were curious.,English
+They knew that there was something under this hair. It was starting to grow. And some people were downright rude,English
+and some people were just so sweet about it. This was constant until it just got to the point where I just had to have some peace,English
+"and stay at home. I stopped with the doctors. I just couldn't hear it anymore because they were, some of them were downright cruel",English
+in some things that they said and I couldn't deal with it. I may not have liked the course that my life,English
+"was taking because of this decision. But I would never have said, okay, I've had enough. I felt so strong that somehow, someway,",English
+"some day, something has to give here. But then probably the last 10 years that I spent in this house,",English
+I was giving up that hope. What has changed since I've had the surgery? I got my life back.,English
+"I was living in sort of a limbo. Inside, I was just, I don't know, it was very, very, very difficult.",English
+I was always putting on a show. And finally I don't have to do that anymore. I can walk out my front door.,English
+"Which I never did. I walked out the back door. The rest is history, as you know. - She came to the office for a follow up,",English
+"some time later, like, I think it may have been over a year. She was a completely different woman. She is dressed, you know, to the nines.",English
+Her hair was done. She came in with her daughter. They'd been traveling all over the world. She was living the life that she missed for all those decades that she was,English
+kind of locked away in her home. And that was actually the most rewarding part. Not doing the surgery successfully but successfully giving somebody back their life,English
+that they lost because of this tumor. And that was really exciting to see. And that was the most rewarding part for me.,English
+"- I think you still kind of wake up everyday thanking your, you call them your guardian angels?",English
+"- Dr. Hamilton and Dr. Osborne, of course. Yeah, they are my guardian angels. They made me who I am today.",English
+- And we thank them everyday for changing our lives and our family's lives. - Now since that time we've had,English
+"several cases that are comparable to Madeline's. And I think our experience with her and the confidence that we have from that case,",English
+"and even, you know, having her speak to other patients that were potentially in her similar situation, I think has just been very helpful for the practice",English
+and has allowed us to grow and help more people in her situation. - This case really touched him at a personal level.,English
+"You know, he's the kind of person, I feel, that takes on challenges. Like, he doesn't go the easy route even when he's got it.",English
+"You know, so, and he's always talked about himself being that way. So I think these large tumors that kept",English
+"coming his way kind of put that to test. Like do you really mean that you want those challenges, like, here you go.",English
+"And so FLT3 kinase inhibitors have been approved, IDH 1,2, also mutated enzymes for which there are selective inhibitors.",English
+"And then there's some other approaches you'll hear. I'll talk a little bit about BCL2 inhibitors, which have shown some promise in AML, and there's a lot of other strategies being explored.",English
+"And so on the surface, this sounds great. There's all these new FDA approvals. And if you look at the initial response rates, it does seem encouraging",English
+"that there are some good responses initially to some of these new therapeutics. Unfortunately, these are almost across the board,",English
+"not durable when used as single agents, or even in some cases when used in combination with other agents,",English
+"almost all patients still after some time experienced drug resistance, disease relapse. And so we still have a lot of work to go.",English
+"Why is it that these targeted therapies based on rationally guided, genetic guided approaches are not working more durably?",English
+"To understand that we have to look a little deeper into the biology of this disease. There's a number of papers that have looked sort of pan cancer analysis,",English
+"pan genomic cancer analysis looked at the mutational burden of different tumors. and all of these papers, acute myeloid leukemia, AML is always on the quiet side of the landscape,",English
+meaning that there are fewer mutations per tumor in AML than in many other tumors. And so I think this is absolutely true.,English
+"It's absolutely accurate data, but I think it gives a little bit of a false impression that this is a genetically simple disease. When we look at the data across tumors,",English
+"it becomes much clearer that this is a very genetically complex disease. And this is from the cancer Genome Atlas Data for AML published in 2013,",English
+"200 AML patients, which are shown on this matrix plot, every column being one of those patients, every row, being a gene or a family of genes.",English
+"And we can see that there is across 200 patients, really incredible genetic diversity, even though there may be only somewhere around 5 to 15",English
+"mutations per tumor, they occur in many different combinatorial patterns, and almost every patient shows a different mutational profile.",English
+And this can be shown even in greater detail when looking at just seven of the commonly mutated genes in AML on this pie chart leads to something around 40 or 50,English
+different combinatorial mutational patterns that can be observed across different patients with this disease.,English
+"In addition to the genetics, which I think clearly are maybe more complex than might be inferred through some sources.",English
+"There's also additional factors that complicate AML history in therapy about 20 to 30% of AMLs arise,",English
+"either from a prior solid tumor or a prior form of cancer, which a person received a DNA damaging therapy for, and then some years later developed AML",English
+as a result of the DNA damage of that previous round of therapy. And there are those are called therapy-related another 10 to 20%,English
+"are secondary to a prior myelodysplastic syndrome. And these are very genetically complex cases that are very recalcitrant in many cases,",English
+"most cases to therapy. And so those are very difficult to deal with. We also have, as I'll talk about in just a minute, the cell biology of the disease,",English
+"the cell differentiation state of the blasts, the AML blasts, which range all the way from completely undifferentiated cells",English
+"all the way through to really pretty mature looking cells, monocytic, basophilic, erythroid looking cells. And these usage of morphology to classify AML",English
+"was very popular, 10, 20 years ago, it has really been replaced with genetics of late, but I'm going to make an argument before I hand it over to Karin",English
+"that we perhaps need to explore, reincorporate these morphologic states, which I think may explain responses and resistance to some of these newer therapies",English
+"and possibly to some of the older ones as well. So I think, you know, to summarize some of the challenges that we have with precision medicine and AML,",English
+it seems very logical that you just take a mutational profile and diagnose a drug based on that profile. But we have some really important challenges,English
+"in that there's a lot of genetic heterogeneity. As I tried to illustrate many of the mutant genes, we don't actually have drugs for in many cases, there are loss of function mutations,",English
+"we don't understand the biology well enough yet to understand what the drug that should be used for those loss of function mutations. We have this whole issue of cell differentiation state,",English
+"which is not yet explored fully. And then finally, the genetic signature of AML tells us really nothing at this point",English
+"about the micro environmental factors, or immune suppression that may also be playing a role in the disease. And so some years ago, I think about, gosh,",English
+"at this point about seven or eight years ago, we established the Beat AML program. And this was an effort that was coordination",English
+"with the leukemia lymphoma society and the Knight cancer Institute, as well as about 11 or 12 academic medical centers around the country,",English
+"and OHSU was sort of the central component of this, where we received samples from all of these dozen or so medical centers processed these samples.",English
+"The goal was to the development of cohort of about 900 AML patient samples, we surpassed that at this point, perform functional screens.",English
+"And what that means, I think I have on the next slide is essentially ex-vivo drug sensitivity, I'll talk about that in a second, perform exome, and RNA sequencing on a subset study,",English
+"the immune microenvironment, which we won't have too much time to talk about today. And then through computational biology, integrate all of these data together to nominate",English
+biomarkers or mechanisms that can explain drug sensitivity or resistance and parlay that information into clinical trials. And so we have completed in a sense,English
+the first phase of this program and that we did collect actually more than 900 samples. And the first sort of tranche of data from this data set,English
+"was published in nature hard to believe almost three years ago now. And I'll just walk you through sort of what's in that paper very briefly,",English
+"just to give you a little more background on the ex-vivo drug sensitivity assay. This is really in many ways, a pretty simple concept. It's just high throughput screening,",English
+"except rather than using cell lines, we're using primary patient material. And so we can take blood or bone marrow from AML patients, isolate mononuclear cells hormone",English
+"on a nuclear cell fractions, we process the samples immediately. We have sort of an ongoing staff that's constantly on call to receive these samples, process them,",English
+and then immediately plate them against libraries of drugs. And then three days later perform a colorimetric high-throughput cell viability assay to understand patient specific drug sensitivity profiles.,English
+"And so we have done this now, a lot of this it's again, over 900, in fact if you look across all the heme malignancies,",English
+"we've screened over the past 10 to 15 years, we've screened greater than 2,500 heme malignancy patient samples. And we really see this as a visual",English
+"that shows the small molecule drug sensitivity results. And you can see that there's really a lot of heterogeneity of drug sensitivity across these patient cohorts,",English
+"Looking, I think in this case at about maybe 300 or 400 patient samples screened against about 125 different drugs. We can also see that this heterogeneity of drug sensitivity",English
+"matches a similar plot to what I showed you earlier from TCGA. This is our version from Beat AML, where we actually have now an even larger cohort than TCGA,",English
+"and we see similar patterns of genetic heterogeneity across the patient cohorts. In fact, when we compare Beat AML to TCGA,",English
+"we do see at the most common side of mutations, those that are most commonly observed, we see pretty good lineup of the mutational frequencies,",English
+"some notable outliers like SRS2 but by enlarge the most commonly mutated genes, we see a very good agreement. If we look at the long tail, the very rarely mutated genes,",English
+"there's actually a lot of disconnect where we are seeing mutations that were missed in TCGA, conversely TCGA found mutations that we've not seen.",English
+"And so I think even with collectively over a thousand patients sequenced between the two efforts, we still probably haven't fully captured",English
+"the genetic heterogeneity of the disease accounting for all those private mutations. From a transcriptional profile,",English
+"We've also performed RNA-Seq on all of these samples. And we see that again, there's a lot of diversity of gene expression patterns,",English
+some of which do tend to organize a little bit around some of these recurrent genetic features such as mutation of NPM1 or some of the rearrangements that are observed in AML.,English
+"We did include healthy bone marrow, either whole mononuclear cells or sort of primitive CD 34 positive enriched bone marrow cells as comparitors for AMLs",English
+"in this RNA-Seq dataset. We did our informatics computational team led by Shannon McQueen,",English
+"we did just an incredible job with every aspect of this project. As you mentioned, they're still doing an incredible job. We actually have a new trench of data that we're readying",English
+"for a new publication in which we hope to be submitting any time now, probably in the next couple of months, we'll be submitting a new paper",English
+"that releases a whole new set of data, but the data that's currently been released in that original paper is all available in many different places,",English
+one of which is this home built a web portal called Vizome that Shannon and her team did an incredible job of developing a point and click tool,English
+"that I think leads to a democratization of this dataset, where you don't have to have any programming skills to be able to go in and ask questions, visualize,",English
+"explore the data set. And this website has been extremely well accessed and had, you know, and I think in the first month or so",English
+"it had 10,000 or 20,000 hits on this website. So it's been a very popular tool for people to explore this data set.",English
+"So, you know, what can we do with these data? You know, it's one thing to show the landscape of mutations, extreme expression, drug sensitivity. What we really want to do is to integrate the data.",English
+"And so that's really what that first nature paper did was to show, make predictions about, for instance, if you have mutations in particular genes,",English
+"those can confer either greater sensitivity, or greater resistance to one or more of the drugs on the panel. We could look at the gene expression data,",English
+"and we could pick a drug and say, what are the 20%, most or least sensitive samples to that drug? Can we find a gene expression,",English
+"differential expression signature that distinguishes those most from least sensitive samples? And the answer was for about two thirds of the drugs in the panel,",English
+"we could find a statistically significant signal. We could be even more nuanced with the approach and look at the gene expression and drug sensitivity,",English
+"both as continuous variables, overlaying also mutations on this very complex looking buzzsaw plot as we call it. And this approach allows us to extract additional signal",English
+"regarding correlations between drug sensitivity and mutations versus expression that were not observed in the more simple approaches above. And then finally,",English
+"we could look at the way we really spent a lot of time collecting detailed clinical annotations, Nicole, Long on our team is our clinical data manager and does just has done an outstanding job",English
+"of collecting accurate detailed clinical annotations on this whole patient cohort. And so we have the opportunity to understand that for instance, although you can't read it,",English
+"this is looking at some of those Denovo versus the MDS transformed AML cases, and seeing that we in fact do see some differential drug sensitivity",English
+"between those clinically distinct subsets. So long story short, this paper produced many predictions",English
+"of biomarkers for drug activity, almost all of which are many of which we still are working on developing mechanistic and clinical validation. And so with the last couple of slides before I hand it over,",English
+"I want to show you just a couple of examples of how we have leveraged into some newer studies where we have been able to do just that. And before I get to those, I'll just mention that, you know,",English
+"to our knowledge, this is the largest functional genomic data set of primary tumors that has been produced to date. And that we do feel that both the public access of the data,",English
+"as well as just leveraging of this large data set, can really help to inform new biomarkers and drug combinations.",English
+"And so I think, you know, in essence, although the first phase of the project is done, it's really just getting started, and in particular, the fun part is just getting started.",English
+"So just a couple of really short vignettes before I hand it over to Karin about how we have been able to leverage this data set, and I'll begin with one of these newly approved.",English
+"In fact, I think this may be the most recent approval for AML is the BCL2i inhibitor Venetoclax, which is used in combination with hypomethylating agents",English
+for elderly AML patients who are not fit for the current standard of care cytarabine plus daunorubicin regimen.,English
+"And as I mentioned earlier, you know, the initial remission rates seem incredible, and this is really a difficult to treat population. And the initial remission rates of 60 to 80%",English
+"are just far better than anything we've seen before. Unfortunately, this is not held up durably. And so after one year,",English
+"that response rate goes down to 30 to 40%. And I think almost all patients who have seen this eventually have relapsed, unfortunately.",English
+So it's not been a long-term solution. And so we wanted to understand what are the mechanisms of resistance and potentially biomarkers of sensitivity,English
+"to this BCL2 inhibitor. And so we turned to the dataset and ask the question, what does correlate with Venetoclax sensitivity and resistance?",English
+And we've just recently published this may have actually been a year ago at this point published this paper in nature cancer. And what we found,English
+"was that one of the most striking correlations was in fact, not necessarily genetic, but it was those cell states",English
+where we found that the AML tumors that had a more Mont acidic differentiation state were more resistant to Venetoclax. Those that were more primitive were more sensitive.,English
+"This was a surprise because typically speaking those more primitive cells have been described as the quote ""leukemia stem cells"" that everyone feels are problematic",English
+"and give rise to resistance, at least in response to the standard chemotherapy approaches. And we found that Venetoclax tended to show the opposite.",English
+"It does correlate to some extent with mutational profiles, where there are particular gene rearrangements in particular that PML RAR alpha, which is extraordinarily sensitive.",English
+"And these do have very high levels of BCL2 expression, and then we did see that there were a smattering of point mutations, particularly in TP53 RAS, SF3B1.",English
+Some of these do correlate with Montessori differentiation state that were resistant. So that is very consistent. And then we could turn to the gene expression data,English
+"and understand that some of the BCL2 family members, alternative usage of BCL2 family members, such as BCL2A1",English
+"was correlating with extreme resistance to Venetoclax. If one looks at normal hematopoietic cells, one can observe that in the monocytic state,",English
+"we do see downregulation of BCL2, upregulation of other BCL2 family members such as BCL2A1. So I think that all of these are interconnected",English
+"and in fact can be shown on this little cartoon diagram where we can see that cells that have a monocytic state, sometimes which might be driven by mutations",English
+"in RAS pathway, or P53 have altered utilization and expression of BCL2 family members altered mitochondrial metabolic states,",English
+"which correlates with resistance to Venetoclax. And comfortingly this has been confirmed, these findings have been also seen",English
+"by several other groups around the world, groups both in Finland and in Denver using sometimes similar approaches, but completely orthogonal data sets",English
+"have made these very same observations that Venetoclax is less effective against monocytic myeloid cells. And in fact, the Denver paper in cancer discovery",English
+"showed that in patients clinically treated with Venetoclax, relapse was often observed with a monocytic phenotype of the cells that were relapsing.",English
+"Similarly in Montreal, a group using a similar approach, but distinct cohort of samples observed BCL2A1 to be one of the strongest",English
+"correlates of resistance to Venetoclax. And then finally, the clinical trial data shows us at the genetic level that P53 and RAS pathway",English
+almost always correlate with either primary refractory or disease relapse. So it's was very nice to see that many groups around the world,English
+"are coming to the same findings around Venetoclax sensitivity and resistance. And just finally one similar finding, except the opposite of what I just told you",English
+"just very recently, Kyle Romine a graduate student that I co-mentor with Evan Linde has put out a paper in blood cancer discovery,",English
+"again, leveraging this Beat AML data set, as well as some genome-wide CRISPR screening to study mechanisms of sensitivity and resistance",English
+"to BET inhibitors, VRD four inhibitors, and finding really the converse story of what I just told you with Vonetoclax that in contrast to Venetoclax,",English
+"which is more effective than the primitive, these BET inhibitors seem to be more effective on the monocytic and resistance seems to correlate with those more primitive cells.",English
+"And so consequently combination of BCL2 plus BET inhibitors, is a very attractive option to us at this point. So, you know, long story short,",English
+we have developed this very large dataset. We have been able to use it to leverage some interesting findings regarding drug sensitivity or resistance,English
+"that said we've been missing until this collaboration with PNNL came along, we've been missing an obviously very important component to this entire data set,",English
+which is proteomics and fossil proteomics. And so we were thrilled to jump at the chance to collaborate with Karin and the team at PNNL to apply a mass spec based proteomics and phosphoproteomics,English
+"to this cohort, and adding this new data dimension, as you're gonna see from Karin has really led to some important and impactful findings",English
+"that are already being leveraged into, you know, sort of new biological understanding, and then just some forthcoming clinical trials. And so with that,",English
+"and PNNL has been funded in several prior iterations of the clinical proteomic tumor analysis consortium, which was really initially focused",English
+on complimenting TCGA analysis of multiple tumor types with in-depth quantitative global proteomics and adding phosphoproteomics,English
+"on to measurement of protein abundance, but also measuring plus correlation at specific peptides. And in 2015, they came out with a call",English
+for the proteogenomic translational research centers to try to leverage the NCI funded clinical trials and get proteomics applied to clinical trial samples.,English
+"So all the PTRC sample centers were supposed to have both a preclinical arm, which was our kind of standard proteomics",English
+with retrospectively collected samples with clinical outcomes data or preclinical models like cell lines and PDXs,English
+"and derive a signature for something relevant, translationally relevant. And at that point in time,",English
+we were picking the ability to predict the response to the small molecule inhibitors. And we were also intended to have a clinical arm,English
+using actual clinical trial samples to validate the conclusions that came from the preclinical arm.,English
+"And the little US map just shows where the various centers are really is a national consortium. Next slide, please, Jeff.",English
+"So this is the PNNL-OHSU PTRC and our initial specific games. In the preclinical arm,",English
+"We wanted to leverage the beautiful ex-vivo drug response data that Jeff and colleagues had come up with,",English
+"that was so key to the nature paper and see if we could develop a proteomic signature based either on protein abundance,",English
+"which we call global proteomics or protein phosphorylation, which we call phosphoproteomics, to predict the response to the particular patient",English
+"in the ex vivo IC50 asset. Then in the clinical arm, we wanted to leverage Beat AML samples,",English
+as well as a couple of small clinical trials that OHSU to validate the signature and see if we could reproduce in clinical samples,English
+"with the preteomic signature, the ability to predict the ex-vivo signature, and then if we could to actually compare the two predictors, the ex-vivo response and the proteomic data.",English
+"And I have to say that OHSU has always been PNNL's go-to place for our clinical partners,",English
+"we've got some of the best mass specs in the world and people who know how to use them, but they're no good unless you have an interesting clinical problem to tackle.",English
+"And that's what we got from collaborating with Brian and Jeff in OHSU. So I can have the next slide please. So our preclinical experiments, we started with cell lines.",English
+"A lot of this was to work out the methods. And so there are four AML cell lines that are incorporated into the ex-vivo essay panel by the FDA,",English
+"so that you get in a known response to benchmark. And these are K562, which are BCR-ABL cells, MOLM14s with a FLT3-ITD mutation,",English
+HL60s with an NRAS Q61L and CMK with a JAK3 mutation. And we treated each one of these cell lines with the appropriate inhibitor for its driving mutation,English
+"to satin it for a K562, Serafenib for MOLM14, trametinib for HL60 and ruxolitinib for JAK3. And we also did a time course study.",English
+"I can have the next slide. So the time course a study was zero times 30 minutes, 3 hours and 16 hours.",English
+"Look at this as a mega Western, instead of being limited to the proteins and phospho proteins that we had antibodies for.",English
+"We could look at everything all at once and use computation to sort out the 50 most differentially abundant, or most differentially slash correlated things.",English
+And we're no longer looking under the lamppost. We're looking at everything and trying to assess its change. And from just the rough heat map,English
+"that you can see on this slide, you can see that there are varying patterns of response. Sometimes things change quickly. Sometimes they change slowly.",English
+"Sometimes they revert to where they were at 16 hours after three hours. If I can have the next slide please. Working with AMIC and Oz goon at OHSU,",English
+"using their causal path tool, we were able to identify the pathways that were most differentially affected, not just the individual proteins from that heat map,",English
+"but the pathways, which I always am convinced, contain the most significant information about how the cell phenotype is changing.",English
+And the pathways are the executioners of the driving mutations. And that is how you can access the ways in which multiple mutations in the same cell line,English
+interact to modulate the phenotype of the cell. So some of our conclusions from this very preliminary pilot study actually,English
+"was that in both the MOLM14s and the HL60s, we saw the first effect of the inhibitors was in the map kinase pathway,",English
+"which was quickly downregulated at 15 minutes and 30 minutes. And this is interesting,",English
+"even though there are two different driving mutations, you had the FLT3 drug mutation versus a RAS, but think about it FLT3 feeds into the RAS pathway.",English
+"It's not that unusual that the downstream events should converge, which is one of the driving motivations",English
+behind this proteomic study. Can we find the converging parts on pathways that are treated with multiple inhibitors or have multiple driving mutations,English
+so that we can actually target a point of convergence that has multiple upstream modulators and have a more robust patient response.,English
+"For the CMK with the JAK mutation, we got a very rapid and nice almost textbook downregulation of the step pathways",English
+"In general, the 3 hour time point looked a lot like the 30 minute time point, just more so, but consistently in all four cell lines.",English
+"After about 16 hours, we saw upregulation of apoptotic pathways. So the cell lines that we were known to be sensitive",English
+"to these inhibitors were starting to die. We went on to build a combinatorial experiment, which I'm not going to report on",English
+cause we haven't analyzed the data yet. May have the next slide. Because that leads to what the real challenge is. And the real challenge is how do you interpret,English
+all these data when you have RNA DNA proteome and phosphoproteomic from the same patient. So we started by selecting a cohort,English
+"from the Beat AML1 study of 38 patients, all of whom had the ex-vivo drug response and clinical annotations proteomics, RNAC,",English
+"and whole exome sequencing. So this is just a list of the 38 patient IDs that we selected. We handed this over to our bright computational people,",English
+"Sarah Guzzling, predominantly to come up with a workflow for integrating mutations, transcripts, proteins,",English
+"and phosphosites across patients in the context of their drug response. May I have the next slide, please. So the first line tool is our correlation tools,",English
+"correlative tools, what mutations correlate with what drug response, what changes in protein abundance, correlate with what changes in drug response.",English
+"And we basically used two different methods of doing linear regression, of doing this comparison. One is a Lasso Regression Technique",English
+"and you can think of it as a continuous versus a continuous technique. We take a look at the level of abundance of genes, transcripts, proteins, phosphosites,",English
+"and correlate them with the area under the curve measured in the ex-vivo drug response. So it's a linear to linear,",English
+and we use leave one out cross-validation to measure the mean squared error. So that is the difference between the observed drug sensitivity,English
+"and the predicted drug sensitivity. For the logistic regression approach, we bind our eyes to the population. We either defined a patient as being sensitive to the drug",English
+"or resistant to the drug. And we used an area under the curve of 100. If it was 100 or less, they were sensitive. If it was greater than a hundred, they were resistant.",English
+This can kind of crispen up the data by getting rid of the middle ground where they're more or less resistant.,English
+"And so, again, we were using this approach to identify a features that predict being classified as sensitive or resistant.",English
+"And so we were looking at misclassification error. Next slide, please. Both approaches worked quite well but slightly differently.",English
+"So when we use the lasso approach, as you can tell in this slide, and hopefully you can see my little cursor, the gray boxes on the top row are the sensitive patients",English
+"and they correlate with light blue areas under the curve in the second row of ribbons, and the white are resistant",English
+"and they have the darker colored area under the curve, the higher guys of Aron perch. And we can see that sensitive and resistant patients",English
+stratified quite nicely. There are a number of different proteins that appear to be driving the clustering. And we see the same thing with phosphosites.,English
+"So the smaller panel below looks at a particular peptide that has a phosphorylation on a particular amino acid searing when 218 in map one age, for example.",English
+"So this was using quizartinib response, which is the FLT3 inhibitor. And we got some very nice data.",English
+"Next slide, please, Jeff. We then used the logistic prediction to compare the two methods and workflows",English
+"and same footnotes here, gray boxes are sensitive, white boxes are resistant. And we got tighter clusters.",English
+"We got some very strong apparent correlations, which does happen when you do this. But there was very little overlap",English
+"between the apparent driver proteins between the first method, the lasso method, and the second method, the logistic method.",English
+"So we need to go in and figure that out. One can take this simple approach of saying those things that do replicate and both methods are more robust,",English
+but we have to do some actual looking at pathway members to try to figure out why the overlap is not tighter than it is.,English
+This work has been written up and we're publishing it as a way to certify the workflow that we're going to use with a 220 patient cohort,English
+derive from the Beat AML 900 patient cohort and where we're basically going to correlate the protein signatures with the ex-vivo drug response.,English
+"Next slide, please. So a summary of what we found in this preliminary workflow was that both proteomics and phosphoproteomics",English
+"did a good job of distinguishing drug sensitivity, even with a very small sample cohort. So we have a cohort of 38 patients and we're measuring",English
+"thousands of possible peptides and 10,000 to 15,000 proteins. So that's a model for what we call a false prediction",English
+"of our overfitting, but we were able to get some really reasonable data despite the small sample cohort.",English
+"When we compared the error measurements with the proteomic data, compared to the error measurements with DNA mutations",English
+"or transcriptomic data, we actually found that the proteomic model was more robust and had lower error values than either DNA mutations or RNA-Siq expression.",English
+"They weren't hugely different, but they were consistently better when we looked at the protein values as compared to mutations or RNAC.",English
+And so we're revising and going on with the larger cohort. So that was what we had set out to say we were going to do.,English
+"And as always happens with good science, as you get doing it, you find an even more interesting question that is worthy of your effort.",English
+"So if I could have the next slide, Jeff. One of the major targets in Beat AML and AML is a FLT3 receptor.",English
+"And FLT3 inhibitors have become quite successful in the clinic. A third of all AML cases have mutations in FLT3,",English
+either an internal tandem duplication that is in-frame or point mutations that are activating mutations of kinase activity.,English
+Either type of mutation makes it constituently active FLT3 and stimulate so growth. There've been multiple FLT3 inhibitors developed.,English
+"Some of them are dirty and have a lot of cross-reactivity. Some of them are cleaner. Many of them have a very nice initial response,",English
+"but almost all of them demonstrate the eventual development of drug resistance For this study, we focused on gilteritinib,",English
+one of the more recently FDA-approved inhibitors. I think it was improved last February just before the COVID shutdown. And it showed a really nice,English
+"six to seven month initial response. May have the next slide, Jeff. So this is work of Ailey Trayer Antonio Joshi,",English
+"and they had the brilliant idea to me of looking at the development of resistance over time, not just the late resistance that you have",English
+"after growing a sunline and the presence of inhibitor for months and months and months, which the field has tended to concentrate on,",English
+but to look at the process of selecting from initially sensitive cells to resistant cells and what are the intermediate stages.,English
+And so this is what actually happens in the patient during the early days of treatment when you have your initial response,English
+and it happens in the bone marrow. So they theorize that factors in the bone marrow could be contributing to the survival of the AML cells,English
+"during this early resistance stage. So could I have the next slide, please? So they started out by culturing primary patient,",English
+the cell lines that the MV4 11 MOLM14 cell lines in the presence of gilteritinib of which is the yellow line and the cells did not grow,English
+"or in the presence of gilteritinib plus either FGF and teal or FLT3 ligand in the reddish color. And they could say after a certain amount of time,",English
+"somewhere around 25 days, the cells that were cultured in the presence of ligand started to grow out again.",English
+"Next slide, please. They termed this early resistance. No, it's very clear. Then if you took these early resistant cells",English
+"and removed the ligand and you took the FGF away, they crashed, they died. But after a certain length of time,",English
+a new population grew out and they turned this ligand independent culturing or lately assistance. May I have the next slide now.,English
+And their concept was to characterize all aspects of the transition from early resistance to late resistance,English
+"in a very multi-dimensional study. They used whole exome sequencing, small molecule inhibitor sequencing, proteomics, and phosphoproteomics, metabolomic analysis.",English
+And then hypotheses that came from the descriptive data were validated with a certain level of CRISPR-CAS9 screening.,English
+This work was just recently published in may in cancer cell. And this was just the most fun project I've ever had.,English
+"Next slide, please. So if you take a look at NRAS of mutations, which are very prevalent in the late resistance environment,",English
+"you see both the MOLM14 and the MV4;11 had large numbers of NRAS mutations, although they were different specific mutations.",English
+"You see that in very low levels of FLT3 mutations, and this matches the clinical data. This is known to be what you find in patients.",English
+"May I have the next slide, please. But if you take a look at the emergence of these NRAS mutations,",English
+"you find that initially during ligand dependent culturing, when the cells are beginning to grow out, they still have a very low allelic frequency of mutant RAS.",English
+It is not until well into the ligand independent culturing that you really see a massive outgrowth of the RAS clones.,English
+"So the NRAS mutations that were not necessary for the ligand dependent early resistance phase, and this was confirmed with CRISPR casts",English
+"knocked down experiments. At the next slide, please. Looking at the metabolomics during this transition was also very interesting.",English
+"The parental cells, as we know in culture depend on glucose metabolism. But as you've switched them to early resistance,",English
+"you saw a decline in the products of glucose metabolism and a gradual increase in non glucose related sources of energy,",English
+"particularly lipid metabolism, and interestingly, two different classes of lipids and the two different ligands.",English
+The FGF2 late cells had upregulation of single limits and the flip Ligands had carnitine and fatty acid metabolism.,English
+"Next slide please. And this is where the PNNL collaboration came in. We were asked to do proteomics and fossil proteomics,",English
+"and the very initial data analysis that we do when we do these kinds of studies, is a PCA analysis to see who groups with whom.",English
+"And we did both global and phosphoproteomic and initially it was so striking. The parental cells all grouped by themselves,",English
+"the ligand dependent cells grouped further away from the parental cells and the ligand independent cells, all grouped by themselves. And as you can see again,",English
+in the teal for the FGF2 and in the red for the FLIP3 the two different ligand classes,English
+also grouped together within this larger group of early resistance and this held even into late resistance. And this clustering was even more prominent,English
+with the phospho data. And this really led us to think that we might have a key with the proteomic data to understanding the actual process,English
+"of transition from early to late resistance. May I have the next slide, please? So we did kinase enrichment,",English
+"kinase substrate enrichment analysis, which counts the phosphorylation level on known substrates of a kinase",English
+and gives a score to kinase activity based on the percentage of known substrates that show increased phosphorylation,English
+as a result of your percolation. And we found some very interesting differences as we went from early resistance to late resistance.,English
+"In the ligand dependent culture in the early resistance, basically we saw a slowing down of cell cycle proteins, multiple CDKs were down-regulated in the early resistance",English
+"compared to the parental cells, but there was a very marked and significant increase in Aurora kinase space signaling, which was then lost when we went to the late resistance,",English
+we found upregulation of multiple cell cycle related proteins indicating recovery of cell cycle function.,English
+"We saw hyper activation of map kinase pathway members, which would go along with the NRAS activation. And we had lost that nice, increased neurotic kinase speed.",English
+"So next slide, please. That led to the hypothesis that perhaps if we inhibited Aurora kinase speed during that early resistance phase,",English
+"when we were doing the LIG independent culturing with FGFR or FLT Ligands, which if you remember is supposed to be mimicking the stromal contribution",English
+"to survive or during early resistance, could we perhaps prevent the development of late resistance or have a more complete response in early resistance?",English
+"And you can see from this slide where we treated in black with gilteritinib alone in blue with a novel through our county SPI inhibitor,",English
+"ACD 2811, and the combination of the two, when we added the Aurora kinase B inhibitor, we left shifted the viability curve,",English
+"and we got a cell death much earlier, and we mitigated the ability of the ligands to promote survival in the early resistance phase.",English
+"It was not quite as effective looking at the late resistance phase, the combination did have some effect, but not to Alyssa by itself.",English
+And this also does kind of make sense if we think that there are kind of SPI is really only contributing to the early resistance phase.,English
+"Now these were cell line studies, May I have the next slide, please? What happens in patients? And this was so we,",English
+"Emmy Cheir had a gilteritinib clinical trial going on and timing wise, this was just at the start of COVID,",English
+"but because it was a treatment human subjects protocol, it got to continue, so we actually got to continue this work.",English
+And so the thought was that the early Reavis resistance phase in vitro is modeled by the early response face.,English
+So we had pre-treatment samples from FLT3 ITD patients who were then treated with the FLIT3 inhibitors,English
+"and a bone marrow sample was taken at day 28 to 56. And we either had sensitive or resistant patients at that stage and relapsed, you know,",English
+"the return of very large tumors would be analogous to the late resistance phase. Whereas these cells that survived the initial treatment,",English
+"would be the early resistance cells. And again, they separated out very nicely on PC2. When we took a look at a heat map of the kinases",English
+"that were up and down regulated in the pretreatment and the early resistance phase, they separated out very nicely.",English
+"And when we did the pathway analysis on these results, it was very, very consistent with what we had seen in vitro with the cell lines.",English
+"We saw a decrease in cell cycle related proteins. We saw an increase in map kinase related signaling, and we saw an increase in fatty acid metabolism.",English
+"And so based on this work, there's actually a clinical trial that LA is the PI on being proposed",English
+"to combine the Aurora kinase B inhibitor with the flip three inhibitors in actual patients. May I have the next slide, please?",English
+"This is the actual data on drug sensitivity in samples from four patients with one exception, we got a very nice response during the early resistance",English
+"to the gilteritinib plus the Aurora kinase B inhibitor. In general, in pretreatment, it didn't make a difference.",English
+"There was no difference in cell viability from the kinase B inhibitor or the guilt or retina or the combination,",English
+"but it's like I said, one patient. But in all four patients, the combination really did decrease cell viability. So potential therapeutic approach,",English
+"motivation for a new clinical trial. To me, this is a beautiful series from going from very basic science.",English
+"What are the mutations? What are the changes in RNA expression, protein expression, protein phosphorylation? To actually a mechanistic explanation,",English
+"which, by the way, it has also been tested by CRISPR CAS knock downs and knock ins and leading to a potential translational output.",English
+"and because of the collaboration with OHSU, because of the great reputation of OHSU for translational work, we can go very smoothly into the patient",English
+"and actually test this out in a clinical trial. So if I may have the next slide, please. So the model that has come out of this,",English
+"and there are similar parallel data with quizartinib, which is an earlier of a type two inhibitor of FLT3. So it specifically targets the kinase activity",English
+"in the point mutants, whereas gilteritinib targets that FLT3 ITD mutations. But we saw the same pattern",English
+"with quizartinib as with gilteritinib that during early resistance, we saw a downregulation of cell cycle and we saw CDC7 being essential",English
+"for the quizartinib early resistance in Aurora kinase B being re central for the gilteritinib resistance, and then the outgrowth of the mutations",English
+"that conveyed late resistance. So if I may have this last slide, please. So proteomics is a team sport.",English
+Translational research is a team sport. We have pictures of the PNNL integrated Omix team and pictures of the Beat AML team,English
+"and all of the specific contributors marked down here, The early and late resistance work was really the PhD thesis of Sunil Joshi under the guidance of Elie Traer",English
+and has been presented in much greater detail with much more flair for the biology of the FLT3 inhibitors and the FLT3 kinase by GOC during his thesis defense.,English
+So I wanna thank you and we have some time for questions. We would be glad to take them. And my roofers were quiet.,English
+"- Thank you, Jeff and Karin. And Karin, that was really wonderful work. Very fun to hear that story. I've heard Sue Neil's version",English
+"and it's nice to hear your version. We have a little bit of time for questions. If people have questions,",English
+"- Hi Karin, this is Sunjay - Go ahead, Sunjay - Excellent work. I'm curious, you showed last few slides",English
+"with cruises, acne and FLT3. And from the resistance might accrue, you know, when you see in vivo and in vitro analysis,",English
+"and when you use this combination of, I think it was easier ACD 2811, and you see a reduction in the growth.",English
+So is it fair to believe that the FLT3 is the target for - I should defer that question to Jeff. - I can take it instead of you. That's a great question.,English
+"And in fact, one of the papers that was referenced on that slide was from Neil Shaw's lab the GCSF. And that was a nature paper",English
+so i chose to to go on and get my pharmd so while i was doing my pharmd rotations i did an infectious disease rotation at northwestern memorial hospital in,English
+chicago um and prior to that i really thought that i would end up working in a community pharmacy that was where i had done all of my work as a as a student all of my,English
+summers all of my internship all of my you know second job after going to school was always in a community setting and i,English
+really loved that patient contact that i had there but going on rotation and particularly going on in infectious diseases,English
+inpatient clinical service was really what changed my career trajectory um and because of that experience i ended up interviewing for pgy1,English
+residencies so that's the postgraduate year one residency the time they didn't call them that they just called them pharmacy,English
+practice residencies which allowed you a little more flexibility than the current structure so i have a nice old picture of myself,English
+there with my co-residence you'll see all of our stacks of paper because everything was not quite so easily available so we had,English
+all of these file folders of all of our data that we needed so during that pharmacy practice residency i was able to,English
+kind of design my own training program and i spent eight of the 12 months doing infectious diseases,English
+rotations ranging from hiv general infectious diseases um immunocompromised service lots of,English
+different different id focus in this era you would do a pgy1 where you would do you would have kind of set requirements,English
+to go through lots of different practice areas and then a pgy2 would allow you to do the more specialized training that i was able to do during that time,English
+but i was lucky i got through in a year and i decided to stay on at northwestern after that time i took a job as a medical intensive care,English
+unit pharmacist um and my reason for that was i wanted to have a little more of a diverse practice experience,English
+the nicu the way it was structured is at northwesterners we would spend two weeks going on clinical rounds in the in the medical icu with the team,English
+we'd spend one week doing staffing so staffing in the mcu which also covered the emergency room and then i,English
+actually did a fourth week in the outpatient hiv clinic so as part of my pgy1 my ambulatory experience was working in an,English
+hiv clinic um and i really wanted to maintain that so i was fortunate staying there they kind of allowed me to have this,English
+very unique practice setting where i did an outpatient hiv clinic and very intensive inpatient clinical service for a few years,English
+after you know getting my practice experience under my belt i started to kind of wanted wanted to get back into some research that i had,English
+been doing as a student and then as a resident but i found it really hard to compete with,English
+phds and other individuals who had had additional research training so while i was working full time i went back and got a master's of science and,English
+clinical investigation also at northwestern it was a program that was really designed for clinicians so it was a lot of physicians i think i was the first,English
+pharmacist to do it but subsequently several other pharmacists went through that same program and kind of while i was doing this i had the opportunity to,English
+kind of start to focus a little more on infectious diseases so the id program was starting the antimicrobial stewardship program which,English
+i'll explain to you a little bit more about in subsequent slides and so i transitioned from the mcu to starting the antimicrobial stewardship,English
+program at that time still hanging on to my hiv clinic because i really loved that and then after a few years of doing that i had an opportunity to transition to,English
+the medical school at northwestern and focus in more so on hiv particularly global health and my current research program,English
+after about five or six years of doing that i decided that i really missed teaching uh in my own discipline and i really wanted to get back to a college,English
+of pharmacy so i i went on kind of a tour of available uh,English
+options at the time and ended up at unmc so i've been here at unmc for about eight years um and as i mentioned here i don't get to do quite as much clinical,English
+time as i as i once did but i hope that i can kind of give you uh examples of all of the different types of clinical,English
+experiences that i have that led me to um what i do today uh so i guess my other uh story here is that sometimes you know i think we're,English
+always in a rush to get to kind of our final uh career position and i think what i always like to explain with with this process is that i've done,English
+a lot of different things and i feel like each one of them has has really helped me grow and develop um,English
+different goals and i think that's still true today and so again it's just another great thing about pharmacy is that you can,English
+grow and evolve and develop without necessarily always having to go down a straight path,English
+all right so infectious diseases of uh pharmacists um so infectious diseases has been a lot in the news a lot uh lately with copen so i,English
+have a feeling most of you have a general understanding of what an infectious diseases specialist may focus on um but there are lots of different,English
+subcategories within infectious diseases so there's bacteria there's fungus there's viruses um just a little bit of everything um,English
+and a lot of kind of what's unique about it is my training program there's a couple of us who focus very heavily on hiv a couple,English
+of us that focus very heavily in new drug discovery a couple of us that focus in much more general clinical infectious diseases and,English
+it really gives you a lot of different options when i think about my time on the general infectious diseases in patient,English
+service the things that i really enjoyed about it were that team-based approach so,English
+it was always physicians pharmacists nurses all working together um going around to see infectious diseases,English
+consults and so then as a consult service it meant that you were also getting to work with the general medical team as well,English
+and so you were able to really focus in on the infectious diseases aspect of what was going on with the patient but it was always really important to,English
+know what the whole picture was of the patient as well because a lot of their either pre-existing conditions or whatever currently brought them into the,English
+hospital um might really be contributing to what kind of id management we were going to give them for those of you who worked in a hospital know that a lot of times so,English
+they don't consult the id service for regular utis it's always the the id specialists tend to come out when they've given a few,English
+days of antibiotics they can't quite figure out what's going on and they need the id service to help them out so i a lot of times thought of it as,English
+kind of putting the puzzle pieces together or really doing kind of some deep investigation into what might be going,English
+on for the patient and then um as a pharmacist on the team the the role was always to um really optimize the antibiotic use,English
+but in the context of whatever else was going on with the patient so we'd always have to make sure that we were considering other medications that they,English
+were on using the shortest duration of antibiotics that we could using the most effective antibiotics,English
+very often id would get consulted and the patient would be on four different antibiotics none of which was probably the best option for whatever was going,English
+on and i always liked kind of that kind of investigative nature of id,English
+so um i don't know if this still exists in the current world of um the emr but a really common order that,English
+we would receive in the inpatient pharmacy when i first started out was pharmacy to dose and this has kind of a,English
+big history with clinical pharmacy in general because particularly in an inpatient setting the use of a antibiotic called,English
+aminoglycosides so it's a group of antibiotics that tend to have a lot of toxicities also vancomycin which i've listed here,English
+on the graph as well um they they particularly can cause a lot of toxicities and have to be very carefully,English
+dose-adjusted based on the patient's organ function um so dosing antimicrobials was one of the first ways that inpatient infectious,English
+inpatient pharmacists in general not non-infectious diseases all inpatient pharmacists really started to contribute to the clinical care patients,English
+so so much so that by the time i arrived at northwestern um we would get well refer to well definitely all of the,English
+vancomycin and aminoglycoside orders were always pharmacy to dose um and it was the old paper order so we would get,English
+you know a piece of paper with the patient information stamped on it it would just say bank and gent pharmacy to dose and that was all of the information you would get so you'd have to go to the out you have,English
+to walk out to the chart because we didn't have ehrs at the time and gather all of the information that you needed to clinically make a decision,English
+to dose the medications so for those of you who like math um it is a nice way to do that and i will say,English
+back in the day i could do these off the top of my head because i i did it enough um however the good news is for those of you who don't love math so much is uh in the last 20 years or so we've,English
+developed a lot of great clinical tools to do these types of dosing um using electronic resources so the vancomycin calculator i have here in the lower left,English
+hand corner is something that we can now use instead of having to do it by hand the way we used to but it was a great way to,English
+optimize the pharmacists skill and knowledge and understanding how the antibiotic worked and target the appropriate dose for the,English
+patient so i mentioned the antimicrobial stewardship program and that is really a booming area of opportunity for infectious diseases pharmacists either,English
+even especially today so when i started the antimicrobial stewardship program at northwestern,English
+it was a really new concept before that antibiotics were somewhat limited by the formulary so the hospital would have this particular formulary and certain,English
+medications would be on it certain ones wouldn't but that was really often the only restrictions we had and then with some of the more expensive medications sometimes it required a,English
+little bit of an additional layer of approval but generally speaking the physician could prescribe pretty much whatever they wanted as far as antibiotics went,English
+so antimicrobial stewardship programs were implemented first in the hospital setting because really to address a few different things so really from a,English
+patient safety perspective it was um there was a growing of growing evidence of antimicrobial resistance so as these,English
+really broad spectrum antibiotics were being used to treat things like urinary tract infections or very simple infections that could be treated with a,English
+narrow spectrum agent by giving people these really big gun antibiotics we were kind of breeding antibiotic resistance in the organisms,English
+particularly in hospital settings where organisms sometimes tend to recirculate among our patients so,English
+the programs really started to do some more specific targeted interventions on individuals um to tailor antibiotics to be more,English
+appropriate and often de-escalate antibiotics so take that person who is on three or four different antibiotics for a simple uti,English
+and tailor those or that antibiotic appropriately um and over time it grew from from kind of this i didn't really know where it was going at the time to today where it's,English
+it's now a requirement for all hospitals to have an antimicrobial stewardship program the cdc and the world health,English
+organization both have guidelines for antimicrobial stewardship programs and what those programs look like,English
+and importantly in those programs it's recommended that there be a pharmacist who is a co-director of the stewardship program,English
+so nebraska medicine we have a wonderful antimicrobial stewardship program that probably leads the country in in its um resources that are available if you ever,English
+google the just nebraska medicine antimicrobial stewardship there's a huge amount of resources that are open to the public,English
+so even before i came here i knew about it just from the kind of national recognition of the,English
+program here what's been kind of cool to watch with antimicrobial stewardship is um at first it focused on hospitalization,English
+hospitalized patients only um because we thought that that was where a lot of the resistance was coming from because we had these really big,English
+broad spectrum iv antibiotics but it turned out once we got that under control what we realized is that we were having a lot of,English
+antimicrobial resistance problems arising from the community both from community use of antibiotics as well as agricultural and,English
+animal use of antibiotics so stewardship now exists in the hospital setting as well as in an outpatient setting they coordinate,English
+outpatient iv centers there are stewardship programs in emergency departments and urgent cares and,English
+also in long-term care facilities uh and so the nebraska medicine stewardship program when uh when i first came was just one person and now there,English
+are about four or five pharmacists across the street who all focus in infectious diseases and antimicrobial stewardship,English
+and they really span the state in in their impact not just at nebraska medicine so um i think this is an area that will continue to grow,English
+over over the next decade or so um so here i've given a little push to the society of infectious diseases as pharmacists they had a really nice,English
+description of kind of what id pharmacists do so we've talked about them being steward stewards of appropriate antimicrobial use,English
+but they also do a lot relating to education not only of of students but also other healthcare team members,English
+they really work really closely in collaboration with the microbiology department the infectious diseases physicians,English
+as well as really all of the different services within the hospitals and then i think there uh really are advocates and also innovators and we'll,English
+talk about that a bit when we talk about coven but i think id pharmacists starting at that very early in the 1980s when people started writing,English
+pharmacy to dose to today i i think pharmacists in general have been really good at innovating and in id i think we've seen some,English
+specifically and then i've just highlighted uh one of our our clinical faculty clinical associate professor scott bergman uh he's actually,English
+the he's the direct one of the heads of the antimicrobial stewardship program over at nebraska medicine and he's also the current,English
+president of the society of infectious diseases pharmacists so a real national leader that we have here on campus,English
+um so i can't do an id talk without uh mentioning the covid 19 pandemic um i think we all know that it's affected all of us those of you working,English
+particularly in outpatient settings know how much pharmacy has has really uh taken on a huge role in the care and prevention,English
+of code 19 in our communities and so i just wanted to highlight this is something you know we see it,English
+highlighted here and i think pharmacy is getting recognized for how much we've done in the covid um era but i think this is something that really illustrates what pharmacists do,English
+in general i think we we did this with point of care strep testing we've done this in uh point of care hiv prevention services,English
+we've we've done this in other areas um as well and i just think that kovud was a way to really highlight this for the community,English
+the challenge is finding the time to do everything that community pharmacists are now being asked to do,English
+but it is really a true public health role that that pharmacists have um so for those of you not familiar with it if we do have any prospective students,English
+so um pharmacies have been a huge source of of uh getting the community vaccinated for copen,English
+now a huge source of dispensing oral anti-copita therapies for patients who are positive,English
+and then just community education on the inpatient side what what people may not be as familiar with if they don't work in a hospital setting is the,English
+id pharmacy group really led a lot of the early vaccination efforts of health care,English
+workers so almost all of the pharmacists that i know that still work in a an inpatient setting um,English
+really led the the organization's efforts for getting individuals vaccinated and so again i think it's just a demonstration of the,English
+huge public health impact that pharmacists can have all right so now i want to shift gears a little bit and talk more about what i do,English
+currently or what i have done in the last few years because i think we think about uh id is mostly antibiotics but there's also the whole,English
+area of viruses and hiv has been one of those areas that i focused in um,English
+over the last well i always did from residency on but uh over the last about 15 years it's pretty much,English
+been my primary focus so um so i've put up just some general statistics here so hiv is um is also a global pandemic so about just,English
+under 40 million individuals living with hiv worldwide um the highest burden of hiv infection is in sub-saharan africa but we do have about 1.5 million people,English
+living with hiv here in the u.s and a couple of thousand people living with hiv here in nebraska so it is something that still,English
+touches close to home so how i got interested in it um as i mentioned i think at the beginning in my pgy1 we were required to do,English
+outpatient ambulatory longitudinal experience so we did a month of training in the outpatient clinic and then we did one day a week throughout our pgy1,English
+and at the time our only ambulatory or outpatient options were either hiv or anticoagulation so i'd gone to school in iowa,English
+i had done an anticoag rotation as a student but i didn't really know anything about hiv at the time so i,English
+opted to do that it was also a really interesting time in hiv this was the late 90s and,English
+really effective medications for hiv had only just come out prior to that there was not really a,English
+very effective medication strategy the mid-90s was really the first what we call highly effective anterior viral regimen some people call it heart some,English
+people call it art you'll see it probably abbreviated as art on my slides but at the time this picture here is is,English
+a true example of how many pills per day the patients would have to take in order for it to work so it was highly effective which was,English
+you know really life-changing for people who were living with hiv at the time but as a pharmacist it was a huge challenge,English
+so patients had a lot of barriers to accessing the medications and then when we get them the medications they would,English
+have to take sometimes 20 pills per day they all had food requirements they all had drug interactions,English
+and it was just a really cool place i think as a young pharmacist for me to see like how pharmacy could impact um directly on patient care,English
+um the other thing that i really liked about it was it sort of merged my kind of two passions so i told you as a student i worked a lot in a community and i loved that patient engagement,English
+well then moving into the hospital setting particularly in an icu environment you don't get to talk to very many patients in an icu setting,English
+um unfortunately they're mostly uh sedated and intubated and you don't get that patient contact that i was missing um,English
+and so that week a month that i got to spend in the hiv clinic was really a way for me to stay connected with patients and gave me a chance to see patients,English
+we've come a long way since the mid 90s we now have i should remember this off the top of my head we have about eight regimens now if,English
+i'm remembering correctly that can be given as a total regimen of two to three medications in a single pill once a day and we've removed a lot of our prior,English
+concerns about taking it with food and some of the drug interactions so it's been uh great to see the evolution of hiv care over,English
+the last couple of decades and the even better news is now with this effective therapy the life expectancy for an individual,English
+living with hiv is almost the same as uh as a peer so as long as they can get uh into care get on medications get access to the medications,English
+none of which are are easy hurdles to get over but if we can do that we can give them a life expectancy similar to that of their peers,English
+which now means that we have an aging population so we're not only taking care of their hiv but we're taking care of all of the,English
+other things that come with aging like high blood pressure and diabetes and anticoagulation and really have,English
+have kind of turned the corner into a long-term chronic illness so with that i wanted to just touch on ambulatory care,English
+i know our students are very familiar with this but for any of you who are not familiar with it so it's really a patient-centered care so it's really,English
+with the patient at the center of all of our our care and it's it's really a t it's again a team-based,English
+clinical environment you probably hear themes that i bring up a lot and what i've talked about but it tends to be the the types of,English
+environments that i have always enjoyed working in are team-based settings so back in my inpatient days rounding in the micu or on the id service,English
+where i really got a lot of professional satisfaction was was from team-based care in ambulatory care outpatient,English
+care the role of the pharmacist was not very developed at the time like i mentioned there was only two options anticoag or hiv,English
+and now we have a huge number of clinics that integrate pharmacists into teeth-based care in an outpatient setting,English
+so i've kind of highlighted a few things here that we do every day in not only an hiv clinic but in,English
+ambulatory care in general but i just wanted to highlight any of you who didn't catch dr cook's presentation last month she did a great job of of,English
+really describing what a day in the life of an ambulance ambulatory care pharmacist is like and i would really encourage you to,English
+go back and listen to that if you're interested in kind of learning more about that so for hiv um as i mentioned,English
+lots of drug interactions lots of different regimens that we have to select based on patient-specific characteristics so it's a little bit,English
+like antibiotics and that effect we're looking at the whole patient we want to talk to them and see if we can understand what their goals are of,English
+therapy or any potential barriers they may have to certain regimen so if i have a medication that has to be given with food and the patient tells me they fast during the,English
+day and don't want to take anything at night obviously i'm going to steer to another option the clinic here on campus has a full-time pharmacist,English
+who is also a clinical faculty member here dr josh havens he meets with all of our new patients who come in,English
+prior to starting medications a lot of patient education a lot of help accessing therapy,English
+and then some unique things that he he does and pharmacists in hiv clinics in general do are are really focused again back to public,English
+health so we have a pharmacist run pre-exposure prophylaxis clinic um so that's a new type of strategy to prevent new hiv infections by giving,English
+medication to an individual who's at risk for hiv so perhaps somebody who has a partner who's hiv positive or has several partners who are they're not,English
+sure if they're hiv positive or not it's a new strategy that's incredibly effective at preventing new hiv infections um so although it it it's directed at,English
+healthy individuals so people not living with hiv in theory it should be given in a primary care outpatient setting it doesn't happen very much i think a,English
+lot of primary care providers are are just not as comfortable with it so josh has a huge clinic that's a pharmacist-based clinic,English
+that provides hiv prevention services to the omaha community so lots of different options there,English
+so i'm going to rewind a bit and tell you about my past so again i started out in the hiv clinic working,English
+eventually about half time in the hiv clinic half time in the inpatient id antimicrobial stewardship program,English
+and while i was doing that i was happy doing it but i you know it was still an early stage of my career and one of,English
+the physicians that i was working with had started to work with a program called the president's emergency plan for aids relief so this was a u.s,English
+government there is a u.s government-funded program that still exists today but it started out as a five-year,English
+program in 2004 that was at first really an emergency response so this was when we identified that we were doing all of,English
+these great strides and caring for patients living with hiv in the us but we weren't really doing anything for people living with hiv in the areas of,English
+the world hardest hit by hiv infection so the first five years were targeted at the 15 countries who were most hardest hit by,English
+the hiv epidemic and so that was the emergency response portion of it and the goal of it really was to,English
+scale up the support and treatment options for patients with hiv but in doing so it involved procuring the medications and sending medications to those countries but,English
+another component was also scaling up the healthcare provider ability to use those medications because you can't just drop,English
+a bunch of drugs in a setting where they don't know what to do with them so it was a lot of capacity building a lot of,English
+infrastructure support to build up um the clinics to be able to to provide care for a really growing number of of,English
+individuals and then it focused on really sustainability so as i mentioned it's still going on today,English
+um this cuts off at 2013 because that's when i get transitioned to nebraska but,English
+the it still goes on but there's a lot of in-country partners now who have taken over the the,English
+day-to-day operations of the program so i was helping out this physician um in this program by developing some drug,English
+information tools so like for example this card on the right here to keep in mind in the clinics they did not have,English
+computers when the program first started out so they needed some quick reference tools um so kind of,English
+the call it the second shift so after i get done with my shift for the day i would go home and i'd work on some of these,English
+tools to help them just distribute into the clinics in nigeria specifically um and then i did this for a little while just to help out and uh one day he,English
+came into my office where i was seeing patients and he was like so how do you feel about traveling to nigeria,English
+um it was not something that i thought of as a as a pharmacist that i would end up doing but i i took the chance to do so and,English
+that's when i transitioned into the medical school and i became paid pretty much entirely by this grant to work on training and,English
+education programs for our colleagues in nigeria so i split my time between chicago and nigeria um doing this,English
+uh originally it was just supposed to be drug information and and training um but we quickly realized that uh they needed some support in supply chain management,English
+so although i've not really done a lot of drug ordering or drug supply procurement um if you're a pharmacist they're going to assume that you can do,English
+that so so i did start helping out with that as well not the day-to-day shipping but just helping them understand how to quantify how many medications they would need,English
+um all of the medications that we were giving at the time were individual drugs uh with different dosing so it wasn't quite as simple as one pill once a day,English
+and so to help them understand how to provide a complete regimen and plan for that so i did that for several years mostly just again on the kind of,English
+scaling up the capacity um but as i was working on the the training programs i kept getting these clinical questions that would come up over and over again,English
+and one of those in particular was what kind of birth control can i use for my patients taking in retroviral therapy because there are,English
+a lot of drug interactions and most of the studies that have been done related to hiv were done in the u.s or europe where,English
+the hiv epidemic particularly back then was primarily affects males and there were just not a lot of women that were included in clinical trials so,English
+there wasn't a lot of information on how how to manage women's health issues so it was one of those things where i,English
+just didn't have a good answer for them of what kind of effective contraception um so hormonal contraception that i could could offer them um,English
+in addition to the use of of condoms which uh women in sub-saharan africa don't always have the the ability to enforce,English
+in a relationship um so that question really was what led me to,English
+kind of pursue my next passion which is research um and it was really something that i don't think i would have uh come up with had i not been in those,English
+clinical clinical settings answering those questions so i just have a couple of slides on it i'll save more details on it for another,English
+presentation but um the first study we did was looking at the leave in a gestural contraceptive implant so that's a an implant that is,English
+placed subdermally on the inside of the arm it's intended to be used for five years five years,English
+but it can be removed at any time to allow a return to fertility and the implant was being rolled out really globally it was kind of,English
+simultaneous with the pepfar program there was a program to increase access to contraceptive options throughout the world so they were rolling out this implant um,English
+at the same time we were rolling out this medication for hiv and if you looked at the package insert it said not to combine them but everybody was combining them anyway um,English
+because there was no other option basically so we decided that we would um just do a easy pk study where these were,English
+women who were already going to get the combination of antiretroviral therapy plus this implant and we would just check drug concentrations periodically,English
+while they were on it to see at what point they fell below a threshold we thought would be effective for contraception,English
+because it was used for five years it starts out kind of high and then kind of gradually falls off so we thought that possibly it would be good for the first year or two but maybe not for the full five,English
+years so long story short we enrolled about 20 people per group um these lines probably look very similar but this is a one-year period of time,English
+and so the implant is placed you see kind of a pretty fast increase in concentration so it works very quickly to provide birth control,English
+um and then it sort of stabilizes over time so the red line is what you would expect the concentrations to look like so these are people without a drug interaction so these were women living with hiv who,English
+did not yet qualify for antiretroviral therapy at the time and then the orange line which is notably lower,English
+were women on a favorance based antiretroviral therapy which is a type of medication that's known to speed up the metabolism of some,English
+medications which we clearly see here happening so we saw about a 50 reduction in leaving a gestural exposure over that,English
+first year but if you look at what we thought we understood or thought we knew about the the threshold for effectiveness of,English
+contraception um it had been well quoted for a very long time that that concentration was 180 picograms per ml so you know our,English
+concentrations were above that um so in theory we thought this uh might be okay however uh of the 20 individuals in our efavarians group we observed three,English
+pregnancies um over that first year of use which if you're ever doing a birth control study it's not something you,English
+want to get a phone call about but one of your participants has become pregnant um however you know honestly the individuals were okay with it they were not,English
+you know they were it was not a bad news for them their family was was fine and happy with it so that made me,English
+feel a little bit um better but it did help us understand that the concentration that we thought was providing the best,English
+effectiveness for the contraception was not correct so two of our three concentrations were above that 180 picograms per ml,English
+so i don't like to just find a problem and not try to fix it so we have done some more work in this area to try to overcome this interaction so,English
+i'll just show you briefly this was a study using another type of implant but very similar similar type of implant that's used over,English
+three years the blue line is individuals without an interaction the red line is,English
+with ephaverins again and this the single implant and then this orange line here we took a second implant and so instead of putting,English
+in one we put in two to see how it did it did double the exposure but it didn't quite get up to where it was before,English
+without the interaction so still a little bit lower but the good news was this study we actually evaluated all of the women had a second form of,English
+contraception in addition to the implant and then we evaluated how many women ovulated so the way that the implant,English
+works is it prevents ovulation it also changes how the cervical mucus looks and so we were able to see that we had,English
+fewer women ovulating in the double dose group at least over the first 12 months of therapy so we're encouraged that we may be able to find some strategies to,English
+overcome this so that's just a quick highlight of my work that i spend a lot of time on i think it's a good example of,English
+how clinically based questions can lead to practical solutions and then i just wanted to highlight so i've just talked about sort of the,English
+areas of id that i have worked in but there are so many other options out there for id pharmacists and i've worked with different pharmacists in each of,English
+these different areas so the national institute of health have they have traditional pharmacy roles they also have pharmacy research roles,English
+they also have a pharmacist who leads their clinical guidelines for not only hiv but also opportunistic infections,English
+so really strong clinical background that then translated that to again public health guideline approach the fda there's tons of pharmacists,English
+working in the fda the head of the antiviral uh an anti-infective branch is a pharmacist not a phd pharmacist she's a pharmd,English
+some additional training um but there's lots of pharmacists that work in regulatory approval cdc uh,English
+it's kind of interesting they have a cdc job profile for pharmacists and kind of shows what different pharmacists do within the cdc,English
+both related to epidemiology and also more traditional medication management as well as research and then an area that i think people,English
+often don't think about but is the u.s public health service so there's lots of different roles um in the public health service that are,English
+specific for pharmacists so um and then of course there's academia uh which i come to you from so,English
+um there's there's really not a shortage of different opportunities available so i think i will close there and hope that uh you have a few questions for me,English
+and that i haven't put you all to sleep or sent you off to study for your cardio exam,English
+all right are there any questions you can either say them or you can put them in the chat as well i'm monitoring that as well,English
+apbes um and either we have the opportunity to work with some infectious disease pharmacists or just infectious disease residents and,English
+potentially our internal med rotations or even if we're doing an antibiotic stewardship rotation how do you um recommend us as,English
+pharmacy students as far as putting ourselves in those conversations to potentially make recommendations just because we haven't,English
+had a lot of experience in it but just for like our learning purposes um and just staying up to date and just being part of the team how do you,English
+recommend us going um about um and making those recommendations to either pharmacists or providers that's a great question um and i will,English
+"and that is what cancer and cancer metastasis is, an emergent system. And this approach of putting things together",English
+"is one which is very natural to physicists and engineers, because engineers are the one who put together this car.",English
+"So, can we put together different genes or proteins in the way that they interact in a cell in order to get a better understanding of metastasis",English
+"as a system, as an emergent, complex system? Let me give you an example: weather forecast. Today, we can predict weather very accurately...",English
+"well, what is going to happen in the next 7 days or even further? When are we going to get thunderstorms? When are we going to get good sunlight?",English
+"And based on that we actually make our travel plans, which means that we trust it so much. Well, it took at least a century to get here.",English
+"Climate scientists, physicists, and engineers, they collected all different factors that contributed to the weather of a particular place,",English
+"the climate of a particular place, and then put them together in the way that they actually interact, including how strongly they interact with one another.",English
+"And this is just a 'primitive' set of equations that actually controls this, there's a lot of math that went behind it,",English
+"and that is where we are today, after having undergone this validation and calculation of the model. So, can we, today, begin this journey of",English
+"putting together various genes and proteins that interact with each other to control metastasis and, not necessarily today, but some years down the line,",English
+"can we build a model which can actually predict metastasis? Can we have that amount of trust in it, just as we have in the weather forecast today?",English
+"So, today I'm going to take you on the first few steps of that journey that I have latched onto. Alright... so, metastasis...",English
+"when cancer cells leave the primary tumor, they can do it in two different ways: they can either leave as single cells or they can form a cluster",English
+before the enter the freeway and then leave together. It is like whether... is there a set of cars leaving at different times,English
+or is there a set of cars that are together on a ramp just waiting to get on the freeway? Experiments have shown that there are,English
+30 times more single cells that are shed off the tumor as compared to only clusters. But the clusters form,English
+"50 times more secondary tumors, or metastases, than single cells. And these clusters are not too large,",English
+"they are 2-7 cells large, so you can do the math and realize that there is indeed something",English
+"to cancer cells staying together and that is what leads to much more metastasis. There is a value in staying together; united they stand, divided they fall.",English
+"So, what exactly is this value and how do cancer cells utilize it? Let's go through that. So, if these are the real villains of metastasis,",English
+"these clusters, then let's try to understand, how do cancer cells form these clusters? How can we break these clusters, what target can we use?",English
+"And, eventually, why do these clusters form much more metastases? Let's go to the first part: ow do cancer cells form these clusters?",English
+"Before we go into the details, let me give you a relatively detailed understanding of how metastasis actually happens. So, let's consider that",English
+"these primary lung cancer cells, now, they do not have the innate property to move, as we discussed earlier,",English
+"so in order to move, in order to get on the freeway, they need to do two things: they need to break their bonds with their neighbors, the tight cell-cell adhesion that they have;",English
+"and at the same time, they need to gain the property to migrate and invade. Now, this property of staying together and not moving",English
+"is the property of epithelial cells in our body, such as the skin, and the cells that line multiple organs, such as breast, prostrate, and lung.",English
+"On the other hand, the property of not adhering and migrating is the property of mesenchymal cells in our body,",English
+"such as red blood cells. So, when cancer cells have to get on the freeway, they need to take on these properties of mesenchymal cells.",English
+"I'm not saying that they have to convert to mesenchymal cells, they don't have to become red blood cells, but they have to take on these properties.",English
+"And this transition is what is called as epithelial-to-mesenchymal transition, which is usually the first step in the metastatic cascade.",English
+"Now, once they on the freeway, once they're in the blood circulation and they survive and they get out at a different organ, take an exit,",English
+"now what they need to do is that... grow an entire new tumor, for which they need to shed their migration",English
+and invasion properties and regain their property of adhering to their neighbors. And this is the exact opposite transition,English
+"that we just talked about, mesenchymal-to-epithelial transition, which is usually the last step in this metastatic cycle, and the cycle can continue, go on and on,",English
+"forming multiple secondary or tertiary tumors at multiple different organs in the body. Now, EMT or MET,",English
+"as I'll refer to them throughout the talk, are not some new processes invented by cancer.",English
+These are normal physiological processes that happen during embryonic development and even wound healing and these processes are co-opted by cancer,English
+"to metastasize. Let's talk about wound healing for a bit. So, when you get a wound on your skin, you see the cells move together",English
+"and actually close that wound, and once the wound is filled, they stop moving and settle down. So, this is exactly what EMT and MET is going on.",English
+"But those cells typically move collectively, so... which is not really epithelial and not really mesenchymal. So, is there a state somewhere in between",English
+"where cells can both adhere and migrate, which can close the wound and, in the case of cancer, it can form much more clusters...",English
+"is there a stable state, a hybrid state, in between? So, recent studies have observed that in circulating tumor cells in patients,",English
+"those cells can co-express epithelial and mesenchymal proteins, suggesting that they're somewhere hybrid in nature. More importantly, what they observed",English
+"based on the biopsies of primary tumors, is that the more aggressive the cancer is, the more the number of such cells.",English
+"Of course, this is just a correlation, not a causal effect, but it definitely points to some correlation... it definitely points to some",English
+"connection between how hybrid cells... how many hybrid cells are out there and how aggressive the tumor is. But despite this,",English
+"the feeling in the field has been that, well, this is just a transient nature; cells cannot actually maintain this state for a very long time",English
+"and this is just a snapshot that got captured when cells were in route at EMT. So, that is the question that got me most excited:",English
+"is this a stable state or is it just a transient, intermediate, unstable state? So, here are the three states we have been talking about:",English
+"epithelial, to the very left, where cells adhere very strongly and do not move; mesenchymal to the extreme right, where cells migrate but they do not adhere;",English
+"and in between is this hybrid state where cells both adhere and migrate, therefore leading to this collective cell migration",English
+"or clustered cell migration. Now, how do we understand how cells can attain this state, whether hybrid is a stable state at all or not?",English
+"Again, going back to the approach of putting the car parts together... so, what I did was scan through literature of multiple different cell lines belonging",English
+"to multiple different cancers and try to identify, well, is there some core unit, is there some core set of proteins, genes, microRNAs,",English
+"that interact with each other and control EMT in multiple different contexts? And this is the network I came up with,",English
+"where there are four different players, which are connected to each other in a relatively complicated manner, the details of which I am not going into.",English
+"And there... two of which are transcription factors and two of which are microRNAs. The numbers you see here represent some kind of a quantitative relationship between them,",English
+"but, again, I'll not bore you with the details. The only thing I want you to remember is that what we know experimentally is that the amount... if the amount of SNAIL is ZEB are high,",English
+"then cells are mesenchymal, and if the amount of SNAIL and ZEB is low, then cells are epithelial. Alright.",English
+"So then, after finding these interactions, I wrote down mathematical equations which actually represent these interactions and, after doing calculations with these equations,",English
+"let's see what exactly the model predicts. So, here is the prediction of the model, where there are three solid lines,",English
+"each of which represents a stable state, which is a phenotype that cells can attain. The dotted red lines represent unable states. So, going back to standard high school physics,",English
+"we know that if the unstable state is perturbed, it exits that state, so cells cannot actually stay in that state, so therefore we are going to focus only on the unstable states",English
+"in this context. Now, let me break down this graph for you. So, out of the four players that we've discussed, I've here taken only two players, just for the purpose of representation,",English
+"to see what exactly the model says. So, at very low levels of ZEB, which is the y axis,",English
+"you see there is only one state, which is epithelial, and that is what we know from experiments. At very high levels of ZEB,",English
+"again, there is only one state, which is mesenchymal. And in between, you see this... another solid blue line,",English
+"which corresponds to intermediate ZEB levels, ZEB levels which are higher than those seen in epithelial",English
+"and lower than those seen in mesenchymal, and this intermediate state corresponds to a stable hybrid state. So, a prediction of the model is that,",English
+"yes, there is stable hybrid state that cells can achieve. Alright. Let me walk you through another facet of this graph. So, if you see, the very left part of the graph...",English
+"now let's look... we have already looked horizontally, now let's look vertical... so here, what you see is that",English
+"if the amount of SNAIL protein is less than 180,000 molecules and if you walk vertically upwards, there is only one blue solid line that you cross,",English
+"which means that there is only one state that cells in this region of parameters, or in this region of conditions, can attain, and that state, as you can see from ZEB levels,",English
+"is the epithelial state. Going to the very right, there is another region in which, again, there is only one state,",English
+"but that particular state is not epithelial, but the state with highest ZEB levels, which is mesenchymal, actually. And in between we see this interesting region.",English
+"For example, let's draw a vertical line from 200,000 molecules of SNAIL, and you see it will cross three distinct blue curves,",English
+"and each of those blue curves corresponds to a stable state, as I've already mentioned, and these three stable states are epithelial, mesenchymal, and hybrid.",English
+"So, again, what the model predicts is that there can be some conditions under which these three states can coexist with each other,",English
+"so if... there might be experimental cases, some cell lines, in which you can see that all these different,",English
+"three kinds of cell or phenotypes are present in the cells with the same genetic background, which is what a cell line is. So, once we made this model,",English
+"we wrote to a couple of experimental biologists working on EMT, trying to see, well, how do they react to this? Do they react in a very similar way",English
+"that my master's experimental biologists did, or they are actually supportive of this? So, one group is Seattle actually wrote back, among other groups as well,",English
+"and said, well, we have two pieces of good news for you. One is that we have been looking at a cohort of 40 different lung cancer cell lines",English
+"and we actually see that many of them lie somewhere in between epithelial and mesenchymal. And the other good news is that we are moving to Houston,",English
+"right across the street from Rice University at MD Anderson Cancer Center, so why don't you come over and we can discuss. And this was indeed the turning point.",English
+"So, once we discussed with them, they had these intermediate cell lines which were lying somewhere in between epithelial and mesenchymal, and how did they identify that these were intermediate?",English
+"Because they took measurements of several epithelial and mesenchymal proteins and their mRNA levels. But beware, all these measurements",English
+"were taken on a population level: they took 1000 or more cells of this and then crushed them and see, what was the amount of RNA present in them?",English
+"And this is the problem with taking population-level measurements, that you actually do not see what is going on at the single cell level.",English
+"So, when we looked at those cell lines, what we observed was that there were some cell lines in which there were some epithelial cells",English
+"and some mesenchymal cells, but not hybrid cells. So, here is a cell line, as shown here, where red is marking an epithelial protein",English
+"and green is marking a mesenchymal protein in these immunofluorescence images, so you see cells have only red or only green, which means they're only epithelial or only mesenchymal.",English
+"Another cell line where you see that cells actually co-express red and green at a single cell level, so these are indeed hybrid cells,",English
+"which is different from a mixture. So, a mixture is different than a hybrid cell. Its characterization is different, its migration traits are expected to be different,",English
+"and so on and so forth. Again, this is a snapshot. What is a stable state? If it is perturbed, it comes back,",English
+"or, in other words, it retains itself if not perturbed. So, in order to see whether this hybrid cell line which got us so excited",English
+"was indeed a stable state, we... our experimental collaborators, they actually cultured this cell line for multiple passages",English
+"and saw that, even after two months, they were actually coexpressing red and green, which is what is suggesting that, yes, can they be indeed stably present",English
+"in that hybrid state. Now, another thing that I've been talking about is that these hybrid cells are likely to move collectively.",English
+"Now, let's see if that is shown in the experiments, also, because eventually the proof of the pudding is in the eating, right?",English
+"So, here we take a mesenchymal cell line and a hybrid cell line and what you do... our experimental collaborators did is a scratch assay,",English
+"where you actually grow cells until they are confluent on a plate and then you just mark a scratch using a needle, and the way cells move to fill in that gap",English
+"is what is used to characterize their migration properties. Now, let's see how mesenchymal cells moved. So, the rightmost column",English
+"is just showing a zoomed in image of the middle column, as you can see these cells are flying out as single cells -- they just don't have any direct physical connection to each other.",English
+"However, the hybrid cells are moving more collectively -- they have not yet broken the bonds with their neighbors, they're actually moving collectively --",English
+"therefore leading to these finger-like projections as pointed out by these white arrows. So, indeed, these cells are hybrid, because it's a stable state",English
+"and of course they move collectively. Now, we were very intrigued with this hybrid cell line, because in our diagram, in our model,",English
+"we did not have a parameter region in which the only state was hybrid, so that's what got us thinking that,",English
+"well, what... how can we tweak the model, how can we add or delete components from it so that we can get a region in which the only state",English
+"is hybrid? And also, at the same time, we wanted to identify, well, what targets can break these clusters? So, if we can identify",English
+"what can give us a stable hybrid state, only a stable hybrid state, deleting that can destabilize the hybrid",English
+"and potentially lead to disrupted collective cell migration. Alright, so let's go back to the math.",English
+"So, this is the diagram that I showed you earlier and I would, again, like to highlight here that there is no parameter region in which the only state is hybrid.",English
+"There is a parameter region in which the only state is epithelial, there is a parameter region in which the only state is mesenchymal, but not a region in which the only state is hybrid.",English
+So then I went back to the wound healing and developmental EMT literature to see if they are talking about some players which can either disrupt or maintain,English
+"collective cell migration and, once I had a list of players from that literature, I looked at, well, do we know how exactly they couple to the players that we have here?",English
+And once we had a list of players which were implicated in collective cell migration as well as we had enough quantitative information,English
+"about that to couple to this model, I actually incorporated that into our model and, as you will see, the diagram changes. So, this is just one example that I'm showing you, here,",English
+"this particular protein called GRHL2, which connects with ZEB -- it inhibits ZEB and is inhibited by ZEB -- and you see the diagram changes",English
+"and if you look at approximately 400,000 molecules of SNAIL and go vertically upwards, as shown in this region highlighted by this dotted rectangle,",English
+"you see the only state is hybrid. So, adding this single factor stabilized the hybrid state.",English
+"Again, let's go to the inverse -- deleting this should destabilize the hybrid state. Again, let's go back to the experiments",English
+"and see if it actually holds true. So, we went back to the same cell line, which was stably hybrid and, as you can see",English
+"again, they're moving collectively, as you can see in the left column. On the right column, what we did was we deleted that particular protein from the cell line, and you see that their migration",English
+"is not completely collective now -- it has been disrupted and they start to begin moving more as single cells. Also, when we looked for the presence of red and green,",English
+"or epithelial and mesenchymal proteins that we have been talking about, this intermediate cell line, as I showed you earlier, this hybrid cell line,",English
+"co-expresses red and green in the same cells, but with the knockdown of this single protein, as predicted by the mathematical model,",English
+you see that the red just goes away and the cells are only mesenchymal. And that is consistent with the idea that they're moving more as single cells,English
+"rather than as collective cells. So we predicted this from the model and then we got it eventually validated, but I should remind you that",English
+"the whole idea about this project came from... that there is a stable hybrid cell line, so this is a wonderful example of how biology can inform math and math can inform biology,",English
+"and we can iteratively go forward to have a better understanding of the system. Now, once we had done this in vitro validation, we wanted to go to some clinical data",English
+"and see if it supports our hypothesis. So, a high amount of this protein, GRHL2, will potentially lead to more collective migration,",English
+"more clusters, and more clusters will decrease the survival period. So, what I did was look at a cohort of approximately 1000 lung cancer patients,",English
+"which were divided into high and how amounts of this protein, and then we looked at their 5-year and 10-year survival probabilities. As you can see, the patients that have",English
+"high amounts of this protein have a lower probability of progression-free survival, which means that the disease has actually progressed, in more cases,",English
+"as compared to the percentage of cases in which there is a lower amount of this particular protein, and that is what is shown in the graph here. The red line shows the cases where the protein...",English
+"where the patients have high amounts of this protein and the black graph shows that... the black curve shows the cases where the patients have low amounts of this protein,",English
+"and there is a difference, a stark difference in both the 5-year and 10-year survival probabilities, which is consistently with our hypothesis. Alright, so we have talked about these two aspects,",English
+"both of which are connected to how cancer cells get on the freeway. Now, let's talk about the last aspect,",English
+"that is, once they have survived the circulation and gotten off the freeway to a secondary organ, to a distant organ,",English
+"how exactly do they form secondary tumors. So, why do clusters form more metastases? Again, a very similar approach to what we have been talking about,",English
+"putting together parts of a car. Take the EMT network that we have been studying and take the tumor initiation network, as reported in published experimental data,",English
+"and see how they're connected to each other, again, as published in the data. And then simulate this and",English
+"see what the model predicts. Now, why this project was most exciting to me was because there were three different papers comparing the tumor initiation abilities",English
+"of epithelial and mesenchymal cells -- the cells that do not move and the cells that move as single cells, individually -- and they said three completely different things.",English
+"One... the first paper said that when cells undergo EMT to become mesenchymal, they form much more tumors. A couple of years later, another paper saying that,",English
+"well, when cells become mesenchymal, their tumor initiation ability goes down and the cells that are epithelial are the ones that form more tumors.",English
+"And the last one saying that, well, they are almost comparable -- epithelial and mesenchymal can initiate almost equal numbers of tumors, there is not a stark difference in that ability.",English
+"Now, this is conflicting, hugely confounding, and one of the reason why I thought that this paradox is being reported is that...",English
+"because all these studies actually categorized cells into two categories, either epithelial or mesenchymal.",English
+"So they completely missed out on these hybrid, stable cells, which were miscategorized as either epithelial or mesenchymal,",English
+"and it can be different in different studies, therefore leading to these potentially different results. So, then when I simulated this model",English
+"of EMT and the tumor initiation network together, the model predicted that the cells in the hybrid... the cells that are hybrid actually form",English
+"much more tumors than cells that are only epithelial or only mesenchymal. Now, one year later, after we published this, there was an experimental study,",English
+"which, to the best of my knowledge, is the first study that categorizes cells into three different categories -- these are also breast cancer cells --",English
+"epithelial, hybrid, and mesenchymal, segregates them, and then looks at their tumor initiation ability and, as you can see,",English
+"tumor initiation ability of the hybrid cells is ten times more than the tumor initiation ability of only epithelial or only mesenchymal,",English
+"which is, again, very consistent with what the model predicted. Of course, we didn't have this ten times number, but it's qualitatively the same result.",English
+"So, just summarizing... so, I've taken you through a journey of how theoretical physics or mathematics can be coupled with experimental biology",English
+"to get insights into this entire process of tumor progression and metastasis. So, the first part was, well, how do cancer cells form these clusters,",English
+"where we made a network of EMT and MET, and predicted that, indeed, the hybrid state is a stable state,",English
+"which is what is in contradiction to the current existing framework, where people believe it's just a transient state. Then the next part was, well,",English
+"how can we break these clusters? Where, again, based on mathematical modeling, then in vitro experimental validation, and then based on some clinical data,",English
+we concluded that GRHL2 might be an important player to break that clustered migration.,English
+"And then in the last part, we tried to offer an explanation of why clusters might be forming more metastasis, because clusters are the ones that are",English
+"usually corresponding to a hybrid state, and the hybrid state is the one that has much more tumor initiation ability than either mesenchymal or epithelial.",English
+"So, just concluding, as I already indicated, the existing framework has been that this hybrid state is just transient, cells can not maintain it for a very long time,",English
+"but what we showed, first based on mathematical modeling and then based on experimental validation, that, indeed, it can be a stable state,",English
+"in some scenarios, and it can move collectively. Therefore, this state might be the reason behind why clusters form much more metastases,",English
+"because it enables the formation of clusters of circulating tumor cells, or CTCs. Now, what are the clinical implications of this work?",English
+"So, these days, there's a lot of talk about liquid biopsy. Now, what is liquid biopsy? How is it different from solid biopsy? So, solid biopsy is when you take",English
+"a chunk of mass from a tumor, from a patient, and then try to characterize it. Liquid biopsy is that, instead of taking that chunk of solid tumor mass,",English
+infectious disease fellow and he said well let me check up on you and so he checked up on me a couple of days later he called me up and said,English
+we'll take you so that's i sort of backed into infectious disease and i kind of think probably the man,English
+upstairs wanted me to be an id doc so that's how i ended up well we'll get to a little bit more on your infectious disease journey in a,English
+second okay for those who would want to pursue infectious disease how long does your training take after medical school okay you have to do a,English
+residency in internal medicine which would be an internship and two years of internal medicine residency,English
+then you're eligible to sit for your boards in internal medicine once you're board eligible you can take then take a two or three year,English
+id fellowship if you choose a three-year that means one year is going to be research but most people just do a two-year,English
+fellowship and then they're eligible to take their infectious disease boards so what would you say is the most unique,English
+part of infectious disease the most unique i think it's the sherlock holmes of medicine where you have,English
+simple tools you have your ability to take a history to do a physical exam and you've got to know how to examine most parts of the,English
+body pretty well as an id doc and then you got a microscope and,English
+last but not least you've got your brain to try to figure out what's wrong with mrs smith or mr jones and you know they've got fever and,English
+nobody can figure it out for example so that's the kind of thing that id docs do okay so speaking of that to elaborate what does an average day look like for,English
+an id doc an average day uh well it depends on whether you have clinic that day or uh if you're an academic,English
+medicine like i was you know you're not on call every month you know you have a couple of months where you're on call and then a couple of months where you're,English
+supposed to be doing scholarly kind of work uh toward publishing and uh then,English
+sorry my dog barking in the background but uh if you're in private practice you probably see some patients in the,English
+office and then you you go make rounds after you've done that and you're making rounds on patients,English
+for the doc the patients of doctors who asked you to consult on their patients so you're doing consult kind of rounds,English
+okay so i always let physicians try to sell their specialty like a car salesman so why should a student you want to go out,English
+back sure it's a beautiful day outside sorry maggie maggie wants to be interviewed also,English
+it is actually kind of pleasant out definitely georgia is starting to feel fallish it is,English
+all right so so what was that last question i oh so why should someone choose infectious disease okay,English
+well if as i said if you like trying to figure out what the diagnosis is um that's a good specialty for you,English
+because every patient is a puzzle and uh not all patients are the same and they have different ways of giving,English
+you a history and so you've got to try to get to the bottom of what's what's going on you need to,English
+know what where they've been what what their profession is have they traveled you know those kind of things you got to kind of put all the,English
+pieces together so on the other side why should someone not choose infectious disease,English
+well it's not particularly a lucrative specialty like for example if you're a gastroenterologist and you're doing,English
+procedures you may do a procedure that takes you a half an hour and you just made two thousand dollars for it whereas,English
+infectious disease is a cognitive kind of specialty and you may spend two hours with one patient,English
+trying to come up with the diagnosis and probably the most you could charge would be two hundred dollars for two hours work,English
+something like that so it's not lucrative but it is very satisfying to make a diagnosis,English
+and then get a patient on the right treatment and watch them get better that's very very satisfying of course now kind of a fun question are there any,English
+stereotypes about your specialty stereotypes oh i guess uh,English
+obsessive-compulsive would would be one stereotype for an infectious disease doctor i don't know if that's completely true but i think they sort of,English
+think of infectious disease doctors as nosing around and checking everything and if you see what i mean exactly um now i know you work with a lot of,English
+students at the medical college and there's this thing students uh and i guess residents will call pimping,English
+so what is your go-to question to ask students when they're on the wards oh my my go-to question is what do you think the diagnosis is,English
+and why and i often say if you're the only doctor in the hospital what would you do for this patient i heard that a lot,English
+remember that one that's right i asked you that several times oh goodness so i put i what i like to do is get the students,English
+into a thinking mode and give them responsibility to make to speak out rather than watch me practice infectious disease,English
+i want to watch them practice it so i'll say all right take a look at this gram stain and,English
+tell me what you see and if they get it right i'll say yeah you that's perfect you got it exactly right but if they say uh,English
+these are gram-positive cocci when they're gram-negative rods i'll say wait a minute here you better look at this again,English
+make sense so in your time as an infectious disease physician what is the most rare case you have ever seen,English
+i the most rare case i ever saw i think was a an irish traveler,English
+from augusta you know north augusta that's there's a sort of a colony of irish people who are descended from,English
+the irish traveling their gypsies but they came from ir they're irish gypsies and they came over here probably around the,English
+time of the potato famine their ancestors uh because there was no food or wherewithal in ireland so a lot of people a lot of irish people came around,English
+that time and the original irish travelers were called tinkers where they were mending,English
+called tinkers because they mended pots and pans and things like that and uh they had a reputation for stealing chickens and,English
+trickery and so anyway there is a colony of those folks in north augusta,English
+and one irish traveler had copd and he was taking corticosteroids and he came into the hospital terribly,English
+ill with a bilateral pneumonia a ammonia on both sides and he was essentially dying of it and so they asked me to take a look at,English
+him and he was on a ventilator and he was very very ill so i asked the nurse i said,English
+what are you suctioning out of mr we'll call him o'hara and they said well it's just kind of,English
+blood and pus i said would you get me a sample of that and let me take a look at it,English
+under the microscope so they got me a sterile cup suctioned him out and i took that down to the lab and started playing with the,English
+of stronges which is a type of round worm so what was wrong with him was not any bacterial infection or fungal infection,English
+he was eaten up with worms essentially so he had what we call in medicine disseminated stronger diocese,English
+and that's probably one of the rarest things i've seen wow that is that's an incredible story because that's one of the first things,English
+you learned in med school i still remember learning that in like our first couple weeks yeah and it turns out that the the how did he,English
+get it you know it's these irish people in the summertime they go around barefoot and they picked up the larvae from,English
+walking around in the grass barefoot but his problem was that he was on corticosteroids he was immunocompromised,English
+and so that probably made it worse for him wow that's i'm speechless just hearing hearing what's in the textbook actually,English
+happening it's kind of crazy um oh i guess go back on track what is the most common case that you saw,English
+no i think the most common case is going to be something like a skin infection due to staff or strep those are probably,English
+the the most common so how many patients do you see on an average day,English
+well academic medicine is different from private practice of infectious disease so i would say let's take academics which is all i've known i was in private,English
+practice for about six years but mostly academics and so each day we would probably have an average of,English
+four or five new patients that somebody asked us to see because they had fever or they wanted advice,English
+about antibiotics or something and so maybe four or five new patients a day and if you're on call for a month you,English
+know that's 30 times five okay so you're seeing 150 patients in the course,English
+of a month what is the most amount of patients you've ever seen in a day i think i think one day,English
+um well that's a good question because i spent about six months at a in a hospital in charlotte,English
+and i was attending on internal medicine and my team had something like 24 admissions to the team,English
+and so as the attending i had to go see all 24 of them uh and sort of sign off on what the residents had decided to do,English
+so by the time i got to number 20 the other four had already been,English
+discharged before i even got to see them so that's probably the most i've ever seen in a day but they weren't all infectious disease patients i think the,English
+most infectious disease patients i've seen in a day like on call is going to be,English
+10 something like that 10 new consults okay so how many hours do you work in an average,English
+week um well as you know i am semi-retired,English
+so i i get a half a salary a half-day salary five days a week but i've managed to extend it into a full day because i love to write and,English
+things like that but so an average average day,English
+um i'm probably going to work 60 hours a week if if that's what you're getting at okay so,English
+what time do you normally wake up i get up at 4 00 a.m every day goodness though how many hours of sleep are you,English
+typically working on i go to bed you know in the neighborhood of 9 to 9 30. so i get maybe six hours,English
+of sleep of course at my age i'm up a few times tonight you'll you'll see what i mean in about 50 years andy,English
+so do you have to take call and i know you mentioned that uh previously no i not anymore i i uh,English
+when i turned 70 in 2013 uh i retired from seeing patients and being on call,English
+and so they re-hired me to teach you guys so i teach physical diagnosis i have small,English
+group activities i still give a lot of lectures i'm shooting off my mouth right and left but i don't see patients anymore,English
+so how many or do you have to take call when you were working absolutely yeah i had to take my share of,English
+call and we rotated it we maybe had five infectious disease doctors and so your time but you had to cover internal medicine and infectious disease so you,English
+were on one or the other about probably every couple of months all right so how long when you worked as um,English
+infectious disease physician did it take for you to chart the other day because i'm sure your workouts are pretty extensive,English
+each each patient is probably about takes about two hours to evaluate and get a note written that would be an average i would say,English
+if i'm doing it by myself i can do it maybe a little faster than that maybe an hour hour and a half but if i've got students in residence,English
+and i want them to learn something i've got to say well what do you think the diagnosis is let's go take a look at the microscope you know we have to involve them i don't as i said i don't,English
+want to have them just watch me practice infectious disease that's no learning hey who are you most thankful for on your,English
+care team on my care team i mean when i was actually seeing patients yes i guess it would be the infectious disease fellows,English
+who would tell me how many new patients we had to see give me an idea of what the day was going to look like,English
+so that whoever happened to be the id fellow on that month would be my go-to person okay and now this might open up the,English
+floodgates but what is your favorite patient story that you've encountered my favorite patient story yes,English
+well that that patient with the stronger diocese is one of them uh but i've had had some other ones um,English
+i think one of them was a woman who also was immunocompromised and she she came in,English
+with a cough and of course the doctors taking care of her had sent,English
+sputum down to the lab to be stained and they cultured it and everything like that and the laboratory,English
+had reported that there were no organisms seen on the gram stain and so and they asked me to see her and,English
+she had a lung abscess and i said i can't believe there wouldn't be some kind of organism that you could see on a gram stain or,English
+something so i i said let me go take a look down in the micro lab,English
+and look at the smear myself the one they said was quotes negative and so and,English
+it's really unfair to do this because the micro lab those technicians process hundreds of smears in a day,English
+and they have maybe a minute to look at a gram stain but they didn't have 15 minutes which i had to look at the same gram stain so,English
+their report said no organism seen and when i started looking i saw what they meant they couldn't you couldn't find very many,English
+organisms at all i didn't see any but i stumbled on a filamentous organism that looked to me kind of like nocardia,English
+uh it was a for those who know some medicine it was a beaded gram positive filamentous bacterium and uh,English
+and i think we ought to change the report because these organisms are here and i found several more examples,English
+and so we ended up getting the patient on the proper therapy and uh,English
+so it's kind of one of those stories andy even a blind squirrel stumbles on an acorn every once in a while and i i was the blind squirrel,English
+and i was able to make that diagnosis that's one of my favorite patient stories there's some others but what is the most common medical advice,English
+you give to your patients um i think it's to encourage is it has to do primarily with hiv patients,English
+you know back when we started there was not good medicine we could give them that would help them but once once good medication came that could control the virus,English
+it was being a coach encouraging them to take their medicine and explaining to them how hiv,English
+was trying to attack their immune system and once they understood what it what hiv was doing to their immune system,English
+sort of coaching them into believing that taking their medicine would work i think i guess that would be it,English
+oh what is the most common drug you prescribed the most common drug i prescribed um,English
+well if you're talking about clinic it would be one of the hiv medicines if you're talking about being on the consult service and looking at patients,English
+with fever you know i think one of them would be vancomycin that would be one of the common ones and another one would be piptazo pipracil and tazobactam,English
+you know broad-spectrum therapy um and another one would be amphiterus and b,English
+which is an anti-fungal all the memories of your foundation's lectures are streaming back to me,English
+they're haunting your dreams i wouldn't say haunting i need it um now this is i think my personal favorite question to ask you yeah um,English
+because i know you're incredibly passionate about the art of medicine as you'd say and you've been doing this for a while you,English
+even mentioned multiple times that you've been able to stretch half days into full days because you love doing it so much,English
+so what is the secret to loving practicing medicine for as long as you have well one thing it's solving puzzles but,English
+you know i i think what really motivates me most is i love people and i want them to do well and i i,English
+i really feel like that this is what the good lord wanted me to do i think this is god's work,English
+and i feel like i want to make him proud of me it it has to do with loving your fellow,English
+person great answer so now kind of transition a little bit we've talked a lot about your life as a,English
+physician clinician so how about your life when you're not in the hospital so what is your favorite thing to do when you're not working,English
+well my favorite thing to do is to be around my kids and grandchildren that's my favorite thing to do,English
+but if i'm left to my own devices my favorite thing to do and there's nobody around is go play golf i love golf,English
+you mentioned you have kids and grandchildren so how many well i we have six children three boys and three girls we started,English
+out with identical twin girls wow and uh yeah ding and dong [Laughter] they're really great gals but um,English
+and so we had six children and 12 grandchildren and one on the way,English
+congratulations that's my sweet daughter she is due with your family ever expanding does,English
+your family ever ask you for random medical advice oh yeah yeah my daughter's in law will call me and my,English
+kids sometimes call me and ask me about a rash or what what should i do about this and so yes they do occasionally it's not,English
+frequent but i would say it's a couple of times a month what's the weirdest question a family or,English
+friend has ever asked you a family or friend yes the weirdest question i have to think about that for a there's not not a weird question that,English
+comes up well i guess as as an infectious disease doc you see all the crazy and weird so i guess,English
+weird might be a different standard for you it may have had to do with,English
+just recently somebody asked me uh if i thought the pope should allow president biden,English
+to receive holy communion that was one of the weird questions and i you know i i sort of,English
+dodged that question a little bit i i i hate the politics of of the present era i don't like the,English
+it's there's anger in the politics i don't i don't like the anger you know if we may have differing,English
+opinions but can't we sit down and calmly talk about what our differences might be if only everybody thought like that,English
+because people know i'm a catholic physician so they asked me that that kind of question which kind of caught me off guard but,English
+i i don't like the present era of angry politics understandable well on a more positive note do you have,English
+any pets yes maggie who practically attacked you when you came in she was just jumping up and she's,English
+what is your favorite animal not a dog or cat favorite animal not a dog or cat,English
+that's a good question back in the day it used to be turtles look at that turtles but because i had a,English
+strange story about a turtle that i wrote an essay about but anyway if there was one place in the world you could visit where would it be,English
+ireland ireland the west coast if you could have dinner with anyone in history who would it be,English
+dinner with anyone in history i think i would want to have dinner with,English
+jesus of nazareth great answer and what would you guys be eating at that dinner uh,English
+we probably would be have there be bread and fish most likely like cooked fish and bread,English
+and do you have any artistic hobbies you keep up with uh i love to write and i like to write,English
+humor i like to write humor and i like to write philosophy of medicine and i'm starting to write a play it's not very far along,English
+and i i like to write uh catholic apologetics so i've written several essays that have been published,English
+that are essentially catholic apologetics explaining catholicism because i think most,English
+non-catholics don't really and many catholics don't truly understand their catholic faith,English
+and a lot of non-catholics have ideas about the catholic religion that are that are totally ludicrous,English
+my religious beliefs and i've done that in essay form because i love to write that's awesome putting putting the artistic hobbies to,English
+good use and i like to sing and play the guitar yes you're quite the hit at the fox slayer,English
+by a soda uh i love coca-cola but i don't drink much of it i'm trying to keep my school boy figure [Laughter],English
+water might help with that and next question is how much water should you be drinking every day oh i i drink a lot of seltzer without,English
+calories or sodium i drink a lot of that just in the last few years i've been doing that instead of just plain water,English
+i like the fizz and so i think you ought to drink i'm going to say,English
+2 500 mls a day very accurate number oh favorite meal from the hospital hospital,English
+cafeteria if you ever had one i think my favorite meal from a hospital cafeteria would be grilled cheese sandwich,English
+classic one random task you'd say you're really good at random task yes,English
+i'm i'm pretty good at cleaning up the garage that is definitely one random task,English
+so one random task you wished you could be better at i wish i could be better at um,English
+that again is one random task this is the lowest golf score you've ever shot i have shot the lowest my lowest round,English
+is 75 and i just shot my age a couple of times this year one lower actually than my age,English
+impressive and what is your favorite golf course the augusta national easy it's the reason i moved here,English
+very fortunate to have done that favorite season of the year july 8th at noon very specific,English
+what is your favorite music artist because i i like heat i like it hot and humid and they said you you live in the right,English
+place if you like it hot and humid you were one of very few people that would say that what was your favorite music artist,English
+my favorite music artist uh sort of as a young adult it might have been james taylor uh then folk music,English
+uh would be the kingston trio that you may not remember at all but they were at the top of the pop charts when i was your age,English
+uh and a blind guitarist by the name of doc watson excellent choices now what is the best way that you relax,English
+having having a beer in the evening with my wife she's having a glass of wine uh and chit chatting or with my kids same thing,English
+watching football notre dame football for example are you a night in or go out on the town kind of person,English
+watching a movie or something do you prefer indoors or outdoors outdoors the beach or the mountains,English
+uh the beach would you consider yourself more of an introvert or an extrovert extrovert and would you consider that personality trait a factor in you choosing infectious disease,English
+it was it's certainly a factor in choosing medicine not specifically infectious disease but i i because i love people i enjoy,English
+finding out about them and their families uh and so that's i think,English
+helped me in in medicine well i said so we're getting close to the end only got a few more questions left sure uh but these are very,English
+reflective questions okay oh what did you think you were gonna be when you grew up when you were a kid i thought i was gonna play baseball,English
+major league baseball uh or be a cowboy when i was five but uh once i hit high school,English
+uh i decided i was going to be a doctor because i had an uncle that was sort of my role model he was a physician and i never looked back,English
+in high school i ran for city physician where you spent a day with one of the city administrators and,English
+i with the city physician i stayed with him for a day and it's almost like,English
+i had to be a physician after that i couldn't because i kept telling all my classmates i was going to be a doctor uh and so,English
+i actually never looked back once i decided to be a doctor great story and is there a different specialty you think you could have done besides infectious,English
+disease pathology because i love microscope work but i wouldn't have been able to see patients,English
+and i'd be doing autopsies but i like the microscope i think that would be the reason but uh,English
+maybe cardiology so if you didn't do medicine what do you think you'd be doing right now i'd probably be teaching grade school,English
+passion for teaching i'd love it uh you said you were very gung-ho about becoming a physician from an early age but i think anybody that's gone through,English
+this route i mean me even even at the beginning of the process knows that it's not very easy,English
+so were there any times you doubted you would make it as a position uh yes when i was at uh i started out at notre dame and i was,English
+trying i was a liberal arts major to start off with because i didn't have the grades to be accepted into science pre-med program,English
+and so at notre dame you start out in liberal arts and i had to make the grade in liberal arts to be in liberal arts,English
+pre-med and so i was failing three of my subjects when i was a freshman at the halfway point midterm,English
+the lung or the GI tract or also the pancreas organ And also the pancreas organ And also the pancreas organ And they originate from originate they originate from originate they originate from originate from these neuroendocrine cells,English
+from these neuroendocrine cells from these neuroendocrine cells which are cells that in a lot which are cells that in a lot which are cells that in a lot of organs such as the lung or of organs such as the lung or of organs such as the lung or the gut are kind of,English
+the gut are kind of the gut are kind of interspersed there and they interspersed there and they interspersed there and they kind of modulate and kind of modulate and kind of modulate and communicate with other around communicate with other around communicate with other around them and modulate their,English
+them and modulate their them and modulate their function. And probably the best function. And probably the best function. And probably the best best way to to to understand best way to to to understand,English
+best way to to to understand what neuroendo consumer cells what neuroendo consumer cells what neuroendo consumer cells in general usually do. So those in general usually do. So those in general usually do. So those cells where these tumors come,English
+cells where these tumors come cells where these tumors come from is from the endocrine from is from the endocrine from is from the endocrine pancreas right? So the pancreas right? So the pancreas right? So the endocrine pancreas is very,English
+endocrine pancreas is very endocrine pancreas is very important functions. The important functions. The important functions. The pancreasism kind of two organs pancreasism kind of two organs pancreasism kind of two organs in one that makes the,English
+in one that makes the in one that makes the pancreatic juices for digestion pancreatic juices for digestion pancreatic juices for digestion but it's also an endocrine but it's also an endocrine but it's also an endocrine organ making hormones such as organ making hormones such as,English
+organ making hormones such as insulin. Right? And some of insulin. Right? And some of insulin. Right? And some of those neuroendocrine tumors in those neuroendocrine tumors in those neuroendocrine tumors in the pancreas for example can,English
+the pancreas for example can the pancreas for example can make insulin as well. And that make insulin as well. And that make insulin as well. And that comes with certain hormonal comes with certain hormonal comes with certain hormonal syndromes. Um patients will,English
+syndromes. Um patients will syndromes. Um patients will have you know too much insulin have you know too much insulin have you know too much insulin around and might suffer from around and might suffer from around and might suffer from low blood sugars. Um but,English
+low blood sugars. Um but low blood sugars. Um but Neuroendocrine tumors like I Neuroendocrine tumors like I Neuroendocrine tumors like I said they can actually said they can actually said they can actually originate anywhere. Um of the originate anywhere. Um of the,English
+originate anywhere. Um of the typical or our organs are the typical or our organs are the typical or our organs are the the small bowel where it's the small bowel where it's the small bowel where it's often associated with carcinoid often associated with carcinoid,English
+"often associated with carcinoid syndrome because they produce syndrome because they produce syndrome because they produce also certain substances which also certain substances which also certain substances which lead to diarrhea, flushing, and",English
+"lead to diarrhea, flushing, and lead to diarrhea, flushing, and some other manifestations and some other manifestations and some other manifestations and or for example in the lung or for example in the lung or for example in the lung where they also can lead to you",English
+"where they also can lead to you where they also can lead to you know, constriction, narrowing know, constriction, narrowing know, constriction, narrowing of the of the breathing ways, of the of the breathing ways, of the of the breathing ways, the bronchi, and can lead to",English
+"the bronchi, and can lead to the bronchi, and can lead to asthma-like symptoms, right? asthma-like symptoms, right? asthma-like symptoms, right? So, in in summary, in summary, So, in in summary, in summary, So, in in summary, in summary, they are actually origining,",English
+"they are actually origining, they are actually origining, originating those near-ended originating those near-ended originating those near-ended consumers from Neuroendocrine consumers from Neuroendocrine consumers from Neuroendocrine cells which are usually cells which are usually",English
+cells which are usually indispersed in a lot of organs indispersed in a lot of organs indispersed in a lot of organs and we would then differentiate and we would then differentiate and we would then differentiate them clinically by the organ,English
+"them clinically by the organ them clinically by the organ where this neurando consumer where this neurando consumer where this neurando consumer started, right? So, we would started, right? So, we would started, right? So, we would actually call it a a pancreatic actually call it a a pancreatic",English
+"actually call it a a pancreatic neuroendokin tumor or a lung neuroendokin tumor or a lung neuroendokin tumor or a lung neuroendo consumer. Sometimes, neuroendo consumer. Sometimes, neuroendo consumer. Sometimes, also interchangeably the term",English
+also interchangeably the term also interchangeably the term carcinoid is used which is carcinoid is used which is carcinoid is used which is really an old term. Um but it's really an old term. Um but it's really an old term. Um but it's an important term because an important term because,English
+"an important term because Carson and I basically says Carson and I basically says Carson and I basically says that under the microscope, it that under the microscope, it that under the microscope, it looks like very much like a looks like very much like a looks like very much like a cancer. Yet, they don't have",English
+"cancer. Yet, they don't have cancer. Yet, they don't have really this this classical really this this classical really this this classical cancerous behavior as we see it cancerous behavior as we see it cancerous behavior as we see it with a lot of other cancers,",English
+"with a lot of other cancers, with a lot of other cancers, right? And I think that's right? And I think that's right? And I think that's another important point which I another important point which I another important point which I always mention if you, for always mention if you, for",English
+"always mention if you, for example, you look at the guests example, you look at the guests example, you look at the guests on Tesla tract. Um when we on Tesla tract. Um when we on Tesla tract. Um when we think about Kansas and how",English
+"think about Kansas and how think about Kansas and how common they are, we think in common they are, we think in common they are, we think in two terms which is incidents, two terms which is incidents, two terms which is incidents, meaning, how many patients are",English
+"meaning, how many patients are meaning, how many patients are diagnosed per year with a diagnosed per year with a diagnosed per year with a certain disease or for example certain disease or for example certain disease or for example the other term prevalence is",English
+"the other term prevalence is the other term prevalence is how many people are at a how many people are at a how many people are at a certain point alive with a certain point alive with a certain point alive with a certain disease, right? And",English
+"certain disease, right? And certain disease, right? And they actually after colon they actually after colon they actually after colon cancer, the most prevalent cancer, the most prevalent cancer, the most prevalent cancers. That also tells you cancers. That also tells you",English
+cancers. That also tells you that patients with that patients with that patients with Neuroendocrine Tumors usually Neuroendocrine Tumors usually Neuroendocrine Tumors usually do much better than other do much better than other,English
+do much better than other tumors. Although that is tumors. Although that is tumors. Although that is something which I always in something which I always in something which I always in this first discussion where I this first discussion where I,English
+this first discussion where I also describe this point out is also describe this point out is also describe this point out is something that is important for something that is important for something that is important for us to learn about the next one,English
+us to learn about the next one us to learn about the next one 2 years. Um what the course of 2 years. Um what the course of 2 years. Um what the course of the disease will be and what the disease will be and what the disease will be and what the necessity for a treatment,English
+the necessity for a treatment the necessity for a treatment is. That's how I would is. That's how I would is. That's how I would summarize that. Thank you very much. Doctor,English
+"Thank you very much. Doctor Songbald, can you go into a Songbald, can you go into a Songbald, can you go into a little bit of detail about what little bit of detail about what little bit of detail about what are the important things are the important things",English
+"are the important things patients need to know about patients need to know about patients need to know about their Neuroendocrine Tumor? their Neuroendocrine Tumor? their Neuroendocrine Tumor? Yeah, I think that's a great Yeah, I think that's a great",English
+"Yeah, I think that's a great question. I think one of the question. I think one of the question. I think one of the main things I tell patients is, main things I tell patients is, main things I tell patients is, I mean, as Doctor Elsa",English
+"I mean, as Doctor Elsa I mean, as Doctor Elsa mentioned that these tumors mentioned that these tumors mentioned that these tumors arise from any part of the arise from any part of the arise from any part of the body, so the first question we body, so the first question we",English
+"body, so the first question we ask is, where is it coming ask is, where is it coming ask is, where is it coming from? Uh a lot of times, we can from? Uh a lot of times, we can from? Uh a lot of times, we can really find out where it's really find out where it's",English
+"really find out where it's coming from but there are coming from but there are coming from but there are sometimes where we don't know sometimes where we don't know sometimes where we don't know where it's coming from. So, where it's coming from. So, where it's coming from. So, location is key. Uh because",English
+location is key. Uh because location is key. Uh because three overall and the three overall and the three overall and the management is is this there are management is is this there are,English
+"management is is this there are similarities, but there are similarities, but there are similarities, but there are some differences, depending some differences, depending some differences, depending where it's coming from. Um, and where it's coming from. Um, and",English
+"where it's coming from. Um, and then the second thing I, I tell then the second thing I, I tell then the second thing I, I tell patients, it's, I, one of the patients, it's, I, one of the patients, it's, I, one of the main things I ask, myself, when",English
+"main things I ask, myself, when main things I ask, myself, when I meet a patient with neuron to I meet a patient with neuron to I meet a patient with neuron to consumers, I always tell consumers, I always tell consumers, I always tell patients that I ask the",English
+"patients that I ask the patients that I ask the pathologist, how do the cells pathologist, how do the cells pathologist, how do the cells look like under the microscope? look like under the microscope? look like under the microscope? Do these cancers cells look",English
+"Do these cancers cells look Do these cancers cells look like the normal cells in the like the normal cells in the like the normal cells in the body, in terms of the, the body, in terms of the, the body, in terms of the, the shape, that's what we call well shape, that's what we call well",English
+"shape, that's what we call well differentiate neuro and the differentiate neuro and the differentiate neuro and the consumers or they look ugly, consumers or they look ugly, consumers or they look ugly, large, or small, aggressive, large, or small, aggressive,",English
+"large, or small, aggressive, that's what we call poorly that's what we call poorly that's what we call poorly differentiated neurological differentiated neurological differentiated neurological tumors. So, they're well tumors. So, they're well",English
+"tumors. So, they're well differentiated ones, our differentiated ones, our differentiated ones, our well-behaved ones and then, the well-behaved ones and then, the well-behaved ones and then, the well, the new, the poorly well, the new, the poorly",English
+"well, the new, the poorly differentiated ones are poorly differentiated ones are poorly differentiated ones are poorly behaved ones and then, under behaved ones and then, under behaved ones and then, under the microscope, we also tell the microscope, we also tell",English
+"the microscope, we also tell them, we ask the pathologist, them, we ask the pathologist, them, we ask the pathologist, can you do some coloring? We can you do some coloring? We can you do some coloring? We call it KS 6seven Steam and call it KS 6seven Steam and",English
+call it KS 6seven Steam and count to us how many of those count to us how many of those count to us how many of those cancer cells are aggressive cancer cells are aggressive cancer cells are aggressive under the microscope and based under the microscope and based,English
+"under the microscope and based on that, they can give us a on that, they can give us a on that, they can give us a score goes from zero to 100 score goes from zero to 100 score goes from zero to 100 percent. And based on that we percent. And based on that we",English
+"percent. And based on that we can assign a grade one, two, or can assign a grade one, two, or can assign a grade one, two, or three. So I I always tell three. So I I always tell three. So I I always tell patients you can imagine that",English
+patients you can imagine that patients you can imagine that there is a spectrum that start there is a spectrum that start there is a spectrum that start from a grade one well from a grade one well from a grade one well differentiated northern differentiated northern,English
+differentiated northern consumers end up with a grade consumers end up with a grade consumers end up with a grade two and then grade three and two and then grade three and two and then grade three and then ends up with the highest then ends up with the highest,English
+then ends up with the highest grade is grade three. Poorly grade is grade three. Poorly grade is grade three. Poorly differentiate Neuroendocrine. differentiate Neuroendocrine. differentiate Neuroendocrine. We start calling it carcinoma,English
+We start calling it carcinoma We start calling it carcinoma at that time. So that at that time. So that at that time. So that distinction is important distinction is important distinction is important because also the management because also the management because also the management across the spectrum is,English
+across the spectrum is across the spectrum is different. The other thing we different. The other thing we different. The other thing we also discuss is the stage. So also discuss is the stage. So,English
+also discuss is the stage. So we've learned there's something we've learned there's something we've learned there's something called the grade which is under called the grade which is under called the grade which is under the microscope and then there the microscope and then there,English
+the microscope and then there is the stage which the question is the stage which the question is the stage which the question is has this cancer metastasized is has this cancer metastasized is has this cancer metastasized or left the original place,English
+or left the original place or left the original place which for example let's say it which for example let's say it which for example let's say it came from the pancreas. Has it came from the pancreas. Has it came from the pancreas. Has it left the pancreas and gone left the pancreas and gone,English
+"left the pancreas and gone somewhere else such as liver, somewhere else such as liver, somewhere else such as liver, bone or something else like bone or something else like bone or something else like that or not. And usually we",English
+"that or not. And usually we that or not. And usually we determine that with scans. So determine that with scans. So determine that with scans. So that gives us this stage. Is it that gives us this stage. Is it that gives us this stage. Is it one, two, three, or four. When one, two, three, or four. When",English
+"one, two, three, or four. When it has already spread, that's it has already spread, that's it has already spread, that's what call a stage four cancer. what call a stage four cancer. what call a stage four cancer. And then the last thing I think And then the last thing I think",English
+And then the last thing I think that's important as well to that's important as well to that's important as well to remember that as Doctor Elsa remember that as Doctor Elsa remember that as Doctor Elsa mentioned a lot of these neuro mentioned a lot of these neuro,English
+mentioned a lot of these neuro and the consumers they have the and the consumers they have the and the consumers they have the endocrine capacity. So they endocrine capacity. So they endocrine capacity. So they have the capacity and and the have the capacity and and the,English
+have the capacity and and the ability to produce hormones. So ability to produce hormones. So ability to produce hormones. So there is what we call there is what we call there is what we call functioning Neuroendocrine,English
+functioning Neuroendocrine functioning Neuroendocrine Tumors and non-function in the Tumors and non-function in the Tumors and non-function in the endocrine tumors. Uh because a endocrine tumors. Uh because a endocrine tumors. Uh because a lot of these neuron some,English
+lot of these neuron some lot of these neuron some neuroendocrine tumors they neuroendocrine tumors they neuroendocrine tumors they produce hormones that can be produce hormones that can be produce hormones that can be problematic to patients. Like problematic to patients. Like problematic to patients. Like we hear with this small bowel,English
+we hear with this small bowel we hear with this small bowel neuroendocrine tumors with the neuroendocrine tumors with the neuroendocrine tumors with the serotonin causing the diarrhea serotonin causing the diarrhea serotonin causing the diarrhea and carcinoid heart disease and,English
+and carcinoid heart disease and and carcinoid heart disease and things like that and then we things like that and then we things like that and then we hear also like with the hear also like with the hear also like with the pancreas for example some of,English
+pancreas for example some of pancreas for example some of them produce insulin or them produce insulin or them produce insulin or glucagon and kind of disrupt glucagon and kind of disrupt glucagon and kind of disrupt the the whole blood glucose and,English
+the the whole blood glucose and the the whole blood glucose and blood sugar in the body. So I blood sugar in the body. So I blood sugar in the body. So I think those those are the the think those those are the the think those those are the the main points so really the grade main points so really the grade,English
+main points so really the grade and the differentiation. So how and the differentiation. So how and the differentiation. So how do how do the cells look under do how do the cells look under do how do the cells look under the microscope? Is it the microscope? Is it,English
+the microscope? Is it functioning or not and the functioning or not and the functioning or not and the stage has it spread or not. I stage has it spread or not. I stage has it spread or not. I think and where it's coming,English
+"think and where it's coming think and where it's coming from, those main things are from, those main things are from, those main things are very important to know. very important to know. very important to know. Great.",English
+"Thank you. Uh Doctor Thank you. Uh Doctor Koiken, how are Neuroendocrine Koiken, how are Neuroendocrine Koiken, how are Neuroendocrine Tumors diagnosed? Okay, so Tumors diagnosed? Okay, so",English
+"Tumors diagnosed? Okay, so that's a great question. Well, that's a great question. Well, that's a great question. Well, a lot of the time, they are not a lot of the time, they are not a lot of the time, they are not diagnosed for quite some time,",English
+"diagnosed for quite some time, diagnosed for quite some time, unfortunately, because they're unfortunately, because they're unfortunately, because they're a little bit of a zebra. So, a little bit of a zebra. So, a little bit of a zebra. So, like we said before, they are",English
+"like we said before, they are like we said before, they are the endocrine tumors that are the endocrine tumors that are the endocrine tumors that are functioning, so that they are functioning, so that they are functioning, so that they are producing hormone that produce producing hormone that produce",English
+producing hormone that produce symptoms. A good example for symptoms. A good example for symptoms. A good example for example would be a small bio example would be a small bio example would be a small bio endocrin tumor that's producing,English
+"endocrin tumor that's producing endocrin tumor that's producing serotonin. You could have serotonin. You could have serotonin. You could have symptoms like diarrhea, symptoms like diarrhea, symptoms like diarrhea, flushing, wheezing, so those",English
+"flushing, wheezing, so those flushing, wheezing, so those are symptoms that are often are symptoms that are often are symptoms that are often pretty general and often are pretty general and often are",English
+"pretty general and often are overlooked for quite some time overlooked for quite some time overlooked for quite some time until patients actually get until patients actually get until patients actually get diagnosed with a neuronoquine diagnosed with a neuronoquine diagnosed with a neuronoquine tumor. So, you know, obviously",English
+"tumor. So, you know, obviously tumor. So, you know, obviously a lot of people like people can a lot of people like people can a lot of people like people can have diarrhea or or or GI have diarrhea or or or GI have diarrhea or or or GI problems. So, so it may take a",English
+"problems. So, so it may take a problems. So, so it may take a lot of time for the primary lot of time for the primary lot of time for the primary care physician or the GI care physician or the GI care physician or the GI physicians to realize that this",English
+"physicians to realize that this physicians to realize that this is a neuroendocrine tumor. is a neuroendocrine tumor. is a neuroendocrine tumor. Hence, it's important to do Hence, it's important to do Hence, it's important to do Webinar because I think it just Webinar because I think it just",English
+Webinar because I think it just raises the whole Neuroendocrine raises the whole Neuroendocrine raises the whole Neuroendocrine tumor topic to our patients as tumor topic to our patients as,English
+tumor topic to our patients as well as to providers or well as to providers or well as to providers or physicians that are watching physicians that are watching physicians that are watching this as well. But so so that's,English
+this as well. But so so that's this as well. But so so that's one way how how Annette could one way how how Annette could one way how how Annette could be could be diagnosed. There be could be diagnosed. There,English
+be could be diagnosed. There are some neuronoquin tumors are some neuronoquin tumors are some neuronoquin tumors that cause symptoms. Again it's that cause symptoms. Again it's that cause symptoms. Again it's probably not the majority. Um,English
+probably not the majority. Um probably not the majority. Um but for example again if you but for example again if you but for example again if you have a small endocrine tumor have a small endocrine tumor have a small endocrine tumor that's large enough so it,English
+that's large enough so it that's large enough so it causes an obstruction or a causes an obstruction or a causes an obstruction or a blockage of his small intestine blockage of his small intestine,English
+blockage of his small intestine or it causes bleeding so you or it causes bleeding so you or it causes bleeding so you would have blood in your stool would have blood in your stool,English
+"would have blood in your stool or dark stools. You know, those or dark stools. You know, those or dark stools. You know, those are sort of things that can are sort of things that can are sort of things that can also happen. They can happen also happen. They can happen",English
+also happen. They can happen with a lot of tumors but they with a lot of tumors but they with a lot of tumors but they can also happen with nanokin can also happen with nanokin can also happen with nanokin tumors. I said it's not that tumors. I said it's not that,English
+"tumors. I said it's not that common because it's also common because it's also common because it's also growing tumors generally, at growing tumors generally, at growing tumors generally, at least a well differentiated one least a well differentiated one least a well differentiated one and and so, most patients don't",English
+"and and so, most patients don't and and so, most patients don't have these symptoms but that's have these symptoms but that's have these symptoms but that's definitely something that can definitely something that can definitely something that can happen. And then I would say if",English
+"happen. And then I would say if happen. And then I would say if I look at our practice for I look at our practice for I look at our practice for example in our patient example in our patient example in our patient population, we see a lot of",English
+"population, we see a lot of population, we see a lot of tumors that are already talking tumors that are already talking tumors that are already talking about stage at a further stage. about stage at a further stage. about stage at a further stage. Um just because a lot of these",English
+Um just because a lot of these Um just because a lot of these symptoms or I should say a lot symptoms or I should say a lot symptoms or I should say a lot of these patients don't have of these patients don't have of these patients don't have any symptoms and so and so it's,English
+any symptoms and so and so it's any symptoms and so and so it's hard to diagnose them and and hard to diagnose them and and hard to diagnose them and and you know they're sort of what you know they're sort of what you know they're sort of what we call incidental diagnosis.,English
+"we call incidental diagnosis. we call incidental diagnosis. So, you know, you have a car So, you know, you have a car So, you know, you have a car accident to get a CT scan, you accident to get a CT scan, you accident to get a CT scan, you know, and they see lesions in",English
+"know, and they see lesions in know, and they see lesions in your liver, it gets biopsy, your liver, it gets biopsy, your liver, it gets biopsy, then it's diagnosed as well then it's diagnosed as well then it's diagnosed as well differentiated nanocontromers",English
+"differentiated nanocontromers differentiated nanocontromers and you never really had any and you never really had any and you never really had any specific symptoms. So, once the specific symptoms. So, once the",English
+"specific symptoms. So, once the diagnosis is made and usually diagnosis is made and usually diagnosis is made and usually it's made through a biopsy or it's made through a biopsy or it's made through a biopsy or through sometimes a special",English
+"like pet scan called the like pet scan called the Dorotate Pet Scan, which is Dorotate Pet Scan, which is Dorotate Pet Scan, which is highly sensitive for neurendo highly sensitive for neurendo highly sensitive for neurendo consumers, but once the consumers, but once the",English
+"consumers, but once the diagnosis is made, then we talk diagnosis is made, then we talk diagnosis is made, then we talk about the staging, like we about the staging, like we",English
+"about the staging, like we briefly mentioned before, to briefly mentioned before, to briefly mentioned before, to try to understand, is the tumor try to understand, is the tumor try to understand, is the tumor localized? Um, and can it be",English
+"localized? Um, and can it be localized? Um, and can it be removed surgically, or is it removed surgically, or is it removed surgically, or is it of, further spread, beyond, of, further spread, beyond,",English
+"of, further spread, beyond, just where it started, and for just where it started, and for just where it started, and for that, there's a whole bunch of that, there's a whole bunch of",English
+"that, there's a whole bunch of therapies, which I'm sure we'll therapies, which I'm sure we'll therapies, which I'm sure we'll talk about later, but I think talk about later, but I think talk about later, but I think the, the general concept on how the, the general concept on how the, the general concept on how Neuroendocrine Tumors are,",English
+"Neuroendocrine Tumors are, Neuroendocrine Tumors are, diagnosed comes through many diagnosed comes through many diagnosed comes through many many different ways. Uh again, many different ways. Uh again, many different ways. Uh again, incidentally, because you get a",English
+"incidentally, because you get a incidentally, because you get a scan for something else, scan for something else, scan for something else, because you have symptoms, that because you have symptoms, that because you have symptoms, that are either due to hormone",English
+"are either due to hormone are either due to hormone production, or symptoms that production, or symptoms that production, or symptoms that are due to a blockage, or the are due to a blockage, or the are due to a blockage, or the tumor causing some problems",English
+"tumor causing some problems tumor causing some problems locally that would cause you to locally that would cause you to locally that would cause you to have pain or weight loss, have pain or weight loss, have pain or weight loss, etcetera.",English
+"Thank you very much. Doctor Thank you very much. Doctor Hughes, can you please explain Hughes, can you please explain Hughes, can you please explain what a multidisciplinary, a what a multidisciplinary, a what a multidisciplinary, a multidisciplinary team is, and",English
+"multidisciplinary team is, and multidisciplinary team is, and how the team communicates about how the team communicates about how the team communicates about a patient's care. What happens a patient's care. What happens a patient's care. What happens in tumor boarding? Can patients",English
+"in tumor boarding? Can patients in tumor boarding? Can patients attend these tumor board attend these tumor board attend these tumor board discussions? Yes, so discussions? Yes, so discussions? Yes, so multidisciplinary tumor boards",English
+"multidisciplinary tumor boards multidisciplinary tumor boards are very important. Um are very important. Um are very important. Um basically, it is a group of basically, it is a group of",English
+"basically, it is a group of physicians that are familiar physicians that are familiar physicians that are familiar with the disease process and with the disease process and with the disease process and they are usually surgeons, they are usually surgeons, they are usually surgeons, medical oncologists, radiation",English
+"medical oncologists, radiation medical oncologists, radiation oncologists, radiologists, oncologists, radiologists, oncologists, radiologists, pathologists, and they really pathologists, and they really pathologists, and they really visit the facets of all the",English
+visit the facets of all the visit the facets of all the patient care The benefits of patient care The benefits of patient care The benefits of that are that you have the that are that you have the that are that you have the advantage of multiple opinions.,English
+"advantage of multiple opinions. advantage of multiple opinions. Classically, we don't have Classically, we don't have Classically, we don't have patients participate next. We patients participate next. We patients participate next. We talk about multiple patients",English
+"talk about multiple patients talk about multiple patients and because of privacy issues and because of privacy issues and because of privacy issues and things like that, you can't and things like that, you can't and things like that, you can't hear about other people and",English
+"hear about other people and hear about other people and their issues. Uh and that way, their issues. Uh and that way, their issues. Uh and that way, physicians can freak speech physicians can freak speech",English
+physicians can freak speech speak freely and dialogue back speak freely and dialogue back speak freely and dialogue back and forth about ideas if and forth about ideas if and forth about ideas if there's no set right answer for,English
+there's no set right answer for there's no set right answer for a patient. They can talk about a patient. They can talk about a patient. They can talk about Multiple different options and Multiple different options and Multiple different options and weigh the pros and cons of all,English
+"weigh the pros and cons of all weigh the pros and cons of all of them and come up with a of them and come up with a of them and come up with a consensus. Um but in general, consensus. Um but in general, consensus. Um but in general, it's important because it it",English
+"it's important because it it it's important because it it allows everybody to look at the allows everybody to look at the allows everybody to look at the entire case, review the entire case, review the entire case, review the pathology, make sure you",English
+"pathology, make sure you pathology, make sure you understand the grade, whether understand the grade, whether understand the grade, whether it's high grade or low grade it's high grade or low grade it's high grade or low grade and acting, you know, like a",English
+"and acting, you know, like a and acting, you know, like a slow growing tumor or a super slow growing tumor or a super slow growing tumor or a super aggressive cancer and so it aggressive cancer and so it",English
+aggressive cancer and so it allows everybody to weigh in on allows everybody to weigh in on allows everybody to weigh in on what they think is the best way what they think is the best way what they think is the best way to treat a patient. Um I think,English
+to treat a patient. Um I think to treat a patient. Um I think it the other piece that's it the other piece that's it the other piece that's important when you're selecting important when you're selecting important when you're selecting surgeons and this is partly the,English
+surgeons and this is partly the surgeons and this is partly the American Association of American Association of American Association of Endocrine Surgeons has a a Endocrine Surgeons has a a Endocrine Surgeons has a a large you know population of,English
+large you know population of large you know population of very qualified surgeons that very qualified surgeons that very qualified surgeons that have a lot of knowledge about have a lot of knowledge about have a lot of knowledge about Neuroendocrine Tumors and so I,English
+Neuroendocrine Tumors and so I Neuroendocrine Tumors and so I think it's important when you think it's important when you think it's important when you go to a specialist for go to a specialist for go to a specialist for Neuroendocrine Tumor that you Neuroendocrine Tumor that you,English
+Neuroendocrine Tumor that you make sure that they have some make sure that they have some make sure that they have some basic knowledge because there's basic knowledge because there's basic knowledge because there's not thousands of us that do,English
+not thousands of us that do not thousands of us that do this but there are enough this but there are enough this but there are enough across the country that you can across the country that you can across the country that you can get really good care in both,English
+get really good care in both get really good care in both states. Thank you. Um Miss Yin how will Thank you. Um Miss Yin how will having a neuroendocrine tumor,English
+"having a neuroendocrine tumor having a neuroendocrine tumor affect a patient's life? Will affect a patient's life? Will affect a patient's life? Will they be able to work, travel, they be able to work, travel, they be able to work, travel, exercise, and do the other",English
+"exercise, and do the other exercise, and do the other things they enjoy doing? Thanks things they enjoy doing? Thanks things they enjoy doing? Thanks for asking this question, for asking this question,",English
+"for asking this question, Doctor Woodruff. As a caregiver Doctor Woodruff. As a caregiver Doctor Woodruff. As a caregiver myself, I can say that myself, I can say that myself, I can say that neuroindegrant tumor not only neuroindegrant tumor not only",English
+"neuroindegrant tumor not only affects a patient's life, it affects a patient's life, it affects a patient's life, it also affects the lives of their also affects the lives of their also affects the lives of their loved ones. How it affects",English
+"loved ones. How it affects loved ones. How it affects someone's life? Really? It someone's life? Really? It someone's life? Really? It depends on so many factors. All depends on so many factors. All depends on so many factors. All the things that Doctor Elsie, the things that Doctor Elsie, the things that Doctor Elsie, Doctor Sombal, and Doctor",English
+"Doctor Sombal, and Doctor Doctor Sombal, and Doctor Koiken described so well. What Koiken described so well. What Koiken described so well. What type of neuroendocrine tumor, type of neuroendocrine tumor, type of neuroendocrine tumor, grade, is the tumors produce",English
+"grade, is the tumors produce grade, is the tumors produce hormones, how much disease hormones, how much disease hormones, how much disease there is, where the disease is, there is, where the disease is, there is, where the disease is, what symptoms people what symptoms people",English
+"what symptoms people experience, type of treatments, experience, type of treatments, experience, type of treatments, etcetera. Um but those are just etcetera. Um but those are just etcetera. Um but those are just the medical factors. That the medical factors. That",English
+"the medical factors. That doesn't even mention the doesn't even mention the doesn't even mention the stress, anxiety, depression, stress, anxiety, depression, stress, anxiety, depression, and trauma people experience. and trauma people experience.",English
+and trauma people experience. Um and all those things affect Um and all those things affect Um and all those things affect one's capacity. So my husband one's capacity. So my husband one's capacity. So my husband and I like to think of it like,English
+and I like to think of it like and I like to think of it like a bank account. And there's a bank account. And there's a bank account. And there's things like stress or side things like stress or side things like stress or side effects of treatments that make effects of treatments that make,English
+effects of treatments that make withdrawals. And there's things withdrawals. And there's things withdrawals. And there's things like support and education that like support and education that like support and education that might make deposits. And we're might make deposits. And we're,English
+might make deposits. And we're definitely much aware now of definitely much aware now of definitely much aware now of our bank accounts than we were our bank accounts than we were our bank accounts than we were before diagnosis. And there's,English
+before diagnosis. And there's before diagnosis. And there's ups and downs and different ups and downs and different ups and downs and different seasons where one's capacity seasons where one's capacity seasons where one's capacity might be less than it was might be less than it was,English
+"might be less than it was before. And for my husband and before. And for my husband and before. And for my husband and I, his diagnosis, surgery, and I, his diagnosis, surgery, and I, his diagnosis, surgery, and treatments, they completely",English
+"treatments, they completely treatments, they completely disrupted both of our lives. disrupted both of our lives. disrupted both of our lives. And our ability to work and And our ability to work and And our ability to work and travel for at least the first travel for at least the first",English
+travel for at least the first couple of years. But not couple of years. But not couple of years. But not everyone has that kind of everyone has that kind of everyone has that kind of experience. One thing I can say,English
+"experience. One thing I can say experience. One thing I can say for sure is that we make for sure is that we make for sure is that we make different choices now, since different choices now, since different choices now, since his diagnosis. And that's his diagnosis. And that's",English
+"his diagnosis. And that's because our prior are because our prior are because our prior are different. And when I say that different. And when I say that different. And when I say that things are not the same, in",English
+"things are not the same, in things are not the same, in many ways, it's not all bad. Um many ways, it's not all bad. Um many ways, it's not all bad. Um for example, we savor the for example, we savor the for example, we savor the things we enjoy much more now.",English
+things we enjoy much more now. things we enjoy much more now. We find joy and beauty in even We find joy and beauty in even We find joy and beauty in even the small things. And I can't the small things. And I can't the small things. And I can't say there's one universal,English
+say there's one universal say there's one universal answer to this question of how answer to this question of how answer to this question of how net affects one's life other net affects one's life other net affects one's life other than it often changes our,English
+than it often changes our than it often changes our outlook on life. And even if outlook on life. And even if outlook on life. And even if and when people return to doing and when people return to doing and when people return to doing some of the same things like,English
+"some of the same things like some of the same things like work, exercise, the things we work, exercise, the things we work, exercise, the things we enjoy. We're in the process of enjoy. We're in the process of enjoy. We're in the process of learning to find a new normal.",English
+learning to find a new normal. learning to find a new normal. We might have to plot out We might have to plot out We might have to plot out bathrooms on a road trip or bathrooms on a road trip or bathrooms on a road trip or take more breaks or plan around,English
+"take more breaks or plan around take more breaks or plan around monthly shots. But it is monthly shots. But it is monthly shots. But it is possible to find a new normal. Thank you, Lisa for those",English
+"Thank you, Lisa for those additional inviteful additional inviteful additional inviteful commentary. I know that's a lot commentary. I know that's a lot commentary. I know that's a lot of what our audiences is",English
+"of what our audiences is of what our audiences is wanting to hear. Doctor Sambo, wanting to hear. Doctor Sambo, wanting to hear. Doctor Sambo, can you talk a little bit about can you talk a little bit about",English
+can you talk a little bit about Carsonite syndrome and Carsonite syndrome and Carsonite syndrome and carcinoid crisis? Um how is carcinoid crisis? Um how is carcinoid crisis? Um how is this treated?,English
+"So, carcinoid syndrome, I mean, So, carcinoid syndrome, I mean, in general, the term carcimate, in general, the term carcimate, in general, the term carcimate, we, is a, in general, it's an we, is a, in general, it's an we, is a, in general, it's an older term, really one, these,",English
+"older term, really one, these, older term, really one, these, these tumors first described, these tumors first described, these tumors first described, they thought they were not they thought they were not they thought they were not really cancerous, so they call really cancerous, so they call",English
+"really cancerous, so they call them cancer oids, or, or them cancer oids, or, or them cancer oids, or, or carcinoids, or like cancer, and carcinoids, or like cancer, and carcinoids, or like cancer, and then later on, we learned that",English
+"then later on, we learned that then later on, we learned that they are actually malignant, they are actually malignant, they are actually malignant, and they have the malignant and they have the malignant and they have the malignant potential, so they, they are, potential, so they, they are,",English
+"potential, so they, they are, cancers were, so we're trying cancers were, so we're trying cancers were, so we're trying to avoid the term carcinoid in to avoid the term carcinoid in to avoid the term carcinoid in general as tumors, but the, general as tumors, but the,",English
+"general as tumors, but the, there are some things that are there are some things that are there are some things that are still used, such as the still used, such as the still used, such as the carcinoid syndrome, a carci carcinoid syndrome, a carci",English
+"carcinoid syndrome, a carci crisis. So as as Doctor Ulsa crisis. So as as Doctor Ulsa crisis. So as as Doctor Ulsa mentioned before, these tumors mentioned before, these tumors",English
+"mentioned before, these tumors can produce hormones and when can produce hormones and when can produce hormones and when when these hormones are when these hormones are",English
+"when these hormones are produced, there is what we call produced, there is what we call produced, there is what we call carcinoid syndrome and carcinoid syndrome and carcinoid syndrome and carcinoid syndrome can manifest carcinoid syndrome can manifest",English
+carcinoid syndrome can manifest with multiple types of symptoms with multiple types of symptoms with multiple types of symptoms that can be depending on most that can be depending on most,English
+"that can be depending on most commonly, it's really coming commonly, it's really coming commonly, it's really coming from when when the tumors are from when when the tumors are from when when the tumors are coming from the small bowels coming from the small bowels",English
+"coming from the small bowels and it can happen also in one and it can happen also in one and it can happen also in one neuroendo consumers or lung neuroendo consumers or lung neuroendo consumers or lung carcinoid. So, for example, in carcinoid. So, for example, in",English
+"carcinoid. So, for example, in small boundary endocrin tumors, small boundary endocrin tumors, small boundary endocrin tumors, we see with the Carson we see with the Carson we see with the Carson syndrome, the symptom, the syndrome, the symptom, the",English
+"syndrome, the symptom, the patient describe is a flushing patient describe is a flushing patient describe is a flushing which is different from the hot which is different from the hot which is different from the hot flashes. The hot flashes is",English
+"flashes. The hot flashes is flashes. The hot flashes is more what we call subjective, more what we call subjective, more what we call subjective, meaning the patient would feel meaning the patient would feel meaning the patient would feel it. The flushing, it's",English
+"it. The flushing, it's it. The flushing, it's objective that even someone objective that even someone objective that even someone else can see it or the patient else can see it or the patient else can see it or the patient can see it in the mirror. It's can see it in the mirror. It's",English
+"can see it in the mirror. It's mostly in the on the chest and mostly in the on the chest and mostly in the on the chest and on the face, it can happen and on the face, it can happen and on the face, it can happen and then, I also, as a then, I also, as a",English
+"then, I also, as a manifestation of that, we see manifestation of that, we see manifestation of that, we see loose stool and a frequent loose stool and a frequent loose stool and a frequent stool or diarrhea. Uh as a",English
+stool or diarrhea. Uh as a stool or diarrhea. Uh as a manifestation of carcinoid manifestation of carcinoid manifestation of carcinoid syndrome as well in patients. syndrome as well in patients. syndrome as well in patients. Um the the more severe form or Um the the more severe form or,English
+Um the the more severe form or of carcinoid syndrome is of carcinoid syndrome is of carcinoid syndrome is sometimes when these tumors sometimes when these tumors,English
+sometimes when these tumors they produce a lot of hormones they produce a lot of hormones they produce a lot of hormones if any manipulation can be done if any manipulation can be done,English
+"if any manipulation can be done on the tumor, most most on the tumor, most most on the tumor, most most commonly with a surgery for commonly with a surgery for commonly with a surgery for example, intervention on the",English
+"example, intervention on the example, intervention on the tumors and these tumors produce tumors and these tumors produce tumors and these tumors produce serotonin. Uh sometimes when serotonin. Uh sometimes when serotonin. Uh sometimes when you intervene on these tumors,",English
+"you intervene on these tumors, you intervene on these tumors, there is a flush of serotonin there is a flush of serotonin there is a flush of serotonin happening in the body. So, a happening in the body. So, a happening in the body. So, a lot of these hormone ones just lot of these hormone ones just",English
+"lot of these hormone ones just get released in the body, in get released in the body, in get released in the body, in the bloodstream, and that can the bloodstream, and that can the bloodstream, and that can lead to really dangerous lead to really dangerous",English
+lead to really dangerous fluctuation of blood pressure fluctuation of blood pressure fluctuation of blood pressure and the hemodynamic status of and the hemodynamic status of and the hemodynamic status of the patient and that's what we the patient and that's what we,English
+"the patient and that's what we refer to carcinoid crisis. Now, refer to carcinoid crisis. Now, refer to carcinoid crisis. Now, I just want to mention that I just want to mention that I just want to mention that carcinoid crisis is is very carcinoid crisis is is very",English
+carcinoid crisis is is very rare. One of the reasons why rare. One of the reasons why rare. One of the reasons why it's rare is because the it's rare is because the it's rare is because the surgeons and the and all of us,English
+surgeons and the and all of us surgeons and the and all of us in the community are very aware in the community are very aware in the community are very aware of of it and how to prevent it. of of it and how to prevent it. of of it and how to prevent it. Uh like a lot of times when my,English
+"Uh like a lot of times when my Uh like a lot of times when my colleagues in surgery, they see colleagues in surgery, they see colleagues in surgery, they see a patient and they want to a patient and they want to a patient and they want to operate and they feel that the operate and they feel that the",English
+"operate and they feel that the patient is a high risk. They patient is a high risk. They patient is a high risk. They asked me to start the patient asked me to start the patient asked me to start the patient on on whether long acting, on on whether long acting,",English
+"on on whether long acting, sendostatin, or lineartype sendostatin, or lineartype sendostatin, or lineartype beforehand and then they have beforehand and then they have beforehand and then they have the the drip of ready if",English
+the the drip of ready if the the drip of ready if needed. Uh so someone might needed. Uh so someone might needed. Uh so someone might argue that it's actually rare argue that it's actually rare argue that it's actually rare because we're more aware of it,English
+because we're more aware of it because we're more aware of it and we are preventing it. So and we are preventing it. So and we are preventing it. So that's what we refer to our that's what we refer to our that's what we refer to our carcinoid crisis. The last,English
+carcinoid crisis. The last carcinoid crisis. The last thing is that something you you thing is that something you you thing is that something you you didn't ask about but I want to didn't ask about but I want to,English
+didn't ask about but I want to also cover which is the heart also cover which is the heart also cover which is the heart disease because patients also disease because patients also disease because patients also is something that's important,English
+is something that's important is something that's important and being recognized is very and being recognized is very and being recognized is very very important because it's very important because it's very important because it's under diagnosed still. Meaning under diagnosed still. Meaning,English
+under diagnosed still. Meaning that a lot of patients with that a lot of patients with that a lot of patients with neuroendocrine tumors are neuroendocrine tumors are neuroendocrine tumors are walking around and have walking around and have walking around and have carcinogen heart disease,English
+carcinogen heart disease carcinogen heart disease without knowing. Carson or without knowing. Carson or without knowing. Carson or heart disease is what happens heart disease is what happens heart disease is what happens is those neurendocrine tumors is those neurendocrine tumors,English
+is those neurendocrine tumors again most commonly the small again most commonly the small again most commonly the small bowel ones. They can produce bowel ones. They can produce bowel ones. They can produce serotonin and that on the long serotonin and that on the long,English
+"serotonin and that on the long rung can lead to further rung can lead to further rung can lead to further disruption destruction of the disruption destruction of the disruption destruction of the heart heart valves, most",English
+"heart heart valves, most heart heart valves, most commonly the right heart commonly the right heart commonly the right heart valves, the tricuspid and and valves, the tricuspid and and valves, the tricuspid and and the pulmonary valves and that",English
+the pulmonary valves and that the pulmonary valves and that can lead to what we call can lead to what we call can lead to what we call carcinoid heart disease. So the carcinoid heart disease. So the carcinoid heart disease. So the early recognition of of these,English
+"early recognition of of these early recognition of of these things in general is is key in things in general is is key in things in general is is key in in managing any of those in managing any of those in managing any of those things. Thank you, Doctor",English
+"things. Thank you, Doctor things. Thank you, Doctor Samball. Doctor Elsa, is Samball. Doctor Elsa, is Samball. Doctor Elsa, is Neuroendocrine Tumor genetic? Neuroendocrine Tumor genetic?",English
+"Neuroendocrine Tumor genetic? Do patients need genetic Do patients need genetic Do patients need genetic testing and what about their testing and what about their testing and what about their family members? Should they family members? Should they family members? Should they have testing or screening? So,",English
+"have testing or screening? So, have testing or screening? So, that's of course an important that's of course an important that's of course an important question and a question very question and a question very question and a question very dear to my heart. Although I'm",English
+"dear to my heart. Although I'm dear to my heart. Although I'm an endocrinologist by training, an endocrinologist by training, an endocrinologist by training, a lot of my life is actually in a lot of my life is actually in a lot of my life is actually in cancer genetics. I staff a cancer genetics. I staff a",English
+"cancer genetics. I staff a cancer genetics clinic as well. cancer genetics clinic as well. cancer genetics clinic as well. Um so, when it comes to the Um so, when it comes to the Um so, when it comes to the evaluation for genetic",English
+"evaluation for genetic evaluation for genetic contribution, basically, contribution, basically, contribution, basically, something somebody is born with something somebody is born with something somebody is born with that gave them a higher risk to that gave them a higher risk to that gave them a higher risk to develop these neuroendo",English
+develop these neuroendo develop these neuroendo consumers. It's again very consumers. It's again very consumers. It's again very important to see where these important to see where these important to see where these tumors are arising. And it it,English
+tumors are arising. And it it tumors are arising. And it it particularly important genetic particularly important genetic particularly important genetic considerations for patients considerations for patients considerations for patients where the tumor is actually,English
+"where the tumor is actually where the tumor is actually arising somewhere in what we arising somewhere in what we arising somewhere in what we call the fore gut which call the fore gut which call the fore gut which actually includes the lung, the",English
+"actually includes the lung, the actually includes the lung, the pancreas, as well as the pancreas, as well as the pancreas, as well as the dualdenum and the stomach. And dualdenum and the stomach. And dualdenum and the stomach. And you know the classical",English
+you know the classical you know the classical carcinoid is usually somewhere carcinoid is usually somewhere carcinoid is usually somewhere behind that in the mid cut behind that in the mid cut behind that in the mid cut small bowel. And there's really small bowel. And there's really,English
+small bowel. And there's really nothing known about hereditary nothing known about hereditary nothing known about hereditary predisposition to carcinoid in predisposition to carcinoid in,English
+predisposition to carcinoid in the small bowel. There are some the small bowel. There are some the small bowel. There are some suggestive findings but nothing suggestive findings but nothing suggestive findings but nothing we would actually clinically,English
+we would actually clinically we would actually clinically test for. So the majority of test for. So the majority of test for. So the majority of considerations is actually for considerations is actually for considerations is actually for our patients that have either,English
+our patients that have either our patients that have either stomach or pancreatic or stomach or pancreatic or stomach or pancreatic or duardinal carcinoids. And again duardinal carcinoids. And again duardinal carcinoids. And again it's important to see what,English
+it's important to see what it's important to see what hormones do they produce. So hormones do they produce. So hormones do they produce. So for example gastronomas for example gastronomas for example gastronomas patients that have a nova patients that have a nova,English
+patients that have a nova secretion of gastroin which secretion of gastroin which secretion of gastroin which leads to very high stomach as leads to very high stomach as leads to very high stomach as well as ulcers. Um those,English
+well as ulcers. Um those well as ulcers. Um those patients probably have a higher patients probably have a higher patients probably have a higher chance to actually have some chance to actually have some chance to actually have some genetic predisposition for,English
+genetic predisposition for genetic predisposition for this. And the same is probably this. And the same is probably this. And the same is probably two for pancreatic neuroendo two for pancreatic neuroendo two for pancreatic neuroendo consumers. Um in the main,English
+consumers. Um in the main consumers. Um in the main syndromes we consider here are syndromes we consider here are syndromes we consider here are probably multiple endocrine probably multiple endocrine probably multiple endocrine neoplasia type one. And when,English
+neoplasia type one. And when neoplasia type one. And when hippo lindo disease. So hippo lindo disease. So hippo lindo disease. So multiple hip and multiple hip and multiple hip and endocrineoplasia type one is endocrineoplasia type one is endocrineoplasia type one is actually a syndrome which comes,English
+actually a syndrome which comes actually a syndrome which comes with tumours of the pituitary with tumours of the pituitary with tumours of the pituitary small that is on the bottom of small that is on the bottom of small that is on the bottom of the brain as well as hypo,English
+the brain as well as hypo the brain as well as hypo parathyroidism dosa glands that parathyroidism dosa glands that parathyroidism dosa glands that regulate calcium levels in the regulate calcium levels in the regulate calcium levels in the blood and pancreatic neuro and,English
+blood and pancreatic neuro and blood and pancreatic neuro and the consumers as well as the consumers as well as the consumers as well as sometimes Neuroendocrine s of sometimes Neuroendocrine s of sometimes Neuroendocrine s of the lung and the dualdenum as the lung and the dualdenum as,English
+the lung and the dualdenum as well. Um however for multiple well. Um however for multiple well. Um however for multiple endocrineoplasty type one I endocrineoplasty type one I endocrineoplasty type one I think it's always important to,English
+think it's always important to think it's always important to understand that usually these understand that usually these understand that usually these patients will have some other patients will have some other patients will have some other manifestations prior to having manifestations prior to having,English
+"manifestations prior to having symptoms or a diagnosis of a symptoms or a diagnosis of a symptoms or a diagnosis of a Neuroendocrine. So, I can tell Neuroendocrine. So, I can tell Neuroendocrine. So, I can tell you that I have never diagnosed",English
+you that I have never diagnosed you that I have never diagnosed the patient in my professional the patient in my professional the patient in my professional life based on the occurrence of life based on the occurrence of life based on the occurrence of a neuro and a consumer with,English
+a neuro and a consumer with a neuro and a consumer with multiple endocrineoplasia type multiple endocrineoplasia type multiple endocrineoplasia type one. Particularly the high one. Particularly the high one. Particularly the high function of the parathyroids,English
+function of the parathyroids function of the parathyroids and the high calcium levels and the high calcium levels and the high calcium levels precedes the diagnosis. Um and precedes the diagnosis. Um and precedes the diagnosis. Um and patients will have a strong,English
+patients will have a strong patients will have a strong family history of either of family history of either of family history of either of these manifestations. Basically these manifestations. Basically these manifestations. Basically the same thing as two for,English
+the same thing as two for the same thing as two for ventipalindo disease which ventipalindo disease which ventipalindo disease which comes with manifestations of comes with manifestations of comes with manifestations of the brain with hemoji which are the brain with hemoji which are,English
+"the brain with hemoji which are blood vessel tumors, kidney blood vessel tumors, kidney blood vessel tumors, kidney cancers, as well as pancreatic cancers, as well as pancreatic cancers, as well as pancreatic neuroendocumers and also in the",English
+"neuroendocumers and also in the neuroendocumers and also in the adrenal gland. Um again, adrenal gland. Um again, adrenal gland. Um again, usually other manifestations usually other manifestations usually other manifestations precede the diagnosis of",English
+"precede the diagnosis of precede the diagnosis of Neuroendocrine Tumors. That's Neuroendocrine Tumors. That's Neuroendocrine Tumors. That's why in general, I'm convinced why in general, I'm convinced why in general, I'm convinced that a genetic evaluation with",English
+that a genetic evaluation with that a genetic evaluation with a full family history and a a full family history and a a full family history and a full personal history which is full personal history which is full personal history which is really the key to the diagnosis,English
+"really the key to the diagnosis really the key to the diagnosis of what we do and ultimately of what we do and ultimately of what we do and ultimately decide for genetic testing is decide for genetic testing is decide for genetic testing is valuable for everyone. However,",English
+"valuable for everyone. However, valuable for everyone. However, a general diagnosis of a a general diagnosis of a a general diagnosis of a Neuroendocrine probably has a Neuroendocrine probably has a",English
+"Neuroendocrine probably has a fairly low outcome in terms of fairly low outcome in terms of fairly low outcome in terms of genetic testing. Yet, it's genetic testing. Yet, it's genetic testing. Yet, it's important for for example, one",English
+"important for for example, one important for for example, one related tumor which is often related tumor which is often related tumor which is often mentioned together with mentioned together with mentioned together with Neuroendocrine Tumors and those",English
+Neuroendocrine Tumors and those Neuroendocrine Tumors and those are the few neomas which are are the few neomas which are are the few neomas which are tumors of the adrenal gland or tumors of the adrenal gland or,English
+"tumors of the adrenal gland or related tumors elsewhere. Um related tumors elsewhere. Um related tumors elsewhere. Um those have a very, very high those have a very, very high those have a very, very high genetic component and about one",English
+genetic component and about one genetic component and about one in three people with that in three people with that in three people with that diagnosis will have an diagnosis will have an diagnosis will have an underlying genetic change that underlying genetic change that,English
+underlying genetic change that gave them a higher risk for gave them a higher risk for gave them a higher risk for this. Um there's also another this. Um there's also another this. Um there's also another emerging field where it's,English
+emerging field where it's emerging field where it's highly important to know highly important to know highly important to know whether a patient actually has whether a patient actually has whether a patient actually has an underlying genetic syndrome an underlying genetic syndrome,English
+an underlying genetic syndrome such as the highlighted with such as the highlighted with such as the highlighted with disease. There was just a disease. There was just a disease. There was just a recent study testing a new in,English
+recent study testing a new in recent study testing a new in class drugs specific for class drugs specific for class drugs specific for disease associated and disease associated and disease associated and pancreatic neuroendo consumers,English
+pancreatic neuroendo consumers pancreatic neuroendo consumers and these patients almost and these patients almost and these patients almost responded through the board responded through the board responded through the board with that drug with very little,English
+"with that drug with very little with that drug with very little side effects. So, that just side effects. So, that just side effects. So, that just tells us that the genetic tells us that the genetic tells us that the genetic makeup of the tumor and also",English
+makeup of the tumor and also makeup of the tumor and also the genetic makeup of the the genetic makeup of the the genetic makeup of the patient with the risk increases patient with the risk increases patient with the risk increases about these tumors is highly,English
+about these tumors is highly about these tumors is highly important and will become even important and will become even important and will become even more important in the future in more important in the future in more important in the future in terms of therapy of these terms of therapy of these,English
+terms of therapy of these tumors. The last thing I would tumors. The last thing I would tumors. The last thing I would like to say is that in case a,English
+"like to say is that in case a like to say is that in case a genetic syndrome is diagnosed, genetic syndrome is diagnosed, genetic syndrome is diagnosed, it's of course highly important it's of course highly important it's of course highly important for the family because every",English
+for the family because every for the family because every first degree relative will have first degree relative will have first degree relative will have a 50% chance to carry the same a 50% chance to carry the same a 50% chance to carry the same genetic change and will be at,English
+genetic change and will be at genetic change and will be at risk for those tumors as well risk for those tumors as well risk for those tumors as well and that actually gives us the and that actually gives us the and that actually gives us the opportunity to start,English
+opportunity to start opportunity to start surveillance in these patients surveillance in these patients surveillance in these patients very early on and hopefully very early on and hopefully very early on and hopefully catch the tumors at a stage catch the tumors at a stage,English
+catch the tumors at a stage where the multiple endocrine where the multiple endocrine where the multiple endocrine surgeons and other surgeons on surgeons and other surgeons on surgeons and other surgeons on this panel can take care of this panel can take care of,English
+this panel can take care of these tumors before it comes to these tumors before it comes to these tumors before it comes to the point where they actually the point where they actually the point where they actually metastasize and are not,English
+metastasize and are not metastasize and are not curable. Um so yeah family curable. Um so yeah family curable. Um so yeah family testing is probably but family testing is probably but family,English
+testing is probably but family testing is really something testing is really something testing is really something that that should only come that that should only come that that should only come after the initial testing of after the initial testing of after the initial testing of the what we call probe and the,English
+the what we call probe and the the what we call probe and the initial patient. Um and then we initial patient. Um and then we initial patient. Um and then we kind of walk our way through kind of walk our way through kind of walk our way through the family.,English
+"Thank you, Doctor Elsa. Doctor, Thank you, Doctor Elsa. Doctor, how do you determine where the how do you determine where the how do you determine where the tumor comes from and how does tumor comes from and how does tumor comes from and how does this guide your treatment",English
+this guide your treatment this guide your treatment decisions? How how important is decisions? How how important is decisions? How how important is it for us to find the primary it for us to find the primary it for us to find the primary set of the tumor and what set of the tumor and what,English
+set of the tumor and what happens if we don't know where happens if we don't know where happens if we don't know where the tumor is coming from or the the tumor is coming from or the the tumor is coming from or the side of origins unclear? Sure.,English
+"side of origins unclear? Sure. side of origins unclear? Sure. So, again, it comes back to the So, again, it comes back to the So, again, it comes back to the diagnosis of these tumors, diagnosis of these tumors,",English
+"diagnosis of these tumors, right? So, again, with, with right? So, again, with, with right? So, again, with, with regular CT scans, MRIs, you can regular CT scans, MRIs, you can regular CT scans, MRIs, you can figure out whether there is a",English
+"figure out whether there is a figure out whether there is a mass or not and like I said, mass or not and like I said, mass or not and like I said, you can either biopsy it or get you can either biopsy it or get you can either biopsy it or get a donut to Pet CT if it's in an a donut to Pet CT if it's in an",English
+a donut to Pet CT if it's in an area where you can't biopsy it area where you can't biopsy it area where you can't biopsy it and see if it's a and see if it's a and see if it's a Neuroendocrine tumor. Um but Neuroendocrine tumor. Um but,English
+Neuroendocrine tumor. Um but occasionally we do have occasionally we do have occasionally we do have patients that have what's patients that have what's patients that have what's called unknown primary tumor in called unknown primary tumor in,English
+called unknown primary tumor in a setting of metastatic a setting of metastatic a setting of metastatic disease. So you know the disease. So you know the,English
+disease. So you know the occasionally we see patients occasionally we see patients occasionally we see patients that are convinced they have a that are convinced they have a that are convinced they have a neurendocrine tumor but they,English
+neurendocrine tumor but they neurendocrine tumor but they have no evidence on scans that have no evidence on scans that have no evidence on scans that they that there's a they that there's a they that there's a neuroendocrine tumor. So you,English
+neuroendocrine tumor. So you neuroendocrine tumor. So you know those are the hardest know those are the hardest know those are the hardest cases because you know like we cases because you know like we cases because you know like we said can secrete hormones that,English
+said can secrete hormones that said can secrete hormones that sometimes we even measure sometimes we even measure sometimes we even measure because we don't know exactly because we don't know exactly because we don't know exactly what they are and all kinds of,English
+what they are and all kinds of what they are and all kinds of symptoms can come up. But symptoms can come up. But symptoms can come up. But generally if a neuronoquin generally if a neuronoquin generally if a neuronoquin tumor produces symptoms related,English
+tumor produces symptoms related tumor produces symptoms related to hormones it will show up to hormones it will show up to hormones it will show up somewhere. Um it may not show somewhere. Um it may not show,English
+somewhere. Um it may not show up as a primary tumor but it up as a primary tumor but it up as a primary tumor but it will show up usually as will show up usually as will show up usually as metastatic disease. So let's metastatic disease. So let's,English
+metastatic disease. So let's say you have you know disease say you have you know disease say you have you know disease in the liver where the tumors in the liver where the tumors in the liver where the tumors don't come from. They come from don't come from. They come from don't come from. They come from somewhere else and go to the,English
+somewhere else and go to the somewhere else and go to the liver. You have a biopsy. You liver. You have a biopsy. You liver. You have a biopsy. You know it's a neurandogen tumor. know it's a neurandogen tumor. know it's a neurandogen tumor. Uh you,English
+those are sort of the tumors those are sort of the tumors that that you know may or may that that you know may or may that that you know may or may not have a primary tumor that not have a primary tumor that not have a primary tumor that is detectable on a scan. So is detectable on a scan. So,English
+"is detectable on a scan. So when we talk about unknown when we talk about unknown when we talk about unknown primary tumors, we usually talk primary tumors, we usually talk primary tumors, we usually talk about unknown primary tumors in",English
+"about unknown primary tumors in about unknown primary tumors in the setting of metastatic the setting of metastatic the setting of metastatic disease. So, we don't talk disease. So, we don't talk disease. So, we don't talk about unknown primary tumor about unknown primary tumor about unknown primary tumor where you you scan and there's",English
+"where you you scan and there's where you you scan and there's just nothing there. Uh you just nothing there. Uh you just nothing there. Uh you know, you have endoscopies, you know, you have endoscopies, you know, you have endoscopies, you have your colonoscopies, you have your colonoscopies, you",English
+"have your colonoscopies, you got your PET scan, you got your got your PET scan, you got your got your PET scan, you got your CT scan, you got your MRIs, and CT scan, you got your MRIs, and CT scan, you got your MRIs, and there's just nothing there. You there's just nothing there. You",English
+there's just nothing there. You probably don't have an probably don't have an probably don't have an endocrine tumor. Even if your endocrine tumor. Even if your endocrine tumor. Even if your biochemical work your biochemical work your,English
+biochemical work your promegranate for for example is promegranate for for example is promegranate for for example is positive and there's a reason positive and there's a reason positive and there's a reason why I didn't mention it last why I didn't mention it last why I didn't mention it last time as diagnosis because,English
+time as diagnosis because time as diagnosis because pomegranate is an reliably pomegranate is an reliably pomegranate is an reliably unreliable marker that is not unreliable marker that is not unreliable marker that is not helpful for diagnosing,English
+helpful for diagnosing helpful for diagnosing neuroendocrine tumors at neuroendocrine tumors at neuroendocrine tumors at baseline. Sometimes to follow baseline. Sometimes to follow baseline. Sometimes to follow up these like these like,English
+"up these like these like up these like these like tumors, yes, but not to tumors, yes, but not to tumors, yes, but not to diagnose. You know, again, if diagnose. You know, again, if diagnose. You know, again, if you, if there's nothing there,",English
+"you, if there's nothing there, you, if there's nothing there, you probably don't have a you probably don't have a you probably don't have a neuroendocrine tumor. If you neuroendocrine tumor. If you neuroendocrine tumor. If you have metastatic disease or you have metastatic disease or you",English
+"have metastatic disease or you have, let's say, a mass in your have, let's say, a mass in your have, let's say, a mass in your small biomesentary, the area small biomesentary, the area",English
+"small biomesentary, the area that supplies your small bowel, that supplies your small bowel, that supplies your small bowel, it's quite common actually it's quite common actually it's quite common actually that, especially for small",English
+"that, especially for small that, especially for small bowel neuronal consumers, we bowel neuronal consumers, we bowel neuronal consumers, we don't see the primary tumor on don't see the primary tumor on don't see the primary tumor on the skin. That doesn't mean the skin. That doesn't mean",English
+"the skin. That doesn't mean it's not there, it just means it's not there, it just means it's not there, it just means that it's usually too small to that it's usually too small to that it's usually too small to be actually detected on a",English
+"be actually detected on a be actually detected on a Dolotape Pet CT or on a CTE Dolotape Pet CT or on a CTE Dolotape Pet CT or on a CTE scan. So, I think that, that, scan. So, I think that, that,",English
+"scan. So, I think that, that, when, if you know enough about when, if you know enough about when, if you know enough about this neuroendocrine tumors, and this neuroendocrine tumors, and",English
+"this neuroendocrine tumors, and you know the pattern on how you know the pattern on how you know the pattern on how they tend to spread, especially they tend to spread, especially they tend to spread, especially to lymph nodes, you can to lymph nodes, you can",English
+"to lymph nodes, you can actually a pretty good idea of actually a pretty good idea of actually a pretty good idea of where the primary tumor is. I where the primary tumor is. I",English
+where the primary tumor is. I give you an example. If you give you an example. If you give you an example. If you have a lymph node mass or mass have a lymph node mass or mass have a lymph node mass or mass that you think are basically,English
+"that you think are basically that you think are basically enlarged lymph nodes along the enlarged lymph nodes along the enlarged lymph nodes along the vessels that supply the distal vessels that supply the distal vessels that supply the distal part of your small bowel, they",English
+"part of your small bowel, they part of your small bowel, they are called the ilecolic vessels are called the ilecolic vessels are called the ilecolic vessels but you have had a scan that but you have had a scan that but you have had a scan that doesn't show anything else. Um",English
+"doesn't show anything else. Um doesn't show anything else. Um most likely, the primary tumor most likely, the primary tumor most likely, the primary tumor is in the small bowel in the is in the small bowel in the is in the small bowel in the distal small bowel next to the distal small bowel next to the",English
+distal small bowel next to the right colon. Um and then when right colon. Um and then when right colon. Um and then when you take them to the operating you take them to the operating,English
+"you take them to the operating room, that's what you're room, that's what you're room, that's what you're going to see. It's important to going to see. It's important to going to see. It's important to to know understand the disease",English
+"to know understand the disease to know understand the disease process, to understand how and process, to understand how and process, to understand how and where these tumors tend to where these tumors tend to where these tumors tend to spread, and then, usually just",English
+"spread, and then, usually just spread, and then, usually just looking at regular scans, you looking at regular scans, you looking at regular scans, you can get an idea or the DotaTape can get an idea or the DotaTape can get an idea or the DotaTape Pet Scan, you can get an idea Pet Scan, you can get an idea",English
+"Pet Scan, you can get an idea of where the tumor is even if of where the tumor is even if of where the tumor is even if it doesn't light up. Also, it doesn't light up. Also, it doesn't light up. Also, important as surgeons to know important as surgeons to know",English
+"important as surgeons to know when you go in that you have to when you go in that you have to when you go in that you have to run the entire small bowel, you run the entire small bowel, you run the entire small bowel, you know, because some of these",English
+"know, because some of these know, because some of these tumors can have about thirty for example for small boundary",English
+"for example for small boundary consumers have multiple sites, consumers have multiple sites, consumers have multiple sites, not just one side, so you may not just one side, so you may not just one side, so you may find find one side, you're all find find one side, you're all find find one side, you're all happy, you take it out, but happy, you take it out, but",English
+"happy, you take it out, but then you didn't run the rest of then you didn't run the rest of then you didn't run the rest of the small balance, so you have the small balance, so you have the small balance, so you have unknown second primary tumors unknown second primary tumors unknown second primary tumors that you haven't found, right?",English
+"that you haven't found, right? that you haven't found, right? So I think like Marybeth, said So I think like Marybeth, said So I think like Marybeth, said before, I think, you know, before, I think, you know,",English
+"before, I think, you know, going to experienced surgeons going to experienced surgeons going to experienced surgeons that know what they are looking that know what they are looking that know what they are looking for is really important. To",English
+"for is really important. To for is really important. To your last question, does it your last question, does it your last question, does it matter? What do you, whether matter? What do you, whether matter? What do you, whether you see or know the primary you see or know the primary you see or know the primary tumor is. It does matter if the",English
+"tumor is. It does matter if the tumor is. It does matter if the disease is localized. You're disease is localized. You're disease is localized. You're doing an operation and you're doing an operation and you're doing an operation and you're trying to cure the patient. trying to cure the patient. trying to cure the patient. Ideally you, you know, in those",English
+"Ideally you, you know, in those Ideally you, you know, in those cases, you really want to take cases, you really want to take cases, you really want to take the primary tumor out. So, the primary tumor out. So, the primary tumor out. So, again, you gotta run the bowel, again, you gotta run the bowel,",English
+"again, you gotta run the bowel, you gotta, if it's a gastenoma, you gotta, if it's a gastenoma, you gotta, if it's a gastenoma, you gotta pop it to do adenum, you gotta pop it to do adenum, you gotta pop it to do adenum, you know, if it's in the tail you know, if it's in the tail",English
+"you know, if it's in the tail of the pancreas, you may of the pancreas, you may of the pancreas, you may want to do an EUS pre-op or use want to do an EUS pre-op or use want to do an EUS pre-op or use ultrasound in the OR. There's",English
+"ultrasound in the OR. There's ultrasound in the OR. There's many things that we can do as many things that we can do as many things that we can do as surgeons, pre-op, or during the surgeons, pre-op, or during the",English
+"surgeons, pre-op, or during the surgery to try to figure that surgery to try to figure that surgery to try to figure that out. does it matter if you have out. does it matter if you have out. does it matter if you have metastatic disease? Less so and",English
+metastatic disease? Less so and metastatic disease? Less so and I certainly have a handful of I certainly have a handful of I certainly have a handful of patients where you know they've patients where you know they've patients where you know they've had liver lesions. We've taken had liver lesions. We've taken,English
+had liver lesions. We've taken into the aura. We've taken out into the aura. We've taken out into the aura. We've taken out the liver lesions and we run the liver lesions and we run the liver lesions and we run the bowel. We did the the bowel. We did the,English
+the bowel. We did the ultrasound of the pancreas. We ultrasound of the pancreas. We ultrasound of the pancreas. We palpated the duodenum. We palpated the duodenum. We palpated the duodenum. We looked everywhere. And there's looked everywhere. And there's,English
+looked everywhere. And there's just no primary tumor to be just no primary tumor to be just no primary tumor to be found. I mean there are these found. I mean there are these found. I mean there are these these exceptional cases where these exceptional cases where,English
+these exceptional cases where this is the case. Uh when you this is the case. Uh when you this is the case. Uh when you have metastatic disease the have metastatic disease the have metastatic disease the cats out of the back in the,English
+"cats out of the back in the cats out of the back in the sense that even if you operate sense that even if you operate sense that even if you operate the recurrence rate is very the recurrence rate is very the recurrence rate is very high in the liver. So, so, you high in the liver. So, so, you",English
+"high in the liver. So, so, you know, it doesn't mean you can't know, it doesn't mean you can't know, it doesn't mean you can't live very long. It doesn't mean live very long. It doesn't mean live very long. It doesn't mean they're not great therapies to they're not great therapies to",English
+"they're not great therapies to treat you but in those treat you but in those treat you but in those situation, I think that, that, situation, I think that, that, situation, I think that, that, you know, if you really can't",English
+"you know, if you really can't you know, if you really can't find a primary tumor in in your find a primary tumor in in your find a primary tumor in in your experience and you have looked experience and you have looked experience and you have looked where you need to look, it's where you need to look, it's",English
+"where you need to look, it's not the end of the world. You not the end of the world. You not the end of the world. You just basically do what you can just basically do what you can just basically do what you can surgically to remove the surgically to remove the",English
+"surgically to remove the metastatic disease if it is metastatic disease if it is metastatic disease if it is receptable and then, you just receptable and then, you just receptable and then, you just continue to surveil the",English
+continue to surveil the continue to surveil the patients and maybe the primary patients and maybe the primary patients and maybe the primary tumor will show up at some tumor will show up at some tumor will show up at some point and then you can take point and then you can take,English
+"point and then you can take care of it or maybe it won't. I care of it or maybe it won't. I care of it or maybe it won't. I mean, I have a patient where I mean, I have a patient where I mean, I have a patient where I did a right liver lobectomy six",English
+"did a right liver lobectomy six did a right liver lobectomy six or seven years ago and that was or seven years ago and that was or seven years ago and that was it. You know, it never showed it. You know, it never showed",English
+"it. You know, it never showed back up, we, we, we just don't back up, we, we, we just don't back up, we, we, we just don't know where the primary tumor know where the primary tumor know where the primary tumor is. Side note, there are is. Side note, there are",English
+"is. Side note, there are certain stainings nowadays, on certain stainings nowadays, on certain stainings nowadays, on pathology, there's also",English
+"pathology, there's also pathology, there's also molecular, genetics of the molecular, genetics of the molecular, genetics of the tumor, they can give you a hint tumor, they can give you a hint tumor, they can give you a hint of where the primary tumor is,",English
+"of where the primary tumor is, of where the primary tumor is, the certain mutations, ATRX, the certain mutations, ATRX, the certain mutations, ATRX, maximum one that are very maximum one that are very maximum one that are very typical with peanuts like with",English
+typical with peanuts like with typical with peanuts like with pancreatic neuronoquine tumors. pancreatic neuronoquine tumors. pancreatic neuronoquine tumors. Certain stainings like CD2 that are also very typical,English
+"CD2 that are also very typical for small bile or GI neurono for small bile or GI neurono for small bile or GI neurono consumers. So if you work consumers. So if you work consumers. So if you work together with a pathologist,",English
+"together with a pathologist, together with a pathologist, you could certainly get an idea you could certainly get an idea you could certainly get an idea even before you take somebody even before you take somebody even before you take somebody to the OR by by using some of to the OR by by using some of",English
+"to the OR by by using some of that biopsy samples to to you that biopsy samples to to you that biopsy samples to to you know, kind of give us give you know, kind of give us give you",English
+"know, kind of give us give you an idea. So, it's a long answer an idea. So, it's a long answer an idea. So, it's a long answer I gave but but I hope it was I gave but but I hope it was I gave but but I hope it was somewhat clear",English
+"Yes, thank you very much for Yes, thank you very much for that helpful information. Dr. that helpful information. Dr. that helpful information. Dr. Hughes, how do you determine if Hughes, how do you determine if Hughes, how do you determine if a patient is a surgical",English
+a patient is a surgical a patient is a surgical candidate and what is the best candidate and what is the best candidate and what is the best surgical approach and what are surgical approach and what are surgical approach and what are the other possible treatment,English
+the other possible treatment the other possible treatment options? That's a great options? That's a great options? That's a great question. I think that's question. I think that's,English
+question. I think that's probably one of the most probably one of the most probably one of the most important things we do as important things we do as important things we do as endocrine surgeons is when we endocrine surgeons is when we,English
+"endocrine surgeons is when we have a patient and we look at a have a patient and we look at a have a patient and we look at a couple different things. So, couple different things. So, couple different things. So, where is their tumor? What type",English
+where is their tumor? What type where is their tumor? What type of neuroendocrine tumor are we of neuroendocrine tumor are we of neuroendocrine tumor are we dealing with and what operation dealing with and what operation dealing with and what operation would be required and then we would be required and then we,English
+"would be required and then we look at their fitness. So, it look at their fitness. So, it look at their fitness. So, it has to with your medical has to with your medical has to with your medical conditions, it has to do with conditions, it has to do with",English
+"conditions, it has to do with with your, you know, cardiac with your, you know, cardiac with your, you know, cardiac disease or lung disease or disease or lung disease or disease or lung disease or things like that you to be",English
+things like that you to be things like that you to be kind of medically fit to be kind of medically fit to be kind of medically fit to be able to tolerate an operation able to tolerate an operation able to tolerate an operation because we don't want to hurt because we don't want to hurt,English
+"because we don't want to hurt you with an operation. We you with an operation. We you with an operation. We want to help you. So, that's want to help you. So, that's want to help you. So, that's very important and so we look very important and so we look",English
+"very important and so we look at all those factors. So, if if at all those factors. So, if if at all those factors. So, if if it's a pancreatic neuron it's a pancreatic neuron it's a pancreatic neuron consumer for example, it",English
+"consumer for example, it consumer for example, it matters the location in the matters the location in the matters the location in the pancreas. Um so, if it's on the pancreas. Um so, if it's on the pancreas. Um so, if it's on the pancreas and doesn't involve",English
+"pancreas and doesn't involve pancreas and doesn't involve that main pancreatic duct, that main pancreatic duct, that main pancreatic duct, then, sometimes you can do then, sometimes you can do then, sometimes you can do what's called a nucleation",English
+what's called a nucleation what's called a nucleation which is kind of just taking which is kind of just taking which is kind of just taking out the tumor with a little of out the tumor with a little of out the tumor with a little of normal pancreas which is a,English
+"normal pancreas which is a normal pancreas which is a little bit different than other little bit different than other little bit different than other kind of pancreas tumors and kind of pancreas tumors and kind of pancreas tumors and then, if it does involve that",English
+"then, if it does involve that then, if it does involve that main pancreatic duct, then, you main pancreatic duct, then, you main pancreatic duct, then, you have to do a formal resection have to do a formal resection have to do a formal resection of the pancreas. If you're at of the pancreas. If you're at",English
+"of the pancreas. If you're at the tail of the pancreas, that the tail of the pancreas, that the tail of the pancreas, that involves, you know, cutting in involves, you know, cutting in involves, you know, cutting in front of it whereas this",English
+front of it whereas this front of it whereas this negative edge and taking the negative edge and taking the negative edge and taking the the downstream part that heads the downstream part that heads the downstream part that heads toward the spleen. If it's in,English
+"toward the spleen. If it's in toward the spleen. If it's in the head of the pancreas which the head of the pancreas which the head of the pancreas which is over by the small intestine is over by the small intestine is over by the small intestine duodenum, then, often that will duodenum, then, often that will",English
+"duodenum, then, often that will require pancreatic odeonectomy require pancreatic odeonectomy require pancreatic odeonectomy or a whipple procedure which is or a whipple procedure which is",English
+"or a whipple procedure which is a little bit more extensive. Um a little bit more extensive. Um a little bit more extensive. Um if it's a small intestine if it's a small intestine if it's a small intestine neuroendocrine tumor, then that",English
+"neuroendocrine tumor, then that neuroendocrine tumor, then that requires an intestinal requires an intestinal requires an intestinal resection for small intestines. resection for small intestines. resection for small intestines. We always try to preserve the We always try to preserve the",English
+We always try to preserve the ileocecal valve if possible ileocecal valve if possible ileocecal valve if possible just because that's the little just because that's the little just because that's the little valve that lets all the liquid valve that lets all the liquid,English
+"valve that lets all the liquid from the small intestine go from the small intestine go from the small intestine go into the colon. Sometimes, it's into the colon. Sometimes, it's into the colon. Sometimes, it's not possible because of where not possible because of where",English
+not possible because of where it's located or where the where it's located or where the where it's located or where the where it's gone to lymph nodes along it's gone to lymph nodes along it's gone to lymph nodes along those blood vessel,English
+sometimes you have to take that sometimes you have to take that out and put the intestines back out and put the intestines back out and put the intestines back together. Um how we do those together. Um how we do those together. Um how we do those operations varies and but what,English
+operations varies and but what operations varies and but what I mean by that is sometimes we I mean by that is sometimes we I mean by that is sometimes we do laparoscopic assisted cases do laparoscopic assisted cases,English
+do laparoscopic assisted cases where we can do a small where we can do a small where we can do a small intestine operation but we intestine operation but we intestine operation but we always like Doctor told us that,English
+always like Doctor told us that always like Doctor told us that we like to run the small bow we like to run the small bow we like to run the small bow which is you want to feel the which is you want to feel the which is you want to feel the small bowel to make sure you're,English
+small bowel to make sure you're small bowel to make sure you're not missing any of the smaller not missing any of the smaller not missing any of the smaller neuroendocrine tumors that may neuroendocrine tumors that may neuroendocrine tumors that may be there if they're multiple. be there if they're multiple.,English
+"be there if they're multiple. So, about 30% or 30 cases, they So, about 30% or 30 cases, they So, about 30% or 30 cases, they can be and you really don't can be and you really don't can be and you really don't want to miss those because then",English
+want to miss those because then want to miss those because then they'll just represent later they'll just represent later they'll just represent later with issues Um there are also with issues Um there are also,English
+with issues Um there are also circumstances where if the circumstances where if the circumstances where if the tumors already spread from what tumors already spread from what tumors already spread from what we call the primary site to the,English
+"we call the primary site to the we call the primary site to the lymph nodes and to the liver, lymph nodes and to the liver, lymph nodes and to the liver, there are times when we will there are times when we will there are times when we will operate on metastatic disease",English
+operate on metastatic disease operate on metastatic disease and do what we call surgical and do what we call surgical and do what we call surgical theta reduction or debulking. theta reduction or debulking. theta reduction or debulking. You'll hear those terms where,English
+"You'll hear those terms where You'll hear those terms where if you can get out the vast if you can get out the vast if you can get out the vast majority of the tumors of this majority of the tumors of this majority of the tumors of this data between 75%, 90%. Um I",English
+"data between 75%, 90%. Um I data between 75%, 90%. Um I tend to be on the 75percent the tend to be on the 75percent the tend to be on the 75percent the newer data but if you can get newer data but if you can get",English
+"newer data but if you can get 75% of the metastatic tumor out 75% of the metastatic tumor out 75% of the metastatic tumor out and your primary out, then, the and your primary out, then, the",English
+"and your primary out, then, the patients seem to drive a both patients seem to drive a both patients seem to drive a both survival and progression of survival and progression of",English
+"survival and progression of benefit. Um but not everybody benefit. Um but not everybody benefit. Um but not everybody is aggressive like that. So, is aggressive like that. So,",English
+"is aggressive like that. So, that's why you have to get a that's why you have to get a that's why you have to get a surgeon who has that surgeon who has that surgeon who has that experience. Um and sometimes,",English
+"experience. Um and sometimes, experience. Um and sometimes, tumors widespread and in bones tumors widespread and in bones tumors widespread and in bones and things like that and and things like that and and things like that and sometimes surgical resection",English
+sometimes surgical resection sometimes surgical resection doesn't make sense. If it's a doesn't make sense. If it's a doesn't make sense. If it's a not functioning tumor where the not functioning tumor where the not functioning tumor where the it's not making hormones. It's it's not making hormones. It's,English
+"it's not making hormones. It's not making people symptomatic not making people symptomatic not making people symptomatic from that. There are other ways from that. There are other ways from that. There are other ways to treat the, like, let's say",English
+"to treat the, like, let's say to treat the, like, let's say there's a lot of burden in the there's a lot of burden in the there's a lot of burden in the liver. There are interventional liver. There are interventional liver. There are interventional radiology procedures that can radiology procedures that can",English
+"radiology procedures that can allow you to decrease the allow you to decrease the allow you to decrease the amount of tumor in the liver amount of tumor in the liver amount of tumor in the liver without undergoing, you know,",English
+"without undergoing, you know, without undergoing, you know, an operation operation by a an operation operation by a an operation operation by a surgeon. So, some of those are surgeon. So, some of those are surgeon. So, some of those are what we call bland embolization",English
+what we call bland embolization what we call bland embolization where they kind of go up into where they kind of go up into where they kind of go up into the arteries feeding the tumors the arteries feeding the tumors the arteries feeding the tumors because the Neuroendocrine because the Neuroendocrine,English
+because the Neuroendocrine Tumors are very bright on what Tumors are very bright on what Tumors are very bright on what we call arterial phase because we call arterial phase because we call arterial phase because they they take up a lot of the,English
+they they take up a lot of the they they take up a lot of the arterial blood flow as opposed arterial blood flow as opposed arterial blood flow as opposed to the portal blood flow like to the portal blood flow like to the portal blood flow like normal liver and so you can,English
+normal liver and so you can normal liver and so you can target them by going up into target them by going up into target them by going up into the paddock artery and kind of the paddock artery and kind of the paddock artery and kind of choking off their blood supply choking off their blood supply,English
+choking off their blood supply and that really helps a lot and that really helps a lot and that really helps a lot with the tumor volume and often with the tumor volume and often,English
+"with the tumor volume and often if it's functional, that helps if it's functional, that helps if it's functional, that helps with that as well. You know, if with that as well. You know, if with that as well. You know, if you're secreting these hormones",English
+you're secreting these hormones you're secreting these hormones can decrease the amount that can decrease the amount that can decrease the amount that goes right into the bloodstream goes right into the bloodstream goes right into the bloodstream and makes you have symptoms. Um,English
+and makes you have symptoms. Um and makes you have symptoms. Um there are other types of there are other types of there are other types of embolizations such as radio embolizations such as radio embolizations such as radio embolization where they put,English
+embolization where they put embolization where they put little radiation pellets up to little radiation pellets up to little radiation pellets up to the hepatic artery as well. Um the hepatic artery as well. Um the hepatic artery as well. Um and then there of course are,English
+and then there of course are and then there of course are other treatments like Ludifera other treatments like Ludifera other treatments like Ludifera or PRT that you'll hear about. or PRT that you'll hear about.,English
+or PRT that you'll hear about. Which that kind of goes Which that kind of goes Which that kind of goes everywhere in the body. Um and everywhere in the body. Um and everywhere in the body. Um and that's a radio labeled little,English
+that's a radio labeled little that's a radio labeled little radiation marker but you have radiation marker but you have radiation marker but you have to have serotonin two receptors to have serotonin two receptors to have serotonin two receptors which you would know if your,English
+which you would know if your which you would know if your tumor was bright on a dota tape tumor was bright on a dota tape tumor was bright on a dota tape PET scan that that would be PET scan that that would be,English
+PET scan that that would be something you may be a something you may be a something you may be a candidate for but there are candidate for but there are candidate for but there are side effects and you have to side effects and you have to,English
+"side effects and you have to have good kidney function and have good kidney function and have good kidney function and things like that. So, there's things like that. So, there's things like that. So, there's kind of a lot that goes into kind of a lot that goes into",English
+kind of a lot that goes into all these different treatments. all these different treatments. all these different treatments. Um I hope that answers most of Um I hope that answers most of Um I hope that answers most of the questions but there's,English
+"the questions but there's the questions but there's different approaches, both different approaches, both different approaches, both surgically, laparoscopic, surgically, laparoscopic, surgically, laparoscopic, robotic, open operations, and",English
+"robotic, open operations, and robotic, open operations, and then, of course, there's then, of course, there's then, of course, there's multidisciplinary team with multidisciplinary team with multidisciplinary team with interventional radiologist. Um",English
+"interventional radiologist. Um interventional radiologist. Um sometimes if you have a single sometimes if you have a single sometimes if you have a single site of focus in the liver, you site of focus in the liver, you site of focus in the liver, you can just do an ablation and can just do an ablation and",English
+"can just do an ablation and that can be done that can be done that can be done percutaneously. Uh of course, percutaneously. Uh of course, percutaneously. Uh of course, it can be done operatively as it can be done operatively as",English
+"it can be done operatively as well. Thank you, Doctor Hughes. I Thank you, Doctor Hughes. I think your answer really think your answer really",English
+think your answer really highlights the value of highlights the value of highlights the value of multidisciplinary team both multidisciplinary team both multidisciplinary team both with ensuring that every team with ensuring that every team,English
+with ensuring that every team member knows their role and member knows their role and member knows their role and then also the all the then also the all the then also the all the coordination of that care,English
+coordination of that care coordination of that care across the different across the different across the different specialties both for timing and specialties both for timing and specialties both for timing and sequencing and ensuring,English
+"sequencing and ensuring sequencing and ensuring everybody knows the next step everybody knows the next step everybody knows the next step to come. Miss Yen, if we can, to come. Miss Yen, if we can,",English
+"to come. Miss Yen, if we can, direct a question now to you, direct a question now to you, direct a question now to you, what can caregivers and what can caregivers and what can caregivers and patients do to help prepare for",English
+"patients do to help prepare for patients do to help prepare for both the surgery itself as well both the surgery itself as well both the surgery itself as well as the post-op phase? thank you as the post-op phase? thank you as the post-op phase? thank you for this question, Doctor",English
+"for this question, Doctor for this question, Doctor Altman. This is a very good Altman. This is a very good Altman. This is a very good question and a question that question and a question that question and a question that comes up often in our support comes up often in our support",English
+"comes up often in our support groups. In fact, we released a groups. In fact, we released a groups. In fact, we released a blog article a couple months blog article a couple months blog article a couple months ago with practical tips from ago with practical tips from",English
+ago with practical tips from those in our Lachnets community those in our Lachnets community those in our Lachnets community after some very lively after some very lively after some very lively discussions based on first hand,English
+"discussions based on first hand discussions based on first hand patient and caregiver patient and caregiver patient and caregiver experiences. We know, of experiences. We know, of experiences. We know, of course, that the surgeon will",English
+"course, that the surgeon will course, that the surgeon will explain the surgery and explain explain the surgery and explain explain the surgery and explain it very well as Doctor Hughes it very well as Doctor Hughes it very well as Doctor Hughes just did. Um and I'm also",English
+just did. Um and I'm also just did. Um and I'm also curious what are surgeons. Uh curious what are surgeons. Uh curious what are surgeons. Uh on the panel. Think about this on the panel. Think about this on the panel. Think about this question. Um I'm just going to,English
+"question. Um I'm just going to question. Um I'm just going to share a few tips from our share a few tips from our share a few tips from our patient community and of patient community and of patient community and of course, these tips do not course, these tips do not",English
+"course, these tips do not replace the instructions given replace the instructions given replace the instructions given by the medical team and I would by the medical team and I would by the medical team and I would talk to your doctor about your talk to your doctor about your",English
+"talk to your doctor about your own individual care. So, in own individual care. So, in own individual care. So, in terms of before surgery, my terms of before surgery, my",English
+"terms of before surgery, my husband was given this specific husband was given this specific husband was given this specific charge from his surgeon. The charge from his surgeon. The charge from his surgeon. The surgeon told my husband that",English
+surgeon told my husband that surgeon told my husband that his job was to get as strong as his job was to get as strong as his job was to get as strong as possible and Doctor Hughes possible and Doctor Hughes possible and Doctor Hughes mentioned being medically fit.,English
+"mentioned being medically fit. mentioned being medically fit. So, for my husband, this meant So, for my husband, this meant So, for my husband, this meant getting stronger by walking, getting stronger by walking, getting stronger by walking, being physically active and being physically active and",English
+being physically active and eating a balanced diet of eating a balanced diet of eating a balanced diet of nutritious foods. It was not nutritious foods. It was not nutritious foods. It was not the time to start dieting or the time to start dieting or,English
+the time to start dieting or suddenly become vegan. Not that suddenly become vegan. Not that suddenly become vegan. Not that there was anything wrong with there was anything wrong with there was anything wrong with plant-based diet but not the plant-based diet but not the,English
+plant-based diet but not the time to start making very time to start making very time to start making very drastic changes and it's drastic changes and it's drastic changes and it's important to be honest with important to be honest with,English
+"important to be honest with your medical team and tell them your medical team and tell them your medical team and tell them all the medications, all the medications, all the medications, supplements, vitamins, and",English
+"supplements, vitamins, and supplements, vitamins, and complementary treatments that complementary treatments that complementary treatments that you're taking. In terms of you're taking. In terms of you're taking. In terms of preparing for the recovery in",English
+"preparing for the recovery in preparing for the recovery in the hospital, it's important to the hospital, it's important to the hospital, it's important to ask about pain management. ask about pain management.",English
+ask about pain management. Who's going to be managing the Who's going to be managing the Who's going to be managing the pain after the surgery and when pain after the surgery and when pain after the surgery and when will that relationship begin? will that relationship begin?,English
+will that relationship begin? Is there a payment team Is there a payment team Is there a payment team involved in the care. Um also involved in the care. Um also involved in the care. Um also having someone present who can,English
+"having someone present who can having someone present who can take notes, ask questions, and take notes, ask questions, and take notes, ask questions, and advocate for you if you have advocate for you if you have advocate for you if you have concerns, issues with managing",English
+"concerns, issues with managing concerns, issues with managing pain, or difficulty pain, or difficulty pain, or difficulty communicating with your medical communicating with your medical communicating with your medical team. It's very helpful. You're team. It's very helpful. You're",English
+"team. It's very helpful. You're on a lot of drugs, lack of on a lot of drugs, lack of on a lot of drugs, lack of sleep, pain, stress. There's a sleep, pain, stress. There's a sleep, pain, stress. There's a lot of things that's clouding,",English
+"lot of things that's clouding, lot of things that's clouding, communication, and judgment. So communication, and judgment. So communication, and judgment. So it's helpful to have someone it's helpful to have someone it's helpful to have someone there. Um and another thing is",English
+"there. Um and another thing is there. Um and another thing is really to think about setting really to think about setting really to think about setting up a healing environment. So up a healing environment. So up a healing environment. So the doctors, the nurses, the the doctors, the nurses, the",English
+"the doctors, the nurses, the staff, they're taking care of staff, they're taking care of staff, they're taking care of all the medical things. Um but all the medical things. Um but all the medical things. Um but also consider preparing a music also consider preparing a music",English
+also consider preparing a music playlist with healing music and playlist with healing music and playlist with healing music and download or practice some download or practice some,English
+"download or practice some mindfulness meditations, mindfulness meditations, mindfulness meditations, breathing exercises, or breathing exercises, or breathing exercises, or visualization exercises. They visualization exercises. They",English
+"visualization exercises. They can all help with healing. And can all help with healing. And can all help with healing. And then in terms of preparing for then in terms of preparing for then in terms of preparing for your return home, we like to",English
+"your return home, we like to your return home, we like to consider your mobility, pain, consider your mobility, pain, consider your mobility, pain, and the symptoms you might and the symptoms you might and the symptoms you might experience. And prepare your",English
+experience. And prepare your experience. And prepare your home for the things you need to home for the things you need to home for the things you need to have on hand to really conserve have on hand to really conserve have on hand to really conserve your energy and prioritize your,English
+"your energy and prioritize your your energy and prioritize your recovery. So you can really recovery. So you can really recovery. So you can really focus on your recovery. And not focus on your recovery. And not focus on your recovery. And not have to worry about and other have to worry about and other have to worry about and other things. So, this means",English
+"things. So, this means things. So, this means preparing a list schedule of preparing a list schedule of preparing a list schedule of your caregivers, maybe finding your caregivers, maybe finding your caregivers, maybe finding out what diet you'll be on",English
+out what diet you'll be on out what diet you'll be on after surgery so you can buy after surgery so you can buy after surgery so you can buy the appropriate foods or the appropriate foods or the appropriate foods or prepare meals before you go prepare meals before you go,English
+"prepare meals before you go into surgery or tell your into surgery or tell your into surgery or tell your friends and families who might friends and families who might friends and families who might be preparing your meals, what",English
+"be preparing your meals, what be preparing your meals, what kind of diet you need to be on, kind of diet you need to be on, kind of diet you need to be on, I like to stock up my I like to stock up my I like to stock up my medication cabin cabinet with",English
+medication cabin cabinet with medication cabin cabinet with over-the-counter medications over-the-counter medications over-the-counter medications you might need after surgery or you might need after surgery or you might need after surgery or even in a long run like even in a long run like,English
+"even in a long run like acitaminophen or Eleanor, soul acitaminophen or Eleanor, soul acitaminophen or Eleanor, soul softeners, and laxatives. That softeners, and laxatives. That",English
+"softeners, and laxatives. That way, you don't have to make a way, you don't have to make a way, you don't have to make a sudden run to see to a pharmacy sudden run to see to a pharmacy sudden run to see to a pharmacy and then, plan on a system to and then, plan on a system to",English
+"and then, plan on a system to call for help for your family call for help for your family call for help for your family or friends or caregivers that or friends or caregivers that or friends or caregivers that might be in the house with you.",English
+might be in the house with you. might be in the house with you. Because sometimes our house can Because sometimes our house can Because sometimes our house can be very big and it it's helpful be very big and it it's helpful be very big and it it's helpful not to have to get up and down. not to have to get up and down.,English
+not to have to get up and down. So you might want to have a So you might want to have a So you might want to have a hand bell or flick buttons to hand bell or flick buttons to hand bell or flick buttons to be able to call someone. And be able to call someone. And,English
+be able to call someone. And then last but not least it's then last but not least it's then last but not least it's helpful to set realistic helpful to set realistic helpful to set realistic expectations. We like to all,English
+"expectations. We like to all expectations. We like to all push ourselves and do a lot of push ourselves and do a lot of push ourselves and do a lot of things but this is the time to things but this is the time to things but this is the time to take it slow, to listen to our",English
+"take it slow, to listen to our take it slow, to listen to our bodies, to know there's no bodies, to know there's no bodies, to know there's no rush, you're going to have good rush, you're going to have good rush, you're going to have good days and bad days, and patients",English
+"days and bad days, and patients days and bad days, and patients often say it takes a lot longer often say it takes a lot longer often say it takes a lot longer than expected to recover. You than expected to recover. You than expected to recover. You don't get gold stars if you do",English
+don't get gold stars if you do don't get gold stars if you do it faster than someone else. it faster than someone else. it faster than someone else. And there's no need to compare And there's no need to compare And there's no need to compare to how someone else recovered.,English
+to how someone else recovered. to how someone else recovered. This is all about you. And it This is all about you. And it This is all about you. And it may take a lot more time than may take a lot more time than may take a lot more time than you expect. To feel like you're,English
+you expect. To feel like you're you expect. To feel like you're back to what is your normal. So back to what is your normal. So back to what is your normal. So it's important to yourself it's important to yourself it's important to yourself grace.,English
+So much Miss Yin for those So much Miss Yin for those helpful tips and insights. Um helpful tips and insights. Um helpful tips and insights. Um we have one last question for we have one last question for we have one last question for you. Uh what do you think are,English
+you. Uh what do you think are you. Uh what do you think are the unmet needs of patients the unmet needs of patients the unmet needs of patients with neuroendocrine tumor and with neuroendocrine tumor and with neuroendocrine tumor and their caregivers? Wow. This is,English
+their caregivers? Wow. This is their caregivers? Wow. This is such a big question. Um we all such a big question. Um we all such a big question. Um we all recognize that access is a big recognize that access is a big recognize that access is a big issue. Access to providers who,English
+issue. Access to providers who issue. Access to providers who really understand that and really understand that and really understand that and access to treatments including access to treatments including access to treatments including clinical trials. Um there's,English
+"clinical trials. Um there's clinical trials. Um there's financial gaps of course financial gaps of course financial gaps of course including cost of medications, including cost of medications, including cost of medications, treatments, Travels to see",English
+"treatments, Travels to see treatments, Travels to see specialists or doctors and one specialists or doctors and one specialists or doctors and one important unmet need is in important unmet need is in important unmet need is in reaching underserved",English
+reaching underserved reaching underserved communities. We know that there communities. We know that there communities. We know that there are racial disparities in are racial disparities in are racial disparities in diagnosing and treating,English
+diagnosing and treating diagnosing and treating patients and we need to do patients and we need to do patients and we need to do better increasing diversity in better increasing diversity in better increasing diversity in clinical trial enrollment as clinical trial enrollment as,English
+clinical trial enrollment as well. Um it'll take us all well. Um it'll take us all well. Um it'll take us all working together to try to working together to try to working together to try to bridge these gaps in care in,English
+"bridge these gaps in care in bridge these gaps in care in order to reach all people order to reach all people order to reach all people affected by nets. In terms of affected by nets. In terms of affected by nets. In terms of educational needs, I would say,",English
+"educational needs, I would say, educational needs, I would say, personally, high grade, lung personally, high grade, lung personally, high grade, lung nets, carcinoid heart disease, nets, carcinoid heart disease, nets, carcinoid heart disease, the rare nets like Theopera and",English
+the rare nets like Theopera and the rare nets like Theopera and Adrenal Cortical cancers and I Adrenal Cortical cancers and I Adrenal Cortical cancers and I would say there's a gap in would say there's a gap in would say there's a gap in terms of patients knowing what terms of patients knowing what,English
+terms of patients knowing what available clinical trials there available clinical trials there available clinical trials there are specifically for them. are specifically for them. are specifically for them. There's actually a lot of,English
+There's actually a lot of There's actually a lot of effort being done in terms of effort being done in terms of effort being done in terms of patient education especially in patient education especially in patient education especially in terms of educating patients terms of educating patients,English
+terms of educating patients about disease and treatments as about disease and treatments as about disease and treatments as we're saying seeing this week we're saying seeing this week we're saying seeing this week and this month with Net Cancer and this month with Net Cancer,English
+and this month with Net Cancer Day and Net Cancer Awareness Day and Net Cancer Awareness Day and Net Cancer Awareness Month. I personally believe Month. I personally believe Month. I personally believe there needs to be more,English
+"there needs to be more there needs to be more attention in terms of the attention in terms of the attention in terms of the cycle, social, emotional, and cycle, social, emotional, and cycle, social, emotional, and mental health care as well. Um mental health care as well. Um",English
+"mental health care as well. Um both patients and caregivers both patients and caregivers both patients and caregivers are experiencing so much are experiencing so much are experiencing so much stress, so much grief and loss",English
+"stress, so much grief and loss stress, so much grief and loss with a cancer diagnosis. with a cancer diagnosis. with a cancer diagnosis. there's loss of identity, of there's loss of identity, of there's loss of identity, of dreams and aspirations, of the dreams and aspirations, of the",English
+"dreams and aspirations, of the life you once knew. And I know life you once knew. And I know life you once knew. And I know that the Medical College of that the Medical College of that the Medical College of Wisconsin, we heard this from",English
+"Wisconsin, we heard this from Wisconsin, we heard this from Nanette's, the symposium last Nanette's, the symposium last Nanette's, the symposium last week, that they have a week, that they have a week, that they have a psychologist who's present in psychologist who's present in",English
+psychologist who's present in the very first appointment with the very first appointment with the very first appointment with every net patient. And this every net patient. And this every net patient. And this helps the destigmatize and,English
+"helps the destigmatize and helps the destigmatize and normalize the need for normalize the need for normalize the need for psychological support. And so psychological support. And so psychological support. And so in my ideal world, every net in my ideal world, every net",English
+"in my ideal world, every net patient would see a patient would see a patient would see a psychologist, and every net psychologist, and every net psychologist, and every net patient diagnosed with net patient diagnosed with net",English
+patient diagnosed with net would be referred by their would be referred by their would be referred by their doctor to a net patient and doctor to a net patient and doctor to a net patient and caregiver support group or a caregiver support group or a,English
+"caregiver support group or a net patient advocacy group. Thank you, Doctor Yin. I think Thank you, Doctor Yin. I think those are all excellent points",English
+those are all excellent points those are all excellent points and often areas that get and often areas that get and often areas that get overlooked and those are the overlooked and those are the,English
+overlooked and those are the ones that really impact a lot ones that really impact a lot ones that really impact a lot of the takeaways that both the of the takeaways that both the of the takeaways that both the patient and their caregivers,English
+"patient and their caregivers patient and their caregivers have, both of them are leaving have, both of them are leaving have, both of them are leaving the doctor's office as well as the doctor's office as well as the doctor's office as well as when they're leaving the when they're leaving the",English
+when they're leaving the hospital system. We're going to hospital system. We're going to hospital system. We're going to transition off of one of the transition off of one of the transition off of one of the comments that you've made about,English
+comments that you've made about comments that you've made about sort of upcoming clinical sort of upcoming clinical sort of upcoming clinical trials and we're inject this trials and we're inject this trials and we're inject this question to Dr. Sunball. Can,English
+question to Dr. Sunball. Can question to Dr. Sunball. Can you talk to us little bit about you talk to us little bit about you talk to us little bit about any areas of clinical trials any areas of clinical trials,English
+"any areas of clinical trials that are currently available? that are currently available? that are currently available? Yeah, there actually really Yeah, there actually really Yeah, there actually really good, there are lots of efforts",English
+"good, there are lots of efforts good, there are lots of efforts right now being done. I mean, right now being done. I mean, right now being done. I mean, it have been done on for a it have been done on for a it have been done on for a clinical trials. I usually",English
+clinical trials. I usually clinical trials. I usually think of clinical trials think of clinical trials think of clinical trials aspects in terms of new things aspects in terms of new things aspects in terms of new things being tested or kind of moving,English
+"being tested or kind of moving being tested or kind of moving things around. So, like to give things around. So, like to give things around. So, like to give examples with moving things examples with moving things",English
+"examples with moving things around like for example, one of around like for example, one of around like for example, one of the studies that is available the studies that is available the studies that is available multiple centers over the US multiple centers over the US",English
+"multiple centers over the US is, you know, the standard of is, you know, the standard of is, you know, the standard of care after doing pancreatic care after doing pancreatic care after doing pancreatic neuroendocrine tumor surgery is neuroendocrine tumor surgery is",English
+"neuroendocrine tumor surgery is to do nothing and just observe to do nothing and just observe to do nothing and just observe the patient and follow its the patient and follow its the patient and follow its scans. But now, one of the",English
+"scans. But now, one of the scans. But now, one of the studies is is asking the studies is is asking the studies is is asking the question, can we do more? Can question, can we do more? Can question, can we do more? Can we give an oral chemotherapy we give an oral chemotherapy",English
+we give an oral chemotherapy called or captem? Uh and and called or captem? Uh and and called or captem? Uh and and see if that would help see if that would help,English
+"see if that would help patients. So, that's a study patients. So, that's a study patients. So, that's a study that's being done because we that's being done because we that's being done because we know that CapTEM works in know that CapTEM works in",English
+"know that CapTEM works in metastatic Tumors. So, let's metastatic Tumors. So, let's metastatic Tumors. So, let's try to bring it to that earlier try to bring it to that earlier",English
+"try to bring it to that earlier stages of the disease. Uh same stages of the disease. Uh same stages of the disease. Uh same thing like, like what was thing like, like what was",English
+"thing like, like what was mentioned before that, those mentioned before that, those mentioned before that, those neuroendocrine tumors, they neuroendocrine tumors, they neuroendocrine tumors, they have on the surface of them, have on the surface of them,",English
+"have on the surface of them, they have, I call them like they have, I call them like they have, I call them like antinas, they can think of antinas, they can think of antinas, they can think of them, or like that we call them them, or like that we call them",English
+"them, or like that we call them receptors, the somatostat and receptors, the somatostat and receptors, the somatostat and receptors. So, a lot of them, receptors. So, a lot of them, receptors. So, a lot of them, they have those receptors and",English
+"they have those receptors and they have those receptors and we can target them with we can target them with we can target them with multiple therapies. So, I think multiple therapies. So, I think multiple therapies. So, I think Doctor Hughes already mentioned",English
+"Doctor Hughes already mentioned Doctor Hughes already mentioned how we have the PRRT, which is how we have the PRRT, which is how we have the PRRT, which is kind of injecting intravenously kind of injecting intravenously",English
+"kind of injecting intravenously with a drug that goes all over with a drug that goes all over with a drug that goes all over our body, hook up to those our body, hook up to those our body, hook up to those cancer cells and those cancer cells and those",English
+"cancer cells and those receptors and then deliver receptors and then deliver receptors and then deliver radiation inside. So, that for radiation inside. So, that for radiation inside. So, that for that, we have a already an",English
+"that, we have a already an that, we have a already an approved drug called Loticum approved drug called Loticum approved drug called Loticum one seven seven or Lutifera and one seven seven or Lutifera and one seven seven or Lutifera and that has been approved for a",English
+"that has been approved for a that has been approved for a few years now but it's approved few years now but it's approved few years now but it's approved as what we call a second line as what we call a second line as what we call a second line therapy. Meaning, it's a therapy. Meaning, it's a",English
+"therapy. Meaning, it's a patient already got linear tide patient already got linear tide patient already got linear tide or octeriatide and now it's not or octeriatide and now it's not or octeriatide and now it's not working and now they're",English
+working and now they're working and now they're going to go the PRRT. Uh one of going to go the PRRT. Uh one of going to go the PRRT. Uh one of the studies is asking the the studies is asking the,English
+patient with metastatic patient with metastatic disease. Uh would it be disease. Uh would it be disease. Uh would it be beneficial to start right now beneficial to start right now beneficial to start right now with Lotician one seven seven,English
+"with Lotician one seven seven with Lotician one seven seven rather than waiting for later rather than waiting for later rather than waiting for later on? And then the other question on? And then the other question on? And then the other question is, we know that Leticia one",English
+are covered by these incredibly complex layers of material that protect the vulnerable inside compartments. And penicillin basically helps to break down,English
+"one of those layers and effectively causes the bacteria to explode. But for a variety of reasons, we don't use penicillin when we have patients who have TB because TB bacteria seem",English
+"to be inherently resistant to penicillin, and so one of the things I said my lab would focus on is, can we develop a new penicillin type antibiotic",English
+"for TB, something that targets the same layer in the TB bacterial cell wall that penicillin targets in other bacteria.",English
+"And so that layer is called a peptidoglycan layer, and it's made up of a whole lot of cross-linked sugar type polymers that create a mesh around the cell",English
+and it gives the bacteria rigidity. And so a fair amount of the work in my lab today is focused on trying to understand,English
+"how do bacteria remodel this peptidoglycan layer, because if you imagine you're a bacterium and you need to grow as you expand,",English
+"you're cutting this penicillin sensitive layer to allow for the insertion of new cell wall material. And at that point, when you are cutting and remodeling",English
+"as a bacterium and a bacterium is cutting and remodeling the cell surface, it's incredibly vulnerable. So those enzymes,",English
+and those molecular machineries that are involved in remodeling of the cell surface become very attractive from a target perspective. And so one component of my lab focuses,English
+"on discovering new TB drug targets, particularly those that would attack the cell wall and behave in a way like penicillin",English
+"does, cause the bacteria to break down and perhaps even explode. And that work is ongoing. We, we have several different interesting techniques",English
+"that we apply to that, we do gene editing of the TB bacteria, changing particular components of enzymes that we model the cell surface.",English
+"And then we take the organisms that result from there. And we do lots of different experiments with them, including time-lapse microscopy. At a real time.",English
+We see how the bacteria extend and how they divide and how those processes are perturbed when we've interfered with some of these enzymes that,English
+"remodel the cell surface. You have just shared, I think one of the critical aspects of understanding, if you will, a pathogen. So that therapy can really then flow from that.",English
+"So in a way, what you're really expressed, I think, beautifully, is how understanding the basic biology of a pathogen of multiple processes",English
+"in the life cycle of a pathogen can, in fact, provide all manner of windows into ways in which you can try to destroy the pathogen. And so I think that you really",English
+"express that connection between basic science and translational medicine really beautifully, and that's, I think also you hit the nail on the head that, you know,",English
+"when we look at TB as a disease, as I said, it's been around for centuries. It represents a public health failure of massive proportions.",English
+"Right, and why is it we have that? One of the reasons, I would argue is that we have failed to understand the fundamental biology of this pathogen, of this bacterium.",English
+"And a better, more enhanced understanding will allow us to develop more precise therapeutic interventions that are perhaps more long lasting. And in fact, you can see, you know,",English
+"when we fail to understand pathogenesis and basic biology, you can see the very dramatic effects on public health today. When you look at the coronavirus pandemic.",English
+"Right, we have so many unanswered questions that are holding back public health interventions. When do antibodies against the coronavirus develop?",English
+"When somebody has antibodies, are they protected if somebody has viral RNA in the throat? Does it mean they're infectious? You know, some of these basic things that sometimes",English
+"fall by the wayside in our drive to, you know, just develop health care products, then come back to haunt us? The failure to understand the basic biology",English
+"comes back to haunt us. And so we really try to take this approach in the lab that, you know, the more knowledge we develop in, the more holistic our understanding is, the better.",English
+We can place new health interventions. So it seems as if we look at the COVID-19 pandemic that we're all experiencing right now,English
+"and suffering through right now, what's quite clear is that what you've just shared with us about how with TB, there's this complex matrix of not just",English
+"the pathogen, not just the pathology of the actual disease itself, but there's also how research is funded, how public health is really designed and implemented",English
+"based on our understanding. And how do we think about, at a societal level, the question of why is it that there are so many therapies,",English
+but there's still 1.5 to 1.8 million deaths per year within that context and that deep background that you have? Looking at what's happening now,English
+"with the novel coronavirus and COVID-19, you've touched on already, things we should maybe, you know, pitfalls we should avoid.",English
+"Are there some other perspectives or aspects that you think we would do well to learn from TB, to apply to the huge",English
+effort that we're doing right now to try to address COVID-19? I think a significant challenge the world has had when it comes to the coronavirus has really,English
+"been around its diagnosis. You know, the readiness level to do diagnosis for a new pathogen like the SARS coronavirus, too, was really not at the level",English
+"where we would have liked it to be. And in fact, most of the world has been rapidly playing catch up in terms of trying to develop the testing capacity,",English
+"implemented throughput testing. But remember, testing for the sake of testing is really not useful. It's only useful when you couple the results are very important.",English
+"And precise downstream public health interventions such as isolation and very careful contact tracing. And I think that, you know, that was something we",English
+"it was a lesson that we learned in TB sometime ago. And we learned it hard because we know that a lot of TB, especially in South Africa",English
+"and in other endemic countries, a lot of TB that we see is driven by transmission. And by and large, you know, you'd be surprised to hear that we know very little about TB",English
+"transmission. All we know is you have to share it with somebody. And, you know, through the sharing of the respiratory aerosol droplets,",English
+"you inhale these TB bacteria and you eventually develop disease. But when we go down to the nuts and bolts of it, and we ask what, who's transmitting TB to who,",English
+"you know, say if we look at a place like South Africa. And we see, OK, 100% of all of our TB cases, can we track down every single one of these?",English
+Where did the infection occur? And the best we can say is roughly 20% to 30% of infections occur in the household.,English
+"And for the rest, we have no idea how they occur. And, you know, the TB field has really been pushing long and hard to try to develop new ways of understanding how transmission",English
+"occurs. So that you can develop novel transmission blocking strategies. Right so interruption of transmission, you know, will have a very dramatic effect in terms",English
+of containing the disease and allowing the other public health interventions to reap maximum benefit. And I think all those lessons are really important today,English
+"when we think about another infection that you can get by sharing of it, which is the coronavirus, the idea we need to understand who is infecting who, who's the most infectious.",English
+Where are the infection hotspots where you deploy the best public health interventions. And in a situation where even the best resourced countries,English
+"have health systems that are experiencing substantial strain, how do you deploy these very valuable and nowadays scarce health resources to the areas where",English
+"they're needed the most? You know, and I think that we can learn a lot from what's been done in TB. We can also learn a lot from what's",English
+happened in the feel about what not to do. But I do believe that those lessons are being learned as the world experiences the coronavirus,English
+"pandemic as an entire entity. You know, no one has the perfect solution. You have countries that go through different stages",English
+"of lockdowns. You know, the science around all of this is not clear. It's not perfect. But I do feel like a lot of the expertise",English
+that we've had in terms of respiratory and other viral diseases have been brought to bear on the coronavirus pandemic with as lethal precision as is possible.,English
+"And also, you're starting to do some work, um, directly, um, related to COVID-19. Am I correct, Bavesh?",English
+"Yes, you know, in addition to working in, you know, in the lab, looking at the cell wall of TB bacteria, you know, my lab has two other big focus areas",English
+"and they somewhat relate to how we ended up, you know, trying to assist with the coronavirus problem today. So the first is the idea that I mentioned",English
+"when we started chatting, is why is it that you have to treat TB patients for so long? I mean if you get an antibacterial disease today,",English
+"and you go into antibiotic treatment, you take antibiotics for roughly five days. Right, and you'll remember, if you've ever been on antibiotics, what does your doctor tell you?",English
+"The full course. Right, finish the full course. You know, and really the hypothesis there is that there are bacteria.",English
+"You know, if you're infected with bacteria, there are bacteria that will very quickly respond to the antibiotic and they'll die. And then there's a small proportion",English
+"of bacteria that are in your system that resist the antibiotic. They're genetically susceptible to the antibiotic. They will die, but they just take longer to die.",English
+"And a small proportion of them hang around for a very long time. We call these persisters. And so I started off wanting to ask,",English
+why is it that we need to treat TB patients for six months? What goes on in six months that can be achieved in five days with TB patients?,English
+And so we set out to look in South African TB patients here in Johannesburg. We have a lot of TB and we have a lot of HIV associated TB also.,English
+"So we went to our communities. And we said to, to all participants, can you give us sputum specimens when you're diagnosed with TB?",English
+"And then when you go on to TB treatment for the six month time frame, can you actually give us sputum specimens as you're taking treatment",English
+so we can take a look to see what is happening with the bacteria in your body? Why are they taking so long to be eliminated?,English
+And what we did was we developed ways of differentiating bacteria that are very easy to grow the replicating the responses to the antibiotics.,English
+"And then those bacteria that are somewhat more difficult to grow, we call them differentially culturable because they don't grow under certain conditions in the lab.",English
+"And you need to give them some juice and stimulants so that they can start growing. So their culturability Is different. So we use the term differentially culturable,",English
+"I mean, because they're non replicating, differentially culturable, in a somewhat lazy state, they are not as susceptible to antibiotics as the ones that",English
+"are replicating, the ones that are replicating are quite susceptible because many of the antibiotics target processes that actively replicating bacteria use.",English
+"So if you're a lazy bacterium and you're differentially culturable, you're not wanting to grow, you have some sort of inherent tolerance to the antibiotics.",English
+And so this was our hypothesis. We went to these clinics in these communities. And we took TB patients. And we got specimens from them.,English
+"And what we found was incredibly surprising. You know, a TB infected individual before they even start treatment,",English
+"they have large numbers of these differentially culturable bacteria in their sputum. And when we follow those over time,",English
+"you see that the bacteria that are actively replicating, or that you can grow very easily, they actually get eliminated quite quickly. That it's these ones that are in the sort of differentially",English
+culturable state or a non-replicating state. They are the ones that hang around for a very long time. And they are the ones that necessitate,English
+"the long course of treatment that patients have to take. Now, this is important because when we want to shorten the duration of therapy, we need to know which populations",English
+"we should be looking at in terms of bacterial populations. And so now we've been able to show that if you want to shorten therapy with new drugs, we need to make sure those new drugs actually",English
+"target these differentially culturable bacteria. And then you can talk meaningfully about treatment shortening. But we then thought, well, if these organisms are not",English
+"growing so nicely and they are starting to grow, you know, part of the way we diagnose TB, we actually grow bacteria, we do TB culture, at least",English
+"this has been the way it's been done for a very long time. But there's a more new way of doing TV diagnosis, and that's using molecular diagnostics, which",English
+detect the DNA of TB bacteria. But let's go back to using diagnosis and culture for diagnosis.,English
+"So if these bacteria are growing properly, there is a possibility that you could misdiagnose people, you could get a negative result. And that person actually has tuberculosis.",English
+"But because there are so few organisms that are growing, well, you're not getting the results you're looking for. So we thought, well, we need to maybe engage our minds",English
+a little more on diagnosis. And we spent some time developing ways of actually modifying the culture media we use to diagnose TB to pick up these differentially,English
+"culturable organisms. But as we started working more and more in diagnosis, we got involved in molecular diagnostics. And, and that's sort of the third component of what",English
+"we do in the lab. And so for the longest time, when you think of it, when you think about TB diagnosis, you'd be shocked to hear for the longest time how horrible",English
+"it was, right, we used a diagnostic test that's over 100 years old, smear microscopy. We take a sputum specimen and we smear it onto a slide.",English
+"And then we look down the microscope to see if we can see bacteria. Over 100 years ago, when Robert Koch first described the TB bacteria as the causative agent of TB,",English
+"he used the same method. And 100 years later, we were using the same method. Half the time, it's wrong.",English
+"Now, if you have very few organisms, it misdiagnoses you as being negative. So that's the one way we had of diagnosing TB. The other way was culture.",English
+Culture takes up to 42 days to give you a negative result. This is horrible. We had these diagnoses that could be wrong and that made patients wait a long time,English
+"to be able to get a definitive answer as to whether they're infected or not. So to address this, you know, a lot of work has been done on molecular diagnostics, particularly",English
+"on detecting TB DNA. In roughly in 2010, the South African government, through its national department of health, decided to implement molecular diagnostics for TB.",English
+"We were using two molecular diagnostics at the time, the, the Hain line probe assay and this diagnostic called the GeneXpert, and it's marketed by a company called Cepheid.",English
+So the GeneXpert is really a very neat device in that it gives you the ability to do diagnosis sort of in a near patient setting.,English
+"So you could put it at microscopy level centers and get patients coming into the community clinics, into primary health care clinics and giving a specimen and being able to get a result in a relatively",English
+short period of time. But so the South African government saw this and they thought this was a great opportunity to deliver more quality health care to people.,English
+"And they decided to invest in the Xpert, the GeneXpert, as a device for TB management through the national policy program.",English
+"But then they ran into a stumbling block. They bought the first few GeneXpert devices and, and then they were hit with the conundrum of how",English
+"do you verify these instruments? When you have an instrument in a central lab, you have a lot of quality control, got a lot of training, you've got a lot of infrastructure",English
+"on that instrument. And, you know it works. But now when you send it out to clinics and, you know, you need to imagine South Africa, you need to imagine some of our settings and the associated",English
+"infrastructure and resource constraints. You know, how do we know that when we place a device somewhere, let's",English
+"say, in an informal settlement or near a clinic, in an informal settlement, that it's actually performing properly? So let's step back and think about that for a minute.",English
+"And how do we know, if we have a diagnostic device, how do we know it's working? So let's say we put 100 bacteria in there. And if the diagnostic device tells us there are 98 bacteria,",English
+"then we say, OK, this works. The margin of error is 2%. And I'm willing to take 2% in my national system. And you run with it, you put the device out",English
+in the health care system. The problem with TB is you can't do that. TB bacteria are dangerous. So we can't do that.,English
+"We can't send the TB bacteria to that clinic in the informal settlement and say, here, use these to see if your device is fit for purpose.",English
+"We're going to make, we're going to make people sick. And so the government approached us. They said, can you, the national department of health, through the national priority program,",English
+"and my colleague Leslie Scott and Randy Stevens at the University of the Witwatersrand, where we work, they approached us and they said, look,",English
+"can you assist with this? And so I sat with my team and, you know, we thought, well, the GeneXpert or in fact, any molecular device doesn't care whether the bacteria are alive or dead.",English
+"Right? It just detects a piece of DNA. As long as the DNA is there, you're going to get a result, if it works. So what we did was we developed a pipeline",English
+"to grow large amounts of TB bacteria and then we inactivate the bacteria. And we have a way of sustaining them,",English
+"and then we use a process called flow cytometry, which allows you to measure single cells. And so we do the flow cytometry and we",English
+quantitate the amount of single digit TB cells we have. We do a whole lot of QC to make sure the cells are dead. And then we take a known number of dead bacteria.,English
+"And we spot it onto a little dried culture spot on a piece of paper, and that little dried culture has a barcode.",English
+"We then put that into a Ziploc bag. It doesn't need any cold chain, it doesn't need any special handling. And we send it to that clinic",English
+in the informal settlement. The operator at the clinic receives it. He or she pops out the little dried culture spot. We put a bit of color in there,English
+"so you can see where the spot is. They mix it with a bit of buffer, the bacteria uncoat, and then that operator will add the bacteria to the GeneXpert cartridge.",English
+"And then as the GeneXpert is running, we can see the performance of that spot using cloud based software. And immediately, we can say, OK, that device works.",English
+That that clinic near the informal settlement is now validated. It can take specimens from the informal settlement and it can report the results to the patients.,English
+"Everything is working properly. And so we initially started off this validation for the national department of health. And then in 2011, we did it for all the instruments",English
+"they bought initially. But by the end of 2012, we had done it for the entire country. And then, as you know, there was greater awareness for the approach that we were using.",English
+"The CDC came on board and they endorsed the dried culture spots. Subsequent to that, the WHO endorsed the dried culture spots.",English
+And before you knew it we were sending these to over 20 countries who were using the GeneXpert device in their national priority programs.,English
+"And so suddenly from being this little lab that, you know, they did some really cool stuff on the TB bacterial cell wall, we became a lab that was enabling many countries",English
+to actually validate their TB diagnosis. And that was great. But there were a couple of problems in the health system.,English
+"There's always a crisis. There's always an emergency. And usually, you know, somebody would come to us and say, we need, we need new spots or we need spots for drug resistant",English
+"you know, so we can add a culture for you. But it's going to take us a month to grow it. Then we have to kill it. And we have to wait two months to make sure it's dead.",English
+"And then we will, you know, we'll do the flow cytometry, will measure the organisms, will create the spots for you. So I recognize you're having an emergency. I can give it you in four months,",English
+"you know, which was somewhat, as you can imagine, that was somewhat undesirable. So at some point, I said, this is not working anymore, you know, so we sat down again with the team and I said,",English
+"how do we make this even faster? Right, and so we just extended our thinking. Right? These molecular devices don't care whether the bacteria is alive or dead.",English
+"And so then I asked my team, does it even care whether the bacteria are TB or not? All it needs is a little piece of DNA that calls the, calls the test TB.",English
+"We just need to make sure that little piece of DNA is there. Right, and so what we did was we embarked on this approach called biomimicry. And so biomimicry is really trying",English
+"to mimic what happens in nature. And when you look at nature, nature has spent hundreds of thousands of years of evolution solving problems that we face today.",English
+"And so we took this biomimicry approach where we found safe bacteria that are not harmful, that are stable at room temperature.",English
+They are not difficult to grow. And we engineer their genomes just to carry the bits of DNA that get recognized by these TB molecular diagnostics.,English
+"And lo and behold, when you put those safe bacteria into the device, it calls it TB because it doesn't know the difference. And so suddenly we went from taking two months",English
+"to grow up something for somebody to two days. You know, these bacteria are fast growing. It was quick. There were no safety concerns, you know, and so",English
+now the biomimicry approach we were able to use to provide products for TB to people who need to validate TB diagnostics.,English
+"But here's where the COVID twist comes. So in addition to doing drug sensitive TB, I'm sure you're aware that the world also",English
+faces a huge problem of antimicrobial resistance. The so-called AMR problem. A large proportion of that EMR problem is due to TB.,English
+"It has a lot of drug resistant TB out there. And many countries who are battling with this, they also need verification material for drug resistant TB.",English
+"And it becomes somewhat challenging for us when someone says to me, Bavesh, I want a validation strain for extremely drug resistant TB that's",English
+resistant to many antibiotics. It becomes a bit challenging for us to grow something that dangerous in the laboratory and inactivate it.,English
+"And so we said, well, can we actually repurpose our biomimicry approach to mimic drug resistant TB? And that's, you know, we just put in that little piece of DNA",English
+"where you have the drug resistant mutation. We just swap that into the genome of a safe, noninfectious bacterium and now it reads like drug resistant TB,",English
+"and there are none of the safety concerns that are associated with that, it's noninfectious, it's safe, it's easy to use. And so we started to do this for drug resistant TB.",English
+"But when the coronavirus pandemic came to South Africa, you know, one of the big things that South Africa and I think many countries around the world have faced",English
+"is, you know, how do we get appropriate controls to make sure that the diagnosis we're doing and the diagnostic tests we're running are actually correct.",English
+"Coupled with that, you know, it's important to recognize that one of the things the coronavirus pandemic has done, it's also created this big surge of new tests entering",English
+"the market. Many companies have repurposed the production pipelines and repurposed the IP to produce coronavirus tests. And, you know, as a health system, when you",English
+"receive these new tests, how do you know they fit for purpose? How do you test them? How do they work? How do you deploy them in the health system that, you know,",English
+"a coronavirus test works if you put coronavirus inside, and it tells you, hey, I found coronavirus. But again, we come back to the same problem.",English
+The coronavirus is very infectious. It's airborne. How do you do you work with this? And it's also hard to get your hands on the coronavirus.,English
+"So we went back to the drawing board. And we said, this biomimicry approach that we use with TB. Can we actually use it for the coronavirus,",English
+"you know, to develop an encapsulated control. So it won't be the coronavirus, it will be a bacterium, it will be a bacterial cell wall, but inside of it,",English
+it carries genetic material that looks at the coronavirus. And as new kits and testing reagents become available we can provide this control to people,English
+"to say if you're looking for a positive control, to see if a kit is fit for purpose, you know, we can give you this. It, it will allow you to assess whether the extraction process,",English
+"you know, you've got to break the coronavirus surface and get the genetic material out, and that genetic material is then used for testing using polymerase",English
+"chain reaction, or PCR. So you have two separate steps that will allow you to actually determine whether your new test is fit for purpose",English
+"for those two particular steps of the testing strategy. And so, you know, we started this process in March, and we used the target that was available from the CDC",English
+and the WHO for a large number of tests that were already out there. And we engineered our bacterial biomimetics to start to look like coronavirus.,English
+And we provided this to our national testing system. And that enabled them to start to validate tests and to actually start rolling out testing on a mass scale.,English
+And it's really very simple. It becomes like all we do is we grow up these bacteria. They take about a day and a half to grow. They carry these coronavirus targets.,English
+"We inactivate them just to be absolutely sure, even though there's no safety concern because the inactivation also stabilizes them. And we just send them out wherever testing is being done.",English
+"And we say, if you want to validate your test, if you want to make sure your workflow operates correctly, if you want to put a little small car or a truck outside",English
+"of the mine and you want to do testing on a remote level, you need some controls, here are controls. So it's an enabling reagent that allows people to develop quality assurance and proficiency",English
+testing. So we started our coronavirus work using this biomimicry approach. And then we sort of got into the sort of more hardcore stuff.,English
+So you'll be aware that coronavirus testing can be done in two basic ways. You either detect the virus or detect antibodies,English
+"to the virus in people. So we call the antibody detection, serology testing, or antibody testing. I mean, there are lots of antibody testing kids",English
+"that are coming out onto the market because these are more easier to use in the home, they're more easier to use in the remote settings. You don't need any lab infrastructure.",English
+"You just put a drop of blood. And you can get an answer. But for validation of antibody tests. Now, we can't cheat antibodies,",English
+"antibodies are very specific. They'll know that we have a bacterium and not a coronavirus. And so for that, we need the coronavirus.",English
+"And so a few weeks ago, we have these biosafety level three containment labs where we do our TB work, we repurposed this laboratory to actually start",English
+to grow coronavirus. And so we grow coronavirus on mammalian cells. You develop a monolayer of cells on the surface of a Petri dish.,English
+And then you add an aliquot of the coronavirus and then it infects those cells and multiplies in the cells. And then gets secreted out into the medium.,English
+And so we set this up. It took a bit of doing to repurpose the personal protective equipment and all of our safety protocols.,English
+"And last week, we were able to harvest our first batch of viable coronavirus. And we're now providing this resource to the national testing system, to use as an additional control",English
+"either for PCR based testing or for, for cells. Yeah, so I think this is enormously exciting Bavesh. Kudos to you and your research group for doing this.",English
+"I think really you've raised a point that is not really discussed at all, which is the importance of validation. Right. The importance of positive controls and the complexities",English
+"that exist around that with a pathogen that is easily spread, is quite difficult to get a hold of in some ways. And at the same time, I think you've also",English
+shown sort of the power of really biomimicry creating a much safer alternative for creating that kind of a validation protocol.,English
+"So kudos. Absolutely brilliant. I think it's fantastic. So, Bavesh, one thing I wanted to do is, you know,",English
+"I think for all of us, you know, there are often, when you think about our pathways in our lives, there are forks in the road, and sometimes you go left and sometimes you go right.",English
+"And based on the choice that you make, you end up where you are today. So I'm curious if all in all the different crossroads that you pass through, you know, from your childhood to now.",English
+"Was there a crossroad where if you had gone left instead of right or right instead of left, basically the Bavesh would be talking",English
+"to today would be doing something completely different? And if that's the case, can you share with us, in a parallel universe,",English
+"what that Bavesh would be doing? That's a very interesting question. You know, as I said, growing up, I",English
+"wanted to help people who had TB. And I must admit, as a kid and even as a kid in high school, you have quite simplistic views of the world,",English
+"right, and the only way I saw myself doing that was being a doctor. And not getting into medical school, you know, that was a point in my life where I had a fork.",English
+"There were other things I could go off and do, you know, I come from a family that has a strong interest in farming and commerce. I could go off and do that, or I could go off",English
+"into this career in science. I chose a career in science. And it's been a wonderful, wonderful journey. Science, fundamental research, exploring",English
+"biology, learning how the world works has really been, for me, very satisfying. And it's given me the opportunity to take these basic ideas, turn them into really cool research,",English
+and then take that research and translate the whole body of work that I've done over a long time into actual useful things that people can use every day,English
+"go off and perhaps work in a company, you know, develop a sort of more commercial career? And I must admit, the allure of that was very enticing.",English
+"I had a couple of options to pursue what they would have called, what you would call a career postdoc and actually develop a career in industry.",English
+"And maybe I would be working in a large pharmaceutical company now. But again, I have no regrets staying, staying in academia.",English
+"I've also, I've also had the privilege to work with wonderful mentors. I did my PhD with Valerie Mizrahi here at the University of the Witwatersrand in Johannesburg.",English
+"And, you know, she really inspired in me the love of science. And when I was in the US, I worked with Dr. Gilla Kaplan, who was at Rockefeller, and then went off",English
+"to the Public Health Research Institute and in fact, became the global director of TB at the Gates Foundation. And she, too, inspired me in many ways",English
+"to try to make a difference. You know, whenever I went to her with a problem, she would ask me, well, if you had the answer, what would it mean?",English
+"You know, she always forced my thinking. And in fact, I spent some time at Harvard, too, with Eric Rubin and Eric. Yeah, Eric Rubin was just one of those guys that",English
+"has such a love for science that it's infectious. And when you're with Eric, you can't imagine doing anything else except science.",English
+"That's just, that's the beauty of a guy like that. And so, you know, I'm glad that I chose the road that I did at those different folks because they brought these wonderful people into my life.",English
+"And then I'd be lost without my team. And I've given you a 30, 40 narrative of the kind of science that I do. But I really want to emphasize that, you know,",English
+"I'm one person, I sort of sit in my office these days and do very little lab work. I have a wonderful team of graduate students",English
+and postdocs and researchers who have come into my life and really enriched me in many wonderful ways. But the thing that they've done is,English
+"they've bought into my thinking around TB research and they've really driven it and taken it to a different level. So, I mean, I really want to acknowledge my team.",English
+"It's a group of wonderful people. And, you know, you go to work, you do this great job and you have these wonderful people that you work with and who could ask for more.",English
+So I hope that answers your question. It's almost hard to imagine myself doing something else when you have so many wonderful things going for you,English
+"in the path that you've chosen. No, of course. Of course. And also, it's fair to say that even though you mentioned that you might have gone into sort of more",English
+"of a commercial sort of direction, from the work that you're doing, I'm sure, and it's quite clear that you do have interactions with pharma,",English
+"sort of, et cetera. So in a way, you're really, it's not as if you're cut off from that world, you just have a different relationship with that world.",English
+"So in some ways, that element, I'm sure, is certainly still there. You say, you could say I'm living the best of both worlds.",English
+"But also the thing that's, I think science is changing, and the way we view science has to change too. Right, you know, when I was a postdoc,",English
+"of science aids, encourages thinking that, that's more, that has greater latitude, it's more relevant. And now as youngsters come to science, graduate students and postdocs,",English
+"they come to me today and they say, well, I want to do something that has meaning. I want to do something that has impact. And so, in a way, having this sort",English
+"but also to give a more balanced outlook to the scientific world, to the people who trained with me. So, so thank you for pointing that out.",English
+"It is like having the best of both worlds. Yes, absolutely. So, I mean, you know, you're sure shared with us earlier sort of your very interesting path.",English
+"or limitations that we had to overcome to basically end up where we are today. So I'm wondering, would you mind sharing with our viewers",English
+"and listeners, was there one hurdle in your pathway that you had to overcome prior to you being where you are today?",English
+"One hurdle. Oh, dear. There were many hurdles. But, you know, there are a couple that stick out.",English
+And so schooling was separate depending on racial categories. The school I went to was in an informal settlement.,English
+"It was a wonderful school. I had really wonderful, committed, brilliant teachers who did the best that they could with what they had. But I must admit, when I got to university, first of all,",English
+I was dealing with disappointment that I didn't get into medicine. And I was doing a science degree. I felt very underprepared.,English
+"You know, I would sit in lectures, I would sit in courses. And sometimes what the lecture would be saying sounded like Greek, like",English
+"it was - I was sitting in a math class and I thought, this can't be math. I've never seen this before. And then I turned to the person sitting next to me and said,",English
+"you know, do you know what's going on. And they said, well, we did it in our final year of school. And I didn't do this in my final year of school. And, you know, as I went through that first year,",English
+"your first year, at college, at universities, is very defining in a number of ways because you break the boundaries of school, you're more independent and kind of it's really up to you",English
+"whether you make it or break it. And so I went through this first year. And as the year progressed, I just felt heavier and heavier. I was failing in class, as much as I tried",English
+"I was either failing, or just barely managing to pass, you know. I used to do reasonably well in school. I wasn't accustomed to failure. It was something that I was not mentally ready to deal with.",English
+"And as I failed again and again and again, you know, rather than, you know, developing the skills to deal with that, I just sort of curled up inward saying, oh, my god, this is turning into a huge mess.",English
+"should give up this University career. I'm not made for it. You know, affording university education was also a problem. You know, it wasn't like my family had infinite resources",English
+to continue to send me to university. They were really reliant on me getting bursaries. And my academic record did not look like one that would attract a lot of bursary funding.,English
+"It was, it looked like I was done. And I remember that at the end of that academic year, you know, when you go and you look at your marks and they're up on the notice board.",English
+"the so-called helminths. These are the worms that can infect us and cause a range of significant diseases. Throughout most of humanity's history,",English
+infectious disease has been the primary reason why we die. It's really only in the last four or five generations that that has not been the case.,English
+This next graph shows the mortality rates in the United States of America over the course of the 20th century.,English
+"So this is the number of people dying in the US per year per 100,000 people-- per 100,000 head of population.",English
+So the mortality rates as we went through the 20th century fell quite dramatically. And if you drill down and you see,English
+"what are people actually dying from, the death from non-infectious diseases actually remained relatively constant",English
+"as we went through the 20th century. What changed was the deaths from infectious disease. If you go back to the beginning of the 20th century,",English
+"you see that there were approximately similar number of deaths from infectious disease as there was from non-infectious disease. But, as we progress through the 20th century,",English
+"the death rate from infectious disease fell dramatically. And this was due to a whole range of different measures-- public health measures, improvements in sanitation.",English
+"In the early 1900s, around 1910, across the United States, they introduced chlorination of the water supply that killed the pathogens that were getting into the people",English
+"from the water supply. Here you can see the 2018 influenza pandemic, causing a big spike-- a big increase in the number of deaths from infectious disease.",English
+"In 1941, there was the first use of penicillin, the first really effective antibiotic. And that had a dramatic effect in terms",English
+"of driving things down, as we had the ability to treat bacterial infection. And that continued to drive down. You see, in the latter part of the 20th century,",English
+"there was a slight increase, and that was associated with the AIDS epidemic. But, by and large, it's very clear. We had great success as a result of a range of public health,",English
+"sanitation, and medical breakthroughs-- great success in treating infectious disease. What's true of the United States is",English
+true of most countries in the developed world. This is a graph showing the top 10 causes of death in Australia in 2019.,English
+"And the blue bars are non-infectious disease, and the green bars are infectious disease. And what is very clear is that nine",English
+"of the 10 major causes of death in Australia in 2019 were non-infectious diseases. It's things like ischemic heart disease and stroke,",English
+"things like Alzheimer's disease, and a range of different cancers. So that's true in the United States. It's true in Australia.",English
+"But you don't have to look very far before you see countries for which this is not true. Our nearest neighbor, Papua New Guinea-- if you look at the 10 top causes of death",English
+"in Papua New Guinea in 2019-- again, the green is infectious disease. The blue is non-infectious disease.",English
+"And here you can see that, although the top causes are non-infectious diseases, there's still a very strong effect of infectious diseases, things like TB, things like respiratory infections,",English
+"things like diarrhea disease. And, in particular-- and I'll come back to this-- things like malaria are still a major cause of death in Papua New Guinea",English
+"and, indeed, throughout the developing world. And, of course, just as this was the case in 2019, we all know what happened in 2020.",English
+"And, if you look back to the United States of America and you look at the top 10 causes of death in the United States of America in 2021,",English
+"you can see a single green bar. And you know what that is, of course. COVID-19 was the third highest cause of death in the United States in 2021, so a salutary reminder",English
+"that although, on the whole, we've been very successful in the developed world at suppressing death from infectious disease, it's never very far away.",English
+And the COVID pandemic gave us a salutary reminder of that-- that infectious disease can still kill a large number of people.,English
+And what I'd like to highlight here is the effect of vaccines and the effect of drugs. And I'm going to start with vaccines we have very effective vaccines against a range,English
+"of infectious diseases, particularly those caused by viruses. We have good vaccines for smallpox, for polio, and of course now for COVID-19 as well.",English
+"And, just to illustrate the effectiveness of having a vaccine, what this data shows is deaths from smallpox in London, first",English
+of all through the 1700s. So this is the 18th century. And this is showing the deaths by smallpox as a percentage of the total number of deaths,English
+"that happened each year. And you can see, for example, in this year around 1750, 18% of the total deaths in London that year was due to smallpox.",English
+"You can see it was a major thing killing the Londoners throughout the 18th century. In 1796, Edward Jenner developed the smallpox vaccine.",English
+"And, over the following decades, the smallpox vaccine was rolled out. And you can see the effect. The occurrence of smallpox, the deaths from smallpox in London,",English
+"decreased dramatically. So, by the time you got to the end of the 19th century, there was almost no one dying of smallpox in London, as a result of the effectiveness of this vaccine.",English
+"So the UK effectively eliminated smallpox completely in 1934, and the WHO certified the global elimination eradication,",English
+of smallpox in 1980. And this is the first part of the ANU story that I want to tell you. And I want to tell you about Professor Frank Fenner.,English
+And Professor Frank Fenner was a professor at the Australian National University for 61 years. He was Professor of Microbiology at the John Curtin School,English
+of Medical Research from 1949-- he was one of the foundation professors-- through to his death in 2010.,English
+"And Frank, during the Second World War, had worked on malaria. He'd worked in Papua New Guinea, and he'd worked in Egypt, working on malaria.",English
+"Immediately after the war, he did some work on smallpox. And then he joined the ANU in 1949, and a key interest that he had then was in the myxoma virus.",English
+"And this is a virus, of course, that infects rabbits and ultimately kills rabbits. And at that point-- 1949, 1950-- there was the proposal",English
+"to introduce the myxoma virus into the Australian environment, to control the rabbits that were there. And the public was very concerned about this.",English
+"There was a lot of apprehension about the notion of releasing a new virus into the environment to kill the rabbits. So Frank, together with Macfarlane Burnet from",English
+"the Walter and Eliza Hall Institute, and Ian Clunies-Ross, who was the head of the CSIRO-- the three of them each injected themselves with a syringe full of myxoma virus,",English
+"enough to kill 1,000 rabbits each, and they were fine. And the Argus Newspaper, which was at the time",English
+"the big Melbourne newspaper, reported on this. And it said, ""This news is the kind of thing that goes far to restore our faith in humankind."" So that was Frank from the John Curtin School demonstrating",English
+"to the Australian public that you can inject yourself with a rabbit virus, that you could expose yourself in the highest possible way, and not suffer any ill consequences.",English
+And that was a significant factor in the public accepting the rollout of the myxoma virus and eliminating the rabbit plague.,English
+"In 1977, Frank came back to smallpox. And, in particular, Frank was in 1977 appointed the Chair of the Global Commission",English
+"for the Certification of Smallpox Eradication. And this is a document-- it's a historic document. It was released in December 1979,",English
+"and it declares that, ""We, the members of the Global Commission, certify that smallpox has been eradicated from the world.""",English
+And the top signature on the top left-hand side is that of Frank Fenner from the Australian National University. And there's Frank in May 1980 announcing to the assembled,English
+"WHO audience in Geneva that smallpox had, in fact, been eliminated from the whole world. And, as a result of this, Frank received the Japan Prize",English
+"in 1988, and there he is at the Japan Prize ceremony. So that's the first part of the ANU involvement that I wanted to talk about--",English
+Frank Fenner from the John Curtin School of Medical Research at the ANU playing a key role in the rollout of the vaccine and the eradication of this particular disease from the world.,English
+"Now, what a vaccine does is-- it's something that you take in order to train your immune system to recognize",English
+"a particular pathogen. What a vaccine is, is-- typically, it's a molecule from the surface of a virus or of a bacterium. And so your immune system learns to recognize that so that,",English
+"when you are infected with that virus or that bacterium, your immune system knows what to do. It knows how to recognize it, and it knows how to destroy it.",English
+So a vaccine is something that teaches your immune system how to destroy the pathogen. A drug is something quite different.,English
+"Drugs include antibiotics, which target bacteria; antivirals, which target viruses; and antimalarials, which target malaria parasites.",English
+"And a drug is a small molecule. It's a chemical which itself disrupts or destroys the particular pathogen-- the parasite, the bacterium,",English
+or the virus. So they're fundamentally different approaches to treating and preventing infectious diseases. And this brings me to my second ANU story.,English
+And this is a photograph taken fairly close to here. I'm not exactly sure where. It is on the site of the ANU. And it shows three of the founders,English
+"of the Australian National University, three people who were key in establishing this university. And those three people are Mark Oliphant, the physicist; Keith Hancock, with the pipe-- the historian;",English
+"and Howard Florey. And all of them were working overseas, but all of them were instrumental in persuading the government to set up a national university.",English
+"And Howard Florey, at the time, was working at the University of Oxford. At a later point in the 1960s, he actually became the third Chancellor of the ANU.",English
+"He played a key role in setting up the John Curtin School of Medical Research. So, although he never actually worked here himself, he was an absolutely key part in the early decades of the ANU.",English
+"And Howard Florey won the Nobel Prize in 1945 for his role in the development of penicillin, the first really effective antibiotic.",English
+"The penicillin story, at least the modern part of the penicillin story, starts with the famous observation by Alexander Fleming.",English
+And Alexander Fleming was a Scotsman working at Saint Mary's College in London. The story starts with him leaving a Petri dish on the bench top when he went on holiday.,English
+"And he came back-- and this is from the original paper in 1929. This is the Petri dish. He came back, and on the Petri dish",English
+were a whole lot of spots on one side. And each of these spots is a colony of bacteria. Each of these is a clump of thousands of bacteria that had grown while he was on holiday.,English
+"On the other side of the plate is this great big spot here, and that's not bacterium. That's a spot of mold, or fungus.",English
+"These are fungus cells growing. And the key observation is this-- that, on this side of the plate, the bacteria grow fine, nice colonies.",English
+"As you get closer to this, you can see they're not growing fine. They're actually all bursting. And the interpretation is that this mold, this spot of fungus,",English
+is secreting something into the dish that is causing anything nearby to burst. The bacteria can't grow.,English
+There's a molecule there that is killing the bacteria. Fleming himself didn't take it any further than this. He knew they were secreting something.,English
+He didn't know what it was. The work that was done to turn this into a workable antibiotic was done by Howard Florey and his colleagues working in Oxford.,English
+And here's Howard Florey treating a mouse. They isolated the molecule. They identified the penicillin. They learned how to grow the mold.,English
+They learned how to isolate significant quantities of the penicillin. And here they are treating a mouse that has a bacterial infection.,English
+"And they went on from there to publish in 1940 this seminal paper with Howard Florey as one of the key authors, describing penicillin",English
+"as a chemotherapeutic agent. So this was the first report of the use of penicillin as an antibiotic, and this had a massive effect",English
+"in terms of our ability to treat bacterial infections. Here's a wartime poster from the Second World War. ""Thanks to penicillin, he will come home!""",English
+"So it had a major effect in terms of supporting the Allied work effort. And then, back on the streets of London and New York, ""Penicillin cures gonorrhea in four hours""--",English
+"gonorrhea, a bacterial infection. So this just transformed our ability to treat a whole range of bacterial diseases, to treat infectious disease.",English
+"However, this is a graph showing three different species of bacteria becoming resistant to three different drugs.",English
+And this is the phenomenon of antibiotic resistance. And this is a graph that goes from 1980 up until the early 2000s.,English
+"And it shows what we know to be the case-- that multiple strains of bacteria are becoming resistant to multiple different antibiotics. And the WHO has identified antibacterial resistance,",English
+"or antimicrobial drug resistance, as one of the 10 top threats to human health over the coming decades. And this illustrates exactly that phenomenon.",English
+So what I'm going to talk about now is drug resistance. I've illustrated that bacteria are becoming increasingly drug resistant.,English
+"And I want to talk now, in part because I'm a biochemist, about mechanisms of drug resistance. And, in order to talk about mechanisms of drug resistance,",English
+I first of all have to talk a little bit about proteins and protein structure and protein shape. So let me do that now.,English
+I need to explain that protein-- so everything that's interesting at a molecular level inside the cell is essentially carried out by proteins.,English
+"We have about 20,000 or 30,000 unique proteins inside every one of our cells. And each of those proteins does something really important that",English
+"allows our cells to survive. Bacteria have a few thousand proteins. Malaria parasites have about 5,000 proteins. So you need to know what a protein is.",English
+"And every single protein is essentially a long chain of small molecules, and these small molecules are called amino acids.",English
+And we have 20 different amino acids. And we have the same 20 amino acids as plants do and bacteria do.,English
+It's true all over biology. There are 20 amino acids with which we build proteins. And proteins can be thousands of amino acids long. So this is a long chain of amino acids.,English
+"It might be 1,000 amino acids long. And at each of those 1,000 places is one of 20 different amino acids. And our thousands of proteins-- each one",English
+is unique because it has a unique sequence of amino acids. And the characteristics of those amino acids determine what that protein actually looks like.,English
+"So, when you actually look at a protein, it doesn't look like that. It's folded up in a very particular way. And you often see these helical structures showing up,",English
+"and you see bits where the chain comes back on itself, back and forth. And you might see another helix just there. And you might see it going back and forth there, and maybe",English
+another helix there. And that particular shape is characteristic of this and only this protein.,English
+And I'm emphasizing shape because shape is absolutely crucial in terms of what a protein is able to do. So I want to make two points in relation to this.,English
+"First of all, this particular protein has this exact shape. And the reason why that's important is that this particular protein has just the right shape",English
+"to be complementary to this molecule here. And this molecule comes in, and the shape you'll see there is exactly complementary to the protein.",English
+"And so that particular molecule sticks there because it's exactly the right shape. And then some sort of chemical reaction takes place, and then it's released.",English
+And this protein then clearly is an enzyme. It's an enzyme that carries out a chemical reaction. And it carries out a chemical reaction because it has a place in the protein that is exactly,English
+"complementary in shape to recognize and bind that particular molecule and no other molecule. So that's the first point I want to make, that protein shape is critical.",English
+It determines what the protein can do. And we have proteins that can carry out reactions. We have proteins like antibodies that can recognize pathogens.,English
+That's because they have the right shape to recognize those pathogens. We have proteins that sit on the surface of our cells and move things in and out.,English
+"In each case, they recognize something and move it in or out of the cell. Protein shape is critical in terms of what",English
+the protein can actually do. The second thing I want to talk about-- and now I want to come back and talk about drugs. The way that drugs work--,English
+a drug interacts with a particular protein because it has the right shape to interact with that particular protein.,English
+"So we saw this protein had a good apple binding site. But, as it turns out, this is sufficiently similar that this can actually sit in the apple binding site.",English
+And that actually stops the apple from getting in. And that's what an inhibitor does. That's what a drug does.,English
+"A drug is the right shape to stick to a particular protein and then somehow, in most cases, stop the protein from working. So protein shape is important.",English
+Protein shape is determined by the sequence of these amino acids. And protein shape is important because it determines the biological function of the protein.,English
+"And, when we talk about drugs, it's important because drugs will interact with proteins because they are the right shape to stick at a particular place on the protein",English
+"and stop the protein from actually carrying out its function. So let me just show you a couple of real proteins, at least illustrations of those.",English
+This is the protein we all have. It's called glucokinase. Glucose in our diet-- this is the protein that recognizes glucose,English
+"because part of the protein is exactly complementary in shape to glucose. And it will then turn the glucose into something else, and it's the first step in our metabolism",English
+of this particular sugar. And you can see there's the glucose molecule there. There's the glucose molecule there. And you can see it's sitting in this place in the protein that,English
+"is exactly complementary in shape. So, to emphasize the point again, the ability of a protein to do something biologically is dependent on its shape.",English
+This is the protein in bacteria that binds penicillin. It's called the penicillin-binding protein for historical reasons.,English
+What it actually does-- it's a protein that carries out a chemical reaction that's important in building cell walls. And there is penicillin.,English
+"Penicillin sticks to this protein because it is exactly the right shape to fit and stick to the protein, and it stops this protein carrying out its function.",English
+"So penicillin stops this protein. The job of this protein is to build bacterial cell walls. And, with penicillin there, then the bacterial cell walls",English
+"aren't built, and the bacteria burst, and that is how penicillin works. So that's when penicillin works, but I started this",English
+by talking about drug resistance. And I now want to talk about-- I've talked about how drugs do work. And what happens when they don't work?,English
+"So here's a schematic representation. This shows what happens when drugs work. So this is some sort of protein inside the cell. It's a bacteria, or it's a malaria parasite.",English
+"And here's a protein that's doing something really important that that cell relies on to survive. And here's a drug, and the patient takes the drug, and it comes into the bacterium or the parasite.",English
+"And it sticks because it's complementary in shape, and it stops that protein from working. And, as a result, the bacterium or the parasite dies.",English
+So that's a schematic illustration of what's supposed to happen. That's how a drug actually works. Why does it stop working?,English
+"How does resistance happen? What actually happens-- and commonly-- and this is one of several mechanisms of resistance, but it's the one I want to talk about today.",English
+"If you get a mutation, a change in that sequence of amino acids-- if one of those 1,000 amino acids changes--",English
+"and this happens spontaneously through mutations-- if one of them changes into a different amino acid and that changes the shape a little bit at the point where the drug binds,",English
+"then that has the effect of making this resistant to the effect of the drug. So I've illustrated that there, there's been a mutation.",English
+"There's been a change in the sequence of amino acids. That has changed the shape of the place where the drug is supposed to bind. And, as a result, the drug doesn't bind,",English
+"and it doesn't work anymore. And that bacterium is now resistant to that particular drug. So that's a common mechanism of resistance-- a mutation,",English
+"a chemical change, in the protein that is being targeted by a particular drug. So I showed you this graph already showing you the advent-- the increase in resistance--",English
+"since the 1980s, the advent of antibiotic-resistant bacteria. Don't we have new antibiotics? Well, not very many.",English
+This is a graph showing the number of antibiotics that were registered for use in the United States by the FDA. And you can see that the numbers are very low.,English
+"If you go from the 1980s, there was a peak. But, from the 1980s, there have been very few new antibiotics registered for release into the community.",English
+"So we've got the situation where bacteria are becoming increasingly resistant to the drugs we do have, and the drug companies are not releasing new drugs.",English
+We don't have very many antibiotics in the pipeline. And why is that? You think that would be the sort of thing that drug companies would be interested in.,English
+"And the answer, of course, is a financial one. Latest estimates suggest that it's about $1.1 billion US dollars to do all the research, to do all the trials,",English
+to bring a new drug to market. So a pharmaceutical company needs to think about that if it's going to be developing a new drug.,English
+"And, when it comes to antibiotics, there are poor financial returns. Because, if you take an antibiotic, as you know, you'll take it for a week or for 10 days,",English
+"and then you'll stop taking it because you're cured. And then, ideally, you will not have to buy that antibiotic again. They cure their target disease.",English
+"And, in any case, as I've shown, the bacteria will become resistant. So, if you're a pharmaceutical company",English
+"and you've gone to a lot of expense to develop a drug, and within a few years, there's going to be resistance to that drug, again, there's a financial disincentive to develop the drug.",English
+"So, for those financial reasons, we have relatively few antibiotics coming down the pipeline at a time when we actually have a dire need for them.",English
+"So, in the last part of my talk, I'm actually going to talk a little bit about some of the recent research in which I and other colleagues at the ANU were involve,",English
+"and this relates to malaria. And malaria is a single-cell parasite that infects red blood cells. These are the normal red blood cells,",English
+"and these are malaria parasites escaping from red blood cells. In 2021, about half the world's population was at risk. It's a disease of the developing world.",English
+"There were an estimated 247 million cases, an estimated 617,000 deaths from malaria in 2021. Parasites have become resistant to most",English
+"of the antimalarial drugs that we currently have. The story that I showed you for bacteria is also true of malaria parasites. Each time we've had a new drug and released it,",English
+"the parasite has shown it has become resistant. And we actually have very, very few antimalarials left to which the malaria parasite is not resistant.",English
+"And I want to tell you a story now, just in this last part of the talk, about a new antimalarial. And this is a report in the New England Journal of Medicine",English
+"from 2014 describing the first trials for this new antimalarial. It's a drug that's known by the name of cipargamin, or the code name KAE609.",English
+"It was identified in a massive screening program. It was in clinical trials in 2014, and they were very encouraging.",English
+A dose of 30 milligrams for three days cleared the parasites from people with malaria. It's now in advanced clinical trials.,English
+This may well be the next big antimalarial that's released as a means of treating malaria out in the developing world.,English
+And I want to tell you a little bit of work that's been done at the ANU on this particular drug. So the drug was being developed.,English
+"And, at that point, it was known that it was very effective at curing-- at killing parasites, at clearing them from people who were infected with malaria parasites.",English
+"But it wasn't known how this particular drug worked. To tell you how it works, I need to tell you just a little bit of cell physiology.",English
+"And this is a story of salt, of sodium and chloride ions and what happens to them inside cells. So sodium chloride is, of course,",English
+"common table salt in a water solution, as you find inside cells. The sodium chloride dissociates. You get the sodium and the chloride as separate entities.",English
+Cells spend a large part of their energy budget pumping out sodium. Sodium is potentially toxic inside cells.,English
+"And every single one of your cells has at its surface a protein that is the right shape to recognize sodium, sticks to sodium, and pumps it out.",English
+And anything up to a third of the total energy that you consume in your diet is spent pumping sodium out of cells to keep the sodium levels low.,English
+So you pump the sodium out. The sodium comes back in again. It's leaking back in. And it's analogous-- and I've got this nice picture here--,English
+it's analogous to these people in a boat. You've got the pumps pumping the water out. The boat has got holes in it. The water is leaking back in.,English
+"Providing they pump fast enough and get the water out fast enough, it'll keep the level of water low, and the boat will stay afloat. And, similarly, in all of your cells, in every plant cell,",English
+"in every sort of cell that we know about, there are molecular pumps that pump the sodium out in order to keep the sodium level low because it's potentially toxic inside the cells.",English
+And I want to tell you now about Natalie Spillman. And Natalie came from Rockhampton. She came down to the ANU to do a science degree. She did various research projects as an undergraduate.,English
+"She then went on and did honors and did a PhD. And I want to show you a little bit of her PhD work. Her challenge was to understand, how does sodium",English
+"work in a malaria parasite? And what Natalie showed is that a malaria parasite, like every other, cell pumps sodium out, and it leaks back in again.",English
+"And what she discovered was that the pump that a malaria parasite uses is quite different from the pump that a human uses and quite different, indeed,",English
+from the pumps that any other organism uses. This shows one bit of data from Natalie's thesis when she was a student here at the ANU.,English
+She developed a method for measuring the sodium level inside a parasite. And that's the sodium there. It's very low.,English
+"And what she then showed was that, when you take this new antimalarial, the one that was just being used in early clinical trials, but which we didn't know how it worked--",English
+"when she added that to these malaria parasites, the sodium straight away increased. The sodium in the malaria parasite",English
+"increased dramatically. So, essentially, without going into a lot of detail, what Natalie had discovered is that this new antimalarial that had just been released and which is now in final-stage clinical",English
+"trials-- the way that it works is because it blocks, it inhibits, it sticks to the sodium pump at the surface of the parasite. And, as a result, the parasite fills up with sodium,",English
+"the sodium continues to leak in, and it's that that actually kills the parasite. So she had discovered the mechanism of action",English
+of this new antimalarial. And it actually got quite a lot of publicity. And it was covered. We've did interviews with people all over the world.,English
+"And this was our favorite interview, and it taught me a valuable lesson. So this is from Top News in the Arab Emirates. And we began to read this, and got a little concerned.",English
+"""Salt Overdose Enough""-- because, in explaining this to Top News and everybody else, I thought it's good to simplify stuff. You have to-- you can't talk about too complicated science.",English
+"I just talked about salt, toxic salt, salt would kill the parasite. And then I saw it was being reported like this. ""At study carried out by researchers at Australian",English
+"National University has discovered that the deadly malaria parasite can be defeated with the use of salt alone. Researcher Natalie Spillman, who conducted research with an aim",English
+"to find the way the salt balances""-- well, that bit was all right. But, essentially, they were saying, well, you just need salt, just a little bit of table salt.",English
+"And I thought, wow, I've clearly made a mess of this into the communication. I hope no one actually thinks that that's true because it's not true.",English
+"The particular drug blocks the sodium pump, and the cell does fill up with salt, but common table salt itself is not an effective antimalarial.",English
+"And then the very last thing I want to show you is some very recent work. And this was published at the end of last year, and it was published by Adele Lehane and her research",English
+co-workers. Adele heads a group in the Research School of Biology here at the ANU. James was an honor student. [INAUDIBLE] is a postdoctoral researcher who works with her.,English
+"And this describes a very simple experiment. They took malaria parasites and they added this new drug, first of all at very low levels, so the parasite didn't notice.",English
+"And then slowly, over three months, they gradually increased the level of the drug until, three months later, the parasites were growing in a concentration--",English
+at a level of the drug that would easily kill a parasite that hadn't been exposed in this way. And this is a graph showing how well,English
+"the parasites are growing as you increase the concentration of drug. And the drug is cipargamin. And these are healthy parasites, 100% growing.",English
+"And these are parasites that are dead. And, at very low levels of this drug, normal parasites are killed. This is a really good antimalarial.",English
+"You can kill parasites. But parasites that have seen this over a period of three months with increasing concentration-- you do the same experiment, and they look like this.",English
+"This is resistance. These parasites, over the course of three months, have become resistant. You need 10,000 times as much drug",English
+"to kill these parasites as you do to kill these parasites. And you can't give people this higher concentration of drug. And the reason these parasites are resistant,",English
+"they showed from sequencing the genome, is that this pump-- this protein at the surface of the cell that pushes sodium out--",English
+"has a mutation in it. This pump is 1,500 amino acids long, and just one of those amino acids is changed. It's changed from one of the 20 to a different one of the 20.",English
+"And this is the effect. As a result of that single change in the amino acids in that protein, the parasites have become very highly resistant",English
+to this drug to an extent that you can't use this drug to kill these particular parasites. And just to show you the very last bit-- John is a PhD student who works with Ben Corry.,English
+"And they use-- and John's here-- and they use the latest artificial intelligence tool, which allows us to predict with great accuracy",English
+"the shape of a particular protein. They use this tool to predict the shape of this sodium pump sitting at the surface of the malaria parasite,",English
+"recognizing sodium, pumping it out. And then they use the supercomputer to ask the question, and putting in the structure of this drug, where does this drug stick to this protein?",English
+"And, using the supercomputer, they learnt the answer to that, and there's the drug. This is cipargamin, sticking, as predicted by the supercomputer,",English
+"to this particular place on the sodium pump, stopping the sodium pump from working. And this is how this drug works. It sticks there because it's the right shape,",English
+and the parasite fills up with sodium. The mutation is exactly there. That's the mutation that has changed,English
+"in these mutant proteins-- in the parasite. And just to blow that up, that region there-- the mutation has changed that one amino acid.",English
+"The amino acid is bigger than the one that was there before, and it's exactly the right place to push the drug away. Because of that change of that one amino acid",English
+"there at the place where the drug sticks to the protein, the drug no longer works. It no longer kills parasites. That is how the parasite has become resistant.",English
+"So that is essentially all I want to say. I wanted to tell you a bit of a story about infectious disease. Infectious disease is something that, in the developed world,",English
+"we are now largely able to control. But COVID has reminded us that that's not always the case. Part of that control has been medical science breakthroughs,",English
+"in which ANU has played a critical role. I've talked about Howard Florey, and there he in the late 1940s planning the Australian National University,",English
+"for which he was later to become the Vice-Chancellor. I talked about Frank Fenner and his role in the rollout of the smallpox vaccine and, essentially, curing the world of smallpox.",English
+"But I also talked about, and I wanted to talk about, work that is happening right now in the Research School of Biology using a range of different tools,",English
+"including the latest AI tools, including the very most sophisticated research techniques, to address questions relating, in that case, to the malaria parasite.",English
+And I'll just end with one reflection I emphasize the point that drug companies are not particularly interested in developing antibiotics because there's very little money,English
+"to be made in antibiotics. There's even less money to be made in antimalarials because malaria is a disease of the developing world, and they're just not going to be able to sell them",English
+"for very much money. And it's a critical role for institutions like ours, like the Australian National University and others like it, to carry out research that is for the public good, that",English
+"informs the development of vaccines and of drugs, because the pharmaceutical companies aren't particularly interested in doing this sort of work. So it's a critical role that this institution has played",English
+and continues to play today. And I'll finish there. Thank you. [APPLAUSE],English
+"Well, I'm Andrew Phelan. And my role here, firstly, is to facilitate some questions. Our first test is to actually fit our bodies to these weird structures down here.",English
+"[LAUGHTER] But, to me, what you finished with shows how important the institution like the ANU is.",English
+"How sustainable is what you do at the present time, or what would be needed to make a sustainable",English
+"effort to deal with what you're dealing with there? Look, I'm aware that my friend and colleague Professor Schmidt's just there, and we spent",English
+"some of the afternoon discussing that exact thing. Because the sorts of things we talk about, and science in general, relies on infrastructure, on equipment.",English
+"I mentioned the supercomputer, for example. The fact that we're able to the structure of this particular protein that's the target relies on the supercomputer.",English
+All that costs a lot of money. So the sort of things we do-- the sort of things we need to do to be at the cutting edge-- and whether it's biology and biomedicine or physics,English
+"or chemistry or astronomy-- does require significant investment in infrastructure. And, to be honest, in Australia at the moment,",English
+things are not sustainable as they are currently. So that's the equipment and infrastructure side of things. And then there's the people side of things as well.,English
+"The sort of people I've talked about train and do PhDs, and we don't really have good structures for them, either, to encourage them to continue doing the sorts of research",English
+"that we do. So look-- ANU is important, and we're able to do this sort of research. But there's multiple elements of it",English
+"which are not particularly sustainable at the moment. We do our best, but it does require some more root and branch approaches",English
+"to some of the things. What about international cooperation, in terms of leveraging yourself and others-- your expertise-- your world-class expertise and reputation, and leveraging",English
+"off that to produce cooperative models of developing? That's very much a part of what we do. The ANU in particular, of all the universities,",English
+is very international. We have a very high level of international collaboration. So the work that I talked about was done in collaboration with people overseas.,English
+"in part funded by money that came ultimately from Bill and Melinda Gates. And I talked about-- pharmaceutical companies are not very interested in-- well, they're",English
+"totally disinterested in antimalarials. And this is an area where Bill and Melinda Gates, who are actually very interested in malaria, know a lot about malaria as individuals,",English
+"put a significant fund-- amount of money into that. And, if you look at the total money spend on malaria research worldwide, Bill and Melinda Gates are actually, if not the biggest,",English
+"certainly close to the top. So we've been able to access those sorts of funds through international partnerships. But, nevertheless, we are heavily",English
+"reliant on local support, and that's not always straightforward. Yeah, key message there. Now, there are obviously a lot of questions.",English
+"So perhaps-- I think there's a roving microphone somewhere. Peter? Thank you, Andrew.",English
+"I'm Peter McDermott, one of Andrew's predecessors here. And I've been watching these things for a long time. About 15 years ago on an Australia Day function,",English
+"I think it was, Professor Fenner came out and spoke to us. We gave him 20 minutes. After 45 minutes holding us in the palm of his hands,",English
+I had to get up and offer him a cup of tea. But he was talking with great vigor about the work that he had done. And I took the opportunity afterwards,English
+"to ask him, because I am in the Rotary, and we have a great interest in polio, whether polio will go the way of smallpox, i.e., dead.",English
+"He wasn't sure that would happen. And I wonder, having listened to what you have said in the mechanisms, why did smallpox not evolve to escape the vaccine?",English
+"Was it by chance, or was there some difference between what happened with smallpox and what's happening with current viruses?",English
+"Well, smallpox-- viruses, as I emphasized, are relatively small and relatively simple. So their ability to change things",English
+is actually quite limited. And COVID is showing some ability to adapt. Smallpox didn't show that ability. So smallpox was eliminated because it didn't develop,English
+"resistance to the vaccine. Whether polio will go the same way-- it came pretty close, I think. This is not my area of expertise.",English
+"I know there's people in the audience who know more about this than I do. But polio was at a very, very low level. And they were-- WHO and others were sending people",English
+"to the most remote communities to try and eliminate all the polio. But it didn't actually happen, for all sorts of geopolitical reasons, apart from anything else.",English
+And so there is still a reservoir out there of polio. It's not gone the same way as smallpox. Yeah.,English
+"I'm curious with the cipargamin, if I pronounced it correctly. What are the implications of the resistance that you've documented, given that it's just in clinical trials right now?",English
+It's an interesting question. So any antimalarial we produce-- the parasite will become resistant.,English
+"It always has. Knowing how it becomes resistant and what to look for educates how we use drugs. So, for example, one lesson we've learnt is that we should",English
+never use a single drug as a single treatment. You should always combine one drug in the same tablet with at least one other drug because the parasite may,English
+"be resistant to one, but the chances of it being resistant to two is actually much less likely, and three, even less likely.",English
+"So one of the considerations-- seeing now that the parasite can relatively easily become highly resistant to this molecule, that informs the drug development",English
+"people that we need to combine this with other drugs, that we should never put this out there by itself. It's very good at killing parasites, providing they haven't got this mutation.",English
+"And, if we combine it with another drug, then that's the approach we should use. And then the question comes, well, which other drug? And then you have to think about, well, I take a drug,",English
+"and it stays in my system. And one drug might stay in my system for an hour, and another drug might stay in there for three days. So then the parasites may see one drug by itself.",English
+"So it brings in all those sorts of considerations as well. So what we would say is that, yes, it is disappointing that the parasite shows its ability to become resistant.",English
+But it's expected. It just informs our strategy in how we package drugs and put them together to put into place a viable treatment.,English
+"Yeah. That's good, I think.",English
+"We can hear you. Yeah. Kiaran, great talk. Question about the pump-- as you know, SCU was able to show that potassium",English
+goes the opposite way. Was potassium looked at in this study? Indirectly. So you're quite right.,English
+"I emphasize that every one of your cells in every one of your bodies spends a lot of its energy budget pumping out sodium. And, as [INAUDIBLE] has alluded to, at the same time,",English
+it's pumping in potassium. And that's what a human or an animal pump does. This pump doesn't do that. So one of Natalie's discoveries was--,English
+"when she looked at it, this pump actually looks like the pump you see in plants. And then Adelaide, another PhD student, looked at it more closely, and she said, well, actually it's",English
+"not really like the one in plants. It's actually its own special category of pumps. And this pump doesn't pump potassium, so it's not like an animal pump.",English
+"It actually pumps acid-- hydrogen ions-- in the other direction. So it's an unusual pump that has these particular features, which is why it's a good target.",English
+"Whenever you're looking for a target, you're looking for something that the pathogen has that a human doesn't have. Because, if you gave them a drug that",English
+"blocks all our sodium pumps, we would all die very quickly. You need some difference. And that was the exciting thing. This is a pump that is nothing like a human pump.",English
+"It's an unusual pump, and it doesn't do what a human pump does. Kiaran, hello. Hello, [INAUDIBLE].",English
+"So you've outlined some fascinating discoveries, very important discoveries. But the challenge is translation because the pharma companies",English
+won't invest in this area. What have we learned from COVID that could give us lessons on how to more effectively or more efficiently,English
+translate the fundamental science into new drugs or new treatments? It's a good question.,English
+"And I'm aware that the Dean of Health & Medicine is in the room, and he can-- Ross here for a Director of Research in the College of Health & Medicine here.",English
+"They could probably reflect on that more wisely than I can. You're right-- in terms of translation, just coming back to the original thing--",English
+I mentioned how drug development is done now in malaria and other developing world diseases-- it's public-private partnerships.,English
+"Drug companies will not invest significantly in this, but they are prepared to get a little bit involved. And if Bill Gates is prepared to put",English
+"in a bunch of money and the Wellcome Trust and the NIH prepare to put a bit of money, then these partnerships can be formed for developing these sorts of drugs.",English
+"The real striking feature of the COVID situation was the rapidity with which things were developed-- the vaccines, and how the publications worked,",English
+"and how things were put out there straight away. And I'm not sure, in terms of the malaria field, for example-- I think it's not yet clear whether this is now",English
+"a new way of working, or whether that was a COVID emergency response. But I don't know whether, Russell or Ross, you have any reflections on that.",English
+I think it was a COVID response. I think it was a COVID response-- the imperative to get it out there. But the problem with malaria is that it's still,English
+"seen as someone else's disease in third world countries. Indeed, indeed. Thank you very much.",English
+"Well, you're absolutely right. Many of these diseases are zoonotic originally and come from animals.",English
+That was certainly true of the COVID virus. It's true of many of the diseases I've been talking about.,English
+"And our ability-- you're quite right. There's a whole range of issues that give rise-- for example, in the case of COVID, to the wet markets in China, to the deforestation,",English
+"to the pushing together of animals. Because, for example, the malaria parasites-- there were certain strains of malaria for which there is a large reservoir in the jungles.",English
+"The animals carry the parasites. And, the more we push the humans and the animals together, then we get more and more zoonoses. And that's a source of a significant number",English
+"of these infections. So you're quite right on the bigger scale. Ideally, we'd be talking about not treating the disease when patients show up in the hospital with these particular",English
+"disorders, but addressing the core issue, which is all the sorts of issues that expose us to pathogens that come from the environment, that come from animals",English
+"and come from elsewhere. So, back on that point about what we could learn from the COVID-19 pandemic--",English
+"and the point about was that, when that first-- we were able to get ahead of structure right away from the start of what the target should be.",English
+"And that was developed within a month. And, therefore, they could design molecules that could bind to it, and also antibodies, and therefore make the virus.",English
+"So it's a question of funding that fundamental research, really, at the basic level, as you outlined, that really leads to the ability to move very quickly to build",English
+"these type of defenses, if you like, against this pathogen. You're right. The vaccines that we have, for the most part,",English
+"with some exceptions, are against the viruses, because they're very simple. They're relatively limited in terms of what they can do. If you have a vaccine that targets them,",English
+"they have very little genetic resources to draw on. And that's not true of a malaria parasite, for example-- very, very complicated.",English
+"A malaria parasite-- in the first instance, it hides inside red blood cells, so the immune system can't really see it. It does change the red blood cells.",English
+There are new molecules on the surface of the red blood cell that the parasite has put there. But the parasite actually has 100 different versions,English
+"of those it can choose from. And then, as soon as the immune system recognizes one of them, the parasite just changes it for another one. It's got all of these genes, got many different proteins,",English
+"and it can just switch things around, which is why we still don't have a really effective vaccine against malaria because it has all these resources which a virus doesn't have.",English
+"A virus is simple. It may even have just a single protein on its coat, in some cases-- the simplest viruses. So, yes, we need the fundamental research, exactly as you said.",English
+"Developing vaccines against the simplest of these pathogens is a lot easier than developing them against these very complex, very sophisticated pathogens.",English
+"I'm an undergrad student in your College of Science [INAUDIBLE].. Oh, great. Thank you for coming. No, no, not at all.",English
+Attending [INAUDIBLE] lectures is one of the most enlightening things about attending university for me. They're great.,English
+"When I have the time, it's something I look forward to. So you've said that new drug developments have been falling, but antimicrobial resistance continues to rise.",English
+"What do you think the long-term future of medicine is? Will we always be able to keep up, or do you think we're living in a unique period in history",English
+"where we don't have to fear disease? Well, that's a very good question. The current model, where we rely-- have relied primarily on pharmaceutical companies",English
+"to develop drugs, is not-- this is the concern of the WHO. It's not really providing the new drugs that we need because the incentives--",English
+"the incentive model is misaligned. In terms of the future, I'm an optimist. So I think we will be able to combat these infectious diseases as we get better and better and more",English
+"sophisticated technologies and approaches. And universities like this one, I think, will play a key role in that. So I think maybe we're at a particular point--",English
+"these last 50 years have been the time where infectious disease hasn't been the major cause of death, and maybe we're heading back in that direction. But I'm confident in medical science in places like this",English
+"to be able to develop new drugs. And our abilities are getting better and better all the time, so I'm optimistic. Are there any other questions?",English
+"to get their drugs registered, and that gives you $1 billion plus for marketing? Whereas sometimes there may be a case of being less risk averse",English
+"And it's set at a particular way now, and maybe that changed during COVID. But it's-- I'll take that as a comment. It's a very appropriate-- it's an [INAUDIBLE]..",English
+"It may be also how risk is allocated within society and between societies. So, for example, I guess the US, with a very litigious",English
+environment-- the risks associated with putting out a drug on the market that may have unintended consequences may far outweigh the ability of a--,English
+"well, the ability of a company to accept that risk. I think, in COVID, wasn't it a situation where governments accepted a lot of the risks themselves",English
+"through regulation and other means? Professor-- [INAUDIBLE] Professor, can I take you back to Andrew's first question, where you said, yes,",English
+Can I put an advert in for the Order of Australia Association? We own a foundation called the Order of Australia Association,English
+"So they've proved their worth by first-year stuff-- $45,000 a year, spread over three years,",English
+"where the intention is to keep some talented people at university who otherwise might not be able to do. Therefore, could I suggest undergraduates and whatever",English
+"might like to google the Order of Australia Association Foundation? Good on you, Phil. [APPLAUSE]",English
+"be a CT scan also known as CAT scan or an MRI of the brain. If we see something abnormal, then we would typically meet, discuss, and Dr. Das and her team, whether to biopsy",English
+"or we'll make attempt to remove it all, if possible. At times, it is not possible to remove the entire tumor, so it really depends.",English
+"It's a case-by-case decision that we make. Then once the tissue is removed, it is sent to our pathologist, who will take the tissue,",English
+"make thin sections, stain it, look under the microscope. We often join him for this. And he will also take remediating material",English
+"and sequence the DNA to identify the subtype of tumor to arrive at an exact diagnosis. So when you identify that subtype of tumor,",English
+"what are you looking for and how does that help you as you diagnose and, I guess, determine the course of treatment?",English
+"So we so we look at an example of glioblastoma, for instance. I mentioned it is unfortunately the most common. We know that there are subtypes of glioblastoma",English
+and it's not readily distinguished by looking under a microscope. So we need to actually sequence particular genes,English
+"to further classify. And the reason that's important is because it will speak to prognosis, potential outcome we discuss with the patient, and also enrolling",English
+into conquered trials. Because a lot of the trials are really moving forward towards highly targeted personalized studies. So this information is absolute critical,English
+"to provide care for our patients. So we are receiving some questions from viewers, which we always love to see that because they have usually really good questions.",English
+"And want to start with the first one, this is from Stella, and Stella says my husband was found to have a pituitary tumor causing no symptoms. Does it have to be removed?",English
+"No, it does not. It depends very much on the symptoms and the size and how he presented. Many pituitary tumors are not growing.",English
+"They grew at some point and now they're static in size, meaning they'll stay in there and not cause any problems.",English
+"Occasionally these tumors can be growing, and that is when we usually treat. If they're large they can cause problems with your vision,",English
+"and so it's very important to note if the vision is normal or not. And occasionally these tumors can secrete hormones,",English
+"which can also require surgery. But not each of these tumors require surgical intervention. Many times we can watch this, and so just as Dr. Park",English
+"mentioned about malignant tumors, it's very important that we take the personalized look at patient scan and also what's",English
+"Thank you, David, for the question. So astrocytoma is a type of glioma. So these are intrinsic tumors that",English
+"arise from the brain cells. And there are different types, and people often mistake it by calling it a stage.",English
+But we're not talking stage here. We're talking about grade. And grade just means how aggressive the tumor looks under a microscope.,English
+"And grade goes from 1 through 4. And that drives how aggressive the tumor may be and also how we plan our therapy, depending",English
+"we call something a cancer, by definition, we call it cancer because it has the ability to spread, or invade, or metastasize.",English
+"Brain tumors typically do not leave the brain. There are certain situations it does. Those are very, very rare.",English
+"However, we define aggressiveness by its ability to infiltrate across the brain. So typically grade 1 tumor we may call it benign.",English
+"However, if a tumor is located in a critical area of the brain, now, the tissue itself may appear benign, but due to its location in a critical part, to the patient",English
+"it's not acting benign. The patient may be left with losing vision or, for instance, not able to walk. So these are certainly not benign.",English
+"So we have to be careful of the term that we use here. Now for grade one tumors, if Dr. Das goes in and removes all of it, often we just watch.",English
+"And we'll do serious scans every three months, every six months. And often the patient will do quite well. When we get to grade 2, these are now",English
+"what we'll call infiltrated tumors. They're not growing like a ball. They're projecting roots, like tentacles, so it's very difficult to remove all of it.",English
+"These patients we have to monitor more closely. They may require radiation and chemotherapy. Once we go to grade 3, definitely",English
+"get radiation and chemotherapy. And then grade 4, we often will combine radiation and chemotherapy upfront together to try to hit as hard as possible,",English
+"because I think oftentimes we think of tumors in various parts of the body. And if they are benign, you leave it alone. But in the brain, it's certainly a different situation,",English
+"and are growing, there are many safe surgical techniques where we are able to remove tumors fully without leaving patients with much deficit at all.",English
+"That's great. So we have more viewer questions. We've got some really good viewer questions that have come in so far, and so I want to get to as many as we possibly can during the program.",English
+"Elizabeth asks if there's a lesion on the back of the skull from prostate cancer, do you often see that shrink after chemo? Yes, many times if it's outside of the brain,",English
+"like let's say if it's in the skull where these can often be found, these can decrease in size with systemic therapy, if overall the cancer is responding to that",English
+"elsewhere in the body as well. Dr. Park, Natalie is asking, should I see a neurologist if I'm being treated for another type of cancer?",English
+"That would depend on what type of cancer. And also whether or not her nervous structures, including brain and spinal cord, and even the peripheral nerve,",English
+"that are involved, and may be involved due to the growth of the cancer going directly, pushing against it. Or it could even be as a result of chemotherapy or radiation.",English
+"So, yes, having neurologic symptoms definitely should be seen by a neurologist. Sounds good. Carmen asks if there's a family history,",English
+"should you be screened? So usually not, most of the brain tumors that we see are sporadic, meaning they're arising by chance",English
+due to genetic mutation. There are some very rare genetic hereditary disorders where people are predisposed to certain tumors.,English
+"And this usually would be found like over many, many generations and people would already have the diagnosis.",English
+"But usually if you just have one or two people in the family that have had a brain tumor, certainly if it's metastatic, you know that is probably sporadic and there's",English
+"no reason to screen for that. Great. So Dr. Park, how are tumors tested for cancer in general? I know you touched on this earlier in the program,",English
+"but if you could kind of just walk us through that process, what do you do and what do you see and look for? A lot of that work is done by our colleagues in pathology.",English
+"So they will first screen by taking a section. I mentioned looking at the microscope. And there are certain features that we look for. We may look at part of the cell nucleus,",English
+see how aggressive it looks and if are there cells that are dividing. The normal adult brain would only,English
+"have cells that are dividing. There are few exceptions, but we look for the presence of cells that are dividing the tumor tissue. And if so, what's the percentage of cells that are dividing?",English
+"And that gives us the sense of how aggressive the tumor is. In addition, there are a series of genes. There's a whole panel that we test for,",English
+"looking at disruptions of the gene, and that could affect these signaling of the cells to state whether to divide or not to divide.",English
+"So there are varieties that we look at to determine how cancerous it is or how aggressive this tumor may be. So we have another question, and I'll throw this one",English
+"to either one of you. This is from Eileen. And Eileen had a meningioma removed in May of 2019. She says she's doing well, but she",English
+"as many people as possible to get the vaccine. Would that be accurate? Yes, and particularly patients that",English
+"Perfect. This is kind of a difficult question, but it is one that gets asked a lot. How long will you live if you do have a brain tumor?",English
+"What would you-- what do you tell patients? So I think that's very different for different types of tumors. Like if we talked about these benign tumors, even",English
+"let's say if it's in a difficult area, that could affect their life expectancy. A benign tumor that we could take out completely may not have any effect on the life expectancy.",English
+"And certainly on the other end of the spectrum, we have our malignant brain cancer, like the glioblastomas that Dr. Park was talking about.",English
+"And although the average life expectancy is thought to be about 18 months or so for that, everybody is different.",English
+And we look at the genetics of the tumor to help predict their course. And certainly the patient's underlying medical conditions,English
+"can also affect what they're able to tolerate, like if they're able to tolerate the chemotherapy, surgery, or radiation. So everyone is very different, so it's very hard",English
+"to make a blanket statement. Sure. So Dr. Das, I am kind of curious because we've heard about, and I've spoken with other physicians about this,",English
+"and one of the things that always impresses me about the work that's being done here at UChicago Medicine is the team approach that happens. And I would imagine in your field, especially,",English
+"it's important. Can you talk to us a little bit about that? And when you work with the patients, you really develop a plan and you communicate with the patients and their families",English
+"as well from the very start, if I'm not mistaken. Absolutely. The team approach is so important, especially for treating brain tumors.",English
+"Because it's not just the surgeon, it's also what can our radiation oncologist do for the patient? What can Dr. Park, as the oncologist, do for the patient?",English
+"And we use this team approach to make the decisions that eventually get implemented into treatment. And actually every week, we have a tumor conference",English
+"where we all sit together, including at other surgeons, so we can get multiple opinions. Because the more minds there are looking at a problem,",English
+"certainly we can come up with better solutions. To me, that's just so impressive because it's putting aside territory and egos and things like that",English
+"and working together, which we do here at UChicago Medicine, and do it quite well. And listening to other people's thoughts, and that's just going to be critical to what you do.",English
+"Oh absolutely. And it's not just people from other specialties, but also our own partners maybe in the same specialty. People can really open your eyes to look",English
+"at problems in different ways because they have a different way of thinking. And that's so important. And from the patient's standpoint,",English
+"And communication is key, and I've heard this from many patients, that the communication here is also very, very good.",English
+And we have our office staff and everyone available to give us the questions if they're coming through over the phone.,English
+"Or we're able to call you back right away if it's something critical. Great. And Dr. Park, if we can, we've always",English
+received a lot of questions about COVID and the impact of COVID on visitors and patients. One of the things that we want to make clear,English
+"in all of these programs is that we are open for business, and it's better to go in and get treated for your serious illness.",English
+in managing our patients. This would include our radiologists. And our imaging facility here is excellent.,English
+"So we follow the hospital policy, whatever is recommended by CDC hospital policy.",English
+"done with the NIH, it's been sequenced the entire tumor genome sequence, but that are yet to translate into effective therapy.",English
+"And we are working with very limited armamentarium here, so trials are absolutely critical and these studies can really only",English
+"And, yeah, thanks for joining. Today, wanna give a brief view of clinical trials and then NF2.",English
+"I've asked our neurotology fellow Dr. Varadarajan he goes by Dr. V, to help me with his presentation. So I'm gonna kick it off",English
+"and he'll give you guys some overview and what kind of opportunities are out there in terms of what new drugs are out there,",English
+"where those trials are. So please feel free to also use the chat, maybe to engage with others and us and if you have any questions, feel free to ask them.",English
+"So I'm going to maximize my screen here. So again, state of clinical trials... Again, I'm gonna kick it off and Dr. Varadarajan will go from there.",English
+Here are my disclosures. And I think an important one to keep in mind is that this presentation will include the discussion,English
+of off label drugs. The topics that we will go through is really two folds. One is the clinical presentation diagnosis of NF2,English
+to really why we wanna have more newer clinical trials and drugs available,English
+"for folks who have NF2, and then really emerging treatments with what is out there. So again, NF2 is due to a gene",English
+really the codes for Merlin and Schwannomin. It's a tumor suppressor gene. It's usually inherited.,English
+"But again, 50% are about inherited. The other 50% of folks of NF2 have what we call de novo mutations",English
+where there is no family member affected. It is passed down as an autosomal dominant on a path of inheritance means,English
+"that every generation usually has a 50% chance of getting it although there is some incomplete penetrance, mean that even if you have the gene,",English
+it doesn't mean that you will get disease. Most sporadic of vestibular schwannomas actually interestingly have the same mutation.,English
+"And as we all know, stimulus went almost sort of the classic NF2 lesion that we are dealing with.",English
+"Prevalence; really the numbers vary quite dramatically on we're in the world you live. It's been anywhere between one and 25,000",English
+"to one and almost 100,000 folks who are currently live have this. The average age of diagnosis is about 25 years of age.",English
+"However that may be even young children. I've seen five and six year olds,",English
+"but in some folks are really not diagnosed until they're in the 40s or 50s. And correspondingly, there are two main types",English
+"and there are several genetic alterations that has been linked to each one of these is the wizard type in the garden at times,",English
+"it really depends on the severity in the age of onset. Again, and those have been correlated with different genetic defects.",English
+The hallmark of NF2s we all know vestibular schwannomas are also called acoustic tumors. There can be multiple other central,English
+"and peripheral nervous system tumors. Again, the most common one with has been a schwannoma. If there again on the acoustic nerve they're called acoustic tumors or acoustic neuromas.",English
+"Again, there are other cranial tumors optically almost spinal tumors, peripheral nerve sheath tumors, and affected individuals also have some skin changes",English
+"we call it an neuro ectodermal syndrome, simply because the skin into central nervous system are really arising",English
+"from the same from the same tissues during development. Some have NF2 plaques, cafe au lait spots, that's milk coffee spots.",English
+"In some folks have cutaneous schwannomas but that's less common. Cataracts and hamartomas are also part of NF2,",English
+"usually diagnosed by ophthalmologists, that's why for us, it's really important to also have an ophthalmologist part of the team.",English
+Here is the diagnostic criteria for NF2. So as definitive NF2 is really bilateral vestibular schwannomas,English
+"and it's first degree family relative with NF2, and unilateral schwannoma. So if you have unilateral schwannoma,",English
+"and you have a first degree relative with NF2, you probably have NF2 at less than 30 years of age. And there are some less definitive variables here",English
+"that are listed out on the slide. So, those are to consider when diagnosing NF2, obviously, there's a genetic way to diagnose NF2,",English
+"but again, the bilateral vestibular schwannomas are most commonly associated with NF2. So these are some examples.",English
+This is the left ear. This is the right ear. And we can see nicely here the right side of the vestibular schwannoma,English
+"and the left side of the vestibular schwannoma. In here on, we can see a little meningioma. Here is another meningioma.",English
+Those are the two vestibular schwannomas and you're probably a glomus jugulare tumor. Here's another folks with NF2 with some other meningiomas here.,English
+We call those convexity meningiomas. Then we have ependymomas in the spines. So those are sort of classic tumors in NF2.,English
+"Meningiomas are the second most commonly identified lesion in NF2. There are also benign or slow growing tumors,",English
+and about the half of folks who have NF2 also have a meningioma somewhere along what we call the neutral axis.,English
+This picture here is a one that's what we call a petroclival meningioma. It's a pulmonary artery and a posterior to be sometimes see.,English
+"But meningiomas can be a little more difficult to manage, can be a little more difficult problem for us in terms of surgery.",English
+"It really depends on their location and how we address these. And they're also atypical meningioma, which can sometimes act more like more aggressive tumors,",English
+"sometimes even more of a cancerous kind. Vestibular schwannoma it's the most common one, it's benign. It may actually in NF2...",English
+"Folks who have NF2 we may deal with more than one in one internal canal. So in this area, you can have a schwannoma",English
+"from the classically it was single nervous, it's a balance nervous sometimes, we can have schwannomas from the two balance nerves, or to the balance nerve,",English
+"and then there's the acoustic nerve, or the hearing nerve as well as the facial nerve. So it's really, you know, difficult to ascertain exactly",English
+which cranial nerves they arise from. In sporadic tumors are definitely a little different than NF2 genetic tumors,English
+"in terms of their firmness and their aggressiveness. So, that certainly is something considered that sporadic tumors behave often very differently",English
+"from NF2 tumors. Hearing loss, as you can imagine is the main concern with vestibular schwannomas",English
+"balance problems are part of that as well and vertigo. When tumors are larger, they can push against the fifth cranial nerve,",English
+"we call that the chewing nerve, it can cause some facial sensation, right. And ultimately, with facial weakness, those would be for very, very large tumors",English
+"or multiple tumors. Interestingly, the facial nerve can also have a schwannoma. Obviously, their concerns with very large tumors,",English
+"they can be a threat to life. So tumor this size, obviously, would have blocked the outflow of cerebrospinal fluid from the brain basically and causing hydrocephalus.",English
+"So those will be instances where we would have to act more quickly. Most commonly, and by far more common is that",English
+"this is a quality of life, kind of a situation where we want to preserve function, rather than emergency surgery.",English
+"Again, vestibular schwannomas is about 90 to 95% of bilaterally in the folks who have NF2 and this substantial variability and how this present.",English
+"Most commonly, however, and that's why neurotologists are so critical at the center of this, many times vestibular schwannomas",English
+"are either the first tumor, but oftentimes they're really the most significant medical issue that folks are present with.",English
+"In management of these vestibular schwannomas we have multiple tools available. In general we can observe, which is I would argue most common in NF2,",English
+"we can operate, we can take these out and we can radiate them, right. And what we'd like to talk about today is you know,",English
+"some of those clinical trials, where we actually try to stop growth via again, a non surgical non radiation approach.",English
+"Just a few words to each of these approaches. Observation again, most common in patients with NF2, many tumors show no growth up to a certain degree.",English
+"However, true growth patterns are often hard to, you know, exactly delineate given that we're looking at two dimensional MRIs,",English
+"and not a three dimensional, you know, nature of the tumor. It's really hard to assess that sometimes. Sometimes it's very clear.",English
+Sometimes it's a little hard and usually you need a few MRIs over time to really get a sense of this. Surgery: multiple approaches.,English
+"Someone who's allows to preserve hearing so with very lot of small tumors, one approach is really to go in and take the tumor out",English
+or at least to debulk the tumor and not take hearing away. There's middle fossa approaches a classic one.,English
+So that's certainly one way to do this. Radiation is the goals or the staff tumor growth. We don't like to radiate tumors,English
+"where we don't have a documented growth. I would add here for NF2 We really don't like to use radiation,",English
+"simply because folks would benefit to have a tumor suppressor gene issue, and we don't like to radiate a genetically altered tumor.",English
+"So it's a little... It's a very controversial, not just a little controversial, I would say. But really, overall, we'd like to, if possible,",English
+"not radiate folks with NF2. And then hearing rehabilitation with either, of course, trying to save hearing as much as possible as long as possible really.",English
+"And then either cochlear implants or brainstem implant or preferencial implants, since brainstern implants, as many of you know,",English
+"do not work as well as cochlear implants, but sometimes it's the only option we have available. And multidisciplinary team and according approach according,",English
+"you know, approach is very important, including a neurotologist and neurosurgeon neuro-oncologist, ophthalmology, maybe a radiation oncologist again,",English
+"that's controversial geneticist, and of course audiology to really cater to to hearing needs,",English
+"of affected individuals. And treatment priorities are really, we wanna make sure you know,",English
+"obviously, if there's a life threatening issue such as hydrocephalus, really fluid buildup in the brain and those kind of things that we address these properly",English
+"to get with neurosurgeon, but overall CNS function is really critical. And then facial nerve.",English
+"Yeah, unfortunately, it's common that the facial nerve cannot be preserved. But it's really a priority to preserve the facial nerve",English
+"Hearing, and I will sometimes argue that hearing in NF2 is almost almost above the facial nerve. It's really a priority for us to hearing",English
+"for the longest period of time. Balance usually falls by the wayside, and a lot of affected folks have a real balance problem. In addition, there are some spinal tumors",English
+"that certainly do not help. General health, mental health, those are all priorities, I would say in folks with NF2. I think the next topic or next sections",English
+"is drug based treatment and I'll pass this on to Dr. Varun Varadarajan. Again, thank you so much for joining us today. I hope everyone's doing well,",English
+"obviously, different times and especially at different times. If you're chronic patient, you have to come in",English
+into the hospital. So we appreciate you joining us this way. And I'd be happy to take any questions. I'm sure Dr. Varun Varadarajan will at the end of this talk.,English
+"And I hope you have a good meeting. - Hello, everyone, my name is Varun Varadarajan and I'm the neurotology and skull base surgery fellow",English
+at The Ohio State University and Nationwide Children's. I work very closely with Dr. Adanka and I wanted to thank you all,English
+for allowing me to join you today. Very excited to share with you what we learned so far about drug based treatments for neurofibromatosis type 2.,English
+"Now, drug based treatments, also known as biologic therapy for neurofibromatosis. They're an ongoing area of study in clinical trials.",English
+There are many potential mechanisms or targets for these biologic treatments. And no drug has been shown to be 100% effective just because a patient or a trial has shown that,English
+"there are very good outcomes, they may not be right for you, and they may not be right for every patient. Several drugs are in various stages of clinical trials",English
+"of tumor suppression and the inhibition of a tumors growth. Now I wanna share a number of these drugs for you and if it's an active ongoing trial,",English
+"I will provide the ClinicalTrials.gov identifier number or the NCT number on the trial. And if after this presentation,",English
+"you wanna reach out to us and find out what a particular NCT number was, we're happy to share that information with you so you can learn more about it.",English
+"Here I've summarized the timeline for drug development, and this is a good overview so you can understand the different phases of drug development.",English
+"And many of these trials are in phase two, which means that the researchers are trying to assess the efficacy of a certain drug.",English
+"Now before a drug even gets to that stage, and this is not only true for drugs, is for any new medical treatments, but it starts off with preclinical or animal testing,",English
+"in which the efficacy, the toxicity and the earliest signs of safety that we can gauge from a drug are investigated.",English
+Then it proceeds to clinical testing. Phase one of clinical testing primarily looks at the safety in both the pharmacokinetics and pharmacodynamics.,English
+"Now, pharmacokinetics are another term for describing what your body does to metabolize the drug, how quickly the drug is metabolized in the body,",English
+"or in short, what the body does to the drug. Pharmacodynamics or what the drug does to the body, it just sort of really sort of tells you",English
+"the interaction between your body and its metabolism and the drug under investigation. Then once phase one is completed,",English
+"it oftentimes takes one to two years, the average duration for many studies, it goes on to phase two. And phase two studies",English
+"are investigating the signs of efficacy. Once phase two studies are completed, the studies move on to phase three clinical trials.",English
+"Phase three trials compare the effectiveness of a new agent to the standard treatment that's in existence. And once phase three trials are complete,",English
+"the FDA reviews the data and determines if the drug is going to be released to the public. Like I mentioned before, there are many potential mechanisms",English
+"or sites of action for biologic medications. Now this is a very complicated flowchart that I'm not gonna go into detail,",English
+"but it sort of summarizes a handful of cellular mechanisms for growth and proliferation of cells. Now as you heard about,",English
+Merlin is a protein or molecule that is transcribed by the NF2 gene and inactivation results in abnormal cellular mechanisms,English
+"that result in cell proliferation and tumor growth. Now, many of the medications that are under investigation like I've listed here,",English
+"can target various different cellular mechanisms and enzymes that can inhibit tumor growth, and ultimately stop growth",English
+"or even potentially even shrink the tumor. Now, these are some of the drugs that I'll be discussing today. But I sort of wanted to show you how",English
+there are many potential sites of action that are under investigation. And researchers are currently even discovering more potential signs of activation.,English
+"Today, we're gonna discuss the following medications. And I'm not gonna go into too much detail, I just want you to be aware of some of the trials that are currently underway.",English
+"And like I said, I'll provide the NCT number and at the end, I will provide some links as well for you to learn more about these trials if you're interested in learning more.",English
+"Now, some of these are completed trials and some of these are active trials that are recruiting. And I'll mention that",English
+"if there is an active and recruiting trial, that it's something that you'd be able to look into to see if you would potentially be a candidate for the study.",English
+I also at the end will list a few medications that were considered to have poor responses and have that in a separate side for under poor response trials.,English
+"The first medication I'll discuss is Bevacizumab or Avastin. Avastin is an anti-VEGF monoclonal antibodies. And VEGF is vascular endothelial growth factor,",English
+is another cellular mechanism or molecule that helps angiogenesis or the growth of new blood vessels for a tumor.,English
+"And now, this antibody helps prevent the blood vessel growth, ultimately to stop the tumor from getting a blood supply.",English
+"Its administration is an IV or a port. And there have been a couple of phase two trials that are completed. And actually, one of the bigger trials",English
+showed a 41% hearing improvement in adults with similar schwannomas and a 23% tumor response as well. Another trial showed a similar rate of hearing improvement,English
+"and a 43% tumor response on imaging. That being said, Bevacizumab, or Avastin, its efficacy has been shown for schwannomas only,",English
+"and there are risks to this medication as well as every biologic that we'll be discussing today. But some of the well known risks are high blood pressure, kidney failure, severe bleeding, nausea, fatigue, headaches,",English
+"skin rash, and especially impaired wound healing. And the reason this is relevant is because a lot of patients who are candidates",English
+for Bevacizumab or enroll in a clinical trial may be considering surgery for their vestibular schwannoma at some point.,English
+"But that being said, you need to talk to your physician to see when you stop your Avastin or your Bevacizumab before undergoing surgery,",English
+"and when you can restart your medication as well after surgery is complete. Avastin is approved treatment in some countries, although currently it's not approved by the FDA",English
+for vestibular schwannoma treatment. The next medication I'll discuss is Axitinib. This is a VEGFR receptor and TKI inhibitor.,English
+"And this is a similar target mechanism as Avastin and follow the same vascular growth pathway. It's a pill actually, it's an oral medication.",English
+"And there's an active trial at NYU, phase two trial, that they're not currently recruiting. In the study will test Axitinib,",English
+"it will shrink vestibular schwannomas. And if this proves to be promising, then oral administration could actually be more practical than Bevacizumab, which is like I said, is an IV medication.",English
+Axitinib is also been described for both breast and kidney cancer. The next medication I'll discuss is Selumetinib or AZD6244. And this targets the MAP kinase pathway,English
+or it's a MEK inhibitor. This is also an oral medication and there is a phase two trial that's currently recruiting at Cincinnati Children's,English
+"that's not too far from us. This study will test whether or not Selumetinib will affect NF2 tumors. And this includes schwannomas, meningiomas,",English
+"ependymomas, or gliomas and they'll typically pick a target tumor and see its response on the tumor growth. They'll also record things like hearing daily activities",English
+"and the overall physical and emotional health of the patient. The next medication is Icotinib. And this is an EGFR receptor,",English
+"epidermal growth factor receptor inhibitor. The administration is oral, is also a pill. There's actually a phase two trial in China",English
+"that's examining or investigating this drug, in Beijing. Now, unfortunately, the status is unknown about this trial but it is listed in the ClinicalTrials.gov website",English
+"This study will evaluate tumor volume for NF2 related tumors, hearing ability as well as quality of life. The next medication I have listed here is Lapatinib.",English
+"And this is an EGFR or RrbB2 inhibitor. This targets the RTK pathway. And I know, I'm gonna be mentioning",English
+these pathways and mechanisms. But this is more so for your reference. And you don't really necessarily need to understand the exact cellular mechanism,English
+"of what how these medications work. But this is also a pill. And there was a phase two trial that was recently completed, and also at NYU.",English
+"And this trial showed a 31% hearing improvement and a 24% target tumor response. Major side effects are actually uncommon, but some common side effects are memory loss, acne,",English
+"light sensitivity, as well as liver damage. And actually the medication has been approved for breast cancer. And so hopefully, there'll be more information",English
+coming on this medication. The next medication that I'm gonna discuss here is something that we're all very excited about. This is called Brigatinib.,English
+And this is an ALK inhibitor. It is a pill. And there's a big multicenter phase two trial underway. The main sponsor is Massachusetts General Hospital,English
+and it's active and recruiting. It's also known as the INTUITT-NF2 trial. And this stands for innovative trial for understanding the impact of targeted therapies in NF2.,English
+Most trials are investigating a drugs effect on a target tumor. This trial is unique that it monitors all NF2 tumor types.,English
+"the Children's Tumor Foundation, the Synodos for NF2 effort to thank for this trial. The next medication is AR-42.",English
+This is a histone deacetylase inhibitor. This is an oral medication. A phase one trial has been completed. And this was the first human trial for this medication,English
+and it targets NF2 tumors. Thus far has been very well tolerated. The drug does reach the patient's schwannomas and the preliminary results show that,English
+there is some anti-tumor activity with AR-42. The next medication I'll discuss is AZD2014 or Vistusertib. This is an mTOR pathway inhibitor.,English
+This is also a pill and it's in a phase two trial currently which is active but not recruiting. The results of this trial are pending.,English
+The sponsor for the trial is Mass. General Hospital. And this medication is also being started to determine if the drug will shrink,English
+"or slow the growth of recurrent meningiomas in non NF2 patients. So we look forward to the results of this trial. The next trial actually takes a look at FAK inhibitor,",English
+that's the GSK medication and Hh inhibitor which is a Vismodegib. It is an oral medication. Both of them are oral medications,English
+and a phase two trial have essentially been suspended. The sponsor was the Alliance for Clinical Trials in Oncology.,English
+Intention was to study NF2 patients with growing meningioma. There are also several medications that were considered to have poor responses.,English
+"That includes; Erlotinib: This is an EGFR inhibitor, and it's been shown to be not effective for hearing or tumor response in patients with fast growing tumors.",English
+RAD001-Everolimus: Has also been shown to be not effective. Nilotinib: That trial ended as it resulted in death. But there's also a couple several other medications,English
+including Dasatinib and Aspirin that have shown to have a poor response. The future directions are actually very exciting and gene therapy has promised as far as treatment for NF2,English
+"and several other medical conditions. Gene therapy refers to the introduction of DNA into a patient to treat a genetic disease. It may replace a mutated gene,",English
+"it may inactivate a mutated gene or it can modify an existing mutated gene as well. The NF2 gene is relatively small,",English
+which actually makes it feasible to be carried by a viral vector. That puts NF2 patients as a great population that may be benefited by gene therapy in the future.,English
+And there's more information about this @nf2biosolutions.org website That website actually summarizes four laboratories that are working on gene therapy.,English
+"And one of these laboratories is actually Dr. Meyer's lab right at Nationwide Children's, down the street from us. The Meyer labs actually investigating NF2 gene therapy",English
+to be able to insert the functioning and NF2 gene into mutant cells to be able to halt tumor growth. I have listed here several other websites,English
+"that may be beneficial to you. The clinicaltrials.gov website, obviously, you can learn about any of these trials, the nf2is.org, this is a great website",English
+"for NF2 information and services. Obviously, the Children'sTumorFoundation.org Thank you so much for hosting us, today.",English
+"The advocurenf2 website actually has information on clinical trials as well. And lastly, centerwatch.com has true clinical trial information",English
+"listed on their website as well. If you're interested in a clinical trial, make sure you speak to your clinician about enrollment. And they can use any of these resources",English
+"Feel free to reach out with any other questions as well. - Wonderful, thank you so much to both Dr. V, and Dr. Adanka.",English
+We're now gonna move on to one more presentation before we have our first live Q&A session. And This presentation is brought to you,English
+"by Dr. Long-Sheng Chang, who is a renowned expert in the field of NF2. So I'm looking forward to this.",English
+"- Hi, my name is Long-Sheng Chang. I am an investigator at Nationwide Children's Hospital and The Ohio State University.",English
+"represents a multi institutional colaboration, consisting of investigators from eight academic institutions around the world.",English
+"The NIH, NCATSA and Sage Bionetworks. Along the width, the patient representative Tracy and Salvo from the CTF.",English
+The team utilized a systems biology approach to identify the effective drug for photo clinical development.,English
+"In another word, we use the matched NF2 expressing and NF2 deficient cells to identify drug or drug combinations",English
+"screen a libraries of about 2000 compound which consists of drugs, now that either FDA approved or are active preclinical and clinical developments.",English
+Drug and the drug combinations that are potently inhibiting NF2 deficient cells was selected for further animal evaluations.,English
+and anaplastic lymphoma kinase inhibitors appear to be effective in both meningioma and schwannoma cell models.,English
+"In addition, ALK-IN-1 in combination with the AKT inhibitor and MK-2206 showed us synergistic inefficient in meningioma. And simmilarly, ALK-IN-1",English
+"in combination with the tyrosine kinase inhibitor certainy also showed a kurose synergistic course inhibition, in schwannoma cell models.",English
+"At the time of the discoveries, Ariad Pharmaceutical which developed ALH-IN-1 have developed a second generation inhibitor",English
+"called Brigatinib, with much better drug like properties. Therefore, the team decided to further evaluate Brigatinib instead of ALK-IN-1.",English
+"To determine whether Brigatinib is as effective as ALK-IN-1, the MTH team, led by Vijaya, showed that, indeed, Brigatinib potently inhibit meningioma growths.",English
+also founded that Brigatinib effectively inhibited schwannoma cell growth and it can synergize with Dasatinib,English
+"for close enough patience. Using an orthotopic NF2 division meningioma model, we showed that Brigatinib can cause tumor shrinkage",English
+"as compared to the core treated control which steadily grows over time. In addition, combination of Brigatinib",English
+"with the AKP inhibitor MK-2206, a larger tumor shrinkage and faster tumor shrinkage was also observed.",English
+As NF2 patient may require a long term treatment and may need to take a break from treatment due to side effects.,English
+"We showed out meningioma will regrowth upon cessation of Brigatinib treatment. However, retreatment with Brigatinib",English
+can further shrink tumors. This result suggests that a patient may be able to take a drug holiday,English
+if it is needed during Brigatinib treatment. The Indiana team led by Dr. Clapp also showed that Brigatinib inhibit schwannoma growth.,English
+"As shown in here Brigatinib treated a tumor is smaller, and it can improve the hearings in genetic engineering and a tumor models.",English
+"Following our findings, Brigatinib received FDA approval for a treatment of ALK+ lung cancers, and the drug brand name is ALUNBRIG.",English
+"In conclusion, Brigatinib had high potent anti tumor activity in NF2 deficient tumors. Based on these findings, CTF have collaborated",English
+"with the drugmaker Takeda, which now own Aria Pharmaceuticals. Initiate a multicenter clinical trial called INTUITT-NF2",English
+"which you have just heard from the previous speakers. And it's trial is led by Dr. Plotkin, at MGH. I would like to point it out that Brigatinib",English
+"is not the only potent drug or any tool that does you know, for an adult to discover. The tour top one two inhibitor, called INK 138,",English
+"shown in the middle panel here, also appear to be effective in suppressing meningioma growth compared to veto treaty control. In additions",English
+"among the top compounds or compound combinations identified from the library screening, there are several other potent inhibitors",English
+"that need to be fully investigated. These include histone deacetylase inhibitor, proteasome inhibitor, kinase inhibitors,",English
+"tubulin inhibitors and topoisomerase inhibitors. In addition, we have identified two natural compounds, not potently inhibit both NF1 and NF2 tumor grows.",English
+"So, it is anticipated that more effective drug will be discovered in the future. So please stay tuned and never give up.",English
+"So I would like to thank the Children's Tumor Foundation, the Galloway Families, and the US Department Defense for supporting our research.",English
+"Thank you very much. - Excellent, thank you so much to all of our presenters this evening.",English
+So I've been watching the chat box and trying to sort of keep up with some of the really great questions that we're seeing. Before we start in with that,English
+"I do wanna encourage, if director of our presenters who are here with us this evening, if you can turn on your video and unmute yourselves, I will present some of the questions I've been asked",English
+and feel free to answer whichever ones are relevant to your work and that you want to jump in on. And I just wanna encourage everyone,English
+"that if there are questions that we do not have time to respond to tonight, do not worry. We keep an eye on all those questions, we record them,",English
+and we're happy to reach out to you afterwards. I'll also include my contact information in there so that you can get a hold of me following our presentations tonight.,English
+"Okay, so the first question I'm gonna ask came into chat and said, Has there been any research looking specifically",English
+"at the impact of some of these drugs such as Brigatinib on vestibular schwannomas that have already been treated with radiation, particularly if growth has actually been stopped",English
+or inhibited as a result of radiation? Or are these clinical trials are people considered ineligible if they've previously had radiation treatment?,English
+"- So, yeah, generally speaking, you wouldn't be considered eligible if you have a stable tumor that's not growing, right. The only exception maybe",English
+"if there's progressive hearing deterioration over the course of time, that would maybe be an exception to that rule.",English
+"But generally speaking, these trials are for growing tumors in specifically to stop growth. - Yes, thank you, Dr. Adanka.",English
+"Another question coming from chat tonight was How exactly are... Well, maybe not exactly,",English
+"but how are drugs chosen to move into that human clinical trial phase? Maybe an example of kind of how we've done that in the past, but seems like there are so many options,",English
+and so many things that have been tried. So maybe just for the the non medical non research person to help understand how that process works?,English
+"- I guess that's a great question for launching. I mean, he's been at the forefront of this Long-Chang, Do you want to tackle this one? - Hey, yeah, try to give two cents kind of comments there.",English
+"Basically... Usually, we want to make sure first is that a drug is safe, and short efficacy there. So that's why we've gone through",English
+"multiple different kind of models. And so even even in cell cultures, we do even patient tumor cells, as well as some some available cell line",English
+"or genetic engineer the cell nine, and then we move into the animal, it's really efficacious. And sending anymore, we want to make sure, again,",English
+"animals were tolerated. And sometimes we even do the so called toxicity study. So wanna make sure that in animals,",English
+"we do not see any organ toxicity. And then, of course, most importantly, is also showing that it would be able to shrink tumor",English
+"or pure tumor cells. And then from there, you know, sometimes if it's more serious conditions,",English
+"we may even take it to a larger animal. So for example, we might even do a dog test or monkey test before we move into humans.",English
+"And so with all our old thing there, then, everything is done well and then drug, is potent.",English
+"And then we went more into the clinical trials. - Excellent, thank you. - Quite a complex process.",English
+"You know, and some of us have seen this now with, of course, what's in the news, the COVID vaccine, it's not a simple process,",English
+"even for the accelerated one that's going on right now. And we're all observing. So, Long-Chang has been really at at the front of this.",English
+So we rely on people like him. - Absolutely. Thank you. And it's definitely an effort of teamwork.,English
+"Absolutely. Okay, so in the interest of time... - This is also why those take, you know, a few years to develop for the whole process,",English
+"and get through these stages. - Yeah, absolutely. Thank you so much to both of you. So we're gonna move to our next presentation,",English
+"keep the questions coming into chat. Our presenters will stay with us tonight, and we will have one more Q&A towards the end. Okay, so next, we're going to hear from Dr. Marco Giovannini",English
+"Unfortunately, he's not able to join us live tonight. But please feel free to continue to ask questions and chat related to the presentation you're about to see, because we do have some other experts here tonight",English
+"who may be able to speak to some of those questions. So I'm looking forward to hear what he has to say he's going to be talking to us tonight specifically about gene therapy,",English
+"which I've already seen questions about. So let's get started. - Good evening, everybody.",English
+"I am Marco Giovannini, Faculty in the Department of Head and Neck Surgery at UCLA and Co-Director of the UCLA Multidisciplinary",English
+Neurofibromatosis Clinic. I will give you a short introduction on the potential of gene replacement therapy,English
+"for neurofibromatosis type two. What are the challenges to therapeutic intervention in NF2, in general?",English
+"First of all, the benign nature of the tumors precludes the use of strategies that target rapidly dividing metabolically active cells",English
+such as those of malignant tumors cancers. Next is the reduced therapeutic window for treatment that is benign tumors provide.,English
+And then the question of exploiting unique features of NF2 tumor cells to target the root consequences of NF2 protein loss.,English
+"Very important question before we even think of gene replacement therapy as an option is, what NF2 three expression.",English
+"Even he successfully delivered stock of reverse tumor growth. In order to do so,",English
+"we need to identify tumor specific therapeutic targets, strategies for delivering therapeutics and validate NF2 gene replacement",English
+as a viable therapeutic strategy. If you look at similar situation where inactivation of a tumor suppressor gene,English
+"is the initiating the cause of the the band in tumorigenesis, we immediately see when we do a bibliography",English
+search is that there are very few examples of gene placement strategies in conditions similar to NF1,English
+and NF2 what kind of matters is So one is the approach of restoring E53 function in tumors. And the idea was the proof of concept,English
+that was provided by the lab of Tyler Jack's in Boston. They show that that restoration of PTT free function,English
+"in mice leads to tumor regression in vivo. And there are a few, a couple of therapeutic approved cheers ongoing",English
+"but there is very little information out there about both of them. The first one is from China, Jellison",English
+which consists on intratumoral injection of a adenoviral vector expressing the p53 gene. It has been cleared by China FDA 2003,English
+"for head and neck squamous cell carcinoma suggesting positive results and safety. Since then, it has been tested",English
+"in a number of clinical trials for other cancers. However, no information is available about the submission of clinical data",English
+for approval from the US FDA. They other one is a similar adenoviral P53 factor for this time systemic intravenous delivery.,English
+"And again, no FDA approval yet. So in summary, adenoviral P53 gene therapy seems to be well tolerated and feasible",English
+"with promising anti tumor effects in some cases in some tumor types. However, the overall clinical efficacy is not conclusive,",English
+"and no FDA approval yet. Another example is re expression of the TSC-1, the tuberous sclerosis gene",English
+in a genetically engineered mouse model. This was done by the group of Sandra Brickfield at MGH. And what was interesting here is that they showed that,English
+"again, adenovirus vector expressing the TSC1 gene was able to increase survival time of mice,",English
+of tuber sclerosis mice by at least three to 13 fold and the increase in survival was accompanied by normalization of sizes of ventricle,English
+"and neuron cell bodies in the brain, which are hallmarks of the disease. And overall these was well tolerated. So what are the challenges",English
+"for gene replacement therapy for NF2? First is the vector selector using a viral such as the EED. But if that's the case,",English
+which satified would be most efficacious in targeting schwann cells and recognize cells that are the cells of origins of genomes and meningioma. The other vector selection option could be non vital,English
+for example exploiting characteristic of NF2 deficient cells such as micro pinocytosis proficiency,English
+as suggested by Andy McClatchy lab. The other question... The other challenge is optimizing,English
+"transduction efficiency and selectivity for example, intratumor delivery versus systemic delivery, intravenous or interest CSF cerebral spinal fluid,",English
+and what are the NF2 expression level and expression pattern of mosaicism that are necessary or sufficient for efficacy.,English
+"Another challenge is of course, what is the face safety of acute reexpression of NF2 of course, if we inject",English
+"back to a minor factor for example, expressing NF2 would this sudden re-expression have some deleterious effect.",English
+"So, we need to test all of these variables before we can even think of adopting the strategy in be more patient.",English
+"So, our take on this... Our idea was to genetically evaluate NF2 genome replacement as a therapeutic strategy in vivo",English
+by generating a new strain of mice that in which NF2 re expression can be induced by injection of adenoviral protein called Flpe.,English
+"So, injection of the either adenovirus expressing this protein in the NF2 deficient mice, which develop NF2 tumors would eventually shrink,",English
+"or at least stop the proliferation of those tumors. So, what we know so far is that at least in vitro, that trick seems to work",English
+"as in cells originated from those mice expression of the Flpe, efficiently results in a reexpression of Merlin",English
+and cells in which Merlin has been or DNA to protein has been re expressed as stop drying. These experiments experiment was performed,English
+in the lab of Andy McClatchy in Boston and she kindly allowed me to show this unpublished result. Next we are working on notice the best delivery route,English
+"of vital factors or micro therapeutics to NF2 tumors. Jeremy V in my lab, found that injection in the CSF",English
+"at the level of the cisterna magnet, which is just behind below the cerebellum, results in efficient diffusion of the viral solution",English
+"targeting at the skull base, meaning just some cranial nerves set up by loom in factory ball, and as well as along the spinal cord,",English
+"DRGs, dorsal, root ganglia and spinal rudan nerves which are often tumoral in NF2 patients. So in summary, we think our hypothesis is that viral",English
+and micro therapeutic delivery are viable options for NF2 gene replacement in an estimated tumors. And these approaches initiate a new pipeline,English
+for preclinical studies in NF2 schwannomatosis specifically using the new NF2 mouse model of trinoma and menengioma with the reversible aleo that we develop.,English
+"of course, advanced testing of these approaches for safety and efficacy we require scaling up in larger animal models,",English
+"such as pigs, before translating into clinical trials in people. I just want to mention my team, Dr. Jeremy Vitte,",English
+"our collaborator, longstanding collaborator, Dr. Andy McClatchy, Christine Sharon Mackenzie, Dr. Nanfu, the Co-Director of the UCLA NF clinic,",English
+Dr. Michel Kalamarides is in Paris for the meningioma model and our collaborators at other institutions.,English
+"Thank you, good night, and unfortunately, I will not be able to participate to the Q&A session because I'm in Europe.",English
+"So, the timezone does not allow me to be there with you. But please do not hesitate to email me if any question. Good night.",English
+"- Wonderful, thank you so much. I know he's not here, but I hope everybody really enjoyed that presentation. I'm really enjoying seeing all of you interact with each other in the chat as well.",English
+That's always been such a strength of this meeting is the time together. And just that the way that that benefits the whole NF2 community.,English
+"And so it's been really great to see that happening even virtually. So next we're going to hear from, Well, it's Dr. Savaltore,",English
+but if you work at CTF we know him fondly as Salvo. Salvo is gonna be speaking tonight with a few different people that I will let him introduce,English
+"and sort of explain. But following his presentation, and the discussions you're about to see, we will have one final Q&A session.",English
+"So please keep the questions coming in. And now I'll hand things over to Salvo. - Hi, I cannot switch on my camera.",English
+"So please control room if you can help me. In the meantime, I will start sharing my screen. Okay, I hope you can hear me.",English
+"- Yeah, we're hearing you just fine. Thank you. - Okay. Can you see my slides Kate? - Yes, yep, we can see everything. - Okay, so let me just switch this.",English
+"Okay, let's see my full presentation. Okay, so thank you for being here. And allow me to present today about the NF2 accelerator.",English
+"And I like a lot this picture about, this comic strip about the accelerator by Moxie and spark that explains to Maria, how the accelerator works.",English
+"Is really is about speed and accelerate site. So let's dive into it. First of all, as an outline of today,",English
+"I'll talk about briefly about investments in NF2 Schwannomasis that CTF has done in the past years, just to put this into perspective of where we are now.",English
+"And then I'll dive into the NF2 accelerator, special guests for the NF2 accelerator parties, Michael Wootton as CEO of NF2 therapeutics",English
+in charge of our gene therapy approach program for NF2. And they will join me with some comments explaining where we are with the study.,English
+"Then we'll talk about the nonprofit marketplace, a new business opportunity that CTF has put in place for companies to get new drugs into the clinic.",English
+"And then at the end, we'll have a special guest discussion with Eddie Garrett and John Morris to understand from them as patients and caregivers,",English
+"what they think about the NF2 accelerator. Why there are two accelerators of this program. Okay, so as a start, you saw from Annette earlier",English
+"that CTF business model is really about connecting, catalyzing and having patients at the center. But what I want to focus your attention is",English
+"that you know, in this bit of catalyzing and investing in NF2 schwannomasis, CTF has been very active with this two models, mainly.",English
+"The Discovery Fund, which is a fund that funds the best and boldest from bench to bedside. And it's very competitive grant program.",English
+"Is one of those that you know, they send us the application, we select the best and we fund it. And then the other one is a team science approach",English
+"with Synodos that we heard from Long-Sheng Chang about this Synodos NF2, where we actually build a preclinical pipeline",English
+"that allowed us to identify brigatinib, in Iran between 2014-2017. And now the synopsis for schwannomatosis",English
+"that analyzed largest number of tumors and is wrapping up right now with a publication that is coming up very soon,",English
+"has been already approved. But the most interesting part that I want to drive you on this slide is that since 2006,",English
+"which is you know, the last 15 years that CTF has been operating, 33% of CTF funds, this is the entire budget that every year",English
+we give to research or we allocate to research has been dedicated to NF2 schwannomatosis. So it's not that the incidence of NF2 schwannomatosis,English
+"is less important, is as important as NF1. And sometimes we find compelling studies that we fund just because the science is at the level",English
+that we're required for funding. So this huge investments of about 50 millions in the last 15 years,English
+"has really brought us the to the cusp of, you know, discovering and bringing the first drugs to patients. Okay, so now, the NF2 accelerator",English
+"is a program that basically was activated in 2019, after we completed the synodos NF2",English
+as the follow up study that we thought was most appropriate. Is basically formed in its part,English
+by three or four different parts. Is a 2.36 million investment program,English
+"to expand the drug pipeline and accelerate treatments. Is a three years undertaking. We're already halfway through,",English
+and the three or four parts are basically expanding the clinical drug pipeline for NF2. And I will show you two different modalities,English
+"that are connected, one and two. Then the second part that we thought was critical to include in the accelerator was improving drug selection,",English
+because sometimes we've been successful and we seen a very good results in mice and animal models but this didn't really translate into effective treatments,English
+in patients in clinical trials. And then the other part is the development of gene therapy option that address the underlying genetic cause of NF2.,English
+"And we'll hear from Michael there. So, first part is really the basket platform trial for NF2 and you heard already about into it",English
+in the list of clinical trials that are now ongoing. And the drug that is... The first drug that we have on this platform trial,English
+"is Brigatinib by Takeda. It's an ALK inhibitor, but the group believes and I saw a questions on the chat",English
+that is not by its main target out that this drug works. Because how it actually is not expressed in an NF2 cells. So it's one of the many off target effects,English
+that this drug has. So this is a multi kinase inhibitor and has a lot hundreds of targets that inhibits different potency.,English
+"So, themes already identified target and the publication is ongoing. But if you think about this, this drug and the Intuit platform.",English
+"Basically how this works is that you know, once you have patients that enter the trial, the trial monitors all of the different tumor types",English
+"that NF2 has. And depending on what tumor type best respond to the drug treatment, after another evaluation,",English
+"if there is a geographic response or stable disease patients stay on trial and you know, receive the drug treatment and keeps on being on the trial.",English
+"Or if there is progressive disease, meaning that the trial doesn't work is put off protocol in the natural history harm and actually is back to the allocations.",English
+So you may change the arm or may change drug. So the status of this Takeda Brigatinib trial is that of course the main PI is Dr. Plotkin,English
+at Massachusetts General. We have five participating sites and one site at MGH is already open,English
+"and six patients are already receiving the medication. Importantly, Takeda has a big role here, because the trial is co funded by the NF2 accelerator",English
+and CTF and Takeda pharmaceutical. Takeda is building a million dollar and CTF is pulling through the NF2 accelerator 300K.,English
+Now think about how this can really accelerate drug testing. And I would like to think about this trial. Because this is the real benefit of having a platform trial,English
+"is like you know, you can basically have this as a main socket, where you can like different drugs to the same to the same main protocol.",English
+"So if you think about the first drug Brigatinib, then you know, the second drug, third drug, fourth drugs, and fifth drug will come very easily.",English
+"So we don't have to basically use a different protocol, we use the same muster with cut bureaucracy of trial opening and all the amendments to add new drugs.",English
+"So that's basically the huge, huge speed up in this process, that we will be able to plug on this trial multiple drugs and have a very coherent way to evaluate drug response",English
+"and a phasing. So the end result is that in very short time, patients have access to multiple drugs and mechanism as this drug become available for NF2.",English
+And we are also actively talking to pharma and biotech to get their drug into its' platform. What is the second level of how we actually push those drugs,English
+into clinical trials. And the other way to do it is to really fund new ideas and new drugs testing for NF2 schwannomatosis.,English
+"I think I presented the first three awards that we funded through the NF2 accelerator to Vijaya Ramesh, looking for drug combinations",English
+"from synodos NF2, that were as potent as Brigatinib. And then, you know, new oligo antisense that were studied by Castellano in Barcelona,",English
+and Hippo-Yup/Taz inhibitors study by Chunling Yi. This is a very interesting mechanism for NF2. This themes are now wrapping up their results.,English
+"There's been some delays due to COVID. But we are close to you know, seeing the first outcome from this grant. But then we also found it recently a ways for instance,",English
+"at University of Plymouth, and Columbia University that are looking at more like basic science into the same Hippo pathway, looking at new inhibitor,",English
+"new way to interfere here, but also new substrate for instance, schwannomatosis that connected to all LZTR1.",English
+"And very recently, we assigned other grants to Jeremy Vitte at UCLA for micropinocytosis for therapeutic delivery to cells, and to Dr. Lei Xu at MGH",English
+"for the treatment or schwannomatosis associated pain. So far, the NF2 accelerator has funded 670 supporters for this grants for $678,000.",English
+"And we'll keep doing it. We'll keep assigning the best and brightest, promising scientists, more grants",English
+"that new options will become available soon. The third part of the NF2 accelerator, as I said before, is to have models for NF2",English
+"that will allow us to have better decision and broader accessibility. For this part, we are working with Marco Giovannini,",English
+"at UCLA, and Wade Clapp under the JWR company that is a nonprofit zero to look, first of all at NF2 minipigs model.",English
+And this study is basically monitoring if minipigs will develop the same feature as NF2 patients do so that we have close to human model,English
+"that will allow for better evaluation of drugs. But also with Wade Clapp, we are trying to create mouse models",English
+"that are accessible to everyone. Unfortunately, we've seen so many collaborations failing because companies they are not able to strike a deal",English
+within academic institutions and get access to their models and their research facilities. This has been for many years a problem,English
+"that either delays enormously or you know, completely, the deal is not happening. So we are now collaborating with Taconic",English
+"to create models that are no strings attached. And unfortunately, we had to start from scratches, create those models because there are IP",English
+"and there are you patents that institution that created this deal on. So in order to free them from everyone,",English
+"CTF will collaborate with Dr. Wade Clapp and make this available to any for profit, non for profit organization",English
+"that wants to test drugs for NF2. That will open a new stream of drugs available. And last but not least,",English
+"of course, we have our gene therapy for NF2. And I'm very glad we have Michael Wootten, CEO of NF2 Therapeutics with us.",English
+"And Michael, if you unmute yourself. - Yeah, I'm here. Glad to be here, Salvo. - Thank you so much, Michael.",English
+"And I actually put, you know, those bullet points that highlights where we are with the project. But I would like you to comment and update everybody",English
+on where we are first. But where are we heading? Right. Thank you. - Sure. Absolutely. Thank you Salvo.,English
+"And you know, first of all, I'd like to just say that we're very grateful for the support of the Children's Tumor Foundation.",English
+"They have provided support to NF2 therapeutics for a long period of time, and we've been sort of the best kept secret for some time,",English
+"but we've made great progress and, you know, in a very, sort of clear timeframe, with the support of the Children's Tumor Foundation,",English
+"we'll be able to achieve proof of concept in gene therapy or demonstrate that is not gonna be viable. We are obviously very, very optimistic.",English
+"And, you know, just a quick little bit about the company before I talk about where we are. So it was founded by myself, Dr. Scott Plotkin",English
+and Mark D'Souza. It's actually my second NF company. The three co founders also founded a company,English
+"called Inflection Therapeutics. And we have a topical mek inhibitor in clinical trials for cutaneous neurofibromas in NF1,",English
+"currently, so very, very excited about that. So, in NF2, we have developed a gene replacement therapy for NF2 and, you know, in Marco's talk,",English
+he talked about some of the the strategies for developing gene replacement therapy. Our approach is an adeno associated viral approach.,English
+"So unlike the COVID-19 virus, this is a good virus, this one's our friend, because it doesn't make humans that's not associated with disease in humans.",English
+And it is a very efficient way of delivering the gene to the cells that we're targeting. So instead of the gene,English
+"of a virus developing instructions to the cell to produce copies of itself, it's delivering our instructions",English
+"to produce a copy of the healthy Merlin protein. And so, we have developed the gene therapy, and we have recently completed a 28 day study",English
+"in non human primates. And so specifically sign a sign homologous mechanics, or the the species of monkey,",English
+"and there were six monkeys involved in that study. And essentially, what we're looking for from that study is one confirmation of delivery.",English
+"So confirmation that we see the trans gene in the cells of interest, and then also, safety. So we're looking at any potential signs of toxicity",English
+within the the monkey study. And the fact that it is a monkey study is very important. There is real challenge in the field of gene therapy,English
+"in translating data from cells, or even small mammals to what we see in humans. And so it's very important to work in a species",English
+"that is as close to humans as we can. It's also what the FDA expects, in terms of the data necessary to move into clinical trials.",English
+"So in the study that we've completed, in the in life portion of that study, measure an array of different characteristics,",English
+"including the behavior of the animals, the weight of the animals, a full sort of blood workup on the animals",English
+"at various points across the 28 days, as well as observations like skin color condition for fecal consistent discharge,",English
+"any other potential signal of toxicity from the study. And the great news is that after the 28 day study,",English
+"there were no significant signs of of toxicity, which is a great sort of data set from a safety perspective.",English
+"So we're very excited about that. And after that 28 day study, so on day 29, the monkeys are sacrificed.",English
+"And they're sacrificed so that we can do pathology on those monkeys and look at an array of tissues, specifically, schwann cells, arachnoid cells, upendo cells,",English
+"were some of the the tumors that NF patients experience occur. And there we're looking for delivery,",English
+"we're confirming, are we seeing delivery in those cells. And then we're also looking at a broad array of other cells, 14 different levels of the brain, other organ tissues,",English
+"and we're looking for safety. So we're looking for any evidence of toxicity, we're looking at glial cells in the brain",English
+"to see if there's any change in the shape of those cells, and a broad sort of cross section of cell types. And so we expect the the data from the pathology portion",English
+"of that safety study, as well as the data on bio distribution of the vector and expression of the trans gene, by the end of the year.",English
+"So we're very excited about that. And then beyond the non human primate study, we are also working on a mouse model of NF2.",English
+"So it's a knockout mouse model in the lab of Dr. Marco Giovannini. And so, we will essentially be able to see if,",English
+in Dr. Giovannini model we're seeing regression of schwannomas in NF2 and also differential growth rates between mice that had been treated with our gene therapy,English
+"what is the time that those will go into human? - So, the kind of 2022, 2023 timeframe is when an initial human trial could commence.",English
+"You know, we'll be driven by the data, obviously. And so, you know, these studies will kind of steer the course going forward.",English
+But we're optimistic and that's our goal is really to have a first trial by sort of late 2022 or 2023 timeframe.,English
+"- And last question, maybe what apart from of course, everything has to be according to plan, what is your number one warning of, you know,",English
+"problem that you see for getting there? Is it distribution? Is production? What is it? - Yeah, so I think it's really",English
+"the distribution question, you know, are we going to see expression of the trans gene in the targeted cells?",English
+"And so we're gonna have an answer to that pretty quickly, which is quite exciting. You know, we just heard about a study where",English
+reexpression of healthy Merlin can rescue the phenotype. And so we're excited to to see the result of that as well.,English
+"But it's the delivery question is the sort of key thing that's keeping us up at night. - Great. Thank you, Michael.",English
+"I think I fulfill quite a few people with that question, or asking about, you know, when we will see this gene therapy in humans.",English
+"Thank you so much, and stick with us, please, because there will may be some other questions at the end. I'll just keep going with the presentation. - Thank you.",English
+"- My next slide is about, very quickly because then I wanna talk to our patients and caregivers,",English
+"it's about, you know, putting things in perspective. And if you think this is a timeline of short term, midterm and long term, when I say NF2,",English
+"the NF2 accelerator is really a balanced portfolio. Think about time, this is time to bring treatments to patients.",English
+"So we talked about the INTUITT and NF2 platform trial. If you think about this trial, is already bringing drugs to (indistinct).",English
+So the first drug is already into the socket of this platform trial. And we are ready to plug as many as we can,English
+"into the same protocol. So this is a ready to go to be used, very short term project that will allow drugs that are ready to go into the clinic to move on.",English
+"And then we'll learn from, you know, from Michael, that the gene therapy for NF2 is really not far from there. And it's a big bet, because either we hit jackpot,",English
+"or you know, we fail. And unfortunately, if we fail, we need to go back to the drawing board. And that will require more time, of course,",English
+"to think about how we need to supply to that change, but things will move quickly. And we'll have an answer very quickly,",English
+"hopefully, you know, fingers across everybody here is, you know, is a fun of up NF2 therapeutics and gene therapy. So we want to basically this to succeed.",English
+"And then if you think about the medium term, how do you feel that gap, and what is the NF2 accelerator doing is investing in new ideas,",English
+"because today, we have a knowledge about what we can plug into that platform trial. But we don't know if there are new way",English
+to stop tumors to grow. And that's why we need to go back to basic biology. And we need to increase our funding,English
+and understanding of basic mechanism by which this tumors are proliferating and acting. So that's where our investments are so important.,English
+"And then, you know, plaque into this new animal models that we are trying to make available to everybody. And that will actually free a lot of momentum",English
+"for other companies to bring their own drugs and test them in relevant animal model, have a very quick decision",English
+"on is this drug making sense for NF2. It doesn't for schwannomatosis. It does, we don't know. But you will allow us in the short to medium term",English
+"to have a stream of drugs coming awfully coming from the industry. And this is powered by the nonprofit marketplace,",English
+a new business model that I talked to you before. And I want just to explain briefly. What we created is a marketplace partners,English
+"where, you know, three companies, the Children's Tumor Foundation, the Milken Institute, and Cure Search for Children's Cancer, they're putting together this marketplace",English
+"that you see here in the middle. So how this works is basically composed of experts in the field of drug development,",English
+"that is not per se only CTF or the Milken or Cure Search. But there are external people that have extensive experience in, you know,",English
+"bringing those assets to the clinic, where they're screening, they're identifying assets, they're externalizing, those assets and frameworks,",English
+"and they're making matchmaking to develop new partner. So how this works, basically, there is a partner that is far mined by the company",English
+that will bring their assets. So we're talking to them to free this assets built in the nonprofit marketplace. And then after an assessment of this drug into those models,English
+"that I was talking before in those neural results that I was talking before, we'll go back to the partners and create an accelerator",English
+"for those assets or create companies of those single assets, so that they will be able to develop this drug. The good news is that this models is quite interesting",English
+for investors as the first venture partners is already on board and Bridge Bio is willing to put their own investing money into this model,English
+sustaining the development of this drug and of course benefiting from you know the outcome and potential revenue that this drug will generate.,English
+"So there you have, thank you so much. I really appreciate the opportunity to talk but now we'd love to have Edith Garrett and Joe Morris",English
+"Okay, she will join I hope or you know Let me know if she's not with us. But John, thank you so much. I know you've been involved with us so long.",English
+"And you are in NF2 accelerator. So can you tell us why you got involved in this initiatives? - Sure, I can sound well, thanks for having me.",English
+"So I've been involved with CTF for probably approaching 10 years now, my youngest son was diagnosed with NF2",English
+"when he was 10 years old. And he's doing quite well. But as all of you know, it's a it's a lifelong situation.",English
+"And my wife and I decided that if there's a way we can help, this is where we were gonna put our time and money. And so we've done exactly that.",English
+"And I'm proud to be an NF2 accelerator and hope we can encourage a lot more people to do so as well. - So, tell us a little bit more about your role.",English
+"I mean, what do you do I mean, as an accelerator, as an NF2 accelerator. So we formed a committee with the help of our friends at CTF",English
+and along with my co lead RB Harrison. We are trying to do two things. We're trying to get the word out,English
+transmission outbreaks are something that we sort of used to see fairly commonly. Between 1957 and 2003,English
+when the last one of this was in Palm Beach County. We had about 63 outbreaks of malaria in the US but we've just not had an outbreak,English
+"of locally acquired transmission since 2003. So that we have now two; one in Texas,",English
+one in Florida with four cases that do not seem to be related is enough to get our attention.,English
+"Again, 20 years since the last outbreak and therefore, it's not terribly new. It's not all that threatening",English
+"to specialists and other mosquito-born diseases like chikungunya, dengue had cases in the southern states",English
+but they also did not establish prolonged outbreaks. Neither did these outbreaks that happened before 2003 in the US.,English
+"West Nile, however, which is now endemic here, also started as a local outbreak. And last year we had an outbreak",English
+"with several severe cases including a deadly case in Richland and Lexing of West Nile virus. So, you don't want these diseases to become entrenched",English
+"in your local mosquito population and this is why it's noteworthy and we need to react and everybody needs to, if they see a case,",English
+react appropriately so that it doesn't lead to a spread in our local mosquito population.,English
+One thing to say about this particular strain that we were told,English
+"is in all these five patients is called plasmodium vivax. That can cause severe disease, but it's not nearly as deadly",English
+"or threatening as other strains. If I see somebody with this particular malaria, I would expect that I can treat",English
+clearly nine or more out of 10 patients in the outpatient setting. We,English
+have good treatments for this. We should know how to diagnose that which is in this particular strain,English
+is actually more tricky than the treatment for it but,English
+it's certainly not as threatening as some other malaria types can be. Maybe I'll stop here and sort of,English
+"take questions, - [Rebecca] Sure. - for this. - [Rebecca] Let's see. WSPA has posted a question.",English
+"""What is it like as a physician to get an alert like this? What does it change for you?"" - Not much because we see returning travelers",English
+"and we do similar things with that. What we do, we go through our treatment algorithms. We let people know that",English
+"to include Florida and Texas and probably other southern states in our travel history,",English
+if we have a compatible disease. We make sure that we have enough tests on hand. There's rapid tests available now,English
+"in the last five years that are much easier than to have an experienced lab person, really. That we have enough malaria medicines stocked",English
+for severe cases. That we touch base in a large healthcare system like PRISMA Health.,English
+That we have all our ducks in a row in all of our hubs that we have and we go over,English
+"our algorithms and our treatment schemes. But for us, this would be nothing new.",English
+"It's just awareness is I think, what changes to us that, yes, after 20 years it's good to know",English
+that an outbreak is happening again and sort of brush up for all of my colleagues,English
+"in Texas and Florida are of the same strain and is the treatment adjusted to the particular strain, I suppose?",English
+"- Yes. The treatment for this particular strain is different than, for instance, the more deadly strain",English
+"because it, unlike the very deadly strain that lives mostly in red blood cells and infects a whole lot more,",English
+"this one, the tricky part of it is that it creates a latent dormitory in the liver of patients.",English
+"So you need, in order to eradicate that after you've treated the acute disease, you need other treatment to eradicate that.",English
+"Again, they're standard but it's a little different. You need to know what you're doing but I would expect every",English
+infectious disease and tropical medicine trained person to know this. We have current information,English
+that the strains that they found is plasmodium vivax and therefore we can adjust our thinking,English
+"and our diagnostic scheme and our treatment to that. We would make the diagnosis,",English
+"we would confirm that if we would see that here. But yes, that's what we've heard so far from the CDC",English
+"is relatively low. If they are severe enough to and you had an exposure history that makes some sense,",English
+"I would think. The fever has certain characteristics; every three to four days, depending on the species.",English
+These red cells that have these parasites fall apart and then you get a fever bounce. It's sort of a cyclical fever.,English
+Every three to four days you feel sicker and you develop a significant fever spike. If you don't have,English
+"significant muscle and pain and headaches and significant fever, set it out and think of",English
+"whether this is something else. This is typically not subtle. If you have no symptoms, please don't show up",English
+"So this one runs a little bit different. First of all, we know that we have these mosquitoes here",English
+"like essentially any state in the continental US has that. The last large scale assessment,",English
+we found that over 50% of our South Carolina counties here had malaria mosquitoes.,English
+"And I think actually we, it's fair to say that a hundred percent of counties in South Carolina should have these mosquitoes.",English
+"I know I have them in my backyard, including the ones that transmit this quite nicely. That means we have the mosquitoes that can carry this.",English
+"But we have, as far as we know, none that carry the malaria parasite currently, as far as we know.",English
+"So if you decide to avoid mosquitoes or treat mosquitoes in your backyard, it's not for malaria,",English
+it's for nuisance things and it's good thing to not have standing water and to chlorinate water,English
+"and those kind of things but you can't completely avoid mosquitoes. Right now, the specific, the particular strain",English
+"that we're worried about, it's different strains of Anopheles mosquitoes, they're called, are here but they don't do anything to you",English
+"other than annoy you and give you itchy bumps. So right now, you really don't have to do anything, even if you have a pregnant wife at home",English
+"or small children, unless you want to protect them from mosquitoes, per se. But you shouldn't do that for malaria.",English
+and you can do certain lemon aromas and otherwise they're just not effective enough.,English
+"If you really mean it, you have to use something that has a chemical in this which are known to be safe",English
+"but don't drink it. Don't put it in your eyes. Have a certain concentration of, for instance, DEET is the most common,",English
+"None of these mosquitoes can find humans because it's hotter outside than our body temperature is. So in the evening and in the early morning,",English
+"you need to protect yourself and everybody knows how to do that, either with spraying something on you",English
+"and wearing long sleeves and having, checking your",English
+"that the screens in your house are still functional. These particular mosquitoes do not dwell in houses as much as the ones,",English
+"for instance, that transmit West Nile. So it's not as much of a threat that this becomes an ongoing problem",English
+"- [Rebecca] Yeah, yeah. (laughs) The CDC warning also did mention that fully 95% of malaria infections are acquired in Africa.",English
+"So that goes to what you were saying that most cases are imported, so to speak. So is there anything,",English
+any other advice you would leave us with or any other thoughts you may have just about the CDC warning in general,English
+"and the warnings that the individual states are rolling out this week? - Yeah, I think that knowing the strain",English
+that this is not as threatening as it sounds initially and it's not as new to us.,English
+"right off the top of the warning. - No. And it's not unexpected for us to see these kind of things. People are traveling again,",English
+we're going to have more influx of people coming back from these countries where there's a lot more malaria. Covid has devastated,English
+"some healthcare systems, not only because every priority was Covid, they've neglected other diseases.",English
+"So we expect more of these things swapping back in. We had to worry about vaccinations, not about mosquito pools that much.",English
+"the medical team must decide if the sepsis evaluation is negative or positive. If it is positive, it must further",English
+"be determined if the infection is pneumonia, meningitis, or a urinary tract infection. Factors that support a negative sepsis evaluation",English
+"are one, limited perinatal risk factors for sepsis, and mild clinical course with the newborn asymptomatic at 48 hours,",English
+"and laboratory testing that does not indicate sepsis. This could include a total white cell count between 5,000 and 20,000, granulocytes less than 70%,",English
+"or negative CRP and blood culture. When a sepsis evaluation is determined to be negative, antibiotic therapy should be discontinued after 48 hours.",English
+"If there are additional concerns, observe the newborn for one to two days of antibiotics, and monitor for signs and symptoms",English
+of partially treated sepsis. Factors that support a positive sepsis evaluation are history for multiple perinatal risk,English
+"factors for sepsis, a clinical course that is more severe and still symptomatic at 48 hours, and laboratory testing plus or minus chest X-ray",English
+"supportive of sepsis, total white cell count of less than 5 or more than 20, granulocytes more than 70%,",English
+"And if response is poor after 48 hours, change gentamicin to third-generation cephalosporin, cefotaxime preferable or ceftriaxone.",English
+"If symptoms persist after one week, continue antibiotics for up to 14 days or until symptoms resolve.",English
+"If there's no improvement, consider bacterial process resistant to current antibiotics, and other diagnoses such as viral process, malaria,",English
+"tuberculosis, atypical pneumonia, like chlamydia, or congenital heart disease. Once a newborn has been diagnosed",English
+"with bacterial infection, it is critical to consider whether she has meningitis given the high risk of simulation from the blood through meninges.",English
+"Factors that are concerning for meningitis are a clinical course with systematic symptoms, such as poor perfusion, abnormal neurological exam,",English
+Antibiotic therapy should be 14 days for gram-positive organisms and 21 days for gram-negatives. Gram-negative coverage should be with a third generation,English
+"cephalosporin, ideally cefotaxime, and not gentamicin due to its poor CNS penetration. If a specific organism is identified,",English
+"look for abnormal vital signs, ill appearance after seven days, or a concerning urinalysis with high white blood count, positive leukocyte esterase, cloudy appearance,",English
+and positive nitrites. Treatment involves ampicillin and gentamicin for seven days. There are certain considerations to keep in mind,English
+when giving antibiotics. Antibiotics that cover gram-positive and negative organisms must first be given for the same duration,English
+to ensure adequate treatment unless a specific organism is identified. Ampicillin should be given by a slow intravenous push,English
+"over three to five minutes, followed by a saline flush to clear all the medication from the infusion line. Give gentamicin separately over 30 minutes by a syringe pump",English
+"or slow push, followed by a saline flush. This is important because if beta lactam therapy, such as ampicillin or cephalosporins",English
+"is given in the same syringe or immediately before or after aminoglycoside therapy, it may result in an activation of the aminoglycoside.",English
+This table reviews antibiotics and their dosing information. This table reviews the antibiotics,English
+that should be given for each condition. Both tables can be found in the neonatal protocol.,English
+"Some maternal infections can be transmitted perinatal if proper preventive measures are not in place. If the mother has HIV, it is important to note",English
+if the mother has been started on antiretroviral therapy and to start the newborn on nevirapine EMTCT protocol.,English
+"For mothers with syphilis, the infant is at risk if the mother was not treated or partially treated for the infection during her pregnancy.",English
+"Full maternal treatment is 2.4 million international units benzathine per week for three weeks, given more than 30 days prior to delivery.",English
+"Treat with one dose of 50,000 international units per kilogram of IMB benzathine-penicillin if the mother had no or inadequate treatment",English
+"and the baby appears well. Treat with 50,000 international units per kilogram per dose IV penicillin G twice a day for 10",English
+"days if clinical signs of syphilis are present in the newborn. These signs might include bullous rashes, anemia, hepatosplenomegaly,",English
+"pseudo-paralysis of a limb, coryza, and jaundice. If the mother is hepatitis B surface antigen positive, give the hepatitis B vaccine and anti-hepatitis immunoglobulin,",English
+"200 international units, if available within 12 hours of delivery. If signs of maternal and/or newborn TB are present,",English
+"refer to national protocol for treatment details. Newborns may develop minor skin infections, such as pustules and vesicles.",English
+"Lesions should be cleaned with an antiseptic and, if closed, kept clean and monitored. If open, apply topical antibiotic ointment.",English
+"If a newborn has many pustules and no danger signs, start cloxacillin, 25 milligrams per kilogram per dose, twice a day, orally, for five days.",English
+"If pustules are very large and/or numerous with danger signs, hospitalize the newborn and treat with antibiotics against staphylococcus",English
+"aureus, vancomycin, or cloxacillin. If vesicles are present, consider a diagnosis of herpes simplex virus,",English
+and treat with acyclovir. Case studies. We will now practice with a case study,English
+"of Emmanuel, a full term baby boy who is now eight hours old. He was just transferred to a neonatal ward from maternity.",English
+"His mother had rupture of membranes for 24 hours prior to delivery. And he presents with respiratory distress, poor perfusion,",English
+"and a capillary refill time of four seconds. The fontanelle is flat, and the baby is not irritable. What laboratory evaluation would do you request?",English
+"You'd request a full blood count and CRP. The results come back white cell count, 22,000, granulocytes 82%, and CRP is positive.",English
+What's your diagnosis and treatment plan? Which antibiotics would you prescribe? At what dose? For how long?,English
+You diagnose Emmanuel with presumed sepsis or pneumonia and prescribe ampicillin and gentamicin. Ampicillin should be given at a dose of 50 milligrams per kg,English
+per dose every 12 hours. Gentamicin should be given at the dose of 5 milligram per kg per dose IV every 24 hours.,English
+"These antibiotics should be given for one week. And if symptoms persist, extend treatment and consider other diagnoses.",English
+"You should consider meningitis in all cases of sepsis, but in this case, rule it out due to lack of meningitic signs and the presence of localizing respiratory symptoms.",English
+"Alice is the subject of our next case study. She was born full term, and her mother had intrapartum fever at 39 degrees Celsius,",English
+and a rupture of membrane for 36 hours prior to delivery. Alice has been admitted to the neonatal unit and started on ampicillin and gentamicin.,English
+"She's now two days old. On her physical examination, you observe a full fontanelle and notable lethargy.",English
+What is your presumed diagnosis? What will you do for evaluation and treatment? You diagnose Alice with probable meningitis.,English
+"You perform a lumbar puncture and send CSF for a cell count, glucose and protein, gram stain. To treat Alice, you continue ampicillin,",English
+and you increase the dose to 150 milligrams per kg. Change gentamicin to cefotaxime or ceftriaxone.,English
+"The CSF results show 97 white cell blood count, 4 red blood cells, glucose 12 milligrams per deciliter, protein",English
+76 milligrams per deciliter. Gram stain shows gram-positive cocci in chains. What course of antibiotics is appropriate?,English
+"Treatment for gram-positive meningitis should continue for 14 days. If the gram stain showed gram-negative bacteria,",English
+"the treatment should be extended to 21 days. If a specific organism is identified, tailor the antibiotic coverage accordingly.",English
+Alice looks entirely well on day 10 of treatment. The weekend doctor wants to stop antibiotics and discharge Alice home. Is this the appropriate plan?,English
+"The answer is no. The full antibiotic course must be completed, even if the baby looks healthy. If antibiotics are discontinued after 10 days of treatment,",English
+"there is a risk of leaving Alice with partially treated meningitis. Infection could recur off antibiotics, and this could put Alice at risk of further impairment",English
+"to her CNS. Summary. At the end of this chapter, you should now be able to one,",English
+long and maybe two or three weeks since they were exposed to someone who had something similar now for infectious mono we need to spend some time on this,English
+disease because it's fairly common but I want to emphasize that this is a sub acute illness these patients have been complaining of a sore throat and fatigue,English
+for maybe two or three weeks finally they come to the doctor one interesting point is that when they first went to the doctor with their sore throat they,English
+may have been given amoxicillin and developed a rash and so they were told they were probably allergic to amoxicillin on an exam you find mild to,English
+moderate tonsillar enlargement with exudates so the exudates can look an awful lot like group a strep and they also may have those palatal petechiae,English
+they will have very impressive lymph adenopathy they and it's not only anterior cervical but it's posterior cervical lymph adenopathy and in my,English
+experience axillary lymphadenopathy is common and splenomegaly and as a matter of fact if you suspect infectious mono and a patient you should carefully,English
+examine the abdomen for a palpable spleen and if this is a young athlete then you need to advise them that they may need to stay away from contact,English
+sports if they have splenomegaly because if they have splenomegaly and they get trauma to their left side then they can actually rupture their spleen and bleed,English
+out so a physician needs to really carefully evaluate somebody with mono for splenomegaly and regardless of what you do they will gradually get better,English
+over about a month but this is a kind of a nagging illness for teenagers it is spread by intimate kissing and as you can imagine,English
+that's pretty common in teenagers so we need to have our antenna up for this cause of sore throat and once again remember that and this is curious that,English
+if they get antibiotics particularly amoxicillin a large percentage of them will break out with a rash and then the amoxicillin will forever be listed as an,English
+allergy but it's not related to an allergy to amoxicillin it's just something related to infectious mononucleosis which we don't,English
+clearly understand it's an idiosyncrasy of that illness so turning now to how do you actually diagnose group a streptococcus pharyngitis well since the,English
+1960's physicians in primary care have been employing the center criteria and they have been modified as follows it's a actually a scoring system to help,English
+a physician determine whether to get a throat culture and whether to use antibiotics so if the patient is from 3 to 14 years of age then as you can,English
+remember group a strep is likely so they get 1 point for that if they're 15 to 44 it's sort of come cecum saw they don't really get a point if they're over 45,English
+years of age then of course group a strep becomes less and less common and you take away a point they get a minus 1 if on exam you find the eggs you date or,English
+swollen tonsils you give them a point if they have tender swollen anterior cervical nodes they get another point if they have fever more than 38 they get,English
+another point and remember this if they do not have a cough they get a point but if they have a coughed present they get nothing so,English
+how do you use this scoring system if they're added up score is minus one or one their risk of group a strip is less than 10% so they should get no,English
+antibiotic and no throat culture we could save a lot of money and save a lot of allergic reactions if we would follow that if they have a score of two or,English
+three their risk of strep is between fifteen and thirty two percent still pretty low but possible so you would get a throat culture and but you wouldn't,English
+give antibiotics until you found the results of the throat culture and if it's group a strep you then treat them you still have some time you really have,English
+up to ten days to prevent the sequela of group a strep so you can wait for the culture if they have a score of four or five their risk of group a strep it's,English
+not a hundred percent by any means it's only fifty six percent you would certainly then go ahead and and either do one of the rapid strep screens or,English
+culture and give antibiotics if positive and I want to emphasize the current recommendations of the infectious disease Society of America empiric,English
+treatment is no longer recommended just on the basis of symptoms alone and the other thing about antibiotics let's say a patient has had three days of a sore,English
+throat and it's caused by group a strep if you give antibiotics after three or four days the antibiotics don't do anything for the symptoms so you're not,English
+going to hasten the resolution of the symptoms yes you will eradicate strep the throat but you have to really to get any resolution of symptoms you've got to,English
+start antibiotics within the first 24 hours ideally so there's no rush if the patient's had several days of symptoms you can wait to get the culture and you,English
+can wait up to 10 days to prevent the sequela a throat culture is very sensitive and very specific for a group a strep the microbiologists deal with,English
+this organism all the time and they can recognize it quickly there are rapid antigen detecting systems they have a decent sensitivity from 70 to 90 percent,English
+not as good as culture but their specificity is about the same as a culture and here you're showing group a strep growing on blood agar and there's,English
+a zone of inhibition around a bacitracin disc in most cultures not particularly shown in this one but you can see the beta hemolysis so the goals of treatment,English
+then for group a streptococcal infection and really that's the main one we're focusing on is the resolution of symptoms and you need to start early as,English
+I mentioned this also is a contagious disease so the earlier you start the less contagious the patient will be and if you can start within ten days you can,English
+reduce the risk of complications so what is the treatment well it's my favorite antibiotic penicillin and in the form of oral penicillin it would be penicillin V,English
+or amoxicillin and we generally use a 10-day course because that's generally required to get rid of strep from the pharynx remember amoxicillin given to,English
+somebody with infectious monocoat cause Rasch if a patient has a penicillin allergy then we prescribe as a throw myosin clarithromycin or clinda myosin,English
+and there are intramuscular regimens in patients that really can't take oral medication for some reason you can give them a dose of long-acting benzathine,English
+penicillin g dosing according to their kilogram weight if they do have that dreaded anaerobic infection views of bacterium the craw from we've got to use,English
+something that is very good for anaerobes and we will probably hospitalized these patients because many of them are sick and it's recommended,English
+that they get ampicillin sold back Tam now the so back Tam is a beta-lactamase inhibitor it's what you call a suicide beta-lactamase inhibitor it will remove,English
+all of the beta lactamase produced by this organism out of the system so that ampicillin which it's attached to can go do its thing on the bug many people,English
+recommend that you add metronidazole for extra anaerobic coverage because it tends to penetrate clots I'm not certain whether you absolutely,English
+need to use metronidazole but that's what's recommended for corynebacterium diphtheria you can remove the organism in somebody with active diphtheria with,English
+penicillin but to actually get rid of somebody who simply colonized penicillin won't work a macrolide is needed so we talked about the complications that,English
+we're trying to prevent and these are they a peritonsillar abscess doesn't have to be caused only by fuse aback Tyrion but can be caused by group a,English
+strep you can get have these dreaded pair of pharyngeal space infections which can involve the dangerous areas of the head and neck lymphadenitis,English
+sinusitis and otitis media can result and mastoid itis in very serious complicated otitis necrotizing fasciitis is pretty rare and so in in this case we,English
+would be talking about necrotizing fasciitis of the soft tissues of the neck a group a strep can produce the toxic shock syndrome which is,English
+characterized by diffuse erythema of the skin with desquamation hypotension and it can result in multi organ failure and this is caused by a cytokine storm which,English
+the organism can result in liberating from phagocytic cells there are some non separative complications as well the most dreaded of course is acute,English
+"THE SECOND GROUP IS PERSONS WHO INJECT DRUGS, NOW MOST NEW HEPATITIS C CASES AS YOU HEARD ABOUT EARLIER ARE IN A YOUNGER POPULATION FROM FOLKS WHO WERE INJECTING DRUGS.",English
+"FOR THIS GROUP, WE'VE GOT TO FOCUS ON COMPREHENSIVE PREVENTION SERVICES, AND DR. MERMIN TALKED ABOUT THIS QUITE EXTENSIVELY EARLIER, MEDICATION-ASSISTED TREATMENT, SUPPORT FOR SYRINGE PROGRAMS",English
+"TOGETHER CAN REDUCE THE RISK OF HEPATITIS C PREVENTION BY 75%. SO IT'S IMPORTANT THAT WE GET THE SCIENCE OUT THERE, ABOUT EVIDENCE-BASED SOLUTIONS, BUT ALSO THAT WE PARTNER WITH FOLKS",English
+"TO MAKE SURE WE'RE ADOPTING THESE EVIDENCE-BASED SOLUTIONS, BECAUSE THE SCIENCE ALONE IS NOT ENOUGH. AND SCIENCE IN CONCERT WITH COMMUNITY ORGANIZATIONS AND",English
+"OTHER PARTNERS TO DEVELOP EFFECTIVE POLICY TO HELP ELIMINATE HEPATITIS C UNFORTUNATELY, GOALS TO ELIMINATE HEPATITIS THAT HAVE BEEN ACHIEVABLE ARE NOW",English
+THREATENED BY THE OPIOID EPIDEMIC. THIS IS HAVING AN IMPACT ON OUR ECONOMY. THE OPIOID AND INFECTIOUS DISEASE EPIDEMICS ARE IMPACTING,English
+"FAMILIES AND COMMUNITIES TREMENDOUSLY, AND IT'S ONE OF THE REASONS WHY I'M SO EXCITED ABOUT THE OPPORTUNITY TO TRY TO BRING IN THE BUSINESS COMMUNITY TO ADDRESS THIS.",English
+"WHEN PEOPLE EXPERIENCE ADDICTION, IT IMPACTS THEIR ABILITY TO WORK AND TO CONTRIBUTE TO THE CARE AND THE SUPPORT OF THEIR FAMILIES. AS GREATER NUMBERS OF PEOPLE USE OPIOIDS AND HEROIN, WHOLE",English
+"COMMUNITIES ARE IMPACTED, AND WE SAW THIS HAPPEN IN SCOTT COUNTY, INDIANA, WE'VE SEEN IT PLAY OUT IN THE APPALACHIAN TERRITORY OF OUR COUNTRY AND ACROSS THE ENTIRE UNITED STATES.",English
+EMPLOYERS LOSE EMPLOYEES AND THEIR INVESTMENTS IN STAFF TRAINING. THEIR HEALTH COSTS MAY INCREASE WHILE THEIR PRODUCTIVITY DECREASES.,English
+"THE OPIOID EPIDEMIC IS BAD NEWS FOR BUSINESSES AND FOR COMMUNITIES, AND YOU HEARD JANET YELLEN MENTION THIS JUST A FEW WEEKS AGO IN HER COMMENTS.",English
+"IT'S ALSO IMPACTING COSTS ON A NATIONAL SCALE. FURTHER, A 2014 ANALYSIS REVEALED THAT 26% OF PEOPLE WITH HEPATITIS C WERE COVERED BY MEDICAID.",English
+THIS INDICATES A SIGNIFICANT PORTION OF THOSE WITH HEPATITIS C RELY ON MEDICAID PROGRAMS. WE KNOW TREATMENT AND ESPECIALLY ELIMINATION OF HEPATITIS C WILL,English
+REQUIRE A TREMENDOUS INVESTMENT. YOU SAW DR. MERMIN TALK ABOUT THE COSTS WHERE IT GOES FROM COST-EFFECTIVE TO COST SAVINGS.,English
+A RECENT MODEL SHOWED TREATING ALL PATIENTS WITH CHRONIC HEPATITIS C WOULD RESULT IN A $3.8 BILLION SAVINGS AND AN 18.3% DECREASE IN THE PROPORTION OF TOTAL COSTS ATTRIBUTED TO,English
+HEPATITIS C INVESTMENTS IN CURING MED CANE ENROLLEES OF HEPATITIS C COULD ALSO SAVE -- WHO ULTIMATELY GO ON TO HAVE AND,English
+"NEED TO BE TREATED FOR HEPATITIS C UNDERSTANDING THE TOTAL ECONOMIC COST AND BENEFITS OF ADDRESSING HEPATITIS C, IT'S PARAMOUNT TO BUILDING THE PARTNERSHIPS NEEDED TO ADDRESS",English
+"THIS DISEASE AND ULTIMATELY TO ELIMINATE IT. AND WHILE I WON'T GO TOO MUCH INTO THIS TODAY, IT'S WHY I'M EXCITED TO ANNOUNCE THAT I HOPE ONE OF MY SIGNATURE SURGEON",English
+"GENERAL'S REPORTS WILL BE ON HEALTH AND THE ECONOMY, SHOWING THE LINK BETWEEN THE ECONOMY, WHICH IS ONE OF THE THINGS THAT FOLKS PRIORITIZE WHEN THEY VOTE, AND THE NEED TO TREAT PUBLIC",English
+"HEALTH DISEASES SUCH AS HEPATITIS C AND HIV. NOW I WANT TO TRANSITION INTO MY OWN PERSONAL STORY THAT YOU HEARD ABOUT IN SCOTT COUNTY, INDIANA AND IMPLICATION FOR THE",English
+"BROADER RESPONSE, BECAUSE I'VE EXPERIENCED THIS FIRSTHAND. I'M NOT JUST TALKING ABOUT IT, I'VE LIVED IT. WHEN I WAS STATE HEALTH COMMISSIONER, A SPIKE IN NEW HIV",English
+CASES AMONG PEOPLE WHO INJECTED DRUGS WAS DETECTED AND WE ARE NOW UP TO 225 CASES OF FOLKS WITH HIV. THIS IS IN A SMALL COUNTY THAT RARELY HAD AN HIV INFECTION AM,English
+"THIS WAS UNPRECEDENTED AND AS DR. MERMIN MENTIONED, BECAME THE LARGEST DOCUMENTED OUTBREAK OF HIV AMONG PERSON WHO INJECT DRUGS IN THE HISTORY OF THE UNITED STATES.",English
+IT SHOWED VERY CLEARLY HOW THE OPIOID EPIDEMIC COULD DRIVE LARGE SCALE CHANGE IN HIV DIAGNOSES IN AB AREA THAT HAD BENEFITED FROM SO MANY SCIENTIFIC ADVANCES IN HIV,English
+"PREVENTION, CARE AND TREATMENT. I ALSO HAD THE OPPORTUNITY TO SPEAK QUITE EXTENSIVELY WITH DR. WOODY MYERS, WHO WAS THE HEALTH COMMISSIONER BACK WHEN",English
+"RYAN WHITE LIVED IN INDIANA. MANY OF YOU ALL MAY NOT REALIZE, RYAN WHITE IS FROM INDIANA. I ACTUALLY HAD THE OPPORTUNITY JUST A MONTH AGO TO VISIT THE",English
+SCHOOL THAT HE WENT TO ON THE 30TH ANNIVERSARY OF RYAN WHITE. WE THOUGHT WE SOLVED HIV. WE THOUGHT THERE WAS NO MORE NEED TO ADDRESS IT ANYMORE.,English
+"WELL AGAIN, NOW THAT WE'RE SEEING THIS OPIOID EPIDEMIC EVOLVE, WE'RE SEEING THINGS THAT WE THOUGHT WE HAD A HANDLE ON COMING BACK AGAIN IN MANY NEW AND DIFFERENT WAYS.",English
+"WELL, WE'RE NOW AT ABOUT 400 CASES IN THE COMMUNITY OF HEPATITIS C AND MORE THAN 95% OF THE PEOPLE WITH HIV WERE CO-INFECTED WITH HEPATITIS C SO WHAT ARE THE LESSONS THAT WE",English
+"LEARNED FROM SCOTT COUNTY THAT I WANT TO SHARE WITH YOU TODAY? WELL, THERE WERE MANY LESSONS IN TERMS OF MOUNTING AN EFFECTIVE RESPONSE, AND THAT RESPONSE WAS EFFECTIVE.",English
+"WE'RE NOW UP TO 76% OF THE FOLKS FROM SCOTT COUNTY WHO HAVE HIV BEING VIRALLY SUPPRESSED. THAT MEANS THAT SCIENTIFICALLY, THEY CANNOT AND WILL NOT GO ON",English
+TO TRANSMIT HIV TO OTHER PEOPLE AS LONG AS THEY REMAIN VIRALLY SUPPRESSED. BUT WHAT WE LEARNED WASN'T THE SCIENCE. WE KNOW HOW TO GET PEOPLE VIRALLY SUPPRESSED FROM THE,English
+SCIENCE. WE LEARNED THAT PUTTING THE NEEDS OF PEOPLE AND THE PATIENTS IN PARTICULAR FIRST WAS CRITICALLY IMPORTANT. WE COULD NOT ADOPT A SINGLE ISSUE APPROACH.,English
+"FOR THOSE WHO ARE PASSIONATE ABOUT HEPATITIS, THAT IS SOMETHING I IMPLORE YOU TO THINK ABOUT. MASLOW'S HIERARCHY DOES NOT HAVE HEPATITIS ON IT.",English
+FOLKS ARE THINKING ABOUT THEIR OTHER NEEDS LONG BEFORE THEY'RE THINKING ABOUT HEPATITIS C AND THE COMPLICATIONS THAT CAN OCCUR DECADES DOWN THE ROAD.,English
+"WE HAD TO ADDRESS MULTIPLE NEEDS SIMULTANEOUSLY, INCLUDING HOUSING, WHICH IS RIGHT UP THERE ON MASLOW'S HIERARCHY. OVERDOSE RATES, WE WANT TO MAKE SURE PEOPLE AREN'T DYING.",English
+"HIV. AGAIN, WE USE THE OPPORTUNITY TO TALK ABOUT A DISEASE WHICH PEOPLE ARE SCARED OF TO RAISE AWARENESS ABOUT DISEASES THAT PEOPLE AREN'T AS SCARED OF.",English
+CRIMES. CRIME WAS A BIG ISSUE IN THE ECONOMY. WE HAD TO SHOW HOW TREATING HIV AND HEPATITIS COULD HELP US LOWER THE CRIME RATES AND THE REVOLVING DOOR.,English
+"JOBS. FOLKS WHO HAVE HIV ACTUALLY -- I CAN'T TELL YOU HOW MANY FOLKS I'VE TALKED TO WHO DIDN'T SAY I WANT TREATMENT FOR THE HIV, THEY SAY I WANT A JOB, I WANT A HOME, I WANT TO BE ABLE TO TAKE CARE",English
+OF MY FAMILY. AND THEN FINALLY THE ECONOMY. WE REALLY TURNED THE CORNER WHEN THE GOVERNOR WENT WITH US TO SCOTT COUNTY AND WE TALKED TO THE LAW ENFORCEMENT COMMUNITY,English
+"AND THE BUSINESS COMMUNITY, AND THEY SAID, WE KNOW THE SCIENCE. BUT WE THINK THAT WE NEED TO COME UP WITH A COMPREHENSIVE APPROACH SO THAT WE AREN'T PUSHING BUSINESSES AWAY, SO THAT",English
+"WE CAN HAVE A HEALTHY WORKFORCE, SO THAT, AGAIN, OUR JAIL ISN'T BECOMING OVERFLOWING. WE HAD TO LEVERAGE EXISTING INFRASTRUCTURE AND RESOURCES AS",English
+MUCH AS POSSIBLE BECAUSE THIS WAS A VERY UNIQUE ENVIRONMENT. AND WE HAD TO ADAPT TO THE CONTEXT OF THAT ENVIRONMENT. YOU THINK THAT'S SOMETHING ELSE THAT I FEEL REALLY HELPED US AND,English
+"THAT I WOULD CHALLENGE YOU ALL TO DO, IS TO REMEMBER THAT BOSTON, MASSACHUSETTS ISN'T THE SAME AS SCOTT COUNTY, INDIANA, ISN'T THE SAME AS LOS ANGELES, CALIFORNIA, ISN'T THE SAME AS",English
+"WEST VIRGINIA OR OHIO, WHERE WE'RE SEEING THESE OUTBREAKS OF HEPATITIS AND HIV, SO WE'VE GOT TO TAKE THE COMMUNITY INTO ACCOUNT, MAXIMIZE THE RESOURCES AND MAKE SURE THAT WE'RE LOOKING",English
+"AT THEIR UNIQUE OBSTACLES INCLUDING THE CULTURAL OBSTACLES TO DEALING WITH THESE INFECTIOUS DISEASES. AND TO DO ALL THOSE THINGS, PARTNERSHIPS WERE KEY.",English
+"FEDERAL GOVERNMENT PARTNERSHIPS SUCH AS WITH THE CDC AND HHS, STATE PARTNERSHIPS, WE HAD TO BRING TOGETHER MULTIPLE DIFFERENT AGENCIES WHO QUITE FRANKLY DIDN'T TALK TO EACH",English
+OTHER QUITE OFTEN TO DEAL WITH THIS. LOCAL PARTNERS. WE REALLY LEANED ON THE LOCAL DOCS IN THE COMMUNITY AND LOCAL ASSETS IN THE COMMUNITY AND THEN COMMUNITY PARTNERS AND,English
+"FAITH-BASED PARTNERS. THAT'S WHY AS SURGEON GENERAL, I'M COMMITTED TO MY MANTRA OF BETTER HEALTH THROUGH BETTER PARTNERSHIPS.",English
+"THIS MEANS USING MY COMMUNICATION AND CULTURAL CHANGE PLATFORM TO STRENGTHEN RELATIONSHIP WITH TRADITIONAL PARTNERS SUCH AS MANY OF YOU ALL IN THIS ROOM, AND TO FORGE NEW ONES WITH NON-TRADITIONAL PARTNERS, ESPECIALLY, AGAIN, THE",English
+"BUSINESS, LAW ENFORCEMENT AND FAITH BASED COMMUNITIES. WE KNOW WHEN BUSINESSES INVEST IN THE HEALTH OF THEIR COMMUNITIES, EVERYONE PROFITS.",English
+"YOU ALL CAN TWEET THAT. IN A WORD, TO KEEP AMERICA AT THE FOREFRONT OF ECONOMIC PROSPERITY AND LIFE, WE NEED TO WORK TOGETHER AS PARTNERS FOR THE BENEFIT OF ALL, ESPECIALLY WHEN WE'RE TALKING ABOUT THE",English
+"OPIOID CRISIS AND ITS INFECTIOUS DISEASE CONSEQUENCES. SO YOU DON'T WANT TO JUST SIT UP HERE AND TELL YOU ALL THE PROBLEMS OR SPEAK AT THE 30,000-FOOT LEVEL.",English
+I WANT TO GIVE YOU A COUPLE OF PROGRAMS THAT ACTUALLY WORK. ONE EXAMPLE OF A PUBLIC-PRIVATE PARTNERSHIP IS THE CHEROKEE NATION HEPATITIS C ELIMINATION PROJECT.,English
+"AMERICAN INDIANS ARE DISPROPORTIONATELY AFFECTED BY HEPATITIS C AND HAVE THE HIGHEST RATES OF DEATH, AS WELL AS THE HIGHEST RATES OF NEW INFECTIONS, SO THIS IS ONE OF THE TOUGHEST",English
+"COMMUNITIES TO TRY TO COMBAT HEPATITIS C IN. IN RESPONSE, THE CHEROKEE NATION HEPATITIS C ELIMINATION PROGRAM RESULTED IN THE POPULATION BEING SCREENED AND GROWING SUCCESS IN",English
+"GETTING FOLKS CURED. THE PROJECT HAS BEEN SUCCESSFUL IN PART BECAUSE OF NON-TRADITIONAL PARTNERSHIP WITH FOLKS WITHIN THE CHEROKEE NATION, FOLKS WE USUALLY WOULD NOT HAVE REACHED OUT TO AND",English
+"THOUGHT ABOUT CONVENING TO DEAL WITH AN INFECTIOUS DISEASE. I MENTIONED THE VETERANS' ADMINISTRATION. FOR HEPATITIS C TREATMENT, THE VETERANS' ADMINISTRATION IS THE",English
+"GOLD STANDARD RIGHT NOW IN TERMS OF AN EXAMPLE. THROUGH THE USE OF VARIOUS PARTNERS, WE'VE GOT TO MAKE SURE WE'RE NOT LEANING JUST COMPLETELY ON DOCTORS BUT WE'RE",English
+"BRINGING TOGETHER NURSES, PHYSICIANS ASSISTANTS, PHARMACISTS, ALL SORTS OF DIFFERENT -- HEALTH INFORMATION TECHNOLOGIES AND EXPANSION OF CARE TO PSYCHIATRIC AND",English
+"SUBSTANCE USE CO-MORBIDITIES, THE V.A. HAS TREATED OVER 92,000 VETERANS WITH A CURATE OF 90%. LET ME SAY THAT AGAIN FOR THOSE OF YOU WHO WANT TO TWEET THAT",English
+"ONE OUT TOO. THE V.A. HAS TREATED MORE THAN 92,000 VETERANS WITH CURE RATES OF MORE THAN 90% FOR HEPATITIS C SO WE CAN DO THIS IF WE PARTNER.",English
+MULTIDISCIPLINARY TEAMS ADDRESS GAPS AND IMPROVE HEPATITIS C MANAGEMENT. FINANCING -- WHEN YOU TALK TO,English
+"FOLKS, THEY WERE ABLE TO ACHIEVE ALL OF THAT THROUGH THAT INTEGRATIVE APPROACH THROUGH BRINGING NON-TRADITIONAL PARTNERS TOGETHER. ANOTHER GREAT EXAMPLE THAT I LOVE TO TALK ABOUT IS PROJECT",English
+"ECHO. ANY OF YOU HEARD OF PROJECT ECHO? A GREAT, GREAT, GREAT EXAMPLE OF BRINGING TOGETHER FOLKS TO EXPAND CARE TO AREAS THAT MIGHT NOT HAVE NECESSARILY HAD ACCESS",English
+"TO IT. AND I BRING IT UP BECAUSE IN INDIANA, I'M PROUD TO SAY WE WERE ABLE TO IMPLEMENT PROJECT ECHO TO DELIVER HEPATITIS AND HIV CARE TO SCOTT COUNTY,",English
+"INDIANA. WE UTILIZE THE LOCAL DOCS IN THE COMMUNITY WHO ALREADY HAD A RELATIONSHIP, WHO ALREADY HAD TRUST, AND WORKED WITH A LOCAL ACADEMIC CENTER TO HELP PROVIDE SUPPORT FOR PROJECT ECHO.",English
+"WE'RE WORKING WITH THE LOCAL HEALTH DEPARTMENT TO HELP IDENTIFY FOLKS, THEN WE ALSO HAD TO WORK WITH THE MEDICAID DEPARTMENT BECAUSE WHAT YOU ALL MAY OR MAY NOT REALIZE IS THAT",English
+"WE CAN SET UP THE BEST PROGRAM IN THE WORLD BUT IF WE DON'T FIGURE OUT HOW TO PAY FOR IT, HOW TO REIMBURSE PROVIDERS, HOW TO PAY FOR TREATMENT, IT'S ALL GOING TO BE FOR NAUGHT, SO WE",English
+WORKED WITH THE MEDICAID DEPARTMENT THAT MAKE SURE THAT NON-TRADITIONAL PARTNERS COULD GET REIMBURSED FOR PROVIDING HEPATITIS B CARE.,English
+"THERE ARE ROLES FOR MULTIPLE SECTORS AND SIGNIFICANT PROGRESS IS POSSIBLE IF WE ALL DO OUR PARTS AND ACT STRATEGICALLY. FOR EXAMPLE, OTHER PARTNERS INCLUDE THE EDUCATION SECTOR,",English
+"WHO HAVE A ROLE IN PRIMARY PREVENTION, EDUCATING OUR YOUTH TO PREVENT OF INITIATION OF RISK BEHAVIORS THAT INCREASE THE RISK FOR VIRAL HEPATITIS B AND HEPATITIS C SO HOW MANY OF ALL",English
+"HAVE INVITED SCHOOL TEACHERS AND PRINCIPALS TO DISCUSSIONS ABOUT HEPATITIS C? WE ALL NEED TO. POSITIVE PREDICTIVE RISK FACTOR FOR RECOVERING FROM THE OPIOID,",English
+"FROM ADDICTION, IS HAVING PERMANENT SUPPORTIVE HOUSING. HOW MANY OF YOU ALL HAVE INVITED THE HOUSING COMMUNITY TO YOUR DISCUSSION ABOUT HEPATITIS C AND HIV AND THE OPIOID EPIDEMIC?",English
+THE VETERANS HOMELESS INITIATIVE IS ONE PROGRAM EXAMPLE THAT YOU CAN LOOK UP. AGAIN I MENTION THE BUSINESS SECTOR SO I WON'T BELABOR THE POINT.,English
+"THE JUSTICE SECTOR, SUPPORTING ENVIRONMENT FOR SYRINGE SERVICE PROGRAMS TO INCREASE ACCESS TO PREVENTION STRATEGIES FOR VIRAL HEPATITIS.",English
+"FOLKS ASK ME ALL THE TIME, HOW DID YOU CONVINCE GOVERNOR PENCE, THEN GOVERNOR PENCE, NOW VICE PRESIDENT PENCE, TO ALLOW ON AN EMERGENCY BASIS A SYRINGE SERVICE PROGRAM FOR THE STATE OF",English
+INDIANA? I SAY TWO THINGS. I DIDN'T NEED TO CONVINCE HIM. HE KNEW THE SCIENCE. IT WASN'T ABOUT THE SCIENCE.,English
+WE KNEW THE SCIENCE. IT WAS ABOUT HE WANTED TO MAKE SURE HE WAS DOING SOMETHING THAT WOULD BE ACCEPTED IN THE COMMUNITY AND THAT THE COMMUNITY WOULD EMBRACE.,English
+"WE WENT DOWN TO THE COMMUNITY, WE TALKED TO THE LOCAL SHERIFF. THE LOCAL SHERIFF SAID TO US, I'M UNCOMFORTABLE WITH THIS, BUT I THINK WE NEED TO DO IT FOR THE SAKE OF OUR COMMUNITY.",English
+"AND AGAIN, WE PARTNERED WITH FOLKS TO MAKE THAT HAPPEN. THE JUSTICE SECTOR IS CRITICALLY IMPORTANT. AND THEN COMMUNITY AND FAITH BASED ORGANIZATIONS, WHAT YOU",English
+"OUGHT TO KNOW, THERE'S A TOOLKIT RECENTLY RELEASED FROM THE HHS CENTER FOR FAITH BASED AND NEIGHBORHOOD PARTNERSHIPS. I HOPE YOU GET A CHANCE TO LOOK THAT UP. IT HAS SOME AMAZING, AMAZING ADVISE, AMAZING TOOLS FOR FOLKS",English
+"WHO WANT TO ENGAGE THEIR FAITH BASED COMMUNITIES AND COMMUNITY PROGRAM, CRITICALLY IMPORTANT BECAUSE THEY'RE THE ONES ALREADY DOING THIS WORK, THEY'RE THE ONES WHO ARE PROVIDING FOOD, WHO",English
+"ARE PROVIDING SHELTER, WHO ARE PROVIDING SUPPORT FOR MANY OF THE FOLKS WE'RE TRYING TO REACH OUT TO, AND WE'RE NOT GOING TO GET THERE WITHOUT THEM, AND IF WE LEVERAGE THE POWER OF THE",English
+"FAITH BASED COMMUNITIES, SCOTT COUNTY, INDIANA IS AN INTERESTING EXAMPLE, AND YOU'LL SEE THIS THROUGH A LOT OF THE AREAS SUFFERING FROM HEPATITIS C AND FROM INFECTIOUS DISEASES",English
+"FROM THE OPIOID EPIDEMIC. DRIVE DOWN THE STREET IN SCOTT COUNTY, YOU CAN'T THROW A STONE WITHOUT HITTING A CHURCH. THERE ARE JUST CHURCHES EVERYWHERE.",English
+"SO WE REALLY, REALLY ARE NOT TAKING ADVANTAGE OF THESE FOLKS OUT THERE WHO WANT TO HELP US. AND ANOTHER POINT I'LL MAKE BECAUSE I GET ASKED QUESTIONS",English
+"ABOUT THIS ALL THE TIME AND I DON'T KNOW IF WE'RE GOING TO TAKE QUESTIONS, WE'RE SEEING PEOPLE PUSH BACK AGAINST SYRINGE SERVICE PROGRAMS IN INDIANA.",English
+"THERE WAS A QUOTE IN THE NEWSPAPER FROM ONE OF THE PLACES THAT ACTUALLY RECENTLY CLOSED THEIR SYRINGE SERVICE PROGRAM, THE INDIVIDUAL SAID, I KNOW WHAT THE SCIENCE SAYS, I'M",English
+"UNCOMFORTABLE BECAUSE I DON'T THINK THIS IS SOMETHING THAT GOD WOULD WANT ME TO DO. NOW YOU CAN JUDGE THAT IF YOU WANT TO, BUT AS I SAID EARLIER,",English
+"THE SCIENCE IS NOT ENOUGH. AND WHEN I READ THAT, I DIDN'T THINK THAT THERE WAS A PROBLEM WITH THE INDIVIDUAL FOR SAYING THAT BECAUSE I'M NEVER GOING TO QUESTION SOMEONE'S RIGHT TO EXPRESS THEIR RELIGION.",English
+I THOUGHT THERE WAS A PROBLEM WITH OUR COMMUNICATION WITHIN THAT COMMUNITY. IF WE HAD BEEN ABLE TO REACH OUT TO THE CHURCHES AND BEEN ABLE TO,English
+"HAVE THE CHURCHES AND THE FAITH BASED COMMUNITIES ON OUR SIDE, THEN WE WOULD HAVE HAD ANOTHER PARTNER HELPING US UNDERSTAND THAT WE ALL NEED TO IMPLEMENT THESE SCIENTIFICALLY BASED AND",English
+"VALID APPROACHES TO COMBATING INFECTIOUS DISEASE. SO I WANT TO CLOSE WITH WHAT YOU CAN DO, BECAUSE EVERYONE HAS A",English
+ROLE TO PLAY IN OUR NATIONAL RESPONSE AND THE FIGHT AGAINST HEPATITIS. YOU CAN'T ENGAGE A NEW PARTNER OF A CROSS COMMUNITY TO BREAK THE SILENCE AROUND VIRAL HEPATITIS.,English
+"YOU CAN EDUCATE TO RAISE AWARENESS AND ENCOURAGE TESTING FOR THOSE AT RISK. PARTICULARLY THE BABY BOOMERS. WE'VE ALL GOT GRANDPARENTS, AUNTS, FOLKS WHO WE KNOW ARE AT",English
+"RISK FOR HEPATITIS, WHO WE NEED TO GET TESTED, DIAGNOSED AND APPROPRIATELY TREATED, AND THAT WILL HELP THEM, THAT WILL HELP LOWER OUR MEDICARE COST, BUT IT WILL ALSO HELP US LOWER STIGMA",English
+"in cases with insomnia, and we have wonderful Chinese herbal formulas which help with insomnia, and CBD. CBD is relatively new.",English
+"When I went to medical school, or when I went to Chinese medical school, all I knew about CBD or cannabis that the seeds",English
+"of that plant is helping with constipation. Today it became a very big industry, but unfortunately, you can buy it from dispensary,",English
+"to any place like gasoline little shop, or in boutique store, so it is not regulated system.",English
+"So when you are trying to buy CBD products, make sure that the company which produces this product dealing",English
+"only with organic problems, that it is third lab independent party tested, so it doesn't have heavy metals,",English
+"it doesn't have any bacteria, that it is organic, and also the ratio of CBD and THC is very important. So it's very crucial to go to somebody",English
+"who really understands what CBD is, what THC is. For example, for insomnia, CBN, just one isolate of that plant will be the most helpful.",English
+"If you have a pain, you want a special ratio of THC and CBD, so make sure that you go and consult",English
+"with somebody who has knowledge of that. Not really new, it's three, 4,000 years old, Chinese and Ayurvedic herb, but since it became legal",English
+"on the state level, and still kind of questionable on the federal level, we don't have enough research in that field in United States.",English
+"However, there are a lot of research which comes from Israel, Israel using CBD for at least 25 years, Canada using it for the last 20 years.",English
+"There are a lot of wonderful work which was done on those products in Italy, in England. In United States, we're still in the beginner stage.",English
+"As we know, chemotherapy and radiation will weaken immune system, so when we do Chinese treatment,",English
+"there are ways to build the immune system of the patient to build it, because while chemotherapy will kill cancer cells",English
+"or radiation, in the same time, it will kill the cells who are responsible for the immune defense response of the patient, and right now it's especially important,",English
+"because we're living already set in here in the time of COVID. Alapecia, most patients will lose hair",English
+"if they're doing chemo or radiation, and there are wonderful Chinese herbs which also will be helpful in that treatment.",English
+"Next slide, please. Some patients who will go through chemotherapy will become infertile because of radiation,",English
+so they will go into artificial menopause. Chinese herbal medicine and Chinese acupuncture treatments will help patients,English
+"not to go into menopause. Postoperative pain, because when we do acupuncture, it is very common right now to invite acupuncturists",English
+"in the intensive care unit, I am seeing very often patients after the surgery, because of release of endorphin and serotonin.",English
+"It's basically natural pain killers, and we are dealing and we're living in the era of opioid epidemic, so a lot of patients use too many opioids,",English
+too many painkillers. Acupuncture is absolutely natural way of relieving pain. Some patients who have chemotherapy also will suffer,English
+"from neuropathy. Neuropathy is the numbness in the hands and in the feet. Acupuncture, Chinese herbs,",English
+"and infrared light are very helpful. I suggest a lot of my patients to buy infrared light lamps, and use it no more than half an hour every day.",English
+"Liver toxicity will come from heavy chemotherapy drugs, and we have special ways in Chinese medicine of detoxing",English
+"our patients from side effects of those drugs. And finally, which I feel very, very important, is how Chinese medicine can help patients",English
+"when they're already in palliative care. First of all, of course, control of the pain without using opiates.",English
+"Another one would be the emotional support of the patient, because again, when we do acupuncture, such important neurotransmitters like serotonin",English
+"and dopamine released, so those patients who feel depressed or have the fear of the death,",English
+"who lacking that cuddly, happy feeling will benefit tremendously from acupuncture, from meditation,",English
+"and other techniques. Next slide, please. Now, we have to be very aware that there are a lot of people who will claim",English
+that they can cure cancer with other methods. I can tell you that I never personally work with the energy healers who claim,English
+that they can use their hands or something else to save patient from cancer. I believe that it has to be integrative approach.,English
+"Next one. How do you find the right acupuncturist for your treatment? First of all, absolutely everyone in United States",English
+"who has acupuncture license should have it national and state. National is actually optional, state is required,",English
+"and if you want somebody very advanced, find somebody who also has doctoral degree, because it's additional two years of school.",English
+"You want somebody who has general background in medicine who understands not only Chinese medicine, but the whole area of what patients will deal with.",English
+"It's nice to have somebody with hospital experience, and what is the most important, I think somebody where you have patient doctor relationship,",English
+"because it's a chemistry between the doctor and the patient, and of course, experience working with oncology patients, because working with oncology patients is very different",English
+"than working with other type of patients. Next slide, please. And finally, I'd like to end my presentation",English
+"with a famous Chinese expression that in the battle of the disease, there are three warriors. There is a patient, there is a disease,",English
+"and there is a doctor, and when I say the doctor, I mean really the whole scene of the doctors. Like today for example,",English
+"we have a psychologist, a surgeon, and we have somebody from integrative medicine. It takes a village to help the patient,",English
+"so when the patient and the team of the doctors are on the same side, we believe the disease will be conquered. Thank you.",English
+"- [RJ] Our last question is for Dr. Postolov. the question reads, how do I ensure with regards to obtaining CBD treatment",English
+"that I am getting it from a reputable source? Yes, that was the question. - Well, I would think that first of all, you need to consult",English
+"a person who has license to practice it, because not everybody, actually, everybody can sell it right now,",English
+"but very few people do know what it is. And before I start considering myself an expert in it, I took special educational courses,",English
+"I attended a lot of seminars to educate myself, and I'm on national educational board",English
+"for science and medicine in the field of cannabinoids. The product should be under good manufacture practice code,",English
+"and definitely, you have to get the third party independent report. So if you have a reputable company,",English
+antigen presenting cells that is the macrophages you have the presence of this lectin receptors that is DC sign so the presence of this receptors will,English
+enhance the right will enhance the infectivity of the HIV virus right so presence of DC sign remember they will,English
+further enhance the infectivity by HIV virus okay but the one or which group of individuals are resistant to the HIV infection that is the presence of ccr5,English
+Delta 32 mutation if it is being mutated then the HIV virus cannot bind to the CD4 cells and cannot enter into the CD4 cells and thereby the individual is,English
+resistant to the HIV virus infection okay right that was about the third question and fourth question if you see,English
+exposure to which of the following modes of transmission carries the highest risk of acquiring the infection by HIV the options are needle sharing during,English
+injection drug abuse blood transfusion unprotected sexual intercourse and then the breastfeeding so the one which is,English
+having the highest risk of acquiring the HIV infection is by the blood transfusion so remember exposure to blood transfusion carries the highest,English
+risk of acquiring the HIV right and if you take the sequence after the blood transfusion the next one will be the needle sharing,English
+right needle sharing during the injection drug abuse and the next important will be repetitive right it is not single repetitive annual intercourse,English
+will have the increased risk of development of the HIV right then followed by that the next will be the needle stick injury,English
+right followed by that will be the sexual intercourse that is the vaginal intercourse okay vaginal sexual intercourse so you know this is what is,English
+the uh the descending order so the blood transfusion has the highest risk followed by that will be the needle sharing okay right and what are the,English
+other methods of transmission the other methods of transmission is from the vertical transmission also that is from the mother to child but,English
+among all see you have to remember two points if the question is asked like which is having the highest risk of transmission that will be the blood,English
+transfusion but if the question is asked like the most common mode of transmission worldwide the most common mode of transmission worldwide will be,English
+in the heterosexual transmission that will be the most common mode of transmission for the HIV Then followed by that it will be mother,English
+to child that will be the vertical transmission right and followed by that will be the blood transfusion followed by that will be the needle stick injury,English
+so you should not get confused with the question here so if the question asks like which is having the highest risk of transmission blood transfusion but if,English
+the question asks what is the most common mode of transmission worldwide that will be the sexual transmission all right next then,English
+coming to transmission between the genders male to female transmission is more common or female to male transmission is more common remember it,English
+is male to female transmission will be more common rather than female to male transmission this is another very very,English
+important point right now what about this story of the breast milk and all if you take the viral load in the breast milk,English
+and if you take the viral load in the saliva and if you take the viral load within the tiers,English
+and if you take the viral load within the sweat and even in the urine the viral load in these secretions will be very very minimal in fact in tears sweat,English
+and as well as urine the virus is completely absent okay tears sweat and urine the virus is completely absent whereas in breast milk,English
+and as well as saliva right this will be a very minimal viral load so that is the reason why these particular secretions they are not responsible for,English
+transmission of the HIV because they don't have adequate amount of the HIV viral load and at the same time your tear sweat and as well as urine does not,English
+have the viral load at all so here the correct answer is the blood transfusion right now we move on to the fifth question unexplained persistent parotid,English
+enlargement in an HIV infected child is characterized in which stage of the HIV according to World Health Organization so World Health Organization just now I,English
+have shown you there are totally four stages right out of which the presence of persistent ferotic gland enlargement is under which particular stitching so,English
+you take stage one most of these patients they are asymptote dramatic most of them they are asymptomatic or they have,English
+persistent right they have persistent generalized lymphadenopathy right persistent generalized,English
+lymphadenopathy that will be stage one and your persistent parotid gland enlargement comes under your stage two Right comes under your stage two now,English
+what are all the organs which are enlarged in stage two so if you take in stage two it is not only persistent periodic gland enlargement in stage 2,English
+you have persistent right you have persistent hepatosplinomegali as well right and,English
+along that means even the spleen end as well as liver they are persistently in large then the ulcerations that is these patients they have recurrent oral,English
+ulceration okay so what I will do is I will give you the list of the manifestations that you have in stage two so this will be the manifestations,English
+in stage two unexplained persistent hepatosplinomegaly then proritic eruptions that the skin manifestations extensive Watts that is also a skin,English
+manifestation herpes roster infection extensive contagious recurrent oral ulceration unexplained persistent parotidian enlargement this is what is,English
+our question linear gingival erythema recurrent or chronic upper respiratory tract infection and fungal nail infection so,English
+what is that I want to tell you from this question note that each and every manifestation in the clinical staging is very,English
+important because they can take up one clinical manifestation in any of these stage one two three four and they will ask you under which particular clinical,English
+stage of who does this clinical symptomatology comes under so you need to know each and every manifestation of the individual stages stage one and,English
+stage two is done here stage three and stage four subsequently I'll discuss that okay right then moving to the next question in HIV positive,English
+individual presence with the following what is the diagnosis and who clinical stage of the HIV the options are oral candidiasis in double H4 stage two,English
+oral mainly leukoplakia and who stage three oral candidiasis and wh for stage three act and Double H for stage two okay so,English
+what is that you are observing here the presence of white Curry precipitate and that is present over the soft palate so this is nothing but the oral candidiasis,English
+seen in whoo stage three right oral candidiasis seen in double H1 stage three so in the previous question we have discussed about stage two,English
+now let me discuss about the clinical manifestations of stage three so this oral lesions uh having this candidiasis are generally seen when,English
+the CD4 count is less than 200 per cubic millimeter that is the point when this oral candidiasis will develop now whenever you see this particular white,English
+patches in HIV individual in the oral cavity you need to think of two important differential diagnosis one is your oral candidiasis and the other one,English
+is oral hairy leukoplakia now how will you differentiate these two let me explain so you take this the oral candidiasis oral candidiasis how does it,English
+appear it appears as White cheesy eggs,English
+right it appears as white cheesy exudate and where exactly is most commonly distributed it is distributed over the soft palate,English
+and as well as the posterior pharynx right distributed over the soft palate and as well as the posterior pharynx then how will you diagnose see diagnosis,English
+is by the direct examination under so you need to take the scraping and direct examination under the microscope so what is that you will observe under the,English
+microscope the presence of the pseudo hyphen elements that is what you will observe in the oral candidiasis then you take oral,English
+Haley leukoplakia see okay so this is your oral hairy leukopakia so this,English
+they are present generally along the lateral border of the tongue right they are generally present along the lateral border,English
+of the tongue okay so this is very very important they are generally present on the lateral border of the tongue and sometimes they,English
+are present on the adjacent buccal mucosa right and remember these particular lesions,English
+are caused by the Epstein-Barr virus right and even though we are using the terminology as oral hairy leukoplakia this is not a premalignant condition,English
+remember this is not considered as the premalignant condition okay right so that was about the oral candidiasis so oral candidiasis it comes under your,English
+stage three now let me discuss what are all the manifestations that comes under your stage three so I have already shown you the findings that come across in,English
+stage two then you take in stage three you have a big list right just read two to three times before going to your exam quickly just give an eye on these,English
+adequately responding to standard therapy The Unexplained persistent diarrhea unexplained persistent fever oral,English
+candidiasis this is what our question is just now I have shown you acute necrotizing ulcerative gingivitis periodontitis or periodonitis,English
+lymph node tuberculosis pulmonary tuberculosis bacterial pneumonia lymphoid interstitial pneumonitis so if you see this how are they getting,English
+concentrated the clinical manifestation one is oral manifestation next is respiratory manifestation okay pulmonary tuberculosis pneumonia and all then,English
+chronic HIV Associated lung disease including bronchitectasis so even this is also lung manifestation then unexplained anemia and chronic,English
+thrombocytopenia that is on complete blood picture unexplained severe wasting stunting or malnutrition not responding,English
+to standard therapy pneumocystis Carney pneumonia again it is lung manifestation recurrence severe bacterial infection like imprima biomyositis bone or joint,English
+loss and then you have the other system involvement but very minimal okay but mainly on the Overland lung remember stage three okay right so that was about,English
+mycobacterium tuberculosis disseminated candidiasis cytomegalovirus pneumocysters zero AC pneumonia so remember it is,English
+mycobacterium tuberculosis that is the most common opportunistic infection in HIV infected individual globally and as well as even in India right and in,English
+patients with relatively High CD4 count the typical pattern of pulmonary reactivation can occur it need not be no CD4 count even at a,English
+higher CD4 count around 300 350 also there can be reactivation of the existing pulmonary tuberculosis whereas when the CD4 count is low that is when,English
+CD4 count is less than 200 then there will be disseminated disease right there will be disseminated tuberculosis whereas on the,English
+higher CD4 count there will be reactivation of the existing pulmonary tuberculosis lower CD4 count there will be dissemination of this tuberculosis,English
+as the pyridoxine should be given for nearly around nine months right should be given for nearly around nine months for HIV infected individuals,English
+meeting the following manifestations so which group of individuals you require you need to give isomy acid for nine months number one,English
+the tuberclean test that is purified protein derivative skin test has shown in duration of more than 5 mm then,English
+you need to give isoniasic prophylaxis then positive interferon gamma right positive interferon gamma release essay you need to give isoni acid for,English
+nine months then if the individual has the history of close household contacts with tuberculosis in them also you need to give iSonic,English
+acid for nine months so this is about the indication for giving prophylaxis in an HIV infected individual right so this was about related to tuberculosis then,English
+the next question is a previously untreated HIV positive patient is diagnosed with mycobacterium tuberculosis infection and,English
+treatment is started the patient began to feel better two weeks into treatment and patients suddenly complains of high grade fever severe malaise headache,English
+worsening cough and tender nodes are present within the neck which one of the following explanation is most likely in this case,English
+the options are resisting to anti-tubercular therapy second option concurrent treatment with antiretroviral therapy bacterial endotoxin release due,English
+cell death due to death of tubercle Vaseline hypersensitivity reaction to isoniaism so now what exactly this patient has,English
+developed is this patient has developed what is called as the iris okay and this particular Iris develops when there is concurrent treatment with,English
+antiretroviral therapy so when the patient have been started on anti-tubercular therapy simultaneously when you start antiretroviral therapy,English
+that is the point when the individual will develop what is called Iris which is nothing but immune reconstitution inflammatory syndrome so then what is,English
+that you need to do so once you have started anti-tubercular therapy you need to wait for nearly around two to four weeks,English
+okay you need to wait nearly around two to four weeks for the starting of the antiretroviral therapy when you start the antiretroviral therapy immediately,English
+along with anti-tubercular therapy then there is chance of development of immune reconstitution inflammatory syndrome so basically what happens is once you start,English
+antiretroviral therapy what will happen the CD4 count increases and the increase at CD4 count will start attacking the tubercle bacilli so the tubercle bacilli,English
+are completely killed off and the fragments of the tubercle bacilli which have been released in excess number they will start the immune reconstitution,English
+inflammatory syndrome the tubercle bacilli are the one which are responsible for starting the inflammatory syndrome causing worsening of the headache worsening cough tender nodes with nanik Okay so,English
+concurrent treatment with antiretroviral therapy should not be immediately started and remember at which particular CD4 pound this iris is more common see,English
+it is most common in previously untreated patients starting therapy with CD4 plus T cell count when it is less than 50. when CD4,English
+count is less than 50 right and at the same time you have started anti-tubercular therapy and antiretroviral therapy there is high,English
+chance of starting or developing this immune reconstitution inflammatory syndrome okay so please remember this important Point whereas hypersensitivity,English
+reaction to your isoniazide hypersensitivity reaction to isoni as it is extremely rare and if at all if there is hypersensitivity reaction with isone,English
+acid that will be in the form of maculo papular rash,English
+right that will be in the form of maculopapillar rash and it is extremely rare okay now the point is when the CD4 count is less than 50 and if you are,English
+anticipating that the individual is about to start with Iris about to develop this immune reconstitution inflammatory syndrome then how do you,English
+treat these patients so you need to start the patient on the glucocorticoids right you need to start the patient on glucocorticoids so immunosuppressive,English
+drugs such as glucocorticoids may be required to blunt the inflammatory component okay so the treatment for Iris will be the glucocorticoids right so the,English
+correct answer here is concurrent treatment with antiretroviral therapy right next the next question is about the development of meningitis in,English
+patients with HIV which organism is the leading cause of meningitis in AIDS the options are streptococcus pneumonia herpes simplex virus Toxoplasma gondin,English
+cryptococcus neoformance the correct answer here is the cryptopocus neoformance so this will cause meningitis in HIV infected individual,English
+when CD4 Plus right c d four plus T cell count when it is less than 100 per cubic millimeter that is the point when the individual,English
+can develop cryptococcal meningitis and the picture with cryptococcus neoformance will be in the form of Subacute right it will be in the form of,English
+Subacute meningo Encephalitis in the form of Subacute meningo NK flight is and when you do the CSF analysis in case of the cryptococcus,English
+neoformance the CSF analysis shows that there is increase in the WBC count and predominantly which cells are elevated in fungal infections it is the,English
+lymphocytic predominant and the other parts of the CSF analysis will show you that the glucose levels will be decreased so there will be decrease in,English
+the glucose and there will be increase in the proteins within the CSF and what will happen to the opening pressure within the CSF the opening pressure,English
+within the CSF will be elevated so CSF opening pressure is elevated right and the next important method by which you will be diagnosing or picking up that,English
+cryptococcus is the diagnosis of the cryptococcal meningitis is made by identifying the cryptococcal neo-formance yeast cells,English
+okay so you will identify or you will see the presence of the crypto Focus neoformance yeast cells within the CSF and the stain that we use is the India,English
+instinct right the stain that you use is the India Instinct and the other method by which you can diagnose this crypto focus,English
+neoformance is the detection of the cryptococcal antigen so this we call it as Crag Crag stands for cryptococcal antigen identification and this,English
+cryptococcal identification is being done by latex agglutination that is a method by which you will be able to identify the cryptococcal antigen and if,English
+you see the treatment for these patients with the cryptococcus see during the induction you need to give IV liposomal amphotericin B,English
+and this should be combined with fluocytosine and this combination you need to give for nearly around two weeks and this is what is nothing but the,English
+induction therapy followed by that will be the maintenance therapy the maintenance therapy it is the oral flucanazole and until when you should,English
+give this oral fluconazole you should give this oral fluconazole until the CD4 count increases to more than 200 until then you need to give this oral,English
+fluconazole okay so or you need to give for at least six months you need to give this oral flucanazole okay so that is about your treatment for cryptococcal,English
+meningitis ah now what is the drugs which we can give as the primary prophylaxis the primary prophylaxis against this cryptococcal meningitis,English
+will be oral fluconazole right when CD4 count reduces to less than 100 despite whether the individual has,English
+developed cryptococcal meningitis or not you need to start the oral fluconazole that is given as the primary prophylaxis so this is about your cryptococcal,English
+meningitis causing the meningitis okay right now moving on to the next question which of the following is the multicentric neoplasm,English
+of vascular origin in a patients with the AIDS the options are basically angiomatosis caposis sarcoma primary CNS lymphoma buckets lymphoma the answer is,English
+the caposi sarcoma so caposi sarcoma it is the multi-centric neoplasm of the vascular origin in patients with AIDS and what will be the description of this,English
+lesion so if you take this keposis sarcoma right let me just give you the description of this lesion sarcoma it is,English
+radish purple vascular nodules right radish purple vascular nodules,English
+that is how the lesions of the caposis sarcoma will be now where all it appears it appears on the skin and they also appear on the mucous,English
+membrane as well and multicentric not only in the skin and mucous membrane they also have been reported in virtually every organ right including,English
+heart and as well as the central nervous system so these are all the various places where you can have this uh distribution,English
+of capacity sarcoma and what is the organism causing capacity sarcoma that will be hhv eight okay now when will this occur when CD4 count drops down to,English
+less than 350 to 500 per cubic millimeter that is the point when the individual can develop this capacity sarcoma then how will you diagnose this,English
+keposis sarcoma see diagnosis is confirmed by doing the biopsy okay biopsy is the one which will differentiate capacity sarcoma from,English
+bacillary angiometosis then how do you treat these patients combination antiretroviral therapy combination antiretroviral therapy has been,English
+associated with spontaneous regression of the caposis sarcoma right and this capacity sarcoma it is one of the AIDS defining neoplasm so what all neoplasms,English
+comes under AIDS defining neoclasm that includes number one sarcoma is one next Non-Hodgkin's lymphoma third,English
+invasive Cervical Carcinoma right invasive Cervical Carcinoma these three are considered as AIDS defining,English
+neoplasms okay so that was about your capacity sarcoma which is of multi-centric origin of vascular origin in patients with the HIV right now we,English
+will move on to the next question a 45 year old HIV positive female presented with raised violations papules on the right foot,English
+biopsy and written study stain demonstrated the causative organism which of the following is that particular causative organism the,English
+options are battenola hensalae hhv8 Bartonella Quintana Epstein-Barr virus so remember it is the battery hensalae now,English
+that is the one which is responsible for this violation papule over the right foot so this what does it cause it will cause what is,English
+called as bacillary angiomatosis right it will cause what is called as bacillary angiomatosis,English
+and if you take the biopsy and this bacillary angiometers is caused by Bartonella Hensalae is more common in immunocompromised hose right and it is,English
+an infectious vascular proliferative lesion and what will be the appearance of this lesion it is a vascular proliferative lesion presenting as,English
+radish purple modules right reddish purple nodules okay and it,English
+is almost appearance similar to that of the caposi sarcoma but how will you differentiate capacity sarcoma from bacillary angiomatosis is by biopsy okay,English
+now when you do biopsy and when we use this Warden Starry stain in case of bacillary angiomatosis that will reveal,English
+in the lesions right that will reveal the Tangled bacilli in the lesions and what is the drug of choice for this bacillary enzymatosis that will be erythromycin so,English
+erythromycin is considered as the drug of choice and remember this organism that is it will cause what is called as cat,English
+scratch disease in immunocompetent host whereas in immunocompromised host it will cause bacillary angiomatosis,English
+whereas in immunocompetent host it will cause cat scratch disease which is nothing but necrotizing granulomatous disorder of the lymph node,English
+right necrotizing granulomatous disorder of the lymph node whereas you take the other options the other options like the hhv8 the hhv8 it is associated with the,English
+development of the caposis sarcoma right whereas you take this interna which is transmitted by the human body lies,English
+that is associated with the development of the trench fever right that is associated with the development of the trench fever,English
+particularly in World War one and this is also called as the five day fever whereas you take the Epstein-Barr virus that is associated with the development,English
+of the Infectious mononucleosis so this is about your Bartonella Hensalae in patients with HIV now,English
+we move on to the next question a 35 year old HIV positive male has been diagnosed with pneumocystisiger pneumonia primary prophylaxis for this,English
+condition is recommended to be started at CD4 cell that means the question is about when will you start primary prophylaxis okay,English
+if the individual has been infected with PCP pneumonia then the CD4 count less than 25 percent CD4 count less than seven percent less than 15 percent less,English
+than 10 percent remember when CD4 count is less than 15 percent that is the point when you need to start the primary prophylaxis okay so your CD4 count,English
+should be less than 15 percentage of the normal or the CD4 count should be less than 200 cells per cubic millimeter for starting,English
+the primary prophylaxis work the pneumocystis Carney pneumonia now what is the drug of choice for primary prophylaxis that will be trimethoprin,English
+sulfamethoxazole which is nothing but the quadrimoxazole which is nothing but cotrimoxazole the alternative treatment will be the options like dapson,English
+or pyrulethamine okay or the other alternative agents will be at,English
+overcon right or aerosolized pentamydin right errors aerosolized pentamidin so these are the alternatives for primary,English
+prophylaxis but the drug of choice will be trimethopines Alpha menthoxazole when CD4 count is less than 200 or when CD4 count is less than 15 percent in spite,English
+whether the individual has developed PCP or not you need to start this prophylaxis okay so that was about when to start primary prophylaxis in case of,English
+the PCP next question is which of the following is the faults regarding pneumonia the options are glucocorticoids are indicated if partial,English
+place of oxygen is less than 70 millimeters of mercury and a gradient that is alveolo arterial gradient more than 35 millimeters of mercury that is,English
+first option recent oropharyngeal candidiasis is an indication for prophylaxis elevation of lactate dehydrogenase is a,English
+common finding is used in the treatment okay so which is the false statement just now we were discussing in the previous question that is for PCP what is that we give we don't,English
+give the aerosolized pentameter as a drug of choice it is trimethopine sulfur methoxazole which is used as a drug of choice okay this is not used even for,English
+the about the one which is which it reflexes which one the arrow is less spent terminal then yes glucocorticoid should be given if the partial pressure of oxygen is,English
+less than 17 and when a gradient is more than 35 millimeters of mercury is a true statement and recurrent order of pharyngeal candidiasis is an indication,English
+for prophylaxis yes you need to sort the prophylaxis with flucanazole elevation of LDH will be there in patients with the PCP pneumonia then how,English
+will you diagnose this PCP the investigation of choice for PCP will be you need to do bronchoscopy along with the bronchoscopying you also,English
+need to do the bronchocular lavage this is the most sensitive investigation for PC then you need to observe this fluid,English
+under gomori methanamine stain right now if you are unable to do this and bronchoscopy the alternative method,English
+is you need to do nebulization with hypertonic Saline,English
+right you need to do nebulization with hypertonic saline and then you need to induce this sputum after the induction of this putum in that particular sputum,English
+you need to stain with glomorometin okay that is the alternative one and what will happen to lactate dehydrogenase levels in PCP they are being elevated,English
+what will be the other drugs the other drugs will be dapson or pyrometamine this dapson or pyrometamine should be combined with leukovirin,English
+right or the other alternative will be aerosolized pentamidine see this aerosolized pentamidin it is an alternative drug that is not the drug of,English
+choice that is not the drug of choice and in case of mild to moderate form of,English
+the PCP pneumonia the drugs which are available as an alternative is apart from uh trimethoprene sulfur methoxazole the drugs which are available as an,English
+alternative is dapson or trimethoprin this is one next is clindamycin or the primaquin and the other option is atova cone,English
+okay for severe form of the disease you need to give IV formulations and this IV formulations include IV pentamidine should be given and when are,English
+these glucocorticoids indicated when glucose this partial pressure of oxygen when the levels are less than 70 millimeters of mercury that is the point,English
+when you need to start the glucocorticoids okay so these are some of the very important points related to the PCP mixed a women with HIV was,English
+brought to the emergency Ward after an episode of generalized tonyclonic seizures there is no history of fever no history of night sweats no history of,English
+weight loss MRI was done and image is shown below which of the following is the most likely diagnosis the options are cryptopocal meningitis primary CNS,English
+lymphoma cerebral toxoplasmosis Progressive multifocal encephalopathy right so what is that you are observing here so you are observing,English
+the presence of intracranial space occupying lesion the right now this particular lesion along with the clinical features is very much,English
+suggestive of cerebral toxoplasmosis I will tell you why so this patient is having the presence of the seizures so the diagnosis of cerebral,English
+toxoplasmosis is most likely because the presentation in the patient is having seizures with HIV infection that is the point when which gives us a first,English
+important differential diagnosis is cerebral toxoplasmosis and the other one is in case of MRI when you are done what is that it's showing in the left posterior frontal,English
+lobe right in the left posterior part of the frontal lobe you are having the presence of solitary,English
+Rim enhancing lesion right presence of solitary Rim enhancing lesion that is another important point which is suggestive of cerebral,English
+toxoplasmosis and along with that you also have the presence of the edema so this black colored one this is nothing but the presence of the,English
+vasogenic edema right and not only that there is a very minimal right very minimal midline shift to the right as well and when will this cerebral,English
+toxoplasmosis occurs in patients with HIV this cerebral toxoplasmosis occurs when CD4 count is less than 200 in patients with the HIV and,English
+it is usually the re-activation of okay reactivation of the latent cyst that is what is your cerebral toxoplasmosis and when you do MRI in,English
+patients with cerebral toxoplasmosis what will be the picture most commonly it will be the presence of multiple,English
+intracranial space occupying lesions and that too in multiple locations that is the common picture but some cases write some cases there can be a single,English
+intracranial space occupying lesion right there can be a single intracranial space of buying lesion okay and when you do a Contrast MRI,English
+the Contrast MRI will also show that there is inflammation and Central necrosis showing the ring enhancement okay so,English
+there is inflammation and as well as the presence of right as well as the presence of central necrosis on the Contrast MRI and another,English
+important sign in the MRI that you see in patients with toxoplasmosis will be the presence of the target sign okay so what exactly is this target sign some of,English
+sometimes an eccentric nodular area of enhancement is seen within the ring this is so called eccentric Target sign it is typical for the cerebral toxoplasmosis,English
+right now what will be the differential diagnosis for this MRI having the ring enhancement lesion differential diagnosis for the single or multiple,English
+intracranial space occupying lesion in case of HIV will be primary CMS lymphoma usually in case of primary CS lymphoma it will be the solid religion,English
+right it will be solitary lesion and it will be a solid lesion you do not have a central necrosis there and most commonly the distribution is in the sub,English
+ependymal area right most commonly it is in the subependental area this is one of the differential diagnosis the other,English
+differential diagnosis are the tuberculosis then the fungal infections and even the presence of the bacterial abscesses,English
+write the presence of bacterial abscesses okay so these are the ways by which I mean this is the differential diagnosis then how do you treat this,English
+cerebral toxoplasmosis the drug of choice will be sulfur diazine along with sulfur dyes or the other drug will be pyramid mine so,English
+this spirometamine or sulfur diazine should be given along with new coverin right should be given along with leukovonen and this has to be given for,English
+a minimum of four to six weeks well this has to be given for a minimum of four to six weeks okay so that is,English
+treatment one the individual develops strokesoplasmosis but primary prophylaxis if you see the primary prophylaxis is given mainly to prevent the first occurrence of the,English
+toxoplasmosis and this is given to a patient with IGG antibody to Toxoplasma right presence of IGG antibody against the Toxoplasma or if the cl4 count is,English
+less than 100 that is another indication for giving the primary prophylaxis and this primary prophylaxis should be given with double strength the word d a stands,English
+with double strength of trimethoprin sulfamethoxazole when you give double strength of trimethoprene sulfamethoxazole that is what is the,English
+primary prophylaxis work the cerebral toxoplasmosis then coming this is about the primary prophylaxis and if you take the secondary prophylaxis for cerebral,English
+toxoplasmosis remember that is mainly to prevent the recurrence right that is mainly to prevent the recurrence of the toxoplasmosis and what,English
+should be the CD4 count when CD4 count is more than 200 right to prevent the recurrence of toxoplasmosis infection if the CD4 count,English
+is more than 200 and you need to give this for nearly around six months okay when CD4 count is less than 100 definitely you need to give and after,English
+the patient has developed toxoplasmosis and if the CD4 count has reduced to up to 200 immediately you need to start the,English
+secondary proflexus okay so that is about your cerebral toxoplasmosis then you take the other options in the question because,English
+you have the space of my lesion in the other options also you take the cryptococcal meningitis these patients with cryptococcal meningitis they present with fever okay they present with this projectile,English
+vomiting they present in a state of altered mental status Ms is altered mental status and they have severe headache and they also have meningeal,English
+Signs Now what are these meningel signs these meningel signs they include the presence of neck Ridge DT,English
+these are the meningel signs okay and the whereas in case of cryptococcal meningitis the presence of seizures is very very rare the presence of the focal,English
+uh weakness focal neurological deficit is very very rare in case of the cryptofocal meningitis so seizures they don't go in favor of your cryptococcal,English
+meningitis whereas then what about the primary sinus lymphoma you said like uh one of the very very important differential diagnosis for intracranial,English
+space occupying lesion these primary CNS lymphoma right they do present with seizures,English
+okay they do present with focal neurological deficit and along with that the symptoms of fever night sweats and weight loss they are present,English
+in almost 80 percentage of patients okay so in almost 80 percentage of patients they have fever night sweats and weight loss but what is our patient having,English
+there is no history of fever no history of night sweats no history of weight loss so that will take out your primary CNS lymphoma right whereas you take,English
+Progressive multifocal euclide which is caused by the JC virus and this is an AIDS defining illness and what is this,English
+actually this is a demyelinating manifestation of right this is the demyelinating manifestation of,English
+subcortical white matter right demyelination in subcortical white matter okay and where exactly will be this demyelination that demyelination,English
+will be in the cortical areas right in the cortical areas that you can observe within the MRI in patients with the progressive multifocal leuko-encephalopathy,English
+toxoplasmosis okay the one important area where you can get confused here is with the primary CNS lymphoma because primary CNS lymphoma usually they present with the solitary emissions but solitary lesions in some cases can be,English
+seen even in toxoplasmosis also but the point which is going against your primary CNS lymphoma is there is no fever there is no weight loss and there is no night sweats that is going against your primary CNS lymphoma right,English
+now moving on to the next question the majority of the cases of CMB retinitis occurs in HIV infected patients with CD4 count with CD4 plus T cell count less,English
+than the options are less than 25 less than 50 less than 150 and less than 250. so you come across this CMV retinitis when CD4 count is less than 50 cells per,English
+cubic millimeter and this CMV retinitis If You observe CNB retinitis it is a necrotic retinal infection,English
+right it is a necrotic retinal infection and this will cause irreversible,English
+right this will cause irreversible visual loss right and you have to understand that these patients they will have,English
+painless visual loss right brainless Progressive loss of vision and whenever the individual is about to develop this retinitis these,English
+patients they complain of blurring or fission these patients they come complaints of the presence of,English
+floaters in the visual field presence of simulations a right presence of the scintillations in the visual field right and,English
+this CMV retinite is it is usually bilateral and characterized by perivascular hemorrhage,English
+the right characterized by the presence of very vascular Hemorrhage okay and,English
+these findings are exclusively present within the retina and how do you treat this CMV retinitis B treatment is,English
+should be given for nearly around three weeks this is for induction therapy then what is that you give as a,English
+part of Maintenance therapy for maintenance therapy what we give is orally,English
+oral valagine cycloviron should be given as a maintenance therapy and for how long you should give this oral well again cycler until the CD4 count has,English
+increased it to more than 100 cells per cubic millimeter until then you should be giving this oral gain cycle so if you see the next question,English
+a 42 year old HIV positive mean presents with two weeks history of cough fever night sweats weight loss and diarrhea he is,English
+not on combination anti-red viral therapy and as a CD4 count of less than 50. what is the organism causing the above features,English
+with the particular CD4 count the options are cytomegalovirus candidiasis mycobacterium AVM complex pneumocysters zero AC pneumonia right so,English
+the CD4 count is less than 50 and when the CD4 count is less than 50 what are the most common opportunistic infections that will be disseminated mycobacterium,English
+AVM complex infection that is one when the cv4 count is less than 50 and the other important infections will be histoplasmosis when,English
+the CD4 count is less than 50 Then followed by that will be your cytomegalovirus retinitis and then,English
+primary CNS lymphoma okay so these are the manifestations that you come across when the CD4 count,English
+is less than 50. now so if you know this like you have two options one is cytomegalovirus which is there when CD4 count is less than 50 and mycobacterium,English
+avium complex infection now among these two which is that which is responsible for cough Fever Night switch weight loss and diarrhea,English
+that will be mycobacterium AVM complex infection so the answer is Mac here so if you take some important points related to Mac infection mycobacterium,English
+avium complex infection it is in AIDS defining opportunistic infections and this occurs predominantly when the CD4 count is less than 50 cells per,English
+microliter and the most common presentation is disseminated disease with fever,English
+then weight loss and the presence of night sweats so these are the,English
+features of mycobacterium Arium complex infection and how you diagnose this Mac diagnosis of the Mac is by,English
+culture of the blood that is one important investigation and or you need to do the culture of the involved tissue that is how you need to,English
+diagnose this mycobacterium AVM complex infection and what is the treatment the treatment it consists of clarithromycin,English
+or you need to give azithromycin this clanithromycin or azithromycin should be combined with,English
+ethambitol or rifa butane okay so this is how you need to treat,English
+mycobacterium AVM complex infection so the answer is Mac now the next question if you see all of the following are the AIDS defining,English
+illnesses except the options are encephalopathy attributed to HIV invasive cervical cancer mycobacterium tuberculosis of any site oral Crush,English
+that is by candida the answer here is candida oral thrush it is not the AIDS defining illnesses whereas candidiasis of the esophagus will be the,English
+AIDS defining illnesses candidiasis of the bronchi that will be the AIDS defining illness candidiasis of the trachea this will be the AIDS,English
+"and they sent me to Georgetown University Hospital because they didn't have the capability to take care of it. Dr. Arnazi was my surgeon,",English
+The most common radiation machines that are used are what we think of as conventional treatment machines.,English
+"You know, these are machines that can be used for all different parts of the body. The obvious advantage with the ZAP-X",English
+is that it is a dedicated machine just for treating brain tumors and benign brain processes. So it has that advantage,English
+of being specifically designed to treat problems in the brain. Probably the closest technology to the ZAP-X,English
+"And there are a couple of advantages there. With respect to the Gamma Knife, the ZAP-X machine requires no headframe.",English
+"Let's let's talk a little bit about our program. So the ZAP-X, how does it tie in with the National Cancer Institute",English
+"So basically, there are certain roles we play when you're an academic doctor. One of our main roles is actually,",English
+"the device we're using is only the third of its kind. So Dr. Satinsky and I have a lot of experience with radiosurgery, but we're also given the responsibility",English
+of writing the manual about how to use the ZAP-X. So it's really easy to use the ZAP-X. It's sort of like using your iPhone,English
+"the same engineers designed it, but someone's gotta write the manual, someone's gotta teach the new doctors how to use it. And then we have to do,",English
+"in the future, we'll probably have to do some prospective research to decide, like what's the best way to use the ZAP-X.",English
+"And that's why we were given the privilege of being the third team in the world to have the ZAP-X, because we're a part of the Lombardi Cancer Center.",English
+"- Thank you. Yeah, that is great. Dr. Satinsky, how do you work with the integrated cancer program at MedStar, Southern Maryland?",English
+- So one of the key advantages to being a patient at MedStar Southern Maryland Hospital right now,English
+"multiple MedStar hospitals, both in the DC area and up in Baltimore. And it creates, as you say,",English
+"an integrated system for treating cancer. So at our center, we have basically a comprehensive radiation oncology center",English
+"where we can treat all sorts of cancers. And of course, including the cancers that we treat with ZAP-X.",English
+We also have a full-time dedicated medical oncologist with an infusion center. So for those patients who require chemotherapy,English
+"or immunotherapy as part of their treatment, they don't need to travel anywhere else to see that doctor and have that treatment.",English
+"We have imaging on site, we have surgeons. The Georgetown Hospital neurosurgeons have an office",English
+"about a mile away from the hospital right down the road, where they see patients, they can follow up with patients there.",English
+"And, of course, patients who have had a problem identified at another MedStar Hospital, you know, let's say a patient from St. Mary's Hospital",English
+"has a problem like Mr. McKinney did, and they go into the hospital there, they have a scan, the scan shows, you know, a tumor in the brain,",English
+to maintenance or propagation of the disease? So the other piece to this is the developmental biology. And at least since the discovery or me the method,English
+"that was developed in the early '60s by Till and McCulloch, the pioneers of modern stem cell biology. The field as we have recognized today,",English
+"which is highly quantitative, provides some great insights. Now, the most simplest or most apparent example",English
+"that I can cite to you is that normal cells, in this case a pluripotent stem cell, you could get it from the inner cell mass",English
+"of a blastocyst the embryonic stem cells or you could take any adult cell nor quote unquote ""normal cells"" and introduce",English
+"certain genetic events and then reprogram them to embryonic state and therefore, they would be considered normal.",English
+"And since ,in vitro they can differentiate into different cell types of our interest, we could further explore them to generate normal tissues,",English
+even organs that then could be used for therapeutic purposes. So the very stem cells that can do all of these,English
+"in a very organized manner, if you inject them in a immunodeficient mice in an adult, just take them somewhere in the organism.",English
+"You will see that they form tumor. Normal cells, genetically, normal cells can form tumor. So what does this teaches?",English
+"It teaches that actually it is the developmental state or in this case, the primitive developmental state, embryonic or more pluripotent state",English
+"that actually has the ability to develop. But when it develops in the wrong place, it appears like it is causing the disease.",English
+"Now also from the stem cell field, the other important aspect to remember is that by introducing just four genes, Yamanaka was able to reprogram a somatic adult cell",English
+"like the fibroblast into an embryonic cell. And one of those was actually a proto-oncogene, c-Myc. So therefore, oncogenes could turn on programs",English
+"that are linked to stem cell state. They may not perfectly reprogram them to embryonic stem cell state,",English
+but that there are now growing evidence that mutations tend to rewire cells to a certain state where they could actually then go on to exhibit,English
+some of these developmental properties that we don't usually associate with the site where it is happening.,English
+"Now, if you read articles on cancer, if you want to like really summarize basically everything that is there in the literature,",English
+"you'll see these points emerging. Cancers evolve through clonal expansion, it's a clonal disease. There is a genetic diversification as the disease evolves,",English
+"more mutations happen through random process. And so you have this genetic diversity and then of those genetically diverse clones,",English
+some get selected and that is because they have better ability to adapt to this changing landscape that is dictated by many factors.,English
+"There is definitely a Darwinian process at play. You have clones that are fittest that would actually evolve better, survive, adapt better,",English
+"and therefore, have the chance to actually go on and kill the person. But there is also this information that most people",English
+even working in this area do not remember. And this is very important when you're investigating cancer that these two types of clonal information,English
+"could be operating simultaneously, and what are those? When we refer to clone, most cancer biologists today would consider clone",English
+"being genetically identical. Or you could trace the origin to the common genetic event, common genetic ancestry.",English
+"Therefore, it is really the genetic clone that is being described. But developmentally, that is not how we look at a clone. If you talk to a developmental biologist,",English
+it is the common trait that we are interested in. So a cell that you could develop a tissue into and if they replicate themselves and those cells,English
+"can then go on to make the identical tissue, then we call that process cloning. You could extend this definition to tissues, cell types, organs, organisms, essentially",English
+"a trait that you're interested in. Now, how do therefore you study tumor cell heterogeneity? We all know that tumor cells",English
+"are very heterogeneous in nature, both genetically as well as in their epigenomic states. So how do you look at this heterogeneity?",English
+"The genetic clone structure would force you to assume that cells actually have different genetic makeup and when you organize them,",English
+you would have a hierarchical structure. It all basically leads to common genetic ancestry. Now that is information you actually extract,English
+"from sequencing any tumor. Whereas in the developmental biology sphere, if you take a tissue or a tumor tissue,",English
+"in this case, you have cells that have different functions. Some have growth ability in vitro, some have growth ability in vivo when you transplant them.",English
+"Some can form multi-cell type three dimensional growth, some only growers, 2D colonies.",English
+"So there is different types of growth properties that these cells display. So functionally, they can be very different. Also phenotypically,",English
+they may express different cell surface markers or biomarkers that you can identify or pull them apart. But also when you start carefully mapping,English
+"the hierarchical nature of these cells as to who is coming out of whom or who is producing whom,",English
+"the progenitor progeny relationship. Once you start establishing those through very rigorous experimentation, you will see akin to normal development,",English
+another hierarchy emerging that is cancer specific. Now this hierarchy hierarchy might look very distorted from what you one is used to seeing in normal development,English
+"where in normal mammary development, you have the luminal epithelium and the myoepithelium and you know that that is a bipotent progenitor",English
+that actually generates those two lineages. And in blood you have this common progenitor cells that gives you myeloid and lymphoid.,English
+"So you have a clear understanding of what you're looking for and how you study those. But in cancer, we don't know what we are looking for because the amphipathic is not well-defined.",English
+All we know is that there are some cells that have ability to grow and some cells that do not share that ability. And cells that grow have the ability to generate cells,English
+"that do not grow. And now depending on the growth assays that you have and nuances in your assays, you could still get a fairly robust hierarchical",English
+"differentiation model established and through assays that enable you to see how this structure, this developmental clonal structure can replicate itself",English
+"through the process of self-renewal. Where the sit cells that sit at the top of this hierarchy, which we refer to as too many initiating cells",English
+"or cancer stem cells or clone initiating cells, how do they expand and maintain a pool of cells that continue to propagate and generate all the cells",English
+that form this highly differentiated tumor types or mixed bag of cells in any given tumor.,English
+"Now, the cancer stem cell hypothesis also tries to explain how the disease progress and progress to therapeutic resistance.",English
+"And it may or may not have genetic mutation or structural change in the genome associated with it. Simply by rewiring the cells,",English
+"you could create a certain state that would allow the tumor to resist the therapy. But of course, the genetic event or the constant evolution,",English
+you have more options to use the genetic event towards the advantages in how these primitive cells or cancer stem cells adapt,English
+"or create more variation in their pool. So a normal stem cell would differentiate, that's a normal hierarchy.",English
+"One of these cells let's say gets mutated and therefore, becomes a cancer stem cell that still develops, still is probably responsive to a lot of physiological cues,",English
+"but it forms distorted clones and through self-renewal process, the pool of cancer stem cells continue to expand and it might acquire resistance through various mechanisms",English
+that we know of today . And eventually leading to selection of certain clones because of their relative growth advantage,English
+or adaptability in the environment. How do we therefore look at how do we fit metastasis in this whole clonal structure understanding?,English
+"Of course, you could do the same thing, which is to take DNA from primary tumor, metastatic tumor, look at the genetic makeup, and try to map them out.",English
+"And when you do that, again, very simple structures or these phylogenetic trees emerge where metastatic cells have certain mutations",English
+"that you can map to the primary tumor, a certain subclone primary tumor. And you know that these probably have certain advantage and therefore, they have actually evolved to metastasize.",English
+"But is that what is happening or can that explain metastasis? Certainly not. If genetics could explain metastasis,",English
+I think we would be closer to therapy for metastatic diseases. But it is a lot more complex.,English
+"So the cells actually use, make use of through rewiring process at the epigenetic level can make use of the variations that development offers",English
+"to adapt to the environment and rapidly adapt to environment and sometimes, adapt in ways that normal cells would not.",English
+"And this is could be metabolic adaptation or acquisition of an embryonic state as in the case of pluripotent, the teratoma assay that I was describing.",English
+Or it could be a state that would put them off into some dormancy and then you could wake them up. So there are many things that the cells could actually have,English
+"as a consequence of these epigenetic reviving that can take place. The most experimental biologist,",English
+the most challenging and intriguing observation is that metastasis process the cells that actually get out of the primary site.,English
+That process is very unpredictable. We don't know which cell actually manages to do that. There is no way of predicting that.,English
+"But more importantly, and good news is it's a very inefficient process. Not every cell that is in the tumor has this ability.",English
+"And certainly not every cell that enters into circulation, in the case of using blood route for metastasis, not every circulating tumor cell can survive",English
+"because it's a very hostile environment. So work from Sean Morrison's lab, they very elegantly showed that melanoma,",English
+"it's a mouse model in metastatic melanoma cells, when they enter into circulation, they die. Provided that is actually these preexisting clones",English
+that have redox pathway altered in a way that they would have more NADPH molecules to counteract any sudden rise in the oxidative,English
+"stress level in the cells as they enter circulation. So therefore, these cells would survive in circulation and have a chance to colonize a distant site.",English
+"And by simply modulating the oxidative stress levels or this antioxidant levels in the cells, they were able to wipe out metastasis in the animal model",English
+or get very aggressive metastasis depending on which way the manipulation was. And this certainly tells you,English
+"that certain clones probably enter, but we don't know which clones enter into circulation or if there is a subclonal architecture",English
+"in the primary tumor, it therefore gets very interesting to know, are there specific subclones that have this tendency or is it all random?",English
+"'Cause in cancer process, when you go back in time, you always hear this argument that these things are random. The cell of origin of cancer is random,",English
+a cell gets mutated and you get tumor. But we have debunked that theory. There are very specific cells in every tissues that are actually more vulnerable to cancer initiation.,English
+"And also perhaps within the tumor as we learn more about this clone clonality at the cancer stem cell level,",English
+"perhaps there are some cancer stem cells that tend to be and tend to remain benign and probably there are some clones that actually, through adaptation process, learn to exercise",English
+certain molecular programs that would then make them very comfortable to move out and survive in any hostile environment.,English
+Can we pull them apart? Can we separate them? Can we quantify these clones? Can we find out in a me highly metastatic disease,English
+"there are more of these clones and in a benign disease that is a lack of such clones, can we get the molecular signature of such clones that actually have the tendency to enter into metastasis?",English
+"These are open questions but actually very important that we understand. And therefore, we start with this assumption that in a given tumor, the tumor-initiating cells",English
+"which is also equated to cancer stem cells or clone initiating cells or tumor clone initiating cells. These are used interchangeably,",English
+"although there are operational nuances to these terminologies, which I won't get into. But for today's lecture, if I say cancer stem cells, they're similar to tumor-initiating cells,",English
+"similar to clone initiating cells in the tumor. But they are rare, they should be rare by definition. And bulk of the cells that do not share this property",English
+"are produced from these tumor-initiating cells. And therefore, we need to know which tumor-initiating cells are capable of metastasizing.",English
+"And that is what I'll be describing today, what the advances that we have made. And of course, I've talked about the clonal nature,",English
+the assumptions that we make as the tumor clone-initiating cells expands through the process of self-renew in an aggressive disease,English
+"or individuals who have received a therapy where most of the dividing cells, you have killed the residual disease",English
+"probably enriches for cancer stem cells that have adapted themselves better. And that's why when a metastasis, when you see a relapse of the disease,",English
+"it becomes very difficult to treat because not only you have woken up the cancer stem cells or woken up cancer stem cells that are better adapted and perhaps, also have acquired",English
+resistance to the earlier treatment during the process of treatment through acquired resistance or have accumulated mutation over that period,English
+and therefore have additional ways of defending themselves from the next line of treatment. We need to know about that.,English
+"So how do we study clones? Sounds very simple thing to do, but experimentally, it can be quite challenging.",English
+"The origins of quantitative transplant research goes back to early 1960s where Till and McCulloch, and this is post-Second World War researchers,",English
+very interested to know how bone marrow transplant could save life of lethally radiated mice through syngeneic transplants.,English
+"And they accidentally discovered, well, there was an observation that they made which really, heralded the discovery of all the concepts",English
+"that we actually consider cornerstone in modern stem cell biology. The concept of self-renewal,",English
+the concept of differentiation. All came from that 1961 very classic paper I should say. Well I won't get into the study.,English
+"For anyone interested, please go and read the paper. But in that study, they introduced the concept of limit dilution analysis where you consider,",English
+"well I'll explain the methods in detail, but that's one way of detecting clones and the frequency of clone-initiating cells in any given population.",English
+The most stringent way of starting clone is doing single cell transplants. 'Cause you won't have any ambiguity that the cell,English
+"that you injected gave rise to a clone. But then, it can be very technically challenging, as you one would imagine, to identify the cell",English
+that would actually generate a tumor but also have that cell at such high frequency that you could conduct it in any meaningful manner,English
+"in a research laboratory where you don't need millions of mice but a few hundred mice. And of course, the most recent advancement",English
+"that is cellular DNA barcoding. and Connie Eaves, who's my postdoc mentor, was trained by Till and McCulloch in the '60s.",English
+And so she pioneered many stem cell areas including chronic myeloid leukemic stem cells and also many of the gold standard methods,English
+"that is used in hematopoietic stem cells, including all the long-term culture initiating cell assays that hematologists use, were all from,",English
+"well, she majorly contributed to those, but another biggest contribution was clonal investigation, which led to clonal hematopoiesis concept,",English
+which today is a lot more attractive to studying the context of various geriatric illnesses and also in cancer research.,English
+"But also, it is in her lab when I was doing my postdoc that we started playing with this tool, this concept of how do we exploit genetic barcodes?",English
+"Tagging cells with very unique genetic sequences and following them through their developmental journey and to really find out how big a clone that they can form,",English
+where do they land up and how do we map all these clones to get a picture? And so some of the reasoning from first principles,English
+"was through the transmission of knowledge and all these assays that some of them are published and many of them are like, we just discuss and debate in the lab.",English
+That has really strengthened my resolve that this is probably the best approach to get to this problem. The limiting dilution analysis assumes,English
+"that you have these rare cancer stem cells in a population of cells and therefore, you could serially dilute your population,",English
+"transplant in animals. When the dilution is such that the cell does not exist anymore in that population, you will have a negative outcome.",English
+"Until then, every transplant should give you a positive outcome. And of course, you could use a limit dilution analysis. Based on poison statistics,",English
+you can actually calculate the frequency of stem cells. There are now calculators available. You just plug in your cell dose,English
+"that you injected and the outcome, the number of animals that have positive for the outcome in a calculator and it'll give you the frequency",English
+"and the confidence interval. The single cell transplants, of course, the biggest challenge is actually enriching for your cell of interest.",English
+"Since you don't know who the cancer stem cells are, you don't know how to purify them at unit purity. And if your purity is one in 10, still it's good.",English
+"You could probably do some single cell transplants and have few animals in your experiment that turn out to be positive. But if the frequency is one in 1,000,",English
+"you can imagine it becomes a nightmare to get a graduate student who would inject 1,000 single cells and have one animal that may or may not actually develop a disease.",English
+"More importantly, to load a thousand single cells in a syringe and walk into that animal facility, assuming or hoping that you have actually loaded",English
+"that single cell and it's actually going to land in that site where you're going to inject, it can be quite traumatic for the student. And it is probably easy to visualize the floating cell",English
+in a blood system. But if you're working with solid tumors where you have ripped the cells apart from each other using enzymatic and all sorts,English
+"of mechanical dissociation process and then hoping at the end of all of that, that you have viable cells that you have somehow purified",English
+"and then loaded all in the day's job, then go and inject and feel comfortable about it, it can be even more stressful.",English
+And that's why this is not done. But there are some papers and all those papers are from Connie Eaves' lab.,English
+"So I've seen those experiments, and I'll never do that or never recommend anybody to do that. And it is that that forced us to think of better ways",English
+to deal with this problem. How do you track clones in a population where you really don't know which cell you're tracking?,English
+"And the cell DNA barcoding technology, it is NGS, next generation sequencing-based and therefore, it helps you do things at scale",English
+"but most importantly, you can barcode large number of cells in which a good number of them are your cell of interest. That is the cancer stem cells inject everybody",English
+in a single animal. And you can simultaneously track these competing clones in the same animal and understand their growth dynamics and also all sorts of other dynamics,English
+that you're interested in investigating. The most simplistic description of what this technology is this.,English
+That you have a plasmid library where you have actually introduced unique barcode sequences in each of those vectors,English
+"and this entire library is then converted into a lentiviral library. And so these viruses, each one of them now carry unique DNA barcode",English
+"and the diversity, you maintain them at several hundred thousands to several millions of unique barcodes in your library. And then you introduce or infect your cells",English
+where a single barcode is introduced in a single cell. So you titrate your virus so that your virus only infects a single cell.,English
+"And again, you use poison statistics for that to titrate your virus. So 1/3 of your cells, if you have injected, you can feel confident that most of your cells",English
+"are single integration. And then you purify of course, you barcode the cells, then use them for experiments, whatever that your experiment might be.",English
+"It could be in vitro, drug treatment, transplants, doing basic science or any therapy research. But at the end of that experiment,",English
+"you assume that some clones have expanded. And you isolate the tissue, in this case probably a tumor, you would isolate the DNA from that tissue and then use",English
+the DNA for barcode analysis. That's the technology that we are talking about. It's actually more easier than it sounds,English
+to conduct these experiments. So those who are interested don't get deterred by the complexity of these slides.,English
+"It's actually a lot more simple. You just drop the virus on cells. That's how simple it is. So this is the same thing what I just described,",English
+"but explaining like how it fits in with the cancer studies that you could have a primary tumor with barcoded cells or after therapy and relapse,",English
+you could have some clones that now expand. Most of the clones probably would die if they're sensitive to the treatment. And then you could isolate the either the relapsed tumors,English
+"or primary tumors or all sorts of metastatic tumors, isolate DNA and just do the barcode analysis. It's as simple as that.",English
+"And of course, the data you have to now very cleverly analyze and get maximum. The model that we used of course has to be a model",English
+"that we know for sure would work. And so we use the ovarian cancer as you know it's a highly metastatic disease, very poor outcome,",English
+"lot needs to be understood about this disease. The interesting thing is it is, we call it ovarian cancer, but it's probably not ovarian in origin",English
+"In the last at least 15, 20 years, we have known that fallopian tube epithelial cells, the cells lining the fallopian tube actually",English
+are the precursors from which the cells somehow slide through that tube and stick to the ovarian surface and present as a ovarian cancer.,English
+"And high grade serious ovarian cancers, nearly all of them have P53 some distortion in P53 gene. And so that's a very good biomarker",English
+"if you're looking for early events in the fallopian tube. And the image there shows how normal fallopian epithelial cells that have ciliary cells,",English
+"secretory cells and as they acquire P53 signature, your ciliary cells start disappearing, it looks more secretory-like. And then that leads to some early lesions",English
+"that then start disseminating. And it's a disease that you know for sure, you have dissemination because the way you detect them",English
+"is ovarian cancer, which is actually a metastatic disease. And so there is a lot of confusion is when we refer to ovarian cancer as primary, it's not primary.",English
+"The fallopian should be primary and this should be metastatic. So as an experimentalist, it becomes very difficult to wrap around",English
+"the terminology that is in the literature. But nonetheless, it's a very interesting model and a colleague, Chuck Lunga",English
+"working in Joan Brugge's lab at Harvard, noticed this very interesting phenomena where a mammary cell that actually has the ability",English
+"to form a 3D organoid structure. These are cell lines, mammary cell lines that retain progenitor activity. So as a single cell, they have the ability",English
+"to form this 3D organoid structure. And by activating an oncogene in a single cell in that three-dimensional structure,",English
+they were able to track that cell that had that oncogenic event and showed that those cells usually slip into this luminal space and start growing as a lesion there.,English
+And they call this phenomena translocation. The cells from the epithelial lining slips into this luminal space and comfortably,English
+"is able to establish a colony there. And perhaps, we are seeing something akin to that where cells from the fallopian epithelium",English
+is probably just getting out of that space when they acquire oncogenic events and are able to survive the hostile environment of the peritoneal cavity,English
+"and stick to various surfaces that provides them that adaptation that is required for the disease development. But what I'm going to now describe is actually,",English
+"we've used bar coding to study normal stem cells in mouse and in human and in breast and all that, but what I'm going to describe is this one study",English
+that we recently published where we looked at the ovarian cancer. So it was published as a resource article. We packed quite a lot of information there.,English
+So please go and read the paper. If you're interested or excited about this approach to conduct cancer research. So what did we do?,English
+"This is again, a simplified illustration. We had two cell lines, they are isogenic which means they're identical",English
+"but they differ in expression of a one particular gene. And I'll mention what that is. And we barcode them, purify them,",English
+"mix them equally and then inject. Where do we inject? We chose two sites. One is in the ovarian tissue, another is in the oviduct",English
+which is the mouse equivalent of a fallopian tube except it's very hard to inject in that and I'll mention why.,English
+"And then you wait for the cells to form tumor and then of course, isolate DNA and study the barcodes. The gene that we chose was LRRC15",English
+it's a cell membrane protein and worked from here at Mayo by colleague Dr. Shridhar discovered this gene when she compared the genetic changes,English
+in the debulking surgeries and that of the mental mets and found this gene to be upper regulated in the mets for ovarian cancers.,English
+"And later, I was part of this the other study where later, her team described the mechanism through which LRRC15 promotes metastasis.",English
+"So it's a good gene to have in the study to model metastatic events clonally. And of course, this is the later half of what happens",English
+after the disease is developed. So you isolate DNA and then you barcode sequence them and then you put the data through a data analysis pipeline,English
+"that I'll briefly mention. And this pipeline is fairly available in GitHub for anyone to use. And for those who want to know the complexity,",English
+this is the slide I didn't wanna show to scare off anyone who was actually otherwise interested in pursuing this line of research. There's a lot of multiplexing that happens,English
+"to make it practical, doable and also cost effective for a research labs to carry out. But the good news is the computation effortlessly handles",English
+"the data to unmultiplex. So deconvolute all the data and gives you beautiful results. And it was Dr. Kalari, (indistinct)",English
+"and her staff Xiaojia Tang, they contributed to the development of this clone-initiating cell calculator. And the details of the pipeline",English
+"is again simplified illustration of the pipeline is there and what it does is of course, it deconvolutes but also it actually takes care",English
+"of the error rate, the sequencing error rate and it also takes care of the thresholding that is required. We also have something called spike in controls",English
+"in the experiment. Again, I won't get into the details, but it helps us get absolute counts of these barcodes. So therefore, we could back calculate and actually find out",English
+how many cells were actually present in that tumor that is of our interest so we could actually start quantifying absolute clone size,English
+in that given tumor or tissue that we are dealing with. A talented surgeon from Beijing who was doing postdoctoral training,English
+at that time actually embarked on this study because we initially did not plan to inject in oviduct. It's a very challenging site in mouse to inject,English
+"because none of the needles that you have or you could source for me, would actually help us inject in that size. So we had to pull the capillary glass",English
+in order to get the right size and then use that as a needle to inject the cells in the oviduct. And this is actually a very good model because the take rate,English
+"is 100% and there's another postdoc, senior postdoc in the lab now, (mumbles) who helped develop the barcode libraries,",English
+"participated in this study as well. And you can see that injection of these cells are by around seven, eight weeks, you get quite lethal disease.",English
+You have to sacrifice the mice by then and I've put the experimental design on the right side so that it can follow the results.,English
+"And so you have the two isogenic lines differing in the single gene LRRC15 expression, barcoded, mixed together equal numbers injected in ovary or oviduct.",English
+"So what are the findings? So the first thing is we find that as expected, LRRC15-expressing clones,",English
+"not talking about cells now, I'm talking about clones, are more fit. You find them to be more fit in terms of their ability",English
+to grow in ovarian site and we inject the cells there or in the oviduct site. And please remember this is a competition experiment.,English
+We have both LRRC15 negative and 15 positive cells co-injected in the same site. So the clones are trying to compete,English
+with each other for resources. So it's actually a good way of comparing their growth dynamics. And also less than .05% of cells that we transplanted,English
+had the ability to develop into a clone. That's something to again keep in mind. Fits in with the theory that only a rare cell can engraft.,English
+"Even in cancer, not every cell has that ability and most of the cells, since they don't have the engraftment ability or cloning ability,",English
+they will actually exhaust themselves if they don't have a primitive cell to replace them. So therefore it's really important to study these clone-initiating cells.,English
+"And when you look at the, sorry, the slide has come out very not so clean but what it shows is metastatic clones",English
+"and non-metastatic clones of these tumors that developed. And you can see that majority of them are colored, that means they're metastatic.",English
+"Green or red doesn't matter. So that represents actually metastatic, you can see that most of the clones that were detected were metastatic.",English
+"So this is actually a highly metastatic disease. To begin with, this cell line versus established from a metastatic site. So you would assume that most of the cells",English
+"still have that features and would behave in that manner. And of course, the other nuances that you'll see that there's more metastatic percentage of clones",English
+in the LRRC15 positive arm of the experiment compared with the LRRC15. But then we also should remember that LRRC15 negative cells,English
+are not that fit. So it is among the ones that actually survived we see this distribution. That's something to keep in mind.,English
+"Now what happens when you're looking at all these different sites? Lung, liver like in whatever vital organs that we were able to isolate DNA and analyze barcodes,",English
+we see that LRRC15 positive clones actually outperforming LRRC15 negative clones in all those sites. There is some surprise waiting for you later the tail end,English
+"but with something to again, remember. So this basically gives you an opportunity to study clones and in this manner, study the effect of a single gene",English
+"on the clonal fitness. This again, slide has not come out really well, but we could also take this data and try to fit in",English
+"in a circus plot that were used to seeing for genomics. Basically, the outer arc represents various organs from which we have isolated DNA and analyzed barcodes.",English
+And now you can start seeing how these complex patterns of dissemination are happening. And the top row is a single animal,English
+"where you have deconvoluted the data and you're looking at the competing LRRC15 negative and positive clones. And just by looking at that,",English
+"you can already tell that LRRC15, there's a lot more complex dissemination pattern compared to the LRRC15 negative. And this enables us to now look at clones differently.",English
+"Now you have certain clones that you only find in the primary, you can see those green lines in the black arc region that's clones detected only in the primary tumor",English
+"at the site of injection. And then you have clones where you actually see them in one other tissue, one other organ. And then clones that you actually can find",English
+"in multiple organs. And then there are some rare clones that you can find everywhere. Now you can bend them as different clonal types,",English
+"then you can ask what is the influence of a gene on these different clonal types? And of course, these clone types represent the aggressiveness of the disease as well.",English
+"So within a growing tumor, you have all these different clones performing at different rates and we can quantify them now in any given experiment.",English
+And so this actually enabled us to look at the distribution and both in the oviduct site and the ovarian.,English
+"And you see that in ovarian site, you have these Toti clones appearing. CIC Toti. That is clone initiating cell with the Toti potent ability",English
+"that is found everywhere. So clearly, ovarian site, the clones are a lot more aggressive. But in general, LRRC15 positive cells, those clones",English
+"are a lot more aggressive because you see a lot more pluri, CIC pluri type. This is one way of looking at the data and of course,",English
+you can take all the barcode data and then scale them using multidimensionality scaling methods. And this is across animals.,English
+You see that all the primary tumors actually cluster together based on their clonal behavior and the other organs.,English
+"And something interesting starts appearing. The organs that are accessed through blood, which is the brain, the salivary gland, the heart,",English
+"they all start clubbing together. And then the ones that is close to the right ovary where it was injected, which is the right kidney,",English
+"I don't know what's behind that right kidney. But as I just send, and also the contralateral ovary, which is all peritoneal axis organs,",English
+"they all start clubbing together. And it's also very interesting to note that in oviduct and ovarian, irrespective of the site where we injected,",English
+"irrespective of animals that were injected, we were able to reproduce these differences very, very well. All the primaries were clustering together",English
+"in all these animals. So therefore, we started asking this question. Are the clonal behavior data, which is quite complex.",English
+You have clones everywhere doing various things. Can we use this information to somehow start understanding are there certain clones that have a certain tendencies?,English
+"The first thing that we did, this is basically coefficient of multivariate linear regression analysis showing clone size",English
+"that are observed in blood ascites and primary and then ask whether they're able to predict the clones that will appear in the lung, liver, spleen.",English
+"And you can see that blood is able to predict clones that would appear in the lung, liver, spleen and all the blood axis.",English
+"And then you also see ascites being able to predict leftover and/or mental metastasis, right kidney, etc. So that clearly seems like the clonal behavior",English
+"can be modeled and you could get something out of it. And of course, we did the histology to evaluate that. What we are seeing is not an artifact but real.",English
+So these are human-specific Ki67 antibodies tested on mouse tissues to show human ovarian cancer cell seeing the disease in these distant sites.,English
+"There was something done to validate that these metastasis events are real. And of course, this forced us to think on a per clone basis,",English
+"each clone has a very complex dynamics. It's going to different sites, doing many things. Can we use this information to now start understanding",English
+the relationship or there are specific behaviors that we could actually tease out from this data? And what I'm showing here is basically,English
+"these are Pearson correlation matrix matrix of every clone against every other clone. That information was fed into this again,",English
+"multi-dimensional scaling method or UMAP. And UMAP does a better job where you can see all these clusters appearing,",English
+each clone actually falling into one of these clusters. And now you can take those clusters and start actually looking at the metastasis behavior. So this is actually the highest resolution of a clone,English
+"doing its thing which is metastasis. But actually, you are now able to define these clones based on that common that is the shared properties.",English
+"And of course, what would be very interesting to know is the ones that would go on to kill the animal and what is the molecular property of those clones,",English
+"which is a question that would follow from this research. And of course, we train the elastic net model since we already became quite apparent that the clones,",English
+"the information was enough to probably tease out the blood route versus the peritoneal route of metastasis, we trained the model randomly using some clonal data",English
+"and then tested on the remaining data where we were able to show with very high degree of accuracy and predictability that the model was able to,",English
+"on a per clone basis, was able to predict the organs that would actually use blood route for metastasis or the clones that would use blood route for metastasis.",English
+And we were able to show that ovarian site injection in ovarian site you had more of these clones that would use blood route for metastasis.,English
+negative endocarditis so okay thinking about like um asic groups okay okay okay pretty good,English
+that part but um you know coxiella would be another one okay okay i could see that if he's he doesn't really frequent any areas where,English
+there would be um you know uh any ranch you know animals but it's it's it's he does go freshwater,English
+fishing and in florida those two environments can be mixed any other thoughts before we move on okay so it's type infection i'm sorry he has a hardware so it could,English
+be a step over here so indeed so any kind of staphylococcal um infective endocarditis is in play here um i concur with that so let's move on,English
+so his echocardiogram was positive for a small vegetation on the aortic leaflet uh otherwise there was nothing else um wrong with it so this is his microbiology,English
+so harish was on the money here so on both um uh october 20th of that year he had two out of two bottles,English
+positive for cardio bacterium hominis on the 23rd he had two out of four bottles positive for same organism 25th it went down again,English
+um and again by the the 29th his blood cultures were negative so the sensitivities for the cardiovascular hominis were uh,English
+penicillin ampicillin ceftriaxone cephp meropenem so it's pretty sensitive bug so let's talk about this bug briefly,English
+so it's you know it's a small uh gram variable bacillus but it's really gram-negative in in in composition it is oxidase positive it is catalase negative nitrate negative,English
+it does make biofilms uh can usually grows between three to five days but also um can grow up to three weeks and this um this um you know pictograph here from the,English
+journal of clinical microbiology shows eloquently what the uh the gross micro plate looks like and then going all the way up to a,English
+thousand x where you can see that they're you know these gram variable bacillus but there are gram negative in origin so they have more they they retain more that saffron red so,English
+basic organisms causing infective endocarditis so again you know cardiac implantable devices pacemakers these shield grafts are classic for this a lot of them have congenital heart,English
+disease um and again two to three k they're two to three percent of all infected endocarditis and so what does haysec stand for so it's hemophilus agricobacter which,English
+used to which used to have another genus name bacterium which is one of the ones that which is the one that this patient had iconella and kingella so again they're all gram-negative facilious bacteria,English
+so the treatment guidelines this is what's interesting so you know the american heart association says that you can either use ceftriaxone ampicillin or even ciprofloxacin um for about a,English
+four four week period um the europeans have different uh kind of similar but do have a little bit of a different uh view on on what to do with ampicillin,English
+so they actually add genomics into this regimen um you know for for this for the allotted time of the ampicillin dosage so because there's some inherent resistance to,English
+penicillins that's why the europeans say they do that um however the the data is kind of wishy-washy so uh but what we did was is that you know,English
+i started this patient on he was he was on maripenum for some reason when i saw him um and then i ended up switching him,English
+um to penicillin itself uh and and not adding the gentle myosin and he did well and recovered and did not have any other stigmata of infective,English
+endocarditis questions okay move on to case two 54 year old man day 20 out of an allography um hsct,English
+for mds this was done at shan's uh he was neutropenic for a period of 35 days after induction chemotherapy so he has a,English
+productive cough fevers and shortness of breath so of course the oncologist had him on stuff being vanco and fluconazole,English
+and he had no improvement so besides not am i apologize it's mds um uh he had a ton of selected me that's the only other past medical history that's pertinent,English
+so he's on vancouver cepheum and fluconazole he doesn't have any any drug allergies so social history he lives outside of gainesville,English
+not really rural but in one of the suburbs originally he's from new york new york he has no habits he's a former high school teacher he recently visited his daughter and who,English
+moved into a new apartment in north carolina in the piedmont area otherwise he's had no other travel to new york city to see family,English
+hobbies he likes to watch baseball so physical exam he's febrile at a 38.6 he's tacky to 106. but otherwise he's hemodymically stable,English
+he is on two liters of oxygen and they know nasal cannula um so his he does have dry mucosa he has tachycardic um he does have,English
+coarse breast sounds bilaterally worse at the apices than at the bases he doesn't have any stigma of infective endocarditis,English
+so of course his anc is um you know 100. his platelets are 53 000. he doesn't have a normal creatinine though it's just x-ray is is as shown,English
+um so it looks again he's got this interstitial pattern bilaterally worse on the left and on the right based on the um,English
+on the rheumatography so somebody gave me a syndrome diagnosis for this patient she's a 54 year old guy with mds now he's,English
+um you know status post uh stem cell transplant he's still uh neutropenic and now he's got um you know a respiratory process that,English
+appears uh bilaterally so give me a differential diagnosis for this patient,English
+um so it could be pneumonia um multifocal pneumonia um and within pneumonia it could you could have you know,English
+fungal ideologies bacterial ideologies were probably the most common um uh you could also have i don't know diffuse every other hemorrhage would,English
+present like that but that would be another thing you got to think about i forgot to look at his um counts but that's something that could be you know the differential i guess okay so what,English
+um okay what organisms you said you were a little bit general in there in terms of organisms so so he's on vancock beam and,English
+fluconazole so um and based on his own on where he's been uh any specifics um i mean i think you have a little bit of blasto,English
+um isn't quite go up to you know um all the way to i mean he grew up in new york so um he could have a history of bluffs so another way to,English
+travel if he traveled out west or midwest you'd also have hysto as one of the differentials okay yeah he he did not do that he,English
+um recently like i said was uh um you know what right before all this went down he went to visit his daughter in a new apartment,English
+um like about a month and a half before getting in there uh and then um presenting this way so let's keep going so uh the,English
+the hemant team was worried about pneumocystis and so they started him on iv cotrimoxazole which is bacter right and so uh they consulted us to try to find the souls,English
+so i requested that my team requested to get a bronchoscopy and pathology and microbiology were sent um the patient did improve on,English
+cotrimoxazole though which is strange right so uh you know the gms stain was negative for pneumocystis uh interestingly the bals brazilian demand it was negative as well,English
+so what happened i want somebody to hypothesize why this patient got better on bacteria,English
+don't could it just i mean i don't know i mean you're saying why they got better impact but i'm just thinking could the could it be totally unrelated to the background,English
+could it just be like a viral i don't know i'm just thinking like they're also like viral pneumonias as well that could occur yeah for sure i mean you're bringing up a,English
+good point um again this is that's reverse occam's racer right you know it's like you know what's common is common you know and it could be all this was completely um you know,English
+at um you know at face value and it is what it is as people are saying these days but that's not totally what happened,English
+this is what happened can somebody describe this for me what is that so this is jamie on the line jamie morano i'm,English
+i'm gonna i'm gonna embarrass myself but it is a charcoal agar right and uh charcoal meaning um i believe it's hemolyzed red cells,English
+right um and it's mixed and it's a bc uh why uh legionella i i'm i'm a little bit rusty so forgive me but it's a it's a,English
+special type of agar that um has special growth um and it's i'm trying to think if it's help me out but uh i'm gonna stop there but it is a special i believe it's a,English
+special auger and it's either legionella or something yes go ahead so the good doctor murano is completely correct,English
+this is legionella um and so it is this auger is used as a diagnostic tool um when you do a bal or a speuta,English
+to look for legionella okay so um it's again it's a gram-negative aerobic rod um it has flagellae um and so it's oxidation-negative,English
+catalase positive produces beta-lactamases interestingly enough um again water sources are are its primary,English
+um you know ecology and chlorination really doesn't kill it as well as as we would think um and so one of the things that can,English
+happen is is that you can have this um you know trojan horses effect which i'll talk about in a minute um and what it does is that they infect through living amoeba,English
+and can hijack their um their cells by their their the cell by um instituting a cyclic amp mechanism inside of their um um,English
+euphagga zone and thereby controlling the the cell so it's not digested so this leads down to a trojan horse effect,English
+where you know error this is how aeromonas mycobacteria and other pathogens can get inside the body when they find,English
+what the the the similar cell in the human would be a macrophage right compared to an amoeba it's just an amoeba divide macrophages don't,English
+and so what happens is that then these cells can um these bacteria can get inside these cells and subsequently hang out and then come and attack when um when the time is right,English
+so legionella again is famous uh for being associated with air conditioners aerosolized water sources note he went to visit his,English
+daughter in a brand new apartment in north carolina which is where we thought he um uh he acquired the organism,English
+so for diagnosis he um you can you know you can get a urine legionella antigen or again like like uh you know the good dr morano said,English
+you can use this this charcoal auger uh to uh um to identify it so you can use macrolides or fluoroquinolones for treatment interestingly enough though bactrim or,English
+septra works it does penetrate cells and can get in there and again you know kill the bacteria so um,English
+he improved this is why he improved on on this on backdrop and he was given a 21 day course and you're like well you know anthony does that make sense,English
+usually you treat for you know anywhere around a week for you know for normal legionella however within him being immunocompromised and,English
+using another antibiotic which is not a macrolide in this case the sulfur usually give a longer course and that's why he,English
+had a 21 day course so again think of legionella and this is why you know patients who were on bactrim prophylaxis for,English
+uh you know for pneumocystis you know not only does it take care of that and also um you know toxo but it can also impact them being infected with things like listeria and legionella,English
+since it is covered as those this drug also covers those organisms as well questions on case two okay so let's move on to case three so,English
+this is actually courtesy of um my ex-mentor at ucsd who's not at yale uh joseph bennett's and he published a,English
+paper back in 08 the year before i uh joined uc san diego for fellowship of an amazing case and you can read about it in in um you know the journal of chop med which,English
+is the journal for astmh um and um it was a pretty cool study for what happened from one case so 79 year old woman was found,English
+down by a neighbor and was admitted for obtundation so this is at an outside hospital okay so she was confined to her home after,English
+suffering a back injury from um you know from degenerative disc disease it's been going off for months uh she lived in a very rural area near,English
+hemet california which if anyone knows that's where the joshua tree national park is so it's basically high desert um,English
+and there's not a lot of um amenities around i should say so his past but her past medical history is pertinent for osteoporosis,English
+and degenerative disc disease like i had mentioned hypertension so she had no no no no drug allergies and her only meds she was taken at the time when the pro was naproxen doesn't have any family history of any,English
+dementia cardiopulmonary arrest or anything else that would contribute to her presentation so she's widowed she lived in southern california her whole life um until she moved to hemet about 10,English
+years ago and then was a former school she was also a former school teacher she has two dogs um according to the neighbor the house,English
+is very cluttered and she could be defined as a hoarder so she arrived to her local emergency department in,English
+hemet and her temperature was 38.2 pulse was 110 her blood pressure was 121 over 60 and oxygen saturation was 80 percent on,English
+room air she was arousable but oriented only the person um auscultation of her lungs showed crackles at the left base and the abdomen was soft no no no bowel,English
+sounds no lymphadenopathy okay neurological exam showed no focal deficits on the fact that she was not arousable so her leukocytosis was pretty,English
+impressive at almost 47 000 and it was 19 percent bands so she had a um she had a renal dysfunction with a,English
+creatinine of 1.9 and elevated transaminases ast was 336 alt-59 chess x-rays showed i don't have it here,English
+um but the only thing it showed was lower left lo left lower lung atelectasis so she received a diagnosis of cat,English
+basically was given a dose of ceftriaxone and then they gave her ivs you know amstel back to him and at one dose of levofloxacin so she did okay,English
+and she was starting to wake up however uh 48 hours later she crashed again and she know her renal failure got much worse or her crap and got to 4.2,English
+um you know um her platelets went down to 54 000 and um she had a pretty bad metabolic acidosis so she was transferred to uc san diego,English
+medical center in hillcrest which is the southern hospital near downtown on day three for further management um sure soon required intubation and was on ihd,English
+um in the icu so this is where i think it's interesting so the results from the outside hospital showed that um,English
+she had one positive blood culture going what they determined was a gram-positive bacillus and they said it was a contaminant so they really didn't work it up um her ldh level increased to almost 3,English
+300 okay and there was tons of system fights in the peripheral smear her pt and ptt were starting to go up and um interestingly enough for blood cultures,English
+when she got to use csd were negative so they entertained the diagnosis of ttp and they started they were going to start on plasmaphrases,English
+unfortunately her exam changed so these are pictures from her exam um this is the picture on the left is an area of necrosis on the back of her right shoulder,English
+and then this is her right foot where um her toes were starting to become necrotic um you know and they took a biopsy of this and it showed there was dermal necrosis you know,English
+impressive acute inflammation and small vessel thrombosis nothing was identified in terms of microbiologically so the,English
+ampicillin cell bacterium was changed to ameripenem and she started receiving genomics and as well so she was went into distributive shock occurred again and was placed on base,English
+suppressors so her ct scan is pertinent for you know large gallbladder but look at the at her um the cortical,English
+areas of the kidneys it's almost complete just destruction bilaterally of the kidneys,English
+um anyway so go on,English
+remind me of a performance um so like microplasma would be another thing i would entertain outstanding right so that's one thing i would entertain and another thing she came from remote part,English
+of the woods um i was thinking about like tick-borne like in terms of borrelia rick um tick-borne relapsing fever,English
+um i mean i i i i gotta take a do a little more research into you know in terms of representation but i think you could present like pneumonia,English
+um like that so so it can usually there's an uh a a undulate fever with with you know with the uh you know,English
+recurrentists and so um it you'll usually see the fever pop up every five to six days they usually don't get this this incredible uh,English
+distributive shock though but it is a good thought she could have multiple organisms going on depending on what's you know since she has a hoarder and who knows what's biting her in that house,English
+there are like some necrotic skin changes could be like a clostridial kind of infection maybe anaerobic,English
+no i mean i don't i mean i'm just throwing out tb out there but i don't really think that can explain the skin issues but,English
+i mean disseminated tb yeah it can give you a pretty damn bad fever in fact you know in in parts of african asia it is the,English
+after malaria it's the you know second most common cause of fever so um and if you were to tap patients who you suspected to have,English
+um you know mycobacterium infection you know up to a third of them could have positive blood cultures for tb but why um again she really wasn't,English
+came out of russia um it was actually endemic plague so you're thinking about a hoarder you're thinking about maybe some rodents some fleas um you know maybe some ticks in there i agree,English
+um so um i it's interesting i mean your cindy pestis right can can present his plague i was thinking of anthrax if she had any,English
+you know animal skins or old rugs or something or some spores that might have come in from the environment it's obviously a grand positive rod but um so something like that you can get,English
+pulmonary anthrax you can get skin changes from that as well as cars but absolutely tick-borne um you know having a fluoroquinolone on board and adopts a,English
+people travel and so you've got to think of this now i didn't tell you what what time of the year this is usually they see a lot more haunted hantavirus cases coming from the four,English
+corners area which includes part of of you know southeastern california the desert area but they usually see those cases in the,English
+spring because people are are you know opening up their uh they're cleaning out their barns and their or their sheds and their deer,English
+so this is what um joe did so um the microbiology lab at the outside hospital um you know he called them and said hey,English
+uh we want you just to isolate the you know bring the isolate to us so we know what we can work it up here at the university um and so the outside,English
+hospital at the time told him um by the way we redid the gram stain and it's a gram negative rod,English
+so the the isolate did come to the to the micro lab um but the patient continued to get worse and,English
+they were having i mean at this point she was already on three pressers they couldn't you know her toes were falling off and and she was completely in uric almost by this point uh so the subculture the original,English
+isolate again like i said was that you see you know uc san diego um and it showed a slow growing um small organism with small colonies known to be cocobacillary with bipolar,English
+staining it was non-motile and it was a non-lactose fermenting gram negative rod and so this is for the pathology seen from the um from one of the skin,English
+biopsies i think from the back and so you can see that there was a faceman of the epidermal layer from the dermal air and there's an impressive amount of hemorrhage,English
+and a lot of what looks like could be lymphocytes or or or other mononuclear cells that are coming in here,English
+um and again this is a um i guess a 400 x of that area and and again it looks again you can see the the destruction,English
+this is x and you see that there is what looks like a lymphocyte i mean a neutrophil rather and then you see this small this is an h,English
+and e stain though okay um you know single organism that is bipolar staining so you're thinking that this is,English
+um an enterobacteriacea it's causing this kind of picture so that evening um which of course they identify the organism as,English
+your cenia pestis okay here is a a small funny anecdote about the story a nurse that was um taking care of the,English
+department and the cdc got involved uh they moved the patient of the room and then they sent the fleas to the health department they were determined to be fruit flies actually from uh somebody who brought a fruit basket,English
+into the icu um which was put in the paper was slightly amusing uh the so the patient received 10 days dose of 10 days of um levogen and doxy uh she had,English
+extended hospital stay she was again remained in europe did not want to go undergo dialysis and so she basically succumbed from her uremia,English
+so this was this was plague um and so um septicemic plague to be exact and so um the cdc in the california,English
+department of health got involved like i said and so what they did was is that they captured squirrels dear mice um on her property and then they noticed that there was a deceased,English
+lagomorph or rabbit basically on the property and so they took blood from that and they also took blood from two of the patients um blood from both patients from the patient's two,English
+dogs and so um three of the two two of the three ground squirrels tested positive for antibodies to white pestis,English
+with extremely high titers of one to two thousand forty eight suggested that they had a recent more than likely had a recent infection,English
+um one of the um one of the two dogs tested positive um with antibodies to white passages to one to 64. and the rabbit's blood was positive for white pestis indicating that the rabbit,English
+probably succumbed to plague so let's talk about yersinia pestis so again um non it's a non-fermenting,English
+gram-negative rod intravectory teriyalis as the good dr mercurio said last week or the week before and um the treatment,English
+is really amino glycoside detector cycle you can use a fluoroquinolone it's kind of even though it's part of the regimen there is some debate about it in terms of its,English
+immunosuppressing effect but i'll get to that in a second so there's this 42-hour period to make the diagnosis and there's a reason for that immunologically so anybody who has,English
+exposure um usually gets a tetracycline and then maybe a fluoroquinolone so be a lactams are contra indicated,English
+interestingly carbohydrates may not be um there's an ongoing study right now that i'm part of a phd committee at still at the university of florida the,English
+lake nona campus of a phd student who's actually looking at um how fluoroquinolones could,English
+impact the immunomodulation uh regarding um you know infection natural infection to your cenia pestis and the column 92,English
+united colorado 92 strain which is the standard bearer for for a white pastus and labs and so the reason that beta-lactams are contraindicated is because when you,English
+start blowing up your cynia pestis in the bloodstream it's not just the lps that's the problem so yersinia also has these things called,English
+yachts or your senior outer membrane proteins and there yeah there are some in enterocalica,English
+and also pseudotuberculosis but the ones that really cause disease are associated with your cenia pestis and they do the following,English
+so they they produce one of the parts of the of these yachts produces a soluble il1 beta receptor and so what that does is that chews up,English
+um ila um il1 beta um you know globally and so that again reduces the immune response at the beginning,English
+it also creates an uh one of the ops is also an enzyme that cleaves il-18 and thus really de uh depresses the immune response,English
+uh within that first um 24 to 48 hours um and again uh but around day you know around hour 40 things start to surge so this is a taken from a cytokine,English
+frontiers paper a couple years ago and it demonstrates the il1 family of cytokines and um and you know i know people are probably like snooze but it's kind of important because,English
+if you know we know that that these yachts impact two huge parts of the aisle one family,English
+then you know you have to understand why why starting a a beta lactam um if you're thinking that pestis is is the causative,English
+organism might not be the best option in addition why there's this indolent presentation and then finally an explosion basically of of the immune system um,English
+uh presence to the organism so as you see here what um you know il1 alpha and io and beta,English
+they they stimulate through capsaice one they can stimulate il-6 il-21 il-23 and that's usually done through a th17 cd4 cell and what does that do so um,English
+again this causes this would depress neutrophils from getting into places um like the you know you know like the mucosal areas of the body including the lungs,English
+um and this is what the io one receptor will do is to block this so aisle 18 which also goes through kind of this,English
+caps capstace one um stimulates il-12 to be stim to produce il2 il15 and what do they do well they do a broad range of things,English
+whether that's a th1 response for these cd4 cells to stimulate cd8 to destroy macrophages that are infected after interferon gamma is released,English
+and then you've got um again the same thing with it like i just said cd8s then gamma delta t cells in the mucosal area are also stimulated,English
+and they can um they produce interferon gamma same kind of thing they can also lyse macrophages as well and nk's as well and then you've got,English
+il-33 and l37 i'm not gonna really touch on them but they can stimulate more of a th2 or t-reg response to um,English
+um which causes this anti-inflammatory like picture and can uh can kind of partake into what's going on with infection so um i'll update you at,English
+some point with regards to um uh the phd student's um efforts she's halfway through her phd uh and getting some pretty interesting,English
+results in terms of some other cytokines which are probably um um affected by why past disinfection,English
+any questions on case three anthony yes it's john um this is obviously a potential bioterror,English
+weapon and that anytime that somebody rolls into an ed with bloody sputum a hemorrhagic type of that should really get your attention if,English
+you get two or three rolling in pretty closely together that's when you need to really let people know that you think there's been an event and you know essence would probably let us know that,English
+as well um the way we used to talk about this during the bioterrorism presentations that we used to do was that bipolar staining on a waste and stain although nobody does a waste,English
+instinct anymore and the whole issue is profi uh i mean you have to profit basically everybody that that person was around which can be difficult,English
+and with this one there was a similar outbreak in colorado with a guy who went to see his friend and friend had a cat and the cat seemed to,English
+be sick and crawled under his house so the guy went under the house to get the cat took the cat to a veterinarian who was really concerned because this cat had an appearance that he thought could,English
+be plagued and um it ended up that the one guy who went to visit his friend ended up with plague and um,English
+he did survive but you know they had to go out and then treat with insecticide i forget how men it's a huge area around,English
+in this guy's house to try and kill all the fleas off so it can certainly happen this way but you know the other concern is a bio-weapon,English
+event to be really cautious about right and i think that you know whenever you see a gram positive rod on a blood culture uh you know don't assume it's just,English
+listeria or um or you know part of the serious group or something else um you know actually ask them to do some,English
+some old-fashioned microbiology and i think we've lost a lot of this in id where you know if you see that it's basil species and it's sport you know it could be spore forming ask them to do a motility,English
+test if it's non-motor you've got anthracis you know these are things that um you know i learned in fellowship that you know we take for granted and just go on to the next case but again like,English
+you eloquently said this is a lady who is from literally high desert california she's a hoarder she's got dogs and there are animals on,English
+the property and she grew this this organism on the blood culture and an astute microbiologist would make sure to do the gram stain correctly in this case it was not done correctly,English
+and that's why it was a gram-positive rod um and they kind of blew it off unfortunately and so which could have led to her her diagnosis,English
+and probably proper treatment earlier um you know again you know monday morning quarterback uh it kind of comes into play but at the same time,English
+fedex plague across southern called well he no he was just trying to get the isolate to do the right thing microbiologically um because he did think that the,English
+presentation was strange um and that that generated a whole hoopla of cdc and stuff like that yeah and and it's also important i mean,English
+like you say the old microbiologists would note that these colonies are really mucoid and you get a string test from them when you're pulling them off the plate they they do have that kind of mucoid,English
+stringing like appearance so um but it's a great case thanks yeah so um let's move on to the last case this is um uh this occurred this is what you're,English
+looking at is donovan state prison near the border of california and um uh baja california mexico and as you can see here's the border,English
+and you can see that there's tons of houses on this side of the border and nothing here except for a prison so this console came in,English
+on december 31st 2009 so and you're like well who cares well it was the middle it was the um the last day of that rotation,English
+as when i was a first year fellow and it came in of course at 4 pm so the fellows can kind of relate but again this case illustrates that you've,English
+really got to be on your toes regardless of when it is and what day of the rotation it is so patient is a 39 year old african-american guy who presented to medical center hillcrest from,English
+ucsd who was found unconscious in his prison cell three weeks earlier so the nursing notes stem said that you know it was one month history of worsening confusion,English
+prior to him showing up to the infirmary and then subsequently to ucsd so the chart noted that he had during his internment uh you know at the prison,English
+he had global weakness and a 60 kilogram weight loss over the last year so the chart noted methamphetamine used but quit about 2-3 months before this,English
+so he was admitted to the to the micu in hillcrest with progressive neurological decline he was in the ventilator in a coma and he had this uh you know this fluctuating temperature rage with pretty,English
+labile temperatures so his past medical history had bipolar disorder we really don't know his family medical history from the chart because,English
+we couldn't talk to him social history he was married no other recent sexual partners and there was no uh msm documented uh he lives in el cajon california which is an eastern suburb of san diego no,English
+pets i um the chart did you know state that he had cocaine heroin and amphetamines known in the urine on a talk screen was a tobacco user no alcohol use that,English
+we could that we could decipher and no obviously no recent travel he was incarcerated so no known drug allergies and his only meds was lithium and he wasn't getting that,English
+at the prison so vitals he was you know had a temperature of 38.0 pulse of you know 110 blood pressure was you know slightly,English
+elevated diastolic at 95. so it was ventilated today's thin guy um no lymphadenopathy he definitely had temporal wasting,English
+he had reduced breast sounds bilaterally um he did have some hepatomegaly interestingly enough and there was reduced bowel cells um he,English
+did have reduced deep tendon reflexes so uh his labs his white count was within normal limits uh zamatake was 29 and stroma sites was,English
+131. so alt and alt were asc and lt were elevated total protein was 4.9 albumin 2.1,English
+bilirubin was okay they did a lumbar puncture um about a week before and his white blood cell count was 178,English
+um with 81 lymphocytes um and uh red blood cells nine glucose 27 his total protein was 730 730. so the mtb pcr was pending at the,English
+time and so was the coccidioides caution fixation his hiv antibody was negative and his igg total and the subclasses,English
+were within normal limits so i will do the syndromic diagnosis for him 39 african-american man um who is incarcerated with neurological,English
+uh compromise due to a chronic likely infectious process which based on presentation and data demonstrates dissemination of the pathogen i suggest to the fellows this is how you,English
+put it in the chart this is how you do the impression in the impression and recommendations and i know that's a culture shock but,English
+for billing purposes this describes exactly what's going on with the case number one number two it describes to who's reading the note,English
+that you're what of what you're thinking and you're like well you know people don't read the notes but this was important because what was in the chart is what kind of led to the diagnosis on this patient,English
+and again if notes are not written in in a way where people you know physicians other physicians and other clinical um you know parties can understand,English
+then it could lead to a delay in diagnosis such as in this case so chest x-rays is shown um really not helpful,English
+um a little bit of haziness on the left-hand side um and and some some interstitial pattern but,English
+nothing really to to um to walk home about so here's ct thorax there's a little bit of what looks like,English
+a rind kind of forming here in the lung uh some wispiness in the left uh near in the lingula and this is i believe this is the superior,English
+segment of the uh left uh inferior lobe which is kind of encased in in a material there ct head just shows uh slightly enlarged,English
+uh ventricles but otherwise okay and mri just shows that there was that there's some kind of inflammatory process going on in the posterior um horns of the lateral ventricles and,English
+again it was motion artifact but there could be something going on with with within the brain stem here,English
+so i'd like a differential diagnosis based on my on the radiologic data that i showed you and also the syndromic diagnosis that i gave you follows first please i mean you got,English
+you got always considered syphilis um neurosyphilis okay not a bad thought anything else,English
+this is jamie morano i i think this is this is a great it's definitely a great case i think the desert is really maybe key here um i've always uh the boards love to ask about desert arthritis right,English
+which is coxio um crypto may be less likely unless there's some kind of t cell deficiency or hep c on board which you know is interesting too um and um,English
+yeah no definitely something uh causing systemic function i think that the brain is lighting up from from that as well um but that would be i see it's hiv negative that's that's reassuring,English
+um also contaminants of drugs um i don't think it would cause that long a weight loss and then of course ntm really wouldn't cause the the fevers per se i was thinking leprosy were talking about the tendons and the nerves but it sounds,English
+like they weren't um thickened which would you know and obviously leprosy doesn't prevent like that the hansen's disease but um i would i would think of coccidogoses or some kind,English
+of desert related infection um blasto histo of the spine um could be maybe a dimorphic fungus of some sort,English
+um we think of fevers and and weight loss maybe with the fungal families that's that's just my two cents yeah outstanding i think that to to piggyback on that jamie you know,English
+um you know cryptococcus gadia is endemic along the coast of california going all the way up to british columbia,English
+and and and we're starting to see that um you know patients who are immunocompetent in this area because there's so many eucalyptus trees which the fungus feeds on that they can,English
+actually you'll see cases of this in immunocompetent people so it is a great i do agree it's a great thought anybody else with any kind of um,English
+differential diagnosis okay well we're getting close to the end so let me just get to it,English
+so the mic you wanted to give them glucocorticoids for the brain inflammation i mean they probably should have done that three weeks before but hey you know whatever,English
+um but our differential diagnosis was disseminated michael bacterial tuberculosis and also coccidioides so glucoricoids,English
+and disseminated coxy infection are contraindicated doing that could cause a huge huge huge problem i saw tons of coccy in california and that is a big no-no but we need,English
+another sample to determine the pathogen so what do you do now fellows this is you and now it's about five o'clock after,English
+you reviewed the chart seeing the patient looked all the data you need where what else would you do did you get the blood um antibody for coxy,English
+okay so common fixation which was sent it's in process i think you mentioned it you did have hepatomegaly so you could probably go after an,English
+abscess or a lesion in the liver okay good thought any other thoughts before i move on quickly,English
+and i'm sure john tony will echo this and everybody else the devil's in the details in these cases so you've got to re-review the chart so the patient reported flank pain,English
+initially when he came to the infirmary in his review of systems that was not in the history and physical when he when he was brought up to the icu so we recommended a stat ct abdomen in,English
+pelvis this is what we found um as you can see here um this is his left psoas muzzle and there is something necrotic going on in the middle of it,English
+um this is the coronal cut and you can see that both l1 and l2 are being destroyed by something,English
+and as well this very large longitudinal psoas abscess going into the iliopsoas part of the muscle this is the sagittal section cuts of,English
+both the l1 l2 vertebra again kind of collapsing um posteriorly though not anteriorly and you can see that there was again,English
+this um huge pus pocket um fluctuance rather within the um uh within the source muscle so i we told ir to come back into the hospital from,English
+their new year's eve party and they did see guide aspiration and got 20 milliliters of extremely pure material um i walked a specimen down there myself at around 7 30,English
+to the micro lab and we sat there in the micro lab until we got a result which was about about two hours later and the gram stain was shown a heavy,English
+inflammatory infiltrate but there was heavy afb so we started him on on right vitamin b6 of course and glucorticoids,English
+at about 10 pm in three weeks m tuberculosis grew was pain sensitive unfortunately because of his neurological complication was so,English
+profound that he died five days after beginning treatment so again i talked about mtv last time so i'm not going to go through all this but i will go through a little bit of the,English
+history and some of the path of his um you know again because it's important to know so in ancient egypt it was noted uh middle ages as well they associated,English
+with vampires um dr richard morton from germany uh just i'm sorry britain described these as lung tubercules in these patients and then dr johann lucas online of sean,English
+of the genetic evolution of melanoma from precursor lesions. And this elegant paper that was published in the New England Journal in 2015 highlighted a number,English
+of cases of melanoma arising in the setting of precursor lesions. They had about 40 cases or so.,English
+And I'm going to show you the main upshot of this article. So you can see here that this was a sample case where the essentially took an area where there's,English
+"melanoma arising within nevus. And they laser captured these areas out, and then they did some genomic analysis.",English
+"And what they found, one of their important findings was that in cases where they had a BRAFV600E mutation which we know is very important in initiating melanoma",English
+"or was thought to be, it seems that there's a dose dependent increase in levels of this MAP kinase pathway activation under BRAF.",English
+"So in the area that was nevus, there is one copy number or equivalent. And as they move through intermediate to invasive areas,",English
+"they move more towards biallelic activation. So in this sort of dose-dependent activation, MAP kinase was found to be important,",English
+but not to forget that some level is found even in the nevus. And we'll get back to this point.,English
+Their second main finding was that in areas where they had nevus versus melanoma in situ-- so early melanoma versus invasive melanoma--,English
+they also found that there was a similar dose dependent loss of the CDKN2A locus. And we know that this encodes the very important tumor,English
+"suppressor P16, and also p14ARF. And they found that in nevi, CDKN2A is largely retained. And then, as you get to malignant and frankly dangerous",English
+"malignant behavior, we oftentimes are losing or have biallelic inactivation of CDKN2A. So amongst their 40-some cases, what they did in this table is",English
+"they arranged from benign, to intermediate, to early malignant, to invasive, to metastatic melanoma. They arranged the mutations that were found in the lesions.",English
+"And so they found that BRAFV600E, which was thought to be very important for melanoma specifically, is actually an initiating mutation",English
+in benign lesions. And probably this initiator is necessary to allow solitary or single melanocytes to even form clusters,English
+"or nests to begin with. And then, as you move into the malignant areas, secondary mutations are oftentimes",English
+"very important to acquire. And so not to belabor the individual mutations that are listed here too much, but to say",English
+"that frequent themes that we're going to see and touch on are that mutations in the TERT promoter which encodes for telomerase, activating mutations",English
+in this gene are important in melanoma and seem to happen frequently in melanoma. You'll see TERT appearing here down in the invasive camp,English
+"pretty frequently. And similarly, loss of CDKN2A in deletions of this locus. So I'm a simple minded person.",English
+It's a lot easier for me to remember broad themes. And the broad themes for me are there are melanoma suggestive or specific events.,English
+BRAF and MAP kinase activation by itself is not one of them. But usually these activations of telomerase or loss of important tumor suppressors such as CDKN2A,English
+"are quite important. All right. So this has become largely the canon in the thinking now,",English
+"is that nevi through exposure to ultraviolet radiation will acquire some activating mutation, usually in MAP kinase, like a BRAFV600E, or an NRAS mutation,",English
+"or loss of NF1 can lead to nevi, whereas intermediate lesions will collect other mutations, either NRAS, other NRAS",English
+"mutations, or more deleterious TERT mutations. Early melanoma in situ oftentimes will require something like a TERT promoter mutation.",English
+"And invasive melanoma will acquire a whole bunch of other things, including loss of CDKN2A, and then eventually in the metastatic setting, loss of P53 and PTEN mutations.",English
+So very important tumor suppressors tend to be lost later in the stage. It's found that in the different varieties or varietals,English
+"of benign lesions in their subsequent melanoma cousins, there are specific mutations that tend to cluster.",English
+"So in common acquired nevi, BRAFV600E, NRAS, NF1 are usually the initiators. In acral or mucosal nevi, it was not",English
+"identified what the initial mutations are here. But it's found that KIT, it plays a very important role. In blue nevi, oftentimes GNAQ or GNA11",English
+"are going to be the big time initiators. And in blue nevus-like melanomas and uveal melanomas which share a lot of the same genetic abnormalities,",English
+"oftentimes loss of the BAP1 protein or other events like CDKN2A or P53 are present. And then, in the Spitz family, this is very important.",English
+HRAS activation or a receptor tyrosine kinase-- usually in MAP kinase--,English
+"are going to be fused, and we're going to go over that. But in Spitz melanomas, still, we need loss of these CDKN2A loci frequently.",English
+"So we're going to touch on this a little bit. Right now you may be wondering, why is he quoting all of this sort of genetic and word soup?",English
+Where does all this fit in? And I thought that this figure from this recently published paper in the Journal of Investigative Dermatology,English
+did a really nice job of summarizing the genetic pathways and showing us how these genes interact. So MAP kinase is a very important growth,English
+signaling pathway. BRAF is one of the important constituents. The genes that are highlighted in red are overactivated in melanoma.,English
+And so BRAF activation or NRAS activation upstream of that is very important. Loss of suppressors of this pathway--,English
+so NF1 or PTEN-- are also very important events. And we see these in common acquired nevi,English
+"as sort of initiating mutations. In the Spitz family, oftentimes we're talking about these receptor tyrosine kinases that are upstream.",English
+And it's oftentimes fusion events in these genes that lead to Spitzoid morphology which we're more familiar with.,English
+The blue nevus family and uvial melanomas are really in this GNA11 or GNAQ category. And these probably give rise to these spindled,English
+and elongate dendritic melanocytes that are more dermal. And the pigmented epithelium and melanocytoma family,English
+"is oftentimes associated with these PRK genes. And then later events that are more specific to melanoma,",English
+"oftentimes they happen in the nuclear compartment. So again, TERT activation, telomerase activation, loss of CDKN2A, loss of P53, addition of SF3B1 or EIF1AX.",English
+These are important secondary mutations in the blue nevus family. So this is oftentimes the second hit that will allow for frankly malignant behavior.,English
+"So this, I think, is a nice summary slide of how these pathways all interact. So the WHO classification of melanoma",English
+"was updated from the 3rd Edition in 2006 to the 4th Edition in 2018. And I would say, in my humble opinion,",English
+"this was the most interesting update of this tumor book, was this reclassification of melanoma into these pathways that are largely",English
+"based on the genomic alterations, rather than the histomorphologic pattern that is observed. And so I'm going to show you that table briefly.",English
+"And I think this is a table also worth spending some time with. If there's any one table in the Skin Tumors book, I'd say this is the one to pick out.",English
+"But what you'll see is that essentially, they organized all melanomas into these nine pathways that are based on largely what is the endpoint of the pathway.",English
+"Whether it's low chronic sun damage melanoma, which is formerly known as superficial spreading, versus high chronic sun damage melanomas, lentigo malignas,",English
+"desmoplastics. And then melanomas that have low or little sun exposure related to them, so Spitz melanomas, acral melanomas, mucosal melanomas, melanomas in congenital nevi,",English
+"and blue nevus-like melanomas, and uveal melanomas. So sun exposure is a very important theme here for the mechanism.",English
+And then the different sort of pathways are organized based on their endpoints. And you'll see here that they move,English
+"from the benign variant of the given pathway to intermediate lesions, which are now being called largely melanocytomas.",English
+"So this term here, melanocytoma, has largely replaced language around atypical or MELTUMP, for example.",English
+Melanocytic tumor of uncertain malignant potential. These are oftentimes being lumped into this melanocytoma term.,English
+"So you'll see more and more of this in reports in the years to come. And then, eventually, there's the frankly sort",English
+of malignant variant of each of these families. And what I think is really nice is they list out the common mutations that are seen in these families.,English
+"So superficial spreading melanomas, BRAF NRAS play a big role here. And then loss of TERT and CDKN2A,",English
+"P53, PTEN, these are kind of the more melanoma-specific events. Coming over to desmoplastic melanomas, we see that loss of NF1.",English
+Or amplification of BRAF or other MAP kinase constituents can be important. So a lot of these are shared.,English
+"They're not necessarily unique. Looking at the Spitz family, we see again HRAS, gain of function mutation, or fusion events or rearrangements",English
+"of those other cell surface tyrosine kinase receptors like ALK, ROS, RET, NTRK, even BRAF fusions. And we'll take a look at some of those.",English
+"And then, for Spitz melanomas, loss of CDKN2A is very important. So acral melanomas we know are largely KIT driven,",English
+"but also can have BRAF, HRAS, KRAS mutations. So again, not entirely. We have a whole heterogeneous group of mutations here,",English
+"but KIT is the thing to remember. And they're very similarly mutated to mucosal melanomas, which is interesting because the histomorphology looks",English
+similar between a lot of mucosal melanomas and acral melanomas as well. And then the blue nevus family is really characterized,English
+"by these GNAQ, GNA11 mutations. And then, oftentimes secondarily, that will be lost in the melanoma version of these.",English
+So this table we'll come back to when we go over our cases. So this table highlights how these types of melanomas,English
+"are typically clustered. So high chronic sun damage melanomas, thought of as lentigo malignas, are usually",English
+"these NRAS, NF1, KIT mutated. And they usually arise on the head and neck, as opposed to the low chronic sun damage",English
+trunk and extremity superficial spreading melanomas usually seen with BRAF mutations. And then the sun protected melanomas,English
+"which we tend to see on the acral sites-- palm, soles-- as well as the mucosal sites-- mouth, genitals.",English
+"And then, of course, there are the extraepithelial melanocytes, which include dermal melanocytes in this case, as well as the choroid and the leptomeninges.",English
+"So these are the blue nevus-like and the uveal and leptomeningeal melanomas. And these oftentimes are going to have liver metastases,",English
+"and that's what's highlighted by this here. And so the question then becomes, OK, so we have this fancy classification.",English
+"Does this really in any way matter for patients, or are we just shuffling these things into different bins? And I would argue that this paper here published",English
+"by the Northwestern group, Pedram Gerami being the senior author, and has been doing a lot of work in molecular diagnostics for melanoma.",English
+"They published this very, very compelling paper in which they took next generation sequencing, and reclassified some of their Spitz neoplasms",English
+"and look then at clinical followup. So here, what you see are a whole bunch of what were called Spitz tumors, Spitz melanomas, and melanoma with Spitzoid",English
+features. So these are thought to be basically intermediate grade lesions.,English
+That's how they were initially classified. The Spitz melanomas were thought to be melanoma that were arising from a Spitz lineage neoplasm.,English
+And then there's melanomas that were thought to be basically a true adult or dangerous melanomas that were masquerading as Spitz.,English
+"So that's how these were originally classified. And what they did is they added the genomic data, and the then reclassified these.",English
+"So what you'll see is that many of these BRAF missense mutated lesions that were identified originally as Spitz melanomas,",English
+"according to newer classification, were actually best classified as melanoma Spitz features. So some of these were in the wrong bucket.",English
+"And if you notice, the tumor mutational burden for these BRAF and NRAS more conventional melanoma mutated things, neoplasms are a much higher mutational burden",English
+"right than in the remainder of the Spitz melanoma. So basically they were saying, these lesions were probably not in this bucket to begin with.",English
+They actually belonged over here. And what they showed is that when you look at the recurrence-free survival over a period of 90,English
+"months and you looked at the original morphologic diagnosis, you saw that the patients with Spitz tumors did quite well. As opposed to the patients with Spitz melanomas and melanoma",English
+"with spitzoid features, they had very similar sort of recurrence rates, and they did worse than just the Spitz tumor group.",English
+So there are definitely some dangerous lesions here under both classifications. But when you use genomics to reclassify this bucket,English
+into this bucket-- so this little slice over here-- and you call these true melanomas that are not of Spitz lineage.,English
+"You put them all in that bucket, and suddenly, the Spitz melanomas and the Spitz tumors have very similar behavior.",English
+And so what that says to me looking at this is that probably the initiating mutation is really relevant. And what gives ugly histopathology and even,English
+"some low grade metastatic potential, may be the lymph nodes, which is usually what we see with Spitz melanomas or even atypical Spitz tumors.",English
+"The initiator mutation is probably pretty important. And if it's a BRAF guy, it probably belongs in this melanoma with Spitz features family",English
+"and probably is going to be worse in terms of its biologic behavior, as opposed to these fusion events which tend to be less dangerous,",English
+"even when you have some TERT activation in this family. Although, I'll note, there is TERT promoter activation in this chunk that got reclassified.",English
+So it seems to have some important effect in predicting biologic behavior. It's not just for fluff. So are there any questions before we move on to the cases,English
+"that I wanted to highlight from our UW experience? STUDENT: Ata, can I ask you the question I asked before? What happened to dysplastic nevi?",English
+"ATA MOSHIRI: Yeah. That's a great question, Dr. Drew And what I would say is we still think about dysplastic nevi",English
+"as sort of a precursor lesion. So when we look at this pathway here, you can think of dysplastic nevi as being",English
+"kind of in this category I pathway that's a precursor lesion for superficial spreading melanoma. So the benign variant, we think of a nevus",English
+or maybe an intradermal nevus. And an intermediate or low grade dysplasia essentially would fit in this category.,English
+"So what we frequently talk about is mild, moderate, or severe dysplasia. Mild and moderate would probably fit in this bucket.",English
+"Some people are arguing that we should be moving towards a binary low grade, versus high grade dysplasia model. And that may be something that we",English
+"move towards in our derm path group in the coming years, maybe even sooner. And high grade dysplasia-- so severe versus melanoma",English
+in situ-- kind of fit in the next step up. Nobody really calls these melanocytomas. We call them high grade dysplasia.,English
+"And then the malignant variant would be Frank melanoma. STUDENT: OK, thank you. So it still exists.",English
+ATA MOSHIRI: Still exists. It's still messy and still highly subjective. That's a great question. STUDENT: Can I ask a question?,English
+"ATA MOSHIRI: Sure. STUDENT: So given that a lot or some of the Spitz nevi are reclassified, how often are you or should one",English
+"molecularly analyze these? Like a Spitz, so you have a Spitz nevus. Should we be analyzing all of these to make sure they're not one of these bad actors?",English
+"ATA MOSHIRI: Yeah. That's a great question. And I would say that my understanding of the current guidelines is-- again,",English
+"so I'm a simpleton, so I think of things in pathways. So if I come down here to nevus and I have histopathologic findings of what",English
+"looked to be a Spitz nevus, and it's in the right sort of clinical context-- a younger patient, not a lot of sun damaged skin, not other worrisome or atypical features--",English
+then you probably don't need to be doing a molecular workup. You can think of that as probably an HRAS or some sort of fusion event that happened and nothing that would--,English
+"on the slide, anyway-- make you think, wow, this could be atypical. And sometimes we'll do immunohistochemistry to get at that.",English
+"We'll look for loss of P16, which is kind of a surrogate marker of biallelic inactivation of CDKN2A in a portion of the tumor.",English
+"But you probably don't need to be doing that here in the benign world. But when you start getting into melanocytoma or this,",English
+"I'm not sure. Is this malignant or not? Then this is where the guidelines have really indicated that molecular testing is indicated, actually.",English
+And there are subcommittees from the ASDP-- American Society of Dermapathology that have basically come up with appropriate use guidelines.,English
+"And certainly, atypical Spitz tumors qualify. STUDENT: OK. That makes sense. Thank you.",English
+ATA MOSHIRI: Yeah. Those are both excellent questions. Anything else before we move on?,English
+"All right. Well, I'm going to show you three really cool cases where I think the molecular diagnostics and the data that we generated from it really sort of",English
+helped cinch or make a diagnosis that we might not have otherwise made. So the first case is an example of a case,English
+"of a rapidly growing friable nodule on the left arm of a 13-year-old male. So this is a fairly young man, but a rapidly growing tumor.",English
+"And this is not the actual image of the nodule, but this is pretty representative of what it looked like.",English
+"And so this is the pathology. This is scanning magnification. You can see that at scan, you have a polypoid tumor here",English
+"that has overlying ulceration serum crust. And some focal areas of involvement of the epithelium are apparent here, but predominantly",English
+a dermal-based tumor that extends from the superficial dermis down to the deep aspects of the specimen down probably through the reticular,English
+"dermis, and we can't quite see the bottom of it. Going on at higher power, we can see that there are nests of these cells--",English
+these melanocytes-- which are pretty large. I would say larger than the keratinocytes. They have prominent nucleoli and somewhat,English
+vesicular and pseudoincluded nuclei. There's ample cytoplasm here. There's some clefting around some of the nests as well.,English
+They are forming these fascicles that are extending down into the dermis that are somewhat haphazardly arranged into one another.,English
+"And looking at the deep aspects that higher power, you can appreciate again, there's some pretty significant pleiomorphism here.",English
+There's some dermal mitotic activity even at the deep aspects that's readily apparent. And there's not good signs of maturation here.,English
+"So the melanocytes in the nest are not dispersing well. They're just sort of going all the way down. But it's a young man, and you know melanoma in this age group",English
+is quite rare. We did some additional immunohistochemical studies. We see that the HNB-45 is retained even,English
+at the deep aspects. It's got this fleshy positivity all the way down to the base of the specimen. We see P16 here.,English
+"And there are a few scattered cells that have nuclear positivity for P16. But by and large, it's lost throughout the tumor,",English
+"both in terms of nuclear and cytoplasmic expression. And then PRAME, which is kind of a newer marker preferentially expressed antigen in melanoma, it",English
+has strong nuclear expression that you can see even at scanning magnification throughout pretty much all the tumor cells.,English
+"For those of you who are familiar with this finding, it's usually a worrisome feature for melanoma. So the histopathologic differential",English
+for a tumor like this in a 13-year-old would be basically what was formerly called an atypical Spitz tumor or Spitz melaocytoma.,English
+"A Spitz melanoma certainly, or an adult type melanoma masquerading with Spitz features.",English
+"And it would be hard to make this diagnosis, I think, on histopathology alone. I think this is something that you would show to colleagues and make a consensus decision.",English
+"But in this case, we did UW OncoPlex. And what we found here, we didn't find any specific activating mutations",English
+in BRAF or any other MAP kinase constituent. So that would have helped us classify this as a melanoma with Spitz features,English
+if we could have found some sort of activating mutation there. We also did not find fusion events. But we were told by our outstanding colleagues,English
+on the molecular side that OncoPlex doesn't do a good job of looking for fusion events and there's consideration for sending this for FusionPlex,English
+as well. There is an overall low mutational burden. There's no microsatellite instability. But there was biallelic loss of CDKN2A and CDKN2B.,English
+"So total inactivation of this locus which, as I harped on earlier for you, is known to be a melanoma-specific event,",English
+"and is highly worrisome, and is reflected in the loss of P16 immunohistochemistry. So this put us in this family of some sort of Spitz melanoma,",English
+"whether you could consider something like an atypical Spitz tumor. But really, when you lose CDKN2A,",English
+you really should be more in the malignant category. So we'll come back to how we actually classified this in a minute. But I wanted to highlight a really nice paper from the UCSF,English
+group that was published. The senior author on this one is Iwei Yeh. She works a lot with Boris Bastian,English
+and she's a former UW grad in terms of her dermatology training. This paper classifies or talks about Spitz melanomas,English
+"as a distinct subset of Spitzoid melanoma. So this can sound confusing. But basically, Spitz lineage melanoma or melanoma arising",English
+from Spitz lineage mutations is a distinct subset in terms of its biologic behavior-- two melanomas that resemble Spitz lesions.,English
+"And what they did is they looked at their Spitz melanomas and they found these. They define these, basically, as HRAS activated or ALK, NTRK,",English
+"BRAF, MAP3K8 fused events as being the initiators, as opposed to their BRAF or MAP kinase mutated lesions.",English
+So these would be the melanoma with Spitz features lesions that typically had BRAF or NRAS mutations along with the CDKN2A loss or TERT promoter mutation.,English
+"As opposed to a subset of these, that turned out to be actually MAP kinase wild type and there is no other sort of mutation that was upstream that really sort of",English
+"declared itself, so to speak. And so our guy probably fit somewhere in here. Either it's a true Spitz melanoma",English
+"or it doesn't have anything at all. FusionPlex would have been nice to answer, but that was not something that we",English
+could justify additional testing for at the time. So I'll go on to show a couple histopathologic correlations here that they highlighted.,English
+So these are examples of Spitz melanomas with a BRAF fusion. And they describe these highly cellular tumors that has something of a syncitial growth,English
+"pattern to them. And this is typical for the BRAF fused Spitz melanomas, as opposed to ALK fused melanomas that",English
+tend to have these elongated fascicles that sort of rain down from the epidermis. A lot of mitotic activity.,English
+The melanocytes tend to look somewhat fusiform and arranged in these almost plexiform arrangements in and out of plane.,English
+"So, very typical. And when you become more familiar with this pattern, you start to think about ordering immunohistochemistry",English
+to target it without even doing the full molecular test. And then you have NTRK fusions which tend to have these dome-shaped lesions that again have,English
+these spindle melanocytes that give almost these rosette-like structures. So the NTRK fusions you can recognize,English
+"by these sort of rosettes. So ultimately, where we landed on was Spitzoid melanoma. And we couldn't define the initiating mutation in this,",English
+so we couldn't firmly say. But we could fairly favor that this was likely a Spitz melanoma.,English
+"And not-- absent a BRAF mutation, this was not likely to behave like an adult melanoma or something in that category.",English
+"We don't have followup for any of the cases. I'm going to tell you, they're fairly recent. But time will tell if our classification",English
+was accurate in terms of predicting the biologic outcome. And I don't mean to say that the molecular diagnostics are in any way definitive or one-to-one,English
+at this point in time. This is very much an area that we as a field are still learning and growing. But it's exciting to think about what future larger studies will,English
+"Which ones of these lead to wide excisions? ATA MOSHIRI: Yeah, that's a great question. So we recommend wide local excision for anything",English
+"in this category, pretty much irrespective of age group. So once we're classifying something as a integral Spitz tumor or melanoma, they're usually",English
+"going to get re-excised with a margin around them. If it's been plus or minus and institution-dependent whether or not there's sentinel lymph node biopsy done,",English
+"if we can confidently tell our surgeons that this is a Spitz melanoma in and not something that's masquerading as a Spit, then oftentimes people",English
+"will forego sentinel lymph node biopsy. But otherwise, for things that are going to be BRAF, NRAS, whatever adult melanoma in their behavior,",English
+then it would be the same management as you would anyone else. It'll be based on Braslow depth and guidelines at that point.,English
+But pretty much everything's getting cut out. STUDENT: OK. ATA MOSHIRI: Yeah. I'll show you a case that was published in a moment,English
+"that where something didn't get cut out, and what happened there. But sorry, was there a followup? I didn't mean to interrupt.",English
+"OK. STUDENT: Yeah, not from me, Ata. ATA MOSHIRI: Wonderful. So with our time left, I'm going to touch on our last two cases. So this is a 73-year-old female with a history",English
+of nonmelanoma skin cancers. So no history of melanoma. And she had a one year history of a slowly enlarging black nodule on a right upper arm.,English
+"So those of you familiar with our service recently, we've just signed this case out, actually. And this is representative of what that lesion looked",English
+like on her skin. So it looks pretty scary. This lesion was initially biopsied. So this is the punch biopsy.,English
+You see a dermal proliferation not involving the epidermis. But you see fascicles of these spindle cells with admixed pigmented cells spanning,English
+"from the superficial dermis down to the deep aspects of the reticular dermis. And to some degree, it's sort of hugging the adnexa as well,",English
+"which is a feature of these more dermal-based spindled melanocytic proliferations. Looking at higher power, you see that the melanocytes",English
+are fairly atypical looking. They have prominent nucleoli. But I would say there's not marked polymorphism here.,English
+And dermal mitotic activity was essentially absent in the sections that we had. There are admixed heavily pigmented melanophage here.,English
+And you see that it kind of has this east-west pattern. Some of these fascicles and nests kind of have this horizontal thinking in addition,English
+to these areas of deeper growth. And Melan-A KI67 double stain from the outside institution highlighted that there are a good number,English
+"of mitotically active cells within some of these nests, even within the deeper aspects of the lesion. So this is an elevated proliferative index.",English
+"That's worrisome. HMV-45 is strongly retained within the entirety of the lesion, even at the deep aspects.",English
+"Not necessarily a sign of malignancy. There are some benign families of neoplasms that can have melanocytic growth that can have strong HMV-45,",English
+"and we'll talk about that differential. But before we could actually sign this out, the excision specimen was sent. So they already cut this thing out.",English
+"And when you look at it, it's a very broad proliferation and it looks very similar to the biopsy. So it extends from the superficial dermis",English
+"all the way down to touching the fat, essentially, along the adnexa. It tends to like them.",English
+"And it penetrates down deep here. What you'll see is, on higher power, there's a lot of solar elastosis admixed in here.",English
+"The cells look very similar to what we saw before. Not really any mitotic activity that's conspicuous. Again, melanoma Ki67 double stain",English
+"highlights a good number of mitotically active cells at the deepest aspects of the specimen. Again, that's worrisome.",English
+"PRAME, negative in this lesion. And so the histopathologic differential diagnosis for this would be something like an atypical blue nevus--",English
+"something that would now probably be called a blue melanocytoma. A deep penetrating melanocytoma, or formerly known as atypical deep penetrating nevus,",English
+"these would be the only benign justifications here, or a melanoma that's masquerading as something like that. OK.",English
+"So a deep penetrating melanoma, or blue nevus-like melanoma, or even a metastasis, so metastatic melanoma with features of a blue nevus or deep penetrating nevus.",English
+All are considerations here. So we did OncoPlex. OncoPlex showed a BRAFV600E mutation and an activating,English
+mutation in beta catenin. So we'll touch back on our WHO table momentarily. But there were no additional mutations identified,English
+"in any of the melanoma suspicious activators such as TERT, and no loss of CDKN2A.",English
+"There is an overall low mutational burden, despite this being a new nodule on sun damaged skin and a 73-year-old female, and no microsatellite instability.",English
+"So we'll come back to these two mutations together. And taking a look at our family of the deep penetrating nevus family, which is fits well histologically,",English
+"we see that these are oftentimes driven by a BRAF, or MEK, or NRAS mutation, along with the addition of beta catenin or loss of another Wnt",English
+signaling pathway constituent APC. So these two are important for deep penetrating nevi and they're thought to be the initiating events.,English
+"And we'll talk about, well, what happens in melanoma in these lesions? Well, there is a really nice paper published just last year looking at NGS analysis of atypical deep penetrating nevi.",English
+"So basically, deep penetrating melanocytomas. Daniela Massi served on the WHO paper reclassification",English
+that came up with this table. So she does a lot of this work. She's based out of Italy. And they highlighted 21 cases of what were called basically deep,English
+"penetrating melanocytomas. And what I want to highlight for you is that in general, these patients are younger. They're usually under the age of 60.",English
+"Although, not everyone's young, so to speak. The lesions range in size from several millimeters to nearly two centimeters in size.",English
+"In almost all cases, there was no progression at all outside of the skin, with the exception of this one, which came up in a middle aged woman.",English
+And she had a positive sentinel lymph node and still alive after five years. And everyone else they had followup on similarly.,English
+"So these deep penetrating melanocytomas, anyway, seem to do fairly well with just excision and low rates of sentinel lymph node biopsy.",English
+"Albeit, this is a very small sample size. So again, the activating mutations that are very important. In general, they had a range of tumor mutational burden,",English
+"ranging from low to quite high. Beta catenin was positive in 95% of these lesions. And then, oftentimes they had a BRAF or MAP kinase",English
+activating mutation as well. And then a whole bunch of them had a bunch of other mutated genes that fell out,English
+that I'm not going to belabor because they're not thought to be necessarily contributory to melanoma or malignant behavior at all.,English
+So that that's kind of a whirlwind summary of what we see in atypical DPNs. And the main upshot of this paper,English
+was that there wasn't a good correlation between histone morphology necessarily and which mutations they were seeing present in any given lesion.,English
+So moving on to a case report from Dr. Gerami at Northwestern looking at melanoma arising in the setting,English
+"of an atypical deep penetrating nevus. So this is really what we're worried about, given that she's a 73-year-old female.",English
+"And what he shows here is a case of what was called a deep penetrating, atypical deep penetrating nevus, or deep penetrating melanocytoma.",English
+"What happened is that this lesion was incompletely excised, so there's residual lesion. And several years later, this is what we got back.",English
+"So the tumor recurred. Clearly, it looks a lot more cellular, a lot more angry. A lot of mitotic activity you can see even",English
+at this magnification in the panel. The cells look quite atypical. And they did genomic analysis of this lesion.,English
+"And they found that at the time, the DPN lesion carried with it NRAS, ERBB4, and beta catenin, as well as these IDH1",English
+"alterations. But what happened in the intervening years is the malignancy acquired copy number gains in BRCA2, RET,",English
+"FLT3, IGF2, and also the all-important TERT promoter mutation.",English
+"And these events are thought to be far and away the drivers of the malignant behavior, in this case.",English
+"So going back to ours, there was no deleterious TERT promoter mutation. Nothing that would suggest melanoma a priori.",English
+"Now, a braver dermatopathologist than I might just say deep penetrating melanocytoma or something along those lines.",English
+"But I showed this case to my colleagues in consensus. None of us felt comfortable excluding the possibility of melanoma, despite the genetics not necessarily",English
+cinching it in that way for us. And we hedged and said that melanoma in a 73-year-old woman on heavily sun damaged skin,English
+could not in good conscience be excluded in this case. But given the marriage of the histopathology and the molecular aberrations that probably,English
+"this will behave as a melanocytoma. Now, I'm very interested to see what happens with this patient. It's already been excised with clear margins.",English
+"My guess is that there will be discussion about sentinel lymph node biopsy. And this patient will be followed, and I will be very apt and keen to see how",English
+"This one was signed out by my colleague Dr. George who, I believe, is in the audience. And he is badass, and so I couldn't not",English
+highlight this case. So this is a 30-year-old female with a history of neurofibromatosis type 1. So she has NF1.,English
+And there is a plaque that was biopsied on the right arm. And this is the histopathology.,English
+"So this is a scanning power magnification. What you see here is there's not a lot going on in the epidermis at scanning magnification,",English
+but there is a busy dermis. That's how I describe it. So too much going on here for normal skin. There are lymphoid aggregates that you can see at scan.,English
+"And you can see that there's just too much cellularity here. OK. So looking at higher power, you can",English
+see that there are these spindle cells. Some of them are pretty prominent. They kind of jump out at you.,English
+"And they appear to be sort of interwoven amongst the collagen bundles. It looks a little bit pale. It gives that look of shredded carrots, to some degree.",English
+"And so, given her history of neurofibromatosis, certainly something like a neurofibroma could would be a reasonable place to want to put this.",English
+"But lymphoid aggregates are a little bit unusual for four neurofibromas. Looking at the deep aspects of this specimen,",English
+"we see that it extends all the way down to the deep. And there's still sort of these peaking lymphoid cells around. And we see that, again, some of the cells",English
+"are pretty big and unusual looking. Not totally standard, run of the mill. And looking at higher power, in some fields",English
+"you see a little bit of atypia. And there's even mitotic activity, which is unusual for something like a neurofibroma, or even",English
+"an atypical one. So there were some immunostains done. The SOX-10 highlights, at scanning magnification,",English
+you can see actually overlying portions of this lesion. There's actually an intraepidermal melanocytic proliferation that's quite busy. And you see that the dermal spindle cells are,English
+"highlighting with the SOX-10. So going on to higher power you see, even at the deep aspects, these are all SOX-10 positive. A PRAME was done here.",English
+"The PRAME was negative. You'll have to believe me that there's no nuclear staining here. And on higher power, we see that P53,",English
+"which is helpful in resolving this diagnosis, shows fairly good nuclear expression, which is helpful in this differential.",English
+"And we'll talk about that. So the histopathologic differential diagnosis is something like an atypical neurofibroma, or with the lymphoid aggregates and atypical melanocytic",English
+proliferation overlying a desmoplastic melanoma in a 30-year-old with NF1. So we did OncoPlex in this case.,English
+"And OncoPlex was notable for inactivation of TP53, along with a high tumor mutational burden.",English
+And no other sort of specific activating mutations were identified. But this patient has loss of--,English
+"she has NF1. So looking at this pathway, we can see that the initiating mutations",English
+"in desmoplastic proliferations are oftentimes loss of NF1. And P53, not listed here, is a common event necessarily",English
+"in desmoplastic melanoma, but certainly is thought to be important in late stages of any melanoma development.",English
+So this paper here again highlights how P53 immunohistochemistry can be,English
+"useful in distinguishing neurofibroma from desmoplastic melanoma. I mean, just even saying that out loud is sort of horrifying to think that you could be calling",English
+"something neurofibroma and it's actually desmoplastic melanoma. But I mean, here's neurofibroma. And here you have that kind of shredded carrot look.",English
+"SOX-10 will highlight some, but not all of the cells. CD34 will give you this thumbprint pattern. And P53 should be negative in neurofibromas.",English
+"As opposed to desmoplastic melanoma, where clearly there are some atypia of the cells here. SOX is going to highlight pretty much all of them.",English
+"And the P53 can be pretty strong, actually. And so they did a summary of around 20 cases of desmoplastic melanoma versus 20 neurofibromatosis.",English
+to bring medicine to the patients. And everything starts and end with patients and that's why also we have three patients today.,English
+"But you can see here on the slide, we're trying to connect the community through clinic network and conference.",English
+"We're trying to catalyze new discoveries, funding research through the discovery funds, and maybe some, also some collaborative models like this and others.",English
+"We're trying to bridge between, let's say the funding that we do in academia to the commercial entities that are, you know,",English
+"that are, you know, companies like you, but also companies that develop pharma and biotech companies that develop treatments. And we have a couple of projects here",English
+"that can really enable the R and D platform to transition, including the registry, including the target scan, data hub,",English
+"preclinical initiatives and clinical endpoints that we are developing. So we are working with commercial entities to enable,",English
+"you know, those discoveries, to be taken into a real pipeline for development. And then we're also talking to regulators.",English
+"So we have active dialogues with the FDA and educate them about NF. And you can see here at the center,",English
+"is our patient engagement activities. We always trying to involve patients from, you know, from conference and, you know, getting together",English
+"and understanding how the clinic works to review research, to talk of people, and commercial entities outside of,",English
+"let's say the research, direct research space like today, for instance, and we always trying to help them to",English
+and put them in front of the regulators so that they're aware of the disease. So everything really starts and ends there. So they're really the strategic partner,English
+"for us to bring this mission forward. And when I said, you know, things that we're doing, we're funding the best and brightest.",English
+"So we're like other foundations. We are funding, you know, basic translational and clinical research and contract as well with companies.",English
+"We have a rigorous peer review system that guarantees quality, but we also need to increase the quantity of research that we fund.",English
+Every year we award about three to four millions dollars in grants. And the fund that we've been used to is growing every year.,English
+"So now there is a need for us to speed up and support more research, so we have that capacity. At the same time,",English
+we want to expand our research portfolio to reach out to other scientific communities. 'Cause you may think,English
+"NF is not as big as a research community as cancer for instance, but there are a lot of synergies and connections that will allow us to branch out in those communities",English
+"and bring some of those researchers into the NF space. The active Collaborative Synodos model that I was talking about, when we fund,",English
+"those are at a consortia of researchers that tackle big challenges. For instance, problems that cannot be solved by one single lab.",English
+"And we funded already a few of them. Like in the NF2 space, we're trying to identify a screening pipeline that will allow good translatability",English
+"of drug candidates from bench to bedside. This was because, you know, in the past, in early 2000 and 2010's,",English
+"we saw that there was a lot of drugs that came out good from, you know, cell lines and animal models,",English
+"but they were failing in the clinic space. So we had to, you know, gather all of those systems, model systems,",English
+"to understand what is a real good filter model. For NF1, we needed new animal models or a model system that will help translate drug into the clinic.",English
+"For the same reason, this time, this helps to fund two different pig models that now have NF and that kind of bridge between,",English
+"you know, the mice and the human studies. In low-grade glioma, there was not enough tissue to be characterized.",English
+So we launched a collaborative effort to collect enough low-grade glioma samples to characterize them,English
+"and understand the genetic underpinning of those tumors. And now we have about two studies of 50 samples each that we're going to combine into one single 100,",English
+which is the largest ever collection of gliomas that will help understanding what is the genetic underpinning.,English
+"And for schwannomatosis, also, we didn't really have large cohort of tumors. It's an ultra rare disease.",English
+"There are not much, not many tumors, only working together, we could really gather enough cohort of tumors and evaluate also,",English
+what if there is a genomic pain signature that this could be acted upon as this condition is really characterized by extreme chronic pain.,English
+We also do build communities. So we do have a conference that is organized by CTF since the late 90's.,English
+And now it's really the world venue for NF's research advancements with 750 attendees. We organize the forum,English
+"and this year is gone called, The Summit, even larger, where we hope to gather all of the NF stakeholders, patients, researchers, clinician,",English
+"caregivers, volunteers, industry, educators, together to learn on different tracks and whatever they, you know, resonates with them.",English
+"And we also have fun event, which is the NF Hackathon, now that we have data available, we're reaching out to other scientific communities",English
+"in the medical space. So the last things that I want to point, is the NF registry for patients and researchers.",English
+"It started in 2012, and today counts about 10,000 patients, and it has multiple purposes. First of all,",English
+"we use it for information sharing for patients. So through connecting them to the right clinical trial, you know, pushing information out",English
+"about things that could be useful, but also, you know, as an instrument for researchers to know, sorry, to know the latest research development,",English
+"but also as a tool for scientists, you know, where they can actually participate in ADOC studies that in surveys that we send to through that registry.",English
+"It's already been used for 59 recruitements, and now is available in four additional languages. But the challenge here",English
+is that only a fraction of our global patient population is on the registry. So we would like to expand this tool,English
+"as much as possible to be more effective. And today we are coming to you with an opportunity. And the opportunity is,",English
+"that Charles River Laboratories is offering, as you know a sibable to work with CTF, if you know, don't,",English
+"but they're centrally focused on three opportunities that we laid out for you. And one is exactly, you know, expanding research,",English
+"helping us to double the number of grants and missions. Another one is to identify grant opportunities for us to apply for, to secure, and, you know,",English
+"support all of the amazing programs that we are doing. That is really from federal aids to family funds, trying to identify those that are suitable for CTF.",English
+"And also work with us to expand and diversify the registry. The registry is a key element that will help recruitments, but also increase the number of participants,",English
+"so that we can, you know, leverage this even more and reach out to more and more patients. So today how we are going to work,",English
+"and it's my pleasure to introduce our panelists, Brianna, Cole and Bill. They're representative of many different activities",English
+"that are involved with CTF. Brianna is on the CTF Junior Boards. Cole and Bill are CTF volunteer,",English
+"but they all patient advocate. And as I showed you in that other slide, they're working with us to be ambassadors of NF for themself and for the community.",English
+"So without further ado, I would like to, first of all stop sharing and introduce them with our discussion.",English
+"So we'll go through, you know, trying to have some personal view on, you know, how is your life and what you can tell us about NF1, NF2 and schwannomatosis",English
+"through your personal experience. Because I can tell you about, you know, all of the different medical things and things we're doing, but it's better to listen from all of you.",English
+"So I will start with you Brianna. And help us understand, you know, some of the challenge you battle with. Thank you.",English
+"So I'm the only one in my family to have it. I joke around and say, I'm lucky, I guess, but anyway, so my tumor is mainly encompass my entire left side",English
+with the exception of my left leg. You can't see it anywhere besides my left arm and I can show you.,English
+"So, as you could see, mine is a large plexiform, but it starts right here at my neck. And even with me, I've actually battled cancer three times.",English
+"So I've had malignant peripheral, nerve sheath tumors three times. They've all been removed. And my tumors kind of grow very fast.",English
+"As soon as I stop any form of clinical study, they grow back bigger than what they were prior to the medication.",English
+"So I think that's why it's so important to know how each individual is going to be impacted, because these clinical studies and MEK inhibitors do work, especially if you have, in my case, a large plexiform.",English
+"And I'm already seeing a difference, even in my quality of life. Whereas before my skin was literally ripping apart, because my tumors were just continuously growing.",English
+"And NF1 is mentioned, it causes bone deformity. So my entire spine is made out of metal titanium rods. I've had three spinal fusions",English
+"and a bunch of tumor resections as well. - Thank you, Brianna. And let's go with Cole.",English
+"Cole, how are you first of all? And help us understand how NF2 impacted you or, you know, how you cope with it.",English
+"I was diagnosed when I was 15 years old. I was born with this, but I did not have any presentations until I was 15.",English
+"And this first happened with hearing loss, and this is pretty common with a lot of NF2, where its obviously not everyone.",English
+"But I had drastic hearing lost, one I might use. So that led me to going to a doctor and getting the hearing test.",English
+"And they're like, yeah, it was bad at that time. And so, you know, they're digging further. They're like, well, what's causing the hearing loss?",English
+"You know, you get the skins, done, MRIs. And that was my first. They gave many appointments with a neurologist.",English
+And that's when they found the bilateral acoustic movements. So tumors and face sides of the head. And that also great common presentation.,English
+"I had also tumors throughout my body, a couple dozen legs, arms, a couple on my spine as well. That at 15, that first tumor was very, very large.",English
+"It was about the size of a golf ball, and it was pressing pretty drastically on my brain stem. So I had surgery about a month later.",English
+"Going into that surgery, I knew that they weren't gonna be able to save my hearing and that ear. So at 15, I lost all the hearing in one year.",English
+"And at that point, my hearing was good and my other ear, see and I was school. That was great with friends, not a whole lot changed,",English
+"other than having that initial surgery. Maybe about a year or two later, I started losing my hearing in my other ear. Things were getting a bit more difficult.",English
+"At that time that was, that was when I went on my first drug treatment of avastin and it actually did help.",English
+"I helped preserve that hearing for about another year or two, but it continued getting worse, progressed through a hearing aid,",English
+"progressed through a cochlear implant, went through about as much as I could until finally when I was about 20 years old. Just for reference I'm 28 now.",English
+"So when I was 20 years old, and those surgeries on both sides. At that point, they, when they moving the tumor on the right side,",English
+"they had to cut the nerve above my only good ear. So for about the past eight years, I've been completely deaf, never residual hearing at all.",English
+"And not really any tech, not nothing that can restore my hearing. The only thing out there is an ABI acoustic brainstem implant,",English
+"which is that's a big surgery I have. And in my case, it does work. For some, it's kind of head or miss with how useful it is.",English
+"In my case with my medical history, it actually wouldn't work very well. So I've never gotten it at this point. There's really nothing that can restore my hearing.",English
+"I went through radiation, best in chemotherapy for a couple years, multiple surgeries, that's kind of been my treatment options",English
+"that I've had. I rely mainly on ASL to communicate with my family. I have an amazing wife, Helen, and amazing hero daughter, Harper.",English
+We all use ASL in our lives. So that's very fortunate to be able to learn it through college. And it's just a great aspect of how we communicate.,English
+"It's one of the most difficult challenges with that and becoming deaf later in life is that, one else fortunate, you gotta learn it in college,",English
+"but a lot of people don't have that ability. The older you get, most people know that it's harder and harder to learn new languages.",English
+"You also don't have the resources for it. My family, they try, but it's been hard really outside of my immediate family with my wife and daughter,",English
+"really, no one else knows sign languages. It's just really hard to have those resources and get the options to learn that with the extended family. So that's been a bit difficult",English
+"and I know that's a challenge for a lot of people with NF2 with hearing loss. I also lost, I have no functioning balance,",English
+"notice disease either that was taken with my hearing there, a little bit of limited facial paralysis on one side. Notice that with a lot of people with NF2,",English
+"have we through on one side or even both sides, and then also eyes, not being unusual eyelids. (indistinct) you get trippy eyelids.",English
+"Fortunately, that's been very minor for me, so that's kind of my medical background. And I'll go ahead and (inaudible) we questions.",English
+"- Yeah, thank you, Cole. Thank you so much. Bill, schwannomatosis is always, you know, a very distinct form of NF.",English
+"Let us understand how you cope with it. And what is your personal experience with it? - Well, Salva, first, I'd like to thank Charles River",English
+"for hosting this event. You know, it's a company and researchers like those that work at Charles Rivers, who are gonna be at the forefront",English
+"of helping have earlier diagnosis, better treatments, and ultimately a better quality of life for all of us, with all three forms of NF.",English
+"So I'm the senior citizen here. My name is Bill Riter. I'm a 67 year old patient with schwannomatosis, and I'm the father of a patient with schwannomatosis.",English
+"So with schwannomatosis, the tumors grow on our nerves. And the hallmark of our part of the disease is extreme pain.",English
+Many times it's very difficult to find a schwannomatosis patient. I had my first tumor taken off at the age of 22,English
+"when I was in college. And subsequently at the age of 26, I had my second tumor removed during another operation.",English
+It was just pressing on my hip here. It was a little strange tumor. If I bumped it would send shooting pains down my leg.,English
+"And the doctor said, or the pathologist said, oh, it's a benign tumor, that's good news. And that was the end of that. So from about 1979 until 2003,",English
+I had literally constant pain my entire life. My doctor didn't understand what he was seeing. He would give so many different kinds of treatments,English
+"as I'm sure many of you had before we were, before you were diagnosed, they'd give you tens units. They'd give you lidocaine patches.",English
+"They'd give you various type of exercises and therapies. And then finally in 2003, I knew that something was dramatically wrong.",English
+"And at that point I changed doctors. Within about four months, I was on vacation on a jet ski",English
+"and I got paralyzed from the neck down. About five minutes later, the sensation came back and the next morning I was at my doctor's office.",English
+"And she ordered the first MRI. And it showed of the neck, and it showed tumors throughout every disc.",English
+"Then it was a full spinal MRI, which showed tumors throughout the spine, and then a full body. And I basically was declared disabled at 48.",English
+I had to go to Mass General to a major clinic to get my confirmation. I carry the MRI films with me,English
+"along with a slide of that 1979 tumor from 25 years earlier, that I was able to find,",English
+"and Mass General was able to confirm my diagnosis. I know Cole, Brianna, many of us in our situation,",English
+"in our home communities if we don't have a major NF treatment, a clinic rather treatments can be a challenge. And so I went home to Ohio,",English
+"which was known as the Opioid Jungle. And for the next 14 years, I was treated with high dose opioids,",English
+which did very little for the pain. Maybe I went from a level eight or nine pain every day down to a level five.,English
+"For most of that decade, I was treated with high dose fentanyl patches, which is truly meant more for end of life with cancer than it is for ongoing treatment.",English
+"Thankfully, the state of Ohio Red Flag, my doctors in 2018, I was able, they were told to get me off the opioids.",English
+"A dear friend, who is now Chairman Emeritus of the tumor foundation, who was chairman of the time, was able to get me a quick appointment",English
+"to the specialty NF clinic at Johns Hopkins. And I was put on a regimen of a very simple drug, high dose Gabapentin.",English
+"I'm on about 2,700 milligrams a day. And it virtually takes my pain away. I'm doing well.",English
+"I'm living a fairly good quality of life. One of the reasons, well, a number of the reasons I wanna participate is to help the younger people",English
+that are suffering from these diseases in future generations to find better answers. But also those of us,English
+"that are on these various drugs and treatments, as we max out, we need the next drug treatments to be coming along.",English
+"And that's where we look at researchers like you. I've participated in the hackathon, I've participated in some other things",English
+"and all of us are here really just advocates, not only for ourselves, but for future generations, it's really selfless.",English
+"And we appreciate people like Salva that are there at the forefront, that are there at the forefront every day.",English
+"So I hope that gives you a little bit of an idea of, you know, of where we've been and where we're going and where we'd like to be.",English
+"So thank you again, Charles River and thank you, Salva and Barbara for asking me to participate today. - Yeah, thank you.",English
+"And let's go a little bit now into, a little bit deeper into our discussion. We said, you know, there are clear opportunities",English
+"for Charles River to help CTF, right? And I presented three slides. One is we need to find more research.",English
+"And research is what CTF is all about, right? So we want to really find treatments and explore that biology,",English
+but also explore those drug that are on the market that we can bring to patients. So let's go off with Brianna again.,English
+"And I think, you know, NF1. Can you share what has been your treatment journey? So which medication you're on",English
+"and how that, you know, has helped. What medication have helped you most, solving what problem, right? - So I started doing clinical studies",English
+when I was a junior in high school. I am now 24 years old. So I started with cabozantinib and it was shrinking my tumors.,English
+"It was great, but it was causing my kidneys to fail. So I was out of the clinical study. I could not continue.",English
+"Then I decided to take a break. I had to have a few surgeries to remove some of the tumors, because like, what was just mentioned, you know, we wait for the next drug to come out.",English
+"As soon as you stop taking it, your tumors grow so fast. Even within two weeks time, my arm was, or even the other tumors were bigger than before.",English
+Then I started with binimetinib about two years ago. My time on that study ended. So we quickly moved me to selumetinib.,English
+"So I'm on the MEK inhibitor. I have been on it for three months now. I just had my third month on scheme. And my tumors have shrunk over a centimeter,",English
+"which is big for me and for the tumors that I have, because we're already seeing a significant difference in actually February 28th,",English
+"because this medicine has been working so well. I will be having one of the tumors that has potential for malignancy, that they could not remove before,",English
+to be able to get removed because the tumors around it have shrunk. So I think that's super important. And going off about the importance of using medications,English
+to help other forms of cancer. I also have a nodule on my thyroid from having so many MRIs and PET scans from having cancer previously.,English
+"But because of the other medication I have been on, that tumor has also shrunk and it's not a neurofibroma. They don't know what it is, it's too small to biopsy,",English
+"but they know that ever since started, I've started the MEK inhibitor that tumor or nodule has also shrunk. So I think that's why it's so important",English
+"to continue this research and advancement and get other form of drugs for other patients as well. - Yeah, awesome, Brianna that's awesome news.",English
+"Thank you for sharing. Cole, are you on some medications now? I mean have you been,",English
+and how is that impacting your life? - That's a good question. I'm actually not on any medications right now.,English
+And I've fortunate have to be stable for a while. So I haven't actually been on any medication in the past eight years.,English
+"I think I'm 28. So I'm very lucky with it. But I would say that with the past treatments, the only actual drug treatment I have actually had",English
+"was avastin, which is obviously used to be often enough too. And I would say it did work. I started at probably 13, 14 years ago.",English
+"So I felt like it was probably in the earlier stages. It was back when it was still in trial stages, very early on. And the doctors at that time,",English
+"where, you know, there was really no consensus on, you know, how long should you be on it? What dosage is recommended, kind of that stuff. There was some OB things will work.",English
+"This is kind of what they standardly use, but in your case, we're not sure here, let's try this out. So I was 15 that's when I started losing my hearing. So, you know, there was sign that invest",English
+and could at least helps out helped slow tumor growth or helped preserve some of that hearing. And it did. It worked in my case.,English
+"And I was 15 when I started losing my hearing in my right ear. It worked two hours. I wanna say I is six months on,",English
+then had to stop and then did another probably year. So all together I was on it for about a year and a half to two years.,English
+"One point my mind, they started growing a little bit and I started losing more hearing. So they're like,",English
+"oh, right, we don't think the is quite being effective. And I was on it for very, very long time. At that point so they're like, let's take a break from it. And I think Brianna mentioned this,",English
+"about how a lot of times when you stop those drugs, you get those rebounded fix where those tumors just kind of start going crazy. And that's kind of what happened,",English
+"was when I stopped that, that tumor and that right ear just kind of shot up a little bit. I needed surgery. But at the time, you know,",English
+"I was in high school, you know, 15 to 18 year old in high school, from like sophomore to senior year. That was an important part of my life.",English
+"So I'm happy that that drug worked during that time, helped preserve enough hearing that I could communicate with friends and everything. So I say that, but I just get to show how important this is.",English
+"And there early stages was like, well, how much should we give you. And so much has changed too. I know today, the regimens for that",English
+"has been a lot more fetched out, you know, like three months on three months off or what dosages. It's really come a long way",English
+"and it's been very, very helpful, but obviously we do need to do a lot more research. Thank you.",English
+"- Yeah, I just want to point out to the audience that Brianna has been using the drug selumetinib, is a drug that was approved last year,",English
+"or can't remember it was last year or year before, but anyway, last year. And it's a first drug approved ever for NF1.",English
+It's a drug that has showed efficacy across a large population of NF1 patients. 71% that at least have a 20% shrinkage,English
+"on their tumors and more. Some patients have also observed even 50% shrinkage. But the problem there, is that as soon as you stop,",English
+"as Brianna said, the treatments, the tumor starts grow. So these are medications that are awfully, our patient needs to stay for lifetime.",English
+"So we are not done. We need to find something that either, you know, works even better or solve the question, right? So that's why we need more help.",English
+"And in case of call for NF2, we don't have a medication approved. So there is no drugs. Is an orphan designations,",English
+"but there are drugs like, you know, bevacizumab or avastin, you know, the same drug that have shown some promises, and now we have other drugs that are showing some promises,",English
+"but we need more and more. And Bill, in your case, you said, you know, gabapentin is a tumor, you know, is a pain suppressor.",English
+"So anything else you've been on. And I want to ask you, if you had one drug that you know would work, what would be that manifestations",English
+"because I've had some relief for a couple years with gabapentin, that it works for everybody. Every one of us are different in how drugs, treatment, surgeries, et cetera,",English
+"are administered and are successful. So I am very lucky to have had a couple good years, and I just try to find joy in every day,",English
+"because I don't know when I'm gonna go back to the extremely severe pain. As Cole said, you know, he has many dozens of tumors and that's my case.",English
+"for all of us, but that's that's not the case. But everything that we do and every added new treatment, et cetera,",English
+"takes us a step closer. And with schwannomatosis, we tend to be diagnosed later in life. So we have some other, you know, more personal issues",English
+"or different personal issues to live with. As in did we pass it on our children, because many of us get to childbearing age",English
+"and it's after that that we find out. And I, in fact did pass it on to at least one of my children.",English
+"I just heard from another schwannomatosis patient that contacted me because she knew that I had, and she just had two of her children diagnosed.",English
+"And it's a lot of guilt. And you just have to, to tell them don't be guilty. You didn't know,",English
+"we had our children, we love our children, and we're here to, you know, to help make that better. There's also the issues of, you know, having spouses that may have been in a marriage for 20,",English
+25 years in my case that didn't sign up for this and they may not be as willing to be part of the NF community.,English
+And that was my case. So there's lots of different things that we face with these three diseases.,English
+"I hope that it answered some of it Salva. I mean, today is a good day (laughing) - Guys, this is amazing. I'm always, you know, when I interact with patients,",English
+"I always learn something. And this is, you know, we never really have a full picture and that's why it's so important that your testimonials,",English
+"your commitment to understanding these diseases is vital, to understand, you know, the implications. So thank you for sharing all of this.",English
+So research is important. We'll learn that. But let's move now into something else. And I would like to talk about the NF registry,English
+"and, you know, the way that we can communicate and help the community. So the registry, as I said before, is a tool for patients to register",English
+"and, you know, have their contact information, some basic information about their condition, what kind of tumors, so that we can match them with the right clinical trials",English
+"or if they want, or, you know, we can send the information and reach out. You probably are registered on our registry, I hope.",English
+"And why do you think, I mean, how active are you in learning about new treatment? So how in your daily life is, let's say,",English
+"are you just, you know, seeking for informations every day or you're okay with the information that you receive?",English
+"Would you like to have more, or are you always in constant search for news about NF",English
+"and how the registry has served you in that purpose? If you can share some of that. - Yeah, I could go.",English
+"So my mom, she does not have NF, but she loves the registry. She is a nurse. So up-to-date information on any form of treatment",English
+"is very important to her, because we do see a few patients in my community who also have NF. And unfortunately near me, they don't really know about NF.",English
+"And it's very similar. Just give, give me what, any kind of narcotic I can for pain. And I never take them because it doesn't work for me. So I have the mentality of,",English
+"why take it if it doesn't work. But also as being a former ambassador, I get a lot of messages and ambassador for the Children's Tumor Foundation,",English
+"I should say. But I get a lot of messages asking about their NF, what treatments are available, how can I help them get better?",English
+"And I always refer them to the registry, because also I don't want my story to scare them, because, you know, it might be scary hearing,",English
+"oh, wow, she's had this deadly form of cancer three times. How is she still alive? Am I going to get that? But is it going to kill me?",English
+"And it's always hard for me to have that conversation with them, so I don't want them to get scared and I don't want them to also feel bad for me. So I think this registry is so important,",English
+"cause it also allows them to discover what doctors are near them that can actually help them find new up-to-date information, and not just be given narcotic.",English
+Because they're in pain and the doctor doesn't know what it is. So it's so important for people to have more access. And that's why we need more availability,English
+"with these registries. So people all over the world can have treatment, because like we talk about",English
+"Cole, what is your view? And do you use the registry or do you keep, let's say abreast with the latest NF news",English
+or researching NF2? - So I am on the registry. I've signed up for that.,English
+"Obviously, we're trying to be a part of like CTF, NF outreach and must part of the NF accelerators program and stuff like that.",English
+"So I get a lot of information from that as well, but, you know, we have these new treatments coming up, let's get this out there to other patients, try and share social media, get all this outreach.",English
+"So I have a lot of different areas that I see that information for obviously. All the Zoom calls that we have, I believe they're doing it monthly at this point",English
+"about new drugs, new trials. So when it comes through the registry, I'll be honest,",English
+"I do look at it from time to time, but, you know, I'm being bombarded and this is a great thing within CTF. I mean, I have emails all the time",English
+"about new trials about here, jump on this Jim call. Let's see, let us tell you what's going on. You know, have all the experts talking to you.",English
+"I mean, it's a great thing. And I know from when I've actually to other NF patients, whether NF2, NF1, whenever at the NF symposium or wherever it may be,",English
+"a lot of times for other people who aren't involved in their outreach, like the accelerator program and all that, you know, they said, you know,",English
+"that registry seeing all those resources, seeing, you know, they have no idea what to go like ground. They say you can be a big, scary time, having others resources there to say,",English
+"okay, here's what you have. Here's how you can deal with it. Here's different treatment options, maybe here's contact.",English
+"So you can get in touch with, to figure out what you need to do. I know from personal experience that they've told me that their registry has been amazing,",English
+"and helping them guide them through. Really, when they first find out and even when they've had in it for 10 years",English
+"How involved are you? - I receive it. I know you are. - I receive it almost every day, cause I'm on in a lot of committees",English
+"and just try to be involved. But the NF registry is fantastic. And having been around the NF community for a long time,",English
+I was actually one of the original people to register on day one. So I think it's wonderful.,English
+"And as Cole said, those that are entering the journey, so registry is so helpful to them to help guide them, give them information.",English
+"And also Brianna, I have to say your year as an ambassador, you were spectacular. So thank you for representing all of us so well.",English
+"- Thank you. You're amazing, thank you. - I still have that picture of you in that beautiful dress at the gala",English
+"we're advertising (laughs) (Salva laughing) - No, and this is great. Because one of the opportunity with the sabbatical",English
+"is to trying to expand our NF registry, so that we can be more effective in conveying all of this information we're kind of generating",English
+"and learning from the community back to the patients. And the registry is really the most effective tool, because we can segment that information",English
+"to those patients that really needs it. So because we have information about patients, so help us, join us in this effort to expand,",English
+"we've been investing in translating in four different languages. So now the registry is not only in English, but also in French, Portuguese, Italian,",English
+"and I'm forgetting the forth, and Spanish, four language. So yes, and we hope we'll be able to reach globally more patients than we do today and we serve today.",English
+So this is a great opportunity for any of you that is interested to help with that. Anything else you guys wants to share?,English
+"I mean, I think it's been phenomenal, the discussion we had. And I don't know Barb,",English
+"So it's allowed me connect with people who feel similar as I do, although we have different stories. It's nice to know that you're not alone.",English
+"And it's also helped me be a big leader. Because, I remember I've been involved with CTF since I was eight years old. And again, I'm now 24.",English
+"So they've really seen me develop, and they are my family. And I truly appreciate everybody involved in CTF and the patient advocates.",English
+"And because of working so closely with the Children's Tumor Foundation, I'm actually finishing my last term at NYU online for school counseling,",English
+"because I wanna bridge the gap between education and chronic illness. Because in COVID we saw how we can utilize online learning,",English
+"which I wish was something I could do when I was in the hospital for X amount of time. But they don't allow that if for chronic illnesses, it's only for COVID purposes.",English
+"So now I'm trying to work with legislation to re-enact the law called Brianna's Law, that allows people with chronic illness and mental illness",English
+"to zoom into their classes or record their classes, so they don't get counted as absences and they can still learn equally.",English
+"I believe some have already done it, but they're trying to stagger across different weekends. So they're not all on the same, it's always around Valentine instead.",English
+"And if haven't heard about it, is you do about a mileage run in your underwear, around 30 times say every year to raise money for NF.",English
+"That's an absolutely fantastic time. You don't have to wear your underwear. You can wear a costume pajamas, whatever you want. Obviously, it can be,",English
+"be an interesting experience in below zero weather and snow up in the Northern states, but it's a great time,",English
+"raises a lot of money for NF. With my family growing the past couple years, I haven't been able to be involved with it",English
+"as much as I wanted to, but I definitely did it for two or three years. And it's absolutely fantastic experience.",English
+"So if you do it, sign up for it. If you can get to it this year, if not look out for it next year. I also did a lot of personal fundraisers as well.",English
+Just little like raffle prizes and things like that. And then most unfortunately was the hackathon. I think we've already talked about that.,English
+"I believe that was last year, maybe the year before that, I'm not sure. We just kind of playing together these days, but that was an absolutely amazing experience,",English
+"where you can just see how important it is to have patient advocates. And during that,",English
+"we had patients just like us today discussing this, where there were patients telling multiple medical experts status",English
+"for those people who are software engineering this thing and here it is. Here's problems, we're constantly facing every day. What can do that?",English
+"What can you do to help us out? Whether it's a software for helping manage our care or connecting us to doctors? Like Brianna said,",English
+"a lot of us don't have enough specialists close by. There's nowhere even in my state. Really, I had go I'm in South Carolina. I had to travel to North Carolina and Boston",English
+"to see my NF specialist. So it's an amazing thing, really. If I have those resources to say, okay, here's where you can get to get in.",English
+"Here's maybe other people with NF to connect you to, here's how you can manage your care. There was also machine learning algorithms",English
+"to help better analyze data from drug trials. I believe all that stuff, whatever my age, but it was absolutely amazing.",English
+"- Thanks Cole. And I guess Bill, we wrap it up with you, although you shared a lot of it, but. - That was amazing, Cole.",English
+"So as Cole said, the hackathon, I participated in that the last couple years. I've spoken at conferences representing schwannomatosis only cause they're so few of us, they keep having me back.",English
+"We had an international conference that we spoke to, just participating over the years in CTF. I had a little bit of a unique situation in that.",English
+"As Brianna and Cole talked about, we have so many things that can affect us that when we're first going through the diagnosis process, we literally have to see seven or eight different doctors",English
+"to see exactly what we're gonna lose, what's gonna be affected, what's okay. And in the process, I was fortunate enough to get two common doctors",English
+segments got expressed and the expression level is relatively lower and in some patients the expression is fairly detectable.,English
+"We quantify the expression of TCR and BCR using RNA-seq data, we count the number of reads mapped to each gene segments and then analyzed it with sequencing maps and gene",English
+lines. We also examined a TCR and a BCR clonality by analyzing the soft-clipped reads mapped as --rearrangement break points.,English
+"On the left hand the uniformity of the soft-clipped reads, indicating this is the single T-cell clone.",English
+And then on the right-hand other soft-clipped reads are different. This indicates a polyclonal T-cell repertoire.,English
+Before I move to TCG data I’m going to show you a few examples of the TCR and BCR expression in lymphoma patients.,English
+Here is a picture of TCR expression in T-cell lymphoma patients is a small patient cohort. The first of five samples are conturity [spelled phonetically] cells from donors.,English
+"As you can see here, for most of the patients there is a clonal expansion of one or two T-cell receptor genes, and a few samples of among two show polyclonal seq natures [spelled",English
+"phonetically]. Here is another example of the B-cell receptor expression in a B-cell lymphoma patients. You can see a clonal expansion of immunoglobulin heavy chain gene and a two kappa chain genes,",English
+"which is consistent with a lab test. But with RNA-seq data we are also able to detect expression of the lambda chain gene. As you can see the expression level is relatively lower than the kappa chain gene, but we are",English
+still able to see it. So -- and we’re trying -- with these examples -- I’m trying to see -- characterize of T-cell and B-cell receptor expression with RNA-seq data is sensitive and is very accurate.,English
+"Also with RNA-seq data, we can look at entire T-cell receptor repertoire in these B-cell lymphoma patients. As you can see here, this B-cell lymphoma patient actually has a polyclonal T-cell receptor",English
+"alpha-beta repertoire [spelled phonetically], which predicts a good prognosis for treatment. Okay, now move to the TCGA data.",English
+"I show you a selected subset of CRC patients. So from this -- is a [unintelligible] head map clustering of the expression T-cell receptor,",English
+"both alpha and beta. As you can see here, first, the expression of alpha and beta are pretty consistent. Patients with pretty high expression of alpha had higher level expression of the beta.",English
+"So this is expected because alpha, beta should always express together. The second, you can see, the expression of T-cell is separate with alpha and beta associated",English
+"with [unintelligible]. So you can see here the hyper-mutated patients, they are MS positive, so indicated by red bars.",English
+"And their outer mutated patients, those patients have a mutation in exonuclear dome of the pole E so they’re hyper-mutated [spelled phonetically].",English
+"These patients, they are tightly clustered here. They have a strong expression of T-cell receptors, both alpha and beta. Also, of course, there are some patients classified here with low expression of the T-cell receptors.",English
+"Here the expression of B-cell receptor. The heavy chain, the kappa chain, the lambda chain expression are pretty consistent, but the association of BCR expression and the microreceptors [unintelligible] is weaker.",English
+"Because you can see almost half of the patient in this cluster and half of the patient in this cluster the micro set's less stable [spelled phonetically]. And with this summary graph it is more clear, you can see off of the T-cell receptor expression",English
+the microsatellite stable patients are about 30 percent of patients comprise TCR. The hypermutated patients about 80 percent expressed TCR.,English
+The outer mutated patient about 60 percent is actually a significant p-values between these two groups. But we didn’t see any difference with the current data set with -- for B-cell expression.,English
+"So we tried to characterize the two subpopulations using the defined immune metagenes. We got the metagenes from two, literally two papers.",English
+The gene list one is 812 for 28 immune cells of populations from Angelova's paper. Gene list two is 507 genes for 25 immune cells subpopulation from Bindea's paper.,English
+"So I hope to note that there is a little overlap of gene one and gene one, only 114 genes common. So for our analysis we used both a gene one and gene two.",English
+"So here is their integrated view of expression of their T-cell receptor, B-cell receptor, their metagene list one, metagene list two.",English
+"So, this head map is kind of our -- kind of complicated but first they’re -- we see there’s a small group here, has a high expression of T-cell receptor, B-cell receptor and expression",English
+of -- strong expression of these metagenes. This head map review interesting [unintelligible].,English
+First this group -- about half of the patients -- these show low level expression of T-cell receptors and a B-cell receptor. But there is a higher level of expression of these metagenes.,English
+"Under this cluster, these patients expressed both a T-cell receptor and a B-cell receptor but is low-level expression of these metagenes.",English
+"So that raises two questions. First, is this metagene really immune cell type specific, could this also be produced",English
+"by net immune cells? And second, for these patients, are those T-cell and the B-cells -- with the expression of the receptor -- are they functionally normal?",English
+Why there is no expression of these metagenes? So we have to do first analysis to answer these questions.,English
+Okay so we -- we also tried to look at association with clinical items [spelled phonetically] for this small selected data set.,English
+"But since they’re only about of our half, or 60 patients has a willable [spelled phonetically] clinical data so we don’t have enough power to see any clinical -- to see any association",English
+"with the clinical outcomes. So now is the TCGA data, the testicular germ cell tumors. We had 138 patients with clinical -- with clinical data.",English
+"So here I show the expression of T-cell receptor alpha and beta is like CRC, the expression is pretty consistent.",English
+phonetically] have two clusters have a higher strung expression of T-cell receptors. The same applies for B-cell receptor there’s two -- there’s [unintelligible] has higher,English
+"expression. So with this summary paragraph, you are able to see that there is other T-cell and a TCR and B-cell expression is associated with subtypes.",English
+"So the seminomas -- over 90 percent of seminoma-expressed T-cell receptors, and only like 70 percent of the non-seminoma expression the T-cell receptors.",English
+"But also we see this part with B-cell receptor expression. So we -- 87 patients has clinical outcomes, so I think I might choose the wrong tumor",English
+"type to look at clinical associations because generally, as a TGCT patient has a wonderful response to either a radio therapy or chemotherapy.",English
+"So this 87 patients, only 11 of them either showed partial remission or progressive disease. So it’s hard to tell.",English
+"But you can see about nine of the 11 patients are in this cluster, with relatively lower expression of T-cell receptors.",English
+So here’s a summary figure. Actually we can see there’s some significant difference between these two groups. The patients with complete remission has a higher rate of TCR expression but we didn’t,English
+see this trend with the current data of B-cell receptor expression. So we tried to correlate with a metagene expression. So here is the summary head map.,English
+"First we can see there’s a subset of patients has expression -- high expression -- of T-cell receptor and B-cell receptor, but also the metagenes. But, you can see there are two small cluster here, so in this patient, probably there’s",English
+a stronger expression of TCR -- weak expression of the BCR. Probably the immune cell infiltration in this subset of patients are T-cell leaning dominance,English
+"and in this subset it’s B-cell leaning dominance. But we can still see these pardons [spelled phonetically]. They are two big groups. There’s no expression of a TCR and a BCR, they are expression of these metagenes.",English
+"So we have to look further into it to answer these questions, are those metagenes really [unintelligible]. Are those T-cell immune cells?",English
+"So a summary of my talk today is -- I try to show you -- oh, I accidentally hit some button, I’m sorry.",English
+So the presence and density of TILs can be estimated by analyzing the TCR and BCR data expression using RNA-seq data.,English
+And the TCR and BCR expression profiles associate with molecule and phenotypes and treatment outcomes.,English
+"So for future directions -- so as our -- so we are going to expand our analysis to the PANCAN project, get a comprehensive picture of immune signatures in major type of human",English
+cancers. And we are going to correlate the immune signature with mutational signatures of -- to get more insights.,English
+So I’d like to thank Kyle and Liu for help with the data download analysis. I’d like to thank David and Richard for their support.,English
+Thank you so much for your attention. [applause] Female Speaker: We’re a little bit over time so can we keep the questions short? Thank you.,English
+Male Speaker: Only two questions. All right. Well just a quick one.,English
+"Maybe you said this, but in that analysis where you see different amount of expression for different subtypes, have you -- are you able to control for the handling of the surgical",English
+"sample? In other words, tumor purity, as well as the way the excision has been made, if the excision was made it might inform in part about the difference that you see.",English
+"""A"" is the multicellular tumor spheroids. As I mentioned, this is just aggregation, so you have the tumor cells / the cancer cells, and then you create a situation where they cannot attach to the surface.",English
+This is actually a very less adherent surface that the cells cannot attach to.,English
+"Sometimes you also use agitation or, like, rotating flasks; you don't allow the cells to settle and just attach. In that case, they form the spheroid. This is called multicellular tumor spheroid.",English
+You have a single cell or a few cells that give rise to the sphere; they proliferate and the sphere grows. This is clonal expansion. All the cells in this sphere comes from this initial cell.,English
+"These are the tissue-derived tumorspheres and organotypic multicellular spheroids. You can see here there are other cells,",English
+including the immune cells and whatever comes from that parent tissue that you are using as a starting material. All those cell types are maintained here. Definitely,English
+"this is short-term. We cannot culture these passages and maintain these passages, but this you can and this you can. Normally, this is used specifically for experimental purposes like HiChIP screening of drugs and all that.",English
+"You are making those cells as spheroids; you culture them as spheroids / do experiments, but when you maintain them, you maintain them as monolayers. This model -- specifically, it preserves the properties of cancer stem cells like self-renewal and clonal expansion.",English
+This is currently a very popular way to culture tumor-initiating cells or doing tumorigenicity,English
+"assays where you can actually basically look at how many of these tumor-initiating cells are in a particular population of cancer cells. I will talk about this in a little bit. Going back to the multicellular tumor spheroids; as I mentioned, these",English
+"can be done in several different ways, large-scale or small-scale, whichever way. The most popular method is this: hanging-drop method. You can also do a roller tube where you actually keep the tube rolling with media and cells so that the cells are never attached to the tube,",English
+but do come in close contact with each other and interact with each other to make spheroids while they're rolling. Then you can get those spheroids to sit into different places for your own experiments.,English
+"You can have spinner flasks, gyratory shakers where you keep shaking the flask. The main aim is to not let the cells attach to the substratum.",English
+"Then, you have soft agar liquid overlay. This method evolved through this: people were trying to develop a technique where you just see the cells in droplets and the droplets themselves are hanging",English
+"so the cells would never have a chance to attach to any substratum. They used soft agar liquid overlay. There were some plaques in the beginning that came out; like, you have to see the cells and invert them",English
+"so the drop is hanging, but now there are plates that are engineered in a way that you just have to add the cell suspension in particular spots and that creates the hanging drop. Over time, these cells get compacted and they form spheroids.",English
+"One good use of this is in drug discovery research where you can specifically seed one spheroid per well in these plates; in heights you can format, like, 384-well format or",English
+96-well format and then you can have several different concentrations of drug treatments on that plate where every well has one spheroid.,English
+"The analysis becomes much easier because you can look at how one spheroid is responding to the drug and you can actually add the treatment directly in those drops. You can add one microliter of drug to each drop,",English
+"and it doesn't change the situation in the plate. This is a very popular method. As I said, you cannot maintain a cell / passage them in this format.",English
+"You have to maintain the cell in one linear format, and then when you prepare them for experiments, you can use these other plates, make the spheroids, and do the treatments and stuff. So, tumorspheres -- OK,",English
+"these are micelles. Now, as I said, tumorspheres form from single cells giving rise to spheres by clonal expansion. All the cells in here are coming from a single cell (or two to three cells) inside the sphere.",English
+"These are cells derived from a particular melanocytic lesion of a congenital disease. I will show you that lesion in a moment. As you see, they are brown-colored;",English
+"they have melanin pigment in them and this is what they look like when they grow in a monolayer. They are dendritic; they have a very, very small nucleus. When you plate them in a basement membrane matrix",English
+"or something that will prevent them from attaching to the bottom of the plate, they will make eventually spheres. This kind of sphere growth was first described",English
+"from the brain in people in 3D not so long back. They named them neurospheres, and from then on, right now, this is the only reliable measure to determine self-renewal in cancer stem cells.",English
+"There is a debate about -- some people on the other side of the spectrum, they say, ""Where is the cancer stem cell? Is there any cell like the cancer stem cell?""",English
+"There are markers; there are conflicting opinion about the markers, but the only reliable assay that everybody agrees to is the self-renewal, and that can be assayed in this format where you see the cells and they give rise to other cells clonally.",English
+"They have the ability to self-renew and give rise to differentiated cells as well in the tumor. Actually, this is also known as a tumorigenicity",English
+"assay for a particular tumor lesion or tumor biopsy. We work on this kind of disease. This is called ""large congenital melanocytic nevi,""",English
+"and also another part of it is ""neurocutaneous melanocytosis."" This is a complicated name, I know. This little baby was born with this much / a huge burden of a tumor.",English
+"This tumor is benign actually / not malignant, and it's called ""large congenital melanocytic nevi,"" melanocytic because this is a pigment cell tumor. This is called nevi. You can have acquired nevi from sunburn, which can eventually transform melanoma.",English
+"This is congenital, so kids are born with this kind of lesion. This is a very advanced stage of this lesion, but sometimes, you have birthmarks; sometimes you have moles,",English
+"it's of the same nature, but this is a huge burden of tumor. This particular patient also had a brain lesion that --",English
+"he had proliferation of melanocytes inside his brain and deposits of melanin inside his brain. When the picture was taken, the patient was one year and nine months, and",English
+"all his cells harbor a somatic mutation in NRAS exon three, which is a Q61K mutation. These",English
+"cells, since they're benign, they're not like malignant cells. Mostly the treatment that's available to these kinds of patients is surgery.",English
+"You just take out the lesion and they'll be fine. This has been going on for years now. This disease was first described in 1861, and from then on to now, the only treatment available was surgery. The problem is",English
+"surgery could not provide any cure because that little kid will eventually get the tumor back. The question is, what causes the tumor to come back if it's not malignant?",English
+"One answer could be -- our colleagues and friends, they came out with this paper recently, ""Clonogenic Cell Subpopulations",English
+"Maintain Congenital Melanocytic Nevi,"" where they actually cultured some cells in a spheroid format, but they don't look like very compact spheroids because they were cultured in agarose.",English
+"I will show my pictures, which are compact columns, but they sort of use this spheroid culture to count and figure out how many of those cells exist in a particular number of lesions /",English
+"a particular number of tumor cells. When they took out the tumor cells and cultured the spheroids, one in two hundred-fifty cells were tumor-initiating cells. One in two hundred-fifty cells were capable of repopulating the tumor",English
+"and they could self-renew, they could express stemness markers like Oct4 messaging. They also express drug resistance genes like ABCB5 that comes out drugs",English
+"so whenever you treat with those sorts of drugs, they are resistant because they have the ability to pump the drug out. This paper actually prompted us to think that,",English
+"""OK, if clonogenic cell subpopulations exist in nevi and the only way to catch those cells is to grow them as spheroids, why don't we grow them as spheroids?"" What I did is",English
+I cultured some cells from a lesion of this patient. We actually have an IRB-approved protocol of receiving freshly-excised tumor tissues from these patients.,English
+"This patient had undergone surgery in Chicago, not sure which system, but they shipped us the sample, and we have a tissue repository in the lab that maintains tissues from all these patients.",English
+"We sort of tried to culture cells from this lesion and tried to grow them as spheroids. Here you see a bright picture of cells trying to form a spheroid — these are even not compact either,",English
+"but they are sort of trying to form a spheroid. They express the melanocytic markers here, which sort of validated that these cells are really coming from the lesion, not from another place.",English
+The way we culture them also eliminates the possibility of growing other cells in the tumor. I'll go over that in a minute. I tried many different other patient samples and they all were capable of growing as tumorspheres.,English
+"We named them nevospheres now. This patient, ""PS01"" -- his cells came from a spinal cord lesion.",English
+"This patient, who you already saw, it came from the skin. This patient -- also from the skin. This patient here, the tumor cells came from the brain, but they all behaved similarly.",English
+When we put them on Geltrex -- Geltrex is a basement membrane matrix that has laminin and collagen in it -- they grow better than in monolayers.,English
+"Here I show you that the proliferation ability of those cells when grown as spheroids is way more than when they are grown as monolayers. OK,",English
+"so this spheroid formation is not actually a mere aggregation; there's something biological going on inside. This is proof that E-cadherin, which normally maintains the contacts / cell-to-cell contact on the epithelial cell",English
+"membrane -- when you grow these cells as a monolayer, they are -- they express E-cadherin / they are not localized on the nucleus, but when you transfer them to Geltrex matrix, E-cadherin is redistributed to the membrane and cytosol.",English
+"These spheroids actually are maintained by cell-to-cell contacts, and E-cadherin is on the membrane here. We can actually count the number of spheroids; we can compare the number of spheroids",English
+"present in each patient sample, and this has perfect correlation with the aggressive ability / proliferative ability of the cells. These cells grow faster and more aggressively",English
+"in culture, so definitely they generated more colonies than the other three. Also, we can measure the diameter of the spheroids",English
+"using software and microscopes. You can put the spheroid colony under a microscope, and you can measure the micrometers of the spheroid / the diameter of the spheroid / how much micrometer.",English
+"The specific good thing as a whole is that you can actually passage them and maintain the same ability — I followed them for, like, five passages, and the number of spheroids remained almost the same.",English
+"The self-renewal ability is preserved, and you can basically maintain these cells as spheroid colonies, and you can preserve their properties.",English
+"Definitely the one which has more colonies over passages showed some difference / going down a little bit, but all others, I couldn't see any significant difference.",English
+"OK, here's the good thing about it. If we can maintain sphere colonies / maintain over passages, we can actually use them for drug treatment or drug sensitivity assays.",English
+"We can treat them with drugs and measure the number of spheroids / diameter of spheroids -- specifically, if the spheroid is not growing.",English
+"If the self-renewal ability is impacted by the drug, the spheroid size will not grow. Compared to vehicle here, which is untreated,",English
+this is -- vemurafenib is actually FDA approved for melanoma. with BRAF mutations. MEK162 is in the last stages of clinical trials.,English
+"It's not approved yet, but it's showing very good response to for BRAF- mutated melanoma. GDC0941 is a PI3-kinase inhibitor, and GSK2126458 is a Akt inhibitor.",English
+"NRAS mutation has redundant signaling going on, and people have tried to target those mediators; MEK is one of them. Another target mediator is Akt,",English
+"so those works are going on. Still, NRAS-mutant melanoma has no no sure-fire cure like BRAF. We took these photographs and we sort of tried to see -- since we detected NRAS mutations in this disease, whether these drugs can affect",English
+"the self-renewal ability of these cells. As you can see, vemurafenib did not affect anything; MEK162, a little bit; GDC, same as MEK; but this one (GSK) turned out to be the most effective, which targets AkT.",English
+"Then we measured the diameter, and this is definitely very significantly down here. I did not put the significance analysis here, but visually you can tell the difference.",English
+"This (Vem) is also effective, but I think this drug is not -- it's not inducing cell death as this one (GSK) is. In this one, you can see a lot of dead cells around; Vem probably stops cell proliferation, but",English
+"cells are still surviving. This kind of study usually gives us, like, more reliable data about drug action because it's it's working on spheroids in the in vivo environment,",English
+"so we are working more on this. This is just preliminary data, and we hope to find out more. These are some cell viability assays you can do using the spheroids. The same drugs are used here with different patient samples / different spheroid cultures.",English
+"GSK turned out to be the best one in every case, although there are some patient-specific differences. This is another aspect I'm so interested to pursue. You can use this as a preclinical model to test drugs before you give it to the patient.",English
+"Incidentally, these four drugs (except vemurafenib), none of them are approved yet, but if the doctors want to prescribe a drug which is approved, you can basically use this model to test the drug before you give it to the patient to see",English
+"how good that patient would respond to the drugs. Yes? [Audience Member]: Have they been used in animal models? [Dipanjan Basu]: Yeah, they have been used in animal models, but the problem is animal cells (like mice cell) and human cells are genetically not similar,",English
+"so this is more liable. If you get the cells directly from the patient, you just -- you can grow the cells from a very little tumor biopsy. You can pull out using a needle, culture the cells in the lab,",English
+"test the drugs, and then you can tell the patient, ""Well, this is the drug that works for you."" [Audience Member]: What's the time frame for that? [Dipanjan Basu]: Two weeks at least. Yeah, because we need to first make the cells survive, then expand, then go into the spheroid, and then treat,",English
+"so yeah, at least two weeks, because -- I would guess that the more aggressive the cancer is, the timeframe will become shorter and shorter; since these are not aggressively dividing cells,",English
+"the timeframe is longer. OK, so this is, like, a summary of what I was trying to say all this this time:",English
+"really, how do we grow these cells as spheroids? We get a tumor sample from a biopsy or something.",English
+"Sometimes very early, we get a sample when a patient is dead; that's very sad, but normally we get a biopsy instead of an autopsy. We trypsinize and plate the cells -- like, this is a picture after seventy two hours, which shows you that the cells are still",English
+"shaking -- some cells are attached to the bottom of the flask, but they have not yet started to give out their dendritic extensions,",English
+"so it takes a while for these cells to really go into division. That's what I was mentioning. By six days, you can see clones of cells coming out on the plate.",English
+"There are several areas on the plate where you see bursts of proliferative activity, and those cells are like this: they have short dendritic extensions, and not so brown at this point,",English
+"but the more they grow, like -- by ten days, they sort of start dividing now, and they become a clump by twenty one days. If we have enough cells, then we can trypsinize them and put them in the matrix where they will round up.",English
+"This is a low magnification; it's not the same as this, I just wanted to show you how many we get from, like, a grown up cell.",English
+"They round up like sphere colonies, and then this is how they look like: one colony looks like this. You have cells radiating out from the column.",English
+"Those are the differentiated melanocytes, and I would guess the cells in the central part would be more or less differentiated, kind of. That's the timeline,",English
+"and once we get this, then we can now seed them for experiments; we can study drug sensitivity or cell signaling or whatever you want to do with them like immunofluorescence. One problem with --",English
+"not a problem, but I mean, the ways we harvest cells from monolayer cultures and the way we harvest cells from spheroids is different. So far, cell survival assays like MTT and all that, you can directly do in the plate; you can add the reagent and it's colorimetric,",English
+"so you can wait for the change in color. If you want to do Western blot or something / if you want to harvest the cells, then normally have to get rid of the matrix first,",English
+"so you solubilize the matrix in PBS, EDTA, or something like that, and then you pellet down the cells, then you lyse the cells, and you go from there.",English
+"It's not very -- I mean, you cannot really get an exact count of cells in every sample or have an equal number, but what we do normally is we estimate protein content and then normalize with that.",English
+It works very well. Here's some useful resources that I used that helped me start this method. This is definitely a very good book:,English
+"""3D Cell Culture"" by John Haycock. Geltrex matrix -- if you go to lifetechnologies.com, they have different kinds of",English
+"matrixes that are used for different purposes; like, they have embryonic stem cell-qualified matrix, they have virus-free / growth-factor free -- different kinds of matrixes.",English
+"We sort of -- our choice of matrix was based on previous efforts of other groups that tried to grow melanocytes. They found that having laminin and collagen increases cell survival,",English
+"so we used the matrix that had laminin and collagen in it. Also, 3D Biomatrix is another company that recently -- they have a lot of protocols on their website that are free that you can go through",English
+"and use them. They also sell the plates that I mentioned, the multicellular tumor spheroids / hanging-drop method plates. They have those plates as well. I don't use them, but I found them there.",English
+"Those are some useful resources that you can use if you want to grow your cells as spheroids. This is our group. This is my boss, and these three students are from Pitt;",English
+"First Experiences in Research, they started this year so they work with me and did some projects. That's all for today.",English
+"Thank you for your attention; I look forward to your questions. [Audience Member]: You did a drug assay with the 3D microspheres / the spheroids, so I was wondering, did you actually do a comparable assay also on the monolayer to see the variability of the drugs?",English
+"[Dipanjan Basu]: Yeah, that's a very good question Yeah, we actually did, we actually did. The way we are growing the spheroids, we are actually selecting the tumor-initiating cells in the very beginning when they're growing in the monolayer, because if you go back to the slide where I summarize the matter --",English
+"What happens is between these times -- at seventy two hours, here you have all kinds of cells, but at six days, all the other cells like fibroblasts, blood cells and whatever comes from the tumor lesion. The media",English
+"we are using has these specific set of growth factors and only supports the growth of these cells. Basically, if you take these cells now and do the drug treatment assay,",English
+"the data that you receive -- and if you take these cells now and do the drug sensitivity assay, there's not much difference in terms of viability, but there will be a difference when we look at interaction with the matrix or cell signaling or other parameters.",English
+"Yeah, that's a good question that reviewers ask us: ""Why don't you use the monolayer then? What is the use of using spheroids? Yeah, I mean, there is no difference in terms of viability,",English
+"but definitely if you look / if you delve deeper into other intricate questions, then there will be differences in the spheroid model. [Audience Member]: I was wondering because it's in the spheroid, you could probably keep it longer as opposed to the monolayer plate because of the confluence is so big after",English
+"nd you need to do the drug assay within three or four days. [Dipanjan Basu]: Yeah, if you keep changing the media, you can really keep them for longer. Yeah, I have kept them, like, two weeks or more than two weeks.",English
+"What happens is if you look -- again, I'm going back to the pictures -- if you look at these cells, the number of spheroids will not increase,",English
+"but what happens is, if you look at how these cells are touching each other, as the spheres grow big, they seek out their partners. They're very, very interesting cells. They want to touch each other,",English
+"so as they grow, they come into the vicinity of the other neighboring colonies and sort of touch each other. I'll stop there; we can go on,",English
+"I mean, it's no big deal. Another problem is that the core cells will start dying from -- like I mentioned, the hypoxic core. As you keep going,",English
+"the colony will grow big to some extent, but then it can start dying because the core cells will die. [Audience Member]: When you were doing the viability assay, were you looking at viable spheres or viable cells? [Dipanjan Basu]: I’m looking at viable cells. It’s synonymous,",English
+"because spheres are made out of cells. What I do is I directly -- I do two things: one is I directly do MTT assaying in the well, add the MTT reagent, wait for the color to develop, and measure in a plate reader,",English
+"and the other thing is a parallel plate. I give to my students to trypsinize and count the cells to see if it matches. It sort of matches, sort of matches. Definitely more human error comes with counting cells, but it's sort of in the same ballpark.",English
+"[Ansuman Chattopadhyay]: Is there any difference in the gene expression when you compare the spheroid form versus monolayer form? [Dipanjan Basu]: Oh, yeah, yeah. I cannot give you the data from my cells because we haven't done that in these cells,",English
+"but in other cancers where people have grown monolayers versus spheroids, like Hans Clevers in the Netherlands -- he was the person who made the organotypic colospheres from colon cancer.",English
+"They did a whole transcriptome analysis of monolayers versus spheroids, and there are many genes that are up or downregulated that sort of gives them",English
+"an idea how these cells -- they did, like, the parent tumor, monolayer, and spheroid, and compared those three. Definitely the spheroids most closely resembled the tumor,",English
+"but we haven't done that yet. We are still starting on that. Yes? [Audience Member]: So, your real goal is to characterize the TICs, but if your goal was to really kind of recapitulate",English
+"the key thing here is the tumor heterogeneity. As you mentioned, you need to have all the cells. Each one has its own contribution in the tumor. The problem with these cells is that in the huge lesion you saw, most of the cells of senescent,",English
+"so they don't divide, only a few of them divide. That's why if you have a child with a huge lesion of melanocytic nevi,",English
+"and those cells are at risk of acquiring secondary mutations and transforming into melanoma. Our target were those cells, but other cells -- definitely having those senescent cells could have some implications on the tumor microenvironment,",English
+but we cannot target them because they don't grow in culture. They are senescent; they are permanently cell-arrested because of oncogene activation. Only the cells,English
+"which have self-renewal ability keep dividing, but they are still not very actively growing cells. If you provide them the environment, then they grow.",English
+"they have a lesion in the brain. The precursor sell off melanocytes are neural crest cells. Neural crest cells are cells that -- when the embryo forms and invaginates before the neural tube forms, you have the neural crest.",English
+"Those cells are the stem cells which give rise to many different cells in the body, including melanocytes. Now it is believed, not proven yet, that those cells -- when they start migrating from the neural crest in their journey to the skin,",English
+"at some point during development they acquire a mutation. When they acquire a mutation, they start proliferating, like, abnormally, and then at some point they stop because of tumor-suppressing mechanisms in the cell,",English
+"so you have this benign lesion. Now, the later in their journey they get the mutation, the phenotype is mostly skin; the earlier",English
+"near being entirely predictable for the following reasons, the cancer cells don't necessarily lodge",English
+"permanently in the lungs or the liver. they change their shape, they squiggle around, let's say coming from the GI tract, they may get through the liver",English
+into the inferior vena cava up to the heart and out anywhere in the body. So it turns out that really practically,English
+"speaking, cancer cells once again in circulation are all over the place and",English
+"it also turns out that there are secondary factors that determine where the metastases will occur For instance,",English
+we know that cancer cells get out systemically. We rarely see metastases in skeletal muscle. I have no idea why.,English
+"of one tissue over another, and you'll learn these patterns, I'm not going to afflict you with them. They are",English
+"to an extent predictable. So that's the situation with hematogenous metastases, liver, lung, many other places as well. It's a systemic process",English
+Here are cancer cells in a lymphatic. You probably know less about lymphatic channels than you do about blood channels but these are basically,English
+"they start from small, thin walled vessels like this and and any particular organ almost all organs in the body have a rich lymphatic drainage. The lymph",English
+"is drained into bigger bigger lymphatics. These enter what we call regional lymph nodes. which we'll study in detail, but these are basically like little filter beans",English
+and a clump of cells like that may well lodge in a regional lymph node. Now,English
+"what denotes a regional lymph node? In the case of the bowel, the regional lymph nodes are in the mesentery. In the case of the breast, the regional",English
+"lymph nodes are in the armpit, that's where the lymph is draining. In the case of the mouth and throat, the regional lymph nodes are here in the neck.",English
+"And there's a certain predictability so that if you have a big cancer in the mouth, you're going to worry about the cervical lymph nodes or the",English
+or the breast you're going to worry about what's going on in the axilla. Cancer operations generally involve either excavation or sampling of the regional lymph nodes to see whether the cancer,English
+has spread from the primary there. Now this predictability again can break down because,English
+"lymph nodes are not perfect filters, whatever you might think, these cells might lodge temporarily in a lymph node and some of their progeny",English
+maybe goes scooting out the other side in the efferent lymph which is going to go to other lymphatic channels and eventually dump into the,English
+"superior vena cava and join the systemic circulation. So it turns out that cancer,",English
+"here about metastasis is the possibility of direct metastasis. By that I mean the cells are not picked up in the blood or lymph, but",English
+"if they enter a cavity, let's say the peritoneal cavity, and can drift or swim or float",English
+"across the peritoneal cavity and lodge anywhere in the lining of the peritoneal cavity, it's a sort of direct metastasis.",English
+"We see this one that comes to mind is the ovary. The ovary sit out in the pelvis,",English
+"in the open so to speak, in the peritoneal cavity. Ovarian cancers notoriously will just seed cells into the peritoneum and they'll land anywhere in the peritoneum",English
+and set up these metastases. A variation on this that we don't often see is that the surgeon's knife may pick up,English
+some cancer cells and we'll find a recurrence in the incision or something of that sort. More or less,English
+"a direct, iatrogenic (physician caused) metastasis. But again metastases",English
+"represent a hop skip and jump, it's not direct invasion to get over here, it's a jump to get over there.",English
+"A thing to point out is that the metastasis does not have the the characteristics of the organ that it lands in, it keeps the",English
+"characteristics of the primary tumor. In other words, these metastasizing cells are the genetic progeny of the primary, so they're going to look like it. If the neoplasm",English
+"neoplasm in the primary was making funny glands, the metastasis will probably make funny glands. It's a chip off the old block.",English
+That has some some interesting implications there which you'll get into in future years. But just,English
+"think of it as as a process whereby a single primary can give rise to many metastases. They can be at a great distance, it can be four feet away from",English
+the primary and it can be very devastating and I will show you some examples of this.,English
+This is carcinomatosis which refers to a diffuse spread of cancer.,English
+"This was the lining of the diaphragm, in other words if i took a piece of diaphragm, cut it out and you're",English
+"looking at the under surface of the diaphragm lined by peritoneum, this was from a patient with ovarian cancer, and every one of these little plaques is a",English
+"few million cancer cells growing as a direct metastasis. Now I'm going to give you a long shaggy dog story, here is a",English
+"specimen of peritoneum, this is if I took a couple of pieces of body wall cut them out and you're looking at the peritoneal surface",English
+of the inside of those pieces and you can see studded with a couple a hundred little tiny black spots and here it's actually become kind of almost a confluent,English
+"sheet of neoplasm. And you'd say yeah this looks like many little nodules, why do you suppose it's black like that?",English
+"Any thoughts? Well, the cells are making melanin, this is a malignant melanoma which may have heard about. Now",English
+"I'm getting ahead of your knowledge of histology, but there are no cells in the peritoneum that make melanin normally, so that means these are visitors from somewhere else,",English
+"so clearly just by the sheer numbers and by the fact that it's melanoma we can say that these are metastases from somewhere else. I'll let the plot thicken a little bit, here was the liver",English
+"from the same case. The normal liver is studded with probably thousands of metastases. This is grown together in a big, horrible",English
+"mass which had broken through the hepatic capsule, and the normal liver does not contain melanin producing cells. That fact and the fact that that these are so multiple",English
+Skin. That'd be your first bet. Because melanoma is a common story. But you're wrong. Eyeball.,English
+"This is a bad picture, I screwed up and am not a photographer, but there you see the reflex from the flash, but just behind it there's a little lump",English
+there and that is the primary neoplasm. Now this tells another story. This patient presented with a visual disturbance and the ophthalmologist saw this,English
+and said this eyeball has to come out. And the eyeball was taken out. It is our job as pathologist to assess whether the excision has been complete.,English
+And so we sample the various coats of the eye thoroughly to see if the melanoma cells had penetrated through and if there any left in the in the orbit. And the answer,English
+to it is no. Looks clean. I hope the surgeon didn't say this but this sometimes gives rise to the statement:,English
+"we got it all! Now this patient did fine after removal of the eyeball, did fine for several years. With",English
+"absolutely no evidence of metastases. Then something happened, God knows what, the patient just",English
+went downhill within a period of weeks and died and had metastases all over the body. That brings up another interesting point which I'll just tease you with and,English
+that's the phenomenon we call dormancy. It was very clear from the story that we had taken out the primary,English
+and there was never any recurrence in the orbit and so that what that says is these melanoma cells have gotten into circulation that there were tiny occult metastases,English
+at the time the eyeball was taken out and they chose not to grow for several years and then something changed and they grew.,English
+"And we see that sometimes. In other words earth eighteen months survival or two years survival or five year survival is a statistical thing, but",English
+sometimes it doesn't matter. So this illustrates,English
+"the fact that that metastases can be very distant from the primary, they can be",English
+millions of metastases from one primary and also I threw in this whole phenomenon of dormancy which is a bit unusual but it happens.,English
+"I'll show you some other mets. Here's a lung of a youngster. Every one of these is a nodule of neoplasm, the other lung looked just like this. This happens",English
+"to have been a primary in the kidney which got to the lungs through the renal veins, the vena cava, and on up. The good news is that we can cure many of these, not *at* this stage, but we",English
+"can prevent it from reaching this stage now. Here's an interesting one that we see very often, this is a vertebral column which",English
+"I sliced in a band saw so you're looking at a couple of mirror images and this is a pretty normal vertebra up here, this is an intervertebral disc up here.",English
+"These two lower vertebrae you see these whitish areas here and here. These were very dense bone, and interestingly",English
+"what this represents is metastasis to the bone, it stimulates bone formation around the cancer cells, it's something we call an osteoblastic",English
+"phenomenon or an osteoblastic metastasis. This would have shown up as a density on the x-ray under the microscope, there's a lot of bone there but cancer cells throughout",English
+"and usually cancer cells reach the bone via the hematogenous route. Could be anything, I mean if someone showed me this, I'd say it's metastatic something or other",English
+from somewhere or other but you will learn for instance that breast very often breast cancer very often goes to bone. Prostate cancer notoriously goes to bone.,English
+"I won't bore you with the list, but you're going to learn as you study oncology what the likelihood of I mean if this came from a",English
+"middle-aged woman with with a breast nodule, I'd say breast cancer. If it came from an elderly guy with urinary tract obstruction, I'd say look at his prostate.",English
+"So that is an osteoblastic kind of metastasis. Here is a different one, this one has another story associated with it.",English
+This was a 42-year old guy who came in with back pain and he was a manual laborer that did heavy labor and everyone thought at first well you know it's some orthopedic,English
+injury until they got an x-ray of his back and discovered that one of the vertebrae was essentially turned to mush. Here's a normal vertebra here and here.,English
+"Here's a disc and this is a osteolytic metastasis, it turned out that there was a metastasis that completely destroyed the bone and it simply collapsed.",English
+"Now this man presented because of his metastasis, that sometimes happens, it may not be the primary, it turned out he was a heavy smoker and had a small,",English
+"inapparent bronchogenic primary, in other words, a lung cancer and it metastasize to his bone without even causing any ruckus.",English
+He probably had a little cough as all smokers do but presented because of the metastasis This was,English
+"another smoker incidence, I remember this one very well, the patient came in convulsing, signs of",English
+increased intracranial pressure. They had to take him to the operating room very quickly to decompress the brain,English
+and save him from dying from the pressure and my colleague sent me a piece of this,English
+to look at it quickly with what we call a frozen section. You freeze a tissue and make a quick section of it It was easy to say this isn't,English
+"cancer arising in the brain because it didn't look like that. It looked like a cancer that came from somewhere else. This is not rocket science, you'll learn how to do it in the spring.",English
+"But it's because the metastasis resembles the primary that we looked at it and said, no, this isn't brain, this is metastasis to the brain.",English
+"Poor fellow died shortly after operation, it turned out again he was riddled with metastases with a small lung primary. Lung primary",English
+very often goes to brain like that. Oh one last lovely image,English
+there is a liver riddled with metastases. And if,English
+"someone showed me this liver and said where did this come from, I'd say gee, well look at the GI tract. It can be elsewhere, this was a lung cancer",English
+"that had metastasized and gotten into the bloodstream, had gotten around and liked the taste of liver and produced metastases in the liver. There were metastases in many other",English
+"places as well. Well, i guess that gives you a little bit of an example, a little bit of a feeling for the the destructiveness of this process of metastasis. Again benign neoplasm",English
+"do not metastasize, only malignant ones do. Benign neoplasms do not invade, only malignant ones.",English
+"With those concepts of neoplasia, hope you've all got benign and malignant invasion, metastasis sort of",English
+under your belts. I want to talk for a little bit on how neoplasms are put together microscopically.,English
+"Again, don't worry about being able to do this kind of diagnosis yourself, just listen to the concepts. I want to review the concept of stroma,",English
+"the concept of differentiation, and ideas of grading and staging. All right, let's let's begin with the business of stroma and angiogenesis.",English
+One of things that I should emphasize that I didn't really emphasize so far is that a given module of neoplasm,English
+take one of those metastases in the liver for instance A given nodule of neoplasm is just not a spherical,English
+collection of 100% cancer cells. This is a very important concept and it makes perfect sense,English
+because you could not possibly grow a lump literally that big and have,English
+"a blood supply for the cells in the center, you follow me? In other words, if they were pure cancer cells",English
+"the blood would be out here and the cells would be proliferating here. It doesn't work that way, the cancer needs a blood supply in order to grow.",English
+and it turns out that cancers are able and this is an very interesting phenomenon,English
+to induce the formation of what we call a stroma it's a fibrous particularly a vascular framework,English
+which supports the neoplasm. Now the stroma is not part of the malignant clone,English
+or the neoplastic clone. It comes from the connective tissue cells and the blood vessels cells,English
+around the neoplasm. The neoplastic cells and probably some of the inflammatory cells accompanying the neoplasm are able,English
+to induce the formation of this stroma. It's very much like the the induction of granulation tissue which you're very familiar with from,English
+last week. And what happens is this fibrous and vascular stroma grows into the nodule and enables it,English
+"to proliferate. Now we talk about tumor angiogenesis, I mean the emphasis being on the blood vessels.",English
+"There is abundant experimental evidence to show that and i won't go into the details, but if you create a situation where you got",English
+"a bunch of neoplastic cells growing pure where they can't pick up a stroma, the module will never get bigger than a millimeter or two at the very most,",English
+probably less because because the oxygen and nutrients cannot diffuse in the solid mass any further. There are many experiments that show,English
+"you grow neoplastic cells in these little balls and they stopped growing. and then if you do something to induce angiogenesis, BOOM, as soon as they pick up",English
+the vascular stroma they begin to grow so tumor angiogenesis is exceedingly important. You can,English
+"read a I won't bother you with the details, but we are beginning to know a little bit about how this is mediated and what it looks like is this: again without too much detail",English
+this was a lump in a breast. This was a breast cancer. These dark clumps are the cancer cells,English
+"and the pink in the background is the stroma. I'll emphasize in particular there is a capillary there,",English
+"there is a capillary cut lengthwise there, there's another capillary here and so forth so that any given",English
+clump of cancer cells isn't very far from a capillary. That's the concept,English
+of the stroma and tumor angiogenesis and what it means. If we could stop angiogenesis we could stop tumor growth.,English
+It would be wonderful and some of these attempts have reached the clinical testing testing stage but nothing terribly dramatic yet. But it's certainly a handle.,English
+"Here is kind of a loose stroma, not very fibrous but a lot of blood vessels. Sometimes you can be",English
+very dense. These are cancer cells in a very dense collagenous stroma. This kind of a lump has a,English
+"consistency about like wood. We call that, it's an adjective you'll hear occasionally, it's a scirrhous s-c-i-r-r-h-o-u-s",English
+"scirrhous mode of growth But whatever the variation, any",English
+lump of neoplasm has this vascular stroma that it has induced. Okay.,English
+"Now go onto the next concept, that is related to the fact that since neoplastic cells are derived from a previously normal cell population, they're",English
+going to share many of the genetic traits and are going to have some new ones because of these mutations but they're going to share a tremendous genetic background,English
+"with the parent issues so they're going to resemble the parent tissue to some variable extent. I mean sometimes very sharp resemblance, sometimes maybe not much of a resemblance.",English
+"When the neoplastic tissue resembles the parental tissue, the normal tissue, through a high degree",English
+"On the other extreme, it may look nothing, I'll show you some examples, it may look nothing like the parental tissue, we say that is a poorly differentiated or",English
+"undifferentiated tissue. There's another phrase, another word we sometimes use, that's anaplastic.",English
+we refer to as anaplastic. There's a complete range of possibilities.,English
+"Let me illustrate this for you in two extremes Here is normal colonic mucosa, and we're going to talk about this in detail on Wednesday.",English
+"The mucosa has these kind of tubular glands, that's all I want you to get out of this, this is perfectly normal The next slide will be a cancer derived from this mucosa, looks like that.",English
+"Now you say, that doesn't look anything like it, but in a sense it does. it's got glands, they're kind of funky and kinky and so forth",English
+"but they're clearly glands. You'll also notice that the pink to blue ratio has changed, a lot of hyperchromatism a lot more nuclei here and so forth but basically",English
+a pathologist looking at this would take about a nanosecond as you will learn this spring and say oh! this is a glandular type of,English
+"neoplasm. So we say this is at least moderately differentiated. Now I'll show you a step down,",English
+"here's a normal bronchial mucosa, again don't worry about the details, but they're these tall columnar cells, some of them are secreting mucus",English
+others have cilia on them they're very well organized there The next line is a neoplasm derived,English
+"from that cell population If someone showed me that I'd say that I don't know what that is, that is an undifferentiated, malignant",English
+"neoplasm, or anaplastic neoplasm. And when you look at that, what it really says is it's a population of cells",English
+"that's not maturing you can't tell what it's doing or where it came from, but it sure as the dickens looks malignant, look at those huge nuclei",English
+"increased n-to-c ratio (nucleus to cytoplasm) they are actually pleomorphic, they are hyperchromatic, there are",English
+"tumor giant cells there. Really, you'll learn to look at those things and loathe them, to say that is an ugly cell population",English
+"so that is a highly anaplastic cell population. Now, it turns out well, let me give you",English
+"a rule of thumb first. Benign neoplasms are always splendidly well differentiated, sometimes you get in the",English
+"middle of a benign neoplasm, you can't tell it from the normal tissues, so a benign neoplasms are always well-differentiated.",English
+"Almost perfectly differentiated. Malignant neoplasms show the whole range, there are very well differentiated but nonetheless malignant neoplasms",English
+"and there are highly anaplastic like this. In some situations, in many situations,",English
+"in malignant neoplasms, there is a a rough correlation, I emphasize rough, between the degree",English
+of differentiation and the behavior. This is not uniform for all neoplasms and remember well differentiated neoplasms/cancers can still kill.,English
+"But for some situations, it's a useful label that we give it to send to our colleagues",English
+"where we say we label it depending on the degree of differentiation we call this ''grading'',",English
+"histological grading of neoplasm. The grading of neoplasms is really an assessment of the degree of differentiation of the neoplasm based on,",English
+"i mean we look under the microscope, and we say oh! this looks just like such-and-such tissue that's well differentiated",English
+we sometimes take into account in these grading systems the number of mitoses that's a little less usual,English
+"but it's based basically on the degree of differentiation and we talk about grade one, usually grade one means the best differentiated grade, grade two to grade three, some grading systems are all",English
+"the way through grade four. You get the idea, I mean you will get the details, but when we label with the grade we say this is well differentiated and our colleagues at the other end say, well",English
+"maybe that'll behave a little better than if Abrams said it was anaplastic. And Illl show you what this amounts to visually, again don't worry about being able to pick these out.",English
+"Here is a carcinoma, cancer derived from a squamous epithelium, like the epidermis of the skin and a trained pathologist, which you will be",English
+"next spring, would look at this kind of arrangement or all this pinky cytoplasm which represents keratin and in the cells",English
+"and you'd say oh easy! That's a well-differentiated squamous cell carcinoma, this might be a grade one for",English
+"instance This one is might not look like much to you, but a trained pathologist would look at this and say, well, this isn't terribly",English
+"well differentiated but I can still see areas where I'll bet that's coming from the squamous epithelium, so that would be maybe a grade two or moderately differentiated",English
+"Here again is a completely anaplastic cell population, someone showed me that and said where is this coming from and I'd say God only knows this is cancer.",English
+"When i don't know what kind, this is really an anaplastic, probably grade three to grade four cancer and again there's a rough correlation between",English
+"the degree of differentiation and how it might behave. behave Now grading, this is all microscopic, grading is different than staging.",English
+"Please keep these two straight and read and understand, you're going to deal with these two concepts all your lives.",English
+"Staging a neoplasm is very important because of the stage that we assigned to a neoplasm tells the observer how far along in its natural history that neoplasm is, in other words,",English
+"how big is it at the primary, how much tissue has it penetrated, has it advanced to the point where it's spread elsewhere in the body.",English
+"That is staging. It's based on first of all the size and the extent of the primary, the presence or absence of regional lymph node metastases, and",English
+"the presence or absence of distant metastases. This is sometimes referred to as the TNM system, T for tumor, what's he doing with the primary,",English
+"N for regional nodes, M for distant metastases. Every organ has a slightly different staging scheme, but they're all based on this",English
+"and what it gives you, if it's a low stage or a favorable stage, that says this tumor hasn't advanced as far, maybe it's restricted just to",English
+"the organ, the lymph nodes are negative, and there are no distant metastases, or it may be that it's penetrated quite a way through",English
+"whatever organ it's started in, and there are already lymph node mets but we don't know of distant mets that's quite a different situation which may take a different therapeutic approach",English
+"and finally if they're already distant mets, that's a very different thing. So staging gives you a very important handle on how far",English
+along the neoplasm is in the particular patient and what you should do therapeutically because of that.,English
+"Now's not the time to dwell on how we tell benign from malignant and in our daily work you will again get an appreciation for this next spring, but suffice it to say",English
+that we pathologists can look at a tumor and make some pretty good predictions about how it may behave.,English
+"In other words, if we look at a tumor and it looks very well-differentiated and completely circumscribed and so on and so forth, we say it's benign",English
+"and what that says is if you get the whole thing out, patient is home free. If it's invasive anaplastic, it's a very different situation. I can tell you that that the cornerstone",English
+"of clinical diagnosis in the field of oncology is getting something under glass, getting in the microscope.",English
+Very few instances where therapy will be undertaken without confirmation of the fact that under the microscope that it is such-and-such a cancer and such and such grade and so forth.,English
+so it means we need a piece of the tissue or at least some cells from the tissue,English
+to get under the microscope. What we rely on there as you might surmise from what you've seen is first of all,English
+"the cytologic features, how anaplastic looking are the cells, how bad is the the pleomorphism, the hyperchromatism, etc, we rely on that",English
+"we rely on the relation of the cells to one another, the loss of polarity in the system and so forth, and we rely on the relation of the tumor to its surroundings, the nice pushing",English
+margin vs boy! there goes invasion it's that sort of thing. Now I'll give you just a,English
+"very quick example of that. Here is a you can imagine that colon I showed you in the cut,",English
+"here is a mucosa, a submucosa, here is a muscular wall, here's the tumor arising in the mucosa. You see under the microscope here, you can see kind of glandular spaces there.",English
+"Look what's happening, you've got glands penetrating clear down through the muscle there. That's a no brainer",English
+"when we see something like that we say it's invading, it's malignant. That make sense? Sometimes we don't rely entirely on that, we rely on other things",English
+"The cytology, just quickly, there are normal colonic epithelial cells I'm not going to describe it, just let the pictures speak for themselves.",English
+"You'll catch up with this in the spring. Here are neoplastic epithelial cells. Again, normal...neoplastic. Here's a normal squamous",English
+"epithelium, we're back to cervix, here's normal squamous here's dysplastic. you saw that before, this variation, this loss of polarity, the individual features",English
+"of cytology here, that's a degree of dysplasia, it's a step towards cancer. This one we said was full thickness 'awfulness' with very anaplastic cells, I won't go into the details again.",English
+"The concept is important, when dysplasia gets severe it's tantamount to cancer in situ, whether or not it's invaded,",English
+"you see in the colonic example, we showed you invasion. Here we can say this epithelium is cancerous, dammit! Whether it invaded or not, we got to get it out or something bad is going to happen because",English
+virtually 100% of these severe dysplasias will invade. And that is carcinoma in situ. You'll hear a lot more about that,English
+Now clearly if you look at something like this you realize that that individual cells in that population bear the,English
+"imprint of their malignancy, in other words, they have these anaplastic traits and you can say these are malignant cells. A guy named the george papanicolaou",English
+"over half a century ago realized that that this was a great handle, that if you took cells that exfoliated, that is dropped off the surface, of",English
+"a place where there might be a tumor that these exfoliated cells would bear some of these traits, these anaplastic traits, and all you'd have to do",English
+"is look at these cells and say WOW this is so and so. This is, as I'm sure you're aware, the origin of the so-called Pap smear,",English
+and the beauty of the Pap smear is that you don't have to cut out a piece of tissue from the person. All you need is a sample,English
+"of the usually it's mucus over the area, now this has been perfected, this has changed the whole face of",English
+"how we deal with cervix cancer but you can imagine a cervix...no let's back up, looking like that",English
+"and that are exfoliated, remember they come off here and getting a Pap smear involves getting a little bit of mucus scraped off the surface of the middle of some of these cells and",English
+from a normal epithelium like this you're going to see and i'll show you a Pap smear whereas from this,English
+"or this, you're going to get a different kind of cell exfoliating out and without really having to get a big piece of tissue, you get a little bit a swatch of mucus you can tell what you're dealing with.",English
+"I'll let you see this for yourselves. Well, here are just some of cellular features of anaplasia. Any look at a cell population like this with the huge nuclei",English
+"there's a tripolar division figure there, those are the kinds of features we look for, all right here is a normal Pap smear. You look at that without any training at all and you say well those cells look like one another",English
+"look like they're all out of the same cookie cutter, same N-C ratio the nuclei are not pleomorphic, they are not very regular etcetera etcetera etcetera",English
+"Normal pap smear next case, now suppose that epithelium looked like the bad one I showed you, there you are,",English
+"I'm showing you the extremes, instead of being very regular, these are extremely pleomorphic cells with increased N-C ratio hyperchromatism",English
+"and so forth, the cytopathologist looking at this doesn't have to pause very often and say this",English
+has been exfoliated from a malignant cell population and the nice thing is that in between the cytopathologist can also,English
+"look at this and say well this probably came from a cervix with moderate dysplasia or minimal dysplasia or something like that,",English
+so that not only can we catch cancers when they're perhaps too small to appreciate by ordinary examination we can actually,English
+"catch dysplastic epithelium before it's become cancer or carcinoma in situ before it's invaded, these things are all invisible pretty much",English
+"and they will show up on the cytological exam, so it's become a very powerful screening tool and it's changed the face of what we",English
+"see in the way of cervix cancer, when i was a kid in pathology we used to see nothing but very advanced cervix cancer that were clear into the rectal wall and bladder wall and so forth,",English
+i haven't seen one of those thankfully in decades because of the application of the Pap smear as screening.,English
+and most of the stimulation will also be there in  during the pin application time and during that   time you either you need to increase the depth of  anesthesia or you can give a dose of esmalol or,English
+other beta blockers during that time and in our  center we give scalp blocks after induction so   that will take care during the pin application as  well as during periosteal dissection even during,English
+that time there will be lot of integrate a lot  of sympathetic stimulation so the scalp blocks   will take care of that situation also so coming to  maintenance of anesthesia in this particular case,English
+volatile anesthetics are known to the cerebral  blood flow and intracranial pressure and so   the theoretically drain bulge can increase with  volatile anesthetics and on the other side total,English
+intravenous anesthesia with proper fall decreases  of cerebral blood flow and internal pressure   so theoretically you can have a relaxed brain so  what are studies showing the brain bulge situation,English
+between the total intravenous anesthesia with  inhalational anesthesia and in the first study   they found that the number of patients having  tense brain in inhalation group is high and in,English
+the second study also showed the same thing with  a significant p value the number of patients with   brain bulge is more in the volatile anaesthetic  group so based on these two studies i can suggest,English
+you to use total intravenous anesthesia in this  particular kind of patients during the surgical   maintenance of anesthesia and this is if you want  to do inhalation only and uh between the drugs,English
+most commonly used nowadays are desclutin and  sibo fluorine and in between the two drugs   there is no difference a significant  difference between the neural tension,English
+even before and even after opening  the dura so any drug is okay a small mention about nitrous oxide now nitrous  oxide theoretically increases a cerebral blood,English
+flow and can increase the brain bulge during  the surgery not only that it has some other   problems also while usage uh it's like most  of the patients some of the patients develop,English
+pneumocephalus after the surgery so if you're  using nitrous oxide in that particular patient   there is a possibility that it can get converted  to tension pneumophilus and one more thing is if   you are planning for electrophysiology in that  particular patient for mapping purposes the,English
+nitrous oxide can interfere with those so based  on this i would suggest to avoid nitrous oxide in   tumor surgeries coming to anti-edema measures  uh the three percent saline and mannitol are,English
+commonly used and i would take a call based on the  patient's condition if the patient is hypovolemic   and if i want to replace some volume as well i  will go for three percent saline and if the volume,English
+status is fine and his renal function is fine  then maybe i would go for 20 manitol but the most   important thing is you need to address  a brain bulge in a multimodal way rather,English
+than targeting only two drugs so it is  more like you need to decrease your atc   because your carbon dioxide reactivity will not go  it will be present even in midland shift patients,English
+so decreasing the heat saver too will decrease the  cerebral blood flow and brain bulge will come down   but there is a lower limit less than a pse vertex  of 25 you should not come down and along with that,English
+you should take care the venous drainage is good  and adequate avoid neck flexion and we should also   make sure that the peak lung pressures are not  very high sometimes secretions in the endotracheal,English
+tube will also be there you need to do an eight  neutral suctioning that time and shifting from   inhalation to total intravenous anesthesia is  also a good option to deal with brain bulge if   lumberjane is present you can actually drain  it but very cautiously so after the cradiotomy,English
+you need to drain not before that that is the  situation so summing up uh everything is called   as a chemical brain retractor concept so whatever  i explained now is called as a chemical brain,English
+detector concept we need to do that whenever there  is a tense blend situation during the surgery   and intravenous fluids uh what to  use you don't have to break your head   any uh and i will every iv fluid is fine uh the  target is maintained eu bulimia not the choice,English
+uh if you keep on using the same uh 0.9 percent  dense patient might land up in hyperchlorimic   acidosis so it's better to alternate or  nowadays you're getting balanced solutions,English
+which are isosceles and exact electrolyte  content of the blood you can maybe use them also   so coming to the emergence times emergence  times uh compared within total intervals,English
+anesthesia and sibo fluid and this study found  that there is no significant difference between   the emergence between volatile group  and the tiva group and another study   which has compared the recovery in obese patients  between disciplinarian and sibo fluorine and,English
+practically no difference in the brain bulge  between the two and you can see a significant   decrease the extubation time and discipline and  group so if given an option if brain bulges are,English
+same in both the drugs and the extubation time  and recovery time is less indisputant i would   choose desolution and coming to extubation whom to  exhibit whom not to extubate is mainly determined,English
+by the pre-operative gcs of the  patient if the patient is very drowsy   and he is not obeying commands then better go  for a postoperative ventilation in those patients   and if the patient is conscious and obeying  then you can plan to exhibit on table and,English
+unstable hemodynamics requiring very large  ionotropic supports maybe you need to go for   post-operative ventilation other patients you can  go for extubation so in the exhibition the most   important thing you need to see is muscle relaxant  effect should not be there inadequate reversal is,English
+not acceptable in neurosurgical emergence so that  will lead to a lot of tachycardia and hypertension   can lead to formation of intraocular  hematoma so you need to have a tough   fourth twitch in the top and also timing is very  important for extubation you need to give some,English
+time you need to suction the patient in depth and  you should not keep on stimulating the patient   so you need to wait for the patient to get up on  his own at the time of extubation maybe you can,English
+use agents like esmeralda short acting once or  labatolol these are the initial agents of choice   nitroglycerin is should be the last resort because  theoretically it will increase a cerebral blood,English
+flow and increase the intracranial pressure so i  would suggest keep nitroglycerin as a rescue for   the last don't use it in the beginning so what is  my technique my technique is no touch extubation,English
+so what i do is once the case is over i do  suctioning in deep keep the patient i won't touch   him till the patient opens his eyes maybe i'll  waste another five to ten minutes that's all so,English
+after five to ten minutes once the patient opens  his eye spontaneously then i would extubate him in   this way i have actually seen uh the hemodynamics  are under control there is no way that inadequate,English
+reversal can happen and the complication rate  is very less in this technique you can see three   graphs the hemodynamics are better controlled in  no touch extubation technique so let us go to the,English
+next scenario where the tumor is present near the  allotment cortex so in this particular situation   either we we need to do either speech mapping or  water mapping so both of them actually need away,English
+craniotomy so speech mapping needs to be done in  traffic but for motor mapping there is an option   you can actually do under generation also but  you will get only 40 to 50 percent of the times,English
+so in water mapping what we do is we do  cortical mapping we do sub cortical mapping also   so if you're doing under general anesthesia the  first thing you should do is you should avoid   muscle relaxant maybe intubating those can  be given but after that you should not give,English
+and you need to maintain the patient and  total intravenous anesthesia preferably target   controlled infusion of proper fall at around  between two to three micrograms per ml and you   can supplement that by using fentanyl remember  fentanyl and dexmitted dominion to cut out cut,English
+down the dose of profile usage this monitoring  is mandatory because if you go too much deep   and you don't get electrophysiological signals in  mapping so that is about the general anesthesia,English
+and uh for speed mapping for broca's area and  veronica's area you need to do away craniotomy for   broca's area what we do is called a speech arrest  we keep the patient awake we'll tell him to count,English
+the numbers we stimulate the area and there will  be a certain blockade in this counting numbers   so that is called a speech arrest and bernice area  you need to he needs to understand a situation and,English
+a scenario and needs to explain that so to do  all these things you need to have a craniotomy   for that how we do is we give scale blocks of all  the major nerves supply by telling super properly   a greater hospital lesser hospital or temporal  mouse will be blocked you can use either the,English
+duplicate or before you can both of them are good  and what technique that you need to do is a sleep   awake a sleep technique or awake awake technique  and so in a sleep of a sleep technique there is a,English
+small problem so you will be selecting the patient  in the initial part of the surgery till the dural   opening then you will wake him up some patients  will become delicious during that part of the   when they get up from anesthesia in awake awake  awake we just keep the patient comfortable,English
+throughout the procedure and we'll make sure  he's not having pain and will be continuously   talking to the patient in this kind of  anesthesia there is no risk of delirium   and what drugs to use for sedating a patient in  awake in india most commonly dexmedian has been,English
+used the reason for that is dexmed has a very  good profile of not losing the airway and also   dexmitted omident simulates natural sleep  so when patient gate comes out of dexmitted,English
+dominion the chance of delirium is very less  ah proper foal and the fentanyl combination   is also used in several parts of the world so  both the techniques can be tried but the main   point is patient should be awake and comfortable  at the time of mapping that is the final point,English
+so a study compared between dexmeditor  metal and proper foil and amife antennae   in our craniotomy they observed that there  was no difference between the groups in   in respect to mapping but the respiratory events  are more in the proper called remy fentanyl group,English
+so point to be noted so then coming  to how useful is abecrania to me   uh available a study is done comparing craniotomy  under ga and they have seen the extent of   resection of tumors near the electron cortex and  they found that the tumor extent of resection is,English
+more in our craniotomy group than under general  anesthesia and mapping so in that way a better   survival will be present so let us see what  are the recent trends in the management of uh,English
+supradental tumors this is called as photodynamic  diagnosis in the image you are seeing a red color   the red color is the high grade lesion the  surrounding is a normal brain structure so for,English
+a normal human eye you cannot differentiate to the  extent of what photodynamic diagnosis does will do   so what you need to do is you need to administer  five amino levulonic acid two hours prior to the,English
+surgery and the patient should be kept away from  sunlight for nearly 24 hours because there is a   risk of photodermatitis and as an anesthetic you  should know that hemoglobin and platelet counts,English
+they can decrease by administering 5 ala but i got  a study which is done on 207 cases uh between 2008   to 13. they did not find any kind of skin reaction  and they did not find any kind of hemoglobin or,English
+platelet count drop during administering 5 als so  it is very safe drug to administer and the next   advance is ultrasound intersection ultrasound  actually helps you to localize the tumor and to,English
+know the extent of resection and to know sometimes  to know the vasculature in a vascular tumor you   can put doppler and see whether it is an artery  or a vein so it will give a lot of information,English
+and the next is intraoperative mra and a lot of  centers are now starting intraoperative mra so the   anesthetic relevance is a lot of points are there  here like you need to use mri compatible equipment,English
+and you need to have a separate cable system  so that eddy currents are not generated   and you need to protect the fingertips and  everything from burns so it's a big topic   but this is you need to have knowledge about  interoperate mra as well because uh studies,English
+are showing that uh the 30 37 percent secondary  gross total resection is seen that is like 37   percent of the time the neurosurgeon is actually  deciding to re-explore the lesion so when people,English
+understand the importance a lot of lord centers  will start getting interrupted mri and the next   concept is a daycare supply dental neural surgery  so patient will get admitted on the morning and   he'll go in the evening so this is a study which  has done uh in canada in 198 patients and what,English
+they observed is 88.4 percent of the times they  did not have any problem discharging the patient   on the same day only 1.8 percent of the patients  actually developed intracranial bleed so this is,English
+one more thing out of the 1i 198 patients almost  170 157 patients underwent awakening anatomy so   awakened anatomy forms the major element in same  day discharge and the next thing is improving,English
+the oncological outcomes in future more and more  studies are coming up how anaesthetics actually   impact the oncological outcome so this  study is actually compared volatile and diva   in comparing the outcome in solid tumors what they  observed is volatile and inhalation anesthesia,English
+was associated with the hazard ratio 1.59 compared  to t1 so this study is showing that t y is better   but we cannot come to conclusion but in future the  research will be going in this direction as well,English
+and coming to the final point the pain management  so considering the post-operative pain management   in brain tumor surgeries you cannot use opioids  because they will actually interfere with your,English
+"Older than 60 and growing, is a bad sign What is the worse case scenario for a PTC patient?",English
+Why is it important to accurately diagnose brain and spine tumors? It is incredibly important because this is the building block to do absolutely everything,English
+"else. The treatment plan is going to be based on the diagnosis, as well as of course, other patient related factors like age, extent of resection, etc.",English
+"So, really, we need to start in there to really know what to do next and we also need that information to try to give an estimate about prognosis.",English
+"Every patient is different. Even patients with the same diagnosis may have a different trajectory, but it definitely helps to give a first orientation to know what the accurate diagnosis of the treatment",English
+"What are the challenges to classify rare tumors? In rare tumors the problem becomes even more difficult because precisely because they are infrequent most neuropathologists and clinicians are not used to seeing these tumors and therefore,",English
+"they are more difficult to recognize. So, there are actually studies that have shown up to 10% of diagnosis of a rare tumor can actually be incorrect in some way or incomplete due to lack of molecular data, etc.",English
+"So, access to advanced molecular testing is incredibly important and as you have heard during the talk from Dr. Aldape and Dr. Sahm, we are not even done.",English
+In rare tumors we are learning as we go and there are certainly still new entities and new sub-types that are waiting to be discovered.,English
+"And, we will get there by advancing our molecular diagnosis techniques and analyzing many cases. Do patients typically have access to pathology services at every hospital?",English
+"If not, where can they get these tests done? Well, every patient has access to pathology services at their hospital. The issue sometimes becomes, again, in the case of a rare tumor, and they may not have",English
+"extensive experience diagnosing that particular type of tumor. Or, they may not have access to the proper molecular testing to confirm the diagnosis or the sub-type of the tumor.",English
+"So, typically what happens in that situation is that additional testing is requested to a referral center that can perform a second analysis and collaborate on getting the name",English
+"There’s a very interesting initiative called cIMPACT, which neuropathologists are using to start pulling together their experience and be ahead of the game preparing the ground",English
+"for the following update to the World Health Organization specification of tumors, which is due at the end of this year.",English
+And they’ve been publishing articles on newly defined and newly described tumor entities via using these mechanisms.,English
+"who have brain or spine tumors because the disease has both an oncologic, or cancer effect, as well as a neurologic effect because it’s in the nervous system.",English
+"What I mean by that, is they have a tumor that’s growing, but because of the location they may have symptoms like difficulty with speech, or weakness on one side of the body,",English
+"and understanding the impact of that tumor and the potential benefit of a treatment and reducing those symptoms is really important to measure. As the FDA says, it’s important to assess how treatment improves how long a person lives,",English
+"but also, how it affects the ability of them to work and enjoy their activities. Or, how they feel and function.",English
+"By the use of patient reported outcome measures, were able to ask the patients directly to report how they are feeling and how they’re functioning.",English
+"With the use of these measures, we can, in a standardized way, assess each person in a clinical trial and then pull together that information to see if the treatment has a benefit for that individual and for the patient population as a whole.",English
+"This helps us determine and be able to talk to patients when we then offer that treatment in terms of not only will that treatment impact how long they live, how long we control the",English
+"tumor, but how they’ll feel while they’re on that treatment. Do patients typically have access to clinical trials for rare brain and spine tumors at",English
+"every hospital? And, if not, where do they find information on clinical trials? It sometimes can be difficult for patients with rare brain and spine tumors to find clinical",English
+trials because each physician or each individual institution may only see a handful of patients with a particular diagnosis sometimes it’s hard for them to have a clinical trial that’s,English
+"open to enroll for these rare tumor types. Because of this, the NCI-CONNECT program has developed a network of centers across the country in which we can do studies both at the NCI, but also at these individual centers",English
+and provide support to be able to enroll on these trials. There are many ways you can find information on these trials and we will share resources at the end of this session with ways that you can look up where to find these trials,English
+"are. Magda Magiera, Chair and Co-Founder of Polish charity organization, Glioma-Center Foundation. My question is, how are researchers working together globally to develop clinical trials",English
+for rare brain and spine tumors? This is a really important question because we need to work together to be able to make a difference.,English
+Working in silos doesn’t do anything to improve the outcome for patients with these tumors. There are many ways that scientists and physicians and other health care providers come together,English
+to share information. We do this through national meetings in which we share results in what we’ve investigated. We also do this through clinical trial development with trying to work across countries to determine,English
+"what trials are important and to collaborate together on these trials. As you’ve heard from the other presenters today, we do this not only in clinical trials,",English
+"but in clinical and scientific investigations in the preclinical space as well. Within clinical trials, we then also share when we have the final results of these trials",English
+"if the treatment is beneficial, folks from around the world can learn about it and hopefully have access to that treatment going forward.",English
+"What is NCI-CONNECT? The NCI-CONNECT program that I co-lead with Dr. Gilbert, is dedicated to improving how we communicate globally with providers, scientists, advocates and patients to develop guidelines",English
+and direction related to clinical trial development and care of patients with rare tumors. What are NCI-CONNECT workshops?,English
+"NCI-CONNECT workshops have been held in person, and more recently by webinar, but we find ways to come together as a group to discuss these topics and write companion papers from",English
+"these workshops that we hope will provide guidance to folks outside of that group and the community as a whole. In closing, I wanted to say that I am incredibly hopeful for the future of rare brain and spine",English
+"tumor research because, as you can see, it is possible indeed to collaborate and work closely.",English
+"Not only in different specialties in a given center but also with specialists from all over the country and all over the world to learn things faster, to enroll patients to",English
+"clinical trials faster, and to get the proper answers to keep advancing the field and get the help to these patients. So, I would like to say in closing that global collaborations are essential to advance all",English
+"cancer research but this is particularly germane in the setting of rare cancers and we are hopeful that events like our symposium, that included colleagues from all over the world,",English
+"big tip offs are, so the most common presenting things that we see patients have are either vision loss, so they get into accidents or they noticed that it's more difficult to read.",English
+"They're either lack of energy, or lack of the ability to perform sexually. That's common with non-functioning tumors. With the other functioning tumors, obviously, having milk",English
+"let downs, something that oftentimes shouldn't happen. So that's a symptom. But hypertension at an age when you shouldn't have it. So high blood pressure that's not responding",English
+"to a couple of different types of agents. Those are the most common things that should kind of raise an alarm. When they come to me, someone's done a workup and found out that",English
+"something's wrong with the pituitary gland. That's an indication to get a picture of it. And most commonly that's done with an MRI. And these tumors, very fortunately, very",English
+"frequently we can see them. In some of the diseases, we can't see them as well but we know they're there, because they have the syndromes that some people have had before them with bigger",English
+tumors that we could see. Jason Howland: So then how do you decide on which treatment option medication versus radiation or surgery? Dr. Jamie Van Gompel: So for small tumors that aren't causing,English
+"problems like reduction in pituitary function or not pushing on something, we commonly watch those tumors. For prolactin secreting tumors, so that's again, that's that",English
+"syndrome that causes breast milk or in mein it can reduce people's sexual function, that can be treated with a medication. In the acromegaly and Cushing's disease patients,",English
+"so these are functioning tumors, they do have some medical options, but they're not very good. We oftentimes resect those tumors or take them out to try to treat that disease.",English
+"Jason Howland: And then when patients do have surgery, what's recovery like after surgery? Dr. Jamie Van Gompel: Yeah, people always really want to know what the experience is like. And fortunately, because",English
+"it's such a common tumor, there are a lot of resources on the internet to reach out to people and understand what it's like. We do the best we can explaining it. And I do want to emphasize",English
+"that on the internet, there's a range of experiences. Back in the 80s and 90s, when they did these procedures, they would pack the nose because they were scared of things coming out of",English
+"there. And it was not a great experience for patients. That's not how it is any longer. We've listened to our patients and understand what helps them recover quickly. So,",English
+"fortunately, as we said before, this area is just in the back of the nose. We actually use a normal path to get back to these tumors. And nowadays most people do this with endoscopic surgery.",English
+"And the upside to that is that we actually have to do normal sinus surgery. So if you've previously had some obstruction, so deviated septum or some of the things that cause some",English
+"issues for patients, we actually have to fix that to get back there. So I tell patients all the time, you might get a twofer with this one. And a lot of times after surgery, people are",English
+"better. Their noses are clear, they feel like they can breathe differently. They're not, you know, stuffed up at nighttime all the time anymore. So that's one benefit to these approaches.",English
+"So, getting back there and taking out these tumors, the procedure is not very long, and most patients it's usually about 60 minutes to 90 minutes in the operating room. And then we're",English
+done when we take out the tumor. In a very small sub segment of patients we have what's called a CSF leak. These are clear fluid leaks from fluid that should be in the brain and it kind of,English
+"makes it through where the tumor was. We used to take fat grafts all the time and plug this up. So, it was a separate incision. No longer do we do that very frequently, we take just little",English
+"bits of skin tissue from inside the nose where we've done these repairs and treat it there. And it turns out that actually has a huge improvement in patients healing. When we're done, we put",English
+"just a little bit of absorbable tissue just back where this is, so people can still breathe through their nose after. After surgery, people wake up commonly with a little bit of a headache.",English
+"Not everybody needs pain medications. I would say it's actually in the minority of patients that need something more than ibuprofen or Tylenol. But of course, having narcotic",English
+"agents is always provided if the headache is more severe. That headache goes away very quickly. And in most pituitary tumor surgeries, people feel like they can get back to doing what they",English
+want to do at two weeks. We still recommend people take about four weeks off because we still did a major surgery people are fatigued after. But a lot of people are just doing whatever,English
+"they think they need to, usually by post op day two or three. And I think the recovery is actually quite easy for most patients with this particular operation. There is one caveat in patients",English
+"that have symptomatic Cushing's disease. If we do our job and cure the patients, they don't feel well after surgery because their cortisone drops. And they're actually recovering from",English
+"the disease process. And for those patients, it's a whole different ballgame for them. But that's not normally from the pituitary tumor surgery itself. That's the recovery from the",English
+surveillance do patients need after treatment? Dr. Jamie Van Gompel: It's really uncommon for the tumors to come back. It's more common for some of the more functioning,English
+"tumors like Cushing's disease. For the nonfunctioning tumors, it's not very common. We did a study, not of my own patients, but we looked way back because Mayo Clinic has so many great",English
+"records. Even before modern day techniques, in fact, almost two generations ago for techniques, if you had a tumor resection, and we even see if you had some tumor left behind. As long as",English
+"you got about 80% of the tumor out, the chance of you needing another treatment over the next decade was only 10%. Now fortunately, there are not a lot of tumors that we actually",English
+"choose to leave too much behind. There are very straightforward treatment options for residual tumor that's left behind and starts to grow, though. Nowadays, single session",English
+"radiation, so radiation that's done literally an hour or two, is very effective at treating these tumors. So, it doesn't necessarily mean, even with recurrence, that you need",English
+another operation. And there's also a developing tool bag or toolbox of medications that endocrinologists have been able to use to help control if they come back. But it isn't that,English
+"understanding what realistic expectations are at the front end of an operation. So patients know what they should expect, especially in that tumor. So, it turns out, in that tumor when",English
+"through that door, how big your tumor is, what your age is, what the blood levels of growth hormone or IGF one are, and we can tabulate what are the chances that we can cure you,",English
+"other centers. And I think that's going to continue to expand in pituitary surgery and other tumors, in fact, in which we can give you a lot more information at the outset to at",English
+",if we can talk to our neuroradiologists and say, hey, find this thing for us. And they can tell us with confidence where it is that might be with 7T MRIs, we're opening a PET",English
+"study this coming spring, that might help us find these small tumors in patients, we are eminently more effective at curing patients. And we're also way better at avoiding secondary",English
+"side effects. Our endocrine colleagues are extremely important at tertiary referral centers. Even if you've received an endocrine workup outside, the people that we work with only do",English
+"pituitary tumors, and they can actually find ways, in some circumstances to say, hey, this is not the diagnosis here, this patient doesn't need a surgery. Going through their nose and",English
+"taking the tumor out that we don't know is there is not the right thing to do. So they can sometimes help us pump the brakes. Because, you know, our job is not to cause damage if we",English
+"them, and you might need other colleagues that have an expertise in treating uncommon tumors with chemotherapy agents and things like that. Now again, that's not a common thing that",English
+"we have to do with pituitary tumors. But when they're there, we have huge expertise, and a group of people that know how to manage these types of things with molecular profiling of",English
+unique for pituitary tumors? Dr. Jamie Van Gompel: The endocrine department is one of the most well-known endocrine departments in the world in the,English
+"multitude of PG. So, we call them PG, pituitary group endocrinologists that just do pituitary all the time, a remarkable group of people. Not only do they have one person",English
+"that just spends all their time on pituitary tumors, they have a group of almost eight of them. And if they're confused by something, all they have to do is walk across the hallway to",English
+"the next door and say, what do you think about this? So, I think it's hard to replace that kind of collegiality and ability to have those conversations in real time. In the same way, I'm",English
+"not the only pituitary surgeon at the Mayo Clinic. So, I have a couple of other colleagues that I can talk to, to say, hey, you know, this is a little odd. What do you think about this, and we",English
+"can talk about it and talk about the potential outcomes, and what do we think is the best thing for this patient? And there's not a lot of centers across the world that can say that they can",English
+"do things like that. Oftentimes, when you go to even a referral pituitary center, there's one surgeon and maybe one endocrine specialist. Here, with such a large group of people, it's very",English
+"helpful to be able to treat, especially, very difficult cases. In addition to that we have a lot of resources at the Mayo Clinic that a lot of patients don't have like 7T",English
+"MRIs, which have been helpful for identifying small tumors, or understanding cavernous sinus invasion. PET studies that would help us find tumors that maybe are very hard to find. And also,",English
+there's a bunch of new lab tests that are coming down the line with our endocrine colleagues that would be helpful to figure out some of the more nuanced parts pituitary tumors. We also,English
+have advanced molecular techniques and diagnosis that we think will help us in the future understand some of these tumors and how they may act if they are not completely resected.,English
+"Jason Howland: And all of those things, ultimately improving care for the patients. Dr. Jamie Van Gompel: I think so. And I think that's a really good point, Jason. Not only do we have all those advanced",English
+and in anterior maxilla. young women are  more commonly affected. and canine which   is unerupted is the most common site where the  tumor is seen. so these are the unique features:,English
+women/ second to third decade/ anterior  maxilla/ especially an uninterrupted   canine should give you a clue of adenomatoid  odontogenic tumor. there are different types:,English
+follicular is when it is surrounding the  impacted tooth in this manner there; is an   extra follicular type which is seen in between  the roots or anywhere within the jaw and you,English
+"can also see a peripheral variant that is on the  soft tissue. these are all intraosseous types. radiologically it's not really pathognomic, but  it is still typical for this tumor. that is you",English
+will see a unilocular radiolucency along  with radiopaque margins and there could be   some faint radio-opacities which are referred to  as snowflake calcifications which could help in,English
+"ruling out differential diagnosis.  histopathologically it is very very   characteristic. it is a well-defined tumor which  basically indicates that it is slow growing, it is",English
+"benign, it is non-aggressive. all these three  things are depicted by a well-defined capsule   and this encloses cells that is either spindle or  cuboidal cells which are arranged in the form of",English
+whorls or strands of epithelium as you can see  in this picture. so these are all the whorls or   these are the strands of epithelium okay. it can  be either cuboidal cell or spindle-shaped cells.,English
+along with this we'll see microcysts which  actually look like duct-like structures.   and these microcysts are lined by tall columnar  cells which resemble ameloblasts. and this is,English
+another picture which is showing the microcysts  and here also you can see that it is lined   by cells with hyperchromatic nuclei. so here  I think you can clearly appreciate how the,English
+microcysts are lined by tall columnar cells  which resemble ameloblasts with the nuclei   away from the basement membrane correct?  and these microcysts can contain either,English
+homogenous eosinophilic material or they could  even show amorphous or crystalline calcifications and the most important and characteristic feature  is the rosette-like pattern. rosette basically,English
+means rose like. so the spindle cells of the tumor  are arranged in the form of rose petals. you know   how the petals are overlapping one another?  exactly the same way the cells are arranged,English
+and they can also be called as swirling  patterns so rosette like pattern- is the   most characteristic feature of this tumor.  coming to differential diagnosis the first,English
+and foremost is the dentigerous cyst.  because of the association with an   impacted tooth it has to be differentiated  both clinically as well as radiographically.,English
+and histopathology of course  will finalize the diagnosis.  CEOC and CEOT as you know  are the cystic and the tumor   counterparts but both of them radiographically  look very similar to adenomatoid odontogenic tumor,English
+especially with the specs of radio opacities  within the radiolucency. but all of them have   distinct histopathological picture and that's  how you differentiate them from each other,English
+management can be conservative and the simple   enucleation will suffice the  treatment there are no recurrences. the last tumor which we are going to  study today is squamous odontogenic tumor.,English
+"it is again a benign tumor, it is locally  infiltrative and very occasionally it can get   aggressive. and pathogenesis is that it arises  from epithelial cells of Malassez. so clinically",English
+it is quite rare. it affects the young adults  and both the jaws can be affected. and like I   said it is seen very close to the roots of erupted  teeth along the lateral side. it can be usually,English
+asymptomatic but sometimes there can be a gingival  swelling and the patient might refer to it as   being mildly painful. so radiographically it shows  radiolucency along the lateral surface of the root,English
+"as you can clearly see here, and it is quite  difficult to distinguish it from the vertical   bone loss which happens following periodontitis.  of course histopathological diagnosis will be",English
+confirmatory. so histologically the tumor  can be described as being well circumscribed   and you will see islands of squamous epithelial  cells which are set in connective tissues stroma,English
+and these islands at the periphery show flattened  epithelial cells which is quite characteristic.   sometimes we can even see focus of keratin or  parakeratin and these may also contain some,English
+calcifications or eosinophilic kind of  structures. we cannot really see in this image.   management is quite conservative and the  enucleation with curettage is sufficient.,English
+if there is any teeth involved then extraction  of such teeth is mandated and recurrences have   been reported. the most potential complication  is the development of intraosseous squamous cell,English
+carcinoma from squamous odontogenic tumor.  like I always say do not get overwhelmed.   all these oral pathologies will follow the  same pattern or same way of description.,English
+"clinical picture, radiography, histopathology  and treatment. so you just need to remember   what happens in these four areas of each  oral pathology. so let's start with the",English
+"CEOT. so CEOT is associated with mandible and  especially the posterior premolar molar area,   it is slow growing and quite an expensive  mass, radiographically what we see it's",English
+called as snow driven appearance because  of the mixed radiolucency and radio-opacity   and histopathologically we see sheets of  polyhedral cells with hyperchromatic nuclei,English
+and there is amyloid-like areas extracellularly  and concentric hematoxyphilic calcifications   which are referred to as Liesegang rings. the  treatment has to be slightly aggressive and the,English
+treatment must not be overdone because sometimes  this can resemble poorly differentiated squamous   cell carcinoma. so that has to be ruled out  before you decide the plan of treatment.,English
+the next tumor we studied was adenomatoid  odontogenic tumor. very classically seen   in young girls associated with impacted canine.  radiographically it can be unilocular radiolucency,English
+"associated with the impacted tooth. it is unique  to this but it is not really pathognomic. a lot   of differential diagnosis like dentigerous  cyst, CEOC, CEOT but histopathologically you",English
+can rule them all out. because it has unique  rosette-like structures that is spindle   cells arranged in the form of rose petal like  pattern and along with this you will also see,English
+duct-like structures and that is the reason it  is called as adenomatoid because it resembles   salivary ducts but it's not really salivary  gland in origin it is odontogenic in origin.,English
+so these microcysts are lined by tall  columnar ameloblast like cells and may contain   eosinophilic granuloma or it could even contain  some calcifications and the treatment is quite,English
+conservative simple enucleation and curettage will  suffice as the treatment. and the last tumor is   squamous odontogenic tumor. this is seen in the  anterior teeth maxilla is more commonly affected,English
+radiographically you will see radiolucency but  this can be confused with the vertical bone loss   which is associated with periodontitis.  histopathologically you will see,English
+islands of squamous epithelial cells with  flattened periphery in a connective tissue   stroma. the treatment is quite conservative but  the potential complication is the development,English
+of intraosseous squamous cell carcinoma so we  need to be very careful regarding this tumor. so coming to the multiple choice question  from this presentation. A 11 year old,English
+I think it's very easy for you because just  now we finished revising all of the tumors   when I say that there will be one correct  answer and the others are distractors and,English
+when you read the stem already you know that it is  leaning towards adenomatoid odontogenic tumor but   just to rule out the dentigerous cyst can also be  associated with an impacted tooth but does it show,English
+duct like structures and rosette-like pattern no.  the CEOT show it? no it does not. does squamous or   odontogenic tumor show any such histopathological  depiction? it doesn't so AOT is your diagnosis,English
+or the final answer. so like I always say your  comprehensive type of multiple choice question   is just like how you arrive to diagnosis in your  clinical scenario and that is the reason why such,English
+"And so what I show here is a picture of a bone marrow biopsy from a patient who has follicular lymphoma. And you can see in this particular slide here,",English
+"the blobs of blue that are in there. And those represent residual foci of lymphoma. Now, you can imagine this is not the world's most sensitive",English
+"technique, because-- I mean, if you're lucky, maybe if there's between 1% and 5% of cells represented by a single focus of cancer there in that bone marrow, you might be able to see it.",English
+"But that's not exactly looking for small, really tiny amounts of cancer. So that's one thing you can do. Now if you apply immunohistochemistry,",English
+"this might give you an additional level of sensitivity. So for example, let's say you wanted to look for bone marrow involvement by breast cancer.",English
+"Breast cancer cells will express specific proteins that are lacking in normal bone marrow, such as cytokeratin, for example. And so you could stain a bone marrow for cytokeratin",English
+and maybe find small individual cells that you would not be able to detect just looking through a microscope. So that's one option.,English
+"Cytogenetics is another way you could look for small amounts of cancer. Although, it's not particularly sensitive. So if you do cytogenetics-- if you make chromosome spreads",English
+"and look at them-- typically, in a cytogenetics lab, they're only going to look at about 20 cells. And so in this case, if you find one abnormal cell in 20",English
+that still represents 5% residual cancers. That's not terribly impressive. Fluorescence in situ hybridization,English
+"is sort of an enhanced cytogenetics technique, in which case you can have probes looking for the specific genes that are rearranged,",English
+"for example. And in this case in the setting of fish, you look at 200 cells. And in this case, you might be able to detect small numbers of cells.",English
+"Although, still in the setting of fish, you really can only detect maybe down to 2% or 3%, because there's going to be some background. So fish is not terribly sensitive as well.",English
+"Next, we get into some of the more higher tech ways of looking for small numbers of cells. So flow cytometry. The advantage of flow cytometry is",English
+"you can look at a large number of single cells in one assay. And if the cells you are looking for differ, for example, in their cell surface proteins,",English
+"so that you can distinguish them from normal cells, you can now detect one in 10,000 abnormal cells relatively easily.",English
+"So that gives you several logs more sensitivity. PCR is another way. So if you, for example, have cells that have a genetic lesion that is",English
+"unique to your abnormal cells, you can use PCR. The normal cells in the background won't give you any signal, and you can detect the cells",English
+"with the abnormal genetic lesion down to a level of maybe one in 100,000 cells. So that's quite a bit more sensitive.",English
+And that's what's shown on the gel over there on the right is an example of agarose gel. We're looking for a particular translocation associated,English
+"with lymphoma. Now, next generation sequencing is not normally thought of as a minimal residual disease technique,",English
+"particularly if you're looking at large populations of cells and looking for specific mutations. However, if there's a specific abnormal sequence that",English
+"is contained within your malignant cell population that is not present in any kind of background cells, then actually, you can use the high level of coverage",English
+"that can be obtained with next generation sequencing to look for small numbers of cells. And so again, in the hematopathology world, one thing you can do is look, for example,",English
+"mutations in a gene called NPM1, which is associated with acute myeloid leukemia. We can just PCR amplify that one region that's mutated",English
+"and get very, very high coverage and detect small numbers of cells if you're looking for that particular mutation. Analogously, if you're looking for a specific antigen receptor",English
+"rearrangement in B or T cell neoplasm, if you know the sequence of that rearrangement that you're looking for-- again, you only have to look at this one gene segment,",English
+"We don't normally think of next generation sequencing. Again, it's a sensitive technique. But if you tweak it the right way, and you're looking for a specific abnormality,",English
+it can be actually useful. The last thing I have listed here is cell-free circulating DNA. And this is an area that's really,English
+undergoing a lot of growth. It's not necessarily a technique for minimal residual disease detection. And it's not an area that I have a lot of personal knowledge,English
+"about. I'll talk about it a little bit later, particularly in the context of looking at circulating tumor cells. But self recirculating DNA is just",English
+"another way of looking for residual disease. So this is an example of the kind of data you might get, if you want to consider minimal residual disease",English
+"and what does it actually mean clinically. So this goes way back to 1993. And in the late 1980s, early 1990s,",English
+"PCR techniques were developed to look for specific translocations in lymphoma. In this particular example, we're looking at follicular lymphoma.",English
+Follicular lymphoma has a characteristic translocation involving the immunoglobulin heavy chain gene on chromosome 14 and the BCL2 gene on chromosome 18.,English
+"And you can develop a PCR assay to look for that particular rearrangement, which, again, is lacking in any normal cells, but it will be",English
+"present in the lymphoma cells. And so the sensitivity of this type of PCR reaction is about one in 10,000 to one in 100,000 normal cells.",English
+"And so in this study that was done back in 1993-- or published back in 1993-- they were following patients over time using this PCR technique, looking at their bone",English
+marrow or their peripheral blood and looking could they find cells with this translocation in a very sensitive way?,English
+"And so if they followed patients longitudinally, they could compare whether patients were negative the entire time, or were positive, or in some cases,",English
+patients would go back and forth between being positive and negative. And that's why these three Kaplan-Meier curves are shown here.,English
+"So patients who were PCR negative after, in this case, auto transplantation and then were followed by serial PCR reactions over time-- if they remained consistently",English
+"negative-- they basically did not have a relapse. Patients who were PCR positive after their transplant,",English
+they essentially all relapsed within a few years. And then patients who maybe started out negative and became positive later on had sort of an intermediate course.,English
+So this is really when the first proof of principles where looking at the presence of looking for very small numbers of circulating tumor cells,English
+could tell you whether or not patients would go on to have their disease progressed. These are data that were produced by our own [? Suyen ?],English
+Chen and at the SCCA. Looking at flow cytometry now for minimal residual disease in acute myeloid leukemia.,English
+"And this is showing a same sort of phenomenon. So in the upper left panel, what you see there is the incidence of relapse in patients who either were flow cytometry,",English
+"in this case, positive for AML, which is the upper line, and the solid blue line corresponds to patients who are MRD negative by flow cytometry.",English
+"So they had a lower incidence of relapse. And similarly, they had a few patients who were flow cytometry MRD negative had",English
+"longer survival, as shown in the bottom two panels in this figure. And this is another thing.",English
+"So another question is if patients actually do not have detectable minimal residual disease, can that affect therapy?",English
+"Now, the ultimate question is do we actually treat patients with minimal residual disease or do we leave them alone?",English
+Do we have any effective therapies that can treat this minimal residual disease without causing more harm than good? This doesn't really-- this particular picture,English
+"here in this paper didn't address that specific question. What this paper does show that is in children with acute lymphoblastic leukemia,",English
+"if they become MRD negative, if they have undetectable disease based on flow cytometry, it turns out that you can step back and not treat them as intensively",English
+"as children who still have detectable disease after their first rounds of therapy. So this doesn't necessarily say, ""Yes, you",English
+"need to treat minimal residual disease if you find it."" But what this says is sort of the reverse. That is, ""If you can't detect any circulating leukemia, in this case, that means maybe you",English
+"don't have to treat them quite as intensively."" So the examples I've giving you so far are all from hematopathology, which is my personal bias.",English
+"can pick up about one cancer cell in between 10,000 and 100,000 normal white blood cells. So if you take a normal peripheral blood, for example,",English
+"which-- let's say for the sake of math-- has 10,000 white cells per microliter. Flow cytometry can detect residual disease",English
+"if you have between 1/10 and one cell per microliter or about 100 to 1,000 cells per milliliter. OK.",English
+"So that doesn't sound like a lot, but that's actually a fair number of cells. Now, for solid tumors-- and we know this now having looked--",English
+"but solid tumors, we're talking now about less than one cell per mil or one cell per 10 to the seventh to 10 to the eighth normal cells.",English
+So this is about three logs lower levels of circulating cells than we're detecting in the setting of hematologic malignancies. So this is going to require a different approach.,English
+"We can't just look for cells with epithelial markers by flow cytometry and expect to find them on a regular basis, even in patients with metastatic disease.",English
+beyond just using unique cell markers. So we need to do some kind of cell enrichment. So these are some of the options that one,English
+"can use for enriching circulating tumor cells. So you could take a blood sample, for example, and deplete it of leukocytes.",English
+"If you take out the leukocytes, the remaining cells would presumably be the circulating tumor cells. You can use size selection, based on the fact",English
+that circulating tumor cells tend to be quite a bit bigger than most leukocytes and the peripheral blood. And then you can do other things.,English
+"So you can use immunomagnetic enrichment. You can try to pull cells out with a magnet, based on the cell surface-- antigens they might express.",English
+"And then there's a whole series of different microfluidic devices that people have developed. And I'll show you a couple of pictures of those. And then the last option is to use density centrifugation,",English
+"based on the principle that the actual density of circulating tumor cells is different from lots of the other blood cells. So back around the dawn of the Millennium,",English
+I was working on some research to try to use reverse transcriptase PCR to detect circulating breast cancer cells.,English
+"We used cytokeratin 19 as our marker, and we wanted to see if we could use this as a way of sensitively detecting circulating breast",English
+cancer cells. And so we basically had tried two different approaches. One is to use negative selection. That is to try to remove all the white blood cells from a blood,English
+sample and try to basically end up with just circulating tumor cells left over. And the alternative was to enrich,English
+for circulating tumor cells using beads that were coated with antibodies against epithelial cells.,English
+"They were also magnetic beads. And so this, the data I've shown here, are from some of those early experiments. So the leukocyte depletion method",English
+"uses something called RosetteSep, which is basically a cocktail of anti-leukocyte antibodies. And you add the antibodies to a blood sample,",English
+"it will cause the white cells to agglutinate, and then you centrifuge the blood through Ficoll. And the white cells will sink, based",English
+"on the fact that they're bound up by all these antibodies. And the red cells and neutrophils will also sink. And what's left on top of the Ficoll layer,",English
+"then, is enriched for circulating soup tumor cells. The other method that we tried was using some magnetic beads coated with EpCAM antibodies that",English
+"could pull out circulating tumor cells, based on their expression of EpCAM, which white cells lack. And so what we're showing here is--",English
+"we did flow cytometry, then, to look for the presence of circulating tumor cells. By doing these enrichment techniques,",English
+"we could actually start to see them by flow cytometry. And it turned out that if we did leukocyte depletion, we had a better enrichment.",English
+"And so what's shown over here is these gray dots here, sort of on the diagonal, are the leukocytes that are still present even after leukocyte depletion.",English
+"to residual white cells was higher when we did leukocyte depletion than when we did the reverse, where we were trying to use magnetic beads, which still ended up",English
+"with a lot of white cell contamination in our cell preparations. So in this setting at least, leukocyte depletion was the winner.",English
+"This is another way of looking for circulating tumor cells. This is based on size selection. And this is a very simple technique where you basically take a filter, which has pores",English
+"that will allow red cells and white blood cells to pass through. But the pores are too small for the circulating tumor cells in the blood, and so they get stuck on the filter.",English
+"This has not been used a whole lot, but it's an alternative technique. This is an alternative immunomagnetic enrichment",English
+technique that's used now in the commercial CellSearch assay. And this is the assay that basically killed our reverse transcriptase PCR,English
+"projects, because essentially, as soon as this assay came along, no one was interested in participating in that anymore. But anyway, in this case, we've got magnetic particles and not",English
+"really beads. It's called a ferrofluid, but it's magnetic particles, again, coated with antibodies against EpCAM, which is expressed on epithelial cells.",English
+And then you can use a magnet to pull the epithelial cells out to enrich them. And we'll talk more about this assay in a moment.,English
+"And these are a few examples of microfluidic devices that can be used to enrich for circulating tumor cells. So these are now, basically, printed like a silicon chip.",English
+And there's a couple of different versions of this. So the one on the left here-- this uses a chip that's been printed with a series of posts on it.,English
+"you can then, in a separate step, remove the circulating tumor cells. But it still requires that the cells express EpCAM on their surface.",English
+"This middle device here is called a so-called ""cluster chip,"" which is the same idea. However, in this case, you've got a bigger [? civ ?] diameter.",English
+"And so individual circulating tumor cells will pass through. And this is really just for the isolation of circulating tumor cell clusters, which",English
+"are of interest in some studies to specifically look at cluster circulating tumor cells. So this is designed to isolate those, primarily by size,",English
+"but again, by EpCAM expression. And then finally, on the lower right, around the right hand side here, is something called the iChip, which is a very slick technique, which",English
+"combines both size selection and immunomagnetic selection. And so basically, what it works is at the front end of the chip up here at the top, you put in your whole blood,",English
+"which has also been incubated with anti-EpCAM antibodies-- magnetic anti-EpCAM antibodies-- and as the blood flows through here, it's basically got a continuous flow",English
+"thing, such that the magnetically labeled circulating tumor cells are pulled off to the side and come out one door, whereas the white cells will go out",English
+the other door. And it can be done in real time. And there's some very slick movies where you can watch this happening. So those are microfluidic devices.,English
+"And then finally, another technique that can be used-- and this is the technique I'm going to be talking about quite a bit more-- is density centrifugation.",English
+"Again, based on the principle that circulating tumor cells have a different cell density than a lot of the other blood components.",English
+"So as I said, back in 2005, this assay came out that was FDA cleared. The company was originally making it was called Immunicon.",English
+"This technology has now passed through a number of different companies-- Immunicon then Veridex then Johnson & Johnson, and finally, currently it's Menarini.",English
+"And this is a assay called CellSearch, and this really is the one that you will see predominantly in the literature, because essentially, it's the only FDA-cleared CTC assay that's out there.",English
+"And this assay, again, uses immunomagnetic selection of CTCs in order to enumerate circulating tumor cells. So how does that work?",English
+"Well, basically, you get a tubal blood from the patient and into this tube of blood go these EpCAM coated ferrous particles, as well as fluorescent antibodies",English
+"against CD45, and cytokeratin, and also a fluorescent stain to label cell nuclei.",English
+And so now these magnetic particles-- this whole [? cell gamish ?] goes into a chamber that has magnets. And the magnets will pull out the circulating tumor cells.,English
+"And then you can wash away most of the cells that are not circulating tumor cells. And once that's done, the remaining cells",English
+"are injected into this little chamber here, which is then put into an imaging system. So this is the box that does the cell preparation.",English
+"And then, this is the box that does the image analysis. And see, what you end up with are images that are stained for either cytokeratin or CD45,",English
+"which is a leukocyte marker. And then, they also have to have a nuclear stain. What a circulating tumor cell in this system is defined as",English
+"is a cell that is cytokeratin positive, CD45 negative, and has a nucleus. And so a computer here goes and scans this cartridge,",English
+"looks for all the cells, looks for the different colors that are on there, and tries to count all the circulating tumor cells. And so basically, a lot of clinical work",English
+"has been done at this point, looking at this assay and particularly how it pertains to prognosis and response to therapy for patients with cancer.",English
+"So first of all, it's FDA approved for counting circulating tumor cells and three types of cancer-- breast cancer, colon cancer, and prostate cancer.",English
+"And then, there are specific clinical cutoffs, which are associated with prognosis. So for breast and prostate cancer, patients who have five or more cells per 7.5 mL of blood",English
+"are considered higher risk. And for colon cancer, it's three or more cells per 7.5 mL of blood. People have done studies showing that the number of circulating",English
+"tumor cells correspond to other tumor markers such as urological tumor markers. They correlate with radiological endpoints, particularly in breast cancer.",English
+"You can look at response to therapy. So if a patient has x number of circulating tumor cells, and they get a therapy, and the number of circulating tumor",English
+"cells goes down, that's good. And if not, it suggests the therapy doesn't work. And if a therapy is failing, it can be marked by an increasing number",English
+of circulating tumor cells. So I'll just show you a few examples of some of the data here. So this is data that was published with respect,English
+to circulating tumor cells and prognosis in breast cancer. And so patients in this study had circulating tumor cells measured at the beginning of therapy.,English
+"And as you might expect, patients with more than five circulating tumor cells had the worst prognosis in these cases. And patients with fewer than five had better prognosis.",English
+"And you can do the same thing at first follow-up. So after patients had their first round of therapy, you can measure circulating tumor cells again. And again, patients who have less than five",English
+circulating tumor cells had improved prognosis. These ones over here. And patients with more than five circulating tumor cells had a worse prognosis.,English
+"And then the same thing happens in restaging. So once the patients had more follow-up, and they're being staged again, if you measure circulating tumor cells-- again, if you have fewer circulating tumor cells,",English
+your prognosis is better than if you have more circulating tumor cells. So these are the types of data that at least justify doing circulating tumor cell,English
+"counts in these patients. Here's a similar story with prostate cancer. So again, patients with more than five",English
+circulating tumor cells had a better outcome than patients with fewer than five circulating tumor cells. And this graph here is interesting.,English
+"So this is a receiver operating curve comparing using circulating tumor cells versus using PSA, prostate-specific antigen, in terms of looking",English
+"for patient outcomes. And so in the setting of ROC curves, what you want is a curve that's as close as possible to the upper left hand",English
+corner. So the green line here is the association with circulating tumor cells-- more than five circulating tumor cells an outcome- whereas the red line,English
+"is prostate-specific antigen. And so what this shows, at least in this type of experiment, is that, actually, circulating tumor cells is a better",English
+"predictor of patient outcome than PSA. And then finally, here are the data from colon cancer. Again, the same idea.",English
+"In this case, the cutoff being three cells. And patients with more than three circulating colon cancer cells-- more than three are down here in the yellow line--",English
+"had a worse outcome than patients with fewer than three circulating tumor cells, shown here in the blue line. So again, these are the types of clinical data",English
+that were published and demonstrate that the CellSearch assay has prognostic significance. I should add that it's still not--,English
+"the CNS, anyway, is still not reimbursing us for this. So they don't accept this data yet necessarily as being of clinical utility, but that's",English
+"a talk for another day. So since we have this CellSearch assay up and running, why would we switch to another technology?",English
+"As I said, we got this instrument in 2005. So this is 16 years ago now. And as of a couple of years ago, we",English
+"decided we needed to replace it. There's a 14-year-old instrument at this point. It was breaking down, sort of on a regular basis, as you might expect.",English
+"And the thing that was sort of frustrating is that if we wanted to replace our CellSearch instrument with an equivalent instrument, it would be,",English
+"actually, exactly the same technology as from 14 years earlier. So we would buy a new instrument, and it'd be exactly the same as the old one,",English
+except that it would be a new hardware. The other issue that came up with CellSearch is it really is limited in that it can only detect,English
+"cells that are EpCAM positive. So if you wanted to detect cells that don't have EpCAM, this technology won't work.",English
+"So for example, epithelial malignancies can undergo something called an epithelial-mesenchymal transition as part of their tumor progression,",English
+"and in this EMT as it's called, cells will lose expression of things like EpCAM and so will no longer be detectable using this assay.",English
+"Furthermore, it'd be nice to have an assay for things other than epithelial tumors. For example, it'd be great to have a melanoma assay. And no such assay existed using this technology,",English
+"because, again, melanoma cells don't express EpCAM. And one of the other things that was frustrating working with this assay",English
+"is that it really was a closed system. Because it was an FDA-cleared system, is very limited in terms of what you can do with it beyond what it was FDA-approved for.",English
+"And so there was really-- we're used to the flow cytometry world, where you can develop a new assay if something interesting comes along.",English
+"Here, we really didn't have that opportunity. There's really no way to develop some sort of custom assay, if we wanted to ask a new question. So in 2009, I met a man named Ron Seubert.",English
+"He knew that I was interested in circulating tumor cells, actually, from back in the cytokeratin days. And he actually owned a company called Applied Precision, which",English
+was in Issaquah. And Applied Precision was basically a company that was primarily specialized in high end microscopy.,English
+"So they had the very fancy microscopes. And so he invited me out to Issaquah, and I looked at their shop, and it was your typical thing with engineers.",English
+"I've had the opportunity to work with engineers now and again. And engineers are fun to work with, because if they need-- if they said, ""Well, gee.",English
+"It'd be really nice if we had something that could do x. We'll just build that."" And so you go out to a place like this",English
+"and the place is covered with printed circuit boards and cables and everything like that, and so all these sort of prototype instruments was kind of fun to see that.",English
+But anyway so Ron Seubert was interested in whether he could use some of his microscopy technology to look for small numbers of cells in the peripheral blood.,English
+"And so because he was interested in this, he created a new company called RareCyte and was interested in us collaborating.",English
+"So after some development, they developed this assay to look for circulating tumor cells. In this case, it's based on density gradient",English
+"centrifugation. So the way this assay works is you take whole blood, and you put it into a centrifuge tube. And inside that tube, there is this float-- it is basically",English
+"a piece of plastic. It's a cylindrical piece of plastic that has a very specific density to it. And if you then spin this tube in a centrifuge,",English
+this float will basically go to a particular point in the blood. And any blood cells that have the same density will be sort of coating--,English
+will basically end up between this float and the wall of the tube in which it's spinning. So there's basically a monolayer of cells surrounding,English
+"this tube in this region here. And then, if this tube is optically clear, you can take a microscope and look",English
+through the wall of the tube and essentially collect an image from the surface of this float. And so the tube would rotate and the microscope lens,English
+"would go up and down and to take essentially if you think of this cylindrical thing here, if you unwrap it, you end up with a rectangle that looks something like this.",English
+So this is what it looks like here. So this is a tube of blood. You can see the red cells are here at the bottom. The plasma is up at the top. This is a layer of platelets up here.,English
+"And along the wall of this float, essentially, is a buffy coat. So this is basically creating a very thin buffy coat layer.",English
+"And then, if these cells are stained with fluorescent markers, for example, for CD45 and cytokeratin, and a nuclear stain,",English
+"kind of like you did with the CellSearch assay, you could then image through the wall of this tube and end up with a rectangular image like here in B. And this blue band here across the middle",English
+are basically of the nuclei of all the white cells that are in there. And scattered among these white cells are also circulating tumor cells.,English
+"And that's what you can see in this green cell here in D. If you can get a very close up view of this region, it turns out that scattered among the white cells in here",English
+"are the circulating tumor cells. And so they can be imaged this way. And so this worked. The difficulty here, basically--",English
+"I mean, there's a lot of very fancy things that have to happen, particularly these tubes here. They're not generically available. And so the current assay we're doing now",English
+is a slight modification of this. And so this is how the current generation of the RareCyte method uses.,English
+"And this is what we're using now in our laboratory. So it starts out the same. You start out with a tube of blood that has a float in it. And this tube, again, gets centrifuged",English
+"in a standard swinging bucket rotor, basically. And the buffy coat ends up coating the float here, wedged in between the float and the side of the tube.",English
+"Now, the difference between this and the original assay is now what we do is we kind of we squeeze off the tube-- the buffy coat-- put in a density solution, and manage",English
+"to get the buffy coat out of the tube into a little microfuge tube like this. And then the buffy coat, from this microfuge tube,",English
+"is then spread onto eight ordinary glass microscope slides. And once you have it on microscope slides,",English
+"you can actually use a lot of pre-existing equipment to do stuff with it. And in particular, we can take an automated immunostainer",English
+"and then stain the slide using the various fluorescent antibodies that we're interested in, which then go into an imager, and you end up with images. Very analogous to what we would see with the CellSearch assay.",English
+"And so that's basically how this instrumentation, or this methodology, can image circulating tumor cells. And here are just some examples.",English
+"So for example, here is an example of breast cancer. And what you see is we've got a signal for, in this case, it's a combination cytokeratin EpCAM.",English
+"So rather than relying on EpCAM expression, now we have a cocktail of cytokeratin EpCAM antibodies. And that colors it here in magenta.",English
+The green color here are the leukocytes in the neighborhood. So they're staining green. And then blue is the nuclei.,English
+"And what we see here is a cell that has cytokeratin EpCAM, does not have CD45, and has a blue nucleus. So that counts as a circulating tumor cell.",English
+"And this is an example from a lung cancer patient. Again, it expresses cytokeratin EpCAM, lacks CD45, has a nucleus.",English
+"And then, this is the final example-- prostate cancer. CD45, EpCAM. No CD45. Has a nucleus.",English
+"So this is the kind of cells that we're looking for. And again, we have an automated imaging system and can count cells this way.",English
+"This just four inches-- this is a patient with breast cancer. And this is a very large cluster of breast cancer cells. And again, some of the breast cancer",English
+"researcers that we work with are interested in the significance of these circulating clusters of cells, as opposed to individual circulating tumor cells.",English
+"So because we are in laboratory medicine, we wanted to bring this online as a clinical test. And so we had to validate it as a laboratory developed test.",English
+"And so these, of course, are-- I'm sure most of you are familiar with the things that you need to worry about in terms of validation. So we need to worry about sensitivity and specificity,",English
+"precision, recovery, linearity, potential interferences, and then finally, accuracy. So I'm going to show you some of our data",English
+"now that we used to validate this has a clinical assay. So in order to determine sensitivity and specificity, we basically used an artificial system",English
+where we took cultured breast cancer cells and spiked them into normal peripheral blood and tried to count them.,English
+"And so what we did, we took five tubes each with 25, 50, or 125 cells and then subjected them-- took them through this whole process--",English
+"and tried to count the cells. So the first thing. In all 15 tubes, we were able to detect circulating tumor cells. So that technically would be-- you",English
+"would call that 100% sensitivity. Now, I admit that 25 cells is a fairly high number, but it turns out that it's extremely difficult",English
+"to spike blood tubes with smaller numbers of cells than this reliably. So really, this is the best we're able to do in terms of artificial spiking experiments.",English
+"The good news was in normal blood samples, we did not detect any circulating tumor cells. So that leads to 100% specificity.",English
+"In order to determine whether or not we can detect lower cell numbers than 25, we had to rely on our clinical samples. And we'll get into that in a moment.",English
+"Next, we wanted to look at precision. And so for precision, we took our spiked samples again and looked at the CVs.",English
+"And at the highest number, actually, we see pretty nice reproducibility here with only 3.7% CV. Around 50 cells, we have a higher degree of variability.",English
+"And with lower numbers of cells, we have an even a higher number of degree of variability. One caveat to this is that, again, you're making spiked samples.",English
+Your ability to accurately spike in certain numbers of cells is really dependent on you're making serial dilutions and so on.,English
+"So I think, actually, a lot of this variability here does not reflect so much the assay, as it does the ability to spike in cells.",English
+"But those are the kind of numbers we're getting for CVs. This shows linearity. So again, we're taking those same spiked samples now.",English
+"And in this case, we get very nice linearity out to 125 cells. We got a nice slope there, very close to one.",English
+"And this is our recovery experiments. So again, for these different numbers of spike ins, we actually see very close to 100% recovery, in all cases. So for all these sort of analytical type",English
+"that you need for validation, they look pretty good. Interferences. It's a little hard to see how--",English
+that's sort of the classic interferences would affect an assay where you're looking for circulating tumor cells. We just sort of the classic ones of bilirubin and triglycerides.,English
+"They really had no effect. We didn't bother looking at hemolysis, because if any sample actually came to us and was actually grossly hemolyzed,",English
+"we wouldn't probably want to look for intact cells in that situation. But bilirubin and triglycerides did not cause any interferences, which brings us to the accuracy",English
+part of the study. So what we did is we had 48 patient subjects who had duplicate blood draws.,English
+"One blood draw was run using the predicate method, the CellSearch assay. And the other tube of blood was run using the RareCyte assay.",English
+"And so this is what the data looked like altogether. And so if you do this, we can make a linear regression equation and so on with a P value and an R squared",English
+"and all that kind of thing. But really, it's really not fair to do linear regression on data where 3/4 of the data are really clustered here with less than 10 circulating tumor",English
+cells per 7.5 mL of blood. So the question is what is really the best way to try to compare these things here? So one thing you can do is a log transformation.,English
+"So this is what the data looked like when they are log transformed. I had to cheat a little bit, because we had a lot of zeros.",English
+You can't get a log of zero. So I added one cell to each sample across the board. And we ended up with data that looks like this.,English
+"So it actually does have a pretty nice correlation. But again, a lot of these samples here in the low end-- there's a lot of scatter.",English
+"And so it's really hard to get a meaningful R squared, for example, in this case, given how much the data is biased towards the low end.",English
+"So what else can we do? So these are already a couple of-- well, the t-tests not so much. But the Wilcoxon and the Mann-Whitney-Wilcoxon",English
+are non-parametric statistical tests to compare two sets of data. And then we have the student's t-test,English
+"for paired sets of data as well. And this is what you'd want to see. Basically, you get P values that are not significant,",English
+because the two sets of data should be the same. These tests are really good if you want to show that two sets of data are different.,English
+"But it's really hard to-- what we really want to do is say, ""How can we put some sort of number on how similar these data are not? Are they different or not?""",English
+"So this is like a negative positive test, if you will. So this is another way of kind of looking at it. So in this case, I said, ""OK, well,",English
+"rather than looking at the exact numbers, let's see how good correlation we can obtain if we just say the tests are either positive for having greater than five circulating tumor cells per tube",English
+"or negative with less than five circulating tumor cells per tube."" All the patients in this study either had breast cancer or prostate cancer.",English
+"So five cells was sort of the established clinical cutoff. And so in this case, what you see here is that there's actually very good concordance",English
+"between the two assays, in terms of this positive versus negative type approach. There were three ""false negatives"" in looking at RareCyte.",English
+"And there were three ""false positives."" So basically, six out of the 48 were allegedly discordant. And so when you have a two by two table like this,",English
+"you can do a chi-squared analysis. And so if you do a chi-squared analysis, now you get a very nicely statistically significant P value saying that these methods are the same,",English
+at least in terms of the qualitative-- or semi-quantitative-- approach to whether they have more or less than five circulating tumor cells.,English
+"So I also wanted to look and see, well, let's look at the discordant ones and see what that really means. And this gets into how reproducible",English
+"can a CTC count really be? When you're spiking in samples, those should all be the same. When you're drawing a tube of blood from a patient,",English
+"and they have very small numbers of cells, you run into this mathematical problem called the Poisson distribution. So for example, what I have here on the left is a histogram.",English
+"If you took a patient who truly had five-- if the true number of circulating tumor cells was five in this particular patient,",English
+"and you drew their blood 10,000 times-- I don't recommend it. But if you drew their blood 10,000 times, you get a distribution that looks like this.",English
+"So this is a Poisson distribution, where the ""correct value,"" referred to as lambda, is five. Well, if you could do the 95% confidence interval for that,",English
+"if a patient's true CTC count is five, 95% of the time, you're going to get the number between two and nine, which is a fairly broad range, if you think about it.",English
+"And it also sort of calls into question is how rigid can you be about one of these cutoffs for five circulating tumor cells affecting prognosis when in fact, you're",English
+"looking at a fairly broad range of numbers in real life? And then if you use the colon cancer cutoff of three, the 95% confidence interval with Poisson distribution",English
+will be between one and six. So I wanted to look at our discordant ones and see are they really discordant or is this just noise?,English
+"So here are the six discordant samples. And first of all, you can see that they all had very small numbers of circulating tumor cells. And then, what I did is I was taking the assumption",English
+that maybe the true number of circulating tumor cells is halfway between these results. If you then use the Poisson distribution to decide what is the 95% confidence interval based,English
+"on that ""true value,"" you get these numbers right here. And if you notice, all of these results fit within the 95% confidence intervals based on a Poisson",English
+"distribution, assuming the true numbers is the mean between these two, which is an assumption. I grant you. But that's what it is.",English
+"You stick a needle into a patient's vein and you take out 7.5 mL of blood, these are the numbers you're going to get, sort of on a random basis.",English
+"So just in summary. The two methods are agreeing quite well. If you say where they disagree, I",English
+think I would disagree that they disagree. And we can agree to disagree. This is one other way of looking at the data. So this is a Bland-Altman plot.,English
+And what a Bland-Altman plot is where you take two paired data sets. You take the difference between them and divide it by the mean of the two data points.,English
+"And again, if you've two zeros, that's a problem. You don't divide by zero. But correcting for all that, what you see is that, really, almost all the data here line up",English
+"very nicely along this zero line, which just basically means they're giving you more or less the same result. Bland and Altman, when they published this paper,",English
+they specifically were looking at comparing two different methods in the setting of medical diagnosis and saying are two different methods the same or not?,English
+"And so we get here's a very nice looking graph, except for this one point down here. So I will call your attention to with a red circle.",English
+"So what's the deal here? So in this case, the CellSearch method found 340 circulating tumor cells, which is a huge number. The RareCyte method got 548 tumor cells.",English
+"That's actually quite a significant difference. From a clinical standpoint, it's not a clinically significant difference, because it's a huge number of cells, unfortunately, for this patient.",English
+"But from an analytical standpoint, we wanted to understand that. Well, it turns out for this particular patient, only 25% of their CTCs actually had surface EpCAM.",English
+"And if you recall, the CellSearch method requires that cells have EpCAM on their surface. So this is a potential explanation.",English
+So here's this example of some cells that are positive for cytokeratin but lack EpCAM expression. So this is at least a possible explanation,English
+"as to why you might get such a discordant result, for this particular patient. So at this point, this is a assay we have online.",English
+We're doing this as a clinical assay now. I just wanted to make a few other points. First of all this is just to mention circulating tumor DNA.,English
+"So circulating tumor cells and circulating tumor DNA fall into this category of liquid biopsy, in that you can take a blood sample and not have to actually go in",English
+and get a tissue sample to learn something about a patient's tumor. So I just wanted to show you some of the results from this particular-- the question is,English
+"are circulating tumor cells and cell-free DNA the same or different? And in this particular paper that came out this year, they actually asked this question.",English
+They took a single sample of blood and isolated both circulating tumor DNA and circulating tumor cells and did next generation sequencing to see if they had similar genetic profiles.,English
+And what's really interesting. It turns out that there's a lot of mutations in the circulating tumor cells that are lacking in the circulating tumor DNA.,English
+"There are mutations in the circulating tumor DNA that are absent in the circulating tumor cells. And there is some overlap among them. And then again, that's shown here.",English
+So the red shows you mutations in the CTCs. And the blue are mutations in the circulating tumor DNA. So why do I bring this up?,English
+"And again, this is not an area of particular expertise of mine, but the interesting thing about it to me is that circulating tumor DNA presumably represents",English
+"DNA that's being shed from tumor cells as they die, perhaps, in their tumors, whereas circulating tumor cells are actually viable cells that are in the peripheral blood.",English
+Is there something biologically different about these two populations? And this might be one way to address that. So that's just sort of my philosophical take.,English
+So far what we've been talking about is cell enumeration. But there are some other applications that we can potentially do here. And we're working with some more collaborators at the SCCA,English
+"to try to look at some of these things. So for example, you can look at the androgen receptor in prostate cancer. You look at things like estrogen receptor or HER2",English
+expression in breast cancer. There's an instrument that you can actually use to pull individual cells off of these glass slides that are stained for downstream purposes.,English
+"And we're also going to be looking at-- there's this thing called MUC1 star. And I'll just talk about this in a moment, just a little bit.",English
+"This is an example of some additional biomarkers you can look at. So for example in breast cancer, you can look at estrogen receptor. You can look at HER2.",English
+"For prostate cancer, you're looking at androgen receptor, in this particular isoform of antigen receptor. And also there are assays for example",English
+"for PD-L1 and [? MUM1 ?] that you can look at as well. In terms of prostate cancer, so there's this variant of the androgen receptor",English
+"called AR-V7, which is basically alternatively spliced. And it loses part of the protein that allows the receptor to be targeted",English
+"by anti-estrogen drugs. So if you have this variant version of the androgen receptor, you will not be able to use these androgen receptor agonists.",English
+"And so, for example, you can look at that by RT-PCR. You can look at the RNA. Or you can look at the protein if you've got a specific antibody.",English
+So here are some examples where you can actually look at this AR-V7 version of the androgen receptor versus the full length androgen receptors.,English
+"This is an assay that's available. And our prostate cancer docs are interested in that. And then, you can look at other markers. So for example, when prostate cancer cells",English
+"have been treated with anti-androgen agents, they sometimes undergo what's called neuroendocrine differentiation. And we can identify that by looking at synaptophysin",English
+"as a marker. And so, again, this is another marker that some of our prostate cancer colleagues are interested in looking at.",English
+And so we will be developing an assay for that as well. One of the things that this technology can potentially do is that you can actually take single cells off,English
+of the glass slides that are normally analyzed. We do not have this capability in our lab mainly because the instrument that we,English
+"have is set up to do automated multiple slide loading. There's an instrument where you can load one slide at a time by hand, which is obviously not the kind of thing you",English
+"want to be doing in a clinical laboratory. But if you use that, you can select individual cells off of a slide and do things like whole exome sequencing, array CGH, or RNAseq, or any number of sort of high through put",English
+downstream sequences on these single cells. So these are the things that we're working on right now. Dr. Jennifer Specht is one of the breast cancer,English
+"docs at the SCCA. And she has a study where she's going to be using CAR T cells that are targeted to an alternate version of the MUC1, mucin, marker",English
+"that breast cancer has. And it's called MUC1 star. It's basically a cleaved form of MUC1, which is a common breast cancer marker.",English
+And so we will be developing an assay to specifically look for this MUC1 star version to identify patients who might be candidates for the CAR T,English
+"cell therapy. And then also going forward, again, because this is an open system, we can use whatever antibodies we like to develop new assays.",English
+"I'm definitely interested in looking at assays for malignancies that don't express EpCAM, for example. So things like melanoma or renal cell cancer.",English
+"So those are some of the things that in the coming years, we want to look at as well. So I think I'll stop there.",English
+"I've got pretty good timing, but there's a number of people that I really need to thank me who have helped work on this. First of all, in our department over at the hematology lab",English
+"at Harborview, I need to thank Mike Tam, Michael Hardin, and Sarah Trimble our manager because they're really the ones who did the actual work to validate",English
+"this assay for the clinical lab. I also need to thank, from the SCCA, Tia Higano, VK Gadi, and Evan Yu who are our collaborators working",English
+in breast and prostate cancer. We obviously did this in collaboration with RareCyte. And so the people listed there are from RareCyte.,English
+us to develop better and better treatments for patients with brain tumors. >> As Dr. Gilbert mentioned it's really important to get that expert opinion and an neuro-oncologist,English
+is somebody who has been specially trained in the care and treatment of patients with brain tumors. It's really important to get that expert opinion and an opportunity for second opinions at,English
+"the time of diagnosis or during your treatment if there are treatment decisions to be made. >> Thank you. And just so we all can understand what we're talking about here, are all brain tumors considered",English
+to be brain cancer? >> So that's a great question and so when we look at the tumor we use a classification,English
+"system that has been developed by the World Health Organization, which puts brain tumors in a class ranging from grade one to a grade four.",English
+"Grade one tumors are considered benign and can be cured with complete removal, where has grades two, three, and four are considered malignant.",English
+"The higher the number the more malignant the cancer is. >> Importantly to that unlike other cancers, which oftentimes they look at if the lymph nodes or other parts of the body are involved, most primary brain tumors stay within this",English
+central nervous system. So this grading system that Dr. Gilbert talked about is really important in defining how we treat patients with those cancers.,English
+>> Thank you. And another question that often comes up is you mentioned there's secondary brain cancer is cancer that starts at one part of the body and then moves to the brain.,English
+"So let me ask the opposite, do primary brain tumors that start in the brain ever move to other parts of the body?",English
+">> So it is quite unusual for most primary brain tumors to leave the central nervous system and I would say that the likelihood particularly in diseases like glioblastoma,",English
+"which is the grade four glioma, it's less than 100,000. So it is so uncommon that we don't actually do surveillance as we would do in system of",English
+cancers like lung and brain cancers. >> Thank you that's very helpful. Now that we understand a bit more about that there are many types of brain tumors and different,English
+"types of treatment, let's move to brain tumor treatment and then pivot to research. So if you're just joining us we're talking with Dr. Gilbert, Dr. Armstrong about brain",English
+"tumor research, treatment and research. You can ask questions in the comments and we'll get to as many as possible at the end. Now let's talk about survivorship and the quality of life that patients have during",English
+"and after treatment. Dr. Armstrong, what is that like? Are we improving survivorship and quality of life for patients today? >> It's a great question David, and something that we're really focused on here with the",English
+Neuro-Oncology branch as well your group and others around the country and around the world. We know that the impact on patients can be great. It's estimated that over 50% of low and high-grade tumor patients have difficultly even returning,English
+"to work from the time of diagnosis. We know those symptoms that I talked about can occur at the time of diagnosis, but some can also occur throughout the time the person is dealing with the illness and that can be",English
+"difficult. In addition to people like us focusing on understanding what that impact is and trying to improve it, there's a real understanding of that within understanding the impact of",English
+our treatments. So the FDA has identified that they really are interested in how treatments make the patient feel and function and within our clinical trials we try to identify that and monitor,English
+that for patients throughout the trial. So we really understand that the impact is that we're getting. In addition there's a real emphasis and knowledge that there are people out there living with,English
+"the diagnosis of brain tumors and the Central Brain Tumor Registry of the United States has reported recently that it's estimated over 700,000 people in the U.S. are living",English
+"with the diagnosis of a primary brain tumor. So we have to identify those issues and they face including care issues, financial issues that they may face, and then impact on the extended family.",English
+"The Society of Neuro-Oncology has developed a Survivorship Care Plan, which is a nice guide for physicians outside the fields of neuro-oncology to know how to help patients",English
+cope with their illness and deal with the issues they may face as a result of it. >> Thank you. It sounds like there are a lot if efforts going on to try and improve the care and quality,English
+"of life for patients. And as you mentioned earlier Dr. Gilbert and Dr. Armstrong, there are many different types of brain tumors and among them, although all brain tumors are considered rare, there are",English
+some especially rare CNS tumors. And so what are some of those especially rare CNS tumors and what efforts are being done,English
+to address those rare tumors? Maybe you could start with how do we define a rare central nervous system or CNS tumor? That's a great question.,English
+"If we look at the definition of rare diseases used by the NIH and other organizations, in general there are any diseases that occur in less than 200,000 people per year.",English
+"So all primary brain tumors could be considered rare. Within the over 130 different types of primary brain tumors, there are some that are exceedingly rare.",English
+"And with the Neuro-Oncology branch we're focusing on those tumors that had an incidence of less than 2,000 to 3,000 people per year diagnosed within a special effort that we call NCI CONNECT",English
+"and which we're trying to build networks, partner with advocacy in patients to understand these diseases. Both the impact on the person and develop new treatments for them.",English
+">> Well, Dr. Armstrong just to go a little bit level deeper, do all -- do all of these rare CNS tumors have a standard of care that doctors can deliver or do they not?",English
+"Where do things stand with terms of standard treatment protocols for these rare CNS tumors? >> That's a really, really important question, David.",English
+And unfortunately some of these tumor types do not have a standard of care because of the low incidence and that we haven't been able to do trials to identify what really,English
+helps the person in their survival. So part of our effort is to try to identify and understand that. And we're doing that through several of the projects within NCI CONNECT.,English
+">> And if I could add that there are lots of challenges faced by patients who have a rare cancer, particularly those with the rare CNS tumors.",English
+"And oftentimes there's a delay in diagnosis because the appearance under the microscope is unusual and again, with the delay in diagnosis there's often a delay in initiating treatment.",English
+"As Dr. Armstrong mentioned, it is difficult to establish a standard of care if in fact we have difficulty assembling enough patients into a clinical trial to actually test it",English
+in a way that we can then use that to establish what is the best practice and care for those patients.,English
+"Additionally, the patients with these rare diseases feel like they're alone and can feel isolated and oftentimes their healthcare providers are not familiar with the disease and again",English
+"it leads to uncertainty and anxiety on the part of the patient. And one of the goals of the NCI CONNECT is to bring together patients in advocacy, as",English
+"well as a network of centers and investigators to improve the outcomes for patients with these rare diseases. >> Dr. Gilbert just, could you expand a little bit more in terms of what should a patient",English
+or patients think about asking if they have one of these very rare brain tumor types to make sure that the institution or hospital they're going to has the kind of expertise,English
+"in their area? >> Well, I think that's a great question. I would say that given a ability for the medical community to communicate particularly with",English
+all of the Internet and other opportunities that patients should ask their treating or their healthcare providers their level of expertise and knowledge.,English
+And if they get a sense that it is not very high to really reach out to Centers of Excellence in the setting of where CNS Cancers we would welcome inquiries from patients with these,English
+"diseases. And again some of them will fit into the NCI CONNECT, but overall I think we would be happy to provide some consultation.",English
+>> And I think I would add to that those some simple questions that you can ask if you're diagnosed with a rare CNS tumor or really any central nervous system tumor when you,English
+seek out healthcare is how many of these types of tumors has that particular physician treated in the past and how many they've seen in the last year will give you an idea of their experience,English
+"with that. You know, no one wants to see a physician who maybe says that they've only seen one of these tumors before. You may not feel comfortable with that.",English
+The other thing that's really important within that is to have a partner with you when you see a physician or ask these questions. It could be really overwhelming and there's a lot of information that could be shared.,English
+"But if you're able to have somebody with you at the appointment that can hear what you hear, that can take notes for you, sometimes then you can have that information and remember it after you've been given so much overwhelming information in a short period of time.",English
+So partnership with someone to help you look for that help and support and seek out experts and here are all important ones. >> Agreed.,English
+">> Thank you, Dr. Armstrong. And for those of you who are just joining us we talked about so far two major concepts. Once is understand and know your tumor. What do you have the importance of pathology, Dr. Gilbert underscored, and second Dr. Armstrong,",English
+Dr. Gilbert talked about the importance of finding the right expertise for you providers that really know your tumor type.,English
+And so no let's move to a third concept is what are the new treatment approaches for CMS tumors including rare CMS tumors?,English
+"Dr. Gilbert? >> Yeah, so thanks David, this is obviously critical and I would say very, very exciting. As many people know there have been tremendous advances in our ability to investigate cancers.",English
+We can do genetic analysis that would have been unheard of even five years ago to better understand biology of the cancer to start asking questions about specific treatments.,English
+We consider these treatments targeted therapies. We like to imagine that they are personalized treatments based on the specific characteristics of the cancer.,English
+"So the targeted therapies remain an area of active investigation. And what we're discovering is that many of these cancers even though they fall under the same name, for example glioblastoma that they have individual differences and it's",English
+"through these types of genetic analysis that we're able to think about targeting specific aspects of the cancer. In order to do this we need to have very large collaborative efforts and I'm very, very pleased",English
+to tell everybody that the brain tumor research community is a very collaborative environment and we have studies planned with colleagues not only in North America but also in Europe,English
+and Asia. And we're bringing all of that expertise together for the common purpose of making treatments better. We're not stopping with targeted therapies.,English
+"Of course everybody is interested in immunotherapy. This has been a fantastic advance in other cancers. Diseases that were previously incurable, they are now putting patients into long-term remission",English
+with immunotherapy. And we would like to of course see the same type of success in the brain tumor field. But we are also recognizing that it's more complicated treating brain tumors than other,English
+cancers. And so there are active investigations going on both in the laboratory as well as clinical trials to better understand immunotherapy.,English
+">> I'd probably add about immunotherapy, it's a concept that you may read about or hear about a lot and it's really about harnessing the persons' immune system to help battle",English
+the cancer. And that can be done either passively or actively. Passively by harnessing that immune system or actively by actively engaging your immune,English
+"system. So it's really using a therapy to help your body fight the cancer. >> Yeah, I think that's a great explanation and it will likely turn out that is won't",English
+"be a single immunotherapy that works, it will have to be a combination of strategies to overcome some of the difficulties in getting an immune reaction in the brain.",English
+I also want to talk about metabolomics. So we have discovered that cancer cells have a unique metabolism and there are active studies trying to target that metabolism again looking for that Achilles heel in the cancer and having,English
+the ability to specifically target the cancer without causing much in the way of side effects. And of course all of this means that we need to focus energy and have participation in,English
+"clinical trials. So there are a large number of clinical trials available across the United States, as well as Europe, and Asia.",English
+"But focusing on the United States, if people are interested in participating in clinical trials and we can encourage it enough, there are ways of finding out what's available,",English
+"ask your healthcare providers, at cancertrials.gov, as well as other places to look to be able to navigate to clinical trials.",English
+There is always the issue of paying for some clinical trials. This has been a challenge. We are very pleased to say that for patients who participate in clinical trials through,English
+"the National Institute of Health here at the NCI Bethesda campus, we're able to cover the cost of clinical trial as well as some of the transportation and lodging.",English
+">> So if you're interested in coming here it's important to know that the initial screening cost wouldn't be covered but if you're on a trial, the trial therapy is provided at no change and there's also support for travel and lodging for people who come here.",English
+"And definitely that clinicaltrials.gov website is a great resource for finding trials that are available around the country, particularly if you're interested in trials that may be",English
+"closer to where you live. And then finally I'd add there are different phases of trials. And they are from phase one, which we're really looking at the efficacy of the treatment.",English
+Phase two where we're looking at to see if it has efficacy with the tumor. And then phase three to see if it's better than the standard treatment.,English
+And each phase of these trials are really important to the development of new therapies and advancing the care we can provide to patients. >> Thank you Dr. Armstrong.,English
+"Dr. Gilbert, one question that often comes up is what are the different types of treatments a patient needs to think about based on the grade of their tumor going from the lowest",English
+"grate or benign tumors, to the highest grade tumors? Do all brain tumors patients of all grades need to think about all of these different treatment modalities or does that differ based on the grade and type of tumor you have?",English
+">> So David this is an excellent point to add. There is no cookbook, as we say, that covers all brain tumors.",English
+"And so we need very important information starting with the type of tumor, second is the grade of tumor, and then third as our knowledge is expanding we are increasingly",English
+"relying on genetic changes within specific tumors to help guide treatment. This has been a very pivotal advance in our way of approaching these cancers, recognizing",English
+"that certain treatments were the best for subtypes or within the individual cancers. As we continue our work and as the availability to genetic testing increases, we will be able",English
+to further refine the treatments. We recognize that the treatments have to be individualized and within each patients treatment,English
+"plan, factors such as their functional status, and concurrent illness has to be incorporated into the decision-making process to optimize the therapy for each patient.",English
+"support they have from family, or even therapists if that's needed, undergoing physical therapy they have issues with weakness or speech are really important.",English
+And then finally it's circling back to what we talked about before in relation to the symptoms. It's not uncommon for patients to need other medications during their illness to manage,English
+"those symptoms. Those include things like cortical steroids, a common one that's used as dexamethasone to control brain swelling.",English
+"Oftentimes this is needed to reduce neurologic symptoms or headaches. And then those patients who have had seizures or are thought to be a heightened risk, they're also on anti-convalescents or anti-seizure medications.",English
+And knowing what medications you're on and what you can do to manage your symptoms is critically important. And keeping an open line of communication with your healthcare team about what symptoms,English
+"about all the medication you're taking, even some of the treatments that are considered alternative.",English
+"then there's also the subject of alternative treatments, you're saying please talk to your medical providers and your care team about that. And just a reminder, in a few minutes we'll be taking questions.",English
+treatment modalities for brain tumor creations from low grade to high grade just so we know what those are as we move into research to improve those treatments?,English
+"Dr. Gilbert? >> Sure, so the first step -- sure the first step is a surgical procedure. For most of the brain tumors that we deal with the more extensive the removal of tumor",English
+"the better. Again, this needs to be done with safety in mind . So depending upon the location within the central nervous system that will dictate how safe a reception can be.",English
+"So there are areas of the brain that we call eloquent where functions such as speech, language, memory, we want to make sure that those are not compromised.",English
+">> And importantly that's true whether it's a low grade or a high-grade tumor. So you talked about differences maybe based on that, but where the tumor is in the brain",English
+"really determines the surgery even more that the grade of the tumor. >> That is correct. And so following the surgical procedure, which is used both to help with the treatment and",English
+"as I mentioned before for grade one tumors a complete removal is often curative for the other grade two, three, and four tumors. It is helpful to have an extensive recession.",English
+"But it also, very importantly, provides us the tumor tissue to make the most accurate diagnosis.",English
+"Following that, one of the foundations of treatment for most brain tumors that require additional treatment, there is radiation therapy.",English
+"Radiation therapy has evolved greatly over the last three decades. There is tremendous precision. The delivery of radiation therapy, which maximizes the delivery to the tumor and minimizes the",English
+exposure of the surrounding brain through the potential harm of the treatment. So we are very excited how much improvement there has been in radiation therapy.,English
+"There are different modalities. Typically it's external mean radiation therapy, but there are other modality such as focused radiation, like radial surgery.",English
+This is often either accompanied by or followed by some form of chemotherapy and again that is very much dependent upon the tumor type and the tumor grade.,English
+">> Sure. So thanks for reminding me. There is a device that provides fields, electromagnetic fields through the tumor called tumor-treating",English
+"So increasingly patients are considering this as an adjunct to their surgery, radiation, and chemotherapy.",English
+>> And I think importantly what this highlights is that at each step in the process a patient has a number of choices that they can make regarding their care and they also have a,English
+"tumor research? >> Well, I think the future looks very promising. As I mentioned before there is a level of international collaboration that is unprecedented.",English
+Everybody is recognizing that there needs to be a collective effort to make advancement. And so the scale scope and sophistication of our clinical trials is increasing our integration,English
+"of laboratory science, to our clinical research, and just as importantly the integration of patient outcomes measures into this research is giving us insights into what our clinical",English
+trial really mean and how to build on them in a way that's never been done before. So I'm very excited. I'm excited about the fact that we are making inroads both at the genetic level to find,English
+"targeted therapies, but also immunotherapy and looking at it in a way and using techniques to study immunotherapy that are really cutting edge and will hopefully lead to better understanding",English
+"And this is a common questions that patients come and ask us. So we have a web-based survey that we're doing with rare tumor patients in which we ask about exposures and family history, working with experts, epidemiologists from around the country,",English
+"to make patients lives better. >> Thank you. That's really appreciated and it sounds like there's so much exciting research happening,",English
+"a lot of new doors being open, and that sets up how the NCI CONNECT is really also driving research forward.",English
+And the National Brain Tumor Society is excited to partner with the NCI on the NCI CONNECT project to advance research and help patients particularly with these rare CNS tumors.,English
+Can you share a little bit more information about that new and exciting endeavor? >> Yeah absolutely this is a program which we have had funded through the Biden Cancer,English
+What is the impact of these tumors? And then focused on developing treatments for patients with these tumors. And probably most importantly we are partnering directly with advocacy organizations and with,English
+patients bringing us all together to the same table to try to understand the impact and work together to improve the lives of patients. >> So let me go through the tumor types that we have selected for the beginning of NCI-CONNECT,English
+"program. The hope is we will have opportunity to expand this as time goes on. So the NCI-CONNECT tumor types include atypical teratoid rhabdoid tumors, brainstem and midline",English
+"glioma, choroid plexus tumors, ependymoma, gliomatosis cerebri, medulloblastoma, meningioma, oligodendroglioma, pineal region tumors, pleomorphic xanthroastrocytoma, supratentorial embryonal",English
+"tumors, or PNETs, and primary CNS sarcoma or secondary CNS sarcoma also known as gliosarcoma. >> So Dr. Gilbert has read the list and I think you all were able to see that list of",English
+"tumor types. We also are sharing this through social media, through our hashtag NCI CONNECT and through out neuro-oncology branch website as well.",English
+">> Well this is very exciting. This offers up some really new research and participatory opportunities for rare, these rare CNS patients to engage with the NCI to help advance research by providing their data",English
+"but also for patients to call the NCI CONNECT program and talk about their disease. And so just taking the oligodendroglioma community, 1,500 Americans alone get oligodendroglioma",English
+"and this is a great new opportunity to get involved in a way to work together with the NCI to advance research and get help at the same time. But of course, we want our audience today to know the neuro-oncology branch is even",English
+"more than that and is an outstanding place to go for a second, third, or even fourth opinion depending on what a patient and their family is looking for.",English
+"As said before it's a free service and it really is something that few countries and certainly not every cancer type has a neuro, a branch, devoted to their type of tumor the",English
+"way we have for the neuro-oncology branch. So for our audience, the NOB as we affectionately call it is a very special place that does a great service to the brain tumor community.",English
+"Let's pivot now to our first viewer question for Dr. Armstrong and Dr. Gilbert. Not surprisingly about how brain tumors come into being, and so what progress has been",English
+"made to understand the origin or of primary brain tumors, basically how did they get there in the first place?",English
+">> So that's a great question. We are doing I think a very good job in understanding what the cell of origin is, so what cell within the central nervous system has become malignant to form the cancer, but we don't really understand",English
+"in most patients why that happened. They are uncommon enough that we don't have the types of links, like lung cancer with smoking or other environmental exposure.",English
+"But, you know, we certainly are investigating to see if there are particular patients who have some type of susceptibility and we're doing that along with our colleagues in epidemiology.",English
+">> Yeah, I think I would add to that that the person who asked this question, you're not alone in this question. Probably one of the most common things that people ask us is why did this happen to me?",English
+"And also what about my children? So, you know, in general we don't know in any individual why a tumor developed for them. It's estimated that in less than 5% of all primary brain tumors there's an inherited",English
+"condition that led to it, so most patients do not have that issue. And it's only in those folks that we then consider or concerned about their children.",English
+"So you're not alone in that question and as Dr. Gilbert said, there's many people working hard to identify it but there are very little risk factors that we have for the occurrence",English
+of brain tumors and even less is known about the rare tumors and is the reason we're doing our work. >> Thank you.,English
+"Our next viewer question is, are there any immunotherapy treatments accessible for glioblastoma patients outside of clinical trials?",English
+">> So this is a very important question and I would say to date we do not have substantial evidence that immunotherapy treatments, at least in their current form are effective.",English
+And so I would really encourage people to participate in clinical trials because that's where we will do the work to determine whether or not a treatment is effective. Some of the immunotherapies do have significant side effects and in the absence of knowing,English
+"that they work, I would be reluctant to encourage people to do things that have not been proven outside the context of a clinical trial.",English
+">> And Dr. Gilbert, just a follow up on that. What advice do you think patients and their families should consider or even ask themselves",English
+or ask their providers to assess their sense of risk benefit in deciding whether or not to enter into a clinical trial?,English
+>> So that is a great question and I think that's a very important discussion to have with your physician before you make a decision to participate in the clinical trial.,English
+"Clinical trials are very, very carefully reviewed and vetted. so that we know that we take all the possible measures to make them as safe as possible",English
+and to make sure that when we complete the clinical trial we have answered an important question about that particular treatment.,English
+So I encourage people to consider clinical trials and to realize that is the way we will advance our knowledge and ultimately develop and discover new and ineffective treatments.,English
+"So again, the safety concerns are all being carefully monitored and it's an important way to advance knowledge.",English
+">> There's some really practical questions that people may want to consider and I know the NCI, as well as the NBTS an other groups have a wonderful list of questions that may",English
+help you when you visit with your clinician and physician and ask them about at. Simple things like how often do I need to come to the hospital? And what other medications may I have to take?,English
+And how long does this treatment last? How often will MRIs be reviewed? Understanding the logistics of the treatment oftentimes can help you be prepared for what,English
+"you need to do in the future and help you be able to tolerate the treatment as you know what to expect as you go forward on a clinical trial. >> Thank you, that's very helpful information.",English
+"Our next viewer question is why are some brain tumors inoperable while others are operable? >> So it's a great question and again everything in medicine, particularly in considering a",English
+surgical procedure is a balance of risk and benefit. And so depending upon the location of the tumor within the central nervous system really does depend how operable it is.,English
+So tumors that are deep in the brain are difficult to get to and a lot of the neurologic function is in a very confined space.,English
+"So there's a higher risk of causing neurologic harm by the deep-seated tumors. Again, other areas in the bigger part of the brain, the cerebrum, some areas are actually",English
+quite amenable to surgery so what we do know is areas like the frontal lobes are particularly amenable to surgery because there's a lot of duplication of function between the right,English
+"and left frontal lobe. So it's possible for a neurosurgeon to remove quite a bit without harm, where as other areas, as I mentioned before are eloquent and there is functions that would be at risk if too",English
+"extensive of a surgical procedure. >> I think I would add to that if the tumor is in more than one area of the brain, sometimes that makes the risk of the surgery outweigh the benefit.",English
+"Or if you have other medical conditions that may make the surgeon concerned about putting you under anesthesia or the recovery time, sometimes that can also effect whether a tumor",English
+"is operable. But if you're told that your tumor is inoperable, those are important questions for you to ask so you understand what was used to make that decision.",English
+"So, and in that context in the mind-body  connection there are many areas of studies have   been established and they are flourishing, we have  mind-body medicine, we have health psychology,",English
+"all these are primarily psychoneuroimmunology,  all these areas are based on the foundation of   mind-body connection and people are trying to  understand from the diverse perspective how",English
+"mind-body interacts and what are the consequences  of it, what kinds of therapies and medications can   be developed based on these ideas. So, the modern research it is kind of",English
+"beyond doubt that there are a strong  connection between mind and body and   they are not seen as a separate functioning  entities, but is one functional unit. So,",English
+"mind and emotions are viewed as influencing the  body and as the body in turn can influence or mind   and emotions. So, this is the basic idea between  in the concept of mind-body connections.",English
+"Furthermore when we discussed the physiology  of stress in the last lecture, it was evident   how mind and body is very strongly  and closely connected to each other,",English
+"because we have seen when we experience  stress at the mind, at the mental level and   how the mental experience of stress influence our  body in so many ways and leads to the release of",English
+"various hormones and impact our bodies, various  organs of the body such as heart and other   and endocrine glands directly, because of  our mental experiences of the stress.",English
+"So, this was very evident in the discussion of,  in the last lecture particularly when we discussed   the relationship between, the biology of  the stress. Now, in terms of this mind-body",English
+"connection obviously we need to understand  the concept of psychosomatic diseases.   Now, so psychosomatic diseases are basically  physical diseases that are caused or deteriorated",English
+"by mental factors such as stress, anxiety,  depression, et cetera. So, this is, these   are category of disease where the symptoms are in  the body, but causal reasons could be in the mind,",English
+"so the idea of, basically these are two terms  one is called psychosomatic, so if you look at it   psycho is basically connected with the mind,",English
+"somatic is connected with the body,  soma is basically is body.   So, the psychosomatic diseases are basically  such diseases, where mental factors",English
+"plays very important role in terms of  expression of physical symptoms of disease.   So, researches very clearly shows this  bi-direction relationship between the body",English
+"and the mind and the psychosomatic diseases  are an expression of that relationship,   so psychosomatic diseases involve both mind and  body and it refers to physical symptoms that arise",English
+"from or influence by the mind and emotions rather  than specific organic cause such as injury.   So, there are in such diseases there may not  be very specific organic reason in the body",English
+"such as injury body or in the body parts,  but this may be caused by mental factors.   So, when we talk about psychosomatic diseases  we need to understand that also there are mental",English
+"aspects in various physical diseases. For example,   how we react to a disease whenever a  physical disease happens to your body,",English
+"how you react to that disease?  How you cope with the disease?   Can differ from person to person, so there are  mental factors associated with every physical",English
+"disease in a general sense apart from these  causal reasons in the psychosomatic diseases.   So, for example, skin diseases or rashes in the  body part can influence people particularly faces",English
+"and other body parts particularly, it can  influence our reactions very strongly and   obviously whenever we have mental illnesses it may  have physical connections to it in the sense that",English
+"certain mental illnesses such as depression people  stop eating, they stop taking care of themselves,   so this may further cause other physical  diseases or worsen the existing diseases.",English
+"So, this is a clear  bi-directional relationship, so   every physical disease has mental aspects and the  mental diseases has some physical aspect to it.   So, psychosomatic diseases, we need to understand  in that context and particularly some of the",English
+"physical diseases are very strongly connected with  the mental factors, for example skin diseases,   stomach ulcers, high blood pressure and  heart diseases. So, we will look into some",English
+"of them in more detail. So, in fact a branch of   psychological health, psychology has evolved  primarily to understand the psychosomatic",English
+"aspects of diseases and it investigates the  role of psychological factors such as stress,   emotion, beliefs, et cetera, on our physical  health and illnesses. So, we have a whole",English
+"branch of study one based on the psychosomatic  aspects of diseases and it clearly reflects how   important mental factors are in physical diseases,  particularly experience such as stress.",English
+"Now, if you look at the historical background  of psychosomatic diseases, there are some of the   important landmarks we can find, we can discuss,  so Claude Bernard in 1878 he used the term",English
+"dynamic equilibrium to understand the diseases,  so basically he says the dynamic equilibrium   is the stability or consistency of the inner  environment. So, at the physiological level",English
+"whether your body is stable, consistent or  at the equilibrium stage, so that equilibrium   basically shows your healthy state, so if  that equilibrium state is kind of disturb",English
+"such disturbances may adversely affect  our body and may cause diseases.   So, this was one of the first concept in terms of  understanding psychosomatic diseases proposed by",English
+"Barnard. Then in Walter Cannon in 1929 he used  another term called homeostasis as an extension   of dynamic equilibrium concept of Barnard,  by homeostasis he meant almost same thing.",English
+"So, basically he is talking about  the maintenance of a constant inner   condition is homeostasis. So, maintenance  of homeostasis of the body is basically",English
+"maintaining a constant inner conditions of the  body, but some experience such as stress which   may lead to fight and flight response disturbs  this homeostasis and can lead to diseases.",English
+"So, basically Barnard said that maintenance  of life is basically dependent on this   maintaining of homeostasis in our  body, so this is very crucial for",English
+"maintenance of life. So, he Hans Selye use the  term to represent this effect that stress is   the condition that disturbs that homeostasis  basically and may lead to various diseases.",English
+"Then obviously Hans Selye who did lot  of research in 60 s, 70 s on stress,   he proposed as we have already discussed  the concept of general adaptation syndrome",English
+where he described a physiological response  of the body both short term and long term   in terms of stress both acute  stress as well as chronic stress.,English
+"So, he discussed alarm stage which is more like  activation of fight and flight and activation   of the sympathetic part of autonomic nervous  system, resistance stage was associated with",English
+"release of cortisol and very other stress hormones  particularly cortisol from the HPA axis.   In the exhaustion stage was basically associated  with various diseases of adaptation, which are",English
+"particularly called as psychosomatic  diseases. So, this exhaustion stage   where people, the resistance of the body  is minimized and sometimes it may collapse",English
+"and as a result body kinds of expresses this  decrease of resistant in terms of various   diseases, which are called as psychosomatic  diseases or called as diseases of adaptation.",English
+"So, Hans Selye kinds of further elaborated on  this idea of psychosomatic diseases, recently   a whole branch of study evolved which  is called as psychoneuroimmunology,",English
+"which is in short called as PNI, it is a field  of study based on this mind-body connection   which reveals that there is a constant interaction  between our central nervous system and immune",English
+"system, obviously central nervous system is  influenced by our mental processes, so our   mental processes can influence our nervous system  which can influence the body's immune system.",English
+"So, many studies indicated that  psychological factors such as stress can   influence our central nervous system and  which in turn can influence our immune system.",English
+"So, this area of study is clearly kind of  evolving this whole idea of psychosomatic diseases   and playing very important role. So, we will  look into this particular branch of study",English
+"in more detail in the next lecture when we  will talk about stress and infectious diseases,   where we will specifically look into the  connection between stress and immune system.",English
+"Now, we have kind of tried to understand and  gave you a historical background about the   psychosomatic diseases and how stress can cause  as well as worsen the physical disease, worsen",English
+"physically diseases. Now, we will talk about what  are the pathways that can link stress and health,   what is the mechanism by which stressful  experiences can influence our physical health.",English
+"So, this is a diagrammatic representation  of mechanisms, so here you can see there   are two pathways by which stress can  influence physical health or illnesses,",English
+one is stress particularly the distress part  or the negative experiences of the stress can   directly influence our physiological  reactions of the body or physiological,English
+"mechanisms which include sympathetic  nervous system and neuroendocrine system   and we have already looked into that  part in detail in the last lecture,",English
+"stress may also influence our  immune system, this we will   discuss in more detail in the next lecture. So, by influencing our physiology particularly   nervous system, endocrine system  and immune system stress can",English
+"cause physical illnesses, this is the one pathway,  the second pathway is stress can influence our   behavioural reactions or responses  particularly our react behaviour may",English
+"change under stressful circumstances such as  changes in the health practices or lifestyles,   changes in the adherence to medical advices, so  we will look more detail into that part also.",English
+"So, many behavioural changes may be  associated with the stressful experiences,   which may further worsen the diseases. So, these  are two pathways basically that you can see,",English
+"we can, at least literature shows that through  these two pathways stress influences physical   health. So, basically more simpler form if  I show you it could be shown like this.",English
+"So, this is more simpler form by which we can   kind of understand the mechanism. So, there  are two pathways, physiological changes   and behavioural changes in response to  stress can lead to physical illnesses.",English
+"Now, stress can influence or cause both  infectious as well as non-infectious diseases,   so if you look at physical diseases  broadly we can categorize them into",English
+"infectious or communicable diseases and  non-infectious or non-communicable diseases.   So, stress can lead to both infectious and  non-infectious diseases, infectious diseases occur",English
+"due to attack from an external  agent such as bacteria viruses,   so primarily it comes from outside and it can be  transmitted from one person to another person.   Because the agents are bacteria  and viruses that can transfer from",English
+"one person to another person. So, that is why  they are also called as communicable diseases.   Non-infectious diseases on the other hand  occur primarily because of internal factors",English
+"such as wear and tear or malfunctioning in  certain organs of the body and these are not   transmitted from one person to another  person. So, therefore they are also",English
+"called as non-communicable diseases. So, basically these are some malfunctions in the   organs of the body, so we have various diseases  such as heart diseases, diabetes these are all",English
+"non-communicable or non-infectious diseases,  so flu is a probably it could be a communicable   disease because it can be caused, it  is caused by germs such as viruses.",English
+"So, stress can influence or cause both categories  of these diseases, the today's lecture we will   primarily focus on non-communicable diseases  and how stress is connected to that.",English
+"Now, it was evident that physiological response  to stress is very complex and we do not know   everything about it, but what we understand  is primarily it is done by two pathways,",English
+"one is SAM system and one is HPA system and  the both the system releases end up releasing   hormones such as adrenaline,  non-adrenaline, cortisol,",English
+"et cetera. Now, the question is this is the  physiology primary physiological mechanism.   Now, the question is, how the secretion of this  hormones or stress hormones can lead to both",English
+"infectious as well as non-infectious diseases. So,  this is the question we will try to understand,   today we will try to understand  non-infectious diseases part.",English
+"So, stress can contribute to the development  of diverse non-infectious diseases   that were earlier believed as purely physiological  in origin such as cardiovascular diseases,",English
+"so these diseases were primarily earlier  people used to think their origin is primarily   physiological or in the body, but recent  researches clearly show, such diseases can be",English
+"contributed by mental factor in a very large way,  so they are kind of psychosomatic diseases.   So, there are staggering statistics associated  with stress and the diseases particularly",English
+"non-infectious diseases for example, I  will just read out some of these findings,   so stress-related non-communicable diseases or  NCD s such as coronary heart diseases, diabetes,",English
+"coronary pulmonary diseases, Neuropsychiatric  diseases, et cetera are the major health crisis   in the 21st century, because they are major reason  for deaths related to various physical diseases,",English
+so they are causing major crisis in the 21st  century in terms of disease management.   According to the centres for disease control  and prevention CDC division of global health,English
+"protection, the NCDs or non-communicable diseases  are responsible for more than 68 percent of deaths   worldwide and 75 percent of deaths in low and  middle income countries. So, you can understand",English
+the huge impact such diseases  have in the lives of people   and they are mostly causes  by factors such as stress.   NCDs are generally preceded by  stress-related metabolic problems,English
+"such as hypertension, high cholesterol, reduce  responsiveness to insulin, so all this metabolic   changes happens by the stress and they ultimately  causes all this non-communicable diseases",English
+"particularly psychosomatic diseases, so reduced  responsiveness to insulin may lead to diabetes,   high cholesterol may lead to heart diseases,  high blood pressure lead to hyper tension,",English
+so all these are metabolic changes are caused by  stress related factors and they may further lead   to various non-communicable diseases. Stress related chronic non-communicable,English
+"diseases continue to plague primary care  practitioners resulting in enormous mortality,   morbidity and suffering and contributes to  the expanding of healthcare cost. So, they",English
+"are huge burden on the primary healthcare system  and overall disease burden of various countries,   so these are major chunk of diseases  that we all experience and interestingly",English
+"they are all influenced by maybe influence  very strongly by stress related factors.   So, let us talk now more about  specifically about cardiovascular diseases,",English
+"because this is one category of disease where  stress seems to play most important role.   So, cardiovascular system basically  includes heart, blood and blood vessels",English
+"and it is primarily regulated by autonomic  nervous system. So, now you can understand   the connection because these are regulated by  autonomic nervous system and autonomic nervous",English
+"system can be influenced by stress. So, cardiovascular diseases   are the leading cause of deaths globally and  causing an estimate of 17.9 million lives each",English
+"year, this is an statistics given by WHO in this  year only, so cardiovascular disease are really a   huge category of disease that are causing  one of the largest death globally.",English
+"So, disease related to cardiovascular  system primarily include,   coronary artery diseases, coronary heart diseases  and hypertension. So, primarily heart diseases   and hypertension or high blood pressures are  included under cardiovascular diseases.",English
+"Now, coronary heart disease   develops particularly when our heart, arteries  of the heart of the blood vessels that",English
+"supply oxygen and blood to the heart,   so the vessels that are connected to  the heart which are called as arteries,   when they become narrow due to fatty deposits  of the cholesterol in those arterial wall",English
+"and as a result blood is not able to  freely flow from the heart and to the heart   and this is called as atherosclerosis. So,",English
+"we will also look a little bit  more-deeper into that also.   So, this is the primary reasons or one of the  primary reason for heart disease that is the   blockage in the artery by the cholesterol or  fatty deposits. Hypertensions on the other",English
+"hand is basically a high blood pressure,  it is a condition in which the force of   the blood basically against the wall of the artery  generally becomes higher than the normal situation",English
+"and it can lead to heart diseases, strokes, kidney  diseases, et cetera, sometimes death also.   So, and for example the ideal blood pressure is  generally considered the normal blood pressure",English
+"is between 90 by 60 mmHg basically means  milli meter of mercury, this is the unit   of measuring blood pressure. So, 90 by 60 to 120  by 80 mmHg is the normal range of blood pressure,",English
+"anything above that is considered higher  particularly if it is 140 by 90 mmHg   or more can be considered as hypertension. So, basically these two counts are one is the top",English
+"count is basically systolic blood pressure and one  is called diastolic blood pressure. So, systolic   blood pressure is basically when heart beats you  measure the pressure of the blood and diastolic is",English
+"when heart is not beating, so 90 by 60 means one  is 90 systolic and 60 is diastolic measure.   So, how stress contributes to cardiovascular  diseases, particularly heart disease?",English
+"So, obviously the mechanisms are very  complex and it is still not very clear,   however there are many possible pathways that  have been linked with cardiovascular disease",English
+"of the person, especially to individuals with  pre-existing heart conditions or diseases.   So, one thing is very clear immediately with the  experience of stress the heart beats get faster,",English
+"especially the under the  fight and flight response,   heart beat become very erratic and faster   and when it is experienced again and again can  cause wear and tear in the system particularly",English
+"in the muscles of the heart due to repeated  fight and flight response and can cause   heart-related problems. So,  this could be one direct",English
+"mechanisms where how stress can directly  cause, heart-related issue by particularly   causing wear and tear in the system due to  repeated fight and flight responses.",English
+"Another way by which stress is connected to  heart diseases is through stress hormones,   which are released during stressful situations,  so this cortisol, epinephrine, norepinephrine,",English
+"so these are stress hormones. Now, research have  shown that this stress hormones actually promotes   atherosclerosis, so we have discussed basically  it basically means it blocks the arteries",English
+"by increasing cholesterol leve,l by increasing  the build-up of fatty patches or plaques on the   arterial wall, which leads to the  narrowing down of the artery.",English
+"So, artery is narrowed down because of built up  of plaques and fatty patches in the arterial wall.   This narrow artery decreases the blood flow  resulting in the increase of the blood pressure",English
+"this decreases the blood flow causes  less oxygen flow to the heart muscles,   which may result in chest pain which is  also called angina and heart attack.",English
+"So, stress hormones can promote atherosclerosis  which ultimately can block the arterial wall and   increase the blood pressure by decreasing the  flow of the blood and less oxygen in the heart.",English
+"So, arterial wall and how this build up can be  I will just show you how this is basically.   So, for example",English
+"let us say this is a cross sectional  the artery and this is kind of   the cross section of that arterial one, so this is  a normal arterial opening of the artery, but when",English
+atherosclerosis happens this fatty cholesterol  sort of patches kind of gets build up around this   artery and as a result the area of for the flow  of the blood decreases which further increases,English
+"the blood pressure, so this is how kind of  atherosclerosis happens in the arterial wall.   There is another symptoms which is also  connected to stress and heart disease",English
+"is called as broken heart syndrome. Now,  stress can cause broken heart syndrome   and it is more prominent among women,  following stressful or traumatic events.",English
+So according to John Hopkins medicine  website how they defined this symptom is that   the broken heart syndrome is a condition in which  intense emotional or physical stress can cause,English
+"rapid and severe heart muscle weakness, so with  the increase of the stress heart beat so fast   are particularly if it is a very traumatic highly  stressful event suddenly the heartbeat increases",English
+"so fast that it weakens the muscles of the heart  which is technically called is cardiomyopathy.   So, with stress cardi or the cardiomyopathy  we believe that heart muscle is overwhelmed",English
+"by a massive amount of adrenaline, release  of adrenaline that is suddenly produced in   response to stress, so suddenly there is a high  intensity of stress and there is too much of",English
+"stress hormone and too much of erratic movement  in the heart which can overwhelm the heart,   functioning of the heart, the precise way in  which adrenaline effects the heart is unknown.",English
+"But it may cause narrowing of the arteries that  supply the heart with blood causing a temporary   decrease in the blood flow of the heart. So, it is  possible that , that kind of shrinks temporarily",English
+"because of this erratic movements and the  effect of adrenaline and as a result, you   experience a kind of symptoms of heart attack.",English
+"Now, this broken heart symptom is in  basically a stress-induced symptom can   happen to a normal and a healthy person, so  according to the American Heart Association",English
+"website women are more likely than men  to experience sudden intense chest pain   which is basically reaction to a surge  of, sudden surge of stress hormones,",English
+"it could be due to death of a loved one's,  suddenly you hear about such traumatic events   or even a divorce, break up or physical  separation, betrayal or romantic rejection,",English
+"these are some of the traumatic events  for example in response to such events   broken heart syndrome can happen because these  are very traumatic and stressful event.   Sometimes it could even happen after a good  shock, suddenly winning a lottery, so it can also",English
+"overwhelm your physiological response. So, broken  heart syndrome may be misdiagnosed as a heart   attack, so it is not exactly heart attack, because  the symptom is very similar to heart attack,",English
+"but in heart attack happens primarily because  of blockage of the artery by the cholesterols   another plaques. So, generally it happens due to  blockage of the artery, but broken heart symptoms",English
+"may not be connected with the blockage, but it may  happen suddenly. So, it can happen to a healthy   person in response to a highly traumatic event. Now, another important connection between",English
+"stress and heart diseases is the  connection between stress and cholesterol.   Now, stress can increase bad cholesterol, so  there are two types of cholesterol one is called",English
+"as bad cholesterol and another is called as good  cholesterol you, so bad cholesterol is basically,   called as LDL or low density lipoproteins",English
+"and good cholesterols are called as  high density lipoproteins or HDL.   So, stress can increase the bad cholesterol  level of the body directly or indirectly through",English
+"directly by stimulating production in the body  or indirectly through unhealthy behaviours,   such as , eating unhealthy foods. So, for example  there are many empirical evidences to that",English
+"a study by Catalina Romero et al and his  colleagues in 2013 they collected data from   more than 91,000 participants and  found a positive correlation between",English
+"those who experienced high job stress and  bad cholesterol level in their body.   So, those who have experienced higher stress in  their life their blood cholesterol is particularly",English
+the bad cholesterol level in their blood was  much higher than the people who experienced   less stress. Another study  by Assadi 2017 found that,English
+"psychological stress can lead to  higher levels of bad cholesterol   which are basically low density lipoproteins and  decrease good cholesterol, so it can functions in",English
+"both ways by increasing bad cholesterol level  and decreasing good cholesterol level.   Now, stress hormones such as adrenaline and  cortisol can trigger the production of cholesterol",English
+"which is basically cholesterol is a kind of  waxy and fatty substance produced by the liver   and it is produced primarily to give you extra  energy during the stressful circumstances, however",English
+when it is released too much because of excessive  stress experiences there may be too much of excess   cholesterol on excess energy when it is not  used may get accumulated in the body as fats and,English
+"excess cholesterol can clog the arteries or  block the arteries and basically it can cause   to atherosclerosis and which ultimately cause,  may cause heart disease or heart attacks.",English
+"So, this is one basically direct mechanism and  obviously another way is stress can induce various   behavioural changes particularly eating behaviours  and eating of unhealthy foods such as carbohydrate",English
+"which may further increase cholesterol level  in the body. So, through this mechanism stress   can influence your cholesterol level in the body  which particularly the bad cholesterol, which can",English
+"then further lead to heart disease.   Another important connection between stress and  heart diseases is through personality traits,",English
+"two researcher or heart doctors named Friedman and  Rosenman in 1974, they suggested that people with   certain personality, characteristics or traits are  more predisposed or more vulnerable to suffer from",English
+"stress then other people, because there are  different characteristics of personality.   So, consequently they are more likely to have  heart disease because they are more likely to",English
+"experience stress in their life, so in that  context they identified two personality traits one   is called as type A people and type B people, so  type A personality trait type B personality.",English
+"do you need to win in order to derive enjoyment  from game and sports do you always need to win to   derive enjoyment, do you generally move, walk and  eat rapidly, do you often try to do more than one",English
+"thing at a time, so these are some of the sample  questions obviously, it had many more questions   and they ask such questions and if your answer is  yes to this kind of questions, you are more likely",English
+"to be type A personality. What happens what  are the characteristics of type A people.   So, they found that type A people they show  excessive competitiveness and achievement",English
+"orientation which lead to extreme self-criticism  they also criticize themselves too much,   they have excessive competitiveness in their mind  and they are highly achievement-oriented people,",English
+"they have an exaggerated sense of time urgency,   which leads to constant struggle against the  clock and the compulsion to try to do more than   one thing at a time, so time urgency excessive  competitiveness, achievement orientation.",English
+"Then the third factor is anger hostility  that may or may not be openly expressed.   So, these are the three important or the  prime characteristics of type A people",English
+"and type B people show opposite characteristics.  Basically, they are very easy going and much less   demanding of self and others and they do not  have exaggerated sense of time urgency.",English
+"So, type B people are more relaxed  kind of people, type A people   because of this nature they are more likely  to be stressed most of the time in their life.   So, these are two different types of people  there is nothing wrong in being type A or type B",English
+"these are only different types of people  different psychological makeup.   So, this Freidman and Rosenman conducted  a longitudinal study which basically means",English
+studying a group of people over a period of time.   For eight and half years with a sample of 3524  men which were aged between 39 to 59 years,English
+"and they found that type A individuals were twice  as likely to develop coronary heart disease,   then type B individuals, primarily due to higher  physiological reactivity of type A people then",English
+"type B people. So, the type A characteristics  makes these people more vulnerable for heart   diseases primarily because of their psychological  makeup they are more likely to experience stress",English
+"Now there are a couple of other things, and this I want you to understand at a conceptual level that malignant neoplasms",English
+may be associated with some very significant systemic changes. One of them that you may be familiar with from from familial,English
+"experience or friends, or friends of friends, is that frequently cancer patients will enter",English
+"a phase of disease where they lose their appetites, they begin to lose weight, the weight comes piling off them",English
+"and they get weaker and weaker and weaker and just dwindle and very often, end up so weak that they are bedfast and then the final event in their lives is pneumonia",English
+which typically will overtake a bedfast patient like that. We refer to that sort of wasting syndrome as cachexia there's the spelling for it,English
+"that's a general term, but here we're talking about cancer cachexia we're talking about a patient becoming emaciated and wasted because of a cancer being there. When i was a kid in Pathology, we used to teach that this was simply a caloric matter,",English
+"we had a rapidly growing tumor which is eating up calories, competing with the host, the host lost the appetite along the way and that was that.",English
+We just lost weight on behalf of the tumor. We now know that that's only a small part of the story and this is a rather complex business related undoubtedly to cytokine,English
+"secretion on the part of the tumor as it grows. But be aware that very often in patients with cancer, you see this syndrome of cachexia",English
+"There are also and this is an important general concept, I don't want you to get lost in the specifics, but there are other symptom complexes, that is syndromes, in patients",English
+"with cancer that you cannot explain by local effects, mechanical effects, that you can't",English
+"that they're not explainable on the basis of a predictable endocrine secretion, in other words it's not that this is a cancer that we know",English
+is making insulin and therefore you're getting insulin symptoms. It's not that. We find some,English
+very weird syndromes affecting a variety of organ systems that are due to the presence,English
+"of the cancer, not mechanically, but the presence of the cancer in the body and these are referred to as paraneoplastic syndromes,",English
+"and i want you to get an idea of that concept, not the details of the various syndromes. They're important because first of all they may be a greater problem to the patient than the mechanical",English
+aspect of the tumor itself. Another thing is that the patient may present with the manifestations of a particular paraneoplastic syndrome,English
+"at the time the cancer is still occult, and it behooves you to be able to recognize that oh my goodness this mixture of symptoms may mean whatever.",English
+"I'll give you just a couple of examples along with the rest of your skimming reading, don't try to memorize any of this stuff but one of the commonest paraneoplastic syndromes is hypercalcemia, elevation in blood calcium,",English
+"Now you might think, if you're thinking mechanically, well cancer is spreading to the bone and will destroy bone and liberate calcium. That happens, but that's not",English
+"a paraneoplastic syndrome, that's the mechanical effect, but some tumors will secrete a parathyroid like hormone, in other words they're not related to parathyroid glands of a tumor of this or that",English
+"but it secretes something that has a parathyroid hormone like activity and raises the serum calcium. That's not at all uncommon,",English
+other examples of paraneoplastic syndromes are from what we call ectopic hormone production where a particular tumor is producing,English
+"a hormone that has no business coming from there. We see for instance lung tumors that produce corticotropin,",English
+"in other words, a pituitary hormone that drives the adrenal gland, and this may produce all kinds of hell because",English
+the adrenal is overactive because of that ectopic hormone production. Some tumors provoke hypercoagulability,English
+"in other words, make the blood more likely to clot, you're going to study that in December, but suffice it to say",English
+"I have seen patients that present with deep leg vein clots, you know spontaneously, it's unusual with ambulatory patients,",English
+"but they come in with clots in their leg veins and after all the dust settles it turns out they've got an internal cancer, pancreatic cancer and ovarian cancer and what have you.",English
+It's due to pro-coagulant substances associated with the tumor. Now I'll drop it,English
+"at this and I'd suggest that you take a look at the appropriate pages in the book and just to see the variety of paraneoplastic syndromes, don't try and memorize it.",English
+"Just be aware of that general concept of paraneoplastic syndromes. All right, one more matter before a quick picture show. As a matter of",English
+"nomenclature of neoplasms. I want to emphasize that this is not a trivial matter, it may seem trivial to you, Name the Tumor, so what?",English
+This is very important because if we name a tumor precisely and accurately,English
+"it transmits a lot of information, in other words, as you learn more about oncology, if someone says it's such and such kind of tumor this'll bring up a",English
+little rolodex card of a whole bunch of information. So it's important to be precise in the terminology and you've got to become familiar,English
+"with this, it's just gotta be a reflex for you, you'll use it throughout your career. The time to learn it is right now because it's going to be on your exam this weekend.",English
+"I promise you, it's that important. What I want you to be able to do is take the description of a neoplasm",English
+"and you don't even need the picture, just take a description of it, say OK, with those elements, this is exactly how I'm going to name it.",English
+"You should be able to do this after you leave the room today, but certainly by this weekend and it's very important to you throughout your career. There's a",English
+"table in your book, I think on page 273 if I'm not wrong that shows you a benign this and a malignant counterpart, benign this and a malignant counterpart, and so forth, I don't want you to memorize that.",English
+Spend thirty seconds with that chart and it will give you an idea of how we go about naming things.,English
+"Now basically it's not rocket science, we name tumors on the basis of two things, the tissue of origin,",English
+"and whether it's benign or malignant. In other words, by looking at the neoplasm, and you'll be able to do this this coming spring, you'll be able to decide",English
+its histogenesis what tissue it springs from. That's an important part of the name,English
+"and you'll see this in just a moment and depending on whether it's benign or malignant, we tack on a different suffix and kind of make a compound word",English
+transmits an awful lot of information. So learn how to do this. Now let's dive right in.,English
+"And talk about first of all epithelial neoplasms. Now again the epithelium, you're going to become very familiar with this, is a sort of tissue",English
+"that covers a surface like the epidermis that lines the mouth, or the GI tract, that lines cavities",English
+"by convention we consider liver tissue to be epithelial. Kidney tissue the tubules in particular, to be epithelial and so forth.",English
+"So we're talking about epithelial neoplasms. Now the plot thickens a little bit, there are different kinds of epithelia as you will learn,",English
+"there are glandular epithelia, there are non-glandular epithelia, there's something we call transitional epithelium, etcetera Don't worry about it.",English
+"But concentrate first on glandular epithelia, in other words, these are from structures we're talking about tumors",English
+that arise from epithelial structures that are glandular or tubular or ductal those are those what we call glandular type. The root adeno,English
+"means gland and the suffix oma refers to a mass. By convention, if we have a benign neoplasm of glandular",English
+"epithelium, it is an adenoma. That alone transmits transmits a lot of information, that says to your listener",English
+"if you name something an adenoma, well, it's epithelial, it is in the connective tissue tumor, it's in the epithelial tumor and it's glandular and it's benign.",English
+Good enough? Let's show you some adenomas. This is a cut through the adrenal gland.,English
+"Now the adrenal gland sits deep in the fat above the kidney, way in here few inches in here it's about that big normally,",English
+"and what I've done here is cut through the adrenal gland. This is a cut through the normal gland, the yellow part of the",English
+sandwich is the cortex that makes various steroid hormones and this is the medulla that makes catecholamines like epinephrine,English
+"and so forth right in that dark spot. Now here we have a neoplasm. First of all,",English
+"it's very well circumscribed, it's just shelled out of there. Well it's probably benign, it doesn't look invasive. I can tell you that under the microscope this was perfectly differentiated.",English
+"I mean cell for cell, although they were arranged a little differently, they look like the cells here. You can get a hint of that in that it's the same yellow sort of stuff",English
+comprising of which this is made. So this is an adenoma arising from,English
+"the adrenal cortex, so we call it, give it the whole name, call it the adrenal cortical adenoma. Now the question",English
+"is well how did that patient come in? He didn't say Doc, I've got a walnut sized mass in my suprarenal fat pad",English
+"It's obviously buried in there and no way to feel it the way this presented was because it was making an excess of hormone, in other words, this was a patient who was going on in her life",English
+"and developed a series of symptoms in this particular case, and I can't tell from looking at this, I know the history, this tumor was making gobs and gobs",English
+"of aldosterone. The patient came in with, I won't bore you with it, a syndrome relating to blood pressure and changes in certain serum electrolytes and so forth",English
+"and the smart physician said OH! put these things together, something is making too much of an adrenal cortical hormone",English
+"and then it's simply a matter of imaging, finding out which side, out it comes, and you've got a cure. because that's perfectly benign, very well differentiated.",English
+"Here's one for you, have to explain this a little bit, this is a pancreas that has been sliced in two halves that are looking at you. This is what normal pancreas parenchyma looks like",English
+It's a lobular glandular tissue. Here's a marble! Very well circumscribed marble in the middle,English
+"This was benign. You can't tell that by looking at it exactly, but it's benign and it arose from the",English
+"islets of Langerhans. Now, with that in mind, how do you suppose this patient presented?",English
+"Again, that's a little marble in the pancreas, sitting way in there, how did that patient present or why? Hypoglycemia!",English
+"In other words, that tumor was producing insulin without regard to the needs of the body. These patients",English
+"there are variations on this syndrome, but if they had not just eaten, their insulin level is high, the serum glucose goes down,",English
+you get a variety of symptoms all the way to convulsions and coma. That's the most dramatic part of this. A cure is effected,English
+"by removing that sort of thing. All right here's another sort of adenoma, and we're going to talk about this in detail this afternoon",English
+"so I'm not going to belabor it now, but this is an adenoma arising from the lining of the colon which is a glandular lining",English
+"and it's benign, well circumscribed, non-invasive thing so this is a colonic adenoma.",English
+"It's sort of growing on a stem here, this is normal colonic mucosa sort of pulled out what would be another name for that? Anyone know?",English
+"Right, polyp. Sure. But I warn you you got to be precise, because the term polyp is a topographical term",English
+"Anything that hangs like a dingle berry off of a mucosal surface is a polyp. Now some polyps are in fact neoplasms like this one,",English
+"but some are simply inflammatory masses. Some of you who have nasal allergies may have been told that you have nasal polyps. It's things that sorta look like that up there, but they're not neoplasms",English
+they're just bags of edema fluid and a few inflammatory cells. So anything that is so anything else,English
+"off on the surface you call a polyp, well yeah that's a polyp, but there are other kinds of polyps in the colon they're not all adenomas.",English
+"So if you want to be precise, you could say this is an adenomatous polyp, or simply a polyp. Some of them grow on stems like that,",English
+we call that a pedunculated adenoma some of them are attached to the surface,English
+"without much of a stem, there are a couple of little adenomas that just budding right off the surface. These things are generally",English
+"asymptomatic. It would take a helluva lot, a big adenoma, to produce any symptoms. Occasionally",English
+"they're associated with a little occult bleeding, but basically they're hidden there. The significance is that some of these",English
+"given enough time, turn into cancer. That's going to be the theme of our presentation this afternoon, so i won't belabor it at this point.",English
+"All right, what about, and you can go back on that chart i gave you, the next step down on the left side, benign, non-glandular epithelia. This is a cartoon",English
+"of a benign neoplasm of the lining of the bladder, it happens to be what we call transitional epithelium. Very often these sorts of things grow out and I think",English
+"that this does a good job as a series of finger like projections, sort of pointing at you,",English
+and each one of these is a bit of stromal covered by a layer of neoplastic transitional epithelium and we refer to these finger like projections as papillae,English
+so this becomes a papilloma. This is a transitional epithelium it's a transitional cell papilloma,English
+"And these can be asymptomatic or these papillae can break off break off a little bit and then you get some blood in the urine, hematuria I'll show you a real life papilloma",English
+"These little things, these things presents as very tiny bumps very often in the oral mucosa or the back or the oro-pharynx",English
+"this was one of them, it's about the size of a pea this is the normal squamois epithelium lining the oro-pharynx and what this is a series of these finger like projections growing",English
+"out of this epithelium we don't see the precise point of attachment, and each one of these is a little finger cutting cross-section covered by this squamous epithelium",English
+perfectly benign so this would be called a squamous cell papilloma These are well the variation in this scheme is a common,English
+wart and there are all sorts of variations in this generally caused by one or another strain of the human papilloma virus (HPV),English
+you'll hear about this constantly. But there is a papilloma. Now one other variation on this theme,English
+that if you get a neoplasm of glandular epithelium that grows in bubbles in other words the neoplastic epithelium lines the,English
+"inner aspect of holes which we call cysts, technically a cyst is a hollow space filled with fluid, lined with an epithelium",English
+and there are some that grow as collections of multiple bubbles or cysts and lined by this neoplastic glandular epithelium and a good,English
+example of this is a but I think fairly common benign neoplasm we've seen in the ovary,English
+we call these things because they are multiple cysts we call these cyst one-word cystadenoma,English
+"and here's what it would look like, I don't have a scale on there normal ovaries are about the size of a",English
+"well you know small nut, this thing was about the size of a football they can get big",English
+"the enormity of this would be suggested by the fact that the surface is perfectly smooth. I mean, whatever there is, it's orderly and it's lining",English
+that surface is perfectly smooth cut into the thing you see a cystic character,English
+these were filled with a mucinous material which we washed away but there's a cyst and that's lined by,English
+benign glandular epithelium there and there and there and so forth many little daughter cysts so that is an ovarian cystadenoma,English
+see how we built the names? with that much in mind we go to the next step and say what about,English
+"malignant counterparts? Now the rule here is if you have an epithelial neoplasm of any sort, and it",English
+"is malignant it is a carcinoma so if the word carcinoma appears as any part of the name, you say",English
+"to yourself, gee this is epithelial and it is malignant transmit a lot of information with that",English
+"then you add compound parts of it, if it gets a glandular malignancy",English
+"what do you suppose you'd call it? Adeno carcinoma If it's a squamous malignancy,",English
+"squamous cell carcinoma et cetera and then you can throw on, you'll see in our reports all sorts of things",English
+"moderately well differentiated mucin secreting adenocarcinoma Let's put on some frosting on the cake, but the",English
+basic thing is that tells you that it is glandular and that it is malignant. So I'll show you some carcinomas quickly,English
+"by this I'll give you another few words, these are all words you learn to live with, we would refer to a neoplasm that has grown out like a mushroom here",English
+"we talk about it as fungating -- fungus -- fungating Well, I don't want to give you a generic answer, but some cysts",English
+are not neoplasms that you get for instance a ductal structure and something is secreting into it,English
+"and it's obstructed here, it'll become cystically dilated, it'll form a cyst. Other cysts just happen to be the way they are because they're neoplasms, OK?",English
+"Well, at any rate, getting back into this, this is a fungating neoplasm Another word we use is exophytic (exo meaning outward, phytic, growing outward)",English
+"Well this is partly fungating, but this was infiltrating deeply this is a highly malignant neoplasm even though it's pretty well differentiated. and this is present in the inguinal lymph nodes at the time",English
+that this happened. The covering of the glans is squamous epithelium this was a squamous cell carcinoma,English
+"now this illustrates something you'll learn it is not uncommon that people have a great sense of denial, this thing didn't show up the Thursday night before he came into the doctor",English
+"this has been there many months and people have all sorts of ways of explaining these things away and denying them, hoping they're not there tomorrow morning",English
+"when they shower, and so forth. but that's a highly advanced lesion. Here's for the other half. Now this one",English
+is also a squamous cell carcinoma the labia are covered by squamous epithelium And there it is. Now that was sensed by the patient,English
+as a sore store there that didn't heal it wasn't the mass that was exophytic but this thing penetrated in,English
+about a centimeter or two and it was also present in the inguinal lymph nodes on that side. on that side,English
+when the cell carcinoma here's one that we don't see much anymore and i hope you never see one like this. This is a cervix,English
+tubes and ovaries over here and vagina here. And what should have been a nice cervix here is completely destroyed,English
+by this very very advanced square cell carcinoma. The face of the cervix that just into the,English
+"vagina is covered by squamous epithelium so many of these cancers are squamous, but remember I showed you the endocervix the other day that also has glandular",English
+lines so we do see some adenocarcinomas there but these are basically provoked by a number of strains of the human papillomavirus,English
+"it's a transmissible virus and this is one of the bad outcomes Now, I say that I hope you'll never see, and you'll probably never see one quite this advanced",English
+if you practice in this country because of the widespread use of pap smears. We discussed that last time you can apprehend this sort of thing when it's still in the insitol stage or even earlier,English
+with dysplasia you don't have to wait for this when this woman already had a follow bloody discharge because of this terrible neoplasm.,English
+"Well let's go back to the GI (gastrointestinal) tract. Up in the upper aerodigestive tract, the tongue, the lining of the mouth, the back of the throat, the larynx, and so forth.",English
+We commonly see squamous cell carcinomas. This is a tongue that's been amputated and cut sagittally and you can,English
+"see this very deeply invasive mass, this was a squamous cell carcinoma arising out here. These oral",English
+"pharyngeal cancers are mostly related to smoking and drinking. So, histologically this might look identical to the thing in the cervix but it's got a",English
+different etiology and a different behavior but this was a very deeply invasive squamous call carcinoma.,English
+"here's another one. This is a heavy smoker. This is a larynx, opened in the back, so the",English
+adam's apple is sort of the front. When I spread it open there's a deeply ulcerating tumor there this may have been around for months and months and months and months.,English
+"At first, cancers don't necessarily cause pain, you know, unless they infiltrate nerves they are not going to cause much pain. This guy had irritative cough and his voice changed, as you can imagine the",English
+"vocal cords were gradually being destroyed. But, you know, heavy smokers are used to being hoarse and coughing and so forth and again the denial kicks in",English
+"and this was a long, neglected squamous cell carcinoma of the larynx. Taking it down the esophagus now, the mouth is up there,",English
+"this is the esophagus coming down and the stomach here, and you can see we've opened it up and there is this roughened area and at the cut surface area you can see that the wall is thickened.",English
+"This is a very advanced carcinoma. The lining of the esophagus is squamous and this was a squamous cell carcinoma. These, as you can imagine, will produce some mechanical problems,",English
+"patients will have trouble swallowing and there again, i've seen patients come in, and strain baby food before they finally say 'uncle' and decide",English
+"that something might be wrong. These are very hard to cure because of the fact that they are advanced in their local metastases, if not distant metastases, we can also see",English
+"adenocarcinomas in the esophagus because there are some glandular epithelium there that can also give rise to it. Now if you look at that, I tell you this is a stomach has been opened and",English
+"washed. There is the esophagus up there, this is the duodenum, coming off over here. If you at that for a while at first you might say, 'well nothing wrong with that' but you'll",English
+"notice that the normal fold pattern is ironed out here. It doesn't look so awful at first blush, but that is a diffusely infiltrated carcinoma.",English
+"what kind do you suppose it is, given that the stomach is a glandular lining? Adenocarcinoma.",English
+"These things are very subtle and asymptomatic until they are very advanced, this was very advanced, this was metastatic in the liver already at the time it came.",English
+"So they may have produce early symptoms at all, and an interesting wrinkle here is the incidence of this kind of tumor is very high in Japan, much higher than here,",English
+and it's largely an environmental thing because the descendants of Japanese who come here pick up our other yankee problems. that this incident changes. But it's such a public health problem in Japan,English
+"that they will screen for this sort of thing because, nothing like this is going to produce symptoms early on. So the only hope of getting it earlier is played by population screening and",English
+"that's that's another matter for another time. Here's one that will anticipate this afternoon, getting down to the large intestine.",English
+"This is actually in the first part of a large intestine over here, right where the small intestine enters, where the appendix comes off, this is the so called cecum and it's about",English
+three-four inches in diameter and there's a huge fungating neoplasm there and it's a glandular lining so it's an adenocarcinoma.,English
+"Now, in terms of clinical presentation, this thing isn't, as big as it is, is doesn't obstruct something that big so the",English
+"intestinal contents keep passing by. Doesn't cause any pain One things that happens with these is that they bleed. you know the passing traffic will erode the surface and they'll bleed,",English
+"they'll lose blood. Now this is about three feet from the anus. The colon goes up here, across here, down here, does a little bit of a loop, and goes out.",English
+"The fact is, by the time the blood goes from there to the anus, it's no longer red, it's black. The patient will be passing stools, I mean if he is losing enough blood,",English
+"will be passing stools that perhaps look tarry. That's the epithet given to them. Something we call melena, learn that word if you don't know it,",English
+"m-e-l-e-n-a, means black, tarry stool and patients will come in, in a couple of ways with this they may say,",English
+"elderly patient that comes in and says, ""I'm just pooped all time."" And you know describes being easily fatigued and weak and so forth, you take a look and they look kind of pale, and you do a hemoglobin,",English
+and you find they are terrible anemic. It's from chronic blood loss like this. Colonic cancers on the right side are notorious for that.,English
+"You can get cancers all through the colon, this is one very close to the anus, which encircles the whole bowel now like a napkin ring. And will actually produce narrowing in the lumen, obviously has infiltrated the muscle of the",English
+"wall and that will produce a change in bowel habits. Or, it will produce frank blood in the stool because it is close enough to the anus that if it bleeds it is going to come out blood.",English
+"that's referred to as hematochezia. H-e-m-a-t-o-c-h-e-z-i-a. Hemato meaning blood, chezia is a wonderful Greek word meaning to go potty,",English
+"roughly. So, hematochezia is frank blood in the stool which may be that, and again, people",English
+"deny this is, they say 'oh, I've got hemorrhoids' and they buy preparation H and stick it up there for however long before they finally come in.",English
+"The important thing is, as we'll also point out this afternoon it, the survival and the prognosis is stage related. How far has it penetrated through the bowel wall, is it in the regional lymph nodes,",English
+"and so forth. These are the important factors. All right, couple of smokers things,",English
+"you can see about fifty pack years of stuff in that lung, and here is a mass obstructing a bronchus",English
+"here, and this is the dilated bronchus full of muco purulent exudate. Now, that's the tumor right there, and this",English
+"patient presented, he probably had a cough but all smoker's cough, presented with repeated pneumonia, kept coming with episodes of pneumonia,",English
+and it was always in the same place. And they finally tumbled to the fact that he must have an obstructive lesion there. and there it was.,English
+"Now, the bronchus is lined by a glandular type of epithelium so there are adenocarcinomas involved. But, notoriously there can be metaplasia of the broncos that goes on to display",English
+not only metaplasia but dysplasia human cancer and many of these are squamous cell carcinomas. So there is a relatively small one that produced,English
+repeated bouts of pneumonia. There's a larger one just to show you what they could look like when they really get out of hand.,English
+"Here's an interesting one, close up here trachea coming down here bronchus here, bronchus here you see this little thing this was a",English
+"squamous cell carcinoma and you say well why didn't they simply doing pneumectomy? Take off the bronchus here, you can live with one lung. Well, I'm doing a trick here. This is an autopsy specimen,",English
+"and actually this thing that looks small here had gone through the back of the bronchus. This is all neoplasm, kind of encased the heart. It was hopeless from",English
+"the get go. A squamous cell carcinoma. All right, cystadenoma was the benign one. The nice smooth surface and inside the cysts were lined with a nice smooth epithelium",English
+"Here's the malignant counterpart. You can see this time, this is another ovarian neoplasm. It's malignant so we call it cystadenocarcinoma.",English
+"Not cystadenoma, but cystadenocarcinoma. The thing that would immediately tip us to say this isn't just a simple cystadenoma",English
+"is the surface is no longer smooth like this everywhere, it's got very furry looking growth all over the surface.",English
+"The bubbles inside are filled with neoplasm growing from the lining of each bubble. In other words, you can see some bubbles or some cystic spaces",English
+but many of the previously cystic spaces are filled with this rapidly growing neoplasm. so this is cystadenocarcinoma. I don't have an illustration of it but you can imagine a papillary tumor,English
+"being a papillary carcinoma. You can have the papilloma, or a papillary carcinoma. So learn to handle these",English
+"nomenclature here. As i say, quite quite played by reflex. Now, let's switch",English
+to that but I'll my long beard and say it takes a lot of experience. Under the microscope you would see not only growth of these fingers but you'd see invasion.,English
+"You'd also see more anaplasia in you know, cytologically,it's a combination of things. That's a very good point. And sometimes it's and it's a devilish problem we see a lot of stuff growing",English
+"out we've got to make multiple sections and see if any of it's invading. Now getting away from epithelium, getting to non-epithelial tissues, what we call",English
+"supporting tissue or mesenchymal tissues, like fat, fibrous tissue, smooth muscle, skeletal muscle, bone, cartilage, those are the things we're",English
+talking about. The nomenclature becomes easy if you know a little Latin and Greek. If you have a,English
+"benign tumor of fatty tissue, adipose tissue, we call it a lipoma. Lipoma. If you have benign neoplasm of cartilaginous tissue, chondroma.",English
+"Benign neoplasm of fibrous tissue, fibroma. Etcetera, etcetera. As they say, you have to know a little latin and greek.",English
+The system here is if it's malignant we don't call it carcinoma because that's epithelial if it's malignant and of a mesenchymal or supporting tissue we call it a,English
+"sarcoma. You've all heard these words but now you have to use them precisely. So, a malignant neoplasm of fatty tissue is a liposarcoma.",English
+A malignant neoplasm of cartilaginous tissue is a chondrosarcoma. and so forth.,English
+"The interesting thing about these is they're not organ specific as many organs have smooth muscle in the wall, many organs have cartilage. many places in the body have bone, and many,",English
+"everything, in the body practically has fibrous tissue so you can see these tumors arising in a variety of places. Here's a strange one.",English
+"This is an incidental autopsy finding. This guy died of something completely different and had no GI problems. This is a little piece of colon, I've opened it up here. Mucous membrane here and here.",English
+"And you look at that you say that's a wad of fatty tissue. About the size of a big golf ball. Histologically, that was perfectly well differentiated. I couldn't tell it from",English
+normal fat cells in the center of that. That's just a big glob of adipose tissue. That's a lipoma. They do occur in the,English
+"inner coats of the bowel, but it's quite rare. Where do you suppose lipomas are more common? Well, where there's a lot of fatty tissue.",English
+"They're very common subcutaneously. There may be some lipomas in this room, I could show you at least one. They're not at all uncommon and they're perfectly trivial",English
+"on the whole. Even this big honker didn't produce any symptoms. Alright, the uterus. Here's a uterus and each one of these is what you would call a fibroid",English
+"but now I will give you the correct nomenclature these tumors are benign, they arise from the muscle of the uterus so they are myomas. M-y-o meaning muscle",English
+"and because the particular kind of muscle, which you learn about is smooth muscle this is a, these are multiple",English
+"leiomyomas. You with me and the nomenclature? These can produce a variety of mechanical systems hypermenorrhea,",English
+a big bulk in the pelvis as you imagine and some of the many of them are asymptomatic. Even at this size believe it or not.,English
+"Here is a malignancy of bone. Now, here's the x-ray. You can see what the bone should look like. It's very dense in here. There's obviously more",English
+"bone being made. The outer membrane, the periosteum of the bone has been lifted by something pushing out and here it is.",English
+Here is the the bone forming tumor here that has broken through the cortex and is out into the soft tissues so this is a sarcoma of bone.,English
+"Osteosarcoma. This is by and large a tumor just in passing of growing bones. Teenage kids, young adults.",English
+"Highly malignant, tends to metastasize early on to the lungs. Nothing is immune. Here is a tumor rising in the soft-tissue of the thigh.",English
+"A very fleshy looking tumor. It's derived from the skeletal muscle, myosarcoma, but this time it isn't leio, it's rhabdo.",English
+"You'll learn these details. But, you should be able look at a name like that and say, 'Oh, this is a supporting tissue neoplasm of some sort.'",English
+of other bone and so forth. There are a lot of nice fancy things they could do now so it's nowhere near as dismal as it used to be but it's a highly,English
+"aggressive tumor. Alright, quickly now, another kind of neoplasm. We talked about epithelial tissue, we talked about",English
+supporting or mesenchymal tissues. There are neoplasms of the lymphoid tissues and by hematopoietic I mean blood forming tissues.,English
+There are neoplasms of these and here is where you get into some icky terminology. Neoplasms of the lymphoid tissues are referred to as lymphomas.,English
+"And you would say, 'well that sounds benign.' There's not nice benign neoplasm of lymphocytes. There's no such thing as a benign lymphoma.",English
+"We don't recognize them. If there are, we don't recognize them. So when you hear the word lymphoma, despite what it sounds like",English
+"that's a malignant neoplasm of lymphoid tissue. Similarly, well i'll get to this, but leukemia refers to any situation really,",English
+"where the malignant cells, and they're usually blood forming cells, are out on mass in the circulation. We refer to that as leukemia, white blood.",English
+"The old German was 'weiß blut' was the way that it was described. Alright, lymphomas are interesting, they may present as seemingly localized tumors with some local spread",English
+"but because lymphocytes, there's lymphoid tissue all of the body and lymphocytes you'll learn move around the body lymphomas frequently present as systemic diseases,",English
+"rather than localized. Sometimes localized, but very often systemic. This man came in, this is an old, old photograph,",English
+and you see general swelling in his neck here you can see here's his classical he's got a supraclavicular node there. He's got another supraclavicular node there.,English
+"He noticed those, but his armpits were full of enlarged lymph nodes. By chest x-ray his mediastinum was widened and full of lymph nodes. His abdomen was full of enlarged lymph nodes.",English
+He presented with a systemic disease. This was a widely disseminated lymphoma.,English
+"Lymphoma can afflict many lymphoid tissues in the body this is the retroperitoneum. Here's a kidney, in other words you're behind the peritoneal cavity.",English
+"This is a mass of lymph nodes enlarged, they should be at the most pea sized and these are very big lymph nodes all matted together, this was malignant lymphoma in the retroperitoneum.",English
+"Spleen studded with nodules of malignant lymphocytes, if you will. Lymphoma of the spleen. Even the kidneys, any organ can be infiltrated by lymphoma cells.",English
+"Sometimes the marrow, the bone marrow is overrun and the malignant lymphocytes spill in great numbers into the bloodstream. Then you have a lymphocytic form of leukemia.",English
+"Now, generically leukemia refers to the presence of malignant hematopoietic or lymphoid elements in the circulation.",English
+"So we see other forms of leukemia where the marrow, just the bone marrow itself has gone bad and you see malignant precursors of leukocytes,",English
+"Possibly red cells little bit more rarely, or even platelets so it's malignancy of the marrow tissue with circulating, widely circulating malignant cells, infiltration of organs, and so forth.",English
+"because you want to preserve as much function of the brain as possible. So, this tumor was coming right here. My suspicion, once again, is that this was a non-cancerous tumor",English
+"that we could potentially achieve a cure on this patient. So, we ended up taking the patient to the operating room, and you remember this gigantic tumor in the anterior cranial fascia,",English
+"and it's completely gone and cured. We were able to achieve a cure on this patient. Years later, we have followed her, and her personality has come back to normal.",English
+"Olfaction, unfortunately, was gone because all the olfactory nerves that were in this area were invaded by this tumor",English
+"that was not cancerous in nature, but nonetheless, they were so thin and so damaged that there was no possible way to dissect them away. So, we were able to achieve a cure",English
+"on this tumor, and the final pathology ended up being a meningioma. Let me show you another tumor that is thought to be non-cancerous in nature.",English
+"This is what we call a pituitary giant adenoma. Pituitary adenomas are not thought to be cancers because they don't invade the brain,",English
+"but I would also dare anybody to tell me that this is not a dangerous tumor. You can see, it's almost the size of a tennis ball that has grown right at the base of the skull, up into the brain,",English
+"and it's putting a fair amount of pressure. Up here is the corpus collosum. You can actually see the vessels completely pushed upwards in this area. You can actually see right here,",English
+"on the bottom, the brain completely pushed laterally like this. A very, very challenging tumor to take out.",English
+"We have, at our institution at Johns Hopkins and other parts of the world, people have tried to do this surgery. Surgery for brain tumors that are not cancer is much more minimally invasive.",English
+"At our institution, we have devised ways to be able to take these tumors, sometimes, depending on the size, even through the eye This is a picture of an eyebrow, and you can actually see the eye",English
+"right here where we took the tumor... some tumors through this approach right here. This is a view, as we're going right through the brain, right here,",English
+"moving the brain away, getting right under the skull, because the challenge is obviously to get right under the brain, get into that area, and extract these tumors.",English
+Another way of taking these tumors out is by doing it transphenoidally. This is a picture of a young child. We have actually developed some of these techniques,English
+"and perfected some of these techniques at our own institution Going through one nostril, as you can see right here, to be able to take this tumor out",English
+"right here using maneuvers in the operating room. Sometimes using the own fat of the patient to be able to reconstruct the base of the brain,",English
+"as you can see right here, and to be able to achieve a cure in these non-cancerous tumors. So, once again, we can achieve a cure",English
+"in tumors that are not cancerous, not all the time, but the majority of the time if we do the appropriate approach, the appropriate surgery and if a multidisciplinary team is involved.",English
+"Some of these tumors require a combination between a brain surgeon and an ENT surgeon, or a plastic surgeon, depending on the approach. I always encourage my patients",English
+of anatomy and plenty of experience in doing these approaches. But what about those tumors that are considered to be cancerous?,English
+One type of tumor that is increasingly being more heard about in the media because of people like Senator Kennedy,English
+that was afflicted by a glial tumor also known as a glioblastoma. These are the so-called intraaxial tumors.,English
+"We have, within the intraaxial tumors, we have the low-grade gliomas, we have the high-grade gliomas. Within the low-grade gliomas, we have the juvenile pilocytic astrocytomas --",English
+"the so-called JPAs -- we have the astrocytomas, and the oligodendrogliomas. They're all in the family of cancers. But the low-grades tend to have a much better prognosis than the high-grades.",English
+"That is, those patients that have a low-grade glioma tend to survive much longer versus those patients that have a high-grade glioma.",English
+"The most devastating being the glioblastoma multiforme. Now, I'll tell you something. I believe that glioblastoma multiforme is the most devastating cancer that affects the most",English
+"beautiful organ in the body, which is the brain. One of the challenges that we face is that by the time that these tumors get diagnosed, specifically the glioblastoma multiforme, the GBM,",English
+"most of the cells that we can take out with surgery are visible in MRIs and sometimes they're visible in surgery. So, we can achieve a very good resection of these tumors",English
+"where we can see. The problem is that as we look back in history, a lot of the cells that are malignant have already migrated away from the brain,",English
+"and if you look at some of the studies that have been done up into the contralateral side of the brain, one can actually find cells that have already migrated, and that's one of the reasons",English
+why we can't achieve a cure with brain surgery for this cancer. And this is an important distinction to make between those tumors that some people may call benign,English
+like the meningiomas or the pituitary adenomas versus these tumors that are considered to be malignant and invasive. This is true cancer. Cells have actually moved away from this region.,English
+This is a picture of the necessity that one has to be able to help patients,English
+and sometimes to achieve the best possible resection during surgery. This is a patient that had the tumor before and after,English
+and underwent a sub-total resection. This is a tumor. They had a tumor before and after and had a near total-resection.,English
+This is a patient that had a tumor before and after and achieved a gross total resection in a low-grade astrocytoma.,English
+"Once again, it's still in the family of cancer, but this is the low-grade type. When we look at the overall survival of these patients... This is a Kaplan-Meier. In this axis we have the percent survival,",English
+"and this axis, we have the months. Then, you have gross-total resection (GTR) as seen right here. Then you have near-total resection (NTR), and then you have sub-total resection (STR).",English
+"So, it's clear that the more tumor we can take out in our patients, the better those patients will do after surgery. And that is an important distinction to make. That's why these patients need to",English
+"be seen, in my opinion, by people that have a fair amount of experience taking these tumors out. What about the perspective on the glioblastoma multiforme?",English
+"I told you already, within the brain tumors, it's a spectrum. The low-grades to the high-grades. The low-grades being tumors like the oligodendroglioma",English
+"the astrocytoma, juvenile pilocytic, or the low-grade astrocytoma, versus those tumors that are high-grade like the anaplastic astrocytoma or the most devastating,",English
+"the glioblastoma multiforme. In 1978, the median survival for these patients was about 10 months. That means many patients survived less than 10 months,",English
+"and some patients survived more than 10 months. By 1990 and the 2000s, most people began to do much more aggressive not-only resection, but to treat these patients",English
+"with chemotherapy and radiation, and Roger Stupp in the New England Journal of Medicine published this paper after gross and the best surgical resection that one can do,",English
+"followed by radiation and chemotherapy, the median survival went from about 10 months to 14.6 months. Now, some of you guys may think that that's not a lot,",English
+"but it's about a 50% increment in the survival of these patients. And this is something that one has to take into consideration, if one day we are going to be able to make a difference.",English
+"We can't give up in this disease, which is the so-called glioblastoma multiforme. This is an MRI of a patient that has a glioblastoma multiforme. What you see right here is what I can possibly take out in the operating room.",English
+"Now, this is a tumor that is in the dominant hemisphere of this patient. This is an axial cut and this is a coronal cut.",English
+"Now, we have been able to confuse many people because we actually flip the images. In this case, this is the right side of the patient,",English
+"even though it may look to you like the left side, and this is the left side of the patient. Once again, this is the right side of the patient, this is the left side of the patient.",English
+"The images are flipped. In this case, the patient has a tumor in the dominant hemisphere. And I will tell you a little bit as to how we best do this surgery.",English
+"Before the surgery, most of us use what is called a navigation system. And the best way that I can explain this is that we take an image of your brain",English
+"before the surgery with very high definition magnetic resonance imaging (MRI). And we bring those images into the operating room,",English
+and we use something that is similar to a GPS that you use in your car. So that means that when we're pointing into your brain we have a better idea as to where you or I are in reference to a pathology.,English
+"I know where I am, and I use little pointers to make sure that I am in parts of the brain where I'm going to be able to take these lesions out. And, in this case, it might not be perfect.",English
+"But, it's one of the closest things that we have to be able to have a better idea of how we are going to navigate.",English
+"It's not perfect because as you can imagine, once you open the brain, things shift a little bit. So now you're dealing with shift of the brain",English
+"and an image that was done before we had opened the brain. Nonetheless, this is a very good start to be able to navigate the brain and to achieve, ideally, a much better resection of these tumors.",English
+"What do these tumors look like? So, I'm going to take you now into the operating room, and I'll show you this surgery. This is a young patient",English
+"in which I am taking a tumor near the motor cortex. I have been been able to map the arm in this area, and the forearm, and this, as you can see, is the tumor",English
+that we're taking out. I am working inside of the tumor between a very large blood vessel -- a vein -- that I am trying to preserve.,English
+"And what I'm doing right here is using a small device that is called a bite puller and a suction right here and I'm getting towards the edge of the tumor, and I am making sure that I am resecting as much tumor",English
+"as possible without compromising the normal function of this patient. We are working on the right side of the brain,",English
+"in this case, so it's not the left side, otherwise, sometimes we would have to do these patients awake if the tumor was near the eloquence parts of the brain.",English
+"So, we're working on the right side of the brain. I introduced a small piece of cotton ball to be able to just control the hemostasis -- the blood -- sometimes I try not to use this device too much because",English
+"it actually coagulates the small blood vessels, and right now I am getting under the vein right here and as you can see, there's still a little bit of tumor left",English
+"right here. I'm towards the end of resecting this tumor. This tumor ended up being an intermediate grade tumor, and we gave the patient a gross total resection,",English
+"and this surgery took place over three years ago, and the patient has done very, very well. So this is the resection. I have taken you into the operating room.",English
+"This is the post-operative image of the patient that I showed you after doing a gross total resection of this tumor. As you can imagine, these patients, if the surgery is properly done,",English
+"if we map this brain well, we can achieve very good resection, and these patients can do very, very well. This is an estimated Kaplan-Meier plot of survival",English
+"of patients with Grade III astrocytomas. Remember, Grade I through Grade IV. Grade I and Grade II are the low-grade gliomas.",English
+"Grade III and Grade IV are the high-grade gliomas. And the Grade IV is the glioblastoma multiforme. Here, you have gross total resection, near total resection, and sub-total resection.",English
+"Gross total and near total are significantly different than the sub-total resection. This, as you can see, is the percent survival, and these are the months that the patient survived.",English
+"The more tumor you can take out the better these patients will do. And that is a very, very important difference. Sometimes, you can achieve very good resection, if you not only understand the anatomy,",English
+"but if you also use the state of the art technology, mapping techniques, and other technical adjuncts that you can use in the operating room.",English
+This is the role that extent of resection has in survival after the resection of the malignant astrocytomas. This is the Grade IV astrocytoma.,English
+"And this is after primary resection, and you can actually see gross total resection as the top curve, then there is near total resection as the middle curve,",English
+"and then there is sub-total resection as the lower curve in this case. This is the percent survival on this axis, and these are the months. The more you can take out, also in this Grade IV,",English
+"the so-called glioblastoma multiforme, the better those patients will do. It's not only important, the first surgery, which is the primary resection",English
+"as you can actually see right here -- this is the first surgery. But, what if you have to go a second time? The second surgery, called revision surgery, is also important. Gross total resection, right here, again.",English
+"Percent survival on this axis, months on this axis. And you can see that the more you can take out, the better these patients will do. The more they survive.",English
+"So, the extent of resection is important, not only the first time of surgery, but also the second time of surgery. But what happens",English
+if maximal surgical resection is the goal? What is the effect on survival for patients with malignant gliomas who acquire surgically-induced neurological deficits?,English
+"It makes no sense, if you can take everything out, but if you leave the patient completely devastated and hemiplegic, then it may actually work against you.",English
+"And we have looked, in our own work, and a lot of the data that I've shown you is based on our own work at Johns Hopkins that this is actually true.",English
+"This is the Kaplan-Meier, once again -- the association of surgically-acquired deficits and survival. This is after primary resection of a glioblastoma multiforme.",English
+"In the black line, we have no new post-operative deficits. In the blue line, as you can see right here, we have new post-operative motor deficits.",English
+"And in the red line, we have new post-operative language deficits right here. This is the percent survival, and these are the months.",English
+"But, if you give the patient either a motor or a speech deficit, those patients will survive less. And their quality of life will be absolutely devastated.",English
+"I'll take you now into the intraoperative setup, not only that I show you what the surgery looks like, but let me take you in for you to see some of the pictures",English
+and some of the issues that we deal with in our planning of these surgeries. You can actually see. This is the intraoperative setup for an awake,English
+"craniotomy. This is the left side of the brain right here. An anesthesiologist is on this side right here, and we're all working together with a very large number of people",English
+in this very state of the art surgical room. We have a stimulator right here to be able to stimulate the brain when we are doing the surgery.,English
+"At the time of the surgery, sometimes these patients can be awake or they can be asleep. The tumor can be in the dominant hemisphere. That is the left side. Or they can be in the motor-sensory area",English
+"for those tumors we have to do motor and sensory mapping. For patients that have a tumor in the left side of the brain, many times we have to actually do awake craniotomies.",English
+"We go on and we put small electrodes on not only the arms and legs, because sometimes all it takes is just a little twitch, and sometimes you just can see it,",English
+"but with these small electrodes that are recording EMGs that is muscles that are twitching, we can actually detect very subtle abnormalities.",English
+"We go on and stimulate. This is what is called intraoperative localization of not only motor, but we can also use this device and this is the little electrode right here,",English
+which is no bigger than about 5 millimeters in distance -- between these two electrodes right here is about 5 millimeters. We use this to stimulate if we want to map the motor portions of the brain,English
+"or if we want to map the speech centers of the brain, we use such a stimulator. This is a picture of what it looks like right here.",English
+"In this case, we were on... In the operating room, we mapped the motor shoulder, the motor forearm, the motor hand, motor hand right here,",English
+"and in this case, the sensory hand and arm. And the lesion, roughly speaking is all this area right here. And notice how this tumor has displaced... opened up the space",English
+"in this region, where these cortical, eloquent parts of the brain are found. So, we have to be very careful. Some of the modern technologies that we use have been published by other groups.",English
+"And we can actually use the so-called diffusion tensor imaging of sub-cortical white matter tracts. So, we get a sense as to the relationship between a tumor",English
+"and parts of the brain that are important for naming, parts of the brain that are important for movement of the mouth, parts of the brain that are important for producing speech,",English
+"and you can actually see such a picture, sideways like this, of a tumor that is surrounded by all of these spinal tracts. So, we have to pay close attention to this.",English
+"I'll take you back, into a surgery. There's just a few hours before the surgery in which I mapped a brain in the operating room, in which I am looking at all the spinal tracts",English
+"that carry a lot of information on the brain, and what I'm doing right now, is mobilizing the brain, and looking at it from different angles right here. I have recorded this. I'm looking from the back right here.",English
+"I am using my mouse and moving the tumor. I want to get an idea of where the tumor is in reference to all these cortical, spinal tracts. All these tracts that send information.",English
+"I'm looking at it from the bottom. I'm looking at it from the top. I'm looking at it from the side. Every single possible angle, because I am picturing in my brain",English
+"in a 3-dimensional way, which way is going to be the way that is going to allow me to go in to the brain and minimize the injury to those eloquent",English
+"white matter tracts that carry a lot of information from the brain down to the brain stem. So I'm actually doing this, and I spend sometimes hours,",English
+"sometimes days, studying these cases to make sure that, in the operating room, I maximize the likelihood of minimizing injury to these patients.",English
+"As you can imagine, not only... Awake craniotomies are challenging for the patient as well as for the surgeon.",English
+"Having a relationship with the patient, having a two-way conversation before the surgery will maximize the likelihood that during surgery,",English
+"We can look at Broca's Area, which is for production of speech, which is that little area right here in the front. We can look at understanding of the speech,",English
+"which is also known as Wernicke's Area, which is in the temporal portion of the brain. And then we can look at the connection pathway between these two regions, Broca's Area, Wernicke's Area, and the conduction pathway s",English
+"that connect Broca's to Wernicke's right here. So, whenever we have a tumor in the left side of the brain -- that is, in this vicinity -- most of the time, I do recommend an awake craniotomy,",English
+"unless there's a contraindication to awake craniotomy. Sometimes, I actually recommend that we do a functional MRI, which is also known as fMRI to look at anomia, speech arrest,",English
+"yellow motor, and we have, as well as other groups, done a correlation between the areas that the functional MRI gives you, and the areas that we actually stimulate in the brain",English
+"with the Ojemann stimulator during surgery. So, these studies have been done that these are reliable methods to get a sense as to whether or not",English
+"we should do a patient asleep or awake. In general, my preference is, when there is a tumor in the left side of the brain, which is in this case. Remember! The image is flipped!",English
+"This is the left side of the brain. This is the right side of the brain. So, in this case, most of these patients, I do recommend an awake craniotomy. I do get asked that question -- when to do an awake craniotomy.",English
+"Most of the time it's for speech, sometimes, some patients also get awake craniotomies for tumors that are near the motor and sensory area to be able to map those areas very well.",English
+"And sometimes it becomes a surgeon's preference to do this. This is the picture of one of my own patients, which I did all the way back when I was a resident,",English
+"the mapping of several languages. We now know that patients can actually have languages arrested, both of them, in this case Chinese and English.",English
+"This is the age at which the patient acquired these languages, and some of these patients can have sites with different languages, or in this case, both sites arrested both languages.",English
+"So, the variability is enormous. This is why, many times, you can't just do the patient sleeping. You have to see. You can actually see the resection cavity right here.",English
+"Look how close we are to the areas of the speech. Just millimeters away. This is a picture from the operating room, and we have achieved a gross total resection of this tumor.",English
+"And this is the paper that we published a number of years ago, and this is the overall results. As I was training, we were able to do some number of patients that were bilingual,",English
+"in which we found several areas. As you can see, Chinese and English, English and Spanish, Punjabi and English, Turkish and English,",English
+"as well as Spanish and English. So, there's an incredible amount of variability, and this is why, if the tumor is here, or the tumor is here",English
+"in this vicinity, I would recommend that a patient most likely have an awake craniotomy. This is a reconstruction of an MRI from the operating room. What about the treatment?",English
+"Well, it turns out... This is a paper from Roger Stupp, New England Journal of Medicine. I alluded to it in my prior talk. ""Radiotherapy plus Concomitant use of Temozolomide for Glioblastoma multiforme.""",English
+"That means at the same time. Most patients have it for 6 weeks. They have the chemotherapy every day, they have the radiation therapy 5 days a week. We start 2-4 weeks after surgery.",English
+"And they get radiation plus temozolomide at the same time. Temozolomide is an oral medication. And you can actually see, if we do that with a good, gross total resection of the tumor,",English
+these patients tend to do much better than if we do radiation therapy alone. This is an FDA - this is a government approved treatment for these cancers.,English
+"What about the summary of current treatments for malignant gliomas? Well, if they're new, as you can see in this column, the type of tumor. You can see in this column is the therapy.",English
+"If you have a glioblastoma multiforme, which is a Grade IV -- this is the malignant cancer, we have maximal surgical resection, plus radiation therapy,",English
+"plus concomitant and adjuvant temozolomide or the wafer, the so-called Gliadel... and I'll show you a picture of this right now.",English
+"If it's an anaplastic astrocytoma, we also like to achieve a maximal surgical resection with options after surgery of standard treatment or radiation",English
+"plus adjuvant use or temozolomide or temozolomide alone. These are slightly different protocols. What about an anaplastic oligodendroglioma, astrocytoma (Grade III)?",English
+"Well, you can actually see, maximal surgical resection, with the options after surgery of radiotherapy alone, temozolomide, PCV with or without radiation therapy.",English
+"What about recurring tumors? These tumors are actually more complex in some cases, but also some of these treatments do exist for them,",English
+"like reoperation of selected patients, and I'll show you an image that the reoperation is very, very important for these patients. At Johns Hopkins, we did a study a few years ago,",English
+"and we looked at radiation therapy with no Gliadel, radiation therapy with Gliadel, or radiation therapy with temozolomide, and a selected group of patients, we have used a combination of",English
+"surgery, with good resection as you can see right here, with the intraoperative use of these little wafers that were invented by one of my colleagues by the name of Henry Brem",English
+"that are called Gliadel. We put them in right at the time of the surgery, so the patient is already getting chemotherapy for the treatment. And then, we give them an oral medication",English
+"which, here, is the temozolomide. And, in addition to that, the patients are also getting radiation, and it seems that if we use a combination of good surgery,",English
+"followed by Gliadel and temozolomide and radiation, these patients can survive up to 20 months. And, as far as we know, in our experience, the number of complications",English
+"is very, very minimal on these patients. I'll tell you something, and I'm going to wrap up in the next few minutes with the actual cellular origin of these differentiated glial or stem cell progenitors.",English
+"There's been a fair amount of work in trying to understand how these tumors begin and how they continue. Well, this is the pathway from a low-grade oligodendroglioma",English
+"going all the way to an anaplastic oligodendroglioma, in which, the median survival is 3-5 years. If it's a low-grade oligodendroglioma,",English
+"the median survival is 5-10 years. But these tumors can actually progress from a low-grade to a high-grade. They're all in the spectrum of cancer. If you remember,",English
+"we mentioned that earlier. So, sometimes you can see a fair number of mutations The one that I call to your attention is p53, and as you can imagine, VEGF -- Vascular Endothelial Growth Factor overexpression.",English
+"A lot of these tumors have the marker for Olig2 expression, which is thought to be the cell of origin or one of the cells of origin",English
+for the progression -- the origin and the progression of these tumors from low-grade to high-grade. What about the next type of tumor? The actual tumor that starts when the patient comes in to the clinic,English
+"is already a primary glioblastoma. The median survival for those patients, as you can see, is 12-15 months.",English
+"This is a devestating disease. Once again, the most devestating cancer affecting the most beautiful organ in the body. One of the overexpressions is the Epidermal Growth Factor Receptor overexpression in",English
+"over 60% of these patients. These patients are devastated. A lot of these tumors, they present like this. And the best way that I can tell you is that a lot of my patients tell me",English
+"that this tumor is like driving in the desert with your air conditioner on, and suddenly you get hit from the side and your whole life changes all of a sudden",English
+"because of the diagnosis of one of these devestating tumors. But some patients can start with a low-grade astrocytoma, in which the median survival is 5-10 years.",English
+"It's in the spectrum of cancer. And then, they can move on, if they recur, to an anaplastic astrocytoma, and then, potentially to a secondary glioblastoma,",English
+"which at that point, the median survival is much less. So, that means that they can start with a low-grade tumor and move all the way up to a high-grade tumor.",English
+"As you can see, the median survival varies, depending on where they start. And the higher the grade, the less chance they have of surviving for many years the disease.",English
+"Our work at Johns Hopkins and in San Francisco, where I trained, has to deal with whether or not there is an origin for these tumors and whether or not they are linked to parts of the ventricle.",English
+"Whether or not there's a cell of origin. In 2004, we published this paper. If you want to hear more about it, please tune in to my next segment of this series of talks.",English
+We believe that potentially there's a series of cells that may be normal neural stem cells that can potentially give rise to these malignant tumors.,English
+"That is still a working hypothesis. What we do know, and this is based around the same time in 2004... Our colleagues from Italy and our colleagues from Canada",English
+"published two different papers in two different journals with similar results. That is, if they get tissue from the patient, and they grow them as small spheres,",English
+"and they put them back on animals, those tumors look very much like the tumor of the patient. The same thing with our colleagues from Canada. They did something similar,",English
+"I started getting on the internet and doing research, and that's when I came across Dr. Osborne's website, and it was a huge relief to find",English
+"that there was another option besides having to do this pretty invasive surgery. - As soon as I heard that there would be minimal scar,",English
+and that I wouldn't have... There was much less of a chance of facial paralysis. I felt so much better.,English
+"- The next day I made phone calls all day long, trying to see if there was any local doctors that could do it at Children's in Chicago",English
+"or any of the ENTs around here, but from my research Dr. Osborne was the pioneer of this procedure, and so especially knowing that he does these surgeries",English
+"multiple times a week was a huge comfort because the ENT that we saw only does about ten of them a year. - I talked to him, and even he said",English
+"that this is not one of his areas of specialization. - And other doctors I called in Chicago only did a few of 'em a year,",English
+"and I kept coming up with that same low number, especially with dealing with the facial nerve, I really wanted someone who had a lot of experience",English
+"in this type of surgery. Especially since we're dealing with a teenage daughter, we want to be able to give her",English
+the best possible results from this surgery and put her in the hands of someone who has done this surgery over and over and over again.,English
+"- Some of the difficulties with this case and just trying to manage it, believe it or not come from me as well.",English
+"When her mom reached out to me, she was very eager to move forward with surgery with us, and she wanted to have surgery around Christmastime,",English
+"and a lot of people don't consider this, but I actually love Christmas, it's one of my favorite holidays, and I try not to do anything",English
+"that might be too complex around those times, because if things don't go well, I do not want for my memories of that time period",English
+to be associated with a bad outcome. - I think anytime you go under the knife and you have to go under full anesthetic,English
+"and just the warnings and disclosures are always given with any surgery can create a certain amount of anxiety, but on the whole I don't feel too worried myself.",English
+I'm very excited about the specialist that we found here with Dr. Osborne and so there's not too much worry.,English
+"I think more than anything, there's just this overwhelming sense of gratitude that we found this as quickly as we have and been able to address it so quickly",English
+through one of the best in the country. - The big issue with this case is obviously she's a teenager. She's 16 years old.,English
+"At 16 years of age, you're supposed to be thinking about the prom, probably your social life. Nowadays, people are probably doing selfies all the time,",English
+"texting their friends, going to parties, trying to figure out what they want to do with their lives, maybe looking at colleges.",English
+You are not supposed to be debating whether or not to have a surgery that could alter the way the world sees you.,English
+You're not supposed to have to answer the question could you accept being paralyzed on one side of your face. You're not supposed to be asked the question,English
+do I have a cancer or not? You're not supposed to have to deal with the possibility of having to go on to have disfiguring surgery.,English
+so that You would guide their hands. I pray for a peace that passes all understanding to be with Ashley and all of us.,English
+"Thank You for these doctors, we thank You for this place, and we trust You. In Your name, Amen.",English
+"We had a great prayer session. I feel ready. I'm calm, and I'm not concerned. I feel like our team is ready to go,",English
+- So the surgery went great. I couldn't be more pleased with the result. - Ashley? The surgery's over.,English
+"Ashley, can you hear me? Just waking up? Ashley, you're just waking up, we're right here with you.",English
+"Everything went really well. Can you give me a big, big deep breath? - Big deep breath.",English
+"- Give me a big cough, Ashley. (coughs) - Good.",English
+"- Good job. - It went well, you're all done. (calm music) - I was a little concerned about",English
+"whether we would be able to get a margin around this tumor, but we were. We actually removed some of the layers on top of the gland",English
+which served as a circumferential margin to ensure that we didn't spill any of this tumor out into the surrounding area.,English
+"So I'm very happy with that. In addition her nerve was readily easy to identify. It was stimulated during surgery,",English
+at the end of the case and it completely moved normal so I have no issues or concerns. Dr. Hamilton did a fantastic job of reconstruction.,English
+"- My role is to make sure that once the surgery is completed, that there's no evidence that we were in there in the first place,",English
+"so that Ashley doesn't have a dent in the side of her face, that she doesn't have any problems with something we call Frey's syndrome",English
+"which is where the patients may continue to sweat on the side of the face when they're eating, and that overall there's little to no scarring at all",English
+"after the procedure. And so for Ashley we were able to successfully do that, and I think that long term, there will be no evidence whatsoever",English
+"that she ever had surgery, and she'll be able to put this behind her. - I think she's gonna be very happy with these results. Can you open your eyes?",English
+"Can you raise your eyebrows? Close your eyes tight. Can you smile, like you won the lotto? Bigger, bigger smile.",English
+"(Ashley makes a noise) Your coach called, and she said you need to be back at practice next week. I'm just kidding.",English
+"That's as good as it gets. - When I'm looking at Ashley, I'm just thinking about my own daughter, so I have a high school-aged daughter as well,",English
+"and I couldn't imagine that if we got the news that she had a tumor and that there's a possibility of it being malignant,",English
+"what that would do to our family, and when I'm looking at Ashley I'm just basically thinking about my daughter and Dr. Osborne has a teenage daughter,",English
+"and how would we feel if our children were in that situation? And I think that makes the case a little different. We treat all patients the same,",English
+"but there's these particular cases that really touch your heart, and make you feel that... I mean I always give my best,",English
+"but we have to go the extra mile here, and I feel that in Ashley's case that was really palpable for us during the procedure.",English
+"We wanted this to go as if our own daughters were having this surgery, and that's how we approached it,",English
+"and I think that part of the success was the faith that Ashley had in her parents, and in turn the faith her parents had in us,",English
+"and us looking at her like she was part of our family. And when you put all of that together, and with a little bit of prayer,",English
+"The pathology report came back. - Benign. 1.8 centimeters, which is roughly 2 centimeters. The entire specimen was removed",English
+"with normal tissue surrounding it, so it was completely taken out, there were no little pieces left behind.",English
+"It means, if everything went the way I feel like it went, no more surgery for you. - Okay.",English
+"- So it's an awesome situation. This is where we wanna be. I feel very good about the fact that this is a one-and-done for her,",English
+"that we're gonna put this behind her, and she's gonna take off and never have to deal with this again. I'm very, very happy with this.",English
+"and administered the Nitroimidazole compound called EF5. There's several important points to make from this slide. First of all, the tumor, indeed, does have a number",English
+"of blood vessels and this is shown by immunostaining for the endothelial cell protein, alternatively known as PECAM or CD31,",English
+as shown by the green fluorescent depicted in many parts of this fibrous sarcoma section. Adjacent to the green blood vessels are cells,English
+"that are reasonably well-oxygenated, but not that far away are cells that are clearly quite hypoxic and that is because the Nitroimidazoles",English
+"introduce thiol adducts on proteins and peptides within hypoxic cells. For the reaction to work, the cells must exist",English
+below roughly one to one point three percent oxygen or 10 millimeters of mercury and they are now immunoreactive for an antibody,English
+"that detects these protein modifications. Again, the important point is that, even tumors with blood vessels",English
+"have dysfunctional blood vessels and the result is domains where cells are limited for oxygen, glucose, glutamine, et cetera.",English
+"Now, the oxygen in nutrient-limited cells will respond in a variety of very sensible ways. They will very rapidly limit anabolic metabolism,",English
+"they will rapidly inhibit an mTOR pathway, which is a pro-growth pathway, they will engage along with distress responses,",English
+"which include autophagy, the unfolded protein response. There are a number of oxygen-consuming biochemical reactions that will change and there's a growing family",English
+"of oxygen to oxoglutarate dioxygenases, which regulates DNA methylation, histone methylation, and collagen modification,",English
+among other important biological processes who's CAM for molecular oxygen will indicate that many of them will also be influenced,English
+"by the oxygen gradients typical of most solid tumors. Nevertheless, one of the best characterized oxygen-sensing mechanisms is depicted here.",English
+"This is a large transcriptional response regulated mostly by hypoxia-inducible factors or HIFs and, if you're not familiar",English
+"with these factors, they're dimers. They consist of a constitutively expressed beta subunit, also known as ARNT, show as the light yellow ball",English
+"on the right hand side part of the slide, but they're also composed of extremely O2 labile alpha subunits, and so,",English
+"an oxygen replete or normoxic conditions, the alpha subunits are extremely unstable because they are hydroxoyated on proline residues",English
+"by a family of HIF specific prolyl hydroxylase domain enzymes called PHDs, hydroxylated HIF alpha is now recognized",English
+"by a multi-protein complex that includes the tumor suppressor protein, von Hippel-Lindau, targeting it for proteasome-mediated degradation.",English
+"As O2 levels decline, the alpha subunit is now reversibly stabilized, enters the nucleus, dimorizes with ARNTs, binds to HREs in the genome",English
+"and enhances the expression of literally hundreds of genes that contribute to malignant progression. They're involved in metabolism, tumor endogenesis,",English
+"rates of cell proliferation, and inflammation and among the many things that the HIFs do, its interfaced with metabolic pathways that are active",English
+in proliferating cells and what is shown in the red box region are the domains of metabolic pathways that have been traditionally associated with hypoxia,English
+and activated HIFs and that includes excessive or enhanced glucose import because many of the HIF targets include glucose transporters on the surface of cells.,English
+"Most of the glycolytic enzymes are actually regulated by hypoxia or their HIF targets, rates of oxygen consumption by the mitochondria",English
+"are downstream of the HIFs, glutamine import and glutaminolysis is enhanced by hypoxia in the HIFs to allow TCA cycle anaplerosis to occur,",English
+"maintaining lipid synthesis under low O2 and so, along with other stress responses, such as autophagy or the unfolded protein response,",English
+"the HIF pathway has a role in helping to coordinate oxygen and nutrient availability with the rates of these metabolic pathways to, somehow, allow cells,",English
+"not only to survive in the stressful tumor microenvironment where they're limited for oxygen and nutrients, but to somehow continue to proliferate",English
+"and this is what I would like to talk about today. Now, HIF1 alpha and the related isoform, HIF2 alpha are found in numerous tumor diagnostic biopsies",English
+"and typically correlate with poor prognosis, but one form of cancer is particularly dependent on HIFs and this is the renal cancer known as clear cell",English
+renal cell carcinoma. Kidney cancers can be subdivided based on their histopathology. With clear cell renal cell carcinoma being by far and away,English
+"the most prevalent form. Roughly 75 to 80 percent of renal cancers are of this variety. They get their name because, upon H and E staining,",English
+they have a so-called clear cell cytophil shown in the right hand image in this slide and this is because they're thought to excessively,English
+"accumulate lipid and glycogen and, in over 90% of clear cell renal cell carcinomas, the VHL protein is disabled in some fashion,",English
+"which means that we thought they had essentially full-on HIF activity, making the HIFs central in the initiation and progression of this disease.",English
+"Now, beyond VHL loss, however, they're genetically very heterogenous and we and others have engaged in extensive molecular characterization.",English
+"This includes copy number variation studies, exome sequencing, transcription profiles, and other assays of the genomic and RNA content",English
+of these tumors. We recently complemented this with a pan metabolomic assessment. What you're looking at here is a heat map,English
+of roughly 420 metabolites comparing metabolites and kidney tumors relevant to adjacent healthy kidney tissue,English
+"and we saw a number of consistent changes. For example, the renal tumor had lower accumulation of urea cycle metabolites, they had increased accumulation",English
+"of long chain fatty acids, decreased abundance of lysolipids, but the red box regions showed the metabolites, which were the most different.",English
+"The renal tumors had a significant increase in the abundance of metabolites that fall loosely in the category of glycolysis,",English
+"and what this is depicting is over 2700 metabolic genes, I E, their MRNAs that encode metabolic genes, subdivided into 72 functional groups",English
+"based on the KEGG classification and what's immediately obviously and was somewhat surprising to us is that many of these functional groups,",English
+"if anything, are under-expressed, in the renal tumors relative to healthy tissue. The most under-expressed category was one",English
+"involved in carbohydrate storage. The top fit is the catalytic subunit of glucose six phosphatase, phosphoenolpyruvic carboxykinase, or PCK one",English
+"and then, two isoforms of fructose one six bisphosphatase, or FBP1. Now, all three of these enzymes, as shown in the next slide,",English
+oppose glycolysis in central carbon metabolism. It's appreciated that many malignant tumors and cancerous cells engage in enhanced glycolysis,English
+"to complement oxidative phosphorylation and the three green enzymes, PCK, FBP, glucose six phosphatase would actually oppose this.",English
+They engage in gluconeogenesis and glycogen storage. Kidney is a good example of a gluconeogenic tissue. It's not surprising the gluconeogenic enzymes,English
+"would be down regulated in favor of the glycolytic pathway, but FBP is the rate limiting enzyme and we've been able to, now, assess over a thousand",English
+"individual patient samples and have shown that this is a nearly universal metabolic adaptation. FBP is universally lost at the RNA protein level,",English
+"it's mutated, or I should say deleted, about 40% of the time and so, this is something that the tumors do. They wanna opposed FBP1 activity gluconeogensis",English
+"to promote, instead, glycolysis and glucose carbon flux into the pentose phosphate pathway to produce, not only nucleotides, but reducing equivalents",English
+"in the form of NADPH. Now, this is hardly surprising, but what is surprising is that FBP1",English
+"is another example of a metabolic enzyme that has both a daytime job, that is, it has its metabolic activity in the cytosol,",English
+"but much to my surprise, FBP1 can also be found in the nucleus. In the upper left hand corner is healthy kidney tissue",English
+"whereby IF immunofluorescence, we can show that FBP1 is both in the cytosol and the nucleus. Probably more convincing is the subcellular fractionation",English
+"shown in the right hand side where it's very clear that FBP1 protein is in the cytosol, but also the clean nuclear fraction.",English
+"Also shown is the fact that we can introduce a wild type FBP1, this is in the lower right hand side, into these cells.",English
+"These are renal cancer cells that don't normally have FBP1. If we introduce FBP1 in, we actually saw that a number of canonical HIF target genes that I mentioned previously",English
+"like lytic enzymes, like LDHA, peruvic dehypyruvic dehydrogenase kinase one, the glucose transporter GLUT1",English
+"and the endogenic factor, VEGF, are under expressed, so FBP1 is actually opposing HIF transcriptional activity. If we now tag FBP1 with the potent nuclear export sequence",English
+"shown over in the left hand side, so there's no longer FBP1 available in the nucleus, the ability of FBP1 to attenuate HIF activity",English
+is significantly lost. The take home message is that FBP1 is found in the nucleus and can actually oppose HIF transcriptional activity.,English
+"In fact, FBP1 can physically associate with both HIF1 alpha and HIF2 alpha, as shown here by immunoprecipitation.",English
+"Not shown here is that, not only does FBP1 physically associate with HIF1 alpha and HIF2 alpha, it does so at the level of chromatin",English
+"at the HREs of a number of canonical HIF target genes that fall in the category of metabolic enzymes, inflammatory cytokines, androgenic factors,",English
+and other outputs. To summarize what I've shown you today is that hypoxia and responses,English
+"to the hypoxic nutrient poor microenvironment impose a number of important metabolic changes. Many of these have to do with metabolic enzymes themselves,",English
+"but as shown in the left hand side of this conclusion slide, many metabolic enzymes have surprising roles. Once again, FBP1 in the gluconeogenic tissue,",English
+"such as kidney, has a role in the cytosol where it carefully balances the toggle of glucose carbons in central carbon metabolism through glycolysis",English
+"in the pentose phosphates pathway versus gluconeogenesis. But, surprisingly, and there are a growing number of metabolic enzymes that fit this category,",English
+"FBP1 can also be found in a nucleus and it's actually the nucleus, for a number of reasons, including to restrain HIF activity,",English
+"and so, we thought for some time that the first event in promoting clear cell renal carcinoma is the universal loss of the von Hippel-Lindau tumor protein",English
+shown in the right hand image that we now know that the second hit has to be loss of FBP1.,English
+"Now, because of loss of both VHL and FBP1, we have essentially full-on HIF activity. This revs up glucose uptake, enhances glycolysis",English
+shown through the pentose phosphate pathway and many other metabolic targets of HIFs that sustain tumor self-survival and tumor growth,English
+"in the naturally stressful tumor microenvironment. In the future, we will be performing ChIP-seq for FBP1. That might be surprising for a gluconeogenic enzyme,",English
+but we wanna see how many of the HIF HREs are occupied or co-occupied by FBP1. We've now been able to extend our observations,English
+"in renal cancer to liver cancer by doing ChIP-seq and also performing proteomics and mass spectrometry, we'd like to identify other nuclear factors",English
+"that FBP1 may be influencing. This may involve, for example, Wnt/beta-catenin signaling. We've been able to show that there's a similar relationship",English
+"between the related factor, FBP2, and muscle-derived tumors, such as sarcomas and, finally, we've now established a conditional wheel of FBP1 to explore the relationship",English
+"of FBP1 and HIFs and metabolic donation in liver and kidney where certain oxygenated regions engage in gluconeogenesis, but purely oxygenated regions instead promote glycolysis",English
+and we'd ultimately like to combine VHL loss with FBP1 loss to generate a more faithful replica of clear cell renal cell carcinoma,English
+"in a genetically engineered mouse model, which is something that has not been a benefit to this field up to this time.",English
+"for that very engaging presentation and a great start to the webinar. We are going to move on to our second speaker right now, Dr. Nissim Hay.",English
+Dr. Hay is currently a distinguished university professor in the department of biochemistry and molecular genetics at the University of Illinois College of Medicine.,English
+"The main body of his research has been to delineate the mechanisms by which the serine/threonine kinase, AKT, affects thermogenesis and metabolism",English
+"both at the cellular and organismal levels. In addition, he investigates the role of glucose metabolism in cell perforation and survival of cancer cells",English
+"and how it could be exploited for cancer therapy. A very warm welcome to you, Dr. Hay. - [Nissim] Thank you, Sean for the opportunity",English
+to present our studies today and what I'm going to tell you about is how we could exploit glucose metabolism,English
+in cancer cells for cancer therapy. High glucose rate of metabolic rate of glucose is a feature of cancer cells that distinguish,English
+"the cancer cells from normal cells and this could be exploited for detection of cancer cells in vivo, selective detection of cancer cells in vivo.",English
+"For example, using the fluorodeoxyglucose, FDG, glucose analog as topically labeled in combination with positron emissions tomography and CT scans.",English
+"What you see in this slide is a patient with esophageal cancer, before and after treatment using this technology.",English
+"If high glycolytic rate is exploited for selective detection of cancer, why couldn't it be exploited",English
+"to selectively eradicate cancer? Actually, the FDG PET scan is dependent only on two steps of glucose metabolism.",English
+"The transportation of FDG by the glucose transporters and the phosphorylation of FDG by hexokinase and this is because, unlike glucose,",English
+"FDG cannot be farther utilized in a glucose metabolism. In fact, the FDG PET scan is more dependent",English
+"on hexokinase activity than on the glucose transporter because glucose transporters are often bi-directional. If FDG can not be phosphorylated,",English
+"it cannot be trapped inside cells. By catalyzing the first committed step in glycolysis, hexokinase is determined if lack of glucose",English
+"is not only into glycolysis, but also into other glycolytic pathway. For example, the pentose phosphate pathway,",English
+"which is required to generate ribonucleotide and NADPH or the exozamine pathway, which is required for glycosylation of proteins.",English
+"There are four major hexokinases as expressed in mammalian cells encoded by four separate genes, hexokinase to hexokinase four.",English
+There is also a fifth hexokinase that has not yet been fully characterized yet. The hexokinase one to three are high affinity hexokinase,English
+whereas hexokinase four is a low affinity hexokinase and it is expressed only in liver and pancreas. Hexokinase one and hexokinase two share structural,English
+"and functional similarities and they have the ability to bind to the outer mitochondrial membranes and utilize, preferentially, ATP derived from mitochondria",English
+"to phosphorylate glucose to to glucose six phosphate, thereby coupling of oxidative phosphorylation and glycolysis.",English
+The binding of hexokinase to the outer mitochondrial membrane is also important for cell survival. We are interested in hexokinase two in particular,English
+and this is because both hexokinase one and hexokinase two are expressed at relatively high levels in embryonic tissue.,English
+"However, while hexokinase two is not expressed in most adult tissues, hexokinase one continues to be expressed.",English
+What is shown here at the left side of the slide is immunoblot showing the expression of hexokinase one and hexokinase two in different mouse tissues.,English
+"You can see hexokinase two is expressed at relatively high levels in the heart and skeletal muscles and also in fat,",English
+"which is not shown here. While hexokinase one is considerably expressed in most other mammalian tissues, except in the liver,",English
+"which is expressing only hexokinase four and not hexokinase one or hexokinase two. However, when normal cells convert into cancer cells,",English
+they start expressing very high levels of hexokinase two in addition to hexokinase one and this is manifested by the FDG PET scan.,English
+"and or tumor maintenance? And, I will address that in four types of cancer: lung, breast, prostate, and liver.",English
+"The second question is, is it feasible to systematically ablate hexokinase two and to emulate drug therapy without severe physiological consequences?",English
+"This is an important question because, in mice, the germ line deletion of hexokinase two is embryonically lethal.",English
+"And third, why is hexokinase two expression induced in cancer cells? To address the first question, we employed a mouse model",English
+"of lung cancer, developed by Tyler Jacks Laboratory in which oncogenic K-ras is expressed upon exposure of the lung to adenovirus",English
+"expressing Cre-recombinase. When we analyzed two more lung tumors in this mice, we found that hexokinase two is highly expressed",English
+"in the lung tumors, whereas the normal lung does not express hexokinase two at all. Hexokinase one expression doesn't change",English
+"in the lung tumors. What we did, we crossed this mice with mice that have hexokinase two floxed gene",English
+and we asked where the deletion of hexokinase two will impair the development of cancer induced by oncogenic ras.,English
+"In this generated mice, both K-Ras is activated and hexokinase two is deleted.",English
+"In the controlled group, only K-Ras is activated, whereas in the experimental group, K-Ras is activated together with the deletion",English
+"of hexokinase two. As you can see in the right panel here, at the right panel, the deletion of hexokinase two markedly extended",English
+tumor rate survival and the lifespan of the mice was markedly increased. The medium lifespan of this mice is 665 days,English
+"in comparison with 175 days in the controlled group. We markedly decrease tumor burden in this mice,",English
+as you can see in the slide and average tumor size and proliferation index is measured by BrdU incorporation.,English
+Hexokinase two is required for the development of lung cancer in this model and this is also true in human lung cancer.,English
+What is shown here is a tissue micro-array derived from patient with lung cancer and this is immunostaining with hexokinase two antibodies,English
+and you can see high level of hexokinase two in the lung cancer samples in comparison to normal lung. This is the staining of hexokinase two,English
+"that is associated with the grade of the tumor and also, high hexokinase two expression is associated with poor prognosis of patients.",English
+We have generated a human lung cancer cell line in which we can conditionally silence hexokinase two.,English
+"We then subjected the cells to xenograft assay in mice. When the tumors were palpable,",English
+"we then exposed the mice to doxycycline, which then delete hexokinase two and you can see that we markedly attenuated tumor growth",English
+in vivo when we deleted hexokinase two. We also find high level of expression of hexokinase two in mammary gland tumors in mice.,English
+In several mouse model of breast cancer ERbB2/Neu and polyoma middle T and the level of hexokinase two expression,English
+is almost equivalent to the level we found in a normal fat tissue. We therefore used a mouse model in which ErbB2/Neu,English
+is expressed in the mammary gland together with Cre-recombinase. We crossed this mice with hexokinase two floxed mice,English
+"and we asked, what happened in the absence of hexokinase two? As you can see here, the deletion of hexokinase two",English
+"markedly attenuated the tumor formation and extended the tumor-free survival. In fact, it is more than that because",English
+"when we isolated tumors from the mice without hexokinase two, we found that the tumors were derived from cells that escaped a complete deletion",English
+of hexokinase two. This is true also in human breast cancer. This is a tissue micro-array from a patient,English
+"with breast cancer. You can see high level of hexokinase two expression in the tumor samples and this is, again, correlated with the grade of the tumor",English
+"and high level of hexokinase two is associated with poor prognosis. Here, we have a conditionally deleted hexokinase two.",English
+This is in the bottom part of the slide. We have deleted hexokinase two in breast cancer cell line,English
+"and we also topically inoculated the cells and to developed tumors and you can see here that, in the red line, the tumor growth",English
+was markedly attenuated in absence of hexokinase two. We then wanted to address the question,English
+"whether or not it's possible to emulate drastic therapy, namely to systemically delete hexokinase two whole-body",English
+"and to inhibit lung cancer progression. For this purpose, we used a different mouse model in which oncogenic K-Ras is continuously expressed",English
+in the lung and the onset of tumors is about eight weeks after birth. We isolated cells from the tumors in this mice,English
+and we deleted hexokinase two in-vitro and we markedly inhibited the proliferation of the cells. We cross this mice with mice that have,English
+"hexokinase floxed allele, together with a courier combination that can be induced by test tamoxifen and that is expressed in all cells in the body.",English
+"After eight weeks, after tumor onset, we deleted whole-body hexokinase two by injection of tamoxifen to the mice.",English
+"After 20 weeks, we analyzed the lungs of these mice. What we found is that, here, even after tumor onset,",English
+"the systemic deletion of hexokinase two whole-body decreased tumor burden, number of tumors, and tumor size. Most of the tumors developed in the absence",English
+"of hexokinase two are much smaller, but a subset of tumor have similar size to tumor developed in controlled mice,",English
+"but when we analyzed these tumors for hexokinase two expression, we found that they are still expressing hexokinase two,",English
+"namely these tumors were derived from cells that escaped full deletion of hexokinase two. Now, I would like to switch to another type of tumor",English
+"and this is quite interesting here: liver cancer. As I told you before, normal liver cells and parenchymal hepatocytes do not express",English
+"either hexokinase one or hexokinase two, they express glucokinase. But, once they develop cancer,",English
+"when they are concerted to cancer cells, they turn off the expression of glucokinase and start expressing high level of hexokinase.",English
+"This is also true in human liver cancer cell line, as you can see here.",English
+"They are expressing only hexokinase two. No glucokinase and not hexokinase one. In liver cancer, there is either forms",English
+"which, from the high KM hexokinase, glucokinase, to the low KM hexokinase two, and we analyzed tissue micro-array in patient",English
+"with HCC, hepatocellular carcinoma, and we found high levels of hexokinase two, which is correlated with the progression of the disease",English
+"and this is regardless of the reason why this patient developed HCC, even regardless of hepatitis C or hepatitis B,",English
+"alcohol, and non-alcohol mediated HCC. When we deleted hexokinase two in the liver of this mice,",English
+mice are relatively resistant to hepatocarcinogenesis and the incidence of tumors in this mice was markedly reduced.,English
+"When we conditionally silence hexokinase two in human ATCC cell line, we markedly inhibited",English
+"the proliferation of the cells and the growth of the cells in vivo, here, as shown in the upper part of the slide.",English
+"We inhibited, also, encouraged independent growth by silencing hexokinase two and this is a hallmark of cancer cells",English
+"and we could restore encouraged independent growth by really expressing hexokinase two, but not the kinase that form of hexokinase two",English
+"and not by re-expressing glucokinase. The fourth type of cancer is prostate cancer. Here, we employed a mouse model for prostate cancer",English
+"in which the tumor suppressor, Pten, is specifically deleted in the prostate of the mice. We crossed these mice with hexokinase two floxed mice",English
+"and we asked what happened to prostate tumor development. As you can see in the western block, here, hexokinase two is highly expressed in the prostate",English
+"of the Pten null mice and when we deleted hexokinase two, you can see a good deletion of hexokinase two",English
+"and the deletion of hexokinase two impaired tumor development as manifested by the weight of the prostate and the tumor rate of survival,",English
+"which is markedly increased. When we analyzed the section from the prostate of the mice, we found that the deletion of hexokinase two",English
+"not only inhibited the proliferation of the cells, but also increased cell death as measured by cleaved caspase three.",English
+"When we conditionally silence hexokinase two in human prostate cancer cell line deficient for Pten, we increase the sensitivity of these cells",English
+through other therapeutic drugs and I would like to draw your attention to etoposide. This kind of cell lines are relatively resistant,English
+"to etoposides because they have hyperactive ATP, but once we silence hexokinase two in the cells, we re-sensitize to etoposides.",English
+This is the summary of what I just told you and I would like to emphasize three major take home messages.,English
+"First, hexokinase two ablation reverses tumorigenesis of human cancer cells despite hexokinase one expression. Second, during hepatocarcinogenesis,",English
+there is an enzyme switch from glucokinase to hexokinase two and hexokinase two expression is correlated with progress of HCC,English
+"and most important, systemic whole body deletion of hexokinase two in the mouse does not exert an overt phenotype, but inhibits tumor progression",English
+in mouse models for lung and breast cancer and this is a genetic proof of concept that inhibition of hexokinase two is well tolerated,English
+and therapeutic for lung cancer. I would like to thank the people in my lab who did the work.,English
+The work was pioneered by Krushna Patra and the work on prostate cancer was done by Veronique Nogueira,English
+and the work on liver cancer was done by Dannielle DeWaal. These are my collaborators. Thank you for your attention.,English
+We're gonna move right on to questions submitted by our online viewers. A quick reminder to those watching live that you can still submit your questions,English
+"by clicking the Ask a Question button below the slide window, typing the question into the message box and then, clicking okay. The first question that I have that I'm actually",English
+"gonna put to both of you and, let me start with you, Dr. Simon. Are there specific cancers associated with specific changes in certain metabolic pathways",English
+"or do you see the tumorigenic effects on metabolic pathways are more general? - [Dr. Simon] Well, I think that's",English
+"a really excellent question and I'm afraid the answer is, it depends. One thing that's very interesting about renal cancer,",English
+"or at least the flavor that we're looking at, is that, even though they're genetically very heterogenous, in fact, even in a single patient, sub-domains of the tumors",English
+"have extensive genetic and transcriptional heterogeneity, we are finding common metabolic adaptations.",English
+"In fact, the loss of SVP one appears to be nearly universal. Another pathway that's almost equally down regulated",English
+are components of the urea cycle and this is something that we're seeing in each of the nearly thousand patient samples,English
+"we've been able to query in this regard. However, work from Ralph DeBerardinis' Lab on non-small cell lung carcinoma shows that,",English
+"even in a single tumor, let alone tumor to tumor, their dependence on glucose versus glutamine versus fatty acid beta oxidation can be quite variable.",English
+"Coming back to some of the things that we're looking at with regard to, for example, urea cycles, enzyme changes, a very significant inhibition of gluconeogenesis,",English
+"which we think are very particular to this tumor and then, another area that we're working on is their excessive accumulation of lipid droplets.",English
+"The lipid droplet cenotype is in sort of an extreme case, so we think it's somewhat unique to renal cancer and forms of ovarian cancer and sarcoma,",English
+"but not necessarily as pronounced in other kinds of cancers. The effects on gluconeogenesis, we think,",English
+"are more particular to tissues that tend to be more proactive in this regard. I'm afraid, as is very typical the case,",English
+"some things are nearly universal. I think many cancers are gonna be somewhat glucose dependent,",English
+"but others are gonna be more glutamine dependent. It's gonna depend on the oxygenic background. It's also gonna depend on, in a single tumor,",English
+"the oxygen and nutrient gradients I tried to emphasize. I think the honest answer is some things are gonna be more universal, some are gonna be more particular",English
+"to the tissue type and the oncogenic stress and then, even within a single tumor, it's gonna depend on local oxygen and nutrient availability.",English
+"AML, glioma, chondrosarcoma, angiosarcoma. Sorry. I can't remember the name of this tumor.",English
+bsc which is bovine spongy form encephalopathy which is a mad cow disease which you may have heard and this is essentially via feeding cows,English
+infectious proteins and then they develop the symptoms and then if we were to then eat the cow and its proteins we could then develop these neurological,English
+symptoms or another more human type of mad cow is c j d Creutzfeldt jakob disease okay so that's the,English
+first one done that's prion so prions are essentially not alive they're not a cell they're just an infectious protein so that's the first,English
+one done let's move on to number two so here's number two here and this is a virus so we've all heard of a virus this,English
+is the next sized molecule this is approximately 20 to 400 nanometers in size,English
+okay and it's not a cell it's not alive so basically if this was sitting outside a host on the ground on a bench top,English
+outside a living organism it wouldn't be doing anything so it actually has to get into a host into an animal or a plant to be able to do anything and therefore,English
+what it's called is an intracellular obligate parasite,English
+which basically means that it has to that's obligated it has to be within within a cell to be able to be,English
+functional that means to be able to replicate and to be able to um carry out any kind of activity it has to be able to invade a cell so how do we,English
+so how do we classify viruses well you can classify based on the outside here so if you look at this part outside here this is what we call the capsid,English
+cap sid so that's the outer covering of the virus and inside is the genetic material so this,English
+is the genome of the virus so that's another way we can categorize viruses and the only options is whether it is an rna virus,English
+or a dna virus so that's another way we can classify it so the shape of the capsid is one it's genomic material which is either an rna virus or,English
+a dna virus sometimes it's further encapsulated by an envelope okay envelope,English
+as the virus leaves the cell it takes the membrane with it and it wraps around it so this would dictate whether the virus is enveloped,English
+or not moving on to the disease examples how the virus impacts our body and its ability to cause disease will be determined by where in the body it,English
+infects okay so different regions could be the respiratory tract the git,English
+systemic so means the whole system skin and the central nervous system,English
+so let's look at some examples what's what's an example of a virus that impacts the respiratory tract well we know the common cold,English
+so the common cold is a type of virus we know influenza is a virus and also covid,English
+which is really more sars kobe 2. git where we could have rotavirus which is very common in children,English
+mumps systemic so this means infects the whole body but it can manifest out it can be seen in the skin so an example would be chickenpox or varicella,English
+now you could rather than manifest on the skin it might actually manifest in the blood an example of a systemic virus that affects more blood would be hiv,English
+skin specifically so specifically the virus infects the skin would be hpv which is human papilloma virus which kind of forms warts,English
+and then finally i'll come back to that and finally we have viruses that affect the central nervous system example polio now with the virus or with viruses,English
+because they what they have to do is they have to attach to your cell usually by the outside of the capsid that we have in this case these little spike proteins which can bind to our certain receptors on our membrane and then it,English
+can inject its genetic material into our cell and our cell is tricked to produce its machinery and then make new viruses and as a result generally the cell will,English
+die and this is why it causes the disease but sometimes because the viruses is kind of incorporating its genome into ours it can become,English
+mutated and in some cases viruses will lead to mutated cells which then cause cancer and so an example would be the hpv virus which,English
+generally manifests as kind of a wart-like skin disruption but it can also then lead to certain cancers for instance cervical cancers and that is,English
+because of the way that the virus incorporates its genome and then leads to cellular mutation luckily for this as well as a lot of them we do have,English
+vaccines for now moving on to the next one we have bacteria we jump up a new scale now so we go from a 0.2,English
+to 15 microns so what this basically means 0.2 microns in nanometers is 200 15 microns is 15 000 nanometers so we're now at a scale,English
+of up to 15 15 microns now from everything onwards we are now alive we are now an organism we are now a cell okay so everything all the other agents,English
+now unlike the viruses and prions are actually cells and they are alive okay so the first thing with a bacteria it's what we call a prokaryote,English
+mike has done a video on this so i encourage you to have a look that for more detail but prokaryote basically means is the bacteria does have,English
+dna but it's more of a nucleoid rather than a nucleus so it's not a membrane-bound dna organelle so prokaryotes most only bacteria don't its,English
+organelles aren't actually membrane-bound so what are some of the ways we can characterize bacteria well bacteria do have a cell membrane which,English
+is on the outside but what they additionally have is a cell wall so they have this structure that goes around it the reason why it has that is because,English
+its membrane like our membrane but it doesn't have exactly the same structure is it's more leaky which means if fluid gets into it,English
+it will keep expanding and then eventually explode so luckily for the bacteria it has this outer cell wall which we call,English
+peptidoglycan that's the structure of the cell wall so basically it means it's a pepto protein glycan sugar now there's two main categories of bacteria based on the cell,English
+wall if it's got a really really thick cell wall it's what we call gram-positive and if it's really a thin cell wall but,English
+it's got another membrane on the outside of it it's what we call gram-negative okay so that's the way we can carry the rice further characterize bacteria now,English
+another way we can characterize bacteria is its shape if it's shaped like circles like this it's what we call cocci,English
+well if it's shaped like a rod it's called bacilli and further if it's clustered so if let's just say it's in these little,English
+grape-like clusters that's called staff and if it's in long strings that's called strep,English
+so this is further characteristics by how it appears so we have round and rods staff strep so we may have terms that you've heard of now,English
+called staphylococci or strep or cocaine another way we can categorize is whether it lights oxygen or not so if it needs oxygen to survive it's what we're going,English
+to call aerobic but if it can survive without oxygen it can be called anaerobic now one thing i did forget to mention is,English
+that bacteria unlike viruses which is an intracellular obligate parasite bacteria is a bit of mixture of a whole lot most of them are extracellular,English
+which means most of them survive outside our cells there are some small number that are obligate intracellular,English
+so they have to be in our cell to survive and replicate and produce metabolism et cetera and energy and some are what we call faculty,English
+which means they can kind of move between intracellular so there's three kind of characteristics of bacteria most of them,English
+are extracellular means they'll live outside the cells you know extracellular fluid to get its nutrition but they can replicate they can get their energy,English
+outside the cells obligate intracellular they have to be in the cell to be able to do all their functions and facultative means they can move between and this is important because when we look at the disease these is how we,English
+break it down the obligate intracellular examples would be chlamydia so chlamydia bacteria have to be in the cell to be able to gain its energy and,English
+do all its functioning as a result they can cause scar into the cells so certain locations of where they call scarring could be in the reproductive,English
+tract more so for females and that scarring can lead to infertility or in the eyes it can cause scar in the eyes and leave some to certain forms of,English
+community acquired pneumonia so this is a bacteria that doesn't really have so much a cell wall like the others and so it has the ability to to live within the cell,English
+and then finally we have the extracellular and we went through some examples so we could have streptococcus so streptococcus as an example would call strep throat which is,English
+um within the upper respiratory tract we have staph aurus staphylococcus aureus oris,English
+means golden so this is a type of bacteria that would look golden and that is common for skin infections and another one i'll just throw in is,English
+clostridium tetinae i'll just write the last part and this one is interesting because there's some bacteria that produces if,English
+it's gram-positive bacteria it can produce exotoxins which can cause harm within the body and gram-negative use have endotoxins which is a lipopolysaccharide which is incorporated in its membrane it's out of membrane in,English
+the cell wall so when it's destructed it can release the endotoxin and that can cause serious inflammation and problems in the body whereas the exotoxin like,English
+move to much bigger cells now so what we got now our fungi the size for fungi is 2 to 200 microns now fungi and moving forward is,English
+what we call eukaryotes so these are like our own cells so they have membrane-bound organelles including the nuclei they have a cell,English
+wall they have cell membranes but they also have a cell wall but their cell wall is not made out of peptidoglycan in this case it's made out of chitin chitin is a polysaccharide which is the same kind of structure as insects,English
+like spiders fungi can replicate sexually and asexually and they do rely in many cases things called spores which are kind of like mini seeds when fungi,English
+cause diseases so for this part down here it's what we call mycosis and some examples are superficial infections,English
+usually coming back from the fungi releasing enzymes irritating the skin causing inflammation so itchiness and redness some examples would be tinea,English
+ringworm which the tinier if it affects the top of the head is tinier capitus if it affects the feet it's tinier pettis which is essentially athlete's,English
+then finally we looked at deep infections so this is within organs such as lungs and blood,English
+this will actually lead to some serious outcomes this is usually in cases where a person is immune compromised and the and the fungi gets into the lungs and,English
+known as protozoa or protist these are approximately 1 to 50,English
+multicellular as you can see from the cell here all these cells have all the organelles potentially what our cells have so they would have a nuclei mitochondria and other organelles to help with all their metabolic functions,English
+fashion that will go into the blood and travel to the liver this will then hatch in the hepatocytes and then rupture out of the hepatocytes which then goes in the blood and jumps into the red blood cells this is now going its own cycle,English
+which basically produces through mitosis this is asexually gametes and this this cycle in the red blood cells is where you see the,English
+symptoms of malaria and then once this spills out of the red blood cells it will be in its gamete form another mosquito comes along and sucks up the,English
+blood picks up the gametes which then meet other gametes within the mosquito and this is a sexual phase and then the whole cycle continues so malaria,English
+actually isn't the mosquito it's just the vector the protozoa is actually the infectious agent guardia is a digestive protozoa so this is similar but it comes,English
+go through mitosis and then they go into an early lava form where they latch onto the side of the digestive tract they will suck nutrients,English
+out and this would probably cause irritation to the wall inflammation make it more leaky decrease surface area and this causes the excessive amounts of,English
+back out in the poo and then that would contaminate the next cycle of food and water and then it continues that way finally we're left with helmets,English
+hell mints which are worms or ectoparasites and so these could be anywhere from three millimeters in size all the way to,English
+classify at least the helmets these can be classified in terms of whether they are round to flat,English
+"an estimated 390 million infections occur each year, and out of those, about 24,000 die from dengue. As for Zika, during the famous 2015, '16 Zika epidemic",English
+"in the Americas, more than 40,000 infections were recorded in the US and US territories, and in Brazil, the epicenter of the epidemic,",English
+"Brazil had over 200,000 Zika infections and almost 9,000 Zika-related birth defects. I've told you, people have been trying to",English
+do dengue research for over 70 years. Why are these viruses emerging and re-emerging? And the answer to that question is really us.,English
+"Massive urbanization. People are moving from villages to cities, and our habits, which includes the use of these non-biodegradable containers, which of course,",English
+"are great habitats for these virus-transmitting mosquitoes. And of course, in many countries, there's this massive breakdown of programs",English
+"that are required for vector control and also the general public health program infrastructure, and in this day and age, we can be here in San Diego,",English
+"and then in less than 24 hours, we can be in completely different parts of the world thanks to this global movement. So it's not a surprise,",English
+"now in 2019 and 2020, we're hearing countries like Nepal, who people typically think of as this Himalayan country, now has to deal with dengue.",English
+"So now, I would like to focus on the big question surrounding infections with these viruses, and specifically dengue.",English
+Why don't we have treatments and an effective vaccine against dengue? The answer to that question lies in the fact that,English
+"these viruses exist as four viruses. For dengue, we call them as dengue serotypes one, two, three, four.",English
+"So what this means is that a person does not develop a life-long immunity to infection with dengue. In fact, you can be re-infected,",English
+"a second, third, and perhaps a fourth time, and numerous epidemiologic studies have shown that the single greatest risk factor",English
+"for coming down with severe dengue disease is secondary dengue infection. This is in the case of older children and adults, and in the case of infants,",English
+"it's being born to dengue-immune mothers. So what's so common about these two groups of patients that allows, this prior exposure to dengue,",English
+"being the single greatest risk factor? So before I give you the answer, I have to give you a little bit of background on the adaptive immune response",English
+"to viral infections in general. You have these viruses, dengue. They infect people, and the two major arms of the immune system come into play.",English
+"The first one is called B cells. These are the cells that make antibodies. Antibodies are the ones, they recognize and they destroy these viruses,",English
+"and we call them, they neutralize those viruses. In contrast, T cells, these cells recognize virally infected cells and directly kill them.",English
+"In the terms of the vaccines that are approved for human use, most of the vaccine design is based on this principle here",English
+"where the vaccine-induced antibody responses are directly destroying those pathogen viruses or bacteria. So now, to go back to our central question,",English
+"why are these people with secondary dengue infections and these infants who were born to dengue-immune mothers, they're coming down with severe disease?",English
+"And the answer has to do with the fact that both groups of individuals, they have these antibodies. These antibodies are coming from first infections",English
+"in these people with secondary infection. In the case of these infants, these antibodies are coming from their mother, these are maternal dengue antibodies.",English
+"Based on these epidemiologic observations, this hypothesis called Antibody Dependent Enhancement, or ADE for short, was formulated.",English
+"According to this hypothesis, dengue, this is the virus here, binds with the antibodies. Instead of the antibodies being neutralizing",English
+"and getting rid of these virus infections, these antibodies are sub-neutralizing. So what that means is that now, the virus antibody immune complex,",English
+"they're able to enter these cells. Normally, these cells would not have been able to be infected with this virus.",English
+"Now, through this antibody pathway, they're able to enter these cells, replicate, and these high levels of viral infection",English
+"then triggers all these hallmarks of severe dengue. This hypothesis called ADE, it was proposed almost half a century ago,",English
+"let me explain how this hypothesis fits in the context of human infection. During primary infection with dengue,",English
+"by definition you don't have secondary infection, people develop a nice antibody response, and most people develop actually",English
+"no disease or just mild disease. In the case of secondary infection with the same serotypes, so this is homologous,",English
+"same serotype, the antibody response developed during the first infection, they will be able to recognize and neutralize,",English
+"get rid of this virus infection. So the person is now protected and has no disease. Now, during secondary infection with a different serotype,",English
+"so this is heterologous, so I have a different color virus, the antibody response to the first infection, not all of those antibodies will be able to",English
+recognize the second serotype. This leads to this sub-neutralizing antibody coalition and that leads to this ADE-mediated enhancement,English
+"of disease severity, and in the case of infants, these maternal antibodies, it doesn't matter now if the baby's infected for the first time,",English
+"second, third, or fourth time. These maternal antibodies are sub-neutralizing, so that means they're not good enough to neutralize, get rid of the virus infection.",English
+These sub-neutralizing antibodies again mediate ADE and results in severe dengue in those infants born to dengue-immune mothers.,English
+"So back in 2010, we provided support for this hypothesis by developing a mouse model. We performed a rather simple experiment",English
+"where we took a mouse, injected this mouse with antibodies against dengue or this immune serum from previously infected people or animals,",English
+"then challenged this mouse with dengue. Exactly as predicted by the ADE hypothesis, as the infection progresses,",English
+"we see high levels of viral infection, we see this phenomenon where you have all kinds of immune molecules or up-regulators in this phenomenon called cytokinetic storm.",English
+We have vascular leakage and ultimately the mouse dies. What this work showed is this phenomemon of antibody-dependent enhancement,English
+"converts a mild disease into this lethal disease. In this mouse model, mild disease is, if the mouse was infected only with the virus",English
+"and not antibody, this mouse would survive. It would get a mild disease. And you can imagine, as most of the vaccines that are currently approved for human use",English
+"are involved around inducing antibody responses, this process called ADE can be a problem for designing dengue vaccines",English
+"based on the traditional vaccine approach. Now, since 2016, since the emergence of Zika in the Americas in 2016,",English
+"in these counties that are endemic for dengue, we've been forced to ask many other important questions related to how the immune response to one virus",English
+impacts infection with the other. So one of the first questions that we've been addressing in my lab is,English
+"how does prior exposure to dengue impact subsequent infection with Zika and vice versa? Again, this is an important question in the field",English
+"because these viruses co-circulate. Those dengue-transmitting mosquitoes, of course, are in the same countries, same geographic locations,",English
+"and the immune response, both the antibody and the T cell response to these viruses, are highly cross-reactive, meaning the immune response to dengue",English
+"can recognize Zika and vice versa. Again, we used our favorite model. These are mouse models",English
+"and we did this type of experiment where we took a pregnant mouse infected with Zika, and as expected, Zika replicates at high levels",English
+"in these pregnant animals and both the mother and the babies die. In contrast, if we infect the females with dengue",English
+"and then challenge with Zika, we see that this mother has very little Zika virus. It survives the Zika infection",English
+"and the babies are also born healthy. This kind of experiment showed that this prior dengue exposure, this pre-existing dengue immunity,",English
+"actually provides cross-protection against subsequent Zika infection. We reported our results back in 2017 and 2018,",English
+"and last year in 2019, three different groups representing three independent human cohorts, indeed observed the same phenomenon,",English
+"which is this prior dengue exposure provides cross-protection against subsequent Zika infection,",English
+"even against Congenital Zika Syndrome. The human data allowed us to, gave us more confidence in our mouse model",English
+"of the sequential dengue and Zika infection, and we next asked this following question. How does prior exposure to dengue",English
+"influence Zika evolution? Again, going back to the beginning of my talk, these are RNA viruses.",English
+"Because of the RNA polymerase that is highly error prone, these viruses have high mutation rates.",English
+"So, on the left, is the natural transmission cycle between the mosquitoes and humans. What we decided to do is mimic",English
+"this natural transmission cycle by replacing the human host with a mouse, and instead of using these mosquitoes,",English
+"we decided to use mosquito cells. We took a human isolate, so this is a Zika strain isolated from humans, injected it into the mouse,",English
+and the virus coming out of the mouse was injected back into these mosquito cells and the virus that was grown in these mosquito cells,English
+was injected again back into a new set of mice. So we repeated this cycle 10 times and we used two different types of animals.,English
+"The first one is a naive animal, so they've never seen any kind of virus before, dengue viruses before, and the second kind of mouse",English
+"is a dengue immune mouse, so it's been previously exposed to dengue and has cleared the infection and now we're conducting this passaging experiment.",English
+We isolated these two different what we call mouse-adapted Zika strains. This Zika Naive p10.,English
+"It was passaged only in these non-immune naive animals, and Zika Dengue Immune p10 means this is the virus that we isolated",English
+"from these after passaging alternatively between these mosquito cells and these dengue-immune animals. When we sequenced these viruses,",English
+"we found two mutations in this Zika Naive p10 virus. These exact same two mutations were also present in this Zika Dengue Immune p10 virus,",English
+"plus this virus strain also had an additional mutation in the viral genome. In the next slide, I'll show you",English
+"what these viruses do. When we infect a naive animal, this is the non-immune, they've never seen dengue before,",English
+"we see that 100% of the mice that were mock-infected, just with the virus, and they survive, as expected. In contrast, if the mice were infected with Zika,",English
+"the parental isolate or these two mouse-adapted, mouse-passaged strains, 100% of them die and there's really no difference between",English
+"these three different viral strains. So this is as expected. Now, when we perform the same experiment but instead of naive mice,",English
+"now these are dengue-immune mice, we see that the parental virus, if these mice were infected with the parental virus, 100% of them survive, meaning this prior exposure",English
+"to dengue provided this cross-protection against Zika, just as expected. However, when we infected these animals now",English
+"with our two mouse-adapted viruses, 100% of these animals die, and this virus, the green line here, these are the mice",English
+who usually require a big P article into the neck meet the five-year survival rate for doodle rd no carcinoma is 56% for node-positive and 83% for,English
+node-negative disease patients with metastatic disease at the time of diagnosis rarely survive past six months GIS tees are found most commonly in the,English
+stomach but can be found in other parts of the duct they occur most commonly in the 50 to 70 year age group although the causes unknown patients with neurofibromatosis have an increased risk of developing these types of tumor,English
+patients may be MC asymptomatic and the tumor may present as an incidental mess on a CT scan symptoms include natural gee pain nausea vomiting be seized or Molina surgery is the most effective way,English
+of treating GA STS and the tumor is radial resistant and is not sensitive to convention chemotherapy imatinib is a tyrosine kinase inhibitor that has been,English
+shown to be effective in advanced cases and may also have a role in action with people here in this you can see this very thick D is d and growing outward CA,English
+lymphomas account for 15% of small bowel tumors primary small bubble lymphomas are most common in the item due to the relatively large amounts of kept,English
+associated lymphoid tissue this one is the case that I did and this one is the IDM with this large and informa hood now virtually all small bowel lymphomas are,English
+non-hodgkin b-cell lymphomas that arise either de novo or in an association in association with the pre-existing systemic conditions such as celiac,English
+disease Crohn's disease or immunosuppression that is a micro genacore with HIV the presentation of these patients is highly variable imaging can help make a diagnosis but surgery is frequently required for a,English
+histological confirmation for stage 1 & 2 intestinal NHL treatment includes white segmented bowel resection and at UNT chemotherapy Machop regimen is,English
+pretty good next for neuro endocrine tumors account for around 25 to 30 percent of small intestine malignant Newcastle these tumors arise from the,English
+intera from open cells of intestinal crypts small mobile needs tend to be more aggressive than their appendiceal or rectal counterparts which is typically we may remain asymptomatic until advanced disease causes local,English
+complications of the obstruction pain or bleeding or the systemic carcinoid syndrome metastases are rare in tumors in less than one centimeter in size while half of humours between one to two centimeter,English
+metastasize and almost all tumors more than two centimeters spread here you can see this tumor here we central necrosis and in publication the,English
+carcinoid syndrome implies semantic metastatic spread hormones relieved by released by carcinoid tumors are metabolized by the liver and produce no symptoms whenever however when these hepatic metastases drain to the systemic,English
+circulation causing diarrhea and flushing of the face neck and upper chest we can see this flushing of the face and the neck in the upper chest tachycardia hypotension bronchospasm and hormone may also be observed in,English
+long-standing translates in all patients developed right heart and o cardial and vulgar fibrosis diagnosis of neuroendocrine tumor is made by measuring a 24-hour urinary 5 hydroxy and all acidic s intima this is the,English
+around eighty two hundred percent but in lower specificity then urine Pfeiffer dropsy endure the city isn't levels when entertaining in differential these,English
+conditions need to be considered now if you look at these conditions will have irritable bowel syndrome the plaque also disease chronic gastritis these are benign conditions then we have been Island he normal and so on and so,English
+mainly mean a hyperbilirubinemia which may be related to ability obstruction from perry antenori tumors elevated transaminases levels also may,English
+be found in their presence of liver metastases carcinoembryonic antigen levels may be elevated plain abdominal acceptance may live in partial or complete small bowel obstruction property ACH with small bubble,English
+follow-through show abnormalities in 53 to eighty three percent of patients with small bowel cancer small power and care places studies are done with contrast barium enema which has a sensitivity of around 90% 95% however it,English
+is difficult to perform as it requires the long tube to be inserted in the small bowel to in still air and contrast so you've got this small bowel and we've got this to dinner and here and we've got this and we've got to get this tube,English
+all the way from here to this still air into thee and contrast into this small bowl that's his work in dialysis means now abdominal CT scan may be sedate,English
+beside an extent of local disease and the presence of liver metastases cross-sectional imaging can in many cases detect small ball of those abilities that are usually inaccessible to conventional endoscopy modern multi,English
+detector computer tomography permit accurate diagnosis complete pretreatment staging and olaf of these videos in this coronal CT scan this is the jew Needham,English
+with the tumor this is the pancreas and this tumor is indistinguishable cannot be separated from the pancreas and here in this region this one here this bit,English
+here this is the dilated to Danone proximal to the lesion magnetic resonance and cairo places in this one here this is demonstrating small bowel,English
+up information this is the small bowel you place information I couldn't find one with a tumor but this is very good basically just demonstrating in Tarot places now very I'm gonna graph on this side here this is demonstrating a,English
+typical Apple correlation which is caused by an adenocarcinoma of the small bowel producing a partial obstruction with a dilated proximal bowel so here is the apple core this one and this one is your Apple I'll,English
+paint it red and this the yellow width is the one that you've eaten off okay and here is your proximal bowel which has been which is not heated because of,English
+the stenosis now in those rare cases of bleeding due to a small bowel tumor the diagnostic approach is the same for all cases of,English
+lower GI bleeding in case of negative upper and lower GI endoscopy tag RBC cells hands and angiography can be helpful in localizing the disease,English
+process capsule endoscopy has a better sensitivity and specificity and is performed for occult GI bleeding here you can see this one is an adenoma from,English
+a pail found a pretty endoscopy with small bowel at Cosco P which is pushing towards okay may identify and allow biopsy of lesions in the Judean Amanda,English
+Jeanette pushing telescope it is difficult to performed it needs two scopes and there is if there's an outer sheet and this balloon is a glass inside and then it's pulled back here so it's a difficult and I'd was sort of a,English
+procedure however do not copy with retrograde Dalia scoping may be useful in identifying alien tumors so for the proximal jejunum by the mouth for the eye Liam - now circularly section provide the only hope of cure for,English
+patient - it's small bowel in the carcinomas and Zarkov months this is possible in approximately two-thirds of patients with an inner carcinoma the remaining have unresectable disease as a result of extensive local disease or,English
+metastases to regional lymph nodes the liver or the peritoneum wide local incision excision is used on the young today distributing them content in them,English
+or IDM patients with lesions in the proximal venenum including those in the parry Parry and pewter revision should undergo a peg gotta go to the next bit,English
+so if we got this one here and this is your pancreas and the lien is here they need to go in and get it over to the neck meat which has an operative mortality rate of less than PI procedure in good hands,English
+resection with a 5 to 10 centimeter margin of non and more power on either side of the lesion and the effectiveness entry is performed,English
+for these tumors and you also remove the lymph course training this tumor now since in human cytotoxic chemotherapy and radiotherapy of are of little,English
+benefit surgery is the mainstay of treatment for deaths during surgery the entire bowel is inspected 30 percent of cases have synchronous legions segmental,English
+resection including adjacent 'simply is the mainstay small tumors less than one centimeter of the third or four portions of the duodenum are either locally excites or included in a segmental resection large to do tumors,English
+and area tumors require again a big critical to the neck be locally advanced disease requires a crucible section to delay occurrence of hepatic metastases and Carson are chained wrong solitary inaccessible level regions should be,English
+resected an optional tried offered excellent filiation of carcinoid syndrome symptoms in patients with in unresectable disease now next are,English
+expectancy for patients with resectable node-positive disease the median length of survival is 15 years with unresectable intra-abdominal it sees median length of survival drops for five years and is three years for those with,English
+hepatic and metastasis patients who undergo resection foreign in the partial no mas have an improved 5-year survival data from forty to sixty percent then,English
+the eighty of surgery is required for symptomatic advanced disease such as industrial obstruction I need tumors are more likely to develop intestinal obstruction then general tumors most likely due to the smaller thinner so on,English
+small caliber of the model emergency surgery for these patients relieves obstruction but precludes a complete and negative margin resection despite efficacy of imatinib for GST surgical resection remains the primary,English
+therapy for small bowel sarcoma although 35 to 50 percent are an acceptable because of metastatic disease similar to proximal Davina Ladino,English
+carcinomas small bowel sarcomas located in the earth in this region should be secured with a pancreaticoduodenectomy those in the distal to determine changing room or Allium should be dissected with wide margins tumors close,English
+to the eye leaves which revolve may again require a right to my colectomy lymph node metastasis is rare and therefore an extensive lymph node dissection is not recommended the section appears to prolong survival but,English
+recurrence with widely metastatic disease is typical in these cases no standard regimen demonstrates benefit in an a human or metastatic setting for,English
+small-dollar many new carcinoma and because of the similarity to similarity rule colorectal adenocarcinoma arrangement containing 5-fu with new,English
+covering may be used new religion detective in colorectal carcinoma such as Renata can and obsolete at and may also be considered in combination with,English
+by Fisher small bowel sarcomas most of which are cq+ Gies these are resistant to site of toxic chemotherapy however patients with advanced disease,English
+may be treated with matted in patients who have blundered one surgical resection for localized disease should have a follow-up visit in the outpatient,English
+setting every three months who says for symptoms or science suggestive of recurrent disease CBC count and liver function tests may be checked periodically to identify anemia related to blood loss or abnormal,English
+And the question is why is an ADE a problem for infection with other viruses aside from dengue What is it?,English
+"- The question related to ADE is a really important one, not just in the context of dengue infections, flu virus infections but we think he may be applicable",English
+to other infectious diseases where you have this immunological across reactivity. In that this cross reactivity could be good,English
+and I'm Susan Kaech gave a beautiful presentation and how Jenner used it to his advantage to create this first concept of vaccination,English
+"from getting cowpox to eradicate smallpox now. And so the cross-reactivity is good in that case and unfortunately with diseases such as dengue,",English
+"we're finding out that this cross-reactivity besides being good can also play a pathogenic role, a bad role. And instead of providing this cross protective immunity,",English
+you could actually come down with severe form of these different viral infections. And in the current time in trying,English
+"to bring our focus back to COVID, in fact there are several investigators in the coronavirus field who are looking into",English
+"the dengue field, what we know about ADE and are thinking perhaps there may be issues related to ADE, for instance, there are young healthy people",English
+"who are coming down with severe coronavirus, severe COVID. It's not such a disease that causes severe disease only in the elderly or with comorbidities",English
+and one of the hypothesis surrounding why these young healthy individuals are coming down with severe COVID disease may be related to ADE.,English
+"Do these people's exposure to these common cold causing coronaviruses which are mild, but there is enough cross reactive immunity",English
+that you can imagine under certain conditions in certain people when that antibody response or it could even be T cell response is no longer good enough to protect,English
+"but instead now causing the more severe form of infection. So we think despite the field, taking multiple years",English
+as I explained in my talk over 50 years to really understand this concept of ADE using animal models and using epidemiologist field studies,English
+"in multiple decades, multiple countries, we can apply what we've learned from the dengue Zika field",English
+"and try to see how we can develop better vaccines against you know, the corona viruses but in particular against COVID.",English
+So we think this concept of ADE is really important and there is no reason why it has to be specific for the Flavivirus field.,English
+and TB being very notable vaccines that have not led to the successes that one would hope. My honest feeling is that there was this virus COVID-19,English
+is not COVID too is not going to be a as much of a challenge I think in part because it's not one of these shape shifters like we see with HIV for instance and other pathogens,English
+that do have ways of evading by changing the antigenic profile that the pathogen has. And also we already have evidence that the antibodies,English
+that are being produced can be protective and neutralizing. So there are some viruses for which it is more difficult to develop neutralizing antibodies particularly HIV.,English
+So I feel like this virus isn't holding those kinds of properties that have been historically more challenging to deal with but of course,English
+it does have a base of features. We know it's changing the interferon response very profoundly. We know that the pathology that is causing the death,English
+is due to over over exuberant immune responses. So those you know understanding the nature by which those viruses contribute leading,English
+to those those changes is gonna be important but just my immunological gut tells me that we are going to develop a vaccine,English
+that will be protective. And I honestly think what's going to be important is that the vaccines are being currently tested,English
+that we focus not only on the spike protein which is what people are but consider the other proteins and the virus as well.,English
+I'm a little bit nervous about the vaccines that just focus on the spiked protein and some ways for the antibody mediated enhancement that Sujan just was talking about.,English
+"for our infectious disease pathogenesis. - Yeah, I thank you, a good question. Well, as I show in one of my slides",English
+and many of you actually showed the slides of the cell surface being decorated with glycans; glycoproteins and glycolipids.,English
+And at the very tip of all of these glycans is the sugar nine-carbon sialac acid. So the sialac acids at the very tip of all glycans,English
+at the very edge of the sugar coating of each cell. So it's there available and that's what most of the viruses and pathogens see,English
+"as they're traveling by and then the bloodstream or forever. So these sialac ass is not only interact with pathogens, they also interact with circulating cancer cells,",English
+"platelets, immune cells, so they are really so even in I think... The MERS virus was even though everyone",English
+"was talking about the protein-protein interaction, there was a sialac acid interaction that was discovered. So like the human influenza virus recognizes",English
+the sialac acid which is used to bind and invade and you can even inhibit that using dengue flu. So we're hoping that something like that similar,English
+that this evolved rapidly evolving Siglec which is the sialic acid recognizing receptors have been associated with a lot of the evolutionary events,English
+that have happened over the centuries. So some of the Siglecs for example are present on cancer cells and that might influence,English
+that there are human specific features of group B strep infection,English
+"and immunity for example, Group B Strep has molecules that are variants determinants",English
+which target specifically human IGA but not IGA from closely related species.,English
+And the experimental animals only target human factor H and not other complement regulatory proteins.,English
+"The most other important medical incidents of GBS disease other than humans is in mastitis and cows, but those strains seem very distantly related",English
+"from humans and there's not a lot of evidence of exchange. However, pets like dogs and cats can rarely get disease from their human owners and there are aquatic forms",English
+of Group B Strep and marine mammals and in fish which do seem to have the potential for transmission back and forth,English
+"and share virulence factors and genetic profiles with humans, so perhaps the advent of fishing and aquaculture as a subset of agriculture",English
+may have been an accelerator. All these differences though pose a great challenge to modeling of group A strep,English
+"and other you know pathogens like Group B strep, Group A Staph aureus in animals; mice, rabbits, because they have such unique features.",English
+Some of the toxins that drive the pathogenesis in humans don't target the cells in the experimental animals.,English
+The super antigens which can give you toxic shock syndrome don't tend to react and produce the clonal expansion of the T cells in the experimental animals,English
+which makes therapeutic development and vaccine development challenging because you worry that a candidate therapeutic or vaccine,English
+that performs best in animals may not be the one that ultimately performs best in humans when you go to the large phase two and phase three trials.,English
+Why did artemisinin resistance of plasmodium only develop once it was used in its synthetic form and not during the thousands of years before,English
+"when it was used as artemisia annua, sweet wormwood as a natural drug? Does such knowledge affect the development",English
+because it's mostly just correlation with molecular markers because it's very unlike you know testing the CF strap or resistant to ampicillin or whatever antibiotic,English
+you're using where you can easily culture the bacteria out from your bloodstream and then put them on a plate with a filter disc.,English
+You know taking a parasite out especially in an area with poor resources and then taking them into cell culture and then testing them after a few days to see,English
+if they they respond to a drug is actually incredibly difficult. So I would say there probably was resistance,English
+in the frequency with which younger people become ill when they get infected compared to older people.,English
+It's also true that people who were younger tend to shed less virus during the course of their illness. Now it's hard to separate those two out because,English
+"in general, the more severely ill you are with this disease the more the higher the titers of virus. So they go kind of hand-in-hand.",English
+"One of the curious things that may also be an issue with vaccine development is that in the vaccine studies done in animal models,",English
+"younger animals tend to be much more responsive to vaccines and then older animals, it may turn out that we will have",English
+"And when you think about that you might have to have different either vaccines in general or different vaccination regimens,",English
+"different vaccine doses, different regimens to be able to sufficiently stimulate the adult immune response for lasting immunity.",English
+It's also true that immunity to this class of viruses drops more rapidly than say influenza and some of the other viruses we encounter.,English
+Then may be one of the reasons why this virus which evolves more slowly from the molecular perspective and populations can still come back,English
+and pals return to waves of infection through the population at three and four-year intervals. So I think we have a lot to learn about differences,English
+in the immune response that occur in this virus compared to older people. We still don't understand the recently described syndrome,English
+that were seeing kids which is a hyper inflammatory multi-organ syndrome very much like Kawasaki disease,English
+that we only have recognized in the last several weeks and only in Europe and in the U.S. was not seen in tens of thousands of cases in China and in the East.,English
+as Kawasaki disease of which there is some overlap and the clinical features as well as toxic shock syndrome,English
+which could complicate Staph or strap infections I think this clearly would suggest,English
+that there are environmental co factors or immuno genetic predispositions which have been well documented,English
+in Kawasaki disease for example and another factor I wonder is whether there are special aspects of immune senescence,English
+as we age or just the cumulative damage that occurs to our lungs living in a world,English
+that is not pristine but polluted that are below clinical detection until they get a life-threatening challenge,English
+like COVID-19 pneumonia. And that children have not accrued that amount of change over time,English
+which could be interfering with normal epithelial immune responses. It's also possible maybe that the virus,English
+has a completely different spread and is more of a systemic viremic disease and children associated with minimal immune response,English
+"in the majority of patients, but then the potential for this delayed immune-mediated disease in the unfortunate few.",English
+There's you know quite a few other diseases like Epstein-Barr virus or poliovirus where if you encounter these viruses very young in life,English
+"you're very likely to have you know quite a difference sometimes you know asymptomatic or common cold experience,",English
+whereas people experiencing them later in life have much more inflammatory potential and much more potential for the serious symptoms,English
+that you normally associate with those diseases. I'm gonna look on my list here and I have a question for Mandy Lewis.,English
+"What aspects of human culture, the way we interact in our society could affect the vaginal microbiome of women?",English
+"family planning, menstruation so-called hygienic behaviors as well as other intra vaginal and genital cutting practices that happen in different places.",English
+So you know potential mechanisms by which those behaviors might change the microbiome haven't really been extensively studied but it does appear that from what we know sex partners seem,English
+"to share your genital microbiomes. The microbiome can change, microbiome changes can be triggered by menses and also the use of hormonal contraception.",English
+And then we also know that vaginal washing has been linked with higher risk types of vaginal microbiomes possibly,English
+by eliminating beneficial bacteria but this requires more study. And so I think you know one can imagine a number of different ways that,English
+"and it's from Jason a CARTA student. And he asked, in much the same way that malaria has indirectly resulted in phenotypic changes in humans",English
+e.g sickle cell and selenium has the competition between dengue and Zika produced any adjunct phenotypic changes,English
+"in humans deleterious or otherwise. And I would like to add you know, are there other examples of viruses that have left an imprint on the human genome?",English
+"of dengue infection in humans is these viruses they circulate in Africa, but we don't really hear about dengue being",English
+"a major problem in Africa. In fact all four serotypes, Zika, all these different Flaviviruses are co circulating and usually this co circulation",English
+"of multiple different dengue serotypes, multiple different Flaviviruses is not a good outcome in terms of how that impacts dengue disease severity.",English
+"And based on a couple of anecdotal studies done in Cuba, it seems that the African genetic diversity perhaps",English
+may be protecting that those individuals from coming down with the severe form of dengue infection and in whereas in the case of people in Asia,English
+and people in the Americas both the north and south people can come down with severe dengue. So in terms of how this interactions,English
+between the virus and the human host that is a really important question vastly under studied and I think that really calls to people in the field,English
+"just being understudied you know, because they just say you have a fever and they just assume it's malaria and--",English
+"- Yes, so just like exactly the same issues that we're facing with in terms of the healthcare system of a given country determines",English
+"of dengue in Africa, we don't really know the true incidents of both the mild and the severe consequences of these viral infections.",English
+"And it really again, it's unfortunate reality of the world we live in is this different types of health care system infrastructure",English
+and whether it mirrors the Out of Africa Movement of ancient human populations and are there examples of Salmonella anthroponosis,English
+"was present in ancient humans. And thanks to the advancement in genomics. For example, we are able now to isolate genomes",English
+from ancient humans. And actually this February there was a very interesting study where they showed it were able to isolate Salmonella,English
+from humans 6500 years ago. And that led to the hypothesis that Salmonella might have emerged in humans,English
+with the Neolithic Revolution when humans switched basically from hunting and gathering to farming and the idea is always that Salmonella,English
+has been spread from the animals to humans with the advent of farming. But something interesting that came also from this study is that for example animals,English
+are playing exactly from transmitting Salmonella to people but Salmonella in pigs essentially being found as 4000 years ago.,English
+"So this lead to the hypothesis that is actually humans who transmitted Salmonella pigs. And yes, now pigs are sources of Salmonella",English
+but it seems that when humans first some animals transmitted to humans and the humans eventually transmitted to pigs. So I think you know in general we can consider Salmonella,English
+"and the non Thai food of Salmonella has because they are transmitted from humans but at some point, we were the source of Salmonella",English
+but I'm not gonna be able to give an extremely satisfying answer. I think this is something that we still cannot necessarily provide metrics on,English
+but you can think about some of the events that have probably had the largest influence. One from a genetic perspective on our genomes would be founder effects.,English
+And we've had outbreaks and pandemics of the past where there were significant magnitude of death in the human population obviously,English
+that is going to have a founder effect and have a major impact on our genome that we propagate. The second is the prevalence of the pathogens.,English
+"And I think this is something that's more about adaptation and how we coexist within more of endemic way as we clearly can see genetic,",English
+we just discussed some of them genetic alleles and changes that are are maintained within the population as a consequence of the coexistence with certain pathogens.,English
+There is a little bit of evidence as well that are regions of greatest diversity in our genomes such as our major histocompatibility complex,English
+which is the MHC which is what is used to present the foreign antigens to our immune cells such as our T cells to see the pathogens.,English
+"That the diversity in the high level polymorphism in these alleles is shaped by, in some ways by certain pathogens more than others",English
+and I think this has been probably best seen in looking at another region of our genome which is in our immunoglobulin genes,English
+such as the ones that create the rearranged receptors for T-cell receptor and our B-cell receptor are produced the antibodies,English
+that these germline encoded regions of say regions of those variable domains for instance that are found in the antibodies,English
+that the germline sequence of those already has natural affinity for certain pathogens such as influenza.,English
+don't have some evolutionary advantage to responding to those but obviously there's still further adaptation,English
+"that must happen with the response for better protections. And then our innate immune system which is our germ line, you know hardwired form of defense",English
+that we evolved with that certainly has been shaped by the pathogens. But to answer the question we're specifically about which class I don't think it's gonna be a particular class,English
+that might have happened over history that had major founder effects on our genome. - Thank you. Victor?,English
+because she is equally accomplished as a geneticist as an infectious disease specialist. The malaria pestilence has resulted in several diseases,English
+"as a by-product in regions where it's endemic like sickle cell disease and polycythemia, are there any pathogens outside of malaria endemic regions",English
+that have analogously produced byproduct diseases in which you say human heterozygotes experience a protective benefit.,English
+and I'm thinking of mutations the cystic fibrosis genes and how they may provide protection against cholera.,English
+So there is a theory out there that the cystic fibrosis allele maintains which affects I believe a sodium or chloride channel,English
+and this is maintained in the population because it protects against cholera which was a big killer of children as well.,English
+"- Well, I guess you know with respect to cholera yeah. So the CFTR as a anion pump that produces you know releases chloride and bicarbonate",English
+and I guess mutations impairing its function could reduce the massive volume of secretory diarrhea experience there.,English
+Actually it's very interesting that Ajit Varki and Misty and their mouse lines that they're developing. They have humanized the sialic acid repertoire in a way,English
+that some of the toxins that are produced by enteric pathogens including cholera toxin and toxins from Salmonella are you know less severe,English
+and that might allow us to breed those mice together with you know the CFTR mice,English
+"and find out whether there is indeed a protection once you humanize the background because right now, a lot of the mice just aren't susceptible",English
+that I always found genetics of resistance to malaria very fascinating. And I've been familiar with this my entire life because I'm from the Island of Sardinia,English
+where basically everybody has either a beta-thalassaemia trait or the other trait that is also associated with resistant to malaria which is the G6PD deficiency,English
+and I can tell you in every family that it's either one or the other. And I think the myelin is really the best example of how the entire population has evolved,English
+to be resistant to malaria and how the heterozygous for G6PD or beta-thalassaemia are so widespread,English
+There is a human mutation in a Siglec receptor pair. So normally humans could be said to have both an inhibitory signal and in activating cyclic,English
+that are paired in terms of their same binding interaction with ligands on the outside but one transmits a positive signal to the immune cell,English
+"and the other half of the humans are having mutation in the activity one, so they only have the inhibitory siglec.",English
+And we found in screening population of patients who had had premature delivery of,English
+which Group A streptococcus is an important risk factor that there was an association of the having,English
+the hyper inflammatory phenotype with a greater risk of prematurity and published that a while ago.,English
+- I had one other thing that I wanted to add to that that line of thought and it's something that we haven't really discussed today much,English
+which is tuberculosis. And tuberculosis of course is one of the big killers as well and has had a major impact,English
+"on the human genome I think. And I don't know how well this is accepted but you know, there is some you know there is a hypothesis",English
+"that the human skin color especially for people that live in that you know adapted northern climates, I'm part of the adaptation for a lighter skin color comes",English
+because it provides more vitamin D and it allows you to survive better possibly survive infection from tuberculosis.,English
+"- Yeah, go ahead. - Well, I think there was a question for Chip that I think a lot of people have asked",English
+and how do we know that coronaviruses developed in bats? - There's been a lot of of effort to capture bats,English
+in multiple different locations and study coronaviruses and other viruses that bats carry. They evolve without a bone marrow.,English
+And they do that because they can fly better being lighter and that leaves them with in a immune response that allows them to be a lot more tolerant,English
+of ongoing carriage of an agent without clearing it. So they are really good at being able,English
+to service flying flasks with quite a bit of viral replication going on within them,English
+"and then opportunities for viruses to mix within the an individual bat, within bat populations, they live in very large colonies. So they really socially and immunologically set up",English
+to be a an inner changer of viral genetics and when you look in bad populations you see a large number of variant corona viruses,English
+that are always exchanging RNA and evolving and then periodically spilling over to other species. So they really are kind of a cauldron,English
+that periodically boils over and we happen to be on the wrong end of the catch. It's been going on I'm sure for thousands of years,English
+and there are so many related corona viruses and bats. It's hard to go back sometimes this corona virus is a good example and say this virus came across,English
+at this point in time because the corona viruses and people are actually more diverse with the SARS COVID-2 that people initially thought. So this virus didn't just kind of show up in a tangle,English
+and his people initially speculated in December of 2019. This virus has been spilling over to human population off and on for a while,English
+and then finally managed to catch on and spread. One of the things that has happened that's different with the wildlife populations,English
+"is these novel these events been going on for a long time, we've done two things that have made it easier for the viruses",English
+to play with each other. One is we put a lot of these species together in small cramped conditions that wouldn't normally be together,English
+and shedding pathogens and allow related viruses to spread among quite a variety of species in a given location at a given point in time.,English
+We also do this by creating large populations of animals with breeding facilities and for our food supply.,English
+"And finally, we've given viruses the opportunity when a spillover does occur that might well have died out in a small village to make",English
+its way out of the village with transportation and out of the country with air transportation converted the human population on the planet to basically,English
+a large mixing bowl as opposed to a large collection of small populations that evolved within themselves and develop genetics,English
+as we heard about Sardinia that deal with local pathogens. Now we have to think about ourselves,English
+as a golden community in which the entire population the world might have to rapidly evolve as a pathogen comes along which we're not able to do.,English
+and movement areas where animals that we normally wouldn't come in contact with we're in contact with more often the speculation of about Ebola coupled,English
+"with giving these viruses a way out of where they initially are come in contact with us with transportation has been what's amplified,",English
+"and it also may be because I had two kids that went to public daycare and I got everything. But the other question is,",English
+"are you then more protected against all the sort of sub strains that might be out there and does this you know, even though you might not have",English
+that yeah the more vaccines you were to encounter you would develop a broader and assuming that the drift in the influenza virus,English
+"in particular as an example was sufficiently expanding the different types of viral strains. You were exposed, your body was exposed to",English
+I would think that naturally it could allow for a wider broader immunity to various flu strains but actually one thing that has been seen especially,English
+from the H1N1 swine flu epidemic that we had in 2009-2010 was that there are some more,English
+you know broadly neutralizing analyzed to the two more conserved features of the influenza virus like the stock domain of the hemoagglutinin system region of it,English
+which was found that people who had pre-existing stalk antibodies whether they got them from prior influenza infection,English
+"or because of vaccines, those patients oftentimes had more you know, had less severe outcomes with with swine flu",English
+and we're able to recover more in a more healthy way. But other than studies in mice had shown that if you do give a vaccine,English
+"that is against different flu strains. Actually, where you won't have antibody mediated defenses to the human glutenin portion that's the most aminogenican",English
+"because it's a more routine way of looking at human vaccine responses, but so it's possible to develop",English
+I think more cross reactive protective immunity by giving more different types of vaccines to say flu. So I'm always a proponent of this vaccine.,English
+Dengue and Zika are just two recent viruses that our species is currently facing. There must be more to come.,English
+What do we know about the next one? Do you think that understanding cross your activity will give insight into how to fight it before it appears,English
+"And that means think about that. We know about dengue, Zika, West Nile virus, Japanese encephalitis virus, yellow fever,",English
+these are already severe. These are all the flaviviruses that can cause devastating severe consequences in humans.,English
+Zika emerged in 2016 and with over 70 known flaviviruses I can name whole slew that can potentially emerge.,English
+"So in the animal models in our labs, it's really easy and fun to manipulate different aspects",English
+"of this cross reactivity immunity and try to dissect what gives you immunity, cost protective immunity,",English
+what gives you this cross protective pathogenesis. And in terms of solving these problem that relate with these viruses,English
+"that share this immunological cross reactivity what we wanna do is harness this good aspects, the cross protective immunity",English
+and avoid this ADE type of phenomena and I think it is doable. We need to look at more studies using animal models,English
+following completion of the MSC and we have had so the the programme is now in its fourth year and we've had graduates going into a wide range of positions relevant to infectious,English
+disease epidemiology and this is included academic positions and so research assistant positions and PhD training programmes. Also analyst or policy jobs in organisations such as the UK,English
+Health. Security Agency or and other national public health agencies and we expect students to be competitive for jobs in,English
+international organisations as well and some of those listed on the slides and and yeah and and NHS and local authority public,English
+health teams a wide range of possible options where infectious disease epidemiology skills can be applied. And you can find out more information on the website and,English
+"for the MSC, the Department and UCL Institute for Global Health is on Twitter and and so you can follow there. There's also a paper which I've just snipped the the link button on the slide",English
+"and which explains. Some of the and the kind of the concepts around that, the teaching on the programme which and I'd recommend that you also",English
+"have a look at and understand and how the programmes kind of been developed and come about, really happy to answer any questions and our e-mail addresses are on this slide",English
+"you could type it in the chat, which you should all have access to at the bottom of the screen. If you're more comfortable doing it that way, that's also completely fine. And.",English
+"interested in moving more towards epidemiology and population health. And so I thought that this programme was a good fit for what I needed in terms of experience, so",English
+"services. It was initially about infectious disease that was why it got the job, but they're very far, just is straight from that.",English
+And I was working on design work for more general digital healthcare products. So I I worked there for half a year and then.,English
+this quantitative study and it was really shocking to me. And I just found that qualitative research was so empowering and that gave me the idea of doing a qualitative project for my PhD.,English
+"So I'm mostly focusing on qualitative methods right now. Yeah, that's where I am now. Great. Thank you both.",English
+And we're really happy to take questions from anyone here. You can ask us about the course content about. Kind of projects you might do as well as about opportunities that,English
+"come from the course as. Heather has said it's not just PhD, although we're really proud of the number of students who have done the aid programme and",English
+"gone on to do a PhD. Umm. The current cohort have teaching sessions at the moment, otherwise they would also be here to tell you about life and",English
+"aid now. And while I'm thinking about that, we have now some probably getting on for 100.",English
+Alumni of the programme or will do at the end of this year in the current cohort finishes and there's a fairly well connected alumni network that's organised through LinkedIn that allows,English
+"alumni to share job opportunities and keep in touch with each other, and later cohorts help. Current or more junior cohorts if you like. And the other thing",English
+"that has happened this year in particular, which has been really nice and I think we'll continue is that students have done their programme and then rather got research assistant",English
+post at UCR or PhD posts are starting to teach increasingly on the programme. So you get taught by some of the world experts in infectious disease epidemiology.,English
+"On the programme, but also due to some of the tutors, are students who have done the programme recently who can really understand the challenges of using states here and all of",English
+"the difficulties of being a student on the course. And we can give you advice about that, we hope, and that seems to have worked well from on both sides.",English
+"And. I'll stop there. We're really happy to hear questions. The other thing, perhaps, is that both Emily and Alice are overseas students who came.",English
+"So they can talk about. Have experience of finding? That the in London and and. And how that worked for them, if you've got questions about that.",English
+"Yeah, really happy to hear from you. You don't have to turn your camera on, and if you don't want to talk, you can type. And if you you don't have a question exactly, but there's",English
+"something that you'd like us to say more about or just to give more detail on, then that's also that's also fun. Thank you, Caitlin. We've got our first question. And how many",English
+now we are following the pandemic when of course there are various adjustments that took place and in terms of in person contact hours. So I'm just trying to add it up in my,English
+mind now for term one I think it's. And around about 20 hours a week in term 1. And and there's also quite a bit of of work to do in terms of,English
+independent study. Term one is the most intense in that respect and and then in term 2 there's just the two core modules and and an optional module and starting to think about,English
+dissertations. So as the programme progresses the balance between face to face contact and independent study shifts and and you're expected to do more independent study and then of,English
+course as as we go into. Summer time and people are working on their dissertations and that is majority independent. Study just with,English
+"meetings with your supervisor to to guide the work and to provide appropriate support. And does that answer your question, Caitlin? Feel free to",English
+and ask a follow up if not so if there was something that you didn't think was covered. I I think that's helpful either I just say that.,English
+"And if you're doing the course full-time and there are part time and flexible options. But if you're doing the course full-time, you should think of it as about the same amount of",English
+"time that you would spend on a full time job. Because if there's about 20 hours of face to face teaching, and it's probably at least as much to prepare for that and do work",English
+"that follows on from from the face to face teaching. Thank you. So the next question was, are there examples of previous",English
+dissertation project titles available? And. It's a good question. I think we can. So Alice and Emily have,English
+"told you their dissertation titles. Just off the top of my head, I organised the projects which came from. UK, USA last year I think we had four students who are doing UK",English
+SA projects and the ones I can remember those one on using national surveillance data on syphilis to try and understand an epidemic of syphilis. That's that's been expanding in the UK,English
+"among heterosexual groups. And that's particularly of importance because the number of congenital syphilis infections, although small, has started to creep up in the UK which is",English
+"really worrying. Another student did a project on late diagnosis of HIV in. Migrants from stuff from South America, which was a project I",English
+think he hopes to publish because there's very little data available about that. And another student did a project on gonorrhoea infection,English
+"to using, again using surveillance data to understand and inform the current UK testing guidelines in May have sex with men.",English
+And and. There was another UK NHS a project on using a large database of hepatitis C treatment patient. Individual,English
+patients would receive treatment for hepatitis C trying to look at factors associated with not completing hepatitis C treatment and to understand how hepatitis C treatment services might be,English
+"better targeted and organised to. Got people falling through the gaps. And another student lasted a project on a project of mine, a",English
+"study of mine called by Byrne study, which is a microbiome based study looking at factors associated with opportunistic pathogens in the gut of babies, to try and try and understand",English
+"more about the epidemiology of I've got microbiota in young, very young children. So that's five examples, and I'm sure there's no other if you",English
+"want to add any others, but they're all really all sorts and students are able to choose their own topics, as well as selecting topics that many members of staff offer when the",English
+time comes in the dissertation process. I can just explain broadly there. And so there were different options for dissertations for the aid,English
+programme. So one option is a a literature review and another option is a data analysis dissertation. And I think roughly about 1/3 of students through literature review and,English
+about 2/3 a data analysis and this situation. And of course this is a quantitative course. And so even with literature reviews there's lots of sort of thinking about the quantitative,English
+"aspects of of studies involved and. Included in their in their review, but there's as Nigel said, looks of scope for bringing your own ideas as well",English
+"As for thinking through work that's possible using data sources within the department or available through potential supervisors and the department, so.",English
+OK. Should we take the next question from Saylee fairly? And. I'm very much interested in reproductive health and and,English
+there are a lot of people who work on sexual health and reproductive health in the department. So they provided your interest is is primarily an infectious diseases that sounds,English
+great. And I've applied for the course and received an e-mail stating update been more than two weeks so I'm sorry that you haven't had that. We have had a few problems with admin and staff,English
+have turned over in the last few weeks. So maybe that that your application has been caught up in a delay because of that. But I think what we can say is that we'll take your name away and,English
+"have a look online on the on on the back end to see where your application is and if you want to drop Heather or I and e-mail. I've been very happy to follow up with you after this session,",English
+"but I I, I we should be able to get your application moving through the system as soon as possible. So bear with us, sorry, and we'll get it, we'll get it and",English
+get you a response. I'm just gonna put out emails in the chats in case you want to take them from them. OK. So the next question was from Holly. Could you talk a bit,English
+And many of you may be doing this MSC as a stepping stone to future job and career plans. And if we put to one side for the minute that the fact that,English
+"there are lots of PhD opportunities at UCL and within our faculty and department, we have good access to the MRC doctoral training programme, which is a brilliant PhD",English
+"for different career paths. Broadly speaking, they divide into people who want to be researchers and. And epidemiologists who are primarily kind of probably",English
+quantitative having done the course that that that we are providing and and so some students have gone on to get research assistant posts where they use the skills in the NSC,English
+"to be very competitive to research assistant analyst type posts within UCL within our department and faculty, but also in other universities and higher education institutions and the",English
+"other place. Many students have gone is to organisations like UKSA, the UK Health Security Agency. Or the national equivalent so.",English
+"As a student working for the Korean CDC, Chinese CDC and other national Disease Control government related organisations.",English
+"And some students, as Alice said, have got posts within pharma organisations. And.",English
+Disease Control and which we which we think the course also provides really good training for because it enables with. At the end of the course you should be able to both design but also,English
+"We have on this programme and they're on the at least in terms of the core modules, they're all and coursework. So there were no exams and there's.",English
+Assessments that require you to analyse data and to present that so whether that be in the form of an outbreak investigation or analysing the data set for statistics module. And there's,English
+also more kind of essay based assessments and there's an assessment where you're asked to come up with a proposal to tackle an infectious disease public health problem.,English
+Which is a real life problem that you're asked to research and think about and then construct a proposal to to address.,English
+And I know for the molecular epidemiology module the assessment is a critical appraisal. So you're reading a published paper and thinking through the strengths and,English
+limitations of the evidence that it it presents. And so these are some of the the types of of work that you that you you do on the programme and and with quite a few of these assessments you and,English
+although the assessment is obviously kind of carefully delineated you you can kind of do quite a bit of reading in your.,English
+students done coming into the programme. I studied sociology and politics and science. Not sure if I meet the entry requirements because of my undergraduate.,English
+"And so there's quite a range of students who come to the programme. Broadly speaking, they tend to fall into people who have done BioMed type.",English
+And basic science type noises and people who have done social science and quantitative and undergraduate BSc. Sorry BSc programmes.,English
+modules for this MSC and this year for the first time these two core and that's modules are bespoke for this MSC programme. So previously they were shared with other MSC programmes and,English
+and this year they're just for age students and you're not expected to have sort of prerequisites in statistics and to to take this programme to take those those modules.,English
+And so although and this course is as as Nigel has said is a quantitative course and we're looking for people who are are interested in applying their quantitative skills and you're,English
+you're not expected to come onto the programme with a big background in statistics or to sort of have a lot of prior assumed knowledge and just to clarify that if that's that's,English
+"helpful. Yeah, but really happy to answer questions by e-mail about individual circumstances and. And study to date etcetera.",English
+And I think just adding to that the way we've designed the course. We appreciate that many students come with some knowledge which,English
+"is irrelevant to the course already, but gaps in their knowledge, and different students have different gaps. So what's quite nice, I think, is that the cohort sort of looks",English
+"after each other and fills in each other's gaps. So there are some with really good basic science knowledge, and so the fundamental principles of infection and population health",English
+"module. Some of that content will be familiar to them, although often it's also expanding their knowledge for other students the the stats.",English
+"For sale of there will be familiar with some of the concepts, particularly in the basic stats, although in the context of infectious disease, epidemiology wouldn't necessarily be all.",English
+"Content that they would know and but have less knowledge about the basic science and medicine. So those, particularly the first term and some of the second term modules, try and make sure that",English
+everyone is on a level playing field and fill in gaps in different people's knowledge base. Umm.,English
+Irony. Thank you so much. And then Alex Flint. Hi Alex. I too waiting for application. So I think the same advice is Sally will take your name and follow that up with our admin team.,English
+Make sure that your application is being processed. And we did recently review all of the applications that were in the system and so that any that are that were received at that,English
+"time should be now being processed. I would hope you'd hear very soon. And and and thanks for letting us have your name. On a side note, I'm currently reading infectious disease",English
+epidemiology predominantly written by those at UCLA and we've got me really excited potential to study at UCL. That's great to hear and we look forward to meeting you in due,English
+"course, hopefully if you take the programme. And then the others are thank you. Any other questions that people want to ask?",English
+"We've got about 10 minutes, 10-15 minutes. Yeah, go ahead. I'm wondering whether this is maybe the time to turn off the recording in case anybody has any questions",English
+"they want to ask. Recording, yeah. I'm going to pause the record in case there's anything that anyone wants to. So yeah, Alice or Emily is anything that you wanted to",English
+"know. At the start or before the start of the programme when you're in the same position as. Yeah. Well, I think kind of going up all kind of going off",English
+what we've already been talking about in terms of *** **** coming from different backgrounds and I was coming in with the molecular biology background and really even,English
+"though I've done some calculus in maths as part of that degree, I had not done any statistics, but I felt like I was given, you know, there are plenty of opportunities to develop those",English
+"skills. What? And in terms of the workload, since I already had kind of the biology knowledge, it made it a little bit easier in the first term to focus then on the things that",English
+"were. Genuinely new to me. And felt like, yeah, even though there were students who started off at this like a better stats level than I was, we did manage",English
+"to get to more of an equal playing field by the end. Yeah, you had the same life I I didn't have any stats background coming into this but.",English
+"Yeah, that's fine. Yeah, they have all the necessary introductions. One thing that I wanted to know when I just started was about the dissertation because I didn't do",English
+one for my bachelors. But I remember there was one session within the whole department. I think about the dissertation and like the,English
+chronic metabolic disease nothing wrong with  them you know other than fitting into a swimsuit   conversely and this is the important part 60 of  the normal weight population have the exact same,English
+diseases as did the obese normal weight people  get type 2 diabetes hypertension dyslipidemia   cardiovascular disease cancer dementia fatty  liver disease polycystic ovarian disease too,English
+now they get it at a lower BMI and it's  true that it's 60 percent versus eighty   percent so in fact obesity is a risk  factor for chronic metabolic disease,English
+and I don't argue that that is absolutely true  obesity is a risk factor but it is not a Cause   there's a difference between risk factor and  cause and what we're talking about today is cause,English
+that's not the same tell the NIH so  there are plenty of North you know thin   sick people out there okay and they're  plenty of fat healthy people out there,English
+and so the question is which are you well can I  prove it the answer is yeah here I'll prove it   right here so here are two equally weighted  people CT scans through the abdomen of two,English
+equally weighted people notice trunk fat 12.8  12.8 one's healthy one's sick which one's sick   b b is sick a metabolically healthy obese  he's got big love handles subcutaneous fat,English
+not dangerous in fact might be protective in many  cases protective this guy's got fat all around his   organs intra-abdominal fat okay and we have a  name for this it's called tofi t-o-f-i thin on,English
+the outside fat on the inside real medical term  1500 Medline citations coined by Dr Jimmy Bell at   University College of London neuroimager okay so  my question to you sitting here right now all of,English
+you are you a toffee how would you know how could  you know does your doctor know if your doctor   knows why hasn't your doctor told you and what  would your doctor do about it if they did know,English
+and it goes even further than that because it  turns out it's not just the visceral fat it's the   liver fat so here's a histological micrograph of  normal liver and you can see the sinusoids and the,English
+biocanaliculi and the cook for cells all nicely  ordered and over here we have fatty liver disease   okay and you can see the fat vacuoles and you  can see the beginning of scarring you can see,English
+all the macrophages infiltrating okay now prior  to 1980 if you saw this under the microscope   that was alcohol IC fatty liver disease the  problem is if you look at this now in 25,English
+percent of children you will see the same thing  and children don't drink alcohol and that is   called non-alcoholic fatty liver disease or now  a new name metabolically associated fatty liver,English
+disease so naffled maffled all the same so the  question is how come something that causes disease   and alcoholics is causing disease in children  what's that about what's the exposure there,English
+because everyone's got it 45 percent of adults  have non-alcoholic fatty liver disease 25 of   children I didn't say obese total in fact fatty  liver disease is now the leading cause of liver,English
+transplant in the United States having overtaken  hepatitis C and that's not just in obese people   now it is true that the more obese you are the  more fatty liver disease I'm not arguing that,English
+again obesity is a risk factor I didn't say  it wasn't it is okay but you'll notice we'll   take a look at the prevalence in the normal  weight population and that's around the world,English
+so this is not a uniquely American problem this is  a global problem because of a global exposure and   the question is what is that Global exposure and  if you look here here's BMI Bend here and this is,English
+the Hazardous ratio for fatty liver disease and  you'll notice here's the overweight category you   can see very clearly a signal you can even see the  signal a little bit in the normal weight category   but if you have diabetes take a look even in the  normal weight in fact turns out if you have fatty,English
+liver you are 3.5 times more likely to develop  diabetes because of your fatty liver causational   and it makes sense because after all when the  pancreas releases insulin where's it go es to the,English
+liver via the portal vein now the rest of the body  you know when a hormone is made it goes into the   systemic circulation right but pancreas goes to  the liver and the reason is because the liver is,English
+the primary target of insulin action and so when  your liver's sick guess what so is your pancreas   so the question is what's going on in the liver  so here we have an obese person notice the love,English
+handles on the side but take a look at this  guy's liver notice 2.6 liver fat this is fine   this is MHO metabolically healthy obese nothing  wrong with this guy now take a look at this guy,English
+over here notice obesity but take a look at his  liver 24 liver fat ground glass appearance see   okay this guy's got metabolic syndrome this  guy's got naffled this guy's going to die,English
+now take a look at this guy over here notice no  obesity normal amounts of Sub-Q fat but take a   look at his liver 23 liver fat then sick fat  sick fat healthy in other words it's not the,English
+fat you can see that counts it's the fat you  can't see and particularly the fat in the liver   that you can't see and so the question is how  did the fat get in the liver in the first place,English
+and why is it children have it so my  point is that obesity is not the problem   it is a symptom of the problem  it is Downstream of the problem,English
+and so we are treating the symptom of the problem  and not doing a very good job of it mind you   so what is the problem metabolic syndrome  defective metabolic Health metabolic dysfunction,English
+and that's where all the money goes 75 percent  of all Health Care dollars go to all of these   diseases of which of course diabetes is the  Sentinel disease now here's the pro real problem,English
+none of these diseases have any cures they just  have treatments and in fact the treatments don't   work because they are just treating the  symptoms they're not treating the cause,English
+okay it's like giving an Aspirin to a patient  with a brain tumor because they have a headache   might help the headache ain't going to do  a damn thing for the brain tumor because   the pathology is still there the only way to  fix the problem is to remove the pathology,English
+not to cover it up not to Band-Aid it over  but get rid of it and we're not doing that   because we don't understand it we think obesity is  the problem no obesity is a symptom of the problem,English
+is mental health part of the issue mental health  is metabolic health so anything that happened   and we're going to talk about mitochondria in a  minute okay you got mitochondria in your liver,English
+and when they don't work you get fat in  your liver you have mitochondria in your   brain and when that those mitochondria in  your brain don't work you get mental illness   and the same things that affect your  mitochondria in your liver affect,English
+the mitochondria in your brain so in fact  metabolic health and mental health go hand   in hand and often over not just overlap  but are you know due to the same problem,English
+now example LDL everybody's chasing LDL everybody  thinks get the LDL down right and you'll fix heart   disease right garbage total garbage now  it is true that LDL levels do correlate,English
+with cardiovascular disease that is true the  hazard risk ratio is 1.3 you can see it right   here at 1.3 now the Public Health Community has  settled on 1.3 as when it's a public health issue,English
+so if it was 1.29 it wouldn't be a public health  issue but it's right there on the Edge at 1.3 and   there's your data okay and it's true and it does  correlate and I'm not saying it doesn't it does,English
+okay but there's something that correlates  way better and that's serum triglyceride   serum triglyceride correlates with a hazard risk  ratio of 1.8 and there's the data right there 1.8,English
+so serum clutch triglyceride is actually  50 percent more informative in terms of   heart disease than is LDL now turns out your serum  triglyceride is your very low density lipoproteins,English
+it is made by the liver and it is made  from the conversion of sugar to fat   through a process called de novo lipogenesis your  triglycerides are your vldl and your chylomicrons,English
+but if you're fasting your chylomicrons should  be zero so your vldl and your serum triglycerides   are the same which means that your serum  triglycerides are a measure of liver function,English
+and so if your serum triglycerides  are high it means your liver is sick if you've got fat in your liver it means  your liver is sick and if your liver is sick   that means your pancreas is sick and that's what  drives the chronic metabolic disease now we give,English
+statins for people with high LDL in an attempt  to drive the LDL down because we think the LDL   is the problem the question is is the LDL the  problem well if it were the problem then the,English
+statins would work but they don't and there you  can see right there there's your diamond on the   identity line it's not on the favorable side  there's a Cochrane review this one's for total,English
+mortalities this one's for fatal cardiovascular  events again virtually non-existent okay and if   you look at the data on LDL lowering as a primary  not secondary but primary prevention for heart,English
+disease like if you go to your doctor and your  doctor says oh your LDL is high you need a Statin   that's primary prevention okay as opposed to oh  you've had a heart attack here you need a Statin   that's different that's secondary prevention  everybody see the difference okay so primary,English
+prevention you're not self-selecting  for people who already have a problem   when you do when you look for a primary  prevention turns out the rcts do not show,English
+any benefit on mortality do you know what the  mean increase in lifespan is from treating   high LDL with a Statin is four days four days none  of these trials reduce cvd events and some of the,English
+drugs actually reported harm this just came out  three days ago and so you're looking here sorry at   all cause mortality and this is the degree  of LDL cholesterol reduction and it doesn't,English
+matter if it's statins or acetamide or diet or  anything else that's your your that's your benefit   zero this is from myocardial infarction okay  about a five percent and here's for stroke,English
+about a two percent and more importantly  on this side we have number needed to treat   how many people do you have to treat with a Statin  to actually get it one patient with benefit 754.,English
+ridiculous number needed to treat  maybe 10 might be cost effective   really five might be cost effective 754  really you get the picture and Statin use,English
+is associated with development of diabetes and  the reason is because it's a mitochondrial toxin   that's where it works works at three three  beta hydroxy methylglutaril COA reductase,English
+it's a mitochondrial enzyme okay causing damage so  why should you be surprised it's associated with   diabetes all right let's take a different marker  not LDL let's take hemoglobin A1c everybody says,English
+high hemoglobin A1c bad get it down give insulin  give oral hypoglycemics give glutenides give you   know um uh uh sglt2 inhibitors right well here  are four five studies five studies that show that,English
+lowering A1C didn't help didn't make a difference  in terms of more morbidity mortality so here's the   original UK PDS data okay looking at talbutamide  versus placebo and the mortality rate was actually,English
+higher with the talbutamide and the cardiovascular  disease was higher with the talbutamide even   though the A1C went from nine to seven this is  the famous Rosie glitterzone data from the New,English
+England Journal that you're all familiar with okay  take a look at the Oz risk ratio from myocardial   infarction not all a lot better just as bad  and for cardiovascular death 1.64 not very good,English
+okay this is the Accord trial the Intensive trial  it was in the New England Journal here's standard   therapy and intensive therapy for A1C you can very  clearly see the benefit but when you look at the,English
+primary and secondary outcomes here's mortality  notice intensive therapy worse statistically worse and cvd death statistically  worse so just getting the A1C,English
+down doesn't necessarily translate into  metabolic and or cardiovascular benefit   so we can't fix chronic disease with medicines  we haven't been able to we're not going to be,English
+able to and the reason is because we are not  addressing the problem we are papering it over which then leads us to well what is the problem  and that's where this concept of the hateful,English
+or grateful eight comes in these are the eight  subcellular pathologies that you can't measure   in fact there's no icd-11 code for any of  them your doctor can't bill for any of them,English
+your doctor doesn't know what the hell they  are anyway wouldn't discuss it with a patient   if their lives depended on it because it  basically just be blowing smoke because   they can't do anything about it anyway and so no  wonder no one's heard of him or cares about them,English
+and here they are listed okay now some of you are  medical some of you have heard of these eight some   of you are not MediCal and have not heard of them  but these are what's going on inside your cells,English
+glycation oxidative stress mitochondrial  dysfunction insulin resistance membrane   instability inflammation methylation and autophagy   the point is that not one of these Pathways  is druggable except maybe inflammation and,English
+that's a question mark all by itself depends  on what's inflamed but they're all foodable   you can use food to fix all eight of these  I will show you at the end how you do that,English
+so let's start with number  one glycation here we have   five pictures of food and they all share one  thing in common and don't say they're delicious,English
+they're all delicious for one reason  because they're nope coffees high and fat they're all Brown they're all brown okay  they're all brown because the common link,English
+is the my art or the Browning or the glycation  reaction non-enzymatic glycation The Binding of   a glucose to an Epsilon amino group of Lysine  usually okay so the way to think about this is,English
+the following you can roast your meat at  375 degrees for an hour or you can roast   your meat at 98.6 degrees for 75 years the  answer is the same you are Browning sitting,English
+here right now you are Browning you can't stop  the only way to stop Browning is to be dead you can control the rate of Browning that's the  point okay your mitochondria Brown routinely it's,English
+part of them being mitochondria okay if you  don't believe me here's newborn rib cartilage   nice and white and here's 88 year old rib  cartilage nice and brown you are Browning,English
+as we speak and if you had orange juice for  breakfast you are Browning seven times faster now why does this happen well here's glucose  you'll notice glucose has an aldehyde group on,English
+the position one of the linear form that aldehyde  combined to an Epsilon amino group of Lysine at   position one on the hemoglobin molecule which will  then form a shift base which will spontaneously,English
+decompose to form this covalent linkage and we  call this the amidori rearrangement and you're   all familiar with that this is what hemoglobin  A1c is right here okay and that's what we,English
+measure in diabetics to see how high their blood  glucose has been it correlates with the degree of   blood glucose elevation all true okay turns out  fructose the sweet molecule and sugar does that,English
+reaction seven times faster okay I didn't include  that data because I want to get through this   number two oxidative stress every  time that my art reaction occurs,English
+it releases a little hydrogen peroxide a little  oxygen radical and that oxygen radical has to   be quenched by an antioxidant or it will do  damage it will cause lipid peroxidation or,English
+protein denaturation it will do something to  cause cells to be damaged and die and this   is called oxidative stress it's the same thing  that happens to Nails Nails rust well we rust,English
+too the only difference is that when Nails  rust it's iron oxide and when we rust it's   these carbonyls instead but it's the same process  okay and it's these reactive oxygen species these,English
+superoxides that cause the problem okay and it  happens in carbohydrate and also happens in fat   and that's what causes acrylamide when you put  carbohydrate and fat with heat like french fries,English
+every time that reaction that my art  reaction occurs whether it's glucose   going to the TCA cycle it generates reactive  oxygen species and fructose also generates,English
+reactive oxygen species seven times faster causing  cell dysfunction and death unless it is quenched   by an antioxidant and the antioxidants in  your cells are located in the peroxisomes,English
+that's where reactive oxygen species go to die  so you have to have an appropriate antioxidant   capacity if you don't you will do more damage well  so what where do you get your antioxidants from,English
+you get them from the air you have to  eat them so what foods have antioxidants not orange juice no berries  berries have some yeah not a lot,English
+okay number three mitochondrial dysfunction now  mitochondria burn energy they're supposed to   burn them all the way to carbon dioxide which  is the end product which we then breathe off,English
+okay the question is do mitochondria actually  do that and the answer is only when their Top   Flight only when they're fit and healthy and most  of our mitochondria are not and there are things,English
+that can interfere with mitochondrial function  so this was a study done by Samir soft dick   working in Ron Khan's Lab at Joslin at Harvard  and what they looked at was the difference in,English
+mitochondrial function between glucose is  a substrate versus fructose is a substrate   and what they found was that glucose activated two  count them two enzymes that improved and increased,English
+mitochondrial beta oxidation it increased  ampicinase the fuel gauge on the liver cell and   amp kinase actually is one of the signals one of  the primary signals to generate new mitochondria,English
+I'll show you in a minute how we know that and  also it increased this enzyme here called hadh   hydroxyacyl COA dehydrogenase which is necessary  for fatty acid beta oxidation so the ultimate goal,English
+of glucose is to increase mitochondrial beta  oxidation thus the Green Arrow upwards here   now take fructose notice fructose is in red that's  not in red because it's not green it's red because,English
+it's a stop okay because in fact fructose inhibits  three mitochondrial enzymes it inhibits amp kinase   because a metabolited fructose actually fits  in the active site of the gamma subunit of amp,English
+kinase and renders it inactive non-competitive  inhibition it also inhibits this enzyme down   here called acad L acyl COA dehydrogenase long  chain which is necessary to start fatty acid,English
+beta oxidation and lastly because of it's the  increase in uric acid associated with sugar   consumption the uric acid inhibits this enzyme  here called cpt-1a carnitine Palmetto transferase,English
+1A which regenerates carnitine and carnitines  necessary because it's the shuttle mechanism by   which fatty acids get from the outside world into  the mitochondria so that they can be beta oxidized,English
+the sum total of which is that beta oxidation  goes down with fructose so the molecule sugar   dietary sugar has glucose and fructose what's the  net effect the net effect is actually inhibition,English
+and this is what Ron Khan himself said about  this study the most important takeaway of this   study is that high fructose in the diet  is bad it's not bad because it's more   calories but because it has effects on liver  metabolism to make it worse at burning fat,English
+as a result adding fructose to the diet makes the  liver store more fat and this is bad for the liver   and bad for whole body metabolism couldn't agree  more are there any other good sugars no there are,English
+some that are less bad right another good some  less bad glucose is good ish it also raises   your insulin and Insulin has its own effects on  chronic metabolic disease so it's a it's a wash,English
+okay number four insulin resistance now you all  know about insulin resistance you all heard the   term the question is what constitutes insulin  resistance now it is normally assumed that,English
+obesity leads to insulin resistance garbage  the metabolically healthy obese demonstrate   that that's not true now if you look at  the relationship between BMI and insulin,English
+resistance very clearly there is this hyperbolic  relationship and that is true there is so the   more weight you gain the more insulin resistant  you are at any given BMI that is true I don't,English
+argue that however at any given BMI there  are going to be some people who are going   to be insulin sensitive and they're going to be  some people who are insulin resistant at any BMI   okay and so who's who in that is you don't know  that's what it comes down to so just because,English
+you have an increased BMI doesn't mean you're  insulin resistant and just because you have a low   BMI doesn't mean you're insulin sensitive these  are two separate phenomena and when you actually,English
+look at insulin sensitivity versus resistance as  the variable instead of weight as the variable   as we do here for diabetes or for heart disease  you'll notice that at any given BMI pick your BMI,English
+those who are insulin resistant have more  diabetes and more heart disease than those   who are insulin sensitive and here's your  capital and mire curves showing the rate of,English
+mortality based on insulin sensitivity here  obese or non-obes irrelevant versus insulin   resistance here non-orbese or obese Irrelevant  in other words it's the insulin resistance that,English
+qualifies the Obesity not the other way around  okay it's insulin resistance that matters   now how do you get that insulin resistance well  there are a few ways but I'm going to show you,English
+my favorite okay the one I did the work on okay so  this is our work from UCSF what we did was we took   43 children from our obesity program at UCSF all  with metabolic syndrome all with fatty liver and,English
+all high sugar consumers and we studied them on  their Baseline diet and they all have fatty liver   okay and they all had high triglycerides  because that's what happens,English
+what we then did was we figured out what  they were eating at home on their home diet   and we put them on a diet for the next 10  days we catered their meals no added sugar,English
+we took their percent calories as sugar from 28  percent pre-study down to 10 percent on study   okay everybody with me 28 down to 10. now if  you do that you're going to lose 350 to 400,English
+calories a day out of the diet and if you  do that for 10 days you might lose weight   and we didn't want our patients to lose weight  because if they got better people would say well,English
+of course they got better they lost weight  we wanted them to stay the same weight   so we had to give them back the 350 to 400  calories that we were taking out as something else,English
+we took the sugar out we had to put something  else back in that was calorically equivalent   we gave him extra starch we did a  starch for sugar exchange ISO caloric,English
+so in the vernacular we put took the pastries out  we put the bagels in we took the sweetened yogurt   out we put the baked potato chips in we took the  chicken teriyaki out we put the turkey hot dogs in,English
+everybody got it so we can give them good food  we give him crappy food we gave him processed   food we gave him Safeway food we gave him kid food  food kids would eat but it was no added sugar food,English
+and we gave him a scale and every day we'd wake up  we'd call him up on the phone what'd you weigh and   if they were losing weight anymore in order  to keep their weight up for the 10 days and,English
+then we studied them again at the end of 10 days  every aspect of their metabolic Health got better   their liver fat went down 22 percent the novel  lipogenesis rate went down 46 percent their vldl,English
+in their blood went down 49 their visceral fat  went down seven percent and most importantly   their insulin kinetics came back to normal  we reversed their metabolic syndrome with,English
+no change in calories and no change in weight  just by getting rid of the sugar out of their   diet and substituting starch because we stopped  the liver fat and we've showed that the change,English
+in the liver fat predicted the Improvement in  their metabolic health it's the liver fat people   now why does this happen well this is what insulin  resistance is so insulin binds to its receptor on,English
+the surface of the liver cell and there are two  pathways not one but two now this pathway here   in blue is the pathway everybody quotes this  is the metabolic side of the insulin argument,English
+okay and it is primarily mediated through this  transcription Factor here called akt and this is   the glucose lowering part of insulin this is what  reduces hepatic glucose output this is what causes,English
+glycogen synthesis Etc All the Above so for lack  of a better word we can call the blue pathway good   but then you have this red pathway and this red  pathway is the cell proliferation pathway it,English
+is the mitogenic pathway and this pathway  is the pathway that causes cancer in fact   insulin drives cancer formation and we now know  that clinically because they've done studies,English
+on type 1 diabetics receiving insulin and their  total insulinverted predicts their risk for cancer no surprise okay everybody got the idea so  every molecule of insulin is both good and bad,English
+short-term gain for long-term pain so when you  are insulin resistant you are driving this pathway   and that's causing coronary vascular  smooth muscle proliferation it's causing,English
+glomerulosclerosis it's causing  changes in the brain consistent   with Alzheimer's this is the  bad guy in insulin resistance,English
+you blow it up okay it gets really stretched right  try to poke it with a finger it just come straight   back right now poke it with a pin okay fine so  let's take another balloon we're going to blow,English
+it up to the same level okay we're going to put  it in the corner of our bedroom for three weeks   and slowly but surely over the course of those  three weeks that balloon is gonna deflate,English
+right now take this knot out and  blow up the balloon a second time   to the same level now try to poke it with  your finger now it's going to explode,English
+the membrane changed in the three weeks that it  was under stress that's membrane Integrity or   the lack of it well this happens to neurons this  happens to other cells too okay the composition,English
+of the plasma membrane creates this thing  called membrane fluidity and that is eminently   perturbable and when it's perturbed it means  cells die especially neurons okay cholesterol,English
+and phosphatidylcholine are the prime determinants  of membrane fluidity and Omega-3s are particularly   important in stabilizing that membrane fluidity  and we know that from studies done by Fernando,English
+Gomez pania down at UCLA and it turns out fructose  because of its effects on insulin resistance   Drive changes in membrane fluidity which can be  actually ameliorated by the administration of,English
+omega-3 fatty acids because Omega-3s are part of  the structural components of those membranes and   help them be more flexible and more expansible  but we don't have any Omega-3s in our diet,English
+we have omega-6s which are pro-inflammatory which  we get to next is pro-inflammatory inflammation   Now where's the inflammation coming from  well it can come from a whole bunch bunch,English
+of places of course if you have an autoimmune  disease that's pro-inflammatory you can have   rheumatoid arthritis or lupus or anything  like that but the fact is that most of   the inflammation in our bodies come from our  intestine from our gut okay so our gut has two,English
+barriers that prevent all the junk in our  intestine from basically taking us over   one is the mucin layer that sits on top of the  epithelial cells to act as a mechanical barrier,English
+and the other are these proteins that join the  intestinal anthrocytes together known as tight   junctions so those of you familiar with the idea  of celiac disease okay that's a defect in the,English
+zonulin which is a tight Junction protein okay and  that so when those tight junctions fail then stuff   can enter into the portal system go to the liver  and cause liver inflammation so this is a primary,English
+entry point for inflammatory lipopolysaccharides  cytokines whole bacteria that will end up having   to be cleared by the liver and cause it liver  inflammation everybody with me so far okay well,English
+it turns out fructose nitrates those type Junction  proteins and causes them to be dysfunctional   in addition fructose causes a big problem with the  intestinal microbiome which I'll show you on the,English
+next slide but ultimately these the the defect in  the mucin layer that occurs because of the lack of   fiber in our diet because fiber basically  protects that mucin layer and without the,English
+fiber the bacteria eat the mucin layer for lunch  literally that becomes their food because we're   not feeding them because the fiber is the food  for the bacteria and then the fructose comes in,English
+basically takes care of the other barrier and so  you end up with bacterial and lipopolysaccharide   translocation into the portal vein straight to the  liver causing hepatic insulin resistance hepatic,English
+inflammation fatty liver disease and of course  chronic metabolic disease okay and this just   shows that fructose is worse for glue than glucose  for immune cells so when glucose comes in it goes,English
+into immune cell goes to lactate no problem when  fructose comes in it doesn't go to lactate and it   actually interferes with the ability of the cell  to respond to glutamine which is actually immune,English
+suppressant and so these immune cells get hyped  up and you can see that here in terms of tnf alpha   whether it's glucose or sucrose Administration  tnf Alpha goes up il1 beta goes up il-6 goes up,English
+and you can block that by giving rapamycin  so you know this is a protein synthetic event   because of the presence of fructose in immune  cells so if we take the fructose out of the diet,English
+do does the inflammation get better and the answer  is yes it does okay and you can see that in these   studies done in patients with lupus and you can  see that in patients with rheumatoid arthritis,English
+and it turns out the rheumatoid arthritis  is because of an anti-ideotypic antibody   interaction between group a Streptococcus and the  heart and uh you know and the and the kidney and,English
+it turns out that group a strep grows better  on fructose than it does on glucose and you   can see that here here's two percent fructose  against two and two percent sucrose against,English
+glucose and you notice that the glucose doesn't  cause the bacteria to grow it's only the fructose   that causes the bacteria to grow so we are  actually making our autoimmune diseases worse,English
+by increasing in inflammation in our intestines  driving hepatic insulin resistance and chronic   metabolic disease number seven and so if  you don't have autophagy and by the way,English
+autophagy goes down as you age okay you end  up with cell death cancer problems with your   immune system cardiomyopathy aging infectious  disease fatty liver neurodegenerative diseases   Etc so you want more autophagy you want increased  autophagy okay because autophagy improves Health,English
+span okay it does all of these things all good  okay improves immune responses inflammatory   responses changes cell death rates reduces  cellulose senescence and you avoid oncogenesis,English
+okay it turns out that amp kinase I told you  about okay when it's working you get autophagy   when it's not working autophagy stops and what  did I tell you about ampicinase and fructose,English
+it sits in the gamma subunit and causes  non-competitive inhibition so autophagy stops so the hateful eight how do we  fix it you got to know what's,English
+causing it right you've got to have  a cause in order to have a treatment   well the treat the cause is right there  Ultra processed food which now accounts for,English
+62 percent of all food consumed in America and  67 percent of all kid food consumed in America and here's where the sugar is okay now  you know about the sugary products you,English
+know candy cakes ice cream old news beverages  old news Okay so this part you know about but   it's also in the fruits and the vegetables  the starchy Foods the meat fish and eggs,English
+dairy products fats and sauces salty snacks and  everything and it's there on purpose because   the food industry knows when they add it  you buy more because it's also addictive   that fructose molecule stimulates dopamine in  the reward system and causes you to say this,English
+feels good I want more and so you eat more  and the food industry of course knows that   processed food increases BMI no surprise in  Europe okay 19 countries the percentage of ultra,English
+processed food consumption correlates  with the percentage of obesity okay   and also correlates with mortality rates  as well for exactly the same reason,English
+now a lot of people say it doesn't matter if it's  high fat or high carb okay the diet fit study that   done by Christopher Gardner at Stanford ultimately  showed the exact same effect except that all of,English
+them all both the high fat and high carb diet he  gave was a real food diet so I'm not so concerned   about the fat or the carb as I am about the degree  of processing because processed food is high in,English
+sugar low in fiber high in sugar for palatability  low in fiber for shelf life the problem is the   fructose and the sugar causes the metabolic  damage the lack of fiber in the processed,English
+food causes the inflammatory damage you put the  metabolic damage with the inflammatory damage   you have chronic metabolic disease and there is  no medicine for either of those cannot be fixed,English
+this just shows what happens with fiber so here's  glucose excursions in diabetics on a normal diet   and here's glucose excursions in diabetics on  a low carb diet much better right that's why,English
+everybody's saying low carb diet for diabetes I  understand that but here's what happens on a high   fiber diet not on a low carb diet but a high fiber  diet same thing and the reason is because you're,English
+preventing the glycemic excursions because when  you consume your food with fiber called real food   that those calories those glucose molecules end  up not being for you they are for your microbiome,English
+they your microbiome chews them up because you  have prevented their early absorption because   the fiber acts as a gel a lattice work on the  inside of your intestine coding the inside of your,English
+intestine soluble and insoluble fiber together  prevent the transport of glucose fructose sucrose   simple starches from the intestine from the  Lumen into the portal vein so that your liver,English
+never sees them and because they go further  down the intestine even though you ate them   you didn't get them so who cares what passes your  lips what you really care about is what passes,English
+your intestine so calories are what passes your  lips who gives a flying [ __ ] excuse my French   my job is to kill the calorie I want to kill the  calorie as a unit of measure because it never,English
+made sense and it's actually taken us and made us  you know Miss the mark for just that reason okay   so the hateful grateful eight here they are none  of them have any medicines that work except diet,English
+it's the only thing that does work so glycation is  driven by carbohydrate fructose and lack of fiber   oxidative stress driven by glucose and fructose  mitochondrial dysfunction is driven by fructose,English
+omega-6 is trans fats and lack of micronutrients  insulin resistance driven by fructose and branched   chain amino acids leucine isoleucine valine  present in corn-fed beef chicken and fish horn fed,English
+from Lancet okay and here's this is a very  important quote the emerging and compelling   evidence for nutrition as a crucial factor in  the high prevalence and incidence of mental,English
+disorders suggests that diet is as important as  Psychiatry as it is to Cardiology endocrinology   and gastron neurology I couldn't agree more  and it's nice that somebody at Lancet figured,English
+that out because i' be honest with you they  haven't figured out much of anything else so food what can you do to food to either make  it good or bad okay Real Food Works but clearly,English
+we're not eating real food 73% of the items in  the grocery store are not real food they are   ultr processed food and is that Ultra processed  food actually impacting our brains in a negative,English
+fashion that's the question so what are they  doing to food well you can add something you   can add vitamins and Omega-3s you can subtract  something like artificial colors or allergens,English
+these are all out of you know ultr processed  food to make the food better you could change   the macronutrient composition or the timing so  you could go vegan you could do Tim restricted,English
+eating you know or intermittent fasting you  could alter the microbiome which I think is a   great way to do this and the easiest way to do  that is not with a probiotic but rather with a,English
+Prebiotic because a Prebiotic will allow the right  bacteria to grow a probiotic won't that's why you   have to keep taking a probiotic because after all  if a probiotic worked you'd only have to take it,English
+once it's a live culture why doesn't it just set  up shop the first time the reason is because the   internal mil of the intestine is so inhospitable  that's why those bacteria are not there in the,English
+first place that's how they got killed off that's  why you need the probiotic except that you haven't   fixed the mil so like why would you expect it to  work because it won't take so fix that first and,English
+that's called fiber okay and then of course all  the above and you can do that with a ketogenic �� diet now why would these work why could these food  manipulations have beneficial effects in terms of,English
+psychopharmacology CNS is central nervous system  it could alter CNS energy metabolism that is   making the mitochondria work better to make more  ATP it could alter CNS neurotransmission we're,English
+going to talk about the glutamate Gaba cycle in a  minute it could alter trophic factors in the CNS   like for instance leptin and bdnf brain derived  neurotrophic factor which cause neuronal outgrowth,English
+and in some cases neurogenesis it could alter CNS  exposures like toxins and infections one of the   big ones is strep and I think you all know this  because all you have to do is go back to 1791 when,English
+syum demonstrated that a strep infection caused  severe choreoathetosis called cims Korea due to   rheumatic fever okay like why would a bacteria  cause a change in your central nervous system well,English
+you know we've known that for a long time and of  course all the above and the ketogenic diet does   all those okay so the ketogenic diet again it's  our window into the problem it's not the only,English
+issue but it's a window okay could potentially  have lots of different effects it could change   energy consumption because the mitochondria don't  need insulin and it gets in so it's you know if if,English
+you have a you know Ketone level in your blood  it will make it into the brain and potentially   you can have more efficient ATP production okay  or it could change neurotransmitters over here,English
+so it could change the Gaba to glutamate balance  you know a lot of people forget that glutamate   is the precursor to Gaba okay and so there's a  glutamate to Gaba cycle and that is under the,English
+control of different enzymes that are manipulable  and glutamate is excitatory and Gaba is inhibitory   and so if you have a problem converting one to  the other guess what you might go freaking crazy,English
+and in indeed people do okay gurg transmission  changing glutamate transport Ang which could   lead to angiolytic effects Etc okay everybody  got it in addition maybe more cholesterol and,English
+cholesterol can be converted to pregnanolone which  can then be converted to Alo pregnanolone an Alo   pregnanolone binds to the progestin receptor and  can cause reduction in CNS output so it's a smile,English
+sedative okay and maybe even improve immune  function too all of these plus there are fats   that matter in this story so there are Omega-3s  like EPA and DHA ioso pentenoic acids and DOA,English
+hexenoic acid the EPA DH a and you get these from  where you get these from wild fish not farmed fish   okay and these are necessary for normal neuronal  membranes and normal neural transmission and I,English
+will show you in a minute that these are very  important in terms of uh emotional well-being   and mental health on the other side you have omega  sixes and Omega sixes all come from this guy over,English
+here linolic acid which is in seed oils and this  is pro-inflammatory because it is the precursor   to arachadonic acid and arachadonic acid is  the precursor to prostaglandins thromboxanes,English
+and lucrin all pro-inflammatory so we know that  inflammation of the brain leads to mental health   disorders and so keeping that inflammation  down is necessary so you need a Omega 6 to,English
+omega3 ratio that basically allows for normal  neural connectivity and transmission and doesn't   allow for inflammation well that Omega 6 to  Omega-3 ratio optimally should be about 1:,English
+one maybe even up to 3:1 4:1 our current Omega  6 to Omega-3 ratio is 20:1 and the question   is does that have detrimental effects well we  know that poor psychiatric health is linked to,English
+persistently low Omega-3s in fact significant  depression and schizophrenia too all with low   Omega-3s now is that an epif phenomenon is that  a primary phenomenon is it correlation is it,English
+us to the question of what is is going on in the  brain what makes a difference is it the ketones   is it the type of fat is it the elimination  of carbohydrate or all the above and is very,English
+specifically because it's my interest what is  Sugar's role in this and is the reason that any   of this works just because you're getting rid of  sugar which is possible I'll show you why so we,English
+know that if you do any of these things you will  improve insulin sensitivity well that will lower   the amount of insulin at the level of the neuron  which is good because insulin makes the neuron,English
+do other things other than what you want it to do  okay actually basically drives energy metabolism   in the wrong direction because you're in storage  mode not burning mode and your brain wants to be,English
+in burning mode not storage mode and it turns out  beta hydroxy butyrate which is the primary Ketone   it's not the only one AC acetoacetate is another  one but beta hydroxy butter is the primary one,English
+from fat metabolism turns out it's a signaling  molecule it stimulates the cell to make cerin   in particular S 2 and two which is a primary  driver of mitochondrial biogenesis so you're,English
+making more mitochondria which is good okay so  is it the Improvement in instant sensitivity or   is it the reduction in Sugar consumption itself  we don't know because no one's ever tested just,English
+sugar reduction against carbohydrate reduction  to find that out out so these are still open   questions and every time I go to a talk or a  symposium about metabolic Psychiatry this is,English
+the question I ask and no one can answer it yet  okay and I'm going to be the biggest gadfly in   the world asking which of these or both is is the  important issue in why this matters don't know yet,English
+is it the carb reduction or the sugar reduction  that matters and through what mechanism I care I   think you all care too okay so when we talk about  sugar reduction what are we talking about well,English
+we're talking about two molecules right dietary  sugar I.E sucrose is two molecules one glucose one   fructose bound together with an glycidic linkage  linking the two high fructose corn syrup is one,English
+glucose one fructose not bound together okay now  the enzyme in your intestine SU C Cleaves this Oly   AIC linkage in a nanc you absorb both molecules  separately and they do their own thing glucose is,English
+the energy of Life fructose is consumable poison  it's that simple well if you consume high fructose   corn syrup you're getting the same thing so this  whole concept of sucrose versus high fructose corn,English
+syrup is you know just a tempest in a teapot it  is just garbage okay they're both equally bad   okay but of course the sugar industry thinks will  tell you it's the high fructose corn syrup and the,English
+high fructose corn syrup industry will tell you  it's the sugar and you know because they're all   competing for market share all right now what is  going on in the brain well you got to measure so,English
+if you inject glucose or fructose or both into  somebody's vein and then do magnetic resonance   spectroscopy of their brain here's what the  glucose reference looks like here's what the,English
+fructose reference looks like here's what the  combination looks like it's basically those   two put together and this is a human being okay  who's just eating and you see they're both there,English
+okay they're both there and the reason is because  the human brain turns glucose into fructose this   is work from Rick Johnson at the University of  Colorado and you can actually measure this as well   so this is pregnant women pregnant women here's  the CSF to plasma ratio for glucose that makes,English
+sense because the CSF glucose level is always  half of what the blood level is that's normal   here's for fructose okay why is there fructose in  the brain and why is there more because the brain,English
+converts glucose to fructose now why that's  a complicated story and Rick would tell that   story much better but there's actually adaptive  advantages to that and of course Sorbitol is the,English
+way you get from glucose to fructose this is the  polyol pathway so basically Aldos reductase makes   sorbitol and then it goes to um uh fructose and  fructose has its own potential effects all right,English
+so there's fructose in your brain whether  you like it or not whether you ate it or   not all right it's just a question of how much  and what's it doing well what's it doing it's   changing your mitochondrial metabolism is what  it's doing all right so impaired mitochondrial,English
+function and psychiatric disorders so this is not  like my you know you know imagination it's not   my you know craziness you know other people have  been looking at this and so here's mitochondrial,English
+function right here in the center and you can  see there are a whole lot of things affecting   that okay there's bcl2 which is a anag gene that  causes cell division mitochondrial DNA mutations,English
+glucocorticoid receptor translocation changes  in calcium influx okay that all Impact uh oh   and most importantly reactive oxygen species  we're going to come back to that in a minute,English
+okay all impacting on mitochondrial function  in fact we have a paper that we've got uh uh   sent out uh for review right now on the role of  active oxygen species in the toxic effects of food,English
+okay and why it drives obesity not why it drives  psychiatric disease but it's the same thing okay   and when your mitochondria don't work right you're  going to have problems with synaptic plasticity,English
+neurite outgrowth ATP production apotosis calcium  homostasis okay are which are all going to have   behavioral effects now remember the ketones get  get into the brain without insulin right so here's,English
+the liver making ketones beta hydroxy butyrate  right here entering the brain right here okay and   basically going to both the asite and the neuron  the beta hydroxy berate ends up going from the,English
+asite feeding the neuron and you end up into the  kreb cycle so that you can burn it but you don't   need insulin to do that whereas every other cell  you know if it's glucose you do need insulin to,English
+do that right so that's one of the reasons why  the ketogenic diet might work is because you   don't need insulin so ketones can substitute as a  CNS energy source even when the mitochondria are,English
+dysfunctional even when they're not working right  they will work better on ketones than they will on   glucose because getting from glucose to AAL COA is  its own process which can be affected negatively,English
+whereas ketones bypass that and go straight to the  CB cycle okay and you'll get less oxidative stress   less reactive oxygen species when you're burning  ketones over when you're burning glucose and it's,English
+been shown that the ketogenic diet can improve  cognitive parameters in Alzheimer's disease   maybe every patient with Alzheimer's should be  on a ketogenic diet well Dale breson who wrote,English
+the end of Alzheimer's thinks that that's true  okay now hasn't been tested in a formal fashion   needs to be okay but in his case series which he  has just published that's one of the things that,English
+allowed for survival of Alzheimer's was going on  a ketogenic diet now why is this a problem I mean   what's going on to alter the mitochondria well  that's in this slide here and I think I've shown,English
+this slide at you at Emery Pharma before I love  this slide it's one of my favorite slides okay   here's glucose here's fructose they are not the  same okay the food industry will tell you calories,English
+a calories sugars a sugar garbage total complete  trash okay they say that on purpose because that's   how they assuage their culpability for putting  all the fructose in the food in the first place,English
+they are not the same and this slide shows that  they're not the same glucose actually stimulates   mitochondrial function so you'll notice beta  oxidation up arrow in green hooray that's good,English
+glucose increases mitochondrial function how  does it do it activates two enzymes right here   activates am kinas adenosine monophosphate kinas  this is the fuel gauge on the liver cell when your,English
+cell uses up ATP it makes am right because the  phosphate bonds get broken and that's where the   uh energy is is in those phosphate bonds that's  what the electron transfer support chain in your,English
+mitochondria do is they basically release the uh  uh energy and you turn n into nadh and then go   back and forth Etc you know that's that the whole  oxida phosphorilation that powers cells everybody,English
+familiar with the concept right okay well amp kyes  okay if you have more amp it fits into the active   site and what that does is that tells the cell not  enough energy we're energy depleted because I'm in,English
+I've got instead of ATP and so we need to make  more mitochondria so it increases mitochondrial   biogenesis which is good for burning more energy  in addition it increases this enzyme here called,English
+HH hydroxy Asal COA dehydrogenase which is also  involved in increasing the rate at which two   carbon fragments get converted into energy thus  beta oxidation go going up so glucose for lack,English
+of a better word is good fructose on the other  hand is another story fructose does the opposite   fructose inhibits three enzymes that are necessary  for normal mitochondrial function it inhibits,English
+ayase it inhibits this one down here called aad L  ailoa dehydrogenase long chain which is necessary   to cut up those two carbon fragments and it also  through uric acid inhibits this over here cpt1a,English
+carnitine pido transferase 1A this is the enzyme  that regenerates carnitine and carnitine is the   shuttle mechanism by which the fatty acids get  from the outside into the mitochondria for burning,English
+in the first place the sum total of which is that  beta oxidation goes down glucose beta oxidation   goes up fructose beta oxidation goes down they  are not the same clearly Ron Khan CEO of Joslin,English
+but because it has effects on liver metabolism to  make it worse at burning fat as a result adding   fructose to the diet makes the liver store more  fat and this is bad for the liver and bad for   whole body metabolism and that's just the molecule  itself never mind what it did to the insulin,English
+right well that's one problem there's another  problem okay and it's on this slide and I've   shown this slide here as well you're all familiar  with this concept now here are five pictures of,English
+food they all share one thing in common what  is it they're all delicious brown brown yes   but they're all brown they are delicious and the  reason they're delicious is because they're brown,English
+okay that's the caramelization or the uh Browning  or the myard reaction the myard reaction this is   of course what causes hemoglobin A1c okay so the  way to think about this is you can roast your,English
+meat at 375 degrees for an hour or you can roast  your meat at 98.6 de for 75 years the answer is   the same your Browning and if you don't believe  me here's newborn rib cartilage nice and white,English
+and here's 88-year-old rib cartilage is nice and  brown okay you are Browning as we speak and if you   had orange juice this morning you are Browning  seven times faster and that Browning reaction,English
+is the Aging reaction it is what causes wrinkles  it is what causes cataracts it might even be what   causes Alzheimer's disease might how does it work  well as you know glucose has a ring form and a,English
+linear form this is the linear form when glucose  is in the linear form it has an alahh at one end   at position one and that alahi will bind to an  Epsilon amino group of Lysine at position one,English
+of the hemoglobin molecule forming a shift base  which will spontaneously decomposed to this Cove   valent linkage which then has to be cleared by  the spleen and that takes three months and that's,English
+why measuring your hemoglobin A1c basically  tells you about your glucose burden over the   previous 3 months that that's why diabetics can  use it to monitor their efficacy okay everybody,English
+with me so far okay well not only does it occur  in glucose and every by the way every time that   reaction occurs it releases a little reactive  oxygen species a little oxidative stress which,English
+has to be quenched by an antioxidant or it will do  damage it will cause lipid peroxidation or protein   denaturation ultimately causing cell dysfunction  ultimately cell death ultimately organ death and,English
+ultimately human death okay just does it over  a long period of time like one cigarette won't   kill you okay 100 cigarettes in one day won't kill  you but you know what 10 cigarettes over 20 years,English
+will most definitely kill you okay takes a while  but nonetheless it's still toxic even if it's not   an acute toxin it's a chronic toxin same idea here  okay this is a buildup slowly of damage and turns,English
+out that glucose will do it and you can't stop  it it will happen if you're alive it's going on   but you can slow it down and fructose does it  too and it does it seven times faster and you,English
+can actually measure this in not just the body but  in the food because when you heat Ultra processed   food the fructose in the food binds to the Epsilon  amino group groups of Lysine in the food to create,English
+Advanced glycation end products in the food itself  and there's a receptor for the advanced glycation   end products called rage receptor for advanced  glycation end products and when you stimulate,English
+that Rage with an advanced glycation end product  you generate reactive oxygen species all by itself   so eating food that has been uh that has add  sugar in it and bound is also problematic okay,English
+and it correlates with cardiovascular disease in  patients with obesity now why does this happen and   why is fructose particularly egregious for having  this happen that's here and this is our paper from,English
+uh our kids study okay this is the important term  right here delate now you've h a lactate lactate   is what your muscles make right when you exercise  right lactic acid that's L lactate this is delate,English
+the isomer right the epimer okay Del lactate only  has one source and it's not exercise I will show   you so there are a lot of different things  that affect that amp kinas right it is the,English
+master regulator of all of these Pathways and  it promotes all these good things and it also   inhibits all of these bad things so turning on  your kyes is a good thing that's why metformin,English
+is now being utilized for type two diabetics and  possibly even as a longevity promoting agent near   barsel is you know running this metformin trial  out of Albert Einstein to see whether or not,English
+metformin can promote longevity by increasing amp  kyes by increasing mitochondrial function okay so   there's a a a a a theme here if you will okay so  MP kindness is pretty important and I agree it is,English
+so let's look at amp kyes a little closer three  subunits Alpha Beta gamma that gamma subunit is   the B where the active site is that's where the  fits in to the pocket okay and that pocket over,English
+here okay has three arginines three arginines  three places where something could bind and form   that myard reaction Well turns out a compound  that is made from an intermediary metabolite of,English
+and an amino group find each other right so here's  the myard reaction if if if glucose is uh if the   rate of the glucose at the myard reaction is one  fructose is at seven methy glaxal is at 250 so,English
+goes down what does that mean for mitochondrial  biogenesis means it's in the sewer means you have   decreased your mitochondrial function and if you  decrease your mitochondrial function what does,English
+but different people have different levels of  the glyoxalase one it's genetically determined   so some people will be able to get rid of their  MGO and some people won't so we measured deact in,English
+our obese patients and guess what it's 52% higher  okay and in our kids study where we got rid of the   fructose and substituted glucose deact went down  by 38% in 10 days so the fructose gets converted,English
+remember I told you glutamate to Gaba the link  is the intermediate glutamine glutamate goes   to glutamine glutamine goes to Gaba but it's a  little more complicated than that because there,English
+are different cells and there are different  stoppage points on the way my colleague and   good friend Monica Duce at University of Michigan  studies all this in fruit flies and showed that,English
+if you take fruit flies from a controlled diet and  put them on a sucrose diet it changes their entire   brain structure entire brain structure just  because you added sugar to their diet okay my,English
+calls this carbohydrate Associated reversible  brain or carb syndrome and he actually runs a   Blog called carb syndrome. org which you can  you know access for free okay so I've looked,English
+sugar sleep deprivation drugs each of these has  been shown to increase dopamine increase reward   but dopamine downregulates its own receptor  so the more dopamine the less fewer receptors,English
+therefore you need you get need more and more to  get less and less this is called tolerance okay   because ligans downregulate their own receptor  now that makes you feel lousy because you can't,English
+get the reward signal like you should then throw  some stress on because the cortisol inactivates   the pre frontal cortex and the two of those  together lead to addiction conversely these,English
+five also are all associated with the development  of metabolic syndrome a metabolic syndrome causes   a change in the liver so that tryptophane instead  of being converted to serotonin gets converted to,English
+cyanine which is a different metabolic pathway  so you're basically depleting serotonin because   you're basically fishing it out of the blood and  turning it into this non-helpful curine which,English
+actually promotes inflammation so your serotonin  goes down that makes you dymic makes you feel you   know lower emotional well-being then throw some  stress on which of course cortisol decreases the,English
+serotonin 1 a receptor now you have few lians  less receptors now you got clinical depression   so addiction and depression are two sides of the  same coin driven by the same toxic environmental,English
+stimuli it's just a question of Who's Who as to  which one you get maybe get both now why does   this happen remember I talked about glutamate to  glutamine right well here's glutamate so glutamate,English
+Gaba everybody see how that works so this enzyme  here matters turns out that enzyme is inhibitable   by fructose so if you incubate rack cortical  synaptosomes with glucose or with fructose,English
+you get different answers you get completely  different metabolites so look at the glutamate   to Gaba ratio when you incubate with glucose  basically 3: one okay do it with fructose 50,English
+to1 lots of glutamate very little Gap  but because you've inhibited glutamine synthes and this is true in immune cells and  therefore likely true in CNS cells because immune,English
+cells and CNS cells are very similar and you can  see here we're giving glucose or we're giving   glucose and fructose sucrose glucose or sucrose  okay the difference is sucrose has fructose and,English
+glucose doesn't right and we're looking at cyto  and we're looking at so tnf Alpha we're looking   at il1 beta we're looking at IL 6 okay and  you can see that in each case the fructose,English
+made those cyto much higher right and that can  be inhibited by a protein synthesis inhibitor   Romy in other words this is a protein issue and  fructose is inhibiting that okay and when you,English
+put glucose into immune cells you get lactate  and lactate is okay here this is L lactate when   you put fructose in it basically inhibits the  ability uh uh to metabolize it because it won't,English
+let the glutamine get turned into Gaba okay and  you end up with increased oxygen radicals so you   increase your oxidative stress in immune cells  same thing happens in neurons okay number three,English
+trophic factors insulin leptin and bdnf so Ultra  processed food increased psychological distress   as an indicator of depression this came out one  week ago from a Melbourne study big Melbourne,English
+study okay now this is correlation not causation  this is also correlation ultr processed food   increased risk for depression why well insulin  resistance is a driver of depression and it's,English
+a driver of depression through inhibition of brain  derived neurotrophic Factor here and also glycemic   disregulation here all leading to depression now  what do we know about these trophic factors leptin,English
+is a trophic Factor leptin causes new neurons  to form and causes neuron outgrowth leptin is a   trophic Factor insulin inhibits leptin insulin  blocks leptin signaling we know that leptin,English
+causes neurons to branch and connect we know that  leptin regulates neural and gal protein levels we   know that leptin corrects cognitive defects who  have in patients who have leptin deficiency so,English
+leptin is important it's a trophic factor and  you can actually see under the microscope the   uh increase in neurite outgrowth and increase  in synaptogenesis in response to leptin we know,English
+that Sugar causes insulin resistance we know that  insulin resistance causes leptin resistance the   hyperinsulinemia blocks the leptin signaling this  is part my work actually and we see it in humans,English
+as well again correlation not causation it's hard  to do causation in humans because that means you   would have to take somebody's brain out okay and  they don't let you do that not too often anyway,English
+okay but this is a a correlation study out of the  white hole study in the UK sugar intake from sweet   food and beverages common mental disorders and  depression perspective findings now we showed in,English
+our kids study that um uh fructose makes lots of  triglyceride makes lots of vldl when we take the   fructose out of the diet and substitute glucose  nine days of isocaloric fructose restriction,English
+liver fat went down 22% turning sugar into  fat went down 46% vldl triglyceride went down   49% visceral fat went down 7% all good and most  importantly the pancreas started making insulin,English
+properly again in other words we reverse the  patient's metabolic syndrome with no change   in calories no change in weight just by getting  rid of the toxin the fructose possibly through,English
+methylglyoxal possibly all on its own this has  been independently confirmed by another study done   out of UC San Diego and Emory okay showing that  the control group no effect on liver fat and the,English
+treatment group where you took the sugar out Mega  reduction okay now bdnf turns out to be The Driver   of improved mental functioning due to exercise  due to exercise okay so bdnf increases well sorry,English
+exercise increases bdnf increases hipocampal  volume increases memory function aging reduces   bdnf lack of Serotonin reduces bdnf I already  showed you lack of Serotonin is part of metabolic,English
+syndrome okay and that's reducing hippocampal  volume which is also leading to cognitive decline   how about addiction so could one ingredient lead  to Addiction in food and the answer is well yeah I,English
+mean we already know about alcohol okay but turns  out sugar and alcohol metabolize the same way and   Sugar's addictive you know National Geographic  said why we can't resist it in fact that's right,English
+solution that you dip the p pacifier in and stick  in the normal newborn boy's mouth before the circumcision the Jews have wine everyone else has  sweeties because they do the same thing okay so I,English
+can prove it right so what's going on in the brain  well what makes a milkshake rewarding is it the   fat or is it the sugar turns out it's not the fat  it's the sugar how do we know because Eric sty at,English
+Oregon Health Sciences University constructed this  great Contraption all out of plastic okay with two   bottles one with fat one with sugar and when you  suck okay you get different amounts depending on a,English
+regulator that he controls as to how much fat and  how much sugar makes your milkshake okay so you   can have a high sugar lowfat milkshake or a high  fat low sugar milkshake okay and he stuck people,English
+in an MRI scanner while they were sucking on the  milk shake to determine what was happening to   the reward center and it turned out that the fat  did not stimulate the reward center the fat only,English
+stimulated the smata sensory cortex mouth feel  only sugar stimulated the nucle cumbent the reward   center and increasing the fat did not increase the  reward so it's the sugar that actually drives the,English
+reward in a milkshake this has been repeated in  a different way from a a group in Switzerland uh   vulneren okay who showed no satiety or fullness  with fructose compared to glucose and no insulin,English
+rise with fructose compared to glucose but when  they looked at the fmri the glucose basically   stimulated the anterior FAA and the basil ganglia  whereas the fructose stimulated the whole lyic,English
+system how about dementia so do sugar caused  dementia well D breson would tell you yeah   okay so we know obesity is associated with  dementia that's old news we know obesity,English
+has altered neural projections consistent with  dementia we know that Sugar generates insulin   resistance and hyperinsulinemia old news we  know that insulin resistance and high insulin   levels are associated with dementia we know that�� the Western diet correlates with dementia and we,English
+know that both fat and sugar can cause obesity in  rats but only sugar causes cognitive decline fat   does not that's probably because of the effect  on the mitochondria okay so here's bdnf right,English
+and synaptic plasticity okay here's diet and  exercise affecting mitochondrial function okay   the mitochondria make reactive oxygen species  which can affect cognition unless something,English
+takes those reactive oxygen species and quenches  them and gets rid of them you reduce the numbers   okay well it turns out insulin is a bad guy  in the story the higher the insulin the less,English
+well that happens and it turns out that insulin  and fructose induced hyperinsulinemia changes   membrane characteristics and Alters what is known  as membrane fluidity which has to do with how well,English
+does a membrane bounce back when perturbed either  from biochemical changes or pressure changes a way   to think about this I think I talked about this at  the first talk the 8 you have a balloon okay just,English
+a plain old you know birthday balloon you blow it  up you put a knot in it you try to put your finger   through it okay bounces right back now if you try  to take a pin it will explode okay take the same,English
+balloon new new balloon same same concept blow  it up same level put it in the you know corner   of your bedroom for three weeks it will slowly  but surely deflate right now undo the knot blow,English
+it up again to that same level now try to poke  a hole with your finger now it'll now it'll blow   it wouldn't blow before but it will now because  the membrane has changed because of the pressure,English
+that's membrane fluidity everybody got the idea  well that happens in neurons okay and fructose   and hyperinsulinemia change that membrane fluidity  but there's a way to fix that that's with Omega-3s,English
+because it contributes to neuronal structure  remember EPA and DHA and it turns out that   Sugar consumption correlates with Alzheimer's  preclinical Alzheimer's in population studies,English
+how about cognition this is work from Antonio  conit at uh NYU showing that insulin resistance   as measured by the quick ey score is positively  correlated with changes in hippocampal volume,English
+so more insulin lower hippocampus and also more  CSF so you've lost tissue you've lost tissue and   you've got more CSF not good and that correlates  with changes in executive function and cognitive,English
+flexibility here's your few vales okay this is  an adolescence adolescence so you want to know   why all the kids are doing bad in school because  the hyperemia and what's the hyperemia from the,English
+processed food okay how about Behavior I love this  I mean we're in San Francisco everybody knows what   the twinkie defense is right yes who does not  know what the twinkie defense is you all know,English
+oh you don't you don't know the twinkie defense  oh my God where have you been didn't you see the   movie milk milk Harvey Milk Harvey Milk all right  so as you know Harvey Milk was the first gay uh,English
+legislator right and as a Board of Supervisors of  San Francisco you know that part and you know that   he and mayor George mcone were killed by another  supervisor who was a former police officer named,English
+Dan White and at his trial the uh lawyer the  attorney for Dan White tried to defend White's   actions by saying he was insane because he ate  a junk food diet a lot of Twinkies and so this,English
+became known as the twinkie defense now as it  turns out the jury didn't buy it white went away   for 25 years got released one later one week later  he killed himself that's the story of Dan White,English
+okay point is there might be something to this  twinkie defense because it turns out adolescents   who drink more than five cans of soft drinks  per week are more likely to carry a weapon more,English
+violent with their peers family members and dates  even after controlling for all the things that   might affect their behavior obviously correlation  not causation but you know makes you wonder soft,English
+drink consumption is associated with behavior  problems in 5-year-olds increased impulsivity   lack of being able to sit and concentrate and  finally number four the microbiome now this,English
+gets complicated the gut microbiome may be very  specifically related to CNS development and we   know this because of germ-free mice so they don't  have a microbiome and they have cognitive defects,English
+so the microbiome might actually be supplying  things to your brain now might be through the   blood things that get across or might even be up  the afron vagus nerve anterograde transport like,English
+of serotonin cuz 90% of the serotonin in your body  is in your gut there's very little serotonin in   your brain okay it might be getting there through  the afron Vegas through anr transport so if you,English
+change the microbiome you might be changing�� your neurotransmitter levels okay we know the   ketogenic diet Alters the microbiome also in some  very specific ways okay having to do with with,English
+Improvement in cognitive function we also know  that the intestine has three barriers there's   the mucin layer is the physical barrier there's  the biochemical barrier the tight Junction and,English
+then finally there's the immunologic barrier the  th17 cells which make il17 which basically keeps   all the pathogens out if you destroy the mucin  layer which could be from emulsifiers we talked,English
+about it lunchtime okay it might be more likely  that bad guys will get through if you destroy the   tight junctions like for instance celiac disease  or sugar as you'll see in a minute more likely,English
+bad guys will get through and if you destroy the  immunologic barrier same thing more bad guys get   through so this looked at the microbiome in  associated with fructose consumption and I'll,English
+just read you the one sentence because this is an  awfully complicated concept that associated with   fructose seem to hold more potential to induce  host metabolic disturbances compared to glucose,English
+mainly by promoting bile acid deconjugation and  torine release and compromising intestinal barrier   Integrity fructose Alters intestinal barrier  integrity and how come because fructose nitrates,English
+those tight Junction proteins and makes them  unreliable so they're supposed to basically hold   like this in response to Sugar they go like this  and it might be because fructose changes the ATP,English
+content of intestinal ocytes and makes them ATP  depleted because of that mitochondrial function we   talked about okay got it and so that could lead to  bacteria and lipopolysaccharide translocation into,English
+the liver and now you've got hepatic inflammation  and insulin resistance and high glucose levels can   activate t 17 cells in inflammation also okay and  there is a pathway between the gut microbiome and,English
+autoimmunity that runs through this IL 17 as well  because of an increase in inflammatory cyto kindes   due to micro microbiota disbiosis possibly  due to short chain fatty acid reduction in,English
+association with sugar consumption I've already  shown you this go keep going okay and this might   be relevant to clinical medicine because dietary  intake of sugar is associated with increased,English
+disease activity in lupus in a patient you know a  patient with an inflammatory process sugar makes   the inflammatory process worse okay association  between consumption free sugars and number of,English
+complications and here might be the reason  why we know about Sim's Korea right we know   about a disease called pandas anybody heard of  pandas p n D- Progressive autoimmune neuropathic,English
+disease associated with streptococus disease  related to strepto cacus synm Korea is like   the early famous one but now a lot of kids  have thing this thing called pandas and as,English
+a pediatrician Pediatric and chronologist  I saw this in the hospital okay it's a big   problem well might be because the strep is  growing okay and making bad stuff it makes,English
+toxins okay it makes toxins on your tooth to  eat a hole in your tooth right the strap strep   mutans here okay and strep the caucus in your  intestine so here we're growing group a strep,English
+on different media 2% glucose oh sorry here's  glucose notice no effect here's sucrose huge   effect here's fructose huge effect sucrose  plus glucose same effect so in each case,English
+the group a strep is preferring the fructose  as a substrate for metabolism so increasing   the sugar in the diet might be increasing group a  strep colonization leading to psychiatric disease,English
+uh I'm going to pass this for time so let me just  finish what I've told you food has effects on the   brain okay I mean I don't have to like convince  you of that you already know that but like what,English
+okay it's not just growth but also Behavior  food can act centrally or peripherally can   act via the gut of the liver via afret mechanisms  or could act directly via the blood brain barrier,English
+to alter neuronal function food can act as  an initiating or an aggravating factor for   many psychiatric diseases it can affect brain  metabolism through changes in mitochondrial   function through glutamate neurotoxicity through  insulin resistance and its effect on leptin and,English
+bdnf or through microbiome dysfunction leaky  gut and autoimmunity now the ketogenic diet   seems to affect many of these I'm not saying  everyone needs that but maybe certain people,English
+do okay we don't know if it's due to the sugar  restriction or the carbohydrate restriction or   the insulin reduction or the ketones themselves  because of the cin effect we don't know yet but,English
+might be able to treat some of these pathologies  and this is what Christopher Palmer at Harvard is   doing okay anecdotal data and case series support  the association but we need the randomized control   trials they are now ongoing so we have a ways  to go not there yet but I hope what this has,English
+done this talk has given you some idea about  how important this concept of metabolic or   nutritional Psychiatry is and the fact that our  current disaster debacle of mental health is not,English
+just because of the stress of our politics or even  the stress of our cell phones but actually might   be because of the stress of our diet too so with  that I'll close and of course answer any questions,English
+and you know thank you for [Applause] attending  so uh Rob as we discussed obviously sucrose uh   basically it's a you know molecule that contains  both glucose and fructose right and fructose is,English
+a single molecule right SU R is a combination  of two tiny little molecule right so and what   you're showing is effectively glucose in many  aspects seems to be safer compared to fructose,English
+sure compared to compar toose why why aren't we  using glucose more oh cuz it's not very sweet   cuz it Doesn't generate that reward system okay  okay you don't see people going around chugging,English
+kro syrup do you okay that's glucose not very  interesting okay might be good in a cookie but   you know I mean that's only after you add the  fructose first okay glucose has a sweetness,English
+index of 74 sucrose has a sweetness index of  100 and fructose alone has a sweetness index of 173 okay so it might be just due to the  sweetness but more importantly it's the,English
+reward signal sorry so diet sweeteners have  a very high sweetness index they you know   in the hundreds but most diet sweeteners do  not stimulate the reward signal and so let,English
+me ask you a question have you ever had  a no sugar diet sweetener only chocolate bar are they good no no no they're sweet  are they good no T do you ever want another,English
+one no why not doesn't because you didn't  stimulate the reward center just because   you got the sweetness didn't mean you got the  reward okay they're not the same so it's less,English
+about the sweet and has more to do with the  reward signaling and fructose specifically   drives that reward signal binds to receptors in  on the neuron itself so how do you satisfy that,English
+crave without causing metabolic disease ah  so invite me back and I will give you a talk   that I'm going to give two weeks from now in  uh North Carolina called the true purpose of,English
+nutrition and the true purpose of nutrition is  metabolic health and so the question is if the   true purpose of nutrition is metabolic health and  if Ultra processed food only causes metabolic D,English
+function is ultra processed food food well could  you make Ultra processed food healthy yes or no yes yes if you know what the principles that  you had to abide by are now the current you know,English
+ultr processed food industry they don't care  they don't know but any better I don't they   do they actually do I know they do because they've  told me they do okay but you know it's about money,English
+it's about money they're not going to do anything  that's going to alter their gravy train okay not   until they're told to have to not until there's  regulation okay and they told me so there you   know that's that's their stick okay it's about the  money they're not in business to feed the world,English
+they're in business to make money and anything  that interferes with that is not is not welcome   period could you make ultr processed food healthy  well yes by adhering to three principles and this,English
+is what uh we did with a uh this company in the  Middle East called Kuwaiti Danish Dairy company   kdd okay and um we wrote this up and uh it was  published in frontiers of nutrition in March,English
+okay three precepts if you adhere to those three  precepts you can make Ultra processed food healthy   those three precepts are and they're in the paper  protect the liver feed the gut support the brain,English
+those three why those three protect the liver how  ah how so get rid of the toxins okay so fructose   is a toxin cadmium is a toxin Branch chain amino  acids are toxins to the liver okay feed the gut,English
+well what does the gut want to eat fiber and  support the brain okay well how do you support   the brain short chain fatty acids which can come  from that fiber okay another way is um Omega-3s,English
+okay and few other you know uh things you know  getting rid of all the other stuff and basically   preventing the inflammation so you have to stop  the leaky gut well how do you stop the leaky,English
+gut well I just showed you the three the three  barriers you got to keep those intact could Ultra   processed food keep those those three intact and  the answer is yes if you know what you're doing,English
+right now that's not happening so actually Ultra  processed food could be made healthy and that's   what we did for kdd and we're hoping that we can  get other food companies on you know this track,English
+to basically alter their uh products and their  fair to ultimately become metabolically healthy   yeah I have a two questions um so one one of the  slides you were talking about how the membrane,English
+the separation is not tight IT wi oh the the leaky  gut okay leaky gut is that is that similarly the   reason why fat might get stored in the liver  or is that it could be it could be especially,English
+for medium chain triglycerides probably not for  um uh uh kyom microns because kyom microns get   made from regular uh triglyceride and you know  they're big fluffy things they probably don't,English
+make you know they're made on the other side  of the membrane anyway and they circulate via   the lymphatics and go straight to the liver and  get cleared through the LDL receptor okay and so   it's a slightly different um pathway for them but  medium train Trias rides could certainly do that,English
+"In summary, it is very important for nurses to understand current development of MI/CAD genomics, and the inconsistency in commercial genotyping panels so that information can",English
+"death. There are approximately 795,000 strokes a year. That's a stroke every 40 seconds. The direct and indirect cost is estimated at $38.6 billion a year, and about 6.8 million",English
+Americans have had a stroke in the past. Stroke is the leading cause of adult disability. These disabilities range from minor weaknesses to the need for skilled nursing homes.,English
+"Eighty-seven percent of strokes are ischemic stroke, 10 percent are hemorrhagic, and about 3 percent are subarachnoid hemorrhage.",English
+"Risk factors for stroke are similar to the risk factors for MI and CAD. These include hypertension, dyslipidemia, diabetes, obesity, and inflammation. Family history of stroke or MI also puts one at higher risk for stroke.",English
+"In fact, the paternal history of stroke puts a person at higher risk for stroke than maternal history. In twin studies, a five-fold increase in stroke was seen in monozygotic twins when compared",English
+"to dizygotic twins. The estimated prevalence of stroke are as follows: African-Americans, about 3.8 percent; Caucasians at 2.5 percent; and Asians at 1.3 percent.",English
+Most genetic research in stroke has been completed on Caucasians from North America and Europe. We are starting to see replicated data in other ethnicities such as Japanese and Chinese.,English
+"However, we need to do more research in these other ethnicities. Genes that have been associated with stroke. For ischemic stroke, the 9p21 locus that Dr. Wung mentioned earlier, it was also associated",English
+"with stroke. Apolipoprotein E, prothrombin, and ICAM are just a few of the other genes associated with ischemic stroke.",English
+"With hemorrhagic stroke, it has been associated, again, with Apolipoprotein E, Factor 7, Factor 8, and endoglin, while subarachnoid hemorrhage outcomes, such as vasospasm, have been associated",English
+"with eNOS and haptoglobin. For a more complete list of these genes, there was a review in the Annual Review of Nursing Research, Volume 29.",English
+"In addition, some rare genetic disorders have been associated with stroke. This includes mitochondrial myopathy, encephalopathy, and Fabry disease.",English
+"When there is suspicion of these rare genetic disorders, testing can be ordered by the health care professional. As with MI and CAD risks, the direct-to-consumer testing can be used to evaluate stroke, but",English
+"at this time, it's inconsistent what they are testing for stroke. There are no clinically recommended genetic tests for stroke risks, and the ones that are out there continue to have the inconsistent results.",English
+"It's the leading cause of death in the world, and, in fact, most of the individuals who suffer an acute myocardial infarction die of sudden cardiac death. There is a broad category of inherited cardiomyopathies and channelopathies which account for some",English
+"cardiac death in those under the age of 50. With the advent of the human genome and genetic etiology of many of these inherited cardiac monogenetic disorders, we now are able to test commercially by genetic testing for these",English
+"disorders. Could you go to the next slide, please? The primary electrical diseases or channelopathies listed here, Long QT syndrome accounts for",English
+"about 1 in 3000 people, Brugada syndrome accounts for about 35 out of 100,000 people, and those with other disorders such as CPVT or ARVD are other primary channelopathies.",English
+The chief characteristics and the clinical history is very helpful in those disorders where we are able to see very specific changes on the EKG.,English
+"In the case here on this slide of Long QT syndrome, we see an up-sloping of the ST segments in Long QT Type 1.",English
+"A common trigger for this disorder is swimming, and the incidence is about 30 to 35 percent of individuals. In the case of [spelled phonetically] Long QT Type 2, an auditory stimulation such as",English
+"a loud doorbell or fireworks can account for this syndrome, and classically, we see a broad and flat T wave. In the case of Long QT Type 3 syndrome, this occurs commonly with sleep.",English
+It affects about 5 to 10 percent of the population. You can go to the next slide.,English
+"So in regards to the channelopathies, or rather cardiomyopathies, excuse me, in this image what we see is, in Panel A, a hypertrophic cardiomyopathy heart from autopsy.",English
+"You can notice the very thick and enlarged septum, and that's where, you know, blood and just volume is unable to be pumped effectively and efficiently.",English
+"Hypertrophic cardiomyopathy accounts for about 1 in 500 individuals. Shown in Panel B is a normal heart, normal myocardial thickness, papillary muscles, and",English
+"normal cavity size, and therefore normal function and contractility of the heart. Shown in Panel C is dilated cardiomyopathy.",English
+"This accounts for about 1 in 1,000 individuals, and you can really see the extreme dilatation that occurs of the vessels there.",English
+"We now also are able to identify the genes associated with many of these cardiomyopathies, and test individual families for many of the mutations that are specific to individual",English
+"members. The beta-myosin heavy chain and myosin-binding protein C genes account for the majority of inherited cardiomyopathies, and specifically, hypertrophic cardiomyopathy.",English
+"Once we've identified a proband within the family who has no mutation, we are able to then test for other family members and do cascade screening.",English
+"So, nursing implications. Nurses, as we know, play a vital and critical role in cardiogenetic testing, and are involved in the direct clinical care of patients and families.",English
+"Nurses are on the forefront of obtaining EKGs, identifying potentially abnormal findings on the EKG, providing support, counseling, and education to patients and families, and",English
+they are certainly leading the way and being aware of many of the arrhythmogenic triggers and explaining to patients and families prescribed therapies for protection against sudden cardiac,English
+"death. Some of these therapies may include beta blocker therapy or ICD therapy. So, in conclusion, the channelopathies and inherited channelopathies have really been",English
+evaluated in recent years with the advent of the Human Genome Project completion and the availability of commercial and genetic testing.,English
+In all likelihood in the years ahead we'll see gene therapy and other advances in this area. Thank you for your attention.,English
+"Jacquelyn Taylor: So, as you can see here, we highlight in our paper on Table 1 some of the ethnic differences that you can find in the genomics of cardiovascular",English
+"disease, and some are even cited in some of the work that I do, such as some of the SNPs that are more deleterious for hypertension in African-Americans than in other ethnic",English
+groups. But I wanted to highlight some of the similarities that you can find as well within and between ethnic groups.,English
+"So some that are highlighted in Table 1, you can find that there are similarities with the SCN5A gene and the SNC10A gene with African-Americans, Asians, Europeans, and that's with men and",English
+"women. And in all of these groups you can see that there is an increased prolonged PR interval on electrocardiogram. And then other similarities include the SCARB1 gene, which results in increase cardiac -- CAC,",English
+"common internal and carotid intimal medial thickness. And this can be found with African-American, Asians, Europeans, and Hispanic men and women.",English
+"And then finally, another similarity that you find with Mexican women and Native American women are the FOCAD genes which result in increased heart rate. So one other point that I wanted to make with racial and ethnic differences is that particularly",English
+"when you are doing genome-wide studies, that you should consider ancestry-informative markers when conducting work because we know that there is a lot of ethnic admixture, particularly",English
+with American populations. And that's all I have on this particular slide. Now I'll turn it back over to Shu-Fen.,English
+"Shu-Fen Wung: So, in summary, genetic testing for common cardiovascular disease like MI and stroke is commercially available but not recommended",English
+"for clinical use at this time; however, there are some academic institutes that do offer this in their clinic.",English
+"However, I think health care providers need to know that genetic markers to comprehensively profile these diseases are still ongoing.",English
+"On the other hand, genetic testing for long QT syndrome and hypertrophic cardiomyopathy can provide valuable information for nurses to tailor prevention and management strategies",English
+for individuals at risk for sudden cardiac death. We leave you some clinical resources that may be helpful when you want it to look for,English
+"I appreciate that they are in different locations, and some of them are a little bit lighter to hear than others. I'm sorry for that in terms of the technology.",English
+"But if you have questions now and clarification, or anything you want to follow up on what the speakers are talking about, please feel free to go ahead and write those in currently",English
+"and I will submit them to the speakers. Okay, if no questions, then we'll move on to the next presentation. And hold on one second, Kathy, and I'll let you introduce the next speakers.",English
+"Kathleen Calzone: Okay, for those of you who are joining late, we'll re-introduce our next set of presenters. And we have an overlap, and that's going to include Dr. Jacquelyn Taylor.",English
+"And she's an associate professor in the pediatric nurse practitioner specialty at Yale University School of Nursing, and her research has focused on addressing genomic health disparities and",English
+"hypertension among African-Americans and West African families. In addition, we also have Dr. Ann Cashion, and she is the currently the acting scientific",English
+"director of the National Institute of Nursing Research Division of Intramural Research. And prior to coming to the National Institutes of Health, she was a professor and chair of",English
+the Department of Acute and Chronic Care in the College of Nursing at the University of Tennessee Health Science Center. Her research and clinical interest is focused on genetic and genomic environmental components,English
+"associated with the outcomes of organ transplantation. And then lastly, we do have two of the other authors who are going to be participating,",English
+"and that includes Ansley Stansfill and Ashley Clark, both who are doctoral students at Yale and working with Dr. Taylor on their projects.",English
+Jacquelyn Taylor: Okay. So we're going to start by giving you the general definition of metabolic syndrome. So our paper covered an overview of the genomics of metabolic syndrome.,English
+And determining exactly what metabolic syndrome is really depends on who you ask because there are several independent and expert organizations that have differing definitions of what metabolic,English
+"syndrome really is. But generally, metabolic syndrome is widely recognized -- a widely-recognized concept generally defined as the clustering of risk factors including hypertension, insulin resistance,",English
+and obesity. This clustering of risk factors then leads to an increased risk for diabetes and cardiovascular disease.,English
+"I can't see the slides, but we're on the second slide. Metabolic syndrome -- it's estimated that in the United States it affects more than",English
+"34 percent of the population, and it leads to a three-fold increase in cardiovascular-related deaths.",English
+This lack of consensus on establishing diagnostic criteria for metabolic syndrome leads to an uncertain clinical utility of the diagnosis.,English
+"Next slide, please. So what we have defined in our paper from the Alberti, et al. paper in 2009 is the harmonizing definition of metabolic syndrome that takes into account the definitions of the three",English
+major expert panels that define metabolic syndrome. So one of the first expert panels that we looked at for a definition of metabolic syndrome,English
+"was the ATP3, which is the National Cholesterol Education Program Adult Treatment Panel Three. And their primary outcome for metabolic syndrome focuses mainly on cardiovascular disease,",English
+"while the American Association of Clinical Endocrinologists, or the AACE, their primary outcome focuses in on insulin resistance.",English
+"And then we looked at the definition of the World Health Organization, which looked at a diagnosis being made of metabolic syndrome that focused mainly on markers of insulin",English
+"resistance. So with the harmonizing definition of metabolic syndrome, it takes in to account many of the factors defined in -- with the three major organizations that look at metabolic syndrome,",English
+"but it looks at many other factors as well. So it looks at obesity, where you look at increased waist circumference by populations and country -- using country-specific definitions, elevated triglycerides, reduced HDLC, elevated",English
+"blood pressure levels, and a elevated fasting blood sugar level, or type 2 diabetes. Next slide.",English
+"So some of the risk factors associated with development of metabolic syndrome are similar to those associated with hypertension, obesity, and renal disease, and diabetes.",English
+"And looking at these risk factors, we do understand that although there are genomic precursors for each one of these factors and development of metabolic syndrome, we also recognize that there are lifestyle, gender, and ethnic differences that have to be considered when examining",English
+"development of metabolic syndrome. Many studies have been completed looking at metabolic syndrome and its risk factors including genome-wide association studies, epigenetic studies, and proteomic-type studies.",English
+And although certain risks alleles that have relevance for the individual components of the disease may also have overlapping value and the overall risk for the development of,English
+"metabolic syndrome. So not only do these studies look at metabolic syndrome as a whole, they look at all those disorders that make up metabolic syndrome, so hypertension, diabetes, renal disease,",English
+"and obesity. So in our paper, we looked at the possible contributors to metabolic syndrome individually, and then as a whole.",English
+"So what we're going to do here is first we're going to talk about cardiovascular factors in metabolic syndrome, and we just went through -- so we should be on the slide with cardiovascular factors in metabolic syndrome, or Slide 5 -- so we just went through a whole seminar",English
+"on cardiovascular genomics, so we're not going to go into great detail, but we're going to talk about some of the factors that affect obtaining a diagnosis of metabolic syndrome.",English
+"So one of the major cardiovascular risk factors in metabolic syndrome is dyslipidemia and hypertension. So looking at dyslipidemia first, this leads to alterations in circulating blood lipid",English
+"levels, or predisposition to -- for a predisposition to development of metabolic syndrome. And some of the things we look for with this dyslipidemia is a familial hypercholesterolemia,",English
+or increases in triglyceride and HDL levels. And the major mutations that we found in our search were mutations in the LPL and APOE,English
+"genes, or the lipoprotein metabolism. Next slide on cardiovascular factors in metabolic syndrome include looking at hypertension, which is one of the major risk factors for metabolic syndrome.",English
+"When we did our search, we found more than 50 genes that were associated with blood pressure or hypertension that were related to metabolic syndrome.",English
+"So again, when you look at hypertension, it's important to assess a familial -- to do a family pedigree so that you can assess any type of inherited risk for hypertension.",English
+"So we look at familial hypertension, and this leads us to believe that these risks are -- you have greater risk if you have familial hypertension rather than those that are due to secondary",English
+"types of hypertension. And then other genes that are responsible for hypertension can also lead to proteins that may affect the renal, electrolyte, and water handling system in the body that lead",English
+"to high blood pressure. And these genes can be found in the seminal works created by Lifton, et al. And some of these are even some of the rare renal disorders like Bartter Syndrome, Liddle Syndrome, and",English
+"the like. So next we're going to talk about diabetes in metabolic syndrome, so we should be on the diabetes slide.",English
+"So type 2 diabetes is what we're more interested in in terms of metabolic syndrome, and in type 2 diabetes, we're looking at an overnight fasting glucose of greater -- equal -- 126",English
+"milligrams per deciliter or greater, or -- and/or an HbA1C of greater than 6.5 percent. So a hemoglobin A1C, as you all know, is a three-month average of your blood sugar levels.",English
+"And although diabetes may be more prevalent among specific ethnic and racial groups, we know that this can be true for the other risk factors that we're looking at in metabolic",English
+"syndrome as well. So hypertension, obesity, dyslipidemia, all of those can have certain ethnic and racial pre-existing factors or genetic predisposition for all of those particular risk factors.",English
+But here we just wanted to highlight some of the differences that you can find in terms of ethnic and racial breakdown for a particular risk factor. So although you see that there are more than 15.7 million non-Hispanic whites that have,English
+"received a diagnosis of diabetes, non-Hispanic blacks have a greater percentage of the population. So they -- although there are only 4.9 million non-Hispanic blacks with type 2 diabetes,",English
+"that accounts for 18.7 percent of the black population. And then you can also find differences within ethnic groups as well. So when you are looking at Hispanics, you can see that 7.6 percent of the diagnoses",English
+"for diabetes can be found for Cuban, Central, and South American Hispanics, while, when you look at Mexican Americans and Puerto Ricans, they have a greater prevalence at 13.3 percent",English
+to 13.8 percent. So just something just you want to keep in mind when looking at different ethnic groups and ethnic risk factors for particular disorders.,English
+"Next slide for type 2 diabetes risk alleles. So when looking at risk alleles for type 2 diabetes, the major variant that we found in the literature for type 2 diabetes risk in metabolic syndrome was the TCF7L2 gene.",English
+"And although we know that this particular gene can cause excess fat, glycogen deposition in the liver, hyperlipidemia, glucose intolerance, and lead to type 2 diabetes, we know that",English
+the effects of individual SNPs are relatively small compared to some of the synergistic effects that you can see that contribute to the development of metabolic syndrome.,English
+And we have added in a supplement of a schematic of the synergistic effects of type 2 diabetes risk alleles on development of metabolic syndrome that can be found on the online version of,English
+this paper at the Journal of Nursing Scholarship website. So now I'm going to turn the presentation over to Ann Cashion who's going to talk about,English
+"obesity in metabolic syndrome, and some of the clinical resources for implications for practice and research.",English
+"So Kathy, if you will continue to work the slides, that would be wonderful. Body mass index, or BMI, has been used to clinically evaluate obesity for the last several",English
+"decades. In terms of metabolic syndrome, we are most concerned about individuals who are overweight, which is a BMI greater than 25, or obese, which is a BMI greater than 40.",English
+"The reason for our clinical concern about these individuals is that those who are overweight are five- to six-fold more likely to have metabolic syndrome, and those who are obese,",English
+"the greater than 30 BMI, are actually 32 times more likely to develop metabolic syndrome. So those are significant numbers, and we need to think about that in terms of obesity may",English
+"be a genetic trigger for metabolic syndrome. So an individual may have many risks for metabolic syndrome, but then when they become obese,",English
+"it more or less is the straw that breaks the camel's back, and it flips on the ""on"" switch for interactions between the genes that actually lead to the metabolic syndrome component parts.",English
+"So we are -- however, we also see that some obese patients are not at risk for metabolic syndrome, and that can happen.",English
+"So there is some factors such as the gynoid fat distribution in women that may actually protect against metabolic syndrome, whereas those with central fat obesity, which is the",English
+"accumulation of the fat between the organs, that these individuals may be at greater risk for metabolic syndrome.",English
+"If you could turn to the next slide, the obesity risk alleles. Thank you. Now let's discuss a few top obesity gene candidates or alleles.",English
+"The two main ones that are implicated are melanocortin receptor 4 gene, which is called MC4R, and it's been associated with that accumulation.",English
+"Another top gene frequently mentioned, and I think you can basically tell by the name of this gene how people thought it was going to be very important, that the name of the",English
+"gene is fat mass and obesity gene. And this has also been associated with the development of metabolic syndrome. MC4R gene is most commonly associated with monogenetic forms of obesity; possibly, it's",English
+"also involved in some polygenetic forms of common central obesity. And in some cases, specific SNPs in the MC4R gene have actually been shown to protect against",English
+"metabolic syndrome. The FTO gene is actually thought to control increase in PKA nutrients and decreased satiety. So that means when the FTO gene is active, people feel hungry, and they actually eat",English
+"more. But you can tell from the fact that we know these two particular genes but yet we can't treat obesity using a genetic approach, that there's not a common -- it's not consistently",English
+found what response these genes have. So two other genes that can be implicated in that syndrome that Jacquie talked about,English
+"a little while ago was the LPL and the APOE gene. Next slide, please. Go down a few more slides to the implications for practice and research.",English
+"People are probably guessing that we changed our slide order. So with the implications for clinical practice, we're looking at -- we would love to have",English
+"some genomic-based applications, but unfortunately, they are not clinically available at this point, but they are certainly being developed in labs across the country. The combination of environmental and genetic factors add to the complexity of the clinical",English
+"management of metabolic syndrome. Because of this complexity, at this time the best approach is to manage your clients individually based on what component of the metabolic syndrome they have.",English
+"For example, if they have cardiovascular disease, then manage that according to clinical guidelines; the same with obesity and diabetes.",English
+So there's no real solid clinical management of Met syndrome; it's managing the individual components using established clinical guidelines.,English
+Nursing management frequently includes: to promote lifestyle strategies that target the prevention of metabolic syndrome and the management of the individual components of that syndrome.,English
+One of the things that we do recommend is to look at -- obtain a minimum of a three-generation pedigree.,English
+"In the article, it refers you to the surgeon general's website for obtaining family history, and I know that I have used that website for years to teach how to obtain a family history",English
+and asked students to do that on their family. It's been a very well-received component of the teaching of genetics to undergraduate students.,English
+"Next slide, please. So when we're looking at clinical practice, then one of the first things that we need",English
+to be thinking about is the personalized health care that we hope to see come about soon. And hopefully it will revolutionize the treatment of metabolic syndrome because it will be tailoring,English
+the health care of the person to their individual genetic makeup as well as to the environmental factors.,English
+So it is the responsibility of the health care provider at this point in time to be aware of the best practices for interpreting and delivering results to the patient and,English
+"using them to manage the care. I do want to discuss briefly the direct-to-consumer genetic testing websites. Using these websites is cautioned by the layperson, and even so by the health care provider as",English
+"well, because we're really not sure at this point in time about the clinical validity, the reliability, and I think most importantly, the clinical utility of these websites.",English
+"One of the largest concerns being that you may find out you have an allele that puts you at risk for a specific component of the metabolic syndrome, but yet there's no actual",English
+"treatment or management for that, so we're just not sure how to approach that at this point in time. Next slide, please.",English
+"So the implications for research are also many. Our science has progressed a lot in the last two years, and we are now able to look at the biologic underpinnings and identify specific genes that are associated with metabolic syndrome.",English
+So researchers are moving their research studies from a single gene approach to more of a complex disorder approach.,English
+We've gone from linkage analysis to genome-wide association studies to the current one for epigenetic approaches.,English
+"So -- however, there are multiple limitations for each of those specific types of designs and technologies.",English
+"So, for example, on the genome-wide association studies, while they have been prevalent in the literature, what we see is that they actually account for a very small percent of the variability",English
+"in inheritable disorders such as metabolic syndrome. We also need to take into effect, particularly with genome-wide association studies, the fact -- the ethnic ancestry and admixture mapping that Dr. Taylor has already talked",English
+"about. So if you go to the next slide, as I said, we looked at most researchers are using technologies and designs including linkage analysis, and genome-wide association studies, and epigenetic",English
+"studies, which is looking at actual changes in the genetic makeup due to environmental reasons later on in life, and then you can also be moving into the area of proteomics.",English
+"Next slide. However, we really think the future of genetics in metabolic syndrome probably lies in the area of system-based approaches, and this is using expression arrays, particularly gene",English
+"expression arrays, or other technologies, such as mass spectrometry, and then combining bioinformatics techniques to actually analyze large datasets.",English
+"This is what we're seeing and what's being called the ""big data"" approaches to understanding the biologic underpinnings of disease. So using these systems, researchers can actually address input from hundreds of genes in environmental",English
+"factors. The interactions with the components may be more important than the individual components themselves, is what we're finding.",English
+So direct sequencing of the entire genome is also coming into the future because of the decrease that we're seeing in the cost of actually sequencing this large component.,English
+"For clinical practice, the goal of genomic health care is the integration of clinical and biological data for improving health outcomes.",English
+"Next slide, please. These are our clinical resources that we have used to identify in the -- identify in our clinical resources so the evaluation of genomic applications -- I think you can basically",English
+read through these and see which ones are most helpful to you. Thank you.,English
+Female Speaker: So I'm going to open it up for questions. There were two questions that came in after Dr. Wung's and her group's presentation.,English
+"And so, Shu-Fen, I will open it up for you and if you want to identify yourself or someone else to answer the question.",English
+"I think the concern is really the numbers of subjects you'd need to actually look at individual components right now, and our science and our ability to analyze the data isn't",English
+"far enough long for us to take smaller sample sizes and look at metabolic syndrome, so that's why are limited to looking at each component, primarily, at this point in time.",English
+Thanks. Jacquelyn Taylor: And I think that some of the larger genome-wide studies can be useful in looking at metabolic syndrome where we have some of the larger numbers of individuals with DNA available for us to look at various issues in terms,English
+"of cardiovascular, diabetes, obesity, and the like. So some of the larger family blood pressure program conglomerates might be useful when",English
+that we talk with each other with language and sound. Mitochondria have all of these different ways of talking to each other through chemicals and hormones and ions,English
+and other mechanisms. So there's this social life of these small little being to tubule shaped organelles inside the cell.,English
+"And there's a whole history about how they came to be and why they're at the origin of life that we can get into if that's of interest. - Yeah, it's so interesting to think about them",English
+"as having social interactions with other mitochondria and that it's beyond them just sitting there producing energy, but at their core,",English
+"production of energy is sort of one of the main features. And that's why they're known for that. And when we talk about disorders in human health,",English
+"whether it's mental illness or whether it's other disorders, we're starting to see it as a disorder of energy production, which can then be sort of boiled down to the mitochondria.",English
+"So you said, mitochondria take in oxygen and they take in the food and then they create energy. That's where the magic happens to create energy.",English
+"Now I think what also is a little confusing though, is this happens everywhere, right? It's in your muscles, it's in your liver, it's in your heart, it's in your brain.",English
+So are mitochondria are really just everywhere in our body. - Yes. They're everywhere. The body is made of a few hundred cell types.,English
+"There's one cell type that does not have mitochondria, which is the one cell type that actually carries the oxygen, right, towards, the purpose of breathing",English
+"is to bring in oxygen to your lungs, and then oxygen from your lungs diffuses into your blood, and then the blood circulates and touches literally every cell in the body, right?",English
+"And there's one cell type that is a reason why blood is red because of the red blood cells, right? The red blood cells, their life purpose is to carry oxygen",English
+"towards the destination, every other cell in the body, where mitochondria ultimately are the oxygen consumer. So red blood cells don't have mitochondria",English
+probably because otherwise the mitochondria there would consume the oxygen that they're actually meant to transport.,English
+"But otherwise, every cell in the body, every neuron, every glial cell in the brain, every beating heart cell, every liver cell, every skin cell",English
+have hundreds to thousands of mitochondria per cell. And the beautiful thing that we're just starting to uncover now,English
+"is that mitochondria are not all created the same, and different cell types in the body actually have different types of mitochondria.",English
+"So we think of those as mitotypes, the same way that they're different cell types are different mitochondria types.",English
+"So the brain mitochondria are actually quite different than the heart mitochondria, than the liver mitochondria. So there's this beautiful diversity of mitochondria.",English
+And that makes us think of them as more of a family of related organelles and not just kind of a single thing that's passively transforming energy.,English
+"There's a diversity of different types of mitochondria that actually talk to each other. So the mitochondria in your adrenal glands, for example,",English
+"where cortisol is made, talk to mitochondria in the brain. The organism, you can see if you think about the organism as an ecosystem where you have cells and energetic system",English
+"that talk to each other, mitochondria is a key part of this. And if you look at this from a mitocentric perspective, you can think of the whole ecosystem of mitochondria",English
+"as an energy transformation system. And mitochondria transform energy, they don't create energy per se.",English
+"They take the energy from the food and the oxygen and then as they combine, they can extract energy from this. So they can transform chemical energy",English
+"from the food and oxygen into electrical energy inside the membrane potential that's called. And then take the membrane potential,",English
+"this other form of energy, and then turn this into a different kind of energy like ATP, maybe some people have heard about. And then that is what powers the beautiful diversity",English
+"if you look at it from a mitocentric standpoint, coming from the mitochondria as the center. But I think that's a hard thing for a lot of people to do",English
+"because you can't see mitochondria, you don't get a blood test for mitochondria, right? You get a blood test for your hemoglobin levels and your kidney function and your liver function,",English
+but you don't measure mitochondria. So it's sort of like a leap for people to say or for some people to understand,English
+"how widespread mitochondrial function and dysfunction impact our health. But is it safe to say that they're involved with,",English
+"I mean just about any health or disease process at its core could be related to mitochondrial function? - Yes, certainly.",English
+"We try to review this. I should take a step back and say, we think of mitochondria and that organelle as a potential cause,",English
+"first, a source of health and life, but then a cause of potential diseases, that's a scientific model, right?",English
+"That's a hypothesis that we're invested in rigorously testing. And so we need to do this carefully,",English
+"but what the evidence that's there, if you go into PubMed or onto Google and you look for studies that have looked at some mitochondrial impairment,",English
+"mitochondrial have many functions, right, so alterations and some mitochondrial function including energy transformation, but also mitochondrial signaling.",English
+"And any disease you can think of, there is likely a scientific study that has investigated and identified a connection. And then the question is,",English
+are impairments in mitochondrial biology driving those diseases? And I think the answer is likely yes. And why is that?,English
+"I think it's likely because energy is such a central part of what we are and of who we are to some extent. So I think that's why mitochondria have been implicated,",English
+there's growing interest in understanding the connection between mitochondrial biology and health and different disorders is because energy is central,English
+"to what we are and how we function. And if we think about the brain, if you want to convince yourself and make this real, 'cause you're right,",English
+we can't see mitochondria and we have the chance here to have cool microscopes and you can put living cells and make the mitochondria fluorescent.,English
+"And then you look down the eyepiece and you see them move and fuse. And so you can see them if you have the right equipment, but our day-to-day experience or subjective experience",English
+"and kind of the reality of the body and how we feed it and so on. We're not aware of our mitochondria, which is probably for the better. (laughs)",English
+"But if you want to convince yourself how central energy is, if you just block blood flow to the brain, right? If you occlude the blood going to perfusing your brain",English
+"for just a few seconds, you're out, (laughs) consciousness is gone, right? And the reason consciousness disappears if you don't have blood flow to your brain",English
+"or if your heart stops is because you're not feeding your mitochondria anymore, right, you're not bringing them oxygen, you're not bringing them food substrates",English
+and that shuts down everything. So that's I think a very real example of how energy just sustains human life,English
+"and human consciousness. So anything we do as you've discussed with many scientists and clinicians,",English
+"the way we feed our body, the kind of energy we put into the system can actually influence how the system works, the brain, and the whole organism.",English
+- Yeah. So let's talk about that for a second because one of the things we focus on at Metabolic Mind is the connection between metabolic and mental health. So when there's metabolic dysfunction,English
+"that can impact mental health and contribute to mental illness, and at its core, presumably mitochondria are involved in that.",English
+"So how does metabolic dysfunction and insulin resistance and some things that are so prevalent in today's society, how does that impact mitochondria?",English
+"- So, yeah, metabolic dysfunction is an umbrella term, that in my view reflects impaired energy flow, right? So what sustains life is the blood flow that the,",English
+"beating heart is a clear sign of light because by moving blood, you move energy, you move oxygen, you move ketones bodies, and fatty acids and glucose and proteins and so on.",English
+So these are energy forms. So the disorders of energy or metabolic dysfunction can be reflected in insulin resistance,English
+which is reflected or which represents the inability of cells to take in food substrates when that's needed. So there can be metabolic dysfunction,English
+"at the whole organism level, right? Which can cause or materialize and obesity, for example, then there's kind of systems level metabolic dysfunction,",English
+"insulin resistance would be a feature of this, at the cellular level, there can be metabolic dysfunction there. And then if we go inside the cell,",English
+"there can be mitochondrial energy transformation defect or impairments, which of course ripples out if the mitochondria are not functioning properly,",English
+"that can impair how cells function, how the tissue function, and how the whole organism functions. So mitochondria are such a metabolic hub",English
+that their inability to transform energy properly or misregulation of mitochondria getting turned on and making a lot of ATP,English
+or being dialed down and making less ATP can really affect other levels of biological and physiological complexity.,English
+"- Yeah. Yeah. And I think it's clear there are a lot of things that can impact mitochondria function, but when it comes to mental illness",English
+"and psychiatric conditions in general, there's been a lot of talk about genetic predispositions. So are there genetic predispositions to mitochondrial dysfunction",English
+"as well as environmental factors of just how we live our life that impact it? But what do the genetics say about it? - Yes, that's a great question.",English
+"So, yes. And I'm not a clinician, but I spend half a day a week in the clinic with my close colleague neurologist Michio Hirano, where I see patients",English
+"who have rare genetic mitochondrial disorders. So some people may know mitochondria, those small living life forms inside every cell,",English
+they have their own DNA and that's related to their past life as bacteria and when they were incorporated.,English
+"So they have a circular little piece of DNA like bacteria, which have a few genes that are involved in energy transformation.",English
+"And some people are born with a defect, a mutation, or they lose a chunk of mitochondrial DNA, a portion of the mitochondrial DNA sequence.",English
+So those are called mitochondrial DNA deletions. And that causes primary genetic mitochondrial diseases. So these are rare genetic conditions,English
+but I think they're incredibly illustrative of what impaired mitochondrial biology can do to the whole body and to the whole mind.,English
+"And these people suffer from multi-system disease, right, so often they have cardiac involvement, digestive issues, renal issues, and endocrine issues,",English
+"immune alterations in some ways, and many of them have cognitive and psychiatric manifestations.",English
+So there's a lot of comorbidity between primary mitochondrial diseases that have historically been the domain of neurology,English
+"and psychiatric conditions. And this is an area that we're interested to understand more, but that has been understudied.",English
+"So I think that's one of the good evidence that if something's wrong with the mitochondria, and here we have a primary genetic defect in mitochondria, this leads to impaired brain function",English
+"and psychiatric conditions. - Yeah, that is very clear evidence about that connection. But then as I alluded to,",English
+"it certainly doesn't have to be a genetic reason, there are unfortunately plenty of lifestyle things we can do to ourselves",English
+to decrease our mitochondrial function and decrease our mitochondrial health. And the big ones that seem to get a lot of attention,English
+"are, of course, nutrition and then sort of poor sleep and toxins. And so I mean, how do you see the main detractors from mitochondrial health",English
+"that unfortunately we do in our society? - Yes. So you're pointing to, what I just described were inherited mitochondrial disorders",English
+and then they're acquired mitochondrial disorders. So all of the acquired result from our exposures and kind of internal exposures,English
+who were studying how psychological states and exposure to chronic stress or early life adversity or the kind of the disorders that we can create ourselves,English
+either psychologically or through nutrition and other things and how they can influence mitochondria. So this is all part,English
+"of the acquired mitochondrial impairments or dysfunctions. So there's a number of things there that converge on mitochondria, including diet,",English
+which is a very big one. Everything we put in her mouth ultimately converges either directly on mitochondria or around the metabolic pathways,English
+that mitochondria are involved in regulating. So that's a very big one. There's a lot of good research on insecticides and pesticides,English
+"and some of those that were used back in the days where we used at the laboratory as poisons for mitochondria, if you want to know how a mitochondrial impairment",English
+"will change gene expression, right, some genes that are turned on or turned off in a cell, you can do experiments in this where you have living human cells with their mitochondria,",English
+"which you can image, and then you can perter mitochondria, right, experimentally, and then you ask, ooh, what does that do to the signals",English
+that the cell will secrete or to the process of cell division or the effect on a stem cell or things like that. And some of the tools we use there,English
+or formerly used poisons or insecticides that are direct poisons to mitochondria. So there are many things that we've used,English
+"or that are around our ecosystems that can adversely affect mitochondrial biology. - Yeah, that's really disturbing",English
+that you don't have to come up with some specialized mitochondrial poison. It can just be something that's a run-of-the-mill pesticides that's been used before.,English
+And that's a potent mitochondrial toxin. It's a little disturbing. I like how you also mentioned about psychological states,English
+and how that can affect your mitochondria and so how does our psychological state influence our bodies? That's like a big question that you are researching,English
+"and the whole brain-body connection kind of goes both ways, right? The dysfunction in the body can affect the brain,",English
+"and I don't know if you want to call it dysfunction in the brain, but brain experiences psychological experiences can affect the body. And it seems like mitochondria are the connector there.",English
+"But there's many reasons why we think of brain and body. And I think it's useful to think of brain-body or mind-body processes, right,",English
+"that drive the human experience. And as you know there is good evidence, for example, that the gut microbiome sends signals to the brain",English
+"and then that actually influence mood and affect and might contribute to mental health. So there's clear kind of body to brain signals, right,",English
+"and the brain can experience and respond to the metabolic state of the body. And then there of course a very important drivers,",English
+"top-down brain body signals where the brain actually regulates blood glucose, for example.",English
+"And psychological stress can trigger hyperglycemia, especially in susceptible individuals, right? So you see a stressful email",English
+"or you have a stressful interaction, and then you secrete cortisol that come from the adrenal glands and then cortisol goes to the liver",English
+"and release glucose into the blood and then will go to the muscle, the cortisol go to the muscle and causes insulin resistance.",English
+So then that drives hyperglycemia. So a simple psychological state can drive a change in peripheral glucose levels.,English
+So there's metabolic influence on the brain and the brain can influence systemic energy metabolism. But every little process,English
+"when we think of like brain-body interactions, a stressful thought will accelerate a heart rate within seconds, right, while the heart beating faster cost energy, right,",English
+"every time the heart beats, there's energy consumed that need to come from mitochondria. And if you're having an experience, this changes gene expression inside of cell,",English
+"you produce or release a hormone while turning on a gene, right? Turning DNA into RNA cost energy,",English
+"then taking the RNA making a protein cost energy, and then taking that protein, that hormone, let's say, and then folding it and then packaging it and then releasing it, all of this cost energy.",English
+So every little bit of communication between brain and the body is energetically demanding and is an energetic process by nature.,English
+"So we think that's why energetic processes and then mitochondrial biology being a central part of this is an important driver or if you want the fabric, right,",English
+the brain-body connection is an energetic connection and therefore energetic perturbations in the mitochondria can likely perturb that system.,English
+- Yeah. It is fascinating how the two-way street between the brain and the body is constant and there's such an impact both ways that we need to be aware of in so many variables.,English
+"But now to bring it back to psychiatry and to symptoms of whether it's bipolar disorder or schizophrenia, a major depression.",English
+"What about medications? Because if those diseases have a mitochondrial basis and then medications are used to treat them,",English
+can medications also further mitochondrial dysfunction or are there some that can improve mitochondrial function? What have you learned from a medication standpoint?,English
+"- Yeah, there's recent interest in this. And so people have studied this in fairly rigorous studies in vitro with cultured human cells or in vivo in animals.",English
+"And so you can give cells or animals different classes of psychotropic medication and ask, does this change the ability of mitochondria",English
+"to transport the electrons to charge the membrane to make ATP, so different domains of mitochondrial biology. And the answer yet is yes, certainly.",English
+"There's specific classes of medication that impair mitochondrial energy transformation pretty significantly, which is not widely known.",English
+"And certainly psychiatrists don't learn about this. And so it's not well known. But in the last 10 years,",English
+"there's been quite a bit of research on this as we uncover or starting to understand the role of mitochondria, the role of energetic processes in neurotransmitter release,",English
+"neurotransmitter reuptake, and neuronal firing and neuron to glial cell communication, all of these processes are energetic in nature.",English
+"So as this becomes better understood and the connection with mental health and psychiatric conditions is better understood,",English
+there's been a rising interest to connect those treatments like you're saying to mitochondrial biology and there's a clear connection there.,English
+"And that's not my area. I don't know the details, but there's certainly some classes of medication that have a direct effect on the core machinery",English
+"for energy transformation, which is a little scary because playing with the chemistry without really understanding",English
+"how this chemistry gives rise to human experiences and to mental health is a little dicey. And I think there's a lot of medications in psychiatry,",English
+"lithium being an example. We don't know how lithium works. (laughs) We have no idea of the underlying biology, but there's a clear effect of lithium",English
+on mitochondrial biology. And so there's some people believe that parts of the human experience,English
+and the function of brain circuitry and brain networks is actually driven by mitochondrial biology. So maybe the reason lithium works in some cases,English
+"is because of its effect on mitochondria. Mitochondria could be the target for lithium. I think based on the evidence out there, that's a possibility.",English
+"- Hmm. Yeah, I think it's so interesting though. The way you described that there are certain medication subclasses that are going to impact mitochondrial function.",English
+"And we're going to learn a lot more about this, I think as research focuses on it, but does that separate medications",English
+"into maybe short-term beneficial medications, but long-term harmful medications, like maybe they're doing something in the short-term, but over the long-term,",English
+"if they're degrading mitochondrial function, then they're going to lose their effectiveness. And maybe that's why a number of psychiatric medications worsen cardiometabolic health,",English
+"could mitochondria be a reason for that? I mean, certainly plausible. - Yeah, you mentioned acutely versus chronically, that we have a hard time, I think as the way humans think",English
+"and maybe the way scientists are forced to do their research. It's hard to keep those two things in mind that what you observe acutely,",English
+"does that translate chronically. And there's a lot of stimuli and stressors that have a certain effect acutely,",English
+but chronically the effect is quite different. And a lot of medications I think sometimes acutely can help. And maybe that's where psychiatry is most useful,English
+"in terms of helping people deal with life-threatening acute episodes of psychosis, for example.",English
+"Then chronically we're really bad at helping people, the way we apply pharmacology to treat people",English
+"with severe mental illness, those medications are given without the idea that this should be short term. And most of the time I think it's given",English
+"and patients are told or kind of led to believe that they need to continue taking that medication forever. But we have no idea, I think that there's no data in humans",English
+"on the long-term effects of medications on mitochondrial health and mitochondrial biology, which is a little scary to think about.",English
+"to specifically target mitochondrial health. Because maybe if we're using medications and we're doing other things to target mitochondrial function and overall brain health,",English
+"then we can start to potentially taper those medications under professional guidance, of course, because everything else is improving.",English
+"Because we have heard from a number of people that they're treated, they get over their acute episode, but then they just feel like they can't thrive, they can't get back to their life.",English
+"And it's not until they do other interventions that allow them to get back to their lives, which frequently can also then coincide",English
+"with tapering of medications, which of course is a very complicated topic. And we have a whole video with Dr. Georgia Ede and Matt Baszucki about that.",English
+"- Yes. So you make such a good point, Bret, the ability to thrive, right, and to exhibit resilience and robustness,",English
+"like life is made of challenges. And I think what we do really well as living organisms, not just humans, but all living organisms,",English
+is we take a challenge and then we bounce through it and there are some things then that make us unable to bounce.,English
+And I think that's one way in which I think about acute psychiatric episodes where you go really deep and then it's hard to come out of it.,English
+And sometimes I worry that some of the medication actually promotes this stuckness and prevents this rebound. And if we think about kind of going down,English
+"and then rebounding and this thriving ability, this requires energy, right? It requires fundamentally a change",English
+"in how the brain operates, the brain-body system functions, and your ability to make meaningful life changes or right changes in your social circle,",English
+"all of this requires energy. And I think that's why change, just as a general thing in life, you are challenging to most people.",English
+"And because change requires energy, it's like coming out of inertia if you want to stop something that's moving, right?",English
+So fundamentally there's like an energetic requirement to change and therefore bouncing back is an energetic process.,English
+"So impairing mitochondria in that situation or if you live with impaired mitochondria, I think this can be even more difficult.",English
+"based on kind of scattered research over the last maybe two decades. One thing we know for sure is moving, being physically active, right?",English
+"So I think many people know, exercise is a protective factor against many mental illnesses. And exercise is a protective factor",English
+"for pretty much every disease that we know of. And if we flip this, if we think about health, right, as not just the absence of exercise,",English
+"but this ability to thrive and to live a long, healthy life, exercise is good for this. So moving stimulates.",English
+"And pretty much inside every organ that people have looked at stimulates the production of more mitochondria. So if you move, the body feels, ooh, I need more energy.",English
+"How do I handle this? Let me make more mitochondria. That's called mitochondrial biogenesis. And we know that this happens a lot,",English
+"for example, in muscles. If you go from being completely sedentary to training for a marathon, you can double the number of mitochondria on your muscles.",English
+"So there's quite a bit of plasticity there. And we've done some studies, animal studies of chronic stress, for example.",English
+And this changes how much mitochondria are in different brain regions. So moving is number one thing we can do to increase a number,English
+"And we evolved to do this. And the reason why being hungry, not eating too much is healthy, is not too clear.",English
+Maybe it's because it puts you into ketosis. Maybe it's because it prevents nutritional or metabolic oversupply or overload.,English
+"People have done beautiful studies in cultured cells, where you take cells and then you bombard them with sugar and with fat. And so that causes kind of, there's too much energy supply",English
+"relative to what the cells need. And this causes, within minutes, the fragmentation of mitochondria. So you go from having a beautiful network of connected",English
+and dynamic mitochondria talking to each other to a completely fragmented mitochondrial network. So there's mitochondrial fragmentation,English
+"that arises fairly quickly in cultured cells like this in response to this metabolic overload, oversupply. So if you eat too much and most people are able",English
+"to take the excess glucose, excess fat and excess nutrients in the blood and then store this in subcutaneous adipose tissue, right,",English
+"and then we call this obesity or just adiposity. But the reason this exists physiologically is because having too much energy substrate, too much sugar,",English
+"fat, or proteins in your blood is actually damaging, it's damaging to the mitochondria. So not eating too much and maybe something like intermittent fasting",English
+or just having a good diet where you're hungry once in a while and then you have a good meal and then you're hungry and then you have a good meal.,English
+"Every ancient tradition has kind of a fasting period built into their culture, right? And that's probably for a reason",English
+"'cause once in a while being hungry actually stimulates some cellular processes, probably mitochondria,",English
+"in a way that is helpful and health promoting. - So the magic question with fasting though is how long, and I know it's impossible to answer with certainty,",English
+"but time restricted eating, it can help reduce calories maybe, it can help reduce insulin and improve insulin sensitivity to some degree.",English
+"Probably like a minimum of 12 hours, maybe has to be 16, maybe has to be 18. Do you have any sense when it comes to mitochondria",English
+"where the sweet spot is or it's just clear that some amount of it helps and we still need to learn more about the specifics? - Yeah, I think it's clear that some amount of it helps.",English
+"I don't know that we have the right evidence to be prescriptive here about how long should you fast. And it probably depends, if you're on a ketogenic diet,",English
+"right, and you're on a low carb diet, maybe you don't need to fasts for as long to derive the benefits",English
+than if you're on a regular high carb diet. And maybe each person's metabolism is pretty different. And it's clear that some people respond a lot better,English
+to nutritional ketosis than some others. And so the benefits are individual specific and I think in the same way,English
+"that each person responds differently to exercise, there are some people for whom exercises doesn't seem to trigger a lot of health benefits",English
+and it puts them into a bad place if you do too much of it. But other people just respond amazingly well to exercise and it's life transforming.,English
+So I think there are individual differences that are poorly understood. And most of the studies we do are based on group differences.,English
+"You do an RCT and then you look for a mean difference, and 50 people here, 50 people here, ooh, exercise was good or keto diet was good,",English
+"but there are always people that are at the bottom of low responders and high responders. So I think the way we do our science,",English
+the way we kind of approach things is a little narrow sight. It doesn't respect the degree of individual differences or individuality.,English
+And I think ultimately we need to move towards a more individualized way of doing medicine and of promoting health.,English
+So I don't know that there's going to be one kind of solution for everyone. - I think that's a great point about the translation of the research to the one individual,English
+"or you being your own person and how does that relate. And you have to start somewhere, you have to use the evidence you have,",English
+"but it's not the end all and be all because there are the individual variations. So that makes a lot of sense. Yeah. All right, so we went through moving your body,",English
+"we went through don't eat too much, and then we got number three. So what's number three on mitochondrial health list? - So number three is the most speculative",English
+and we have some evidence that how you feel and I'll focus specifically on positive psychological states might actually drive changes in your mitochondria.,English
+"And we did a study a few years ago with Elissa Epel, UCSF, where they took about 90 women who were asked every morning and every evening",English
+"how they feel. Imagine you wake up in the morning and then you're asked, how do you feel now, right? Do you feel inspired or do you feel confident about your day",English
+"or do you feel worried? And you don't know what's going to happen today and that's really stressful to you. And then in the evening, there was kind of a more elaborate questionnaire",English
+"that asked how much of this did you feel today? And then there were items like love, closeness, and trust, and being inspired and motivated and uplifted",English
+"and connected to others and so on. And then some negative things like feeling betrayed and rejected and feeling sad and depressed. I think everyone can imagine,",English
+"some days you feel a lot of positive stuff, right? Like you had a great day with your partner, with your colleagues at work, so you felt a lot of positive things",English
+"and not so much negative things. And some other days, you feel a lot of negative things because of things that happened, because of your psychobiological state,",English
+whatever drives the emergence of those positive-negative experiences. So they ask those questions so we have kind of reports on how women feel,English
+"for seven days in a row, for a whole week, which is beautiful daily repeated measures of someone. And then we were able to have white blood cells,",English
+"immune cells from these women measured on the Wednesday. So they answer these questions from the Sunday to the Saturday, for these seven days,",English
+"and then on a Wednesday, they came to the clinic, gave blood, then Elissa's team isolated white blood cells and then we assay the mitochondria.",English
+"And then what we measured in the mitochondria is we call the mitochondrial health index, which is, basically, how much energy can each mitochondria transform, right?",English
+So that's kind of a simplistic proxy for mitochondrial health. So we were able to relate for the first time how people felt right across that week,English
+"and there mitochondria in the middle of that week. And so we asked a simple question first, do people who feel more positive",English
+"It seems like people who experience more positive things have slightly better mitochondrial health. But then the more interesting question was, well, we know how these women reported feeling",English
+"for the three days before we took the mitochondria and then for the three days, let's say, after we took the mitochondria, so we can ask, is it how people feel that predicts, right,",English
+"or drives the mitochondrial health or is it the mitochondrial health that drives and predicts how people feel, right? And what the study showed is that how people felt",English
+"in the morning and the evening on the three days before on the Monday, the Tuesday, the Wednesday, actually predicted mitochondrial health, but not the other way around.",English
+"So those are mitochondria in the immune cells, right? Remember what we talked about earlier, the brain mitochondria are different",English
+and the heart mitochondria and the immune mitochondria are also different. So it seems like how we feel might drive a fairly large change,English
+"in the biology of the mitochondria and the energy production capacity of our immune mitochondria. And so if that's true, we need to replicate this",English
+and we're in the process of developing a study to do this at scale and over longer periods and with repeated measures of mitochondria and so on.,English
+"So if that's true, right, that implies that feeling more positive, having more positive experiences can actually directly influence the mitochondrial biology",English
+"and if you can improve the mitochondrial biology and the ability to mitochondria to transform energy in the immune cells, well, maybe that happens also in your brain cells.",English
+"And we have evidence that this is the case. And Caroline Trumpff, who works in our group, has amazing data in brain mitochondria.",English
+"So she was able to measure gene expression in the brain of individuals who've passed away, or colleagues had collected data",English
+"on how socially connected they feel, their level of wellbeing, or their level of depression and isolation before they died, right?",English
+"So you have the psychological exposures, the psychological state of these people before they die, and then you have the brain after they died.",English
+"And then Caroline used some fancy single cell gene expression analysis and neurons and astrocytes and microglia to ask,",English
+"is there a connection between how people, they said, I'm feeling great, I have amazing sense of purpose, I feel like my life is meaningful.",English
+"I have great friends and so on. Well, does this person have better functioning mitochondria in their neurons or in their glial cells",English
+"than someone who says, I wake up in the morning, I don't really want to be here. And I don't feel well and I am fairly depressed.",English
+"And what she's finding is yes, the mitochondria are different and people who report more positive experiences than people who don't.",English
+So this is opening up a new layer of biology that's a direct psychobiological connection between the lived human experience,English
+"and the biology of a mitochondria. So then if we speculate a little bit, it could be that, choosing to do something",English
+"that you find meaningful and purposeful, right? And arranging your life as much as possible in a way that you feel good about it, right?",English
+"And making decisions in terms of what you eat, in terms of the people that you surround yourself with, in terms of the job you choose,",English
+actually makes a difference on your biology and on the biology of your mitochondria. This would be amazing. And I think that would be consistent,English
+with kind of the growing understanding of the metabolic nature and functioning of the brain and mental health.,English
+"And maybe a path to mental health is to taking care of your mitochondria and you can take care of your mitochondria by moving more,",English
+"by being hungry once in a while, and by making choices that make you feel inspired and motivated about life.",English
+"- Yeah, I think that's so interesting. And it can tell your excitement and your passion just in the way you're explaining it, which I think is wonderful.",English
+"But you can look at these studies that show people who are more positive and had a better outlook on life that they live longer, they have fewer health problems.",English
+"And I would always sort of take those with a grain of salt, like, okay, but there's so many confounding variables and it's just an association and it's just that they make better choices in life",English
+"and are healthier in other ways, but now you're saying, well, maybe it actually is causative and there's a mechanism for that causation,",English
+"which is opening up this whole new sort of realm, which I think is really exciting. And so yeah, just be happy and you'll help your mitochondria, but there's more to it.",English
+"So I think that's really exciting. - This is a hypothesis, right? But there's a number of converging lines of evidence,",English
+"what we experience actually translates directly into real molecular changes, energetic changes in our mitochondria.",English
+"And it also alleviates the obese person from being the perpetrator, but rather the victim. Which is how obese people really feel.",English
+"'Cause no one chooses to be obese. Certainly, no child chooses to be obese. Oh, you say, ""Oh, yeah, sure, ""I know some adults who don't care.""",English
+"You know, Rossini, the famous composer, you know La gazza ladra, Figaro, and all that. He retired at age 37 to a lifetime of gastronomic debauchery.",English
+Maybe he chose to be obese. But the kids I take care of in obesity clinic do not choose to be obese.,English
+"In fact, this is the exception that proves the rule. We have an epidemic of obese six month olds. Now, if you wanna say that it's all about",English
+"diet and exercise, then you have to explain this to me. So, any hypothesis that you wanna proffer that explains the obesity epidemic,",English
+"you've got to explain this one too. And this is not just in America, these six month old obese kids, but these are around the world now.",English
+"So, open your minds?, and let's go and figure out what the real story is. Let's talk about calorie intake,",English
+"because that's what today is about. We're gonna talk about the energy intake side of the equation. Sure enough, we are all eating more now",English
+than we did 20 year ago. Teen boys are eating 275 calories more. American adult males are eating 187 calories more per day.,English
+"American adult females are eating 335 calories more per day. No question, we're all eating more. Question is why, how come?",English
+"'Cause it's all there? You know what, it was there before. We're all eating more, there's a system in our body, which you've heard about",English
+"over the last couple of weeks called leptin. Everybody heard of leptin? It's this hormone that comes from your fat cell, tells your brain, ""You know what, I've had enough.",English
+"""I don't need to eat anymore. ""I'm done, and I can burn energy properly."" Well, you know what? If you're eating 187 or 335 calories more today",English
+"than you were 20 years ago, your leptin ain't working. 'Cause if it were, you wouldn't be doing it. Whether the food was there or not.",English
+"So, there's something wrong with our biochemical negative feedback system that normally controls energy balance.",English
+"And we have to figure out what caused it, and how to reverse it. And that's what tonight is about. But, nonetheless, there are 275 calories",English
+"we have to account for. So where are they? Are they in the fat? No, they're not in the fat.",English
+"Five grams, 45 calories out of the 275, nothing. In fact, it's all in the carbohydrates. 57 grams 228 calories.",English
+"We're all eating more carbohydrate. Now, you all know, back int 1982, The American Heart Association, The American Medical Association,",English
+and the US Department of Agriculture admonished us to reduce our total fat consumption from 40% to 30%.,English
+Everybody remember that? That how Entenmann's fat free cakes came into being. Remember that?,English
+"So what happened? We did it, we've done it. 40% down to 30%, and look what's happened to the obesity, metabolic syndrome,",English
+"non-alcoholic fatty liver disease, cardiovascular disease, stroke prevalence, all jacked way up, as our total fat consumption as a percent has gone down.",English
+"It ain't the fat, people, it ain't the fat. So what is it? Well, it's the carbohydrate. Specifically, which carbohydrate?",English
+"Well, beverage intake, right? 41% increase in soft drinks, 35% increase in fruit drinks, fruitades, whatever you wanna call them.",English
+"Just remember, down here, one can of soda a day, is 150 calories. Multiply that by 365 days a year, and then divide that by the magic number",English
+"of 3500 calories per pound, if you eat or drink 3500 calories more than you burn, you will gain one pound of fat. That's the first law of thermodynamics, no argument there.",English
+"That's worth 15 1/2 pounds of fat per year. One soda a day is 15 1/2 pounds per year. Now, you've all heard that before. That's not news to you.",English
+The question is how come we don't respond? How come leptin doesn't work? How come we can't stay energy stable.,English
+"That's what we're gonna get to. So, I call this slide, very specifically, the Coca Cola Conspiracy. Anybody here work for Coke, Pepsi?",English
+"Okay, good. All right, so, this over here, 1915, the first standardized bottle of Coca Cola out of Atlanta. Anybody remember this bottle?",English
+"Sure, a lot of you do. I remember this bottle, because my grandfather in Brooklyn, took me on Saturday afternoon down to the local soda shop on Avenue M and Ocean Avenue,",English
+"and every Saturday afternoon I had one of these. I remember it very well. Now, if you drank one of those every day,",English
+"assuming of course that the recipe hasn't changed, 'cause after all, only two people in the word know the recipe, and they're not allowed to fly on the plane at the same time.",English
+"You know that, okay. Assuming the recipe hasn't changed, if you drank one of those every day for a year, 6 1/2 ounces, that would be worth eight pounds of fat per year.",English
+"Now, in 1955, after World War II, when sugar became plentiful again, and wasn't being rationed, we have the appearance of the 10 ounce bottle,",English
+"the first one that was found in vending machines. You probably remember that one, as well. Then in 1960, the ever ubiquitous, 12 ounce can, worth 16 pounds of fat per year.",English
+"And, of course, today, this, over here is the single unit of measure, 20 ounces. Anybody know how many servings are in that bottle?",English
+"That's a single serving, right? So that would be worth 26 pounds of fat per year if you did that every day. And then, of course, over here,",English
+"we have the 7/11 Big K, Thirst Buster, Big Gulp, whatever you wanna call it, 44 ounces, worth 57 pounds of fat per year. And if that wasn't bad enough, my colleague,",English
+"Dr. Dan Hale, at the University of Texas San Antonio, tells me that down there they got a Texas size Big Gulp. 60 ounces of Coca Cola, a Snickers bar,",English
+"and a bag of Doritos, all for 99 cents. - [Audience] Oh. - So if you did that every day for a year that would be worth 112 pounds of fat per year.",English
+"So why do I call it the Coca Cola conspiracy? Well, what's in Coke? Caffeine, good, good, so what's caffeine?",English
+"It's a mild stimulant, right? It's also a diuretic, right? It makes you pee free water. What else is in Coke?",English
+"We'll get to the sugar in a minute, what else? Salt, salt. 55 milligrams of sodium per can. It's like drinking a pizza.",English
+"So what happens if you take on sodium and lose free water, you get... - [Audience] Thirsty. - Thirstier, right.",English
+"So, why's there so much sugar in Coke? To hide the salt. When was the last time you went to a Chinese restaurant, had sweet and sour pork?",English
+"More salt, more caffeine. They knew what they were doing. That's the smoking gun. They know, they know.",English
+"All right, so, that's why it's the Coca Cola conspiracy. So, are soft drinks the cause of obesity? Well, depends on who you ask.",English
+"If you ask the scientists for the National Soft Drink Association, they'll tell you there's absolutely no association between sugar consumption and obesity. If you ask my colleague, Doctor David Ludwig,",English
+"remember, I'm Lustig he's Ludwig, he does what I do at Boston Children's Hospital. Some day we're gonna open up a law firm. (audience laughs)",English
+Each additional sugar sweetened drink increase over a 19 month follow up period in kids increased their BMI by this much in their odds risk ratio for obesity by 60%.,English
+"That's a prospective study on soft drinks and obesity. The real deal. If you look at meta-analysis,",English
+everybody know what a meta-analysis is? It's a conglomeration of numerous studies subjected to rigorous statistical analysis. 88 cross sectional and longitudinal studies,English
+"regressing soft drink consumption against energy intake, body weight, milk and calcium intake, adequate nutrition, all showing significant associations. And some of these being longitudinal,",English
+"this came from Kelly Brownell's group at Yale. I should comment, a disclaimer, those studies that were funded by the beverage industry",English
+"showed consistently smaller effects than those that were independent. Wonder why. Now, how 'bout the converse?",English
+"What if you take the soft drinks away? So this was the fizzy drink study from Christ Church England James et al, British Medical Journal, where they went",English
+"into schools and they took the soda machines out. Just like we did here in California. We haven't seen the data yet, but they went and did it for a year.",English
+"So the prevalence of obesity in the intervention schools stayed absolutely constant, no change. Whereas the prevalence of obesity",English
+in the control schools where nothing changed continued to rise over the year. So that's pretty good.,English
+"So, how 'bout type two diabetes? Are soft drinks the cause of type two diabetes? Well, this study from JAMA in 2004 looked at the relative risk ratio",English
+"of all soft drinks, cola, fruit punch, and found a very statistically significant trend of sugared soft drinks, fruitades, et cetera, causing type two diabetes.",English
+And you know we've got just as big a problem with type two diabetes as we do with obesity for the same reasons. And this was a sugared sweetened beverage against,English
+"risk for type two diabetes in African American women. Looking here at sugar sweetened soft drinks, just the downward arrow shows that there was a significant rise",English
+"as the number of drinks went up. You can see that here. Whereas orange and grapefruit juice, interestingly, did not. So, two different studies, two different increases",English
+"in type two diabetes, relative to soft drink consumption. So, what's in soft drinks? Well, in America, it's this stuff, right?",English
+"High fructose corn syrup. Everybody's heard of it, right? It's been demonized something awful. So much so that the corn refiners industry",English
+"has launched a mega-campaign to try to absolve high fructose corn syrup of any problems, which we'll talk about in a moment.",English
+"But the bottom line is, this is something we were never exposed to before 1975. And currently we are consuming 63 pounds per person per year, every one of us,",English
+"63 pounds of high fructose corn syrup. - [Audience Member] That's America? - That's America, yes. Now, what is high fructose corn syrup?",English
+"Well, you'll see in a minute. It's one glucose, one fructose, we'll talk about those at great length. One of the reasons we use high fructose corn syrup",English
+"is because it's sweeter. So here's sucrose, this is cane or beet sugar, standard table sugar, you know, the white stuff, and we give that an index in sweetness of 100.",English
+"So here's high fructose corn syrup, it's actually sweeter, it's about 120. So, you should be able to use less, right? Wrong, we use just as much, in fact, we use more.",English
+"So, here's lab fructose over here, crystalline fructose. And they're starting to put crystalline fructose into some of the soft drinks.",English
+"They're actually advertising it as a good thing. Phew. And that's got a sweetness of 173, so you should be able to cut that way back, right?",English
+"They're not. Lactose, down here, milk sugar, it's not sweet at all. And glucose, I should point out over here, 74. It's not particularly sweet, and we're gonna",English
+"get to that at the end, and what goes on with glucose. But anyway, there's why we use it, it's sweeter, it's also cheaper as I'll show you.",English
+"So, here's high fructose corn syrup. One glucose, one fructose. Notice the glucose is a six membered ring, the fructose is a five membered ring.",English
+"They are not the same. Believe me, they're not the same. That's what this whole talk is about is how their not the same.",English
+"And here's sucrose, and they're just bound together by this ether linkage. We have this enzyme in our gut called sucrose, it kills that bond in two seconds flat,",English
+"and you absorb it and, basically, high fructose corn syrup, sucrose, it's a non issue, it's a wash. They're the same.",English
+"And they know that they're the same, the soft drink companies and the corn refiners. Because here are their missives.",English
+"This comes from the Corn Refiners Association. Obesity research shows high fructose corn syrup metabolizes and impacts satiety similar to sugar. Indeed it does, I agree.",English
+"Decent meetings, academic meetings around the country. Hunger and satiety profiles energy intakes following ingestion of soft drinks,",English
+"bottom line, research supported by the American Beverage Institute and the Corn Refiner's Association. They are correct, there is absolutely",English
+"no difference between high fructose corn syrup and sucrose. So much so that the Corn Refiner's Association, in attempt to capture market share,",English
+"came out with this entire ad campaign. You probably saw it on the back page of the New York Times, it was on TV, it's everywhere.",English
+"If you all wanna see all of them, there are a whole bunch of them. You can go to www.sweetsurprise.com and see how you're being hoodwinked.",English
+"But indeed, this is true. High fructose corn syrup and sucrose are exactly the same. They're both equally bad.",English
+"They're both dangerous, they're both poison. Okay, I said it, poison. My charge before the end of tonight",English
+"is to demonstrate fructose is a poison, and I will do it, and you will tell me if I was successful.",English
+"None the less, here's Center for the Science and Public Interest and the Corn Refiners Association. Everybody remember last year, when Gavin Newsom",English
+"floated his soda tax, last February? Governor Patterson of New York has since floated one. And other people are starting to talk about it.",English
+"So, why are they saying this? Well, they're saying obesity's a problem, kids are drinking soda, let's tax it. So they're talking about soda like it's empty calories.",English
+"I'm here to tell you that it goes way beyond empty calories. The reason why this is a problem is because fructose is a poison, it's not about the calories.",English
+"It has nothing to do with the calories. It's a poison by itself, and I'm gonna show you that. Nonetheless, I just wanna read you",English
+"this paragraph here in yellow. ""We respectfully urge that the proposal ""be revised as soon as possible to reflect ""the scientific evidence that demonstrates",English
+"""no material differences in the health effects ""of high fructose corn syrup and sugar."" I agree. Here's the important sentence.",English
+"""The real issue is that excessive consumption ""of any sugars may lead to health problems."" I agree, that's exactly right.",English
+"Not may, does, does. So, here's the secular trend in fructose consumption over the past 100 years.",English
+"Before we had food processing, we used to get our fructose from fruits and vegetables, and if we did that today, we would consume",English
+"about 15 grams per day of fructose. Not sugar, fructose. So sugar would be 30 grams, it'd be double.",English
+"We're just talking about fructose, today. Prior to World War II, before it got rationed again, we were up to about 16 to 24, about 20 grams.",English
+"So, a small increase from the beginning of the century to World War II. Then, in 1977, just as high fructose corn syrup",English
+"was hitting the market, we had increased that, we had, basically, doubled up to 37 grams per day, or 8% of total caloric intake.",English
+"By 1994 we were up to 55 grams of the stuff per day. Remember, if you wanna do sugar, then double the number. So, that's 10.2, so you can see that more and more",English
+"of our caloric intake, a higher percentage is being accounted for by sugar every single year. So, it's not just that we're eating more.",English
+"We're eating more sugar. And for adolescents today, up to almost 75 grams, 12% of total caloric intake.",English
+"25% of the adolescents today consume at least 15% of their calories from fructose alone. This is a disaster, an absolute unmitigated disaster.",English
+"The fat's going down, the sugar's going up, and we're all getting sick. Now let me show you why.",English
+"How'd this happen? Why'd it happen? So, this is where the politics comes in. This is the perfect storm,",English
+"and it was created from three political winds that swirled around all at the same time to create this perfect storm. So, the first political wind,",English
+everything bad that ever happened in this country started with one man. (audience laughs) And it's still being felt today.,English
+"So, Richard Nixon, in his paranoia back in 1972, food prices were going up and down, and up and down. I'm gonna show you that on the next slide.",English
+"And he was worried that this was actually gonna cost him the election. So, he admonished his Secretary of Agriculture, Earl Rusty Butz, I love that name,",English
+"to basically take food off the political table, to make food a non-issue in presidential elections. Well, the only way to do that was to make food cheap.",English
+"So, he was out to find all methods to be able to decrease the price of food. Remember Nixon's war on poverty?",English
+"We're suffering from it today. That's what this is. Second political wind, the advent of high fructose corn syrup.",English
+"So, this was invented in 1966 at Saga Medical School in Japan, by a guy named Takasaki, who's still alive. As far as I'm concerned, this stuff",English
+"is Japan's revenge for World War II, except, of course, that they're suffering from it now, themselves. Like everything, it always comes back to haunt you.",English
+"And it was introduced to the American Market in 1975. So, what do you think happened to the price of sugar when this thing hit the market?",English
+"Here's what happened. So, here's the US producer price index of sugar going up and down, and up and down. This is not good.",English
+"Stability is at 100%, if it stays nice and stable at 100%, that's what you want if you're a politician. Up and down, here's where corn sweeteners",English
+"entered the market, 1975, 1980. And you can see that since then the price of sugar has remained remarkably constant.",English
+"And it did so, not just in the US, but also on the international stage. Here's the London price doing the same thing. And when you look at the difference in price",English
+"between sugar and high fructose corn syrup, you can see that high fructose corn syrup's about half the price.",English
+"So, in other words, it's cheap. So, high fructose corn syrup is evil. But it's not evil because it's metabolically evil. It's evil because it's economically evil.",English
+"Because it's so cheap that it's found it's way into everything. It's found it's way into hamburger buns, pretzels, barbecue sauce, and ketchup, almost everything.",English
+"Somebody emailed me the other day and told me they went into their local grocery store and went through every single loaf of bread on the shelf, and out of 32 types of bread",English
+"on the shelf, only one of them did not have high fructose corn syrup in it. So, we are being poisoned by this stuff,",English
+"and it's been added surreptitiously to all of our food, every processed food. The question is why?",English
+"Well, you'll see why in a minute. So, the corn refiners like to point out, ""Well, you know, it's just been a substitution.",English
+"""As the high fructose corn syrup's gone up, :the sugar's gone down. ""You know, we're just replacing, like gram for gram."" Well, not exactly, because here's",English
+73 pounds of sugar per year. This is from the Economic Research Service of the US Department of Agriculture. So disappearance data.,English
+"73 pounds, up to 95 pounds by 2000. And there's something missing from this slide. Anybody wanna tell me what it is?",English
+"What's missing? Juice, juice is missing. 'Cause juice is sucrose, right, sugar. And juice causes obesity.",English
+"So this is a study done by Myles Faith, a prospective study in inner city Harlem toddlers. And the number of juice servings per day",English
+"predicts the change in BMI score per month in these inner city Harlem toddlers. Now, where do these inner city",English
+"Harlem toddlers get their juice? From what, from where, from whom? From WIC.",English
+"Anybody heard of WIC? You know what WIC is? Women Infants Children, right? A government entitlement program set up under who?",English
+"Nixon, to prevent failure to thrive. They did. This is the equal and opposite reaction.",English
+"So, let's add juice in, here it is. So, most fructose items when you put it together, now we're up to 113 pounds on this graph, and I just heard from Brian Williams,",English
+"of NBC News, after the most recent study came out, that was in the Journal of Clinical Investigation, that we are actually up to 141 pounds of sugar per year.",English
+"Each of us. That's what we're up to. 141 pounds of sugar per year. Now, do you think that this might",English
+"have some detrimental effects on you? Hasn't stopped you, has it? That's the point, it hasn't stopped you.",English
+"That's why we need to talk about this. So, juice consumption increases the risk for Type 2 diabetes. So this is the relative risk ratio",English
+"as juice intake goes up, and this is in the Nurse's Study. Showing again, juice consumption, sucrose, obesity, diabetes.",English
+"Okay, the third political storm, that's swirling around to create this disaster, this mega-typhoon, that thing that happened in 1982,",English
+"the USDA, the American Hearth Association, the American Medical Association, all telling us we had to reduce our consumption of fat. Now, why did they tell us that?",English
+"To stop what? To stop hear disease. Did we? No, we didn't, did we? In fact, it's worked the exact opposite.",English
+"We've only created more. So, now how did this come to be? Why did they tell us to stop eating fat?",English
+"Well, in the early 1970s we discovered something in our blood called LDL, low-density lipoproteins. You've heard of that, right?",English
+"Is it good or bad? - [Audience Member] Bad. - Not so bad, we'll talk about it. In the mid 1970s we learned that dietary fat raised your LDL.",English
+"So, if dietary fat is A, and LDL is B, we learned that A lead to B. Dietary fat definitely increases your LDL,",English
+"no argument, it's true. And then, finally, in the late 1970s we learned that LDL correlated with cardiovascular disease.",English
+"So let's call cardiovascular disease C. So we learned that B lead to C. So, the thought process by some",English
+"very smart nutritionists, et cetera, the USDA et cetera, said, ""Well if A leads to B, and B leads to C ""then A must lead to C, therefore, no A, no C.""",English
+"This was the logic. Now, any logicians in the room? Anybody see any problems with that logic? Go ahead.",English
+"(speaking away from microphone) - That's right, the premise is incorrect. And I'll tell you why the premise is incorrect. Because this suggests that this is all transitive.",English
+"But, in fact, only the contrapositive is transitive. So, it's not no A, no C, it's no C, no A. So, the logic isn't even right.",English
+"There's faulty logic here. So, this doesn't work on any level. So, I'm gonna show you why this doesn't work.",English
+"But, before I how you why it doesn't work, I'm gonna show you that this was a battle royal back in the 1970s. This was not a simple thing.",English
+"There were people lined up on both sides of this story. So, this, over here, is a book, 1972 it came out, and it was called Pure White and Deadly.",English
+"It's all about sugar. Written by a British physiologist, nutritionist, endocrinologist, by the name of John Yudkin.",English
+"Now, I never knew John Yudkin he's passed away. But, I read this book about a year ago. And without even knowing it, I was a Yudkin acolyte.",English
+"I was a Yudkin disciple. Every single thing that this man said in 1972 is the God's honest truth. And if you wanna read a true prophecy, you find this book.",English
+"It's not easy to find, but you go find this book. And I'm telling you, every single thing this guy said has come to pass. It's astounding, I am in awe of this guy.",English
+"But on the other side we had this guy over here. His name was Ancel Keys. Anybody heard of him? So, Ancel Keys was a Minnesota epidemiologist,",English
+very interested in the cause of cardiovascular disease. And he performed the first multivariate regression analysis without computers.,English
+"Now, anybody know what that means? Multivariate regression analysis? So, this is where you take a whole lot of data, and normally you would just run a few computer programs,",English
+"but basically, the object is to try to figure out what causes what, and to try to factor out other things and determine what the contribution",English
+"of various things all at once are to an outcome that you're looking for. So, he was interested in cardiovascular disease. So, what he did was he did this study,",English
+"along with other people around the world, called the Seven Countries Study. Very famous, front page of Time Magazine in 1980. So, here's the data on the Seven Country Study.",English
+"So, we have the US, Canada, Australia, England and Wales, Italy, Japan. And here's percent calories from fat on the x axis,",English
+"and here we have coronary disease death rate on the y axis. And so you'd say, ""Oh, look at that."" I mean, it's very obvious, isn't it.",English
+"Sure, percent calories from fat correlates very nicely with coronary disease, right? Except for one little problem. Anybody see it?",English
+"Japan and Italy? So, how much sugar do they eat? Didn't I tell you the Japanese diet eliminates fructose? They never even had it 'til",English
+"we brought it to them after World War II. Italy, aside from gelato, I mean what else they got? They got a lot of pasta,",English
+"there's a lot of glucose, but no fructose. There's no sugar in the Italian diet other than the occasional sweet, which they moderate.",English
+"They're very careful about moderating, and they cost a lot. But, here we got England, Wales, Canada, Australia, US, you know, we are sugarholics, aren't we?",English
+"We're also fataholics. So, in fact, the fat migrated with the sugar. So, here's, this is from Keys's own work. Page 262, if you wanna pick up the 500 page volume.",English
+And I'm just gonna read you the one paragraph that talks about this. The fact that the incidence rate of coronary heart disease was significantly correlated,English
+"with the average percentage of calories from sucrose in the diet, is explained by the intercorrelation of sucrose with saturated fat.",English
+"In other words, donuts. Where ever there was the fat, there was sucrose too. Because these guys here eat donuts.",English
+"(audience laughs) Partial correlation analysis show that with saturated fat constant, there was no significant correlation between dietary sucrose and the incidence",English
+"of coronary heart disease. Okay, when you do a multivariate linear regression analysis, you have to do it both ways.",English
+"You have to do holding fat constant showing the sucrose doesn't work, and then you have to hold sucrose constant",English
+"and who that fat still works. You see that anywhere? He didn't do it, he didn't do it. He didn't do the thing that you need to do",English
+"to do a multivariate linear regression analysis. Now, this was done before computers. We can't check the work.",English
+"He's dead, he died in 2004. So, we're left with a conundrum. Do we believe this?",English
+"Do we believe this study, because we based 30 years of nutrition education, and information, and policy in this country on this study.",English
+"And, as far as I'm concerned, it has a hole as big as the one in the USS Cole, all right, you got it?",English
+"Everybody, am I debunking, yes, no? Let's keep going. Remember, I told you LDL may be not so bad?",English
+"Well, here's why. Because there really isn't one LDL, there are two. There are two LDLs. Here's one over here, it's called",English
+"pattern A or large buoyant LDL. So, everybody knows that LDL correlates with cardiovascular disease, and that's true.",English
+"I'm not gonna argue that, that is true. But, it's not this one, pattern A LDL. These guys are so light, they are buoyant, they float.",English
+"So, they get carried through the bloodstream, and they don't even have a chance, because they're so big and they're so buoyant, they don't even get underneath the edge",English
+"of the endothelial cells in the vasculature to start the plaque formation process. But, over here we have this other guy, over here,",English
+called pattern B or small dense LDL. You see the difference? These guys are dense. These guys don't float.,English
+"These guys are small, they get underneath the edge of the surface of the surface of the endothelial cells, and they start the plaque formation.",English
+"And it's been shown by numerous investigators now, the dense LDL is the bad guy. Okay, now, when we measure LDL in the bloodstream,",English
+"when you do a lipid profile, you measure both of them together, because it's too hard to distinguish the two. So, when you get an LDL, you're getting both LDLs.",English
+"The neutral one and the bad one. Now, how can you tell whether your LDL is the neutral one or the bad one.",English
+"What you do is you look at your triglycerides level in association with it, 'cause your triglycerides tell you which one it is. So here, here's pattern A over here,",English
+"big large buoyant LDLs, and you'll notice that the triglycerides are low, and your HDL is high. That's what you want, you want a low triglyceride,",English
+"high HDL, 'cause that's the good cholesterol. You want high good cholesterol. Over here, you have pattern B. And here you have high triglyceride, low HDL.",English
+"That's the bad guy, that's the guy you don't wanna be. 'Cause you're gonna die of a heart attack. No question about it. Triglyceride to HDL ratio actually predicts",English
+"cardiovascular disease way better than LDL ever did. Point is, when you measure LDL, you measure both. So, dietary fat raises your large buoyant.",English
+"What do you think raises your small dense? Carbohydrate. Okay, so here's percent carbohydrate,",English
+and here's your pattern B going up. Everybody got it? So what did we do? What did we do in 1982?,English
+"So, here's the low fat craze. Took America and the world by storm. Because the content of low fat",English
+"home cooked food, that you cook by yourself, in your house, you can control the content of fat. But when you process it, low fat processed food,",English
+"it tastes like cardboard. It tastes like (bleep). So the food companies knew that, so what'd they do?",English
+"They had to make it palatable? So, how do you make something palatable that has no fat in it? You add the, sugar. So, everybody remember Snackwells?",English
+"Two grams of fat down, 13 grams of carbohydrate up, four of them being sugar, so that it was palatable. Well, we've just shown you that",English
+"that's the worst thing you could do. And that's what we've done. And we're still doing it, today. So when you find a mistake, what do you do?",English
+"You admit the mistake and you right the ship. We haven't admitted the mistake, and we haven't righted the ship.",English
+"So, we've our food supply adulterated, contaminated, poisoned, tainted. On purpose, and we've allowed it, and we've let it,",English
+"thought the addition of fructose for palatability, especially because of the decreased fat, and also as a ostensibly browning agent, which actually has it's own issues.",English
+"Because why it browns so well with the sugar in it, actually is what's going on in your arteries. Because that's causing what we call",English
+"protein glycation and cross linking, which is actually contribution to atherosclerosis. So it works on your steak on the grill, it works in your arteries the same way.",English
+"And removal of fiber also. Now, why did we remove fiber from our diet? We, as human beings walking the earth 50,000 years ago,",English
+used to consume 100 to 300 grams of fiber per day. We now consume 12. Why? What did we do?,English
+"We took the fiber out. So, why'd we take the fiber out? It takes too long to cook, takes too long to eat, and shelf life.",English
+"So, people ask me, ""What's the definition of fast food."" Fiberless food. I dare you, other than a salad, I dare you to go to any fast food restaurant",English
+"and find anything on their menu that they actually have to cook, that has more than one gram of fiber in it. 'Cause there isn't any, and that's on purpose.",English
+"Because they take the fiber out, 'cause that way they can freeze it, ship it around the world, and cook it up fast, and not only is is fast cooking,",English
+"but it's fast eating, which also causes it's own satiety issues. Bottom line, we have a typhoon on our hands. And then, finally, the last issue",English
+"was the substitution of transfats, which are clearly a disaster, but those have been going down, because we know that those are a problem.",English
+"So we've actually gotten rid of most transfats, not completely, but most. So this is it, this is what we've done over the last 30 years.",English
+"Now, to the biochemistry. Now, how many of you here have taken biochemistry? About 25%.",English
+I am going to show you a lot of reactions in excruciating detail. (audience laughs),English
+"If you've studied biochemistry, you will have an anaphylactic reaction. (audience laughs) If you haven't studied biochemistry,",English
+"you will fall asleep. So, what I'm gonna suggest that you all do is just let me do my thing, to show you that, at least it works, and just count the arrows.",English
+"Okay? You can do that, right? Can you count the arrows, it's not like counting sheep. Okay, you can count the arrows, and just stick with me. Just let me do my thing,",English
+"and let me show you why fructose is not glucose. 'Cause what the liver does to fructose is really unique, and you've gotta",English
+"understand it to understand everything I've just told you. So, number one, fructose is seven times more likely than glucose to do that browning reaction.",English
+"The advanced glycation end-products. The thing that happens on your grill, happens in your arteries for the same reason. You can actually see the color too,",English
+"the color change too. Fructose does not suppress the hunger hormone. There's a hormone that comes form your stomach called ghrelin you've heard about, already.",English
+"So, if you preload a kid with a can of soda, and then you let him loose at the fast food restaurant, do they eat more, or do they eat less?",English
+"They eat more. They just took on 150 calories, yet they eat more. Reason? 'Cause fructose doesn't suppress",English
+"the hunger hormone ghrelin, so they eat more. Acute fructose ingestion does not stimulate insulin, because there's no receptor for fructose,",English
+"no transport for fructose on the beta cell that makes insulin, so the insulin doesn't go up. Well, if the insulin doesn't go up, then leptin doesn't go up, and if leptin",English
+"doesn't go up, you're brain doesn't see that you ate something. Therefor, you eat more. And finally, I'm gonna show you",English
+"liver hepatic fructose metabolism is completely different between fructose and glucose, completely different. And I'm going to show you, before the evening is out,",English
+"that chronic fructose exposure alone, nothing else, causes this thing we call the metabolic syndrome. Everybody knows what the metabolic syndrome is?",English
+"So, this is the conglomerate of the following different phenomena, obesity, Type 2 diabetes, lipid problems,",English
+"hypertension, and cardiovascular disease. Those all cluster together, called metabolic syndrome. I'm gonna show you how fructose does every one of those.",English
+"I wanna show you the difference between glucose and fructose in a way that will be glaringly apparent. So, let's consume 120 calories in glucose.",English
+"Two slices of white bread. What happens to that 120 calories? You eat the 120 calories, 96 or 80%",English
+of the total will be used by all the organs in the body. 80% off the table. Why?,English
+"Because every cell in the body can use glucose. Every bacteria can use glucose, every living thing on the face of the earth",English
+"can use glucose, because glucose is the energy of life. That's what we were supposed to eat. 24 of those calories, or 20% will hit the liver.",English
+"So let's watch what happens to those 24 calories. Here they go. So, the glucose comes in through this transporter called Glut2, out here, the glucose",English
+"is gonna stimulate the pancreas to make insulin, the insulin's gonna bind to it's receptor, and it's gonna take this substrate over here called IRS-1, insulin receptor substrate 1.",English
+"That's not important right now, don't worry. And it's gonna tyrosine phosphorylate it. And it's going to be tyrosine IRS-1, which is now active, that's active.",English
+"And it's gonna stimulate the second messenger here called AKT. Now what AKT does is, it stimulates this guy down here. SRABP1, sterol receptor binding protein number 1.",English
+"So, one of the things that SRABP1 does, is it activates this enzyme here called glucokinase, which takes glucose to glucose 6 phosphate. Now, glucose 6-phosphate can't get out of the liver.",English
+"The only way to get glucose 6-phosphate out of the liver is with hormones. Glucagon or epinephrine, that's the way it can get it out. So now, the glucose is fixed in the cell,",English
+"but it's only 24 calories worth, so it's not a big bolus of it. Now, the glucose 6-phosphate almost all of it, is gonna end up",English
+"going over here to something called glycagen. Now, glycagen is the storage form of glucose in the liver. Because glycagen's easy to fish the glucose out",English
+"with glucagon and epinephrine. So, my question to you, and granted, this is a physiology question, is how much glycogen can your liver store",English
+"before it gets sick? The answer's any amount. It's unlimited. We have carb loaders who run marathons, right?",English
+"Does it hurt them at all? We have kids with a disease where they can't get the glucose out of the glycagen, called glycagen storage disease type 1A,",English
+or von Gierke disease. They got livers down to their knees their so big. They're hypoglycemic like all get out 'cause they can't lift the glucose out of their liver.,English
+"But, they don't go into liver failure. Because glycagen is a non-toxic storage form of glucose in the liver.",English
+"So, the whole goal of glucose is to replete your glycagen. So, this is good, this is not bad, this is good. Now, a little of that glucose is gonna fall down here,",English
+"it's gonna get metabolized down to this stuff here, called pyruvate. And the pyruvate is gonna enter your mitochondria, over here. Remember, your mitochondria are",English
+"the parts of your cell that actually burn the energy. They're your little factories. They make the stuff that lets you live. Called ATP, ATP, adenosine triphosphate,",English
+"that's the energy of life, right there. So, the pyruvate comes in, gets converted to something called acetyl-CoA, gets metabolized by this thing called",English
+"the Krebs cycle, TCA cycle, and you throw off ATP and carbon dioxide which you breath off. So far, so good? Have I snowed anybody yet?",English
+"You're with me? I snowed one guy back there. (audience laughs) I'm doin' my best, I swear to God, I'm doing my best.",English
+"Anyway, so this stuff over here, this acetyl-CoA, gets burned off in the TCA cycle. Maybe you won't burn all of it off, and so, some of it may exit as citrate.",English
+"And the citrate then leaves the mitochondria through a process known as the citrate shuttle. And then that citrate can then be broken down by these three enzymes, which are all",English
+subservient into this SRABP1. This is ATP citrate lyase acetyl-CoA carboxylase fatty acid synthase. They're not important.,English
+"The only thing to know is these three enzymes together turn sugar into fat. This is called denovo, meaning new, lipogenesis, fat making.",English
+"This is denovo lipogenesis. So you take the citrate which came form the glucose, and you end up with something called acetyl-CoA, which then gets packaged with this protein here,",English
+"and you end up with something called VLDL, very low density lipoprotein. Now, anybody heard of that before?",English
+"Is it good or bad? It's bad, that's bad. VLDL is bad because that's one of the things that causes heart disease.",English
+"It's also a substrate for obesity. So, you don't wanna make much of this. But the point is, you started with 24 calories,",English
+"maybe a half a calorie will end up as VLDL. So, that little Japanese guy with the little hat, you know, working out in the field,",English
+"eating rice for the next 90 years, can he die of a heart attack at age 90? Sure. But that's not so bad.",English
+"If you make it to 90, you're doing alright. Because that VLDL coming from glucose. Glucose made a little bitty VLDL.",English
+"And that serves as a substrate for adipose deposition into your fat cell, here triglyceride. In addition, because of the insulin",English
+"went up in response to the glucose, your brain sees that signal. And it knows that that is supposed to shut off further eating.",English
+"In other words, hey, I'm busy metabolizing my breakfast. I don't need lunch. And so, you have a nice negative feedback loop",English
+"between glucose consumption, the liver, the pancreas, and the brain, to keep you in normal negative, yin yang energy balance.",English
+"This is good, this is not dangerous. This is what's supposed to happen. So now, let's talk about a different carbohydrate.",English
+"Ethanol is a carbohydrate, isn't it? Here's the structure, carbon hydrogen oxygen, it' a carbohydrate. But, we all know that ethanol is a toxin, right?",English
+"A poison, right. You can wrap your Lamborghini around a tree, or you can fry your liver, your choice. Depends on how much you drink and how often.",English
+"Right? Okay. So, we know that ethanol is not good for you, except, of course, a little bit is good for you. So, we can talk about that too, later, if you want.",English
+"But, let's talk about how it's bad for you. So, here's acute ethanol exposure. CNS depression, vasodilatation, hypothermia,",English
+"tachycardia, myocardial depression, pupillary responses, respiratory depression, diuresis, hypoglycemia, loss of fine motor control, you all went to college.",English
+"(audience laughs) Here's fructose, nothing. It doesn't do any of those. Because the brain doesn't metabolize fructose.",English
+"Alcohol gets metabolized in the brain, to cause all of those things, but fructose doesn't. So, fructose is not an acute toxin, ethanol is.",English
+"We control ethanol, don't we? We have something called the Bureau of Alcohol Tobacco and Firearms. We have all sorts of things, we tax ethanol.",English
+"We do all sorts of things to limit consumption of ethanol. The Nordic countries, all the liquor stores are state run in attempt to try to set the price of ethanol high enough",English
+"so as to discourage consumption for public health reasons. We have 1500 years of alcohol control policy in this world to draw on, in terms of how to limit consumption.",English
+"Got it? Because ethanol is a toxin, and we know it. So, let's consume 120 calories in ethanol.",English
+"Shot of Makers Mark. Anybody taste it? Yeah, good, okay. So, 24 calories right off the top.",English
+"The stomach and the intestine have something called the first pass effect, so 10% off the top, and kidney, muscle, brain will consume the other 10%.",English
+"So there goes 20% or 24 calories right off the top. 96 calories of the 120 are gonna hit the liver. Now, how many was it for glucose?",English
+"It was 24. So, four times the substrate is gonna hit the liver, and there's the rub. This is a volume issue.",English
+"We're gonna show you how. So, the ethanol comes in, passive diffusion, there's not receptor for it, not transporter. First thing that happens is ethanol",English
+"gets converted to this guy, over here, called acetaldehyde. Anybody know anything about aldehydes? Like formaldehyde? Right?",English
+"Are aldehydes good for you or bad for you? They're bad, right? 'Cause what do they do? They can cause cancer, they cross link",English
+"proteins is what they do. So, if you cross link enough proteins in your liver, what do you think happens to it? You get something called...",English
+"Cirrhosis, right exactly. So this guy, over here, is bad. And it generates something called reactive oxygen species. Reactive oxygen species damage proteins in the liver.",English
+"And the more alcohol you drink, the more of this stuff you get. So far, so good? So, this is one of the reasons why alcohol's bad.",English
+"Now the acetaldehyde will come down here to something called acetate. The acetate will enter the mitochondria, just like the pyruvate did before.",English
+"Will get converted to acetyl-CoA and participate in the TCA cycle, just like before, to generate energy. So that alcoholics don't die form lack of energy,",English
+"they got energy, it's everything else they don't have. They're gonna have a whole lot of citrate. Because they have 96 calories that",English
+"have to get metabolized. How many calories made it to the mitochondria with glucose? About half, right?",English
+"Because most of it went to glycogen. So, we've got a big citrate, so it's in big font to show you that we're talking about big citrate now. And so, the big citrate is gonna get metabolized",English
+"all the way to VLDL by the CRABP1. And so you're gonna get a lot of the LDL. And this is the dyslipodemia of alcoholism, right here.",English
+"Everybody see that? So, the liver's gonna try to export this VLDL out so that it doesn't get sick, because when fat builds up in the liver,",English
+"that's not good for it. Some of it's gonna exit as free fatty acids, and those free fatty acids, will take up residence in the muscle, and you get something",English
+"called muscle insulin resistance. So insulin resistance, that's a bad thing. That makes your muscles and your liver now work so well. And can cause all sorts of other problems like diabetes.",English
+"Some of the acetyl-CoA won't even make it out, and will precipitate as a lipid droplet, so there's your alcoholic steatohepatitis. This acetyl-CoA, and this ethanol,",English
+"and these reactive oxygen species can start this enzyme activated. It's called c-jun n-terminal kinase 1, or JNK1, and it really is JNK1",English
+"because it is the bridge between metabolism and inflammation. So, when you generate JNK1, you do bad things to your liver,",English
+"which I will show you when we talk about fructose. So let's talk about fructose. Fructose is sweet, we like it a lot. We like it in everything, we like it in our bread,",English
+"we like it in our pretzels, we like it everywhere we look. So, let's consume 120 calories in sucrose. A glass of orange juice.",English
+"Everybody got it? So, two slices of white bread, a shot of makers mark, a glass of orange juice, all the same 120 calories. But, three different substrates.",English
+"Let's see what happens to the fructose. So, number one, the glucose, remember, 'cause sucrose is half glucose half fructose, so 60 of the calories of the 120 are glucose.",English
+"12 are gonna make it into the liver, 48 out here for the rest of the body. The same 20/80 split we had before with glucose. So far, so good.",English
+But all 60 calories of fructose are gonna be metabolized by the liver. Why? Because only the liver can metabolize fructose.,English
+"So, what do we call it, where when you take in a compound that's foreign to your body, and only the liver can metabolize it,",English
+"and in the process, generates various problems? What do we call that? We call that a...",English
+"Poison. So, let me show you how it's a poison. So, let's watch the fructose. So, the fructose comes in through this transporter, now.",English
+"Before it was Glut2, now it's Glut5 No insulin, remember, 'cause fructose does not stimulate insulin.",English
+"Fructose, then, gets metabolized by this guy, over here, called fructokinase, to form something called fructose 1-phosphate. In the process, ATP has to give up",English
+"one phosphate to ADP 'cause the phosphate had to come from somewhere, so it comes from here. Now, before we had 24 calories that had to be phosphorylated.",English
+"Now we have 72 calories that have to be phosphorylated. So, we have three times the substrate, and there's the rub.",English
+"It's a volume issue, for right now. So, we're gonna lose a lot of phosphate, aren't we? So there's a scavenger enzyme in your liver called AMP deaminase 1 to rescue",English
+"the phosphates off the rest of the ATP molecule, and it takes ADP down to AMP, adenosine monophosphate, down to IMP, Inositol monophosphatase,",English
+"and finally, to the waste product uric acid. Anybody every heard of uric acid? What is it?",English
+"It's a waste product. Goes out in your urine. 'Causes what disease? Gout, right. Also causes another disease called hypertension.",English
+"Let me show you how. Because uric acid, turns out, blocks the enzyme in your blood vessels called endothelial nitric oxide synthase.",English
+"And that's the enzyme that makes the stuff called nitric oxide, NO. And that is your endogenous blood pressure lowerer. That keeps your blood pressure low.",English
+"So, when you can't make it, your blood pressure goes up. So, this just shows that fructose consumption increases gout in adults.",English
+"So, this is a study that came out last year showing that fructose consumption increases the risk for gout, showing that uric acid's going up.",English
+"And this is a study done by pediatric renal fellow, Stephanie Winn, just published in Journal of Pediatrics, it's not submitted any more, it's long in press,",English
+"showing that this is in the NHANES database in the adolescents, showing that sugar sweetened beverages, as it goes up, your uric acid goes up.",English
+"And, not only does your uric acid go up, but here's your sugar sweetened beverages, and here's your systolic blood pressure going up. And here's a study done by Dan Fige,",English
+"at the University of Texas San Antonio, where he took obese adolescents with hypertension, and he gave them the drug Allopurinol.",English
+"And Allopurinol is the drug that you treat gout with, to lower the uric acid. And look what happened to the blood pressure. Systolic, diastolic, went down.",English
+"Showing that, in fact, uric acid is an important part of hypertension. We have a hypertension epidemic in this country.",English
+"Here it is. It's the sugar. Okay, so, so far we have high blood pressure. Let's keep going.",English
+"The fructose will get metabolized down to pyruvate, the pyruvate will enter the mitochondria just like before, throwing off a lot of citrate.",English
+"And here's a little trick that fructose does that glucose doesn't. 'Cause these to can reform this stuff over here called fructose 1 6 bisphosphatase,",English
+"which can then reform with glyceraldehyde to form this guy, over here, called xylulose-5-phosphate. And I get to xylulose-5-phosphate in a moment.",English
+But I wanna point out this asterisk. That's there to remind me to tell you something. That's there to remind me to tell you that this is why the sports drink companies,English
+"put high fructose corn syrup in the sports drinks. Because if you are glycogen depleted, in other words, if you just ran a marthon,",English
+"and you have no glycogen left in your liver because you burned it all, and you take in a sports drink with high fructose corn syrup, you can replete your glycogen faster",English
+"than with glucose alone. That's true. So, for elite athletes, a high fructose corn syrup containing sports drink actually makes sense.",English
+"And so, indeed, sports drinks have high fructose corn syrup. The question is who drinking the sports drinks? Any elite athletes you know?",English
+"Who's drinking the sports drinks? The kids, right? Why are they drinking it? Because it's cool, right?",English
+"'Cause it's cool and it tastes good. So, before we go on, I just wanna, now, digress for a moment.",English
+"1967, University of Florida patents Gatorade. Everybody remember Gatorade? Okay, 1970, the Florida Gators win",English
+"the NCAA Championship in football. Gatorade makes a big splash. Okay, big deal. Anybody ever taste the original Gatorade?",English
+"coming out of you instead of going into you. (audience laughs) It tasted awful. 1992, Pepsi buys Gatorade, and they say,",English
+"""How are we gonna market this swill?"" So, what did they do? They added the high fructose corn syrup.",English
+"So, now who drinks it? Fat kids, right? Not even skinny kids, fat kids drink it. Okay, so there's a problem here.",English
+"Okay, and we're gonna show you how that works. Okay, so xylulose-5-phosphate, just to show you, if you take a rat, and you glycogen deplete him by making him run on an exercise wheel,",English
+"and then you re-feed them with starch or with sucrose, the xylulose-5-phosphate goes way up with the sucrose. So you get more xylulose-5-phosphate",English
+"through this pathway here, going over here. So why do we care about xylulose-5-phosphate? Well, here's why. Because it stimulates this guy, over here,",English
+"called PP2A, which then activates this transcription factor here, carbohydrate response element binding protein, which then activates what three enzymes?",English
+"New fat making right, the novo lipogenesis. So here's the citrate, we got lot's of that. And here we've got acetyl-CoA, which is the way into fat,",English
+"which then gets packaged to the VLDL, and now you've got the dyslipidemia of obesity of fructose consumption,",English
+"which has, been known for many years. So, here's normal medical students, if you can call them normal,",English
+"taking in a glucose load. Notice, almost none of it ends up as fat. Taking in a fructose load, same number of calories,",English
+"30% of it ends up as fat. So when you consume fructose, you're not consuming a carbohydrate, you're consuming fat.",English
+"So everybody talks about a high fat diet. Well, high sugar diet is a high fat diet. That's the point.",English
+"That's exactly the point. This is a study where they gave acute administration of fructose,",English
+"and you can see the triglycerides going up compared to the control. Serum triglyceride, right there. Here's normal medical students, again,",English
+"six days of high fructose feeding. Triglycerides doubled, de novo lipogenesis went up five times higher, and here's free fatty acids,",English
+"which then cause insulin resistance, doubled. Six days. So, here's the dyslipidemia of fructose consumption.",English
+"We're not done. Some of the fat won't make it out of the liver, just like with ethanol. And now you've got a lipid droplet,",English
+"so now you've got this nonalcoholic steatohepatitis. So, this is work that we did in our clinic looking at sugar sweetened beverage consumption",English
+"against the liver enzyme marker ALT, alanine aminotransferase, which tells you about fatty liver. And sure enough, here's sugar sweetened beverages",English
+"against ALT, and you can see a nice linear relationship in Caucasians. African Americans, it's a different relationship,",English
+"and that' a' whole 'nother story all by itself. So, there's the lipid droplet of nonalcoholic steatohepatitis.",English
+"Some of it will come out as free fatty acids and populate the muscle, will also tell the insulin to go up higher. Remember that JNK1?",English
+"So, here's what JNK1 does. So, the acetyl-CoA and the fructose can all activate JNK1. And what JNK1 does is, remember when we used glucose, this IRS became tyrosine IRS-1",English
+"and that was good? Remember that? Well, JNK1, what it does, is it's serine phosphorylated IRS-1. And serine IRS-1 is inactive.",English
+"So now, the insulin can't even do it's job in the liver. So, now you have liver insulin resistance as well. That's gonna make the pancreas work that much harder",English
+"generating higher insulin levels, which raise your blood pressure even further, cause further fat making, cause more energy to go into your fat cell.",English
+"There's your obesity. And finally, our research has shown that the higher the insulin goes, the less well your brain can see it's leptin.",English
+And so there you've got continued consumption because your brain thinks it's starving. And it's been shown in many different ways that fructose consumption changes,English
+"the way your brain recognizes energy. All in a negative fashion, so that you, basically, think you're starving. Your brain gets the signal that you're starving",English
+"even though your fat cells are generating a signal that says, ""Hey, I'm full like all get out."" So, this just shows you how it goes.",English
+"So, the high insulin generates the obesity because this is that, remember the first law of thermodynamics, the biochemical force generating the energy storage",English
+"as the primary phenomenon, remember, if you're gonna store it, and you expect to burn it then you're gonna have to eat it. So, here's the store it.",English
+"Normally, that would make leptin, and the leptin should feed back and turn everything off, but it doesn't, because the insulin gets in the way,",English
+"and the high fat diet gets in the way. Also, the hyperinsulinemia stops the leptin from acting on that nucleus accumbens, and so you get an increased reward signal.",English
+"So that continues your appetite, continues more fructose, more carbohydrate, generating more insulin resistance than you can see. You generate a vicious cycle of consumption",English
+"and disease, and no stopping. So, here we are, hypertension, inflammation, hepatic insulin resistance, hyperinsulinemia,",English
+"dyslipidemia, muscle insulin resistance, obesity, and continued consumption. Looks like metabolic syndrome to me.",English
+"So, here are the phenomena associated with chronic ethanol exposure. Hematologic disorders, electrolyte abnormalities,",English
+"hypertension, cardiac dilation, cardiomyopathy, dyslipidemia, pancreatitis, malnutrition, obesity, hepatic dysfunction, that's alcoholic steatohepatitis,",English
+"fetal alcohol syndrome, and addiction. Here's fructose. Eight out of twelve.",English
+Why? 'Cause they do the same thing. 'Cause they metabolize the same way. Because they are the same.,English
+"They come from the same place, right. How do you make ethanol? Naturally. Right, you ferment sugar.",English
+"Hasn't changed, 'cause it has all the same properties. Because it's basically taken care of by the liver in exactly the same way, and for the same reason.",English
+"Because sugar and ethanol are the same, every which way you turn. So, here's our clinic intervention.",English
+This is what we do in our clinic. It's as simple as you can imagine. We write this on the back of a matchbook. It's just as simple as you can make it.,English
+"We have four things we teach the kids to do, and the parents. Get rid of every sugared liquid in the house, bar none. Only water and milk, there is no",English
+"such thing as a good sugar beverage, period. Eat your carbohydrate with fiber. Why? Because fiber is good.",English
+"Fiber is supposed to be an essential nutrient. And we can talk later, if you want, after the cameras turn off, as to why fiber is not an essential nutrient.",English
+"Because the government doesn't want it to be. 'Cause then they couldn't sell food abroad. Wait 20 minutes for second portions,",English
+"to get that satiety signal. And finally, buy your screen time minute-for-minute with physical activity. That's the hardest one to do.",English
+"So, if you play for half an hour, you can watch TV for half an hour. You wanna watch TV for an hour, play for an hour. That one's a hard one, but anyway.",English
+"We follow our patients every three months. So, here's my question. Does it work? What do you think?",English
+"Yeah, it works. So, this is BMI z-score time from initial visit. It works. But, we were interested in what made it work,",English
+"and made it didn't work, so we did a multivariate linear regression analysis. The thing that made it not work, sugared beverage consumption.",English
+"The more sugar beverages the patient drank at baseline, the less well lifestyle intervention worked for all the reasons I just showed you.",English
+"So, why is exercise important in obesity. Because it burns calories? Come on.",English
+"20 minutes of jogging's one chocolate chip cookie. You can't do it. (audience laughs) Are you joking me? So, why is exercise important?",English
+"I'll tell you why, here's why. Number one, it improves that skeletal muscle insulin sensitivity because you're insulin actually works better at your muscle,",English
+"which then brings your insulin levels down. Which is good for you. Number two, it's your indigenous stress reducer. It's the single thing that actually stress reduces.",English
+"And if you stress reduce, what do you think your appetite does? Goes down, because stress and obesity go hand in hand, for all sorts of reasons which are beyond",English
+"the scope of this lecture today. But, we can talk about it in the question period, if you want. And then finally, remember that de novo lipogenesis?",English
+"Remember those three nasty enzymes? What if you burned the stuff off before you made the fat? That's what exercise does, 'cause it makes",English
+"that TCA cycle run faster, so you don't get the citrate leaving the mitochondria, so it doesn't get turned into fat, so it doesn't precipitate and cause",English
+"Are you joking? So, why is fiber important in obesity? So, this is my motto in clinic. When God made the poison, he packaged it with the antidote.",English
+"'Cause fructose is a poison. I think I've, hopefully, shown you that. But, wherever there's fructose in nature, there's way more fiber.",English
+They actually did studies on the sugar plantations back in the early 1900s. All of the workers were healthy,English
+"and lived longer than the sugar executives who got the processed product. How 'bout that, wonder why.",English
+"So, eat your carbohydrate with fiber, that's why we say that. That includes sugar, that's why fruit's okay.",English
+"Because number one, it limits how much fructose you're gonna take in, and number two, it gives you an essential nutrient which you needed in the first place.",English
+"And you get some micronutrients along with it so that you actually, your liver works healthier. So, here's what fiber does.",English
+"Number one, it reduces the rate of intestinal carbohydrate absorption. Now, sometimes that's bad. I'll tell you when that's bad.",English
+Now when that's bad? That's bad when you're at a formal function. 'Cause what happens if you reduce,English
+"the rate of carbohydrate absorption in your gut? The bacteria get to it. So, as far as I'm concerned,",English
+"It increases the speed of transit of the intestinal contents to the ilium, and that raises this hormone over here called PYY, which goes to your brain",English
+"and tells you the meal's over. That's your satiety signal. So when you add fiber to your diet, you actually get your satiety signal sooner,",English
+"because the food moves through faster. And then, finally, it also inhibits the absorption of some free fatty acids all the way to the colon, and then those",English
+"get chopped up into little itty bitty fragments called short chain fatty acids, and those actually suppress insulin, as apposed to long chain fatty acids",English
+"Takes about a week. Because you're getting that 100 to 300 grams of fiber I mentioned before. That's why, 'cause fiber is good for you.",English
+"and, of course, the world. Ready? Another quiz. Can you name the seven foodstuffs at McDonald's that don't have",English
+"By the way, the chicken McNuggets, we have a disclaimer, because no one eats the chicken McNuggets without a dipping sauce. And there's a whole bunch of high fructose corn syrup",English
+"in the dipping sauce, right? Okay, good, all right. So, who's really drinking this? We talked about this before.",English
+"Gatorade AM. So, this is an attempt by Pepsi to capture market share on the juice market.",English
+"Do you think there are any elite athletes who actually drink this stuff? You gotta be kidding me. Okay, this is for kids, right?",English
+"So, this really blew my socks off. This was my daughter, when she was in second grade, two years ago,",English
+"Miriam Lustig, brought these two cartons of milk home for me, and said, ""Dad, you're not gonna believe this."" Second grade.",English
+It's like a glass of milk plus a half a glass of orange juice. And that's what we're giving to our kids. And do you know what the,English
+"So, could this be the reason? So, here's a can of formula. 43.2% corn syrup solids, 10.3% sugar.",English
+"It's a baby milkshake. Soda, Coca Cola, is 10.5% sucrose. Formula is 10.3% sucrose.",English
+"Any difference? And there's a huge literature that's now coming of age that shows that the earlier you expose kids to sweet,",English
+"the more they're gonna crave it later. Plus, there's a new literature that shows the more sugar the pregnant woman drinks or eats",English
+"during the pregnancy, the more that gets across the placenta, and actually causes what we call developmental programming,",English
+"changing the kids adiposity even before the kid is born, and driving this whole epidemic even further. So, we'll close in a few minutes.",English
+"But, I just wanna point out what's the difference. Here, we got a can of Coke. Here we got a can of beer.",English
+"And I'm not picking on Schlitz, or anything. It's any beer you want, okay. So, 150 calories each, no difference in terms of total calories.",English
+"Percent carbohydrate, so 10.5% from sucrose here, except it's high fructose corn syrup, but who cares. 3.6% alcohol, here's the breakdown.",English
+"as it relates to immunity, metabolism, and the connection there in. I'm also going to share with you",English
+"some proof of concept studies that we've done now to instantiate our ideas. So two weeks ago, we saw the report that the epidemiological transition 2.0,",English
+"where cancer leaped over cardiovascular disease, as the most common cause of mortality among the HICs, the high income countries.",English
+"Now, when I heard this, I was celebratory, but then I was annoyed. I was annoyed because how come psychiatry is going in the wrong direction?",English
+"Why is it that HIV mortality is going down, many forms of cancers going down, cardiovascular disease mortality is going down,",English
+this is the state of the union. And it's unacceptable. My first message really is is that immune metabolic or inflammable metabolic morbidity,English
+"is the principle cause of premature excess mortality. And you know that. A good friend of mine in Toronto, Ben Goldstein",English
+"led a group of us in this paper on behalf of the American Heart Association, where bipolar is now in there as a tier two risk factor,",English
+"you could say added to the Framingham risk factors for cardiovascular disease. So we know that this is the most common cause of premature, excess mortality being immune metabolic,",English
+"and this identification that there's some type of intrinsic commonality between bipolar disorder and in quotes, immune metabolic conditions really in fact, has,",English
+"I think now had it's life, it's got a well-established story, and it gets more interesting, women, more effected by men it seems like",English
+"in bipolar disorder, by some of these immune metabolic conditions. You know, for us, we've been trying to focus on, okay,",English
+"is there a way we can better manage the cognitive impairment in people who have bipolar disorder, and related to that,",English
+"I've got, you know, something wrong with the atoms of cognition or something wrong with my, you know, reward-based decision-making.",English
+"They come in, they say, I'm depressed, I'm despondent, I'm flat, I'm suicidal, I can't function. What they're saying is I've got a cognitive problem,",English
+"I've got a reward-based decision problem. And to move along with this in terms of the actual statistics, of course,",English
+"folks here know this well, cognitive impairment, when I first started in this business, cognition wasn't even on the radar screen in bipolar. We now know this is a core dimension, can be progressive,",English
+"that's going on here, which I think is looking extremely exciting. Now, what I want to do now is I want to step outside the psychiatry clinic,",English
+"and let's walk into a diabetes clinic. And if we walk into a diabetes clinic and we sit down with people with type two or type one, but type two diabetes,",English
+"and we asked them to in fact, go through a set of psychometric testing, what we find is is that in diabetes type two, these individuals have very similar",English
+"cognitive dysfunctions as people who have bipolar, the type of cognitive problems, the magnitude of the problem and the clinical correlates.",English
+"So the reasoning has been in my lab that have diabetics have similar cognitive problems as people with bipolar disorder,",English
+"then perhaps there may be some underlying substrates in common. So we ran an analysis of the extent literature looking at cognition in bipolar disorder,",English
+"nobody needs to be convinced this is a problem, I think that's well-presented. We were trying to look at the moderational influence of obesity,",English
+"and what we found was is obesity's anti-cognitive, that's well-described in the general population supported by pre-clinical work,",English
+"and in the bipolar population, obesity is particularly associated with deficits in executive function and processing speed.",English
+"Now the million dollar question is what came first, is obesity anti-cognitive, or did these persons have some type of brain alteration",English
+"at the get-go that really predisposed obesity, for example, impulsive behavior and or disturbances in hedonistic tone,",English
+"and these are questions that go on. But for us, in fact, what was more compelling was a separate part of this analysis that we did, and that is the brain substrates",English
+"in these persons with bipolar disorder, the nodal regions, the structures, the actual circuits were more likely to be abnormal",English
+"in people who are obese when compared to people who are healthy controls. One of the other sort of validators, if you will,",English
+"of the concept is the dose response curve, this is another line of evidence showing that in bipolar disorder and schizophrenia,",English
+"that the higher the BMI, the greater the cognitive impairment. What our work showed, what this work showed, so there was a replication of this,",English
+is it up to about a third of the variability or the variance in cognition could be directly accounted for by obesity. I'm involved in a study in China right now,English
+"where we're taking ultra high risk and high risk children who have a parent or parents plural with bipolar disorder, and we're trying to establish whether or not exercise",English
+"could reduce the progression into clinical bipolar disorder. And my message, and in keeping with the theme of this talk is that we're not just talking about obesity,",English
+"having an association with cognition in people who have declared bipolar disorder, these are in children or adolescents,",English
+and what we found interesting enough using the matrix was that these children with bipolar disorder were particularly susceptible to decreased cognitive performance,English
+"as a function of elevated BMI, something we did not see in the healthy control, so there's something about the cognition function in these",English
+"at-risk children that leaves them particularly susceptible to obesity, so obesity as anti-cognitive in bipolar, obesity is anti-cognitive from perhaps even a,",English
+"if you will, a tailwind for people at risk. This was a study we did with colleagues in Italy, looking at social cognition,",English
+"so mentalization theory of mind using the theory of the mind test, reading the mind in the eyes test,",English
+"and we were able to show really, it was an extension of what's been shown in healthy controls that when you provoke the immune inflammatory system,",English
+"you reduce performance and social cognition. So cognition is a very broad universe, social cognition being the mentalization piece,",English
+"a profound disturbance in people who have bipolar disorder. Now, Andrea Fagiolini was in Pittsburgh at the time he's back in Italy,",English
+"this is just really more of the clinical piece in so far as I'm here to say that we think that there's a metastatic process, which I'll get into in a moment,",English
+obesity and brain manifesting on the surface as cognitive impairment and reward. Other aspects of phenomenology,English
+"that have been well-described, I think this has more of a clinical translation, is it obesity is associated in the bipolar population with a more complex presentation,",English
+"higher rates of non-recovery recurrence and suicidality. And that's been well presented. Now I want to just draw your attention if I can, to this line here with the star, down here,",English
+"I'm just going to orient you very quickly. This is major depressive episode in bipolar, non-obese, a major depressive episode obese.",English
+What is the message? The message is is that obese individuals tend to have more mixed features. Now I had a presentation I gave about two weeks ago,English
+"and the presentation was entitled Where Have All the Euphoric Manic Patients Gone? Ross, where have they all gone?",English
+"because when I've started in this business, the ward was overrepresented with people with elated mania. Now I'd pay to see a person with elated mania.",English
+"Now we see people with what I call the five A's, they're anxious, they're agitated, they're angry, they can't pay attention, they're anhedonic,",English
+"they got mixed. And we have, I published a paper recently, it was just kind of a fun paper to write where I conjectured that the obesity epidemic",English
+"is changing the phenomenology of bipolar disorder. And it's not totally and utterly speculative, but it in fact is supported in part empirically,",English
+"because obesity, when it does communicate to brain, it's communicating to brain regions, subserving cognition, subserving reward, subserving arousal,",English
+subserving chronobiology and mixed features is the five alarm fire of psychiatry. And so it's something I've been curious about,English
+"for a long, long time. And something just that we've been sort of had a little fun with sort of thinking it through. Let's talk about reward.",English
+"You know, that reward cuts in two pieces, anticipation and liking. This is the wanting and the liking. And anticipation's largely dopamine,",English
+"the consummatory piece is largely cannabinoidergic and opioidergic, and there is no question that this is a terrible problem in people who have bipolar disorder along with cognition,",English
+this work's going on here in terms of delayed discounting and probabilistic discounting and so on. For those of you in the room who perhaps don't,English
+"maybe sort of snuggle up to the journals and read this literature every night in terms of reward paradigms and so on, simply put, is that reward involves",English
+"many aspects of anticipation and learning, and it has been shown that in people who are obese and people who have bipolar disorder,",English
+"they have abnormalities, or they have, so the difference in performance when compared to healthy controls on these tests,",English
+"the greater the insulin sensitivity, the more people will defer gratification and go for larger rewards later, it's supposed to be,",English
+"it's a reflection of optimal reward-based learning, and in diabetics, particularly people who are obese, they perform very poorly on these tests,",English
+"and this is something we also see in the bipolar population, not just a disturbance in the anticipation of reward, the learning of reward,",English
+"as well as reward-based processing, and every clinician knows that bipolar disorder is really the exemplar of reward-based disturbance, whether you're talking about comorbidity",English
+"or you're talking about the phenomenology of depression and mixed. Okay, so let's talk if we can now, at the molecular level, insulin, we're talking, Dost,",English
+"about you and I love MAO inhibitors, well, so does Mother Nature because insulin is a monoamine oxidase inhibitor,",English
+"it inhibits, MAO on the outer mitochondrial membrane, that's thought to be relevant to dopamine signaling, hence we prescribe these drugs,",English
+"so does Mother Nature, and when it's abnormal, I'm going to come back to this, what's the evidence of insulin resistance in the brain, there was a wonderful K award,",English
+"just one here yesterday, the champagne's still flowing on insulin resistance in the brain and bipolar disorder. We think this is one, one target.",English
+"In other words, we do believe that a story could be told around the cognitive impairment and or the reward disturbance",English
+"in the bipolar patient via this metabolic pathway. And we think that the metastatic process is, is that obesity leads to insulin resistance,",English
+"which then leads to you know, other chemical changes that are relevant to cognition and reward.",English
+"This is a collaboration I have with colleagues in China, sorry in Taiwan, Vincent Chen and friends in Taipei. And what we've been looking at is, yes, brain images,",English
+"looking at bipolar, there's a very well, robust, I think a fairly robust story around the brain topology alterations in bipolar disorder,",English
+"brain, what we're finding interestingly enough is that in the bipolar population that is obese, they have a very different brain circuit network",English
+"functional interconnectivity when compared to the bipolar group that's abnormal weight. Said differently, the specific regions of interest",English
+"that being the cognitive control networks, the sensory cue networks, certainly reward networks are more abnormal",English
+"in terms of functional interconnectivity. That was of interest to me on so many levels, when I then saw this paper,",English
+"which was in 14-day old-neonates, who participated in this study, these are pretty bright neonates, they signed the consent form at age 14 days.",English
+"I hope they paid them for their participation. Anyhow, these 14-day-old neonates have a story to tell because their moms were obese.",English
+"And in the MRI scanner, when they looked at the brain, these young 14-day-old neonates had brain circuit alterations and sensory cue reward",English
+"cognitive control, motor control, identical to what we saw in the adults. It's interesting because obesity, metabolic and inflammation marches in the same direction as the bipolar phenotype,",English
+"and it's an interesting question what came first, are these brain substrates that are now abnormal in a younger brain,",English
+"are they, in fact, not only involved in obesity and appetitive behavior, consummatory behavior, but maybe also involved in the phenotype of mood.",English
+"Now this was in fact, a publication just a few months ago now, this was the largest publication, or a sample we've seen now, bipolar genetics,",English
+"again, that's a three-hour symposium in itself in terms of genetics and bipolar disorder. But why did I put it in here? A, I like the diagram, it's very nice.",English
+"But why I really put it in there is because I'm as guilty as anyone else of confirmation bias, and in this particular analysis, one of those 30 low side that chemo",English
+"was the low side for insulin. And the other one that came out was for cannabinoid signaling. And this has been replicated a couple of times,",English
+"along with inflammatory low side. What I'm trying to get at is that the genetic architecture of bipolar is a long, complicated story,",English
+"and that's well beyond the scope we're going to talk about, but what we're seeing at least is overlapping. We talk about genetic relationships",English
+"between bipolar one and schizophrenia, bipolar two and major depression. That's very interesting, but what I find no less interesting is that genetic links",English
+"that we're seeing now between bipolar one disorder or two and other NCDs, non-communicable disorders like diabetes and obesity.",English
+"We had access to post-mortem brain at the NIH, Rodrigo Mansur as a PhD, MD PhD in my lab, and we ran, we looked at these in the prefrontal cortex",English
+"of our, these post-mortem brain samples we had from NIH, looking at gene expression, and I'll keep that again very brief here.",English
+"We looked at a variety of of potential genetics. What was interesting, what really came out as being quite different",English
+"in the bipolar sample that was obese, so we have bipolar brain, we categorize them as obese versus non-obese, and we found that there were very significant differences",English
+between groups in the insulin cascade or the insulin pathways in the inflammatory pathways and the dopamine pathways.,English
+"Which was kind of interesting how that all just came together. So we think that in fact, that aligns with some of the other peripheral data we have,",English
+"like this, we've done a lot of this work looking at cytokines and interleukin ones and sixes and CRPs on, and the way the story's been told",English
+is that about half of people with bipolar disorder are in a state of pro-inflammatory balance in the periphery. And we think that transfers to some extent,English
+"to the central system, but the question really is how did it end up this way? Well, we start off with of course genetics,",English
+"but what about the environment, rates of childhood trauma, extraordinary and bipolar disorder, childhood trauma is pro-inflammatory",English
+"and highly insulin resistance enhancing through a set of different pathways, and that in fact is an observation",English
+"which I'm going to come back to in a moment, it set the stage for why we did an anti-inflammatory study with a particular view of looking at trauma.",English
+"I've been interested philosophically in this global epidemic of loneliness, we just finished a huge meta-analysis of the loneliness literature, looking at health outcomes,",English
+"mental health outcomes, but there's no doubt about it that the social network, the social matrix of our patients in many cases is less than ideal,",English
+"and that could also be contributing to some of the insulin resistance, and also some of the inflammation. Now, just to sort of touch base on a couple of other areas,",English
+"I think this is one that I'm not a sleep researcher, but this is clearly a major contributor to why these patients have such profound insulin resistance",English
+"and inflammation that being the sleep alterations, but I'll just, that's more for completeness. I wonder if I can talk about this process now",English
+"of inflammation and this notion of inflammaging. And this is a very interesting story, around everything from telomeres",English
+"to a variety of other types of molecular manifestations of premature aging. This has now been identified in bipolar disorder,",English
+"this was a study we did in Brazil showing that in bipolar patients, they exhibit molecular evidence of premature aging, but where we saw it most pronounced",English
+"using this CD 69 measure is in the obese group. So we think that obesity is not only in fact related to the cognition and reward,",English
+"but we also think it's prematurely aging bipolar patients, which is already probable with premature aging disease, Dost, you probably saw this machine learning paper",English
+"that was published, which I thought was really interesting showing that this was using a large number of scans that people who are obese have also premature aging of brain",English
+"on the two to three years, first episode psychosis does as well. If your first episode psychotic, manic or schizophrenic and obesity have even greater aging.",English
+"So this aging process for me, really brings up the phrase of disease modification, I think lithium's the closest thing we have",English
+"to disease modification, I'm not sure we can still use the language disease modification with lithium, but that's clearly what we need.",English
+"Let's talk about exosomes. So the challenge I have had throughout my career among many, it has been in fact to convince myself what we're looking at",English
+"in the periphery is what's occurring in the brain. MRS gives us certainly a reason to believe, the other way is looking at exosomes.",English
+"Dimitrios Kapogiannis is at NIH he's been a collaborator with our team. He's developed a technology at NIH, a capability, where he's able to look at exosomes,",English
+"and just so everyone's aware, exosomes are neurally derived, and they're accessible in the periphery. So they are from the CNS,",English
+"and he has shown in Alzheimer's disease as well as in type two diabetes, that there is in fact impaired insulin signaling",English
+"using the phosphorylation of the searing. I mean, at least he's demonstrated this. I was hoping I would have it for today, 'cause we're just finishing the analysis.",English
+"We've now run for the very first time through our knowledge exosomes analysis, looking at immune, inflammatory, metabolic targets in a sample 60 people",English
+"at my center who had bipolar disorder, and we are hypothesizing that use these neurally derived exosomes that we're going to see differences",English
+"between those with bipolar and healthy controls in the metabolic pathways, as well as in fact, the inflammatory pathways.",English
+"One of my team members also just finished this analysis, I think for now what I'll do, I'll keep this maybe just very simple.",English
+"And that is, is that within the metabolic inflammatory signature of the bipolar population,",English
+it won't surprise you that there's further subpopulations. And part of this is influenced by sex. And we're trying to understand this a bit more.,English
+"You could be saying, well, what is the point of this? This seems like unnecessary interrogation and there's bigger things in life to think about. Well, for us, in fact,",English
+"to believe that we can give someone a metabolic treatment or an inflammatory treatment, we've really got to get the subpopulation down.",English
+"I'm convinced, looking for a biomarker for a DSM five phenotype doesn't make a whole lot of sense,",English
+"given the CAPRA correlations that we have, that is the suboptimal interobserver agreement we have with DSM,",English
+"but we've got pretty good agreement on cognition and good agreement on the domain of reward. And from that, we're trying to really understand",English
+"using machine learning, how in fact, we can identify the groups that are more likely to benefit. So we've been very interested in these two processes,",English
+"we came up with this new neologism metab-optosis so apoptosis driven by metabolism, I was hearing about ketogenic diets for opioid use",English
+"and alcohol use disorder, which is kind of cool, and it's pretty interesting 'cause you would know the ketogenic diets are all probably",English
+"pretty good for apoptosis, but we do think there is this process going on and this is why I coined this sort of phrase that they have this we do think that obesity's metastasizing",English
+"upward to the brain, through insulin, primarily through insulin as well. Now one plus one equals five in neuroscience. You guys know that.",English
+"This was a study out of China showing that when you're, sorry, the pointer's a bit thin, but over here, as CRP goes up,",English
+"CRP is a nonspecific acute phase reactor, of CRP, as the levels went up, there was a greater likelihood of incident depression",English
+"as DPP4 went up, which is dipeptidyl-peptidase that went up, we had a greater likelihood of depression and then we had this multiplicative effect.",English
+"This is why we believe that two obverse sides of the same coin, inflammation, metabolism, need to be explored contemporaneously,",English
+"and we think that both of them are combustible mix on brain in bipolar. Now at this stage, I think we're still very early",English
+"in understanding the role of bowel in terms of cognition and reward, this is the gut brain axis story, which is to the media, seems to have a lot of interest in this.",English
+"a host of studies, we just published this one recently looking at microbial diversity because we think that the obesity inflammatory phenotype",English
+"and bipolar may, may to some extent be moderated we're open to this idea, by gut. And we looked at a variety of attacks on and so on.",English
+"And we found there was decreased microbial diversity in the bowel of people who have bipolar. Now, if I was the reviewer of my own paper,",English
+"I would put in some critiques saying, well, this is highly associative, then what came first here, drugs for bipolar, like Olanzapine,",English
+"they can disrupt the gut biota, sleep can disrupt the gut biota, so can traumas. So how do you really know what's going where here?",English
+"And I have to say, I agree with those critiques. That's why I find this data very interesting. This is colleagues of mine in Copenhagen,",English
+"Dost and I were just over in Europe at ECMP. And one of my friends at Copenhagen has published this and you don't need to, in fact,",English
+"the up-to-date on your bacteria in your bowels, I'll just tell you good guys and bad guys. So for this one here, Flavonifractor this is one in fact that's linked",English
+to oxidative stress and inflammation and what they reported in Copenhagen is that their sample of people with bipolar,English
+"had a higher percentage, interestingly, the ultra-high risk group also had of course a lower, but so the, and this was apparently",English
+"statistically significant, they told me, and the healthy controls, in fact were less, this is a bad guy in a separate analysis that was done",English
+"looking at people who are affected by bipolar disorder, those at high risk, those at low risk, this is in fact a particular species here",English
+"that is a good guy. It turns out that the good guy was overrepresented in those with the low risk, and certainly was minimal most for higher risk.",English
+"So this is an interesting story. I think that this phenotype of obesity, the phenotype of inflammation in the bowel is certainly becoming more convincing",English
+"as it relates to bipolar, as they say more work is needed is I guess almost a cliche. But I think in fact,",English
+it's this type of work that I think is more compelling in terms of making the case there could probably or possibly be something there.,English
+"So ketogenic diet, restriction diets, circadian diets. Let's talk about anti-inflammatory treatments and pro-metabolic treatments for our patients",English
+"with bipolar disorder. I think it's remarkable in 2019 that we still don't have a large, well-designed,",English
+"well-executed, well-analyzed study with exercise in bipolar disorder. Now we do in major depression,",English
+"the TREAD study was a wonderful study, NIH supported from Texas, but in the bipolar area someone needs to do this study,",English
+"with respect to dietary modification, we don't have a large ketogenic diet. We don't even really have any large interventional diet",English
+"studies in bipolar disorder, so against that somewhat anemic landscape, what we did was we reached out to folks at NIH",English
+"who had completed the calorie study. The calorie study was a study we weren't part of, we had access to the data, and this was in adults, healthy adults,",English
+"these are not people with medical or mental disorders who were 18 to 49 and normal body weight. So this was a unique group,",English
+"and this group, in fact, subjected themselves to a two-year-study. So I could, two years of either eat ad libitum,",English
+"eat what the heck you want, or two years of caloric restriction. So these guys obviously were pretty committed to the cause. I don't think compliance was 100%, this is my guess,",English
+"but they did reasonably well. So we had the data, we had the blood analysis and so on, and what was interesting is that",English
+"the caloric restriction group, this may not surprise you, had a greater change in interleukin six. So when the body is exposed to stress,",English
+"the body reacts to stress with pro-inflammation, and it does it through a host of different mechanisms. The one that we often talk about is called the DAM pathway,",English
+"which is the damage associative molecular pattern pathway, and that leads to the increase in IL-6. So caloric restriction reduced IL-6 levels,",English
+"by the way, for those who may be less familiar, caloric restriction is the most potent anti-aging intervention. And now caloric restrictions are a hard thing to do",English
+"because our food is very hedonistic, and highly palatable and are often low quality. So our food is, our intake of food is driven",English
+"by homeostasis and hedonism, and it's the hedonistic part that gets us into trouble. But it turns out in fact that caloric restriction in animals",English
+"is the most robust way to slow the aging process. I will say to my students, if you want to look great for your high school reunion,",English
+"just stop eating, slow down that aging process. Then what we did is in fact, we looked at the cognition in calorically restricted people,",English
+"and the calorically restricted people performed much better than the control group on a variety of cognitive measures, this one was working memory.",English
+"So how's that relevant to bipolar? Well, we believe that there is, in fact, a story around inflammation and metabolism,",English
+"part of the metabolically obesity. Then the question is, what can we do about it? Let's start it off with behavioral modification and maybe in fact there's something to be said here,",English
+"someone's got to do a ketogenic or a restriction diet in bipolar, we did this a number of years ago now, intranasally delivered insulin in adults",English
+"with bipolar disorder who do not have diabetes, and these were individuals who were brought in, they were euthymic,",English
+"and very difficult to find euthermic patients at a university-based hospital. Nonetheless, we demonstrated that it was pro cognitive,",English
+"and of course this is a well-known story here, and doing the MRS work with intranasal insulin here at McLean,",English
+Suzanne Craft in North Carolina has been doing a lot of this work showing pro-cognitive effects of intranasal insulin in adults who have mild cognitive impairment.,English
+"Now, when you start trespassing in someone else's turf, you get carried away. So I've been trespassing in diabetes for a long time,",English
+"I'm a psychiatrist. And we became very interested in glucagon-like peptide one, GLP-1, and we became interested in GLP-1",English
+"for a number of reasons. GLP-1 by the way is produced it's an incretin produced in the L cell of the intestine. It's also produced in the nucleus tractus solitarius,",English
+"and relevant to today's discussion is, is that GLP-1 is, receptors, that canonical receptors are located on cognitive control and reward networks,",English
+"which are already identified as abnormal in bipolar disorder. GLP-1 treatment, by the way, is available at drug stores,",English
+"it's for weight loss, it's also for diabetes. We did a study, it was a small pilot study at my foundation where we gave individuals with bipolar disorder",English
+"who are not diabetic, we gave them exogenous GLP-1, this is a drug called Liraglutide, Victoza. And what we were doing was we were trying to determine",English
+"whether there'd be any effect on brain target, we looked at NAA creatine ratio, we showed a change in the ratio,",English
+"and interestingly enough, we showed also a change in cognition. This was a small study, so-called target engagement study, this has set, this provided for us pilot data",English
+"for an NIMH grant that we've submitted, trying to stop to get these types of grants, these types of intervention studies,",English
+we've submitted to a couple of the organizations to really get funding because we believe that perhaps this incretin could be pro-cognitive,English
+and could also have pro-hedonistic effects in individuals who have bipolar disorder. Now we have been looking at not only,English
+"repurposing anti-diabetics, but also the repurpose of anti-inflammatory, and this was a study that we recently published",English
+"Infliximab in JAMA, and this is an anti-TNF, an anti tumor necrosis factor alpha drug.",English
+"This wasn't a sample of people with bipolar depression. It was a two-sided study, Toronto and Stanford, Trish Suppes at Stanford, my team in Toronto,",English
+"and we looked at the effect versus placebo of Infliximab adjunct at 12 weeks administration, three infusions in adults, N equal 60 was the sample.",English
+"And what we found after a, I could tell you a very laborious study, because we had to see many, many people",English
+"to get into this study. We didn't find any between group differences in the total matrix score reduction. But we had built in a secondary question,",English
+"and a question that was in form not just by preclinical, but also clinical experience, and that is, is that we know that",English
+"when patients with bipolar and depression have been victims of trauma, they're less likely to respond to our conventional therapies.",English
+"And what was interesting was that in the group that was traumatized physically or sexually, I have the physical abuse slide here, we saw a robust separation in this group,",English
+which kind of resonated in terms of sort of the framework that we had here. So what does this mean?,English
+"Well, what this means is, is that as we're beginning to design and consider these trials in this area, trauma history is extremely pro-inflammatory,",English
+"also insulin desensitizing. And that might be a historical marker that may in fact, identify a subgroup, more likely to benefit",English
+"from these therapies. This was an interesting analysis that was recently published, talking about a drug that's indicated, you know,",English
+"FDA indicated for bipolar. This is the Trazodone, it turns out it doesn't work. It doesn't work in people who have CRPs less than two.",English
+"But it works in people who have CRPs north than two. Now I'm being a little bit dramatic, I don't think I could conclude it doesn't work",English
+"in people less than two, this was a post-hoc analysis, but it's part of an interesting story how inflammation may be moderating responses",English
+"to some treatments. This is one of the few examples where a pro-inflammatory signature actually does well for the treatment's response,",English
+usually it's the other way around. This came out of Scandinavia a few months back looking at the HMG coenzyme A reductase inhibitors.,English
+"This is Metformin, the biguanides. This is yet another study, this is observational, very large, 35,000 foot view,",English
+"but it would really add to what's come out of Australia, Michael Berk's work with the mitochondrial and antioxidants and anti-inflammatories that you know,",English
+there seems to be some type of favorable effect on the course and outcome of people with bipolar disorder who take these anti-diabetics,English
+"and anti-inflammatory treatments. Of all the anti-inflammatory treatments that we give people,",English
+"we think the one that has the most compelling evidence at least today is minocycline with RCT supporting its benefit,",English
+"we've never actually looked at the effect of minocycline in the bowel, but the challenge with all of these anti-inflammatory approaches, frankly,",English
+"is the tremendous heterogeneity in the samples, the methodology and so on, so I don't think we're really at that stage yet,",English
+"other than lithium, to say that we've got an anti-inflammatory ready for the prime time. Given what I said earlier about the loneliness epidemic,",English
+"it won't surprise you that there's literature, this is from NHANES showing that there's this decrease in inflammatory markers in people who have",English
+"more substantive social ties. And I have to say that as a clinician for 19 years in this area,",English
+"I have not routinely asked about loneliness and social networks as much as I should have been doing, but we certainly have in the last five to 10 years,",English
+"given what we're learning here, and it just speaks to some of the psychosocial interventions and opportunities. One final slide, I'll just put this in here.",English
+"This was a study we've got in press right now. We're all interested in early predictors of response, or even baseline predictors of response",English
+"in bipolar or major depression. I want to know which patient, which drug, which dose, we all want to know that.",English
+"And there's lots of interesting things and also some gimmicks in this area, quite frankly, but with respect to this,",English
+"this was a study, what we did was we looked at MVP, not most valuable player, but this was moderate to vigorous physical activity.",English
+And what we found was interesting is that we know that people who are reporting higher levels of activity,English
+are more likely to benefit from cognitive behavioral therapy in major depression. What we found was that people who increase their MVP,English
+"early in the treatment course are more likely to achieve PROs, patient report outcomes at eight weeks. So almost as though activity can be",English
+"a response predictor perhaps, but why we got interested in this is a number of reasons, but how it relates to today's conversation, activity clearly has anti-inflammatory,",English
+"it has insulin sensitizing effects and we started wondering biologically does this early activity reflect more motivation,",English
+"better performance on reward early on as a predictor. So I've been talking about, we want to improve cognition,",English
+"we want to improve reward, perhaps improvements in these dimensions or domains early could be a predictor of response",English
+"to a treatment in bipolar disorder. And then finally getting a good night of sleep. No one's going to debate that. That seems pretty potently anti-inflammatory,",English
+"and that's been shown in the bipolar area. So just to summarize, I think that psychiatry, frankly, has been in a bit in a cul-de-sac for a little while.",English
+"We haven't truly had novel, innovative therapies for a long time, I mean, we've had lithium was discovered, well, isolated,",English
+"I said discovered during one of my classes, that, in my undergraduate class, I inadvertently said, you know, discovered in 1817, one of the students goes,",English
+"no, it wasn't, it was discovered during the big bang. Said okay, I get your point. Anyway, so 1817 Sweden, 1882 was Divalproex, 1882,",English
+"Chlorpromazine, 1950, carbamazepine 1953, imipramine, 1957. These are fossils. We haven't actually had innovation for a long, long time.",English
+We've been stuck. And I think that the preponderance of the evidence now gives us a reason to believe that inflammation metabolism is relevant to dimensional,English
+"or domain psychopathology, it can be trans diagnostic, but we're focusing on cognition and reward. And we're using this information to try and test this,",English
+"these different repurposing opportunities with some of these interventions. We're not confined to pharmacology is what I do as the probe, but I've got a reason to believe",English
+"that we might possibly be getting closer to the disease process here. And maybe, maybe, maybe some disease modification. I'm going to stop there.",English
+Thank you very much. (audience applause) - [Dost] Thanks very much Roger. We have time for a few questions from the audience.,English
+- [Audience Member] The paper in Lancet of two or three weeks ago established that the polypill was able to achieve,English
+both primary and secondary prevention of cardiovascular disease. So therefore in thinking about that as a treatment,English
+"for any patient with, I'm not a mental health provider, with a mental health disorder that requires treatment with an anti-psychotic drug,",English
+"it's an obvious, it seems to me benefit for every one of those patients to be on this combination.",English
+"And that makes me in terms of your talk, wonder about a polypill intervention for patients with some of these bipolar disorder,",English
+"studies could that, and what would be the effect of that on cognition, on relationships, and so on and so on? - Was this polypill exercise, what was this poly --",English
+"- [Dost] No, no, it's ACE inhibitor plus -- - Oh yeah. - [Audience Member] Aspirin and ACE inhibitor, a statin and a low dose of Hydrochlorothiazide.",English
+"- Well, the, so 60% of the world's mortality is due to bad diet, smoking cigarettes,",English
+"habitually being inactive, and also drinking too much alcohol. So I would first of all, argue, let's deal with that first, those fat four, right?",English
+"In other words, no smoking, reduce the booze, get some exercise, and eat better. The polypills, interesting, because,",English
+"well, first of all, what are they targeting? They're targeting inflammation, and they're targeting metabolism. That's what's catapulting the aging process.",English
+"The bipolar population has premature aging. Again, that's a broad state, but not every individual, as a group.",English
+"And in young people with bipolar disorder, they're differentially affected by age-related diseases like hypertension, diabetes, arthritis,",English
+"and a friend of mine in Toronto, his work in pediatric bipolar, they been looking at adolescents with bipolar, showing that for example,",English
+"the carotid artery and there on their neck is looking like someone much, much older, it's thick and full of calcium, and so on.",English
+"So the notion would extrapolate here as well, in other words, I think that so much to do a polypill, that's it, I look at that paper,",English
+"this particular polypill, but it's coherent, it makes sense. But I do think in fact that, you know,",English
+"some of these other strategies may have as much if not greater effect size, in terms of the actual exercise,",English
+"but admittedly there's issues around fidelity to all of that. So I think what you're doing is that, that work in that you're citing is only instantiating",English
+"the relevance of inflammatory and metabolic targets and sure why not? I think in fact, and I'm willing to actually debate",English
+"someone on this, I do think the time is now, the time is now, that we have to do some of these prevention studies in bipolar disorders,",English
+so mark of how few we do there was the omega three studies that came out of Europe and schizophrenia started off with a lot of excitement,English
+"and that kind of a beta to some extent with failure to replicate. But I think in some of the high risk groups, I don't see why we can't, now in 2019,",English
+"really put together a serious anti-inflammatory, pro-metabolic prevention study. That was the concept behind the study I'm doing in China.",English
+"- [Audience Member] It'd be a perfect population for the study, because you need a massive study and you've got access to that population. - True.",English
+"And you can, you have a drug now that is proven to be effective and is extremely, is readily available and extremely cheap.",English
+"- Quite well taken. - [Audience Member] I've bugged Dost about this and he's given me bland answers,",English
+"on the wards with people with chronic psychosis, you don't see too many people flossing, not in the state hospital, flossing, right?",English
+"And they are, everyone has high CRP levels and really poor oral hygiene, and I'm just wondering, is that a confound here?",English
+"What's the role of that? - You know, what's interesting is that there is literature on oral health in people with SMI, serious mental illness,",English
+"and it won't surprise you how it reads out. It's not good. I don't know, I've never actually seen anything like that, but you can think of it in a couple of different ways.",English
+"I mean, poor oral health in of itself could be a portal of entry, vis-a-vis exposing the systemic circulation",English
+"to pathogens that it would not normally be exposed to. And that can be pro-inflammatory. People, for example, have looked at",English
+"seropositivity in bipolar disorder to gram negatives, which are not normal to be exposed to. And they're elevated in people with bipolar disorder.",English
+"It's part of a larger literature that's looked at immune responses to bugs and people who've got bipolar disorder, there's work out of Paris that Marion Leboyer",English
+"has showing that the rates of seropositivity to toxo is almost twice what it is in the French population, which is already high to begin with,",English
+"I guess they love their cats. But anyhow, I don't know that literature, but I would say it's an intuitive, it would make sense.",English
+"thank you for a great presentation. It was really at least up my alley. So the big question, I think you made, you know, you presenting at least compelling evidence",English
+"of a bi-directional relationship between obesity and bipolar disorder. When we look at statistics, at least in the United States of the diagnosis of bipolar disorder among adults,",English
+"and about the last 20 years, there's a doubling of diagnosis of bipolar disorder and among children, as you know, the big statistic,",English
+"40-fold increase. And a lot of people are nay-saying those statistics, nobody's really talking about it, because everybody still thinks of bipolar disorder",English
+"And in fact, it's not fictional. It's not an artifact of physicians are over-diagnosing it, we're looking at little rowdy kids and calling them bipolar",English
+hereditary kidney cancers. But we didn't know if -- of course -- if the gene that caused the hereditary type of kidney cancer would be the same gene that causes sporadic. That's,English
+"not always the case. If you look at BRCA-1, BRCA-2, the hereditary breast cancer gene, that's not necessarily the gene that causes breast cancer in a lady with breast cancer,",English
+"who doesn't run in the family. So, you know, you just don't know. But we figured, well, we'll move and see what happens. At least it's good science if nothing else happens.",English
+"So -- but this was a remarkable type of kidney cancer. So these people get up to 600 tumors per kidney. So managing these people surgically [laughs], you got to rethink things. We're",English
+"not curing these people with surgery, obviously, because if they have 600 tumors, the only way to cure them is take out their kidney, take out both kidneys, put them on dialysis.",English
+"And that is what I did with the first patient I had. Patient came with bilateral multi-focal kidney cancer. The conventional way to manage that was to do an nephrectomy. This was in the early '80s. I saw a patient from up north,",English
+"a bilateral multi-focal clear cell kidney cancer VHL, talked to all sorts of people -- people in my field -- read everything, talked to everybody at NIH. The way you handled cancer is you take those kidneys out. You can't leave cancer in there. I did that. And",English
+"I'll never forget it. I'll never forget when that guy left NIH, I took him downstairs personally to the front door and put him in a taxicab. And I sent that guy home to be on dialysis.",English
+"And I said, ""I'm never doing that again as long as I live."" So we developed an approach -- the management of these people -- that involves partial nephrectomies. Now, people used to think clear cell kidney cancer and VHL wasn't real kidney cancer.",English
+"You can look at my journal -- our journals in the early '80s, and you see journals with titles like ""Clear Cell VHL Kidney Cancer's Not Real Kidney Cancer."" My field didn't understand the term ""lead time bias."" They didn't understand that if you detect a cancer early, it's not",English
+"necessarily going to be the spreadable moment. You have to give it time before it's going to spread, like prostate cancer. A patient to came to us with a large tumor, about an eight-centimeter tumor, and she already",English
+"had a pulmonary metastasis. We've managed many of these patients over the years. We have the world's largest experience with this, and we have about 900 patients now from about",English
+"400 families. And we've developed an approach, which I lost a lot of sleep over for many years -- and that is not taking out their kidneys, doing partial nephrectomies. Today,",English
+"it's rather obvious. But when we started this in the middle 1980s, I woke up many, many mornings, many mornings at 3:00 a.m., knowing that was the day. So what we would do is we'd",English
+"do partial nephrectomies for tumors smaller than three centimeter. When we operate, we operate. I mean, we've taken out as many as 74 tumors from a single kidney. And I saw",English
+a lady last week where we recently did the ninth operation on her kidney. That's going all the way back to '82 -- '83.,English
+"Anyway, so we do active surveillance. We watch these people. At the time, people in my field -- tomatoes, rocks -- I can't remember what else they threw at me. That's not the way",English
+"you handle cancer. And I said, ""God, I'm here by myself."" At NIH, we now had more people, but I'm going, ""Gee, it's going to be over,"" you know. I'd wake up at 3:00 in the morning. I'd come and see patients that day in clinic, and I would say -- I'd have nightmares that",English
+"that would be the day I'd see -- I can still remember where I was in bed when I'd wake up, and I remembered saying, you know, ""That's going to be the day I'm going to see people with pulmonary metastasis."" And people are going to say, ""You idiot.""",English
+"As of September 6, 2013, we have not had one, not one single patient develop metastasis when managed in this fashion. Now have we had patients with advanced disease, patients",English
+"with VHL develop metastatic disease? Yeah, we sure have. We had a bunch. But when the tumors are between three and four centimeters, our metastasis rate is low. It's about 4 percent.",English
+"Between four and five centimeters, they get to be that size, it's about 20 percent. Between -- now, when you start hitting five centimeters and above, it's about 50 percent. So I'll",English
+"come back to what that might mean in a minute. But anyway, so that's how we manage these people. It's called NINCI three-centimeter rule. People refer to it as that.",English
+"And we apply this same approach to managing VHL, managing the next disease -- next type of hereditary kidney cancer, I'd say [spelled phonetically] hereditary papillary kidney",English
+"cancer. And the next one, one called Birt-Hogg-Dube, but we do not use this approach for the final two I'll show you, which are different types of kidney cancer.",English
+"Now, most of our surgeries now, we do robotic. I wanted to show you this one just to give you a little idea. So here we're doing a robotic partial nephrectomy. This is a kidney cancer",English
+"here, a patient with VHL. See the tumor here? So we're coming around, and you're saying, ""Wait a minute. I can see that that's tumor."" That's normal kidney. ""You're not getting much of a margin there, son, are you?"" No, we're not. We do what we call a nucleation",English
+"on these. Now, in the old days -- the old days being the '80s -- I used to do wider margins on these. But after a while I realized, ""My God, I do wide margin, I got no kidney left."" Now",English
+"-- so we now understand a lot about the biochemistry, and I'll show you a little bit of that in different things of these. But this approach, we've not had a problem with in a single patient.",English
+"So we go -- we enucleate these tumors. And, as I mentioned, we've taken out up to 75, I think, in a single patient. Anything like that, we'd do open. Although robotically,",English
+"we're getting so good -- our team's getting so good now -- one of the fellows did one, I think, two and a half weeks ago, we took out 35 tumors robotically. So as our skill set increases, we're getting better and better and better at this. And, of course, it's much",English
+"better for the patients if you can go robotically than if you do a big open operation, which, of course, is what I did forever. So we're right -- as you know, we're right across the street. And this is, of course,",English
+"the hospital. So we want to find this gene. So we brought patients in from mostly U.S., but really around the world. We'll bring anybody. And we looked at -- we saw families. So we",English
+"would -- how do you do this? So we would bring them in, screen them. We have a multidisciplinary team that screens these people. These people get -- also get cerebellar and spinal hemangioblastomas, CNS",English
+tumors. We work with our neurosurgeons -- sensational. Our retinal -- they get retinal tumors. They get retinal angiomas. They get pancreatic endocrine tumors. They get pheochromocytomas,English
+"-- of course, kidney cancers, Epididymal cystadenomas. And they get a tumor in the meso salpanks [spelled phonetically] of the ovary, it's a benign tumor. We work -- we manage them",English
+"with Dr. Pam Stratton, whose actually here. So we brought these people in, and we determined who was affected and who wasn't in these families. So that, then, gave us the power of genetics to trace these genes through these families.",English
+"Now this took us 10 years to do. We evaluated DNA from 4,317 patients. And we localized this gene, this gene was localized here, to the -- this is chromosome 3. This is what",English
+"you call the long arm. This is the short arm, excuse me. This is the long arm. And this is where we localized it to. Then we mapped and mapped and mapped. And that's what this shows, our physical mapping. And we identified some candidate cDNAs, some candidate pieces",English
+"of DNA. And then we evaluated them. And this one here was the seventh cDNA, piece of DNA, that we looked at and sequenced. And we're looking for a change in that sequence -- whatever this is -- that segregates with",English
+"the disease, and that, of course, is what we found. This was -- this -- we called -- there was the human VHL gene. This was the sixth human",English
+"cancer gene when we found this. And we're looking for changes in that gene, mutations. I don't actually use the word ""mutation."" What do you mean you don't use the word mutation?",English
+"Well, I had a lady who said to me once, she said, ""Look, don't call this a mutation."" She said, ""This is me. This is my family. We have VHL. My mom had this. My aunt Susie",English
+"had it. My cousin Fred. My daughter Sarah, and my other daughter Emily, has this. Don't call us a mutation."" I said, ""Right. We're not."" So I say ""alteration.""",English
+"So we look for alteration of these genes that segregate with the disease, and that's what we found. We detected these alterations in 365, actually, and now we're up to 400 families.",English
+"So we're basically 100 percent. Now we wanted to know was this the gene we looked for for so long, for 10 years? Was this the gene for the non-inherited form of sporadic kidney cancer? So we took tumors",English
+"from patients with non-inherited, non-hereditary kidney cancer, and we look for alteration of this gene, and that's what we find. We find alteration of the VHL gene in 95 percent",English
+"of tumors from patients with clear cell kidney cancer, of the VHL gene pathway. The VHL gene itself about 91 percent.",English
+"So this is the clear cell kidney cancer gene. We find these alterations in clear cell kidney cancer, but not in the other types of kidney cancer. So the first evidence that there is",English
+"a genetic -- there's genetic differences between these different types of kidney cancer. So what kind of cancer gene was this? When we found it, it was a completely novel gene.",English
+"We had no idea. Was it an oncogene, which is, you all know, would be a one-hit gene that drives cancer. Or is this a loss-of-function tumor suppressor gene? So we each have two",English
+"copies of each gene: one from our mother, one from our father. These patients inherit an alteration of one copy. And what we showed was, in the other copy, they lose that. They",English
+"delete that. So this is what you call a classic two-hit tumor suppressor gene. This concept of a tumor suppressor gene was developed by the great Al Knutson, who's been",English
+"our mentor and advisor almost 30 years. Al is now 90, and we went up and did a big symposium for him. But this is a two-hit loss-of-function tumor suppressor gene.",English
+Now the other type cancer gene you might think about -- and everyone would associate that with Al Knutson -- the other type of gene I'll show you next is a dominant gene. It's called an oncogene. That's where -- this is a loss-of-function. An oncogene is a gain-of-function.,English
+"So you have one mutation there. This is a two-hit gene. This is a one-hit gene, the next one. I'll show you that in a second. So, well, that looks good, Marston. That's great. Yep. You got that. Runs in people's",English
+"families. You lose the second copy of that gene. It gets deleted. But what other -- I mean, you say, ""That sounds good,"" but what evidence do you have this is a loss-of-function",English
+"gene? Okay, so if we take a cell line from a patient with kidney cancer that has a VHL gene alteration, we put that in the lab gorton [spelled phonetically] culture, then we put it in a mouse -- an immunocompromised",English
+"[spelled phonetically] mouse -- it goes up and makes a tumor. So that's what that looks like. And if you leave it there, it'll -- which we don't, of course -- if you leave it there, it'll do just what it does in our patients. It'll spread and kill that mouse.",English
+"Now, if you make one single change, though, in those cells, only one, you take the cells and you put in those cells that one gene, just one. And then you grow the cells, put",English
+"them back in a mouse, you get little or no tumor. So that is a loss-of-function tumor suppressor gene. So we said, ""Okay, we're on the right path with this gene.""",English
+"Now, when we found this gene -- 1990 -- gosh, it's been 20 years now. We found this gene in 1993. We had no idea what this was. It was a completely novel gene. People would",English
+"say to me, ""Marston, gee, you guys are really the world's experts now in chromosome 3. When the Human Genome Project came, you and your colleagues kind of became the go-to people",English
+"for that chromosome. You going to work on lung cancer now or something?"" No, what are you talking about? No way. We're going to work on kidney cancer. I said, ""We're going to work on this gene."" They said, ""Well, you're not a biochemist."" I said, ""Well, we'll learn",English
+"it."" And so over the years, what we have learned is the following. We had no idea how this gene worked. So what we know now is that the VHL gene makes this protein, VHL protein.",English
+And this protein has two domains. One domain binds these partners here. We call this the VHL complex. And this is what you call an E3 ubiquitin ligase. This is a very conserved,English
+"mechanism throughout biology. You can -- we learned about this because we just, of course, discovered this, and then we identified that this protein that I just showed you, this",English
+"clear cell kidney cancer gene, binds these two proteins here -- we published that in Science -- but it didn't help us. We still couldn't figure out how this thing was working until we found this gene here cullin 2.",English
+"So once we found that, then we had others -- we're then able to put that together, going back and actually studying yeast, if you can believe that, that this complex is what you",English
+"call an E3 ubiquitin ligase. This is a normal gene, of course, becomes a cancer gene when it becomes altered. And that this complex targets this family of proteins called hypoxia",English
+"inducible factor, or HIF, for degradation, for ubiquitin mediated degradation. It puts a ubiquitin grouping on here, and that then degrades. It's just like it takes these proteins",English
+"to the trash can, basically. It's a normal process in itself, okay? Except this is -- I got to learn about this because this is critical to our cancer.",English
+"Now the way this works is it's an oxygen sensor. What's that mean? So when there is a normal amount of oxygen in the cell, oxygen in the cell, this complex targets HIF and degrades",English
+"it. Now, on the other hand, when the cell is short of breath, hypoxia, it doesn't have enough oxygen, this complex cannot target HIF and degrade it, and it accumulates. How's this",English
+"work? What's that? Well, HIF is a transcription factor. So it transcribes things. It turns things on, you might argue. So what it turns on is things like vascular endothelial growth",English
+"factor. That makes more blood vessels. It turns on erythropoietin that makes more red blood cells. It increases something called platelet-derived growth factor, which we'll",English
+"come back to in a second, PDGF, which tells the cell next door to, you know, grow, and help us grow.",English
+"So, basically, you could argue that if you had a 4-year-old child and you took out his right kidney, his left kidney hypertrophies. How does that happen? Well, you could argue",English
+"a very good mechanism for that, is the cell becomes hypoxic -- says, ""We got to grow. We need more blood supply. We need more blood vessels."" And then when it gets a bunch of blood to bring oxygens come, and this, that, and the other, then it reaches equilibrium",English
+"in oxygen and becomes normoxic, as we say, and then it kicks back into degrade HIF. That's a pretty -- it's just a pretty simple system once you understand it.",English
+"However, in our people with kidney cancer, what happens is they get a change in the gene, here in the alpha domain, which binds this complex, or the beta domain, which is target",English
+"specificity, which targets HIF and degrades it. So what happens is, in our patients with kidney cancer, you get this mutation clear cell. You get this mutation. And even in normal",English
+"oxygen, basically the cell thinks it's short of breath. That's essentially it. Thinks it's short of breath. ""I need to grow. I need more oxygen."" So as a urologic surgeon, my God, I can understand this. My tumors are very vascular. This is",English
+"saying, ""We got to grow. Got to make more vascularity."" My tumors are very vascular. My tumors make a lot of erythropoietin, believe it or not. My tumors stimulate the cells next door. So this, I can understand. So that simple principle, then, is the basis for therapy.",English
+"So you could target this pathway. This is VHL. This is HIF. These are the downstream things I mentioned. This is VEGF, platelet drive growth factor. This is another one called",English
+"transforming growth factor alpha. Whatever. Anyway, so this is -- so you could target with an antibody to target VEGF. That makes sense. Or people develop what are called tyrosine kinase inhibitors, TKIs, a tyrosine kinase",English
+"inhibitor. I'll show you in a minute where the tyrosine kinase domain -- what that means. It's not so mysterious, but it's called a TKI. So these are drugs that target these pathways. So you could say, ""Well, we understand the pathway. Let's target this pathway in",English
+"kidney cancer."" So we're going to fast-forward another 10 years to today. Well, anyway, another 10 year -- well, to today, anyway. So as of today, the FDA has approved seven targeted drugs",English
+"against our first cancer gene pathway. Bevacizumab, an antibody -- Avastin, people call it. Temsirolimus, Everolimus. Sunitinib, Sorafenib. Pazopanib, Axitinib. Now you could argue -- well, Sunitinib",English
+"is right now considered the best first-line drug. You get about a 25 percent partial response with that, and about a 20-month disease-free progression. The most recent drug goes -- you",English
+"read New England Journal, article came out just recently, within the past month, comparing this drug called Pazopanib, and this drug, Sunitinib. And this drug looks equal to this.",English
+"In medical oncology lingo, you'd say it's non-inferior, but it seems to have less toxicity, so this will probably move into first line.",English
+"So what do I think about this? Well, it makes my knees weak. I mean, it's -- wouldn't say humbling. It's unbelievable that targeting this pathway, we're seeing tumors get smaller",English
+"in people, and we're extending people's life expectancy. And what you can do, then, is you can sequence these drugs. You can start with this, and go to one of these other ones or two of these other ones, and maybe go back to them. So we're working the field -- I say",English
+"""we"" -- the field is working to make this chronic disease. Why aren't we doing better? So that's clear-cell kidney cancer. Why aren't we doing better,",English
+"though? We understand this gene. Why can't we cure this disease? Well, isn't it true that most of these people eventually fail and die of this disease -- die of this -- yes,",English
+"it is. Okay. So we just are -- so the Human Genome Project, the -- well, the NHGRI, National Human Genome Institute, and the National Cancer Institute collaborate on a project that's",English
+"called the Cancer Genome Atlas, and we just published in Nature a few months ago The Cancer Genome Atlas of kidney cancer. Five hundred tumors. I had the good fortune to work with",English
+"the 300 smartest people I've ever met in my entire life, and did whole genome -- you know, sequencing whole exome, whole genome, all sorts of stuff, and looking at RNA and all",English
+"sorts of things, and looking at a whole bunch of kidney -- 500 kidney cancers. So the VHL gene has mutated, you know, here in about 70 percent. In many other studies",English
+"we've done, other people have done, it's really higher than actually that, showed about 90 percent -- 95 percent, if you look at the VHL pathway. So this is the VHL gene, but these other genes called PBRM1, SETD2, BAP1, they're also mutated, and this gene here,",English
+"BAP1, appears to be critical in progression. So this gives us new targets. In other words, why aren't we doing better?",English
+"Now, another thing, just to -- for those of you who want to philosophize about cancer, this was -- this is a paper in New England Journal. I'm sure many of you saw it. It's",English
+"like in May of '12, and it was by an incredibly gifted group in England at the Wellcome Trust. Andy Fatrayal [spelled phonetically] is basically head of this group, and we know these guys",English
+"really well. And so they looked at a big kidney cancer. Now, how long does it take for a kidney cancer to grow, to develop? Well, if you'd asked me this about 10 years ago, I would've",English
+"said, okay, so let's say you have a VHL -- a clear cell kidney cancer. VHL and non-hereditary are the same. You had a clear cell kidney cancer that's two centimeters in size. How",English
+"long do you think it'd take to get there -- to get two centimeters? Well, I would have said, ""I'm pretty experienced in this area. I'd say three to five years."" Not even close.",English
+"We've done 28,000 tumor measurements. We look at all these growth rates, we follow all these patients: 25.2 years to go from zero to two. Now, so if you look at this tumor that was",English
+"nine centimeters, how long has that boy been there? About 30 years, okay? So it causes us to rethink everything we think, at least about my cancers. They're very -- it's like",English
+"prostate cancer. It's just very slow-growing. But these people looked at multiple parts of this nine-centimeter tumor, and they looked at a couple metastases, and they sequenced all the genes. And what they found was not",English
+"surprising to me, but it was to a lot of people. What they found was big time heterogeneity. In other words, the gene mutated here were different than the ones here and here and",English
+"here and here and here and here and here. The genes mutated here were pretty similar to here, to the metastases, consistent with they came from one place. Makes sense. And",English
+"if you compared the genomic pattern of mutations here and here, they were identical to here, supporting that this went there.",English
+"My God. So how do you -- [laughs] -- how do you think about therapy, then, if you're going to target cancer genes? My God. Should we be sampling a whole bunch of -- this is called",English
+"-- people call this now ""precision medicine,"" where you target a specific gene. And the -- one of the leaders at our place said, ""Well, Marston, you've been doing precision medicine for 30 years."" I said, ""Well, maybe."" But, anyway, so this is now a big thrust of combining",English
+"genomics, Human Genome Project, genetics, with therapeutics in cancer, and something we're making a huge push on. But conceptually, how would you -- how do you think about this? Should we take a tumor",English
+"and do a whole bunch of sequencing on a bunch of parts, or should we take a metastasis and do a bunch of sequencing, and find, maybe ,driver -- you might call those driver genes.",English
+"It's an -- it's a question no one knows the answer to. I'll tell you what I think. But, so, these people when they publish this -- I -- the guy who did this worked -- it's a friend of mine, and I -- he spoke at one of my -- our meeting I sort of help run. And I said to",English
+"what I think."" But in that -- did you read that? If you read carefully that paper in New England Journal, what they said was they think what makes the most sense is targeting what's called the truncal gene, in other words, the VHL gene, which is what we have always",English
+"thought as well. So, you know, so we will see. I guess what I'm trying to say is there are complexities in this, and, you know, we have miles to go before we sleep.",English
+"Okay, so that's the VHL gene. Now the next genes I'm going to show you -- and that really came from our study of patients with non-inherited kidney cancers. I'm going to show you some",English
+"other types of kidney cancer now, and I'm also going to show you one fundamental theme that runs through all cancers, which, to us, is really, we feel, the key to effective therapy.",English
+"And I'm going to tell you what I'm going to tell you, and that is, I'm going to tell you that all these cancers are fundamentally metabolic. They're fundamentally metabolic. So, everything -- as I mentioned, we study patients. Everything we've learned, we've",English
+"learned from patients. So this was a little girl -- young woman I saw in April of '87. She came from Ohio with her mom, her worried mom, and I took out that left kidney. Big",English
+"tumor, T3A, 11 centimeters. I got it all out, I thought, but she went on to die in January of 1988, that little girl, that young woman. Cheerleader. And I took the pathology to Maria",English
+"Marino, our wonderful pathologist, and I said, ""Maria, what kind of kidney cancer is that?"" She said, ""Marston, it's papillary."" Yeah, okay. It's not clear, so, no, it's papillary.",English
+"All right. Another little -- another young woman I saw -- this one was 18, came up from Charlottesville in the spring of '89. I took out that left kidney -- came up with her mom, too. I took",English
+"out that left kidney. She still went on to die in February of 1990. Her mom died 14 months after that of metastatic kidney cancer, and it took me -- took us 18 years to figure out",English
+"Third patient, patient we saw in April -- March of '92. It's a family, another family. This guy comes up -- this guy's 71. He's got multiple tumors in his kidney. Okay. This is his sister,",English
+"It's a different gene, big time different clinical course, very different approaches to therapy.",English
+"All right, I'll start with the third one first. So, another form of inherited kidney cancer. It's -- this hadn't been described before. We called it hereditary papillary renal carcinoma.",English
+"Each of these individuals in this family have papillary kidney cancer. This is what you see, bilateral multifocal. This is the first patient I saw who -- that was the son, the",English
+"42-year-old. All right. Remember I told you about the 21-year-old? I told you about the 18-year-old. My God, I was worried about this spreading and killing this patient. So I took",English
+"out this patient's left kidney right there. That's the last time we've done that, certainly for small tumors in this, and I'll show you why.",English
+"So this is multiple tumors. This is Type 1 papillary kidney cancer. These people get up to 1,100 tumors per kidney. We manage these the same way we manage VHL. For this type",English
+"of papillary kidney cancer, we know the gene for it. We watch them. We do this all the time. We watch them, we do active surveillance, I guess you might say, until the largest tumor",English
+"reaches three centimeters. Then we recommend surgical intervention. When we operate, we operate. We clean that kidney out. But until that time, we do active surveillance. Now,",English
+"the first patient I saw in this was '92, so it's been 21 years. Have we had people develop metastatic disease? Yes we have. But people with larger tumors, we've never yet had one",English
+"of these develop metastatic disease when managed in this fashion, i.e. active surveillance until the largest tumor is three. So we brought people in, again, across the street -- NIH. We did genetic linkage analysis,",English
+"localized this gene to chromosome 7. This area here, we mapped here -- it's a really tough area to map -- and identified the hereditary papillary renal carcinoma gene as this, what",English
+"but this is a proto-oncogene, okay? We talked about tumor suppressor genes, oncogene. All right. Well, this -- these are the real mutations we see in our families. We've detected -- this",English
+"is a rare disease. We've seen 22 families -- detected mutations in all of them. Now, this is -- we see this in sometimes early onset -- 38-year-old, 27-year-old, and we've",English
+"got a 19-year-old in here. So this, targeting a loss-of-function gene in cancer therapy is kind of a -- kind of tough. I mean, it's -- targeting a gain of function you could",English
+"argue should just be tinker toys. I mean, this should just be screening. I mean, you know? This is just chemistry. I mean, you ought to be able to do this. So I'm not saying that it's true, but conceptually, it should be.",English
+"the trans-membrane domain. And this area here -- this, you might argue, is the engine room. This is where phosphorylation, which is how you affect other proteins, kind of happens.",English
+"I've shown you this gene causes this cancer, and so we want to inhibit this tyrosine kinase domain. So we'd like to use a tyrosine kinase inhibitor.",English
+"So we did first trial with this drug called Foretinib, which was a dual kinase inhibitor, a VEGFR, and Met. It had some toxicity we didn't like -- the VEGFR side -- and if you",English
+"all are medical oncologists, of course you know this stuff for breakfast and far better than I do, but you get things like hypertension, malaise, cutaneous, diarrhea, you know, a number of things can happen with these. A lot of that is due to the VEGF pathway inhibition.",English
+"The Met pathway inhibition, we think, is a whole lot less toxic. We'll see. So, anyway, so where are we with this? So we know the gene, we have a drug that targets",English
+"of 1992. Then in May of 1992, we did a right partial nephrectomy and took out 12 tumors from that remaining solitary right kidney. Guy's doing fine, goes back and forth to work,",English
+"little league baseball games, this, that, and the other. We're not carrying him with this partial nephrectomy. He's got this many tumors. So developed -- continues to develop tumors, there was a cord [spelled phonetically]. And in 2000, we took out an additional 59",English
+"tumors from that remaining right kidney. Okay, guy's doing fine. His renal function's a little off, his creatinine's about 14, EGFR's about 55, but he's doing fine. You know, you sit",English
+"next to him on a bus, the guy looks great. You don't -- he's looking fine. However, continues to develop tumor, and tumor now -- largest tumor now was 3.4 centimeters. Well, we don't",English
+"and this one almost undetectable. We've had dramatic response in the lungs. People in medical oncology right now, people in my field will tell you there is no drug that works",English
+"in papillary kidney cancer. This is papillary kidney cancer. Now, this is what you call a waterfall plot. So this shows the decrease of these tumors.",English
+"Now a lot of [unintelligible] experimental thing, works first time, and all that sort of stuff. A lot of these people I had -- we had heavily operated on. They're heavily pretreated with surgery. Many had marginal renal function, and many had to come off drug for all sorts",English
+"of nickel dime reasons. But every single tumor, every single tumor, got smaller during therapy. So this proof of principle that targeting this cancer gene could have an effect on these",English
+"cancers. So are we home? No, we're not home, but we're encouraged about the progress of the work. Our next trials are going to involve specific TKIs, tyrosine kinase inhibitors, that just",English
+"hit Met. And then we have a number of other things that in a lab look sensational against this pathway targeting Met, and we're going to be sequencing those trials and we will hope. But I'm hopeful. I'm optimistic.",English
+"Now how about this little girl? This is the first one I showed you, this 21-year-old cheerleader from Ohio who had papillary kidney cancer. So we took that out, I put that -- we put",English
+"that in culture, and we grew it in a lab. And we showed a funny chromosomal pattern. We showed that part of the first chromosome translocated to the X chromosome. I've got",English
+to move. And this translocation involved a genome chromosome one and the X chromosome gene called TFE3. So this is like many leukemias. This is a fusion cancer. So -- and it's very,English
+"aggressive. We saw a 23-year-old the other day, law student, with this very small tumor, already had local nodes. This you don't do active surveillance on. These spread early. This is called TFE3",English
+"kidney cancer. It now makes up about 1.5 percent of all tumors, but 20 to 45 percent of tumors in young people. We now know this is a family. Subsequently, TFEB has been discovered, which",English
+"is another type of very similar kidney cancer, often in kids, and another one is MITF -- another member of this family, and that gene is mutated, and this can run in families.",English
+"So I'm going to scroll through this and talk about this one. This is called Birt-Hogg-Dube. This is a hereditary cancer syndrome where people get skin bumps. They get fibrofolliculoma,",English
+"benign hair follicle tumors. Runs in families. We showed these people also get kidney cancers. They get different types of kidney cancer. They can get clear cell, they can get something",English
+"called hybrid oncocitic, they can get chromophobe kidney cancer. They get up to 3,000 tumors per kidney. We manage these the same way: three centimeters, active surveillance.",English
+"So we brought these families in, searched for this gene, used the skin marker, the fibrofolliculomas, the benign skin lesions, as a marker to trace the gene in the family, identified it on chromosome",English
+17 in this region right here. This is the gene. We call it FLCN. This is the BHD gene. We've detected mutation in this now in 97 percent of these families. These people also,English
+"-- this is pretty common. You'll see these, those of you who are urologic surgeons, if you are. So they get multiple cysts in the lungs. Thirty percent of these people get",English
+"pneumothorax. We wanted to know what kind of gene this is. I'm going to screen through this because we're running short of time here, and basically to show you that when this gene is mutated, it activates two important cancer pathways",English
+"called mTORC1 and mTORC2. Okay? How's that help me? All right, because there are drugs that target these pathways. So in this mouse model here, we knocked out this gene in mice,",English
+"the same human kidney cancer gene in the mouse -- in the kidney of a mouse, and what we get there is we get a big kidney, a cyst. They're starting to form little tumors, but they die",English
+"of kidney failure in 30 days before they get kidney cancer, they get full-blown kidney cancer. So I said, ""All right. How about if we treat these guys?"" So these guys died about",English
+"30 days of kidney failure. So I treated these guys with this drug -- actually, Rapamycin, which targets that pathway I showed you, and we saw a dramatic effect. We doubled their",English
+"life expectancy. So that's targeting this part of the pathway, and we're now gearing up to do clinical trials in humans hitting both this part and this part.",English
+"Now, in closing, I'll show you this last patient. This was this little 18-year-old, came up from Charlottesville with her mom. You know, we -- you never -- I know you are the same.",English
+"You never forget a patient. You know, this is -- it took us 18 years to figure out what this was in her. In '95, we described another type of hereditary kidney cancer that was",English
+"redescribed and renamed in '99, and now goes by the term hereditary leiomyomatosis renal cell cancer. This people get cutaneous leiomyomas. They get skin bumps. They're little muscle",English
+"tumors, and they get uterine leiomyomas -- some people call these fibroids -- and they get kidney cancer. Runs in families, autosomal dominant, and these are traces in these families.",English
+"These are these, quote, ""skin bumps,"" and they can be very sort of -- these are benign, although many pathologists get them confused from leiomyosarcoma because the pathology's",English
+"a little fussy. But -- and what these are, are the following. These are little muscle tumors, and so if this is a hair follicle, there's a muscle underneath it called a rector p-light [spelled",English
+"phonetically]. So when you go out on a cold morning, and it's cold and you get goosebumps, it's that muscle. That muscle is an energy sensor. It senses that you're short of energy,",English
+"as it were -- energy in the cell called ATP, and it contracts. All right? That's the same muscle a porcupine uses to fire his quills.",English
+"Now, these can be, in these patients, really bad. They can be very painful. We've lost one. Or we had one -- actually, it was a family member of one of ours, committed suicide,",English
+"and we've had another one who's -- we're concerned about. Anyway, they can be -- they can be very symptomatic. Sometimes they're not symptomatic at all. Sometimes you don't have these. But",English
+"-- and it's particularly -- I've got one now. It's a college student in Boston, and got the disease here. Whenever it's cold, he won't go to class. He also gets embarrassed. I mean,",English
+"it's -- we're working on it. But anyway, so that's the skin manifestation, and this is a remarkable one. This is -- they get cutaneous leiomyomas, and it's early onset. And we manage",English
+"these patients with Dr. Pam Stratton, our sensational colleague who's really the world's expert on this -- managing these patients. So when we saw our first patients, and we reported them -- so we look at this. Ninety",English
+"percent of the women have fibroids. This is, by the way, not that uncommon a disorder. I think you will see this at Suburban Hospital. I know for sure many hospitals -- I can think",English
+"of many hospitals [unintelligible]. So you'll see these patients. Now, it's early fibroids. In our initial report, 90 percent of the women get these early onset fibroids and are initially",English
+"is a catastrophic -- can be a catastrophic phenotype for women. Fifty percent of our women in our first report had hysterectomies in their 20s. So we hate this. So now, we",English
+"and others -- I say ""we"" -- NIH and others, Dr. Stratton and her colleagues, are doing myomectomies, and I think now she has, I think, four patients who've had babies after that,",English
+"and we're very proud of that. But this is a very dominant phenotype. Now, we got into it because of this, obviously, the kidney cancer. So this patient here, that 18-year-old I mentioned to you -- I lost her. Her mom died. God, I",English
+tried for years to find her. This was in Charlottesville. We found out 18 years later that what happened was her siblings moved in with the father who had a different last name. The parents,English
+"us with very advanced disease. This is a very catastrophic phenotype if not diagnosed and treated. If you treat it, you're good.",English
+"This is a very -- this is the second patient I saw, a 21-year-old came to me with this tumor here, came up from -- Cuban descent from Miami, and I took this out. I know, aggressive cancer, but I'm good. He died 17 months later of metastatic disease. This guy came to us",English
+"-- 32-year-old whose father had died of metastatic cancer. You can see the skin bumps here. It's really -- we don't understand this yet. [laughs] It's really remarkable. They don't cross the mid-line. They stop right in the mid-line. Boom, look at that. You can see we biopsied",English
+"this guy, and when we screened him -- oh, he's an asymptomatic guy, doing fine, 32. When we screened him, we found they can get cysts in their kidney, and they can get tumors",English
+"inside the cysts, and they can get just plain tumors, as it were, and they can get just plain cysts. We go crazy over managing these people. I mean, we agonize over them. So this guy had cyst, but he had tumor inside it. I'll show you that. Doing fine. Very small",English
+"tumor, half centimeter, one half centimeter. When we took this out, you can see it's a half centimeter, the rest of it was totally cystic. But he already had a big, positive",English
+"node. These spread early. You do not do active surveillance, and you have to screen them every year. Every year, MRI. These can be -- it's an unusual type, of course, of papillary",English
+"kidney cancer with these prominent -- our colleagues in -- if we have any in the audience who are pathologists -- would tell us these are prominent nucleoli, and they would describe",English
+"this as perinucleolar halo. So it's a very sort of characteristic pathologic phenotype. Once you see it, you can make the diagnosis on this. Maria Marino, our wonderful pathologist, she looks at that and she says, ""This is it.""",English
+"She's batting 100 percent. So -- but this can be early onset, too. We've got this in kids, 10-year-old came to us with this. Big tumors. We've seen it first time in a 77-year-old.",English
+"I mean, his first tumor. These people are at risk for multifocal and bilateral. This is Sophie's Choice. What, do you take out the kidney? Horrible cancer. What are you",English
+"going to do? So how are you going to manage them? So this patient here, 24, comes to us with this. So you get this CT. I don't know. I can't call anything in that. That's a cyst. There anything",English
+"in there, I'm not -- I don't. Do an MRI. Well, I don't know. Is that just a cyst? Is that volume averaging? I don't know. Come back -- come back in nine months, we'll get a new",English
+"CT and a new MRI. Got a CT. Nothing, that's nothing. I don't -- just a cyst, right? MRI, boom. We call that a double bump. See that? So we said, ""We're operating.""",English
+"When we operate -- remember I showed you how when we did the VHLs, clear cell kidney, we know the gene, know the pathway, know they grow slow. We just did nucleation here. No way. So here, we go wide, big time. Why don't you just do a nephrectomy, Marston? Well,",English
+"we don't [laughs] -- these people are at risk for multifocal. I don't want to be just whipping out these kidneys. So we do partial, but -- and we've had number of patients come to us, where",English
+"people just did your usual partial, and it was a disaster. And this lady shows you why. So we went way wide. We went all the way up to the hilum of the kidney. We dissected out",English
+"the hilum, did very, very wide operation; did really almost a heminephrectomy on that. So, Maria Marino looked at the path, I thought, she was, she said, I thought she was going",English
+"to throw up. She said, ""Marston, you've got to come over and look at this."" Said, ""You know, your little girl, is it 24-year-old?"" I said, ""Yeah."" I said, ""The one with the cyst, and the tumor in the cyst?"" She said, ""Come over here."" I said, ""All right."" She",English
+"said, ""Look. See this path?"" I said, ""Yeah."" She said, ""Here's your tumor. This is the cyst; here's your tumor."" Said, ""But look at this. This is the normal kidney. It's infiltrated all up into the normal kidney."" I said, ""Don't tell me my margin's not clean."" She said,",English
+"""No, your margin is fine."" She said, ""You did a huge margin."" [laughs] I said, ""Yeah."" She said, ""You have two centimeters clean here."" She said, ""But this thing --"" she said, ""This thing was invading all the way up into the periculum."" I said, ""Maria, I knew that.",English
+"I mean, I sensed that, but we couldn't see it. You can't see it on imaging; nobody can. She said, ""Well, this is a nightmare.""",English
+"Now, she's fine. This is '08, and we're now five years out. She's disease-free, doing fine. But we've had a number of patients who came in after just partials, just regular partials. Nightmare. Positive margins, disease spread. If you spill these cells, it's bad",English
+"news bears. So you got to be real careful how you manage these people. So, well, what are you going to do? Just wait until stuff happens? No. We're going to image these people every year.",English
+"So, here's a lady we saw. Came up from Baltimore. In '03, we saw her. She's germ-line positive for this disease. We told her that imaged every -- we recommended imaging every year.",English
+"Whatever reason, wasn't done. In '06, she had imaging which was called normal. Then, in -- right before Christmas, right before the holidays in '10, I got a call from guys",English
+"at Maryland -- University of Maryland. They said, ""Marston, we've got one of your over here."" She didn't have screening in four years. This is what she had then. We took this out in January, you know, right after the holiday. Ten of 59 nodes positive. We now -- she's",English
+"now in one of our therapeutic trials, actually doing very well with metastatic cancer. When we first saw her, she had no disease. So we do not do active surveillance. And when we do surgery, we go wide. We don't do any",English
+"of these robotic. We go wide. I don't want to do -- I want to go open and go wide on these. They also can be multifocal, so we have to be real careful about them. This gene is on chromosome one. This is what the gene is. It's a Krebs cycle enzyme called fumarate",English
+"hydratase, which takes you from fumarate to malate. I know we've got to -- we've got to stop, so I'm going to -- I'm going to just abbreviate this. To make a long story short, we had mutations in all of these cancers. This is a very aggressive",English
+"And as the weight goes down, other issues such as sleep apnea, which can also be a driver of high blood pressure, tends to get better.",English
+So we are trying to figure out what is the glue that is holding together all these conditions. Try to dissolve the glue so that we can then,English
+"reduce the risk of people ending up with an irreversible cardiac issue. - So I really liked when you said, ""It's like a gang that's attacking, unfortunately,",English
+"""our patients,"" I don't know about you, but I'm no superhero, and I cannot do it myself. (laughs) So it's, to kind of defeat a gang,",English
+"you're gonna need a couple of, smart, well-prepared, specialists to be able to, join forces to defeat the gang.",English
+"So from our end as an endocrine, we kind of care about the metabolic part, which include the diabetes, the prediabetes,",English
+"the obesity, somewhat, the cholesterol and the hypertension. And also we kind of recently in the last couple of years,",English
+"we were so lucky to have multiple medical treatments that not only treat those chronic medical conditions that I treat my patients with,",English
+but also shown efficacy in decreasing the bad outcomes that we're talking about from the cardiovascular system.,English
+"So, that's where most of the, medical societies in United States has been, advising, us to do by the trying to have",English
+"this multidisciplinary approach for this very complicated issue. - And so from my perspective, when I see that gang start to cause problems,",English
+"it falls into two main camps. The first is that gang is horribly, difficult on blood vessels, particularly arteries.",English
+"Arteries are the blood vessels that supply blood that's very needed to all the organs of the body. If you have these risk factors, high blood pressure,",English
+"diabetes, cholesterol, and on top of that, if you smoke, that gang can really damage the inner lining of blood vessels",English
+leading to cholesterol build-up inside the blood vessels. This cholesterol build-up we call plaque. The plaque sometimes can lead to sudden ruptures,English
+"in these plaques, which can lead to heart attacks or, over time, can actually make the blood vessels very stiff and difficult to fill.",English
+"The other thing that the gang can sometimes do is have a direct effect on the heart muscle, and then the heart muscle can itself over time become",English
+"thickened, scarred, and difficult to work. And so in both cases, it can leave the patient with serious complications",English
+"in the first, as blood vessels become more blocked up, it can increase the risk of heart attack, stroke, both of which we sadly have seen",English
+"in many of the patients we care for and are the things we're trying to avoid. And then if the heart muscle becomes stiff and unforgiving, it means that the heart has to fill at a higher pressure,",English
+"which often is felt by the lungs. And then that means that patients come in with heart failure or shortness of breath. Interestingly, going back to what Dr. Malek said,",English
+"if we look at the inflammation in patient's bodies that have this, their inflammation levels are very high. And so how do we turn the inflammation off?",English
+How do we pour water on that fire? And that's where we realize that we're both looking at the same problem,English
+"from different points of view. If we can work together, then we can actually reduce the risk and turn the fire off. And really that's what we're trying to do.",English
+"And turning the fire off to us means controlling the diabetes, getting the blood pressure under better control, trying to get people back to a closer,",English
+"more ideal body weight, getting them exercising, getting them back to the things that really, mean healthy living.",English
+"- That is is all very interesting. If you're just tuning in. We're joined by Dr. George Ruiz cardiologists and endocrinologists, Dr. Mallick Cheikh",English
+"here at MedStar Union Memorial hospital. Today we're gonna talk more about cardio metabolic disease or disorders. So if you're interested,",English
+"if you haven't heard about this disorder before, keep watching, share this with your family and friends. And feel free to ask us questions in the comment section.",English
+"So considering, the prevalence of things like obesity or high blood pressure and hypertension, how common that is, how common is cardio metabolic disease or these disorders?",English
+"- So that's really a very important question. So from my end, I see mostly patients who have type two diabetes.",English
+"So the teaching for years was the minute that you diagnose somebody with having type two diabetes, they are about, or they already have a heart problem",English
+"that needs to be addressed. So it's only natural that we, collaborate to kind of fight this very complicated issue together.",English
+"Now, almost one out of every two people in the United States have some form of cardio metabolic issue,",English
+"whether it's gonna be diabetes or hypertension or obesity or prediabetes or elevated cholesterol level. And all these things, of course,",English
+"they can not gonna be all the same severity, but almost 50% of population here would have, some sort of, this issue.",English
+"So-- - That's astonishing. - This is how urgent this matter is that we need to figure out a treatment for. - And, look, for fear of turning these things",English
+"into testimonials, right? You say it's probably one and two, right? Well, I can tell you of the one in the two doctors, I can speak for myself that this is something",English
+"that I battle with myself. So, I've been overweight, and I've tried to lose weight because I've started to develop what we call truncal obesity",English
+"where you have, extra of fat around the middle of your body. And it was interesting. I had a patient tell me a couple of months ago,",English
+"And actually, I've been on a weight loss plan myself because I feel like it's one of those things that touches all of us,",English
+including the people who are giving you the Facebook live. And this is why this is something that's very personal for us. We really are tryna reduce the risk.,English
+"And so I also, started to check my cholesterol. My cholesterol was a little high, and I had a strong family history,",English
+"and I ended up on a Statin, which is a medication that can reduce the cholesterol. And by reducing the cholesterol, it can also reduce the inflammation.",English
+"In other words, I started to pour water on the fire, and I'm doing this 'cause I have three beautiful daughters that I wanna walk down the aisle someday,",English
+"is this really about me? It could be, and that's why it's really important to have, yourself evaluated and, either by an endocrinologist,",English
+"to not share these things with them. If it's a solution that I chose for myself, I'm definitely going to, help them,",English
+"defeat those chronic medical conditions to prevent, their natural course if we don't enter interfere. And it can happen to everybody.",English
+"It's very common. It is extremely serious, and it needs to be addressed. - Thank you both for being so transparent.",English
+"or have had surgeries due to heart issues, and that was their breaking point. Not taking those preventative steps",English
+"- So from my end, diabetes, cholesterol, they are mostly a genetical disorder. We don't understand the exact mutation",English
+"that can cause these things. However, if it runs in the family, most likely you're high risk of having similar, genetic predisposition and end up having, those,",English
+"chronic medical conditions. So, in my, case, many members of the family, has high cholesterol levels.",English
+"We have to, screen ourselves for these medical conditions, and if we have any of them, whether it is genetically predisposed",English
+"or, environmentally driven, we have to deal with it. - And from my point of view, the cardiovascular stuff, there is no doubt that there are genetic components to this.",English
+"is that doctors are changing the way we think about these diseases. So, for example, and this is important that hanging around Malek",English
+"and folks like him have reshaped the way I think about it. So I have a patient get admitted to our hospital with heart failure, who has coronary disease,",English
+"and then we routinely check hemoglobin A1C which Malek can talk about, which is a test where we look at how your sugar control has been",English
+"their coming in with either a heart attack or heart failure, and for us now that is a medical emergency,",English
+"and I have to say when I first came out of training, it's something that we would note. We'd say, ""Oh look, their sugars are broken.",English
+"""We'll get them to the endocrinologist at some point."" But now I routinely call doctors like Malek, endocrinologists to come",English
+"and see patients when they're in the hospital to say, ""How do we get you on the right regimen ""to manage your diabetes?""",English
+"But since then, we start to learn more and more that there are some medications that not only can get the sugars, to be under control,",English
+"but also to change the cardiovascular complications of this nasty disease. So, we ended up using more of these medications.",English
+"The patients became healthier for the long run, and we are not just fixing the number, we are paying attention to the patient, but unfortunately,",English
+and ended up with having heart issues. But we're so lucky that we have doctor Ruiz that he's not only much better looking than me (laughs),English
+"but much smarter in treating, conditions of the heart. So we built this collaboration in the last couple of years",English
+"all for the good or for the bad. So what are those risk factors, people should look out for cardio metabolic disorders? - So the biggest one would be of course the genetic,",English
+"the history of having a metabolic disease in the family, like diabetes or hypertension and cholesterol problems, cardiovascular disease, of course.",English
+"The other, as Dr. Ruiz just mentioned, unfortunately, we cannot really change our genetic profile. However the environment because it plays a big role,",English
+"lifestyle habits that we can change such as exercise, weight loss, healthy diets, trying to be active,",English
+"switching the amount of salt that we're taking into diet, the amount of sugar, all these things can have a very positive,",English
+"end result in outcomes on these metabolic issues that we see, absolutely. - And from my perspective,",English
+"and or a combination of these, smoking incrementally turns up the volume on the risk. The risk will go through the roof if you smoke.",English
+"And this is where sometimes when I sadly see patients that have lived with these diseases for many years, we routinely see patients in their late twenties, thirties,",English
+"and forties, when people are really at the prime, come in with horrible cardiovascular disease. And it is inflammation,",English
+"this fire throughout their blood vessels where they really have a lot of cholesterol build-up and or their hearts severely affected. And oftentimes, I see people with similar risk profiles,",English
+"a lot of this is, if you have genetic issues that we can't necessarily change directly, but it's important for the viewers to know,",English
+diabetes is something that we can treat. And nowadays actually we have medications and Malek go into it I'm sure. We have medications now that are far,English
+"more effective than we did many years ago. Number two, high blood pressure imminently treatable. It's something that we can absolutely treat.",English
+and we think that the future really belongs to combinations of doctors working together with the goal of reducing the risk.,English
+"- Great, great. - And patients should know that we have lots of medications that we can use, that we can customize which ones we use. Depending on who you are, what conditions you have,",English
+"whether you have heart failure, whether you have cardiovascular disease that's already there, whether you have kidney issues. By the way, that's something we didn't talk about that,",English
+"just like the heart can be affected by this. The kidneys can be affected by this. I mean, we both see plenty of patients that end up on dialysis at a very early age",English
+because they've had some combination of these risk factors. So we can use medications in a very smart way to try to systematically reduce the risk.,English
+"And you should also know that many of these medications have been proven by large clinical trials to help people live longer. I mean, that's a very important piece to this",English
+that we're not just giving folks stuff just to give them stuff. - Right. - These medications had been proven in large scale trials,English
+"and approved by the FDA specifically to reduce these risks or risk profiles. - For an example, to what Dr. Ruiz was saying,",English
+"is that in 2008, the FDA mandated that any medication for treatment of diabetes needs to go through cardiovascular clearance to make sure",English
+"that it's not harmful for the heart. And since then, we collected plenty of data, starting from 2015",English
+"that we have a couple of options currently in the market. Not only, they are not harmful for, the heart, but they also help to decrease their cardiovascular events",English
+"that, a patient with diabetes may have. And that's only just an example to show, how much more tools we acquired over the years",English
+"- Yes. - Are there any on the flip side, any medications that we need to take note of that could make these conditions worse?",English
+"- So from my end, there are some medications. However, typically they are not used unless you have a serious problem,",English
+"and those medication may make the cardio metabolic health a little bit worse for patients. However, these medications would go under the category of",English
+"cancer medications that the patient definitely needs. Some other medications very commonly used are glucocorticoids, which are with the prednisone",English
+"that you take if you have asthma, or emphysema or COPD, or if you have an allergic reaction that you may be given by your physician,",English
+"a few weeks course or days course, to help with this, asthma attack that you have. These medication may make your sugars go up,",English
+"may make you gain some weight, may make you retain some salt, and make your blood pressure go up. They are typically needed.",English
+The details of the medication that you're given to make sure that that applies to you. If that was a thing that you're worried about.,English
+"- From my perspective, it's important for that, I think the viewers to understand that managing these risk factors,",English
+is something that's very dynamic. It's not we start you on a medication and see you back in a year and wish you luck.,English
+"Reducing the risk is a very active process, and it requires a cardiologist for some of these, an endocrinologist for many of these in a very invested way.",English
+"When they start you on a regimen for any one of these, be it high blood pressure or diabetes, many of these therapies can be escalated.",English
+They can ramp up either the dose or the combination of medications to reduce the risk. And we're finding now more and more,English
+"that many of these medications, when used in combination, can have tremendous benefit for the patient in terms of helping them live longer.",English
+that have traditionally been used for patients with diabetes are now being considered as primary therapies for patients with heart failure.,English
+"And this, I think, really speaks to the fact that, what Malek takes care of and what I take care of are really one process.",English
+"You are one patient with lots of different risk factors, but the body senses it as one process. And even though we traditionally have had very different,",English
+And the heart has a direct impact on these metabolic processes. They work together. And so it's important for the viewers to know,English
+"that we can craft a regimen that is specific to you, what disease you have, the stage you are in that disease. And it can involve medications.",English
+"It can involve lifestyle modifications such as exercise after we've deemed that the heart is okay to do exercise, it can involve smoking cessation,",English
+"So, you may belong to a part of the spectrum. You are gonna need to have a tailored, customizable medical plan that, your one",English
+"or a couple of doctors are gonna need to work on to, figure it out. Because this disease can show itself",English
+or present in multiple different ways. That's why we're trying to collaborate to kind of figure out what is the best treatment,English
+"that would apply to you that maybe differ from what the second patient that we're gonna see is gonna have, that they're gonna require some other medical treatments.",English
+"So this is where a multidisciplinary approach for this medical issue has become very important. And that's why the medical societies, of the endocrine",English
+"and the cardiology has been, advising, most of the medical programs do include this, multi-specialty approach to this issue.",English
+"there are some other issues that's gonna start to happen in your way. Some of these medical conditions can be reversed, though. If you aggressively try to eliminate the reason",English
+"for you to having diabetes or blood pressure problems by, going aggressive with the lifestyle, with weight loss,",English
+"that is gonna take away most of the, disease, issue. That's what I feel.",English
+"in some of the walls of the arteries, in general, it's very difficult for us to make that cholesterol disappear from the wall.",English
+"But if we look at blood vessels that have cholesterol build-up, they could be actively inflamed, or the disease can become more chronic and cooled off.",English
+"And, that's really what we're trying to do, particularly with lowering the cholesterol levels in the blood is to keep cholesterol build-up,",English
+"in other words, these plaques from progressing, becoming more angry, more inflamed, more extensive. So in many ways,",English
+"particularly if we find it early, can be very impactful. Now obviously, for example, a patient that's had longstanding diabetes",English
+"with extensive vascular disease that may have lost, a part of a leg because of infection or something else, some of that vascular disease may be very extensive already",English
+"and keep it from moving further. So, regardless of what stage you're in, there is something that we can try to do",English
+"to make the situation better. If we catch you early, the impact can be more profound. If we catch you later in the disease course,",English
+"the impact can still be meaningful, although it may be difficult to reverse some of it. And that's why we're so excited about",English
+"that yes, these things exist. And yes, many of us have the risk factors, including people who are giving you (chuckles) the Facebook live. But the hope is that,",English
+"where we really do see a complete metabolic phenocopy, and that's quite individuals with lipodystrophy. These are individuals who are insulin resistant",English
+"because they either cannot make fat cells or they cannot keep triglycerides within fat cells, and they develop as pictured here:",English
+"an absence of body fat, fats elsewhere in the... in the body, as shown under the skin of the feet or in the... in the... in the eye circulation.",English
+"And with my wonderful colleague, David Savage, and others over the last few years, we've discovered many of the genes, in collaboration with others,",English
+"and indeed, other groups around the world have discovered other genes. And so, we now understand a lot more about the genetic architecture of lipodystrophy.",English
+"Here's one example, I think, which is particularly illustrative. It's human perilipin-1 deficiency, a specific subtype of mutations within this adipocyte triglyceride coat protein.",English
+"All the members of this family who only carry mutation in... in perilipin-1 all develop partial lipodystrophy, insulin resistance,",English
+"and the full range of downstream abnormalities: fatty liver disease, cardiovascular disease, etc. The individuals carry... carry heterozygous mutations,",English
+which cause one copy of perilipin-1 to be made normally and then another mutant copy with an aberrant C-terminal tail.,English
+"So, what's happening in these individuals? The important fact is that perilipin-1 is only expressed in white adipocytes. So, here we have a disorder",English
+where you simply have one copy of one gene made only in one tissue -- the white adipocyte -- and yet every feature of the metabolic syndrome,English
+"is present in these severely affected individuals. What's happening? Well, what's happening is as follows. Here's where perilipin-1 is.",English
+"It sits on the surface of the lipid droplet in the white cell with its partner molecule, CGI58. And when you're making fat... when you've eaten, your lipid droplet is concerned with making fat,",English
+"and the breakdown enzymes, ATGL and HSL, are kept away from the lipid droplet. Then, when you fast overnight,",English
+"the hormonal milieu of fasting, and indeed sleeping, induces hormonal changes in the body which induce phosphorylation changes",English
+"within the adipocyte. The C-terminal phosphorylation site in perilipin-1 knocks off the binding site for CGI58,",English
+"which then goes zipping around the surface of the... of the white fat droplet and grabs ATGL, the initiating lipase,",English
+"and that starts to break down the triglyceride droplet. Then, at the same time, the second phosphorylation site, nearer the N-terminus of perilipin,",English
+"binds hormone-sensitive lipase, the second initiat... the second lipase. And then the beautiful cascade of lipolysis",English
+"starts to break down the triglyceride, down to three individual fatty acids. So, that's happening in all of you,",English
+"in everybody listening to this talk, in between their fed and their fasted state. And that is natural metabolic health. The unfortunate people who have this C-terminal perilipin-1 mutant",English
+"have, as you see in the bottom here, with the green box... they've lost that phosphorylation site at the C... at the C-terminal end of perilipin-1.",English
+And throughout the day -- irrespective of whether they've been fed or fasted -- CGI58 is free to roam and...,English
+"and binds promiscuously to ATGL. And therefore, throughout the day, whether you're fed or not, your fat cell is breaking down triglycerides",English
+"and releasing molecules of fatty acid. Now, remarkably, this in itself is enough to cause every single feature of the metabolic...",English
+"the metabolic syndrome: Insulin resistance, fatty liver, atherosclerosis. This is a rare condition,",English
+"but I think one which is really illustrative of the very important point that the health of your white fat cell -- and indeed the health... the healthy dynamic of your white cell fat droplet -- is really crucial to your overall, organismal metabolic health.",English
+"Is this, again, more relevant... outside these rarities? And is it... is this sort of process relevant to the wider population of people with the metabolic syndrome?",English
+"Well, to address this, we collaborated with our colleagues in the MRC Epidemiology Unit -- whose names are listed here -- led by Nick Wareham.",English
+"And we asked about genetic variation influencing lipodystrophy-like metabolic phenotypes in the general population. So, we looked at people who had high insulin, low HDL/cholesterol,",English
+"and high triglycerides as a composite index. And in nearly 200,000 people, we found 53 genetic variations in the genome",English
+"that influenced those traits in the general population. And these are shown in the next slide. Now, on the far left of the slide,",English
+"in red and blue and red, there are the 53 genetic loci that we found to associate -- either red being positive, and blue being negative. And of course, that's how we defined our phenotypes,",English
+"so of course you see the consistent red, blue, and red. Now, if you go to the further end of the slide, you should be able to see independent populations,",English
+"where those SNPs are looked at against type 2 diabetes and coronary artery disease. And of course, it's reassuring, scientifically,",English
+"to find that those genes are associated, in totally independent populations, with these adverse outcomes, these... coronary artery disease and type 2 diabetes.",English
+"What we found puzzling and exciting is when we looked in the middle of the slide. There, we took independent populations and said, are these variants, these SNPs,",English
+"associated with more body fat or less body fat? And rather remarkably, you see a lot of blue. And that lot of blues actually tells you that these individuals SNPs and these indivi...",English
+"the genes, when put together, actually are associated with lower amounts of body fat, not higher amounts of body fat. And this is taken further into an independent analysis",English
+"in people who have had compartmental measurements of their body fat using DEXA scanning, so we can actually measure the fat in the arms, trunk, etc.",English
+"And again, looking at the genetic factors that put you at risk of developing these metabolic syndrome phenotypes, what we found quite remarkable",English
+"was down at the bottom of the slide, here. We see that individuals carrying more of these risk alleles actually had less fat... less fat in the gynoid distribution, i.e., buttocks and thighs,",English
+"less fat in the legs, and really, not very much difference in the places we thought would be really important, the visceral fat... only a little bit of an increase in the...",English
+"in the visceral fat. This is... the changes in body fat are driven much more by lower body fat in the legs and thighs. And indeed, when you take these SNPs",English
+"and using bioinformatic tools ask where these variants are expressing their actions most, you see, quite remarkably,",English
+"that they do so in adipocytes and adipose tissue. In other words, we chose these variants in a completely hypothesis-free way.",English
+"We didn't ask the adipose tissue, was it abnormal? The adipose tissue spoke to us spontaneously. And then, when we take some of those variants and manipulate them,",English
+"we can show that manipulating these genes influences adipose tissue fat accumulation. So, in a further body of work led by Luca Lotta",English
+is it worse to have a small bottom or a big belly? And they separated out those variants. In red are the variants that... that cause...,English
+"that are selectively associated with a waist ratio. And in blue are the variants associated with only hip ratios. So, you can see in the bottom there that fasting insulin,",English
+"a measure for insulin resistance, is much more strongly associated with the hip SNPs rather than the waist SNPs. And then, when it comes to the bottom-line data,",English
+"type 2 diabetes risk is greatly influenced by hip, much more than waist, circumference. So, what's actually determining these risks of diabetes is not the big belly;",English
+"it's the absence of fat on the buttocks and legs, much more so than the larger belly. They're much more equal when it comes to coronary artery disease,",English
+but for diabetes it's the absence of fat in buttocks and thighs that's much bigger... having a much bigger influence than the positive presence of fat,English
+"in the visceral deposits. So, that really led me to develop a kind of useful model, an explanatory model,",English
+"or at least an illustrative model, for what's going on. So, you can think of this as a... as a bathroom in a hotel you happen to go into that...",English
+"somebody's left the plug out, and somebody's left the... left the tap on. But that's fine, because the bathroom is... you know, it's an old B&B.",English
+"It's got a [unknown] carpet, and the carpet's perfectly healthy because the flow is fine. You've reached a steady state, and you've got a perfectly healthy, non-soggy carpet.",English
+"But we often think of metabolic disease as being due to too much energy, i.e., pouring too much in, or a decreased energy out, restraining how much we let out.",English
+"And of course, then, you overfill your bath and you get a terrible, messy situation. And that's kind of how we tend to think about metabolic disease.",English
+"I think what our data, both in lipodystrophy and now... and al... now, in the common forms of insulin resistance, is showing that... that really we haven't paid enough attention",English
+"to the size of the bath. In other words, as well as how much energy we take in or how much energy we expend, we differ between us in our abilities",English
+"to safely expand our adipose depots, so that some individuals become severely insulin resistant and diabetic at rather low levels of energy imbalance",English
+"whereas others are capable of tolerating a large amount of obesity without developing any metabolic complications. So, here's one example",English
+"of what one might be able to do in individuals who've got a small bath. We look after, in our clinic, patients with severe insulin resistance and lipodystrophy.",English
+Here's an example of one such patient and a DEXA scan. This person has very low fat in their... in their legs and limbs compared to their central depots. They have severely uncontrolled diabetes,English
+on hundreds of units of insulin a day. And what we've done in this individual is undertake bariatric surgery. But this individual is only very modestly obese,English
+"-- he wouldn't be really defined as severely obese -- but has got a really poor ability to handle any excess calories. Now, what bariatric surgery does",English
+"is it chronically suppresses food intake, largely through suppressing appetite and changing the signaling to the brain. And just within a few months...",English
+"here's April, just a few months after the surgery in December. That individual has lost a large amount of their central body weight. But effectively, what they've done is turned the tap off",English
+"on their small bath. And rapidly, they have... their diabetes has gone away, effectively. They're off... they were on hundreds of units of insulin. They're now on no units of insulin.",English
+"So, individuals with this very limited capacity to store adipose tissue safely are particularly bet... have great benefit from bariatric surgery,",English
+"even, indeed, more so than individuals with severe obesity. And now, this has been spun out in much broader clinical studies to see how... how widely applicable this is",English
+"in partial lipodystrophy. We're now moving, in our next scientific phase, away from, if you like,",English
+"vague hand-waving about these sorts of genes that influence adipose mass, trying to drill down and find precise molecular regulators of fat cells, particularly so that...",English
+"if we can identify those, then perhaps they might be therapeutically manipulable. We might be able to use them as therapeutic targets to increase our safe fat cell storage.",English
+"This is just an overview slide showing that, in using UK Biobank, we can find rare nonsynonymous variants that are strongly associated with waist hip ratio.",English
+"Because Biobank is now so large, and the sequencing and SNP data is so extensive, we can really start drilling down into individual genes. Here, for example, are some variants in the serine kinase Alk7,",English
+encoded by the gene ACVR1C. The two on the right are actually missense variants. They're truly genes that influence...,English
+genes that... variants that cause changes in the amino acid sequence in the... in the genes.,English
+"And looking at the two of them here, N150H is probably a bit less interesting, because it's not so conserved across species.",English
+"But I195T is highly conserved across many, many species. And if you look at what I95T does,",English
+"it has a profound structural impact on the putative functions of Alk7. It influences the... the so-called GS domain, here in green, and really would prevent it flipping away",English
+"when the ligand binds to this receptor, and prevent the access of the next downstream signaling molecules, the SMAD...",English
+"prevent access to the... to the catalytic loop. So, when we went ahead and reconstituted this mutant -- a very talented postdoc in the lab, Nuno Rocha, did this --",English
+"and really wanted to see whether this variant truly does influence signaling. And what Nuno showed, in red here,",English
+"is that this variant, which is associated, as I mentioned, from protection... from protective phenotypes, a low waist hip ratio and protection from type 2 diabetes,",English
+"actually is a loss of function allele compared to a constitutively active, in gray, and one of the other variants, in yellow,",English
+"which doesn't seem to have any effect, but the red is our 195T variant, which is markedly impaired in signaling compared to our wild type.",English
+"So, this is surprising, because in mice, at least, inactivation of Alk7 has been reported to enhance lipolysis. So, we're further working, now, in human adipocytes",English
+to see if this finding is different in humans. But I think this data provides evidence that large-scale human sequencing efforts are now empowering the study of human coding variations,English
+and their links to phenotype. And these rare missense and nonsense variants can now be pretty unequivocally associated with human phenotypes.,English
+"And these were provide an... play an increasingly important role in drug target validation. So, does insulin resistance",English
+"always affect all insulin tissues equally? And the answer to that is, no. Because glucose is handled in different ways",English
+"in different tissues. There are, for example, tissues where... where insulin is not required, particularly, to... to get rid of glucose:",English
+"the brain, the kidney, hemopoietic tissues. But two of the key target tissues I mentioned to you before are liver and skeletal muscle.",English
+"Actually, insulin works in different ways in these two tissues. In liver, insulin reduces hepatic glucose output, reduces glycogenolysis and gluconeogenesis.",English
+"But it does so through post-translational modification, by inducing transcriptional events, and, indirectly, through substrate delivery from fat and muscle.",English
+"Insulin action in skeletal muscle happens in a very different way. There, you get very rapid stimulation of glucose uptake. And here, preformed GLUT4-containing vesicles",English
+"sitting underneath the plasma membrane rapidly flip to the surface... plasma membrane surface in response to insulin. And so, there are some key differences",English
+"in how insulin works in... in these two tissues. And this is illustrated by a rare family that we discovered a few years ago,",English
+"in which... in comparison to most people with insulin resistance, reflected in the blue line above, who have high fasting insulin and high insulin after a meal,",English
+"these two siblings had extraordinarily high insulin postprandially but normal fasting insulin. So, how could that be?",English
+"Well, that was because they had a process, and a mutation affecting a process, that only occurs in skeletal muscle and, in part, in fat.",English
+"And that is the translocation of GLUT4. And there's a key molecule, a so-called Rab GAP, TBC1D4, otherwise known as As160,",English
+which is a key regulatory step in regulating how insulin translocates GLUT4 to the plasma membrane. And individuals who are heterozygous loss-of-function for this mutation,English
+"have a continuous leak of GLUT4 to the cell surface so that, actually, when insulin comes to act, there's inadequate intracellular GLUT4 vesicles,",English
+"and you get a severely impaired postprandial response. Again, we looked for many years and could never find a second family, so this is an exceptionally rare albeit very interesting rarity.",English
+"But in the last couple of years, it's become fascinating that if you look elsewhere, for example in the Greenland Inuit,",English
+the allelic frequency of a very similar mutation is 17%. A very large number of Greenland Inuits carry a very similar mutation.,English
+"And indeed, in those, you can see that those that carry two copies of that have a much higher 2-hour glucose",English
+"than individuals who carry one or no copies of that... of that. So, a rarity in the UK has become a phenomenon of epidemiological proportions in another population.",English
+"And that's another lesson I think we're learning in this field: the importance of studying rare population isolates, and how illuminating they can be,",English
+and how different from each other the architecture of genetic variation causing disease can be between these populations.,English
+"So, the carriers here, interestingly, also have marked postprandial hyperinsulinemia. And many people have thought that if you had,",English
+"for example, impaired insulin signaling in skeletal muscle and had very high insulin, that might put your weight up. These individuals have no difference in body weight",English
+"and, indeed, no differences in circulating lipids, making us think again about what hyperinsulinemia might actually be doing to things like body weight and lipids.",English
+"So, I'm gonna end with an overview, really, of how organs work together. The wonderful thing about endocrinology and metabolism",English
+is they're really not conditions of cells; they're conditions of systems. And you have to understand how the system works to really get a true understanding and true knowledge of disease pathophysiology.,English
+"So, if you were gonna avoid getting type 2 diabetes, how might you go about it? Well, first of all, you'd maintain energy balance. You wouldn't let your energy in get more than your energy out.",English
+"And that, as we've discovered from our genetic studies, it... not discussed with you today, but in other contexts, is really a job of the brain and the gut-brain interface.",English
+"So, the brain is really the most important organ determining who is perpetually hungry, who is easily satiated -- the variation between individuals in energy balance.",English
+The next step is that of the... to store... if you... if you can't manage to stay in energy balance,English
+"and you do accumulate an energy imbalance, then you're fine so long as you can safely store that in fat. So, adipose tissue has really turned out to be",English
+a very important... and not just a passive store of lipid but a very important determinant of how we... how our metabolic balance or imbalance can be main...,English
+"can be maintained. If we can't store lipids safely in our adipose tissue and it goes to liver and muscle, then a key factor there is",English
+"who are insulin resistant and those who then decompensate to diabetes is the genetic architecture of your pancreatic beta cells. Work from colleagues in Oxford, Exeter,",English
+and elsewhere around the world... have really done beautiful science showing how important the genetic health of your pancreatic beta cells is to determine whether you transition to type 2 diabetes or not.,English
+"I'll return to the immune system and the host defense. Much work in mice has really illum... illustrated a critical role, and suggested a critical role,",English
+"for the immune system in maintaining metabolic health. And yet, much of our genetic work and, indeed, very much pharmacology",English
+"really hasn't come up with that much human evidence that this is terribly important. I mean, for example, if you look,",English
+"as Bernstein's lab did a few years ago, at the... at the genetic SNPs... at single nucleotide polymorphisms associated with a variety of inflammatory",English
+"and a variety of metabolic phenotypes, there's really very little overlap. There's almost a complete separation between the inflammatory diseases and the metabolic diseases.",English
+"And in the same paper, looking in a different way at which tissues might be implicated through... through genomics and transcriptomics,",English
+"you can find, for example, in the top left-hand corner here, Bernstein's lab is looking at neurological conditions and showing that they cluster around brain tissue --",English
+"not surprisingly. And then a whole range of immune conditions. Very, very wide... widespread immune conditions. And of course, again, unsurprisingly,",English
+"the genetic variation influencing them is having its major effect on immune cells -- on lymphocytes and macrophages. Again, like with the SNPs and the disease associations,",English
+"absolutely no doubt in anybody's mind that that patient group should be on these drugs, it reduces cardiovascular risk, at least in a population. And you can see it's, you can see the percentage",English
+"is vanishingly small. So in spite of the fact that, you know, our colleagues, Lilly and Novo have developed this spectacular drug, which not only lowers blood sugar not only reduces your body weight, but it",English
+actually reduces your cardiovascular risk and reduces your liver fat and many other things. It's not being used. So there are a lot of reasons why not and I don't certainly don't want to oversimplify it. But a lot of,English
+"people who have gone out and asked this question have found that to a certain extent, it's because of hesitation to take an injectable form of drug. And and there's several reasons for that, to some extent,",English
+"what Well, we found when we started asking physicians that we talked about that a lot of practising generalists, particularly in the United States just don't have the time to teach people to inject. So",English
+"they, they don't do it. They refer their type one diabetics to a endocrinologist, and they just won't do it. A lot of patients, particularly with obesity, where the social social aspects of very complex",English
+"don't perceive themselves as having a disease. So we thought that it was very important to bring to this population, an alternative to injection. Now, I just want to emphasise that, you know, I'm",English
+"not talking about competing with injectables, you know, there's 100 million people in the United States who are obese and could use this. So what we're really thinking about doing is bringing another form of the",English
+"drug to really provide access to people who just for one reason or another, not taking objectives. So above, you can see the history of the search for GLP, one receptor antagonist at Pfizer. It started in",English
+"2004. I mean, that's a long time to be working on a single drug target. I just want to make it clear that I showed up in 2014. So I was not responsible for all of the success or for the ultimate success. And I have",English
+"to say, right now, we have as far as we know, the lead molecule, and it wasn't, you know, it wasn't because everybody didn't try To make this and you know, and I won't go through the details, it just turns out that when",English
+"you're looking at receptors that bind peptides, the peptide binding site actually turns out to be very long and inserts into the membrane. I think Randy alluded to this earlier. So it's really hard to make, you",English
+"know, a small molecule that's really going to replicate the effects. But Pfizer did, and this goes through the history. And it's kind of cool, because it does show you all the things that the scientist medicinal",English
+"chemistry tried, you know, a classic high throughput screen than a larger high throughput screen and then looking for a positive allosteric modulator. And, and then some other things there was a, you know,",English
+"receptor over overexpression, so it sends does well I did that and I got a lot of nonspecific a lot of false positives, because the receptor overexpression mutagenesis, well, where do you mutate it to make it",English
+"more sensitive, and then how do you know it's going to work on wildlife so where it finally where it finally worked, which as I said, started in 230, in 2013, I take no credit for it was actually using a policy poly an",English
+"allosteric policy, I allosteric, modifier positive allosteric modifier developed actually UT Southwestern, for those who don't know, these are drugs, which really are don't activate receptors on their own, but",English
+"when you have them, an activator, will have a greater effect. And you can, you can actually see that over here. So, you know, it's called various things compound being but you can see, this is an insulin secretion",English
+"assay, you know, on its own compound B has a trivial effect. This is GLP, actually real GLP peptide, but together, there's a fairly significant effect. And in this shows, it's actually turns out to be",English
+"a covalent modification modifier of an internal cysteine. So what the Pfizer medicinal chemists did was they repeated the screen in the presence of this Pam. And what they did is they got one hit by the way,",English
+"we've done these number of times, we still have only one chemical series, that worked. But what they found was they found a a molecule that stimulated the activity of the of the receptor, in the presence of the",English
+"pulse, the allosteric, moderate, and the positive allosteric modifier on its own, it didn't, it never would have been picked up. But it's the nature of medicinal chemistry now that once you identify a small",English
+"molecule that binds and then at while this was going on, the structure came out, but much later, then you can do the structure, actual related, you know, relationship and get it up. So the key thing for the Pfizer,",English
+"medicinal chemists was running the screen in the presence of a PAM, getting a hit, and then taking away the PAM, and eventually reaching a point where through classical medicinal chemistry that it really",English
+"works on its own. And my only contribution to this, I will say is even though I didn't come till it was working for 2014, I at least, was",English
+"part of the team that really believed we should stay with this and keep at it, because one having confidence that the chemists at Pfizer are very good and could eventually get there, but also having confidence that, that",English
+"this would be good for patients, I'm not gonna show you all the biochemistry, it turns out that this is a small molecule, high affinity not as high as GLP one which has really low nanomolar. But it's pretty",English
+"high. And I will just tell you that in a lot of biochemical acids, I'm going to show you we have never been able to distinguish a difference between the authentic peptide and in a small molecule which is called Dad,",English
+"it actually has a name, it's called dad new clipper on now, then you click Run and we've never been able to this is turns out like a lot of these molecules to be human specific that you know, the GLP one isn't but",English
+"that's, that's not right. So I'm just going to jump to the question what happens when you put this into people? And what I'm showing you is a four week study, and where we're looking at a number of things, but",English
+"you can see plasma glucose mean daily glucose, haemoglobin? Anyone see and wait. The one thing I should caution you about is again, I think probably most of you know that the biggest problem with this drug is GI and",English
+"tolerability. And the way you get around it is by titrating up, and I can talk about it later, I won't go too now in this study, you know, we basically had a choice we either do a good titration and get up to a whole",English
+"high dose, or we can titrate really quickly not be able to assess and tolerability but get an idea with with a thing worked or not and obviously we elected the latter. So this particular study involve two",English
+"weeks of titration and then two weeks of treatment to the maximal dose and you can see that fasting plasma glucose, you know, if the higher dose",English
+"was decreasing, 90 milligrammes per deciliter, you know, we're dive a typical diabetic with an A haemoglobin a one C around seven it's that's that's correcting the fasting blood glucose, mean plasma glucose",English
+"looking at haemoglobin a one C, even under this this very short time period, it's decreasing at 1.2. And perhaps most impressively, we saw a tremendous amount of weight loss even in the short period. Now, of course,",English
+"these were patients who were having a lot of GI upset. So it's a little bit hard to you know, to really know exactly why they were losing weight so we get into longer study. So We're very excited about this molecule.",English
+"It's currently in in phase. It's currently in phase two, B. And we're developing and we're really optimistic I, as I said, right now, it's indistinguishable between the ones that are on the market. But I",English
+"caution you that they're in general, it's very difficult to compare different studies without running things side by side. And in particular, with this particular class of molecules, you really don't",English
+"know how they work till you do real world to get real world experience, because you really can push the tolerability on an inpatient study. So they're impatient. So anyway, very excited about it. And",English
+"I'm happy to report it to you. But so why, why did I say that I'm going to talk about strategies for developing novel targets for obesity. If I, if",English
+"I've emphasised this, I'm sure all of you heard that this is a great obesity drug, we show you a little bit of where it falls short. So on the left, you can see the, the you know, the efficacy of this, the the",English
+"number, the percentage of patients responding to GLP, one with different levels of weight loss. And you could see what you get up when you start",English
+"asking for 15% weight loss or so half a half of the patients respond. So that's a lot of individuals out there who still are not going to have adequate body weight now, and most people, you know, when you think",English
+"about diabetes, people think about 1010 kilogrammes or so because the best data would say that'll have a profound effect on on metabolic but for for obesity, you want to get higher. So that's one thing. First of",English
+"all, it doesn't work in everybody. And it doesn't even people works. And it doesn't always get to the level of weight loss you'd like. This other one to me is very, very interesting. Again, this is a study that just came",English
+"out a couple of months ago, and really asked the question, what percentage of people who get the drug for weight loss still take it a year later, and two years later? And what this shows you, if you look at the",English
+"far right over here, it shows you that two years after people who prescribed GLP, one, this is all them together, not 667, two thirds of them are no longer taking the drug. And what's to me what was most",English
+"counterintuitive about the study is the compliance is significantly less for the weekly drugs, not the daily. Now, I think, certainly I and most of",English
+"us thought that as you, as the administration would become more intermittent, it would be a lot easier to comply. It's exactly the opposite. And you can see that there. So efficacy, you know, ease of",English
+"taking. So for all of those reasons. I you know, I believe it, I think everybody else believes that there's still a lot of opportunity for other drugs. Okay, so let me I think it went too far. Okay. So, as you all",English
+"know, one of the one of the hardest things about drug discovery, in general, is, is translating animal models to humans, and they don't translate. In the case of obesity, it's even worse, because there are",English
+"many reasons why your mouse will stop eating, other than loss of appetite other than physiologically relevant, increasing energy metabolism. And you don't know which of those even you can do aversion tests and that sort",English
+"of thing. But really, you just don't know till you get it in person. Getting rimonabant is a great example of that, where was a wonderful drug not and people, they got incredibly depressed, and it's not a good drug.",English
+"So that's the sort of stuff so what I'm going to tell you about is something we've begun doing, which really starts with the human genetics, and looks for targets, and then works back to mice afterwards.",English
+"And it really takes advantage of something somebody earlier referred to, I believe, and that's the UK Biobank. So the UK Biobank is a is is something that's going on in the UK, where patients are getting exotics,",English
+they're getting their exome sequenced. And the the data available in their medical record is available isn't publicly by the way this work. The way this works is Pfizer and many other companies fund this. And what,English
+"we get in exchange for it is access to the data for a year. So it's just a wonderful example of a private public relationship where Pfizer gets first look, but all of the data after a year becomes available to",English
+"everybody, even though Pfizer and other drug companies are putting a lot of the costs. So that's it. So that's that. So that so that is the idea. Let's look at a sequenced population of individuals, and see",English
+"whether we can use that to find targets. Well, a couple of obvious problems. The first one is shown on this slide. And that is, you know, once we now have experienced sequencing large populations, what we",English
+"found is, and this is this is high blood pressure, but it's true for every sequencing study that's been done as far as I know of what you find is those mutations with the largest effect size are the rarest,",English
+"and it's why you have to sequence in the case of the UK Biobank. We're now up to 500,000. You don't see these very often. So and when you're talking about stuff like diabetes, obesity, it's such a complex There",English
+"are so many genetic and environmental factors that influence that you just can't interpret a single individual or two or three individuals. So you have this problem of the common alleles, where you can look at a lot",English
+"of patients don't do very much. So they're hard to study, the rare alleles, which you really want to use are very are the rare alleles that have are the ones that have the big effects. So that's one problem.",English
+"The other problem with this kind of studies also, you know, it just makes sense. And that is if you begin looking at coding mutations, remember, these are exon sequencing. We're not finding those kinds of",English
+"mutations that Karen, you know, discussed this morning expression. The reality is, even with the best in silico programmes, it is very hard to predict the biochemical consequences of a given coding mutation. So again,",English
+"this is shown on the left is just something I pulled from the literature. It's it's a fairly famous receptor for obesity, or appetite, control of CMC for our receptor. And in this particular study, what the",English
+"what the, what the scientists did was they just mutated one intracellular loop and ask what's the consequences, and they just did usual scanning type of mutagenesis. And as you can see, on the left, depending on the mute",English
+"the residue, there was differences in cell surface. And as you can see, on the right, the the variation in activity, biochemical activity was enormous, there was some humans that were activating, there were some that",English
+"were inhibitory, most did nothing. So if you take that data, and you look for an association with a phenotype, almost invariably, you're not going",English
+"to find any, because you're looking at a collection of different different biochemical consequences. And you're gonna lose the ones. Okay, so that's, so those are the two problems, the mutations that have the",English
+"biggest effects, eyes are really hard to find. And to, you know, if you just look at a large collection of mutants, you can't relate it to the phenotype. So here's, here's the way we were trying to get around it. And",English
+"that is basically by triangulating to three measurements. One is the mutation itself, so we so these UK Biobank see the sequence, so we know where the mutation is. The second is the phenotype of the individual. And",English
+"that comes out of the UK Biobank also. So what we get from the UK Biobank, we get the mutation, we get the phenotype. And and here's the third thing, which is a little bit different. And that's the",English
+"essentially, the biochemical activity. And that's what makes the difference. And I'll show you why that works in a second. So we have collaborated with a company called domain therapeutics that came out of",English
+"a lab in in McGill and and what they've done is set up a reasonably high throughput assay for looking at of activities of GPCRs. And you know,",English
+"it's a bio lumens transfer assay, very common, you know, you're looking for Association based, what they're looking at is association of a G protein with the GPCR, what they've done is they have a number of cell",English
+"lines where they've put put fluorescent tags or biomass bioluminescent tags on the GPCRs you put on, you want to measure activity put on the like end, and you can not only know the consequences, that",English
+"mutation, you know, the consequences of that mutation on the many different pathways. So it really it works, I'll come back in a little while and talk about his shortcomings. But let me just show",English
+"you what it really works. So again, we're going to win win take three different pieces of data, where the mutation is, what the phenotype of that individual is, and the biochemical consequences of mutation.",English
+"And I'll show you one, where we know a lot about the receptor, this is the beta one, beta one adrenergic receptor right now, if you so on the right is is is is the colourized description of the activity of these",English
+"different mutations. And on the left is the location of the mutations. And the first thing to look at is that the colour distribution, which means that mutations with various biochemical effects are distributed",English
+"throughout the receptor, and other than perhaps a cluster of loss of function. So what we know to be the, the ligand binding unit and the third transmembrane domain, you'd never know and you in the way we've",English
+"presented it here is on the left, you can see where the mutations are. And on the right is the consequence of those mutations lined up from from",English
+"the effect. So either one, the one that tops or loss of function mutations, most of the ones in green have no consequence on activity, and then there's always a handful and this is always the smaller group, the",English
+"gain of function, the constituency active so now we can link those two together. So here's the critical graph. So what you're looking at here is on the on the x axis across your what you're looking at, is the",English
+"activity of the receptor, that mutant specific mutant based on the domain assay described earlier, and on the left is a massaged indication of the",English
+"phenotype. Okay, each hour each circle It tells you a different mutation. And in this particular particular demonstration, the intensity of the red colour tells you",English
+"the number of independent individuals with that specific mutation. Each circle is a mutation at a specific residue, the and as you can see, as I",English
+"said earlier, you look at the ones that extend with the biggest size, whether it's loss of function, or gain of function, you can see that the lightest they have the fewest patients. And in some cases, we're",English
+"talking about one or two individuals, I shouldn't say patients, these are normal individuals, where you're measuring body weight. So that's the graph your as you would expect, you could graph for each mutation, you",English
+"can graph biochemical activity against consequences. So what do you get out of that? Well, okay, the first thing you get out of it is, you know, you have wild type, you can, you can divide everything into four",English
+"quadrants, there's there, you know, there's what we call wild type, wait, if there is such a thing, here's wild type activity, but you can see that everything above, you know, above the wild type activity has, you know,",English
+"has, in this case, we're looking at blood pressure, I'm sorry, I should have said this is the beta adrenergic receptor, we know that's related to blood pressure. So ones that biochemically have, you know, are",English
+"thought to have that where we find their increased activity on the right, it's not working. And on the left, you can see the lower the biochemical activity, as you would expect, the lower the change and",English
+"bloodshed portion. Now there are a lot of, there are a lot of dots that are way off the curve, because a lot of other things. And you know, in in the middle, the ones that have very little consequence, where you see the",English
+"biggest circles, not there, the biggest big red spot in the middle, most mutations doesn't change activity a lot. Okay, so So this is a curve you can have you can do if you have a phenotype and you have",English
+"receptor that's sequenced. And what can you? Yeah, so I'm sorry, let me just tell you so what else can you learn from this, what you can do is",English
+"if you look at the actual y intercept, it will tell you the maximum effect of a loss of function mutation by x travelled, it will show",English
+"you the maximum effect of a heterozygous because everybody we're looking at here, so you can actually get this plot and you can ask the question, if we have if we have a drug that inhibits at 50%, what would",English
+"be the predicted effect size and by if you if you look at the interaction between the two alleles, by looking at large populations, you could actually predict let me give you an example with something which is which",English
+"is okay, and this is the one this again is the beta receptor, and you can see exactly what I what I was telling you about. You can see on the",English
+"predict that a homozygous you don't have any homozygous here, but you can predict by knowing how these alleles interact, that a complete loss of function or one would predict a complete inhibitor would reduce blood",English
+"pressure that much and again, the same thing with activators. Okay. And it's actually not bad. I mean, we since we have Inderal, we can actually go back and ask the question, do these predictions",English
+"actually come out. And when I show you the clinical data, they're really not bad. Now before I go any further I have to acknowledge the people who really developed this and the two there were a lot of a lot of fires or",English
+"colleagues were involved. But the two most important are in bold. A JP for Ken is an expert in gluco. In GPCRs, he runs our biochemical pharmacology group and in collaboration with Eric Feldman, who runs our computational",English
+"genetics group, they came up with this particular strategy. Okay, well, what about a receptor that we really care about in regard to it, we care about obesity, let's look at the MC four receptor now we know loss of",English
+"function MC for mutations are associated with severe obesity, less common or gain of functions, which are protection. And this is exactly what this this slide, this slide shows you this is the same kind of",English
+"analysis I showed you earlier. Again, across the x axis, you can see on the far left at a loss of function experience, loss of function. Mutants on the far right of the few rare gain of function mutants, there are in the",English
+"middle over the green are the majority of mutations, which have no biochemical effect. And as you can see, if you had the state of before you knew about MC four are, you would predict that loss of function is",English
+"associated with an increase in body weight. And again, as shown up here, you actually can predict what the body weight would be. And, you know, seven, seven kilogrammes for a heterozygous individual is a very",English
+"large, a very large effect size of a heterozygous mutation. And, you know, there it isn't perfect for a lot of reasons, but it's pretty good for at",English
+"least comparing effect size, you know, among different targets, which is better which together. Okay, well can we actually use this for something useful or rent to",English
+"solver Aside from finding drug targets, can we actually use it for a solving a real biological question, that's where I want to just just finish with you. And it's, it's, it's the, it's the glucose dependent",English
+"insulinotropic polypeptide receptor, which you've heard about already, Lilly just had approved a peptide which activates both the GLP one receptor, as well as the JL p one receptor and has published some very",English
+"impressive data, indicating that if you activate both receptors together, you get an increase in, in an efficacy on diabetes, and perhaps",English
+"even a more of an increase in efficacy on on weight loss. Here's some of the data in the next slide. So on the left, is is the Lilly data",English
+"looking at increasing doses of gantries appetite, this is the peptide which activates both the GI B receptor as well as the GLP one receptor and at least as best as possible, it's compared with another",English
+"agonist semaglutide, which just activates one the GLP one receptor. So the argument here is that what you want to do is your active one activating both but on the right is an experiment done by Amgen. And what",English
+"they've done is made an inhibitor to the GLP one receptor and shown that if you administer an antibody which box gi p one, it is additive with GLP one. So we've got data out there in the literature in humans, actually,",English
+"that's non human primates, saying that what you want to do to increase efficacy is activated receptor, which you got in Amgen, saying what you want to do is inhibited and I will tell you the mouse knockout data does",English
+"absolutely nothing to resolve this. The last slide I'll show you is what happens when we apply this, this technique and ask the question in humans are is is changes in GIS changes in body weight associated",English
+"with an increase in activity of tip one or a loss of activity. And as you can see, very, let's see, you got to go to the next one. Okay, um, as you can see, as you as you move to the left and have loss of activity",English
+"mutants, body mass index and body weight decrease, okay, as you move to the right and get gay to function, they increase. So this shows to our mind that at least in the genetic model, protection from increased body",English
+"weight is caused by a loss of function of the chip one receptor. Now, I have a couple of slides explaining that to you, I won't take the time to do it because I've run over. But suffice it to say that data",English
+"from both our group as well as Amgen would indicate that the terzetto peptide protein is such a strong activator of the GLP, one receptor GLP one receptor, that chronic treatment is actually down regulating",English
+"it. And you're getting a net inhibition of GLP one signalling so if you wanted to make a better version, if it is possible to make a better version, you really might want to think about an inhibitor. Okay, so",English
+"let me summarise what I've told you about this, we call this human genetic structure active relationship. Let me just summarise what this technique is good for what are the positives, it's in humans?",English
+"Very good. It you can use it to establish the strength of it as well as directionality for you know, people who do G losses. That's one of the things that kills you what direction is it, you can you can",English
+"figure out the approximate maximum effect you determine relevant downstream signalling. But one of the negatives, it requires a very large sequence cohort, there aren't a lot of that running around, you need a",English
+"continuous variable to graph that. Remember, you need a variable where you just can't it isn't binary, you can plot has the disease or doesn't. It's hard to find those obesity or body weight is one of the few blood",English
+"pressure is another one. You need a medium throughput biochemical assay. Again, there really aren't that many around. And lastly, you need to know the lie again remember the critical thing in the assays you activate the",English
+"receptor. And that's the consequences you ever receptor. And you don't know how to activate it, which is true of most GPCRs you can't do it. So let me just again, finish up a lot of people were involved. I really emphasised",English
+"that in terms of the in terms of the HTC SAR that was that was Eric Fomin and JP four can I'll just leave these up there, except to just point out",English
+"that Jeff Pfeffer coin has always been my associate there. I do everything with and I will send some since she was mentioned earlier, I'll point out Kendra Benz who leads our obesity and liver disease group. So",English
+"happy to take questions if there's time. Sorry. Okay, thank you very much, Molly. Beautiful talk and insightful talk as well. So any questions? And okay. Hi,",English
+"curved line, right? It does force a straight line and it's you know, it's clearly one of the you know, it's clearly why it's semi quantitative. So, the weakness is, so",English
+"it's still forcing a straight line. It still preserves the screens of understanding directionality and consequence. Where it falls short, of course, is is quantitative is, is it screws up the magnitude? Now, you",English
+"know, as you know, you through statistical genetics, you can always calculate out what the interaction between the two alleles, there's, and that would, in principle allow you to get the kind of curve line that would",English
+"be more accurate. But we just, you know, even even 400,000 sequences is not enough to get that kind of level of level of specificity to it. More than that, that was quite fantastic talk as such, wish you had",English
+"two hours instead, that would have been really good. First one, a comment on the nonpeptide GLP. One agonist. In fact, the first project that was started in 1990, as Novo Nordisk when I was employed out there",English
+"and told them that this was a great target. And that was actually trying to make a small molecule, agonist for the receptor, which then of course, took 32 years to then make and so I'm happy that I left the company for",English
+"after after that, nevertheless, the studio, which was probably here was was actually the project manager out and over on that project. Could you say a little more about the two separate hype? Because it was, of",English
+"course, it's a totally Enigma in the beginning that why the GFT chip agonist would do that much as they claimed in the very early days. And",English
+"fantastic. So since you asked, I will show you here the two pieces of data. So on the left is a downregulation experiment where the this is our experiment, we",English
+"did a Pfizer joint Buxton dinner, where we pre incubated with various concentrations that are kept reside, trust appetite overnight, essentially, then came in with a new, and as you can see, the, the more you",English
+"incubate with overnight, the more you actually drive down the dose response curve and giving a second dose, that's the way we did it. It Amgen, they did it with gap, not with his appetite. And again, it's the same",English
+"sort of thing a prolonged incubation with GAP obviates the acute response. But what they did is very nice control where they gave, you know, they gave another way of activating cyclic a&p and showed it was still",English
+"there. So it really was at the level of the receptor. So that's what we now i by Lily doesn't believe that now you couldn't, one way of resolving the controversy is simply saying it doesn't matter. Look, the",English
+"drug works, whether it's chronic downregulation or acute activation, who really cares. It's only if you want to make another molecule and more designed way, it really helps. GeoIP is very, very weak, as you saw",English
+"from the flatness of the curve, it has very little effect on its own. So the argument is, it must be either additive or in some way enhance the GLP. One by mechanism, we don't know or it reduces the side effects. And",English
+"some people have argued that really what shift is doing is recruiting the adverse from gi tolerability, so you can just get up to a higher dose. And yeah, thanks. As far as I know, there hasn't been any good genetic",English
+association between the GLP one variants and obesity. So and that's despite GOP one being the best obesity drug out there. So have you,English
+tried running GOP one in your analysis? And how does that look? It's good question. I should know the answer to that. We must have done it. I think we picked it up with this analysis. I'll get back to you. If,English
+"you come down afterwards, I'll make sure you get it. Because if I remember, if I remember correctly, we actually did see an association when we did this analysis, as opposed to just lining up a bunch of mutations.",English
+"Oh, wow, that's quite a bit. It is quite a bit. So that makes sense. So I know that you mentioned  this, I think in your previous talk as well, but   you know the old saying, you know, you are what  you eat. You kind of modified it. It's you are",English
+"what you metabolize. You are what you do with what  you eat, therefore, you are what you metabolize. But in my book, ""Metabolical,""  I made it very clear, actually,   you are what they did with what you eat.",English
+"Got it. Because what they did was they altered the  food in such a way as to alter your metabolism. That's very interesting. It's definitely a  new take, but it makes a lot of sense. I mean,",English
+"you are what you take in and  you are what's in your body. So— Well, I mean, ultimately, you  are what you breathe, right? Right.",English
+"Air pollution plays a role in this. Right? You are   what you drink because there are  obesogens in the water, like PFAS,   polyfluorinated alkylated substances,  like Teflon, right, which never goes away.",English
+"Yeah, right. DDT, the very first insecticide, the  first mass-produced insecticide, okay,   we learned—I mean, ""Silent Spring,""  Rachel Carson, you know, in 1962,",English
+"you know, seminal tome on this issue that really  brought environmental science to the forefront.   You know, documented the problem, and we  banned DDT in 1972. So it's over 50 years",English
+"since DDT has been around, but you can still  measure DDE, which is the metabolite of DDT.   You can measure levels in the urine of pregnant  women here in the Bay Area, and the level of that",English
+"DDE metabolite predicts obesity in their  offspring at age five years and 10 years. Oh, wow. So these environmental chemicals are actually  predisposing you to potentially becoming obese.",English
+"Absolutely. So we have a whole cadre of  environmental obesogens, and we've written several   papers on this, most recently in Biochemical  Pharmacology. We have another one coming up soon.",English
+"And are any of the preservatives  that you're seeing nowadays in   foods and chemicals or any of those  contributing, would you say, to obesity? Absolutely. So there are many things in the food,  there are many things in the food packaging,",English
+"several things in the food that can drive this.  One is phthalates, which are plasticizers. I   mean, they're what rubber duckies, what  they're what make rubber duckies rubber,",English
+"okay, because they're not rubber;  they're plastic, right? But they,   you know, they—they squeeze, right? Pacifiers  are made with phthalates, okay. Flame retardants,   PBDEs, okay, so every kid is bathed in  PBDEs because it's part of their pajamas.",English
+"So how do we stay away from these? Well, you need regulation, right? How can you do this without regulation? Exactly, and we don't have it, and it's  one of the things we're calling for,",English
+"we're trying to advocate for. Um, there  are many, many others, you know. I can   go down this—parabens, okay, which are in  cosmetics, shampoo, shampoos, lipstick,   etc., okay. There's a whole host of these  environmental obesogens, and several of them",English
+"not only do they affect adipocytes but they also  affect the liver. So they can affect PPAR gamma,   which is the adipocyte differentiating  factor, or they can affect FXR and LXR,",English
+"which are the liver differentiating factors. And  so some are both, and they're all around us. And   so I'll point everybody to our paper that I—I'm  first author on in Biochemical Pharmacology 2022.",English
+"Okay, yeah, we will take a look. That's  very interesting. Um, well, trained—I   feel like I was trained at UCSF to treat disease  states, and rarely do they train you to, you know,",English
+"treat things before while they're on the  horizon. What would you say to clinicians   that are interested in looking at,  you know, specific biomarkers or,   you know, things that are indicative that  non-alcoholic fatty liver is on the horizon?",English
+"Anna, you've just opened up the biggest can of  worms in medicine, all right, and, you know,   it's going to be really hard to stuff the worms  back in, uh, now that you've broached the subject,",English
+"all right? In Peter Attia's book  ""Outlive,"" he describes Medicine 1.0,   which was basically, you know, the leeches, okay, and Medicine 2.0,  which is, you know, penicillin and",English
+"our current pharmacotherapies, and now he  talks about Medicine 3.0—very predictive,   very, pretty predictive, precision, and also  preventative—stop the disease before it starts,",English
+"understand the root cause and deal with that  instead of trying to deal with the symptoms   down the line. That's right, right? I completely  wholeheartedly agree with that, right?",English
+"Okay. So how do you do that?  Easier said than done, of course. Well, we know certain things. We know  that there are certain biomarkers that   will tell you that a disease is brewing  before the disease actually occurs,",English
+"like insulin levels, yes, like fasting insulin. I  think that's the most appropriate. I think that's   the best one in terms of understanding what the  problem is. If your mitochondria are working",English
+"properly, your fasting insulin is low, like  below five microunits per mil. The minute your   mitochondria start having a burden and not being  able to process energy at the rate that it should,",English
+"insulin's trying to get more energy into  the cell in order to generate more ATP,   but the mitochondria are the problem.  So fasting insulin is the reflex",English
+"on inherently problematic. Mitochondrial functioning.   So you can see that fasting insulin rises when  you see that fasting insulin rise, you know you",English
+"have a problem and you know that you could fix  it now before it becomes a big problem later. But   the American Diabetes Association says  don't draw fasting insulin, right,",English
+"and it's rarely ordered and covered, exactly.  So this is one of the things I'm trying to fix. Any other biomarkers that you would  say like, I know I think that one",English
+"that I read for cardiovascular  disease is uric acid is a big one. Uric acid is a very good one. So we've learned  a lot about uric acid. Uric acid is a byproduct   of purine metabolism. Okay, so it's a byproduct  of fructose metabolism. It's both, okay, and if",English
+"your uric acid's high, you don't know which one's  the problem. But if you're eating a lot of meat   and you're eating a lot of sugar, okay, probably,  probably you're not on the best diet, right? Okay,   so it's a sign of a problematic diet, to be sure.  Okay, now why is uric acid bad? Well, it's bad",English
+"for two reasons. The first is, it's the endogenous  inhibitor of endothelial nitric oxide synthase or   eNOS. Now, this is the enzyme that lives in your  arteries and makes nitric oxide, and nitric oxide",English
+"is your endogenous vasodilator. It keeps your  blood pressure down, it keeps blood flow moving.   So when you have a lot of uric  acid, your blood pressure goes up.",English
+"Not only does that have its inherent problem  of potential stroke, but it also means that   organs aren't necessarily getting the  blood flow and the oxygen that they need,",English
+"problems down the line, down the line. Okay,  so that's the first problem with uric acid.   The second problem with uric acid is it is also an  inhibitor of an enzyme in the mitochondria called",English
+"CPT-1, carnitine palmitoyltransferase 1. Now,  this is the enzyme that regenerates carnitine,   and carnitine is the shuttle mechanism by  which fatty acids get from the outside of",English
+"the mitochondria to the inside of the mitochondria  so that they can be beta-oxidized, broken up into   two-carbon fragments, and burned to make ATP. So  if you are poisoning your mitochondria with sugar,",English
+"which interferes with AMP kinase, ACC, ATP  citrate lyase, and CPT-1 through uric acid,   and your uric acid is high, you know that's  pretty bad. So fasting insulin, uric acid,",English
+"another biomarker that we've talked about last  time, ALT, right? Alanine aminotransferase,   which is a marker for fat in your liver. Now,  the problem with that is interpreting the number,",English
+"exactly. So we talked about the fact that the  upper limit for ALT is really 25, and if you're   African American, it's really 20, but the lab  slip says 40. It's because of the U.S. average,",English
+"right? Because the average has basically, the  whole curve is shifted to the right, right?   So there are some very clear, easy biomarkers  that could be used to look for disease before",English
+"it even occurs. So we're looking at fasting  insulin, we're looking at uric acid,   and we're looking at ALT. There are others.  Is AST one that you would be looking at?",English
+"Or AST tells you about acute mitochondrial  dysfunction, like if you drank a pint of bourbon,   your AST would go straight up before you  even made liver fat, right? And also,",English
+"if you took Tylenol, that's a great way to find  liver damage due to various toxins, of course. Yes.",English
+"AST is not as helpful and it vacillates a  lot more, so it's not quite as valuable. The other one that we think is very important  is triglyceride, fasting triglyceride, because",English
+"that's telling you how your liver is processing  carbohydrate. People think triglyceride is about   the fat you eat. No, your LDL is about the fat you  eat. The triglycerides about the sugar you eat,",English
+"right? And one thing that I find is that the liver  is a very resilient organ. It's, you know, you   can cause damage pretty quickly, and you can also  turn it around pretty quickly, yeah, as long as it",English
+"hasn't been damaged to the extent, right? Exactly.  Once fibrosis starts, that never goes away. So how does non-alcoholic fatty liver disease",English
+"progress into non-alcoholic  steatohepatitis or NASH? That's a great question, and I don't think the  hepatologists who work on this even know yet.",English
+"What I can say is that there's steatosis, which  means fat in the liver, and then there's steatosis   with inflammation. Now, what bridges that  gap? How do you get the inflammation started?",English
+"That's a complicated question, and, you know,  we're working on it. You know, it may have   to do with these liver transcription factors  because that's where all of the pharmacologic   research has been directed is at LXR and FXR.  But I'm not sure if that's really the answer.",English
+"Here's what I know. I know that when we  looked in the children that we took off sugar,   we found that the percent liver fat was  inversely proportional to the amount of choline",English
+"in the liver. In other words, choline  is a precursor to phosphatidylcholine,   which is a precursor to being able to  make triglyceride and export it out.",English
+"So if you don't have enough choline in your  liver, and you get choline from a good diet,   a nutritious diet, a high amino acid diet because  choline ultimately is made from various sources",English
+"that are replete in an animal-based diet, if you  don't have enough choline, you can't export the   fat out, and therefore the fat builds up. And if  you don't have enough choline, the chances are you",English
+also don't have enough glutathione and you don't  have enough vitamin E and you don't have enough   of anything else that makes the antioxidants  that would actually suppress the reactive oxygen,English
+"species, suppress the inflammation. So we have a  clue that it's sugar plus a bad diet. So you can   have sugar plus a good diet and have steatosis, or  you can have sugar plus a bad diet and have NASH.",English
+"Right, right. And you mentioned vitamin  E, and I know that's something that my   colleagues in pharmacy have been talking  a little bit about. What's your take on   vitamin E and non-alcoholic fatty liver disease? Well, so the problem with vitamin E is that it",English
+"appears to have an inverted U-shaped curve,  that there's too little is not good for you,   but too much is also not good for you, right?  And so finding the sweet spot in that inverted",English
+"U is very difficult. It's hard, yeah.  Studies of vitamin E repletion have not been  valuable, they have not given us the answers   we want, that's true. Having said that, vitamin E  deficiency clearly appears to be associated with",English
+"metabolic dysfunction. Oh, interesting.  So, you know, how do you utilize vitamin E?  Vitamin E is one of the things in the PIVENS study   that was done years ago in adult gastroenterology  that basically helped fatty liver disease.",English
+"So if you're deficient, and it's an  antioxidant, yes, as if you're deficient, yes.  Okay, probably otherwise  not as a supplement, right?  Okay, exactly, and those supplements can get  dangerous with the fat-soluble, you know,",English
+"they kind of stick around, that's right. So that makes sense. Another thing that I,   you know, wanted to ask you about, and it is  being talked about quite a bit a little bit,   is Ozempic, and I know that I'm sure you're  getting a lot of questions on Ozempic,",English
+"but what's your take? What do you think about it? So it's Dr. Casey Means, the chief medical officer   of Levels Health, and I did a podcast, which I  would refer everyone to, just read very recently,",English
+"all about Ozempic and Wegovy and Mounjaro.  You know, the three GLP-1 analogs.   And so in... I refer everyone to  that. It's actually done quite well,",English
+"and everyone should listen to it if they're  interested in this subject. My take is   it's better than nothing, but that doesn't make  it good. And I think that's where we are. I",English
+"think it will ultimately be an adjunct to other  primary therapies, as opposed to a standalone   primary therapy by itself, right? I think that it  works because it tells your brain you've eaten,",English
+"and so if you've eaten and then you try to eat  more, you don't feel so good, you get nauseated,   you get vomiting, you get diarrhea, okay? And  to some extent, that's aversive, and so you stay",English
+"away from food, in part because it's aversive.  Now, can that cause you to lose weight? Sure,   16% weight loss. I mean, that's pretty darn  good, but, you know, at an expense, at a cost.",English
+"And it turns out that a lot of patients  end up with a lot of side effects,   a lot of just nausea and vomiting. Yeah, a lot of people discontinue.  Yeah, a lot of people get  off of it pretty quickly.",English
+"Pretty quickly. So one thing that has   been shown is gastroparesis, your stomach stops  moving. Well, that's a great way to lose weight   and make your life totally miserable, right? And  it doesn't go away when you stop the medicine.",English
+"Oh, my God. All right, another thing that's worrisome,   it might be good, it might be bad, but, you  know, I'm gonna focus on the bad for a minute.   Ozempic has now been used to try to treat alcohol  addiction and food addiction and other addictions,",English
+"and there might be a value to it, in part because  that GLP-1 analog that information that it binds   at the nucleus tractus solitarius that sends  information to the reward center of the brain to",English
+"the ventral tegmental area, and so it's reducing  dopamine and therefore reducing the desire to eat,   okay, the potentially the reducing reducing the  desire to drink, okay, that sounds good, right?",English
+"Exactly. And what ends up happening is that the pendulum  ends up swinging into an equilibrium somewhere.   And I think that will ultimately prove that,  you know, these medicines will become an",English
+"adjunct to therapy, but not a standalone  primary therapy. That's my prediction. That makes sense. I mean, there's  always a cost versus benefit,   you know, ratio that you  have to take into account.",English
+"Always. And, you know, with these medicines,  you know, there is clearly a benefit,   and I'm not discounting that, but  the cost is much more significant",English
+"than people are giving, you  know, paying attention to. So you kind of mentioned the role of  the reward center and mental health,   you know, sugar and mental health. I know there's  a huge correlation, but maybe you could expand.",English
+"We're gonna talk about it today, right? A little teaser for it. In fact, sugar and  mental health, you know, are basically, you know,   inversely opposite, okay? People think sugar is  reward. It is, but reward is not mental health,",English
+"right? Reward is the opposite of mental health.  It's very temporary. It's very, very temporary.   And when the reward goes away, your brain is  worse. You're worse off. That makes sense.",English
+"Well, excited to hear more about it today during  your talk. There's another thing that I've   been noticing. I know we've talked a little bit  about this separately, but in the last couple of",English
+"decades, there's just been such a trend or a huge  increase in prevalence of dietary restrictions and   food allergies in the younger population when you  compare, you know, to older people. You don't see",English
+"as much lactose intolerance, gluten intolerance,  you know, what, why do you think that? Well, that's a good question, and  lots of people are researching that.   My understanding, you know, talking with many  people in the field, it's all about the gut,",English
+"you know? The gut is a sewer, literally. It is a  sewer, all right? It's a pipe, okay, with a lot   of, you know what, running through it, and it is  a sewer. Now, it has the capacity to extract good",English
+"things out and keep the bad things in the sewer,  right? Well, sometimes the bad things get out.   There are three barriers in the intestine:  a physical barrier called the mucin layer,",English
+"a biochemical barrier called tight junctions,  that's what goes wrong with celiac disease,   and finally, an immunological barrier called  Th17 cells, which make a cytokine called IL-17.",English
+"Now, when these three barriers are working  properly, the bad guys stay in the sewer.   But there are numerous things in our environment  that will antagonize each of those three barriers.",English
+"Examples: emulsifiers. Emulsifiers are  detergents. They hold fat and water together.   Emulsifiers are throughout our ultra-processed  food supply. Carboxymethyl cellulose,",English
+"polysorbate 80, carrageenan. Prevalent  in everything, prevalent in everything,   right? Well, what is it? It's a detergent. What  happens if you swallow detergent? Not good. It",English
+"Yes, it's wetting it, but it's draining the tears that you have from your eyes, so that becomes one aspect of the strategy",English
+of treating dry eyes. The other part is that we have very intricate nerve connections on the Ocular surface.,English
+"The cornea has probably one of the highest number of nerves of any tissue in the body. Say, from maybe our brain hopefully",English
+"and consequently if you have an abrasion or you have some sort of breakdown on the surface of the cornea, those nerve endings",English
+"can be raw and exposed and be very irritated and that's what gives you pain and burning, so what's required for a healthy ocular surface?",English
+"Obviously, lubrication and that comes from the Goblet cells. These are the cells in the conjunctiva that secrete the mucin which allows the tears produced",English
+"in the lacrimal gland to stick to the eye. Without those Goblet cells producing enough mucin of quality type, then the tears can bead and roll off,",English
+"because the wettability of the surface is not adequate. It's like it's been sketch guarded if you will, so you need those mucin cells.",English
+Those Goblet cells. You need Aqueous which is the fluid produced in the lacrimal gland and you need oil from the Meibomian glands that I mentioned before,English
+"and that creates the tears sandwich that we see here with the mucin down below, the aqueous here and the oil up top and that decreases the evaporation",English
+"of the aqueous to the outside world, so the function of this ocular surface unit is twofold; to provide a protective barrier so that infection",English
+does not occur and it also is a power refracting surface. That is the cornea has two thirds. You cornea is right here.,English
+The cornea and the lens together bring light to focus on your (mumbles) in the back of the eye. So they are the focusing mechanism.,English
+"The cornea has two thirds of the power. The lens has one third and note that two thirds power of the cornea, the most important part of that is the front surface, so if the front surface is irregular,",English
+it throws off your vision. It can give you glare. It can decrease the ability for the cornea in of itself,English
+to accurately refract or focus light onto the (mumbles). The problem with becomes one of disfunction,English
+"when you have an irregular tear film. Decreased vision, discomfort and possibly infection, because you have a break in the skin of the cornea.",English
+We have bacteria all around us. We have bacteria normal flora along our eyelids. The term Blefaritis.,English
+"Blef meaning lid, itus inflammation is very common in patients; in all of us and so Blefaritis and dry eyes can be a very bad combination",English
+"and you have to treat both in patients who have dry eyes, because of the risk of infection, so you have volume abnormality, mucin abnormality",English
+"which can cause filament production. Now, filaments are small, little skin tags on the cornea, so like if you (mumbles) and you'll see a picture of these",English
+"in a few minutes; it like if you took silly (mumbles) and we used to go like this and make them long, (mumbles); well imagine those being stuck on your eye.",English
+these individuals are in. They're like rocks in your eyes. I once had Filamentary Keratitis many years ago,English
+as a result of a viral infection that I contracted and it was so bad that I asked my wife who was the surgical eyes nurse to put my magnifying,English
+"glasses on and them off for white (mumbles) corneas to which she replied, I will put my hands in someone's chest, but I will not touch your eyes.",English
+"If you have a lipid abnormality, that is the oil glands are producing enough oil, then you have an evaporative tear loss and that can be just as bad,",English
+"because in our society, what are we doing so frequently? We are looking at the computer. Some of my patients are on the computer",English
+"at least for, five hours a day, or if they're not doing that, they're on their iPhone, their iPad. They're doing something or if you're driving,",English
+"you're staring; you're trying not to get killed by the other guy, so activities at near and of concentration decrease your rate",English
+"of or your frequency of blinking at that can be problematic when you have a low tear film or you have an evaporative tear film, because you're not restoring",English
+"the ocular surface and then, the surface cells underneath can break down and aggravate the problem. And, when you have a surface abnormality,",English
+you get decreased vision for the reasons I mentioned a few minutes ago. What's our traditional approach to dry eyes?,English
+"30 years ago, we put lubrication on it. We corrected any malposition of the eyelids, because, remember, they have to act correctly",English
+"to wipe the tears across the surface of the eye and if we couldn't do that and there was exposure, we would close the eye, by sewing the lids together",English
+"to preserve the integrity of the eyes from evaporation, alteration and loss of the eye, so you can see here at the bottom or in the top slide,",English
+there is a picture of an individual with a dryness. That red stain is called Rose bengal. It stains dry portions of the eye,English
+"and you can that the lower third of the cornea has been affected. Now, this comes because people have incomplete blinks.",English
+"How can you have an incomplete blinks? If you had a high speed photography done of your blink reflex, you would see that occasionally, you do go like this and blink completely,",English
+"but infrequently (mumbles) frequently, there are incomplete blinks and if you have a altered tear film and you are at risk,",English
+then it will become manifest by that. The lower picture shows a lid malposition. This occurs; this is called ectropion,English
+"meaning it turns out and therefore, the lids are coming together and not wetting the cornea appropriately.",English
+"This can come from chronic GVHD. We have chronic inflammation and it can affect the skin and cause; the scaring can cause the lid to turn out,",English
+"so these things have to be corrected in order to really address the picture as a whole. So, the goal is prevention if possible",English
+"and there are a lot of strategies that have been evolving over the years to try to prevent systemic GVHD including conditioning regiments,",English
+"tissue matching, trying to prevent local disease and eliminate sense of (mumbles); even trying local immunosuppression",English
+"before the graft, but it's not always successful and these techniques are still being refined as we speak,",English
+"but what are the some of the clinical manifestations about dry eyes that we're talking about? Well, the first one is chronic conjunctivitis. Conjunctivitis; inflammation of the conjunctiva.",English
+"You're guard variety pink eye, but it's not due to a virus. It's not contagious. It's just that your eyes are irritated, red and angry",English
+and it presents as red eyes. You can develop dry spots on the cornea as you can see here and those dry spots is I alluded to before,English
+alter the front surface which need to be smooth. Now it's irregular because of the dryness and your vision drops.,English
+"You can get glare and if it's bad enough, you can get confluent dryness which can essentially be a corneal abrasion; that is a geographic dry spot",English
+that can be very difficult to heal. Filaments I mentioned. Here you can see on the upper slide pictures,English
+"of these tiny, little skin tags on the surface of the cornea. They can be extremely irritating as I mentioned",English
+"and then, you can develop other areas of inflammation such as superior limbic kerato-conjunctivitis which is inflammation of the conjunctiva",English
+on the upper surface of the eyes; sometimes related to problems on the undersurface. That is undersurface of the lid and as it bangs,English
+"up and down over that surface, it can cause chronic irritation. Rarely, one develops a corneal ulcer, but it can happen.",English
+"So, what are some of the aggravating factors for all of this? Well, as I mentioned, there are extrinsic things. Weather.",English
+"People who live in aired climates, dry climates are more severely affected, because there's no humidity. You want to live in a place where they're fish in the air.",English
+(public laughing) Temperature. Somebody living in Arizona is going to be really have a problem with this.,English
+"Some of the activities which require attention at near. Like I mentioned, computer work, reading, driving all decrease your blink frequency.",English
+"What do you do about that? I mean, we all have to blink, but who thinks about blinking until your eyes tell you to blink and so, we want to be proactive in this,",English
+"because as I tell, many of my patients, if you're putting drops in or you're doing something when your eyes bother you,",English
+"you are already swimming upstream. It's already a problem and it's hard to recover, so what you'd like to do is figure out a way",English
+"to be proactively blinking and this is my suggestion to my patients. One, if they're reading a book, make a bookmark",English
+that says blink on the top and stick it a few pages back from where you are. It's in your sphere of reference and you may see it,English
+"and it may help you blink. Two, if you're on the computer, put a little dot or something (mumbles); or something up there",English
+"on the side that means blink to you. I tell them, if you are working you (mumbles) workstation at work, do not put the word blink up on the computer,",English
+"because people will think you're nuts. (public laughing) So, it's got to be your message to you to help you remember. If you find a tear drop or a lubricant",English
+"that works for you, be proactive. Don't be afraid when the doctor says, I think you should put these in hourly",English
+"and you go, doc I got a life. Put them in hourly to see if it works or put them in every 30 minutes to see if it works.",English
+"If it works, then you taper it back to the level where you get the most relief with the least amount of effort, but if you give up by only putting it",English
+"in four times a day and say, this doesn't work, then you've short change yourself on a possible solution. And then, remember that other medications",English
+"that you may take can also aggravate your dry eye. If you asthma or you allergies or you have Parkinson's, medications for those also dry the ocular surface",English
+"and can cause problems and Parkinsonian (mumbles), not only Parkinson's itself will decrease your blink frequency, but some of the drugs that are used",English
+"can decrease the tear film, as well, so generally, both eyes are affected, but one eye can be more affected than the other",English
+"and typically patients will say, well, you know, my left eye is bad, but my right eye just knock my socks off, so you look at it and often times,",English
+"you can see a correlation. Sometimes, there is no evidence of dryness on the ocular surface,",English
+"but they're symptomatic and when that happens, I have to be thinking, well, maybe it's the occult inflammation",English
+inherent to GVHD that's causing them their problems and that leads me on a different of treating them initially. These can be independent of other manifestations of GVHD,English
+or they can become; they can be part of it. They can follow other manifestations such as your (mumbles) or GI problems and they can also,English
+"if the GVHD systemically is quiet and all of a sudden you start having a problem with your eyes, it could be the heralding of a flare-up of GVHD.",English
+"Now, often times, colleges are just looking at the systemic problems and I have to say that I'm a big advocate of one myself working with",English
+"the oncologist and I regularly write letters to them letting them know how my patients are doing and whether they're having flare-ups,",English
+but I have a luxury of having a really good relationship with city of hope hematologist that I work with and they know that having not had someone like my team,English
+"that I work with who is responsive, because before we came on the scene, these patients were going into the community",English
+and their doctors were not as responsive in part because the low back pain problem. Okay?,English
+It's throw drops on it. A lot of practicing ophthalmologists don't understand GVHD. They don't understand the steps.,English
+They're often times quite busy with surgical practices and they don't have time to spend with the patients and listen to them.,English
+"How do you treat? Well, you can treat either locally or systemically or both and that's why it's important to communicate",English
+"with the oncologist, because the oncologist may be called upon if I am not able to turn something around that I think needs maybe some increase in prednisone",English
+"or I think it's heralding a GVHD flare-up, I need to communicate that with the oncologist and frequently with that communication,",English
+you get an understanding that I'm not crying wolf. I think you have to try this whereas there have been,English
+"situations where and I still get this where the oncologist says, I don't really think we need to bump this up. In fact, I'm going to taper it, so we see what happens",English
+"and sometimes, it's not good, but if you can do it locally, it spares having to use systemic drugs, which is always a good thing if possible.",English
+The treatment goals are to treat the underlying disease if there is a flare-up or to reduce the symptoms and that's what we're doing locally with topical medication,English
+"and we can often do both at once or may need to do both at once, so if you have a systemic flare or site-threatening problem, we add or increase",English
+systemic agents as necessary and that may include corticosteroids or Prednisone. Other forms of immunosuppression,English
+"that spare the body; the aggravation of Prednisone includes cyclosporine A, tacrolimus, a sirolimus and mycophenolate.",English
+"There are biologics and photopheresis as possibilities, but those are sequential steps down the road if the early ones do not work.",English
+Let's talk a little bit about the local treatments. Topical steroids. They work well in many patients.,English
+The downside of (mumbles) and some of the other ones are that you can be prone cataract formation if you are using them for a long period of time,English
+"and you can develop glaucoma in a certain subset of the population who are called steroid responders. That is if you put steroid on their eye,",English
+"their interocular pressure goes up and they can be prone to glaucoma, so any time you go on that, you have to be; what you have to let",English
+"the ophthalmologist know, is there anybody in you family who has a history of glaucoma. Have you ever been treated for glaucoma?",English
+And have you ever taken topical steroids before for any other reason? Perhaps for cataract surgery or for some ocular surgery that you had as the younger person,English
+"and did you have problems with steroids? All have to be taken into account, because you can make allowances for by using certain types of steroids.",English
+"These can come in drops and ointment forms, so we have a little bit leeway there depending upon the individual.",English
+Another form of topical immunosuppression is Cyclosporine or Restasis. I'm sure many of you have heard of Restasis.,English
+You've all seen the pictures of the beautiful woman with twinkling in her eye that's put the drop of Restasis in her eye for dry eyes. She does not have this problem.,English
+"(public laughing) And typically speaking, Restasis has been disappointing for a lot of GVHD patients.",English
+I will tell why it may need to be done as part of a sequence of events leading to the ultimate hopeful victory in a few minutes.,English
+"Serum tears are quite beneficial in a number of individuals. Now, this is where you blood is drawn from your vein.",English
+It's spun down by a pharmacy and put in the serum. The clear serum is put into eye dropper containers and you use those serum tears four times a day in your eyes.,English
+"It's quite good for people with the Filamentary Keratitis and it can be wonderful for other individuals who'd maybe not have Filamentary Keratitis,",English
+"but have other symptoms, dryness and what not. Serum has a lot of beneficial factors and we don't know why totally, but they seem to work.",English
+The problem is they're hard to get. It has to be done by specialized pharmacies. Compounding pharmacies are becoming more and more difficult,English
+"to one, find and two, to perform this task. We have asked. I have been on a personal mission to try to get the hospital",English
+"where I work to use or to somehow develop the capability in the protocol for doing serum tears, because the patients",English
+"are there regularly. They're getting their blood drawn regularly, take another pint and get a process and that way, they have it,",English
+"but it's not as simple as that apparently, but it's something that if you can advocate for and either with your ophthalmologist or the oncologist,",English
+it can be worthwhile. There is a lot of artificial tears out there. There is more artificial tears than there is to base products and that just means,English
+that there is no one product that's good for everybody. There are ones like Refresh that is good for the individual that walk down with me,English
+"this morning and there are those that need something more viscous, but don't want something so viscous that it blurs their vision,",English
+"because they want to work and they want to be able to see, what not and there are others who; that will help the individuals who are so photophobic or light sensitive",English
+and just want relief that they don't care about the decrease in quality of vision. To those individuals I will ask them to use,English
+"the viscous solution and then, maybe, chase it with something less viscous, so you still get a barrier; a little coating, but it dilutes it out.",English
+One of the benefits of lot of these tears is that most of them come in non-preserved form and that's really good.,English
+"It looks like a lot of people who are older don't like the non-preserved, because they have Arthritis or it's too difficult to twist those things of and it looks",English
+"wasteful; many of the products now, you can recap and so, it's just not one use and throw away. Another point is it learn how to put tears in.",English
+You lift; you use as a guide and you can figure out where the tip of that dropper or that bottle needs to be in your lower tear film to get it into that pocket.,English
+"It's not irritating, but it's very, very. It's soothing and it's much more economical. So, what else can we do?",English
+"Well, we can try to keep the tears around longer. I alluded to that by occluding the puncta, which is the entrance to the nasal (mumbles)",English
+"where the tears drain and we can do that with small plugs like you see right here, there's a little plug. It's a silicon plug mounted on a stylus and you insert that",English
+"into the puncta and then, you push the little button and the insert pulls back and it leaves the plug",English
+"which essentially is like a small toggle bolt which goes in there and then, it can't come out, 'cause there's a; it doesn't hurt, but that's the effect of it and it's designed",English
+"to keep your tears around longer. If that doesn't work, then, there are some that go way into the nasal (mumbles).",English
+"They swell. You don't feel them, but they stay intact for about six months and lastly, one can physically (mumbles) the puncta",English
+"by either sewing it closed or traditionally, people will cauterize it under a little local anesthetic as you can see down on the left.",English
+"Do not underestimate trendy-looking glasses. Okay? This individual; well, there are a number",English
+of eyecare products out there that have gaskets around the back side that will fit to your face and keep the evaporation factor down to a minimum.,English
+I have a patient who showed me the glasses. He introduced me to them and you know where he got them from?,English
+A Harley Davidson website. (public laughing) And you can write this down. If you you go on the website 7;,English
+"the numeral seven, eye; E-Y-E; you will find a whole myriad of these types of glasses and you can;",English
+so he took a selfie and he sent it to them and he sent them three pairs of glasses which he thought might work. He said send the ones you don't use back,English
+"and the gasket on the back is made of foam, but you can pop it off so that you can wash the glasses and then, pop it back on",English
+(public laughing) Thank you. Got to have this. This is why you.,English
+"Okay, let's talk a little bit about contact lenses as we wind up, so bandage contact lenses are quite helpful for abrasions. They are named bandage, because if you have an abrasion",English
+"on your skin, nerves are exposed and it hurts. Wind bothers it. Sun bothers it.",English
+"Rubbing up against things bother it. If you put something over that, you're covering up the nerves and decreasing the stimuli to it.",English
+"Well, that's what a bandage contact lens does. It has no value as far as vision goes in terms of correction.",English
+It's there to cover up the cornea and cover up barrow nerve endings. The downside of these in dry eye patients,English
+"is that they are sometimes difficult to keep on the eye and because they have a high water content, you put them on a dry surface and bias moses",English
+"the water leaves the contact lens and will dry up and tighten up on the cornea, which then makes taking the lens off a little bit",English
+"problematic and it can actually worsen your symptoms and predispose you infection, so in really severe dry eye patients, it is not a really good option.",English
+"However, there are scleral lenses which do provide a wonderful alternative to this and we'll talk a little about that.",English
+The problem with scleral lenses is that not all (mumbles) are facile in fitting them and it does require a certain amount of sophistication,English
+"to fit them. The goals of these lenses are one, to promote healing, to give mechanical support",English
+"and protection. Because you put fluid in-between and I'll show you a diagram in just a second. You put fluid in them, it maintains hydration of the cornea",English
+"and it can actually heal some of the problems that we've seen on these picture. It's covering the surface, so it's covering up",English
+"those nerve endings and it therefore relieves pain and hopefully by virtue of all that, the side-effect is good vision.",English
+"Let me go back. So, you can see here how big these are. This is the upper edge of this lens and from here",English
+"to the edge of the cornea it sits on the sclera and then it volts of cornea. I'm sorry, somebody said something?",English
+"So, one specific type of scleral lens that I have become quite familiar with and have contributed some, too",English
+"in terms of clinical trials, is the PROSE lens. This comes out of the Boston Foundation for Sight in Boston and it's gone through a number of name changes.",English
+"It was the Boston lens. I can't even remember the number of lens names they had. Then, they finally settled upon PROSE which stands",English
+for the Prosthetic Replacement of the Ocular Surface Ecosystem. Why?,English
+Because they were having difficulties with insurance companies who wouldn't reimburse contact lens. A lot of exclusions are for contact lenses.,English
+"I mean, just straight off. It is contact lens? We're not going to pay for it. So what the Boston Foundation for Sight has tried to do",English
+"is to show and underline the importance of this as a therapy and so, it's to restore vision to support the healing.",English
+"All the things that we talked about and it can be really, really helpful in this regard. Here's what it looks like.",English
+"You can see the part that sits on top of this (mumbles) and then, the optic volts over the cornea and there is a fluid reservoir between the lens",English
+"and the cornea, so you can see that one, it's not touching the cornea, so it'll fit well. Two, it's hydrating the cornea.",English
+"It's healing it because of the hydration and it improves the vision, because now, this front surface has become the front surface of the optical system of the eye.",English
+"It is no small device. You put fluid in here and before you put it in, it's not like putting your regular contact lens",English
+"where you can watch yourself do it in the mirror. You actually have to bend over and learn how to insert it, because you've got fluid and if you did it the other way,",English
+"we'll trade them out at 12 hours. So, here at the bottom you can see Filamentary Keratitis before the lens went in and then, four hours afterwards,",English
+"you can see how it's resolved with just the hydration. Again, same picture and you can see how debilitated this individual is with photophobia and light sensitivity",English
+"and decreased vision. Now, there are newer generations of these lenses. Problem with the PROSE lens and some of these lenses",English
+"is that you can only customize certain quadrants of the sclera with its fit. Now, there are individuals who will glaucoma surgery",English
+"or have little bumps and things on their sclera, which cannot be addressed in the usual way and you can see in this picture,",English
+"this is a cornea. This is an imprint much as one would take what you do with dental imprint and I'll show picture of it in just a sec,",English
+but this was the glaucoma valve that was placed on the sclera; this would be very difficult to fit and you would get air in-between on the sides,English
+"if that were not overcome, so it's individuals who have scleral irregularities that the next call for evolution has come",English
+"and this is an individual who places an ocular surface mold like a dental implant on the surface of the eye and when they take that off, they then go ahead",English
+and design the lens based on that imprint and you can see on this next picture how some of these; you could see the irregularity.,English
+"The elevated surface here as well as over here and this picture which is called an OCT which is a cross section; here is the lens,",English
+"here is the bump on the sclera and you can see how this is alluded to just a mold right to it and overcome that, so this has expanded our ability",English
+to treat GVHD patients who may have other ocular surface problems separate and distinct from GVHD. The predated their development of the dry eye.,English
+Insurance issues can be problematic. Right? Therapeutic contact lenses are typically covered,English
+"cosmetic or not and so, it becomes a real process to try to educate the insurance companies that this is not a cosmetic lens.",English
+It is a therapeutic lens and that is you have to advocate for yourself; the doctor has to advocate for you. There are many standard letters and templates,English
+that we use to write to the insurance to get pre-authorization so that you're not on the hook for the cost of these lenses which can be high before you know how much you're going to be on the hook for.,English
+"They require appeal. You have to be stubborn. You got to stay with it. PROSE, in my opinion, is a medical treatment",English
+and should be covered and think that this will continue to evolve this as the insurance business becomes more educated about it.,English
+"Now, the doctor needs to document the treatment steps. Now, this gets back to the point I made about using Restasis even though we know Restasis",English
+"is not helpful in a lot of patients, because they want to know when they look at the record on the insurance; people are looking at the record, they want to say,",English
+have you used artificial tears? Have you used Restasis? Have used topical steroids? Have you had punctal plugs? Have you done this?,English
+"Just all the things that lead up to this big ticket item, they want to know that you've done it rather than jumping straight to the big ticket item, so when someone says, you need to try these",English
+"and you're saying, I really want to get to the end point, there's a reason for this and it's for the betterment of your pocket book so that it's not such a strain",English
+although there are ways to expedite this. There was an online survey that was done about the clinical experience of patients with ocular,English
+GVHD and you can see these here; you can see that over 95% of them had severe discomfort of the people (mumbles) ocular GVHD,English
+"with difficulty reading, worried about eyesight, having problems with quality of living; their daily life, hobbies and with night driving.",English
+"Treatment response when we ask them or when it was asked; I didn't ask them. When it was asked was that with topical immunosuppression, punctal plugs, oral antibiotics, fish oil,",English
+"flaxseed oil, all these things that we typically think of; the group that we interviewed said, zeppo. Didn't help a bit.",English
+"Lubrication alone helped 7% of them. Scleral lens therapy 72%. So, the Boston Foundation for Sight and I've heard",English
+"this been said a number of times, they consider ocular GVHD dry eye the low-hanging fruit for the use of PROSE",English
+"that there is such a great response rate positively with ocular GVHD in these patients and the PROSE that it's almost what they call a no-brainer,",English
+"so it's always in my back pocket as a positive thing and when I speak to somebody the first time and giving them the spectrum of what they can expect, I always say,",English
+"we're going to start with tears, we may end up over here, there's a whole lot of possibilities in the middle, but I want to be able to give them",English
+"what the spectrum is and there is light at the end of the tunnel given the statistics that we have, so in the future, we expect better technology",English
+"and as we get better technology, it'll be less expensive. We'll enhance our fitting process. That'll be decreased cost for manufacturing.",English
+We'll have better experience on which patients will be appropriate for which types of technology and treatments.,English
+I think there will be greater availability as newer optometrists come online and develop interest in this and that there will be,English
+"an increased awareness of this therapy by both ophthalmologists, optometrists and oncologists. I've been doing this for 10 years with the PROSE therapy",English
+"and it is a constant discussion to let people know about this; the other healthcare professionals know that there is a possibility out there, so in summary,",English
+"just to reiterate, despite really good care and attend of lubrication, ocular GVHD patients with dry eyes can have foreign body sensation, discomfort,",English
+"poor vision and the important thing is seek treatment; seek it from those who have experience and who have an interest in helping them,",English
+"so in conclusion, in was in Chile a year and a half ago, giving a talk about the Scleral lens and it's evolution and I went to lunch",English
+"and I saw something that caught my eye and I thought, huh, this looks vaguely familiar, so basically, the scleral lens could be",English
+"a scleral lens and a salad bowl and so you can get nutrition from it, as well. Thank you.",English
+"- [Man] Thank you Dr Irvine. (public applauding) So, we have some time for questions. If you have a question, please, raise your hand",English
+"and we'll get the mic to you. - [Man] I have GVHD and one of the things that I have is light sensitivity, that's why I wear these covers",English
+"on my eyes, but as well, do you know of any eye drops that, 'cause I have tried about six different eye drops. I've used Restasis and Xiidra and none of them worked,",English
+so my question to you doc is is there any type of eye drop or lubricant that is a little thicker than like sustain and all those others.,English
+"- [John Irvine] Yes. So, the question is despite the use of Restasis which is immunosuppressive drug to try to improve",English
+"the volume of tears and a newer medication called Xiidra which is (mumbles) which works along a different pathway, one can still not get the relief that you would like",English
+"and so, what are some other slightly more viscous drops that are available that might help you and as i alluded to and I have no; my disclaimer",English
+"is I have, unfortunately, no financial commitments to any of these companies or relationships, but I have found that something like Sustain Ultra",English
+which is a little bit more viscous. I carry a bottle of Sustain Ultra in my pocket and I reached out and I grabbed the patient's finger,English
+and I put a drop in there and I have noticed the viscosity of it especially if they've been using refresh or something which is just like water.,English
+"It doesn't blow your vision if you use Sustain Balance, that in my opinion doesn't work as well and Regular Sustain is a little too milky",English
+"and will blow your vision, so the Ultra in my opinion; I mean, I have dry eyes and it's my go to drop. There are others, GenTeal is good.",English
+"TheraTears is a good one. There are all kinds of viscosities for these, so getting back to my first point,",English
+do not be discouraged. There's plenty of opportunity in the pharmacy. Just keep track of the ones you use and ask the pharmacist for the (mumbles) to severe dry eye.,English
+"and then, chase it couple of minutes later with a less viscous one which will dilute it, but will still give you the lubrication",English
+or they just clear and then you have to get glasses on top of that for the reading or for the eye sight. - [John Irvine] Right.,English
+Are they able to get to a pharmacy that can do the serum tears? Is is the scleral lens dispensary close to them?,English
+"with muscus production and what not that I haven't gone into, but while it improves your vision, it's not a panacea; there are some problems",English
+"those and what they do. There's a lot of models, but we won't talk about this in this presentation. Basically they simply amplify sound. Then we can change the sound transmission",English
+"itself and here so called middle ear prostheses or middle ear active implants are important because for example, if we miss the ossicles, we can replace them by titanium prostheses,",English
+"and this device has certain outlets where you can kind of shoot electricity out that directly stimulates the auditory nerve, and so you kind of circumvent these hair cells",English
+that usually make the transition from the mechanical stimulus to the electrical stimulus. It's really great that this actually works. What is gene therapy? So the idea is that,English
+"you kind of introduce normal genes into cells, and with those you can then replace missing or defective genes so that the cells work again as they should. There's about 100 genes",English
+"that cause non-syndromic hearing loss that could potentially be targeted with gene therapy. When we compare our field - the field of ENT, you know, ears nose and throat, to ophthalmology",English
+"it's relative sad because right now there's about 30 gene therapy trials for 10 diseases of the retina (so the structure in the back of the eye); however, there's only one for",English
+severe to profound hearing loss going on. The ophthalmologists already have one drug FDA approved since December of 2017. So we really have to catch up in this way.,English
+"This is an image that shows how a virus transduces a cell, so how a virus gets taken up by a cell. This is an adenovirus. Most of the talk is about an adeno associated virus, which",English
+"is a relatively similar virus, and the main difference is with adenovirus you can cause a transient expression of the gene, with adeno associated virus usually the gene you want",English
+"to replace stays there pretty much until the cell dies, so pretty much forever. At least that's the assumption right now - at the moment we don't really have the data in clinical",English
+trials that show how long. There have been studies that have shown this expression for several years over the decades. And this adenovirus attaches to the cell and,English
+"is taken up by the cell, and the virus itself cannot replicate or double itself basically so what it needs is the machinery of the cell to actually kind of – yeah, replicate itself.",English
+"So what it does is that it delivers the gene that it has been loaded with into the inner part of the cell, and then the effects take place that we could then potentially use for",English
+"the gene therapy. So what we briefly have to talk about genetics as well, because those have implications for therapy, and so basically every human gets",English
+"one gene, so it has two copies of a certain gene. And one is received by the mother, and the other one is received by the father. And if just one of those two has to be affected,",English
+"then we are talking about a dominant disease. So one of the two has to be affected so that the patient has the disease, and then it's a dominant disease. However, if both have",English
+"to be affected, then it's a recessive disease. So dominant would mean my father gives me a faulty gene, my mother gives me a healthy one = disease. Recessive disease means both",English
+"my mother and my father have to give me the faulty gene, so I have the disease. That is important because that means how we can or that playing a role regarding how we can treat",English
+"these diseases. So the simple gene addition would be relevant for a recessive disease, because in recessive cases, as we've just discussed, we basically",English
+"have no functioning gene, and so the delivery of a copy of a normal gene could then just kind of make the cell function again. That's what has been done in most animal studies",English
+"so far. However, in a dominant case we can also use so called gene we cannot use the gene addition therapy or strategy, but here we'd have to",English
+"use a gene disruption therapy because here we have this dominant gene that will independently if there's a normal copy will still produce the faulty kind of protein, the faulty mechanism,",English
+"and so we kind of have to target that somehow. So by targeting that, the remaining gene can then take over. And the last part is the gene editing part",English
+"where with a recessive or dominant missing, that's a completely irrelevant mutation. If you have a minor part affected, you can then use a so called CRISPR Cas9, so the gene scissors,",English
+"again, to replace that specific part of the gene. The functional gene addition is also something that we'll skip for this talk. So how would the gene therapy work specifically",English
+"for the inner ear? Well, we've talked about like how the hearing works, and so if we cut a piece of the cochlea out here and look into it, then we see three fluid filled chambers.",English
+"The names are irrelevant, but in the scala media, we have the inner hair cells and three rows of outer hair cells. One row of inners and three rows of outers. The inner hair cells",English
+"make this transition from the mechanical stimulus to the electrical stimulus, while these outer hair cells have more of an amplifying function. And in one human ear we have about 15,000",English
+"hair cells, and it's the same cell type in the vestibular system, so the five organs we discussed before with the utricle and et cetera. All of these have these stereocilia",English
+"on top and the hairs give them their characteristic look and name and we'll see a few pictures afterwards. What's interesting in birds, for example, these cells regenerate without any problems, while in mammals including humans they don't.",English
+"There's just one exception. In 2014 researchers found out in neonatal mice, newborn mice, some of these hair cells do regenerate, and here supporting cells come into play. We'll",English
+talk about them later. Those are the cells right next to the hair cells here. And one potential surgical approach for gene therapy is the round window here. That's also,English
+"the place where usually the cochlear implant is introduced, at least nowadays is introduced. So that would be a relatively straightforward process for the injection.",English
+"We've talked about the success story of the cochlear implant that has really enabled so many patients to actually learn language and everything without any problems, however, there's still some issues, namely the natural sound perception (so sound perception in general",English
+"is not that great), frequency sensitivity (enjoying music, for example, is relatively hard), and speech discrimination in noisy environments. In a bar, for example, with",English
+"a lot of background noise, it's really hard with these devices to actually filter out that one voice. The goal of gene therapy is to kind of restore natural hearing.",English
+"And this is the mouse inner ear, the mouse cochlea. It's relatively similar to the human ear. We have the turns up here where we hear with the hair cells, and we have the oval",English
+"window here and the round window that could be used for gene therapy and is being used for gene therapy by a lot of groups. It's right here. I'm sorry, I'm just trying to",English
+"remove this bar here from my screen. Okay. So the first study that I'm trying to or I'll present is the VGLUT3 study, and it's one of the first rescue studies in mouse models.",English
+This VGLUT3 is a receptor in inner hair cells and that's what we discussed in the last few slides. It's right there at the connection between inner hair cells and the auditory,English
+"nerve. Mice lacking this transporter are actually deaf, and it's only relevant in a few human patients but what makes this model interesting or what made these models interesting is these adeno associated viruses that I mentioned",English
+"before actually specifically target these inner hair cells, so that's what needed here. What's a relevant fact is these mice in general usually develop hearing around two weeks after",English
+"birth, whereas, humans are born with hearing. So that is interesting in terms of timing afterwards because potentially that would mean that if a mouse is injected immediately",English
+"after birth, in humans we have to go into the womb or like the baby would have to be injected in the womb. And if we see that these mouse pups who are",English
+"lacking the transporter are injected with VGLUT3, then they actually did not go deaf. So this is a slide that or a figure that will be used in several of these studies, and what",English
+"you can see here on this Y axis is the loudness level. Down here it's like a whisper basically, and up here it's like if a jet engine would start right next to you, so very loud.",English
+"These curves that you can observe are functions of basically an objective hearing test, so once you see the curve, you can tell that the mouse heard that. You can see in wild",English
+"type mice, regular mice, healthy mice, we have these curves somewhere around here. In knockout mice, the mice affected by this disease where the transporter is not there, we don't",English
+"have any response at all, so those are basically deaf. In these rescued animals where the VGLUT3 was injected with a virus, we can actually get responses again. It means that these mice",English
+"heard because the VGLUT3, the specific transporter, was introduced into the inner hair cells, and in a different way that is depicted here, you can see 95 decibels is really, really",English
+loud - no response at all while the wild type animals and the injected animals are actually pretty good. So that was a really remarkable paper that came out in 2012.,English
+"What other functional rescue studies have there been? Quite a few published in the last few years. However, what is common or what is like the same in all of them is that they",English
+all talk about the inner hair cells and outer hair cells are really hard to target and you can see that in these images where you can appreciate that all of these viruses kind,English
+of just target the inner hair cells while the three rows of outer share cells that should be out here somewhere remain dark. What is that dark part? So everything that's green,English
+"lights up with so the lighting up means that it's GFP, green fluorescent protein. If a virus transduces a cell, gets into a cell, you can tell what it expresses, and basically",English
+it expresses this green fluorescent protein and then the cell lights up. That is something that researchers can use to determine where the vector goes.,English
+"For the rest of the talk, you can remember green cells are good, because that means that the virus got into the cell, and we could potentially deliver something into the cell including the healthy gene. So in this 2011 study, you can see that they tried five different",English
+"serotypes, and for all these adeno associated viruses, these inner hair cells were the most effectively transduced cochlea cell types. So it’s good that it worked in this specific",English
+"disease model before, but the difficulty is to get these outer ear hair cells I mentioned before. Here a virologist comes into play, Luk Vandenberghe",English
+"and the institute affiliated with it comes into play. His lab looked at a computer model, synthetic AAV, so they looked at the predicted ancestor of adeno associated virus types 1,",English
+"2, 8, and 9 and those are commonly used viruses. What they were looking for was that ancestor because everybody has had a cold, and this adenovirus is actually the common cold virus.",English
+"The adenovirus and adeno associated viruses are relatively similar, so our immune system actually recognizes the similarities and neutralizes some of these adeno associated viruses immediately",English
+"before they can target the cells they should target. His lab hypothesized that this novel ancestor, predicted ancestor could actually circumvent",English
+"this pre existing immunity. They did a lot of high throughput screening, in vitro, in vitro means in the petrie dish, and injected them into mice. So you can see AAV2, AAV8,",English
+"so these conventional adeno associated viruses in these columns, and Anc80 is the new virus and you can see expression in the liver, muscle and retina, and Anc80 seems to outperform",English
+"all these other conventional adeno associated viruses. But nobody had tried that in the ear, so we did that in the ear and we tried it on something",English
+"called cochlear explants. These are like microdissections of these mouse inner ears, and we can grow them and culture and add certain viruses or whatever we want to them and see what they",English
+"do. Then in red, you can see hair cells, so a specific hair cell marker. In blue you see a marker for neural structures, and in green",English
+"we have, again, this GFP, so the green fluorescent protein, which means that the virus went there. Every column here represents one of the conventional viruses, and here the last two columns on",English
+"the right are Anc80, so that's this new virus. What you can see is that Anc80, so this new adeno associated virus, really outperforms all of the other adeno associated viruses,",English
+"and we were very happy when we saw that for the first time. Specifically, it was not only at the level of inner hair cells but also outer hair cells and supporting cells. I'll",English
+"show that to you in a few slides later. You can see that these micro-dissections are really tiny, so it's really my thumb next to it. You see these white, little dots, those",English
+are the explants. So mouse inner ears are not really very big. We then also tried this together with or this work was primarily done in Jeff Holt's lab at Harvard Medical School.,English
+"They injected mice with the virus, the most promising vectors we identified in vitro in the Petri dish. Anc80 still outperforms all the conventional viruses. They did a bunch",English
+"of studies regarding how the uptake of the virus would change the cells, and it was normal in terms of how the cells reacted and how these animals then heard and then had these",English
+"objective hearing tests in a way. Again, for you to appreciate how tiny everything is, we have a mouse pup here, and that's where you the injections then take place, so you",English
+have to expose the round window back there. It takes about 10 minutes per pup once you establish the approach. Some more images of this GFP expression. You,English
+"see along the whole length of the cochlea, we get a lot of viral expression in inner hair cells and also the outer hair cells that could not be reached with the conventional",English
+adeno associated viruses are finally transduced with Anc80 with a maximum follow up up to a month and the expression was stable which was interesting because mice live between,English
+"2 to 3 years, something like that. It depends on the strain. So a month is a pretty substantial amount of time. With the in vivo injections we showed that",English
+"from the very apex or the very top of the cochlea up until the very base of the cochlea, so up all the way to the bottom of the cochlea, so throughout the cochlea we had a lot of",English
+"expression of this virus, which is very promising, and it was so strong that we sometimes even saw it on the other side of the ear. Then we were wondering, how does it actually get",English
+"there? For that we used brain slices of the mice, so we cut the brain like this. You can see the A here, so the section is called an axial section with this human head. For the",English
+"mouse in front here, we have the snout while here we have the cerebellum, which is the posterior part of the brain back here. You can see that this is where we get the predominant",English
+"GFP expressions of green fluorescent protein expression, and you can see that these cells here take it up, and so what we think is what happened is that the virus travels to the",English
+"other side through a structure that's called the cochlear aqueduct, which is a connection between the fluid of the inner ear and the cerebrospinal fluid - that's the fluid where",English
+"the brain and spinal column kind of swims in it. That is actually known in rodents that this is relatively patent, so we have to figure out how far that is translatable to larger",English
+"animals, because that would be another hurdle until it goes into clinic because you want to avoid that it actually goes into the brain. We also looked at the vestibular system and",English
+"what you see in mouse tissue that we get a lot of green cells, so it's very positive - we can actually reach them and what's very interesting is it was done by collaborators in London, we also got it into human tissue. In some surgeries you actually have go through",English
+"the inner ear, and what they do in this case or to resect certain tumors you have to go through the inner ear and you can get access to the precious human tissue. You see that",English
+"we have this excellent expression also in human tissue, so it seems to be a promising candidate for clinical studies. Excuse me. This is another study that used Anc80 in adult",English
+"animals. In 7 week old animals they were injected through the posterior semicircular canal. That could be an approach used in humans, specifically the lateral semicircular canal",English
+"that seems to be accessible. What you can see here is that, again, in these adult animals that couldn't really be transduced at all until now with this new virus, you",English
+"get a lot of outer hair cells at the apex, not so much at the base (not so much at the bottom of the cochlea). Still relatively promising. Other collaborators at the Harvard Medical",English
+"School used this virus in a model of Usher syndrome. That was Holt's group and Géléoc’s group. What Usher syndrome is, it's the leading cause of deaf blindness and is inherited recessively.",English
+"Both genes have to be affected then. What you can see in this figure is that it's a scanning electron micrograph, so it's the highest resolution of the the highest resolution",English
+"of basically the common microscopes that you can see. What you can see on the left side here is a wild type animal, so a healthy animal. What you see in the middle is a diseased animal, so that's an animal with Usher syndrome. What",English
+"you see on the right side here is an animal that has been injected with this Anc80 that had had protein that is missing had this gene that is missing in these animals, and you",English
+"can see that the hairs to the stereocilia that give the hair cells their name, are really similar to these wild type healthy cells compared to the Usher cells.",English
+"So that was really remarkable these cells could be rescued to such an extent. They performed many additional experiments and specifically performed these hearing tests, objective hearing",English
+"tests again and what you can see here is that the control animal, so the Usher animal with the disease, did not show any thresholds at all with the hearing, so the louder it gets,",English
+"deaf animals no responses, while here on the right side - the animals that were injected did actually have relatively nice hearing. For some of them the hearing was as good as",English
+"for wild type animals, as for healthy animals. Several other studies have come out since then and like before them or around the same time, and you they targeted different Usher",English
+"models, so there's a lot of different subtypes. They all showed most of them showed rescue, however, none of them was as substantial as with this novel virus presumably because the",English
+"standard adeno associated viruses did not target, or cannot target, the outer hair cells. Are there any other approaches that allow viruses to target more hair cells? Yes.",English
+"Another lab here at Harvard is working on something called exosomes. They're small vesicles, and for patients I would describe them as “bubbles filled with information” and",English
+"secreted from cells. They enable communication between cells. These other cells then take exosomes up to process it, and these viruses have hijacked this approach to actually get",English
+"into the cells more easily. What this lab is doing now, and a very clever strategy, is they package these conventional adeno associated viruses into these exosomes",English
+"and can target more cells with this approach. Then this CRISPR Cas9, these gene scissors that we briefly had mentioned before, in a very interesting study that was published",English
+"at the end of the last year, they looked at they had a mouse model that lacked Tmc1. That's something I'll explain in a minute. I want to show you this here in this frog",English
+"hair cell you see these stereocilia, so the “hairs” of the hair cells. What you can see here is something called tip links. These are the little bridges between the “hairs”",English
+of the hair cells and this Tmc1 and this transmembrane channel-like gene family 1 is part of this gene complex here that is important to cause the kind of or the movement of these hair,English
+"bundles. In 2002 a study group created a mouse with a TMC mutation, and it showed that it led to slow degeneration of the hair cells. They named this mouse Beethoven mouse, which",English
+is not a great name because the composer had a completely different type of deafness. This mutation is also relevant to humans and has been described in a Chinese family.,English
+"What these researchers did is they injected so called Beethoven mouse pups and compared them to controls and this protein RNA complex, so CRISPR Cas9, targets only the affected",English
+"copy of the gene without influencing the other gene. If we can get the affected copy of the gene, the diseased copy of the gene kind of out of the way, then in theory the normal",English
+"gene should take over and the cell should be functioning again. That's what these researchers hypothesized. What you can see here on the right side, so again, we have inner hair cells here, and then three rows of outer hair cells out here",English
+"all along the length of the cochlea. On the right side you see all the cells are still viable, while here on the left side the uninjected animals, so these Beethoven mice, do have",English
+degeneration at the lower part of the cochlea or the apex (or the top) is kind of still there. Then these injected animals actually have preserved cells all throughout the cochlea.,English
+"So it was a substantial rescue after the injection. Then the researchers obviously again assessed the hearing, and what you can see here, again, loudness on the Y axis - so loudest level",English
+"up here, very quiet level down here. What you can see is that these injected animals actually heard better than the uninjected animals - deaf in some frequencies at least.",English
+"However, the rescue was not as good as for the uninjected animals, healthy animals. However, this study is really proof of concept that this gene disruption be might be a potential",English
+strategy of treatments of some form of this dominant hearing loss. So far we only talked about stabilization. What about restoration actually? That is a,English
+"different an interesting difference between genetic hearing loss and age related hearing loss because for age related hearing loss, we probably need a mix of gene therapy, molecular",English
+"therapy and stem cell therapy or just focus on yeah, there's a lot of overlap between the three fields. As I said before in some of these newborn",English
+"mice, it is actually possible to make a transition from the supporting cells to hair cells, some of these mice still regenerate hair cells. And usually that's through the switch of supporting",English
+"cells into hair cells, and that's been studied extensively and several different signaling pathways have been identified by researchers all over the world. In a relatively recent paper -- and that is lost after like the maturation of the mice",English
+"- so in adult mice, you cannot transition supporting cells to hair cells anymore. However, in a relatively recent paper that also came out last year, a group actually tried to combine",English
+"several of these factors, and then was able to make the switch from supporting cells to hair cells, so you can see here in blue the hair cells, the inner hair cells and three",English
+rows of outer hair cells and here after noise damage they would be lost and could be regenerated after the mix of different factors. So this group shows that for the first time in adult,English
+"animals, which is very relevant for age related hearing loss. The only clinical study at the moment that targets or that is focused on gene therapy in the inner ear that I mentioned",English
+"before is actually targeting ATOH1. That's a study that the lead investigator, the principal investigator is Hinrich Staecker in Kansas, but they also have sites at Johns",English
+"Hopkins in Baltimore and at Columbia in New York. So to summarize, gene therapy is a potential solution to restore kind of natural hearing",English
+"and hopefully millions of people affected by this hearing loss, especially hereditary hearing loss. Anc80 seems to be potent viral vector for cochlear gene therapy and several",English
+"mouse models that could be rescued and the best results for the major deafness genes at the moment seem to be achieved with Anc80, because with Anc80 you can also reach the",English
+outer hair cells and not just the inner hair cells. Gene editing with CRISPR Cas9 is feasible as this last study showed that was published,English
+"at the end of last year, but now the really important part for the patient and also for the physicians that are confronted with these questions all the time: “What are the hurdles",English
+on the way to the clinic?” As we saw in the mouse model with the expression in the cerebellum (so in the brain) - it's really necessary that there are studies in,English
+"larger animal models, specifically for dosing, because the inner ear is so much bigger in larger animals and humans compared to mice, and also the safety issues that I mentioned",English
+before. It's kind of the last step prior to starting multiple independent human experiments. And what was interesting in the study that also came out last year was that a group showed,English
+that they could actually inject a sufficient volume into the inner ears of rhesus monkeys without worsening this objective hearing. They have these ABRs where they can then detect,English
+"the vector correlation, vector result correlation, is under 30% between mice and humans, while it's over 75% between monkeys and humans. You can really see the result.",English
+"Like, I'm also not a big fan of large animal experiments, but if you look at these results, then it really seems to be necessary to have a larger animal model to be sure that what",English
+"goes into human studies that is, yeah, associated with so much like risk, et cetera, can actually work and in vivo as well and humans as well. Another question is can you specifically target",English
+"certain cell types? A way to do that is to give the vectors a kind of a different key. This key is called promoter scientifically, because for some diseases you just want to",English
+target inner hair cells for some diseases and you want to target outer hair cells for some diseases and you want to target neuronal structures. If you have the keys for all the,English
+"different cell types, it's nice to be able to kind of customize a treatment for every patient. For these adeno associated virus vectors,",English
+"the size of the gene you can actually put into them, there are some approaches to try to circumvent that problem. Excuse me. Try to circumvent the problem with very promising",English
+"results that haven't been published yet, but I heard somebody talk about it the other day at a conference. Yeah, there's several options that hopefully can avoid this issue. And then",English
+the time window is another very important thing that I was talking about. The degeneration of cells progresses in several animal models or in many animal and human,English
+"models, human diseases. So the question is, do you really have to treat patients in the womb, or is it sufficient to kind of do it after birth? Would the results be better in",English
+"the womb, and if it has to be in the womb it's associated with a lot of risks and it's really, really tricky to actually get that into the inner ear. Then also the treatment of age related hearing loss. Are these results from the one mouse",English
+"study actually translatable, and what are the results from this multi centered trial I mentioned before beyond the gene therapy trial in humans at the moment. And what's",English
+"really exciting is most gene therapy labs have now ordered this virus, and we really hope to accelerate the translational research, and then there's several more applications",English
+"where definitely more research is necessary. And with that, I'd like to thank all the collaborators that have worked with us on gene therapy projects and all our funding agencies and as Nancy",English
+"said, I did run the Boston Marathon two days ago, and it was really horrible weather. If you want to support our research, then you still have time until April 30th if you click",English
+"on that link you can read some more about me and why I decided to kind of try this marathon. It was my first marathon. Yeah, I finished it. I was very happy with",English
+"was very interesting. It provides so much hope, so promising, this research. Lauren said, if you get a cochlear implant, are you not a potential candidate for gene therapy?",English
+"they started to implant both sides of the both ears of the patient. When that first started, then some researchers said this is madness, and you have to preserve",English
+"make like any predictions when it will be ready, so I am not sure how many questions I answered there, because that's usually a standard question that I get.",English
+"and the criteria for the patient selection are very strict. In the first studies you really have to determine what works in a very small patient pool, and then if it works in",English
+">> LUKAS LANDEGGER: Also after the big paper was published with the virus, I received a lot of e mails and all the collaborators received a lot of e mails. People really appreciated",English
+"that people are willing to really participate in these trials, and hopefully we will be there soon. Right now, unfortunately, there's only this one trial with very limited criteria.",English
+"and they target it. However, a lot of diseases affect both inner and outer hair cells in that these conventional vectors seem not to work so well. That's why this new vector seems",English
+"that's personally, because based on the gene that's affected, it might tell you how will I hear in like ten years? How will I hear in 15 years and so on? You can kind of see",English
+I still have to finish my residency and so on. So I'm kind of hesitant to answer this question and would rather recommend seeing somebody who really has experience with hearing,English
+"hair cells, will the changes in the brain gradually be reversed? >> LUKAS LANDEGGER: That is an excellent question as well. The question regarding tinnitus,",English
+"central gain is just like amped up, and then the brain kind of creates this noise itself. In tinnitus even if you cut the auditory nerve that connects the inner ear and brain, then",English
+"So there's some very interesting tests that you can do with mice to figure out whether they're dizzy. You can kind of film them from the top of the cage and see how they run, or you can put them on a rotating rod called the rotarod and determine how long they stay",English
+and the NIH requires us to analyze male and female mice now because traditionally most of the studies were carried out in male mice because they have fewer hormonal influences,English
+"that play a role in noise exposure in general. What we did for the in vivo studies is we tested it in male and female mice. In vivo studies means the pups that were injected,",English
+"we tested the male and female mice for the so that was the same number, and pretty much the same effect. For the in vitro studies, we don't know. At postnatal day four it's",English
+"really hard to differentiate the sex. We don't specifically look for that. After a few weeks it's relatively easy to differentiate the sex in mice, but in the",English
+"If you use camera words like pixels, that you have several hundreds of millions of visual parts takes place here.",English
+And all this retina is actually is a peripheral vision. But this is where we see the most in a high precision of the sight takes place.,English
+"And this is where the damage took place. As you can see, a kind of white kind of stuff-- it's like some kind of calcification",English
+"or some kind of death of a tissue. And this is what makes the vision completely black for those individuals, wherever these things happen.",English
+"But the interesting thing is that even though the individual has such a severe damage, the human brain compensates quite a lot.",English
+People do not realize they have these diseases because they seem to manage very well. Their day to day life they can do.,English
+"Certain things they may not see it, but they just ignore it rather than seeing it as a problem. So this is the main issue.",English
+"That's why you need regular testing need to be done. So in 1991, Huang developed Optical Coherence Tomography.",English
+That's it's my main-- I talk here. The reason is this is much better technology to understand what's happening in the human eye.,English
+"So its capable of going through the layers of retina. So for example, in this image, let's say this is the top surface of the retina you seeing.",English
+"Now what we want to go is we want to go inside the retina, and we want to see these layers. So this is a particular cross-sectional view of retina,",English
+and this is a macula. This is where we have the acute eye sight that is possible. And you can see there's lots of tissue,English
+"layers within the system. For an ophthalmologist, they are really interested in seeing how healthy these layers are, and they",English
+"really need to know the boundary layers and how they are separated. In fact, you can measure various kind of biomarkers from these layers and then actually tell",English
+how healthy this individual is. And you can see that this the case. This is not smooth anymore. And these are called drusens.,English
+"Basically, what happens in the retina gets shape changed. And in fact, even the focus of the human eye might change because the surface had changed a lot.",English
+"But then, of course, again, the brain slowly compensates these things, and people don't perceive that something has gone wrong for them.",English
+"OK, this is the healthy eye, and this is the other one. So what we really need to do is we need to find how we can find these layers.",English
+Just to give you what OCT does is light is transmitted. This is a low current light. That means you have many real lights.,English
+And then and then the light falls into the eye. And the reflected eye will have a different face depending on the layer thicknesses.,English
+"And that difference in the phase shift is what you can measure the layers. And of course, the intensities will vary,",English
+"and that tells us the layer thicknesses. And these boundary layers are known as a result of that. As light penetrates, as you can see,",English
+the reflected light from the very deep layers still outside will be lot less. And you see generally much less information,English
+"we can gather by using this kind of technology. So this device right now is about-- I think around $15,000 to 50,000,",English
+"depending on the quality of machines you have. But there's a lot of effort going on to make these devices around $5,000.",English
+"If that's the case, even small villages can afford to buy these things. And because this is a non-intrusive mechanisms,",English
+people can actually take images of human eyes without having to have [INAUDIBLE] skill bases. So it is quite practical whereas fundus one-- the one,English
+"I told you-- is, in fact, can be done using a smartphone. You can get probably around $3 or $4 lens units you can mount on your camera, and you can actually",English
+take a picture of the eye. So this is also quite a large interest to study from the fundus images.,English
+"So there are various kinds of models that come into the system. For those who know MRI, you realize that lots",English
+"of techniques in MRI, and similarly here as well, you can do time domain model, or you can use the frequency domain.",English
+Time domain is much more longer procedure because you have to adjust the lens continuously to track the signals whereas the frequency,English
+"domain is much quicker. You take one shot and very quickly the image can be captured. And there's a swept source, which",English
+"is a combination of both the time domain, as well as the aspect of the mind. The combination of that-- that gives you much better imaging,",English
+"but it's a slower process. So just to show you this is the optic disc. When you look at the depth, you can",English
+"see it's quite a concave shape. And to track the layers along these boundaries are very, very difficult. For glaucoma, you really",English
+"need to know the ratio between these red lines, and the yellow lines on the other side as well. So this basically tells us whether the person has glaucoma",English
+"or not. So that means if this optic disc is very small, they're going to lose vision again. So some of these things are very important biomarkers.",English
+So sometimes optic disc. Optic cup is inside. The ratio between these two is an important biomarker for glaucoma.,English
+"And these are the blood vessels and a really interesting thing is that by looking at these blood vessels, you can tell whether someone is suffering from diabetes,",English
+"and we can also tell whether they have-- for example, whether they have hypertension. And looking at the quality of the rest of the retina,",English
+we can also tell almost you can predict with a very high accuracy that this individual will have heart attack or a stroke in the next three to five years,English
+"with a very incredible reliability. And earlier, one of my PhD student did some work on seeing whether the correlation",English
+between the health of the retina and the person's MRI. So we looked at there's a high correlation between some,English
+"of the drusenary, which I'll show you, versus scars in the brain. So, in fact, you can, in fact, tell by looking at the eye, whether the person should have an MRI.",English
+The question is you can get MRI but can we treat them? That is a different question. But at least you know that they are prone to either heart,English
+"attack or stroke. So lifestyles might be changed. They might decide, OK, I'm not going to work on this Google project anymore and have a holiday.",English
+"So if it's going to cause stress, it's not a bad option. OK so whereas the OCT image is much more detailed, as you can see.",English
+"This only shows the surface of the retina, but here you can actually see the inner layers of the retina. So again, showing you this in a large version",English
+"and it's the OCT image looks like. And then if you do the 3D modeling of this OCT because you can get many cross-sectional views,",English
+and you can stitch them together. And you can actually make a multilayered like cake. You can see that. You can see it is a huge pit where,English
+the optic disc is basically-- all the blood vessels and optic nerve go through that part of the space of the eye.,English
+And this is the macula. And you can see a little pic here. I don't know why biologically we have such a pit. It's unclear.,English
+But one possibility is that you'll increase the surface area in a small area so that you have many more sensors located in that space.,English
+"That's the only explanation I have. But there may be other biological reasons why we have this kind of a pit in that space. Again, you can see that 3D view.",English
+You can build these layers. So now I'm going to quickly introduce some of the layers. It is not important to understand this talk.,English
+"But basically, for an ophthalmologist, these are extremely important to understand various layers. The very first one is called internal limiting membrane.",English
+"This is basically the surface of the retina. If you take a fundus camera, you basically see the top layer from a surface point of view.",English
+And then this is called choroid. Choroid is the one that supports the rest of the retina. Sometimes when people get older or either they,English
+"don't have to be very old, sometimes the retina can be detached. Detached means part-- the whole layer can come out, and it has to be put back within a short period.",English
+And sometimes what they do is to make the person legs up in the air and their head down so that the gravity will help them to put the retina back again.,English
+And then sometimes they use laser beam to stitch it-- to stick it to the surface again. And I have known people who've had retinal attachment.,English
+It is not that uncommon. Choroid is the one that actually helps your blood circulation and various fluids to they eye.,English
+And also provides you and stops any excess light so that the retina is not damaged. I don't know whether you have read some history probably,English
+"about Darwin. Darwin, of course-- first person who probably never believed the existence of God maybe Darwin.",English
+But even he had doubts looking at the human eye-- whether this could have ever evolved by evolutionary mechanism.,English
+"It's so complicated organism. Wouldn't this be possible? But of course, we know this is possible because people have found some of the fish extremely",English
+"deep oceans. There's no light, therefore, they eye did not develop there. But apparently, when they were brought to the surface, the eye started developing in those fish as well.",English
+"So you can see that this is an evolutionary mechanism. But the most important thing that I wanted to say is before we started this work, almost",English
+there is no existing automated tools that can actually separate all these 10 layers of retina. And we were the first ones to do this,English
+"to the best of our knowledge. So basically, what we need to do is we need to find these boundaries and measure",English
+"various kinds of thicknesses. And therefore, we can do that. So just to show you here. This is the laser patient sitting in front",English
+"of the this OCT instrument. So basically, you scan through this line. It's going inside the retina, and that's the image",English
+"you build from that point. This point the same as that point, and this point the same at this point. And we're going inside the retina,",English
+and we construct these things. And these are the various kind of layers. This is the choroid is that area. And sclera is that area.,English
+"OK, so the Bruch membrane is also a very important area-- this yellow part area.",English
+And that's also an important biomarker to recognize how healthy a person's eye is. So here is the fundus camera picture.,English
+"A particular patch is taken. And if you see that through a line. And you can see there's a damage here, and you see a huge cyst kind of form here.",English
+It's called microanyeueysm. Microanyeueysm means actually blood clot-- leaking of blood that took place here.,English
+And then here is the geographic atrophy that means actually the degradation of tissue. And you can see this is how it looks like with the OCT image.,English
+"And these are the drusons. These are basically some kind of white matter. So basically, this whole layer gets",English
+bulged out wherever these white spots are there. And this is a cyst-- a form of extra tissue formation that also pushes,English
+"the contours of the retina. So why these are important is like for layer thickness, for example, changing thickness of the retina",English
+"and its layers is a characteristic of many diseases, such as glaucoma, age-related macular degeneration.",English
+"For example, a glaucoma patient has 20% less of retinal nerve fiber layer and thickness than the normal patients.",English
+"In a retinal lesion, there is any scars or any damages are typically is related to diabetic problems. The drusen is actually [INAUDIBLE] stuff again--",English
+"age-related macular degeneration. Our cup-disc ratio is basically glaucoma, as I said earlier. If the cup is very small, there's",English
+"a good chance that they can actually use sight. And in fact, you can tell almost very accurately in how many years they want to lose eyesight.",English
+"And one of the ways to at least control that is to reduce the pressure in the eyeball. So to develop the SDD images, we basically",English
+need to find the boundaries of these retinal layers. And then and then we also need to find the choroid and then need to recognize the pathologies.,English
+"And then we need to measure thicknesses of these retinal layers and cup-disc radio. All of these things if you do that, we can do a phenomenal accuracy.",English
+"You can do that. So you can see these are the boundary layers. And remember, this is how an ophthalmologist has to draw the lines and need to measure the thickness",English
+before they can quantify that. And if they have a drusen and you can see these layers gets really mixed up. And automated tools to do these things is a real challenge.,English
+"And then you have these anatomical features that makes it even harder. So in these areas to track the boundary layer is extremely difficult. So for example, if you have a drusen",English
+"or is a kind of pathology. So pathology means basically that damaged tissue And again, this is the issue.",English
+"And again, I said, this is the macula. Again, the shape is like a cup, and many layers becomes incredibly thin here and attracting the layers",English
+"is very difficult. This is normal macula and then macula with the drusen. So if a person has eye diseases, basically they",English
+have a lot of changes in the structures. And then macula with the drusen and also geographic atrophy. That is basically damaged tissue.,English
+"So this is how the images generally will be taken. This is relatively less noise. This is the enhance the OCT image,",English
+"and this is the noisy SD image. Because remember, this is a passive device. And then the signals are extremely weak.",English
+"And then you're trying to do. And you can also see some of kind of shadows also happens. You can see that this is some kind of an abstractive tissue, and then the whole signal is blocked all the way.",English
+"And you can see these things are happening. So that means if you're trying to track a boundary, then all of a sudden, you have shadows coming.",English
+"And then trying to fill those things will be very difficult. And then you'll have variation of intensities, even though the tissue is very homogeneous.",English
+"But because the light has to penetrate through, the refracted light will not be the same. It varies from point to point.",English
+"And it's an a large version of shadow effect, as you can see. The boundaries are very clear here, and then it becomes incredibly shallow there.",English
+"And again, here and the challenge six is that in some of these areas, the limiting membrane is the thickness variations",English
+can be vary quite a lot and then tracking these lines will be-- you can see extremely very thin layer. Then we needed to build 3D segmentation.,English
+So basically what we do is we build 2D segmentation for each of these scans. We call them B scans--,English
+the ones I showed you. And then those lists can be stitched together to form a 3D representation.,English
+"So typically, I show you B scan in a minute. And then we have to reduce the noise, apply some filters. And then first thing we need to do",English
+is we need to find the area of interest-- region of interest. And this we do by approximately detecting at three different layers.,English
+"And that gives us the guidance where to look for these boundaries. From that, we detect the inner limiting membrane",English
+and retinal neural layers. And then remind from that and then we detect the boundaries. So first we do Weiner filter.,English
+And anisotropic filter we apply so that the same image is much more smooth. And now we can track these boundaries a little bit more,English
+"easily. So the way you can see is that-- by the way, this is called the B scan. This is called B scan, and vertical line",English
+is called A scan-- vertical line. So here this is the vertical line that I was trying to show you.,English
+So basically what we do is we track the intensity from this point to this point. This is how the intensity varies. So these points are guidelines for us,English
+"as an approximate positions of these layers. So we label these pixels, and that gives us the boundary line.",English
+"So basically, we define how to locate those boundary lines. And this is the formula we use to detect this along this line",English
+to mark those pixels. So first thing we do is once you get these approximately layers--,English
+so this is the first original image and then we do the edge pixels. We do counting the filter we run.,English
+"And then this gives you basically the gradients. And then what we do is that from this, we want to select the various kind of nodes.",English
+The nodes will be defined in the following way. That means some of these images are in a positive gradient. Some are negative gradients.,English
+"So we construct a graph using these kind of-- so basically, what we have is these are some of the boundaries that we defined earlier I told you--",English
+approximate boundary layers. And that helps us to be interested in those edge pixels that we can use for constructing it.,English
+"So the way we're going to do is let's say this is [INAUDIBLE],, and this is all boundary. So we basically, this is our area of interest.",English
+So the next thing we need to do is we need to somehow connect stitch all these pixels so that we can form the boundary layer.,English
+"So basically, what we did is that all these edges are actually mapped into a graph. So we can select our graph such that we",English
+can define the distance between various pixels or the group of pixels by constructing some kind of edge,English
+"rates we can give them. And then we basically find the shortest part. And the shortest part happens to be one of these boundary lines. So basically, these are the pixels enlarged here.",English
+You can see that all of these are adjacent pixels in a particular gradient. And then this is about another one.,English
+And there's a gap here. And there's a group of pixels like this. And now the question is we construct a fully connective graph and then we provide some kind of edge rates,English
+"between these kind of nodes. And the edge rates are based on, for example, how far away these are, how much elevation they have from the current",English
+you know you've got one of the things we try to do is these boundaries. You don't want the boundary to go up. It has to be horizontal as much as possible.,English
+"So these are the kind of constraints-- we have to do that. And of these, these are actually learned from gradius manually created their images.",English
+"So once you have that, this is what you have, and then you can see some breaks in it. Then basically we do a standard interpolation",English
+"to construct the whole graph. And this is how the final boundary's built. So here is the enlarged image, showing red color pixels,",English
+"positive vertical gradient, and these things, and the green colors are already to vertical. So basically, you can track these things.",English
+"So basically, the same image shown here for various layers, we basically repeatedly apply the same methods. So contiguously, within three by three neighborhood candidate",English
+"pixels are grouped based on the number of pixels, called pixel group. And the end pixels of each group are basically called nodes.",English
+"There's a group of pixels, group of pixels. So that's the node one, node two of those group pixels. And now we have to connect them.",English
+So the age range is defined by using these three parameters between two nodes and b-- the weight of the edge.,English
+"So phi fab to present the spatial distance. If they're far away-- and of course, the age rate is very high. And the second one is the psi represent",English
+"the slope between and b. So for example, if the pixels are vertical for example, you give a maximal weight.",English
+And then psi represents how well the pixel group contained within the boundary match. So these three parameters effectively defines,English
+"the edge weight. And here in the nodes on a shortest path boundary, basically, we connect them in this example",English
+"to show that two and three are closer. So, therefore, we make that connection. And therefore, all these pixels are basically ignored.",English
+"So basically we do the compute shortest part with that, and this is what we have managed to construct. So the data sets we use this again in this area.",English
+A lot of medical guys say they look at these images and they just do the diagnosis without really doing too much manually computing.,English
+"They only do the manual graduation for publishing papers. But in the actual diagnostics, they just look at it. OK, this is the problem, and this is how they do it.",English
+"But for large-scale studies, you can't have ophthalmologists to visually inspect every image. So you need to do that.",English
+So we have 20 subjects with the various stages of off the eye diseases they had. We have 11 B scans.,English
+"That means 220 we had. There are 10 healthy subjects, 10 B scans per subject, and about 100 B scans we have.",English
+We have Centre for Eye Research in Australia. It's quite a large publicly funded eye research center. So they've given us some data sets.,English
+15 subjects having varying sets of age-related macular degeneration. And we have 49 B scans for each subject.,English
+And each scan is in the image size of this many thick. Middle five B scans for each subject has been manually segmented.,English
+"So this is the original image, and then somebody patiently sits together and then draws these boundary layers for various images.",English
+"We haven't shown all the 10 layers, but only some of them are shown. So there are various people have done that.",English
+"A lot of attempts has been happening for the last 5 to 10 years in this area. And you can see, this is the real manual segmentation.",English
+And you can see now cannot detect the boundaries properly. And you can see the this particular layer is completely misclassified by this method.,English
+"So and again, this is the [INAUDIBLE] this is one of the state of the art method this also failed badly because this is what it should be.",English
+But he was tracking along those lines. And [INAUDIBLE] is another method all of these methods are based on intensity-based algorithms,English
+"with various kind of approaches they have done. Again, drusen area, green boundary, was not tracking properly.",English
+"For example, it should be on top of versus below drusen area. The IOM method is, again, missed--",English
+"this particular layer, completely misrepresented. And this is Aurora method-- again, similar problem.",English
+"So where is the shortest part method has done exceptionally well in all these areas? When the image is very clean, it's no problem.",English
+"All the methods do pretty well-- only when there are diseases. That's exactly where you really want to do segmentation well. All those methods have failed, and this seems",English
+"to track exceptionally well. So this is just a comparison. This tells you with respect to the manual segmentation,",English
+how much deviation these layers went through. This is effectively at each pixel position. You have about 14-pixel positions,English
+drifted by these methods. Whereas all method can see if it's in ballpark within two pixels on average are compared to this approach--,English
+"16, 7, and so on. So these paper appeared in last year or day with 2016 actually transactions.",English
+"And similarly, choroid-- also, we could do that. So I don't want to go through that. This is much harder because of the intensities",English
+are much more difficult. So you really need a good intensity normalization. That's basically what we did and were able to do to properly.,English
+"And so we did 2D segmentation for this. And again results were very, very accurate compared to some of the previous methods.",English
+"OK, The tracking has been very good, irrespective of some of the pathologies in the eye.",English
+So we were able to do 3D segmentation as well based on the 2D segmentation. And then what we do is we take these layers,English
+and then do the correlation between layers and then and then basically mapping to 3D. So these are the three destructors.,English
+"The student was exceptional. The guy built the whole system. And the ophthalmologists were are really impressed, and now they are actually using in their studies.",English
+It's all written in MATLAB-- so very slow. So we actually done the biomarkers. We got all the segmentation.,English
+"We constructed various extractions we did using lots of images. And you can see, once you do the 3D,",English
+"the accuracy really improves-- much, much higher because we have more data points to correlate. And you can see this is less than one-pixel width of errors",English
+"that we could get. And also, you can see the deviation is also very, very small. So we can basically do all the layers within the system.",English
+"This is the picture to show you. All the 10 layers we were able to segment-- even in the presence of a drusen. Again, another example-- we have cyst in this.",English
+"And yet, we were able to get all the layers. And again, a very large cyst happened, and you can see the whole eye contour has changed",English
+because a lot of swelling in the tissue area and still we were able to track all of them exceptionally well. So this is the overall perform out.,English
+"The other thing we try to show is that when you do the 3D, how many B scans you have to take. The more scans you take, of course, more accurate as do.",English
+"And what we were able to show even with 10 scans, you can get-- very useful analysis you can do.",English
+"So this is a quite acceptable error, as far as diagnostics concern. And we can do optic disc as well, using the same technique.",English
+And this is very important for the command detection. And you can see that we can track these layers exceptionally well.,English
+"And this is the top view of the retina, and you actually show you the optic disc cup. We can look at that.",English
+"So this is actually drusen. This is the damage to the eye that manually graded, and this is the automated. It doesn't match perfectly well.",English
+"But from a diagnostics point of view, this is exceptionally very, very accurate in terms of diagnosis purposes.",English
+"Again, this is the original image, and then this is manually graded, and you can see that most of the major pathologies are detected by the system.",English
+"So we have found 45 cases. This is, I think, newer data, I think, from Srinivasan-- 15 patients with diabetic macular edema.",English
+Edema means swelling. And then this is the age-related macular degeneration. And 15 control are normal people.,English
+"And then second data set contains 72 cases-- 15 people with the diabetic macular edema, 28 AMD, and 29",English
+"normal. So we did the same thing, and we tried to do the classification. We basically get the volumes of lesions, and we get the drusen curviness, and then",English
+we also do the OPL-ONM boundaries we extracted and the thicknesses are computer from the those boundaries.,English
+"So for example, this is are curviness zero. That means basically very smooth contours here, and the curviness gone up because you can see the drusen,",English
+and it's even worse the curviness is very high. So we also have another data set. This is the Duke one that I was talking--,English
+And this is also from Duke University. So these are the data sets we have. And we've basically done 15-full cross validation,English
+"on these data sets. And the most important thing you can see is that diagnostics is not phenomenally accurate. Accuracy's nearly 97%, and you can",English
+"see both sensitivity and specificity is very, very high. So from our point of view, now it is completely doable to fully automated accuracy",English
+Part of the reason is people might be surprised by [INAUDIBLE] doing so well? The reason is these bar markers are well-studied,English
+"now does exceptionally well, even regression. Decisional-based regression also works exceptionally well for these things.",English
+"We built a tool called OCD Inspector. Basically, just to show you it does lots of things. [INAUDIBLE] manual correction.",English
+"And then you can retrain the system whenever things are-- or error, for example. An ophthalmologist can correct it,",English
+"and you can see various layers they can do. They can color them, and then they can see a particular layers they want to see. You know you can remove several layers",English
+"and actually see inside layers what's happening. And then they can see cross-sectional use, and they can measure these are optic disc ratios.",English
+"From a machine learning point of view, the only thing we have done is that we needed to estimate some coefficients, which we tried on some manually graded images were used",English
+"And they seem to be pretty robust because when we change those values, plus or minus 10%, still the system performed exceptionally well.",English
+can we do a shortcut using deep neural nets. And you guys might know u-net is one of the very popular segmentation network.,English
+"And they're called u-net that because the network looks like a u-shape. It has a lot of radius deep neural net structures in it,",English
+"and skip connections, fully convolutions, drop-outs applied for middle layers, 23 convolution solution, layers in total.",English
+So what we did is we needed to do patchwise to learn and then [INAUDIBLE] and corresponding ground truth or fact to make this [INAUDIBLE] to learn.,English
+"Again, same data set used. Kernel initializer is Xavier uniform initializer. Patch size-- the patches we use is 40 deep by 48.",English
+"Height/weight-- batches of 32, stochastic gradient method used, loss function is categorical cross entropy, learning rate 0.01 epocha 150.",English
+"the outer hair cells over here, the inner hair cells; again, the outer hair cells are the ones that are more susceptible to damage to begin with, so if there was acoustical trauma or prolonged exposure to noise, the hair cells would be completely lost over time, resulting in that sensorineural hearing loss.",English
+"Occupational noise exposure is a major cause of noise induced hearing loss. Although now with personal stereo systems, it could be the case that those have an even higher risk for noise induced hearing loss.",English
+"so for 90 dB A it's only 4 hours, so for every 5 dB increase, half the permitted time, but for 105 dB A, exposure should be limited to 30 minutes.",English
+"and lifestyle after work, for example, you could be up all night performing as a rockstar, so these individuals, of course, are more prone to have noise induced hearing loss. One of the initial symptoms for any cochlear pathology is this tinnitus, typically reported as a high frequency squeaky ringing sound.",English
+"Some might even have disturbed sleep, if they were exposed to prolonged periods of excessive noise. A less common, but an interesting profile of sensorineural hearing loss, is those that have a sudden hearing loss.",English
+"Often the reason for such hearing losses is not known; some suspect it could be a transient viral infection, and in some cases it could be kind of a miniature spasm kind of stroke in those blood arteries that supply the inner ear.",English
+"But often the longer the period of time that it's identified and identify medical intervention, the less chance of the hearing loss reversing.",English
+"violent stints of vertigo that might be associated with vomiting too. Unfortunately, this type of hearing loss is progressive and is known to run through families.",English
+The main pathology with Ménière's disease is an over-secretion or poor absorption of endolymph. Ménière's disease is also known as endolymphatic hydrops.,English
+"So the endolymph that circulates in the scala media, either because it's not absorbed correctly or because it's an over-secretion, makes this scala media distended, in other words, filled.",English
+"And that's what results in this symptoms of vertigo and hearing loss. It's more often seen in males, and is very unusual to be seen in children.",English
+"It's also been known to be related to hormonal changes, especially in women. It's a paroxysmal, sudden attacks of vertigo, that makes it a very handicapping condition.",English
+So here's a schematic illustration of how the endolymph is within the vestibular organs and within the cochlea of the inner ear. What's presumed to be happening in the Ménière's disease is the dilation of this scala media and the lymphatic sacs over here.,English
+This results in making them hypersensitive to movement and triggering this violate attacks of vertigo. There's no none treatment that completely eradicates Ménière's disease.,English
+"Some kind of diet control, limiting fluid retention and salt intake, is known to decrease the severity of the attacks. In some extreme cases, you might have to do some surgical procedures that would include decompressing or removing the excessive endolymph from the inner ear.",English
+"In some cases, you might have to put a shunt to periodically alleviate some pressure in those endolymph failures. In extreme cases where there's sudden attacks of vertigo often, especially in cases where the cause of these vertigo attacks are leading to suicidal tendencies,",English
+"the surgeon might resort to completely removing the labyrinth or sectioning the auditory-vestibular nerve. Of course, that's going to be related to a sudden, complete hearing loss in that ear.",English
+"But that might be an option to alleviate the symptoms in these extreme cases. So in Ménière's diseases, you expect to see a sensorineural hearing loss, and often, you might see this pattern where there's some better hearing around 2 kHz.",English
+"That's an interesting finding that you'll see in many of those cases with Ménière's disease. As I said, there's no known treatment, mostly diet control can help a few of those individuals and in extreme cases you might have to result to surgical intervention.",English
+"Head trauma can also result in sensorineural hearing loss. The configuration of this hearing loss is typically to what you would see with noise induced hearing loss. But again, depending on the damage, if the damage has affected the middle ear structures or resulting in a tympanic membrane perforation or disarticulation of the ossicles,",English
+"you might see a mixed hearing loss because of the conductive component. Of course, the most prevalent type of hearing loss is the hearing loss we receive with advanced aging.",English
+"Especially with now, with the life expectation that being increased in the past few decades. We are seeing a larger proportion of individuals with this presbycusis.",English
+"The hearing loss usually beings in the early 60s for males and a little later for females on average. About 25% of the age range of 45-64 years, the middle years, are expected to have some degree of hearing loss, and, of course, as age progresses,",English
+"the percentage that have a hearing loss also increases. Again, the higher frequencies are the ones prone to have a hearing loss, especially in those earlier stages.",English
+"But, progressively, the lower and middle frequencies can become affected. So here's an average hearing loss that you would expect to see with age, at 65 years and 90 years, of course, you would expect to see a larger degree of hearing loss.",English
+"As with the case with many sensorineural hearing losses, a common complaint with presbycusis is a speech sounding distorted, so just making it loud and increasing the volume",English
+"on the TV does not help them, and that's because of the distortion that is happening at the level of the inner ear and the auditory nerve. Often, hearing aids would be the first step to take if presbycusis is diagnosed.",English
+and also transmitted cardiac murmurs will cause  pulsating tinnitus and hyperdynamic vascular state   in which condition you can get a hyperdynamic  vascular states in pregnancy then hyperthyroidism,English
+and also in anemia okay so in all  these conditions it will cause a   hyperdynamic vascular state causing it pulsating  tinnitus okay so vascular lesions like glomus,English
+tumors and hemangiomas av malformation aneurysm   and fistulas increase intracranial pressure and  transmitted cardiac murmurs can be heard by as   tinnitus and hyperdynamic vascular states all  these are will cause pulsar tinnitus and myogenic,English
+causes what is that myogenic that is the  abnormal rhythmic activity of the muscles   which are related to the auditory system this will  usually it is heard as clicking or a twitching,English
+sound in the ear so which all muscles are related  closely related to the auditory system one is   palatal muscle so one of the commonest  cause of an tinnitus is palatal myoclonus,English
+okay and also there are two muscles within the uh  middle ear what are they it is uh tensor tympani   and stapedius you have to study the video on  contents of middle ear okay so there are two,English
+muscles which is stapedius and tensor tympani  so tensor tympani and stapedius myoclonus   will be presenting as tinnitus  okay another one is patulous ET.,English
+In patulous eustachian tube there is atrophy  of the mucosa of the eustachian tube or muscle   dysfunction within the eustachian tube so this  eustachian tube remains open so that what will,English
+happen which is each respiration there will be a  to and fro movement of the uh tympanic membrane   in normal condition remember in normal condition  eustachian tube remains closed when you swallow,English
+or you yawn this eustachian tube will open  at that time only there is a balancing the   middle air pressure with that of the  atmospheric pressure usually it is closed,English
+when there is a mucosal atrophy or when there is  muscular dysfunction this eustachian tube becomes   open it is it is remaining open so that leading  to a patulous ET and with otoscopy you can see the,English
+two and fro movement of the tympanic membrane in  respiration and also if you do an um tympanometry   you can see fluctuations in tracing complaints  of patient will be a blowing sound in the ear,English
+or the patient can hear the sound of respiration  or heartbeat and also there will be the patient's   own voice will be reverberating okay so that  is patulous eustachian tube another cause of,English
+objective tinnitus then another reason is  temporomandibular joint dysfunction okay   so one two three four is TM joint  dysfunction this can cause both the,English
+objective and subjective tinnitus another one  is spontaneous oto acoustic emissions you know   what is oto acoustic emission there are different  types of oto acoustic emission the high levels of,English
+spontaneous oto acoustic emission which are  above the audible level of the patient will   lead to an uh objective tinnitus okay so these are  the um causes of objective tinnitus so i explained,English
+"subjective as well as objective tinnitus,  right coming to the pathophysiology of tinnitus this is the auditory pathway it was explained  in detail in a class on physiology of hearing",English
+uh please see that i have given  the link in the description box   so i just summarize that so this uh there  are afferent system and there is efferent   system. Afferent from cochlear to the auditory  cortex and efferent from auditory cortex to the,English
+cochlear level so this outer hair cells and  there is also in the inner hair cells and   this outer hair cell is mainly activated as an  mechanoreceptor transduction system and this will,English
+stimulate the inner hair cells which are the true  auditory receptors so from the in the inner hair   this mechanical stimulation is converted to  electrical signals they are going through to the,English
+cochlear nucleus through 8 nerve/  auditory nerve and from here starts the   central auditory pathway so from the cochlear  nucleus mainly the contralaterall stimulation,English
+of this superior olivary complex lateral  laminiscus then internal coliculus then   from there to medial generate body and to the  cortex and also there is an efferent system,English
+from the cortex to up to the  inner hair cell see these are all   forming a network loop or feedback loop is  formed for the auditory system. feedback looping,English
+so any uh spontaneous abarant activity within  this auditory system will be presenting as   tinnitus there are both excitation potentials  and there are also inhibition potentials this,English
+excitatory and inhibitory signals should  act in a coordinated pathway so if any   uh blockage or hyperactivity or hyper  depression or hyper disinhibition of this loop,English
+or spontaneous cochlear oscillations or eighth  nerve damage or any tumors of the 8 nerve or   can be and glutamate excitator toxicity the  glutamate is the main neurotransmitter in any,English
+mammalian central nervous system okay so uh when  there is an excited toxic levels of this glutamate   again this can lead to tinnitus or there can  be alterations in nmda what is that N-methyl,English
+"D-aspartate, n methyl d aspartate or  non n methyl d aspartate receptors   they are all at the peripheral level or the  efferent level then at the central level",English
+they can be either a vascular loop or tumors  the report will come as AICA vascular loop  in patients with tinnitus so vascular loop  or tumors or external leminiscal auditory,English
+system activation. some time the tinnitus  will be pro probed by jaw movement or gaze   uh fixing will lead to tinnitus that is the  reason for extra leminiscal auditory activation,English
+or reorganization of receptor surface in the  primary auditory cortex all these will cause   some changes in this feedback loop and when there  is either the peripheral level or at the central,English
+level all these causes will lead to spontaneous  firing or there can be inhibition or excitatory   changes in the feedback loop  and this will cause release of,English
+some mediators like serotonin [Music] or dopamine or they can be noradrenaline okay,English
+so this along with the presence of  stress or any psychological problems   stress related or severe mood variations will  lead to this tinnitus okay production of tinnitus,English
+right these are the proposed uh causes or the  proposed pathophysiology for tinnitus though it   is not fully established okay there is not of much  i already told you not much of an evidence for,English
+current pathophysiology investigation and  treatment of tinnitus but these are the   proposed theory behind this so lesions at the  peripheral level or at the central level will   cause and changes in the excitatory or inhibitory  feedback loops which will lead to release of,English
+mediators like serotonin dopamine or noradrenaline  and if it is related or there is presence of mood   variations or stress all these will eventually  lead to tinnitus okay so that is a pathophysiology,English
+next investigations okay whatall investigations we  have to do in a patient complaining of tinnitus so   high level of clinical suspicion and an individual  approach to each patient is needed because,English
+the cause and also the pathophysiology everything  will be different in a young patient and also   in aged patient associated with presbyacusis.  so in each patient the investigations will be,English
+different okay but in general  you have to ask one for history   you should be a very good listener you have to  make the patient talk okay ask him what is the,English
+what is the type of tinnitus or subjective  description of the tinnitus is needed okay   subjective description make the patient  describe his difficulties description,English
+so that you can know whether it is  making an annoyance to his social   life his professional life and also for  sleep okay sleep pattern and daily life,English
+then you have to ask for any associated  auditory and vestibular symptoms   like vertigo or a hearing  loss like that okay auditory,English
+or vestibular symptoms then you can ask for is a patient is taking  any drugs i already told you so many drugs,English
+"like salicylates,quinine like that okay  drug history and also medical history any comorbidities associated and  also you have to evaluate for any uh",English
+existing or past history of any psychological  problems mood variations or stress related like   that okay so all this has to be very clearly  uh asked in the history then in the medical,English
+evaluation i already told you and along with the  causes there are so many cardiovascular metabolic   then joint related all these problems can cause  a tinnitus so medical evaluation has to be done,English
+uh especially the baseline um biochemical and also the  hematological investigations and also   syphilis serology and autoimmune assessment  of the patient has to be done and in the,English
+neuro-otological evaluation what you  have to do is an auditory evaluation for that do an otoscopy to visualize the pathology then do an pure tone audiogram and  tympanometry .Pure tone audiogram,English
+is to find out the sensitivity of hearing  then tympanometry and stapedial reflex that is to know the ear tympanometry is to know  the middle ear status and stapedial reflux to,English
+know the uh whether there is any pathology in the  efferent and different arc of stapedial reflux   again this tympanometry and  stapedial reflex already explained,English
+please go through that and also  cPTA how to do a puretone audiogram   uh everything related to pure tone or diagram was  already explained then uh go an assessment of or,English
+measurement of oto acoustic emissions i already  told you this spontaneous oto-acoustic emissions   itself it is high level uh above the audible  level it can cause an uh objective tinnitus,English
+okay so oto acoustic emission uh you have to  go for in spontaneous otocaustic emissions   evoked oto acoustic emissions and  also olivo-cochlear suppression test,English
+you have to do an olivo- cochlear suppression test right and ah also go for an auditory brainstem  evoked response audiometry that is to find out,English
+whether there is any uh pathology in the retro  cochlear level right so auditory brainstem evoked   autometry right so under auditory comes all  these second is the vestibular assessment,English
+detailed assessment of the  vestibular system because   uh vestibular nerve schwannomas uh will  again may be a cause of these tinnitus then   uh go with a cranial nerve examination cns along  with the cranial nerves that is very important,English
+and next is imaging okay so under imaging the gadolinium enhanced  mri scan is the um the investigation of choice,English
+to find out the uh any pathology which causes a  tinnitus okay so gadolinium enhanced mra and also   fast mri is needed and if you find out if you  suspect any um soft tissue tumors also go for,English
+it contrast enhanced ct scan of temporal bone  and also posterior fossa so under neurological   evaluation think of the auditory vestibular  cns and cranial nerve and also imaging next is,English
+authentication of the presence of tinnitus that is  test to identify and quantify tinnitus objectively   and that is very essential or crucial in the  treatment of tinnitus but this such a type of test,English
+are not available at present because this tinnitus  is purely subjective phenomena so some uh test   to identify and quantify uh tinnitus is under  trial and they are one is matching of loudness,English
+"and frequency,pitch frequency of tinnitus that is we are matching uh the loudness of tinnitus with  that of the puretone or narrowband noise and also",English
+the frequency of tinnitus is matched with  that of the narrowband noise okay and also   tinnitus maskers,English
+"and inhibition of tinnitus that is temporary or long-term  suppression of tinnitus,so under authentication",English
+presence of tinnitus all the three uh these  three tests are under trial only okay and the uh another one important one in the  investigation is psychological,English
+psychological profiling by using multiple  questions this is important in the   assessment of tinnitus because uh there are  there is psychological reasons or psychiatric,English
+reasons will cause next one is functional imaging ah in the investigation mainly  comes the fast mri and also PET,English
+"scan but these two are in the early stage of  development as an investigation of tinnitus   so uh adequate history, medical evaluation,  neuro-otological evaluation then authentication",English
+of the presence of tinnitus psychological  profiling and functional imaging are the   investigations done for uh tinnitus and  also to find out any underlying cause,English
+then what is the uh what about the treatment  of tinnitus review of evidence shows that   there is no effective treatment or there is there  is no well established treatment plan for tinnitus,English
+but we can try we are trying multiple  treatment modalities so i will   write the summary of treatment plans of tinnitus  so as i already told you there are multiple,English
+modalities of treatment for tinnitus the most  commonly used one is pharmacological medicines   uh antidepressants uh before this you have  to remember the pathophysiology that multiple,English
+feedback loops and spontaneous activity um this  counteracting this excitatory inhibitory feedback   loops that you have to remember so antidepressants  like amitryptilian or nortriptyline can uh can be,English
+given GABA analog like alprazolam can be given  glutamine receptor carobarin is also effective   then calcium channel blockers like nemodipine can  be tried anti epileptics like carbamacepin and,English
+also sodium valproate can be given in tinnitus  then prostaglandin analog misoprostol is also   effective the most highly effective drug is  lidocaine okay multiple research trials are,English
+going on on a lidocaine they are giving it as a  local injection into the nasal turbinate and also   intratympanic injection of lidocaine is found to  be effective in many trials which are are going on,English
+so all these other pharmacological or drugs  that can be given in tinnitus the second one is   psychotherapy we can also try psychotherapy  that is mainly the cognitive behavioral,English
+therapy CBT- that is mainly to identify and  dispel the attitude fear and stress of the patient   in relation to tinnitus and the cbt is because  of the covid times the internet based cbt is also,English
+now in practice we can also give bio feedback  sessions relaxation uh techniques and also   stress management because all these are because  uh stress and all psychological problems got a,English
+"direct relationship with the tinnitus then in the  instrumentation mainly hearing aid especially in   old age patients with hearing loss you have , you  might have noticed that patients of presbyacusis",English
+will be complaining of tinnitus also so if you are  giving hearing aid there is a very high rate of   recovery from tinnitus in old  patients but hearing aids are of,English
+a very limited value in children okay in children  the treatment is almost the same as that in adult   in children we give more more of a psychotherapy  and hearing aids are of limited value noise,English
+generators are instruments which which  produce noise and they can be kept as a   hearing aid behind the ear or in the canal noise  generators are available. tinnitus instruments,English
+"about her blood pressure, please? - Very good, because when she came in our outpatient clinic we started doing an additional history taking.",English
+And then the patient mentioned that when she was 36 she had a hypertensive crises with blood pressure up to 240 millimeters of mercury.,English
+And she mentioned that one year earlier her blood pressure was fully normal. She had a checkup at her general practitioner and it was normal.,English
+So in one year it increased from normal to 240 millimeters of mercury. At the time of admission this was well controlled,English
+"with three antihypertensive drugs. What I also asked the patient is whether she had tinnitus, and she told me that sometimes she had episodes",English
+"because of her exertional chest pain, and the cardiologist did an exercise test, and during the exercise test",English
+"she had some ST segment elevations, and therefore the cardiologist decided to do a coronary angiography,",English
+"and these are the results of the angiography. And as you can see, there are no real stenosis in the coronary arteries, but what they did noted was that in the distal",English
+"coronary arteries there's quite some winding of the coronary arteries, which is called tortuosity",English
+and it was an interesting finding I thought. They didn't do anything. They didn't change her medication. They didn't do an intervention.,English
+"- [Garry] Was that noted at the time, or is that a retrospective finding when she knew the diagnosis of this patient? - Sorry, I didn't get the question.",English
+- [Garry] Was that tortuosity of the coronary arteries noted at the time? - The cardiologist wrote down that he thought it was a little strange aspect of the distal coronary arteries.,English
+"They didn't use the term tortuosity, but he noticed that it was not normal. - [Garry] Okay.",English
+"- So to summarize, we have a patient with visceral artery abnormalities with stenosis of the celiac trunk. Occlusion of the superior mesenteric artery",English
+"and additional history taking revealed rapid-onset hypertension, pulsatile tinnitus, and coronary tortuosity. So again the question for the audience,",English
+"what is your differential diagnosis now? What would you do next? - [Anna] Okay, so we two people at the microphone. Go ahead.",English
+"- It looks like it's a disease that affected at multiple levels so I think you would either need a CT angiogram or an MRI of all the blood vessels in the body,",English
+"especially the medium-size arteries. - Excellent suggestion, I think. - Mohammed Barigou From Paris.",English
+"Given the young age of the patient and the fact that she had multiple vessel involvement, and the rapid onset of hypertension",English
+"and the grade three hypertension is really important, we should seek for every secondary cause of hypertension practically",English
+"because there is vessel involvement, take a look to renal arteries if there is the same involvement, and considering the abnormalities",English
+"that we're seeing in her coronary arteries, couldn't we seek for Kawasaki disease that could kill some coronary arteries",English
+"at the same time if there's a systemic disorder, but it's very rare in some conditions. That's my proposition.",English
+"- [Anna] So we now have Professor Persu, a world specialist on fibromuscular dysplasia. I think he'll tell us something we want to hear.",English
+"- When we look at the additional history taking, now each finding separately is not specific, but when we look at all the findings,",English
+it's extremely suggestive for a widespread fibromuscular dysplasia. We have the hypertension. The Americans have learned us that,English
+"pulsatile tinnitus, especially swooshing as you mentioned, is quite suggestive of carotid fibromuscular dysplasia",English
+"and then coronary tortuosity is found in patient with spontaneous coronary artery dissection, which is strongly linked with FMD.",English
+So I would say the probability of fibromuscular dysplasia is very high now. - I think that's an excellent comment.,English
+What I show you here is the most common presenting symptoms of fibromuscular dysplasia. This is a table from the US registry,English
+"of a patient with fibromuscular dysplasia. And if you look at this closely and put our own patient in here,",English
+"and you see the patient suffers from hypertension. She has a pulsatile tinnitus, and chest pain upon exercise",English
+"and also the postprandial abdominal pain, which are all clues that may lead to the diagnosis of fibromuscular dysplasia. As you indeed mentioned, coronary tortuosity",English
+there might be an association with FMD. As you can see the most common coronary artery abnormality that is associated with FMD is the spontaneous,English
+"coronary artery dissection, SCOD. If you perform a CT scan of other vessels in patients with the SCOD you find",English
+"a string of beads in approximately 60% to 80% of the patients, so the vast majority of patients with",English
+coronary artery dissection has FMD. But there are several other coronary artery abnormalities associated with FMD.,English
+"As you can see here in the figure the smooth narrowing or the intimal hematoma. Or as in this case the tortuosity,",English
+"if you look at patients with SCOD, in almost all of those patients have coronary tortuosity. A while ago we questioned ourselves",English
+"whether that might be a clue for FMD as well, so we looked at a few patients, just five of them who had coronary tortuosity",English
+"without a SCOD and looked for them whether they had FMD, and indeed we looked at these five patients and they all had FMD,",English
+so I know it's a very small series but I think there has to be an association between coronary artery tortuosity and FMD.,English
+"So for that reason we thought, would there be any other localizations of FMD? Could we find, for example, a typical string of beads?",English
+"What we first did is we revised the CT scan that was already made in the other hospital and the right renal artery appears fully normal,",English
+but in the left renal artery there appears to be a stenosis at the origin of the left renal artery. It's perhaps a bit difficult to see.,English
+"But this is where the problem is. And therefore we decided to do a renal angiography with a catheter, and my colleague, Professor Kroon, will",English
+discuss that with you. - As is the case in the clinic I was present at the renal angiography so,English
+that's why I discuss it with you. This is the angio we made and I'll show you this picture. This is the midstream measurement,English
+and here you have the right renal artery with abnormalities. And here is the left renal artery,English
+with another abnormality and we have a selective view of the right renal artery again with the same abnormalities,English
+"as you see on this picture. And again here there is the hint of the stenosis on the left renal artery, so",English
+does this change your diagnosis or does this change your ideas with respect to what the diagnosis should be?,English
+"With that respect there is also a difference between unifocal and multifocal disease. The angiographic appearance,",English
+"well, this is the string of beads and this is the typical unifocal stenosis. But there's also histopathological difference.",English
+"Here you have medial disease, which is almost always found in patients with the multifocal disease with the string of beads",English
+and this is the abnormality of the intima which is almost always found in the focal stenosis. And there is also a difference.,English
+"Here you see histopathologically also the severe stenosis and this is, as we've shown in our studies also, there is not that much of the stenosis and they seem to",English
+appear like essential hypertensive patients. And then there is another issue. The clinical characteristics between unifocal and multifocal disease are different.,English
+In multifocal disease patients have a diagnosis of hypertension at much younger ages and the diagnosis of,English
+"FMD is also at younger ages and they have much higher blood pressure, and also, their renal function is sometimes",English
+deteriorated and some of these patients with unifocal disease present with asymmetric kidneys with an atrophic kidney already at young age.,English
+"So and then we've shown ourselves, but I won't allude that now further, that there's also a significant difference in renin secretion",English
+between the unifocal and the multifocal FMD. So in our minds it is two different diseases,English
+is this important to say it's atherosclerosis or fibromuscular dysplasia? My experience is that,English
+with patients with long-standing hypertension starting at a very early age and never screen for secondary forms.,English
+"You can start with fibromuscular dysplasia and after 30 years, 40 years, when they show up they have atherosclerotic lesions,",English
+"be it because of the chronic activation of the renin angiotensin system or because of age or exposure to other things,",English
+"but at that stage they might present with severe resistant hypertension. So I think if I may say, Anna,",English
+"with the polypill approach we are seeing, we will see many more of these cases in the future. - Well I completely agree with this comment.",English
+This is something we've seen already. We have patients of 65 years old who present with fibromuscular dysplasia,English
+"and atherosclerotic renal artery stenosis. So it's a combination and that's due to well, not diagnosing the fibromuscular dysplasia",English
+at early ages. But I think we have to move to as to whether we should do something with this patient. And that may be a point of discussion.,English
+Are we going to balloon angioplasty in this patient or not? - Well I think it's ...,English
+"- [Anna] Could you tell us who you are? - Yehonatan Sharabi from Tel Ha-Shomer. I think it is critical because few years ago, I think it was 2010,",English
+"at ""Hypertension"" they published what is the outcome in FMD when you do angioplasty. And apparently age is a major factor",English
+"because you want to cure patients with FMD, so at a certain age the likelihood that she will be cured, not need medication, and not repeat, is critical.",English
+"So at her age, if I remember well the graph that looked at age and response to treatment in terms of long-term response,",English
+she has like 30 to 40% chances that she will be cured from her blood pressure. So she has to decide whether it's worth the angioplasty.,English
+"And the other thing, again it goes back to what's the etiology, if atherosclerosis, then the likelihood is even less. So it's probably FMD.",English
+At her age and the duration of the disease of her blood pressure are two important factors that you can tell your patient,English
+"whether or not it's going to be for long term or not. - Okay, well, I can agree that and probably I'll await",English
+"the second comment of Alexandre. - Well, I think I would go for blood pressure measurement in this patient because",English
+this focal lesion we are not completely sure if is FMD so how will it respond? And the typical string of beads,English
+is relatively mild so we have learned from Professor Olin that was the same string of bead aspect can have gradient from zero,English
+to very high gradient so I think you might consider in this case and probably this will be proposed for all patient with string of beads,English
+"in the upcoming International FMD consensus. But I know there are no specific study on FMD and we discussed this already,",English
+"but still from a pragmatic point of view, I would do it for this patient. - Well, this discussion is then what one should take off as cutoff",English
+because the cutoffs of the change in blood pressure between a pre-stenotic blood pressure and the post-stenotic blood pressure we have,English
+"is only studied in subjects with atherosclerotic renal artery stenosis and not in FMD, so what would be the cutoff?",English
+"- We don't know the specific of the cutoff, but if the gradient is near to zero which is I think possible here, what would you do?",English
+Would you act only on the other artery and then would you put a stent or not? The question is difficult to answer. - I'll show you the data in a moment.,English
+- [Alexandre] Thank you. - I think that balloon angioplasty is what is being asked for.,English
+"Nevertheless, and I think generally speaking from a clinical perspective, it's a bit obscene to stick to diagnosis",English
+"to diseases to a single patient with a single entity, vascular disease. Nevertheless, it is theoretically feasible",English
+to perform intravenous ultrasound and to identify the presence of atherosclerotic plaque if you think it's critical.,English
+"- Well, that we could have done. You could have done an IV but we didn't do it. We had some argument for what we did.",English
+And one argument is this curve. We have the 45-year-old lady in which the pretest chance of curing her hypertension,English
+would be something between 30% and 40%. Then we had a well-controlled blood pressure with three antihypertensive drugs.,English
+"She had a blood pressure below 140. She had a normal kidney size so no atrophic kidneys, especially on the left side.",English
+"She had normal renal function with respect to GFR and calculated creatinine clearance,",English
+"and we did, Alexandre, for your sake, trans-stenotic pressure gradient and we measured over the right side",English
+"a pressure gradient of 13 millimeters mercury, and over the left side a pressure gradient of 15 millimeters of mercury,",English
+which is somewhat less than 10% of a change. So that left us with the same difficulty as we had,English
+before we did all this. I decided not to do a balloon angioplasty with this information,English
+"so we decided to observe this patient, observe blood pressure and treat blood pressure as best a possible",English
+"and if there were changes going on in blood pressure level under these three drugs or changes in kidney function,",English
+"we will go for angioplasty in this patient but, of course, this is debatable,",English
+to follow up this patient because of course things could progress. We've all seen sometimes quite rapid peogression,English
+"of renal artery stenosis, whatever the etiology, so how frequently are you seeing this lady in your specialist clinic?",English
+- We see her every three months and we do the standard blood pressure measurements. And once every six months we have her creatinine level,English
+"in this patient, and up 'til now everything has gone as we described here. - [Anna] Okay, so any comments on this management?",English
+"- It's just a question of terminology really. Do you consider, then, by this decision that this lady has renal artery disease but does not have renovascular hypertension?",English
+"- You're completely right. She has renal artery abnormalities but we haven't shown that she has renovascular hypertension. Sure, sure.",English
+- Thank you. Dr. Rossi. - [Gian Paolo] Can you tell me where exactly you put your catheter for the pressure measurement?,English
+"- Yes. The farest point we saw abnormalities, there we measured our blood pressure.",English
+And we measured our blood pressure somewhere here for the left renal artery. - [Gian Paolo] Okay.,English
+- So really post-stenotic or post-string of beads. - [Gian Paolo] Because I'm kind of theoretical problems with these measurements.,English
+"- Me, too. - For a number of reasons. This is like when you're watering your garden and you have a number of",English
+"bending of the tube. At the end you have no water, no pressure, so I think one way around would be to measure",English
+"the resistivity index within the kidney in the different poles and see if you have a decreased resistivity index,",English
+which will be indirect evidence for the hemodynamic relevance of the stenosis. I don't know if you agree with it but,English
+I would do this. - You're right. We looked into the echography of the renal arteries,English
+"William Collins, M.D. : Now, the definition of acute otitis media kind of follows exactly the wording here so acute. William Collins, M.D. : It is rapid onset it's the rapid onset of signs and symptoms and middle ear information so by acute we're usually talking to symptoms develop over 24 to 48 maybe even 72 hours, so this is an acute problem that develops.",English
+"William Collins, M.D. : Itis refers to inflammation so any tonsillitis is inflammation of the tonsils appendicitis is inflammation of the appendix so otic means, William Collins, M.D. : refers to the ear and media is the middle ear so it's inflammation of the middle ear so again it's rapid onset signs and symptoms of middle ear inflammation.",English
+"William Collins, M.D. : So what are those symptoms and anybody who's who's had small children, probably has has had at least a few sleepless nights with these so your pain is a big one, as you can imagine, with this pus pushing on that your drama it's creating pressure which translates into ear pain.",English
+"William Collins, M.D. : Often there's fevers associated with this. William Collins, M.D. : Little smaller children or younger children react, a little bit differently so if they're not feeling well, they may not sleep well, they may not eat well they'll be fussy irritable. William Collins, M.D. : They may not be old enough to tell their parents or their caregivers that their ear hurts or localize it to an error.",English
+"William Collins, M.D. : But they clearly in a case of acute otitis media or an acute middle ear infection they clearly act differently, they are symptomatic I mean, in many cases they are, they are frankly miserable. William Collins, M.D. : So what do we do with this when we're looking at in a child's ear and they're having fevers and they're uncomfortable.",English
+"William Collins, M.D. : Believe it or not, you know, there is an approach of watchful waiting, not all ear infections, need to be immediately treated with antibiotics so. William Collins, M.D. : You know our intent in as a medical community and not overtreating with antibiotics we're not trying to make anybody miserable or prolong the pain of children so children are.",English
+"William Collins, M.D. : You know, severely affected, they have high fevers you there's severe pain, where they're not sleeping all night. William Collins, M.D. : And they have on on their examination what looks like puss behind the eardrum, then we would recommend treating those but an older kids might be only in one ear and the symptoms are less severe - then watchful waiting",English
+"William Collins, M.D. : is a very reasonable option. If that is the strategy, there also has to be a a plan B, so to speak, that if the child symptoms worsen over time. William Collins, M.D. : That there is a mechanism or a way to get the child seen again or reevaluated and the possibility of then treating with with antibiotics.",English
+"William Collins, M.D. : As I mentioned younger kids were more likely to treat because they may not always manifest symptoms, the same way as older kids. William Collins, M.D. : Those was severe symptoms so really high fevers you're not sleeping not eating.",English
+"William Collins, M.D. : we're much more likely to to treat those patients, and it is an infection to order and treated with antibiotics that's indicated. William Collins, M.D. : most commonly it's amoxicillin or you know very common broad spectrum antibiotic.",English
+"William Collins, M.D. : And if you know patients don't respond to that or have a second ear infection, you know, within a few weeks. William Collins, M.D. : We will gradually escalated you know to things like eaugmentin or amoxcillin your or even rocephin shots so in general, yes, I think the key point is there are some patients that are good candidates for watchful waiting and not all kids need to be immediately treated for every acute ear infection.",English
+"William Collins, M.D. : So a second type of middle ear infection is is again otitis media with effusion and, as you mentioned that this refers to the middle airspace and effusion is just a fancy word for fluid. William Collins, M.D. : This condition actually has a number of different names that you may read about on the Internet are.",English
+"William Collins, M.D. : referred to in different circles so some refer to it as serious otitis media serious being that the nature of the fluid. William Collins, M.D. : Some call it secret tori otitis media there's also a term called glue ear, because it can be really, really thick mucus in there.",English
+"William Collins, M.D. : So there are different names for this, but essentially this is fluid behind the eardrum and again, if you look at a normal eardrum. William Collins, M.D. : And then you look at a patient with otitis media with effusion, you can see bubbles here, you can see the line of fluid, this was a picture that I took in a patient was sitting up in clinic so the fluid kind of layered out.",English
+"William Collins, M.D. : And you can tell, although the eardrum again is not perfectly translucent you can tell it this fluid looks more like kind of watery or yellow watery. William Collins, M.D. : in nature, as opposed to the earlier pictures of an acute ear infection, where there was pus behind the eardrum just pushing on creating pressure on that eardrum, so this is a kind of a classic.",English
+"William Collins, M.D. : view of a child, with middle ear fluid that's not infected. William Collins, M.D. : So they get fluid in this space back here so it's trapped behind the eardrum and it's not draining down the eustachian tube to hear.",English
+"William Collins, M.D. : Now, surprisingly, these patients will often have very few symptoms, because it's not infected it's not you know expanding and putting pressure. William Collins, M.D. : it's not filled with pus with an acute bacterial infection they usually these patients will not have fevers.",English
+"William Collins, M.D. : They may complain us a mild your pressure pain, but the big big thing that we watch out for in these situations is hearing loss, so if you think about how that. William Collins, M.D. : Hearing mechanism works sound wave comes in here vibrates the eardrum and then gets transmitted in here well that fluid attenuates it.",English
+"William Collins, M.D. : So it's very much like you're underwater and it's just that the water, instead of being out here as if you were jumping in the pool or beach. William Collins, M.D. : stead of the water being out here and filling the ear canal the waters on the inside, and the sound that way, the human error is designed the sound waves do not.",English
+"William Collins, M.D. : transmit as efficiently when they're going through fluid so hearing loss is a big concern in patients with. William Collins, M.D. : You know just fluid in the middle airspace or otitis media with effusion, now the reason we care about hearing loss, particularly in younger children is that is a very critical age in time for speech development.",English
+"William Collins, M.D. : And if you've ever noticed, if you turn on a movie with a few curse words or say something in front of a child, they learn to talk by imitating and they need to hear things their brain kind of processes that sound and they repeat it back so it's important.",English
+"William Collins, M.D. : A big factor when we're evaluating patients who have some sort of speech delay or speech difficulties is, we want to ensure that they're hearing is adequate for speech development and in that younger age group, you know, this is, is it it's often a critical factor in that.",English
+"William Collins, M.D. : So it's not an infection necessarily it's not a acute bacterial infection, so we, we do not recommend treatment with antibiotics for asymptomatic flu so patients just happen to have fluid in their ears like this child does and again can see the bubbles in the fluid level there.",English
+"William Collins, M.D. : We do not recommend antibiotics as opposed to this case where this child is severely affected, and you know it's having high fevers and severe pain this we would treat with antibiotics this, we would not. William Collins, M.D. : But this is a result of that eustachian tube backing up not working efficiently, so we do try to treat the underlying cause.",English
+"William Collins, M.D. : Unfortunately, there is not a a treatment that provides high reliability or a very high success rate, but if patients have. William Collins, M.D. : You know concomitant you know inhalant or respiratory allergies would certainly recommend treating that.",English
+"William Collins, M.D. : Trying to avoid a repeated cycle of viral upper respiratory infections as well, so anything we can do to get the nose working better will help the middle layer drain that fluid in return to function, a little bit quicker.",English
+"William Collins, M.D. : Now it's also important to realize that this state over time, will lead to this state which would eventually resolve in the vast majority of children so. William Collins, M.D. : This is from a a study that was done up in Boston in school children.",English
+"William Collins, M.D. : And at the beginning of this they looked at kids who had a single episode of acute otitis media or an acute middle ear infection so, by definition, they had plus in there, your. William Collins, M.D. : are behind their your drum in the middle airspace, so all of them had fluid when they started.",English
+"William Collins, M.D. : And over time that fluid gradually gets better now notice, you know at a month, maybe you know 60% of those kids that fluid. William Collins, M.D. : was still there, it gets less and less, but by about three months 90% of kids after a single episode of an acute middle ear infection.",English
+"William Collins, M.D. : 90% of those kids that fluid will clear up it's only that last 10% that kind of levels out so that last 10% isn't likely to clear up on its own. William Collins, M.D. : So if the the important message here is that if a child's treated for an ear infection and they go back in a month later.",English
+"William Collins, M.D. : If they just have fluid in their ears, that is no reason for panic or alarm that's part of the normal course. William Collins, M.D. : Now if they have an ear infection and come back in six months, and they still have fluid that's when we really want to do a thorough hearing assessment.",English
+"William Collins, M.D. : evaluate them for their speech development so it's really that three month mark it's kind of critical for us and patients that just have fluid So if you know patient has an ear infection, they have fluid for a month or two no big deal, something we can we can monitor.",English
+"William Collins, M.D. : I know. William Collins, M.D. : It can it can cloud the the decision making a little bit because we don't know. William Collins, M.D. : You know how long the Miller fluid may have been there and and particularly for seeing a child for chronic fluid in the middle ear space on if they show up with an infection and we don't know how long that that food has been there.",English
+"William Collins, M.D. : But you know we can run into a pattern where kids get those acute middle ear infections over and over and over or if that middle ear fluid doesn't clear up after that three month mark. William Collins, M.D. : So what do we do in these cases, you know we've tried multiple antibiotics we've tried allergy medicine clear things up and if things are not getting better that pattern just keeps.",English
+"William Collins, M.D. : Continuing well that's where we come in as surgical specialist and start to you know consider whether putting into your tubes would be an option. William Collins, M.D. : So this is the most commonly performed surgical procedure in children in the United States, it is an outpatient procedure, but it is surgery.",English
+"William Collins, M.D. : Child does require going completely under anesthesia. William Collins, M.D. : itself very quick and kids bounce back pretty quickly and the rationale behind this again remembering the anatomy with the external ear and the ear Canal.",English
+"William Collins, M.D. : So we can look in here we can see the eardrum in the fluid or the infection is in that middle ear space and it's this thing this tube. William Collins, M.D. : The eustachian tube go into the back of the nose that's the problem, so in this tube is not working, this eustachian tube is not draining the fluid it's not ventilating it's not equalizing pressure.",English
+"William Collins, M.D. : You know, like when you go up in an airplane you kind of pop your ears, this is the tube that needs to open and close at the right time, so when this one's not working. William Collins, M.D. : we create a little bypass we create a little hole in the eardrum and put a tube in here to bypass this tube and allow the middle airspace to dream and ventilate.",English
+"William Collins, M.D. : So, to give you an idea how big, these are there's a lot of different names you saw on the previous slide ventilation to. William Collins, M.D. : We called him and asked me tubes here tubes P tubes for pressure equalization they used to be made of a polyethylene so some people call them P tubes for polyethylene plastic.",English
+"William Collins, M.D. : Judging by this this time here, you can see him from the outside, a little fingers even can't even can't even go in there and grab them. William Collins, M.D. : So these are the actual type of tubes that we will insert in the in the ear drum so when do we do this so.",English
+"William Collins, M.D. : Again, that three month mark comes in into play, so if patients have middle ear fluid consecutively for three months in both ears. William Collins, M.D. : Then we'd want to do a hearing test and if there's hearing loss documented they kind of end up on the tail end of that graph that I showed you.",English
+"William Collins, M.D. : That last 10% that's probably not going to clear up that fluid anytime soon and we start to think about your tubes in those children and then. William Collins, M.D. : The more severe cases which fortunately we don't see as much of as we used to, but things like.",English
+"William Collins, M.D. : No complications of the most severe episodes of middle ear infection things like mastoiditis and meningitis things like that which, fortunately, in this era are. William Collins, M.D. : are very, very uncommon so it really comes down to kids getting a lot of your infections and it's not just the number necessarily that we look at, but also the impact on quality of life that factors in in a lot.",English
+"William Collins, M.D. : The you know i've i've seen you know parents lose their jobs and having to take so much sick time to take their children to doctor's visits and follow up visits and. William Collins, M.D. : trips to the pharmacy and things like that, so you know and sleepless nights can can really add up quickly in a in a you know, a family with young children so.",English
+"William Collins, M.D. : Those numbers are rough guidelines, but we really do factor in the impact on the child and the impact on the family's quality of life, as well, when we're looking at. William Collins, M.D. : At whether or not this would be a good option for for a particular child and, in addition, just because they have fluid in their ears I wouldn't automatically recommend tubes either.",English
+"William Collins, M.D. : If they're hearing fine speech development is is adequate they're doing well in school, socially, you know they're they're doing fine and not missing things not getting in trouble with their. William Collins, M.D. : Parents from not hearing things or not, you know missing instructions from the teacher things like that, so they have fluid in their ears, but they're hearing is good and they're functioning really well.",English
+"William Collins, M.D. : that's the situation i'd be very comfortable watching them, so the hearing loss is a critical component in the decision making for patients with that that middle ear fluid, as I mentioned it's a pretty quick procedure. William Collins, M.D. : I always you know will kind of use laughing gas at the analogy, but they will will often get kids to sleep with with gas anesthesia.",English
+"William Collins, M.D. : Particularly in the younger kids nobody likes to get stuck with needles so they're able to get kids asleep with with laughing gas or something equivalent, but they are completely asleep for their own comfort in their own safety. William Collins, M.D. : So this is a little video, so this is looking into the ear, and all this yellow stuff here is ear wax. So we're looking through a little funnel shaped instrument, and this is our",English
+"William Collins, M.D. : So, once we can see the eardrum here we go in with a little sharp instrument little sharp knife make the cut right there. William Collins, M.D. : into the eardrum it's just a little poker sliver and you can see some of that clear fluid coming out I like to get that fluid out of there.",English
+"William Collins, M.D. : At the time to this is our little section, you can see it sucking some of that mucus straight out from our incision or what's called the mirror and got me site there. William Collins, M.D. : And then there's a view of the tube going in, so this is a typical type of tool that we use has a little lip that we engage in half of the tube sits on the outside of the eardrum and half of it sits on the inside of the eardrum.",English
+"William Collins, M.D. : You know, there are certainly some children that are more prone to earwax buildup and things like that, but, but there is no specific post operative care or routine maintenance care that's that's required to have children that had to. William Collins, M.D. : Contrary to times in the past, most of the data now says it is okay to swim with tubes in place, I can remember when I was growing up.",English
+"William Collins, M.D. : We get kids back to normal activity pretty quickly and, in fact, many kids will go back to school daycare normal activity that the day after surgery. William Collins, M.D. : So, as with any surgery, there are certain risks associated with this, so one risk is it kids can continue to get ear infections, or they may get sporadic ear infections.",English
+"William Collins, M.D. : So here's a picture, you can see the blue tube here, you can see mucus kind of streaming out so. William Collins, M.D. : You know I always you know tell parents that just because children have tubes it's not a guarantee that they'll never get an ear infection now some some kids do really, really well.",English
+"William Collins, M.D. : And they never have another ear infection other kids because of the underlying conditions are still there can continue with some you know ear infections and with the tubes in place. William Collins, M.D. : All that fluid, instead of being trapped behind the eardrum can drain out now one of the advantages of having to.",English
+"William Collins, M.D. : Is that instead of you know, having to go on oral antibiotics or analytics by mouth, you can treat with your drops, because the. William Collins, M.D. : antibiotics can go into the tube directly to the site infection, so, in many cases, if you have an ear infection and middle ear infection with tubes in place.",English
+"William Collins, M.D. : and fall into the ear canal usually get stuck in some direction for the rest of the way out and that timeframe could be anywhere from a year or two. William Collins, M.D. : Now, depending on the type of tube, there is also a risk of leaving a tiny hole or perforation in the eardrum, so this is an example can see the eardrum.",English
+"William Collins, M.D. : And one of the things that i've also found is how often when we you know, have a child under anesthesia and put tubes in their ears. William Collins, M.D. : That they're incidentally found to have process behind their eardrum you know they come in the day of surgery, they have no fever, they have no symptoms.",English
+"William Collins, M.D. : And when we make that a little cut and suck the fluid out it actually looks very similar to an episode of acute otitis media. William Collins, M.D. : With that pus back there, so there are a lot of of ear infections that will go away on their own, and we really want to reserve antibiotics for the for the most severe severe cases.",English
+"William Collins, M.D. : it's also important to remember the impact that that middle ear fluid can have on hearing loss and therefore speech delay in this in this critical age group. William Collins, M.D. : And remember, you know when medical therapy and repeated medical therapy has has failed provide long term benefit that that here tubes are an option and children, either with recurrent.",English
+"William Collins, M.D. : episodes of a Q middle ear infection, or if they have chronic fluid in their ears it's affecting your their hearing. William Collins, M.D. : marsha i'm going to turn it back over to you at this point.",English
+Marsha: Alright sounds good. Let's see we got a question here. Marsha: um. Marsha: It's long one so um.,English
+"Marsha: let's see um someone is suggesting that. Marsha: Parents should take action if there's an ear infection and they're very thankful for modern medicine as a teenager who had many ear infections in ENT said, there is a growth in their eustachian tube.",English
+"Marsha: let's see. Marsha: trying to get to the question. Marsha: Okay, so it's just kind of describing like kind of trying to advocate for parents really take these things kind of seriously and and get help when they are there, there were saying that they had a growth when they were a child.",English
+Marsha: That was treated with some sort of a surgical procedure to burn out some of the tissue and they eventually got care through. Marsha: ENT and the pain was really severe and then they ended up having like a mass.,English
+"Marsha: and had to have like kind of major surgery, and the and now they have I guess. Marsha: They said they have three little bones made of titanium and their ear and their their hearing was very compromised by that, so I guess they're kind of saying like really i'm thankful for.",English
+"Marsha: That you know some attention was given to that and that I would encourage other parents to not just kind of assume that you know. Marsha: Oh it's an ear infection everything's just going to be going to be okay, so it sounds like they're just kind of sharing their experience with that so.",English
+"Marsha: We did get another question that came in and it was really a question about swimmers ear. Marsha: With it, you know summertime and things like that Are there things that they can do to prevent that or is there a way that they can prevent that I know when I was a kid going to summer camp, we would always have to get drops in our ears.",English
+"Marsha: Like vinegar or alcohol stuff like that can you talk about swimmers hear me. William Collins, M.D. : yep absolutely so swimmers areas that other common category that I looted to early in the in the lecture you know otitis external or an infection of the.",English
+"William Collins, M.D. : Of the external ear specifically usually an infection of the ear canal so it's usually caused by a combination of William Collins, M.D. : some trauma to the ear canal, and also moisture so we see a very commonly in the summer. People are swimming a lot, moisture gets trapped in the ear canal, you know, then people will put the Q tips in there it'll it's a little bit they'll scrape.",English
+"William Collins, M.D. : You know their ear canal and it's that combination of the moisture plus even a little bit of trauma, not even something that you would obviously recognize. William Collins, M.D. : Because the ear canal is you know basically right there it's not behind the eardrum or anything we usually recommend treating it with your drops.",English
+"William Collins, M.D. : Now prophylactily, you know things you can do to avoid you know swimmers here is. William Collins, M.D. : You know when you're when you're done swimming try to get the ears dry as possible, you know, sometimes that's just a simple case of kind of shaking your head on a towel, some people will use a hairdryer and a low setting you know from a distance and kind of dry it out a little bit.",English
+"William Collins, M.D. : Now here the conditions that kind of set up for that. William Collins, M.D. : You know, very often, the pH can get out of out of balance, this men's will recommend like alcohol drops, you know rubbing alcohol.",English
+"William Collins, M.D. : Or we will also recommend sometimes vinegar drops so white vinegar makes half and half either with alcohol or water and that will help go in and kind of clean the ear canal a little bit maintain the normal acidity of the ear Canal. William Collins, M.D. : And kind of create a setting where a swimmers here is less likely now patients, you know patients that are prone to this can either be those who produce a lot of your wax.",English
+"William Collins, M.D. : And then that earwax traps moisture or they can have the ear canal itself is not just a straight tube so it can have different. William Collins, M.D. : You know bend or two in it, so you know, sometimes patients have a very we call it a torturous or bendy.",English
+"William Collins, M.D. : kind of ear canal that traps wax and traps moisture in there as well, so and then some of those patients, they do require. William Collins, M.D. : You know specialty care to come in, you know every six months, a year, sometimes more frequently to to clean the wax out of the years, and you know, keep the ear and good function shape.",English
+"Marsha: Okay, thank you another question that was submitted was my child has had their eardrum ruptured a couple of different times but hasn't had an ear infection in a while, are there any long term problems that could occur on this.",English
+"William Collins, M.D. : So eardrum ruptures are very common and the good news is the vast majority of the time they will heal up on their own spontaneously probably 90% or more of. William Collins, M.D. : acute eardrum perforations or heal up and it's usually due to an acute ear infection that sort of just puts pressure on the eardrum and then it eventually gives way.",English
+"for an ocular condition a couple of years ago now. MENEZES: Dr. Blodi, could I ask you a little bit   more if you could elaborate on maybe diagnostic  tools in multimodal imaging that needs to be the",English
+challenges associated with that in designing these  trials or from your experience with Stargardt’s?  BLODI: I’m fascinated by the imaging possibilities  we have. I would say at times we need to be,English
+"cautious that we don’t do too many tests. So  in clinical trials, especially with children   involved, we can’t have a three-hour  visit. The patient, the young",English
+"person, is not going to tolerate that and  it’s frankly too tiring. So I think we need   to be very cautious about the number of tests  that happen, imaging tests, at any one visit.",English
+But I will say for children they have  done really well with OCT and OCT-A.   That’s an easy one. I’ve actually seen children  do really well with ultra-wide field imaging.,English
+"It’s not as bright as a standard fundus camera  and it’s not as many flashes of light. So   those two are really, I think, very  generally easy. Certainly, the OCT",English
+and OCT-A could be done at every visit. But there  are definitely challenges with other tests. So a   fluorescein angiogram in a child or young child  would require an evaluation under anesthesia.,English
+"The imaging tests, I think again we’ve seen  now in trials, we rely on certain standard   tests that may occur at each visit. OCT is a  common one. But then only use the other tests",English
+"at milestone visits. So if a photograph or  an angiogram or autofluorescence is needed,   that may be done at six months or one year. Some  of these trials are long—they need to be long—so",English
+"a yearly visit with more imaging  is worthwhile, but I wouldn’t   do that at every visit. That’s too much. MENEZES: Dr. Brooks, in ABCA4 retinopathy studies,",English
+"or any other ocular pediatric studies, can you  share with us any challenges related to maybe the   duration of the study or disease progression  that needs to be taken into consideration?",English
+"BROOKS: Yes. Many of these conditions are  slowly progressive, and so trying to find an   outcome variable that will change significantly  over a modicum of time is a bit of a challenge.",English
+"As we previously mentioned, having good  natural history data across a variety of   modalities is the first step in trying to  define what it is you’re going to follow.",English
+"And in an example of ABCA4 retinopathy that we  have here at the National Eye Institute, we have   been following a cohort of patients with ABCA4  retinopathy under a natural history study now for",English
+"several years, and we’ve gotten approval by the  FDA for repurposing a small molecule, metformin,   which is used in the treatment of diabetes,  as a possible treatment for ABCA4 retinopathy.",English
+"And here, because we’re looking at a rare disease,  doing a Phase IIa study that was a randomized   placebo control would have a sample size that  probably would be prohibitively either long and/or large",English
+for doing the initial evaluation. So in  discussions with the FDA we have been   able to define that the rate of change for an  individual patient using a specific OCT measure,English
+is linear when you either do a log  or a square-root transformation.  Now one of the things that  we run into is that even in a,English
+"genetically comparatively homogenous group of  patients, all of these patients have two mutations   in the ABCA4 gene. You might offhand think  they would all be remarkably similar, and",English
+"I guess in some ways they are, but each patient  progresses at his or her own rate, yet they seem   to follow their own course, their own line. So how does that help us with trial design?",English
+"Well, in discussions with FDA we’ve been able  to design an open-label study in this case   using the existing carefully and systematically  collected natural history data as our baseline,",English
+and then to determine whether when we  intervene—in this case with oral metformin—do   we make the slope of that progression  shallower? Do we have an inflection point?,English
+"And with that, we think that we will be able to  detect a change using this imaging OCT outcome   measure in about two years. So it’s still long  for a typical trial, but is tractable, is doable",English
+"because of the trial design and because of  the natural history data that preceded it.  BLODI: Supriya, if I could jump in right  there, too, I just want to comment on how",English
+I think that is such a great design. It  truly represents personalized medicine.   I think every patient would be grateful  for knowing that their own path is being,English
+monitored and the trial is following  them based on their rate of degeneration.  And I will also just go back to the topic of the  FDA. I think one thing that we need to recognize,English
+"as investigators, and I think the public as well,  is that the FDA does assist investigators in   clinical research at an early stage. Even  if it’s not a drug trial yet, they will",English
+"be there to provide guidance and advice.  Certainly by the time it is a drug trial,   the FDA needs to be involved, but I generally  see that in a very positive light. I think that",English
+they’re providing good feedback so that the trial  design is going to hold up. You don’t want to be   at the end of a trial and then be told this is the  wrong design or you’ve chosen the wrong outcome.,English
+"So I think involvement of the FDA is  something that has improved clinical   research in our country over the last few decades. MENEZES: Speaking on trial design, Dr. Clemons,",English
+"it’s always crucial and an important  component. Could you share some examples of   alternative study designs that may be  appropriate for a rare disease trial?  CLEMONS: Certainly, Supriya. One example is  called a blind-start approach or blind-start",English
+"design. In this type of design, all  patients receive the minimum duration   of active treatment. So for example, let’s  say that you want to treat participants for",English
+"two years. So all participants will receive  the IP for two years; however, the participants   are randomly assigned to begin the active  treatment at different pre-defined time points.",English
+"So they may be randomized following 8 months, 16  months, or 2 years of a sham or placebo treatment   prior to being assigned the active treatment. This study design offers an estimated treatment",English
+effect size that’s similar to that of a randomized  parallel group study in its power to detect   real-effect clinical outcomes that is very similar  to that of the traditional parallel study design,English
+"with the same sample size. Other types of designs or trials   that are being used are called umbrella  trials, where you test many therapies",English
+"for one rare disease. Also basket trials, where  there’s testing of one therapy against many rare   diseases, and then platform trials, which are like  umbrella trials but you use a decision algorithm",English
+"to let therapies enter and exit your platforms. MENEZES: Dr. Blodi, what has been your experience   using a biomarker as a primary outcome  instead of visual acuity, for example?",English
+"BLODI: Thank you, Supriya, that’s such a  good question, especially in ophthalmology   and especially in retina. We’ve had imaging as  part of retina for many decades, and so a primary",English
+"outcome may be based on imaging results,  and maybe the oldest example I can think of   is diabetic retinopathy. So the change  in someone’s diabetic retinopathy status",English
+is not dependent on their vision; it’s  dependent on what we see in the retina   and actually by the photographs that are taken. So a patient will get color fundus photographs,English
+"a specific way to map out the retina in order for  the investigator or reading center to determine   what level of retinopathy is there. Their  vision may be perfect, but they have severe",English
+"proliferative diabetic retinopathy,  so that’s an imaging biomarker.  There are now some other examples,  but for a while that was the only   imaging biomarker that the FDA would accept,  so that was kind of an exception. But we do see",English
+"other imaging biomarkers that are now accepted by  the FDA as a primary outcome, and one is area of   atrophy. When we’re looking at trials where  there’s atrophy, geographic atrophy in AMD,",English
+"Stargardt’s disease, other conditions where  it’s atrophy that’s really what we’re looking at   changing with medication. Can we slow down  the atrophy or even reverse the atrophy?",English
+"The other pretty novel imaging is looking at the  OCT, and Brian mentioned that as well. But in one   condition that affects older adults, middle age  to older adults, is called macular telangiectasia,",English
+"or MacTel, and the ongoing trials are using the  OCT as the primary outcome. And it’s not just   the OCT scan, it’s one layer of the OCT scan which  represents our photoreceptors, our rods and cones.",English
+"So that’s quite a big jump, I think, for the  FDA to make and allow these imaging biomarkers   to be used as a primary outcome. And if I could  make a comment about that, it does really set",English
+"the bar high on quality of imaging. So if you’re  in a site where the quality of imaging is poor,   you could be in trouble because that  is the outcome for that patient.",English
+"Reading centers, and there are a number of  excellent reading centers in this country and   outside of the US all work hard to make sure  there’s quality imaging at the site so that",English
+"the photographers or technicians are trained in  a specific protocol and how to get a good-quality   image, and we also certify the equipment—the  imaging system, the OCT system, or the",English
+"camera system—to make sure that the images are the  best possible images. You don’t want to have an   image that’s non-gradable, because now you’ve  lost the chance to get that primary outcome.",English
+"MENEZES: Thank you. That’s definitely a  point we noted, especially when we work   as the data coordinating and statistical  center. The quality of the data is so crucial,",English
+"and then the grading that comes from it  given that some of that is primary outcome.  So Dr. Clemons, can you share suggestions on how  to demonstrate statistically significant results",English
+"when working in a rare disease trial that  could have lower power due to a small   sample size or maybe a small treatment effect? CLEMONS: Certainly, Supriya. Thank you very much.",English
+"You may want to consider, especially if you have  multiple primary endpoints, to conduct global   tests for multiple endpoints. For example, rank  some tests based on the sum of ranks of data from",English
+"two endpoints from each patient, or also combine  test statistics based on two test statistics   for treatment comparisons for each endpoint. Also, this goes into especially Emmes’s",English
+"experience, as a CRO there are some  quality-assurance measurements,   also training measures that should  be taken into consideration to reduce",English
+noise and variability of your outcome measurements  and potentially increase your statistical power.   You should always include a manual of  procedures that have standardized methods,English
+"and procedures for your outcome assessments and  training the sites on these protocols. And Dr.   Blodi, that also gets into the  imaging and the protocols for",English
+"collecting those images and ensuring that the  photographers are following those protocols.  Also, work with the sites on the importance  of minimizing dropouts and missing data.",English
+"And lastly, ensuring that we’re training personnel  to encourage our participants to complete the   study, even if they stop study treatments early. MENEZES: For everyone, I just want to piggyback",English
+"on something you said, Dr. Clemons,  for Dr. Blodi, and that’s about   engaging a reading center early on on a  study. Dr. Blodi, can you comment a little   about that and how important it is? BLODI: The need for a reading center",English
+is there generally when you have multicenter  trials. So there are certainly studies that are   done at one center and the PI or other researchers  can do the work of analyzing the images.,English
+"But when we’re looking to standardize across  sites, and now we’re seeing clinical trials with   hundreds and hundreds of sites because it’s global  trial, we really need a standardized approach.",English
+And so having the reading center being able  to spend some time with the investigators   virtually or in person to share what we do  and why we do it is really important. So,English
+I go to a lot of investigator meetings  to really get that point across that   we’re here to help the sites and we’re here to  help things be standardized. And that’s important,English
+"in order to get, as Traci mentioned, that good,  quality data. So getting a reading center on   board can really get those investigators and the  imagers (the photographers or technicians) trained",English
+"and thinking about the quality of the images. I’ll just put a shout out to the need for the   coordinating center. So I think as we hear from  Traci, ophthalmologists will all say, “Well,",English
+"I need a statistician,” and that’s true. But  you do, beyond the statistician, who’s going   to be important throughout the trial, I really  believe in coordinating centers because of the",English
+"ability to reach out to the sites and to  bring sites together. They are the glue   that will answer questions, help sites keep  doing things in a standardized fashion,",English
+"trouble shoot issues they may have throughout  the trial. That would be hard for a Principal   Investigator to do him or herself. Even if  there is a group of principal investigators,",English
+"it does take the work of a coordinating center  to see that that trial is going up and started   and then able to maintain good, quality data.  And the support. You really want those sites to",English
+"patient-centric thinking is a  really important place to start,   really probably for any clinical trial. I  think it’s especially true in rare disease.  And Dr. Blodi mentioned the coordinating center.  I couldn’t agree more. Having really good clinical",English
+"coordinators who know the patients, who can  engage the patients, who can follow patients   is extremely important. That’s kind  of your face to the patient community.",English
+"For rare diseases, a lot of these diseases  have support groups, patient advocacy groups,   and so engaging with the leadership of  those organizations at an early point",English
+"is really helpful in my experience. And then just lastly, we live in a   digital age that’s filled with social media,  and leveraging that social media, whether it’s",English
+"Twitter or Facebook or Instagram, can help you  in your recruitment. So I’ll give an example,   and here it’s not necessarily something I’ve done.  My lab studies the pathogenesis, the genetics,",English
+"of a rare ocular condition called uveal coloboma.  It’s a congenital malformation of the eye.   And patients come to us from all over the  nation—in fact, all over the world—and when",English
+they’re here at the NIH I think they have by  and large a pretty good experience. We really   try to give them that patient-centric feeling  for their good and the good of the research.,English
+"Many of those patients have posted on various  Facebook groups, “Was at the NIH, was part of   this genetic study, and it went really great  and I encourage you, if you have any questions,",English
+"moms and dads with kids with coloboma, come on  out to the NIH. Here’s what they have to offer.”  And I can kind of tell whenever somebody posts  something that—we’re not posting it but just the",English
+"parents that are posting this—that we see  an uptick in our recruitment. And in fact   recruitment has not been an issue for this  particular study, so you can only imagine   if you were able to deliberately utilize  the tools of social media how well you",English
+and helps us too because we are able to get  information out to lots of people. And it’s tough   to get many questions because people  will start to have lots of questions when,English
+they realize they have a rare disease  or their child has a rare disease.  But having sources of information that  they can read about I think helps us really   stay focused on what we need to do and gives the  patient that knowledge and understanding of where,English
+we are in the study and where we are  in the knowledge base of this disease.   I actually think that can help cut down on  some of the questions that we have to field,English
+"because we want to just put it out there  so people have access to it to begin with.  BROOKS: Supriya, one thing I might add to  my previous comments is that we’ve talked   throughout this webcast about the importance of  natural history studies. So obviously if you have",English
+"established a natural history study, you  already have a cohort of patients that   you’re following and have a relationship  for, so that would be an additional",English
+"strategy, if you will, for recruiting  patients when you’re ready to have   a clinical trial. So start thinking about your  clinical trial even before you’re ready to   start your clinical trial and be thinking about  it in the course of your natural history study.",English
+"MENEZES: How important is  transparency and communication   with patients and with their families? BROOKS: I think transparency is extremely   important. It’s important for patients to  understand the nature of the trial design,",English
+for example. Is there a chance that I might  be on a placebo group? Are there potential   risks to the treatment that you are offering  for me? When will I know whether the results,English
+"are going to help people like me, regardless of  what group I’m going to be in? And especially   based on at least your best understanding  in pre-clinical data or from early clinical",English
+"trial data, what am I likely to expect? A patient who has hand-motion vision,   if your treatment is designed to slow the  rate of degeneration, or doesn’t even have",English
+"to be hand-motion, it could be 20/80, if your  intervention is designed to slow or even stop the   rate of degeneration, you’re not going to make  that patient 20/20 again by that intervention.",English
+"So setting the expectations. You always want  to provide hope, but you do not want to provide   false hope in dealing with patients. So that  kind of transparency, even though they are",English
+"difficult conversations, is extremely important. BLODI: I completely agree. I think that patients   do want that honesty up front. And I’m sure Brian  would agree that it’s the patients with the rare",English
+"diseases that are most committed to the research,  no matter what. They know that this may never   change their vision or their life, but it can lead  to further progress. And I think many patients",English
+"understand that even if the outcome of the trial  is to show that this treatment does not work,   we have learned something, we need to take a  new direction, there is a lot to be learned,",English
+"even when the outcome is not exactly what we want.  So those patients, I think, are very understanding   and generally very willing to participate. MENEZES: Dr. Brooks, based on your experience",English
+"conducting ophthalmic rare disease trials,  what advice would you give clinicians   who are designing studies and writing protocols? BROOKS: First and foremost, you want to be",English
+"thinking ahead. You want to be identifying  patients, identifying physicians or practices   that are following a lot of patients, and as  Dr. Blodi talked about, coming to consensus",English
+"with other practices if you’re doing a multicenter  study, doing that early because it does take time,   is very important. You want to engage your patient  advocacy group, as we discussed, or engage social",English
+media organizations. That will help to drum up  support. That will help you in your recruitment.  Start designing the trial in your head  as you’re collecting your natural history,English
+"data. Be looking at data in real time so that  you can decide whether this variable that I’m   following in my natural history study that  looks promising or this one, you know what,",English
+we’re not getting usable data. You might even  eliminate that from your natural history study   and perhaps substitute it with something else  that you think might [unintelligible] work. Be   thinking what the paper will look  like at the end of my clinical trial,English
+"in terms of the structure of the trial even  as you’re doing your natural history study.  If you think you might want to  do your trial in a given space,",English
+be prepared to create new outcome  variables. We did some work   in albinism. We mentioned LUXTURNA and  low-luminance maze tests in albinism. We had to create,English
+"a new outcome variable focused on the amount of  light shining through the iris, which is inversely   proportional to the amount of melanin pigment. So we gave patients a small molecule called",English
+nitisinone and observed whether that affected  their pigmentation in a small pilot trial.   Be prepared to think out of the box. You  may not be able to use the normal go-tos,English
+"that people would normally do. And I think as Dr. Clemons and   Dr. Blodi have both mentioned, you want  to work with the FDA early. You want to   start the discussions early, especially if  you’re considering what might be considered a",English
+"non-traditional trial design so that you don’t get  ready to start and get a nasty surprise that the   FDA isn’t buying your particular line of logic. MENEZES: Dr. Blodi, do you have anything that you",English
+would like to give in terms of guidance  or suggestions or advice to clinicians?  BLODI: Sure. I think it can be daunting  to think of an individual ophthalmologist,English
+"starting a clinical trial. But it can  be done, and I think ophthalmologists   know a lot because they’re seeing patients, and  so good observers will see that here are certain",English
+"needs and certain changes in their patients  that may be worth researching on a larger scale.  I really like the idea of repurposing drugs, and  so we are going to all get more information on",English
+"that when we have access to big data, we will be  able to see our certain drugs helping or hurting   patients and that may be something that  an ophthalmologist could easily try",English
+"if there’s a new drug that has some promise. I would, before you go into any trial,   share your ideas with basic scientists who  certainly know a lot about any type of drug",English
+"or class of drug, and I would also share with  other investigators your idea and your protocol.   It really is sort of a community effort. It’s  hard to think that one person would be the one",English
+"that would create the whole trial. There  are so many aspects of a trial that need the   assistance and the knowledge of others, whether  they’re ophthalmologists, statisticians, basic",English
+"researchers. I mean, there’s a whole host of them. I remember hearing Jean Bennett talk once. She was   the main basic scientist behind the LUXTURNA drug  and had worked decades on this drug, getting this",English
+"idea to clinical trials. She says in her talk  describing the journey that the clinical trial   portion was the most complex, the most challenging  of the whole thing–I thought, you just came up",English
+"with this amazing gene therapy–but the steps  along the way are really lengthy but I think   so rewarding. And if you’re in a clinical trial,  I think you’ll see how rewarding it really is.",English
+"MENEZES: Thank you. Thank you, everyone. And I’d  like to wrap up with asking each panelist to share   a success story about your involvement in a  rare ophthalmic disease study or what inspires",English
+"you to continue to participate in research  around rare ophthalmic diseases. Dr. Clemons,   let’s start with you and then we can go to  Dr. Brooks and finally Dr. Blodi. Thank you.",English
+"CLEMONS: Thank you, Supriya, gladly. As Dr. Blodi  mentioned MacTel, I was also a part of the MacTel   and getting the structural outcome  that is currently being used in a Phase",English
+III study I think for me was very rewarding. The Phase I study for the [unintelligible] that   is currently under study started when we were just  understanding the natural history. So we had an,English
+"underlying natural history study that was ongoing,  and at that time we had about six or seven years   of follow-up on those patients. And what we  were learning was that visual acuity was slowly",English
+"progressing in those patients. Actually, we had conducted an analysis,   and on average those patients lost about one  letter of visual acuity per year. So as was noted,",English
+"the outcome for the FDA is usually  best corrected visual acuity,   and it’s usually 15 letters is the bar. So if  we were to conduct a study, as you can imagine,",English
+"in MacTel using best corrected visual acuity,  it would be a very long and daunting study.  This outcome in the Phase I, which was the  safety outcome, and that was okay with the FDA,",English
+"we also used it in Phase II, again to  collect more information again stronger   information with regard to the relationship  of structure an function and it was able to",English
+"provide that information to the FDA and  also to the European regulators, EMA,   to show that, yes indeed, even what we showed  from the natural history data, which was a",English
+"strong correlation of structure and function, was even stronger with our clinical trial Phase   II information—relationship,  structure and function—and",English
+"from that information they did allow for our Phase  III study, which is the pivotal study. So for me   that was very rewarding, especially given that  MacTel is a disease where we have no treatment.",English
+"BROOKS: I think I’ve talked a little bit  about some of my experiences, some of my   successes, the coloboma protocol that we’ve been  doing and engaging social media as a lesson,",English
+"albinism, creating new outcome  variables and engaging the FDA.   And Stargardt’s, again, engaging the FDA and using  each patient as his or her own control based upon",English
+"carefully obtained natural history study. And I want to thank Dr. Clemons and all   those that have been involved in the  MacTel 2 project, because the success",English
+"of one group of people in a rare disease often  can pay forward. So in this particular example,   the fact that MacTel 2 showed that there  was a relationship between retinal structure",English
+"using an imaging modality, OCT, and retinal  function, in the end the FDA cares about function.  And so the fact that that correlation exists now  enabled me as somebody working in Stargardt’s to",English
+"say, you know, my primary outcome variable is  going to be a structural outcome because look   at that result from the MacTel 2 Phase II trial.  So I think that there is a synergy often created",English
+And so how does this work? How do we actually collecting these sounds and turning them into something that has so much meaning for us?,English
+"So it actually all starts with movement of air. So sound travels as wavelengths and that is moving the air, so it's a mechanical thing that has to happen first.",English
+And our ears are an amazing machine that collects this mechanical energy and turns it into a signal that the brain can understand.,English
+"So it starts with the ear, the wavelengths of sound traveling to the ear canal and then causing vibration of these tiny little bones",English
+"shown here, next to a dime, these tiny little middle ear bones that are moving because of the movement caused by the sound. So those bones sit here and then that will cause vibration",English
+that are detected here in the inner ear by the cochlea. So the cells that actually make this happen are the ones that Anil referred to,English
+and those are the hair cells. So why do we call them hair cells? It's because of these little hairs that protrude from their surface.,English
+"And these are basically movement detectors, when the wavelengths of sound move the bones in the ear that transmits two vibrations inside the inner ear",English
+that activate these hair cells. These hair cells will be activated by mechanical force but then they actually turn into an electrical signal.,English
+"Here's what they look like inside the ear, and you can see that they can't do this all alone. You can see them here as well surrounded by all these other cells.",English
+"These other cells, shown in yellow, are the supporting cells. And supporting cells are really just as important. They should not be relegated to supporting status.",English
+"They are part of this whole wonderful machine that has to vibrate in response to those sounds, and cooperate to keep the hair cells active",English
+and alive to transmit the signals that will go to auditory nerve fibers and onto the brain. When the system works it works beautifully,English
+"but there are so many moving parts that of course, unfortunately, there are many ways that the system can stop working. There are many causes of deafness from genetic mutations",English
+"that might keep the hair cells, for example, from detecting the sound to begin with. There are also mutations that can affect the supporting cells and there are mutations",English
+that can affect many other cells around them. There are also ototoxic drugs that can affect survival of the hair cells and many other reasons,English
+why the ear might stop working. But one interesting thing is that very often converges on the hair cells. So many forms of deafness will have,English
+"a hair cell pathology associated. So when we look at a healthy ear, we see all the hair cells. You can see what happens in a damaged ear,",English
+"either with too much noise, for example, or ototoxic drugs you lose these hair cells. And this ends up being a pathology that is associated with many forms of hearing loss.",English
+"Right now, how do we deal with this? Well we need to overcome the loss of the hair cells. And traditionally we've done this",English
+"with things like hearing aids, which basically increase the ability of whatever cell that are remaining there to detect the sound. Or we can use cochlear implants",English
+which are a really wonderful way of working around the absence of the hair cells by directly stimulating those auditory nerve fibers. I think all of us right now can appreciate,English
+how quickly biotechnology is moving. And in the 21st century we have more options for ways to deal with the loss of hair cells.,English
+"So, for one thing, we have a much better understanding of why the hair cells died to begin with, and we are learning ways to prevent that from happening",English
+"and that would be ideal. So not listening to loud sounds, for example, but also finding ways to prevent the effects of ototoxic drugs.",English
+In addition we've made great strides in gene therapy in starting to find ways to replace the genes that are mutated in various forms of congenital deafness.,English
+What I want to talk to you about today is another approach that we are developing through the Hearing Restoration Project and that's hair cell regeneration.,English
+"And that means those hair cells that are missing, let's see what we can do to put them back. So this is not a crazy idea because it actually happens.",English
+So it happens in chickens quite naturally. So this is what a chicken cochlea looks like. Again they have hair cells completely analogous,English
+"to the cells I showed you before from the mammalian ear, and after noise damage those hair cells are lost. But remarkably, 10 days later,",English
+"you'd never know something happened. It is completely repaired. It's much like if you get a cut on your skin you have a scar for a little bit,",English
+and then it heals and it goes away. So this can happen. You can rebuild something as complicated as the chicken cochlea.,English
+"And in fact, the same thing happens in zebrafish. It does not happen in the mature human ear and it does not happen in the mature mouse ear.",English
+"However, we actually through the work we've done have found circumstances in which you can see signs of regeneration even in the mammalian ear",English
+"and that's really encouraging. So while it doesn't happen regularly, there is some low-level spontaneous regeneration that can happen in the vestibular system.",English
+"And in addition, you can also see during the very early stages of life that an injury can lead to replacement of the lost cells",English
+"with new hair cells. It happens in a much lower level than what happens in birds, frogs, and fish, and this capacity is mostly lost altogether",English
+"from the cochlea before the animal can hear. So it might happen in the first week of life in a mouse, for example, and then it's gone. Still, this is really encouraging.",English
+Because it tells us that the cells have the capacity at some point of regenerating. It tells us all the genes you would need to regenerate,English
+are there and that there is the possibility of putting together something as complicated as the mammalian cochlea again from the parts that are left.,English
+So let me tell you a little bit about those parts and what's actually happening because it informs a lot of what we are trying to do,English
+"through the Hearing Restoration Project. So this is a diagrammatic view of what's happening inside the cochlea. The hair cells are shown in purple,",English
+"the supporting cells are shown here in gray. So when there is a damaging stimulus those hair cells die, they are extruded from the surface",English
+and they can actually send signals in the form of molecules that are detected by the supporting cells that basically signals that something bad has happened.,English
+"And the supporting cells in a regenerating ear, they know how to deal with this. They hear the alert and they come to the rescue. So what did they do?",English
+"Well they actually would divide and they divide just once, and they divide for a limited amount of time, and they will produce a new hair cell",English
+"and then they will replace themselves. And through this we now can rebuild the cochlea or the organ of Corti, which is where the hair cells",English
+are embedded exactly the way it was before. You've replaced the hair cell and you've replaced the supporting cell. In other circumstances the supporting cell might respond,English
+"to the signal from the dead hair cell by actually turning into a hair cell itself and that is another form of useful regeneration. So this is what can happen in the chicken cochlea,",English
+"or the fish lateral line, but it doesn't happen in mature mammals. So this is something we would like to understand. What is the difference?",English
+"Why is it in some species this happens and not in others? And if we can identify, say, the signals and how the cells respond to the signals",English
+"and figure out what is different about that, maybe we can come up with ways to overcome this block and basically trick themselves into thinking, for example,",English
+that they are back in their youthful days in that first week of life when they were able to do this unprompted. So this is a hard problem.,English
+I can summarize it in a few words but let's just be honest about what we're asking in terms of what needs to happen to make regeneration happen.,English
+And so let's consider an analogy of a place like Manhattan. So Manhattan relies on a very complicated infrastructure.,English
+"You can think about all the different things that have to be happening to keep the city functioning. We've got the water system, we've got transportation, power, and all of that, all that has to work.",English
+"And now say there is a natural disaster. If a blizzard or flood came, all of these systems would be impacted in certain ways",English
+and you would need to coordinate across those different groups in order to get the city back to its functional self.,English
+"Likewise, if we are going to repair the ear, we need to figure out all the different events that happen and coordinate among them,",English
+and for this to happen we actually need to coordinate ourselves. Understanding any one of these events can take a lifetime in one lab.,English
+"If we really want to figure out a way to regenerate hair cells, we need to do better than that, we need to work together and coordinate across species,",English
+"across cell types, across systems, and really push innovation. So that's where the HRP comes in.",English
+So the Hearing Restoration Project is a consortium and this is a group of 13 researchers at universities across the United States and Canada.,English
+And the way we differ from other scientific groups is that we are cooperating in a very free way to try to get our science to move forward collectively,English
+where we focus on studies that will really leverage the power of collaboration. We prioritize any kind of project,English
+"that is best done by a group of people, versus anything else we can do individually in our labs. We also have a high priority of creating tools",English
+"and resources that will accelerate research not just by these 13 labs, but by anybody who has an interest in this. And today, Dr. Hertzano will show you one example",English
+of a tool we have supported the development of that I think is just a wonderful example of what we are trying to achieve.,English
+We also have a big priority on innovation where we are willing to try things that maybe we are not sure if it'll work,English
+"but it's worth giving it a try because the payoff is so great. And we have a system that promotes cross fostering of data and ideas as early and often,",English
+"where we meet regularly, we make sure that actually through some of these tools that are created, we can share the data well in advance",English
+and not wait around for all these other things to happen before we can make use of that data. So these are all the members of the consortium,English
+"and it is truly a privilege to get to work with such a wonderful group of people who are all brilliant in the science that they do,",English
+and thoughtful and generous in the time they spend with each other and with the members of their labs that they are training who will also go on,English
+"to do wonderful science, and I think you couldn't ask for a better group of colleagues to try to make something really special happen.",English
+"So as a group, the HRP has come up with our strategic plan to see how we can collectively advance efforts for hair cell regeneration.",English
+"And our first goal is to catalog the expression of thousands and thousands of genes across cell types, hair cells, supporting cells,",English
+"and across species mouse, chicken, zebrafish, to find those pathways, those sets of molecules, that are associated with regeneration or its failure.",English
+"For example, what are the molecules that make supporting cells and regenerating species know that they have to divide to produce a hair cell?",English
+"What are the molecule sensor that a hair cell can integrate into the remaining epithelial, for example? This is basically defining the language",English
+"that we need for regeneration. Then we can use a mouse model system, for example, and figure out what happens when we manipulate",English
+"these pathways in the mammalian ear, get a sense of how far can we get. And again, this is a this is a matter of testing things and figuring out what goes wrong so we can make it go better.",English
+"So this is an iterative process. As we identify the pathways and figure out how they are acting in the mammalian ear,",English
+"we can use that Information to design drugs that have the same effects, so that would be the ultimate goal. So towards this big picture plan,",English
+how are we actually do this? Well we support a lot of data collection. Consortium members are collecting huge amounts of data,English
+"from many species, where each lab is using what they know best to generate data that they can share",English
+"with everybody else in the consortium, so we can compare, basically compare pathways across the systems, and understand the problem,",English
+"figure out what's happening, and use that information to devise a solution. At the same time, we are invested in generating tools and resources that will allow us",English
+"to extract meaning from all of this data. That includes the gEAR, which is shown here, and this is what Dr. Hertzano will present.",English
+"And this is a database where everyone in the consortium, in fact, anyone who has data to share can upload it so people can make quick comparisons on their own.",English
+We also invested in a lot of computational analysis of the data to try to go beyond the biology and use computers to pull out information,English
+"that you can't get just staring at a list of genes. So I will say I like staring at a list of genes and I have learned something from it on occasion. And then in addition,",English
+"we are making a testing prototypes where as I said, we are willing to try things, and see how far we get, and use information about how far we get to go back and inform our research again.",English
+Another important part of our model is the teamwork. That is what I started out with by saying that's how the consortium differs.,English
+"And in fact, everybody in the consortium is part of the working group that is a smaller collection of people who work together to do the experiments,",English
+"compare notes, and meet on a regular basis so that everybody's on the same page all the time. And then in addition to that, the whole consortium will meet",English
+"to share data across working groups and share ideas across those groups. We also have an annual meeting where we all come together and really think about what did we achieve this year,",English
+what do we want to do next? Brainstorm new ways to do it. So we are constantly checking in with each other making sure we are doing the work in the best way we can.,English
+And we are very grateful to get additional input from a wonderful Scientific Advisory Board to help make sure we've thought of everything,English
+"and that somebody who isn't down in the weeds but who still can stand back and look at everything, and has a chance to weigh in and make sure the work is going",English
+in the direction that we want it to go. So those are kind of the overall goals of our group. And what I wanna say is that the future really is bright.,English
+"I think that, it's quite plausible to say that yes, we can stimulate hair cell regeneration and this is a reasonable way to go for a eventual treatment",English
+"of hearing and balance disorders. Why am I optimistic about this? Well, we are learning a lot about these pathways.",English
+We've discovered things already. We're starting to get a sense on what is stopping or starting recovery. As we learn more there is just opportunity.,English
+"And I really think it's just a matter of, continuing to do the work we are doing and then we will see and discover these therapeutic targets.",English
+When will that be? I know that's what everybody would like an answer. The thing with science is what we can do is just keep doing the best work we can,English
+and know that we will recognize the answer. It's very hard to predict. And I will say we have a long way to go but we have every reason to be optimistic.,English
+And I think we can get there as fast as possible because every day it seems that somebody comes up with a better way to do science,English
+"and we are very quick at taking those opportunities and accelerating our own work. In fact, the things we are doing now are using technologies",English
+"that did not exist when the consortium started. So while it's a complicated problem and I don't think tomorrow we're going to have the answer,",English
+"we are doing all the right things to get to the answer and I'm really optimistic that we will get there soon. So with that, I just want to say thank you very much",English
+"for your interest in this, and I'm definitely happy to take questions but first what I would like to do is hand things over",English
+"to Dr. Hertzano so she can tell you a bit more about what she's been doing through the HRP to produce a resource that, as I said,",English
+"that is helping not just members of the consortium but really anybody with an interest in hair cell regeneration. So I was going to give the screen to Ronna now,",English
+"if you are ready. RONNA HERTZANO: Thank you, Lisa, let me share a screen. It's great to be here this afternoon",English
+"with my colleagues and friends, Dr. Goodrich, Dr. Anil Lalwani, and Hearing Health Foundation, and you, our supporters. I'm a surgeon-scientist,",English
+"and it's not easy to be a surgeon scientist. It's not an easy career path. It's very busy. And it's also difficult to convince people that you can do it,",English
+"and that you are a worthwhile investment. And in that sense, Hearing Health Foundation played a critical role in enabling my career",English
+"as a surgeon-scientist. And you can see here after getting a small resident grant for two years, Hearing Health Foundation actually funded",English
+an idea that I had on how to actually be able to analyze gene expression and different cell types of the ear,English
+"without using complex models. And this really lead to additional funding that allowed me to establish everything I do today,",English
+"and coming back to HRP as sort of a senior member was a delight. And I think one of the greatest things about the HRP,",English
+"as Dr. Goodrich said, is the fact that, we use this combination of expertise. So we use something that is called comparative genomics.",English
+This is the ability to compare how genes are expressed or regulated across species to reveal the secrets of hair cell regeneration.,English
+"And you can imagine that a researcher that is an expert in chick biology or in zebrafish biology, they are different researchers,",English
+"they grow in different worlds, and in different labs, but having their knowledge in silo is not enough. And just to demonstrate to you how far behind the field was",English
+"and how close we are now, thanks to the consortium, we all know that all of these species have hair cells and supporting cells,",English
+"and roughly what do their ears look like. But until now, we were never able to say supporting cell A in the chick is the closest neighbor or the equivalent",English
+"of supporting cell D in human, or supporting cell F in zebrafish and now because we know these things,",English
+we can start to build a map and build a blueprint that will allow us to come up with ideas of drugs that we can use to induce regeneration,English
+"in these species that do not regenerate. We are very close to doing that. And, in fact, one of our strategic goals for this year",English
+is to come up with a paper that will map the hair cells as far as this goes. But how do you get researchers to be able,English
+to see these data across all these species? These are very complex data. These are massive data sets.,English
+And this is an example here of a data set from the Stefan Heller's lab that shows expression of a certain gene in a chick.,English
+"And you can see that as expressed in these cells that are hair cells in different types of them, and at that it said from Dr. Piotrowski's lab showing that the same gene has",English
+a little bit of a different pattern because the hair cells are only this group and if it's colored red it means it is expressed. You can see already there is differences,English
+and this is a another data set from Dr. Heller's lab and is a data set from Dr. Dabdoub's lab where it's actually more similar to chick.,English
+"And the idea is you're saying that these vast amount of data and we need to be able to see everything in one page. And what the HRP has been doing,",English
+it's been supporting an idea that we had and really allowing us to develop it to support the consortium.,English
+"The consortium served as a focus group and they really bring this tool as it's developed at real-time before publication,",English
+and make it a main go-to in the field which is really neat because when you think about it and research it in almost anything in life,English
+"first to develop something, then you publish it, then people can use it. With the HRP and the very strong knowledge",English
+"that this is funded by HHF there was not a worry of funding, and we were able as we are developing this amazing resource",English
+"to share it in real-time with the entire community and advance discovery. So what this tool is it allows you to put in a gene name,",English
+"and then immediately comes up with multiple datasets as you choose, and it shows you the expression of that gene",English
+"and the different data sets, and there are more than 100 curated datasets, they are all from ear that are public,",English
+"and they are organized according to topic, there are more than 800 data sets just to show you how many people use it most of which are private.",English
+"The tool gives you information about the gene you're looking at. It provides additional information if a gene causes hearing loss in mouse or in human,",English
+"it will light up a button. And it turns out that there are more than 1000 genes that when we cause a mutation in them, they will cause hearing loss in mouse or in human,",English
+"and it's impossible to remember all of these 1000 by heart. So this is very useful. The tool allows us to learn about any data set,",English
+"expand our knowledge, or go to for publication, it allows us to take any dataset for example, a dataset that compares expression in hair cells,",English
+and supporting cells and turn it into an instant graph and ask to see genes that are high in one population and or low in another.,English
+Or look at all kinds of other research questions that are important in order to develop hypothesis. We have additional options in a new age,English
+of omic gene expression called single cell RNA-seq where we take the tissues and now instead of taking the tissue and sequencing what genes,English
+"are expressed in the tissue, we now take the tissue and sequence every single cell separately and in fact, the HRP has been a pioneer",English
+"of that in the ear. And you can imagine how important that is. Because, the techniques that were used previously they were like taking a class that has 30 kids,",English
+and averaging their score after every exam to determine if a specific child did better. And this technique is like getting the score,English
+from every single child separately. And we're doing it at the single cell level for all the organisms and really being able to identify,English
+"all these very small populations to really find what are the cells that are similar, and are we missing cells that are necessary",English
+for regeneration in one species? Do we need to create them? Is it that the cells that are the source for regeneration in one system they are there they are just not responding,English
+"to a certain signal and if that's the case, what drug based on, for example, a drug we’ve got, can we add? And then we have a team, like Dr. Goodrich said,",English
+"they would do that, they'll do that with gene editing, they will do that with trying drug delivery, they will do whatever is needed.",English
+And the tool allows gene browsing so on and so forth. And the neat thing is it is used now as a catalog in the field.,English
+"So much so, that as of today, we have more than 100 data sets and public profiles, more than 1200 registered users of the gEAR,",English
+"and more than 1000 monthly entries for research. An important feature of the gEAR and what HRP and HHF did,",English
+"was really encouraged teaching. If you make a tool and you do not teach how to use it, it is not useful.",English
+"So what we've done is with the support of the HRP and HHF, we've been going to every single large ear meeting,",English
+"and doing hands-on workshops, and teaching individuals for 90 minutes, for shorter sessions, or longer sessions, how to use the tool that we developed.",English
+"We have gEAR swag we get people to take home, we offer private sessions to labs, we offer private learning,",English
+"we have a help desk, we do all of these things because in the HRP we think data sharing is important not just inside the consortium,",English
+"but that it is important across the board and in fact, the papers that we generate are based on a data that's not just generated by the HRP,",English
+"but also people from ERG, or any researcher anywhere in the world. Finally, I'm really excited to share",English
+"that the gEAR actually did get published at this seminar was very timely, it got published in nature methods, high-impact journal just on June 25 a couple weeks ago.",English
+"And I will be remiss if I won't thank my team of collaborators. Anup Mahurkar, Seth Ament,",English
+"Dr. Ament is also a member of the HRP, and he is one of our lead analysts. Joshua Orvis is the father of gEAR,",English
+"he's the lead engineer. Dr. Shaun supports the help desk. I can't say enough to thank the HRP, HHF, and you because this has really transformed things",English
+in the ear field and it would not have never been possible without your support. - Dr. Goodrich and Dr. Hertzano that was wonderful.,English
+"Especially I enjoyed your analogy to New York where I live, and the complexity of the system. And along those lines, given the complexities",English
+"if you could have hair cell regeneration, would that lead to hearing or do these synaptic junctions, auditory nerve, and sensory auditory processing,",English
+"also need to be fixed for a human to hear? And that's from Dr. Daniel Fink. That's a really good question. And you are muted, Lisa.",English
+"and on the spiral ganglion neurons. And so, we have thought for a long time about how the hair cells are innervated",English
+"by the spiral ganglion neurons, and actually the supporting cells play an important role in that not just the hair cells. And so, what I can say is there is a lot of evidence",English
+"that in the mouse when you can create hair cells in a place they are not supposed to be, the spiral ganglion neurons will follow,",English
+and they are pretty good at sorting out and trying to find a target to innervate. And I think there is a very good chance,English
+"that if you made a hair cell in the right place that it could get innervated, and the neuron is already connected to the central nervous system",English
+"and will be there and ready to go. So, of course, it's going to depend on why the hair cells are lost, and what the state of the spiral ganglion neurons is,",English
+And which is a little different than what happens to the mature cochlea which is what we deal with with age-related hearing loss.,English
+"and hair cells are quite different across species, and species hear from different frequencies. And so part of what we are trying to do is to understand not just how to make just any hair cell,",English
+And then we do not need regeneration. Then maybe the consortium switches its path to maintaining a healthy cochlea people age 40 and above.,English
+"It's just a great journey. - Dr. Hertzano, that's a great thing. Some of the people asked about is it possible to maintain hair cells and maintain the hearing.",English
+"So the answer is clearly yes. Some of the things you discover, in fact, are preventative as opposed to after-the-fact and trying to restore something that was lost.",English
+"Along those lines several have asked whether hearing loss is the only thing we can address to this project, or are there things like tinnitus,",English
+"and hyperacusis with Ménière's disease? If you could take that specifically or broadly, that would be great, either one of you. - I'll start by saying that,",English
+"the hair cells in the vestibular system are very important as well, and that maintains your balance. So yes, that would be one obvious target",English
+"for generating those hair cells. Tinnitus, which I actually suffer from so I really feel for everybody, it drives me crazy.",English
+But that often starts with injury to the periphery. But just restoring the hair cells is unlikely to just make the tinnitus go away because that's kind of,English
+a response of your central nervous system to the damage that happened. And so there are parallel efforts,English
+"that are attacking the tinnitus. There may be situations depending on why one has tinnitus where you could fix both things at once,",English
+"but I think they are biologically different problems. Ronna, would you like to add more clinical insight? - Yeah, so you are right on.",English
+"Really, one thing that is important to know is, it's extremely rare to have tinnitus without hearing loss. So when we are born, we hear up to 20,000 Hz.",English
+"And as we age, we lose the high frequencies because sound comes into the ear from the base of the cochlea where the higher frequency detectors are.",English
+"So, you can Google how old are my ears and find out how old you are. Hearing loss is not something private for a group of people that have some kind of mutations.",English
+"You are human by having hearing loss, and as we age and we have more hearing loss, all of us have tinnitus.",English
+"And if we take anybody and put them in a complete soundproof room, we can elicit tinnitus in almost everybody. If we just keep them in the antiechoic chamber long enough.",English
+"So to answer your question Dr. Lalwani, if we focus our efforts on presenting hearing loss and now HHF has now a beautiful campaign",English
+"to prevent exposure to loud sounds, we will significantly decrease tinnitus. But just as Dr. Goodrich said,",English
+"once you have the tinnitus it's not maintained anymore by the cochlea, it's maintained probably by the cerebellum and the brainstem and that's a different ballpark.",English
+"- We have an interesting question for both of you, even though I don't think your talk focused on this, but this is a good question. I'm sure the audience will be interested in.",English
+"Nancy and others ask about stem cells and their role in potentially hearing restoration, hair cell regeneration or anything.",English
+"You can take that question broadly and maybe address that. - Do you wanna start this time or do you want me? - I can, although I think you know more",English
+"on stem cells than I do. So, stem cells are a great question. When I started hearing about stem cells,",English
+"what I imagined was we are just going to be dropping stem cells into the ear. Maybe not really pipetting them but maybe injecting them,",English
+and all of a sudden everything is going to grow back. And it's clearly not possible. The fluid milia out of the ear is completely toxic,English
+"to cells that are free floating, and cells need to integrate. So, that's not going to be the role of stem cells. We use stem cells to learn on how to direct",English
+"the tissue that is there and there is this assumption, that this is probably true because it's true across almost all tissues,",English
+that there are what we call resident stem cells in the tissues that are sitting there and are waiting for the right signal.,English
+"And if we can wake those up, and make them do the things we want them to do, then we will be able to unlock regeneration.",English
+"And so the HRP does a fair amount of work with stem cells, specifically the lab of Dr. Edge and Dr. Heller. And I believe that's much of what we are using it for.",English
+"And I will pass it on to Lisa. - And I agree, one thing I want to add is that, actually the supporting cells, they are kind of stem cells.",English
+"If you look at the morphology of those cells, if you look at the genes they express, they have a lot in common with the population",English
+of cells in your brain that actually produce new neurons when you need them. There is something about those supporting cells,English
+"that early on in life they have a lot of potential. And so one of the reasons why I have a lot of optimism for hair cell regeneration is that,",English
+"it is not just that the supporting cells are conveniently located for generating hair cells, this is kind of what they do.",English
+"This is just getting them to relive their youth. This is what they started out doing. So, a lot of it is about reawakening that.",English
+And if you think about many of you may have heard about the Nobel Prize-winning work where Yamanaka discovered a few factors you can add to the cell,English
+"to kind of turn it into a stem cell. And that has been very powerful. It is the same thing, if we could find a few factors",English
+"to convince the supporting cells in a mature ear to become stem cell-like again or stem cell-like, I think that is the best opportunity for using stem cells.",English
+Is to really leverage the natural biology. - This kind of reminds me about 10-15 years ago I went to a seminar on stem cells,English
+"within the Belfast Trust. Within the team we have obviously optometrists like myself, we have research nurses, we have Ophthalmologists, we have imagers admin staff.",English
+"And of course you'll see in the right hand corner our registered genetic counsellor, Claire. She kind of doesn't work in the NICM, but she definitely gives a lot of input and helps",English
+"with many of our studies, whether she wants to or not. Claire, isn't that right? So the areas that we cover I think at the minute we've got maybe about twelve or 13",English
+different studies currently running where we are either actively recruiting patients or whether we are in the non-recruiting phase where we're treating patients.,English
+"We don't just deal with macular eye disease, we also would do retinal vascular disease. So if there's any vein occlusions or anything like that, dry eye glaucoma and refractive",English
+"air. And obviously as Claire's going to talk to us about, next would be our inherited retinal degeneration.",English
+"So I'm just going to pass over to Claire and Claire, just you tell me when you want the next slide. Thank you, Shelley.",English
+"So Shelly has I've put a little thing up here on the left hand side of the screen, which some of you may be able to see, is made up really of squares and circles.",English
+"That's a family tree and that's like my pen and paper of my work in genetics. We take a family history from patients and we do that for a number of reasons, mainly,",English
+"of course, to find out who is affected in the family with the inherited retinal degeneration. Are there some family members who've maybe been lost to follow up and who we can get",English
+"back into the system, the health system? We find out more about how the gene is inherited through the family tree and it also sets up rapport with patients, I find, because once we start chatting about a family history,",English
+"then you get to hear the human side of things, the stories about the previous generations and so on. So it's essential to our work and it's the first port of call for talking to any patient",English
+"is to go through as well as their own clinical history, is to talk about the family history. Now, Shelly has put a photograph of an eyeball, I believe, beside that.",English
+"Normal retina. That's a normal retina. Very good. So Shelley, if you could just get the next slide for me please, that would be brilliant.",English
+"So in terms of genetics then, I've been doing the ophthalmology work for the inherited retinal conditions for about over four years now.",English
+"And what has amazed me about Ophthalmology is actually the number of genes involved. So for other genetic conditions, like cystic fibrosis or Huntington's disease, there's",English
+"only one gene. That's it, that's the gene. But for these retinal conditions, we know now that there are over 300 genes. So some of these genes are actually incredibly rare.",English
+"So when a patient finds out what their family gene is, sometimes they'll say to me, what do you know about it? What will I be like in ten years or in 20 years?",English
+"For a lot of cases, that is actually almost impossible to tell. There are some conditions where the gene is more common, like Stargardt disease.",English
+So the main gene there is ABCA Four. And somebody in America has done a lot of work on the natural history of the ABCA Four gene and they're actually able to pinpoint progression or let you know how your condition,English
+"will progress with certain mutations. So for example, for some of the risk factors, they know that you won't be affected till middle age and your presentation will be quite mild.",English
+"So there's so much to learn about the genes, but the more rare that the gene is, well, the more actually important that you are to us, to the community, for research and so on, and the more you can help us.",English
+"And again, that's where the family history comes in because we can look at the presentation of a gene in the family history, not just in one individual. Colin mentioned earlier that this chat really is for people of he mentioned working age",English
+and indeed the inherited retinal conditions are the leading cause of vision loss in people of working age. So that's between 16 and 64.,English
+"So there's not just the personal implications and the family and carer implications, but it's a huge loss actually to society as well in some ways.",English
+"So these conditions are caused by what we call pathogenic or likely pathogenic variants in genes and they're critical to the function of the retina. And as I mentioned earlier, there are currently over 300 genes that we know about.",English
+"So Shelley, could you move on please, for the next slide? So just to give you an idea, overall the inherited retinal conditions are rare. This is what we call a rare condition.",English
+We know that one in 3200 people will have an inherited retinal dystrophy. The EU defines a condition as rare if it affects fewer than one in 2000 people in the general,English
+"population. Now, don't despair and think they're going to forget about us because this is a rare condition. But as people say, rare conditions together are actually common.",English
+"There are more in England. But with this, with inherited retinal conditions, we know more than 2 million people are affected worldwide.",English
+"So, Shelley, please. So there may be quite a few of you who have never had genetic testing. And I know quite a few people get lost to follow up at the Ophthalmology clinic because",English
+"So if there's been no genetic testing in your family, we would recommend that you get referred for genetic testing through your ophthalmologist.",English
+"Now, when we start testing in a family, initially we always start with somebody who's affected and that person has what we call a gene panel test.",English
+"So the laboratory will actually it's like a needle in a haystack. They will look at over 300 genes in your sample and if the familial gene is identified, we can then offer cascade testing or predictive testing to other family members.",English
+"So if you find out what your gene is, we can then offer testing to your siblings, your children and so on. Well, why would you do it?",English
+"It confirms a diagnosis, it gives you a reason why this happened. It also refines a diagnosis, because even though we have this very, very broad terminology",English
+"of inherited retinal degenerations, they are quite different in their own ways and a gene actually makes it very refined. We can also establish the mode of inheritance and that's important for other family members",English
+"or for people who want to have a family and want to know the risk to their children. And leading on from that, then we can make referrals to the genetic service. There is potential there for something called pre implantation genetic testing.",English
+"So it's a form of IVF and only the unaffected embryos, or the embryos that don't have the gene change are implanted in the womb. Now, that's not for everybody, but again, it's down to your own personal history of",English
+"your condition or maybe what you've seen in family members in terms of their condition. But as I say, it's not for everyone. But it is important to know that it's available.",English
+"But it's also essential to have your genetic report and your gene prior to joining clinical trials and especially gene therapies. Thanks, Shelley.",English
+So I'm just going to say something very brief about the chromosomes. We have 23 pairs.,English
+"One to 22 of those pairs are called autosomes, and they're pretty much the same in men and women chromosomes one to 21.",English
+"So when you hear a genetic the same, your condition is autosomal. It means that your gene is on chromosomes one or chromosomes two or three or four, it's",English
+on a pair of the autosomes. Then different to that are the X linked conditions. The 23rd set of chromosomes are the sex chromosomes.,English
+"For females, that's Xx, for males, that's XY. And for genes on the X chromosome, that condition is X linked. Thanks, Shelley.",English
+"So we've got a wee pictorial representation here of autosomal dominant inheritance. Now, for this condition, as I said, our genes come in pairs and our chromosomes come in",English
+"pairs. So the genes are on the chromosomes like a little string, like a necklace. Each bead is a gene and it's on that necklace which is chromosome. So we've got 23 pairs.",English
+"One comes from dad in the sperm, one comes from mum in the egg. So for autosomal dominant, you just need one of your two chromosomes to have a little alteration",English
+"or spelling mistake in order to be affected with the condition. So on this representation here, one of dad's two genes has an alteration and he is affected",English
+"with the condition. So each pregnancy they have, whether it's male or female, will inherit a working copy of the gene from mum.",English
+And its 50 50 whether they inherit their dad's working copy or the one with the alteration. For an autosomal dominant condition.,English
+"We're able to tell people that for each pregnancy, there's a 50% chance that it will inherit the gene change and will be affected. Thank you, Shelley.",English
+"The one on, as you look at your screen on your right hand side, is healthy eye. So you'll see it's a nice orangey red colour, the nerve, which is a little like yellowy",English
+"dot, it's a nice bright colour. On the healthy side, if we go over to the left, there are these little black speckles that are surrounding the middle part of the eye.",English
+"These speckles are called bone spickle, dark deposits, and they are very characteristic of patients with retinitis pigmentosa.",English
+starts to degenerate a little bit as well. Generally the symptoms would begin in adolescence and young adulthood and then progresses then over time a little bit with that.,English
+"That's that Claire, I'll pass you back. Thank you. That's really helpful because I've seen bone specules written in clinic letters and things. I've never been quite sure what that meant.",English
+So that's very helpful. So we're sticking to autosomal inheritance. So the autosomes this time I want to tell you about autosomal recessive inheritance.,English
+"So if you remember, with the dominant type, you just need one of your two genes to have a little alteration. To be affected with the recessive type, both of your genes need to have an alteration.",English
+"We used to use the phrase mutation, but it's more nuanced now. So both copies need to be affected for you to be affected with the condition.",English
+"And I'll go back to one of the most common genes, ABCA Four. That's how this condition is affected. So if you have that condition, you can bet that both of your parents are carriers, what",English
+And that's simply it. So that little group of children or siblings will be the only section of the family with affected family members.,English
+"You will have carriers on both sides of the family who won't know their carriers. But it's when you get one carrier having children with another, you start to see the condition.",English
+"Some of those children will also just be carriers, so they'll be unaffected, and some of them won't even inherit an altered gene at all. The assuring thing, I suppose, with knowing about the inheritance pattern is if I meet",English
+copies. But they'll get a wild type normal copy from the other parent. ABCA Four will be the most frequent gene in the population out of all these inherited,English
+vetna conditions. But it's not frequent enough to warrant carrier testing in the general population. So we don't actually do that.,English
+"We don't offer carrier testing. It's really not needed. It would just be an issue if you knew that somebody was going to marry, say, a first cousin or something like that, and that doesn't happen a lot, but I have come across it in",English
+"clinic and when that happens, then we do carrier testing for the cousin and so on. So it's just a bit different from the dominant inheritance.",English
+"So thank you. Thanks. And again, here we've got photographs. This is for the ABCA, for Stargardt. Yeah.",English
+"So in this slide, both photos are of the CMI, but photo b on the right is just a more magnified version of it.",English
+"So there's little dull yellow deposits just surrounding a peeler area just in the middle of the photograph, just around the macula. These deposits are called flex and are a hallmark of Stargardts.",English
+"Yes, that's right. Shelley said the clinical presentation is highly variable and that comes down to the type of gene change that you carry and the combination of gene changes in both of your",English
+"genes. So it is quite fascinating. And there's also a new science that, if you like, it's called eye to gene. So it's quite amazing that an ophthalmologist can look at a photograph of an eye or an image",English
+"genes on it. So it's all about the X chromosome. Now, that's a very busy picture there on the left, and I don't like it.",English
+"So sorry. Thank you, Shelley. Shelley's, put up a few more photos now of an excellent condition. Yeah.",English
+"So these slides are just showing copraemia, which is in this case cause for the CHMG. So again, on the right hand side we have healthy retina, and then on the left hand side we",English
+"have retina affected by copraemia. So anything that's kind of pale in the retina generally means that it's not really working anymore, that it's waste away.",English
+"So the only part of this eye which is healthy or seeing well is right in the middle, in the macula. So people with this condition will very much have tunnel vision and how this varies.",English
+"Again, the severity of the symptoms can vary between patients, even within the same family with this particular one. So, yeah, I'll move on to the next one.",English
+"Claire, thank you. Yes, well, I took my just put this up. It's a bit geeky, I suppose, a bit nerdy, but I suppose what I'm trying to say with this slide is, look, the family tree really helps us to consider a mode of inheritance",English
+"for the family. But you do not really know what's going on until you actually do the genetic test. So just looking at that family tree, you would say, well, this is a sporadic case.",English
+"What's the inheritance here? Well, believe it or not, it could actually be dominant, even though I talked about how dominant genes are inherited.",English
+But what's actually happened in this case is this patient here who's affected that genetic alteration actually occurred spontaneously at conception.,English
+"So there's no family history, but it has started for the first time in this person. And the importance about knowing about this de novo genetic alteration is that going forward for this person, any children they have will be at 50% risk of inheriting that alteration.",English
+So there's the importance of doing a gene panel for that person and working out how this genetic alteration came about. So it's de novo in this person.,English
+"It wasn't inherited, it happened at conception, but going forward, all of that, his children will have a chance of inheriting, 50% chance.",English
+"So the other thing is, it could be autosomal recessive, both parents are unaffected carriers, or it could be X linked. So each of the females, his mother, his maternal grandmother and so forth, where X linked carriers",English
+"who didn't develop the symptom, the condition, but have maybe, when they are examined, have very, very subtle signs.",English
+"So in boys, though, unfortunately, it tends to be quite severe and quite affected at a young age. Anyway.",English
+"Thanks, Shelley. So I don't have too much more to say on this, you'll probably be quite glad, but I just wanted to give you I think it's very important, when we're counselling people who are having",English
+"gene panels, it's important to let them know that we may not find your gene. And that's down to technology, really. There are parts of the gene which are not very well characterized and are quite hard",English
+"to access, so a lot of people will be hoping for a positive result and find out what their gene is. But I just did a wee snapshot of our results for 145 patients and it was over a year, 2019",English
+"to 20. And out of the people who had gene panels, 79 of them got a genetic diagnosis. So that's 54%.",English
+55 of them got a negative report. So the causative gene was not identified. But that doesn't mean that your condition is not genetic.,English
+"So you're at a bit of an impasse there until the technology improves and we can look at other parts of the genes, but there's a very small percentage.",English
+"8% of people will have what they call a variant of uncertain significance. And that's a kick in the teeth for the professionals involved as well, because what's happened",English
+"is the lab has identified a good gene and there is an alteration in it, but there isn't enough scientific evidence to say whether it's caused the condition or it's just one",English
+"of those benign changes that occur in all of us across. The general population, there's just not enough evidence. And part of that is because these genes are so rare and they maybe haven't seen that particular",English
+alteration before. So these variants of uncertain significance tend to be reviewed every two or three years. So it can happen if you do family studies and try to follow this change through the,English
+"family, through affected family members, you can sometimes upgrade that classification to likely pathogenic.",English
+"So it's just to manage people's expectations there. Thanks, Shelley. And this again, it's just these patients where we did get a diagnosis in 79, it was in 19",English
+"different genes, the most common of which I've mentioned them before, ABCA Four, we had 34 patients with a diagnosis, the OSH two, a gene which is also autosomal recessive,",English
+"so carriers aren't affected. It causes Usher Syndrome. Type 212 of our patients had that. And then as you go down, you can see how rare some of these genes are.",English
+"Like, quite a few of them only happened in one patient. So the next one there is RPGR. That's the X link one.",English
+We have six patients with that. So it's quite a range. So.,English
+"Thank you, Shelley. And without stepping on Shelley's toes, I did think I'd just put this in about gene therapy, because I know these things seem to move very slowly, but there is actually",English
+"a genetic retinal condition where there is gene therapy. So there's a condition called Libra, congenital amaurosis, and it affects, really, toddlers",English
+"by the age of 18 months to two years. They're almost blind. But for that condition, that's caused by this one particular gene, RPE 65, there is a gene",English
+"therapy and it's funded by the NHS. Now, we've been trying for years, as Shelley knows, to find a patient in Northern Ireland with it, and we haven't. We think there are three patients in Dublin.",English
+"So it's quite an amazing thing, but it does give us a great deal of hope for other genes going forward. Thanks, Shelley.",English
+"And just finally, there's a very smart registrar working with us in Belfast. He did some work over in Moorfields in the eye hospital, and there's a lovely app he has.",English
+"You can download it on your phone. It's called Genevision and it goes through all the different genes. And actually, Shelly had a look at it when she was preparing her slides and that's where",English
+she picked up the photographs for the eyes for the different genes. But it's a lovely app. It's been developed for patients.,English
+"It's got information about support groups and so on, and I really recommend that you have a look at it. So that's it for so, yeah, back to me.",English
+"So, yes, just as Claire was saying, that website is really good, particularly if you've had genetic testing. And you know what your condition is, even if you don't, and you know the name of your",English
+"condition, you can click. On the condition on that website and it will have the most up to date information if there are any current clinic bill trials going on. So you can kind of link with that and see if they're recruiting patients or if there's",English
+"any way you can participate. So, like I said at the start, Claire's done all the heavy work and I'm just going to wrap things up here in the last few slides and I just really want to talk about, just briefly",English
+"a few of the studies that are currently going on in the NICN. At the minute, I just wanted to focus on ones that are more macular based or inherited rental",English
+"degeneration based, and just to show you a sample of the different types. So the Galtoff study, this study is looking at people with a more advanced form of macular",English
+degeneration. So geographic atrophy and atrophy is from the Greek word meaning wasting away. So it's where part the retina kind of starts to not work at all anymore.,English
+"And that's what gives us that kind of that blurred vision. So currently in the UK, there's no approved therapies to treat this. Now, there have been some that have been approved in the US, but that hasn't reached us here.",English
+"So this is an example of what I was talking about earlier, where sometimes we don't have enough information about a disease or why it affects some people more than others. So with this study, what we are doing is just monitoring the disease over a period of time.",English
+"The patient doesn't even have to come to see us in the research department. We're observing their general care and their general visits, and it's just to see why once",English
+"they get all the information from all the different sites, because it's not just us, its many sites across the UK and Europe that are doing the study, then they will hopefully try and find out why one group is different than the other.",English
+"And hopefully that will lead to further research. This next study is called the Tiger Study, and you will notice that studies all have these very catchy names and that's on purpose because catchy names that people remember",English
+"them compared to the very technical name, which I'll not go through, but there's about 20 words to it. So the Tiger Study, I just want to give an example of a macular condition that's more",English
+"an acute one, so it happens more suddenly. In this study, the patients that are affected have a sub macular bleed. From the photos, you can see there's a really heavy blood clot just centrally, and the OCT",English
+"image on the right, that's just showing that big kind of hill, which is just where the clot of blood has kind of gone underneath the macula, which should normally be a phallic as opposed to a hill in that picture.",English
+"This study is comparing two types of comparing a new treatment versus the standard of care. So this is an example of trying to find a more efficient, better way to treat a certain",English
+"condition. So in this case, it's comparing the standard eye injection to the eye to help the little blood vessels to stop bleeding versus the injection plus surgery where a clot busting",English
+drug is inserted at the same time along the gas bubble to take the blood away more quickly. I have a video on the next slide and if you are squeamish and don't want to see horrible,English
+"things happening to you, I would advise you not to look at this next bit. But if you're interested to see what an eye injection looks like, just to be more reassured that it's not as scary as what you think, then just for the next minute, I'll let you",English
+"watch. So bear with me. There is sound in the video, but you'll not be able to hear it. So I'll just kind of talk a little bit about it.",English
+"Hopefully you can hear me still. So basically, this lady is one of our research patients and she is getting one of the eye",English
+injections. The surgeon has just marked on the eye where he's going to do the injection and ask the patient to look up and to the left and he has just popped the injection in.,English
+"just says it's not painful, it's just pressure. So I was trying to show my husband this image during the week and he almost vomited. So there we go.",English
+"I'm not even joking. Last study I'm going to talk about is obviously the magpie study, which we're very thankful that the Magnificent Society has funded in this study.",English
+"It's an example of where there currently isn't maybe a treatment for a macular condition. So in this study, it's not just people with macular generation, it also includes people",English
+"with inherited retinal diseases. And the study is aiming to see if intraocular magnifier can help patients reading ability. So if somebody's already had their cataract removed, they'll have an artificial lens in",English
+their eye already and the implant just slides almost like a piggyback system on top of that lens. The central part of the lens provides about two times magnification and then the outside,English
+of it is clear. So the point of that is so that it still gives patient distance vision while also helping with the reading.,English
+"Because as we read, our pupils naturally shrink and should be focusing onto the more magnified part of the lens. Alongside this study, we're also testing out a contact lens and the similar principle with",English
+"the magnifying area in the centre and clear bit on the outside. And with the contact lens, we're trying to see whether it's comparable to the lens implant. So that if people don't want to have surgery, then that's another option for them now, because",English
+"obviously some people might be listening going two times. My question. Share that's not very much. And you're right, it's not load.",English
+"So the patients in this study generally would have a more mild to moderate visual loss, rather than we wouldn't be recruiting people with more severe types of vision loss for",English
+"this study. So, last slide, really. So how can you get involved in research? So the Magnus Society I've been looking at the website, are very good in updating you",English
+"what's currently available, what's going about, and obviously are funding research all over the UK, which is absolutely fantastic.",English
+"Without the funding, research can't happen and we can't move forward. But if you are, obviously everyone in this call isn't from Northern Ireland, so if you're",English
+"living in the UK, the people that do the research are clinical research networks, like what we do in Belfast. They're all across Scotland, England and Wales.",English
+"You can contact your local research network, your research facility, your clinical trial unit, any of your universities, and just ask if they have any studies running with regards to your condition.",English
+"Just an important point. The thing with clinical trials, or with any study, they do generally have quite a strict what's called eligibility criteria.",English
+"So even though you may have the condition, you may not fall in line with what they want. It may be you have to have a certain amount of vision loss or impairment. Like I mentioned, the MagView study, you may have to only have an eye condition that's",English
+"stable, that you can't be receiving injections for, or you may not be able to participate in the study if you have other conditions like diabetes or hypertension, et cetera. But don't let that dishearten you.",English
+"There's always something coming up. Even just letting the people, the researchers know that you're interested means that if anything does come up, they will be the first to contact you.",English
+"And just following on from that, if you are in Northern Ireland and you are not known to us and you are interested in taking part in any, please, please drop us an email at the vision research team at Belfast Trust HSENI net, or give us a call on the number",English
+"Thank you ever so much. Yeah, it's brilliant. I think understanding genetics and sort of what you guys are doing over there as well over in Northern Ireland is brilliant.",English
+"Yes, we've got a couple, both from the same person, but they're not particularly related. So the first question is it's to Claire?",English
+When you talk about people needing to know their genetic mutation alteration in order to take part in gene therapy or go in a clinical trial. Can you explain why?,English
+It's a bit like matching pieces of a jigsaw puzzle. The gene therapies are targeted very much towards that specific alteration or spelling,English
+"So if you don't know what that gene is, then you can't match the jigsaw puzzle, you can't put the lock in the key and match the things together.",English
+"I don't know if I've made that. The gene therapy is specific for that gene. No, it doesn't stop anybody taking part in any studies.",English
+"It's just if it's particularly gene therapy where it's targeting the actual gene, but they could still take part in a study where they're looking for people with ABC Four gene. It's just the actual therapy where they need to target the gene, then that's where you",English
+need to know what gene it is you have. I've seen the eligibility criteria for clinical trials and there was the Stargardt one not very long ago where you couldn't find out what your alteration was through the trial.,English
+"You had to know it already for them to consider you for the that's you had to have had that genetic diagnosis before you would even be couldn't just say, I've got Stargardts, and",English
+"they would look at you. Yeah. And one of the reasons is I've mentioned ABCA Four quite a lot, but there is another gene which causes Stargardt's disease, PRPH Two.",English
+"It's inherited in an autosomal dominant fashion. So if a clinical trial or particularly a gene therapy, but if it is targeted towards a particular gene, it wouldn't be helpful for somebody with Stargardts which was caused by the other",English
+"gene. I don't know, Shelley, if you want to comment on that no, I think that's a big reason why there's a lot more funding and stuff going into people who haven't got genetic testing",English
+"to find out. Genetic testing, it does take a long time to find that gene, and if a study has already been given the go ahead, they might have a limited timeframe in which to see the patients.",English
+So if it's going to take maybe I don't know. Claire can it be up to six months? Four months? I don't know.,English
+"It can be quite a long time. Basically, if you've got your genetic report and you know your genetic alterations, you're good to go. You don't have to go through that genetic or the genetic testing.",English
+"generally it's about a year to get a result. So this is why it's really important, I think, to have all that background work done. And then if something does come up, like something that targets ABCA Four, as I say, you're good",English
+"to go. If, as Shelley said, you'll fulfil all the other eligibility criteria, maybe your vision has to be at a certain level and so on.",English
+"But, yeah, that's the importance of having your genetic report. Lovely. Thank you. So another one's come in.",English
+"Now, drusen is something I know of in relation to age related macular degeneration. So can you recognize that as a diagnosis related to an inherited disorder?",English
+So what is it? They're asking what is it? I would like to know more about this bilateral macular drusen.,English
+"So it's bilateral macular drusen, but it's also at the disc as well. A few drusen to the optic disc. And they've just popped in the chat that they're 30 years old.",English
+"Okay. That's very young to have drusen. It's quite young, but it's not completely unheard of.",English
+"We have seen people in the past. I also work in community practice as well, and there would be maybe the OD person you would see who would have more like a juvenile kind of drusen.",English
+Because I don't know the person or I haven't seen their images. I can't really say lots about it. It wouldn't be as common.,English
+"It depends if the Dresden is near the disc. Then again, that kind of would fall in line with any Dresden that's more associated with",English
+"when you're younger, because it wouldn't necessarily just be at the magnet. It could be a bit more scattered. If it's Optic disc drusen as well as that, that would be I don't know if I've come across",English
+"If the person is unsure and wants to know more about it, don't be afraid to ask for more information.",English
+"I think sometimes we get into the clinic room and we're told something and we go, Is that okay? Here's a leaflet.",English
+"them down and the next time you go to the eye clinic or whomever, just take those questions with you so you don't forget to ask the relevant questions that you think of over dinner three",English
+"weeks later. Yeah, because it's the worst thing, us as professionals, that's what we're there for. We're not there to yes, there's busy clinics, whatever, but you are still worth the time",English
+"is that we can see down here, this is the Eustachian tube, This is open, it's allowing the pressure in here to be equalised. And",English
+"as you want to tell, it's not allowing any fluid to build up, it's all been drained straight away. If we look over here to the middle ear, which is considered to have Otitis media, we can see that there is",English
+"a fluid build up here. So it's a little bit difficult to see, but you can, you can see it's kind of a dark brown and these yellow little spots indicate fluid. So I suppose first of all what you",English
+might notice when you look into an ear is the eardrum might be a little bit cloudy or it can be dull because of the fluid behind it.,English
+"Also, because there's fluid behind this eardrum, it can be very difficult for the eardrum to move, so it's a little bit less mobile and this impacts how the sound is",English
+"the fluid can be drained itself. So we would have to wait until that year that Eustachian tube is opened or if intervention is supplied, to open it. Now what I'm going to show next is just a",English
+"few real life eardrums. So for anyone who is a little bit squeamish, it might be good to look away now, but there's nothing bad anyway.",English
+"So here are three different eardrums. So if you look into an ear, this is what you could see. So I'm going to start with this one again. It's considered to be a typical or normal eardrum.",English
+"There's a few different hallmark features you look for when you sticky thing here, which is which is actually one of the bones in the middle here and this light. So that shows us",English
+that light is passing through the eardrum. There's no fluid or anything there. So that would be considered a healthy eardrum or it would have no abnormalities. As you can see on this eardrum,English
+"we can see all these little air bubbles. Now it will be quite unusual to see an eardrum with air this pronounced, but that would be a certain, you know, or very likely indicative of fluid",English
+"behind that eardrum. You can also see that around the eardrum it's quite red. That would be described as an angry ear or an angry drum, and that's often",English
+"linked with kind of infection building up. And then over here on this side, while it is harder to see, it's slightly duller just within the body of the eardrum itself. And that again,",English
+could possibly indicate that there's some fluid behind that. So I think what's important to know is the difference between,English
+"50 to 70% of children will have one of these, if not both at some point, kind of under the age of three to five. And what do they look like? So in the acute otitis media, they",English
+"occur rapidly. It's an infection. The children will have earrings, they will spike temperatures, they'll generally be sick, and sometimes you can notice pus draining from the",English
+"ear. So that means the eardrum itself has actually burst to let out all that fluid and infection. And it often kind of heals itself. It doesn't always heal itself, but it often will.",English
+"Then in Otitis media with a fusion, it's a little bit more tricky because you don't have those associated infection signs with it. So",English
+"while you may have hearing loss, you'll likely just have a feeling of fullness or pressure in the ear. Sometimes children might pull their ears.",English
+They might have difficulty hearing very softer high frequency sounds which will be discussed in a little bit more. And often in the clinic we see that Otitis media with Effusion,English
+"can be linked with kind of persistent nasal issues, tonsillitis kind of those congested children who have speech sound difficulties. They are often linked with this",English
+"otitis media with Effusion because it's more long term. So this fluid can be their unknowns for a while. Whether it's with a Otitis media, it's generally not as likely because the child will",English
+"just be really, really sick for a few days, then it will resolve like an infection. OK, so there's a couple of different, I suppose risk",English
+factors or red flags for Otitis media with Effusion that can put a child at more of a risk of of having it than other children. And I've separated these into kind of medical and non medical,English
+"factors. I suppose the big one is age. So Otitis media with Effusion is really prevalent in the paediatric population, particularly children aged between six months and kind of",English
+"up to three years. And there's a few different reasons for this. So first of all, because of their anatomy, they're still growing. So",English
+"everything is really, really small and that includes their Eustachian tubes. So in children, Eustachian tubes are actually quite horizontal and they're narrow and they're",English
+"shorter. So when anything goes into the back of the throat, the nose, because it's so horizontal, everything can just pass up into that ear. And then that facilitates fluid",English
+"accumulation. And also the adenoids in children are often larger. So they can, they can kind of impact as well the Eustachian tube and how",English
+"fluid and things can pass through. I suppose family history plays a role in lots of things, and genetic factors can certainly influence the structure of the",English
+"Eustachian tube. So yeah, like if you have, you know, you're often here of families having grommets, you know, first cousins have grommets, uncles have grommets, that kind of thing. So I suppose",English
+that would put you kind of you'd be taking a good few boxes for red flags there for a title you do with Effusion. So children or adults who are exposed to tobacco smoke or,English
+"other environmental pollutants in the house or just in their environment, it does list their, I suppose, their ability of or chance of acquiring Otitis media with Effusion. And that's",English
+"because this smoke actually irritates the Eustachian tube. And then because of their back to their age, again, children are in",English
+"child care. You know, especially at a young age. Do you have an increased risk? I suppose that's not something that can be helped. You know,",English
+"and particularly after COVID, I think when a lot of children's immunities were just down anyway, we did definitely saw spikes in these things, but it's just something to be aware of",English
+"more that needs to you know needs to be changed. It doesn't. Then there is some medical red flags for Otitis media with a fusion. So one would be that history of acute Otitis media, so",English
+"ear infections. So if a child is having a repeated ear infections, you know, lots of antibiotics for ear infections within a 12 month,",English
+"you would be looking at maybe risk factors for Otitis media with Effusion, recurrent tonsillitis and nasal congestion as I said. So they often involve bacteria and viruses within",English
+"these infections. And then as I said, these infections can just spread to the Eustachian tubes into the middle ear, and that leads to inflammation and fluid production.",English
+"There's some research now to suggest allergies like hay fever and respiratory allergies can be associated with Otitis media with Effusion. Again, it's thought that they're linked to",English
+kind of inflaming and irritating the Eustachian tube and that impacts its ability to function in what's considered typical. But I think more kind of research is needed in that area.,English
+"And then certain cranial facial abnormalities, so certain structural abnormalities in the head and neck area can be associated with increased risk of developing a types media with",English
+"Effusion. For example, in the cleft palate and Down syndrome population, often the outer middle ears and Eustachian tube functioning are impacted.",English
+"I suppose it's important to note that while these factors can increase the risk of having a Otitis media with diffusion, they don't guarantee that you're going to develop the condition.",English
+So not every child who has a family history of grommets or you know who has had recurrent ear infections is going to develop these things. And it's important to note that these are,English
+"also risk factors for adults. It's less likely that it will occur, but it can occur. Next we're going to talk about the treatment.",English
+"So the treatment approach for a Otitis media with Effusion depends on lots of different things. So like you consider the severity of symptoms, the duration of the fluid, how long",English
+has it been in there? Does the child or patient have any other underlying conditions that you need to consider? And I suppose often otitis media with Effusion will resolve on its own. So,English
+"that's the big thing. Like often children will have this and you won't even know about it, and they can clear the fluid themselves. So",English
+"they're Eustachian tubes will close for a while, maybe while they have the cold, but then it will open. And it takes a little bit of time, but it does happen. And that's considered spontaneous. But then some",English
+"children, they won't be able to clear it and that's where intervention comes into play. So within the protocols of the HSC, the first step I suppose in the intervention process is",English
+"considered to be this watchful waiting. And this means that basically when a child presents to clinic with suspected otitis media with Effusion, they will actually be wait listed for a",English
+further three to six months depending on whether the otitis media is in one or both years. And this is just to see if the child can actually clear it,English
+themselves. If after that three month watchful waiting period has ended and there is still fluid at this point it is considered to be persistent. And this is when you may consider,English
+"onward referral to an ear, nose and throat specialist to consider putting grommets in. It is ultimately the decision of the ear, nose and throat doctor",English
+that will decide whether a child is suitable or not for grommets. And basically a grommet involves placing a small tube through the eardrum which can allow drainage of fluid and basically this,English
+allows for equalisation of the pressure because it allows that Eustachian tube to open. The only function of the Eustachian tube is to open because this keeps everything else balanced.,English
+So that's what the Grommet does effectively. Sometimes hearing aids will be considered for children who have otitis media. With Effusion,English
+"like one, it's because of lengthy weightless at the minute. So if children are waiting quite a while to be seen by an ear, nose and throat doctor and maybe after a",English
+"decision is made to get grommets, there's still quite a time between those two appointments. Umm, you know, that's a valuable time that children can be having access to",English
+"speech and language so they may fit hearing aids. And I suppose it's important to note that with Otitis media, with Effusion, while it causes a hearing loss, it doesn't impact one's",English
+permanent hearing. So often we say that the underlying hearing is OK and it's just that the sound can't get to the underlying hearing to be processed. And all that has to,English
+"happen is you have to make the sound louder and then it will actually, you know, get to the cochlear and be processed by the brain. So it's just a blockage getting there",English
+"and that's why hearing aids are introduced. Also, hearing aids are sometimes recommended for certain populations. So for example in the Down syndrome population,",English
+"because of anatomy and things, their ear canals can be quite small and narrow and difficult to fit grommets. And in that situation then hearing aids may be the first protocol for",English
+"treatment. Sometimes antibiotics are recommended if it's suspected that there is an acute otitis media and that's only to treat an infection if if it's pure otitis media with Effusion,",English
+"there is no infection. So antibiotics are generally not the first protocol, but that's down to the decision of the GP and the ear, nose and",English
+"throat doctor again. And clinically, I have seen a lot of nasal cardiosteroids or decongestants being prescribed and if they feel that kind of",English
+"dysitis media is stemming from allergies. But again, that's kind of down to the ear, nose and throat doctor and GP and the parent to have a discussion around that.",English
+"And I suppose it's really important that if you have a concern, you kind of consult with your health, healthcare professionals. And in terms of a Otitis media with Effusion, it",English
+"will be your audiologist, your GP, your ear, nose and throat doctor and your speech and language therapist to a certain extent.",English
+"Um, when you're making, you know, the best possible treatment plan. OK. So what I'm going to show you now is just some different types of treatment. So over here, we",English
+"actually have a grommet in an eardrum. So that grommet is considered to be in situ. So as you can see, it's a tiny little tube and that just sits in the eardrum. And it allows that",English
+"pressure to equalise. It allows that Eustachian tube to stay open. And then over time, the grommet will just fall out. So often, parents will see that the grommets may be on the pillow in",English
+the morning when a child wakes up. And then the eardrum is great because it just closes itself. So it just heals like any other wound or cut.,English
+"And often, children might need a set of grommets or maybe two sets of grommets. So it wouldn't be unusual, you know, to have maybe not multiple sets, but maybe one or two.",English
+Here we have a little girl wearing what's considered to be a soft bend kind of hearing aid. It's a bone anchored hearing aid and basically it sits behind the ear as it's seen here,English
+and it bypasses all that fluid. So it sends the sound directly into the cochlea and where it can be processed and it doesn't account for any flute. And then on this side we have kind of,English
+traditional hearing aids for want of a better term. So you have your little earpiece that sits into your ear and then you have the the kind of technology aspect which sits over the ear,English
+"and they can be programmed to, you know, the hearing loss that the child has to make sure that it's loud enough for the sound to bypass the fluid and get into the",English
+"into the ear. So they're kind of the three main intervention options, probably. You know, grommets are quite common, but as I said, in some situations hearing aids will be",English
+offered. Maybe both will be offered as well sometimes. OK. So what we'll do now is we'll get into kind of the speech and language therapy aspect of it and kind of discuss,English
+the impact that Otitis media can have on speech and language development. So one of the main reasons that you provide intervention to,English
+"children who have Otitis media with Effusion is to prevent developmental consequences. So for example, the distribution and variability in auditory input caused by this fluid can",English
+cause children to hear and process information completely inaccurately. And this then goes on to impact their phonological working memory and it really generates a build up of,English
+"incorrect words. So they're hearing words wrong, but they think they're hearing it right. So that causes, you know, a knock on effect for all all aspects of language. The",English
+"literature conducted over the last kind of 30 years is a little bit inconsistent, umm considering speech and language development and otitis media. But I suppose there is a certain",English
+consensus that studies have found links between children who have media when they're young and then this having a knock on effect with both their understanding and use of,English
+"language when they kind of hit that preschool, primary school level. And I think we're also seeing that now particularly post COVID clinically. Obviously that's very anecdotal, but there is",English
+"some kind of indications that this is a problem. I suppose Otitis media impacts speech and language development in a few different ways. So first of all, it causes a",English
+temporary hearing loss. So it usually results in mild to moderate hearing loss. And then this impacts how sound is transmitted through that auditory pathway and,English
+"particularly in the middle year. And then when the child experiences a hearing loss, they can have difficulty hearing sounds, processing sounds, and then that impacts language",English
+"development. It can also actually impact their auditory processing. So when there's fluid in the middle ear, that dampens the sound vibrations and it makes it more difficult for children to",English
+"perceive and distinguish between different sounds. And then this can impact their ability to develop phonemic awareness. And phonemic awareness is the ability to recognise, identify,",English
+"manipulate sounds and spoken words. And that's crucial when you're learning to read, write and spell. I suppose it has been linked to language delays. So in speech",English
+"and language I always tell parents to consider speech is like your pronunciation, your speech sounds, and then language is everything else. So how you use language, your sentence",English
+"structure, the amount of words you have, your understanding that that kind of a thing. And there is some links to suggest that children who have persistent or recurrent otitis",English
+"media with effusion do have language delays and it can be seen for problems with vocabulary acquisition, sentence structure and just overall",English
+"use of language. And then additionally to that, we have the articulation and pronunciation aspect. So, you know, it can impact the ability to perceive and imitate certain speech sounds, particularly high",English
+"frequency speech sounds which we'll be discussing. And then that can just lead to children kind of saying incorrect words. So for example, you have speech sound error, so fish might be",English
+"fit or chair might be tear, or people might describe the child as having kind of a muffled or dampened voice quality. And that's because that's how they're hearing it. So sometimes",English
+"people will describe it as sounding like they're underwater, or the child might describe what they're hearing as being underwater, and that's",English
+"basically because that's how they're hearing it. Everything that's been said has been dampened down by that fluid. And I suppose considering all of that, it can go on to impact",English
+"social and academic success. So speech and language are fundamental for communication, interaction, social interactions and academic success. And children who have Otitis media",English
+"with Effusion, I suppose. And the language delays that are coupled with it can face challenges in lots of areas in the classroom for",English
+"participation to developing relationship with peers to just effective interactions in general. So again, it's important to note that while this can happen when",English
+"children have OME, it's not necessarily going to happen to every child that has an otitis media with Effusion. Some will experience delays, some won't, you know. But it's important",English
+"that if there's a suspection that this may be occurring, you know, to get, um, diagnosis and treatment promptly. So the best possible",English
+intervention can be implemented. So what I just want to have a look at here is just the hierarchy for how you acquire speech sounds. So this is how we,English
+"basically learn how to how to talk. And what I want to draw your attention to is this very bottom tier. So as we can see at the bottom, listening and attention kind of form the",English
+"foundation for how children learn everything else. So if you can't hear, you're not going to be able to listen and that's going to impact your attention. So basically, if hearing is",English
+"impacted, which is right down here at the bottom of the hierarchy, everything else is also going to be negatively impacted. So it really plays a role in all aspects",English
+"of acquisition when you're small and you're learning all your speech and language. So on this slide, we're just going to focus purely on",English
+language development. So hearing sounds and words does help children learn to understand and talk. So children learn so much accidentally. And I suppose if a child has Otitis media with a,English
+"fusion, they're going to miss out on some of this language. And then this can result, as I've said, in problems with speaking, reading, school success and social skills.",English
+"So a few interesting points are that children with Otitis media with Effusion may not learn words as fast as those who have typical hearing. And furthermore, it's easier for",English
+"children to learn concrete words like cash, jump, 5 so things that they can see. But it's not so easy to learn abstract words. So before equal to, like and are so those more abstract. There's",English
+"not a picture for them, there's not an action for them. They, children, Metatus, Media and Effusion also can have trouble knowing the different meaning between words.",English
+"For example, the word bash as we know it can be describing an animal or a type of sports equipment and children. Military media have been proven to just not be very confident in knowing",English
+"these several meanings for for the same word. And I suppose important to note is that children, Metatus Media can fall behind children who are the same age, who have typical",English
+"hearing. We don't catch up without intervention, and we're talking kind of preschool, starting school age to early school years, that kind of age group.",English
+So next we're going to talk about speech. So children hearing loss cannot hear the sounds as well as and then this impacts on their speaking. So the clarity of,English
+"their speech and the errors that they have in speech, the main, well, all frequencies can be impacted, but the main frequencies that are sometimes impacted are considered high",English
+frequency sounds. And that's so those kind of consonant sounds. And they're really important to ensure you know the clarity in your speech. And,English
+"they're really difficult for children to hear in the presence of fluid. And also what's interesting or important is that when children have flu, they don't hear themselves talking",English
+back. So they're not receiving any auditory feedback to regulate themselves. So this can mean that they're speaking too loud or too soft,English
+because they can't hear their own volume. And they also might be speaking at a really high pitch or low pitch and they might be mumbling or sound different to what other children,English
+"sound like, but they don't know that. And it's really difficult for them to correct these mistakes when they can't hear themselves.",English
+So what I have here is an audiogram and a speech banana. So I'm going to talk when a child comes in for a hearing test. This is kind of what will be shown in the results. So on,English
+"the screen, this whole graph is an audiogram. An audiogram basically helps us. It helps us to plot hearing abilities of a child. And it's really important when you're considering speech",English
+"and language development because all of the speech sounds that we acquire are plotted somewhere on the audiogram. So if we look at the horizontal axis here, we can see that this is the frequency",English
+"or the pitch of a sound. So down at this side we've kind of those lower pitch sounds, so a tap dripping or even like men's voices. So they wouldn't be very high",English
+"pitched sounds, whether it's at this end of the graph up here, it's kind of more your high frequency sounds. So children's voices, women's voices, shrill singers, you know, like that can",English
+"really hit the high notes. That's up here on the vertical aspect. Then we have basically how loud a sound has to be to hear it. So kind of up on this end of the graph,",English
+"it's very low sound. So taps dripping, leaves rustling in the wind, footsteps. And then down here we have the really, really loud sounds. So",English
+"lawn mowers, concerts, jet engines, that kind of thing. So in the middle of the audiogram, then we have the speech banana. And this refers to a specific region, OK, that",English
+"covers all the speech sounds that we need to be able to hear and use to ensure that we can speak properly. And basically the speech banana, as you can see, it ranges from",English
+"25 to kind of down just before 60 decibels. So that's how loud you have to be and it goes all the way across. So there's some low frequency sounds and there's some high frequency sounds, and",English
+"if they're impacted, depending on the level of hearing loss, that can result then in speech and language difficulties. And I'm going to go through a few different types of hearing loss",English
+"just to show you how a child, I suppose, can miss out in certain aspects of language. So what we have here again is an audiogram. It's just in a",English
+"different way. And the speech banana and this graph represents kind of a mild hearing loss. So when we say mild hearing loss, it's anywhere in between these two red lines. So if a child has",English
+"a mild hearing loss of, let's say 30 or 25 ish, that's about this red line. They can't hear anything above the red line. They can hear everything from here down, but they can't hear",English
+"anything above it. So if this if a child came into the clinic and had a hearing loss just at the red line, that probably wouldn't have a massive impact on their",English
+"because you can see all the speech sounds are lying below their level of hearing, so they have access to all those speech sounds. It is possible that they might have difficulty hearing",English
+"some faint sounds, but it's likely they'll be fine. However, if you look at, let's say the 40 DB mark. OK, so if a child's hearing",English
+"was at this red line here, everything above the red line, they can't hear. OK, so low frequency sounds, they're going to be fairly OK at they're",English
+"going to miss this one here and this one potentially. But as you can see, there's lots of high frequency sounds in the area they don't have access to anymore, so they're going to",English
+"miss all those sounds. So when they hear fish, it's not going to be anymore for them. It might be, but OK, so it's all going to be dampened down. So these children who have a hearing loss",English
+"kind of at this red line, so the lower red line will probably have difficulty in school, and they'd likely they'd benefit from being positioned near their",English
+"teachers. They're going to struggle in a noisy classroom environment and they're probably going to be depending a lot on speech, reading and kind of environmental cues to pick up on",English
+what's happening. And they're really good at masking. So children in this bracket are very good at not letting on that they have a hearing loss and then it can actually go unmissed,English
+"or missed for a while. And likely they're going to have pronunciation issues. So when? Oh sorry. So when you have the kind of 40 DB loss here, you",English
+"know you're going to have issues with FS, THS, SS case, PS, a few of the lower frequency sounds. And on this slide we have what's considered a moderate hearing",English
+"loss. So these are hearing losses that can occur with fluid in the middle ear. OK, um, as I said, it's usually mild to moderate. So we're within the realm and as you can see, most",English
+"to nearly all of the speech sounds now are being cut off. So if a child has a hearing loss at just the start of the moderate brackets, so at 40 they can't hear anything up here. So",English
+"again, we have all of our high frequency sounds and again we're touching into the low frequencies. If we go to the other extreme of moderate, OK down here at 70, now the child",English
+can't hear anything above this red line. That's all of the speech sounds we need to have access to in order to develop speech and language. So if you have a child who is learning how,English
+"to speak and they're trying to have access to speech and language, if they have a hearing loss of 70 GB, they don't actually have access to any of that. And it's all going to sound muffled and",English
+"distorted to. So children will need favourable seating in school, They can miss up to 50% of what's happening in the class, They're going to have",English
+"speech difficulties with lots of different sounds and they're probably going to have a very limited vocabulary and compared to their other age appropriate kind of typical hearing peers,",English
+"peers. Now, it's unlikely that fluid is going to cause, you know, a very severe hearing loss of 70 GB, but it's very likely that you can get a child, you know, with a hearing loss kind",English
+"of at the 50 or 60 level. So that wouldn't be unusual. And at this point, you know, you would really be considering grommets if they're appropriate hearing aids to try and ensure",English
+that child is getting access to all the speech sounds while they're waiting to see if grommets are appropriate. And so that's what I'd be pushing for in my clinic.,English
+"OK, so just to conclude the presentation, I suppose there's a few things you can do if you're concerned that your child might have an otitis media with Effusion and if they have Co",English
+"occurring speech and language difficulties, or if they have speech and language difficulties and now you're thinking maybe it's caused by Otitis media with Effusion. First of all, I",English
+"would really recommend you consult with the correct professionals. As I said, for this area of concern, it's your GP. They'll send out your referrals,",English
+"audiologists, speech and language therapists, and then through those professionals, they will send you on to your nose and throat professionals or anyone else they feel",English
+"appropriate if needed. It's really important to follow the treatment recommendations, you know. So if hearing aids are recommended, why are they recommended and use them? You know, if you don't, if it's in",English
+"the drawer, it's not going to help. And often, you know, people will get hearing aids and they'll take them home and they won't wear them. And there is, you know, certain stigmas around",English
+"hearing aids. And I understand all of that. But really, they're a temporary measure, usually when it's the tightest media with Effusion and they can have a massive impact",English
+"Speech therapy. There's loads of evidence to suggest that early intervention is key. Loads of children are coming, you know, presenting with",English
+"suspected attackers, media with Effusion and starting speech therapy before they start school because they can have such an impact when they are trying to. You know that phonological",English
+"awareness, reading, writing, spelling. So it's better to have that done where possible before they have to start doing the OR learning to do those skills.",English
+"I would suggest all parents who think maybe they there's an otitis media with Effusion to monitor their child's hearing themselves. Now, it's a difficult thing to do, but,",English
+"you know, sometimes you can notice a regression in a child's hearing. So they might start sitting closer to the television. They might start asking you to repeat yourself",English
+"more. And this all might be linked into times when they're really stuffy and have nasal congestion and all the rest of it. And that can maybe be some, you know, informal evidence that",English
+"OK, maybe there's a bit of fluid moving into this year. They also might start to have regression in their speech. So they might actually do really well with their speech then be hit by kind",English
+"of that runny nose, tonsillitis, he kind of infections and then you might notice their speech takes a dip that's not unusual and that's kind of characteristic of an otitis",English
+media with Effusion. And I suppose the main thing is to be patient and supportive with both the children and the healthcare professionals. There is waiting lists at the minute and you know,English
+people are working as fast as they can to kind of clear those waiting lists. But unfortunately they're there and I think the best thing to do is if if you're suspecting it,English
+"and get them checked out sooner rod than later. So they do need the intervention down the line. They've been seen, they're LinkedIn with the system. So what I'm going to share so thank you for listening. First",English
+"of all, I've left my contact details for cats there and I am happy to answer any questions now. But just before we do that I want to draw your attention to some important links. So I've",English
+left a speech and language referral access kind of contact details there to those e-mail. I've also let put a link into the HTC Audiology contact details. So depending on where,English
+"you are in the country, this is a list of all the areas that there's a HC audiology department and their",English
+"numbers. So you can get a referral form or you can ask your GP to refer you in if you suspect any difficulties. There's also an NHS information sheet on Glue Ear, so just if",English
+"you want to do a little bit more reading, and there is some more reading from the HTC on Otitis Otitis media, sorry. So yeah, I just thought I'd draw your attention to them.",English
+"Now, so I'm gonna stop sharing now, so if anybody has any questions, I'm happy to take them. And if anybody wants to send questions privately, that's",English
+"have only a small group and he's fine and hearing, but with the big group, all the noise he can't hear. So we've kind of started doing is love with him because then he doesn't get",English
+"frustrated. But I don't know if we're doing right or wrong, you know, we've asked mum to get his ears tested, OK. Has very bad balance. Like he'd stand up for over his feet or he'd get up off",English
+the chair. Next thing. He's on the ground now. Mom hasn't got his nerves tested and then his speech is pronunciation. Pronunciation is,English
+"not great. Now he is only three, but I'm just wondering is there any other strategy maybe we should try or I suppose he has a few risk factors for Otitis media with Effusion, but he has",English
+a few risk factors for other things as well. You know the balance system is within the ear. Now we didn't go into detail in that at all today because it's beyond the scope of,English
+"it, but it actually sits beside the cochlear and often if there's fluid in the ear it can impact balance. Sometimes, you know, or if there's hearing difficulties, it can kind of Co",English
+occur with balance issues and the fact that he not doing well with noisy environments and he's doing better with one to one,English
+"suggests, you know, that there could be maybe a potential conductive hearing loss there. Is he a congested child, Would he have runny noses? Anything like that all the time, All the",English
+"time we spend our time wiping his nose? Yes. So I I suppose from an audiology point of view, I really want to test his ears. You know, like I I'm not going to say 100% that I know there is",English
+fluid and I think that the problem with fluid is it's transient. So you can go to a clinic and get tested and have no fluids,English
+"and potentially leave and get sick the next day and get fluid, you know, and that's the nature and it can be quite frustrating for parents. But I think he has definitely more than enough",English
+criteria to suggest that he would be at risk for Otitis media with Effusion. So I would push for the audiology referral and based on that I would probably start pushing for,English
+"them. OK And we have been in line to the doctor and she has been on three antibiotics, one very, very strong antibiotic. She'd literally get them and then she'd take the antibiotic",English
+back everyone's heard of the rods and the  cones and the ears are the photoreceptors   but a lot of times we don't give enough credence  to the two layers underneath that the rpe or   the pigment layer which acts as a barrier between  the photoreceptors and the choroid or blood layer,English
+and it's very important in the removal of  waste because when light comes into our eyes   our retinas absorb that light turn it into site  information but all the waste material needs to,English
+be disposed of and the amount of light our eyes  take in a daily basis makes that a very active   part of our eyes and the choroidal blood layer is  actually the most dense blood layer in your body,English
+and so it's normal that just like any  other part of our bodies our eyes age   but normal aging includes the retinal  arteries becoming somewhat more narrow   it includes that gradual separation of the  vitreous or jelly from the retina that many of us,English
+experience a few floaters but macular degeneration  is this different it's a disease of older people   and it differs from normal aging because it  actually results in a loss of vision and it's,English
+important for everyone in the audience to realize  that it is not normal for people to lose vision   as they get older that is not part of our prop  disease i'm not sure if you could see my screen,English
+what happens with macular degeneration and krista  please let me know if there's any problems seeing   the screen is that those waste materials that  i was talking about earlier as they accumulate   in the retina the rpe cells are not able to  get rid of them and so what you'll see is a,English
+collection of material under those cells and we  can visualize them when we look into your eye   through your pupil and we can see many little  white dots that represent this material,English
+and we call them druzen and i think the simplest  way to think of druzen is they are collections   of waste material that make the distance between  the seeing cells and the blood layer that serves,English
+them with nutrients further along we talk about  two forms of macular degeneration a dry form   which affects about 85 percent of patients  there's a slow loss of those rods and cones,English
+but it only causes about 10 to 20 percent of  the vision loss associated with this disease   whereas the wet form of macular degeneration  affects only 10 to 15 percent of people but it,English
+results in a rapid and sharp decline in central  vision typically over the span of a few weeks or   a month and it results in 80 or 90 percent of the  vision loss from people with macular degeneration,English
+diabetes to me is vastly different in the sense  that eyes are only one part of the disease   where macular degeneration affects only the eyes  diabetes obviously is an effect on the entire body,English
+and we tend to break these  effects down into two forms   the micro vascular or small blood vessel forms  and the macro vascular or large blood vessel forms   and it's important at least from this portion  of the talk to understand that retinopathy,English
+is the major microvascular complication of  diabetes how that happens is that the elevated   blood sugar levels result in some damage to the  finest blood vessels at the back of the eye in,English
+the retina called the capillaries that damage  results in changes that result in the production   of that growth factor i mentioned earlier that  jeff that jeff attempts to help the situation,English
+by encouraging the growth of new blood vessels and  trying to restore the oxygen supply to the retina   but what in fact it does is it results in what  we call ischemia or a loss of oxygen supply,English
+to the retina and this in turn results in two  major problems for diabetics some of the blood   vessels become increasingly leaky or permeable  resulting in the edema i mentioned earlier,English
+and other things is the development of new blood  vessels which sounds like a good thing but it is   not those new blood vessels proliferate or  grow in a way that does not help your vision   and so just like with macular degeneration we  really have two forms of diabetes diabetic eye,English
+disease we have a non-proliferative form or  npdr and a proliferative form in which the   abnormal blood vessels are growing and for those  of you who are aware diabetic macular edema or,English
+swelling of the retina can occur in both  forms it's not an advanced portion nor can it   cannot happen in the advanced forms and so  it's important to look for this in both cases,English
+diabetic changes are clearly visible when we  take the time to look properly at the back of   the eye this doesn't require any special tests  you can see at the back of the eye some very,English
+fine little dot red spots that are the micro  aneurysms or dilation of the small capillaries   you can see some yellow spots that represent  cholesterol or exudate which has leaked out of,English
+the blood vessels and you can also see some  larger hemorrhages as the diabetes worsens   in the retina the blood vessels start to look  more angry as i sometimes explain to patients,English
+or you can get these white spots that are called  cotton wool spots that indicate that the nerve   transmission to the brain is being affected  by the ischemia that i mentioned earlier,English
+and lastly at the most end stages we start to  see the growth of blood vessels like rats nests   on the surface of the retina and what's  interesting and important to let patients know,English
+is that at this point a patient can have excellent  vision with little or no noticeable symptoms   but that can change literally overnight by  the development of a vitreous hemorrhage,English
+or attraction retinal detachment so that what  you end up with is almost no sight out of the eye   macular edema again is a visible thing  where you can see the area of swelling,English
+with the exudates or cholesterol  present and the thickening of the retina   and again it's very it's due to a breakdown  of the barrier level layer related to the jeff,English
+and again in the initial or early stages you  may not notice anything but as you can see as   it progresses your ability to make out  and discern more detailed items goes away,English
+the two diseases are similar in the ability  for us to model them with a couple of   different tests we have one being something  called an intravenous fluorescein angiogram,English
+essentially we inject a food soluble dye into  the hand and then we snap photographs on slide   left you can see a blood vessel growing like  a little nest right under the central vision,English
+in someone who has wet macular degeneration  and because that blood vessel is abnormal   it doesn't hold its water as well as  it should and you develop this leakage,English
+and swelling similarly in diabetes just in a  different spot the blood vessels grow but they   grow abnormally on the surface so instead of under  the retina they're on the surface of the retina,English
+and what they come from is these bigger areas  of loss of circulation and so you can see in   this black patch there are none of the finest  blood vessels supplying nutrients to the retina,English
+a more common test that many people may have seen  or had is called an optical coherence tomography   or oct for short this test allows us to  visualize the finest retinal structures,English
+it shows traction but can also reveal  the earliest amounts of edema or swelling   that you could see from this little heightened  area here so why do we care about these diseases,English
+well certainly it's because of the impact on  our patients our family and on our friends   to start with with macular degeneration i would  call it nothing short of an epidemic in the sense,English
+that 30 percent of patients over the age of 75  suffer from this disease and it is clearly the   leading cause of visual loss in canadians and in  fact if you take prostate cancer breast cancer,English
+alzheimer's disease and parkinson's and combine  them all four diseases you've all heard of   less patients have those four things  put together than macular degeneration,English
+its impact is staggering in that the world health  organization has caused the leasing cause of   blindness in developed countries and in fact the  cnib currently reports that more than 50 percent,English
+of people who apply to seek assistance from the  cnib are applying because of macular degeneration   and in fact it has been stated that we will lose  more sight from amd in the future if only because,English
+our population is continuing to age and it's just  the loss of psych that we have to worry about   it's the secondary effects people with macular  degeneration have been shown in studies to have,English
+a twice increased fall rate a quadrupled increase  in the need for assistance in daily activities   they suffer from anxiety 30 percent more of the  time and depression 42 percent more of the time,English
+diabetes is no shurker it doesn't fall  far behind macular degeneration in north   america 37 million people have diabetes and  that number is projected to increase by 37,English
+by 2035 although we like to think that we are  further ahead than our neighbors to the south   canada clearly ranks third in the prevalence or  number of patients between the age of 20 and 80,English
+who had diabetes and this is really  due to a number of different factors   one is our population is aging and our ability to  control the other factors of diabetes has improved,English
+so our diabetic patients can live longer which  is a great accomplishment but it increases the   number of patients with diabetic eye disease  there's an increasing percentage of obesity in,English
+our population and that is linked with diabetes  there's a growth in immigration from high-risk   populations and we are certainly unfortunately  seeing more obesity and diabetes in childhood,English
+it's also important to put a little bit of a  criticism towards we as medical professionals   although diabetic retinopathy is the leading cause  of severe vision loss in patients of working age,English
+population hence the most common microvascular  complication of diabetes physicians commonly are   focused on the heart and the macrovascular changes  whereas the number one concern for patients,English
+is the fear of going blind from diabetes and  we need to turn that misconception around many   people will ask well how many people with diabetes  actually develop eye disease and although this is,English
+an old study it really clearly points to up  to what happens back when this study was done   they looked at the patients turning diabetic  before the age of 30 and they found that within 15,English
+years of turning diabetic 100 percent of patients  if you looked at the back of their eye could have   some form of diabetic retinopathy and almost  one in four had the severe or proliferative form,English
+in the older age onset that number wasn't quite  as high but still was upwards of 80 percent   and interestingly many of them had diabetes at  the time of diagnosis suggesting what we all know,English
+and that's that diabetes is present in some  of our older onset patients long before it's   actually diagnosed but it did raise the question  once i have diabetes does controlling my sugar,English
+actually change my risk of losing vision and  that was clearly done in this study the diabetes   control and complications trial this study which  was done in large part in conjunction with many,English
+centers but london was a pivotal center showed  that if you took patients who had no retinopathy   and treated them aggressively got their sugars  down and help them you could see a 76 percent,English
+reduction in the progression to develop  retinopathy and even if you took those who   already had diabetic changes in their retina but  you aggressively tried to control their sugars,English
+meaning don't just say do your best  but actually push them to do better   54 saw a reduction in the risk and as you can see  from these curves as time goes by the benefits,English
+grow and grow and grow and so it's not just a  matter of doing it for a short period of time   it's an ongoing need and that study was done  in our type 1 diabetics this study was done in,English
+the type 2s and it clearly showed the same thing  controlling your sugars or glucose is important   and it's not just important for the  individual it's important for society,English
+because in canada in 2007 it was projected that  approximately 15.8 billion dollars is spent   in some form of financial cost because  of diabetes and eye care in general,English
+so let's talk a little bit more  again about macular degeneration   i already mentioned the dry form but i want  to go a little more into depth it is the slow   decline form it does not generally provide  as severe a vision loss as the wet form but,English
+some people will progress to what we call legal  blindness or only reading the big e on the chart   it's important for all people to realize  that this vision loss cannot be reversed,English
+once damaged it is permanently damaged but it's  also important to be a little bit optimistic   and realize that your peripheral vision your  getting around vision will always be maintained,English
+there are factors which contribute to developing  macular degeneration i tend to break them into   the changeable and the non-changeable ones the  non-changeable ones well you can't change your age,English
+you can't change your genetics you can't change  your gender or your race the alterable or the   changeable ones we can quit smoking and we  can provide people with better nutrition,English
+the age one i mentioned earlier almost one  in three canadians over the age of 75 will   have at macular degeneration like it  or not is an older person's disease,English
+smoking has been associated  with a three to four times risk   of non-smokers in developing retinopathy and  that is confirmed by the fact that there is a   dose response meaning someone who smokes more has  more risk what we do know is that sun exposure or,English
+overuse of your eyes does not increase your risk  of macular degeneration and what i like to say   to people sometimes is your eyes were made to use  please use them enjoy them that's what they're for,English
+they also have shown that although cataracts  are an age-related associated disease they   have no association in their progression having  cataract surgery does not speed up the development,English
+of macular degeneration it is associated in  only in that older people get both diseases   and so with macular degeneration of the  dry type at the present time all we can do,English
+is offer optical aids or magnifiers some of these  can be very effective in a motivated patient   and some of them are funded under the  assisted devices program programmer adp,English
+we know that antioxidants both vitamins  and minerals which come in a pre-made   supplement available at your pharmacy without a  prescription are helpful i should mention they,English
+are only helpful or proven to be helpful in people  with macular degeneration they are not helpful for   all eye diseases and the cmib provides some  wonderful low vision assistance for our patients,English
+the audience today like any other time  i've mentioned this with a live audience   half the audience is closing one eye  and testing the other as we speak screening for macular degeneration and diabetes  most certainly starts in one place and that's a,English
+visit to your eye care professional whether  that's an optometrist or an ophthalmologist   your vision can be checked your pressure can be  checked but most importantly it requires and i,English
+emphasize the word requires a dilated fundus  examination most of my practice is macular   degeneration or diabetes and i spend all day every  day looking at the back of people's eyes and i,English
+only do it with your people dilated so that it's  like looking through a doorway not trying to look   through a keyhole you cannot do a full examination  on an undilated pupil so for those of you with,English
+diabetes or macular degeneration booking your next  appointment it must be done in a dilated fashion for diabetics we have similar guidelines brought  to us by the canadian ophthalmology society,English
+those guidelines state that in individuals who  are diagnosed with type 1 diabetes after puberty   they should be seen within the first five years  of diagnosis if you were diagnosed as a small,English
+child before puberty you should be screened  at the time of puberty and if you're a type 2   diabetic then you should be screened at the time  you're diagnosed and it's that examination that,English
+dilated fungus examination that determines how  frequently you should be seen and at a minimum   that should be a once a year assessment and for  most people with significant disease it should be,English
+more often than that patients who are considering  who or who have become pregnant should also be   seen more frequently and that's because some  pregnant patients can have a rapid progression,English
+in their diabetic retinopathy during pregnancy  and so the current recommendation is that they   should be seen in their first trimester  and then see in each trimester thereafter   and despite this in a developed country like  canada 38 of people with diabetes have not had an,English
+eye examination and one in three 32 percent don't  follow the current guidelines part of this is due   to a multi-factorial reason one is that patients  sometimes don't know how important their diabetic,English
+eye examinations are how threatening it is to  their vision and how effective our treatments   are which we'll get to in a moment some patients  have access issues they either live far away from,English
+a person who can screen them or they feel they  don't have access because of economic penalties   i would make it clear to everyone that  all eye examinations for retina pathology,English
+that means a retina problem whether it's  diabetic retinopathy or macular degeneration   are covered by ohip that is not something  which you have to pay out of pocket for,English
+complained they introduced a proactive component  and what they said was if we haven't give given   somebody an injection for the last 12 weeks even  though they're stable let's reinject them let's,English
+prevent further damage and what that showed was  many patients could go 12 weeks and remain stable   but some patients could not and so it's important  that we try to figure out who is who and that led,English
+to a large canadian study is formulated out of  here in toronto called the can treat study in   which what we proved was that the treat and extend  meaning the spread people's visions out slowly,English
+approach rather than the monthly approach resulted  in equally good vision outcomes resulted in a   significant reduction by two years in the number  of injections required and just think if we can,English
+reduce by six injections in two years what's going  to happen over five or ten years is much bigger   and if we look as well over 70 percent of  patients were able to be spread into eight,English
+or more weeks between injections and 40 percent of  patients could be spread out to 12 weeks or more   in diabetes the whole idea is much the  same we treatment we treat consistently,English
+because of the fact that it has been  demonstrated to have a significant   and superior vision benefit over laser in our  patients with diabetic macular edema or swelling   and that treatment again is individualized  we treat monthly until the disease stabilizes,English
+once there is no change in the swelling and no  additional benefit to vision we stop treatment   and we monitor them and why we're monitoring is  we're looking for a recurrence in disease activity,English
+it did show us one other thing though and that's  that when we were treating those patients with   diabetic swelling we noticed that their overall  retinopathy improved and so it looked like we,English
+were making them less diabetic and so one of  the studies done by what's called the diabetic   retinopathy clinical research network a large  clinical group across canada and the united states,English
+looked to see whether you could do injections  instead of laser that prp i mentioned and maintain   vision and what they showed was that the anti-vegf  therapy was equally beneficial to the laser it was,English
+purported that it would have a slight less reduced  in reduction sorry in vision loss peripherally   and less incidence of surgery but it has not  replaced laser as the primary treatment because,English
+of the fact that you are only stable as long as  your eye is getting an injection and so there's   a concern when patients are lost to follow-up  and some of the benefits have reduced over the,English
+prolonged follow-up and so in fact we still do  a lot of laser and we augment it in those with   proliferative diabetes with injections as  needed and one of the other big reasons is,English
+the cost and treatment burden on our patients is  sizably different in those receiving injections   just talking a little bit about the  agents which are currently available,English
+all three agents can be provided for you in  ontario they are all what we call monoclonal   antibodies and antibody targets and abnormal  tissue and specifically is targeted at vegf,English
+unfortunately i know you'll all grimace at this  but they are all administered by a needle in the   eye there is no other treatment available no  drop no pill and they are all initiated on a,English
+monthly basis but what's important you recognize  is that all three drugs work to rapidly reduce the   swelling in both macular degeneration and diabetes  and on average provide an improvement in acuity,English
+ilea and lucentis or ranibizumab and a  flipper sept are the two approved therapies   and are 100 percent covered for  macular degeneration and diabetic,English
+macular edema in all patients on the ontario  drug plan and i do mean 100 percent covered   avastin is an off-label drug and so currently  not and likely not to be covered in ontario,English
+it is utilized mainly here on  patients under the age of 65   who don't have coverage and so i just want to  talk for last couple of minutes about the future   we have to think about this because of the  growing burden on our clinics on our patients,English
+on our society our population is only getting  older and remember that if one-third of patients   over the age of 75 have amd and the population  is aging so is the number of people getting amd,English
+we're seeing a growing diabetic population and  since retinopathy affects both type 1 and type 2   we're also seeing an increasing incidence of  diabetic retinopathy fortunately at the present,English
+time there are at least five different agents in  or completing phase iii trials and that's because   they are attempting to target other growth  factors or growth factors in addition to the,English
+jeff in dry macular degeneration at the present  time there are no available therapies i'm for i'm   happy to say that there are two studies currently  underway at the iv for dry macular degeneration,English
+or specifically the severe form of dry in which  people get atrophy or withering of the retina   but again they are both injections in the eye  and at the present time there is no stem cell,English
+transplantation which is available it's still a  ways off but it still is a hope for the future what we need to talk about is  a little bit in how our system,English
+delays the establishment of care and that's  partly was a result of many different factors and   the first one is we need to know who's at risk  and if we're going to determine who's at risk,English
+we need to encourage everyone over the age of 65  or with a family history of macular degeneration   to be seen on a yearly basis for a dilated  examination by their optometrist if druzen,English
+are seen you have dry macular degeneration  and you need regular and routine follow-up   our diabetic patients i already showed  you the current screening guidelines,English
+this requires an examination to an optometrist  or an ophthalmologist at least on a yearly basis once you know if you have these diseases  it's important to monitor your vision,English
+as i mentioned one eye at a time it's important  for our patients with macular degeneration to be   started on vitamin supplements and it's important  for our diabetic patients to be aggressively,English
+encouraged to control their sugars they need to  know that if you notice a change in your vision   don't delay don't put it off don't make excuses,English
+call your eye care professional and get it checked  ensure that you're looking out for yourself   what we know is that if you delay care you do  not see the same benefits of treatment and this,English
+slide in the bottom left just shows those people  in the studies i showed before that benefited   if they were treated later sure it flattened off  but it didn't improve and so timing is everything,English
+similarly we have to not be forgetful of  the importance of monitoring and ongoing   sustainability of our treatments our treatment  is expensive and if it's expensive what we,English
+want to do is gain vision and maintain that  effect for the benefit of patients and society   it's important to remember that diabetics never  become non-diabetic at least in the current,English
+world and so there's always an ongoing risk of  recurrent edema or progressive diabetic changes   similarly macular degeneration patients whether  they receive an injection or not are never cured,English
+they can be controlled and stabilized but we  don't get younger and the disease is never gone   and really what nobody who meets me with loss  of vision in one eye wants to hear but everybody,English
+needs to hear is that fifty percent of people who  get wet amd and one eye will get it in the other   and so they need to be very diligent and monitor  the other eye as well and monitoring is placing,English
+a large burden because of the importance of  doing it but it's also a burden on the patients   and caregivers because these patients often can't  drive themselves to the appointments and certainly,English
+wouldn't on a routine visit want to be  driving themselves to get a needle in the eye   for some patients the distance of travel and the  cost of making those trips has become an issue   and certainly for those under the age of 65 time  away from work and the cost of testing as well as,English
+the cost of treatment can affect their outcomes  fortunately many of our general ophthalmology   colleagues have started treating both diabetic  patients and macular degeneration patients,English
+and are able to limit some of the travel time and  i'm hopeful that the establishment over the past   10 years of the ontario telemedicine network or  otn will help with the monitoring as well at the,English
+present time otn provides support for some select  populations typically in very far remote sites   but it has the potential for expansion because  ophthalmology is unique in the medicine world,English
+for the high amount of quality and the highly  available digital photographs and oct machines   currently available in most optometry offices  allowing for rapid and concise transfer of,English
+information to retina specialists i can look  at a picture of an individual in owen sound   as quickly as i can look at an image at the back  from someone here in london and so in summary,English
+early retinopathy whether macular degeneration  or diabetic changes the protection is important   it requires a routine dilated examination by  either an ophthalmologist or an optometrist,English
+or in one of the screening programs we  need to treat the modifiable risk factors   we need to lower our glucose control our blood  pressure and quit smoking and most importantly,English
+i would wish on all of you to spread the word  that our treatments are effective at improving   maybe not restoring yet but improving vision and  salvati and providing salvage to other eyes and,English
+that laser and anti-vegf injections are effective  at preventing and in some instance restoring some   of the vision loss which has occurred i have  hoped for the future there are many new and,English
+exciting possibilities but at the present time i  just want to thank you all for coming and putting   up with my issues at the beginning of the talk  and i'd welcome you for any questions thank you,English
+thank you very much dr shanko lots of information  there to share i've been monitoring the chat box   and there are uh several questions that have  come in so uh some of them have already been,English
+answered actually they came in halfway through  your presentation and then you immediately   touched on the topic uh but let's see if we  can get uh some of these questions out for you   um uh josie has said i am not a diabetic but i  have part of this condition responsibility for,English
+improvement i think you've touched a little bit  on that is that there there are adequate and in   fact positive and promising treatments available  now that people can take advantage of there are,English
+um i guess if i'm understanding the question uh  right now i think that what i would say is if you   don't have retinopathy and if that's what you mean  you're diabetic but you don't yet have retinopathy,English
+there isn't any specific treatment for you but  it is still very important that although you can   rest assured that right now things are stable  and good i think it's really important that you,English
+maintain those regular checkups and that's  the most important thing i can encourage is   that ongoing once a year almost like you have  a birthday every year make sure you get checked,English
+okay and scott asks are retinal is  primarily related to diabetic related issues um there's other retina problems you could  have retinal problems from blocked veins,English
+blocked arteries and many other conditions so it's  not just diabetes but certainly when you look at   the back of someone's eye and when you see the  type of changes i showed on a few of the slides,English
+and they're present in both eyes it  classically is diabetes and so i would say that   within our clinics um 50 of people   probably closer to 70 or 75 percent of people have  either diabetes or macular degeneration and so,English
+although it's not always it's primarily those two  diseases that we're seeing at this point in time   you've talked a lot about prevention uh mitigating  the factors that can exacerbate these conditions,English
+so i'll ask a question that emily has posted which  i think is important for all of us particularly if   we have young people in our household how bad is  looking at the phone for four hours a day for my,English
+eyes and will this contribute to vision loss so  what what is the impact of elevated screen time   on on the uh on the vision that we're experiencing  these days but it's actually a good question and i,English
+but i'll get off topic in a second using a  screen whether it's a computer screen a ipad   phone none of those hurt your eyes use them as  much and as often as you can in fact in some of,English
+my macular degeneration patients i tell them if  you can get used to not holding that look in your   hand or the paper get an ipad or a tablet because  the improvement in contrast is actually going to,English
+help you read and see better and so screens don't  hurt your eyes your eyes can get dry people with   vision loss tend to stare more the more you stare  the more your eyes dry out the more your eyes dry,English
+out the more they burn and itch and get stored  but it doesn't hurt them you don't do any damage   the caveat to that is little kids young  children on screens too much too long,English
+it has been shown that it increases the  development of myopia or near-sightedness   and so we are certainly seeing many more people  develop a degree of near-sightedness which is   further through the use we believe of increased  screen time less play outside is also a concern,English
+for some reason sunlight helps us imagine that but  as far as using a screen for adults we like to get   out but it doesn't hurt us okay great great um ron  has asked if you could provide a little bit more,English
+you can do is if you go into the pharmacy uh the  name of the study that was shown was called a r e   d s or a reds and the two drugs that you could buy  most commonly are called vitalux or preservision,English
+and they're both available in most pharmacies  and i suspect that if you go into rexall or   shoppers or whatever your current pharmacy  is there may be a generic form of them too   everybody comes in saying i'm taking my lutein  gluten is part of the antioxidant is not the whole,English
+picture and so i always encourage my patients  to take the full picture if you're going to take   something take the whole package and that's why i  currently recommend either vitalux or preservation,English
+but you can get those bottles and look and you'll  see all the different components that are in it   but it's a component of minerals vitamins  and lutein interesting diane is asking if,English
+it tends to affect people's macula so just  like macular degeneration that affects the   central portion of your reading so does that  be retinal membrane and as i commonly say to,English
+people and they think i've stopped talking  the most common reason is just because   no other reason there are other reasons for  it sometimes you can get it after a tear in,English
+causes a distortion in the center by almost  like an elastic bunging up the center vision   but they're not related to diabetes specifically  or macular degeneration but it is just another,English
+problem in people's macula okay thank  you for having me fixed with surgery   another question is that a vast number of this  same population that suffers from amd also,English
+less strong or lasting tears as we get older dry  macular degeneration is in the inside at the back   totally unrelated okay thank you for that uh final  question and then we'll wrap things up and this,English
+also comes from emily and i think it's a great  question how do we currently enable screening   for underrepresented or marginalized groups or  populations and what would be your recommendation,English
+to enable better screening to these groups and  to the public if catching these conditions early   and creating prevention opportunities is so  important any thoughts i think michelle if we go,English
+is in some people taking the time to get seen  you can't get your eyes assessed unless you make   an appointment to get assessed and i don't  mean to point my finger back i mean to say,English
+as i mentioned an optometric assessment or an  assessment by an ophthalmologist is covered   for everybody with an eye disease now yes if  you call up and say i want to have my glasses,English
+"through the channel much better than they can come out. And so ions will go in at a high rate, but they'll come out at a much slower rate.",English
+"And so this got us thinking about aminoglycosides. So aminoglycosides are an antibiotic, the most widely used antibiotic in the world.",English
+"They're used a lot here, for example, on infants in the neonatal intensive care, and they're also used in cystic fibrosis patients a lot.",English
+"And there's a big side effect, which is deafness. And the aminoglycoside selectively kill the sensory cells. Oh, sorry.",English
+"So this is an aminoglycoside, and what we found is that it can go through the ion channel. And so the question is,",English
+"well, if we stop it from going through the channel, will that stop toxicity? So the first test was we made Texas Red Gentamicin.",English
+"So we made an aminoglycoside that we could see. We weren't the first to do this, we got the recipe from Peter Steyger.",English
+"And what we found was, this is now a cochlear explant and you can see the red stripe, and the red stripe are the hair cells.",English
+"So the hair cells all take up this gentamicin. And so we said, okay, if we block our favorite ion channel, in this case with curare,",English
+"you can see that the drug doesn't go in. And so to us this suggested that, well, this is why hair cells are selective,",English
+"because they got this big channel that the drug can go through. So if we can stop it from going through this channel, then we would stop the ototoxicity.",English
+"Now the caveat here, and we'll talk about this more later, is that this is neonatal tissue and it's an explant. And so access to the drug is different than in vivo.",English
+"So, the question is, if we don't let the drug in, can we make it not--will it then not hurt the hair cells? And so to do this,",English
+"and I know this looks complicated, but don't worry about it. This is simply the crystal structure of of the ribosome that the aminoglycoside binds to.",English
+"So when it's killing bugs, it binds to this ribosome. And so what we want to do is make it still kill the bugs and not kill the hair cells.",English
+"And so we looked at where does it bind in the ribosome, and we selected targets where there was space to put another molecule on",English
+"that wouldn't interfere with binding. So again, this is the aminoglycoside, this is the channel. The idea is we're going to stick something on here",English
+"that stops it from going in the channel, but all of this is still available to interact with the ribosome. So that was the idea.",English
+"So we made that compound. And this is the result. So this is the histology where you can see three rows with outer the hair cells,",English
+"and a row of inner hair cells. The parent aminoglycoside kills all of the hair cells. So there are no hair cells here. And the new compound,",English
+"you keep all of the hair cells, so the hair cells don't die. So this supports the idea then, that if we don't let the drug in,",English
+"it can't kill the hair cell. Again, this is neonatal tissue. So we tested it in a model of deafness in adult mice.",English
+"So this is called a auditory brainstem response. So what we're measuring is the electrical activity of the brain across at different frequencies of sound,",English
+"and different loudness of sound. So we increase the intensity. So the better you hear, the lower this number is, because it means the softer the sound you can hear.",English
+"So this is control. And when you put a typical aminoglycoside on, you can see that now these animals are deaf.",English
+"When you put our new compound on, you can see that the animals are no longer deaf, that they can tolerate this.",English
+"And there's a maybe a little bit of loss at high frequencies, but in general, it's much better than the parent compound. So this is exciting to us.",English
+"But again, this work is in neonatal cultures, which is not their normal environment. And here we're not measuring directly",English
+"uptake into the hair cell, we're measuring the fact that hair cells are dead. So it's a correlation and not causation. And so there's been bickering around,",English
+"well, is what's happening, what you really think is happening? So legitimate questions,",English
+"the problem is then how do you answer that question? And so what we decided was we need to measure uptake in the cochlea in the adult while it's happening,",English
+"so we can see directly what's going on. So you might say, well, why has-- this would be a good thing to have, right? There's lots of experiments you could do it,",English
+"potentially could be diagnostic, why hasn't this been done before? And the - largely the reason is because it's really hard to do.",English
+"And if you look, the cochlea, which is a bony structure is here, and this is the whole inner ear. You have facing outward, the middle ear.",English
+"And if you do any damage to that, you're going to lose hearing. Surrounding the inner ear is all bone.",English
+"So it's all bony structure. And if it's not bone, it's blood. So it's a really difficult place to get to. And if it's not bone or blood, it's brain.",English
+"So it's really hard to get at the cochlea. But even if you get to it, there is still two other problems.",English
+"The cochlea itself, now we're just looking through a cross section of it, is surrounded by very hard bone.",English
+"And inside the cochlea, it's basically this coil structure, and there are three fluid-filled compartments. And there's a pressure gradient in the cochlea",English
+"and across these compartments, because if you zoom in on this spot, the sensory cells are here and it's this vibration of what's called a basal membrane",English
+"that's stimulating these cells, and that's driven by this pressure difference. So if you do anything that hurts the pressure, you're going to lose hearing.",English
+And these mechanical receptors are some of the most mechanically sensitive cells in the body. So getting through all of this bone,English
+without mechanically stimulating them is also not a trivial thing to do. We decided we were going to try to figure this out.,English
+"And so the first step was, well, what was the view that we want? And so we decided, because we're working in mouse,",English
+"it was actually somewhat limited. We're going through the apical turn, and we're going to try to come through, kind of through the stria",English
+"so that we get a look at the hair cells, and we should also have access to the spiral ganglia and the nerve fibers that way.",English
+So that's how we're going. So this is a cartoon of a mouse just to show you how we're going in.,English
+"So the cochlea is in blue, the bulla which is the bone around the cochlea is in this translucent light.",English
+"So first we have to go through the bulla, then we have to make this, we're calling it an imaging window on the cochlea.",English
+"Now the TM here is the tympanic membrane. So we need, there's a very small region that we can get at, and that's where we're going.",English
+"So how do we get at the two issues, the mechanical sensitivity and the pressure? So in the first one is the mechanical.",English
+"So what we decided to do is we developed a, what we're calling a chemical mechanical approach. So we use this phosphoric acid gel",English
+"to dissolve the bone, and then we scrape it away, and then we dissolve the bone some more. So it's a very gentle approach. This phosphoric acid gel is actually what dentists use.",English
+"So those of you who have ever had a cap put on your tooth have had this done. So after they clean up the bone,",English
+"before they put the glue on, they put this gel on, it punches holes in the bone, then they put the glue on, and that makes it stick really hard to the cap,",English
+"so the cap doesn't pop off. I spend more time in the dentist's office than I like, so that's where I learned about this stuff.",English
+"So we tried--so that's the approach. And then the second approach is, so there's this thin membrane here called the endosteum.",English
+"And it basically separates between the bone and the intra-cochlear fluid. And so our thought was,",English
+"if we can get the bone off without damaging the endosteum, we would keep the pressure intact, that was the idea.",English
+"And I can tell you I've done thousands of dissections. I'd never heard of an endosteum and I'd never seen it, because every time I take the bone off",English
+"the endosteum goes with it. And so we found it was there. And so our approach is to thin the bone,",English
+"and then just to pick it off to keep the endosteum in place. So just to give you an idea, we put the gel on, it punches holes in, then we scrape that down,",English
+"and then we do it again, and we scrape it till it's really thin. And then we can come in with a needle and just peel this little bit of bone",English
+"and leave the endosteum intact. So that's how we do it. Just to show you, this is the eardrum, the tympanic membrane.",English
+This is the bulla that we want to open. And you can see there's a big old blood vessel right here. So we don't have a whole lot of space.,English
+"So we put on the gel, and then when we peel it away, you can see that we leave the tympanic membrane is fine.",English
+"You can see the blood vessel here. and now you can see the cochlea is exposed right here. So then we go to the cochlea and we use the gel again,",English
+"we put some gel on the cochlea, we thin that down, and we can make this imaging window. So you can see the window here.",English
+You can also see there's no fluid coming coming out. And that's really the tell. If there's fluid coming out then we took the endosteum away.,English
+"So this again is the hearing test where lower is better, and this is across frequency. And what you can see is that each stage of the surgery,",English
+"we have no hearing loss. In guinea pig, we've actually-- it's a recovery surgery where we've gone for weeks and the animals are fine.",English
+"In mice, we've gone out to about five hours. And this is about what you can see. So you can see three rows of outers,",English
+"and this is the tunnel, and this is the inner hair cells, and this is where the nerve fibers would be. So, this is really the first kind of live,",English
+"functioning cochlea at the cellular level imaging that's been done. So back to the question,",English
+"do aminoglycosides go into hair cells through this channel in the adult cochlea? So now again, this is the view that we're going to have.",English
+"We're using the same drug, the Texas Red-labeled gentamicin. And here we're looking at the stria, and you can see the blood vessels in the stria",English
+"where we put it in IV, it goes to the stria, and then over time you can see it's reducing. And it's reducing because it's being cleared out",English
+"of the bloodstream. So then we look deeper at the hair cells, and you can see even at 10 minutes you can start to see the hair cell signal,",English
+and that signal is growing. And now you can see three rows of outers and a row of inners pretty clearly. And there's really no other cells,English
+"that are accumulating the aminoglycoside. So we can see it now for the first time ever, in real time, hair cells taking up the aminoglycoside.",English
+"Is it going through our favorite channel? So to test this, we used an animal, a genetically mutated animal",English
+"where they do not have the mechanotransducer current. So in that case, again, when we look at this stria, it looks pretty comparable.",English
+"It fills up the blood supply, and then you can see it's slowly reduced over time. When you look however at the hair cells,",English
+"there's no accumulation in the hair cells. So this suggests that in fact, the answer is yes, in vivo, in adult mice,",English
+the aminoglycosides are going through the mechanotransducer channel. So there are a lot of experiments that we can do now with this preparation.,English
+"And part of the math, I guess, that I do when I'm deciding what to pursue is we developed, I mean,",English
+"developing that technology took almost four years to do. And honestly, it was not supported by NIH, because NIH kept saying,",English
+"well, you can't do it, it's not possible to do it, so we're not going to pay you to do it. So it's been foundations and philanthropic dollars",English
+"that supported making this happen. Now that we have it, there are a lot of basic science experiments we can do. One thing that would be really useful",English
+"is can we apply locally drugs into the inner ear now, and study their responses in the hearing organ",English
+"for basic research purposes. But also, again, it's one of those cases where a local delivery of drugs into the cochlea",English
+"would be really translationally useful. If we could put protective drugs only into the inner ear, say, during cisplatin treatment or something like that,",English
+"so cisplatin gets the cancer and the ear still keeps working because it's protected, that would be a simple example.",English
+"And so we decided this is something we wanted to look at. So we went at drug delivery through the semicircular canal. Now again, we were not the first people",English
+"to inject a drug through the semicircular canal. And I think what we're bringing to the work: one, is an optimized approach-",English
+"surgical approach-to make things very reproducible and qualifiable, and not damaging in and of itself to either the ear or the vestibular system.",English
+"And the second thing is characterizing specifically where the drug is, where the drugs are going. Is it perilymph, is it endolymph?",English
+"Is it both, is it reproducing them? And so I want to show you a little bit about that. So this is the human ear.",English
+"You can see where the semicircular canals are. In the mouse, we're going to go back here to the semicircular canal. And we first tried this, we did this experiment",English
+"before we had a good surgical approach for it, and we simply compared round window injection with a dye to semicircular canal injection.",English
+And this is the methylene blue. And you can see with a round window injection that it doesn't get all the way to the apex.,English
+"Yet when you do a posterior semicircular canal, you can see it's really pretty unfilled, it's pretty uniform.",English
+"And we did this in adult as well, and round window injection in adult was even even worse than with neonatal,",English
+"and that it was not getting to the apex. And yet when we do posterior canal, you can see that it fills nicely.",English
+"Now there were two issues here. First, with these experiments, we couldn't differentiate which compartment",English
+"we were actually hitting, perilymph or endolymph. And secondly, with our initial experiments, there was some hearing loss associated with it.",English
+"So we decided to modify how we do the cochleostomy to the canal injection. So here's the set, we isolate the semicircular canal,",English
+"just showing you here. We used this blue gel and we dissolved the bone. So you can see that here. So there's just a little hole,",English
+"and we have really good, the bone doesn't crack, we can make it exactly the same size, it's very, very reproducible. And then we can put our tube in the hole for drug delivery.",English
+"And then when we're done, we tie the tube off, we actually leave the tube in the ear, or in the semicircular canal. And just to show you the CT scan.",English
+So here's the canal in the-- this is the mouse. And now we're going to flip it over so that you can see the canal better,English
+"where we do the canalostomy here and not here. If you zoom in, you can see where the canalostomy is for. And you can kind of, if you use your imagination,",English
+see the tube. And then this is without-the control side. So are there functional effects?,English
+"So we did what's called VSEP, which is basically a vestibular evoked potential. And here I'm just showing you an example.",English
+"So again, you basically, you're vibrating the head while you're measuring electrical output. This is going up in intensity,",English
+"so the red line is what we're calling our threshold. After injecting artificial perilymph, you can see that there's basically no effect",English
+"on the threshold. And then similarly, we did the auditory testing. Here I'm just showing you the one time point,",English
+the 16 kilohertz and the raw data. This is what we call threshold. This is getting louder. This is the electrical response.,English
+"You can come down, see this is where we're first detecting it. An hour after injecting artificial perilymph, basically there's no effect on the hearing.",English
+"So, we have the method worked, the surgical approach worked. So the question is, where does it go? So we're injecting in the posterior canal,",English
+and so it could push down on the membranous labyrinth and only go in the perilymph. It could penetrate the membranous labyrinth,English
+and only go into endolymph. Or it could do some combination of both and be random. So obviously this would be the worst case scenario.,English
+"Either of those would be useful. So again, the reason this is important is that when you look in the cross section of the cochlea,",English
+"there are different cells that are exposed to perilymph compared to endolymph. And so, for example,",English
+"if you want spiral ganglia cells or neurons, you don't want to put the compound into the endolymph. If you want stria,",English
+"then you you want to get it into the endolymph And with the hair cell, it's kind of a mix. If you want to get the apical part of the hair cell,",English
+"then you want endolymph, and if you want the basal lateral part, then you want perilymph. So our first test in figuring this out is to use a drug.",English
+"We put a drug that blocks our favorite channel up here. So if it's effective, it means it's in the endolymph, and you'll have hearing loss.",English
+"If it goes in perilymph, then you won't. We also could block the synapse where the hair cells talk to the nerves with a drug.",English
+"And then if it goes in endolymph nothing would happen. But if it goes in perilymph, it should block it. And we could block action potentials in the nerve",English
+"using a sodium channel blocker. And in that case, again, if it goes in perilymph it should impact the hearing.",English
+"And if it goes in endolymph, it should do nothing. So that was our first test, that's just a note. So we did curare which goes and blocks",English
+"the transduction channel. And you can see from the raw data there's no effect. And in the summary data, there's basically no effect. So this would argue that our infusion",English
+"is not actually into endolymph. And we used CNQX which blocks these receptors, the synaptic component.",English
+"And you can see there's a big effect. So now the animal cannot really hear, it's more than a 20 dB effect.",English
+"So that would argue, okay, the infusion is into perilymph. And then confirmation of this, is blocking the sodium channels,",English
+"the action potentials with lidocaine, and you can see that had a huge effect. And so the animals are basically deaf with that drug.",English
+"So pharmacologically it suggests that the drug is going into the perilymph, but seeing is believing.",English
+So we used optical coherence tomography. So this is a cool technique that allows you to image through the bone in living in vivo conditions.,English
+And so what I'm going to show you is we're imaging this part of the cochlea. I'll show you the movie in a second.,English
+"This is what we're looking at. These are perilymph and this is endolymph. And so when you watch them moving,",English
+"you can see the bright spots where the beads are, and the beads are going into into perilymph. So I'll just show you one more time just so you could see.",English
+"So this supports the idea that it's going into perilymph, and I'm going to just show you one application. So this is using AAV adenovirus",English
+where we expressed GFP or mCherry using a semicircular canal injection. And you can see virtually all the hair cells in the utricle,English
+"are labeled with the GFP, meaning the virus worked and got into all of these cells. This is the cochlea.",English
+"We got most of the cochlea in this picture. There's more base here, but what you can see is all the inners are lit up, and in fact, most of the outers are lit up.",English
+"And if you look at spiral ganglia, so it's saturated here just so I could show you all the fibers.",English
+"But pretty much all the fibers get labeled, and this is a pretty picture showing how the fibers are all pretty much filled.",English
+"The green dots are the synapses on the hair cell here, just so you can put it together. So just to summarize where we're at,",English
+I think it's important for people to realize that basic science questions can be foundational and important to solving translationally relevant problems.,English
+I showed you that aminoglycoside antibiotics enter hair cells through the mechanotransducer channel. And that blocking this entry is protective.,English
+"And so this is now a big target site for generating new aminoglycosides, or preventing aminoglycoside entry into the endolymph space.",English
+We've shown you that it is in fact possible to open and image within the cochlea without causing hearing loss. And I'm really excited because this is really,English
+"a direction that we're pushing the lab in now, both basic science and translationally. And finally we ended with showing you",English
+"the semicircular canal injection is a viable drug delivery to the inner ear, and that it targets the perilymph.",English
+And just to quickly-- short term we're looking at putting pumps in for slow release of drugs to see how that will work.,English
+"We're optimizing the imaging approach for repeated measures so that we can study noise, aging and regeneration, things like that.",English
+"How big an animal will the surgical approach work in? We've not tried, human bone is a heck of a lot thicker than mouse. And so we don't know if any of these will work that way,",English
+"but we're going to see, we're going to try, and we're thinking maybe some combination would work. And similarly with the canal injection.",English
+Long term we're thinking that we can use optical tools potentially as stimulation through imaging windows,English
+where there might be hearing loss. So in a sense you could think of it as a cochlear explant instead of a cochlear implant where you could actually put something around the cochlea,English
+that would stimulate. And could we better target small implants to regions if we had better access,English
+to different parts of the cochlea? And we're looking at potentially developing some diagnostic tools this way as well.,English
+"So finally, I just, I showed you literally 20 years of stuff, so I only have kind of some of the people to thank here, and thanks for listening.",English
+"And I will again say, a lot of what I presented today wasn't really all funded by by NIH.",English
+"A lot of it is because developing new technologies and whatnot, a lot of times isn't something,",English
+"NIH wants to take a chance on. And so using foundation money and using philanthropic money is really critical for that, for those efforts,",English
+"for really getting new things started. So thank you. - Well I'm just going to clap out loud,",English
+"Professor Ricci, that was an amazing, amazing talk. Anil Lalwani, chair of the Council of Scientific Trustees, and it's my pleasure this afternoon",English
+"to moderate the session of question and answers. And you know you talked about the translatability to humans. As you know, in the past",English
+"there was an operation called fenestration, where we would thin the bone over the lateral canal and release the otosclerosis.",English
+"And the other thing where we do something similar is when you have a congenital abnormality of the cochlea and the balance canal,",English
+sometimes we fenestrate the balance canals to get into the cochlea. So I think you've hit another approach to how we get materials into the inner ear.,English
+"Any thoughts to why a round window membrane injection wouldn't get all the way to the cochlea, but a vestibular labyrinth,",English
+"which is very similar in terms of connection, would? Any thoughts about, any insights you can provide there? - So the simple idea,",English
+"so if you look at when you're injecting in the round window, you need some release valve, kind of. So, and I think there are papers that say,",English
+"if you put a hole somewhere else, you actually get better penetration that way. So that's one.",English
+"And when you're going from the canal, you're actually kind of going downstream, and the cochlea is in the middle between where you're injecting",English
+"and where the exit point would be. I think for me, I would really be interested in revisiting what the cochlear aqueduct is doing.",English
+"So certainly in mice, it's very clear that when you go into the round window and we see this both in neonatal and adults,",English
+"that depending on how fast you're injecting, you can send most of what you're injecting through the aqueduct.",English
+"So to me, although I know everyone seems to think the aqueduct is always closed in adult and it's species dependent,",English
+"I actually think of it more like a pressure release situation. So I think you could use the round window, but you'd have to be really slow in injection,",English
+"and not open the cochlear aqueduct. If that's true in humans, I haven't done those anatomy there,",English
+"so you would know more than I would. But I think a lot of it's done on cadavers, in which case this-- there's not going to be pressure.",English
+So I think it would be interesting to actually look and see if pressure makes a difference there for the translation side of it.,English
+"- Yeah. So I can tell you, it's one of those things, I'd have lost my house, because I thought oh it's going in endolymph.",English
+"If you're going in and you're tearing it open, there's not that much space for this tube to go in. That's why we did so many different experiments, because every one we did, I was like,",English
+"that can't be right, that can't be right. Because then eventually you have to believe the data. I do however think that we can use it for endolymph.",English
+"What we're doing now, really, you saw the tube. The tube is almost the same size as the canal, and it's very blunt. I could take,",English
+I guarantee that I could take a beveled patch electrode and just put it in and it would go right through the membranous labyrinth into the endolymph.,English
+"The question though is, how much can you inject in the endolymph without doing any damage, and can you get it where you need it to be?",English
+"Because then the hole is not so conducive to flow I think. But that's actually on the list to try, because I like home runs.",English
+And so I just want to congratulate on your amazing feat in actually making such a small fenestration in being able to use that.,English
+"yeah, so firstly, so in mouse we put it on it's like for 10 seconds, and it goes in and and you scrape it off.",English
+"So it's pretty quick. In guinea pig it takes tens of seconds, and repeated measures, treatments.",English
+"But when you get close then I think you use the gel, and then you scrape the last bit away.",English
+"And I think that'll save on the hearing side of it. I mean we found out, again, I don't do-- humans aren't typically volunteering for this.",English
+"So in the mouse, like even going through the bulla, there's a percentage of time where you do a little middle ear damage",English
+when you're going through. So we use it there as well. And I mean it's been amazing. I mean it took--Jinkyung Kim is the postdoc,English
+"who really pushed this in the mouse. It was Jen Alyono and Eduardo Corrales, were two residents that did it first in the guinea pig.",English
+"And all of them, what they had in common was resilience because none of-- like it seems, oh this is easy,",English
+"or that's the right way to do it, but we probably tried, I don't know how many different ways to do it, all of which did not work to get it.",English
+"But now it's really, it's standard practice in the lab. So I think it's-- I do hope that it can be useful on the surgery side.",English
+I'm hoping we'll get some interest in trying it out. Because I mean I think as you're going to-- there are a lot of places where,English
+the round window membrane's compromised or changed because of the pathology. And so that's now that could be a problem,English
+"in getting in the way. So yes, it's more invasive, like to get to the canal to do surgery, but if you can use it to get at a living cochlea,",English
+"and not do damage, it opens a lot of doors for treatment. You don't have to be completely deaf to get treatment, maybe.",English
+"that melts away bone. Now we have a, actually a great question from Ruben [inaudible] who says, ""Great talk Dr. Ricci.",English
+"Which strategy do you think has the most potential in preventing ototoxicity, designing novel aminoglycocides",English
+"that do not pass through the MET channel, or blocking aminoglycoside passage through a stria vascularis as your lab has shown recently?""",English
+"- So that's a that's a good question, and thanks for looking at the paper. So, scientifically I would say the answer is,",English
+"using both, a combination of the two. So using aminoglycosides that are inherently less toxic because they don't get in as well to the cell,",English
+"and coupling that with blocking transport would be the optimal way to do it. I think, because it's like a double protector.",English
+"I think practically getting a new antibiotic through the FDA, we need younger people because I'll be dead",English
+"by the time it happens. So I think that will be tougher. But the drugs that are blocking the transporters,",English
+"I think is already approved. And so I think that can be optimized and used now, and honestly what really should be used is with cisplatin",English
+because it's a better blocker of cisplatin transport than it is of aminoglycoside transport. So getting--,English
+"now the problem with the transport that has, it needs its own, I think it needs to be modified itself, but you need to get it there",English
+and has to be there long enough to block the transport. So it's going to be finding this balance between them. So short term I would go for that.,English
+"Long term though I think, I mean we worked out the chemistry, I mean it also, it was eight years to figure out how to manipulate aminoglycoside",English
+"so that you can make the compounds that you want, and we've got all of that. So I'm hoping that, that will be used. And now again the chemistry is,",English
+"it's not trivial but it's worked out compared to what it was before. So I mean we have three compounds now that are 40 times less toxic than parent compounds,",English
+and we have seven more in the freezer that we're running through the tests that are the second generation of it. So I'm hoping that we'll find a way,English
+"to get them tested in human as soon as they come out, as soon as we can. That's the part of science",English
+"I don't really know that much about, so I'm going to need some some help on on that part of it. - Well I was just thinking",English
+"you could probably live forever if you just go up the street at UCSF, and get those telomere injections, and this lasts forever. But there's another great question from Wafaa Kaf,",English
+"and this is a very broad question, Professor Ricci, which is, ""What about the use of nanomedicine via nanotechnology delivered into the inner ear?""",English
+"And I think you can take that question any way you want to and kind of broadly address technology out there, or what are your thoughts?",English
+"- So I think, what I've looked at are-- and you can correct me if I'm getting on the wrong topic, but there's been kind of liposomes used for delivery of",English
+drugs and there's nanoparticles with slow release that have been used for for drug delivery. And I think they all show some promise.,English
+"The question is getting them across. Most of the time I see it on round window. So if you can find a way across the round window,",English
+"I think then that can be useful. If you just have one, have a gel that will stick to the round window so it's there long enough",English
+"for it to penetrate the round window. The problem, and even I did not show this, because I didn't want to go on and on,",English
+"but even with a local injection in the canal where the drug ends up in the body,",English
+"or even within the ear, depends on the chemistry of the compound, because the blood perilymph barrier",English
+"is selected and grows both ways. For example, when we put the gentamicin Texas Red in the canal,",English
+"you watch the mouse turn red. So you can see it goes up and down the spinal cord, it goes into the paws,",English
+"so you can see that it's going right across the blood into the bloodstream and being transported. Similar, we've seen similar things with AAVs as well,",English
+"that we can find expression in places not the brain. So not where, oh it flowed into that place, but places that had to get into the bloodstream somehow.",English
+"So I think, I don't know if you like solve the problem of the round window diffusion with nanoparticles, will you then create the problem",English
+"of how do you keep it in the ear once you, once you get across. And I don't know honestly know the answer to that. But I think it's definitely a really good way to go at it,",English
+"because if you can get around the surgery then you'd be better off. - Well, you raised some really good questions about",English
+"safety issues in whatever delivery method you might choose and distributions. So that was very useful,",English
+"I think it's very useful to our audience to know that every route has this potential benefits as well as drawbacks, depending on what you end up doing. There's another question that's kind of interesting,",English
+"and I suspect it would be broad interest to our audience, which is, ""Does salicylate toxicity, aspirin toxicity occur by a similar mechanism?""",English
+"Is it the same channel, different channel any, I actually haven't looked it up for a while so I don't know what the answer is. And I'm curious, do you know?",English
+"- Well, so it's interesting the- Why cells die with salicylate, I do not understand. I know that salicylate has very little effect",English
+"on the transduction channel. I haven't published that, but I've tested that. And there's small effects.",English
+"Now it has big effects on the outer hair cell function, because it interferes with prestin and the motor, it shifts that curve.",English
+"Why that leads to outer hair cell death, I have no idea, to be honest. And there's lots of things I don't have any idea about,",English
+"but like, why do mutations in prestin cause outer hair cells to die? I mean you're deaf, but why does that make",English
+"the outer hair cell die? So it seems to me the prestin, there's something else going on there, and maybe salicylate is a tool to give us some idea",English
+"of what that might be. Sorry, that's not a great answer, but. - That was great.",English
+"There's a question that I'm going to just twist slightly differently to ask your opinion about something, and somebody's wondering, is our goal to repair the hair cells or to replace them?",English
+"And I'm curious, based on everything you know, Professor Ricci, which direction do you think will be the first one that we're able to successfully do,",English
+"repair them or replace them? Or are they both equally likely down the road? - Depends how long the road is. - That's actually, that's part of the question too.",English
+"So actually if you can sort of give us your insight into where the field is heading, and where you think our opportunities are,",English
+"it becomes critically important to figure out a way to detect it. Now again, luckily for us, the one photo would be used for diabetic screening is also useful",English
+for screening for glaucoma. So we can sort of combine the two together. - Primary care physicians have a lot to do in those short visits that they have,English
+in terms of preventative healthcare and immunizations and other things. What would you tell a primary care physician in terms of what's important to look for,English
+"or what symptoms or signs you should be thinking about when you see people in their 40s, 50s, and 60s? - Yeah, that's a good question.",English
+"And one of the things we've tried to do is actually take the screening process out of the hands of the primary care doctor so they don't have to be burdened by it,",English
+"but that's a separate question. So the question is how should a primary care doc during the history sort of screen for eye problems? Yeah, well the number one is how's your vision?",English
+"Are you seeing clearly, do you think your vision is getting worse, changing, that kind of thing. And that alone will pick up most problems",English
+associated with the central portion of your vision. So really the only disease that you're not identifying with that kind of question is glaucoma.,English
+"And for that reason, we need to do more, but it's not easy to screen for glaucoma by history because most patients are asymptomatic.",English
+"So that becomes challenging. And so doing peripheral vision tests like we all learned in medical school has some value, but it's not quite as easy as that.",English
+"So as a general rule of thumb for those patients over the age of 40, if you're African American or maybe Hispanic, when you have a higher prevalence",English
+"of disease that sort of picks up after the age of 40, age of 60 in Caucasian folks tends to be when glaucoma kind of the prevalence increases.",English
+So that luckily sort of dovetails with the need for reading glasses to a large degree in terms of your mid 40s or 50s.,English
+"So I'd say that if you are that age, you should be heading to the ophthalmologist. And so the primary care doc blurry vision,",English
+"and if you are of the right age, off you go to the ophthalmologist for a visit. - Do you think, now that you can get reading glasses",English
+"pretty much anywhere, Costco, BJ's, drug stores, there's that whole set of cheaters or whatever they're called, is that delaying",English
+"necessary visits to ophthalmology for people in their 40s and 50s, do you think? - For the reading portion, yeah, I think so.",English
+"Is that a huge problem for the most of humanity? Probably not, it's probably better to allow people to see clearly than to make them all go to the eye doctor.",English
+"It just from a pure population health perspective, it sure is nice to have the ability again, not to see normal patients.",English
+"So as a result, most people are not gonna have an eye problem, so to drag them all in for reading glasses seems to be overkill.",English
+"- Okay, so what are the current barriers in getting people to ophthalmologists for screening. And tell us some of the processes",English
+you and your group at Temple have implemented to increase access? - I think the perfect screening exam is going to combine elements of glasses care as well as a photo,English
+"of the back of the eye. Because again, these are the principle cause of blindness and it turns out that the glasses are actually the hook that tends to get people to want to come in",English
+"because that's a tangible take home benefit to an eye exam. So when I go say to the health center, Health Center number five for the City of Philadelphia",English
+"and we do our free monthly exams, most of the patients are coming in for glasses and oh, by the way also have diabetes.",English
+But the real reason they wanna come in is to get the glasses. So the health center can provide them with no cost pair of glasses and that turns out,English
+"to be a huge benefit to the patients. I think the bottom line is that when you set up a screening program, it's actually, I've learned,",English
+"not the screening program itself that is the critical portion of the whole screening process, it's actually the ability to care for the patient",English
+"after the screening that makes a huge difference. And by that, I mean, how are they gonna get the glasses? I mean, you can give them a prescription,",English
+"but if they can't actually go somewhere to get the glasses and they cost $300, that's probably not useful. And if the patient screens positive for a disease,",English
+"what are you gonna do with the patient after they screen positive? And so the question is, should you even be screening at all if you can't care for these people after the fact.",English
+"And so I think that's one of the issues that the screening has to take into account because the act of the screening, yeah, you wanna put the screenings in places where people go.",English
+"If it turns out old people have eye problems, then you got to go where the old people are. If it turns out that you wanna identify childhood blindness",English
+"or loss of vision, you screen in schools, if you want to identify older folks, you stick them in primary care doctor's offices because they tend to go to primary care doctor's offices.",English
+We found that to be a much better place to stick them and in senior centers or nursing homes or places like that. We've also found that by enrolling the primary care doc,English
+"kind of in the process, then they may easily get the patient to buy into the concept of going to our follow up visit because they sort of trust their primary care doc.",English
+"And if the primary care doc said, ""Yeah, this is a serious problem, ""then we think that they're more likely ""to actually follow up for an eye exam.""",English
+"So I think that from our point of view, for several years now, we've really tried to focus on the primary care doctor's office as the location for an effective screening.",English
+"And that has, I think, worked out pretty well. - Great in your talk, you talked about some mobile units and they utilize artificial intelligence systems",English
+"to help facilitate screening. And you know, the hope is that these AI systems can help facilitate care and serve to provide additional and important information to physicians",English
+"who incorporate that information in the care of their patients. As AI systems are being developed and marketed to physicians, what questions should physicians ask",English
+to determine whether the systems have been adequately validated and whether they're appropriate for their particular patient populations?,English
+that the methodology and the results of the testing are valid. Now you can certainly find examples of photography systems,English
+that are tested on patient populations that are not representative of the same group of people that you yourself might be caring for.,English
+"The lucky thing about diabetes is that I don't care what genetic makeup you are, your retinal findings are the same.",English
+And so that allows for all patients to have one sort of AI program work for them. Now that's a little different when it comes to say glaucoma.,English
+"Now glaucoma is a disease of the optic nerve, or we at least that's the location that we are most easily able to examine",English
+"the health of the nerve tissue in the back of the eye. And the problem there is that different racial groups appear to have different sized optic nerves,",English
+"different shaped optic nerves. If you're nearsighted versus not nearsighted, you can have a different look to your optic nerve. It can really be very difficult to sort out between normal,",English
+"but funny looking and abnormal, but there's sort of an overlap there between early abnormal and normal, but unusually shaped.",English
+And so that's really difficult to tease that out. And these AI programs of course rely on massive quantities of photos,English
+"that someone has given a stamp of disease, no disease. And they've got to be in different patient populations and all that kind of stuff.",English
+And it's really hard to pull that off in a disease where there's an overlap of the spectrum from weird normal to early disease.,English
+"And that maybe not be so easy to ever tease that out with solely a photo. That's why in normal situation,",English
+"we rely on peripheral vision testing as well as a photo, as well as serial photography, looking for change as well as eye pressure, as well as the way your eye",English
+"is sort of shaped, in order to be able to tease out whether this is glaucoma versus sort of unusual normal. But diabetes and macular degeneration, cataract,",English
+"they're more universally applicable to all individuals, so that makes life a lot easier. So for diabetes, I think the issue really boils down",English
+"to the follow up. I'm not so worried about whether the machine is able to diagnose disease, we've actually found that the machine's a little over call the disease.",English
+"Whereas we are like, well, we're not really convinced, but the machine is like, that looks like a little bit of a fishy, like micro aneurysm or something.",English
+"And so the issue then becomes all right, what do you do with the patient afterwards? Are you gonna be able to examine that? Do you wanna set the cutoff for referral",English
+at moderate retinopathy as opposed to mild retinopathy where you know that those patients probably aren't at serious risk of vision problems.,English
+"So we're only gonna really focus on the patients that are higher at risk. Again, the FDA approval process probably gives you the clearance.",English
+"It is always worth knowing if your patient population is similar to the group that was studied as the normative database in the clinical trials,",English
+"but again for diabetes and AMD and cataract, not to worry about that, it's really a glaucoma issue. So that I think takes some of the concern away.",English
+based on whether you were going to refer to an ophthalmologist or whether you're using it as sort of a low level cutoff to identify,English
+"as opposed to using a photo once the patient already has a known diagnosis. - Yes, yes. - Yeah, so that's a great point.",English
+"it's really those who have diabetes then get a photo. And to me, the issue is even more complicated because most people with diabetes",English
+"are not gonna have diabetic retinopathy. And so the question then becomes, can you further refine your screening metrics or your criteria, I guess,",English
+"to identify, or at least screen more than annually, more appropriately, we'll call it for those people more likely to have disease,",English
+"versus those who are not as likely to have disease. And so we're trying to figure out kind of using sort of predictive modeling, what sort of biological characteristics",English
+"that a primary care doctor would easily have access to. If we put them together in some kind of formula that spit out a number, and we say,",English
+"everybody with this number or higher, you're more likely to be at risk for retinopathy, therefore we'd like to screen you once or twice a year, depending, maybe on the range.",English
+"And if you are a low risk of retinopathy, maybe every two years. Because even the photograph still costs $50, so the question is, is that a worthwhile spend",English
+"for a patient? Yeah, it's cheaper for an insurance company to do $50 for an AI assisted photo than it is $100 for an eye exam, but still it's still $50.",English
+"And for society is that worthwhile thing. And for the patient, is that something that's worthwhile? So we've got to sort of, I think refine that",English
+"a little bit better 'cause currently the dogma is annual eye exam for diabetes, there you go. But like we know 85% of people will not have retinopathy.",English
+"you wanna put your camera in everybody's office nationwide. - Absolutely, yes. - And the real money is of course in primary care",English
+"because there're way more primary care docs than there are ophthalmologists. So you need to be convincing the primary care doctors and oh, by the way, the real money",English
+is in the population health payments that are made to primary care doctors by meeting the HEDIS requirements that enable them to generate the quality scores,English
+"and the quality payments that would be like bonus payments from the insurance companies, from managing that panel of patients. So from an ophthalmologist's perspective,",English
+"this actually loses us money from our department 'cause we bought the cameras, that's 15,000 bucks. We stick the camera out in the primary care doctor's office.",English
+We have to hire the person to train the staff. We have to pay the optometrist to do the reads for the diseases that are not diabetes.,English
+And we need to make sure that we have the office staff in place to be able to handle the patients that are going to be found positive by the screening.,English
+"So that is costly and so we actually find that to be not helpful from an ophthalmology perspective, until you see patients that get sick,",English
+"that are sick and that need the help, then we actually can start to recoup some of that cost. So the real money is in the quality payment system,",English
+"going to the primary care offices. And for them it's basically money for nothing. They just have a camera over in the room next door and the patients get photographed,",English
+the primary care doc doesn't have to worry about that. And then all of a sudden they magically have a higher HEDIS score and hopefully a higher quality payment system.,English
+"And so from their perspective, it's a wonderful thing, from ophthalmologist's perspective, eh. So if you are a private practice ophthalmologist, eh, right?",English
+"So why would I want to buy a camera and put that in a primary care doctor's office? The primary care doc may not send me the patients, I'm not gonna really recoup the money,",English
+"15,000 bucks at a $50 clip payment reimbursement. And by the way, you have to pay the AI company a portion of that.",English
+"So let's say your net profit is I don't, let's call it 20 bucks. You got to do a lot of exams before you recoup your cost. So luckily since I work within a health system,",English
+the health system looks at this more holistically. And so the practice plan is of course going to be receiving a portion of the money that the health system earns,English
+"in quality payments that's gonna go a bit to ophthalmology, a little bit to primary care, probably mostly the primary care.",English
+"So from our perspective, that's really where the action is in terms of making this cost effective for a health system to do.",English
+"So we found that to be just the economics of it, to work much better in the context of an integrated health system.",English
+"- Right, and I guess it also emphasizes the fact that in order to provide the right care to the right patient at the right time, you need this systemic coordination",English
+"between primary care doctors and ophthalmologists, and this is just a tool that helps give you extra information about a patient.",English
+"- Yeah, so the other thing that doesn't really get talked a lot about is insurance status. So if you're working within the context of a health system, in theory, everybody takes the same insurance.",English
+"So if you're a private practice ophthalmologist and you set up a camera and a primary care office, you may not take the insurance that the person who screened positive would be,",English
+and that's impossible for the primary care doctor's office to keep a list of insurance plans that you participate with so that they send patient A to the camera,English
+"to then go to doctor B versus doctor, I mean, forget it. So the point is that that's one of the problems I've seen in other systems is that the ophthalmologist",English
+"is not tied into the system in a way that allows the patient to follow up in a appropriate fashion. And that doesn't get a lot of press,",English
+"but that's a big roadblock. - Yeah, and I guess this is just an example because ophthalmology has used these AI systems earlier",English
+than some of the other specialties. This is actually something that applies to all situations where AI technology will be used.,English
+"So it's a problem that we'll see again and again, and again, ophthalmology may be experiencing it before other specialties.",English
+"- No, I think you're right about that. But the AI system is also more cost effective. So in other words, to put a retina specialist, looking at those photos, that's a very expensive way",English
+"to do it. So I do think that, and if you put an optometrist, an excellence route for sure, and lower cost probably than a retina specialist,",English
+"but still on balance, you'd be better off deploying that person, taking care of patients as opposed to screening photographs.",English
+"So we feel that the AI is probably more cost effective. Now it costs a lot of money to develop an AI program and so to recoup that money,",English
+I mean the screening reimbursement codes have thankfully increased over time. So that a couple years ago you used to get paid $15,English
+"to do one of these telemedicine screening photos, now it's closer to $50 if you involve artificial intelligence because it costs money",English
+"to develop the programs. They have to recoup their costs too, and these programs, I think in the long run will save money, but the challenge is of course,",English
+"convincing insurance companies that the benefit that is going to be 10, 15 years from now is going to be useful to the insurance company.",English
+"And the problem of course, for most insurance companies is they don't keep the same patient population long enough to see the payoff for the preventative eyecare.",English
+"So that's another potential benefit for our patient population, which is often older and Medicare age.",English
+And so they tend to be maybe a little more static insurance type than if they have Medicare than some of the younger patients that may be moving around different insurance plans.,English
+"Diabetics of course occur at all age. So they're a little bit different, but the older folks that tend to get high disease tend to have a little more static insurance.",English
+"- Yeah, and I guess the other thing to think about, and this will probably be my last question on this is this whole issue of screening. I'm a geneticist and so we talk about screening tests",English
+"with patients all of the time and there is no normal and abnormal, a screening only really identifies someone at increased risk or decreased risk.",English
+"And so having that conversation with patients takes time, whether you're in the primary care office, calling someone back or whether in the ophthalmology office.",English
+"And so that needs to be figured in to patient visits also, is the time it takes to talk to patients about this. - Yeah, so that's an excellent point.",English
+And so the screening process is not going to include a lot of patient feedback until they screen positive,English
+"and they would end up in the doctor's office. So we wouldn't necessarily at the point of care, shall we say, be providing that kind of feedback, the primary care physician, if it's within their office,",English
+"may be able to, if it's set up that the patient is seeing the primary care doc at the time their photo is taken, but you're right. In general screenings are identifying levels of risk.",English
+"And certainly in glaucoma, that would be probably more where you are. I mean, glaucoma has a spectrum of damage",English
+"to the optic nerve and like I said, the early disease looks an awful lot like unusual, normal. It can be very hard to tease that out.",English
+"And then as you get over to the extremes of definite disease and definite normal, it becomes a little bit easier, but there's a pretty broad gray area in the middle there",English
+"that makes our lives much more difficult. Luckily with diabetes and macular degeneration, it's there, you can see it, it's there or it's not there.",English
+"And that's kind of an easy, yes, no question. Cataract's a little more difficult because cataract is the kind of thing that can be physically present, but yet not impairing vision to the point",English
+"where the patient is bothered by it. I've even had patients that are legally blind due to cataract and they go, ""I'm perfectly fine. ""I have no interest in seeing any better",English
+"""than I'm seeing now."" I'm like, ""Really, you're blind."" And they're like, ""I'm doing fine, don't touch me."" And I'm like, ""Okay, I can't touch you.""",English
+So the point is that cataract has a whole level of patient interaction to their visual needs and desires that you don't have with some other conditions.,English
+"And so for diabetes and macular degeneration, like I said, the photo is really very helpful. So I think the question then becomes, all right, where do you draw the line",English
+"about who you actually want to refer because if you know that people that are moderate, severe or proliferative diabetic retinopathy state,",English
+"they're the ones who need the attention more so on the severe to the proliferative, but even the moderate state,",English
+"those are the people we wanna target. And they're gonna, if a 15% of people have retinopathy, only half of them are gonna fall into those three categories.",English
+"And still half of the people with retinopathy are gonna fall into the mild category, at least that's what we found. And so those patients, you can probably just do annual exams",English
+"and keep tabs on them. So at some point you have to sort of a cost benefit analysis a little bit, so that's where we've sort of drawn the line",English
+in terms of the AI program. - So I always give people the opportunity to give sort of any final thoughts or messages,English
+"that you'd like the listeners to be aware of. - Well, you know, ophthalmology tends to live off in its own little world somewhere.",English
+"We speak a funny language, we write funny things. We don't really communicate as effectively with the rest of the house of medicine",English
+as we probably should. And yet we can provide really a value added service that I don't know that we always are providing.,English
+"And so I think that ophthalmology is not the end all and be all, but I think it can be a very useful sort of tip of the spear, tip of the iceberg,",English
+"something like that 'cause people hang their hats on their vision, they like to see. So you can kind of leverage that a little bit towards getting patients to hopefully be more involved",English
+in their own care if you're a primary care doc. And the other thing is that the whole milieu of medicine in theory is changing.,English
+"Now, I've been told that ever since I was in med school and it sort of has changed and hasn't changed simultaneously. But the goal I think is as a general theme",English
+"to try and prevent patients from getting sick. And not to fix the sick patients, but to fix the conditions that made the patient sick and try and prevent them",English
+"from getting sick. And on the one hand, that's sort of like, why would a hospital ever do that? Because by preventing people from needing them,",English
+"they're sort of putting themselves out of business. But that's kind of where the action is, if you're a member of society, you don't wanna be a body repair shop,",English
+"you wanna be a teach safe driving. So the goal here is really to figure out more innovative ways to reward behavior for physicians,",English
+to prevent people from getting sick in the first place. And these quality payment systems are really the first model that I've seen that can help to drive,English
+"that kind of behavior on the physician side, because you're actually getting paid for taking care of people and preventing them from getting sick.",English
+"So this I think is kind of the leading edge of where medicine's headed and it's not unique to ophthalmology of course,",English
+but we just so happen to have a lot of cameras and fun things that we can kind of do. And it's a little bit easier for us to take a photo,English
+"of your eye. How do you take a photo of someone's liver? I mean, I have no idea, that's kind of difficult. So the eye tends to be more accessible in some ways,",English
+um it's interesting to me so this  is looking at the basilar membrane   from underneath so you're looking up at the  basal membrane not in Scala timpani and so that   these cells are underneath it and in the apical  term you can see that they're very [Music] um,English
+fibrillic and as you get towards the basal  turn they're more globular and you know why   is that why does that shape difference I guess  I would speculate that it has to do with the,English
+micro mechanics of the organocorty that [Music]  um it helps to have them in a different shape so now comes a touchy subject here are there in  fact macrophages in the organocorty or not and in,English
+the human this is a section again from Jennifer  O'Malley's collection this is a radial section   and over here you can see the pillar cells  this is the basal membrane down here you can,English
+see there's some cells in the basal membrane  but there clearly are also in the epithelium   um some labeled cells so it looks like there's  macrophages in the human sensory epithelium this,English
+is a you can see the pillar cells here interpolar  outer pillar and a huge macrophages in in organ   or in the tunnel of Cordy you can also see  the basal membrane um macrophages down here,English
+but if you look at um non-malian I'm sorry  non-human mammalian cochleus you don't see   um macrophages in the organ accordion the  sensory epithelium and Antonin in 2014 and,English
+leave it all in 2021 published really beautiful  papers showing that the hair cells when they die   from either acoustic drama or ototoxic damage  are phagocytosed by the Dieter cells that the,English
+um the processes of the Dieter cells  up against the reticular lamina   um close in on the dying hair cell and the hair  cell goes beneath and is phagocytosed by the,English
+Dieter cells keeping the rest particular lamina  sealed at all times and so there's it's happens   very quickly and you wouldn't want first of all  macrophage is too slow to get in there and deal,English
+with that but second of all you wouldn't want  to macrophage in there messing around with this   beautiful structure so I think this is a really  unresolved and um deserving of more experimental,English
+um more experiments to figure out what exactly  is going on in here when this happens [Music]   so um and the medialis you've got again lots  and lots of ganglions or lots and lots of,English
+um macrophages among the ganglion cells  the nerve fibers the around the vasculature and this is a higher mag of the among the  ganglion cells this is again a micrograph,English
+from Jennifer O'Malley um showing the macrophages  among all of the neurons in the rosenthal's canal   so um like the the vestibular system is the poor  cousin of the cochlea there's much less known,English
+about it but care at all have been working on  looking at the immune activity in the vestibular   system in the saccule in the semicircular  canals and among those epithelial cells,English
+you know it's not quite as organized as as the  cochlea is and um there are macrophages among   those cells and they do seem to be phagocytizing  the dying sensory cells so the the vestibular,English
+um epithelia and the cochlear epithelia look  to be working differently in that situation   um okay so what about the anolymphatic sac  and duct this is not very often thought of,English
+anymore it's that people [Music] um looked  at a long time ago but as you can see in   this section here that that cells are stain for  macrophage there are macrophages in the lumen,English
+and this is a diagram showing this is a diagram  from physiology of the ear by Jan and Sato Saki   and it I like it because it shows that it's a  very nice illustration of the endolymphatic space,English
+and the paralympatic space in the inner ear  and the semicircular canals and they all this   endolymphatic space these cells continue on here  and form a blind ending in the dura of the brain,English
+so you know what is this all about first of  all I'm going to say that the lining cells are   continuous so in the the lining cells of the duct  and the sac are continuous with the aligning cells,English
+of Scala media and and those are epithelial cells  whereas a sub-epithelial tissue is the continuous   with the perilymphatic space and those are um  connective tissue cells you know like they um,English
+and so all all of those cells continue out and  form that um sac and the bond the sac is next   to bone marrow and um if you create an immune  response you can see some bone marrow cells,English
+moving into the sac so the sac is it's sort  of got a upper hand a close connection with   the white blood cells and immune cells the Lumen  contains the normal high sodium fluid and I'm not,English
+going to get into what that's all about but um  what it means is that cells can live inside that   fluid as opposed to in the endolymphatic space in  the cochlea where it's a high potassium fluid and,English
+cells can't live in that environment um so there's  macrophages lymphocytes plasma cells and cellular   debris if you look inside the Lumen and in the  connective tissue you've got the whole gamut of,English
+immune cells monocytes macrophage lymphocytes  plasma cells pmns and blood vessels and most   importantly fenestrated vessels that were seen  in the electron microscope but they're likely,English
+to be lymphatic vessels so with lymphatics  you can connect to the systemic immune system   um so and so let's say a little bit about  an lymphatic sac and the cochlea antigen,English
+injected into the Scala tympani reaches um  the sac and his phagocytos there bacteria   injected intrathecally reach the sac and the  cochlear act and they're phagocytized there so,English
+bacteria getting in there are phagocytized  and and sorry and antigen is also there um,English
+foreign so what's the relationship between the cochlea  and the endolphatic sac experimentally induced   inflammation in the cochlea causes icam expression  on the end lymphatic Sac vessels so if you create,English
+an inflammation you know in the inner ear the end  of that exact knows about it very quickly and I   chem expression on the vessels induces influx  of inflammatory cells from the circulation so,English
+expression of pro-inflammatory cytokines il1  beta il6 dnf Alpha and um are in some of the   inflammatory cells that are there so there's  already sort of a stirring up of trouble when,English
+some when you create something in the inner in the  cochlea beta expression this is a graph from Sato   in 2003 Iowan beta expression is induced in  the um by the cochlear immune response so,English
+in the cochlea you can see at starts right away  obviously and then goes out to 168 but you also   get it il1 beta expression in the endosac lumen  and in the pericular connective tissue cells so,English
+um again you're sending out signals  quite rapidly from the animal fatic sac   um so with its vascular lymphatic  and immune systems immune cells,English
+operates in a coordinated manner  with the inner ear immune responses so what about the vasculature let's  because vasculars is very important to,English
+um immune responses and lymphatics so let me  just take a minute and review I'm sure you all   have seen this figure and know this but I'll just  say it again the spiral artery enters the cochlea,English
+branches come across between above the scale  of a stimuli and over to the spiral ligament   where they Branch into capillary beds into in the  street of vascularis and coalesce and not so now,English
+they're venules in the lower part of the Spiral  ligament and back to the posterior's biomedio   vein to leave the cochlea but the important part  here is this intense capillary beds Out Among the,English
+studio vascularis and the spiral ligament and the  that's the place where throughout the body where   cells extravasate from the circulation into the  tissues and so you see it here there's a scale of,English
+timpani you have a guinea pig with an experimental  inflammation created there and you can see the   cells coming out here and another point is  that you can't float or cells can't swim so,English
+a matrix is very rapidly formed here and while  all that happens it clogs up the blood vessels   Upstream from that and so you get expanded um  of stasis and expansion of the capillaries up,English
+in Austria and here's a higher mag of leaving  the blood vessel on the scale of timpani um so,English
+immune inflammatory cells interact  with the extrater Matrix proteins and   um create that inflammatory Matrix  fluid-filled paralymph is a unique,English
+environment I guess I already said  that um but I think this is another   area that should be examined is how is this  Matrix formed what cells do it and we all know,English
+that you can get an ossified cochlea especially  if it Cochlear implants they've see that a lot   but how is this all formed and regulated I  think we don't know anything about that yet,English
+so now let's look at lymphatic drainage so when  I started this business There Was You Know ears   didn't have lymphatics but if you put an antigen  inside the if you inject it into Scala timpani,English
+it's rapidly taken up by look at in this   um spiral ligament here the periosteal  cells and probably into this vein as well um,English
+and if you look 15 minutes later  at the Deep cervical lymph node   you can see labeled cells in the node [Music]  and this was just hrp that we put in here,English
+um 15 minutes later it's also in the spleen  so whatever happens in the inner ear as very   quickly recognized or at least the fact that  it's there I don't know that you recognize what,English
+it is but the systemic immune system is aware  that something happened in the cochlea [Music]   so that's that's just saying the same thing  quickly there all right so what happens in,English
+the other way around what happens if you're  if you have a systemic infection you have a   cold you have uh covid does the ear know about  that so you can [Music] um model that by putting,English
+lipopolysaccharide which is a endotoxin it's a  cell wall component of gram-negative bacteria   you can inject it into peritonealy and use it to  simulate a systemic infection and if you do this,English
+it induces cytokine secretion adhesion molecule  expression on endothelial cells and in the cochlea   vascular permeability is increased type 2 spiral  ligament fibrocytes Express nfcap B which is an,English
+innate immune activator type 1 spiral ligament  fibrocytes Express il1 beta cd45 leukocytes   enter the Scala timpani and noise damage is  increased so think about going to a rock concert,English
+when you have a cold it's probably not  as good as if you don't have a cold   um so this is just some illustration of that  72 hours after injection of LPS nothing else,English
+has happened you just inject LPS into  peritoneal and you get labeled fibrocytes with cells that expressing il1 beta  which is a pro-inflammatory cytokine so,English
+right away things are happening in your inner ear   inflammatory cells move into the inner  ear so you see some cells in here okay and activation,English
+and again if you inject so now if you inject  antigen so you put LPS into peritoneali and   then put antigen that the animal is sensitized to  intrathecally so you haven't touched the cochlea,English
+you get um up increased number of leukocytes in the sections  in intrathecal injections you get a few and if you   put LPS into peritoneally you get a lot and you  can see that over here there's a few cells here,English
+that come in with the intrathecal injection  of antigen but there's a whopping number of   cells here if you put antigen in there and LPS  IP into peritonealy so I think this is a very,English
+unappreciated part of um inner ear Behavior  but if you have an infection systemically   the inner ear is aware of it and reacts to it,English
+so that's I'm just saying this over  again is that activity in the cochlea   is constantly monitored by systemic immunity and  conversely systemic immune activity can induce by,English
+um infection that affects the cochlear okay so um so what are the immune responses to acoustic  trauma so that's a big stressor that we're all,English
+familiar with and so how what is what's going  on there with relative to the immune system   um macrophages assist and repair of damaged,English
+um synapses between the hair cells and the  spinal ganglion cells so this is synaptopathy   um we know the acoustic trauma that you get sent  up top of three but it does look like macrophages,English
+can move in from the osteospiral lamina and go in  and help repair that so that's looks like a good   function of of macrophages there's upregulation of  pro-inflammatory mediator NF Kappa B and there's,English
+secretion of pro-inflammatory cytokines such as  dnf Alpha il1 Beta il-6 And chemokines um mcp1   mcp5 and um ccl2 and recruitment of inflammatory  cells circulating inflammatory cells so,English
+every time you have acoustic  trauma all this activity goes on okay um so innate activity innate  immune activity is activated by,English
+acoustic trauma and this shows this was a  mouse cochlea and NF Kappa B is activated in   the um type 1 fibercytes and the type 2  fibrocytes and this was a study done by atoms,English
+okay and um f480 is activated macrophages they're  increased and [Music] um cd45 leukocytes come in and this is a figure from Frye at all  2018 and this is the same group that,English
+you I showed you originally the basil membrane   um macrophages below the bathroom membrane in  it here you can see it with acoustic trauma   that the number is increased in the area of the  immune system or sorry the acoustic stimulus,English
+so but it's not clear exactly  what these cells are doing   um during acoustic drama but they're  certainly increasing their numbers,English
+and this shows you inflammatory cells  this is a cat cochlea it's a salon h   e stain section where it just seems  really nicely Illustrated that you,English
+with an antigen and get him stimulated to that  and they have circulating titers against the   antigen so we put the antigen alone and then if  you put antigen plus noise you get a much larger,English
+response to that antigen so in conclusion inner ear immune  activity is an exciting topic of   Investigation I hope I've given  you a few ideas about things that,English
+certainly need to be investigated and it's  not isolated from the systemic immune activity   but affects it and is affected by it and  immune surveillance is a constant occurrence,English
+and I'd like to thank this is just some  of the collaborators but I mostly want to   thank Jeff Harris and Alan Ryan and Gary  feierstein who have been my colleagues in,English
+these studies and Hainan Lang Who provided me  a beautiful micrograph and Jennifer O'Malley   Who provided so many of those micrographs for  this talk so um thank you very much everybody,English
+is relay those to you um Dr lefon asked about the  different shapes of the macrophages you know the   the ones who are sort of fibrillary or elongated  in the Apex versus globular at the base could the,English
+ones in the base be more likely to be activated an  activated form because they're closer to the round   window membrane and more likely to be exposed  to middle ear immunogenic materials or mediators,English
+um the round window membrane has immune cells  in it has macrophages in it and certainly is it   changes if you create a middle ear infection the  Roman membrane gets thicker and cells move into,English
+there so yes it's very responsive and yes those  cells could be from there have migrated in yes okay and then uh and Alyssa lisikowski also  asked you um that when you say that macrophages,English
+um Taj Mir is going to give a talk in a in the  future and she probably will talk about that I   don't know I there's there's a publication that  I've read but that's I don't know how it works but,English
+when you see a greater number of them there is  it because they've come in from the circulation   um I think those are all really wonderful  questions and I don't know the answers   well I you know based on our work in the  interviewer I can add a little something,English
+you know and go back into the circulation and may  end up somewhere else doing another job they're   sort of the handyman of the immune system running  around you know doing things when they're needed,English
+um we don't know the answer to that so say I told you  it's a very exciting field we need the people to   answer these questions to do some more research  yeah no question about that you know we know that,English
+"Well, this is the driest topic that we could possibly pick for you, and I'll try to make it as exciting as possible. Dry eye in fact,",English
+is not that dry of a topic because similar to how the health of the eye can give us some reflection on the health of your body,English
+the deep study into dry eye can tell us many things. Sometimes just about your eyes but also about the general state of health of your body.,English
+"If I were to ask you, what does dry mean to you? Everyone might come up with a different idea. Maybe a dry martini sounds good right about now,",English
+or a dryer or some dry ice. Where I'd like to start with this dry eye talk is just to accept the general concept that,English
+this term dry eye mean something completely different to everyone who uses it. It means something different,English
+to a patient who has dry eye. It means something different to your primary care doctor. It means something different to,English
+"your optometrist or your general ophthalmologist. As a matter of fact, it means something very specific to a cornea specialist.",English
+"Now, when you're suffering from dry eye, it is often the case that you are referred to a cornea specialist.",English
+"Not if you have mild dry eye, you do well with basic treatments of which we'll discuss. But when the dry become severe, you often meet one of us.",English
+"The reason why is we call ourselves cornea specialists. But the truth is on our diplomas, it says that we are not",English
+"only cornea specialist in the cornea, but we all have a fellowship in cornea and external disease. What external disease means is the ocular surface.",English
+"We have studied the cornea as well as the ocular surface. The ocular surface is the lining of the outside of the eye,",English
+"which is the conjunctiva, the eyelids, the eyelashes, and of course the tear film. This is how many cornea specialists think",English
+about dry eye and study dry eye and take care of dry eye. This is how we together are talking about why the cornea is important and that leads right,English
+"into a discussion of why dry eye is important. In general, dry eye is a disorder of the tear film. When we started talking about the function of the eye,",English
+"we said when light comes in, it hits the cornea and goes through the eye. But in fact, that's not perfectly correct. What's perfectly correct is that the first thing",English
+"that light hits when it hits the eyes is the tear film. In order to have crisp, clear vision, you need a perfect tear film.",English
+Tear film is more than just water. There are components to the tear film and that's how we'll start. We'll talk about what's the recipe for healthy tears?,English
+"Remember, the tears will sit over the cornea. Tears have a very basic recipe. In the recipes, you need a little part of mucus,",English
+"and we often call that mucin and you need a lot of water, which is aqueous and a little bit of fat, which is lipid or oil,",English
+"and the directions or you have to mix well together and then blink about 22 times a minute, which is what we normally do in a relaxed state. When that occurs and you have",English
+"a healthy cornea and a perfect tear film, your vision is great. If there is a disruption in your ability to produce any of these components,",English
+"it ends up that you develop a dry eye syndrome. The anatomy of where these components come from. The white part of the eye is called the sclera,",English
+"and there's a lining on the outside of the white part of the eye called the conjunctiva, and there's tiny little blood vessels on that lining. There are also cells called goblet cells and",English
+those goblet cells make a product called mucin. The mucin is in charge of helping the tears stick to the cornea.,English
+"Up above the eyeball, underneath the eyebrow off to the side, so up in the lateral part of the orbit sits our lacrimal gland, way up here.",English
+"The lacrimal gland is in charge of producing aqueous or the water component of our tears. In our eyelids are cells,",English
+"in the eyelids themselves the lower lid and the upper lid are tons of glands, about 22, 24 glands all across horizontally, the upper and lower called meibomian glands.",English
+"These meibomian glands make the fat and the lipid. When we blink and when we live, all of these parts secrete",English
+their part of the recipe to make the tears. Now I won't spend a ton of time talking about disorders of conjunctiva cells and goblet cells where,English
+you would have a mucin deficient dry eye. Although at UCSF you can imagine we see just about everything. We certainly see mucin deficient dry eyes,English
+"that tends to be more specific diseases, unusual diseases like Stevens-Johnson syndrome or graft versus host or",English
+"very severe complications that you've had to an antibiotic or a drug, or certain types of reactions, side effects of bone marrow transplants",English
+and severe diseases. What the vast majority of people have when they have a dry eye is,English
+"either an aqueous deficiency or a lipid deficiency. I'll say something interesting, when everybody says, I have dry eye, almost everyone thinks that",English
+"they have an aqueous deficiency. What aqueous deficiency means, you actually don't produce enough tears. Your lacrimal gland is not functioning well.",English
+"It turns out in the United States when you have dry eye, the vast majority of people have a lipid deficiency. This means that you actually are",English
+"producing the aqueous tears fine, but the lipid whose job it is to stabilize the tear film on the eye.",English
+"If you can imagine a really great Italian dressing, the oil will come up to the top and the fatty tears also come up to the top and",English
+"stabilize all of the aqueous of the tear film. You are making tears, they're just evaporating too quickly.",English
+"If you were to Google dry eye and try to get into the nitty-gritty of it, you'll find that there's this tear film and ocular surface disease society,",English
+which sounds like a great group to meet at a cocktail party. They come with a complicated diagram of which we love. I will not go into this in detail or,English
+else our dry eye lecture really will turn dry. What I would like to do is bring your attention to the bottom through a blue and yellow here.,English
+"The 43 word description of dry eye really ends in a picture saying that the vast majority in that yellow, the vast majority of people end up",English
+having an evaporative type of dry eye. There are some people with a true aqueous deficient dry eye and we'll talk about that. Then there are few people who have,English
+"a component of both that, would be both aqueous and evaporative losses. Again, aqueous meaning you're not making enough water tears,",English
+"and evaporative dry eye, meaning that the lipid component of your tear film is dysfunctional and you're making enough water,",English
+it's just that your tears are evaporating too quickly. Let's dig in to what it means to have aqueous deficient dry eye.,English
+"Again, with aqueous deficient dry eye, your lacrimal gland is not producing a lot of aqueous tears. When you have aqueous deficient dry eye,",English
+that type of person will have the following symptoms. My eyes feels dry. Feels like there's something in my eyes.,English
+"My eyes are burning. Many times throughout the day my vision just doesn't seem to be clear, I almost have to blink myself into good vision.",English
+"My eyes are red and irritated. My eyes just feel tired. Then when you come to see us, if you'd had your eyes examined,",English
+"you put your chin in a chin rest and your forehead comes forward and a big microscope called a slit lamp is put in front of you, and here I am examining maybe you.",English
+What we see with aqueous deficient dry eye is that you don't produce tears. One way we measure that are with,English
+tiny baby rulers called Schirmir strips. We have you close your eye and the strip is filter paper and it actually gathers,English
+"the amount of tears and we measure what your production is over a five-minute period of time. In addition, we can put in different eye drops that stain your tear film.",English
+"We can measure what we call the tear meniscus. We know how many tears, how high the layer should be, the layers over the bottom eyelid.",English
+"Additionally, we can tell if there's damage to your cornea. If you don't make enough water, your cornea can desiccate,",English
+which means dry out. Which means you can get teeny tiny little scratches in your cornea. We take that reasonably seriously,English
+"because just like if you have a scratch anywhere else on your body, the concern is that it would get infected if the skin is left open, and if there's constant",English
+"epithelial or skin breakdown of the cornea, your vision isn't good, you are often very uncomfortable and it's a risk for a corneal infection. As you remember from the earlier picture,",English
+"sometimes corneal infections can become terrible and visually significant. When you have no water and your cornea is very rough, we take that quite a bit more seriously.",English
+We'll talk about some systemic diseases or body diseases that can be associated with an aqueous deficient dry eye. One of the diseases that can be associated with,English
+an aqueous deficient dry eye is something called Sjogren's disease. This is an auto-immune disease where the body's immune system is,English
+"hyperactive and attacks things as foreign, which are actually self. With Sjogren's disease, the immune system attacks the lacrimal gland,",English
+"often attacks the salivary glands as well, and oftentimes this can be associated with different autoimmune diseases, different arthritis conditions,",English
+"rheumatoid arthritis, for example. If you have a severe dry mouth and have dry eyes, during your examination,",English
+"that's something you should bring up. Someone with a severe dry mouth, someone with a lot of cavities, as a cornea specialist, we would like to know that information.",English
+"Sjogren's disease has other systemic implications and there are ways that we can test for that. If you have a severe dry mouth,",English
+"bring that up and your cornea specialist will know how to further evaluate you. With age, and there's just no nice way to say it,",English
+"so I just say with maturity, we produce less aqueous from our tear film. Oftentimes it's post-menopausal. There are many hormonal changes",English
+"where aqueous production goes down. But to be fair in men as well, as you get older you produce less aqueous. Also as we get older, we take more medications,",English
+"and many medications such as antihistamines, antidepressants, antianxiety medicines can decrease the aqueous production and",English
+at least contribute to some dry eye. Then there are many more severe diseases where the lacrimal gland can,English
+"be obliterated and severely damaged. Complications of bone marrow transplant called graft versus host, complications of radiation in and around your face",English
+"and eyes can develop a very severe dry eye. When you are treating an aqueous deficient dry eye, you are acting like a plumber.",English
+"You are saying, I need more water in this bucket, and the bucket would be the eye. The way you get more water is to",English
+either turn on the faucet and give yourself more water or to plug all of the outlet holes to allow,English
+"the water that is there to stay there longer. In terms of aqueous deficient dry eye, turning on the host and adding more water means an eye drop.",English
+"We have to add more water to the surface of the eye, so we need to use eye drops, and plugging the holes, if you look along the flat part",English
+"of the eye lid where the eyelashes are, and right in the corner is a teeny tiny little drainage hole called a punctum. There's one in the lower lid and in",English
+the eye lid it's a hole that goes to a little tube that connects into your nose. This is why your nose runs when you cry. Because the tears go into,English
+"that little hole and drain into your nose. Well, it turns out in severe aqueous deficient dry we want to plug that hole. There are many different ways to do that with",English
+"little silicone plugs or other plugs. Sometimes in severe cases we just surgically destroy the hole, sometimes with heat called punctal cautery.",English
+"What that does, it's just like when you have a bathtub with two drains, if you were to plug up the drains, the water that is there stays around longer.",English
+"Typically the next question is often, which eye drop should I use? It's a bit like saying to someone off the street,",English
+what shoes should I wear? It depends on the context. are you going jogging? Are you going to work? Are you going to have fancy party?,English
+"In general, for aqueous deficient dry eye, we do not recommend the get the red out drops, really for any condition,",English
+"we don't recommend the eye get the red out drops. If you're getting married tomorrow and you have photos, possibly we'll recommend it for the photos.",English
+"In absent of that, they get the red out drops had active ingredients, either tetrahydrofolate and nafcillin. What they do is they vasoconstrict.",English
+"We don't like this for long-term use, why? Because when you use it constricts the blood vessels, it constricts the muscle and the blood vessels",English
+"to make the blood vessels skinny so you don't see as much of them. When the drop wears off, the blood vessels dilate. Then you use the drop again and it",English
+"constricts that whereas often it dilates. Just like any muscle, if you constrict and relax and constrict up, the muscle gets big.",English
+"What happens with chronic use is that you get something called reflex vasodilation. With chronic use, you actually get a much redder eye,",English
+"which is fantastic view on stock and it get the red out drop, but it's terrible if your eyes are red and irritated. For mild dry, you can actually use any brand you'd like.",English
+"You can use generic brand, brand name, there's many different on the market. If you're using tears about one to four times a day because your eyes feel a",English
+"little bit dry and you put in tears and feel better, that's fantastic. You should just find the brand that you can afford and feels best on your eyes.",English
+"Just like shoes, you have to try a couple of different brands. Just because some people like one brand doesn't mean that you will, you just have to trial a couple and you'll",English
+"find one that feels soothing when you put it on. Now in true aqueous deficient dry eye or more severe dry eye, you're using these, you're turning on the faucet,",English
+"you have to put an artificial tears many more times a day. In that instance, what we'd like you to do is use a preservative free artificial tear.",English
+"The reason is, is because when artificial tears are preserved, the common preservative is called benzalkonium chloride. That preservative when using more than four times a day,",English
+"becomes toxic to the surface of the eye. It in fact, worsens your dry eye symptoms. Remember when we stay in the cornea,",English
+"we could see tiny little drops of aqueous deficiency where the cornea is damaged. When with prolonged use of preservatives, we can actually see damage to the cornea as well.",English
+"Sometimes when your eye feels really dry and you're just pouring in too many drops with preservatives, it compounds the problem",English
+"and it's hard for us to tell which is dry eye and which is just preservative toxicity. When you're looking on the market for artificial to your options,",English
+"there are drops which are just more like water. There are gel that stays around longer, so the first few blinks are a little thicker. There's ointment that we often recommend at bedtime,",English
+"but sometimes when it's severe during the day ointments come in a tube. As dry eye progresses, sometimes we're discussing options like",English
+"autologous serum and then when it's very severe, there are some specialty contact lenses that are rigid contact lenses",English
+"that are vaulted over the query that can bathe accordion fluid all day long. A note about ocular surface inflammation, so if you have very dry eyes,",English
+"they can be inflamed eyes, so inflamed eyes are often red. Sometimes we use anti-inflammatory drops to help with the discomfort of the dry eye in addition",English
+"to giving you more water on the surface of the eye, we actually have a decreased inflammation. Mild steroid drops are excellent anti-inflammatory drops",English
+in most people who are really suffering feel great on a little mild steroid drop. There are many different types of steroids drops with various different types of,English
+"potency and the truth is you don't need a high potency steroids for a dry eye disease. For example, high potency steroids get inside",English
+"of the eye and nothing about dry eye inside of the eye, it's all on the surface of the eye. We really only need very mild steroids drops",English
+"when we're using them for the purpose of dry eyes. It's absolutely true that in some people, steroid drops can be associated with complications and",English
+"those complications could be increased risk of infection and increased risk of your eye pressure going up, or an increased risk of cataract development.",English
+"However, that is with the use of high potency steroids many times a day for months and in general for dry eye, we're talking very rare use of low potency steroids.",English
+"In general, this ends up not being a risk, but I will say anyone on topical steroids can be used topical steroids for a very long time safely,",English
+"as long as you are monitored carefully and that's what we would ask for you, is to just maintain your relationship with your ophthalmologists.",English
+"We will check your eye pressure and make sure that those complications don't occur and if they occur and we catch them early, we can just stop the drop",English
+"and the pressure would come down. Preservative-free steroids drops are also available. Then oftentimes is the question, how do we use Restasis and Cequa and Xiidra now those",English
+are drops with non-steroid anti-inflammatory medicine. Restasis and Cequa using medication called cyclosporine in,English
+a very low concentration inside or uses a novel medicine called the photographs. I'll just tell you that many people feel strongly about these drugs.,English
+"it's expensive, it stings."" We have people that say it helps and we have people that say they don't help. They really don't cause problems,",English
+"so if you can afford it and want to try it, that's okay they're very well marketed drops. When you have a situation where it helps some people and it doesn't help others,",English
+how in academic nerdy medicine do we sort that through? But we do something called a randomized controlled trial where we put some people on the drug and we put other people on,English
+placebo and we see how well does the drug really work. I'm just going to put out there and I will say it with the context that many people,English
+"feel strongly about these drops, but there is a group called the Cochrane Research Group that analyzes the research that's available for efficacy of",English
+"many different treatments and it turns out, I think not two years ago they evaluated all the randomized control trials that were associated with cyclosporine drops,",English
+"so that's the Restasis. The end assessment is that the Restasis is a bad, this is a tiny little conclusion, but just tiny little font,",English
+"but remind me to tell you, when this group looked at 18 randomized control trials, their assessment is that the Restasis type drops",English
+"work as well as an artificial tear. Now a lot of people are not going to like that sentence because a lot of people believe that it works,",English
+"but a lot of people don't believe that it works. The data that we have right now would indicate that we need to look at this a little bit more, but if you are taking it and don't believe it works,",English
+you shouldn't feel emotionally obligated to continue it because research would show that perhaps an artificial tear is just as efficacious.,English
+"Now, let's move on to evaporative loss dry eye, remember with evaporative loss dry eye, you make plenty of watery tears,",English
+but the lipid which should stabilize the aqueous on your tear film isn't coming out of the meibomian glands correctly.,English
+"Now, when you were a patient with evaporative loss dry eye, your symptoms are very similar. My eyes feel dry,",English
+"feels like there's something in my eyes. My eyes are burning, I feels like I have to blink throughout the day to get clear vision.",English
+"""My eyes are red and irritated, my eyes just feel so tired."" There is one symptom that you don't get in an aqueous deficient dry eye and that",English
+"""My eyes tear when they're irritated."" Oftentimes people come with a complaint of tearing and we say, ""Oh, your eyes are dry"" and that doesn't make any sense.",English
+"The reason why it does make sense is if you're making plenty of aqueous, but the lipid is in stabilizing the tear film and the tears are evaporating.",English
+"Your brain is recognizing, ""Oh my conny isn't going to get injured and so then it reflex tear."" You're trying to tear to keep enough fluid on",English
+"the surface of your eye to keep your formula from getting damaged. On examination for evaporative loss dry eye, you have plenty of tears when we measure by Schirmers",English
+"strip and when we put in the drops to stay in your tears, what we do is we have you blink and then hold your eyes open and we can",English
+measure how many seconds it takes for your tears to evaporate. This is the flat part of eyelid called a lid margin and in,English
+"the flat part of those meibomian glands. Maybe you can see these teeny tiny little perfect dots, that those are normal meibomian glands. Here you can clearly tell those are dramatically clogged.",English
+"Meibomian glands with a meiboma and the secretion is really plugged in the lid. The thing to remember here, there are some systemic associations",English
+"with evaporative loss dry eye, ocular rosacea has clogged sebaceous glands and in ocular rosacea, we often are recommending",English
+"more systemic or oral treatments and we treat you more like a dermatologist would treat rosacea. Again, as we get older,",English
+"our meibomian glands do not produce as well. There are post-menopausal hormonal changes that decrease the flow of meibom through our lids,",English
+"but again with men as well, just getting older contributes to evaporative loss dry eye. Recurrent styes are associated with",English
+"clogged glands and can be associated with demodex. Demodex is a mite that grows on our skin, it has nothing to do with",English
+"cleanliness everyone has demodex. You don't like to think about it if you Google it, but everyone has bacteria and demodex all over our skin.",English
+"It turns out that people with ocular rosacea or recurrent styes have an overgrowth of demodex. Again, nothing to do with hygiene, but sometimes we have to target",English
+"the demodex and then I think everyone can relate to this is that computer use any prolonged electronic device use, remember the recipe for tears as you needed",English
+"every component and then you have to blink 22 times a minute. When you measure people's blink rate at a computer, it goes down to six times a minute.",English
+"When your blink rate, you're really concentrating on that fabulous YouTube video, your tears are evaporating and computer associated dry eye is a real significant thing.",English
+"Also, if you are on the fence about having dry eye and then sit for a long time at the computer, a lot of us know at the end of a long day of",English
+"chatting along day of using our eyes at work on the computer, our eyes just feel so tired and that's computer associated evaporative loss dry eye.",English
+"Again, the lipids stabilizes the water film, so what we need to do is melt the lipid out of our meibomian glands.",English
+"How do we do that? well, at room temperature the thick meibom is stuck in the eyelid, but when we hit up ayelid it helps that",English
+"meibom come out of the meibomian glands. Your treatment is a warm compress, how do you do a warm compress?",English
+"When you take just a towel and you warm it up under the faucet and you put it on your eyes, it feels great, but the truth is, as the heat that goes away in a few minutes.",English
+"Brooder is a brand name, we're not supported by Brooder, but it's a nice brand. It's a little seeds in the little masking,",English
+"put it in the microwave and it warms up, it feels really great. You don't have to buy that, you can use a clean dry sock and put in rice that is not",English
+"cooked and tie off your sock and put that in the microwave and that keep heat for three to five minutes it's really nice. Just meditate, put it on your eyes,",English
+"it usually feels great. Whereas with aqueous deficient dry eye, I said just pick whatever feels good. If you're obviously don't have time",English
+"at a busy day of work to do a nice warm compress, we do want you to think about some lipid-based artificial tears and tears that have oil in the ingredient name.",English
+"Here's some brand names that have mineral oil or castor oil and again, it's an artificial tear that will supplement a little more oil tear to help prevent evaporation.",English
+"We do some things called environmental changes recommendation. These are onion goggles, so to keep you from tearing when you chop onions,",English
+"what it does is it makes a chamber around your eye. If you just have to work for four hours tonight after this, and you know your eyes are going to feel dry,",English
+you can put just put some onion goggles on your face or over your glasses and that creates a little moisture chamber so tears are less likely to evaporate.,English
+"Again, this is a big deal, my eyes will be dry after this talk because I'm looking a little bit up at the camera and I want you to just watch,",English
+"if I'm working on my computer all day and if I'm looking up at you, look up the camera, look at the surface of my eyes, how much room there is to evaporate.",English
+"If I move my camera down and I looked down at the camera, what you can see is that all this and there's much less surface area,",English
+"so at the end of the day when I have to sit and do my chatting, the first thing I do is I move my whole monitor down so I'm looking down and that really helps a lot.",English
+"If you have a fan blowing on you in the office or at night, we really turn that off. Sometimes we can squeeze",English
+"your meibomian glands just to get them going if they're clogged, so this is called meibomian gland expression. You can see that squeezing out and popping there,",English
+we can do that in the clinic with a forceps. There are many difference or the expensive ways to warm up your eyelid with different devices that warm and squeeze.,English
+"Essentially, there's some site, to be fair one doesn't really work better than the other, but we want heat and expression of your lids.",English
+"Evaporative loss dry eye can also be inflamed. The first picture you see just clogged glands, and the second picture you see those red lines,",English
+"those are blood vessels. Those can be really inflamed, and that's called meibomian gland clogging. That is associated with eyelid margin inflammation.",English
+"In that combination on that flat part, that lid margin of gland clogging, and inflammation is called posterior blepharitis.",English
+"Bleph is eyelid and aritis is inflammation. Many of us use as a synonym for posterior blepharitis ocular rosacea means your sebaceous glands,",English
+"which are meibomian glands, are clogged and inflamed. In these instances where things are warming, clogged, and sticky, you get an overgrowth of normal flora.",English
+"We all have bacteria all over us. It's not that you have an infection, but we have staph, that ladies, for example, staph and strep that grow on our skin.",English
+"But if you culture someone with ocular rosacea, there were more staph and strep than is normal. In that instance, we are sometimes using antibiotic drops just to",English
+"decrease the overgrowth of normal flora. We're often using steroid drops to decrease the lid margin inflammation. Again, when you have true ocular rosacea,",English
+"we're often talking about oral therapy. A little pandemic comment is this is new, this mask associated dry eyes, we all have it,",English
+"and we have all this air blowing up at our eyes all day long. Just remember to wear your glasses over your mask, or your mask tucked under your glasses.",English
+"Oftentimes in the operating room, we will place tape over our nose just to keep our glasses from getting fogged up. There are also special mask inserts that you can put in.",English
+"But mask associated dry eyes and evaporative loss that's sort of new to us all. I just want to say if you are giving yourself artificial tears,",English
+"and you're giving yourself warm compresses, and you have seen someone and you're treating the inflammatory component, and you still just don't feel good in your eyes,",English
+"feel dry, there could be other ocular surface contributors to dry eye. Remember this whole sort of picture where it's mostly aqueous and evaporative,",English
+"and if you're doing everything, there could be something else. My timing is a little off here. But if you look at the",English
+"first picture with the clogged glands, and the vessels, you can see that the eyelashes look sort of clean coming off the skin. But in the second picture,",English
+"they are sort of crusty, and that crust is called anterior blepharitis. Sometimes there's extra skin or an infection on the eyelashes.",English
+"In those instances, we want you to scrub your eyelids. We can scrub with medicated antibiotic scrubs or there are certain over-the-counter",English
+"scrubs that will recommend. Not everyone needs to scrub their eyelashes. You don't need regular eyelash hygiene, just washing your face is normal.",English
+"But if you have all this crustiness, you do need to scrub your eyelids, there's a very specific pattern to Demodex where the crust actually encircles the eyelash,",English
+"we call that a sleeve. In that instance, we have very specific Demodex treatments that we recommend. Lastly, if you're just not",English
+"responding to dry eye treatment, this is somebody whose eyes are itching, and they can't keep their hands away. This is a terrible allergy season right now.",English
+"We often flip your eyelid upside down, inside out, and we see tiny little red dots called papillae. This is the teardrop",English
+"standing around these tiny little bumps, and this is a sign of allergic eye disease. Here, we don't want to use warm to make the meibomian glands produce more meibom,",English
+but we want to use cool because things don't itch as much when they're cold. We recommend your artificial tears coming out of the refrigerator that feels good.,English
+"There's many different types of over-the-counter, no side effect to any of these antihistamine drops. Then there is a new preservative for antihistamine drop that came out a few months ago.",English
+"In conclusion, we love the cornea, we love to talk about it. The dry eye is a real umbrella term. It means something different to",English
+"everyone who talks about it. But hopefully, now you can see it from the eyes of a cornea specialist that there are many different components to the dry eye.",English
+"When we examine you, we try to break it up into the components of the tear film and see which component needs help",English
+and how we can help you feel better. One of the amazing perks of being a cornea specialist and thinking about dry eye is the health,English
+of the tears even can reveal a lot about the health of the whole body. That is a dry talk on dry eyes. With that I will stop.,English
+"We can stretch our legs for just a moment. I will turn the baton over to my bright, and talented colleague, Dr. Julie Schallhorn,",English
+"who will review the clarity of the cornea in more detail, and then talk about surgeries of the cornea. Take it away, Julie.",English
+"Thank you for that great talk. Alright. Bringing clarity to the cornea part 2. As Gerami alluded earlier,",English
+"I'm going to talk a little bit about corneal physiology, just so we can get on the same page as to why we need to do",English
+"surgery in the cornea in the first place. Meet the cornea again, like Gerami said earlier when it's functioning you don't even know it's there.",English
+"When you look in somebody's eyes, you don't see it. But that's because it's totally clear, which is an amazing thing. It's also amazing, it's",English
+"about 11 to 12 millimeters wide or in diameter really, and at its center, it's about half a millimeter thick.",English
+"We have a whole branch of medicine devoted to something that is effectively clear, and smaller than the size of the tip of my pinky,",English
+"which is amazing, but it is such an important part of the body. It does so much for you. Let me try, and share some of my enthusiasm for you.",English
+"Backing up we talk about the cornea and here it is with, Gerami who was talking earlier about a device called the slit beam.",English
+Let's just look with this very thinly focus light to get an idea of what's going on inside the cornea. This is the cornea here. You can see it,English
+"arching over iris here. Then this structure right here, which is part of the pupil, is normally the lens. That structure is actually",English
+"composed of many different layers. Starting with the outside there's the epithelium, which is the skin of the cornea.",English
+"There's Bowman's layer, which is this thick, like fibrous tissue that makes up the front part of the cornea. The stroma, which really is the meat of the cornea.",English
+"Then this very specialized layer of cells on the back of the cornea called the endothelium. We'll go through those layers, and talk about why they are important.",English
+What does the cornea do? Why is it so important? It has three main functions that are totally essential for provision.,English
+"Number one, it's a barrier against the external environment. It keeps, it protects the inside of the eye, and lets a clear window in.",English
+"It provides a smooth refractive surface. When light enters the eye, the first tissue that interacts with is the cornea.",English
+"It is responsible for shaping those light beams and focusing them perfectly so you can actually perceive them, and actually see them.",English
+"It's completely, and totally transparent when it's healthy, which is amazing. Let's go through these functions.",English
+"Number 1, a barrier to the environment. When you think a barrier to the environment, you look at your hands, ah skin. Not like skin at all.",English
+The cornea is very very different than skin. One of the reasons why cornea barrier is different from the skin is how it heals. Think about it.,English
+"If you get a cut on your skin, if you get a substantial scratch, you heal with a pretty big scar. If you get a scratch on the surface of your eye,",English
+"you can get a scar which is a cross-section here, showing some scar in this stroma. But the surface of the cornea, the surface epithelium, those cells on the very outer layer",English
+"magically grow back in, meet each other and even compensate for any deformity that caused on the surface underneath by the injury.",English
+"It remains totally clear when it's doing this. Now, those cells, and these are the same cells that look raggedy dry,",English
+"when you get dry eyes. Those cells are regenerated here at the edge of the cornea, right where it runs into the white part of the eye,",English
+"which is called the limbus of the eye. They're constantly turning over. There are cells out here called the limbal stem cells, they are constantly dividing and dividing and dividing.",English
+"Those cells, as they divide, migrate centrally in the cornea, and recoat the cornea,",English
+"which is this amazing regenerative, totally clear layer. Now if you look at this picture here, you can just see those swirls ever so lightly",English
+because the patient in this picture actually has a condition called February's Disease in which those cells carry a little bit of pigmentation along with them.,English
+"You can see that migratory pattern here in that swirling of the epithelium, which is totally amazing.",English
+"its clarity, and its structure. The cornea is one of the most densely innervated tissues in the body. That is so important because",English
+"the surface of the cornea is heavy, and it being in that perfect smooth condition is so important for vision that even small injury,",English
+"rubbing it with a tissue, rubbing it with your finger, if you were to actually scratch yourself, it can have a really really big impact on vision.",English
+Those nerves are also so important because they have a reflex feedback loop with your eyelids so,English
+a smooth refractive surface. Much like this picture of Mount Rainier refracting in a lake.,English
+"When the surface is totally smooth, you can get this beautiful mirror-like reflection. Images are refracted perfectly,",English
+"but if the surface is rough and bumpy, your image goes terrible. A big reason for that actually in a lot of people is dry eye,",English
+just as even the surface being somewhat dry can really result in a lot of image quality distortion that typically fluctuates throughout the day,English
+and even from blank to blank. Which can be treated by treating all those wonderful treatments tacker sites we just talked about.,English
+This is so important because most of the refractive power of the eye. We saw that schematic of the eye earlier with light being focused from,English
+"the front part of the eye to the back of the eye. A lot of people think that I have a lens in my eye. That's what actually does the refractive power, but that's not totally true.",English
+"The majority of the refractive power actually comes from the cornea. Your cornea effectively is like a really high-quality, super fancy lens like in your SLR cameras.",English
+"That is really what's doing the effect, that intense refractive focusing of light. That's because light is bent most when it",English
+"goes from material different optical density. Going from air to the cornea, for instance, light really bends a lot.",English
+"Whereas going from inside the eye to water to the lens, it doesn't bend as much. Your cornea is really important to refraction. Much like your fancy SLR lens.",English
+"The shape of the cornea is incredibly important because it is a lens. If you've ever looked through a funny shaped lens,",English
+"those funny mirrors at a funhouse, or even through the side of a fish aquarium. Well as bowl fish aquariums, you know",English
+"that light passing through an irregularly shaped lens can cause a lot of visual distortion. Any perturbation in the shape of the cornea,",English
+"not just its smooth surface, but in the shape of it, can be really visually significant. Probably the primary cause that we see at this",English
+"is a condition called keratoconus where you're looking at this, you're like, it's round. It looks like a lens. It doesn't look that strange to me,",English
+but it's much steeper here than it is out here. If you really look at a detailed sheet map of it. That just has massive repercussions,English
+on how well you can see. The shape of this cornea is just incredibly important to your vision. Moving on to clarity now.,English
+The cornea is totally clear in its healthy state. It's like a window. It's amazing. How does it do it? How does your body make something that has,English
+a strong fibrous structure but stays totally clear? The answer really comes because the cornea is incredibly organized.,English
+It's mainly made of collagen and the collagen fibrils. These are just collagen wound around itself into these big thicker fibers.,English
+"The collagen fibrils are held at these exact spacing distances by these things called proteoglycans,",English
+which are little proteins with sugars on the end of it. They interact with one another and act as a little spacing rods between these collagen fibrils.,English
+Then these rods of collagen fibrils are then arranged in sheets that are super regularly spaced on top of another.,English
+Why does it matter that it's so well structurally organized? How does that actually make it clear?,English
+"This is really cool for the physics nerds out there. Light can be both a particle and a wave. If we think back to our high school physics classes,",English
+"when waves at the same frequency or their peaks and valleys are lined up interact, you get a bigger wave amplitude overall.",English
+But if you shift the wave so that a pick of the light is lining up with the valley of light. You cancel the wave out and effectively as,English
+"light is passing into your cornea and hitting these collagen fibrils. The light that gets reflected back towards you,",English
+away from your eye toward somebody else. That light is reflected in such a way that its wavelength is shifted and you,English
+"get no backscatter of light. The cornea looks totally transparently clear as light is coming in, which is amazing.",English
+"The spacing of these collagen fibrils is what makes this happen and because that spacing is so important, anything that perturbs the spacing can",English
+"make the cornea not transparent anymore. That brings us to this structure here, which is called the corneal endothelium.",English
+The corneal endothelium is a really unique structure in the eye and in the body. It is a single layer of,English
+cells that are stuck to the back of the cornea. These cells are packed super-duper densely and they actually look like little hexagons.,English
+"That's because when you pack something that's flat together, the highest density that you can get when you pack it together is a hexagon.",English
+"It looks like a honeycomb on the back of the cornea. The whole purpose of these cells is as water, there's water inside the eye",English
+"and there's no water outside the eye. The whole purpose of these cells is to prevent that water that's in the interior chamber, it's not technically water,",English
+"but it's very similar to that, is to basically pump it back out and keep the stroma of the cornea dehydrated. Remember that if the stroma of the cornea gets swollen,",English
+"spacing of those collagen fibrils will change and the cornea becomes cloudy. This works really well,",English
+"except what happens if you lose it endothelial cells. Well, if you lose a few is probably fine. If you use a few more you're probably fine because",English
+"the endothelial cells that are next to get bigger and move over. These cells never replicates. When you lose them,",English
+those neighboring cells they're not extended. They're not going to re-divide and fill in the gaps. But the remaining cells will get bigger and try and take up that space.,English
+"But at some point, you overwhelm the ability. If you lose enough cells, you overwhelm the ability of the remaining cells",English
+"to pump water out of the cornea and the cornea gets swollen. As the cornea gets swollen, you space out these collagen fibrils in",English
+an irregular way and you start to see they're nice and compact here and they're really spread out here. You can see that you start losing,English
+that negative interference and the cornea becomes opaque. Lots of nice and clear here in this experiment. Swollen cornea becomes very cloudy.,English
+The most common condition that we see with this is something called Fuchs endothelial dystrophy. This is it's actually,English
+"a hereditary disease, variable penetrance. Some people have it much worse. Some people have it really not that bad at all.",English
+But it's a disease where your endothelial cells die off at a faster rate than what is normal. People can develop swelling of the cornea.,English
+"Moving on, what happens when you have a problem with the cornea? What happens if it gets cloudy and if he gets scarred, if the shape becomes abnormal?",English
+"Well, then we do surgery to try and fix it. There's a lot of different surgeries on your cornea that you can do.",English
+"If you've ever talked to a corneal specialist hurt us, in one of our meetings. There are just so many acronyms, so we'd like to talk about DMEK, DSEK,",English
+"DWEK, DLEK, PKP, ALK, DALK, K-PRO. Those are all very confusing to think about. Really what to think about is,",English
+"what the underlying problem is and how we can treat that specific problem. This is a concept called lamellar corneal surgery. Like we talked about earlier,",English
+"the cornea is composed of a surface epithelium, that skin type area, the stroma, which is our collagen,",English
+and then Descemet membrane endothelium. Those are really the three primary layers that we can surgery on.,English
+Surgery on the epithelium is pretty specialized and there are a few specific cases that we really need to do that,English
+"because for most people your epithelium continually regeneration, even if you have surgery in the cornea, your own natural epithelium will come in to cover it.",English
+There are cases where people lose the ability to regenerate the epithelium. Then we do some very specialized surgery for those people.,English
+"But for most people, if you do need corneal surgery, it is usually a problem either with the stroma or your endothelium, or both.",English
+"Endothelial problem, we treat that nowadays with an endothelial transplant, which is amazing that it's a single layer of cells,",English
+those hexagonal cells that we talked about earlier that just line the back layer of the cornea. If you lose those hexagonal cells for a variety of reasons and your cornea gets swollen.,English
+We treat that really just with replacing those cells that are on the back of the cornea. Not with replacing your whole cornea.,English
+"Which is pretty cool. What we do, is we take out the disease portion, the portion that's not working, and we've put a new layer of endothelium",English
+"in, which is great. This is something called a Descemet stripping endothelial keratoplasty or Descemet membrane endothelial keratoplasty,",English
+"DSEK, or DMEK in our alphabet soup. Descemet membrane endothelial keratoplasty refers just to that layer of cells and then the membrane they sit on.",English
+"A Descemet stripping endothelial keratoplasty, you transplant that membrane of cells and then a little tiny bit of the stroma tissue too.",English
+There're specific situations where one is preferred to another. It depends a little bit on,English
+"what prior surgeries that you've had in your eye and a few other factors. But from genes and purposes, people end up recovering very well for both of",English
+"them that they're really fairly equivalent. Now, how do you get those cells to sit at the back of the cornea? Because if you think about it,",English
+"you're sitting upright, your corneas are facing forward. How do you get the cells to stick? If, especially if it's just a single layer of cells,",English
+"we can't put stitches through a single inner cells. How do we get them on the back of the cornea? Well, it's pretty cool. We put in the new layer of cells and then we put a bubble inside the eye.",English
+A lot of gas or of air and that bubble floats up against the cells. It pushes them into place. It gives a chance to those,English
+"endothelial cells as healthy cells that we just transplanted to start pumping to take the water out of the cornea, and they suck themselves onto the back",English
+"of the cornea and become stuck. Then your body dissolves the bubble, naturally goes away and you're left with a new layer of cells,",English
+"which is pretty damn cool. The advantages of the endothelial transplant are many really. If you've just have an endothelial problem,",English
+"it's really the preferred technique for surgery nowadays. You typically have a much quicker recovery between one and three months depending upon how you heal,",English
+"how your transplant heals. Instead of about a year, if we were to transplant the whole cornea, doesn't really affect your glasses prescription very much for",English
+"your curvature of the outside part of the cornea stays the same. We really don't induce a lot of refractive error with it, which is really nice.",English
+"There's a lower risk of rejection, particularly if we're just able to transplant that single monolayer of cells. There's also a lower risk of glaucoma.",English
+"If you have an endothelial problem, the endothelial transplant is really the ideal surgery. The downside is that you have to",English
+position because you have that bubble of the eye. The bubble stays there between a day and four days depending upon the type of bubble we use.,English
+"Much like, if you've ever used a spirit level where you turn the level to one side or another and the bubble rocks back and forth,",English
+"the bubble inside of your eye is doing the same thing. In order to get that bubble to push right up against the front part of your cornea, you have to be flat on",English
+"your back and you have to stay there. You can get up and use the restroom if you need to and to eat, but",English
+"no pillows underneath your head. No lifting the head of the bed up, you can put pillows underneath your feet but that positioning on your back is really",English
+important for the first part of that surgery. The other downside of the endothelial transplant is that sometimes,English
+the cells don't stick all the way and part of the transplant can peel off. It's not terribly uncommon. Actually about five percent or,English
+"about one in 20 people will have a graft detachment. If that happens, we go back in and put another bubble in, help it stick up. About one in 100 people",English
+"will have what we call primary graft failure, which is the cells just didn't like being transplanted. They didn't survive surgery sometimes, because we have to peel off",English
+"a cell layer from the donor who's passed away. That can be to some cells just don't do well with that, and if that happens then we got to go",English
+"back and replace transplanting, people do very well with their second surgery if that does happen. What type of conditions can we treat with this?",English
+"There's a lot, really, it's any type of corneal edema where that back layer of cells isn't working. Probably the most common thing that we",English
+"see is Fuchs endothelial dystrophy, that hereditary condition we talked about earlier where you just lose your endothelial cells at a faster rate than average.",English
+"Some people also develop corneal edema after having cataract surgery, especially if it's like a really advanced cataract or having multiple surgeries previously,",English
+they've had retinal detachments and glaucoma surgery. All that can take a little bit of toll on the corneal endothelium. Sometimes you will just end up developing edema.,English
+Or if you had a corneal transplant previously and you had possibly rejection or just lost a lot of cells from it. That's another thing that we can,English
+"do in the endothelial transplant. People that have had full-thickness transplants for conditions, 30, 40 years ago.",English
+"If their graft is becoming swollen because that back layer of cells is not working, we'll do just nowadays just an endothelial transplant",English
+"given that the rest of the graft is functioning well. Moving on, if you have a stromal problem, the solution to that is to replace the stroma,",English
+"something called a lamellar keratoplasty. If you have a stay or your endothelium is totally fine. Here's the schematic recording when your endothelium is totally fine,",English
+"but you've got a scar in the stroma or you've got some type of abnormality in the stroma, we can basically just take off the stroma that doesn't",English
+"work and then just replace it with a donor layer of stroma. The advantages, this is something called a deep anterior lamellar keratoplasty or a DALK in our terminology.",English
+"The advantage of that is that because you're preserving your natural endothelium, that back layer of the cornea is still yours,",English
+"There's a less risk of rejection. There's a less risk that your body will see, ""Hey, I see cells that aren't part of me and I'm going to send my immune system to attack them.""",English
+"You can still get a rejection of a stroma. But it turns out it's actually less common, which is nice. The downside of the lamellar keratoplasty,",English
+"it's a lengthy healing process, it's about a year to take care of it. It's also really technically difficult to do. Sometimes we can't separate",English
+the stroma off that back layer of cells. Sometimes it's really tightly adhered and we have to transplant the whole thickness of the cornea.,English
+That's something called a DALK. What we typically do this for is if you have a scar in your cornea will do that for it.,English
+"Or if you have cured the corneas where the problem is just the structural integrity is causing the cornea to bow forward unusually, we will do a lamellar keratoplasty or DALK.",English
+"Moving on, The full-thickness corneal transplant, penetrating keratoplasty, or PKP. With this one, it's what it",English
+sounds like you've got a problem in the cornea. We take out that section of the cornea and we give you a new section of cornea and a new section,English
+"of Descemet's membrane attached to it. Yeah, about 15 years ago, this was really the only type of",English
+transplant that people would do. Everybody would get a full-thickness transplant. Then we really had a blossoming of these lamellar transplant techniques which have,English
+"just been so helpful in getting people to heal. But if you need a full-thickness transplant, this is still a really good surgery. Typically will do this surgery if you have a problem in",English
+your stroma and a problem in your endothelium. Or if you've developed a huge amount of scarring in your cornea and,English
+"Descemet's membrane is really stuck down to it. Things that we do full-thickness transplants for, if you had a really bad infection in the eye and you developed a lot",English
+"of scarring from the infection, we'll do a full-thickness transplant for that. If you had a bad injury, you've got really bad cut or",English
+"burn on the cornea that really caused a full-thickness injury, we'll do a full-thickness corneal transplant for that. It's a very effective surgery.",English
+"A really common question I get asked, is how you plan for corneal surgery. Corneal transplant is a transplant procedure that the corneal tissue,",English
+come from people that have passed away that have donated their organs. It's really an amazing thing. How come it's not like,English
+"a liver transplant or kidney transplant? I know people that have been on this for years. We're really fortunate here in the United States and for many reasons,",English
+"but one of the things we're extremely fortunate for in terms of corneal blindness, is we really have a very robust system of eye banks.",English
+"Eye banks, when somebody passes away and their loved ones decide to donate their organs, the eye bank will come, they'll",English
+"assess the corneal health, assess if the person is a good donor. Then they'll take the cornea with them and they store it back at the eye bank.",English
+"Corneas because unlike a heart or a kidney or liver, the surface of your eye and your cornea really gets oxygen mainly from",English
+the air so its cells remain viable even after somebody's heart has stopped beating. The cornea can be taken then back to,English
+the eye banks and then stored. They keep it in this very special media to keep it healthy. It can actually be viable for up to two weeks under,English
+those conditions which is truly amazing. So many people in the United States are so generous with donating their organs when they,English
+pass away that we really don't have a shortage of corneal tissue and we're pretty much able to schedule surgery on demand.,English
+I've never actually had to have a surgery canceled because we haven't had corneal tissue. This is not the case in the rest of the world.,English
+"I have colleagues in China who have people on wait lists for years and years waiting for an organ donor. But we're just extremely fortunate that, A,",English
+"so many people are organ donors, and B, we have this really strong and robust network of eye banks. Just as a separate announcement,",English
+"if you really consider becoming an organ donor if and when you do pass away, it can really transform people's life in terms of eyes and for everything else.",English
+"Even if you can just donate your eyes it really makes my job possible and it gives people the ability to see again,",English
+"which is a huge gift. We're very fortunate for that reason. After care for corneal transplants,",English
+"where you need to be worried about, the biggest concern both short and long term is rejection. These are donated cells.",English
+Your body could recognize that they're not part of you and attack them with your immune system. Most people need to be on anti-rejection medications long-term.,English
+Some people are able to come off with them. It's a little bit individualized discussion when it comes to that. The mainstay of anti-rejection medications,English
+"in corneal transplants, they are topical steroids, actually more potent ones than the ones Dr. Seitzman was talking about earlier. But topical steroids nonetheless.",English
+"Which is really nice because steroids, especially pills that you take, steroids have a lot of really bad side effects. If you're having a solid organ transplant,",English
+"a kidney transplant, or a liver transplant, you can't just be on steroids your whole life to prevent rejection because of",English
+"all the horrendous side effects that come with oral steroids. Fortunately, localized to the eyes, steroids actually are quite horrible for most people,",English
+"they can cause eye pressure to go up and glaucoma is a concern if you have a corneal transplant, particularly a full-thickness corneal transplant. That's something that we monitor",English
+"for and watch for closely. If people do start developing eye pressure problems, we address that appropriately. But we are really quite fortunate, again with that.",English
+That we're able to just treat localized without exposing your whole body to these very potent immunosuppressive medications. That is all I've got today.,English
+"If you want from us more information, you can check us out ophthalmology.ucsf.edu or come visit us in our beautiful new building at 490 Illinois Street.",English
+"Thank you very much for your attention and thank you for listening to me, being excited about the eyes. Thanks. Thank you guys. That was awesome.",English
+"The aqueous comes out of the lacrimal gland and the meibomian glands create the lipid tiers. With aqueous deficient dry eye,",English
+"you're not making the water. In general, we use those strips called the Schirmer's strips to measure what tear production you have.",English
+"Now Schirmer's strips are not the most accurate measurement, meaning that if I measure your Schirmer strip recording on one Monday,",English
+"Wednesday, and Friday, you would have a different number of millimeters per five minutes. But in general, what we're looking for when we put the little strips in your eyes and have you",English
+"close your eyes for five minutes, and measure how much aqueous you make. Is, are you making none or very little? Or do you make a ton?",English
+"Because ocular rosacea people, for example, fill those strips. If somebody puts a little strips in your lid and you fill them up,",English
+"we know you're not aqueous deficient. For MGD, which is called meibomian gland dysfunction, we can actually examine your meibomian glands at the microscope and",English
+"oftentimes we'll press on it and so in a perfect state, the secretion that comes out of your eyelid looks a little bit more like olive oil.",English
+"Then if it's really looking more like toothpaste coming out of it, then we know that you'd have a meibomian gland dysfunction.",English
+"Then when it comes to long-term steroids for dry eyes, would you do that even for patients that have glaucoma? Let's talk about that separately.",English
+"It's not as easy as looking at the percentage strengths, you can't go one percent versus one percent or five percent or 10 percent, it doesn't work that way.",English
+It ends up being the chemical structure of the drop and how well it binds to water and lipid and fat and penetrates through all the structures of the eye.,English
+"There's no way by looking at a bottle that you would just know my doctor gave me a mild or moderate, we know from the chemical structure.",English
+"For example, the most potent, and when I use the word potent, I mean how well does the steroid drops gets through the whole eyeball and get inside",English
+the eyeball because there are many diseases where we need the inside of the eye to calm down as far as inflammation. The most potent steroids drops there is on,English
+"the market is called brand name Durezol, which is generic difluprednate. Then after that comes a drug called Pred Forte,",English
+which is prednisolone acetate. They get into the eye very well. Their risk of having a steroid-induced high eye pressure is much higher.,English
+"There's a list of them and we know them when you use all the different. But to be fair, the people who who really think",English
+"about the potency of steroid drops are often cornea specialists. A lot of people just say, ""I would just use the steroid,"" and they'll just pick whatever steroids",English
+"that they can think of, where is the cheapest or your insurance covers. But cornea specialists, we're often perseverating. We just need the cornea to get on the eye,",English
+"we don't need it to get in the eye. The weakest, the least potent steroid drop that's available is one called Fluorometholone.",English
+"That's a long word. We don't like saying it all the time, so we call it FML. In order of potency, there's a Fluorometholone class and",English
+"then comes a load of prednil class, and then comes a dexamethasone, prednisolone phosphate, and a prednisolone acetate. I don't think it's important for you to",English
+"know which is which, but I think it is reasonable for you as a patient to ask when someone is giving you a steroid for a dry eye condition.",English
+"Now that's not a steroid for corneal transplant rejection as Dr. Schallhorn was talking about, it's not a steroid after cataract surgery, but a steroid for a dry eye.",English
+"They work just as well for dry eye. Sometimes you have to ask about that. Now, how do you get glaucoma? There are many different types of glaucoma.",English
+"When your eye pressure is elevated for a long period of time. Like a tire has a pressure,",English
+"an eyeball has a pressure. You don't feel this kind of pressure, it's a measurement that we take at the office. When the eye pressure is",English
+"elevated for a long period of time, it can damage the optic nerve, which is a structure in the back of the eye. When the optic nerve is damaged,",English
+"slowly over time, your peripheral vision comes in. Typically there's a lot of time to figure out if this is happening.",English
+"A drug has to increase your eye pressure, it has to stay high, maybe undiagnosed or this",English
+why we want to see you frequently. It has to stay high and not be treated for a long period of time and then it could develop into glaucoma.,English
+"If you take a steroid and your eye pressure never gets elevated, you don't develop steroid-induced glaucoma. The number has to be high.",English
+"If you have glaucoma but you took a mild potency drop and we follow you very closely if we know you have glaucoma,",English
+"because if you have glaucoma, you're more likely to have a steroid-induced high pressure rise. But if you had glaucoma and it was",English
+"well-controlled on your medication or path through your surgery and then we gave you a mild potency steroid drop and we follow you and your eye pressure doesn't go up,",English
+"you're good, nothing bad will happen. Also if you do develop high eye pressure and we measure it, we say,",English
+"your eye pressure went up, we take away the steroids and then almost always your eye pressure goes back down to normal.",English
+"Any negative effects with that? Washing your eyelids with like water, even a gentle detergent",English
+"such as a really mild soap can be okay. The surface of your eyes, you typically don't need to wash or",English
+"rinse out a lot unless you get something in the eye. If you're feeling drier, using an artificial tear can be really,",English
+"really helpful to get rid of that feeling, but rinsing it out is not going to help you out so much. That's because your tears are actually a really, really complex structure that",English
+enables them to spread out evenly over the surface of the eye and form that nice stable surface coating. If you introduce a lot of,English
+"other fluids into the tear film, you're not introducing the same stuff that makes up your normal tear film, you can dilute out those helpful protein,",English
+"those helpful lipids that really make your tears stable. Unless you specifically have something in the eye, doing a serious wash of the eye",English
+"That is totally okay to do, but you don't need to rinse the eyes out regularly. You agree with that, Gerami? I agree completely.",English
+Eyelashes are there to protect us so that dust and things in the environment don't fall into our eyes.,English
+"Loss of eyelashes do not cause dry eye, but when you have infection and inflammation around your eyelashes, for example,",English
+"we talked about anterior blepharitis where you can get an infection of your eyelashes or crusty skin around your eyelashes with chronic inflammation around your eyelashes,",English
+"you can get eyelash loss. If your lashes are falling out, that's something that we would look at at the microscope is to see if",English
+"you have anterior blepharitis. Now remember when you have anterior blepharitis, you have all that deposit along the eyelashes. Some of that can fall into your eyes.",English
+It feels like you have some in there all the time because the debris can fall in. Anterior blepharitis can masquerade as dry eye because it makes it feel like,English
+"Yes, it can make the secretions not be as thin. But a lot of people have meibomian gland dysfunction and",English
+"have meibomian gland dysfunction, your secretions are thick, and so heat can make that go. Then if you also have allergic eye disease,",English
+all the nerves spire at once and you get a sharp stabbing eye pains and it absolutely means nothing. It's very common. It's sometime,English
+a two-part question here and just combine two. One is how do contact lenses affect the cornea? Then the second part is what is the latest thinking about,English
+the practice of using hard contact lenses to reshape the cornea? Contact lenses are really interesting and contact lenses really fall into two main branches.,English
+"There are soft contact lenses, which is what most people wear, and then there's hard contact lenses, and they both affect the cornea in very, different ways.",English
+We'll talk about hard contact lenses when we talk about reshaping the cornea. Soft contact lenses basically fit over the cornea like a well-fitting glove.,English
+They just change the contour of the cornea just a little bit to change that refraction as light enters the eye to focus and account for some refractive error.,English
+Because soft contact lenses really snug down and sit right on top of the eye. Your natural tears don't percolate underneath of them.,English
+"They percolate over the top. Remember, the cornea gets its oxygen mostly from the air. At night time when your eyes close",English
+it gets the oxygen from this very rich network of blood vessels in the back of your eyelids. In order for oxygen to get,English
+"your cornea through your contact lens, it actually has to dissolve from the air into the contact lens and then from",English
+the contact lens into your eye. Contact lenses all have varying amounts of oxygen permeability.,English
+"Some are less permeable to oxygen, some are more permeable to oxygen. As cornea specialists, we really like contact lenses that are very",English
+"permeable to oxygen because if you cut off oxygen from the surface of the cornea you can get problems with your epithelium, it can break down.",English
+"If your epithelium breaks down, then you can get bacteria into there and that cause infection. It can also just cut off oxygen and your cells are like,",English
+"""Help. I need oxygen."" That encourages blood vessels to grow in the cornea, which is not good because quite explicitly clear on those that are not getting the cornea.",English
+"Then in really severe cases for people that are wearing contact lenses for really long time without good oxygen permeability,",English
+"it can cut off those cells that regenerate and cover the surface of the eye and give you something called the meristem cell deficiency,",English
+"which is really to treat. Contact lenses, soft contact lenses. The other thing is that especially",English
+"depending upon where you are keeping them, they're in a warm and moist environment and warm, moist environments invite all sorts of nasty bacteria to grow.",English
+"It is very important to keep them in, change out your case routinely so you don't get bacteria that are coding the case",English
+"The best thing for the surface of your eye is your own natural tears, so keeping those natural tears around that hard contact lens are the best.",English
+"They're also very oxygen permeable, way more oxygen permeable than soft contact lenses. You typically don't have any problems",English
+"with ischemia of the surface from them. Now, reshaping the cornea using contact lenses, uses hard contact lenses that basically don't fit well.",English
+Hard contact lenses or orthokeratology can be effective in treating low amounts of nearsightedness on the plus side so that you wear them,English
+"overnight you're minus two, but during the day you are okay and then regress slowly throughout the day and you put those orthokeratology",English
+lenses back in at nighttime. There's also some literature suggesting that they can delay the progression of nearsightedness in kids and,English
+that's in young kids around like 7-12 years old. I personally don't love orthokeratology lenses because I only end up seeing the bad things that can happen from them.,English
+"Because you're wearing contact lenses all night long, you can get infections with them, especially if you wash them in tap water or things that have amoebas or bacteria growing in them.",English
+You can get some really bad infections from orthokeratology. I know Gerami you've seen several in young kids that have been treated for myopia.,English
+the integrity of the cornea and then increase the incidence of dry eyes. The incision is required because remember the lens is behind the colored prototype.,English
+"in the cornea and in a normal situation, the skin epithelium will heal right over the incision and you won't know anything about it. In general, most people do",English
+"very well after cataract surgery. However, if you have dry eyes to begin with, remember we talked about a little bit that the preservatives",English
+and drops can cause exacerbation of symptoms. After cataract surgery you're often given a lot of drops at a reasonably high frequency,English
+"in a short period of time. Take this strap four times a day, three times a day to jump with a taper. People who have a tendency to have dry eye,",English
+it is not uncommon for their eyes to feel completely different after cataract surgery and in a way that's sort to describe.,English
+"I didn't have this problem before cataract surgery, but after cataract surgery my eyes just feel different. I think a lot of that is from preservative use of the drops.",English
+that infection can be blinding. We really feel strongly about antibiotics around the time of surgery to prevent the infection after cataract surgery.,English
+"It turns out in some people, it is possible that it could short-term alter what we call a microbiome of the conjunctiva.",English
+"into by high frequency hearing loss as occurs during age-related hearing. So when one has problems with hearing, you go to see the physician or the audiologist",English
+"or whomever you go to, and they are first going to determine two important facts. What kind of hearing loss do you have in broad strokes? One kind is called conductive hearing",English
+"with some degree of hearing loss. And for those with profound deafness, we had the cochlear implant that we'll show you an example of a little bit of time. This is really an amazing prosthetic advance. And then in the future, and what's happening now, what's being developed,",English
+"cochlear really does look like a snail shell, as the Greek word tells us, and within it, there are three parallel chambers which are divided by this structure called the basilar membrane, on which is sensory epithelium. And the vibrations of sound cause this little",English
+properties of the basilar membrane on which the hair cells are seated. So hair cells are seated all along this structure and they are innovated by neurons. And so pure tone stimulation,English
+sets up a traveling wave that looks a lot like a water wave. It approaches the beach and breaks at a point where it reaches its maximum. And the mechanical properties of,English
+"the basilar membrane vary from end to end, so that lower frequency waves propagate down to the more flexible, less stiff part of the basilar membrane at the very tip of the snail",English
+"shell. But higher frequency vibrations peak at a point further from the tip of the cochlea. And so there are, there's a systematic progression of best vibration frequencies along the length",English
+"of the basilar membrane. So, what this shows again, here is the same idea as you move from the base of the cochlea down near where the stapes footplate and impacts on the cochlea,",English
+"the bottom of the shell, there's highest frequency vibration. And at the very tip of the snail shell, there's the lowest frequency vibrations. And so the sensory hair cells, the things",English
+"that convert that vibration into electrical signals are strung in rows all along that mechanically tuned structure. And they are selectively innervated by neurons, so that",English
+"a nerve cell down here, which contacts hair cells in the high-frequency end is a labeled line for 10 kilohertz. When it fires a signal to the brain, the brain says, oh, that neurons",English
+"firing must be 10 kilohertz, and then progressively lower and lower frequencies as you move up toward the tip of the cochlea. The great thing about this is that this means that this information",English
+"propagates throughout the neuraxis all the way up to the cortex where the auditory cortex, the primary auditory cortex, is found on the superior surface of the temporal gyrus, where",English
+"there is basically a little picture of the cochlea that works exactly like a piano keyboard. No it doesn't. But anyway, the idea is right, that there is a frequency map in the auditory",English
+"cortex, which represents the spatial map of a little bit of epithelium. And that is super cool because that's exactly how the brain does everything. If you think about how we",English
+"understand the meaning of a somatic sensation, it's based upon where that sensation occurs on the body surface. So there's a surface map. Same with vision, our eyes report the",English
+"location of an object in visual space, according to which part, which area of the retina is stimulated. So the brain understands vision in a spatial map and understands touch in",English
+"a spatial map and by this extraordinarily cool function of the cochlea, which converts a frequency map into a spatial map, the brain can understand sound frequency in exactly",English
+"the same way using the same rules of neural organization. I love the cochlea, as you can tell. Okay. Plus this really amazing transform that",English
+"takes place in the cochlea also enables the most remarkable prosthetic device I think has been invented. Which is the cochlear implant that can restore functional hearing to people that are profoundly deaf, in the best circumstances. So again, I want to show you how that works.",English
+"The cochlear implant is a set of electrodes that gets inserted into the ear. So let me stop sharing this. Share the right thing now here, and I'm going to share that. So I hope what you see as a kind of a picture of a cochlea here with a set of electrodes inside it. Each",English
+"little white patch is one pair of electrodes, which is driven by a particular frequency component of sound. So there's an electronic device on the outside of the head that has",English
+"in turn from the apical tip of the cochlea down to the base and back again. You see how electrons turn red...Also, you can look at how...speech sounds...mostly vowel...",English
+"So that's the cochlear implant. That is a device, a prosthetic device, which has been a tremendous boon to providing hearing to people that are profoundly deaf. And it's",English
+"still being improved today, as are hearing aids. So let me now again, go back to our show. Share screen, PowerPoint, share, hopefully this is here for you. Yes. I hope you can see that we're back to the picture of a cochlear implant. And so now I talked a little bit",English
+about mechanisms involved in the cochlea results in the processing of sound. But I want to dive in a little deeper and figure out what are the molecular mechanisms whereby these,English
+operations occur. So we're going to take a cross section through the cochlea and look at the cellular elements. So it's a little more complicated. There's a lot of elements,English
+"here that I won't go into today, but basically there's a lot of fancy mechanisms that provide specialized cellular and molecular activities. What we want to focus on here is what is the",English
+"essential stimulus? And it turns out that as the, that traveling wave propagates along the length of the cochlea, it actually kind of does something sort of rocks from side",English
+"to side a little bit like that. The consequences that there's an overlaying, acellular tectorial sheet, which differentially moves with respect to the underlying sensory epithelium, causing",English
+this lateral motion of the little hairs on top of the eponymously named hair cells. These are the sensory cells that convert a mechanical stimulus into an electrical signal. And you,English
+"can see that as the cochlea vibrates, it causes the hairs to be pushed from side to side. And that's important because that is what causes an electrical signal. Now, this drawing",English
+"looks like something that came out of the art books of Rube Goldberg, but actually it's pretty accurate in most respects. The hair cell is able to convert mechanical energy",English
+"into an electrical signal because it has ion channels, aqueous pores in the tops of the hairs with a gate that can be pulled open and closed. And that gate is pulled open when",English
+"the hairs are pushed toward the right, toward the tallest hairs. That puts tension in this extracellular linkage, which pulls on the gate of the channel. When the channel opens,",English
+"it provides an aqueous pathway for positively charged ions to enter the cell. So those positively charged ions, they cause a change in the membrane potential the voltage of the hair cell. So",English
+"this is the conversion. This is mechanotransduction. This is converting a mechanical force into an electrical signal by the use of an ion channel that allows the flux of charged particles,",English
+"ions. So the hair cell generates an electrical signal. Now we've learned a lot about how this works over the years and Ulli Mueller, who's one of the professors here at Johns Hopkins is one of the leading investigators who have",English
+defined many of the molecular components of this structure. And there's a bunch of them. There are several dozen different proteins that participate in the mechanotransduction,English
+"complex. And I'm going to talk about, I'm talking about them because we know that there are a number of human deafness genes, inherited forms of deafness, which actually affect some of these proteins. So I'll talk about one in particular, because we already have animal",English
+"studies which have shown that it's possible to repair that genetic defect by helping to correct the activity of this one here, which is TMC one and two. That's also shown here",English
+"in this kind of blue, inside the red circle. So TMC stands for transmembrane channel, a very inventive name. It is the aqueous pore. It has the gate. It",English
+"allows the passage of ions into the hair cell to change the membrane potential. And there are mutations of TMC1 when it is mutated, some of these mutations cause deafness, both",English
+in humans and in mice. And so this has been a big target for gene therapy. It's a monogenic form of deafness. All you have to do is fix that one gene and you can restore hearing.,English
+And that actually has been done in mice already. And I'll show you just one example from the work of Jeff Holt up at Harvard and others have done this too in the past. So this is an example of some mice that are called Baringo mice. I don't know where the name comes from.,English
+"They have a mutation in the TMC1 protein, and they cannot hear. So these are the electrical signals that give rise to the audiogram that I showed you previously.",English
+This is the auditory brainstem evoked response. You can record it in humans by putting a couple of paste electrodes on behind the ear and on the back of the head. You get an electrical,English
+"signal in the brain when sound successively stimulates the cochlea. So you can measure thresholds this way. These are just those electrical wave forms, showing that the threshold",English
+"in this wild type mouse, it doesn't have a mutation. The threshold is down here between 20 and 30 decibels of sound intensity. But Baringo mutant can't hear at all. There's",English
+"no auditory brainstem response. If you take a virus and infect the inner ear of a Baringo mouse with a corrected form of a TMC1 gene, you restore hearing. So this is gene therapy.",English
+"This is gene therapy using viral constructs, which are non-pathogenic viruses to introduce the corrective genetic material into the cochlea. Now it's not perfect. You can see that the",English
+"thresholds are still not as good as the control animal, the wild type animal, but it's better than it was in the, in the mutant case. So monogenic deafness for this protein, and actually",English
+now quite a significant number of others has been successful in animal models. And there are human trials ongoing for similar sorts of studies.,English
+"are actually injecting the genetic material right into the eyeball. And it works and it's, you know, local anesthetic. It sounds gruesome, but it's not. But the eye is right out here",English
+"on the surface of the head. The inner ear is inside here in the really hard temporal bone of the skull. So it isn't easy to get to. And so thus far, people have been using",English
+surgical strategies to introduce genetic material or drugs into the inner ear by actually making a hole somewhere and then just injecting the materials directly in. Most progress has been,English
+"by my son, Sam, when he was, I don't know, 10, 12 years old. So it shows the external ear, and it shows the internal ear right there. And so the surgery that one would do would",English
+"be to simply make small incisions through the skin, very delicately drill through the bone, so that one can then access the semicircular canal quite close to the surface of the bone",English
+"and inject your therapeutic agent right in there. And this works really well. I mean, it sounds crazy, but it works really well in animal models. So you can put in therapeutic",English
+"agents without damaging the hearing. And as I said, the similar kind of strategy is being considered for human therapies. And again, it may sound a little bit extreme, but if",English
+"you think about it, the surgery that is done to implant a cochlear, cochlear implant electrode is actually a little more rigorous than that. So it isn't a really big surgery, and it depends",English
+"upon the benefit as to whether one would like to be able to proceed that way. But at the same time, there are other options that are being introduced. So there's something called nanoparticles, which are little lipid vesicles that contain DNA or others agents of interest.",English
+"So for example, these have been developed for the vaccination regime that in for COVID in which the RNA is being introduced by a nanoparticle inject, use, injection. So nanoparticles",English
+"can bring in drugs that can bring in big chunks of DNA. And that's been looked at in the context of hearing therapies as well. Particularly magnetic core nanoparticles, because those",English
+shown to be very effective in correcting monogenic deafness in mice. Okay. So what happens next? You have this mechanotransduction process that changes the,English
+"voltage of the hair cell, and that's shown very simply here in this picture, which tells us that as the bundle of the hair bundle of the stereocilia, the hairs on top of the hair",English
+"cell are pushed from side to side, the voltage, the membrane potential of the hair cell alternately goes positive and negative. And that results in the release or transmission of a chemical",English
+"neurotransmitter, which causes increased and decreased rates of firing of an associated afferent neuron. So signaling to the brain begins with mechanotransduction and electrical",English
+"signal in the hair cell, but then it gets converted into a chemical signal that sends that information to the brain. So this is a slightly more realistic picture",English
+"of the innovation of the cochlea. This is a cross section, like one I showed you earlier, but now the hair cells have been drawn in with white outlines, seen here. There's two",English
+"different classes of hair cells, excuse me, inner hair cells and outer hair cells. And there are a couple of different kinds of neurons. There are afferent neurons that carry information",English
+"to the brain, and there are efferent neurons that bring information back from the brain to regulate the sensitivity of the cochlea. I'll come back to those in a bit. The intriguing",English
+"thing are many, one of many intriguing things about the afferent innervation of the cochlea is that the inner hair cells, which make up just one quarter of all the hair cells in the cochlea, this is a cross section, so these are rows that extend throughout the length",English
+"of the cochlea. Overall there's about 30,000 hair cell in total, and so maybe about 3000 or so of them are inner hair cells. These are the hair cells that send signals to the",English
+"brain. That's because type one, cochlear afferents make up 95 percent of the afferent neurons that carry information to the brain and they all connect to inner hair cells. In fact,",English
+"each afferent, type one afferent, has one synaptic connection with one inner hair cell. So everything, an individual afferent neuron can tell the brain about the acoustic world",English
+"comes from that one hair cell. Now, from the point of view of the hair cell, it has a whole team of type one cochlear afferents. In fact, the average number is about 20. So this inner",English
+"hair cell sends a kind of multiplex complex signal to the brain, which has carried on 20 individual lines or wires carrying that information to the brain. And they differ",English
+"somewhat in their properties, but they all report the same frequency because this is just one point along the frequency tuned cochlea. Okay. So, I want to tell you a little bit more about that connection because that's another site of pathology and some ideas about",English
+"repair. So the hair cell, this inner hair cell, has a bunch of afferent contacts. And at each of those contacts, there's a specialized, interesting looking, synaptic structure, which",English
+"releases the neurochemical glutamate, an amino acid, which is an excitatory neurotransmitter found throughout the nervous system. It is the excitatory neurotransmitter in the brain",English
+and the ear uses it to send signals from the ear to the brain. These synaptic structures have this kind of dense bar in the middle. And it's surrounded by these little clear,English
+"vesicles, each of which is filled with the neurotransmitter glutamate. So here at the point of contact with the afferent neuron is where the excitatory neurotransmitter glutamate is released as the membrane potential, the hair cell, goes up and down and triggers the",English
+release of those vesicles. Now why am I grinding on about this? Because it turns out that another one of the gene therapy strategies that was developed had to do with repairing a mutation,English
+"in the protein that fills these little vesicles with glutamate, it's called the secular glutamate transporter. And its abbreviation is Vglut3 and its present in hair cells. And it is responsible",English
+for making sure that glutamate can be released by filling the vesicles. But there are mutations where this gene is disrupted. And Larry Lustig and Omar Akil actually were one of the very,English
+"first teams to show that gene therapy could be used to repair a monogenic defect. And they did that by restoring the function of Vlgut3 in a mouse model, which didn't have",English
+"any Vglut3. Now, then they also did the audiograms and the ABR waveforms that I showed you before. But I wanted to show you a slightly different way of visualizing successful gene therapy,",English
+which involves using antibodies to label the protein that you expect to be produced by your gene therapy technique. And so that is done here in this picture was shows that the,English
+"hair cells in a cross section of the cochlea are labeled green by an antibody to the protein myosin, which labels those cells and Vglut3 has an antibody that labels it red. So in",English
+"wild type animals that have normal expression of Vlgut3, you have a green hair cell that's also red. The combination is yellow. In an animal that does not have Vglut3, its hair",English
+"cells are still green because it still has myosin, but it doesn't have Vglut3, it stays green. But then after gene therapy introduced by a virus, you can see that now we're back to having Vglut3 and the combination results in yellow.",English
+consequence of acoustic trauma and age-related hearing loss is not just the death of hair cells. It also turns out that these multiple synaptic connections onto an inner hair cell,English
+"shown here in electromicrographs, those multiple connections can degenerate and pull away. So the hair cell can be denervated, even though all the hair cells in the cochlea are still",English
+"present. So this is a slightly different form of hearing loss because it's denervation as opposed to cell death, it's often called synaptopothy pathology of synapses, and it's commonly called",English
+"in noisy environments and they get their hearing tested in the quiet for pure tones and it turns out their thresholds are normal. They have perfectly sensitive hearing, but they",English
+can't discriminate signals and noise. Now if you think back the fact that each inner hair cell has 20 lines that carry information to the brain what happens with synaptopathy,English
+"is that half of them, or some fraction of them are lost. So now your capacity to discriminate those fine details of a signal in a noisy environment is much degraded. And we know",English
+"now that there is considerable evidence for age-related hearing loss to involve not just the loss of hair cells, but also denervation of the cochlea where the afferent neurons",English
+"go away, or the contacts go away. In fact, they don't die. The afferent neurons are still alive, they just don't have a connection. So many people are working to try to figure out how to prevent that from happening or repair it once it has happened. I'll just",English
+"mention briefly that Elizabeth Glowatzki here at Hopkins has developed a really great model system with her postdoc, Felipe Vincent, where they can put a cochlear tissue in culture",English
+and cause it to be re innervated by either transplanted neurons or neuronal stem cells that they add to the dish. So they're using this as a model system to ask what kinds of molecular tools can be used to facilitate that reinnervation process. So we've talked,English
+"about the afferent denervation and now there's one other kind of neuron I want to mention, which are the efferents that also innervate the cochlea. These reside in the brainstem as shown in this picture, they are activated by sound. In fact, their activity level rises",English
+as the sound intensity rises. So they're sort of responding to sound. But what they do is feed back to the cochlea where they suppress the activity of the cochlea. They are inhibitory.,English
+"They make synapses onto hair cells in the cochlea and they turn them down. Well, that seems useless. I mean, why would you want to degrade your sensitivity? The problem is",English
+"this, our ears are very sensitive. We can detect sound in very, very, very low levels when our hearing is normal. But at the same time, we have to be able to",English
+"hear in an acoustic world where sound intensities vary a million-fold, a million-fold. Each individual afferent fiber, if you ask what intensity range can it encode, it's about",English
+"a hundred. So have afferent neurons, which can vary they're firing over about a hundred-fold range, but we have to be able to use them over a million-fold range. So the efferent",English
+"neurons, which are driven by sound can turn down the sensitivity of the cochlea, according to the intensity of sound in the acoustic environment. So it's a great device for extending",English
+"the dynamic range of the cochlea in terms of encoding frequencies throughout that million-fold range. Now, the other thing about the efferents, which is really quite cool is that these efferents",English
+"not only help with signal processing, but there's really good evidence from animal studies and some studies in humans that they also protect the ear from acoustic trauma. So they",English
+can prevent the onset of noise-induced hearing loss and they can reduce the level of age-related hearing loss in animal models. Now let's quickly show you at least the last,English
+"example of that, so that I save a little bit of time. This is an example of mice, which lose their hearing as they get older. In a mouse that means when it's one year old, so they don't live very long, but normally in one year old mice, you have a loss of sensitivity.",English
+"The acoustic thresholds shift up, as you see here compared to the six-month-old mouse. But in this mouse, what was done here is to genetically engineer the efferent system so",English
+"that it worked better than normal. So increase the capacity of the fan feedback to regulate and protect the ear from acoustic trauma and in these animals, there was no age-related",English
+hearing loss. So we find this to be really exciting. This is work that has been going on in collaboration with people we've worked with for many years in Buenos Aires led by...who,English
+cloned the molecular receptors for acetylcholine receptors and provided the ability to do genetic manipulation of that gene product. So we're now going forward with gene therapy strategies,English
+"in animals to see if we can help a mouse to avoid noise, noise-Induced hearing loss, or age-related hearing loss by giving it this gain of function, acetylcholine receptor,",English
+"which makes its efferent system work better than usual. That's work which is being done now by Dr. Zhang in Johns Hopkins. So here's hair cell regeneration, just a very",English
+"quick couple of words about that. We mammals don't regenerate our hair cells. So we are in a tough place with respect to that. Once they're damaged and died, they're gone for",English
+"good. But other vertebrates, fish, reptiles, amphibians, birds, they can grow new hair cells after damage. So many people have been gone have begun to look at the molecular mechanisms",English
+"that regulate hair cell regeneration, and non-mammalian vertebrates to find out what's gone on that changes the mammalian hair cell into one which can't regenerate. And I'll just mention Angelika Doetzlhofer here at Hopkins, who has been one of the leading scientists",English
+"studying these sorts of molecular mechanisms and has made some steps forward to figure out ways to try to genetically manipulate hair cells and the surrounding non hair cells,",English
+"which can serve as stem cells to produce new hair cells in the ear. So, that's the end of my talk. Thank you very much for your attention. It's been great to",English
+"it? Oh, wow, that's a toughie. So tinnitus is ringing in the ears. It's a common consequence of hearing loss for many, many people. For some, it is really morbid. It can produce",English
+"quite severe depression, social avoidance, a variety of other sorts of problems. So tinnitus has been a really quite intractable problem for a long time. And there have been sound",English
+therapy strategies that try to decondition the ear and things of that sort. I think these are of limited utility. I'm hoping that in the long-term strategies like we've been exploring,English
+"with enhancing the strength of efferent feedback might, may actually have application to pathologies like tinnitus and hyperacusis, but that's a little ways off for now. We're still trying",English
+to make sure that it works at the experimental level. Okay. Leslie asks is there anything promising on the horizon for restoring or reversing nerve damage to the inner ear? Some folks have been looking into neuronal stem cells,English
+"and trying to actually put those into the ear to see if they can regrow and make new connections. Personally, I think this is really expecting a lot of some poor little neurons",English
+"that they not only would find their way to the ear, send their processes out to the ear, but also up to the brain to make their connections. But I will go back again to what Elizabeth Glowatzski has been doing, who is looking at an in vitro model to try to use neuronal",English
+"stem cells to cause that, to produce regenerated connections in this in vitro animal model and hopefully that'll give us some clues to do for what to do in people.",English
+"So also from Leslie, would a cochlear implant be a viable option for someone with significant nerve damage to one ear and reduce auditory ability in the other ear, currently improved with a hearing aid. You know, I don't want to say too much since I myself am not a clinician.",English
+So the folks that do cochlear implant surgeries and treat hearing loss have done a lot of work toward trying to figure out what's really optimal for folks with a partial hearing loss,English
+"or unilateral hearing loss, one-sided hearing loss. And to what extent cochlear implants can be utilized. So the cochlear implant depends upon having nerve fibers to be able to stimulate.",English
+"So if there's no nerve there, then the cochlear implant is not going to be beneficial. On the other hand, if the other ear gets worse and worse and hearing aids are no longer beneficial,",English
+"then a cochlear implant on the other side might be beneficial. I'll just mention too that there have been attempts to develop, not cochlear implants, but brainstem implants, where the multi electrodes are inserted into the part of the brainstem",English
+where the cochlear nerve enters the brain and stimulate the next stage of neuronal processing. That has not advanced terribly rapidly. It's been used to some extent in experimental studies,English
+"in animals. There's no, as far as I know, there's not been a great deal of success with a human application. Bob asks long-term prognosis for tinnitus. I did talk about that. Unfortunately,",English
+"as I said then, it's pretty tough. It's really intractable at this stage. I can only say that we hope that as we understand the molecular mechanisms that give rise to normal function",English
+"and pathological function, we'll be better able to address such a problem. Joyce asks, is there any help research children with the genetic disease neurofibromatosis type two?",English
+"I'm sorry. I'll have to defer an answer to someone who has more clinical experience than I do since I'm not a clinician. So I don't want to make statements about things that I'm ignorant of. Carlos, what advancements are there in understanding causes of otosclerosis,",English
+"what can be done to prevent it from moving from middle ear to inner ear? So otosclerosis is this process of scarification of the middle ear bones after, say, multiple courses of infection and middle ear infections, for example. They can be surgically trimmed up a little",English
+"bit, as I understand. And sometimes there are middle ear implants that can be used to restore motility. So the mid, the eardrum is then connected up to the cochlea by way",English
+"of a prosthetic device. But as far as I know, otosclerosis per se ought not to move to the inner, otosclerosis is a scarification process that affects the motility of the middle ear",English
+"ossicles. Now whether middle ear infections might propagate into the inner ear is a different question, but that would be treated with antibiotics not to do with otosclerosis. Marla, how to",English
+"prevent future vertigo events. That's a great one since I have a little dizziness myself. You know, I've only talked about the cochlea, of course, since we're talking about hearing,",English
+but the other part of the inner ear is equally important for the quality of life. The vestibular system operates at a molecular level in many of the same ways as the cochlea. There are hair cells and afferent and efferent neurons. And so gradually as we learn more about the,English
+"innervation mechanisms of the cochlea, I think these are going to be applied more and more to the vestibular epithelium as well. And it's my hope that by understanding better",English
+"how we, the brain can control the inner ear, both in terms of hearing and balance, that we'll be able to better treat other pathologies like vertigo.",English
+"Anita asks, are there devices for people who have hearing loss due to nerve damage for many years of disease? I'll have to pass. I'm sorry that I don't know an answer to that question. Percy, is there anything that can be done to improve hearing that's impaired",English
+"within a certain frequency range? Yeah, so that's a, that's a specific hearing loss. I mean, it's just something that, as I mentioned in presbycusis, you begin to lose high frequency",English
+"hearing first, and then it spreads lower and lower. Not really, I guess, would be the answer to that. So if there's a localized loss of sensitivity within just one narrow frequency",English
+"band within the ear, unfortunately there isn't really anything at this stage that one could say, you could address that problem specifically. You know, we're still at the point where we're trying to fix sort of global damage to the ear and localized damage like that, I think",English
+"would, would be require some novel strategies which have not yet been invented. What about the relationship, from K.E., what about the relationship between ear issues",English
+"and dizziness? Yeah. So we've touched on this already and I'll go back to it. Age-Related hearing loss isn't the only problem of aging and there's lots. And the other one is a vertigo,",English
+"dizziness. So the inner ear, you know, some of the problems that alter the capacity of the inner ear to perform hearing well also alter the capacity of the interviewer to perform the sensations necessary for adequate balance. And a lot of that has to do with something",English
+"that I really flew over and didn't touch, which is that the inner ear isn't only specialized enormously mechanically and neuronally and cellularly. It also has these really unusual",English
+ionic environments. So the inner ear has very specialized fluids that fill it. It has highly vascularized epithelia that generate those fluids. So a lot of the problems that we think,English
+"Dr. Teixido: Well, the treatments are the same  as for patients who have migraine headache   that is chronic. So if you have symptoms all  the time, it’s better to just prevent them",English
+from happening than to try to catch  up with them and put out these fires   day by day. And the way we manage this in patients  with chronic migraine is with migraine preventive,English
+medications. And what those do is stabilize the  central nervous system so that the threshold for   triggering goes higher and higher -- but also  with trigger identification and avoidance.,English
+"Now, if you’re having symptoms every day,  it’s hard to tell what your triggers are.   So we usually start out with some medication  to elevate the threshold, but then we reduce",English
+"triggers, at least the obvious ones. So  it’s hard to control stress sometimes.   You can’t control weather changes. We can’t  control hormones. We can completely control",English
+"the foods that we put into our bodies.  And so I tell people to avoid obvious   migraine triggers and to cut down on strong  triggers like caffeine, chocolate, red wine,",English
+but not to go too far. The idea is to reduce  the food triggers by about 70 to 80 percent.   Why not go 100 percent? I’ll tell you why. It’s  because the most potent trigger for migraine,English
+"activity is stress, and trying to eliminate  food triggers 100 percent using a big list   that was accumulated from thousands of people,  only a few of those triggers probably apply",English
+"to any individual patient. And trying to  follow that list 100 percent is stress   generating for the patient, for their family. You never want to be sitting there with your",English
+"patient, sitting there in the restaurant with  their list. It’s all about them and their list,   or they can’t eat the food that their family  has prepared for them because they are objecting",English
+"in their list. That’s stress. Let’s forget  that. So let’s not be black and white.   And then the other thing is just general lifestyle  change. A lot of times, patients who have an",English
+"emergence of these new kinds of symptoms that are  chronic, whether it’s headache or ear symptoms,   we find that, yeah, they’ve been really fatigued.  They’ve been sleeping terribly for one reason or",English
+"another, or they have a big stress, or they  have allowed themselves to get dehydrated   all the time. That’s a common trigger. So we treat these symptoms the same way that we",English
+"treat patients who have chronic migraine headache  -- with lifestyle changes, diet modification,   and preventive medications. And why not just start  small? Well, the reason that we don’t start small",English
+"is there is a phenomena of chronification. Maybe  the lifestyle changes will work right away,   but maybe not. And so someone tries  with diet, and that doesn’t work,",English
+"and then you try lifestyle modification, and that  doesn’t work with the diet. And then, finally,   you get around, nine months later, to using  these medications after a few appointments.",English
+"Well, that’s nine months of time during  which the brain is actually practicing   and burning in these pathways. And, in my mind,  those symptoms get more durable, more resistant to",English
+"treatment as they are becoming more established  and the brain is repeating activity.   So the way I think about stopping these  symptoms is that, “Look, we’re going to",English
+"put your brain in reform school. It has a very bad  habit. It’s not going to happen over a weekend,   but over a semester or two of  really suppressing the symptoms,",English
+"your brain will stop defaulting to this. And  you’ll get to a point where you’re so well treated   that you’re asking the very reasonable question,  “I wonder if I still need this medicine?”",English
+"And that’s exactly when we start backing it off,   seeing if the coast is clear, backing it off a  little bit more, and month by month we get off   the medication. And about half the time, if we’ve  really controlled things for six months or more,",English
+"patients get off their medication. They  have occasional symptoms, and when they   do have symptoms, they know what it was. Molly: Retraining that brain on how to process.   Dr. Teixido: Yeah, that’s right. Molly: So thank you for sharing all that,",English
+"some things that we can do ourselves as migraine  patients and then along with working with our   doctor our healthcare provider to find some  treatment. So there are options out there.   Let’s talk a little bit about dizziness. So  some people have migraine-related vertigo,",English
+"and then some people have vestibular migraine.  Can you explain the difference between the two?   Dr. Teixido: Well, vestibular  migraine is a diagnosis which is",English
+"really a misprocessing of normal balance  information that comes from the inner ear   after it goes to the brain. So imagine the  inner ear is working perfectly normally,",English
+"but it gets to the brain, where it gets processed,  and the processing gets messed up. And we get   symptoms that can seem like symptoms that can  come from the inner ear, like spinning vertigo,",English
+"or we can get little episodes of disorientation,  like an invisible man just shoved us.   Or we can get other symptoms that  cannot come from the inner ear,",English
+a symptom like being displaced in space as  if you’re looking at the world from a foot   behind where you’re actually sitting. We  call that the Alice in Wonderland syndrome.,English
+"That’s a symptom that comes probably from  the thalamus, where awareness occurs.   Another characteristic symptom that separates  central dizziness from something that happens in",English
+"the inner ear are patients who have a constant  rocking sensation. Even though they’re sitting   still, they feel that they’re rocking back and  forth. Once again, this is not a symptom that can",English
+be generated in the inner ear. So we know it’s  coming from the central nervous system and is   more likely to respond to migraine therapy than  to any kind of therapy directed at the inner ear.,English
+"So that’s vestibular migraine. Now, another term that you used is   migraine-associated vertigo, in my mind,  suggests a group of patients who have",English
+"inner ear disease that is provoked by migraine. I  mean, as I mentioned, the inner ear is innervated   by the trigeminal nerve fibers. It’s very  sensitive. The patients with migraine are wired in",English
+"all different ways so that they can get activity  in their face or in their head or in the neck   or in the inner ear. And if in a migraine episode,  the inner ear has these blood vessel changes and",English
+"the secretion of inflammatory mediators like CGRP,  well, those can actually injure the inner ear.   We now know that about half of the patients  who get the benign positional vertigo,",English
+"loose crystals in the inner ear, they get the  BPPV at the start -- it all starts with a strong   migraine headache in about half of cases. And  patients with migraine are about seven and a half",English
+"times more likely to get loose crystals, BPPV,  than other patients. So that’s pretty strong   testimony that the inner ear can be injured like  an innocent bystander during migraine activity.",English
+"Now, the same is true of Ménière’s disease.  Ménière’s disease -- the incidence of migraine   in the general population, the prevalence is  about 13 percent. Well, if you get a room full of",English
+"patients with Ménière’s disease and you  find out how many of them have migraine,   it’s about 55 percent of them have it. And if they  have Ménière’s disease in both ears, it’s about",English
+"85 percent. So it’s not likely a coincidence. It’s likely that in some susceptible individuals,   the migraine activity is injuring their inner ear  and that the inner ear eventually gets so injured",English
+"that it takes on a life of its own. It just  doesn’t work right. It works like a jalopy   of a car. It’s constantly backfiring, making  noise, swelling, having vertigo episodes.",English
+But it also acts up when it gets another wave of  migraine activity coming through. And that wave of   migraine activity may have been the very injury  that caused it to go bad in the first place.,English
+"So there are two distinct categories of patients:  those who have migraine activity that has created   real inner-ear disease that is related to  the migraine, and other patients who have a",English
+"migraine activity in a portion of their brain that  creates an abnormality of vestibular processing,   and that creates symptoms that sound  just like inner ear disease, because",English
+"dizziness is dizziness and it’s hard to  describe. But it also creates some of those   extra symptoms that are unique, that can’t even  be created in the inner ear, like the rocking   and displacement in space that I talked about. Molly: We have some questions from our followers,",English
+"around the blood vessels both on the surface of  the brain and in the inner ear and in tissues.   And that CGRP locks on to receptors that  are also present on mast cells. Now,",English
+"what is a mast cell? It’s a part of our immune  system, and it’s filled with histamine, and it   causes histamine to be released. And so if you  get histamine release, so you’re going to itch.",English
+"And so a patient who has migraine has higher  histamine levels than a patient who doesn’t   have migraine. And a patient who has migraine  who’s having a migraine attack, their histamine",English
+"levels are really, really high during the attack.  So some patients actually can have symptoms that   can be reduced during a migraine attack just  by taking an over-the-counter antihistamine,",English
+"symptom like we’ve already kind of gone over? Dr. Teixido: Well, the way to think about ear   fullness is that it’s ear pain. It’s just ear  pain that’s turned down to a level of 1 out of 10.",English
+"You can tell it’s there. It feels full. You  can’t make it go away. You pop your ear,   and it doesn’t change. It doesn’t eliminate  it. Your doctor tries to put a tube in the ear;",English
+"it doesn’t change it or improve it. And after a while, you realize, well, it is just   having a mild headache, like people get pressure  in their forehead. It’s not even in the outer ear",English
+"and the tissues here, but it’s deep inside, in  the inner ear itself. So we tend to treat this,   once again, with these preventive medications  to try to calm down the nervous system.",English
+there to pull on the hearing bones and to make  them stiff when we’re in really loud situations.   So we measure those muscle reflexes with -- we  call them stapedial reflex testing. And we have,English
+"patients who come to us who are having spasms of  those muscles. We call it middle ear myoclonus.   And I think some people have experienced a little  twitching under their eye. Well, imagine if that",English
+"was happening in one of the muscles in your ear.  It would feel like there was a moth or something   in your ear. Well, almost every patient  I’ve met who has this middle ear myoclonus   actually has headache, and they’re having some  actual irritability in there and spasm of one of",English
+the muscles. And one of the two muscles  is innervated by the trigeminal nerve.   So just like we get chronic tension in our  masseter muscle and temporalis muscle -- these are,English
+"also innervated by the trigeminal nerve  -- if you get too much tension in the   tensor tympani muscle in the middle  ear, you can get this myoclonus.",English
+"to stop this. And what I really do is I find out  that they have migraine headaches about four to   five days a week. We take away their migraine, and  then that myoclonus just goes away. So that’s one",English
+"who have inner ear disease, like Ménière’s  disease or BPPV -- you can keep on getting   treated again and again for those problems,  and the attention turned to the inner ear",English
+"As we went along, I was hired here at the University of Colorado with support from institutional funding, started my own lab, got some more funding from the Children's Hospital,",English
+"and also some travel grant from the Philippines, from PCHRD. And we were able to continue with more visits to the island. And so this has been a project",English
+"Tasnee and Zubair. Unfortunately, we lost Debbie and Michele to cancers, but we will always remember their efforts for the study.",English
+"excellent investigators, helping out with the project, they keep me working every day. So why study otitis media? Otitis media is inflammation of the middle ear,",English
+"which is usually due to viral or bacterial infection. It can affect any person, any age, but in most cases, you see it in children under five years old.",English
+"In the US, around 40% of children under age one will have at least one otitis media episode. In most cases it will resolve, however,",English
+"in a certain proportion of children or adults, it can become recurrent, meaning repeated infections, or chronic, wherein you have a long-term infection.",English
+"So to give you an idea how it looks like when you examine the ear using a handheld otoscope, the upper right would show you a normal ear,",English
+"where you see a translucent eardrum, and there's no fluid behind it. And you also see some reflection of light",English
+"called the cone of light, meaning that the eardrum is in the proper position. On the other hand, if you have an acute suppurative otitis media,",English
+"this is the classic appearance, wherein you have a bulging eardrum that's very inflamed or infected, and you have pus behind the eardrum,",English
+"meaning that the ear cavity is full of infection. If this is not treated, let's say with antibiotics or surgery, what might happen is a spontaneous rupture of the eardrum,",English
+"where you have a hole or perforation, and this might cause some relief to the patient who might be experiencing pain and resolve eventually.",English
+"On the other hand, it might also progress. That person might have persistent fluid in the middle of your cavity.",English
+"And this might be how it will appear, wherein you have fluid behind the middle ear. There's no more pain,",English
+"but there's still some fluid behind with some bubbles showing you that there's some air on top, but then there's some hearing loss without pain.",English
+"Some of this might resolve on its own and become recurrent, or it might become chronic like this, where you have a persistent perforation, or a hole,",English
+where there's draining fluid that's usually filled with mucus or pus. And then you have thickening of,English
+"the middle ear lining or mucosa. This is classic case of chronic suppurative otitis media. In some cases, this might also heal.",English
+"The perforation might heal. We don't know though, unless we test this ear, whether there's some damage that's already inside",English
+"like in the ears, in the middle ear bones, that connect the eardrum to the inner ear, or in the inner ear itself.",English
+"When it heals, you might see this, where you have scarring, you have fibrous material deposited on the eardrum, or it might look normal, but there's some damage behind.",English
+"So the worst case though is when you have a cholesteatoma. This is usually for chronically draining ears that are not treated or poorly treated,",English
+"usually because patients might not have proper access to healthcare, or they're just predisposed to having some form of cholesteatoma.",English
+"But this is really typical draining, not-treated cholesteatoma, wherein you have some keratin debris",English
+"that you can see behind the eardrum. And there's a chronic perforation, and very inflamed mucosa. In this case, it looks like a granulation tissue,",English
+"or polypoid, because of the severe inflammation. What this shows you, there's a huge spectrum in terms of otitis media.",English
+"All of this is otitis media, but they can appear differently. How an acute otitis media becomes chronic though, is still not well understood.",English
+So how does otitis media cause hearing loss? It depends on what type of structure in the middle ear is affected.,English
+"If it's just the eardrum that's affected, you might have some small loss in hearing, usually in the low frequency.",English
+"But if you have the middle ear cavity filled with middle ear fluid, then you have a little bit more loss, and you can feel this as decrease in hearing.",English
+"If there's some damage to the bones that connect the eardrum and the inner ear, here they're called the ossicles,",English
+"then this can cost an even larger drop in hearing, around 40 to 50 DB of loss. And this might affect not just the low frequencies",English
+"or low tones in your hearing, but also the middle and higher frequencies or tones. If the cochlea is affected, your sense of hearing organ,",English
+"then there might be a severe to profound hearing loss, usually including the high frequencies. In the typical patient,",English
+"you might have variability in how your hearing is affected, depending on when you have the infection, and whether it's affecting multiple",English
+"structures in the middle ear. So this is an example of how we've studied the hearing loss in the indigenous population,",English
+"in the island that we've visited. Over time, we've taken audiometric measurements that's community-based.",English
+"And so you can see that there are some patients with chronic suppurative otitis media, some have healed otitis media, or some still have normal ears,",English
+or those with otitis media with effusion. The normal ears are quite similar in hearing with otitis media with effusion.,English
+"But once you have some healing, or scarring in the middle ear, you might have some patients with hearing loss already,",English
+"even though it looks quite normal from the outside. And then obviously, for those with chronic suppurative otitis media,",English
+you can have permanent hearing loss already with severe to profound loss. Here you can see that some of the losses,English
+"are more severe at 4,000 Hertz, around 70-to-profound hearing loss. And so you might think like, well,",English
+"if it's going to heal well, why do we care? Especially in the children, if you think that it will resolve on its own,",English
+"then shouldn't we let it be? The problem is, especially in the children who are less than five years old,",English
+"where this occurs more often, they do have sequelae, or outcomes that they carry through,",English
+"or all through their childhood, or even in adulthood. It's known that children with repeated ear infections have worse developmental outcomes",English
+"may it be in speech, language, or cognition, or even affecting their academic performance at school. They might have worse reading ability,",English
+"because they cannot connect the sounds that they hear with the words that they read. And sometimes, they might not have any sense of rhythm,",English
+"or they might be out of tune when they hear music. Sometimes when you hear somebody sing out of tune, that might not necessarily be genetic,",English
+"they might have had some ear infections when they were kids. The other thing is because when one ear is more affected than the other,",English
+"then they lose their sense of having hearing from both ears. And some of this affects the auditory pathways, the nerves that connect your inner ear to the brain.",English
+"And this might occur even after the infection has resolved. In longitudinal studies, even after 30 years from the childhood",English
+"ear infections, in adults, they might detect some permanent damage to the cochlea, especially at the high frequencies.",English
+"Some of these might not be easily noticeable, because they're at the very high frequencies beyond what you can measure with a regular audiometer.",English
+"So in effect, we really have to treat the otitis media in younger children, because we do not want them to have hearing loss,",English
+"it will affect their overall development. Aside from hearing loss, there are other complications from otitis media, it might affect their sense of balance,",English
+"it might cause facial paralysis, it might cause collections of infection in the bone behind your ear called the mastoid,",English
+"or it can extend even to soft tissues in the face, or in the neck. The worst case scenarios would be when you have infection going to the brain.",English
+"And these are obviously emergency cases. These are not that rare in places where there's less access to healthcare,",English
+"but even in developed countries, we still occasionally see these complications. And so it's important that otitis media",English
+"is treated effectively. The global morbidity, or burden of disease due to otitis media in 2019, before the COVID pandemic,",English
+"you can see it here measured across different countries. Most of the burden is borne in developing countries, worst hit being the Indian subcontinent,",English
+"here, you can see it in red. But also countries in sub-Saharan Africa, Latin America, and Southeast Asia are disproportionately affected.",English
+"If you want to look at the burden of disease over time, a lot of this has improved since the 1990s up to the present.",English
+"But what I want you to notice here, the United States is somewhere around this, then it's flat-lined, which is good.",English
+"It means that it's been pretty controlled over the decades. But it has remained at the 40 DALY, which is a measure of morbidity or burden of disease",English
+"over all this time. And if you compare that to hearing loss in the under five year old children, it's actually a bigger burden of disease",English
+for otitis media than hearing loss. Part of it is because of the lack of research in otitis media.,English
+"If you track the publications for otitis media over the past 70 years, it's flat-lined, which is very different from how hearing loss",English
+has progressed immensely in terms of research over the past 70 years. And diagnosis and treatment have remained the same.,English
+"In terms of diagnosis, we use otoscopy or audiology in diagnosing. And if we want to look at the structures in the middle ear,",English
+"if they're affected, then we use imaging. For treatment, it's still antibiotics and surgery. Antibiotics is usually systemic oral,",English
+"or locally instilled ear drops. For the systemic oral, it's a concern because if it's used inappropriately,",English
+"it can cause resistance to, bacterial resistance to antibiotics. One thing that has really improved otitis media incidence,",English
+"not just in the United States, but around the world, is the introduction of vaccines against Streptococcus pneumoniae, which is a top bug that causes acute otitis media.",English
+"in acute otitis media incidence."" The problem with that, people misinterpreted it as otitis media being solved by pneumococcal vaccines.",English
+"And here you can see historically, it's only partially true. From 15 million cases per year in the children under five, the otitis media",English
+"incidence has decreased to around 9 million. This is probably the wrong slide, sorry, around 9 million per year, which is a 40% drop,",English
+"not a hundred percent. And this is because it's not just Streptococcus pneumoniae, that's causing acute otitis media.",English
+"It's also Haemophilus influenzae, which is now the top bug in some countries, or in some communities, and Moraxella catarrhalis, for which we still don't have vaccines at this time.",English
+"The other thing is there are viruses that cause acute otitis media, the top ones being the viruses that cause common colds, which is rhinovirus, and the older coronaviruses",English
+"that have been around for centuries. The chronic otitis media types, they're caused by multiple bacteria,",English
+"the most common being Pseudomonas and Staphylococcus aureus. And so if we're just targeting strep for prevention or vaccination,",English
+"then naturally, there are other bacteria or viruses that come into play. And it doesn't really solve",English
+"the high incidence of acute otitis media around the world. Now, the effects of COVID-19",English
+"is another event that has affected otitis media research. You can see here that after the lockdowns in the US, there's been a precipitous drop in cases of otitis media",English
+"recorded across clinics, as well as decrease in surgeries and complications. This is partly because of social distancing, better hygiene,",English
+"which is great, but then this is probably temporary. And as you can see here, if you track the blue line, you'll already see that there's an increase",English
+"beginning from May 2021. And if I hear my colleagues here right, right now they're about 90 to 100 percent already,",English
+as the same as pre-pandemic levels in terms of otitis media cases. So these are temporary effects,English
+"on the otitis media incidence. In the end, what we think is for otitis media research, it will continue to be important in the next decades.",English
+"And we will still have to look at disease mechanisms, try to understand how they happen, so we can create more effective management strategies,",English
+"including prevention of hearing loss. There are many known risk factors for otitis media, many that we've known for decades, and we try to prevent.",English
+"For example, we know that it's very prevalent in young children, so we try to monitor their ear health. If you see a child that's tugging their ears,",English
+"they're probably in pain, and we have to take a look at that. If there are upper respiratory infections, we try to manage them along with other co-morbidities",English
+"like allergies, or immune conditions, to minimize the effects. If a child is attending daycare, we try to practice hygiene,",English
+"and also minimize crowding in the home, or at school. We promote breastfeeding, no smoking, or less exposure to tobacco smoke would be good,",English
+"and optimize the nutrition of children, keep their ears clean, especially if they're swimming, try to not put dirty water in their outer ears.",English
+"And all these we've been trying to do. But in some cases, even if you try to optimize conditions for children, there are still some who might have family history,",English
+"or inherited factors that cause them to have a higher risk of otitis media. And this is what we've been targeting with our studies,",English
+"so that eventually we can have targeted management for those who have family history of otitis media. And just to show you,",English
+"there's a few more topics that are not as well teased out. This includes laryngopharyngeal reflux, air pollution, chemical exposures,",English
+"and other adult-onset diseases that are associated with otitis media. Since we got our funding from NIDCD, we've tried to identify genes and variants",English
+"that confer susceptibility to otitis media, and how these variants change the microbial profiles in the middle ears.",English
+"And this includes both good and bad bacteria that are detected in the middle ear. Our motivation for this is because for otitis media genetics, it remains understudied.",English
+"Most of the studies that are done in thousands, or hundreds of thousands of individuals are in adults rather than in children.",English
+"On the other hand, we have access to DNA samples, and clinical data from families that we know have high heritability for otitis media.",English
+"We hope that the variants that we find will be useful for screening, surveillance, and for counseling these families.",English
+"At the same time, if we know what bugs are prevalent, depending on what variants they have, or what kind of microbes are",English
+"in the specific middle ear tissues, then this might be used to guide antibiotic treatment, or the need for surgery.",English
+"So our study rationale, if you look at these cartoons, if somebody has a change in their DNA sequence, then we expect that this might change how the coding",English
+"is transferred or transmitted to the cell, which makes the proteins that are expressed on the mucosal",English
+"cell surface. So if we change the expression of proteins, or the levels of proteins on the surface of the cell,",English
+"this might also change how the good and bad bacteria are on the surface of the cell. Which we might say is the microbiome,",English
+"or the collection of different bacteria on top of the mucosal lining, or the lining of the middle ear.",English
+"And so far, what we found, this kind of holds up. For some of the genes that we found, we know that specific microbes bind to the middle ear lining",English
+"depending on what variants are present. So for example, for FUT2 and ABO, the variants that we've detected, they determine the levels of A antigen.",English
+"Like the A antigen is what you detect when you have your blood typed, right? So if you're type A, you have A antigen, and you express it also",English
+"in the epithelium or the lining of your middle ear. So based on whether you have A antigen or not, the types of bacteria that bind to the mucosa",English
+"or the lining would differ. And we found that type A for example, was associated with an increased risk for chronic otitis media with effusion.",English
+"While those that have a type O, they're protected against recurrent acute otitis media. This is also similar to what we see",English
+"with a CDHR3 variant, which changes how a person might have rhinoviral infections.",English
+"And as we've said earlier, the more you are at risk for rhinovirus, and rhinoviral infections,",English
+"the more at risk you are for otitis media. The other thing we've found is depending on your genetic variant for FUT2,",English
+then you might also have differences in how your genes are expressed in the middle ear. And what we found for those who carry this specific variant,English
+"that's found in around 50% of many populations around the world, it changes how mucins are expressed in the middle ear,",English
+"and not just the epithelium is changing in terms of expression, but also how their immune system,",English
+"or the defense system in their mucosal lining might also change in how they express themselves. Altogether, this changes a person's risk for otitis media.",English
+"The other class of genes that we've seen, are those that the first that we found, A2ML1, and SPINK5, these are genes that encode serine protease inhibitors.",English
+"So what do these do? When the proteins are encoded, what they do is they try to catch the enzymes that might cause damage to the mucosa,",English
+"and clear them out of the middle ear. So if these genes are defective, then it might lead to undue damage to the middle ear.",English
+"And true enough, what we see in the middle ears of the mice that we have so far, for further study, we see some persistent eardrum perforations.",English
+"This might explain why we see atypical bacteria in the middle ears of patients with variants in these genes. Our hope in the future,",English
+"if we are successful with this mouse model, would be to find a way to introduce protein",English
+"into the eardrum, so that it can heal properly. So what do we do now, if there are multiple variants? This is not your typical Mendelian gene for hearing loss,",English
+"where one gene causes the disease. What we see in otitis media, there are multiple variants that might change somebody's",English
+"risk for middle ear infections. So using the indigenous population as an example, we've seen three different genes with variants",English
+"in this population, and we've counseled them depending on what variants are in each individual. So here, the easy thing is",English
+"we haven't seen any significance in terms of the other environmental risk factors, except for gingivitis and the genetic variants",English
+"that contribute to otitis media or middle ear infections. So because we've been going to the community several times for the past how many years,",English
+"we've provided services to them. One is to do follow-up or surveillance of their middle ears using audiologic screening and examinations,",English
+giving them the proper medical treatment. We brought in genetic counselors and also dentists to help educate them on how to mitigate,English
+"or decrease the risk for disease. We've taught them how to clean their ears, promoted pneumococcal vaccination, and used the microbial data that we have",English
+"to guide antibiotic selection. Unfortunately, because of the access to health care, we have not done any surgical intervention.",English
+"For us, this is an opportunity also to figure out if we did tympanoplasty, for example, if we tried to fix the eardrum, would they heal properly,",English
+or would persistent perforations occur because of their genetic defect? And we'd like to know more about that using the mouse model.,English
+"So in summary, how does our research help management of otitis media? In the future, we want to know if a genotype or combination of genotypes",English
+"will help predict our risk for otitis media, whether it's recurrent or chronic, if it's predicting risk for hearing loss",English
+"and other complications, including occurrence of cholesteatoma, whether they are associated with a specific microbial profile",English
+"that might guide our use of antibiotics and surgery, and eventually novel treatments for specific genetic variants.",English
+"So we're nearing the end. I'm going to the non-genetic component of our study. What we did, we took samples from the middle ears of individuals",English
+"undergoing surgery at the Philippine General Hospital. So you can see here from the left panel, a picture of cholesteatoma,",English
+"that's the keratin debris that you see on the upper left. And then you also have granulation tissue, or inflamed middle ear lining that was sampled.",English
+"So what we found in these samples, if you compare the cholesteatoma itself versus the mucosa or the granulation tissue,",English
+"there's lower biodiversity, or there are less bacteria that are detected in the cholesteatoma, and the pus or middle ear discharge",English
+"compared to the middle ear lining. And the types of bacteria that we found, it would be helpful, because these are not your typical bacteria.",English
+"We see Porphyromonas, Fusobacterium, for example, that's more in the cholesteatoma than in the mucosal tissue.",English
+"Similarly, if you grouped by cholesteatoma diagnosis, whether a person has cholesteatoma or not, we see differences in the other types of tissues.",English
+"Overall, what this leads us to think is depending on the bacterial studies that are done intraoperatively,",English
+"and then submitting those samples for antibiotic sensitivity tests, then it will be helpful to guide how to give postoperative antibiotics.",English
+"And this is important because in many cases, what we've been using may be studies from 20 years back. And so what's happening is we keep pushing",English
+the microbial profile of the patient towards more and more infection with bacteria that are not being treated well.,English
+"So what you might see is recurrence of cholesteatoma, and otitis media. All right.",English
+"Last few slides, for the future directions of our research, we'd like to look more into viruses, how our immune system responds to the different",English
+"otopathogens with their genetic background that we see, application of new analysis techniques, and also sequencing, the latest sequencing techniques that we have.",English
+"And eventually, what we want to see are comprehensive profiles that will allow us to predict risk for children",English
+so that we can identify them early if they're going to have recurrent or chronic otitis media. And so we can implement some preventive measures.,English
+"Lastly, this is a slide that somehow outlines all the otitis media research excitingly going around the world.",English
+"And so for Hearing Health Foundation, I hope that you continue to support early stage investigators that are working on otitis media, so they can also contribute in decreasing",English
+"the burden of hearing loss. Thank you. - Well, that was an amazing talk, just really amazing.",English
+"It's kind of interesting that in the past, we would have never thought about genetics, or genes, playing a role in otitis media.",English
+"We just thought it was bacteria. And now, you're showing us that it's not only the genetics, but the population of bacteria as well.",English
+We no longer think about a single bacterium being important as much as the population of the microbiome of the bacteria. So that's really fascinating.,English
+"One of the questions we have from Sharon Jenkins, she asked, as she's been a teacher of the deaf and hard of hearing for about 28 years in Chicago,",English
+"and over the last few years, she's seen fewer students with conductive hearing loss, and then it may, I'm sorry,",English
+then the recent uptick in the last five years. So have you found a reason why ear infections may increase or decrease over time? Is it a population-specific thing?,English
+"So maybe if you could broadly comment about what leads to prevalence just going up and down of conductive hearing loss, that'd be great.",English
+"- All right. So it also depends on the characteristics of the population you're looking at. So for example,",English
+"if you're talking about very young children, if they have less of the risk factors, which is great, that might be better breastfeeding,",English
+"less smoking, less daycare, also early catch of the infections as they come, so they get treated, or they're surveilled,",English
+or watched more often. So these contribute to the decreasing acute otitis media incidence.,English
+"What we're saying here is there's still a segment of the population that even if you tried to give them all the benefits of what's around us,",English
+"including vaccination, they might still have some of the recurrence or chronicity. So following them over time,",English
+that might also give us an idea of what's going on in that population. What we also see is there are differences in the genetics of different populations.,English
+"So for example, the FUT2 variant, it's not significant in the Finnish population, but the ABO variants are.",English
+"So depending on what the genetic background of your population is, that might also change how they manifest otitis media.",English
+"- We have a question from Jane, what are possible complications from chronic childhood ear infections for adults aside from hearing loss,",English
+"and are there ways to prevent or treat these possible long-term consequences? And what do you recommend? - So the good thing is around the world,",English
+"it has improved quite a bit. Many of these complications that you find in textbooks, they're quite rare now, but they still exist.",English
+"You can still see them. So there was a slide that I presented where you can see it can affect the cranial nerves or the facial nerve, for example,",English
+"where you can have facial paralysis, you can have the infections extend to the soft tissues close to the middle ear,",English
+"where you can see it here, or down here, or even to the neck. And for these types of infections, the important thing is to try to",English
+"treat the middle ear infection, drain if there's any pus that's in there, and in the affected structures.",English
+"For those that have problems in the middle ear bones that connect your eardrum to the inner ear, that's fixed by the otologists by reconstructing",English
+"those middle ear bones, so that you can hear again, and if you try to repair the eardrum also that contributes to better hearing.",English
+"For other severe infections where you have brain abscesses, that's an emergency situation. Usually it's the problem in the neurology,",English
+"or in maybe in your balance, or in how they move their limbs that would manifest first, or in sensorium, or in how, whether they're awake or not.",English
+"These are the ones that manifest first that's primarily a neurosurgical problem that has to be treated, and then we can go to the middle ear and treat the source.",English
+"more susceptibility to certain bacterial infection over others. Or more viral, could you talk about that some more?",English
+"- Yes. So that's what we're seeing. It seems like depending on what variant you have, you might have a different profile in your middle ear,",English
+"or even in the back of your nose, your nasopharynx, what types of bacteria might be more prevalent. And in this case,",English
+"we're talking about not just the bad bacteria, the pathogens that cause the infection, but also the commensals, or the good bacteria that are normally in the back of the nose.",English
+"It might make it to your middle ear when you have an infection. So it's important because the balance of the good bacteria and the bad bacteria in your nasopharynx,",English
+they predict your risk for otitis media also. And they also contribute to your immune response or to the response of your defense system against infection.,English
+"What we want would be a good balance between these bacteria, rather than eradication of all bacteria. That will not be good.",English
+"We want to have more of the good bacteria in our nasopharynx, or in the back of our nose, so that our middle ears also stay healthy.",English
+"- There's been a lot of work on changing the bacterial composition that we have in our body, and like, you know, eating stool for the GI tract, or",English
+"blowing bacteria, or taking probiotics. Do you envision a future where, you know, the balance of bacteria could be restored",English
+"in a nasopharynx, which may be a source for otitis media? Do you think something like that may be a part of what we do down the road?",English
+"- That's an active area of investigation that's very interesting. People have tried that, even done clinical trials, wherein they sprayed the nose with",English
+"bacteria that are known to be good, for example, Corynebacteria, this is known as a good commensal. And so there are some active studies doing just that,",English
+"trying to make probiotics for middle ear health. - There is a question that you may, or may not have the answer to for one of our listeners.",English
+"What is the combined sensitivity of otoscopy and tympanometric findings in otitis media with effusion? It's a very specific question,",English
+"not really about your presentation, but if you have an answer, that'd be great. - So for that, it really depends on what type of otitis media",English
+"you're looking at, it will vary. So if you have a perforation already or middle ear hole, right in the eardrum,",English
+"then tympanometry will not help, because you already know that's going to be a type B, whatever you do. So it will vary.",English
+"We have a manuscript written up based on that slide, where we have the hearing losses, and we have the sensitivity and specificity profiles.",English
+What we see is it really depends on what's the current condition of the patient when you're doing the tests.,English
+"What is the current understanding of their roles in recurrent ear infections, are they not being effectively treated with antibiotics?",English
+"- So this is really exciting, because there are a lot of new data coming out in terms of biofilms, how both the host defense system",English
+"contributes to the formation of biofilms, and obviously the types of bacteria that contribute to it. And there's some exciting research coming out",English
+"of Lauren Bakaletz's group for example, wherein they do some kind of, how they target the scaffolding",English
+that you find in the biofilm so to get rid of it. So I think is a very active area of investigation that you should look out for in terms of treatment.,English
+"- There are studies on audiometry. This has gone on for several years now, where they say you see something in the audiometry result,",English
+"if there's a specific air-bone gap, and then you couple that with what you see in the otoscopy or the imaging,",English
+"then you can predict that there's ossicular discontinuity, meaning that the connection between your middle ear bones are broken.",English
+And that will give an idea to the otologist that they have to repair those bones. So that's one. There are also new techniques for imaging that are coming up,English
+"aside from the usual imaging MRI, CT, that also tries to detect biofilms, and how to associate that with specific bacteria.",English
+So I put that in the last slide. Those are probably coming up in clinical trials in the years to come.,English
+"- Some clarification, you had mentioned that you can develop high frequency hearing loss from chronic ear infections. Is this for children, or adults, or both?",English
+- All ages. It can happen to anyone. I think that's what I wanted to make clear. People think that you can only have hearing loss,English
+"if you have a chronic infection that's been going on for many years. Unfortunately, that's not true. Studies show that you can have residual hearing loss,",English
+"even from just one about, or multiple bouts of acute infections when you were a kid. - You know, one of the risk factors",English
+"you mentioned was smoking. And I think that's a really interesting one, in that it not only affects, of course, the microbiome,",English
+it affects the vasculature. There's a lot of literature about causing sensorineural hearing loss. What's your advice for families,English
+"that have smokers and stuff? What do you normally, would tell those parents? - Of course we'd want them to quit, right?",English
+"And I felt like I was taking up everybody's time. I had issues from not being able to even remember what he told me to do when I went across the track,",English
+"different things like that. And so it was like, I'm not running well. I don't understand why. And I always thought that I was just, you know, I'm a details person.",English
+"I've got sticky notes everywhere of my goals and my dreams that I want to accomplish. And now, I had signed those goals of, this was a realistic goal",English
+"that I thought that I could accomplish, and now, somethings going on. So I actually gave my coach a resignation letter saying that I don't want to take up your time.",English
+"I feel like I probably need to go somewhere else and do something else so at least the athletes that are out here training, you can still keep training them.",English
+"And he wouldn't take the letter. He's like, No. Not going to do it. That's a good coach. Yeah, it is. You know, it's like, don't know what you're going through,",English
+but we're going to go through it together. And that that was comforting to me. But it was still two-and-a-half years.,English
+"You know, I had goals and dreams year by year of what it was that I was trying to accomplish. And, you know, you go into a room, your head is pounding and there's",English
+"no answer for you, go to the doctors and you're still not getting answers. And so you start thinking that, okay, is it me? Am I really crazy? What's really going on?",English
+"You know, and I prayed over those years, I just need an answer. I need an answer. The worst place for me to be is in limbo of not knowing.",English
+"And I did not know. And every time, you know, someone tells you, well, maybe it's this. Maybe you train to school, maybe you're doing this, that that can't be what it is.",English
+"You know, I so it's it's it's one of those things that I, I was thankful when I got the answer.",English
+"That was probably one of the happiest days of my life to just say, okay, it's not you. There is something wrong with you.",English
+"It's not. You didn't make this up. It's not. You know, when you look in the mirror and you see this face that you don't recognize anymore, because you've lost so much weight,",English
+"your eyes look totally different. You've got this goiter. And now, you know, you thought that that was your state of normality and and now somebody's saying, no, it's not.",English
+"There's actually something wrong with you. Gail you were right. You do know your body. Well, figure this out. Right?",English
+"And that validates and meant the world to me. Yeah, absolutely. So with all the difficulties you had with your eyes and your vision",English
+"and your overall physical well-being, how were you able to go on and win three World Champions Championships in hurdles, how did you do that?",English
+"You know, I always tell people hurdling is a rhythm. And so it's like, you know, there's from the blocks, there's eight steps to the first hurdle three steps in between each hurdle",English
+"and then five steps off the last hurdle to the finish line. So you're running in rhythm. Now, the difference is I try to tell people, I try not to run in rhythm.",English
+I wanted to be a sprinter and just take it and just learn to negotiate the hurdle as I feel it. And so,English
+"you know, you couldn't see the hurdle. And so it didn't matter. You just keep looking forward. I always say I don't look at the hurdle that I'm going over anyway because that keeps me right here.",English
+"I want to look to the future, so I'm looking to the next hurdle that I'm trying to get over. And I know three steps is going to be there. You just take the hurdle and keep going.",English
+"Absolutely. I mean, you're incredible. You're a world champion hurdler. You're running record breaking times",English
+"and quite literally without being able to clearly see the obstacles in your way. So you mentioned this this long quest for answers, these two-and-a-half, three years, which seems long.",English
+"I mean, in the grand scheme of a lot of different diagnoses, it's actually not that long, unfortunately. We hear about people who wait 10, 20 years for diagnosis. But three years, when you don't know what's going on, when you live in a body",English
+that you also live off of can you tell us what was that journey to diagnosis like for you both emotionally and literally physically? Wow. It was an experience that I say,English
+"that nobody, no one in this world should ever have to go through. And I take it upon my own shoulders to say that because I've gone through it, if I could make sure no one else has to go through",English
+that I could do about it. It wasn't that I had a hard workout and my body just didn't recover. This was my body now. And I couldn't stand the person that,English
+you're supposed to have your whole life to look forward to. And it wasn't that way. I tried to blackout the whole world.,English
+"I mean, I covered my mirrors. Then I literally stopped looking at myself because I could not stand that person that was looking back at me. I just I all my sticky notes",English
+"and the things that I had, I remember going from writing my goals to writing. This doesn't feel like me, I need answers. I got to catch up to the old Gail.",English
+"Once I catch her, I got to pass her. So these were the things that I was writing down and putting them on top of the sheet that I covered the mirror with, because that's all I wanted to see.",English
+"I mean, how did you end up getting a diagnosis,? That's a good one. Oh, I actually,",English
+"and just kind of catching up on old times. And she looked at me and said, I think you have a very serious problem with your thyroid. Now, before this, I stop going out.",English
+"And it was a blessing. To be honest, it was a blessing. I felt such relief",English
+"from her telling me that. And I went and I had a TSH test, which I didn't know what that was. I mean, I know now thyroid stimulating hormones. Yes.",English
+"And then the tears just came. The tears just came down. It was like, oh, my goodness. I went from almost three years and now in the span of two days,",English
+"here's my blessing, here's my answer. Yeah. I mean, I can relate so much to this,",English
+"And then, there's a moment of celebration, briefly, because we have a name for it. Briefly because you don't know what's going on now.",English
+"come alongside the Graves' disease? Did they come at the same time together? Well, I'm still waiting, you know, I still live with this. So for me, you know, you have you're told,.",English
+"you know, hey, listen to your eyes for real. And now, you know, I think we always think that is together that, okay, any symptoms that I'm experiencing has to deal with my Graves' disease.",English
+"or most people were dealing with double vision, or blurry vision, that I'm still seeing cloudiness, that the redness that I have in my eyes, the sensitivity to the light,",English
+"So you're in that space right now. I'm in that space right now, yes. Whoa. Gail. This is, I mean ... So none of your doctors told you",English
+"that your eye symptoms could be separate from your Graves' disease? I mean, first of all, it sounds like there needs to be more education for these endocrinologists and specialists in thyroid disorders.",English
+"Right. You know, to understand when their patients come to them that, like, there could be these comorbid conditions. Right. But I mean, how does that make you feel that, like,",English
+"you might have other birthday coming up, but. Exactly. Sure. Yeah. I'm I'm actually excited you know, because like you",English
+"said, education is the key for everything. And which is why I'm so so so I mean, from from the bottom of my heart, I am so appreciative to Horizon Therapeutics because they're allowing me",English
+to not just share my story and raise the awareness. There's so many things that that's possible it's and I and it's not just for me.,English
+"IIt's for me to understand that all the things, and wanting to be strong, and to deal with my Graves' disease that I have dealt with,",English
+but there's still other things that I'm dealing with that may not be. It may be something totally different. Yeah.,English
+"You know, and so the cool part is that, like you said, I may have another birthday coming. And that's going to be a joyous day for me.",English
+And what I want to do in this whole process is just make sure people understand. Listen to your eyes. Listen to your body.,English
+"And if you have Graves' disease, thyroid, go and get it checked. Talk to your doctors, let them know everything that you experienced so they can make a proper diagnosis.",English
+"But also listen to your eyes the things that you may be experiencing may not just be just because I have this, it may be something else that that can be taken care of.",English
+"And that's what we're supposed to do. We're supposed to help each other. And so if my journey from 30 years ago and I'm still dealing with some things that also may have an answer,",English
+"you know, and I'm telling everybody that that, you know, so this, you know, the campaign, the awareness, all of that is so needed. It's so many.",English
+"Do you think about the statistics of how many people are out there with thyroid disease, graves disease, and they may be experiencing it because they're not listening to their eyes.",English
+"They're just assuming that this is just how it's got to be and that may not be the case. Well, so many of us learn to push through. Yes. I mean, you've certainly done that in in your career.",English
+"I'm sure. You know, we do that as as women, you know. Right. No, you're right. You know, I'm also I'm also curious, you know, you mentioned that",English
+it was your doctor who was sort of part of the team structure at UCLA who then got you in to see a specialist to get your Graves' diagnosed. What was it like having these people on your team?,English
+"Like, you know, knowing that you had it sounds like you learned to advocate for yourself. Right? You also had this support",English
+and I'm curious about sort of the emotional journey towards self-advocacy and all of that and what it felt like to have people supporting you. I say no one accomplishes anything by themselves.,English
+"You know, as far as being a self advocate, it's because you do know your body better than the doctor that you may see once or twice a year. So I tell people write it down.",English
+"If you're feeling something, write it down because you may not you know, it's like when your car something's going on with your car, you take it in that and that ticking stops. Okay, well, wait a minute.",English
+"It was happening but if it doesn't happen on that day, you forget to tell the doctor and the doctor may not be able to make a proper diagnosis. So for us to be advocates of our own health,",English
+"we need to make sure that we're writing everything that we're experiencing down. So I'm a big person of your personal journals, and then you go in and you talk to these people",English
+"and let them know if you have a doctor that you know is not spending time with you. You know, I need you to come in and talk to me",English
+"and ask me from the last time, which I love my my doctor, because from the last time I see him to the you know, we have a conversation first. And so that's what you need.",English
+"But just also to know like you said, the support it was from my UCLA days,",English
+"her coming aboard, sending me to my other doctor who ended up making the diagnosis and eventually going to another doctor who throughout me, my pregnancy and all of that is the same doctor that I have now.",English
+"And so this is that team to the point that I'm like if if my numbers if my body feels like, oh, I know, I can call and say, hey, I probably need to get tested",English
+"just to make sure that I'm where I need to be. And so having that team behind her, just like in athletics, I may be the one that's out there competing,",English
+"but to get me on that line, it took a whole team. It took this I always tell people is not even a gold medal team. It's a platinum team is this platinum level team that got me where I need to be.",English
+"And it's the same thing with my health. I want platinum level. I want that kind that if I'm feeling something, I can I can talk to my doctor and find out what's going on.",English
+"And this last piece for me, listening to your eyes is so important for me to make sure everybody understands that it's not just on the one side. There could be something else. TED is real.",English
+"It's real. And if you have TED, it can change your life to get diagnosed and to finally feel out what type of treatment you can go through",English
+"so that what you thought was normal does not have to remain normal. Oh, definitely not alone. That's the thing.",English
+"And I think even with my Graves' disease, going through what I went through, and you meet people. And I kid you not, probably every third out of five",English
+"people will tell you either about themselves or someone else who has an autoimmune disorder or something like that. And you share these stories and you figure out that we're a very big family,",English
+"and we're only separated by one or two people in stories. And so if we share that, it's that common knowledge. When you think",English
+"you're on an island by yourself, and you think, Okay, well there's no help. But when you start opening your mouth and you're sharing and you find out that there's a whole bunch of people that's going through this and we can get help,",English
+"there is help. This does not have to be where our life is. Yeah, we can get better and we can we can start feeling like, you know, one of the best days for me",English
+"was to get back to the point where where I felt like Gail Devers again. And you know, that came shortly after my diagnosis, you know, coming back from 1990 to 1991 and it took a couple of years for me",English
+to get back to that point. But I found her and then I passed her and that was the greatest thing. And like,English
+"to figure it out, because I think I deserve the best quality of life. We have one life to live and you deserve the best quality of life. So if there is information out there that can help me",English
+"be the best me that I can be till I'm 100, I'm going to figure it out and then I maybe I want to do the one. That's right.",English
+"And then we become a relay. We're a positive relay, because I'm going to pass it on, the knowledge that I have, I'm going to put it in that little baton, and I'm going to pass it to you.",English
+"And with your podcast and what you have and the access that you have, you pass it on to other people. And then we're helping the whole world and that's what we're supposed to do.",English
+"Well can you talk to us about that recovery process? After you were diagnosed Graves', in that period from '88 to '91, what was that experience like for you?",English
+"I'm going to run till the wheels fall off. I remember saying that. And for me, that didn't mean just running on the track. That meant running my mouth, opening up about my journey,",English
+"And the only way we're going to do that is to make people aware of what it is. Get early diagnosis because the earlier you get diagnosed, the better your chances.",English
+"And so that's been me running my mouth and running my feet just because I will save it. And mentally, I was back on the track.",English
+"And so when my teammates would job and warm up, we brought a stationary bike on the track, and I would get on the stationary bike. And when they're going speed work, I go faster on the bike.",English
+"When they were cooling down, I'd go slower. When they were doing intervals, I was doing that. And for me, I needed to go back and find my sticky notes. And they were a little rusty, a little dusty.",English
+"I had to brush them off, but they were still those goals that when I first said, I want to go to the Olympic games. And the irony is that I didn't put a date.",English
+"I didn't say when I wanted to go. I didn't say when I want it to go, even though they were written back in 1988 and 1987, those goals still apply.",English
+"And I always tell people that I sign my name on the bottom of my, my sticky notes because that's like me signing the contract with myself. And word is bond.",English
+"And so I had to dust them off and get back. And going out there on the track, that was that first step of getting back into the environment and finding Gail.",English
+"And I ended up doing that. I ended up making the team a couple months later, just being back out there. And when you set a goal for yourself, and your work hard",English
+"to accomplish that goal, and you see those baby steps leading to that big step. I set short-range, mid-range, and long-range goals. And this is where I was.",English
+"So for me, getting back on track was, was the end all be all. S So beautifully said. So how did your career unfold from there? You got back on the track?",English
+"I did get back on the track. You know, like I said, I had an amazing support system. I still had my goals on my sticky note.",English
+"And so I went back in 1992. I went to the world championships in 1991 that year and so when I left track and feel I left running, I'll give you just an example in the hurdles.",English
+"12.61 was my American record. So when I came back in, 91 came back world championships in Tokyo",English
+and I ran 12.63 so I was very close but I wasn't done. So I kind of had not really caught back up to Gail.,English
+"And so I went on and ended up running. That year, I think I ran like 46 or something, 12.46. So I caught her, passed her.",English
+"Came back in '92. And I always tell the story of my youngest daughter always says back in the day, because she just thinks that's ancient times.",English
+"So back in the day when I ran, they didn't have like now they do like a heat draw and they just put you in. But back then if you, if they thought you had a shot,",English
+they gave you lanes four or five and six. I was in lane two. So I always tell people what did they think of me? And so I was in the Olympic,English
+"games, in lane two, running the 100 meters. And I remember my friend said, ""Good thing you weren't able to hear them",English
+"announce you."" Because they talk about Graves' disease, and I keep saying we got to figure out how to change the name of that because I know what it feels like to be",English
+"undiagnosed and somebody say Graves'. I mean, it just sounds like hey, come on. I know it's odd. It's a bit unfortunate as a name. Yeah, it really is. Really.",English
+"I mean, I know it was because of the gentleman, but we need to figure that out. We need to find a happier name. Yeah, it was a little bit of a twist of fate",English
+"there that the person is exactly the diagnosis was on Mr. Graves. So I came back and won my first gold medal in 1992, and I remember taking my victory lap and you know, you, this is something that,",English
+"you know, you've got this sticky note, you written it down and now you come back, something that you didn't know, you know, you remember I remember crawling on the ground, you know, 18 months prior to that.",English
+"And now I'm in a lane, at the Olympic games. And I'm a person that I visualize. So I had visualized myself going across the finish line. Now I've got to put it into action.",English
+"I've got to execute what I've been taught. And so I, I remember when the gun went off and I can remember the race, you know, I said, I got to get out.",English
+"Like they've shot me out of a cannon, I've got to move and I got to just keep going and get to the end. And I always tell people, everybody has a forehead.",English
+"I have a eight head. And it's won me some races. So I had to get to the end I just got to get over that finish line. And I remember it. It felt like,",English
+"you know, when you saw people say, oh, it felt like time stood still. It basically felt like time stood still while you're waiting for them to announce the winners.",English
+"And they still came down to a pretty close finish, right? Oh yeah. At that time in 1992, that was the closest finish for when the 100 meters like that many people had run under 11 seconds.",English
+"And so it was hard to separate. And then they start from lane nine or the ninth place all the way up and you're just waiting like, okay, just say it, just say you say",English
+"somebody just say my name is somewhere so I'll take the tension off the moment. And I still remember him announcing. He says, ""And champion [foreign language]",English
+"It was one of those like, oh my goodness. And so I remember just taking off. I heard my coach's voice and I ran and we celebrated and he picked me up",English
+"and I think people were like, well, who was that? I said, That was my coach. And I said, and I believe at that time there were probably two, maybe three people in the world that believed that I could do this.",English
+"And it was, well, you were one of them myself. And I don't even know who the third person was. Yeah, but and I remember taking my victory lap",English
+"afterwards, and I was running so fast. I remember that the camera man had the big camera and, you know, and they're trying to keep up.",English
+"of winning a gold medal, not just for myself, but for my country. And then just knowing all in that moment, even now, when I think about it, it takes me back to that.",English
+"You're making me get emotional sobbing. I saw it not to. I said it wasn't going to but it's just so amazing to come from, like you said, crawling on the floor.",English
+"Yeah, yeah, yeah. You know, it's just just to watch everything and to see it happen and to know that all that work, all the unanswered questions",English
+"that, you know, being diagnosed or not diagnosed or told that it was this or it was that your was the athlete it and and still having that vision that I see myself crossing the finish line",English
+"and then to cross the finish line, that was a victory for myself. That was a victory for my country. That was a victory for any and everyone who's",English
+going through anything in life that you think you can't get over sometimes you have to reach deep down inside yourself and keep being that advocate for yourself.,English
+"Because had I given up, I wouldn't have had the career that I had. I would not have been taking that victory lap. I wouldn't be able, you know, and I always tell people I wanted",English
+"I always wanted to be a teacher. And had I done it my way, I would have been in a classroom with 25 kids, you know, but doing it this way and following my goal,",English
+"following my dreams, I have the world as my classroom. And educating people about Graves' disease, educating people about TED, opening up and making people aware",English
+of the things that are around you and how you can save your quality of life. I am a teacher. I am a tale.,English
+"Oh, give me chills. I'm sorry. That's don't you dare apologize. I mean, it's just you're an inspiration, you know?",English
+"I'm just I'm just blown away by your story and you have so much knowledge and experience and wisdom to offer everyone, let alone people who are going",English
+"through the kind of experiences with their health that you did. I'm wondering, based on your experience, is there advice, like specific advice that you would give to others",English
+"who are living with Graves' disease and thyroid eye disease, who may know it or not? Oh, wow.",English
+"You just want to learn cool things about the eye. And so I, I do have that level of expertise for you. Okay.",English
+"type of like, what is this disease? This is a disease seen mostly, there are different risk factors for this. It's mostly seen in, um, young gestational age, so less than 30 weeks of gestation,",English
+"uh, um, uh, and low birth weight. Infants less than 1, 500 grams, that's another risk factor. So small, uh, preterm babies, okay.",English
+"They're born, uh, before their retina vasculature, all those blood vessels that start growing into your eye and they, they, they, they vascularized everything",English
+"and allow everything to work perfectly. Well, sometimes babies are born. Um, before that process finishes. So all those blood vessels, what they do is when they start growing, they come into",English
+"the back of the eye, the very back part. Alright, the back of the retina, where the fovea is, where the macula is, and then they spread out from there and innervate the rest of the retina.",English
+"Well, if a baby is born too soon, alright, that process hasn't finished yet. And so, it's not quite there. You have areas that That aren't vascularized yet.",English
+And so that is retinopathy of prematurity and there can be lots of stages of this. There are things that can make retinopathy of prematurity worse.,English
+"There are ways to make it better, to treat it, to keep it from causing permanent blindness. This is an enormous topic and so that's why that we're only, we're",English
+"solely focused on this right now. I'm not going to talk about other things. So that's basically it. Retinopathy of Prematurity. Uh, let me, um, uh, take a quick break and then I'm going to give you some, a",English
+"Oh, they, they specialize in these custom EMS bags. Yes. And they're as obsessed with the organization as I am. So I love everything about this.",English
+It's amazing. You've got one for emergency surgery. That's right. And here's emergency airway. I got one for major trauma and diagnostics.,English
+"And this isn't even all of them. There's so many. When you open these up, there's a spot for everything. For splinting, for wounds, for meds.",English
+"It's all labeled. It's, it's really, this is a, this is, I could see how, how, how helpful this would be in an emergency. Yeah, when you're in an emergency, maybe the light's not great.",English
+"Conditions are not great. It's just open it up. You know exactly where everything is. Just grab it and go. Absolutely. To get your custom medical bag, go to the RecessTailor.",English
+"com. That's the R E S U S. S T A I L O R dot com slash K K E to get your custom bags. Knock, knock.",English
+"I customers receive 15 percent off their first order. Okay. So this is a, this is fascinating.",English
+"And I, I'd heard this, uh, the history of this. You know, years ago in residency, but, uh, I, I, I went back and I read a little bit more about it, um, in preparation for this.",English
+"So ROP, I'll, I'll just call it ROP from now on because retinopathy or premature, that, that is a mouthful you guys. So ROP, that's what I'm going to refer to it as, uh, first described",English
+in 1942 and at the time it was the leading cause of blindness. in kids in the United States. So this was a pretty big problem.,English
+"And there are three distinct time periods where there was a big, a large incidence of ROP.",English
+"All right. The first one was right after it was described. So 1940s, 1950s. Um, and this was primarily driven by the use of supplemental",English
+"oxygen in babies who are born. Um, Especially preterm babies, alright? They just slap on an oxygen mask, give them all this unmonitored, unregulated,",English
+"just blasting these babies with oxygen. Turns out, that causes damage. Having a large oxygen environment in the baby, in the bloodstream, uh,",English
+"can damage those very fragile babies. Capillaries in the retina and can cause worsening of ROP because the fetus is in utero is in a hypoxic state, all right, in contrast to after birth, right?",English
+"So it's generally a little bit more hypoxic in utero and so if a baby is born prematurely All of a sudden, they're exposed to the",English
+"world with all this oxygen, alright? And then, if you have protocols in place like they were in the 1940s and 50s, where you want to just give just a whole bunch of oxygen, try to get",English
+"that baby to, to, to cry, to, to, to breathe, to, to, to pink up, alright? Baby comes out a little blue. You pink him up, you get that oxygen going, uh, turns out, yeah, that",English
+"might help save the baby's life, but it also, uh, had a tendency to worsen significantly retinopathy of prematurity and cause blindness.",English
+"And so, um, we figured that out. All right, sometime in like the 50s, 60s, 70s, somewhere around there, and there were new protocols in place that regulated the amount of oxygen, and this is when",English
+"I gotta shout out those NICU nurses. My goodness, there's a, they're so protective over these little babies, and that's because you get like, like, you know, residents like me in ophthalmology",English
+"would come in like, I'm gonna do some retinopathy of premature, and they're like, no, no, You're going to stand over there in the corner, alright? We'll trust the board certified pediatric ophthalmologist to come in and do it.",English
+"But no, no, you're not getting anywhere near these babies. For good reason, because of things like this, now they have protocols in place regulating the amount of oxygen very specifically.",English
+"Like, these are Very tightly, uh, tightly regulated types of things of management of these preterm infants. And so, um, and so that helped, all right, it, it really, it brought down the, the,",English
+"the, the amount of ROP that was happening. Uh, and then in the, um, the second big upswing in ROP started",English
+"to occur in, uh, about the 1970s. And that was because our technology in medicine had gotten so much better that we were starting to see babies, uh, or be able to save babies who were",English
+"born earlier and earlier and earlier. So all of a sudden you got, you got little infants who are like, you know, 35, uh, 33, 30 weeks, even under 30 weeks.",English
+"Who are, who, who are able to survive because of all the, the advances that we've gotten, if you had medicine. Well, that's a huge risk factor for retinopathy of prematurity, because we",English
+"already talked about those vessels in the retina, they, they, they, they're, they haven't finished developing. And so we started to see a lot more.",English
+"Retinopathy or prematurity around there. And then the third big upswing, the third big epidemic, uh, actually started happening in, uh, communities and countries around the country and",English
+"underdeveloped countries around the world, uh, who were just kind of lagging behind the U S in terms of how they. They, um, uh, they managed, um, uh, preterm infants and use of oxygen.",English
+"And so it was just, it was like the same thing that we went through with unregulated oxygen. And, and, and, and, and so we started seeing a lot of that around the world.",English
+"And then eventually, you know, they caught up as well. Uh, and now, you know, I talked a lot about this use of oxygen. That's not.",English
+"As big of a problem now because of the protocols we have in place, because of all the work that so many people have done in trying to figure out exactly how",English
+"much oxygen you can give to make sure the baby is healthy, but also without, uh, damaging those little capillaries, those really small, very fragile blood",English
+"vessels that are in the back of the eye. So the oxygen thing, we've got, we've got that under control, but, but now, well, we still have babies who are born very early, less than 30 weeks of gestation.",English
+"And, um, and so that is a huge risk. I always talked about, I already talked about low birth weight. That's another risk factor. Um, and, and so, And so now we have to deal with this.",English
+"And so the general, as far as the pathophysiology of retinopathy of prematurity, there's a lot we could go into.",English
+"Um, I'm, I'm going to kind of not really partly because I don't quite understand all of it. There's, there's VEGF involved, there's vascularization of different parts",English
+"of the retina and when they occur. And, um, but basically, um, When a, when a, when a, when a, a preterm baby comes in and is born early, uh, ophthalmology gets involved.",English
+"All right. We get those NICU consults. Not me. I, I don't, I, I've, I've seen maybe one and not since I graduated residency because I'm not a pediatric ophthalmologist.",English
+"Um, and so what we'll do though, is when we go in to see a preterm infant, um, the, uh, There's a very strict, very strict diagnostic criteria to",English
+"determine that baby's risk of having severe retinopathy and prematurity. I guess, you know, I should do, let's go through like the different",English
+"general stages of this disease. All right. So, um, when we, when we, When we look at the eye and examining a preterm infant, you might think, Oh, that's really hard.",English
+"It's really not that hard because they're not that strong. Baby infants are incredibly weak. You guys, uh, uh, an adult could easily overpower one.",English
+"It's very simple. No, they, they, you get, they get swaddled and then, um, and so they're immobilized in a swaddle. And then you do, we have pediatric speculums.",English
+"So speculum. Y'all probably know what a speculum is, at least half the population does, but it's, it keeps tissue open, right?",English
+"So, so it's a pediatric speculum just like, you know, you see in like, uh, the, the, the Clockwork Orange, people always use that example. Uh, it just goes under the eyelids and just pulls those eyelids open.",English
+"Well, we have little tiny ones that are for babies. So we'll put the speculum in the eye, we'll dilate the patient, and usually that involves ordering the drops from the pharmacy, because",English
+"this is all happening in a hospital. Alright, this is, this is hospital based, this is high level of care type of stuff, because we're talking about a NICU for the most part. And so we ordered the drops.",English
+"The NICU nurse, the wonderful NICU nurses will administer the drops. So by the time we get to the, and I'm going to say we as a general, just the ophthalmology, by the time we get to the, to see the patient, the",English
+"little baby, the eyes already dilated. All right. So we put the little speculum in and you get a beautiful view of the eye. because otherwise the eye is generally pretty pristine.",English
+"There may be some other issues with the eye if they're very, you know, maybe a little bit of cataract in some cases, but generally you can get a fairly decent view to the back of the eye.",English
+"And so we're looking for where the vascularization is or where there's how far anteriorly in the eye those blood vessels go. Looking for areas of A vascular retina, where there are no blood vessels.",English
+"And then, um, in the later stages of ROP in a premature infant, the, um, it can, it can lead to, you can have a partial retinal detachment",English
+"or Complete retinal detachment. That's like worst case scenario. You look back there and you see the retina has detached. And again, part of that is just because, uh, of, uh, again, partly the, the,",English
+"the, you know, being born into a high oxygen environment, but also the, uh, you know, when you're born early, it arrests that, that normal vascular development. And so, so we look at the eye and determine where the retina is.",English
+"In the retina, the problem is what it looks like. There are certain terminology like demarcation lines and ridges and extra retinal fibrovascular proliferation, basically blood vessels that are not",English
+"just on, on or in the retina, but now the blood vessels are actually growing into the vitreous in the center part of the eye, which can lead to bleeding and scarring and retinal detachments.",English
+"All right. So we're, we're just evaluating the severity. Of the ROP. And then there's things like plus disease, which is a measure of",English
+"how tortuous the vessels are. And, uh, and, and, and so we're, we're, we're, and this is all, it can be, it's all staged like stage three with plus disease and certain clock hours.",English
+"How much, how many clock hours are involved with the ROP? It's very complicated, but also very well studied. It's, it's, and, and, and the, the protocols for this are very tightly held.",English
+"Okay. Um, for good reason, because we're talking about lifelong vision. We're talking about if you, if you, and why this is such a difficult thing to",English
+"do that only so many, not even every pediatric ophthalmologist does this. Um, because the decision to treat. An infant or not treat can have lifelong consequences.",English
+"You can, you can save a patient's eye. You can save the baby's vision or you can not. And it's, um, uh, it's, it's, it's very challenging.",English
+"Sometimes it's a judgment call. Uh, and, um, and the doctors who do this are very, very good at it because they do a lot of it.",English
+"And so usually it's like contracts, the hospital contracts with a practice or with specific ophthalmologists. This is also, by the way, an area of very high litigation, probably",English
+"the highest litigation in the U. S. in ophthalmology would be ROP because if, if, if, you know, you know,",English
+"despite your best efforts as an ophthalmologist, if, if the little baby does end up going blind, that can be determined years and years later. So in some states, you're, you know, you're, you're subject to litigation.",English
+"And so, um, it's, uh, which is probably why it's, it's not for everyone. It's not for everyone, but it can be very rewarding because you can't really",English
+"save vision in these little babies. And so there's, there's a whole, as far as treatment, let's talk about treatment, shall we?",English
+"Um, this is a treatment I've seen done, but I've, I've, I've done, uh, types of this treatment because some of the treatment involves like cryotherapy, um, and so that was actually the first treatment that was",English
+"ever described for ROP was cryotherapy. You take, you, you figure out where the avascular retina is and you put like liquid nitrogen, a little probe.",English
+"On the retina and you basically destroy that area and that prevents abnormal blood vessels from growing in that avascular retina, which can lead",English
+"to retinal detachments and things. So you're, it's, uh, the treatment is, is basically destroying that area that, that does that. That's what it does.",English
+"It prevents those, the extra retinal vascularization, those, which is, which are, which is made up of, Fragile, not great blood vessels, right?",English
+"So cryotherapy was the first treatment that was described and, um, I believe it's still done, uh, but there's, there's other treatments that have come up. There's just conventional laser treatment, pew, pew, pew, pew.",English
+"We do a lot of lasers in ophthalmology. It's one of the fun parts. So that's why retina surgeons love what they do. They get to just, they get to shoot so many lasers.",English
+"I get a few, I get a, I get a couple of different lasers I get to do, but, um, uh, they, they do a lot more. So shout out those retina doctors with their lasers, their fancy lasers.",English
+"Um, and so. And that's really been the mainstay of, of disease for, of this disease for a long time as far as treatment goes is cryotherapy, laser, basically destroying",English
+"that avascular retina, that problematic retina, um, uh, to try to, to, to stem the tide of progression of this disease.",English
+"Okay. Um, and by the way, uh, Just because a, a, an infant has retinopathy or prematurity doesn't mean they have to get treated.",English
+"That's part of the judgment call of this disease. It's determining, do we treat or do we not treat? Or do we just, do we maybe let the, let the eye develop?",English
+"Let the eye continuing develop under these awesome protocols and NICU with oxygen and when to oxygenate, when not to oxygenate, and eventually allow that eye",English
+"to try to develop on its own normally, which can happen, which can happen. And so it's, it's that judgment call. But whenever treatment is decided, when the ROP disease is severe enough,",English
+"You got to start treatment and you got to start it pretty quick, like within, you know, 24, 48, 72 hours, somewhere in like within days, you got to, you got to get treatment started.",English
+"Um, and then, uh, and so, you know, cryotherapy, laser, and more, more recently there's, there have been studies that have looked at using anti VEGF because VEGF, Vascular endothelial growth factor is, is thought, is thought",English
+"to be involved in, in these abnormal blood vessel growth seen in ROP and also other diseases like proliferative diabetic retinopathy, which we",English
+already use anti VEGF agents to treat. And so there have been some studies looking at using anti VEGF in addition to laser.,English
+"I'll be honest, I don't know. I'm not going to speak on what Treatment is recommended. It's probably a very specific to the patient. Uh, and I am not.",English
+"Super up to date in literature on this topic, which is probably not something you even want to hear about. You don't want me throwing out P values during these, these, these",English
+"conversations we have, you guys. That's, that's, uh, that's your, don't do that eyeball at the tip of the week. Don't ask Dr. Glockenflecken to tell you anything about P values.",English
+"All right. How about that? We'll stick to that. Don't do that eyeball tip of the week. Um, that was kind of a lame one, but it is what it is.",English
+"the eye with silicone oil and all. Just all kinds of stuff. And very frequently, you end up with terrible scarring and severely limited vision.",English
+"That’s super, super important for starting the cascade of good microbiome health and thus, affecting the ear, too. Evan Brand: Yeah.",English
+"Now if you’re an adult and like myself, too, I was formula fed for most of my baby years. I mean there’s nothing we can do now but to work forwards.",English
+"So this is involved – this is getting the testing run now. So if you’re an adult, and you’ve had ear infections, or you had your tubes in, or you had the adenoids removed, well, you—you gotta get yourself tested because 9 out of",English
+"every 10 clients that we test, we’re gonna find some type of issue in the gut. And this is bacterial in nature, which could be for previous antibiotic use. This is yeast so we’re talking, Candida mainly, we’re looking for albicans and SPT—",English
+"Dr. Justin Marchegiani: Yup. Evan Brand: Although there is about 20 different species of Candida. And then we’re looking for parasites, too, because anything that’s gonna damage the gut barrier, can also leave you susceptible to ear infections, sinus problems, any type",English
+"of allergies. Because your gut is basically the foundation. So, you don’t necessarily have to go straight to the ear which we’re gonna talk about some ear treatments that you can do to fix your infections and these problems.",English
+"But a lot of times, do you agree this has to start in the gut. We’ve gotta make sure that you’ve got a healthy gut, and a healthy blood brain barrier, and a healthy—uh – basically a sealed-up gut, for lack of a better term.",English
+"Dr. Justin Marchegiani: 100%. It all starts in the gut, it all starts with the food. Now, I see people, I seen parents online and I—I jump on there, and they’re like complaining about their kid’s ear infection and I’m just like, “Alright, I’ll be a good Samaritan",English
+"Get this done! Get antibiotics!” And then my comment that actually addresses a solution goes like, unanswered, kind of ignored because it actually involves making some changes.",English
+"So, people— I think people are getting the idea that the conventional solutions for these things aren’t working and are creating more problems. But uhm—you know, it’s definitely some extra effort that you have to do, but in the",English
+"end, I remember of having tubes and chronic ear infections for so long up into my— even early teens. It was terrible, I was miserable!",English
+"Now I didn’t get a lot of the sinus stuff, my brother got a lot of the sinuses. But in my opinion, whether its ears or sinuses, it’s just the weak link in the chain. The same mechanism that’s affecting the sinus issues is the same thing that’s affecting",English
+"the ear issues. Evan Brand: Yup. Well said. Dr. Justin Marchegiani: What about allergies too? I mean you and I talk a lot about the stress bucket, and so what you and I were talking",English
+"mean that it’s normal. And you’ve got these Claritin commercials and you’ve got these other pharmaceutical drugs to get on TV, and they make it seem like everybody needs—everybody needs that,",English
+"everybody has allergies. The outdoors, it—it’s just a crazy environment, there’s grass, and trees, and flowers and oh my god, you’re not meant to live outdoors.",English
+"You’re meant to live in your little bubble, and anytime you go outdoor, well, you need our pharmaceutical protection. And that’s just crazy.",English
+"If you do have environmental allergies, there’s likely some deeper stuff going on. That could be adrenal related, it could be gut related, the yeast, the bacteria, the parasites.",English
+"It could be detox problems, if you got sluggish liver, if you’re not digesting your foods well, if you’ve got food sensitivities, so you’ve not remove the gluten and the dairy from the diet, that stress bucket’s full.",English
+"Then you go outside and then you do get allergies which gives you the sinus problems and maybe that gets worse and worse and turns into some type of ear problem. We have a question, from—let’s see—Genesis, on here, he said, “Why do my ears ache when",English
+"it’s windy?” What’s your take on that? To me, I would just say go you get your gut check. But I’m not sure why that would happen. Dr. Justin Marchegiani: Yeah, that’s kind of—that’s kind of vague—uhm—typically,",English
+"the more inflamed certain parts of the body are, the more sensitive to certain things it will be. Like if I have from chronically inflamed to shifting my manual car may create some elbow",English
+"inflammation. Now, is the shifting of the car really the problem? No. It’s the roomful of gasoline or the roomful of gas fumes and it’s that small little",English
+"match that— that burns down the house. Even though the match went off, it’s with the inflammatory environment of all the gas fumes that are hanging out.",English
+That’s the issue. So I was always look at the underlying inflammatory environment that’s setting up the milieu to then when that spark goes off to create that issue. And that spark essentially being the wind there.,English
+Evan Brand: Yup. Well said. I wanna go back to not just making it an anti-antibiotic podcast but I do want to mention the fact that—that even the US Center for Disease Control and Prevention they write that ear,English
+"infections will often get better on their own without antibiotic treatment. Taking antibiotics when they’re not needed is harmful. Un— unwanted side effects like diarrhea, rashes, nausea stomach pain, more serious",English
+"side effects can occur. Dr. Justin Marchegiani: Right. Evan Brand: Which can include life-threatening allergic reactions, kidney toxicity, severe skin reactions.",English
+"And each time your child takes antibiotic, the bacteria that live in the body ,skin, mouth, intestine. And now we know that there’s a microbiome of the ear. Isn’t that crazy?",English
+"Dr. Justin Marchegiani: It’s crazy. The microbiome of the ear. Everywhere. I mean vaginal canal, gut, everything. It’s all—It’s interconnected, for sure.",English
+"So also, couple of side effects with the antibiotics that we really need to talk about is the mitochondria. Mitochondria are like these little power houses of the cell that generate ATP which is the currency of energy in which our body functions.",English
+"And that’s so important for optimal energy. I mean, Dave Asprey has got a book coming out or it’s coming up very soon. He’ll be here in Austin next week.",English
+"And its called, Head Strong and it’s all about basically improving your mitochondria. And your mitochondria is so important. Just google “mitochondria and antibiotics” you’ll see a strong connection.",English
+"We put some of these links in previous podcasts. I’ll let the viewers do your homework. I will post a reference section on the bottom. Antibiotics and mitochondria, you’ll find significant disruption of the mitochondria",English
+"with antibiotics. And obviously, it’s dose-dependent, right? The more you do it, the more you use it, the potential that increase has to happen. So that’s another mechanism.",English
+"Now, we can talk about some solutions. Any thing else you want to address, Evan, before we actually dig in with some solutions? Evan Brand: Sure. I’d like to just pile on top of the mitochondrial thing you mentioned.",English
+"You know, a lot of clients come to us with brain fog and chronic fatigue as well as a starting place and maybe they’ve had these type of infections but they’ve also got chronic fatigue.",English
+"And you’ve just brought the word “mitochondria” so it sounds like to me, we could infer based on someone’s use and history of antibiotics that we can infer. Well, here’s a root cause of chronic fatigue is the mitochondria that’s been damaged",English
+"from antibiotics. So that’s really gonna make us have to do a lot more work on supporting mitochondrial health, but then getting the gut back in check, too. Dr. Justin Marchegiani: Absolutely.",English
+"And also, cortisol. I mean if—if we’re bringing babies into this world that are adrenally-depleted, again, this is kind of weird but if a woman is stressed, especially that during pregnancy, you can",English
+"put on certain you can activate certain epigenetics that will start exacerbating or stimulating that babies adrenal in the third trimester. And the more stressed that mom is throughout pregnancy, you’re activating certain epigenetics,",English
+"but also in the third trimester, gonna be stimulating the babies adrenal glands. So if you bring a baby into this world with a lot of adrenal dysfunction, off the bat,",English
+"they may have an inability to regulate inflammation in general coz they’re not spitting out enough cortisol. Now we don’t ever want to treat a baby directly, you know, supplement-wise.",English
+"We would do it by getting the mom really healthy. Uhm—the only thing I recommend to a child, probably off the bat, if they’re having issues, is probiotics.",English
+"And then we could talk about maybe some homeopathic drops, or some natural solution to be put in the ear topically uh—to hit the area very focused versus do a systemic kind of",English
+atom bomb dropped. Evan Brand: Yeah. Well said. I thought that was crazy 3-4 years ago when I heard the fact that you can basically steal,English
+your—your baby your fetus’ adrenal glands. This is why some women report feeling so good during pregnancy and some of it could be that they’re deriving some of their boost from the adrenals of the baby and then you give,English
+"birth. Now instead of having four adrenals that your thriving energy from, you got two adrenals just—you’re driving energy from. And some women have kind of that postpartum either Hashimoto’s or some type of postpartum",English
+"depression. So yeah, that’s a trip. There was a question here, “Can your sinuses get clogged for years?” I mean I would say, “Absolutely!”",English
+"What do you think? If you’ve got these uhm— food allergies in your diet for years and yeah, you could stay clogged up all the time. Dr. Justin Marchegiani: Yeah.",English
+"Absolutely. So that congestion can happen. Now we also have to look at physical structure issues, especially in the nasal area. So being a chiropractic doc, you really want to make sure that you are well-adjusted like",English
+"make sure you at least see a good chiropractor once a month and make sure your cervical spine and everything is doing well, number one. Number two, you may have some turbinate issues with these bones up here in the spine.",English
+"You may need a technique called “nasal specific” where they put these balloons up and they can help declog any of these turbinate issues whether from trauma or malformation. And again, Weston A. Price talks about poor nutrition.",English
+"One of the things that happens is narrowing of the middle third with this area— here is broken into a third – a third – and a third. And the more nutritionally-deficient the parent was that brought you into this world, this",English
+middle third starts to narrow. So one of the biggest signs of gluten sensitivity and poor nutrition is a narrowing middle third and a very large upper thirds.,English
+"So when you see people walking down the street with that big forehead and you see that smaller middle third, with that smaller lower third, gluten deficiency, poor nutrition of the parents, big time, off the bat.",English
+"So again, some of this we can’t really change, right? Like the parent stuff, that’s all epigenetic stuff. But we can at least be aware that we’re bringing kids and babies into the world, right?",English
+"We got to get the nutrition dialed in. That’s number one. Number two, uhm—chiropractic’s helpful on the spine as well as the nasal canal and nasal specific.",English
+"And also, acutely, chiropractic can be great for the—uhm— for the canal of the child. The person with the ear issue. Now when you’re younger, the ear canal tends to be more parallel, right?",English
+"So it won’t drain as well. You have that—that draining angles. So one of the things that some chiropractors will do is, pull my ear front out, they’ll do a specific adjustment where they rotate the ear, they pull it, they rotate it in clockwise",English
+and they tug. And that tug kinda opens up the uhm—the nasal canal and will allow some of that junk to drain.,English
+"Now, is that root cause? No. Is it palliative without any— without very little side effects and no— not affecting the microbiome and inflammation?",English
+"Yes. So it’s a really good from a palliative perspective. Again, spine, really good. Nasal really good and then the ear adjustment, that’s the next really good step.",English
+"Dr. Justin Marchegiani: That was the Citricidal Eardrops. Those are great. Little bit of grapefruit seed extract in there. Those eardrops are phenomenal. Also, men, Hydrogen Peroxide, 3% it’s like two dollars at your uhm— drugstore.",English
+"Just a little cap for that, it will bubble like crazy. Leave it in there till the bubbling stops and then you can dump it out. That was my go-to ear infection.",English
+"And one of the things I did was hydrogen peroxide and I diluted with a little bit of silver. So hydrogen peroxide – silver. That way, I could just clear that crap right out.",English
+"It’s irritated, it’s inflamed. Uhm— when you have an ear issue, man, it screws everything up because just sounds that come in are just like balance, just you’re over hyped up.",English
+So everything is irritating and kinda bother you. That my wife just leave me alone for a few days but then we just gonna do all the good things that help with the inflammation and all the good healing nutrients.,English
+"I use the uh—the Similasan’s. Similasan’s, they have a really good homeopathic eardrop that we used. I use the Citricidal eardrops.",English
+"I use some silver and I used some hydrogen peroxide and I kinda just rotated those. And growing up, hydrogen peroxide was absolutely phenomenal for the ear coz it’s just so cheap and it’s great.",English
+And actually that’s a natural—uhm— flu or cold kind of cure because they say a lot of ways that viruses kinda vector into your body is through the ear.,English
+"the adrenals. Obviously, try to have a vaginal birth. It’s gonna be essential because the activation of the bacteria in the vaginal canal and how that affects the child’s immune system.",English
+"Number two, if you can’t get, for some reason, emergency happens where the cord gets wrapped around the child, the child’s oxygen levels drop and you have to have a C-section or the baby’s breach, number one, see a chiropractor beforehand.",English
+"Get Webster technique to get that baby to go headfirst. But let’s say you can prevent that. Number two, go in there, and again, the doctor and the midwife probably won’t do this.",English
+"So you have to get in there, get in there with a good swab. Swab your wife’s vagina area and then afterwards, when that baby comes out, you swab the baby with it because the baby would be getting exposed to that, anyway and now it’s not.",English
+"So do a good swab, put it in like a little baggie and then after the C-section, then you— when you’re doing skin-to-skin, have that baby all swabbed on. Now don’t tell the— the doctor or nurse what you’re doing coz they’re probably",English
+"look at you like 10 heads. And this is—you know, I told my OB about this ahead of time, she’s like, “Oh, well, you know, you can do that, but just keep it to yourself. We don’t have a problem with it, but you just keep it to yourself.”",English
+"I mean we talked about that but any type of gluten issues you’re gonna be creating the intestinal permeability. Even if you don’t have celiac, doesn’t matter.",English
+"The gluten is still gonna affect the gut which is therefore going to make you more susceptible to ear infections and allergies and sinus problems. Uhm— secondhand smoke, we talked— you talked about that a little bit, that analogy.",English
+"But yes, uhm— there is research that secondhand smoke also increases the risk of ear infections for children. So if you’re going over to a family’s house or someone in the family smokes—",English
+"That’s something that I just learned this morning with some research, but it makes sense. Dr. Justin Marchegiani: Yeah. Yeah.",English
+"Absolutely. Also, the quality of the food that the mom eats has a huge effect on the baby, okay. I’ll give you an example, alright? My neighbor —her child had a really difficult time sleeping continuously, up every half-hour.",English
+"The big thing that they did is they pulled out eggs, and it was one nightshade family made up of eggs and tomatoes. And that one tweak, change the composition of the breast milk and the baby slept like",English
+"just magic. So quality of breast milk is incredibly important and is dependent upon what the mom eats. So if you’re having issues with your child off the bat, even if it’s just sleep or",English
+"ears, get your diet super, super clean. Super, super clean. Just because you’re feeding a baby or growing the baby, it’s not a license to eat whatever",English
+"the heck you want. Nutrient density is incredibly important. With my wife being pregnant, we— we’re doing lots of things to increase nutrient density.",English
+"She gets exposure to a little bit of liver everyday. Uhm— she does a green smoothie with organic vegetables in the morning, we mix in some MCT oil there.",English
+We do some collagen. She gets some Pasteur-fed eggs and Pasteur-fed bacon from time to time. And she’s eating 3 solid meals a day.,English
+"And then get one good, healthy, organic shake in there. And really mitigating stress, and some probiotics and some magnesium to keep the bowel moving. So when you get pregnant with the hCg and all that stress down, it can create some issues",English
+"with regularity. So that’s — I don’t wanna go too much on that, that’s a separate podcast. But, you know, we could just— we could do a podcast marathon and be here for 8 hours—I think, it allows us to do 8-hour straight, so we should uh—we should push that one",English
+"So if you’re dairy-sensitive, you pull the dairy out for a few weeks to a month, and the first thing you add back in should be the ghee. Ghee is clarified butter so they suck out the lactose part.",English
+"They suck out the casein part. All you got is the butter fat. So you have, basically, you know, very little casein, maybe microscopic levels and very little lactose.",English
+"So you— it’s gonna be even better than butter, per se. An then if you do go with ghee, then you can try a little bit of grass-fed butter which will have very tiny amount of lactose and very tiny amounts of casein which may be acceptable",English
+"level for you. Evan Brand: For me, I could to the good quality grass-fed butter without a problem. Dr. Justin Marchegiani: Cheese, though—ee—cheese and even raw milk, man. I don’t do good with those.",English
+"I just—I really don’t. Skin breakouts, gas, bloating—not good. But I can do great with ghee and great with grass-fed butter. Evan Brand: Isn’t it amazing, though.",English
+"I mean just that one simple swab you got on me, you’re like, “Evan , man, you’ve gotta get rid of the cheese. Coz I would talk you through, you know, we’re kinda—you and I will talk off-air about",English
+"what you eat, what do you do in diet-wise and what’s working and I told you, “Man, I’m doing this organic cheese.” And I don’t know if would say I was having sinus issues, but I definitely had some—I",English
+"guess I would call it head pressure. Basically, kind of like a mild headache in the front of my—in the front of my head. I did not know that that was caused from dairy. And it was.",English
+"Dr. Justin Marchegiani: Your skin looks a thousand times better since you cut a lot of that cheese out. Evan Brand: Yeah. I feel good. And I cut out corn, too.",English
+"Now, I will do a little bit of some organic—blue—uh—blue corn chips maybe once a month or something now. They just taste so good.",English
+"Dr. Justin Marchegiani: Alright. That’s one paleo demerit down there. Evan Brand: Hey, I know you’ve done some corn in 2017, right? Dr. Justin Marchegiani: A little bit.",English
+"Well, I mean—obviously, it’s a Mexican restaurant, called Maddy’s. And we’ll do a little bit of their gluten-free organic corn chips that are like in a plastic bag.",English
+"So it’s totally a waste, there’s no cross contamination. So, I will, from time to time, as a little reward. It’s Friday, you know, a little—little NorCal margarita, a little bit of Dr. J’s Moscow Mule.",English
+Yeah. Absolutely. Love it. Add it to the list. Evan Brand: And now is that—are—or now is that blue? Or is that—is that yellow corn?,English
+I may be one up on you in the blue here. Dr. Justin Marchegiani: Uh—Yeah. I think it’s probably just the yellow. But it’s least organic and GMO free which is essential. Evan Brand: Totally—totally.,English
+"Dr. Justin Marchegiani: Yeah. Evan Brand: Maddy’s is good and what was it—Tacodeli down there in Austin. They’ve got organic, pasture-raised pork shoulder tacos. Dr. Justin Marchegiani: Unbelievable.",English
+"Evan Brand: Have you had those? Dr. Justin Marchegiani: I’ve not. Tacodeli? Evan Brand: Oh my, god. You’ve gotta go, man.",English
+"It’s off uh—I wanna say it’s off of 360. Shouldn’t be too far from you. And they do organic uhm—they do organic tortillas as well and pasture-raised pork, so.",English
+"Dr. Justin Marchegiani: Love it. Love it. Very cool. So let’s kinda summarize, alright? So you’re coming into this here and you missed the whole 45 minutes chat.",English
+"So what are the key take homes? Diet, of course, refined sugar, dairy, gluten, grains—cut that out. If that’s not enough, you can go do an autoimmune template where we cut out, nuts, seeds, nightshades",English
+"and eggs. You’ve left meat, vegetables, maybe a little bit of low, sugar fruit, maybe a little bit of starch and healthy fats minus dairy and uhm—nut and seeds. So that’s our good first step that we need.",English
+"Now, after that, there are some preparation and things we can do ahead of time but may not help you in the moment. That’s the healthy pregnancy, that’s the stress, that’s getting the vaginal canal",English
+"in contact with the baby on the way out to activate the immune system, that is the good quality breast milk, that is all that good stuff there. And keep them mom’s nutritional density high when she is breastfeeding because that",English
+"becomes the building blocks to a lot of the uhm—raw material in the breast milk. You know my expression is you can’t make chicken salad out of a chicken shit, right? Evan Brand: Yup.",English
+"Dr. Justin Marchegiani: If you got crappy quality ingredients going in that mom, guess what, you can’t make this awesome breast milk with bad ingredients. So let’s really keep the quality high.",English
+"Next, we have for the sinuses, you have structural issues, you can do the nasal specific chiropractic technique, you can do adjusting of the spine, and the whole—the neck as well, especially",English
+"the upper cervical area and then adjusting Eustachian tube to help increase the angle to allow the ear to drain, right? Now we have the rinses for the sinuses.",English
+"We have the bulletproof rinse, we have colloidal silver uhm—for the sinuses. And we also can do hydrogen peroxide in water, 50-50 split and do drops in the nose, 4x a day, 10 drops.",English
+"And then we also have the ear. We can do Similasan Homoeopathic, we can do the Citricidal; we can do the Hydrogen Peroxide; we can also do the silver. And then you can also do a little bit of garlic oil in there, as well.",English
+"What do you think, Evan? I think we just like hit it all at once. Evan Brand: Yeah. That was good. And treat the gut, too.",English
+"Dr. Justin Marchegiani: Of course. And the best things—the supplement you can use on your baby if they’re newborn, Infantis Probiotic.",English
+Infantis is a specific type of probiotic. One that we like is Ther-biotic Complete for Kids. That’s a great one uh—for kiddos. And—and that can be powder so you can just put in on your finger and then you can just,English
+"put it in the gums or if you’re breastfeeding, you can put in the nipple area and have the child, get it from that. And also, give it to the mom and it will help with any potential translocation via the breast",English
+"milk as well. Evan Brand: I will say one last thing about breast milk and this is probably gonna only apply to maybe just a few listeners, but there are breast milk donation services out there,",English
+"where for some reason if the mother is just too busy, she is working too much, I’ve seen women going and getting breast milk from other moms. I would never do that from my baby because who knows what that moms diet is like.",English
+"Who knows how much glyphosate is in that. If the mother is not eating organic. We know, I just chatted with Dr. William Shaw in my podcast, you know, we’re talking about parts per billion of glyphosate which is what’s used a non-organic produce.",English
+"Parts per billion being enough to disrupt uh— gut bacteria and kill beneficial bacteria in the gut which can lead to these ear infections. And so for me, I would never ever, ever, ever unless there’s was just something so wrong",English
+"with the mother that she could not feed the baby—her breast milk. And she had to get another mom’s breast milk, I would literally have to do an interview process of that— of that mother.",English
+"Is your diet organic? Are you eating gluten? Are you eating dairy? Because that’s gonna—breast milk is not all created equal, like you mentioned. Dr. Justin Marchegiani: Yeah.",English
+"I mean, it’s really simple. You just pay a little bit more money. You—you provide that food for that mother who’s donating the milk if that’s your only option.",English
+"Evan Brand: Yeah. Dr. Justin Marchegiani: I mean, for the first 6 months. What you’re doing there, for 6 months to your kid is a better investment than paying for college or any of that.",English
+"That’s like the best investment. So if you’re in that position and you have to do that, then definitely find someone. You know, the Lalecheleague’s a really good reference for that.",English
+"But really find high-quality breast milk, if you need. There’s some Weston A Price recipes where you can do some home-made breast milk with liver extract and cod liver oil and raw milk or raw goat’s milk.",English
+"But then also, like if the mom can’t breastfeed, it’s typically something wrong from a stress perspective and from a diet perspective, so really look at getting the diet fixed.",English
+I see a lot of women who go low fats have problems with producing breast milk. So— Evan Brand: Yup.,English
+"Dr. Justin Marchegiani: That’s really, really important. And then don’t quit. Like, don’t quit. Like can you imagine, like evolutionary times where like food’s like, you can’t feed. You don’t have like formula, you didn’t have all these things.",English
+"So you couldn’t breastfeed your kid, like what would you do? That was it. Evan Brand: You’re done for. Dr. Justin Marchegiani: This is it. They can’t eat solid food, right?",English
+"Too young, what do you do, right? So maybe there will be another woman in the tribe that you give the baby off to and they would lactate for you. But ideally, you gotta get the diet right, you gotta get the stress right and then also,",English
+make sure that the inflammatory foods are out of there so the highest quality nutrients are coming through. Evan Brand: Yeah.,English
+"It sounds like we have to do a whole breastfeeding. Dr. Justin Marchegiani: Yeah. Evan Brand: Or optimal baby podcast. Dr. Justin Marchegiani: Yeah. Evan Brand: But I’ve heard many women, who they’ve completely just given up on breastfeeding",English
+because they said they were too stressed or too busy or something like that. But you really gotta try to modify that to make it possible because— Dr. Justin Marchegiani: We’ll do a whole podcast on this.,English
+"information that is not readily available. Even in 2017, somebody’s gonna go down the street to the clinic, and maybe regret the mode of action that was taken.",English
+"without eyes, or you can have your eyes removed for various reasons, which may be eye disease, which is more rare now, or due to trauma. And as you’ll remember, if you remove the eye,",English
+"retinopathy, you’re more likely not to perhaps. But again, we don’t have people who are severely blind. And severity of diabetic retinopathy made no difference whatsoever.",English
+"We have another disorder, retinitis pigmentosa, and they did sleep worse. So glaucoma and RP seem to be conditions where people sleep worse. But there was no difference with severity.",English
+"But RP’s quite rare, and we didn’t really have very many people. So although it looks like the people who have got very severe RP should have worse sleep, there’s more people",English
+"who have severe RP than don’t. So it might not be true, that’s my caveat. Age-related macular degeneration, no difference at all. And severity made no difference either.",English
+"So we’re seeing that although the eye’s very important, different eye disorders and different eye diseases have a differential impact on whether we sleep well or not. So cataract leads to improved cataract surgery leads to improved sleep. Glaucoma and RP are",English
+"associated with worse sleep. Diabetes and AMD makes no difference. However, you could argue that not many people in our population were blind. Which is quite exciting in a way. Because if you have got this disease and you turn up in clinic, and",English
+"you might have sleep problems. Well if you’ve got severe visual impairment, you really should be asking these questions. And we need to do more work on it.",English
+"But it’s not always disease specific. If you have eye disease and poor sleep, maybe you just need to be treated. So we’re now looking at the whole cohort of all of our eye diseases, and taking people who have poor sleep, and we’re going to be asking whether",English
+"giving people melatonin, our ‘vampire hormone’, will help set their clocks or help them with their sleep. Anyway I’m sure you’re all far more interested in aniridia. Actually we haven’t got the",English
+faintest idea. There’s a couple of studies which I’ll tell you about. We don’t really know about the eye and sleep for this condition. And there’s obviously photosensitivity that’s,English
+"involved in it as well, so we have to consider that too. But what’s quite interesting is PAX6 is involved in pineal development, and individuals who have this are more likely to have lower melatonin. If melatonin triggers everything",English
+"that you’re doing at night, then hows your body coping with this? So Hanish et al have done some quite good work on this, and they have shown that the pineal is smaller in individuals with the PAX6 gene mutation. And it’s small numbers,",English
+"17 control participants, but this is probably ok. They also found that the melatonin levels were lower in the morning than the control ones. Now remember melatonin’s dissipating in the morning, it’s peaking halfway through",English
+"the night. But irrespective of that, there’s lower melatonin. Well it might be driving the sleep problems. Because parents of children with PAX6 report worse sleep. But it’s a bit complicated. Because in this crowded table, the age group",English
+"is 10-19 years. Your sleep duration changes over your lifetime, and it’s at your longest when you’re a teenager. There’s nothing you can do about it. It’s at your longest",English
+"when you’re younger, but your latest when you’re a teenager. And there’s nothing you can do about it. So you’re going to naturally be going to bed much later, and a 10 year old is very different to a 19 year old.",English
+"But I found it curious because if you look at the weekday times of how long these individuals slept for, it’s actually quite short, it’s about 8 hours. But the sleep duration was",English
+"not different between the controls and the individuals with PAX6. It was how long it took to go to sleep. And I think that’s interesting because if it takes you longer to go to sleep, is it",English
+"that you’re having trouble going to sleep, which is a sleep condition problem, or is it that your melatonin is still hanging about, it’s not saying it’s night time? So are you naturally a very late person?",English
+"So this shows that the individuals who are trying to go to sleep struggled if they had the PAX6 mutation, compared to the healthy controls. So it was 2 studies that are telling you that",English
+"it might be interesting, and it’s done in children, and we don’t know about adults. I work with a million people. I do very little in comparison to what everyone does. And these",English
+"are all the people. So I really work with Susan Downes, who’s the clinician in the eye hospital. Russell Foster’s the head of the circadian neurosciences team, which is where I work. And then all these people helped collect the data, and we all supported",English
+"each other in doing our work. And that’s it, thank you very much. [Applause]",English
+"it’s totally black. Would that affect it? [Iona] Well your visual system isn’t working in that eye, but we don’t know the non-visual.",English
+"And there’s suggestions that the non-visual is a little bit more robust than the visual. But if your other eye is ok, it should be compensating for it. I say ‘should’...",English
+"[Delegate 1] I also have glaucoma. [Iona] Well this is the other thing. So glaucoma, we think people sleep worse. But it is possible. It’s a very wishy-washy answer isn’t it? [Laughs]",English
+"There’s all sorts of things you could do. So if you’re having regular access to daylight in the mornings, and if you’re active during the day, and if your night time sleep quality",English
+"is such that you’re struggling the next day, it’s possible that it could be down to eye issues. The other thing is that sometimes we think we aren’t sleeping well, like all night",English
+"we might be up. But the next day we discover after our 17th cup of coffee that we’re actually quite functional. And that’s not ok. If you need to really get going in the morning,",English
+it’s not quite right either. [Delegate 2] You spoke about a reduced pineal gland in some people. My daughter actually,English
+"has no pineal gland at all, so I don’t know how that impacts on what you were talking about. Slightly different from what you were saying. [Iona] It is isn’t it? I haven’t got the faintest idea! [Audience laughs]",English
+"It's going to be the universal answer to all your questions. But we do know that melatonin’s really important. So the rising of melatonin sets everything that we do for us at our night time. So if you have no melatonin, what is the impact?",English
+"Well I’m not sure. And if it’s from birth, you may have learnt strategies to deal with it. But we just need to know, because it’s so important. Sleep’s very, very important.",English
+"[Delegate 2] It took us until she was 4 to get a diagnosis and a good night’s sleep, and now she sleeps well, but with melatonin. But without it, as you say, she doesn’t sleep very well.",English
+"[Iona] So a sample size of 1, it sounds like it’s really important! [Audience laughs] [Delegate 3] I struggle to get to sleep at night and sometimes I can’t get to sleep",English
+until midnight. And at my grandparents I get up at 7. When it’s a school day I have to get up at 6:30. And in the weekends that’s the only time I get a lie in. And I don’t,English
+"know how to cope with it, because I’m very grumpy at school. [Audience laughs] [Iona] Oh, I can relate to that. You’re not alone, you’re absolutely not alone. There’s a lot of research to suggest that school starts far too early. And part of our",English
+"group was trying to get UK schools to start a little bit later, which went down like a ton of bricks. And what they found is that lots and lots of children are having to get up too early,",English
+"and then they’re sleeping in during the weekend. But if you have a confounding issue of eye disease, it’s quite possible that you’re being amazing by going to school and staying at school, and then at the weekend sleeping in.",English
+"You just have to deal with it, and that’s not ok at the moment. So we’re trying to understand a lot more about it, and that’s why it’s so important. But you’re not alone. That’s no help whatsoever is it?",English
+[Delegate 4] I have a couple of questions about the operation of melatonin and how it governs the sleep/wake cycle. Just because I haven’t seen it anywhere else and you may know.,English
+"So if you did have a pineal gland that wasn’t working very well, does that affect in the morning if you get exposure to light, is it cleaning out melatonin from the system,",English
+"or is something else doing that? [Iona] Well if you haven’t got a pineal that’s functioning, you’re probably not producing the melatonin. Well, melatonin’s produced in other places, but it is considered to be quite important.",English
+"[Delegate 4] Yeah, say you were supplementing... [Iona] So if you’re supplementing with melatonin, they’re done on slow release or fast release, so your body breaks it down. So I think the whole point of taking it is that it either",English
+"sets your internal clock, so instead of the light coming in and telling your ‘master clock’ what time is it, the melatonin will be doing it. It has been shown to do that, it has to",English
+be appropriately timed. And it seems from our sample size of 1 in the corner that if you do supplement with melatonin that it will help. Have I answered your question at all?,English
+"[Delegate 4] Yes, sure. One other question that’s similar, which is do you know... because I’ve seen conflicting things... if you are supplementing, or if it's",English
+"naturally produced melatonin, is the dosage or concentration particularly significant, or is it just having it or not having it at some level?",English
+"[Iona] No idea is the short answer. And the long answer is timing is really where I’m a bit more clued up in. Because as I said, melatonin comes out at night. Now we all know",English
+"when the sun goes down that if you’re what I called free running, you’re not necessarily going to be operating on a day/night cycle with the environment. You’ll be on a day/night",English
+"cycle of your own internal rhythm. So at some point, at 10 o’clock in the morning, you're ready to go to sleep. So the important thing with the timing is to make sure that you’re doing it at bedtime,",English
+"and your internal bedtime, not when everyone wants you to go to bed. And that can take a while to come around. There is evidence to suggest you can just bang it in at any time, but it is awkward.",English
+"But I think really the timing of melatonin is considered to be very important, because if it’s appropriately timed, it means that you get a better result. But people do do it where they just put it in half an hour before you’re meant to go to bed.",English
+"As for the concentration, I’ve seen conflicting reports on it, and I haven’t worked on it yet. [Delegate 5] So if you think you have sleep problems and you want to maybe try a melatonin",English
+"supplement, how would you go about it? Because it’s not licensed in the UK is it? [Iona] It’s not licensed, which is why we’re doing a trial to try and get it clear that it really does help. So I can’t really tell you how to get it, because that would be naughty!",English
+[Audience laughs] It would be really naughty. [Delegate 5] So I’ve had a personal experience. So I know that I’ve got a smaller than average,English
+"pineal gland, through doing research in America. I’m totally blind, no light perception at all, and I’ve got glaucoma. So all those things.",English
+"I went to a neurologist... well, I went to my GP several times, and finally got a neurologist appointment, and I was prescribed Circadin, which is the slow release melatonin.",English
+"And it did work a little bit, but not as much as the actual normal melatonin. And so now I have antidepressants that I use for sleep instead of melatonin.",English
+"[Iona] And do they work? [Delegate 5] Yes, I find they do work. [Iona] Great, I’m all for it. If it works, that’s fantastic. We’ve got a lot of research that we really, really need to do. A lot of the sleep work is based on insomnia or pre-existing",English
+"sleep disorders. On all of our work, if you have a pre-existing sleep disorder you’re not allowed to participate in our studies. We’re specifically interested in eye disease. As a result we do tend to take out. Sometimes sleep apnoea might be linked to the development",English
+"of diabetic retinopathy, due to raised BMI - Body Mass Index - and all sorts of things. But we really haven’t made these links of how to help people who have got sleep problems,",English
+"and we’re really hoping to do that with our next big study, which should be starting soon. And hopefully it will mean that when you go to your eye consultant you will be asked about your sleep and treated accordingly. But at the moment, as you know, it��s not the case.",English
+"[Delegate 6] Where else in the body is melatonin made? [Iona] The retina. [Delegate 2] I was just thinking about, with aniridia and the retina’s not always developed,",English
+He did smoke. Occasional binge drinking. Marijuana only. No other injection drug use.,English
+"He lives with his fiance. He had no recent travel in the past five years. No animal, insect, or TB exposure.",English
+"And as sexual history, he had two female partners in the past year-- one casual and one regular. And he's an electrician.",English
+So here's his physical exam. His vital signs were stable. He was thin. He was not in any distress.,English
+"Well appearing. Moist membranes. But on examination of the mouth, he did have white patches on his tongue.",English
+"The eye exam, his pupils were dilated, they were sluggish, he had conjunctival injection in the right eye, greater than the left.",English
+"His visual acuity was as follows-- o the left, he was able to count fingers at four feet, and in the right eye, he was able to count fingers",English
+"at two feet. His visual fields are shown here. He had no lymphadenopathy. His cardiac, lung, and abdominal examinations",English
+"were within normal limits. He had no genital urinary lesions that were noted. But on his skin, he did have a hyperkeratotic, scaly plaques",English
+"on the torso, the buttocks, and the palms and soles. Neurologically, he had no facial asymmetry, no meningismus, normal sensation and strength.",English
+This is what his skin examination looked like. I want you to pay attention. And this is his eye examination.,English
+"So he went for a slit lamp exam, and he was determined to have a panuveitis and bilateral acute retinal necrosis.",English
+"Quote unquote, ""extensive abnormalities and retinal findings are suspicious for infectious etiology.""",English
+An anterior chamber paracentesis was performed and aqueous humor was obtained. These are his laboratory results.,English
+"And you can see, with a quick scan, that the pertinent abnormalities are an increased white count and an increased neutrophil absolute count.",English
+"Otherwise, this pretty much falls within normal. His chest X-ray was normal, and his test results were as follows--",English
+"HIV negative; reactive protein reagent test, positive, at 1 to 512; Treponema pallidum particulate agglutination confirmatory test was positive;",English
+"and he did receive spinal tap. The CSF showed a VDRL, venereal disease research laboratory test, of 1 to 2.",English
+"He had 75% white cells, 78% lymphs, 3% neutrophils, 19% monos/macrophages combo, 35 red cells, protein 58,",English
+"glucose 57. Other tests were done because of the psoriasis in the work up, and he was ACE negative, ANA positive,",English
+"on 1 to 160 speckled pattern, ANCA negative, HLA B27 positive by flow of cytometry. His Lyme serology was negative.",English
+"They gonorrhea and chlamydia NAATs of the throat and urine, which were negative. And on the aqueous humor that was sent, the PCR that was done",English
+"was negative for Herpes, CMV, Varicella zoster virus, and Toxo. So he was admitted.",English
+"And due to the acute retinal necrosis initially-- and it was a concern for the viruses that are listed here and the results weren't back, that was high.",English
+"And so they started him on IV acyclovir. And intravitreal ganciclovir was considered, but it was deferred.",English
+"So once the PCR returned, acyclovir was stopped. He had the results of this serologic test for syphilis. He was treated with IV aqueous penicillin G, 24 million units",English
+"daily, and Solu-Medrol for three days, and then steroid eye drops. And he was diagnosed with secondary syphilis.",English
+"With that diagnosis, he did recall a painless chancre. Other points to solidify the diagnosis is his high RPR titer, the mucous",English
+"patches in his mouth, the hyperkeratotic plaques with ""collarette scales"" on the palms and the soles. And you remember, this is pathognomonic",English
+"for secondary syphilis. And so he was given a diagnosis of secondary syphilis with ocular involvement and, actually,",English
+"neurosyphilis by the CSF. And as time progressed, here actually had no improvement in his vision at discharge.",English
+"His prognosis was guarded. Here are the plaques that were seen, and this is the ""collarette scales.""",English
+And this is clipped out of the New England Journal. You can read a little bit more about that if you go to that site. But do not miss this.,English
+And these were the mucous patches in the mouth. So here's another case. It's going to be shorter.,English
+We have a gentleman who says he has sex with other men. He presents with rash and blurry vision. He's 31 years old.,English
+"He says he's a man who was sex with other men, or MSM. He does use methamphetamine. He had symmetric macular rash on the trunk",English
+"He was on no medications. He had no allergies and no travel history. He was sent to an ophthalmologist,",English
+"and the diagnosis was retinitis. Turns out that his lab results showed he was, indeed, HIV positive, with a CD4 count of 50",English
+"and a viral load of 75,000. He had normal CBC and electrolytes and negative PPD. And in this case, his RPR was negative.",English
+"Now, the question that everyone pondered was, what might explain this patient's rash and ocular manifestations with a negative RPR?",English
+Could he have an acute rash with CMV retinitis? Certainly. Could this be a prozone phenomenon with ocular syphilis and secondary syphilis?,English
+"Could the rash and the retinitis have separate etiologies? Or was it none of these? Turns out, what he had was the prozone phenomenon,",English
+"which is a false negative RPR, where have so high antibody titers it prevents the antibody/antigen lattice",English
+"formation. And consequently, it will not precipitate down with a positive RPR test. It's rare, but we may see it more commonly in HIV+ than",English
+actually with neurosyphilis. So what you do in that case-- and there's references here on this slide on where to look if you want more information-- but what we do in this case is we,English
+"asked the lab to dilute the serum and then do the test. And what happened with this was that he, indeed, had a positive RPR at 1 to 1,024.",English
+"So he was prozone initial false negative RPR. The retinitis, in this case, was a manifestation of ocular syphilis.",English
+"This is his rash and the palms. This is what the eye looked like. And this, again, is a case that was shared from Denver.",English
+"So his lumbar puncture revealed a CSF VDRL of 1 to 16, eight red cells, 80 white cells, 93% of which were lyphocytes.",English
+"His glucose was 39. His protein was 100. And indeed, this was evidence of neurosyphilis. Some questions that come up in this",English
+"is, what stages of syphilis can involve the eye? Well, all stages. Eye involvement tends to occur, actually,",English
+"most frequently in secondary syphilis and then again in late disease, but it can occur at all stages. What part of the eye is involved?",English
+"This is not going to be simple. Every part of the eye can be involved, again, at any stage of the disease. But the vast majority of eye problems associated",English
+with syphilis are also associated with many other infectious and non-infectious diseases. So you have to think about this.,English
+"In other words, there's almost no eye findings that are absolutely specific for syphilis. I can look like anything, just like syphilis in general.",English
+"And these days, we have to have a high index of suspicion to pursue this as a differential diagnosis. So here is a cartoon of the eye.",English
+"And here's a list, actually, from 2008, that was in Review of Ophthalmology about ocular syphilis and the manifestations.",English
+"And look. You can see almost anything-- conjunctivitis, scleritis, episcleritis, uveitis, increased pressure, chorioretinitis. All the way down the line patients",English
+"can come in complaining of redness, and pain, and floaters, flashing lights, loss of visual acuity, and sometimes, unfortunately, if it's let progress",English
+"too long, even blindness. So the diagnosis can be confirmed if you can get them to an ophthalmologist for a split",English
+lamp. And that will add to the findings and increase your differential diagnosis bent toward neurosyphilis.,English
+"But you also want to do serologies. You want to do an RPR or a VDRL, whatever you have, and the confirm it with treponemal tests.",English
+"You also want to do a lumbar puncture. Now, this is another review-- this was in 1983--",English
+"again, showing the acute and chronic manifestations of ocular syphilis. And look, it involves all parts of the eye.",English
+"And you can go through all these, but the bottom line is, there's protean manifestations of this and not one thing can point you directly to the diagnosis.",English
+"This is a review, actually, in 2015, done here at Hopkins, and it looked at the clinical features and incidence rates of ocular complications in patients with ocular syphilis.",English
+"Now, mind you, this was a review from 1984 to 2014. I'm going to come back to this. It was 35 patients, or in 61 eyes.",English
+"And the gave comparison to HIV positive to negative, and the only real difference was that the HIV negative patients had a higher percent of cataracts than the positives,",English
+"and the HIV positive patients were more likely to have optic nerve involvement than were the negatives. Otherwise, everything was pretty much the same.",English
+"So are ocular syphilis and neurosyphilis the same thing. Well, actually, no. They are separate entities.",English
+"But there's a lot of overlap, and it has to do with embryologic development of the eye and the connection to the CNS, or central nervous system.",English
+But the bottom line is that it's very difficult to tell and to say one isn't involved with the other. So important points to remember.,English
+"One, all stages of syphilis can involve the eye. And the second one to remember is neurosyphilis can occur at any stage of the disease.",English
+"So again, this is a little cartoon trying to review for you how syphilis would progress if it read the textbook. The problem is, it doesn't always read the textbook.",English
+"So quickly, you may have exposure. Someone will be exposed to syphilis. Their partner has syphilis, and they have sex,",English
+"and they're exposed. And at the site of inoculation, where they had sex, maybe in three to four weeks, or we we call it nine to 90 days,",English
+"people can develop primary chancre. Now, not all develop a primary chancre. 30% to 50% do. And you have the chancre.",English
+"You do nothing about. Two to six weeks, you may go into secondary. But not everyone goes into secondary. Secondary can the progress, if not treated, into latency.",English
+"And among 30% of those patients with latent disease, they can go on to tertiary or end-stage manifestations-- destruction of end-organs by, perhaps, even the footprint",English
+"of this heirarchy. Bottom line is, syphilis can go from exposure into a latency, not manifesting with primary-secondary disease.",English
+"But here's the take home message. We used to be told, a long time ago, or at least thought we had been told that neurosyphilis",English
+is a late manifestation of syphilis. It's not. It can occur at any stage along this cartoon. So keep that in mind.,English
+"So what do we do to diagnose ocular syphilis specifically? Well, ocular signs and symptoms in a person who has syphilis",English
+"should trigger you to think about this, because most diagnoses are presumptive. And most patients will help positive serologic tests",English
+"if we look for them. So in patients with late ocular syphilis, honestly, 30% may have a negative serum RPR or VDRL, heart but all",English
+of them will have a positive serum treponemal test. So if you're doing the reverse algorithm you're going to pick this up.,English
+"Don't be surprised if the VDRL, RPR, whatever you're using as the non-treponemal test is negative, because some people in late stage lose that.",English
+"Very rarely, someone with early syphilis, in the primary stage, will also have negative syphilis serologies and eye problems. So again, you've got to talk to you patients",English
+and put the whole picture together and keep syphilis in mind. Do you need to do an LP in someone,English
+"who only has eye symptons and no other neurologic symptoms? Yes, and here's why. If the CFS VDRL, which is the test we do,",English
+"is positive in someone who has eye symptoms, you can make a definitive diagnosis of ocular syphilis. And that's really the only way to make a definitive diagnosis.",English
+"Let me remind you, up to 70% of patients with ocular syphilis will have evidence of neurosyphilis on LP.",English
+"Some won't. Some will. But you're looking for that, because if they do have evidence of neurosyphilis, clinicians really should follow them with LPs maybe every six",English
+"months to make sure that they responded to therapy. Also, if you have an LP at the beginning of therapy, you're hopefully pretty clear that you ruled out",English
+"other causes of this, and it gives you a more complete picture of what you're dealing with. So here are some symptom questions to ask,",English
+"and the DHMH is putting this out. You can see this. Symptoms of ocular syphilis, simply to remind you to ask the questions-- have you,",English
+"the patient, had a change or blurring in your vision? Do you see flashing lights? Do you see spots that move or float in your visual field?",English
+Have you recently had pain or retinus in the eyes? All good screening questions. Other questions of neurosyphilis--,English
+"have recently started to have headaches? Have you had new weakness in any part of the body-- arms, legs, facial droop?",English
+Have you had problems walking? Have you had problems with memory or confusion? And do you feel or have been told that your personality has changed?,English
+"All of these, again, may lead you to think about neurosyphilis or put the differential higher in the list.",English
+"Now, what should you do if you suspect someone has ocular involvement? Well, here's the problem.",English
+"In rare cases, syphilis of the eye can progress very rapidly and cause blindness, so you want to act relatively quickly. It's someone suspects that eye symptoms are due to syphilis,",English
+"the patient should be evaluated by an ophthalmologist. Now, that's great, but if you don't have access to an ophthalmologist--",English
+"AUDIENCE: I'll see all the patients. ANNE MARIE ROMPALO: --then the patient needs to be referred to the local ER. And we have an ophthalmologist sitting here in the room,",English
+"and he'll see them. If the ophthalmologist finds any evidence of eye involvement, then the patient will most likely need an LP. How do we treat ocular syphilis?",English
+"Use the same regimen as neurosyphilis, even if the lumbar puncture is normal. Even if the lumbar puncture is normal.",English
+"Remember, 30% of patients with ocular syphilis will have a normal LP. Now, listen, if you can't get them to see an ophthalmologist,",English
+"if you can't get them in immediately, if you can't get the LP done immediately, don't delay antibiotics. One should be careful not to delay antibiotics",English
+"while waiting for the LP or further evaluation. So if you think this is eye involvement, set everything up with neurosyphilis.",English
+"Set everything up. And if you can't get the work up rolling quickly, then start antibiotics. Because the whole point is to start Aqueous Procaine",English
+"penicillin, short-acting IV penicillin, to get into the CSF and hopefully get the eye some treatment as quickly as possible so it doesn't progress.",English
+"Now, here you go. Ocular neurosyphilis treatment, as recommended by the CDC 2015 Treatment Guidelines, is listed here.",English
+Aqueous Crystalline Penicillin G. That's not the long-acting benzathine penicillin that you give in shots.,English
+"This is the aqueous form, so it gets good absorption into the CFS. And you give it 18.4 to 24 million units, intravenously.",English
+"You can give it as three to four million units IV every four hours, and you give it for 10 to 14 days. Now, some people have given daily injections.",English
+"It's hard to tolerate them. But in Britain, they do this. And I put this up for completeness, along with probenecid, to keep the penicillin levels",English
+"in the serum high. And again, that's for 10 to 14 days. So experts say that after you give this IV therapy for 10 to 14 days, you should then",English
+"give long-acting bicillin, 2.4 million unit shots once a week, up to three weeks. Some only give one shot.",English
+"Other clinicians say, maybe we should give three additional shots. Again, the key is to get 10 to 14 days of IV Aqueous",English
+"procaine penicillin on board. And then, if you want to, you can email us and we can talk to you about where you want to go with the shots.",English
+"Get the IV penicillin started. Will patients with ocular syphilis get better with antibiotic treatment? Yes, the majority of patients will actually",English
+"get better if the antibiotics are not significantly delayed. But you're going to find some patients, particularly those with late ocular syphilis, they may not improve.",English
+"Remember, the goal of therapy in late syphilis is to stop further progression of the disease. Whether it causes a major improvement in the signs",English
+"or symptoms is great, but it may not. But we don't want it to progress any further. So all of this is predicated on a 2015 clinical advisory",English
+"that came out in April. And it was Ocular Syphilis Alert. And it was from California, Washington,",English
+"and a few other states. And it was in the MMWR, as you can see. There were 24 cases that were reported to the CDC. The majority were HIV infected, and they",English
+"were men who had sex with men. Few, however, were not infected, and they were both men and women, which made us stop and think.",English
+"There's significant sequelae that were reported, also including blindness. So the CDC admonished us all, at that time,",English
+"to be aware of ocular syphilis. And again, I'm going to go through this. The symptoms that they wanted us to pay attention to is loss of vision, floaters, blue tinge in vision,",English
+"flashing lights, and blurring of vision. And be sure that you do a careful neurological exam in these syphilis patients.",English
+And patients with syphilis and ocular complaints should really be sent to the ophthalmologist as quickly as you can get them in.,English
+You should perform and LP in these cases. And then question came up-- is this because we're seeing more syphilis in general?,English
+"The rates of syphilis are, indeed, increasing among the MSM population. And now, we're seeing more in females, and also, we're seeing more congenital syphilis cases.",English
+"Is this merely because we're seeing more syphilis, and this is something that we'll see because we have greater numbers? Or is there some sort of neuropathogenic strain",English
+"emerging? And the answer to that is, we really don't know. So let's talk a little bit about what we're seeing here Maryland in the past year.",English
+"And if you recall that the Hopkins review ended in 2014-- it was like 1984, 30 years, to 2014-- well, this is what's happened in 2015.",English
+"And these are preliminary findings. In this slide, we had a total of 14 cases. Most of them, 79%, almost 80% were among men,",English
+and 20% were among females. So it's not only men. Two cases counted in the total but couldn't be located for a follow up.,English
+"And here among the men, we had six MSM, three men who said they had sex only with women, and two who did not tell us or we couldn't",English
+find their sexual preference. Here's the-- it came up wrong. But here's the distribution.,English
+"And unfortunately, this came up. And I will put up the Anne Arundel county and each county on here as it came up.",English
+"I believe, of the 14 cases-- and I apologize-- Anne Arundel County had the highest number.",English
+But we'll put this up here with the exact percentages. All right. The age at diagnosis.,English
+"Ages ranged here in Maryland, from 22 to 64. The mean was about 50 years old. And you can see their racial ethnicity distribution",English
+"listed here in the bar graph. The majority of eight of the 13 were Caucasian. HIV status-- one unknown, three diagnosed",English
+"with HIV simultaneously, three had previous HIV, and seven were HIV negative. So it was almost neck and neck between HIV positive and non.",English
+"And here's how they fill out in stages. And you can see that secondary is on there, but early latent and late latent also made up",English
+"a good chunk of our ocular syphilis cases. In the state of Maryland, the reported symptoms and the diagnose conditions were as follows--",English
+"we had patients come in with blurry vision, painful eye, the whole gamut. Loss of vision, eye pressure, one photosensitivity, and quote unquote, ""eye infection"" in one.",English
+"And the diagnosis that was made was three had uveitis, one scleritis, one swelling of the optic nerve, one ""leaking optic nerve,"" quote unquote,",English
+"and one retinitis. Nine people reported visiting an ophthalmologist, and three reported extra-ocular neurologic symptoms",English
+"of hearing loss and headache. So of the 13, we were able to document treatment in 12 patients.",English
+"And this is what we know. One didn't have any improvement, one improved completely, and we have seven that are still out there, we're trying to locate and find.",English
+So here's the big question that we contemplate. Is this increase in ocular syphilis indicative of a more virulent form of neurosyphilis?,English
+"Or is it because, as I said before, we're seeing increase in cases and more protean manifestations of an old disease?",English
+"Well, the people in Seattle have done some studies on Treponema pallidum strains associated with neurosyphilis, and this is what they reported.",English
+"And you can see that it's in the Journal of Infectious Disease, 2005 and 2010. And they continue to do work on this.",English
+Treponema pallidum DNA from 83 patients were evaluated for neurosyphilis. Most of these LP specimens came from Seattle.,English
+"21, or 50%, of the 42 patients with one strain, and that's the 14d/f, had neurosyphilis. And then, 24 of 41 patients with seven other strains",English
+"had neurosyphilis. So it looked as if the 14d/f strain was more frequently associated with invasive disease. Now, in rabbit studies, which they do in Seattle,",English
+animals infected with the 14a/a strain and this d/f strain actually had the greatest degree of neuroinvasion. Further studies are needed.,English
+"We don't know what's causing this or if it has anything to do with the strain. But the [INAUDIBLE] are interested, along with the CDC, in pursuing the question.",English
+"So the ocular syphilis specimen protocol, as published on the CDC website, is as follows-- CDC's study of strain types associated with ocular syphilis",English
+"is what they're trying to do. Again, University of Washington lab is doing the strain typing. So what do they need?",English
+"Ideally, they need specimens before antibiotics are given. But again, I'm telling you, don't delay antibiotics until you get the spinal tap.",English
+"That's just not the way to go. But if you can, before you start the antibiotics, if everything lines up appropriately,",English
+"think about this. They need 3 milliliters of blood in a purple top EDTA tube. Hopefully, they need, if the person",English
+"has primary or secondary lesions, a sterile Dacron swab from these lesions. And then, if you can put it in a glass container",English
+"and put it in the freezer, that's great, or plastic and get it into a negative 80 degree freezer. If you do a spinal tap, 2-3 milliliters of CSF",English
+"would be ideal. And ocular fluid, if for some reason there is an aspirate done of the chambers.",English
+"Freeze the specimens at negative 80 degrees, as we talked about. If you don't have a negative 80 degrees, negative 70 will be fine.",English
+"And hopefully, let them know to call up the numbers that are indicated on the CDC website, and let them know, and they'll tell you how to ship",English
+"these specimens on dry ice. Here's the recent contact that's listed on the website with a phone number, if it comes up.",English
+So ocular syphilis-- the ongoing questions and challenges is that there is a lack of clarity whether this truly represents an outbreak of a more neuro/ocular-tropic strain,English
+"of syphilis, versus increased awareness of a known complication of syphilis in the setting of increasing numbers of syphilis cases.",English
+"Again, there's limitation of current surveillance system, unfortunately, to detect or record ocular syphilis cases. So we depend on all clinicians that",English
+"are out there to let us know that this is what you're seeing. So in summary, clinicians should be aware of ocular syphilis",English
+"and screen for visual complaints in any patient at risk for syphilis. And the risk factors for syphilis include having sex with anonymous or multiple partners,",English
+"sex in conjunction with illicit drug use, or having a partner who engages in these behaviors. Assure that all patients diagnosed with syphilis",English
+or suspected of having syphilis are evaluated for ocular and neurological symptoms. So ask the questions.,English
+"Refer patients with positive syphilis serology and either ocular or neurologic signs or symptoms immediately, either for ophthalmologic evaluation or evaluation",English
+for an LP with a CSF examination-- that may be to the ED-- and even for possible hospital admission and IV therapy.,English
+"When referring a patient for evaluation, communicate the need to evaluate specifically for ocular or neurosyphilis using--",English
+"we have the Maryland Ocular Syphilis and Neurosyphilis Screening Guide, which I believe was shot out last week. But you can get it, and I'll show you on the website",English
+where you can download that. Send the patient with something-- if you're sending them to the ED-- that indicates that this,English
+"is what you're thinking about, and this is what they need to consider and work on. So obtaining a lumbar puncture, as I said, is ideal,",English
+but treatment should not be delayed while waiting for an LP. Manage ocular syphilis according to the current CDC treatment,English
+"guidelines for neurosyphilis. So eye involvement that you think is due to syphilis, regardless of the CSF findings,",English
+"gets the treatment IV aqueous procaine pencillin-- I'm sorry. aqueous crystalline penicillin G for 10 to 14 days, ideally.",English
+Test all patients with syphilis for HIV. Always co-test patients with syphilis for HIV if the status is unknown or they were previously negative.,English
+"Report all cases of ocular syphilis to your local health department, ideally within 24 hours of diagnosis. So the case definition for an ocular syphilis case is",English
+as follows-- it's a person with clinical symptoms or signs consistent with ocular disease-- and we talked about all that are listed here--,English
+with syphilis of any stage. This is the more confidential morbidity reporting instructions that are available.,English
+"It's the morbidity card, and you can see where it's available. And what is listed here is the reporting. And what you can see is we have Syphilis Stage, Other,",English
+"which you can actually write optic on there if you think that's part of it. So Syphilis Stage is what it is. And then the Symptoms, you can indicate here under Other,",English
+"you could do Neurological or Other, Optic, which would be very helpful to the state to see how many cases they're actually seeing.",English
+There's a lot of this out there and in many other cities and states besides ours. And you can see some of them are listed here--,English
+"Washington, Philly, LA. But we want to be on top of this. So I'm going to-- I stopped early, which we have a lot of time for questions.",English
+"If you need to receive technical assistance, it's on here, with the treatment guidelines, ocular syphilis, neurosyphilis, specific case consultations,",English
+"you can get to us through this address or you can call, 410-767-6690. And for additional information, the website is listed here.",English
+There's also a lot of information at the CDC website. So I will see if we have any questions floating about. These are our sponsors.,English
+"And email questions to the presenter, again, and you can get C1 credits for this. So if we have any questions in the audience.",English
+"Yes, ma'am? LUCY WILSON: I'm sorry. We're having a microphone problem. Could you go up and share the microphone and ask the question?",English
+We're trying to get a new mic in here. Just so people-- ANNE MARIE ROMPALO: We are writing our questions up so you can see them too.,English
+"ANNE MARIE ROMPALO: That's a great question, and it's come up multiple, multiple times. The reason for doing the LP is that you have a baseline.",English
+"So you don't know whether it's going to be positive or negative when you start. And also, when you're working up the patient you think it's syphilis, but there's many, many other things",English
+"that could be involved. I mean, what if it's CMB retinitis? What if it's any of the HSU, the things that were listed there? You'd like to have a complete picture of what's going on.",English
+"TheBalancingAct.com, or get a little bit social. Care to share, by logging onto Facebook/thebalancingactfans.",English
+(music). It is a truth universally known. We women have a love-hate relationship with our hair. Good hair days are great!,English
+"Bad hair days, not so much. This morning, we've got some wonderful options when it comes to glamming up our own crowning glory. Joining me is Kat Lewis, an educator for DreamCatchers Hair",English
+"Extensions and our stunning model Kim Billick, who is here to help demonstrate the process. Thank you both for coming in today. Yeah, thank you for having us.",English
+"Now, I saw some amazing transformations going on in the green room. We won't get to that right now. First of all, I just wanted to talk to you Kat, are all hair",English
+"extensions created equal? Unfortunately not. One thing you really will see with extensions is the fact that you hear the horror stories of them damaging your natural hair,",English
+"or pulling, or being so expensive, or looking unnatural, that it's great now that DreamCatchers has come out, that you can really get a beautiful look without damaging your",English
+"natural hair, and you can reuse it, month after month, and even some cases year after year. That's amazing, and one thing from my days in L.A.",English
+"and on Entertainment Tonight, I can tell you, almost every star uses hair extensions, and they're not just for the red carpet or the spotlight.",English
+"They're really affordable, for everyday use. Oh, absolutely. Most of my clients that I actually have personally, as well as all the other stylists around the country, all of their",English
+"clients really are working women between the ages of 30 and 45, that just want to give their hair that extra pep in the step. Take me through a little bit of the process of what you did with",English
+"Kim. We took her hair, which was relatively short, a little bit thinner. We added in the DreamCatchers and gave her length, volume, as well as some extra bit of color without actually chemically",English
+"processing her hair. It feels like your natural hair. It moves like your natural hair, and it all comes pretipped right at the top, with a rubber tipping, so when it goes into",English
+"the actual bond that holds it together, it doesn't damage your natural hair and it doesn't slide out. That's great, and it comes in, well this is fun...",English
+"but you have length options, color options, all kinds of things, right? Absolutely. We've got different wave patterns.",English
+"Different colors. Different lengths to match exactly what you're looking for. Now, tell me, you actually you actually, you do yoga, you're running around.",English
+"Tell me about how they work for you, Kim. Honestly, they've changed my life. It makes my days a lot easier. I'm a full-time occupational therapist.",English
+"I teach yoga. I'm in the yoga studio everyday. I do hot yoga, and it's so versatile. I just throw my hair up.",English
+"It's changed your life, you said. That's amazing. Yeah, it definitely has. The can actually improve your own hair when you have them in. Tell me about that.",English
+"Tell me about that. Absolutely. If we were to color our natural hair, maybe Kim's hair for example, her hair is a little bit darker, and to become this little bit lighter, she would have to process her natural,",English
+"whereas when she wears the dreamcatchers, it's less processing because we're putting in her highlights using the extensions.",English
+"She only has to do a little bit of color on the top, and the rest is all colored with these. That's so great. Were you going to put this in Kim's hair?",English
+"Oh yeah, I can show you how to do these. The way that we attach these is there is no heat, no glue, no sewing, no braiding, no chemicals of any kind. It's all put in with a small cylinder just like this, and",English
+"they come color coded just to match the base tone of whatever your hair is. That way, it just looks like it's growing out naturally with your own hair.",English
+"You grab a section of the natural hair and you bring it through the loop. You slide the cylinder up and then you just pull. Then, you take the extension, pop it into the cylinder, and",English
+"Well, one thing that's great is that we do certify stylists all over the country, and we have classes going on year round. Now, if you are looking for a stylist in your area, we have an",English
+"855 number, it's actually 855-thesalon, and when you give it a call, it's going to redirect your call to the closest DreamCatcher stylist, so that way you can come in for a",English
+"little bit social, log in and share your thoughts about all things beauty at Facebook.com/TheBalancingActFans (music).",English
+"If you're pregnant or a new mom, congratulations to you and your growing family, but listen up, because we have some information on a rare and dangerous blood clotting disorder that's",English
+"important for anyone diagnosed with it, but most of all, for you expectant moms out there. Joining me to talk about this is maternal-fetal medicine",English
+"that's great. It's awesome. The problem is, there are some people who actually clot too easily. In other words, they actually have clots that can put their",English
+"lives at danger, and the specific clotting disorder we're going to talk about today is the anti-thrombin 3 deficiency. It's a hereditary type of blood clotting.",English
+"something so dangerous. So, how rare is this? It is a rare condition, but not as rare as people think. Okay.",English
+"in pregnancy, she's planning her family, she's planning for a healthy baby, she's looking to the future. She wants to ensure she does everything to get there, but at",English
+"the same time, she has this deficiency in her blood that causes her to clot spontaneously. It can happen in her arteries.",English
+"from getting adequate oxygen, and placing her life at risk, as well as her baby. Unfortunately, that event is not 100% predictable, so we can't",English
+"will develop a clot, and they can have a life-threatening event in that pregnancy. Now, you mention, doctor, that it's inherited. So, are there signs that someone can look for, maybe in terms of",English
+"maybe recognizing that they could have this? That's important. So, since it's inherited, it means we have to look at our whole family.",English
+"We have to step back and not only think about ourselves, but think about what happened to my mother, what happened to my father, do I have sisters? The family tree.",English
+Exactly. We need to look at everyone in the family. Have we had individuals with early heart disease? Have we had other individuals that have had these clots?,English
+"Maybe they've happened in their leg, maybe they had clots that went to their lungs, sometimes called a pulmonary embolus. Exactly. That caused them to be admitted to the hospital.",English
+"or brother, is on a blood thinner. A blood thinner is there to protect that person from these types of clots. The question is, what caused their clot?",English
+We also have some information to share with you about how to reduce the risk of blood clots. Very important. Especially if you're pregnant.,English
+"She's anticipating a healthy child, a healthy delivery, and really we're not focused on the complications, but we know that sometimes complications do creep in to these scenarios.",English
+"We do things in obstetrics to try to elicit this information, to try to find out, is there a risk in this family? For instance, we might ask a woman, do you have any family",English
+"history of things like blood clots. We may refer to terms like thrombophilia, meaning that a person clots too easily.",English
+We may ask those questions. Sometimes patients don't actually know. They don't know the answer to that. They may not know their family history completely.,English
+"One of our jobs is to try to alleviate that, to make a plan, to make a plan to minimize the risk of a thrombophilia upon that pregnancy.",English
+"To minimize the risk of clotting too easily, and in the case of anti-thrombin 3 deficiency, it's very important to know if this deficiency exists in the patient so that we can make a plan for",English
+"how to care for that pregnancy. And you can make a plan, and here's the good news, because you can reduce the risks of blood clots. What are they?",English
+Absolutely. When we look at these women who have hereditary anti-thrombin 3 deficiency. We're talking about women who have low amounts of this,English
+"protein, anti-thrombin 3. So, the reason they're clotting is not just accidental. It's occurring because they have a deficiency of something that",English
+"normal people have enough of, and that protein is important in balancing clotting versus anticoagulation. If you don't have enough of that protein, you're more likely to",English
+"clot. In fact, as that protein gets lower and lower, you're clotting risk is going higher and higher. So, the key is we have the ability to donate this molecule,",English
+"this anti-thrombin 3, we can get it off of the shelf from other patients, and give it to a patient to replace their ability to prevent clots, to keep them in a normal balance that they",English
+"should have in pregnancy, and thus protect their pregnancy, as well as their outcome for that pregnancy. Doctor, I know you're very passionate about this, and",English
+"There are many resources a person can go to. For instance, ClotConnect.org and it's actually put out by physicians, and it actually gives you reliable information",English
+"When you go in, talking to your physician should be a two-way discussion. You should be providing information, they should be providing you information, and you should both make a plan",English
+This is a very special type of clotting disorder that really places a person at a very different degree of risk than the other clotting disorders.,English
+"So what does that do for people, here 20 years after we began the clinical trials are the results.",English
+So the treatment to try to get rid of the last cancer cell in the body is to use high doses of drugs like these three,English
+that I'm listing on the top. You give a lethal dose. As you get rid of more and more cancer cells with higher and higher doses.,English
+"You also get rid of the body's own blood-forming stem cells. So you need to replace them after you finish this high dose chemotherapy,",English
+"the standard of care for the last 30 years, which really ended in the early 2000s was to give back mobilized blood",English
+"contaminated with cancer cells, but containing stem cells. And here we did that at Stanford,",English
+"and we found that half of the women were dead a little over two years, about 26, 27 months. And all of them were dead or had disease",English
+"by 10 years to 15 years later. When we rescued them with cancer free stem cells, we found that we extended the median survival.",English
+"So only half of them were dead at 10 years. So we had for the majority of the people treated and extension of life with their family at home,",English
+"doing their jobs from two years to 10 years. And today, 20 years later, actually more than 20 years later,",English
+"one third of the women are alive without disease. On my 80th birthday last year, I met two of those women",English
+And I'll leave it up to you to think what too better too better for them. But I could calculate from this extension,English
+"of median survival, that after the end of the chemotherapy, before we rescued them with cancer free stem cells, they had less than 100,000",English
+cancer cells in the body. Even though they started with 10 to a hundred billion cancer cells.,English
+So the chemotherapy was terrifically effective. And the only way we could get the full effective chemotherapy was to rescue them with cancer-free cells.,English
+"So when you think about I can purify blood-forming stem cells, what are all the diseases you could and we are approaching",English
+by isolating at least blood farming stem cells. So here's a cartoon of blood-forming stem cells going through the steps to make blood.,English
+"You can see there are lots of steps on the way which are defined steps in development. Now, if you have a blood-forming stem cell",English
+"and you have sickle cell anemia, all of your blood cells will have sickle cell anemia or Mediterranean anemia or hemophilia",English
+not take a drug every day. You could either transplant stem cells from a donor who's stem cells don't have the disease.,English
+"Replace your own blood farming system with blood framing systems that work, and that will cure every one of those at least experimental models of disease.",English
+"The other way, which is always dramatic and exciting and almost science fiction",English
+So it's a little more involved because you've got to get out the stem cells. You've got to find a way to fix just that gene and don't alter another gene.,English
+"Institute at Stanford. So now you want to purify the stem cells to go from a donor to a host. Now, when a donor and a host are genetically different,",English
+a skin graft on the recipient would be rejected by the T cells on the donor. And if you transplant those T cells along with stem cells,English
+"into the host, they'll attack the skin and the lungs and the mouth and the liver and the heart and the patient would be in hospital",English
+purified stem cells don't have T cells. They do not cause graft versus host disease. So we want to change the whole field,English
+"of bone marrow transplant to purified stem cells from yourself, free of cancer cells to enable cancer treatment from a donor",English
+"in order to get their system and your body. Now, what are the advantages of doing that? Well, here's a disease that you might not spec,",English
+"is a disease of the blood-forming system. It's called juvenile diabetes, a type one diabetes. And in the mouse model of this disease",English
+that weren't taught to know self from non-self. When we tried to save them with the animal's own bone marrow,English
+"after high dose chemotherapy or radiation, we just bought a month, that wasn't enough. So when we purified the stem cells,",English
+"so none of those diabetes causing T cells were crossed, you bought another month, but if we transplanted stem cells from a donor",English
+"that didn't have the genetic predisposition for the disease, we could prevent completely the development of diabetes if we just did it a week before,",English
+"they would have gotten diabetes. For those that had diabetes for a long time, we needed to be able to transplant blood-forming stem cells",English
+"and the insulin producing organ or stem cells from the donor. So along the way, we found that",English
+if we transplant blood farming stem cells from a donor to a recipient and they take the immune system comes from the donor,English
+"and it won't reject an organ coming from the donor. And then in the model I just showed you, we co-transplanted blood-forming stem cells",English
+and insulin producing eyelid cells into animals. Mice that had juvenile diabetes were maintained on insulin for at least six months.,English
+And we cured them. That should have been a therapy when We first published it in 2001. It's still not a therapy because,English
+"there was deliver of purified stem cell therapies out there, largely because we had depended on a company. Now we wanted to be able to take that",English
+"to children with diabetes. But as I told you to prepare somebody for a blood farming transplant, you give high dose radiation or chemotherapy.",English
+"And if you've got a kid who's just showing the first signs of diabetes drinking too much, peeing too much. 'Cause the sugar is just building up in the body.",English
+"You don't wanna give chemotherapy or radiation, which has a 15 to 20% risk of killing them. And if you didn't get rid of the T-cells,",English
+"another 30, 40% of graft versus host disease. So if we use purified stem cells, we developed a new method to replace radiation chemotherapy",English
+"with an antibody that gets rid of their own disease stem cells, another antibody to get rid of the T cells that would reject",English
+the stem cells coming from the donor. And that worked. We just published last year,English
+"that we could almost take any donor and any recipient. So here we have a mouse we're gonna to get the bone marrow, pure stem cells from it.",English
+We'll transplant it into an animal that we had given the antibodies that get rid of the stem cells and the T cells.,English
+"We give another antibody that helps him. And when we do that, you get donor derived blood, the immune system and the innate immune system.",English
+"Now we take hearts that we get obtained from genetically identical donors, and we transplant them and we put",English
+"a little bit of a heart tissue into the ear of a mouse. So now you have the beating heart in the ear. And if we take it from the stem cell donor,",English
+"it survived without any chemotherapy, any immunosuppressive drugs, nothing. And when we look at the tissue, you see the heart tissue.",English
+"If we get it though from a third party like this one, not identical to the blood farming stem cell, so you gotta have that match.",English
+"It's rejected within 13 days. So this makes blood-forming stem cells, the platform for all of regenerative medicine",English
+"and all organ transplants, because you take away the toxicity with the antibiotic conditioning. We found a few years later that we could isolate",English
+"in pure form human brain forming stem cells. And we tested them in many ways for their ability to restore brain,",English
+"by putting them into the brains of immune deficient mouse and found they behave just like the mouse brain forming stem cells, but these were human.",English
+So they would keep self renewing in the stem cell zone. They'd migrate long distances to make new neurons and our astrocytes or oligodendrocytes.,English
+"And they would be cite appropriate and their parents. And this is just to show things could go wrong in some people,",English
+"and you could get a cancer of the brain called glioblastoma, and I'm gonna come back to that, but I just want you to see the enabling.",English
+"Now we wanted to know, could we co-transplant, brain forming stem cells and blood-forming stem cells from the same donor?",English
+"Well, first we developed brain stem cells from a common donor that we could expand and did clinical trials at a company I cofounded",English
+"called Stem Cells Incorporated for macular degeneration the dry type for spinal cord injury in the neck or in the chest are genetic diseases of newborns,",English
+which are always lethal. And those cells work and they were going well. And we now need to move this into clinical trials,English
+at a much higher case. We found that we had to maintain immunosuppression. So we paused everything until we could get the blood-forming,English
+"and the brain forming stem cells from the same donor, so that we could now move into safe methods of doing it. While we were thinking about how cancer start,",English
+how leukemia start. We were finding that every tissue and organ in the body has its own tissue specific stem cell,English
+"and that some place in the development of cancer, a cancer cell gains the self renewal property that we thought was limited to normal stem cells.",English
+"A bunch of us did that trial and we found in the experimental therapies, if you've got rid of everything, but the cancer or tumor stem cell, the cancer comes back.",English
+"This is about all of the drugs that we had in the 20th century because companies tried to say, can you get rid of 90% of the cells?",English
+"that if you get rid of the tumor stem cells alone, the tumor goes away. So back in 2000 with two of my postdoctoral fellows",English
+"from Japan, we got bone marrow samples from Hiroshima hospital of people who got acute leukemia 15 to 20 years after the a bomb explosion.",English
+"And we were able to separate those bone marrows into the markers that would be blood-forming stem cells. And then we found a particular cell type,",English
+"which had the leukemia stem cell. It was a cell that normally doesn't self renew on its own, but with the mutation.",English
+"And here's one we're showing that causes the leukemia, all of these leukemia stem cells have it. So when you try to pass the disease",English
+"from a human into an immune deficient mouse, these cells, passage leukemia, the bone marrow stem cell don't,",English
+"but we found that five to 40% of the stem cells from those people, with the leukemia, even though they're not yet leukemic,",English
+"they have the mutation. So that made us pause and think and say, just a second, if we have blood farming stem cells",English
+"that go through those progenitors to make blood, and we have multiple mutations that could occur to lead to the leukemia stem cell,",English
+"'cause we had isolated it. And with Katrina Jamieson, we also isolated it for myeloid blast crisis of chronic myelogenous leukemia.",English
+So we had all of the acute myelogenous leukemia and the killing phase of chronic myelogenous leukemia. And we found there were a number of mutations.,English
+"Now, if those mutations had occurred in the many more numerous cells downstream, they would be lost with the lifespan of those cells.",English
+"These cells don't self renew, even if they have the first mutation or the second or the third. So many more cells in the body are getting those mutations,",English
+"every human being that we've tested. And others have tested, have this translocation that can give rise to leukemia, but they don't have leukemia.",English
+"So that said to us, the only way that that's gonna persist and be able to make the clown, the daughter cells that are leukemic is if",English
+"it is in the blood-forming stem cell. So our hypothesis was that this expands, this expands, and then one of the daughter cells that had mutation",English
+"when it gets one, two, and so on. Now, if that hypothesis is correct, we ought to be able to find all of the mutations",English
+"in a person's leukemia stem cell, and then by isolating the single blood-forming stem cells, we ought to have one, if all seven mutations were there,",English
+"we had to have one that has six, another one that has five, another four, three, and all the way back. So we thought this was a brilliant idea.",English
+"Let's see if it works. So with a whole team of people we found and published eight years ago,",English
+"that every patient that we've looked at with acute myelogenous leukemia at Stanford, we could do a DNA sequence of the leukemia",English
+"and find all the mutations. And we would simultaneously do a mutation of their normal cells. So we would look for mutations in the leukemia,",English
+not in the normal cells and patients 70. This is just our jargon so that nobody else can understand us,English
+"of the mutations and the genes that are mutated, but we could make with DNA technology probes specific for each mutation.",English
+"And then we can take from the same bone marrow of the same patient, single blood farming stem cells, and test all of these mutations to say,",English
+"does that stem cell have zero or one or two of these? And here is that patient on this lower, right? The first mutation that occurred,",English
+turns out to be a gene called tattoo and it now had expanded. So it was in fact pretty numerous.,English
+"And then a second mutation. It turned out to be the other chromosome that has Tattoo. And it wasn't just this patient 70,",English
+but another patient that we looked at. And so we could look at the step wise events in normal stem cells until the very last event,English
+"makes the leukemia breakaway. Now we could look at each event and begin to say, how numerous are they?",English
+Do they keep repeating from patient to patient? Are there different paths? And can we look at each mutation and find a therapy that would target that mutation,English
+"when it's a full leukemia or when it's a pre leukemia, you don't know which leukemia yet. So what we found is we could find those for each one.",English
+"I'm gonna show you very soon what that could be. But on the way Wendy Peng and I showed another lethal disease,",English
+"blood-forming disease in humans is a mutation in blood-forming stem cells that in older people, cause it takes a long time for that to develop",English
+the blood-forming system is entirely taken over by that mutan stem cell and it can't make some cells like platelets,English
+"or red blood cells or granulocytes. And then two years after that, one of our former trainees now,",English
+"then at Harvard Sir Jace, while working with Ben Ebert Charlotte, the older you get, the more likely you have a cell with the first mutation expanding,",English
+"their are 100 to 1,000 fold, more frequent. Than the ones that have these incurable diseases, AML and myelodysplastic syndrome,",English
+"but they predispose to these and other blood diseases. And amazingly, those people have the highest risk factor for heart attacks and stroke and aneurysms.",English
+"So what we thought we were dealing with was just something that would help blood formation. And as we get to the point that with purified cells,",English
+"we can begin to understand the order of events and in normal population, what happens? We get way further down the line.",English
+"So back in 1998, and then again, in the 2000s, we began comparing highly purify blood-forming stem cells",English
+"for the genes that are expressed in leukemia stem cells. And we found one that was always on leukemia stem cells, never at high levels or significant levels or normal.",English
+"And it was called CD47. What it is is a don't eat me signal. And it works by preventing the scavenger cells in the body,",English
+macrophages that are all throughout the body and all places in the body. It blocks their ability to eat cells that they think are dangerous.,English
+"And they know they're dangerous because those cells have put an eat me marker on their surface. And so if this binds to this receptor for it,",English
+"it gets eaten unless the don't eat me signal, countermands it. So we made an antibody that blocked the don't eat me signal,",English
+"and we put the cells together with macrophages human leukemias and it worked, it took us about eight or nine years",English
+"to do a real clinical trial. And these are patients with two incurable diseases, acute myelogenous leukemia of the elderly.",English
+"And what I told you about myelodysplastic syndrome. And I had the company, we started called 47 Inc. Almost all of the patients with AML or MDS",English
+"instead of growing more tumor, the tumor shrank down and then shrank down for as long as we followed most of the patients.",English
+"So already from a discovery that we began funding in the 2000s, just to follow this discovery.",English
+"We're curing patients. We hope for a long time, when we looked at incurable patients with really high grade lymphomas,",English
+we found that we could add the standard therapy called rituximab to this blocking antibody and those patients even though,English
+they were resistant to rituximab and all other drugs over half of them showed shrinkage for quite long periods of time.,English
+"So in the two first cases that we looked at, we have real therapies now going on in late stage clinical trials.",English
+"And just as a teaser, we found the same when our colleagues, Mike Clark and friend Sheeran gave us human breast cancer cells,",English
+the cancer stem cells that we could put into an immune deficient mouse into the breast and the Anti 47 got rid of it.,English
+"So if you think about, we cured a third of the patients by risk during them from high dose chemotherapy, with trust post-transplant antibodies, pardon me,",English
+"high dose chemotherapy. We wanna get the other two thirds cured. If we can, by adding second therapies,",English
+"when they only have 100,000 cells, rather than a hundred billion cells to get rid of. That we hope to do soon in the future.",English
+That set of therapies and those diseases turn out to be not the only ones that show abnormal expansion of a stem cell.,English
+"So with Gerlinde Werning we've shown in patients with incurable, pulmonary fibrosis, lung fibrosis. Usually a little later in life",English
+"or liver fibrosis requiring a liver transplant, their lungs go from here to here. The fiber blasts that are taking over the lungs",English
+"come from the outside layer of the lung, the drugs that are the standard of care, open it up a little bit, but they really just slow it down.",English
+"But if we give that blocking antibody plus an anti inflammatory antibody, at least in mice, and next we try in humans,",English
+we can clear an already fibrotic lung. Adhesions following surgery can come back and come back. And you've all rank of itch.,English
+"And Jonathan Saya and I have found two antibodies together in the mouse model of parity on two occasions, we can cure it.",English
+"And probably the last and most amazing part is that even atherosclerosis that causes the heart attack, the stroke, the aneurysm,",English
+"losing your limbs or going blind because of diabetes, the abnormally expanding smooth muscle cells that block the artery have the eat me",English
+"and don't eat me signal and we published and now we have more recent publications that at least in the mouse model,",English
+"we can get rid of the plaque or prevented its development. So that's a whole bunch of diseases. Now to finish, I'll just say,",English
+"as we follow our basic science line of research, and of course, as we are aging, that is we aging investigators.",English
+"We wanna look is the blood farming system of a young person or a young mouse exactly the same as an 80 year old person,",English
+or two year old mouse? And we found it isn't. There are at least two kinds of blood-forming stem cells that are formed during the embryonic phase of life.,English
+"The ones that dominate when you're young, make lots of immune lymphocytes to fight new infections. The ones that dominate in the old part of life",English
+"don't bother making new lymphocytes, but they make many more granulocytes and macrophages to get rid of acute infections.",English
+"Now that whole system evolved before trains, planes, and cars. It's the same in mice, as it is in humans and humans have this old one.",English
+In this pandemic because we don't have many lymphocytes left that can make lots of new lymphocytes,English
+"to get rid of the infection T cells and B cells. The trains, planes and the car is bringing HIV or Ebola, or COVID.",English
+"And we know that the oldest people are the most susceptible to lethal infection with COVID. We know that at the time they get it and get the lethality,",English
+"they have dominating old type stem cells. So we are working on, can we find a simple and safe way to get rid of the old ones",English
+"and rejuvenate the blood-forming system so that it acts like you're young. If that works, that would work not only for COVID,",English
+but all of the infections. So what I've told you is that starting with a simple look at the blood,English
+to find the blood-forming stem cells we've tapped into and many other scientists have tapped into ways to analyze the system,English
+that 20th century science didn't develop. And 20th century pharmaceutical companies didn't go after and we should have learned.,English
+"And we are learning that large pharmaceutical companies do what they do. Doctors trained in the 20th century, do what they learned.",English
+"So we have to do and redo every step of the way to take our discoveries through translation. And we think that should be funded,",English
+"not by profit incentive, but by those institutions that are not for profit, but want to see this new approach to end disease.",English
+"we have some questions. I'll start with the first question about COVID-19 and CD47, knowing that CD47 is an immune checkpoint.",English
+How do you think it plays a role in older patients susceptibility to COVID-19 or SARS-COVID-2 infection? - My point of view is that the immune system did develop.,English
+"They have lots of lymphocytes for transplants and cars that recognize new infections, and we make what are called memory cells.",English
+That's what vaccines do. All of us who had measles are immune to measles for life because we have long lived lymphocytes.,English
+"But as soon as trains, planes and cars came in new viruses, new bacteria and new diseases came up.",English
+"But we as old people, not you Cat, but me now are living on a system that was highly efficient before trains, planes, and cars.",English
+It made lots of granulocytes and macrophages to clear out acute bacterial infections. And it wasn't able to anticipate that you need,English
+"lots of new lymphocytes for life. So when an old person gets COVID-19, there's a much higher chance that they will end up",English
+in the intensive care unit on ventilators with admittedly 20th century medicine to treat them. And so that means that because,English
+"we haven't kept up with the science, the stem cell field has not developed itself commercially, the doctors trained in the 20th century",English
+"think they understand all the diseases they treat. So the wall street and venture capitalists, they would say, well, this work.",English
+And I've had to close down two companies that went broke because they talk to their family doctors or somebody they knew who had,English
+the gall to say it won't work. That's why the California Institute of Regenerative Medicine is the most important experiment,English
+to bring discoveries to people because it steps in it's the onwards person for people with disease. It isn't thinking about a profit.,English
+"Now, the way it's done is that you come, if you're from California, you make your grant request to serve and you get a review",English
+and you can battle the review of you think that you were dealing with those people trained in the 20th century and it can be overturned.,English
+The Anti-CD47 therapy was the first thing we brought. It was funded almost entirely by CIRM. It went from a laboratory experiment to a therapy.,English
+Today it happened that the FDA gave breakthrough status for the treatment of myelodysplastic syndrome with the companies Anti 47 plus AZ (mumbles).,English
+So what I'm trying to say is that you need that intermediate. You need somebody who you can trust.,English
+"Now I'm gonna add one more point because it's extremely important. We were able to isolate human blood-farming and the human brain-forming stem cell,",English
+"because we could try to repopulate the complex organs of the body with candidate stem cells. But if we're gonna do that,",English
+"you're not gonna get people to volunteer, to be irradiated to see if your blood farming stem cell works or have brain surgery",English
+to see if your brain forming stem cell works. So we were able to develop an ethical U.S. government approved ethical society approved way,English
+"of testing human fetal tissues, which were the result of somebody else's decision to have a therapeutic or elective abortion.",English
+We had to set it up so that no part of the process did the person who was deciding to have the abortion knew about it.,English
+"After the abortion they used, they signed an approval for the tissue to be used for research, instead of throwing it away,",English
+nobody involved in the process got a profit no matter what you've heard from the groups that are,English
+"completely against this, not only for themselves, but for all of us as well. I'm saying that because last year, and now again,",English
+"And they've just requested all embryonic stem cell research be banned. Now they believe in all their hearts,",English
+"they're doing the right thing. And I think everybody has a personal right to refuse to have a therapy or not have therapy or do something,",English
+"but they don't have the right, in our State, were have our federal government separation of church and State. They don't have the right to impose their religion",English
+"or their politics or their moral beliefs. It has happened unfortunately, once again, now that embryonic stem cell research and fetal research",English
+"is banned or is about to be banned, sorry, I took so long, but I wanted to make very clear that even these, this new research COVID-19",English
+"that there are ways because we could isolate stem cells, which required the use of human fetal tissues to do it. And now we have a path to test,",English
+"will this therapy or another therapy work? Something we can spread to everybody, except those people who are funded by the federal government.",English
+"- I think that probably was made very clear by Jake Heavier earlier today as a patient advocate, where he said that he had the best of the worst condition.",English
+We don't want anybody to have to deal so positively with such a tremendous onerous responsibility to take up the torch for everyone.,English
+"And certainly, Irv you been a champion for stem cell research, both at the bench and in the clinic in bringing the two together",English
+in terms of funding of CD47 and sort of de-risking it. Do you think that CIRM played a role there compared to your previous two companies?,English
+Did that help in terms of de-risking it for future companies or venture capitalists? Is that a model that we should use going forward?,English
+"- So when we made the discovery, Ravi McGeady and Sir Jay Swell, and a whole bunch of us, including you, as you remember,",English
+we applied to the national cancer Institute of which I was on the advisory board and they turned it down. They said it won't work.,English
+"We applied to CIRM and they funded in 2009 enough money for us in the academic institution, working with our own clinicians,",English
+"hiring regulatory people and FDA savvy people and people who do toxicity. All of the things that usually are in a startup company,",English
+"which spends most of its time looking for more money, but CIRM provided the money. In return, Stanford university,",English
+"and everybody else who accepted CIRM money said, if this works, there will not only be a benefit for people, but the royalties that Stanford gets",English
+by some predefined mechanism will be given back to the State of California. And I hope the state of California uses it,English
+"to support this kind of research they're not required to, but I hope they do because then you would make evergreen this process.",English
+"So four years after we got $20 million to develop a mouse study, we filed an initial new drug application",English
+"to do clinical trials with both the FDA and the United Kingdom equivalent MHRA. And I'll say proudly, they had no comments, no questions.",English
+"They were actually wild that we could do so much science. And that's simply because the people who made the discovery developed the therapy,",English
+"when things would go wrong in between, they already knew the system. If you sell it to a biotech and I've started many",English
+"or to a big pharma, they're siloed. When things look wrong and somebody a rising stars says it won't work,",English
+you save 50 billion bucks or more. So that kind of Macchia Valium promotion by saving money,English
+"can unfortunately derail many of the therapies. We're not the only ones who've had discoveries that could make therapies, but it's very important.",English
+"So they funded, CIRM funded with $20 million, a four year program and helped us develop it at Stanford.",English
+"And then another 13 million to do the clinical trial. At which point Stanford says, this is now getting too practical.",English
+It should be licensed to one or another company. So we had to scramble to form a company to do it. There's no doubt that none of this would have happened,English
+without CIRM funding 'cause we tested the National Cancer Institute and they said it wouldn't work. - And we've had a very similar experience.,English
+"And I completely agree of course you taught me that many years ago. I didn't believe it at first, but I had to learn it myself. And there are a few questions here.",English
+"I know that our fearless leader, Maria Melan wants to close out the day, but I thought I'd just ask these very quickly. Thanks sir, for a very exciting talk.",English
+"The use of pure blood-forming stem cells in a CD47 therapy appear to carry real therapeutic benefits. One of cancer cells, a unique hallmarks is metabolic reprogramming",English
+where nutrients are recruited from altered pathways to sustained rapid growth. Is there any link between the efficacy of an Anti-CD47 therapy and these metabolic changes,English
+"which may shape how cancer cells evade, the eat me signal. - It is a great idea. We don't know the answer yet, but members of the team,",English
+"Roy Mote and the Mirror Black Call, and a whole bunch of others have developed a method to see are there any more don't eat me signals we haven't seen.",English
+"And we've discovered three more, when we get to the point of looking at each person's cancer and saying, well, we will have to prescribe",English
+"an antibody to don't eat me signal one and don't eat me signal two, that's precision medicine. When we do that, we'll have to look at the question.",English
+Does diet or metabolic changes play a role? I would be surprised if it didn't. - Right also...,English
+"Sorry, not to interrupt, but there's another question related to that from (mumbles) Shankar, is it known, Well we know that human and mouse immune systems",English
+"have important differences in B and T cell repertoires, for example, but how do these differences affect the recognition and effects",English
+"of blood-forming stem cells in treatment? - Well, what you're trying to give back to somebody when you give",English
+a blood-forming stem cell transplant is the capability to restore everything that a young person's blood-forming system could do.,English
+"So it means that we will have to use young people's blood-forming stem cells for transplant. If we want to get everything back,",English
+or the long shot that I send at the end is find a way to eliminate the aging stem cells from aging people so that the young ones,English
+"have a chance to redevelop or rejuvenate an immune system. I don't know if that answered the question, but that's the answer I got.",English
+"- Yeah, I think there are a lot more mainly laudatory comments. Great talk, three exclamation marks. Thank you so much for your word, three exclamation marks.",English
+"Here's one from an anonymous attendee. Would it be worthwhile then to breeze away some of ones bone marrow when young or cord blood cells? - Yes, Well,",English
+cord blood has enough stem cells for when you're a baby. And those who have used cord blood for transplants,English
+"have to use multiple cords for multiple different people to get even the development of new platelets, the development of new granulocytes",English
+in a period that the patient could survive. There are some promising new ways perhaps to expand them. But right now cord blood is mainly,English
+"a commercial enterprise or a public benefit enterprise. The commercial ones say, well, you might get this disease",English
+"or your kid might get this disease. You better save the kid's blood farming capacity. But if it's a genetic disease,",English
+"the cord blood has the same disease. But it's lifesaving, if you have 40,000 or 100,000 or 200,000 people",English
+"who have given their bone marrow, so that a chance match at the HLA locus will allow a recipient who needs it,",English
+"but maybe he has no siblings to get a transplant. So you could say eventually, maybe you should have mobilized blood",English
+taken from young adults and frozen down or children for the future. That would be an enormous logistical issue.,English
+"When I first discovered or my team first discovered this stem cell, oddly enough, a couple of commercial atomic energy companies",English
+"quietly came to us and said, we wanna have it for our employees. And I thought it was lockable,",English
+"but their public relations department says to them, do you know what you're saying? That your people are at risk.",English
+"may improve insulin sensitivity, thus helping with diabetes. That's no secret, because it's part of a healthy, balanced diet that we're going to talk about.",English
+"Number five, dental health. The role of vitamin K2 in dental health, particularly the criminalization of teeth, has been observed. There was a famous researcher, Dr.",English
+"Weston Price, and he essentially studied this over decades and said if patients are taking the proper amount of vitamin K2, he's never had any that haven't had a cavity.",English
+I know that could help me. I'm starting to eat it. I have four kids. I don't want to be paying for braces for four of them. I don't want to be fixing cavities for four kids.,English
+"Number four, reduced risk of cancer. That American Journal of Clinical Nutrition found that there was an inverse relationship between vitamin K2 intake",English
+"and the risks of certain cancers, especially prostate cancer. This is not universally accepted, but more studies are ongoing. Number three supports a blood clotting vitamin.",English
+K2 role in blood clotting is well established. Now we hear about blood clots more than ever over the last three years potentially. I don't know why I don't want to get demonetized.,English
+"So that's as far as I'm going to go. But there's a lot more blood clotting happening. I think statistically that shows eating proper diet, proper nutrition, that could potentially impact that.",English
+"Number two, cardiovascular health. A significant amount of research, including studies published in the Journal of Nutrition, support, the role of vitamin K2 in reducing arterial calcification",English
+and lowering the risk of coronary artery disease It's important for your cardiovascular health to prevent arterial calcification. So it takes that calcium out of your arteries and focuses it into that bone,English
+"where it should be. And there's a lot of great studies how vitamin K2 lowers calcification, Calcification of arteries is a very big problem these days. It is one of the major causes of arterial stiffening.",English
+Take a look at this C.T. angiogram. This is someone with calcified that means bone in your arteries. It stiffens them so they're not flexible.,English
+"It decreases the blood flow. You get cold toes, blood flow. As a foot and ankle specialist. I checked the posterior tibial artery pulse, the anterior tibial artery pulse.",English
+"This sets a good guideline. If those feel great, then you don't have to do much more. And the way you feel is bounding pulses up and down. And we also check the capillary full time.",English
+"That means when you squeeze the toe, does it refill instantly? If it doesn't, if it's more than 3 seconds, we can use a computer to perform a test.",English
+We could perform what's called an ankle brachial index. So that's basically comparing your arms to your feet. Are there potential blockages somewhere?,English
+"And if there are blockages, so for example, if one ankle is much worse, flow than the other or compared to your arms, then we might want to do more testing.",English
+You can check the toes and then you can order imaging. You can get what's called a CT angiogram. But what I do is I work with a vascular surgery team.,English
+"So I work with great vascular surgeons essentially right away. They can do a test, which is an angiogram, where they can release dye. They can essentially check",English
+"if anything's narrowed or blocked and then you can correct it. So this is one of the images where you could see, is there cholesterol buildup? Is there a plaque? Is there calcification?",English
+But one of the things that can really help with this is vitamin K2. You want to get that calcium into your bone. So studies show vitamin K2 is very beneficial,English
+"with patients with aortic valve, calcification and a couple other studies, too, combined with vitamin D. Now, we won't reverse your arteriosclerosis",English
+"and make you like a baby again, but it can prevent it from getting worse. And especially the earlier you start, the more benefit it can have. and number one",English
+"bone health, the most substantial and well-supported benefit of vitamin K2. Numerous studies, including the Journal of Bone and Mineral Research, have demonstrated",English
+"clearly that vitamin K2 supplementation improves bone, mineral density decreases fracture risk, especially in postmenopausal women. So I go over a lot of arteriosclerosis videos, a lot of osteoporosis videos.",English
+"I go over all that stuff in detail. A lot of stuff is important for bone health. Specifically, we're talking about how to get calcium out of your blood and into your bone.",English
+"Vitamin K2, especially M K7 does a few things. It essentially causes gamma carboxyl portion of glutamic acid residues. And what that does is it activates a matrix GLA protein and osteocalcin.",English
+"These are important in taking calcium and putting it into bone. So essentially, when you're getting proper vitamin K2, your teeth will be stronger, your bones will be stronger.",English
+"All these things will do a little bit better. You'll have less osteoporosis. At the very least, it reverses the benefits of a deficiency. So that's what the studies show.",English
+The way I like to think about it and these are well-proven studies at this point is vitamin D puts calcium into your blood. Vitamin K2 takes that calcium and puts it into your bone.,English
+"If you don't have proper vitamin K2, that calcium can get into the wrong places. Calcification, and can occur in your arteries. Very, very common.",English
+"Vitamin K2 in arterial health upregulates, something called the Matrix GLA protein which inhibits calcification in the artery. A study in the Journal of Nutritional Biochemistry suggested that vitamin K2",English
+A study in the Journal of Thrombosis and Hemostasis indicated that vitamin K2 intake was associated with reduced vascular calcification and lower cardiovascular mortality.,English
+"Just be aware. Check with your cardiol just because it could change your bleeding time, it can change your clotting time if you're eating extreme amounts. But for the average person that doesn't have atrial fibrillation or isn't on blood",English
+I'm very interested to see how this stuff works in the real world because the studies aren't very reliable. But the beauty of natto is it's the only one with natto kinase.,English
+"It's made by the fermentation. But a lot of other foods have different types of vitamin K2, which is also beneficial. You have cheeses, you have goose liver.",English
+"I can't pronounce some of them, but chicken liver, gouda cheese eggs are really easy. Want to get some vitamin K2?",English
+"Pepperoni, salami, cheeses, chicken wings. Now, my carnivore friends will love this because the beauty is especially with butter.",English
+"Some of these foods get a really bad rap for heart health, but a lot of new studies now because of things like vitamin K2 are showing that potentially things like butter may not be as bad as we thought.",English
+"They might actually offer some benefits. Now, something to think about. In Hong Kong, they had the highest rates of meat eating and they have the longest lifespan at over 85 years old.",English
+"on an airplane for 14 hours and you're not moving  about the cabin and walking around, that can put   you at higher risk for the same reason. There  are certain infections that can put you at higher",English
+risk because they're pro-inflammatory that cause  inflammation in the body and that then leads to   blood clotting as a response to that inflammation.  One of the common infections that we've all heard,English
+"of is Covid-19. We've seen a higher association  with DVT's and PE's in those patients that have   Covid-19. Interestingly pregnancy, pregnancy is  a common thing and it puts you five times higher",English
+likelihood of forming a blood clot while you're  pregnant. And that risk actually can last up to   even three months after delivery. So we always  ask our pregnant patients “are they having any,English
+signs or symptoms of this condition?”. Some  other common ones are cancer. Cancer is a   pro-thrombotic condition. It makes you at a higher  risk of forming blood clots. Certain medications   such as estrogen therapies. Whether it's hormone  replacement therapy or even oral contraceptives,English
+that are estrogen based can put you at higher  risk. And then another big one that impacts   unfortunately a large percentage of our population  are those that are overweight or obese. And the,English
+"reason for that is kind of interesting. It is not  just because people who are less well-conditioned   don't move around as much, which is one of  the earlier reasons I gave - immobility. But",English
+"interestingly enough when we're overweight or  when we're obese we have more adipose cells,   more fat cells. And adipose tissue produces  estrogen. High levels of estrogen in our body.",English
+And like I mentioned with the oral contraceptives  a minute ago. Higher levels of circulating   estrogen actually put you at higher risk of blood  clotting. So that's one of the reasons why people,English
+"who are overweight are also at increased risk.  And if we jump back to when you talked about the   immobilized individuals being higher risk, does  that also mean that if you're quite active that",English
+you don't always have to worry about DVT and  PE as much? Not at all. And I mentioned there   are certain genetic risk factors. There is certain  situational risk factors. Let's say you're a very,English
+"active person and maybe you had knee surgery  and then you were temporarily immobile. But,   I think we can look to common popular culture as  some examples. And these are in the news, I'm not",English
+"breaking any HIPAA violations by mentioning them.  But, Serena Williams, a very famous tennis player   had blood clots. Chris Bosh, basketball player  with the Miami Heat who won an NBA championship",English
+unfortunately had to retire because of blood  clots. There was recently in the news this week   Al Roker of The Today Show was hospitalized with  blood clots. I'm a big music fan and there are,English
+reports out there that Jordan Feldstein who was  the manager of Maroon 5 and a good friend of the   band Maroon 5 died of pulmonary embolism (PE).  And that the song Memories is actually written,English
+"after his memory, but it's not just well-known  individuals, it really affects moms, dads,   brothers, sisters everyone in the population.  For sure. What are some things that everyone",English
+can be on the lookout for related to signs and  symptoms of DVT and PE so they can hopefully try   to get treatment before they end up having some  serious consequences? Yeah awareness is key. You,English
+"hit the nail on the head. And, it is important  to know both the signs and symptoms of deep vein   thrombosis, DVT, as well as pulmonary embolism,  or PE. Sometimes people can pick up the DVT early",English
+on and they may realize that they have some leg  swelling. They may have some redness in their leg   or some pain in their leg. That may be an early  sign. However sometimes they never realize that,English
+they had a DVT and their first manifestation of  symptoms is actually a pulmonary embolism. Some   of the symptoms of pulmonary embolism (PE) to be  aware of are chest pains and sometimes that chest,English
+pain is worse when you take a deep breath or when  you're coughing. Patients will a lot of times have   shortness of breath. Activities that usually they  didn't think much of all of a sudden they feel,English
+"more winded when they do them. They may experience  a fast or irregular heart rate or palpitations,   we sometimes call it irregular sensations in the  chest. Sometimes people can even present with back",English
+"pain because remember your lungs are both at the  front of your chest as well as in the back. So,   sometimes people will feel a little pain towards  the back of their chest area. Although it's more",English
+"rare, occasionally patients will cough up blood.  And then another telltale sign is vital sign   changes. So you may notice that you have all of a  sudden low blood pressure, or you may feel dizzy,",English
+"or you may even pass out. Those could be signs  that you may have a pulmonary embolism (PE) and   it's worth getting checked out at that point. And  an individual comes in, and let's say they have",English
+some of these symptoms. What is their timeline  in terms of going to seek help? Well I think as   as soon as you recognize that you may be having  symptoms of a PE or a DVT like I just described.,English
+"And you may have noticeable risk factors. Some  patients don't have any of those risk factors I   mentioned earlier, but you may recognize that  you have some of those risk factors. And you",English
+"may want to be at a higher sense of alert if  you recently had surgery or you're on an oral   contraceptive let's say, and you're experiencing  such symptoms. Time is of the essence. Time is",English
+key. And really it's important to get help as soon  as you recognize that something may be wrong. And   usually you'll go to your local emergency room  or urgent care and you'll get further imaging,English
+to diagnose whether you're having a DVT and or  a pulmonary embolism (PE). Then what does the   treatments actually look like for somebody who  comes in and they are confirmed to be having DVT?,English
+Is there anything available for that individual?  Absolutely! The treatments are very effective once   we recognize what's going on. And the mainstay  treatment are anticoagulants or blood thinners.,English
+"And you may have heard of some of them on the  market. There's Coumadin, or Warfarin is one of   them. There's also some of these newer drugs such  as Xarelto or Eliquis which you may have seen on",English
+the market. And they work a little bit differently  but essentially at the end of the day they thin   your blood and they stabilize the clot. So what  they do is they thin your blood so you don't form,English
+"more clots and then they stabilize the clot that  you currently have and allow your body the time it   needs to break it down. So, it's interesting  they don't actually break down the clots but",English
+they stabilize the clot and it's your body's own  mechanisms that help break down that clot over   time. And then in the meantime the blood thinners  prevent the clot in the legs from breaking off,English
+and forming more potentially deadly pulmonary  embolisms. Definitely a big misconception for   blood thinners out there in terms of actually  clearing the clot versus preventing more clots,English
+from being formed. How about any type of surgical  interventions that take place for people with DVTs   or PEs? So there are depending on the individual  and how they're presenting clinically. Those that,English
+"have more severe deep vein thrombosis (DVT)  they're at higher risk of worse outcomes from   pulmonary embolism (PE). If they present let's  say with low blood pressure or very symptomatic,",English
+there are certain things that can be done in  addition to those blood thinners and to more   urgently intervene. Some of those include a  medication called TPA which is a clot busting,English
+"medication. So, that medication actually goes in  and tries to break up the clots quickly. There is   an increased risk of bleeding with that medication  so we don't use that with every patient but for",English
+the right patients we may choose to use that if  it's a more severe situation. There's also devices   where you can actually go in and break up the  clot or extract the clot so it's really tailored,English
+"to the particular case and situation. But, there  are additional techniques we could use. So now   that we've talked about some of the environmental  factors, and you brought up the genetic factors",English
+"earlier on, what are some ongoing risks for an  individual if they did have a DVT or PE? How   long are they actually treated for that condition  and how long should they be on the lookout for",English
+something coming back? Generally speaking we keep  someone on a blood thinner for at least three to   six months for their initial event. Now whether  we stop the blood thinner after those first three,English
+"to six months or continue it indefinitely depends  on someone's ongoing risk factors. So if someone   has a strong genetic predisposition, maybe we  tested their genes and it came back positive",English
+"or maybe they have a strong family history of  blood clotting, we may choose to keep someone on   a blood thinner longer. Maybe even for the rest  of their lives. Now if it was someone who had a",English
+transient risk factor meaning they just had let's  say knee surgery. Now they're active. Now they're   recovered. We would treat them for those initial  three to six months and then we may choose to stop,English
+"the blood thinner after that. Now with that said  anyone who has had a DVT or PE is at a higher risk   even if it was a transient risk factor that led  to it. So, anyone who's had one episode is at a",English
+"five to seven percent, per year, increased risk  which is about 50 times higher than the general   population who never had a blood clot. So, we may  weigh the risks and benefits and decide to stop",English
+the blood thinner but we're always at a high index  of suspicion. And we're always monitoring these   patients closely in case they develop any future  symptoms that could be suggestive of a recurrence.,English
+"plane ride maybe I put you on a blood thinner for  a few days during that period of time in order to   protect you.” Okay yeah, so really looking at  an individual's circumstances at that time. I",English
+"think that's really important if you have had a  DVT or PE to talk to a healthcare provider, or a   clinician that you trust that understands this  condition and that you can really kind of weigh",English
+"the pros and cons of all these decisions. And  that they continue to follow you long term   so as new issues arise they can guide you and  deal with that. So, as we close out this great",English
+"conversation with the community, what's something  they can take away from DVT or PE? Yeah I think   the main point that I'd love to raise with your  viewers is that awareness is key and awareness",English
+"is life-saving. DVT and PE are part of a spectrum  of the same condition. Whether you catch it while   it's still in the leg or whether it breaks off  and it goes to the lungs, it's part of the same",English
+"kind of spectrum of disease. And it's common. It  is very common. It's very deadly and unfortunately   we've done a poor job in the medical community of  raising awareness for this. So, I think because it",English
+"In fact, there was a paper that was just recently published in the New England Journal of Medicine, asking this question and reviewing a number of cases, and they also seem to see a situation",English
+"where antibodies are being formed against platelets and this platelet factor 4, which is causing a pro-thrombotic state and also low platelets as well.",English
+"And, again, they are advocating in that paper, as well as in the United States, that if we see those type of cases, as we would do in heparin-induced thrombocytopenia, not to use",English
+"heparin products, but rather other anticoagulants, in addition to, by the way, something called IVIG, intravenous immunoglobulin.",English
+"This is an antibody that binds these antibodies that are being made so that they cannot produce the type of negative effects. Again, this is a one-in-a-million shot.",English
+"This is a very rare side effect that they are seeing, but they are seeing it both, potentially, in AstraZeneca in Europe and here with the Johnson & Johnson vaccine in the United States.",English
+"And we'll talk a little bit more about what these numbers really mean. But, I think the key point here is they wanted to be, out of an abundance of caution, even though this is 6 cases out of 6+ million doses, they wanted to make sure that healthcare workers",English
+"were understanding of this, aware of this, so that they could be looked at and they could be surveyed and treat them appropriately. Kyle: You mentioned that the FDA and CDC made this decision about the Johnson & Johnson",English
+"vaccine ""out of an abundance of caution."" That was certainly one of the talking points for public health officials today. I put together a slide that shows some of the relative risks of a blood clot, potentially",English
+"from the Johnson & Johnson vaccine versus other things and was wondering if you could walk us through that. Dr. Seheult: Yeah, so cerebral venous sinus thrombosis is not something that is new.",English
+"It's been around. It can happen. As we talked about, it tends to happen more in women than in men. But if you were to look at the general population, what would be the chances of somebody coming",English
+"down with a case of CVST? And if you look at this, the general population's about 0.5 per 100,000 per year.",English
+"Actually, if you were to come down with COVID-19, the relative risk there is 4.5 to 20 per 100,000 cases of COVID-19.",English
+"Obviously, in women who are pregnant, there is a hyper-coagulable state associated with that. And again, we see about 10 to 12 per 100,000 deliveries can develop CVST.",English
+"Oral contraceptives are well-known to cause a hyper-coagulable state, and we see a wide range of increased risk there are 2.7 to 40 people per 100,000.",English
+"And so what we're looking at here when we're talking about 6.8 million doses given and 6 individuals coming down with cerebral venous sinus thrombosis, we're looking at potentially",English
+"0.09 people per 100,000 vaccines given. You're looking at about 1 in a million. You know, another way of looking at this, Kyle, is about 115 million people every day",English
+"get into automobiles and travel, and of those 115 million people, 16,000 of them get into some sort of a car accident or fender bender.",English
+"And, unfortunately, every single day 100 people die in automobile accidents. So, if you look at those numbers, that's also about a one-in-a-million chance, maybe slightly",English
+"less. Very similar to the chances that we're talking about here with the Johnson and Johnson vaccine. Kyle: So you mentioned the VAERS, or Vaccine Adverse Event Reporting System.",English
+"Can you explain more about what that is and some of the misunderstandings about this reporting system? Dr. Seheult: Yeah, so basically it's a clearing",English
+"house, where anybody can put in information about what may have happened after a vaccine was given. And it's a clearing house and a repository of information so that scientists and vaccine",English
+"experts can look over this and see whether or not there is a signal that shows that, above the population level, above the baseline level that we would normally see, there is a problem that needs to be investigated.",English
+"You know, look, if you were to follow 100,000 people for a year, just at random, 100,000 people for a year, at the end of that year, Kyle, 700 people would be dead in that cohort.",English
+"And that's just based on all-cause mortality. That happens to be the all-cause mortality here in the United States. And so, any time you take a population and follow it, things are going to happen.",English
+"People are going to get sick and people are going to die. So the question is when these things get fed into the system, when you look up on the VAERS and you see that there are certain adverse reactions, things that have happened, the",English
+"assumption is to think, at least initially, that these are all the things that have happened as a result, as a cause of getting -- or as a result of getting -- the vaccine when that's not necessarily the case.",English
+"It's associated in these same individuals, but then the hard work of understanding statistics and epidemiology to figure out whether or not there is a higher than normal frequency",English
+"of these events starts, and that's where they are right now looking at these adverse reactions. Kyle: So a big question that's out there right now is people who have already had the Johnson",English
+"& Johnson vaccine, is there anything in particular they should be doing or looking out for? And also, people that were scheduled or planning on getting the Johnson & Johnson vaccine,",English
+"what should they be doing right now? Dr. Seheult: Yeah, well first of all if you're scheduled to get the Johnson & Johnson vaccine, in a number of cases they've already switched those out to either the Pfizer-BioNTech vaccine",English
+"or the Moderna vaccine. If they haven't, they've already probably notified you, and we anticipate that this pause in the campaign for vaccination by the Federal Government is going to be paused for",English
+"a couple of days and we'll hear more information very soon about where that's going to go. Now, if you've already gotten the vaccine, the Johnson & Johnson vaccine, and it's been less than two or three weeks since you've gotten it -- if it's been more than 2-3 weeks,",English
+"then you probably have nothing to worry about, because these things all popped up within two weeks of vaccination. And when I say ""worry,"" it's a one-in-a-million shot it seems, but it's always wise to look",English
+"out for some of the signs of this kind of complication, and what would that be? A CVST, or a cerebral venous thrombosis, would be, the kind of things that you'll be interested",English
+"in looking at is: headaches that are continuous constant, double vision, weakness on one side of the face or the other or even in the arms or legs, or even seizures, as we've talked",English
+"about before. So these are warning signs to go and seek medical attention in the emergency room, if that's happening.",English
+"And of course, let the providers there in the emergency room know that you are a recipient of the Johnson & Johnson vaccine. Kyle: So far you really focused on the blood clots that can happen in the brain, but can",English
+clotting from this condition happen other places in the body as well? Dr. Seheult: Absolutely. It's interesting to me that almost all of these cases focused on the Cerebral Venous,English
+"Sinus Thrombosis, but absolutely, Kyle, you can get blood clots in the lungs. You can get blood clots in the organs of the abdomen. You can get blood clots in the legs.",English
+"All of those, of course, have different symptoms. Let's start with the lungs first. It would be a sensation of sudden shortness of breath and what we'd call shortness of",English
+"breath on exertion. The other symptoms could be abdominal pain, epigastric (that would be sort of above your belly button, a continuous abdominal pain there).",English
+"If it was in your legs, then you would have pain in your legs, either on one side or on both, if there was clots on both sides of your legs.",English
+"And you might even see swelling, particularly at the end of the day when you're walking around. So these are all danger signs that you need to go to the hospital and be checked out in",English
+Dr. Seheult: That's a very good question. We don't know what their use is of oral contraceptive medication. I know they're investigating that.,English
+"That would be an added risk factor, in terms of thrombosis. But if you look at this two different ways: if this is an immune-related thrombosis, or",English
+"if it is a hypercoagulable-related thrombosis, in both of those situations, women typically are at higher risk. You know, women's immune systems are generally more robust than men's -- this is the reason",English
+"why men had a more difficult time with COVID-19 in the hospital in terms of mortality and morbidity over women. And in this situation, women are more likely to get antibodies, autoimmune conditions -- we",English
+"see that disparity in all sorts of autoimmune conditions, such as lupus, rheumatoid arthritis, and other autoimmune conditions.",English
+And so it's certainly possible that that is what we're seeing. There is some data out of Europe that is looking at the AstraZeneca vaccine and the thromboses,English
+"there. They also are seeing a predominance in female over male. And also younger, as well. And, again, there is the specter that is raised: are they autoimmune situations?",English
+So I think that's primarily the two reasons why I would say that we are seeing women represented disproportionately here in these complications.,English
+"Kyle: In the news cycle today, public health officials in the US were very quick to point out that there has been no increased safety signal in the mRNA vaccines.",English
+"Even though there is only a one-in-a-million chance so far based on these results of getting a CVST, we have an alternative that hasn't shown that signal in any way, shape, or form,",English
+and that's the Pfizer-BioNTech and the Moderna vaccines. There is some interesting data that's looking at why that might be the case. The two vaccines that have shown a potential increase in blood clots is the AstraZeneca-Oxford,English
+"vaccine and, of course, the Johnson & Johnson. Both of those use an adenovirus vector to get the DNA into the cells to make the spike protein.",English
+"As you know, the Pfizer-BioNTech and Moderna vaccines don't use the adenovirus at all. They use lipid droplets to get the messenger RNA into the cells to produce the spike protein. And again, we have not seen any sort of increased risk of blood clots and they're not under",English
+"any kind of investigation for this. And so, yes, absolutely. If people are interested in getting a vaccine and they have been concerned about this development,",English
+"I would definitely direct them over to the remaining two vaccines that are currently available in this country. Kyle: Of course, this decision that the CDC and the FDA made to pause the Johnson & Johnson",English
+vaccine temporarily has been controversial. There's been strong arguments on both sides. A well-known economist and statistician named Nate Silver has been very critical of this,English
+"decision from a pure stats and numbers standpoint. And then public health officials and scientists on the other side are saying ""Absolutely, this is the right call.",English
+"When you get a safety signal like this it's really important to investigate it and it helps build public confidence in the vaccine process."" So, of course, vaccine hesitancy is a potential problem in the United States right now.",English
+"What's your opinion on all this? Do you think the FDA and the CDC made the right call? Do you think this will make vaccine hesitancy potentially worse? Dr. Seheult: Yeah, it's a very good question.",English
+"Should I not get the vaccine?"" And then this news comes out that's kind of spooky, and you say, ""you know what, I'm going to hold off at this point, because I don't know what's going on, and I don't know...""",English
+"And therefore that could be, obviously a bad thing, a negative thing if you're trying to get people vaccinated. Of course, there's the other side of it where people are like, ""well, I don't really trust",English
+"the FDA; I don't know if they're doing what they need to be doing, if they're not watching this very carefully."" And certainly after today with just a one-in-a-million chance potentially -- obviously, six people",English
+"who get a CVST is six people too many. But, obviously, things happen, and when you're vaccinating hundreds of millions of people,",English
+these sorts of things pop up. And to know that the FDA is monitoring this and they're willing to actually put a stop to an active vaccine campaign -- and I'll just clarify there that they haven't mandated,English
+"that everybody stop. A physician and a patient, if they choose to get a Johnson & Johnson vaccine can still do that. But in terms of federally operated vaccine campaigns, they have stopped using the Johnson",English
+"& Johnson at least temporarily here. To think that they're actually willing to do that, based on a small signal such as this, leave some confidence to people that yes, the people at the top are monitoring things",English
+"and looking at this. And that's purely from a PR standpoint. From a medical, scientific standpoint, it's absolutely the right thing to do if you want",English
+"to make sure that you're not harming people unnecessarily. It's an interesting thing, Kyle, because right now in this country, if we had nothing else -- if we just had one vaccine, the Johnson & Johnson vaccine -- it would be a much more",English
+"difficult decision to do. But, you know, we have choices at this point. We have three different choices to choose from, and if one of these things does increase",English
+"the risk of unnecessarily, then we can always fall back on the other two. And I'm happy to say -- and I've seen some differences in this -- but I'm happy to say from what I've read, it seems as though there is enough supply and there's enough room there",English
+"for Pfizer-BioNTech and Moderna to increase their supply to take up the difference. Again, less than 5% of the vaccines currently in this country that have been delivered into",English
+"""well, I probably won't get it at this point,"" what information would you share with them about where we are in the pandemic and the risks of COVID-19 at this time?",English
+"Dr. Seheult: Yeah, so we've had increasing cases in places like Michigan, New York, Pennsylvania, Florida, and we're on a race, basically, a race to suppress the current wave of infections",English
+"here in the United States. Obviously there are countries around the world that have it much worse than we do, such as Brazil and now emerging is India.",English
+"about a week ago, it shows that the Pfizer-BioNTech and the Moderna vaccines were 80% effective at preventing infection after the first dose.",English
+"And after the second dose, that went up to 90%. So that was the real-world example in terms of efficacy at preventing asymptomatic transmission of the virus.",English
+"And if there's one thing that will shut down a pandemic real fast, it's if that virus can't spread to somebody else. back to large gatherings of people, and moving to a better place with this pandemic is vaccination",English
+"at this time? Dr. Seheult: Well, there's, yeah, so basically there's things that we can do for ourselves and there are things that we can do for other people.",English
+"diagnosed with Alzheimer's disease. The work that  you're doing can't stay in Sweden or in the United   States alone. We need to make sure that there's  access to this technology throughout the world,",English
+but that also speaks to the value of what you're  doing with blood because it's easier to collect   blood than it is to do a lumbar puncture and  collect spinal fluid or to get very advanced   imaging techniques that usually only occur  at an academic center. Before we get into the,English
+"implications of that, which I'm very excited to  ask of you, I want to go to just the basics of the   test itself. How accurate are the current tests  in truly reflecting what's happening in the brain?",English
+"Starting with the spinal fluid that you  study, and then also then the blood. Karikari: Yeah, that's a question  that we ask ourselves all the time,   because one thing that I also quite love about  working with a very diverse group of scientists",English
+"across multiple centers is that we try to be  quite critical. We try to ask questions like,   what do we know and why do we think we know  this? What further evidence could we generate?   One of the first things I would say in sort of  being able to reflect what's happening in the",English
+"brain, when we started, for example, with our  plasma phospho-tau, I was quite curious to see   that – although from the start we're showing that  they correlate quite well with clinical diagnoses   and also with data from, for example, CSF and  also from imaging like amyloid-PET and tau-PET",English
+"imaging studies, I was quite curious to see how do  these measures reflect what happens in the brain   because the brain is the ultimate source of  the pathological diagnosis of Alzheimer's",English
+"when someone unfortunately passes from the  disease. Continuously there's data that comes into   parts to show that in some unique studies where  individuals – early adults – gave blood samples,",English
+"either at one point or over several years before  they passed on, and then after death they had   signed to donate their brain to research then  there were pathological diagnoses that were done",English
+"by board certified pathologists. What  was beautiful was that we could take   the blood samples that were given up to  ten years before these people passed on,",English
+"and then measure these new markets blindly. Then  you get to reveal the pathological report, then we   can try to match them and see how they agree. One  important thing that these results have revealed",English
+"is that when you look at those, the blood markers  agree better with the pathological diagnosis. The   diagnosis of the changes in the brain after death  at autopsy are better than clinical diagnosis,",English
+"which means that if we use biomarkers which  actually reveal the biological changes in the   disease it's going to provide a better way of  characterizing Alzheimer's disease and also,",English
+"importantly, to differentiate it from very similar  forms of the disease that are seen by clinicians   who look at such diseases because one thing we  see is that, for example with plasma phospho-tau,",English
+"levels are increased only in individuals who have  Alzheimer’s at autopsy. Those who have Alzheimer’s   plus other forms of dementia also have high  levels of the biomarker, which means that as",English
+long as someone has Alzheimer's disease the  levels of this biomarker is going to increase   regardless of any other pathologies that the  individual might have. The levels also are low,English
+and almost normal when you look at individuals  who were diagnosed with other pathologies and not   AD or not Alzheimer’s form. Basically it’s similar  to if someone passes on with let's say Parkinson's,English
+"disease, for example, then the biomarker levels  give you basically the same readout – similar to   someone who passed on and then the pathological  diagnosis was done and in the brain they didn't",English
+"find any abnormalities that would signal the  person having died of or from any dementia   form. It's a very good way. It means that  if you use the blood, it can predict and",English
+"it can also provide a good measure of what is  happening in the brain. I think, in addition   also, we've been able to look at some studies  that show that what you measure in the brain,",English
+"it's quite similar to what you’re measuring the  CSF or what you measure in the blood as well   because the absolute levels do differ. At the same  time also, there's some studies that are using   a method called SILK that they use some radio  ligand-labeled materials and then those ones",English
+"go into the persons when – some people swallow it,  for example – then they can be metabolized in a   way that can go into the CSF or that go into the  blood and also reflects in the brain. In that way",English
+"we can be sure that what we measure agrees with  the metabolism of the forms of tau and amyloid   that exist in the brain, and some come down to  a CSF and some go down to the blood as well.",English
+"in autopsy findings. I think that speaks to  the value and the need when people donate their   bodies and the gratitude that scientists have to  those who have donated their brains to science,",English
+"because that is the only way you can know for  sure since this is a disease of the brain.   I wanted to clarify, too, for our listeners  when you say p-tau and and then you're saying",English
+"phospho-tau and then plasma phospho-tau – plasma,  for our listeners, meaning just in essence blood.   Then p-tau or phospho-tau is sort of a protein,  a specific protein that you're looking at.",English
+"Chin: So then let me ask you this, because when we  measure these types of proteins whether it's p-tau   or a different type of amyloid or tau itself, are  those the actual proteins from the brain when you",English
+"look at it from the spinal fluid compared to  the brain or the blood compared to the brain? Karikari: Yes, I think there are some caveats  there. So what we’ve seen – and then this is   the hypothesis – is that when there are these  changes that occur in the brain, so for example",English
+"in the course of developing Alzheimer's disease,  you get to have accumulation of abnormal forms   of tau protein that could be phospho-related  and also amyloid as well. These form the kind",English
+"of clumps that are often seen at autopsy when  the brain is examined by pathologists, but then   we have also over the years, together of  course, a lot of scientists have shown that",English
+"when these clumps are building up in the  brain there are some forms that do get   chopped off. Basically there's some core part of  these proteins. Once they're sticking together,",English
+"there’s some core parts of them that  like to attract to each other and keep   sticking together and then they keep piling up and  they form massive clumps, and there are some other   parts that get chopped off. These parts that get  chopped off, they are the ones that also most of",English
+"the time get to reflect in the CSF and also go  down to reflect in the blood that we're able to   measure now. Basically what we are measuring in  blood, and also to a larger extent in CSF, are",English
+"sort of indirect measures of what is happening in  the brain because it means that, for example, once   you have a lot more of these proteins clamping up.  If you have 20 units of the protein clumping up",English
+then the amount that would also – those parts  that will get chopped off now will result in   the CSF and in blood will be corresponding to  that 20 units of the protein that clumping up,English
+"in the brain. The same way if you have, let's  say, 100 units then the amounts that you see   in the blood, in the CSF, will increase. That is  for phospho-tau or p-tau. For amyloid it would be",English
+"the reverse, and then that would reflect, so more  like looking at a direct kind of association of   what's happening in the brain. Although, I might  say that more and more we continue to try and   also target new forms or newer forms that are less  studied in blood and also in spinal fluid that are",English
+"core part of the tangles in the brain, because  we realize that some of these core parts   can still leak into a cerebrospinal fluid and  also we think could go into blood and that",English
+"we'll be able to measure them. But the interesting  things are these core parts of the brain or of the   tangles and the plaques that form, they only  start to increase in the symptomatic phases,",English
+"have shown that they tend to increase quite nicely  in the disease right from the very early stages. Chin: Well, that's very helpful. Thank you. Not  everything is linear. Not everything is a static",English
+"progression. There are obviously different  changes as a person is changing and things   are accumulating. I think it's also helpful  because many people think that the blood tests   means that the amyloid is starting new outside of  the brain and that it's forming in the blood, but",English
+"really it is leaking from the brain to the CSF to  the blood, so thank you for clarifying that. Just   as you've said, there are certain tests that can  be useful in those who are already having symptoms",English
+but also you're showing – and your colleagues  – that these proteins are actually becoming   abnormal or elevated in people before they  have symptoms. How far back are you identifying,English
+"proteins of Alzheimer's disease – amyloid or  p-tau – in people before they have symptoms? Karikari: That's a very important question. I  also like, for example, in the early stages when   we looked at some of the research cohorts and then  we saw the way the biomarkers were able to predict",English
+"disease changes years before. In a way it was  exciting that we can use this, but it was also   quite frightening in that in just a little drop of  blood you could provide with quite good accuracy,",English
+"you could be able to tell what's happening for an  individual. That raises lots of qualms and ethical   issues as well. Then to answer your question,  how far back, I think it also depends on several   things. For example, if the person has, let's say,  early-onset Alzheimer's disease, which is likely",English
+"to be caused by genetic predispositions to the  disease then such individuals would show signs   earlier, so it could be like in their early 40s or  around 40 years of age, compared to those who have",English
+"late-onset and that could be after 65 years of  age. It means that if someone has early-onset   then you can predict that far back into maybe when  about 30 years, but then if someone has late-onset",English
+"then the prediction will be far back to when  they're about, let's say, fifty years or so.   Of course, it depends on, for example,  the genetic risk when someone has ApoE   4 allele of the ApoE gene; that also has an  effect. Also it’s all about the subtype and",English
+"then some demographics as well. We continue to  study what specific factors predispose people   to build up changes in amyloid and build up  changes in tau in the brain at quite quick,",English
+"faster pace compared to others, and that would  also allow these blood markers to be able to   pick said-changes much earlier. In a nutshell,  we can develop – we can predict, in some of the",English
+"studies we've done, it can go quite far back about  less than ten years or about a decade before, but   then it depends on the person's background also in  terms of the risk for the disease. For example, in",English
+"terms of early-onset you have people who have down  syndrome. People with down syndrome have a very,   quite high risk to develop Alzheimer’s disease  and it seems like in such individuals, you're",English
+"almost certain that the biomarker is going to  perform quite well. For such people, you can   also predict – you can look at the estimate of the  age of onset of the disease, so it's much cleaner   for people with genetic risk. You can predict  with higher accuracy how far back they will be",English
+"to develop the disease, but then people with  sporadic forms, which is like late-onset,   because we are not exactly sure of the cause of  the disease then it makes it a bit more tricky.",English
+"What we know is that the biomarkers can predict  changes of Alzheimer’s as far back as several   years back up to like a decade and that, in  some longitudinal studies that are beginning to",English
+"surface, we've shown that these predictive  changes are quite accurate because a lot   of the individuals that, from the early stages at  baseline when they were studied, showed high risk",English
+"to develop the disease actually went on to develop  the disease. Also in the same way, we've shown in   some neuropathology studies that those who donated  their blood and then you could see high predictive",English
+"That's why I know that your group and other groups  are looking at risk calculators and how do we   actually share predictions for at the individual  level. In these situations of risk calculation,",English
+"it seems like there's multiple variables, which  you mentioned: genetic risk and lifestyle risk and   other factors. When you think about the  future of risk calculation or prediction",English
+"at the individual level, how accurate or  reliable do you think these things could be? Karikari: Yeah, when it comes to these predictive  algorithms, they can be only as good as what you",English
+"put in them. As you said, there are different  aspects of – I mean when it comes to Alzheimer’s,   it's quite easy for someone to look at a blood  test and that predicts that the person can have",English
+"the disease. I'm quite wary of that. We shouldn't  just focus on this. We should integrate with the   existing paradigm where it looks at, you know,  how does a clinician look at Alzheimer’s as of now",English
+"and then integrate these blood tests to  be another way of providing a tool to   the clinician to make a good diagnosis. You could  have the clinical, the neuropsychological testing",English
+"and that would also give a predictive accuracy but  then you have to add in a lot more. You have to   add in the ApoE genotype, other forms of genetic  risk that we know or we don't know about, and then",English
+"the person’s – but another thing is that a lot  of studies continue to show that there might be   other things, for example, some comorbidities like  people with cardiovascular disease hypertension",English
+and some other forms of disease that could  increase one's risk for Alzheimer's disease. One   issue there is that these risk factors  or these risk models have not been,English
+"tested in a lot of populations. It makes me a bit  wary because before we can roll out anything to be   a very good predictive model of Alzheimer’s in a  global population using blood, because one thing",English
+"we should remember is that once you talk about  blood, blood is available everywhere. Blood can   be taken anywhere, so we have to validate  these models in a wide group of people   before we can be sure. For example, the ApoE 4  genotype that we know is very well associated",English
+"with Alzheimer’s, in more recent studies  that are beginning to surface what we've seen   is that – and these are actually new pathological,  so brain studies of people who've passed on,   who've died from Alzheimer's and related  dementias – what they've shown is that for people",English
+"of non-European ancestry the ApoE 4 gene –  the allele – may not be a very good predictor,   so it’s not a well-associated biomarker or risk  factor when it comes to developing Alzheimer’s",English
+"in people of non-European ancestry. However, this  ApoE 4 allele genotype is very well established   and it's very well used in clinical scenarios.  So we have to try these models, and I like that",English
+"these models are beginning to show up. We have  to try them in a wide variety of people to get   to understand where does it work, where does it  not work, and in what conditions does it work,",English
+"in what conditions does it not work. Also, what  are some of the risk factors or what are the   special disease factors that would affect  the performance of these calculators?",English
+"think worry you if we were to just immediately  start implementing the blood test today? Karikari: Yeah, I think there are few things. One  is that even within people of European descent   that have been studied quite extensively,  there's one thing that also worries me. We,",English
+"you know, as scientists we depend on our  volunteers who are well in to donate their time   and the biospecimen to be taken for research,  but then more often than not these are people who",English
+"you don't need to explain much to them to  come to donate their time from research   or they might have spare time to spend. These  people tend to be those who are well educated,   those who live in quite affluent suburbs, and also  might have time on their hands. We don't have a",English
+"lot from people from the other part of the working  class, so those people who live in suburbs that   are highly likely to have, let’s say, high  cardiovascular burden or other kinds of",English
+"diseases that we often don't see. Basically  what I'm trying to say is that the research   cohorts that we have studied so far tend to  be quite clean, right? These are people who",English
+"have the capacity to live quite healthy lifestyles  and it doesn't allow you to study the disease in   the very real world setting that we would – that  you would like to. For example, once we go into",English
+the clinic with these blood tests this is going to  be quite a big test for the test themselves. Are   they going to perform as well in the cohorts that  we've studied? In addition to all the other things,English
+"I've said, these other cohorts are also very well  phenotyped because we've studied them – most of   those cohorts have been studied with, like they've  gone through all the extensive biomarker testing",English
+before they were used for the blood testing as  well. It means that anyone with quite questionable   diagnosis oftentimes get to be excluded as  a basic setup for the cohort from the start.,English
+"We have to start looking at real world data. We  have to start looking at populations that just   include people from everyday life, people from  all walks of life, people from all the different   classes of suburbs that you would see or the  classes of occupations, and also from the classes",English
+"of ethnicity, you know, people from all the  aspects of life. One aspect, for example – when   we often look at these cohorts, we tend to see the  people that we study. One thing we should look at,",English
+"for example, is when it comes to immigrants,  we don't have a lot of cohorts to look at. When   these tests go into the clinic, it’s not going  to discriminate against anyone. We're going to",English
+"be using them the same way for every individual.  There are few studies that we have been looking at   that tend to suggest that, for example when it  comes to the blood test, the way they perform",English
+may not be exactly the same across the board.  We're still very interested to try to understand   why and how that these things do happen. Our  working hypothesis is that there could be,English
+some specific factors that may interact  with the development of the disease and that   these ones could be more predominant in specific  populations of people compared to others.,English
+"To be able to understand this as much, there's  a lot more that we have to do. In as much as   the tests going to the clinic, there's a lot  more that we should do in terms of identifying",English
+"what affects the performance of the test from  a very physiological point of view as well. Chin: Well you’ve given us a lot to think about. I  guess my question – my last question – to you, Dr.",English
+"Karikari, is what is the next most important study  in fluid biomarkers and Alzheimer's disease that   you're working on or that you're going to work  on or that you feel the field needs to address?",English
+Karikari: Thank you. This is something that I  discuss with my bosses sometimes. We just wonder   what's next for the field because it seems we've  been – we’ve seen quite good successes lately and,English
+"those successes tend to show that there isn't  much to do. However, I think that there's a lot   more to do, to try, as we talked about. With these  tests going to the clinic, there's a lot more to   do to identify what affects the test performances  and also how to improve the ability of the test",English
+"to work the same way for everyone, but when it  comes to the next stages we're quite interested   in looking at the other forms of pathology in the  brain. Alzheimer’s, as we know, is not a very pure",English
+form of pathology in the brain. People with  Alzheimer’s are likely to have other pathologies   and that would include TDP-43. It could be  alpha-Synuclein. It could be other aspects.   What we're trying to do is focus on developing new  tests for these pathologies so that we'll be able,English
+"to provide a better way of characterizing not just  Alzheimer’s but all the spectrum of dementia that   we get to see. At present, the best way that we  can say is that – with these tests you can say,",English
+"‘Oh the person doesn't have a high level of, let's  say, phospho-tau or amyloid in the blood, so then   they are not likely to have Alzheimer's,’ but then  there's a lot more as a huge spectrum of diseases",English
+that could they could belong to. What we want to  do is to better characterize that other spectrum   to try to better differentiate what forms of  disease that these individuals are likely to have.,English
+We think this would be extremely important now  that these steps are being used in clinical trials   and also new drugs are emerging for Alzheimer’s  and hopefully for the related dementias as well.,English
+"which is how can we treat blood pressure correctly if we're not measuring it correctly? And I would argue, we don't measure it correctly",English
+in any of the settings in which we have the opportunity to measure it. So let me review that a little bit. It's also humbling to talk about this because,English
+"for any of you who are health professionals, yourselves, or have family members or who are health professionals, this is the almost the first thing everyone learns.",English
+"And yet despite that, we do it quite imperfectly as a profession. Now this is confusing because",English
+"there are three different ways, they'll actually be a fourth that I'll mention as well, to measure blood pressure.",English
+"And it has to do with the setting in which we measure it. So the most common is you go into someone's office, a doctor, a nurse practitioner, whomever,",English
+and they measure your blood pressure. So that's called office measurement and that's actually been our gold standard. So when we look at studies of treatment,English
+"of high blood pressure, almost all of them have used office measurement as the gold standard. But of course you can also measure blood pressure at home.",English
+"And if you do that, (clearing throat) if you include home measurement as part of someone's regimen, it turns out that the patients end up using less medication,",English
+"but they also have less good blood pressure control. And so it's a little bit of a trade off 'cause you tend to get lower numbers on average,",English
+"when you measure at home, and I'll say more about that. And then the third option is something we called an ambulatory monitor,",English
+"and these have been around for decades, but they're very underutilized. And what they are as you would wear a blood pressure cuff,",English
+"you could wear it for 24 hours or 18 hours while you're awake, it can be programmed to automatically take your blood pressure",English
+"no matter what activity you're doing. And it gives us an average blood pressure done robotically, if you will, over the course of 18 hours or 24 hours.",English
+"And it turns out from some recent evidence, these ambulatory monitors, this 24 hour average, correlates to the best with strokes and heart attacks.",English
+"And when I use that abbreviation CVD, I'm talking about cardiovascular disease, which includes heart attacks and strokes. Now we have these three different categories",English
+"of blood pressure, and it turns out they measure different things and they don't correlate all that well with each other. Sometimes in medicine, if we comparing diagnostic tests",English
+"with each other, we compare them to a gold standard and we can describe the characteristics of the test,",English
+"which patients they might miss, which patients they might over detect. The problem here is that we don't know which is the gold standard.",English
+"So we can compare them to each other, but we don't really know what is the objective truth. So what we end up with is three different strategies",English
+for measuring blood pressure that we have to interpret each one on its own. Now the medical community has reached consensus,English
+"on how to measure correctly. And the last time I counted from one of the official guidelines that I'll make reference to later,",English
+"there were 19 different elements that constituted an accurate blood pressure measurement. Now I've summarized these into eight,",English
+but it includes all 19. I've just combined a few. But what I want you to do as I go through these is think about the last time you had,English
+your blood pressure measured in the office and which of these were followed and which of these were not.,English
+"And that's really the punchline. And we'll also get to the second punchline, which is when you're measuring your own blood pressure at home,",English
+"you should do the same things that I'm about to describe that the clinician should do in the office. And so again, think about how you're measuring",English
+your blood pressure at home and which of these best practices you're following. So one of the most important things,English
+"is that you need to be seated for five minutes before the blood pressure is taken. So in my office, what happens often the patients have trouble.",English
+"They're late for the appointment. They're having trouble finding parking, there's traffic around the office. They finally get in",English
+"the parking spots are painted too tight. Finally, get it in, you almost hit the posts. You rush upstairs, the elevator stopping at every floor.",English
+"You finally come in, there's still time to get checked in by the nurse. And she sits you down and she starts reviewing your chief complaint and starts reviewing your medications.",English
+"And while she does that, she's cranking up the blood pressure. (audience laughing) So there are about six things wrong with that particular scenario.",English
+And one of the most important is to allow the body to equilibrate before the blood pressure is measured.,English
+"While the measurement is done, the back should be supported, and the feet on the ground. Now, even in my own office where I see patients personally,",English
+"I cannot do this because I have an exam table. And the way the exam table is positioned to the cuff on the wall, I don't...",English
+"It's not an exam table, it goes up and down. So my patients don't have their back supported and don't have their feet on the ground, even in my own office.",English
+So you're not supposed to take any caffeine exercise or smoking for 30 minutes. I'll say more about caffeine later. Caffeine is not associated,English
+"with high blood pressure chronically, but in the short term, if you drink a cup of coffee right now, it can increase the blood pressure.",English
+My personal favorite is no talking. So no talking by the patient and no talking by the person who's taking the blood pressure.,English
+"So this is one, certainly that these initial blood pressures were often done incorrectly. There should be no clothing under the cuff.",English
+"Another common mistake. So often your blood pressure is being taken in a public setting, the cuff is put on over your clothes.",English
+"That's incorrect. The arms should be supported at the level of your heart, the atrium, one of the chambers of the heart.",English
+"So usually on a table or on the clinician's arm, but up in this relaxed position. And probably the most important of all,",English
+"or one of the most important of this list is a correct cuff size. And so most of the blood pressure cuffs you purchase, if you don't go out of your way to ask",English
+for a larger cuff will be too small. And that's true for because of obesity and overweight. That's true cause of excess skin folds.,English
+"That may be true cause of excess muscle mass. But in our society, in my practice, I hang up the large cuff, I take out the other ones",English
+"I set them aside, and I never use them all day long. 'Cause the large cup will fit almost everyone. And if the large cuff is too large,",English
+you do not get a falsely low value. The only thing that all of these different factors do is give you a value that's too high.,English
+So basically what we're doing is over diagnosing high blood pressure by the incorrect measurement of blood pressure.,English
+"And that's true in the office, and that's true at home. So again, that's a long list. It's a lot of time spent on this simple subject,",English
+"but I think it's on the very short list. One of the most important things we can do to improve the way we manage high blood pressure. And as I implied, this is also true at home.",English
+to make the way cuffs? - Let's take your questions at the end for the editing purposes. But the question was how tight to make the cuff.,English
+"The cuff is automatically, it's marked where to the fit it around the arm. Uninflated it should be comfortable.",English
+"And when you're inflated, it gets tight. and the tightness is derived by how many millimeters of mercury you inflated to. So if your blood pressure,",English
+"if I think your blood pressure might be 180, then I need to go higher than 180 in order to come down to get that measurement correct.",English
+"And if I get up to 200, it's gonna hurt. If I think your blood pressure is 130, I might go up to 160 and that would feel",English
+on the comfortable side of tight. So the cuff itself just comfortably around that. So it stays on the arm by itself basically.,English
+"and then the pressure is what determines that feeling that, ooh, that hurts a little or that's too tight. The other controversy is what blood pressure to count.",English
+"And what do you write in the chart, or what do you write on your log at home? Most of the guidelines in the United States talk about doing repeated measurements and averaging them.",English
+"That's okay. It's a little hard to do the arithmetic in your head. You know, you have to be, slick with the... Write down the value 'cause you'll forget.",English
+Write down the second value than average the two that one can do that. In the office it gets a little more complicated because the medical assistant or nurses,English
+"taking a blood pressure or two then do I count his or hers and then my own and average those two, or they do it twice myself and just average my two.",English
+"So there's a lot of uncertainty about the best practice. But it turns out, and I'll show you this in a few slides. It turns out that the acceptable way, and this is true.",English
+"The Canadians do it this way. And in fact, most of the quality measures in the United States do it this way, is you can record the lowest value.",English
+"So if you've taken it two or three times, you don't have to average, but you record the lowest one. And our definition of blood pressure control is determined",English
+using the lowest value. So many people make an error on that as well. Now all of these things can lead to a dramatic increase,English
+"in blood pressure, and I'm talking dramatic. 30 points millimeters of mercury. On average people report about 20,",English
+"but some people it can be substantially higher. So if your blood pressure is high, one of the first things to do is repeat it.",English
+"And in fact, a study was just done that was published earlier this year. And it was a study from 20 different clinics in a city like ours.",English
+And the medical assistants were instructed on these 19 features that I just reviewed of taking the blood pressure best practice.,English
+"And then they were instructed with one other thing, which was, they were told if the blood pressure is elevated over in this case, 140/90, take it again.",English
+"And just by taking it a second time, the blood pressure was under 140/90, over a third of the time.",English
+So repeating the measurements routinely give you a lower measure measurement in part maybe because that resting,English
+"is happening now a little bit, that's settling down that we talked about and so on. So that's a very easy trick, is just take it again, and you can record the lower of the values.",English
+"And as I talked about, this is an ongoing controversy and different practices do this differently, but I think when you look at quality measures",English
+"in the United States, including the ones we use from the federal government that are called HEDIS Measures or like the Kaiser's do in their population studies",English
+"and so forth, the quality community accepts the lowest measurement when two or three values have been taken. But the guidelines still often talk about",English
+averaging multiple measurements. Now there's also something that's not common. I call it research grade measurement.,English
+"And the way this was done in this one particular study, which I'll come back to called the SPRINT Study, the Systolic Blood Pressure Intervention Trial,",English
+"they had the medical assistant take the blood pressure akin to the way we would in the office, and then they would instruct the patient",English
+"to go into a quiet room that was with them dim lighting. They would have an automatic machine, a robotic machine, to take the blood pressurement.",English
+They would sit for five minutes. They had three automated measurements with some pause in between. There was no human in the room.,English
+"All the different 19 features were being adhered to, and the blood pressures were averaged. And what was fascinating about this",English
+"is that when they compared the values they got in the dark room with the automated measurement, it was 12 and a half points lower than what the nurse got",English
+in their advanced high blood pressure setting. This is a place where people were coming to see experts to participate in a big study.,English
+"And even in that big study compared to the robotic dark room, the dark room was 12 and a half points lower. Keep that in the back of your mind,",English
+because you'll see this study turns out to be one of the major studies that has influenced some of the guidelines that suggest we should treat people,English
+"at much lower values. And so it's a little bit of a catch 22. If you're gonna use the research grade measurement,",English
+"which is 12 points lower, then treating at a lower threshold may be okay. But if you're gonna measure it the way we normally measure it,",English
+then may be treating it at the higher threshold is also okay. And you'll see where the guidelines fall out in that regard. But remember this robotic measurement.,English
+And what we may see in the future is that more people will move to this. It would be pretty easy to do in a busy office setting.,English
+"You just set up, you need an extra room and a robot, just an automated machine basically and it's pretty easy to do,",English
+"but it's not how it's currently done. (clearing throat) Now, the other issue that has become part of common practice",English
+led by consumers and also device makers is to measure the blood pressure outside the office. And there is a consensus about doing this.,English
+"In fact, the U.S. Preventive Services Task Force as early as 2015, so several years ago, as part of their official recommendations",English
+"for blood pressure management, suggested that measurements should be a pain outside the clinical setting, meaning outside of the physicians,",English
+"nurse practitioners office, before starting treatment. This is not common practice. Most clinicians continue to treat",English
+"based upon their own measurement, but it is interesting because many of us follow the U.S. Preventive Services Task Force guidelines for other things like cancer screening.",English
+"But in this case, it hasn't really been fully integrated into a common practice. People use home measurement for a variety of things,",English
+"but it's not that common to use it routinely as a second test, if you will, before you begin treatment. However, in England, that's what they do.",English
+"And so the blood pressure has to be checked outside of the office before the patient gets treated, especially with medications. All right, let me move next to home measurement briefly.",English
+"I've already said several things about this, and it turns out this is not well standardized. You all, if you're measuring your blood pressure at home, you're all doing it in your private time and space,",English
+"and I have no idea how you're doing it. I barely know how my medical assistant is doing it, but I certainly don't know how you're doing it.",English
+"Although one good trick is to bring your machine in with you when you see your clinician and demonstrate to them how you are taking it,",English
+"which gives you the opportunity to also make sure the cuff size is correct, that your technique is correct, the machine is a well standardized machine,",English
+correlates with the office measurement and so on. So that's not a bad little trick if you wanna be a little bit more precise,English
+"in your home measurement. It's also not fully evidence-based, and what I mean by that is when patients are assigned blood pressure treatment with home measurement",English
+"and compared to blood pressure treatment without home measurement, and that's the only extra intervention, there's no benefit of home measurement.",English
+"Now that's a little misleading because if you did a real comprehensive program of blood pressure control,",English
+"that included pharmacy involvement and home checks and frequent checks and combination pills and things like that, and home measurement,",English
+"that is part of an integrated comprehensive plan, home measurement can be a useful tool. But when it's been isolated, as the only extra thing that's done,",English
+"it doesn't help that much. It's a little bit like checking blood sugars in people who are on pills for diabetes,",English
+"where, now I'm not talking if you're taking insulin, then you must check your home blood sugar. But if you're just taking pills, depending on the pills, many patients do not need to check their home blood sugar,",English
+and it's not associated with a very significant change in diabetes control. And this is analogous to that. Correct home monitoring requires all 19,English
+"of those other elements. So everything that I suggested in the office you should do at home and therefore again, bringing your equipment in and having the nurse or physician",English
+"watch you take your blood pressure is a good way to make sure that your own skills are up to best practices. And again, things like correct equipment",English
+"is also extremely important. And that's complicated now 'cause there's so much new equipment. Many, many of the new devices have not been well-validated.",English
+And so people are selling all sorts of things on fingertips and wrists and so forth. And many of those measurements have not been validated,English
+in rigorous studies. And when they have been studied in rigorous studies do not correlate particularly well with the measures that I'm discussing.,English
+"The correct timing is interesting because as I mentioned with the ambulatory monitor, it's around the clock. And so you could argue that doing home measurement",English
+"that mimics the ambulatory monitor might make sense, and that's not a bad way to do it. So rather than checking it every day",English
+"or every day twice a day, or whatever, you could argue, maybe I'll check it five times a day, one day per month,",English
+"akin to my using an ambulatory monitor, so getting a measurement throughout the day, because the blood pressure goes up and down",English
+"in a diurnal rhythm over the course of a 24-hour period. It's highest in the morning and it's lowest in the evening. So if you're checking your blood pressure after dinner,",English
+"especially after a glass of wine, kids are asleep, everything's copacetic, you're gonna get a lower blood pressure then,",English
+than if you check it when you first wake up in the morning before you've taken your medications. So that's important to know.,English
+"And so what our current guidelines are, you can do this all day, one day, every now and again model, but the standard recommendations are to check it",English
+"in the morning before you take your medications and then before dinner, as a way to frame the higher and lower.",English
+"But I don't recommend. They're very, very few patients who need to do this every day. You get too much information, you get too worried about it.",English
+"It's not adding value, but it is something to do occasionally and keep track of it. And again, share that information with your clinician.",English
+"Home measurements, as I mentioned, are lower than office measurements. And sometimes people talk about having different normals, but the relationship is not uniformly predictable.",English
+"So I can say if your blood pressure is 145 in the office, it's 135 at home. It could be, but it might not be.",English
+"So it's not a fixed relationship. On average, it's lower, but in any individual patient or any individual measurement,",English
+"the correlation is a little bit better than a coin flip, but not a ton better. It's about 60 or 70% correlation.",English
+"And as I mentioned, when you isolate home management as the only intervention, the evidence has shown little impact. All right, the final part of this section",English
+"is to talk about ambulatory blood pressure monitoring. And again, this is a machine you would normally pick it up from the cardiology suite",English
+"or where you might get an electrocardiogram or maybe an echocardiogram, or certainly a Holter monitor. That's where these live. They're relatively inexpensive.",English
+"Medicare will cover these, especially if the right diagnosis is put down, the right diagnosis being elevated blood pressure,",English
+"'cause you're using it to help decide whether someone has hypertension, which is the disease, versus not hypertension. So Medicare will pay if you use elevated blood pressure.",English
+"And again, I already described how it works, you can program it to do anything you want, typically it's several times an hour while you're awake. And usually a few times at night,",English
+"most people can sleep through this. Again, it's slower than the office, but the relationship is unsettled. But as I mentioned, the recent studies,",English
+including a very thorough review by the U.S. Preventive Services Task Force has suggested that it predicts,English
+"amongst a population of people, who's gonna get into trouble with cardiovascular disease than the other tools.",English
+That is to say it's makes blood pressure measurement the most predictive risk factor for heart disease and stroke compared to office measurement or home measurement.,English
+"So it's available, it's safe. It's not that expensive, but we use it quite infrequently in modern American medicine.",English
+And I think one of the things I favor is using it a bit more because misdiagnosing someone with high blood pressure usually means a lifetime of medications.,English
+"'Cause it's rare once people get diagnosed with high blood pressure that they get undiagnosed with high blood pressure, that requires a little bit of courage",English
+on the patient's part and the clinician's part. It also is the best way to detect something that's been called white coat hypertension.,English
+And this is that syndrome where your blood pressure is high in the office and low everywhere else. That does exist.,English
+It's more common in women than men. It's more common in young than old. It's more common in Caucasians than African-Americans. So it does exist.,English
+"which is very important to diagnose correctly because of the impact it can have on pregnancy, but it can also be over-diagnosed. And that's a setting where careful home measurements",English
+or an ambulatory monitor can be particularly important. You can also use it to monitor treatment and for some other purposes.,English
+"So in summary, this simple task that we do from the pharmacy to the hair salon, to your home, to my office, to the cardiologist's office,",English
+"turns out to be a little bit more complicated than we thought. And from a clinician point of view, we talk about really rethinking the office workflow.",English
+I think who's ever taking the blood pressure it's good to repeat the measurement. Whoever you're working with should think about whether to take averages or record the lowest value.,English
+"Home measurements are good. We probably do it more than we need to, but less accurately than we need to. So if you're gonna do it and do it well,",English
+"but maybe a little less often, and make sure you're following best practices, particularly things like cuff size breasts and so forth.",English
+"And again, similarly, the ambulatory monitor should be used more. Probably doesn't need to be used in every patient or even every patient with nuance and high blood pressure.",English
+"But we certainly, whenever we have a sort of a tiebreaker, and a patient doesn't wanna be on meds, for example, and the clinicians thinking, eh, I mean,",English
+"you should be on meds, perfect situation to get another data point and get the average under the curve and the area under the curve and use the ambulatory monitor.",English
+"All right, so I'm gonna move on. That's what I have to say about measurement. I think that's the longest section of the talk but I think probably the most impactful of the way it would,",English
+I wanna speak briefly about treating high blood pressure without medications. This is something I've been interested in,English
+between nutrition and internal medicine and chronic illness for my entire career. And one of the first studies I ever participated in,English
+"was a study that compared what we call nonpharmacologic or non-drug therapy for high blood pressure with drugs. That study, it was a great study.",English
+We had 300 patients that we recruited and we managed them very carefully. My job was to teach them how to manage it without drugs.,English
+"And at the end of a year of followup, the drugs won hands down. And in fact, the NIH had funded that study",English
+"and they had funded about a dozen others at the same time. And every single study showed the same thing, the drugs outperform non-drug treatment uniformly",English
+across the board. So medications are very effective for lowering blood pressure. We'll see more about that in a minute.,English
+"And nonpharmacological therapy is a relatively modest tool in your toolbox across all patients. But for individual patients, it can be the answer.",English
+"And so in the study, we were looking at the average blood pressure between 300 patients or 150 on the non-drug and 150 on the drug,",English
+"but for an individual patient, the things I'm about to talk about can be extremely effective and can either slow the need to take medications",English
+"or allow you to take one less medication, or in some cases completely, treat the blood pressure without medication.",English
+"So it's a very potent tool in the toolbox for a motivated patient, especially one who has certain clinical characteristics.",English
+"and you have high blood pressure, and there's a close correlation of those two things, then weight loss is uniformly effective",English
+"at lowering high blood pressure. So if a patient can lose 20 pounds and keep it off for a year or so, the blood pressure will go down a ton",English
+and it's worth at least one or two different pills or classes of medications. The problem is that it's really hard to lose 20 pounds,English
+"and keep it off. But for the patient, who's at that point where you're ready to do that, then weight loss always works at lowering blood pressure.",English
+"And it's quite well sustained. Now, eventually as you gain weight, or even if you kept the weight off as you age, you're at risk of the blood pressure drifting upward again",English
+"over time, but you can delay medication for quite some time if you're effective at treating high blood pressure with weight loss and those that are overweight.",English
+"Alcohol can also raise blood pressure. You don't have to become a teetotaler if this is the case, but if your blood pressure is high",English
+"and you're a moderate to heavy alcohol user, three, four, five drinks a day kinda class is the way some of these studies were done,",English
+"and can get down to one drink a day, the blood pressure can come down quite nicely. Although the amount you'll see is smaller",English
+"than with weight loss, but it's a real effect, but there aren't that many patients who drink that much and are willing to stop drinking",English
+"just for a little bit of blood pressure control. They'd rather take a medication I think in many cases. Salt intake is something I'll say more about,",English
+"but we've recommended salt restriction or sodium restriction for decades for high blood pressure. It's part of our public health recommendations for a healthy diet,",English
+"and the numbers are complicated and I won't review them particularly, but in general, restricting sodium can lower blood pressure",English
+"very effectively, but only in some patients. And it's probably somewhere about a third to a half. And so it's a very effective tool for treatment",English
+"of high blood pressure in some patients, but it's more controversial about whether the whole society needs to lower our salt intake.",English
+"In other words, 'cause a lot of patients with high blood pressure won't benefit from sodium restriction, but if you have high blood pressure",English
+"and if you're on a high sodium intake, and if you're African American in particular or older in particular,",English
+"both of which are associated with reduced clearance of sodium by the kidney. So reduce handling of a salt load, if you will,",English
+then sodium restriction can be quite important. Some of the recommendations in the past have recommended extreme sodium restriction,English
+"that doesn't work and may be dangerous. And again, moderate sodium intake for most people is fine, but it's a tool in your toolbox",English
+"if you wanna give it a try, especially if you're not overweight, and if you don't drink that much, then it's third on the list and it's worth a try,",English
+"and I'll come back to that in a minute. There's something called the dash diet, which has been around for about 15, 20 years, which is basically just a heart healthy diet.",English
+"So all the principles of eating a healthy diet with mostly plants, not too much real food and relying on mostly fruits and vegetables,",English
+"whole grains, small amounts of meat, fish, and fowl, nuts and oils, and so on, a Mediterranean type diet or a heart healthy diet,",English
+"that's been shown to lower blood pressure. And in fact, it's additive with sodium restriction. So if you combine a heart healthy diet",English
+"and sodium restriction, the blood pressure goes down further. Physical activity can lower blood pressure. We recommend physical activity for everyone anyway,",English
+"as I like to say, physical activity is Biblical and that means you should do it six days a week and one day of rest. The recommendations are 30 plus minutes a day.",English
+And that if you're start sedentary and you get to that point can lower the blood pressure by five to 10 millimeters of mercury.,English
+"And as I implied earlier, a habitual caffeine consumption or coffee consumption is not associated with the risk of high blood pressure. In fact, coffee consumption seems to be the Teflon substance",English
+"that it's not been shown to be bad for almost anything, but certainly the studies that have looked at mortality, heart disease risk, cancer risk, stroke risk",English
+"and the like, have shown caffeine to be not associated with bad outcomes in general. Now clearly it can make you irritable.",English
+"It can give you GI problems. It can cause atrial fibrillation in some people. But in general, when you look at populations, caffeine as a fatigue, mitigator,",English
+"as we call it with the residents is safe and effective. Once upon a time when I was a nutrition graduate student, I used to say, and I had a slide that said this,",English
+"it was a while ago, that a third of the salt in the human diet comes naturally occurring in food, a third comes from food processing",English
+and a third comes from us as consumers at the stove or at the table. And that now is just totally wrong.,English
+We've evolved over those 40 years to the point where our diets are different and our sodium sources have changed to the point now,English
+where processed and restaurant foods account for almost 80% of our salt intake. So still a small amount from naturally occurring in foods,English
+"and still some at home. But if someone tells you or someone suggest to you or for your own reading suggests that you wanna be in a lower sodium intake,",English
+worrying too much about what you do with the stove or the table is most likely the wrong tactic. And what you need to do is not purchase anything,English
+"in a bag or a box or a can, unless it says in really big letters, low salt, because anything in a bag or a box or a can",English
+"is high salt, unless it says otherwise. And so the whole story of when you go to a big market, only shopping on the outer aisle of the market,",English
+where the produce is and the dairy and so forth makes very good sense. So don't limit your consumption of things in general,English
+"that are in a bag, or a box, or a can, if you're concerned about your salt or for that matter current dietary recommendations. Secondly is restaurant food",English
+"and other package and prepared foods. So a lot of the services that are out there delivering food, but particularly restaurant food.",English
+"I don't know if any of you have gotten into the game of weighing yourself every day and the night after you went to your favorite, whatever restaurant that's particularly high in soy sauce",English
+"or whatever, and your weight goes up four pounds and you say, ""This is not possible. ""I didn't eat anything yesterday.""",English
+But then you realize you went and had sushi or your favorite Thai food restaurant. And it was all because of the sodium intake.,English
+"So those changes in weight are all salt and water, so a couple of days later it'll come off. But that's showing you how much sodium is in that food",English
+"that you ate at the restaurant. And the worst culprit of course is fast food. So not to pick on Asian cuisine, but fast food is by far and away the biggest culprit here.",English
+"And of course in our society, that's a concern. So sodium restriction is if you're eating a mostly plant diet and you're eating your nice tomatoes",English
+"and you wanna put some salt on it and that makes you more tomatoes, that's a good thing to do. Or if it helps you consume your lettuce and your big salad,",English
+"do it because that's healthy, but going to a fast food restaurant or buying food, that's in a bigger box or can is not.",English
+All right. I'm gonna move next to some of the clinical questions that are most on the mind of clinicians working with patients,English
+"with high blood pressure in terms of medication management, labeling and so forth. And most of what we know about high blood pressure",English
+"over the course of the last decades, most of all of my career, have been from an entity called the Joint National Commission.",English
+"And this is a NIH brought together panel of experts. They meet every five to seven years or so, and they come up with different recommendations,",English
+and over the years they've defined what's a normal blood pressure. They've recommended certain types of drugs over other drugs and so on.,English
+"And the most recent one was a few years ago. It was the eighth version of this, and they asked three questions",English
+"and this was good because they were three really good questions, the three questions that we all care about, which is, does treatment of blood pressure",English
+"at a certain level of elevation work? If so, how low should I treat it? Good questions.",English
+"And third, what medication should I use? Does it matter? And what they did was, which was different than the seven previous",English
+"Joint National Commissions, is they only looked at what we call Randomized Clinical Trials, which is the highest level of medical scientific evidence,",English
+"where there's a control group, a blinded evaluation of large populations of patients. And there had been several dozen of these",English
+that met the criteria for various questions related to high blood pressure. And they came out with nine recommendations. I'm not gonna read them all.,English
+"I'll summarize. The one that was most surprising, I wouldn't call it controversial at first, but it was definitely a surprise,",English
+"was the recommendation that for people over 60 years old, which is a lot of the population that has high blood pressure in the United States,",English
+that we could use 150 as our cut point rather than 140. So this was really great news for primary care and really great news for patients.,English
+"Because if it meant we can let people ride a little higher, then that means one less medication, typically, less side effects, less cost and so on.",English
+"And they recommended lowering it below 150 and also lowering a second number, the lower number, the diastolic blood pressure to less than 90.",English
+"So this was a surprise, but favorable, and it wasn't pulled out of the sky and I'm not gonna review this,",English
+"But each of these abbreviations stands for a really big, well done, publicly funded randomized clinical trial of the treatment",English
+"of high blood pressure. And so they looked at a very large body of evidence in order to make this conclusion. So it was very, what we would call, evidence-based.",English
+"The other recommendations were not as controversial. They said for everyone else under 60, then you should use 140 as your cut point.",English
+Or if you're treating both the high number or the low number using 90 as the low number. I should just point out it turns out that the high number,English
+"is more important than the low number. When I was in medical school, that wasn't the case. We mostly focus on the lower number,",English
+"what we call diastolic hypertension. But it turns out that systolic hypertension is the most predictive of cardiovascular disease,",English
+"heart disease and stroke. At the time these studies were being analyzed, the diabetes community was trying to suggest",English
+"that lower values would be better, but they reviewed the evidence carefully and said, even in diabetics, it doesn't really matter.",English
+"People with kidney disease, CKD stands for Chronic Kidney Disease, didn't matter, You could use 140.",English
+"And people were pushing that in the African American community, where there was a lot of risk associated with hypertension that lower numbers might be better.",English
+"They looked at that literature and said it doesn't matter. And so basically they concluded that 140/90 was fine for everyone,",English
+that there were many patients over 160 that you could let ride a little bit and drift up to 150. Although they also said if the patient was under 140,English
+"and well-controlled, that was fine too. So you were given some flexibility for people over age 60. The medications they recommended were four,",English
+"and previous recommendations have favored one class over another. They were a little bit more agnostic,",English
+"gave us a smorgasbord of four medications, except it was really four ways to get to three, because two of them shouldn't be used together.",English
+"So the four categories are thiazides, which are water pills, weak water pills, but which have independent blood pressure lowering effect.",English
+CCB stands for Calcium Channel Blockers. I'll give you the specific names of some of these in a minute. Those work.,English
+"ACEI stands for ACE Inhibitor and other I'll give you the names. And the fourth category are angiotensin receptor blockers,",English
+"or ARBs, and they also can be used as the first class of drugs. The one corollary here was not to use ACE and ARB together.",English
+"So you could use ACE or ARB, either first, second, or third, and then thiazide first, second, or third with calcium channel blockers for a second or third.",English
+"So that was sort the modern menu. And that was again good for patients, 'cause there were a lot of medicines in these classes,",English
+"good for physicians, 'cause they're medicines we knew how to use. You'll note or you may note that one class of medicine that's not on this list are beta blockers.",English
+"And beta blockers have been used for high blood pressure for many, many years, they're very good for other conditions. But when studied compared to these four drugs,",English
+they're not as effective as a single therapy. But that's a little misleading because they're excellent as the third or fourth drug,English
+"or they're excellent if you need it for something else. So it still lowers your blood pressure, just not quite as evidence-based",English
+"in terms of preventing strokes in particular as these other four classes of medicines. But it's still on the list, we use it all the time.",English
+"It's very effective way to lower blood pressure, but just not as the first or second drug as the main blood pressure lowering treatment.",English
+"And something that not everyone knew, although it's been in the literature for several decades is that ACE inhibitors and angiotensin receptor blockers",English
+"do not work as well in African Americans as the other classes of drugs. So they specifically went out of their way and said for African Americans,",English
+"we recommend thiazides or calcium channel blockers first. Again that's also a little misleading because many patients need,",English
+"most patients need more than one medication. And again, once you've gotten to drug number three, you begin to go to back to ACE and ARB very quickly",English
+"in African Americans, but you would start with thiazide diuretics or a calcium channel blocker as your drugs of first choice. And in kidney disease,",English
+"that's the one disease with specific recommendations, especially if you're spilling protein in the urine, then ACE inhibitors and ARBs have a long history",English
+of helping preserve kidney function. But that's really more in the context of having chronic kidney disease than just bland essential hypertension.,English
+"So those were the recommendations and we read this and said, all right, that's sensible. They asked the right questions, they looked at the right body of evidence.",English
+"These are patient-centered, good for primary care, everything was good. And then the sky fell.",English
+"(audience laughing) But these are the medicines that, just to show you some of the names, these are not the brand names,",English
+"these are the generic names or the chemical names, but you may still recognize them 'cause many of these medications have been around for decades.",English
+"They're all generic, they're inexpensive. they're on everyone's formulary, not necessarily all of them in each category, but one from each category is on everyone's formulary.",English
+And so it's pretty easy to find an ACE inhibitor that works. An enalapril or lisinopril are pretty common. Angiotensin receptor blockers.,English
+"Losartan is probably the most common. Valsartan is the one that had a little bit of imperfections in the synthesis. So that's been out of circulation of late,",English
+"but there are others in that class. The calcium channel blockers, amlodipine is a common one for high blood pressure.",English
+"Diltiazem is another one. And then the thiazide-type diuretics in the United States by far and away, the most common is hydrochlorothiazide,",English
+"although some of the others also work. So again, lots of choices, they're cheap, they're easily available.",English
+"Doctors and nurses know how to use them 'cause they've been around forever. And so it's a good list. And then there is,",English
+"I'm not gonna show you, but there's of course, 15 other categories of medicines that high blood pressure experts and others can use if you need more than three classes of medicine,",English
+"although most patients do not. So then what happened, is soon after the guidelines came out, a big study was published,",English
+"and I've already made reference to this, the SPRINT Study. This was the one with the robot in the dark room, measuring blood pressure.",English
+"It was a really well done study. It was at almost 10,000 men and women. They were over age 50. They had a predesignated group that were over age 75.",English
+"So it was well done. To get into the study you needed a blood pressure over 130, which was fine, and you needed to have a high cardiovascular risk.",English
+"And I'll explain that more in a moment, but it's an important part of this conversation. Interestingly, they did not accept people",English
+"with diabetes into the SPRINT Study. And that was a little bit puzzling, unless you knew that in the year or two",English
+"before the SPRINT Study was being planned, there had been another big study funded by the National Institutes of Health,",English
+"so a very well done, randomized trial that compared 140 versus one 120, the two blood pressures,",English
+"in patients with diabetes to see which was better, and there was no difference. And so the conclusion was that 140 was as good as 120,",English
+"and of course that made it much easier to treat patients 'cause again, it was one or two less medications. Each medicine lowers your blood pressure about 10 points",English
+"or so on average. So 20 points is a couple of meds. So that was sort of weird because we already knew that in diabetes, it didn't make any difference,",English
+"but they were doing the study again, but had to exclude patients with diabetes. So it was a little bit funny the way that played out. But it does mean that the results of the study",English
+do not apply to patients with diabetes. Who of course are one of the groups of patients for whom treatment of high blood pressure is most important,English
+"'cause they're at high risk of strokes, heart attacks, kidney disease, and so on. They compared people to get, they randomize people to 120 or 140",English
+similar to the diabetes study. It took an extra medicine to get people under 120. And it turned out it was hard to get people under 120.,English
+"The average was actually 121, which means on average, about half the patients couldn't get below 120, even though they were getting free medicine,",English
+being seen by their clinician regularly more frequent than you would see someone in a normal clinical practice and so on. So that was interesting.,English
+"Also that people couldn't actually get less than 120, especially this cohort of somewhat older patients. And this is the diabetes study.",English
+"I won't go over it in detail, but again showed that there was no difference between 120 and 140 before the SPRINT Study.",English
+"Now, the SPRINT threw us a curve ball because the results were positive, that is to say when they looked at all the events",English
+"associated with high blood pressure, that is stroke, heart attack, non-fatal stroke and heart attack, death from stroke and heart attack,",English
+it turned out that there were less events in the group that was treated to 120. So this was a positive study suggesting that 120,English
+was better than 140. But this was a little counterintuitive 'cause we already had six or seven studies,English
+"that I showed you 10 slides ago that said, it didn't really matter. We had this big diabetes study that said it didn't matter, but here was this new study that said it matters.",English
+"And then the hooker was that it also led to less mortality that people died less so often at 120, then one 140.",English
+"So this created two different conversations. So there's a group of people who thought that SPRINT was the end all,",English
+and that affected the way you look at this. Other people looked at this is an unexpected result. We're not sure what it all means. And the conversation continued and got louder.,English
+There were a lot of side effects on the SPRINT Study. These were things they looked at carefully in advance. There was 67% more risk.,English
+And these were serious side effects. The criteria for this was side effects that the clinician thought was serious enough to send the patient to the emergency department,English
+"or might be life threatening. That was the way the criteria was defined. So these are real low blood pressure. 67% more syncope, that is passing out, losing consciousness,",English
+"a third more of blood chemistry abnormalities, a third more and kidney problems, two thirds more. So there were a lot of side effects, but nonetheless,",English
+"the overall effect was beneficial. And it's a little hard to explain the concept here, but there's something in medicine",English
+"when you think about a lot, which is called the number needed to treat. And I'll show you this graphically in a couple of slides, but basically it's a way to put the odds",English
+deciding what to do for you. And so what's the likelihood that you will benefit given what we know about these populations that benefit?,English
+"You're with me on this? It's a confusing subject, but it's a way to put some numbers on the concept of better versus worse,",English
+"and quantitated so that people can make individual decisions. And I'll show you this graphically, it'll be clear in a minute.",English
+"But in general, the number needed to treat was about roughly a hundred, depending on what you're measured over three years.",English
+"So that's about 300 over the course of any one year. So it means that if you and I are sitting across the table from each other, the odds are 299 to one",English
+"that you're not the one that's gonna benefit. You're with me on this? So the population benefits, but you may not.",English
+"In fact, the odds are you won't. And that's just the way medical science works. Similarly, the number needed to harm is about the same.",English
+"So we get some benefit, we get some harm and you'll have to decide for you, which is better. Now, of course, in the way this study was done,",English
+"the benefits are better than the harms, right? The benefit included heart attacks, strokes, and death. And the harms, the harms are things like feeling lightheaded and falling down",English
+"and having an abnormal blood test. So they're not the same, but it is worth noting that the frequency was similar. These are all comments I've already made.",English
+"And the last bullet though, is that when you look at how the SPRINT Study applies to the community at large, to all of you,",English
+"statistically, they're only about one out of six of you that would meet the criteria to have been a subject in the SPRINT Study.",English
+"In other words, whether it's age or other diseases or what your cardiovascular risk was, whether you had diabetes,",English
+"all those things were factors that determine whether you can enter the study or not, and only one out of six patients with high blood pressure",English
+"were able to enter the study. So again, the generalized stability to the community at large is modest. And here are some of the risk factors.",English
+"And so there was no one who had diabetes, no one with stroke, no one was frail, and no one who was, let's just say under age 50. And as I mentioned, there was free care,",English
+"frequent visits and so forth. And this very careful measurement that was lower than the usual measurement, if you remember. Then the other thing that was really important to know",English
+"is that these were very high risk patients and that many of you have probably gone to websites and measured your 10-year risk of cardiovascular disease,",English
+"of having a stroke or a heart attack. There's a very good one on the Mayo Clinic, it's called the Mayo Clinic Statin Decision Site.",English
+"If you just Google Mayo Clinic Statin, it comes up, and you can put in your various risk factors and calculate your 10-year risk.",English
+And we use it in clinical practice a lot to decide who needs a statin drug for them for their risk. But it's also relevant in this conversation,English
+"about high blood pressure. And in fact, to enter this study, you needed a 10-year risk of 15%, and in fact, most people had 20%.",English
+"If you've had a heart attack, your risk of having an event in the next 10 years is 20%. So 20% is a high number in this conversation.",English
+"It's like, you've already had a heart attack. And so these are people who are on the fairly far along spectrum of risk of cardiovascular disease.",English
+"And here's a cartoon. It doesn't project super well, but what this is trying to say is bring to life",English
+"that concept of number needed to treat. And what I mean by this is, so each little gray box represents one person.",English
+"And if we have, say on the left hand side here, a thousand people, we can show who are then treated for three years",English
+"to a blood pressure goal of 120, rather than 140, based on the data from the SPRINT Study. We know that 16 of them will not have a heart attack",English
+or stroke in the three year period. It's the same as the number needed to treat. I've just done some arithmetic and made it a cartoon.,English
+"But the point of this, the way to think of this, again, if you think about odds, if you started as one of the gray people, the vast majority of the gray people stay gray",English
+"after three and a half years of being on two and a half medicines, right? Only a very small number become blue. And that's that idea that what happens in populations",English
+is different than what happens in an individual patient. You're with me? So this is a very intriguing way,English
+"to think about medical interventions. And you can do this kinda chart with anything. And we do it with cholesterol, we do it with a lot of cardiovascular management,",English
+"but you can do this with lots of other things. So if you have pneumonia from pneumococcal disease, and I give you penicillin, almost every one of you,",English
+"maybe 80% of you will get better, right? So the number of boxes, this would all be blue. If this were talking about pneumonia and penicillin,",English
+but now we're talking about treatment of a risk factor to prevent events over a period of time. And the number of people benefit one by one is much less.,English
+"And so this is an important concept. And again, just to balance it, almost an equal number were harmed.",English
+"Although to be fair, the benefits are more important than the harms, but the harms are real. And again, take home point here,",English
+"most people started gray and stay gray. Very few people change as a result of this intervention, even though everyone has to take the medication.",English
+"All right, so let me close this part of the conversation and we can then take some questions. The long and the short of it is this study came out",English
+"and then started and has continues to this day, a debate in the medical community about what to do. And so the cardiologist took this study",English
+"and came out with some guidelines that said, I'll show you them in a minute, we should follow these guidelines. And then just around the same time,",English
+"the primary care community, the internal medicine community and the family medicine committee looked at the guidelines and said, you know, actually we like the Joint National Commission guidelines.",English
+"We like 150 if you're over age 60, for everyone else 140, But the cardiologists said something totally different.",English
+"They said that if it's over 130, you should be treated, 140 everyone should be treated and 130, if you're at high risk.",English
+"And that anyone over 120, we would call an elevated blood pressure. So it totally changes the conversation from 140 to 120",English
+"based on the results of this one big study. And so these are what their recommendations are for treatment, basically saying",English
+"if you've already had a heart attack, then we should treat you using 130 as the cut point. If you're at very high risk of having a heart attack,",English
+"we should treat you at 130, and if you're at lower risk, less than 10%, then 140 is okay. And so that's now the debate.",English
+"We have the 130 and 140 school, and we have the 140 and 150 school. And we're all just caught in the middle,",English
+"and we have two groups of really smart people looking at the same studies and drawing completely different conclusion. Now, to try to sort this out,",English
+"there've been a couple of studies of late. There was one just published this week. I don't have a slide from, but it's consistent sort of with what I'm gonna show you.",English
+"But this was a very nice study that was published this year that looked at all of the studies of high blood pressure, was 70 different studies, 300,000 patients,",English
+"included men and women 60 years old. And basically they tried to answer the question of, does it matter what the blood pressure is when you start,",English
+"when you start treatment. And basically they looked at all the studies and they said, and the star here, the asterisk means that",English
+"the results are significant. And what they showed is that if your blood pressure is over 160 and you treat it, treatment works. There's a 7% reduction in mortality",English
+"and a 22% reduction in cardiovascular events. So everyone agrees with that. If it's over 160, it should be lowered.",English
+"that just showed even between 140 and 160. It's not so clear that it works. (audience laughing) If it's less than 140, it doesn't work.",English
+"So even though blood pressure becomes a risk factor at low levels, if you're less than 140 when you treat it, you don't get any benefit from that treatment",English
+"according to these 70 studies. So over 160 it works, over 140 it works, although now we have a little debate there,",English
+"but under 140, it doesn't work with the one possible exception in people who have heart disease. CHD stands for coronary heart disease.",English
+"So if you already have had a heart attack, then it's reasonable to treat at 130, which is what the cardiology guidelines say.",English
+"And then what happened after this conversation is that the family physicians independently in the internist, again, looked at their data",English
+"and all the recommendations they say, ""Well, what do we think? ""Are we gonna go along with the cardiology guidelines?"" And they both said no. So we're gonna stick to the guidelines",English
+"we published a couple of years ago, and still stick with a 150 if you're over age 60 or 140 for most patients.",English
+"It's also worth noting that if you use 120, if use the guidelines that the cardiology guidelines suggest that half the population is now labeled",English
+"as having hypertension. And you know, that just doesn't have face validity, right? It doesn't make sense that all of us would be sick.",English
+"So my final thoughts, and then we'll open it up. We talked about measuring blood pressure differently in the office, with carefully following the 19 guidelines.",English
+"I would say if you're a patient in an office like that, you should ask the clinician to retake your blood pressure if the first measurement is high.",English
+"Sometimes it's not feasible to do that out where the medical assistant took the blood pressure. But maybe when you get in to see your personal clinician,",English
+"that would be a time to have the blood pressure taken again in a close to correct method as possible. I think it's excellent to do home monitoring,",English
+"Get a good machine, something that fits over the arm, don't play with the wrist fingers and so on. Make sure it covers your arm",English
+"the way the dimensions are supposed to. Many of you will need a large size cuff, which takes an extra conversation",English
+"with who's ever selling you the machine, and then sit comfortably, have your arm be unclothed and so on, as we discussed before you take it.",English
+"Take it before breakfast, before your medications, and take it before dinner. Consider ambulatory monitoring for those who are in a toss up zone",English
+"you're just not sure what to do, especially after this talk. And so an ambulatory monitor is a excellent tie-breaker. Gives you another complete, relatively inexpensive,",English
+"totally safe and noninvasive way to collect information. And look at your cardiovascular risks. So you would be doing this anyway,",English
+"if you're interested in preventing heart disease or stroke with the use of aspirin or statins, 'cause we make those decisions based on your risk,",English
+and what this literature now suggests is that we should be using that risk prediction to help decide who should be on blood pressure pills too.,English
+"And if you're really low risk, then the benefit for you may be a very high number needed to treat.",English
+"In other words, it may not be worth it to you to take the medications. And again, then it depends on side effects",English
+"and preferences and costs and so on. I think 140//90 is a reasonable compromise these days. I think, although this new paper, again,",English
+"questions, whether that's maybe too low, but nonetheless, I think most of the literature would suggest that for most people,",English
+"140/90 is a good number at which we begin treatment, but make sure that is taken correctly. 'Cause if it's falsely elevated",English
+"then way too many people will be treated. 150/90 is probably fine for a lot of low risk, older, over age 60 people, not so old.",English
+"But over age 60, to be between 140 and 150 is not the end of things. It's fine if especially if you're having side effects,",English
+"don't wanna take a third medicine say or whatever, that may be fine for a lot of people, especially if your overall risk is low",English
+or whatever your personal preferences are given that gray box diagram that I showed that you may not be the one who benefits.,English
+"And for those who are very high risk, especially those with bad heart disease treating less than 130/80 may make sense.",English
+"If you're in that situation, you're probably seeing a cardiologist already anyway, and it will be their preference to treat you to 130/80. And that's okay.",English
+"'Cause that's where the evidence is strongest. And again, you shared decision making. What we mean by this is that try to understand the numbers",English
+"as well as you can. Health literacy is complicated, and this is what we call health numeracy, which is understanding the numbers,",English
+"which is even more complicated. But if you're inclined that way and have a clinician who's willing to the numbers or point you to a good website,",English
+"then it's worth thinking about it. And you given the number needed to treat and the uncertainty here, I think it would be incorrect for clinicians to be dogmatic.",English
+And so I think your preferences about this rule the day. And what we've learned particularly strongly off late is that using team approaches are very effective.,English
+And some of the big systems like Kaiser Northern California and others have done a terrific job controlling blood pressure in their population,English
+"with some innovative strategies that really rely on non-physicians particularly helping to manage blood pressure, but it also includes careful measurements",English
+so that people aren't mislabeled. So with that I'll thank you and stop and leave plenty of time for questions. Thank you very much.,English
+"(audience clapping) Yes, the question is where does stroke and atrial fibrillation come in?",English
+"Well, the easiest thing to say is that in the causative relationship, high blood pressure is a risk factor for producing both.",English
+So we definitely know that people with hypertension and elevated blood pressure are a greater risk for stroke and also greater risk for atrial fibrillation.,English
+"Atrial fibrillation, the medicines we use to control atrial fibrillation often do double duty as blood pressure pills.",English
+"So some of the calcium channel blockers, beta blockers, things like that. And so it's not in clinical practice. It's usually not that big a conversation",English
+"'cause you already need those medicines to control your heart rate since that's one of the ways they work. But for stroke, we do recommend tighter control,",English
+"but 140 is probably fine, you don't have to go to 130, 'cause there is a little bit of risk of being too low for some of these diseases as well.",English
+"And so 140's probably the right way to go for both atrial fibrillation and stroke. And very importantly,",English
+"although this is more your clinicians issue, is when you're in the hospital with a stroke, we let the blood pressure ride very high.",English
+"And we've learned that treating it too soon can be quite dangerous. So that's a little counterintuitive, but if you wander the halls",English
+"of the neuro intensive care unit here, you'll see people with blood pressures routinely over 180, 190 and so forth. That's just when they're in the hospital",English
+"during the acute stroke. As they come out over the course of four to six weeks or whatever, then we begin to begin to treat it",English
+"with a goal of getting less than 140 for sure If they have concurrent heart disease, then we go to 130. So the question was in the grid",English
+"with the number needed to treat. The harms were low blood pressure, syncope, blood tests, abnormalities, and kidney abnormalities.",English
+So they were all pre-designed side effects that were thought serious enough to send the patients to the hospital to be evaluated.,English
+"But so they're serious, but they're not like having a heart attack or a stroke or dying, you know? So that's when I say they're serious,",English
+"good news, because that's the only cholesterol  that the intestine can recognize and pull in,   people who have pancreatic problems, they don't  make enough lipases, these fatty acid esters pass",English
+"right through them, they have malabsorption, they  have fatty diarrhea, so that would be in the most   extreme form, but we all have different genetics  and we all manufacture lipases to varying degrees,",English
+"so different individuals have different ability  to de-esterify some of the things you're eating,   and that's going to affect absorption of  both fatty acids and cholesterol Ester. okay,",English
+"so I'm eating an egg, most of the cholesterol  in there is cholesterol ester, it´s in the yolk,   and it's going to go down, and if my pancreas is  working, some of that cholesterol Ester will be",English
+"de-esterified into free cholesterol, that that is  not is going to pass right through me because it's   just too big, the intestine has no receptor that  can attach to cholesterol Ester and pull it in,",English
+"but the receptor in the lining of the enterocyte  does have the ability to recognize unesterified   cholesterol, so when cholesterol Ester comes down  and it's de-esterified into free cholestero,l",English
+"it's gonna be in the proximal, that's the  beginning part of the small intestine,   and then the intestine has a decision  to make, wow, this person just ate,",English
+"there's a lot of stuff in that gut Lumen,  there are fatty acids, there's cholesterol,   there's glucose, there's a lot of stuff that this  person ate so I now have to decide what to absorb,   all right, so the intestine is looking at the  gut Lumen and it sees free cholesterol, now,",English
+"if I could take one of those little submarines  and go right down your esophagus, stomach,   into the intestine, and I could start interviewing  cholesterol molecules and I went up to each and   every cholesterol molecule, and there would be  bazillions of them sitting in your gut Lumen,",English
+"and that cholesterol molecule would say, well,  he ate an egg and he swallowed me and here I got   de-esterified, separated, and here I am, and  you know what, about 20 to 25 percent of the",English
+"cholesterol molecules I interview in the gut Lumen  would give me that answer. well, if you know how   to do math you would say, wait a minute, maybe  20-25% of the cholesterol molecules were ingested?",English
+"that means 75-80, even 90 percent did not come  through this human's mouth, how did they get   into the small intestine? all the intestine knows  is, if I see free cholesterol, I might absorb it,",English
+"it could care less how it got into the small  intestine, so a little bit comes from what we ate,   the overwhelming vast majority, there's another  entrance to the small intestine that has nothing",English
+"to do with your mouth, the esophagus, as  you know Gil, as a doctor, our intestine is   connected to our insides via a passageway from  the liver to the small intestine, and that's",English
+"called our biliary system, our bile ducts, so  the liver can take things that it doesn't want,   secrete it into the bile, sometimes it's  transiently stored in the gallbladder but",English
+"ultimately it will pass out of the gallbladder,,  through our bile ducts and come out in the very   early part of the small intestine and enter  the Lumen of the smaller intestine so the truth",English
+"is that 75 to 90 percent of the free cholesterol  molecules, those are the only absorbable molecules   that are in our small intestines at any given time  of the day, came via the liver and the bile duct,",English
+"they did not come from our mouth, and in general  that is why the amount of cholesterol you eat,   for the most part, and there are exceptions, has  nothing to do with the bulk of cholesterol that's",English
+"going to be absorbed. the overwhelming majority of  cholesterol that you and I are probably going to   absorb during the day was produced in our body, it  was shipped back to the liver, get rid of it, the",English
+"liver pumped it into our bile ducts and it wind  up in the intestine, and the liver and our insides   are hoping, God, I hope that intestine excretes  this unneeded cholesterol into the stool. the",English
+"intestine isn't that bright, so the cholesterol,  x amount is going to be absorbed, so the majority   of the cholesterol molecules that make up the  pool of absorbable cholesterol are endogenous,",English
+"meaning they were synthesized in your body,  and shipped back to the small intestine, yes,   some of the cholesterol you ate is going to be  in that pool and is available for absorption but",English
+"in general seven to eight out of ten cholesterol  molecules in your small intestine you didn't eat,   they were put there by your body, so that's why  eating cholesterol is not a major league player",English
+"on however much cholesterol you're going to have  in the tissues or in the blood of your body,   but it's always more complicated, isn't it?  so the next thing I'm going to talk about is,",English
+"all right, how does that intestine decide,  let's let some of this free cholesterol in?   well, it has to, it doesn't diffuse through the  intestinal membrane, there are molecules that",English
+"can diffuse right in, but cholesterol, lipids in  general cannot, we have specific receptors that   bind to, recognize the lipids and pull them  through the enterocyte cell membrane and up,",English
+"before you know it, it's inside the cell, the  enterocyte, so we have one receptor that has the   ability to recognize quote-unquote sterols, that  means anything that has the sterol structure, it",English
+"would recognize, but it's constructed so it has an  incredible Affinity to recognize cholesterol, it   has very little Affinity to recognize phytosterols  that you may have eaten in your veggies,",English
+"it might recognize a few and pull them in but very  few, if you have the perfect receptor, and let's   give that receptor a name, it's a mouthful, it's  the Niemann-Pick C1 like one, Niemann-Pick C one",English
+"like one protein, so if I express that receptor,  it's going to recognize mostly cholesterol, a few   Phytosterol molecules, and it's going to grab  them and pull them inside the enterocyte cell,",English
+"that's step one of absorption, going from  a gut Lumen into the gut cell, the small   intestinal cell, all the lipid absorption is long  before this stuff ever gets down to the colon,",English
+"this is all the early part of the small intestine  where most lipid absorption occurs but you know,   the small intestine is 20-30 feet long, so  it's got a lot of surface area to do that,",English
+"but it's in the beginning third or half  where most cholesterol gets in, all right,   and maybe some phytosterols, a little bit of an  aside, because is there anything that regulates",English
+"how much Niemann-pick C1 like one an intestinal  cell may produce? number one is, yeah, your genes,   there's a very specific Gene that if you have  will produce the proper number of Niemann-Pick",English
+"C1-like proteins but what if something went wrong,  or maybe something went right, for some reason you   inherited the genes where you don't make very  many Niemann-picks C1 like proteins, that's",English
+"called a loss of function, good news, if you don't  make very many Niemann-picks C1 like proteins,   you are what is called a hypo-, under-absorber  of cholesterol, so you're actually denying the",English
+"body a source of cholesterol, here's even the  better news, throughout life those people's   cholesterol as measured in the blood might be 15  to 25 percent lower than people who have proper",English
+"Niemann-pick function, but you would think that  little change in serum cholesterol doesn't matter,   over a lifetime, they have almost no heart disease  whatsoever, so blocking absorption of cholesterol",English
+"genetically is a gift from God because you  will have a much lower incidence of ever having   atherosclerosis in your body, right, but there's  going to be another part of this receptor that",English
+"we'll get to, but anyway, hope you are born with  loss of function of Niemann-pick C1 like protein,   so if we did cholesterol absorption studies  in most humans, let's say in the middle is 50,",English
+"that means you will absorb 50% of the free  cholesterol molecules that make it into your gut   Lumen, that's on average what a normal human will  absorb, and we're only talking cholesterol here,",English
+"not fat, not saturated fat, cholesterol. there are  about 20 percent of people, most of them because   of that loss of function of Niemann-pick C1 like  one, who are these hypo-absorbers of cholesterol,",English
+"but on the other end, there's about 20-25% of  people that are over-absorbers of cholesterol,   and guess what, they are the people who are  going to correlate with increased cholesterol",English
+"in the serum and possibly, often times,  increased incidence of coronary heart disease,   atherosclerosis. so when people ask me, does it  matter whether I eat cholesterol or not? I say,",English
+"you know, I can only answer that question if I  knew are you a hypo-absorber, an average absorber   or a hyper-absorber, if you're a hypoabsorber, eat  42 eggs a day, it doesn't matter, most of it is",English
+"see how it affects it, so that's the only way to  answer that question, you cannot make the general   statement ""eating cholesterol is bad because it's  going to get in"", in some people it will get in,   in many people it will not, and in some people it  will never get in, and very few of us are checking",English
+"our genetic function of the Niemann-pick  C1 like protein but there is a blood test,   and I'll get to it in a moment, that could  tell me or you as doctors that, oh boy,",English
+"this is a person who is either over-synthesizing  internally cholesterol molecules in their cells or   this is a person who for a variety of reasons  is over-absorbing cholesterol, you know Gil,",English
+"and you give way better dietary advice than I  ever do, whatever dietary advice you're going   to suggest to a patient, you're individualizing  it for that given human based on so many things",English
+"you've found in the history, their nutritional  history, their biomarkers that you're checking   in the blood, so in most of those I don't think we  have to shove down everybody's throat you can only",English
+"eat 200 milligrams of cholesterol a day because  the amount of cholesterol you're eating may have   nothing to do with your atherosclerotic risk,  but there are some who would, so you can do it by",English
+"trial and error, you're not measuring phytosterols  or genetic tests for hyperabsorption, they have a   high ApoB, LDL-cholesterol, you want to give them  two months of stop eating cholesterol and see what",English
+"happens, okay, no harm done, so many doctors  will do it that way, I'm just a lipidologist,   I know this stuff, I know how to use biomarkers,  so you will get a more serious, thorough",English
+"comprehensive exam from me, other clinicians will  say, oh my God what a waste of time and money,   you don't need them on everybody so... and  look, I'm the guy who wrote the chapters on this   stuff so it's been a lifetime studying sterol  homeostasis. well that's why we have you on.",English
+"all right, the next step, I´m a free  cholesterol, Niemann-pick has pulled me in,   that intestine is going to say, either we do  need some of this cholesterol to get inside,   to get internalized, or good God  we don't need any more cholesterol,",English
+"we have to get rid of the cholesterol that  the Niemann-pick C1 like protein allowed in,   so as I said, there's several forces at play, the  Niemann-pick is what we call a cholesterol influx",English
+"protein, it brings cholesterol from the gut Lumen  into the enterocyte. there's a parallel receptor   that sits very close to it on the cell membrane,  between the enterocyte and the gut Lumen, exact",English
+"place where the Niemann-pick also sits but they're  different receptors, this receptor is called the   ATP binding cassette transporter G5 or G8,, there  are two of them they work together co-jointly if",English
+"they're working properly, and what the purpose of  that receptor is, the intestinal cell says, oh my   God we absorbed too much cholesterol through the  Niemann-pick, we're not going to let it go inside,",English
+we're going to evict it right back to the gut  Lumen and they turn on the genes that express   ATP binding cassette Transporters G5 and G8 so if  too many cholesterol molecules pass from gut Lumen,English
+"into the enterocyte, they can be immediately  re-evicted right back to the gut lumen,   in which case then they will pass through the rest  of your intestine and be excreted in the stool,",English
+"so you can see what is the major regulator  of cholesterol absorption is going to be a   wonderful joint action of the Niemann-pick C1  pulling it in, nd the ABC G5 G8 evicting it.",English
+"if they're working in harmony we will wind up with  the proper amount of cholesterol that our body was   hoping would be absorbed, but if we have defects  in Niemann-pick C one like one or if you have",English
+"loss of function of ABC G5 G8,, you got the wrong  genes again, any cholesterol that gets into your   enterocyte has little ability to be evicted back  to the gut Lumen, then it is going to wind up in",English
+"your body because it's got to go somewhere so  you have this happy interplay of G5 and G8,   as a quick little aside, because the body just  so tightly regulates cholesterol absorption,",English
+"the liver was also given a set of G5/G8 and  Niemann-pick C1L1, so if phytosterols ever   wind up in your liver because somehow they pass  through the intestine or if you even absorb too",English
+"much cholesterol, the liver has a defense, you  thought you were gonna get in, I'm gonna evict   you through the ABC G5G8 right back to the bile  and you're going right back to the intestine,",English
+"buddy. it's like a backup door bouncer, you may  have gotten through the first bouncer, the G5/G8   Niemann-pick in the intestine, but the odds are  less you're going to get through the liver because",English
+"the liver will recognize you as fraudulent and  express them. now, there are a lot of people who   don't have total loss but they have partial loss  of G5/G8 so they're not going to Super absorb,",English
+"a few more Phytosterols than usual get in, if  we measure that we know the system is broken,   and that's how phytosterol is measured  in the blood, it has clinical value,",English
+"but remember, the ABC G5/G8 also evicts extra  cholesterol at the intestine it doesn't want,   or even the liver if the liver's got too much  cholesterol, get out of here, I'm putting you",English
+"right back in the bile and I'm sending you down  to the intestine again, so if you have partial   loss of function of ABC G5 or G8, you are going to  be one of those 80% hyperabsorbers of cholesterol",English
+"or maybe more, you might be a 95%, if you do  have a loss of function of ABC G5/G8 you are   going to have too much cholesterol in your system,  probably you'll have a high ApoB level, and it's",English
+"very treatable, hyperabsorption of cholesterol,  so it's crucial for a clinician to know that,   if for some reason you did a genetic test and  it indicates partial loss of function of G5/G8,",English
+"the odds are huge you're going to need an Apob  lowering therapy that blocks the absorption   of cholesterol, and doctors know and many  patients know that's a drug called ezetimibe,",English
+"then try to eat a few eggs, maybe a couple  eggs a day and then measure it? well yeah,   but there's a better way of doing it, there's  a blood test that's going to tell us, not a",English
+"genetic test which are more expensive,, harder to  find but a simple blood test that would tell us,   oh my God you're absorbing too much cholesterol,  well that is almost always due to loss of function",English
+"enterocyte has a a pool of cholesterol that it  finds acceptable but it knows it has to get it   into the body, it either has to be delivered  to this tissue or that tissue or most of it's",English
+"going to go to the liver and then the liver can  decide what to do with the absorbed cholesterol,   so how does cholesterol now get from the cytosol,  the inside of the enterocyte, into the liver?",English
+"well, it has to be put in something that's  going to take it out of the enterocyte,   take it through some circulatory pathway and dump  it in the liver. the enterocyte says, all right,",English
+"give me X glob of cholesterol, give me X glob  of triglycerides, I'll make an oil droplet, now   all I have to do is wrap them with a protein and  I've created a lipoprotein. it happens to be one",English
+"of that ApoB family of lipoproteins, and the big  and it's a big one, it's our biggest lipoprotein   by far, is produced in the intestine, it is called  a chylomicron, which the intestine just secretes",English
+"into something called our lymphatic system, it's a  different type of circulatory system that connects   cells with the blood, so the chylomicrons get  poured out of the intestine into lymphatics,",English
+"it's a short Journey, our lymphatics enter the  bloodstream up in our neck, so those chylomicrons   take a sub-Pathway to get to the bloodstream, the  lymphatic system. now, the big purpose of that",English
+"giant chylomicron carrying energy, triglycerides,  is to rapidly rush to muscle cells or adipocytes,   the two tissues that Express an enzyme that sucks  those triglycerides right out. now, when I take a",English
+"big chylomicron and I remove a large chunk of its  triglycerides, it becomes a much smaller kind of   chyloMicron that's called the chyloMicron Remnant.  the liver has receptors that recognize chyloMicron",English
+"remnants and pull that now reduced but still large  chyloMicron molecule into the liver, and what's on   the inside of that chylomicron Remnant? that's how  the cholesterol goes from your intestine to your",English
+"liver, it co-shares space with triglycerides. the  triglycerides are removed by muscles or fat cells,   the remaining shrunken chyloMicron or remnant  delivers the cholesterol to the liver,",English
+"now the liver says, haha I have a nice supply of  intestinally absorbed cholesterol, now it's up to   me to decide what to do with that, the liver will  also be synthesizing some cholesterol and the two",English
+"pools mix and then the liver decides what to do  with both synthesized and absorbed cholesterol,   all right, but let's go right back to  the intestine, I told you, all right,",English
+"step one is to throw the cholesterol ester and  triglycerides inside a chyloMicron, ship it out,   there's still some remaining free cholesterol  molecules there that have not been esterified,",English
+"Pathway 2 how cholesterol exits the enterocyte  is not going into a chylo, much of it does,   but there's a backdoor exit going into an HDL  particle. one of the crude signs that a doctor can",English
+"look at in the bloodstream that at least should  suggest I might be dealing with a hyper absorber   of cholesterol is their HDL cholesterol is tending  High, because the HDLs acquire extra cholesterol",English
+"molecules at the small intestine. most of the  cholesterol in HDL comes out of your liver but   x amount comes out of the intestine, especially if  you're a hyperabsorber, so it's a real Poor Man's",English
+"clue that if I see, geez, LDL-cholesterol is up  but your HDL cholesterol is up too, at least think   of hyperabsorption of cholesterol. you see a man  with an HDL-cholesterol of 60. that's unusual. 70,",English
+"God, what's going on here, maybe you want to  check absorption in that man. a lady would be   a little bit higher because as you know women have  slightly higher HDL cholesterol than do men. but",English
+"it's a poor man's surrogate of hyperabsorption  of cholesterol. I've already talked about it but   there is a third way that that enterocyte can get  rid of unwanted cholesterol. so chylomicrons, one,   lipidate HDLs, 2, but remember, it could send any  unwanted free cholesterol right back out through",English
+the ABC g5/g8 back to the lumen of the intestine  and we can Kiss It Goodbye. are there ways that   the intestine can prevent any free cholesterol  molecules from attaching to the Niemann-pick C1,English
+"Like protein? yes. the intestine is full of what?  tons of Flora. microbes. bacteria. and bacteria,   we're learning more and more, regulate many  homeostatic mechanisms in the human body,",English
+"so guess what, we have some bacterial species that  have the ability to take that free cholesterol   put it through a chemical reaction cholesterol  changes into a group of molecules called a",English
+"stanol and here's the wonderful thing about that  little bacterial trick the Niemann-Pick C one   like protein has almost no ability to recognize a  stanol, so you will, if those bacteria do us the",English
+"favor and change cholesterol to cholestanol,  it's going to go right out your rear end,   so that's another bodily defense about regulating  cholesterol, there are lactobacilli products,",English
+"commercial products that we can, sort of like a  yogurt, that you can swallow, and lactobacilli   are the ones that convert cholesterol to  cholestanol, so that can be one of these,",English
+"I hate to recommend supplements because  you really never know what the hell is   in any given supplement you're buying, but a  reputable lactobacillus product is a, nowhere   near as potent as Zetia or a ezetimibe, but it  is a way of reducing cholesterol absorption,",English
+"it's a capsule full of a ton of  these phytosterols that I mentioned,   way more than even a vegetarian eats in a day,  you know, a couple of grams of phytosterols,",English
+"a vegan might eat 600 milligrams of phytosterols a  day, and on the premise that if you swallow a lot   of exogenous phytosterols, they will compete with  cholesterol for absorption into your enterocytes,",English
+"so you will probably absorb a little  bit less cholesterol and you know what,   that would be fine and dandy, unless you're one  of those ABC G5/G8 loss of functions, because",English
+"you're going to create, not true phytosterolemia,  but a serious Phytosterol level in your blood,   and once a threshold is crossed, phytosterols  have the potential in some people to do bad",English
+"things ,so before I let anybody go to a supplement  store and let some kid behind a counter sell them   Phytosterol supplements, I would prefer to  measure phytosterols in the blood, and if I",English
+"could see they're a hyperabsorber, I tell them,  pretend that's arsenic, never buy that product,   because it can't possibly do you any good  over time. so another important thing to know.",English
+"there are out there, not everybody knows about  them, but I told you stanols cannot be absorbed,   so if you're looking for a supplement  that will compete with cholesterol for",English
+"absorption but it itself cannot be absorbed, the  Phytosterol might be, depending on your G5/G8,   they're called, there's one phytosterol product I  know available on the market, it's called benecol,",English
+"it's a phytostanol, it's a specifically made  product, used to be made in Finland, now you go   on Amazon you can buy it, I think in the grocery  store we used to see it all the time, that's one",English
+"of these supplemental ways to, if you want to  start addressing hyperabsorption of cholesterol,   but I would tell you, if your ApoB is seriously  High, go right to Zetia or ezetimibe. you know",English
+"so even though it can't get get absorbed by the  Niemann-pick, it can compete with cholesterol?   yes. trick the Niemann-pick? yes, it's similar  enough in structure to a cholesterol that it",English
+"fakes out the Niemann-pick, so... and the other  thing, all of the lipids I mentioned, fatty acids,   cholesterol, when they are sitting as a pool in  our intestine, there's actually another component",English
+"that rounds them all up and sort of acts like a  ferry boat and brings them to the intestine for   absorption, and that is bile acids that our liver  makes, secretes through the bile. bile acids Round",English
+"Up lipids into little collections called biliary  micelles, they're little ferry boats full of   lipids, they almost are like a lipoprotein but  there's no proteins on them, and they traffic",English
+"cholesterol, sterols, fatty acids, omega-3 fatty  acids, phospholipids, to the brush border of the   intestine, where the Niemann-pick can grab  them, so there is sort of an intermediate,",English
+so the phytostanol really blocks cholesterol from  going into the biliary micelle and that gets in   there and when it docks at the enterocyte the  Niemann-pick doesn't absorb the phytostanol and,English
+"there's less cholesterol in the biliary micelle,  so you've reduced cholesterol absorption. it's   kind of cool. it's weak, but it's an option.  you know, if you're one of those FH patients,",English
+"if you've had your bypass, I mean you want to take  a phytostanol, be my guest but you're never going   to get apoB under control with a supplemental  product alone. so if you understand those Concepts",English
+"and I'm a doctor and I would really love to know  who's a hyper absorber of cholesterol, because   I have, if you're in a certain high risk zone or  your apoB, we discussed that last time, have too",English
+"many particles carrying cholesterol, we want to  get rid of them, we do turn to pharmacological   treatments sometimes if lifestyle hasn't corrected  the issue, all right, so how would I know,",English
+"Gil, whether you're a hyper absorber or even a  hypersynthesizer of cholesterol? well, remember,   if we eat vegetables, Phytosterol should pass  right through us if we have normal absorption,",English
+"maybe just a few Phytosterols will make it into  the intestinal cell, most of them will be evicted   right back out to the gut lumen, but if we tend to  absorb more Phytosterol molecules than we should,",English
+"and that's because you at least have some degree  of loss of function of ABC G5/G8, it might only be   minute, it might be horrific, phytosterols  are going to get into your chylomicrons,",English
+"or they're going to be evicted into your HDL  particles. if phytosterols enter your chyloMicron,   they're brought to the liver, the liver  exports lipids by making VLDLs and LDLs and",English
+"all of a sudden your VLDLs and LDLs are carrying  phytosterols when they never should, and the HDL   is now circulating carrying something that you'd  never carry, phytosterols so if you and I measure",English
+"phytosterols in the bloodstream, the simple blood  samples we take out of our patient's arm, and we   tell the lab, measure phytosterols, there might  be a trivial amount, okay, a few molecules maybe",English
+"and that means nothing, means you're basically  a normal absorber, but as those phytosterol   levels start to go up up up to different  thresholds, it's a major league clue that",English
+"I'm dealing with a person who has hyperabsorption  of phytosterols, even though it's a small degree.   anybody who's hyperabsorbing the phytosterol  is way more seriously absorbing cholesterol,",English
+"because the Niemann-pick has a much greater  affinity for cholesterol than phytosterols,   so if you and I measure phytosterols, and the  two that are usually measured in the bloodstream,",English
+"and you got to go to certain Laboratories that do  these, not every lab in America will offer them,   so it's an advanced test, some doctors  like Gil knows about them, others no clue,",English
+"a lipidologists usually knows how to get this  stuff if they want it, the two major phytosterols   that Laboratories have the ability to measure  are something called sitosterol or campesterol,",English
+"so if I measure sitosterol or campesterol, and  most Labs do both, and they're elevated, you're   dealing with hyperabsorption of cholesterol,  the next test, you've probably already done an",English
+"apob level and you say, oh my God the APOB, the  particle number is too high here, this person's   at risk for the sterol molecules being delivered  to the artery wall and my therapeutic mission",English
+"is to clear those apob particles by inducing  LDL receptors in the liver, a hyper absorber,   the best, a really effective either monotherapy  or an add-on therapy is, let's add Zetia or",English
+"ezetimibe, swallow it, you stop absorbing  to a large degree, not totally, cholesterol,   your liver is denied a source of cholesterol, the  liver makes more of those LDL receptors that clear",English
+"your apoB particles. APOB is the goal of therapy  but we measure phytosterols to give us a clue,   I now understand the pathologic mechanism  that might be at play in a given individual,",English
+"and understanding that may help me make a smarter  therapeutic choice if I have to choose a drug   in this person. now, many doctors just, they  usually go, I'm going to start with a Statin,",English
+"if it doesn't work or I don't get where I want  it, I'll add ezetimibe or zetia to it. personally,   I would rather you know that ahead of time because  I think there are many people who would benefit   just taking a ezetimibe or zetia and may not need  a Statin. the nightmare cases will need a Statin",English
+"added to ezetimibe, some of them will need even  a third drug that further clears ApoB particles,   the pcsk9s, but it's nice to know, step one,  which drug has the best chance of working. at",English
+"the end of the day you don't have to listen  to a word you and I talked about, measure   ApoB in your blood, if it's above a certain  level, do what you can do to increase hepatic",English
+"liver clearance of those apob particles. here's a  lifestyle, it might work in person A or person B,   and they might be different Lifestyles, and here  are, basically we have four drugs that can enhance",English
+"clearance of ApoB particles: cholesterol synthesis  Inhibitors, cholesterol absorption Inhibitors,   LDL receptor regulator drugs like the pcsk9, and  a rarely used drug anymore, used in my Heyday but",English
+"rarely used anymore, the bile acid sequestrants.  for those who need pharmacologic lowering of apob,   I prefer to do what we call optimize our lipid  therapy, not drown you with a Statin at a higher,",English
+"higher, higher dose, then go to plan B, add  Zetia, then go to plan C, add bempedoic acid, then   throw a pcsk9 inhibitor at you. the first step I  think ought to be, a dual ApoB lowering therapy,",English
+"and here's why: say I do the blood tests on you  and it shows Gil´s mostly a hypersynthesizer of   cholesterol, that's why his apoB is high. well,  logic tells me, just give Gil a statin, because",English
+"that would stop cholesterol synthesis to a large  degree and It'll have a nice impact on his APOB,   but is there a downside to just inhibiting  cholesterol synthesis? and vice versa,",English
+"suppose I found out you're a hyperabsorber, I'm  going to give you zetia monotherapy because it'll   block absorption, I'll get a nice drop in your  APO B but what is the long-term consequence of",English
+"inhibition of cholesterol synthesis or inhibition  of cholesterol absorption? in X number of people,   and it's going to vary on your genes, if I take  out cholesterol synthesis with a Statin, those",English
+"forces are going to go into play, the body knows,  oh my God we've lost the ability to synthesize   cholesterol, I have to get it somewhere else,  so your intestine reflexively starts absorbing",English
+"cholesterol, so one downside, statins would be  more efficacious if they didn't cause some degree   of hyperabsorption of cholesterol, vice versa, if  I gave you only zetia and blocked your absorption,",English
+"all of a sudden your body says, God, we're not  absorbing cholesterol anymore, so what, I'll just   start rev up the synthesis and I'll make more, so  Zetia monotherapy turns on cholesterol synthesis",English
+"And it's not about the doctors and it's not their fault. It's really that particular moment can impact a patient's psyche one way or the other, right?",English
+"They'll go down a rabbit hole or they can become really calm, someone's brain at that particular moment in time. And so I went completely the other way where I was just",English
+"blank and just confused really is the right word to describe it. I think that's immediately where my mind went was just death, really, just to be honest, right?",English
+And just how long do I have? And then you start to walk off the ledge a little bit once you become more educated about what you have.,English
+"But that could be a year from now, right? For me, it was a whole year before I really understood it. I appreciate it because it's really going in depth that will help people connect with what you're saying.",English
+"So in that moment, you went blank. You heard the word leukemia. You're familiar with leukemia. I mean, I don't think many people hear polycythemia vera",English
+"right? It's just not something that comes up even anywhere. And so you left the office. No questions. You were sort of like, ""Okay, I don't know",English
+"what to do."" You left the office. How did you break the news to Kara and others? I remember where I parked specifically in the parking lot.",English
+"I just monotonously walked to my car. I spent about 15 minutes in my car, just all these questions flooded in.",English
+"All these questions that I should have asked the doctor and the top one was, ""How?"" How did I acquire this? Was it something I ate?",English
+"Was it alcohol? All these questions flood in. How long am I going to live? And then you start doing the worst thing that you could possibly do, which is Google.",English
+"It was just a confusing name polycythemia vera, right? It's just a confusing moment. That's the only word that I could really use.",English
+"I just didn't know how I got it. I didn't know what the long-term prognosis was. It was just a very confusing time. So it was less of the sadness because it was, ""What are we",English
+"dealing with? We have no idea."" It's not like you got some diagnosis. Again, if it was leukemia, it's a little bit more understood just because there are movies about it, right?",English
+"So what were those next steps for you and Kara? I think to your point before about meeting that doctor for the first time, we wanted a second opinion.",English
+And so we had gone to Cornell to get a second opinion. And that doctor was really great and really breaking it down and explaining exactly what it was,English
+"and how it would sort of evolve. I don't know if that put us at ease. I mean, I will get very descriptive here.",English
+"Walking into Cornell, into the blood cancer center, and seeing people that are just a lot further along than I was or just had different types of blood cancer I had to leave",English
+"the room and I got really, really emotional. And I'm getting emotional now because just thinking back at that particular moment, that's where the sadness kicked in",English
+"as you were talking about, right? It went from confusion to then sadness where that might be my outcome. Yeah. It brings back all the moments, all the thoughts that",English
+"I was feeling about my kids and not being there for my kids. My wife is pregnant at the time looking at her and not being there for her, right?",English
+"We're supposed to be life partners, right? And to kind of remove myself from those life situations was really difficult for me.",English
+And I developed anxiety over it. I still get anxiety today. It was difficult. It's difficult to remember back on that.,English
+And it really hit me hard. It hit you the hardest thinking about the absence that might be the result of.,English
+It's not supposed to be that way. And you go from that emotion where you're angry and sad and your life's not supposed to work out this way.,English
+"And then the hope is you transition into something else. But at that moment, I was angry. I again appreciate you sharing that because I think it's so natural.",English
+"And people often feel alone, I think, in feeling these things. And it's like, ""Look, you are definitely not alone."" How did you process and move through, by the way, all of",English
+"these different, not stages, but lots of different emotions are coming up, but they don't happen only once, right? So how did you manage your way through?",English
+I don't know. I don't think I managed very well. I internalized everything. I started to recognize the symptoms more so not only was I,English
+"dealing with some mental health issues and depression and anxiety, but also I started to recognize the symptoms. And I really struggled with communicating.",English
+"How am I supposed to tell Kara I'm tired, I'm fatigued right? What is that? Or I'm itching or I have bone pain, right? Or I have blurry vision.",English
+I felt like I would be looked at like I'm a complainer. Right? And so I just internalized everything and it just ate at me and ate at me.,English
+"And it really just affected my personality even, right? It sort of changed me.",English
+"And like I said before, it's not supposed to be that way. But life life doesn't always work out perfectly, right? There's so many quotes out there that says, ""It's [not] how",English
+"you get knocked down, but it's how you get back up."" It's tough to realize that in that moment, right? And some people can do that, some people take a while.",English
+"For me, it took a while for me to realize that. But I think what's important is to allow ourselves the space to be able to feel the way we feel without guilting ourselves, right? That's the worst, I think, is to feel it",English
+"and then be like, ""I can't believe I'm doing this to myself,"" you know? So moving back to now, I'm curious how that doctor at Cornell.",English
+"By the way, was it just that Cornell had a reputation big institute, academic institution? How did you know to go there? And then if you could also describe how the doctor laid out",English
+"what PV is, was for you at the time? The local doctor recommended someone at Cornell and",English
+"since then, I've changed doctors, which is hopefully another topic we'll talk, too, about really personalized care and really being your own advocate.",English
+"diagnosis. And really, the great thing about this particular doctor was he got up on a whiteboard, right? And he really sketched out where it came from, right, and",English
+"the bone marrow and the particular body part and the long bones and sort of the evolution of the stem cell mutation. We learned so much, right?",English
+"We have a histamine stem cell that derives from that that also gets mutated, which is why sometimes the itching happens. And so he really broke it down. And I took a picture of that.",English
+"And I have it to this day and I occasionally refer to it just to, again, understand everything that's going on. But he really took the time.",English
+"We were there for three or four hours of him just explaining it. Yeah, and I also had the bone marrow biopsy but a good portion of that was him explaining it and answering our",English
+"questions. And we didn't feel rushed at all, which was great. And we'll talk more, too, about the advocacy work in general and your greater purpose here that you've really dove into.",English
+"how this would impact your life? A lot of times people think, ""Well, what's the treatment and how am I supposed to deal with this? "" Right? That's the general conversation.",English
+"You may get a few symptoms. They may be severe. They may not be. And so it was almost like from that point, I was hanging by",English
+"every day, right? What's going to happen today? What's going to happen tomorrow? Am I going to progress tomorrow? Are my symptoms are going to be bad? Are they going to be low?",English
+And it was just consuming. With similar toxins. We're talking about that. Were you able to figure out how to deal with all these,English
+It was just a freeing feeling and I wanted to continue to do that. And it was just a great feeling. It was just a great feeling.,English
+"Nick, you know, part of this, too, made me think about how PV and other very rare cancers, so little is known. Also, when you don't have to go through the stereotypical",English
+"Seems like you are totally fine, right?"" Can you talk about that? I think a lot of people I've talked to, a lot of patients",English
+"that really look great, right, but they get beat down by the symptoms, right? Every single day, very severe.",English
+"about how I'm feeling. But, yeah, we can get dismissed. I've had an experience prior to this current doctor where I was dismissed, right?",English
+"every single day. Either a combination of things or one, like you're talking about, would be very severe and the others would be very low. And it's really difficult to deal with.",English
+"I think the exciting thing is, and you mentioned this that there's been a lot of advancement in treatment options for PV. And so when I was diagnosed, it was a wait-and-see",English
+approach. Baby aspirin and phlebotomies every so often and phlebotomies can be taxing. My iron levels really dropped.,English
+And I remember when I got to the doctor that I have now and we talked about drugs that are on the horizon. We talked about being a patient advocate or being an,English
+"advocate for yourself in treatment. I would suggest doing the research on what's out there currently, but also what's to come and really having a conversation with your doctor about that.",English
+And so we got to talking about a potential drug that is now FDA approved where that could be a more proactive approach to your treatment options.,English
+"And that's the drug that I'm on now, Besremi. That also is supposed to slow progression, which was, for me, something that I was extremely worried about and a lot",English
+"of PV patients are, too. So there are a lot more options now, front-line options now, with PV than there ever were before. And so can you compare also how often you are having to go",English
+in for phlebotomy or take baby aspirin versus now being on Besremi? What the differences are and what that looks like for other people who are curious?,English
+I was going every week to start and then it graduated to two weeks and then I settled in on like every three weeks. But also going to the randomness aspect of this.,English
+"Sometimes I'd go months without a phlebotomy and then all of a sudden, I'd have to go every two weeks again. And so that's the frustrating part because you can take that and overreact to it, right?",English
+"I equate PV and MPNs to a baseball season, right? And even a basketball season. A basketball season is 82 games.",English
+It's long. You can't overreact to any one game or one day one loss or one win. You have to look at it as a whole and really be in it for the long term.,English
+I'm so happy to hear that because these are the little nuances in the quality of life that build up and matter right? But can be hard to see.,English
+So any last thing you want to say in terms of the shift? And I do want to talk about actually what prompted you to,English
+"go see another specialist, to see somebody else after that Cornell doctor. What was it that drove that conversation and how did you",English
+"find that person? And then what's the difference been? Yeah, I think it was that dismissive part that we talked about, right? Not feeling that the person was spending time",English
+"And then the second number is called diastolic blood pressure. And as many of you are surmising, this is the pressure of the blood on the arterial walls",English
+"when the heart relaxes, and so during diastole, and this is typically the lower of the two numbers. Next slide, please.",English
+"And so since 2017, we've had a revision of the blood pressure categories, and this is from our colleagues at the AHA",English
+"and the American Stroke Association, but now normal blood pressure is still considered less than 120 systolic",English
+"and 80 diastolic. Elevated blood pressure, which you can see there in yellow, is now between 120 to 129 systolic,",English
+"so when the heart is pumping, and a normal diastolic blood pressure, so less than 80, and this is measured in millimeters of mercury.",English
+"And this is new, since 2017, but high blood pressure, or Stage 1 hypertension, is now defined as a systolic blood pressure",English
+of greater than or equal to 130 and less than 140 or a diastolic blood pressure,English
+"of greater than or equal to 80 but less than 90. Stage 2 hypertension, which you can see in kind of that lighter shade of red,",English
+"is a systolic blood pressure of 140 or higher, or a diastolic blood pressure of 90 or higher. You know, blood pressure,",English
+"both of these numbers will tend to go up in tandem. And then what we call hypertensive crisis, which is something that needs to be addressed more urgently,",English
+"is a systolic blood pressure of greater than 180 and/or a diastolic blood pressure higher than 120. And again, this usually requires more urgent attention.",English
+"Next slide, please. So one of the reasons why blood pressure is called the silent killer is that most people with high blood pressure",English
+"have absolutely no symptoms and they may not have symptoms for years. And high blood pressure not only causes the heart to work harder,",English
+"but it can exert excessive pressure on a number of end organs and, essentially, injure or cause damage to almost every organ system in the body.",English
+"For those people who do have symptoms, the most common symptoms will tend to be headache, fatigue, vision changes, nausea,",English
+"and we often refer to that particularly if the blood pressure is in the hypertensive crisis area, hypertensive emergency,",English
+"because that is evidence of end organ injury or damage. Next slide, please. And so, as Melanie mentioned,",English
+"if you have hypertension you are definitely not alone. The Center for Disease Control and Prevention in the United States estimates that there are,",English
+"essentially, one in two adults in the United States have hypertension, about 116 million people, but only about a quarter of them have their blood pressure",English
+"or their hypertension controlled to an adequate level. And this comes at tremendous cost, not only to the individual",English
+"in terms of what we call morbidity, mortality, but also to society in general, to the tune of about $130 billion-plus per year.",English
+"Next slide, please. And as I mentioned, uncontrolled blood pressure for long periods of time can go undetected and if allowed to remain uncontrolled",English
+can essentially result in end organ damage to almost any organ system in the body. The most commonly sort of feared ones,English
+"are probably stroke and heart disease, but chronic kidney disease. Hypertension is the number two cause",English
+"of chronic kidney disease in the United States and in most high-income nations. You can have visual changes, which can be catastrophic",English
+"to an individual's quality of life, as well as damage to your reproductive organs, compromised pregnancies, et cetera.",English
+"Fortunately though, high blood pressure can be easily detected. Next slide, please. And so what about chronic kidney disease?",English
+And so most people in the United States have two kidneys and the adult kidneys are roughly about the size of your fists.,English
+"We sort of grade kidney disease on a scale of 1 to 5, and this is based on what we call the eGFR,",English
+"which is an estimated glomerular filtration rate or, put into more sort of comprehensible language, basically is the kidney's ability to filter waste.",English
+So Stage 1 and 2 chronic kidney disease essentially are very mild forms of the disease. Often the kidneys are either minimally,English
+"or very mildly impacted in terms of their ability to filter waste, but you may have some other abnormalities, which your care team has picked up,",English
+"such as having a little bit of the excess protein in the urine. You could have some blood in the urine, which is coming from your kidneys,",English
+"which may persist over time. Cysts are very commonly observed. Recurrent kidney stones, for example.",English
+"However, most people who have been told that they have chronic kidney disease typically have Stage 3 or higher. And so in Stage 3, we have an earlier stage of Stage 3,",English
+"which is Stage 3a, and then a more advanced stage, which is referred to as Stage 3b. In Stage 3a, as you can see, the eGFR,",English
+"or the kidney's ability to excrete waste, is between 45 to 59, and we measure this in milliliters per minute,",English
+"but many people, and I think it's very reasonable to, consider this as a percent kidney function. Typically, this means that your care team has detected",English
+"some abnormalities in the filtering ability of your kidneys. Stage 3b is more advanced, where your kidney function is between 30 to 44,",English
+"and we would consider this moderate to moderately severe kidney disease. Fortunately, Stage 4 and Stage 5 are far less common,",English
+"but are much more advanced. Stage 4 means that your kidney function, or your kidney's ability to excrete waste, is between 15 to 29.",English
+And Stage 5 means that the kidney function has dropped below 15. And then what we call end-stage kidney disease,English
+is defined as the need for either dialysis or a kidney transplant to sustain your life. And so the Center for Disease Control,English
+"estimates that approximately 37 million people in the United States, or about one in seven US adults, have chronic kidney disease.",English
+"Fortunately, most of the people with chronic kidney disease have earlier stages of the disease. And the two most common causes of chronic kidney disease",English
+"are diabetes, number one, and hypertension, number two. Next slide, please. So there are a number of options for kidney disease testing",English
+"and these options are typically available at almost any clinic, any medical clinic. Sometimes you'll commonly see your serum creatinine,",English
+"which is a very, as I mentioned, common blood test. It's really, creatinine is a waste product of muscle and healthy kidneys are essentially able to secrete",English
+"or eliminate creatinine into the urine. And so we know, based on elevations in your serum creatinine levels,",English
+"that your kidneys may not be functioning at, for example, 100%, and then we use that value of the serum creatinine",English
+"to estimate your glomerular filtration rate, and that's what you'll often see as your eGFR. And this is a calculated value.",English
+"It's an estimate in which we take your serum creatinine, so the amount of muscle waste product in your blood, and we put it into a formula",English
+"that takes into consideration your age and your sex to produce this number called the eGFR. Next slide, please.",English
+"And so just in summary, before I move on to my colleague, Kathy Wong, that blood pressure and hypertension is actually very, very common.",English
+"So if you have hypertension you're definitely not alone. As we mentioned, approximately half of American adults have hypertension,",English
+but only about a quarter of them have that controlled. And so uncontrolled hypertension over a period of time can cause not only heart disease and stroke,English
+"but it can cause the arteries to the kidneys to weaken, they will become thickened, and the amount of blood that is reaching the kidneys",English
+"will decline or decrease, and this will result in further kidney injury, kidney damage, kidney scarring.",English
+"And this becomes, actually, a vicious cycle, because the kidneys are very integral not only in kind of cleaning out or filtering the waste in your blood,",English
+"but also in controlling blood pressure and blood volume. And so, as you can imagine, the more damage that you have to your kidneys,",English
+"the more difficult it actually becomes to control your blood pressure. And sometimes you may develop swelling, other conditions that are associated with this.",English
+"But fortunately, most of these things can be either prevented or treated, and Kathy's gonna talk a little bit about, really,",English
+what I consider the fundamental step in preventing and in treating both hypertension and one of the major causes of chronic kidney disease,English
+"in the United States and other high-income nations, which is foundationally based on your dietary intake. Thank you.",English
+"So as you know, managing what you eat is just critical, especially when you're at Stage 3. Kathy Wong, can you discuss the role of a renal dietician,",English
+"who have the scope of practice to translate information, scientific information into more practical solutions or ways that we can follow in real life,",English
+such as diet recommendations. And that's so that it can address certain disease states and any healthcare goals that you might have.,English
+"Now, this is different from someone who call themselves just a nutritionist, as they don't have the necessary qualifications or license. So technically, they're legally only allowed to educate",English
+"on the general diet for the general population. So I mention that because there's so much out there online,",English
+"and so it's important to be mindful of the sources that you're getting information from. Specifically for renal dieticians,",English
+"we help you navigate your labs, decipher what diet recommendations truly fit your individual needs,",English
+based on your kidney function. The most important thing is to prolong the health of your kidneys,English
+"and to prevent the progression of the kidney disease. So we can't reverse the disease,",English
+"the damage that has been done, but studies have shown, just as Dr. Hall has mentioned, there is significant evidence stating",English
+"that how effective diet management is to prolong the health of your kidneys. And so touching on diet,",English
+people commonly express feeling defeated by their health conditions. And so I hope one takeaway from this session,English
+"is that you can feel more empowered by the fact that you can still regain some control over your health, especially through just a simple act",English
+"of putting something into your mouth. As mentioned, hypertension is one of the leading cause of kidney disease and so, for this reason,",English
+"diet recommendations to manage or to control the hypertension or high blood pressure can, in turn, delay the progression of the kidney disease.",English
+"But it's always best to talk to your doctor or your registered dietician before starting any kind of diet, including this one that we're gonna talk about,",English
+"as general recommendations, general diet recommendations, they don't always fit your specific needs. So as you can see on the slide, the DASH diet stands for",English
+"Dietary Approaches to Stop Hypertension. And it's an intentional choice to eat foods, such as fruits, vegetables,",English
+"dairy products that are low in fat, whole grains, fish, poultry, beans, seeds, and nuts. It is also encouraged",English
+"for people to consume less salt, low in added sugars, low in red meats, and also lower in fat.",English
+"If you already have chronic kidney disease or on dialysis, some of the foods that are encouraged in the DASH diet may need some modification to address your specific needs,",English
+depending on your blood test readings. So the recommendations within the DASH diet that are particularly helpful,English
+"are to limit salt, limit saturated fat, and to limit sugar. Let's be honest, a lot of these things are in a ton of foods",English
+that we normally encounter on a day-to-day basis. And so the key isn't to think about how we can completely cut them out,English
+"or to stay away from them for the rest of our lives. I hope that we can take on a different mindset and to think of it as more of a lifestyle change,",English
+"to take on a different set of glasses or eyes in terms of whenever we look at our foods, entering into a journey",English
+"and seeing our daily plate or bowl, or however we choose to eat, to be more intentional with the choices,",English
+"the foods that we make. And so it can seem hard, but I hope",English
+"perhaps you can kinda muster up a little desire. Even a small change can make a big difference. Because if you think about it,",English
+consider every single item that we put into our body having the power to make a positive or negative effect on your health.,English
+"And so any small change or small step can make an impact, whether big or small. And so don't feel discouraged",English
+"if you feel like you can only muster up a little bit of change, or, ""I can only do this much for now."" That's okay. Commit to that.",English
+"And also, let your doctor or your dietician know because then they can walk alongside you on your journey towards regaining some of this control",English
+"of your health again. And so next step, I'm gonna talk about some suggestions you can consider related to the DASH diet.",English
+"As you can see in the pictures, those are some examples of perhaps some of the things that you can think of when, or consider eating,",English
+"when trying to make these small changes. So for one thing, be mindful of food labels. The nutrition facts label,",English
+"usually on the back of food items, can empower you to become an informed consumer. They are your guide to what's inside your food,",English
+"especially in processed and packaged foods. The next thing, as we mentioned, or as I mentioned earlier, salt, sodium.",English
+"The DASH diet encourages us to limit our sodium or salt intake to no more than 2,300 milligrams per day. That's about a teaspoon.",English
+"So if you were to scoop out a teaspoon of salt, rest it on the table, and just allot yourself that amount for each day. It's not a whole lot,",English
+but it's to help with bringing down the blood pressure. And so some tips for that include looking for items at the store,English
+"that are listed as ""unsalted"" or ""no added salt."" Another way is to remove salt shakers or soy sauce bottles from your dining table,",English
+"whether it be at home or at the restaurant. Just out of sight, out of mind, hopefully. And then also, another tip can be",English
+"just preparing more foods at home, eating at home more, because you have more control over what you put into your food",English
+rather than when you are to go out. There's less control there. Not to say that there isn't. The next thing is fat. We also touched on fat earlier.,English
+"And so saturated fat are found in foods such as most animal products, so beef, pork, poultry, full-fat dairy products,",English
+"and also certain oils, such as coconut oil and palm oil. Why focus on saturated fat? The reason is because the saturated fat we eat",English
+"is made into cholesterol by our liver. Therefore, eating too much saturated fat can raise our cholesterol levels.",English
+"Our body needs a certain amount of cholesterol, but any extra will build up on the walls of our arteries. So if you remember what Dr. Hall mentioned,",English
+"our arteries are linked to our blood pressure. And so when the walls of our arteries start to narrow because of this buildup,",English
+"in turn, it affects our blood flow. And so it can increase our blood pressure as well as our risk for heart disease",English
+"and the worsening of our kidney disease. So one tip can be, if you're thinking about protein, ""Well, I eat most of my protein from animal products.""",English
+"Well, you can probably consider plant-based protein, such as beans, lentils or tofu. Those are much lower in saturated fat.",English
+"Actually, they probably don't have any because they're plant-based. So all in all, work with your registered dietician and your doctor",English
+"in setting goals that are realistic for you. It's okay to let him or her know that you're not ready for certain changes,",English
+"because then you can explore together what are things that you are ready to do. And if you don't already have a registered dietician, again,",English
+"you can let your doctor know and they can refer you to one, or you can even look up on the eatright.org website to find a dietician in your area",English
+"where sodium is hidden in the foods that we eat and seasonings and things like that. So that was very, very helpful, I'm sure.",English
+"So I mean, just thinking about working with a dietician, so you're recommending",English
+talk to your doctor about getting a referral somewhere. Any other ways that you can find a dietician on your own and making sure that they're certified?,English
+"- Yeah, so the eatright.org website, you can search by where you live and the specialty of the dietician that you're looking for.",English
+"- Great, thank you. So if you're just joining us in this session on Stage 3 kidney disease and high blood pressure, a reminder, at the end of our panel discussion,",English
+"you'll have the opportunity to ask questions, but you don't have to wait until the end of the panel discussion to submit your questions.",English
+"We'll be on hold and hopefully we'll be able to get to all of the questions that we have. Again, you can drop your comments in the window next to or below the Facebook livestream",English
+or in the chat box if you're here with us on the Kidney Fund website. So we'll try to get to as many as possible.,English
+"But before we get to questions, Dr. Hall, question to you. Can you discuss the recommended treatment options for managing Stage 3 kidney disease and high blood pressure?",English
+"particularly in patients with chronic kidney disease. And so the foundational approach is really what you're doing every day. Kathy mentioned paying attention to your diet,",English
+"but there are a number of other things that you can also incorporate into your daily lives. One of the big things that I recommend is 30 minutes,",English
+"Sometimes it's available right in your home, if you're fortunate enough to have a treadmill or a stationary bicycle. It is inexpensive and, for the most part,",English
+there are additional benefits beyond just blood pressure and preventing progression of kidney disease in terms of both physical and mental health.,English
+"There's some medications and, you know, medications, poisons, toxins, they're essentially all the same thing. They're just sort of given with different intents.",English
+"And in particular, the non-steroidal anti-inflammatory medications such as ibuprofen, naproxen, Aleve, Advil, these are medications which we use",English
+"There are high-quality ones that are widely available, either on Amazon, online. They're commonly available at places like Walmart,",English
+"and you can get a very, very high-quality one for between 30 to $40. And then keep a log and communicate the readings of that log",English
+"with your medical care team. Obviously, understanding the risks of long-term blood pressure on your kidneys and on other organ systems in your body,",English
+"like your brain and your heart, is very important. But the changes that you make in your daily life are gonna be the ones that are most impactful.",English
+"I mean, you may come and see a kidney dietician once or twice over the course of a year. You may come and see me once or twice",English
+"over the course of the year. And so really, your daily lives and incorporating a lot of these healthy habits into your daily lives is really what I would consider",English
+"- Thank you very much for that overview. So thinking about eating, Miss Wong, people don't always eat at home.",English
+What do you recommend for managing your kidney disease and your eating when you're eating at restaurants? And that could be if you're dining in a restaurant,English
+"the focus of the DASH diet is to limit the high-fat foods. And so if you were to go out,",English
+"there's always options to choose for leaner meats, such as fish or chicken. And again, for low fat,",English
+consider things that are grilled versus fried. And then also consider choosing menu items that have more vegetables and fruits.,English
+"of adding more vegetables, or the menu item itself already has a lot of vegetables. Those are good options. And then also, another thing you can consider",English
+"Sometimes they really can't. But it doesn't hurt to ask. Another thing to consider is maybe asking for the sauces on the side,",English
+"'cause sauces tend to have more of the salt. And so if you were to ask for the sauce on the side, you can control how much of the salt",English
+"you're putting into your food. - That's great advice. And I think it's great now we have the internet, you can look up a menu online",English
+that you can submit your questions now. We're still gathering questions and we'll be ready in a few minutes to answer those. You can just drop those in the comment box,English
+"What are you supposed to do? We all know exercise is good for you for managing high blood pressure, but how much physical activity",English
+"the studies have shown that 30 minutes, at least, of physical activity, and this (indistinct) defined as aerobic activity. So it's something that essentially gets your heart rate up",English
+"and gets you breathing to a point where it's slightly uncomfortable to talk. And so my favorite, again, is walking.",English
+"to reduce your risk of heart attack, of strokes, and it will also reduce your blood pressure. - Thank you, so transitioning a little bit",English
+"Miss Wong, do you have any tips to help people looking to start a healthy eating routine or eating well with kidney disease at Stage 3?",English
+"if not, you can ask for one, because they will be the ones who know specifically what your needs are and what to focus on.",English
+"And then I think also, in general, it doesn't hurt to start leaning more towards the fruits and vegetables because they are lower in fat and lower in salt.",English
+So it's a healthier eating habit to also help lower your blood pressure. I think one thing I usually encourage people to start with,English
+"is consider your plate or your bowl. Every time you eat, try to have at least half of that meal",English
+be fruits and/or vegetables. I think it's just a good state of mind to have whenever you approach food or your meals in a given day.,English
+"That way you're making sure you're incorporating the fruits and vegetables, and the lower fats and lower sugars and salt.",English
+"So here's one, really, it's a good one to start off, and this does come from our audience. So, ""When should someone",English
+"who's been diagnosed with kidney disease first see their nephrologist?"" And I think that could go to you, Dr. Hall, but I think it's a good question for you, too, Miss Wong,",English
+"about when should a patient start seeing a dietician? So I'll start with you, Dr. Hall. When should a patient first see their nephrologist?",English
+"- Sure, so as we mentioned, one in seven American adults have chronic kidney disease. And so the vast majority of people with chronic kidney disease",English
+"probably do not need to see a kidney specialist. The two most common causes of chronic kidney disease are diabetes mellitus and hypertension,",English
+"and these are conditions which most primary care providers are very, very good at managing. And so I would say,",English
+most people who need to see a kidney specialist or a kidney care team probably have more advanced kidney disease,English
+"or have some laboratory abnormalities, such as a high level of protein in their urine, or their kidney function is dropping quite dramatically.",English
+"Those are the folks who I would recommend perhaps inquiring with their care team about specialist referral,",English
+"specifically people with Stage 3b, for example, or, really, Stage 4, Stage 5 disease, or with high levels of protein in their urine",English
+and/or rapidly declining kidney function. I think those folks would probably benefit from having a kidney care specialist involved in their care.,English
+"- Thank you, and so, Ms. Wong, what about starting to work with a dietician when you have kidney disease? What stage would be the best time?",English
+"- Yeah, so I think, and also, a lot of studies have shown that it's best to work,",English
+"well, best to work with a dietician as early as you can because of that piece with how effective diet management is",English
+"to prolong the progression of kidney disease. So the earlier stages you're at, definitely reach out to your doctor",English
+"to see if you can see a renal dietician, or even just a regular dietician, to start talking about the foods.",English
+"Also, as Dr. Hall mentioned, oftentimes kidney disease isn't caught until it's later stage.",English
+"Therefore, when you go to your annual physicals, if there's anything that's brought up, especially if you already have diabetes,",English
+that's also a good place to consider checking in with a dietician. - Thank you.,English
+"So looking at the questions, there are a couple that relate to how long between stages. So one is, ""How many years are you likely to stay",English
+"at a particular stage of kidney disease? And is there an estimate about how long it takes to progress among the stages from Stage 3a to Stage 5?""",English
+"And just to follow up, and I'll remind you the questions, too, does everyone necessarily progress to kidney failure? - Yeah, it's a great question and, fortunately,",English
+"the vast majority of people with chronic kidney disease do not progress to end-stage kidney disease, so as I mentioned, the 37 million Americans",English
+"who are estimated to have chronic kidney disease. But at any given time, there's probably only about 550 to maybe 600,000 people",English
+"in the United States who receive what we call maintenance dialysis, and then maybe another 150,000",English
+who are living with a functional kidney transplant. And so there's a big drop-off from 37 million to less than 1 million people,English
+"who have end-stage kidney disease. And so, fortunately, the vast majority of people with chronic kidney disease will never reach end-stage kidney disease.",English
+"And most people, though, with chronic kidney disease have risk factors, such as hypertension and diabetes, that place them at high risk for cardiovascular events,",English
+"such as heart attack, as well as other events, such as stroke. And so this is one of the reasons why this sort of multidimensional,",English
+"foundational approach to health works very well in patients with hypertension and chronic kidney disease. You know, the exercise, the attention to diet,",English
+"to optimal weight, and then avoiding any potential medications or supplements that could potentially harm the kidneys.",English
+"- And what kind of tests are run typically to diagnose kidney disease? - Yeah, so the most common test is gonna be a blood test,",English
+which is the serum creatinine. It's probably one of the most common blood tests that we get in medicine. It's widely available at almost all of the medical clinics.,English
+"And, as I mentioned, it's a measure of really muscle breakdown and the kidneys' ability to excrete",English
+"that breakdown product of muscle. And so as the serum creatinine rises, it's usually an indicator that the kidneys are not functioning as well as, you know,",English
+"sort of not functioning normally. So that would be the most common test that people would get. Other tests that they would get, some people have heard of the blood urea nitrogen,",English
+"or B.U.N or BUN, which is a breakdown product of protein. It will also commonly go up in conjunction with the serum creatinine concentration or level.",English
+"Also, another sort of indicator of potential kidney dysfunction, the amount of protein in your urine,",English
+either through what we call a dipstick or through quantitative assessment of the amount of protein in the urine,English
+"is another common test. And then, more uncommon tests probably are like a kidney ultrasound to ensure that there is nothing structurally obstructing,",English
+"for example, the kidneys, like a kidney stone or a narrowing in the ureters, which are sort of like the hose-like apparata,",English
+"which drain the kidneys to the bladder. And then, very rarely will people proceed to get a kidney biopsy,",English
+which is actually a piece of the kidney where we look at it under the microscope using a number of special stains. - Thank you.,English
+"So you were just talking about testing and eGFR, and this actually came up in our session about eating with The Cooking Doc, too,",English
+"and I'll direct this to you, Miss Wong, ""What foods should I eat to improve my eGFR?"" - Hmm, well, a lot of the things",English
+"that we mentioned earlier in this session can help. So making sure that you're, like, for example, blood pressure or diabetes,",English
+"making sure those are under control. So you're eating to manage those things, blood pressure and/or diabetes, will help.",English
+"So things like lower salt, lower fat, lower added salt, I mean, sugar. And then the positives would be,",English
+"leaning more towards lean meats and the fruits and vegetables will help. - Dr. Hall? - Oh, and another thing,",English
+I know the AKF has the Kidney Kitchen where you can scroll through different recipes and suggestions based on various diets that you're considering,English
+"or are interested in, for example, lower fat. You can probably scroll through that and see examples of recipes that you can try.",English
+"- Yeah, that's absolutely true, and thank you for mentioning that. On kidneykitchen.org, we have a lot of information about foods that are, let's say,",English
+"high in potassium or high in phosphorus, things about protein, eating with your stage. So we have information about what you should be eating",English
+"at Stage 3 kidney disease, and a lot of helpful resources. Dr. Hall, did you wanna comment at all on what foods I should eat to improve my eGFR?",English
+"- Yeah, it's a great question. I usually tell my patients, generally speaking, when they approach a grocery store",English
+"to shop on the peripheries, because that's essentially where all your fresh fruits, your fresh vegetables, your fresh meat section, and then your fish sections are located.",English
+"And to the extent possible, kind of avoid the middle aisles, which is, generally speaking, where all your packaged and processed foods are located.",English
+"So the cans, the boxing, the freezing, the processing of all of that, typically requires additives, including salt.",English
+"Nowadays most Americans, their diets, generally speaking, the salt content comes not from what they add",English
+"in the cooking process or what they add at the dinner table, but what is already added for them by the food industry.",English
+"And so the best advice I usually give to my patients, or the general advice I usually give to my patients, before sending them on to more expert advice",English
+"from people like Kathy is to shop really on the peripheries of the grocery stores for that fresh food and fresh vegetables, and really try to make their own food",English
+"from scratch, where possible. - Thank you, so getting specifically into blood pressure, here's a question from someone in the audience.",English
+"It says, ""If you're suspected of having Stage 1 hypertension, should you take your blood pressure daily and provide the data to your doctor,",English
+"or just a few days a week and provide that data to the doctor?"" What should someone do? How much should they monitor, depending on stage,",English
+"and this one's specifically about Stage 1? - Yeah, it's a great question, and the guidelines now are recommending what we call out-of-office blood pressures.",English
+And so measuring your own blood pressure at home and then sending those values to your care team is an outstanding way to sort of participate in your care.,English
+"I usually recommend, you know, measure their blood pressure several times a week, typically at the same time of day. And I usually teach them kind of the proper way",English
+"to measure blood pressure, which is seated with their back supported, feet flat on the ground, not having ingested any caffeine",English
+"within the last 30, 40 minutes or so, and then making sure, I like the upper arm blood pressure cuff,",English
+making sure that the cuff is at the level of the chest and really at the level of the heart. And I usually recommend to take the first reading,English
+"and kind of ignore that, and then look at the second reading, and if it differs substantially from the first reading, maybe even take one more",English
+"to ensure that you're getting an accurate reading, and then to write those down or record those in a smartphone, for example,",English
+"or in your computer, for those who use them, and then transmit those periodically to their care team. - Thank you.",English
+"So again, with blood pressure, Ms. Wong, you introduced us to eating with kidney disease",English
+"and talked about the DASH diet. So if someone has high blood pressure and they're diagnosed with kidney disease,",English
+"is the diet the same? Is there a way to have to modify, let's say, what you eat to address high blood pressure",English
+"and somehow integrate that into what you have to consider when you have kidney disease, and how does a dietician help someone do that?",English
+"- That's a good question because there's so many diets out there for different disease states. I think, with hypertension, or high blood pressure,",English
+"and kidney disease, though, that diet does come hand-in-hand. It's not as complicated as other ones. And so by following",English
+"the low-fat, low-salt, definitely low-salt, recommendation will help. Specifically, though,",English
+"for detailed recommendations on what types of food to have and not to have, that will depend on your kidney disease,",English
+"how well your kidney is able to filter out certain things. One thing I had mentioned early on is, for example, some people that are in later stages of kidney disease,",English
+their kidneys might not be able to process potassium as much or phosphorus as much. So those people may need to have,English
+more specific recommendations to limit some high-potassium or high-phosphorous foods. And that person might be different,English
+"from someone with hypertension and kidney disease but in an early stage of kidney disease, because with earlier stages of kidney disease,",English
+"their kidneys are still able to process some of those things, so they might not have the same recommendation. So all in all, it's best to talk to your doctor",English
+"or your dietician for specific recommendations, because they will have the data, meaning, your lab values,",English
+"to know exactly what to recommend for you. - Thank you, so looking at some more questions. Here's a question about intermittent fasting,",English
+"and I'll start with you, Dr. Hall. Let's see, ""Is intermittent fasting safe for people in Stage 3 CKD?""",English
+"- Well, it's a great question. And I will say that the answer is probably not as great as the question.",English
+"I'm not aware, to be honest with you, of any large what we call randomized controlled studies comparing randomized fasting",English
+"to like sort of standard eating in terms of their outcome, or those outcomes, on either blood pressure control",English
+"or progression of a chronic kidney disease. I will say, though, that weight loss, or maintaining optimal weight,",English
+is one of the foundational approaches to managing blood pressure and what I would consider earlier stages of chronic kidney disease,English
+as well as diabetes. And so at times people may need to fast for periods of time.,English
+"But again, I would say this is something that you probably do wanna talk with somebody like Kathy about or your primary care team about.",English
+"You know, intermittent fasting can mean a lot of different things to different people, and so I think the details are probably important here as well, too.",English
+or I'm not aware of any direct correlation to the effectiveness of intermittent fasting and specifically CKD.,English
+"So I would also suggest to talk to your dietician or your doctor if you are considering that. Also specifically,",English
+Other people interpret it much differently. And so the specifics of how you think of intermittent fasting,English
+"is something that, it's also important to tell your doctor or your dietician. - Thank you, so I think we have time",English
+"for maybe one more question, maybe two, but a couple of things came up about coffee. So, ""Is coffee safe for someone",English
+"with CKD and hypertension?"" And then the other question about coffee was, ""What kind of coffee creamer do you recommend?""",English
+to not drink caffeinated beverages before taking their blood pressure. And it's interesting because I don't think there's a consistent relationship,English
+"with caffeine intake and with blood pressure. There are some people who seem very, very sensitive to caffeinated beverages,",English
+in and they're on Clopidogrel and Clopidogrel or Plavix that's producing a reduced clotting risk for that patient also will suffer a reduced clotting,English
+"protection when we go ahead to operate on them. And it's not just blood loss where they're going to bleed and become anaemic, it's blood that gets into the wrong places, it's blood",English
+"that gets into a joint that subsequently can be at a higher risk of infection or a higher risk of producing intra articular fibrosis and therefore giving a pathetic outcome,",English
+where instead of bending their knee to 110 degrees they bend their knee to 75 degrees because it's all clagged up with coagulated blood that then goes on to fibrose.,English
+And then there are things like Dextrin and beta blockers and I have physicians who help me out with these things to get us around them. So the definite things like Warfarin,English
+"and Heparin and low molecular weight Heparins, the Clexane and 'Enoxaparin', these drugs are designed to interfere with the coagulation. But luckily we can stop these and what we do with them",English
+is to stop them sufficiently so that we get into a safe zone for a short time of the surgery and then reintroduce a control where it's absolutely necessary. So these are the drugs,English
+"that worry us. But it's important and it's important for your hospital preadmission clinic, it's important for your surgeon and it's important that your patient information highlights these",English
+"things because it might be missed. You ask the patient ""are you on Clopidogrel"" and the patient says ""no, I'm not on Clopidogrel"" because they call it Plavix or it may be that",English
+"some other of these drugs is given another name, it's such a pathetic thing that Warfarin is disguised in so many guises and it could be missed with a terrible outcome.",English
+And then there are the things that people take like fish oil which is now a very well established anti inflammatory effect that helps arthritic patients and then there's garlic oil.,English
+I give my patients garlic oil because it acts to reduce coetaneous staphylococcal colonisation. If you take garlic oil regularly for six weeks it reduces your staphylococcal count on your skin.,English
+"And one of the things I don't welcome into my surgical world is the staphylococcas. But it does, if you take lots of it, if you have a patient who says ""damn, I forgot to",English
+"take my garlic oil for the last two weeks I'll take 14 the day before the operation"" then they'll have a problem. So they have to be warned of these things and they can",English
+aggravate bleeding. So there are emergency things that my anaesthetist and physicians are very clever and my haematologist may be called upon to help me with these things.,English
+"But it's not a one off thing, it's a continuing observation and continuing testing, continuing awareness of the risks of these things. And there are going to be times when the",English
+absolute necessity is going to be there because the patient hasn't had a chance to go to a preadmission clinic. So what about your platelet count? Now we know that platelets are the things,English
+"that produce a web of blood cells that initiates a control of bleeding locally at vessel injury. But if we have few platelets then that web's not going to be as efficient. But we're happy,",English
+"I'm happy as an orthopaedic surgeon if the patient's platelet count is more than 100,000 but if it's below that I get my haematologist in and it may be that we need to boost their",English
+platelet count. People who have had chemotherapy may well be lacking in platelets. And people who have secondary malignancy in their bone marrow may have problems with producing platelets.,English
+And people who have had mylofibrosis will similarly. And then there are the situations with disseminated intra vascular coagulation and hypersplenism,English
+"and bacterial counts, the septicaemic patient may be at risk than the viremic patient. So what do I like to do? Well I like to see my patients sufficiently early if possible to",English
+"review their blood counts, to look at their liver function, to look at their renal function and then many of these people I'll be putting on iron because I want to maximise their iron",English
+stores and what we see is the patient who comes in with a haemoglobin of 124 after taking a course of oral iron will build their haemoglobin up to 142 by the time they actually get to,English
+"their surgery and so that these people will start off higher and we know that they're all going to drop about 30 grams during the procedure, if they drop from 142 down",English
+"to 112 it's better than dropping from 102 down to 72. So give orange juice, it increases the absorption. If you take milk within two hours it blocks",English
+"it. And so the idea is to help it get to the blood not to the bowel. So what about this fellow, this fellow didn't come to the preadmission clinic six weeks before and he had an altercation,",English
+"he's a chef and there was an unhappy diner whose steak wasn't done sufficiently well and he arrives at the hospital like that, complaining of retrosternal pain.",English
+probably goes all the way back to his spine and there is a lot of red and blue structures on the anatomy book that lie in that area apart from the oesophagus and a few things,English
+like that. So if we take that out it's going to bleed. I remember a chap who was a pilot in a plane who had been shot and he had wounds that came,English
+"in through the bottom right area of the chest and out through the back of his shoulder blade. And we opened up that guy's chest quickly, he had virtually no blood pressure, he was",English
+"talking, he was talking as we opened up his chest and as the anaesthetist was putting numerous venous cannula in and we scooped out of his chest about two litres of blood",English
+which were then put immediately into a hard plastic normal saline container and was run back in and filtered back into that person. And he had bullets that had gone through the,English
+"back of his left atrium. And that's a situation that is frightening, absolutely horrid, it caused the death of that person. But this is the sort of thing",English
+"that can happen. And sometimes we have a retrievable situation, you may be able to get around these things. The leg wound, these wounds are the things that arrive by helicopter from the",English
+region of Murray Bridge on the highway where people roll over and have their legs smashed to smithereens. They lose blood at the place. We stop the bleeding and then we re-explore,English
+these things. This is unplanned trauma surgery made a lot more difficult by the fact that our retrieval is so much better. So when we get into the operating theatre,English
+what techniques do we have to reduce this red flow of carnage. Well we have hypotensive surgery. And my anaesthetic colleagues are excellent. We do the majority of our planned,English
+"arthoplasty surgery under spinal anaesthesia, we drop their blood pressure. We know that a 40 millimetre drop in blood pressure will decrease the blood loss by 70% and there's",English
+no danger with circulation dividal structures. Now this ought to be written on every anaesthetic machine throughout the whole country and it ought to be indelibly given to our patients.,English
+"Patients benefit from spinal anaesthesia. What can I do? Well before the operation if I'm doing a hip replacement I infiltrate, I mark the wound",English
+with my indelible pen and through a sterile clean area I infiltrate with a long spinal needle into the hip wound that I plan to go into. And it's injected into that plane with,English
+"one in 100,000 adrenalin in saline and that reduces the blood loss. When I make my incision there is less bleeding or the bleeding that is there is easily identified and easily controlled",English
+with diathermy. As the patient's going off to sleep we give them intravenous tranexamic acid and we know that that will help stabilise clot. And in the people that we do use it,English
+"it's a good outcome and every now and again due to an anaesthetic problem it's not given and we know that that's different. So we have peri operative haemostasis, we",English
+"know that if we put pressure on an area that we can get these things to stop bleeding and we can identify. We have things like the argon beam coagulator which is very very helpful,",English
+"I use it on my haemophiliac patients. Tourniquets, I use a tourniquet at 250 millimetres of mercury and I exsanguinate the limb when I'm doing knee surgery with an esmark. Tranexamic acid is",English
+"the one that we use of all of those things. We know that if we lose lots of blood then we may need blood but we prefer to use plasma expanders, we can get blood quite quickly",English
+"these days, we don't have to get lambs to come in and have transfusions. We have a big volume transfusion and you'll see the module 1 of the blood management program, it was",English
+"up there. And again, when you've got major bleeding have your haematologist, we no longer use autologous transfusion. I introduced it to orthopaedic clinical use in Adelaide in 1985 and I remember going to the blood bank to",English
+"give a lecture on it in Perry Street. We don't use it anymore because it's costly, complicated and it still has the dangers. We don't use normovolaemic haemodilution either but some people do, it's not",English
+"practiced in Adelaide and this means that at the time of surgery draining some blood off, replacing it with salines that if they do bleed they bleed a dilute blood and we",English
+give them back their blood again. I don't use it. We do use peri operative blood salvage techniques and the fifth module coming out is one on intraoperative cell salvage and,English
+I'm very pleased to have been part of that program as well. The ICS document will be towards automated cell salvage and we think that washed salvaged,English
+blood concentrated re-suspended and re-infused is safest. This is the old Royal Adelaide operating theatre and you can see where the students sat but around the edge of the operating,English
+table there's a little gutter and there's a downpipe. This is the first use of sterile blood drainage that we could find in Adelaide but it was taken out and put on the hospital,English
+"rose garden. Now we have things like bellovac that we use and constavac and these systems are a closed sterile system filtering blood, post operatively from a drain in a wound and",English
+it can be used. Now I don't use these things again because we stop all the bleeding and I don't put a drain in my hip and I don't put a drain in my knees anymore. But it has,English
+"to be maintained in a very strict 'inaudible' thing. So what's the worry? If we give a blood transfusion, we've heard about expense but most patients",English
+"will say ""well I've been paying my taxes for the last 50 years if there's an expense I think I deserve the best"". But if we tell them that there are people who have an allergic",English
+"reaction, you may be allergic to shellfish and the donor that you got the blood from might've had a big meal of prawns the day before he gave the donation, infection's always",English
+"a possibility, we don't have a perfect system. There are situations where viral diseases can be transferred albeit very very unlikely. Immunomodulation is a real thing, people who",English
+"have blood transfusions are more likely to have an infection in arthroplastic surgery, this is documented. There are people who might be given the wrong",English
+blood group by wrong labelling. They might be the wrong patient. You might have two patients called David Jones in the hospital at the time. There is transfusion related acute lung,English
+"injury and that's a problem and there's now one that's called tragi which is gut injury and there's the sludging that's been shown. They are the relative risks and really, we",English
+drive around the roads of Adelaide at more risk than those figures but they are there. Even when we use the low molecular weight after surgery there is a danger of increasing,English
+bleeding and there are therefore ways that we best use it where we delay till the morning after surgery before it's used. In the post op monitoring I check my haemoglobin of the,English
+"patient 48-72 hours, they continue with their iron, we use the lower triggers, a healthy patient and I would be reviewing the patient and seeing if they have problems at Hb of",English
+"70 grams or below. Transfusion of compromised patient, people who've got bad lung, bad heart, a problem, it may be that they are transfused if they drop below 100 but again, only if",English
+"they're in trouble. And we supplement their oxygen. So the management of surgical blood loss is at three stages, it's before the operation",English
+"by selecting and supplementing the patient's needs, it's during the operation by being clever and it's post operatively again having a sensible idea that blood is not the cure all.",English
+But there's a team of people who work together and I really feel supported by those people with those capital letters there because they're great friends of mine. And then when,English
+you've got nothing else to do some night get on the Google machine and always remember that the bottle of red that's best is the bottle of red that comes from this place that,English
+you can enjoy at the end of a hard day rather than the bottle of red that you inflict on your patient. Thank you very much.,English
+"Thanks, Daryl. Questions? I'd say there'd be a thousand questions. Thanks, Leigh. You know my question already,",English
+"Daryl, it's about the role of the patient and patient awareness. Thank you. A reminder was that how do we actually get the surgeons to change their practice?",English
+"Now surgeons are fixed, they've got concrete ideas, you can see how many are here today. And they are, they're very concrete people, they don't want to change. But when I say",English
+"all say ""thank you, doctor, I don't want to have a blood transfusion"". So the knowledge is getting out there to the patients somehow but we need to get that knowledge to the surgeon.",English
+"Now luckily, this place is full of beautiful young women and there's one thing that a surgeon will listen to and it's that you are trained, you are scientifically accredited now we've",English
+"all got it and you've got to say to these guys ""there's no such thing as a top up transfusion because you're putting your patient at risk"". Thank you.",English
+"Can I just ask why you don't use acute normovolaemic haemodilution? It has a risk of infection, it's the sterility",English
+"of the thing being done, it puts some people temporarily at risk if you're not balancing the maintenance of their blood volume levels. So if you're taking out 100 ml you've got",English
+"to have 100 ml going in etc, etc, got to do it. And if you ask me how many of my hip arthroplasty patients and how many of my knee arthroplasty patients have I transfused in",English
+"the last 12 months, zero, all right? I'm not a Jehovah's Witness but the Jehovah's Witnesses come to me because they know that they're not going to get a transfusion but they hopefully",English
+"think that the same practice of treating everyone as though they were a Jehovah's Witness is going to work. Now there will be someone who needs a transfusion occasionally, there will be someone.",English
+"The other day I had a Jehovah's Witness thalassemic 84 year old lady who had hips like square blocks in a box, right and we did her first",English
+"is something we could have always fallen back on. - So in Evvie's case, they took some of her own blood STEM cells, right? And genetically corrected the flaw,",English
+"returned them to her, and that built a new blood supply and repaired her immune system. How quickly after that procedure,",English
+"did you begin to see changes? Did you begin to see her immune system really reconstitute itself? - So realistically, it was slow.",English
+"Because it's, blood draw by blood draw, she was in the hospital for six weeks. They did chemo, it just wipes out her little system out. But it was probably about three to four weeks in,",English
+"and it was around Christmas that Dr. Kohn came in and says, it looks like it's working. And those cells were duplicating in her body.",English
+"So it was soon, but it was a gradual increase to where she could get to being outside and then potentially playing with other children,",English
+"and living a normal life. - How's she doing today? - Oh, she's wild, she's into everything. She is around her peers, she's living a normal life.",English
+"She's at the beach, she's on her skateboard. She's riding horses, she's pulling her sister's hair. (laughing)",English
+"She's just a normal, beautiful, healthy child. - So, before this, did you have any ideas about what STEM cell research was,",English
+"and then how did this change your perception of it? - I didn't understand STEM cells at all. Sitting here today, I have no idea how I voted",English
+"and I always had the perception of the embryos, and babies, and I was uneducated. And now I know that it's just this,",English
+"- So since then, you've become not just a parent of a child who has benefited from it, you've become a real supporter of STEM cell research and a great patient advocate.",English
+"How important do you think it is to have that kind of voice, the voice of a patient advocate, of someone who's gone through this, to help talk to others about this work?",English
+"- Well, because people don't realize it could be them. I didn't think it was gonna be me. And I would have never, in my wildest dreams,",English
+"We never know, and we never see it as it's us. But it was me, it was my daughter, it was my family. It was my sister, my brothers, my cousins,",English
+"we all went through it. But I also can't look at my child daily and say, look at the gift I've received,",English
+"You're on one of the Clinical Advisory Panels, a CAP, and you're helping to guide some of this research along. How important is that role for you?",English
+"they know their reason why, but they have to be reminded of who. Who they're treating, who they're potentially curing,",English
+"who they're affecting with their daily work. They know the why, why, you're sick and we wanna fix you. But who are they?",English
+"I gave these people a family, I kept their unit together. - We know that many clinical trials now do a good job",English
+"of kinda reaching out to different communities, but often miss out and ignored or overlook underserved communities. How important is it for the roles",English
+"of patients and patient advocates to be able to kind of remind the researchers that there are many, many different groups out there, and we need to do as good a job of reaching out",English
+"It wasn't until, Dr. Buchbinder at CHOC said, Hey, they're doing this at UCLA, you might wanna look into it.",English
+"Do you want me to have them reach out? That's because I was in that situation. Now, are there ways that maybe, these things should be more broadly advertised",English
+"so that people think, Hey, there is another option besides, you know what, maybe your physician is limited in knowledge. Because not every physician is going to be privy",English
+"to all these trials and all these other studies. So I think with social media, things can be kind of, I guess, advertised in that sense.",English
+"Another way that for example, underprivileged individuals, may get it sooner, or at least get it directly to them is, we have wonderful school districts that,",English
+"that I think every one of those social media and news networks and even simple thing as a school district, can get to people that are underprivileged.",English
+"- So as you know, there are a lot of clinics out there offering therapies that haven't really been proven to be either safe or effective. You've become kind of a spokesperson for this.",English
+"they have somewhere, Oh, I'm putting these STEM cells on my face, and it looks younger or great. But to me, I look for institutional backing.",English
+"and as always for sharing your story, it's always a delight. - Hello everyone, I'm Jennifer Puck from UCSF.",English
+"And with Morton Cowan, we are going to tell you about a gene therapy trial for Artemis Deficient Severe Combined Immunodeficiency, that we call ART-SCID.",English
+"SCID is a very severe disease. It used to kill all infants, but now we realize it can be treated",English
+"with a bone marrow transplant from a healthy person. However, infants who develop infections are much more difficult to treat.",English
+"And this is data from the Primary Immune Deficiency Treatment Consortium, which has 47 centers around the US and Canada,",English
+"showing that treatment is very successful if given at a young age, less than 3.5 months, before babies have started to get serious infections.",English
+"But these infections begin, and they certainly compromise survival. And this is even modern data in the last decade,",English
+showing survival decreasing to around 50% if infants have an active infection at the time of their bone marrow transplant.,English
+"Fortunately, now we have newborn screening for SCID in all States as of 2019. And the screening is based on detecting",English
+"these little circles of DNA called TRECs that are produced from the recombination of the T-Cell Receptor,",English
+that has to cut and paste different pieces together in order to generate the T-Cell diversity that helps us fight infections.,English
+And we'll talk about this some more in a few minutes. But this byproduct of T-Cell Receptor rearrangement produces a very handy analyte for newborn screening.,English
+And this graph just shows that newborn screening has increased as a diagnostic method of SCID In the past several years.,English
+You can see the years and percent of cases screen. Whereas the percentage of infants diagnosed by having infections has fortunately gone down.,English
+Another determinant of survival for SCID is the genotype. There are many different genes that interrupt T-Cell development.,English
+"And what you see on this graph, again, data from the Primary Immune Deficiency Treatment Consortium is that the survival is the worst for a gene called DCLRE1C.",English
+"And we don't like saying that string of letters over and over, so it's called the Artemis gene. This was the name given to it",English
+"by the first group that cloned it, and mutations in the Artemis gene produced SCID that has the worst survival of any of the SCID genotypes.",English
+"Again, even modern data up to 2018. So, what is different about Artemis Deficient SCID? This is an ultra rare disorder,",English
+"only about three to 5% of ART-SCID, and SCID itself, occurs in only one in 60,000 births. The gene encodes a DNA repair enzyme.",English
+"And this repair enzyme is necessary in order to accomplish the T-Cell and B-Cell receptor rearrangements that I just alluded to,",English
+"that are required in order to make T-Cells and B-Cells mature. So this is called a T minus, B minus form of SCID.",English
+"And because DNA breaks can't be fixed, these individuals also have increased sensitivity to radiation.",English
+"There is a founder mutation in Navajo and Apache Native Americans, so that they have a much more frequent incidence of SCID,",English
+"one in 2000 births, due to a stop codon mutation in the Artemis gene. Why does ART-SCID have the poorest survival?",English
+"Well, even with a matched sibling donor, which is the ideal donor for a transplant, B-Cell reconstitution is rare in Artemis deficiency.",English
+"And even T-Cell reconstitution often incomplete. When there isn't a matched sibling, and there isn't in the majority of cases,",English
+"alternate donor transplants have a high rate of rejection, poor immune reconstitution, and a very high incidence of graft versus host disease,",English
+"which we think may be mediated by those encase cells which are present, even though T-Cells and B-Cells are absent.",English
+Individuals with ART-SCID are very sensitive to high dose chemotherapy that's used for pre-transplant conditioning.,English
+"And even the survivors have short stature, poor tooth development, endocrinopathies, and increased mortality.",English
+"So all these things together, made us decide that, Artemis would be a good candidate for autologous gene therapy.",English
+"That is, putting a correct copy of the gene into bone marrow STEM cells. We worked a lot with the Navajo and Apache tribes,",English
+"and UCSF has a long history of treating Navajo and Apache children with ART-SCID. The Navajos live in very challenging circumstances,",English
+Many of them far out in the country. You've heard about their awful experience with COVID-19 in the recent months.,English
+"And some of our patients come from houses with dirt floors and no indoor plumbing. Fortunately, we have a trusted and experienced",English
+"local physician, Dr. Diana Hu in Tuba City, who helps us follow these patients. And we have sent a team to the reservation annually",English
+to hold SCID clinics to follow our patients who've been treated there. But this was the first year,English
+we couldn't go in person due to the pandemic. We had to have a Zoom SCID clinic. Our Navajos bringing their traditions with them,English
+when they come to UCSF for transplants. And many of them arrive with a cradleboard like this one in the picture.,English
+It just has to be fully disinfected and all the bedding has to be sterilized before they can bring it into the transplant room.,English
+"And despite all these things, stress levels are high. Patients are far from home, and a transplant of any kind takes at least three to four months.",English
+"And gene therapy is unfortunately no quicker. So this is a picture of our gene therapy vector, which I'm not gonna go into in detail.",English
+But one important feature is that it uses the endogenous Artemis promoter to drive expression of the Artemis cDNA.,English
+"And most vectors for other gene therapy have used some other type of vector, but we believe that, this will give the right amount of Artemis protein",English
+"in the right cells at the right time. To date, we've enrolled 10 patients, and I'm not gonna have time",English
+"to talk about the ones in light blue, who are older individuals who've already had treatment as infants, but the treatment was not successful.",English
+"The rest of the time, I'm gonna focus on the one shown in darker blue here. These are newly diagnosed infants.",English
+"And although several of our patients are Navajo, we've been surprised to find every ethnicity has Artemis SCID to one degree or another,",English
+"as you can see here. Our treatment protocol involves a very low dose of Busulfan. This is a dangerous chemotherapy agent,",English
+but we need to use it to make space in the bone marrow for the corrected cells when we reinfuse them. And we've taken pains to do targeted pharmacokinetics,English
+"for each infant to adjust their dose based on their own metabolism, and that's important. You can see here that the dose required",English
+"varies by a factor of two. So if we'd just done a weight-based dosing, some patients would receive too much and some too little.",English
+"So in terms of the followup, I'm gonna show you just the data from infants. And right now we have over 13 months mean followup.",English
+So first here is the vector copy number that we're observing in the T-Cells that develop and the B-Cells that develop in these infants.,English
+So each infant is shown here in a different color. We also see the vector coming up in natural killer cells and in myeloid cells.,English
+"So that means we're getting multi lineage engraftment, which is a good indication that we have true STEM cells that would be needed for durable, successful treatment.",English
+"And these are the numbers of T-Cells, B-Cells, and T-Cell subsets that we've seen develop. So these infants have almost all started",English
+"with undetectable cells, 'cause this is a T minus B minus SCID. And the cells that were present in one patient",English
+"were actually maternal cells. You can see that over time, after about three months, the numbers of gene-corrected,",English
+"functional T-cells has shot up, and all the patients shown here have developed B-Cells, once they get out past three months.",English
+We are also looking carefully at the insertion site profile because we want to avoid having clonal proliferation as occurred in the original SCID gene therapy trials,English
+"for excellent SCID with gamma retrovirus vectors in France. In these cases, we're gratified to see almost all of the clones that we look at.",English
+"We see only one time, whereas the insertion sites that are seen multiple times account for a very modest percent of the total cells.",English
+And the other thing that we're looking at is the diversity of the T-Cell Receptors that these patients are generating.,English
+"So, as I already said, the recombination of these T-Cell Receptor genes is what gives us the diversity of our T-Cell population.",English
+"And we need this in order to be able to recognize all of the things in the environment that we need to respond to, and these are called antigens.",English
+"So T-Cells have on their surface these receptors, and this is the variable region of the T-Cell receptor right here.",English
+And what we do is we actually sequence the RNA that is encoding that portion of T-Cell Receptors.,English
+"So you can see in data from a healthy infant cord blood or a healthy adult, there is a great deal of diversity. And this diagram depicts each unique sequences of dot,",English
+"and the size of the dot is proportional to the number of times that sequence occurred. So there's a huge variety, very little predominance,",English
+of one clone or the other in either cord blood or adult blood. We measure this with something called the Shannon Index,English
+"which is around 9.6 or 9.8. And here is patient double O Seven, who we treated with gene therapy.",English
+"He started off with essentially no T-Cells and extremely low diversity, but by three months you can see T-cells starting to develop,",English
+"and a good amount of diversity beginning to be detected. And by six months, he's already got a Shannon index of nearly as much as the adult and cord blood donors.",English
+"So in conclusion, to date, we've treated 10 patients with our autologous corrected CD34 STEM cell preparation. And we have had no serious adverse events,",English
+"no rejection, no graft versus host disease. And the low dose busulfan targeting appears to be working well.",English
+We have not had toxicity from this. And our preliminary studies indicate significant diversity of insertion sites,English
+"with no dominant clones, and also diversity of the T-Cell repertoire that's developing. We have had two patients who developed autoimmune",English
+"hemolytic anemia, a temporary complication likely associated with early B-Cell reconstitution. And we are following these patients.",English
+"We've treated them successfully, and we're looking into why this happens. We clearly need to enroll more patients",English
+"and follow them longer, to know if this is going to be a fully successful treatment, but we're very optimistic at this point.",English
+"And I'd like to end just by thanking all of the team at UCSF, and our NIH collaborator, Harry Malech, Scott McIvor",English
+"who helped us make the vector, and doctors who referred patients to us, as well as the patients and their families.",English
+Thank you very much. - I'm gonna talk about Hematopoietic STEM cell gene therapy,English
+"for Primary Immune Deficiencies. My conflict of interest statement. I'm an inventor on the work I'll talk about, patented by the University of California Regents,",English
+"and this intellectual property was licensed to Orchard Therapeutics, the work on ADA SCID. I'm also on the Scientific Advisory Boards listed there including Orchard Therapeutics,",English
+"and some of the preliminary clinical trial results I'll show from ongoing studies, not final results. So among the different white cells",English
+"there are immune deficiencies involving most of them. And I will talk today about work we've done on Adenosine deaminase, or ADA Deficient SCID.",English
+"This was with a CIRM grant, and in collaboration with Orchard Therapeutics. I won't talk about other than to mention right now, that we're also doing trials for neutrophil defects,",English
+"X-Linked chronic granulomatous disease under a certain CLIN2. And that was just published in ""Nature Medicine"". And also Leukocyte Adhesion Deficiency",English
+"under a different CIRM grant to Rocket Pharma. So ADA deficiency is illustrated here, the biochemistry. The enzyme, ADA Deaminase adenosine or deoxyadenisine",English
+"to make inosine or deoxyinosine, which can then either be excreted ultimately as uric acid or salvaged. And it turns out that",English
+"in the absence of ADA enzyme, genetic deficiency, it was observed that ADA enzymes were missing in a SCID patient that led to the suggestion",English
+"it could be involved in the disease. And we now know that in the absence of ADA, high levels of the nucleoside that build up are phosphorylated,",English
+"especially in lymphocytes to deoxyadenosine triphosphate. And this is what's lymphatoxic, kills off the immune system and leads to ADA SCID.",English
+"So ADA SCID is about 10 to 15% of all human SCID. And our estimate is that there's about 10 children a year born with that,",English
+"between the US and Canada. And of the different forms of SCID, it's the first one where the biochemical and genetic bases were determined.",English
+"And we know that ADA Deficient SCID patients have profound pan-lymphopenia, meaning they have low levels of T- B-, and NK lymphocytes from these accumulated lymphatoxic adenine metabolites",English
+"I just showed you. And there are several therapeutic options for these patients including, allogeneic hematopoietic STEM cell transplant",English
+"either from a matched sibling or matched family donor, or from a matched unrelated donor, or from a haploidentical, usually a parent donor.",English
+"And then what I'll talk about today, is autologous hematopoietic STEM cell transplant with gene therapy. And there's also an enzyme replacement therapy for ADA SCID",English
+"where bovine ADA is conjugated to polyethylene glycol. It could be given as repeated injections. But for the gene therapy that I'll talk about,",English
+"the schema is shown here. So in our study, we used bone marrow as the source of hematopoietic STEM cells. They were harvested from the patient to operating room,",English
+"taken to the GMP laboratory, where we enriched for the CD34 fraction. We then used a Lentiviral Vector to add a normal ADA gene.",English
+"The cells were then formulated and certified. During this time, the patients receive some cytoreductive chemotherapy to make space for the STEM cells,",English
+"which are then re-infused intravenously. And then we follow those patients for the different endpoints of the study. For safety, for the clinical outcomes,",English
+"measuring the gene frequency, gene expression, and looking at the vector integration sites. So this is our lifetime total work",English
+on ADA SCID patients with gene therapy. We treated three patients in the early '90s using their umbilical cord blood. It really didn't bring any efficacy.,English
+"And we did studies over about a decade, using a gamma retroviral vector. And then in 2013, we opened up our trials, using the EFS-ADA Lentiviral Vector",English
+"that I'll talk about today, and that has been licensed to Orchard Therapeutics. So this is a map of the vector that shows that it's a relatively simple vector",English
+"carrying a normal human ADA cDNA that's been codon optimized to improve translation. Uses the elongation factor, short promoter,",English
+"has a WPRE to stabilize the message. And that's the transcript that made, this vector was made by colleagues in University College, London,",English
+"Adrian Thrasher and Bobby Gaspar. And then we, together, have studied it. And so there were parallel trials in the UK and the US, using this vector to treat patients with ADA SCID.",English
+"I'll talk about our studies, the initial trial using fresh cells, and then followup studies and cryopreserved cells. And that's just a picture",English
+"of Bobby Gaspar and Adrian Thrasher, our colleagues. And so for the fresh trial, this is the schema that the patients follow.",English
+"So following consent and screening studies they would be admitted like on a Monday. Tuesday morning, they'd go to the operating room for a bone marrow harvest and placement of a PICC line.",English
+"We isolate the STEM cells in the laboratory, and then do the Lentivirus transduction of the gene transfer over a two-day period. During that time,",English
+"they'd get a single dose of chemotherapy to make space, and then on Thursday, to get the cells re-infused. And then if all went well, one month later,",English
+"we'd stop their enzyme therapy, and then follow their immune reconstitution. And we enrolled and treated 20 patients under the schema between 2013 and 2015.",English
+"And these are some of the results from the study. These are our interim trial results, and not fully validated Data, But it shows that the patients went from having",English
+"basically no ADA in their red cells due to their ADA deficiency, to on average levels of ADA that were above the normal range that were really quite stable and sustained",English
+over the two years of followup. The bad metabolites that accumulated in their red blood cells were down until we stopped their enzyme therapy.,English
+"It came back up, but then over time, they came back down, showing the effects of the ADA expression. And then their T-Cells also dropped,",English
+"after stopping their enzyme that was keeping them alive. But then the T-Cells came back up into a therapeutic range, and the same thing with B-Cells.",English
+"So, based on these positive results, we actually applied to the FDA for Orphan Drug Designation, which was granted in October, 2014.",English
+"We also applied for and received, Breakthrough Therapy Designation, and then licensed this to Orchard Therapeutics in February of 2016.",English
+"So then, going forward from that point, we developed a new clinical trial. And this was funded by CIRM and Orchard Therapeutics,",English
+"and was designed to assess a cryopreserved cell products. Rather than giving the cells fresh to the patient, we froze them at the end. We enrolled 10 patients in the study,",English
+"completing all followup by September 2019. And the advantage of a cryopreserved product, among others, was that it would allow administration",English
+"at a local pediatric transplant center, rather than within a few blocks of our cell processing laboratory as the fresh requires. So we call this the frozen trial for the frozen cells.",English
+"And now the schema was a little more complicated for the patients, so we dissociated collection and transplant. So they'd come in for the bone marrow harvest,",English
+"and the same process was used to add the gene. But then the cells were frozen. And then we could take the time we needed to certify the cells to make sure they were sterile,",English
+"had adequate vector copy it up, all the other end points of the certificate of analysis. Then the patients would come back in for a second admission, and would receive their chemotherapy,",English
+"now split and adjusted to hit the right total level. Then the cells were thawed and given back, and again, followed for 30 days, stopping their enzyme,",English
+"and then looking for immune reconstitution. So this just shows the enrollment for the study. So by the time we got it started, we'd already had a backlog of patients referred.",English
+"So we treated all 10 planned patients within about eight months. Red is the one we did their bone marrow harvest, green is when they got their transplant.",English
+"This one patient actually did not, we did not recover adequate cells from one harvest, so we did a second harvest, and ultimately she went on to not engraft.",English
+"So she's our only patient that needed to go onto an allogeneic transplant, because the gene therapy didn't work. So we transplanted these 10 patients,",English
+and infected two more at an expanded access program. And this is just the people in my group that did all those cell processing.,English
+"And that's a lot of cell processing to do in that course, and they were great. And so we presented with Orchard at the 2019 ASH meeting,",English
+"a comparison of the outcomes for multiple parameters. The two most important ones are shown here, between the fresh cells and the cryopreserved cells,",English
+all of them all added together. And you can see that they're basically indistinguishable. And so the frozen cells gave us the same grandiose-like vector copy number,English
+"as a measure of STEM cell engraftment, and the same lymphocyte recovery kinetics. And so this allowed the two trials, to be put together for subsequent analysis.",English
+And the next analysis that was done by Orchard was to acquire data for a comparative group for the FDA. And so they licensed data from two major centers,English
+"that treat a lot of SCID patients, Duke University in the US, and Great Ormond Street Hospital in the UK. And from them, there were 26 ADA SCID patients,",English
+"who had Alginated transplant between 2010 and 2016. So a relatively contemporaneous group. 12 of them received transplants from matched related donors,",English
+"and 14 from non-matched related donors. So the 12 that got matched related donor, 11 used bone marrow, and no condition was given before the transplant,",English
+"sort of the classical way of transplanting SCID patients with a sibling match. One of them, there was a cord blood and they got only serotherapy.",English
+"So really, no marrow or cytoreduction for those patients. The 14 that got the non-match related donor transplants, nine of them were haplos, they were parental transplants.",English
+And then the other five were matched unrelated to mobilized peripheral blood and three cord blood. The nine haplos got no conditioning. The five unrelated donors got a variety of both cytoablative,English
+"as well as immune suppressive chemotherapies. And this group of patients matched the gene therapy cohort for agent diagnosis and treatment,",English
+"and for the CD34 cell doses delivered. And so the first comparison was for overall survival. So the blue line are the gene therapy patients, or OTL 101,",English
+"and there were no deaths in this group. A hundred percent survival. Whereas in the transplant groups, there were three deaths. One of the match-related donor from a sibling,",English
+had a late death from graph versus host disease. And two of the non-related donor transplants also died shortly after transplant.,English
+"And we also looked at event-free survival, where an event is defined as either death or failure of the immune reconstitution,",English
+"so that an allogeneic transplant or enzyme therapy were needed. And so, as I mentioned before, one of our patients did not engraft",English
+"and needed a transplant, whereas in the Allotransplant patients, there were a total of 10 events. In the matrilater, where they needed",English
+"either a rescue transplanter to go back an enzyme, and six in the non-matched related donor group. So the gene therapy was statistically better",English
+"than a transplant for event-free survival. And then finally, we looked at parameters of immune reconstitution.",English
+And so red blood cell ADA was higher in the gene therapy group than in the transplant patients. Those who got no conditioning,English
+"basically developed no STEM cell engraftments, and so no ADA containing red cells were produced. Metabolites went down, and all the patients were actually lowest throughout",English
+"with the gene therapy group. A CD3 positive T-Cells came up to a higher level in the gene therapy group, as did naive T-Cells, suggesting ongoing T-Cell production.",English
+"B-Cell counts also came up to a higher level after gene therapy, but then after the Allotransplants. And in fact, because of better B-cell and graph development,",English
+"more of the gene therapy patients, three out of 29 only, were still on immunoglobulin replacement at two years. And so 89% of the gene therapy patients",English
+"were off immunoglobulin, originally 70% for the sibling transplants. And I just wanted to close by mentioning that, obviously the work we're doing is presented by CIRM,",English
+"and over the last 12 years or so of CIRM, we've had many grants starting with maybe grant number five from CIRM training grant, the grants for the specific trials that I've mentioned.",English
+"And we've also collaborated on many other grants throughout UCLA, UC Irvine, UCSD, UCSF, UC Berkeley. And most importantly, we've had 10 CIRM's Bridges students",English
+in our labs over the last 10 years. And so I just wanna thank the patients. Some of our graduates are shown here,English
+"at various times after gene therapy. And thank my lab that did all the work that I showed you. They're working on vectors, and editing, and clinical work.",English
+"Our support at UCLA is from multiple institutions, including the Broad STEM Cell Center and the Alpha STEM Cell Clinic. The ADA work that I talked about over the decades,",English
+"has been funded by multiple sources, most recently CIRM and Orchard therapeutics. And this is a list of our collaborators, thank you. - Good afternoon, my name is Mark Walters.",English
+"I'm at University of California, in San Francisco at Benioff Children's Hospital, Oakland. And the name of my talk is entitled gene correction in sickle cell anemia.",English
+This schematic shows the hemoglobin molecule that pairs alpha and beta subunits. Each subunit has a heme moiety,English
+"that carries oxygen to the tissues. So alterations in this hemoglobin molecule that alter its abundance and or function and stability,",English
+"are among the most common genetic disorders worldwide. And together, they're associated with anemia, reliance on red blood cell transfusions, chronic illness,",English
+"and in sickle cell disease, early mortality, and extensive morbidity related to this underlying mutation. The gold standard for curative therapies today, still today,",English
+"is Allogeneic hematopoietic STEM cell transplantation for sickle cell disease. However, many, if not most patients,",English
+are not considered for an allogeneic transplant because they lack a well-matched donor. Or they have advanced disease that makes an allogenic transplant too risky.,English
+"And in these data published in the last year or so from registries in Europe, and in the United States, worldwide, the overall survival after transplantation is shown.",English
+"And while the mortality is less than 5%, if there's an HLA matched sibling is the donor, the mortality increases to 10 to 20%",English
+"if an alternate donor is utilized. so together, these transplant data show that only 18% of families",English
+"have an HLA identical sibling donor and only 19% have a well-matched unrelated donor. And even if we were willing to accept a mortality risk of 10 to 20%,",English
+"when an alternate donor is selected, most patients still won't have a suitable donor. In addition, clinicians who take care",English
+of sickle cell disease patients don't refer them because of these concerns about graft versus host disease and the risk of dying of the transplant itself.,English
+"So until very recently, transplant was largely restricted to children, but applied very sparingly. So the opportunity and the gap",English
+"that this research aims to address is that, first is that, can we modify autologous cells for clinical benefit,",English
+"and thereby expand the availability of a curative therapy? Because a person with sickle cell disease can act as their own donor. And second, can we ensure equitable access",English
+"to a novel curative therapy that applies this new approach? So, the current genomic modification therapies",English
+"for sickle cell disease are listed in this slide. The best, most widely developed experimental therapy, that's nearing FDA approval is gene addition therapy.",English
+So STEM cells are transduced via Lentiviral vector with an anti-sickling beta globin or a fetal globin for the same anti-sickling activity,English
+"to elicit a curative effect. There are also gene therapy trials that are currently active that edit a molecule term,",English
+"(speaks in a foreign language) that increases fetal hemoglobin, and thereby elicits a curative or beneficial effect. And then this talk will focus",English
+"on gene editing to correct the sickle mutation directly. All of these approaches rely on ex-vivo modification of the metabolic STEM cell,",English
+in vivo gene editing has still not yet reached the clinic. So what level of gene correction will be clinically important?,English
+"So this is important because, using the current gene editing protocols, it is not possible to modify all the metabolic STEM cells",English
+"and thereby correct the sickle mutation. So we know from transplantation using allergeneic donors, that as little as 20% of the patient's marrow",English
+made up of donor cells is sufficient to cure both sickle cell disease and Beta-thalassemia. And that's because there's this natural enrichment of the donor erythrocytes and precursors,English
+"that occur in the marrow and in the bloodstream to elicit a curative effect. So these data that I'm not showing today, would indicate that correcting at least one sickle mutation",English
+"in at least 20% of the engrafted STEM cells, should be curative. So I'm gonna share some details about the sickle allele editing project",English
+"currently supported by CLIN1 funding, initially supported by a CRIM1 CIRM grant that involves investigators at three sites. So the first is at Benioff Children's Hospital, Oakland,",English
+"at our research Institute, David Martin, Weny Magis and Dario Bofelli. At UCLA, it's the manufacturing site where some of the most important IND enabling studies",English
+"were performed led by Donald Kohn, and the project manager Mark Dewitt, Zulema Romero-Garcia and Suzanne Said. And then the Innovative Genomics Institute of Berkeley,",English
+"Jacob Corn, who was more recently replaced by Fyodor Urnov with Stacia Wyman and Jonathan Vu. So the schema for the preclinical development",English
+is shown in this diagram. It begins with collecting perk for mobilized discard medical and STEM cells from simple donors.,English
+"These are electroporated by our gene editing reagents, edited and then injected into a xenotransplantation model, whose marrows are harvested 16 to 20 weeks later,",English
+"sufficient for hematopoietic STEM cell engraftment. These marrows are analyzed by a next-generation sequencing, both on and off target.",English
+"There is a single off target, OT1 that is monitored. They're also selected by CD3 positive beads and CD234 positive beads.",English
+"The latter is an erythroid marker for RNA-Seq, and ultimately RNA erythroid differentiation to look at the books, the hemoglobin and RNAC,",English
+"for gene expression profiles. And then colony essays from the CD34 positive cells, again, to get a gene expression in erythroid colonies",English
+"derived from these mouse marrows. So the results of the correction are shown, each dot represents a mouse,",English
+four cohorts of xenografted mice are shown. And the average correction from sickle to wild type at HBB is 23.4%.,English
+"So meets that 20% threshold or benchmark that we hope to achieve. But this is balanced by indels,",English
+"which introduce the equivalent of a thalassemia or a null allele that doesn't generate a stable hemoglobin, that occurred at 65 of the HBB allele.",English
+"So really the question is, is this ratio, is this balance sufficient to elicit a clinical effect? So the possibility that it might be",English
+"is suggested by the next slide, in which the frequency of gene edited cells from two manufacturing lots were tabulated. So colonies in soft agar were picked,",English
+"and several thousand colonies were picked, and then genotype, according to the derivative HSPC. And what's shown in blue are the cells",English
+"that have at least a single corrected allele, the green slices of the pie are uncorrected or retained sickle mutation.",English
+"And then the red are indel homozygotes. So these would be thalassemia type cells. And what we observed is at least 40% of these cells,",English
+"of these colony forming units, have at least one corrected allele, so 40% balanced by about 40% containing an indel at two alleles,",English
+"and then the remainder being uncorrected. So, based on the mixed consumerism data and allele transplantation, we would predict that this level of correction,",English
+"having a single corrected allele at least 40% of the cells would be curative. And, while one cannot prove this outside of the clinical trial,",English
+"we do get a glimpse of this in the following experiment. So it's possible to look at HDR events that extend to the sickle allele and correct it,",English
+"that's shown by the guide RNA in red, showing a cleavage site above it, where the strand extension and DNA prolimeration commences.",English
+"And it's possible, and luckily this happens rarely, for that strand extension to stop after it reaches the PAM mutation",English
+but before it reaches the sickle mutation. So those are the internal controls for the homology directed repair events that we'd like to compare.,English
+"So in this experiment, what was done, was to genotype individual marrows from mice that were xenografted.",English
+"And, beginning in the far left panel, These are the unedited controls in what's shown as that unfractionated marrow, CD34 positive progenitors from the same marrow,",English
+"or erythroid progenitors, the CD235 positive cells, all show about the same level of representation. Both in the unedited controls,",English
+"and then those mice that had homology directed repair that only reached the PAM mutation. So, no difference between",English
+unselected marrow progenitors or erythroid cells. But look what happens when sickle corrected homology directed repair has occurred.,English
+"This occurred in 20 to 25% of the mice, as I just showed, both in marrow and CD3 to four positive cells. But the erythroid cells show this marked enrichment,",English
+"representing approximately half of the alleles that were genotype, and shows what we would project, which is an enrichment of the corrected alleles",English
+"in the marrows of these xenografted mice. What's interesting if I take you to the far right panel, these are the non-homologous enjoining events",English
+"that generate a thalassemial allele. These actually drop out of a representation in the erythroid series, just as one would predict.",English
+"So in the clinical trial, what we strongly suspect will happen is that the thalassemial alleles won't contribute",English
+to erythroid alleles and will fall out in the marrow. Whereas the corrected alleles will make healthy red cells that repopulate and expand in the circulation.,English
+"So another adverse event that's important to study is a chromosomal translocations. And in this case, we're looking at principal locations",English
+"between the on-target HBB gene and the principal off-target, which we see which we call OT1. So it's possible to assess for this risk",English
+"by droplet digital PCR testing using the primers as shown, to bridge the junction chromosomal translocation break. And using a threshold of 0.01%,",English
+"what this figure shows is that, the level of translocations was at, or below, the level of detection.",English
+"In one case, it did exceed the level of detection, but this occurred both in the mock and experimental pools. So these results suggest that translocations",English
+"are an incidental finding unrelated to the gene editing in our manufacturing protocol, or they're an extremely rare occurrence,",English
+"confirming the safety of this manufacturing protocol. So, in summary, I'd like to finish with this notion of the ideal cell therapy profile.",English
+"It should protect from hemoglobinopathy-related complications, both clinical, and sub-clinical events. There should be a safety acceptable toxicity profile",English
+"in the short term and the longterm. It should be accessible and available to most patients, which is a significant hurdle in the future,",English
+"and safe in both children and adults. And then ideally, a comparative trial design would show evidence of benefit of the curative therapy",English
+"compared to existing supportive care treatments. We hope to have at the end of these studies, more than one choice to choose from.",English
+"Both gene addition and gene editing approaches that might enable our patients, which are really the focus of the studies,",English
+"how to expand curative options for them. So that patients would have a choice, and could make that choice",English
+based on both benefits and risks to them in the longterm. I'd like to finish by acknowledging the funding sources for this work.,English
+"California Institute of Regenerative Medicine, We've also had assistance through the Alpha STEM Cell Clinic for Infrastructure In IND Development,",English
+"from the National Heart, Lung, and Blood Institute and the Cure Sickle Cell Initiative, and then philanthropic funds through the Jordan family at Benioff Children's Hospital, Oakland, thanks very much.",English
+"- Looking at the field of gene therapy over the last 30 years, I think that many of us remember well",English
+"some of the challenges that threatened to derail this therapy early on. In particular, the problem of insertional mutagenesis",English
+"of causing cancer in the engineered STEM cell population. And so much work has gone into optimizing vectors,",English
+moving away from retro into lenti and all of that. And so I guess I'm interested in your perspective as to whether that problem is solved.,English
+"- Well, we certainly can't say that it's solved yet, but it's definitely showing signs of progress. And as you mentioned, the original problem",English
+"was the gamma retroviral vectors that were derived from a mouse leukemia. And at that time, the problem was that,",English
+we didn't believe we would ever get enough expression in the cells. And so everybody was trying their hardest,English
+"to make the vector that carried in this correct copy of the gene, have as much expression as possible.",English
+"And used the promoters that were, the long terminal repeats of the vector to drive this very high degree of expression.",English
+"But unfortunately, those long terminal repeats could function bi-directionally, and they could turn on adjacent genes.",English
+"And this led to having clones expand beyond control, if they happened to have a vector that landed next to a growth factor gene.",English
+"And, 'cause the other name for a growth factor gene is an oncogene. So that turned out to be a very unfortunate",English
+and unacceptable kind of approach. The lentiviruses that we're using now don't have the same insertion proclivities.,English
+They don't wind up in the same position relative to genes. But it is true that these vectors that we're putting into the cells,English
+"go into places that we can't direct. And so there is a certain amount of randomness involved, even though they don't tend to sit",English
+"in the five prime end of genes. But they definitely go into open chromatin, which is the genes that are being expressed in the cells at that particular time.",English
+"And so I say that the risks are decreased and we measure this, we have assays, to look whether there's any cell transformation going on.",English
+from can only provide a limited amount of blood. >> There are people that actually refuse to have blood drawn from their children in their arm. And they're more apt to have their finger pricked,English
+for the testing. >> Collecting capillary blood samples with a microtainer is a minimally invasive way to get the blood sample you need,English
+"to do a limited number of nutritional tests. Microtainers are made of plastic and can only hold small amounts of blood, up to 500 microliters.",English
+"Microtainers with a purple top are sprayed with the anticoagulant EDTA, which prevents blood from clotting. This blood can be used for cell counts, malaria smears,",English
+"hemoglobin analysis, and many other tests that require using whole blood that is not clotted. Some people will provide venous samples",English
+"which will be collected using a vacutainer containing EDTA identified by its purple top. Vacutainers are made of plastic or glass, and typically hold",English
+"between five and fifteen milliliters of blood. To collect a capillary sample from a fingerstick, you will need a lancet, alcohol swabs, gauze, a bandage,",English
+"a microtainer, powder-free gloves, a sharps container, and a biohazard bag. To reduce the odds that your sample",English
+"and supplies will be contaminated, as well as to avoid contamination of the work area with blood, place all collection materials on top of a disposable pad, then prepare the patient",English
+to collect the sample. Make sure both you and your patient have clean hands. Also make sure that the patient's blood flow will not be,English
+"restricted by jewelry or clothing. Before collecting blood, put on safety glasses and protective gloves. Begin by turning the patient's hand upward.",English
+Massage the hand and lower part of the finger to calm the patient and to increase blood flow. Then scrub the finger with an alcohol swab and dry with gauze.,English
+"Take the sample from either the middle or ring finger. Hold the finger in an upward position and lance the palm side surface of the finger with a lancet,",English
+appropriately sized for an adult or child. The most imprecise hemoglobin results are due to poor capillary blood flow.,English
+"Thus it is important to make a deep puncture. Press firmly on the finger when making the puncture, and apply slight pressure to stimulate blood flow.",English
+Wipe the first drop of blood on a gauze pad to stimulate further blood flow. Maintain blood flow by gently massaging the finger while,English
+"holding it in a downward position. Hold the microtainer at a 30 degree angle below the puncture, and try to fill the microtainer to the 250",English
+"to 500 microliter level by touching it to the drop of blood. As you collect remember that time is of the essence. If the collection takes more than two minutes,",English
+"the blood could become clotted due to insufficient mixing with EDTA. Now you may not be able to see this by eye. If you can't collect the sample you need within two minutes,",English
+it's best to stop and move on to the next person. Milking the puncture site may adversely affect test result accuracy.,English
+"When you have collected your sample, cap the microtainer and gently invert it at least ten times to prevent clots from forming.",English
+This must be done immediately. Don't cap the microtainer and go do something else. Microtainers are sprayed with anticoagulants.,English
+Rocking the microtainer back and forth will help the anticoagulants dissolve into the blood. Place the label on the microtainer.,English
+"If the label contains a barcode, the barcode needs to resemble a ladder when placed on the microtainer. Once you have collected your sample, apply a sterile bandage",English
+"to the puncture site and properly discard all used materials. Refrigerate the sample until processing, testing, or shipment.",English
+>> Often surveys take place in very humid and high-temperature conditions and it's important that the samples are not allowed to degrade. So when you collect these samples you want,English
+"to keep them cool by putting them in a Styrofoam container with a cold pack, and when you transport these you want to make sure they stay chilled also.",English
+"One thing you want to avoid is during a lunch break if you leave your samples in a hot car, that's going to cause the samples to derogate.",English
+>> Collecting a capillary sample using a microtainer is one of the least invasive ways to get the samples we need to determine whether populations are suffering,English
+"from micronutrient deficiencies. In our next segment, we'll show you how to use the samples you collected to test for hemoglobin by using the HemoCue instrument. [ Music ]",English
+A HemoCue instrument can help you determine if a patient is anemic. >> The HemoCue is a great instrument because it only takes one drop of blood to perform the test.,English
+You want to make sure that you review the operating manuals to learn about troubleshooting should you have a problem with your test results or quality control.,English
+and test a blood sample for hemoglobin. Begin by putting on safety glasses and gloves. Turn on the HemoCue by using the switch,English
+"on the back of the instrument. The letters HB will appear on the display screen once the instrument is running. Before you measure your sample,",English
+you'll want to verify the calibration of the instrument to insure that you are getting an accurate reading. [ Music ],English
+"against the HemoCue serial number. The calibration verification process insures the correct optical alignment of your instrument,",English
+which is the only way to insure you will get an accurate reading. Place the control cuvette into the holder and gently push it into the HemoCue instrument.,English
+"If the control cuvette reads within the range specified on its container, calibration has been verified. If the reading is not within the specified range,",English
+"clean the control cuvette and the cuvette holder and try again. If you are still not successful, the instrument should be sent back",English
+"to the manufacturer for servicing. Assuming you have successfully passed calibration verification, you will next perform one",English
+"of the daily quality control tests before measuring your samples. Use the HemoTrol blood product's low, normal,",English
+"and high controls for this purpose. To reduce contamination, always wear powder-free gloves before handling cuvettes.",English
+"Cuvettes are stored in a humidity-controlled container. Don't remove cuvettes from this container until you are ready to use them, and remove cuvettes only one at a time.",English
+Recap the storage container immediately after removing each cuvette. Place a drop from the manufacturer-provided HemoTrol sample on a surface like Parafilm or plastic wrap,English
+"that won't absorb the blood. Fill the cuvette by placing the open end in the middle of the drop. To avoid contamination, it is not recommended",English
+"to dip the cuvette into the HemoTrol vial. Before placing the cuvette into the HemoCue instrument, clean excess blood from the cuvette using a lint-free wipe.",English
+"After 15 to 45 seconds, the instrument will display the hemoglobin result on the screen. Record that number on the quality-control results form,",English
+"either through humidity or the fact that it may be expired. Also, the control material may be bad, so you want to get a new bottle of control.",English
+"Collect the blood sample using the microtainer collection technique we described in the last segment. You can fill the cuvette with blood from the microtainer,",English
+"or you can fill the cuvette directly from the finger. Completely fill the cuvette all at once. If you interrupt the filling,",English
+"you will likely introduce an air bubble which could give an inaccurate reading. If you don't completely fill the cuvette on the first try, throw it away and repeat the procedure with another cuvette.",English
+"Before placing the cuvette into the HemoCue instrument, clean excess blood from the cuvette using a lint-free wipe. Do not touch the open end of the cuvette with the wipe",English
+because it could remove some of the blood in the cuvette. Be sure to inspect the cuvette for air bubbles. Small air bubbles along the edge should not influence the result.,English
+Then gently insert the cuvette into the HemoCue holder. You'll notice that the shape of the holder matches the shape of the cuvette and won't allow you,English
+"to insert it backwards or upside down. It's important to push the holder in gently. If you push too hard, blood can splash out",English
+"and make the optics dirty. After 15 to 45 seconds the result is displayed. If you encounter an error message, please refer",English
+"to your operator's manual. Record the result the same way you recorded the results of your quality control readings. Be sure to dispose of the cuvette, wipe, and Parafilm",English
+">> In our next segment, we'll find out how to process whole blood, to prepare dried blood spots, and how to ship them to a laboratory for testing.",English
+"[ Music ] In our first segment, we showed you how to collect capillary blood using a microtainer.",English
+dried blood spot samples are easy to ship to a laboratory where testing can be done. They also take up less room for long-term storage.,English
+Dried blood spot samples are useful in detecting iron and vitamin A deficiencies. But they can be used for many other tests.,English
+"To prepare dried blood spot samples, you will need an approved filter paper, a pipette, and a drying rack or box.",English
+Various types of drying racks are available for this purpose. The 1997 NCCLS document blood collection on filter paper for neonatal screening specifies which types,English
+of filter paper are suitable for preparing dried blood spots. Paper is chosen based on characteristics such as thickness and absorbency.,English
+"Although dried blood spots can be prepared directly from a fingerstick, for the purposes of most nutrition surveys, blood is collected into a microtainer",English
+"and a fixed volume is then applied to a filtered paper card using a pipette. If you are processing blood from a refrigerated sample, allow the sample to warm for a few minutes at room temperature.",English
+"When you're ready to collect the sample, gently invert it 20 times to insure complete mixing before it is placed on the filter paper.",English
+"Most studies call for 100 microliters of blood, since that is the volume that will fill a circle on your filter paper. For some tests, it is possible to use less.",English
+"Do not touch any part of the filter paper circle before or after the application of the blood. Place spotted filter paper cards in a drying rack or box,",English
+and allow the blood spots to dry at room temperature for a minimum of three to four hours. Drying may take longer if the humidity is high.,English
+to touch other surfaces during the drying process. [ Music ] Whether your dried blood spot samples are shipped,English
+"at room temperature, refrigerated, or frozen, depends on the specifications of your study protocol. >> To prevent degradation of the samples, it's important",English
+that these samples be stored in a cool condition. You also want to avoid any pre cell cycles during transit or during storage.,English
+"Once the samples arrive, they need to be store in a refrigerator or freezer. >> Gather all the materials you will need for shipping, including a sealable plastic bag, humidity indicator cards,",English
+"Desiccant packs, a Tyvek envelope or a second sealable plastic bag, and a Styrofoam shipper. Visually inspect the blood spot cards.",English
+"If they appear dry, pack them up. Separate blood spot cards with weighing paper to keep the samples from contaminating each other.",English
+Pack the blood spot cards in three mil thick backs such as those made of Serenex to provide a barrier against gases and water vapor.,English
+Pack the plastic bag into a second sealed container such as a plastic bag or a Tyvek envelope. And place into a Styrofoam box containing cold packs.,English
+Household Ziploc bags should not be used because they will not provide an adequate vapor barrier. Desiccant packs absorb any moisture,English
+"that might enter the plastic bag. If humidity rises above 30%, the indicator cards will change from blue to pink, and the card",English
+"and Desiccant packs should be changed. Keep humidity-sensitive materials such as indicator cards and Desiccant packs in sealed containers until they are needed,",English
+and only handle humidity sensitive items with gloves. Ship the package to the appropriate laboratory. Be sure to contact the laboratory you are sending your,English
+because paperwork was not filled out properly. When the samples were received at CDC they were totally useless because of the temperature of the container that they were in.,English
+">> Even if you aren't shipping the dried blood spot cards immediately, you still need to pack the cards as soon as they are dry to control the humidity",English
+and avoid contamination. Refrigerate the packed dry cards until they are ready to be shipped. These instructions are for dried blood spot samples.,English
+Next we'll talk about preparing and shipping serum and plasma samples. Stay tuned. [ Music ],English
+"In the past three segments, we've shown you how to collect whole blood, measure hemoglobin, and prepare dried blood spot samples.",English
+But there are analytes that can only be measured in serum or plasma. In these cases you will need to know how to process whole blood to obtain serum or plasma.,English
+"As a quick review, if blood is collected in a vacutainer or microtainer that contains the anticoagulant EDTA, the blood will not clot.",English
+"This blood can be used for cell counts, malaria smears, hemoglobin analysis, and many other tests that require whole blood that is not clotted.",English
+"If blood is collected in a tube with an anticoagulant and it is spun down, the fluid at the top is called plasma. Blood collected in a red-top tube or a container",English
+that does not contain EDTA or any other coagulant will begin to clot immediately. The blood will clot and be ready for centrifugation in 30 minutes.,English
+"Centrifuged blood collected in a red-top tube is called serum. In serum, all the clotting factors are used up. It's important to remember that vitamins",English
+and other micronutrients contained in serum and plasma are sensitive to degradation from light and oxidation. Minimize the exposure of serum or plasma,English
+"That's why you want to use serum instead of plasma. >> For serum, allow whole blood collected in a red-top vacutainer to clot at room temperature",English
+for at least 30 minutes but no more than two hours. Allowing the blood to sit for a minimum of thirty minutes will lead to a natural separation,English
+of the blood cells from the serum. Plasma can be prepared immediately after blood has been collected into a purple-top vacutainer. It does not need to sit for any length of time,English
+"at room temperature before centrifugation. If the processing of blood to serum or plasma is delayed, blood should be kept refrigerated and protected",English
+from light to avoid degradation of vitamins and other nutrients. Ensure that the vacutainer tubes are balanced before placing them into the centrifuge.,English
+"When you are ready to centrifuge the blood, place the vacutainers in a centrifuge holder. Microtainers can be centrifuged",English
+in a regular centrifuge using adapters or in a microcentrifuge. Centrifuge the vacutainers for ten minutes at 2500 to 2800 revolutions per minute.,English
+"When the centrifugation is complete, the serum will be the liquid in the top portion of the red-top vacutainer, and the plasma will be the liquid",English
+at the top of the purple-top vacutainer or microtainer. Pipette the appropriate amount of serum or plasma into a two milliliter cryo vial.,English
+"Depending on your study criteria, you may have to prepare more than one two-milliliter cryo vial. When filling the cryo vial, consider liquid expansion",English
+"when frozen, and do not fill the cryo vial past the 1.8 milliliter mark. Make sure to tightly cap the vial for shipping and storage.",English
+"After transferring all of the serum or plasma, discard the used blood collection materials in accordance with your hospital or lab regulations.",English
+Place the cryo vials containing serum or plasma into a labeled box for frozen storage. >> It's important to label your sample properly,English
+"so the label is legible and the label does not come off the tube. Also, you want to identify what's in the vial whether it's serum, plasma, or urine,",English
+"because these three things look very similar when they're in a vial. >> On each vial, also include your study number and the date and name of the study. Also include information on the analyte to be measured. Once you have prepared your serum or plasma samples,",English
+"when in reality the person shipping the sample, it's their responsibility to make sure the forms are filled out properly.",English
+>> Serum and plasma samples will almost always be shipped frozen. It is critical that the samples still arrive frozen,English
+"Daily tracking of the shipment is advised. Assemble all items for packing and shipping frozen samples, including the specimen box, specimen shipping list,",English
+"Ziploc bags, Styrofoam shipping box, dry ice, and packing material such as a newspaper or bubble wrap. Make sure the identification numbers",English
+on the specimen shipping list match the identification numbers on the cryo vial labels in the specimen box. You may want to secure the lid of the specimen box with one,English
+or two rubber bands to avoid opening of the box. Then wrap the specimen box with absorbent paper. Place the specimen box into a Ziploc bag and seal the bag.,English
+Place the Ziploc bag in the bottom of the Styrofoam shipping box and use bubble wrap to ensure that the specimen box does not shift during transport.,English
+"To keep the samples frozen, fill the Styrofoam shipping box with dry ice. Dry ice burns, so protect your hands and eyes with heavy gloves and safety glasses.",English
+"Allow one pound of dry ice for every two hours of transport. For international shipments, a minimum of 50 pounds of dry ice is recommended.",English
+Fill empty space with bubble wrap or newspaper to help keep the specimen box from shifting as the dry ice begins to evaporate.,English
+Place the Styrofoam lid on top of the shipping box. Do not tape the Styrofoam lid shut. The packaging must allow the release of carbon dioxide,English
+as the dry ice evaporates to prevent damaging the shipping box and its contents. The Styrofoam container is shipped inside a cardboard box. Complete the specimen shipment list and place,English
+in on top of the Styrofoam lid. Also remember to photocopy the specimen shipment list and retain a copy for your records. Tape the cardboard flap shut.,English
+Ensure that the Styrofoam shipping box remains upright by marking the box on the outside with arrows. Label the cardboard box with a dry ice sticker. Use a preprinted label or a marker to label each box with the recipient lab address and return address information.,English
+Both addresses should include a contact name and telephone number. Remember to contact the recipient lab before shipping the specimens to insure that the staff is prepared to receive the shipment.,English
+"We've completed all four steps of collecting blood, measuring one indicator in the field, processing, and shipping blood samples to a nutrition laboratory for testing. Again, the work you are doing is very important in our fight",English
+"to limit the negative impact micronutrient deficiencies are having worldwide. [ Music ] Well, we've come to the end of our program.",English
+"The tips we've shared today help standardize the way we collect and process blood samples, which will help us reduce errors as we assess micronutrient deficiencies worldwide.",English
+"The work you're doing in the field is making a profound difference in the lives of millions of people throughout the world. Now before we end the program,",English
+"we'd like to review a few universal precautions to help ensure your safety while collecting and processing blood samples. At all times, when handling blood you, you should be",English
+"on guard to prevent against possible exposure to HIV, hepatitis, and other blood borne pathogens. >> Collecting blood is basically a safety procedure.",English
+"You should remember that each sample could be contaminated, therefore you should handle it safely. >> For your own safety, wear protective equipment",English
+"and follow universal precautions as described by CDC guidelines. Standard protective equipment includes eye protection, disposable powder-free gloves, and a lab coat or gown",English
+"that will protect you in the event of a spill. Also, use retractable lenses, a puncture-resistant sharps container,",English
+and biohazard-labeled discard bags. Proper work practice controls can also reduce the likelihood of exposure.,English
+"Proper work practice controls include; preventing the storage of food and drinks where blood and other potentially infectious materials are kept,",English
+"refraining from eating, drinking, smoking, applying cosmetics, or handling contact lenses in the work area, routinely decontaminating work areas by wiping them",English
+"with a bleach solution, washing hands when gloves are removed and immediately after skin makes contact with blood or other potentially infectious materials.",English
+Remember that many micronutrients in blood are sensitive to light and elevated temperature. Never ship samples unless you've contacted the recipient,English
+"laboratory and they are ready to track and receive the samples. Once again, worldwide recognition that micronutrient deficiencies are having a significant impact",English
+on the health of people in the developing world is a fairly recent phenomenon. But the work that people like you are doing is having a positive effect.,English
+"Up until 2005, the number of screen conditions varied significantly between states. In 2005, the Secretary's Advisory Committee",English
+on heritable disorders in newborns and children recommended that 29 conditions make up the original recommended uniform screening panel or RUSP.,English
+"All except congenital hearing loss are screened through dry blood spots, with hearing screening, being the first condition under the point",English
+of care screening paradigm. Since the acceptance of the original RUSP there had been 5 new conditions approved,English
+by the Advisory Committee through evidence review and subsequently approved by the HHS secretary. All 5 conditions are screened,English
+from dried blood spots except critical congenital heart disease which is the second point of care screen. Just as nationally notifiable diseases must be made reportable,English
+"to state health departments, it is still up to states and territories to enact newborn screening requirements via laws or other means to begin screening",English
+"for conditions added to the RUSP. Traditional blood spot screening uses blood collected by pricking the newborn's heel,",English
+"but now there is this newer paradigm point of care screening which is utilized for 2 conditions, congenital hearing loss which is coordinated",English
+through a national program known as Early Hearing Detection and Intervention or EHDI and critical congenital heart disease or CCHD.,English
+"The goals are the same as for blood spot screening, the timely identification of every baby with the condition and getting him or her into the appropriate interventions.",English
+"However, the processes of these newborn screening paradigms differ leading to unique challenges. As I've defined them on this slide,",English
+you will hear the acronyms EHDI and CCHD throughout today's presentation. Point of care tests are performed,English
+"at the birthing facility typically at 24 to 48 hours after birth, but before discharge and newborns who do not pass the screen are referred for diagnostic testing.",English
+"Since point of care screening is not conducted centrally but rather at thousands of birthing facilities, this results in difficulties monitoring screening",English
+effectiveness such as the number of true and false positive screens and the number of infants not identified by newborns screening,English
+but detected clinically. Congenital hearing loss is the most common condition identified by newborn screening in the United States.,English
+Over 97% of neonates were screened for hearing loss in 2013. The incidence that year was 1.5 per 1000 neonates screened.,English
+"However, this incidence estimate cannot account for infants who fail the newborn hearing screen, but lack confirmation of follow-up diagnostic testing to either confirm",English
+"or exclude the diagnosis of hearing loss. In 2013, this loss to follow-up or loss to documentation rate for neonates who did not pass the initial screen was 32.1%.",English
+Screening for congenital hearing loss is conducted through a noninvasive test either the automated auditory brain stem response test shown in the upper photo,English
+or the otoacoustic emissions test shown in the lower photo. Newborns who do not pass the screen in 1 or both ears are referred for a diagnostic hearing test,English
+that all infants are screened no later than age 1 month. All infants who do not pass the screen have a diagnostic test no later than age 3 months and all infants,English
+"with confirmed hearing loss receive appropriate intervention no later than age 6 months. To help achieve the 1-3-6 month goals,",English
+every state in US territory and the District of Columbia have an EHDI program. The EHDI program support families,English
+"of children identified with hearing loss. They collect individual level data on infants in the state or territory and whether they meet the 1-3-6 month goals,",English
+and they report aggregate data annually to the CDC. CCHD the other point of care screening condition has a,English
+"significant risk of mortality. Prior to the institution of newborn screening, one study showed an infant mortality rate of about 18%.",English
+"CCHD is more common than congenital hearing loss with an estimated incidence of 2 to 3 per 1000 live births. However, most newborns with CCHD are identified prior",English
+to newborn screening either prenatally or because early neonatal symptoms or a heart murmur prompted a diagnostic echocardiogram.,English
+"Therefore, the estimated newborn population with CCHD potentially detectible by newborn screening is about 4 per 10,000.",English
+"Unlike for congenital hearing loss, there are yet no national data available for the incidence of CCHD identified by newborn screening",English
+or the false-negative rate. Screening for CCHD has been part of the RUSP since 2011. This noninvasive screening is conducted,English
+by placing a pulse oximeter on the right hand and 1 foot. The pulse oximeter indirectly monitors the percent of the newborn's blood that is saturated with oxygen.,English
+The typical normal range of oxygen saturation is 95 to 100% with no more than a 3% difference between the measurements in the right hand and the foot.,English
+Oxygen saturation is typically lower than expected in the presence of any of the critical congenital heart defects.,English
+The oxygen saturation values in the hand and the foot are evaluated by an algorithm to determine whether the screen was passed,English
+"or whether a repeat screen or a diagnostic test is indicated. The 12 heart defects that cause CCHD are provided here. While the noninvasive screening is optimized to detect CCHD,",English
+"some noncritical congenital heart defects, as well as, some non-cardiac causes of low blood oxygen saturation might be detected as well.",English
+All of these secondary targets of screening can benefit from early diagnosis and treatment. Newborns who do not pass the screen are immediately referred,English
+for an echocardiogram which is an ultrasound imaging study of the heart. One challenge for CCHD screening is,English
+that many birthing facilities do not have onsite access to echocardiography or to a pediatric cardiologist which would necessitate the transfer,English
+of the screen-positive newborn to another facility. Other higher level challenges for CCHD screening relate to the fact that this screening program is not as mature,English
+"as the newborn hearing screening program. All except 2 states currently have universal CCHD screening, but there is no EHDI-like program for CCHD.",English
+"Not all states collect screening data. Among the states that do collect data, the data elements vary from state to state and states also differ",English
+"as to whether data are collected on all screened newborns or on just those with a positive screen result. Keeping in mind the various challenges,",English
+"than what is the role of public health in point of care newborn screening? The state and territorial EHDI programs, as well as,",English
+"HRSA and CDC had been instrumental in supporting congenital hearing loss screening. Activities include providing consultation, coordination,",English
+and technical assistance to improve all aspects of hearing screening collecting and organizing data for evaluation of screening of effectiveness,English
+and quality assurance evaluating the impact of newborn screening on short and long-term outcomes such as improved development in school performance and providing support,English
+"for affected children, families, and their health providers. Public health must have similar roles in CCHD screening, but it will take some time and effort to get there.",English
+"Coordination at a national level can accelerate the process. Our next speaker, Marci Sontag will elaborate on the crucial role of federal partners.",English
+I will be speaking about the landscape of hearing loss and congenital heart disease newborn screening at the state level and the collaborative role,English
+"of federal participation. I will present current activities to support newborn screening for both hearing loss and CCHD through implementation, data collection,",English
+"technical assistance, and quality improvement. Universal screening for early hearing loss was not a rapid process, but rather took much support",English
+"from many organizations to implement. Currently, all states are offering universal screening for early hearing loss through structured programs,",English
+"although the processes and support structures are varied. CCHD newborn screening had very rapid implementation since 201. Through the coordinated efforts at the local, regional,",English
+"and national levels, most states have universal screening for CCHD although the development of CCHD programs is limited.",English
+"All states are universally offering screening for hearing loss, but it was a long process to get to this point.",English
+"Beginning in 1990 with only 2 states, 13 years passed before all states developed comprehensive EHDI programs.",English
+EHDI programs found their roots at the local level and gained strength through the years to reach the well-established multi-agency programs we have today.,English
+"In contrast, CCHD screening implementation began later and was relatively rapid. In 2012, only 5 states were screening for CCHD.",English
+"And additional 20 states began offering universal screening in 2013, and by 2014, 40 programs offered universal screening for CCHD.",English
+"All but 5 programs were offering screening in 2015, and currently, all but 2 states are offering universal screening for CCHD.",English
+"Wyoming has recently approved CCHD newborn screening with a January 1st, 2017 start date. To really understand the nuances of CCHD",English
+"and early hearing loss newborn screening, we need to look carefully at the legislative requirements. In some cases, newborn screening is mandated with no provisions",English
+"for data collection while in other cases, screening is universally offered in the absence of a requirement but the state's public health department oversees data",English
+collection and quality improvement activities; details at the nature of the legislative and regulatory approval for each of the newborn screening programs reveals,English
+"interesting parallels. Congenital hearing loss screening is required in 46 programs, 30 programs through legislative mandates",English
+and 16 through rules or regulations without specific legislation. Five programs support EHDI screening through standard of care.,English
+Quality newborn screening systems must include mechanisms to collect and evaluate data. Early hearing loss data collected at the hospital level are required to be reported,English
+"to the public health systems in 36 states. Even in states with no specific data requirements, programs have been developed,",English
+"programs have developed mechanisms to collect data through the electronic birth certificate, dried blood spot card, or other electronic reporting systems",English
+resulting in data collection at the state level with subsequent reporting to national data systems in all state programs. While only 30 states have early hearing loss newborn screening,English
+"legislation, 41 states have active legislation related to newborn screening for CCHD. Eight states require CCHD screening through rules",English
+"and regulations, 2 states support screening within their hospitals through standard of care but do not require screening. One state, Kansas, supports screening through standard",English
+of care and has developed a system to collect screening outcomes on all infants even in the absence of legislation to mandate screening.,English
+"Most states have requirements to collect CCHD screening at the Department of Health, but 15 states have no requirements",English
+"for data collection. The type of data collected within each state also varies, with some hospitals reporting all screening values and times, while other hospitals are only reporting aggregate data",English
+such as the number of newborns receiving screening and the number who failed screening. The differences in data reporting to public health programs between CCHD,English
+and EHDI programs is amplified nationally where EHDI programs are supported by integrated efforts across agencies and CCHD screening support is,English
+still developing. Hearing loss and CCHD are both reportable conditions and the birth defects prevention network supported,English
+by CDC's national center on birth defects and developmental disabilities can be utilized for surveillance purposes to identify newborns,English
+with early hearing loss or critical congenital heart defect. This can help to better understand the impact of these screening programs and to determine the efficacy,English
+of the screening programs. HRSA provides technical assistance for both hearing screening and CCHD screening. HRSA also financially supports state EHDI programs.,English
+Early funding from HERSA was offered to 6 programs to demonstrate the capabilities and challenges of CCHD newborn screening implementation.,English
+Congressional funding support for early hearing loss newborn screening totals over 26 million dollars with 10.8 million dollars appropriated to the CDC.,English
+"CDC provides direct assistance to 45 state EHDI programs. The funding is used to support activities related to improving screening processes, decreasing loss",English
+to follow-up with children with failed hearing screens and tracking long-term outcomes in children with hearing loss. CDC's technical assistance also includes the EHDI-DASH an,English
+interactive online tool that presents annual data from states and territories for infant screen for and diagnosed with hearing loss. The EHDI-DASH map displayed here shows the percent of newborns,English
+that are reported to have been screened in each state. The network of technical assistance and informatics support will be discussed by Dr. Mason.,English
+Congressional appropriations to HERSA for hearing loss screening totaled 17.8 million dollars. HRSA has funded 1 technical assistant center,English
+that is dedicated to early hearing loss newborn screening. The goal of this program is to ensure all children with hearing loss receive appropriate,English
+"and timely identification and treatment. The resource center includes videos, telehealth courses and guides, and technical assistance activities.",English
+NCHAM supports activities to reduce the loss to follow-up of infants who have not passed a newborn screening examination prior to discharge from the newborn nursery.,English
+All states receive funding to support their EHDI programs via HRSA or CDC appropriations. When we examine the data and resource environment,English
+"for CCHD screening, a different picture emerges than for the more developed EHDI programs. These differences are best summarized in the areas",English
+"of data collection, federal assistance, and resource allocation. The American Academy of Pediatrics recently published Lessons Learned",English
+"from newborn screening for CCHD. Despite widespread implementation of CCHD screening, a common challenge is limited funding",English
+"across the all programs. While the cost of screening is bore the birthing hospital, additional funding is needed to support education of parents and healthcare providers, infrastructure",English
+"for data collection, and quality assurance activities. There are few key limitations to CCHD data collection at the state level.",English
+There is limited local data frequently collected in aggregate and date collection has only recently begun in many programs.,English
+National standards for data collection have only recently been presented resulting in varying data collection. Data systems within the public health departments are limited,English
+by both funding for staffing and a lack of data infrastructure. The report recommends the optimal dataset for CCHD surveillance at the state level,English
+which would give a strong foundation for data collection and analysis at the national level and provide vital information,English
+to make sound evidence-based recommendations. HRSA's New Steps program is a national resource center for blood spot and CCHD newborn screening.,English
+"New Steps provides technical assistance, quality improvement support and a data repository for the conditions identified through dried blood spot and point of care newborn screening.",English
+New Steps fosters ongoing collaboration and networking between programs. New Steps data repository collects quality indicators,English
+from states and case level data on infants identified by newborn screening to assess the outcomes of screening programs.,English
+This case level data collection is just being introduced to the CCHD community. Support for CCHD surveillance and data collection is,English
+at the local level and is the responsibility of the state and hospital and there are currently no federal funding initiatives to directly support CCHD implementation,English
+"at the local level. The current programmatic and funding activities that are in place for early hearing detection, should service a model for CCHD and other point",English
+"of care screenings that are implemented in the future. As in conclude, I would like to compare the follow-up systems and impact evaluation of both programs.",English
+"While both programs have developed networks with clinical specialists, the public health programs and EHDI are well-established while CCHD programs are",English
+still developing. Follow-up for hearing loss incurs entirely after discharge while CCHD follow-up begins in the birthing facility.,English
+Without public health interventions there would be a high number of infants loss to follow-up after an abnormal hearing screening.,English
+"Conversely, infants who fail CCHD screening typically do not leave the hospital. Evaluating the programs involves tracking the rate of newborns",English
+that are screened and receive the necessary follow-up assessment by a specialist. The ability of the current systems to track and report on the efficacy of both programs is limited.,English
+"Finally, impact evaluation assesses how newborn screening and subsequent interventions affect long-term outcomes. The more established",English
+"and nationally funded EHDI programs are able to compare outcomes longitudinally and across programs, while CCHD has limited data and resources",English
+to support outcome evaluation. There has been broad uptake of both early hearing loss and CCHD newborn screening.,English
+"Programs differ with regard to federal resource allocations and data collection issues; however, efforts at the local level continue",English
+to support data collection and program improvement. The evaluation of both the short and long-term follow-up of infants is critical in assuring,English
+that quality screening programs identify at risk infants and move them into appropriate care. New Jersey is one state that has a developed a model program,English
+"for CCHD newborn screening. I am pleased to introduce, Dr. Kim Van Naarden Braun, who will be presenting a New Jersey's implementation of CCHD screening.",English
+"As a CDC assignee to the New Jersey Department of Health, I've been fortunate to work closely with New Jersey's dedicated staff",English
+"on the implementation evaluation of the statewide critical congenital heart defects screening mandate and surveillance program. As you've heard, relative",English
+"to other longstanding newborn screening programs, screening for CCHD is in its early stages, particularly related to data collection and surveillance.",English
+"My goal is to share the evolution of our experiences in New Jersey particularly with respect to surveillance, the lessons we learned and the questions that remain.",English
+"On June 2nd, of 2011, New Jersey Governor Chris Christie signed legislation mandating that each license birthing facility",English
+in New Jersey perform a pulse oximetry screening at a minimum of 24 hours after birth on every newborn in its care. This unfunded mandate required,English
+that statewide implementation occur within 90 days. New Jersey was the first state in the nation to both legislate and implement CCHD screening statewide.,English
+"The New Jersey Department of Health, quickly sprang into action in the summer of 2011 to develop and disseminate a screening algorithm, train birthing facility staff and create mechanisms",English
+"for data reporting to monitor and evaluate the unique contribution of the statewide mandate on early detection of CCHD. On September 1st, 2011, a day after the lobby came effective,",English
+"in preparation for discharge home, baby Dylan Gordon received the newly mandated CCHD screening. After failing the screen and the resulting diagnostic evaluation,",English
+it was determined that Dylan had a previously unrecognized critical congenital defect and needed lifesaving surgery. This outcome might have been very different,English
+"that are son's life was saved. Our son Dylan is proof that the test is worth doing."" This immediate evidence",English
+of the CCHD screening's lifesaving impact further motivated all involved to create a mechanism to monitor the mandated screen.,English
+New Jersey was eager to know how many more wonderful stories like Dylan there would be. We explored the state's existed data collection mechanisms,English
+"to determine whether data fields could quickly be added without additional funding. This included the newborn blood spot card,",English
+"electronic birth record, immunization registry, and New Jersey's birth defects registry. We found that the crucial component for establishment",English
+"of the New Jersey CCHD screening surveillance program was bridging newborn screening with birth defect surveillance. In 2011, New Jersey DOH was developing its new electronic",English
+"birth certificate platform. Therefore, our goal of individual level screening data needed to be a part of a longer term plan.",English
+"To assess screening coverage rapidly, we created a one-page form for each birthing facility to submit aggregate screening data quarterly.",English
+The new vital information platform or VIP was ruled out statewide in 2015 and is a rich source of individual level screening data.,English
+"Upon implementation, concerns were voiced by the medical community regarding a potential added burden on clinicians and hospitals due to false-positive screens.",English
+"This reinforced that we needed to understand not only the program's successes, but the characteristics of all failed screens and the implications on resource burden.",English
+We were able to add module to New Jersey's longstanding birth defects surveillance infrastructure to capture all failed screens regardless,English
+of their final diagnosis. A series of questions were developed and field tested to capture the relevant clinical information needed,English
+to evaluate the unique contribution of screening to early detection of CCHDs. The NJBDR has proven to be a very effective method,English
+for CCHD screening surveillance. The aggregate data form and quarterly submission process enabled us,English
+"to assess screening coverage quite quickly. From the inception of implementation on August 31st, 2011 through December 31st, 2014,",English
+99.7% of eligible infants born in New Jersey birthing facilities were screened. The proportion of infants screened has been extremely high,English
+since the first quarter after implementation. The small proportion of missed screens in the first quarter of 2011 was drive in large measure by a misinterpretation,English
+"of the legislation that infants in the neonatal intensive care unit were exempt from screening. In New Jersey, all newborns are mandated",English
+"to be screened regardless of their clinical status or location. Since the beginning of 2012 through the end of 2014, less than 4%, .4% of eligible infants were not screened.",English
+Birthing facilities report all failed CCHD screens to the NJBDR. Healthcare professionals are required to register infants,English
+with the CCHD who are New Jersey residents and we built upon this practice to include all failed screens. The NJBDR staff's relationships with each,English
+of the birthing facilities supported the rapid implementation of this new module. Data from this model are reviewed by the core CCHD team,English
+"on a monthly basis, follow-up with hospitals is done when needed to clarify and infant's clinical course and a separate database is populated with the clinical data",English
+for analytic purposes. Quantifying the screening program's unique contribution to early identification is complex.,English
+"As mentioned by Dr. Shapira, 3 other methods including prenatal ultrasound, diagnostic echocardiography or clinical presentation contribute",English
+"to the identification of CCHDs, and therefore, information on their presence is needed to evaluate the unique contribution of the pulse oximetry screening.",English
+We collected data on these pre-identified factors for all failed screens. We attributed early detection to the screen,English
+"if an infant failed the screen without any of these 3 factors. Since August 31st, 2011, 295 infants have been registered",English
+"in the BDR with a failed CCHD screen. Approximately, 45% or a 133 of all registered fails did not have any",English
+of the 3 pre-identified factors described previously. Twenty-five infants had a CCHD that was unsuspected prior the screen,English
+"or approximately 1 infant every 2 months since implementation. Through surveillance, we're able to quantify how many more infants",English
+"like Dylan have benefited from the CCHD screening. In addition to the 25 infants with unsuspected CCHD, we identified 19 infants",English
+with previously unrecognized noncritical congenital heart defects and 10 infants with other significant non-cardiac medical conditions,English
+"that cause hypoxemia such as sepsis and pneumonia, all of which, identified early because of their failed screened.",English
+"While the immediate impact of CCHD screening has improved survival, early detection brings additional potential for long-term improved outcomes.",English
+New Jersey collaborated with CDC to assess the costs to hospitals to screen for CCHD. A study was conducted in a sample of 7 hospitals,English
+and staff were observed performing this screening. Screening took an average of 9 minutes per infant and the average cost per infant was approximately 14 dollars.,English
+The same time emotions study method was subsequently repeated in 2 other states and found similar screening times. Because the number of infants,English
+"who required clinical exams was small, those exams added very little to hospital costs. To date, no analysis has been done of the money spent",English
+by state governments in New Jersey or elsewhere. New Jersey's high rate screening coverage and successful ongoing use of the NBDR have gone hand-in-hand,English
+with extensive education and training efforts by DOH in collaboration with New Jersey American Academy of Pediatrics. In addition to the New Jersey recommended screening algorithm,English
+"and its associated quick guide, New Jersey DOH has created paired information materials in 6 languages and work collaboratively CDC",English
+"to adjust cost and burning questions. Providing feedback and our findings to New Jersey hospitals and partners, has been of high importance and we continue",English
+to strive to keep all parties engaged. The ability to build upon the BDR's existing infrastructure was crucial.,English
+"A quarterly aggregate data collection form enable timely evaluation of screening coverage and the quick dissemination of a standardized tool, both assisted with implementation",English
+and also served as an internal quality assurance in accountability measure for the hospitals. The need for strong and ongoing communication,English
+with New Jersey's birthing facilities continues to be essential for the success of the program. Many question remain with respect of both implementation,English
+and surveillance of CCHD screening and they're of national relevance as CCHD screening has become near universal in the US.,English
+"As most states, legislature requires screening all live births with fewer no exemptions when and how to screen specific subpopulations including infants",English
+"in the NICU. Out of hospital births, and high altitude geographies, has been an important topic of national discussion.",English
+"New Jersey recently concluded a multi-state evaluation of CCHD screening in a NICU, the results of which are forthcoming.",English
+A pervasive challenge across CCHD screening programs is quantifying false negatives particularly infants with unsuspected CCHD,English
+who passed the screen. Linkage of NJBR with birth certificate data will enable assessment of one aspect,English
+"of the potential false positive population, yet considerable resources are needed to evaluate the issue of false negatives including reach beyond New Jersey borders.",English
+Studies are needed to address the national cost and burden of universal CCHD screening. The New Jersey experience demonstrates far fewer reported,English
+"failed screens and false positives than the current literature suggests. Finally, metrics for follow-up of CCHD screening need to be defined.",English
+"Should or can benchmarks for follow-up similar to those for EHDI be used for CCHD? As discussed, the timing for intervention, potential sequela",English
+"and clinical and clinical and long-term acuity differ from hearing loss. I've shared today New Jersey's experience, but many states have done excellent work implementing",English
+"CCHD screening. For many states, though data collection continues to be a challenge. Thank you for your attention and I'd",English
+"like to introduce our next speaker, Dr. Craig Mason. [ Applause ] >> Thank you Kim.",English
+"EHDI programs began with universal newborns screening that expanded into long-term follow-up. As described previously by Stuart,",English
+the 1-2-3 month goals define a process from screening no later than 1 month of age to diagnostic evaluation no later than 3 months of age to early intervention no later,English
+than 6 months of age. Following newborns from birth through early intervention requires for liable public health surveillance in order,English
+to minimize loss to follow-up and prevent loss to documentation for children needing services. CDC EHDI has taken the lead by supporting the collection,English
+and use of quality data. This has resulted in a dramatic increase in the number of infants served at each step of the 1-3-6 process.,English
+Screening rates increased from 52% in 2000 to 98% of all births in 2014. The number of infants identified,English
+"with hearing loss has shown a 7 fold increase to over 6000 annually, children who previously may have only been diagnosed after missing key developmental milestones.",English
+The number of young children with hearing loss and EI has shown a nearly 9 fold increase helping thousands of children reach their full developmental potential.,English
+"To accomplish this, EHDI programs collect different data from different systems reported at different points in time. Since 2000, states have moved from collecting aggregated data",English
+"to collecting and linking child-level data from vital records, hospitals, audiologists and other healthcare providers.",English
+"CDC annually conducts the hearing screening and follow-up survey in which states voluntarily report aggregated data on screening, diagnostic and EI rates,",English
+"as well as, loss of follow-up. However, there can be issues with relying on aggregated data to inform policy. Therefore, in 2010, CDC piloted the iEHDI project in which Iowa,",English
+"Indiana and Nebraska began reporting quarterly child-level data that was anonymized and yet able to be linked over time. iEHDI required states to report data coded in the same way,",English
+so CDC developed a validation tool states could use to check the accuracy of their data prior to submission. This is a significant step to improving the quality and value,English
+"of national surveillance data. Challenges to collecting complete state and national data, includes structural issues",English
+"that may impede monitoring. For example, it can be difficult to access EI database outside of the health department or to collect data for out",English
+of state or home births. Lack of standardization and differences in data quality and timeliness can create gaps in EHDI data systems.,English
+"Once lost at one point in time, a child may remain lost and subsequent follow-up assessments. This creates challenges to using data for surveillance",English
+"and program improvement. Nevertheless, as seen in these declining rates of children lost to diagnosis or EI, EHDI has addressed",English
+such challenges while documenting improved timeliness and reduce loss to follow-up. I'll quickly describe several strategies that have been used,English
+"and note how a few states have adopted these to reduce loss to follow-up and diagnosis. Recently, CDC EHDI collaborated with states on a set",English
+"of functional standards that identify operational, programmatic and technical criteria programs should incorporate in EHDI information systems.",English
+This can help states develop systems that provide complete and accurate data necessary for surveillance and program improvement.,English
+The national data committee has promoted standardized definitions to improve consistency in reporting. This includes collecting additional detail,English
+on EHDI activities such as whether testing is in process or whether a family is not advancing through the 1-3-6 process.,English
+It has encouraged expanding annual data reporting to create a more comprehensive national picture of EHDI activity and impact.,English
+CDC EHDI has furthered this by developing examples of HSFS items to help ensure reliable reporting. EHDI has also promoted electronic data transfer.,English
+"For example, integrating the healthcare enterprise has published NANI, the newborn admission and notification information standard",English
+which is a messaging platform that automates the merger of vital patient admission and demographic data and shares it with designated public health entities.,English
+This system is designed to improve the completeness and quality of data by translating hospital information into a format that can be used by EHDI programs.,English
+It's also a model that can be adapted by other public health programs such as CCHD screening. Even high-quality data is of limited value,English
+if it is difficult to use. EHDI has several initiatives to make data more useable to inform policy and practice. Annual reports were developed by the CDC and the directors,English
+"of speech and hearing programs in state health and welfare agencies that illustrate trends for screening, diagnostic and EI rates for each state or territory.",English
+"This slide shows the report of 2013 for Maine, national averages and targets are included for comparison. Reports are generated annually",English
+and provided directly to each EHDI program. All underline data are available on the CDC website. Reports also include a case flow for all births,English
+"in the jurisdiction illustrating the flow of each child from birth to screening, to diagnosis to early intervention or loss to follow-up.",English
+Another tool is EHDI-DASH an interactive dashboard reporting state and national data. It includes customizable maps and tables.,English
+States have used EHDI-DASH to illustrate their own performance relative to other states. Anyone can explore the data to identify areas,English
+"of success or concern. EHDI also works to inform families. When a newborn fails a hearing screen,",English
+parents may have trouble finding a facility with audiologist trained and equipped to serve infants. This can lead to loss to follow-up.,English
+EHDI-PALS is an online website where parents anonymously answer a few questions about their child and receive a GO code list of the nearest providers with equipment and training,English
+"that fits their specific needs best based on the best practices algorithm developed by the American Academy of Audiology,",English
+the American Speech Language Hearing Association and others. Iowa has cut loss to follow-up for diagnosis nearly in half in part by targeting the quality and timeliness of data.,English
+"Families needing diagnostic testing are more quickly identified and supported. In 2009, the diagnostic loss to follow-up rate",English
+"for Texas was over 80%. From public health perspective, high loss to follow-up in a state like Texas with more than double the births of all",English
+"of New England, has a disproportion impact nationally. By expanding the use of NANI and electronic data transfers and promoting EHDI-PALS, loss",English
+to follow-up has been reduced by nearly a third. CDC EHDI organized a partnership of the 5 states with the largest birth cohorts with the goal of reducing loss,English
+to follow-up through innovative strategies including leveraging technology such as electronic health records and electronic data exchange that are practical in states,English
+"with 150,000 or more births each year. As states begin to evaluate long-term impacts, they face technological and policy challenges.",English
+EHDI programs identify the Family Educational Rights and Privacy Act and part C regulations of the Individuals with Disabilities Education Act as challenges,English
+"in conducting long-term impact studies. With no equivalent to public health exemption seen in HIPA, many states cannot access EI or educational outcome data.",English
+"Furthermore, policies that existed when a child is screened may no longer be in place when they enter kindergarten.",English
+"With multiple data sharing partners, a successful EHDI program must constantly revisit what is or is not based, was not possible based on change",English
+"in permissions and management requirements. However, research does suggest significant benefits of EHDI for children with hearing loss.",English
+"The EHDI development outcome study funded by CDC is a long-term project examining language outcomes. Compared to children with hearing loss diagnosed later,",English
+children diagnosed before 6 months of age had greater expressive vocabulary at age 2. This was particularly true for Spanish speaking children.,English
+"Data from the main EHDI program linked with main Department of Education statewide testing data, were used to examine third grade reading and math proficiency",English
+for all children with hearing loss whether or not their hearing loss had been detected through the EHDI program. Children with hearing loss identified,English
+through EHDI were significantly more likely to meet third grade math standards versus children with hearing loss not identified through EHDI.,English
+"A similar trend, although not statistically significant, was seen for reading. In summary, surveillance programs face challenges",English
+as they follow-up longer term outcomes. This requires greater access to higher quality data for more sources including ones outside the realm,English
+"of public health. Sharing sensitive data across agencies brings additional policy barriers. However, such efforts can help families receive better quality,",English
+"more timely care for their children. They can also help healthcare officials, providers, policy makers and researchers identify policies and practices",English
+that help the people they serve while promoting a deeper understanding of long-term impacts of services and programs.,English
+"and I think we'll start with some from social media if you some Susan. >> We do, Dr. Shapira.",English
+What is CDC doing to promote continued screening of hearing in children during the Well-child visit recommended schedule specifically addressing,English
+the important public health issue of early detection of hearing loss beyond the newborn period? >> Well I'll ask Craig if he can comment on that.,English
+">> Yes. I think in terms of individual states, there's a variety of programs going on where at the state level some are trying",English
+"to expand their EHDI systems to incorporate data on a non-newborn hearing screen, but acquired or progressive hearing loss as well.",English
+"So, but that again meets some of the challenges of your working often outside of systems that were typically working with newborn screening.",English
+">> Another question. Oh, Dr. Schuchat. >> Yeah, thanks so much for a really interesting session.",English
+"I had 2 kind of related questions. I was curious in New Jersey about whether there was an event, individual advocate",English
+"that brought the law to reality and then for the history I guess any of you, in the 60s when the program really began,",English
+was it because the test was identified for Phenylketonuria or was it because you know people where pushing that we needed to do more?,English
+I'm just kind of interested in when we get a law versus when we just thing somethings a good idea. >> So I can address the New Jersey piece.,English
+There as a legislator that was personally impacted by a relative with a critical congenital heart defect and that served as the impetus for the legislation.,English
+">> And for blood spot screening, the development of the test by Robert Guthrie brought that about as initially shown",English
+"to be advantageous to detect; it had been shown previously that early detection through family history, through other affected children one could improve outcomes",English
+"because diets were developed that were specifically low. This is for people in the room who aren't familiar, the first test that was utilized for newborn screening was",English
+"for PKU or phenylketonuria where children have an inability, well individuals with PKU have an inability",English
+"to breakdown the amino acid phenylalanine which accumulates and can cause toxicity to the nervous system over time. So, treatments were developed where diets are low",English
+in the amino acid phenylalanine and then supplement an amino acid that's deficient in these individuals called tyrosine.,English
+"So I think that first there was the development of an efficacious treatment for PKU and then through Dr. Guthrie's efforts, the development",English
+of an easy relatively easy screening test that could be applied at a population level which allowed the initiation of a statewide,English
+and then national newborn screening programs for PKU. >> What are the major reasons for the relatively high rate of,English
+loss during follow up for babies who fail hearing screening? I see it's like 40 or 50%.,English
+">> I think the programs have been kind of targeting this now for a few years and that's one of the areas of particular focus, I think going forward is reducing loss",English
+"it to continue to reduce loss to follow-up. The, some of the issues that some states have experienced is whether",English
+or not is reporting is mandated and other issues that educational communicating to providers or audiologists,English
+for example that they need to report cases where a child has passed their hearing screening or pass their hearing test.,English
+"Some may only report cases where the child has a diagnosed hearing loss, but as we can see that for public health reporting it's important",English
+"to get the complete data on children who have also passed. The, you know, it's again some of those challenges looking outside of the",English
+into a whole new arena of working with audiologists and audiological clinics versus your traditional in-hospital screening.,English
+>> Another question Susan. >> This question is specific to Dr. Van Naarden Braun kudos to New Jersey for rapidly developing a comprehensive,English
+and thoughtful surveillance program. Can you speak to the initial concerns that the clinical community had regarding added resource burden from false-positives?,English
+>> Well thank you. The issue of defining false-positives is a layer topic so I mentioned there were 25 infants with CCHD,English
+"that was identified because of the screen, but pulse oximetry screening isn't selective for CCHD so we identified 19 other infants",English
+"with noncritical heart defects and then 10 other conditions, so collectively, it represents 54 success stories as a result of this screen.",English
+The remaining infant were made up of infants that were true-false positives that were identified after quality control of the hospitals,English
+"so there was no added resource burden, or echocardiograms that were done and yielded unresolved PFO or a PDA. What's interesting and I think compelling to us is",English
+"that of the approximately 480,000 infants that have been screened through June 30th of 2016, there were only 52 echocardiograms",English
+"that were done unnecessarily. Among those infants for which they failed and the diagnostic workup was done because of the screen,",English
+"only 52 unnecessary echocardiograms out of 480,000 babies screened and there were no unnecessary transfers.",English
+So I think those data to us speak to one aspect of the burden. >> You have a question.,English
+"So you're talking about the successful numbers, so did you actually miss any cases I guess? >> That's a terrific question and one",English
+"that I think nationally is a part of a major discussion trying to identify methodologies for identifying false-negatives,",English
+birth defects surveillance is really an important part of that and linking that to statewide individual level screening data and now we've begun to collect those data in New Jersey,English
+and we hope to look at it to get a more comprehensive picture through birth defects to identify all this CCHDs and then having all of their individual level screening data,English
+"to access how many actually passed. >> Other questions in the room, if so please use the microphone",English
+"so that those on the webinar can hear. >> Yeah, hi thanks. There is some genetic indicators for both of the point",English
+have in their circulation they have Rh antibodies and if they have Rh antibodies they're going to react with anyone who is positive and so if they,English
+react with anyone who is positive we cannot give them a positive blood we can only give them a negative blood alright so that's who could receive from,English
+"this person right now let's go on and keep moving forward here, one more thing let's also think about another situation what if this person doesn't",English
+even have any antigens whatsoever no antigens what is that called whenever they don't have an A antigen or B antigen or an Rh antigen well we know it's the,English
+lack of A and B is 0 and the lack of Rh is negative so who is our universal donor in other words O-negative so O,English
+negative can also give this blood okay they can also receive from O-negative now come over here what if someone clumps in,English
+A any clumping the Rh that means that they're A and positive this is A positive blood so they're A positive,English
+blood again let's go back up here what type of any]tibody that this person have they would have anti-B antibodies again who can A donate to A can donate to A,English
+and AB the rule sets positive can only give to a positive so you can only give to A positive and AB+ next thing what,English
+does this person have it in circulation be antibody so we cannot give this person any type of blood with B antigens on it so you can only get it from A or O,English
+again so you can get from A or you can get it from O but does this person have Rh antibodies no so it does not matter,English
+whether you give them Rh positive blood or Rh negative blood because they have no antibodies to react with so therefore you can give this to they can receive,English
+from A negative 0 negative A positive or 0 positive it's so easy right I suppose come in here do this one let's say now,English
+there's clumping and be so there's agglutination reaction be but no agglutination reaction here in Rh so what,English
+does that mean we already know this right a lot of easier now because now we know what just going to be B but without the Rh so it's B negative going,English
+"based off that chart again who can B give to, you can give to B and AB but what does the rules say negative can give to",English
+a negative and it can also give to a positive so we're good you can give to B negative he can give to AB+ he can give to B positive and it can give to,English
+AB- not bad right now the next thing what kind of antibodies would this person have in their plasma they would,English
+have anti A antibodies and they would have anti Rh antibodies so you cannot give them any type of blood that has A,English
+first off so they can't get a so they can't get A or they can't get AB so they can only get B or 0 because all they can actually receive from they can,English
+only receive really from B and O O will always be a universal donor so you can always put 0 in there right now let's go back to this thing what do they,English
+have in their plasma Rh antibodies so they cannot receive blood from anybody with Rh positive so what does that mean this can only receive from B negative,English
+and O Negative easy right now let do this next one what if it clumps within B and it clumps with an Rh what,English
+does that mean that means that they are B positive right so it's B positive who can B give to you can give to B and AB what kind of antibodies does,English
+this person have within the circulation anti and anti a antibodies the next thing if this person is B positive positive can only give to positive so,English
+they can only donate to someone whose B positive and someone who is AB+ who can they receive from they just cannot,English
+receive from anyone who has a so they can't receive from A or a B so they can only receive from B and from 0 and again,English
+if you look at it what would this person have does you have any Rh antibodies no so therefore it wouldn't matter if he's Rh positive or Rh negative it wouldn't matter there would be,English
+compatibility so you could receive from B positive O positive B negative and O negative alright alright let's go do some,English
+more examples over here we come over here and let's say that this person has clumping within A clumping within the B,English
+but no clumping in the Rh that means that they're AB- alright so the first things AB- so this person is AB- right,English
+what does that mean for their antibodies what would they have within their plasma circulation they would have anti Rh antibodies within their plasma right so,English
+they have it have anti Rh antibodies who can they donate to like AB can only if you look at the chart AB can only donate to himself because AB is the,English
+universal recipient so we've been receiving from everybody but doesn't like to donate to anybody but himself so he can only give to AB what's the,English
+rule though AB- so negatives can give to negative or positive so you can give to AB- and it'd be positive so what if,English
+the others in its circulation is Rh antibodies but he doesn't have antibodies and he doesn't have B antibodies so what does that mean I can give him A blood B blood and AB blood,English
+"right so if you think about it again who can donate to anybody O, O can always give to anybody who wants so they can receive",English
+from 0 again we're going to receive from they can receive from A they can receive from B they can receive from AB and,English
+they can receive from O but again what do they have in their circulation the plasma circulation they have Rh antibodies so if someone decides to give,English
+this person positive blood it would interact and cause the aggkutination so they cannot receive from positive blood only from negative so it can only,English
+receive from A negative B negative AB- and O negative ok now do this next one let's say that the person actually has,English
+clumping here here and here so this person's a B+ now again who can AB give to he can only give to himself same,English
+thing can only give to himself then we follow the rule positive can only give to a positive so this is just AB,English
+positive here that's it receive again this guy is the universal recipient so he loves to receive from everyone so,English
+"again he loves recieve from A, B, himself and O and again what does the evidence circulation he has no Rh antibodies so",English
+this is a perfect recipient he can receive from anybody doesn't matter what blood type doesn't matter what you're Rh factor so you can receive from A,English
+positive and negative B positive and negative AB positive and negative and O positive and negative it's easy right,English
+all right now let's come over here and do this one let's say that this person does not have any clumping whatsoever no,English
+clumping whatsoever well I know that if they don't have any A they don't have any B that's O and they don't have the Rh,English
+negative O negative now if their O negative right they don't have the A antigens they don't have the B antigen,English
+and they don't have the Rh antigen so what would they have in their plasma circulation they would have all of the antibodies in their plasma they would,English
+have A antibodies they would have B antibodies and they would have Rh antibodies so if you think about it who,English
+can they donate to well they can actually donate to anyone because they have no antigens whatsoever so it doesn't matter what's in that person's the recipients plasma circulation it,English
+"wouldn't matter because he has no antigen to attack so he can literally give to everyone he can give to A, B, AB and himself and again he's negative",English
+negative can give to negative or positive so you have the positive negative positive negative positive negative positive negative but receiving look he,English
+can't receive from Jack diddly squat right he can't receive from A he can't receive from B and he can't receive any Rh because he has everything to attack,English
+that so literally all he can receive from is himself alright that's all he can receive from so all he can receive from is himself so he's a great donor,English
+but a terrible recipient and again why can only be negative because if you try to give them an Rh positive blood the Rh,English
+antibodies will attack it come over here what if this person does not clot in A doesn't clump in B but does clump within,English
+the Rh well this person is no A no B that's O clumped in Rh positive that's 0 positive so this person is O positive,English
+where do you know who we can donate to we can donate to everyone he's the universal donor right but specific ones will talk about which one so A you can,English
+give to A he can give to B he can give to AB and he gives himself but positives can only give the positives it can't gives negatives so you can only,English
+give to A positive B positive AB+ and 0 positive what type of antibodies does this person have a net circulation he,English
+has A antibodies anti B antibodies so if you try to give this person A blood B blood AB blood it would,English
+actually cause clumping so that's not good we do not want that so again he cannot receive he can only receive from O in general you can only receive from,English
+himself so he can only receive from O but does this person have an Rh antibody No so because he doesn't have an Rh,English
+antibody it does not matter what kind of blood you give him whether you give them positive or negative they don't have antibodies to attack it so this person,English
+can receive from 0 positive or 0 negative that's it now before we finish up I want to talk about one of the most,English
+dangerous mismatched transfusions but it's actually endogenous it's actually within the person's body so when a woman is pregnant it's usually isn't a problem,English
+in the first birth and sometimes not even in the second birth it might actually be that the chances increase every birth where a mother let's say the,English
+mother is Rh negative and the baby is Rh positive so again it's not a,English
+problem within the first birth and sometimes not even in the second birth but the chances increases with every birth if the baby is already positive,English
+that means that it has to have a Rh antigen on the membrane so look here's this Rh antigen and the baby this is your placenta fallopian tubes right now,English
+here's your baby and it's got the Rh antigen right there so the Rh antigens present there in the first birth whenever the placenta breaks away from,English
+the actual from the uterus some of the blood from the fetus can actually leak into the mother's blood and whenever the mother receives this,English
+Rh-positive blood let's say that she's Rh negative so she doesn't have any antibody so look this actual babies red blood cell gets leaked over into the,English
+mothers circulation in the first birth so the first birth it was okay right because mom doesn't have Rh antibodies unless she's actually had some type of,English
+mismatch transfusion if these red blood cells get leaked in here now look it's got the Rh antigen right here if it's got the Rh antigen the the moms,English
+immune system will produce antibodies against large antigens but in the second birth so now in the second birth this person let's say that she has,English
+another baby is Rh-positive by terrible chance now she has the antI Rh antibodies so in the first birth her immune system so let's say here's her,English
+immune system the immune system will produce these antibodies in response to this actual mismatch transfusion from,English
+the baby but now watch what happens here in the second birth if the mother again is having a baby's Rh positive these,English
+antibodies they can cross the placenta another igg antibodies and igg antibodies or IGM antibodies can actually will specifically igg,English
+antibodies can cross through the placenta and look what happens over here it comes over in an attacks it attacks this baby's red blood cells and if these,English
+antibodies attack this baby's red blood cells undergo agglutination and hemolysis then this baby is going to have hemolytic anemia and this is a very,English
+very terrible condition because it actually destroys a ton of the baby's red blood cells increases bilirubin levels to the maximum and actually can,English
+cause kernicterus and mental retardation a lot of problems this baby will develop a condition which is called hemolytic disease of a newborn or,English
+okay this next question is from MiO Shaw one  hi Mio Shaw one you asked how can I tell if   the bubbles are from kidney issues or just  from urinating with Force okay and you must,English
+be referring to the fact that I always say if you  see bubbles or foam in your urine that could be   a sign of kidney disease how do you tell the  difference excellent question okay so yes when,English
+you urinate with force or even when you just  urinate regularly and look at the toilet and   yes I want everyone to look back at it look at  the or forward at it when you urinate look at   what's coming out of your body when they're tiny  little bubbles that are scant then yes that could,English
+be normal or certainly if you're urinating with  forests then you could have more skin bubbles   when I'm talking about kidney issues I'm talking  about very bubbly urine like foam if you think,English
+about those beer commercials where they're like at  the tap and they got the cold beer and there's a   whole lot of white foam that builds up I'm talking  about foam like that but quite honestly there's no,English
+way to know 100 just by looking you have to get  tested so when you see your doctor for a routine   health physical so when you go in because you're  concerned about bubbles in your hearing then you,English
+ask them to test your urine they can test a spot  urine meaning just a one-time sample where they   can do a urinalysis and it can assess if you have  excess protein one plus two plus three plus this,English
+is just a general screening test they can also do  a more specific test with your urine sample the   one time urine sample where they check your urine  protein to creatinine Ratio or your urine albumin,English
+to creatinine ratio and that gives you an idea  of if you have excess protein in the urine but   really the best way to know for sure is to do a 24  hour urine test where you save every drip drop of,English
+urine you make for 24 hours in a container and the  container must be kept cold in the refrigerator   yes or you can actually get like a bucket or a  tupperware of ice and sit it next to the commode,English
+and collect the urine you check how much urine  you have in 24 hours and if that's excessive   that's how you know the bubbles or a foam really  give you just a hint but the only way to know,English
+definitively is to see your physician and have a  Laboratory test great question this next question   comes from arletto liver 83. thank you for this  question you asked Dr. Frita are you taking on,English
+new patients if so where are you located well it  just so happens that I am taking on new patients   my office is actually located in Atlanta  Georgia but now I am offering a concierge,English
+Telehealth consultation service so no matter where  you are located in the world you can talk to me we   can have medical conversations and I can give you  personalized information just make sure you click,English
+the link you go to my profile and you can set up  your appointment today okay I will talk to you and   just really take my time and give you world-class  Health advice not just generalized advice but,English
+advice that is personal to you so yes I am  taking you on new patients with my VIP concierge   Telehealth medical service because I believe  everyone deserves access to world-class health,English
+and I'm here to give it to you thank you for  that question okay this next question is a very   important question and it comes from user Dash  e i 8 f c 4 i t six H thank you so much for this,English
+question you shared I get foamy urine I tested  and I have traces of protein how can I remedy this   this is very a very very important question first  of all I'm sorry that you're going through this,English
+I am happy that you shared I thank you because  this gives me a chance to address this question   for everyone who may be going through the same  issue so as we discussed having foamy urine can,English
+be a sign of having protein and in your case you  did exactly what you were supposed to do you got   tested in order to confirm that you have protein  but now the question is is it a significant amount,English
+of proteins is something worrisome or is it just  you know a little protein like something called   orthostatic proteinuria is it no big deal well  now it's time to do the workup once you do the,English
+work up and know exactly why you have the urine  then you'll know how to remedy so if it's just   traces of protein in the urine it could be a  bunch of things it may be after you exercise a,English
+jog or first thing in the morning you have heavy  amounts of protein so the first thing you want   to do is get that 24 hour urine where you go to  your doctor and at this point point I recommend   that you get referred to a nephrologist someone  who specializes in kidney disease and have them,English
+to do a 24-hour urine to find out exactly how much  protein you have is it less than 300 milligrams in   24 hours if so that may not be very worrisome but  if it's higher than that if it's a gram of protein,English
+certainly if it's more than three grams or 3 000  milligrams of protein in 24 hours that could be a   sign of very serious kidney disease it's normal  to have zero milligrams of protein in the urine,English
+or very very minimal amounts of protein having  protein is a sign that there's something that's   not quite right with the kidneys if it's actually  coming from the kidneys which also your kidney,English
+doctor will help you to figure that out so you do  the 24-hour urine to find out exactly how much and   depending on what your doctor finds they'll also  do blood tests or screen do you have Lupus do you,English
+have hepatitis do you have rheumatoid arthritis  do you have diabetes diabetes is actually the   most common cause of protein in the urine do you  have high blood pressures that was causing protein,English
+in the urine there are lots of possibilities but  it'll be up to your kidney doctor to help to find   point and figure out why you have a protein in  the urine if your doctor can't figure it out by a   history and by blood test alone and urine test  you may actually have to have a kidney biopsy,English
+again consult with your physician get referred to  a nephrologist because these are all the things   the wheels that will be turning in the doctor's  heads as they try to figure out the cause so yes   you figure out the cause first that leads to the  remedy one thing you also want to find out is your,English
+kidney function is that an issue do you have CKD  or chronic kidney disease if you do and if you're   egfr your estimated glomerular filtration rate  is less than 60 okay less than 60 milliliters per,English
+minute then having a modest protein restriction  in your diet may be a way to help to remedy some   of the protein that you're spilling out in  the urine something like 0.6 to 0.8 grams per,English
+kilogram or maybe 60 to 80 milligrams of protein  in 24 hours consult with your physician consult   with your registered dietitian to find out bottom  line you've done the absolute right thing in going,English
+and finding out that you have some protein in the  urine but you need to find out how serious it is   or if it's not serious at all I love the fact that  you're facing it head on and you are prioritizing,English
+your health and I thank you so much for your  support and for bringing this question to me   so that I could share it and so that everyone  can be helped I appreciate you and be well   all right this question is from lipsticks bullets  4075 hello lipsticks bullets I like that name,English
+um okay your question is about oats you asked what  type of Oats do you recommend and how do you make   them into a healthy snack or meal also is it a  common thing to eat homemade guacamole and what,English
+do you eat it with like can you eat it with baked  chicken okay well let's start off with the oats   because believe it or not oats can actually be a  little controversial so we know that oats can be   an excellent source of a good grain right they  have lots of fiber minerals they can be healthy,English
+they can be filling they can cut your appetite but  they can have some issues as well so to answer the   question the kind of Oats that I recommend are  still cut oats still cut oats because they have,English
+very little processing meaning they're holding  on to most of their health benefits right they   have the fiber they don't have added sugar they  don't have the added salt you still want to look,English
+at the labels and make sure that the oats are  gluten free oats are gluten-free by nature but   you want to make sure that when they are processed  to whatever degree they that mixed in with gluten,English
+so look to make sure that they're labeled as  being gluten free and organic so those would   be the best kind of Oats that I recommend okay  still cut oats gluten-free boom the way that I,English
+make my oats into a healthy snack or meal I like  to mix say like two cups of oats with two cups of   an almond milk right and I like to add fruit  okay so I'll add blueberries or raspberries,English
+strawberries bananas even I try to stick with  fruits that are high in antioxidants right high   in vitamins minerals nutrients and this is a tasty  way that I like to enjoy my oats now here's the,English
+thing to look out for because especially if you  have diabetes or if you have pre-diabetes then if   you're having a lot of fruits and even the oats  that can in some cases increase the blood sugar,English
+and so you want to make sure you consult with  your physician and that you do so in moderation   the other tricky thing about oats we classically  think of Oats as a breakfast food right oh let me   start my day off with some oats some oatmeal  but one thing that's interesting about oats,English
+is that they contain melatonin and we know that  melatonin is something that you can use to help   you to sleep better and so having oats in the  morning may make you sleepy so it may not be the,English
+best idea a good idea would be to have oats later  in the day or when you're settling down or even   as a snack you know kind of closer to when it's  time to go to bed maybe a few hours before it's,English
+time to go to sleep because that melatonin could  actually affect you and make you sleepy now for   guacamole oh my gosh y'all know I love guacamole  guacamole of course is made with avocados you can,English
+take your avocado which is loaded with potassium  good healthy fats it's really just a good food for   you avocado but if you're making the guacamole  you want to make sure that you're not adding a,English
+lot of salt to it okay you don't want to defeat  the healthy you know benefits from the avocado   with salt don't add salt but add other spices I  like to add chili flakes or Red Pepper or even   lemon zest and or even sometimes I'll just grate  a little bit of onion and add it there and I eat,English
+the guacamole that way guacamole homemade in and  of itself is really not bad okay it's really not   bad for you you're not adding a bunch of salt and  other things what makes people get into trouble is,English
+when they eat the guacamole with these fatty salty  processed chips okay the tortilla chips eating a   lot of these salty chips that's what gets you  into trouble and so I actually like to eat my,English
+homemade guacamole just by itself or maybe even  slice up certain vegetables like sliced carrots   or get some broccoli or celery and you could  eat your guacamole that way now I haven't tried,English
+guacamole with baked chicken I'll be honest that's  a whole lot okay that's a whole lot but if you do   eat chicken make sure that you eat the white meat  and that you take off the skin and so you can eat,English
+the chicken in the healthiest way possible and  enjoy the benefits of a lean protein thank you for   your question lipsticks bullets all right hello  ayetos roccos Mike one five one five you asked,English
+the question can high blood pressure cause edema  in the legs and feet okay so edema when you talk   about edema you're talking about swelling right  that's swelling or puffiness that can happen in,English
+your legs and feet that might make your socks  tight and leave an indentation or make some of   your shoes tight can high blood pressure cause it  the short answer is yes but the deeper question   is high blood pressure can cause swelling in the  legs and feet but also Health processes that cause,English
+edema in the legs and feet can lead to high blood  pressure so what came first the chicken or the egg   the egg or the chicken let's talk about it so  if you have high blood pressure it can lead to   damage of the blood vessel walls right it can lead  to a shearing or damage of the endothelial cells,English
+and yes you could get a leakage or an edema also  having the high blood pressure can affect your   kidneys high blood pressure is the second leading  cause of kidney failure and so if you have kidney,English
+damage or if you start to get some signs of kidney  disease this can affect how you metabolize sodium   how you hold on to your sodium or how you excrete  your sodium and if you are holding on to too much,English
+sodium this can lead to swelling in your feet and  your legs so yes high blood pressure can lead to   edema of the feet and legs but there are also some  other disease processes that can cause you to hold,English
+on to fluid and if you are holding onto fluid  if you have edema if you have increased fluid   in your vessels The increased fluid will cause  you to push out the vessel walls right having   high pressure on the vessel walls and this high  pressure can lead to hypertension so the swelling,English
+can lead to hypertension as well bottom line make  sure you're seeing your physician regularly that   you understand what your blood pressure is and  that you're getting to the bottom of it and that,English
+you're maintaining a healthy blood pressure thank  you so much for that question hello love blue 8017   I love that name love blue 8017 thank you for your  question you asked can high blood blood pressure,English
+cause chest pain or pressure or can the blood  pressure medications actually cause the chest pain   or pressure absolutely high blood pressure can  cause chest pain high blood pressure is a leading,English
+cause of heart disease okay of heart disease  which is the number one killer of people in the   United States high blood pressure can also cause  Strokes high blood pressure is also the second,English
+leading cause of kidney failure so when I see my  patients in the dialysis units most of them have   high blood pressure it is the high blood pressure  that is the problem so you want to make sure it's,English
+managed the other question is about blood pressure  medication so this is a very good question because   sure there are certain medications that people  can have reactions to they can have medications,English
+that can cause them to have heart palpitations  but by and large when your physician especially   a physician you trust gives you a medication  they're giving you that medication for a reason,English
+because they have researched it and they know  that the benefits of that medication will far out   away any risks so if you are concerned that  a medication is causing an issue please don't,English
+just stop the medication call your physician or  go to the emergency room depending on what that   issue is like chest pain to find out here's  something that's very important that I want   patients to understand and this is in dealing with  high blood pressure medicines and we as Physicians,English
+don't always do the best job in explaining if you  have been living with a very high blood pressure   and especially if you've gotten to the point where  you're not having symptoms you're not having chest   pain you're not having shortness of breath you're  not having nosebleeds then your body has adjusted,English
+to the high blood pressure and has protected  you from symptoms but that's not necessarily   a good thing because while you're not having  symptoms your body is still being damaged by   the high blood pressure so when we start you  on a high blood pressure medicine well now,English
+we're shifting and we're telling your body to get  used to a normal blood pressure so what your body   does is as the blood pressure starts to decrease  toward normal your body starts to feel like oh no,English
+this is not normal for me and your body may feel  a lot lightheaded or even nauseated or even having   chest palpitations or even just having you know  major problems and you may tell yourself oh I'm,English
+taking those medications and now that my blood  pressure is getting normal I don't feel good and   you might tell yourself okay that means that a  low blood pressure is not normal for me or that,English
+I'm allergic to the medication but that's not  necessarily the case you have to give your body   usually two to three weeks to adjust your body  has gotten used to having a high blood pressure   is going to take time for your body to get used  to having a normal blood pressure the truth of,English
+the matter is that you may feel sick or tired or  nauseated as your body adjusts if you can stick   this out for two to three weeks then usually you  will feel better and your body will appreciate the,English
+normal blood pressure your body will appreciate  the normal blood pressure but that's something   that a lot of us Physicians don't share with  patients when you take medications and your body   is having to get used to a normal blood pressure  you're not going to necessarily really feel good,English
+that doesn't mean that you're allergic to the  medication make sure you have very open and direct   conversations with your Physicians and don't  just stop the medication have the conversation   for your health thank you for that question but  yes high blood pressure most definitely without,English
+a doubt can cause chest pain and can lead to  heart disease okay let's do one more this last   question comes from utilda Brown 3936 hello utilda  Brown you asked is type 2 diabetes worse than type,English
+1 diabetes the short answer is they're both  bad news okay and so you want to manage them   and prevent them if you can so for the type 1  diabetes that's the one that used to be called,English
+juvenile diabetes it tends to happen in younger  people oftentimes than people and it's when you   just don't have the cells that make insulin your  cells and your pancreas are not making insulin,English
+properly and so you are insulin dependent okay  you need to have insulin for the type 2 diabetes   that's the one we seem to hear more about and  actually with the type 2 diabetes there are,English
+a lot of things that you can do potentially to  prevent it for many people when they are living   with obesity or when they are overweight that puts  them at higher risk or when they're eating a lot,English
+of the processed foods and they tend to get the  type 2 diabetes later in life even though now we   have more and more children living with obesity  who are getting type 2 diabetes earlier both   of them lead to end organ damage meaning for  both type 1 diabetes and type 2 diabetes they,English
+can lead to kidney failure in fact diabetes  is the number one cause of kidney failure in   the United States diabetes can also lead to heart  disease both type 1 and type 2 diabetes can lead,English
+to blindness okay you can get diabetic retinopathy  in both type 1 and type 2. diabetes can lead to an   increased risk for strokes for heart attacks both  type 1 and type 2. are you getting the picture yes,English
+the only thing with the diabetes Mell is type 1  is that because people tend to get diagnosed at   younger ages that's a longer span of time of the  body falling to the damages from the disease so a,English
+yet they are the people most likely to be the perfect match for most sickle cell patients. I could screen a thousand Caucasian donations and probably not find one,English
+specially-matched product for my sickle cell patient. But I could screen a thousand African-American donations and probably find a few hundred that would match our sickle cell patients.,English
+"So why is that? Well, it has to do with antigens. You may not know it, but our red blood cells have antigens on them. Antigens are sub-typing on the surface of our red cells.",English
+"There are more than 350 different antigens that exist. Our genetics determine the antigens we have and the antigens we lack. When it comes to blood transfusions,",English
+"patients must receive blood that not only matches their blood type, but also matches their antigen profile. There are teams of people working behind the scenes that one,",English
+"blood searching day and night trying to find blood that has the perfect combination of antigens to provide for sickle cell patients and as you're about to see, it can often be like finding a needle in a haystack.",English
+"This unit right here you'll notice is big C, big K, FYA, or Duffy A and B negative. It may sound like a secret code...",English
+"That's a really, really good one. But in actuality they are names of antigens. This is a great rare unit that certainly matches one of our sickle patients",English
+"And when it comes to finding the perfect match, it all comes down to one thing. It's all about the antigens, whether they're there or whether they're not there. Around the clock,",English
+"the OneBlood reference lab team is testing and screening blood donations for sickle cell patients, searching for the right unit of blood that has exactly the right combination of",English
+"antigens. OneBlood never sleeps. We have stat requests in the middle of the night. We have stat requests on Christmas morning. People when they need blood, they need blood when they need it.",English
+Meeting that need requires a diverse blood supply. This is what we refer to as the global antigen frequencies. And what this tells us is how often a certain antigen type occurs in our,English
+population. The people most likely to have the perfect combination of antigens for many sickle cell patients are African Americans. And you'll notice here that the Duffy antigen occurs and 66% of Caucasian.,English
+"But only occurs in 10% of African Americans, I have less than 34% chance of finding in the Caucasian population. I can find it, but only a 34% chance.",English
+"But I've got a 90% chance of finding a Duffy, a negative match blood product for my sickle cell patient. If I screen African-American donors,",English
+"you'll notice that if I needed a unit that was Duffy three negative, 100% of Caucasians are going to have it. But over 70% of African Americans will lack it.",English
+"So when I need to find a unit that is negative for the Duffy three, I'm not going to find it in the Caucasian population. I'm only going to find units negative for the Duffy three in our African",English
+American donors. This is where we target our African American donors in order to provide these specially matched products for our sickle patients.,English
+"How hard is it to find that combination? Hard, very hard. Takes a lot of effort and a lot of dedication by a team of people and we're very",English
+"fortunate to have a great team of people dedicated to do that here in OneBlood. When a rare unit is found, it is carefully categorized, specially tagged and stored. Some are used right away.",English
+Others head for the deep freezer where they can be stored for up to 10 years. This little E negative is extremely rare as well. We have to screen 100 donors to find one donor that is literally negative.,English
+So this is a pretty rare unit right here. There is a constant need for rare blood to help sickle cell patients and the only way to increase the supply is to increase the diversity of the donor,English
+"population. Typically the donor population maybe isn't as diverse as we would like it to be. If it was more diverse, that would give us more opportunities to screen more units and to be able to",English
+provide more specially-matched blood to our sickle patients. OneBlood has multiple reference labs throughout its service area where team members are testing and screening the blood supply searching for where blood,English
+"matches for a multitude of patients, but the majority of what they are looking for will go to sickle cell patients. In fact, in our North Carolina region,",English
+"65% of lab operations there are dedicated to finding sickle cell matches. In our Miami lab it is 45% in Jacksonville and Tallahassee,",English
+"35% in Orlando and St. Petersburg, it is 25%. And they could find the matches a lot faster if we had a more diverse blood",English
+"supply. Cause screening the right ethnic group, it makes it easier, quicker and faster to find the specially-matched blood products for our sickle",English
+"cell patients. OneBlood not only provides rare blood for sickle cell patients in our region, but also around the world. In July, we sent two units of extraordinarily rare blood to Paris to help treat a very",English
+"sick 10 year old boy. His sickle cell anemia was so severe that he needs a bone marrow transplant, which requires additional blood to improve the young boy's condition.",English
+He needs to receive five units of blood 15 days before the bone marrow transplant. Thanks to OneBlood's extensive antigen testing program. We have identified two units from one donor who matches the child's transfusion,English
+needs. And we were lucky to find two very special units here in the South Florida area. So we packed those units and we send it to Paris and it's going to help for the,English
+"future bone marrow transplantation in their child. So in order to complete process of transplanting his bone marrow to cure him, we did approximately 10 units of blood in order for us to continue helping the",English
+"patient and give him transfusion to him. We need to test approximately a hundred thousand people to find one matching unit of blood. And at last check they have only found four units, but again,",English
+they need as many as 10 units of specially-matched blood in order to proceed with the bone marrow transplant. Families of sickle cell patients are often impacted by their loved one's,English
+disease. OneBlood's Sarina Fazan shows us how a OneBlood team member is turning his wife's fight against sickle cell into a mission to recruit more African American,English
+"donors to not only save his wife's life but also the lives of other sickle cell patients. As a mother, Hynees Garcia tries to keep up her strength for her family,",English
+but sometimes it's physically difficult. All her blood cells are bad. Hynees has sickle cell disease. An incurable blood disorder.,English
+I just... Maybe later on tonight end up in the hospital. It's just how sickle cell is. She was born with sickle cell. Patients like her do not have enough healthy red blood cells.,English
+"Those cells are essential for carrying oxygen throughout the body. And because of the lack of oxygen and how they get stuck in the blood vessels, um, I, that's what produces the pain.",English
+And leaves Hynees in dire need of blood transfusions. Her only lifeline comes from willing donors. They're not just saving one life. They're saving an entire family.,English
+"But for Hynees, it's harder to get the blood she desperately needs. Donors that match your genetic profile are more hesitant to give blood. Her husband Edson was one of them.",English
+"Growing up, I didn't know the importance of donating. You know, until one day the blood bus came to, you know, to my job where I used to work, you know,",English
+"and the lady asked me to donate and I said to her, I didn't want to donate. You know, that I was afraid. Fear of donating is one reason why fewer African and Hispanics donate blood.",English
+"Another reason, a lack of awareness, but Edson did not let fear stop him that day. Love for his wife and that blood bus took such a stronghold and it changed the",English
+"course of his life. I work for the blood center. Um, I've been there for 12 years. His job at OneBlood recruiting minority donors and educating them on why it's so",English
+"important for them to donate blood. For Edson, working at OneBlood is more than a job. It's personal. No, it is a big challenge. I love what I do. You know, I'm,",English
+I'm motivated because of my wife. And their children. Hynees' greatest need for transfusion came during both girls delivery.,English
+"The most important blood donations I have ever gotten was when I was, I'm in labor. A story Edson openly shares with potential donors.",English
+"Well, without the blood transfusions, you know, I don't think that my wife would be alive today. It just gives me so much grace, It gives me so much happiness. The fact that,",English
+"you know, he gets the chance not just to do it for his wife, with, to do for other people as well. So all those suffering with sickle cell have hope to enjoy another day.",English
+"It's really fun when mommy is energized. For OneBlood. I'm Sarina Fazan. It's one thing to live with sickle cell and all of its challenges,",English
+but it's another to be a doctor who lives with the disease and Orlando physician is fighting the effects of sickle cell and makes it public in a big way. Her influence goes around the world.,English
+"She wants to help those with sickle cell and change what we all think about it and what we can do about it. Hello and welcome to another episode of Dr. Simone says,",English
+"I am a medical doctor with sickle cell disorder. For Dr. Simone Uwan, sharing her life with sickle cell disease has become her new profession.",English
+"Even on days when she doesn't quite fell up to it. It's not just when I'm at my mountain top, it's when I'm in the Valley. That's, that's when I want to be able to connect with you guys.",English
+"From her Orlando home, she reaches around the globe with her YouTube channel, Facebook forums, and other forms of social media. This all grew out of her bestseller book called ""A doctor in a Patient's Body:",English
+"Dreaming Big with Sickle Cell Disease and Chronic Pain."" I stopped practicing, but I don't have to, um, let that knowledge die. I can apply it elsewhere.",English
+"There are people who need it. A lot of what people experience aren't even in the textbooks yet, but I've experienced it, too.",English
+"And like most sickle cell patients, she depends on blood donors to help her survive. I easily had. And I tell people this, uh, I've easily had over 200 units of blood. Um, I, you know,",English
+"I am in my forties and I, especially when I was first diagnosed, even before I was diagnosed, they didn't know what I had. I almost died at 12.",English
+"I got a boatload of transfusions. You know, during the span of one month. Sickle cell has taken its toll. Just breathing is difficult.",English
+"Forcing her to depend on supplemental oxygen. I've been on it ever since and it's 24, seven, seven days a week. I have to sleep with it.",English
+"She says she connects so well with others battling sickle cell because she understands the pain. There is so much pain and pain and pain, you know,",English
+"bone pain all the time. You know, I used to tell my husband if I, if I didn't live with this disease, I would think they were lying like that you could have that much pain and still",English
+"be breathing. And now she's pleading with the African American community to donate blood to help others like her. You never know when that your turn comes around that you actually need a,",English
+"a matched, you know, transfusion like from your own community too. And so, um, I, I just urge everybody, uh,",English
+"to donate and I believe the good will come back to you. And without it we can't live. We basically die an early death. Um,",English
+and I have watched too many of my friends die and a lot of times you don't see a face. But this is my face and my face is representative of many people in my African,English
+American community that need blood to live. Dr Uwan is working on a second book that is geared towards the medical community to better understand the challenge of sickle cell patients face.,English
+We also want to take our message of the need for more African Americans to donate blood directly to blood donors themselves. And our Stephanie Zaurin joins us now for that part of the story.,English
+"Every 56 days, Joseph stops by a OneBlood donor center to give blood, but he did not know the impact he was having specifically on sickle cell patients.",English
+We took him on a behind the scenes tour of what happens to his blood at our Orlando donor center where he learned that ethnicity plays a major role in helping sickle cell patients.,English
+He says now that he knows there's no stopping him from continuing his life-saving mission. I never would have thought in my wildest dreams that it took so much work to,English
+"differentiate between the different types and what's necessary, what's needing for this type or that type, but what you told me, amazing. It's a lot of work given up. The blood is not a lot of work.",English
+"It's very easy. Just go. We educated Joseph on the importance of his donation and as a result he was inspired to educate his friends. A week after we first interviewed him,",English
+"Joseph returned to a one blood donor center. Only this time, he brought us friend to donate along with him and we were there. That's my son, my first born,",English
+"first born boy, Yes, he's 26 when he died. Died in 1994. And he would get up in the morning and he would have a lot of pain some days,",English
+"couldn't even get out of bed for that matter because his joints were paining him so much. And he since passed away and he used to have, uh,",English
+"regularly blood transfusions. Every time I look at him, every time I looked at him and he's getting blood, I like, if somebody didn't give, he couldn't get any,",English
+even inspired me more to donate year after year after year. Yes. And I brought my friend with me.,English
+"I brought my friend to donate whole blood today and I'm going to try and get him to donate regularly. Whenever I come, bringing him here. Now I have taken it upon myself to try and encourage more of my friends for",English
+"mostly African Americans to donate because of this, because of what I know. I figured it's good. We're going to be hanging out every Thursday anyways. So an extra day a week ain't going to hurt",English
+"me. And then when Joe asked me, I didn't think twice. That is going to be a lifelong mission. As long as I live. I'll be going out there talking to my friends and encouraging them to come in",English
+"and I come in at least every time I come, I have to bring someone. I must get someone. Oh, I just wanted to say thanks for coming in, bro.",English
+"that was based on the bone marrow biopsy, I guess that's where they get all their information about my cell count",English
+and my platelet count. And I guess that's the key to this is is through the bone marrow biopsy.,English
+"They just looked at my count, so my platelet counts were getting gradually worse and worse and worse. And they just",English
+"the next step was the biopsy, which was pretty much a no brainer. It takes like 10 minutes. And then they felt and they said,",English
+"this is what we recommend it was. I mean, obviously it was frightening, but I felt confident this wasn't something I was going to die",English
+"prematurely of. I mean, there was treatment for it. And I'm not like when I get my readouts, I don't I",English
+"my sister's a nurse and she's always my right hand when it comes to looking at my blood, working my white cell count.",English
+And she knows my neutrophils and she's just kind of my interpreter because a lot of that's,English
+"so foreign to me translates all the and she was my donor, so she took a really vested interest in it.",English
+And she just kind of translates because the medical world and not particularly that in or comfortable,English
+not that comfortable with the medical world and actually went for a second opinion at Hopkins and she had a,English
+"she the doctor there, her name was Dr. Jain. She was a really nice Indian woman. But and she recommended book.",English
+"And I went to Barnes Noble. It was all about myelofibrosis. I could never get my hands on. The book, I guess was a popular",English
+"it was out of print or something, but I would have definitely read that. But I've never heard of it, I suppose. I guess your",English
+"platelets become like concrete. They're supposed to be spongy and they become concrete. Everyone said, What?",English
+"And even when people say, What were you out with? They said it was kind of like a blood disorder. But there's no",English
+point in saying myelofibrosis because nobody knows what it is. I vaguely remember there was,English
+"no other option on the transplant. I mean, I couldn't take there was no medication to improve my platelets.",English
+"My only option was when to do it, picking a timeframe of finding a donor. Luckily, I have two children",English
+and that's a really good thing because they said age of the donor is important to its success,English
+and that's when my son was living in Malawi. So he wasn't an option or I didn't,English
+"want him to interrupt his life. And Daniel stepped up to the plate and said she would do it. And then she started going for all the visits,",English
+"the background, the bloodwork, the lung tests, the she started to go to all the visits. And then when she was diagnosed,",English
+"so she went through starts, started going through all the tests that a donor needs to go through",English
+"or that you need to match and all these different ways, not just I mean, everybody thinks it's the same blood type. It's not even that.",English
+It's just there's all these chemical matches. And she was going through the whole process of and they were confident.,English
+"You know, she was young, she was 24 or 25, and they were confident she'd be great because she's really healthy, too.",English
+"And then when it came to the chest x ray, they it was Friday afternoon. I remember she they took her in",English
+"after the result and the doctor said, you have a tumor. And it was pretty sizable. And she called me.",English
+"Obviously, she goes, Where are you? And I said, I am just about to take off. We were taxiing out, but I just want to know",English
+"if anything was up or what was going on. And she goes, Oh, nothing. I'll I'll talk to you when you come back Sunday,",English
+"because she knew I would probably break down. And so Sunday we came over here and I remember going,",English
+"do you want to go watch the Ravens games at the sports bar? Or said, Do you want to go out? And, you know, and I thought",English
+"my first thought was, I can't be my donor. And I thought it was somehow I thought",English
+that she had news to tell me through the process. I thought she was going to tell me she couldn't be my donor,English
+"because we didn't match. And so when she said she came upstairs and she said, I have a tumor in my chest and it's big,",English
+"that's near my heart. And we just we was we just started crying and going,",English
+This doesn't make any sense. This doesn't make any sense. And then that we cling on to the hope,English
+"that would be benign because when she went through the PET scan, she went to the biopsy of the tumor. We all kept going.",English
+It's going to be benign. It's going to be benign. It's going to and it wasn't. And that's when they put her on a chemo treatment.,English
+That was a roller coaster because she handled it well. And she got she rang the bell. She was done with her chemo treatment and,English
+"but they but then, like, you know, they saw that she had a little cancer free celebration. But then like four months",English
+"after she stopped chemo, they found a lymph node. They said they called it hot. It was like open showed up red on the PET scan.",English
+And that's when they said it never it was called refractory because it didn't she didn't respond to the chemo,English
+in order for this lymph node to come back. And I that's was probably the worst part of the whole thing,English
+"because I then I thought she was headed towards what I went through, which was it's really hard when, you know, 25 was to be doing",English
+"so many other things and got through it. And I don't know, she, her and her boyfriend have this great relationship.",English
+"They still were able to laugh and enjoy themselves and go for walks. I mean, they're in and",English
+"they got a kitten that they loved to death. They got through it. You know, they navigate their way through it.",English
+And now we're just in a state of relief and they have a great future ahead of them.,English
+Yet another thing was they have a bank called Find My Match. It's this huge stem cell bank worldwide.,English
+And they said you are literally one in a million. I did not have a map because I've seen all these videos where people meet the person,English
+"who gave them their cells and they might be from a different country, but I had no match in there and they couldn't really it's there.",English
+"But so even though my sister was 61 at the time, they said pretty much there's there were advantages",English
+"because we were siblings from the same parents. We had certain met there, but they didn't dwell on the fact that she was old",English
+and they never blamed that for being. I really reject it. I remember the radiation was being fitted and it was so it seemed medieval.,English
+You get filled with straps and you go into this. I did two days of radiation. I think it was like,English
+15 minutes on each side. And then it's and then the chemo. I never really knew how that worked.,English
+You get a port and it just goes right in your port and you don't feel a thing. There's no pain,English
+"or you don't feel anything. And then I felt they call it the eat, drink and be married.",English
+Days after the chemo went in. I felt really good and I would go on the treadmill. I couldn't leave the floor.,English
+But then and then my nurses were all right. They predicted a great like by about day ten.,English
+"You feel really sick and you don't have any energy, You have no appetite, no energy. So",English
+"everything they say about chemo is true. Whereas Danielle had went to Hopkins, different team, different probably",English
+"they call it mixture, different doses and everything like that, and it did not affect her as badly. I don't think she ever diarrhea.",English
+And I had it pretty much for like two months. So it affects everybody differently. But it was a slow healing.,English
+"And again, Danielle didn't have a slow healing. She was sick right back at it. It's it's",English
+it could have been we had kind of different treatments. I was in the hospital five weeks and it was like being in a bubble,English
+"and you think it's really relaxing. Like you could read or watch a lot of TV or movies, but they're constantly checking you.",English
+"Every 3 hours. They tweak vital vitals, but I got a lot of support from them and of course I had",English
+"my designated visitors and the five weeks went by fast. And then when I got home, my best friend from Indiana,",English
+"you need a caregiver. You need somebody to look in case you fall, in case somebody has to",English
+"check your temperature every every morning, every night just to really monitor you.",English
+"And she gave up three months of her life and came to live with me. And because she has a really busy life and she was the perfect person for it,",English
+"you know, she's a court reporter, so she's she took notes. She took charge of my meds because you're you know, you're taking 20 pills a day.",English
+She organized charge of arm. She went with me to every appointment. So she's just an incredible person to do that.,English
+And I wasn't allowed to vacuum. I wasn't allowed to go anywhere without a mask. I wasn't allowed in restaurants. I wasn't allowed to eat anything,English
+that other people brought in. And they made me kind of paranoid of germs and going outside and,English
+"eating anything that hasn't been washed, no sushi, no undercooked, no lunch meats. I mean, they really put the fear of",English
+"if I got sick, pneumonia or cover that, it could have been really bad. But because I didn't have anything off. But I didn't they put the fear in.",English
+"And when my then when they found out I did not accept any of my sister, I accepted like 2% of my sister cells.",English
+"They were obviously they looked at it as somewhat of a failure. I mean, I remember this one nursing",English
+"since your transplant was a failure. And I was so mad because I said to Dr. Rappaport, why didn't she call it a failure?",English
+"And he goes, was just a bad choice of words. It just didn't it didn't work as planned. But he said you still succeeded",English
+in getting rid of the jack to Mike. They called it a mutation. I got rid of some mutations in it.,English
+"Like I said, I'm not privy to all this term terminology. They said it wasn't a failure. And then I",English
+"Yeah, and I was just so upset about that because it didn't show. I wasn't doing anything drastic. It didn't show that I had a",English
+my immune system was weak. All I been on yesterday was actually the first day I went off Valtrex. It was.,English
+"But I think the bottom line is if this comes back or I get another one, I met people on my floor",English
+that were on their second or third. I think that's happens and I would do it again in a second.,English
+"I mean, it's really interesting because Danielle different than me. Like I, I just wanted to get through it without anything.",English
+She investigated and she talked to people who had been through it. And she want to know where you are at this point.,English
+In this point in this point. And I just want to kind of dive in and then afterwards forget about it. But she,English
+she met a few people that had myelofibrosis online and they talked my best friend came to me to one of my appointments,English
+"and she goes, I don't understand really what's going on with Kristen. And she cancer free and the not Dr. Rappaport.",English
+"The other one said you're never she's never going to be cancer free. It's just the way it works. I could be, but there's no guarantee.",English
+"Yeah. I mean, I obviously when I go to the doctor, I have kind of like little fear of this little. But he he emphasizes, Dr.",English
+"Rappaport, that I have been stable, stable, stable. My numbers are stable. They're not off the charts great, but they're not getting worse.",English
+"They've been stable like the last year, and he's just such a great guy to deal with because he's",English
+"he always looks on the bright side and he always, you know, he says, you're doing well and that's all you want to hear",English
+after something like that. And I eat more sleep than I ever did. But I think,English
+"that's all right. I get more sleep. That's about it. You know, I rave about Dr. Rappaport",English
+"because he was positive, but there's a lot of negativity. And, you know, when I was in New York City",English
+"and I started running a fever, I said, Can I come in tomorrow and call University of Maryland?",English
+"I said, I'm running a fever and I don't feel that bad. I'm just running a fever. And I know you don't like that. And I mean, you",English
+"get to an emergency room right now. I was like, Why? Why can't I see you at eight",English
+"tomorrow morning? I'll catch the next flight. And she said, Because it could go into your bloodstream, the infection",English
+"could go into your bloodstream, and you could you do with some fatalist people. And she quietly",English
+"said, this is an emergency situation. And I did. I went to the emergency room. And as you know, in New York City,",English
+that took about 6 hours. And they diagnosed me with pneumonia. And I went on medication and I got over it in a couple of weeks.,English
+"But you deal with that or the glass is half empty and and, you know, your numbers",English
+next we will hear from Dr Burton  who studies genetics from a medical   and anthropological context specifically  in regards to a blood disorder. One thing that has interested me  a lot in the course of my research,English
+is the overlap between the history of medical  genetics and anthropological genetics.   The birth of medical genetics as we know it now  and the birth of anthropological genetics was done,English
+through the study of more or less similar sets of  genes and so in my own research I've focused on   sickle cell disease. Sickle cell disease is  an inherited medical condition which is caused,English
+by mutations in the gene that produces  hemoglobin and hemoglobin is the protein   in your red blood cells that carries oxygen  from your lungs to other parts of your body,English
+so obviously it's a protein that plays a very  important role under certain conditions it changes   the shape of your red blood cells so that normally  your red blood cells are round however the mutated,English
+hemoglobin can cause them to form a flattened  or a sickle shape I think many people will be   familiar with the story of sickle cell disease  and how it's commonly racialized especially in,English
+"North America as a disease that predominantly  affects black people, people of African descent,   however what many people might not know is that  sickle cell disease is also extremely common in",English
+parts of the Middle East and India and South Asia  and it was actually the discovery in the early   1950s by scientists working in the Middle East and  India that sickle cell disease was prominent in,English
+so-called white racialized people or people  who were not known to have African ancestry   that contributed to a major shift in the way that  sickle cell disease was understood as a genetic,English
+condition. Prior to that time it was conceived  as being an indicator of African ancestry so when   patients in parts of North America and in a  few cases in Europe were found to have sickle,English
+cell disease or to carry the sickle cell trait  that was considered to be an indication that   that these people had some kind of African  origin so in that sense it was considered to be a,English
+racialized disease that even though we understand  that sickle cell disease is a medical condition it   was associated very strongly as a way of tracing  anthropological origin so that's why I say there,English
+there hasn't historically been the sharp division  between medical and anthropological genetics. Now   the discovery of sickle cell disease sometimes in  surprisingly high rates in different populations,English
+in the Middle East and India that narrative was  forced to change right so these discoveries were   really important in the eventual acceptance of  the idea that sickle cell disease isn't always an,English
+"indicator of ancestry whether that be  African or another kind of ancestry   so Middle Eastern scientists, Middle Eastern  patients with sickle cell disease - all the",English
+people who played a part in the discovery  and treatment of sickle cell disease in these   other parts of the world gradually contributed to  this major international scientific debate about,English
+how do we understand the origins of sickle cell  disease and where it's distributed in different   parts of the world um so now people might also be  familiar with the notion that sickle cell disease,English
+is related in its distribution to areas of the  world which have high rates of endemic malaria   they might be familiar with the understanding  that there's an evolutionary connection between,English
+the presence of malaria and the natural selection  toward uh people who carry the sickle cell trait. What is Dr. Burton referring to when she mentions  the evolutionary connection between malaria,English
+"and the natural selection for the sickle cell  trait? To answer that, affecting humans and other   animals malaria is a life-threatening infectious  disease the parasite moves through the bloodstream",English
+and infects the organism's red blood cells which  is why it is transmitted by mosquitoes which well   feed off blood it is thought that if a person  carries the gene for sickle cell disease their,English
+blood cells would have an abnormal sickle shape  and therefore a less than optimal environment for   a parasite to thrive in this means if a person had  the sickle cell trait they could be more resistant,English
+to malaria and these individuals would likely  live on to reproduce and pass on their traits   meaning evolutionarily speaking these traits would  be selected for whereas maybe those without the,English
+sickle cell trait are more susceptible to malaria  and therefore would be more likely to die before   passing on their genes these traits would not be  selected for since they are well not successful.,English
+It's important to understand that the first time  that this hypothesis was proposed again in the   early to mid 1950s it was not immediately accepted  in fact it took a few decades for people to come,English
+around to this idea and to find the real evidence  that sickle cell disease is actually caused by   multiple different kinds of genetic mutations  there's not one single mutation at the DNA level,English
+and therefore you can't understand sickle  cell disease only through this mechanism   of anthropological ancestry you have to also  account for other kinds of evolutionary processes,English
+and so it was this research being done in India  in the Middle East which helped eventually   to confirm this new vision of this new  understanding of sickle cell disease.,English
+All this research on the circulatory  system blood disorders and diseases   would not have been possible without individuals  asking questions and then testing those questions   similar to the discussion in episode 1 we were  taught that legitimate science was a western way,English
+in my education the concept of scientific method  was always credited to white men the scientific   method being the process in which you make an  observation ask a question create a hypothesis,English
+test that hypothesis with an experiment  and then analyze the results well surprise   it wasn't just white men who were  asking questions and then testing them   I had Dr. Fancy tell us a little about  what this looked like in his research.,English
+The one aspect that is probably shared widely  is the notion of establishing and proving one's   claims rigorously often though not exclusively  but often through rigorously set up experiments,English
+with well-thought-out controls so we can think  about clinical trials and how they're conducted   for drugs or vaccines for the medical works that  I read rigorous investigation and proofs were the,English
+norm and these proofs could be philosophical  proofs or empirical proofs the latter often   included the kind of rigor we associate with  modern science and scientific medicine now,English
+finally to pick up on what would be really a  classic scientific method type of experiment I   want to turn to Ibn Nafis' commentary on the canon  from 1242 CE. So first he identifies a problem,English
+he comes across this notion that the masses state  that snow even though it is cold to touch has a   warming effect on the body which is why people  feel thirsty after consuming it the physicians,English
+on the other hand laugh at this and make fun of it  so he turns around and he says well let's test it   right uh his hypothesis based on the arguments  and stuff that he means he goes he agrees with,English
+the masses stating that snow is inherently once it  loses its accidental coldness warm in its potency   so it has the same effect on the body as other  warming medications right so this is kind of his,English
+you can also see it as a hypothesis and then he  provides five arguments for us the first of it   is the following experiment so I'm gonna use two  containers same size made up of the same substance,English
+then we're gonna fill them up with the same amount  of water from the same water source then we're   going to place them in the exact same place which  is extremely cold so that the water gets as cold,English
+as it can get without freezing then take them and  place them elsewhere again both of them together   and only in one should you put snow but not  in the other and at that point he says check,English
+the one that has the snow you'll notice  that it's colder than the one without snow   then he says leave it and return back after some  time and then feel them again and you'll find out,English
+that this the water that had snow in it is warmer  right so this is a wonderful display of what we   teach as a scientific method especially since  he claims he has also repeated it many times,English
+and found the same result so the repetition part  comes in as well however I will end with the   following caveat: his experiment is also a good  reminder for us that a method is no guarantee,English
+for the validity of the theory. His  experiment is very rigorous and works but his   theoretical explanation for what is going on is  wrong from what we know now for even in appease,English
+his world is made up of just four elements that  are a combination of the two pairs of contrary   is cold hot and dry moist so fire is hot and  dry uh air is cold and uh hot and moist etc.,English
+his rigorous controlled experiment yields real  empirical results that we can even duplicate   now however we would explain the results  very differently since we no longer uphold   the theory of four elements we would instead  explain the result using our modern theories,English
+of specific heat capacity in which snow has  a lower capacity than water and so forth. It's easy for us reading to make the assumption  that these discoveries were immediately recognized,English
+as being correct and important and  influential and it leaves out the fact that   we discover in historical research that many  times these experiments um or these discoveries,English
+were at first rejected and were subject  to you know very passionate debates   I want to put front and center the  notion of science as a process the,English
+really important role of these international  debates to replicate and interpret the data   that there's a huge number of people involved  not just one grand person making the discovery.,English
+So to wrap up I asked Dr. Fancy and Dr. Burton  if they were adding to a science textbook what   would be on their missing page? Well because  I work so much on Ibn Nafis and some of these,English
+"Arabic medical commentaries I think for me that  will be the big one - is to highlight just the   accomplishments and the intellectual rigor and  transformations of medical theory that under,",English
+"that were undertaken by Ibn Nafis  and his subsequent his successors   and also by some of his predecessors who  usually are left out of these stories. If I had the opportunity to edit or revise a  science textbook, to fill in the missing pages",English
+I would emphasize the number of people that were  involved in a long process a slow process in fact   of um contributing data of interpreting results  I also would want to foreground the contribution,English
+"WE CAN GET THEM TO SURVIVE LONGER AND, MORE IMPORTANTLY, HAVE A BETTER QUALITY OF LIFE. >> SO, EXERCISE IS PRETTY DARN IMPORTANT, ISN'T IT? IF YOU CAN'T WALK, YOU CAN'T EXERCISE.",English
+">> INTERVENTIONS ARE IMPORTANT, BUT ALSO THE RISK FACTOR, YOU KNOW, CHANGES ARE JUST AS IMPORTANT AS INTERVENTIONS. SO, IF YOU DON'T HAVE AN INTERVENTION, AND YOU CONTINUE TO SMOKE,",English
+"YOU'LL BE LIKELY OR WILL PROGRESS TO LOSING A LIMB, WHEREAS, IF YOU QUIT SMOKING, WITH OR WITHOUT AN INTERVENTION, THE RISK OF YOU ACTUALLY HAVING AN AMPUTATION IS LOW.",English
+">> SO, EARLIER, WE TALKED BEFORE THE CAMERA CAME ON ABOUT THE CHANGES FROM PEOPLE WHO HAVE A VASCULAR FIX IN THEIR LEGS AND CONTINUE TO SMOKE",English
+"VERSUS SOMEONE WHO HAD THE SAME VASCULAR REPAIR AND QUIT SMOKING. WHAT ARE THOSE NUMBERS? >> WELL, THE CHANCES OF ANY INTERVENTION YOU DO STAYING OPEN,",English
+"IF THEY CONTINUE TO SMOKE, IS MUCH LOWER. BUT, IN GENERAL, IF YOU TAKE ALL PATIENTS WITH CLAUDICATION OR PAIN WHEN THEY'RE WALKING, AND THERE'S TWO KIND OF -- TWO IMPORTANT DIVISIONS OF ARTERIAL DISEASE.",English
+"THOSE ARE THE PEOPLE THAT Dr. BACHARACH TALKED ABOUT, THAT AT REST ARE GETTING ENOUGH BLOOD FLOW TO THEIR LEGS. WHEN THEY WALK, THEY NEED MORE OXYGEN AND THEY CAN'T GET",English
+"THAT SO THAT'S WHY THEY GET THE PAIN. THE SECOND GROUP ARE PEOPLE WITH WHAT WE CALL CRITICAL LIMB ISCHEMIA, THOSE ARE PATIENTS THAT EVEN AT REST THEY'RE NOT GETTING ENOUGH BLOOD FLOW.",English
+"THEY'RE AT HIGH RISK OF LOSING THEIR LIMBS. THEY'LL WAKE UP WITH PAIN IN THE FOOT, HANG THEIR FOOT OVER THE BED, IT WILL GET BETTER BECAUSE GRAVITY WILL HELP THE BLOOD FLOW.",English
+"SO IF YOU TAKE PATIENTS THAT HAVE PAIN WITH WALKING, IF THEY CONTINUE TO SMOKE, INTERVENTION OR NOT, THEIR RISK OF GOING TO CRITICAL LIMB ISCHEMIA,",English
+"IN SOME STUDIES OVER SIX YEARS HAS GONE UP AS HIGH AS OVER 80%. YOU TAKE THE SAME PEOPLE, INTERVENTION OR NOT, HAVE THEM QUIT SMOKING, ONLY ABOUT 8% WILL DEVELOP CRITICAL ISCHEMIA.",English
+"IT'S IMPORTANT TO PREVENT THAT BECAUSE ONCE YOU GET CRITICAL ISCHEMIA, THERE'S STUDIES PUBLISHED IF YOU PRESENT WITH AN ULCER ON YOUR FOOT, THE MORTALITY OF THAT IS ABOUT 20% AT A YEAR. AND THE LIMB LOSS IS UP TO 40%.",English
+"AND, SO, IF YOU LOOK AT THAT, AT A YEAR, ONLY ABOUT 40 OF THOSE PEOPLE ARE ALIVE WITH BOTH THEIR LOWER EXTREMITIES. IT'S VERY IMPORTANT TO PREVENT PEOPLE FROM GETTING TO THAT CRITICAL LIMB ISCHEMIA.",English
+">> A LOT IS RELATED TO DIABETES, TOO, ISN'T IT? I MEAN, VASCULAR DISEASE KIND OF FOLLOWS DIABETES. WOULD YOU AGREE WITH THAT? >> CERTAINLY, DIABETES IS ONE OF THE CONTRIBUTING FACTORS.",English
+"THE PATTERN OF DISEASE WITH DIABETES IS A LITTLE BIT DIFFERENT. IT'S OFTEN IN THE LOWER PORTION OF THE LEG, FROM THE KNEE DOWN, AND IT'S MORE DIFFICULT TO TREAT. IT'S MORE DIFFICULT TO TREAT ENDOVASCULARLY AND IT'S MORE DIFFICULT TO TREAT SURGICALLY.",English
+"SO THAT'S WHY IT'S IMPORTANT TO MANAGE AND OPTIMALLY MANAGE DIABETES, IF YOU HAVE IT, TO KEEP YOUR, YOU KNOW, YOUR HEMOGLOBIN A1C REDUCED TO THE LOWER LEVEL,",English
+"THAT YOU MONITOR YOUR BLOOD GLUCOSE, THAT YOU EXERCISE, THOSE SORTS OF THINGS. SO OPTIMAL MANAGEMENT REALLY IS IMPORTANT WITH DIABETES. >> YOU'RE RIGHT. I WAS THINKING ABOUT VENOUS DISEASE, EARLIER, BEFORE THIS SHOW,",English
+"THINKING ABOUT ARTERIAL DISEASE AND VENOUS DISEASE, THOSE ARE THE BLOOD VESSELS AND THAT'S VASCULAR SYSTEM. YOU KNOW, IT GOES OUT AND COMES BACK, IT'S THE CYCLE OF LIFE,",English
+YOU'VE GOT TO HAVE THE CIRCLE TO WORK FOR THE ARTERIES TO BRING THE BLOOD OUT AND THEN BRING IT BACK. A LOT IS -- THERE'S A LOT OF PROBLEMS PEOPLE HAVE WITH VENOUS DISEASE.,English
+"DO YOU DEAL A LOT WITH THOSE? >> WITH VASCULAR DOCTORS, WE TAKE CARE OF, YOU KNOW, ATRIAL, WHICH WHEN YOUR HEART PUMPS THE BLOOD, THE HIGH PRESSURE",English
+"THAT CARRIES YOUR BLOOD TO THE EXTREMITIES OR TO YOUR ORGANS, THE VEINS WHICH CARRY IT BACK TO THE HEART. >> LOW PRESSURE. >> WHICH IS LOW PRESSURE. SO WE TAKE CARE OF THAT. AND THEN WE ALSO TAKE CARE OF, WHICH IS A DIFFICULT THING",English
+"TO TAKE CARE OF, BECAUSE THERE'S NOT A LOT OF INTERVENTIONS FOR IT, LYMPHATICS, WHEN THE BLOOD FLOW GOES FROM THE ARTERY TO THE VEIN, SOME OF THE BLOOD FLOW LEAKS INTO THE TISSUES THERE, THAT'S CARRIED BACK TO THE HEART",English
+"WITH LYMPHATIC SO WE TAKE CARE OF ALL THREE OF THOSE SYSTEMS. >> AS AN INTERNIST, I DEALT TIME AND TIME AGAIN WITH SWOLLEN LEGS. AND THEY SAY THAT, OF COURSE, IT'S THE SYSTEMS OF LOW PROTEIN",English
+"FROM LIVER DISEASE, LOW PROTEIN FROM LEAKY KIDNEYS. IT'S VENOUS DISEASE FROM NOT BRINGING IT BACK AND THEN IT'S HEART PUMP WEAKNESS.",English
+"SO, THOSE ARE THE REASONS WHY PEOPLE HAVE SWELLING IN THEIR LEGS. BUT THE MAJORITY IS PROBABLY VENOUS DISEASE, WOULDN'T YOU SAY?",English
+">> IT'S DIFFICULT TO TELL. I THINK THAT THE MAJORITY OF PATIENTS WITH BILATERAL EQUAL LOWER EXTREMITY EDEMA IS COMMON THAT IT'S A SYSTEMIC PROBLEM, LIKE HEART DISEASE, SLEEP APNEA THAT'S NOT TREATED THAT WILL LEAD TO THAT.",English
+"NOW IF THEY HAVE LARGE VARICOSE VEINS, THEN IT'S OBVIOUSLY MORE LIKELY TO BE VENOUS DISEASE. THOSE ARE VERY GOOD PATIENTS TO TAKE CARE OF, BECAUSE THEY HAVE SIGNIFICANT RELIEF",English
+"OF THEIR SYMPTOMS, WE HAVE GOOD TREATMENTS FOR PATIENTS WITH INCOMPETENT VEINS, MEANING THAT THE VEINS ARE SUPPOSED TO CARRY BACK TO THE HEART, BUT GRAVITY WANTS IT TO GO DOWN TOWARDS THE FEET. >> THE VALVES ARE GONE.",English
+">> SO IF THOSE VALVES AREN'T WORKING, YOU GET A LONG COLUMN OF BLOOD, WHICH IS HIGH PRESSURE, THEN IT MAKES THEIR VEINS COME OUT AND THEY GET VARICOSITIES, THEY CAN GET EDEMA, ULCERS, EVEN, FROM THE VENOUS DISEASE.",English
+"THOSE ARE PATIENTS WHEN THEY TREAT, THEY REALLY DO HAVE A SIGNIFICANT IMPROVEMENT IN THEIR QUALITY OF LIFE. >> BY REMOVING THE BAD VEINS AND USING A LOT OF SUPPORT. >> YES. SO A LOT OF IT IS EXACTLY THE FIRST TREATMENT ON EVERYBODY IS THE COMPRESSION STOCKINGS.",English
+"AND THOSE HELP A LOT. THEY PUSH THE BLOOD FLOW - THE SWELLING INTO THE DEEPER TISSUES WHERE WE WANT THEM TO BE. IF THAT DOESN'T WORK, IF THEIR VEINS AREN'T WORKING, THEN WE CAN USE CATHETER,",English
+TO EITHER USE A LASER OR RADIOFREQUENCY TO SCAR THE VEIN DOWN. >> SO THERE'S A LOT ABOUT VENOUS DISEASE THAT'S REALLY IMPORTANT. WE CAN TALK ABOUT THAT. WE'VE GOT QUESTIONS THAT WE'LL NEED TO ANSWER.,English
+>>> MEDICAL OUTCOMES ARE ALWAYS BETTER THE EARLIER THEY ARE DIAGNOSED. WAITING FOR A PROBLEM TO STRIKE ISN'T THE BEST TIME TO START TREATMENT.,English
+">> I GOT DONE RUNNING, AND I CAME HOME AND I HAD WHAT THEY CALL AN AORTIC DISSECTION, IT WAS RIGHT OUTSIDE THE AORTA. I CALLED 911, THE AMBULANCE CAME AND GOT ME. WE WENT TO THE HOSPITAL HERE IN BROOKINGS.",English
+"AND THEN THEY ASKED ME WHERE I WANTED TO GO, SO I WENT TO SANFORD IN SIOUX FALLS. THAT'S WHEN THEY FOUND IT. I THOUGHT I WAS ORIGINALLY HAVING A STROKE. MY DAD DIED OF A STROKE WHEN HE WAS 60. AND IT KIND OF RUNS IN OUR FAMILY.",English
+"SO, MY LEG HAD GONE NUMB, AND MY LEFT HAND HAD GONE NUMB. SO I KIND OF WAS WORRIED ABOUT A STROKE. HE STARTED RIGHT UP THE AORTIC VALVE.",English
+AND THEN HE COMES UP AND OVER AND HE LAID IT AT A CERTAIN ANGLE SO Dr. KELLY COULD PUT HIS STENTS IN AND FINISH THIS.,English
+"SO, IT WAS AN ORCHESTRATED PLAN ONCE THEY DID THE FIRST ONE. AND SAVED MY LIFE. THREE YEARS AGO, I RAN MY ONE AND ONLY HALF MARATHON IN SIOUX FALLS.",English
+"I RAN IT IN AN HOUR AND 50 MINUTES. I WAS PRETTY PROUD OF THAT. BUT THEY ALSO SAY IF I WOULDN'T HAVE BEEN IN THE SHAPE I WAS IN, THE CONSEQUENCES MAY HAVE BEEN DIFFERENT. MY HEART WAS GETTING REALLY WEAK.",English
+"AND JUST FROM BEING UP AT CARDIAC REHAB AND MOVING AND DOING EVERYTHING THEY SUGGEST YOU DO, IT'S KIND OF A AT YOUR OWN PACE,",English
+"BUT JUST HAVING THE CAMARADERIE OF OTHER PEOPLE THAT HAVE GONE THROUGH SIMILAR THINGS, IT HELPS. I WISH I WOULD HAVE WENT TO THE DOCTOR MORE.",English
+"WHEN I WAS LAYIN' IN THE HOSPITAL, AFTER MY EMERGENCY SURGERY, THEY WERE ASKING ME, WHO MY DOCTORS WERE. THOSE KIND OF QUESTIONS.",English
+"AND I SAID, YOU'RE LOOKING AT A GUY THAT'S 55 YEARS OLD THAT DOESN'T GO TO THE DOCTOR. AND WE SHOULD ALL GO TO THE DOCTOR. JUST BE PROACTIVE INSTEAD OF REACTIVE.",English
+I THINK IT MIGHT BE A LOT BETTER OFF FOR THEM.,English
+>> THIS IS YOUR PROGRAM AND YOUR QUESTIONS ARE KEY TO THE DIRECTION OF OUR DISCUSSION. CALL IN YOUR QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO ASK@PRAIRIEDOC.ORG.,English
+"WE WOULD LOVE YOUR QUESTIONS. THAT MAKES US HAVE A DIRECTION. SO, PLEASE GIVE US YOUR CALL. HERE'S AN INTERESTING STORY OF A MAN WITH MULTIPLE AORTIC ANEURYSMS,",English
+"YOU KNOW, COMPLEX AORTIC ANEURYSMS. >> SOUNDS LIKE HE HAD A TYPE ONE AORTIC DISSECTION, A TEAR OF THE INNER LINING. YOU HAVE TO REMEMBER THAT THE AORTA IS MADE UP OF MULTIPLE LAYERS.",English
+"WHEN THE INNER LAYER PULLS AWAY FROM THE OUTER LAYER, THAT'S CALLED A DISSECTION. GENERALLY THERE ARE SOME STRUCTURAL THINGS AND SOME GENETIC ASPECTS,",English
+"BUT THE VAST MAJORITY OF THOSE ARE RELATED TO HIGH BLOOD PRESSURE. WHERE BLOOD PRESSURE'S NOT PARTICULARLY WELL CONTROLLED. SOME CASES HARDENING OF THE ARTERIES, ARTHROSCLEROSIS, TOBACCO USE,",English
+THOSE THINGS CONTRIBUTE TO WEAKENING OR DEGENERATIVE CHANGES OF THAT BIG BLOOD VESSEL CALLED THE AORTA AND THAT CAN RESULT IN A TEAR. SO THAT'S A LIFE-THREATENING EVENT AND CERTAINLY KUDOS TO THE PHYSICIANS,English
+WHO LOOKED AFTER HIM BECAUSE THAT'S A HIGH MORTALITY OPERATIVE PROCEDURE AND ONE THAT -- SOUNDS LIKE HE DID REALLY VERY WELL.,English
+">> HE RAN ONE-HOUR-50-MINUTE HALF MARATHON, LET ME TELL YOU, I'VE RUN A LITTLE UNDER THAT AND OVER THAT WHEN I WAS RUNNING.",English
+"SO, MIKE DESCRIBED IT AS A TEAR IN THE WALL AND THEN IT DISSECTED IN AND THEN I'M SURE THAT THAT PUSHED INTO THE FLOW. BUT THERE ARE OTHER KINDS OF ANEURYSMS WHERE IT DISSECTS OUT.",English
+"I MEAN, IT BLOWS UP LIKE AN INNER TUBE, RIGHT? CAN YOU DESCRIBE -- THERE'S DIFFERENT KINDS. >> I MEAN, WELL, THERE'S TWO DIFFERENT THINGS. A DISSECTION IS WHEN YOU HAVE THE WALLS SEPARATE. AND YOU CAN HAVE -- HIS MUST HAVE BEEN PART OF THE AORTA BETWEEN THE HEART",English
+"AND THE CAROTID ARTERY OR THE NECK VESSELS AND THOSE NEED TO BE SURGICALLY REPAIRED RIGHT AWAY. NOW THERE'S ALSO DISSECTIONS THAT GO DOWN AFTER THE BLOOD VESSELS TO THE BRAIN,",English
+"AND THOSE WE CAN OFTEN TREAT MEDICALLY WITH BLOOD PRESSURE. NOW, THOSE DISSECTIONS AREN'T ANEURYSMS. SO AN ANEURYSMS IS AN ENLARGEMENT OF THE ARTERY,",English
+"UP TO ONE AND A HALF TIMES THE NORMAL ARTERY. SO NORMAL AORTA IS ABOUT TWO CENTIMETERS, SO ANYTHING OVER THREE CENTIMETERS IS WHAT WE DEFINE AS AN AN [OVERLAPPING CONVERSATION].",English
+"NOW A DISSECTION, YOU CAN IMAGINE IF YOU HAVE THREE LAYERS OF BLOOD VESSEL AND YOU GET THE INNER LAYER TORN OUT, THAT DOES WEAKEN THE WALL. SO IT DOES INCREASE YOUR RISK OF HAVING AN ANEURYSM.",English
+"AND WE DO MONITOR THEM FOR ANEURYSMS LATER ON. BUT A DISSECTION, ANEURYSM ARE DIFFERENT. ANEURYSM IS A DILATION OF THE BLOOD VESSEL. JUST LIKE IF YOU SIT THERE AND BLOW UP A BALLOON,",English
+"THE BIGGER THAT DILATION GETS, THE TIGHTER THE WALL IS, EVENTUALLY IT CAN POP. AND IF IT'S AN AORTIC ANEURYSM, IT POPS, THEN YOUR RISK OF MORTALITY IS VERY HIGH, ABOUT HALF THE PATIENTS DON'T MAKE IT TO THE HOSPITAL. >> YEAH.",English
+"SO, THAT LEAVES ME WITH A QUESTION ABOUT ULTRASOUND OF THE ABDOMINAL AREA LOOKING FOR AORTIC ANEURYSMS, CLASSICALLY, QUOTE, UNQUOTE.",English
+"SO, THERE'S BEEN A TRAVELING CIRCUS THAT BRING IN - I'M SORRY, I DIDN'T MEAN TO BE NEGATIVE - THEY ULTRASOUND YOUR CAROTID, THEY ULTRASOUND YOUR AORTA, THEY ULTRASOUND YOUR LEGS,",English
+"THEY DO A BONE DENSITY ULTRASOUND, THEY TELL YOU ALL OF THIS FOR $150 OR WHATEVER IT MIGHT BE. I'VE OFTEN THOUGHT THAT, I TELL PEOPLE, SKIP ALL OF IT BUT GET THE AORTIC ANEURYSM TEST.",English
+"AND IF THAT'S ABNORMAL, THEN YOU GO TO YOUR REGULAR DOCTOR, GET ONE. BUT WILL IT PICK UP A DISSECTION? >> PROBABLY -- I MEAN, IT COULD.",English
+"PROBABLY NOT ONE OF THE SCREENING STUDIES. BUT GENERALLY IF YOU HAVE A DISSECTION -- THE DIFFERENCE BETWEEN DISSECTION AND ANEURYSM, GENERALLY WHEN YOU HAVE A DISSECTION, YOU KNOW THAT THE BLOOD VESSEL WALL TEARS,",English
+"SO THEY'LL HAVE PAIN, USUALLY THEY'LL - [OVERLAPPING CONVERSATION] WHEREAS, AN ANEURYSM, MAJORITY OF THOSE ARE ASYMPTOMATIC, UNLESS THEY RUPTURE. SO ONCE THEY RUPTURE, THEN THERE'S A VERY HIGH MORTALITY.",English
+"SO THE SCREEN FOR AN ANEURYSM IS VERY IMPORTANT BECAUSE IF YOU CAN FIND IT WHEN THEY'RE ASYMPTOMATIC AND FOLLOW IT, THEN YOU CAN FIX IT ONCE IT GETS TO A SIZE WHERE THERE IS A RISK OF RUPTURING, RATHER THAN WAITING UNTIL THEY'RE SYMPTOMATIC,",English
+"WHICH IS GENERALLY A RUPTURE WHICH HAS A HIGH MORTALITY. >> JUST AS A COMMENT. THE SCREENING ISSUES HAVE BEEN CONTROVERSIAL BECAUSE, YOU'RE RIGHT,",English
+YOU WOULD LIKE TO IDENTIFY THESE ANEURYSMS BEFOREHAND BECAUSE WE CAN FIX THEM AND PREVENT A RUPTURE FROM OCCURRING. >> RIGHT. >> THEY OFTEN ARE ONLY FOUND BY INCIDENTAL FINDINGS.,English
+"SOMEONE COMES IN WITH ABDOMINAL PAIN, THEY HAVE AN X-RAY, OR THEY HAVE GALLBLADDER AND THEY GET A C.T. SCAN AND THEN THEY FIND IT. SO, A LOT OF PATIENTS THAT COME BOTH TO Dr. WEISS AND MYSELF",English
+"WERE FOUND INCIDENTALLY, THEY'RE NOT AWARE THAT THEY HAVE A PROBLEM. THE SCREENING RECOMMENDATIONS, THE FORMAL SCREENING RECOMMENDATIONS - >> YEAH. >> -- ARE YOU GET MEN WHO SMOKE, AGE 65 OR OLDER, GET ONE SORT OF FREEBIE",English
+"ULTRASOUND AT THE TIME OF THEIR FIRST MEDICARE PHYSICAL. AND THAT'S IT. SO, MEDICARE HAS CHOSEN NOT TO SUPPORT SCREENING PROGRAMS,",English
+"AND, YOU KNOW, WHAT DO YOU DO WITH WOMEN? WE DON'T KNOW. WHAT DO WE DO WITH MEN WHO HAVEN'T SMOKED? WE DON'T KNOW EXACTLY. SO, ONE OF THE THINGS THAT'S IMPORTANT, WHAT WE TELL OUR PATIENTS,",English
+"NUMBER ONE, IF YOUR FAMILY MEMBER HAD AN ANEURYSM, YOU KNOW, MOM, DAD, GRANDPA, THAT PUTS YOU INTO, YOU KNOW, - >> HIGHER RISK. >> CATEGORY, AND IF YOU'RE A SMOKER, MAN OR WOMAN, YOU KNOW,",English
+"YOU'RE IN A HIGHER-RISK GROUP. AND, YOU KNOW, AGAIN, MANY OF THESE SERVICES, WHILE I'M NOT A HUGE PROPONENT OF SOME OF THESE SERVICES,",English
+"MANY OF THEM ARE RELATIVELY COST EFFECTIVE AND THEY PROVIDE SERVICES IN SOME OF OUR MORE RURAL OR GEOGRAPHICALLY ISOLATED COMMUNITIES WHERE THAT ISN'T AVAILABLE. SO TO AVAIL YOURSELF TO THAT, YOU DON'T NEED TO DO IT EVERY YEAR.",English
+"THAT'S PROBABLY NOT HELPFUL. BUT FOR A ONE-TIME EVENT, AND THEN IF THEY IDENTIFY A PROBLEM, THEN YOU GO ON AND GO TO A LARGER CENTER WHERE IT MIGHT BE TO GET A MORE FORMAL EVALUATION.",English
+">> AND I'VE GOT SOME QUESTIONS, AND I REALLY APPRECIATE THEM. BUT I WOULD ASK THIS, IT ALSO DOES ULTRASOUND OF THE CAROTIDS IN THESE TRAVELING PROGRAMS.",English
+"AND I'VE OFTEN POOH POOHED THOSE BECAUSE ONCE YOU HAVE AN ABNORMAL, IT'S A MORE COMPLICATED THING TO INTERPRET. COMMENT? >> I THINK, YOU KNOW, CAROTID DISEASE, WE'RE TREATING LESS AND LESS ASYMPTOMATIC PATIENTS.",English
+"80% IS WHAT WE GENERALLY USE, STENOSIS, THEN YOU DO HAVE A BENEFIT TO TREATMENT. CHECK THE PRESSURE IN YOUR ARM AND YOUR LEG AND THAT CAN DETECT PERIPHERY ARTERY DISEASE.",English
+"WE TALKED ABOUT PAIN WHEN YOU'RE WALKING, BUT OFTEN PATIENTS WILL, YOU KNOW, SUBCONSCIOUSLY KIND OF ADJUST TO THEIR PERIPHERAL ARTERY DISEASE. >> WALK SLOWER. >> SO THEY'LL BE LESS AND LESS ACTIVE.",English
+"ARE YOU SYMPTOMATIC, THEY'LL SAY NO, BUT THEY DON'T WALK TO THE GROCERY STORE. >> ARTERIAL BRACHIAL ARTERY INDEX.",English
+">> IF YOU IDENTIFY PATIENTS, THEY'RE AT MUCH HIGHER RISK OF STROKE AND HEART DISEASE. IF YOU CAN TREAT THEM MEDICALLY, THEN YOU CAN REDUCE THE RISK OF MORTALITY FROM THOSE TWO.",English
+>> YOU ENCOURAGE THE SCREEN. MAYBE ONE TIME? >> YEAH. >> CALLER FROM VIBORG HAD OPEN HEART SURGERY. EIGHT YEARS AGO DEVELOPED PERIPHERAL ARTERY DISEASE AND COULD BARELY WALK.,English
+"HAD SURGERY ON LEGS TO PUT IN A STENT ON THE KNEE. HOW LONG CAN YOU GO THROUGH LIFE WITH PERIPHERAL ARTERY DISEASE AND A STENT? >> WELL, - >> IF YOU DON'T SMOKE, OBVIOUSLY IT'S A WHOLE LOT BETTER.",English
+">> SO, WHETHER YOU'RE TREATED SURGICALLY, ENDOVASCULARLY, WHATEVER, AGAIN, Dr. WEISS ALLUDED TO THIS, OPTIMAL MEDICAL MANAGEMENT IS CRITICALLY IMPORTANT. YOU NEED TO NOT SMOKE, YOU NEED TO WATCH YOUR BLOOD PRESSURE,",English
+"YOU NEED TO, YOU KNOW, EAT RIGHT, YOU NEED TO EXERCISE. AND, IN FACT, THOSE ARE THE PINNACLES THAT EVERYBODY SHOULD GET, WHETHER THEY GET AN OPERATION OR WHETHER THEY GET A STENT.",English
+"NOW, STENTS WORK VERY WELL AND THEY IMPROVE BLOOD FLOW. THEY'RE NOT PERFECT. THEY HAVE A TENDENCY TO RENARROW. WHY THEY RENARROW IN SOME PEOPLE MORE THAN OTHERS,",English
+"CLEARLY, IF YOU CONTINUE TO SMOKE, THEY'LL RENARROW FASTER. SO THAT'S ONE OF THE CAVEATS. BUT EXERCISE IS PROBABLY THE MOST IMPORTANT THING.",English
+"IF YOU WALK AND EXERCISE REGULARLY, NUMBER ONE, IT WILL HELP KEEP IT OPEN. NUMBER TWO, IF IT BEGINS TO NARROW, YOU'LL IDENTIFY IT RIGHT AWAY BECAUSE IT'S MUCH EASIER TO FIX THESE WHEN THEY'RE PARTIALLY BLOCKED",English
+"THAN WHEN THEY'RE COMPLETELY BLOCKED. ONCE THEY'RE COMPLETELY BLOCKED, IT'S MUCH MORE DIFFICULT TO FIX. >> BOY, WHEN YOU SAY THE WORD ""EXERCISE"" TO ME, YOU'RE TALKING TO ME RIGHT - [Laughter] SO I THINK THAT'S SO, SO IMPORTANT.",English
+"I THOUGHT WE MENTIONED EARLIER SOMEWHERE, MAYBE IT WAS BEFORE THE CAMERA WAS ON, ABOUT SLEEP APNEA. DUSTIN, DO YOU THINK THAT THAT'S A BIG FACTOR HERE?",English
+">> I'M NOT SO CERTAIN WITH ARTERIAL DISEASE. BUT WITH EDEMA, SLEEP APNEA THAT'S UNTREATED, YOU DO INCREASE YOUR HEART PRESSURE, SO THEY'LL MANIFEST AS EDEMA. WE DO SEE PATIENTS WITH LEG SWELLING",English
+"THAT DON'T HAVE VENOUS DISEASE, THAT'S SOMETHING THEY NEED TO SEE THEIR PRIMARY DOCTOR AND SEE IF THEY CAN MANAGE THEIR LEG SWELLING.",English
+">> I WOULD INTERJECT, IT'S NOW RECOGNIZED, CERTAINLY IN THE CARDIAC ARENA, NOT SO MUCH IN PERIPHERAL VASCULAR DISEASE, BUT IN CARDIAC ARENA, THAT SLEEP APNEA IS A CONTRIBUTOR BECAUSE IT REDUCES YOUR OXYGEN SATURATIONS AT NIGHT,",English
+"IT PUTS A STRAIN ON YOUR HEART, IT CLEARLY CONTRIBUTES TO CARDIAC MORBIDITY. AND, SO, - >> DEATH. >> YEAH. AND, SO, THERE'S NO QUESTION THAT WE'VE -",English
+"AND THAT'S BEEN KIND OF A RENAISSANCE THAT WE'VE RECOGNIZED THAT WE NEED TO SCREEN MORE AND, YOU KNOW, OBESITY'S A PROBLEM IN MANY OF THOSE PATIENTS. WEIGHT LOSS, WHICH IS DIFFICULT - >> REALLY DIFFICULT.",English
+">> BUT OFTEN THAT WILL HELP. BUT, AGAIN, WE PROBABLY - IT'S ONLY NOW THAT WE'RE BEGINNING TO RECOGNIZE THAT WE NEED TO TEST MORE PATIENTS FOR SLEEP APNEA. >> ATRIAL FIB, ALSO THAT ABNORMAL RHYTHM. ATRIAL FIB.",English
+"PLEASE DISCUSS HOW TO TREAT SWOLLEN, WEEPING LEGS. IF THE FLUIDS FROM THE LEGS HAS A STRONG, BAD SMELL AND WEEPS AND PUDDLES, IT IS LIKELY INFECTED? ARE OTHERS AT RISK IF THEY COME IN CONTACT WITH LEG FLUID?",English
+"WHAT WOULD YOU DO WITH SOMEONE THAT SERIOUS OF A VENOUS PROBLEM? >> I THINK, I MEAN, THE FIRST THING IS COMPRESSION. AND IF YOU HAVE OPEN SORES, YOU KNOW, COMPRESSION STOCKINGS ARE GREAT,",English
+"BUT IF YOU HAVE OPEN SORES, THEN THEY DEFINITELY NEED TO SEE THEIR PRIMARY DOCTOR AND PROBABLY A VASCULAR SPECIALIST. WRAPPING THE LEGS, WE'LL DO LEG WRAPS, AND THAT WILL OFTEN GET THOSE TO HEAL.",English
+"AND THEN THEY NEED TO LOOK INTO THE CAUSE. IF THEY HAVE VENOUS DISEASE, THAT DEFINITELY NEEDS TO BE TREATED. IF THERE'S OTHER PATIENTS THAT HAVE, YOU KNOW, PROBLEMS WITH LYMPHATICS,",English
+"WE TALKED ABOUT, AND THERE ARE SOME TREATMENTS FOR THAT, MAINLY THE COMPRESSION BUT THEN YOU COULD ALSO GET SOME PUMPS THAT HELP RELIEVE THE FLUID. >> SOMETIMES WHEN YOU GET THE FLUID OUT, THOUGH, AS YOU'RE GETTING THE FLUID OUT, IT HURTS.",English
+"SO THEY AVOID THAT TREATMENT. >> AND YOU CAN DO IT -- AND THEY DO MASSAGE, TOO, TO GET THE FLUID OUT. BUT GETTING THE FLUID OUT IS IMPORTANT BECAUSE THAT'S GOING TO - THEY WON'T HEAL THE CRACKS IN THE SKIN OR THE SORES, AS LONG AS THEY HAVE THE SWELLING.",English
+"AS FAR AS THE FLUID, LIKE THREATENING TO OTHER PEOPLE, NO. IS IT INFECTED? IT'S HARD TO TELL. GETTING THE EDEMA OUT IS IMPORTANT BECAUSE YOU DO -",English
+"WITH LIGHT SWELLING, YOU ARE AT INCREASED RISK OF INFECTION IN THE SKIN IN THE FLUID. IF YOU GET CELLULITIS, THEN THAT JUST MAKES THE FACTORS WORSE AND WORSE.",English
+"IT'S KIND OF A VICIOUS CYCLE. SO I THINK IT'S SOMETHING THAT THAT PATIENT DEFINITELY NEEDS TO SEEK SOME MEDICAL CARE. >> MY EXPERIENCE, WITH THAT PATIENT THAT YOU DESCRIBED,",English
+"A PATIENT WHO'S LARGELY NONAMBULATORY AND SPENDING A GREAT DEAL OF TIME WITH THEIR LEG DEPENDENT. >> YES. >> GOT TO GET IT UP. >> FREQUENTLY BECAUSE OF SPINAL STENOSIS OR BACK PROBLEMS, ORTHOPEDIC ISSUES,",English
+"THEY TEND TO SLEEP IN A RECLINER, RATHER THAN IN BED. IF THEY CAN GET THEIR LEGS UP, ELEVATED TO AT LEAST THE LEVEL OF THEIR HEART, THAT OFTEN WILL HELP. THIS IS ONE OF THOSE CHRONIC SITUATIONS,",English
+"WHEN IT GETS THAT BAD, MY SENSE IS THAT THIS IS SOMEONE WHO'S SPENT A GREAT DEAL OF TIME WITH THEIR LEGS DOWN AND GRAVITY IS NOT THEIR FRIEND. >> NO. AND TIME AND TIME AGAIN, WHEN I'M GETTING RESULTS, YOU KNOW,",English
+"I'M FINAL DIURESING THEM, MAYBE I'M ADDING A DIURETIC, I'M RELUCTANT BUT I DO IT, YOU ELEVATE THE LEGS, THEY GET THE ACE WRAPS, OFTENTIMES I HOSPITALIZE THEM,",English
+"COVER THEM WITH PAIN MEDICINES, FORCE THE EDEMA OUT WITH THE WRAPS, WHATEVER, AND ELEVATION UNTIL THEY'RE THERE AND THE PAIN IS REDUCED.",English
+"AND THEY CAN LOOK FORWARD TO GETTING BACK TO EXERCISE. WE HAVE A ROLL-IN. >>> THE VALUE OF HAVING A PRIMARY CARE PHYSICIAN CANNOT BE OVERSTATED,",English
+"BUT YOU ALSO HAVE TO GO AND SEE THEM REGULARLY, EVEN IF YOU DON'T THINK ANYTHING IS WRONG. >> OH, I WENT IN TO MY PRIMARY CARE DOCTOR AND SHE LISTENED TO THE ARTERIES.",English
+SHE SAID SOMETHING DIDN'T SOUND RIGHT. SO THEN SHE SENT ME TO Dr. WEISS. IN SIOUX FALLS AT THE HEART HOSPITAL. THAT'S WHEN THEY SAID IT WAS 70-99% BLOCKED.,English
+THAT'S THE FIRST I KNEW ANYTHING ABOUT IT. FELT FINE. FELT LIKE BEFORE I HAD IT DONE. IT WASN'T BOTHERING ME AT ALL. JUST THAT THE PRIMARY DOCTOR FOUND IT. WENT FROM THERE.,English
+IT PROBABLY COULD HAVE DEVELOPED INTO SOMETHING IF WE HADN'T CAUGHT IT EARLY ENOUGH. RIGHT HERE IS THE INCISION FROM YOUR EAR DOWN TO YOUR NECK.,English
+AND THEN HERE THEY CUT IT OPEN AND SCRAPE OUT ALL THE PLAQUE THAT WAS BUILT UP IN IT. BYPASSED THE BLOOD FLOW. SEW IT BACK UP. IT'S AMAZING WHAT THEY CAN DO.,English
+"THREE WEEKS, SOMETHING LIKE THAT, YOU KNOW, BECAUSE I USUALLY GO UP TO CARDIAC REHAB, AND WITHIN A WEEK OR SO I WAS BACK UP TO CARDIAC REHAB.",English
+"YOU KNOW, DOING IT EASY, BUT, YOU KNOW, STILL BACK UP THERE DOING THE EXERCISES AND STUFF LIKE THAT. KEEP GOING TO YOUR PRIMARY DOCTOR, THEY'RE THE ONES THAT FIND IT.",English
+"I MEAN, I HAD NO IDEA THAT I EVEN HAD IT, YOU KNOW, I WAS NEVER SHORT OF BREATH OR ANYTHING LIKE THAT. I NEVER HAD ANY SYMPTOMS.",English
+">> WELL, WE REALLY APPRECIATE ROGER'S PRIMARY CARE PROVIDER, VERY GOOD CLINICIAN.",English
+"ANY COMMENTS ABOUT WHAT ROGER WAS SAYING? >> I THINK, YOU KNOW, A PHYSICAL EXAM IS IMPORTANT FOR VASCULAR DISEASE. I MEAN, WE LISTEN TO THE CAROTID ARTERIES. IT SOUND LIKE -",English
+">> WHOOSH, WHOOSH. >> THAT LED TO FINDING THE STENOSIS. AS WE SAID EARLIER, IF IT'S OVER 80%, YOUR RISK OF STROKE IS SIGNIFICANTLY DECREASED BY EITHER A CAROTID ENDARTERECTOMY OR A STENT.",English
+>> A CALLER HAS A CALCIUM BUILDUP IN THE VEINS IN HER LEG. THE DOCTOR HAS BEEN REMOVING THE CALCIUM ABOUT EVERY TWO WEEKS. IS THERE ANYTHING I CAN DO TO STOP THIS BUILDUP?,English
+"I DON'T UNDERSTAND, DO YOU HAVE ANY IDEA ABOUT WHAT KIND OF CALCIUM REDUCTION THIS PERSON IS GETTING? MIKE? >> YOU KNOW, I DON'T. AND I NEED -- VERY HONESTLY, I'D NEED A LITTLE BIT MORE INFORMATION.",English
+"THERE HAVE BEEN SOME TECHNIQUES CALLED CHELATION THAT WAS TO REDUCE ARTERIAL CALCIFICATION IN THE ARTERIES, NOT IN THE VEINS, TYPICALLY. IT WAS NOT PARTICULARLY EFFECTIVE.",English
+"AND IT'S REALLY KIND OF FALLEN BY THE WAYSIDE BECAUSE IT REALLY DIDN'T ACCOMPLISH WHAT IT HAD HOPED. >> IT WOULD SUCK THE CALCIUM OUT OF THE BLOOD VESSELS,",English
+"THE BLOOD VESSELS WOULD GO TO THE BONES, READILY GRAB ALL - VERY EASY ACCESS IN THE BONES, NOT THE ARTERIES. AND IT JUST DIDN'T WORK. >> RIGHT. SO I'M NOT SURE. I WISH I COULD ANSWER THAT, BUT WITHOUT A LITTLE BIT",English
+"MORE INFORMATION, I'M SORRY, I CAN'T. >> I DON'T HAVE A GOOD ANSWER. A CALLER FROM COLERIDGE, NEBRASKA, STATES THAT AFTER A FEW VASCULAR SURGERIES ON HER LEGS, WHY AM I FINE WALKING AROUND AND SITTING BUT FEEL",English
+"LOTS OF LEG PAIN SHORTLY AFTER LAYING DOWN? MAYBE THAT'S WHEN THE EDEMA REALLY DOES REDUCE AND SHE CAN FEEL THE PAIN. >> I GUESS IT COULD BE. I MEAN, OR IT COULD BE THAT, YOU KNOW,",English
+"HER BLOOD VESSEL DISEASE, YOU WOULD EXPECT HER TO HAVE PAIN WHILE SHE'S WALKING. >> YEAH. >> ESPECIALLY IF YOU'RE HAVING PAIN AT REST. IT COULD BE THAT SHE'S MORE ACTIVE, SHE CAN HAVE SOME JOINT PROBLEMS,",English
+"SOME ORTHOPEDIC PROBLEMS, AS WELL AS THE VASCULAR DISEASE. >> THERE'S SOMETHING ELSE HAPPENING. >> I THINK IT'S IMPORTANT FOR PATIENTS TO REMEMBER AND FOR OUR AUDIENCE",English
+"TO RECOGNIZE THAT VASCULAR DISEASE, WHEN IT INVOLVES THE LEGS, PRESENTS ITSELF AS DISCOMFORT OR DISTRESS WITH WALKING, WITH EXERCISE, TYPICALLY, EXCEPT FOR WHAT Dr. WEISS HAD PREVIOUSLY DESCRIBED",English
+"WHERE YOU HAVE REST PAIN. BUT FOR THE VAST MAJORITY OF PATIENTS WITH CLAUDICATION, YOU HAVE TO WALK TO BRING THE DISCOMFORT ON. THERE'S LOTS OF REASONS FOR PEOPLE TO HAVE LEG DISCOMFORT.",English
+"YOU KNOW, THERE'S PERIPHERAL NEUROPATHY, THERE'S SPINAL STENOSIS, THERE'S ORTHOPEDIC ISSUE, DEGENERATIVE HIP DISEASE, OR KNEE OR OTHER PLACES. SOME OF IT IS JUST MUSCULAR. TYPICALLY PAIN AT REST IS NOT USUALLY CLAUDICATION.",English
+"AND THE OTHER THING IS, IT'S NOT VARIABLE. IT TENDS TO BE THE SAME EACH TIME. SO SOMEONE WILL SAY, EVERY TIME I WALK A BLOCK, I GET THIS DISCOMFORT.",English
+"IF I STOP AND REST, IT GOES AWAY. THOSE ARE KIND OF THE KEY COMPONENTS THAT WE ASK PATIENTS ABOUT THAT HELP US MAKE THAT DETERMINATION. >> RIGHT.",English
+"A MAN FROM RAPID CITY ASKS, WHAT ARE YOUR THOUGHTS ON USING DAFLON FOR SWELLING IN LEGS? IT'S VERY EFFECTIVE FOR ME. SO I'VE NEVER HEARD OF DAFLON FOR SWELLING IN THE LEGS.",English
+"MAYBE IT'S - MAYBE IT'S TEFLON OR IS IT A TYPE OF - >> I DON'T KNOW. I'M NOT SURE IF IT'S SOME TYPE OF WRAP. >> ELASTIC WRAP. >> OR SOMETHING THAT'S TAKEN. PRETTY MUCH FOR LEG SWELLING,",English
+IT'S IMPORTANT TO HAVE COMPRESSION TO HELP PUSH THAT OUT. WE HAVE COMPRESSION STOCKINGS THAT ARE TIGHTER AT THE BOTTOM THAN THE TOP TO HELP PUSH IT DOWN.,English
+">> I LIKE TO START WITH 15 TO 20 POUND, THEN GO TO 20, 25, THEN MAX OUT AT GOING TO 30. BUT CERTAINLY YOU'RE SAFE AT 20.",English
+"THE PROBLEM IS, IF YOU GET TOO TIGHT AND THERE'S ARTERIAL DISEASE, THEN YOU CAN COMPROMISE THE ARTERIAL FLOW. DO YOU SEE THAT HAPPEN? >> NO, NOT USUALLY BECAUSE MOST OF THE TIME THE BLOOD PRESSURE'S HIGH ENOUGH",English
+"THAT EVEN WITH 30 OR 40 MILLIMETERS OF COMPRESSION, YOU'RE NOT - NOW, THERE'S A FEW CIRCUMSTANCES WHERE IT CAN OCCUR WHERE YOU HAVE REALLY REDUCED BLOOD FLOW, BUT FOR THE VAST MAJORITY OF PEOPLE,",English
+"BLOOD FLOW, EVEN IN SOMEONE WITH CLAUDICATION, STILL MAY HAVE AN 80 OR 100 MILLIMETER MERCURY OF PRESSURE BELOW THE KNEE SO YOU'RE NOT GOING TO COMPRESS THAT ENOUGH TO -",English
+">> TO COMPROMISE ARTERIAL FLOW. MOST OF THE TIME IN MY CAREER, I WENT FOR 20-POUND SUPPORT HOSE AND I WENT BELOW THE KNEE BECAUSE THEY'LL ACTUALLY WEAR THOSE.",English
+"AND PUT THEM ON IN THE MORNING, TAKE THEM OFF AT NIGHT. >> THE CRITICAL ISSUE, THEY DON'T DO ANY GOOD IF THEY SIT IN THE DRESSER DRAWER. SO YOU HAVE TO WEAR THEM. IF THEY'RE TOO TIGHT, PEOPLE WON'T PUT THEM ON.",English
+"IF THEY WON'T WEAR THEM, THEN OBVIOUSLY THEY'RE NOT DOING ANY GOOD. SO I THINK YOU'RE ABSOLUTELY RIGHT. >> THE MAJORITY OF THE PATIENT'S SYMPTOMS ARE BELOW THE KNEE AS WELL.",English
+">> RIGHT. >> IF THEY CAN'T WEAR COMPRESSION STOCKINGS, THERE ARE SOME OTHER DEVICES THAT YOU PUT ON THAT ARE VELCRO SO YOU CAN PUT THEM ON, IT'S NOT AS TIGHT, STRAP THE VELCRO TO TIGHTEN IT.",English
+"OFTEN A LOT OF PATIENTS THAT HAVE SOME SWELLING, IT WILL BE DIFFICULT FOR THEM TO GET DOWN THERE AND PUT THE SOCKS ON SO THERE ARE SOME OTHER OPTIONS. COMPRESSION, WHICHEVER TYPE OF DEVICE YOU'RE USING IS THE KEY.",English
+">> I'VE RUN INTO THOSE. >> PEOPLE HAVE ARTHRITIC SYMPTOMS IN THEIR HANDS WHERE THEY JUST CAN'T PULL THE STOCKINGS ON, THERE ARE SOME DEVICES THAT WILL HELP,",English
+BUT ALSO THE VELCRO DEVICES HAVE BEEN QUITE HELPFUL. >> HERE'S A QUESTION ABOUT AN AVM. CAN IT BE DETECTED WITH A SCREEN? WHAT IS AN AVM? MIKE? >> IT'S AN ARTERIAL VENOUS MALFORMATION.,English
+"AND THOSE ARE - >> IN THE BRAIN OFTEN? >> WELL, THEY CAN OCCUR IN THE BRAIN. THEY ACTUALLY CAN OCCUR ALMOST ANYWHERE. AND INTERESTINGLY, THEY HAVE BEEN - THEY OFTEN ARE BROUGHT -",English
+"THEY'RE THERE BUT THEY'RE SORT OF QUIESCENT AND THEN IT TAKES A LITTLE BIT OF TRAUMA TO BRING THEM OUT, THEN ALL OF A SUDDEN THEY FLOURISH AND YOU FIND THEM.",English
+"THEY WOULD NOT BE ROUTINELY FOUND ON SCREENING. NOW, IF YOU HAD A SPECIAL, YOU KNOW, SCANS OF THE BRAIN FOR SOME REASON, THEN AN AVM OF THE BRAIN WOULD BE FOUND.",English
+"IT DOES PUT PATIENTS AT HIGH RISK FOR BLEEDING EVENT, YOU KNOW, AN INTERCRANIAL BLEEDING EVENT FOR THAT TYPE. FOR THOSE THAT ARE PERIPHERAL AVMs, THEY WILL BECOME EVIDENT",English
+"IF THEY ENLARGE, AND YOUR PRIMARY CARE PERSON MAY NOTICE THAT THERE'S A BULGE OR IF THEY CAN LISTEN WITH A STETHOSCOPE OVER THAT AREA AND THEY'LL FIND A HIGH-PITCHED SORT OF SOUND",English
+"THAT'S CONTINUOUS, SORT OF A MACHINERY-LIKE MURMUR. >> IS IT NECESSARY TO FIX THEM? >> YOU KNOW, SMALL ONES CAN BE OFTEN LEFT ALONE.",English
+"LARGER ONES, IF THEY CAUSE PAIN, IF THEY'RE PROBLEMATIC, THERE ARE TECHNIQUES, SOME OF THEM CAN BE EMBOLIZED SO YOU DON'T HAVE TO HAVE AN OPERATION.",English
+"BUT, FORTUNATELY, THEY'RE NOT A REAL FREQUENT PROBLEM. >> I'VE GOT A GOOD ONE FOR YOU. SLEEP APNEA CAUSES GLAUCOMA? [Laughter]",English
+">> I'M NOT AN OPHTHALMOLOGIST. >> NO, YOU SAID THAT EARLIER. >> YEAH. >> A MALE CALLER FROM SIOUX FALLS ASKED, WHAT IS THE DIFFERENCE BETWEEN PLANET HEART HEALTH SCREENINGS AT AVERA VERSUS THE TRAVELING SCREENINGS",English
+"MENTIONED EARLIER? THAT'S A GOOD QUESTION. >> I THINK IN GENERAL, MOST OF THE SCREENINGS WILL INCLUDE THE CAROTID ULTRASOUND, BLOOD PRESSURE FOR YOUR LEGS AND ABI, THEY'LL CHECK AN ANEURYSM,",English
+"THEN THEY'LL DO SOMETIMES A BONE SCAN, CALCIUM GOING TO THE HEART. AS FAR AS THE DIFFERENCES, I'M NOT SURE. OBVIOUSLY IT DEPENDS ON THE TRAVELING ONES, IF YOU'RE IN A SMALL TOWN, THAT'S AVAILABLE.",English
+BUT I'M NOT SURE WHAT THE COST WOULD BE. BUT I THINK AS LONG AS - THEY PROBABLY HAVE THE SAME GENERAL SCREENING. DON'T YOU THINK? >> YEAH. EXCEPT FOR THE CALCIUM SCORE.,English
+"THAT WOULD BE THE ONE THING THAT PLANET HEART WOULD HAVE WHERE YOU COULD LOOK AT THE CALCIUM OF THE CORONARIES, WHICH REQUIRES A SPECIALIZED C.T. SCAN WHICH IS NOT AVAILABLE",English
+"AT MOST OF THE THE TRAVELING-TYPE PROGRAMS. >> HOW GOOD OF A TEST IS THAT? >> WELL, IT'S - THERE IS A CERTAIN GROUP OF PATIENTS IN WHICH IT'S QUITE HELPFUL.",English
+"THOSE WHO ARE UNAWARE THAT THEY HAVE CORONARY DISEASE AND PERHAPS FIT INTO THE MID AGE GROUP, YOU KNOW, SAY 45 TO 65, YOU KNOW, THAT KIND OF THING. ONCE YOU GET TO BE MORE ELDERLY, BEYOND 65 -",English
+">> YOU'RE GOING TO HAVE AN ABNORMAL. >> YOU'RE GOING TO HAVE A CALCIUM SCORE, RIGHT. THE REAL YOUNG PATIENTS, PROBABLY NOT GOING TO HAVE ANY CALCIUM. IT'S REALLY THE MIDDLE GROUP. IF IT GETS THEM TO LOOK AFTER THEMSELVES,",English
+"IF IT GETS THEM TO QUIT SMOKING, IF IT GETS THEM TO EXERCISE, THEN IT'S A BENEFIT. >> YEAH. >> THE PLANET HEART SCREEN IS VERY COST EFFECTIVE. I CAN'T TELL YOU THE EXACT COST.",English
+"I WOULD GUESS THAT THE PLANET HEART SCREENINGS ARE A LITTLE BIT CHEAPER BUT I DON'T KNOW THAT FOR A FACT. >> A MALE CALLER FROM SIOUX FALLS ASKS, WHAT EXACTLY IS A STROKE? DUSTIN?",English
+">> WELL, A STROKE IS WHEN YOU HAVE -- IT'S SIMILAR, LIKE A HEART ATTACK, YOUR HEART'S DAMAGED BECAUSE YOU INTERRUPT THE BLOOD FLOW THERE. A STROKE IS THE SAME TYPE OF PROCESS BUT TO THE BRAIN. DIFFERENT CAUSES.",English
+"BUT A STROKE, IN GENERAL, IS ANY TIME THAT YOU HAVE BLOCKAGE TO THE BLOOD FLOW TO THE BRAIN, CAUSING DAMAGE TO THAT TISSUE. >> GO AHEAD. >> IT COULD EITHER BE A STROKE, WHICH IS A SIGNIFICANT DEFECT, YOU KNOW,",English
+"EITHER CAN'T MOVE YOUR ARM, LEG, SLURRED SPEECH, CAN'T SEE OUT OF AN EYE, NEUROLOGIC THING, OR IT CAN BE A TIA WHERE YOU MAY HAVE A NEUROLOGIC DEFICIT",English
+"BUT IT LASTS ONLY A FEW MINUTES. BOTH OF THEM ARE THINGS THAT NEED TO BE - YOU NEED TO SEE A MEDICAL - GO TO THE EMERGENCY DEPARTMENT, SEE A MEDICAL DOCTOR.",English
+"OR MEDICAL CARE PROVIDER AS SOON AS POSSIBLE. BECAUSE THOSE ARE BOTH THINGS THAT CAN'T BE IGNORED. EVEN IF YOUR SYMPTOMS GET BETTER RIGHT AWAY, YOU'RE GOING TO BE AT HIGHER RISK OF HAVING ANOTHER STROKE.",English
+"SO IT'S IMPORTANT TO BE EVALUATED. IT CAN BE CAUSED BY CAROTID DISEASE, THERE'S OTHER FACTORS. >> CAN OCCUR JUST RIGHT IN THE BRAIN. >> IT CAN BE FROM THE HEART.",English
+">> BUT IF IT'S A CLOT THAT FLIPS FROM THE HEART OR FROM THE CAROTIDS, THOSE ARE IMPORTANT TO DISCOVER. YOU NEED TO GET IN. >> YES. >> SO, YOU HAVE TO SEPARATE, I THINK, REMEMBER THAT SOME STROKES ARE HEMORRHAGIC STROKES,",English
+"MEANING YOU HAD A BLEED. THAT'S A SEPARATE CATEGORY. SO HALF OF THEM ARE KIND OF RELATED TO BLEEDING EVENTS, ALL RIGHT. AND THEN THE OTHERS ARE, YOU HAVE, AS YOU SAID, CARDIOEMBOLIC,",English
+"SO IF YOU HAVE ARTERIAL FIBRILLATION, YOU NEED TO BE EVALUATED, PUT ON BLOOD THINNER, PUT ON A NORMAL RHYTHM. IF YOU HAVE BLOCKAGE IN THE BLOOD VESSELS, YOU NEED TO HAVE THAT EVALUATED,",English
+"DETERMINE WHETHER THAT NEEDS TO BE FIXED. IF YOU HAVE HIGH BLOOD PRESSURE, YOUR RISK OF STROKE IS SEVEN-FOLD INCREASED IF YOUR BLOOD PRESSURE'S NOT ADEQUATELY CONTROLLED.",English
+"SO, ONE OF THE THINGS THAT WE OFTEN SORT OF NEGLECT IS THE PATIENT WHO DOESN'T GET THEIR BLOOD PRESSURE CHECKED VERY OFTEN OR DOESN'T LIKE TAKING THE MEDICINES, SO THERE ARE MEDICAL THINGS THAT CAN BE DONE TOO",English
+"THAT ARE VERY IMPORTANT AT HELPING PREVENT STROKE. >> AND FOLLOWING THE DOCTOR'S ORDERS. OR THE DIRECTION OR CHOOSING TO DO WHAT THE DOCTOR RECOMMENDS IS A GOOD IDEA. FEMALE FROM SIOUX FALLS ASKS, CAN YOU TALK ABOUT SMOKING AND CHEWING TOBACCO?",English
+"IS CHEWING TOBACCO AS SERIOUS AS SMOKING? FEMALE FROM RAPID CITY ASKS. THAT WAS IT. CHEWING VERSUS SMOKING. THEN THROW IN VAPING. >> WELL, YOU KNOW, I HAVE A COMMENT JUST REAL BRIEFLY.",English
+"CERTAINLY, TOBACCO USE IN GENERAL IS BAD, OKAY. THE CHARACTERISTICS AND THE TYPES OF DISEASE PROCESS ARE A LITTLE BIT DIFFERENT. CLEARLY, CIGARETTES HAVE BEEN ASSOCIATED WITH ORIGINALLY LUNG CANCER",English
+"AND THEN IN THE '70s, WE RECOGNIZED A MAJOR CONTRIBUTION TO CORONARY DISEASE AND PERIPHERAL VASCULAR DISEASE BECAUSE ALL OF THOSE BAD HUMORS, TAKING IN THE SMOKE, ARE COATING THE INSIDE OF YOUR BLOOD VESSELS.",English
+"CHEWING TOBACCO, LIP AND TONGUE CANCERS ARE PROBLEMATIC. THERE ALSO IS INCREASED RISK, POTENTIALLY, IN BLADDER CANCER,",English
+"SOME OF THE OTHER THINGS. BUT IT'S A LITTLE BIT DIFFERENT IN THE SENSE THAT THEY DON'T CONTRIBUTE TO THE SAME EXTENT TO OBSTRUCTIVE LUNG DISEASE, COPD OR EMPHYSEMA.",English
+>> ALL RIGHT. VERY GOOD ANSWER. HARD QUESTION. I HAVE THREE VARICOSE VEIN SURGERIES OVER THE LAST 20 YEARS. I BROKE MY ANKLE LAST YEAR AND MY LEG SWELLED UP SO BAD IT BROKE OPEN MY STITCHES.,English
+">> IT'S NOT THE VARICOSE VEIN SURGERY THAT BROUGHT THIS ON. >> SO THE VARICOSE VEINS, STRIP VARICOSE VEINS, THOSE ARE SUPERFICIAL VEINS. THE VEINS THAT YOU REALLY COUNT ON TO DECREASE YOUR EDEMA,",English
+"PROBLEMS LIKE THAT AFTER SURGERY - >> ARE INSIDE. >> IS THE DEEP VEINS. AND THOSE AREN'T VEINS THAT WE WILL SURGICALLY - SURGICALLY TAKE OUT. SO WHEN YOU HAVE A HEART BYPASS, WE USUALLY USE THE SUPERFICIAL VEIN.",English
+"THAT'S GENERALLY WELL TOLERATED. OR EVEN THE PERIPHERAL. NOW, CERTAINLY, IF YOU HAVE SURGERY, YOU HAVE A LOT OF SWELLING, YOU ARE AT INCREASED RISK OF HAVING A BLOOD CLOT IN YOUR VEINS AFTER SURGERY.",English
+">> ALL OF US WANT OUR FAMILY, NEIGHBORS, AND FRIENDS TO HAVE THE ABILITY TO MAKE APPROPRIATE DECISIONS ABOUT THEIR HEALTH CARE. TO DO SO, THEY NEED ACCESS TO INFORMATION FROM RELIABLE SOURCES,",English
+"LIKE Dr. HOLM AND HIS GUEST PHYSICIANS. HELLO, I'M STEPHANIE HERSETH SANDLIN AND I SERVE ON THE VOLUNTEER BOARD OF DIRECTORS OF THE HEALING WORDS FOUNDATION,",English
+"A 501c3 FOUNDATION ESTABLISHED TO SUPPORT THE WORK OF THE PRAIRIE DOCS. WITH YOUR CHARITABLE DONATION, YOU CAN HELP THE FOUNDATION CONTINUE",English
+"TO OFFER FREE AND EASY ACCESS TO THE ENTIRE LIBRARY OF PRAIRIE DOC HEALTH EDUCATION PROGRAMS. THIS MISSION IS SO VERY IMPORTANT TO RURAL COMMUNITIES AND RESIDENTS,",English
+"IN PARTICULAR, ACROSS SOUTH DAKOTA AND NEIGHBORING STATES. PLEASE CONSIDER A PERSONAL OR CORPORATE GIFT. JUST GO TO PRAIRIEDOC.ORG TO FIND MORE INFORMATION ON HOW YOU CAN HELP.",English
+"THANK YOU. >> WHAT IS YOUR THOUGHT ABOUT, 15 SECONDS, BOTTOM LINE, PEOPLE NEED TO TAKE HOME? >> I THINK FOR PERIPHERAL ARTERY DISEASE, IMPORTANT THING TO DO IS, YOU KNOW,",English
+"LIFESTYLE MODIFICATIONS, QUIT SMOKING, GET UP AND WALK, MAKE SURE YOU SEE YOUR PRIMARY CARE DOCTOR LIKE WE TALKED ABOUT EARLIER TO MAKE SURE THAT YOU'RE BEING TREATED WITH ASPIRIN AND MEDICALLY MANAGED APPROPRIATELY.",English
+">> ALL RIGHT. MIKE? >> AND IF YOU HAVE PROBLEMS, YOU KNOW, YOU SHOULDN'T BE AFRAID TO SEE A PRACTITIONER. YOU KNOW? THERE ARE MANY THINGS THAT CAN BE DONE, IT DOESN'T MEAN THAT YOU'RE GOING TO HAVE AN OPERATION.",English
+"MANY THINGS THAT CAN BE DONE, LESS INVASIVELY NOWADAYS, AND WE OFTEN STILL USE MEDICATIONS AND EXERCISE PROGRAMS SO THERE ARE MANY THINGS THAT CAN BE DONE. SO DON'T AVOID COMING TO THE DOCTOR IF YOU KNOW YOU HAVE A PROBLEM.",English
+"KEEPING CHOLESTEROL IN CHECK. AGREE, GENTLEMEN? IT'S A TOUGH ISSUE. OF COURSE, CARDIOLOGISTS. IT WAS MARY FROM SIOUX FALLS WHO ANSWERED THE QUESTION CORRECTLY.",English
+"THANK YOU, MARY, FOR PARTICIPATING AND A BOOK WILL BE IN THE MAIL TO YOU SOON. WE'LL BE RIGHT BACK AFTER THIS. >> FOR NEARLY TWO DECADES, THE PRAIRIE DOC ORGANIZATION HAS ENDEAVORED",English
+"TO ENHANCE HEALTH AND DIMINISH SUFFERING BY PROVIDING USEFUL INFORMATION BASED ON HONEST SCIENCE IN A RESPECTFUL AND COMPASSIONATE MANNER. HEALTH PROFESSIONALS VOLUNTEER TO ANSWER YOUR QUESTIONS EACH WEEK,",English
+"TO THE ENTIRE PRAIRIE DOC LIBRARY. >> FOR YEARS I CARED FOR A YOUNG GENTLEMAN WITH RECURRENT LEG SWELLING ASSOCIATED WITH REDNESS, FEVER, PAIN AND OPEN SORES BETWEEN HIS TOES",English
+"you need to come off of that. And so that was the point where we decided , okay I'm not going to go on birth control again, We're going to see a specialist.",English
+"But the specialist recommended this very specific pill. She was like, this is a really good one. And there was a reason she like,",English
+"specifically was picking this pill, but I can't remember why. I mean, this was when I was 16 or 17 and I'm 27. It was a long time ago.",English
+"I started taking the pill went and got the blood test. And pretty much immediately when I started taking this pill I, it was June.",English
+"I lived in a city that got very hot in the summer. So it was June, it was very sunny, it was very hot. I could not go outside.",English
+"Like, I'm a sun bunny, I love the sun. If I would go in the sun, I would break out in full body hives,",English
+"Head to toe, full body hives. Like bumpy, itchy, red rash all over my body. And I was like, why does this keep happening?",English
+"And then I looked up the pill. One of the very rare side effects was getting a head to tow sun rash, when you get, when your skin was exposed to sun.",English
+"So that was fun. But I literally only took it for like, I believe either, just under a week, or just over a week. Like I did not take it for very long.",English
+"And they said that when they got my blood results back all the things that they were actually testing for were totally fine, thankfully, but something",English
+they were completely not looking for came back. And that is that I had low Protein S in my liver. I'm not a doctor. I don't know much about this.,English
+"So I'm just explaining to you what I understand of it and what I know. And then I'll leave some information linked below, if you want to explore and learn more,",English
+"on your personal free time. So they said you have low Protein S in your liver. Which I believe, I was going to say I believe as an enzyme,",English
+"but it's a protein. It's literally called Protein S. Good job, Molly. So you get a low Protein S in your liver, and that is a blood clotting risk.",English
+"And so you've ever, you know, you're, one of the reasons you're not supposed to take birth control if you smoke cigarettes is",English
+"because cigarettes increase your risk for blood clots. And so does birth control. So if you're smoking and, like smoking cigarettes and taking birth control, your",English
+"risk for blood clots, goes higher. And so anybody with any form of blood clotting problems, cannot take things like birth control.",English
+"And that's why they were like, you need to immediately stop the use of birth control. And we're going to send you to thrombosis at sick kids. Which is the blood clinic.",English
+"And so I went to see a blood specialist , and they did a whole workup, of my family's history, and all that.",English
+"And we had no history of blood clots in the fam. My father's sister did pass away of blood cancer, when she was 11. Leukemia.",English
+"But there's no history of like blood clots. That's the closest thing to blood problems, that have been in my family's history on either side.",English
+"They determined, majority of people who have. So, the actual disorder is called, Protein S deficiency disorder, which is why I had to get checked.",English
+"'cause I had low levels of Protein S, and then from there, they had to go and diagnose me with Protein S deficiency disorder. And so there's Protein C, from what I understand,",English
+"again this is just me. There's Protein C deficiency disorder and this protein S deficiency disorder. Both are blood clotting disorders, protein.",English
+"we have a whole host of problems with Ms. Lavender pie. If you can check out this video recently did. Protein C deficiency disorder is believed to be,",English
+"one in 300 people that have it. And then Protein S deficiency disorder. It's believed to be ,one in 20,000 people who have it. So like, far more rare than Protein C deficiency disorder.",English
+"Either way, both are, you know, medical conditions that you need, you know, you need to be aware of. And I feel very, very, very blessed,",English
+"that I got diagnosed by complete accident. That they found this anomaly in my genes. It is a genetic condition,",English
+"So it is passed down from your family. However, the doctor told my mom and I at the appointment that you can also develop it.",English
+"So most people with Protein S deficiency disorder, is passed down as a faulty gene from either the mother or the father or both. But in my case, they believe I developed it,",English
+"through the use of birth control. So, this is just what I've been told. Again, not a doctor.",English
+And I'm certainly not pulling this fact out of nowhere. This is what I was told by a medical professional. They believe that I developed Protein S deficiency disorder,English
+"from using birth control. I would like to say I was on birth control for an entirety of probably just over a month, between two different pills, that's all.",English
+"For, let's say, a maximum of six weeks in my life. I have taken a birth control pill. - [Momma B] They only think that, there's no proof. - So this is what they believe, they can't,",English
+"there's no way that, there's nothing they can test, right. To like find out that, that's the conclusive way that I got it. That was just one of their hypothesis, hypotheses?",English
+"Anyways, that was just one of their kind of guesses, as to how I could have developed this without it being genetic.",English
+"Because they said there has been a link between, between that. So that's all I can say as to how I potentially got it. I eventually was transferred out of sick kids thrombosis,",English
+"when I was 18, to an adult hospital, which anybody who ever grows up going to a children's hospital knows it's a very",English
+"sad day when you have to start going to an adult hospital, because it is not the same. I kind of like fell off. So, when I went to the adult specialist",English
+they got me custom socks made. So here are kind of some of the things that I was told with Protein S deficiency disorder. I was told that I needed to maintain my weight.,English
+"I should not gain too much weight. And I did touch on this, in my weight gain and weight loss stories, that I did recently",English
+"or like probably like eight months ago, now. I'm not sure. But that is, is, it's very literally like my Protein S deficiency disorder",English
+is very much the reason that I chose to lose weight. I was at my highest weight. I was at the top range of healthy for my height.,English
+"And so, at the end of the day like if I continue to gain weight, I was going to go over the healthy weight range, into considered overweight category.",English
+"I was explicitly told by a medical professional that I should try to maintain my weight and stay at it, at the lower end of my healthy weight range.",English
+"Because again, just like smoking cigarettes is a high risk for blood clots. Birth control, high risk for blood clots. So is weight gain. The heavier you are,",English
+"the more likely you are to develop a blood clot. That's just the reality. And so, I was told I had to maintain my weight. I was not allowed to take birth control.",English
+"I always need to tell medical professionals that I have Protein S deficiency disorder, before taking any kind of prescription, because certain medications are higher risk for blood clots.",English
+"So, I always have to make sure that when I'm getting prescribed to anything that they know that I'm high risk for blood clots. When I travel on long flights,",English
+"I'm supposed to make sure I'm getting up and moving, walking around. Again, being stagnant. Not moving enough, higher risk for blood clots. I also got custom made compression socks.",English
+"Now you'll probably see these at drug stores Like a Walgreens or CVS, or shoppers drug Mart, London drug, whatever.",English
+"Rite Aid. Let me just list all the drug stores, in case you don't know the names of them. Good one Molly that's very helpful for everyone.",English
+"So you'll probably see them there, and you'll kind of think, Oh, old ladies wear those. But, so I basically had those compression socks but custom made so much tighter,",English
+"and incredibly hard to get on, and incredibly uncomfortable to wear. But they were custom made compression socks that were the same color as my skin.",English
+"And they went up to my knees and I'm supposed to wear those on long haul flights, anything over six hours. As you guys know, pre COVID, I spent my life traveling,",English
+"and honestly was really bad about it. Like, I, I never, I never wore them. I wore them, near the beginning of my diagnosis,",English
+"when I was younger in my early twenties, but I kind of just honestly forgot that I had this, and not to say that, like every time I would go",English
+to the emergency room for something I would make sure my intake form to let them know I have Protein S deficiency disorder. It's not that I forgot I had it.,English
+"I was aware of what things that I should avoid, and things that I should look out for, and things that I should mention to doctors. And like warning signs that I'm getting a blood clot.",English
+"But I kinda just like forgot that it's like a big deal, that like people die of blood clots and that you should actually take your health seriously.",English
+"So, I just wasn't wearing my compression socks, which I should do when I start traveling again. I will try my best. Is, you have to drink a lot of water",English
+"when you're, when you're on long haul flights or long haul car rides. Just, basically anything that lowers risk of blood clots. My, a lot of my family members were quite concerned,",English
+"when COVID popped up, and the link of COVID deaths, and blood clots was starting to arise.",English
+"Also, I would just like to mention that, I feel like I've seen a lot of people over the last year that COVID's been going on be like,",English
+"Oh, well most people dying have pre-existing conditions. As a, as a way to be like,",English
+"Oh it's not like a, like, I wouldn't die. Cause like it's just people with pre-existing conditions dying. And that's not, like that's not as bad somehow.",English
+"As somebody with a preexisting condition, who if I got COVID and passed away from would be considered a category of somebody who died with a preexisting condition.",English
+"I would just like to say that number one, lots of people have preexisting conditions and don't know they have them until they die. So you might have one and not know it.",English
+"And number two, people with pre-existing conditions are still valid people, like they're still loved. They still contribute to society.",English
+"We're still, you know, we still have friends and family, and we still have a job and we still have a heart. You know, we're still people,",English
+"just because you have a pre-existing condition doesn't mean that you're less than, or that like your death doesn't matter as much,",English
+"as somebody who may be healthy, or seem more healthy because you just don't know that you have something. Or because even if you don't,",English
+"Again, this is just from my understanding. The reason that people with COVID are dying from blood clots, is specifically because the level of Protein S in their",English
+liver drops and I already have a deficiency of my Protein S. I have a mild case. Majority of Protein S deficiency disorder is mild.,English
+"It's, it's far more rare to be severe. Most people are mild and I'm very thankful to be a mild case, but nonetheless, it is something that I know.",English
+Like particularly over this last year of my life with COVID like I've needed to be more aware of. And I literally read this article from a thrombosis doctor just the other day. That was like,English
+"And because in particular young people who are dying from COVID, it tends to be blood clots due to the Protein S levels dropping.",English
+"I would have to most likely get a shot of a blood thinner in my stomach every day, throughout my COVID. I have had that once before in my life, I went to the ER",English
+"in the stomach, of a blood thinner. It's like a sharp, it's like a burning pain. And it just goes, it's not a big deal. But I would most likely if I got COVID that like",English
+"that would be something I'd immediately disclose that I have Protein S deficiency disorder. And they would most likely have me go get blood thinner shots every day, to try to stop",English
+"any increased risk. Like this really popped up in my mind the other day, when the Johnson and Johnson vaccine was recalled for blood clots in women,",English
+"18 to 48 And one has passed away. And one is in critical condition. Obviously, it's only six women,",English
+"in the grand scheme is a small number, but those six people matter. And I can't help, but wonder if if any of them were living with Protein S deficiency",English
+"I let them know. And, you know, the AstraZeneca vaccine, also causes blood clots. It `has been found to cause blood clots.So,",English
+"I got my first shot yesterday. I don't know if I got Pfizer or Moderna but I got Pfizer or Moderna, yesterday. So please send me good vibes.",English
+"Please send me all your good vibes. Okay. Because again, I am the person who gets all the side effects. So I'm definitely nervous, but I know that it's,",English
+"it's the right thing to do, because the risk for me getting COVID is just too high. And that's why I'm able to get my vaccine earlier",English
+than a lot of people my age. Because I'm considered medically extremely vulnerable. That's the category I fall under.,English
+Many people have underlying conditions that go undiagnosed until they pass away. Or until something serious happens. So I'm really lucky.,English
+"on Saturday. So in two days, today's Thursday for me I'm getting a full panel done to check my liver enzymes and just track like all my blood counts right now,",English
+"because I, like I said, honestly, like ,having anxiety and PTSD and being blind, and all of these other things that like affect me very regularly on a daily basis.",English
+"I'm just kidding. I'm just kidding. I turned 47 last year, and I'm quickly approaching the big five. But when I was in training, this concept",English
+We never thought about it. We ignored it. And there's still a lot of physicians who still ignore white coat hypertension. But the data shows that white coat is,English
+"So unlike before, you still have to pay attention nowadays to white coat. Then there's what's called dippers and non dippers.",English
+"And so there's actually four types of high blood. I'm sorry, four types of blood pressure. You need to understand dippers are people whose blood pressure dips in the evening. So, Michelle, if I took your blood",English
+"And I think that's just a really important thing to emphasize is that if you have high blood pressure, if you're recommended to check your blood pressure",English
+"at home, please check your blood pressure at home. Make sure you have a machine and cuff that work because it's so much easier for your doctor to dose your medication and provide",English
+"recommendation if they know what it is at least once a day, but ideally twice a day versus they're just going off one point in time. When you come into the doctor, that's not",English
+"really representative of what it is on a daily basis. And then the other thing that I think is really important to mention with this is just, again, knowledge is power and awareness around this.",English
+And I've heard way too many times that people said they had no idea they had high blood pressure because they don't go to a regular PCP or they don't do annual exams or things like that.,English
+"So they haven't had their blood pressure checked in 510 years, and then all of a sudden it's been high. It's been damaging the kidney. So it's something for everyone to whether",English
+"you have kidney disease or not, if you have any friends, family, loved ones that maybe are putting off just regular physical exams or putting off blood",English
+"pressures, just white coat syndrome, it might be important to check that at home and really see what it is on a daily basis. Yeah, you said something that's really, really important, which is no symptoms.",English
+"So remember, guys, we've talked about this in all of our episodes. One in seven have kidney disease. 90 plus percent of the patients who have",English
+"kidney disease don't know they have kidney disease because there are no symptoms. High blood pressure. In the majority of people, there are no symptoms.",English
+"If you're waiting until you have the headaches, then that's where the blood pressure is like 200 and something. And it's really critical. But people walking around with blood",English
+"pressures in the 150s, 160s, 170s, it's really high and it's really bad and it's stiffening your blood vessels and you need to know about it. So if you haven't checked your blood pressure, please, every single store out",English
+"there, they have a cuff that you can use for free. But nowadays the cuffs are about $20. You don't need any of the bells and whistles, a basic blood pressure cuff.",English
+"Remember, you want to have your back against a chair, you don't want your legs crossed. And you want to make sure you pee before you check your blood pressure because if",English
+"hand, heart level and get your blood pressure checked. And if it's elevated, it's not the end of the world. That's where Michelle and I are trying to help you guys with that.",English
+"Physical activity is also important. So if someone is physically inactive or they're very sedentary, that can impact and raise your blood pressure levels.",English
+"Other things like smoking, always come up. Alcohol intake is important, and then even excess body fat can also contribute to elevated blood pressure levels.",English
+"So I'd say those are all things on the side of lifestyle. And, of course, diet is a lifestyle as well. But then from the food side of it, we are looking you mentioned salt, and sodium is",English
+"a huge part of that, as well as when we think of excess body fat and obesity, potentially excess calories, the type of if it's a highly",English
+"standard American diet of highly processed, refined foods. And then the other thing that comes up, it's not as directly related to blood",English
+"pressure, but kind of overall cardiovascular health is fiber intake. And most Americans are not getting enough fiber in the diet. And so all of those things, we can dive more into details of those.",English
+"But all of those things are very important, and we're going to go a lot more into the sodium. But people are always asking, well, how much sodium should I have in a day?",English
+"And one of the important things to recognize is that most and I would say most Americans, because I'm not positive. I'm sure other countries potentially have similar issues.",English
+"But at least in the United States, most people are consuming 34, 3600 milligrams of sodium per day or more. And what is generally considered or recommended is 2300 milligrams or less.",English
+But we really want to go even tighter with that for kidney and heart health and recommend up to 1500 milligrams of sodium a day. And that does not mean that you have to,English
+eat right if you've consumed 1200 mg for the day that you need to now add in the salty snack to get to that 1500 milligrams. But it's typically up to that 1500 milligrams of sodium Mark for the day.,English
+"And when we think of the majority of salt, if someone say, oh, well, I don't put salt on my food, so I don't consume too much sodium, 70% 75% of the salt that we actually consume usually comes from",English
+"processed food, packaged food, fast food restaurant food. And if you've ever looked up online the nutrition information for a restaurant or a fast food restaurant, it truly is shocking.",English
+"Like if we're trying to limit to about 1500 mg a day of sodium, one dish, one meal at a fast food restaurant can be that or even twice that amount.",English
+So it will come down to reading the labels because it's shocking how much salt is really added to processed packaged food and then restaurant and fast food meals.,English
+"We will dive into this more. But what I often get asked, too, is, well, how do I make sure I'm getting enough sodium? And we've said this before is if you simply track your intake for a couple of",English
+"days, you can really see how much salt you're getting in your diet. And you'll see how I think most people are shocked how quickly sodium can add up unless you're literally cooking absolutely everything from scratch and you're not",English
+"adding any salt to your fully home cooked meals. But even in that case, on that lower end, potentially around 500 mg, maybe even a",English
+"little less, that's where we're looking at on the lower end of sodium than what you would want to take in, which is really easy to get. Most people are not consuming too little sodium.",English
+"people have to worry about getting too little salt, period. Yeah. So that does lead to, I guess, a couple of two part question.",English
+"So when it comes to sodium intake and we talk about a number like 3600 milligrams, that's an average number. What the average means is you're taking",English
+"all those numbers and trying to find a point in the middle. That means half the people consume more than that. In fact, it's not uncommon for the typical",English
+the standard American diet to be consuming 5000 mg or more. So what the data shows is that 50% of the people consume more sodium than they're supposed to.,English
+"What's the issue with sodium? It's causing water to be retained inside the body. Now, your kidneys work extra hard to try to get rid of that. Remember, as it's trying to do that and",English
+"hold on to water, it's also creating more pressure against those blood vessels. As it does that, it creates stiffness. So what that means is over years and",English
+"years, that will lead to stiffer blood vessels. As the blood vessels get stiffer. That's when we start to run into issues of",English
+"having things like high blood pressure, having things like pulse pressure, which is the difference between the top and the bottom number. And some people, in some studies, it shows that that number is important.",English
+"In others, it shows that, you know what? Pulse pressure doesn't really matter. You don't need to pay attention to it. Just pay attention to the overall blood pressure number.",English
+"But regardless, you want to focus on trying to eat less processed foods, more whole foods, and focus on the sodium content. Because no matter what you think you eat,",English
+"every time you go out to eat, you're consuming way more sodium than what Michelle and I are trying to ask you guys to do. Yeah. So that effect of that fluid retention and",English
+"is that happening with a high sodium diet, regardless of someone is having fluid, like seeing swelling or edema and let's say their ankles or their feet, like they",English
+"might have absolutely no signs or symptoms of that. But on the inside, excess sodium intake, there's more fluid retention kind of on the inside. And then the kidneys are having to work harder.",English
+"Yeah. So when we have patients who have been on dialysis for a while and they look great, they don't have swelling in their legs going on. And we put a brand new kidney into them.",English
+"The first thing that happens over the first 24 to 48 hours, they pee out like crazy. And when I was a fellow in training, I remember I used to always surprise me.",English
+"I would say, where the heck is this water coming from? It's not in their ankles. It's not visible to us. But this is what you got to remember.",English
+"Is there's things that are visible and then there are things that are invisible to us. Just because we don't see them, it doesn't mean that they still can't hurt us.",English
+"So that's where the fluid retention is just there. And your kidneys are working so well to balance out the extra fluid, but you're just adding more pressure where you don't",English
+"need to you don't need to make your kidneys work harder than they need to, and you don't need to make extra pressure on your blood vessels if they don't need it.",English
+So another question with this that came up and comes up often then is how do our blood sodium levels relate to the sodium that we eat in our diet? And if someone,English
+"has low blood sodium levels, does that mean then that they need to eat more salt? Yeah. So a very complex issue. So when we talk about low sodium inside",English
+"the blood, we're talking about a medical term called hyponatremia. Now hyponatremia comes in a lot of different varieties that you want to know about.",English
+"The first thing you got to know is we classify low sodium into mild, moderate, and severe. On the severe side, you need to really be",English
+"careful because it can cause seizures, coma, and death. So normal sodium inside your blood is about 135 milligrammels per liter to 145,000,000 equivalents per liter.",English
+"Now low sodium is classified in those three categories. So mild is about 130 to about 134 moderate. I think of it as about 120 to 129, but severe is less than 120.",English
+So now you have the definition of hypo or low nutrimia or salt. Now comes the next question of deciding how do you treat it?,English
+"Right now, there are two big things you have to know. Is it acute or is it chronic because the treatment is different? If it's chronic, you have to be very",English
+"concerned about raising the salt level too fast, because if you restore their salt level too fast, you will permanently damage their brain.",English
+"It is a very serious, irreversible condition. So you got to know, is it acute? The definition is less than 48 hours,",English
+"meaning you just had surgery and your salt level dropped. If it's acute, nine out of ten times, it will correct by itself. My job is to monitor it, stay out of the way and only intervene if it's needed.",English
+"If it's chronic, meaning more than 48 hours, I usually have to get involved. Now when I have to get involved, what I need to know is what's going on.",English
+"You see, low salt is usually not because of low salt intake one more time. The blood salt level is usually not low because you're not consuming enough salt.",English
+"It's usually low because your body is holding on to too much water. So remember, imagine if I have I'm holding up my left hand, so I have five pieces of salt in my cup of coffee here.",English
+"So I have a concentration of, let's say five in 100 CCS. But if I change this coffee cup into a gigantic cup, that's 1000 CCS, my concentration has drastically gone down.",English
+But did I change my five pieces of salt? Absolutely not. So concentration matters.,English
+"So if I get somebody who has a lot of water, meaning I look at them, they're swollen everywhere. We call that hypervolemic, meaning hyper, meaning high volumeic hypodermic.",English
+"So they are high sodium level going, I'm sorry, they're high volume, hypervolemic, high volume and low salt. The treatment is I need to get rid of the water from them.",English
+"Right, because I'm going to change the concentration and bring them back. Then there's the opposite spectrum, which is hypovolemic, hyponatrimia. That means my volume is very down.",English
+I've been throwing up like crazy and all sorts of other things have been happening. The treatment is you just have to give those people a little bit of volume and it will fix the salt because the kidneys will take care of it.,English
+The ones that are the hardest to treat are what we call you volemic. They're like you and I. Their salt level is okay. I'm sorry.,English
+"Their volume level is okay. So the water is okay, but their salt is low. And the most common type of that is called SIADH, which stands for Syndrome of inappropriate anti diuretic hormone.",English
+"That's a mouthful, but that's why it makes me sound fancy. And even though all I'm saying is their volume is okay and their sodium is low, now the treatment for that is we restrict their fluids.",English
+"That's first and foremost, and we give them some salt tabs. So the answer to that question is if your sodium is low, you need to make sure that",English
+"you work with your doctor so we can figure out in that whole complex thing that I just went over in detail to know, where do you stand and how we can fix it.",English
+"Okay, got it. That's very helpful. And in that third situation, then where their fluid volume is normal, but they're having the low blood sodium levels and you're restricting the fluid.",English
+"Is that because I hear that often people say, oh, well, my blood sodium was low. So I was told I'm drinking too much water. And I feel like that oftentimes comes up",English
+more and more elderly population and where they're told that. So how is that related? And is that something where they have to,English
+"always consume a lower amount of fluid or is that a short term thing until you get the blood sodium back up, or will it just keep going back and forth? So low sodium or hyponatremia is a really difficult thing to control.",English
+"Number two is you have to be very careful about restricting their fluid level because you don't want to make them dehydrated. Remember, the definition of you volemic",English
+"means on the outside, I look like my fluid status is okay. But on the inside, I still have extra water. So the fluid restriction is because of what's happening on the inside.",English
+"But as I do that, I have to be very careful, especially with my folks that are elderly, not to dehydrate them. So this is why when I have patients who",English
+"are older, I always end up having to use salt tabs with it because of the fact that it's not realistic to restrict them down to a liter a day, 1200 CCS a day, because",English
+"when I do, they're not going to do a good job of measuring. And they can go into acute kidney injury or acute renal failure simply because of what I was trying to do.",English
+"So this is why it's so important to work with your nephrologist on this, because we deal with this so much and it's like this really medicine is an art more than it's",English
+"anything else in the art or practice of medicine. It's the more experience you have making small changes and seeing how the reaction is, the better off we're able to deal with that.",English
+We don't want to correct it too fast and we don't want to bring the volume down so much that you go the opposite direction. Got it? That's very helpful.,English
+And that's something that a lot of people ask questions on. So I'm excited that you're able to answer that. And I think we'll have to talk about this topic because there's so much more on this,English
+"low sodium issue because it is a serious condition. And by the way, both low sodium and high sodium in the blood can cause seizures, coma, and death, and we need to be concerned about that.",English
+But what the salt level you take in? It's a little bit different than what's really happening to your sodium level because of the fact that salt goes in and out of cells and it goes out the kidneys.,English
+"So your body has mechanisms to protect yourself. All right, Michelle, time for one last question, which is can you provide some tips for how to flavor food or meals and so forth when people are trying to take",English
+"our advice and follow a low sodium diet, what are some tips for them? Yes. So still add flavor to your food. I think the biggest thing is, again, saltiness is something that we",English
+"kind of grow accustomed to and our taste buds become heightened for. And the more we are eating out, the more we're eating salty food, the more we feel like we need it on our food.",English
+"So first, I would say is if you are consuming the standard American diet, potentially having double or triple the amount of sodium that you should be having, and you're starting to cut back and food is just kind of tasting bland.",English
+"One is know your taste buds will adjust and just give it a little time, and it's a very short amount of time for your taste buds to adjust.",English
+But you want to replace that salt that you're typically adding to your food with other herbs and spices and that are just naturally salt free or lower in sodium.,English
+"So some of my favorite are things like garlic and onion different either spice blends or powders. So think of black pepper, cumin, chili",English
+"powder, paprika, Rosemary, Bay leaves, I mean, unlimited amount of spices that are just naturally salt free or lower in sodium.",English
+"And then there are a lot of blends. Like if you find the what is it, the seasoning salt or different spice blends that are very, very salty.",English
+"You can usually find a low sodium version of that online where you just combine those different herbs and spices yourself, like a barbecue rub that doesn't",English
+">> YEAH, IT IS A SIGNIFICANT DISEASE. THAT'S WHY IT'S IMPORTANT TO CATCH IT EARLY AND TO DO LIFESTYLE MODIFICATIONS AND MEDICAL TREATMENT AS MUCH AS POSSIBLE. EARLY ON.",English
+">> SO, THE MOST IMPORTANT THING WE CAN DO TO HELP PREVENT VASCULAR DISEASE, LIKE THIS, THAT WE'RE TALKING ABOUT IS LIFESTYLE CHANGES. NOW, BEFORE WE ASK THAT QUESTION, THOUGH, IF I HAVE CLAUDICATION, IN OTHER WORDS,",English
+"I HAVE ANGINA OF THE LEGS AND I'M FEELING PAIN WHEN I'M WALKING, WHEN I STOP, IT GOES AWAY, WHAT DOES THAT SAY ABOUT MY POSSIBILITY OF HAVING OTHER VASCULAR DISEASE, STROKES AND HEART ATTACKS?",English
+">> WELL, I MEAN, THERE HAVE BEEN LARGE STUDIES DONE IN THE PAST THAT GO BACK A NUMBER OF DECADES NOW THAT CLEARLY ESTABLISH THAT PEOPLE WHO HAVE BLOCKAGE IN THE LEG BLOOD VESSELS HAVE A VERY HIGH RISK OF HAVING BLOCKAGE IN THE HEART BLOOD VESSELS AND PROBABLY IN THAT 80% RANGE.",English
+"SO IT'S VERY SIGNIFICANT. DOESN'T GUARANTEE IT. AND THERE ARE SOME FOLKS THAT ARE LUCKY THAT DON'T. BUT IT'S A VERY HIGH PERCENTAGE. NOW, NOT ALL OF THEM NEED TO HAVE SOMETHING DONE.",English
+"THEY MAY HAVE BLOCKAGE THAT'S NOT CRITICAL, BUT IT IS A MARKER FOR TROUBLE, THAT'S RIGHT. >> ALL RIGHT. >> SOMETIMES AT THE BEGINNING OF A STROKE THERE IS A DISCONNECT BETWEEN ONE'S",English
+"THOUGHTS AND ACTIONS DUE TO DAMAGE THAT IS HAPPENING TO THE BRAIN. >> MY DAY STARTED AS A NORMAL DAY. I MEAN, I GOT UP. I WAS GOING TO GO TO WORK. I HAVE MY ROUTINE, YOU KNOW, SHOWER, SHAVE, SHAMPOO.",English
+"AND GET READY TO GO. HAVE SOME BREAKFAST. AND WHEN I GOT TO THE KITCHEN, THINGS WERE A LITTLE CONFUSING FOR ME. I GOT THE OATMEAL OUT OF THE CUPBOARD, AND I GOT THE BOWL OUT OF THE CUPBOARD.",English
+"AND I GOT THE SPOON OUT OF THE DRAWER, AND I COULDN'T FIGURE OUT WHAT TO DO WITH THEM. SO I HAD THESE THREE OBJECTS IN MY HAND AND I WAS FROZE IN PLACE.",English
+"MY WIFE CAME IN AND AT THAT POINT WHEN SHE CAME IN, SOMEHOW I FIGURED IT OUT AND I HAD THE BOWL IN FRONT OF ME AND I WAS SITTING AT THE TABLE.",English
+"BUT AS I WAS EATING, THE STUFF WAS COMING RIGHT OUT. SO ONE OF THE TESTS I HAD WAS AN M.R.I. AND THE TEST RESULT SHOWED THAT I HAD A STROKE. ONE OF THE THINGS THAT I",English
+"REMEMBER THE MOST IS THAT ONE OF THE PERSONS WHO MUST HAVE BEEN A SPEECH THERAPIST, AUDIOLOGIST, AND SHE SHOWS ME THIS PICTURE AND THIS PICTURE IS SOMETHING OUT OF DICK AND JANE.",English
+"I KNOW I'M DATING MYSELF WITH THAT. AND IT'S A VERY SIMPLE PICTURE. AND I CAN'T TELL HER A THING. A DEFINING MOMENT FOR MYSELF IN MY RECOVERY, THE PHYSICAL",English
+"THERAPY, THE OCCUPATIONAL THERAPY, BUT ESPECIALLY THE SPEECH THERAPY, BECAUSE THAT WAS THE HARDEST FOR ME, TO MY SURPRISE, ONE OF THE FIRST THINGS THE SPEECH THERAPIST",English
+"DOES IS SHE PUTS THIS PICTURE IN FRONT OF ME AND SHE SAYS, CAN YOU DESCRIBE WHAT'S ON THIS PICTURE? AND I JUST -- I GET EMOTIONAL ABOUT IT. BECAUSE IT'S THE SAME PICTURE THAT JUST A FEW DAYS, WEEKS",English
+"AGO I WAS SHOWN AT THE HOSPITAL AND I COULDN'T DESCRIBE A THING. AND I TOLD THE SPEECH THERAPIST, YOU'RE GOING TO SIT HERE FOR THE NEXT HALF HOUR BECAUSE I CAN TELL YOU EVERYTHING THAT'S IN THAT PICTURE. AND I WANT TO PUT THAT PICTURE",English
+IN A FRAME BECAUSE I KNEW I WASN'T BACK ALL THE WAY BUT I WAS COMING BACK. SO YOU BETTER WATCH OUT. [MUSIC],English
+">> WELL, THAT'S A GREAT STORY. THANK YOU FOR SHARING YOUR STORY WITH US. I MEAN, HE PRESENTED WITH AN INTERESTING ARRAY OF SYMPTOMS. YOU KNOW, HOW COMMON IS THAT?",English
+"AND HOW COMMON ARE STROKES? >> WELL, YOU KNOW, I THINK HIS PRESENTATION'S ACTUALLY RELATIVELY COMMON. IT BECAME APPARENTLY AS HE DESCRIBED IT, HE REALLY DIDN'T UNDERSTAND WHAT WAS GOING ON.",English
+"IT DIDN'T COME TO THE FOREFRONT THAT HE WAS HAVING A STROKE, HE JUST COULDN'T FIGURE OUT WHAT WAS WRONG. AND I THINK THAT THIS IS WHY WE, PERHAPS, DO NEED TO USE THE NAME BRAIN ATTACK AS OPPOSED, LIKE A HEART ATTACK,",English
+"ONLY OF THE BRAIN, AS OPPOSED TO THE STROKE THAT SEEMS SORT OF ABSTRACT, MAYBE IT WILL RESONATE WITH PEOPLE. AND I THINK THAT MORE EDUCATION ABOUT THE KINDS OF SYMPTOMS THAT PEOPLE WILL HAVE.",English
+">> LIKE WHAT? >> WELL, THEY MAY HAVE WEAKNESS OR CLUMSINESS IN AN ARM OR A LEG, AND IT MAY BE TRANSIENT, IT MAY BE A RELATIVELY LIMITED-TYPE THING. THEY JUST CAN'T HOLD THE",English
+"COFFEE CUP OR THEY DROP SOMETHING THAT THEY WOULDN'T USUALLY DROP. THEY MAY DEVELOP SLURRED SPEECH OR WORD FINDING PROBLEMS, LIKE HE COULDN'T DESCRIBE SOMETHING. MAY BE THAT YOU'RE SITTING ACROSS FROM YOUR WIFE AT THE BREAKFAST TABLE AND YOU WANT",English
+"HER TO PASS SOMETHING AND YOU CAN'T ASK FOR IT. I MEAN, IT IS NOT ALWAYS THIS SITUATION WHERE YOU SUDDENLY FALL DOWN OR LOSE MOTOR FUNCTION IN AN ARM OR A LEG. >> IT CAN BE A VERY SUBTLE THING. >> YES. >> THE IMPORTANT POINT IS THAT IT CAN BE TRANSIENT.",English
+"SO YOU CAN HAVE THESE SYMPTOMS AND ALL OF A SUDDEN YOU FEEL NORMAL AGAIN. BUT, STILL, IT'S A MAJOR PROBLEM. IT'S SOMETHING YOU NEED TO SEEK MEDICAL HELP IMMEDIATELY BECAUSE IT'S A SIGN THAT IF YOU DON'T GET TREATMENT SOON, YOU WILL HAVE A MAJOR STROKE.",English
+">> SO, THAT'S A TRANSIENT, ISCHEMIC EVENT. AN EVENT THAT HAPPENED IN THE BRAIN, GOES AWAY, IT SHOULD NOT MEAN, OH, IT'S BETTER AND I DON'T NEED TO DO ANYTHING ABOUT IT.",English
+"IT MEANS YOU NEED TO GET IN. NOW, WHAT WOULD YOU DO? WOULD YOU SAY -- LET'S SAY IT'S 9:00 AT NIGHT. WOULD YOU GO TO THE EMERGENCY ROOM OR WOULD YOU GO IN THE NEXT MORNING OR WHAT WOULD YOU DO?",English
+">> WELL, WHAT WE ADVISE PATIENTS, IF THEY HAVE A SPECIFIC NEUROLOGIC DEFICIT, MEANING THAT THEY HAVE CLUMSINESS OR THEY CAN'T -- >> RIGHT ARM DOESN'T WORK.",English
+">> THAT SORT OF THING. THAT THEY SEEK MEDICAL ATTENTION IMMEDIATELY. EITHER THEY GO TO THE URGENT CARE CENTER, GO TO THE EMERGENCY CENTER, DESCRIBE THEIR SYMPTOMS, EVEN IF THEY'VE RESOLVED AND ARE NO LONGER HAVING ACTIVE SYMPTOMS.",English
+"THEY CAN UNDERGO EVALUATION, MAY BE A BRAIN SCAN, MAY NOT BE, OR THERAPY CAN BE INITIATED. MAYBE IT WAS RELATED TO BLOOD PRESSURE THAT'S OUT OF CONTROL.",English
+OR IT MAY BE SOME OTHER THINGS. IT DOESN'T ALWAYS MEAN THAT YOU'VE HAD AN ACUTE PERMANENT DAMAGE TO THE BRAIN. BUT IT'S SOMETHING THAT YOU CLEARLY NEED TO HAVE EVALUATED. >> RIGHT.,English
+">> I WOULDN'T WAIT UNTIL THE NEXT MORNING. >> YOU WOULDN'T WAIT UNTIL THE NEXT DAY. WOULD YOU TAKE AN ASPIRIN BEFORE YOU GO TO THE EMERGENCY ROOM? >> LOTS OF PEOPLE DO. LOTS OF PEOPLE DO. THE ONLY PROBLEM IS THAT, REMEMBER, 50% OF STROKES THAT",English
+"OCCUR THAT ARE ACUTE ARE HEMORRHAGIC, THEY INVOLVE SOME FORM OF BLEEDING. AND AS A RESULT, ASPIRIN MAY NOT ALWAYS BE OF BENEFIT TO YOU. SO I THINK THAT YOU'RE PROBABLY BETTER OFF IN SEEKING MEDICAL ATTENTION ON AN URGENT",English
+"BASIS AND THEN ALLOWING THE CLINICIAN TO MAKE THAT DETERMINATION AS TO WHETHER YOU SHOULD BE ON ASPIRIN OR WHETHER YOU NEED BLOOD THINNER OR WHETHER YOU DON'T NEED EITHER ONE. >> SO IF YOU HAVE A T.I.A., WHICH IS EXACTLY AS HE DESCRIBED -- BUT A T.I.A.,",English
+"IT'S GONE WITHIN AN HOUR OR SOMETHING LIKE THAT, RIGHT? >> LESS THAN 24 HOURS, TECHNICALLY. >> ALL RIGHT. BUT IF YOU HAVE A T.I.A., SOMETHING THAT GOES AWAY, WHAT",English
+"IS THE PERCENTAGE THAT YOU'RE GOING TO HAVE A BIGGER STROKE OR YOU'RE GOING TO HAVE ANOTHER STROKE OR YOU'RE GOING TO HAVE A VASCULAR EVENT? >> WELL, THAT'S A LITTLE COMPLICATED TO ANSWER BECAUSE IT DEPENDS ON THE CAUSE. IF IT'S RELATED TO BLOCKAGE IN",English
+"THE NECK BLOOD VESSELS, AND YOU HAVE SEVERE BLOCKAGE AND YOU'VE HAD A T.I.A. OR SMALL STROKE THAT THEN RESOLVES, YOUR RISK OF HAVING ANOTHER MAJOR EVENT IS ABOUT 10% PER YEAR.",English
+"IF, HOWEVER, IT'S DUE TO ATRIAL FIBRILLATION OR SOME OTHER HEART EVENT, THEN IT'S A VERY DIFFERENT SITUATION, YEAH. >> RIGHT. BUT THEN THAT'S ANOTHER DIAGNOSIS THAT NEEDS TO BE MADE. >> THAT'S RIGHT.",English
+">> AND YOU TREAT THAT WITH A WARFARIN COMPARED TO ASPIRIN FOR THIS, FOR EXAMPLE. >> RIGHT. THAT'S CORRECT. >> WELL, WE HAVE QUESTIONS ABOUT THAT. BUT ANYTHING ELSE THAT WE SHOULD MAKE SURE THE PEOPLE REALIZE?",English
+"I MEAN, THAT'S, UNFORTUNATELY, AND THAT WAS MY OWN FATHER, WHO IS A HEALTH PROFESSIONAL AND SHOULD HAVE KNOWN BETTER. BUT -- AND, OF COURSE, HE LIVED IN A DIFFERENT CITY AND",English
+"I HAD TO CALL A FRIEND TO GO GET HIM. YOU KNOW, IT WAS -- BUT, I MEAN, BUT IT WAS -- RIGHT. >> ISN'T A DAD OF A DOCTOR SUPPOSED TO BE SMARTER BECAUSE OF -- >> HE SHOULD BE.",English
+">> HERE'S THE PICTURE. YOU KNOW, WE CAN LOOK AT THIS PICTURE OR THIS PICTURE. HOW ABOUT SHOWING ME, THIS IS A HEMORRHAGIC. >> YES. SO THIS IS A SITUATION WHERE YOU SEE THIS BLOOD CLOT HERE.",English
+">> PUSH HARD. >> YOU SEE THIS BLOOD CLOT RIGHT IN HERE THAT'S TRAVELED UP AND IT'S CAUSED -- THIS IS ACTUALLY BLEEDING INSIDE THE BRAIN, THIS WHOLE AREA HERE. AND, SO, THAT'S A SITUATION",English
+"WHICH YOU WOULD NOT PUT SOMEONE ON BLOOD THINNER. >> THIS IS BLEED. AND THEN THIS IS CLOTTING. >> I SEE, YEAH. SO THAT'S A SITUATION WHERE IF YOU HAVE A BLEEDING INTO THE BRAIN LIKE THIS, THAT'S NOT A GOOD -- YOU WOULDN'T PUT SOMEONE ON BLOOD THINNER AT THAT POINT.",English
+">> WHAT DO YOU DO? >> WELL, IF, FOR EXAMPLE, THEY'RE ON BLOOD THINNER, YOU KNOW, SAY THEY'RE ON WARFARIN OR COUMADIN FOR SOME OTHER REASON, YOU'D STOP IT, CORRECT IT, YOU'D DO THOSE SORT OF THINGS. IN SOME CASES, IT'S A MATTER OF SYMPTOMATIC CARE.",English
+"IF YOU GO TO THAT OTHER PICTURE. >> RIGHT, THIS ONE. >> SO, THIS IS WHERE YOU HAVE -- >> PUSH HARD. >> WHERE YOU HAVE PLAQUE HERE THAT'S RESULTED IN PROBABLY A NARROWING.",English
+"AND NOW THIS CLOT HAS OCCURRED HERE. IF THIS TRAVELS UP, IT WILL PLUG UP AN AREA AND THEN A WHOLE AREA OF THE BRAIN, THIS WHOLE AREA NOW, THERE'S NO BLEEDING THERE, BUT WHAT'S",English
+"HAPPENED IS IT'S NOT GETTING ENOUGH OXYGEN AND BLOOD. SO THAT AREA THEN BECOMES DAMAGED AND THAT CAN RESULT IN A MAJOR STROKE EVENT. >> RIGHT. SO, A THING THAT HAPPENED 15 YEARS AGO WAS THE IMMEDIATE INTERVENTION OF A HEART ATTACK",English
+BY USING A CLOT BUSTER DRUG. AND THEN LATER WE WERE TALKING ABOUT INTERVENTION OF STROKES WITH CLOT BUSTER DRUGS. AND THEN THERE'S BEEN SOME ARGUMENTS THAT WE'RE NOT DOING,English
+"THAT ENOUGH BECAUSE WE WAIT TOO LONG OR WE DON'T HUNT DOWN THE CASE OR THE PATIENT DOESN'T COME IN. COULD YOU EXPLAIN THAT, DUSTIN? >> WELL, YES. SO THE IDEA WOULD BE THAT BY GETTING RID OF THE CLOT,",English
+"YOU'RE GOING TO REPROFUSE THAT AREA OR GET BLOOD FLOW BACK TO THAT AREA OF THE BRAIN. >> RIGHT. >> BEFORE IT'S IRREVERSIBLE. AND THE GENERAL RECOMMENDATION IS IF IT'S LESS THAN THREE HOURS, YOU CAN USE SYSTEMIC, WHERE YOU GIVE A MEDICINE THAT WILL ACTUALLY DISSOLVE THE CLOT.",English
+AND THAT'S SPECIFICALLY IF YOU HAVE AN EMBOLIC STROKE RATHER THAN A HEMORRHAGIC STROKE. >> RIGHT. >> AND THERE IS DEVELOPMENTS NOW WHERE PEOPLE ARE USING CATHETERS SIMILAR TO THE,English
+"CARDIAC, THEY'LL GO UP AND THEY'LL TREAT THE SPECIFIC BLOOD VESSEL WITH THE LYSIS OR COMMONLY SUCTION OUT THE AREA OF THE BLOCKAGE. >> STENTS, OR GET THE BLOCK OUT OF THERE?",English
+">> I'M NOT FAMILIAR WITH A LOT OF INTERCRANIAL STENTING. >> MOST OF THAT IS DONE WITH -- BUT THE ISSUE THERE REALLY BECOMES, THERE ARE A COUPLE OF POINTS, THERE ARE CHALLENGES",English
+"FOR US, ESPECIALLY HERE IN SOUTH DAKOTA. ONE IS AN AWARENESS, AND AS WE KIND OF EMPHASIZED TO PEOPLE WHEN THEY HAVE SYMPTOMS, THEY NEED TO RECOGNIZE THAT THEY NEED TO SEEK MEDICAL ATTENTION. AND THE OTHER THING IS, YOU KNOW, WE'RE A GEOGRAPHICAL",English
+"STATE IN WHICH PEOPLE LIVE QUITE FAR FROM MAJOR CENTERS SOMETIMES. AND, SO, THERE'S A TRAVEL, AND, SO, IF YOU DELAY IN COMING AND SEEKING MEDICAL",English
+"ATTENTION BECAUSE YOU'RE NOT SURE OF YOUR SYMPTOMS AND THEN IT TAKES YOU A FEW HOURS TO GET SOMEWHERE THAT PERHAPS THAT MEDICAL THERAPY CAN BE PROVIDED, NOW YOU'RE OUTSIDE THE WINDOW. AND, SO, WHAT COULD HAVE BEEN",English
+"PERHAPS MORE EASILY TREATED IN A LARGE METROPOLITAN AREA, YOU KNOW, THAT'S NOT A -- THAT'S NOT NEARLY THE CHALLENGE THAT WE FACE HERE IN SOUTH DAKOTA. >> YEAH. SO, THIS IS THE HUGE THING BECAUSE MANY OF THESE PEOPLE ARE WAY PAST THE THREE-HOUR WINDOW.",English
+"AND YOU CAN'T EVEN TREAT THEM WITH A THROMBOLYTIC. >> RIGHT. >> SO THAT'S DIFFERENT. LET'S JUMP INTO SOME QUESTIONS. WE HAVE AN 87-YEAR-OLD WOMAN, 87, WANTS TO KNOW, WHAT DO THE",English
+"DOCTORS THINK ABOUT OPENING A BLOCKED CORONARY ARTERY? >> THAT MEANS THAT YOU PUT A CATHETER UP THERE, YOU BLOW UP A BALLOON THAT OPENS UP THE ARTERY AND THEN PUTS A STENT IN. MIKE?",English
+">> WELL, I DON'T WANT TO MAKE THE QUESTION MORE COMPLICATED THAN IT IS. BUT USING THE TERM ""BLOCKED,"" WE DEFINE BLOCKAGE BY THE DEGREE OF NARROWING.",English
+"WE'LL CALL IT STENOSIS. OR IF IT'S TOTALLY BLOCKED. NOW, FOR MANY YEARS, IF THE ARTERY WAS STILL OPEN, EVEN IF IT WAS ONLY -- IF IT WAS SEVERELY BLOCKED, WE CAN OPEN",English
+"IT WITH A BALLOON OR A STENT. AND, SO, IT WORKS VERY WELL. IT OFTEN ALLEVIATES SYMPTOMS, IMPROVES CHEST PAIN AND SHORTNESS OF BREATH AND, IN FACT, YOU CAN EVEN ABORT A",English
+"HEART ATTACK FROM OCCURRING -- IF YOU CATCH IT EARLY ENOUGH. WHEN IT'S BLOCKED ENTIRELY AND THEN PERHAPS FILLS VIA SORT OF SOME NATURAL BYPASSES,",English
+"SOMETIMES THOSE ARE PATIENTS THAT WE TREAT MEDICALLY. NOW, THERE'S A GROUP OF THOSE PATIENTS THAT ACTUALLY STILL HAVE CHEST PAIN. AND THEY WOULD BENEFIT. SO THERE'S SOME NEW TECHNIQUES. ONE OF OUR COLLEAGUES, HAS ACTUALLY BEEN DOING CHRONIC",English
+"TOTAL OCCLUSIONS, HE'S OPENING UP SOME OF THESE BLOCKAGES THAT HAVE BEEN CLOSED FOR A LONG TIME, AND HE HAS SOME VERY UNIQUE TECHNIQUES WHERE HE CAN COME BOTH FORWARD AND",English
+"KIND OF REVERSE THROUGH THAT AREA TO OPEN IT. SO THAT'S -- >> IF THEY HAVE SYMPTOMS. >> IF THEY HAVE SYMPTOMS, THAT'S RIGHT. >> THERE IT IS. >> YUP. >> IF IT'S BLOCKED -- I MEAN, IT'S SORT OF LIKE, MY MOTHER HAD ONE CAROTID ARTERY COMPLETELY BLOCKED.",English
+"AND I EVEN THREW THE CASE AT YOU. YOU SAID, IT WOULD BE GREAT TO HELP BUT IT WON'T MAKE ANY DIFFERENCE BECAUSE SHE'S BLOCKED AND SHE'S ALREADY COLLATERALIZED, IT WON'T MAKE ANY DIFFERENCE. AND THAT KIND OF POINTS THAT OUT. HOW ABOUT AN 87-YEAR-OLD WOMAN WHO SAYS SHE HAS ATRIAL",English
+"FIBRILLATION, THAT MEANS THE HEART IS IRREGULARLY IRREGULAR AND IS AT RISK FOR A CLOT FROM THE HEART, ON BLOOD PRESSURE MEDICINES, WARFARIN. I STILL HAVE A RACING HEARTBEAT, IS THAT NORMAL?",English
+"AND THAT'S A GOOD QUESTION. >> YEAH. >> THE ANSWER IS, YOU CAN SLOW THAT HEART RATE DOWN A LITTLE -- >> SO ATRIAL FIBRILLATION IS VERY COMMON. AND AS PEOPLE GET OLDER, WE'RE SEEING MORE AND MORE OF IT. IT IS -- IS A RISK FACTOR FOR STROKE BECAUSE CLOTS CAN FORM IN THE UPPER CHAMBER OF THE HEART.",English
+"AND, SO, BLOOD THINNER IS IMPORTANT. YOU GENERALLY -- YOU'RE NOT DAMAGING YOUR HEART, EVEN THOUGH YOU'RE IN ATRIAL FIBRILLATION IF YOU CONTROL THE HEART RATE.",English
+"SO, MEDICATIONS LIKE METOPROLOL OR CARDIZEM, THERE ARE A VARIETY OF MEDICATIONS THAT CAN SLOW THE HEART, IF THE HEART RATE IS STILL RACING, SHE SHOULD BE ON THOSE MEDICATIONS. THERE ARE NEWER TECHNIQUE, TOO, FOR PEOPLE WHO CAN'T TOLERATE A BLOOD THINNER.",English
+"THERE ARE THESE NEW DEVICES, ATRIAL APPENDAGE DEVICES, THERE'S NEW TECHNOLOGY THAT'S OUT THERE, NOT WIDELY AVAILABLE BUT IT'S COMING. YOU KNOW, 87-YEAR-OLD, YOU",English
+"WORRY ABOUT BLOOD THINNER, TOO, JUST BECAUSE OF THE RISK OF FALLS. >> FALLING. YEAH. SO THERE'S A BALANCE. PEOPLE AT A CERTAIN AGE WHEN THEY'VE HAD ONE FALL, EVEN",English
+"THOUGH THEY HAVE ATRIAL FIB, AND THEY'VE BEEN ON WARFARIN, I'VE TAKEN THE WARFARIN AWAY. >> RIGHT. >> YOU THINK THAT THE NEWER AGENTS THAT ARE LIKE WARFARIN ARE ANY BETTER THAN WARFARIN?",English
+">> WELL, THERE IS SOME DATA NOW FOR SOME OF THE NEW ORAL ANTICOAGULANTS THAT ARE OUT THERE. WE'VE SEEN THEM ADVERTISED ON TV. BUT, IN FACT, SOME OF THEM DO HAVE A LOWER BLEEDING RISK.",English
+"AND VERY HONESTLY ONE OF THE PROBLEMS IS THAT SOME OF THEM ARE FAIRLY EXPENSIVE. AND, SO, FOR SOME OF OUR PATIENTS IT'S MORE DIFFICULT. >> YEAH.",English
+">> YEAH, I MEAN, THEY DO -- I THINK MOST OF THE PEOPLE RESPOND TO THOSE MEDICATIONS IN A SIMILAR MANNER, THEY'LL GET A MORE LEVEL THINNING OF THEIR BLOOD, WHEREAS,",English
+"COUMADIN, THEY'LL HAVE TO ADJUST DOSING AND IT WILL KIND OF GO UP AND DOWN. AND, SO, IT IS MORE CONVENIENT FOR THE PATIENT. AND I THINK THE BLEEDING RISK MAY BE A LITTLE BIT LOWER BECAUSE YOU GET -- YOU DON'T OVERANTICOAGULATE PATIENTS BUT",English
+"THE DISADVANTAGE, WHAT I ALWAYS INFORM MY PATIENTS ABOUT, THE REAL HARD THING WITH THOSE, THERE'S NOT A REVERSAL AGENT FOR MOST OF THEM. MOST OF THE PATIENTS WILL COME IN, IF THEY DO HAVE SOME SORT OF TRAUMA OR FALL, WITH",English
+"COUMADIN IT'S EASIER TO REVERSE AND THICKEN THEIR BLOOD. WHEREAS, THE NEWER AGENTS, IT'S NOT THAT EASY. >> THERE'S ONE THAT HAS REVERSIBLE, BUT MY SENSE IS",English
+THAT THERE'S NO MORE DANGEROUS DRUG THAN WARFARIN OR ALL THESE OTHERS. AND THERE'S ONLY ONE DRUG THAT I HAVE OUT THERE THAT I CANMONITOR THAT THEY'RE TAKING IT.,English
+"AND THAT I CAN WATCH IT, HOW WELL THEY'RE RESPONDING. SO I CAN DO THAT WITH WARFARIN AND IT'S FOUR TIMES CHEAPER, EVEN IF YOU COUNT THE MONITORING.",English
+"SO, COMPLIANCE, THEY SAY, 60% AT BEST. WITH ALL TAKERS ACROSS THE BOARD, IN TAKING YOUR MEDICINES. THAT'S WHY I'M A WARFARIN GUY. BUT THERE ARE TIMES WHEN THOSE OTHER MEDICINES ARE RIGHT.",English
+">> I GUESS THAT'S -- I GUESS IT DEPENDS ON WHERE HER DISEASE IS AT AND WHAT VESSELS ARE BLOCKED. YEAH, THERE'S NO LIMIT ON THE NUMBER OF STENTS A PATIENT CAN HAVE.",English
+"BUT I WILL SAY, IF THERE'S A PATIENT THAT YOU'VE HAD THE SAME VESSEL THAT'S OCCLUDED MULTIPLE TIMES, YOU KEEP DOING INTERVENTIONS AND INTERVENTIONS, THE MORE YOU DO",English
+THE LESS LIKELY IT'S GOING TO BE A LONG-TERM FIX. AT THAT TIME THE STENT MAY NOT BE THE BEST PROCEDURE. >> LIFESTYLE CHANGES ARE THE MOST IMPORTANT THING WE CAN DO TO PREVENT HEART DISEASE.,English
+"LET'S TALK ABOUT THAT. >> WELL, YOU KNOW, YOU'RE ABSOLUTELY RIGHT. AND I THINK ONE OF THE THINGS THAT, YOU KNOW, AEROBIC EXERCISE IS PROBABLY THE MOST IMPORTANT.",English
+"IT HAS BEEN SHOWN TO PROLONG SURVIVAL. PEOPLE HAVE BETTER QUALITY OF LIFE AND IT SIGNIFICANTLY REDUCES THEIR CARDIOVASCULAR, CARDIAC MORTALITY AND MORBIDITY. SO, JUST WALKING, BIKING, SWIMMING, AEROBIC EXERCISE REALLY -- AND THAT'S BEEN WELL",English
+"SHOWN IN STUDIES PROSPECTIVELY LOOKING AT LARGE POPULATIONS. GETTING OUT THERE, WALKING REALLY IS A CRITICAL ISSUE. FOR MANY OF US, IT'S SOMETHING THAT'S HARD TO WORK INTO OUR DAILY ROUTINES. AND IT'S CHEAP. DOESN'T COST ANYTHING.",English
+">> NO PHARMACEUTICAL INDUSTRY -- [ Laughter ] >> IT DOESN'T HAVE TO BE OVERLY STRENUOUS, EVEN 30 MINUTES THREE DAYS A WEEK MAKES A SIGNIFICANT DIFFERENCE. >> IT HELPS WITH WEIGHT AND CERTAINLY LIPID MANAGEMENT.",English
+">> MOOD. >> CHOLESTEROL. >> MOOD. >> EVERYTHING. >> YEAH. >> THERE ARE CERTAINLY MEDICATIONS THAT HAVE HAD A DRAMATIC IMPACT. ANTIPLATELET THERAPY, ASPIRIN, NOW SOME OF THE NEWER AGENTS THAT WE USE.",English
+"CHOLESTEROL-LOWERING MEDICATIONS, AGAIN, IT'S BEEN -- WHAT WE CALL THE STATIN MEDICINES, WHICH IS A HOST OF MEDICINES THAT WORK BY REDUCING YOUR CHOLESTEROL REALLY HAVE DRAMATIC EFFECT.",English
+"THEY NOT ONLY REDUCE YOUR CHOLESTEROL, THEY PROBABLY -- PROBABLY STABLIZE SOME OF THE UNSTABLE ELEMENTS IN THE INSIDE OF THE BLOOD VESSEL, THEREFORE, MAKING THEM LESS",English
+"VULNERABLE TO RUPTURE OR HAVING A SUDDEN BLOCKAGE, BOTH IN THE HEART AND IN THE BRAIN. SO, -- >> HOW MUCH SLEEP APNEA? >> WELL, SLEEP APNEA IS NOW RECOGNIZED AS AN IMPORTANT",English
+"COMPONENT OR CONTRIBUTOR TO CARDIOVASCULAR DISEASE. FOR YEARS, WE DIDN'T REALLY UNDERSTAND IT, WE DIDN'T PAY MUCH ATTENTION TO IT. WE NOW KNOW THAT WHEN YOU HAVE AN APIC EPISODE, YOU DON'T BLEED, YOUR OXYGEN SATURATION",English
+"DROPS AT NIGHT, YOU'RE NOT GETTING ENOUGH OXYGEN TO YOUR BRAIN AND OTHER PARTS, THAT IT IS DETRIMENTAL, TO SAY SOMETHING OF THE FACT THAT YOU FELL ASLEEP IN YOUR SOUP AT LUNCH.",English
+"BUT, NO, IT'S REALLY -- THAT'S NEWLY RECOGNIZED, I THINK, THAT THAT'S A CONTRIBUTOR AND, SO, WE'RE BEING MUCH MORE AGGRESSIVE ABOUT TESTING FOR IT.",English
+"TREATMENTS NOW ARE MUCH BETTER, CPAP MACHINES ARE SMALLER. >> EASIER -- >> FIT BETTER. ABSOLUTELY. YOU KNOW -- >> HUGE THING.",English
+">> WE'LL SEE A LOT OF PATIENTS EVEN WITH LOWER EXTREMITY EDEMA, OR SYMPTOMS THAT YOU WOULDN'T THINK WOULD BE ATTRIBUTED TO SLEEP APNEA THAT IMPROVE. >> ONE OF THE MOST COMMON PROBLEMS OF ATRIAL FIB IS SLEEP APNEA, IT'S JUST NOT RECEIVED THE PRESS.",English
+THAT'S WHAT WE NEED TO DO. WE'RE GOING TALK ABOUT ONE OTHER LIFESTYLE CHANGE. ONE THING TO MAINTAINING A HEALTHY HEART IS TO MAINTAIN A HEALTHY DIET.,English
+"THINK ABOUT THE FOOD YOU EAT. >> A HEART HEALTHY DIET HAS THREE MAIN FOCUSES. FIBER, FAT, AND SODIUM. INCREASE THE FIBER IN YOUR DIET BY INCREASING YOUR INTAKE OF FRUITS AND VEGETABLES.",English
+"CHOOSE FRESH FOR THE MOST FIBER AND CHOOSE CANNED, FROZEN AND COOKED WHEN FRESH ISN'T AVAILABLE OR IN SEASON. ALSO, MAKE SURE YOUR GRAINS ARE WHOLE. LOOK FOR THE PHRASE WHOLE WHEAT OR WHOLE GRAIN ON THE",English
+"INGREDIENTS WHEN CHOOSING A BREAD, PASTA, CRACKER, OR ANY OTHER TYPE OF GRAIN. REDUCES THE FAT IN YOUR DIET AND SELECT THE RIGHT FATS TO HELP REDUCE YOUR CHOLESTEROL",English
+"AND IMPROVE YOUR HEART HEALTH. FOCUS ON THE GOOD FATS, SUCH AS OMEGA 3s, MONOUNSATURATEDS AND POLYUNSATURATEDS, THESE WOULD BE FOUND IN FISH, FLAX SEEDS,",English
+"NUTS, AVOCADOS AND OILS SUCH AS CANOLA, FLAX, OLIVE AND PEANUT OILS. REDUCE YOUR INTAKES OF SATURATED AND TRANSFATS. THESE WOULD BE FOUND IN ANIMAL-BASED PRODUCTS SUCH AS",English
+"BACON, BUTTER, CREAM, LARD, SHORTENING, AND COCONUT, ALONG WITH SOME PREPACKAGED FOODS. FINALLY, WORK TO REDUCE THE SODIUM IN YOUR DIET. EXCESS SODIUM INTAKE CAN",English
+"AFFECT YOUR BLOOD PRESSURE AND POSSIBLY MAKE YOU RETAIN EXTRA FLUID. WORK TOWARDS A GOAL OF ONE TEASPOON OF SALT PER DAY, WHICH WOULD EQUAL 2,400 MILLIGRAMS.",English
+USE LESS SALT AT THE TABLE AND LOOK AT THE SODIUM CONTENT ON FOOD LABELS. TRY TO COOK WITH MORE FRESH FOODS INSTEAD OF PROCESSED. [MUSIC],English
+">> WELL, AS WE WERE TALKING ABOUT LIFESTYLE CHANGES, WE REALLY HAVEN'T SAID MUCH ABOUT SMOKING. DUSTIN. >> I THINK THAT THE BIGGEST LIFESTYLE MODIFICATION THAT A PATIENT WITH CORONARY DISEASE CAN MAKE IS SMOKING CESSATION. THE PROGRESSION OF THEIR DISEASE, AS WELL AS THE",English
+"DURABILITY OR HOW LONG ANY INTERVENTION THAT IS DONE WILL DEPEND ON THEM QUITTING SMOKING. AND, SO, ESPECIALLY PERIPHERAL ARTERY DISEASE OR BLOCKAGE IN THE LEGS, PATIENTS THAT COME",English
+IN AND QUIT SMOKING HAVE A SIGNIFICANTLY DECREASED RISK OF MORTALITY AS WELL AS AMPUTATION. >> DEATH RATE OR LOSING A LEG. >> YES. >> IF YOU REALLY LOOK AT ALL,English
+"THE THINGS, YOU KNOW, WE TALK ABOUT HIGH BLOOD PRESSURE AND DIABETES AND ABNORMAL CHOLESTEROL, ACTUALLY SMOKING CESSATION IS WORTH THREE OF THOSE OTHERS.",English
+"SO, IF YOU'RE GOING TO DO SOMETHING -- THE BANG FOR YOUR BUCK IS TO STOP SMOKING. >> STOP SMOKING. I MEAN, IT'S HUGE. I MEAN, YOU GUYS SEE THOSE VESSELS. THE QUESTION ABOUT WHETHER THEY'VE BEEN SMOKING OR NOT IS ALMOST OBVIOUS.",English
+">> WE SEE PARTICULARLY IN OUR WOMEN PATIENTS, AND ONE OF THE THINGS EPIDEMIOLOGICALLY THAT'S BEEN DISAPPOINTING IS THE FACT THAT SO MANY YOUNG WOMEN ARE STILL SMOKING.",English
+"WE'VE REALLY NOT MADE A HUGE IMPACT. WE HAVE YOUNGER WOMEN WHO COME WITH SEVERE ARTERIAL DISEASE, IF THEY WOULDN'T HAVE SMOKED THEY WOULDN'T HAVE IT. >> THEY JUST WOULDN'T HAVE IT. IT'S A BIG DEAL. MY MOM SMOKED.",English
+"I DID AS MUCH AS I COULD TO TRY TO GET HER TO QUIT SMOKING. AND I FAILED. BECAUSE IT'S A TOUGH HABIT. >> IT IS A TOUGH HABIT. >> I MEAN, YOU KNOW, I HAVE TO SAY, IT'S NOT -- THE WAY I",English
+"LOOK AT IT, WITH THE PEOPLE THAT I'VE CARED FOR THROUGH THE YEARS, THE ONES THAT WERE SMOKERS WERE NO NICER OR MEANER THAN THE PEOPLE WHO WERE NOT THE SMOKERS.",English
+"I MEAN, IT'S NOT A MORAL ISSUE. I MEAN, THEY'RE GOOD PEOPLE WHO SMOKE. AND THERE ARE MEAN PEOPLE THAT DON'T. YOU KNOW WHAT I MEAN? IT DOESN'T HAVE ANYTHING TO DO WITH THAT. IT'S JUST -- AND SOME OF THEM I THINK MAY HAVE -- DEPRESSION IS TREATED SOMEWHAT BY IT.",English
+"WHO KNOWS WHY PEOPLE CANNOT QUIT. BUT IT'S AN IMPORTANT, IMPORTANT THING. >> IT'S VERY ADDICTIVE, VERY DIFFICULT TO QUIT. AND SOME PATIENTS, WHEN YOU",English
+"SEE THEM, YOU'LL TELL THEM THEY NEED TO QUIT SMOKING, THEY'LL TALK ABOUT THEIR PARENT THAT SMOKED THEIR WHOLE LIFE, SOMEBODY THEY KNOW WHO SMOKED THAT DIDN'T HAVE PROBLEMS. UNFORTUNATELY, WE DON'T KNOW HOW PEOPLE RESPOND TO IT. THERE ARE SOME PEOPLE, LESS",English
+"COMMON THAN NOT -- MORE COMMON THAN NOT, LESS COMMON THAN NORMAL, THAT DO SMOKE AND DON'T HAVE PROBLEMS, BUT THE MAJORITY OF PEOPLE WILL DEVELOP DIFFICULTY, PROBLEMS.",English
+"LIKE DR. BACHARACH SAID, YOU KNOW, WHEN WE SEE THESE YOUNG WOMEN WITH PERIPHERAL ARTERY DISEASE, IT'S PRETTY MUCH, IF THEY WERE NOT SMOKING, THEY WOULD NOT BE IN THAT SITUATION. >> YOU KNOW, WE HAVE THE SOUTH DAKOTA QUIT LINE, WE HAVE BASICALLY RESOURCES FOR",English
+"EVERYONE, WHETHER THEY -- AND MANY OF THEM ARE, IN FACT, FREE OF CHARGE. SO, IT REALLY IS INCUMBENT UPON THE INDIVIDUAL TO SAY, YOU KNOW, I CAN'T DO THIS ANYMORE, I HAVE TO STOP. >> WHAT ABOUT NONSMOKE TOBACCO PRODUCTS? MY PERSONAL BIAS IS WAY BETTER THAN SMOKING, BUT, STILL,",English
+"THEY'RE PROBLEMATIC. WHAT'S YOUR TAKE? >> YOU'RE TALKING ABOUT THE BLUE CIGARETTE-TYPE THINGS? >> YEAH, YOU KNOW, I DON'T KNOW WHAT -- THEY'RE LITTLE AEROSOLIZER THINGS. >> YOU KNOW, AT THIS POINT, I'M NOT AWARE OF ANY SPECIFIC DATA THAT SUGGESTS THAT THEY'RE SAFE.",English
+"OKAY. THERE HASN'T BEEN ENOUGH LONGITUDINAL STUDIES TO SAY THAT THEY'RE DANGEROUS OR THAT THEY CONTRIBUTE TO VASCULAR LUNG DISEASE, THE WAY WE KNOW CIGARETTES DO. BUT I THINK THAT THERE'S THESE -- THERE'S STILL CONCERN, AND I KNOW AT THE",English
+"N.I.H. LEVEL THERE'S STILL SIGNIFICANT WARNINGS ABOUT, YOU KNOW, -- >> NATIONAL INSTITUTE OF HEALTH. >> AND, AGAIN, IT'S ONE OF THESE THINGS, MANY OF THESE YOUNG PEOPLE ARE USING THEM AS",English
+"OPPOSED TO REGULAR CIGARETTES. SO WE MAY NOT KNOW FOR A NUMBER OF YEARS NOW WHETHER THERE'S REALLY SIGNIFICANT DETRIMENTAL EFFECTS FROM THEM. >> 59-YEAR-OLD MAN FROM YANKTON, WE NEED TO TALK ABOUT ABDOMINAL AORTIC ANEURYSM, LET'S DO THAT, THAT'S THE",English
+"BIGGEST FACTOR, RISK FACTOR FOR SMOKING, ISN'T IT? I MEAN, THE NATIONAL RECOMMENDATION FOR ULTRASOUND OF THE ABDOMINAL AORTA, AS A SCREENING TOOL, IS FOR MEN WHO HAVE SMOKED.",English
+">> SMOKING AND FAMILY HISTORY ARE THE TWO HIGHEST RISKS FOR ABDOMINAL -- >> ABDOMINAL AORTIC ANEURYSM. >> YES, THAT IS TRUE. WE RECOMMEND, IF YOU'RE MALE,",English
+"OVER 65, SMOKER, YOU SHOULD HAVE AT LEAST ONE SCREENING, ULTRASOUND OF YOUR AORTA TO LOOK FOR ANEURYSMS. ACTUALLY RECOMMENDS, ACTUALLY, FEMALES, 65, SMOKERS AS WELL, OR FAMILY HISTORY.",English
+"IF YOU HAVE A FAMILY HISTORY, MALE, USUALLY WE SCREEN THOSE PATIENTS AT 55. THE SCREEN IS IMPORTANT, MOST PATIENTS WILL NOT KNOW THEY HAVE AN ANEURYSM UNTIL IT'S ENLARGED TO THE POINT IT RUPTURES OR CAUSING SIGNIFICANT PROBLEMS.",English
+"IT REALLY IS A DISEASE THAT SCREENING IS IMPORTANT. BECAUSE IF YOU FIND IT, IT'S VERY TREATABLE. BUT IF IT'S SOMETHING THAT IS NOT FOUND BEFORE IT DOES RUPTURE, IT'S VERY HIGH MORTALITY. >> ONCE THEY BREAK, THE CHANCE THAT WE CAN SAVE YOU IS VERY LOW. NOT ZERO, BUT IT'S VERY LOW.",English
+">> I HAVE A DEAR FRIEND, WHO -- WHOSE NAME IS VERY SIMILAR TO YOUR NAME, WHO WAS A PATIENT OF MINE, LEANED ON ME, SMOKER, YOU KNOW, HAD FINALLY QUIT.",English
+"CAME IN ONE DAY TO THE EMERGENCY ROOM, SEVERE PAIN, WE GOT HIM TO SIOUX FALLS. YOU GUYS -- IN TO THE ABDOMINAL SURGERY. AND LOST HIM ON THE TABLE. AND I JUST -- I THINK ABOUT THAT GUY.",English
+"EVERY TIME I THINK OF AN ABDOMINAL AORTIC ANEURYSM, IF I'D ONLY SCREENED HIM, IF I'D ONLY DONE WHAT I COULD DO TO HELP HIM. >> YOU KNOW, BOTH THE VASCULAR",English
+"SOCIETY, SURGICAL SOCIETY, AS WELL AS THE VASCULAR MEDICINE SOCIETY NATIONALLY HAVE ADVOCATED A MORE AGGRESSIVE SCREENING FOR THAT VERY REASON. MANY PATIENTS, ESPECIALLY IF THEY'RE WELL NOURISHED, IT'S HARD TO FEEL AN ANEURYSM WHEN YOU GO UNDER EXAM.",English
+">> BIG BELLY. >> BIG BELLY, THAT'S RIGHT. BUT, IN FACT, AGAIN, THEY'RE INSIDIOUS. SO MANY PEOPLE HAVE THEM AND ARE UNAWARE THAT THEY HAVE THEM. >> DO YOU RECOMMEND SCREENING, ULTRASOUNDS OF THE ABDOMINAL AORTA, MOVING FROM TOWN TO TOWN, SOMETIMES AT CHURCHES?",English
+">> TYPICALLY NOT, ALTHOUGH I WOULD TELL YOU THAT IF THERE'S -- IT'S IMPORTANT TO KNOW YOUR FAMILY HISTORY, IF YOU CAN. YOU KNOW, WHAT DID YOUR GRANDFATHER DIE FROM? WHAT DID YOUR UNCLES DIE FROM? IS THERE ANEURYSMAL DISEASE IN",English
+"YOUR FAMILY? AND A REALISTIC ASSESSMENT OF YOUR RISK FACTORS. DO YOU HAVE HIGH CHOLESTEROL? HAVE YOU BEEN A SMOKER? DO YOU HAVE HIGH BLOOD PRESSURE? THOSE ARE THINGS THAT, YOU",English
+"KNOW, I THINK THAT -- >> CAN THEY ASK THOSE -- AND THEY ASK THOSE QUESTIONS AT THOSE FAIRS. >> IF YOU CAN PICK ONE TEST, I'D TELL THEM, WELL, I DON'T BELIEVE IN THE CAROTID ULTRASOUND THING, THE PERIPHERAL LEG ULTRASOUND. IF YOU CAN PICK ONE, 50 BUCKS, WHY NOT DO THE ABDOMINAL AORTIC.",English
+">> YOU KNOW, ACTUALLY THE A.B.I., ACTUALLY CORRELATES WITH THE CORONARY DISEASE. AND THAT CAN BE DONE WITH JUST A BLOOD PRESSURE CUFF. SO, I WOULD TELL YOU THAT",English
+"THAT'S ACTUALLY -- THAT WAS A TEST, THAT'S THE TEST I'D GO FOR, JUST BECAUSE IT'S THE MOST COST EFFECTIVE, I THINK. AND IT'S NOT OPERATOR DEPENDENT. I MEAN, IT'S VERY EASY TO DO. >> VERY INTERESTING. >> SO, I MEAN, FACT THAT THERE'S PERIPHERAL DISEASE IN THE LEG SAYS THAT THERE'S",English
+"CORONARY DISEASE, IS AN IMPORTANT THING AGAIN. >> I TELL PATIENTS ALL THE TIME, YOU KNOW, IF YOU HAVE -- I GREW UP IN AN AREA WHERE THERE WAS LOTS OF IRON AND CALCIUM IN THE WATER. SO THAT THE PIPES WOULD GET PLUGGED UP. >> YEAH. >> I TELL THEM, I SAID, IF YOU",English
+"HAVE THAT, IT DOESN'T JUST GET PLUGGED UP IN THE KITCHEN OR BATHROOM, RIGHT? IT GOES THROUGH THE WHOLE HOUSE. NOW, THERE ARE CERTAIN AREAS WHERE IT'S MORE LIKELY. YOU KNOW, UNDER THE SINK, THAT KIND OF THING. BUT THE FACT IS, IT'S A SYSTEMIC DISEASE. IT'S A DISEASE THAT POTENTIALLY AFFECTS ALL OF THE ARTERIES.",English
+"AND THAT'S WHAT YOU HAVE TO EMPHASIZE, RECOGNIZING THAT YOU HAVE TO ADDRESS, THEY HAVE AN ANEURYSM, YOU NEED TO ADDRESS THEIR HEART. IF THEY HAVE PERIPHERAL VASCULAR DISEASE, YOU NEED TO ADDRESS THEIR HEART AND CAROTID ARTERIES. YOU NEED TO LOOK AT THE WHOLE,",English
+RECOGNIZING THAT THE DISEASE PROCESS INVOLVES ALL OF THE POTENTIAL ARTERIES. THAT'S RIGHT. >> THE NEXT QUESTION IS ABOUT DIABETES. HOW BIG OF A RISK FACTOR IS DIABETES FOR VASCULAR DISEASE?,English
+">> IT'S A SIGNIFICANT RISK FACTOR. I MEAN, WHEN WE SEE PATIENTS WITH PERIPHERAL ARTERY DISEASE OR CORONARY DISEASE, YOU KNOW, WITH LIFESTYLE MODIFICATION, ANOTHER THING IS IF THEY ARE",English
+"DIABETIC, TO MAKE SURE SURE THEIR BLOOD SUGAR IS CONTROLLED AS WELL AS POSSIBLE. >> THE OTHER THING, I WOULD ADD TO, THE DIABETES, THEY'RE AT INCREASED RISK FOR LIMB LOSS COMPARED TO NONDIABETICS. >> RIGHT. >> AND PART OF THAT ISN'T ALWAYS JUST THE BLOCKAGE.",English
+"IT'S THE FACT THAT THEY DON'T HAVE GOOD FEELING IN THEIR FEET, THAT THEY INJURE THEIR FOOT, AND THEY GET A SORE, AND THEN IT GETS INFECTED. >> WELL, AND THEY'RE WALKING ON A PEBBLE, THEY DON'T KNOW THERE'S SOMETHING GOING ON. >> EXACTLY. SO, EASY THINGS, GOOD SHOES,",English
+"LOOKING AT YOUR FEET ON A DAILY BASIS. IF YOU HAVE TROUBLE WITH YOUR NAILS, GO TO A PODIATRIST. YOU KNOW, JUST GOOD NAIL CARE. GOOD HYGIENE THINGS. THEY MAKE THE DIFFERENCE BETWEEN KEEPING YOUR LEG",English
+"SOMETIMES. >> I REALLY LIKE TO ENCOURAGE PEOPLE TO WASH THEIR FEET. I MEAN, YOU KNOW, IT'S WAY DOWN THERE, YOU KNOW, AND I HAVE TO WASH MY HAIR, I WASHED EVERYTHING ELSE.",English
+"GET DOWN, YOU KNOW, GET A SHOWER CHAIR AND GET DOWN AND CLEAN YOUR FEET. AND KEEP THE HYGIENE THERE. IT WILL KEEP A LOT OF THAT PROBLEM, BECAUSE IT GETS SCALY AND TROUBLE. SO WORK ON KEEPING YOUR FEET IN GOOD ORDER. >> IT'S IMPORTANT, PATIENTS WITH PERIPHERAL ARTERY DISEASE, A LOT OF THEM WILL",English
+"GET BY FINE, ONCE THEY DEVELOP A WOUND ON THEIR FOOT, THEY WON'T HAVE ENOUGH PROFUSION TO HEAL THAT. THAT'S WHEN THERE IS A RISK OF LIMB LOSS, RUN INTO PROBLEMS. >> PARTICULARLY DIABETICS.",English
+"THAT WAS THE QUESTION, 59-YEAR-OLD FROM YANKTON, ABOUT DIABETES. HOW DOES THAT AFFECT THE HEART AND HOW DOES HAVING LOW BLOOD SUGAR READINGS IN THE 20s AFFECT THE HEART?",English
+"LOW SUGARS MEANS YOU'RE TOO TIGHT. I MEAN, I'M AFRAID OF THAT AS WELL. >> YEAH. YOU KNOW, NEITHER DUSTIN OR MYSELF ARE EXPERTS IN DIABETES. SO, I DON'T WANT TO OVERSTATE THIS.",English
+"BUT CERTAINLY THE BLOOD SUGAR NEEDS TO BE IN A CERTAIN RANGE. IF IT'S FOR HIGH, IT'S BAD, IF IT'S TOO LOW, IT'S BAD. IF YOU GET THIS LOW, YOU CAN PASS OUT, YOU CAN, YOU KNOW, --",English
+>> BRAIN CELLS. >> YOU GET WHAT WE CALL HYPE GLYCEMIC TO THE POINT WHERE YOU CAN'T FUNCTION NORMALLY. I CAN'T TELL YOU THAT IT HAS A DIRECT EFFECT ON THE HEART. ALTHOUGH WE DO KNOW THAT WHEN,English
+"THE BLOOD SUGARS ARE VERY HIGH FOR LONG PERIODS OF TIME THAT IT'S VERY DETRIMENTAL TO THE INNER LINING OF THE BLOOD VESSELS. >> SO WE HAVE A PERSON ASKING ABOUT ATRIAL FIB AND WARFARIN, XARELTO, WE ANSWERED THAT EARLIER, SHE SAID, IS IT NORMAL TO HAVE ONGOING",English
+"DIZZINESS WITH ANY OF THE MEDICINES THAT SLOW THE HEART AND ALSO LOWER THE BLOOD PRESSURE? >> WELL, YEAH, THAT'S THE CRITICAL INFORMATION. YOU KNOW, IS IT DIZZINESS AND",English
+"VERTIGO OR IS IT A SENSE OF LIGHTHEADEDNESS? IF IT'S LIGHTHEADEDNESS, WHEN DOES IT OCCUR? DOES IT OCCUR WITH STANDING OR ANY TIME? THE MEDICATION, LIKE METOPROLOL, WHICH IS A BETA",English
+"BLOCKER MEDICATION, WILL BLUNT YOUR NORMAL RESPONSE, SO WHEN YOU GO FROM SITTING TO STANDING, NORMALLY YOUR HEART RATE INCREASES TO KEEP THE BLOOD PRESSURE UP AND BLOOD FLOW TO YOUR BRAIN BECAUSE YOU'RE NOW GOING AGAINST GRAVITY.",English
+"IF YOU'VE BLUNTED THAT RESPONSE, NOW ALL OF A SUDDEN YOU GET LIGHTHEADED BECAUSE BLOOD FLOW ISN'T THERE. SO YOU HAVE TO BE MORE CAREFUL ABOUT GETTING UP SUDDENLY. YOU HAVE TO DO THOSE THINGS.",English
+"IF YOU'RE DIZZY ALL THE TIME, LIGHTHEADED ALL THE TIME, THEN THAT'S AN INDICATION THAT SOMETHING'S NOT RIGHT, THESE ARE THE MEDICATIONS -- YOU'RE ON TOO MUCH MEDICINE OR THERE'S ANOTHER ISSUE GOING ON AND YOU SHOULD SEEK MEDICAL ATTENTION.",English
+IT'S AMAZING HOW MANY OF THOSE PASSING OUT FROM TOO MUCH MEDICATION HAPPENS WHEN THEY STAND UP TO SING AT CHURCH. [ Laughter ] WHY IS THAT? 76-YEAR-OLD FEMALE FROM,English
+"BROOKINGS HAD QUADRUPLE BYPASS SIX YEARS AGO, HAS NINE STENTS, HAS BEEN ON COUMADIN, STILL NOT REGULATED. HER CARDIOLOGIST TELLS HER SHE STILL CAN'T DO -- HE CAN'T DO ANYTHING FOR HER ANYMORE.",English
+"SHE IS STILL HAVING PAIN AND BREATHLESSNESS AND DISCOMFORT. THIS HAS BEEN OFF AND ON FOR THE LAST SIX YEARS. DO YOU HAVE ANY SUGGESTIONS? >> WELL, YEAH, I MEAN, I'LL TAKE THAT. SO, YOU KNOW, SHORTNESS OF",English
+"BREATH AND LIMITATIONS WITH FUNCTIONAL ACTIVITIES, DOING THE THINGS THAT YOU NORMALLY DO, DAILY ACTIVITIES, IS A FUNCTION NOT ONLY OF THE BLOCKAGE BUT BASICALLY IT'S",English
+"REALLY -- IT'S PREDOMINANTLY THE FUNCTION OF THE HEART, HOW WELL THE HEART'S PUMPING. IS THE HEART REGULATED? IS THERE -- AND SOMETIMES WHEN THERE'S BEEN SIGNIFICANT DAMAGE TO THE HEART, THERE ISN'T MUCH TO DO TO IMPROVE THE PUMPING FUNCTION.",English
+"BUT WHAT YOU DO, YOU CAN PUT PEOPLE ON MEDICINE. YOU LOWER THEIR BLOOD PRESSURE A LITTLE BIT SO THE HEART DOESN'T HAVE TO WORK SO HARD. THERE ARE SOME THINGS THROUGH EXERCISE THAT CAN BE DONE. NOWADAYS THERE ARE SOME SPECIALIZED PACEMAKER,",English
+"RHYTHM-MANAGEMENT TOOLS THAT CAN BE USED TO TRY AND IMPROVE THE CARDIAC FUNCTION. YEAH, SO SOME OF THIS -- SO THERE'S NO ONE THING. JUST FIXING THE ARTERY DOESN'T",English
+"ALWAYS FIX THE PROBLEM. >> THERE WE GO. 68-YEAR-OLD WOMAN FROM WALL, WHAT CAUSES THE ENZYME TROPOMIN TO ELEVATE? WE USED TO LOOK AT L.D.H.s, C.K.s, ALL THAT, NOW WE HAVE",English
+"TROPONIN, WONDERFUL ENZYME. >> IT'S RELEASED FROM THE MYCARDIAL CELLS WHEN THERE'S DAMAGE. A COUPLE OF DIFFERENT KINDS BUT WE'RE TALKING REALLY ABOUT CARDIAC.",English
+"AND IT IS AN INDICATOR THAT THERE'S BEEN SOME DAMAGE OR THAT THE HEART MUSCLE, THE CELLS HAVEN'T GOTTEN ENOUGH BLOOD AND OXYGEN. SO IT'S RELEASED.",English
+"AND WE CAN DO JUST A BLOOD TEST AND CHECK IT. AND, SO, IT'S ONE OF THE TOOLS THAT WE USE TO TRY AND DETERMINE WHETHER SOMEONE'S HAD AN ACUTE HEART ATTACK. THE DIFFICULTY WITH IT IS THAT, YOU CAN'T ALWAYS COMPARE WHAT YOU GET FROM WESSINGTON",English
+"SPRINGS COMPARED TO WHAT YOU MIGHT GET IN BROOKINGS OR SIOUX FALLS. THAT'S NUMBER ONE. NUMBER TWO, THERE ARE A FEW THINGS THAT CAUSE A PROBLEM. >> FIVE SECONDS. >> RENAL DYSFUNCTION, A FEW OTHERS THINGS THAT WILL GIVE YOU RESULTS.",English
+">> IT'S A DIFFICULT ISSUE. >> YEAH. >> AND NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION. WHEN A BLOCKAGE OF AN ARTERY OCCURS, THE BODY CAN REPAIR ITSELF BY MAKING ANOTHER BLOOD",English
+VESSEL TO BYPASS THE BLOCKAGE. TRUE OR FALSE? THE ANSWER IS TRUE. IT WAS FLORENCE McDANIEL WHO IS A DEAR FRIEND OF OURS FROM BROOKINGS WHO ANSWERED THE,English
+"QUESTION CORRECTLY. THANK YOU, FLORENCE, FOR PARTICIPATING. AND A BOOK WILL BE IN THE MAIL TO YOU SOON. WE'LL BE RIGHT BACK AFTER THIS. [MUSIC] [ COUGHING ] >> SORRY. FLU. [ WHISTLING ]",English
+">> YOU'RE NOT YOU WHEN YOU HAVE THE FLU. GET VACCINATED. STOPPING THE FLU STARTS WITH YOU. >> GEORGE IS A MIDDLE-AGED FRIEND WHO IS PHYSICALLY ACTIVE, NON-SMOKING,",English
+"RELATIVELY-THIN, NON-STRESSED, HAS LOW CHOLESTEROL, AND LAST MONTH HAD HIS THIRD HEART ATTACK. WHY IS HE STRICKEN WITH THIS CONDITION? WHAT CAUSES BLOCKED BLOOD VESSELS, OR ATHEROSCLEROSIS,",English
+"AND HOW CAN GEORGE, OR ANY OF US, PREVENT ATHEROSCLEROSIS AND THE RESULTING HEART ATTACKS, STROKES, OR LEG AMPUTATIONS? PATHOLOGISTS HAVE FOUND ON THE AUTOPSIES OF YOUNG SOLDIERS",English
+"WHO'VE DIED IN WAR THAT EARLY ATHEROSCLEROSIS IS OCCURRING IN DISTURBINGLY HIGH NUMBERS. ASIDE FROM GENETIC INFLUENCES, THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE LISTS THE MAIN",English
+"CAUSES FOR ATHEROSCLEROSIS AS SMOKING, HIGH AMOUNTS OF CERTAIN FATS AND CHOLESTEROL IN THE BLOOD, HIGH BLOOD PRESSURE, AND HIGH AMOUNTS OF SUGAR IN THE BLOOD.",English
+"THE INSTITUTE STATES THAT THE MOST IMPORTANT STEP TO PREVENT VASCULAR DISEASE SHOULD BE WITH LIFESTYLE CHANGES. IF YOU SMOKE, QUIT. EAT A MODERATE, BALANCED DIET WITH ENOUGH FRUITS AND",English
+VEGETABLES. EXERCISE REGULARLY. AND PERIODICALLY MONITOR YOUR BLOOD PRESSURE AND BLOOD SUGAR. GEORGE HAS BEEN DOING ALL THAT. SCIENTISTS AND THE PHARMACEUTICAL INDUSTRY HAVE,English
+"LONG SOUGHT A SIMPLE PILL TO PREVENT VASCULAR DISEASE AND PILLS TO CONTROL BLOOD PRESSURE AND BLOOD SUGAR HAVE HELPED. ALTHOUGH HIGH CHOLESTEROL LEVELS ARE A RISK FACTOR,",English
+"UNFORTUNATELY, STATIN AND LIPID-LOWERING MEDICINES HAVE PROVEN ONLY MEAGER BENEFIT IN OUR FIGHT AGAINST ATHEROSCLEROSIS. GEORGE HAS CONTROLLED HIS BLOOD PRESSURE, SUGAR, AND",English
+"BEEN TAKING A STATIN PILL FROM THE BEGINNING. A MALICIOUS, LESS-KNOWN, AND YET TREATABLE RISK FACTOR FOR VASCULAR DISEASE IS SLEEP APNEA.",English
+"THE CONSEQUENCE OF PROLONGED PERIODS OF LOW OXYGEN CAUSED BY SMOKING OR SLEEP APNEA IS ATHEROSCLEROSIS. IN A 13-YEAR AUSTRALIAN STUDY OF 30 TO 65-YEAR-OLD PEOPLE, FIVE TIMES AS MANY PEOPLE WHO",English
+"HAD MODERATE TO SEVERE SLEEP APNEA, 33%, DIED COMPARED TO THOSE WHO SLEPT WELL AT NIGHT, 6%, THE DIFFERENCE MOSTLY FROM VASCULAR DISEASE. NOW WE CAN TREAT SLEEP APNEA",English
+"WITH CONTINUOUS POSITIVE AIRWAY PRESSURE, OR C-PAP, WHERE A NOSE OR FACE-MASK AIR-PRESSURE DEVICE PREVENTS OXYGEN LEVELS FROM DROPPING HARMFULLY LOW DURING SLEEP.",English
+"RECENT STUDIES INDICATE THAT THE USE OF C-PAP BRINGS A SIGNIFICANT REDUCTION IN DEATH RATE. ANOTHER WAY TO TREAT SEVERE SLEEP APNEA IS WEIGHT LOSS, BUT ACCOMPLISHING SIGNIFICANT",English
+"AND PERMANENT WEIGHT LOSS REMAINS A VERY DAUNTING TASK. I ADVISE MY PATIENTS THAT UNTIL WEIGHT LOSS OCCURS, WE BEST TREAT SLEEP APNEA WITH C-PAP.",English
+GEORGE WILL BE HAVING A SLEEP STUDY SOON. [MUSIC],English
+">> THANK YOU FOR HAVING US. >> NOW ONTO OUR FLU SEASON UPDATE. THIS WEEK I ADMITTED A PATIENT IN OUR COMMUNITY WITH INFLUENZA A, AND THE PATIENT HAD NOT BEEN TRAVELING OUT OF OUR LOCAL AREA. THE BUG IS AROUND US, WHEREVER WE ARE.",English
+THERE WILL BE MANY ADDITIONAL CASES OF INFLUENZA THIS YEAR BUT HOPEFULLY FEWER THAN IN RECENT YEARS. THE NUMBERS MAY STILL GO VERY HIGH BEFORE WE'RE THROUGH AND,English
+"THE PEAK MAY BE DELAYED TO MARCH OR EVEN APRIL, BUT IT WILL GET HERE. DO NOT DELAY, GET YOUR FLU VACCINE NOW TO REDUCE YOUR CHANCES OF CATCHING THE FLU BUG. THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT ""ON CALL WITH THE PRAIRIE DOC,""",English
+"UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE. AND THANK YOU. >> THANK YOU. >> THANK YOU. >> WHETHER YOU AVOID DAILY DANGERS IN YOUR HOME, HOW ABOUT PREVENTING DIFFERENT",English
+Both the relative risk and the native risks combined make what we may call the absolute risk,English
+"and I'll say more about that throughout the course. But the key principle here is that you as a consumer of healthcare,",English
+"as a patient, really want to be as informed as possible, not just have the benefits of what is being offered, but also what are the potential harms",English
+and what is the likelihood that you statistically will benefit rather than the population at large.,English
+We don't have a formal polling system that we're going to use tonight but I do want you to at least think to,English
+"yourself to this question because it's going to underlie much of the conversation we have, especially about the central issue of",English
+what threshold do we use to treat high blood pressure? This turns out to be much more complicated than you would think.,English
+"If we chart the relationship between your systolic blood pressure, that is the upper number against your risk of stroke,",English
+"heart attack, and mortality. We can find abnormality statistically in the population at large, and blood pressure levels as low as 118 or close to 120.",English
+But the increase is very gradual as we go through that 120 and 130 and 140 and then the curve begins,English
+to become sharper up and the risk becomes greater. There's been a lot of debate in the medical community and the medical literature and I'll spend some time,English
+discussing that tonight as to what number we should use in order to begin treatment formerly,English
+"especially with medications for someone's blood pressure. I'll conclude with some options so I will answer this question throughout the night,",English
+"but I want you to think about it. Let's use as a case, a 60-year-old person. In the office, the blood pressure taken carefully and",English
+"I'll explain what I mean by that soon, is 145/85. Let me just say one other thing quickly,",English
+"which as we talked about the upper number, which is the systolic blood pressure. The lower number on the other side of the dash is the diastolic blood pressure.",English
+"It turns out both are important but the higher number, the systolic blood pressure, turns out to be more predictive",English
+of strokes and heart attack than the lower number. But we will also treat an elevated lower number but most of our attention focuses on the upper number.,English
+"Especially as you get older, the measurement of the lower number becomes a little less reliable. It's the systolic blood pressure that drives a lot of",English
+our thinking and that would be true in this case as well. The patient had a blood pressure of 145/85 and the patient,English
+"is in good health without any evidence of diabetes, any prior heart disease or stroke. Kidney function is normal and they're otherwise, well.",English
+We'll talk about some of their lifestyle or behaviors in a moment. But let's talk first about as a patient going into,English
+"What would be the point at which you would begin treatment? Would it be 150 millimeters of mercury? That's the unit we use to measure blood pressure,",English
+140 millimeters of mercury or 130? Just think about that for a minute and we'll go through some definitions and what different types of,English
+evidence there is for each of these and how the medical community has actually had diverse opinions,English
+"on what you would think would be a relatively simple question but it turns out it's not. Now, I want to spend a moderate amount of",English
+time on measuring blood pressure. The reason for this is because if we measure blood pressure incorrectly,English
+"and especially incorrectly in the too high category, then we will end up treating many people who",English
+simply don't need treatment of their blood pressure. This is most important the major error is in overestimating blood pressure.,English
+"Now, there are three basic ways to do this, and you've probably encountered these. The most common is office measurement in",English
+"the clinician's office and for most of our scientific lives, these are the measurements that have been used in",English
+the scientific research trials or the clinical trials that have demonstrated that treatment of high blood pressure with medications,English
+"prevents heart disease and stroke. That's a good baseline to appreciate. Increasingly, especially over the last decade or so,",English
+there has been much more attention to home blood pressure measurement. There are many ways to do this and we'll discuss that as well.,English
+It turns out that the blood pressure measurement at home is a little bit lower so our normal values at home,English
+"should be at least five or 10 points lower than it is in the office. The third way to do it, and this is one you may not have heard about before or",English
+used is what we call an ambulatory blood pressure monitor. This is where you wear a device around the upper arm usually that,English
+inflates itself like a blood pressure cuff and measures your blood pressure periodically throughout the day.,English
+"This gives you a 24 hour average of your blood pressure. In some recent studies, although we've traditionally considered",English
+the office blood pressure as the best correlate with stroke and heart disease. It turns out that the ambulatory monitors,English
+actually add additional value. We have three unique methods for measuring blood pressure and it turns out that,English
+there are different and they may come out with different results and it's necessary sometimes to balance one against another and,English
+"maybe even break the tie with something with a third test like an ambulatory monitor. Now, one of the very first things that we teach",English
+"our health professional students in health care training is how to take the blood pressure. It turns out though,",English
+"that despite this being one of the very first skills that people learn, is that when you analyze what people do in the real-world,",English
+"that this is very commonly done incorrectly. Unfortunately, in each instance,",English
+"if you do this incorrectly, the results come out too high. It's very hard to get blood pressure results that are artificially too low.",English
+"They're almost always artificially too high if they are incorrect. Now, what does it mean to be correct,",English
+"what do we use as the gold standard as I implied? Sometimes we need different methods to get a more complete picture,",English
+"that is the office value, a home value, and maybe a third test. But nonetheless, wherever we're",English
+"measuring the blood pressure, we want to use these best principles. There you can break this down into",English
+"around 19 different factors that constitute a well-taken blood pressure, I've summarized them to seven or eight.",English
+But one of the most important ones is that the person should be seated in a chair for about five minutes,English
+"before the blood pressure is taken. Typically, this is with your feet on the ground and your back supported. Very importantly, you should not",English
+have had coffee drinks or other caffeine drinks in the periods half an hour prior to taking your blood pressure.,English
+"You should not have just come off exercise, you should not have just rushed to the doctor's office, and you should not have had a cigarette",English
+"for at least 30 minutes or longer. Also very important for a correct blood pressure to be taken,",English
+there should be no talking by the patient or the observer. Talking by the patient when a blood pressure is being measured elevates,English
+"at the same time as one is taking the blood pressure. Blood pressure to be taken most accurate,",English
+should be taken without any clothing under the blood pressure cuff. This is another very common mistake when you see blood pressure taken in medical offices.,English
+The cuff is put on over a shirt sleeve or a sweater sleeve and that will also falsely elevate the blood pressure measurement.,English
+"The arm should be supported either on a table or by the clinician's arm, so that it's horizontally",English
+"at the level of the center of the heart. Then finally, it's really important that one uses a blood pressure cuff",English
+that is the appropriate size. Blood pressure cuffs now are marked to designate how much of an arm can fit in,English
+"a given blood pressure cuff but it's very common if you purchase a blood pressure cuff without thinking about the size,",English
+"about half of us or more, may end up with a cuff that's too small. Once again, here to a cuff that is too small or too",English
+"tight may incorrectly elevate the blood pressure. Because of muscles or fat, it doesn't matter what makes your arm larger.",English
+"But for again, about half of individuals, you need an adult large size cuff rather than an adult regular.",English
+The correct cuff size is one of the most common errors that's made in blood pressure measurement.,English
+"You can see this is a lot to think about. This is what we teach in our offices although often it's not done exactly correctly,",English
+"even in our own medical offices. If you are taking the blood pressure at home for yourself,",English
+you want to use the same exact principles. I'll give some additional tips on taking blood pressure at home in a minute but,English
+each of these general principles are the same in the office as they would be at home. You can also take more than one measurement and,English
+"either record an average of two measurements or three, and write that down as the measurement of record or you can keep",English
+a record of the last blood pressure measurement. This turns out to be a bit of a controversy in the literature.,English
+Many guidelines recommend averaging multiple measurements. At home that's an easy thing to do.,English
+"In the office, though, when people are rushing into the office and as I mentioned, may have clothing on or maybe talking,",English
+the first blood pressure may be artificially elevated. Even averaging with that may not be accurate. One of the newer approaches to this is,English
+"to count the last measurement if you do two or three, count the last one and put that in the medical record. Either of these is correct but again,",English
+"for home purposes, either of these is correct. In the office, I often especially if there's a difference between the first one and the second one,",English
+"I will record the second blood pressure. Now, I've talked about three ways to do this, is actually a fourth.",English
+"This mostly came from a very big study which we'll spend some time on throughout the evening, it's called the SPRINT trial,",English
+which was the systolic blood pressure intervention trial. The SPRINT trial drives some of the recommendations and some of,English
+the controversy about blood pressure treatment thresholds. What they did in this study was that they,English
+"basically use the mechanical measurement tool, almost a robotic measurement tool. Again, very carefully put the patients,",English
+"the subjects in a dark room. There was no human interaction. They rested for a period of time, 5 minutes or more.",English
+There were automated measurements and the numbers were averaged. This was following the guidelines of,English
+"the prior slide but to the max. Interestingly, when they compared their blood pressure taken",English
+"in this what we call research grade measurement, or really careful measurement. It was over 12 points lower than what happened when",English
+"the initial blood pressure was taken by a clinician at the entry into the office for that visit. This study used doctors, clinicians offices.",English
+"A blood pressure was taken by a medical assistant or an LVN the way it is in our offices. But when the research grade value is measured,",English
+"is really carefully done value, it was over 12 points lower. I'll come back to that point",English
+because the SPRINT trial makes recommendations that are lower than many of our other sources of evidence.,English
+It's worth noting that they used a particularly careful way of measuring the blood pressure. One might argue that one would want to reproduce,English
+that measurement if one was going to use their thresholds. But I'll come back to that. Now I said I would return to,English
+"home blood pressure measurement. It turns out the science behind this is not as extensive as you would think. But increasingly, many clinicians in",English
+"the United States and certainly in other parts of the world, will demand a home blood pressures in combination with Office blood pressures before",English
+one officially diagnosis and certainly before one begins medications for high blood pressure. Does measuring at home really make it better?,English
+"Well, there's not the great evidence one way or another. There aren't that many studies that just do home measurement with or without and compare the two.",English
+But there are many studies that have a more comprehensive approach to blood pressure measurement of which home monitoring is part of the care.,English
+"In those studies, which also have other factors like other health professionals helping manage the medications and teaching and diet and so on,",English
+"there is a benefit to this home measurement. As I mentioned, if you're doing blood pressure measurement at home,",English
+"you want to use the same principles that we just discussed. The same principles of office measurement of sitting for five-minutes,",English
+"not drinking any coffee, having your arm baird, not talking, not smoking and so on, and having the correct equipment.",English
+"which is that we know and some of the guidelines agree with this, which is where my opinion is derived,",English
+is that because the blood pressure varies over the course of the day in a somewhat diurnal rhythm so that the morning blood pressure may be,English
+"higher than the late afternoon blood pressure. It's important to take both. Therefore, what we often",English
+"recommend is not to check your blood pressure every day. But if you're in the process of assessing whether you need medication,",English
+"you might check in more often or if you're monitoring it for effectiveness of the treatment, I would pick one or two days a",English
+"week on a day that you can check it twice, and check it in the morning. In the morning value should be before you've taken",English
+"your medications,and before you've had coffee. So you wake up, wash up. Don't have coffee.",English
+"Sit, relax for several minutes up to five and then with a bare arm, take your first blood pressure.",English
+"Then go about your day and before dinner, again without coffee, without cigarettes, without wine, and so on, take a second value before dinner.",English
+Those two then form a nice framing of your blood pressure. Different people have different patterns,English
+of which one is higher. Not everyone's the same. But it gives you a way to frame the highest and,English
+"the lowest over the course of a day. Again, one keeps a record of these and averaging over time is the most effective way to do that.",English
+"Now, ambulatory blood pressure monitoring, abbreviated ABPM, is a test ordered by clinicians. It's usually in the same place,",English
+"you might get an electrocardiogram or an echocardiogram. As I implied, this is the most sophisticated approach to",English
+an out of office measurement of your blood pressure. The machine on its own checks the blood pressure several times per,English
+hour as opposed to the resting blood pressure that we just described carefully. This is a little different approach,English
+"because it includes resting, and it can also be programmed to be taken during sleep. It also includes measurements during your daily activities.",English
+"Overall, it's lower than the office visit, than an office blood pressure. But the exact relationship is",English
+"not the same in each patient. In other words, this is not always five points lower, ten points lower, but it's typically a bit lower and we use a somewhat,",English
+"we take that into consideration in deciding whether to treat a patient. As I mentioned, this technique which",English
+should not be used in every patient or even maybe most patients. But it's an excellent tiebreaker. When you're just confused because,English
+the office visits are showing one thing and the home visits that showing a different thing. Or the morning is showing one thing and the evening is showing a different thing.,English
+This may give you a third data point to help sort out where we're going and what our next best step is.,English
+"Let me conclude this section of the talk. I've spent a lot of time on this, but I really feel that this is in some ways the most important thing we can do.",English
+"Which it's hard to treat something effectively if you don't measure it effectively, and many of the other things we're going to talk about in",English
+"this course are much more precise, whether it's your blood sugar or your blood cholesterol. But this is one that",English
+requires a human factor unless you're using the robotic measures that require some thought and some best practices.,English
+"Wherever you are, make sure that best practices are being used. I would argue that because",English
+"best practices are not done everywhere, that some of those blood pressures should have less importance.",English
+"For example if you go to the dentist's office and the blood pressure is high, that's somewhat predictable if it's higher at the dentist's office or if you go into",English
+"the emergency department with an orthopedic problem or an abdominal pain, your blood pressure is highly",English
+"likely to be higher and so on. Or if you're in seeing a clinician who doesn't care as much about your blood pressure,",English
+"they may not use the same best practices. Places that care most until your primary care office at cardiologist's office,",English
+"your kidney doctor office, your neuro doctor offices. Those are the places typically where people will use",English
+"the best practices and those are the measurements that maybe are the most important. As I said, we use repeat measurements.",English
+"We typically average of at home, in the office though it's okay to record the last value. We recommend home blood pressure measurements",English
+"from most patients, especially before starting medications if there's a difficulty with control as measured in the office.",English
+"We don't use ambulatory monitoring as much, maybe not as much as we should. I'm not advocating that",English
+"every patient needs it by any means. I think home measurements serve the same function for most patients. But ambulatory monitoring is very effective,",English
+"it correlates well with the things we care most about, and it serves as a good tiebreaker when others uncertainty as to what to do next.",English
+Let's talk next about both treatment of high blood pressure without medications.,English
+"In some respects, this also serves as an opportunity to discuss prevention of blood pressure. Because the things that work to treat",English
+blood pressure in people who have high blood pressure also are the same measures that work to prevent high blood pressure,English
+"in people with normal blood pressures. So just again to get you thinking a little bit about this, we'll start with the same patient.",English
+"There's a six-year-old person, their blood pressure in the office was 145/85, carefully measured. You're going to think about",English
+"non-drug treatments of your blood pressure. When we think about non-drug lifestyle modifications,",English
+which of these would you say is the most effective method of lowering an elevated blood pressure or a borderline blood pressure?,English
+"The options are weight-loss if you're overweight or meet the criteria for what we call obesity. Alcohol restriction, especially in people who",English
+"drink more than three or four drinks per day. You don't have to become a t toddler for this to work about lowering alcohol use to one or so drinks per day,",English
+has been shown to be effective. Use of limitations of salt in the diet or sodium restriction.,English
+"The dash diet dash stands for dietary alternatives to stop hypertension, this was a study of the diet used",English
+"in a famous series of studies by the federal government. It's basically a heart-healthy diet that we'll talk about as the course develops,",English
+"but that's also an effective way to lower your blood pressure in physical activity, that is a regular exercise.",English
+"Which of these would be the most effective if you could just snap your fingers and make it happen? Well, it turns out that they are all effective,",English
+"and the most effective though is weight loss in patients who are overweight or obese. Now, this is not",English
+"necessarily the easiest one on this list to do, but if you can get people to lose weight or if you yourself can lose weight,",English
+"this is an extremely effective way to lower blood pressure, and I'll show you the quantity in the next slide. But it turns out all five of these are",English
+"effective ways to lower your blood pressure without medications, and they all work in combination with medications.",English
+"You can start this way before you take medication and spend some time deciding whether you're going to start a medication or not and give it a good shot,",English
+"thinking that these are tools in your toolbox, if you will, as ways to lower your blood pressure without medications,",English
+"and you may be if you're successful at losing some weight or the other things listed here, you may not need medication.",English
+"Similarly, if you're already on medication and you do any of these things effectively, you may be able to decrease the dose of a medication,",English
+"or you may be able to prevent the need to start a second or third medication, so these are very effective at any phase of the blood pressure,",English
+"and as I implied, these same methods are also applicable to the community at large,",English
+"so if we as a population, lost a little bit of weight or drank lists, or had less sodium in our food supply.",English
+"Or eight or more heart-healthy, lower fat, more natural food, diet, and exercise more then",English
+"our entire population's blood pressure would go down, and that would prevent a very large number of heart attacks and strokes.",English
+This works both on the personal level for each of us and also on the population level for all of us as a community.,English
+"Here are some of the science behind that slide, so the weight-loss studies, as I mentioned, are the most impressive.",English
+"The problem is that you have to lose a fair amount of weight, most people who enter a weight-loss program might lose on average",English
+"about seven percent of their starting body weight, and for a few weigh 200 pounds and you lose 15 pounds, your blood pressure will come down significantly.",English
+"It may be as much as five or 10 or even 20 millimeters of mercury, so when people lose even more weight than that",English
+"from other types of weight loss interventions that we'll discuss later in the course, the amount of blood pressure reduction",English
+"can be quite impressive. As I mentioned, limiting alcohol to less than a drink a day can lower your blood pressure to a certain extent,",English
+"a more modestly, and reducing your salt intake also can lower your blood pressure. This doesn't work in everyone,",English
+"but it does work in older folks particularly well where as you get older you lose some of the ability to handle salt in the kidney,",English
+"so older people, or who are maybe more sodium sensitive is a phrase we use, that is to say, that if you restrict your salt intake,",English
+"the blood pressure may go down more impressively. The dash diet or the heart-healthy diet lowers in the studies that were done,",English
+"lowered your blood pressure by 6 mm of mercury, and you can combine the dash diet with sodium restriction and get double the benefit.",English
+"An exercise also lowers your blood pressure, this is a consistent with the national exercise recommendations of",English
+"about 150 minutes of moderate exercise per week as a minimum, and that lowers your blood pressure by four to nine points,",English
+"from the big studies. I like to tell both practice and tell my patients that physical exercise is biblical,",English
+"I tell him that's a joke, and what I mean by that is six days a week of exercise and one day of rest, and that way if you do",English
+"the arithmetic and you exercise 30, 35 minutes a day, you can get up as a minimum to that, 150 plus minutes per week.",English
+"A recent study has shown as some older studies, that twice that amount, even 300 minutes a week is even more effective",English
+"in preventing more early mortality, as well as strokes and heart attacks, so physical activity turns out to be",English
+"one of the best things one can do when one thinks about one's life expectancy over the next many decades. I put here as a PS that coffee,",English
+"it turns out I've already I gave Beth said something bad about coffee. Don't date, don't drink coffee before you take your blood pressure,",English
+"before you have anyone else take your blood pressure, but it turns out that habitual caffeine consumption is not associated with the risk",English
+"of chronic high blood pressure. Coffee drinking is fine, the other things on this slide are things to focus on, but coffee is still okay, cool.",English
+"Coffee may have other side effects , may upset your stomach, cause reflux, make you jittery, anxious, cause atrial fibrillation, etc,",English
+"but it is not associated with the risk of hypertension, nor is it associated with the risk of heart disease in the long term,",English
+"so we still recommend coffee for those who want it or tea as a fatigue mitigator, if you need that, get you going in",English
+"the morning as long as you don't overdo it. Just a word or two about salt, once upon a time when I",English
+"first studied nutrition in my youth, I was taught and I used to repeat the principle that about a third of",English
+"our salts in the US salt and the food supply came naturally occurring from food, a third came at the table and the stove,",English
+"and a third came from processed foods and restaurant foods. That is wrong, so that was true many decades ago,",English
+it is not true currently. What is true currently is that the vast majority of salt in the US diet is comes from process are,English
+prepared or restaurant-based foods. The amount of salt that you get from takeout or eating in restaurants of,English
+"almost any variety is substantially more than what most of us use in our own food preparation,",English
+"so even if you have a preference to salt foods at home, it's unlikely you're coming near the dose that you would",English
+"get from your favorite local restaurant. Cooking and eating do account for some salts in the diet,",English
+"and naturally occurring still accounts for some of the food and diet, but those two numbers, which used to be the majority of salt in",English
+"our diet has been now overwhelmed by the fact that we have moved our food supply into foods that come in a bag or a box or a can,",English
+or foods that come from the takeout driver or your local restaurant. Focusing on eating less of,English
+"those types of foods is how you lower salt in the diet. From my way of thinking, if you're eating some fresh",English
+"tomatoes and they need a little bit of salt that tastes better by all means, or you're cooking your favorite dish and you need some sodium salt by all means, but focus,",English
+"don't focus on the salt shaker home as much unless you're a really heavy-handed, but focus on process foods and pre-prepared foods.",English
+"Now, if you think about the way your local supermarket, Bailey's, the big chain type supermarkets are laid out, you know that most of the fresh food is",English
+"around the circumference of the store, and the middle aisles of the store is where most things that are in a bag or",English
+"a box or a can or placed. Now I'm not saying never buy anything in a bag or a box or a can, but do so strategically,",English
+"because if you buy something in a bag or a box or a can unless it says in big letters, low sodium or low in salt,",English
+"you can be sure that it's pretty high in salt, and remember our goal is about 2 grams a day or two-and-a-half grams a day of salt,",English
+and so you get up very quickly from many of the foods that we typically consume. That's a change in the way we,English
+"teach about sodium restriction. We do recommend sodium restriction, again, particularly effective in older patients. The way you do it is",English
+"avoid foods in a bag or a box or a can, and really be thoughtful about takeout food and restaurant food.",English
+"This is a slide from food consumption data. It may not totally reflect our local cuisines in San Francisco and the Bay Area,",English
+but it gives you an idea of the foods from which most of the salt in the diet comes. It turns out if I showed a list of the foods,English
+"in which most of the excess calories in the American diet come, it's almost exactly the same list. There's a slight change",English
+"in order and some of the elements, but mostly it's the same. Things that we mostly focus on are things with",English
+"added sugars like deserts, and things with processed flours like breads. You can see the other types of takeout foods,",English
+"fast food in particular, that make this list, so chicken fast-food, pizza fast food, soda pop and energy drinks,",English
+"cold cuts are famous for salt, many of the condiments are high in salts, our salsas and salsas.",English
+"Mexican mixed dishes, this is a fast food phenomenon. Any other cultures would make the list in the Bay Area. This is a national database.",English
+"But this is like Taco Bell and fast foods of that sort. Hot dogs and sausages and bacon you can imagine, cheese is relatively high in salt.",English
+"Most cheeses and desserts are typically high in salt. Again, these foods are where most of your salt comes from,",English
+it's not the little bit of salt you put into your stew or on your salad. Let me move next to,English
+medications and begin this section of the talk by focusing on several studies that have tried to get at the three key questions that we,English
+"should be thinking about as we decide how to treat high blood pressure. Those three questions are, does treatment at a specific blood pressure threshold,",English
+"that is that 150 or that 140 or that 130, improve outcomes, that is, reduce heart attack and stroke,",English
+"and is there science to support that? Does a treatment to a specific goal improve outcomes, reduce heart attacks and strokes?",English
+Do different medications differ in their effectiveness to prevent heart attacks and strokes? These are the things we're thinking about.,English
+"As patients and as clinicians, that is, should I call this patient high blood pressure? Should I start treatment?",English
+"Should I use a medication? If so, to what goal? What medication should I use? When this study was done,",English
+this came out about five years or so ago. This was one of the large studies funded periodically by the National Institutes of Health,English
+on this topic. It's a series of studies that has driven our primary approach to hypertension for decades.,English
+This was the eighth version. They are done about every five years. It's been about 40 or 50 years or so that we've had this approach to decision-making.,English
+Each time it looks at the newest data and tries to put it all together. This time it was particularly carefully done because they only,English
+looked at what we call the randomized clinical trials. That is the big studies that gave a placebo to half the patients at,English
+"random and gave a medication to the other half, also chosen at random, followed them for a period of time,",English
+"usually about five years or so, and measured the amounts of heart attacks and strokes. I'll give you some examples of this in a moment.",English
+"But the first recommendation, it was the one that surprised people the most, which was that based",English
+"upon the dozens of studies that existed, admittedly many of them older, that is, that have been around for",English
+"several years or decades in some cases, that it turns out the evidence that starting above 150 was strong and starting above 90 was strong,",English
+"but their treating levels lower than that had less evidence to support it. Now, when this came out,",English
+this was revolutionary because we were all using 140 as the magic threshold. Also 90. But 140/90 has,English
+"been our standard for quite some time, and this study began to raise the issue. Well, maybe the evidence isn't all that great,",English
+"between 140 and 150, and that we should at least in older patients, let the blood pressure ride a little higher and",English
+"accept blood pressures between 140 and 150 without using medication. Again, the goal was just to",English
+"get it less than 150 in these studies. This was not agreed to by everyone, even on the commission.",English
+"It was a strong recommendation from the panel, but it was not unanimous. You'll see in several slides,",English
+"the level of the lack of unanimity is striking. That is to say, this is not a recommendation that is widely",English
+held and it's not routinely standard of practice. But it is worth noting that if you're very strict about demanding,English
+"evidence to support what we do in clinical practice, that the evidence is not that strong at",English
+"treating at lower values in older patients, prevents heart attacks and strokes. That doesn't mean we shouldn't do it,",English
+"but it's worth noting that for patients who prefer to be between 140 and 150 for other reasons like the case we first discussed,",English
+"who was 145/85, that might be an acceptable option. We'll come back to this from different angles",English
+because there are many different opinions about this. The other recommendations were less controversial and mostly,English
+"reinforced our practice at the time this was published, and to much degree,",English
+"our current practice as well. What this said was that for patients less than age 60 or patients that are at higher risk,",English
+"you should use a lower threshold that is back to 140/90 to start medication. 150 and lower risk patients who are a bit older,",English
+but 140/90 for people at higher risk and younger patients. They also reviewed all the medications,English
+and came up with about the same list that we had been using from the earlier reports by this panel over the years. Certainly a couple of iterations of this report.,English
+"Basically, we have four classes of medications that are shown here, and it turns out that they're all relatively equivalent.",English
+"Some of the older recommendations had more stronger opinions about thiazides as a preference, hydrochlorothiazide is the most common thiazide.",English
+"But you may take Dyazide or chlorthalidone as a thiazide type of medication. That's no longer the drug of first choice,",English
+"but it's in the top three. The second category, which wasn't always included but has been for the last decade or so,",English
+are what we call calcium channel blockers. You may take diltiazem,English
+"or nifedipine or other calcium channel blockers. These are excellent drugs. They can be used as the drug of first choice,",English
+or they can be used in combination with the other drugs on the list. You can start with a calcium channel blocker,English
+"and we often do, and then we might add a thiazide as a second medication. Or we would add a third category which is",English
+"equally as good as the other two, which are ACE inhibitors, so lisinopril or benazepril. Again, there's about a dozen of these,",English
+and these have been around a long time. They're also extremely effective and they've been shown to prevent heart disease and strokes. The fourth category are what we call angiotensin,English
+"receptor blockers, commonly called ARBs. These are things like losartan or cozaar and other medicines in that class.",English
+All four of these can be used. You can use thiazides and calcium channel blockers together,English
+and with either of the ACE inhibitor or the ARB. The one proviso is not to use an ACE and an ARB together. It's really three classes of drugs of,English
+"which two are an either or category. That is either an ACE or an ARB, a calcium channel blocker or a thiazide-type diuretic,",English
+"are the three first choices for the vast majority of patients. There are other medicines that can also be used,",English
+"but they're not as effective as solo drugs, again, for our goal of preventing a stroke and heart disease.",English
+"However, if you have a simultaneous other medical problems, they have migraine headaches,",English
+and a Beta blocker is particularly effective for preventing migraine headaches for you. Or you have urinary tract symptoms,English
+"and Alpha blocker is effective at preventing a urinating at night, then those are other types of medicines or less effective blood pressure medicines.",English
+"But also medications that will lower your blood pressure as well. But these are the three classes,",English
+"the four ways to get to three, if you will, of medicines that we rely on thiazides, calcium channel blockers, and",English
+"either an ACE inhibitor or an ARB. There's no preference anymore as to which to use first. Different clinicians have different preferences,",English
+"different patients have different preferences. They have slightly different side effects, if any. Depending on conversations we would",English
+pick one of these three major categories. The one place where it's recommended based on scientific evidence to give,English
+"preference to one of these classes over the others are in patients with chronic kidney disease or CKD. CKD in chronic kidney disease,",English
+"especially moderate levels of severity, especially when there's protein in the urine. The ACE's and the ARB's,",English
+either or both of them have been shown to prevent the progression of renal failure. Both of these are recommended as the drug of,English
+"first choice for someone with kidney disease. For heart disease or strokes, or other reasons to treat",English
+"blood pressure or just a high blood pressure, it doesn't matter again, any of the three are fine. But for CKD we say either an ACE or an ARB.",English
+"Again, not together. Too many side effects when used together, but either or an effective first drug for high blood pressure.",English
+"Many patients with high blood pressure need more than one drug. In fact, many patients need three drugs. It's very common for patients to",English
+"take two or three medicines for high blood pressure. That's not unusual, it's not abnormal. These medicines work extremely well together.",English
+"Once you get over three, if the blood pressure is still poorly controlled, that's a separate conversation. There are a variety of medical conditions",English
+and social determinant type conditions which cause refractory high blood pressure. Some hormonal observations or abnormalities.,English
+"If you need a fourth drug. First, the clinicians need to think why is this happening? The most common reason it's happening is because",English
+the patient is not taking the medicine on a regular basis. Imperfect adherence to the medicines is the most common reason why three drugs don't work.,English
+But there are many others and it requires a bit of an evaluation and assessment and some thought as to what the best forth drug would be.,English
+But we have a long list of at least a dozen. Certainly a good half dozen are very commonly used medicines that work very well with these,English
+three as medicines that can be used as a fourth drug if it's needed. But it shouldn't be started without a thought process as to why is this happening?,English
+"Why does this patient need a fourth drug? Now, let's turn next to the sprint study as an example of one of the",English
+"best done studies in high blood pressure. This was very well done, was funded by the National Institute of Health.",English
+"There are about 10,000 women and men that were over age 50 and almost 30% or over age",English
+"75 to enter the study and needed a blood pressure, the top number, the systolic blood pressure of over 130. Interestingly though, to get into the study,",English
+"you needed to have a high risk of cardiovascular disease, that is of heart disease or stroke. We use a risk equations",English
+to calculate one's cardiovascular risk. I'll go into detail about that later in this course when we talk about cholesterol.,English
+"But the equations are in common use now, and you can find them yourself. I'll show you how to do that and when we get there.",English
+"But the patients who entered the study were pretty high cardiovascular risk. It turned out that they had a 20% risk of having a cardiovascular event,",English
+that is a stroke or a heart attack in the next 10 years. That's high. That's about the same risk as having a second heart attack if you've had a first.,English
+That's high risk and I'll come back to that because it makes the generalized ability of this study questionable when you,English
+"apply it to people who were not at such high risk. Interestingly, in this study they excluded people with diabetes and that was a little bit weird.",English
+But the reason they did that was because there had just been another study with the same design that is comparing treating,English
+"a beginning at 120 versus treating at 140. In patients with diabetes, and it turned out that there was no benefit.",English
+"In the diabetes study, there was no extra benefit by treating to less than 120 than there",English
+"was to treat him to less than 140. That's why our recommendations, even for diabetes was to treat to 140 until this sprint study came out.",English
+This is a little bit confusing because we have another study that contradicts what I'm about to show you. But also makes the generalizability of,English
+"the study get a little bit uncertain. Doesn't make it right or wrong, but uncertain about patients with diabetes.",English
+"The basic principle of the study, the basic experimental research question was, if we treated people to under 120,",English
+did they do better than if we treated people to 140? There are a couple of observations was that Number 1 is that to,English
+"even though the design was to get these people under 120, the actual blood pressure was 121.",English
+That was the average. That means about half the patients did not get under 120. What that implies is that it's,English
+hard to get people under 120. I'll show you the side effects that interfere with getting to under 120 in just a moment.,English
+"But nonetheless, there was a difference in the two arms, 121 versus 136. It allowed the investigators to really try to answer the question,",English
+"which is was tighter control, if you will, more effective than a looser approach, is 120 better than 140?",English
+The answer in this study was yes. I already showed you the results of all the prior studies put,English
+"together where the answer was no. But in this study, very well done. Federally funded, there was",English
+a 25% reduction in cardiovascular events and the people who are in the tight control group.,English
+"Now it's worth noting that the event rate is pretty rare. In this five-year study, not that many patients had heart attacks or strokes.",English
+Remember I told you that the prediction would be that they would have 20% in 10 years or 2% per year and that's what they found.,English
+"The reduction was to 1.5% per year. Statistically, it's significant for an individual person one would have to decide,",English
+"is that amount of a difference of risk worth the extra medication. Strikingly, most importantly about this study,",English
+"that not only did it prevent heart attacks and strokes, but it also saved lives. There was a reduction in the death rate,",English
+"but again by a quarter, reducing the death rate per year from 1.4-1.0. Again, statistically significant event,",English
+"the absolute amount is small, but again, a life is a life. This shows that if you can do it in the right,",English
+"patients are getting down to less than 120 can prevent heart attacks and strokes and save lives. Now, this came at a bit of",English
+a cost and the investigators were looking for side effects and so they predefined certain side effects,English
+"that they were most worried about. These were all side effects that were serious enough for the patient, for example, you go to the emergency department.",English
+There was an increase rate by 67% of low blood pressure requiring a visit to the emergency department.,English
+There's a one third increase in passing out requiring a visit to the emergency department. A third of patients had more problems with,English
+"their blood chemistries usually potassium abnormalities either too low or too high. Initially, there was some change in kidney function,",English
+"although the long term effect on the kidney was actually positive, and I'll review that at the end.",English
+"But there was some short-term temporary damage during the study, but this is not important in the long term.",English
+But it does illustrate that taking three medicines and to a blood pressure of less than 120 has some side effects in,English
+"some people as compared to two medicines in 140. In medicine, if you remember",English
+"that first slide of the Seesaw where we're balancing risks versus benefits, one way to think about that is how many patients does one need",English
+"to treat in order to get the benefit that we are thinking about. In this particular case,",English
+"for the primary aggregate outcome, which meant that combination of heart attacks, strokes, and death and so on,",English
+"we had to treat 60 patients to prevent one outcome. To save a life, we had to treat close to 100 patients.",English
+"If you're that one patient, then this was really important. If you're the other 90 patients, then you didn't benefit.",English
+That's the trade off that we have to think about when we define risk with individual patients and how,English
+"risk averse are you in other words, willing to do more to prevent a risk of a heart attack or stroke versus",English
+preferring to do less because you don't want side effects or you figure the odds are still on your side. This is the conversation we,English
+"have in almost every test in medicine. Certainly was active during the COVID pandemic with medications and vaccines, and we'll talk about that later in the course.",English
+The side effects have relatively similar numbers needed and then H stands for number needed to harm. This is the number needed to benefit,English
+"and this is the number needed to harm. Again, roughly equal amounts. But keep in mind the benefits are much greater than the harms.",English
+But it does show that a fair amount of patients also develop side effects as we discussed. How do we interpret all this data?,English
+I'll show you what the community has done in recent years as a result of this data. But this study showed in a very well done fashion that,English
+treating to a blood pressure of under 120 had better cardiovascular disease and mortality benefit than a systolic blood pressure of under 140.,English
+We had to treat 61 patients over three years or 180 patients per year in order to get that one person who benefited.,English
+"Notably, there were adverse effects requiring emergency room visits that were also about the same order of magnitude,",English
+"but not as serious as these benefits, but nonetheless, important. In conclusion, I think one of",English
+"the controversies is that these were very high risk patients. That is, their risk of having a heart attack or stroke was very high and in fact,",English
+"they did have heart attacks at the risk of 2% per year, as we would have predicted. But a risk of this high,",English
+"the 20% threshold, only applies to about one out of six patients with high blood pressure. If you're a patient with high blood pressure",English
+"whose risk of having a heart attack or stroke is lower, then I would argue this study applies to you less and maybe not at all.",English
+But certainly if you're a patient at high risk and certainly if you're a patient that's already had a stroke or had a TIA or had,English
+"a heart attack or heart failure or kidney disease, then this does apply to you. That'll be the conclusion",English
+that we circled back to in a minute. There are other features of this study. It doesn't really tell us much about diabetes.,English
+"They excluded some people that were all the frail. They excluded people who are young. As I mentioned, these are individuals",English
+"who are high risk of having cardiovascular disease. I'll show you how to calculate that later in the course. Like many studies, this is free care,",English
+"frequent visits research grade blood pressure measurement, and very careful monitoring and adherence of taking the medicine.",English
+"One final point. Remember that the blood pressure, based on this research grade measurement in this study was 12 points lower than it was in the regular office.",English
+That may also be an important thing to keep in mind if you're deciding to use these values in your decision making.,English
+"As a result of this study, the expert panel coming from the cardiology field, the American College of Cardiology and the American Heart",English
+Association took this study and to upset the cart right away and change some definitions.,English
+They define a normal blood pressure as less than 120 and for the first time they define an elevated blood pressure as anything between 120 and 130.,English
+"This was new as a result of this study and similarly, this was new, that is, the hypertension was now defined as anything over 130.",English
+This was new and it has major public health implications if we adhere to this because it makes,English
+about half the people in the United States having definition of hypertension. Currently it's about a third and with,English
+this moving from this definition of 130 is the threshold rather than 140 takes it from one-third of the population to one-half.,English
+That's an important public health consideration. Their thresholds for treatment are aligned with,English
+"the definitions for secondary prevention and by that, we mean people who have already had a stroke or a heart attack.",English
+The recommendations are to use 130 as the threshold and the goal to be less than 130 and less than 80.,English
+"People at high cardiovascular risk, they might say 10% in 10 years or 1% per year. They would also use 130 as",English
+a threshold and less than 130 and less than 80 as the goal. For people who with lower risk they would use 140 and 90. A little bit different than what we saw from,English
+the big federal study on initial Joint National Commission Study and this really upset the cart,English
+"and changed practice in the United States considerably. Now, this created a fair amount of controversy and it's",English
+"why I'm talking on this subject because there is still controversy. That is to say the internal medicine community and the family medicine community,",English
+"the two professions that are in addition to pediatrics make up primary care, or in this case, adult primary care. Said, we've looked at this data and we don't think",English
+"it applies to all of the population, nor does it reflect all of the other studies that were done",English
+"before this newer study was done. In fact, they came out and said, we hear you to the cardiologists.",English
+We hear what you're saying. We see this very nice study in high-risk patients. But we still think the literatures strongly suggest what I said earlier.,English
+"That is that for patients over age 60, we could use 150 as a threshold. For people over 60 who are at higher risk,",English
+"we should use 140, and for younger patients we should use 140. We now have two groups of",English
+"really smart people who have thought a lot about this, coming up with different recommendations. This is still where it stands.",English
+They also said that they were not going to endorse the Heart Association guidelines.,English
+"They thought that the Joint National Commission Report upheld scientific rigor, but that the cardiology reviews",English
+"did not put together all the prior studies, but rather was just relying on this one new study. As I mentioned earlier,",English
+"if you use the values from the SPRINT study, it means half the population has hypertension as opposed to a third.",English
+"The primary care community said, not yet. Now, since these studies came out, there have been a few other studies.",English
+This now looking at what we call meta-analyses is putting all these studies together and see what they all show together.,English
+Here's a well-done one that looked at all the world's literature and try to answer the same,English
+"question that we've been getting at, which is what is our threshold? What they showed was, as the earlier study showed,",English
+"that if you started with a blood pressure that was higher than 160 and you treated it to less than 150 at least, that you save lives",English
+and you prevented heart attacks and strokes. These numbers with the asterisks are statistically significant.,English
+"This shows that treating high blood pressure works, we know that. Interestingly, they showed if you",English
+"start at 140 as your threshold, rather than 160 it still works. That if you treat people who are",English
+"140 or 145 or 150 or 155, you also prevent heart attacks and strokes and save lives.",English
+"Again, statistically significant. Interestingly, in this very large meta-analysis of the world's literature,",English
+"they found that in patients whose blood pressure was less than 140, there was no benefit of treating the blood pressure,",English
+"no impact on events, and no impact on the death rate. This is different than the SPRINT study.",English
+"But now again has an opposing point of view looking at all of the studies done in the literature. Now they did find, make one observation,",English
+"which is they did find a subset of patients. If you had a heart attack in the past and your blood pressure was less than 140,",English
+"at least by a little, it did prevent events. It didn't save lives but there was a reduction in a recurrent heart attack or stroke.",English
+This is encouraging because this at least gives us a little bit of overlap with SPRINT. That is in patients who have,English
+"very high risk of heart disease or stroke, that are being more aggressive with treatment is effective.",English
+"Now in the last few years, a variety of other groups of experts. I've given you the American Heart Association,",English
+"cardiology experts, and the internal medicine and family medicine groups of experts and their professional opinions.",English
+"But a variety of other groups have also looked at all this and again, come up with different recommendations.",English
+"At first, it was interesting that the European Society of Cardiology and the European Society of high blood pressure said that,",English
+"let's look at all the literature together and we'll stick with 140. The British system that has its own National Institute for Health called NICE,",English
+"National Institute for Health and Care Excellence. They reviewed the literature and for their national health policy, they said, we're going to stick with 140 as well.",English
+The International Society of Hypertension and other specialty organization also reviewed the literature and said 140. The nephrologists reviewed the literature,English
+"and they agreed with the cardiologist. They also used a lower threshold for them. We have the nephrologists,",English
+"the kidney specialist in the heart, and the cardiologists in one camp, the family medicine, internal medicine, and some of these international groups in another camp.",English
+"In summary, what do we do for this 68-year-old patient? In this case I said woman, her blood pressure was 145/85.",English
+"There was again, no history of diabetes, heart disease, or stroke. As you've seen, we have",English
+"two different opinions in the community. Since she's at low risk of having a heart disease or stroke, because she has no other risk factors,",English
+you could either do what the Joint National Commission does and let her be alone at 145/85 because,English
+"you're using 150 as the threshold, or you could say, well, it should be less than 140. Are older recommendation because she is",English
+"at risk of events but simply based on age. The yellow here are the correct answers in my opinion,",English
+"for this particular patient in this model question, if a patient is 145 or 85, you can do either. It really becomes up to the patient",English
+and the clinician to really think this through. This would be an excellent situation to make sure one is checking the blood pressure correctly.,English
+One might do home monitoring to make sure that number in the office is correct. Repeat the measurement in the office to make sure it was done correctly.,English
+One might even consider an ambulatory blood pressure monitor to see what it looks like over the course of a 24-hour period.,English
+"But if the patient says, I'd rather not take any medication, this might be a blood pressure that you can accept. On the other hand, if she says no,",English
+"I'm really afraid of a stroke or a heart attack, I'm willing to take my medication then it would be perfectly correct. The first try if she's motivated on",English
+non-drug treatment within the efforts we discussed or start a medication with one of the three classes of medicines.,English
+"Again, that we are four classes that we discussed. In summary, rethink the way blood pressure is measured.",English
+"If you get a high blood pressure measurement, it's always okay to ask for repeat measurement. Use home blood pressure monitoring,",English
+but do so with greater rigor. Consider ambulatory blood pressure monitoring before making major treatment decisions.,English
+"For most patients, we still use 140, less than 140 and less than 90 as our threshold. But there is some evidence that for some older patients",English
+"whose preferences to use one less medicine, that we can allow 140-150 for some lower-risk older patients.",English
+"Conversely, the evidence would suggest based on the SPRINT study and the meta-analysis I showed you,",English
+"acute leukemias are malignant diseases of the bone  marrow acute leukemias are more common in kids   the first one is your acute lymphocytic  leukemia it is, it presents with anemia",English
+neutropenia and thrombocytopenia so this is a  lack of neutrophils a lack of platelets and then   obviously here lack of red cells or hemoglobin  both um approximately 10 percent of the patients,English
+can develop disseminated intravascular coagulation  so this is where there's clotting going on   micro clotting going on all over the body  and that uses up all the clotting factors,English
+so it's a clotting problem that eventually  develops into a bleeding problem because all the   clotting factors get used up you see an increased  cell turnover uh and that results into high LDH,English
+as these cells get destroyed a lot faster  than normal uh so all your cells have LDH so   you know any of those increased turnover of  those leukemia cells will cause an increase,English
+in LDH and in uric acid because that is the  waste product of your purine metabolism which   is coming from your nucleic acids from DNA and  RNA cells contain DNA and RNA so if they're being,English
+turned over and destroyed at a higher rate  you're going to have an increase in uric acid   as your neutrophil count declines then  the patient can become more susceptible   to bacterial infections because you neutrophils  are your main line of defense against bacteria,English
+and the lymphocytes that are produced do not  function as mature lymphocytes so there's   a bunch of them but they're just crowding up  the bloodstream and they're not actually doing   their job the next one is your acute myelogenous  leukemia so the lymphocytic was obviously in the,English
+lymphocytic line and myelogenous is going  to be in that myeloid line and it's um   the main pathology is it's an arrested  development of the myeloid progenitor stem cells,English
+to diagnose acute myelogenous leukemia there  must be at least 20 blasts in the bone marrow so   you have to do bone marrow aspiration for most of the leukemias you have to do bone marrow aspiration,English
+to diagnose it anyway in the initial stage you  see a decrease in the production of your   normal blood cells so therefore you'll see anemia  thrombocytopenia and neutropenia just like in ALL,English
+but then in the second stage you would see a  proliferation of the cells in the bone marrow   and in the peripheral blood so some of those  earlier cells are starting to show up in the blood,English
+um and they're also proliferating in the  spleen and liver so you may get spleen and   liver enlargements um so the problem is these  cells do not undergo their programmed apoptosis so,English
+some of the cells like um if they're like a  neutrophilic line of them some of them have   you know programmed apoptosis that's usually  not very lengthy they don't live very long,English
+uh so they don't die and they're just hanging  out there for a long time and they don't function   as normal neutrophils which then lead again  to an increase of bacterial infections so,English
+AML patients may have also DIC disseminated  intravascular coagulation and they frequently   have elevated uric acid and LDH results both  of these were same as for ALL right the,English
+you see micro clots everywhere it uses of the clotting  factors and then it's a bleeding problem and then   the cell turnover that can happen this increased  amount of cells being put out and then eventually,English
+"destroyed because they get stuck in places and  they plug up the microcirculation too because   the myelogenous lines, the  myeloid lines are bigger cells   and the bone marrow studies done and the testing  is done to locate translocations or deletions",English
+on specific chromosomes uh to identify  the different types so there is definitely   all kinds of there's different ones different  classifications so we're not going to go into that   depending on which line is involved so the first one was  the lymphocytic line this one's the myelocytic,English
+line and then you have chronic leukemias so  um chronic leukemia tend to happen more in adults   the first one is chronic lymphocytic leukemia  so it is the most common form of leukemia seen,English
+in adults and it is generally asymptomatic you  know symptoms you have large numbers of small   non-functional lymphocytes in the bloodstream they  are seen as smudge cells on a peripheral smear,English
+and you can do cytogenetic studies to come to a diagnosis people can live   with chronic lymphocytic leukemia for a decade and  not really have any kind of symptoms again usually,English
+what it could is it converts to an acute  leukemia then you can start seeing symptoms   hairy cell leukemias um the lymphocytes have  hair-like projections on their surface so they look,English
+hairy basically that look like  they are surrounded by little hairs   on the smear they are there's often extensive  bone marrow involvement that leads to pancytopenia   meaning all the cells are decreased so all the  lines are affected and cytochemical stains such,English
+as the acid phosphatase after tartrate incubation  are useful to diagnosis for the diagnosis of hairy   cell leukemia of course you know in any of  those you can use cytogenetic studies also,English
+"and then you have the chronic myelogenous  leukemia or CML, CML is characterized by the   presence of that Philadelphia chromosome I'll show  you that in just a second the white count can be",English
+greater than 100 000 which is 100 times 10 to  the nine which is really big um thrombocytosis   is often present but the platelets typically do  not function well and patients often have anemia,English
+and splenomenally here with chronic myelogenous  leukemia one thing to distinguish between the   two again the myelogenous lines cells are bigger  so they tend to create a little bit more problems,English
+whereas lymphocytic lined cells are smaller so  the numbers can get higher before you actually   see issues and some symptoms and sometimes again  with a chronic one there's no symptoms this is a,English
+Philadelphia chromosome so it's a translocation  a 9-22 translocation so what happens is   um the tail end of these chromosomes here  of 9 and 22 swap places so the bottom of 9 ends,English
+up at the bottom of 22 and the bottom of  22 ends up at the bottom of 9. so it's a   translocation and the Philadelphia chromosome is  this chromosome 22 here with these two genes on it,English
+all right so next poll question  so do you remember which   leukemia which leukemia is most commonly seen in  kids? if you're not sure go back and rewind the,English
+video next one so knowledge check which leukemia  will show the Philadelphia chromosome? which we   just looked at so again if you're not sure just  go back a little bit and answer that for yourself,English
+then we have myelodysplastic syndrome so to break  that down myelo means bone marrow and then    dysplastic is abnormal growth and the it's a syndrome  and so it's a primary neoplastic pluripotential,English
+stem cell disorder so again cancer-like uh  it affects the pluripotential stem cell   um and so therefore there are multiple  lines that are involved the cell,English
+lines that are involved are the erythrocytic  granulocytic and the thromboplastic lines   and you see in the peripheral smear a decrease in all  the blood cells with one or more peripheral blood,English
+cytopenias along with prominent abnormalities  in the bone marrow so the abnormal growth is   just aplastic in the bone marrow but then you  get you know cytopenias in the blood smear,English
+so leaving the leukemias behind so leukemias  all have abnormalities in the bone marrow   which affect the cells that are present in  the peripheral blood lymphomas are different,English
+"so lymphomas are malignancies in the lymphatic  system okay so different, lymphatic system not   the cardiovascular system, not the bone marrow so  and they are derived from abnormal B and T cells",English
+so Hodgkin's lymphoma you see abnormal B cells  it has five different classifications the cause   is unknown although the Epstein-Barr virus  can be linked to this disease this is the,English
+"virus that causes mono, HIV patients have a  higher risk of developing Hodgkin's lymphoma   than the HIV-negative patients do and the first  symptom is often a single painless lymph node in",English
+the cervical region and cervical meaning neck so  a big node in the neck on one side or the other   and the lymph nodes in Hodgkin's lymphoma  contain Reed-Sternberg cells which are stained,English
+in particular histochemical saying here  okay so we are in the lymphatic system   so it affects your lymph nodes uh  and lymphatic you know vessels,English
+so the non-Hodgkin lymphoma originate either  from a B line or a T line; B line or T line here   and has more than 30 different classifications a  bunch of different ones uh the peripheral lymph,English
+nodes throughout the body will increase in size  so not just cervical could be anywhere and this   disease has been seen in patients after exposure  to pesticides chemicals and organic solvents,English
+and like farmers are susceptible to this because  of how much chemicals they're around peripheral   blood hematology tests will reveal little and don't  aid in diagnosis so again this is a big difference,English
+between the leukemias and lymphomas it is in the  leukemias there's usually something's off on the   CBC in the peripheral blood and in the lymphomas your  CBC your peripheral blood stuff will look normal,English
+"but the abnormality again is in the lymphatic  system most lab results including your chemistry   results reveal very little, just non-specific findings  nothing that just is really pointing to it",English
+um and so diagnosis has to be made from imaging  studies like CT scans and biopsies and obviously   so revealing those enlarged lymph nodes and biopsy-ing  the lymph nodes to find out what's going on,English
+staging is the assessment of the disease  progression this is done in a lot of cancers and   this can help determine the type of therapy and  it's also useful when monitoring the patient,English
+"all right so what is the key difference again  between the leukemias and the lymphoma so think   about that if you're not sure go back and rewind  the video and watch there's, there are some key   differences there between leukemias and lymphomas  and then this is a little activity for people in",English
+my class in Nearpod all right so moving on to the  red cells so we are leaving the white cells behind and   we're going to start looking at hemoglobin so  hemoglobin is a protein that transports oxygen,English
+and carbon dioxide however it does not transport  carbon dioxide the way it the same way it   transports oxygen just as a review we talked about  this a little bit in acid base but your oxygen,English
+is transported onto iron molecules here in the  middle of each of these chains the globin chains   CO2 actually gets converted and  it can actually also just tag onto,English
+um the protein part of the molecule because CO2 is  converted to bicarb and that's how it's carried uh   but yeah so uh a CO2 molecule can tag itself onto  the globin portion of the hemoglobin molecule,English
+so it generally has four globin chains two alpha  chains and two betas okay so the alphas here are   represented in blue the betas are represented  in green and then this orange dot on or in the,English
+middle of each of them is where your iron heme  molecule is where the iron is and where the oxygen is   transported so that one molecule of hemoglobin can  transport a maximum of four molecules of oxygen,English
+all right so iron is used throughout the body it  is found in myoglobin um attached it is attached   to enzymes so enzymes need iron to function it is  stored in tissues and in an iron circulating pool,English
+in red cells one iron is inserted into  the center of the ringed heme molecule and   the molecule is inserted inside the globin  and 4 globins make hemoglobin it is important to,English
+know that for example our iron is also used in  the electron transport chain in the mitochondria   etcetera which is another reason why when  people have iron deficiency anemia they're,English
+really tired because you need iron to produce  energy to produce ATP okay um and then iron   is also again in myoglobin is like a modified version  of hemoglobin it's just like muscle hemoglobin,English
+it's muscle globin um and it holds it can hold the  oxygen in the muscles so that's a variation there   so storage of iron so let's talk iron and storage  of iron so ferritin is the primary storage form,English
+"of iron it's found in the liver spleen and bone  marrow and we can do ferritin levels on the blood   and a ferritin level then would assess  your storage, the storage capacity of iron",English
+hemosiderin is an aggregate of  lipid protein carbohydrate and iron   it is found primarily in macrophages and is  formed from the partial degradation of ferritin   you would only see hemosiderin granules if  you have excess ferritin if there's really way,English
+too much to the point that it is degrading; heme iron is  found in red meat and is most easily absorbed and   non-heme iron which is found in vegetables  and whole grains although you can get it,English
+but again that's another advantage of having an  omnivore diet you don't have to eat nothing but   meat but having meat as part of a well-rounded  diet does give you the advantage that you will,English
+absorb the heme iron better and you'll have a  less you're less likely to become iron deficient   um so a little bit on iron absorption so this  is from the GI tract so once you have ingested,English
+it and it's going down the GI tract your  iron has to be in a ferrous state to be absorbed   uh apotransferrin binds ferric iron to form  transferrin so then it has to to be converted,English
+from the ferrous to ferric state for the  apotransferrin to bind it so   um the apotransferrin is the protein that  picks up that transfers ferritin or iron,English
+that transfers iron and when it  picks it up it makes transferrin so this is   iron that's being transferred or carried in  the body this transports iron to the liver,English
+which is where it is stored and throughout  the body to meet the needs of the body again   remember iron is needed for mitochondria it's  you know needed obviously in the liver it can   be stored up there it's going to be needed in the bone marrow if you need to make more red cells,English
+um and the molecule hepcidin regulates the  absorption of iron depending on your need so let's talk about porphyrins now as part of  red cells so the porphyrins are the components,English
+are composed of four pyrroles and this is a  pyrrole molecule right here so four of those   bound in a ring shape and this makes this  porphyrin ring and once you have the ring,English
+"shape it can bind iron molecule in the middle  the side chains of the molecule allow for the   variability of the porphyrin there are bunches, a bunch of different porphyrin types",English
+um the important ones that we're concerned with  are uroporphyrin protoporphyrin and coproporhyrin   and in order to make heme iron has to be in  the ferrous state to be able to get in here,English
+and bind here in the middle of this   porphyrin ring and um the oxygen binding is the process   of an oxygen molecule that binds to one heme  group and it binds on that iron molecule,English
+so let's talk about iron deficiency  so again iron is an integral part   of the hemoglobin molecule so we need it  to make hemoglobin but it plays a part,English
+in the peroxidase and cytochrome function  so again more than just making hemoglobin   you need it for energy production peroxidase is  the enzyme that is used for hydrogen peroxide,English
+"to you know kill bacteria and stuff, very  useful, the consequences of iron deficiency   can first it leads to the production of small red  cells they're microcytes or micro-cytes and they",English
+have too little hemoglobin and so they are hypochromic  so it's a microcytic hypochromic type of anemia   but cytochrome function is also affected  therefore you're not as good at the production,English
+producing energy the patient would be more tired  and low energy would be a sign of iron deficiency   in your lab test if you have iron deficiency you  would expect to see low iron levels so lower than,English
+normal or maybe even on the low end of normal  and um your total iron binding capacity test it   measures the amount of iron that can be bound by  transferrin will be high because you have a low,English
+amount of iron uh it has a high binding capacity  that means it's looking for it is going to pick it   up um and so that's why the lower the iron is  the higher the binding capacity is because it is,English
+wanting to find some iron because we need some  iron in that body and of course if you have   iron deficiency the ferritin which is the  storage form of iron is also going to be low now on the other end who can have iron  overload? so women are more prone to,English
+"iron deficiency because of the monthly  cycle and bleeding, of losing the blood   um in men because they don't have that monthly  cycle they are more at risk for this iron overload",English
+the most common form of iron overload is  going to be hereditary hemochromatosis and in   this disease you have a genetic mutation with  an increased absorption of iron in the GI tract,English
+and then of course because iron is valuable  to the body it's sent to storage uh where's   the storage site? it's mainly the liver but then  because there's excess it's going to try,English
+to start storing in other places and so you'll see  uh it'll start accumulating not only in the liver   but in the heart the spleen and in the skin  and that leads to a bronzing of the skin because,English
+of all the iron that's in the skin as well as a  cirrhosis of the liver and diabetes and this is   both because of the way the liver  is affected by all this excess iron,English
+the lab tests that are done to diagnose  hereditary hemochromatosis is going to be   a genetic test and liver biopsy quite involved  but the blood test which we would want to do,English
+that first because it's less invasive other I mean you can do genetic testing on blood    the liver biopsy is more invasive um your iron  levels of course in the blood would be high,English
+the iron binding capacity would be low and the  ferritin would be high so complete opposite   of the iron deficiency and the way you treat or  manage this is to donate blood so because you have,English
+the body has too much iron if the person donates  blood on a regular basis then it forces the body   to use up the iron to make more red cells and it  solves the problem the alternative is therapeutic,English
+phlebotomy where the blood is collected but  then not used which again if the person is   eligible for blood donation that's a win-win  situation because it's like they get the therapy,English
+and doesn't cost them anything and the blood  can go help a patient actually four patients   all right so if your patient has iron deficiency  which set of results would you expect? high iron,English
+high ferritin low TIBC? low iron high ferritin  low TIBC? or low iron low ferritin high TIBC?* so   if it has iron deficiency if you're not sure  again you can rewind and go back and look,English
+if your patient has iron overload would you see  low ferritin or higher ferritin*? which one would you   see if they have iron overload? again if you're  not sure go back to the iron overload section,English
+all right so um let's talk about porphyria so we  we introduced the porphyrin molecules but if you   have a problem producing the porphyrin molecules  or somewhere in that production pathways then a,English
+patient can end up with porphyria um there are  two big classifications of porphyrias you have   the acute ones and the chronic ones uh the acute  porphyrias are evidenced by periodic neurovisceral,English
+attacks psychiatric symptoms and red urine and  the most common of these is acute intermittent   porphyria chronic ones you get extreme sensitivity  to the sun the skin can blister which then can,English
+cause infection and scarring and the patients may  develop liver and nervous system disorders and uh   the porphyria cutanea tarda is the most well known  these are kind of known as the vampire diseases,English
+because they need blood because some of them are  not really good at making blood um you know they   have red urine have psychiatric symptoms they have  attacks they don't like the sun and so these are,English
+uh called vampire diseases so here's the  production of porphyrin and heme and so you   can see there's enzymes that are involved in all of  these different steps and depending on which one,English
+is defective you have these different types of  porphyrias so uh for example if you have uroporphyrinogen   one synthase deficiency or problems  then you will get acute intermittent porphyria,English
+if there is a problem with co-porphyrinogen  oxidase you get hereditary corporphyria uh and   so there you go you can just kind of see  we're not going to go over all of them but,English
+it's good to see what's going on there and so  basically you want to find what is accumulating   and which enzyme is deficient to properly  diagnose the patient and then manage the patient,English
+a little bit on modified hemoglobins so these  tie back into kind of the acid-base chapter   but um there are different forms of hemoglobin  these will all be measured usually by the,English
+co-oximeter on an ABG analyzer the first form  that can be measured is the a carboxyhemoglobin   so this is hemoglobin that has been bound with  carbon monoxide and the binding affinity for,English
+carbon monoxide is anywhere from 200 to 250  times greater than that of oxygen basically   meaning if carbon monoxide binds on the heme it's  not letting go and oxygen therefore cannot bind,English
+and therefore you have a limited capacity to carry  oxygen um and so if a carbon monoxide molecule is   bound then it increases the oxygen affinity for  the remaining subunits of the hemoglobin and the,English
+tetramer that thus um CO2 not only decreases  the oxygen content of blood it also decreases   oxygen available to the tissues meaning that if  carbon monoxide is bound it's going to hold on,English
+to that oxygen tighter and won't let go of it in  the tissue where it's supposed to be delivering   that oxygen so there's a really real problem  here the carbon monoxide is usually seen,English
+poisoning or exposure seen in fires smoke  inhalation house fires um but also if you burn   some certain types of fuel in the house that are  meant to be outdoors like an outdoor camping type,English
+situation but you're doing it inside and it's not  well ventilated and you can also accumulate carbon   monoxide um above a certain threshold this can  be lethal but um ideally if it's lower than the,English
+toxic threshold then the cells are just having to  be destroyed and replaced and the patient just   needs to have some extra oxygen be on oxygen  support the other form is sulfemoglobin,English
+so uh it is another non-functional hemoglobin  where there's sulfur involved here a sulfur   group the oxygen and sulfhemoglobin cannot  attach so it's a non-functional hemoglobin,English
+it cannot bind and carry oxygen um and this is  a non-reversible condition and occurs usually   after the ingestion of certain drugs like sulfur  drugs like sulfonamides so this is drug-induced,English
+and so again it has to be pulled out and recycled  and obviously you want to withdraw the drugs so you   don't keep having a problem then those patients  cannot take sulfa drugs anymore and the hemoglobin,English
+will be replaced methemoglobin forms after the  ingestion of nitrates quinines and aniline dyes   so again kind of another drug induced one it is also  a non-functional hemoglobin it cannot,English
+transport oxygen and in methemoglobin iron is  in a ferric state instead of the ferrous state and   therefore oxygen cannot bind so again all three of those usually can be measured on a typical ABG,English
+okay so which one of these was not triggered  by a drug? so we have you know the choice you   can always rewind if you're not sure carboxihemoglobin* methemoglobin sulfhemoglobin,English
+"and then moving on to hemoglobinopathies so first  we're gonna we're gonna go into um well there's   a whole bunch of them in the hemoglobinopathies of these  but they are, hemoglobinopathies are mutations in",English
+the hemoglobin chain so they're inherited variants  so these is something that is inherited through uh   genetics and if you think about it so  this is a protein right the globin chain is,English
+"a protein, proteins are made from a sequence of  amino acids that have to be added, all the right   amino acids in the right order to get a properly  functioning 3D molecule that functions as the",English
+globin chain and if you have a genetic mutation  that swaps an amino acid for different amino acids   that you're going to have some variations here in  the way the chain is formed okay there are over,English
+900 ways this can go wrong so over 900 mutations  in hemoglobin chains have been identified   most are asymptomatic so most of them the change  doesn't affect its ability to transport oxygen,English
+and but we're going to go over some of the  ones that are more problematic so hemoglobin E   is a beta chain variant uh and is found in  southeast Asia with mild symptoms hemoglobin C,English
+is a beta chain variant with moderate anemia and  what happens is hemoglobin C polymerizes and   forms short thick crystals inside the red cells  so these hemoglobins polymerizing kind of stick,English
+to each other and form little hemoglobin crystals  which then of course they can't carry oxygen in   that form and then hemoglobin S which is probably  the one you're going to be the most familiar with,English
+is also a beta chain variant it can be fatal  uh such this is your sickle cell hemoglobin   and this one polymerizes into rigid aggregates  that then makes the cell assume this crescent,English
+shape so these hemoglobin molecules basically can  stack and get stuck together in this like crescent   shape and they won't unstick and so therefore then  um not only uh are the cells assuming the crescent,English
+shape no longer are they biconcave discs they  can't flow through the capillaries as well and   they get stuck so you get a hemolytic anemia you  can get vaso-occlusions because these cells get,English
+stuck because they're no longer flexible and then  you can get also overwhelming infections um the   hemolytic anemia is obviously the cells as they  change shape and get stuck they get destroyed,English
+uh and so this is the hemolysis of the red cells  um and this interestingly though um it gives the   people that have hemoglobin S protection against  malaria which is also why it probably has stayed,English
+in the population so well and hemoglobin SC is  a combination of hemoglobin S and hemoglobin C   so it's two different beta chain variants  so two genetic mutations that are combined,English
+so in contrast your thalassemias are  disorders of globin chain production   so your hemoglobin in hemoglobinopathies there's  a problem in amino acids being switched around,English
+"in your beta chains where uh here we're having  problems making them, and alpha thalassemia um   it's genetics obviously all of these are genetic  uh each parent contributes two genes and uh in",English
+hemoglobin Barts there's no production of alpha  chains um and you get a tetramer of four gamma   chains that's what's produced and that's incapable  of effective oxygen delivery and it is fatal um,English
+"and so they don't, they just don't live because  you can't transport oxygen your beta thalassemias   the genetics is each parent contributes one gene  look at those so there are several types of beta",English
+thalassemia there's beta thalassemia major where  two mutated genes are inherited it usually becomes   apparent during the first year of life you produce  more hemoglobin F and you produce hemoglobin A2,English
+so you get severe anemia with red cell fragments  and microspherocytes and in beta thalassemia   intermedia and beta thalassemia minor both involve  a decreased production of these beta chains so,English
+it's beta thalassemia because the beta chains  aren't being produced appropriately and they're   being replaced by hemoglobin F or A2 the symptoms  of beta thalassemia are going to be symptoms of,English
+"anemia therefore weakness dizziness shortness of  breath upon exertion tachycardia and this all will   depend of course, the severity of symptoms will depend  on the degree of anemia that has been developed",English
+okay so what again is the key  difference between the hemoglobin   hemoglobinopathies and the thalassemias?  there is a key difference between the two   if you're not sure rewind the video  then go back and think about it for a second,English
+all right and then let's go over your normocytic  normochromic anemias so the cells are normal the   hemoglobin looks normal they have the right color  but there's not enough of them so they're still an,English
+anemia so aplastic anemia is the first one uh you  get this bone marrow failure syndrome   is acquired it can be exposure to toxins  or chemicals but basically it just quit,English
+making red cells not a good thing so aplastic no  production here of red cells uh you have anemia of   chronic renal and endocrine diseases um these are  simply the side effect of a decreased production in,English
+erythropoietin so again erythropoietin is produced  in the kidneys if there's chronic kidney disease   then this erythropoietin production is hampered  erythropoietin is the hormone that signals the bone,English
+marrow to release and to make more red cells and  if there's not enough of it then it's simply the   bone marrow does not get the message to make more  red cells um some of this can be fixed by giving,English
+a synthetic form erythropoietin to uh just take over  the job or or supplement so that they make enough   of because the bone marrow is fine at the  moment can make it it's just it's not getting,English
+the signal to make it um immune hemolytic anemias um  so alloimmune so this would be a transfusion   reactions and hemolytic disease of the newborn  so uh you know antibody and antigen reactions,English
+where the antibodies are against uh the cells that  have been transfused or in hemolytic disease of the   newborn antibodies cross from the mom to the  baby and are attacking the baby cells or they,English
+can be autoimmune like a cold agglutinin where an  auto antibody is tagging on the red cells and   causing the destruction so on this one again it's  a hemolytic anemia means hemolysis or destruction,English
+of the red cells red cells are being killed and  it's an immune system reaction to the red cells   uh hereditary spherocytosis or  elliptocytosis are membrane defects then,English
+that are causing anemia glucose 6 phosphate  dehydrogenase deficiency or G6PD deficiency also   causes a normocytic normochromic anemia and paroxysmal  nocturnal hemoglobinuria in which um you,English
+have an absence of certain surface proteins which  leads to an uncontrolled amplification of the   complement system and hemolysis usually at night  right uh and causes causes hemolysis and problems,English
+so your macrocytic and your microcytic anemias so  um the macrocytic ones are pernicious anemia and   your folate and B12 deficiencies so in pernicious  anemia the intrinsic factor is missing and so you,English
+need intrinsic factor the intrinsic factor helps  protect B12 in the stomach and then allow it to   be absorbed in the small intestines further down  if you do not make intrinsic factor it does not,English
+matter how much B12 you're ingesting or that is part  of your diet it's just not going to be absorbed   and so the lack of B12 leads to a macrocytic  anemia so folate and B12 deficiency are related,English
+but instead of being the intrinsic factor  that's missing you simply don't have enough   B12 or folate and B12 and folate are needed for  DNA synthesis which is part of making red cells so,English
+deficiencies of vitamin B12 then can also cause  neurological issues and so this was our first   case that we led with it's probably really a B12  deficiency more than likely because of the neuro,English
+issues uh that can be cause of the tingling  in the hands and feet can be a B12 deficiency   so just not enough folate and B12 that's part of the  diet or you know yeah usually it's part,English
+of the diet problem there and then you have  iron deficiency anemia so your iron stores   in the body are depleted and you're not absorbing  enough or there's not enough iron in the diet this is,English
+a microcytic anemia so it can be inadequate  ingestion or inadequate absorption of iron   um and or it can also be because it cannot  incorporate an iron into the heme molecule,English
+as seen for example in lead poisoning um and so  all of those would be microcytic hypochromic   anemias like iron deficiency anemia and so  some of that can be fixed by supplementing,English
+with iron and vitamin C is also necessary  to absorb iron properly caffeine can work   against absorption of iron so you have to know  kind of what to do here to be able to properly,English
+"treat that so the patient takes their  supplement and it's actually getting ingested/absorbed   hemolytic anemias are____ what do you think?  are they microcytic, macrocytic or   normochromic normocytic? so  which ones did they fall under?",English
+and that was the classifications that  we looked at in this presentation? so   iron deficiency anemia which one is  it? again same three classifications   uh and so we're gonna go over the common clinical  chemistry test for the next few slides so,English
+iron is usually done by a colorimetric method  iron has to be first released from transferrin   and then release to the ferrous state and then  complexed with the chromogen something that,English
+would change color as it's bound onto the iron  and the color change is proportional to the   iron concentration pretty straightforward  that would be read by spectophotometry   total iron binding capacity the excess iron to  be added to saturate all binding sites is what's,English
+measured the leftover iron is then removed and  that leftover iron corresponds with the total   number of binding sites um and so that's you  know iron binding capacity both of these are,English
+EARLY AND FREQUENT COMMUNICATION WITH THE COORDINATION EFFORTS I SPOKE OF AND THE INITIAL RESPONSE TO SUPPORT THE MERCY,English
+AND COMFORT. WE ALSO WOULD HAVE SUPPORT THE FIELD HOSPITALS SET UP AND KEEP THAT GOING. ALL THAT DIALED DOWN AND IT WAS VERY GOOD COORDINATION AND,English
+WORKING WITH INDUSTRY PARTNERS TO MAKE SURE THOSE BLOOD PRODUCTS WOULD BE AVAILABLE AFTER HOURS AND ON THE WEEKENDS.,English
+WHAT ALSO WENT WELL IS THE TRANSPORT OF BLOOD SUPPLIES TO THE LOCAL HOSPITAL TO GUAM. BEING ABLE TO COORDINATE NA AND,English
+"PROVIDE THAT SUPPORT IN THE EARLY WEEKS, A COUPLE MONTHS OF THE PANDEMIC THAT WENT VERY VERY WELL. AND THEN THE WEEKLY MEETINGS HOSTED BY THE AABB WE CONTINUED",English
+"TO HAVE EACH THURSDAY BRINGING IN EXPERTS, HAVING THAT DISCUSSION WITH EVERYBODY ON THE LINE IS SOMETHING THAT REALLY WENT WELL DURING THIS PANDEMIC AND CONTINUES ON EVEN NOW.",English
+SO SOME OF THE WEAKNESSES WE EXPERIENCED I BELIEVE ARE CONSISTENT WITH EVERYBODY ELSE. THE VULNERABILITY OF OUR STAFF,English
+"EXPOSURES TO COVID-19, WE PROBABLY ARE NOT THE ONLY ONES WHO HAVE EXPERIENCED A BLOOD DONOR CENTER HAVING TO SHUT DOWN",English
+BECAUSE OF AN EXPOSURE WHETHER IT WAS FROM A DONOR THAT CAME IN AND AS A STAFF MEMBER WE HAVE EXPERIENCED THAT SO REALLY TRYING TO KEEP THE STAFF SAFE THROUGHOUT THIS WHOLE PROCESS,English
+AND IMPLEMENT THOSE MEASURES TO KEEP THE STAFF SAFE. I THINK THAT WAS A WILLINGNESS. DECREASED DONORS FOR DRIVES THAT,English
+"WE STILL SEE HAVE RECRUITERS TO GET THE MESSAGE OUT, LETTING PEOPLE KNOW THEY HAVE IMPLEMENTED MEASURES TO KEEP",English
+THEM SAFE. THE DONATING PROCESS IS SAFE. WHILE THINGS HAVE GOTTEN BETTER NOW INITIALLY DURING THE FIRST TWO MONTHS IT WAYS STRUGGLE ACROSS THE BOARD.,English
+THE UNCERTAINTY OF PPE I THINK OUR STAFF MEMBERS WERE WORRIED ABOUT THAT WHILE WE WERE WORKING VERY HARD TO MAKE SURE THAT ALL,English
+OF OUR EMPLOYEES HAVE WHAT THEY NEEDED IN ORDER TO DO THEIR JOB. OF COURSE EVERYBODY WATCHES THE NATIONAL NEWS. THE WORRY OF THE PPE I THINK DEFINITELY HAD AN IMPACT.,English
+AND THE ADAPTATION TO HOW BLOOD DRIVES AND COLLECTIONS WOULD TAKE PLACE WITH THE NEW MEASURES. SO WE DID GET A POLICY OUT TO MAKE SURE ALL OF OUR CENTERS,English
+UNDERSTOOD WHAT NEEDED TO BE IN PLACE IN ORDER TO CONDUCT THE BLOOD DRIVES AND HOW IT WOULD SPREAD OUT. IT DID CAUSE THEM IN SOME PLACES WHERE THEY WOULD NORMALLY DO A,English
+BLOOD DRIVE. OF COURSE THEY HAVE TO TALK TO THE SPONSOR ABOUT GETTING ANOTHER LOCATION THAT WOULD ENABLE THEM TO SPREAD OUT LIKE THEY NEEDED TO BE.,English
+AND ALL THE ADDITIONAL MEASURES OF TAKING TEMPERATURES AND EVERYTHING THAT NEEDED TO BE DONE AND WE HAD TO PULL THAT TOGETHER AND OF COURSE WAITING ON GUIDANCE TO BE IMPLEMENTING,English
+THE SAME TYPE OF MEASURES AS EVERYONE ELSE. A WEAKNESS FOR US WAS A HUGE POPULATION WHICH WAS OUR,English
+TRAINING POPULATION AND I KNOW WHEN WE MET WITH THE ARC EARLY IN THE PANDEMIC WE DID EXPRESS THAT WE WERE EXPERIENCING THAT SO INITIALLY THE TRAINEE POPULATION WHICH THEY ARE VERY,English
+MUCH IN A CONTROLLED AREA THAT WAS AN ISSUE AS THEY DIDN'T WANT US COMING IN AND POTENTIALLY EXPOSING THE TRAINEES SO THAT,English
+"WAS A HUGE WEAKNESS FOR US BECAUSE WHILE WE ARE JUST TRYING TO MAINTAIN OUR NORMAL COLLECTIONS, OF COURSE START TO COLLECT CCP, LOSING THAT POPULATION HAD A HUGE IMPACT ON",English
+OUR ABILITY TO PROVIDE THE REQUIRED O BLOOD AND ALL THE OTHER BLOOD PRODUCTS THAT WERE NECESSARY. THINGS HAVE STARTED TO NORMALIZE BUT WE STILL DO FACE CHALLENGES,English
+WITH THOSE LARGE POPULATIONS IN MAKING SURE WE CONDUCT THE BLOOD DRIVES WITH ALL THE RIGHT MEASURES IN PLACE.,English
+ONE OF OUR HUGE WEAKNESSES ALSO I BELIEVE WAS OUR LACK OF REQUIRED AGREEMENTS IN PLACE FOR THE PROCUREMENT OF BLOOD PRODUCTS. WHILE WE COLLECT BLOOD PRODUCTS,English
+WE WORK CLOSELY WITH CIVILIAN COUNTERPARTS. PRIOR TO THE PANDEMIC REQUIRED AGREEMENTS BETWEEN THE ARMED,English
+"SERVICES BLOOD PROGRAM AND BLOOD CENTERS OF AMERICA, ART, WE'RE NOT IN PLACE. THEY HAD PREVIOUS AGREEMENTS",English
+THOSE HAD EXPIRED. WITH COVID AND EVERYTHING WE NEEDED TO DO IT DID OPEN THE GATEWAY ON THE AGENCY TO REALLY,English
+"WORK AND GET BEHIND US IN COORDINATION WITH BCA, ARC TO GET SOME AGREEMENTS IN PLACE. NOT ONLY FOR CPP BUT FOR BLOOD",English
+PRODUCTS IN GENERAL. NOT HAVING THOSE ALREADY IN PLACE WAS DEFINITELY A WEAKNESS. WE WERE ABLE TO GET THEM IN PLACE AND MAKE SURE THEY ARE SUSTAINED BUT THAT WAS,English
+DEFINITELY A WEAKNESS. SO WHAT ARE SOME RECOMMENDATIONS? AN EMERGENCY RESPONSE PLAN.,English
+PROBABLY ONE ACROSS THE DOD AND THIS IS ALSO AN EFFORT THAT WE WERE WORKING ON PRE-COVID LIKE OUR OWN INTERNAL EMERGENCY RESPONSE HOW WE TAP INTO THE NATIONAL DISASTER TASK FORCE AND,English
+WORKING THROUGH SOME OF THAT. WE WERE WORKING ON THAT PRIOR TO THIS PANDEMIC HITTING. TRYING TO GET THAT SOLIDIFIED IS DEFINITELY A PLUS. BUT EVEN ON A LARGER SCALE,English
+"BEYOND DOD, WORKING THROUGH ANYTHING THROUGHOUT THE BLOOD ENTERPRISE TO FACILITATE AGREEMENT.",English
+ANY PLANNING WE CAN DO NOW I THINK IS DEFINITELY A RECOMMENDATION SO WE AREN'T ALL FIGURING OUT AS IT HAPPENS. THERE WILL BE SOME DEGREE OF THAT BECAUSE WE DON'T KNOW WHAT,English
+"THE NEXT PANDEMIC WILL BE SO IT WILL BE THAT REQUIRED BLOOD PRODUCT BUT ANYTHING WE CAN DO TO FACILITATE COORDINATION, PLANNING, AGREEMENT, ANYTHING LIKE THAT I THINK IS DEFINITELY",English
+A RECOMMENDATION. HAVING THE ABILITY TO QUICKLY IDENTIFY AND MOBILIZE AND TRAIN ADDITIONAL MEDICAL SUPPORT I THINK WOULD BE A RECOMMENDATION. I KNOW HHS DID REQUEST SOME,English
+"PERSONNEL SUPPORT AND THEY HAVE BEEN MOBILIZED AND I BELIEVE ARE PROVIDING SUPPORT IN THE SAN ANTONIO, TEXAS AREA AS FAR AS COLLECTIONS BUT EVEN WORKING THROUGH THAT PEOPLE HAVE TO",English
+"FIGURE OUT WHAT, WHO, HOW, WHAT WAS AVAILABLE. IS MAYBE IDENTIFYING THESE RESOURCES AHEAD OF TIME SO WHEN PERSONNEL ARE PLACED INTO THESE POSITIONS THEY COORDINATE THIS",English
+TYPE OF SUPPORT I THINK WOULD BE BENEFICIAL. EVEN US IN MY OFFICE TRYING TO RESPOND TO HHS AND GET ON ALL THE ANSWERS THEY NEED. WE WEREN'T EQUIPPED TO GIVE THEM,English
+THE SPECIFIC INFORMATION THEY NEEDED. ANY TYPE OF WORK WE CAN DO BEYOND THIS PANDEMIC TO GET READY FOR THE NEXT THAT WOULD FACILITATE THAT TYPE OF,English
+COORDINATION I BELIEVE WOULD BE VERY IMPORTANT. AND GAINING AN UNDERSTANDING OF HOW DOD IS SUPPORTED BY HHS AND,English
+DOMESTIC RESPONSES. WE TALKED ABOUT THAT BUT I SHOULD HAVE BROKEN THE BULLET OUT MORE. WE COORDINATED THE BLOOD PRODUCT SUPPORT THROUGH THE SUPPORTS OF,English
+"COMFORT HOWEVER, THE PAYMENT MECHANISM THAT THAT NEEDED TO HAPPEN WAS A GRAY AREA AND WORKED FOR WEEKS TO FIGURE OUT",English
+HOW THE BLOOD THINNER WOULD BE REIMBURSED. THAT'S AN EXAMPLE OF WHATEVER TYPE OF AGREEMENT AND HOW THAT WOULD ALL WORK IS DEFINITELY A RECOMMENDATION.,English
+WHILE WE ACTIVELY WERE ABLE TO GET THE SUPPORT IN PLACE THE FOLLOW ON MECHANISM OF THE PAYMENT AND HOW THAT WOULD WORK WAS DEFINITELY NOT FIGURED OUT AND IT TOOK A FEW WEEKS TO SOLVE,English
+THAT. THAT WOULD BE RECOMMENDATION AND DROVE IN WITH THE RECOMMENDATION FOR AGREEMENT EVERYTHING IT'S ALL ROLLED TOGETHER. AND THAT SUPPORTS THE LAST,English
+"BULLET THERE. IDENTIFY AND ESTABLISH REQUIRED AGREEMENT FOR SUPPORT, PAYMENT, WHATEVER IT IS WE NEED TO FIGURE OUT AS AN INDUSTRY WOULD BE VERY BENEFICIAL.",English
+I BELIEVE THAT'S IT. IT'S PROBABLY A BROKEN RECORD. WE'RE ALL SAYING THE SAME THING A LITTLE DIFFERENTLY BUT THAT'S ALL I HAVE PENDING ANY QUESTIONS.,English
+"THANK YOU. >> THANK YOU, COLONEL TAYLOR. THAT WAS VERY USEFUL FOR US TO RECOGNIZE YOU HAVE THE SAME",English
+ISSUES WE ALL HAD WHICH IS GOOD BECAUSE WE CAN WORK TOGETHER ON SOLUTIONS. THANK YOU FOR SHARING THAT WITH US AND THANK YOU FOR YOUR SERVICE TO OUR COUNTRY.,English
+"WE REALLY APPRECIATE IT. >> THANK YOU. THANK YOU, AGAIN. >> NEXT WE ARE GOING TO HEAR FROM AMY EFANTIS WHO IS CEO, PRESIDENT AND CEO OF PPTA.",English
+I THINK ONE THING THIS PANDEMIC HAS ALSO CALLED TO ATTENTION IS THE NEED TO REALLY WORK COLLABORATIVELY DURING THESE TIMES BETWEEN OUR BLOOD AND PLASMA ORGANIZATION.,English
+INTRODUCTION AND INCLUDING US WITH THE STAKEHOLDER INPUT. I'M AMY EFANTIS PRESIDENT AND CEO OF PLASMA PROTEIN,English
+THERAPEUTICS ASSOCIATION OR PPTA. IN ADDITION TO THE ADVOCACY WE ENGAGE IN ON BEHALF OF PLASMA,English
+"PATIENT THERAPIES, OUR PROGRAMS ARE INTENDED TO BE ENHANCING TO REGULATORY BODY STANDARDS. WE REPRESENT THE COLLECTORS AND",English
+MANUFACTURERS OF PLASMA AND RECOMBINANT THERAPIES. SO THE SOURCE OF PLASMA IS,English
+COLLECTED AROUND THE WORLD BY OUR MEMBERS AS ARE THE MAJORITY OF THE PROTEIN THERAPIES DEVELOPED BY OUR MEMBERS.,English
+THIS IS A LIST OF OUR NORTH AMERICA MEMBERS WHO PROUDLY REPRESENT. PLASMA PROTEIN THERAPIES ARE,English
+MADE FROM CAN BE DERIVED FROM PLASMA RECOMBINANT AND MEANT TO TREAT PEOPLE WHO ARE BORN WITHOUT CERTAIN PROTEINS.,English
+FOR SOME PATIENTS IT'S THE ONLY TREATMENT AVAILABLE TO THEM. THIS IS AN IMPORTANT POINT WHICH IS A THEME BECAUSE IT,English
+DIFFERENTIATES WHAT IT IS OUR MEMBERS DO. PLASMA DERIVED THERAPIES TAKE BETWEEN 7 AND 12 MONTHS TO,English
+"MANUFACTURE. FROM COLLECTION TO FINAL THERAPY, IT'S A LONG PROCESS. THIS IS REALLY CRITICAL RIGHT NOW IF YOU THINK ABOUT THE PANDEMIC AND THE IMPACT OF IT",English
+AND WHILE SOME OF OUR COUNTERPARTS ARE DOES BANDING THEIR PROCESS TEAMS IT'S LIKELY TO BE FELT FOR MONTHS.,English
+I'D LIKE TO INTRODUCE TO YOU SOME PATIENTS SERVED BY PLASMA THERAPIES. A PATIENT WITH A DEFICIENCY IS,English
+MISSING THE INHIBITOR WHICH IMPACTS THE LUNGS AND CAUSES WHAT WE REFER TO AS INHERITED EMPHYSEMA. THERE ARE 1700 PEOPLE ON THERAPY IN THE UNITED STATES WITH ALPHA,English
+"1 DEFICIENCIES. FOR PEOPLE WITH FACTOR DEFICIENCY, THEY DON'T HAVE THE ABILITY, THEIR BLOOD DOESN'T",English
+"CLOT AND THERE'S 30,000 PEOPLE ON THERAPY IN THE U.S.�TO TREAT BLOOD CLOTTING DISEASES. FOR THOSE BORN WITHOUT THE",English
+INHIBITOR WHICH RELATES FLOWING THOSE FOLKS CAN SOMETIMES SUFFER FROM SEVERE EDEMA THAT CAN BE FATAL.,English
+"THERE'S OVER 5,000 PEOPLE ON TREATMENT IN THE U.S.�FOR THAT. AMONG THE PROTEINS THAT ARE FRACTIONATED FROM PLASMA THE",English
+"IMMUNOGLOBULINS ARE THOUGHT OF AS THE WORKFORCE. FOR INDIVIDUALS THAT ARE BORN WITHOUT CERTAIN ANTIBODIES, IMMUNE GLOBULINS ARE IMPORTANT FOR THEIR HEALTH AND WELL BEINGS",English
+"AS THEY SUFFER FROM ILLNESSES. THERE'S OVER 400 PRIMARY IMMUNE DEFICIENCIES AND OVER 40,000 PATIENTS ON THERAPIES IN THE",English
+UNITED STATES. SO PLASMA PROTEIN THERAPIES ALSO SERVE A VARIETY OF OTHER USES. YOU CAN SEE THE,English
+WIDE USES AND INFECTIONS AS WELL. WHEN WE THINK ABOUT EVEN FOR A BLOOD TRANSFUSION PATIENT THE,English
+"AVERAGE USE IS I THINK THREE UNITS WHEREAS WHEN YOU THINK ABOUT ONE OF THESE PATIENTS WHO RELIES ON PLASMA PROTEIN THERAPIES FOR SOMEONE WITH AN ALPHA 1, THEY REQUIRE 900",English
+DONATIONS IN A YEAR TO SUPPORT THEIR THERAPY. THESE ARE VERY RESOURCE INTENSE PRODUCTS AND IT IS ESSENTIAL,English
+HEALTHY DONORS ARE WILLING TO DONATE. SO WHEN YOU THINK ABOUT PLASMA THAT'S USED FOR FRACTIONATION,English
+"IT'S IMPORTANT TO LOOK AT HISTORICAL TRENDS AND WHILE WE'VE SEEN FAIRLY STEADY STATIC GROWTH WITH RECOVERED GROWTH,",English
+SOURCE PLASMA HAS GROWN PRECIPITOUSLY. THAT'S IN LARGE PART TO INCREASED ABILITY TO IMPROVE DIAGNOSES WHEN YOU LOOK AT THE TRAJECTORY OF SOURCE COLLECTION,English
+"WHICH HAS OBVIOUSLY GROWN VERY STEADILY, YOU SEE THAT WE REACHED RECORD LEVELS OF COLLECTION IN THE UNITED STATES IN 2018 AND AGAIN IN 2019. DESPITE THAT GROWTH, THERE WERE",English
+STILL PATIENT ACCESS CHALLENGES FOR THERAPIES LIKE IMMUNE GLOBULIN IN 2019. WE KNOW WHAT WE'VE SEEN REPORTED,English
+"IN THE USE RECENTLY, TWO OF THE LARGEST COLLECTORS IN THE UNITED STATES WHICH MAKE UP MORE THAN HALF REPORTED SHORTFALLS",English
+"THIS YEAR BECAUSE OF THE PANDEMIC. IF YOU THINK ABOUT A YEAR LIKE 2019 WHERE IN A RECORD YEAR OF COLLECTION AFTER THE YEAR 2018, THERE WERE STILL ACCESS",English
+CHALLENGES. WE CAN IMAGINE WHAT IT WELL LOOK LIKE FOR PATIENTS IN THE FUTURE AND THE URGENCY FOR PLASMA COLLECTION NOW. THIS SLIDE SHOWS YOU THE,English
+PREPONDERANCE OF PLASMA CENTERS OVER THE UNITED STATES. THERE ARE REGIONS IN THE UNITED STATES PRIMARILY THE RUST BELT,English
+AND THE SUN BELT THAT SHOULDER THE BURDEN FOR THE REST OF THE COUNTRY. THIS IS THIS WAY BECAUSE OF,English
+"CERTAIN STATE LAWS MORE RESTRICTIVE. YOU CAN SEE STATES LIKE CALIFORNIA, NEW YORK AND ACTUALLY I THINK MASSACHUSETTS DOESN'T HAVE PLASMA CENTERS.",English
+THEY ARE UNDER REPRESENTED. THIS SHOWS AN IMAGE OF WHAT PLASMA CENTERS LOOK LIKE IN THE U.S.,English
+SO WE WERE ASKED TO ADDRESS A FEW QUESTIONS ON WHAT WORKED WELL. WE BELIEVE AND I BELIEVE I'M ECHOING WHAT OTHERS SAID THE APPROACHABILITY AND WILLINGNESS,English
+ON AGENCIES TO LISTEN AND DEMONSTRATE FLEXIBILITY WITH IN EYE TO SAFETY WAS EVIDENT AT THE BEGINNING OF THE PANDEMIC AND,English
+THOUGH I WASN'T WITH THEM DURING OTHER CRISES I WAS TOLD THIS RESPONSIVENESS WAS A BIG IMPROVEMENT OVER PAST CRISES.,English
+THE NOTICES WERE VERY CLEAR. I THINK EVEN BEFORE GUIDANCE COULD BE ISSUED THERE WERE SUGGESTIONS BEING GIVEN. WE'RE VERY GRATEFUL FOR THAT. IN TERMS OF WEAKNESSES AND I,English
+HAVE HEARD OTHERS SAY THAT AWARENESS IS NOT AN ISSUE AND IT'S MORE ABOUT EFFECTIVE COMMUNICATIONS. I ECHO THE EFFECTIVE COMMUNICATIONS PIECE OF THAT.,English
+"I HEARD SOMEONE SAY YESTERDAY WE HEARD THE TERM OMNI CHANNEL MARKETING WHICH IS IMPORTANT BUT FOR PLASMA AND SOURCE PLASMA, AWARENESS IS CRITICAL. ONE OF THE CHALLENGES THAT WE",English
+CONTINUE TO FACE IS THE CONFLATION OF DEFINITIONS AROUND PLASMA AND THE CONFUSION BETWEEN PPC PLASMA FOR TRANSFUSION AND,English
+PLASMA INTENDED FOR FURTHER MANUFACTURE FOR THERAPIES TO TREAT COVID-19 AND THEN THE NEED FOR SOURCE PLASMA WHICH IS PERPETUAL AND ONGOING AND WE BELIEVE THAT WOULD BE VERY,English
+HELPFUL. ALSO EARLY ON I THINK THERE WERE RECOGNITION OF CRITICAL INFRASTRUCTURE WAS GREAT AND,English
+HELP ON THE FEDERAL LEVEL BUT DIDN'T ALWAYS TRICKLE DOWN TO THE LOCAL LEVELS AND WE DID SEE CHALLENGES AT OUR CENTER FOR EMPLOYEES AND DONORS THEMSELVES AND WE DEVELOPED A REPOSITORY OF,English
+DOCUMENTS THAT COULD BE USED BY EMPLOYEE OR DONORS TRAVELLING TO AND FROM CENTERS AND REFLECTING WHAT I HEARD FROM OTHERS WITH,English
+THE DIFFICULTY WITH THE PPE. THEE WERE DIFFICULT TO FIND AND THAT DOVETAILS ON THE IDEA OF PRIORITIZATION FOR THINGS LIKE,English
+PPE. AND PLASMA CENTERS. WE ALSO FACED AN ONGOING ISSUE WHICH BECAME MUCH MORE APPARENT,English
+"DURING THE PANDEMIC WITH CLEO THE CLINICAL LAB IMPROVEMENT AMENDMENT. THE REASON PLASMA CENTERS FALL UNDER THIS AT ALL IS BECAUSE THE CENTRAL TASK, ONE MODERATELY",English
+COMPLEX INSTRUMENTS WHEN THE LAST TIME IT WAS UPDATED WAS IN ANALOG INSTRUMENT AND NOW DIGITAL AND DOESN'T LIKELY NEED,English
+A PHYSICIAN OR REGISTERED NURSE TO OPERATE IT. IT'S BEEN A CHALLENGE AS HAS THE PERSONNEL STANDARDS AND LICENSING STANDARDS THE STATES OFTEN LAYER ON TOP OF THAT.,English
+WE BELIEVE THAT DONOR BEHAVIOR RISK CRITERIA SHOULD BE RECONSIDERED. THINGS LIKE TATTOOING AND PIERCING AND RISK PERCEPTIONS ASSOCIATED WITH THAT.,English
+SYPHILIS TESTING SHOULD BE UNDER BEHAVIORAL RISK AND THE DONOR SUITABILITY ON THE HEALTH ELIGIBILITY WHICH RELATE TO,English
+"UNITS NOT ALLOWED TO BE USED, IF FOR EXAMPLE, A DONOR HAS BLOOD PRESSURE MISSED DURING THE SCREENING THAT UNIT CAN'T BE",English
+"USED. WE THINK IT SHOULD BE RECOGNIZED AS AN ERROR, AT THE END IT'S STILL VERY APPRECIATION.",English
+"SO TO SYNTHESIZE THE TOP THREE TO FIVE THINGS WE THINK CAN BE DONE IN THE NEAR TERM, I BELIEVE FIRST AND FOREMOST IS ENSURING THE PATIENT VOICE IS ALWAYS INCLUDED TO INFORM POLICY.",English
+THE PATIENT'S VOICE HAS BEEN FIRMLY EMBEDDED IN THE DRUG APPROVAL PROCESS AND CERTAINLY WHEN IT COMES TO CRISES SHOULD ALWAYS BE INCLUDED AS WELL. STREAMLINING AND EXEMPTING CLEAR,English
+REQUIREMENTS FOR DONOR CENTERS WOULD BE VALUABLE. EVALUATING DONOR AND BEHAVIORAL RISK CATEGORIES AND STUDYING DONOR MOTIVATION FOR PLASMA AND BLOOD DONORS IS HELPFUL IN,English
+"DETERMINING HOW DONORS ARE MOTIVATE AND HOW TO ENCOURAGE MORE DONORS. AND FINALLY AS THE CHANGES ARE MADE TO ENSURE WE'RE NOT COMPROMISING SAFETY, EXPANDING",English
+ON SYSTEMS LIKE TTIMS OR SOMETHING LIKE THAT TO CONTINUE TO MEASURE ANY OF THOSE CHANGES. FINALLY I'D BE REMISS TO NOT,English
+MENTION THE VALUE OF THERAPIES AND WHAT THEY BRING TO PATIENT. FOR A PATIENT WITH A DEFICIENCY IN 1971 THEIR 10-YEAR SURVIVAL,English
+RATE INCREASED MARKEDLY BETWEEN THAT POINT AND 2008. FOR SOMEONE WITH HEMOPHILIA THEIR LIFE EXPECTANCY INCREASED,English
+AND WE KNOW IT DEPENDS ON THE SAFE DONATION FROM HUMANS WILLING TO DONATE. THANK YOU.,English
+">> THANK YOU, AMY. THIS WAS VERY HELPFUL AND WE SHARE COMMON EXPERIENCES DURING THIS PANDEMIC.",English
+I DON'T KNOW IF YOU WERE ON THE CALL EARLIER WHEN WE KICKED OFF OUR STAKEHOLDER DISCUSSION WITH A PATIENT ADVOCATE NATHAN,English
+SCHAFER FROM A PLUS AND HE ALSO ELOQUENTLY COMMUNICATED THE NEED FOR BLOOD AND PLASMA TO WORK COLLABORATIVELY ON THE ISSUES OF,English
+"DONOR AVAILABILITY. WE'RE APPRECIATE OF YOUR INPUT. >> THANK YOU. >> LASTLY THIS MORNING, WE HAVE",English
+OPPORTUNITIES FOR PUBLIC COMMENT. WE'VE HAD ONLY ONE REQUEST TO MAKE A PUBLIC COMMENT AND DR. RICHARD BENJAMIN IS FAMILIAR TO ALL OF US AND WAS ON THIS,English
+"ADVISORY COMMITTEE FOR THE PRIOR, I THINK PRIOR TWO YEARS AND A MEDICAL DEVICE MANUFACTURING REPRESENTATIVE.",English
+"WELCOME, RICHARD AND WE WILL TURN THIS OVER TO YOU FOR YOUR STATEMENT. >> THANK YOU, JACKIE AND",English
+ADVISORY COMMITTEE FOR THE OPPORTUNITY TO COMMENT TODAY. I DO NOT HAVE SLIDES. S AWAY OF INTRODUCTION I'M CHIEF MEDICAL OFFICER FOR A MANUFACTURER OF PATHOGEN,English
+REDUCTION TECHNOLOGIES. THERE'S NO EVIDENCE TO SUGGEST COVID-19 IS THE LAST GLOBAL PANDEMIC.,English
+"IF ANYTHING, OUR INTERCONNECTED WORLDWIDE COMMUNITY AND GLOBAL WARMING WILL ACCELERATE THE PACE AT WHICH WE SEE PATHOGENS EMERGE. WE SHOULD ASSUME THE NEXT",English
+OUTBREAK WILL BE TRANSFUSION TRANSMISSIBLE AND ASYMPTOMATIC INDIVIDUALS COULD PRESENT AS BLOOD DONORS. IF ONLY THROUGH THE GRACE OF GOD THIS MAY NOT BE THE CASE FOR,English
+COVID-19. WE NEED TO THINK ABOUT HOW THAT MIGHT HAVE AFFECTED THE RESPONSE THIS YEAR. THE FIRST LESSON FROM THE CURRENT CRISIS IS THAT,English
+TECHNOLOGIES ALREADY IN ROUTINE USE WILL SAVE THE DAY. INNOVATION IN THE FACE OF ADVERSITY IS SELDOM ACCESSIBLE IN TIME TO MEET THE CURRENT CHALLENGE.,English
+"FOR EXAMPLE, IN MANY PARTS OF THE WORLD, CONVALESCENT PLASMA IS BEING PATHOGEN REDUCED BECAUSE PLASMA PATHOGEN REDUCTION WAS ALREADY IN ROUTINE USE TO PROTECT PATIENTS AND",English
+THERE SAY STRONG RATIONALE FOR BEING CAUTIOUS ESPECIALLY WITH MANY FIRST-TIME DONORS AND IN THE ABSENCE OF REAL-TIME DATA REGARDING TRANSFUSION TRANSMISSIBILITY.,English
+"AS WE LOOK TO THE FUTURE, WE NEED TO BE PROACTIVE AND ADOPT BEING PROACTIVE AS A MIND SPENT THE BLOOD COMMUNITY'S AUTHORITY HAS BEEN LARGELY REACTIVE AN ADOPTING CHANGE BUT THAT",English
+APPROACH IS INADEQUATE WHEN FACE INFECTIOUS DISEASES. A CULTURAL CHANGE IS NECESSARY. A FEW EXAMPLES OF OUTBREAKS FROM,English
+AROUND THE WORLD CAN PROVIDE PERSPECTIVE. IN THE PAST WE HAVE SEEN AREAS FOR ZIKA AND DENGUE FEVER HAVE,English
+STRATEGIES AND THEY ARE DETRIMENTAL AVAILABLE THE IN 2014 THE FRENCH FACED AN OUTBREAK OF CHIKUNGUNYA WITH 40% OF BLOOD DONORS INFECTIONS. BY DEPLOYING GOALS FOR,English
+SYMPTOMATIC DONORS AND TESTING IN FRANCE FOR RED BLOOD CELLS AND PATHOGEN REDUCTION FOR PLATELETS THEY WERE ABLE TO,English
+>> SICKLE CELL ANEMIA HAS HAUNTED ARTHUR BROWN HIS WHOLE LIFE. >> I HAVE GOTTEN TO THE POINT WHERE I HAD TRIED TO KILL MYSELF.,English
+"I HAVE BEEN THERE. >> AS WE ARE ABOUT TO SEE, GROWING UP WITH SICKLE CELL",English
+"ANEMIA CAN BE A HARROWING EXPERIENCE. >> KITS ARE SUPPOSED TO GO TO SCHOOL. THEY ARE SUPPOSED TO PLAY WITH THEIR FRIENDS, RIDE BIKES.",English
+"MANY TIMES OUR KIDS CANNOT DO THAT BECAUSE THEY ARE IN THE HOSPITAL, IN PAIN. ♪ [CRYING]",English
+">> EVERY SICKLE CELL STORY BEGINS WITH THIS. TINY DROPS OF BLOOD THAT REVEAL A PROBLEM WITH HEMOGLOBIN, A PROTEIN INSIDE RED BLOOD CELLS THAT CARRIES OXYGEN.",English
+">> EVERY CELL IN OUR BODIES, EVERY SKIN CELL, KIDNEYS, BRAIN CELL, EVERY CELL NEEDS OXYGEN AND EVERY ONE OF THOSE CELLS GETS THEIR OXYGEN FROM HEMOGLOBIN.",English
+"IF YOU MESS WITH HEMOGLOBIN UMASS WITH EVERY CELL IN THE BODY. >> IN HEALTHY ROUND RED BLOOD CELLS, HEMOGLOBIN IS WIDELY",English
+"DISPERSED. IN SICKLE CELL ANEMIA, THE HEMOGLOBIN CLUMPS TOGETHER, YOU'VE EVENTUALLY STRETCHING AND MISSHAPEN TO SELL -- MISSHAPING THE CELL, LEADING TO PILOTS IN THE BLOODSTREAM.",English
+-- PILEUPS IN THE BLOODSTREAM. HEMOGLOBIN ABNORMALITIES ARE INHERITED AND ARISE FROM A MISTAKE IN THE BODY'S GENETIC CODE PASSED ON FROM PARENTS TO CHILDREN.,English
+">> ONE M THE GENETIC CODE IS CHANGED -- ONE LETTER IN THE GENETIC CODE IS CHANGED, THIS CHANGES THE HEMOGLOBIN MOLECULE. HEMOGLOBIN IS SO IMPORTANT, IT CARRIES AND DELIVERS OXYGEN TO",English
+EVERY CELL IN THE BODY. THE WHOLE BODY GETS AFFECTED. >> THESE HEMOGLOBIN EFFECTS APPEAR FOR A REASON. THEY ARE A PRODUCT OF EVOLUTION.,English
+"A WAY FOR THE BODY TO WARD OFF ANOTHER DEADLY DISEASE. >> IN PARTS OF THE WORLD WHERE MALARIA IS ENDEMIC, HAVING A",English
+"GENE OR A GENETIC CODE THAT HAS THIS CHANGE ACTUALLY PROTECTS AGAINST MALARIA. IN PARTICULAR, IT PROTECTS AGAINST A VERY DEADLY FORM OF MALARIA THAT AFFECTS THE BRAIN.",English
+THAT IS WHY THESE ABNORMALITIES EXIST. >> THAT IS WHY SICKLE CELL DISEASE IS FOUND MOST OFTEN IN AFRICA.,English
+"BUT ALSO IN THE MEDITERRANEAN, LATIN AMERICA, THE CARIBBEAN, INDIA, AND THE MIDDLE EAST. HERE IN THE U.S., AN ESTIMATED TWO MILLION PEOPLE WHOSE",English
+"ANCESTORS COME FROM THOSE PARTS OF THE WORLD HAVE THE SICKLE CELL TRAIT. ABOUT 100,000 AMERICANS HAVE THE FULL-BLOWN DISEASE.",English
+MOST OF THEM ARE AFRICAN AMERICANS. ABOUT ONE IN 10 AFRICAN AMERICAN BABIES IS BORN WITH THE SICKLE CELL TRAIT.,English
+"ABOUT ONE IN 500 ACTUALLY HAS THE DISEASE. PEOPLE WHO HAVE THE TRAIT, CARRIERS, USUALLY DO NOT GET SICK.",English
+"THEY DO NOT DEVELOP THE DISEASE. BUT THEY CAN PASS THE DISEASE ON TO THEIR CHILDREN. >> WHEN A CHILD IS BORN, HALF OF THEIR DNA, HALF OF THE GENETIC",English
+"MEANS THEY WOULD HAVE ONE ABNORMAL HEMOGLOBIN, THEN THEY HAVE A 25% CHANCE OF HAVING A CHILD WITH SICKLE CELL DISEASE.",English
+">> OHIO, ALONG WITH MOST OTHER STATES, REQUIRES NEWBORN SCREENINGS FOR SICKLE CELL. THIS DID NOT START UNTIL 1990.",English
+PEOPLE BORN BEFORE THAT MAY NOT HAVE BEEN TESTED. THERE IS A SIMPLE BLOOD TEST ADULTS CAN HAVE TO DETERMINE IF THEY CARRY THE TRAIT.,English
+BUT LOTS OF PEOPLE DO NOT KNOW ABOUT IT. GENETIC COUNSELOR LESLIE CARTER ADVISES COUPLES TO FIND OUT THEIR TRAIT STATUS BEFORE THEY HAVE CHILDREN.,English
+>> MANDATORY SCREENING AT BIRTH FOR GENETIC DISEASES LIKE SICKLE CELL ANEMIA IS CONSIDERED ONE OF PUBLIC HEALTH'S GREATEST VICTORIES.,English
+IT HAS MADE A DRAMATIC IMPROVEMENT IN EXTENDING LIVES OF CHILDREN WITH SICKLE CELL. ABOUT 90% NOW MAKE IT INTO ADULTHOOD. >> WE CAN START THIS ANTIBIOTIC LEVEL ACCESS -- THIS ANTIBIOTIC,English
+"PROPHYLAXIS, WE GIVE THEM ANTIBIOTIC MEDICINE EVERY DAY. THIS HAS REDUCED THE DEATH RATE. >> WHILE ANTIBIOTICS HELP PREVENT DEADLY INFECTIONS, THEY",English
+"DO NOT HELP REDUCE THE PAIN OR HALT THE PROGRESSION OF THE DISEASE. TODAY, THERE IS ONLY ONE DRUG APPROVED BY THE FDA TO TREAT SICKLE CELL ANEMIA IN CHILDREN AND ADULTS.",English
+"IT IS CALLED -- AND HELPS REDUCE PAIN ATTACKS AND OTHER SYMPTOMS, IT DOES NOT WORK FOR EVERYONE. SEVERAL NEW MEDICINES ARE IN DEVELOPMENT.",English
+"ONE IS JUST BEGINNING CLINICAL TRIALS IN HUMANS. CURRENTLY, THE ONLY WAY TO REACH YOUR SICKLE CELL ANEMIA IS WITH A BONE MARROW TRANSPLANT.",English
+"A PROCEDURE IN WHICH BONE MARROW IS REMOVED FROM A DONOR, PROCESSED, AND THEN INFUSED INTO THE PATIENT. BASICALLY GIVING THE RECIPIENT A NEW FACTORY TO MAKE HEALTHY RED",English
+"BLOOD CELLS. TRANSPLANTS REMAINED EXPENSIVE, RISKY, AND NOT WIDELY AVAILABLE. FOR MANY PATIENTS, IT IS HARD TO FIND SUITABLE DONORS.",English
+"FOR THE TIME BEING, LOTS OF PATIENTS OF ALL AGES HAVE TO LEARN TO LIVE WITH THE DISEASE. AND TO LIVE WITH PERIODIC EPISODES OF SEVERE PAIN.",English
+"AT AGE 16, WHILE HE WAS IN HIGH SCHOOL, IT WOULD BE PAIN THAT WOULD DRIVE ARTHUR BROWN TO THE BRINK. THE ORDEAL BEGAN IN THE MORNING WITH A BOTTLE OF VICODIN.",English
+">> ONE MORNING, I WAS ABOUT TO GO TO SCHOOL, I DID NOT. I HAD SOME VICODIN AND I TOOK 15 OR 16. I COULD NOT TAKE IT ANYMORE.",English
+"I SAID I AM DONE. I JUST THREW MY HANDS UP AND I TRIED TO KILL MYSELF. WHEN MY MOM GOT HOME EIGHT HOURS LATER, SHE FOUND THE EMPTY",English
+"BOTTLE NEXT TO ME. SHE MADE ME STAND UP, SPLASHED A BUCKET OF COLD WATER ON ME, WAS HITTING ME, OH MY GOSH, WHY WOULD YOU DO THAT TO ME, WHAT",English
+"AND I FOUND OUT I HAD A STROKE. >> WHAT HAPPENS IS, THAT IS ABNORMAL RED BLOOD CELLS STICK TOGETHER EVERYWHERE IN THE BODY.",English
+>> STROKE WAS THE LEADING CAUSE OF DEATH FOR CHILDREN WITH SICKLE CELL UNTIL THE 1990'S. WHEN DOCTORS STARTED USING ULTRASOUND TECHNOLOGY TO,English
+">> ADULTS LIKE ARTHUR BROWN, WHO HAVE ALREADY HAD STROKES AS WELL AS HIGH-RISK CHILDREN, USUALLY NEED MONTHLY BLOOD TRANSFUSIONS. >> WE ARE ON A POSITIVE, -- O PO SITIVE, THIS IS O NEGATIVE.",English
+">> DURING THE PROCEDURE, BROWN'S SICKLED CELLS WILL BE REMOVED AND REPLACED WITH HEALTHY RED CELLS DONATED AT BLOOD DRIVES.",English
+>> 10 BAGS. THESE ARE THE RED BLOOD CELLS WE ARE GOING TO BE GIVING TO ARTHUR TODAY. THAT IS THE PREMISE OF THIS WHOLE TREATMENT.,English
+"OUT WITH THE OLD AND IN WITH THE NEW. THIS IS THE DONOR BLOOD LINE, IT IS GOING INTO THE RIGHT CHEST PORT.",English
+"THIS LINE HERE IS TAKING THE DISEASED CELLS OUT. >> WITHIN FIVE MINUTES, BROWN IS HALFWAY THROUGH BAD ONE WITH NEW",English
+"BAGS ON THE WAY. THERE ARE SEVERAL RISKS WITH TRANSFUSION. IF PATIENTS GET BLOOD THAT IS NOT A PROPER MATCH, THEY ARE AT RISK FOR REJECTING THE BLOOD.",English
+"BLOOD COLLECTED DURING BLOOD CHIVES IS MATCHED FROM DONOR TO RECIPIENT BASED ON BLOOD TYPE. RED BLOOD CELLS ALSO HAVE OTHER MINOR PROTEIN MARKERS ON THEM, WHICH CAN MAKE THEM INCOMPATIBLE BETWEEN DONORS.",English
+"PEOPLE OF THE SAME RACE OR ETHNICITY TEND TO HAVE THE SAME MINOR MARKERS, WHICH IS WHY IT IS IMPORTANT FOR MORE AFRICAN-AMERICANS TO DONATE BLOOD. >> A UNIT COMING FROM ONE AFRICAN AMERICAN TO ANOTHER IS",English
+STATISTICALLY A LITTLE BIT LESS LIKELY TO HAVE THIS MINOR INCOMPATIBILITY. IT IS IMPORTANT.,English
+"WE DO NEED MORE MINORITY REPRESENTATION IN OUR DONOR POOL. >> WHAT DO YOU CONSIDER THE PEOPLE THAT DONATE, HOW WOULD YOU CATEGORIZE THEM?",English
+">> THEY ARE DEFINITELY HEROES. THEY ARE NOT JUST MY HEROES. THEY ARE HEROES TO ANYONE WHO REQUIRES BLOOD. ANY NEXT -- ANEMICS, ANYONE WITH BLOOD TRANSFUSIONS FROM A",English
+"TRAUMA OR LOSS OF BLOOD. THEY HELP A LOT OF PEOPLE. >> HOW ARE YOU FEELING, ARTHUR?",English
+">> IN THIS SESSION, ALL GOES WELL. BUT AS WE ARE ABOUT TO SEE, YOUNG ADULTS LIKE ARTHUR BROWN OFTEN HAVE TROUBLE GETTING THE CARE THEY NEED.",English
+MANY SAY IT IS TIME TO RAISE AWARENESS AND MAKE NOISE. >> I THINK PATIENTS WITH SICKLE CELL DISEASE ARE NOT BEING HEARD .,English
+"SOMETIMES THEY ARE YELLING AND THEY ARE STILL NOT BEING HEARD. I THINK IT REALLY IS UP TO US AS THE MEDICAL PROFESSIONALS, AS DOCTORS AND NURSES, AS SCIENTISTS AND RESEARCHERS TO BE",English
+THAT VOICE. >> IT NEEDS TO BE MORE EDUCATION AS FAR AS IN THE COMMUNITY. AS WELL AS THE HOSPITAL.,English
+BECAUSE PEOPLE REALLY DO NOT KNOW OR UNDERSTAND. THEY ARE REALLY IGNORANT TO IT.,English
+">> ON THE HEELS OF THE CIVIL RIGHTS MOVEMENT IN 1971, PRESIDENT RICHARD NIXON PROPOSED A FIVEFOLD INCREASE IN FEDERAL SPENDING FOR SICKLE CELL RESEARCH.",English
+"40 YEARS AND $1 BILLION LATER, A LOT HAS BEEN ACCOMPLISHED. ESPECIALLY FOR CHILDREN. THOSE WHO TYPICALLY DIED BY AGE 14 NOW LIVE INTO THEIR 40'S AND",English
+"BEYOND. COMMUNITY OUTREACH, SCREENING, GENETIC COUNSELING, AND TREATMENTS TO MANAGE COMPLICATIONS HAVE ALL EXPANDED. THAT MANY PHYSICIANS REMAIN FRUSTRATED THAT MORE HAS NOT",English
+"BEEN DONE. FOR STARTERS, THERE IS ONLY ONE FDA APPROVED DRUG. >> WE ARE LIVING IN THE 21ST CENTURY AND YET IN THE LAST 100 PLUS YEARS SINCE WE HAVE KNOWN ABOUT SICKLE CELL DISEASE, WE",English
+HAVE ONE MEDICINE. >> WHAT DOES THAT TELL YOU? >> THAT TELLS ME THAT THIS HEALTH CARE DISPARITY NEEDS TO,English
+"STOP. >> MONEY IS A BIG PART OF THE PROBLEM. AN ARTICLE SIX YEARS AGO IN THE JOURNAL ""PEDIATRICS"" HAS BECOME",English
+"A SPRINGBOARD OF DISCUSSION ABOUT INEQUITIES. IT COMPARED FUNDING LEVELS BY NIH, THE GOVERNMENT'S MAIN FUNDER OF MEDICAL RESEARCH, BETWEEN SICKLE CELL DISEASE AND",English
+CYSTIC FIBROSIS IN 2004. BOTH ARE SERIOUS GENETIC DISEASES ASSOCIATED WITH SHORTENED LIFESPANS.,English
+"SICKLE CELL DISEASE, BY SOME ESTIMATES, AFFECTS AS MANY AS 100,000 AMERICANS. WHILE CYSTIC FIBROSIS AFFECTS ABOUT 30,000. YET CYSTIC FIBROSIS GOT MORE FUNDING.",English
+FOUR TIMES MORE ON A PER PERSON BASIS. THE NECK WOODY HAS CONTINUED. >> -- THE INEQUITY HAS CONTINUED.,English
+>> SICKLE CELL DISEASE IS THE MOST COMMON GENETIC DISORDER IN THE U.S. AND YET THE AMOUNT OF SUPPORT THAT SICKLE CELL DISEASE GETS IS SIGNIFICANTLY LESS.,English
+"LESS THAN OTHER GENETIC DISORDERS THAT ARE MUCH LESS COMMON. >> IN THE FIERCE COMPETITION FOR RESEARCH FUNDING, ADVOCATES FOR",English
+"MANY CONDITIONS FEEL SHORTCHANGED. IT OFTEN COMES DOWN TO WHO HAS THE BEST ORGANIZATION AND CLOUT. MANY PATIENTS WITH SICKLE CELL ARE POOR, MINORITIES, AND LACK",English
+"INFLUENCE. >> BECAUSE OF SOCIOECONOMIC'S, THE LOBBY THAT ADVOCATES FOR RESEARCH, FOR PROGRESS IS NOT A STRONG ONE.",English
+"THIS ALSO HAS A MAJOR IMPACT ON FUNDING LEVELS. SO THERE IS CLEARLY, WITHOUT A DOUBT, THERE IS A SOCIOECONOMIC ASPECT TO SICKLE CELL DISEASE.",English
+">> THE ARTICLE IN ""PEDIATRICS"" ALSO EXAMINES THE ROLE OF RACE. STATING ""AS A COUNTRY, WE CONTINUE TO STRUGGLE WITH IT THE IMPLICATION OF PAST AND PRESENT RACIAL BIAS FOR HEALTH.""",English
+"THE AND EQUITY IN FUNDING, THERE ARE PROBLEMS DELIVERING CARE TO SICKLE CELL PATIENTS, PARTICULARLY YOUNG ADULTS. THERE IS A SHORTAGE OF SICKLE CELL SPECIALISTS.",English
+"ONGOING TREATMENT IS OFTEN FRAGMENTED, THE HEALTH CARE SYSTEM IS HARD TO NAVIGATE, AND MANY LACK INSURANCE. ONE CONSEQUENCE OF ALL THIS IS THAT MANY PATIENTS DO NOT SEEK",English
+"MEDICAL ATTENTION UNTIL THEY ARE IN DIRE STRAITS. THEY HAD TO THE EMERGENCY ROOM IN SEARCH OF NARCOTICS FOR PAIN. PAIN THAT CAN BE AS SEVERE AS THAT OF A BROKEN BONE, BUT NOT",English
+AS OBVIOUS. IT CAN BE A CONFUSING SITUATION FOR MEDICAL STAFF AND RESULT IN UNDERTREATMENT. >> ONE OF THE THINGS THAT DOCTORS AND NURSES ARE LOOKING,English
+FOR OUR PATIENTS TO DEMONSTRATE PAIN BEHAVIORS THAT ARE APPROPRIATE FOR THE AMOUNT OF PAIN THEY ARE HAVING. SOMEBODY THAT HAS GROWN UP WITH PAIN THEIR ENTIRE LIFE HAS,English
+"LEARNED TO COMPENSATE FOR THAT PAIN. AND SO TYPICALLY THEY WILL NOT SHOW THOSE KINDS OF PAIN BEHAVIORS. >> ON TOP OF ALL FACE CHALLENGES, THERE ARE",English
+"COMMUNICATION PROBLEMS CAUSED BY DIFFERENCES IN RACE AND CULTURE. >> TO STAY OUT OF THESE EMERGENCY ROOM SCENARIOS, SICKLE CELL PATIENTS NEED QUALITY, ONGOING CARE.",English
+"BUT IN 2010, ARTHUR BROWN FOUND HIMSELF MISSING JUST THAT. HE BECAME UNEMPLOYED, LOST HIS HEALTH INSURANCE, STOCKS GO IN",English
+"HIS MONTHLY BLOOD TRANSFUSIONS, AND BECAME DEATHLY ILL WITH PNEUMONIA. BROWN ENDED UP IN AKRON GENERAL'S INTENSIVE CARE UNIT.",English
+"ON A VENTILATOR IN A MEDICALLY INDUCED COMA, FIGHTING FOR HIS LIFE. >> WILL HE WAKE UP?",English
+"I WAS WORRIED ABOUT THAT, WILL HE WAKE UP, WILL HE -- WILL THEY BE ABLE TO BRING HIM OUT OF IT? >> THAT'S THE MOMENT WHEN I REALIZED HOW MUCH I REALLY DID",English
+LOVE HIM. I JUST WANTED TO BE WITH HIM NO MATTER WHAT. SO I WAS THERE.,English
+">> I CAME OFF THE VENTILATOR AND -- THAT WAS PRETTY MUCH IT. THAT WAS THE CLOSEST I HAVE EVER BEEN TO DYING. IT IS LIKE MAN, I AM STRAIGHT.",English
+"I DO NOT THINK IT CAN GET MUCH WORSE, HOPEFULLY IT DOESN'T. TO ME, I HAVE BEEN THERE AND BACK. >> THESE DAYS, ARTHUR BROWN HAS A FULL-TIME JOB WORKING FOR THE",English
+CLEVELAND CLINIC READING EKGS FOR HEART DISEASE PATIENTS. HE FEELS BLESSED TO BE BACK ON HIS REGIMENT OF MONTHLY BLOOD TRANSFUSIONS.,English
+"HIS PAIN ATTACKS NOW COME LESS FREQUENTLY. AND HE USUALLY ONLY ENDS UP IN THE HOSPITAL ONCE A YEAR. ♪ SOMEDAY, BROWN AND HIS WIFE HOPE",English
+TO HAVE CHILDREN. SHARDAY WAS TESTED FOR THE SICKLE CELL TRAIT AND CAME UP NEGATIVE.,English
+THAT MEANS THERE IS NO RISK THAT ANY CHILDREN THEY HAVE WILL HAVE SICKLE CELL ANEMIA. >> LET'S LISTEN TO YOU. >> BROWN HOPES THE NEXT GENERATION OF CHILDREN GROWING,English
+UP WITH SICKLE CELL ANEMIA WILL LEARN FROM HIS EXPERIENCE. ONE THAT LEAVES HIM ABLE TO CALL THE DISEASE BOTH A CURSE AND A GIFT.,English
+">> ALL THE SICKNESS AND THE WEAKNESS, THE FATIGUE. I ALSO VIEW IT AS A GIFT. IT LETS PEOPLE SEE THAT YOU CAN GET THROUGH THINGS. ♪ >> HERE ARE A FEW THINGS TO",English
+"That makes a big, big difference. Ankle pumps. So same thing, just moving your ankles. That alone, it seems like nothing, but that will get that blood flowing.",English
+"Inconsistencies the key like once an hour if you're on the plane train like I said, or on the couch, lift your legs or walk to the bathroom if you have a broken leg or something, lift your legs up.",English
+"That makes a big, big difference. Rates of blood clots are increasing because people are not moving and other factors today. So get up every hour",English
+"because sitting for three plus hours is that one of the biggest risk factors? And bicycle kicks, you can sit on your back, move in your leg, pretend you're riding a bicycle A huge difference there.",English
+"Easy. It's almost too simple. But the studies are there, especially in the hospital, in planes that prevents blood clots. Number three, strength training.",English
+"Strength training is huge. If strength training was a treatment, everything else would be way behind. I watched the Steve Prefontaine running movie where he was setting",English
+all those records and he was like one lap ahead of everybody in the seventies. This is what strength training is. Strength training doesn't mean heavy weights.,English
+"It means you could basically be sitting in a chair and getting a start. You could be really out of shape and getting a start. You could be a senior 70, 89 years old",English
+and basically lean against a wall or squat. I've had patients who could barely get up out of bed. Build up strength gradually.,English
+"It's never too late. Don't give up. You get your best gains immediately. Strength training is more important than walking, running everything that gets your good hormones up.",English
+"It gets your blood vessels nice and strong, it gets your hormones flowing. So here's specifically what studies show. It gives you vessel dilation. Number one.",English
+"So that means your blood vessels get used to opening number, and that's shown in the journal Physiology in 2005. It gets nitric oxide production, so your blood flow is healthier",English
+and more nutrients. That's a study published in the American Journal of Hypertension showing that nitric oxide is produced by strength training. Improved artery function.,English
+"As you have higher strength, your arteries get stronger. The European Journal of Applied Physiology in 2013 showed this get some strength training.",English
+"It, do some air squats, do some calf lifts, increase capillary density people who strength train. So even just like standing up on your toes do an air squats like this",English
+that gives you more blood vessels it perforate better. And that's proven by the Journal of Applied Physiology in 2010 This is a great chart summarized,English
+"by Coach Barkley, but in just 2 to 3 sessions per week for about three months, you gain about 3lbs of lean muscle strength, a better strength, better metabolism, about five plus pounds of lost fat,",English
+"stronger bones, stronger metabolic rate, better weight management and better blood sugar, less diabetes. Who doesn't want that? This stuff is amazing.",English
+"Everyone has time to do it. It's the best investment you'll make. and much less peripheral arterial disease strength training, if you can do it. More important than anything else, gradual strength training throughout your life.",English
+"And we specifically show you fit specific exercises. I linked that below, but I do a guide where I show foot specific strengthening exercise to improve your blood flow down to your feet.",English
+"Number five leg elevation, elevating your legs above your heart level. If you can't move, if you have a broken bone or joint, a study published in the journal Vascular Surgery in 2015",English
+showed that leg elevation increases venous blood flow and reduced venous pressure in individuals with chronic venous disease. Elevating your legs can work really well.,English
+But I love these pumps if you're at a desk or a computer chair. These change people's lives as well and really can reduce fatigue. Check the links below.,English
+"Number six, massage therapy. So there's a lot of great stuff like skin brushing, which is using a big brush to brush your skin.",English
+"There's massaging the legs, there's foot massagers, there's massage guns. I love all these things. Realistically, if you get home and you can use a foot massager,",English
+"I link some of my favorites. I love foot massagers, I love calf massagers, and there's actual physical massage. Let me give you a story.",English
+"When I sit and work at the computer, I get a lot of notes to do when I see patients, and that can take me hours. Sometimes I wear compressive cuffs",English
+"when I sit, my energy level feels great. It keeps the blood flow moving and I make sure to get up for like 5 minutes out of every hour.",English
+"That's what I talk about with massage therapy. So compression cuffs, foot massagers, there's thigh massagers out there. There is a massage, guns to loosen up those thick knotted muscles.",English
+"Take a look at these right here. Powerful ones, smaller ones for sitting in a chair. I love all these. They can work out the knots in your hips, your butt,",English
+"your lower back, your thigh muscles, your calf muscles. As those knots get worked out, these massage guns become exponentially more effective and your leg gets better.",English
+"Blood flow starts moving in order. I would usually say you need good support. Then number two, you need good massage. Then number three, you need stretching.",English
+"And then number four, those exercises, all four of those are really important for most cases. That right there you can quit the list already.",English
+"That's a very effective plan. Don't quit just yet. I still got some good stuff for you, but a study published in the Journal of Alternative Complementary Medicine",English
+"in 2010 found that foot massage increased the blood flow, velocity and enhanced vascular function in healthy individuals. Basically, the more massage you get, the looser muscles are the better",English
+"than inflammatory fluids move, the less you swell the next day. Number seven, warm water. So I'm a big fan of taking a bath using Epsom salts.",English
+"So Epsom salts, not only do they clean off your thick, dry skin, if you have athlete's foot toenail fungus, it'll help with that. Getting that inflammation from that thick, dry skin will decrease your swelling,",English
+"your inflammation, because inflammation causes swelling and swelling causes inflammation. It's a vicious cycle. Warm water soaks with Epsom salts, definitely improves circulation.",English
+A study in the Journal of Cardiology in 2017 demonstrated that warm water immersion actually improved blood flow and decrease dust resistance and peripheral arterial disease.,English
+"Number eight, missing nutrients. This means good diet. If you're heavily overweight, you've got to lose some weight if you're eating sugary foods and you have diabetes, you got to correct all that.",English
+There are specific nutrients that help with poor blood circulation and poor blood flow. I have an amazing top 15 list for blood flow getting down,English
+"and a top 19 list for swollen legs, varicose veins, all that kind of stuff. There are actually two different pathways. One is getting the blood flow down. That's the arteries.",English
+"One is the veins getting the blood flow up. So there are two different systems, even though they both can result in swelling and pain in the feet, you want omega three fatty acids, you want some magnesium,",English
+"you can use some root and you can eat vegetables, whole grains, fruits, meats, get your B vitamins in there. Realistically, you could even get a blood test to see what's missing.",English
+"The bottom line is to make it simple. Cut out the garbage, calories, the sugar, the high diabetes inducing food, all that unhealthy stuff.",English
+"Get natural, healthy food like lean meats, healthy vegetables, green vegetables. This has been well-studied.",English
+"I could say 8000 articles, but this leads to healthy arterial blood flow and endothelial function and increases your health and ability to move around. Make sure you cut out the junk.",English
+"I have guides the top 29 worst foods for your blood flow, the top 15 and 19 supplements and foods. For all of this, I have guides for all of it.",English
+Check those out. They include the studies. They're very detailed and in-depth. But you also want to take a look at magnesium.,English
+"That's a good one. Omega three fatty acids bromelain, that's one that's included here. I wouldn't put that at the top of my list, but it's included as one very well studied.",English
+Vitamin C is a lot. So your citrus fruits can make a big difference. Rutin is another great remedy. So Rutin is a great supplements.,English
+I have the details in the videos below. Number nine Horse Chestnut. I included this one specifically because it's a very popular one for swelling and varicose veins.,English
+"It's mentioned by a lot of people, especially in the news. Horse chestnut extract has been traditionally used to support venous health, reduce swelling in the legs. It is believed to improve blood flow, strength and capillaries.",English
+Very well studied. There's a lot of studies out about horse chestnut. Check that out. I have some links to some of my favorites below.,English
+"Hydration number ten. This sounds counterintuitive. Hydration. By drinking enough, it actually keeps your kidneys flowing.",English
+"You don't retain as much salt. It kind of clears your body. Realistically, if you have congestive heart failure or kidney",English
+"issue, drinking too much water can lead to some issues because you could retain some water weight. But we're talking for the people who don't have kidney failure and don't have congestive heart failure.",English
+"But if you do, always check with your doctor because too much fluid can actually cause even more bloating. But we're talking for eating salt, things like that in your diet.",English
+You want blood flow to help maintain circulation. You don't want your blood to be as dense as it is when it's dehydrated. Can look at your urine.,English
+"If your urine is like a dark color when you pee, you're probably dehydrated. If it's nice and clear, you're probably well hydrated. I have a link for my favorite drink that includes",English
+"certain secret ingredients that keeps you well hydrated. And I tell you why. I include that link below. Nonetheless, a glasses a day is probably a great start.",English
+"11 Health issues. So diabetes, peripheral arterial disease, smoking. If you have underlying health diseases, the number",English
+"one thing you can do is work with your doctor to take care of that. So stop your smoking, stop eating sugar, lose some weight and put pressure off your heart.",English
+"These are complex topics on their own, but the reason I mention them is I know they're common sense, but the reality is this guide and every other YouTube guide is completely worthless",English
+"if you don't fix these major underlying issues. A study published by the American Journal of Physiology Heart and Circulatory Physiology in 2017 said basically,",English
+"if you have these issues, none of these tricks will work. So, for example, if you're smoking, it doesn't make sense to just eat healthy. You have to stop smoking as well. Weight loss.",English
+"I'm just going to toss this fact out here. If I put 1lbs in a backpack, so pretend I was wearing a backpack right here. If I'm wearing a backpack and I put 1lbs and as I'm walking,",English
+"that increases my surface pressure to my toes, to my feet by 5lbs. So it's a 5 to 1 ratio. Forget about all the heart benefits, the kidney benefits, everything like that.",English
+"For every 1lbs you lose, it's 5lbs less on your foot when you're walking. That is huge. That should be a great motivator right there.",English
+Simply just wearing less clothes is less pressure on your feet. That's how you have to think about it. Get that weight down and get health. Avoid prolonged sitting.,English
+"I talked about exercise getting up and moving. Studies show that basically if you sit all day long, like three plus hours at a time, that is as dangerous for your health as smoked.",English
+Let me repeat that smoking one pack per day is as dangerous as sitting for more than 3 hours at a time. The reality is you've got to get up.,English
+"You've got to get your blood circulating. If you sit at a desk all day, consider a stand up desk. Consider getting up for 5 minutes every hour.",English
+"If you're sitting in a car, you know, maybe do some leg pumps, do some exercises and that counts. There's always a solution. Stand up desks are unbelievable.",English
+"This has changed my life. But pain, hamstring, thigh pain, the lower back pain all gets immediately better. The studies verify this and combine it with a stretch mat",English
+"so these types of mats can stretch your calf muscles, your thighs, your hamstrings, your lower back all while standing. And you can sit down any time.",English
+"These are stable, they hold you computer. It's really the way to go. here are the two big secrets. The two biggest secrets that comes down",English
+"to all of this stuff's worthless if you don't do these two things. And these are the number one things that I see, people who stand all day, they have prior injuries.",English
+"You could have a tight hip, a tight knee, a tight lower back, a prior injury, a prior sprained ankle. You have to get a biomechanical exam.",English
+"What I mean by that is if you're leaning more on one side or the other side, this is the most common problem I see with people. They usually have some type of arthritis or joint pain",English
+"and they don't wear good shoes, they don't wear good orthotics, they don't wear good braces, they don't use a massage gun to work out those knots. Their muscle strength is not equal.",English
+their risk of developing high blood  pressure or manage their high blood pressure it's also important and i don't know that i  mentioned it any time in this presentation but,English
+i will just kind of point out that   blood pressure medications can interact with other  medications and blood pressure medications often,English
+need to be adjusted based on age and weight my  grandmother was on blood pressure medication as   are many people that are over 65 and when her  blood pressure medications would get too high,English
+she would have problems with dizziness and  falling and other things so we want to recognize   that blood pressure can play a role  in symptoms that we might attribute to,English
+cognitive dysfunction or something else okay so  cardiovascular disease uh cardiovascular disease   is a group of disorders of the heart and  blood vessels including coronary artery,English
+disease cerebrovascular disease rheumatic heart  disease and other conditions now what we want to   focus on with this is not the specifics but the  fact that it's cardio the heart and vascular the,English
+veins and arteries so there's a problem with  the blood oxygen transport system basically   four out of five cardiovascular deaths  are due to heart attacks and strokes,English
+now the prevalence i just kind of  want you to wrap your head around this   so you can recognize how prevalent it is about  655 000 americans die from heart disease each year,English
+in 2021 so this year a little over  600 000 people will die of cancer   five hundred and twenty eight thousand six  hundred and three americans die of cr died of,English
+coronavirus in a year so we want to recognize and  and not minimize the impact of and the prevalence   of heart disease and cancer we want to rank it up  there with the coronavirus you know let's start,English
+taking it just as seriously but risk factors for  cardiovascular disease include high blood pressure   high ldl cholesterol that's your bad cholesterol  obesity unhealthy diet smoking and heavy alcohol,English
+use now alcohol use was not as much of a risk  factor according to the research i did for   blood pressure but for vascular disease it does  become an issue and they define heavy alcohol use,English
+is approximately five ounces of wine or 12  ounces of beer more than eight times a week so   the clients that we work with that minimize  their their alcohol consumption because they're,English
+only drinking wine or only drinking beer we do  want to point out to them that there could be   side effects from that aside from the fact that  alcohol does alter your neurotransmitters and,English
+your mood and your it impacts your hpa axis it  also is a risk factor for cardiovascular disease   physical consequences of high blood  pressure and cardiovascular disease,English
+heart attacks well when somebody has a heart  attack that is a life-threatening event it can   be extremely traumatic it is not uncommon  for people who develop heart attacks to,English
+develop health-related anxiety to develop ptsd  related to the heart attack episode or and or   to have to grieve because they may lose  functioning in certain aspects of their life or,English
+they can't do things like they used to after they  have a heart attack they may be angry that they've   got to go through rehabilitation so we do want to  recognize that there is a significant emotional,English
+and cognitive component to recovery and living  with high blood pressure or cardiovascular disease   strokes are another common problem associated with  high blood pressure and cardiovascular disease,English
+when the brain doesn't get enough oxygen people  can have a stroke and this can lead to dementia   and physical dysfunction we we all know of people  who've had strokes that have lost functioning in,English
+part of their body or lost the ability to speak  again for the individual as well as for their   family there is a certain amount of trauma that's  associated with one of these life-altering events,English
+and anxiety there also may be a grieving process  as people adjust to their new normal post   incident kidney disease can be a consequence of  high blood pressure and cardiovascular disease and,English
+if it develops to the point where the person has  to be on dialysis that can be more of a problem   there are potentially pain associated with  kidney disease and there's a lot of other,English
+side effects like fatigue and other things  that need to be managed so when people develop   high blood pressure or cardiovascular disease they  are a greater risk for significant health events,English
+that can impair their activities as they know them  sexual dysfunction is another impact of high blood   pressure it is important to put this out there  because that can be a motivating factor for people,English
+but also clients that we're seeing that have  um erectile dysfunction or reduced libido   we want to examine have they had their blood  pressure checked that's one of those easy,English
+things to figure out and if they do have  high blood pressure or low blood pressure   make sure that they're getting that evaluated  because sexual dysfunction can have a significant,English
+impact on mood and self-esteem peripheral  artery disease is another consequence of   high blood pressure or cardiovascular  disease and it can lead to excuse me,English
+sorry it can lead to pain and excessive fatigue  when your arteries peripheral means you know not   in your trunk but in your arms and legs and things  when they're when they are diseased they are not,English
+going to be carrying the oxygenated blood as  effectively which can contribute to pain swelling   and excessive fatigue when you're not getting  blood oxygenated it's not running through that,English
+oxygenation system quickly enough you know it  starts to become you know think stagnant you   know that's not exactly what happens but when you  have high blood pressure or cardiovascular disease,English
+because the arteries are diseased it often  contributes to accumulations of those ldl   of that ldl cholesterol of those plaques in the  arteries which further makes the arteries diseased,English
+now if that wasn't enough you know the  diseases themselves or the conditions   themselves have some significant potential side  effects that we need to help people be aware of,English
+learn how to cope with prevent when possible but  the medications people take for cardiovascular   disease and high blood pressure also have side  effects balance and coordination difficulties,English
+are one of them as i mentioned when my  grandmother's blood pressure medication would   be too high she would start having a lot  of difficulty with balance and coordination   and falls but this can happen to younger people  who are on high blood pressure medication too,English
+which can make them put them at risk for injury  it can make them um more prone to fall in stores   have more fatigue and difficulty shopping  and doing their activities of daily living,English
+that can be extremely frustrating for people and  they may start feeling hopeless helpless depressed   because they just can't do what they used to do,English
+headache is another symptom of these uh  medication side effects and increased   risk of sleep apnea with if if somebody's  taking antidepressants or benzodiazepines,English
+and antihypertensives there is an increased  risk of sleep apnea we want to be aware of that   because sleep apnea as we said earlier is a  risk for high blood pressure so it may worsen,English
+high blood pressure but again sleep apnea can also  contribute to cognitive decline and mood disorders   so that's one thing we certainly want to rule out  especially if the person's mood markedly changed,English
+or their cognitive abilities markedly changed  after starting their antihypertensive medication   statins interestingly enough are designed to lower  cholesterol and have been found to interact with,English
+antidepressants improving the mood response so  they suspect that statins reduce inflammation   and that reduction in inflammation works in  tandem with the antidepressants to improve,English
+improve mood response in some people which again  underscores the importance for our clients who are depressed or anxious and i throw anxious  in there too because a lot of ssris treat,English
+anxiety it's important to make sure that their  blood pressure is within normal limits because   that can be a significant confounding  factor to their adequate recovery,English
+can taking antihypertensives and an snri that  increases norep epinephrine be unhealthy because   of the neurotransmitters going in both directions  that is a great question and i don't know the,English
+it easy for you to move your practice online  and focus on what you love most helping others   betterhelp's easy-to-use platform  takes care of referrals and billing   and provides a secured platform to communicate  with your clients join more than eighteen,English
+thousand therapists at better help helping  to improve people's mental health and lives   affective cognitive consequences now these  are the ones that we can dig our teeth into,English
+um pre-existing consequences of diagnosis  or the clinical event so prior to somebody   learning they've got hypertension they may  be angry struggling with grief or depression,English
+uh anxiety fatigue or ptsd so this may  be a pre-existing issue that exacerbates   and promotes the development in some ways of high  blood pressure and or cardiovascular disease or,English
+and it can also be a consequence once somebody  gets a diagnosis so we want to recognize that   there are a lot of issues going on a lot of the  post diagnosis or post-incident issues have to do,English
+with trauma surrounding the issue grief over not  being as healthy as they thought they were over   fear of a force for shortened future um over not  being able to do some of the activities that they,English
+used to do there's a lot of things that may need  to be addressed post-incident or post-diagnosis   even for some people if they're told that  they've got a really significantly reduced salt,English
+that may lead to a lot of anger at the situation  and you know part of that grieving process denial   anger bargaining depression acceptance um we need  to help them figure out a way to work through that,English
+so motivational enhancement techniques can  be really helpful here for increasing their   motivation to comply with the doctor's treatment  recommendations as well and the dietitians,English
+as well as encouraging them to embrace  the dialectics or as hayes would say in   acceptance and commitment therapy encourage them  to live in the and i can have high blood pressure,English
+and still live a rich and meaningful life  i may have to make some modifications   but i can have both of these things  concurrently we want to address anxiety,English
+and and all of these things like i said could also  occur beforehand that because of trauma because   of stressful environments because of whatever  that increased their hpa axis dysregulation that,English
+contributed to the development of these things  through through excess stress keeping their blood   pressure up and or through self-medication of the  of that stress with alcohol or nicotine products,English
+so we do want to recognize that people who  develop these conditions probably had some   stressors going into it and the more we can help  them address those stressors the more we can help,English
+them re-regulate their hpa axis and potentially  eliminate this confound to their condition fatigue   is one that is challenging for a lot of people  and you know we already talked about the fact that,English
+fatigue happens when the cardiovascular system  isn't working as effectively so all that oxygen   isn't getting where it needs to be and that can be  an extremely debilitating and frustrating symptom,English
+so we do want to help people learn how to set  goals and to pace themselves so they can do the   things that they want to do within reason even  with the diagnosis my stepfather and it wasn't,English
+his wasn't cardiovascular disease but as he got  older um you know once he got into his mid 80s   his fatigue that he would get tired a lot easier  and his fatigue kept him from being able to,English
+walk the golf course 18 holes and that just  drove him batty but you know he he compromised   by agreeing to use one of the little golf  carts um instead of trying to walk the course,English
+was it the ideal solution no he's you know  he was still angry that he couldn't walk   walk the course but he did still find a way to  keep that activity which was crucial critical,English
+to his definition of a rich and meaningful life  and then vascular dementia occurs when the oxygen   level to the brain drops for a period of time and  it can occur in people with severe sleep apnea,English
+because there's repeated instances where  the oxygen is is stopped to the brain   but it also occurs after a stroke and and other  cardiovascular instant incidents now this dementia,English
+is a result of brain damage so the individual  as well as their caregivers or their family   may have to learn different ways of being in the  moment different ways of planning and and alter,English
+their interactions with one another because  the depending on the severity of the dementia   um obviously the person may need more help than  than they use than they needed prior to the event,English
+in terms of interpersonal consequences of  high blood pressure and cardiovascular disease   in both the individual as well as their loved  ones especially immediate family there's often,English
+an increase in anxiety and depression which may  abate over time especially with health education   and treatment compliance so getting a diagnosis  of heart disease is terrifying i remember when,English
+my grandma grandfather got that diagnosis i was  like okay what does that mean and understanding   helping people understand in common terms what  that means what the prognosis is you know what the,English
+next 5 10 20 years is going to look like that's  important helping them identify and learn the   strategies they can use to maximize their quality  of life and minimize or slow the progression,English
+whenever possible can be extremely helpful too  because you're empowering them you're saying here   are all the things that you can do and instead of  feeling like you are a prisoner to your own body,English
+there are active steps you can  take so you're empowering them   now the challenge comes when the patient is  not treatment compliant and the patient may be,English
+crisis they just found out about the diagnosis  or found out about it a couple of days ago and   they're still kind of reeling from this idea that  they or their loved one has a chronic condition,English
+so we don't want to overload them we want to  make sure that it is something that is either   preferably written down and if possible that  there are videos that you link to um for certain,English
+a couple of times in order to get everything so  it is important to pace yourself when providing   information but to provide information in  a way that is empowering and motivating to,English
+the individual create win wins whenever possible  you know if you take this medication and we can   get you stabilized on it get you at the right  dose then you know what are the benefits to you,English
+changes in leisure activities and family  responsibilities may also result in a   grieving process for the individual as well  as the whole family there is going to be   potentially a readjustment maybe dad has  high blood pressure or had a heart attack,English
+and you know he really shouldn't be out push  mowing the lawn in the 90 degree heat anymore   so somebody else has to pick up that chore um or  medications that the person is taking contribute,English
+cardiovascular disease under control then you may  have the energy you may be able to reduce some   of your meds some and have more energy to do the  things that you want to do and it's likely that it,English
+the foundation for a healthy blood  pressure according to the experts   consists of a healthy diet adequate exercise  and mental and environmental stress reduction   so not only cognitive stress but we also want to  reduce environmental stress and that can include,English
+you know noisy environments heat stress anything  that may increase blood pressure we want to try to   make sure that we're we're addressing trait  mindfulness may have protective effects on,English
+blood pressure when caregivers and individuals  with the disease face high levels of stress   and getting a diagnosis is one of them but  even after their diagnosis or before it,English
+they may anyone is prone to experience periods of  high levels of stress so helping people develop   trait mindfulness helping them develop this  ability to be aware of how they're feeling and,English
+what they're needing and identify their emotions  before they're out of control and figure out how   to regulate them more effectively all of that  is super helpful heartiness and resilience,English
+both decrease the effect of stressful life  events mediating the development of illness   symptoms so even if somebody has cardiovascular  disease or even if they've had a heart attack,English
+bigger picture not just focus in on the one  thing that is distressful control helps them   identify the aspects of all of the things in  their life including whatever is going bad,English
+helps them identify which aspects they can control  what can they do to mediate the situation or   eliminate the situation and then people who view  all of these things as a challenge instead of a,English
+chore or a barrier also tend to have much greater  outcomes if they get a report back that they've   got high blood pressure and they're like all  right gosh darn it i am going to get that blood,English
+pressure down i am not going to end up on blood  pressure medication um if they're at that stage   then they may see it as a challenge  to figure out how to get their body to,English
+do what they want it to do so viewing things  as challenges or learning opportunities can help promote hardiness resilience and optimism,English
+you can use techniques like in dialectical  behavior therapy such as distress tolerance   and dialectics helping people embrace the and  living in the and as we've already talked about,English
+or in cognitive behavioral therapy i abbreviated  fcp i don't know you know however you want to   abbreviate it but help them evaluate you know  when they start feeling anxious or depressed,English
+identify their thoughts evaluate the  facts for and against their beliefs   once they figure out what is fact-based then  identifying what aspects of the situation,English
+they have control over and finally looking at the  probability if based on the cr the facts in this   current situation if i do the things that i can to  control the situation what is the probability that,English
+i can have a positive outcome so facts control  and probability maintaining hope and positivity   versus managing worries fears and anxieties is  also predominant and that is another one of those,English
+sort of semantic twists but we've talked about  it some in acceptance and commitment therapy   using energy to move toward a goal instead  of trying to eliminate a problem can be,English
+very liberating so using energy to  maintain hope and positivity and optimism   when you're having when you're emphasizing those  there tends to be less worry fear and anxiety,English
+yoga and meditation were also found to be very   helpful in helping people develop auto autonomic  cardiovascular control they start to be able to,English
+practice breathing in deeply and exhaling and they  learn how to slow their heart rate for example   they can learn how to trigger that rest and  digest which can help lower blood pressure,English
+so since autonomic cardiovascular control  is impaired in people with hypertension   it leads to an increase in sympathetic  influences to the heart and peripheral vessels,English
+which is a gobbledygook way of saying when people  get stressed out their hpa axis is activated and   it causes a dump of a bunch of adrenaline and  the heart rate starts speeding up and a lot of,English
+physiological responses but people can learn  to identify those physiological responses   as at least moderately controllable and  develop strategies for down regulation,English
+improvement in family relationships and reductions  in interpersonal stress are also important when   we're talking about cardiovascular disease and  high blood pressure anything that causes that,English
+heart to start speeding up causes the blood  pressure to go up like triggering the hpa   axis trigger triggering the threat response system  is probably going to aggravate the condition,English
+so we want to help people identify what are their  triggers for anxiety and anger and irritation   particularly and how can we help them moderate  those as much as possible we want to help them,English
+reduce environmental stress triggers and  vulnerabilities so let's start with triggers   if they have a bunch of dogs and solid surface  floors when when the dog starts barking furiously,English
+it may startle them and it may trigger  an anxiety response but there can be   other environmental stressors such as you know  living in unsafe housing that increases people's,English
+underlying sense of stress and unsafeness so  their hpa axis is always somewhat activated   so we want to look have them look in their  environment and identify what in your environment,English
+is stressful noises smells sights those are the  big ones and sounds i guess that goes with noises   um you know if they live next to a railroad  track and the train comes by every quarter hour,English
+that could potentially be an environmental stress  trigger in terms of vulnerabilities we want to   eliminate anything that keeps people from  getting adequate quality sleep getting,English
+they're setting their circadian rhythms so being  able to get out get sunlight get bright light   you know if they're in a cave like atmosphere  all day long that's going to contribute to excess,English
+stress and circadian rhythm dysfunction  um so noise that keeps them from sleeping   if they are doing shift work shift work tends  to be really hard on the cardiovascular system,English
+because it throws the circadian rhythms completely  out of whack so that might be another intervention   that they need to look at for you know going  to day shift or or um if they insist on staying,English
+night on night shift then staying on night  shift even on their days off an adjustment   and motivational enhancement for new eating and  activity patterns helping people figure out how to,English
+not only implement the requirements but  maintain them so the doctor says you've   got to start walking 30 minutes a day  and that's just completely overwhelming,English
+okay so ideally you know work with the rest of the  multi-disciplinary team but for some people they   may need to break it up and do 10 or 3 10  minute episodes at first throughout the day,English
+and then eventually work up to doing a solid 30  minutes so it's important to work with people to   figure out okay what is it that you can and are  willing to do right now our goal is over here,English
+you're here what is it that you can do to start  moving towards that goal even if a little bit hypertension and cardiovascular disease can both  be aggravated by and cause the development of,English
+depression anxiety anger grief and even ptsd if  there is a life-threatening episode high blood   pressure and cardiovascular disease are largely  preventable and or treatable so it's important,English
+to help people recognize that you know this isn't  this is likely something that you can work with   this is likely something that you can slow the  progression of if it is a progressive illness,English
+in terms of the roles of the counselor or  social worker we need to address grief and   health anxiety in both the patient and the family  providing them with tools such as heartiness,English
+mindfulness meditation activities yoga  optimism and cognitive restructuring   now i say yoga and that's kind of one of those  general terms that that's there but tai chi has,English
+"supports; their family and friends, that that’s  going to be better for individuals than being   isolated in an institutional setting. We’ve been  in a time of change and we continue to be in a   time of change. You know, for state hospitals, the  olmstead decision means we have to make sure that",English
+"we are serving people in the least restrictive  setting and that we’re doing more community   integration than we’ve done historically. And  from a justice perspective, that’s absolutely",English
+"the right thing to do. We’re embracing that.  But, it definitely is a time of change. Announcer: this most recent closure of the  civil beds at Norristown state hospital   effects real people, as you’ll hear from two  Pennsylvania mothers, the closure is a big deal",English
+"in their lives and the lives of their  children. And it has them concerned. I’m making it a short story, but it’s a  long, long. It could be a movie. A nightmare. There’s my beautiful son. He was a normal  kid. He played football, he played lacrosse.",English
+"He loved cars. Started to get a little  sick around 18. He was playing football and   when he was last year in high school, he kept  saying that they were jealous of him. But,",English
+I didn’t nothing of it. And he graduated from  high school and then he went into the army. The   worst day of my life was on a Saturday. My  nephew was getting married. I was going to,English
+the reception and I was so happy. And the phone  call comes from the army and they say your son   is mentally ill. We’re gonna send  him home. He’s schizoaffective.,English
+"And they put him on a plane and send him  home. And he came home, he was so sick.   And I didn’t know what to do. I didn’t  know nothing about mental health.   And I had to call the police. I told them not to  put the sirens on please. Went to the hospital.",English
+Came out after two weeks and after that  it was one hospital after another. One   place after another. And me trying to get the  private psychiatrist. I had to fight for him,English
+"for everything. They put in a place, and they  kick him out. He ran home. He came home. He was   out. In and out. In and out. In and out all  the time. Finally, you know, he was so sick.",English
+"I said put him in Norristown for a while. I  begged the doctor. He was there for eight years.   I went to see him every week, but he was getting  better. He got better. There was the greenhouse",English
+"over there. He worked in the greenhouse. And  he started to get better and better. Finally,   you know, there was no reason for him  to be there anymore. [ Cars driving by ]",English
+"the people that were there  were not educated to be there.   And they don’t even get paid enough to do  that kind of work, okay? I don’t blame them.   He became psychotic in this ltsr. They called  the police instead of taking him to the hospital.",English
+"He resisted arrest. He was sick. He was  psychotic. They should have taken him straight to   the hospital. No, they took him to a  regular jail and they put a beehive   over his head and he banged his head in the  jail all night long. He never been in jail.",English
+"We went and I saw him. It was so sad.  You know, I hadn’t seen him for a while.   And he was like a robot. He was just like  a robot, overmedicated. And he was scared.",English
+"Like even if I went to touch him. Like he was not  himself anymore. My strong healthy son, you know?   They do not belong in jail. They have to find a  place for them. And they’re closing every place.",English
+"Very, very sad. Not just for my  son, but for everybody else because   that was a safety net for the mentally ill. It’s really a big loss that  that hospital is closing.",English
+This is such a horrible disease. I don’t know  how I can describe it. It’s just — it numbs you.   All of a sudden she just  started to get very paranoid.,English
+"She was married at the time and her husband  really took pretty good care of her. But, I   was devastated because this is what happened to my  family. I grew mostly from home to home. I lived",English
+"I worry about what’s gonna happen to her.  And all mentally ill people who don’t have   families to go to. Like, they’re closing  the hospitals and they said to go live",English
+"with their families. I just read it.  But, some of them don’t have families.   They’ve been abandoned by their families  because they don’t understand the illness.   She says she wants to come with me, but",English
+"I don’t — I don’t believe she’ll be able  to live on her own ever again. Not ever.   You couldn’t sleep, you couldn’t go to  the bathroom; she’d be out the door.",English
+"She’s still like that today. She still  wanders the streets. And I’m afraid   she’s gonna wander and I’m never gonna see  her again. We found her about three times,",English
+"lying in a parking lot. She  disappeared for six weeks one time.   And my heart and — it was the worst thing  in the world, not knowing where she was.",English
+"And it’s really a nice facility, I have to say  that, but it’s gonna last only two years. I’m   worried about what’s gonna happen to her after two  years. What can I do to help her? What can we do",English
+"Announcer: as our mental health system  continues to move towards community-based care,   many like the two moms you just  heard from wonder what’s next.   With challenges like funding, and staffing, and  waiting lists; how secure is community-based care?",English
+there’s been a big push to reduce the number of  people with serious mental illness in prison. We have individuals sitting in jails with mental  illness that are not getting the treatment they,English
+"need today. Not in as timely of fashion as we  want. This has been an issue around for years.   And when we have a state hospital that doesn’t  have room for them, that becomes a challenge.",English
+"It’s a big deal to close a facility and move  people into the community. We know it’s the   best thing for most people and what most people  want. But, it sometimes still has challenges.",English
+Families are simply scared and concerned that  their love one not come into the community   and then have things really fall  apart. It’s a valid concern.,English
+"The biggest challenge I think we have  is developing those community placements   and the time it takes to do that. We  had hoped to have Norristown state   hospital on the civil side closed,  I think last year was our goal.",English
+"This particular closure has been slow and it  really does allow the counties to identify what is   needed and then to develop it. And sometimes that  takes longer because they might have to, you might",English
+"have to buy a building, they might have to  renovate a buildings. There’s a lot of things that   go into that. But, by the time everybody leaves  the civil unit of Norristown state hospital,   there should be programming in  place to meet that person’s needs.",English
+There’s a what I call a continuum of residential  services. We have some that are what I call very   restrictive. And very treatment focused. We have  a long-term structured residence. And then we have,English
+"community residential programs that are groups  homes that are staffed, some of them 24 hours,   some of them are staffed maybe only 16 hours.  And then we have personal care homes that are",English
+a bridge between people who need medical  care in addition to psychiatric care.,English
+"have their own rooms. I’m glad he’s here and  not where he was because that was not very   livable so to speak. And they were treated  like prisoners really. Dad loves you, okay?",English
+"We usually have somewhere in the neighborhood  of 50 people waiting for residential services   in all different types. Part of  our system is dependent on people   getting better and moving through the system.  As I say in our residential continuum,",English
+"no one goes in until someone goes out because  it’s fixed beds. Because of a pretty much lack   of funding, we haven’t really done much  community expansion in the last ten years.",English
+"I look at it as a tripod. There is the  county-based dollars. Those are state dollars   that are allocated every year. Then there’s  the state hospital dollars, so when a state",English
+hospital calls or even when beds close and those  — a percentage of those dollars come into the   community. And then you have Medicaid. Medicaid is  the big buck. The dollars that came as a result of,English
+"either a hospital closing or a bed closing. I  don’t think they’ve ever had a cost-of-living   adjustment attached to those dollars. And the  community-based dollars, those haven’t had a",English
+"cost-of-living in a long, long time. In the  long run, it stretches a county way too thin. From a funding perspective, our system took a  10% decrease in the sort of state/county funded",English
+"system. 10% Decrease about eight years ago  and its been flat funded ever since. So,   we’re trying to operate essentially on  early 2000s funding level in 2019. And so,",English
+that creates some gaps in services. It creates  gaps in quality. Staff recruitment and retention   for all of our providers is an issue. Maintaining  a quality trained workforce is an issue. Given our,English
+"current sort of average waiting list of 50, I’d  like to have 15 more beds in one kind or another.   We’ve been consistently asking for at least a  restoration of the 10% cut we had. In a perfect",English
+"world, we’d be adjusting that for inflation. I  mean, I feel like a 20% increase is about what   we need at this point, but given that we haven’t  had any, 10% would be better than nothing.",English
+This is convenient because it means that we can use it and had to have the whole experience be within a workday. Some other psychedelics that you may,English
+"have heard of like LSD have a longer half-life so that would be a much longer period. It's a sympathomimetic, which means that when you",English
+take people's heart rate and blood pressure go up. This is the part that we make it seem so sterile with our scientific language,English
+"as potent effects on perception, mood, cognition, and behavior. That's what we mean by psychedelic effects or the trip if you will.",English
+I'll get more into that in a second. But some people describe it like dreaming while awake. This is the compound that has been studied the,English
+most in this modern era of psychedelics and there are a growing number of trials suggesting that it can be helpful for several different disorders.,English
+"I'm only going to be talking about some tonight. It's going to take a moment to talk about this art here in the top right-hand corner here. This is from the cave painting in Algeria,",English
+"I believe, called the B-headed shaman. You can see that along this figure skin, what looks like mushrooms,",English
+"and then both fists are full of mushrooms. Then, the head is replaced with the B hence the B-headed shot.",English
+Those mushrooms that are depicted look a lot like the mushroom that we're talking about and it is pretty trippy.,English
+People have taken this as one of the very first evidence that humans were interested in the psychedelic mushrooms. The point here is that people have,English
+"been using psychedelics for various purposes, for thousands of years. There's a long tradition, including with mushrooms.",English
+"That's what I was saying before about how you start with psilocybin, and then it gets broken down to psilocin, which is the active metabolite.",English
+"Well, I'm not going to get too much into the chemistry, but I just want to show you this is what serotonin looks like. Even for non-chemists,",English
+"Another thing to keep in mind is that while I was talking about the mushrooms and actually the vast majority of people have used psilocybin,",English
+"did it by eating mushrooms, over 10% of Americans have tried this psychedelic. In the trials,",English
+were using synthetic psilocybin. This is pure psilocybin that was made in a lab. Keep it in mind that this is the difference,English
+between caffeine and coffee. Caffeine is the part that gets people excited about coffee,English
+"this potent effects on cognition, behavior, and thinking. This is one way to try and capture the effects of psilocybin.",English
+"What this graph shows is large number of healthy people were given increasing doses of psilocybin. You can see here the red, the green,",English
+"and the brown are increasing doses. Then they filled out a detailed questionnaire about their experience,",English
+"that has all questions. Then it's graphed on this thing called a spider plot. Basically, the farther away on each axis the dot is,",English
+"the higher the people rated that domain. If you look here, these blue like audio visual synesthesia,",English
+that's seeing sounds and hearing colors. That's what synesthesia means. You can see that as,English
+"people had higher doses of psilocybin, they rated that more and more strongly. Elementary visual alterations things like seeing",English
+squiggles or lines or dots. You can see that also is pretty common. Vivid imagery would be,English
+a fully formed thing like a dragon or something like that. Changed meaning of percepts. That really means that the things that,English
+"typically what they're doing is they're using it maybe every three days. There does seem to be some traditional cultures that have used low doses of psychedelics,",English
+"but it's a lot less common than the macro-dosing. The modern practice started with this book from 2011. As opposed to macro-dosing,",English
+"that's what's been studied mostly in the trials. That's where people take a high dose, where people trip or have a full psychedelic experience.",English
+"As I said earlier, when people do that, people are typically using that every month or more than every year.",English
+"That has a much stronger traditional history of use, probably for thousands of years. Let me talk about each of these separately.",English
+"For micro-dosing, there's a lot of talk about it helping people. But the evidence for that is pretty small.",English
+"Basically what happens is a lot of studies have said, hey, do you micro dose? Well, tell us about your experience with it.",English
+It turns out that people who micro dose say that it helps them. But of course they know they're micro-dosing and that's why they're doing it.,English
+"That doesn't tell us that much. Here, you can just see that this is a self-reported anxiety, depression, stress. You can see that people who micro-dose",English
+rate themselves as lower on those things. That's a start. It would be concerning if it was the opposite. But it doesn't really prove it to us because,English
+"the people believe in it and they know what the study is about. Surprisingly, there have been no randomized controlled trials of micro-dosing.",English
+But there was this one amazing citizen science study I just want to take a moment to talk about. What this study did was take,English
+advantage of the fact that micro-dosing is so popular and that people who micro-dose are pretty dedicated to,English
+"the mission of trying to understand if it works. They recruited people online where they said, are you about to start micro dosing?",English
+"If so, why don't you participate in our study? People said, okay, and then what they did is they used this very",English
+clever system of sending people envelopes and capsules that they could put their own drugs into. They were able to figure out a way,English
+"to get people to blind themselves to their own drugs that they had at home. Think about that again. People had some mushrooms at home and they're like,",English
+"I'm going to start micro-dosing with the mushrooms that I got on the black market. This researcher who sends you an envelope and you take your mushrooms and you put them in pills,",English
+and then you do this moving things around. You don't know if you're taking a placebo or an inactive capsule or,English
+you're taking the capsule that has your drugs in it. They did this. They managed to complete it. They had almost 200 people do it.,English
+"Well, there's a major advantage of this. One being cost. This is much cheaper than recruiting people, randomizing them, giving them drugs, and so on.",English
+"What you can see that they did three different groups. One was the placebo group. If you're in the placebo group, you got inactive placebos the whole time.",English
+"If you're in the half-half group, half the time you get placebo and half the time you get active.",English
+"The microdosing group, you have two weeks would get active and two weeks when you get placebo.",English
+"What did they find? Well, this is a lot of lines. I'm just I'm sorry, it's a little bit busy. But basically what they found was that, yes,",English
+"some people reported better well-being, better mindfulness, better life satisfaction, but they didn't really get separation between the groups.",English
+"Microdosing group is in red, and you can see it doesn't really separate, it's not different than the other groups. Maybe cognition is different in",English
+"that the microdosing group got better on cognition, but the other ones didn't. But actually when they went back and they asked people what drug did you think you were getting,",English
+it turned out that lots of people in the placebo group thought they were getting the active condition and that explains the entirety of the effect.,English
+"If you can control for how many people basically got it wrong, they thought they were at getting the active drug,",English
+"the differences between groups went away. In this study, it really suggests a lot of the benefits of microdosing are placebo.",English
+"Placebo effects people's expectations. But wait a minute, these people didn't have a clinical disorder,",English
+"these were just random people from the Internet who were going to use microdosing. We know very little about them, they don't have a clear disorder,",English
+so what are you even trying to improve? This is my lemon summary on what's going on with microdosing.,English
+"We don't have clinical trial evidence as of expectations likely play a large role, but we haven't said in clinical populations.",English
+"That healthy population, it's very difficult actually the show a benefit. Then you think about that for a second, it's just because what",English
+"are you trying to improve in healthy people. Healthy people are usually healthy, they're usually pretty good at these different things that you're looking at,",English
+there is no clear deficit that you're trying to fix. The fact whether or not it works in healthy people doesn't really tell us if it's going to be,English
+an antidepressant for example. I think there's a lot of work still to be done with microdosing and that will probably change in the next couple of years.,English
+Now going to macrodosing. This is a tweet in 2021 actually from a researcher from Hopkins,English
+and I like to show this because I think it really captures something about how modern psychedelic trials are done.,English
+"I'll get into that in a moment. But basically they are a combination treatment. With microdosing you can think of it like,",English
+"you just take this drug every three days, and it's a little bit like an SSRI or an antidepressant that you can feel better. Now, whether or not you really feel better,",English
+"more than you would if you're just taking sugar, it's still an open question. But with macrodosing is higher dosing, it's not like that.",English
+The way it works is like this. These are pictures from UCSF. The patient will come in and meet,English
+"with a psychotherapist or usually about six hours spread out over a couple of sessions to do what's called preparations psychotherapy,",English
+"and say this a depression trial. They will build trust and rapport talking about their history of depression,",English
+"there'll be a fair amount of psychoeducation where the therapist will tell the patient what they might experience when they take psilocybin,",English
+there's also practical things like here's the bathroom and here's the couch and nothing is surprising on the dosing day.,English
+"Then the patient will come in on the dosing date, psilocybin session, their therapists will be there and they take",English
+"the drug and then they spend the whole day in this room, and they're encouraged to listen to music and have eye shades and lay down into their experience.",English
+But the therapist is there the whole day with them in case they want to talk about everything or they need reassurance.,English
+"You can see there's the blood pressure monitor so we would monitor blood pressure to make sure everything's okay. Then as I said,",English
+"it lasts about six hours, the person comes out of that, we clear them for them to go home. It's like when you go to the dentist and you have",English
+"a big surgery or colonoscopy, someone has to come pick you up and go home. We don't let people just drive home afterwards. Then they go home and then the next",English
+"morning and then a couple more sessions about six hours again, they have what's called integration psychotherapy. Integration psychotherapy is where",English
+the patient will talk about what they experienced on the psychedelic and figure out how they want to integrate that into their lives,English
+"and other changes that they might want to make. Currently, the approach that people use the psychedelic psychotherapy",English
+"is what I described, building rapport and trust is critical. It's pretty non-directive supportive approach, is not like homework or a worksheet.",English
+"There is this idea of some set excited expectations and being open to unusual experiences, which the psychedelic experience is.",English
+"Then another interesting element is music. I would say always, there is music during a dosing session,",English
+"and the patient's, therapists all swear that it's incredibly important, which I think is pretty interesting. Now I have a video.",English
+"This is a video not from us, this is a video of the presence of my life, a patient that participated in a study at Hopkins.",English
+He has prostate cancer and he had a shortened lifespan because of that and he participated in,English
+a trial where he got psilocybin using that same model that I'm talking about. He talks a little bit about what he experienced.,English
+What it led to was a reawakening what it felt like when my first daughter Tanya died.,English
+my guides they will come and comfort me. They won't stop me. Let me go into it. I did that almost 30 years,English
+"of not did I but putting it down, suppressing how that felt. Just a couple of elements there that we often will see.",English
+"This is the memories that come back, these intense feelings. Engaging with traumatic memories.",English
+We've heard this several times now where people say was in denial but just had pushed it down and then somehow it comes up.,English
+The intense emotions that he's describing and then the ability to somehow tolerate them. That was very liberating,English
+"Psilocybin in the context of having support, readily at hand support that you trust. Very important.",English
+and felt that he could enjoy things again. These are all themes that we hear a lot and other studies as well.,English
+"I want to tell you about one of the this is the first study we did at UCSF. That was a couple of years ago now. If you look at the picture on the left there,",English
+that's the gay men wire. The people in white represent original members.,English
+"People in black turned away from the camera, represent people who died due to the AIDS epidemic. This is just a snapshot of what",English
+AIDS did to a particular community in the Bay Area. We wanted to see if we could use psilocybin therapy to help,English
+people who have been through this. People who were diagnosed with HIV before 1996 for them it was a death sentence,English
+because at that point they knew what it was and they all their friends or many of,English
+"their friends had already died from it. It wasn't just any death sentence, it was also stigmatized sentence. Was a gay men's disease, something like that.",English
+"It was a really terrible time of course. Yet for some people who got diagnosed with before 1996, they didn't die either",English
+because they were genetic non-regressors that have a genetic abnormality genetic variant that made HIV go slower in them.,English
+"Or they survived long enough for the medications to come along. The medications have really changed with HIV,",English
+"the nature of the illness. Nowadays, it's much more like a chronic illness that people manage and life expectancy",English
+"actually isn't an insurer if you have HIV, if you take your medications. But for these people who went through this,",English
+"many of them have a lot of complex psychiatric sequelae from this. And as our first study at UCSF,",English
+we want to see if we can help them with psychedelics. Both because the AIDS epidemic is due to her heart at UCSF.,English
+Also because we saw this as a model of people surviving a horrible thing like a natural disaster or,English
+"environmental disaster or a war where not everyone survives, but some people do and they have to live with that. Or maybe even a global pandemic.",English
+"There will be another example. Also, we thought this was a good place to start because just by the demographics that people were",English
+"older and they had other medical comorbidities including HIV, and they were other medications. We thought this was a place where we could leverage UCSF,",English
+expertise and medical care. Understand who we can treat with these drugs. The other thing that we did in this study,English
+that was novel was we used a group therapy format. I told you about how,English
+"other studies have it where you have typically it's even two therapists and the patient. Well, we thought, why not have",English
+some of the preparation and the integration done on the group? If we're trying to help people not be alone. Why make them go outside of the treatment?,English
+which I can tell you as a pharmacological researcher is very rare. No one in the Prozac trials really want to speak to them and people who got Prozac.,English
+"Also, psychedelics are often used in group settings in traditional and indigenous practice and we were also concerned about",English
+the cost of the therapist. Group therapy has a long tradition of being used to be a more efficient way of delivering psychotherapy.,English
+"There are a bunch of reasons why we wanted to do it that way. This is our study design, we open-label study. There was no control group.",English
+We did the preparation of the integration as a group. We had 18 people in three groups of six. Demoralization was our primary outcome.,English
+"Demoralization, you can think of it as similar to depression, but it's the same, it comes from the palliative care world.",English
+It's really a loss of purpose and meaning in life. That was what we were focusing on. You can see here that there were,English
+four group sessions for PrEP. Then we dosed individually. Everyone had a single psilocybin dose,English
+on different days because we didn't have enough space to couldn't do them all at once. They got back together for more sessions as a group for integration.,English
+"Then we followed people out to three months after the end of the psychotherapy. What do we see? Well, this is demoralization and as I said, the primary outcome.",English
+"You can see that it's high and will give us an assignment and it goes way down and stays low for a long time, three months after the last psychotherapist session,",English
+"which is almost four months after the dosing. This is consistent with other studies, open-label, but still exciting.",English
+"The other thing we were wondering about is, well, what about how challenging the experience was? One thing we did is we had people fill out",English
+"this challenging experience questionnaire. The score has all this goes 0-140, with 140 being",English
+"the most challenging experience you can imagine. This questionnaire has questions like, I felt like I was going insane or I",English
+felt like I was going to die. Pretty scary things. You can see that some of the people had very high scores on this.,English
+"However, if you ask people how beneficial or harmful they thought it was, you can see that everyone thought it was very",English
+"beneficial or almost everyone and nobody thought it was harmful. How challenging their experience was,",English
+was not related to how beneficial or harmful they thought it was. I can also tell you that how challenging they thought it was,English
+also was not related to how much better they got. Everyone got better. Challenging experiences didn't relate to whether or not people got better.,English
+"This fits with a larger butter body of research that what people think of as bad trips. In the setting where you have this therapist,",English
+"you have all this support around the experience, bad trips can still be therapeutic. I think that's another reason why to",English
+have a therapist is so important. Now we said that there were a lot of clinical trials out there that,English
+"were supporting the use of psilocybin, Here's one. This is a recent study that came out in New England Journal of Medicine.",English
+"This was a large multicenter study. I wasn't involved in the study and what you can see on the y-axis here, this is the change in your MADRS,",English
+"which is a measure of depression. The farther you go down on this, the more on average that group",English
+had improvements in their depression. There are three groups here. What they did is they took people with depression and they,English
+"randomized them to get one milligram of psilocybin, which is a negligible amount. You won't feel one milligram so they're using that as their placebo.",English
+"Ten milligrams of psilocybin, which is a medium dose where you might feel something, or 25 milligrams of psilocybin, which is the full dose,",English
+which is the dose that the man in the video was talking about. That's the dose where people have disillusion of the self other boundary.,English
+"In this study, they got the preparation of the integration like I described, and what you can see is that after the single dose of psilocybin,",English
+there was this large decrease in depression and much bigger in the 25-milligram dose versus the one-milligram dose.,English
+"This is one reason that people are excited about psilocybin, is that you can get these rapid improvements in depression.",English
+The other thing you notice is that this improvement in depression lasts for many weeks. The difference actually is that in,English
+"this study continued out to nine weeks. Actually I think it was nine weeks, and was not really present at 12 weeks. But other studies have found separation",English
+more improvement in depression in the active condition out to three months or six months even. That's why people are excited.,English
+"They have this rapid improvement that's also durable after a single treatment. That's very exciting and true,",English
+and you don't have to take the drug every day. You don't have to do it over and over again. You do it once and people feel better for a long time. I think that's where a lot of,English
+the excitement around these drugs are coming from. But the excitement is also a challenge because there's a lot of hype and hope.,English
+"The hope is totally understandable. As I told you, the treatments that we have are not that effective. There are a lot of people who are suffering",English
+and everyone is desperate for new treatments. People have a lot of hope that psychedelics are going to be that.,English
+"On the other hand, there's a lot of stuff in the Xite guys about how effective they can be. So here's, here's a quote from Michael Pollan from",English
+"his book How To Change Your Mind, which really shifted the last couple of years ago, where he's talking about when he interviewed scientists,",English
+"he said, 'To solve the environmental crisis to end war. Brady piece. This is not what you expect to hear from scientists who are always",English
+"It's just that's a pretty big thing, you can't do a clinical trial on that. The FDA will give you an approval for war ending.",English
+"Then here's a quote by Rick Doblin, the CEO of MAPS which is the non-profit pharmaceutical company that's working on bringing",English
+but I think it means that we would be curing trauma as fast as we were creating it so that there would be net-zero. That's a pretty bold statement.,English
+"Unfortunately, there's a lot of trauma in the world. That's how much hope there is for these compounds. I think one thing that's related to",English
+"that is when people use these drugs, this is from that Hopkins study, if you ask them, how personally meaningful was your psychedelic experience,",English
+"was your experience, sorry, I was going to say what's the experience? People say, this study, they also use a low dose or negligible dose,",English
+"I think it was one milligram versus the high dose, which is 25, 62% of the people said that their high dose experience was among",English
+"the top five most meaningful experiences of their entire life. Which is, I think a really interesting finding. In Prozac trials, we never",English
+"even asked this because we don't want to assume it won't be. But personally meaningful, something about the psychedelic experience is very personally meaningful.",English
+"But I think that adds to this that people, that experiences really mattered to people. That's probably a good thing for a treatment.",English
+"But it does make studying it hard. We did one thing trying get at this, we had the opportunity to have the therapists in a trial",English
+complete our anonymous survey where we asked them a whole bunch of questions and one thing we asked them was about their own psychedelic use.,English
+"It turns out most of them had use psychedelics, not so surprising, and almost all of them they use psilocybin in",English
+"particular and the median last year, this was in the last 6 - 12 months. I can say those rage, but some of the people had used a lot of psilocybin over",English
+11 different kinds of psychedelic and over 50 lifetime uses. There were some people had a lot of experience with psychedelics,English
+"as the people who were the therapists in the trial. Again, not a bad thing, just unusual for a pharmacological trial.",English
+"We also asked people, the facilitators, compared to placebo, how effective do you believe psilocybin will be?",English
+Some therapy would be for treating depression. You can see that they all thought it was going to be more effective.,English
+"Most of them thought it was going to be substantially more effective than placebo. Now this is interesting. Well, when people do psychotherapy trials",English
+"like with cognitive behavioral therapy for example, most of the therapists probably would think this, that they're targeted behavioral therapy is going to be more effective.",English
+"It's very common for psychotherapists to believe in the psychotherapy they delivered. But for a pharmacology trial, I don't think it's as common.",English
+"Maybe the researcher is like, yes, I really think this new SSRI is going to work, but all the people working in the study, I don't know what they would think.",English
+"We don't usually ask this. But you can see here that at least in the subset of facilitators, there were strong positive ideas",English
+"about what the psychedelics could do. Why does this all matter? Well, what people think about how the treatment is going to affect them,",English
+"what we call expectations, can have powerful effects on what happens to them unless we call these placebo effects.",English
+"This is just an example from the pain literature where this has been studied really well. What they did here is they gave people remifentanil,",English
+"which is a very potent opioid. It's like fentanyl, it's even more potent I think. They studied the effects on pain intensity.",English
+"But the manipulation was, they told people that this has got to work really well. They manipulated the expectancy.",English
+"They're like, this is a super effective analgesic. That's the positive expectancy. Or they said, no, this isn't going to work that well, this is not a good manager,",English
+that's a negative expectancy or no expectancy. I didn't manipulate. Baseline is where if people started. So what you can see is,English
+"that if you give remifentanil with no expectancy, you see a decrease in pain intensity. That's good. That's what you expect. If you tell people it's going to",English
+"be an effective analgesic, you double the effects. You see this is much lower than that, so you're getting extra effect on the pain.",English
+"If you tell people that it isn't going to help them, giving them remifentanil, you're saying this is not going to help your pain,",English
+you completely block the analgesic effects of a remifentanil. What this study is doing is manipulating,English
+people's expectations about what will happen. That's with talking. This had very potent effects and the pain.,English
+Here we have this combination where we have people coming into the trials who really believe that,English
+"the psychedelics is going to cure them. I've had people say to me, I know this is going to work for me, or this is the only thing that will work for me.",English
+"You'll have a situation where the facilitators and the other people who were in the study also really believe that. That's a good thing if you want big treatment outcomes,",English
+but it's a challenge if you're trying to show a drug specific effect. This brings us to the last thing. This is the only meme I've ever made in that we often,English
+talk about masking or the double-blind studies. Now what is a double-blind study? Double-blind study is where both the patient and,English
+"the provider doesn't know which treatment the person do. Double, two of us. Why do we do that? Well,",English
+"we do that because of the effects that we're just telling you about, about expectation. You keep the patient unsure about which treatment by got so that",English
+their expectations can't affect their outcomes and you keep the researcher or the assessor or the therapist uncertain so their expectations can affect the person.,English
+"It turns out that it's easy to unconsciously communicate these things to people. For example, if you give someone",English
+"a placebo injection but you know that it's placebo, it's a lot less effective than if you give them a placebo injection and",English
+you don't know that it's a placebo. We're communicating things in all ways. This meme is pointing out,English
+that in many clinical trials we talk about double-blind. I put it in quotation marks but we don't actually ask the participants what they thought that got.,English
+"Because if you do, certainly, this has been shown in an antidepressant trials. Often people do know what arm there in,",English
+"which is a big problem. How do people tell? Well, a couple of reasons. One is that they can tell about side effects. Another is that if they get better,",English
+they say that they've got the active. Now that's interesting because that suggests that we don't want to control for that but,English
+"also there are the acute subjective effects. You can take with psychedelics, it's actually very difficult. No one's figured out a way to have",English
+"the confused people about whether or not they had a full psychedelic experience. It's hard to imagine. We've had ""double blind trials"",",English
+like we didn't tell people that this is psilocybin but in all the trials people knew if they tripped or not. That's an issue because,English
+we could have inflated effect side. Here's another study that was recently done by excellent group in Switzerland.,English
+This is a similar patient group to the one I showed you before is this major depressive disorder versus treatment resistant depression.,English
+"Again, it's the MADRS, which is this measure of depression. Now, instead of a change score, they just have the raw scores here.",English
+"You can see in this study they use 15 milligrams out the 25 milligrams to the other segments, so a lower dose but everything else is pretty similar.",English
+"Preparation, dosing, integration, single dose. You can see that in this study, the people who got 15 milligrams of psilocybin have",English
+"this big decrease that continues for at least two weeks. If you look here, it looks like about 15 points. Yeah. We have about 15 point improvement",English
+with the 15 milligrams versus placebo. Now this is an inert placebo. Now you go to that city I showed you before you can see the difference between this,English
+"and that is about less lousy. Nine minus it's like eight, was even less effective even though this is more",English
+"psilocybin but overall it's about 15 point decrease from here to here. Look, from here to here, 15 points.",English
+"From here to here, 15 points. The same size improvement but then you have this 10 milligram dose,",English
+"which is a smaller one in this study, but in 15, that's the one that had the big one. The point I'm trying to make is",English
+this two-arm study here where people know my options are either I'm going to get psilocybin or placebo that probably contributed the thing where,English
+"if they felt anything psychedelic. They're like, ""I'm in the active arm"" and they got better. Whereas in this study where people are",English
+"like I could get 1, 10 or 25. I know that 25 is the ""right dose"" the one that works. Because there have been other studies for 25.",English
+"Many people probably could guess that they were in 25 arm and they're the ones who got better. Now, actually both studies",English
+didn't actually ask people what they thought they got so we don't really know but I think this is a really important thing for the field.,English
+"Just put it all together. We have this hype and hope, it's really intense. People have these very strong",English
+positive expectancies about the treatment. We can't mask so people can really tell which arm of the study they're in. All of this contributes to inflated effect sizes.,English
+"We have some ideas about how to solve this, but it's a very challenging thing. I'm going to talk about one other topic that we've been working on,",English
+which is shifting gears. What about psilocybin and mania psychosis? Is that a concern?,English
+"This is a really complicated question because there are anecdotes. People have said, people can",English
+become manic or psychotic after using a psychedelic but it was so politicized and such so much hype both ways.,English
+"It's hard to get a straight answer. Actually, in all of the modern clinical trials with psilocybin.",English
+"There hadn't been any trials in people with bipolar. Actually most of the trials have excluded people, not allowed people to be in the trial.",English
+"If they had a family history of bipolar, which is pretty unusual if you think about it. There aren't other places",English
+"and medicine really where we say, if you have a family history of this thing, you can't get this treatment. There's at least one and M seizure with",English
+"malignant hyperthermia but I can't think of one in psychiatry. The reason they did that is that people were concerned about this,",English
+even though the actual evidence for it was small but causing someone to have bipolar would be a really bad outcome.,English
+People were being extra cautious. We started by reviewing literature. Always a good place to start. We did a systematic review looking for,English
+"any case studies that would describe this. We found four cases of someone who did not have bipolar disorder,",English
+who took a psychedelic without other drugs and developed mania. One of these cases is this one. Twenty-one-year-old a woman hospitalized,English
+"36 hours after using psilocybin. She had irritability, pressured speech, decreased need for sleep, paranoia and delusions, which is",English
+a classic presentation of mania. She has a family history of bipolar or someone in your family has bipolar.,English
+"She was treated with drugs that we typically use for bipolar successfully. Then months later, she had a what's called a mixed episode.",English
+"It's another kind of manic episode that was unrelated to psychedelic use. Now, what this case is",English
+"describing is someone who was healthy, uses a psychedelic and now seems to have bipolar, which is very concerned.",English
+"Now, would she have developed bipolar anyway? Impossible to know. This highlights the challenge in the field.",English
+"The next thing we did was we said, well, there are a lot of people with bipolar around the world and they",English
+probably have used psychedelics. Why don't we ask them? We did this international survey. This is a map of where all the people who completed the survey were.,English
+"Darker reds are more people in that country. Most of the people from North America, but you can see people were all over. We asked them a whole bunch of things",English
+"about what happens when they use psilocybin. Over 500 people, many of the people said that they have used",English
+psilocybin to try and treat their mental health. About a third of them said that they had worsening or new symptoms immediately or up to 14 days,English
+"after using psilocybin, with manic symptoms and insomnia being the most common. So that's pretty concerning. 4% said they needed to use the psilocybin",English
+"ultimately need emergency medical services, including psychiatric hospitalization. Also very concerning. On the other hand,",English
+everybody rated the harmfulness of psilocybin as low and the perceived helpfulness as high. Even the people who had worsening symptoms,English
+or who needed emergency medical services. The other thing we did is we had an open-ended question at the end.,English
+"We said, is there anything you want to tell us? Usually when you do that people complain. But in our study they told us about all these positive things.",English
+"So here's just an example of one of the health benefits people describe. When I'm feeling the negative effects of my bipolar II disorder,",English
+I can sometimes put myself in the same headspace I was in when I took psilocybin and it helps me calm down and put things in perspective. You can read that because I have to take a drink.,English
+"Well, I think this one here really smokes us. Some of the best growth in my life and also the worst experiences of my life. Really shows you this dual edge nature.",English
+"We then did follow-up, in-depth interviews and basically found the same thing. People say, ""Oh, it helps me. Helps my depression.",English
+"Lifts my mood. But it makes me so I can't fall asleep."" And this one person said, the only time I go into",English
+"a full blown manic episode is what I've done psychedelics. It unlocks it for me. So very concerning. So putting it together,",English
+I did say this but bipolar depression is a big problem and we don't have good treatments. And so we need treatments. psilocybin therapy has significant potential.,English
+"For some people and some disorders, people can have transformative change and long-lasting benefits. But there are these challenges.",English
+"So it's a combination treatment. It's this psychotherapy and drug combination, which is new for the field.",English
+It's a radically new approach that requires us to think about things in new ways. It also has challenges from systems point of view.,English
+How would we even deliver it? How are we going to do that effectively? How can we regulate psychotherapy in a way where it is combined with the drug?,English
+"We don't do that now, psychotherapy is regulated one way, and drugs are regulated another way. There's a lot of hype of hope,",English
+"which is good in lots of ways, but also has challenges. Especially because we haven't figured out how to effectively",English
+"mask these trials and we need new approaches. I didn't get into those last things, but the high-risk population when I did.",English
+We are now doing a trial and bipolar depression. But it's really focused on safety. We know so little. But we think that the cost-benefit for doing,English
+"a trial makes sense. But we'll have to see how it turns out. Okay, so this is just us.",English
+So I directed the Translational Psychedelic Secondary Research Program. We call ourselves TrPR. Cute name. That's our website. And then,English
+"I can just tell you that we're doing a whole bunch of trials. I can't tell you about any of the data yet because it's not finished, but we're doing a trial.",English
+"Depression, anxiety, and Parkinson's disease. We're doing bipolar to depression. We're doing a study on chronic low back pain.",English
+"We're ramping up and do a study of methamphetamine use disorder, as well as anorexia and young adults. So 18–25-year-olds.",English
+We're also doing a study of psilocin and versus psilocybin as well as botanically sourced DMT and Harmell alkaloids and the pill.,English
+"We are looking at several different possible mechanisms, but inflammation is one that we're particularly interested in.",English
+"And here are all the people that make it possible. The first question is, what is the effect on the heart?",English
+"I see that. So the effect is, well, so when we talk about macrodosing, so this is like you have to take one large dose.",English
+"When you do it that way, people's blood pressure goes up temporarily and the heartbreak goes up. So it's sympathomimetic.",English
+"So people, it's like, your heart goes faster and you have an increase in blood pressure. Usually it's not an issue but we",English
+"make sure that people don't have high blood pressure beforehand. People have to have their blood pressure under control and then,",English
+it's kind of like a hard workout a little bit. So it's very well tolerated. When people do it as micro dosing.,English
+Now this has not been studied as much because there haven't been studies of it. There is this concern about these heart valve issues.,English
+"There was a drug called fen-phen, fenfluramine. Then I forget what the other phen was. But one of them had effects on",English
+the different serotonin receptor which is the 2B receptor and that's why fentanyl was actually taken away from the market because some people developed,English
+these problems on their valves in the heart. There is this theoretical concern that psilocybin and other,English
+"psychedelics actually do have activity at the 5-HT2B receptor, and so if you were taking them all the time like you do with microdosing,",English
+"maybe that would cause valve problems. It hasn't been described, there aren't examples of it, but it's something that people are concerned about,",English
+"and might be why there hadn't been a lot of microdosing trials. But many people are doing this out in the world, and we would hear about it if there was a case,",English
+"I think, but you never know. So those are the two. I'm trying to see what questions can be also grouped, but is it safe to use so psilocybin,",English
+"if there's a family history of schizophrenia. That's a great question. I would love to know the answer. I can tell you that every modern study,",English
+"except for our bipolar study, has excluded people who have a first-degree relative with schizophrenia.",English
+"Now, if you think about that for a second, first-degree relative, that's a mother or father or sibling. But it's kind of weird because",English
+"suppose you have one sibling or no siblings, or you have like 10 siblings? It's a very coarse thing.",English
+"Or if you're adopted, you don't know any of your siblings. So people are using that as sort of a hack",English
+"or rule of thumb for genetic risk is what they're trying to do. And yet, we don't know exactly what the risk is in people like that.",English
+"I can tell you that the risk of developing psychosis or mania after using psilocybin is probably very low in general,",English
+but it's not zero because we can find these cases where it's happened. And we really don't know what that risk is as it's really based on these anecdotal reports.,English
+"But that doesn't mean it's not significant. I mean, it's a really bad outcome to develop schizophrenia. It's just a very difficult thing to study because it's",English
+"a low-probability event that's a complex thing that involves genetics and environment, what people are going through.",English
+"So that's how I would ask you a question. So I can't say yes or no. I would just say, beware, be cautious.",English
+I think there's a couple of folks asking about psilocybin's research and looking at things like anxiety and rumination.,English
+"Another attendee's asking about PTSD. So I'm also just curious if you have thoughts on resources,",English
+if people are interested in there's good landing spots for people that want to look at these different mental health diagnoses and what there is out there with psychedelic research.,English
+So I don't know what the best resource would be. It's a good question. I think it's an evolving field.,English
+"Most of the studies have been in end-of-life anxiety. So there have been a handful of really good studies in that space and then depression,",English
+"mostly just because depression is the most common and the pharmaceutical companies are like we're going to go for that and let's go out. And then in those studies,",English
+people also measure anxiety and those go down. There have been also some studies in substance use disorder. So alcohol and nicotine has been studied the,English
+"most and those also show promising effects. There's been a small study TOCDC, you want to study in social anxiety",English
+in people with autism. I think that was also promising. So I'm probably forgetting some at the moment. But there's studies that,English
+"are happening and then more of our study is happening all the time. Anxiety by itself, so anxiety disorder, generalized anxiety disorder, I",English
+"don't think has been studied yet, though people talk about it. I suspect it would work. PTSD is something that we would really like to do it.",English
+"In our HIV study that I told you about. Some of the people did have high PTSD symptoms and those symptoms got better. But there actually hasn't been a trial in PTSD because C,",English
+"which is a little surprising, I suspect it's because MDMA therapy has had a head start It was really only focused on PTSD.",English
+So they've captured a lot of the attention. But I suspect the psilocybin therapy will probably also be effective for PTSD.,English
+"But it hasn't been studied yet. It's so interesting. I'm looking at this attendee's question,",English
+and I had a similar question. It seems a single dose of psilocybin can have a long-term positive effect. Why?,English
+"you how it's done and all things, like I skipped over that. [LAUGHTER] Sorry. I would say because we don't know why or how.",English
+"I can tell you our working model, we know that in animal models, and if you study this in a dish, that psychedelics induce neural plasticity.",English
+"That's a broad term, it can mean a lot of things. But practically if you put psilocybin in a dish with a neuron,",English
+"the axons will sprout all these spines like the outgrowths, like it's very prolific. You can show that it actually goes on to form",English
+new synapses in a full living animal. Depression in particular is associated with decreases in,English
+"synapse formation and the loss of synapses, so decreased neuroplasticity. What people think with the working model is that",English
+"somehow taking a psychedelic induces this plastic state. Clinically, people will talk about an afterglow.",English
+They feel different for the week after one of these high dose experiences. We think that that's why the psychotherapy is so important.,English
+"I didn't really even talk about why it is, hinted on it. We think that the psychotherapy is important for two reasons. One is safety, and I did talk about that.",English
+"The dose that we use clinically isn't very high dose. Using that by yourself, sometimes people freak out.",English
+They have challenging experiences that become bad trips because they can't manage it on their own. I think that's really important.,English
+We also think that the psychotherapy is somehow getting in there and having more effects of helping people change. Why do we think that?,English
+"Well, one thing is that there's this paradox. I've talked about psychedelics so good blah blah blah, but millions",English
+"and millions of people have used psychedelics. As I said, over 10% of Americans, the number's going up over time. You go to raves or in",English
+Burning Man and they're very popular. But not all of those people stop using drugs and have their depression and anxiety cured.,English
+"There is even some evidence, now this is again, subject to self-report anecdotal thing, that when people are using it in a rave,",English
+"they feel good for awhile, like days, and they feel like, oh, everything is possible, but it fades. It doesn't last in this way.",English
+"We think if you push most psychedelic researchers that there's something that's going on there,",English
+but this combination of the environment and the drug. Now I could be wrong about that. The counter argument would be that animals seem to have,English
+long-lasting antidepressant effects after psychedelics. You give a single dose of a psychedelic and in certain animal models you can get,English
+these long-lasting effects that look like antidepressants effect. Now the mouse or the rat can't tell you that they're not sad.,English
+"So the models are, how do I put it? They are just models of depression.",English
+"But still you can find effects on the behavioral outputs in the rat like a month later after a treatment,",English
+and a month for a rat is like an a lifetime. Nobody is shaping the experience that the rat goes through.,English
+"No one's doing the prep and integration. I could be wrong about that. Maybe it's only for safety and maybe actually,",English
+"but I still think all these people are using psychedelics out in the world and they're not all cured, it's unclear place.",English
+"But on the other hand, we know that you can have long-term effects after using a drug. Ketamine. We use ketamine as as an antidepressant now,",English
+"and it's cleared from the body within hours, but the effects last for at least days or a week. In depression that's pretty compellingly shown.",English
+"So it's not impossible that it can last a long time, is just surprising. [LAUGHTER] What I can tell you clinically,",English
+"the patients say, is they will say, oh, I had a realization that I don't need to do that thing anymore.",English
+"[LAUGHTER] I laughed because it's like, yeah. I met a guy I was given one of these talks to the NIH and it was open in",English
+"the public and someone came and they're like, oh, I was a participant in the alcohol study. We were debating about the subjective experience. I was here saying objective experience important.",English
+"He said, well, I saw an alcohol bottle in the desert and the alcohol bottle dissolved, and I knew I would never drink alcoholic again.",English
+"I'm like, okay, I feel like yeah, and he's like it was incredibly powerful.",English
+"But I don't know what to make of that. It's good. I've heard people say things like, I realize I had to stop smoking.",English
+Which it's like it just has a weightiness to it. Or patients will say things like I was able to forgive myself for,English
+"this thing or that person or things that people knew they had to do but couldn't, and then they could.",English
+"That's a little handwavy I know, but that's what seems to happen. I'm curious as you're talking about the lasting effects in animals and the examples of",English
+"the mice and the rats if they're much better at having beginner's minds than us humans. [LAUGHTER] It's true. Yeah,",English
+I think that's a really good idea. I hadn't thought about it like that. That's right. [OVERLAPPING] I come up with a lot more baggage. [LAUGHTER],English
+"They're like, oh, what's happening now? What's next? What's next? Maybe that's interesting. Actually, that's a really interesting idea.",English
+"I've never heard anyone put it that way [LAUGHTER] because they can start fresh and maybe resets them. Yes, every day is a new day.",English
+It's interesting I feel like some of the critiques they've heard of this synthetic use of psychedelics and then this,English
+"""clinical setting"" versus people doing it indigenously or in community with natural substances. I don't even really know what my question is,",English
+"but just if you could speak to those are really different experiences. I'm curious. Obviously, we need",English
+"control environments to collect data, that's important, but it really potentially strips away a lot of the meaning that people maybe are",English
+"looking for coming to and they experience. I'm curious what you think. Big part of my question is like, once we have data on,",English
+"we know these are good doses and this is what it's helpful for, is it going to move out of the clinical settings so that it is more",English
+"like that setting is really attended to for [inaudible]? Well, so a couple of things. First thing I would say is in the clinical setting,",English
+"the setting is really attended to. The therapists and the dosing room, a lot of attention is put to that. Actually, we don't do",English
+what indigenous groups do with setting but we do our own thing. We do our Western medicine things like maybe the doctor there's,English
+"like the hospital building and we're measuring their symptoms. We have a lot of our rituals, if you will. Ceremony, ritual [OVERLAPPING]",English
+"Yes. Taking their blood pressure. This is a ritual. I mean, we need to know those numbers, but still we're also doing this thing.",English
+"The people actually in our studies find it very meaningful, and on other people's studies do. It's not that it's",English
+"cold or indifferent or anything like that. But it's different, and it's very costly for one thing.",English
+It's very specific and you have to get into the trial. It's a medical model. It's something that insurance might,English
+"theoretically pay for or the VA where I work. But these drugs or these compounds, they have indigenous use and they're part of",English
+religious and cultural practices. That's a whole separate thing. Then American society is also grappling with,English
+what we think about drug use in adults in general. I showed you that thing about which drugs are the bad ones and,English
+"good ones and why are certain one is illegal and other ones are not. A lot of it actually has to do with racism, I think. Which ones were targeted?",English
+"We tried to make alcohol illegal and that didn't work out that well just because people refused, white people basically. [LAUGHTER]",English
+"I'm not a politician, and I don't know, but society is turned to the side like, well, aren't we going to allow people to psychedelics?",English
+"If we do that, how is that going to look? What does that mean? In practice, in California, at least,",English
+psilocybin is basically decriminalized. I don't think people are going to jail for using psilocybin.,English
+"Again, I'm not a politician. But you can go to Oakland, there are stores. You can buy these things. The vast majority of people",English
+"use these drugs like with their friends or on their own and parties, not as therapeutics, they're for fun.",English
+"I have my personal views on all of that. But what we're trying to do in the lab is to see, what happens when we do it in",English
+this highly controlled way for sick people? Can we do it safely? That's a really important part for people who have a serious problem with depression.,English
+We did a study of people with Parkinson's. They have neurodegeneration damage in their brain. They have a risk for psychosis as well.,English
+Will they become psychotic? People with bipolar. What will happen if we give a high dose?,English
+"These are open questions. Then we're hoping that if it really is effective and safe, then it will be a treatment",English
+"They'd come out, they'd ask the 12 questions. And if a schizophrenic can get it together for that time frame to answer those questions,",English
+"and then straight after be mentally, totally gone. And so they'd go and say, ""He's left with you 'cause he's sane."" They'd leave me with him and then two hours later,",English
+I'm ringing the police and ambulance again. The court was told Ben Daly was a paranoid schizophrenic,English
+"and drug user. When he inflicted the fatal wound, the angels inside his head were telling him to hunt and kill paedophiles.",English
+REPORTER 2: Mr Daly claims at the time he was so mentally ill he did not have the capacity to control his actions and to know what he was doing was wrong.,English
+Late last year a judge found Ben Daly not guilty of murder because he wasn't of sound mind. He's detained indefinitely in secure psychiatric care.,English
+"It took the murder of an innocent person, Ian... ..for Ben to be removed from the community and receive treatment.",English
+There is something seriously wrong with the system. Emerald Baz wants her children to understand,English
+"the man who killed their father needed help. I said, ""He has a mental illness and he's not well. ""He's not thinking right.""",English
+"I said, ""He's not necessarily a bad person. ""He's done a terrible thing, you know, he's done a bad thing... ""..and sometimes people that have mental illnesses",English
+"""do things that don't make sense."" It's frustrating because you just know that something has to be done and obviously what is currently available is not sufficient.",English
+"It's not working. There are terrible gaps in our system. Patients, I think, come to harm on a regular basis and we're incapable of providing care",English
+for...certainly for the sickest patients in our community on a regular basis. There's not enough capacity in our system. There's not enough acute beds.,English
+There's not enough capacity in our community and there's not enough services provided to provide 24-hour-a-day services.,English
+"The Government of Western Australia last month announced it would fund 20 new mental health beds. But across Australia, acute mental health services are under-resourced",English
+"and struggling to cope with demand. I've lived through the last 30, 40 years of mental health care in Australia.",English
+"I've seen the Burdekin inquiry appear in the 1990s, which swept away the old asylums, and there was a tremendous optimism",English
+"that we were going to develop a modern community-based system of care. And we reduced the number of beds on the basis that we would have strong, dynamic,",English
+effective community mental health services. That promise was broken by every single state government in this country. We did not develop those sustainable systems and they've just crumbled.,English
+Australian Institute of Criminology data shows over the past decade around 10% of homicide offenders were found to have a mental illness. I think the tragic cases are happening,English
+"with monotonous regularity. You know, we know there's about half a dozen homicides by the mentally ill in New South Wales every year.",English
+About half of them have presented to mental health services in the weeks or two beforehand. There's reluctance to talk about this group,English
+"because it might stigmatise the wider group of people with mental illness who, you know, do not present a risk of violence, who are not violent or dangerous.",English
+"I don't think it's helpful to ignore the problem, but it is helpful to have balance and perspective. # I'm only one call away",English
+# I'll be there to save the day # Superman's got... # # I'm only one call away. #,English
+"Before this catastrophe, I had a life. I had a beautiful son, and a beautiful grandson. And within a blink of an eye, it changed.",English
+"It changed my life. It changed the family's life, and it will never, ever be the same again.",English
+"We begged, and we begged for my son to be admitted to a mental health bed, but was told that there was a bed block, and no beds available.",English
+"We took my son home and two days later... ..he killed my grandson. WOMAN: I still miss him every day,",English
+still want him to come back. I keep asking myself why it happen like that. Why is it happen to me and my son and my partner?,English
+"You want to put onion on, too, Mum? I have no onion. You did have a red one. For legal reasons we can't use the real names",English
+"of anyone in this family. We've changed them for this story. It's not supposed to be dry, Mum. I know, I know it's not supposed to be mooshy.",English
+Maybe a bit of... Oil. Yeah. Susan's son Michael has schizophrenia. That's good now. Yeah.,English
+"Ann is Michael's partner. They had a baby boy in 2012. And I thought, ""Oh my gosh.""",English
+"I have never been so proud or so happy as I was that day, first grandson. He was very good. He loved his son.",English
+"He took him everywhere. He used to... ..pick him up, put him over his shoulder and walk.",English
+"Like, so proud that he was a father. Wheels. Ooh, wheels! Good job, Daddy.",English
+"You're an excellent man, Daddy, I like you're a excellent man. He good. He love his son so much.",English
+Couldn't imagine how much he loved that boy. This...this one here. Like that. OK?,English
+"Not long after his son started school, Michael's mental health deteriorated. Be good for Daddy.",English
+"Bye-bye. Have fun. You could tell it by his... the tone of his voice, the way that he sits,",English
+the way that he's trying to tell us something but doesn't quite know how to get it out. So we knew that he was not well. We took him to Hornsby Hospital,English
+"and he admit that straightaway, by one of the psychologists there. So she found a bed for him.",English
+"What did doctors assume was wrong with him? That he hadn't been taking his medication. In fact he was, but the high dose simply wasn't working anymore.",English
+"Doctors changed his medication. The switch to a medication that is lower in potency and proved to be ineffective for his symptoms,",English
+"and as a result of that switch, there was a relapse. After a month in hospital he was discharged to the care of his local community mental health team.",English
+"PROF. McGORRY: When you change a medication, you don't know if the new medication is going to work as well as the old one, so you really do have to monitor the person",English
+"very, very carefully in that early period after changing, probably for the next few weeks, actually. And the system, because it's so weak and threadbare,",English
+"is unable to do that, really. Ann was worried as her partner's behaviour became increasingly erratic.",English
+"He get a little bit confusing and talking about, you know, just the devil, God, something like that.",English
+"I keep monitoring him. Keep watching him, watch what's wrong with him. But he seemed to be... not getting better.",English
+"He stopped eating, but he still take medication from discharge from hospital. Michael was seen by community mental health workers several times.",English
+"When they ask my partner questions, he always say, ""I'm alright. I'm fine."" And that's it. And they not even want to ask me any question.",English
+"I'm trying to push so hard to tell them he not well, he not good, he need help... ..but they just ignore me.",English
+"In a last-ditch attempt to get help the family took him back to Hornsby Hospital's mental health unit. When you said, ""He needs to be admitted,"" what did they say to you?",English
+There's no beds. There's a bed block on the North Shore. I said to her that he'd just come out of hospital and that he was having thoughts that his son was the devil.,English
+"Anyway, I pleaded with her. Oh, my God, I've never pleaded so much in my life. I've never pleaded so much.",English
+"Anyway, with that, I took my son, I took him out. I said, ""Come on, we'll go."" And he's going, ""I want to go home now. I want to go to bed."" He said, ""I'll be OK. I'll be OK. I'll sleep it off.""",English
+"He was in need of some attention. He was so in need of some attention, but they just... ..just weren't interested.",English
+"They just weren't interested. Two days later, their lives changed forever. I took his partner to work",English
+and then I went back to get him ready for school. REPORTER: Good morning.,English
+"A 5-year-old boy has died after been stabbed in a horrific case of domestic violence in Sydney. REPORTER: Weighed down with shock and grief,",English
+"a grandmother falls into the arms of police. REPORTER: A 36-year-old man, believed to be the boy's father, has been taken into police custody and is currently being questioned.",English
+"REPORTER: Sources close to the family say he is a victim, too, a man who tried over and over again to get help. I saw him in prison about, I don't know,",English
+"four or five weeks after this event, and he was still acutely unwell, actually, with florid delusional beliefs",English
+and other signs of acute psychosis. Did he have an understanding of what had occurred when you interviewed him?,English
+"Not the first time, no. He's still affected by acute delusions and just didn't have a full appreciation of it. Four Corners has obtained the Health Department's internal investigation",English
+which catalogues a disturbing litany of failures. It shows poor communication: ..and lack of checks led to,English
+"a lower dose of antipsychotic being given to Michael. Critically, the report states that mistake: New South Wales Health told Michael's family:",English
+The Health Department told Four Corners it's implemented all the report's recommendations including improving communication and staffing.,English
+(PRAYS IN NATIVE LANGUAGE) Michael was found not guilty of murder,English
+by reason of mental illness and is now in a secure forensic hospital indefinitely. His partner Ann seeks solace in her Buddhist faith.,English
+"(PRAYS IN NATIVE LANGUAGE) I'm not angry with him, even first day when it happened.",English
+"I worry about him, what he's gonna be doing in the future. I forgive him, the first time. I'm concerned, I worry he's gonna get hurt,",English
+"he's not gonna get fixed, he's not gonna get better. If your son had been admitted to hospital that day, do you think this would've happened?",English
+"No. No, definitely not. Because he would have got the help he needed. He would've had his medication sorted out.",English
+He would've been fine and we would not... ..we wouldn't be here today. What's your reaction when you see these horrendous crimes on the news?,English
+"Well, it's an intense feeling of frustration and even I feel physically sick sometimes because I think this tragedy has occurred, it's preventable,",English
+"and it's caused endless suffering for so many people and it's preventable. My name's Gina Tatto, and my brother was mentally unwell.",English
+"He didn't get the help that he needed when he needed it the most. It ended in tragedy, heartbreak. Two families have been torn apart, one life lost.",English
+"NEWSREADER: Joshua Josef Barker deliberately drove onto a footpath, killing Dale James Watson who was walking to the shop. NEWSREADER 2: A Kings Meadows man has pleaded not guilty to murder",English
+after a fatal hit-and-run in Launceston. The 31-year-old's defence argued Barker had post-traumatic stress disorder,English
+"after being assaulted in the area years before. In March 2018 in Launceston, Joshua Barker drove his car off the road, killing another man.",English
+His sister still struggles to understand how he could take a stranger's life. It's not like he woke up one morning and went nuts.,English
+"His mental health deteriorated over a 10-week period. Because we're not experienced, we didn't know what was happening. We didn't realise the signs.",English
+"But to a professional, they would've known exactly these signs of his declining health. It was an escalation. Four weeks before the hit-and-run, Gina called 000",English
+"when her brother threatened to hurt himself with a knife. And I just said, you know, ""Look, he's not crazy, ""he's not dangerous.",English
+"""He's just...he's getting sick. ""We're scared he's gonna take his own life."" MAN: He was taken by police to the hospital",English
+"so that they could then have him presented to the hospital to be given some assessment and, if appropriate, admission to the hospital, or at least observation and treatment.",English
+Josh arrived at the hospital and was discharged within half an hour. What do we do now? That was our last resort.,English
+"Um... We were deflated, we were exhausted. We felt so alone. For the next three weeks, Joshua Barker had no treatment",English
+while his family struggled to manage his increasingly erratic behaviour. I frantically called anyone and anyone I could.,English
+"Anything that said ""mental health"", I rang it. We didn't know what to do. I reckon I called eight or nine places.",English
+"With all my experience with these mental health lines, that's all I got constantly, was, ""He's gotta come in himself."" And I kept saying, ""But he doesn't know he's getting sick.",English
+"""He thinks he's fine."" The night before, the 8th, before Josh took somebody's life, Josh sat for several hours with his friend",English
+"and talked about all of his beliefs, believing that the world was divided into three groups of people that were angels and devils and people in between.",English
+"His mental health is gone. He's out of reality. He's delusional, he's saying weird things. Um...so, then I panicked, started ringing everyone again.",English
+"The last person I rang at 10:45 Friday morning was the hospital, the CAT team, Crisis Assessment Team. Um...told them it was urgent, we needed help desperately.",English
+"And she said, ""I'll get someone from the assessment team ""to call you straight back."" Hour and a half later, they called back. It was too late.",English
+Joshua Barker was already driving to a suburban street in Launceston's south. Dale Watson was in the same area.,English
+The two had never met. My name's Terry Watson.,English
+"Um...I'm here because my son was mowed down at Prospect by a hit-and-run driver, by Joshua Josef Barker. Our family's struggled with this for near....oh, two years,",English
+and we're still waiting for answers. Why? And we still get no answers - why? Dale Watson died on the pavement.,English
+"He went up to see a friend. He was just walking down after seeing his friend, coming around a corner, going to the shop he was, and this Josh Barker come from behind,",English
+rode a gutter. And Dale was nearly on a lady's front lawn. He'd come that far over to hit him.,English
+"Joshua Barker kept driving. The next day, police charged him with murder. Prison staff there.",English
+That's the actual prison van that Josh will be in. That's family. That's Gina waving to Josh. Joshua Barker's murder trial was held last September.,English
+"(VEHICLE REVERSING ALARM BEEPS REPEATEDLY) If somebody with a mental illness ends up before a court, then that's a failure, in my view.",English
+"Somebody with mental illness should be assisted through the mental health system. And if they end up before the criminal justice system,",English
+it's because they've not been able to... ..or haven't received the appropriate care and help that could've prevented that happening.,English
+"As the jury considered its verdict, both families waited for news. (KNOCK AT DOOR)",English
+"Yep, so, the jury's obviously reached a verdict on the case. Um...when it comes to a verdict, I'd ask you not to react no matter what the verdict is, OK?",English
+"So, if it's one that goes in your favour, then don't react. If it's one that we're not expecting, then stay calm. Go! They won't convene without me, Gina.",English
+"It's alright. But what happens if I do react? Just do your best, mate. So, we've just a had quite a quick outcome from the jury.",English
+"After just 40 minutes of deliberations, they've found him not guilty by reason of insanity. In this, there's no answers.",English
+"You know, I feel sorry for his parents too. You know, they've lost a son in one way, so, you know, we're both losers, so...",English
+"MAN: Thanks for speaking, Terry. Good on you, mate. WOMAN: Thank you. The judge ordered Joshua Barker receive psychiatric treatment",English
+in a secure hospital indefinitely. Our prisons are now our new asylums and we've got literally hundreds of people with severe mental illness,English
+"in prison, uh...receiving, often, their first ever treatment. GINA: It's starting to get chilly now.",English
+"(BLEATS) Oh, yeah, they've just found their food. Joshua Barker's family wants him to be treated in the community. Do you worry that, if he is released, that something like that",English
+"could happen again, he could hurt someone else? No. No, he's on board now. He's on board. He wants...he wants the help.",English
+He wants to make sure that he never gets to that level again. Terry Watson believes his son's killer shouldn't be released.,English
+"TERRY: My own opinion is that he should pay for what he's done 'cause I believe if he gets out, like I said, he'll do it again. Do you think there needs to be better mental health resources",English
+"for people like Josh? Yes, there's gotta be. There has to be. Because if we don't do anything about it, it's gonna keep going on and on,",English
+"and whoever commits a murder can plead post-traumatic stress, insanity. I could kill you here now,",English
+"five minutes later, walk out of that door and say, ""Look, I had post-traumatic stress. ""I didn't know what I was doing."" Research shows offenders who receive intensive psychiatric treatment",English
+"are far less likely to offend again. Once they've been treated and rehabilitated over a long period and gradually returned to the community,",English
+"they're actually a very safe group. The forensic mental health system is effective, but it's costly, and it is...you know, you don't really want a mental health system",English
+that can only provide that level of care once someone's committed a very serious offence. That we have to wait for that to happen makes no sense.,English
+"Well, look, it's a complete indictment of the system, isn't it? You know, to think that the only way you can get good treatment - and the treatment you get in the forensic mental health system",English
+"is, you know, the best treatment available - is by committing a tragic offence, you know, is, um... ..it's, uh...it's, um...absurd.",English
+My name is Vicki Walker. I'd just like to talk to you about what happened with my son Clinton in December 2016.,English
+"Please don't judge my son Clinton. He didn't get the help he needed and the help that he'd asked for, and as a result of that, myself and his girlfriend were stabbed.",English
+"REPORTER: For years, Clinton Walker collected swords and knives. Last night, police allege he used them. REPORTER: Police found a harrowing scene at the home,",English
+"seizing a machete and a sword, and forcing their way into a room where the two women were hiding. We just heard this screeching and swearing,",English
+"and, ""Get out, f-ing this and f-ing that."" REPORTER: It's believed that these women were being repeatedly stabbed from head to toe by a man who was armed with not only a machete",English
+but also a sword. (BURBLES),English
+Are you trying to tape me on video? Are ya? Are ya? Are ya? Vicki Walker's son Clinton grew up on the outskirts of Sydney.,English
+"MAN: Good on you, Clint. He was an outgoing child and a promising rugby league player. VICKI: He was first diagnosed with having a mental illness",English
+"when he was about 16, but that was mainly depression, anxiety. It wasn't until he was 18",English
+that he got labelled with PTSD and anxiety. They didn't know whether he had schizoaffective disorder,English
+"Oh, it was pretty scary but... Because no-one really talked to you about what it meant or... ..what future Clinton could have or how it would affect him.",English
+Throughout his early 20s Clinton had a series of hospital admissions. Clinton would recognise when he was becoming unwell,English
+"and we would, through his help with his psychiatrist, get him back into the private hospital. In late 2016, Clinton began having disturbing hallucinations.",English
+"He said to me, ""Mum, I need to go back and see a doctor,"" who he hadn't seen a lot in a couple of years before because he'd been well.",English
+"So, he started seeing him again and... Anyway, probably two weeks before everything happened, he was really unwell, he became really paranoid.",English
+"Clinton was taken by ambulance to hospital in delusional and paranoid state. He believed his mother's house was on fire, which was not the case.",English
+And ambulance officers on arrival on the scene decided that it would be good for Clinton to be examined by mental health team.,English
+"VICKI: He'd never been this anxious and this paranoid before, and he'd been scheduled before for a lot less symptoms, if you like. So, in Clinton's mind, he thought",English
+"that they weren't going to give him a bed, he thought that they weren't going to help him. After waiting for two hours,",English
+"Clinton left without being seen by the mental health team. His medical notes recorded no follow-up was required. Well, the problem was he wasn't treated, you know?",English
+"He was given, I think, a small dose of a low potency antipsychotic medication, and no arrangement was made for proper follow-up of what was an acute relapse",English
+that was really going to require hospital admission. I really thought that the police would come back and get him because they'd scheduled him so many times before,English
+"for a lot less symptoms and a lot less bizarre behaviour. They didn't come and then I thought,",English
+"""Oh, well, maybe the after-hours mental health service ""from the hospital will come."" They didn't come either and Clinton slept.",English
+"The next night, Vicki woke to Clinton screaming, and went to check on him. He had this ornamental sword and...",English
+"I didn't know that's what it was, but that's what come through the door, and it happened to get me right in the abdomen area. I just froze. I didn't know what the hell was going on.",English
+"I'd never ever seen Clinton violent before, let alone... ..do anything like that. Clinton's girlfriend was also in the house and rushed to help.",English
+"She was stabbed too. And it was that point that I got scared because I thought... ..""He doesn't know who I am.""",English
+"and the fact that people believe they can somehow cope, that it will probably work out somehow. That seems to be connected to resilience,",English
+"Professor and Psychiatrist Marianne Müller is also conducting research at the resilience center in Mainz, investigating what makes some people particularly resilient.",English
+"I think this is promising in terms of better understanding psychiatric illnesses. For many decades, we’ve had only moderate success in trying to understand how psychiatric illnesses,",English
+"for example stress-related illnesses such as clinical depression, develop. While psychiatric research focuses primarily on the clinical picture,",English
+the science of resilience is more concerned with healthy people. Müller is first exploring the basics: What does resilient behavior even look like?,English
+"With her colleague Ulrich Schmitz, she is investigating this in mice. Resilience can only be measured in the context of stress. That’s why they put small brown mice",English
+"This means that if you place a test mouse with a larger mouse in its home cage, the larger mouse won’t accept it and will try to scare or drive it away.",English
+"They want to know: What is the long-term effect of this permanent stress on the behavior of the stressed mice? After a day’s break, they undertake a second experiment:",English
+How do the previously stressed mice behave? Do they stay away fearfully? Are they brave enough to approach the white aggressor in the cage?,English
+"with which the stressed little mouse has had no negative experiences so far. Our test mouse was allowed to freely explore the box,",English
+This is directly transferable from mice to humans. There’s a lot of data showing that people who can distinguish between negative stimuli and neutral stimuli are better protected,English
+"against stress and associated stress-related mental illness. In this respect, we are also quite confident that we can use this",English
+to derive further neurobiological findings. Moving on.,English
+"He was in a good mood, looking forward to the evening with his friends. And in retrospect, I’m glad that the last time we saw each other was really a pleasant moment",English
+"that someone accepts the burden for me, that I could now pass it in to other hands. Maybe there is a bit of religion in me after all.",English
+"The physical part will be buried for now, but the emotional part, it will take a very long time before this wound is no longer quite so open. Munich.",English
+while others become ill under the same stress? One topic we researched was genetic predisposition. Could it be that certain people are genetically predisposed,English
+The stress response is then switched off in the brain and we calm down again. At least when everything is functioning correctly.,English
+"Many people are nervous at interviews, but normally, when the situation is over, our stress hormone levels should downregulate again.",English
+"People with this particular genotype are not so good at this. So for them, the stress hormone stays higher for longer. The question Binder asks is: Why is that?",English
+Why are some people not as good at calming down than others? And this is where genetics come into play. One of the genes responsible for our stress regulation is the FKBP5 gene.,English
+It is activated during stress and ensures that an important enzyme is released. It has the same name as its corresponding gene - fkbp5,English
+"The problems start when too much of it is released Then the enzyme wedges its way between the stress receptor and the cortisol, and thus blocks the stress receptors’ message to the brain",English
+that there is enough cortisol. The brain is misinformed - it keeps firing and we can no longer calm down. We think that stress causes too much of this fkbp5,English
+to be released and that people simply release too much of the stress hormone after even the slightest stress. And we know that too much of this stress hormone,English
+"in the long term is bad for many processes including in the brain, which also increases the risk of psychiatric illnesses. The researchers have identified the FKBP5 gene",English
+as one of several important causes of our hormonal stress regulation. Variants in this gene could be partly responsible for why we react with more or less stress.,English
+"The researchers are now looking for a way to block activity directly at the FKBP5 gene. And here at the institute, this has been investigated in mice",English
+that have been given this FKBP5 blocker whether they are more resilient to stress and are better able to cope with it,English
+"to the extent that this can be measured in a mouse. The next step is to develop a drug specifically for people in whom this stress gene variant can be detected in the blood,",English
+and who therefore presumably have a higher risk of mental illness. The South of France.,English
+Psychiatrist and neurologist Boris Cyrulnik lives and works in Toulon. He’s considered a pioneer of resilience research. The traumatic experiences of his own childhood,English
+"how we can find our way back into life after war, as I had lost almost my entire family in Auschwitz. As a four-year-old, Boris was left on his own, without a mother or father.",English
+"I reject this curse! At the age of 11, Cyrulnik already knew that he wanted to become a psychiatrist.",English
+"After the war, he studied medicine in Paris. The memory of his loving parents also helped him to forge his own path. I fought to study, even though everyone told me:",English
+"Don’t bother studying, you won’t make it. Well, I made it. When the trained psychiatrist came across the term resilience",English
+"for the first time, he found his life purpose. When I came across the word resilience, I said to myself, this is a word that needs to be developed scientifically,",English
+"and we need to bring it into our culture to make people understand that if we abandon injured people, there will be no resilience. Due to his own painful experience, one focus of Cyrulnik’s research",English
+is child protection. He’s particularly interested in the interaction between mother and child. We started our research into early childhood in 1981 on the island,English
+"Embiez, near Toulon, where we gathered a team of international researchers. The question was: What makes one child more resistant to crisis,",English
+"while another is very vulnerable to it? He sees one of the reasons for this in the mothers of these children. If the mother is not doing well, her relationship with her child suffers",English
+This is a vicious circle that can begin during pregnancy. We have been able to scientifically demonstrate that when a pregnant woman is stressed the stress hormones enter the uterus,English
+"and the baby swallows stress hormones such as cortisol, which are harmful to the baby’s brain This means that the baby is born with cognitive changes",English
+"that are not caused by the mother, but by the mother’s unhappiness. The researchers identified a particularly sensitive phase",English
+"in the final weeks of pregnancy and the first two years of a child’s life. New networks are constantly being formed in the brain during this time. If nobody does anything, it’s a neurological catastrophe.",English
+"The brain atrophies. But we can intervene, we can intervene gently very early and easily. And the earlier we intervene, the easier it is to trigger",English
+"the resilience process. But if the child is left very isolated for a long time, the resilience process will be difficult to initiate.",English
+Elisabeth Binder is also studying this particularly vulnerable phase of life at the Max Planck Institute in Munich. The biggest correlation is an almost 40-fold,English
+"risk of having attempted suicide when someone experiences severe traumatic experiences as a child. Even during pregnancy, too much stress or trauma",English
+can lead the embryo’s natural barrier against the mother’s stress hormones to break. Why is chronic stress harmful to the brain?,English
+Because chronic stress leads to our neural circuits becoming weaker. Binder suspects the stress hormone cortisol causes this.,English
+"But to prove it, she would have to be able to examine the brain of an embryo under stress. It’s difficult of course to get to the developing brain",English
+"and to expose it to certain factors and investigate how it reacts. Because this obviously is not an option, the researchers are using a novel method to recreate",English
+a developing brain outside the womb. A brain-like cell structure is grown from stem cells. The researchers call this simulation a brain organoid.,English
+We can only properly model very early brain development. We can’t model all cell types in the brain and we can’t model how different brain areas talk to each other.,English
+"So it’s a very simple and limited model, but it’s the first time we’ve been able to do this. How old are these organoids now?",English
+"These ones are about 40 days old. 40 days old. So that means we could begin. Yes, this would be a good time to start.",English
+"Once the simulated embryonic brain - the brain organoid has reached a certain stage of maturation, Binder and her team add synthetically produced cortisol.",English
+The effects of the hormone on the development of the brain cells are then investigated. And then we see that this stress hormone actually alters,English
+"the development and, in particular, the gene expression of genes that have also been associated with the risk of psychiatric illnesses. There’s no doubt about it: Even in the womb,",English
+the mother’s stress influences how strongly genes manifest themselves in the child and can therefore have a lasting effect on their mental health. A finding that could have real life implications.,English
+It’s also important to screen for psychiatric symptoms during pregnancy. Some clinics already screen for depression and treat the mother in good time.,English
+There are now many studies experimenting with using therapy during pregnancy to possibly mitigate risk. Environmental influences therefore have a direct impact on our genes.,English
+Scientist and psychiatrist Katharina Domschke in Freiburg is investigating exactly what this looks like. We think that environmental influences can trigger illnesses.,English
+"So now the question is, how does the environment affect our genes? Domschke is Head of Psychiatry at the University of Freiburg Medical Center. In her laboratory, she investigates epigenetic processes",English
+how and why changes occur in our genes. Let’s imagine we have a certain genetic predisposition and there is a particular adverse environmental event.,English
+"But how does this environmental event cause our genes to express, or trigger, so to speak, and ultimately lead to illness. This is where epigenetics play a role.",English
+"In order to understand this communication between environment and genes in more detail, Domschke and her team are looking at another stress gene",English
+the MAOA gene. It provides instructions to make an enzyme also called maoa.,English
+"This enzyme migrates into our nerve cells and attaches itself to the synaptic clefts, the area between the nerve cells. This is where our happiness hormones - serotonin and norepinephrine",English
+"are normally transported from cell membrane to cell membrane. However, if too much of the maoa enzyme attaches itself to the synaptic cleft,",English
+it turns out to be a real happiness eater: it simply degrades away the serotonin and norepinephrine. one of the main suspects in the development of mental illness,English
+"is monoamine oxidase A, or MAO-A for short. This is because MAO-A breaks down norepinephrine and serotonin. But in some of us, this happiness-eating Maoa enzyme",English
+is more active than in others. Why is that Domschke takes blood samples to monitor the MAOA gene and see how much methylation has occured.,English
+"Methylation is a chemical process where a methane derivative binds itself to specific sites on our DNA, deactivating them. This can be imagined as a kind of cap that sits on our genes,",English
+"putting them to sleep. If the cap sits on the gene, it is considered methylated, and the gene is dormant, silencing its activity. If the cap is removed, however, it becomes active again.",English
+"In the case of the MAOA gene, more happiness eaters are produced. The MAO-A enzyme is more active and breaks down more serotonin",English
+and norepinephrine. There’s less of those hormones available in the synaptic cleft between the nerve cells and it may be easier for depression,English
+"and anxiety to develop. This means that we are in a state of risk. If these caps are on our stress genes,",English
+they protect us from producing too many happiness eaters. This can make us happier and more resilient. But that doesn’t always happen for everyone.,English
+"What we saw was that negative life events were more likely to lead to the MAO-A being less methylated, i.e. having fewer caps on the gene, and possibly being at risk,",English
+"while positive life events were more likely to be associated with increased methylation. So that means the caps were more likely to be on the MAO-A gene,",English
+possibly indicating resilience. Positive environmental influences and experiences can affect how our genes are expressed.,English
+Domschke’s next question is can this also be demonstrated in successful use of therapy? We’ve known for a long time that psychotherapy works.,English
+"Psychotherapy is one of the most effective treatments anxiety disorders. What we don’t yet know is how it works in detail And based on our research findings,",English
+one possible mechanism could be working at the cell nucleus level Can we put these caps back on the stress genes,English
+with the help of psychotherapy? Domschke examines the blood of patients who are afraid of heights she climbs the tower of the Freiburg Cathedral,English
+"with them every day for two weeks. The patients did what we call exposure exercises, where they exposed themselves to their fear of heights",English
+"So they went up the tower, had to look down and after the therapy we took blood samples again. And what we saw was that in patients with a successful response",English
+"to psychotherapy, MAOA methylation had returned to the level of the healthy control subjects. Domschke also obtained the same result in a study on psychotherapy.",English
+"The number of test subjects is still too small to make a definitive statement, but the initial results are promising. So there are stress gene variants that we bring into the world with us,",English
+"The will to keep going was gone, you’re no longer capable of anything. That was at the beginning. And then things got better.",English
+"Music was like a prayer, a meditation, a connection that helped me tremendously. A lot of people might ask, where is God, but that didn’t happen to me.",English
+"The fact that his son had to die, the senselessness of it, almost brings him to despair. When you think about the trivial reason that led to this terrible end,",English
+you just don’t understand It’s so meaningless. Georg Ballmann wants to do something about that meaninglessness.,English
+"And that’s why we very quickly had the idea of setting up a foundation to turn this meaninglessness into something meaningful. Together with Freddy’s parents, Ballmann established",English
+"the “faustlos” foundation, a program that starts in kindergarten to prevent violence as early as possible. It allows him to stay active, and keep the memory of his son alive.",English
+"At the Mainz resilience center, psychologist Michèle Wessa focuses her research on very practical help for people in crisis situations. She says that resilient behavior can only develop very gradually.",English
+"It doesn’t work to develop training courses that somehow make people more resilient and more efficient within an hour and a half or even a day,",English
+"which is perhaps what some people would like to see. That won’t work and that’s not what we aim to do. For Wessa, resilience is regulated by the self.",English
+She tells us her favorite story to help explain what she means. The story of the elephant in chains by Jorge Bucay,English
+"is about a very small elephant, a newborn, being chained to a small wooden peg in a circus. The baby elephant keeps trying to break free from the chain,",English
+"but to no avail. But it eventually grew bigger and stronger, in fact, it could have broken free long ago.",English
+"It lacks the belief that it can do it, and that alone causes it to stand still and not try to free itself. When we have the feeling that we can do nothing,",English
+"that we are powerless and at the mercy of others, this is known in psychology as “learned helplessness”. Wessa examines this state in detail in various experiments.",English
+"In the experiment, the test subjects are first given an unpleasant noise and at the same time a somewhat unpleasant stimulus on their skin. They are shown circles, triangles and squares,",English
+"on which they have to press a different button. If the participants press the right button, they can stop the unpleasant noises.",English
+"This applies to one group. In a second group, however, pressing the right button sometimes causes the noises to stop,",English
+"but sometimes it doesn’t. What one group learns is, I press a correct button, so I have the situation under control, the stimulus is over.",English
+"The other group learns that no matter what I do, chance determines what happens. If this happens several times in a row,",English
+it leads to an experience of helplessness there is nothing we can do. We might recognize this from our working life:,English
+"I do a certain task and I always do it the same way. One day the boss is very happy, the next day he throws it back at me and says it’s terrible.",English
+"In other words, I have the feeling that I have no control over it. And that’s a very important aspect of how stressed I actually feel. How does the experience of losing control affect future behavior?",English
+"In a follow-up experiment, the two groups can only stop the unpleasant noise by finding the safe green squares on a field as quickly as possible.",English
+Do the two groups behave differently when searching for these squares? The result is that people who have already felt they were in control in the previous experiment find these safe green places much faster,English
+than the group that experienced a loss of control. This experience that I have never been able to do this before also leads,English
+"to passivity and something like the story with the elephant: That I just give up, I submit to my fate. And so I move further and further into this cycle",English
+"of helplessness and passivity. According to Wessa, when we manage to free ourselves from this cycle, we can effect change in our lives.",English
+"But what about the situations in life that we cannot change? I may not be able to change the actual situation that triggered the stress, but I can always change something about how I react to the stress.",English
+"And I think it’s really important that I learn for myself that although I don’t always have control over the stressor, I do have some control over my reaction to it.",English
+"Wessa puts her research findings into practice at a school in Bad Dürckheim, Germany She is conducting a WHO-sponsored resilience training program",English
+"in a 7th grade class. Mental stress has increased significantly in recent years, particularly among children and young adults,",English
+largely due to the Covid pandemic. For me it’s important that we give them strategies at an early stage that they can use themselves to protect their mental health.,English
+"She works with the students on how they can free themselves from a stressful spiral of negative thoughts and feelings. First, she asks the question: What happens",English
+"when we are convinced that we will fail at something? Your thoughts influence your actions. If you think you can’t do it,",English
+"then it may well be that you really can’t do it. So you would then say yes, I can’t do it anyway, so I won’t even try. If negative thoughts lead to bad results,",English
+"shouldn’t the reverse also be possible? That’s precisely where we can do something for our health and resilience,",English
+namely by looking more closely at things that we have already achieved. We often pay much more attention to the things we haven’t achieved. And we remember things that went wrong.,English
+And we somehow forget even the little things that have gone well. She does a simple exercise for this by asking the students to remember,English
+"But this time I really did it with some structure and it was much, much better than just throwing everything in somewhere. Remembering the successes, trying not to judge experiences too negatively,",English
+"staying active despite adversity - these are key factors for resilience. We’ve learned a lot. I understand the term now, and know more about the topic of resilience.",English
+"appreciate you highlighting that because I'm  noticing that a lot of people, they experience   this revelation or this insight or the call of  God to cast out demons. And that they have really",English
+"as to begin to tell those people to stop taking  medication. And the medication that you know,   was helpful to them, and not with the spiritual  problem, with the physical problem that this",English
+"little education and knowledge, especially in  the area of spiritual warfare. They go just all   the way into deliverance. And then there's some  people who are teaching on mental health so much   that they ignore the supernatural component of  deliverance and ministry of exorcism. What are the",English
+"most common mental disorders that you have seen,  that deliverance ministers mistaken for demons?   Well schizophrenia is right at the top, no  question about it. It is the one condition that",English
+"most closely aligns itself, what we know as  demonization. And that is because it is a   condition in which people lose touch with reality  and they develop psychosis. Which basically",English
+"means that their mind is not properly perceiving  reality. So when people start hearing voices,   or they hear voices telling them to do things  that are absolutely absurd, like kill somebody",English
+"or harm themselves or cut themselves or threaten  suicide. It's very easy to jump to the conclusion,   oh that is a demon. Not necessarily. Demons do  those things. And sometimes demons have created",English
+"characteristics of demons but the demons  aren't even there. It's just broken. You know,   it's like the devil comes up and he pushes you  and you fall and you break your arm. And he walks,",English
+"cannot look at me, either a demon doesn't want  them to look at me. Or they are incapable of   connecting with another human being because  they're living so much in a private world of",English
+"mental illness. I look for signs of restlessness.  So demons can make a person restless but it's an   aggressive kind of restlessness. But I will  tell you this, I've seen some remarkable",English
+"changes in people's lives once you get  past the symptomological aspects of   the humanness of the mental illness, to the  demon that's actually hiding behind it. And",English
+"that's what some people in deliverance don't want  to do. ""Oh it's autism, you got a demon. Oh it's   schizophrenia, you got a demon. Oh, you're manic  depressive, you've got a demon."" Well you might.",English
+"But if you don't go through those processes of  healing, you're going to damage that person, drive   the demon down deeper and make it less likely  they'll get real help. Wow. Wow. That's huge.",English
+"of what her father has done to her. How can  she survive without a complete mental collapse?   Well people who can't dissociate, develop  psychosis and mental illness and states of",English
+"unreality. That's how they deal with it  or they use alcohol, or drugs, or sex,   or something to numb it. But for some people,  particularly if they're a Christian and they're in",English
+"a situation where it's supposed to be Christian.  They split off a part of them that is the person   who experienced the trauma. So all the pain,  all the shame, all the emotions and the trauma",English
+"are locked up in not Susie, but Mary.  And they'll give this person a name.   And so what you have to as you work with  this person, I watch them. I ask friends,",English
+"do they ever act in a regressive way like they're  a child at times? I've had husbands say to me,   ""Ah my wife's got the biggest teddy bear  collection on the planet."" I say, ""Bingo.""",English
+"""She just loves to cuddle her teddy bears."" Okay  what's that all about? How many people do that?   They don't. So she's doing that, she's regressing.  She's regressing and when she feels safe,",English
+"the child comes out. So basically, as we describe  it in our school, there's a process by which   you learn to spot this. And if you see  it, even if you're not well versed in it,",English
+"just ask the Holy Spirit to lead you to say, ""Is  there anybody inside of Susie who has a secret?   Something you'd like to tell me?"" I just had  a lady in my office a couple days ago and",English
+"very same thing. And she just broke down weeping,  crying and kind of huddled up like a little child.   And then I just very gently said,  ""What is your name? Who are you ?""",English
+"She began to speak in a very childlike manner and  describe sexual abuse she'd experienced. And I   said, ""Have you told anybody?"" ""No. I can't  tell anybody. I'm protecting the big lady.",English
+"I'm keeping her safe by not letting her  know."" And oftentimes the person who has   an altered state of mind does not have the memory,  somebody else has the memory. But the key is,",English
+as they receive healing the memory  starts coming back in a very healthy way. And there are people in inner healing that  know how to do this. Unfortunately some of   the people in inner healing that know how  to do this don't also cast out demons.,English
+"Because almost always there's going to be a demon   attached to that altar state because it's  stuck in anger, and shame, and trauma. Mhm so good. That's so good. And I think it's  very important for everybody that's watching",English
+"and re-watching this video, also to understand  that you know, concerning medicine. And you   advised me one time when I asked you, you know  when somebody comes to you and they are taking",English
+"medication, for example against depression.  Or they're taking medication prescribed by   their doctor, their therapist. And you don't  encourage people after they get delivered to   get off of medicine and pretty much declare  themselves as healed. What is your process?",English
+"What my process is, is if you're genuinely  healed in body or mind, the proof of that is   eventually going to come out and you're going to  be able to function. But you don't want to come",English
+"off a medication quickly, now you got another  problem. Because medications have side effects,   and you can send somebody into a psychotic state.  You can really permanently damage that person,",English
+"because of what's going to happen to their body  that's become dependent on that drug and doesn't   have it anymore. That's a physical thing. Not a  spiritual thing. So when I say to them, look, you",English
+"go back to your doctor, you go to your clinician  .You tell them you believe that the Lord has done   a healing with you, but you would like to work  with them to gradually get off the medication and",English
+"to be monitored through that process. That brings  glory to God. But doctors have horror stories.   They can tell you of people who claim they were  healed of this, claim they were healed of that",English
+"and they end up worse later. That's, that's so  good. That's so good. I think that's such a wise   advice to everybody. I was reading a comment of  when you were speaking about the mental illnesses",English
+"and one person, and I'm not going to mention  her name. But she says, ""I no longer take my   autistic son to church. They always come our way  and start trying to cast something out of him and",English
+"his behavior gets more erratic. I pulled him out  quickly and left."" And I've seen this actually   happen with especially in pentecostal churches,  charismatic churches. People super zealous.",English
+"They see you know, a child. I remember one  time we had a person, she had a brain tumor. So   because the tumor was lodged in the  brain, so she would have seizures. And   everybody went casting out demons and we  had to stop and say, ""Whoa. Whoa. Whoa.",English
+"You know, did anybody even ask what's happening  to her? She has a seizure she doesn't have a   demon."" Not that demons cannot cause seizures  but I like how you pointed out, we have to   ask questions first. We can't jump in and treat  everything as a demon and use this deliverance as",English
+"a hammer and everything is a nail. We have to  interview. Like even Jesus, that boy that was   having epileptic seizure. Jesus didn't go cast out  demons; He started to ask the father a question.",English
+"""How long did this happen? How did this start?""  And so interviewing the family, interviewing the   people and instead of just jumping into that.  What would you say about the people or churches",English
+"who are constantly just going at it right away,  any autistic children or any anybody who's having   seizures. And they're saying, ""This is demonic. We  just go hard after it."" What would you tell them?",English
+Well they mean well in most cases. They're  just not educated in areas of mental health   and in areas of physical health. And God  works through many different ways to bring,English
+healing to the mind and body. And we  need all these disciplines to cooperate.   So the doctor's not your enemy. The psychiatrist  may not be your enemy. The devil may be your,English
+"enemy. But all these people, unless they are  you know, unless you're psychiatrist, and this   does happen, says, ""I want you to go to Tibet  and you know, meditate with a Dalai Lama."" Then",English
+"you might want to reconsider what the guy said.  But approach it very carefully. Educate yourself.   We have this, we have something today that's  really marvelous; it's called the internet. Google",English
+"the condition. Start reading some of the health  sites about what they say about that condition.   They're marvelous places that you can look and  glean information, rather than some preacher who",English
+"stands up and says, ""Every child is autistic."" And  I saw a guy do this recently on the internet. That   this is a demon. Your child's autistic. You got a  demon. What a horrible burden that puts upon this",English
+"parent. I mean it's awful because now if their  child's not better, they don't have enough faith.   You know they're not trusting God enough. And  that's a guilt trip. That is just a horrible thing",English
+"to put on people. What would you tell parents  that have children with mental illnesses? How to   walk that process of healing, deliverance.  What encouragement would you give them?",English
+"Got to adjust my camera here.  Got a little out of adjustment.   Well yeah, the first thing is, have you sought  medical advice? Have you got an opinion on this",English
+condition? Have you spoken with a clinician about  this? Have you seen what they have to say? Doesn't   mean you have to accept what they say but you at  least need to listen to what they have to say.,English
+"I will tell you Pastor Vlad, the majority of  people who come to me with cases like this   have not taken them to any type of doctor.  They're anti-doctors, so they don't want",English
+"to talk to a doctor. Well okay, but they're  trained. As you know my my oldest daughter   is about to finish medical school and go into  the medical profession. And those people know",English
+"a lot of stuff. They don't have all the answers;  they're not God. But they can be of assistance,   so let's go through the proper channels here  you know. Talk to the doctor. The doctor may",English
+"recommend a psychologist, or a psychiatrist,  or a social worker, or clinician of some kind.   See what these people have to say observationally  about the symptoms. The cause is another matter.",English
+Cause may or may not be something that's  spiritual but let's see what the symptoms say.   Are these common symptoms of someone at this  age doing this under these circumstances?,English
+"Does it fit a predetermined template that  a clinician has seen over and over again?   Now that doesn't mean that you know, you're devoid  of praying it away, fasting it away, seeking the",English
+"Lord to mitigate it. It just means, let's find out  what you're dealing with. And then sometimes there   is a demon behind it, but you have to expose that  demon by stripping away the layers that hide him.",English
+"The symptomological layers of behavior that allow  the demon to hide, and then he's forced out into   the open. I remember one time I had a man come to  me and he brought his son. And he said, ""My son",English
+"is autistic and he has demons."" So you  know I'm thinking very skeptically here   and I said, ""What do you do for a living  sir?"" And he said, ""I'm a pediatrician.""",English
+"He said, ""Look I have analyzed this from a  medical standpoint every which direction.""   And I said, ""Well if that's the case  I'm going to talk to the demons."" And",English
+"a couple of minutes later I was talking with  this little boy's demons. The father actually   gone through my school was learning how to cast  demons out of his son. But there was a medical   opinion there. He had eliminated all the other  possibilities. Christians have to stop this,",English
+"we call it mystical thinking, magical thinking.  Magical thinking that we're going to skip over   the medical profession. We're to  skip over the psychiatric profession.",English
+"We don't need any of that or worse yet, it's  of the devil. We're just going to jump over   here and get rid of the devil. The person's  going to be better. Especially if they have   dissociative identity disorder and they have an  altar state that's trying to protect that person",English
+because they've been abused. Guess what? You  are the new abuser. You mean well but now this   person is going to hide even deeper down inside  and you may never be able to help them. Wow,English
+"okay. That, that hits. That hits straight. You  know this has been huge for us in the ministry of   deliverance. And we actually started to even work  with local therapists and local counselors. With",English
+"anybody who gets delivered and who had trauma, who  had abuse. You know after we've taken them through   the inner healing, because we're not counselors.  I'm not a you know, professional counselor. And so",English
+"and a lot of times what pastors do, they think,  well we know three verses. You know Psalm 23.   Here you know, we're just gonna take them through  that. That's, that's enough you know. Apostles did",English
+not have those degrees so we don't need to have  any of that knowledge. But apostles also did not   drive a car you know. Like all apostles did not  do a lot of other things that we all benefit,English
+"from. Now we don't have to do those things. We  can all ride horses, yet we take advantage of   the technology, the advancement of our world.  We benefit from that to make our life easier.",English
+"But when it comes to mental health, when it comes  to physical health, like nobody would take that   approach toward their physical health. Everybody  will go to the doctor. And I think that especially",English
+in the pentecostals and charismatic circles this  anti-doctor or anti-medicine movement. And I even   had to correct it in our own church one time. A  person gets up and shares their healing testimony,English
+"and you know and they're bashing the doctor. The  doctor said this. Because the doctor gave them   diagnosis and I said, I rebuke you devil. And I  pulled them back and I said, listen the doctor was",English
+not the devil. He didn't mean you harm. He went  to 12 years or 14 years of training to help you.   I'm like he's not doing this because he wants to  kill you. He wants to help you. Why in the world,English
+"So, behaviors that cause the individual or others significant distress often get labeled as abnormal or unhealthy. Depression is a prime example, as we'll see when we talk about",English
+"the characteristics of it. It's a miserable state of being; you're unhappy, you're sad, you may even feel so badly you want to kill yourself.",English
+"And that very, very high level of distress is part of the reason why it's labeled as a mental disorder. Other mental disorders don't cause the individual distress,",English
+"but they may cause other people distress. So, one example of this is something called ""antisocial personality disorder,"" where the individual has no",English
+"regard for the rights of other people, has no hesitation to steal or--steal from or hurt other people,",English
+has no empathy or sympathy for other people's feelings and so can inflict a lot of harm on other people and has absolutely no distress over this whatsoever.,English
+"But this behavior causes other people distress, and that's one of the reasons why that's labeled an abnormal behavior or a mental health problem.",English
+"The second general criterion is ""dysfunction."" If a set of behaviors prevents the person from functioning in daily life, then it might be labeled as abnormal or might end",English
+"up being labeled as a mental health problem. Again, depression is a good example. People who are depressed often become completely",English
+non-functional. They can't get up and go to class; they can't go to work; they can't interact with their friends; they withdraw and become totally isolated socially.,English
+"So, they might lose their job; they might flunk out of school. And this complete decline in functioning is one of the major reasons that we consider depression one of the most",English
+"debilitating disorders. And then finally, ""deviance,"" the behaviors or feelings are highly unusual. This is probably the most controversial of the three",English
+"because it weighs, it is so heavily influenced by the social norms. What's deviant in one culture is not deviant in another culture.",English
+"But if a set of behaviors is completely unacceptable to a culture, highly unusual, they're more likely to end up getting labeled as abnormal. Okay.",English
+"So, how do we pull this all together? Well, these days the manual for making diagnoses in clinical psychology and psychiatry in the United States is called the",English
+"Diagnostic and Statistical Manual or the DSM, and it's in its fourth revision. It's been around since the, I believe the '50s, and the early editions in the",English
+"'50s and '60s were highly subjective and based on Freudian theory. But since 1980 there's been real effort to make the criteria much more objective,",English
+"to make the set of behaviors or observations that are required to diagnose someone be things that are observable,",English
+"that you can see in other people that they can report on reliably, and that one clinician and another clinician will agree upon. So, the DSM gives lists",English
+"of symptoms with the required symptoms for a diagnosis, the number of symptoms that have to be present, and the notions of deviation, dysfunction and distress are",English
+"built into these criteria. And I'm going to give you a couple of examples of these criteria when we talk about the specific types of mood disorder. So as I said,",English
+"I'm going to use mood disorders as kind of a case example here of how we go about diagnosing and understanding psychopathology, but I also just want to impart",English
+some information because mood disorders are one of the most common problems that people face. As many as one in four women will have an episode of serious,English
+"depression at some time in her life, and about 13% of men will have an episode of serious depression in their lives. So, these are extremely common",English
+"kinds of problems that people experience, particularly at your age. The college years are one of the peak times of onset, first onset,",English
+"of depression in particular. And also, for bipolar disorder, or manic-depression, the late adolescent, early 20s are the peak onset times for these disorders as",English
+"well. So, the mood disorders divide into what's called unipolar depression disorders, which is depression only and then bipolar disorders where the",English
+"person cycles between depression and mania. And here are the DSM criteria for major depression, one of the most severe forms of depression.",English
+"And as I said, the DSM sets up these relatively observable criteria and how many you have to have and what absolutely has to be present in order to get the",English
+"diagnosis. So, the first criterion in the DSM for major depression is that the individual has to either show sadness or a diminished interest or pleasure",English
+"in their usual activities, which is referred to as anhedonia. So, you have to have one or the other of these to sort of pass the first criterion.",English
+"So, you might say that you feel sad and blue and just--or actually say you feel depressed. Some people feel those feelings very strongly. Other people don't really feel",English
+"so sad or blue, but what they'll say is that nothing interests them anymore. It's like the emotion has been sucked out of their life altogether.",English
+They don't have any fun doing the activities they used to do before. They don't want to hang with their friends. They just--they don't care,English
+"about eating. Just nothing feels right, feels good, anymore. And then the individual has to have four of the--at least four of the following symptoms in",English
+"addition to sadness or anhedonia. First, they can show significant weight or appetite change. So, you may completely lose",English
+"your interest in eating and lose a lot of weight, or some people go on eating binges. I had a very good friend who was depressed for about a year,",English
+"and she gained fifty pounds because she would just eat. She would binge eat, especially at night. There are sleep disturbances--insomnia,",English
+"which is having trouble sleeping, or hypersomnia, which is sleeping all the time. There's a particular form of insomnia that's especially likely in depression where you",English
+"can go to sleep at night, but then you wake up at about three or four in the morning every night and you can't go back to sleep at all. You're just up for the rest of",English
+"the night. But other people want to sleep all day long, and in the clip I'm going to show you in just a minute the woman talks about sleeping twenty, twenty-two hours a day,",English
+"getting up, eating a little bit, and then going back to bed because she was exhausted still. The third criterion is psychomotor retardation or agitation.",English
+"The retardation is much more common, and what this means is that sort of everything about the person's movement is slowed down. They'll walk more slowly.",English
+"Their reaction times will be slowed down. And because they're so much more slow moving, depressed people are often more prone to accidents.",English
+"They just can't react as quickly as they need to when they're driving or when they're crossing the road and a car is coming at them suddenly. So, they get into more",English
+"accidents. And their speech may be slowed down. They may talk very, very slowly and it's as though it just takes a tremendous",English
+"amount of energy to get even a common sentence out. A much more, much smaller number of people get agitated instead of slow down.",English
+"They may be hyper and just feel like they can't sit still and such, but the agitation is much more rare than the retardation. People feel really tired, fatigued and like they have",English
+"absolutely no energy. They can't get up and can't get moving. As I said, they may want to just sleep all of the time. Number five is feelings of",English
+"worthlessness or excessive guilt. They may feel as though everything is their fault, and the guilt feelings or sense of worthlessness can even get",English
+"psychotic. They can lose touch with reality. When a person loses touch with reality when they're depressed, it typically has really depressing themes. They may believe that they are",English
+"Satan and that they have to commit suicide because they're inflicting evil on the world. They may believe as though random events are their fault, you know, that a flood that",English
+"just happened somehow they caused. So, the feelings of worthlessness and guilt can get completely out of touch with reality, psychotic.",English
+"More commonly, they're just unrealistic. They're negative self-esteem, just being down on yourself, feeling stupid and worthless and ugly and bad.",English
+Number six is diminished ability to concentrate or indecisiveness. When you are depressed it's really hard to pay attention. You'll read a passage over and,English
+over again and you just can't process it at all. You can't concentrate on a lecture so going to class is just useless. You have to make a decision,English
+"about what a paper topic is, and it just seems like the most monumental thing on earth. You just can't decide anything, you can't think anything; your thoughts are completely",English
+"clouded and overwhelmed. And then suicidal ideation or behavior; it means you think about committing suicide, you think about dying.",English
+"And a subset of people actually take action to try to hurt themselves or kill themselves. Now, it should be said that suicidal thoughts and behavior don't only happen in depression.",English
+"They actually happen in all types of psychopathology, but they're particularly common in depression. So, you have to have at least one--four of those symptoms plus",English
+"sadness or anhedonia, and these symptoms--it can't just be a bad day that you're having. These symptoms have to be present persistently for at",English
+"least two weeks to get the diagnosis. Now, truth be told, most episodes of major depression actually last a lot longer than two weeks.",English
+"In fact, the average length of an episode, if it's not treated, is at least six months. So, people stay this miserable for a very long period of time, but the minimum criterion in",English
+"the DSM is at least two weeks. So, what I want to do is to just show you a short clip of a woman who has had a lot of episodes of depression.",English
+"Fortunately, at the moment she's not in an episode. But she can speak very articulately about what it's like to be in the midst of an",English
+episode and some of the significant symptoms that she had. Okay. There are couple of things she talks about that I just want to,English
+"comment on. One is this differentiation between everyday sad mood and the kind of depressions we all experience and the kind of debilitating,",English
+overwhelming depression that she experiences. And it is true that there is this continuum from getting bummed out because you didn't do well on a test or because you,English
+"broke up with a boyfriend or girlfriend or something like this and being completely not functional, vegetative, the way that this woman becomes whenever she gets",English
+depressed. And it would be nice if we were really sure where the cutoff was between those normal everyday depressions and what's really a disorder.,English
+But the reality is we don't really have real clear demarcation lines. There are a lot of people who have more moderate forms of depression than Tara here talks,English
+"about but who still would qualify for a diagnosis and are still suffering and impaired by their symptoms. So, I don't want you to get the sense that if you don't have the",English
+"kind of horrible version on the extreme end of the continuum of depression that Tara has, then there's nothing wrong with you, because that's not the case.",English
+"People who are really slowed, whom their functioning is interfered with--they're just really unhappy with life--have",English
+problems that can be helped and do need attention. And it is the case that much more moderate forms of depression can morph into more serious forms if they're left,English
+"untreated. So, there is this continuum. The other things I wanted to comment on that she talks about early on in this piece is the fact that she hauls herself up",English
+"and goes through her day, even when she's feeling really, really depressed. And there is this characteristic of a lot of depressed people that I call the",English
+"""walking wounded."" They just haul themselves through the day trying to act normal, trying not to let anybody know that there's anything wrong with them,",English
+trying to keep up with their schoolwork or their employment. But they're miserable and they're not functioning at the level that they're capable of and such.,English
+"And that's something that's very, very common, and it's in part because people don't feel as though they should have to get treatment or they're ashamed of getting treatment or",English
+"seeking help for depression. And so, they just keep going on and going on, sometimes for years, in a very sorry state before--sometimes they",English
+just--they end up actually falling apart to the point where they have to get help. Okay. The other category of mood disorders that I mentioned is,English
+"bipolar disorders. And as I said, bipolar disorder involves symptoms or periods of depression but then also distinct periods of the opposite",English
+"of depression, which we call ""mania."" So, the person cycles back and forth between debilitating depressions and manic episodes. So, let me describe manic",English
+"episodes to you now. So, the first criterion is that instead of feeling down, blue or depressed the person has an abnormally and persistently elevated expansive",English
+"or irritable mood that isn't just, again, a good day because you won a prize or got an ""A,"" but rather, it's this unusually positive,",English
+expansive mood for at least one week persistently. And then the person has to have three or more of the following,English
+"insightful, powerful person on earth, and they are perfectly happy to tell you this. So, there is no problem with self-esteem, thank you very",English
+"much. ""If you can't keep up with me it's your fault."" There's a decreased need for sleep; they may only sleep a couple of",English
+"hours a night and get up raring to go. They tend to be more talkative than usual, and there's a really pressure to their talk. They'll talk really pressured,",English
+"and they'll talk really, really fast. And one of the reasons they're talking really, really fast is they have this flight of ideas. The thoughts are just racing through their mind,",English
+"and they can't talk fast enough to get them out. And if you can't follow them, that--well, that's because you're not smart enough to follow them. But they've just got too many good ideas and they've got to",English
+"get them out. They're highly distractible. And then there is this increase in this--what the DSM calls this ""goal-directed activity.""",English
+Out of their grandiosity will come these grand schemes for--often for making a lot of money and they'll pursue these with great vigor no matter how totally irrational they are.,English
+"So, it's not at all uncommon for them to cash out all the family bank accounts, to sell the house, to sell the car, to sell the kids so that they",English
+can finance this great scheme for making a zillion dollars on the Internet tomorrow. Right? Okay. And they'll pursue this with,English
+"tremendous vigor. They'll also get involved in all kinds of, what the DSM discreetly calls ""pleasurable but dangerous activities.""",English
+"There's a lot of sexual promiscuity, a lot of drug abuse, a lot of, as I said, getting--going and gambling, believing that you're on a hot",English
+"streak, there's nothing can stop you. You know, you're just so brilliant and you've got this scheme, you've got the plan. You're going to make it. Okay? So, the individual has three of",English
+"more of these kinds of symptoms plus this elevated, expansive and often quite irritable mood. It's not just that they're happy, you know,",English
+and sort of upbeat. It's just that they're just impatient and irritable and trigger-fire. And sometimes they can become violent because they're,English
+"just--they're so incredibly agitated and irritable. So, let me show you a couple of clips. I have one really short one. It's not a real high quality",English
+and racing thoughts can look like. And then the other one is--I'll introduce whenever you--we do it. So while she was at the,English
+hairdresser's it's a nice example of how she was just pressured to speak. Nobody was telling her that she had to say all of these things. They were just standing there,English
+with a camera and she was going on and on and on about these things. And as you could see she was getting more and more agitated and more and more irritated as,English
+"she was retelling her story. And then what? In the last little bit there you saw her flip from her mania into a more depressed state. And this poor lady,",English
+"unfortunately, is having a hard time finding a stable point. He talked about lithium there, and I'll talk about it in a little bit--about the use of",English
+"lithium as a drug to try to stabilize these mood swings. But at this point in this video, it's not working for this lady. And so, she's flipping back and",English
+"forth, but they're having a hard time finding that middle ground. So, I want to show you another clip--it's a little bit longer--of a man who has bipolar disorder.",English
+"He is not currently in an episode of either depression or mania, but again, he can talk about some of the things he got himself into and how it manifested in his",English
+behavior. Okay. Just a couple of things that Bernie talks about that I want to comment on. One is that just as in,English
+"depression, mania has--runs along a continuum. So, it can be relatively mild all the way to extremely severe and even psychotic. So, when a person with mania",English
+"loses touch with reality, instead of having beliefs that they are Satan or they've done some horrible thing, they'll believe that they are some supernatural being.",English
+"They may believe that they are the Messiah or that they are Albert Einstein, you know, come back to life, or that they have supernatural powers or something of this",English
+"sort, so that their false beliefs, their delusions and their hallucinations, the things that they see and hear that aren't really there",English
+"tend to be very grandiose in their themes. Bernie's mania is not on the far end of the continuum by any stretch, but you can see it still gets him into trouble.",English
+"Now, there are people who have--who cycle between fairly low levels of mania and fairly low levels of depression, back and forth. And there's been some argument",English
+"that people who are kind of chronically, mildly manic--especially if they're really smart or they have a special talent – can make it work for them.",English
+"And there is a wonderful book by Kay Jamison, who is a professor at Johns Hopkins where she chronicles--She does sort of historical biographies on a",English
+"number of well-known authors and poets and musicians, Robert Schumann and a number of politicians, Winston Churchill",English
+"and such, arguing that they actually had mild forms of bipolar disorder and that they were able to sort of channel the manic episodes through extraordinary talent or",English
+"intelligence in ways that made it work for them. There are also a number of arguments that very, very successful CEOs sometimes are people who are chronically",English
+"slightly manic. They can go on a couple of hours a night of sleep; they're obviously really quite grandiose and self-confident, and that they can maintain this",English
+"kind of moderate level of mania, keep it under control and channel it in ways that work for them. So, if you're interested in that book, send me an email and",English
+"I'm happy to send you the citation for it. But for the most part, mania can get people into tremendous trouble. They can, as I said,",English
+get involved in sexual promiscuity that puts them at risk for sexually transmitted diseases. They can get involved in drug activity.,English
+They can get themselves arrested. They can certainly send themselves and their family into bankruptcy. And these kinds of negative consequences of the mania often are what motivates the person to,English
+"get help because the mania itself can be rather pleasurable to have. Also, what motivates them to get help is the plunge into depression, the knowledge that",English
+"they will, at some point, come out of the mania and go into a debilitating depression. Bipolar disorder is much less common than depression.",English
+"I said that about 22% of women and about 13% of men will have an episode of serious depression at some time in their lives. Bipolar disorder occurs in only about 1% of the population,",English
+"and it's equally prevalent in women and men. So, it's a really quite different disorder in many ways from depression alone. I want to give you some other",English
+"statistics about depression per se, and this only applies to depression. There are quite large age differences in the prevalence of depression.",English
+"These are data from a nationwide study of people between the ages of fifteen and fifty-five, and these are the percentages of people in this study.",English
+And there were several thousand people in the study. These are not people who have sought treatment for depression but just a random community sample.,English
+"And this is the percentage who've had an episode of major depression in the past month. And as you can see, the fifteen to twenty-four age range has the highest rates,",English
+"and then they go down somewhat, although the thirty-five to forty-four is fairly high as well with age. You might be surprised to learn that the rates of major",English
+depression in the elderly are actually quite low by most national statistics. And that's true up to about age eighty or eighty-five. And the arguments for why this,English
+"is the case are very interesting. There are some people who argue that as you get older you get wiser, and so that's why we see lower rates of depression in",English
+older age. There are other people who argue that current generation--younger generations now; your generation and the one,English
+"above you--are more prone to depression and will be for the rest of your life compared to your grandparents, because of historical changes in the kinds of social support",English
+and family networks available and a number of other historical cultural changes. The other sort of side of the argument is that because depression is known to impact,English
+"negatively your physical health – depression is associated with higher rates of cardio-vascular disease, stroke, immune system diseases, a whole host of diseases that",English
+"people die from--that people who have a lifelong history of depression are actually more likely to die at an earlier age, and that's why we see relatively low rates in older",English
+age people. We don't know yet which of these explanations is true. It may be that they're all true to some extent. There are also gender,English
+"differences in depression. These are data from a compilation of hundreds of studies of children and adolescents, looking at not full-blown",English
+"depression but levels of depression on self-report questionnaires. Probably most of you have filled out these questionnaires, like the Beck Depression",English
+"Inventory that ask you how you've been feeling in the last month. And there's a kiddy version of this, and these are data from that, from several thousand",English
+"children. And as you can see here, prior to the age of about thirteen, boys and girls have relatively similar levels of depression.",English
+"But beginning around the pubertal years, girls' rates of depression go up quite dramatically and boys' rates stay the same or go down. And by the time they're",English
+eighteen or twenty you get almost a two-to-one ratio of depressed girls to depressed boys. And then this is true for the rest of the adult age span.,English
+"There are lots of hypotheses about this, why it's true. There are biological hypotheses that have to do with hormones. There are sociological hypotheses that have to do with",English
+"the kinds of stress, and particularly abuse, in girls' lives relative to boys'. We don't know exactly why. It's probably a lot of these",English
+"things coming together that make this huge two-to-one ratio true. So, let's talk a little bit about the major theories and treatments for the mood disorders.",English
+"There are biological theories and treatments, what are known as cognitive behavioral theories and treatments and then interpersonal theories and treatments. And I'll walk you through",English
+"examples of each of these. So, first, genetics. It's pretty clear that genetics are involved in the mood disorders, especially bipolar disorder.",English
+"There is very strong evidence in bipolar disorder, and there are a number of ways--Have you talked about how you do genetic studies? Okay.",English
+"So, you guys know about twin studies for example and family history studies. So, this is actually a compilation of a group of studies.",English
+"And here you've got some of them – twin studies--compared. So, in monozygotic twins, if your identical twin has bipolar disorder, you have over a 60% chance of",English
+"having the disorder yourself. In contrast, if it's your--if you're just a fraternal twin of a person with bipolar disorder, you only have about a 12%",English
+"chance of having the disorder. So, that massive difference there is very strong evidence that there's a genetic component to the transmission of the disorder.",English
+"Similarly, the more distant you get in terms of your biological relation to a person with bipolar disorder, the lower your rate or your risk of the disorder is.",English
+"So, the second degree relatives of a person with bipolar disorder only have about 2% chance of getting the disorder. And that's barely above what's in the general population,",English
+"which is about a 1% chance of getting the disorder. So, it's very clear that bipolar disorder has a genetic component to it. With depression alone,",English
+"major depression, there are probably versions of the disorder that have a stronger genetic component to them than others. And in particular,",English
+"folks who have what's called ""early onset depression,"" where their first episodes come on in childhood or very early adolescence, seem to have a form of",English
+"depression that has a stronger genetic component to it. Whereas, people who have depression that is clearly triggered by a major life event like a trauma or a loss--those",English
+types of depression are less clearly linked strongly to genetic factors. There are also a number of neurotransmitters that have been implicated in the mood,English
+disorders. And the class of neurotransmitters that's been researched most often is what's called the monoamines. I'm sure you've heard about the,English
+"link between serotonin and depression, but there are two other monoamines, norepinephrine and dopamine, that have also been linked to both of the mood disorders,",English
+both bipolar disorder and depression. And it used to be thought that it was just that in people with depression they didn't have enough of these,English
+"neurotransmitters, enough serotonin, in particular, in the system, in the brain, in order to function normally.",English
+But now the theories on what the role of neurotransmitters is have a lot more to do with the receptors for these neurotransmitters and their functioning.,English
+"And the notion is that the receptors for neurotransmitters like serotonin don't function efficiently. So, even if there's enough of the chemicals in the synapses in",English
+"the brain, the neurons can't make use of them because the receptors aren't functioning appropriately. And so what the drugs that help relieve depression do is to",English
+improve the functioning of these neurotransmitters. There's a very interesting line of work that's going on right now looking at the intersection of genetic predisposition,English
+"neurotransmitter functioning and stress. And we have one of the world's experts on this kind of work now here at Yale, Julia Kim-Cohen,",English
+"who just joined us in the last year. But there are several recent studies. There's another person in psychiatry, Joan Kaufman, who's done some of this work. But there are several recent",English
+"studies that find that certain variations or polymorphisms on the serotonin transporter gene predict who will become depressed in the face of stress. So, a classic study was done by",English
+"Avshalom Caspi and colleagues, and they found that people who have one or two of what's called the short allele on the serotonin transporter gene--so this is a particular variation",English
+"on the serotonin transporter gene--if they had one or two of these short alleles and they were confronted with stress, they were more likely to develop depression.",English
+But it's important to sort of dissect this. So people who had--it didn't really matter which of these genes you had. If you were never confronted,English
+"with major kinds of stress, like maltreatment, if you weren't confronted with stress, you were no more likely to have depression regardless of what",English
+"kind of serotonin gene you had. But if you had either one short allele or two short alleles and you were confronted with maltreatment as a child, you had a much greater",English
+"probability of becoming depressed at some time in your life. And this has been replicated with other samples, with other forms of major",English
+"Now, that may not be true for all genetic predispositions or all forms of depression, but this serotonin finding has actually been replicated now in at least four different studies.",English
+"So, it seems to be a pretty reliable effect. So again, genes do not determine the disorder, but the intersection of genes and stress seems to be a major",English
+risk factor for the disorder. There are a number of brain areas that seem to be involved in the mood disorders where there is just dysregulation or dysfunction.,English
+"The prefrontal cortex, as you probably have studied, is an area of the brain that's very involved in higher order complex thinking and problem solving and in goal-directed",English
+"behavior. In people with depression, there's lowered activity in the prefrontal cortex, suggesting that--which may play a role in the difficulties in",English
+"concentration, in goal-directed behavior, in planning and problem solving and in regulating emotion. The amygdala is an area of the brain that is involved in the",English
+processing of emotional information. And people with mood disorders show overactive amygdala responses to emotional information.,English
+This is true in both bipolar and in depression. The hippocampus is an area of the brain that's very involved,English
+"in memory and in concentration. And in people with chronic depression, you often see shrinkage in the hippocampus, and this may be related to their problems in concentration",English
+"and attention. And then finally, the anterior cingulate is an area of the brain that's involved in a lot of different activities, but pertinent to the mood disorders, particularly in",English
+responses to distress--to stress and in sort of the choice of behaviors. And it may be that dysregulation of the anterior cingulate may be involved in the,English
+"person's difficulty in responding appropriately to stress, in choosing good coping behaviors and changing their behaviors whenever their",English
+"behaviors aren't working well. So, from the biological theories come a number of different drugs to treat the mood disorders.",English
+Two of the older classes are called the monoamine oxidase inhibitors and the tricyclic antidepressants. The tricyclics are still used these days to some extent.,English
+"They're relatively effective. About 60% of people respond well to the tricyclics, but they have a lot of side effects, and they can be fatal in overdose.",English
+And so there was a--has been always a search for other alternatives to them. The drugs that have really taken over the market are the selective serotonin re-uptake,English
+"inhibitors or SSRIs. This is Paxil, Prozac and the like. They were introduced in 1987--Prozac was--in the U.S. market and truly took over the",English
+"market in the treatment of depression and anxiety and a number of other disorders. Now, they're not that much more effective than the sort of old style antidepressants,",English
+"but they have fewer side effects and they tend to be easier for people to tolerate. More recently, there are selective serotonin/norepinephrine",English
+"re-uptake inhibitors. These drugs, by the way, what these drugs supposedly do is to prevent the re-uptake of serotonin or serotonin and norepinephrine",English
+"back into the sending neuron. So, it creates more of the neurotransmitter there in the synapse. And these are reasonably effective drugs,",English
+"although, again, there's a substantial number of people who don't respond to them, especially immediately. And they'll often have to cycle through a number of drugs before",English
+they find one that works. Lithium is the drug of choice for the treatment of bipolar disorder. It seems to stabilize the mood swings by stabilizing the number,English
+of different neurotransmitter systems. But the lithium is problematic because there are tremendous side effects. It's also dangerous for women,English
+"to take while they're pregnant in terms of fetal development. So, it's a very tough drug to stay on. There are lots of gastrointestinal side effects",English
+"and such, and people are often on lithium and the antidepressants because lithium often only affects the manic episodes but it doesn't really relieve the depression.",English
+"And then finally anti-psychotic medications, that is those help people who've lost touch with reality, are sometimes used to treat the mood disorders whenever the",English
+person has lost touch with reality. I'm going to go through and talk about some of the psychosocial treatments because I want to get to them as well.,English
+The cognitive behavioral therapies are based on Aaron Beck's Negative Cognitive Theory of Depression. Aaron Beck is a psychiatrist at the University of Pennsylvania,English
+"who really founded this whole line of work. And according to Beck, this--now, this applies to depression alone. It doesn't really apply to",English
+"bipolar disorder. People who are depressed have a negative view of the self, of the future and of the world, and he calls this the ""negative cognitive triad."" And this negative cognitive triad is fed by specific",English
+"cognitive deficits or biases. So, depressed people show a lot of distortions in thinking. ""All-or-nothing thinking"" is thinking that things are either all good or all bad.",English
+"They can't sort of see the gray areas in between. There's ""emotional reasoning,"" and an example of that is just if I feel like a loser I must be a loser.",English
+"Of if I feel stupid, I must be stupid. And then ""personalization,"" that is the self-blame that you often see in depressed people. And these kinds of distortions",English
+"in thinking, these distorted ways of interpreting situations, feed a kind of general negative view of the self and hopelessness about the future. People who are depressed also",English
+"make attributions for negative events that are internal, that is, they blame themselves--that are stable. They see bad things as lasting forever and that are global.",English
+"They see bad events as affecting many areas of their life, which, again, feeds their depression and their general assumption that life is terrible.",English
+"And evidence that these--for these cognitive theories, that these negative cognitive styles predict depression--one of the best studies predicting this was a study that was",English
+jointly done at Temple University and the University of Wisconsin where they identified first year college students with a negative cognitive or attributional style.,English
+"But these were people who had never experienced an episode of depression yet. They then tracked them for the next two years, and the bars here--the red bars",English
+are the percent of those with a negative cognitive style who developed an episode of major depression in that two and a half years versus the percent of those without a negative,English
+"cognitive style. And as you can see, there's quite a substantial difference between the two. So prospectively, these characteristics seem to",English
+"predict your risk for depression. In turn, there is a cognitive behavioral therapy that's based on Beck's theory. And the major steps in this",English
+involve identifying the themes in a person's negative thoughts and triggers for them and in helping the person challenge those thoughts by asking them what the evidence is for their,English
+"interpretations, whether there are other ways of looking at the situation, how they could cope with the situation if a bad thing really did happen.",English
+"So, the therapist helps the client recognize negative beliefs or assumptions and then challenges the truth value of these, and then change aspects of the",English
+"environment that are related to depressive symptoms. So, they challenge your rational thinking, but they also recognize that there are really bad things that",English
+"sometimes are going on the life of a person who is depressed, and they help them engage in more active problem solving to change those environments. They also teach the person ways",English
+to manage their mood so that they don't tumble down into depression. And these cognitive behavioral therapies have been shown to be extremely effective and as,English
+"effective in some ways as the drug treatments. So, this is a recent study in which they had 240 patients with major depressive disorder. They gave them four months of",English
+"acute treatment with either cognitive behavioral therapy or Paxil, which is an SSRI. And in eight weeks here--they also had a placebo control group where they just got a pill,",English
+"but it was a sugar pill. At eight weeks, the Paxil group, which is in red, and the CBT group, which is in yellow, were relatively even, although the Paxil group had a",English
+little bit of an edge over the CBT group. But by sixteen weeks the Paxil and CBT group were absolutely even in terms of the percent of people who were no longer,English
+"transformed my sleep. I sleep so much deeper. I wake up far less during the middle of the night, if at all. And I wake up feeling far better than I ever have even",English
+"after the same amount of sleep. If you want to try Eight Sleeping, you can go to eightsleep.com/huberman to save up to $400 off their sleep fit holiday bundle,",English
+"which includes their new Pod 3 cover. Eight Sleep currently ships in the USA, Canada, United Kingdom, select countries in the EU, and Australia.",English
+"Again, that's eightsleep.com/huberman. Today's episode is also brought to us by ROKA. ROKA makes eyeglasses and sunglasses",English
+that are of the absolute highest quality. The company was founded by two All-American swimmers from Stanford. And everything about ROKA eyeglasses and sunglasses,English
+"were designed with performance in mind. I've spent a lifetime working on the biology, the visual system. And I can tell you that your visual system has to contend with an enormous number of challenges in order",English
+"for you to see clearly-- for instance, when you move from a sunny area to a shady area and back again, whether or not you're looking at something up close or often to the distance.",English
+ROKA understands the biology of the visual system and has designed their eyeglasses and sunglasses accordingly so that you always see with perfect clarity. ROKA eyeglasses and sunglasses were initially,English
+"designed for activities such as running and cycling. And indeed, they are very lightweight. Most of the time I can't even remember that they're on my face.",English
+"They're so lightweight. But the important thing to know about ROKA eyeglasses and sunglasses is that while they can be used during sports activities,",English
+"they also have a terrific aesthetic. And they can be used just as well for wearing to work or out to dinner, et cetera. If you'd like to try ROKA eyeglasses and sunglasses,",English
+"you can go to ROKA-- that's roka.com, and enter the code Huberman to save 20% off on your first order. Again, that's ROKA, roka.com, and enter the code Huberman",English
+ANDREW HUBERMAN: I have a lot of questions for you. And I'm really excited about this topic because I think most people know what mental illness is-- or they have some idea what that is.,English
+Most people have some idea what nutrition is. Fewer people certainly know how closely those things can interact.,English
+And I think everybody is familiar with the feeling of a food or the ingestion of a food making them feel good in the short term.,English
+"When we eat a food that tastes delicious to us or that we associate with something nice, then we feel good mentally and physically. Whereas, when we eat something that gives us",English
+"food poisoning or maybe even something that just doesn't taste that great or that we associate with a bad experience, we feel less good in the short term. But I believe that very few people understand",English
+"or are familiar with the fact that nutrition and our mental health interact in this very intimate, maybe even causal, way and that is something that occurs",English
+"over long periods of time. Meaning, what I ate yesterday or the day before, maybe even 10 years ago, could be impacting the way that my brain and body are making me feel now.",English
+"So if you would, I'd love for you to just tell us about a little bit of the history, in particular, your history with exploring the relationship between nutrition and mental health.",English
+"And then we can dive into some of the more particulars of ketogenic diets versus other diets, and some of the truly miraculous findings",English
+that you and others are coming up with based on real patients and real experiences of people who suffer and then find relief by altering their nutrition.,English
+"But to set the stage, when I was a kid, I definitely had mental illness, started with OCD. A series of events happened in my family.",English
+"My mother had a horrible kind of psychotic break, and all sorts of adverse childhood events for me. She and I were actually homeless together for a while.",English
+"I went on to have subsequent depression, suicidality, all sorts of things. But somehow or another, I pulled myself together and got",English
+"through medical school-- actually did quite well in medical school, got an award for being one of the top students, and then was doing my internship and residency at Harvard.",English
+"And at that point in time, I was diagnosed with metabolic syndrome. So I had high blood pressure, horrible lipids,",English
+"and pre-diabetes. And I was doing everything right supposedly. I was on a low-fat diet, and I was exercising regularly. And year after year, my doctor kept",English
+"telling me diet and exercise. I kept asking him, what diet? What exercise? I was doing everything he kept telling me to do.",English
+"Everything was getting worse. My blood pressure kept going higher. And at some point, he kind of said, you're going to have to go on medication.",English
+"I need to put you on something for your pre-diabetes, something for your cholesterol, and something for your blood pressure. So three pills out of the gate.",English
+"And I'm like, I'm only in my 20s. ANDREW HUBERMAN: Were you overweight? CHRIS PALMER: No. Technically, no. I had a gut, so that's a sign of insulin resistance, I know now.",English
+"I didn't know it then. And he actually kind of leaned in at one point and said, do your parents have diabetes?",English
+Yeah. Do your parents have high blood pressure? Yeah. Are your parents overweight? Yeah.,English
+"Oh, I'm really sorry, it's genetic. Basically, you're screwed. It's your genes.",English
+"You're just going to have to bite the bullet and take meds. And as a physician, I knew what that meant. I knew that I'm in my 20s, if I'm already",English
+"on three meds for metabolic syndrome, I'm going to be screwed by the time I'm 40 or 50. And I'm probably going to be having heart attacks.",English
+And I'd heard through the rumor mill that the Atkins diet could somehow help people improve their cholesterol in pre-diabetes.,English
+I actually didn't really believe it. I was highly skeptical. And I believed everything I was taught in medical school. Why would my professors lie to me?,English
+They knew what they were talking about. Low-fat diet was the thing to do. And the Atkins diet was clearly dangerous and reckless.,English
+"But I had been trying the medical dogma for years, and it wasn't working for me. And so for whatever reason, I decided",English
+"I did my own special version of it. I still avoided red meat because I was terrified of red meat. I tried to do a healthy version, which it's probably",English
+"more like the South Beach diet. This was before the South Beach Diet was invented. But within three months, my metabolic syndrome",English
+"was completely gone. ANDREW HUBERMAN: So blood pressure normalized, lipids normalized. Did your weight change?",English
+You mentioned that you were of healthy weight but that you had a bit of abdominal-- CHRIS PALMER: Yes. ANDREW HUBERMAN: --fat. CHRIS PALMER: I lost the abdominal fat.,English
+"I probably lost about 10 pounds through this process. But everything got normal. And when I went back to my doctor, he was shocked.",English
+Because it sound like you're very clear that there was metabolic syndrome or you were headed towards more severe metabolic syndrome. You mentioned OCD.,English
+"I actually am familiar with this. As a kid, I had a low level kind of Tourette's grunt. And probably me, obsessive still to some extent--",English
+"although not full-blown clinically diagnosed OCD, so I can relate somewhat. If you're willing, what was the context",English
+"of all that before and after this nutritional switch? CHRIS PALMER: So before the nutritional switch, I was still struggling with low grade depression and OCD.",English
+"Again, it wasn't necessarily interfering with my ability to function because I was functioning at a high level. Anybody looking from the outside, you're a top student.",English
+"You just got into one of the most competitive-- actually, at that point, it was the most competitive residency program in the country for psychiatry.",English
+"So they would have looked at me and said, you're fine. But I wasn't. I was actually on medications. I was trying different medications,",English
+"trying to figure out how to feel better, how to stop obsessing so much, how to not be so depressed. And I found that those medications,",English
+they actually came with more side effects for me than benefits. I was on Prozac for a long time. It totally messed up my sleep.,English
+"that's not really resonating very well with me. And I'm now a psychiatrist. I'm in my psychiatry residency. And I'm thinking, you know what?",English
+That's just not sitting well with me that you're going to prescribe more and more meds for all the side effects that you're causing.,English
+"And yet at the same time, I wanted to feel better. And I was learning chemical imbalances. This is what we do to get rid of depression and OCD.",English
+You're supposed to take your pills. And so I was taking my pills. I was in psychotherapy. I had been in psychotherapy on and off for years.,English
+I had received much more intensive treatment when I was younger. And that was essentially worthless for me. It actually probably just caused harm at the end of the day.,English
+"ANDREW HUBERMAN: Psychoanalysis? CHRIS PALMER: Various psychotherapies-- not psychoanalysis per se, but some of them",English
+"were psychoanalytically-oriented psychotherapies. I was actually hospitalized at one point. I had been put on lithium and imipramine, which",English
+"is a tricyclic antidepressant, and other things. And they were actually horrible. They were horrible.",English
+They did nothing beneficial for me. I gave them a decent amount of time to work. I really wanted to feel better.,English
+"So at the time that I tried this diet, I certainly wasn't impaired in the same way. I wasn't struggling that much.",English
+"But I was-- still have these low grade symptoms, was trying to feel better. And the thing that was the most striking to me,",English
+"after doing the diet for three months, was not the fact that my metabolic syndrome was gone. That was my goal, and it was a seemingly miraculous",English
+achievement because I got rid of everything with one dietary change. But the thing that I noticed was dramatic improvement,English
+"in my mood, energy, concentration, and sleep. I-- for the first time in my life, I started waking up before my alarm went off",English
+and feeling rested. That never happened to me before. I was meticulous about planning when my alarm went off,English
+"and how many times I could push the snooze button in order to be on time for wherever I needed to be, whether it was school or the hospital or whatever.",English
+"I had it. I had this good system. I was never late for anything. But that was shocking to me, that I felt so good.",English
+"And one of the things that I've often said to people, prior to the diet, I always felt like there are two types of people in the world.",English
+"There are ""haves"" and ""have-nots."" There are these happy, peppy people, who just are so positive, and they've got energy. And they have the saying, they like",English
+to work hard and play hard. And I always understood working hard. I totally got that because I was a hard worker,English
+"and I understood the value of hard work. And you got to do something useful with yourself. But I never understood who the hell wants to play hard,",English
+like who's got energy for that? Aren't you tired from working so hard? How on Earth do these people have energy to go and play hard?,English
+"And I assumed that they were just part of the ""haves"" in the world. And they were just lucky and privileged.",English
+They either had good genetics or maybe they had good childhoods or good parents or something-- something that I didn't have.,English
+"ANDREW HUBERMAN: The kids with genuine smiles in the yearbooks. CHRIS PALMER: Yes, exactly. ANDREW HUBERMAN: [LAUGHS] CHRIS PALMER: Yes.",English
+"ANDREW HUBERMAN: Whereas, the rest-- and by the way, I really appreciate you sharing some of your personal story because I think it is very important for people",English
+"to hear and understand that people like yourself, who are extremely high functioning and accomplished, that the road was--",English
+"from everything I'm hearing and understanding-- very choppy internally at times, and that you've overcome a lot in order to get there.",English
+"And also, have been going through what sounds like a very long iterative process of trying to figure out what works and what doesn't work to finally arrive at a solution,",English
+and then make that the basis of much of the work that you're doing today for other people. I think it's very important because I think many people,English
+share with you this notion that there are indeed two groups-- a happy group and then fated-to-be unhappy group.,English
+"And it speaks to the fact that-- your story, rather, speaks to the fact that what we see is not always what's going on internally with people and that",English
+"this notion of there just being two groups-- the happy or the haves and the have-nots-- can't be the way that it works, and there are probably",English
+"many more people suffering than we realize, and that there is an important need for tools to overcome that suffering.",English
+"So I really just hear you. Even early in our discussion, I just want to extend a genuine thanks because so much of what I hear from people is questions about health,",English
+"and mental health, and physical health. But that clearly point to the fact that many people are struggling to varying degrees. And even the people who are in this category",English
+of great childhood and happiness could do far better for themselves and then also for other people. So thank you for that.,English
+I want to know. At the point where you realized that nutrition can play a profound role in how you feel and operate,English
+"in a large number of domains, you are still a student or a resident at that point? CHRIS PALMER: I was a resident.",English
+"ANDREW HUBERMAN: At that point, did you decide that you were going to explore this in a professional context? CHRIS PALMER: Not yet. ANDREW HUBERMAN: OK.",English
+So what was the journey forward into the work that you're doing now? CHRIS PALMER: So the next step was that I just,English
+"had friends and family who saw me, saw that I had improved my health, saw that I lost some weight pretty easily.",English
+"In particular, I remember my sister and sister-in-law, they got really pissed at me one Thanksgiving because I could resist all the pumpkin pie, and apple pie,",English
+"and everything else. They were like, how the hell are you doing that? How are you resisting all of this food? And I said, I don't crave it anymore.",English
+"I don't want it, I'm fine. I'm just-- I'm having turkey and green beans. And that's good enough for me. So I got them to do the diet.",English
+"And they too noticed dramatic improvement in their moods, and energy, and sleep, and everything else. So within a few years, the primary thing I noticed",English
+"is this powerful antidepressant effect. And now, I'm an attending physician. I've got all these patients in my clinical practice",English
+with treatment resistant mental illness. I'm in a tertiary care hospital. So I almost never get somebody off the street with their first episode of depression.,English
+"Out of the gate, as part of my career, I get treatment resistant mental disorders. So I get people who've already been to 6-plus psychiatrists,",English
+therapists. They've usually tried dozens of different medications. They've been in decades of psychotherapy. They've often had ECT and other things.,English
+"And nothing's working. And I'm thinking, well, we're kind of out of options for these other people. And this diet is having this really powerful antidepressant",English
+"effect. I think I'm going to try it and just see if any of my patients are game to try it to see if it might help them. Sure enough, it did.",English
+Didn't help everyone and not everybody was interested and/or able to do it. But some of the ones who were able to do it,English
+ended up having a remarkable and powerful antidepressant effect. One woman actually became hypomanic within a month. And she had been depressed pretty much,English
+"nonstop for over five years-- chronically depressed, suicidal, in and out of hospitals. And I saw her become hypomanic.",English
+"And I'm thinking, wow, this really is a powerful antidepressant effect. This is amazing. This is like a medication but better because it actually",English
+"is working for her. But I laid low at that point because, at that point, we didn't have many clinical trials of the safety",English
+"or efficacy of the Atkins diet for even weight loss or diabetes, let alone any mental disorders. And so I really actually felt like I'm on the fringe here.",English
+And this is not going to be met with praise by anyone. So I'm just going to lay low. I'm going to offer it to patients.,English
+And I went along that way up until 2016. ANDREW HUBERMAN: And may I just ask about the diet?,English
+"When you say ""Atkins diet,"" so this is low to zero starch, so low carbohydrate diet, certainly low sugar.",English
+"CHRIS PALMER: Yeah. ANDREW HUBERMAN: And was it traditional Atkins? Were you tailoring it to the individual patient depending on their psychiatric symptoms,",English
+"whether or not they were overweight or not overweight? I'm assuming you're not a nutritionist, so how did you prescribe a nutrition plan for your patients?",English
+"And what was involved in making sure that they adhered to that, maybe even some of the things you observed in terms of who was more willing to try this or not try this?",English
+"Any observations or maybe even data? CHRIS PALMER: So early on, I was winging it. And I was-- the first few patients,",English
+"it was try this Atkins diet. I want to see ketosis, so I was going for ketones. ANDREW HUBERMAN: So they were pricking their finger, and they were doing a blood ketone test?",English
+CHRIS PALMER: I didn't know about blood ketone monitors if they existed back then. So I was-- we were using urine strips. ANDREW HUBERMAN: Which are not quite as accurate,English
+"but still useful as a general guide, from what I understand. CHRIS PALMER: True. ANDREW HUBERMAN: Is that right? CHRIS PALMER: Absolutely. ANDREW HUBERMAN: OK.",English
+"CHRIS PALMER: So I was strongly recommending that patients achieve urinary ketosis. And the interesting thing is I noticed a pattern,",English
+"that when they were trying the diet and not getting ketones, they often did not get a clinical benefit. It was once they got into ketosis",English
+"that I began to notice the clinical benefit and the powerful antidepressant effect. ANDREW HUBERMAN: So probably any nutrition plan, a.k.a diet,",English
+"that elevated ketones in the urine to the point where you would say, this person is in ketosis-- or they would say I'm in ketosis--",English
+"that was a step in the right direction, independent of exactly what they were eating or not eating to get there, including fasting?",English
+"At that time, probably, fasting wasn't as popular now. Thanks to the incredible work-- I think it's incredible, and he is a former colleague. And I know there's a lot of controversy about fasting.",English
+"But I think, for many people, fasting is a powerful tool. For others, it's a less useful tool --of Satchin Panda and others.",English
+But fasting certainly will limit your carbohydrate intake and get you into ketosis. Correct? CHRIS PALMER: It will.,English
+"ANDREW HUBERMAN: Did you have any patients fast or do intermittent fasting? CHRIS PALMER: I did. I had some patients who did what Atkins had called a fat fast,",English
+where they eat primarily fat. So they either fast and/or they eat primarily fats to try to get into a state of ketosis.,English
+"So for some patients, it was actually quite easy to get into ketosis, especially overweight and obese patients. They have a lot of fat stores on their body",English
+"and actually limiting carbohydrates usually results in high levels of ketosis for them. ANDREW HUBERMAN: And they probably feel better too, I imagine, because when",English
+"we limit our starch intake, we start to excrete a lot of water. People can get some pretty quick weight loss that even though it may not be fat loss,",English
+makes them feel literally a little lighter and maybe a little more energetic. Is that right? CHRIS PALMER: Absolutely.,English
+"And as the years went on, the field was advancing, more research was coming out. People were getting a little more sophisticated",English
+"with blood ketone monitoring, with different versions of ketogenic diets. And I was evolving my practice.",English
+"The thing that completely upended everything that I knew as a psychiatrist, though, was when I helped a patient in 2016 lose weight.",English
+"So this was a patient, 33-year-old man with schizoaffective disorder. He had been my patient for eight years now.",English
+"ANDREW HUBERMAN: Could you clarify for people what schizoaffective disorder is? I'm not a clinician. But as I recall, it's like a low level of schizophrenia.",English
+"So there might be some auditory hallucinations. If I met this person, I might think they're kind of different, quote unquote, ""weird."" But they would not seem necessarily",English
+"scary to me and to typically to other people. And I mean that with respect, of course. But oftentimes, people with schizophrenia",English
+"can seem just like-- you don't even know how to interact with them because their world seems so altered because they have all these so-called positive symptoms-- hallucinations, and they're",English
+"talking to people that no one else can see, et cetera. Is that schizoaffective? CHRIS PALMER: So no. So schizoaffective is the same as schizophrenia essentially.",English
+"The only difference is it's schizophrenia with superimposed mood episodes. ANDREW HUBERMAN: Oh, so it's actually more severe than-- CHRIS PALMER: It can be.",English
+"ANDREW HUBERMAN: OK. So I have it backwards. CHRIS PALMER: So schizoaffective disorder is essentially schizophrenia and plus some mood episodes. ANDREW HUBERMAN: Ah, maybe I'm thinking of schizotypal?",English
+"CHRIS PALMER: Schizotypal is the low grade, kind of mild paranoia, or kind of eccentric beliefs, and other things.",English
+"ANDREW HUBERMAN: OK. Folks out there, I have my nomenclature backwards. Schizotypal is the, quote unquote, lower-- ""low level"" schizophrenia or schizoid-like.",English
+"Schizoaffective is as or more severe. CHRIS PALMER: Full-blown schizophrenia plus full-blown usually bipolarism. ANDREW HUBERMAN: And now, it's absolutely clear",English
+who the clinician in the room is. [LAUGHTER] Thank you for that reminder. CHRIS PALMER: No worries. So this man had schizoaffective disorder.,English
+He had daily auditory hallucinations. He had paranoid delusions. He could not go out in public without being terrified.,English
+"He was convinced that there were these powerful families, that they had technologies that could control his thoughts. They could broadcast his thoughts to other people.",English
+They were trying to hurt him. They had targeted him for some reason. He wasn't quite sure why. He had some suspicions and beliefs about maybe,English
+"when he did this bad thing when he was 11 years old, that's why they decided to target him. This man was tormented by his illness, tormented.",English
+"It ruined his life. He had already tried 17 different medications, and none of them stopped his symptoms. But they did cause him to gain a lot of weight.",English
+"ANDREW HUBERMAN: These medications, as I recall, for schizophrenia-- the classical ones are dopamine receptor blockers-- caused people to-- huge increases in prolactin.",English
+That's why sometimes men-- CHRIS PALMER: Yes. ANDREW HUBERMAN: --will get breast development. And they'll put on a lot of weight. And they'll be catatonic-- or movement disorders.,English
+"CHRIS PALMER: Yes. ANDREW HUBERMAN: They make you feel like-- I have to imagine, given how good most things that release dopamine make us feel, that blocking dopamine receptors with antipsychotics",English
+makes people feel lousy. CHRIS PALMER: Horrible. And it's a huge challenge in our field because a lot of patients don't want to take them.,English
+"And then you get these rebound effects. If patients are on them for several months, and then they stop them cold turkey, they can get wildly psychotic and ill,",English
+end up aggressive or hospitalized or sometimes dead. So that's him. He weighs 340 pounds.,English
+"And for whatever reason, he gets it in his head, I'm never going to get a girlfriend if I don't lose some weight. He also recognizes, I'm never going",English
+to get a girlfriend because I'm a loser. I'm schizophrenic. I live with my father. I have nothing going for me.,English
+"But I could at least try to address one of these awful, horrible things about myself. And maybe I could lose some weight.",English
+"So he asked for my help. For a variety of reasons, we ended up deciding to try the ketogenic diet. Now, at this point, I have no anticipation",English
+that the ketogenic diet is going to do anything for his psychiatric symptoms because this man has schizoaffective disorder. That's not depression.,English
+"Depression is very different. They're totally different disorders. So he decides to give it a try. Within two weeks, not only does he start losing weight,",English
+but I begin to notice this dramatic antidepressant effect. He's making better eye contact. He's smiling more.,English
+"He's talking a lot more. I'm thinking like, what's gotten into you? You're coming to life. Like you're-- I've never heard you talk this much.",English
+I've never seen you so excited or present or alive. I haven't changed his meds at all. The thing that upended everything,English
+"that I knew as a psychiatrist was six to eight weeks in, he spontaneously starts reporting, you know, those voices that I hear all the time?",English
+"They're going away. And he says, you know how I always thought that there were all these families who were controlling my thoughts",English
+"and out to get me, and they had targeted me? And I'm thinking, oh, yeah. We've been talking about that for eight years. We can talk about that again.",English
+"He says, you know what? Now that I think about it, I don't think that's true. And now that I say it, it sounds kind of crazy.",English
+It probably never was. I've probably had schizophrenia all along like everybody's been trying to tell me.,English
+And I think it's going away. That man went on-- he's now lost 160 pounds and kept it off to this day.,English
+ANDREW HUBERMAN: Wow. CHRIS PALMER: He was able to do things he had not been able to do since the time of his diagnosis. He was able to complete a certificate program.,English
+He's able to go out in public and not be paranoid. He performed improv in front of a live audience. at?,English
+"One point, he was able to move out of his father's home and live independently. And that completely blew my mind as a psychiatrist.",English
+And I went on a scientific journey to understand what in the hell just happened. ANDREW HUBERMAN: That is indeed mind-blowing.,English
+"I'd like to take a quick break and acknowledge one of our sponsors, Athletic Greens. Athletic Greens, now called AG1, is a vitamin mineral probiotic",English
+"drink that covers all of your foundational nutritional needs. I've been taking Athletic Greens since 2012, so I'm delighted that they're sponsoring the podcast.",English
+The reason I started taking Athletic Greens and the reason I still take Athletic Greens once or usually twice a day is that it gets me the probiotics,English
+"that I need for gut health. Our gut is very important. It's populated by gut microbiota that communicate with the brain, the immune system, and basically",English
+all the biological systems of our body to strongly impact our immediate and long-term health. And those probiotics in Athletic Greens are optimal and vital for microbiotic health.,English
+"In addition, Athletic Greens contains a number of adaptogens, vitamins, and minerals that make sure that all of my foundational nutritional needs are met.",English
+"And it tastes great. If you'd like to try Athletic Greens, you can go to athleticgreens.com/huberman, and they'll give you five free travel packs that make it",English
+"really easy to mix up Athletic Greens while you're on the road, in the car, on the plane, et cetera. And they'll give you a year supply of vitamin D3/K2. Again, that's athleticgreens.com/huberman",English
+"to get the five free travel packs and the year supply of vitamin D3/K2. I have a couple of questions. First of all, did he stay on any kind",English
+"of antipsychotic or other medication? If so, were the dosages adjusted, excuse me, while undergoing this remarkable transition?",English
+"Because as we know, it's not an either or medication or nutrition changes, it can be both. And then the other question is one of adherence.",English
+"I think about someone with schizoaffective disorder, who's suffering from all the sorts of things that you described. How does somebody like that organize themselves in order",English
+to stay on a ketogenic diet? And I say this with all the seriousness in the world. I think there are a lot of people who do not have schizotypal or schizoaffective disorder,English
+"who have trouble, they claim, adhering to a ketogenic diet. It's not the easiest diet.",English
+"Certainly in its extreme form at first, it's not the easiest diet to stick to. So how did he do it?",English
+That sounds like a remarkable individual. And I'd also like to just know your general thoughts about adherence to things when people are back on their heels,English
+"mentally. How do they get motivated and stick to something? So the questions were, medication, yes or no? If yes, dosage adjusted, yes or no.",English
+"And if people are suffering from depression or full-blown psychotic episodes, how does one ensure that they continue to adhere to a diet?",English
+"CHRIS PALMER: So in terms of medications, he has remained on medication. So early on, I wasn't adjusting anything.",English
+"I was just in disbelief and shock that this was happening. I didn't know what was going on. Over the years, we have slowly but surely",English
+tried to taper him off his meds. He has been on meds for decades. He started medications when he was a young child.,English
+His brain is as developed in response to all sorts of psychiatric medications.,English
+And it has not been easy to try to get him off. We continue to try to get him off medication. And it's challenging and difficult.,English
+"And I just want to say for any listeners, it is-- getting off your meds is very difficult and dangerous. And you need to do it with supervision,",English
+"with a mental health professional or a prescriber because it is dangerous. When people reduce their meds too much,",English
+they can get wildly symptomatic. ANDREW HUBERMAN: Is that true for depression as well? CHRIS PALMER: It's true for any psychiatric medication.,English
+The brain makes adaptations in response to psychiatric medications. And when you stop them cold turkey-- some people are fine.,English
+"But I wouldn't recommend finding out because I've seen patients-- when they stop antidepressants, I've seen patients get flooredly depressed and suicidal",English
+"within three months. I had one patient, almost quit her job because she became convinced that, well, my life sucks, and it's all because of my boss.",English
+"And I know that she's just a horrible human being. And she's abusing me. And I was like, whoa, whoa, whoa.",English
+"I think this is related to your medication change. We got her back on her meds, within three days, she said, oh my god, I can't believe that happened.",English
+I almost quit my job. And that would have been the most illogical and irrational decision I've ever made in my entire life.,English
+"But somehow, it seemed so real just several days ago. And now that I'm back on this medication-- and it doesn't mean that she needs the meds.",English
+"But it doesn't mean that he needs the meds. It means that meds need to be adjusted very safely, and cautiously, and gradually.",English
+"So that's the medication piece. The adherence piece was not easy for him and for other patients. It is very rare that I have a patient who I can say,",English
+"do the ketogenic diet. Come see me in 3 months, and let me know how it was going. That almost never happens. It has happened, I think, on two occasions.",English
+"ANDREW HUBERMAN: But that is, if I understand correctly, what-- perhaps not you-- but many psychiatrists do with medication.",English
+"It's, here's your prescription. Let's talk in-- CHRIS PALMER: Yes. ANDREW HUBERMAN: --a month or three months. CHRIS PALMER: Yes.",English
+ANDREW HUBERMAN: So that's a variable that is probably worth us exploring a little bit here as the conversation continues. CHRIS PALMER: Absolutely.,English
+"ANDREW HUBERMAN: That frequent contact and making micro adjustments or macro adjustments to medication or nutrition, could be meaningful. CHRIS PALMER: Absolutely.",English
+"So with this particular patient, early on, he was actually pretty adherent. I was seeing him once a week.",English
+And so I could do a lot of education. I was weighing him. I was checking his ketones. I was checking his glucose levels.,English
+"At that point, I had a blood ketone monitor in my office. So I knew whether he was compliant or not, which is so beneficial in doing clinical work",English
+"and research on this diet. It's the only diet where within seconds, I can have an objective biomarker of compliance or noncompliance.",English
+"ANDREW HUBERMAN: Such a key point and again, brings to mind, for me, the parallel with medication. A patient can say they're taking their medication,",English
+"and unless they're in a hospital setting, where somebody's checking under their tongue and all of this, they very well could not be taking it or taking more.",English
+And you and I both know that blood draws for neurotransmitter levels are complicated because you want to know what's in the brain,English
+and what's functional in the brain. And then we have to imagine that most people there prescribed drugs for any number of different psychiatric conditions are not giving blood every time they,English
+"talk to their psychiatrist or psychologist. No? CHRIS PALMER: No. On that front, when we've looked at studies of compliance,",English
+the majority of patients are at least somewhat noncompliant with prescription medications. It's not on purpose.,English
+They forgot. They take it at night. They were out late. They were off their routine.,English
+"They forgot to brush their teeth-- because that's when they take their meds. And so because it was so late, they just crashed when they got home.",English
+"They forgot to take their meds. Happens all the time. If it's a medication that people take more than once a day, the noncompliance rates are much higher because it's just",English
+easy to forget. So it's not that people are willfully disobeying their doctors or anything else. It's just hard to remember to take meds consistently,English
+"every day. ANDREW HUBERMAN: When you say measuring ketones, I want to drill into this a little bit because it does seem that the presence of ketones",English
+"and somebody being, quote unquote, ""in ketosis,"" it turns out to be the key variable. Certainly, in your book, that's one of the major takeaways--",English
+although there were many important takeaways-- that people get into ketosis. Do they have to stay in ketosis?,English
+"So for instance, I've followed the-- I don't any longer. But I've tried, in the past, the so-called cyclic ketogenic diet, where every third or fourth day, get",English
+"some pasta, or rice, et cetera. That was interesting as an experiment. But to stay in ketosis, what sort of blood levels of ketones",English
+do you like to see in your patients? What is the range that you think most people could aspire to? CHRIS PALMER: So it really depends on the patient,English
+"and what I'm treating, quite honestly. And I don't think every patient needs the ketogenic diet. For some patients, simply getting rid of junk food",English
+"can make a huge difference in a mood disorder, for instance. ANDREW HUBERMAN: So a junk food, meaning, highly processed food, food that could last on the shelf a very long time.",English
+"CHRIS PALMER: Highly processed foods that are usually high in both sugar, carbohydrate, and carbs, and fats.",English
+"Those seem to be the worst foods. That combination-- high sugar, high fat-- seems to be the worst combination",English
+"for metabolic health. And lo and behold, we've got emerging data that suggests, that strongly suggests, it's also bad for mental health.",English
+Depression and anxiety are the most common mental disorders. And so we have the best data for those disorders. But we actually have a lot of data with even bipolar disorder,English
+"and schizophrenia that insulin resistance, in particular, and insulin signaling in the brain is impaired in people with chronic mental disorders",English
+"kind of across the board-- all the way from chronic anxiety, depression, to bipolar, to schizophrenia, and even Alzheimer's disease. We know that patients with all of those disorders",English
+"have impaired glucose metabolism and that the insulin signaling system in the brain, which is different than insulin signaling in the periphery, seems to somehow",English
+"possibly be playing a role. So to step back from that, so for some patients, I might just want to decrease glucose and insulin levels.",English
+"And I can do that by getting rid of sweets. For other patients, like patients with schizoaffective disorder or schizophrenia or bipolar",English
+"disorder, especially if it's chronic, if I'm using it as a brain treatment, then I do want a ketogenic diet.",English
+"And I usually want reasonably high levels of blood ketones. Usually, for depression, I want to see at least greater than probably 0.8 minimal.",English
+"For psychotic disorders and bipolar disorder, I usually want to see levels greater than 1.5. That's what I'm shooting for, if at all possible.",English
+"So yeah, I think that's what I'd go for. ANDREW HUBERMAN: Yeah, so-- and sorry, I didn't mean to imply",English
+that people need to be in ketosis in order to see some mental health benefits from changing their diet. You make very clear in your book--,English
+"and we'll go into this in more detail-- that avoiding insulin resistance, reversing insulin resistance, and essentially trying",English
+"to reverse what earlier you described as this metabolic syndrome, which is a bunch of different things, is the target.",English
+"And for some people, getting rid of highly processed foods and focusing mainly on nonprocessed or minimally processed foods will really help.",English
+"For others, going straight to the full-blown ketogenic diet will be of most benefit. I'd like to back up a little bit in history",English
+"and get to something which I find incredibly interesting, which is epilepsy and the longstanding use of ketogenic diet and fasting to treat epilepsy.",English
+"And the reason I want to kind of rewind to that point in history is that, I think that for a lot of listeners and people out there who are familiar with how changing your diet",English
+"or changing your exercise can positively impact sleep and weight and all these things, and it cascades into feeling better-- that makes perfect sense.",English
+"But for a lot of the world still, the idea that changing or using nutrition as a dissection tool or as a treatment tool to understand and treat",English
+"mental illness, is still a kind of heretical idea, that to them, it kind of falls in the, OK, well, that's like a woo science or something like that.",English
+"Now, obviously you're a board-certified physician or psychiatrist at arguably one of the finest medical schools in the world, Harvard Medical School.",English
+"Even though I'm on the Stanford side, we acknowledge-- we acknowledge our East Coast-- CHRIS PALMER: You're the Harvard-- ANDREW HUBERMAN: --friends.",English
+CHRIS PALMER: --of the West Coast. ANDREW HUBERMAN: We're not going to talk-- OK. CHRIS PALMER: [LAUGHS] ANDREW HUBERMAN: We're not going to talk-- CHRIS PALMER: Or we're the Stanford of the East Coast. ANDREW HUBERMAN: That argument could go back and forth,English
+"a number of times. You're a serious clinician and a serious scientist. And you're a serious thinker. But for a lot of people out there,",English
+"the notion of using diet, they immediately think, ah, well, that makes perfect sense. Or I think there's a category of people who think, well, yeah,",English
+didn't Atkins die of a heart attack? I hear that a lot. That was crazy. People immediately discard the Atkins diet,English
+"for that reason, which I do think is throwing the baby out with the bathwater. But it's an interesting thing nonetheless. And then I think that the majority of people",English
+"sit in the middle and just want to see science and medicine come up with treatments that work. And I have to say, I'm very relieved to hear what you said",English
+"earlier, which was-- you never said that people should come off their medication and just become-- go on a ketogenic diet and everything will be cured. You're certainly not saying that.",English
+"CHRIS PALMER: No. ANDREW HUBERMAN: And rather you're saying, if I understand correctly, that nutrition needs to be considered one of the major tools in the landscape of effective tools",English
+"and that it can be very effective, evidenced by the story that you shared. And there are many other stories in there as well of truly miraculous transformations.",English
+"So let's talk about epilepsy and how the ketogenic diet is not just used for epilepsy but is one of the oldest, if not the oldest, examples",English
+"of the use of nutrition to treat a condition of the nervous system that can be incredibly debilitating, even deadly.",English
+"CHRIS PALMER: Yeah. And the reality is that this literature, and this clinical history, and all of the research we have was the godsend that I needed to do the work that I'm doing.",English
+"Otherwise, I would have been discredited on day one. Chris Palmer is claiming that a dietary change can influence schizophrenia or schizoaffective disorder.",English
+That's impossible. And he's a quack. But the thing that immediately got me credibility was I didn't focus on it as a diet.,English
+"I did a deep dive into the epilepsy literature. So the ketogenic diet, unbeknownst to most people, was actually developed a hundred years ago, 1921,",English
+by a physician for one and only one purpose-- to treat epilepsy. It wasn't developed as a weight loss diet.,English
+It wasn't developed as the diet that all human beings should follow. And the reason it was developed is,English
+"because of this longstanding observation, since the time of Hippocrates, that fasting can stop seizures.",English
+"Now, fasting is not a healthy diet. Fasting is the process of no diet. So we now understand a tremendous amount of science.",English
+"Most people think going without food is bad. And they equate it with starvation. But in fact, when we go without food,",English
+"it causes tremendous shifts in metabolism-- both brain and body metabolism. And it puts the body into a mode of autophagy, and conservation",English
+"of resources, and all sorts of things that are beneficial to human health. And this is why fasting has been used",English
+"as a therapeutic intervention in almost every culture, in almost every religion for a millennia. But for the most part, that was all",English
+thought to be religious folklore. That was just crazy talk. And those stupid people way back then thought God cured everything.,English
+"And so they fasted. And they just assumed that they were getting better. Well, in 1921, one physician used intermittent fasting",English
+"on a child with seizures and found that, oh, Lo and behold, this religious folklore stuff has something to it. It actually worked.",English
+"The problem with fasting is that you can only fast for so long before you starve to death. And that's not a very effective treatment. ANDREW HUBERMAN: And this child was ingesting water, correct?",English
+CHRIS PALMER: Yes. ANDREW HUBERMAN: It was just food elimination fasting. CHRIS PALMER: Food elimination. ANDREW HUBERMAN: OK. CHRIS PALMER: So no special diet.,English
+"But the problem with fasting for epilepsy is that as soon as people start eating a normal diet again, their seizures usually come right back--",English
+"oftentimes, with a vengeance. And so it can be a good short-term intervention. The fasting can take a few days because it can",English
+take a few days to get ketosis. And then you can get some relief from chronic seizures. But it's not a good long-term treatment,English
+"because, again, people will starve to death. As soon as they start eating, seizures come back. So it was actually Dr. Russell Wilder at the Mayo Clinic",English
+"who developed the ketogenic diet with one and only one purpose. He wanted to see, can we mimic the fasting state, using this special diet, to see if it might stop seizures long-term?",English
+"And lo and behold, it worked. Early results were extraordinarily positive. 50% of patients who use the ketogenic diet",English
+"became seizure-free. And another 35% had a 50% or greater reduction in their seizure frequency, so about 85% efficacy rate.",English
+ANDREW HUBERMAN: Sorry to interrupt. I didn't mean to do that there. Was it just for pediatric epilepsy or for adult epilepsy as well?,English
+"CHRIS PALMER: So back in the 1920s, we didn't have many anti-epilepsy treatments. And a lot of adults were struggling as well. So they were using it on anybody who would do the diet.",English
+"By the 1950s, pharmaceuticals were coming out. And we had many more anticonvulsant treatments. And there's no question, they work for a lot of people.",English
+That's great. And taking a pill is so much easier than doing this diet. So the diet pretty much fell out of favor. And nobody was using it from the 1950s to about the '70s.,English
+"But lo and behold, even to this day, people with epilepsy, about 30% don't respond to the current treatments that we have available.",English
+"30% will have treatment resistant epilepsy, which means they continue to have seizures no matter how many anticonvulsants they're taking,",English
+"even if they've had brain surgery. It just doesn't stop their seizures. And so in the 1970s, the ketogenic diet was resurrected at Johns Hopkins for these treatment-resistant",English
+"cases. And lo and behold, it works-- not for all of them, but it works in-- about 1/3 become seizure-free.",English
+"And these are people who've tried everything and nothing's working. So 1/3 become seizure-free. Another third get a clinical benefit,",English
+"meaning a 50% or greater reduction in their seizure frequency. And the other third, it doesn't seem to work. It's not always clear if that's because of noncompliance",English
+"or if that's because the diet's just not working. But about a third, a third, a third-- seizure freedom, reduction in seizures,",English
+"or it just doesn't work. And so the reality, the godsend for me is that we have decades of neuroscience research",English
+"on the ketogenic diet and what it is doing to the brain. We know that the ketogenic diet is influencing neurotransmitter levels-- in particular, glutamate, GABA, adenosine.",English
+"It changes calcium channel regulation and calcium levels, which is really important in the function of cells.",English
+It changes gene expression. It reduces brain inflammation. It changes the gut microbiome.,English
+Gut microbiome is a huge topic right now. And there are some researchers who argue that is the primary benefit of the ketogenic diet-- it's changing the gut microbiome in beneficial ways.,English
+"So it's doing a lot of things. It obviously improves insulin resistance. It lowers glucose levels, lowers insulin levels, which improves insulin signaling.",English
+"The key for my research that I've outlined, the real magic, is that this diet stimulates two processes that",English
+"relate to mitochondria. It stimulates a process called mitophagy, which is getting rid of old and defective mitochondria, and replacing them with new ones.",English
+"And it also stimulates a process called mitochondrial biogenesis, which means that after people have done the ketogenic diet for a while--",English
+months or years-- many of their cells in their bodies and brains will have more mitochondria. And those mitochondria will be healthier.,English
+And I believe that is the reason the ketogenic diet is such a powerful treatment not only for epilepsy but also for people with chronic mental disorders.,English
+"ANDREW HUBERMAN: Would you mind listing off a few of the mental disorders? And I know this is not meant to be inside ball, but we should distinguish between psychiatric disorders",English
+and neurological symptoms and diseases. The fields of psychiatry and neurology hopefully someday will just emerge.,English
+"But for instance, typically if somebody is presenting with something that looks like Alzheimer's, dementia,",English
+"they'll talk to a neurologist. Whereas, if somebody is presenting with symptoms, like schizophrenia, bipolar, they'll talk to a psychiatrist. But if you wouldn't mind wearing a dual hat,",English
+could you just quickly list off some of the neurologic and psychiatric disorders for which ketogenic--,English
+or let's just say-- nutrition changes have been shown to improve symptoms significantly. And then maybe we can dive into a couple of these as well as get more deeply into these two very interesting,English
+"aspects of mitochondrial function and repair and turnover. CHRIS PALMER: Yeah. In terms of nutritional psychiatry, it's a broad field.",English
+"And it's in its infancy, is the real answer. If you're looking for randomized controlled trials documenting efficacy in large numbers of patients with these disorders,",English
+we don't have them. They're underway now. But we don't have them yet. What we do have are case studies.,English
+We have a lot of mechanistic science papers by some of the leading neuroscientists and psychiatrists in the world--,English
+"and neurologists in the world kind of outlining, this is everything we know that the ketogenic diet is doing. These are the problems in the brains",English
+of people with these chronic mental or neurological disorders. So we know that they should work. But the disorders range from chronic depression to--,English
+we've got a trial underway for PTSD. We've got one actually decent pilot trial from the National Institutes,English
+"of Health for the ketogenic diet for alcohol use disorder, of all things. And we can go into that a little more.",English
+We've got a couple of pilot trials of the ketogenic diet for Alzheimer's disease. And those are randomized controlled trials.,English
+"We've got case studies of the ketogenic diet for chronic depression, bipolar disorder, and schizophrenia. The largest study that we've got in that mental health sphere",English
+is a pilot study of 31 patients admitted to a French hospital. 28 of those patients were able to do the diet,English
+"and stay on the diet. So 10%, off the bat, noncompliant, couldn't do the diet. So we need to include that.",English
+"But of the 28 patients who were able to do-- and these are 28 patients with treatment-resistant mental disorders, chronic depression, bipolar, and schizophrenia.",English
+"Of the patients who were able to do the ketogenic diet, 100% had at least some improvement in symptoms. 46% had remission of illness.",English
+"Remission of illness, that does not happen with current treatments. And 64%, I think, were discharged on less medicine",English
+than they went into the hospital on. So it wasn't that the people were prescribing more medicine and that's why.,English
+"They were being discharged on less medication. We've got at least-- again, a lot of the hard core scientists are going to say,",English
+"show us the randomized controlled trial with hundreds of patients. And we've got five randomized controlled trials underway now,",English
+funded primarily through philanthropy. I can tell you that-- we've talked about that one index patient.,English
+"But at this point, I have now treated dozens of patients. And I've heard from hundreds of patients who've been treated by other clinicians, researchers--",English
+"or I've just heard from patients from around the world-- who have shared stories of complete remission of long, chronic mental disorders--",English
+"like bipolar disorder and schizophrenia-- off of psychiatric meds. Some of them-- not all of them, but some of them are able to get off all psychiatric meds",English
+"and remain in remission. Again, I think I didn't say this before. But it's really important to mention.",English
+"For people who might be unfamiliar with the mental health field and its connection with epilepsy, the reason that it's such an important connection",English
+"is that we use epilepsy treatments in psychiatric patients every day in tens of millions of people. So a lot of people don't know this,",English
+but I'll list off some names that a lot of your listeners may have heard of. And they probably know them as psychiatric drugs.,English
+"But in fact, these are epilepsy drugs. Depakote, Tegretol, Lamictal, Topamax, Neurontin or gabapentin, Valium, Klonopin, Xanax--",English
+"those are all medications that stop seizures. And many of them were developed initially for seizures. But we, in the mental health field,",English
+"quickly steal them and start using them in tens of millions of people, even if they're off label. So that means, we don't have research studies documenting",English
+that they're effective. But we go ahead and use them anyway because the reality is far too many patients aren't getting better with the FDA-approved treatments,English
+that we do have to offer. So psychiatrists are just winging it in some cases. And we're just throwing whatever we can at them and we absolutely include epilepsy treatments.,English
+"So in many ways, using the ketogenic diet as a treatment for serious mental disorders, is nothing new at all. It's an established evidence-based treatment",English
+"for epilepsy. We use evidence-based treatments for epilepsy across the board for a wide range of mental disorders. And so in many ways, that's all I'm",English
+doing with the ketogenic diet. It just happens to be a diet. [CHUCKLES] ANDREW HUBERMAN: I love it. I love it.,English
+"And I should say, I love it because we had a guest on here early days of the podcast. He's a colleague of mine at Stanford.",English
+"He's a bioengineer, and a psychiatrist, phenomenal scientist and psychiatrist, called Deisseroth, who won the Lasker prize, and so on and so forth.",English
+"And he made a really important point, which should have been obvious to me but wasn't until he said it, which was the psychiatrist has tools, just like the surgeon has",English
+tools. But the tools are language and observing behavior. Those are the dissection tools for what's going on in someone's brain.,English
+"And then as a neuroscientist, I'm familiar with the neurotransmitters and neuromodulators. And you mentioned that--",English
+"and there are these tools of altering brain chemistry, which are of the sorts of drugs you just listed off, or antidepressants, or antipsychotics,",English
+"And it seems to me, it's an incredible field. But that the field is still very much in its infancy that it wasn't about a hundred years ago that people were",English
+"measuring bumps on the head as a way to diagnose phrenology, and that there's still so much to learn. And so when I hear you say, adjusting nutrition or putting",English
+"people into a ketogenic state or even just eliminating highly processed foods, sugars, et cetera, taking care of metabolic syndrome, and then observing tremendous relief",English
+"in clinical syndromes of-- or symptoms, rather, of psychiatric disorders, it makes perfect sense to me.",English
+"It's yet another dissection tool. And a tool for altering brain chemistry. If I think about the landscape, the sort of sociology out there",English
+"of-- again, there seem to be these bins, like a third of people saying, of course, diet, and exercise, and social connection, and limiting",English
+"stress, that's the good stuff. That's the stuff that we really works. And then about a third of people are sort of unclear. And then a third of people think, well,",English
+"if it's not a prescription drug, then it just has no place in medicine. And hopefully, that's changing. And certainly, the work that you're doing",English
+is going to be important in that transition that I think we will see. I'd like to talk about mitophagy and mitochondrial biogenesis.,English
+"I think most people learn that the mitochondria are the energy factories of cells and that indeed, they are. As a neuroscientist, what I know about",English
+"them is that they are present everywhere in neurons. Not just in the so-called cell body, but you can find mitochondria in the furthest little bits of neurons.",English
+"And neurons can be quite big, very large. In fact, meters long or more in some cases and some species, including us.",English
+"Depending on how tall somebody is, could be many meters-- or several meters rather. And that mitochondria do a lot of stuff besides just",English
+"produce energy, because I think people hear ""mitochondria,"" ""energy,"" and they think, oh, so these patients felt better. They lost weight.",English
+"They had more energy. And then they're doing better. But here we're talking about remission of auditory hallucinations, people feeling suicidal",English
+"and then changing their diet and feeling like life is something they can deal with, and maybe even function extremely well, and et cetera.",English
+So maybe we could just talk about mitochondria for a moment. And then talk about these two major effects. What are some of the other things,English
+"that mitochondria are important for in neurons and maybe other cells of the brain? Because as an access point for all this,",English
+I think it would be great if people could learn a little mitochondrial biology. CHRIS PALMER: So I guess the first thing that I'll say,English
+is that this field is one of the most cutting-edge fields in medicine right now.,English
+"20 years ago or so, I think the majority of research scientists thought of mitochondria as nothing more than little batteries.",English
+"They take food and oxygen and turn it into ATP. And that's really important. Yeah, we get that.",English
+But they're just little batteries. That's all they are. And so one of the reasons that this work is so important,English
+it's because it combines cutting-edge research in the metabolic field in the aging field. And we can start to pair it with a mental health,English
+"and neurological health field. So mitochondria-- one scientist gave me this analogy. He said, if you think of the cell as a computer,",English
+"a lot of people think of mitochondria as the power cord to that computer because they're providing the power. And they are, in fact, the power cord to that computer.",English
+"But actually, their real function is the motherboard of that computer. So mitochondria are directing in allocating resources throughout a cell.",English
+"That is their primary function. And then they happen to be powerhouses as well. And so to give some clear examples,",English
+"mitochondria play a direct role in the production, and release, and regulation of some really key neurotransmitters, including serotonin, dopamine, glutamate, acetylcholine.",English
+"Those are pretty powerful neurotransmitters. ANDREW HUBERMAN: Yeah, I would call those-- I would consider those the-- I know you listed more than three.",English
+But the sort of primary colors of neurotransmission. CHRIS PALMER: Yes. ANDREW HUBERMAN: Any one of those in excess or deficiency,English
+"is going to have profound negative effects on a nervous system. Or it's going to alter the way that people and animals feel, think, move--",English
+"CHRIS PALMER: Yes. ANDREW HUBERMAN: --remember, et cetera. CHRIS PALMER: So mitochondria are providing both some of the building blocks, if you will,",English
+"for some of those molecules that are part of the Krebs, citric acid cycle. Some of the intermediate products actually go into making those neurotransmitters.",English
+"Much more importantly, mitochondria provide the energy for the production of those neurotransmitters. And fascinatingly, mitochondria are directly related",English
+to the release of neurotransmitters. ATP alone is not enough. There have been some research studies that have actually,English
+"found that mitochondria move along the membrane of the synapse to release batches of vesicles of neurotransmitters, and that if the mitochondria are removed",English
+"from the synapse and researchers flood that cell with ATP, neurotransmitters usually are not getting released.",English
+Mitochondria are doing other things. We don't entirely even understand what all they're doing or how they're doing it.,English
+But they're doing other things than just providing the power. Another really important example is that mitochondria are actually the primary regulators,English
+of epigenetics. If you look at any one factor-- so one study actually found that they're responsible for the expression of about 60%,English
+of the genes in a cell. And mitochondria do this through a lot of ways that have been known for years and sometimes decades.,English
+So mitochondria are directly related to the levels of reactive oxygen species in a cell. They are managing calcium regulation in cells.,English
+And we know that those things play a role in epigenetic expression. We know the levels of ATP to ADP or AMP also play a role.,English
+"And mitochondria are doing those things. But it turns out, mitochondria are actually doing much more sophisticated things than even those in terms of gene expression.",English
+"Mitochondria at least play a role in all of the aspects of the human stress response. So when humans are stressed, either",English
+"physically or psychologically, there are several things that happen-- increased cortisol increased adrenaline, noradrenaline,",English
+"inflammation, and gene expression-- in particular, in the hippocampus-- occur with the stress response. And one group of researchers actually",English
+"genetically modified mitochondria in four different ways, and found that all of the stress response, all those four buckets of stress response were impacted in one way or another,",English
+"implying that mitochondria are somehow playing a role in those. In terms of their role in cortisol,",English
+"we know that mitochondria actually have the enzyme required for the synthesis of steroid hormones. So that includes cortisol, estrogen, testosterone,",English
+"and progesterone, some names that maybe everybody's heard of. so that means that if mitochondria",English
+"are in short supply or dysfunctional, the production of those hormones may become dysregulated. Mitochondria play a direct role in inflammation.",English
+And they turn the inflammatory system both on-- or they at least play a role in turning the inflammatory system both on and off.,English
+"I'm not going to be able to quote the exact study and author. But one paper in cell actually identified mitochondria as the key regulator in turning certain inflammatory cells off,",English
+"and that when you inhibit mitochondrial function, those cells don't turn off, that mitochondrial levels of reactive oxygen species are a key signaling process",English
+to turn the inflammatory cell process off. Another study found that macrophages-- so macrophages are an important immune cell,English
+"that play a role in healing. So if you cut yourself, your body will get-- send inflammation that way and send immune cells that way",English
+to try to heal your skin. And macrophages play an important role in that healing. One group of researchers tried to figure out,English
+how do macrophages know to switch between the different phases of wound healing because the macrophages do different things,English
+in the different phases of wound healing. And the conclusion of all of their research was that it's mitochondria.,English
+Mitochondria are sending the essential signals that change the state of the macrophages to induce these different phases of wound healing.,English
+"So I've just talked about neurotransmitters, hormones, epigenetic expression, inflammation. For anybody familiar with the mental health field,",English
+"they know these are some of the key variables that researchers have been struggling with for decades, trying to figure out",English
+how do these fit together. We know that all of those buckets can be disrupted in people with mental disorders.,English
+"And our field has struggled to understand, but how do they fit together? How can we make sense of this disruption? And I believe once you understand",English
+"the science of mitochondria, you can actually connect all of the dots of the mental illness puzzle. ANDREW HUBERMAN: I'd like to take a brief break",English
+"and thank our sponsor, InsideTracker. InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA",English
+to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact,English
+"your immediate and long-term health can only be analyzed from a quality blood test. The problem with a lot of blood and DNA tests out there, however, is that you get data back",English
+"about metabolic factors, lipids, and hormones, and so forth. But you don't know what to do with those data. InsideTracker solves that problem and makes it very easy for you to understand",English
+"what sorts of nutritional, behavioral, maybe even supplementation-based interventions you might want to take on in order",English
+"to adjust the numbers of those metabolic factors, hormones, lipids, and other things that impact your immediate and long-term health to bring those numbers into the ranges that are appropriate",English
+"and indeed optimal for you. If you'd like to try InsideTracker, you can visit insidetracker.com/huberman to get $200 off an ultimate plan or 34% off the entire site",English
+"as a special Black Friday deal now through the end of November. Again, that's insidetracker.com/huberman and use the code Huberman at checkout.",English
+"Super interesting little subcellular goodies, these mitochondria are. I come from a field where people are often divided",English
+"into lumpers and splitters. And I'm somewhere in between. For those of you who don't know, lumpers are people that like to make things really simple--",English
+lists of no more than three functions or dividing brain areas into no more than three. Splitters are people that like to subdivide into a ton of detail.,English
+There's a history of scientists being splitters in order to be able to name things after themselves because-- CHRIS PALMER: [LAUGHS] ANDREW HUBERMAN: There's more territory,English
+"to go around if you're splitting than if you're lumping. But we are doing neither here. What I'm hearing is that mitochondria, in addition",English
+"to being important sources of energy production and output in cells-- which, of course, they are-- probably have other roles.",English
+"Maybe someday, what we call mitochondria will actually be two or three different little subcellular or organelles. There may be little bits in there",English
+"that are controlling gene expression and little bits in there that are controlling neurotransmitter production. But at least for now, the name is mitochondria. And thank you, by the way, for illustrating",English
+"some of the other things that they do because in the landscape of science education, oftentimes, people will think, OK, energy production.",English
+"There'll be a picture or a cartoon of mitochondria flexing its muscles. People go, OK, energy, mitochondria, mighty mitochondria.",English
+"And then they'll think, oh, they're just sort of like a dumb jock portion of the cell. They're not doing anything sophisticated. And everything you listed off is that they",English
+"are doing many sophisticated intricate things within cells. So I think how things are cartooned and discussed actually has an impact-- and not just on the general public,",English
+"but on the medical field and on the science fields. Anyway, that's more science sociology. But now that everyone is well aware that mitochondria are doing a large number of very important",English
+"things in a very regulated way, let's talk about mitophagy. A few years ago, because a Nobel Prize was given for autophagy-- sometimes called autophagy.",English
+"Look, people, you can say it either way. People will know hopefully what it means is more important, which is the gobbling up of one's own cells that are dead or injured.",English
+"And this idea of autophagy, of cells being eaten up within a system-- nervous system or other system--",English
+"is the, intentional or not, gobbling up of mitochondria, presumably to replace them with newer healthier mitochondria.",English
+"Is that right? CHRIS PALMER: It is. So in many ways, mitophagy is a subset of autophagy. But it's got its own name because it",English
+is specific to mitochondria. There do appear to be some unique regulators of mitophagy compared to autophagy more broadly.,English
+Mitochondria actually are playing a role in autophagy itself. And this makes sense because one of-- so the global picture,English
+"of autophagy is stimulated by fasting states or fasting-mimicking states. So when your body senses that you don't have enough food,",English
+it actually hunkers down and starts to recycle dead old parts in this kind of carefully,English
+orchestrated way. And it takes them to lysosomes. They get degraded. And then those degradation products,English
+get used for either energy or to build new things. Autophagy is always occurring at a low level. But you can really hyperstimulate the process,English
+"through fasting, calorie restriction, fasting-mimicking diets, other things. And this is why fasting and calorie restriction",English
+is so kind of such hot topics in the medical field now. It's because they've been shown to induce longevity. And we think it's probably through that process,English
+that you're stimulating the body to kind of become lean and conservative in terms of its allocation of resources.,English
+And the body doesn't just destroy the healthiest tissue along with the old dead stuff. It has these processes that identify the old and defective,English
+parts first. And they go first. And that's what's beautiful about the whole thing. And that's why fasting is so important.,English
+"So mitophagy we know plays a really important role because-- so there's this term called mitochondrial dysfunction,",English
+"which some researchers are actually wanting to get rid of and move away from because, as you just said, mitochondria do so many different things. And different mitochondria even within the same cell",English
+"may very well be specializing in different tasks. And mitochondria from one cell to another are sometimes doing very different things,",English
+like not all mitochondria can produce cortisol. That's specific to specific cells where those genes are getting turned on.,English
+"So it's not like all mitochondria are producing cortisol. Just the ones in your adrenal gland, for instance, are producing cortisol.",English
+"But there is this term ""mitochondrial dysfunction."" And it has long been known, for decades, that mitochondrial dysfunction is associated with everything",English
+"that ails us essentially. So in the 1950s, we had a theory of aging that was based on reactive oxygen species.",English
+And that's where all the inflammation is bad for you comes from. ANDREW HUBERMAN: And where all the noise about antioxidants-- CHRIS PALMER: Yes.,English
+"ANDREW HUBERMAN: Like in the '90s, it was like, it contains antioxidants. Not to say antioxidants are bad, but they are certainly not the be-all-end-all of health.",English
+"CHRIS PALMER: They are not. But that's exactly where that research came from, is that researchers were narrowing in on these reactive oxygen species are highly, highly",English
+"correlated with all of the diseases of aging and poor health outcomes. It turns out, they're also highly, highly correlated",English
+"with all chronic mental disorders interestingly. So researchers used the antioxidants to see if, well, maybe if we can stop,",English
+"somehow tame these reactive oxygen species, we'll improve health outcomes. Doesn't seem to work. By the 1970s, our understanding of mitochondria",English
+"and their role in the production of reactive oxygen species expanded. And that led to the mitochondrial theory of aging. So in the 1970s, we had this mitochondrial theory of aging,",English
+"based primarily and exclusively on reactive oxygen species. Fast forward a couple of decades, that was disproven because we now reactive",English
+oxygen species aren't all bad. They actually serve a signaling process. They're a normal part of human functioning and cellular function.,English
+"So they're not all bad. But we still know high levels of reactive oxygen species are bad for you. Fast forward to just, I think, maybe last year,",English
+with this expanded role of all of the different things mitochondria are doing. So David Sinclair published a paper,English
+"in one of the cell journals, I think, saying that, oh, mitochondria are actually the unifying link of everything that we know about aging.",English
+"Mitochondria are the cause-- or defective mitochondria or defective mitochondrial function, mitochondrial dysfunction,",English
+is possibly the unifying cause of aging and all of the aging related disorders. So mitophagy is trying to address all that.,English
+"It's trying to say, OK, this is bad. We don't want defective mitochondria and how can we get rid of old ones or defective ones and replace them with new ones.",English
+"And I think the most powerful signal and tool that we have right now is, in fact, related to diet.",English
+"It's calorie restriction. That is the oldest, truest, kind of best-proven way to prevent aging in a wide variety of animal species--",English
+"fasting and intermittent fasting. And again, you can only do those things for so long. And then fasting-mimicking diets can also",English
+"stimulate this process of mitophagy. ANDREW HUBERMAN: Before we talk about mitochondrial biogenesis, if--",English
+and I certainly accept the idea that mitochondria are extremely important in physical health and mental health.,English
+"That's, for me, is a straightforward conclusion at this point, based on what you've said, whatever and elsewhere, et cetera.",English
+"And if various diets, including ketogenic diet, including fasting, reducing sugar intake, et cetera, can assist in mitochondrial function and mitophagy--",English
+"and that's at least one of the levers by which diet can positively impact mental health and physical health, can we conclude that there's something special",English
+"about low blood glucose in the brain? The sort of common pathway of all of those things-- fasting, ketogenesis--",English
+"for some people, maybe they-- maybe some people have great insulin management, so just removing sweets, refined sugars,",English
+brings down their blood glucose level substantially. They don't need to go on a ketogenic diet in order to relieve a low level depression or something like that.,English
+"Seems like the common theme here is that glucose levels in the brain need to be reduced, which for me, is surprising",English
+"because neurons love glucose. There are some really nice studies. One that I can think of recently that was published in Neuron, if you just",English
+"look at the tuning of a neuron, how well a neuron in the brain represents some visual image in the environment in terms-- here, we can just generalize and say,",English
+"more action potentials, more electrical signals from the neuron generally correlates with better high fidelity representation. It's sort of if everyone's time someone says, shout,",English
+"and then someone shouts, the neuron is the one responding to the order. And these neurons just, when there's high glucose, they are faithful representatives",English
+"of what's out there in the world. But then when you fast an animal, they become less faithful representatives of what's out there.",English
+"And yet when I've done intermittent fasting, and I do a kind of modified version of it, my mental clarity is far better than when I've had a big bowl of pasta--",English
+"probably for other reasons related to serotonin and tryptophan. So I think for the typical listener out there, I have to imagine, it's got to be a little confusing.",English
+"We hear neurons love glucose. They live on glucose. And here, we're saying, let's deprive them of some glucose. Or let's just bring glucose levels down.",English
+Or let's switch the fuel source of the brain from glucose to ketones. And now the brain really works the way it's supposed to.,English
+"So this raises a little bit of just so story question, like why would it be the case that neurons love glucose, and yet if there's too much glucose around,",English
+"they become sick? And of course, with any why-would-it-be story, as I would say, I wasn't consulted at the design phase.",English
+"And I'm going to presume that you weren't consulted the design-- CHRIS PALMER: I was not. ANDREW HUBERMAN: --phase either. And that if any of us say that we are,",English
+then we are probably the patients that need evaluation. So I think there's a name for that. There's delusion-- CHRIS PALMER: Yes.,English
+ANDREW HUBERMAN: --right? OK. I threw out my first correct clinical assessment of myself. So how do I get my head around this? You've got me sold on mitochondria--,English
+"not that I needed to be sold. But that's an easy yes, yes, absolutely, yes. The idea that diet can impact mental health and physical health-- yes, absolutely--",English
+"by way of mitochondria-- at least in part, great. But then neurons love glucose. So what's going on?",English
+Or what do you think is going on? CHRIS PALMER: I am not convinced that glucose is the real story.,English
+"Glucose may, in fact, be a symptom. We know that parts of the brain-- there have been a couple of studies that just came out",English
+"in the last couple of weeks, I think, documenting that actually astrocytes in the hypothalamus play a key role in glucose regulation throughout the body.",English
+"And it appears to be a metabolic role, which in my mind, implies that the mitochondria in those astrocytes",English
+are probably playing a key role because we know mitochondria play a key role in sensing glucose levels. They play a key role in the release of insulin,English
+from the pancreas. But mitochondria in the brain is also playing a role in kind of balancing,English
+"how much glucose is around. And so it's a difficult question because I think in some cases, high glucose levels are actually a symptom",English
+"of metabolic dysfunction somewhere in the body or brain. And when I think about, well, what does that mean? In my mind, most of the evidence currently",English
+is pointing to mitochondrial dysfunction somewhere in the body or brain. That is the most likely cause of that dysregulation,English
+"of glucose levels. But we know that if you consume massive amounts of junk food, sugar, and other things,",English
+"that you can get dysregulation of glucose levels. The conundrum, though, is that that's not a universal response.",English
+"ANDREW HUBERMAN: And what about the typical person? I've never really liked junk food that much. Maybe as a kid, I can recall liking candy. But I was a sandwich for lunch person for a long time.",English
+"And as I've changed that out for salad and maybe a small piece of meat with my salad or something like that, I feel far better during the day, far more alert.",English
+But I do eat carbohydrates. I eat starches typically at night. But I tend to do some very hard training at some point during the day.,English
+So I imagine I have some glycogen to repack. OK. That's me. I only mentioned that because I'm not in ketosis,English
+"as far as I know. I haven't-- unless you brought the strips, I haven't done the blood glucose test today. So what about the typical person who's",English
+"an omnivore eating some rice, some pasta, pasta salads, people that are eating not junk food massive amounts",English
+"of sugar but have blood glucose that's in kind of moderate range? Do you think-- and here, feel free to speculate. Do you think that those people might feel far better--",English
+or even a little bit better-- if they were in a lower glucose state? And I ask this because I think there,English
+"are a lot of people out there who suffer from full-blown depression. But there are also a lot of people who suffer from moodiness and feeling not so great,",English
+"subclinical depression. CHRIS PALMER: Yes, burnout is what I would call it. ANDREW HUBERMAN: Yeah, or just feeling some days are great, and then other days, they feel lousy for reasons",English
+they don't understand. CHRIS PALMER: Yeah. ANDREW HUBERMAN: And those make for less dramatic case studies. And yet I have to assume that that description will,English
+net a large fraction of the general public. CHRIS PALMER: So the way that I kind of break this field-- and I'm probably getting too nerdy right now.,English
+But I kind of break this field into cause-- what's the actual root cause-- and what are effective treatments.,English
+"And I really see them as two separate things. Just because the ketogenic diet is an effective treatment, does not imply that the cause of the problem",English
+was eating carbohydrates. And I think that's a really important distinction. There are many people who disagree with me on that.,English
+"There's no doubt about it. And everybody's heard people say, sugar is the cause of everything that ails you. Or carbs are the cause of everything that ails you.",English
+"If everybody does a low carb diet or a ketogenic diet-- and then they go to, so it must be sugar that was the cause. I don't see it as clearly black and white as that.",English
+"Calorie restriction, ketogenic diet, carbohydrate restriction are inducing metabolic changes in the brain and body.",English
+"And regardless of what the person was eating, they are inducing metabolic changes that can be really beneficial to brain health.",English
+So let me just give a clear black and white example of this. And then I can speak to the broader topic that you brought up about just the general population.,English
+The easy example of the ketogenic diet being an effective intervention for somebody who was not following a bad diet is an infant with epilepsy.,English
+"There are lots of infants who have uncontrollable seizures. They are drinking breast milk. To the best of our knowledge, that",English
+"is the primary, most beneficial food source an infant could be consuming. Now, some might say, well, maybe the mother is--",English
+"whatever, I don't buy that. The mother's breast milk is, in fact, the optimal food source for that infant.",English
+"And yet that infant is still seizing. If we put that infant on a ketogenic diet, a lot of those infants seizures will stop.",English
+It doesn't mean that the cause of the infant seizures was a bad diet. But it means that dietary intervention,English
+"can change brain metabolism and improve symptoms in that person. So going to your broader question about adults,",English
+"modern-day, the real answer is-- there was just this conference in London, the Royal College of obesity medicine or something like that.",English
+"That's not the name. But it's something along those lines. The conclusion of that conference that invited the greatest minds in obesity medicine,",English
+the overarching conclusion of that conference was we don't know what causes obesity. It's really important that we sit with that.,English
+We don't know what causes obesity. ANDREW HUBERMAN: They don't think excess caloric intake beyond one's daily metabolic needs is causing obesity?,English
+"CHRIS PALMER: Some will argue that. And so some will say yes, it's all energy balance. But why do we have an epidemic of obesity?",English
+"ANDREW HUBERMAN: Oh. Well, that's the N-gazillion dollar question. CHRIS PALMER: Yes. Some will say, it's all the junk food.",English
+"But we had junk food in the 1970s. When I was growing up, I grew up on Kool-Aid, and Twinkies, and King Dons, and HoHos, and--",English
+"[LAUGHS] ANDREW HUBERMAN: I'm rewatching the Mad Men series now. I love that series, and I'm rewatching it. And I happen to know someone who worked on that series.",English
+"They researched everything for the props, and the costumes, everything, right down to diet. And if you look at the diet, it was terrible. It was mostly-- yes, there was a lot",English
+of excessive amounts of drinking and cigarette smoking. But the diets were terrible. It was pre-packaged foods. It was frozen dinners.,English
+"That really came to prominence in the '70s and '80s. But even in the '50s and, from what I've been reading, even in the '30s and '40s, people were not",English
+eating grass-fed meat and Brazil nuts with a little bit of broccoli rabe on the side. That's not the typical intake.,English
+"So something out there-- or maybe multiple things-- are at play to increase obesity. CHRIS PALMER: And at the end of the day, I believe--",English
+some will call this speculative. But I actually think we've got a tremendous amount of evidence that continues to point in this direction. I believe that mitochondria are the key,English
+"to the obesity epidemic, that there is something in our environment. So that is either our food, environmental toxins, stress",English
+"levels, poor sleep, not getting adequate sunlight, whatever you want to speculate on, all of the above, all of those things",English
+"are known to impair mitochondrial function. And if parts of your brain that regulate metabolism and that regulate eating behaviors are not metabolically healthy,",English
+"it means that they will not stop you from eating. Or it means that your metabolism will not rise to the challenge of 10 donuts,",English
+"because some people can eat 10 donuts and go on staying thin and healthy. ANDREW HUBERMAN: I totally agree. Although, I would just like to say",English
+"that it seems to me that compared to when I was growing up-- and again, I haven't run the statistics-- there are fewer and fewer of those individuals around now. Just as when I was growing up, it was one or two kids in class",English
+"that were quite overweight. And then there were some that were mildly overweight. But most were of healthy weight. Nowadays, that's dramatically altered.",English
+The landscape is dramatically altered in the other direction. It is rare when I encounter one of those can-eat-anything type people.,English
+"I know one, he's actually an employee at Stanford. He's in our media team at Stanford. And this guy, when I take him to lunch, it's like-- he's in his early 70s, and he can eat.",English
+"And he's incredibly lean. He exercises a little bit. But he's one of these mutants that just can eat, and eat, and eat, and he's lean and he's vital, and he's--",English
+it's wild. And he's an expensive lunch. CHRIS PALMER: [LAUGHS] ANDREW HUBERMAN: But those people are seem rare.,English
+"And even those kids are now seem rare. CHRIS PALMER: They're getting increasingly rare. And that leads me to think it may be epigenetic factors in the womb environment,",English
+"so that kids are actually coming out predisposed to obesity. ANDREW HUBERMAN: Well, let me ask you about that because I had a note here to ask this later.",English
+"But I'm going to interrupt you now in order to capture this moment. My understanding is that-- well, as everyone knows, we inherit DNA.",English
+We get genes from both of our parents. And they mix. Although there are incredible data from Catherine Dulac's lab at Harvard and others showing that we actually,English
+"have entire regions of our brain that carry neurons that are of purely of mom's or of dad's DNA, depending on the brain region.",English
+"This is a wild finding. But it's accurate. And this has actually been known about in terms of heritability of disease, et cetera.",English
+"Maternal DNA, DNA from mom, genes from our mother-- not to place blame on mothers at all. My understanding is that the mitochondrial DNA",English
+"And yeah, psychiatrists are known for blaming mothers. And some might say that I'm trying to redo that whole thing and blame mothers again.",English
+ANDREW HUBERMAN: The data are the data. I'm not trying to blame mothers here. Mothers play an essential role in everything. But if it is true that mitochondria,English
+"are the linchpin of all this and maternal DNA is what determines the mitochondrial DNA, I think it's an important place to look. CHRIS PALMER: It's an important question.",English
+"And the answer is unequivocally no. That's not the way it works. ANDREW HUBERMAN: Well, then vindication for anyone that was asserting that.",English
+CHRIS PALMER: And so let me explain it. So mitochondria have 36 genes unto themselves. 13 of those genes code for some of the mitochondrial machinery,English
+"of making ATP. And the other 36 play roles in epigenetic regulation, play roles in whole body metabolism, and other things.",English
+"So that is what you're inheriting from your mom. It's the mitochondria and those 36 genes for the most part. But the majority of proteins that make up mitochondria,",English
+"over, I think, 1,300 genes that make up mitochondria are actually encoded in the nuclear DNA. And so you inherit a copy from both your mother",English
+and your father. So the majority of people who have mitochondrial defects or rare mitochondrial diseases actually,English
+could inherit them from either mom or dad because it can be a defect in the nuclear genes that code for proteins that make up mitochondria.,English
+"The much bigger issue when-- so when I talk about mitochondrial dysfunction being a primary driver of mental illness, metabolic illness,",English
+"it's not that people inherit a defective mitochondrion or mitochondria from mom, and then that just ruins their life forever.",English
+That's actually not the way it works. The beautiful thing about this theory is that it connects all of the risk factors,English
+that we already know play a role in mental health but also metabolic health. Sleep disruption impairs mitochondria and mitochondrial,English
+"function. Stress, high levels of stress and trauma, impair mitochondrial function. Drug and alcohol use, alcohol, tobacco definitely--",English
+"in terms of the smoke-- and marijuana-- THC, in particular-- all impair mitochondrial function. ANDREW HUBERMAN: THC directly or the smoke?",English
+CHRIS PALMER: THC directly. Those studies have been done. So mitochondria actually have CB1 receptors right on them.,English
+"And various researchers, a couple of studies from Nature actually documented this, that the mitochondrial CB1 receptors are primary--",English
+"kind of primary points of the influence of marijuana on human behaviors and effects. Because when they remove CB1 receptors in animal models,",English
+these changes don't happen. So the CB1 receptors-- we've got some large studies of adolescents,English
+who use a lot of marijuana. And the areas where the mitochondria have the greatest number of CB1 receptors are areas of their brains,English
+that actually are atrophied or shrunk compared to normal healthy controls. So that means their brain tissue is aging prematurely.,English
+It's shrinking prematurely. But the CB1 receptors on mitochondria also seem to play a role in the memory impairment that,English
+"can be induced from THC. And they also play a role in the kind of lack of motivation, the behavioral amotivational state",English
+"from THC. Now, again, for people who want to chillax, that's what they're looking for. They don't want to remember anything.",English
+They don't want to think. They want to be spaced out. They want to relax. That's great.,English
+But it's important that they know that they're actually harming the mitochondria in their brain cells. And that although there's always an opportunity,English
+"to repair mitochondria and always an opportunity to stimulate mitochondrial biogenesis, so you can get it back, but if you keep doing it chronically,",English
+"you're probably not helping your overall mental or metabolic health. ANDREW HUBERMAN: Yeah, I'm glad you brought up THC. We did an episode on cannabis.",English
+"We also did one on alcohol-- probably lost some friends from that one. When you look at the data, it's very clear. I'm not arguing that people dislike",English
+"the effects of these compounds when they take them. But it is clear that, at least to me, based on the data that regardless of what people",English
+"have read about red wine, that not drinking any alcohol is going to be healthier than drinking alcohol, and that the thresholds for alcohol ingestion before people start to negatively impact their health",English
+"is about one or two per week. And then THC, because of the very high concentrations of THC that are present in a lot of products now-- vaping and smoking THC and even edibles--",English
+"that it can be problematic. You mentioned adolescents that predisposition, and brain atrophy, psychosis, et cetera. In any case, because you mentioned alcohol",English
+"because it is a commonly used substance, I heard you give a talk in which-- I think I have this right-- in which alcohol can disrupt",English
+"the way that the brain uses fuels of all kinds, which may disrupt one's response to alcohol, make alcohol seem more rewarding to those that drink alcohol.",English
+"So drinking alcohol makes alcohol more rewarding to the brains of alcohol drinkers, but that it also might alter glucose metabolism,",English
+that basically alcohol is not good for our brains. Do I have that correct? CHRIS PALMER: You do have that correct.,English
+ANDREW HUBERMAN: OK. What happens if you take an alcoholic or somebody that just drinks two to four nights a week a couple,English
+"of drinks, which I think is pretty common out there, and you put them on a ketogenic diet? Has that experiment been done?",English
+"CHRIS PALMER: That experiment has been done. ANDREW HUBERMAN: Ah. CHRIS PALMER: It led by none other than a woman named Nora Volkow, who",English
+is one of the leading neuroscientists and addiction researchers in the world. She is the director of the National Institute,English
+"of Drug Abuse. She's been hot on the trail of metabolic abnormalities in the brains of people with alcohol use disorder, which I will just refer to as alcoholics",English
+"because that's what everybody knows it as. So she's been hot on this trail for many, many years. And as you said, it turns out that the reward pathways,",English
+"in particular, are metabolically compromised in alcoholics. And the metabolic compromise essentially, in a nutshell, means they aren't getting enough fuel from glucose.",English
+"The interesting thing is that when people drink alcohol, your liver converts alcohol into a molecule called acetate. That acetate travels up to the brain and fuels brain cells,",English
+"in particular, some of these reward pathway cells more than others. And so chronic alcoholics have this chronic deprivation",English
+of energy in these cells. And so Nora Volkow and other researchers at the National Institutes of Health did a study in which they set out,English
+to see if we can change this brain metabolic problem in alcoholics. Will that affect clinical symptoms of alcoholism?,English
+And will it do anything? It's clinically useful. And so they actually did a pilot randomized,English
+"controlled trial, admitted alcoholics to a detox unit. Half of the patients got a ketogenic diet. The other half got the standard American diet.",English
+"And then everybody else, all of them got the same detox protocol. The patients who got the ketogenic diet required fewer benzodiazepines for their detox.",English
+"Despite that, they had fewer withdrawal symptoms from the alcohol. They reported fewer cravings for alcohol.",English
+"And the researchers did brain scans, which showed improved brain metabolism in these key areas that they were looking at.",English
+"And their brains showed reduced levels of neuroinflammation, which was also something they were really interested in.",English
+"And so that one study says to us that even though most people would think alcoholism has nothing to do with diet,",English
+"alcohol is just drinking too much. It's a matter of willpower. Or it's somebody who's addictive. They've got an addictive personality,",English
+"and it's that simple. You come out of the womb with an addictive personality. And those people are novelty seekers, and they're impulsive.",English
+And they have no patience. They have no discipline. They can't sustain any kind of rewarding experience. ANDREW HUBERMAN: Or childhood trauma.,English
+"CHRIS PALMER: But what that research study strongly suggests-- and again, yes, maybe we need larger controlled trials. But this is one of the leading neuroscientists in the world",English
+who's hot on this trail. This is what she believes. And this is what I believe. It's that if we can correct the brain metabolic defects,English
+"from chronic alcohol use, we might be able to help people be sober and give them a fighting chance.",English
+"Or give them an edge up or pull a lever that we can use in their favor, for their benefit. There's one caution to all of this research",English
+"that I really do want to highlight. And so now, I'm going to get hate mail from all the keto community. ANDREW HUBERMAN: That's OK.",English
+"I admire you for talking about nutrition at all because anytime one talks about nutrition, you're going to get hate mail from somebody. CHRIS PALMER: So the caveat to all of this",English
+"is that as part of the research that those researchers were doing, they actually wanted to see what will happen to alcohol levels",English
+if an animal consumes alcohol while on a ketogenic diet. So they didn't do this in humans yet.,English
+This is a fairly easy study to do. So I'm hoping somebody will do this study soon. But they instead put rats half of them on a standard diet and half of them on a ketogenic diet.,English
+And then they exposed them to the exact same amount of alcohol. The rats who were on the ketogenic diet had a five-fold increase in blood alcohol levels.,English
+"Five-fold increase. ANDREW HUBERMAN: Meaning, they drank more? Or-- CHRIS PALMER: No. ANDREW HUBERMAN: --it was metabolized differently. CHRIS PALMER: It was metabolized differently.",English
+"The rats all got the same amount of alcohol. ANDREW HUBERMAN: So for people out there who are ketogenic, I'm chuckling, but who are not alcoholics-- please,",English
+"alcoholics, please do something about it because it's so detrimental. But I guess does this mean that they can drink less in order to get the effect of alcohol that most people are seeking?",English
+CHRIS PALMER: Cheap dates. Cheap date is what you call that. You only need a half a drink instead of three drinks. ANDREW HUBERMAN: I would think the keto community would thank,English
+you for this unless they somehow have a stake in the alcohol industry. CHRIS PALMER: The reason that I put it,English
+"as a caution is that if anybody is struggling with alcoholism and thinks hey, I need an edge up. I need a lever to pull because I'm really struggling",English
+"to give this stuff up. I just find myself going back. And if you're telling me my brain metabolism is messed up, and this might help it, I'm all in favor of that.",English
+"And yes, that's what the researchers are pursuing. And that's what I'm saying with the following caveat-- that if you relapse while on a ketogenic diet,",English
+"you better not drink the same amount of alcohol that you think you can drink. ANDREW HUBERMAN: It could be deadly. CHRIS PALMER: It could be deadly,",English
+"and/or it could be really-- yeah, deadly to you or someone else because unfortunately, a lot of times when people drink,",English
+"they get behind the wheel. And they think that they can handle two drinks safely. And they think, well, I can go out for dinner and have two glasses of wine and drive home safely.",English
+"I know myself. If you go to a ketogenic diet, please don't drive with the same two drinks because it means your blood alcohol level--",English
+if it models anything that we found in the rat study-- your blood alcohol levels may be five times higher than they would normally be.,English
+"And that means you are really wasted. And you're probably not safe to be driving. ANDREW HUBERMAN: Probably the same is true for drinking on an empty stomach, right?",English
+"CHRIS PALMER: Yup. ANDREW HUBERMAN: Yeah. Now, it's a very important point. And thank you for raising that. I hear this again about mitochondria,",English
+"about blood glucose, you mentioned astrocytes. And for those of you-- that earlier astrocytes are a non-neuron cell type",English
+"in the brain, a glial cell type that my postdoc advisor was known for popularizing the modern science of glia, which include astrocytes.",English
+And I'd be remiss if I didn't say that they are considered the cells that hold everything together in the brain and are kind of passive observers.,English
+But they do many things actively. I think now people appreciate the astrocytes at least as important as the neurons.,English
+"And certainly, for disease, they are often implicated in warding off of disease, et cetera. Everything that you're telling me about the fact",English
+"that the brain can regulate things that are happening in the body, metabolism, et cetera, organ health, obesity, et cetera, to me, as a neuroscientist,",English
+"that's not surprising. All of it just screams hypothalamus, hypothalamus, hypothalamus because here, you're telling me, it's regulating these basal functions like metabolism.",English
+"It's regulating how much we crave things. And of course, hypothalamus is involved in motivation and craving. There are other areas, too--",English
+"other areas of the brain, too, of course. But I would imagine that someone ought to or has mapped out where the receptors for all this business",English
+"are in the brain. And I guess that raises the question of, when one goes on a ketogenic or low blood glucose diet or fast,",English
+"has anyone observed changes in the brain? Has anyone had neuroimaging of humans and their brains under conditions of ingesting one diet or another,",English
+"When you do a neuroimaging study, you can measure a lot of different things. So one thing with a PET scan, you can measure glucose metabolism.",English
+"So a researcher, Stephen Cunnane is doing that research in particular in Alzheimer's disease patients and Alzheimer's disease models but in humans.",English
+"And that's because we know that-- again, a common finding in patients with Alzheimer's disease is this glucose hypometabolism,",English
+"some people are attributing it to insulin signaling impairment. And so some people are calling it type III diabetes. At the end of the day, I think the clearest",English
+say that's backed by numerous research studies. There's debate in the research field about whether that's a primary driver of the illness.,English
+"I happen to believe it is. And if you ask the question, well, why would cells not be getting enough fuel from glucose? You have to focus on mitochondria",English
+because they're the ones producing the fuel from that glucose. So you somehow you have to implicate mitochondria in that process one way or another.,English
+"Others will say, no, that's just a side effect of whatever's causing Alzheimer's disease. So Stephen Cunnane has done studies where he even",English
+"gives ketone supplements. ANDREW HUBERMAN: These are liquid ketone esters? CHRIS PALMER: Yeah, ketone esters or ketone salts. And it has actually found that these brain metabolism deficits",English
+"can be corrected, at least short-term, by giving a ketone supplement. ANDREW HUBERMAN: Is this in the context of people",English
+"also ingesting some carbohydrate? Because I confess, I've tried the ketogenic diet. I probably did it wrong. This was years ago.",English
+"And then the cyclic ketogenic diet. But in the last year or so, I've started using liquid ketone esters. And I do eat some carbohydrates each day,",English
+"usually in proportion to how much high intensity exercise I'm doing. Those liquid ketone esters, for me--",English
+at least subjectively-- I feel greatly increase my energy levels and my ability to focus mentally. And they improve my sleep.,English
+"This is my observation tracking some data but just, again, subjectively. So in this example, are you talking about people taking ketone esters or ketone",English
+salts on a backdrop of a ketogenic diet or on the backdrop of a more typical diet? CHRIS PALMER: So he's done both.,English
+So he's done studies where patients aren't doing anything special with the diet. So they're eating whatever they normally,English
+"eat, absolutely nonketogenic, giving them a ketone salt or ester, and then noticing immediate and direct changes in the metabolism",English
+"of these metabolically compromised brain cells as measured by PET imaging. ANDREW HUBERMAN: These are not household pets, by the way.",English
+"Sorry, I have-- we have to just-- P-E-T, positron emission tomography, not pets. Although, I'm sure that there are people out there who have their dogs, or cats, or whatever,",English
+"or their pet kangaroos, whatever you might own, on ketogenic diet. OK. CHRIS PALMER: Absolutely.",English
+"So he's actually moved further. He's done a pilot trial in a nursing home actually, where he did not put the patients on a ketogenic diet.",English
+He simply reduced carbohydrate consumption at breakfast and lunch. They still got the same dinner as everyone else.,English
+And simply reducing carbohydrate consumption at breakfast and lunch resulted in cognitive improvement in a statistically significant way in some of those subjects.,English
+"ANDREW HUBERMAN: Oh, I love that result. I'm sorry, I just have to highlight this. I'm a huge believer in directing carbohydrates to specific portions of the day when",English
+"one needs to be less focused and alert and yet can replenish glycogen. Limiting carbohydrates most of the time during the day,",English
+"liquid ketones to people who are challenged with mood disorders-- or things of that sort-- could be beneficial, even if they are not willing or able to adhere",English
+"My speculation, my hunch, having tried that clinically with patients, is it doesn't seem to work. It's not the same thing.",English
+The bigger reason for my feeling confident in saying that is that we've had ketone salts and esters available for over a decade now.,English
+"We have tens of thousands of children and adolescents who are following a strict, ridiculously strict, ketogenic diet to control their epilepsy.",English
+"Those kids would love to be off the ketogenic diet. Their parents would love to have them off the ketogenic diet. ANDREW HUBERMAN: They had no birthday cake, no ice cream.",English
+CHRIS PALMER: There is not one case report of any child controlling his or her seizures using exogenous ketones without also doing the ketogenic diet.,English
+and even schizophrenia who are doing extraordinarily well on a ketogenic diet. They have tried to switch off the ketogenic diet using,English
+"exogenous ketones. Their symptoms came back. And so they found that it just wasn't effective. Now, again, those are anecdotes.",English
+My scientific speculation about why is because the ketogenic diet is actually not necessarily about ketones themselves.,English
+"Ketones are one of a multifaceted story there. And so when people do a ketogenic diet, they're also improving-- they're lowering glucose levels.",English
+"They're improving insulin signaling. They're ramping up mitochondrial biogenesis, in particular, in the liver because mitochondria actually",English
+make ketones. That's where they're made. And they're primarily made in the liver mitochondria. So when somebody is on in a fasting state,English
+"or on a ketogenic diet, their liver mitochondria go through the roof because they're being called to action. It's like, hey, body's in starvation mode.",English
+Get to work. And so the mitochondria-- the cell senses we need more mitochondria to process fat to turn it into ketones so that those ketones can get up,English
+"to the brain and keep the brain fueled, because fatty acids can't fuel the brain. Only ketones can.",English
+"Now, so my sense is that-- and the gut microbiome changes and everything, the changes in hormones-- so if you're eating a lot of donuts",English
+"and drinking a bottle of ketones, the donuts are going to prevent your body from lowering glucose levels.",English
+You're still going to have the high glucose levels from the donuts. You're still going to probably have the impaired insulin signaling.,English
+You're probably still going to possibly have some inflammation from the inflammatory effects of that food.,English
+"And so just drinking ketones alone won't be enough. I think for people who are metabolically healthy, I'll",English
+"include you in that, I think ketones can play a really beneficial role, no doubt. I think exogenous ketones may, in fact,",English
+proven valuable in clinical use for patients who maybe can't follow a super strict ketogenic diet but maybe could do a low carb diet.,English
+"And then given the research that's happening with alcohol use disorder, I could imagine a situation-- here's the million dollar tip to whoever",English
+"wants to go out and get this, if it actually turns out to be true. I could imagine a scenario where we use exogenous ketones with alcoholics.",English
+"And that every time they have a severe craving for alcohol, they drink ketones instead. ANDREW HUBERMAN: Which sort of tastes like alcohol.",English
+"The ketone esters, when I take them, I drink them straight. Sometimes I'll put them in seltzer. And I'm not a big drinker, as I mentioned.",English
+I might have an alcoholic drink every once in a while. I just don't ever crave it. I just do it every maybe-- I think 2020 was the last time I had a drink of alcohol.,English
+"So obviously, I'm not a good representative example. But the ketones taste good to me. And they obviously don't get you drunk.",English
+They do seem to flick on my alertness pretty quickly. My understanding is that they are the brain's preferred fuel,English
+"source. Meaning, they are going to be the first fuels used by the brain when there's a buffet of fuels available.",English
+"If there's glucose in my bloodstream, there's circulating liquid ketones, the ketones would be used first or preferentially. Is that true?",English
+CHRIS PALMER: I think it's a complex question. Some research that we have suggest that there are brain areas or brain cells that require glucose and cannot use,English
+ketones. So 100% of the brain cannot be fueled with ketones as far as we can tell. So there are some areas that require glucose.,English
+"And that's probably the reason we have gluconeogenesis to keep the body going and keep the brain going no matter what. But when ketones are available, especially if ketones are high,",English
+the way I think about it is not that ketones are the preferred fuel source and glucose goes to the wayside.,English
+But the way I think about it is that you have a range of cells with varying degrees of metabolic health.,English
+And some of those cells are going to be extraordinarily healthy with appropriate healthy abundant mitochondria.,English
+"And those cells are probably going to continue to use glucose as a fuel source. But if ketones happen to be there, sure, they'll use that, too.",English
+"Why not? But the real money is metabolically compromised tissues, whether it's brain cells or other tissues that--",English
+"we're talking about the brain. So if you've got metabolically compromised brain cells-- because it's not across the board. Like with Alzheimer's brain scans,",English
+there are specific regions that are more metabolically compromised than others. And that's why we see patterns of atrophy in specific brain,English
+regions. It's because those regions are dysfunctional metabolically for whatever reason. And we can get into why that might be.,English
+"But my sense is that if you've got a metabolically compromised cell, that cell is sending out a distress signal. That cell is calling resources from the body, like feed me.",English
+"Give me something. And if it can't use glucose effectively, it is going to suck up those ketones and then start running on all cylinders or closer to it.",English
+And that process is so critical because what it means is that if that cell was barely getting,English
+"by on 60% of its real ATP requirement, it means that it doesn't have enough energy for maintenance and repair functions.",English
+"As soon as you give that cell a hundred percent energy or close to it, even if you get it up to 90% of its preferred energy amount,",English
+"it can start to repair itself. That's the beauty of the human body in living organisms, is that they",English
+"have a priority list of what they're going to do. If that cell senses that there are defective molecules,",English
+"defective proteins in this cell that need to be replaced, once it gets enough fuel, it will start repairing itself and doing that work.",English
+ANDREW HUBERMAN: That makes sense. Thank you for that clarification. I'd like to talk about Alzheimer's and age-related cognitive decline generally.,English
+"I know many people out there are just terrified of losing their memory for the obvious reasons. Memory sets context, et cetera.",English
+And many people have relatives that suffer from Alzheimer's or other forms of dementia. I've heard that the ketogenic diet and diets like,English
+it can be very effective for helping to offset some of the symptoms of Alzheimer's and age-related cognitive decline.,English
+"In fact, I even have a friend I won't out by institution, who's the chair of Cardiology, who contacted me, of all people, asking whether or not I was aware of any studies",English
+"or whether or not I knew of anybody who had benefited from ketogenic diet for Alzheimer's. And I thought, well, why don't you ask one of your colleagues",English
+in neurology? But his response was really interesting. He said there are many books out there for the general public. There are a lot of online discussions about this.,English
+"There are a lot of assertions about this, and some animal studies. Again, these are his words. There are very few, if any, controlled clinical trials",English
+exploring the role of the ketogenic diet for the treatment or reversal of Alzheimer's and age-related cognitive decline.,English
+"I'm hoping that statement was incorrect or soon will be incorrect-- because those trials are ongoing-- but he said, yeah, the people are most popular for telling us",English
+"about the important role and positive role of being in ketosis for Alzheimer's, for some reason, they just won't do a clinical trial.",English
+"And that's been frustrating to the community. So this is a very educated, very accomplished person who's a physician of heart medicine as opposed",English
+"to something else related to the brain. But what is the story there. And for goodness' sake, why aren't there clinical trials",English
+"on ketogenic diet and Alzheimer's? I don't expect you to be responsible for that fact. But goodness, I would think this would",English
+be the obvious thing for NIH. I'm on study section but not for these sorts of experiments. Why isn't money just avalanching into this area based on all,English
+the anecdotal evidence that people are talking about? CHRIS PALMER: So we've got a couple of small pilot clinical trials.,English
+"The best one was a randomized controlled trial. I think it only included 26 subjects, something like that, randomized to 12 weeks of a low fat diet, 10-week washout,",English
+12 weeks of ketogenic diet. Some of the participants got keto first and then low fat. Other participants got low fat then keto.,English
+"And that trial actually found that when patients were in ketosis, they had statistically significant",English
+improvement in activities of daily living and quality of life. And they did have improvement in cognitive function.,English
+"But it didn't reach statistical significance, that improvement did not. We've got other trials.",English
+We've got several animal models showing that the ketogenic diet can improve biomarkers of Alzheimer's disease in Alzheimer's models.,English
+"So it can reduce plaques and tangles, can even improve cognitive impairment in animal models. And we've got a couple of other small pilot",English
+"trials of ketogenic diet in humans, showing that it improves biomarkers compared to, say, the low fat diet or the American Heart Association",English
+diet. So we've got those. I think one of the biggest challenges that I'll just share openly--,English
+and this is-- I'm somebody who's pretty passionate about this research. And I believe it has a lot of potential. But Johns Hopkins' researchers attempted,English
+"to do exactly this kind of a study, Alzheimer's patients' ketogenic diet versus the, I think,",English
+"American Academy of Aging-- or something like that-- diet, is the controlled diet. ANDREW HUBERMAN: Which presumably has starches in there.",English
+"CHRIS PALMER: Yes. ANDREW HUBERMAN: I think that's the key variable. CHRIS PALMER: Probably lots of-- yeah, lots of-- ANDREW HUBERMAN: And some potatoes-- CHRIS PALMER: Whole grains, lots of whole grains. ANDREW HUBERMAN: Yeah, some potatoes.",English
+"CHRIS PALMER: And they spent, I believe, over three years. They screened over 1,300 people who expressed interest.",English
+"At the end of the day, I think they only got 27 people to enroll. And only 14 of those people completed the study.",English
+"ANDREW HUBERMAN: Wow. CHRIS PALMER: Despite that, what they found was that the subjects who achieved ketosis had cognitive improvement.",English
+"But people on study section are going to look at a study like that and say, even if the science is there, if you can't get people to do this diet,",English
+"why would we spend money on researchers trying to get people to do this diet? ANDREW HUBERMAN: I should mention,",English
+study section is this closed door panels of 40 or so people. There are many of these panels. Different divisions in the National Institutes of Health,English
+"use different panels. And then grants are evaluated in a very small, because of the size of the federal budget for research, a very small percentage.",English
+"Usually, about 10% of these studies are funded. The rest generally don't end up happening. That is very informative.",English
+"What you just described is very informative because now it makes sense to me. There's no conspiracy. It's not big pharma, I don't think,",English
+is trying to suppress trials of ketogenic diets on Alzheimer's because I would imagine the first thing that pharma would want to do,English
+"is to see that study done. So they didn't have to. And then the moment it was done, if it showed a positive effect, they'd probably want to isolate the molecule and wrap it up in something that people would take, right?",English
+"CHRIS PALMER: Yes. ANDREW HUBERMAN: So I don't think there's any active suppression by pharma. I think pharma would probably be cheering from the sidelines because they could capitalize on it, because ultimately,",English
+the studies are done by scientists. But the treatments are generally doled out by pharmaceutical companies and/or physicians. So I don't believe there's a conspiracy there.,English
+"That is very interesting. And it's kind of amazing, given our discussion of earlier, which is that you had a patient that was having schizophrenic symptoms who",English
+"managed to stay on this diet. So is there something special about Alzheimer's patients and people with age-related cognitive decline? Presumably, they're very dependent on others",English
+to cook for them and shop for them. I think that this is almost perfect controlled environment for getting this study done.,English
+"CHRIS PALMER: I think that is the key issue. So again, I got patients-- I get patients with bipolar disorder, schizophrenia,",English
+extraordinarily impaired people to do this diet and stay with it. But it's because I'm providing a weekly session for them.,English
+"And I imagine this study did not provide that kind of intensive support. In the pilot trial that I described to you,",English
+"they actually got, I think, over 90% compliance with the different dietary interventions. So some of it is going to be dependent on the research",English
+"group. And does the research group understand that this is not-- it's not like prescribing a pill. Here, take this pill.",English
+"And take it every day and come back in three weeks. And even then, we don't know for sure that the patient took the pill every day.",English
+"We just assume they took the pill every day. And studies say they probably didn't. So I think when we think about a dietary intervention,",English
+we need to think about more intensive support and education. And that support could be a health and wellness coach.,English
+It could be a dietician. It could be education of the family. It might even be providing them with dietary meals.,English
+"That maybe for six months, we actually provide them with ketogenic meals-- once a week, put them in your freezer.",English
+"Microwave them when needed-- to make this diet as easy and doable as possible. Because if we can get people to do the diet,",English
+"if we can get them through the first couple of months, most people can learn how to do this diet. More importantly-- I didn't mention this before.",English
+"But the number one reason I am so successful at getting patients to stay on this diet for years, is because of the consequences to them when they go off of it.",English
+"That is the reason I can get schizophrenic patients and bipolar patients to do this diet, whereas other people can't get an everyday human",English
+being to do it for weight loss because the weight loss patient doesn't experience devastating tormenting symptoms when they break the diet.,English
+"Oftentimes, they are rewarded. They eat something they really enjoy. And they get a little bit of a dopamine rush from it. And they're off to the races.",English
+"They're like, I'm going to-- oh, I've already cheated. I'll cheat again. I'll get back on it someday. And they never get around to it.",English
+"My patients, when they go off the diet, they start hallucinating within 48-- or 24, 48 hours.",English
+And they quickly realize that was a really stupid thing to do. That piece of cake was not at all worth the torment that I'm experiencing now.,English
+"So they get back on the diet. I suspect with Alzheimer's disease, we might notice something similar. Some of these people have very mild symptoms.",English
+"So maybe they won't have that kind of a reinforcement, negative reinforcing kind of experience. But I think some of them will.",English
+"Some of them recognize that they are impaired cognitively. And if this diet could help them remember better,",English
+"if this diet could help them function better-- and again, that's what the pilot trial showed, is activities of daily living. That means these people are able to go",English
+"to the bathroom on their own. They're able to get themselves dressed. Whereas, they needed help with those things before. Those are actually really important things",English
+"to both the patient and the caregiver. And if they go off the diet and then quickly revert into a more symptomatic state,",English
+"that might be reinforcing enough for them to figure out a way to do the diet on their own. And if we think about, if this really",English
+"is an effective intervention-- and yes, we need longer trials, larger trials, all of that, because there are plenty of stories in the medical field where pilot trials looked really",English
+"spectacular and promising. And then larger trials just failed to show the benefits. I believe, based on all the science of metabolism,",English
+"mitochondria, glucose hypometabolism, all of that, I believe the science makes this an obvious treatment that has real potential.",English
+and extensive clinical observation at that-- I think biases that are simply because we want to feel a certain way or believe something,English
+"are worth critiquing. But bias based on observation-- here, I should mention that most of what we know about human memory",English
+"was sparked by one patient, a famous HM, who I think was living in Harvard Medical, in one of the hospitals around. There are many hospitals on Longwood Campus.",English
+"But one patient, the reason we associate the hippocampus with memory is because we knew that HM's the hippocampus was intentionally",English
+"damaged for epilepsy treatment. So this idea that everything has to be a randomized clinical trial, to me, is crazy.",English
+"Of course, that's a gold standard. And it's essential. But there's so much information in textbooks, medical textbooks",English
+"in particular, that are gleaned from single-patient case studies or from three-patient neurostimulation in the brain or something of that sort.",English
+"So to me, I'm still perplexed as to why there's this insistence on only one form of evidence.",English
+"Clearly, what you're doing, the important work that you're doing clinically, and in the research side, and in public communication, is assisting this.",English
+is a very interesting aspect of the diet as is intermittent fasting for weight loss even though it might just be by way of caloric restriction,English
+"that occurs with fasting. But then in some ways, the effects of the ketogenic diet on weight loss are a bit of a decoy for most people.",English
+That's where their mind goes. This person lost X amount of weight. Maybe that made them feel better. Maybe that actually made them underweight. I think you've talked about it.,English
+"For some people, it can actually bring them under weight. I'm glad that we got the chance to dive into the description of ketogenic diet for epilepsy",English
+because it really is a medical intervention that has a side effect of weight loss or could be used to treat obesity and induce weight loss.,English
+"But it's really about far more than that. And that raises a question for me, which is-- we've been talking about the ketogenic diet as one thing.",English
+"But I've heard you discuss this before, where just as a physician will prescribe different dosage ranges of a given drug, you can prescribe different dosage",English
+"ranges of a nutritional plan, a diet. It's not one thing. It's not necessarily zero carbohydrates or 100 grams or 50 grams.",English
+It depends on the patient and a lot of other factors. I've heard you list off various things classic keto. Maybe you could just briefly tell us what that typically,English
+"is, because I think most people think it means eating a lot of meat and not carbohydrates. But it might not be that.",English
+"Fasting and then some of the other-- you mentioned Atkins earlier. We don't have to go into each of these in detail. And I know in your book, you talk about",English
+"not just the science and clinical background but also some actionable steps that people could consider. So they can refer there for more detail. But for somebody who, let's say, is",English
+"observing all this. But what is the typical thing that you probe with first? Just like with a drug, you might probe with 20 milligrams of a drug.",English
+"What's your typical initial dietary intervention probe? Terrible languaging, I realize. And I'm criticizing myself for that.",English
+I try to meet them where they're at. So if somebody-- and I want to point out. You mentioned the all-meat version,English
+"of this diet, which is often referred to as the carnivore diet. ANDREW HUBERMAN: Very controversial diet. CHRIS PALMER: There is no doubt that exists.",English
+Some people swear by it. They swear they've tried other versions of ketogenic diets and only when they went to a carnivore diet did they get benefits.,English
+"But there are vegetarian and vegan versions of the ketogenic diet. So in my mind, this is not at all about the diet wars of animal-sourced",English
+"versus plant-sourced foods. It's about inducing a state of ketosis, which is mimicking the fasting state. That is what it's about.",English
+"And you can do that by not eating anything, by fasting and/or intermittent fasting. And you get your results. So no diet is a ketogenic diet.",English
+So it's not about the foods or the types of foods that you're eating. It's about inducing a state of ketosis. The first variable I'm going to look at when I recommend this,English
+"for those two situations. In the obese patient, they have tons of fat stores on their body already. Usually, it is a goal of theirs to tap into some of those.",English
+"So that person, really, the diet is carbohydrate restriction. And that usually is a sufficient intervention. ANDREW HUBERMAN: Both simple carbohydrates,",English
+You can have added natural sweeteners like stevia or monk fruit. You might use artificial sweeteners.,English
+"Years of doing this, I'd probably recommend steer away from them if you can because I think they tend to stimulate cravings for high carb foods.",English
+"So if you can kind of get through a couple of weeks without sweet things, your cravings for those will go down.",English
+"And it'll make the diet easier and a little more sustainable. But let's say you can have your artificial sweeteners, if that's what you really want.",English
+So I'm going to say less than 20 grams of carbs a day for those people. They can have all the protein they want. They can have vegetables.,English
+"And they can have all the fat they want. But I'm not going to push fat on those people. I'm not going to tell them, eat a lot of fat, at the same time because I want to use the fat on their body as the fat source,",English
+"at least early on. ANDREW HUBERMAN: Are you encouraging healthy fats like monounsaturated fats, like olive oil? Are you encouraging people to eat a little less",English
+"And it's going to depend on the person. A lot of times, people come to me with very specific ideas. But I'm going to tend to encourage olive oil, avocados,",English
+"nuts, which are usually considered, even by the American Heart Association, healthy sources of fat. The more controversial thing are things",English
+"like coconut oil or coconut cream, which the American Heart Association might say is not a healthy fat, I kind of disagree with that and don't think",English
+it's unhealthy at all actually. And when you look at the epidemiological studies of saturated fat causing heart disease,English
+"or causing adverse outcomes, at best, maybe increases your risk 10% to 15%-- at best. ANDREW HUBERMAN: How much coconut oil",English
+"can people ingest, anyway, before they either develop diarrhea-- no joke-- or just sort of get tired of coconut oil?",English
+"Anyway, your point is taken. But they can eat meat if they like meat? CHRIS PALMER: Absolutely.",English
+"ANDREW HUBERMAN: Or they can eat eggs. Or if they don't like meat and eggs, they could eat sardines or things of that sort. I personally can't-- I can't even stomach the--",English
+"I don't even like the word ""sardine."" I have nothing against the actual fish. But that's just me. But obviously, people have--",English
+"I say this because people have different preferences, right? CHRIS PALMER: Yes. ANDREW HUBERMAN: I'll eat a steak. But I'm not going to eat a sardine. CHRIS PALMER: And I'm going to go with that.",English
+"And again, there are vegan sources of protein that-- people can eat tempeh and other things. So that's the obese person.",English
+It's carb restriction as the primary initial phase. The thin person is going to need to eat a lot of fat because they don't have a lot of fat stores on their body.,English
+"And if I want them in ketosis, clinical ketosis, I'm going to have to feed them fat. So that's the person that I'm going to say, make sure you get in avocados,",English
+"olive oil, butter, maybe heavy cream. So heavy cream is delicious. It's a delicious way to get your fats in.",English
+"I have one patient who just drinks it straight, to just try to get it in. ANDREW HUBERMAN: I get it. I've never had an appetite for sweets.",English
+"I absolutely love savory fatty food. When I was in high school, I was thin. So I was able to do this.",English
+"But I used to drink half-and-half. Sometimes I wake up in the middle of the night and drink it just because it tastes so, so good. CHRIS PALMER: It does taste good.",English
+"So if they're on a ketogenic diet, I'm going to push them away from half-and-half and toward heavy whipping cream. So you can whip that up.",English
+You can freeze it. It turns into ice cream. You can add vanilla. You can add cocoa powder. You can add all sorts of things.,English
+"And you're off to the races with shakes, and ice cream, and mousse, and all sorts of things that you can have. With any of these patients, the beauty of this diet",English
+is I have objective biomarkers. I'm going to have them measuring ketones. And I'm going to adjust the diet based on their state of ketosis,English
+"and/or the clinical benefits that I'm looking for. If it's an average person, who is not currently under psychiatric care, not taking prescription medicines",English
+"but is saying, I'm burned out. I'm exhausted. I want some of that brain energy that Andrew Huberman is talking about.",English
+"He talks about feeling good. I want some of that. I'm probably actually going to recommend the protocol you describe, which is,",English
+"let's see if we can just carb restrict for a while and see if that produces clinical benefit. I have one-- he's not even a patient,",English
+just somebody who read my book. I didn't tell him anything. And he came away from it saying--,English
+"he was ready to start an antidepressant for his anxiety. He had chronic anxiety, was trying meditation, was trying all sorts of things.",English
+Nothing-- those things weren't enough. He was ready to go on prescription medicine. He read an early copy of the book.,English
+He took it upon himself without consulting with me to restrict carbohydrates alone. He did not go ketogenic. He is a vegetarian.,English
+"He restricted carbs. Within three weeks, said, I don't need prescription medicine. I can't believe how much better I feel.",English
+"And all I did was cut out some of the high carb foods in my diet. So I think for some people, it can be that simple.",English
+"For people with serious mental disorders, if they are chronically depressed, if they're on lots of prescription meds, if they're",English
+"disabled by their symptoms, and certainly, if you're bipolar or have schizophrenia or something, those are the people I really do want",English
+them to work with a medical professional because meds may need to be adjusted. They need a real shot at this diet.,English
+"It's not like weight loss. Weight loss, everybody wings it. And either you're successful or you aren't. You look on the internet or you read a book or you do--",English
+"even the colleague that you mentioned, he's probably just reading-- who knows whether it's credible information or not--",English
+"and just winging it, and seeing whether it works or not. For people with serious mental disorders, I want you to treat it like you have epilepsy because you do",English
+have a serious brain disorder. It's impairing your ability to function in the world. It's impairing your health and happiness.,English
+You deserve a competent medical treatment. And we have that. We have a hundred-year evidence-based.,English
+We've got dieticians who know this like the back of their hand. They can monitor your level of ketosis. They can help look for vitamin and nutrient deficiencies,English
+"that can be a consequence of the diet, and make sure that you're not developing those. They can help tweak the diet if needed. They can give you ideas if you're getting bored with eggs",English
+"every morning. They can give you ideas for what else you might have. And if you're using it to treat a serious disorder, I think you need serious help.",English
+"ANDREW HUBERMAN: A couple of questions, a little more detailed, but I think a lot of people will have this on their mind. Is it ever the case that you'll prescribe",English
+"somebody the ketogenic diet in conjunction with intermittent fasting? So eat keto but eat between the hours of, whatever, 11:00 AM and 8:00 PM or something like that.",English
+That's the first question. CHRIS PALMER: Absolutely. And I have one patient with type 2 diabetes and chronic depression.,English
+"And he will try to follow the ketogenic diet. And sometimes, his blood sugars are still very high. And sometimes I will ask him to do",English
+either intermittent fasting or even a three or four day water fast. And it is shocking.,English
+"When he does a three or four day water fast, the first day or two, he feels like crap. I'll just say up front, don't do it if you've got",English
+an important meeting or business trip or anything. Don't be-- ANDREW HUBERMAN: So this is just consuming water. CHRIS PALMER: This is just consuming water.,English
+ANDREW HUBERMAN: No black coffee? CHRIS PALMER: I usually tell him he can have plain black coffee or tea. But--,English
+"ANDREW HUBERMAN: You have mercy after all. CHRIS PALMER: I have a tiny ounce of mercy. But when he does it, his blood sugars plummet in a good way,",English
+"his blood sugars are normalizing. But the last time he did it, he actually got to seven days at one point.",English
+"And he said, I feel great. I want to keep going. I can't believe that I'm not hungry. But I am not hungry at all. I don't miss food at all.",English
+"And at seven days, I kind of cut the cord. I was like, no, no. We're done. ANDREW HUBERMAN: He needs to eat. CHRIS PALMER: [LAUGHS] We're done.",English
+"ANDREW HUBERMAN: You got to eat. Well, I find it really interesting that the intermittent fasting, of course, controversial at some level, but as to whether or not it's just beneficial by way of caloric restriction--",English
+because it is one way to achieve caloric restriction-- whether or not has additional benefits. But I'm very interested in the neural side of it.,English
+"And it does seem that the fasted state can start to take on its own rewarding properties, where people get dopamine release not",English
+"from eating, as most everyone does, but from abstaining from food. Now, this can be pathologic in the sort of example of anorexia nervosa, which is we both know as the most",English
+"deadly psychiatric illness. But for non-anoxerics, I think it's interesting to note that eventually not eating can have",English
+"its own rewarding properties to it that aren't just related to weight loss. But in the short-term, feeling-- in other words, feeling really good by way",English
+of abstaining from eating. CHRIS PALMER: Yes. And that's actually-- it raises an important risk that I haven't mentioned yet.,English
+"But at least in psychiatric patients-- but even in some patients who just use the keto diet for weight loss, I have seen definite hypomania.",English
+"CHRIS PALMER: No. So the distinction between hypomania and mania-- so mania, you might become psychotic and delusional. Mania, by definition, is problematic.",English
+"It's causing a problem in some way or another. And if you have psychotic symptoms, it's definitely called mania, full-blown mania. Hypomania, for better or worse, is",English
+something every human being probably craves. So it is feeling extraordinarily good. It's getting by on less sleep.,English
+But you don't need to sleep. Who needs sleep? I've got things to do. My brain is running on all cylinders.,English
+"I feel so creative. There have been lots of famous people through the ages who have been bipolar, probably bipolar.",English
+"And some of their most productive periods of time, whether it's art or creating scientific models or what-have-you, were probably during hypomanic episodes.",English
+ANDREW HUBERMAN: So what do you do in that case? I'm obsessed with getting sufficient quality sleep. It's a kind of a repeating theme in our podcast,English
+"and many of my social media posts. And I always recommend behavioral tools first, then exercise, viewing sunlight, et cetera,",English
+"at appropriate times, avoiding late night artificial light exposure, et cetera, and occasionally, for people who are doing all that",English
+"and still struggle with sleep, supplementation. One of the things that I've seen some data on is that for people who are following a low carbohydrate",English
+"diet, that inositol, in particular, can be helpful for getting into sleep probably because it's a bit of an-- has",English
+"a bit of an anti-anxiety effect. But presumably, there are other things out there, too. The magnesiums will generally do that. A hot bath will do that, too, for that matter.",English
+"But what you're talking about is people who are going, what, a day and a half without sleep? Or they're just two hours of sleep a night? CHRIS PALMER: So the worst case I",English
+saw was actually a mental health professional who didn't recognize it initially. He went six months with two to four hours of sleep every night.,English
+"ANDREW HUBERMAN: Because they were on a ketogenic diet? CHRIS PALMER: He was on a ketogenic diet, was getting by on two to four hours of sleep every night, did not initially recognize that this was a problem.",English
+"He was feeling great. He was feeling that keto high. And he was actually waking up at 4:00 AM,",English
+"going for 10 to 20 mile runs most days. He finally stopped the ketogenic diet after about six months because he said, I can't maintain my weight.",English
+"I'm losing too much weight. ANDREW HUBERMAN: Sorry, I didn't mean to interrupt. I was just thinking there are some social media personalities associated with nutrition",English
+that might be hypomanic. I'll let you do the clinical evaluation. So what does somebody do in that case?,English
+"So I don't know that I've ever been hypomanic. But as I mentioned earlier, unless I've done a very high intensity workout early in the day",English
+"and I need to replenish carbohydrates, I typically eat meat, fruit, and vegetables throughout the day-- minimum amounts of fruit but some.",English
+"And then at night, I switch over to mainly carbohydrate. It really helps me sleep. It replenishes glycogen stores. I sleep really well, wake up the next morning, repeat.",English
+"And of course, this goes against a lot of the dogma that, oh, you're not supposed to eat carbohydrates late in the day and [MUMBLES]. This is what works for me.",English
+"And so I do it. For somebody like this mental health professional, who is hypomanic, would going off the ketogenic diet entirely",English
+be the best idea? Or could it be that adjusting when they eat their carbohydrates would be advantageous in order to make sure that they felt,English
+alert and great during the day? Maybe not hypomanic but then could have a four to eight-hour a night sleep as opposed to a two,English
+"to four hours a night, which is really very little sleep. CHRIS PALMER: Yeah, it's not-- ANDREW HUBERMAN: It can't be healthy. CHRIS PALMER: It's not healthy.",English
+"ANDREW HUBERMAN: Even if you can do it and feel great, I imagine that the brain is suffering. CHRIS PALMER: It is. And the body is suffering. ANDREW HUBERMAN: And your friends and family",English
+"are suffering. CHRIS PALMER: The body is repairing itself with sleep. And so yeah, it's-- if it's somebody who is not a patient,",English
+they're not a mental health patient. They're not using the ketogenic diet as a mental health treatment. They're simply doing it for whatever.,English
+I actually start with everything you've just outlined. Let's start with behavioral measures first. And the first intervention is education.,English
+"You need at least six hours of sleep a night. Period, end of story. That's non-negotiable.",English
+"If you're not getting at least six hours of sleep a night, we need to consider this a problem. So figure out a way to get 6 hours of sleep.",English
+"For some people, that's enough, just the education. They don't get out of bed at 3:00 AM. It might take them an hour to fall back to sleep.",English
+"They fall back to sleep. For most people, if you can get three nights of decent sleep in a row, the hypomania goes away.",English
+That is the way to extinguish it. And then they still go on feeling a high from it. They feel great.,English
+"Their brain feels good in terms of memory, concentration, motivation, all of those things. But they're not hypomanic anymore.",English
+"And then I might use supplements, melatonin, others that you mentioned, magnesium is a big one. And for some, I will recommend exactly what you're doing--",English
+eat some carbohydrates in the evening before you're going to bed. Either have them at dinner and then wait a few hours before you're going to go to bed or have them right,English
+"before you're going to go to bed, just to try to calm your body down and get it going. When I'm using this as a clinical intervention,",English
+"especially with patients with serious mental illness, I actually want them in a state of ketosis long-term. So I'm not going to do the carbohydrate intervention.",English
+"I'm going to try all the other ones. But if they still can't sleep even with supplements, over the counter supplements, then I'm probably going to go with prescription, sleeping",English
+"medicines, as a temporary stopgap to try to get them three to seven days of decent sleep. That usually breaks the hypomanic cycle.",English
+And then they stay on the ketogenic diet because it ends up resulting in all of these other improvements that I've described.,English
+Their illness can sometimes go in to full remission. ANDREW HUBERMAN: Is it low dose trazodone as a first line prescription?,English
+CHRIS PALMER: I would not use trazodone. I would actually specifically avoid trazodone because it's an antidepressant. And they're already hypomanic.,English
+"And then he went to high school. He had friends, but not as many as his brother. He spent a lot of time in his room, drawing,",English
+"he was quite an artist. Today, I would say he was withdrawing, but I didn't see that then.",English
+"He started smoking in high school. I didn't know that. When you look at the yearbook from Trinity High School, where he graduated, you'll find his picture",English
+"where all of you guys will have your picture one day here. But if you look through the yearbook at all the candid shots: the basketball games, the dances,",English
+"the football games, the soccer games, you won't find his picture because he wasn't there. He was probably home, drawing or withdrawing.",English
+"He was pretty smart, but he didn't do as well as he should have, I didn't think. But because he was smart, he tested well. He got into a pretty good college in New York.",English
+"It could be true. I'm not recommending it, but it could be true. And my son, who grew up in a house where we didn't drink, we just didn't like the taste of alcohol.",English
+"My son started majoring in drinking, apparently. I didn't see him all that often, but I could hear it some nights when he called us,",English
+"I could hear it in his voice. And sometimes, when we'd be down on the campus, kids who I didn't know, fellow students would come up to my wife and me and say,",English
+"""we're worried about him. He seems to drink a lot."" I would talk to him about it and he would say, ""Dad, I don't drink more than anybody else. I don't know why they're saying that.""",English
+"I couldn't prove it. I couldn't do much about it. He graduated from college. Again, he didn't do great, he did okay.",English
+"He tested well, he got into a good graduate school in Boston and by then, he was drinking every day. Every single day.",English
+"He lived with us for some of that time. He lived alone, north in Boston, for a while. Somehow, he got through graduate school. I don't know how he did it.",English
+And then he got his first job and he held it for four weeks. But it wasn't his fault he lost the job. Took longer to get the second job.,English
+"He held that for about three weeks. It wasn't his fault. And at that point, his drinking seemed to be the problem. It was alarming, actually.",English
+"So my wife and I went and talked to the alcohol experts, told them what was going on, and they said to us, ""With absolute certainty, your son, Judge, is an alcoholic.",English
+"That's what's happening here. So here are your choices. You can put him on the street, literally. Maybe he'll hit bottom and bounce back.",English
+"Or you can keep him in your house and he'll die drinking in your house, Judge. You can't drink when he's drinking. It won't be next week or next month or next year,",English
+"but at some point, he's gonna die drinking."" And my wife and I didn't like those options. So, we convinced my son to go to rehab,",English
+"which was pretty silly, looking back. He didn't think he had a problem. He said, ""dad, if I didn't have these feelings, I wouldn't be drinking.""",English
+"We talked to the alcohol people and told them that, and they said, ""Judge, everybody who's an alcoholic has a reason. He's an alcoholic.""",English
+"so we sent him off to rehab and he did the world tour of rehab. He went to New Hampshire Hyannis on Cape Cod. Wesleyan, Connecticut and Florida.",English
+"And he came back from Florida after weeks, he had been drinking on the plane on the way home. So obviously, it wasn't taking.",English
+"And you guys don't know my wife, and she's not here today, so I'm not trying to curry favor with my wife. Not that I'm above doing that,",English
+"I'm just not doing it now. My wife is a decent, kind, compassionate person. We both loved our son.",English
+And I tell you that because she and I were the decision tree as to what to do. And so we put him out. It was the hardest decision we ever made.,English
+We thought it was a tough love decision. It was such a bad decision. We didn't know when my son went out,English
+that he had underlying mental health problems. All we saw was alcohol. And he didn't know he had a mental health problem. He just had feelings.,English
+"And when we put him out, he was there for three weeks. He slept in his car, some nights he slept at the shelter. He ate at the soup kitchen.",English
+"He continued to drink. And after three weeks of dreading that phone call that every parent dreads, that something happened to our son",English
+"or that he'd run into a family while driving drunk, we brought him home. And we knew when we did that, what that likely meant.",English
+"That he would die drinking with us, but at least he would be with us. What we didn't realize is when we put him out,",English
+"my son's underlying mental health problems exploded. I hadn't seen them for what they were. And when we brought him home, he was so traumatized",English
+"by that experience, he was drinking as much, if not more, than when we put him out. And I believe he was afraid we would do that to him again",English
+"and he just couldn't deal with it. So one night, he assaulted me. I went to the intensive care unit",English
+"at the Elliot Hospital in Manchester. I was there for eight days, they tell me. I have no memory of that. I've no memory of going to the hospital.",English
+"But my wife does. And my son does. I was on the Supreme Court at the time, it got a fair amount of coverage.",English
+You might imagine that would be an interesting story. It's kind of a man bites dog story. Judge's son goes to jail.,English
+"He was arraigned, issued an orange jumpsuit and went to the Valley Street Jail, in Manchester. I was in the ICU.",English
+"I don't know how my wife survived that. I don't. She says the first time she visited him, he had the orange jumpsuit on.",English
+"I am so sorry. Is dad gonna be okay?"" She didn't know back then. She didn't know.",English
+"She couldn't visit every day. So I said, ""mom if you could come, I'm usually in my cell at 3 o'clock. I can see the cemetery here from my window,",English
+"and I just don't want to feel like my family's abandoned me, so if you came there, that would comfort me that I could see you."" And so, she did.",English
+"I can't imagine what that was like for her. She drove to that cemetery, sit on the corner, waved at the building, not knowing what window he was in or even if he was at a window.",English
+"Gave him a thumbs up sign. Later, she said, ""it was a good distance away, cuz he couldn't see me crying from that distance.""",English
+"She'd leave the hospital in the early days, it was late March, early April, still pretty cold. She said in the early days, there were satellite trucks,",English
+"TV trucks outside, she said, ""I avoided that. I went home and there'd be 20 messages on the answering machine and I just deleted all of them. What would I have told him?",English
+"What would I have said?"" When I was in the intensive care unit, my doctors went on the Today Show, apparently. The story was in the New York Times, the Los Angeles Times,",English
+it wasn't exactly below the radar. People Magazine reached out to my wife. She didn't respond to that.,English
+"After eight days, they took me up to a private room on the sixth floor at the Elliot Hospital. I then realized I was in the hospital.",English
+"I had no idea why. And the fella who was pushing me upstairs, I asked him and he said, ""I think you fell."" and I didn't remember that, but I had no other memory.",English
+"I felt pretty sore for someone who had fallen. And so, after two days in that private room, my wife and I went home.",English
+"I couldn't get out of bed for a week. And she told me what had happened, as best she knew. And the two of us just cried.",English
+"I'd been a lawyer and a judge my whole life. I knew what it meant. I didn't understand what happened, but I knew what it meant for him, for us, for his brother.",English
+And I never thought that it had been on the newspaper. I never even had that thought. And I'm glad I didn't.,English
+"It was the most hopeless feeling I ever had in my lifetime. Lying in the bed, my son's in jail. I couldn't do anything.",English
+"And my wife was trying to deal with all of that, pretty much on her own. My son was not supposed to have any contact with me while he was at Valley Street Jail.",English
+"I couldn't visit. But that Father's Day, about two months in, he made a card, he was a good artist,",English
+"and he mailed it to us. And my wife handed it to me, we were driving. I couldn't drive the car then. And I read it, and when I read it, my eyes got watery",English
+"cuz that was my son who wrote that card. That was the guy I knew who wrote that card. Apologizing. After six months at Valley Street,",English
+"my son was sentenced to the state prison. I hope none of you have that day in your lifetime. And because I was on the Supreme Court,",English
+"and because it was still newsworthy, there were members of the press there. I hadn't seen my son in six months,",English
+"and suddenly he appeared in the courtroom. My wife and I were behind the rail in the public section. He came over, I stood up, and he gave me a big hug",English
+"I don't know how my wife survived that hearing, to be blunt. He was sentenced to seven and a half to 15 years. They suspended four years of the seven and a half.",English
+"And if he behaved himself, he might not have to serve that time. But he had to serve the rest. And so off he went.",English
+"Twenty percent of the cases I heard on the Supreme Court came from the place where he was gonna take up residence. We heard appeals from inmates, his new neighbors.",English
+"One day, I said to him, ""do you want me to step down? I'll step down from the court. I love it, it's a great honor, but your health is more important than that job.""",English
+"We'll issue a press release at your resigning."" He didn't. He didn't. After 30 days, my wife and I were allowed",English
+"to go up and visit, and we met him in the secure psychiatric unit of the state prison. He wasn't housed there,",English
+"but that's where the meeting took place. Met with my son, the head psychiatrist, two social workers. The secure psychiatric unit is a sad place.",English
+"It has a hopelessness to it. Kinda antiseptic, a lot of steel on steel. A lot of clicking heels on linoleum.",English
+"He has serious depression. anxiety and panic attacks are almost off the charts. If you had his problems, Judge,",English
+"and I said, 'hey why don't you have a six-pack every day. It'll make you feel better for a while.' You might reject it, but eventually you'd do it.",English
+"I look back and I think, how ignorant was I? My ignorance caused a lot of problems in my family. So he said, ""we're gonna work with your son.",English
+"We're gonna see if we can help him."" When my wife and I walked up the long driveway, behind the secure psychiatric unit, that day to our car,",English
+I thought my son was right. He wasn't an alcoholic. His problem is mental illness. Not alcohol.,English
+"And all those images from my ten year old self, of that guy across the street, flooded us. I thought, maybe that'll be my son.",English
+"for the balance of his time in the prison. He had mental health problems. My son was married in prison,",English
+"and for those of you, in the future, who might be making wedding plans, I wouldn't go there. Just my thought. It wouldn't be my first choice.",English
+My son's wife had done her Master's degree with him. She later won an Emmy in New England for her work on film and film editing.,English
+"She was twice nominated. I've held the Emmy statue. If she would let me keep it, I would do that. But she won't.",English
+"They have a nine year old daughter, my granddaughter. As you all know, grandparents are very objective, very fair about their grandchildren.",English
+"So even if I weren't totally fair and objective, my little nine year old granddaughter is stunning. She could be a child model.",English
+"She really could. And every time I hug that little girl, I say you are a miracle child. From where we were and where we are, she's impossible to me.",English
+"When my son was paroled, and I never thought they'd parole him, cuz I was then Chief Justice. And I said they're not gonna parole the son of a Chief Justice.",English
+"And that day, they sent a camera crew out from Channel 9 to ask my wife and I to comment and I said, ""we're really happy my son's coming back to real life.",English
+"I knew I had failed him. I went back to the court. And by the way, he told me, my son, that they gave him an IQ test at the prison",English
+"and I said, ""how did you do?"" And he said, ""I was three points below genius."" I knew he was smart. And I said, ""Really?",English
+"I said, ""Okay, you're a genius."" I think he is a lot smarter than his father. I know that. I went back to the Supreme Court, I talked to my colleagues",English
+"about what we were doing, but no one else. That's the world I grew up in. Didn't talk about it. But people talked to me.",English
+"their cousin, their daughter. Mental health stories were everywhere. And they would tell me because I was safe. I wouldn't be judging them.",English
+"Who would I be to judge somebody with a mental health issue? I said to my wife, ""do you realize how widespread mental health issues are?",English
+"Maybe he'll like to help."" And so I called her. But before I called her, I did what all of you would do. I googled her.",English
+"Oh, come on, you all do that. And I found out that she was on Time Magazine's 100 list. Hundred Most Influential People on the Planet Earth.",English
+"That would've been me, by the way. We launched this campaign a year ago in May, in an empty statehouse chamber.",English
+"of our congressional delegation, the Governor, the Attorney General, business leaders, civic leaders, family members. It was the most impressive room I'd been in,",English
+"in four decades. The most impressive room. And Barbara Van Dahlen, the genius behind this campaign, asked that group this question.",English
+But what I didn't expect is what happened. Not one hand went up. Not one hand went up. Meaning everyone had been touched.,English
+"She gave these statistics, which may explain one of the reasons I'm here this morning. Half of all mental illness,",English
+more people died by suicide than in every car accident in this country. We don't talk about that much.,English
+"We never talk about that. I said, ""Barbara, what can I do to help?"" She said, ""Can you form a steering committee",English
+"to launch this?"" So, I said, ""Well, I'll try."" It was the easiest thing I ever did.",English
+"And everybody I asked had a mental health story for me. Everyone. And they would tell me, they might not tell you",English
+I had no idea. We raised it in no time. First place I went was Dartmouth-Hitchcock. I didn't work there then.,English
+"Jim Weinstein was the CEO, Doctor Weinstein. Took me five minutes to get money. Elliot Hospital, Catholic Medical Center,",English
+"the New Hampshire Hospital Association gave us $40,000. We got to within $15,000 of that goal and I called former Governor Craig Benson,",English
+"Since then, we've raised another $184,000. We've raised a third of a million dollars. Dartmouth, alone, has put in a third of that.",English
+"After we launched this campaign, we waited to see if anyone would ask us to do anything with them or for them or talk to them.",English
+We didn't have a manual on how to do it. This morning is probably the 158th time I've spoken in the last 17 months.,English
+"I've traveled about 20,000 miles. I've spoken in person like this morning now, to almost 22,000 people. I've been to 50 high schools.",English
+I almost can't keep up with the invitations. It's not about me. It's about these issues that I feel so strongly about.,English
+"My family's tragedy is that it happened at all. I was pretty ignorant, then, about mental health. I'm not ignorant now.",English
+No one can be ignorant now. No one should be ignorant now. I spoke at a gym at Pembroke Academy.,English
+"Cuz maybe they hadn't been able to hear me. So I stopped and held my breath. Two seconds passed, I would say.",English
+"It's not me they're applauding. These kids wanna talk about it."" This generation's smarter than mine was. And there were kids in that auditorium that day,",English
+"in that gymnasium, who were suffering. We need to get real. We need to take away the shame and the stigma.",English
+"If you were a better person. If someone had diabetes, would you ever say snap out of it? People say they're depressed.",English
+"They say, ""what do you have to be depressed about?"" If I knew, I wouldn't be depressed. It's way past time that we changed it.",English
+"You can do that, if you want. My generation, the baby boomer generation, failed miserably. Our solution was don't talk about it, hide it.",English
+"Keep it a secret. Sometimes when I go to high school gyms or other places, people come up to me with wet eyes and cracking voices.",English
+"and you didn't pick your eye color. You're no different for that. Let me tell you something else. There are kids in this room today,",English
+"statistically, I know it's true, that have some sort of mental health issue. Hopefully, they're being treated here in school.",English
+"Someday, many of you will have children. Statistically, some of them will have mental health problems.",English
+We can do it now or we can wait for your children. And they can sit on the bleachers with their wet eyes. It's not right.,English
+"It's not morally right. And it's not necessary. When I was a kid, one of my friend's mothers was quite sick.",English
+"Some people in my childhood didn't even say the word cancer. They would say he or she has the C word. In my childhood, I never heard an adult say the word breast,",English
+"other than Hugh Hefner in Playboy Magazine. 1954. It's true. People whispered the word cancer, if they said it at all.",English
+"And no one, other than Hugh Hefner, said the word breast. Some decades later, some brave person or people said why don't we put those two words together?",English
+"Get a color, namely pink, a megaphone, and go to the Times Square and say, ""Enough. Enough already.""",English
+"300,000 women last year had breast cancer diagnoses. Their results are dramatically different. Why?",English
+Cuz we finally started talking about it. I can't look at the color pink without thinking about Breast Cancer. I bet you can't either.,English
+"The Patriots wear pink, the Red Sox wear pink. What's the color for mental health? In the 1980s, when the AIDS epidemic hit,",English
+"people were dying when we found out about it. And we said, ""What's going on with these people?"" Maybe they're bad people. Maybe they're doing bad things.",English
+"Who are they? We quarantined them, we stigmatized them. Can I get AIDS if I'm in the same room with someone, If I touch them?",English
+"And then Magic Johnson of the Los Angeles Lakers, superstar Magic Johnson, went to a bank of microphones in California, October 1991.",English
+"He said, ""I have HIV."" Suddenly, it not only okay to have HIV, we loved Magic. We had to find a cure or a treatment.",English
+"He's doing fine today, 25 years later. Mental health has never had a Magic Johnson moment. It desperately needs one.",English
+"And you can make that happen, if you want. Sometimes people say how close with this. Sometimes people say it's hard to change the culture.",English
+"Maybe if you make it hard, it is. When I was a kid, my parents used to take us out to dinner every Thursday night.",English
+"My father was a high school chemistry teacher. He must've been paid on Thursdays, that's why we went out. At the restaurant that we went to,",English
+every table had an ashtray. Every table. Several had many ashtrays. Every one in that restaurant was smoking.,English
+"My parents smoked. My parents worshiped my sister and myself, as they blew smoke in our face across the table. And then we'd leave that smoke chamber",English
+that strives as a restaurant and go home. Every room in my house had an ashtray. The bathrooms had ashtrays.,English
+"My bedroom, my sister's bedroom were the only rooms that didn't. Can you find an ashtray today? Can you find one?",English
+I haven't seen one in years and years and years. They're not in your car anymore. If you had said to me one of those smoky nights,English
+"in the restaurant, when I was a kid. If you said, ""John, in your lifetime, ashtrays will disappear.""",English
+"I would've said, nah, that's not happening. I'll be smoking, but then that's disappearing. We used to have a black and white television set.",English
+"I know what you're thinking. How old is that guy? But that's what we had. It had three channels, by the way,",English
+"and it went off the air at midnight. And no one had ever used the word in-ter-net. Somehow, we survived it.",English
+"Some nights on the news, I would see African Americans being attacked by police dogs or billy clubs. They seemed to be minding",English
+"their own business, marching peacefully. I didn't know why they were marching, but they weren't bothering anyone. It was very upsetting to watch.",English
+"it's happening in the United States."" President Barack Obama. I didn't know the president.",English
+"This is really important."" And so I bought an airline ticket, I flew to Washington for the inauguration. And I stood on the mall that day,",English
+"with 1.3 million of my closest friends. And by then, I knew Barack Obama's voice and I heard it live.",English
+"On the jumbotron, he was about 15 feet tall. And when he took the oath of office as President of the United States,",English
+would've been impossible in my own. Well it's now part of the history and fabric of the United States.,English
+"from the culture I grew up in, we can't learn the five signs? You don't have to go outside.",English
+You don't have to join a march. You don't have to write a check. But you do need to change your mind. And you need to learn what it is and what it isn't.,English
+And the reason you wanna do that is not because I've asked you. It's because it'll matter in your life. It will matter in your life.,English
+"Nothing to be afraid of, by the way. Nothing to be afraid of. Do it for them. Maybe do it for someone else's children 20 years from now.",English
+Or we can just keep kicking the can down the road and say we'll just keep it quiet. And we'll lose another generation to the shadows.,English
+"We need to change. If I can do this all by myself, I would do it. But I can't.",English
+"And my generation had an opportunity, and they didn't seize it. Your generation needs to force the discussion. There's no shame and no stigma.",English
+frequent mental distress or fmd yes it's  actually a syndrome if you will it's not in   the dsm but it's something that is recognized  by people who work with an older population,English
+frequent mental distress may interfere with  major life activities such as eating well   maintaining a household working or sustaining  personal relationships older adults with fmd were   more likely to engage in behaviors that contribute  to poor health such as smoking sedentariness,English
+and eating a diet that is not super healthy  very few fruits and vegetables let's think   about this when people are going through all of  these issues when they're experiencing anxiety,English
+when they're experiencing depression when they're  experiencing potentially ptsd after a stroke or a   heart attack or something some people do end up  developing um post-traumatic issues then um it's,English
+important to recognize that that alters the  neurochemistry that alters the hpa axis distress   anxiety anger depression tends to contribute to  inflammation inflammation tends to contribute to,English
+more distress especially depression and it can  contribute to cognitive decline and reduced energy   so people who are experiencing distress,English
+are often experiencing not only cognitive  things you know their thoughts their um   feeling helpless and hopeless perceptions you know  lots of things going on with that but they are,English
+also having the physiological issues that result  from that hpa axis activation so it's important to recognize the stressors that impact people  who are older you may think well they're,English
+older they're retired what do they have to  stress about well a lot there actually is a lot   so it's important to take a step  back and be sensitive and empathetic,English
+mood issues are not bold under underscore  i should have italicized it too mood issues   are not a consequence of normal aging expecting  somebody to become depressed as they get older,English
+is not realist not should not be expected  people will go through episodes of   depression and grief when they lose people  or things change like everybody else however,English
+clinical depression generalized anxiety ptsd  these are not things that we should expect   are a direct consequence of aging what can cause  them well depression can be caused situationally,English
+by grief or by life transitions when people have  to go from independent living to assisted living   for example when they have a significant other  pass away there are a lot of situations that can,English
+contribute to depression and grief okay so we want  to be cognizant of those things and we've talked   we talked about some of those on the last slide  vascularly there's a bi-directional association,English
+between depression and cardiovascular disease if  you remember from the blood pressure presentation   last week 45 of americans have hypertension  so 45 percent of americans are at risk for,English
+cardiovascular disease and problems with  oxygenation and increased inflammation in the   in the body we see with high blood pressure  we often see increased inflammation,English
+with depression we see increased inflammation  with depression depression tends to worsen   cardiovascular disease and blood pressure issues  and blood pressure issues and cardiovascular,English
+disease worsened depression it's important  that if you're working with an older adult   that their cardiovascular health be assessed  you know they need to be going and getting their,English
+annual checkups and their blood pressure work and  if they're not feeling well encouraging them to   maybe get a home blood pressure monitor to keep  a log of their blood pressure for a week or two,English
+and if it seems high or if it seems low to  contact their doctor about it because it's really   for their um mood for their balance for a  lot and for their cognition it's important,English
+for their cardiovascular system to be functioning  as optimally as possible unfortunately elderly men   have the highest rate of suicide of any group so  we do want to pay attention if we have an older,English
+man who is starting to feel depressed now that  doesn't mean we don't want to pay attention   when other people express suicidal ideation of  course you want to pay attention but you do want,English
+to recognize that elderly men tend to have a much  higher rate of actually actual completed suicide   when untreated depression reduces life  expectancy versus medic worsens medical,English
+illnesses enhances health care costs and is  the primary cause of suicide among older people   the foundation of depression apathy hopelessness  and helplessness so we need to explore that,English
+identify what is prompting this  depression you know what what is   triggering it and it could be physiological  psychological environmental or interpersonal,English
+we need to look at all those different areas to  identify okay what triggered this episode what is   maintaining this depression what is maintaining  your sense of hopelessness and helplessness,English
+sometimes with older people unfortunately  a lot of older people are on a lot of meds   and the meds can actually contribute to depression   looking back with the person looking retro  retroactively and saying before you felt,English
+depressed what was different or what has changed  that prompted your depression and you know total   side not related to elderly people but i just  got new flea and tick collars for our dogs,English
+and two of our dogs seem to have had a  very bad reaction to those flea collars   you know they've worn flea collars before but this  particular time this particular brand they don't,English
+it seems to be um toxic to them in  some way and you know my my boxer is   lethargic his appetite is kind of gone and my  husband noticed that those symptoms started,English
+like 24 hours after he started wearing the collar  so we took the collar off and we're going to see   where we go from there if uh if it was the  collar or not now obviously older adults,English
+aren't going to wear flea collars my point  being if they start a particular medication   that may contribute if they are going through  a grieving period and their nutrition is poor,English
+to explore the biopsychosocial determinants of  this person's mood both exercise and dietary   interventions can promote mental health in older  adults encouraging exercise not only stimulates,English
+the endogenous endorphins it also stimulates  the endogenous cannabinoid system and encourages   oxygenation and the release of serotonin there's a  lot of good things with exercise for older adults,English
+just like for anybody else you know start slow you  know encourage them to do a little bit we don't   want them to do something and then wake up in pain  the next morning consult with their doctor and,English
+about anything that you know they can do or  should do and but a lot of times physicians   for older adults will recommen recommend water  aerobics swimming easy cycling especially on,English
+a stationary bike check with your local mall  if you have indoor malls where you are still   in gainesville florida our mall used to open  at six a.m so people could go in and walk,English
+in a safe environment now obviously the stores  were closed but people were able to power walk   through the mall so a lot of older adults tended  to use that as a safe place to exercise and they,English
+would also by virtue of all being there at the  same time would end up garnering social support as far as dietary interventions that's outside  the scope of most of our practice but it is,English
+important to recognize that what goes in is used  to make all of the hormones and neurotransmitters   and everything so if you're not getting all  the raw materials in if you're not getting,English
+all the supplies to make what you need then the  system's going to break down almost half of older   adults who are diagnosed with a major depression  also meet the criteria for generalized anxiety,English
+let that sink in for a second we don't want to  just stop at depression we want to say what's   prompting this depression almost half of those  adults may have such high levels of anxiety,English
+that they have and chronic anxiety that they've  prompted some hpa axis dysregulation so now they   have that hypocortisolism they have a that flat  apathetic feeling a lot of times because their,English
+hpa axis is not as responsive anymore it was  it's holding on to stuff it's stopping response   in order to try to protect the brain  we do want to recognize that because,English
+treatment for the underlying anxiety  treatment for what's causing the depression   and causing the hpa axis activate activation come  to better help every day looking for a counselor,English
+better help makes it easy for you to move your  practice online and focus on what you love most   helping others betterhelp's easy to use platform  takes care of referrals and billing and provides a,English
+secured platform to communicate with your clients  join more than 18 000 therapists at betterhelp   helping to improve people's  mental health and lives,English
+so let's talk for a minute about normal aging  because as i've said multiple times already   things happen as we get older and they're not  necessarily pathological occasional forgetfulness,English
+try using notes as reminders as we  get older sometimes it takes longer   to process now i'm not talking a minute two  minutes but i'm you know it takes us a little,English
+bit longer to hear and process information  that's just a fact of life now people who   remain engaged and play games and or play  music and do things that keep their brain,English
+working that processing stays a little bit  faster people who are isolated who sit at   home by themselves watch tv all day their  cognitive processing slows a lot more quickly,English
+it may take increased time for complex tasks  because everything just goes a little bit slower   they're able to follow written and verbal  directions so that's normal aging if people,English
+can't follow these things then you know we want to  be a little bit concerned my grandmother you know   was always very independent and you know just spry  as i'll get out but as she got older she started,English
+especially once she you know was in her upper  70s she started getting confused very easily and   she did get to the point where she couldn't  follow written or verbal instructions she'd,English
+start doing something and forget where she was  and then get all flustered so we do want to   pay attention to those things it takes longer to  learn new information as we age give people time,English
+because they're processing a little bit more  slowly which is another issue if you have groups   for example when i used to work in residential  we would have groups that were very homogeneous,English
+heterogeneous and we would have 20 year  olds and we would have 70 year olds in group   and at that point i didn't recognize the need  the the cognitive processing speed differences,English
+so i think the people who were older that were  in my group may not have gotten as much out of it   because we were going at a  faster pace so it is important to,English
+check for understanding slow down a little  bit if you've got older people in your group   people as we age may have difficulty finding the  right word you know we've we've spoken millions of,English
+words and sometimes it's just trying to find that  name or that word that we're thinking of can be a   little bit more difficult and i i've noticed that  in myself over over the years slowed reaction time,English
+that's another issue you want to be aware of  especially for falls for example when you're   younger you have a faster reaction time and  you can brace yourself for a fall whereas,English
+older people sometimes aren't able to react as  quickly and they lose their balance or they fall   and they don't break their fall effectively which  results in much more severe injuries now people,English
+who are aging are still able to complete their  activities of daily living if people start being   becoming unable to complete activities of daily  living that's an indication of uh that needs to,English
+be assessed and it could be because of physical  ailments could be because of cognitive issues   but it's important to note when that happens  generally when people are unable to complete,English
+three or more activities of daily living  on their own they start qualifying for   some level of assisted care especially  if they've got long-term care insurance,English
+it's important if they're on medicare and med and  or medicaid to check with the state's policies to   find out uh what they can qualify for for example  in florida medicare will provide for short-term,English
+um in-home assistance for people like after they  have their hip replaced if they are unable to   complete their adls without assistance so it  isn't important to know what the older person,English
+is has access to and as we get older we tend to  have more issues with balance partly because our   reaction time is slower partly potentially because  our blood pressure may be a little bit different,English
+there's a lot of reasons but if a person  starts having significant issues with balance   it's important to have them  assessed by a neurologist,English
+as we age regardless of if you have you know  other confounding conditions it's important to   recognize that balance can become an issue and put  in guard rails or hold hold bars grab bars in the,English
+bathroom you know next to the commode and in the   in the shower make sure that they're all of the  rugs are taped to the floor so somebody can't,English
+you know scuff them up and trip over a corner  you know look around and there are a lot of   checklists that are out there a lot of times by  hospice facilities but i also i have several of um,English
+videos on case management and  case management assessment   needs assessments on the youtube channel if you  are either living with an older adult have a love   older adult loved one that you're concerned about  or if you work with the older adult population,English
+having those checklists and handy so people  know what they probably should do in order to   make sure that they or their loved ones stay  safe can be really helpful and comforting,English
+in terms of dementia cognitive and  sensory changes memory loss and this is   generally significant memory loss a  lot of people with dementia will have,English
+long-term memory they can remember things that  happened five years ago but they may not remember   what happened five days ago and so when you one  approach called reminiscence therapy that has been,English
+shown to improve the mood as well as to decrease  agitation and a lot of people with dementia   involves taking pictures or trinkets  or some some sort of memory trigger,English
+from the person's past it can be music or  a television show from the person's past   and you know letting them experience that  because a lot of times that will bring back   those historical memories and obviously you want  to bring back memories from a pleasant time in,English
+their past but that can help them be in a moment  that is calming and reassuring and happy for them   even though it's not the present moment so to  speak and it can reduce their agitation they may,English
+have difficulty in communication especially  finding the right words to communicate or   keeping track of a conversation normally our  processing slows you know that's you know,English
+totally expected but if people really start  having a lot of difficulty communicating   and it's frequent or they get lost frequently in  conversations especially one-on-one conversations,English
+then it needs to be assessed um to identify any  signs of dementia or alzheimer's or or other   cognitive issues that there are medications and  there are treatments that can slow the progression,English
+if they have a reduced ability to organize plan  reason or solve problems or difficulty handling   complex tasks or even confusion and disorientation  such as getting lost in familiar places,English
+maybe they forget how to get to the bathroom in  your house when they're visiting or something   those are all signs that someone  may need a neurological evaluation,English
+if they have difficulty with  coordination and motor functions   more than just you know being a little  bit having a little bit less um um balance and having slower reaction times but if  they have start having a lot of difficulty feeding,English
+themselves washing holding a glass definitely  get them evaluated they may have loss or reduced   visual perception a metallic taste in their mouth  a decreased sense of smell or agnosia which is the,English
+loss of ability to recognize objects person sounds  shapes or smells even though that sensory organ is   not defective so they may see something and their  eyesight is fine but they can't identify what,English
+it is those are all indications that the person  probably needs to be evaluated now when people   start having difficulty with daily activities of  daily living like gwen points out a lot of times,English
+when older people fall they may not tell  anybody because they're afraid they're   going to be moved into assisted living it's  important to talk with the older adults in our,English
+in our family that we care about and let them know  you know if you fall you know there are things   that we can do to help you out you know we're not  going to we're going to do whatever we can to try,English
+to help you stay as independent as possible for  as long as possible but it's important to let us   know i know my grandmother fell a couple of times  and she had like huge bruises up you know all the,English
+grab bars and things but we need to know when  people start having cognitive and sensory changes   if they start losing hearing if they start  having other problems they also may not,English
+tell people because they're afraid number one  number two they may be afraid of being sent to   in um assisted living they may not be  sure exactly what's going on or have an,English
+ability to communicate it and all of this can  lead to withdrawal withdrawal and isolation   is one of the key factors that we're going to  talk about one of the key preventable factors,English
+for dementia psychological changes in people  with dementia changes in personality or behavior   significant sudden changes depression anxiety  hallucinations mood swings agitation especially,English
+with changes in routine apathy isolation and  withdrawal now obviously some of these are   characteristics of depression and even depression  with psychotic features so it's important to,English
+have an accurate and thorough cognitive and  psychological assessment but if you see any   of these symptoms any of these symptoms indicate  that there's somebody that's really struggling,English
+so something needs to be done and figuring  out what's causing it is usually the beginning   authors estimate that as much as 35 of  dementia cases could be prevented by targeting,English
+10 modifiable risk factors wow 35 so what are they  early life education and they're not sure exactly   why that is protective they hypothesize that  people who have early life education tend to go on,English
+to be of higher socioeconomic status so they have  more access to you know the things that they need   and cognitive stimulation even as they get older  but that's just a hypothesis midlife hypertension,English
+contributes to the development of vascular  problems which can lead to stroke and the   development of vascular dementia hypertension  needs to be addressed hypertension is largely,English
+preventable there's you know physiological factors  cholesterol and all that stuff that can contribute   to poor cardiovascular health but there's also  psychological factors stress management coping,English
+skills anger you know all that stuff obesity  increases the risk of dementia in general   by 42 percent it increases the risk of alzheimer's  by 80 percent and vascular dementia by 73 percent,English
+obesity is a big issue you know and we've talked  before about some of the other things that obesity   contributes to but it is important to make  sure that people are managing that because we,English
+see that it does have a significant impact on the  development of cardiovascular and cognitive issues   diabetes can contribute to the development of  dementia through causing systemic inflammation,English
+and through instability of blood sugar as  well as secondary consequences of diabetes   like liver and kidney dysfunction that  can contribute to cognitive dysfunction,English
+managing diabetes really important hearing loss  when people don't hear as well they get frustrated   in conversations and may not engage with others as  much when they don't when they start withdrawing,English
+they don't have that cognitive stimulation  of being around others and they also tend to   feel more depressed hopeless helpless isolated  which contributes to systemic inflammation and,English
+cognitive problems old age smoking i thought that  was interesting is not all smoking but smoking   in old age so smoking when they're older can  contribute to dementia depression can contribute,English
+to the development of dementia and vice versa  hypercortisolism when people are initially when   they have high levels of anxiety high levels  of cortisol create a neurotoxic environment and,English
+an inflammatory environment in the brain that's  been associated with the development of dementia   and since a lot of people have concurrent  anxiety and depression we want to look for that,English
+physical inactivity reduces the oxygenation  in the blood reduces circulation   that can contribute to dementia and social  isolation that social isolation and finally,English
+traumatic brain injury from falls as people  get older they tend to have more difficulty   with balance they have slower reaction  times if they fall they hit their head,English
+it can cause swelling concussions and other issues  that can contribute to the development of dementia   so interventions encourage supervised  medically supervised physical activity,English
+maintenance of their treatment plan to control  their blood pressure not smoking social engagement   depression prevention and intervention that's  a broad category there and that will differ for,English
+for different people and it's important to  but it's important to explore some of those   things and there are going to be periods of  grief and depression potentially around life,English
+transitions for example when somebody goes into  assisted living when their spouse of 30 years   dies when you know fill in the blank um so  there are going to be episodes of depression,English
+technically according to the  dsm they'd probably be more   diagnosable as adjustment disorder because a lot  of these episodes of depression are due to an   acute stressor however they're depressed they're  feeling depressed that's really what we want to,English
+take home from this and diabetes management you  know all of these things can be really helpful   as well as making sure the older adult is having  their vision and hearing screened on an annual,English
+basis to make sure that they are as able to  participate in their environment as possible   chronic health conditions we can see medication  buildup or side effects a lot of people who are,English
+older do not go to a physician who specializes  in geriatric medicine as people get older their   liver clears medication a lot more slowly their  body processes medication a lot differently so,English
+certain medications can become toxic or have  more profound side effects in older adults   pain unfortunately tends to happen just as a  course of you know getting older you start having,English
+a little arthritis here and a cramp here but  chronic pain contributes to hpa axis activation   contributes to inflammation contributes to poor  sleep and contributes to a reduced quality of life,English
+we want to work with people to advocate with  their physician as well as potentially a   physical therapist but also we can work with  them on some cognitive strategies mindfulness,English
+and meditation strategies and guided imagery  to address any pain that they're experiencing   increased injury risk is a big issue you know  they may fall more often it may take wounds a,English
+little longer to heal especially for people with  diabetes you know we have delayed wound healing   and sometimes there's peripheral neuropathy  so they may get an injury and not even feel it,English
+so it is important to encourage people to be  cognizant of their environment and and make it as   safe as possible chronic health conditions reduce  physical activity so we want to work with the,English
+person as well as their physician to identify  what they can do and we can work with them to   help increase their motivation to engage in some  sort of meaningful physical activity whatever,English
+that looks like for that person and the key is  meaningful you know it may be going on a walk it   may be feeding the birds it may be playing with  their dog or their you know grandchild whatever,English
+it is but we need to identify what is meaningful  physical activity for this person chronic health   conditions contribute to sleep impairment again  with adults especially older adults it's going,English
+to be a multi-disciplinary team so referring them  for a sleep evaluation is going to be important   and they may go for a sleep study getting their  apnea if they have it addressed is going to be,English
+important but also we can work with them as  far as educating them about sleep hygiene   as people age it's a fallacy that they need less  sleep as people age they still need seven to nine,English
+hours of good quality sleep every night and if  they're not getting it we need to examine why   is it because they've got to pee three times a  night well what can we do about that is it because,English
+they're having hot flashes you know multiple  times a night okay what can we do about that   social support um tends to go away or not be there  for a lot of people with chronic health conditions,English
+could be because they're mood because they're  cranky and they tend to alienate people   so we want to look at that  and make sure that they've got   some compassionate supportive people or it  could be like in the case of my grandmother,English
+they just refuse to ask for help even though  they need it and they tend to be more withdrawn   if people start withdrawing we want to examine  what is that behavior saying what are they,English
+trying to communicate maybe they can't hear  us and understand what we're saying anymore   maybe we're talking too fast and they just can't  process it that quickly and they get frustrated chronic health conditions often are  treated with certain medications,English
+so we do want to pay attention to any medication interactions or any other  supplements that the person's taking   frailty syndrome is a geriatric syndrome  characterized by the clinical presentation,English
+of identifiable physical alterations such as  loss of muscle mass and strength energy and   exercise tolerance and decreased physiological  reserve they get wiped out really quickly,English
+this can be due to malnutrition  lack of exercise or depression   horticulture therapy gardening shows great  potential in enhancing mental health cognitive,English
+functioning and physical health in the elderly  especially if you're using raised garden beds   they don't have to stoop down or if  you're using you know potted plants,English
+just being able to tend to something can  give some meaningful activity to people   in terms of medication age-related physiological  changes that can impact drug effects include,English
+changes in absorption they're increasing gastric  ph and decreasing absorptive surface in their   in their system can affect the level of  medication that gets into their blood system,English
+they have a difference in the way their body  distributes medication because there's a decrease   in total body water lean body mass and serum  albumin they have decreased hepatic liver mass and,English
+blood flow so the metabolism of their medication  that is often metabolized by cytochrome p450   in in the liver tends to go down tends to slow  down and excretion changes generally slows,English
+because of decreasing renal or kidney blood  flow gl glomerular filtration rate and   tubular secretion so your body has a hard  time you know pushing out the bad stuff,English
+some of the most common medicines likely  to have adverse effects incl include   anticoagulants antibiotics who knew diuretics  like lasix hypoglycemic agents benzodiazepines,English
+this is a big one opioids and nsaids your  ibuprofen and naproxen type medications   hormonal changes and other physiological  changes associated with aging affect,English
+sexual interest erectile dysfunction is a problem  in men increasing with age diabetes cardiovascular   cancer and chronic respiratory diseases and  also some medications may also reduce sexual,English
+capacity and desire the most common cause for  male erectile dysfunction are vascular diseases   which you know cardiovascular diseases age is  not a barrier to sexually transmitted diseases,English
+and in women lack of emotional well-being and  a sense of intimacy during sexual intercourse   can lead to reduced sexual interest it's important  to recognize that even older people you know,English
+sexual desire our need to connect our you  know benefits of oxytocin don't go away   with age so it is important to support  healthy sexuality in older adults,English
+healthy sexuality prompts um bonding and it helps  them feel more whole when they don't have that   aspect they may feel like they part of their  life is missing and they may be grieving that,English
+the causes of malnutrition can stem from other  health problems bariatric surgery dementia that   causes people to forget to eat depression which  people just may not want to eat or they eat poorly,English
+you know not all nutrition is created equal so we  want to it's not just the calories but the quality   of the nutrition alcoholism contributes  to malnutrition because it prevents the,English
+absorption of certain vitamins and minerals  dietary restrictions reduced social contact   limited income reduced mobility and dental  problems all also contribute to malnutrition so,English
+if you're working with an older adult making sure  that you know their dentures if they have them   are fitting right so they can eat effectively  that they are able to get into their kitchen and,English
+access everything they need so they can cook what  they want to cook or they know how to order in encourage them to engage with other people reduced  social contact can contribute to depression,English
+but when you have reduced social contact  you also don't have somebody noticing   hey doesn't seem like you've  eaten anything in a week or so sleep needs don't decrease with age short and long  sleep duration groups had increased prevalence of,English
+mental health issues by 66 and 26 percent  so people who slept less than seven hours   had a 66 percent increase in mental health  issues and people who slept more than nine hours,English
+had a 26 increase in mental health issues poor  quality insufficient sleep is associated with   poorer physical function and cardiovascular  issues with aging slow wave sleep that deep,English
+sleep that we need to get rejuvenated to  clear out the adenosine from our brain less slow slow wave sleep is expected along  with more awakenings and a tendency towards,English
+earlier sleep times our circadian rhythms  actually move a little bit as we age but   there are a lot of ways that we can prevent some  of the frequent awakenings like slowing down the,English
+fluid intake after a certain hour causes of sleep  problems bladder control issues now obviously not   drinking 36 ounces of fluid right before bed  that's going to help for some people they may,English
+need to wear adult undergarments when they're  sleeping so it doesn't wake them up or if they   have don't have bladder control for men they  may need to have their prostate evaluated,English
+so there are a lot of things that  a urologist can help people with   neurological conditions lung diseases including  asthma and copd chronic pain sleep apnea anemia interestingly enough and gastroesophageal  reflux disease or really bad heartburn,English
+can all cause sleep problems all of these do have  uh interventions that the physician can use to   help people may not solve it completely but there  are a lot of interventions that can make life a,English
+lot better rapid eye movement sleep behavior  disorder often represents the earliest sign   of lewy body dementia in rem sbd people often act  out vivid unpleasant dreams with vocal sounds and,English
+sudden often violent arm and leg movements during  rem sleep so if somebody starts you know they've   generally slept pretty calmly most of their  life and suddenly they start having these,English
+violent arm and leg movements during their rem  sleep it's worth getting looked at and a lot of   times the person will be referred for a sleep  study because it is such a good indicator of,English
+lewy body dementia and there are some  medications that can help slow that progression   social support serves major functions including  emotional support duh informational support people,English
+who can provide advice and guidance like case  managers and congregational care managers and   pastors and you know health educators  and then instrumental support are people,English
+either within the person's social circle or in  the community that can provide rides or assist   with housekeeping and those sorts of things and  my mother's church they used to have a list of,English
+volunteers who were willing to come in and  help out during tough times for people in the   congregation either you know after a surgery or  something help with cooking meals or housekeeping,English
+or mowing the lawn or doing things like that that  you know not forever but as a temporary stop gap   while people were recovering from some sort of  life-altering or life-transitioning event adequate,English
+social support is associated with reduced risk  of mental illness physical illness and mortality   older people also often experience retirement  blues you don't really think of it when you're,English
+working a lot of times you're like oh  i can't wait to retire it'll be so nice   to be able to you know sit back and relax  but a lot of us have our social needs met   and our social circle um kind of revolves a lot  around work so once you leave work those people,English
+you used to see every day those routines you  used to have they're gone and a lot of people   don't plan for that transition ahead of time and  have you know another set of activities to go into,English
+so people can start feeling very um withdrawn  and very unsteady after they retire and yes your   identity is of self changes when when you're  retired because you see yourself you know,English
+that's another marker towards becoming older and  it's a role you no longer embrace just like when   children move out and people develop empty nest  syndrome because it's i'm no longer a 24-hour mom,English
+well that's when a roll gets put kind of on  the back burner because you're not doing it   or not doing it the same way anymore it's even  more so when you retire because at least when,English
+kids move out you're still mom or you're  still dad but when you retire you are now   you know not that thing anymore we see  a lot of retirement issues in soldiers,English
+and law enforcement a lot of people in those two  occupations really have difficulty transitioning   technology-based interventions to reduce social  isolation have a moderate but short-term impact,English
+on reducing isolation you know face time zoom  whatever you can do and we've had to adjust to   a lot of this over 2020 because we couldn't be in  person with people so it's been embraced a little,English
+bit more but it's not the same you know watching  your grandkids play in the playroom through a   zoom camera is not the same as sitting on the  floor and playing with them but you know it is a,English
+stop gap to a certain extent and people do  benefit from telephone or video based contact   especially older adults who live alone  uh benefit from that on a regular basis,English
+social support intervention should focus on  connecting the person to the outside world helping   them gain social support helping them engage in  meaningful activities and boosting self-confidence,English
+life satisfaction is the self-evaluation of  one's life as a whole and is influenced by   their socioeconomic health and environmental  factors life dissatisfaction is associated,English
+with obesity and risky health behaviors such as  smoking physical inactivity and heavy drinking   which all impact the risk of dementia  life dissatisfaction is often associated,English
+with depression depression is associated  with inflammation and dementia as well as less healthy lifestyle behaviors,English
+"COMFORTABLE AND HATRED. THEY GET REALLY COMFORTABLE AND THAT MAKETH YOU ON SOCIAL MEDIA. YOU ARE SITTING THERE,",English
+SCROLLING AND FEELING UNPRODUCTIVE AND LAZY THAT YOU CAN'T DO ANYTHING RIGHT AND THAT SOMETHING IS WRONG WITH YOU. JUST BECAUSE EVERYONE ON SOCIAL,English
+MEDIA HAS THE MOST TOGETHER AND ARE PROJECTING THE AND YOU ARE SITTING THERE AND YOU CAN'T GET OFF YOUR PHONE. YOU ARE FROZEN TO IT.,English
+CAN YOU TELL ME IN A SENTENCE OR CLOSE TO IT MEAN THINK YOU WANT OLDER PEOPLE LISTENING TO KNOW ABOUT WHAT,English
+IT'S LIKE TO BE IN HIGH SCHOOL? SOMETIMES THERE ARE TIMES I JUST NEED TO VENT TO SOMEBODY. I AM NOT EXPECTING A RESPONSE.,English
+"I JUST NEED TO GET WHAT'S IN MY HEAD OUT AND TELL IT TO SOMEBODY, WHETHER IT BE MY MOM, ANKLE, AUNT, FAMILY MEMBER OR COUNSELOR.",English
+I WOULD SAY JUST ACKNOWLEDGE THOSE FEELINGS AND BE OPEN MINDED AS WELL. WHEN THEY TRY TO REACH OUT,English
+"TO SOMEBODY AND TRY AND EXPRESS WHAT THEY ARE FEELING AND TRY TO GET HELP FOR ANYTHING, I FEEL LIKE YOU SHOULD NOT",English
+IMMEDIATELY GO TO BLAMING THEM OR JUDGING THEM. HAVE AN OPEN MIND. I WOULD SAY EVALUATE YOUR ROLE WITHIN THE RELATIONSHIP YOU,English
+"HAVE WITH AP STUDENTS, YOUR CHILDREN, RELATIVES, OR IS AND SEE IF YOU ARE TRULY SUPPORTING",English
+THEM. FORGET AN EGO. FORGET ANY PRIDE. THEY ARE MOVING FROM MENTAL HEALTH AND PEOPLE ARE BEING,English
+MORE OPEN WITH THEIR EMOTIONS. IT'S TIME TO ADAPT AND HELP THE YOUTH.,English
+REPORTER:? LET'S TAKE A CLOSER LOOK AT ONE NUMBER. 57% OF FEMALE STUDENTS SAYING THEY FELT PERSISTENTLY SAD OR HOPELESS.,English
+OUR HEALTH AND MEDICAL REPORTER ERIKA LEVITZ JOINS US ON THE SET. I KNOW THAT YOU TOOK THIS DEEPER DIVE INTO OUR TEEN GIRLS. IT'S NOT WHAT'S WRONG WITH OUR,English
+"GIRLS, IT IS WHAT IS HAPPENING TO THEM.",English
+WHAT DID YOU FIND? THE ISSUES FACING TEEN GIRLS THESE DAYS ARE WIDE RANGING. I SPOKE WITH TWO INCREDIBLE YOUNG WOMEN WHO SPOKE ABOUT,English
+"SEXUAL ASSAULT, BODY IMAGE ISSUES, EVEN INTENSE CASES OF FEAR OF MISSING OUT. 16-YEAR-OLD SOPHIE IS THE GO TO GIRL WHEN A FRIEND NEEDS ADVICE, FEELS SAD, OR SIMPLY",English
+NEEDS TO VENT. I DON'T LIKE SEEING MY FRIENDS DOWN. SOPHIE'S EMPATHY INSPIRED,English
+HER TO CREATE BRIEF SAVE SPACE.COM WHERE GIRLS CAN WRITE ABOUT MENTAL STRUGGLES ANONYMOUSLY. IT SUPPOSED TO BE SOMETHING WHERE YOU KNOW YOU ARE NOT,English
+ALONE. IT OFFERS A CLEMSON TO,English
+WHAT'S DRIVING THEIR SADNESS. ONE SAYS SHE FEELS PRESSURE TO BE THE BEST. ANOTHER WRITING I ALWAYS FEEL THE NEED TO SUCK IN MY STOMACH OR WHERE OVERSIZED CLOTHING SO,English
+"NO ONE WILL SEE MY EXTRA FAT. WHEN YOU LOOK THROUGH THE STORIES ON YOUR WEBSITE, DO YOU SEE ANY THEMES? THE MAJORITY OF THEM ARE",English
+ABOUT SEXUAL ASSAULT AND . ONE GIRL SAYS SHE FELT UNSUPPORTED AFTER A SEXUAL ASSAULT. YOU PUT YOURSELF IN,English
+THAT POSITION IS THE SENTENCE THAT CAME OUT OF MY PARENTS MOUTH WHEN I TOLD HIM I HAD BEEN . OUR GIRLS ARE BEING FACED,English
+WITH A BARRAGE OF STRESSES AND NEW EXPERIENCES THAT ARE REALLY BEYOND THEIR ABILITY TO COPE.,English
+NANCY CUNNINGHAM SAYS GIRLS ARE PARTICULARLY VULNERABLE TO A VARIETY OF STRESSORS. A LOT OF IT IS ACADEMIC STRESS PROJECTS HAVE AND ON TOP OF THAT HAVING FRIENDSHIP DRAMA.,English
+Reporter: 14-YEAR-OLD HARPER DRAKE SAYS SOCIAL MEDIA HAS TAKEN FRENCH RIP DRAMA TO NEW LEVELS. WE ALL GET A FEAR OF MISSING OUT.,English
+"THE SOMEONE IS POSTING ON TIKTOK, INSTAGRAM, OR A SNAPCHAT STORY, YOU CAN SEE THEY ARE ALTOGETHER. AFTERSCHOOL ACTIVITIES CAN BE INTENSE AND TIME-CONSUMING",English
+LEAVING MANY TIME IN MANY GIRL ' LIVES TO JUST BE GIRLS. IF WE WERE GROWING UP WITH ALL OF THIS INFORMATION AT OUR,English
+"FINGERTIPS ALL THE TIME, YOU MIGHT FEEL THIS WAY, TOO. ONE OF THE THINGS ARE STARTLING.",English
+THE POST SHE SEES MOST ARE ABOUT SEXUAL ASSAULT AND . YOU KNOW THERE WAS ANOTHER DISTURBING STAT IN THIS REPORT THAT SAID 14% OF GIRLS HAVE,English
+BEEN FORCED TO HAVE SEX. I BROUGHT THAT UP WITH THIS PANEL OF TEAMS I SPOKE WITH WHEN I WAS IN VIRGINIA. LET'S LISTEN TO THAT.,English
+DOES THAT SURPRISE YOU ALL? UNFORTUNATELY NOT. NOT PARTICULARLY. WHICH IS A SAD THING TO SAY. WHY NOT? WHAT HAVE YOU HEARD?,English
+"WHAT DO YOU KNOW FROM FRIENDS? THERE IS KIND OF THIS UNSPOKEN LANGUAGE OF LET'S SAY YOU KNOW A FRIEND WHO'S GOING TO A FOOTBALL GAME, EACH OTHER,",English
+"IT IS AT SUCH AND SUCH SCHOOL. BE CAREFUL, THAT AREA IS KNOWN FOR NOT HAVING GUYS WHO CAN CONTROL THEMSELVES AND THINGS LIKE THAT.",English
+IT IS SAD BECAUSE WE ALL KNOW. IT IS JUST NOW THAT THE PUBLIC IS COMING TO THAT REALIZATION. I TAKE THE BUS TO WORK SOMETIMES.,English
+WHEN I TAKE THE BUS TO WORK I WEAR A FAKE WEDDING RING AND BAGGY CLOTHES AND MAKE SURE I LOOK LIKE NOT A WOMAN. I HAVE TO DO THESE THINGS JUST,English
+TO PROTECT MYSELF. IT IS VERY UNFORTUNATE. THAT IS THE WAY IT IS. IT IS NORMALIZED. NOBODY IS ASKING WHY ARE YOU WEARING A FAKE WEDDING RING.,English
+"IT HAS REACHED THE POINT WHERE IT IS KNOWN AMONGST US THAT IT IS NOT NECESSARILY CONCERNING TO HAVE OUTSIDE PARTIES. IT'S LIKE OH, I DID THIS TO",English
+MAKE SURE I WOULD NOT GET ON THE STREET. AGAIN HIGH SCHOOL STUDENTS WE ARE HEARING THAT FROM.,English
+THE SURVEY WAS DONE IN 2021 THAT WE ARE TAKING THE STATS FROM. WHAT WAS IT ABOUT THAT YOUR THAT WE MAY HAVE SEEN A PSYCH,English
+INSPECTION SPIKE AND SEXUAL ASSAULT? KIDS WERE LOCKDOWN AT HOME AND WHAT SHOULD HAVE BEEN A,English
+SAFE PLACE. SEXUAL ASSAULT REMINDS EXPERTS REMIND US THAT SUCH ATTACKS GENERALLY OCCUR IN FAMILIES OR WITH OTHER CLOSE FAMILY,English
+RELATIONSHIPS AND NEIGHBORHOODS. LOCKDOWN MAY HAVE INCREASED EXPOSURE TO INDIVIDUALS IN SOME CASES.,English
+WHAT ROLE DO YOU THINK SOCIAL MEDIA PLAYS HERE? CRISIS CENTER SHOWED ME THEY SAW A HUGE INCREASE IN CYBER,English
+"SEXUAL VIOLENCE, LIKE ONLINE STOCKING. I TALKED WITH HIGH SCHOOL GIRLS WHO SAID THEY THINK THESE",English
+NUMBERS ARE UNDER ESTIMATE. MANY GIRLS ARE SIMPLY TOO,English
+"AFRAID TO SPEAK UP. I ALSO HEARD FROM THE TEENAGERS I SPOKE WITH ABOUT THIS MISOGYNISTIC CONTENT WE ARE SEEING FLOORS ONLINE, THESE RUBBER HOLES TEEN BOYS CAN END",English
+"UP DOWN. THEY THINK IT MAY BE IMPACTING SOME OF THEIR BEHAVIOR. CORRECT. IT IS NOT JUST WHAT'S HAPPENING WITH GIRLS OR AROUND US, BUT",English
+ALSO WHAT'S HAPPENING AROUND BOYS. WHAT ARE THEY EXPOSED TO? THAT'S ANOTHER PART OF THAT STORY TO TAKE A LOOK AT.,English
+"IF YOU ARE SOMEONE YOU KNOW IS IN CRISIS, PLEASE CALL 988. THAT IS THE SUICIDE AND CRISIS LIFELINE. ALSO ON YOUR",English
+> TEENS MAY BE UNDER PRESSURE BUT MANY SCHOOLS ARE TO UNDER RESOURCED TO TACKLE THIS COMPLICATED CHALLENGE. THAT IS WHY THE DEPARTMENT OF EDUCATION SAYS IT IS PROVIDING,English
+$188 MILLION TO HELP FIND MORE MENTAL HEALTH RESOURCES IN DISTRICTS THAT NEED IT MOST. I SPOKE TO EDUCATION SECRETARY,English
+MICHAEL CARDONA AND THE SURGEON GENERAL ABOUT WHAT IS CALLED THE EXISTENTIAL CRISIS OF OUR TIME. YOU KNOW HOW IT IS A FULL BLOWN CRISIS IN OUR COUNTRY,English
+RIGHT NOW. THE NUMBERS HAVE BEEN TELLING US THIS FOR YEARS. THE SITUATION IS GETTING WORSE.,English
+"WE HAVE TO MAKE SURE THAT NUMBER ONE, KEATS WHO NEED HELP CAN GET IT. NUMBER TWO, WE HAVE TO INVEST IN PREVENTION.",English
+"WE HAVE TO STOP THIS AT THE ROOT. FINALLY, WE HAVE GOT TO ADDRESS THE SHAME AND STIGMA THAT SURROUNDS MENTAL HEALTH. SO MANY KIDS ARE FEELING",English
+INHIBITED ABOUT COMING FORWARD AND ASKING FOR HELP. WE HAVE GOT TO CHANGE THAT. WHAT SPECIFICALLY IS HAPPENING TO OUR GIRLS?,English
+WHY IS IT WORSE FOR THEM? WE SEE RECORD NUMBERS OF LONELINESS AMONG KIDS IN GENERAL AND INCLUDING AMONG YOUNG GIRLS.,English
+THAT INCREASES THE RISK FOR DEPRESSION AND ANXIETY. WE ARE ALSO SEEING AN EXPERIENCE,English
+"OF TECHNOLOGY, SOCIAL MEDIA IN PARTICULAR, HAS NOT BEEN HEALTHY OR POSITIVE FOR MANY PEOPLE. IT IS ESPECIALLY TRUE FOR YOUNG GIRLS FOR THEIR SENSE OF SELF,",English
+THEIR CONFIDENCE IN THEIR YOUNG BODY IS ADVERSELY AFFECTED THEIR PARTICIPATION IN SOCIAL MEDIA.,English
+IT IS IMPORTANT TO ALSO REALIZE THAT HIGH SCHOOLERS TODAY HAVE SO MUCH PRESSURE TO DO WELL AND GET GOOD GRADES. EVERYTHING IS LIKE A,English
+COMPETITION IN HIGH SCHOOL. WE HAVE TO RECOGNIZE THAT THEY ARE UNDER A LOT OF STRESS. IS MENTIONED A COUPLE TIMES ABOUT SOCIAL MEDIA.,English
+THIS ALSO CAME RECENTLY THAT SENATOR HAWLEY ANNOUNCED HE IS INTRODUCING LEGISLATION WHERE HE WANTS TO MAKE THE MINIMUM AGE 16 ACROSS-THE-BOARD. IS THAT SOMETHING EITHER OF YOU,English
+ARE IN SUPPORT OF? I AM GLAD WE ARE HAVING A CONVERSATION ABOUT HOW TO MAKE,English
+SOCIAL MEDIA SAY FOR OUR KIDS. I THINK 13 IS TOO YOUNG FOR KIDS TO BE USING SOCIAL MEDIA,English
+"IN ITS CURRENT FORM. AT THE AGE OF 13, YOUR BRAIN IS STILL DEVELOPING. YOU ARE DEVELOPING YOUR SENSE OF SELF.",English
+YOU'RE BUILDING YOUR RELATIONSHIPS. ALL OF THAT MAKES FOR A SENSITIVE TIME FOR WHEN YOU ARE YOUNG.,English
+MOST OF THE PRODUCTS AND HAD TO MEET SOME SORT OF SAFETY STANDARD TO BE SOLD. WHERE ARE THOSE SAFETY STANDARDS FOR SOCIAL MEDIA?,English
+ESPECIALLY GIVEN HOW OFTEN OUR KIDS ARE JUST FIGURED IT UBIQUITOUS IT IS. WE HAVE GOT TO DEMAND TRANSPARENCY FROM SOCIAL MEDIA COMPANIES WHEN IT COMES TO THE,English
+DATA THEY ARE COLLECTING ON THE IMPACT OF SOCIAL MEDIA AND THE MENTAL HEALTH OF YOUNG PEOPLE. I DO THINK THAT 13 ACCESS TO SOCIAL MEDIA IS TOO YOUNG.,English
+IT REMINDS ME OF JOE CAMPBELL TARGETING CIGARETTES TO CHILDREN. NOW WE ARE SEEING VAPOR CALL PRODUCTS BEING SOLD TO,English
+CHILDREN. THEY TARGET HONORABLE CHILDREN AND THEY ARE PRAYING ON THEM. I THINK IT IS AN INTERESTING,English
+"COMPARISON. WAS ON A BOX OF CIGARETTES, A SURGEON GENERAL'S WARNING. DO YOU THINK SOCIAL MEDIA NEEDS",English
+TO COME WITH SUMS TYPE OF WARNING AND WOULD YOU GO A STEP FURTHER AND TRYING TO ENFORCE,English
+WHAT YOU SEE IS HOT? WE HAVE TO GO BEYOND WARNINGS. DATA HAS BEEN TELLING US MORE AND MORE CLEARLY THAT THERE ARE,English
+A SIGNIFICANT NUMBER OF KIDS HARMED BY THE USE OF SOCIAL MEDIA. WE NEED OUR SAFETY STANDARDS,English
+AND THOSE HAVE TO BE ENFORCED. WE HAVE AGE-BASED REGULATIONS THAT NEED TO BE ENFORCED.,English
+WE NEED TO INCREASE SPACES IN A CHILD'S LIFE ON SOCIAL MEDIA. THAT COULD BE AROUND THE DINNER,English
+"TABLE, AROUND THE TIME, A TIME WHEN THEY ARE AROUND FAMILY AND FRIENDS.",English
+THAT NEEDS TO BE ENFORCED. DOES THAT MEAN LEGISLATION ON THE KIDSHAVE TO BE TO BE ON,English
+THE APP? COMPANIES ON THEIR OWN ARE NOT GOING TO SET THE RIGHT AGE LIMIT AND ENFORCE THEM BECAUSE THEY ARE NOT DOING IT NOW.,English
+SOCIAL MEDIA HAS BEEN AROUND FOR YEARS. WE CANNOT WAIT ANY LONGER FOR THIS SYSTEM TO SELF-CORRECT. THE NUMBER ONE QUESTION AS A PARENT IS ABOUT SOCIAL MEDIA.,English
+"PARENTS ASK IS SOCIAL MEDIA HURTING MY CHILDREN? THE ANSWER IS YES. SCHOOLS ARE NOTORIOUSLY UNDERFUNDED, TEACHERS ARE",English
+UNDERPAID AND WE DON'T HAVE ENOUGH AS IT IS. RIGHT NOW IT IS TOO MUCH BEING ASKED IS TOO MUCH BEING ASKED OF TEACHERS AND CLASSROOMS?,English
+ABSOLUTELY. TEACHERS GET INTO THE,English
+PROFESSION BECAUSE THEY CARE ABOUT KIDS AND WENT TO HELP. WE HAVE ASKED TOO MUCH OF OUR TEACHERS. IT IS NOT FAIR AND WE MUST PROVIDE THEM THE SUPPORT,English
+"BECAUSE IF WE PROVIDE THEM THE SUPPORT, OUR STUDENTS WILL BE BETTER. WE NEED TO MAKE SURE TEACHERS HAVE SUPPORT IN THEIR SCHOOLS,",English
+"I KNOW SOCIAL WORKERS, SCHOOL COUNSELORS.",English
+"IN SOME PLACES, IT IS 500 STUDENTS TO CUT ONE COUNSELOR. WHEN WE TALK ABOUT INVESTMENT TO HEALTH, ARE WE SERIOUS? WITH A 502, ONE RATIO, ARE WE",English
+SERIOUS ABOUT HELPING STUDENTS ADDRESS THE NEEDS THEY HAVE? WHAT ENDS UP HAPPENING IS THE CLASSROOM TEACHER IS ADDRESSING A LOT OF THIS.,English
+THAT IS WHY I AM PROUD OF WHAT WE HAVE FOR THE FUNDING HERE. WE TEAMED UP TO REACH THOSE MOST IMPACTED BY THIS ISSUE. I WROTE AN OP-ED THAT YOU CAN,English
+FIND ON THEIR WEBSITE AND TEAM FOLKS APP SUPPORTER. > THE TYPICAL UP REGULATOR IS,English
+"SO GOOD AT SENDING YOU CONTENT THAT RELATES TO YOUR LIFE, I THINK THAT THE CRITICAL THING",English
+ABOUT SOCIAL MEDIA WITH YOUNG PEOPLE IS THAT YOU NEED TO TAKE WHAT IS GOOD FOR YOU FROM IT AND MAKING COMMUNITIES WITH,English
+PEOPLE YOU MIGHT NOT HAVE FOUND OTHERWISE. YOU ARE SEEING PEOPLE PRESENT IDENTITIES WITHOUT THE SUBMACHINE WE USED TO HAVE ON SOCIAL MEDIA.,English
+"WHEN THAT IS PRESENTED TO YOU, IT CAN HELP YOU REALIZE THINGS ABOUT YOURSELF. TO HAVE A POSITIVE RELATIONSHIP WITH",English
+"SOCIAL MEDIA, IT IS IMPORTANT TO FIND HER LIVING CORNER OF IT.",English
+"IT IS SO FAST. IF YOU FIND A SPACE WHERE PEOPLE LIKE YOU ARE TALKING ABOUT THINGS THAT YOU WANT TO TALK ABOUT, IT CAN BE REALLY",English
+HELPFUL. IT IS REALLY IMPORTANT TO ESTABLISH BOUNDARIES. YOU DON'T WANT TO BE SCROLLING ON TIKTOK OR INSTAGRAM ALL DAY LONG. EVEN WITH AUTHENTIC,English
+"INFLUENCERS, IT IS STILL JUST A HIGHLIGHT REEL. PEOPLE ARE SHOWING WHAT THEY WANT TO SHOW YOU. YOU HAVE TO REMEMBER THAT YOUR ACTUAL LIFE CANNOT BE COMPARED",English
+"TO PEOPLE'S SOCIAL MEDIA FEES. WHEN YOU'RE YOUNG AND HAVING MENTAL HEALTH STRUGGLES AND CAN FEEL LIKE YOU ARE ALONE, FOR JEN Z, THEY CAN GO ONLINE AND",English
+"> WE SPENT A LOT OF TIME ON THE STRESSORS TEENS ARE FACING, BUT NOW WE NEED TO TALK ABOUT WHAT CAN BE DONE TO HELP. TO GET INSIDE, I SPOKE TO DR.",English
+"KATHLEEN, DIRECTOR OF THE DIVISION OF ADOLESCENT AND SCHOOL HEALTH AT THE CDC. THANK YOU SO MUCH FOR JOINING US ON THIS. IT IS SO GOOD TO TALK WITH",English
+SOMEBODY WHO IS INVOLVED IN THIS STUDY. I KNOW YOU CALLED THIS CDC DATA ON YOUTH MENTAL HEALTH DEVASTATING. HOW CAN WE FACILITATE,English
+CONVERSATIONS WITH STUDENTS? WHAT CAN YOU SAY TO TRY TO GET THROUGH TO TRUST YOU TO OPEN UP TO YOU?,English
+"I THINK THE ESSENCE OF CONNECTION BETWEEN YOUNG PEOPLE AND ADULTS, WHETHER THAT IS THEIR PARENTS, COMMUNITY MEMBERS, TEACHERS, SCHOOL",English
+"COUNSELORS, IS INCREDIBLY IMPORTANT AND CAN REALLY BRIDGE THAT GAP BETWEEN HOW STUDENTS ARE FEELING AND SOLUTIONS TO HELP THEM FEEL BETTER AND DO",English
+"BETTER. A LOT OF IT IS ASKING THEM QUESTIONS, ASKING THEM HOW THEY ARE FEELING, ASKING THEM WHAT'S",English
+"GOING ON WITH THEM, NOTICING WITH THERE ARE CHANGES IN THEIR",English
+"BEHAVIOR, WHEN THERE ARE CHANGES IN THEIR EATING AND SLEEPING PATTERNS FOR PARENTS, CHANGES IN WHAT'S GOING ON IN THEIR CLASSROOMS. TO REALLY BE",English
+ATTENTIVE. I THINK THAT IS THE MOST IMPORTANT THING ADULTS CAN DO IS TO PAY ATTENTION AND TO ASK.,English
+"TO ASK GOOD QUESTIONS. THAT LEADS TO EVERYTHING ELSE. Reporter: ABSOLUTELY. ONE OF THE THINGS I HEARD FROM THESE TEENAGERS, SEVERAL GROUPS, WAS THE ONES WHO HAVE",English
+MADE A RELATIONSHIP WITH THEIR SCHOOL COUNSELOR COULD NOT SPEAK HIGHLY ENOUGH ABOUT IT. THAT RELATIONSHIP CAN MAKE SUCH,English
+A DIFFERENCE. WHAT DO YOU THINK SHOULD BE DONE THERE? IS IT ENCOURAGING MORE STUDENTS,English
+TO TALK TO THAT TRUSTED ADULT? HOW CAN WE MAKE MORE TEENAGERS BENEFIT FROM THAT? SCHOOL COUNSELORS ARE,English
+INCREDIBLE. THERE ARE NOT NEARLY ENOUGH OF THEM. IT WOULD BE GREAT IF MORE SCHOOLS HAD A SMALLER RATIO BETWEEN THE NUMBER OF STUDENTS,English
+AND THE NUMBER OF COUNSELORS THAT ARE AVAILABLE TO THEM SO THAT THERE WERE FEWER STUDENTS PER COUNSELOR.,English
+"I DON'T THINK ACROSS THE COUNTRY THAT IS GOING TO HAPPEN, WE JUST DON'T HAVE ENOUGH COUNSELORS. I DO THINK THAT WHILE THEY ARE",English
+bonjour c'est bon j'espère que vous allez bien aujourd'hui on se retrouve pour une nouvelle vidéo sur la visite médicale restez avec nous on se retrouve,French
+et là c'est Noane en fait qui se fait ausculter une petite visite médicale afin d'avoir des certificats qui,French
+serviront pour les activités extrascolaires voilà donc cette année Soélan fera,French
+si tout se passe bien de la natation de l'équitation et puis voilà ce qui s'est passé juste avant vous verrez avec un,French
+retour en images il ya eu le téléphone téléphone qui a sonné et là du coup lorsqu'il passe il est en crise il est en crise parce qu'il,French
+se remémore la sonnerie du téléphone mais ça va vite passer donc un petit retour en images et vous verrez ce qui,French
+s'est passé quelques minutes avant tu élèves un peu ton t-shirt? oui voilà tiens,French
+tu t'installes bien comme il faut d'accord donc voilà le téléphone sonne un peu creux,French
+et c'est la panique j'ai que main c'est pas le moment j'ai fait la grosse grosse erreur de,French
+mettre fin à l'appel et en plus je lis mais ce journal ludique sur le réveil alors bon je n'ai pas rangé les choses allô oui oui je suis,French
+chez le docteur oui tout va bien c'est lui il est panique oui au revoir,French
+allez on revient sur cette visite,French
+médicale un vrai baromètre émotionnel mais ça ira juste après voilà ça s'est fini bien oui en tout cas ton coeur bat,French
+bien je garde un petit peu tes yeux d'accord le ventre est bien souple assieds-toi un,French
+petit peu je vais écouter tes poumons respire bien bien fort avec la bouche grande ouverte vas-y,French
+vas-y respire bien fort vas-y vas-y qu'on continue respire,French
+et d'accord j'ai un petit peu,French
+oui eh ah? il ronfle tout ça hein,French
+c'est dûr mal oui je sais ça fait mal mais ça fait rien ça serre ça serre un petit peu soélan regard on va faire comme moi,French
+descend bien faire comme tu as fait tout à l'heure essaie de faire quinzaine de fois comme ça remonte bien chaque fois,French
+bonjour monsieur guérini s'il vous plaît allez papa c'est pas vous oui allez papa venir allez papa je vais attendre ici,French
+monsieur guérini venez je vais vous aider aller venir on va aller voir cette salle là c'est vous voulez vous venir oui,French
+alors vous venez pour quoi aujourd'hui j'ai perdu les dents d'accord les dents vous avez bien vu un appareil qu'on met où vous avez vos dents,French
+j'ai pas les médicaments elle cachait d'accord si vous voulez m'aider s'il vous plaît il l'a perdu comment ah oui il a perdu son appareil à la maison de,French
+retraites et il a besoin qu'on va refaire simple en acier qui est très pratique pour manger les repas d'accord est ce est-ce que vous preferez santé générale,French
+ou préférez mieux approfondir ou est-ce qu'il faut quelqu'un particulier j'ai une dame il a encore dû faire attention mais,French
+il prend des médicaments oui ah oui les pilules bleues d'accord dans une boite la dame la dame qui est gentille m'ai donne vous pouvez faire passez vos ordonnances,French
+on va la voir là bas les dents allez ça va,French
+allez donc ouvrez la bouche monsieur ouvrez la bouche un peu plus grand monsieur ouvrez allez bon oui alors ça sera pas,French
+très compliqué voilà vous pouvez vous appuyer il manque effectivement les dents s'il y avait un appareil qui a été,French
+perdue c'est certain qu'il va falloir très tard alors que nous nous revoyons plusieurs fois aujourd'hui je vais vous faire les papiers,French
+le devis toutes les explications pour envoyer à votre mutuelle comme ça vous saurez exactement combien ça va vous revenir,French
+parceque malheureusement il rend pas les plus en charge pour pédagogie voilà ya une possibilité aussi si vous voulez que l'on marque le nom ou,French
+les initiales sur la courtesse donc nous allons nous revoir plusieurs fois la prochaine fois on va commencer les,French
+empreintes une nouvelle séance d'empreintes les essayages ça va prendre plusieurs rendez vous et,French
+moi l'appareil il n'y a plus alors c'est ce que je vous explique monsieur sait que va faire plusieurs séances  des empreintes,French
+pour relever un petit peu la forme de votre bouche pour que vous soyez bien à l'aise après qu'on mange et pour l'appareil allait bien,French
+exactement sur vos dents là beof c'est un petit peu long mais au moins nous aurons,French
+un appareil qui vous permettra de bien remanger et bien parler et bien essayez pour faire le travail il y a beaucoup de,French
+travail à faire d'accord et d'appareil où il est l'appareil c'est ma fille qui l'a prise,French
+on va refaire donc si vous voulez bien madame je vais vous donner le rendez-vous et les papiers pour la mutuelle monsieur dame je vous,French
+bonjour madame Vakili? oui je suis qui va occuper de vous si vous voulez bien reçue,French
+juste là madame je vous laisse rentrer vous pouvez laisser vos affaires sur le porte-manteaux,French
+puis après je vous propose de vous asseoir vous êtes bien installé,French
+ouais parfait madame Vakili qu'est ce que je peux faire pour vous comment puis-je vous aider? c'est à dire que,French
+j'ai très mal appuyez vous vous êtes bien comme ça,French
+parfait bonjour madame Vakili venez avec moi,French
+allez-y vous pouvez vous asseoir alors donc on va commencer par vous,French
+bonjour docteur errr bonjour madame vous,French
+vous avez de la fièvre oui j'ai 39. vous fumez? non j'ai arrêté,French
+il y a un an. et puis vous avez pris des médicaments j'ai pris un doliprane ce matin,French
+un doliprane. vous dormez bien? non je dors mal. et vous toussez? et oui beaucoup surtout soir. d'accord je vois que vous avez une,French
+enveloppe avec vous. ah oui je vous ai amené l'année dernière j'ai fait une radio des poumons je me suis dit que ce soit utile. ah oui oui,French
+bonjour monsieur Journel. oui et mon épouse. madame journel bonjour je,French
+"suis docteur celle sous c'est moi qui va m'occuper de vous. est-ce que vous avez oui et vous madame Toto, je ne pars jamais sans Toto",French
+"madame peut aider vous asseoir. non non c'est pas très bien je me vais avec vous. allez-y, vous asseoir. madame si vous voulez venir ici, voilà. donc monsieur, pourquoi vous venez me voir",French
+"beaucoup, mais elle préfère que je vienne consulter. [..] vraiment",French
+pourquelles vous vous occuper un petit peu pour voir ceux qui alors on va faire mes choses si vous permettez un,French
+questionnaire médical faire un petit peu le point sur votre état de santé quel est votre médecin généraliste il s'appelle docteur unia et il est,French
+"à Toulon très bien, la dernière fois que vous l'avez vu c'était combien de temps? ah il y a quelques jours d'accord très bien. si vous voulez vous",French
+installer? voilà. ah il est confort voilà voilà je suis très bien. monsieur journel après,French
+examen j'ai constaté qu'au niveau de vos gencives vous avez des dents qui ont des choses si on peut dire et donc vos gencives sont malades,French
+donc j'aimerais si vous voulez bien je vous donnais le miroir je vous renvoie lunettes voilà et je vais vous expliquer un petit,French
+peu voilà regardez vos dents est ce vous voyez votre gencive? un petit peu rouge un peu gonflé. ah c'est un problème,French
+"depuis docteur unia. alors elle est un peu gonflée d'accord? des points là monsieur on a terminé, donc vous assis essayer vous",French
+rester assis quelques instants quand même vous n'êtes pas restez assis quelques instants quand même. ça va?,French
+on y va? allez je vous aider. donc je vais vous expliquer un petit peu plus ces brossettes interdentaires dont je vous parlais,French
+donc ça ressemble à ceci c'est un style comme elle nous pillons que vous allez devoir passer entre les,French
+dents tous les jours donc vous voyez que je prends de la brossette et je vais passer ici entre les dents vous essayez pas de sortir vers,French
+le haut mais c'est comme ça en hiver pour tous les jours est-ce que vous avez bien compris oui mais tout les les dents semblent,French
+peut-être très serrés chez moi et est-ce que ça va passer? ah on va faire après un test pour voir l'espace entre les dents pour définir quelle taille,French
+de brossette ah d'accord ok c'est pour l'instant voilà vous avez compris? on le passe ici. je vais vous prescrire un ordonnancier avec des,French
+tailles de brossette et vous allez pouvoir le donner à votre pharmacie qui va nous donner les références que je vais vous marquer où il y aura des,French
+bonjour madame Justin je suppose? oui tout à fait. alors nous allons entrer votre dossier si vous voulez bien? donc je vais récupérer votre,French
+carte vitale. bien tout à fait. merci beaucoup. alors nous allons vérifier votre numéro de téléphone,French
+est ce que c'est bien le 06 27 51 34 39? tout à fait. et votre adresse? 4 rue artisia à tours? parfait. très bien. donc je,French
+"vais vous mettre ce questionnaire médical je vous laisse commencer à remplir en salle d'attente, il sera revu lors de votre consultation avec le docteur celle sous.",French
+Très bien voilà vous avez une salle qui peut être trouvée jusqu'au fond du couloir si vous voulez vous brosser les dents les toillettes celles sont à la gauche. eh bien. je,French
+madame Joselin le docteur celle sous va avoir 15 minutes de retard est la première fois un patient en urgence ce qui a perturbé son emploi du temps est,French
+"ce que vous préférez reprogrammé le rendez-vous ou plutôt attendre? oh non je préfère attendre. très bien je vais lui transmettre, à tout à l'heure.",French
+bonjour madame Joselin oui je suis docteur rantoranis c'est moi qui vais m'occuper de vous. très bien. si vous voulez on va passer,French
+au bureau très bien,French
+voilà si vous voulez vous installez quelques instants. merci. si vous voulez me dire qu'est ce que je,French
+"peux faire pour vous? alors j'aurai besoin d'un détartrage éventuellement également d'un contrôle de de tous mes dents, et un blanchissement si c'est possible. très",French
+bien d'accord. si vous permettez on va reprendre le questionnaire que vous avez rempli. très bien. également. alors je vois que vous ne fumez pas c'est très bien,French
+vous n'avez aucune maladie je vois pas de problème ni cardiaque pas de problème de tension pas de problème oral. non j'ai de la,French
+chance tout va très bien. vous n'avez jamais perdre de connaissance? non plus. pas d'allergie? non plus. et vous ne prenez pas,French
+de médicament? aucun traitement médical? eh non. c'est très bien de la chance. c est bien. est-ce que vous avez déjà eu des réactions anormales par exemple à des,French
+anesthésies locales general? non jamais très bien. pas de saignement prolongé après une intervention chirurgicale,French
+d'extraction? non plus. c'est très bien. est-ce qu'on va parler de vos habitudes alimentaires? oui,French
+est-ce que vous grignotez entre les repas de temps en temps. d'accord. on verra après vous expliquer un peu plus de ma,French
+"question. d'accord. est ce que vous prenez régulièrement des sodas, du coca cola rarement très rarement. très bien en ce qui concerne l'alcool",French
+est-ce que vous buvez plus de dix verres par semaine? ou non. non. c'est très bien donc je vais vous demander de regarder et de,French
+"signer dans la première colonne s'il vous plaît, et on le remettra à jour régulièrement au fur et à mesure de votre suivi. très bien. je vous remercie.",French
+si vous voulez peut-être vous mettre à l'aise enlevez votre veste c'est les ranges papiers à la zone de soin vous asseoir sur le fauteuil,French
+appuyez-vous appuyer la tête. est-ce que c'est confortable? très bien parfait. je vais vous mettre une serviette qui vous,French
+servira [...] voilà vous pouvez vous installer est-ce que je peux commencer maintenant?,French
+alors je vous allonger un petit peu je vais commencer par examiner vos muqueuses. et ensuite on examinera les dents,French
+d'accord? donc le contrôle des muqueuses tirez la langue s'il vous plaît ne révèlent rien de particulier tout va,French
+bien. concernant les dents je peux vous confirmer qu'il n'y a pas de caries. par,French
+contre je constate une légère gingivite tient un saignement des gencives et celui ci disparaîtra à la suite du,French
+prochain rendez-vous où je vous ferai un détartrage et en même temps nous vous apprendrons un petit peu une nouvelle technique de brossage afin de maîtriser,French
+toute cette plaque dentaire qui vous gêne et qui vous donne cette gingivite. si vous voulez prendre le miroir je vais,French
+vous montrer. donc les gencives sont légèrement rouge au niveau des papilles là où elles sont enflammés et là,French
+elles sont en bonne santé comme ici par exemple elles sont rose pâle voilà. donc je vous propose la prochaine fois nous,French
+"nous retrouvons à ce moment là nous ferons le détartrage, je vous apprendrai une nouvelle technique de brossage et après éventuellement si vous voulez nous",French
+bonjour Marius salut mon jour tu sais je m'appelle,French
+nathalie et je suis la dentiste et je vais m'occuper de toi aujourd'hui on y va aller si vous voulez venir avec moi.,French
+"Marius, dis moi tu as déjà été chez le dentiste? Oui. Bon c'est très bien. Est-ce que tu sais ta date d'anniversaire alors dis-moi tu es né",French
+quand? 5 octobre 2011. c'est bien. et dis-moi est ce que tu sais pourquoi tu viens me voir aujourd'hui? d'accord. s'il vous plaît est-ce qu'il,French
+avait problèmes de santé? non pour le particulier le médecin traitant? madame martin. son poids? il doit faire 23 kg. très bien.,French
+"est ce qu'il y a des allergies? non pas du tout. allez marius, si tu veux venir? viens. regarde. je t'ai mis un réhausseur tu peux installer",French
+son fauteuil allez-y. appuie la tête voilà regarde marius. ce qu'on va utiliser un,French
+petit génère qui fait comme le vent dans ta main regarde. après on va utiliser de l'eau regarde. tu veux que je te montre? regarde. hop. ça mouille. oh c'est pas,French
+grave il fait beau. et est ce que tu connais l'aspirateur regarde,French
+"ceux-ci salue c'est rigolo? oui bien sûr. Marius, dis-moi on va regarder tes dents tu veux bien? hein?",French
+alors tu veux te tenir un stylo argenté hein? tu veux tient bien et regarde le miroir. tu vois? ça va me permettre de,French
+regarder tes dents dans ta bouche aller appuie-toi. ouvre bien la bouche. oh ce sont de jolies dents tout ça. alors regarde,French
+"marius, on va nettoyer tes dents avec la petite brossette avec un peu de pâte. regarde c'est quand tu vois? c'est rien",French
+du tout! allez on va faire pareil sur tes dents. ok. oui et superb ouvre bien ouvre bien la bouche voilà parfait! oh ça va bruyer,French
+ça. donc j'ai bien vérifié les dents de Marius. il commence à avoir ses dents permanentes embarquent donc il va,French
+falloir faire attention tu vas les garder toute ta vie. il se brosse bien les dents donc il faut qu'il continue comme ça c'est très bien marius. j'ai,French
+vérifié un petit peu. ferme la bouche. [...] des dents pour l'instant c'est bien mais il faudra,French
+quand même le surveiller une fois par an contrôle pour voir s'il continue à aller bien dans le même temps on affine,French
+"tu as été superb, alors on va faire quelque chose. regarde. on va faire un ballon d'air. appuie sur la pédale.",French
+vas-y. oui. est ce que ça fait,French
+oups on arrête? on arrête il va exploser,French
+"allez regarde, regarde le ballon tout est ronflé et voilà et après tu vas nous décider des yeux",French
+une bouche et tu vas le [...] tu as été très sage tu sais les enfants ici,French
+"chaque fois qu'ils ont été sages ils peuvent repartir avec un petit jeu à la maison, donc si tu veux tu te choisis un petit jouet. comme tu veux. ça y est c'est",French
+fini. viens. tu as été superb aujourd'hui. je suis très contente de toi tu peux être fier c'est très bien. allez au revoir.,French
+je suis le dr Sidonie Chhor je suis médecin généraliste installé en ville à rennes et je suis aussi en parallèle enseignante associée au département de,French
+médecine générale de rennes. donc être universitaire de médecine générale ça veut dire exercer la médecine générale en tant que médecin généraliste installé,French
+dans des cabinets ambulatoire et plus spécifiquement lorsqu'on est enseignant en médecine générale les chercheurs,French
+"en soins primaires, on exerce donc au sein du département de médecine générale à mi temps pour des activités de formation des étudiants, des formations",French
+"des maîtres de stage, et les activités de recherche sur les soins primaires. je suis en partie responsables du renseignement sur le troisième cycle",French
+pour les internes qui ont choisi la spécialité de médecine générale. mais on est aussi en charge des enseignements sur le deuxième cycle et le premier cycle. on,French
+a tous à peu près pris le pli de se dire cette année va être de toute façon particulière. on a de toute façon basculé tous nos enseignements sous un,French
+format dématérialisé. alors je vous présente ici une notion assez importante pour comprendre pourquoi les patients que vous allez,French
+rencontrer en stage de médecine générale pendant votre externat ne sont pas les mêmes patients que ce que vous avez pu rencontrer jusqu'ici pendant vos stages,French
+au CHU. alors qu'on connait pas le patient donc la question hyper large au début quoi. alors effectivement vous allez apprendre à faire un examen et un,French
+"interrogatoire qui sont ciblés par le motif de consultation du patient, par son histoire de vie et vous pourrez pas aborder les choses de manière aussi",French
+"structuré systématisé que votre grille habituelle l'observation appareil à part par appareil avec signes fonctionnels,",French
+"signes cliniques etc. c'est aussi dans le cadre de cette mission accueillir des stagiaires dans nos cabinets en tant que maître de stage de l'université de rennes 1, c'est la",French
+faculté qui organise ces stages en s'appuyant sur son réseau de 380 maîtres de stage rattachés à l'université de rennes 1.,French
+l'actuellement en stage moi j'ai un étudiant il est interne exactement en médecine générale et il doit valider un stage de pédiatrie et de gynécologie et,French
+si au sein de mon cabinet qu'il le valide. donc voit du coup je m'appelle Hugo donc je suis internes en médecine générale depuis trois mois c'est un manche en le,French
+cabinet à anatole france en fait. je m'appelle Bérengère Pierre je suis j'ai 24 ans et je suis en 6e année de médecine à la faculté de rennes. et je,French
+suis actuellement en stage en médecine générale avec deux praticiens dont docteur chapron à québec. du coup tu as vu ça chiant ce qui venait pour la fièvre,French
+c'est ça? exactement. la consultation a été assez hypersonic réveiller j'ajouterai une sono vite à droite,French
+j'aimerais que tu jettes un coup aussi d'accord ben écoute on va aller regarder le petit tympans puis on fera un point ensuite ensemble.,French
+c'est le seul stage de son parcours qui est hors CHU et donc c'est découvrir la diversité des patients des pathologies,French
+dans ce contexte je leur rend un environnement de vie habituel et la singularité du lien entre un médecin traitant et médecin de famille qui accompagne les gens pour,French
+tous les motifs de consultation tout au long de leur vie. on se voit pour quel sujet ce matin? pour le faire. pour le faire? depuis vendredi dernier,French
+j'avais très mal à gorge juste mal à la gorge. d'accord. et que j'ai une toux d'irritation la nuit de mardi et mercredi. elle va,French
+découvrir ce qu'elle a appris de manière théorique transposer sur des patients peut-être moins sévère moins emblématique que ce qu'elle peut lire dans ses livres ou voir,French
+dans les lits d'hospitalisation de l'hôpital avec des symptômes parfois atypiques ou pas encore suffisamment installés pour voir porter facilement,French
+des diagnostics alors toute de suite qu'on montre un petit peu donc si on regarde sur le suivi proche pas si on regarde sur le suivi,French
+et l'évolution. donc là tu vois au stade intolérance au glucose on est donc bien sûr aux mesures diététiques seul. donc,French
+monsieur à une hyper faible de rétinie et on voit que tu vois entre 753 au mois de novembre à 570 aujourd'hui ça a réussi,French
+"à baisser bon ok donc là je vais vous examiner on a le vaccin à faire, est-ce qu'il y a d'autres sujets à aborder",French
+respirez fort par la bouche. les patients qui sont donc dans les cabinets des maîtres de stage de la faculté sont,French
+très habituels à voir leurs médecins consultés avec une personne à côté. il ya parfois des consultations où je me laisse faire l'interrogatoire et faire,French
+l'examen clinique un peu comme je le sens donc là je me sens plus médecin. pour toi aussi tu me poses des questions du coup ça me ramène un côté,French
+étudiante et parfois je fais tous les examens cliniques. bah je varie entre les mais en fait je fais des allers retours. d'opérations de la dame? tu es le,French
+docteur? tu joues un docteur. ici c'est bien pour la. 37.7,French
+vous avez pris de doliprane avant? j'ai pris un ce matin à 7 heures ok. j'ai mal à la tête. 37.8 38 donc on,French
+continue un peu. alors sur le plan examen du coup je vais appuyer au niveau de nez c'est mal quand j'appuie?,French
+non ça va ça. ok. et au dessus? si ici vous avez mal? on est déjà mal dans les positions. et au fur et à mesure de cette année là,French
+cette année actuelle je me dis que c'est vraiment ce qui fût ce que j'ai envie de faire c'est verser dans plein d'endroits à l'hôpital ou en cabinet [...],French
+moi ça pourrait être ça m'intéresse c'est le côté un peu à la diversité des consignes des patients et de du lieu où,French
+travailler quoi. donc tu vois elle n'a pas d'encombrement donc la toux lui est dû à,French
+l'écoulement postérieur six musiciens et il n'y a pas de temps d'appel puis maintenant donc on va trouver ça oui. mon projet pour l'instant c'est vraiment de,French
+rester le plus le plus généraliste possible et après j'ai des idées un petit peu pour éventuellement faire trois quatre jours dans un cabinet,French
+éventuellement une journée après ailleurs par exemple là par exemple j'ai commencé aussi au planning familial c'est un endroit qui me plaît bien là je,French
+suis allé quatre fois et ça m'a beaucoup plu. je vais piquer. et l'ordonance [...] 3,French
+mois à peu près. donc là ce patient sur le temps de la consultation il y avait entre quatre et cinq motifs à aborder à gérer avec ce que tu disais l'autre,French
+fois c'est un petit peu des fois fatigue en fait la consulte de jongler entre les différents appareils des différentes circonstances mais mais c'est le propre,French
+dans cet épisode on va suivre Bertrand médecin généraliste en Belgique derrière c'est la première fois que je tourne cette série là en tout cas à l'étranger,French
+je suis très content bref on va découvrir son quotidien et surtout l'envers du décor de son métier. pour commencer j'ai rejoint Bertrand en pleine consultation dans son cabinet. un,French
+petit peu que je prenne votre tension. j'ai 14 8 c'est pas mal ça met en parallèle avec tout le reste évidemment.,French
+respirez bien fort. on fait les piqûres. vous savez que c'est votre femme qui a pris le rendez-vous?,French
+vous voulez bien que je vous dise le message qu'elle m'a mis elle vous l'a dit ? bonsoir docteur visite du mois pour plus petite piqûre que vous avez pris là entre nous je suis très triste il n'a,French
+toujours pas mis. il nous a tous câchés le médecin au final il fait pas que que,French
+la médecine parce que là typiquement il y avait un message de sa femme. il y a un côté tu t'es vraiment au cœur de la vie des gens quoi en étant médecin,French
+généraliste et surtout je précise on n'est pas en ville on est plus dans un village ça c'est voilà et donc ça se rapporte quoi. oui c'est on connaît les,French
+gens on les connaît presque par coeur parce qu'il y a des familles que moi ça fait ça fait 8 ans maintenant que je suis médecin. il y a des familles que je,French
+suis depuis 8 ans et donc je connais je connais le mari je connais la femme je connais le fils je connais pas le grand-père parce que il est chez un autre médecin mais je connais la,French
+grand-mère qui me parle du grand-père. donc on apprend plein de trucs aussi et ça permet aussi parfois d'intégrer des choses mais avec une petite difficulté qui est que ici je sais plus le mari qu'à la,French
+"femme il se parle beaucoup il se parle de quand ils viennent ici ils viennent souvent ensemble il y a pas de souci par rapport à ça. mais il y a parfois des gens qui me disent ben voilà mon mari ait fait ça il fait ça, mais il veut pas",French
+que je vous le dise. ah oui d'accord ok donc je prends l'information et je dois poser la question que quelqu'un qui aimerait par exemple et... vous fumez,French
+toujours? non je fume pas. toi tu sais qui fume mais tu peux rien dire. mais c'est fou parce que tu as vraiment pas du tout le,French
+même rapport en tant que médecin généraliste que ce que j'ai pu suivre avant ou les gens effectivement il n'y avait pas de suivi pour eux c'était de la médecine la chirurgie mais dans,French
+pathologies des trucs comme ça. les spécialistes c'est du One Shot il voit les personnes alors le cardiologue on dit toujours il ose sa salle d'attente il y a des parties des personnes qu'on,French
+n'est pas des problèmes de cœur moi ici j'ouvre ma salle d'attente c'est des personnes que je connais et qui viennent parfois pour des choses différentes ou pour la même chose que la dernière fois,French
+et dont on reparle donc c'est totalement différent au niveau de l'approche oui et le rapport est aussi différent. bon ils savent bien que en général je suis à,French
+l'heure ça se passe bien et ça va un petit peu comment on approche les choses ils savent ce qu'ils peuvent me dire ils savent ceux qui n'ont pas envie de me dire que je sais quand même il y a plein,French
+de trucs comme ça donc faire. en parlant d'heures je vais pas te mettre en retard si tu as un autre rendez-vous. donc le matin comme ça comme ça tu auras un,French
+petit peu le rush ça va passer en par quart d'heure en général après c'est plutôt 20 minutes. tu as combien en tout par jour de,French
+patients? ça dépend. les grosses journées j'en ai 30 35 ici sans compter les visites la maison de repos etc. 30 35? et,French
+les journées standards j'en ai 20 25 alors dites-moi j'ai un petit problème de spasme qui se passe ici dans le haut,French
+de la poitrine. de l'autre côté cette fois? 138 108 pas mal pas de nausée pas de constipation non,French
+ça se passaient mais ont disparu comme ça donc ce qu'on peut ressentir à travers la paroi du ventre c'est le côlon qui peut être parfois le siège de qui contraction,French
+mais non pas aussi rapide que ce que vous m'avez décrit. le fait que ça descende comme ça c'est aussi le trajet des grands droits vous vous souvenez que,French
+vous avez déjà été blessé de ce côté-là? c'est aussi les muscles abdominaux ici les tablettes de chocolat pour moi c'est musculaire ce que vous avez ici. c'est,French
+plutôt alors que sur la musculature ou du système digestif ou de la paroi c'est une des petites contractures suite à éventuellement une petite douleur un,French
+petit faux mouvement ou autre mais ici si c'est réglé tout seul. on ne fait rien évidemment. ce qu'on remarque aussi c'est que les gens viennent pour,French
+différentes quoi. en fait tu es la porte d'entrée évidemment sur la première ligne. voilà sur le milieu médical pour eux tu peux pas tout connaître. c'est pas,French
+possible de la médecine non. donc comment tu fais dans ces cas-là on doit être compétent dans plus ou moins tout mais de façon parfois un peu superficielle et,French
+on doit pouvoir avoir le la la présence d'esprit de référé quand on connaît pas. voilà simplement. donc on doit pas jouer les monstres d’ego qui sont tous en,French
+jamais avoir l'aide de personne on doit pouvoir renvoyer les gens chez quelqu'un de compétent quand il y a quelque chose qui nous dépasse. il faut que tu,French
+t'y connaisses un petit peu surtout comparé aux autres qui s'y connaissent beaucoup sur un petit secteur? Oui c'est ça les spécialistes qui connaissent tout sur rien,French
+"et moi je connais rien mais surtout. c'est le principe bah, moi ici je l'ouvre ma porte et j'ai jamais ce qui vient de tomber dessus dans la journée donc c'est",French
+bien parce que c'est stimulant mais parfois il y a des moments où il y a quelques trucs qui tombent dessus en même temps c'est un peu chaud aussi. donc ici chez vous en fait donc on a trouvé,French
+où effectivement voir pour la la boule on a trouvé une lésion qui a l'air tumorale évidemment dans le sein. on vous a envoyé faire une IRM qui confirme bien,French
+que il y a des... et des biopsies ça j'ai reçu aussi les analyses. le bilan d'extension c'est voir si le cancer en question il est toujours localisé là ou si,French
+éventuellement il y a un risque qui soit parti autre part. ils ont vu au niveau de vos poumons qui avaient des nodules. le but ce sera d'avoir un traitement qui va,French
+"agir et sur le sein et sur le poumon et avec un je sais pas encore vous dire ce que vous aurez parce que je sais pas en côlon évidemment, mais le but ça va être",French
+d'avoir quelque chose qui agit sur l'ensemble évidemment d'où le PET scan pour voir si éventuellement il y en aurait ailleurs et une fois qu'on a,French
+cette information là je pense qu'ils vont lancer le traitement. en général ils ont plus confiance au médecin traitant qu'aux spécialistes et il y en a beaucoup qui est spécialistes disent oui oui oui,French
+oui oui vous avez compris oui oui ils ont rien compris donc ils viennent me voir en disant ben voilà j'ai retenu ce mot là celui-là et moi je leur ai expliqué,French
+derrière. donc c'est c'est un petit peu j'essaye de me débrouiller j'essaie de il me faut que je reçois quand je les reçois et je dois réexpliquer en termes,French
+compréhensible ce que le spécialiste a dit avec ses grands mots mais comme c'était un grand professeur on a proposé la terreur. oui c'est ça. et donc moi je suis là pour faire le lien en quoi oui une relation,French
+générale et pourquoi justement pas une spécialisation? sur le principe le pour moi la médecine générale c'est,French
+paradoxalement peut-être dans l'esprit des gens mais c'est la plus complète c'est là qu'on voit le plus de trucs et c'est aussi la moins la moins,French
+rébarbative. on voit des trucs tout le temps différents et surtout on connaît les gens. faire du soin en ayant quelqu'un qui vient vous venez pourquoi,French
+je viens pour j'ai fait un infarctus. ok on fait ça tac tac tac suivant merci. c'est bien c'est des très beaux soins etc mais c'est pas moi ce qui m'arrachais. donc,French
+tout ce qui urgence hôpital tout ça... c'est les urgences c'est encore un petit peu stimulant mais les urgences c'est,French
+tellement mal imaginé par les gens que c'est compliqué. parce que souvent les personnes les urgences pour eux c'est mon médecin,French
+n'était pas là où il m'a pas répondu assez vite oui c'est pas me recevoir dans la demi-journée donc je vais aux urgences. mais c'est pas une urgence c'est les urgences. on a mal au ventre,French
+depuis trois mois bon ben c'est sale d'aller à l'hôpital. il faut venir ici. que vous avez les mêmes problèmes aussi engorgement des hôpitaux,French
+ici hein c'est ça c'est un peu partout mais les gens cette fâcheuse habitude de se dire je vais aller à l'hôpital directement. mais on,French
+est dans la génération du tout tout de suite donc j'ai mal au ventre depuis 3 mois mais aujourd'hui j'ai envie de me servir. voilà donc il faut que aujourd'hui on me soigneait et ben des fois c'est,French
+"justifié mais des fois ça fait pas du tout et même pareil pour moi ici vous voyez que au niveau des rendez-vous j'ai la chance d'avoir des rendez-vous plus ou moins dans la journée, mais il y a des",French
+personnes qui m'appellent à 10h je leur dis vous pouvez venir à 14 ça va pas. c'est trop tard. et bien ils viennent et qu'est-ce qui se passe depuis une,French
+semaine bah ça pouvait attendre deux heures. on peut prendre rendez-vous dans la journée toi mais c'est ça c'est une,French
+folie en France c'est impossible. c'est bien impossible. alors je veux bien aimé parler de ce problème là mais bon vous avez de la chance ici ce n'est pas le,French
+cas oui mais en France il y a un énorme problème avec les médecins parce qu'il n'y a pas de rendez-vous il y a des déserts médicaux il y a des trucs comme,French
+ça c'est très très compliqué. et bien quand je vais en vacances en France je vois partout des panneaux médecins venez ici médecins,French
+mais voilà c'est... je vous souhaite pas que ça arrive ici en tout cas j'ai l'impression qu'il commence un petit peu à se bouger les fesses les responsables,French
+politiques pour que ça bouge un peu parce qu'il voit l'exemple le contre exemple de la France mais ça va pas vite quoi avoir des problèmes en France aussi,French
+"poursuivre un petit peu certains médecins sur Twitter c'est l'absentéisme, mais je veux bien croire que quand on a des gens à qui on dit bah ok vous avez mal au ventre venez dans 10 jours. Ben 10",French
+jours après 3 cas sur 4 sont résolus donc la personne se souvient même pas qu'elle avait rendez-vous et du coup elle y va pas et du coup ça fait une plage vide,French
+donc le médecin il a des délais qui s'allongent parce que il y a des gens qui ont plus le problème qu'ils avaient. donc c'est aussi un truc qu'on a pas trop ici en Belgique c'est qu'on peut,French
+recevoir les gens relativement vite. c'est une chance  c'est vraiment une chance pour le coup,French
+j'entends un cas des petites choses qui circulent quand vous toussez encore plus évidemment c'est un peu moulant dans le fond il y a des sécrétions qui,French
+coulent de votre nez vers l'arrière sortez quand il est encombré pour moi c'est clairement allergique ici ce que vous avez à cause du taux de pollen,French
+qu'on a pour le moment donc je vais vous donner un traitement pour l'allergie et on va traiter un peu les symptômes aussi si vous le souhaitez mais c'est surtout,French
+l'allergie qu'il faut arriver à traiter pour que ça calme tout ça il faut compter trois quatre jours pour vraiment voir un mieux tu sais quand tu dois donner un,French
+"diagnostic est-ce que tu es sûr à chaque fois de ce que tu donnes comme diagnostic? quasi jamais? quasi jamais non j'exagère, mais ici en médecine générale",French
+temps et je dois travailler sur un petit peu le la statistique c'est à dire que la personne elle présente tel symptôme d'où l'intérêt de vraiment parler avec,French
+la personne pour avoir quelque chose de vraiment bien bien complet bien établi je donne un traitement en disant bah voilà je pense que vous avez ceci tout,French
+quelque chose de vraiment vital quelqu'un qui vient avec ses cuit respirer on va pas dire on verra bien demain non là on prend les choses en place mais quelqu'un qui vient qui a une,French
+charnière etc et après on se revoit si il faut on va faire une radio s'il faut on va plus loin avec un scanner etc donc on travaille vraiment comme ça pas en,French
+c'est à dire que [...] les médecins libéraux comme ça on est payé à l'acte et malheureusement le,French
+rentabilité c'est quoi tes horaires tu travailles? en général je commence à 8h et j'essaye souvent de terminer à 18 19.,French
+quand même? ouais. tumeurs intradermiques bénignes correspondant à un dermatophibrome à,French
+noter que la lésion atteinte focalement les traits de section donc ça veut dire que ce qu'on vous a enlevez on n'a pas tout enlevé manifestement il est possible pour vous recontacte pour faire,French
+qui me sont proches. pas de température ok venez je vous écoute,French
+"au final tu écris plus rien à la main toi. c'est fini non que quasiment pas, c'est une très bonne chose que je sais l'ordinateur. voilà. parce que c'est vrai que dans l'inconscient collective pendant",French
+l'impression que les médecins écrivent mal et qu'on a du mal à regarder ou pas? je crois en fait que ça vient des années d'études on a pendant 10 ans le prof qui est,French
+"médicament vous mettez dans la bouche ils ont pas confiance ils le feront pas. il y en a qui viennent on m'a dit de prendre sage. c'est justement toi, toi tu montres que toi t'as un rôle avec eux une relation en fait avec tes",French
+patients. est-ce que au-delà de ça une autre aide je pense à une psychologue? mais si c'est bien à la prise de sang est vraiment très bonne donc ne changez rien,French
+si vous pouviez bouger un peu plus et bouger un peu plus en endurance. et en termes de rémunération un médecin alors pour le coup là on va parler de la,French
+Belgique combien il peut gagner quand il installe comme ça un médecin généraliste? alors chez nous la consultation elle est à 30 euros mais 30 euros brut évidemment,French
+ça ferait des chiffres astronomiques je dois dire je peux dire les vrais chiffres ici? c'est toi qui vois ça c'est surtout est-ce que tu veux veux dire,French
+essaye parce que moi... moi j'ai lancé en France ça se fait pas trop moi je m'en fous de dire. bah écoute fais-toi plaisir. donc moi moi j'ai un salaire net donc ce que,French
+je touche à la fin du mois qui avoisine les 2500 euros un petit peu moins. mais si je prends en compte les crédits que je dois payer ici pour le bâtiment le,French
+salaire et les charges de mon employé qui décroche le téléphone le les charges de mon salaire à moi les impôts de société tout ce que à payer à côté,French
+je sais pas me payer plus. ok. donc j'ai un salaire qui est bon ça reste un salaire correct mais c'est sûr que j'ai pas quatre maisons [...],French
+c'est plus les les chirurgiens cardiologues... je ne peux que le supposer mais pour avoir quelques connaissances qui sont,French
+spécialistes oui les chiffres sont évidemment beaucoup beaucoup plus haut mais avec aussi des responsabilités qui sont encore différentes pour les,French
+chirurgiens sont sont en commentaire et et une pratique totalement différente aussi et si on me proposait ici tu peux gagner 3,French
+fois plus tu devienne un cardio je suis pas certain que je le fais. fin de tes consultations ici au cabinet? ouais. mais par contre après là tu vas enchaîner sur les consultations... ouais je vais,French
+aller voir des gens à domicile ici maintenant est-ce que toi tu trouves que la le,French
+rapport au médecin a changé surtout dans les dans les villages dans les choses comme ça? parce qu'il y avait quelle mille époque où le médecin c'était c'était le,French
+même place que le maire ou l'instituteur tu vois ce que je veux dire? oui c'est ça et c'est quelque chose que j'essaie moi personnellement de combattre un petit peu parce que j'essaie de me placer en,French
+étant pas le le grand gars qui dit des choses et qu'il faut faire Esther. j'essaye justement d'expliquer aux gens comment ça se passe mais oui le rapport,French
+a beaucoup changé aussi alors je travaille pas depuis plus de 40 ans mais au niveau de la consommation du soin le médecin maintenant c'est devenu un bien,French
+de consommation je paye donc je veux ça et tu fais ça tu me fais ça tu me fais ça et si je te paye tu fais ce que je te,French
+demande bah non ça marche pas comme ça. on n'est pas on n'est pas là pour faire ce que les passionnants on est là pour agir dans leur intérêt parfois leur intérêt c'est pas être d'accord avec eux.,French
+tout à fait. mais c'est ça demande des capacités de négociations et de l'adaptation aussi de parfois voilà OK comme avec la dame tout à l'heure elle,French
+empty. le BL. ouvre les yeux. moi j'ai vu vraiment le scénario le pire. vie elle basculer on a rien de temps. c'est ça savoir ce qui est grave le savoir d'un seul coup d'il prise de produit toxi,French
+pandaison arme à feu tout est possible. vous allez le voir venir au monde.,French
+là il y a rien on va arrêter. hôpital d'Arras service du Samu. enayet Eden est médecin urgentiste,French
+"originaire de l'île Maurice il vit dans le nord depuis 15 ans. on y va. 8h du matin Eden et son équipe sont appelés pour une urgence. un homme de 40 ans vient de faire une tentative de suicide, il est inconscient. pour l'instant Edden",French
+n'en sait pas plus. est-ce qu'il a pris des médicaments? est-ce que il il a essayer de se pendre ou c'est avec une menace par à feu? a priori ça doit être grave parce que sinon c'est pas parti.,French
+il faut faire au plus vite arrivé au domicile de la victime les pompiers sont déjà sur place. comment il va le patient? la conscience? il répond? il répond ou pas? - sur la cogné pas -ah bon -à l'étage. l'homme,French
+a une trentaine d'années il a été retrouvé ici par sa femme dans un état comateux. ça fait combien de temps il est comme ça? quand je suis arrivée il était comme ça inconscient il anormément rurgité. - il était plus bleu ou pas?,French
+"l'homme aurait pris des médicaments pour en finir. pourtant autour de lui aucune boîte ouverte, pas de comprimé. le médecin doit découvrir très vite ce qu'il a avalé pour pouvoir le sauver. il va questionner sa femme qui attend en bas.",French
+qu'est-ce qui s'est passé vous savez pas trop? Bah c'est dire que il a su au début de semaine qu'il était censé et puis alors il me dit je je vais être tranquille il dit je rentrer à la maison je vais être tranquille. est-ce qu'il a,French
+déjà fait des tentatives de suicide madame? il y a longtemps. et il avait pris quoi à l'époque comme médicament? il ne prend rien de la passerelle. d'accord et là est-ce qu'il y a des pesticides chez vous? c'est à dire? des des engrais des conneries,French
+comme ça? du Mor il y en a pas non plus? bizarre. Eden doit absolument trouver ce que cet homme a ingurgité pour pouvoir le sauver. le patient est toujours entre la vie et la,French
+mort. le mec il a fait une belle tentative de suicide a priori. il est il est inconscient on essaie de lui mettre un antidote. a priori on va attendre un petit peu pour voir s'il réagit ou pas. on va voir s'il se réveille. le médecin,French
+pu ingérer et quelques secondes plus tard les pompiers trouvent enfin plusieurs boîtes de médicaments cachés en haut d'une armoire. ah ben voilà on,French
+a pas mal de médicaments. en théorie sont intact. bah là on a trouvé les filles. il y avait de la morphine à la maison je vais demander à sa femme parce que je sais pas comment fait qu' peut expliquer ça.,French
+madame dites-moi madame. c'est à qui ça? c'est lui quand s'est fait opéré du du genou il y a 2 ans. et vous pensez qu'il a pu en prendre ou pas? moi parce que on trouve que les,French
+boîes sont un petit peu vides quoi. et ça il en a pris ça madame? non? les boîtes sont pratiquement vides c'est donc de la morphine que cet homme aurait pris il serait en état d'overdose.,French
+"si rien n'est fait il peut mourir dans les minutes qui viennent, il faut l'emmener au plus vite en service de réanimation. Eden doit d'abord réconforter sa femme. je vous explique un peu ce qui se passe. bah oui. je pense qu'il en a pris",French
+beaucoup quand même quoi. je sais pas. vous inquiétez pas. on s'en occupe d'accord? moi j'ai pas fait gaffe les boîtes cachées posées là. j'ai pas fait attention quoi. vous savez,French
+pour l'instant ça va encore? oui. et on fera le maximum. donc il a il a il a il a fait une tentative. il était pas avant de,French
+"faire la tentative, il a vraiment fait une tentative de suicide et il a pris les médicaments en quantité inconnu et dont on connaît pas toutes les classes parce que même si on a fait les poubelles il a pu les les jeter ailleurs",French
+ou les donner ailleurs et tous les scénarios sont possibles. l'homme est resté longtemps sans oxygène emmené en réanimation il a pu être sauvé in extrémist. un drame social comme il en existe beaucoup dans cette,French
+"région. le Nord ancien fief industriel et minier, aujourd'hui fortement touché par le chômage et l'alcool. ici le taux de décès est le plus élevé de France pendant des mois nous avons partagé le",French
+"quotidien des équipes médicales de l'hôpital d'Arras et de celui de Roubaix. urgence SAMU mais aussi maternité, ici plus de 100000 patients sont soignés chaque année. Jérôme est infirmier anesthésiste,",French
+enfant du pays. il travaille ici depuis 6 ans. il vient d'être bipé pour une intervention en urgence à lance à quelques kilomètres de là. donc là on va prendre un charge à patient de 56 ans qui présente une crise d'asthme. ça peutre,French
+très grave et on peut en mourir on peut en mourir. il faut faire vite. le temps il vraiment pourri. malgré la pluie il faut arriver au plus vite,French
+"pour cela ils prennent tous les risques. la pluie, la nuit, les usagers qui ont pas l'habitude d'attendre les gyrophares tout ça c'est c'est quand même dangereux. double vigilance ça.",French
+parce en plus quand il y a de la pluie il faut vraiment moi j'ai toujours les deux mains sur le volant pour garder un écart les sur la route [...] et ça la route-ci dans le Nord c'est quelque chose de fréquent? à,French
+part juillet août est-ce que c'est un petit peu ensoleillé c'est quand même humid. [...]arrachez les trips alors revaloriser le nur et toi tu dis ah bah tous les jours,French
+"il pleut à part juillet août de temps en temps il fait du soleil. là je su obligé de dire je tour c'est qu'un forêt donc je non je reprends ses propos il pleut que pendant l'hiver, l'hiver donc de Septembre à Juin hein. c'est ça? non non",French
+il pleut mais il pleut mais pas plus qu'ailleurs pas plus qu'ailleurs. on va dire que la pluie c'est la rosée quoi? voilà. la pluie c'est la rosée du matin. non mais il fait beau qu'and juillet août ah j'ai envie de j'ai envie de brire tiens.,French
+quelques minutes plus tard l'équipe arrive au domicile du malade. c'est ici que vit l'homme de 40 ans avec sa mère et son frère. comment,French
+vous inquiétez pas vous inquiétez,French
+pas. [...] la mère du patient est très inquiète. Jérôme se charge de la rassurer pendant que le médecin s'occupe du malade. [...] de gravité moindre que prévu,French
+donc ça va pour l'instant. la maman elle est toujours très angoissé. mais il faut assiez-vous tranquillement détendez-vous madame. faut pas [...] comme ça ça,French
+sert à rien ça sert à rien ça sert à rien. il est pas mal il est pas mal. c'est pas dramatique d'accord? alors respirez regardez,French
+respirez tranquillement. le malade est emmené aux urgences pour être placé sous surveillance. sa mère ne parvient toujours pas à se calmer. mais vous inquite madame c'est pas [...],French
+d'accord souvent derrière les interventions des équipes du SAMU se cache une véritable détresse morale. la dame elle était pas bien hein la maman elle est désespérée he elle en a,French
+"même beaucoup de problèmes familiaux, ils ont quand même beaucoup de problèm d'argent, donc il sont demandeurs ils ont besoin d'être écoutés d'être entendu et qu' entend un peu [...] après une nuit en observation le malade est rentré chez",French
+lui en bonne santé. le SAMU d'Arras c'est 6800 sorties par an plus de 193000 appels de détresse et presque 7000 km carré à couvrir. le lendemain matin Jérôme,French
+"est appelé pour une nouvelle urgence, un adolescent s'est blessé à Thierry. impossible d'y aller en ambulance, il faut prendre l'hélicoptère. là c'est assez primordial l'hélicoptère déjà pour",French
+localiser et pour accéder rapidement parce que les routes d'accès sont difficiles les voies d'accès sont difficiles difficilement pratiquable en voiture. donc on se pose à proximité de l'enfant ou la personne en détresse,French
+"c'est là à cause de l'hélicoptère. direction le Thierry, une montagne de charbon comme il y en a beaucoup dans cette ancienne région minière. une montagne devenue le terrain de jeu des ados du",French
+coin. un jeune de 17 ans vient de faire une mauvaise chute en vélo. il aurait perdu connaissance. après plusieurs survols l'équipe localise la victime les pompiers sont déjà sur,French
+"ont accès à ce service de réanimation, mais pour voir leurs enfants ils doivent suivre des mesures d'hygiène très strictes. toute la zone stérile il faut écarter tout risque d'infection. les bébés qui sont dans ses couveuses se",French
+respire plus. pour Virginie c'est l'angoisse car elle sait qu'elle ne peut rien faire. la puricultrice tente de faire,French
+repartir la respiration du bébé. Théo reprend enfin sa respiration. c'est ça arrive donc c'est toujours,French
+stressant pour la maman. ça va passer. ça va se passer avec avec le temps ça. c'est pas à chaque fois mais bon des fois ça,French
+ça. ça va vite. comme quoi ben la vie elle peut basculer. on a rien de temps quoi. Théo est encore fragile. ses parents vont,French
+"devoir vivre dans l'angoisse pendant de longues semaines. car malgré tous les efforts de l'équipe chaque année, une dizaine d'enfants décèdent dans ce service. dans la chambre à côté, une petite fille Louan est considérée comme",French
+une véritable miraculé. Louan c'est on va dire c'est notre doyenne du service. elle est là depuis un mois et demi à peu près. c'est un bébé qui grossissait pas,French
+"bien au départ, qui était trop petit qui était pas dans la limite de la viabilité et elle est née à 29 semaines avec un poids de 600 g. Louan est né à 6 mois et demi avec en plus un retard de croissance",French
+"important. à 600 g elle était à la limite légale de la réanimation. actuellement la loi dit qu'un bébé est viable à partir de 22 semaines et 500 g, ou 500 g. il y a",French
+"30 ans en France on vous disait que les enfants de moins de 1000 g bon c'était pas la peine de on narriverait pas les réanimer. Louan revient de loin. aujourd'hui elle pèse 1 kg, mais elle ne peut pas encore manger, ni respirer",French
+"seule. à quelques kilomètres de là sur la grande place d'Arras, ses parents Lidy et Vincent essayent tant bien que mal de vivre avec l'absence de leur fille. Lidy prépare la sortie de Louan, Vincent lui",French
+"préfère rester prudent. [...] le tapis d'éveille donc ça c'est l'arrière- grand-mère qui a acheté donc elle est loin de le mettre hein. c'est clair? le lit sera au milieu, la table allongée dans le",French
+coin et la petite armoire peut-être ici. j'imagine déjà la chambre. il y a papa qui doit faire maintenant. ouais bon on va attendre. on va attendre un petit peu et c'est c'est toujours de la,French
+"réanimation hein, donc si c'est pour après vivre un drame, c'est ça sert à rien en fait. Vincent est encore inquiet. au fil des semaines, le couple a accepté la prématurité de sa fille, mais les débuts étaient difficiles.",French
+avant de la ramener à la maison. si tout va bien. Roubaix service d'urgence. ici on soigne plus de 63000,French
+"personnes chaque année. un chiffre colossal qui en fait un des services les plus saturés de France. il est à peine 10h les couloirs débordent de patients, la salle d'attente est déjà pleine. chaque jour une centaine de personnes se",French
+présentent aux urgences et l'attente peut durer plusieurs heures. déjà ce matin elle m'a dit je vais dit aïe aïe aïe aïe on va passer tout le tout le samedi ici. la première fois que ça m'est arrivé j'ai dû attendre plus de 3h. j'ai,French
+"discuté dans le couloir aux urgences une dame et 3h et demie elle est là, elle attend toujours. on sait quand est-ce qu'on rentre mais on sait pas quand on sort. une attente très longue sauf dans les cas d'extrême urgence quand le pronostic",French
+"Roubaix, c'est lui qui s'occupe des cas les plus graves aujourd'hui. où il est retrouvé? sur la voie publique. [...] pas de tension. les pulsations au départ je dis à",French
+derniers temps je sais pas. il est froid extrémités froides donc c'est un patient qui saigne énormément. a priori d'origine digestive chez un patient qui prend des,French
+"anticoagulants au long court et qui probablement à surdoser son traitement. donc c'est assez son état est assez compliqué. tentative de suicide, accident, pour",French
+l'instant impossible de savoir ce qui s'est réellement passé. une chose est sûr: son état est tellement grave qu'il faut absolument le transférer au service de réanimation intensive. je viens voir une entrée amenée,French
+"par le SAMU, monsieur cinquantaine d'années, donc nous il a une tension à 10, il a dû ventilé c'est daté, il a du sang qui continue à couler de la gastrique on est presque à 1 L. on a tout besoin d'une place chez vous. l'homme a",French
+"perdu 1 litre de sang, le réanimateur vient de prendre le relais. pour nous c'est fini le réanimateur est là on lui laisse. il sait mieux faire que nous. pour ce malade le pronostic est",French
+sombre. après examen les médecins découvriront une tumeur dans son estomac. la salle de déchocage va être libérée. et nous on va nettoyer la salle,French
+"parce qu'on a fait sortir de personnes d'ici, pour installer ce monsieur et des personnes sont dans les couloirs on va faire revenir ici. une situation de crise à laquelle le docteur Pochet d'habitué. ici les places",French
+"sont chères surtout le weekend. on est samedi, les patients vont commencer à arriver. on a sur les trois lits les capacités d'accueil. il y a six malades qui commencent à s'agglutiner dans les couloirs donc là c'est un samedi classique. donc ça va commencer. ça commence comme il faut.",French
+"le samedi classique c'est quoi? c'est du monde partout avec des infirmières qui courent partout, du sang plein les draps, ça c'est un samedi classique. sauver des vies c'est pour",French
+"cela que le docteur Pochet a choisi d'être médecin urgentiste. mais les urgences c'est aussi des problèmes administratifs. il est midi et avant de voir d'autres malades, le médecin a d'abord un petit souci à",French
+"régler. maintenant on a plus qu'à signer les lettres de sortie, à gérer les demandes abusives d'ambulance. là il y a une jeune dame avec qui je vais avoir quelques soucis je crois. cette femme c'était arrivée",French
+"la veille pour une douleur à la poitrine. elle a subi toute une batterie d'examen, elle est en parfaite santé mais elle refuse de partir de l'hôpital par ses propres moyens. je demande au médecin de m'appeler une ambulance pour pouvoir",French
+"rentrer chez moi tranquillement, et là le médecin refuse, me dit de me débrouiller, que je dois rentrer en pyjama et en pantoufle, voilà. elle aimerait bien que je lui je lui offre une ambulance",French
+allongée pour la ramener chez elle. et une ambulance allongée c'est 200 €. il y aura de question que l'hôpital paye 200 €. je lui demande de faire au moins l'effort de téléphoner ou sinon on lui appellera un taxi qui sera assez frais,French
+"mais on fera pas de bon transport. c'est de l'argent qu'on aura pas pour des médicaments ou du matériel à l'hôpital. mais rien à faire la patiente n'en démore pas, elle vient harceler le médecin jusque devant son bureau. je vous",French
+"demande monsieur si je suis venue ici aux urgences, c'est que j'étais malade. je sais et moi mon travail de médecin, mon travail de médecin je l'ai fait, je vous ai examiné, je vous ai soigné, je vous ai fait le bilan. je suis pas venue ici me disputer",French
+"avec vous. ah moi non plus. d'accord je vous demande de faire votre travail jusqu'au bout monsieur. mon travail est fait [...] vous n'en aurez pas madame, ça sert à rien de... et pourquoi vous voulez pas faire la [...]",French
+"oui vous pensez vous allez m'obliger à faire une prescription. vous êtes médecin. même un médecin généraliste. des prescriptions pour des ambulances. il y a des gens qui sont eux malades, ils ont besoin de moi. mais non vous n'êtes",French
+"plus malade. mais la patiente ne s'arrête pas là, elle passe aux menaces. j'ai prend une ambulance sur le compte de l'hôpital puisque monsieur ne",French
+"veut pas, et si en bas on veut pas appeler l'ambulance et ben je ferai appeler le directeur d'AST. vous allez me donner votre nom pour que je puisse demander au directeur",French
+"de l'hôpital ce qui s'est passé. vous étiez moins casse-pieds hier quand vous êtes arrivé, vous aviez mal à la poitrine et vous étiez inquiète. bah oui je savais pas que ce bref séjour que j'ai passé ici allait se passer comme ça. voilà vous êtes déçue",French
+il faudra plus revenir dans cet hôpital madame. ah non je viendrai plus mais vous vous n'avez plus travailler ici. mais vous attendrez parler de moi docteur? et oui madame. oui vous attendrez parler de moi. je pense qu'il faut être assez ferme,French
+et puis et puis pas céder à des menaces de plainte de de licenciement parce qu'elle connaît du monde et cetera. puisque ça on a l'habitude de le voir parce qu' ils ont un peu tous le même discours. stop on arrête là on arrête là c'est bon. pas,French
+"paiera pas les ambulanciers, ils lui enverront une facture, sans être sûr d'être payé un jour. attention ça commence. on est parti. on va",French
+où? un arrêt cardiaque. allez c'est parti. retour au SAMU 8h du matin le docteur Eden et son équipe partent en intervention. les pompiers viennent de,French
+"donner l'alerte, un homme qu'il transportait pour un simple malaise vient de faire un arrêt cardiaque dans leur véhicule, il faut faire vite. les pompiers ont préféré s'arrêter au bord de la",French
+"route. te libère te vas-y Marchaud. la victime, un homme d'une cinquantaine d'années est en arrêt respiratoire et cardiaque. les pompiers massent le cœur du patient pour le",French
+maintenir en vie. quand tu es arrivé le mec ça allait? ouais ça allait. il avait une tension correcte le rythme était normal.,French
+"progressivement le rythme a diminué. c'est pas top c'est arrêt respiratoire. on l'a récupéré pour l'instant. tu peux commencer à rouler. direction les urgences de l'hôpital, une",French
+"course contre la montre commence. la victime est stabilisée, mais il faut l'amener très vite en réanimation. quand tu arrivais il était bleu? il était pas bleu quand on est arrivé, il avait connaissance. il vomissait. il vomissait du",French
+"sang, c'est tout? il crachait ou il vomissait? salut c'est [...] en intervention sur route nationale de Saint-Paul. c'est un arrêt cardio respire. récupérez, ça marche? vas-y.[...] le cœur du",French
+patient vient de s'arrêter pour la deuxème fois. il n'y a qu'une seule solution: l'électrochoc. t'es prêt? c'est bon. touchez pas le brancard.,French
+"vas-y. vas-y [...] la tenstion monte dans le véhicule, toute l'équipe est en suspens et attend de savoir si le cœur va repartir. vas-y lâche un cou... 2 secondes arrête",French
+après quelques secondes les battements reprennent.,French
+yes. on a récupéré pour l'instant. les per on a été bon là. regarde ça. c'est pas mal.,French
+"empty. arrivé aux urgences, l'équipe continue à masser le patient. son état est très grave, son rythme cardiaque ne cesse de",French
+chuter. direction le déchocage. mais malgré tous les efforts le cœur s'arrête une nouvelle fois. cette fois il ne repartira,French
+"plus. plus de circulation, on a eu une petite tension tout à l'heure à 10 à 12.",French
+là il y a rien on va arrêter. 35 minutes quand même sans parler d'avant quoi. les urgentistes ont tout tenté pendant,French
+presque une heure. moi je te remplis les papiers. alors difficile. très très difficile. difficile parce que après une,French
+"réanimation qui était longue et conséquente 45 minutes à peu près, en tout et pour tout il est décédé. voilà donc difficile parce que il va falloir annoncer à la famille, expliquer tout ça, et humainement c'est toujours très",French
+"difficile de faire quoi. voilà. même après des années aux urgences, Eden n'accepte pas la mort d'un patient.",French
+"on vit comme un échec forcément parce que notre travail c'est quand même à la base d'aider les gens, et là visiblement on est pas arrivé. c'est forcément un échec. mais ça va tellement vite. je pense",French
+"que les ressentis c'est c'est secondaire et après l'intervention quoi. c'est jamais pendant parce que ça va à une vitesse où il faut réfléchir il faut agir, il faut travailler en équipe, faut gérer les équipes et on a pas le temps en fait. c'est qu'après le coup on a le",French
+"temps de de se poser et puis de se poser des questions. là je suis en train de faire mon dossier, et je réfléchis en même temps sur ce qu'on a fait. voilà.",French
+"première intervention de la journée, la famille sera avertie dans l'après-midi.",French
+"pour l'équipe la mission s'arrête ici. va prend la commande. accident de la route, suicide, crise cardiaque, des cas tragiques qui sont le lot quotidien des",French
+"hommes du SAMU. le seul moment de répis, un repas vite avalé dans la salle de repos. moi je rigole je fais toujours le con voilà. c'est manière bah voilà c'est certainement ma manière de de d'extérioriser et puis... moi",French
+"personnellement les images violentes m'ont jamais impressionné. on voit du cerveau, voit des boyaux, voit tout ce qu'on veut parce que tu vois des choses dramatiques. le drame c'est c'est ce qui gravite autour. moi j'ai déjà pleuré et j'ai pas",French
+"de le dire. quand on a eu un gosse de 2 ans et demi qui est mort dans un incendie je veux dire, et quand il avait fallu le dire à la famille tout ça, honnêtement on est vraiment très mal. et c'est quand la vie d'enfant est en péril que les équipes prennent encore plus de ris pour aller vite. quand tu as un appel pour un gamin si",French
+c'est pour une noyade ou n'importe quoi [...] tu fais gaffe tu doubles ta vigilance mais tu prends un peu plus de risque. y a personne qui,French
+personne qui quand on voit si on prend la fiche en disant putain un enfant de 6 mois en arrêt ou un noyade un enfant de 4 ans noyé peut dire que on rigole,French
+"pas. retour à Arras, service de maternité. ici plus de 20 sages-femmes mettent au monde plus de 2000 bébés chaque année. l'équipe se prépare car dans quelques minutes une",French
+"petite fille va voir le jour. son papa veut assister à l'accouchement, c'est sa première naissance en direct.",French
+"ah oui c'est ouais c'est vraiment nouveau, je suis sous une tension de voir comment ça fonctionne on va dire. ça fait drôle ça fait drôle. le papa n'est pas au",French
+bout de ses surprise car aujourd'hui Mathilde va mettre au monde sa fille d'une manière un peu inattendue. vous allez accoucher sur le côté. si vous voulez? on l'installe plus forcément les,French
+"femmes en position gynécologique pour accoucher. les dames qui se trouvent bien sur le côté, on les maintient dans cette position et en fait le bébé vient au monde ici. voilà. derrière elle. ça change que d'avoir les deux jambes. c'est autre",French
+chose. j'ai jamais entendu parler de ça. je sais pas qu'on pouvait accoucher sur le côté. la prochaine fois. et le couple va vivre cette nouvelle expérience ensemble dans quelques minutes le bébé sera là. allez-y encore encore encore,French
+encore encore. essayez de pousser un petit peu plus longtemps. si vous pouvez d'accord? ayez confiance en vous c'est important.,French
+"je sais pas si nous les hommes on arriverait à supporter ça. on dit qu'on est fort mais je ne pense pas. allez-y, allez-y plus que ça. c'est bien. il y a une petite mèche de cheveux de bébé qui arrive. c'est un petit brun comme son papa.",French
+est-ce que papa il veut voir la tête de bébé? tu peux ou pas? comme vous voulez. voyez ses cheveux là comme elle touche bien. voilà bébé qui arrive tout doucement. voilà voilà vous êtes bien là,French
+Monsieur ou vous voulez retourner là-bas? comme vous voulez. non je reste là. ça vous gêne pas? non. alors vous allez le voir venir au monde. le papa assiste émerveillé aux premiers instants de vie de sa fille. vous sentez qu'elle vient là?,French
+"oui. vous voyez votre bébé venir au monde? doucement, maintiens bien la tête. doucement poussez plus madame, poussez plus. là on laisse souffler le bébé on laisse venir. allez souffler. allez-y",French
+maintenant. allez-y. doucement circulaire. on va couper un petit peu le cordon. le cordon est enroulé autour du cou du bébé. il y a un,French
+risque de strangulation. les sages-femmes ne paniquent pas. alors ça c'est le coquet. 1 2 et 3 tours de cordon. venez là. prenez là. là voilà. comme le cordon met sa petite tête,French
+devant. voilà. voilà. super. ça y est. bienvenue mademoiselle. on va,French
+[...] oui c'est beau je vais,French
+"dire que je l'ai vu son premier petit cheveux jusqu'à son dernier pied, dernier  orteil. c'est magnifique. c'est vrai que c'est beau he je. pensais pas que c'était comme ça. un moment inoubliable pour Mathilde",French
+"et son mari. Véronique est sage-femme depuis 15 ans, mais à chaque naissance elle est touchée par l'émotion des parents. on partage des moments de la vie des femmes",French
+qui sont particulièrement précieuses. je dirait l'émotion des parents voilà cette maman qui attrape son bébé qui met sur son ventre on se dit mais stop là ça c'est ça c'est un moment de,French
+"grâce. pas le temps de s'attarder une alarme se déclenche, c'est celle de la chambre de cette future maman. alors comment ça va? ça fait très",French
+mal. Magalie attend des jumelles. elle est là depuis plusieurs heures et ne supporte plus la douleur. à tel point que tout examen est devenu insupportable pour elle. ça va comme ça? j'y vais?,French
+"ah arrêtez ça fait mal mal. calmez-vous calmez-vous. c'est tout c'est tout c'est pour moi un petit peu tôt pour aller en salle d'accouchement, je vais voir avec le médecin si on peut pas quand même vous installer avec la péridurale. parce que",French
+vous avez des contractions qui sont encore assez régulières. oui je sais bien. d'accord? courageuse. levez les mains. le travail est très lent il est encore trop tôt pour poser une péridurale mais la sage-femme s'inquiète pour Magalie qui,French
+"souffre depuis plus de 10 heeures. elle préfère en parler à l'obstétricienne. elle a vraiment très mal, elle se fatigue un peu, qu'est-ce que tu penses de la mettre en salle avec une péri, c'est trop tôt? je l'examine parce que. je sais pas.",French
+bouge pas depuis un petit moment là du coup. ça bouge pas depuis 2 he. mais c'est un peu juste pour mettre... tu vois c'est un peu ou je bien... Magalie est épuisé par la douleur.,French
+"Le médecin décide de lui poser une péridurale pour qu'elle puisse accoucher dans les meilleures conditions. on naime pas passer les patientes en salle trop tôt, pas poser une péridurale trop tôt ou",French
+pour rien. là dans son cas on pense que ça ça nous permet un de la soulager et deux plus faire attention à la à la fatigue et pour pas que la patiente arrive au bout d'un travail de plusieurs,French
+"heures, pour des jumeaux alors qu'on sait que ça va être un accouchement un peu plus sportif, soit pas trop fatigué. oui c'est ça qu'on prend qu' plutôt la fatigue. Magalie n'est pas au bout de ses peines. ce qu'elle ne sait pas encore,",French
+c'est que rien ne va se passer comme elle l'avait prévu.,French
+"6h du matin, c'est une journée particulière pour les urgentistes du SAMU. aujourd'hui ils seront sur une manifestation exceptionnelle  l'enduro du Touquet, une course de moto",French
+sur les dunes. une compétition qui fait de nombreuses victimes tous les ans. les urgentistes transformment l'aéroport de la ville en hôpital de campagne. donc là on va avoir certainement besoin d'un coup de main on va décharger le camion. le coin sutur se fera juste ici. l'équipe a,French
+"quelques heures à peine pour créer un service d'urgence. 19 tonnes de matériel médical, 50 infirmiers et médecins bientôt prêt à prendre en charge les premiers blessés. là on installe ce qu'on appelle les ua les urgences",French
+"absolues. tous les patients les plus gravés à stable on les prend en charge ici. et à côté dans la salle d' côté ça va être les ur les urgences relatives. donc là ce sera la petite traumatologie, la petite bobologie, les sutures. il est",French
+"midi le dispositif est opérationnel. la course commence dans moins d'une heure, à peine le temps d'avaler un sandwich. la friterie Momo. alors je vais",French
+prendre un fr fricadel fr. pour l'instant c'est le calme avant la tempête. l'équipe se prépare au coup de feu. généralement c'est lors des première,French
+minute de la course qui arrive la plupart des blessés. c'est une très physique sur le long terme donc les jeunes les poireaux commme on les appelle qui se donnent à fond le premier tour et des moments il,French
+"matrisent pas toujours bien où il y a quand même pas mal de de de dégâts et de casse, donc dans les premiers tours de course on a récupé beaucoup pas mal de de blessés plus ou moins légers. l'enduro du touquet c'est l'une des",French
+"courses de moto les plus importantes du monde. un millier de motards au départ parmi eux des professionnels mais surtout des amateurs. et plus de 450000 visiteurs dans une ambiance surchauffée,",French
+"vitesse, alcool, fête, un cocktail explosif. alors cette année une équipe d'urgentistes se rend au pied de la course pour être au plus près d'éventuelles victimes.",French
+normalement on doit suivre le le cortage à la fin. nous ouvrir là? ouais ouais ça marche merci. dès que c'est fini dès que,French
+c'est passé j' ouvre là pour qu'on suive. on va prendre une photo bah obligé hein obligé ça c'est extraordinaire. la course va commencer dans quelques instants. les moteurs commencent à chauffer.,French
+ah c'est c'est du sport hein [...] c'est des chens fous des fou. Jérôme et son équipe arrivve sur place le départ vient d'être donné. les concurrents sont partis pour 3 heur de,French
+course à plus de 100 km he. aux urgences de l'aéroport on suit l'événement sur l'écran. la course est commencé depuis 20 minutes. c'est l'heure des premiers accidents spectateurs pilotes les,French
+"voir. quoi? oui? plus fort. parle plus fort. le petit garçon réagit faiblement, il est encore sous le coup de l'accident. il était avec son père au première loge de",French
+la course quand une moto a perdu le contrôle.,French
+il était atteint à côté par la moto? il était atteint [...] mais il a pris le casque,French
+"l'enfant souffre d'un petit traumatisme crânial, et le médecin soupçonne une fracture du nez.",French
+"le petit garçon a peur, les infirmiers improvisent de quoi l'amuser avec les moyens du bord. lui trouver quelque chose qui l'amuse un petit peu.",French
+"il se trouve là devant tout le monde, à se demander qui fait quoi, certainement avoir très peur. tu aimes un petit ballon? gars, tenir un rigolo. tu viens avec moi? je te",French
+"prends dans les bras. le garçon est emmené à l'hôpital le plus proche pour une radio de contrôle. son père est rassuré, mais l'accident aurait pu être beaucoup plus grave.",French
+vous avez eu plus de fleurs ouais ouis on vu la vitesse calé vu comment on a a revu la barrière après on a eu de la chance. ou franchement la barrière elle est coupé,French
+en deux. donc on a vraiment de la chance qu'est-ce qui s'est passé avec le moteur. il s'est relevé puis il nous a fait au revoir et alors...,French
+qu'est-ce ça serait bien qu'il disent s'excuse qui quand même il prend des nouvelles. voilà. le petit garçon a eu de la chance il s'en sort avec une fracture du nez. il,French
+rentrera chez lui dès le lendemain. à Arras urgence au service néonatalité. Theo fait encore un malaise.,French
+Theo le fils de Virginie le petit prématuré d'un kg. son alarme s'est déclenché il ne respire plus. cette fois sa maman n'est pas là.,French
+allez on y va. les deux infirmières tentent de faire repartir l'enfant en le,French
+stimulant. après 2 minutes d'apné Théo ne respire toujours pas. j' expire juste un instant en bouche.,French
+voilà le la repartie. Théo reprend enfin sa respiration. ça va mieux? ça a l'air. c'est très fréquent chez les,French
+petit pépère. tu as l'air d'être mieux que tout à l'heure. ah oui alors ça ça panique les parents tout le temps. les les malaises les bradycardies c'est-à-dire le cœur qui qui ralentit,French
+"brutalement. alors c'est tous les prématurés qui en font parce que les bébés pr��maturés sont immatures ils sont aussi immatures du cerveau. le cerveau c'est ce qui commande la respiration, donc temps en temps ilst oublié de",French
+respirer. mais pour Virginie et Guillaume les parents de Theo ces malaises à répétition sont insupportables. à chaque fois qu'elle y assiste cette maman ne s'en remet,French
+"pas. là je crois que on pense à tout, à tout... même à des choses qu'il faut pas penser quoi",French
+"mais... moi je le voyais partir je voyais que j'avais j'aurais pu bébé. quand vous voyez votre enfant tout bleu, c'est...",French
+moi ce matin ça m' ça m'a fait très peur. hier ça allait très bien et... comment,French
+"aujourd'hui il nous a fait ça. demain il peut très bien nous faire quelque chose. donc on sait pas du tout à quoi s'attendre, et on sait pas comment bah avancer. demain Virginie quittera la",French
+"elle est toute toute épanouie là, avec ses grands yeux. c'est la première fois que je la vois comme ça. l'habitude je vois toujours ces petits yeux. on va pas dire inquiète mais ces",French
+petits yeux endormis. ah je suis vraiment impressionné [...] et papa il veut pas faire du peau à peau? c'est-à-dire du peau à peau? sur,French
+"vous? moi non c'est la peur de lui faire mal je sais pas comment comment la maintenir. c'est moi qui veux vous la mettre après. moi non, je préfère pas en fait. c'est vrai? ouais je préfère",French
+pas. je vais pas vous obliger. voulez pas tenter? non non. difficile pour Vincent d'établir un véritable lien avec sa fille. et si ce papa ne vient qu'une fois par semaine. c'est une volonté de sa part. c'est un choix parce que c'est,French
+"peut-être au départ la peur de de m'attacher. c'est vrai que le pire peut tout le temps arriver, peut toujours avoir un coup téléphone dans la nuit en nous disant bon la petite, la petite va pas très bien et elle risquerait elle",French
+risquerait d'y laisser la vie. donc c'est un choix. mais c'est vrai que des risques il y en a,French
+"toujours. au SAMU d'Arras Richard Loubert est médecin urgentiste. il intervient sur une fête d'anniversaire. un homme de 54 ans a fait un malaise, visiblement dû à l'alcool. messieurs",French
+dames. vous avez consommé beaucoup ce soir? vous avez consommé beaucoup d'alcool ce soir? ouais trois tronches. trois tronches? ça veut dire quoi trois tronches? disons pour une fois qu'il vient à mon,French
+"anniversaire. malheur, il m'a gâté hein. lui 64 ans. habitué à boire c'est ça? l'alcool trop fort c'est ça d'accord il a pas mangé. ah oui il a mangé aussi. un tartin bon c'est pas assez. ouais mais",French
+tu aurais vu il a mangé un filet mignon comme ça fumé? ah. ouais rien de grave. depuis le début les pompiers sont avec lui et le patient semble leur être très reconnaissant. il prend plus de cacher. les les pompis sont,French
+"hyper. bien ouais bon monsieur on va devir vous hospitaliser parce que là là comme vous êtes cogné la tête et vous avez perdu connaissance, il va quand même qu' va falloir qu'on vous qu'on vous surveille cette nuit. mais je tiens à dire que... que",French
+monsieurs là ils sont bien. ah oui ils sont bien. j'ai répété déjà mais vous l'avez déjà dit trois fois ça. vous voulez répéter? direction les urgences il faut déplacer le malade sans rien,French
+casser. on va passer devant non il y a toute ma vaisselle dedans. on va pas les casser. ma vaisselle. et encore une fois merci.,French
+"des interventions liées à l'alcool, les urgentistes du SAMU y sont habitués. il y a des périodes, il est début de mois, les gens boivent plus qu'en fin de mois. en fin de mois ils ont plus de sous. alors on a des on appelle ça on a nous on",French
+appelle ça la Saint-Rémi. enfin la Saint-Rémi. quand ils ont touché la Saint-Rémi en début de mois en général un petit peu plus de consommation. là c'est plutôt la fête qui a mal tourné. le patient en tout cas n'a qu'un,French
+"seul mot à la bouche, merci. vous avez beaucoup de... ah les pompiers il sont bien chez pompiers chez pompiers bravo super les pompiers. ah ouais vous l'avez pas encore beaucoup dit Monsieur, si vous pouviez le répéter encore une fois? pour être chez",French
+"elle tranquillement devant la télé ou je sais pas quoi elle est là à vous tenir la main. c'est beau hein? c'est beau. arrivé à l'hôpital, le patient n'est pas encore complètement",French
+"dégrisé. bon monsieur, au revoir. merci et encore une fois merci. merveilleux merveilleux. doucement j'ai besoin de mes doigts j'ai besoin de mes doigts. ouais mais vous l'avez déjà dit.",French
+hez on dit jamais assez. bon. je le note.,French
+"Maternité d'Arras. oui bonsoir monsieur. nous venons passer votre femme en salle d'accouchement, donc si vous voulez vous rapprocher vers nous? à tout à l'heure monsieur. pour Magalie la maman des jumelles c'est le",French
+"grand jour. après plus de 24 heures de contraction, l'accouchement est pour bientôt. Jérémy le futur papa vient d'arriver. hello monsieur madame. allez-y, je vous la installer le",French
+siège est pour vous hein monsieur. tu vois j'ai jamais fait le trajet aussi vite. tout j'ai un truc je suis parti à la,French
+vite. je pensais pas quand même en baver comme ça. honnêtement je je sais pas comment certaines femmes font simpler l'ennui. pérural alors je sais pas. magalie est,French
+"soulagé dans quelques heures les bébés seront là, l'aboutissement d'une belle histoire d'amour elle vient du sud il [...] elle l'a suivi. comme on dit la première fois que je suis venue",French
+"j'ai j'ai vu le temps j'ai dit oh là là, et quand je suis repartie bah j'ai pleuré comme dans le film. donc j'ai suivi jusqu'ici. sans regret au contraire. on est bien?",French
+et on est bien. tout à coup dans le couloir des cris de douleur. un accouchement se passe très mal. allez on,French
+pousse. allez on pousse. allez encore. depuis une demi-heure l'équipe essaie de mettre un enfant au monde. ils ont tout essayé forceps ventouse mais,French
+"l'enfant ne sort toujours pas. son rythme cardiaque est en train de chuter. il y a une césarienne en urgence c'est la course contre la montre. il faut qu'il aille en césar non il n' arrive, parce que la dame...",French
+la mère est emmenée au bloc opératoire.,French
+"en quelques minutes, l'enfant et la mère sont hors de danger. faut que ça aille très vite parce que le bébé est en souffrance. au niveau de son cœur ça ralentit, donc faut aller très vite en césarienne, c'est pour ça moin 5 minutes",French
+il est il est né. le papa n'a même pas eu le temps de réaliser ce qui s'est passé. c'est vrai pour moi c'était dûr à à vivre. elles ont eu le bon affaire de pas,French
+"me demander de les suivre, parce que je pense que je coupe et donc j'ai attendu je leur ai fait confiance et puis voilà, c'est impeccable le gamin est en pleine fort, la maman aussi et le papa est content.",French
+"voilà. pour Magalie par contre, l'attente devient de plus en plus difficile. ces douleurs reviennent. cela fait maintenant 36h que le travail a commencé. on va quand même essayer de se",French
+"tourner sur le côté droit, pour essayer de vous soulager. non c'est c'est toi on va se remettre sur le dos. moi je pensais que ça serait moins",French
+"long, même même Magalie je pense qu'elle s'attendait pas à ce que ce soit aussi long et puis, peut-être aussi pénible pour elle. Magalie est épuisée, et l'équipe médicale commence à s'inquiéter. ça fait un petit moment que cette dame",French
+"est en route. ça traîne. et elle a beaucoup de chance parce qu'elle a des petits jumeaux qui vont naître. mais il y a une anomalie dans ce dossier, c'est la lenteur avec laquelle le col se dilate",French
+"et la tête ne descend pas. après un jour et demi d'effort et de douleur, Magalie et Jérémy s'apprêtent à apprendre une mauvaise",French
+"nouvelle. 15h retour aux urgences de Roubaix, un homme se présente amené par son épouse. il a 34 ans, il souffre de schizophrénie. moi je suis partie travailler et en partant travailler je",French
+l'ai vu à pied dans la rue [...] qui tombait partout que qui disait n'importe quoi qui était vraiment dans un état pitoyable. d'accord donc là aujourd'hui vous venez parce que ça va,French
+plus vous péter un câble? moi je tiens pas en parler du tout parce que je m'en souviens pas du tout de tout ce qui s'est passé donc. l'homme a consommé de l'alcool il n'a pas dormi depuis,French
+"plusieurs nuits et ne se souvient de rien. vous s'attendez en danger pour vous-même ou pas? pour moi-même pour les autres oui. d'accord moi j'ai peur pour lui, parce que j'ai peur qu'il fasse des qu'il fasse l'irréparable",French
+"donc, donc, bon c'est vrai que le vie actuelle en fait on est en pleine séparation, donc mais c'est pas parce qu'on sépare que que je vais l'abandonner",French
+donc voilà quoi j'ai très peur j'ai peur pour lui parce qu'il est capable d'aller d'aller très loin. premier réflexe de l'infirmière vérifier son traitement pour la,French
+schizophrénie. une liste impressionnante de médicaments. ça marche. mais si je n'avais pas tout ça j'entendrai beaucoup de personnes qui n'existent pas. je verrai,French
+"beaucoup de personnes qui n'existent pas. et j'en serai limite agressif, parce que tenir dans un monde",French
+"irrationnel, c'est pas mon domaine. enlevez votre manteau, vous pouvez le mettre sur la chaise. le docteur Babet est chef du service des urgences. elle va examiner l'homme car avant de faire un diagnostic",French
+"psychiatrique, elle veut s'assurer qu'il est en bonne santé, mais elle va avoir une surprise. vous avez pris des comprimés? donc en ce moment il y a beaucoup de perte de connaissance comme ça? oui en ce moment oui, ça me paraît",French
+"bizarre. il y a des cicatrices là, c'était quoi? tu aut euh... c'était vous? oui. un coup de couteau? oui. un coup de fusil?",French
+"d'accord. vous aviez quel âge? 17. 17 ans. assiez-vous, je vais écouter derrière. le fait qu'il a eu ce traumatisme important dans la jeunesse, ce patient pour nous c'est ça montre qu'il peut avoir des actes",French
+"très violents, et et si on l'avait pas déshabillé, un psychiatre qui le voit en consultation tout ça ça lui échappe. des cas comme celui-ci le docteur Babet en voit beaucoup. dépression,",French
+"tentative de suicide, schizophrénie, à Roubaix on compte en moyenne une douzaine d'urgences psychiatriques par jour. ça représente énormément de patients. bon c'est vrai qu'à Roubaix il y a pas énormément de boulot que il y a",French
+"beaucoup de gens au chômage, qui ont des situation sociale délicate et les services d'urgence sont un certain reflet de de de ce qui se passe à l'extérieur. après examen le médecin ne",French
+"décèle aucune pathologie physique. une prise de sang dans mon bureau, et un électrocardiogramme. là ça va. donc c'est possible que ce soit la prise de médicament qui vous fasse perdre un peu",French
+le fil et que vous tombiez. l'homme va néanmoins devoir consulter un psychiatre. gérer les problèmes sociaux et psychiatriques des patients c'est le quotidien du docteur Babet. à peine,French
+"a-t-elle quitté le malade schizophrène, trouve confronté à un autre problème. c'est pas possible d'avoir un café quelque chose? si et vos sous ils sont là on va les donner à l'ambulancier et vous allez repartir avec. et un café?",French
+et un café. bah dis donc que je viens de manger donc un bon café pour manger c'est toujours bon. est-ce qu'il y a des soignants qui disponible pour offrir un café à Monsieur. offrir? c'est mon argent? oui,French
+"c'est votre argent. je vais vous le mettre dans une enveloppe. et vous pourrez m'offrir un café? oui. cet homme est là depuis hier soir. sans domicile, il est atteint d'un syndrome démentiel, mais",French
+"il n'est pas assez dangereux pour être hospitalisé. il y a énormément de gens qui ont des problèmes sociaux, beaucoup sont des éthyliques chroniques qui viennent le soir avec 4 g d'alcool, ils",French
+"savent qu'on on va leur donner une douche, on va souvent les changer de vêtements, on va leur donner un lit pendant quelques heures, on peut pas les laisser dehors, surtout ce temps-ci il a fait extrêmement froid on est obligé de",French
+les héberger. les médecins doivent trouver à ce malade un endroit à dormir ce soir. [...] bah on fait plus qu'hôtel hein parce qu'il faut essayer de lui trouver une,French
+"solution d'hébergement, mais on fait plus qu'hôtel. en attendant toute l'équipe doit faire preuve de beaucoup de patience. allez-y. un café je peux avoir un café? allez lui demander monsieur, elle est derrière. est-ce que quelqu'un peut mettre monsieur dans sa",French
+chambre? et lui apporter un caféur? et mon argent vous pouvez emporter ici? oui monsieur. et mon café? on vous l'apporte. et mon argent aussi? aussi. de son côté le patient schizophrène sort de,French
+"sa consultation psychiatrique. il est autorisé à rentrer chez lui, à condition de revenir dans la semaine, pour voir un psychiatre, et de ne plus boire d'alcool. prend des médicaments et bois un petit coup, ça fait beaucoup plus d'effet que s'il",French
+avait y laisser. par contre s'il prend une voiture je sais pas vous conduisez? non non là je en là. normalement. vous vous mettez en travers. je sais. ça va aller? je connais pas tout.,French
+rentrer c'est ça allez. au revoir. mon retour la sortie c'est par là. oui. voilà. éviter les mélanges. oui. merci Monsieur. bonne,French
+soirée. bon courage je sur vous pour la consultation du jeudi.,French
+"maternité d'Arras. le docteur doit annoncer à Magalie et Jérémy, les futurs parents des jumelles que toute ne se passe pas comme prévu. le premier bébé ne parvient pas à s'engager. on",French
+"s'attendait à ce que ça puisse avancer sans trop de souci et bien non ça avance plus. donc moi je vous propose d'arrêter parce que vous avez tout essayé, courageuse, on a tout essayé, et vous faire une césarienne pour sortir les bébés dans une condition sécurisée au final.",French
+"après 36 heures de douleur et d'attente, pour Magalie c'est une énorme déception. toutes ces douleurs toutes ces",French
+"toutes ces souffrances pour en arriver là, j'aurais quand même voulu, mais bon c'est pas grave ça ce que je veux et puis là des bébés avant tout",French
+"c'est pas le but, qui reste coincé. direction le bloc opératoire. exceptionnellement Jérémy peut assister à la césarienne, pour lui c'est un",French
+soulagement. ça va un peu mieux. toute manière je crois qu'elle aurait pas couché dans bon condition parce que [...] elle est fatiguée. l'essentiel c'est bonne santé toutes les,French
+"deux, c'est essentiel. plus ça serait bien. après plus d'un jour et demi d'attente, il va enfin pourrir découvrir ses filles. regarder ces petits coeurs. Maya la première des jumelles voit le jour.",French
+"Jérémy est papa, pour lui tout le reste est oublié c'est le bonheur.",French
+"he heureux, ému heureux. c'est génial.",French
+"quelques minutes après Mélissa la deuxième des jumelles arrive. les deux  se ressemblent la bouche de la maman. le petit nez, la bouche. un peu plus tard les deux petites filles en bonne santé sont amenées à leur",French
+"maman, heureuse. c'est la petite famille qui qui se forme. tout simplement. c'est que du bonheur. oh oh là là elles sont toutes",French
+"mignonnes, elles sont toutes sages. retour à l'enduro du Touquet avec le SAMU. l'équipe de Jérôme placée au",French
+"pied de la course, vient d'être appelé pour une intervention. un monsieur qui fait un gros malaise qui est pas très bien d'après les témoins. ils ont envoyé la Croix Rouge les pompiers puis on va aller en renfort de tous ça. le problème c'est qu'en plein milieu de la cohue",French
+difficile pour l'équipe de trouver son chemin. l'escalier 5 c'est où? l'escalier 5? idée? c'est l'escalier 5? le secours il est,French
+où? que SAMU arrive. un peu tout droit [...] la ville du Touquet transformée en stade géant. il faut faire vite. mais l'équipe est complètement perdue.  absolument pas par rapport à ce qu'il a autour on est dans la foule on,French
+voit pas ce qu'il y a on voit pas les panneaux on voit pas ce qu'on voit d'habitude. on arriver jamais venir ici jamais c'est trop de monde dans la ville. bordel. au bout de 20 minutes les urgentistes trouvent enfin le poste de,French
+"secours, mais le malade a repris connaissance. ça vous déjà arrivé de faire des malaises comme ça? vous avez de l'épilepsie ou",French
+pas? hier vous a dormi où cette nuit? je suis dormi dans un camion. dans un camion? et ce matin j'avais froid alors. vous avez mangé? ouais j'ai mangé,French
+un kébab. oh c'est très bien vous êtes sauvé avec ça. un malaise surtout dû au manque de sommeil et à l'alcool. première intervention bon ben,French
+"voilà. assez rapide rien de bien méchant. mais bon. aux urgences de l'aéroport en revanche les équipes sont débordées accident de course, un pilote vient",French
+d'arriver. comment? ce jeune motard vient de faire une chute en moto il s'est déboîté l'épaule. c'est la pire.,French
+"réduction. l'épaule est déboîté, il faut mettre maintenant tête humérale dans la cavité. c'est déboîté c'est très douleureux. c'est pourquoi parfois au bloc opératoire on peut y aller avec l'anesthésie",French
+"hey salut les pompes là, j'espère que vous avez bien. aujourd'hui une nouvelle vidéo, on va parler des gestes de premiers secours à savoir vraiment la base, ça soit pour la PLS, l'arrêt",French
+"cardiaque ou l'obstruction totale des voies aériennes, ça soit chez l'adulte, l'enfant, le nourrisson, au revoir tout ça. allez c'est parti.",French
+"comme tu l'as vu en introduction, on va",French
+"parler des gestes de premiers secours vraiment, ça c'est la base à savoir quoi parce que si tu tombes sur un accident, si quelqu'un de ta famille, c'est tout je",French
+"vais pas, il est inconscient, c'est important de savoir les gestes à effectuer. ce sont des gestes simples mais ça peut sauver la vie. doit avoir",French
+plusieurs situations que tu peux retrouver dans la vie de tous les jours. donc par exemple on va voir en premier quelqu'un qui va s'étouffer au revoir,French
+les choses à faire. la deuxième chose ça va être la PLS position latérale de sécurité et ensuite la troisième chose ça va être le massage cardiaque pour un,French
+"adulte ou un bébé. donc pas si tu tombes sur ces situations, qui regarde cette vidéo qui va durer 10 minutes est normalement",French
+"tu vas pouvoir faire face à toutes ces situations, et comme j'ai dit c'est important, parce que tu vas pouvoir sauver des vies, c'est des gestes je vous",French
+"ai dit simple, mais qui sont efficaces. avant bien sûr l'arrivée des sapeurs pompiers qui eux après prendront le relais. déjà je t invite tout de suite à",French
+"mettre vos pouces bleus en bas de la vidéo si tu veux, une partie 2. allez on va attaquer pour obstruction totale des voisins on appelle ça maintenant",French
+"obstruction aiguë des voies aériennes c'est quelqu'un qui va plus respirer. ça peut être vu chez un adulte, il va manger et",French
+"il va s'étouffer, moi j'ai déjà vu sur intervention avec un gros bout de viande, la personne n'avait pas bien coupé ces aliments pas bien coupé son jambes quand",French
+"elle a avalé pas forcément, elle s'est étouffée. donc ça ça peut arriver chez l'enfant ou le nourrisson qui pas ils peuvent aller chez moi des lego débit",French
+"des choses comme ça. là on est sur l'obstruction aigue des voies aériennes on est bien d'accord il n'y a plus des airs qui passent, la personne souvent va",French
+"maintenant au coût pour essayer de chercher de l'air, il n'y a aucun bruit, aucun son qui passe et va commencer... donc là on était bien d'accord, tu vas",French
+"falloir vite faire des gestes, parce que la personne si à la pudeur eh ben elle va tomber en arrêt cardiaque, elle va mourir. allez je vais vous montrer les",French
+"gestes à effectuer donc j'ai Mika qui fait la victime. déjà la première chose à faire c'est regarder dans la bouche si on voit le corps étranger, et si on peut",French
+l'extraire. ensuite on va faire cinq de une à cinq lacs dans dos vigoureuse entre les omoplates. on va faire une,French
+"compression abdominale, donc là on comprime l'idée c'est de faire un effet pistons. donc voilà on fait de une à cinq",French
+"fois, ensuite je regarde dans la bouche si j'ai un corps étranger, si je peux l'extraire et on enchaîne ça. voilà donc 5 claques dans le dos, on regarde dans la",French
+bouche. et on fait ça jusqu'à ce que la victime recrache le corps étranger ou s'il avait qui me tombe en arrêt cardio respiratoire.,French
+maintenant on va faire la même chose avec un bébé. doublé tout. je regarde si je peux sortir le corps,French
+étranger et ensuite je vais faire 5 attendu mais mes doigts à la commissure des lèvres.,French
+je mets sur mon avant bras. je fais de une à cinq claques vigoureuse entre les omoplates. je mets ma main sur,French
+"le côté pour pas taper sa tête. ensuite on retourne toujours sur notre genou. on se bat, on appuie sur mon avant bras",French
+mets la pression sur le genou et là on fait 5 compressions thoraciques. l'idée c'est de faire en effet pistons pour qui recrache le corps étranger. fait,French
+ça jusqu'à ce qu'ils retracent le corps étranger ou ici tombe en arrêt cardio respiratoire. maintenant on va voir l'obstruction,French
+"partielle des voix zaria c'est à dire que la personne va manger quelque chose, mais elle peut quand même respirer. donc là la procédure s'est toujours bien sûr appelé",French
+"les secours, mais voilà mettre la position où elle se sent le mieux, la l'encourager à tousser. pourquoi parce qu en toussant,",French
+elle va pouvoir faire remonter le corps étranger et peut-être le sortir. mais aulas est important bien sûr d'appeler les secours parce que si,French
+jamais elle obstrue totalement la trachée là tu comprends bien que ça peut être là. deuxième geste à savoir on va,French
+parler de la PLS position latérale de sécurité. en fait il y a beaucoup de fois sur intervention chaque fois que j'arrive sur,French
+l'intervention je vois toujours ils les mettent les personnes les met toujours en pls et même si elles sont conscientes tout le temps j'ai l'impression c'est,French
+ouais il un malaise ps. non je vais vous expliquer pourquoi faire une pls. déjà la pls elle s arrête pour une personne qui,French
+est inconsciente mais qui respire. c'est à dire qu'on a bola stimulée par exemple lui dit cérébralement ouvrez les yeux je,French
+"mets des petites claques je sais pas, je la stimule elle réagit pas. donc là ok. on passe à deuxième étape pour voir si elle",French
+respire. la personne respire que ça c'est déjà une bonne chose. et là on voit la mettre en PLS donc sur le côté. pourquoi pour éviter deux choses: pour,French
+éviter est bien d'accord que si elle est allongée si elle vomit elle va s'étouffer avec son vomi parce que le vomi va pas ressortir. et la deuxième,French
+"chose c'est pareil elle est inconsciente donc là il ya plus de réflexes, la langue peut tomber et obstruer les voies",French
+aériennes donc on peut s'étouffer. donc pourquoi on va la mettre sur le côté justement pour éviter ces deux choses aller sur le côté si elle vomit ça va,French
+directement évacués et la langue ne va pas pouvoir tomber. voilà à quoi sert la pls maintenant je vous montre les gestes à effectuer pour faire une bonne pls.,French
+monsieur monsieur serrez-moi les mains ouvrez les yeux. ok personne en conscience. comme cravates ceintures,French
+le col la libération des voies aériennes et là je regarde sur dix secondes qui je vois,French
+risquerait. donc là c'est bon je vois son nom qui se lève. je sens sur main qu'il respire donc là c'est parti le but c'est de mettre sur le côté on va faire une pls,French
+positiol latérale de sécurité. on va mettre son bras à 90° côté retournement ensuite je prends sa paume de ma paume contre paume je l'amène sur,French
+"sa joue. ensuite je lève sa jambe et je bascule la personne sur le côté. ensuite j'enlève ma main, j'ouve sa bouche,",French
+"je continue à mettre sa jambe à 90 degrés, je couvre la victime en attendant les secours et je fais une surveillance",French
+donc je regarde s'il respire. là c'est vraiment les gestes techniques mais ce qui est important à savoir c'est mettez la sur le côté après que le genou,French
+le bras et pas 90 franchement ça c'est pas le plus important. si vous le faites tant mieux pour la personne mais le plus,French
+important c'est vraiment la mettre sur le côté. troisième chose à faire on va parler du massage cardiaque déjà il faut savoir pourquoi effectuer un massage,French
+bien-être ne va pas faire un massage et après quelqu'un qui est conscient le pauvre je pense qu'il va ramasser dans quoi pourquoi effectué un massage,French
+cardiaque on évalue la conscience c'est vraiment l'amour vrai les yeux ok pas de conscience on évalue la respiration sur dix n'ont pas de respiration inconscient,French
+"pas de respiration donc là on va effectuer un massage cardiaque. le but du massage qu'avec ça va être d'appuyer sur la poitrine, et c'est de",French
+faire un effet pistons. pour comprimer le coeur en fête le coeur c'est tout simplement une pompe qui envoie le sang l'oxygène aux organes au cerveau donc en,French
+"effectuant un massage cardiaque justement on alimente les organes, on alimente le cerveau. voilà pourquoi c'est important d'effectuer un massage",French
+cardiaque. on va utiliser bien sûr un dsa dae c'est ce que vous trouvez dans des gymnases dans des mairies défibrillateur semi-automatique,French
+défibrillateur automatique externe là ça c'est exactement la même chose. on a les patchs et à quoi ça va servir en fait?,French
+"comme notre personne est en arrêt cardiaque le coeur qui bat de manière anarchique, un peu n'importe comment. la note des usa notre 2e va nous servir",French
+en fait ce qui va faire ses cuivres envoyer des décharges électriques au coeur pour réinitialiser le coeur comme ça il va recommencer à battre comme il,French
+faut. après si c'est un tracé plat c'est à dire que notre coeur il bat plus malheureusement le dessin va servir à rien et ça on ne sait pas donc c'est,French
+pour ça c'est important de mettre tout de suite ce DSA ce DAE. là j'arrive sur une personne je sais pas il me répond pas donc bonjour madame,French
+serrez-moi les mains ouvrez les yeux j'ai pas de réponse. la vie à l'aide à l'aise. si j'ai mon téléphone portable je peux commencer à appeler le 18 en mettre en,French
+haut-parleur et c'est parti donc code cravates ceintures au tac libération des voies aériennes regardez ma main bien sûr le front,French
+là je regarde toujours sur dix secondes si je dois le ventre qui se lève ou si je sens respiration sur ma joue.,French
+donc là j'ai rien la personne est en arrêt cardio-respiratoire. donc là c'est parti. donc là j'ai toujours soit le 18,French
+"en [...] le but très vite de prévenir les secours, parce que moi je vais entamer le massage cardiaque. donc",French
+là c'est parti donc pour le massage cardiaque on regarde la ligne imaginaire des tétons doigts les coudes sont verrouillées et là le but c'est de faire,French
+un massage cardiaque à peu près cent par minute. donc là j'enchaîne le massage cardiaque,French
+"j'en fais trop de compression si c'est quelqu'un que je connais c'est quelqu'un de ma famille, je peux faire du bouche à bouche donc là le bouchonner et je",French
+souffle deux fois de plus c'est que la cage thoracique se lève donc ça n'est pas obligatoire. c'est quelqu'un vous trouvez dans la rue les vous n'êtes pas,French
+obligé de faire le bouche à bouche vous faites du massage cardiaque non-stop. donc ensuite on va être le petit dsa déférer la theurre semi-automatique donc,French
+ça c'est ce que vous trouvez dans des mairies je vous ai dit dans des gymnases donc déjà il faut que la victime soit sèche. si elle est mouillée il faut,French
+sécher. ensuite il va falloir raser la victime pour que les patches collent bien. si vraiment à des poils en beaucoup de points ensuite c'est simple pour mettre,French
+des patchs vous avez les dessins comme ceci est aussi les dessins pour l'enfant je met en place comme sur le,French
+dessin franchement il n'ya rien de compliqué. tak tak l'idée c'est en fait de faire un diagonale en passant par le,French
+coeur parce que le courant électrique va chercher le chemin le plus facile le plus direct donc là on voit que je suis pas mal là notre courant électrique va,French
+passer au niveau du coeur. puis ensuite c'est ça on a lu et on écoute ce qui nous dit donc bien sûr on l'a jamais le massage cardiaque pas même,French
+si vous mettez les électrodes y en a un qui met les électrons loti continue le massage cardiaque ah si c'est un enfant je les dis peut y avoir une petite,French
+claire pédiatrique qui assure le dsa et le met comme ça le choc électrique sera un peu plus faible. et si un choc est délivré ça va lancer on sait car le but,French
+pour travailler aux urgences pédiatriques il ne suffit pas d'avoir le coeur sur la main il faut aussi l'avoir bien accroché,French
+"nous sommes à Trousseau un des plus grands hôpitaux pour enfants de France au coeur du 12e arrondissement de Paris. ici les urgences sont prises d'assaut, bronchiolite, gastro, entérite, bras cassés,",French
+"simples bobos, épidémies ou maladies graves, le personnel soignant est sur tous les fronts.",French
+"dans les couloirs des urgences, nous avons suivi Aminata, l'aide soignante qui doit décelé dès l'accueil les cas prioritaires. Pierre-Michel l'infirmier qui a toujours un geste tendre pour ses petits patients,",French
+"et Thibault le médecin qui n'arrête jamais, qui sont ceux qui sauvent nos enfants, comment réagissent les petits patients et leurs parents, secrets des coulisses des urgences pédiatriques.",French
+"Hôpital Trousseau à Paris, il est 7 heures du matin.",French
+"Aminata l'aide soignante est prête à monter au front. c'est elle qui accueille les petits patients et leurs parents dès leur arrivée aux urgences. d'accord, vous avez rien donné comme médicament? non j'ai rien donné. c'est la première fois qu'elle",French
+"vient chez nous? elle s'est senti mal, fatiguée, vertige. elle s'appelle comment? Norma. alors qu'est ce qui lui arrive à cette jolie fille? en fait elle est [...] tout se passe ici à l'accueil on a là le",French
+"premier à arriver des enfants, on les voit en premier, les infirmières qui ont des questions, par exemple est-ce que cet enfant je le vois avant l'autre? les voir arriver à prendre la fuite.",French
+"et la priorité ce matin elle vient de tomber. ah lui j'ai pas très bien suivi. une brûlure, d'accord, une brûlure. dans quelques minutes un enfant gravement brûlé va",French
+"arriver avec le SAMU. Aminata part à l'accueillir. bonjour. et ouvrir la salle de déchocage, la salle où sont examinées les cas les plus sérieux.",French
+sa température elle est à combien? Handy 18 mois vient de se brûler le bras au deuxième degré en renversant une casserole d'eau chaude. toute l'équipe,French
+médicale est mobilisée. il est tirs croisés par la maman avec de l'eau. [...] les infirmières doivent rapidement,French
+"évaluer son état. tout ça en gardant leur calme. le cas du petit est inquiétant mais pas question de transmettre le stress à l'enfant et à la maman. le SAMU repart, le cas critique est passé.",French
+"vous avez rien donné à la maison avant? oui du doliprane. vous avez pris du doliprane? c'est moi qui lui a donné le doliprane. c'est vous? et la codéine? c'est moi. merci. l'intervention en salle de déchocage n'aura duré que dix minutes, ici on part au plus rapidement. pour la suite des soir",French
+Handy est transféré dans le service des grands brûlés de l'hôpital. à Trousseau il y a les vraies urgences comme celle-ci et les petits bobos,French
+"c'est maman qui me raconte ou c'est toi? c'est maman. premier recettes pour les traiter rapidement, savoir s'adresser aux enfants comme ici la petite Julia. trois ans. ah trois ans. tu",French
+"vas à l'école? t'es en vacances là? là c'est plus l'école, c'est les vacances. ah c'est bien. ok. alors t'es tombée? papa m'a étendu. éta quoi? étendu? est tordu? t'as tordu le bras?",French
+"julien vient pour ceux qu'on nomme dans le service le coût du manteau un grand classique. mais il a enlevé le manteau, on était dans le métro très serré, elle avait chaud du coup on n'était pas dans",French
+"une position confortable, il a dû il a tiré la manche comme ça le bras peut-être qu'elle n'était pas prête je sais pas ils bradent, et donc il a hurlé et après elle reste. c'est un déplacement des eaux du coude qui va",French
+être réglé en un tour de bras. c'est où t'as mal? c'est au cou ou c'est devant? c'est là. c'est ici? t'as fait mal.,French
+"le médecin ne dit rien, pourtant elle est déjà en train de soigner la petite. t'as fait mal. et en un tour de passe passe, tout est remis en place. Anne la maman est la",French
+première surprise. en fait très certainement le papa quand il a tiré [...] qu'on appelle nous la rotation douloureuse. c'est une la rotation des deux eaux quand on tire dessus il se met pas bien,French
+et puis il suffit juste de les remettre en place pour que. on va voir dans la salle d'attente [...]. t'as plus mal? voilà. une consultation express et c'est une,French
+petite Julia toute très parée qui repart chez elle. ah bah j'ai jamais vu. et je pense qu'on est resté une demi heure peut-être ici.,French
+"à l'accueil les poussettes s'accumulent, nous sommes au début de l'hiver et l'épidémie de bronchiolite, cette infection respiratoire très contagieuse, frappe déjà.",French
+Aminata l'aide soignante porte un masque pour éviter de propager le virus. elle reçoit essentiellement des nourrissons comme Niels un mois,French
+"[...] et vous lui avez donné du doliprane mais votre médecin avait pas donné du doliprane? mais c'est bien de donner des dolipranes, pour moi ça me va. le bébé a une petite",French
+"fièvre, rien d'inquiétant au premier abord. pourtant Aminata l'envoi en priorité auprès de Sylvia l'infirmière. Sylvia suspecte une infection",French
+"urinaire, une des causes les plus fréquentes des fièvres chez les bébés. un bébé stagiaire de ne pas faire de fièvre même si 37 9 c'est plutôt une fébricule donc on va mettre une petite poche qui peuvent marquer",French
+les urines. pour pouvoir les analyser après. pour ne pas être contaminé par un virus,French
+"en salles d'attentes, Niels est mis dans un box à l'écart en attendant un médecin. car pour l'instant ils sont très occupés.",French
+dans la salle de réunion l'équipe de jeunes urgentistes qui a travaillé toute la nuit transmet les dossiers des petits malades aux médecins de jours. les traces sont tirées.,French
+"celui qui prend des notes c'est Thibaut, 33 ans. le pédiatre va travailler pendant 24 heures non-stop de 8 heures ce matin à 8 heures le lendemain matin. et un des patients qu'on lui a transmis c'est Luc,",French
+huit ans. le petit garçon est épileptique. bonjour luc. donc je suis docteur [...] pédiatre. alors j'ai revient sur l'histoire mais je voudrais reprendre petit avec,French
+vous voir tous les élans vous embêtez pas là je suis là.[...] luc est arrivé dans la nuit aux urgences parce qu'il multiplie les convulsions.,French
+"bon et si ça dure dix secondes? beaucoup moins du beaucoup moins de bruit. même pas une minute quoi d'accord. et quand il fait ses crises c'est comme les crises qu'il faisait avant? ah c'est les mêmes. alors c'est quoi ces crises qu'il fait? les crises, les tremblements, comme il pleure en terreur.",French
+d'accord et il bouge un bras ou une jambe un peu comme ça? t'inquiète pas. d'accord il fait ça. d'accord.,French
+[...] et c'est fini toujours avec le cri ou non pas forcément? ah non non non oh la la la la la perfusion non c'est bon là c'est bon.,French
+l'épilepsie c'est un trouble neurologique dont on connaît mal les causes et contre lequel les traitements ne sont pas toujours efficaces. la maman de Luc est impuissante face à la maladie de son fils. il faut rechanger.,French
+"je viens pour trouver un traitement déjà que  [...] et pour lui trouver un traitement adéquat, Thibault va agir en concertation au téléphone avec le",French
+médecin traitant de Luc. les heures là depuis 7h ce matin on a fait trois. dont une devant moi qui dure moins de dix secondes qui sont comme d'habitude voilà j'ai pas j'ai pas modifié à doser,French
+[...] et je n'ai pas baissé [...] en fait voilà. oui voilà c'est l'idée on est d'accord pas de Dilantin. ouais non non on verra d'accord.,French
+"il est hospitalisé? oui hospitalisé, donc a priori en neurologie on a pas assez de place, il ira dans un autre service de l'hôpital où il sera vu de toute façon par le neurologue, c'est pas le souci qu'il soit en neuro [...]",French
+dans le box d'à côté Niels le bébé est venu pour une petite fièvre va être examiné par Diana l'interne.,French
+la piste de l'infection urinaire a été,French
+écartée. pourtant en une heure à peine la santé de Niels s'est dégradée. des marbrures ce sont des traces qu'ils apparaissent sur la peau indiquant que le sang circule mal. Niels a aussi de plus,French
+en plus de mal à respirer. il tousse beaucoup? bah en mangeant.,French
+j'ai dû m'arrêter souvent. dans la nuit c'était plutôt... [...],French
+"le médecin ne veut prendre aucun risque. On va faire le bilan: une prise de sang,on va faire aussi une radio des poumons. ça met deux heures à priori pour les résultats. il faut faire vite car la fièvre chez",French
+"les tout-petits peut monter très brusquement. sur le tableau, Niels au box 2 est passé en orange la couleur des cas prioritaires. aux bureaux des médecins, Thibault a un",French
+sérieux problème. il a beau faire le tour des services. il ne trouve aucune place pour hospitaliser Luc le petit épileptique. en fait on a 0 place pour l'instant. cheryl il est chez nous mais il est transmis aux,French
+seniors. ouais ça va je suis aux portes et je sers compter les places et t'en aura pas ce soir.,French
+voilà on va appeler là on va appeler l'administration. non parce qu'en neuro il y a déjà un problème de l'infirmière. plus ou moins une place. tu tu ah bah tu me tiens au courant parce que,French
+"c'était vraiment une place en plus. appèle-moi parce que c'est vrai que c'est un peu compliqué. le manque de lits est un problème récurrent à l'hôpital. chercher des places, c'est devenu une partie du travail de Thibault.",French
+"là bas ça pose pas de souci sauf que quand il y a des problèmes de d'infirmières qui sont absentes en arrêt maladie, du coup il faut fermer des",French
+"lits sur l'hôpital, mais après le problème c'est que quand il faut garder des patients... Luc et sa maman vont devoir s'armer de patience. voilà. on est là et puis quand est ce qu'on est",French
+passé quant à ce qui est monté. voilà. c'est normal. il faudra deux heures à thibault et l'arrivée d'une infirmière intérimaire en neurologie pour décrocher le Saint Graal. un lit pour Luc ce soir,French
+il dormira à l'étage. les urgences ce sont des coups de stress et des moments bien plus légers.,French
+c'est un sacré doudou. Thomas 8 ans vient d'arriver aux urgences pour des allergies. il doit,French
+faire une prise de sang. et c'est sans doute le seul enfant qui va avec le sourire aux lèvres. tu connaissais le masque ou pas encore? oui je sais trop bien. t'est sûr?,French
+ce masque thomas l'a déjà vu lors d'un précédent passage. parce qu'il se souvient de l'association lui a fait. c'est du protoxyde d'azote qu'on appelle,French
+également gaz hilarant. il atténue la douleur. Thomas ne va pas dormir juste plein nez et avoir des réactions inattendues.,French
+tu sens où sur la lune ou pas encore? oui sur la lune. les effets du gaz se font déjà sentir. l'infirmière va pouvoir travailler. non?,French
+"moi je tiens le masque, ça me dérange pas. en 5 minutes l'opération se termine. Thomas sort de son rêve il est un peu dans les vagues.",French
+si c'est fini. attend. [...] pose la tête. pose la tête [...] ce que peut avoir la tête qui tourne alors je peux te laisser le masque mais sans la bouteille. sans la bouteille.,French
+ça va? ça va mieux? c'est pas votre sac madame? ah si. apparemment les effets sont durables.,French
+plus rien senti. t'as rien senti? ouais. Thibault continue sa tournée des patients.,French
+"Raphaël est arrivé cette nuit aux urgences pour une pneumonie. le médecin surveille heure par heure l'évolution de la maladie. et pour écouter la respiration de Raphaël, Thibault a sa technique. tu vas souffler sur la feuille et faire",French
+comme ça. papa va tenir la feuille et toi tu vas souffler.,French
+c'est mieux on va voir. c'est pas sûr qu'il sorte ce soir. on va voir dans l'après-midi mais c'est pas sûr parce que l'on va voir comment il est. d'accord?,French
+la longue journée d'un médecin aux urgences ne se limite pas à l'auscultation des enfants. il est 13h et plutôt que d'aller manger Thibault s'attaque aux tâches administratives.,French
+"parmi ces activités réjouissante, le codage qui permet de facturer chaque acte médical à la sécurité sociale. j'écris un numéro qui correspond à une pathologie par exemple là il a une pneumopathie",French
+donc j'ai code la pneumopathie. de plus il a un problème neurologique donc je code ce problème neurologique. il avait de la fièvre donc je code de la fièvre. la néphrite je code de la néphrite. voilà si je n'avais codé que la pneumopathie,French
+et tous les autres codes que je n'ai pas mis c'est de l'argent en moins pour l'hôpital. la sécurité sociale rembourse l'hôpital en fonction des codes attribués par les médecins pour chaque patient.,French
+et aux urgences il y a certains actes qui sont plus difficiles à coder que d'autres. Aurélien 22 mois est paniqué.,French
+"même le fameux gaz hilarant n'a aucun effet sur lui, et tout ça à cause d'un drôle de mal, un cheveu étrangle. un cheveu très fin est enroulé autour de",French
+son orteil et en se resserrant il a empêché le sang de circuler. en conséquence il faudra bien désinfecter. ouais ça arrive et ça sans rester bien dans les draps. c'est souvent comme ça. je vais me couper les cheveux.,French
+"non il faut juste bon c'est difficile mais regardez les draps d'utile quand vous allez rentrer regarder s'il y a pas des choses, parce que les cheveux restent en fait. cette pathologie un peu ridicule est peu",French
+"courant aux urgences a pourtant un nom, mais lequel? Aura, je veux juste savoir comment ça s'appelle quand les enfants ils ont un petit cheveu autour des orteils-là? j'ai",French
+"oublié le nom. aussi. toi aussi? Lucy? eh oui une question. quand les enfants ils ont des cheveux au niveau des orteils, comment ça s'appelle? c'est une bonne question. toi aussi.",French
+on va retrouver. le syndrome du tourniquet puisque c'est son nom fait l'événement jusqu'en salle,French
+de pause. ça de frais ça ressemble à une salade de fruits? tu envoie des papiers? super bien comme le dessin. c'est comme ça? comment c'est possible parce que toi tu vas m'expliquer les sens de près j'ai pas tout compris des cheveux. on va exactement. il,French
+"s'enroule autour de l'orteil et puis au début c'est c'est comme si tu avais comment dire... deux plaies. comme si tu avais alors c'est pas trop resserré au début tu vois, mais après ça commence à serrer puis résultat ça fait",French
+"deux petits boudins, et puis de petits boudins s'infectent et elles... deviennent bleues. deviennent bleues et ça fait [...] dans la pièce d'à côté, au bureau des médecins, le cas de Niels le bébé atteint de fièvre fait débat. deux écoles. à",French
+"droite celles qui sont pour l'examen approfondi et à gauche celle qui l'aurait déjà renvoyé chez lui. Moi, je ne le garde pas. Un mois? Moi je ne le garde pas. Tu ne l'aurais même pas surveillé? on n'est même pas à douze heures de fièvre.",French
+"s'il va parfaitement bien... ou on peut le garder jusqu'en fin de journée? on peut attendre la température? attends! 37,9? oui! j'avais l'impression de... oui, c'est pour ça que,",French
+"par précaution, on fait le bilan. par précaution, on va le surveiller un petit peu plus longtemps. Par précaution, on va le re-convoquer demain. mais, tu vois...",French
+l'enquète des médecins piétines elle n'arrive pas à établir un diagnostic. c'est donc accompagné d'un pédiatre titulaire que Diana l'interne retourne,French
+ausculter Niels. [...] mais ce que l'on me dit on va rien ne m'est venu à tenir. bonjour.,French
+"Niels se va mieux. les résultats sont tombés. ses radios des poumons toutes comme sa prise de sang sont normaux. mieux, sa température a baissé.",French
+"ce qu'on va faire, c'est qu'on va re-contrôler la prise de sang en fin de soirée, à douze heures, vers 21h30. si d'ici là, il n'a pas eu de la température,",French
+"pas plus de 38, et que la prise de sang est toujours très bien, vous rentrerez à la maison. ça a l'air mieux madame? oui, déjà de pas être toute seule. on a des mauvais souvenirs ici, alors...",French
+"Mode est une habituée de trousseaux. sa fille aînée il a été hospitalisé plusieurs fois, mais cet après midi la maman Denise il se retrouve le sourire, son fils a de grandes chances de pouvoir sortir ce soir.",French
+"aux urgences pour tromper l'ennui, l'astuce c'est Marie Paule et sa collègue Françoise, les deux grands mères sont bénévoles pour l'association ""Main dans la main"" une fois par semaine elles organisent des jeux de société dans la",French
+j'aime bien les verts.,French
+"c'est quoi mon rôle? et bien justement voyez c'est de donner des jeux aux enfants pour tout se calme, alors on essaie d'en donner à tout le monde pour qu'il ne passe pas et puis",French
+vont parler un peu avec les parents quand c'est vraiment trop long on parle un peu avec les parents aussi parce que c'est vrai qu'il fasse deux trois quatre heures ici. c'est quand même assez long. Marie Paule et bénévole depuis dix ans. si cette ancienne assistante commerciale,French
+a choisi les urgences c'est pour combattre le blues de la retraite. c'est l'activité. c'est pour rester en mouvement le monde parce que bon bah quand on est,French
+"à la retraite on voit pas beaucoup de monde, on n'est plus dans la vie sociale, et là bas on voit ah voit des gens on voit le service médical on voit tout ça donc c'est pour moi c'est intéressant.",French
+et même à l'hôpital ces réflexes de grands mères ne sont jamais très loin. là bas? faites attention aux canes parce que vous en avez déjà cassé les jambes.,French
+"alors il faut pas faire ça, attention. aux urgences près de 80 médecins et infirmiers se relaient pour soigner les patients.",French
+"il y a alors qu'Aminata termine sa journée. Pierre-Michel, l'infirmier de nuit commence la sienne.",French
+"bienvenue dans l'antre. l'autonomie. le fait qu'ils aient beaucoup moins de personnel, on travaille beaucoup plus ans",French
+"en équipe de toute façon même de jour mais disons que là l'équipe est beaucoup plus soudé je peux profiter quand même donner d'enfant pleinement, je les vois, je m'en occupe et et j'ai pas mal on a des jours de",French
+"repos effectivement même si on travaille en 10 heures, cette semaine on va faire 50 heures, la semaine prochaine ses petites semaines on en fait 20, donc du coup ça nous donne quand même du",French
+"temps libre, ils permettent de faire des activités avec la famille. Thibault lui continue sa course effrénée.",French
+"apparemment la nuit s'annonce corsée. prendre une minute pour prendre des forces avant, il aurait commencé.",French
+"là depuis 8 heures ce matin, on a commencé à la garde avec quatre places qui restent au lit porte, plus de place en hospitalisation, et a priori on a j'ai plein j'ai encore des enfants",French
+"hospitalisés et j'ai pas de place pour l'instant. on va refaire le point d'ici une heure, donc voilà. c'est pas trop stressant? un peu. c'est c'est stressant oui en garde mais après on aime bien on",French
+aime ça aussi. si c'était un stress paralysant ben je l'aurais arrêté je ferai autre chose. et justement Thibault va être servi en termes de stress. venez? ah un des deux,French
+"Santiago a 19 mois. il est originaire du Chili et parte des vacances en france en famille, mais sa première visite à Paris elle est aux urgences de Trousseau. il n'est pas allergique à des médicaments? non. allergie?",French
+aliments? pas d'allergie? alimento? non. il prend pas de médicaments de façon chronique? et il n'a jamais fait d'asthme? le petit garçon souffre justement d'une,French
+crise d'asthme. son état de santé est inquiétant. mais Thibault a à peine le temps de l'ausculter qu'un autre cas grave se présente en salle de déchocage.,French
+bonjour madame vous êtes la maman? je suis docteur [...] de garde. cette petite fille n'est que deux semaines. et elle en est déjà à sa deuxième bronchiolite. elle consulte pour... une gène. elle a été,French
+hospitalisée pour une bronchiolite c'est ça? d'accord. et là elle finira en temps? elle a eu les lèvres bleues? elle a eu les lèvres bleues madame? je vous pose plein de questions c'est pour,French
+savoir elle a eu les... comment? essaie une donnée et ça c'est pas grave ça. ça vous inquiétez pas. Thibault est débordé.,French
+[...] ils viennent tous en même temps. positionnement? non mais là ça devient n'importe quoi là. comment.,French
+c'est l'effervescence dans les couloirs. la salle d'attenté ne désemplit pas. Thibault doit gérer une vingtaine d'enfants en même temps.,French
+sans compter les parents à patients. on est plus vite on arrête pas. il y a trois médecins pour 150 passages donc voilà. on essaie d'aller au plus vite.,French
+un moment que Mode sa maman appréhende. on va être obligé de le repiquer.,French
+"le problème c'est que les veines de Niels sont très fragiles. pour obtenir la quantité de sang nécessaire, il faut s'y prendre à plusieurs fois, et dans différents endroits du corps.",French
+Mode est une bonne mère. vous allez encore le piquer?,French
+"au bout de la quatrième tentative, la prise de sang est réussi. résultat dans deux heures.",French
+la nuit s'est installé sur Trousseau. dans les couloirs la tension retombe.,French
+"tout est bon pour tuer le temps. faire des bulles, ou raconter une petite histoire. ça y est le guignol va commencer son",French
+numéro. c'est ce qu'il dise. foutu mais quel pays qu'il faut tu me paie. mets quel pays quel ou là là c'est demain enjeux sur tout le corps le corps enfin il devient,French
+avoir un peu maintenant ma pharmacie ou là ou là où. mais la pause n'aura été que de courte durée. les enfants touchés par l'épidémie de bronchiolite affluent. Pierre Michel,French
+d'appareiller des urgences. arrête. ses urgences graves parfois vitales sont le lot quotidien de Pierre,French
+David va vivre un week-end d'astreinte qui va mettre toute son expérience à l'épreuve. ça lui sauve la jambe au patient. ce fonds ne sais pas il peut perdre sa jambe dont il faut que ça marche. il va devoir sauver le genou d'un jeune homme explosé par un coup de,French
+fusil. Emilie est en septième semestre de gynécologie obstétrique. au cours d'une garde elle va prendre en charge un accouchement par césarienne qui ne se,French
+présentent pas très bien. [...] elle va mettre toute son énergie pour sortir l'enfant du ventre de sa mère. le flux important de patients difficiles va finir par mettre Paul en difficulté.,French
+"doit garder son calme, pas facile après autant d'heures de travail. vous avez mal où là? hein?",French
+d'un hématome. pour écarter la fracture la jeune femme est immédiatement dirigé vers le service de radiologie. sous bonne escorte. Paul c'est des patients pas très facile. pour coffrer surtout à cette heure-là.,French
+mais pourtant il faut quoi garder son calme. il faut être rigoureuse que c'est à ce moment c'est à cette heure-là de la nuit qu'on loupe des trucs. c'est à dire? c'est trop facile de louper un petit fracturé un petit patient qui va pas bien,French
+en scan crâne qu'on aurait dû faire les communs comme ça. douleur cheville malléole ext douleur en genoux.,French
+"une demie-heure plus tard, Paul peut vérifier son diagnostic. une simple entorse, et pas de fracture. elle s'en va.",French
+allez salut tout le monde. bye bye. cela fait déjà douze heures que Paul enchaîne la prise en charge des patients sans vraiment faire de pause.,French
+oh putain ça glisse. bon va falloir rentrer en scooter maintenant. il y a combien combien il gare là.  croyons à 6 7 cm.,French
+quelle horreur. c'est sûr c'est une bougie un peu glauque je sais pas si je vais la garder très longtemps hein. il est plus de minuit Paul peut enfin rentrer chez lui mais arrivera-t-il,French
+"encore longtemps à tenir ce rythme infernal? un dimanche matin sur le parking de l'hôpital de la Conception, David vient",French
+"d'être appelé par Pierre, son interne. on peut rien prévoir le week-end quand on ne garde. ce qui avait plein son dont le pote blanche. plusieurs urgences l'attendent au bloc opératoire.",French
+"allez c'est bon. bonjour bonjour ça va je suis pas trop en retard? raconte moi un peu Pierre. c'est une plaie par quoi tu m'as dit? par verre, en ouvrant une bouteille.",French
+"une plaie sans gravité pour ce premier patient Justin est à  recoudre, un travail très accessible pour Pierre. mais un coup de fil d'un autre service de",French
+"l'hôpital va troubler cette quiétude du moment. Pierre, il y a eu 4 autres personnes qui sont parties de là.",French
+"je vais le revoir, je vais le voir. tu vas continuer tout seul. pas une seconde à perdre, David doit très vite évaluer la gravité de cette nouvelle urgence.",French
+"c'est une patiente qui est pas à moi qui est hospitalisée dans un service et qui fait une hémorragie, qui a été vue ce matin qui n'était pas",French
+dans un état critique et puis là il s'aggrave considérablement donc on est obligé de l'in de l'interférer de le mettre entre deux patients en bloc. bonjour. bonjour. je suis venu voir ce,French
+"monsieur. je fais un ticket. oui je vais le prendre. absolument. il faut le reprendre il faut vite le reprendre. le reprendre, cela signifie que",French
+David doit le réopéré. ça me saoule parce que je pense que ce matin et les internes auraient dû être interpellés et il aurait dû me le dire avant. David n'est pas très content des internes,French
+"de ce service. à cause d'une mauvaise évaluation, ce patient qui présente une hémorragie importante est maintenant en danger. une urgence qui va bouleverser cette journée qui paraissait pourtant assez calme. Pierre hier soir et ce n'est",French
+"pas comme ça le patient? mais hier soir, j'étais pas là, moi. voilà vu le dos qu'il a ça date pas de cinq minutes son hémorragie. pas le temps de souffler pour David. [...] il doit très vite se",French
+reconcentrer pour superviser le travail de Pierre. une fin d'opération troublée par l'anesthésiste de garde. il vient de juste prendre sa brioche sortie,French
+"déjourner, le monsieur [...] allez il est très urgent. qu'il verse agence clément. je sais c'est pas toi je sais que c'est pas toi. je suis désolé mais c'est toi qui est présente",French
+je ne prends pas mal à trouver matière à ce disque. je veux pas prendre de risque de lui faire une réduction [...],French
+que là c'est le bordel là je suis désolé. la situation se complique pour David son patient qui souffre d'un hématome aurait,French
+dû rester à jeun au moins six heures avant de se faire opérer. une précaution pour éviter qu'il ne régurgite des aliments directement vers ses poumons pendant l'anesthésié générale. un risque d' asphyxie que l'anesthésiste et David,French
+"ne peuvent pas prendre. comme partout ça arrive que des coups de gueule, ne faut pas oublier qu'on a la vie de patient entre les mains donc bien sûr l'attention on a l'air détendu on rigole d'entre nous, mais la pression et attention il existe quand même et puis",French
+c'est parce que surtout on s'inquiète des patients quoi. David et Pierre n'ont plus qu'à attendre le feu vert de l'anesthésiste pour intervenir. mais une nouvelle urgence va de nouveau compliquer cette journée.,French
+"les pompiers amènent un jeune patient. cette nuit dans un bar, un homme lui a tiré dessus. petite reconstruction de jambes, du dimanche après midi. donne moi des compresses? la tête j'ai fait un exposé l'inflation.",French
+"ça s'est passé quand? s'est passé cette nuit hein? bon c'est sans doute une histoire de trafic de drogue ou un truc comme ça encore. ah il nous a dit. et je ne comprends pas pourquoir, d'un coup j'ai mal au genou. et j'ai regardé, et hop! je m'étais pris une balle.",French
+"c'est toujours ça. sur la radio, des dizaines de petits points blancs, des plombs de chevrotine ont fait exploser le genou de ce jeune",French
+patient. on a un gros trou dans le dans la peau avec l'os qui est parti en miettes. regarde c'est vraiment de la petite grenaille.,French
+un par un David va récolter quelques plombs qui vont peut-être aidé les policiers à retrouver l'auteur du coup de feu. ah non c'est non c'est pas possible,French
+"d'enlever tous les plombs parce qu'il ya plein de petites grenailles qui partent dans tout le tissu de la jambe ce qui est important. c'est que ça ça affecte pas? à vie, il va garder ses plombs. mais il y a plus important. pour que le jeune homme",French
+"puisse remarcher normalement un jour, il faut maintenant reconstruire son genou. donc de gens à retrouver le nerf le plus important de la jambe qui n'a pas été traumatisé... ce qui est bien pour lui.",French
+"très bien. David va mettre toute son expérience pour réaliser cette délicate intervention. je ne décolère plus ma pauvre encore. ça, on va le couper aussi.  une intervention qui se termine",French
+par une greffe de peau. c'est manifique ça! et le patient comme ça va parfaitement bien cicatrisé? quasiment aucune conséquence motrices.,French
+"ça me va. en un peu plus d'une heure David et Pierre ont sauvé le genou de ce patient. une petite victoire qui va faire du bien à David, car sa journée est loin d'être",French
+terminée. je sens que j'ai passé une bonne partie de la journée ici. il y a des chances son patient qui présente un hématome n'a toujours pas digéré son petit déjeuner.,French
+impossible de l'opérer donc. un contretemps qui va finir par accentuer encore un peu plus la fatigue de David.,French
+"une fois par mois, Emilie quitte son service de gynécologie pour celui de l'obstétrique. il est 18 heures. c'est le",French
+début de sa garde. emilie profite d'un moment de calme pour revoir ses fiches. un moyen de se rassurer. ici plus qu'ailleurs elle n'aura pas le droit de,French
+faire la moindre erreur. cédric c'est toujours stressant parce que c'est un peu vite vite aller très mal. quand ça se passe bien ça se passe bien mais quand ça se passe mal ça peut,French
+"vite allez, donc très très mal. c'est impressionnant imprévisible stressant... faut être réactif et c'est la spécialité où je pense fonce à la minute près et que ça compte donc voilà.",French
+"cette angoisse qui monte, Emilie a besoin de la partager avec un senior du service. elle a l'air impatient d'avoir un premier extraction et en même temps je mets mon temps en temps, mais non. c'est normal je me dis que c'est comme le vello. c'est normal que tu soies un peu stressée. quand c'est la première garde que tu reprends en obstétrique. en plus c'est calme. T'as pas de raion de...",French
+j'ai même peur de refaire les coudres. les coudres tf1 maîtrise tant d'ardeur quand j'en ai pas fait pire. peut-être un moment de plaire. mais dire boutons.,French
+"habitants c'est vrai six ou... j'ai sept le faire mais. ben là, tu vas avoir l'occasion. tu mets doucement en bain. c'est pas trop agité ce soir. c'est ça. en effet Emilie va devoir très vite retrouver la mémoire. une patiente",French
+"enceinte de huit mois vient d'arriver aux urgences. et vous sentez moins bouger depuis quand et où? ben, hier soir. hier soir. cette femme angoisse terriblement pour son enfant qui ne",French
+bouge plus depuis presque 24 heures. Emilie doit très rapidement la rassurer ainsi que son mari.,French
+Emilie va mettre quelques minutes à retrouver le bon fonctionnement de l'échographe. le bébé a la tête en bas... et annoncer la bonne nouvelle à sa patiente. ah elle bouge bien.,French
+"c'est complètement tournée. bon ça me rassure. vous sentez bien bouger? c'est pour ça... d'habitude elle bouge comme ça. qui le stimule, en tout cas, c'est un foetus. tout va bien Emilie va",French
+"pouvoir s'entraîner à prendre des mesures. elle se laisse pas bien faire. et estimer le poids du bébé. elle est coriace toujours. il n'y a pas que moi qui ait un sens. je me disais bon, je suis peut-être pas très doué mais j'arrive pas à voir.",French
+plus imagine. mais je pense qu'elle mesure quelque chose... se trame un peu quand même. j'ai pas... le bébé n'était pas lucien aussi pour lui même mais bon déjà voilà j'essaie de,French
+retrouver mes repères de refaire sur les boutons d'échographes. Emilie aura le reste de la nuit pour retrouver ses réflexes et reprendre confiance en elle.,French
+"j'ai l'impression d'être à l'ouest. ça va revenir. elle va devoir faire vite, un accouchement en urgence va nécessiter son intervention.",French
+"faculté de médecine, un peu avant 9 heures. cela fait plus de dix ans qu'Hayatte attend cette journée. bonjour la salle pour les thèses s'il vous plaît.",French
+la salle des thèses oui. on n'a pas de loge pour ça. la salle des thèses. M 47. M47? vous montez là. vous les suivez,French
+si Hayatte est si tendue c'est que dans quelques secondes toute sa carrière va se jouer dans cette pièce. pendant 15 minutes et pas une seconde de plus son travail va être décortiqué et jugé par,French
+"fait le voyage pour l'encourager. contre sociale. je vous remercie pour votre attention. il y a du travail, la présentation était de bonne qualité. la mission est remplie. malgré le stress est",French
+"probité. je respecterai toutes les personnes, leur autonomie et leur volonté sans aucune discrimination selon leur état ou leurs convictions. même sous la contrainte, je ne ferait pas usage de méconnaissance",French
+merci beaucoup jour y est. voilà. même faire une journée à vous. au revoir. Jean aborde,French
+triangulaire comme ça. là quand on touche effectivement on sent bien la bosse qui est à l'avant du crâne qui défend son front. si on ne le perd pas le cerveau d'Alexis n'aura pas la place nécessaire pour se développer normalement dans son,French
+"théorie, ce n'est pas lui qui va s'occuper de la pratique. un senior va s'en charger mais pas n'importe lequel. c'est le spécialiste pour toute la région Bretagne. une aubaine pour Jean",French
+qui est régulièrement à ses côtés. il veut profiter le plus possible de son expérience. donc il faut qu'on lui fasse deux bosses frontales. et qu'on lui écarte les yeux. évidemment c'est pas compliqué.,French
+"on va faire l'infiltration. pour réduire les risques d'hémorragie lors de l'ouverture du crâne, le senior va injecter un produit un peu particulier, un mélange d'adrénaline et de xylocaïne, un mélange qu'il faut",French
+continuer d'apprendre une chirurgie qui le passionne. aujourd'hui ce qui est très intéressant parce que l'on doit anticiper comment le crâne va se reformer et pour que les...,French
+"il a à nouveau un crâne biarrot est pas complètement déformés, c'est intéressant qui intéresse en pédiatrie aussi parce qu'il faut anticiper un résultat qu'on verra que dans 10 20 ans quoi. bien de savoir faire pareil.",French
+"c'est beau là. moins de trois heures. comme quoi, il a été bon. il m'a bien aidé. j'ai été plus vite que d'habitude grâce à lui. un bon quart d'heure de moins. vous",French
+"rigolez mais [...] plus c'est rapide, moins ça saigne. je sais pas si j'ai passé un quart d'heure on verra sur la répétition des",French
+"interventions si je fais vraiment gagner un quart d'heure. ça devrait bien se passer pour lui, je crois. faut pas trop le dire, mais il fait des bons débuts.",French
+l'opération est une réussite totale. quelques semaines plus tard Alexis rentrera chez lui avec un crâne remodelé. un crâne qui va aujourd'hui permettre à son cerveau de se développer,French
+normalement comme tous les autres petits garçons de son âge. début de journée aux urgences pour Paul. j'ai pas du tout du tout du tout du tout,French
+Paul exprime un certain mal de vivre. une souffrance qui le ronge de l'intérieur. la cause: le rythme impitoyable imposé par les urgences et la multiplication de patients agités qu'il faut prendre en,French
+"rôle c'était voilà en essayant de l'examiner brièvement en regardant un petit peu ce qui m'intéresse c'est au niveau du ventre, au niveau des poumons, en regardant un petit peu ses jambes voilà ce qui m'intéressait voir qui est pas de",French
+"gros soucis somatique. a priori non il faut que j'aille revoir sa prise de sang, revoir son scanner cérébral qui l'a eu. le scanner cérébral ne montrera rien de bien inquiétant. Paul",French
+"a donc écarté d'urgence médicale. mais compte tenu du comportement très agité de son patient, il va demander à l'équipe de l'immobiliser et l'isoler pour sa propre sécurité. comme à chaque fois, dans pareil cas",French
+"l'homme doit maintenant être évalué par un psychiatre une fois calmé. l'équipe va administrer des sédatifs à ce patient, mais pendant de longues minutes il va falloir supporter ses cris",French
+"dans tout le service. la porte du box doit rester ouverte, c'est le moyen le plus efficace de suivre à distance l'évolution de l'état de conscience du patient, et qui permet à",French
+"toute l'équipe peut continuer de gérer les urgences qui arrivent sans cesse. un moyen efficace mais qui peut devenir à la longue un peu pesant pour tout le service, surtout pour Paul qui est déjà bien épuisé nerveusement.",French
+"dimanche 17 heures retour à l'hôpital de la Conception, le patient de David qui souffre d'une grave hémorragie peut maintenant passer au bloc. il a enfin digéré son petit déjeuner. l'anesthésié",French
+générale est donc possible. comme ça. au départ cet homme est venu aux urgences suite à un accident de scooter au niveau de son mollet. un mollet totalement déchiqueté qu'il a fallu,French
+reconstruire avec des muscles prélevés dans son dos. on peut l'ouvrir juste pour regarder? qu'il ne fasse pas un hématome sous le lambeau aussi. c'est pas exclu. le mollet de ce patient va bien. aucun,French
+"saignement à l'horizon de ce côté là. mais après quatre heures d'attentes le petit hématome du départ a pris des proportions inquiétantes dans son dos. il faut maintenant intervenir d'urgence, la",French
+vie de ce patient est en danger. c'est la quatrième intervention au bloc pour David aujourd'hui. donc vers la fatigue commence à se faire sentir. car aussi fatigué.,French
+jamais fatigué. c'est interdit de dire quand même fatigué on nous traite de petite [...] si on nous dit qu'on se dit qu'on est fatigué. bon allez-y. si ça peut être la dernière de la journée ce,French
+"serait bien. a mon avis, non... cinq heures c'est encore tôt hein, on est de garde jusqu'à demain à 8h30 donc... sachant que demain à 8h30 c'est une journée normale on enchaîne.",French
+"voilà l'aspiration et le bistouri sont branchés. première étape, David doit évacuer toute la quantité de sang emprisonné sous la cicatrice. tu peux mettre encore plus",French
+"en lumière si tu plaît? qu'on voit où ça saigne. la deuxième urgence, trouver l'origine de l'hémorragie et l'état de fatigue de David ne va pas l'aider.",French
+il n'y a rien d'évident. là je ne vois rien qui saigne. j'aimerai pas qu'on y retourne après. je n'ai pas envie de le ré-opérer cette nuit encore. c'est des vaisseaux qui saignent bien peu après colmatée par les matins il se met à s'arrêter [...],French
+"après il retrouve plus. il n'y a pas un truc qui saigne quand même? ça me fatigue ça. au fond, il y a un truc. david a fini par trouver le vaisseau responsable. là! un petit truc là. c'est la fin de l'opération.",French
+"Marcel, tu peux les passer deux agrafes [...] reste à refermer la plaie avec quelques agrafes, un geste assez simple que David a réalisé des milliers de fois.",French
+"on s'en fout [...] fait exceptionnel, David ne va pas finir l'opération. épuisé par ses heures enchaîné au bloc il passe la main à Pierre, son interne.",French
+"et bandol surveille quoi qu'on en foulant? l'hémorragie? dans le bloc, une patiente est arrivée à terme de sa grossesse. mais le rythme cardiaque de son bébé présente depuis quelques",French
+"minutes des anomalies importantes. problème, son col de l'utérus n'est pas assez ouvert pour permettre de sortir un enfant immédiatement par voie basse. cette Emilie qui réalise cette césarienne d'urgence sous le contrôle de",French
+"tout le personnel du bloc peut enfin se détendre, à commencer par le chef d' Emilie. tout nickel. tout bien passé. on n'a pas fait d'erreur aujourd'hui.",French
+je lance donc aujourd'hui cette nouvelle série de vidéos avec un scientifique dont le nom vous dit peut-être quelque chose,French
+"monsieur Yohann Gregor Mendel. Mendel c'est tout simplement le premier scientifique au 19e siècle à avoir compris la transmission des gènes,",French
+le début de la génétique tout ça en observant des plans de petits pois. plutôt pas mal ah? avant toute chose pour bien comprendre,French
+cette vidéo je vous renvoie vers une vidéo plus classique sur la cellule humaine je vous conseille de l'avoir déjà au minimum regarder et comprises ça va vous,French
+aider pour comprendre quelques notions que je vais aborder ici dans la vidéo. mais tu épouses ici partait sur la prochaine et on se retrouve dans quelques minutes,French
+c'est bon vous avez regardé la vidéo on peut y aller allez c'est parti juste après le générique pour la première capsule d'histoire,French
+Yohann Mendel nait le 20 juillet 1822 à Heizendorf. à l'époque ce territoire appartient à la silésie autrichienne.,French
+plus tard pendant la vie de Mendel ce territoire sera rattachée à l'empiré austro hongrois. à l'époque actuelle il se situe en république tchèque. pour,French
+vous donner une idée sur l'époque en 1822 on est trente trois ans après la révolution française. c'est l'année où Champollion parvient enfin à décrypter,French
+"les hiéroglyphes grâce à la fameuse pierre de rosette. c'est également l'année de naissance de Pasteur, grand scientifique connu pour avoir mis au point entre autres le",French
+"vaccin de la rage. en 1820 de l'espérance de vie n'atteint même pas les 50 ans, il existe en effet de nombreuses maladies infantiles pour lesquels il n'y a pas de",French
+"traitement, il ya donc de nombreuses pertes chez les jeunes enfants. Yohann a trois soeurs il est le seul garçon de la famille. son père anton gère la ferme familiale comme",French
+ça se faisait beaucoup à l'époque et sa mère Rosina est la fille d'un célèbre jardinier qui à l'époque déjà s'occuper des familles riches. parmi ses trois,French
+soeurs seule une rosina qui porte le même nom que sa maman parviendra à atteindre une espérance de vie plus ou moins correct pour l'époque et décédera,French
+"à l'âge de 40 ans. en 1822 on est plus de cent ans avant la découverte des antibiotiques, la moindre blessure peut causer une mort",French
+dans d'atroces souffrances. pour un agriculteur comme le père de Mendel un simple coup de fourche mal placé et une entaille dans le gros orteil peut,French
+"provoquer la mort par septicémie très rapidement. Yohann Mendel est envoyé à l'école qu'il réussit brillamment, et il est encouragé par ses professeurs à",French
+"poursuivre ses études à l'université. malheureusement son père tombe gravement malade au cours de ses études, et la ferme étant la principale source de",French
+rentrées financières à l'époque. la famille ne dispose plus d'assez de rentrer donc plus assez d'argent pour envoyer johan à l'université.,French
+Mendel entre donc au monastère pour devenir moine car il a bon espoir que le monastère puisse financer ses frais de scolarité.,French
+c'était monnaie courante à l'époque que les moines sont envoyés dans les écoles aux frais du monastère. Mendel entre donc en tant que moine au monastère,French
+de Brunn qui est déjà à l'époque un haut lieu de la recherche scientifique. les moines s'intéressent en effet fortement à la transmission des,French
+caractères génétiques héréditaires. dès le début de sa vie de moine au monastère Mendel s'intéressent fortement aux sciences naturelles. il entame un,French
+cursus en agriculture et en viticulture. en 1851 Mendel peut assister à des cours à l'université de Vienne. il y étudie,French
+diverses sciences parmi lesquels la botanique les mathématiques la physique et les sciences naturelles. il assiste également à des cours donnés,French
+"par un grand scientifique de l'époque est passionné par la transmission des caractères héréditaires chez les végétaux, monsieur Franz Unger. en 1854",French
+Mendel retourne dans son monastère avec une bonne formation pour devenir professeur de sciences. et en parallèle de son activité de professeur il,French
+"s'intéresse fortement à la production de plantes hybrides en utilisant les plantes qui sont cultivés à l'époque dans le monastère, les pois. ses études sur",French
+les pois seront au coeur de toutes ses expériences et lui permettront d'éditer des fameuses lois de Mendel dont nous parlerons dans le chapitre prochain.,French
+après avoir étudié les points Mendel va même s'intéresser à l'hybridation et à la reproduction chez les souris mais il sera rapidement,French
+rappelés à l'ordre car l'élevage de souris qu'il fait dans sa propre chambre pose des problèmes de propreté au monastère. en 1865,French
+Mendel publié les premiers résultats de ces études que l'on appellera plus tard les lois de Mendel. et à la même époque il est bombardé responsable du monastère,French
+dans lequel il vit depuis longtemps. ses nouvelles responsabilités l'éloignent un petit peu de ses études et de ses recherches.,French
+on connaît à l'heure actuelle Mendel surtout pour ses fameuses lois de Mendel sur la génétique mais c'était en réalité un très grand scientifique qui a,French
+"travaillé sur énormément d'autres sujets parmi lesquels l'horticulture, l'apiculture et surtout à l'époque la météorologie. le 6 janvier 1884 Mendel",French
+"décède des suites d'une insuffisance rénale il sera enterré à Brno, la ville dans laquelle il a résidé dans le monastère.",French
+quelques jours après son décès son successeur à la tête du monastère brûle l'entièreté de ses archives. on est décidément peu de choses. Mendel a,French
+été très apprécié dans sa communauté et surtout reconnu pour ses travaux en météorologie. à l'époque ses recherches sur la,French
+"génétique et la transmission des caractères héréditaires passe relativement inaperçue, relativement inaperçue jusqu'au début du 20e siècle",French
+où ses découvertes sont en fait redécouverte et loups ont défini des fameuses lois de Mendel. toujours à l'époque actuelle,French
+on parle de transmission Mendélienne pour de nombreux caractères génétiques transmis par les chromosomes. je vous place ici autour de moi quelques liens,French
+vers des vidéos déjà réalisées sur des sujets équivalent qui pourrait vous intéresser avant d'aborder le prochain chapitre.,French
+avant de réellement aborder les expériences de Mendel il est très important de comprendre le principe de gènes dominants et de gènes récessifs.,French
+"chaque cellule possède en réalité deux copies d'un même gène, une copie transmise par le père et une copie transmise par la mère au cours de la",French
+reproduction lors d'un processus que l'on appelle la méiose. je n'ai pas encore réalisé de vidéos sur ce sujet mais si ça vous,French
+intéresse n'hésitez pas à me le signaler en commentaire et on en parlera très rapidement sur cette chaîne dans une capsule médicale. ces gènes sont en,French
+réalité des informations transmises sous forme d'ADN qui contiennent des informations sur l'être qui le composent dans l'exemple des pois utilisés par,French
+Mendel dont nous allons parler tout de suite nous parlons de la transmission du gène qui donne la couleur des fleurs des plantes.,French
+cette information a été obtenue par Mendel sans même en connaître la notion de gênes ou même d'ADN simplement par l'observation. la couleur des fleurs des,French
+plantes des pois est transmise depuis des parents vers leurs enfants de façon génétique mais ça Mendel ne le savait pas encore. parmi ces gènes qui sont,French
+transmis certains sont dits dominant et d'autres sont dits récessifs. lorsque la plante possède deux copies d'un même gène soit le dominant deux fois soit le,French
+récessif deux fois elle va exprimer la couleur qui est transmise par le gène en question. par contre lorsqu'une plante possède une copie de chaque gène donc,French
+une copie du gène dominant et une copie du gène récessif c'est la couleur du gènes dominants qui sera exprimée et le gène récessif sera,French
+réprimé. la plante sera donc de la couleur du gène dominant uniquement. dans sa première expérience Mendel à réaliser des croisements entre,French
+deux familles de plantes. la première possédait des fleurs exclusivement mauve et l'autre possédait des fleurs exclusivement blanche.,French
+les plantes utilisées venaient de familles de lignées pures ceci veut dire simplement que tous les parents de toutes les plantes utilisées avait,French
+exclusivement des fleurs de la même couleur. on peut donc déduire de ceux ci que toutes les plantes posséder deux gènes,French
+exactement les mêmes depuis plusieurs générations. lors de la première expérience de croisement entre les lignées pures de fleurs mauves et les lignées pures de,French
+"plantes à fleurs blanches le résultat obtenu est sans appel, toutes les fleurs sans exception sont de couleur mauve, tout 100% pas une seule",French
+fleur blanche parmi les filles. Mendel va donc réaliser une nouvelle expérience en reprenant les plantes obtenues sur cette deuxième génération,French
+qui sont donc tout à fleurs mauves. il va à nouveau les croiser entre elles et il obtient alors des résultats intéressants sur les nouvelles plantes obtenu trois,French
+sur quatre ont des fleurs mauves mais une plante sur quatre ou 25% des plantes a à nouveau des fleurs blanches alors que ses deux parents avaient des,French
+reprendre les différents plantes et je vais vous notez à côté les gènes qui les ont transmis. la plante de couleur mauve possède deux copies de son gène de,French
+couleur mauve que l'on nomme A majuscule ici par convention on utilise la majuscule pour exprimer le caractère dominant du gène la plante de couleur,French
+blanche possède deux copies de son gène de couleurs que l'on nomme a minuscule. on utilise ici la minuscule pour exprimer le caractère récessif du gène.,French
+comme chacune des plantes parente en transmet à une plante enfante l'un de ces gènes de façon aléatoire et comme on connaît par définition les deux copies,French
+des gènes de chaque parent on peut en déterminer que chaque plant enfant reçoit un gène A majuscule et un gène a minuscule. ainsi la plante enfant possède,French
+une copie de gènes dominants et une copie du gène récessif. et c'est donc le gènes dominants qui est exprimé. la plante obtenue après la première,French
+"génération est de couleur mauve. et puis lorsqu'on reproduit à nouveau ces plantes entre elles, chaque plante transmet à son tour l'un",French
+de ces gènes à ses descendants. ainsi une distribution statistique s'établit. comme chacune des plantes transmet soit un gène,French
+"A majuscule soit un gène a minuscule, on se retrouve au final avec 25% des plantes qui possède les gènes A",French
+"majuscule A majuscule, 25 % des plantes qui possèdent les gènes A majuscule a minuscule, 25 % des plantes qui possède",French
+les gènes a minuscule A majuscule et 25% des plantes qui possède les gènes a minuscule a minuscule. dans le cas des,French
+plantes qui possèdent au moins une copie du gène a majuscule la couleur mauve et donc exprimée car dominante. pour les plantes qui possède les deux gènes,French
+récessifs un minuscule un minuscule la couleur blanche est retrouvée alors que les parents possédaient pourtant des fleurs mauves. ceci prouve donc bien à,French
+"Mendel que les gènes récessifs et dominants sont bien transmis de cellules parentes à cellules enfantes, simplement l'expression des gènes",French
+récessifs paraîent diminué alors que quand on regarde la première génération de plantes obtenues on peut remarquer que 75 % des plantes,French
+"possèdent pourtant un gène récessif, mais lorsqu'on les regarde à l'oeil nu 75 % des plantes sont de couleur mauve.",French
+le gène récessif blanc apparaît donc minoritaire alors qu'il est bien transmis de cellules parents à cellules enfants. cette découverte était déjà,French
+"majeur est génial pour l'époque, mais Mendel ne s'est pas arrêté là il a analysé bien d'autres caractéristiques que les simples couleurs des fleurs des plantes de pois.",French
+en étudiant la transmission des caractères héréditaires Mendel réalise encore une troisième expérience qui lui permettra de mettre sur pied sa,French
+troisième loi la troisième lois de Mendel. accrochez vous car celle ci est un petit peu plus difficile à suivre? Mendel étudie alors deux familles de,French
+"plantes de pois, l'une est qui possède des plantes mauvais et des graines lisses et l'autre à plantes blanche et à graines ridées. dans cet exemple la couleur mauve",French
+est dominante ainsi que le côté lisse des pois. la couleur blanche et le côté ridée des pois est récessif. en reproduisant deux plantes,French
+de deux lignées pures Mendel obtient comme pour la première expérience des plantes de pois qui possèdent tous les mêmes caractéristiques des fleurs mauves,French
+et des petits pois lis. les caractères de la deuxième plantes semblent ici tout à fait éteints. puis en reproduisant à nouveau entre les plants ainsi obtenues,French
+"il obtient cette fois des plantes totalement différents selon la répartition suivante: 9/16 sont des plantes mauves à grains lisses, 3/16 sont des plantes mauves à",French
+expliquer cette répartition? eh bien regardez le schéma suivant: 9 plants sur 16 possèdent au minimum 1 gènes dominants de la couleur de la,French
+"plante et de texture de graines. ils apparaissent donc mauves avec des grains lisses, 3 plantes sur 16 possèdent un gène dominant dans la couleur",French
+de la plante mais deux gènes récessifs dans la texture du grain. la plante est donc mauve et le grain ridé. trois plants sur 16 possèdent deux gènes,French
+récessifs dans la couleur de la plante et au moins 1 gène dominants dans la texture du grain. la plante apparaît donc blanche et le grain lisse. et enfin un,French
+plant sur 16 ne possède que les gènes récessifs et la plante apparaît donc blanche et des grains ridés. il est également intéressant de noter que si on,French
+"ne regarde qu'un seul paramètre de l'expérience, on retrouve exactement les mêmes résultats que dans la première expérience. en effet en 3e génération on",French
+retrouve douze plants sur 16 qui possèdent une couleur mauve dont 75 % et 75 % des grains qui présente un aspect lisse donc 75 % également. les 25%,French
+consignes donc toutes ces expériences il en tire les conclusions que nous connaissons aujourd'hui et il publie tous ses résultats dans les revues de,French
+l'époque. Les 3 lois de Mendel les expériences de Mendel lui ont permis,French
+des dictées trois lois qui à l'heure actuelle sont toujours utilisés en génétique moderne. la première loi est la loi de,French
+"croise deux plants de lignées pures donc dit homozygotes parce qu'elle possède deux gènes que les mêmes soit dominant soit récessif, on obtient une nouvelle",French
+famille de plantes qui sont toutes hétérozygotes et qui possèdent toutes un gènes dominants et un gène récessif. dans l'expérience de Mendel donc ici on,French
+obtient tout des plantes à fleurs mauves mais qui possède un gène A majuscule pour la couleur mauve et un gène à minuscule pour la couleur blanche.,French
+"les plantes sont donc hétérozygotes leurs gènes ne sont pas les mêmes, mais seul le gène dominant est exprimée la plante est mauve. la deuxième loi de",French
+l'aspect extérieur de la plante ici de la couleur de ses fleurs. la troisième loi enfin est la loi de l'indépendance de la transmission des caractères. ceci veut,French
+"dire que si dans une expérience on se focalise sur deux caractères qui ont une transmission génétique, on obtient les résultats caractéristiques 9 3 3 1",French
+"comme je vous l'expliquais dans l'expérience précédente. 9 3 3 1 ça veut dire que sur les 16 plants obtenus après hybridation, on obtient neuf",French
+"plantes qui ont un caractère dominant strict, six plantes qui ont des caractères mixte dominant est récessif, et enfin une plante qui n'a que des",French
+caractères récessifs. et si par contre on se réfère à un seul caractère on retrouve comme dans la deuxième loi de Mendel 75% de plantes qui ont un aspect,French
+dominant et 25% de plantes qui ont un aspect récessif. ces différentes lois vont alors être publiés par Mendel dans l'indifférence,French
+totale mais plus tard plusieurs dizaines d'années après elles vont être redécouverte lorsque de nouvelles découvertes sur la génétique sur l'ADN,French
+sur la transmission des gènes seront mises au point. plus tard on observera les chromosomes l'aspect en double brins de l'adn et grâce aux nouvelles,French
+technologies de microscopie on pourra voir la reproduction des cellules et on comprendra enfin de nombreuses années après que Mendel avait déjà tout compris.,French
+c'est plutôt impressionnant non? on est ici face à un homme qui au 19e siècle rien qu'en observant pousser des plants,French
+de pois dans la serre de son monastère parvient à en tirer de nombreuses lois qui vont gouverner alors la génétique à l'exclure moléculaire plusieurs dizaines,French
+"voire plusieurs centaines d'années encore après lui. pour vous donner une idée l'ADN sera découvert en 1869,",French
+mais à cette époque on découvre seulement la molécule on ne sait rien de sa forme on n'en sait rien de sa fonction et on ne connaît,French
+encore rien des gènes et des chromosomes. ce genre d'expérience évidemment ça fait réfléchir. quand je vois que moi je ne suis même pas capable,French
+de maintenir en vie une orchidée quelques semaines. Et aujourd'hui ? la transmission Mendélienne des gènes,French
+"est encore utilisé de nos jours, pour expliquer la transmission de nombreux caractères héréditaires et physiques. par exemple la couleur des yeux et d'une",French
+transmission génétique qui possède aussi des caractères récessif et dominant. il ya plusieurs gènes qui expliquent la couleur des yeux d'un individu mais on,French
+est quand même en règle générale face à une transmission d'une couleur brune dominante ou d'une couleur bleue récessive.,French
+mais pour étudier la transmission de ses caractéristiques on est ici face à une difficulté technique et un peu éthique,French
+il ne faut pas se le cacher. comment peut-on à l'avance calculer la pureté des chromosomes d'un parent? il est certain qu'une personne qui a les deux,French
+"yeux bleus possèdent les deux gènes récessifs on en est certain, mais comment être certain que quelqu'un qui a deux yeux bruns ne possède pas un gène dominant brun et un gène récessif",French
+bleu qui peut être transmis dans la famille depuis de nombreuses générations? si on voulait en effectuer l'expérience il suffirait de regarder la couleur des,French
+"yeux de leurs enfants. mais pour que ces résultats soient statistiquement intéressants, il faudrait qu'il y ait de nombreuses enfants bien",French
+"entendus. comme je vous l'ai déjà expliqué si un parent a les yeux bleus c'est très facile, on sait qu'il transmet à tous ces enfants un gène récessif",French
+bleu au minimum. mais c'est pour le parent qui a les yeux bruns que ça va se compliquer. alors on va regarder tous ces enfants,French
+si tous les enfants ont les yeux bruns on sait que le parent aux yeux bruns possédait en fait deux gènes dominants bruns et donc tous ces enfants sont,French
+"hétérozygotes un gène dominant brun et un gène récessif bleu, leurs yeux apparaissent brun. si par contre ses parents aux yeux bruns possédent en fait",French
+un gène récessif bleu 50% de ses enfants recevront son gène dominant brun et nous aurons donc les yeux bruns. et 50% de ses enfants recevront son,French
+gène récessif bleu et comme ils auront deux gènes récessifs bleus ils auront les yeux bleus. pour bien entendu moi j'essaye de vous expliquer ceci de façon,French
+"très simple, mais comme toujours dans la vie en sciences et en médecine, rien n'est jamais tout noir ou tout blanc. je veux dire par là que si vos deux parents",French
+"ont les yeux bleus et vous vous avez les yeux bruns, il ne faut pas forcément crier à l'adultère d'un de vos deux parents. dans 10% des cas, deux parents",French
+aux yeux bleus donnera naissance à un enfant aux yeux bruns. c'est aussi ça la beauté de la génétique tout n'est pas toujours explicables facilement en,French
+divisant les gènes par deux. en ce qui concerne la couleur des cheveux on est plus ou moins sur une transmission équivalente.,French
+après la vie de Gregor Mendel dont je vous ai parlé dans une précédente capsule d'histoire que je vous replace sans sommation et sans prévenir,French
+"directement ici dans le coin supérieur gauche de l'écran, je vous encourage à la regarder, nous allons aujourd'hui nous intéresser à la vie et à l'oeuvre d'un",French
+"français qui s'appelait monsieur Louis Pasteur. Louis Pasteur on le considère comme le père de la vaccination, on lui attribue la Pasteurisation qui porte son",French
+"nom est un grand institut, l'Institut Louis Pasteur porte son nom en France. mais au fait savez-vous exactement qui était Louis Pasteur? quelles sont ses",French
+inventions? quelles sont ses découvertes? connaissez-vous plus que le vaccin ou la Pasteurisation? on va parler de tout ça et de plein d'autres choses encore dans,French
+cette nouvelle vidéo une deuxième capsule d'histoire sur la chaîne juste après ce petit générique que vous adorez a tout de suite,French
+"Louis Pasteur naît le 27 décembre 1822 dans le Jura en France, quelques mois à peine après Gregor Mendel. Louis est le",French
+troisième enfant de la famille Pasteur. son père Joseph Pasteur a d'abord été soldat Napoléonien puis il s'est reconverti dans la,French
+"tannerie, la production de cuir à partir de peaux de bêtes. la mère de Louis Jeanne-etiennette Rocqui est mère au foyer mais elle jouera un grand rôle",French
+dans l'éducation morale et civile de son fils. d'ailleurs Louis Pasteur les rendra hommage dans une lettre où il dit ceci: Tes enthousiasmes ma vaillante mère tu les a,French
+"fait passer en moi. si j'ai toujours associé la grandeur de la science à la grandeur de la patrie, c'est que j'étais imprégné des sentiments que tu m'avais",French
+"inspiré. et oui on dit que derrière chaque grand homme il y a une grande dame, et à nouveau cette fois ça semble être le cas. Louis Pasteur suit une",French
+formation des colliers classiques au collège d'Arbois une petite ville du Jura Français. à cette époque il se fait surtout connaître pour ses capacités en,French
+"peinture. après quelques hésitations, il obtient le baccalauréat en lettres et puis enfin le baccalauréat en mathématiques à sa deuxième tentative.",French
+"il entre ensuite à la Sorbonne puis à l'école normale. dans cette école il se concentre sur la physique et sur la chimie, il se concentre principalement",French
+sur l'étude des cristaux que l'on appelle la cristallographie. cette période de sa vie est particulièrement importante car elle va lui permettre de,French
+faire de nombreuses découvertes sur la forme des molécules. en effet la structure tridimensionnelle d'une molécule permet de déterminer sa forme,French
+"et en connaissant la forme d'une molécule on peut en déduire les interactions possibles avec d'autres molécules, et donc des corps de plus en",French
+plus grands. c'est d'ailleurs grâce à ces travaux qu'il obtient sa première médaille grâce à son travail sur la chiralité moléculaire. bon ne vous,French
+inquiétez pas on parle de ça dans le chapitre suivant. après ses études Louis-Pasteur devient professeur à Dijon puis à Strasbourg et enfin il devient le,French
+doyen de la faculté des sciences de Lille. en 1861 et 1862 Pasteur permet à la science d'effectuer un grand bond en,French
+"avant en réfutant catégoriquement la théorie de la génération spontanée. la génération spontanée c'est une théorie complètement folle à l'heure actuelle,",French
+mais qui date de l'époque d'aristote et qui a survécu pendant plus de deux mille ans. restez avec moi dans le prochain chapitre on va en parler vous allez voir,French
+c'est absolument passionnant. entre 1865 et 1869 Pasteur est foudroyé par une thrombose cérébrale. il gardera comme,French
+séquelle une faiblesse de l'emi corps gauche donc une faiblesse pour se déplacer pour utiliser sa main gauche. en 1882 il est élu à l'Académie Française.,French
+en 1885 il découvre le vaccin contre la rage véritable phénomène qui lui voudra enfin la reconnaissance et la postérité,French
+"partout dans le monde. si aujourd'hui vous parler de Louis Pasteur ou si on vous en parle, on vous parlera probablement du vaccin contre la rage.",French
+c'est son oeuvre la plus remarquée et la plus connue. mais il y en a bien d'autres évidemment. de cette oeuvre des couleurs à l'institut Pasteur qui est fondée en,French
+1888. Louis-Pasteur décède le 28 septembre 1895. son corps d'abord déposé à notre dame est ensuite transféré dans,French
+l'institut qui porte son nom à Paris où il repose dans l'une des cryptes à l'Institut Pasteur. donc au cours de sa vaste carrière Louis Pasteur s'est,French
+également intéressée énormément à la fermentation et principalement à la fermentation dans le cadre du vin. et oui il est français monsieur Pasteur. on va,French
+parler de tout ça et des micro-organismes qui l'a découvert dans le prochain chapitre également. enfin sachez que Louis Pasteur s'est marié en 1849 avec Marie Laurent et qu'il a eu cinq,French
+"enfants dont le dernier qui s'appelle également Louis Pasteur, a également été membre de l'Académie Française. l'épouse de Louis Pasteur a joué un",French
+"grand rôle dans sa carrière, ça n'a jamais été démenti, mais comme souvent à l'époque elle a énormément vécu dans son ombre. voilà c'est tout pour cette",French
+"première approche sur la vie de Louis Pasteur, vous pouvez le remarquer il est notable de voir que Louis Pasteur n'a pas tout réussi du premier coup, par",French
+"exemple son baccalauréat en mathématiques, comme quoi rien n'est jamais tracé rien n'est jamais simple. enfin ceci c'était pour parler de",French
+"l'homme, à présent à bord dont un peu ses découvertes et pour ça commençons le prochain chapitre. les découvertes de Louis Pasteur ont été nombreuses et afin",French
+de ne pas faire une vidéo qui pourrait durer plus de quatre heures je vais me contenter de vous en expliquer les quatre principales en tout cas selon moi. La chiralité moléculaire,French
+Louis Pasteur a beaucoup travaillé en chimie sur les cristaux. il a ainsi pu,French
+résoudre une énigme de l'époque qui avait attrait à l'acide tartrique. bon je ne vais pas vous détailler le contenu de cette expérience c'est pas le sujet de,French
+cette vidéo mais je vais plutôt vous parler de la chiralité moléculaire. la chiralité moléculaire c'est quelque chose de très important en chimie et,French
+"principalement en pharmacologie, donc ça me concerne directement en tant que médecin généraliste. le principe de la chiralité c'est de dire qu'une molécule",French
+complexe possèdent souvent plusieurs versions d'elle-même. on appelle ces deux versions d'elle-même des isomères. en,French
+cristallographie lorsqu'on envoie à rayons lumineux à travers un mélange d'un seul décisionnaire ce mélange va dévier le rayon lumineux dans un sens ou,French
+"dans l'autre. ceci est assez particulier car lorsqu'on a un cristal qui est composé d'un désir mer uniquement, la lumière est déviée dans un sens.",French
+lorsqu'un cristal est composé de l'autre isomères la lumière est déviée dans un autre sens. et lorsqu'un troisième cristal est composé des deux îlots mais,French
+"en même temps la lumière n'est pas dévié. par contre si dans ce cristal ou dans cette solution vous parvenez à isoler les isomères, vous pouvez re créer deux",French
+solutions ou de cristaux différentes qui vont à leur tour dévier la lumière. ces deux isomères ce sont en fait exactement la même molécule mais deux image miroir,French
+de cette même molécule. bon laissez moi vous expliquer ceci avec une métaphore à peu perché comme je les aime. voici deux personnes qui se ressemble très fort. l,French
+"oms le même code génétique et disons le même aspect elles sont composés des mêmes molécules, mais voici ce qu'il se passe si vous essayez de leur serrer la",French
+main. si vous tendez votre main droite comme le veut la tradition vous remarquerez que seule une de ces personnes vous correspond. pour l'autre,French
+il est impossible de lui serrer la main ça paraît logique alors on est bien d'accord que cet exemple est particulièrement idiot. pour la personne,French
+à qui vous ne savez pas serré la main droite il suffirait de lui serrer la main gauche. oui sauf que dans le corps humain ce n'est pas comme ça que ça marche. et pour vous expliquer ça je vais,French
+parler d'une molécule connue que l'on appelle l'oméprazole. cette oméprazole elle est en fait un mélange de 2 oméprazoles comme vous pouvez,French
+"le voir sur cette représentation. pour vous expliquer un peu plus les images ici un isomère est dit dextrogyre lorsqu'il dévie la lumière vers la droite, et il",French
+est dit lévogyre lorsqu'il dévie la lumière vers la gauche. bon ce technique ça n'a pas un grand intérêt ici. cette propriété de former des isomères est en,French
+réalité dû aux atomes de carbone. les atomes de carbone possèdent quatre sites de liaison et ils sont donc dit asymétrique. bon je ne vais pas m'étendre,French
+"beaucoup plus sur le sujet car ce n'est pas le sujet de cette vidéo, qui est une vidéo d'histoire après tout, mais si ça vous intéresse n'hésitez pas à me",French
+"laisser un commentaire dans la vidéo et en fera une vidéo sur les isomères, sur l'asymétrie du carbone, c'est relativement intéressant surtout en",French
+"chimie. et alors croyez le ou non mais en général, sur les 2 isomères un seul a une réelle propriété l'autre ne sert",French
+"strictement à rien. reprenons pour ceux ci le cas de l'oméprazole. lorsque vous consommez un comprimé de 20 mg d'omeprazol, vous consommez en réalité 10",French
+"mg d'oméprazole dextrogyre et 10 mg d'oméprazole lévogyre. ceci peut vous sembler assez fou, mais sur les",French
+"20 mg d'oméprazole en fait seuls 10 mg sont réellement actifs. et la raison de ceci est particulièrement simple, la cause est la chiralité moléculaire. en",French
+fait une des deux molécules d'omeprazol peut se lier à son récepteur et effectuer son action et l'autre qui lui ressemble très fort mais qui est son image en,French
+miroir ne peut donc pas se lier aux récepteurs et donc inactif dans le corps humain. pour terminer avec l'exemple de l'oméprazole sachez que cette,French
+"isomère dextrogyre qui n'a pas d'activité il ne fonctionne pas tout simplement, et l'isomère lévogyre est la molécule active du produit. d'ailleurs",French
+pour votre information il existe actuellement une autre molécule que l'on appelle esoméprazole qui est en fait uniquement l'isomère lévogyre,French
+purifié de l'oméprazole. ceci veut dire qu'avec 10 mg d'esoméprazole vous avez le même effet qu'avec 20 mg d'omeprazol. mais alors,French
+le sujet de cette vidéo nous en reparlerons dans une prochaine si vous le souhaitez. La fermentation,French
+on le sait moins mais Pasteur a également été un des premiers à découvrir les levures ces fameux micro organismes dont je parlerai probablement,French
+un jour sur la chaîne. à l'époque de Pasteur de nombreux travaux existaient déjà et de nombreuses théories prévalait pour expliquer certains processus de,French
+fermentation principalement dans le vin. Pasteur découvre alors que certains microorganismes peuvent survivre sans la présence d'oxygène et il définit donc le,French
+terme anaérobie. il démontre alors que certains microorganismes peuvent en l'absence d'oxygène consommer du sucre,French
+pour former en échange de l'alcool. il décrit ainsi le processus de la fermentation alcoolique. en revanche si la levure se trouve en,French
+présence d'oxygène la production d'alcool sera bien moindre on appelle ceux ci l'effet Pasteur. à l'époque de Louis Pasteur la france était déjà,French
+grande productrice de vin bien entendu et il existait ce que l'on appelait la maladie des vins. en réalité de nombreux micro organismes pullulent et à,French
+l'intérieur du vin et pouvait provoquer la formation de vinaigre ce qu'ils altéraient bien entendu la qualité et le goût du fameux vin. Pasteur eut l'idée,French
+qui semble simple aujourd'hui de chauffer le 20 à 57 degrés afin de tuer les micro-organismes qui s'y trouvaient pour en favoriser la conservation et le,French
+stockage. ce procédé de chauffage du vin on l'a appelé tout simplement la Pasteurisation et ça a été utilisé pendant très longtemps mais depuis c'est,French
+abandonner pour le vin depuis les années 1930 plus ou moins et ça a été transposée au lait. et oui maintenant le lait est Pasteurisé. et ses travaux sur,French
+les micro-organismes permirent également à Pasteur de faire de nombreuses découvertes sur la transmission des maladies par les micro-organismes. à,French
+cette époque Koch le fameux scientifiques dont je parlerai probablement dans une prochaine capsule d'histoire avait déjà découvert le bacille qui portait son nom et les,French
+recherches sur les bactéries allaient bon train. à cette époque un chirurgien qui s'appelait joseph lyster avez lu les travaux de Pasteur sur les,French
+micro-organismes et il décida d'appliquer ces conseils de propreté pour ces patients opérés. et très rapidement il remarqua une chute,French
+drastique du taux de mortalité de ces opérations mais également du taux d'infection des plaies suite à ces opérations.,French
+sur les mains du chirurgien sur les outils utilisés et enfin dont les plaies du patient. La génération spontanée,French
+ce chapitre va vous sembler complètement fou mais il faut absolument qu'on en parle et pour en parler. retournons plus de 2000 ans en arrière à l'époque,French
+d'aristote donc avant l'an zéro de notre ère. à cette époque les connaissances en sciences sont bien entendu très faible. Aristote propose donc une théorie à,French
+l'explication de la vie sur Terre. dans des conditions particulières des molécules peuvent magiquement s'associer pour former la vie. Aristote a en effet,French
+"remarqué à force d'observation qu'après un certain temps des moisissures apparaissent comme par magie sur le pain, des mites apparaissent dans la laine.",French
+des souris apparaissent dans des vieux vêtements qu'on a laissé traîner dans une grange. et si vous laissez traîner un morceau de viande fraîche sur une table,French
+vous allez voir que comme par magie au bout de quelques jours des asticots vont sortir de cette viande. comment peut-on en vouloir à Aristote à une époque où la,French
+"science n'existait même pas, il a eu le mérite de faire beaucoup d'observations et de trouver une théorie qui expliquait les choses selon lui mais surtout qui",French
+"permettait de répondre aux questionnements des gens. car il faut bien comprendre qu'à cette époque on est avant la plupart des religions, on est avant l'an 0 de notre ère. et bien entendu",French
+à cette époque les religions n'existant toujours pas il n'y a pas de réponse officielle qui était donné à l'apparition de l'homme et du vivant sur,French
+la terre. quelques centaines d'années après avec l'apparition des religions des réponses seront apportées qui encore quelques centaines d'années après seront,French
+"balayés par la science. mais là où l'histoire est complètement folle, c'est que cette théorie de la génération spontanée d'Aristote a tenu plus de deux",French
+mille ans jusqu'au milieu du 19e siècle. vont en réalité au xviie siècle Redi et Spallanzani ont déjà essayé de réfuter,French
+"cette théorie, mais sans pouvoir le prouver. et quand une théorie existe depuis plus de 2000 ans je peux vous assurer qu'il faut des arguments solides",French
+"pour arriver à la démonter. il y a 150 ans à peine Pasteur parvint à démontrer que la génération spontanée n'existait en réalité pas, et ceci grâce à une astucieuse",French
+expérience. selon lui l'apparition de souris de mites dans la laine ou de moisissures sur le pain est en réalité dû au transport de micro-organismes,French
+invisibles à l'oeil nu dans l'air ambiant. ceci a provoqué un énorme bouleversement à l'époque car la théorie de la génération spontanée étaient,French
+portés par des hautes personnalités comme par exemple Georges Clemenceau et elle existait depuis plus de 2000 ans. plusieurs expériences ont donc été,French
+menées au cours des années ou des décennies pour montrer que la génération spontanée n'existait pas. une des premières expériences a été de placer un,French
+"morceau de viande dans un bocal sur lequel on déposait un filtre. mais pas de chance, on a découvert que des asticots se développer quand même dans la viande.",French
+"un argument pour la génération spontanée. donc ultérieurement des expériences sont en réalité montré que les mouches sont capables de se déposer sur le filtre, et",French
+d'envoyer leurs oeufs directement dans la viande d'où le développement des asticots. puis Louis Pasteur eut une idée absolument géniale qui lui permit de,French
+réfuter enfin officiellement la théorie de la génération spontanée. pour ceci il a utilisé un ballon à col de cygne comme vous pouvez le voir sur cette,French
+"représentation. dans cette expérience Pasteur place à l'intérieur du ballon un col de cygne un milieu de culture et il ne filtre pas l'air, il ne souffre pas le",French
+"culture. cette expérience prouve donc la génération spontanée n'existe pas, car même si le milieu est excellente pour la croissance des micro-organismes, rien ne",French
+s'y développent. cette expérience très simple est particulièrement intéressante car elle est fortement reproduisible ce qui est un des points clés de la,French
+"science. elle donc reproduite de nombreuses fois à l'époque et dans la plupart des cas, aucun micro organismes ne se développe dans le milieu de",French
+culture. c'est en réalité un des points clés de la science bien entendu une expérience doit être reproduisible et reproduite dans des conditions,French
+différentes pour être validée. une expérience qui donne un résultat étonnant mais qui est impossible à reproduire n'est en général pas validé,French
+"par le monde scientifique. et dans ce cas-ci pour reproduire cette expérience c'est relativement simple. prenez un ballon à col du cygne, mettez un milieu",French
+de culture à l'intérieur et voyez ce qu'il se passe. dans de nombreux cas il ne se passera rien tout simplement. bon en réalité avec l'oeil scientifiques,French
+d'aujourd'hui les expériences de Pasteurs sont loin d'être irréfutables et elles sont grévées de nombreux billets. mais après tout soyons honnêtes qui,French
+aujourd'hui pourrait encore prétendre que la théorie de la génération spontanée est une réalité. non ne répondait pas je préfère pas,French
+savoir. Vaccin antirabique dès 1876 ce fort de ses travaux sur la fermentation et sur les micro-organismes,French
+Pasteur en déduit que la plupart des maladies contagieuses sont en réalité due également à des micro-organismes et n'ont pas non plus à la génération,French
+spontanée. il devient donc un partisan important de la théorie microbienne des pathologies infectieuses. en 1880 il découvre même le Staphylocoque. Pasteur,French
+"s'intéresse alors au processus de la vaccination, une étape qui était déjà bien engagée par son homologue anglais Edward Jenner mais qui avait pour défaut",French
+"d'injecter à ses patients des virus vivants, ce n'était pas sans effets secondaires bien entendu. la découverte de Pasteur sera d'arriver à atténuer le",French
+"virus qui est envoyé dans le patient, c'est à dire lui enlever son pouvoir pathogène et diminuer les réactions négatives du corps humain. Pasteur",French
+"découvre alors que lorsqu on injecte de vieilles colonies de choléra à des poules, celle ci non seulement ne meurt pas mais en plus elle semble protéger",French
+contre des affections ultérieure peu importe le choléra. et c'est là qu'il va créer un vaccin d'un nouveau type il va prendre un virus atténué pour l'injecter,French
+à des poules et créer une réaction de vaccination. en 1880 Pasteur parvient à immuniser un troupeau de moutons de la,French
+"maladie du charbon, grâce à un vaccin de sa composition. en 1880 également il commence à travailler sur la rage. au bout de quatre années d'expérimentation",French
+sur divers animaux Pasteur en vient à la conclusion qu'on peut obtenir un virus de la rage atténué en exposant de la moelle épinière de lapin atteint par la,French
+"rage à l'air libre. c'est d'ailleurs le sujet d'une des plus célèbres illustrations de Pasteur que je vous place ici, vous avez probablement déjà vu cette peinture. ses deux premières",French
+"tentatives de vaccination sur l'être humain un homme d'une soixantaine d'années et une jeune fille de 11 ans, ne furent pas couronnée de succès.",French
+la jeune fille mourut malheureusement le lendemain de la rage qui a l'air décontracté avant même la vaccination. plus tard un jeune homme qui venait,French
+d'être mordu par un chien enragé fut emmené chez Pasteur qui lui administrent à son vaccin et le jeune homme survécu. mais bon à l'époque difficile de prouver,French
+que le chien avait réellement la rage et enfin qu'il l'avait réellement transmise à l'enfant car ils n'en avaient pas encore les symptômes. pour prouver,French
+l'efficacité de son vaccin Pasteur injecta alors le vrai virus de la rage à l'enfant qui survécut également. il en déduit donc que son vaccin avait du,French
+marché. et oui visiblement l'éthique médicale à l'époque de Pasteur n'était pas la même que celle qu'on pourrait avoir aujourd'hui. et bien entendu à,French
+cette époque la vaccination contre la rage et son principe ont été fortement contesté et de nombreuses plaintes ont même été déposée contre Louis Pasteur. à,French
+"-Bienvenue dans cette émission spéciale ""Etat de santé"" consacrée au médecin de famille, une espèce en voie de disparition. Ce médecin de famille qu'on consultait toute sa vie",French
+"et qu'on pouvait parfois déranger nuit et jour, qui connaissait précisément toute la famille, eh bien, il n'existe presque plus. Alors Pourquoi ? On va essayer de le comprendre évidemment avec tous nos invités. Et puis, quel modèle va remplacer",French
+"ce précieux médecin de famille qu'on ne verra bientôt que dans les films et les livres ? On va en parler avec vous, Dr Marine Crest. Merci d'être avec nous. Vous êtes médecin généraliste à Marseille, vous avez fondé",French
+"l'association Guérir en mer, vous nous direz tout à l'heure. Guérir en mer, on a compris l'idée, qui accompagne les soignants victimes de burn-out. Vous m'avez dit que Vous en avez eu un, mais pendant vos études, et maintenant, vous aidez",French
+"les médecins, jeunes ou moins jeunes, peut-être, à combiner la vie professionnelle avec la vie personnelle. Et Vous avez été chargée par le ministère de la Santé, en mars 2023 de rédiger un rapport sur la santé des soignants.",French
+"Frédéric Valletoux, [...] député Horizons de Seine-et-Marne, rapporteur de la proposition de loi sur l'accès aux soins qui vient d'être adoptée en 1re lecture au Sénat. Elle est ressortie un peu amendée, pour ne pas dire pas mal amendé d'ailleurs,",French
+"mais vous nous direz quelles sont vos propositions, précisément, pour faire muter ce ce ce métier de médecin que vous connaissez parfaitement bien.",French
+"Bonjour Arnaud Bontemps, merci d'être avec nous. Vous avez été en charge de l'organisation territoriale des soins à la CPAM la Caisse Primaire d'Assurance Maladie de Seine-Saint-Denis, en pleine crise du Covid. Alors, vous avez dû voir évidemment ce que c'est",French
+"que la santé sous tension. et Vous avez cofondé le collectif Nos services publics pour mettre la question du service public au coeur du débat euh politique. Merci, Maria Roubtsova, d'être avec nous.",French
+"Economiste, chargée de mission santé à l'UFC-Que Choisir, vous avez participé à l'écriture de rapports sur les déserts médicaux. Et enfin, Dr Hamon, Dr Hamon, on vous connaît bien. Euh Vous avez 50 ans d'exercice.",French
+"Bel anniversaire ! 50 ans de médecine générale au sein de votre cabinet à Clamart, en région parisienne. Egalement président d'honneur de la Fédération des médecins de France,",French
+"vous portez depuis longtemps la parole syndicale des médecins généralistes. Vous continuez de consulter d'ailleurs ? -Je consulte à temps plein, à temps plein dans un groupe de cinq médecins généralistes qui a été créé en 52, à l'époque où l'Ordre des médecins considérait",French
+"que ce n'était pas bien de se regrouper. C'était un médecin... -On y reviendra tout à l'heure, mais c'est intéressant le regroupement évidemment. Ma docteur Dr Crest, le médecin de famille a disparu.",French
+"car ce sont des métiers qui sont très féminisés à mon avis. Il y a 10 ans, je faisais une émission dont le titre était ""Enquête de santé: ""la fin du médecin de famille"". Donc C'était une des 1res émissions, c'était il y a 10 ans.",French
+"Moi Je suis toujours médecin généraliste et je pense être un médecin de famille. Alors Si la question c'est : ""Il n'y a plus de médecin de famille ?"", je pense que la réponse est : il y en a. Mais c'est pas ceux qui étaient là avant et ce ne sera pas ceux qui seront là demain.",French
+"il y a les patients aussi, et puis il y a les générations, les générations qui évoluent. Même moi, J'ai du mal, parfois, à communiquer, à comprendre des confrères qui sont un tout petit peu plus jeunes ou un petit peu plus âgés parce que Chacun intègre en fait sa profession dans son quotidien",French
+"de manière différente, avec des nécessités, des besoins qui évoluent avec ceux de la société. C'est ça qui fait que c'est un médecin qui change. -Un médecin de famille, un médecin de famille d'ailleurs c'était en général un homme Et c'est un modèle en voie de disparition. Il s'est énormément féminisé,",French
+"le nombre de médecins généralistes, aujourd'hui, qui disent non à de nouveaux patients ? -Alors aujourd'hui, près de la moitié des médecins généralistes refusent les nouveaux patients.",French
+"Donc c'est particulièrement compliqué de trouver un médecin traitant, sachant que il y a eu des annonces qui ont été faites par les autorités cette année pour dire qu'on allait trouver des médecins traitants aux patients notamment aux patients en affections de longue durée sans médecin traitant.",French
+"Et La première chose qu'a faite la Sécurité sociale c'était écrire aux patients qui n'avait pas de médecin traitant, comme si c'était aux patients de se débrouiller, alors que les patients sont aujourd'hui dans un problème systémique de pénurie,",French
+"et donc c'est pas souvent... Souvent, c'est pas faute de volonté du patient qu'on trouve pas de médecin traitant, c'est faute d'accessibilité, selon où on habite, selon euh est-ce que les médecins sont proches de leur départ en retraite,",French
+"est-ce qu'ils ont déjà beaucoup de patientèle. Vous avez déjà euh résumé ou cité quelques causes, évidemment, de la démographie euh médicale en grande pénurie euh.",French
+On s'arrête quelques instants pour un petit point d'histoire. Pourquoi les généralistes sont-ils de moins en moins nombreux ? Explication de texte.,French
+"-En France, 1 personne sur 3 vit dans un désert médical. 6 millions de personnes n'ont pas de médecin traitant, et leur recherche pourrait bien durer, car la pénurie a empiré ces dernières années.",French
+La densité de médecins généralistes est passée de 153 pour 100 000 habitants en 2012 à 140 pour 100 000 en 2021. Pourquoi ?,French
+"Principalement parce que nous ne formons pas assez de médecins, et cela remonte aux années 70. A cette époque, les cabinets médicaux poussaient comme des champignons et les bancs des facs de médecine",French
+"étaient remplis de futurs généralistes. Mais c'est aussi à cette époque qu'on a découvert le trou de la Sécu. Pour le combler, et sous l'influence des médecins libéraux, le gouvernement a choisi de limiter les dépenses",French
+"en limitant le nombre de médecins. Le numerus clausus faisait son apparition. De 8500 places offertes aux étudiants en 1977, on est descendus jusqu'à 3500 admissions en 1993.",French
+"Le nombre de nouveaux médecins a drastiquement baissé, et dans le même temps, la demande de soins, elle, a augmenté car la population vieillit. Les baby-boomers nés après la Seconde Guerre mondiale",French
+"ont atteint le troisième âge dans les années 2010. On parle de papy-boom. Et Pour ne rien arranger, les généralistes, eux aussi, vieillissent comme tout le monde : près de 50 % des médecins inscrits à l'Ordre",French
+"ont plus de 60 ans. Ainsi, depuis 2020, il y a davantage de départs à la retraite que de nouveaux arrivants. Heureusement, le numerus clausus a augmenté au début des années 2000.",French
+"En 2020, il a été remplacé par un numerus apertus, c'est-à-dire un quota minimum de places fixé par les facs de médecine en fonction des besoins du territoire. Mais ces décisions ne devraient porter leurs fruits",French
+"qu'à partir de 2030. -Si on comprend bien, Arnaud Bontemps, en 2030, essaie de voir ce qui qui peut nous donner",French
+"un peu d'espoir, en 2030, ce sera le pic de la pénurie de médecins liée à cette logique du numérus clausus. On commencera à avoir un petit peu moins de pénurie à partir de 2030 ?",French
+"-Ca, ce serait faire abstraction de l'évolution continue, dans le même temps, des besoins de santé. Le reportage mentionnait la question du vieillissement de la population. Dans les 10 dernières années, c'est 12 % de plus de 75 ans en plus",French
+"dans la population. Dans le même temps, ce qui est encore plus frappant, c'est l'évolution du nombre ce qu'on appelle des affections longue durée, en clair les maladies chroniques et les cancers. Dans les 10 dernières années, c'est plus de plus 30 %.",French
+"Aujourd'hui, c'est 1 patient sur 6. Donc en fait C'est ça, ça l'enjeu auquel il faut qu'on réponde. C'est pour ça qu'il y a une crise du système de santé aujourd'hui, en particulier la médecine de ville :",French
+"c'est que on a un système qui a été inchangé dans ses modalités, alors que les évolutions pathologiques elles sont épidémiologiques et sont très fortes. Et donc En effet, le médecin le modèle d'un professionnel de santé qui serait un médecin isolé ne correspond plus",French
+"à la prise en charge des patients chroniques qui nécessite un travail en équipe entre différentes professions. Et donc C'est ça qu'il faut que notre modèle arrive à inciter. -Vous direz quelles sont les solutions qu'on peut mettre en place raisonnablement,",French
+aujourd'hui évidemment au bénéfice de tous. Il y a moins de médecins et il y a un problème de répartition. On va Regarder cette carte. Vous allez regarder attentivement. Toute cette carte de France est en fait mitée par des petits points blancs.,French
+"Et ces petits points blancs C'est là où il y a pratiquement aucun ou presque aucun médecin. Et Ensuite, vous voyez que, plus c'est foncé, plus il y a de médecins disponibles au service des patients. On voit bien que le sud, au sens large,",French
+"est assez bien doté, avec les parties littorales, où il y a quand même, là, une démographie assez positive, et puis, plus on monte vers le nord, et surtout autour autour de la capitale et ainsi que le centre de la France,",French
+"eh bien là, il y a une pénurie de médecins caractérisée. Je voudrais qu'on aille tout de suite dans la Creuse. C'est un des départements les moins dotés. La Creuse, à Châtelus-Malvaleix,",French
+"écoutez ce couple de médecins, 66 et 64 ans. Il voudrait, ce couple de médecins, prendre sa retraite. Il ne trouve pas de successeurs. Et Vous entendrez, dans la foulée,",French
+"un patient, évidemment, qui est pénalisé. -On a mis des annonces un peu partout et bon je pense qu'on n'est pas les seuls à chercher.",French
+"Ca fait 36 ans que je suis là, que je connais les familles depuis deux-trois générations, donc c'est ce sont plus des amis que des patients, donc c'est très difficile de les laisser tomber.",French
+"On a soigné les parents, maintenant les enfants, maintenant, on soigne les petits-enfants. Donc Ca fait un peu mal au coeur, quoi. Il y a des gens qui ne seront plus suivis, qui vont arrêter leur traitement. Donc Ca va être vraiment dramatique, je pense, oui.",French
+J'ai proposé à la commune de travailler deux jours par semaine comme salarié avec ma femme pour essayer de dépanner un petit peu en attendant de trouver un successeur.,French
+"-Ca m'inquiète parce qu'il va falloir retrouver un médecin, et les médecins, ils sont surchargés. Le désert médical, c'est c'est de pire en pire alors.",French
+"Je sais pas où on va aller comme ça, où on va... Qu'est-ce qu'on va faire ? Bon ""Qu'est-ce qu'on va faire ?"" C'est bien poser comme question. Il s'agit de trouver des réponses. Frédéric Valletoux, vous avez présenté",French
+"une proposition de loi, soumis une proposition de loi au Sénat, avec un certain nombre donc de mesures que vous préconisez. Et Tout de suite, je vais poser la question qui fâche,",French
+"parce qu'on tourne autour en France depuis des années. D'abord, la coercition, l'obligation faite aux médecins, par exemple, à la sortie de leurs études, de s'installer là où les patients en ont besoin, vous n'y êtes pas favorable ?",French
+"-Je n'y suis pas favorable dans la période actuelle. Je n'y suis pas favorable la période où effectivement on a si peu de médecins chaque année, vous donniez les chiffres, à dire imaginer répartir là où il y a des besoins.",French
+"Par contre, que, dans l'avenir, dans les années qui redeviendront, ""fastes"", c'est peut-être un grand mot, en tout cas meilleures, dans les années 30-32-35, quand effectivement plus de jeunes auront été formés,",French
+qu'il y ait un système qui veille à ne pas reproduire les erreurs du passé de concentration et de juste répartition. -Par quels par quels moyens ? -C'est à la profession,French
+"d'y réfléchir, c'est pas après nous, les parlementaires qui se sont pris par la main et et qui ont imaginé des systèmes, les pharmaciens, ils ont imaginé d'eux-mêmes des systèmes",French
+"pour répondre au à l'intérêt général et aux besoins des des des Français. Donc On pourrait attendre effectivement que, dans les années qui qui qui nous nous éloignent de ce de cette époque",French
+"de 2035 que j'évoquais, on puisse voir émerger des propositions pour qu'effectivement on on dise bah: ""On va pas reproduire ce qu'on a vécu par le passé."" Il y a un besoin effectivement qu'on soit pas tous concentrés parce que Là, on parle des généralistes, mais si on regardait les cartes pour les spécialistes, c'est encore pire.",French
+"La concentration des spécialistes, c'est encore pire que la question la question des généralistes. eh et et et Donc voilà, c'est un système à à inventer. je pense que Pour l'instant, c'est pas le sujet.",French
+"et La coercition, on sait que malheureusement, c'est un sujet qui fâche. Et Si on veut que cette profession évolue, et comme toutes les professions elle doit évoluer, il faut qu'on arrive à emmener avec nous les... - D'accord donc Si pas de coercition",French
+"dans un système hyper tendu où, pour l'instant, il y a un manque criant de de médecins entre guillemets disponibles. -la rareté ça rendra personne riche. -Pour éclairer nos débats si vous voulez bien, c'est toujours intéressant de se comparer aux autres.",French
+"Regardez cette carte qu'on a préparée, justement, pour vous montrer ce qui se passe ailleurs. Aux Pays-Bas et en Belgique, à l'instar de la France, les médecins sont libres de s'installer",French
+"où ils le souhaitent. Il y a des mesures incitatives. On va parler de l'Allemagne, le Danemark et la Norvège. Là, il y a des mesures coercitives. Par exemple au Danemark et en Norvège, pour prendre cet exemple, les médecins généralistes sont libéraux,",French
+"mais ils doivent passer un contrat avec les autorités locales qui régulent la distribution des cabinets sur le territoire. En Grande-Bretagne et en Espagne, les systèmes de santé sont publics, les généralistes britanniques sont installés, sont salariés",French
+"par la National Health Service, NHS, et donc leur installation est parfaitement régulée en fonction des des besoins. Les généralistes espagnols sont salariés par les régions autonomes",French
+"et ce sont elles, les régions, qui décident des effectifs de médecins à former et leur installation. Donc On voit bien là que des pays ont adopté des systèmes qui sont extrêmement différents.",French
+"La coercition, est-ce que ça marche ? Est-ce que ça permet à ces pays puisque on dit que ça existe... Est-ce que ça permet aux pays aux patients d'être mieux soignés ? Est-ce que ça permet d'avoir des systèmes qui fonctionnent mieux ? -Alors Il y a un rapport de la DREES,",French
+"le service statistique du ministère de la Santé, qui dit que les mesures coercitives sur installations, combinées à d'autres mesures, ont contribué, dans d'autres pays, à améliorer l'accès aux soins. C'est sûr C'est pas la coerc seule, mais ça peut être un élément",French
+"d'une politique qui marche bien. Ils citent plusieurs exemples. Mais par contre, là où je ne partage pas l'analyse de M. Valletoux, c'est que, pour nous pour l'UFC-Que Choisir, c'est parce que la pénurie est particulièrement intense aujourd'hui que c'est le moment de prendre des mesures contraignantes",French
+"sur la liberté d'installation. Puisque donc Ce que vous montriez sur la démographie médicale, et le cas de la Creuse qui était dans le reportage, sont assez symptomatiques. Puisque ce qu'On a montré, dans notre étude sur l'accès aux soins qui est paru cette année,",French
+"c'est que les départements où les généralistes sont les plus âgés sont aussi les moins denses. C'est-à-dire que Dans la vague de départs en retraite qui n'en est qu'à ses débuts, ça va être les départements déjà les plus démunis",French
+"qui vont perdre le plus de médecins suite aux départs en retraite. Et donc Pour nous, c'est pour ça qu'il faut réguler maintenant pour gérer la pénurie. Et par ailleurs Ce que défend l'UFC-Que Choisir, ce n'est pas la coercition",French
+"au sens de prendre un jeune médecin et de lui dire d'aller dans la Creuse, nous ce qu'on défend c'est fermer l'installation dans les zones les mieux dotées. Par exemple, sur le littoral. -Est-ce qu'il y a des zones qui sont surdotées, ou elles sont simplement mieux dotées que les autres ? -Il y a des zones",French
+"mieux dotées que les autres, mais dans la situation de pénurie c'est enfin dans tous le cas pénurie c'est quand il y a une pénurie qu'on rationne, et donc pour nous, il faut envoyer les patients dans les zones... -Donc On déshabille Paul pour habiller Jacques ? Vous dites c'est un moindre mal qu'on ne peut pas faire autrement ?",French
+"-Il y a une pénurie On va dans 10 ans de pénurie. Il faut gérer les pénuries. -Vous auriez accepté pén à la sortie de vos études et etarement vous allez avoir la parole dans une seconde. Mais Vous auriez accepté, docteur, qu'on vous dise, à la fin de vos études ben:",French
+"""Il vaudrait mieux aller là, avec plus ou moins de..."". - Pardon. -""Vous allez ou voulez, sauf les zones les mieux dotées."" -Voilà, merci d'avoir reformulé la question. -Ce qui est compliqué c'est que Il faut pas, à mon sens...",French
+"he Les ""il faut"", ""on doit"", ""c'est la faute à"" ""c'est la faute à""... comprendre que Quand vous faites médecine ou une autre profession de soins d'ailleurs, au départ, vous le faites plutôt par vocation et par élan. Aujourd'hui, cet élan est en train de se tarir.",French
+C'est que Les jeunes n'ont pas envie d'y aller parcequ'ils voient ceux qui sont sur le terrain qui s'en vont qui arrêtent et du coup ils n'ont pas envie d'y aller. Ils sont accompagnés par des professionnels de santé qui sont en souffrance.,French
+"Et donc du coup Ils ont même pas ni envie d'y aller, puis plus envie de rester. Obliger quelqu'un avec une contrainte comme ça, ça ne marchera pas, et je pense encore moins en France : parce que ça ne correspond pas à la personnalité du Français et ça correspond pas à un besoin.",French
+"C'est que Si on vous force à faire un métier là où vous n'avez pas envie de le faire... ""On ne va pas y aller."" on n'ira pas. Moi On m'aurait fait réfléchir sur comment est-ce qu'on peut répondre à un besoin, et que ça vienne de la part des professionnels de santé eux-mêmes...",French
+"Il faut comprendre que c'est des femmes, des familles, sur des zones où il y a pas d'attractivité dans les métiers et les territoires. C'est une politique qui est tellement multifactorielle qu'il ne faut pas juste centrer sur : ""On leur dit qu'il ne faut pas aller là,",French
+"""mais ils peuvent aller là."" mais attendez Ca dépend pas uniquement de ce facteur-là, ça dép. -Alors Dr Hamon, parce que vous bouillez depuis tout à l'heure, -Je suis heureux que M. Valletoux dise qu'il est contre la coercition mais maintenant ça a pas toujours",French
+"été son cas. - Vous avez parlé vous avez parlé -On va essayer d'être constructif. -Il aura du mal. -Je peux parler du Danemark, car j'y suis allé, justement. Et Au Danemark, si un médecin veut s'installer dans une région, on lui dit : ""C'est à tel endroit.""",French
+"Mais dans la région. Il choisit la région où il veut s'installer. Et le médecin danois Il ne travaille pas dans les mêmes conditions que le médecin français. Si vous voulez permettre aux jeunes de s'installer,",French
+"il faut qu'ils bossent avec un secrétariat présentiel, avec des locaux corrects et faire découvrir et faire découvrir aux internes cette cette médecine qui est passionnante à exercer. Et au Danemark La différence, c'est que les médecins danois collaborent avec l'hôpital :",French
+"c'est-à-dire qu'ils vont régulièrement à l'hôpital et il y a une vraie collaboration avec l'hôpital, tandis qu'ici, avec l'hôpital il y a maintenant une concurrence avec l'hôpital qui fait des choses qui pourraient parfaitement être faites en ville. et et si on veut -Donc, c'est un système",French
+"qui vous qui vous paraît plutôt positif ? -Mais mais Vous avez parlé du Danemark, vous avez parlé aussi de la Creuse. La Creuse Je suis allé à Royère-de-Vassivière, où qui qui est un désert de population. Mais mais à Royère-de-Vassivière,",French
+"les médecins ont fait venir des internes, les les maires ont logé les internes, il y a eu une prime pour que les internes puissent venir dans la Creuse. et Quand j'ai visité ce cabinet, il y avait quatre médecins qui avaient deux collaborateurs,",French
+"qui étaient d'anciens internes c'est-à-dire des. -C'est exemplaire, ça ? -Des gens qui étaient prêts à venir s'installer parcequ'ils ont découvert une médecine de de de de 1er recours qui est passionnante à exercer, pour pourvu qu'on donne l'habitude aux internes d'aller dans ces zones",French
+"dans de bonnes conditions. Et Là, ils y allaient dans de bonnes conditions et dans la  -aller dans la Creuse Vous seriez allée vous installer si vous aviez eu la promesse d'avoir des bons collaborateurs ? - C'est aussi simple que ça ? -Non. C'est pas aussi simple c'est que la problématique c'est que Les futurs médecins généralistes sont formés à l'hôpital,",French
+"dans un système universitaire,d'accord? pour toutes les problématiques aussi de main-d'oeuvre à l'hôpital, de les internes qui vont aider à ça aider à ça. C'est la problématique des formations initiale la formation continue juste à la sortie de l'internat.",French
+"Si on arrive à revaloriser ce métier au sens large, redonner du sens redonner envie de le faire... Les maîtres de stage sur le terrain transmettent une passion d'un métier. Encore faut-il qu'elle existe. et Une fois qu'elle est transmise, si elle arrive à être transmise mais Je pense que les gens ils ont envie",French
+"de faire de la médecine, ils envie de faire du soin, finalement quel que soit l'endroit, à condition, comme le disait le Dr Hamon, que ils puissent y vivre confortablement, avec leurs familles une attractivité aussi pour les conjoints pour avoir des professions etc. C'est la répartition sur le territoire qui compte",French
+"avec l'organisation par territoire. -Alors Pour bien comprendre ce qu'est l'exercice de la médecine aujourd'hui, et vous l'avez dit, il suffit pas de faire des incitations, il faut rendre une attractivité au métier. Il y a Beaucoup de jeunes médecins aujourd'hui qui cherchent un bon équilibre",French
+"pour ne pas craquer, pour ne pas avoir de burn-out. Je voudrais qu'on aille qu'on suive alors un médecin à Marseille, un jeune médecin que généraliste qui a a trouvé une solution pour pouvoir combiner son plaisir, sa vocation,",French
+"avec sa vie personnelle. C'est un reportage de Marianne Cazaux. -Nager pendant sa journée de travail, c'est commun pour un athlète, moins pour un médecin généraliste,",French
+"Depuis cette période-là, je vois les choses différemment, et je prends plus le temps de décompresser, de gérer les choses, de mettre des limites, ce que je faisais peut-être pas. -Une décision nécessaire",French
+"pour tenir le rythme, car les journées du Dr Nieto ressemblent souvent à un numéro d'équilibriste. Ouverture du cabinet à 8h45. -Ce matin, j'ai 12 consultations qui sont prévues.",French
+"-Quelques minutes avant que le flot ininterrompu des patients n'arrive. -Bonjour, monsieur. -Jeunes ou âgés, en bonne santé ou souffrant de plusieurs maladies chroniques, les patients se suivent et les consultations s'enchaînent.",French
+"-Alors voilà, on a la prise de sang de contrôle. On a dit la mammo. La colon, on est bon. Vous en êtes où niveau vaccination Covid, grippe ? -En tant que médecin traitant,",French
+"Thierry Nieto doit faire de la prévention, prendre le temps d'expliquer... -Elle est nickel, la tension : 107/59. En langage courant, on dit 10/5. -...et de rassurer les patients. -Quand on manque beaucoup de fer,",French
+"on a fini par faire des anémies, on a les globules rouges baissent et c'est là qu'on a des symptômes : he qu'on est fatigué, qu'on est essouflé. C'est pas le cas du tout hein. Vous, c'est juste les réserves en fer qui sont un peu basses, mais ça s'explique par rapport à votre alimentation. -Mais ce faisant, le temps file,",French
+"alors il faut gérer les priorités... -Ca peut être intéressant de faire la kiné, rééducation du rachis lombaire. -D'accord. -Et après, on s'occupera",French
+"du problème hémato sans urgence. Bonne journée. A bientôt - Merci -...ce qui est difficile à vivre pour ce médecin très investi. On est tout le temps torturé entre essayer de faire de la qualité, et donc là si je veux faire de la qualité, je garde tout le monde longtemps",French
+"poser les questions qu'il faut pour pouvoir les soigner plus rapidement. Et Oui, c'est ça qui est qui est dommage, en fait. -Car aux consultations s'ajoutent plus de 5 heures par semaine de tâches administratives.",French
+"-Il n'y a plus rien qui marche. -Thierry Nieto s'y attelle pendant sa pause déjeuner, avant de commencer sa tournée des visites à domicile.",French
+"-Du coup, vous toussez un peu. -Elles sont essentielles pour ces patients âgés qui ne peuvent plus se déplacer jusqu'au cabinet. -Ils vous ont remis un petit peu d'attaque. -Les autres docteurs, c'est très compliqué.",French
+"Il y en a qui ne veulent plus venir à domicile. C'est vrai, hein. J'ai subi sept opérations, quand même. Deux de la colonne vertébrale, deux du genou, dans la prothèse, et quatre de la hanche.",French
+"-Thierry Nieto se voit comme un médecin de famille. Il tient à ces moments privilégiés avec des personnes qu'il suit sur le long terme, comme cette patiente dont il a accompagné la mère",French
+"jusqu'à la fin de ses jours. Mais il a décidé de ne plus prendre de nouveaux patients qui n'ont pas la capacité de se rendre au cabinet, car une visite n'est pas rentable pour un médecin libéral. Elle prend 3 à 4 fois plus de temps",French
+"qu'une consultation pour seulement 10 euros de plus. Du coup, 35, s'il vous plaît. -En faisant ce choix, Thierry Nieto ne peut s'empêcher de culpabiliser. -On essaie de leur trouver des solutions,",French
+"mais ils nous disent : est-ce que ""Vous connaissez un confrère ""qui fait des visites à domicile ?"" Malheureusement Non, parce que la plupart ils sont dans le même cas que moi. Il y en a qui en font plus du tout d'ailleurs. Nous On fait quand même ce boulot pour pour aider les gens, pour les soigner et pas pour refuser des soins.",French
+"Donc oui, c'est un vrai échec. -Mais pour lui, il n'y a qu'avec cet équilibre fragile qu'il peut tenir sur la durée.",French
+"-Bon, c'est pas le seul métier qui est sous stress, on va pas non plus dramatiser, mais quand même, c'est pas un métier comme les autres. Vous aussi d'ailleur,",French
+"est-ce que vous allez à la piscine, Dr Crest pour...? -Pour moi Je fais du bateau. - Du bateau? mais c'est vital pour vous ? C'est pas seulement un loisir ? -Comme tout le monde C'est l'équilibre de la vie, quelle que soit la profession. Dans la police, les artistes, voyez c'est partout. C'est un équilibre vie privée-vie professionnelle,",French
+"sport-santé, alimentation-santé, sommeil, gestion des émotions. Le métier du soin il subit un certain nombre des violences, en particulier actuellement, des violences par le métier qui est difficile avec ce qu'on vit, les institutions qui mettent des pressions extrêmes sur les médecins généralistes,",French
+"comme si le médecin, en fait, finalement était la cause de toutes ces problématiques du vieillissement de la population du etc, du mal-être de la société. Et Toutes ces pressions font que bah il a vraiment besoin de prendre soin de lui. Parce qu'En fait, si le médecin ne va pas bien, ou l'infirmière, ça marche pour tous les professionnels de santé",French
+"demain, il n'y aura plus personne pour s'occuper des gens. -Alors quoi qu'on en pense voilà, Les jeunes médecins ne veulent pas travailler comme vous avez travaillé pendant des années docteur Hamon. Dire 50 heures par semaine, c'est fini, hein ? -Mais je vous dire, c'est C'est normal,",French
+"parce que les 35 heures sont les 35 heures sont passées par là. Moi Quand je me suis arrivé, quand je me suis installé, j'étais on avait encore l'image du du du médecin généraliste qui était taillable et corvéable à merci, qui se levait la nuit etc.",French
+"que 5 médecins généralistes qu'on est actuellement il faudra sans doute qu'on soit 6 ou 7 pour assurer la continuité des soins. Mais Il faut les moyens d'avoir un secrétariat, c'est-à-dire qu'il faut pouvoir le payer ce secrétariat, C'est ça qui nous décharge",French
+"des tâches administratives. C'est ça qui nous permet d'avoir d'aller faire des visites à domicile chez les personnes âgées qui n'ont plus les moyens de se déplacer. Parce que Ca aussi, si vous voulez on parle du maintien à domicile et personnes âgées, on parle de du vieillissement de la population,",French
+"mais on ne peut maintenir les gens à domicile qu'avec des infirmiers et des kinés qui puissent se déplacer. Or actuellement, les infirmiers se déplacent pour 2,50 euros, 2,75 euros, M. Braun a tweeté qu'il avait augmenté de 10 %",French
+"27 consultations par semaine, 27 consultations par semaine. -On peut aller vérifier ? -en étant salarié en Saône-et-Loire... -On peut vérifier ? -Oui, 300 millions de recettes pour 84 médecins vous faites le calcul. -Bon mais est-ce que vous êtes tous d'accord pour revenir sur la téléconsultation ?",French
+"que pour vous c'est un contre-modèle ? Ou est-ce que... J'aurais vu Il y a un chiffre qui m'a frappée. 80 000 téléconsultations en 2019, avant le Covid, bien sûr. 9 millions 400 mille",French
+"en 2021. -7 sur 10 en zone urbaine. -7 sur 10 Et alors, quelles conclusions ? -Quelles conclusions ? C'est que La télémédecine, c'est un outil qui s'adresse à des patientèles, c'est une étude de la DREES, qui sont jeunes, qui sont connectées, qui sont",French
+"et donc en effet qui ont moins de problèmes de santé et qu'on est plus à l'aise avec le numérique. A priori, c'est peut-être un petit peu mieux. - D'accord. - En revanche, pour aller vers l'accompagnement",French
+"des personnes qui sont en pathologies chroniques éstar, il faut il faut du lien humain et on là on a besoin de sortir du modèle du seul médecin traitant qui fait tout, On a besoin d'aller sur des délégations d'actes, on a besoin d'aller sur du travail en équipe,",French
+"de travail avec des infirmiers. -Et Zéro coordination. Zéro coordination -C'est important, on on l'a pas évoqué encore, mais une des voies d'avenir effectivement, c'est de sortir du mythe du médecin qui peut tout faire",French
+"et qui travaille beaucoup plus en équipe en travaillant et en acceptant par exemple de faire monter en en en en en responsabilités... -Attendez, alors mais de quelle de quelle ... De quelle tâche doit-il se décharger, vous dites le médecin qui peut tous faire?",French
+à à des infirmières qui sont formées pour ça. -C'est votre proposition de loi ? -C'est dans une autre... -Des certificats pour enfants malades peuvent être remplacés... -Le Sénat l'a rajouté.,French
+"-...ça a été adopté par des déclarations sur l'honneur. Intéressant. Est-ce que Vous êtes d'accord ? -Alors,il y a beaucoup de choses, il y a le tout ce qui est tâches administratives, les certificats, etc., effectivement ça c'est il faut absolument revenir là-dessus, c'est une perte de temps incroyable,",French
+"par contre, si la médecine de demain, c'est les téléconsultations et cetera, moi, j'arrête le métier que je fais parce que, j'ai besoin de toucher les gens, les examiner, de leur parler . -Vous les verrez toujours, vous aurez toujours des patients. -ça sera pas du tout pareil.",French
+"et je pense que C'est une grosse perte de sens sur le métier. Par contre, il y a un truc qu'on a pas abordé, c'est que le patient a un rôle-clé à jouer là-dedans, et on parle pas beaucoup de prévention. On n'est pas très bons, en France, par rapport à ça. il y a Beaucoup de téléconsultations sur les jeunes et cetera",French
+"sont pour des réponses d'anxiété, de manque de formation d'éducation en santé de la population de manière globale, c'est-à-dire que les gens sont extrêmement anxieux, surtout depuis le Covid, ils ont besoin d'être",French
+"encore plus assistés, écoutés et accompagnés. Ca tombe sur le médecin traitant forcément, mais sur les autres professionnels de santé. En termes de prévention, il y a énormément de travail à faire. On pourrait limiter l'accès... Bien sûr oui ! Tout ce qui est prévention santé, alimentation santé, sport santé,",French
+"ça a un impact pas forcément un instant T, mais un instant T+1, sur toutes les maladies chroniques et cetera. -Si je comprends bien docteur, pour résumer, mais si je me trompe vous le dites, la prévention, c'est tellement important que vous êtes d'accord pour déléguer certaines tâches,",French
+"par exemple certificat médical au début de l'année scolaire pour les enfants... - ou le certificat médical, il n'a pas de valeur juridique. -Et même les vaccins ? Les vaccins? Le renouvellement de vaccins? -La délégation de tâche elle doit se faire de manière bilatérale et coordonnée. Evidemment qu'Il y a des tâches",French
+"qui sont qui sont à déléguer à d'autres personnes de du moment ça permet de faire la prévention évidemment -Chaque fois qu'on a voulu avancer dans cette voie là on s'est heurté à des batailles sans fin, enfin rappelez-vous la bataille pour que les pharmaciens puissent vacciner, ça a été une bataille effectivement contre pardon mais les syndicats de médecins,",French
+"qui étaient contre. Les infirmières de pratique avancée bataillent contre les syndicats de médecins qui son contre . A chaque fois qu'on a eu la la la volonté de dire : ""et On va on va on va essayer de de d'organiser",French
+"""des des des équipes de de soin autour du médecin..."" peut dire Il s'agit pas de de de mettre marginaliser le le rôle et la place du médecin... -Et pourtant, ça permet de faire de la meilleure qualité. un exemple Dans un centre de santé où je suis bénévole en Seine-Saint-Denis,",French
+"dans lequel il y a une infirmière de pratique avancée qui travaille aux côtés de médecins, elle prend des consultations de 1 heure avec ses patients diabétiques. La qualité est incommensurable. Le suivi des patients... - Diabétiques etc c'est de la délégation de T extrêmement efficace,",French
+"avec le médecin dans le bureau d'à côté... -C'est grâce à quoi ? - ... avec des professions qui travaillent ensemble. - Grâce à quoi ça existe ? -ça c'est parce qu'on est détaché du paiement à l'acte, parce qu'on accepte La délégation de tâche et parce qu'on a des structures pluriprofessionnelles, avec des des professionnels qui travaillent ensemble.",French
+"-Je voudrais qu'on... je voudrais... -Pour généraliser ça en France entière, et et imaginez le coût de ce que vous présentez là ! Imaginez que que moi J'ai une infirmière en pratique avancée qui prend une heure avec un patient. Ce serait Formidable, mais qui la paye, et combien vous la payez ?",French
+"Et et Quels locaux vous avez vous savez? -Alors Docteur, je voudrais vous soumettre un autre modèle vous allez me dire parce que C'est assez frappant. On va retourner dans la Creuse, pardon. Parceque C'est encore une fois un des départements les plus concernés par notre sujet, à Ajain.",French
+"Et bien Là, les médecins sont pas regroupés, les médecins se succèdent, et ils font des missions d'une semaine, et c'est à cette condition-là qu'on arrive à avoir un médecin devant les patients.",French
+"Reportage Marianne Cazaux. -C'est peut-être difficile à croire, mais il est parfois plus facile de trouver 50 médecins qu'un seul. Dans le village d'Ajain,",French
+"dans la Creuse, chaque semaine, les généralistes se suivent et ne se ressemblent pas. -C'est une dame, le médecin, aujourd'hui. C'est une dame. Elle est très gentille.",French
+"-Sous le regard des coordinatrices, les praticiens se relaient pour assurer l'accès aux soins des habitants de ce désert médical. 1200 patients ont choisi ce centre de santé comme médecin traitant.",French
+"-Centre médical d'Ajain, bonjour ? Je vous mets avec un autre patient, mais comme c'est une urgence... Quand il y a eu une proposition de poste de publiée,",French
+"je me suis demandé ce que c'était. C'était assez curieux. et et On se lance là-dedans, parce qu'on se dit qu'on est dans une aventure où on est là pour aider, pour trouver des solutions, surtout,",French
+"de pas juste rester en se disant ""mince on n'a rien"". -Plus de 200 généralistes se sont eux aussi engagés dans le projet du collectif des Médecins Solidaires. Le planning des remplacements est plein jusqu'en janvier 2024.",French
+"quand tu rentres ici tu sais jamais comment va être ta nuit. [...] Moi j'aime beaucoup ce que je fais, mais c'est fatiguant. ça ne fait que 2 ans que je suis là, et j'en peux plus. ça sent fort là. il y a",French
+"des insectes là, Monsieur. il faut qu'on s'accroche, parce que sinon l'hôpital va s'éteindre, et donc c'est les plus pauvres qui qui subissent les",French
+conséquences de ça. je sais que c'est pas marrant. ils sont déjà partis les pompiers? vous,French
+avez des pompiers? d'Argenteuil. bonjour monsieur.,French
+Monsieur bonjour vous êtes à l'hôpital. est-ce que vous avez mal quelque part? dans la tête ça fait mal ou pas? dans la,French
+tête ça fait mal? dans la poitrine ça fait mal? d'accord bouger les jambes. bouger les deux jambes s'il vous plaît. bouger les jambes.,French
+pourquoi vous pourquoi vous me donnez pas encore on arrive il faut être un peu ferme avec,French
+lui tu vois Alicia tu as un patient qui répond pas enfin tu vois qu'ils peuvent pas vraiment faire il faut que toi-même tu fasses des examens pour voir. donc j'ai,French
+pas l'impression qu'il est évident. là je me pose la question parce que je tiens un peu moins bien. tenez la jambe tenez la jambe,French
+le bilan l'IRM la totale. oui bonjour madame docteur Girard aux urgences de,French
+à tout de suite au revoir. donc il est prof de gestion à 70 ans franchement,French
+stylé il y a quand même des gens stylés dans ce monde mais bon là tu te dis vraiment le mec. elle est très bien il y a 5 heures et là,French
+ça se trouve il va être handicapé à vie quoi. OK,French
+je sais pas on va prendre malades dans une gare au niveau minimum 20 minimum 20.,French
+après ça va de la consultation très facile au cas qui vont prendre 8h ou tu vas pas t'en sortir tu vois donc ça les chiffres ça fait un peu tout leur dire.,French
+ça ça représente les urgences vraiment géographiquement avec tous les patients qui arrivent et donc là on a toute la,French
+partie plus grave des urgences qu'elle SAS et pour l'instant on a un patient qui est et donc là j'ai un choix horrible. est-ce que je mets un jeune de,French
+19 ans qui a hyper mal à cause de cette épanocytose dans un lit ou est-ce que je mets un monsieur de 81 ans qui a un AVC et pour lequel il y a pas de place en,French
+neuro et donc voilà on est obligé de choisir.,French
+"bonjour monsieur racontez-moi ce qui vous amène soulevé un pack de dos, ça fait 10 kilos",French
+et puis j'ai très mal. vous êtes tout seul à la maison? et vous,French
+gérez tout seul le pavillon? c'est vous qui vous faites à manger? oui. vous êtes totalement autonome? oui. [...],French
+"vous avez 90 ans? oui bientôt. bientôt. vous avez mal? si, là. là ça vous fait mal? oui de droite à droite.",French
+le fait d'avoir porté une charge lourde et d'avoir senti ça c'est ce qu'on appelle un lumbago. oui j'ai fait ça. comme je me croyais toujours en moi-même.,French
+Je vous l'aide? croyez-moi. on va essayer de vous soulager surtout de vous trouver un médicament pour la douleur qui peut vous aider on appellera une ambulance pour,French
+vous faire rentrer avec ce médicament là d'accord? c'est ça qui vous inquiète?,French
+il faut plus que vous vous mettiez en position complètement couché monsieur il va falloir rester assis le temps que le lumbago passe parce que c'est ce,French
+mouvement là qui va vous faire très mal. pour essayer de me lever quand je suis,French
+arrivé là j'ai voulu me retourner je suis tombé. hier je suis tombé aussi. bon. je vais appeler votre fille et je vais discuter avec elle. d'accord?,French
+c'est compliqué ça. en 20 ans les hôpitaux publics ont perdu,French
+"un quart de leur capacité d'accueil soit quasiment 80 000 lits, une baisse qui s'explique parce qu'on appelle le virage ambulatoire. au lieu de soigner à",French
+"l'hôpital on développe la médecine de ville, d'une part via la médecine libérale, médecin généraliste, infirmière à domicile etc., d'autre part via des hospitalisations de plus en plus courtes",French
+"à l'hôpital histoire que les patients ne dorment pas sur place. par ailleurs, depuis les années 2000 on a réduit la prise en charge des personnes âgées à",French
+l'hôpital avec le développement des EHPAD et des soins à domicile. mais alors est-ce que ça a vraiment fait baisser le nombre de passages aux urgences? et bah,French
+"pas vraiment, ce chiffre a même augmenté de 67% en 20 ans. beaucoup critiquent la logique de rentabilité qui s'est installée à l'hôpital. et c'est vrai que",French
+les économies qui lui sont demandées ont drastiquement augmenté depuis 2016.,French
+les gars je suis en train... ah attendez... qui est scan? qui autres trucs? ok super,French
+j'ai eu votre fille au téléphone elle elle m'a dit qu'elle pouvait se déplacer chez vous demain mais pas ce soir.,French
+"et la nuit vous allez dormir monsieur. j'ai pas dormi de la nuit dernière. c'est pas que je veux pas vous garder,",French
+c'est que je ne peux pas. vous comprenez ça? je sais bien vous avez mal c'est ça qui,French
+je mets votre sac à côté de vous d'accord?,French
+ça me brise le coeur de mes retours,French
+la patientèle Saint-Denis bah oui il y,French
+a une précarité qui fait que il y a certaines situations sociales qui nous amènent à devoir prendre des décisions à des moments qui sont pas juste médical,French
+mais social. vous prenez votre douche ou pas Monsieur? est-ce que ça sent fort là?,French
+"il y a des insectes là Monsieur. c'est la conséquence directe de gens qui trouvent pas de médecin généraliste, savent plus quoi faire, ont mal et donc consultent",French
+parce que ils viennent pas par plaisir aux urgences les gens ils viennent jamais leur plaisir ici. vous avez quoi comme couverture sociale?,French
+rien? je peux vous donner le contact d'une assistante sociale. c'est beaucoup plus important et beaucoup plus compliqué aujourd'hui,French
+finalement de trouver un médecin généraliste quelqu'un qui va vous suivre de manière assez complète que finalement d'avoir accès à un médecin aujourd'hui,French
+"avec la téléconsultation doctolib on voit se multiplier cette cette offre là et tant mieux on en a besoin. mais en fait quand on creuse le sujet, ça ça",French
+reste comme notre chef le dit de la médecine fast food et ça c'est très compliqué notamment pour la patientèle qu'on a ici.,French
+ça je pourrai pas comprendre parlez-moi en français. je vois que vous parlez très bien français. je vais vous donner un médicament.,French
+"qui parle pas français, qui a pas de couverture sociale, et qui sait pas où elle est, bah en fait à part les urgences en rouge ou vert 24 heures sur 24,",French
+je vois pas comment d'autres il pourrait être insérés dans un circuit en fait si on est très honnête. si l'hôpital le fait pas il reste quoi quoi.,French
+parce que nous pour l'instant on a trois on a trois patients qu'on doit garder. alors ce qu'il faut savoir c'est que j'ai renforcé les urgences avec le,French
+renfort du renfort. le renfort du renfort? ou l'héberger en chair pour que la,French
+Neurol reprenne on héberge non? normalement oui. d'accord. on va héberger en chair.,French
+quand tu rentres ici tu sais jamais comment on va être ta nuit ou ta journée. j'ai commencé à 21h je me suis pas,French
+"j'ai travaillé, j'ai bougé beaucoup de dans tous les sens.",French
+le salaire pour moi il doit être proportionnelle à la charge de travail,French
+et il est pas proportionnelle. vous faites combien d'heures? c'est vraiment le minimum en moyenne moi c'est ça 40 à 60 heures,French
+on s'en va du tout protéger on a ma sécurité les patients sont très très,French
+"agressifs parce que du coup bah forcément vu avant de personnel il y a beaucoup d'attentes, donc les gens s'impatientes et du coup bah ça va",French
+rapidement en insulte en violence voilà. je trouve qu'ils sortent. ça fait une baisse d'empathie je trouve,French
+des gens on est moins empathique qu'avant. il baisse empathie aussi ouais ça se ressemble à des patients c'est on est en fait voilà ça se ressent. je fais juste,French
+du travail à la chaîne c'est même plus parce qu'on a pas le temps de de prendre en charge le patient correctement. après on est consciencieux quand même dans,French
+notre travail on va faire les choses mais on les fait tellement rapidement et tellement machinalement. on prend plus de temps de discuter avec le patient et de,French
+"voir si on a plus le temps de voir s'il va mieux, pourquoi il est dans ces conditions, pourquoi il est comme ça, parce que des fois psychologique pour le patient son",French
+passage aux urgences et on n'a pas le temps forcément de discuter avec eux. c'est juste faire les soins et partir,French
+je suis en train de gâcher ma jeunesse ici on aime vraiment ce qu'on fait moi,French
+"j'aime beaucoup ce que je fais mais c'est fatiguant et ça ne fait que 2 ans que je suis là, et j'en peux plus franchement j'en peux plus. défense le lien entre nous on se",French
+reconvertit on va changer on va ouvrir un resto ouvrir un resto. quasiment toute la Seine-Saint-Denis est,French
+classée comme désert médical avancé. il y a un médecin pour 990 personnes là où la moyenne française est de 1 pour 676 personnes. les médecins en,French
+Seine-Saint-Denis doivent donc potentiellement s'occuper d'un tiers de patients en plus. pénurie de médecins à 100000 travers la France la raison trop peu de place dans les facs de médecine sur les,French
+"10 dernières années les gouvernements ont augmenté le nombre d'admissions jusqu'à supprimer la limite de place le numerus clausus en 2021, seul bémol les",French
+effets de ces décisions ne seront pas visibles avant une dizaine d'années. pour ce qui est du personnel soignant à l'hôpital de La Fontaine 20% des postes d'infirmiers aide-soignants sont vacants.,French
+si on compare aux autres pays européens le salaire des infirmiers français est à la traîne. les infirmiers espagnols sont payés 32% de plus et les Allemands 42%,French
+quant au Belge c'est 98% de plus. dans ces conditions c'est pas étonnant que 99% des établissements en France déclarent avoir des difficultés à,French
+"recruter. pour enrayer la crise, le gouvernement a annoncé une augmentation des salaires de 183 euros net lors du Ségur de la santé. mais c'est jugé",French
+"insuffisant par beaucoup de soignants au vu des conditions de travail, et ça reste en dessous de la moyenne européenne.",French
+hier. et là il est 4h du mat tiens à 5h du,French
+matin. vous vous êtes? le fils. et vous vous êtes? la fille. d'accord je voulais juste faire un point parce que nous on l'a vu hier votre papa,French
+chute. nous ce qu'on aimerait en fait c'est qu'il puisse arrêter de faire les allers-retours et qui sont en fait dans un service neurologique on peut lui,French
+il est complètement confus mais genre genre faux de verniquer quoi c'est tout son aire du,French
+langage mais qu'il est prof de gestion à 70 ans en école de commerce il était en cours tout à l'heure quoi. c'est triste.,French
+donc finalement ça saigne à l'intérieur de sa tête. donc là faut croiser les doigts pour,French
+qu'en fait le saignement se résorbe. pendant cette phase aiguë de quelques jours il va rester dans un centre spécialisé pour être sûr que les choses,French
+ne s'aggravent pas et à partir du moment où on sait que c'est stable ils peuvent penser avoir une idée de ce qui va garder malheureusement et elle a le,French
+potentiel de récupération qui va avoir quoi. puis voilà mais bon un monsieur qui était encore en activité jusqu'à aujourd'hui je pense quand même que il y,French
+aura aucun retour à l'état antérieur possible quand on voit la taille de son saignement je lui souhaite de récupérer au maximum mais intégralement j'ai du,French
+mal à y croire. comment tu fais en toi les impacts de des maladies d'éléments éventuels? comment on gère bah il,French
+faut toujours avoir beaucoup d'humilité parce que en fait le principal concerné c'est le malade c'est pas moi. ensuite tu prends du recul c'est à dire que moi je,French
+me dis toujours j'assiste à la proportion de choses comme ça qui arrive c'est sûr que on la voit de manière très condensée dans notre métier mais c'est,French
+"en fait entre guillemets juste la part statistique de gens malades on voit de très près dans notre boulot, donc on gère comme ça quoi, avec un peu d'équilibre de",French
+puis-je faire pour vous bonjour c'était pour prendre un rendez vous s'il vous plaît oui très bien puis-je vous demander votre nom et votre,French
+prénom s'il vous plaît oui alors c'est lucmila vakili d'accord pourriez-vous me rappeler votre nom s'il vous plaît alors V A K I L I d'accord,French
+très bien et pouvez vous me dire le motif de votre visite oui alors c'était pour un détartrage et un contrôle très bien quelles sont vos,French
+disponibilités s'il vous plaît madame Vakili alors je finis le travail à 18 heures donc après ça c'est bon d'accord donc cette semaine nous avons mardi ou,French
+jeudi à 18 heures quel rendez-vous vous conviendrait le mieux je dis 18 heure c'est parfait d'accord alors madame Vakili pouvez vous,French
+me donner votre numéro de téléphone s'il vous plaît bien sûr alors c'est le 06 84 30 73 83 d'accord et une adresse s'il,French
+vous plaît alors 182 avenue de guéroult d'accord si toutefois vous aviez un empêchement auriez vous la gentillesse,French
+de nous rappeler afin que nous puissions donner votre rendez vous à quelqu'un d'autre oui aucun problème très bien merci donc jeudi à 18h parfait merci beaucoup au,French
+revoir madame Vakili bonne fin de journée au revoir,French
+bonjour cabinet dentaire de docteur celle sous ici qui est à l'appareil que puis-je faire pour vous oui bon je vous appelle parce que j'aimerais venir car j'ai très très,French
+mal à une dent d'accord est ce que vous pourriez me décrire un petit peu la douleur s'il vous plaît oui alors en fait ça me lance depuis depuis hier soir,French
+ça me fait très très mal quand je bois de l'eau froide ça va vraiment pas s'arrêter même si je prends des anti douleurs,French
+d'accord effectivement vous êtes bien gêné le docteur va vous recevoir au plus vite nous avons une place à 13 heures est ce,French
+que cela vous convient oui c'est parfait merci très bien alors je vais prendre votre nom s'il vous plaît alors lucmila,French
+vakili d'accord et un numéro de téléphone 06 84 30 73 83 très bien et bien à tout à l'heure à 13h madame Vakili,French
+à tout à l'heure merci beaucoup bonne fin de journée merci et au revoir,French
+bonjour cabinet dentaire de docteur celle sous icila à l'appareil que puis je faire pour vous bonjour je vous appelle car j'aimerais être prise en urgence,French
+aujourd'hui s'il vous plaît oui que vous arrive-t-il alors j'ai très très mal à une dent d'accord cette douleur vous gêne-t-elle,French
+depuis longtemps oui depuis un moment mais j'ai attendu et puis c'est passé et cette douleur vous at elle déjà réveillé la nuit,French
+non sinon je serais venu aussitôt d'accord nous allons nous en occuper je vais prendre votre nom s'il vous plaît alors c'est Vakili d'accord et,French
+pourriez vous me donner un numéro de téléphone s'il vous plaît bien sûr c'est le 06 84 13 73-83 très bien alors nous pouvons vous recevoir,French
+après demain à 18 heures est ce que cela vous convient pas avant c'est difficile écoutez nous allons conduire d'une chose si vous voyez que la douleur semble,French
+augmenter nous vous recevrons dès votre coup de téléphone sinon le docteur est à même de vous consacrer plus de temps comme convenu après demain qu'en pensez vous mais,French
+écoutez d'accord très bien donc à après demain à 18h bonne fin de journée madame Vakili merci vous aussi au revoir au revoir,French
+ich aber was ist mit dir welche weiterbildung würde dich dann interessieren im moment habe ich sehr viel arbeit und eigentlich gar keine zeit aber weißt du was ich vielleicht mache,German
+ich erledige alle Einkäufe noch selbst und gehe jeden Tag mit unserm Hund durch den Park. Jetzt mit dem Knie dauert es natürlich schon ein bisschen länger.,German
+Trinken Sie bitte mindestens zwei Liter pro Tag. Zwei Liter Alkohol geht noch. Aber Wasser?,German
+entschieden haben aber müssen diese chipkarten da nicht irgendwie personalisierte werden es ist so alle mitarbeiterinnen und mitarbeiter erhalten mit ihrer chipkarte natürlich die zutrittsberechtigung,German
+und ihre Veränderungen miterlebt. Am letzten Tag vor den Ferien trifft sich die Klasse zum Frühstücken. Sie wollen über ihre Erfahrungen aus dem 1. Jahr sprechen.,German
+"ganz egal wo: in 'nem Mordfall Wallanders mit dem Game Boy aufm Klo Ich will weg, einfach verschwinden ein Ticket, ne Bahn und dann nirgends zu finden; am Fischmarkt,",German
+kreis anfangen sie hat zum beispiel erzählt dass sie für eine freundin schon einen internetauftritt gemacht hat und eine idee von ihr ist noch dass sie einfach direkt sodann personen hingeht und,German
+Der Ablauf geht so: Die Patient:innen werden in der Notaufname versorgt. Danach müssen sie auf die Stationen darüber verlegt werden – um Platz zu machen.,German
+mich ja bereits in den vergangenen wochen war ich als externe beraterin für datensicherheit in ihren abteilungen unterwegs und habe mich unter anderem mit ihnen aber auch den mitarbeitenden,German
+auf die nächste lieferung einen nachlass in höhe von 50 prozent des damaligen rechnungsbetrags ja danke das ist doch ein gutes angebot ich schaue mir die farbe auf ihrer homepage an,German
+"Was? - Bei dem Fahrrad. Wisst ihr, woraus das Kabel ist? Aus Kupfer. - Aus Kupfer. Das ist so braun geworden, so dunkel.",German
+komme natürlich auch nicht in leggins und switches für arbeit das alles ist aus meiner sicht wichtig für ein bewerbungsgespräch danke sie haben davon gesprochen dass man für ein vorstellungsgespräch,German
+"der nächsten Zeit noch öfters vermittelt bekommen, aber genau das wäre so ein Fall. Ist doch eigentlich nichts passiert … … Nichts passiert? Patientensicherheit ist",German
+"dann einfach in Chemnitz an der TU einschreiben? Na ja, ganz so einfach war es dann auch wieder nicht. Ich konnte mich online einschreiben, musste aber natürlich die Einschreibungsfrist einhalten.",German
+"aufpasst oder ihnen einen Arzt empfiehlt. Diese Anfragen stellen viele Menschen lieber online, damit sich die Nachbarn nicht belästigt fühlen. Und welche Nachbarschaftsprojekte",German
+"2, 2, 3, 3, 2, 2, 3. Gut, dann könnt ihr jetzt anfangen. Hier läuft vieles anders.",German
+das Krankenhaus der Rettungswagen Der Rettungswagen fährt zum Krankenhaus.,German
+"betrieben wird. Toll! Und die kann man jetzt einfach an irgendeiner glatten Fläche befestigen und dann ein Gerät anschließen? Im Prinzip ja. Ist halt erstmal eine Art Prototyp,",German
+geld verdienen aber ich glaube faire preise glauben sie dass sie davon leben können ich habe mir das so überlegt dass sich das am anfang nebenher machen das heißt ich suche nach meiner,German
+werde ich auf jeden Fall noch üben! Keine Sorge! Und was für ein Rad haben Sie da? Das ist ein E-Mountainbike. Damit kann man auch in den Bergen fahren.,German
+"Was haben Ihre Eltern gesagt, als Sie sagten, ich mach ne Pflegeausbildung? Sie waren auch schockiert, weil sie haben das nicht erwartet.",German
+"Aber auf jeden Fall finde ich, Corni ist ein sehr netter Lehrer. Natürlich sagt er zu den Kindern auch, dass sie leise sein müssen, aber wir sind ein Team.",German
+"Erst so zwischen den Schultern und dann hat es mit den Kopfschmerzen angefangen … Das ist ja jetzt seit ungefähr einem halben Jahr so … Ja, genau. Ein halbes",German
+der Rollstuhl Er sitzt im Rollstuhl. die Krücke,German
+"Also um ganz ehrlich zu sein, erwarte ich nichts, weil ich habe mich nicht getraut, mir vorzustellen, was da alles reinkommt. Ich habe richtig Angst, weil wenn jemand reanimiert werden muss oder wenn da so eine klaffende Wunde ist, bei der ich mir denke:",German
+Emily und Anastasija haben sich angefreundet. In der Pflegeakademie sind sie in derselben Klasse. Wir sind zum Sport gegangen zusammen.,German
+"konnte oder können sollte. Das ist heute anders! Aber ich möchte noch für die jungen Kolleginnen und Kollegen anfügen, dass es wichtig ist, einen klar strukturierten Untersuchungsablauf zu haben!",German
+"dass sie Beschwerden in beiden Beinen haben. Nehmen Sie deswegen das L-Dopa ein? Ja, das ging ja gar nicht mehr! Ich konnte nächtelang nicht schlafen. Ich",German
+unternehmen deren firmengebäude wir reinigen haben ihre bestehenden aufträge entsprechend ihrer neuen regeln geändert wie ihr euch denken könnt heißt dass wir haben mehr,German
+"Es entsteht ein Rückstau in der Notaufnahme, ein so genannter Exit-Block. Das kann dazu führen, dass Notfallpatient:innen nach der Behandlung in weiter entfernte Krankenhäuser verlegt werden -",German
+"ja vom Kofferschleppen, ich weiß es nicht. Aber auf jeden Fall trau ich der Sache nicht. Hat er denn schon länger Probleme mit der Husterei? Er meint, er hätte schon ewig damit zu tun. Aber da wäre nichts! Naja!?",German
+"30 sek. - 30 sek, genau. Morgen. - Morgen. Fangen wir mit Blutdruckmessen an. Das 1. Mal jetzt am Patienten.",German
+"Oder die allermeisten. Also die... Das gehört, glaube ich, dazu. Das gehört zu dem Lebensabschnitt dazu, glaube ich.",German
+Da war vorher eine Raufasertapete drauf. Jörg Schmitz legt auf diese Vorträge großen Wert. Seine Azubis sollen Routine bekommen,German
+"Einen Ultraschall hat der Hausarzt auch bei mir gemacht. Aber von der Leber. Da war auch alles in Ordnung! Muss ich auch noch geröntgt werden? Nein, eine Röntgenaufnahme wird nicht notwendig",German
+"Wir lassen den Perfusor sonst immer mit der Einstellung Milliliter pro Stunde laufen, aber hier ist jetzt Milligramm pro Stunde eingetragen worden. Würden Sie bitte den letzten Teil noch mal wiederholen, ich habe nur Milligramm verstanden",German
+lokale Injektionsbehandlung mit einem Kortikoid brachte kurzfristig eine deutliche Verbesserung der Schmerzsymptomatik. Nach Wiederauftreten der Beschwerden wurde eine Resektion des Prozessus,German
+"Und denken Sie noch dran, die Infusion zu wechseln! Schwester Sigrid, meinen Sie, man hätte ihm einen ZVK legen sollen? … und dann auf die Intensivstation? Ja, schon. Die Oberärztin hat so komisch geguckt? Die schaut öfter mal so ernst. Aber der Herr",German
+auch sehr gern und ich stelle mir das so vor dass sich eventuell auch kurze interviews machen könnte mit den personen um sie so vorzustellen natürlich würde ich auch die speisekarte zeigen,German
+können Sie es anheben? … Sehr gut … Vorhin konnte er es noch nicht anheben. Und er hat es auch nicht gespürt. Der Notarzt hat richtig reingekniffen und er,German
+Untertitel: WDR mediagroup GmbH im Auftrag des WDR (Frau) Hallo. Wir können nicht so lange bei Ihnen bleiben.,German
+"doch nur zu ihrer Mutter. Wo wohnt sie zurzeit? Sie ist schon vor zwei Jahren ins Nachbardorf gezogen. Allein? Jetzt frage ich Sie,",German
+"Anreisedatum, bei Haus Sonja ist die Frist 25 Tage vor Anreisedatum, und bei Pilsachhof 30 Tage. Alles klar. Und gibt's weitere Dienstleistungen in den einzelnen Häusern? Massage oder sowas?",German
+"Er habe dann halt ein bisschen mehr getrunken und die Analgetika seiner Frau eingenommen, wenn die Schmerzen zu arg waren … Also, ein gewisser Alkoholabusus dürfte wohl anzunehmen sein … Ja, da haben Sie wohl recht. Aktuell",German
+nicht mehr ausreichend kalorien und das müssen wir schnellstens ändern ich habe ihn ja schon hochkalorische getränke gegeben ja mehr kalorien aber die drinks schmecken echt nicht so super,German
+so gut ich habe in einer event agentur gearbeitet und die chefin hat dort nie mit den mitarbeitenden über ihre entscheidungen gesprochen deshalb waren die mitarbeitenden oft,German
+"Stell das Beatmungsgerät an! Hat einer das Gel fürs Sono gesehen? Guten Tag, mein Name ist Khadivi, ich bin der diensthabende Arzt der Notaufnahme",German
+die Narkose die Narkosen die Operation,German
+"egal, ob für Gitarre und Schlagzeug oder für ein ganzes Orchester. Doch wie bringt Tobias seine Kompositionen unter die Leute, wie schafft er sich ein größeres Publikum als",German
+sehr hilfreich dort konnte ich mir auch fotos von einigen mitarbeitern ansehen und mir gleich einen eindruck davon verschaffen wie meine zukünftigen kolleginnen und kollegen aussehen und angezogen,German
+"Warum auch immer, wir wissen es nicht, aber es könnte sein, dass sie wieder reanimiert wird. Für die anderen Patient:innen heißt das: Zwei Pflegekräfte und eine Ärztin weniger, längere Wartezeit.",German
+"Sie kommen selbst aus der Pflege. Das ist am Anfang für eine 16-Jährige oder einen 16-Jährigen sehr schwierig, weil damit hatten die noch nie was zu tun.",German
+"Herr Schäfer, ich verstehe Sie richtig, dass Sie schon seit längerem über Luftnot klagen? Also Luftnot … … Schwierigkeiten bei der Atmung?",German
+"Man muss aber auch noch dazu sagen, dass Plastik in den Gewässern nicht nur vom liegen gelassenen Müll stammt, sondern z.B. auch von Kunstfasern aus der Kleidung. Wenn",German
+rote Punkte Samuel hat ganz viele rote Punkte im Gesicht. der Kinderarzt,German
+ins haus zu kommen dann komme ich jetzt dazu wie wir es regeln wollen wenn guten tag aber schneider hier ich interessiere mich für den büroraum in der thüringer straße 12 sie schreiben dass es,German
+"dann wieder stark und so weiter. Denkt hier an die Bewegung, die man mit einem Hammer macht. Etwas ähnlich sind ****************pochende**************** oder",German
+in ihrem Lebenskonzept zu sensibilisieren. Was erwarten Sie von ihrem Leben und wie wirkt sich die Suchtproblematik auf diese Erwartungen aus. Wie groß ist die Spanne zwischen Wunsch,German
+"Ja, ich weiß. Bei meinem Mann mussten sie es schon mal abbrechen, weil noch so viele Körner drin waren. Ja, das ist sehr ärgerlich, wenn sich jemand nicht an die Anleitungen hält. Deswegen dürfen Sie auch drei Tage vor der Untersuchung kein Müsli,",German
+"Jetzt gehts rüber. Kinn auf die Brust. Jawohl. 1, 2, 3. Ja, Moment.",German
+"belasten? In welcher Etage wohnen Sie denn? Naja, genau in der zweiten. Das ging halt nicht in einem durch. Da bin ich kurz stehen geblieben, durchschnaufen und dann weiter.",German
+"oder Bären die geplante Untersuchung vorspielen … … das dürfte wohl kaum das Jahresbudget sprengen. Frau Dierhof, Sie möchten noch etwas einwenden? Nein, nein. Ich möchte auf einen weiteren Punkt",German
+auf keinen fall ich möchte mich bei meinen kolleginnen und kollegen ja nicht gleich unbeliebt machen das verstehe ich bei mir ist es auch so,German
+dich vorher um private dinge kümmern irgendetwas mit dem neuen pizza käse nicht einige kunden haben sich schon beschwert kennst du das problem wie wäre es wenn wir die nächsten tage die gäste immer,German
+dann ist das schon viel für ein Warenhaus. Nur im Weltladen bekommen die Kunden die ganze Welt des Fairen Handels geboten und hasten nicht nur daran vorbei. Weltläden nennen sich nicht umsonst Fachgeschäfte des Fairen Handels. Hier,German
+"Und da können wir nach der Schule, nach der Arbeit oder Wochenende, wenn wir es abklären, üben. Und die sind halt wie in den Prüfungen, diese Kojen.",German
+in dem bereich ganz viel ganz schnell ändert welche weiterbildung möchtest du denn machen ich glaube ich sollte mein englisch verbessern wie kommst du denn auf englisch ich bin froh dass ich,German
+"Viele Pflegekräfte selbst ausbilden ist die eine Strategie des St. Martinus-Krankenhauses. Die andere: herausfinden, was junge Pflegekräfte brauchen,",German
+lastkraftwagen herstellt wie zum beispiel schrauben verbindungsteile und so weiter die sprachen in der firma waren türkisch aber auch englisch und da ich türke bin spreche ich,German
+"Ja, so ist gut. Geht es so mit dem Kopf oder liegt der zu hoch? Tiefer wäre mir lieber. Ich habe es ja auch an der Halswirbelsäule. Na ja, man wird nicht jünger.",German
+"die Besuchszeit die Besuchszeiten Wusstest du, dass sich neue Wörter am besten einprägen,",German
+"Beispiel eher ziehenden oder schneidenden Charakter oder sind sie drückend, brennend? Eher so komisch dumpf und drückend. Strahlen sie die ganze Zeit in den",German
+"seiner COPD schon ein paar Mal bei uns. Heute Morgen ist er wegen erneuter Atembeschwerden aufgenommen worden. Ich hab ihn mir vorhin angeschaut. Neben einer mäßigen Dyspnoe, klagt er vor allem über Schluckbeschwerden … Seit wann?",German
+"etwas Auffälliges gefunden haben. Sie spielen wahrscheinlich auf die alkalische Phosphatase an. Genau. War so ein Gedanke von mir. Nein, die ist nicht erhöht. Bis auf ein grenzwertig normales CRP ist die gesamte",German
+das finde ich gut aber wir müssen uns überlegen was wir bis dahin machen was machen wir wenn das buchungssystem wieder einen fehler macht und noch ein gas vor uns steht denn wir kein zimmer geben,German
+"Wie soll man denn den inneren Schweinehund überwinden? Man muss jeden Tag laufen. Denn das ist natürlich, im Gegensatz zum Sitzen am Schreibtisch. Kleine Kinder rennen permanent umher, bei ihnen gibt es keinen Ausruhetag in der Woche, das müssen wir",German
+zu hause arbeiten liegt mir ich würde ja ständig etwas anderes machen wollen wirst du gar nichts abgelenkt man muss halt diszipliniert sein und ein arbeitszimmer haben mein privates handy bleibt draußen und mein mann und die katze dürfen auch nicht rein,German
+"zweiten Teil der Veranstaltung zu den Fragen aus dem Publikum. Wer möchte … Mir hat das Experiment geholfen, bewusster einzukaufen. Zum Bioladen bin ich mit einem",German
+"aber krankheitsbedingte Ausfälle gibt es auch. Dann guckt man immer, ob man ein bisschen Personal von einer Station auf die andere verschieben kann.",German
+"Also in der letzten Zeit ist es immer schlimmer geworden. Jetzt sind die Schmerzen nicht nur im Knie, sondern im ganzen Bein. Es zieht sogar nach oben und laufen kann ich ja fast gar nicht mehr.",German
+"dass eine Kollegin ungeduldig wurde und Emily angemotzt hat. Wer so schnell nervös, das kann ja eigentlich sehr problematisch sein.",German
+dahin bitte kein hochladen von dokumenten und dateien in die cloud und auch keine sicherung dort videokonferenzen dürfen nur noch über ein gesichertes konferenzprogramm stattfinden,German
+"normal gewesen, aber dann zum Mittagessen nicht mehr erschienen. Eine Pflegekraft habe sie sehr unruhig und aggressiv im Bett vorgefunden. Bei der Aufnahme war",German
+"ich nicht sagen. Seit Anfang des Jahres nehmen Sie noch ein Antidepressivum ein … Ja, da ging es mir gar nicht gut. Gab es für Sie einen Grund, dass es ihnen nicht so gut ging?",German
+dort zusammen gelegt denn so war das ja auch im vierten stock so sind denn entschuldigung ja bitte frau teslin im ersten stock ist aber doch das lager oder nicht einen moment frau teslin,German
+"ermitteln. Erst mit der Erfindung der Münze wurde dieser Zwischenschritt überflüssig, denn von da an konnte man durch aufgeprägte Bildmotive und Symbole auf den Metallstücken",German
+"hier einen Stand auf der Messe? Also, dieses Jahr bin ich zum ersten Mal hier. Mal sehen … Gespräch 2 Entschuldigung, ich habe gerade mitbekommen, dass Sie Unternehmensberater sind. Sind Sie aus beruflichen Gründen hier?",German
+interessieren wie für sie ideale arbeitszeiten aussehen - flexibilität sehr wichtig ich stehe zum beispiel nicht so gerne früh auf und finde es gut bin ich erst um 9 oder sorge erst zum 10 in,German
+Also gestern Abend war noch nichts. Aber heute Morgen konnte ich konnte ich fast nicht aufstehen. Ich fühle mich so schwach.,German
+"Oh je, der hat bestimmt zwei Mal auf der Station angerufen. Was denn los sei? Er war fürchterlich aufgeregt. Das kannst du wohl sagen. Ich hoffe, ich konnte ihn wenigstens ein klein bisschen beruhigen. Er kommt gegen späten Nachmittag.",German
+"Ein neues Knie! Richtig, und zwar links! Weil rechts hab ich ja schon eine Prothese. Sollte wohl keiner verwechseln, oder? Das denke ich auch. Frau Dr. Lurtz hatte",German
+"Aussage René Vogel Mein Name ist René Vogel, ich bin 27 Jahre alt und seit sieben Jahren arbeite ich als Mechatroniker bei einem",German
+"Ja. Schon. Ja, klar. Meine Frau hat sich da von mir getrennt. Nach zwanzig Jahren … Das ist eine lange Zeit, die sie zusammen waren. Ja, und dann ist sie einfach so ausgezogen.",German
+oder bagatellisiert wird. Das höre ich immer wieder: „Die Wunde war ja so winzig und es hat wirklich nicht viel geblutet.“ Oder ich höre Erklärungen wie: „Wir hatten,German
+"Sie kommen und gehen wie eine Welle am Strand. - Wenn der Schmerz aber immer gleich stark ist, könnten wir sagen: “Der Schmerz ist konstant.”",German
+"Wenn wir gehen, schwingen unsere Arme normalerweise mit. So, sehen Sie. Und bei unserem Patienten fehlte dieses Mitschwingen. Und ich gebe Ihnen noch einen Hinweis. Diesmal",German
+"möchte auch keine Tropfen nehmen? Nein, nein! Sie will das Novamin lieber als Tropfen einnehmen. Danke, jetzt habe ich Sie verstanden. Ja, von mir aus spricht nichts dagegen, wenn Frau Itter statt der Tabletten Tropfen einnimmt.",German
+"Was ist passiert? Nichts erklärt usw. Ich soll Vitalzeichen messen, dann muss ich noch die Betten machen. Ich kann das nicht alleine alles auf einmal so.",German
+"auf und waren eine echte Novität Denn anders als Vieh, Getreide oder Muscheln handelte es sich hier nicht mehr um Waren, die man selbst– etwa als Nahrungsmittel, Schmuck oder Kleidung - nutzen",German
+Die sind aber trotzdem schon ganz gut. Darf ich mal probieren? - Klar. Sind doch Superbrötchen.,German
+"Die Sprechstundenhilfe sagt: ""Darf ich bitte Ihr Kärtchen haben?"" Tim gibt der Sprechstundenhilfe seine Versichertenkarte.",German
+"wie wir weiter vorgehen wollen und was wir noch untersuchen werden. O.k., danke, Frau Doktor! Die körperliche Untersuchung habe ich jetzt soweit abgeschlossen und Schwester Sylvia wird gleich bei",German
+"beim Touareg, und vier Sitzplätze beim Opel, und ja, der Smart ist ja berühmt für seine Kleinheit, da gibt's halt nur zwei Sitzplätze. Und wie sieht's denn mit der Sonderausstattung aus?",German
+"Das Omeprazol? Ja, so ähnlich. Das hat mir der Herr Waldmüller noch verschrieben, weil ich immer Sodbrennen hatte. Und da ist es ja auch erst mal besser geworden. Aber seit ein paar Wochen hilft das auch nicht mehr so richtig. Obwohl es",German
+"Neugeborenen, Säuglingen, Kleinkindern, Schulkindern und Jugendlichen zu tun. Lassen Sie uns ganz grob den Fokus auf das Alter zwischen ein und sechs Jahren legen. Ich denke, der Umgang mit Frühgeborenen betrifft doch eher nur eine kleine Gruppe von",German
+die fahrten dahin sind leider zu teuer das können wir uns nicht jedes jahr leisten ja das verstehe ich das ist bei mir ganz ähnlich ich habe auch noch viel verwandtschaft in meinem heimatland,German
+"Am Anfang war ich schon ein bisschen aufgeregt. Ich bin ja neu in der Stadt und kannte noch keinen. Aber man lernt an der Uni schnell Leute kennen, weil alle sehr offen und entspannt sind. Schwierig finde ich, sich in den vielen verschiedenen",German
+"wie ein starker Sonnenbrand” oder “Es fühlt sich an, als würde jemand meinen Magen auseinanderziehen” oder “Es fühlt sich so an, wie wenn man sich den Ellbogen stößt”. Der",German
+Na dann. Der Magentumor hat noch nicht gestreut. Die Leber ist gesund. Wir haben dort keine Tochtergeschwülste gefunden. Ihre Lunge ist völlig Ordnung!,German
+"Aha. Ja gut. Dann werd'ma uns das gut überlegen, und müssen uns da irgendwie an den entsprechenden Orten melden. Dafür bräuchten wir vielleicht eine Telefonnummer. Ja also die Telefonnummer. Vorwahl ist bei allen 004304242, und bei Pilsachhof wählen",German
+"Die Leute sind alle sehr nett, da gibt es nix. Mir tun nur die Schwestern so leid, weil sie so rennen müssen. Ja, ist nun mal so.",German
+- 0 wäre: “Es tut gar nicht weh” oder “Ich habe gar keine Schmerzen”. - Auf den Stufen 1 bis 3 sprechen wir von “leichten Schmerzen”. Wir können zum Beispiel sagen: “Es tut ein bisschen weh”,German
+schmerzbedingt kaum schlucken. Schon eine minimale Drehung des Kopfes verschlimmerte die Schmerzsituation ins Unerträgliche. Nach eingehender Untersuchung erfolgte eine MRT der,German
+könnte ich mich gut aus was willst du denn wissen wie ist es denn zum beispiel mit den pausen du hast das recht auf mindestens 30 minuten pause wenn du zwischen sechs und neun stunden arbeit ist wenn du neun stunden arbeitet darfst du 45 minuten pause machen das kann ich,German
+"Wie beschreibt man eigentlich Schmerzen auf Deutsch? Als ich Anfang des Jahres im Urlaub in Spanien war, musste ich als Notfall ins Krankenhaus. Ich wurde dort",German
+malermeister fechner ich bin ja schon lange ein zufriedener kunde bei ihnen aber kürzlich hatte ich leider ärger mit einer außenfarbe da musste ich eine garagenwand dreimal streichen um,German
+"Ist ein 12-Kanal-EKG vorhanden, kann die Diagnose eines ST-Strecken-Hebungsinfarktes mit großer Sicherheit gestellt werden.",German
+werden konnte das unternehmen hat viel geld in grüne technologie investiert und auch auf dem gebiet geforscht das besondere an unserem unternehmen war dass es viele weiterbildungen,German
+"kernhaltiges Obst oder Paprika mehr essen. Auch kein Vollkornbrot? Um ein verwertbares Ergebnis zu erreichen, sollten Sie auf Vollkornbrot verzichten,",German
+"Auf 6,5 runtergegangen. Ich wollte ja nur sagen, was alles noch anliegt. Könnte ich eventuell bei einer Koloskopie dabei sein? Von mir aus geht das in Ordnung. Wir haben nur heute Nachmittag noch zwei",German
+Und nun werde ich ihre Temperatur messen. Also Sie haben leichtes Fieber und Ihr Hals ist rot.,German
+dem notebook zu hause lesen oder die anhänge verdächtige e-mails öffnen anstatt sie zu melden oder die mail gleich zu löschen wenn sie verhindern möchten dass sich kriminelle,German
+heißt es muss zur branche zum betrieb und zur position aber auch zu einem selbst passen in der baubranche zum beispiel wird er kein anzug erwartet aber wer sich für eine leitende position,German
+welchen beruf man sich bewirbt sind vorstellungsgespräche unterschiedlich jetzt spreche über angemessene kleidung für das vorstellungsgespräch denn auch die kleiderwahl ist davon abhängig wo man sich bewirbt angemessen zum schluss möchte ich noch über typische fragen sprechen die bewerber oft gestellt werden fast immer ich möchte darüber sprechen worauf es in ein bewerbungsgespräch in deutschland ankommt als,German
+"erkennen, wie wertvoll sie jeweils waren. Die ersten bekannten Münzen kamen im 7. Jahrhundert vor Christus zur Herrschaftszeit des Königs Krösus im Gebiet der heutigen West-Türkei",German
+in unserem Haus passiert sind. Fall 1: In die Notaufnahme kommt ein 43-jähriger Patient mit Verdacht auf innere Blutungen bei infaustem Tumorleiden und ebenfalls bekannter,German
+"Nein, gar nicht. Möchte ich auch nicht. Wenn ich aufstehen muss oder drücken, oh je! Haben Sie zu Hause Fieber gemessen? Ja, mein Mann hat es mir gemessen.",German
+"von Stadtvierteln oder Nachbarschaften, die diese Funktion haben, gerade weil sie sich zu bestimmten Zielen zusammenschließen, z.B. um für mehr Grünflächen oder eine Verkehrsberuhigung",German
+"120 zu 80. Der ist in Ordnung. Geht es Ihnen wieder besser? Ja, ja. Es war mir nur plötzlich ein wenig komisch … Das passiert schon mal. Ist",German
+"ist, ob sie das CE-Siegel trägt. Und dann diese App auch nur genau für den vorgesehenen Zweck zu nutzen. Anderenfalls könnte es zu Fehlern kommen – etwa wenn eine nicht zertifizierte",German
+"vorstellen würde. O.k., was hat er denn? Zu mir ist er wegen einer Post-Zoster Neuralgie im linken Thorax Bereich Höhe Th 7 Th 8 gekommen. Der Mann ist 72 und arbeitet als Schreinermeister noch im Betrieb",German
+"Knoll war doch die ganze Zeit stabil. Sie wollte, glaube ich nur, dass er von sich aus mehr trinkt … … aber ein wenig verwirrt war er schon bei der Aufnahme … … wenn Sie jeden ein bisschen Verwirrten auf die Intensiv legen wollen, herzlichen",German
+"d.h. wie gut sind die Debattanten informiert und wie viel Kenntnis wurde über die Aktualität und die Bedeutung dieser Fragestellung deutlich. Zweitens das Ausdrucksvermögen, also wie gut",German
+"Ja, ich glaube, gut. Wollen wir mal gucken gehen? - Ja. Dein Lehrer ist da. Hi.",German
+"Tim macht den Mund auf. Die Ärztin schaut in Tims Mund. ""Sag bitte: Aah!""",German
+"Stadtrundfahrt und die Sissi-Tour mitmachen. Und gibt's denn da irgendein interaktives Angebot? Leider sind wir da noch nicht so weit, da können wir ihnen leider nichts anbieten.",German
+"Du hattest im Quartal eine 3+, im letzten, also im 3. Quartal. Jetzt hast du eine 3+ noch mal geschrieben. Ich würde lieber keine Noten geben müssen.",German
+aus dem vierten stock ausziehen korrekt herr stock sie und ihr team werden von ganz oben dann in den ersten stock ziehen auf ihren und den wunsch ihrer mitarbeiter hin werden die einzelbüros,German
+"ich noch gut Einkäufe erledigen, Ausflüge machen, und eben auch mal weitere Strecken bewältigen. Das ginge sonst bald gar nicht mehr. Ja, da ist ein E-Bike wirklich hilfreich. Und",German
+"Das meiste aber lernen sie direkt auf der Station mithilfe ihres Teams. [Die] größte Herausforderung ist natürlich für die ganzen … für die Pflegeteams, in die diese ukrainischen Pflegekräfte integriert sind:",German
+"Der Rettungswagen soll in 10 Minuten hier sein. Das Team weiß nicht genau, was sie gleich erwartet. Raphael bereitet sich so gut vor, wie es geht… Wie viele Leute werden hier gleich...? Alle, die da sind. Also hier die Ärzte, der Oberarzt kommt mit. Normalerweise sollten es schon zwei Pflegekräfte sein,",German
+weißt schon das haus mit der großen terrasse dort sollt ihr das wohnzimmer und die küche neu streichen okay ist gut weiß emilio schon bescheid oder muss ich ihnen noch informieren,German
+"Raphael bereitet ein Medikament vor, das Wasser aus der Lunge lösen soll. Raphael, mach mal 80 Lasix... 80? Trotz aller Eile: Jetzt darf er keinen Fehler machen.",German
+mit einer tasse kaffee in der hand bequemen sessel vor dem monitor genau so ist es na ja es stimmt schon dass man zeitlich etwas flexibler ist aber trotzdem brauche ich dann ruhe und muss,German
+"genau stellen. Ich schlage Ihnen vor, dass wir schnellstmöglich einen Termin für Sie organisieren. Meine Arzthelferin macht Ihnen einen Überweisungsschein fertig. Ich wollte Ihnen meine Tochter vorstellen. Ich habe Sie gebeten, bei dem Gespräch dabei",German
+"die Modelle werden ja auch immer handlicher und werden heutzutage auch gut ausgestattet, gerade auch in puncto Sicherheit. Man muss dann nur rechtzeitig die Bremse finden ... Wenn ich mir eins zugelegt habe,",German
+"Ok, dann hör ich eben. Was hörst du denn? Also, ich hör mir mal an, wie dein Herz schlägt: bumm bumm bumm und dann will ich mal hören, ob du auch richtig tief ein- und ausatmen kannst. Das glaub ich nämlich nicht,",German
+Bereich Der ganze öffentliche Nahverkehr wird ja demnächst auf Elektrofahrzeuge umgestellt. Alle Busse und so. Richtig so. Die Luftverschmutzung ist schließlich ein,German
+"Gibt es die Angst, Fehler zu machen? - Natürlich. Ich arbeite ja mit Menschenleben quasi. Ich gucke 2-, 3-, 4-mal noch mal genauer,",German
+"aktiv zu werden, eine Tempo-30-Zone oder auch einen Zebrastreifen etwa. So ein gemeinsames Ziel schweißt die Leute zusammen. Ein weiterer Trend besteht darin,",German
+Deine 26. (Frau) Hallo. Was ist denn los?,German
+gemeinsamen mittagessen und die gespräche in der kaffeeküche das vermisse ich schon sehr sarrazin sieht man nicht auch mal wieder arbeiten hallo alena arbeiten sieht man,German
+"halten wir für inkonsequent. Dopingmittel, die nachweislich die Gesundheit nicht schädigen, sollten daher erlaubt werden. Die kontrollierte Freigabe trägt dazu bei, die gesundheitlichen Gefahren für Sportler zumindest im Bereich der leistungssteigernden Substanzen zu verringern. In",German
+"weswegen wir gleich noch einmal bei Ihnen Blut abnehmen werden. So, dann schau ich mal weiter durch Ihre Befunde. Das EKG haben wir und eine Lungenfunktion ist auch dabei, wunderbar. Der",German
+trinke meinen kaffee nur aus danach gehe ich dann direkt zur mobil das heißt ihr müsst den neuen drucker in die buchhaltung bringen und die software installieren die warten da nämlich schon,German
+"es zu verlieren oder dass es gestohlen wurde. Die vorerst letzte Station in der Geldentwicklung sind die elektronischen Bankkarten, die Mitte des 20. Jahrhunderts aufkamen. Es handelt sich um",German
+"von der Hochschule Rhein-Main von Marie Brand. Guten Tag, Herr Dammann. Vielen Dank, dass Sie sich die Zeit für das Interview nehmen. Sehr gern.",German
+"Gern geschehen. Machen Sie es gut. Wir sehen uns in zwei Tagen wieder. Wenn dir das Video gefallen hat, schenk mir bitte einen Like.",German
+ausschließlich auf diesen geräten zu speichern und für alle abzulegen im moment überprüfen wir noch inwieweit die cloud den anforderungen entspricht und werden sie dann informieren bis,German
+"Da habe ich ja alles abgegeben. Sehr gut, Frau Tietke. Also, für Ihre 86 Jahre erscheinen Sie mir wirklich sehr fit. Meinen Sie? Ja, da haben Sie eigentlich recht,",German
+"Er hat Schmerzen. Die Schmerzen sind aber schon bekannt. Du weißt woher der Schmerz herkommt und es ist einfach so, die Priorität lag jetzt wahrscheinlich bei jemand anders. Und deswegen hat der Kollege eine andere geholt, weil der 2 triagiert...",German
+"Jeder sollte das machen, was er gerne macht, und das tue ich. Bis später. Soll ich das Licht wieder ausmachen? - Ja bitte.",German
+"sich die Operation bei Ihrer Frau um eine Stunde verzögert. Ja, sie ist ja schon seit heute Morgen im OP. Herr Turino, Sie hatten mich ja gebeten, Sie nach der Operation kurz zu informieren, ob",German
+"Er hatte auf seinen Spaziergängen beobachtet, dass die Früchte der Klette immer im Fell seiner Hunde hängenblieben und sich nur schwer ablösen ließen. Er untersuchte den Mechanismus,",German
+"Nein, ich finde eigentlich nicht. Auf dem Gymnasium fand ich auch nicht alle Fächer leicht. Allerdings bekommt man dort das Wissen in kleineren Portionen vermittelt. Und die Lehrer geben vor, wie viel und welchen Stoff man lernt. Im Studium muss man sich halt",German
+"Ja, ich bin wütend! Ziemlich wütend! Und was macht Sie so wütend? Aber du musst doch jetzt nicht sauer sein! Wir sind doch alle bei dir. Die ganze Zeit!",German
+"Der Patient ist zu Hause gestürzt. Bald kann er wieder entlassen werden. Also, bei mir war 140 zu 80. - 140 zu 80?",German
+"Die Note bekommen Sie nach den Ferien. Ich sehe schon, dass sie gemeinsam das Examen bestreiten. Und bin eigentlich der Hoffnung,",German
+"Ja, bei Ihrem Alter … 81. Genau, ein sehr gutes Ergebnis. Und der Husten ist jetzt auch nicht mehr vorhanden, oder? Es war immer so ein Reizhusten, ganz plötzlich. Aber der ist schon seit zwei Wochen weg.",German
+"Nicole Ehrmann ist die Praxisanleiterin. Was ist bei den Patienten akut? Was müssen wir machen? Ich glaube, alles.",German
+"seiner COPD schon ein paar Mal bei uns. Heute Morgen ist er wegen erneuter Atembeschwerden aufgenommen worden. Ich hab ihn mir vorhin angeschaut. Neben einer mäßigen Dyspnoe, klagt er vor allem über Schluckbeschwerden … Seit wann?",German
+"Was tut Ihnen weh? Ich habe Kopf und Bauchschmerzen. Meine Nase ist verstopft, ich huste und niese.",German
+"Opa. Die freuen sich auch schon gewaltig. Ich glaube, mit Ihrer Abreise morgen früh, das halte ich für keine so gute Idee. Ach so, wie? Das, was Sie und auch Julian geschildert haben und auch die Untersuchungen deuten auf eine",German
+"zu finden, der das Fest abwickeln könnte. Die Sekretärin berichtet nun über ihre Recherche. Guten Tag. Ja, wunderschönen",German
+"sprechen, den wir gerade vor uns hatten. Ist Ihnen irgendetwas Besonderes an ihm aufgefallen? Ich fand es bemerkenswert, dass er irgendwie abwesend auf mich wirkte.",German
+staub auf den umkleide schränken und im damen umkleidebereich war der fußboden zu schmutzig wenn euch da in zukunft was auffällt sagt mir bitte gleich bescheid sowas muss ja nicht sein,German
+"Ich könnte meine Tochter fragen, ob sie mich holt. Wir können ja gleich im Terminplan nachschauen und Sie fragen Ihre Tochter, wann es ihr am besten passt.",German
+"Ja, Manfred Schneider. Es ist jetzt eine richtige Fahrerei bis man beim Hausarzt ist. Der Doktor Waldmüller hat seine Praxis ja Anfang des Jahres zugemacht.",German
+Bitte achtet bei Frau Sandholz auf den Zugang. Sie hat richtig schlechte Venen. Ich mache noch einen Verband … Wir mussten am linken Unterarm einen Neuen legen. Da ging nur eine 20 G rein. O.K. Hat sie schon was gegen die Schmerzen,German
+und dafür sollen wir auch noch mehr als sonst bezahlen ja ich habe also gerade mehrmals versucht mich ein zu locken aber es wird keine verbindung aufgebaut ich,German
+"bestimmte Dopingmittel, die von Medizinern als gesundheitlich unbedenklich gelten freizugeben. Sie sollten auf einer Liste veröffentlicht werden und unter ärztlicher Kontrolle verabreicht werden",German
+"(Frau) Hallo. Wir können nicht so lange bei Ihnen bleiben. Eine verwirrte Patientin versteht nicht, was passiert.",German
+reinigungsunternehmen ändert sich einiges uns treffen dieser neuen hygieneregeln besonders denn nicht nur unser hauptauftraggeber die firma wand sprache sondern eigentlich alle,German
+"Ja, ja, ja da fing das an … denke ich. Sie haben noch eine Tochter, die ist fünfundzwanzig, oder? Ach die, hören Sie auf … die hält",German
+"man muss hören, was passt und was nicht, was harmonisch und was disharmonisch klingt, und natürlich ist das, was wir da machen, Musik, verteidigt Tobias vehement seine Leidenschaft. „Wir kombinieren Töne und Klänge zu kompletten Musikstücken, genauso wie das traditionelle",German
+hätte noch eine idee du hast doch letztes jahr diese weiterbildung gemacht so dieses seminar kommunikation mit eltern und kindern was hältst du davon wenn du mérite darauf hinweist ja das,German
+"dass er auch genug trinkt. Ich habe den Eindruck, dass er da ein wenig hinterherhinkt … Kann schon sein. Aber es geht ihm doch ziemlich gut dafür, dass er erst einen knappen Tag bei uns ist … So soll es ja auch sein …",German
+die wirtin und ich schon besprochen aber heute wollte ich mir im restaurant ansehen wie man den raum dekorieren und die tische stellen könnte das schaffe ich aber nicht könntest du vielleicht für,German
+"Und es wäre tatsächlich so, wenn wir alle Betten hätten, wäre es eigentlich gar kein Problem. Weil ""Betten"" klingt für mich, wie dass ein Möbelstück fehlt. Aber das ist ja eigentlich das Personal... Ja, es ist halt die Personal-Besetzung. Und es ist vor allen Dingen die pflegerische Besetzung.",German
+aus welchen gründen die band sich aufgelöst hat ja ich glaube das war weil der himmel es von teneriffa weg gegangen ist außerdem hatten einige mitglieder der band auch wenige zeit weil,German
+der Gips die Gipse die Krücke,German
+gut aber was sollen wir beachten können sie uns da genaueres sagen dazu komme ich jetzt was muss zukünftig also strenger als bisher beachtet werden geschäftliche e-mails von privaten,German
+gestern hat sich der vater von uran beschwert und gesagt dass er gesehen hat wie marita ungeduldig wurde als urahn sich die hände nicht waschen wollte eine schwierige situation und wenn du,German
+"Einige Sportler könnten sich die Dopingmittel beschaffen, andere aber aus finanziellen Gründen vielleicht nicht. Das sei äußerst unfair und habe seiner Meinung nach mit Sport nichts mehr zu tun.",German
+Auswirkungen des Fehlers auf deren Gesundheit in Kenntnis setzen. Zeigen Sie bei allen weiteren Abläufen Präsenz und kümmern Sie sich um das Wohl des Patienten.,German
+"Wie ist denn die Bettensituation? Katastrophal! Wir haben auf unserer Intensivstation, die hat eigentlich 12 Betten, haben wir nur 8 Betten, die wir belegen können. Und es ist bei allen Stationen so, dass die 20-30 Prozent Reduktion haben.",German
+"ja noch das ganze Leben lang arbeitet, da soll man seine Kindheit ruhig genießen. Gab es noch andere kulturelle Unterschiede, die dich erstaunt haben? Ich war erstaunt, dass auch die Rumänen",German
+klingt als ob du richtig produktiv arbeiten könntest gar keine nachteile und doch ganz klar mit den kollegen mal telefonieren ist nett aber es ersetzt mir nicht die,German
+beispiel als kundenbetreuer in einem fitnesscenter vorstellen wird man von ihnen erwarten dass sie sportlich auftreten und freundlich so dass man weiß ja der kann mit unseren kunden gut umgehen,German
+"Vergessen Sie das nicht. Versuchen Sie mindestens acht Stunden pro Nacht zu schlafen. Alles klar, Herr Doktor.",German
+"Wir haben hier Blut und Urin von der Patientin. Und dann drücke ich das und schickt das ins Labor. Blau ist Notfall. Wenn wir damit Blut schicken, dann ist das Blut innerhalb von zehn, 15 Minuten am Computer angekommen.",German
+"Leistungssport ‚sauber’ zu halten, d.h. frei von Leistungsmanipulation durch Doping. Unter Doping im Sport versteht man die Einnahme von unerlaubten Substanzen oder die Nutzung von unerlaubten",German
+"Beatmungsschwierigkeiten? Aspiration? Nein, war alles unauffällig. Intubation ohne Probleme: AMV 7,5 l bei einer Beatmungsfrequenz von 12. Atemgeräusche",German
+"ist doch der Magen? Oder die Leber? Man sagt ja, dass die Leber gar nicht weh tut. Jedenfalls habe ich dieses Magenmittel eingenommen. Irgendwas mit O glaube ich...",German
+"Sie meinen jetzt mit dem Magen, oder was? Erst einmal möchte ich wissen, wie es Ihnen im Allgemeinen geht. Ich vertrag ja jetzt überhaupt keinen Kaffee mehr. Wobei der Kaffee hier, das ist ja kein Kaffee. Aber dieser Druck und dann diese Übelkeit. Das",German
+wenn ich ihn beim Hausarzt kontrollieren lasse. Da ist er dann oft über 150 zu 90. Kontrollieren Sie den Blutdruck denn regelmäßig? Ich habe mir ein Gerät gekauft und da ist,German
+"Warum denn? Corni ist sehr nett, sehr freundlich, sehr hilfsbereit. Also alles, was nett ist, auf maximal.",German
+problematische situation zu der sie lösungswege diskutieren sollen hier sind die situation und ein paar stichwörter die ihnen helfen können bitte lesen sie und beginnen sie dann,German
+wegschicken wir haben den gästen dann mit einer entschuldigung blumen aufs zimmer gebracht aber manche waren doch ziemlich böse was meinst du was wäre eine gute entschädigung ich schlage,German
+das Pflaster die Pflaster die Spritze,German
+"Merken Sie sich das gut, Frau Steffen: Es kommt gar nicht selten vor, dass Symptome einer Lungenembolie sehr uncharakteristisch sind oder die Patienten sie zum Beispiel als leichten Infekt",German
+Für die verstopfte Nase können Sie diese Nasentropfen benutzen. Kommen Sie bitte wieder in drei Tagen,German
+dann alle gegen marica sind vielleicht könntest du zuerst noch mal mit ihr sprechen ihr versteht euch doch gut okay das probiere ich mal aber es ist schon ein problem dass wir ins team bringen,German
+"die ständig mit Kindern zu tun haben, anderen Kolleginnen und Kollegen geben? Frau Müller? Ganz kurz, zu Beginn, lassen Sie uns bitte eingrenzen, über welche Kinder wir reden. Wir haben es mit Frühgeborenen,",German
+"tagtäglich bei meiner Arbeit. Wir haben zwar bei uns in der Stadt keine Müllberge, aber wenn man alles einsammelt, was man auf den Grünflächen findet, kommt schon ein bisschen was zusammen. Ich glaube, vielen sind die negativen Auswirkungen gar nicht bewusst. Was",German
+gelaufen wir wollten 20 a4 ordner und fünf kartons kopierpapier aber sie haben uns fünf ordner und 20 kartons papier geliefert bitte schicken sie jemanden vorbei das umtauscht und ich möchte,German
+--- - Die Steigerung davon sind dann “mittelstarke Schmerzen”. Wir könnten hier sagen: “Die Schmerzen sind unangenehm” oder “sehr unangenehm” oder “ziemlich unangenehm” oder,German
+"Essen Sie sich jung. Essen Sie wenigstens 50 Prozent Leben, Obst und Gemüse in seiner rohen Form. Und messen Sie die Frohwerte im Blut. Messen Sie Ihren Eiweißgehalt im Blut und",German
+den Patienten und gibt gegebenenfalls Anordnungen an sein Team. In dem zweieinhalbminütigen Gespräch – so lange dauert nämlich einer Studie zufolge im Durchschnitt,German
+"auf dem genau draufsteht, was Sie machen müssen, damit der Darm perfekt gereinigt ist. Wir fangen gleich an und fahren Sie langsam rein. O.K. Und Sie sind immer da?",German
+"Also am Anfang war es so, dass ich sehr unsicher war. Natürlich, diese Verantwortung, das zu erkennen, ist schon groß. Und manchmal gehe ich nach Hause und sage so: Habe ich da richtig triagiert?",German
+"Momentan wünscht sich Emily, nach der Ausbildung hier eine Stelle zu bekommen, auf Station 1. Ich finde die Arbeit da zwar stressiger und anstrengender,",German
+"unangenehmen Untersuchungsschritte durchführen! Und welche meinen Sie damit, Frau Dierhof? Alle die, von denen ich weiß, dass sie schmerzhaft sein werden. Und dann die Inspektion des Mund- und Rachenraumes oder der Ohren.",German
+"ich muss mich wieder hinlegen … Wenn Sie sich so wohler fühlen, dann legen Sie sich erst mal wieder hin. So, wie ich Ihre Situation gerade einschätze, ist es, denke ich, besser, ich gebe Ihnen etwas zur Beruhigung.",German
+"Vorher müssen sie erneut geschult werden, und zwar hier im Krankenhaus in Weilheim in Bayern. Da ist Inna Tkachenko, sie kommt aus Charkiw und ist 34 Jahre alt.",German
+"Für uns ist es mit Mehrarbeit verbunden. Und für den Patient selber... Ich glaube, das ist eher das Problem. Weil die länger warten werden. Ich verstehe auch die Sorgen, die die haben, aber man muss sich selber manchmal fragen? Sind diese Bauchschmerzen, die ich seit einem Monat",German
+aufgebraucht sind ich muss sie daher bitten schnellstmöglich das 50 gramm papier kostenfrei zu liefern das beanstandete papier steht abholbereit in unserem laden und kann dann,German
+wissen sehen das unternehmen für was sucht wenn man dann danach gefragt wird warum man ein guter neuer mitarbeiter wäre dann kann man die passenden qualifikationen und berufserfahrungen nennen,German
+"Hier machst du die Bremse einseitig runter. Dann ist es ganz einfach, wenn das Bett einmal knackt. Dann kann man das wunderbar mit einer Hand fahren.",German
+"Wenn man nur mit gut gelaunten Menschen arbeiten möchte, dann muss man in eine Wellnessfarm gehen oder so. Man muss auch mal mit Menschen hier umgehen,",German
+"Weil Trinity noch keine Wohnung in Mettmann gefunden hat, lebt sie gleich neben dem Krankenhaus, in einem Zimmer für Personal.",German
+"Weil sie haben mir gesagt, diesen Job braucht Geduld. Und wir wissen, dass du gar kein geduldiger Mensch bist. Aber sie haben mir vertraut.",German
+"über Kopfschmerzen. 42 Millionen sind zu dick, die haben Bluthochdruck und Durchblutungsstörungen oder der Magen drückt. Ich sage: „Kinder, Ihr könnt ein bisschen glücklicher leben. Du kannst",German
+Wie viele Zigaretten rauchen Sie pro Tag? Ich rauche täglich etwa zehn Zigaretten. Das ist zu viel.,German
+ihre arbeit hatten werden auch die neuen fahrzeuge nach den bekannten regeln nutzen neu müssen wir dann festlegen wie wir mit den e bikes umgehen wahrscheinlich aber nicht viel anders und wo,German
+"oder das Gegenteil, ob es geplatzt ist. Das kann man ohne diese Untersuchung nicht unterscheiden. Ich möchte mit Ihnen über den Patienten mit den Schulter- und Halswirbelsäulenbeschwerden",German
+Und die gegenteilige Frage wäre dann: - “Was lindert den Schmerz?” Das bedeutet: Was macht den Schmerz schwächer? Mögliche Antworten darauf könnten sein:,German
+"sie hat ein schweres Asthma und zieht zu einem Kettenraucher, der auch noch Katzen hat … das macht man doch nicht. Hat sie denn mehr Probleme mit Asthma? Sie ist doch nur noch bei den Ärzten. So kann man unser Gesundheitssystem auch kaputt machen.",German
+Bitte einmal den Arm leicht anheben und gerade lassen. Drehen Sie bitte Ihren Kopf von rechts nach links. Stemmen Sie bitte mal die Arme in die Hüfte.,German
+"zeigen, trotz Geiz ist Geil: Es gibt einen Trend zu Biologischen und Fairen Produkten - die Menschen wollen wieder wissen, was ist drin und wie ist es da reingekommen. Die Kundschaft ist",German
+oder sowas da verletzt man sich nicht so leicht yoga das ist nicht dein ernst das ist doch total langweilig mir langsam egal ich will wegen dir nicht auch noch krank werden lauterach ihm du,German
+ich habe das thema arbeitsumfeld gewählt für dieses thema habe ich mich entschieden weil das arbeitsumfeld ganz wichtig für den beruf ist also ich finde es wichtig eine gute arbeit zu,German
+"Patient mit einem i.v. Zugang versorgt und, wenn möglich, Blut zur Laboranalyse abgenommen. Zur Analgesie und gleichzeitigen Abschirmung der Patienten empfiehlt sich die Gabe von",German
+"nur damit in 20 Jahren irgendetwas nicht passiert. Ich schildere Ihnen lieber, was an Schönem auf sie zukommt, wenn sie meinen Ratschlägen folgen. Auf diesem Wege verhindern die Leute ihre Krankheiten.",German
+schmerzbedingt kaum schlucken. Schon eine minimale Drehung des Kopfes verschlimmerte die Schmerzsituation ins Unerträgliche. Nach eingehender Untersuchung erfolgte eine MRT der,German
+"Dahinter ist die Pathologie. Weil natürlich haben wir Notfälle, die leider nicht überleben. Dann bringt Raphael die verstorbenen Patient:innen hier her. Das passiert regelmäßig.",German
+"in bar von einem Ort zum anderen transportiert werden, wenn es den Besitzer wechselte. Deshalb ging man im 17. Jahrhundert zum sogenannten Buchgeld über, bei dem die Bank die Münzen,",German
+ja für gerne ernährung ist zur zeit im trend wir bieten dazu auch einiges an warme und kalte platten sogar ganze buffets wenn es rechtzeitig bestellt wird das habe ich schon befürchtet,German
+Weltladen-Deutschlandkarte hat noch zu viele weiße Flecken. Darum brauchen wir mehr Weltläden. Aber inzwischen gibt es doch auch in Supermärkten fair gehandelte Produkte.,German
+"Ja, wegen der Voroperation. Das haben wir erwartet, dass es etwas länger dauern würde. Das hatten wir ja auch im Vorfeld besprochen, dass möglicherweise Vernarbungen gelöst",German
+"Abführmittel. Das sind zwei Beutel … Das schmeckt doch so eklig, oder? Toll schmeckt es nicht. Manche Patienten geben ein bisschen Apfelsaft rein. Dann ist der Geschmack nicht so intensiv.",German
+"Und wie lang dauern denn diese Touren? Oh, das ist sehr unterschiedlich. Also die historische Stadtrundfahrt, es klingt schon sehr umfangreich, dauert fünf Stunden. Wien by night",German
+"Können wir damit mal anfangen? Kette, Licht, Reifen und Bremsen. Sollen wir den Schutz abmachen?",German
+wir versuchen die übergaben immer durch eine person in bereitschaft möglichst störungsfrei zu halten das heißt eine oder einer von uns ist auf abruf wenn es etwas zu tun gibt dann findet,German
+Wir haben heute Nachmittag eine 78-jährige Patientin aus dem Altersheim in der Einliegerstraße mit Verdacht auf Exsikkose aufgenommen. Beim Frühstück sei sie noch völlig,German
+"Dann gibt es doch auch noch das Zahnradphänomen, oder? Und ist nicht auch eine Verminderung des Geruchssinns beschrieben? Ja, dann wollen wir mal schauen. Ich würde den Patienten jetzt noch mal hereinbitten.",German
+essen super aber ich glaube dass man an einem internetauftritt noch einiges verbessern kann wenn du hier unterstützung möchtest kann ich das anbieten natürlich nicht umsonst ich muss ja auch,German
+"Entfernung der Mandeln, als auch die Behandlung mit einer Bissschiene und die Extraktion der Weisheitszähne brachten keine Besserung der Symptomatik. Zeitweise nahm der Patient",German
+"spezialisierten Ärztinnen und Ärzten. Sind Sie auch damit einverstanden, Frau Dierhof? Ja, das können wir erst mal so stehen lassen. Und ich möchte gleich zu Beginn einen wichtigen",German
+"Am besten wir lagern ihn mit unserer Schaufeltrage um. Analgesie? Hat vor fünf Minuten noch Fentanyl bekommen. Gut Leute, alle auf mein Kommando: Sylvia, pass auf die Drainage auf. Martin, du sicherst die",German
+"Wie sollen wir 30% zusammenbekommen? Das Gebäude würde fast 50 Mio. kosten. Da sitzt man mit Politikern zusammen, auch mit Ministern z.T., die dann uns zwar Verständnis schenken.",German
+"Wissen Sie schon, wie lange die Untersuchung dauert? Kann ich mit meinem Herzschrittmacher ins MRT? Frau Jankovicz, wir haben die Darmspiegelung bei Ihnen für Dienstag, den 16., um 7 Uhr 45",German
+das hier bei uns abläuft ja das habe ich auch schon bei ihm gesehen er konnte nicht mal ein taxi bestellen das geht so nicht weiter da müssen wir was machen vielleicht können wir,German
+"Dabei richtet sich das Angebot sowohl an Existenzgründer, als auch an schon im Fairen Handel engagierte Personen oder Gruppen, die den Schritt hin zu einem Ladengeschäft wagen wollen.",German
+wenn du sie wiederholst? Schaue die Videos so oft bis du die Wörter verinnerlicht hast. [Musik],German
+"Ich möchte noch Ihr Fieber messen. 37,5 Grad.",German
+flaschen kosten acht euro rufen sie uns einfach an wenn sie interesse haben noch eine bitte sagen sie uns wegen der bürste bitte heute noch vor 17 uhr telefonisch bescheid mein name ist super illu,German
+"Erst so zwischen den Schultern und dann hat es mit den Kopfschmerzen angefangen … Das ist ja jetzt seit ungefähr einem halben Jahr so … Ja, genau. Ein halbes",German
+schon über fünf jahre hier ohne dass es in der zeit neue bodenbeläge oder farbe an den wänden gegeben hätte darüber können wir gerne demnächst reden herr stock klar aber jetzt geht es erstmal,German
+ihnen zu kaufen wir bräuchten 30 bürostühle und zwar das modell mit der artikelnummer a 39 wir möchten die stühle am liebsten in blau wenn das geht achso und alle stühle,German
+"Christoph, wer oder was hat Ihnen denn bei der Entscheidung geholfen? Na ja, ich habe mich halt im Internet intensiv über verschiedene Studiengänge informiert. Information ist natürlich wichtig. Aber noch besser ist es, man geht mal an die Uni und sucht",German
+"Was glaubst du, wie sieht es bei der sonstigen Mitarbeit aus? 4? Mal so, mal so, ne?",German
+Balkon geflüchtet und runtergesprungen. Wirklich?! Welches Stockwerk? Erstes. Er ist intubiert und links haben sie eine Thoraxdrainage gelegt. Dann hat er noch,German
+"Studenten bei der Wahl eines Studienfachs und beim Einstieg ins Studium. Hallo und herzlich willkommen. Guten Tag. Außerdem sitzt neben mir der frischgebackene Student Christoph Bauer. Er hat gerade angefangen,",German
+"was anderes! Immerhin, das falsche Auge wurde getropft! Es entstand im OP eine Wartezeit, um das richtige Auge zu erweitern! Die Patientin konnte für eine Zeit lang fast nichts sehen!",German
+"alle drei Rundfahrten. Persönlich können sie sich auch anmelden bei der historischen Stadtrundfahrt, und telefonisch bei der Sissi-Tour. Was ist denn die Mindest-Teilnehmerzahl?",German
+er fängt um 18 45 an ich muss auch ehrlich sagen so spielt kann man mal ganz in ruhe arbeiten ich sag ja flexible arbeitszeiten haben viel für sich da geht vieles einfach entspannter,German
+mag einfach nicht mehr weiter essen ja aber wahrscheinlich leer aus erschöpfung ab weil für viele alte menschen das kauen und schlucken eine große anstrengung ist das problem ist er bekommt,German
+"Dann gibt es doch auch noch das Zahnradphänomen, oder? Und ist nicht auch eine Verminderung des Geruchssinns beschrieben? Ja, dann wollen wir mal schauen. Ich würde den Patienten jetzt noch mal hereinbitten.",German
+"im Umgang mit Kindern zu sprechen kommen. Es ist wichtig, mit dem Kind zu reden! Das wird so oft vergessen. Das Kind ist der Patient! Viele reden gleich mit den Eltern über das Kind,",German
+Bitte einmal den Arm leicht anheben und gerade lassen. Drehen Sie bitte Ihren Kopf von rechts nach links. Stemmen Sie bitte mal die Arme in die Hüfte.,German
+"wo es am Ende des Jahres hingeht. Trinity hat immer noch vor, nach der Ausbildung Medizin zu studieren. Wer möchte von euch?",German
+"Und mir auch selber sicher war, dass mir das gut gefällt, dass es mir mehr gefällt als ein Bürojob. Ich bin die 1. Frau in meiner Familie",German
+"Schade. Ja und wie sieht's mit den Türen aus? Das seh' ich jetzt hier vom weiten nicht. Ja, Anzahl der Türen, das ist immer eine gute Frage. Es kommt ja drauf an, wieviele Leute da einsteigen wollen, natürlich. Also der Touareg hat fünf",German
+Pieks! Das ist nicht schlimm. der Impfpass,German
+3 die gäste empfangen die gruppe wollte dann noch auskunft über verschiedene abläufe im hotel aber er konnte dazu nichts sagen er wusste offensichtlich überhaupt nicht wie,German
+Ihnen die Narkose. Können wir machen. Haben Sie den Fragebogen schon ausgefüllt? Das sollte ich ja machen. Hat sich in den letzten vier Wochen an Ihren Beschwerden etwas geändert?,German
+"Sie nehmen die Tabletten nur bei Bedarf und nicht regelmäßig ein? Ja, klar. Sie haben ja schon gesagt, dass Sie nicht mehr rauchen. Trinken Sie Alkohol?",German
+"Also in der letzten Zeit ist es immer schlimmer geworden. Jetzt sind die Schmerzen nicht nur im Knie, sondern im ganzen Bein. Es zieht sogar nach oben und laufen kann ich ja fast gar nicht mehr.",German
+"Und die man für ihre Arbeit schätzt. Gleichzeitig ist es auch so, dadurch dass wir ein junges, engagiertes Kollegium sind, ist auch die Taktung hoch.",German
+"und neue Perspektiven erkennen, werden gebraucht ... So, ich glaube, es geht los. Hallo Elisa! Was machst du denn hier? Hallo Sara! Ich komme gerade von meinem",German
+"Plastikkarten, auf denen Geldbeträge elektronisch abgebucht werden können oder mit denen man Einkäufe auf Kredit tätigen kann die Girokarte und die Kreditkarte. Sie ersparen uns beim Bezahlen",German
+"ja vom Kofferschleppen, ich weiß es nicht. Aber auf jeden Fall trau ich der Sache nicht. Hat er denn schon länger Probleme mit der Husterei? Er meint, er hätte schon ewig damit zu tun. Aber da wäre nichts! Naja!?",German
+"Komponisten auch tun. Und es gibt immer mehr Menschen, denen unsere Musik gut gefällt.“ Und dabei muss man sich im Klaren sein, dass die Entwicklung schon viel weiter gegangen ist. Mittlerweile kann künstliche Intelligenz schon ganz alleine Musik komponieren. Es gibt",German
+das Nasenspray Nasenspray hilft bei Schnupfen. hatschi!,German
+"Und gibt's ein Mindestalter? Ja, Mindestalter gibt's auch. Sie können sich vorstellen, dass die Wien by night natürlich vielleicht für kleine Kinder nicht so geeignet ist, also Wien by night, da sollten sie 12 Jahre alt sein, die historische",German
+auch die bestellmöglichkeiten über das internet ich glaube wenn man das professionell macht hilft das auch den gastronomiebetrieben heutzutage orientieren sich ja fast alle über ihre handys,German
+"Zur Installation und Pflege gibt es verschiedene Möglichkeiten, das anzubringen. Hier ist ein Video, da hab ich einfach nur die kleine Wandfläche vorbereitet.",German
+der Gipsarm Sie hat sich den Arm gebrochen. Oje! Sie hat einen Gips am Arm.,German
+können Sie es anheben? … Sehr gut … Vorhin konnte er es noch nicht anheben. Und er hat es auch nicht gespürt. Der Notarzt hat richtig reingekniffen und er,German
+"… vor allem dann, wenn die Gesamtumstände der Untersuchung hektisch und schwierig sind. Da macht man das Wichtigste zuerst … Apropos zuerst! Zuletzt sollte man die",German
+und gäste ein zimmer gebucht hatten und wir von nichts wussten ja schrecklich mir ist das auch passiert ich dann an der rezeption eine frau wollte einchecken und ich hatte keine,German
+sich ein großer parkplatz der könnte zum teil aber auch für eine erweiterung der halle genutzt werden es sei denn sie brauchen viele stellplätze für fahrzeuge augenblicklich befinden sich auf,German
+sind so war ich gut vorbereitet danke frau cosima war herr gül ich habe nicht ganz verstanden warum sich frau cusano war die mitarbeiter einer firma im internet angesehen hat wie haben sie,German
+Husten Sie? Ein bisschen. Drehen Sie sich mit dem Rücken zu mir.,German
+"unangenehmen Untersuchungsschritte durchführen! Und welche meinen Sie damit, Frau Dierhof? Alle die, von denen ich weiß, dass sie schmerzhaft sein werden. Und dann die Inspektion des Mund- und Rachenraumes oder der Ohren.",German
+"ich schlafe jetzt wieder! Ich merke noch etwas, aber das spielt keine wesentliche Rolle. O.k. Ihren Medikamentenplan haben wir ja hier. Sie sollten an Ihrer Einnahme nichts ändern.",German
+"sie sich ausdrücken und wie sie ihre Argumente vortragen. Drittens die Gesprächsfähigkeit; sie zeigt sich darin, wie sie sich ihren Mit-Debattanten gegenüber in der Debatte",German
+"das Rezept Die Ärztin schreibt ein Rezept. ""Danke schön!"" - ""Bitte schön!""",German
+"Das werde ich natürlich nie wieder machen. Also, erst einmal finde ich es sehr gut, dass Sie mir darüber berichten. Und dann denke ich, dass es wichtig ist den Fall in unserem",German
+"Stell das Beatmungsgerät an! Hat einer das Gel fürs Sono gesehen? Guten Tag, mein Name ist Khadivi, ich bin der diensthabende Arzt der Notaufnahme",German
+"ich merke das nicht mehr. Und auf der Arbeit, die Kollegen kenne ich jetzt. Schule habe ich nette Kollegen.",German
+Die Patientin soll im Laufe der nächsten Woche in die Reha-Klinik in Bad Lauterhausen verlegt werden. Ich habe diesbezüglich schon eine Zusage von der zuständigen Oberärztin Frau Domrindt erhalten.,German
+Alle zusammen haben die Ideen in einen Topf geschmissen. Wir haben daraus unsere eigene Struktur gemacht. Das läuft ganz gut.,German
+hier an der Heliosschule zu reduzieren: Jeder muss nur einen Teil des Unterrichts vorbereiten. Wir verstehen uns als Teamschule.,German
+das condor oft geht es um die menge ja auch es kommen zehn personen mehr zehn portionen mehr können wir ohne probleme machen gut aber könnten sie auch mehr vegane häppchen bringen und dafür,German
+"Glückwunsch, Herr Doktor Müller! So eine Exsikkose kann man leicht unterschätzen. Ja, ja. Ich wollte nur wissen, wie Sie das einschätzen. Bei Herrn Zumplik war der Blutdruck wieder über 110 diastolisch.",German
+"ihre Anwendung finden müssen. Wenn ein Mensch jedoch kein Vertrauen in sich selbst setzt, sich nicht vorstellen kann, bestimmte Verhaltensweisen ändern zu können, so erscheinen mir alle",German
+"und der dritte Partyservice Freiberger. Aha. Woher haben Sie das Angebot? Also BeckerCo. finden sie ausschließlich im Internet, Firma Partyspass hat auch ein Prospekt,",German
+"ich die letzten Monate in Rumänien am schönsten – da hatte ich mich dann so richtig eingelebt. Man hat Freunde, hat sich in die Familie eingefunden und kann einfach Alltag leben. Das Schönste ist",German
+"am Stachus und Unter den Linden Ich will raus, ich will hier nicht laufen auf zugigen Straßen und ich will auch nichts kaufen auf Wies'n und Wasn Ich will hier nicht bleiben, denn dieser",German
+"Wenn ich hier so unter deinen Kiefer taste, meinst du? Da spüre ich so ein dickes Ding … Das sind die geschwollenen Drüsen, oder? Siehst du, deine Mama kennt sich aus. Das sind",German
+"ist er zwar wegen seiner rezidivierenden Schmerzsymptomatik gekommen. Was ihn aber eigentlich beunruhigt ist eine neu aufgetretene Dyspnoe. Ist er zyanotisch? Nein, aber er hat schon",German
+"Na, dann versuchen wir es mal. Beugen Sie sich jetzt bitte nach vorne und stützen Sie sich mit Ihren Unterarmen auf der Liege ab. So o.k.?",German
+ihr alles per e mail schicken aber die dateien sind wahnsinnig groß und das klappt nicht ich habe markus aus der it-abteilung angerufen und er meinte nur ich solle die dateien komprimieren,German
+"Und, hat sie denn einen Herzinfarkt? Nein. Alle Untersuchungen, angefangen vom EKG bis zu den Laborwerten sind in Ordnung … Guten Tag! Sie sind die Eltern vom Julian?",German
+"Ja, Klinger hier. Sie hatten um Rückruf gebeten? Guten Tag, Herr Klinger. Danke für den schnellen Rückruf. Ich habe gerade einen Patienten gesehen, den ich ihnen gerne konsiliarisch",German
+"Ja, wieso? Der Doktor Luno will was von dir. Komme! … Hallo, was ist denn los? Hallo Helena, ich wollte wissen, ob Sie Herrn Zwingler schon aufgenommen haben? Mache ich gleich, er wollte erst in Ruhe",German
+die Finanzexperten bisher nicht einig. Wie funktioniert Nachbarschaft heute? - Ein Interview mit dem Soziologen und Nachbarschaftsforscher Tim Dammann,German
+"Nein, also ja, ein bisschen. Ich hatte so einen Husten, der nicht so richtig wegging. Und dann hat der Hausarzt gemeint, wir sollten das da doch auch machen. War doch alles gut, oder?",German
+alle Pläne erstellen muss und die anderen auch nicht. Und dann ist es ganz ökonomisch. Normalerweise ist es nicht so laut hier drin.,German
+"Aber dann hört man wieder wochenlang nichts. Das ist noch immer nicht gleichgestellt, die Universität und die fachliche Ausbildung.",German
+ja erst virtuell stattfinden aber nun komme ich doch direkt zu euch in die abteilung und wir gehen alles zusammen durch das ist mir vor ort sogar lieber dann können wir hallo ich bin rainer haben,German
+persönlich zu uns kamen und dann nicht lange durch die firma laufen mussten mit der zeit hat sich das geändert wir haben auch immer mehr internationale kunden und beraten immer häufiger telefonisch,German
+wenn du arbeitest nimmst du ihn mit dann kam ich öfter in eurer abteilung rüber leider nicht meine mutter kommt mittags und kümmert sich um ihn ich habe in der firma gefragt ob er mit darf aber ein,German
+"Aha. Gut. Dann bräucht ich jetzt aber mal die Telefonnummern. Also BeckerCo. sag ich als erstes durch 3260102, Firma Partyspass",German
+"Markt zwingt uns Unternehmer, immer günstiger und effizienter zu werden. Und das betrifft ja nicht nur die Unternehmer und Mitarbeiter, sondern der Konkurrenzkampf findet auch zwischen Mensch und",German
+da muss man dann aber immerhin fliegen und das gepäck kostet extra um mit den kindern das ist auch nicht so stressfrei ja genau deshalb machen wir dieses jahr vielleicht einfach urlaub an der,German
+"Wenn man sich in die Lage versetzt, dass man Patient ist, und wir haben 6 Uhr, da kommt jemand rein: Guten Morgen, erst mal Vitalzeichen messen,",German
+mit denen wir über den Studienbeginn sprechen wollen. Bei uns im Studio ist die Studienberaterin Dr. Susanne Scherer. Frau Dr. Scherer informiert und berät angehende,German
+übernimmt die firma dann natürlich gut wie soll ich mich vorher noch mal bei ihnen melden damit sie wissen ob es klappt wie kann ich sie denn am besten erreichen ja am besten unter der nummer,German
+"Du brauchst Vertrauen. - Okay. Das ist auch was, wo man sich selber zurücknehmen muss. Wo man mit Bildern, die mit dem Beruf assoziiert sind ein bisschen",German
+"Nicole ist supertop, fragt viel, kann das auch sehr gut umsetzen. Also, sie wird ne gute Schwester. Gut bedeutet in diesem Beruf auch, belastbar zu sein.",German
+gerne der austausch im team ist uns sehr wichtig und dementsprechend gestalten wir die übergaben zwischen unseren drei dienstschichten die übergabe von der früh an die spätschicht ist die kern,German
+unternehmen in der it abteilung gearbeitet dieses unternehmen möchte ich beschreiben das unternehmen ist ein zulieferer für die automobil branche dass bauteile für,German
+"Leute so satt ich fühle mich heute so stadt: so unfreundlich und kühl so übersättigt und schwül so „Mir doch egal, was mit dir passiert“ so „Hast du schon meine Bitterkeit probiert?“ Ich fühl mich",German
+"Ja, klar. Ich schreibe Sie erst mal für weitere zwei Tage krank und wir warten auf die Ergebnisse der Untersuchungen.",German
+raustragen … aber was will ich denn machen? Und zu der Zeit ging es Ihnen seelisch auch schon nicht mehr so gut … Mir ging es doch nie gut! Da war das endlich,German
+war wohl zuerst falsch adressiert deshalb kamen die geräte erst gestern an aber das war nicht so schlimm die hauptsache ist dass die lieferung vollständig war wir wollten die geräte gleich,German
+"Familie und ihren Traum, Musikerin zu werden. Mika spielt Geige und Irina, unsere Tochter, spielt Klavier und vorgestern haben sie ein wunderbares Hauskonzert für die ganze Familie",German
+"sie verwirrt und war sowohl zeitlich, als auch räumlich nicht adäquat orientiert. Als weitere Befunde zeigten sich eine leicht erhöhte Temperatur mit 37,2 Grad,",German
+"Die kommen jetzt. Das schaut schon mal gut aus... 0,3. Servus. Servus! Noradrenalin läuft im Moment auf 0,3 Okay gut, dann... Die wurde 20 Minuten reanimiert.",German
+"dich jetzt untersuchen, o.k.? Scheint ihn ja nicht besonders zu interessieren. Pupillen … sind in Ordnung! Die Eltern sind informiert und müssten gleich kommen! Dann werd ich ihm jetzt mal",German
+Ihre Lunge klingt in Ordnung. Haben Sie sonst andere Beschwerden? Mir läuft die Nase und ich habe Schnupfen.,German
+"Wenn ich Wasser trinke, dann mein Blutdruck ist in Ordnung. Dann, ja, geht. Um abzuschalten, schaut Trinity Krankenhaus-Serien.",German
+"Für 15 Schülerinnen und 2 Schüler beginnt ein neuer Lebensabschnitt. Sie sind zwischen 16 und 39 Jahre alt. Einige kommen direkt von der Schule, für andere ist es die 2. Ausbildung.",German
+"eine Veränderungsabsicht beim Patienten hervorzurufen ist es nicht notwendig, dass derjenige sich selbst als „alkoholabhängig“ bezeichnet. Das haben mittlerweile einige Studien bewiesen.",German
+"überhaupt nicht schlimm. Dann drehen Sie sich jetzt bitte auf die rechte Seite. Wie … so auf die Seite ? Genauso, wie Sie sich im Bett auf die Seite legen und dann ziehen Sie die Beine an. Oh je, das fällt mir schwer, hier auf",German
+nicht optimal gelaufen ich war nicht im haus als sie angerufen haben aber herr stumpf hat mir ausgerichtet dass bei den beamern nicht die korrekten fernbedienungen dabei waren,German
+"dass wir da gleich tapezieren können. Katja hatte erst eine Ausbildung zur Bürokauffrau angefangen, aber dann gemerkt, dass das nichts für sie ist.",German
+ich mir zuerst die webseite der firma gründlich angesehen besonders die seiten die etwas versteckt sind da gab es eine seite wir über uns auf der sich die firma selbst beschreibt das fand ich,German
+"Auf der Homepage der Uni wird man darüber informiert, welche Unterlagen man hochladen muss, zum Beispiel ein Passfoto, eine Kopie des Abitur-Zeugnisses und eine Bescheinigung von der Krankenversicherung. Und ich musste auch noch ein Motivationsschreiben schicken.",German
+"Überhaupt nicht Idealist. - Kein Idealist. Nee, es macht einfach Spaß. Zumindest die Arbeit am Kind, die Verwaltungsaufgaben nicht,",German
+"Ihnen das weitere Vorgehen besprechen. Wie lange wird das denn alles dauern? Ich schätze mal, dass wir so gegen fünf Uhr alle Ergebnisse zusammen haben. Oh, das ist gut. Bis dahin ist mein Mann bestimmt wieder zurück.",German
+in informatik war ich auch sehr gut in der schule weil ich mir nicht so gut vorstellen kann immer eine person über mir zu haben die mir sagt was ich tun muss träume ich davon mich nach,German
+"werden die Doping-Täter, um Wege zu finden, an den Regeln und Kontrollen vorbei die sportliche Leistung unerlaubt zu steigern. Meiner Meinung nach wäre es daher besser und ehrlicher,",German
+"Aber getrunken hast du schon was, oder? Ja, aber das tut ganz schön weh. Das Schlucken? Ja! Tut dir sonst noch was weh? Da …",German
+hallo hier spricht max grün von business solutions es geht um unser büro matte ja ich hatte ihnen ja die bestellung letzte woche übermittelt aber leider ist er wieder was schief,German
+"beschriebenen Beschwerdebild würde ich in gleicher Weise vorgehen. Guten Abend, mein Name ist Lukacs, ich bin die diensthabende Neurologin. Ja, guten Abend, Müller. Das ist mein Mann, Walter Müller.",German
+"... Ja, hier steht statt Milliliter Milligramm. Und wir lassen den Perfusor eigentlich immer in der Einstellung Milliliter pro Stunde laufen. Jetzt habe ich alles mitbekommen. Sie haben völlig Recht. Das war bestimmt eine Unaufmerksamkeit.",German
+"Die Ärztin kommt herein. ""Guten Tag, Frau Doktor!"" ""Guten Tag, Tim!""",German
+bin 22 und studiere in Berlin „Zukunftsforschung“. Innerhalb des Studiums arbeite ich in einem Projekt zum Thema ‚Arbeitswelt Deutschland im Jahr 2050’. Das Schlagwort der Zukunft heißt,German
+"die Kinder dann in den Behandlungsraum kommen, lasse ich ihnen erst mal Zeit. Ich habe ein paar Spielsachen und Plüschtiere … Die hat natürlich nicht jedes Krankenhaus, Frau Müller … Ich bin schon der Auffassung,",German
+"Wissen Sie, den meisten Männern ist diese Untersuchung sehr peinlich und manchmal kann auch ein leichtes Druckgefühl auftreten. Aber schmerzhaft ist die Untersuchung nicht. Ich werde Ihnen genau sagen, wie es abläuft und was ich mache.",German
+"den die Studenten haben müssen. Ja, genau. Ich hab‘ im Abi einen Notendurchschnitt von 2,3. Das hat dieses Semester leider nicht gereicht. Deshalb habe ich nach etwas",German
+Ich möchte heute über die präklinischen Basismaßnahmen bei Verdacht auf einen akuten Myokardinfarkt referieren. Häufigste Ursache der koronaren Herzkrankheit ist die Arteriosklerose,German
+"Trichter wie meins hier. Und dann hielt man sich genau so einen Trichter ans Ohr. Wenn du willst, darfst du mal hören. Nee, will ich nich.",German
+"die Kinder dann in den Behandlungsraum kommen, lasse ich ihnen erst mal Zeit. Ich habe ein paar Spielsachen und Plüschtiere … Die hat natürlich nicht jedes Krankenhaus, Frau Müller … Ich bin schon der Auffassung,",German
+"wie zum Beispiel Brandverletzungen, gebrochene Knochen oder Vergiftungen. Ohrentzündungen, gerissene Bänder oder Magen-Darm-Infekte gehören nicht in die Notaufnahme!",German
+"Wir hatten zum Beispiel letzte Woche den Fall, dass bei einer älteren Patientin das rechte Auge weit getropft worden ist, obwohl das linke operiert werden sollte. Unten im OP",German
+"drei Monaten Training beteiligte ich mich an einem Triathlon und kam auf Platz Drei meiner Altersklasse. Ich war völlig überrascht, ich hatte vorher gedacht, danach ist man tot.",German
+"Azidose. Nach Rücksprache mit dem diensthabenden Oberarzt wurde die Patientin reintubiert, sediert und eine Entwässerungstherapie durchgeführt. Der hinzugezogene kardiologische Kollege konnte",German
+"Lauter Flecken, wie so ein allergischer Hautausschlag … Ja, und das, Lena, was du da hast, nennen wir Scharlach! Kinder sind keine kleinen Erwachsenen, sagt man ja so gerne, wenn es in der Pädiatrie",German
+"so Häuserschluchtenwind so Familie von heute ohne Kind so „Hast du's denn immer noch nicht kapiert? Ich bin für deine Probleme blind!“ Ich fühl mich so hilflos, so ausgeliefert und müde hab",German
+"oder in meinem Freundeskreis, die einen handwerklichen Job hat. Da kann ich nicht erwarten, dass alle sofort Verständnis haben. Aber es hat mich überrascht, da waren viele Freunde dabei",German
+"Sie haben das Forever Young Erfolgsprogramm geschrieben. Können Sie den Weg zum Erfolg schildern? Das Erfolgsprogramm steht auf drei Säulen. Laufen Sie sich jung: Täglich, am besten 10 Kilometer, wie ein Kind. Langsam lächelnd,",German
+"das Vincent Schröder, aus dem Jahrgang 11 eines Gymnasiums aus Köln. Er greift den Vorschlag der Pro-Seite zunächst auf, entkräftet ihn aber mit einem Gegenargument der Chancenungleichheit.",German
+mitarbeitern geht eine schriftliche vereinbarung zu welche apps sie auf dem diensthandy installieren dürfen keine privaten jets oder mails über dieses telefon auch nicht mit kolleginnen und,German
+Bitte einmal den Arm leicht anheben und gerade lassen. Drehen Sie bitte Ihren Kopf von rechts nach links. Stemmen Sie bitte mal die Arme in die Hüfte.,German
+"Wirklich, die haben richtig gut mitgearbeitet. Das hab ich nicht erwarten. Aber die hatten echt Spaß daran, wie man merkt.",German
+1. Schultag. Direkt neben dem Krankenhaus ist die Pflegeakademie Bergisch Land. Hier startet die Klasse mit der 3-jährigen Ausbildung.,German
+"wie man Musik machen kann. Für unseren ersten Beitrag ist unsere Musikredakteurin Julia Schlag zu einem Festival gereist, zu einem großen Event in einer kleinen Stadt, wo Jugendliche aus aller",German
+"Ja, zusammen mit der Schilddrüsentablette, aber nur eine halbe morgens. Haben Sie aktuell wegen Ihrer Pollenallergie Beschwerden? Nein, im",German
+"zu Rhythmusstörungen. So ein paar Aussetzer. Und wurde das genauer abgeklärt? Wie meinen Sie das? Waren Sie bei einem Kardiologen, der Sie untersucht hat?",German
+weil sie warm sind und man sie gut waschen kann. Wir können bei unserer Arbeit nicht auf Plastik verzichten. Wir verwenden Blumentöpfe aus Plastik. Die sind viel leichter als Tontöpfe. Sonst müssten,German
+"Bis auf ihre Blutfette, oder? Er war ganz zufrieden. Das freut mich. Eine Kollegin, die Frau Müller wird bei Ihnen eine Ultraschalluntersuchung durchführen. Sie ist unsere Spezialistin für solche Untersuchungen!",German
+"Natürlich für die Zwischenprüfung und für die andere Prüfung, weil ich möchte auf jeden Fall nach der Ausbildung meinen Wunschplatz bekommen.",German
+bei den anderen schon gäste beschwert haben wenn alle im ziehen sagen dass das ein problem ist dann machen das management auch was vielen dank die zeit des dummen ihrer ergebnisse bekommen,German
+"wenn es sie in der Apotheke zu kaufen gäbe. Nichts rückt dem Fett effektiver zu Leibe, nichts macht resistenter gegen Stress, nichts hält jünger, macht zufriedener, fröhlicher, gesünder, ja sogar klüger. All dies ist wissenschaftlich nachgewiesen:",German
+"Ja und wie sieht's denn mit der Erstzulassung aus bei den Wagen? Naja, der Smart hat ja - wie gesagt - schon 125 Tausend Kilometer hinter sich, also der ist bereits seit 2010 unterwegs, der Opel Corsa seit 2012, und der VW",German
+"Sie sagen es! Ich wollte wegen der Perfusoreinstellung nachfragen. Ich denke, es wurde nur aus Versehen falsch aufgeschrieben! O.K., was wurde denn vermerkt?",German
+Ich möchte dich nicht anstecken. Vielleicht sollte ich meinen Mund und meine Nase mit einer Maske bedecken.,German
+"Meldesystem zu dokumentieren. Das hilft allen Beteiligten, mögliche Fehler zu verhindern. Sie wissen ja jetzt, wie Sie es sagen müssen, oder?",German
+hallo hier ist ingo weiss von der firma baden pharma wir haben im vergangenen jahr schon einmal büromöbel bei ihnen bestellt und waren sehr zufrieden deshalb überlegen wir wieder bei,German
+"Er sieht aber auch noch so manches, wo sie noch Lernbedarf haben. Kompetent sind sie jetzt schon, man muss halt nur sehen,",German
+"ich bin hier direkt neben Ihnen … Ja, ja, ich höre Sie. Wie geht es Ihnen …? Nicht gut ... ich glaub mein Herz schlägt bis in den Kopf ... Versuchen Sie, wenn es geht, ganz ruhig",German
+"und die Augen strahlen, obwohl es denen wirklich mistig geht, dann weiß man, das erfüllt mich gerade. So wie ich vor einem Jahr war und wie ich jetzt bin,",German
+"BfArM und das Deutsche Institut für Dokumentation und Information DIMDI überwachen die Einhaltung des MPG, welches auf der Grundlage europäischer Richtlinien basiert und auch für Österreich",German
+"Untersuchung langsam an. Die Kinder erschrecken sich sonst fürchterlich, wenn plötzlich ein unbekanntes und kaltes Ding auf ihrer Brust ist. … oder das Kind vorher mit dem Stethoskop den",German
+Ich möchte noch Ihren Blutdruck messen. Setzen Sie sich bitte hin und machen Sie Ihren Oberarm frei.,German
+"Am Anfang war es so, man musste jede Aussage denen aus der Nase rausziehen. Mittlerweile machen die mit, haben Spaß daran. Das merkt man schon.",German
+"Wir müssen kontrollieren, was die Schulen machen. Und stattdessen 2 Dinge: Den Schulen Vertrauen zu geben und sie zu unterstützen.",German
+"oft den unmittelbaren Bedürfnissen vor Ort In Hamburg gibt es jedes Jahr ein Musikfestival, das komplett von jungen Menschen aus dem Viertel organisiert wird. In Duisburg kenne",German
+"Alles klar. Das Loipennetz ist hoffentlich nicht allzu weit entfernt von den entsprechenden Orten. Nee, die sind eigentlich alle drei ziemlich nah, am nahesten liegt Pension Edenhof mit einem halben",German
+"Gut ok, das dauert dann ein bisschen... Ein bisschen... Was verstehen Sie darunter? 3,4 Stunden? In der Notaufnahme ist Zeit sehr relativ!",German
+die vielleicht auch mal grimmig sind und nicht gut drauf sind. Ich bin ja 39 und war vorher im Einzelhandel tätig.,German
+"normal gewesen, aber dann zum Mittagessen nicht mehr erschienen. Eine Pflegekraft habe sie sehr unruhig und aggressiv im Bett vorgefunden. Bei der Aufnahme war",German
+"Jetzt, zwei Jahre, nachdem sie die Ukraine verlassen hat, ist sie anerkannte Krankenpflegerin und freut sich, die neuen Kolleginnen einarbeiten zu können.",German
+"Das ist ja schön, aber das ist auch sauviel. Seid ihr so ein paar total verrückte Idealisten, weil ihr diesen Beruf ergriffen habt? - Nee.",German
+würdest du denn gerne gleitzeit haben naja ich finde eine feste anfangszeit einfach stressig weißt du ich habe zwei kleine kinder und bis die morgens immer fertig sind das dauert oft,German
+"es da noch Möglichkeiten eventuell von der Reise zurückzutreten? Von dem Aufenthalt zurückzutreten? Ja, also kostenlose Stornierung gibt' s bei allen dreien. Bei Pension Edenhof bis zu 15 Tage vor'm",German
+"kennt den Pflegebereich im Krankenhaus noch nicht so gut. Aber sie bekommt Unterstützung. Kommt Scan,",German
+"Wer außerhalb einer Klinik reanimiert wird, hat schlechte Überlebenschancen: Von zehn Menschen schaffen es statistisch nur ein bis drei. Auf – das ist zum beatmen…",German
+"er ja doch geht gesagt, oder? Herr Müller, es kann sein, dass Sie etwas sagen möchten, aber dass es Ihnen nicht gelingt. Nein …st. Nein … eh …st Nun sag schon, Herbert …",German
+"hektisch oder unkoordiniert. Diese Beobachtungen sind schon ein wichtiger Teil der Untersuchung. Was würden Sie denn zum Gangbild sagen? Ich fand, dass er ein wenig zu langsam ging. So, als wäre er unsicher … aber so richtig auffällig,",German
+"Niedermeier hat mich das letzte Mal untersucht. Gut, die kenne ich. Da veranlasse ich gleich, dass die uns den Arztbrief zufaxen. Das ist kein Problem. Sind seit der",German
+"Sie darauf geachtet haben. Sie meinen sein Gangbild? Erst einmal nehmen wir einen Patienten als Ganzes wahr, wenn er herein kommt. Wir betrachten seine Körperhaltung, seine Bewegungen. Sind sie kraftvoll,",German
+Samuel muss zum Kinderarzt gehen. Sie hat Fieber. Ihre Stirn ist ganz heiß.,German
+olga bist du fertig soll ich anfangen ja gerne also olga ich glaube wir haben ein problem in unserem kindergarten in letzter zeit haben sich eltern beschwert dass unsere kollegin marita oft,German
+"Du hast mich auch nicht gefragt, ob du was zum Projekt machen darfst. Ist wunderschön, aber auch in 3 min gemacht. (Akin) 3? - 2,5. (Akin) 10.",German
+"oder Bären die geplante Untersuchung vorspielen … … das dürfte wohl kaum das Jahresbudget sprengen. Frau Dierhof, Sie möchten noch etwas einwenden? Nein, nein. Ich möchte auf einen weiteren Punkt",German
+"Schrittmacherimplantation noch einmal Probleme bezüglich der Herzrhythmusstörungen aufgetreten? Überhaupt keine. Deswegen vergesse ich ja oft zu sagen, dass ich das Ding habe. Ist denn der",German
+und melde mich dann noch mal sehr gerne herr fechner und vielen dank für ihr verständnis hallo frau bertram hallo herr sauter schön dass sie pünktlich sind fangen wir gleich an,German
+Hallo. - Hallo. Der Herr Ziegner hat heute seine TEE bekommen. Den Perfusor haben wir noch mal nachgestellt.,German
+"Gut, dann schaue ich gleich mal, wie’s ihm geht. Vielleicht hat er ja erhöhte Temperatur? Sollen wir ein kleines Blutbild abnehmen …? … und CRP. Sicherheitshalber. Ja,",German
+"dass, was sie trinkt, dass wir das aufschreiben. Lolita Garchert leitet das Pflegeteam für Notfälle und OP-Nachsorge.",German
+"etwas Auffälliges gefunden haben. Sie spielen wahrscheinlich auf die alkalische Phosphatase an. Genau. War so ein Gedanke von mir. Nein, die ist nicht erhöht. Bis auf ein grenzwertig normales CRP ist die gesamte",German
+und uns noch einmal entschuldigen ja auch gut einzustellen und was wollen wir als entschädigung von der computerfirma zuallererst sollen sie den schaden beheben dafür zahlen wir natürlich,German
+"Sie nochmals den kleinen Beinahe-Unfall! Kein Problem, ist ja nichts passiert! Ihnen auch noch einen schönen Tag! Gespräch 5",German
+"1 – Empathie ausdrücken. Und hier ist mit Empathie keineswegs gemeint, dass wir als Behandler und Therapeuten in der Erlebnis- und Gefühlswelt des Patienten unkritisch",German
+Immerhin findet sie sich inzwischen im Krankenhauslabyrinth zurecht. Komm schon. Halleluja.,German
+"hier nur Jugendliche auf. Die Hälfte der rund 200 Teilnehmerinnen und Teilnehmer kommt zum Beispiel aus Ländern wie Ungarn, Estland, Spanien, Russland, Polen oder Schweden,",German
+"und dafür eignet sich ein Online-Kontakt sehr gut. Häufig geht es auch darum, dass Leute Informationen oder Hilfe suchen. Sie brauchen zum Beispiel jemanden, der auf ein Haustier",German
+"Der eine braucht ein bisschen länger. Der andere geht schneller. Aber es macht Riesenspaß, mit den Kids zu arbeiten. Es ist mein Wissen, was ich weitergeben kann.",German
+"noch zusätzlich Schmerzmedikamente ein? Wenn’s gar nicht mehr geht, nehme ich so eine Tablette … also Tro… oder Troma… Tramadol.",German
+"Yldiz hier von der Ambulanz. Ich möchte Sie auch nicht lange stören. Dann schießen Sie mal los. Bei mir hat sich eben ein junger Mann vorgestellt, der seit gut acht Wochen über diffuse Knochenschmerzen vornehmlich",German
+"gerne mein Video dazu an, da erkläre ich genauer, wie das funktioniert. Ich verlinke euch das Video hier oben und in der Videobeschreibung. Der Arzt kann euch auch fragen,",German
+etwas wirklich notwendig ist was noch im lager ist wird verteilt oder entsorgt die möbel werden wir im keller aufbewahren aber im keller ändert sich sonst nichts richtig bei den heizungs räumen,German
+"weist sie darauf hin, dass dies doch ein Arbeitsunfall sei und sie auf jeden Fall zum Durchgangsarzt müsse, weil das doch der Berufsgenossenschaft gemeldet werden müsse! Sonst hätte sie keine Ansprüche auf Zahlungen! Eine weitere Kollegin will schauen, ob man über den Patienten etwas herausfinden kann. Sie sehen, so kann es auch ablaufen. Was möchte ich Ihnen mit diesen Beispielen aufzeigen? Zum einen, dass Nadelstichverletzungen nicht nur beim ärztlichen oder pflegerischen Personal vorkommen, sondern bei allen, die",German
+"links. Zusätzlich gibt er an, in den letzten drei Monaten 5 Kilo an Gewicht verloren zu haben … Ich glaub, den schicken sie mal gleich zu mir rüber.",German
+"aber das können ja nicht so viele sein, oder? Und man braucht auch andere Qualifikationen. Dann müssen wir irgendwelche Jobs annehmen, die viel schlechter bezahlt sind. Aber es geht ja nicht nur",German
+"es sowas schon. Aber ich selbst bin erst seit Kurzem dabei und wollte mich hier im Workshop nochmal etwas informieren Tipps mitnehmen, Erfahrungen austauschen und so. Und Sie?",German
+kellner ich empfehle jedem sich sehr gründlich auf das vorstellungsgespräch vorzubereiten man sollte sich zum beispiel genau über den betrieb informieren bei dem man sich beworben hat das,German
+"Ja, mach mal. In einer Schicht werden um die 100 Betten verlegt. Man muss es so sagen, am Anfang der Ausbildung wird ein Schüler...",German
+"wann Sie Grapefruitsaft trinken, es besteht immer die Möglichkeit, dass Sie viel mehr an Wirkstoff von Ihrem Medikament im Blut haben und dadurch gefährliche Nebenwirkungen auftreten können. Also, besser verzichten?",German
+"...ist es viel einfacher für euch. Jörg Schmitz macht seine Azubis fit. Als Vorstand der Düsseldorfer Maler- und Lackiererinnung weiß er,",German
+Richtig! Er konnte den Unfallhergang genau schildern. Unabhängig von den Schmerzen entwickelte er eine zunehmende Tachypnoe mit deutlicher Abnahme der Sauerstoffsättigung. Links thorakal konnte ich kein Atemgeräusch mehr auskultieren und,German
+"Stoffbeutel gegangen. Getrunken habe ich nur Leitungswasser oder Getränke aus Glasflaschen. Hi Matteo, war mega-anstrengend gestern, das Ruder-Training. Das hast du dir schon",German
+"Wenn Sie die Beschwerden beschreiben müssten, wie würden Sie die Schmerzen benennen? Sie meinen jetzt, ob die bohren oder schneiden? Zum Beispiel, ja! Sind die Schmerzen an der Oberfläche und hämmern und schneiden oder sind sie eher krampfartig in der Tiefe und",German
+"Natürlich, das Maskengesicht: Morbus Parkinson. Sehr gut. Was würden Sie jetzt für Untersuchungsschritte durchführen, um Ihre Verdachtsdiagnose zu erhärten? Ich würde ihn etwas aufschreiben lassen. Ja, eine Schriftprobe ist eine gute Idee.",German
+"Ja, aber nur gelegentlich. Rauchen Sie? Ja, ich bin Raucherin.",German
+"Die Geschichte des Dopings im Sport hat unserer Meinung nach gezeigt, dass Verbote wenig Wirkung zeigen und je intensiver die Anti-Doping-Bewegung nach Regeln und Vorschriften sucht, desto aktiver",German
+"weil ein passendes Geschäftsmodell fehlt. Die Idee verschwindet in der Versenkung, einfach, weil der Erfinder nicht weiß, wie man sie auf den Markt bringen und die Finanzierung dafür finden",German
+möchte gerne einen arbeitgeber beschreiben für den ich gearbeitet habe bitte ich habe informatik studiert und bin programmierer von beruf in ankara habe ich bei einem großen internationalen,German
+"beidseits vorhanden mit deutlichem Giemen links. Kreislaufstabil, Sättigung immer um die 99 Prozent. Ihr könnt ja mal eine BGA machen! Nach dem Thorax, ist das in Ordnung?",German
+"das ist mir oft ein bisschen zu langweilig. Aber wenn du da bist, dann macht es bestimmt Spaß. Super! Dann sehen wir uns da. Ja, ich freue mich schon! Bis dann!",German
+"Sie sollten weniger rauchen oder am besten gar nicht. Ja, ich weiß. Treiben Sie Sport?",German
+ist lag an menschlichen sicherheitslücken wir haben festgestellt dass ihre mitarbeiterinnen und mitarbeiter die datenschutzregeln zwar kennen alle haben die datenschutzregeln,German
+anzug und krawatte passen da nicht gut wenn sie sich dagegen für eine leitende position in einer versicherung oder so bewerben wird man ein anderes auftreten und formelle kleidung voraussetzen weil,German
+"Das kann ich Ihnen ganz genau sagen. Das war kurz nach fünf. Also vor gut einer Stunde. Ich war im Garten. Wir wollten noch in die Stadt. Und er ist nicht runtergekommen, als",German
+eine ziemlich hohe rechnung bezahlt ja das wollte ich ihnen sagen und auch fragen können sie mir da vielleicht einen anderen typ farbe empfehlen herr fechner das tut mir sehr leid schon einige,German
+"der Schule haben. Woanders wird eine Skateranlage gebaut, oder es gibt Koch- oder Fahrradprojekte. Wie sehen Sie denn die Rolle der Nachbarschaft in der Zukunft?",German
+"Glückwunsch, Herr Doktor Müller! So eine Exsikkose kann man leicht unterschätzen. Ja, ja. Ich wollte nur wissen, wie Sie das einschätzen. Bei Herrn Zumplik war der Blutdruck wieder über 110 diastolisch.",German
+der Bauch Die Ärztin untersucht Tims Bauch. Das tut nicht weh.,German
+dass wir nicht gleich wechseln alle mitarbeiter sind so gut in das programm eingearbeitet und der programmierer firma sollten wir erst mal die chance geben das system zu reparieren stimmt,German
+"Darf ich sehen? Unten. - Ja, sehr gut. Alles klar, Armbändchen. Da muss der Name draufstehen.",German
+Ach so. Hallo Frau Winkler. Es ist in der 1. Zeit die Probezeit.,German
+"Türen, und der Opel Corsa und der Smart haben drei Türen jeweils. Und wie sieht's mit Sitzplätzen aus? Ja. Fünf Türen und fünf Sitzplätze auch",German
+"belasten? In welcher Etage wohnen Sie denn? Naja, genau in der zweiten. Das ging halt nicht in einem durch. Da bin ich kurz stehen geblieben, durchschnaufen und dann weiter.",German
+mir vorstellen aber hier kommt alle naselang jemand ins büro und der müller telefoniert immer noch so laut dass alle mithören können und sich keiner gut konzentrieren kann tja so,German
+"können wir nicht entscheiden, ob wir sie gut finden oder nicht. Sie kommt im wahrsten Sinne automatisch und führt zu einem immer härter werdenden Konkurrenzkampf. Der Wettbewerb auf dem",German
+was da kam doch gestern diese mail von der personalabteilung dass man sich als ersthelfer im betrieb ausbilden lassen kann das finde ich sehr interessant ah ja das habe ich auch gelesen,German
+ja ich muss ja auch mal wieder ausschlafen oder einen tag nichts tun jetzt habe ich nur das geld sag mal amadeo kennst du dich eigentlich mit den ganzen regelungen für die arbeit aus wieso was,German
+"einen die Endosonografie, um die lokale Tumorausbreitung zu präzisieren. Um mögliche Metastasierungen in Lunge, Leber und angrenzenden Organen zu entdecken, würde ich eine RöntgenThorax-Aufnahme",German
+cool probiere das doch mal hmm danke herr gül stellen sie bitte die nächste frage ja ich möchte gerne mal die kolleginnen und kollegen zu mir nach hause einladen hast du das schon,German
+"Stadtrundfahrt ist das Mindestalter 10 Jahre, und Sissi, die Sissi-Tour-Alter 6 Jahre alt. Okay, vielen Dank. Bitte schön.",German
+"In Teams müssen sie Aufgaben lösen. Die 1.: Haare waschen im Bett. Ist zu warm? - Wärmer wie eben, aber ist gut.",German
+"Scherer, dass Sie so wertvolle Ratschläge gegeben haben. Ich denke, unsere Zuhörer haben viel Neues erfahren. Wenn Sie nächste Woche wieder Lust haben, hören Sie rein. Panorama immer mittwochs um",German
+man denn da eine ladestation installieren auch da gibt es möglichkeiten die details besprechen wir dann ich will kurz noch etwas zum fahrtraining sagen naja autofahren können wir ja alle oder,German
+und 10 uhr zur arbeit kommen kannst also hättest du gern gleichzeitig weiß nicht ich habe noch nie gearbeitet ich war nur in der schule und dann bin ich nach deutschland gekommen aber warum,German
+"das Pädagogische fast überwiegt. Und man manchmal denkt, ich bin eigentlich hier, um euch Sachen beizubringen.",German
+"sogar bis hinten reinleuchten! Du hast gewonnen! So, Saskia, jetzt hol ich mal mein Telefon. Das ist doch gar kein Telefon. Ja, stimmt, du hast Recht, aber früher, da gab es Telefone, die hatten vorne so einen",German
+"sehr viel besser organisieren. Ansonsten sehe ich da nicht so viel Unterschied. Ja, so langsam geht unsere Sendezeit zu Ende. Vielen Dank an Sie, Christoph, dass Sie über Ihre ersten Erfahrungen berichtet haben. Viel Erfolg in Ihrem Studium. Ich danke auch Ihnen, Frau Dr.",German
+"zu Rhythmusstörungen. So ein paar Aussetzer. Und wurde das genauer abgeklärt? Wie meinen Sie das? Waren Sie bei einem Kardiologen, der Sie untersucht hat?",German
+"Nehmen Sie genügend Flüssigkeit zu sich. Also mindestens zwei Liter Tee oder Wasser. Ob ich mir das alles merken kann? Sehen Sie, Frau Jankovicz, das geht fast allen Patienten so. Deswegen gebe ich Ihnen auch den Zettel mit,",German
+chip die wie ein schlüssel funktioniert und mit der sie so einfach wie bisher alle türen öffnen bis sie an ihren arbeitsplatz gelangt sind ist das denn nötig das ist doch bestimmt alles aufwendig,German
+"Einen Ultraschall hat der Hausarzt auch bei mir gemacht. Aber von der Leber. Da war auch alles in Ordnung! Muss ich auch noch geröntgt werden? Nein, eine Röntgenaufnahme wird nicht notwendig",German
+"und der was erzählen kann, sondern die müssen teilweise funktionieren. Das ist dem Pflegenotstand geschuldet. Auch Imane hat mitbekommen,",German
+"Schau mal, du solltest unbedingt zum Arzt gehen und dich untersuchen lassen. Stimmt, du hast recht.",German
+"Dann würde ich dir das Tesa geben. Dann machst du das wie die Mädels, einmal abkleben. Wenn die sich Mühe geben, wird es schön,",German
+"Ort. Wie sieht's da mit der Verpflegung aus? Naja, also Halbpension hat...gibt's bei Edenhof, Pilsachhof und Edenhof haben zudem auch im Angebot nur Frühstück, und Selbstverpflegung",German
+"Erstklassige Musikpädagogen, renommierte Chorleiter, professionelle Jazzmusiker oder Sänger bieten kostenlos Workshops an, in denen die Teilnehmerinnen und Teilnehmer ihre musikalischen",German
+"Untersuchung langsam an. Die Kinder erschrecken sich sonst fürchterlich, wenn plötzlich ein unbekanntes und kaltes Ding auf ihrer Brust ist. … oder das Kind vorher mit dem Stethoskop den",German
+"Den finden Sie hier in der Praxis. Vor allem bin ich Arzt und Forscher und nicht Laufguru oder ähnlicher Quatsch. Ich will den Leuten beibringen: „Ihr könnt Euch Operationen und Medikamente sparen, Ihr müsst nur eine halbe Stunde am Tag laufen.",German
+"ich ihn gerufen habe … und dann habe ich gleich die Notrufnummer gewählt. Ich dachte ja zuerst, er hätte wieder ein Zuckerkoma … Das war die absolut richtige Entscheidung. Benötigt er Insulin? Ja, er spritzt sich schon seit Jahren.",German
+Aber es halt in nem Krankenhaus ganz andere Umstände sind. Ich mach das erst mal von unten nach oben. Und ich versuch dann von der Seite.,German
+"(Lolita) Ich schicke das in unsere WhatsApp-Gruppe. Für die, die nicht da sind. Ich würde sagen, offiziell ist das Büffet eröffnet.",German
+"Niedergeschlagenheit nicht erkannt. Ja, und dann habe ich auch öfter ganz schön tief ins Glas geschaut. Waren sie in der Zeit danach in einer speziellen Behandlung? Ich habe ein Antidepressivum bekommen. Damit",German
+"konnte oder können sollte. Das ist heute anders! Aber ich möchte noch für die jungen Kolleginnen und Kollegen anfügen, dass es wichtig ist, einen klar strukturierten Untersuchungsablauf zu haben!",German
+"U-Bahn, da hat es angefangen. Wo genau tut es denn weh? Hier unten rechts! Strahlen die Schmerzen denn irgendwohin aus? Nein, Herr Doktor! Wenn Sie die Schmerzen",German
+"Haben Sie denn auch schon den Infostand zur E-Mobilität besucht? Da erfährt man alles über Infrastruktur, Preise, Auflademöglichkeiten für Akkus, usw. Wird ja viel passieren in dem",German
+"Um ehrlich zu sein, kann ich Ihnen das im Moment nicht sagen. Unabhängig von den Untersuchungen, die ich Ihnen gerade aufgezählt habe, müssen Sie dringend zu einer Magenspiegelung. Ich habe es schon geahnt. Mit dieser Untersuchung kann man die Diagnose",German
+"gibt, an denen die Beschwerden auftreten, oder wann sie besonders unangenehm sind? Es ist völlig egal. Jetzt werde ich sogar schon nachts wach und habe Bauchschmerzen. Gibt es bestimmte Auslöser, z.B. Getränke oder Speisen?",German
+Die verwirrte Patientin ist immer noch beunruhigt. Aber die anderen. Sie kriegen ja gleich eine Untersuchung. Lange warte ich schon.,German
+dass das wahrscheinlich zu knapp ist was machen wir da jetzt bei einigen salaten können wir die käsewürfel weglassen oder ersetzen bestimmt können wir auch noch zwei oder drei warme platten vegan,German
+"doch nur zu ihrer Mutter. Wo wohnt sie zurzeit? Sie ist schon vor zwei Jahren ins Nachbardorf gezogen. Allein? Jetzt frage ich Sie,",German
+mindestens zweimal die woche schon um 7 im büro zu sein kannst du nicht mehr schlafen oder warum na ja es gibt schon vorteile früh anzufangen wenn ich richtig produktiv arbeiten will dann geht das,German
+Er wiegt 45kg. der Augentest Tim macht einen Augentest.,German
+trotzdem ganz schön viel oder lohnt sich das na ja irgendwas muss ich dafür immer machen sport machen und freunde treffen kann ich da tatsächlich nicht mehr ich brauche jede minute zum lernen wenn,German
+"Trinity, alles gut, relax, relax, alles gut. Und das geht eigentlich auch. Und Wasser trinken natürlich.",German
+"120 zu 80. Der ist in Ordnung. Geht es Ihnen wieder besser? Ja, ja. Es war mir nur plötzlich ein wenig komisch … Das passiert schon mal. Ist",German
+"oder das Gegenteil, ob es geplatzt ist. Das kann man ohne diese Untersuchung nicht unterscheiden. Ich möchte mit Ihnen über den Patienten mit den Schulter- und Halswirbelsäulenbeschwerden",German
+und regisseurin online wo sie einen kaffee trinken oder eine kleinigkeit essen können und ich finde es gibt sehr viele webseiten die überhaupt nicht professionell gemacht sind und so potentielle,German
+"Ja, ich weiß. Bei meinem Mann mussten sie es schon mal abbrechen, weil noch so viele Körner drin waren. Ja, das ist sehr ärgerlich, wenn sich jemand nicht an die Anleitungen hält. Deswegen dürfen Sie auch drei Tage vor der Untersuchung kein Müsli,",German
+"155 zu 90. BZ im NAW war 115. Herr Müller, versuchen Sie mich anzuschauen. … Ja, das geht doch. Es wird gleich mal hell. Ich überprüfe Ihre",German
+"Ich spreche von Frohmedizin. Ich sage nicht: „Tu das nicht, damit nicht..."" Das hat noch nie genützt. Wenn es Dir heute gut geht, verzichtest Du nicht auf Dein Bier oder Schnaps,",German
+übernachtung bei uns schicken einverstanden das können wir aber nicht entscheiden müssen das mit dem management ab sprechen das können wir nicht alleine entscheiden richtig das muss eigentlich,German
+"ein Symptom, was wir nicht gesehen haben. Häufig findet man bei der Untersuchung der Patienten, dass ihre Hände zittern … Oh ja, Tremor, Rigor, Bradykinese …",German
+guten tag beate richter hier vom küchen haus in der city ich rufe wegen ihrer kleinen werbegeschenke für kunden an sie meinen unsere werbeartikel ja genau die werbeartikel wir haben,German
+"Ehm … Igelgruppe. Oh, Igel. Ich kenne Igel, die können so weit den Mund aufmachen. Siehst du, so weit! Das können Igel gar nicht.",German
+"Dann denkst du auf einmal, okay, ich leide nicht an einer Krankheit. Das ist ja wirklich eine Lektion, die ich hier in diesem Job gelernt habe.",German
+"im rechten Oberschenkelbereich klagt. Hat er anamnestisch über ein Trauma oder eine ungewöhnliche Belastung berichtet? Nein, die Anamnese ist dahin gehend völlig leer. Vom Orthopäden wurde schon eine konventionelle Aufnahme gemacht,",German
+"Nein, also ja, ein bisschen. Ich hatte so einen Husten, der nicht so richtig wegging. Und dann hat der Hausarzt gemeint, wir sollten das da doch auch machen. War doch alles gut, oder?",German
+"und die den Kontakt nicht abbrechen lässt. Patient: Okay, vielleicht habe ich ein paar Probleme mit dem Alkohol, aber ich bin kein Alkoholiker. Therapeut: Sie haben kein Problem",German
+"nicht. Das kann ich nicht. Das ist ja … Mir wird ganz anders … Dr. Hufer, wenn Sie mal kurz rein kommen könnten ... Herr Messenzahl, schauen Sie,",German
+"Zeig mir mal... Das ist die Aufgabe für das Blatt, ne? Es wär wichtig, dass du dich an dem inhaltlichen Teil mit beteiligst. - Tu ich ja.",German
+"mehr Stellen abgebaut und immer neue, perfektere Maschinen angeschafft, die unsere Arbeit ersetzen. Man sagt uns zwar immer wieder, es würden durch die Automatisierung ja auch neue Jobs entstehen,",German
+"Gesundheit. Es gibt aber auch intensive, harte Trainingsmethoden, die Schädigungen der Gesundheit nach sich ziehen können. Die sind erlaubt, Doping jedoch ist verboten. Das",German
+"uns anschauen, was als Sofortmaß- nahmen nach Nadelstichverletzung empfohlen wird, so haben Sie die wesentlichen Punkte genannt. Man kann zum Beispiel nach der intensiven Spülung noch einen antiseptischen Verband anlegen. So, dass Sie quasi ein Depot im Bereich",German
+"das Gespräch mit Studenten. Und man kann auch fragen, ob man sich mal eine Vorlesung anhören darf. Da entwickelt man dann ein ganz gutes Gespür dafür, ob es passt. Kurz gesagt, der",German
+mehr werde im home-office noch im büro meine arbeitszeiten sind hier wie dort immer von 8 bis 17 uhr und um 13 uhr mache ich mittagspause wenn du mich also erreichen willst kannst du das,German
+"Wichtigstes Ziel der Erstversorgung, zum Beispiel im hausärztlichen Bereich, ist die Optimierung der Sauerstoffversorgung, also die Gabe von Sauerstoff über eine Sonde oder Maske. Der",German
+"Mit der Pflege sind viele Klischees verbunden. Unterbezahlt, fehlende Anerkennung und schlechte Arbeitsbedingungen. Sie wollen den Job trotzdem machen.",German
+sehr gutes angebot für ein büfett machen was meinst du beruflich mal zurück hallo hier ist jessica büren von autor experience ihre nachmeldung geht klar da es jetzt über 20,German
+"Darf ich denn auch einen Kaffee trinken? Selbstverständlich. Nach der Entnahme, die dauert so eine gute halbe Stunde, bleiben Sie noch ein wenig bei uns. Wir werden ihren",German
+"Hat das Kaffeehaus also noch Zukunft? Neben aller Weltoffenheit besinnen wir uns immer mehr auf unsere Wurzeln. Der Begriff „Heimat"" verankert sich wieder stärker in",German
+"wie ich mit meinem Gehalt klarkomme. Oder ich den ganzen Monat nur Dosenravioli esse, nur weil ich Krankenschwester bin.",German
+"ich ein Projekt, bei dem junge Leute für ein Jahr in leerstehende Wohnungen ziehen. Während dieser Zeit geben sie Nachhilfe und unterstützen Kinder und Jugendliche, die Schwierigkeiten in",German
+"wie man so schön sagt, haben. Und darüber hinaus natürlich, ob er auch wirklich funktioniert. Mhm, das kann ich verstehen. Wissen Sie, ich bin, also ich war ja Maschinenbauingenieur.",German
+ihnen erzählt was sie macht so will sie versuchen die leute von ihrem angebot zu überzeugen und aufträge zu bekommen sagen sie mir bitte auch noch was frau die sino war nach ihrer,German
+"stört mich schon. Da wird es ja wohl bald besser … Da wissen wir heute Mittag schon mehr. Mit der Luftnot ist es auch nicht mehr so schlimm, oder? Ach, das war doch gar nichts. Sie konnten sich nur nicht",German
+"Ja, wenn z.B. ein Patient vielleicht stirbt vor mir, wenn ich auch da bin.",German
+"Arzthelferinnen eine beruhigende Ausstrahlung auf Kind und Eltern haben. Sie sind die ersten, die die Kinder sehen. Sie müssen abschätzen, wie der Zustand des Kindes ist. Spielt es,",German
+"Hat sie doch gestern schon gemacht … Ja, das klappt schon recht gut. Die Arztbriefe nicht vergessen! Danke, Schwester Sigrid! Danke!",German
+geht um die flyer die sie für uns entwerfen und drucken sollen sie haben uns ja die kalkulation über 1000 stück geschickt das liegt deutlich unter unserem budget schicken sie uns doch,German
+"Wir sind da immer so, dass wir sagen, okay, wenn ein Patient sagt, er möchte noch nicht aufstehen, dass wir sagen, okay, dann kommen wir halt später noch mal.",German
+guten tag er ist gern schröder bürotechnik spreche ich mit frau heimann ja herr schröder endlich wir warten schon dringend auf ihren anruf das tut mir sehr leid frau heimann das ist heute,German
+machen hmm kommenden montag und dienstag sieht es nicht so gut aus wir haben ausnahmsweise schon am mittwoch unsere abteilungs besprechung weil ja donnerstag der feiertag ist die dauert mindestens,German
+"Und so erreichst du viel mehr Leute als auf der eigenen Homepage. Vielen Dank für das Gespräch, Tobias, und toitoitoi für deine Karriere als Digital-Komponist. Danke! Soweit unser Bericht über",German
+"die Blutwerte abgenommen und ich begleite Sie jetzt zur Computertomografie. Dort wird Ihr Kopf untersucht. Besser gesagt, wir schauen nach, ob sich in Ihrem Gehirn ein Gefäß verschlossen hat",German
+ich erledige alle Einkäufe noch selbst und gehe jeden Tag mit unserm Hund durch den Park. Jetzt mit dem Knie dauert es natürlich schon ein bisschen länger.,German
+"Musst nur dran denken, deswegen hast du immer n Eimerchen mit Wasser: das Werkzeug sauber machen. Sonst hast du nachher überall den Kleister hängen.",German
+könnten sie mir das bitte kurz erläutern wenn ich das richtig verstanden habe möchte sie erst einmal mit ihrem freundeskreis anfangen sie hat zum beispiel erzählt vielen dank dass er teil 1,German
+(Frau) Hallo. * Musik * Im Krankenhaus Mettmann sind aktuell 20 Pflegestellen unbesetzt.,German
+genau die laserpointer wir wollten die die in der fernbedienung mit dabei sind ich verstehe die fernbedienungen mit dem integrierten laserpointer genau so hier habe ich alles,German
+raustragen … aber was will ich denn machen? Und zu der Zeit ging es Ihnen seelisch auch schon nicht mehr so gut … Mir ging es doch nie gut! Da war das endlich,German
+4 galina du gehst heute bitte auch noch zu herrn schröder bellaguarda krank ist sei beim einreichen des mittagessens besonders aufmerksam er verschluckt,German
+"Haben Sie sonst noch etwas bei Ihrem Mann beobachtet? Zum Beispiel, dass er sich übergeben musste oder gekrampft hat. Er hat nur immer so herumgewedelt,",German
+"Na, dann versuchen wir es mal. Beugen Sie sich jetzt bitte nach vorne und stützen Sie sich mit Ihren Unterarmen auf der Liege ab. So o.k.?",German
+"Bevor wir in ein Patientenzimmer gehen, Hände desinfizieren. Und wie lange desinfizieren wir unsere Hände?",German
+"Herr Herberling, sind Sie es? Hier ist Schneider von der Inneren am Apparat … Grüße Sie. Stehe hier gerade in der Umkleide. Was gibt’s denn? Ich hab einen Patienten für Sie … Aber Herr Schneider, heute ist",German
+"Wenn da z.B. das Handwerk so viel größer, sag ich mal, oder überhaupt richtig vorgestellt werden würde, dass sie sich dann vielleicht eher für eine Ausbildung entscheiden.",German
+können Sie den am Vortag noch trinken. Sie können sich ganz einfach merken: Vermeiden Sie in den Tagen vor der Spiegelung schwer Verdauliches. Damit erleichtern Sie mir die Arbeit. Sie dürfen,German
+"Zentralverriegelung? Oder CD-Player, oder sowas? Ja also das ist jetzt ein bisschen unterschiedlich. Also Zentralverriegelung haben natürlich alle, das ist ja Standard. Einen elektrischen Fensterheber hat der VW",German
+und immer wieder auf die vereinbarten regeln zur datensicherheit hinzuweisen und die einhaltung zu kontrollieren machen sie noch mal auf die konsequenzen aufmerksam die ein sorgloser umgang,German
+"Weil es Spaß macht, mit den Auszubildenden einen Ausbildungstag zu machen. Die Auszubildenden am Samstag, freiwillig mehr oder weniger, da ist keiner gezwungen.",German
+"auf dem genau draufsteht, was Sie machen müssen, damit der Darm perfekt gereinigt ist. Wir fangen gleich an und fahren Sie langsam rein. O.K. Und Sie sind immer da?",German
+"Dass du ein bisschen drandrückst, aber vorsichtig. Weil wenn du doll drückst, ziehst du die wieder weg. Kann man die denn schieben? (Meister) Mhm.",German
+hallo das ist eine nachricht von mila hanna von der firma conrad denn es geht um den raum den ich für unsere veranstaltung am elften elften brauche es muss bitte der größere raum sein mit,German
+"das sind 2 verschiedene Personen. Ich hab mich von verschiedenen Seiten gesehen. Ich bin jetzt anders geworden, viel, viel besser. Natürlich werde ich eine gute Krankenschwester, inshallah.",German
+"Und da habe ich eine wirklich gute Nachricht. Und ich kann Ihnen sagen, dass ich mich selbst darüber sehr freue. Es gibt es also doch: Das Gute im Schlechten!",German
+"Huch, der ist ja feuerrot! Und die Zunge! Du hast eine Himbeerzunge, Lena! Ziehst du bitte mal deinen Pullover hoch? Guck mal Mama: da unten, rote Punkte!",German
+"zu vermeiden! Mein Mann hat mich ganz durcheinander gebracht, wissen Sie! Guten Tag, Sie sind der Herr Schneider, nicht wahr?",German
+"morgens leichter aus dem Bett, Du brauchst keine Migräne zu haben, der Mensch muss nicht leiden. Wie oft sollte man laufen? Sieben Mal die Woche für das Glück. Und fünf Mal für ein längeres Leben. Wie kann man nun seinen untrainierten",German
+"Ja, ich weiß es nicht, woran Sie ganz genau denken, aber wir haben zum Beispiel eine Servolenkung bei den beiden Autos links und rechts, also beim Touareg und beim Smart. Winterreifen hat der Opel Corsa und der Smart, und Sportsitze hat der VW Touareg.",German
+"rechts, hier so unterhalb vom Bauchnabel. Seit wann haben sie die Beschwerden schon? Es fing gestern Abend an. Ich dachte ich hätte mir den Magen verdorben von dem Nudelsalat, den ich mittags gegessen hatte. Weil mir ja auch übel",German
+"Wirkung auf die Gesundheit. Und wenn Sport als gesunde Betätigung angesehen werden soll, dann sollte es der Leistungssport auch und Doping ist nun mal auf längere Sicht gesundheitsschädlich.",German
+die mitfahren die hotelzimmer gebucht wunderbar dann ist das ja schon erledigt vielen dank dafür wie gefällt es dir denn in der neuen firma na ja ich bin ein bisschen genervt von den,German
+"Die Eltern sind auch gerade angekommen … Oh, Mist. Lass die nich rein … ja … ok? Bitte! Du bleibst jetzt erst einmal hier und ich rede mit deinen Eltern … und dann sehen wir weiter.",German
+mich schon aber eher als zuschauerin ich sehe mir wichtige spiele im fernsehen an und selbst machst du keinen sport aktiv meine ich doch meine ärztin hat nämlich gesagt dass ich unbedingt,German
+santa rita gesprochen hast aber sie ihr fallt nicht ändert was hältst du davon wenn wir ihr ein team gespräch anbieten du meinst gleich mit allen ich bezweifle dass das eine so gute idee ist wenn,German
+"Das ist aber lieb, Louis. Dafür kriegst du diesen Imbus-Schlüssel, um das aufzumachen. Ich freu mich natürlich, wenn die mich mögen oder wenn die meinen",German
+"Was mach ich denn jetzt nur! Frau Leiffold, Sie haben mir gesagt, Sie hätten einen halben Löffel Amoxicillin Saft 5-prozentig gegeben? Ja, und ich habe schon versucht Erbrechen auszulösen.",German
+"meiner Mutter sehr früh an einem Schlaganfall gestorben ist. Vielleicht lag das ja auch daran, dass sie erhöhte Blutfettwerte hatte. Darf ich fragen, ob Sie ganz bestimmte",German
+die gibt es aber nicht mehr und wir müssten eine andere nehmen das nachfolge modell kostet 30 euro mehr das wäre doch bezahlbar oder dann reicht es aber nicht mehr für diesen milchaufschäumer,German
+"weil dann denkt ihr auch dran. Die ersten Monate sind Probezeit, und die gilt es zu bestehen. Bald werden die Neuen zum 1. Mal geprüft.",German
+"Warum? Und dann hab ich erzählt, dass ich keine Ruhe mehr im Bett habe, wegen der Beine. Und dann wurden Sie untersucht? Ja, und dann hat man diese …, wie heißt",German
+"Und dazu gibt es einen kleinen Piks, genau hier … Nich piksen, das is Gesamtkörperver…letzt… So, schon passiert. Halten Sie mal gerade den Arm. Gut, und legen wir ihn auf die Trage …",German
+"Wir können Schmerzen auch als ******************drückend****************** beschreiben. Stellt euch ein Gefühl vor, als würde etwas fest auf die Körperstelle drücken. Dann haben wir noch den",German
+"Schwitzen Sie nachts? Ja, ich schwitze nachts. Mir ist jetzt auch heiß und ich bin verschwitzt.",German
+"von jemandem helfen, dass die nicht stirbt. Das A und O für mich ist, jemandem zu helfen und zu unterstützen.",German
+"Die haben den ganzen Tag Fußball gespielt. Der Junge ist immer fit. Es gibt einen Entzündungswert, den wir im Blut messen können, und der zeigt uns, dass bei Julian Zeichen einer Entzündung vorliegen. Aber er muss doch nicht operiert werden …?",German
+"Hat sie doch gestern schon gemacht … Ja, das klappt schon recht gut. Die Arztbriefe nicht vergessen! Danke, Schwester Sigrid! Danke!",German
+"Hallo Frau Schütze. Wie geht es Ihnen? Aller Anfang ist schwer. Ich habe Angst, wenn ich etwas nicht weiß.",German
+"Er hat nie sein Gesicht verzogen. Nicht mal ein angedeutetes Lächeln … Als würde ihn das hier gar nicht interessieren. Richtig, er wirkte sehr teilnahmslos, obwohl wir uns sehr um ihn bemüht haben. Würden Sie die Gesichtszüge als starr beschreiben?",German
+"lächelt es, bewegt sich oder ist es apathisch … Ja, Herr Steiger, da stimme ich Ihnen in Gänze zu. Damit etabliert man schon ein Gefühl der Sicherheit und Geborgenheit. Und wenn",German
+die Muskulatur an. Wenn Sie sich bitte auf die Untersuchungsliege setzen würden. Stellen Sie sich bitte breitbeinig hin.,German
+"Ja, ich glaube, auch mit Gewöhnung schwierig. Du musst schon dafür stehen. Raphael übergibt seine Patientin an die Nachtschicht.",German
+"5 %! Und wie viel Löffel haben sie davon gegeben? Er ist ja 9 und wiegt 30 Kilo. Und dann habe ich mir das noch mal nachgerechnet. Und ihm, statt eines ¼ Löffels einen halben Löffel gegeben. Und das sind ja über 1000 Milligramm.",German
+"Kommt schon. Hallo, Herr Kollege Nolte. Servus, Herr Khadivi! Pass einer auf den Zugang da rechts auf! Das der nicht rausrutscht! Nein,",German
+"Auf Station 3E sucht die Leiterin händeringend nach einer Kollegin, die woanders einspringen kann. Wir haben sicherlich Personal,",German
+"gibt's bei Pilsachhof und Haus Sonja. Ach ja. Na gut. Kann man sich ja überlegen. Wenn jetzt irgendwas kurzfristig, nachdem ich gebucht habe, dazwischenkommt - gibt",German
+"Haben Sie einen Allergiepass oder einen Patientenpass? Dann könnte ich da mal nachschauen, ob ein spezielles Antibiotikum eingetragen worden ist. Ja, ich habe beides, da steht alles drin. Die bringt mein",German
+"Nicole Ehrmann will mit der Stationsleiterin sprechen. Die Emily kam zu mir und sagte, sie wäre überfordert auf Station,",German
+"die aber unauffällig ist. Unter NSAR-Medikation hat er zwar weniger Beschwerden, aber über eine ernsthafte Besserung berichtet er nicht. Mich würde noch interessieren, ob sie im Labor",German
+"Wenn du eine Praxis hast, bist du ja automatisch Chef! Stimmt. Jetzt will ich erst einmal die grundlegenden chirurgischen Techniken lernen. Kannst du in dem Haus zwischen den Abteilungen rotieren?",German
+"Und welchen Tag wir heute haben? Naja, also Donnerstag, oder? Freitag? Es ist Freitag. Der Blutdruck war stabil in den letzten Stunden, oder? Ja, vorhin habe ich 130 zu 70 gemessen,",German
+"Mach ich. Und Herr Kollege … Ja? … … den Konsilschein nicht vergessen. Am besten ausgefüllt! Herberling! Hallo,",German
+die sicherheit auf dem ganzen gelände durch die schließt karte wird festgehalten wer gerade wo in den geschäftsräumen ist das konnte ein schlüssel nicht leisten außerdem können sie geld auf die,German
+denn zuerst umgestellt werden das ist so geplant da unsere mitarbeiter im außendienst oft sehr lange strecken zu kunden fahren und elektroautos nach circa 300 kilometern wieder aufgeladen werden,German
+"Falls du etwas schmutzig machst, ist nicht schlimm, wir können das später wegmachen. Die Azubis sollen heute zusammen mit den Schülern",German
+"für 32 Euro haben wir dort schon Zimmer anzubieten pro Person. Im Pilsachhof wird's ein bisschen teurer mit 38 Euro, und die Pension Edenhof liegt ganz weit vorne mit 42 Euro.",German
+irgendwann in die eulen gruppe mit den vorschul angeboten das wird ja dann ihr bereich unter anderem darauf freue ich mich schon es macht mir unheimlich spaß mit den vorschulkindern,German
+"(Corni) Wenn die Schüler*innen mitkriegen, dass das, was sie tun, gesehen wird, das kann sehr motivierend seien. Kinder und Jugendliche beim Erwachsenwerden zu begleiten",German
+die pause drin was ändert sich ich beginne mit unserem hauptauftraggeber der firma wann sprache ich beginne mit unserem hauptauftraggeber der firma anspacher die größte änderung dort,German
+"Und dazu gibt es einen kleinen Piks, genau hier … Nich piksen, das is Gesamtkörperver…letzt… So, schon passiert. Halten Sie mal gerade den Arm. Gut, und legen wir ihn auf die Trage …",German
+"beidseits mit mäßiger Rechtsherzbelastung. Bei Aufnahme deutliche D-Dimer Erhöhung. Anamnestisch eine TVT linksseitig vor 15 Jahren und eine Fettstoffwechselstörung, die mit Simvastatin",German
+"Ja, so ist gut. Ich kann das nicht, irgendwo vorm Computer sitzen 8 h, den ganzen Tag und mit niemandem reden.",German
+"schlimm? Es wird wichtig sein, wie wir mit diesen Veränderungen umgehen. Wenn wir Roboter für uns arbeiten lassen, haben wir doch die Chance, das Geld, das die Roboter erwirtschaften,",German
+"Es ist sehr wahrscheinlich, dass wir hierbleiben. Guten Tag, ich bin Pflegehelfer Inna, ich möchte Ihren Blutdruck kontrollieren.",German
+"Nase. Aber mit der Atmung ist alles in Ordnung. Sind Sie denn noch gegen andere Stoffe oder Medikamente allergisch? Ja natürlich, Penizillin! Nehmen Sie außer der Tablette gegen den Zucker noch andere Medikamente ein?",German
+"Guten Abend, Herr Müller. Können Sie mich verstehen? Ja, das ge… das … das ge… ge… geht … Versuchen Sie, ganz ruhig zu bleiben.",German
+"Sachen kümmern. Und sagen Sie der Schwester Maria, sie soll schon mal das CT blockieren und im Labor nachfragen, wie viel 0 negatives Blut die haben, und gleich drei Konserven zurückstellen lassen. Mach ich. Soll ich den Oberarzt informieren? Lassen Sie uns warten, bis der Patient da ist.",German
+"beschriebenen Beschwerdebild würde ich in gleicher Weise vorgehen. Guten Abend, mein Name ist Lukacs, ich bin die diensthabende Neurologin. Ja, guten Abend, Müller. Das ist mein Mann, Walter Müller.",German
+"das Wartezimmer ""Geh bitte ins Wartezimmer!"" Tim geht ins Wartezimmer.",German
+die Muskulatur an. Wenn Sie sich bitte auf die Untersuchungsliege setzen würden. Stellen Sie sich bitte breitbeinig hin.,German
+"Die haben den ganzen Tag Fußball gespielt. Der Junge ist immer fit. Es gibt einen Entzündungswert, den wir im Blut messen können, und der zeigt uns, dass bei Julian Zeichen einer Entzündung vorliegen. Aber er muss doch nicht operiert werden …?",German
+"wichtig ist, dass der Zwischenfall analysiert wird und entsprechende Maßnahmen ergriffen werden, um solche Vorgänge in Zukunft – zum Wohle anderer Patienten – zu vermeiden …",German
+Tim wartet. der Arzt die Ärztin,German
+Frau Ott? Guten Morgen. Gut geschlafen? - Ja. Ja? Sehr schön.,German
+"denn natürlich hat man die Möglichkeit, seinen Weg zu ändern. Wenn man sich für ein Fach entschieden hat und nach ein oder zwei Semestern feststellt, dass es nicht das richtige ist, kann man das Fach",German
+"14 muss heute noch in die Bronchoskopie, Herr Sammer und Herr Welter zur Koloskopie. Ja, das weiß ich. Wie war denn das CRP von Frau Gundlach? So, was liegt für heute noch an? Die Oberärztin möchte, dass wir die",German
+"Deutschland getrennt und Plastik recycelt. Also, das ist so nicht ganz richtig. Recycelt wird in Deutschland bei weitem nicht alles. Die Recyclingquote für Plastik ist längst",German
+"Also, Miriam, wir beide machen jetzt die Kreuzprobe bei Herrn Müller und hängen die Konserve an und dann telefoniere ich mit Herrn Puntiolo … Noch eins, Miriam – ich weiß, du bist die erste Woche hier –, hast du schon Erfahrung im Blut abnehmen?",German
+ist das ist natürlich auch wichtig dann machen wir mal weiter guten morgen ich begrüße sie alle recht herzlich wie sie wissen steht demnächst eine umstrukturierung unserer abteilungen an,German
+"konnte sie gut zählen und aufbewahren und sie war nur schwer nachzubilden, wodurch sie so gut wie fälschungssicher war. Außerdem war sie – im Gegensatz zu Lebensmitteln - nicht verderblich,",German
+dann sagt joop mir das bestimmt der ist immer ganz direkt ja vielen dank das war teil zwei vielen dank das war teil zwei wir kommen jetzt zum dritten teil sie arbeiten zusammen und haben eine,German
+"Von der Wunde weg. Okay. Auf die Wunde drauf. So zart wie möglich. Perfekt. Und noch mal? Ja. Also, die Einstichstelle schaut gut aus.",German
+"war und ich dachte, gleich muss ich bestimmt brechen. Mussten Sie sich denn übergeben? Nein, es blieb nur bei dem Brechreiz. Und dann dachte ich, dass diese ganzen",German
+bin früher auf morgens mit der s bahn gefahren da habe ich eigentlich nie einen sitzplatz bekommen und das fand ich immer sehr anstrengend und vor allem abends müde dann wieder in eine volle bahn,German
+"Ja, also die drei Pensionen haben eine Apré Ski-Party in der Nähe, wenn Sie mit Kindern unterwegs sind, können wir bei Haus Sonja die Märchenwelt empfehlen,",German
+die wir legen viel wert darauf dass die kinder jeden tag an der frischen luft sind gehen sie auch manchmal in den wald hinter dem kindergarten ja natürlich frau moretti geht heute nachmittag,German
+"Knoll war doch die ganze Zeit stabil. Sie wollte, glaube ich nur, dass er von sich aus mehr trinkt … … aber ein wenig verwirrt war er schon bei der Aufnahme … … wenn Sie jeden ein bisschen Verwirrten auf die Intensiv legen wollen, herzlichen",German
+hin bestimmt dann zeige ich ihnen jetzt noch die materialausgabe ich nehme an auch hier spielt nachhaltigkeit eine rolle ja definitiv sie sammeln die wünsche der kolleginnen und kollegen,German
+"Genau, die Frau Steffens. Sehr nett. Herr Knoll, mein Name ist Howe. Ich behandle Sie zusammen mit meinem Kollegen, dem Herrn Lange. Haben Sie heute schon von dem Tee getrunken?",German
+"Immobilienagentur. Er ist verheiratet. Seine Frau hat viel Verständnis für seine Beschwerden. Er hat zwei erwachsene Töchter, mit denen er sich gut versteht. Bei der Aufnahme konnte der Patient",German
+"Katja Kuznetsov und Vivien Tambunan: Malerazubis. 8-mal Reno, 2-mal Acryl. Sie sind 2 von insgesamt 10 Auszubildenden",German
+"Die Frau war zu Hause, ihr Herz ist stehen geblieben, sie musste reanimiert werden. Ursache unklar! Die Überlebenschancen nach einer Reanimation außerhalb einer Klinik sind schlecht. Statistisch schwanken sie zwischen 10 und 30 Prozent.",German
+"Guten Tag, Frau Doktor … jetzt habe ich Ihren Namen vergessen. Köchling, aber das macht nichts. Ist ja auch schon eine Weile her, dass wir uns gesehen haben. Wir wollen heute über die Eigenblutspende vor Ihrer Knieoperation sprechen.",German
+für wasser und strom sind vorhanden das wäre also machbar das hört sich doch schon mal gut an es wäre auch platz um einen umkleideraum einzurichten falls sie so etwas benötigen sollten,German
+Das Lachen wird mir noch vergehen! Ich werde später nämlich wirklich Blut abnehmen. Jetzt sind wir erstmal fertig für unseren ersten Patienten: Wir haben jetzt hier einen Patienten. Du kannst kommen.,German
+"Yldiz hier von der Ambulanz. Ich möchte Sie auch nicht lange stören. Dann schießen Sie mal los. Bei mir hat sich eben ein junger Mann vorgestellt, der seit gut acht Wochen über diffuse Knochenschmerzen vornehmlich",German
+"Laufen sorgt für ein powervolles Immunsystem, ein leistungsstarkes Herzjunge, glatte Gefäße, es vertreibt mit körpereigenen Glücksbotenstoffen, Endorphine und Serotonin,",German
+"Scheine hatten den Vorteil, weniger zu wiegen und waren auf Reisen gut zu verstecken, wodurch die Kaufleute bei Überfällen besser vor Raub geschützt waren. Viele Händler",German
+guten tag ich bin euer gago sein mofa und komme aus russland ich lebe seit drei jahren mit meiner familie hier in deutschland in russland war ich assistentin der geschäftsführung danke,German
+"Neuaufnahmen. Da wäre es gut, wenn du da wärest. Wer weiß, was sonst noch kommt! Ja, bin ich. Anne, Herr Knoll ist doch dein Patient, oder? Ja, warum? Pass bitte gut auf,",German
+"Herr Herberling, sind Sie es? Hier ist Schneider von der Inneren am Apparat … Grüße Sie. Stehe hier gerade in der Umkleide. Was gibt’s denn? Ich hab einen Patienten für Sie … Aber Herr Schneider, heute ist",German
+schließen anfasst die fensterrahmen und griffe und alle stuhllehnen wie bisher aber nicht nur einmal die woche sondern jeden abend ja und in den in den aufenthaltsräumen den teeküchen den,German
+Die Parkgebühren hätte sie sich gerne gespart. Im 1. Ausbildungsjahr lebt sie von 950 Euro netto. Fertig.,German
+Aber leider ist es durch diesen Pflegenotstand... Sie war da oben mit einer examinierten Schwester für einen Flur zuständig.,German
+"Der ist auch hier in Sanhofen? Ja, 00276 Sanhofen. O.k., Frau Menzel. Wo haben Sie denn aktuell ihre Hauptbeschwerden? Hier unten! Im unteren Bauchbereich?",German
+"Das kann ich Ihnen ganz genau sagen. Das war kurz nach fünf. Also vor gut einer Stunde. Ich war im Garten. Wir wollten noch in die Stadt. Und er ist nicht runtergekommen, als",German
+"Das ist leider Krankenhaus, da ist immer mit viel Warten. Hallöchen. - Hallo. Nicole kennt die Warterei. Ihr Sohn wurde mehrmals operiert.",German
+"Ich komme gleich kurz dazu. Ich hänge ihr nur ganz kurz ihre Antibiose an. Ich kann Ihnen was gegen die Schmerzen anhängen, ja?",German
+werden dann fragen gestellt wie wo man sich in fünf jahren sieht oder was die eigenen stärken und schwächen sind als bewerber oder bewerberin muss man sich natürlich sehr gut über das unternehmen,German
+"Der schmeckt ja nicht. Aber Sie haben schon fast einen halben Liter getrunken. Der Harn sieht noch sehr konzentriert aus. Strecken Sie doch mal bitte Ihre Zunge raus, Herr Knoll!",German
+das weiß ich auch nicht fragt doch mein job wenn der dich eingeladen hat dann kannst du ihn doch auch mal einladen ja das ist doch eine gute idee das mache ich und wenn man das hier nicht macht,German
+"Wunderbar! Und man will ja nicht die ganze Zeit nur in der Pension verbringen, und auf den Skipisten herumfahren...Gibt's noch andere Möglichkeiten sich zu unterhalten in der Nähe?",German
+"Müssen wir Gas geben, das zeige ich dir gleich alles. Wir kriegen das hin. Bis später. - Tschüs.",German
+"den Transport des Patienten zu organisieren und die Möglichkeit einer Thrombolysetherapie zu eruieren. Abschließend lässt sich sagen, dass es in der präklinischen Behandlung darum geht,",German
+Wird der Schmerz denn tagsüber erträglicher? Mittags nehme ich eine Ibuprofen ein. Aber die hilft auch nicht mehr richtig. Nehmen Sie außer dem Ibuprofen,German
+pfannkuchen oder bremen kompott auch mal berät das obst damit auf seine vitamine kommt wie er das annimmt muss dokumentiert werden unter markus lass dir zeit wenn dem essen gibst,German
+"Traurigkeit und Depressionen, Laufen stärkt das Selbstbewusstsein und die Knochen, es vertreibt Rückenschmerzen, strafft die Figur - und Laufen lockt kreative Gedanken.",German
+bemerkbar hier ist der video konferenzraum wir schalten mehrmals in der woche eine konferenz um uns mit unseren standorten in bonn berlin brüssel und basel abzusprechen wir sparen,German
+"irgendwelchen Halbkriminellen auf Sauftour. Und da sind Sie auch nicht mehr an ihn herangekommen … Mach doch was, hat meine Frau immer gesagt! Sag was, du bist der Mann! Was denn machen? Ich habe überall Schmerzen,",German
+"können. Viele glauben auch, dass die Studienwahl unabänderlich ist und das gesamte Lebensglück von dieser einen Entscheidung abhängt. Mit so einer Haltung blockiert man sich selbst,",German
+"sein. Dazu gibt es im Moment keinen Anlass. Wir werden schauen, was bei der Ultraschalluntersuchung herauskommt, und die Laborbefunde abwarten und dann werde ich mit",German
+"Funktion zu erfüllen, nämlich Menschen zusammenzubringen, Menschen zu verbinden und etwas Länderübergreifendes zu schaffen. Das ist bei unserem zweiten Beispiel ganz anders.",German
+"sind die Tastatur und der Computer. Und trotzdem verstehe ich mich als Musiker. Wenn man das Studio von Tobias betritt, sieht das eher aus wie ein moderner Arbeitsplatz in einem Großraumbüro. Monitor, Computer, Kopfhörer – von Musik keine Spur. Nur",German
+"Und welchen Tag wir heute haben? Naja, also Donnerstag, oder? Freitag? Es ist Freitag. Der Blutdruck war stabil in den letzten Stunden, oder? Ja, vorhin habe ich 130 zu 70 gemessen,",German
+"Die Werkstattslots können sehr anstrengend sein. Gerade weil das, was ich gerne mit denen machen würde, ist eher so ein 1-zu-1-Ding, vielleicht mit 2, 3 Kindern.",German
+sollen bitte rollen für hartböden haben wie viel würde das inklusive lieferung des ende mai kosten falls sie rückfragen haben können sie mich telefonisch erreichen,German
+"zu sein. Das ist doch in Ordnung für Sie, oder? Das ist völlig in Ordnung. Wir kennen uns ja schon. Wir haben neulich auf dem Flur kurz miteinander gesprochen. Ja, richtig, Herr Weissberg, nicht wahr?",German
+"Ja, das kommt doch wunderbar bei Ihnen. - Ja. 143. * Musik *",German
+der Aufkleber die Spritze Die Ärztin klebt den Aufkleber von der Spritze in den Impfpass.,German
+"auftreten. Wichtig ist noch, dass alte Menschen und Diabetiker wegen ihrer veränderten Schmerzwahrnehmung seltener über die typischen Infarktsymptome klagen!",German
+"Es gibt hier eine große Onkologie, Strahlentherapie und eine plastische Chirurgie. Ich konnte bei einem Forschungsprojekt in der Tumortherapie einige Einblicke in das wissenschaftliche",German
+"doch gar nicht Freitag, oder? Ein ganz normaler Dienstag, aber … Na gut, was haben Sie denn für mich? Den Herrn M., er ist knappe 56. War wegen",German
+Sie bleibt im Bett. Sie muss viel Wasser trinken. Ein kalter Lappen auf der Stirn tut gut.,German
+"Zentrale Notaufnahme, Städtisches Klinikum, Schwester Sylvia Müller! … Ja, o.k.! Verstehe! Männlich, ca. 30 Jahre, intubiert und beatmet. Messerstecherei in der Wohnung,",German
+"Applikationen kurz Medical Apps; doch deren Gebrauch, vor allem was die Rechtssicherheit angeht, wirft noch viele Fragen auf und ist auch vom Gesetzgeber nicht abschließend geregelt.",German
+klingt alles sehr gut ich stimme mit meinem chef einen termin für eine besichtigung ab und melde mich noch mal sehr gerne auf wiederhören vielen dank und auf wiederhören hallo olaf erst ines,German
+Referate sind hier oft Podcasts oder Videos. Es gibt viele fächerübergreifende Projekte und Werkstätten. Und Lehrer und Schüler duzen sich.,German
+dazu komme ich gleich sind denn erst mal fragen zur bisherigen verteilung nein gut dann gibt es noch eine wichtige änderung frau teslin hat ja gerade schon das lager angesprochen das bislang,German
+"Untersuchungen alle Befunde bestens. Dann können wir also starten? Richtig, Frau Winter. Wir werden Ihnen für diese Operation einmalig einen halben Liter Blut entnehmen. Sie dürfen zu Hause ruhig noch ein Frühstück zu sich nehmen. Und denken",German
+"So, bitte schön. Gut, wir verlassen das Zimmer. Trinity hat ihr Abitur in Simbabwe bestanden.",German
+"brechen muss, und damit auch meine Rolle sich auf einmal ändert. Ich bin nicht mehr der Vermittler. Wir sprechen hier an der Schule nicht von Lehrer*innen,",German
+"Olpe. Dass gerade heute so viele zu unserem Podiumsgespräch gekommen sind, finde ich toll. Heute ist nämlich der internationale Tag der Umwelt, und Umweltschutz geht uns alle an.",German
+"Schneider? Ja, also hier ist der Aman… Anamnese-Fragebogen. Genau, den habe ich fast vollständig ausgefüllt. Und das Versichertenkärtchen bringe ich die Tage vorbei. Ich habe es zu Hause liegen lassen.",German
+Ihre Nase läuft. Ihre Nase ist rot. das Taschentuch,German
+"versuchen Sie es … Das ist hier so um den ganzen Brustkorb wie eingeklemmt … und dann soll ich da gleich rein in den Tunnel … Das ist ja schlimmer als in der U-Bahn … ich glaub,",German
+"Wie kann man das Problem mit dem Plastik in den Griff bekommen? Welche Maßnahmen wären eurer Meinung nach wichtig? Ich glaube, es muss auf politischer Ebene viel",German
+denn für mich gehören Kartenspiel und Schach ebenso zum Café wie Billard. Dies sollte wieder mehr im Bewusstsein verankert werden. Ich selbst nütze das kulturelle Angebot der,German
+"nur zwei Möglichkeiten. Die historische Stadtrundfahrt wird täglich angeboten, das schließt natürlich das Wochenende ein, und ""Wien by night"" wird ausschließlich am Wochenende angeboten. Ansonsten ist Sissi-Tour nur am Montag, Mittwoch, und Freitag, und ja ... das war's dann.",German
+"so viel Energie übrig, wie ein kastrierter Rüde und doch muss ich gehen es gibt keine Schonung und würd' ich auch flehen Ich verlasse die Wohnung verlasse das Haus und stürz mich hinaus ein Lied",German
+so herr demir jetzt habe ich ihnen schon sehr viel über unser seniorenheim erzählt ich möchte sie gerne noch über ein paar arbeitsabläufe in unserer wohneinheit informieren ja sehr,German
+"und Partyservice Freibergerfinden sie auch in der Zeitungsanzeige. Alles klar. Wir sind jetzt nicht so eine große Gruppe. Gibt es denn so eine Höchstzahl an Beteiligten? Ja, also BeckerCo. veranstaltet Partys",German
+"der Seite. Die Hüfte, wissen Sie! Wenn das für Sie zu schmerzhaft ist, können Sie sich auch auf die linke legen. Ja, das geht besser. So …?",German
+"Opa. Die freuen sich auch schon gewaltig. Ich glaube, mit Ihrer Abreise morgen früh, das halte ich für keine so gute Idee. Ach so, wie? Das, was Sie und auch Julian geschildert haben und auch die Untersuchungen deuten auf eine",German
+"Melanie hat in der heutigen Debatte per Los die Pro 1-Position vertreten, d.h. sie argumentiert, unabhängig von ihrer persönlichen Meinung, für eine kontrollierte Legalisierung von Doping. Die",German
+"Richtig. Guten Morgen, Herr Trabitz. Ich heiße Howe und bin Oberärztin. Der Doktor Lange hat mir schon einiges über Sie erzählt. Wie geht es Ihnen denn, heute?",German
+"Und, weißt du schon was du nach dem Studium machen willst? Erst mal die letzte Prüfung schaffen! O.K. Was willst du machen, wenn du die Approbation erhältst? Ich hab ja als Wahlfach im PJ Gynäkologie",German
+"Was bedeutet für Sie persönlich ein Kaffeehaus? Cafés sind mehr als nur Kaffee-Trinkhäuser. Sie sind ein Stück österreichische Seele, in der unsere Kultur entstand. Sie sind auch menschliche Begegnungsstätten - Orte,",German
+"Dass sie verstehen, warum sie die ein oder andere Note bekommen und auch verstehen, was sie ändern müssen, um sich zu verbessern. Gleichzeitig bleibt das ein Spannungsfeld,",German
+dem parkplatz ungefähr 50 stellplätze so viele fahrzeuge haben wir nicht und publikumsverkehr haben wir auch eher selten von daher könnten wir den parkplatz für eine erweiterung verwenden das,German
+"wie man so schön sagt, haben. Und darüber hinaus natürlich, ob er auch wirklich funktioniert. Mhm, das kann ich verstehen. Wissen Sie, ich bin, also ich war ja Maschinenbauingenieur.",German
+Raphael arbeitet seit 5 Jahren in der Notaufnahme und macht gerade eine Weiterbildung zum Notfallpfleger. In seinem Job geht es jeden Tag um Leben – und Tod.,German
+wieder mal probleme mit dem beamer im tagungsraum da ist bestimmt eine birne durchgebrannt oder der hat irgendwo einen wackelkontakt das war schon mal ich bin noch in der kantine und,German
+"seines Sohnes mit. Den Zoster hatte er schon vor 6 Monaten und hat keinen Arzt konsultiert. Wie bitte? Ja, er hat eine bemerkenswerte Indolenz.",German
+bisschen mehr zählt ja gerne also ich habe gitarre gespielt also akustische gitarren aber elektrisch verstärkt und ein freund hat schlagzeuge spielt und eine freundin klavier und ja eine sängerin,German
+"es ja doch sehr schlecht um ihn? Nein, nein. Das ist jetzt erst einmal für den Anfang wichtig. Schließlich hat er einige Verletzungen, die einer genauen Beobachtung und speziellen Behandlung bedürfen. Zu Ihrer Beruhigung: Er ist von Seiten des Herzen",German
+"geplant. Ist das o.k. für Sie? Ja, das passt mir sehr gut. Ich erkläre Ihnen die Vorbereitungsmaßnahmen und den Ablauf der Untersuchung. Damit ich",German
+"und Sie sind bestimmt die Frau Meier? Ja, Christine Meier. Wie geht es ihm denn? Es ist ja alles so schrecklich! Ich wusste doch nicht, dass er gleich so aggressiv wird!",German
+"Sie haben sehr schnell und umsichtig gehandelt, Frau Müller. Da brauchen Sie sich keine Vorwürfe zu machen. Herr Müller, Frau Müller, hören Sie mir jetzt kurz zu. Sie sind im Moment in einem stabilen Kreislaufzustand, wir haben",German
+"bekommt ihr zu allen meinen Videos Quizfragen und Aufgaben, ihr könnt euch die Skripte als PDF herunterladen und meine Videos als Podcast anhören. Mittlerweile sind das schon über 150",German
+"Kommt schon. Hallo, Herr Kollege Nolte. Servus, Herr Khadivi! Pass einer auf den Zugang da rechts auf! Das der nicht rausrutscht! Nein,",German
+"hat mir wegen der Bauchschmerzen seine Novalgintropfen gegeben. Die wirken so ein bisschen. Wie viel und wie oft nehmen Sie denn die Tropfen ein? Na, so 20 bis 30 Tropfen. Manchmal drei-, viermal am Tag.",German
+"werden. Frau Witte hat angerufen: Es fehlen noch die Arztbriefe von Anfang der Woche! Und Ihr Kollege Puntolo … Puntiolo, Allgemeinchirurgie … …, ja genau, der möchte Sie unbedingt wegen eines Konsils sprechen. Es sei dringend!",German
+"Trichter wie meins hier. Und dann hielt man sich genau so einen Trichter ans Ohr. Wenn du willst, darfst du mal hören. Nee, will ich nich.",German
+"O.k. Funkt mich an, wenn der Sohn da ist, und ich komme sofort hoch … … da bin ich mal gespannt. Gibt es sonst noch was? Drei Sachen noch. Das Blut für Herrn Müller ist vorhin gekommen. Das müsste noch drangehängt",German
+"Pilsachhof, Haus Sonja, und Pension Edenhof. Ja, alles hier in der Nähe von Villach. Können Sie mir sagen, wie weit wir da reisen müssen, um da hinzukommen?",German
+"Ja, da vorne sitze ich. Und Sie haben hier den Drücker. Da brauchen Sie nur draufzudrücken und wir stoppen die Untersuchung. Und Sie kommen dann? Genau. Also wir starten dann jetzt … Nein, nein, das geht jetzt hier gar",German
+"dann fällt ein kleiner Stein vom Herzen auf jeden Fall. Einmal Gruppe 3, bitte schön.",German
+gehört und ehrlich gesagt kann ich das absolut nachvollziehen sonst tanzen die einem jahr später auf der nase herum und wollen immer bedient werden genau fürs mittagessen hängen dann,German
+der Verband der Fuß Er hat sich den Fuß verstaucht.,German
+Ein halbes Jahr ist vergangen. Bis auf eine Person haben alle in der Klasse die Probezeit bestanden. Ich bin da.,German
+Aufgrund der vorliegenden Befunde sollte eine dauerhafte Antikoagulation durchgeführt werden. Im Rahmen einer länger andauernden Schmerzbehandlung mit NSAR wird,German
+"Aber am Ende des Tages haben wir genug darüber geredet, was nicht gut läuft. Wir sollten da hingehen, das zu verändern. Ich glaube, dass wir mit dieser Station ein Stück dazu beitragen",German
+"Manchmal druckt der Drucker schräg, dann steht der Name nicht drauf. Richtig, ich hab genau drauf geachtet. Hast du sehr gut gemacht.",German
+"seiner COPD schon ein paar Mal bei uns. Heute Morgen ist er wegen erneuter Atembeschwerden aufgenommen worden. Ich hab ihn mir vorhin angeschaut. Neben einer mäßigen Dyspnoe, klagt er vor allem über Schluckbeschwerden … Seit wann?",German
+"wenn ich in Ihr linkes Bein kneife? Ho, Hoh. Können Sie es anheben? … Prima! Und Ihr rechtes Bein? Merken Sie das? Eh … Eh … Was meinen Sie,",German
+"Tagen und das Ergebnis des Urintests in einem Tag. Und in der Zwischenzeit, was soll ich machen?",German
+"Wie freundlich von Ihnen, danke. Sehr freundlich. Nicole darf heute zum 1. Mal eine Übergabe leiten.",German
+"Also ich empfand ihn eher als arrogant und unsympathisch. Können Sie das begründen? Der kam herein. Und man konnte sagen was man wollte, er hat überhaupt keine Reaktion gezeigt. Was meinen Sie genau mit keine Reaktion zeigen?",German
+"Er hat nie sein Gesicht verzogen. Nicht mal ein angedeutetes Lächeln … Als würde ihn das hier gar nicht interessieren. Richtig, er wirkte sehr teilnahmslos, obwohl wir uns sehr um ihn bemüht haben. Würden Sie die Gesichtszüge als starr beschreiben?",German
+"Die sind schon ein bisschen aus sich rausgekommen. Doch, sehr gut. Nach den Sommerferien",German
+"Da sind die Urinflaschen. Für mich jetzt... Ich hab ja ein Kind, ich hab Pampers gewechselt.",German
+"Nehmen Sie genügend Flüssigkeit zu sich. Also mindestens zwei Liter Tee oder Wasser. Ob ich mir das alles merken kann? Sehen Sie, Frau Jankovicz, das geht fast allen Patienten so. Deswegen gebe ich Ihnen auch den Zettel mit,",German
+"Beispiel eher ziehenden oder schneidenden Charakter oder sind sie drückend, brennend? Eher so komisch dumpf und drückend. Strahlen sie die ganze Zeit in den",German
+"Musikerinnen und Musiker nicht nur musikalisch zusammen, sondern sie erhalten auch einen ganz persönlichen Einblick ins deutsche Familienleben. Und die Gastfamilien lernen im Gegenzug auch eine",German
+"uns über eine Art Bewerbungsbogen auf www.unternehmen-weltladen.de auf. Dort finden Sie auch noch einmal etwas mehr Informationen zur Initiative. Ein Fragebogen klärt, ob Sie einige",German
+"dass Praxen, Notfallambulanzen oder Krankenhäuser, die gelegentlich Kinder als Patienten aufnehmen, eine Art Minimalausstattung haben sollten. Da können sie zum Beispiel an einem Elefanten",German
+"der Arzt wissen wollen, wo der Schmerz ist; in welchem Körperteil. Typische Fragen sind hier: - “Wo haben Sie Schmerzen?” oder “Wo tut es Ihnen weh?”",German
+"Ich kann mich nicht für euch zusammenreißen. Das müsst ihr selber hinkriegen. Es ist z.T. so, dass je nach Tag und Situation",German
+"Ich helfe mit ganzem Herzen, mit ganzer Seele, weil das ist [sind] meine Leute aus meiner Heimat.  Ich muss helfen.",German
+"dem Namen Büttner auf der Station gibt? Ich bin ja heute erst aus der Freiwoche zurückgekommen. Und dann sollte alles ganz schnell gehen, weil Sie schon angerufen hätten, wo die Patientin",German
+"Aber das Bein ist das, wo die Rötung ist. Hier. (Frau Ott) Ach so. (Lolita) Haben Sie mittags einen Tee getrunken? - Ja.",German
+"die nach einer Rücken-OP Schmerzen hat. Wir zeigen, wie wir das schmerzarm für Sie am besten hinbekommen. Was stellst du fest? Hier ist ein Knick im Bett.",German
+"Belül... Nee. Belül. Jungs, was sind das für Faxen? Nee, ihr könnt nicht dahinten hin.",German
+ausbildungsplatz zu bekommen kann ich mir auch vorstellen einen erzieherischen beruf zu erlernen ich glaube ich kann gut mit kindern und jugendlichen umgehen das würde mir sicher auch viel spaß machen sie haben ja das praktikum erwähnt dass sie absolviert haben haben sie,German
+"Nee, ich hab gerade eben schön Cappuccino getrunken. Sehr schön. Bis später.",German
+"oder Spritzer von infektiösem Material auftreten. Es wäre wünschenswert, wenn man diese Unfälle entsprechend kodieren könnte, damit die Zahlen etwas verlässlicher würden. So, Sie haben",German
+"Da ich 14 Jahre Begleitperson meines Sohnes bin, der ist mit einer Behinderung auf die Welt gekommen. Somit waren wir stetige Gäste, sag ich mal, in der Orthopädie.",German
+"Ihnen Blut abnehmen. Wir werden dann sehen, ob Entzündungszeichen im Blut nachweisbar sind. Letzte Woche hat der Hausarzt erst Blut abgenommen. Da war alles in Ordnung.",German
+nicht zu sagen wie wichtig gute kommunikation unter uns mitarbeitern ist wenn informationen fehlen oder unvollständig sind dann kann das unseren bewohnerinnen und bewohnern schaden,German
+1 harry - fangen sie bitte an suchen sie sich ein thema aus und sprechen sie darüber ja gerne ich möchte über ereignisse und erfahrungen entsprechen die meine berufswahl beeinflusst haben,German
+"Ja, ich weiß. Bei meinem Mann mussten sie es schon mal abbrechen, weil noch so viele Körner drin waren. Ja, das ist sehr ärgerlich, wenn sich jemand nicht an die Anleitungen hält. Deswegen dürfen Sie auch drei Tage vor der Untersuchung kein Müsli,",German
+"ich bin hier direkt neben Ihnen … Ja, ja, ich höre Sie. Wie geht es Ihnen …? Nicht gut ... ich glaub mein Herz schlägt bis in den Kopf ... Versuchen Sie, wenn es geht, ganz ruhig",German
+"Wir führen bei Frau Müller eine Arthroskopie rechts durch. Ja, korrekt. Die Patientin hat keine Antibiotikaprophylaxe",German
+"Knoll war doch die ganze Zeit stabil. Sie wollte, glaube ich nur, dass er von sich aus mehr trinkt … … aber ein wenig verwirrt war er schon bei der Aufnahme … … wenn Sie jeden ein bisschen Verwirrten auf die Intensiv legen wollen, herzlichen",German
+oder hat ihnen jemand von einem bewerbungsgespräch berichtet wie lief das ab thema 7 sie haben uns gerade ein produkt beschrieben können sie sich vorstellen in der firma zu arbeiten die dieses,German
+"Vielleicht lässt sich ja so was auch ambulant machen? Frau Gundlach in der 14 muss heute noch in die Bronchoskopie, Herr Sammer und Herr Welter zur Koloskopie. Ja, das weiß ich. Wie war denn das CRP von Frau Gundlach?",German
+"dass sich der Schmerz von dort aus noch an andere Stellen “verteilt”, könnt ihr sagen, dass die Schmerzen “ausstrahlen”. Zum Beispiel:",German
+"die aber unauffällig ist. Unter NSAR-Medikation hat er zwar weniger Beschwerden, aber über eine ernsthafte Besserung berichtet er nicht. Mich würde noch interessieren, ob sie im Labor",German
+"Da bekommt man ein großes Gefühl dafür, wie ausgeliefert man eigentlich ist. Das sind ja im Privaten alltägliche Dinge, die man so macht.",German
+"„wie üblich siebeneinhalb in funfzig NaCl“ angeordnet. Ich hab s dem jungen Pfleger Sven so gesagt und gar nicht darüber nachgedacht, dass er ja ganz frisch ist auf der Station. Und dann? Es dauerte jedenfalls eine Ewigkeit bis er",German
+"ihr Mann hätte eine Penizillinallergie … Oh ja, ganz schlimm, da bekommt er keine Luft mehr … Ist er noch gegen andere Medikamente allergisch? Nicht, dass ich wüsste.",German
+"Diese Frage lässt sich einigermaßen leicht beantworten. Selbst, wenn ihr nicht genau wisst, wie ein Körperteil auf Deutsch heißt, könnt ihr ja darauf zeigen und sagen:",German
+"Da ist noch ein Stück, oder? Nee. Und das schon nach wenigen Monaten. So, okay. Bis später. - Bis später.",German
+"Nach unserem Dreh habe ich erfahren: Sie wird wohl aus dem Koma nicht mehr aufwachen. Das nimmt mich echt mit. Ok, dankeschön. Du weißt Bescheid, die Dame, wir waren zusammen...",German
+"Pflege hört auch für mich nie auf. Man darf sich das auch so vorstellen, die Patienten sehen jemanden in Weiß. Die fragen nicht, kannst du das schon,",German
+In die Pflege wollte sie erst nicht. Ich hab im Studienkolleg Biomedizintechnik für ein Jahr studiert.,German
+gefallen mir hier wirklich gut das freut mich dann kommen einfach mal mit ich zeige dir heute noch mal alles in ruhe also hier rechts haben wir die kleiderhaken und daneben wie du siehst kleine,German
+in der anschaffung sind als andere fahrzeuge dass sie sich auf lange sicht aber durchaus rechnen es geht hier aber nicht vorrangig um die kosten für uns als firma für solarzellen geht es in erster,German
+bin ich jetzt musiklehrer ich unterrichte gitarre danke und sie ich heiße oksana des innova und komme aus der ukraine und kleber seit drei jahren hier in der ukraine habe,German
+es mal „kritische Ereignis“ kurz berichten. Es gibt einen Meldebogen. Den können wir ja gemeinsam ausfüllen. Es ist ja zum Glück nichts passiert.,German
+"Man redet den Job schlecht, ohne sich selber ein Bild von der Situation zu machen. Für die Arbeit, die wir leisten, finde ich,",German
+"Ja, Klinger hier. Sie hatten um Rückruf gebeten? Guten Tag, Herr Klinger. Danke für den schnellen Rückruf. Ich habe gerade einen Patienten gesehen, den ich ihnen gerne konsiliarisch",German
+sie denn ausgeben es darf schon ein bisschen was kosten und es muss zu unserem geschäft passen ja da haben wir eine breite auswahl haben sie denn schon auf unsere webseite gestellt,German
+zwei stunden und den derzeit brauchen wir die pcs nicht wie wäre es also am mittwoch super ich trage es ein übrigens hat sich doch noch mal was wegen der schulung für die software geändert die sollte,German
+"Das machen wir heute alles zusammen. Evangelisches Krankenhaus Mettmann, Station 3E. Trinity, Mariam und Kim haben Frühschicht.",German
+"Natürlich, das Maskengesicht: Morbus Parkinson. Sehr gut. Was würden Sie jetzt für Untersuchungsschritte durchführen, um Ihre Verdachtsdiagnose zu erhärten? Ich würde ihn etwas aufschreiben lassen. Ja, eine Schriftprobe ist eine gute Idee.",German
+Edelmetalle zur Verfügung. Die Papierscheine stellten eine Art Zahlungsversprechen dar Bei Bedarf bekam der Besitzer den aufgedruckten Wert jederzeit in Münzen ausgehändigt. Die,German
+"der Seite. Die Hüfte, wissen Sie! Wenn das für Sie zu schmerzhaft ist, können Sie sich auch auf die linke legen. Ja, das geht besser. So …?",German
+hallo alle zusammen wie sie wissen haben wir uns entschlossen unsere alte mechanische schließanlage die bei gründung der firma vor 38 jahren eingebaut wurde gegen eine elektronische schließanlage,German
+"und irgendwann passiert dann was in die richtige Richtung, das kann sehr beflügelnd sein und auch immer wieder überraschend. (Lolita) Frau Bunse, ist das okay, wenn wir das Licht anmachen?",German
+"Ja, so wie ein Revolverheld aus einem Western oder ein Pokerspieler … Rufen Sie sich doch bitte in Erinnerung, wie der Patient hereingekommen ist. Falls",German
+"Schrittmacher ein Risiko für die Operation? Nein, ganz im Gegenteil. Nur für uns ist es wichtig zu wissen, was für eine Grunderkrankung dahintersteckt, also: warum sie dieses Aggregat,",German
+Sie bringt drei Jahre Berufserfahrung mit. Oder Kateryna Balandiukh aus Lwiw: Sie ist seit vier Jahren berufstätig. Kataryna Balandiukh ist vor einem Monat hierhergekommen.,German
+als zehn Minuten oder wenn zum Beispiel eine anstrengende Tätigkeit beendet wird. Differentialdiagnostisch muss immer an eine Lungenembolie oder ein thorakales Aortenaneurysma gedacht werden.,German
+"damit zu sehen, dass Ihnen ihr Trinkverhalten nicht gut tut, aber Sie wollen nicht mit einem Etikett versehen werden, verstehe ich Sie da richtig? Patient: Genau.",German
+"ist komplikationslos verlaufen. Ihrer Frau geht es gut. Sie ist jetzt im Aufwachraum. Ich meine, es waren also keine Probleme. Es hat doch schon sehr lange gedauert?",German
+"Um die Diagnostik zu komplettieren, sollte die Tumorausdehnung und mögliche Metastasierung genau eruiert werden. Ich würde daher die folgenden Untersuchungen vorschlagen: Zum",German
+geschäftsführung wie bisher mit ihrem schlüssel nur jetzt mit der schließt karte kommen sie in ihr büro und ins büro der geschäftsleitung ebenso haben sie zutritt zu allen konferenzräumen aber,German
+"Ich habe das noch nie erlebt. Ich glaube, das würde mich ein bisschen kaputt machen. Weil sie sich noch oft verläuft, macht sich Emily Notizen.",German
+"Ja, die haben mich auf den Kopf gestellt. Da war aber nichts. Wann hatte Ihr Sohn denn das letzte Mal einen Pseudo-Krupp-Anfall? Ach, das ist schon länger her. Was meinen Sie denn mit „länger“?",German
+hallo hier spricht nur wir hatten ja extra unseren urlaub später geplant damit wir an dem wochenende vom stadtfest noch da sind ich weiß dass ihr da ganz viele leute braucht jetzt muss aber mein,German
+"Blinddarmentzündung hin. Ich habe deshalb meinen Kollegen von der Chirurgie gebeten, sich Julian ebenfalls anzuschauen … Wie kann denn das sein? Er war doch jetzt zwei Wochen im Zeltlager. Da war alles gut.",German
+"Ich hatte das 4 Monate geheim gehalten. Ich bin die 1. Frau in meiner Familie oder in meinem Freundeskreis, die einen handwerklichen Job hat.",German
+"ist er zwar wegen seiner rezidivierenden Schmerzsymptomatik gekommen. Was ihn aber eigentlich beunruhigt ist eine neu aufgetretene Dyspnoe. Ist er zyanotisch? Nein, aber er hat schon",German
+40 mg eingestellt ist. Jetzt Thrombose im Bereich der Poplitea rechts und geringfügiges Unterschenkelödem. Auf der Intensivstation wurde die Antikoagulation mit Heparin begonnen und,German
+schlagzeuger der konnte ganz toll komponieren und unsere sängerin hat es super ideen für die texte mich würde interessieren wie lange diese band existiert ja dieser bahn gab es eigentlich,German
+können sie das etwas näher erklären ja gern wir hatten zum beispiel eine kantine in der es keine einmal verpackungen und nur pfandflaschen gab da und in der cafeteria wurde kein plastik geschirr,German
+"Da setzen wir Sie an den Tisch, dann können Sie in Ruhe Ihren Kaffee trinken und frühstücken. Irgendwie ist das wie eine Familie hier.",German
+"Aahh … Ich weiß überhaupt nicht, was ich hier soll. Wissen Sie denn, wo sie hier sind? Na klar, im Krankenhaus.",German
+"Es waren 2 Schüler und eine examinierte Schwester. Dann ist klar, dass die examinierte Schwester nicht die ganze Zeit die Schülerin an der Seite haben kann",German
+"was nicht stimmt. Und jetzt hab ich ja auch die Quittung! Mann, Mann, Mann! Was für ein Mist! Glauben Sie mir, ich kann Ihre Wut gut verstehen. Sie hatten diese Unlust etwas zu essen, dabei immer wieder Bauchschmerzen und es wurde nicht",German
+"linken hinteren Bereich sieht man lateral eine ulzeröse Veränderung. Vergrößerte Lymphknoten? Nein, aber Mundgeruch. Also, was seine Lunge betrifft, ist er jetzt so weit stabil, und wenn Sie ihn sich anschauen …",German
+noch mischen ja mach das bitte übrigens von der familie ist morgen vormittag niemand zu hause den schlüssel bekommt ihr von der nachbarin frau harz die wohnt gegenüber alles klar restaurant,German
+bitte auch die preise für 2.000 stück ihr erster entwurf hat uns schon gut gefallen nur die adresse ist noch die alte falls sie noch fragen haben mein name ist gießhübl,German
+rufe noch mal wegen unserer fortbildung in ihrem hotel an wir hatten 15 einzelzimmer gebucht jetzt können aber doch nur zwölf mitarbeitende teilnehmen würden sie bitte drei zimmer,German
+familie besuchen also meine eltern sie leben in einer kleinen stadt in der ukraine und ich habe dort auch noch viele andere verwandte die freuen sich immer alle uns zu sehen aber,German
+"die Waage ""Stell dich bitte auf die Waage!"" Tim wird gewogen.",German
+"Aber nichts sagen, verstanden? Das werde ich schon selber entscheiden … So, dann legen wir mal los … Darf ich Ihnen unsere neue PJ-lerin,",German
+"Da haben Sie recht. Liegen Sie denn jetzt einigermaßen bequem? Ja, so geht es. So, noch einmal ganz entspannt ruhig und tief ein- und ausatmen. Sie spüren jetzt einen ganz leichten Druck …",German
+"irgendwelchen Halbkriminellen auf Sauftour. Und da sind Sie auch nicht mehr an ihn herangekommen … Mach doch was, hat meine Frau immer gesagt! Sag was, du bist der Mann! Was denn machen? Ich habe überall Schmerzen,",German
+"dumpfen Schmerzen zeigt man eher mit der ganzen Hand: Hier, in diesem Bereich tut es mir weh. ---",German
+"Er sagt immer, ich sollte was einnehmen, aber ich will noch ein bisschen warten. Nehmen Sie andere Medikamente ein? Naja, gegen mein Sodbrennen und das … gegen",German
+"erhalten. Richtig. Sind die angeforderten MRT-Bilder vorhanden? Ja, sind da. Die Lagerung wurde überprüft? Ja.",German
+die Unfälle der Autounfall die Autounfälle,German
+"bleibt einem als große Hilfe nur das Internet. Christoph, Sie haben ja jetzt den ersten Monat an der Uni hinter sich und einen Eindruck von Ihrem Fach bekommen. Wie ist es denn gelaufen?",German
+"Was erwarten sie selbst? Ja, auch die Leute pflegen, waschen und so. Dass man sich auch untereinander vertraut, versteht.",German
+mich zu hause immer aber du hast recht für die besprechung mit dem kunden bin ich heute im büro zu sehen wie übrigens jeden mittwoch nur letzte woche hatte ich urlaub urlaub arbeiten zu hause,German
+"sich oft gefragt haben, was ein deutsches Mädchen denn ausgerechnet in ihr Land treibt. Deutschland schien für sie die bessere Wahl. Denn fast alle Rumänen, die ich kennengelernt habe, hatten",German
+"Das war bestimmt interessant … Also, dann wollen wir mal anfangen … Selbstverständlich, Schwester Anne. Wen haben wir denn als Ersten? Am Fenster hätten wir Herrn Trabitz. 67-jähriger vitaler Patient. Kam wegen Dyspnoe. Lungenembolie",German
+"überhaupt nicht schlimm. Dann drehen Sie sich jetzt bitte auf die rechte Seite. Wie … so auf die Seite ? Genauso, wie Sie sich im Bett auf die Seite legen und dann ziehen Sie die Beine an. Oh je, das fällt mir schwer, hier auf",German
+Sie hat Krücken. der Arm der Gips,German
+der Patient selbst kann 30 Prozent der Redezeit für sich beanspruchen und das Pflegepersonal liegt mit 10 Prozent am unteren Ende der Skala. Während Ärzte durchschnittlich,German
+"war und ich dachte, gleich muss ich bestimmt brechen. Mussten Sie sich denn übergeben? Nein, es blieb nur bei dem Brechreiz. Und dann dachte ich, dass diese ganzen",German
+zwölf personen aber das war natürlich noch etwas anderes als echte kollegen einzuladen ich weiß gar nicht ob man das in deutschland macht mich hat ja auch noch nie jemand eingeladen dich ja das heißt,German
+"Azubi-Tag bei Malermeister Schmitz, an einem Samstag. Ich könnte jetzt im Garten sitzen, das ist wohl wahr. Warum sitzen Sie nicht im Garten?",German
+"im Ohr und zu früh schon kaputt und ermüdet Ich will wohin, wo Gras nach Gras riecht und nicht nach Asphalt und nach Staub wo ich meinen Nachbarn kenne und ihm seine gute Laune auch glaub' wo ich",German
+"die Boxen erinnern an so etwas wie Musik und, was man natürlich nicht sehen kann, das, was Tobias in seinem Computer hat. Wenn man digital gute Musik machen will, ist es am wichtigsten,",German
+"Ich bin doch auch nicht auf dich oder irgendwen sauer. Ich habe es gewusst. Verstehst du das? Dieses Unwohlsein, die Magenschmerzen, diese Appetitlosigkeit … Da merkt man doch, das",German
+"Warum musste er auch so früh nach Hause kommen? Frau Meier, er ist hier vor gut zehn Minuten eingeliefert worden, deswegen kann ich Ihnen noch nicht so viel über seinen genauen Zustand sagen.",German
+"Leben Sie zurzeit alleine? Ja, aber meine Tochter wohnt nur zwei Straßen weiter. Und mein Sohn hat im Nachbarort die Elektrofirma Delius übernommen.",German
+"kann. Ich halte dazu heute Nachmittag hier einen kleinen Vortrag. Die Anmeldung einer Erfindung zum Patent spielt da übrigens auch eine Rolle. Sie meinen, dass man sich als Erfinder oder",German
+"Viele sprechen davon, junge Kräfte müssen wir fördern. Und wir haben gesagt, wir machen das. Wo es die größte Skepsis gab, das hat mich überrascht,",German
+"Musikstile und alle Instrumente spielen, ohne wirklich Ahnung von Musiktheorie zu haben. Einfach mit der Computertastatur eingeben, was ich mir so vorstelle und los geht’s. Ich finde,",German
+eine positive Infarktanamnese in der Familie. Bei einem Herzinfarkt kommt es Ischämiebedingt zum Absterben von Herzmuskelgewebe. Typisch für kardiozirkulatorische Notfälle,German
+"dass man Auszubildende schon noch bekommt. Wir arbeiten mit Schulen zusammen. Ich geh in Elternabende rein. Das sind Punkte, da muss man lange dran arbeiten.",German
+gibt es frühstück aber daran nehmen nicht alle kinder teil das kann man flexibel von woche zu woche anmelden hier an der wand hängen die listen darauf steht wer zum frühstück kommt und ganz,German
+"Sehr gut, danke schön! Noch ist nicht klar, warum das Herz der Frau stehen geblieben ist. Okay, Raphael, 40 Lasix aufziehen.",German
+Soll ich dir dabei helfen? Oder soll ich lieber den Costa fragen? Costa? (Patientin) Können Sie auch Haare waschen? (Lolita) Ja klar.,German
+"und da war es eigentlich katastrophal. Aber hier ist es richtig cool. Und es ist schön, dass ich nicht ins kalte Wasser reingeschmissen werde jetzt.",German
+"Wie schlecht sieht es denn aus? Sie braucht viele Medikamente, die den Kreislauf unterstützen. Raphael und die Ärztin haben die Patientin auch während der Untersuchung im Blick. Plötzlich geht alles ganz schnell –",German
+gold von der buchhaltung sie sind im juni zu der wochenend fortbildung marketing-strategien nach berlin gefahren bei ihrer reisekosten abrechnung ist mir aufgefallen dass sie die reisezeit nicht,German
+"aufstehen, wird jetzt gewaschen. Ist halt doof. Würde ich selber auch nicht wollen. 52 bleibt nüchtern. Und kriegt ne ÖGD.",German
+"Mal gehüstelt, nichts Dramatisches. Dann find ich ihn ein bisschen blass, und er wirkt so schwitzig, nicht kaltschweißig, eher ein Schwitzen, wenn man sich angestrengt hat. Vielleicht kam es",German
+Ich habe ja nur auf einer anderen Station gearbeitet. Und ich habe eine Zeit lang auf der Intensivstation ausgeholfen. Aber ich habe noch nie in so einem tollen Team gearbeitet.,German
+aber jetzt haben wir nur noch ein auto in der familie und das braucht immer mein mann weil er seine arbeit nicht mehr den öffentlichen verkehrsmitteln erreichen kann wo wohnst du,German
+Herr Grübler? Ja. Legen Sie sich erst einmal auf die Liege. Bleiben sie einfach ruhig liegen und ich messe erst einmal ihren Blutdruck. Wird schon wieder …,German
+"die bei ihr deponiert wurden, als Guthaben in Konto-Büchern gutschrieb, statt Scheine auszustellen. So konnte man nun einfach Geld von einem Konto auf ein anderes überweisen.",German
+"um Anamnese und körperliche Untersuchung geht. Aber was ist denn das Besondere, wenn wir kleine Patienten vor uns haben? Ich freue mich, dass ich heute auf dem Podium mit Frau Dr. Müller,",German
+an diesem Tag vor der Darmspiegelung … Also am 15ten. Richtig. … morgens noch ein Frühstück zu sich nehmen und zu Mittag eine Nudelsuppe essen. Ab dann dürfen Sie nichts mehr essen. Am Nachmittag trinken Sie bitte die erste Mischung,German
+"Ich brauche bitte den Arm. Im neuen Jahr dürfen die Azubis immer häufiger ohne Aufsicht arbeiten. Der Puls sieht gut aus, der war bei 80.",German
+buchhaltung und das bleibt auch so anders sieht es beim serviceteam aus unsere kunden legen wert auf eine gute beratung und zahlen dafür auch mehr deshalb mussten wir das team erweitern frau wollte,German
+"So, einen freiwilligen Patienten, bitte. Im Praxisunterricht üben die Schülerinnen auch den Umgang mit Kranken.",German
+"Sie haben sehr schnell und umsichtig gehandelt, Frau Müller. Da brauchen Sie sich keine Vorwürfe zu machen. Herr Müller, Frau Müller, hören Sie mir jetzt kurz zu. Sie sind im Moment in einem stabilen Kreislaufzustand, wir haben",German
+"weil's das nicht geben sollte! Ich will raus, raus aus der Stadt mir ist egal, was sie kann, mir ist egal, was sie hat Ich will raus, ich hab' keine Lust auf das Großstadtschnellleben,",German
+"Ohne gute Planung kann man sich also die Freude am Studieren kaputt machen, sie ist das A und O. Muss man für die Uni mehr lernen als für das Gymnasium?",German
+"immer aus mehreren Veranstaltungen zu einem Thema. Dann sucht man sich im Vorlesungsverzeichnis die entsprechenden Vorlesungen, Seminare und Tutorien, die für das kommende Semester angeboten werden und",German
+"dass Praxen, Notfallambulanzen oder Krankenhäuser, die gelegentlich Kinder als Patienten aufnehmen, eine Art Minimalausstattung haben sollten. Da können sie zum Beispiel an einem Elefanten",German
+"Du hast nichts mehr frei, oder? So, können Sie kurz den Oberkörper... Ich nehme zuerst mal Blut ab. Wieder muss es schnell gehen. Nach fünf Stunden Dienst bin ich schon fix und alle.",German
+"kann man fast nicht aufhören zu essen, weil man von den Gastgebern so bekocht wird. Das ist manchmal ein wenig anstrengend, weil man aus Höflichkeit nicht nein zum Essen sagt. Ein",German
+"sind!“ Das zweite Prinzip beruht darauf, Diskrepanzen zu entwickeln. Dahinter verbirgt sich im Gesprächsverlauf der Ansatz, die Suchtpatienten für Dissonanzen und Widersprüche",German
+verdeutlichen warum im vorstellungsgespräch je nach berufsfeld unterschiedliche anforderungen an den bewerber gestellt werden weil die berufsfelder anders sind man hat dort unterschiedliche ziele,German
+"Ja, also die Entfernung ist beim Pilsachhof 35 Kilometer, Haus Sonja liegt 50 Kilometer von Villach entfernt, und Pension Edenhof 65 Kilometer.",German
+"Also, Miriam, wir beide machen jetzt die Kreuzprobe bei Herrn Müller und hängen die Konserve an und dann telefoniere ich mit Herrn Puntiolo … Noch eins, Miriam – ich weiß, du bist die erste Woche hier –, hast du schon Erfahrung im Blut abnehmen?",German
+"Ich fühle mich abgeschlagen. Mir wird schwindelig und übel, wenn ich aufstehe. Außerdem tun meine Augen weh.",German
+Aufgrund der vorliegenden Befunde sollte eine dauerhafte Antikoagulation durchgeführt werden. Im Rahmen einer länger andauernden Schmerzbehandlung mit NSAR wird,German
+dass für so was oft die öffentlichen Gelder fehlen. Wir in Düsseldorf müssen unser Ausbildungszentrum erneuern und wir müssen aber 30% Eigenmittel bringen.,German
+"Glückwunsch, Herr Doktor Müller! So eine Exsikkose kann man leicht unterschätzen. Ja, ja. Ich wollte nur wissen, wie Sie das einschätzen. Bei Herrn Zumplik war der Blutdruck wieder über 110 diastolisch.",German
+"… vor allem dann, wenn die Gesamtumstände der Untersuchung hektisch und schwierig sind. Da macht man das Wichtigste zuerst … Apropos zuerst! Zuletzt sollte man die",German
+voll ja danke das ist ja interessant ich hätte gerne gleitzeit du auch gleich zeit was ist das denn also ehrlich gesagt weiß ich das auch nicht so genau komisch da sollte uns der chef doch erst,German
+"Ja, genau, Herr Doktor Wendelmeier, ich wollte das sowieso nicht und dann habe ich ja auch noch keine so guten Blutwerte gehabt. Ja, ich sehe. Ihr Hb-Wert ist zwar ohne Spende",German
+der firma zugänglich sind das hört sich gut an dürfen wir diese neuen e fahrzeuge dann auch privat benutzen das wird wie jetzt auch seien mitarbeitende die bisher einen firmenwagen für,German
+die lachen doch über mich das wirst du überleben tragt die anderen schuhe in deiner freizeit und komm morgen mit flachen schuhen hallo zusammen hallo louis du warst schon wieder zwei tage nicht,German
+ich mir das noch nicht überlegt es gibt hier ein paar kollegen die ich nett finde und die ich gerne auch privat besser kennenlernen möchte aber wenn man das hier vielleicht nicht macht,German
+"Natürlich. Ich sag Martina, dass sie uns vorerst an der Leitstelle abmeldet. Hallo, Frau Baussen, ein junger Mann, um die dreißig mit einem Tubus und Bülau-Drainage links. Sie können auf jeden Fall Ihren zweiten …",German
+"Lassen Sie die Eltern bei der Untersuchung im Raum? In aller Regel schon. Ich schaue auch, dass ich nach Möglichkeit immer eine Helferin bei mir habe. Wenn Blutentnahmen geplant sind, macht es Sinn, die Punktionsstelle frühzeitig mit",German
+die Krankenpflegerin der Krankenpfleger Krankenpfleger arbeiten im Krankenhaus.,German
+bitte melde dich schnell bei mir danke hallo hier spielhaus von der firma walter und co es gibt ein großes problem die klimaanlage die sie erst letzte woche gewartet haben ist schon wieder defekt wir,German
+"Hatten Sie in letzter Zeit mit jemandem aus Ihrer Familie Kontakt? Nein, ich hab keinen Kontakt. Und mit den Nachbarn? … die haben drei Kinder. Laute Kinder, die den ganzen Tag rumschreien. Und niemand greift ein …",German
+"Und was ist, wenn ich Angst bekomme? Ich habe gehört, es ist im MRT so laut. Kann ich das ertragen? Wie eng ist denn diese Röhre?",German
+"nicht mehr zusammen, teilweise nicht einmal mehr im selben Land. Daher gehe ich davon aus, dass die Bedeutung der Nachbarschaft und das Interesse daran in Zukunft weiter zunehmen wird.",German
+denn die lage ist ja wirklich optimal für uns ja herr stock wenn wir in diesem gebäude bleiben könnten wir eventuell mal über ein paar änderungen wie neue wandfarben oder so sprechen wir sind ja,German
+in der werkshalle liegt warte oder in der kantine nein danach habe ich noch telefoniert also es ist so ein größeres gerät in einer blauen tasche darauf ist ein aufkleber von meinem fahrrad,German
+"Atmen Sie bitte tief in den Bauch ein und wieder aus. Könnten Sie versuchen, einige Male zu husten? Ich halte jetzt Ihr Bein und Sie spannen",German
+"zum einen durch den Arbeitsaufwand bestimmt, der nötig war, um es zu bekommen. Das heißt Je mehr Mühe oder Zeit in die Beschaffung des Zahlungsmittels gesteckt werden musste,",German
+"der ist nicht so zufrieden bei sich im Betrieb. Das spricht für sich, dass man so viele Auszubildende hat, weil man anscheinend was richtig macht.",German
+"stört mich schon. Da wird es ja wohl bald besser … Da wissen wir heute Mittag schon mehr. Mit der Luftnot ist es auch nicht mehr so schlimm, oder? Ach, das war doch gar nichts. Sie konnten sich nur nicht",German
+"darum, das Gespräch nicht wie ein juristisches Zwiegespräch aufzubauen. Also dem Suchtkranken anhand von Befunden, Einschätzungen und Vorwürfen beweisen zu wollen, dass er oder sie ein Problem",German
+"Da habe ich ja alles abgegeben. Sehr gut, Frau Tietke. Also, für Ihre 86 Jahre erscheinen Sie mir wirklich sehr fit. Meinen Sie? Ja, da haben Sie eigentlich recht,",German
+"und Rollnick entwickelt. Es finden sich dort viele Strategien und Prinzipien wieder, die auch für die allgemeinmedizinische und psychotherapeutische Gesprächsführung sinnvoll sind. Die beiden",German
+schon dokumentiert wie ihr alle wisst kann er wegen seines hohen alters und seiner fortgeschrittenen demenz nicht mehr alleine essen und man muss ihm die nahrung anreichen markus,German
+"Ja, da vorne sitze ich. Und Sie haben hier den Drücker. Da brauchen Sie nur draufzudrücken und wir stoppen die Untersuchung. Und Sie kommen dann? Genau. Also wir starten dann jetzt … Nein, nein, das geht jetzt hier gar",German
+Der freiwillige Azubi-Tag geht weiter. Das sind unsere Azubi-Kojen. Das ist hier unsere ganze Azubi-Ecke.,German
+"Seit drei Stunden sind wir jetzt schon unterwegs. Ich hab nur eine Bitte, ich hab einen Patient mit einem... der hat Schmerzen. Ich will ihm Schmerzmittel geben. Ich bin vollkommen fertig Leute... Also körperlich. Meine Knie und meine Oberschenkel... Ein echter Notfall ist das hier nicht, versorgt wird er trotzdem.",German
+"aber der Smart ist repariert. Und der Corsa nicht... Der Corsa ist nicht repariert, nein. Und wieviel kosten denn die Autos? Ja, nicht unwichtig... Ja, also der Smart",German
+hallo daniel hier es tut mir wirklich leid aber ich muss mich für morgen schon wieder entschuldigen nachdem ich endlich meine üble erkältung überstanden habe hat es jetzt meinen sohn richtig schlimm erwischt vielleicht hat er sogar die krippe,German
+Wir gehen jetzt erst mal zusammen hier rein. Guten Morgen. - Morgen. Die Patientin muss in den OP.,German
+"weil eine könnte schon zu wenig sein. Wir gucken, dass die Beatmungsmaschine kontrolliert wurde...  Vielleicht schon Medikamente aufziehen... Soll ich Noradrenalin ziehen? Ja! … Ja! Raphael und das Team haben nur wenige Infos:",German
+"traditionellen Anlass miterleben? Ja, ich hatte Glück – meine Gasteltern haben mich mit auf eine Hochzeit genommen. Neben Unmengen an Essen bis in die Nacht (den letzten",German
+"Eine der Aufgaben, die Corni als Lehrer an einer staatlichen Schule machen muss: Noten vergeben. (Corni) Hast du durchgelesen, was ich dir geschrieben hab? - Ja.",German
+"und jetzt alles sacken kann. Klausuren bestanden, alle geschrieben. Jetzt können wir schön Weihnachten feiern und allgemein ein neues Jahr feiern.",German
+mutter nicht gut aber marie tat nur geantwortet sie müssen strenger sein so lernt das kind ja nie naja so sollte man mit einer mutter nicht sprechen und auch nicht zu ungeduldig mit den kindern sein,German
+"Was die Verordnung für morgen früh betrifft, so sprechen wir das mit den Kollegen von der Anästhesie ab. Ich werde mir jetzt noch einmal Ihr Knie anschauen und auf Herz und Lunge hören.",German
+"schließlich möchte man ja nicht stören. Wer seine Nachbarn nicht kennt, weiß nicht, wer an Kontakten oder aktiver Nachbarschaft interessiert ist. Man möchte vorsichtig anfragen,",German
+"Ich habe auch ein bisschen Schiss, ehrlich gesagt vor dem, was ich jetzt eventuell sehen werde. Ja, es kann alles möglich sein. Wir hoffen, dass die Patienten überleben. Das ist natürlich unser höchstes Gebot. Aber wir geben alles, bis wir sehen, dass es keine Möglichkeit mehr gibt.",German
+habe in Soziologie mit dem Spezialgebiet ‚Arbeit und Gesellschaft’ meine Doktorarbeit geschrieben. Wir stehen vor großen Veränderungen im Bereich Arbeit. Die hat es aber schon immer gegeben. Durch,German
+"geplant. Ist das o.k. für Sie? Ja, das passt mir sehr gut. Ich erkläre Ihnen die Vorbereitungsmaßnahmen und den Ablauf der Untersuchung. Damit ich",German
+"Und denken Sie noch dran, die Infusion zu wechseln! Schwester Sigrid, meinen Sie, man hätte ihm einen ZVK legen sollen? … und dann auf die Intensivstation? Ja, schon. Die Oberärztin hat so komisch geguckt? Die schaut öfter mal so ernst. Aber der Herr",German
+die Muskulatur an. Wenn Sie sich bitte auf die Untersuchungsliege setzen würden. Stellen Sie sich bitte breitbeinig hin.,German
+ja auch noch im büro ich habe heute auch erst um 10 angefangen wirklich warum weil ich das machen wozu flexible arbeitszeiten eingeführt wurden aber wenn du es genau wissen willst ich musste,German
+"desto mehr war es wert. Eine wichtige Rolle spielte aber auch die Menge, in der es verfügbar war. Für die Salzgewinnung war der Arbeitsaufwand beispielsweise sehr hoch",German
+monaten einige e fahrzeuge für diesen bereich kaufen aber schon in drei wochen werden wir und darüber freue ich mich besonders auch einige e bikes bekommen die dann allen mitarbeitern,German
+"Nein, ich habe keine Ahnung. Oder doch! Letzte Woche war mein Cousin zu Besuch. Ihm ging es an dem Tag sehr schlecht",German
+"nicht in die USA? Englisch zu lernen ist doch total sinnvoll. Welche Sprache spricht man eigentlich in Rumänien? Für mich war es total spannend in ein Land zu gehen, das eigentlich",German
+"Müll konsequent entsorgen würde gäbe es doch eigentlich tatsächlich nicht so viel gegen Plastik einzuwenden, oder Philipp? Na ja, wenn alle wirklich Müll trennen",German
+"Da haben viele Angst, diese Zeit nicht zu bestehen oder da Fehler zu machen. Da hat man schon ne gewisse Aufregung,",German
+restlichen Klamotten ist immer irgendeine Kunstfaser wie Polyamid oder Elasthan dabei. Was ist eigentlich so schlimm am Plastik? Müll wird doch in,German
+"15. Jahrhundert aufkam. Es sollte das Münzgeld nicht etwa ergänzen, sondern vielmehr ersetzen, denn durch den zunehmenden Handel standen vorübergehend nicht mehr genügend Münzen und",German
+"Was kann ich überhaupt heute machen? Temperatur messen, Blutdruck messen. Ich zeige dir, wie man ein EKG schreibt. Blutabnehmen zeig ich dir, wie es geht. Du kannst gucken. Ich bin sehr schlecht in Dart. Also, so viel Erfahrung mit Spritzen habe ich.",German
+gleich durch das personalisieren soll dem nutzer also der person die am computer sitzt die arbeit erleichtert werden ja und dadurch dass ich meine arbeit überall gemacht habe habe ich ganz viele,German
+"wirklich notwendig ist. Schließlich wollen Sie ja auch diesen Blasenkatheter wieder loswerden. So, was liegt für heute noch an? Die Oberärztin möchte, dass wir die komplette Tumordiagnostik durchführen, bevor Herr Trabitz entlassen wird.",German
+"konnte das nicht richtig zuordnen. Ist Ihnen sonst noch etwas bei seinem Bewegungsablauf aufgefallen? Wenn ich jetzt mal ausschließe, dann habe ich weder Lähmungen, Schonhaltungen oder Ataxien bemerkt.",German
+das management entscheiden zuerst müssen wir es aber über das problem informieren du hast recht das müssen wir zuerst tun willst du das übernehmen man müsste dann ja auch mit,German
+"Das war bestimmt interessant … Also, dann wollen wir mal anfangen … Selbstverständlich, Schwester Anne. Wen haben wir denn als Ersten? Am Fenster hätten wir Herrn Trabitz. 67-jähriger vitaler Patient. Kam wegen Dyspnoe. Lungenembolie",German
+"vorstellen würde. O.k., was hat er denn? Zu mir ist er wegen einer Post-Zoster Neuralgie im linken Thorax Bereich Höhe Th 7 Th 8 gekommen. Der Mann ist 72 und arbeitet als Schreinermeister noch im Betrieb",German
+erneut an ihren daten bedienen müssen sie hier nachbessern ja aber was können wir dafür tun muss eventuell auch die technik erneuert werden wie gesagt die gute nachricht dass sich kriminelle erneut an ihren daten bedienen müssen sie hier nachbessern ja aber was können wir dafür tun muss,German
+in meiner freizeit ein fernstudium gemacht und mich zur leitungskraft qualifiziert aber hier wird das nicht anerkannt ich bin ja nicht mehr teamleiterin du hast gedacht dass du nach deinem,German
+"Wenn euch im Gespräch mit dem Arzt diese einzelnen Wörter nicht einfallen oder ein Wort nicht so richtig passt, ist es auch sehr hilfreich, die Schmerzen mit Vergleichen zu beschreiben. Also zum Beispiel: “Der Schmerz fühlt sich an",German
+"Herr Grübler, wir hatten ja darüber gesprochen, dass ich im Rahmen der Erstuntersuchung Ihre Prostata abtasten werde. Ja, ich weiß, aber das tut doch nicht weh, oder?",German
+bringt sich jeder eigentlich ihren oder seinen kaffee mit zu ihrem aufgabengebiet gehört dass sie vor den meetings die technik vorbereiten damit dann auch alles läuft das bekomme ich,German
+"dann doch problemloser ging, als man hätte denken können. Nur die Dekompression L 4 hat ewig gedauert. Bestimmt zusätzlich noch Vernarbungen? Richtig. Auf jeden Fall ging es mit der Spondylodese dann recht zügig.",German
+mit ihrer hasen gruppe auf den spielplatz dort sie können gerne mitgehen um auch das kennen zu lernen das war also unser garten jetzt zeige ich ihnen die räume hier im haus im kindergarten haben wir,German
+"Natürlich. Mehr dankbar geworden als früher. Einen Flur weiter, auf der internistischen Station 1 ist Emily. Soll ich auch für euch stellen für morgen, wenn ihr wollt?",German
+uns buchen ich weiß nicht ob das eine gute idee ist ein hotel ohne elektronisches buchungssystem aber auf der anderen seite haben noch vor ein paar jahren alle hotels es so gemacht es müsste,German
+Durftest du denn auch mal was machen? Naja. Er hat mir mal die Positionierung der Schrauben genauer gezeigt ... Immerhin bist du dabei gewesen. Genau: Meine erste Stabilisierungs-OP L4 L5! Also neurologisch war sie direkt postoperativ,German
+"Es ist ein anderes Gefühl, wenn man die Übergabe mit dem Patienten zusammen macht. Dann weiß der Patient aktuell, wie der Stand ist.",German
+gosei nova bitte fangen sie an ich würde gerne eine weiterbildung machen welche hast du schon gemacht eine weiterbildung hier in deutschland lasst mich überlegen nein hier in deutschland,German
+"Du bist die Lena? Und schon fünf Jahre alt! Ja. Oh, du bist ja richtig heiser, Lena. Hast du denn heute schon etwas gegessen? Nee. Sie isst ja nichts mehr. Seit gestern.",German
+"meine Frau. Den bringt sie nachher mit. Wissen Sie, warum sie den Schrittmacher bekommen haben? … wegen der Rhythmusstörungen. Und dann bin ich einige Male umgefallen, einfach so! Können Sie sich noch erinnern,",German
+"bevor ich die Ausbildung angefangen habe, dass, okay, muss ich jetzt anfangen oder soll ich warten, bis ich auch mein Deutsch verbessert habe.",German
+"Die Lerngruppen hier sind ähnlich groß wie Klassen an einer normalen Schule. Weil auch die Heliosschule staatlich ist, kann Leiter Andreas Niessen",German
+"doch gar nicht Freitag, oder? Ein ganz normaler Dienstag, aber … Na gut, was haben Sie denn für mich? Den Herrn M., er ist knappe 56. War wegen",German
+denn sonst schon praktische berufserfahrungen gesammelt ja ein bisschen erfahrung habe ich mein onkel hat ein kopierladen und da habe ich schon oft ausgeholfen was genau waren da ihre,German
+"Ihre Vitalstoffe. Und füllen Sie dann die leeren Tanks gezielt mit guten Präparaten aus der Apotheke auf. Denn 80 Prozent der Menschen leiden heute unter Vitalstoffmangel, weil in unserem Essen nichts mehr drin steckt. Die dritte Säule: Denken Sie sich jung. Stress",German
+"Jetzt muss die Frau von der Trage auf das Bett. Raphael sagt: Ein kritischer Moment, in dem das Herz wieder stehen bleiben könnte. Kopf sagt an.... Okay, alle bereit? 1, 2, 3...",German
+Der Arzt braucht das Stethoskop zum Abhören. die Waage Die Waage braucht man zum Wiegen.,German
+sie das nicht gut finden ja das ist auch eine möglichkeit und wenn alles nichts hilft was machen wir langfristig ich denke da muss man abwarten aber langfristig soll die arbeit mit den kindern,German
+oder wie lange sind Sie schon im Beruf. Sondern auch die jungen Auszubildenden werden konfrontiert mit den Fragen der Patienten. Mit Patienten kann ich auch reden.,German
+so geht das nicht an ich habe aber schmerzen kein wunder bei diesen stöckelschuhen die du jeden tag trägst mit gesundheitsschuhen würde dir das nicht passieren die die uns der betriebsarzt,German
+"nicht mit Batterien. Das war auch klar. Toll! Na, ich bin gespannt, wie es mit deiner Erfindung weitergeht ... Gespräch 4",German
+"die machen oben einen Platz frei, dann geht einer von der null 02 oben und dann kann sie auf den Platz drauf. Der Pflegenotstand führt jetzt zu noch mehr Stress für das vorhandene Personal:",German
+"den zwölf Minuten der ‚Freien Aussprache’ wurden jede Menge Argumente vorgetragen und begründet, und die Zeit ging wie im Flug vorbei. Im letzten Teil der Debatte, der sogenannten Schlussrede,",German
+"Das ist wirklich viel Spaß in der Schule, auch im Einsatz. Das ist wirklich wunderbar, toll. Ich gebe einmal die Anwesenheitsliste rum.",German
+dem job und der familie alles nebeneinander hinzubekommen ist anstrengender als ich gedacht habe tatsächlich aber du kannst du doch die zeit einteilen und lernen wann du zeit hast du sitzt,German
+"Er hat nie sein Gesicht verzogen. Nicht mal ein angedeutetes Lächeln … Als würde ihn das hier gar nicht interessieren. Richtig, er wirkte sehr teilnahmslos, obwohl wir uns sehr um ihn bemüht haben. Würden Sie die Gesichtszüge als starr beschreiben?",German
+"Herr Schäfer, ich verstehe Sie richtig, dass Sie schon seit längerem über Luftnot klagen? Also Luftnot … … Schwierigkeiten bei der Atmung?",German
+"linken hinteren Bereich sieht man lateral eine ulzeröse Veränderung. Vergrößerte Lymphknoten? Nein, aber Mundgeruch. Also, was seine Lunge betrifft, ist er jetzt so weit stabil, und wenn Sie ihn sich anschauen …",German
+"Hemmungen mich zu fragen, falls Sie bestimmte Begriffe nicht kennen. Sie hatten mich auch gebeten, dass ich die Vorgehensweisen an konkreten Beispielen verdeutliche, und das werde ich nun tun: Nun, ich möchte Ihnen zu Beginn zwei Fälle schildern, die",German
+"Gut. Der ist nicht mehr da. Am Telefon erfährt er: Der Hoden-Patient liegt schon auf dem OP-Tisch. Ah doch, okay. Muss jetzt sofort notoperiert werden. Oh Gott! Also war berechtigt mit der Übelkeit.",German
+"Na, das freut mich aber, was die Frau Lurtz über mich gesagt hat. Wenn ich mich vorstellen darf. Mein Name ist Monzano. Ich bin hier in der Unfallchirurgie als Assistenzarzt tätig. Sie bekommen morgen eine Knieprothese, ist das richtig?",German
+"im Umgang mit Kindern zu sprechen kommen. Es ist wichtig, mit dem Kind zu reden! Das wird so oft vergessen. Das Kind ist der Patient! Viele reden gleich mit den Eltern über das Kind,",German
+"Wie ich sehe, wurde bei der Besprechung vor acht Wochen auf eine Eigenblutspende verzichtet. Also Herr Doktor … Wendelmeier.",German
+"Labordiagnostik blande. Und es gibt auch keine Hinweise auf Sensibilitätsstörungen … Ich könnte Ihnen jetzt alle Befunde der körperlichen Untersuchung vorlesen, sie waren durchweg normal. Auch die",German
+"Also, ich würde auf jeden Fall versuchen es aus der Wunde bluten zu lassen. Durch kräftiges Massieren und Drücken! Und vielleicht auch ausspülen. Am besten",German
+"Mann gleich mit. Die haben wir in der Hektik zu Hause liegen lassen. Frau Henschel, die Schilddrüsentabletten nehmen Sie täglich ein? Jeden Tag eine Hunderter! Seit der Operation. Sind denn bei Ihnen darüber",German
+anbieten ja aber die müssen wir erst bestellen das dauert wer sich heute wieder gäste über die harte matratze beschweren könnten wir diesen gästen eine zusätzliche weiche decke anbieten oder das,German
+kaum gefüllte Jugularvenen. Wir haben sofort mit einer intravenösen Flüssigkeitstherapie begonnen. Dürfen meine Angehörigen bei der Untersuchung dabei sein?,German
+"Danach hab ich so paar Freundschaften gemacht. Und die haben diese Ausbildung gemacht. Dann hab ich gesagt, okay, das ist ja interessant.",German
+"kernhaltiges Obst oder Paprika mehr essen. Auch kein Vollkornbrot? Um ein verwertbares Ergebnis zu erreichen, sollten Sie auf Vollkornbrot verzichten,",German
+und sie hallo mein name ist ist in grün ich bin seit ungefähr dreieinhalb jahren in deutschland ich habe in der türkei informatik studiert und mehrere jahre als programmierer gearbeitet vielen,German
+"Ja, das Insulin. Aber das muss ich ja spritzen. Morgens und abends? Abends auch. Aber das macht meine Frau. Also, Ihre Frau stellt Ihren Zucker ein?",German
+"""Was siehst du?"" ""Einen Stern, ein Haus, ein Herz, einen Hut... ... eine Blume und einen Mond.""",German
+"Sie haben leichtes Fieber. Sie haben wahrscheinlich eine Erkältung. Wissen Sie, wie Sie sich infiziert haben könnten?",German
+"Ich kann wegen der Schmerzen nicht mehr schlafen oder nicht mehr gehen. Falls ihr diese Konstruktion mit “vor” als kausale Präposition noch nicht kennt, schaut euch",German
+"würden ... Aber viele Leute werfen Plastik, Papier und Essenreste halt doch in dieselbe Tonne. Es kommt auch öfter vor, dass Leute ihren Müll achtlos wegwerfen. Das sehe ich",German
+"Vereinsamung zunehmend als Problem empfunden. Was kann man denn dagegen tun, dass sich die Menschen allein fühlen? Da gibt es inzwischen viele neue Projekte, die dem entgegenwirken. Der",German
+Warte. Am Ende soll Katja die Leistungen der Schüler*innen bewerten. Mit den Mädels bin ich sehr zufrieden.,German
+du four das computerprogramm war troja und wir können erwarten dass es funktioniert ich würde sagen die reklamieren bei der computerfirma dass sich gleich ein programmierer darum kümmert ja,German
+halt tag und nacht jemand nur für die buchungen dasein ja stimmt das ist viel zusatzarbeit und wir werden gäste verlieren weil das mehr zeit kostet also keine so gute idee was schlägst,German
+selbst zuständig dafür werden sie ausgestattet und bekommen gebrauchsfertige multi cleanskin spender boxen was sind den multi klien es das sind hygiene tücher die reinigen und desinfizieren man kann sie,German
+"Weil ich trage viel Verantwortung. Von der Triage, bis der Patient da hinten liegt. Und ich würde mir wünschen, dass die Politik diese Verantwortung auch mehr wertschätzt.",German
+Trinken Sie genug Wasser? Vielleicht ein Liter pro Tag. Das ist definitiv zu wenig.,German
+dem firmengelände werden selbstverständlich genug ladestationen zur verfügung stehen wir produzieren hier ja mit unseren solarzellen ökologischen strom da die kollegen vom außendienst die,German
+"Vielleicht ist er ja irgendwo dazwischen. So ein Blauer? Richtig. Da ist er doch. Guten Tag, Frau Winter, nehmen Sie bitte Platz.",German
+"beidseits mit mäßiger Rechtsherzbelastung. Bei Aufnahme deutliche D-Dimer Erhöhung. Anamnestisch eine TVT linksseitig vor 15 Jahren und eine Fettstoffwechselstörung, die mit Simvastatin",German
+"Feierabend für Nicole. Das ist der Raum, wo wir unsere Bekleidung morgens holen. Ich würde mir schon mal eine in den Spind tun,",German
+"Dann erhöhen wir den Betablocker morgens auf 5 mg. Soll ich das in die Verordnungen eintragen? Ja, und kontrolliert bitte heute über Tag den Druck alle 4 Stunden.",German
+"in Erinnerung behalten. Auch in diesem Jahr besteht im Anschluss an meinen Vortrag die Möglichkeit zur Diskussion. Ich hoffe, dass Sie auch dieses Mal von der Möglichkeit Gebrauch",German
+"das bei BeckerCo., oder bei Freiberger. Okay. Ja, gut. Also die Feier soll in der nächsten Woche sein. Wann muss ich mich denn da bei denen melden?",German
+"Stimmt, er ist in den wohlverdienten Ruhestand gegangen. Sie haben es sicherlich schon auf dem Praxisschild gelesen: Ich heiße Kettler und habe die Praxis vor einem halben Jahr von der Kollegin Zubalski übernommen. So weit zu mir: Was führt Sie denn zu mir, Herr",German
+"sie in eine andere Richtung. Ich gebe Ihnen mal ein Beispiel, wie man Widerstand aufnehmen und in eine konstruktive Richtung lenken kann, die dem Patienten noch genügend Raum lässt",German
+"Viele in diesem Team kennen sich durch die Ausbildung im St. Martinus-Krankenhaus. Für das Experiment haben sie sich beworben, Monate vorher getroffen.",German
+"habe bisher schon eine Menge gelernt und tolle Anregungen bekommen. Oft sind es Kleinigkeiten, wodurch ich mich auf meinem Instrument aber wirklich weiterentwickeln kann. In jedem Land, aus dem die Musiker kommen, hat das Christian-Rauch-Gymnasium in Bad Arolsen",German
+können lasst uns vorher noch überlegen was wir den gästen als entschädigung anbieten bei denen der fehler schon passiert ist wir haben es hier zum glück immer ein zimmer frei und mussten niemanden,German
+"Ach was, ich werd wohl aus der Wohnung raus müssen.",German
+"Weshalb ich halt lieber den Spätschicht, wenn in Pflege bin, machen würde. Da ich besser ausschlafen und besser konzentrieren kann.",German
+andere programme sind dafür nicht mehr erlaubt und was ist mit den handys gut dass sie das ansprechen herr müller in den nächsten monaten werden die meisten ihrer mitarbeiterinnen und,German
+"oder eigentlich schon fast alle Freunde, die gesagt haben: Ja, bei dir kann ich mir das gut vorstellen. Katjas Kollegin Vivien",German
+"Frau Gunter, Sie haben drei Kinder, nicht wahr? Ja, zwei Töchter und einen Sohn. Der wird jetzt acht. Sind die Geburten alle komplikationslos verlaufen?",German
+"er immer so 120 zu 70 oder mal 80. Nehmen Sie Blutdruckmedikamente ein? Nein, ich habe ja keinen richtigen Bluthochdruck. Sieht das denn Ihr Hausarzt genauso?",German
+"Und was hab' ich für Optionen beim Zahlen? Also den Touareg, den müssten Sie im Prinzip sofort bezahlen, per Sofortüberweisung ebenfalls den Smart, Sie können den Opel",German
+sich dann ihre aktivierte personalisierte schließt karte gegen eine unterschrift abholen ganz einfach was ist wenn ich meine chipkarte verliere oder sie kaputt geht da müssen sie sich schon anstrengen um,German
+"Sissi-Tour - lediglich 14 Euro ist da der Preis. Und gibt's da irgendeine Ermäßigung? Ja, wenn sie jemanden mit dabei haben, der unter 16 jahren ist, dann gibt's also eine",German
+"für unsere Hörerinnen und Hörer – wie war der Schulalltag in Rumänien? Die ersten Monate war es schwierig, weil ich ja auch die Sprache nicht konnte, aber im zweiten Halbjahr wurde mir einiges klarer. Plötzlich verstand ich meine Klassenkameraden und",German
+tischen und stühlen für 5 und zur sicherheit lieber für 30 personen bitte und eine frage noch sie haben gesagt sie können dann getränke bereit stellen ist es denn möglich dass sie uns,German
+"Der Blick, die Achtsamkeit ist eher fokussiert auf eins und eher immer nach unten. Aber Pflege soll immer noch dieses Rechts und Links.",German
+"schon seit dem Jahr 2000 ein erstklassiges, internationales Jugendmusikfestival stattfindet, das seinen Namen verdient. Es ist erstens wirklich international und zweitens treten",German
+"sind immer dieselben Debattiert wird zu politisch und gesellschaftlich relevanten Fragestellungen. Eine Debatte dauert 24 Minuten, es debattieren vier Schüler bzw. Schülerinnen,",German
+"ganzen Daten schon bei mir im Computer. Benötigen Sie denn auch noch eine Überweisung? Nein. Wenn Sie Ihre Überweisung bei der Verwaltung abgegeben haben, reicht das vollkommen aus.",German
+"hab ich gleich ein Fieberzäpfchen gegeben. Und heute Morgen hat sie noch ein wenig gehustet. Und da sind wir gleich los … Da hat sie schon wieder eine Mandelentzündung, oder? Lena, würdest du mal den Mund – so weit wie s geht – aufmachen … Das machst du wirklich toll …",German
+wochenende gibt es wenige verbindungen aber für den berufsverkehr also zu den zeiten an denen die leute zur arbeit und wieder nach hause fahren geht es um sind die busse morgens tanz davon weißt du,German
+"sein. Dazu gibt es im Moment keinen Anlass. Wir werden schauen, was bei der Ultraschalluntersuchung herauskommt, und die Laborbefunde abwarten und dann werde ich mit",German
+"ist es schon gerechtfertigt, eine höhere Bezahlung zu bekommen. Aber es ist nicht so, dass ich meine Brötchen mir für den Monat aufteilen muss, weil ich nicht weiß,",German
+"ich nicht sagen. Seit Anfang des Jahres nehmen Sie noch ein Antidepressivum ein … Ja, da ging es mir gar nicht gut. Gab es für Sie einen Grund, dass es ihnen nicht so gut ging?",German
+"das kenne ich so nicht aus Deutschland. Selbst Sport treiben die Rumäninnen nicht ungeschminkt. Gab es denn etwas, was dir besonders gut in Rumänien gefallen hat? Ja, auf jeden Fall.",German
+"Das Unterschreiben nicht vergessen! Selbstverständlich, Schwester. Ach so, bevor ich es vergesse, der Sohn von Frau Stingl kommt heute Nachmittag vorbei und möchte gerne mit einem Arzt sprechen … Frau Stingl?",German
+Herzinsuffizienz bekannt. Während der operativen Versorgung wurden insgesamt drei Erythrozytenkonzentrate transfundiert und vier Liter RingerLactat-Lösung infundiert.,German
+"Mann gleich mit. Die haben wir in der Hektik zu Hause liegen lassen. Frau Henschel, die Schilddrüsentabletten nehmen Sie täglich ein? Jeden Tag eine Hunderter! Seit der Operation. Sind denn bei Ihnen darüber",German
+"auf den Großstadthastfrust Literatur - Stadt und Land Und du fragst dich: wofür denn das alles, wofür denn der Scheiß und es kommt niemand vorbei, der die Antworten weiß – Ich will einfach liegen bleiben ich will heut nicht raus Ich habe die",German
+"Du sagst, Doping sei gesundheitsschädlich. Ja, es stimmt, dass manche Dopingmittel erhebliche Gesundheitsschäden auslösen können. Andere hingegen sind eher ungefährlich für die",German
+"Maßnahmen verhindern sogar, dass sich der Kranke verstanden fühlt. Vermeiden Sie also die Beweisführung und insistieren Sie nicht darauf, dass ein Suchtproblem besteht. Um",German
+"Mal gehüstelt, nichts Dramatisches. Dann find ich ihn ein bisschen blass, und er wirkt so schwitzig, nicht kaltschweißig, eher ein Schwitzen, wenn man sich angestrengt hat. Vielleicht kam es",German
+habe heute mein handy in der firma liegen lassen ich habe es erst gemerkt als ich zu hause war und ich wollte da nicht noch mal in die firma fahren kannst du bitte mal nachschauen ob es irgendwo,German
+"der die Untersuchung durchgeführt hat? Ja, ich habe alle Befunde! Aber in der Krankenakte kann ich sie nicht finden. Oh je, da sind die restlichen Befunde und Briefe bestimmt noch in dem Umschlag. Aber den bringt meine Frau auch gleich mit.",German
+"Ziel ist es, das Interesse der Teilnehmer für unterschiedliche Stile zu wecken und zu fördern. Entscheidend für das Festival sind aber neben den Konzerten vor allem die angebotenen Workshops.",German
+"hat deine Gruppe im Kindergarten auch einen Namen? Sagen wir mal Bärengruppe oder Sternengruppe. Nein. Wie heißt deine Gruppe, Julian? Sag schon!",German
+"der uns für unsere Kartoffeln Bohnen überlässt, um über diesen Umweg schließlich an unser Brot zu kommen. Solche Tauschaktionen können nicht nur zeitraubend sein, sie sind auch nicht immer von",German
+vor wir schicken ihnen nachträglich noch einen gutschein mit einer gratis übernachtung das wird teuer wollen wir nicht lieber einen gutschein mit einer ermäßigung für die nächste woche schicken,German
+"beschriebenen Beschwerdebild würde ich in gleicher Weise vorgehen. Guten Abend, mein Name ist Lukacs, ich bin die diensthabende Neurologin. Ja, guten Abend, Müller. Das ist mein Mann, Walter Müller.",German
+"der Seite. Die Hüfte, wissen Sie! Wenn das für Sie zu schmerzhaft ist, können Sie sich auch auf die linke legen. Ja, das geht besser. So …?",German
+die speziellen angebote und was besonderes ist und die üblichen sachen wie eine wegbeschreibung und die seite mit dem kontakt und natürlich diese währungs möglichkeiten ganz wichtig finde ich,German
+"Muss ich ja! Alles Gute, Herr Trabitz. So, und das ist der Herr … Die junge Frau kenn ich! Das ist die Frau Steffens. Die hat heute Morgen bei Ihnen Blut abgenommen.",German
+"Kunststoffe, die biologisch abbaubar sind. Von generellen Verboten halte ich jetzt nicht so viel. Andere Materialien verbrauchen bei der Herstellung nämlich auch viel Ressourcen. Zum",German
+"Vielen Dank, das werde ich machen. Auf Wiedersehen und gute Besserung!",German
+"Lassen Sie die Eltern bei der Untersuchung im Raum? In aller Regel schon. Ich schaue auch, dass ich nach Möglichkeit immer eine Helferin bei mir habe. Wenn Blutentnahmen geplant sind, macht es Sinn, die Punktionsstelle frühzeitig mit",German
+"er ja doch geht gesagt, oder? Herr Müller, es kann sein, dass Sie etwas sagen möchten, aber dass es Ihnen nicht gelingt. Nein …st. Nein … eh …st Nun sag schon, Herbert …",German
+scheinen mir die Verletzungen nur oberflächlich zu sein. Mal ein Vorteil von Körperfülle. Er ist dann über den Balkon geflüchtet und aus ca. drei Meter Höhe auf den Parkplatz gesprungen.,German
+personen sind können wir ihnen einen nachlass von 5 prozent gewähren frau holle ihre ursprünglich vorgesehene trainerin musste leider kurzfristig für uns ins ausland fahren deshalb wird jetzt,German
+draußen ich war über eine stunde ins geschäft und dann abends wieder über eine stunde zurück da wäre ich ja schön blöd wenn ich das angebot nicht annehmen würde und du ja ich bin noch,German
+worüber sich die gäste beschweren was meinst du wie könnten wir die anderen gäste kontaktieren wir könnten sie direkt ansprechen und sie fragen wie sie das öl finden glaubst du das ist eine gute,German
+"Gut, dann schaue ich gleich mal, wie’s ihm geht. Vielleicht hat er ja erhöhte Temperatur? Sollen wir ein kleines Blutbild abnehmen …? … und CRP. Sicherheitshalber. Ja,",German
+"Aber du brauchst dich doch nicht zusammenzureißen! Verdammter Mist, so ein verdammter Mist. So ein Dreck … Ich darf mich doch aufregen Herr Doktor, oder?",German
+"- “Ich habe Schmerzen im Handgelenk, die bis in die die Finger ausstrahlen.” Die Ärztin oder der Arzt wird euch wahrscheinlich auch diese Frage stellen:",German
+Bald ist er wieder gesund. Hatschi! Sie hat Schnupfen.,German
+"man nicht genug fördern. So eine Erfinder-AG scheint mir da eine gute Möglichkeit zu sein. Wird die AG an Ihrer Schule denn gut angenommen? Ja, auf jeden Fall. Wir überlegen jetzt, auch mal",German
+"Merken Sie sich das gut, Frau Steffen: Es kommt gar nicht selten vor, dass Symptome einer Lungenembolie sehr uncharakteristisch sind oder die Patienten sie zum Beispiel als leichten Infekt",German
+"Sonografie war in Ordnung. Ja, ich verstehe schon. Meine Idee ist nun, dem Patienten eine Skelettszintigrafie zu empfehlen, was halten Sie davon? Ja, bei dem von Ihnen",German
+war in meinem letzten Monat in Rumänien – ich konnte also schon ganz gut sprechen und habe mich mit vielen Leuten unterhalten. Erst um 8 Uhr morgens war die Hochzeit vorbei. Das,German
+"Ziel auch eingehalten wird? All die Versuche der vergangenen Jahre haben gezeigt, dass dies unmöglich ist und das generelle Doping-Verbot eher kriminelle Energie freisetzt statt das Problem zu",German
+"""Geh bitte in Zimmer 2!"" Tim geht in Zimmer 2. Tim setzt sich auf einen Stuhl.",German
+die Krücken der Rollstuhl die Rollstühle,German
+"zudem gibt's bei Firma Partyspass und bei Freiberger Geschirr und Besteck, und wenn Sie auch eine Raumdekoration haben möchten, dann tun Sie das am besten bei BeckerCo",German
+kommen am freitag so ungefähr um drei uhr nachmittags mit fünf personen rufen sie mich doch bitte mal zurück meine nummer ist 03 14 276 67 4 roland wörtlich wie,German
+werden gerade eingescannt und digitalisiert und stehen größtenteils schon als akten zur verfügung und muss ich mich bei den konferenzen um die bewirtung kümmern nur in ausnahmefällen da,German
+"geholfen, bewusster einzukaufen. Ich achte jetzt darauf, so wenig Plastik wie möglich zu verwenden. Das ist aufwändiger und leider manchmal auch teurer. Man muss z.B. für das Müsli im",German
+"Ich meine ja auch meine Igel, die ich kenne. Du schaffst das niemals! Doch! Das will ich sehen, ob du das schaffst! So, guck hier! Super, da kann ich",German
+"Mein Name, ist Küppers, ich bin der diensthabende Arzt der Inneren Abteilung. Tut mir leid, dass ich es nicht früher geschafft habe. Ich war beruflich unterwegs: in Mailand … Und, wie geht es meiner Frau? Ich kann Sie beruhigen, Ihrer Frau geht",German
+"O.K., die Internisten haben vorhin einen Infarkt reinbekommen und wir sind auch für die nächste Zeit beschäftigt. Hallo, Leute! Und was ist im Anmarsch? Hallo Frau Baussen, ein junger Mann, um die dreißig mit einem Tubus und BülauDrainage",German
+"also da, es fehlt jedoch vielerorts an Weltläden. 60% der deutschen Bevölkerung haben keinen Weltladen in erreichbarer Nähe. Es fehlt an Läden in den Städten, aber auch in der Fläche. Unsere",German
+kann ich machen das ist eine gute idee vielen dank die zeit ist um und ihre prüfung ist nun zu ende also jakob du fährst morgen dann mit emilio zur familie riester die wohnt in der garten allee 53,German
+"Unternehmen-Weltladen hilft also sowohl beim „Fairwirklichen"" des Traums von Selbständigkeit, als auch beim „Fairwandeln"" schon bestehender Läden oder Gruppen.",German
+"Sich nicht alles gefallen zu lassen, das lernt man auch in diesem Beruf. Was wollten Sie als Kind mal werden? Schauspielerin oder eine Tänzerin.",German
+"Daten Wozu brauchen wir eigentlich Geld? Nehmen wir an, wir wollten ohne Geld auf dem Markt einkaufen. Das könnten wir nur, indem wir Güter zum Tausch anbieten. Wir bringen also vielleicht",German
+"auf einer Skala von 1–10 beschreiben müssten, wo würden Sie sie dann einordnen? Na ja, so auf 6!? Hmm, sind Sie wegen einer anderen Erkrankung bei einem Kollegen in Behandlung? Nein, mir geht es eigentlich",German
+Sie hat Bauchschmerzen. Übelkeit Ihr ist übel.,German
+vorgestern Verlegung auf unsere Station. Thorax-CT ist gelaufen? Natürlich … Irgendein Hinweis auf eine Thrombophilie oder maligne Grunderkrankung? Bisher nicht.,German
+"14 muss heute noch in die Bronchoskopie, Herr Sammer und Herr Welter zur Koloskopie. Ja, das weiß ich. Wie war denn das CRP von Frau Gundlach? So, was liegt für heute noch an? Die Oberärztin möchte, dass wir die",German
+Er meint seit einigen Wochen. Er liegt so bei 40 Zigaretten am Tag und zugebenen 6 Flaschen Bier und mal einen Schnaps … Mir schwant Böses … Mir auch. Er ließ sich mit dem Mundspatel nicht besonders gut untersuchen. Aber im,German
+"Bären untersuchen lassen. Auch eine gute Idee. Und dann gibt es zum Schluss eine große Spritze, kleine Spielzeuge oder ein witziges Pflaster! Passt auch ins Budget! Wir haben sogar eine Tapferkeitsurkunde!",German
+"begründen ihre Position und untermauern sie mit Beispielen. Hier geht es darum, die Argumente der Gegenseite ernst zu nehmen, an dem, was der Vorredner gesagt hat, anzuknüpfen und die eigenen",German
+"konnte. Die Münzen waren nur für den Tausch bestimmt und hatten sonst keinen weiteren Nutzen. Nach dem Münzgeld war der nächste Schritt nun das Papiergeld, das in China im 11. und in Europa im",German
+sie kommen mit ihrer karte zum beispiel nicht in die it abteilung weil sie nicht dort arbeiten auch nicht in die küche oder ins lager diese türen können wie bisher nur von den entsprechenden,German
+Lymphknoten. … Hast du denn heute noch gespielt? Ein bisschen. Sie hat ja die ganze Zeit mit Bauch- und Kopfschmerzen auf der Couch gelegen. Haben Sie Fieber gemessen? 39 hatte sie abends. Und da,German
+"Herzlichen Glückwunsch! Auf deinen ersten Preis kannst du echt stolz sein! Oh, danke! Ja, ich habe mich echt gefreut! ... Hast du hier auch etwas vorgestellt? Noch nicht. Im Moment recherchiere ich hier erst einmal für unsere Erfinder-AG",German
+leider erst noch klären oh nein das ist aber ja es ist blöd deshalb will ich mit dir aber kurz besprechen was denn in den nächsten tagen in seiner abteilung ansteht damit wir gemeinsam einen,German
+"Alles klar. Gab es sonst noch Besonderheiten, die ich wissen muss? Ja, hallo, hier Turino am Apparat. Weiland, Klinik für Allgemeinchirurgie. Ich",German
+im einkauf braucht man ja zum beispiel andere programme als im vertrieb deshalb war das für die eine abteilung so und für eine andere abteilung anders das ziel war aber immer,German
+"Auch nach der Eröffnung lassen wir die Gründer mit ihrem Laden nicht allein, sondern beraten kontinuierlich etwa in Sachen Handelsmanagment. Über den Austausch mit Gleichgesinnten und schon erfolgreichen Läden profitieren die Neugründer von einem umfangreichen",German
+"ausatmen ""Bitte tief ein- und ausatmen!"" ""Bitte durch die Nase ein- und ausatmen!""",German
+"Und, hat sie denn einen Herzinfarkt? Nein. Alle Untersuchungen, angefangen vom EKG bis zu den Laborwerten sind in Ordnung … Guten Tag! Sie sind die Eltern vom Julian?",German
+das Fieberthermometer Mit dem Fieberthermometer misst man die Temperatur. das Stethoskop,German
+zwei büro hunden bei euch gibt es büro hunde das ist doch toll ja für die hundebesitzer und die anderen kollegen sind von den hunden auch ganz angetan du nicht du hast doch nicht etwa angst,German
+gehabt. Ich fand das sehr interessant. Ich könnte nach dem Staatsexamen sogar hier an der Uni-Klinik anfangen. Uni-Karriere! Also Forschung und Lehre!,German
+"Autsch. Leiden Sie an chronischen Erkrankungen? Ja, ich leide seit mehreren Jahren an Diabetes und an Herz-Kreislauf Problemen.",German
+"oder die Uni immer noch wechseln. Wichtig ist auch, dass man herausfindet, was man selbst will. Oft erfüllt man auch unbewusst die Erwartungen der Eltern oder der Freunde.",German
+"sie verwirrt und war sowohl zeitlich, als auch räumlich nicht adäquat orientiert. Als weitere Befunde zeigten sich eine leicht erhöhte Temperatur mit 37,2 Grad,",German
+"Ja. Ist es der ganze Unterbauch, der schmerzt, oder finden Sie, dass es mehr in der rechten oder mehr in der linken Seite weh tut? Es ist eindeutig stärker rechts. Manchmal zieht es auch nach links rüber. Aber eigentlich mehr",German
+"dann ist er aus dem ersten Stock gesprungen? Aber kein Schädel-Hirn-Trauma. Gut, ich geb das weiter. … Thoraxdrainage. Wo? Ach so: links! Ja, … In 5 bis 10 Minuten. … Doktor Khadivi?",German
+das öl noch mal genau ansehen vielleicht war ja nur diese eine flasche schon abgelaufen hier stimmt das sollten wir zuerst tun und wir sollten auch mit der küchenchefin sprechen die muss wissen,German
+"dann auch operiert. Und das war das erste Mal, dass ich auf einer anderen Sprache mit einem Arzt über Schmerzen sprechen musste. Das war gar nicht so einfach. Deshalb möchte ich euch",German
+"ich ihn gerufen habe … und dann habe ich gleich die Notrufnummer gewählt. Ich dachte ja zuerst, er hätte wieder ein Zuckerkoma … Das war die absolut richtige Entscheidung. Benötigt er Insulin? Ja, er spritzt sich schon seit Jahren.",German
+"Deswegen sind wir an dieser Schule. Weil wir hier die Möglichkeiten haben, mehr Freiräume zu bekommen und die Freiheit bekommen, Dinge auszuprobieren.",German
+habe ich aber nicht die tischkarten kannst du die bitte aus drucken der usb stick mit den vorlagen ist irgendwo auf meinem schreibtisch oder steckt im pc das weiß ich jetzt nicht mehr genau ich,German
+"Huch, der ist ja feuerrot! Und die Zunge! Du hast eine Himbeerzunge, Lena! Ziehst du bitte mal deinen Pullover hoch? Guck mal Mama: da unten, rote Punkte!",German
+"Untersuchungsbefund vom Hausarzt und hier die aktuellen Laborwerte. Jetzt fehlt mir noch der Anamnesebogen, den Sie zu Hause ausfüllen sollten. Also, ich habe so viele Fragebögen ausgefüllt.",German
+"Sie daran, vorher genug zu trinken. Das fällt mir ja schwer, das Trinken. Im Alter ist das immer so eine Sache mit der Flüssigkeitsaufnahme! Aber es ist der einfachste Weg sich Schwierigkeiten mit dem Kreislauf nach der Eigenblutspende zu ersparen.",German
+sie ja unterstützung durch frau robbins aus dem verkaufsteam und durch eine neue mitarbeiterin aber sie werden die abteilung dann leighton das team ist dann im zweiten stock neben der,German
+auch kuchen dazu anbieten oder soll ich gehen woanders bestellen ist denn in dem raum eine gute musik anlage vorhanden bitte rufen sie mich morgen vormittag unter folgender nummer zurück,German
+"etwas zu essen mit. Das ist richtig lecker. Samosa oder so was Ähnliches, kann das sein? (Frau) Samsa, hat sie gemeint.",German
+"Frau Gunter, Sie haben drei Kinder, nicht wahr? Ja, zwei Töchter und einen Sohn. Der wird jetzt acht. Sind die Geburten alle komplikationslos verlaufen?",German
+idee wenn sie sich nicht über das öl beschweren dann würde ich sie auch nicht darauf ansprechen ja du hast recht das ist sicher besser wenn aber wirklich mehrere flaschen schlecht sind,German
+"Entfernung der Mandeln, als auch die Behandlung mit einer Bissschiene und die Extraktion der Weisheitszähne brachten keine Besserung der Symptomatik. Zeitweise nahm der Patient",German
+"ist er zwar wegen seiner rezidivierenden Schmerzsymptomatik gekommen. Was ihn aber eigentlich beunruhigt ist eine neu aufgetretene Dyspnoe. Ist er zyanotisch? Nein, aber er hat schon",German
+"Wie seid ihr, wenn ihr krank seid? Wenn ich einen Patienten habe, der gerade seine Krebsdiagnose gekriegt hat, da frage ich den nicht, wie geht es Ihnen denn.",German
+"Herr Müller, ich mache jetzt die gleiche Untersuchung an den Armen … Links ist in Ordnung. Und jetzt drücken Sie mal kräftig mit der rechten Hand zu … So, Herr Müller, schauen Sie mich mal an",German
+immer im frühjahr wenn es wärmer wird geht es wieder los dann holen wir das geld wieder rein und bei dir ich arbeite in einem krankenhaus da gibt es keine chance weniger zu arbeiten,German
+"verantwortlich für Organisation und Verwaltung auf der Pflegestation. Er sagt, er sei überrascht, wie schnell sich die neuen Mitarbeiter zurechtfinden hier in Deutschland.",German
+Ein mechanisch betriebenes Fahrrad geht so langsam über meine Kraft. Das Alter macht sich leider bemerkbar. Aber so ein E-Bike ist da wirklich eine gute Alternative. Damit könnte,German
+bei uns im restaurant vergessen und wie viele stunden darf man pro woche maximal arbeiten hallo abdullah du gehst vormittags einkaufen hast du denn heute frei frei naja wie man es,German
+"Aber nichts sagen, verstanden? Das werde ich schon selber entscheiden … So, dann legen wir mal los … Darf ich Ihnen unsere neue PJ-lerin,",German
+Ort macht mich krank und am Scheidplatz liegt ein Obdachloser schlafend auf 'ner Bank Und ich kann's nicht mehr sehn wie ich's noch nie sehen wollte Nicht: weil es das Bild stört sondern,German
+"als Aussteller auf so einer Messe aufzutreten. Wie schön! Das ist bestimmt sehr motivierend! Ich finde es übrigens auch spannend zu sehen, wie manche Erfindungen entstanden",German
+lokale Injektionsbehandlung mit einem Kortikoid brachte kurzfristig eine deutliche Verbesserung der Schmerzsymptomatik. Nach Wiederauftreten der Beschwerden wurde eine Resektion des Prozessus,German
+"bin ständig herumgelaufen. Hab Kneippsche Bäder gemacht. Und dann habe ich dem Hausarzt gesagt, dass ich jetzt unbedingt Schlaftabletten benötige. Und dann hat er mich gefragt:",German
+"sogar bis hinten reinleuchten! Du hast gewonnen! So, Saskia, jetzt hol ich mal mein Telefon. Das ist doch gar kein Telefon. Ja, stimmt, du hast Recht, aber früher, da gab es Telefone, die hatten vorne so einen",German
+"Die App in der Kitteltasche. Der Smartphone Doc. Aus vielen Arztpraxen und Kliniken sind sie nicht mehr wegzudenken. Sie sind längst im Klinikalltag angekommen, die medizinischen",German
+thema das sie auswählen im zweiten teil führen sie ein gespräch unter kollegen und im dritten teil müssen sie gemeinsam lösungswege diskutieren würden sie sich zu beginn bitte kurz vorstellen,German
+ausbildung vorhat sie möchte zuerst eine stelle suchen wenn es klappt in teilzeit parallel dazu möchte sie sich selbstständig machen wenn sie mit ihrer selbständigen arbeit genug geld verdient,German
+Lebensmittel bekommt. Getrunken habe ich nur Leitungswasser oder Getränke aus Glasflaschen. Und was ist dir am schwersten gefallen? Am Schwierigsten war es bei der Kleidung. Ich,German
+sehr gute erfahrungen gemacht mit dem betrag der alten rechnung kann ich aus buchhaltungs gründen leider nichts mehr machen aber wenn sie jetzt wieder bei uns einkaufen dann gebe ich ihnen,German
+sie bitte an suchen sie sich ein thema aus und sprechen sie darüber ja gerne ich möchte über ereignisse und erfahrungen entsprechen die meine berufswahl beeinflusst,German
+programme die sie gebraucht haben installiert hat durch diese arbeit hat ja sehr viele mitarbeiter und fast alle abteilungen seiner firma kennen gelernt ich hatte den eindruck dass ihn das,German
+"zerfällt in immer kleinere Teile, die man irgendwann gar nicht mehr von Sandkörnern unterscheiden kann. Diese Teilchen sind dann aber trotzdem nicht biologisch abgebaut, sondern sie vermischen sich mit dem Sand, kommen ins Wasser und dann in den Nahrungskreislauf.",German
+deaktiviert die ausstellung eine ersatzkarte geschieht dann wieder in der it-abteilung und ist gebührenpflichtig sie haben am anfang gesagt der einbau dauert etwas wann soll das überhaupt,German
+"Dann müssen Gegebenheiten gegeben werden von der Politik. Kurz vor 2 ist Übergabe für die Spätschicht. Eine wichtige Besprechung,",German
+Ein ganz frisches Team hat vor einem Jahr die Station übernommen. Voraussetzung: Sie alle haben erst vor Kurzem ihr Staatsexamen gemacht. Okay.,German
+"Tim sagt: ""Aaah!"" die Ohren Die Ärztin sagt: ""Ich schaue jetzt in deine Ohren.""",German
+kommen und das überprüfen und er soll bitte auch neue batterien für den laserpointer mitbringen die müssen ausgetauscht werden danke hallo kollegen samuel hier danke für die nachricht es gibt also,German
+"Heute Morgen: Es war aber nur 37,8. Obwohl ich mich viel schlechter gefühlt habe. Bevor ich Sie jetzt gleich untersuche, müsste ich Ihnen noch ein paar Fragen stellen. Sind",German
+Richtig! Er konnte den Unfallhergang genau schildern. Unabhängig von den Schmerzen entwickelte er eine zunehmende Tachypnoe mit deutlicher Abnahme der Sauerstoffsättigung. Links thorakal konnte ich kein Atemgeräusch mehr auskultieren und,German
+alle unsere auftraggeber in ihren firmengebäuden hygiene sensible bereiche haben und der dampf auch eine desinfizierende wirkung hat mit dem trockenen dampfreiniger gewinnt ihr bei,German
+schuhwerk und lange hosen mitzubringen beim klettern dürfen sie auch keinen schmuck tragen wir freuen uns schon sehr auf das wochenende mit ihrem team danke und bis bald,German
+"Bevor der Arzt gleich zur Untersuchung kommt, nehmen wir schon mal Blut ab. Und ja, richtig gehört: Wir. Geht's bei Ihnen? Mit dem Zeigefinger drückst du hier... Und den schiebst du rein.",German
+sind denn die Anhänger gemacht? Die sind aus Elektroschrott. Ich verwende dafür alte Platinen. Alte Platinen? Das sind Träger für elektronische Bauteile. In Handys und Tablets werden sie viel eingesetzt. Aus den Platinen schneide ich dann,German
+"dass Deutschland nur ein Problem hat - nämlich, dass zu wenig Menschen laufen? Das stimmt! Es ging uns noch nie so gut, wir hatten noch nie eine so lange Lebenserwartung. Trotzdem jammern Millionen Deutsche jeden Tag - über ihr Kreuz,",German
+"Ja, so wie ein Revolverheld aus einem Western oder ein Pokerspieler … Rufen Sie sich doch bitte in Erinnerung, wie der Patient hereingekommen ist. Falls",German
+"bei einer Frequenz von 83. Herr Knoll, es ist wichtig, dass Sie weiterhin genug trinken. Sie bekommen heute noch zusätzlich Flüssigkeit über diese Infusionen, die da hängen. Natürlich nur so lange das",German
+Da muss man auf viele Sachen achten. Jürgen. Einen wunderschönen guten Morgen. - Hallo.,German
+"Bitte machen Sie den Mund auf und sagen Sie ""Aaa"".. Aaaa...",German
+den videokonferenz- raum und die materialausgabe zeigen sehr gerne was man da so generell macht damit bin ich ja vertraut aber in jeder firma ist das ja auch ein bisschen anders hmm sie sind ja,German
+richtige person für diese stelle zu sein viele wollen auch wissen wo man sich in fünf jahren sieht oder aus welchem grund man beim vorherigen arbeitgeber aufhören möchte da gibt es sie haben,German
+Konditoreien wären völlig unvollständig. Cafés sind nicht nur vom Sonnenschein abhängig. Sie bieten den Gästen ideale Rückzugsmöglichkeiten bei Schlechtwetter und dem Gast ein Stück österreichische Gemütlichkeit. Wie werben Sie für das österreichische Café?,German
+"Wann sind Sie heute Morgen aufgestanden? - 4:30 Uhr. Und auch, ich bin erst um 12 Uhr eingeschlafen eigentlich. Ist ja auch nur eine Gewohnheitssache.",German
+"Blutdruck regelmäßig kontrollieren. Und dann gibt es da noch belegte Brötchen und Getränke. Wenn sie vom Kreislauf her stabil sind, geht’s wieder nach Hause. Darf ich denn mit dem Bus zurückfahren? Haben Sie keine Möglichkeit sich fahren zu lassen?",German
+"und auch die finanziellen Aspekte, worüber sich die Musiker freuen: Wenn ich ein Stück fertig habe, schicke ich es an den Vertrieb und der kümmert sich um den Rest. Das entlastet mich sehr und ich habe mehr Zeit für mein wirkliches Interesse, nämlich zu komponieren.",German
+"der herzversorgenden Arterien. Als besondere Risikofaktoren gelten in erster Linie Fettstoffwechselstörungen, Rauchen, Zuckerkrankheit, Bluthochdruck, Kontrazeptiva vor allem bei Patientinnen, die rauchen, und",German
+"technische Erfindungen und Entwicklungen sind neue Berufe entstanden, andere sind verschwunden. Das ist eigentlich nicht das Problem. Wir müssen uns aber im Moment durch Automatisierung,",German
+schon wir sind alle schon länger in der baubranche das ist im winter immer so da wird einfach weniger gebaut ich bin nicht unzufrieden und dass wir kürzer als sonst arbeiten ist ja auch nicht für,German
+mittag einen strom im haus das soll ich bis um 4 uhr prüfen jetzt finde ich in der werkstatt aber den spannungs messer nicht ich suche schon seit einer halben stunde ich will deswegen heute,German
+"dann ist er aus dem ersten Stock gesprungen? Aber kein Schädel-Hirn-Trauma. Gut, ich geb das weiter. … Thoraxdrainage. Wo? Ach so: links! Ja, … In 5 bis 10 Minuten. … Doktor Khadivi?",German
+du fährst fast eine stunde das ist aber lang ich brauche nur 15 minuten und ich fahre meistens mit dem fahrrad mit dem fahrrad aber was machst du wenn das wetter schlecht ist wenn es regnet fahre,German
+"Gang gab es um 4 Uhr nachts), haben die Rumänen endlos getanzt. Ich habe dort das erste Mal Hora getanzt – einen traditionellen Hochzeitstanz, den alle zusammen im Kreis tanzen. Die Hochzeit",German
+So war die Kaurimuschel eines der ältesten und am weitesten verbreiteten Zahlungsmittel in der Weltgeschichte. Sie wurde lange Zeit in weiten Teilen Asiens und Afrikas als Geld genutzt – und,German
+"Wenn Schulaufsicht nicht mehr Aufsicht heißt, sondern Unterstützungsagentur, wären wir einen Riesenschritt weiter. Alessandro, willst du einmal kommen?",German
+so ich komme jetzt zu den sanitärräumen die firma wand sprache hat die spender für das desinfektionsmittel nach dem händewaschen und die seifenspender ausgetauscht die sind,German
+"Meine Arbeit ist jetzt getan. Ja, ja. Wie es weiter mit den Neurologen ist, das kann ich nicht sagen. Nur er. Man redet schon viel, ne? Mit Patienten und hört zu und ist eigentlich auch da.",German
+mal erklären was das ist ich finde nicht gut wenn in der firma einfach etwas neues gemacht wird und wir mitarbeiter wissen gar nicht worum es geht oder was meinst du ja da stimme ich dir zu ich,German
+"Das Verb, das sich verändert? Der Teil vom Verb, der sich verändert, genau. Eine simple Idee, um die Belastung der Lehrer*innen",German
+formular letztes mal mussten wir ja leider viel umtauschen das war nicht so erfreulich sie können mich unter der nummer 0 69 542 86 12 erreichen ich heiße apitzsch das schreibt man a,German
+"Ja. Ist es der ganze Unterbauch, der schmerzt, oder finden Sie, dass es mehr in der rechten oder mehr in der linken Seite weh tut? Es ist eindeutig stärker rechts. Manchmal zieht es auch nach links rüber. Aber eigentlich mehr",German
+"spezialisierten Ärztinnen und Ärzten. Sind Sie auch damit einverstanden, Frau Dierhof? Ja, das können wir erst mal so stehen lassen. Und ich möchte gleich zu Beginn einen wichtigen",German
+"Zentrale Notaufnahme, Städtisches Klinikum, Schwester Sylvia Müller! … Ja, o.k.! Verstehe! Männlich, ca. 30 Jahre, intubiert und beatmet. Messerstecherei in der Wohnung,",German
+nicht mehr gebraucht. Das hat für die Betroffenen unterschiedliche Konsequenzen. Für die mit guter Ausbildung und finanzieller Sicherheit heißt das oft mehr Freizeit und Lebensqualität. Doch denen,German
+dreimal die woche training das ist ja ganz schön sportlich ja nicht schlecht oder aber dann hatte ich leider probleme mit dem knie und musste aufhören das ist aber schade machst du denn,German
+"deuten. War Ihnen schwindelig, Herr Trabitz? So ein bisschen. Kam halt so. O.k., Herr Trabitz. Wir sprechen nachher noch mal miteinander. Die Magentabletten nehmen Sie, ja?",German
+"dass Praxen, Notfallambulanzen oder Krankenhäuser, die gelegentlich Kinder als Patienten aufnehmen, eine Art Minimalausstattung haben sollten. Da können sie zum Beispiel an einem Elefanten",German
+"Pupillenreaktion. … Das ist alles in Ordnung. Sättigung 96 Prozent. Hier ist das EKG, das die draußen gemacht haben. Ok. Rhythmisch … kein Vorhofflimmern.",German
+dann mit Zeigefinger und Mittelfinger noch mal draufdrücken. Weil das kann noch ein bisschen nachbluten. Auch auf Station traut man ihr viel zu.,German
+an diesem Tag vor der Darmspiegelung … Also am 15ten. Richtig. … morgens noch ein Frühstück zu sich nehmen und zu Mittag eine Nudelsuppe essen. Ab dann dürfen Sie nichts mehr essen. Am Nachmittag trinken Sie bitte die erste Mischung,German
+dem messestand aus da ist alles organisiert die standfläche habe ich schon gebucht und den plan wer wann am stand ist habe ich auch fertig und natürlich habe ich auch für alle,German
+herr gül sie haben gesagt dass eine ihrer aufgaben in der it-abteilung darin bestand computer zu personalisieren was genau kann ich mir darunter vorstellen ja also das fing bei,German
+"sind dann an einer bestimmten Stelle, ihr könnt mit dem Finger darauf zeigen. Und es fühlt sich so an, als würde jemand mit einer Nadel in euch hineinstechen.",German
+"nicht. Das kann ich nicht. Das ist ja … Mir wird ganz anders … Dr. Hufer, wenn Sie mal kurz rein kommen könnten ... Herr Messenzahl, schauen Sie,",German
+"Es ist schon verblüffend, was da für ein Potenzial in den Auszubildenden steckt. Ich hatte heute Morgen gerade noch in der Zeitung gelesen,",German
+"Herr Schmitz, sind Sie denn ein bisschen stolz auf Ihre Azubis hier? Nee, absolut nicht ein bisschen, sondern ganz, ganz viel. Wenn man die Ergebnisse sieht und dass Auszubildende...",German
+"Guten Tag, Sie sind bestimmt der Herr Wächter? Wie kommen Sie denn darauf? Die Frau Doktor Lurtz hat mir gesagt, dass Sie ein netter, weiß melierter Herr sind. Und den sehe ich gerade vor mir.",German
+"Herr Zwingler? Die Neuaufnahme in der Vierzehn? Ja, bekommt morgen eine Knie-TEP. Helena! Ja? Herr Zwingler in der Vierzehn ist doch dein Patient, oder?",German
+"Getreide und Vieh, die nach einiger Zeit schlecht oder nutzlos werden konnten, aber auch Salz, Schmuck, Pelze, Stoffe oder Waffen. Der Wert dieses sogenannten Waren- oder Naturalgelds wurde",German
+"dann haben wir eine Stadtrundfahrt ""Wien by night'; und die berühmt-berüchtigte Sissi-Tour. Und wo geht's denn da los? Ja, ich weiß ja natürlich nicht,",German
+"Wie ich sehe, wurde bei der Besprechung vor acht Wochen auf eine Eigenblutspende verzichtet. Also Herr Doktor … Wendelmeier.",German
+"Sie kam als Au-pair nach Deutschland und hat schon ein freiwilliges soziales Jahr in einem Krankenhaus gemacht. Also eigentlich wollte ich vorher Medizin studieren in Simbabwe,",German
+"ist es aufgefallen und sie haben da das richtige Auge getropft und die Sache war in Ordnung. Wäre das so ein Fall, den man melden sollte? Sie werden das bei der Fortbildung und in",German
+sport machen muss deshalb gehe ich einmal pro woche schwimmen du gehst regelmäßig schwimmen wurden ich suche nämlich auch schon länger nach einer guten weg fähigkeit zum schwimmen im sommer,German
+"einen Skiurlaub bei ihnen buchen, in Österreich. Gibt es da ganz besondere Angebote, ganz besonders beliebte Orte, wo die Leute sehr gerne hinfahren? Ja, also die drei beliebtesten Pensionen sind",German
+"Touareg seit 2013. Ja also ich hätte gern am besten einen unfallfreien oder reparierten Wagen. Wie sieht's denn da aus? Also unfallfrei ist lediglich der Touareg, die beiden anderen, die hatten leider einen Unfall,",German
+vor hunden nein ich bin einfach kein hunde fan und das ganze büro riecht nach und das mag ich nicht kannst du das nicht mal ansprechen auf keinen fall ich bin neu in der firma und muss mich wohl,German
+Die Patientin wurde auf der Intensivstation extubiert. Im Lauf des Nachmittags klagte die Patientin über zunehmende Atemnot. Die O2-Sättigung fiel trotz Sauerstoffgabe von,German
+kaum gefüllte Jugularvenen. Wir haben sofort mit einer intravenösen Flüssigkeitstherapie begonnen. Dürfen meine Angehörigen bei der Untersuchung dabei sein?,German
+"Aber er hat wahnsinnig geblutet und dann noch der Sprung? Das kann man doch gar nicht überleben. Oder? Herr Doktor, wird er überleben? Ich fühle mich so schuldig …",German
+"ein Symptom, was wir nicht gesehen haben. Häufig findet man bei der Untersuchung der Patienten, dass ihre Hände zittern … Oh ja, Tremor, Rigor, Bradykinese …",German
+"Raphael! Es kommt noch ein Schlaganfall. Ich muss kurz verschwinden... Aber Sie lassen mir die nette Dame da? Nein, ich gehöre ja zu dem. Ich muss sie leider mitnehmen. Vielleicht geht dann ja ihr Blutdruck ein bisschen runter, das wäre gut...",German
+"Neuaufnahmen. Da wäre es gut, wenn du da wärest. Wer weiß, was sonst noch kommt! Ja, bin ich. Anne, Herr Knoll ist doch dein Patient, oder? Ja, warum? Pass bitte gut auf,",German
+Viele waren begeistert von der Idee. Haben wir gemeinsam neue Strukturen geschaffen. Einfach einen Cut gemacht,German
+"Gerne. Gute Besserung. Dialog 3, Niveau B1.",German
+hat das neue öl genommen weil es billiger ist man sollte mit der küchenchefin und mit dem chef darüber sprechen wenn die gäste sich so oft beschweren ist das nicht gut ich kann mich darum,German
+das ist doch insgesamt schon viel mehr arbeit gibt es dafür denn auch mehr geld ja wir stellen der firma wallbacher die zusatzarbeiten rechnung dazu sage ich später noch was jetzt aber noch zu,German
+"man konnte deutlich die Krepitationen hören … Martin, sieh mal zu, dass wir zuerst einen Röntgen Thorax zur Lagekontrolle machen … Ja, Frau Baussen, ist schon alles in der Mache. Also fünfter ICR links Thoraxdrainage mit Entleerung von ca. 500 ml Blut.",German
+"Super! Komm denn! Ich bringe dich mit dem Auto zum Arzt. Danke, Amira, dass du mich zum Arzt fährst, du bist eine echte Freundin.",German
+ja das ist richtig der umbau wird einige zeit dauern und ist natürlich auch mit einigem aufwand verbunden das ist uns bewusst aber das ist es uns auch werth denn so eine schließanlage erhöht,German
+"Blut abnehmen und eine Infusion anhängen … … Waaaasss! Heh! Nein, lass den Scheiß … Ich lasse überhaupt nichts … Was hast du denn alles getrunken? Gefeiert … wo iss Sven? Was du getrunken hast? Du bist",German
+will die Stadt mir nicht geben oder sie kann es nicht Deshalb mein Streben nach Land in Sicht. Kleine Geschichte des Geldes Von der Muschel zu virtuellen,German
+"es noch? Restless Legs. … richtig, diese unruhigen Beine festgestellt. Und konnten die Symptome durch das Medikament gelindert werden? Ich sage Ihnen,",German
+"Ich glaube, diese Situation, die wir mit Emily hatten, ist wegen diesem Pflegenotstand. Sie sollen beobachten viel im 1. Ausbildungsdrittel.",German
+den bodenflächen die zeit die er dann in den büro und personalräumen mehr braucht weil er ja gleichzeitig putzt und desinfiziert ihr müsst nicht mehr zweimal darüber wissen was müssen wir,German
+"Gehst du denn in den Kindergarten, Julian? Ja. Er ist doch jetzt schon vier Jahre alt geworden! So, alt. Eins, zwei, drei, vier Finger. Passt genau! Und",German
+"Spannungsgefühl zum Beispiel im Unterschenkel … Sehr gut. Und was machen wir jetzt? Umstellung auf Marcumar läuft. Er soll ja heute noch in die Endoskopie. Wegen der Magenbeschwerden. O.K. Dann schauen wir, ob da was bei herauskommt …",German
+"raubt uns Lebensjahre. Und es gibt ganz einfache Entspannungstechniken, das Stresshormon Adrenalin in die Wüste zu schicken. Zum Beispiel: „Schultern fallen lassen und tief durchatmen.""",German
+"Gut ist es auch, wenn ihr beschreiben könnt, was dazu führt, dass ihr Schmerzen habt. - “Was löst den Schmerz aus?” ist hier die Frage. Oder: “Was ist der Auslöser der Schmerzen?”",German
+"Aber ich habe doch gar keine Platzangst. Manchmal zeigen sich Ängste erst in ganz besonderen Ausnahmesituationen. Ich denke, es ist vernünftiger, Sie lassen sich jetzt",German
+"rufe wegen Ihrer Frau an, Herr Turino. Ja, ich warte schon die ganze Zeit. Hat wohl etwas länger gedauert? Wir hatten noch einen Notfall. Und so hat",German
+können Sie es anheben? … Sehr gut … Vorhin konnte er es noch nicht anheben. Und er hat es auch nicht gespürt. Der Notarzt hat richtig reingekniffen und er,German
+"deutet auf einen Volumenmangel hin. Wir sollten aufgrund der neu aufgetretenen absoluten Arrhythmie eine Echokardiografie durchführen. 1973, als Kind wurden ihr die Rachenmandeln entfernt.",German
+"hat deine Gruppe im Kindergarten auch einen Namen? Sagen wir mal Bärengruppe oder Sternengruppe. Nein. Wie heißt deine Gruppe, Julian? Sag schon!",German
+"guten Tag. Wir möchten nächste Woche eine kleine Party bei uns zu Hause organisieren. Welche Möglichkeiten können Sie uns da anbieten? Also wir können drei Firmen vermitteln, das eine ist BeckerCo., das zweite Firma Partyspass,",German
+"Wir duften auch was anderes machen außer malen. Wir durften auch schleifen und so, also ich finds cool. * Musik *",German
+"Warum musste er auch so früh nach Hause kommen? Frau Meier, er ist hier vor gut zehn Minuten eingeliefert worden, deswegen kann ich Ihnen noch nicht so viel über seinen genauen Zustand sagen.",German
+"Ja, dann hol ich sie gerade. Sie ist mit meinem Enkel draußen in der Cafeteria. Lassen Sie uns noch den weiteren Ablauf besprechen und dann holen Sie Ihre Tochter, o.k.? Hallo, Schwester Sylvia, wer ist denn von euch für den Herrn Zwingler zuständig?",German
+"Ja, schon gut. Was ist denn los? Es gibt Arbeit. Die Leitstelle hat uns einen Schwerverletzten angekündigt. Um die dreißig. Eifersuchtsdrama mit Messerstecherei. Er hat diverse Einstiche abbekommen. Ist dann über den",German
+branche sich frau karlowski noch vorstellen kann zu arbeiten und welche berufserfahrungen sieht zusätzlich zu ihrem praktikum schon gesammelt hat was machst du denn abends treibst du sport ob ich,German
+Dieser Vorteil des Geldes wurde von den Menschen früh erkannt und im Laufe der Geschichte sind die unterschiedlichsten Dinge als Zahlungsmittel verwendet worden verderbliche Ware wie z.B.,German
+"meine Frau. Den bringt sie nachher mit. Wissen Sie, warum sie den Schrittmacher bekommen haben? … wegen der Rhythmusstörungen. Und dann bin ich einige Male umgefallen, einfach so! Können Sie sich noch erinnern,",German
+"Außerdem verschreibe ich Ihnen Schmerzmittel gegen die Kopfschmerzen. Kommen Sie bitte wieder zu mir, wenn es Ihnen nicht besser geht.",German
+"wochenlang hochdosiert Schmerzmedikamente ein, die jedoch keinen wesentlichen Effekt gezeigt hätten. Eine Physiotherapie wegen der Schulter- und HWS-Beschwerden war anfänglich schmerzlindernd, zeigte jedoch nach kurzer Zeit keinen Erfolg",German
+"Und Frau Steffens, kennen Sie typische klinische Zeichen bei einer tiefen Beinvenenthrombose? Also das betroffene Bein ist geschwollen und schmerzt auch. Manchmal haben die Patienten ein",German
+der Schmerz die Schmerzen die Untersuchung,German
+"Das trifft auf uns leider nicht zu, aber danke. Und muss man sich da vorher anmelden? Ja, sehr zu empfehlen, eine entsprechende Möglichkeit online, also im Internet bieten",German
+"die Sprechstundenhilfe Die Sprechstundenhilfe sagt: ""Guten Tag!"" die Versichertenkarte",German
+"weil am Ende gibts einen 1., 2. und 3. Platz. Die Prüfung heißt Pflege-Olympiade. Klingt wie ein Spiel, wird aber bewertet.",German
+"eine ausschließlich medikamentöse Therapie durchzuführen, verzichtet. Wegen eines Pflegefalls in der Familie wollte der Patient eine operative Behandlung hinausschieben. Eine",German
+"Die Mädchen waren Hausgeburten und mit unserem Jüngsten war ich im Klinikum. Hatten Sie einen besonderen Grund? Nein, mein Mann fing an, sich immer",German
+"Wie viel Uhr haben wir? Ist das immer noch dein Feuerprojekt, Leon? Und Julian, was ist das da? Kaum dreh ich mich einmal um, das ist wirklich sehr interessant.",German
+auch geschult hey hier ist mario ich bin gerade im veranstaltungsraum und checker alles für unseren großen auftritt auf diesem laptop hier ging die datei ganz schnell auf und die folien laufen,German
+überall gut hin ich sehe schon sie denken mit das müssen sie dann im einzelnen mit den entsprechenden mitarbeiterinnen und mitarbeitern klären das gehört auch zu ihren aufgaben manchmal,German
+"Ich komme noch mal zu Ihnen später und dann gucke ich, ob es besser geworden ist. Raphael sagt: Die Schicht heute ist ungewöhnlich ruhig – doch das wird sich bald ändern! Oft sind die Gänge voll mit wartenden Patient:innen - und viele sind kein Notfall.",German
+"Abführmittel. Das sind zwei Beutel … Das schmeckt doch so eklig, oder? Toll schmeckt es nicht. Manche Patienten geben ein bisschen Apfelsaft rein. Dann ist der Geschmack nicht so intensiv.",German
+"Na, dann gratulieren wir ganz herzlich und wünschen den beiden für Berlin alles Gute und viel Glück. Literatur Stadt und Land Der Trott der Stadt Manchmal wünsch ich mir ich wär nicht hier sondern irgendwo anders",German
+arbeitssuche in ihrem land beschrieben haben sie hier in deutschland auch schon einmal eine arbeit gesucht falls ja wie thema 6 hatten sie schon einmal ein bewerbungsgespräch hier in deutschland,German
+"Ja, ich kann doch diese kleinen Zahlen gar nicht mehr lesen. Ich würde gerne wissen, ob bei Ihnen früher schon mal Herzrhythmusstörungen aufgetreten sind. Der Hausarzt hat mir vor Jahren gesagt, ich hätte eine Neigung",German
+"Diese Frauen haben als Krankenpflegerinnen in der Ukraine gearbeitet. Der Krieg hat sie zur Flucht gezwungen. In Deutschland möchten sie in ihre alten Berufe zurück, aber das geht nicht so schnell.",German
+"so oft über alles Mögliche auf! Ja, das könnte es gewesen sein. Aber normalerweise nimmt sie doch ihr Spray und dann geht es wieder. Hat sie nicht gesprayt? Doch, aber darauf ist es diesmal nicht besser geworden.",German
+"Das Duschgel ist im Bad. Jeder hatte andere Abläufe und andere Strukturen von anderen Stationen noch, und es hat jeder was mitgebracht.",German
+"Das ist Amoxicillin-Saft. Und jetzt tun Sie mir einen Gefallen und lesen mir vor, welche Prozentzahl hinter dem Amoxicillin auf der Flasche steht.",German
+"eigentlich AnästhesieDienst? Die Frau Baussen. Sehr gut. Das mobile Röntgengerät steht ja im Schockraum, oder? Natürlich. Ich sag Martina, dass sie uns vorerst an der Leitstelle abmeldet.",German
+"eine Klasse neu gestalten. Das kostet die Schule nichts, denn die Farben stellt der Malerbetrieb. Katja leitet jetzt die Baustelle,",German
+"und dann zieht er auch noch aus. Ohne Arbeit, ohne Geld … „Du bist der Vater! Sprich ein Machtwort“ … da muss man ja Migräne kriegen … Zu der Zeit fing es an mit den Kopfschmerzen?",German
+"Jahr Migräne. Hatte ich früher nichts mit zu tun … War darüber hinaus im letzten halben Jahr bis Jahr etwas Besonderes oder hat sich etwas verändert? Schmerzmäßig gar nicht. Nee, würde",German
+"an der Schule. Bist du auch in so einer AG? Nee, nee. An unserem Gymnasium gibt es so etwas nicht. Ich tüftle einfach so gern an Dingen herum und versuche Verbesserungen zu",German
+club wenn du es findest ruft bitte gleich auf meiner festnetznummer anja danke schonmal für deine hilfe guten tag hier ist die firma print und farbe meyer mein name sie haben letzte woche bei,German
+hier im Düsseldorfer Malerbetrieb. Außerdem hat Chef Jörg Schmitz noch 12 weitere Mitarbeiter. Sohn Sebastian ist ebenfalls Meister und für die Azubis zuständig.,German
+"Auch das soll Stress und Überforderung reduzieren. Das ist motivierend, wenn man mit Leuten zusammenarbeitet, mit denen man gerne zusammenarbeitet.",German
+"Und es nicht damit angefangen hat zu sagen: Dürfen wir das überhaupt? Wünscht Ihr euch mehr Freiräume, also Möglichkeiten, mehr noch selber zu gestalten, oder reicht das?",German
+"In Mettmann hat sie sich inzwischen eingelebt. Ich hab mich irgendwie einsam gefühlt. Aber jetzt, egal ob ich zu Hause bin, ich bin alleine,",German
+"Ich habe sie manchmal besucht. Und irgendwie hatte ich diesen Traum, dass vielleicht eines Tages würde ich einer anderen Mutter",German
+"Das war vielleicht vor 4 Wochen. Die Kontrolle hat der Hausarzt ja extra wegen der Operation vorverlegen lassen. Wäre ja sonst erst Ende des Jahres gewesen. Ja, das ist hervorragend. Haben Sie den Befund vom Kardiologen,",German
+"war in den anderen Pflegeteams. Die gesagt haben, wie soll das funktionieren. Die sollen erst mal zeigen, dass sie es besser machen. Aber das ging schnell, dass die gemerkt haben, das läuft sehr gut.",German
+gleichzeit einzuführen wie findest du das gleiche zeit was war das denn nochmal genau kannst du mir das erklären bitte gleich zeit ist wenn du morgens zum beispiel zwischen 7,German
+mit fordern aber vielleicht kann man ein paar weiche matratzen bestellen und beim einchecken die gäste fragen ob sie lieber auf harten oder weichen matratzen schlafen wollen denn sicher,German
+"Ihnen Blut abnehmen. Wir werden dann sehen, ob Entzündungszeichen im Blut nachweisbar sind. Letzte Woche hat der Hausarzt erst Blut abgenommen. Da war alles in Ordnung.",German
+müssten wir dann genauer sprechen befindet sich auch eine küche oder wenigstens eine kochzeile in den räumen bislang nicht nur ein kaffeeautomat und ein kleiner kühlschrank aber alle anschlüsse,German
+die Operationen das Krankenbett die Krankenbetten,German
+ungeduldig mit den kindern ist eine mutter hat auch gesagt dass sie manchmal nicht sehr freundlich ist was ist denn genau passiert ich habe das nicht so mitbekommen die mutter von helen,German
+in diesem haus ganz aufgeben alles was wir an material in den büros brauchen wird ab jetzt nach bedarf eingekauft also wirklich nur das was sie brauchen das schärft auch den blick dafür ob,German
+zum ochsen sie sprechen mit valentin klein guten tag hier ist helena müller von der firma greiner maschinenbau mein kollege hat bei ihnen vor zwei wochen das catering für eine firmenfeier bestellt,German
+"Zuerst würde ich gern wissen Was sind denn die wichtigsten Faktoren dafür, dass es in einer Nachbarschaft harmonisch abläuft? Eine Nachbarschaft ist eine Art",German
+natürlich die produktpalette kennen oder wenn sie dienstleistungen anbieten welche das sind außerdem sollte man sich mit der geschichte des unternehmens beschäftigen und wissen seit wann,German
+"gegangen. Ich habe Behälter für Wurst und Käse mitgenommen und nichts gekauft, was in Plastik verpackt oder eingeschweißt ist. Ich bin oft in einen Laden gefahren, in dem man unverpackte",German
+"Beschwerden jetzt langsam nachlassen, aber dann fing es unten im Bauch an. So, als wären sie von oben nach unten gewandert. Genau und jetzt sind sie unten. Können Sie mir die Beschwerden näher beschreiben? Haben sie zum",German
+"haben unsere Aufnahmestation gut finden können? Das war kein Problem. Die Dame von der Verwaltung hat es mir gezeigt. Das ist gut, dass Sie die Formalitäten schon erledigt haben. Dann sind Ihre",German
+betrifft die reinigung der bodenflächen in den produktionshallen wir setzen neu trocken dampfreiniger 1 dafür wird es im laufe dieser woche noch schulungen geben die geräte,German
+die bezahlung schon fair sein ich will auf jeden fall so viel verdienen dass ich mir eine schöne wohnung leisten kann und ein auto einmal im jahr in urlaub zu fahren wäre natürlich auch,German
+der wie eine kuh aussieht den du so gerne dazu wolltest so viel geld haben wir nicht gesammelt ja komm ich mache jetzt so sonst müssten wir alle noch mal um ein paar euros bitten hallo kollegen,German
+"oft gepaart mit Schluckbeschwerden, klagte. Immer wieder berichtete der Patient über ein komisches Globusgefühl im Halsbereich. Gelegentlich habe er starke Kieferschmerzen gehabt. Sowohl die",German
+"konnte oder können sollte. Das ist heute anders! Aber ich möchte noch für die jungen Kolleginnen und Kollegen anfügen, dass es wichtig ist, einen klar strukturierten Untersuchungsablauf zu haben!",German
+"kernhaltiges Obst oder Paprika mehr essen. Auch kein Vollkornbrot? Um ein verwertbares Ergebnis zu erreichen, sollten Sie auf Vollkornbrot verzichten,",German
+"Menge, das kann Gabriele Walter bestätigen, die die 17-Jährige Mika aus Estland zu Gast hatte. Ich bin froh, dass wir uns entschieden haben, einen Gast aufzunehmen. Wir erfahren so viel",German
+"Nase. Aber mit der Atmung ist alles in Ordnung. Sind Sie denn noch gegen andere Stoffe oder Medikamente allergisch? Ja natürlich, Penizillin! Nehmen Sie außer der Tablette gegen den Zucker noch andere Medikamente ein?",German
+büro würdest du auch nicht wollen oder nein das ist schon gut für mich so wie es geregelt ist schön dass ihr alle da ihr habt ja schon aus der einladung zu dieser präsentation,German
+"häufig eine Magenschutztherapie verordnet. Die Visite im Krankenhaus ist eine besondere Kommunikationssituation, an der mehrere Personen in unterschiedlicher Funktion beteiligt sind. Bei einer größeren Stationsvisite sind in aller",German
+"Aber es gibt ein Problem in den Kliniken – und zwar in ganz Deutschland: Es gibt viel zu wenige Pflegekräfte! Berufsverbände sagen: Es besteht die Gefahr, dass dringende Behandlungen zu spät erfolgen.",German
+eventuell auch die technik erneuert werden wie gesagt die gute nachricht ist dass sie bereits,German
+"Herr Müller, ich mache jetzt die gleiche Untersuchung an den Armen … Links ist in Ordnung. Und jetzt drücken Sie mal kräftig mit der rechten Hand zu … So, Herr Müller, schauen Sie mich mal an",German
+"Vor allem die vielen DJs, die in den Clubs ihre eigenen Kompositionen aufgelegt haben, sind immer populärer geworden. Natürlich brauche man ein Gefühl für Musik, für Harmonie und Rhythmus,",German
+"Regel ein Oberarzt, ein Assistenzarzt und eine Pflegekraft mit im Patientenzimmer. Normalerweise wendet sich der Oberarzt als Hauptgesprächspartner an",German
+Deswegen habe ich ja ein Kreuz auf Ihren rechten Oberschenkel gemacht. Frau Sandholz? Allergien sind keine bekannt bei Ihnen? Gegen Tierhaare. Aber das hatte ich angegeben ...,German
+deswegen bin ich jetzt gibt darin lehrer an einer musikschule das macht mir sehr viel spaß danke ich habe eine frage sie haben die band erwähnt die sie gegründet haben können sie dazu noch ein,German
+Aber es sollte nachdenklich stimmen. Ein derartiges Gesprächsverhalten nimmt den Patienten als Person nicht ernst und schafft sicher kein Vertrauen zwischen Arzt und Patient.,German
+"unauffällig. Sie ist nur mit dem Hb etwas knapp ... Wie ist er denn? 9,5. Und präoperativ hatte sie gut 13. Der Blutzucker lag bei 240. Alles nichts Dramatisches. Ich habe schon mit dem Ehemann telefoniert!",German
+um 15 uhr in die südstadt fährst dann bringe ich das der kundin ihr später es wird wieder nichts mit einem pünktlichen feierabend na ja selbst schuld danke und bis später,German
+von teneriffa weg danke frau ließ ihn aber dann sprechen sie jetzt bitte über ihr thema ja also ich würde gerne einer geschäftsideen beschreiben ich möchte später danke eine frage,German
+"was hat das dann noch mit Musik machen zu tun? Unser Reporter Frank Schirmer, wird uns in seinem Bericht diese Frage beantworten. Dazu hat er den Musiker Tobias Lochner in dessen Studio besucht.",German
+und sind gespannt auf den karaoke abend am freitag guten tag hier ist peter schmidt von der firma glasklar gmbh einem unternehmen für fenster und wintergärten guten tag was kann ich für sie tun wir interessieren uns für die räume die,German
+Ich will wissen: Wie hart ist der Job wirklich? Und was müsste in der Notfallversorgung besser laufen? Meine Schicht mit Raphael beginnt mittags und soll acht Stunden dauern.,German
+müssen bleiben wir hier erst mal noch bei unseren bisherigen fahrzeugen beziehungsweise werden wir einige hybride fahrzeuge anschaffen aus demselben grund schaffen wir vorerst keine fahrzeuge für den,German
+"Ausschnitte aus, poliere sie, damit sie schön glänzen, und dann fasse ich sie in Silber ein. Oder auch in Holz. Das sieht auch gut aus, nicht? Ja, auf jeden Fall! Ich hätte nie gedacht,",German
+"Der Oberarzt versucht ein Intensivbett zu organisieren. Also ist alles geregelt. Die kann dann auf die 02, aber da gibt es jetzt so einen Ringtausch von dann,",German
+fangen um halb sechs an und decken die tische wenn die gäste kommen sind sie im gastraum wenn die gäste den tisch verlassen räumen sie ab und decken neu ein wenn sie sehen dass auf dem buffet etwas,German
+"hektisch oder unkoordiniert. Diese Beobachtungen sind schon ein wichtiger Teil der Untersuchung. Was würden Sie denn zum Gangbild sagen? Ich fand, dass er ein wenig zu langsam ging. So, als wäre er unsicher ��� aber so richtig auffällig,",German
+und der hausmeister kammer bleibt alles beim alten und der hausmeister bleibt auch natürlich was ich aber noch ändert ist dass es ab kommendem monat eine eigene abteilung für qualitätssicherung,German
+"Ist der jetzt sinnvoll? Also, wenn sie liegt, ja, das ist sinnvoll. Aber dann, wenn wir sie auf die Bettkante setzen, das muss flach sein, für mich das ist ein bisschen angenehm.",German
+"ein Symptom, was wir nicht gesehen haben. Häufig findet man bei der Untersuchung der Patienten, dass ihre Hände zittern … Oh ja, Tremor, Rigor, Bradykinese …",German
+"Ja. Ja. Mein Name ist Norberger, ich bin die zuständige Oberärztin. Und, was meinen Sie? Aktuell geht es ihm ja wieder etwas besser … Das Fieber ist ja auch nicht weiter gestiegen … Richtig.",German
+Es sind pochende Schmerzen. Treten die Schmerzen plötzlich auf oder sind sie die ganze Zeit da? Sie treten plötzlich und heftig auf.,German
+"mitschwimmen. Also die Ängste oder Wutgefühle spiegeln a la: „Oh, ja. Das tut mir so leid. Ich könnte das auch nicht!“ Empathie unter professionellem Gesichtspunkt verlangt vielmehr",German
+ein bisschen mehr erzählt ja gerne also ich habe gitarre gespielt also akustische gitarren aber elektrisch danke herr minister frau ließ sie nur war jetzt habe ich eine bitte an sie ich,German
+"wenn ich in Ihr linkes Bein kneife? Ho, Hoh. Können Sie es anheben? … Prima! Und Ihr rechtes Bein? Merken Sie das? Eh … Eh … Was meinen Sie,",German
+"ein wenig Zeit. Wenn Sie sich besser fühlen, besprechen wir in aller Ruhe das weitere Vorgehen. Ja, Müller am Apparat. Grüße Sie, Herr Müller,",German
+"Infusionstherapie. Aber nicht zu schnell ausgleichen! Richtig. Und geht es ihm schon besser? Ja, Frequenz ist schon runtergegangen. Aber er braucht noch etwas Zeit. Wir sollten vielleicht schauen, ob man ihn",German
+"Unsere Praxisanleitung, wo ist die? - Keine Ahnung. Die Auszubildende verlässt die Station, weil sie Hilfe braucht. Was ist denn vorgefallen?",German
+"weil ich morgen schon wieder Früh habe. Ja, das wars. Guten Morgen.",German
+Österreich wäre ohne Kaffeehäuser nicht Österreich. Bei internationalen Messeauftritten oder Ausstellungen der Wirtschaftskammer gehört ein Kaffeehaus immer dazu. Die,German
+"Die Untersuchung. Wie geht es Ihnen, Frau Heuer? Hm.",German
+begleitender Übelkeit von den Kollegen der Inneren Abteilung gastroskopiert wurde. Dabei zeigte sich im Bereich des Antrums ein polypös wachsender Tumor. Histologisch stellte sich,German
+"bevor Sie sich hinsetzen und das Frühstücksei köpfen. Sie frühstücken automatisch. Und genauso ist das nach vier Wochen mit dem Laufen. Es gehört dann, wie das Atmen zu Ihrem Leben.",German
+"mit einem Antiseptikum, welches auch die Viren abtöten kann. Man könnte ja auch versuchen den Stichkanal zu vergrößern. Dann würde es auch intensiver bluten und mögliche Erreger ausschwemmen. Vielen Dank für Ihre Vorschläge. Wenn wir",German
+"seine Sachen auspacken. Ist was mit ihm? Ich bin mir nicht ganz sicher. Aber ich habe das Gefühl, dass bei ihm ein dicker Infekt im Anmarsch ist und er versucht, das runterzuspielen. Damit er auch auf jeden Fall operiert wird? Genau. Er hat während des Gesprächs ein paar",German
+"bekommen? Hallo, wo bin ich denn? Guten Morgen, Frau Sandholz. Ich bin der Herr Wagner. Ja, ja! Ich erkenne Sie an der Stimme! Dass Sie mir ja die richtige Seite operieren!",German
+heimatland beitragen gute idee nun zu den abläufen am morgen bevor die kinder kommen tauschen wir uns darüber aus wie morgen paul was ist denn mit dir los morgen lisa immer diese arbeit am computer,German
+"habe... Also ein bekannter Schmerz, den ich habe. Ob ich jetzt sofort in die Notaufnahme muss, kann ich jetzt nicht zuerst zum Hausarzt gehen? Die Notaufnahme ist zuständig für schwere und lebensbedrohliche Erkrankungen und Verletzungen,",German
+"handlicher zu sein als etwa Vieh oder Getreide, allerdings konnte man die unterschiedlich großen Metallstücke nicht einfach abzählen, sondern musste sie jedes Mal wiegen, um ihren Wert zu",German
+"Grüß Gott! Ok, wunderbar, den könnt ihr gerne auf den Shuttle legen. Sauerstoff. Genau, Puls misst er auch. Ahja. Ich brauche einen Finger, um den Sauerstoff zu messen.",German
+das ist gut zu wissen aber das wird für uns eher nicht erforderlich sein ist die werkstatthalle gegebenenfalls erweiterbar ja auf dem gelände ist noch relativ viel platz vor der halle befindet,German
+"Oder ich finde es peinlich, wenn ich einem Patienten nicht helfen kann. Das sind die Pflegekräfte von morgen. Bei ihrer Ausbildung erleben sie zum 1. Mal den Alltag im Krankenhaus.",German
+"Hand Geld vereinfacht den Warentausch erheblich, denn so können wir zu einem beliebigen Zeitpunkt etwas erwerben, ohne dafür gleichzeitig eine andere Ware eintauschen zu müssen.",German
+"Das ist das, was wir erhofft haben. Das kennen wir sicherlich alle, nachdem wir eine Ausbildung, ein Studium absolviert haben, kommt man in den Berufsalltag.",German
+eigentlich genau so wie hier in deutschland wenn man ein bewerbungsgespräch hat muss man sich gut darauf vorbereiten man wird zu beginn immer gefragt ob man sich kurz vorstellen kann,German
+"links. Zusätzlich gibt er an, in den letzten drei Monaten 5 Kilo an Gewicht verloren zu haben … Ich glaub, den schicken sie mal gleich zu mir rüber.",German
+"So, Frau Walborn, 13.12. Die beiden Praxisanleiterinnen sind das Bindeglied zwischen Krankenhaus und Schule.",German
+"im Portemonnaie haben oder wird das Bargeld verschwinden, weil wir demnächst nur noch Geldkarten, Online-Banking oder Bezahl-Apps einsetzen? In diesen Fragen sind sich auch",German
+Der Zustand der Patientin verbesserte sich innerhalb der folgenden 24 Stunden. Sie konnte am Folgetag extubiert werden. Gestern haben wir sie auf die Normalstation verlegen können.,German
+"Aufgrund meiner privaten Vorerfahrungen bin ich sehr orthopädisch unterwegs, durch meinen Sohn. Da kommen, glaube ich, ganz viele Komponenten zusammen,",German
+seine frau hat doch erzählt dass er immer so gerne erdbeereis mochte und sich manchmal noch nachts welches an der tankstelle geholt hat stimmt sie hatte zählt dass er gerne süßes ist dann,German
+"Wie oft laufen Sie? Jeden Tag ein bis anderthalb Stunden: Das ist ein Glaubenssatz geworden. Laufen macht glücklich. Ich will jeden Tag glücklich sein. Die Leute machen den Fehler und fragen sich, wie sie das Laufen in den Tag einbauen. Wenn man so denkt,",German
+"Kontakt zu Musikgruppen. Die Schule koordiniert dann all diese Kontakte zu einem großen Event, wodurch dieses einmalige Festival entsteht. Bad Arolsen hat leider keine Jugendherberge.",German
+"Die Jugendlichen können z.B. selbst entscheiden, welches Fach sie an welchem Wochentag machen. Alles ist über iPads organisiert.",German
+"War es Glück oder Zufall, dass der Fehler entdeckt wurde? Warum wurde das falsche Auge getropft und gibt es Möglichkeiten den Fehler zu verhindern?",German
+"Frau Dr. Dierhof und Herrn Dr. Steiger drei Fachleute aus der Praxis begrüßen darf, mit denen ich über dieses Thema spreche. Welche Tipps können Sie als Ärzte,",German
+"und helfen ihnen unter Einsatz all unserer Kräfte. Seit ich meinen Eid begriffen habe, gehe ich raus und kümmere mich um Gesunde. Ich habe gelernt, dass unsere Medizin auf dem falschen Bein aufgebaut ist. Unsere Medizin ist eine Drohmedizin. Wir drohen dem Menschen,",German
+"der dahintersteckte und entdeckte eine neue Möglichkeit, zwei Materialien miteinander zu verbinden. Es war Zufall, aber Voraussetzung für zündende Ideen ist ein aufnahmebereiter",German
+"Sie wissen schon, dass er lieber heute als morgen nach Hause will?! Ja, ja. Wir warten jetzt erst mal den Endoskopie-Befund ab, und dann sehen wir weiter. Vielleicht lässt sich ja so was auch ambulant machen? Frau Gundlach in der",German
+"morgen auf die Geriatrie verlegen kann, oder? Ich werde mein Bestes tun. Bei Herrn Müller liegen deutliche Hinweise auf eine Rechtsherzbelastung vor. Die deutliche Sinustachykardie bei Herrn Trabitz mit gleichzeitigem Blutdruckabfall",German
+"Punkt nennen, der oft vergessen wird, weil er vielleicht so banal erscheint: ein warmes und ruhiges Untersuchungszimmer! Wenn kleine Kinder oder gar Säuglinge zur Untersuchung entkleidet werden, kühlen sie enorm schnell aus. Für mich ist es wichtig, dass schon die",German
+und war im Rettungswagen dabei. Und hier war ich Praktikantin im Kreißsaal. Da ging's... ab!,German
+mache sie dann nachher bekannt wir sind ein nettes team und sie werden gut zu uns passen marina h wichtig auch mal wieder wie geht es dir im home office hallo andreas super,German
+"Tagen nicht verbessert, kommen Sie bitte wieder in die Praxis. Vielen Dank, Herr Doktor.",German
+"Jahr Migräne. Hatte ich früher nichts mit zu tun … War darüber hinaus im letzten halben Jahr bis Jahr etwas Besonderes oder hat sich etwas verändert? Schmerzmäßig gar nicht. Nee, würde",German
+"Vielen Dank! Bis später! Wie kommst du mit der Verantwortung und dem Druck klar, dass du hier entscheidest, also wirklich grundlegend, wie es mit dem Menschen hier weitergeht.",German
+"gegenseitig, denn das Wichtigste ist, dass man miteinander debattiert und nicht gegeneinander. Auch wenn dies alles ein Wettbewerb ist, in dem Sieger und Siegerinnen bestimmt werden müssen.",German
+auch ein elterngespräch anbieten wenn die eltern möchten das machen wir bei anderen problemen ja auch dann kann auch marita erklären warum sie sich in der situation so verhält und die eltern warum,German
+"Neues und Interessantes. Wir wussten ja vorher nicht, dass wir einen Gast aus Estland bekommen. Jetzt haben wir von Mika viel über Estland erfahren, aber auch über Musik, über Mikas",German
+die Ärztinnen der Arzt die Ärzte,German
+"morgen auf die Geriatrie verlegen kann, oder? Ich werde mein Bestes tun. Bei Herrn Müller liegen deutliche Hinweise auf eine Rechtsherzbelastung vor. Die deutliche Sinustachykardie bei Herrn Trabitz mit gleichzeitigem Blutdruckabfall",German
+der Schnupfen Augentropfen In der Apotheke gibt es Augentropfen.,German
+zum thema gab ich habe regelmäßig veranstaltungen im it-bereich besucht auch sonst hat die firma das umweltbewusstsein von uns mitarbeitern sehr gefördert ich fand das toll vielen dank,German
+eben später weniger arbeiten das steht bei ihnen prinzipiell die bereitschaft auch am wochenende zu arbeiten ja also nicht jedes wochenende aber gelegentlich könnte ich mir das schon vorstellen,German
+"Sodass wir halt die beste Vorbereitung für die Prüfung haben. Legst du hier oben richtig an. - Mhm. Dann weißt du, die muss so laufen.",German
+"Die Azubis kann sie noch nicht verschieben, weil sie bisher nur wenige Dinge selbständig übernehmen. Emily könnte ein Telefonat mit dem Chefarzt machen.",German
+notebooks sind weiterhin nicht erlaubt dafür dürfen nur die computer im unternehmen oder die besonders gesicherten dienst notebooks eingesetzt werden dateien die das unternehmen betreffen sind,German
+meine wenn sich morgen oder so wieder eine mutter oder ein vater beschwert dann müssen wir zuhören und das muss man ernst nehmen und sagen dass wir die kolleginnen darauf ansprechen wir könnten,German
+verschieben aber das ist ja immer schwierig es gibt hier eine schöne alternative direkt am seeufer wir haben gerade dort gegessen super lecker die könnten uns bestimmt ein,German
+"Sie beinhaltet Krankenpflege, Altenpflege und Kinderpflege. Unterricht und Arbeit im Krankenhaus wechseln sich ab. Dieses Vitalzeichen-Ding,",German
+"werden. Frau Witte hat angerufen: Es fehlen noch die Arztbriefe von Anfang der Woche! Und Ihr Kollege Puntolo … Puntiolo, Allgemeinchirurgie … …, ja genau, der möchte Sie unbedingt wegen eines Konsils sprechen. Es sei dringend!",German
+"Das ist jetzt schon besser. Vielen Dank, die Herren. Kommen Sie bald wieder. - Bestimmt.",German
+"Weltladen-Dachverbands hat in den letzten Jahren gezeigt, dass neu gegründete oder umgestaltete Weltläden viele neue Kunden in die Läden ziehen und diese zu erfolgreichen Aushängeschildern des Fairen Handels machen. Trotzdem bleibt ein Laden natürlich immer ein",German
+"Niedermeier hat mich das letzte Mal untersucht. Gut, die kenne ich. Da veranlasse ich gleich, dass die uns den Arztbrief zufaxen. Das ist kein Problem. Sind seit der",German
+Ich sehe verschwommen. Seit wann haben Sie denn Übelkeit und Schwindel? Seit circa zwei Tagen.,German
+"nicht einfach noch mehr Lehrer einstellen, wie er es gerne möchte. Natürlich ist die Klassengröße ein ganz elementarer Faktor, v.a. was die Belastung mit Arbeit und Aufgaben der Lehrkräfte",German
+"Emily und Anastasija haben gute Noten bekommen. Ein perfekter Grund zu feiern. Wenn sie am Ende ihrer Ausbildung das Examen schaffen,",German
+ein bisschen im park spazieren gehen um sonst nicht viel machen vielen dank das war teil zwei vielen dank das war teil zwei der prüfung kommen wir zum letzten teil sie sollen,German
+"damit ich ein bisschen näher habe mit meiner Arbeit. Alleine? - Nee, mit meinem Freund. Wann beginnt denn die Frühschicht?",German
+"Wer weiß, vielleicht ist es viel heiße Luft. Wir benötigen bestimmt das OP-Team. Ich meine wegen der Frakturversorgung. Und da will der Doktor Landmeier immer dabei sein …",German
+"Ja, das ist immer alles... und du musst alles gleichzeitig machen. Unser nächster Patient kam zu Fuß: Verdacht auf Herzinfarkt. Wenn du es dir zutraust, das alleine zu machen? Oben einmal, zwei mal unten? Genau.",German
+weil ich so weit außerhalb einsteige bekomme ich immer einen sitzplatz aber je näher man ans zentrum kommt desto voller wertes am ende müssen immer einige leute stehen das kenne ich,German
+um motiviert zu bleiben. Ein Punkt ist der Wunschdienstplan. Willst du viel Frühdienst am Stück machen? - Ja.,German
+"Wenn wir gehen, schwingen unsere Arme normalerweise mit. So, sehen Sie. Und bei unserem Patienten fehlte dieses Mitschwingen. Und ich gebe Ihnen noch einen Hinweis. Diesmal",German
+"Moment geht es. Das ist ja fast nur im Frühjahr. Ist es in erster Linie mit einer fließenden Nase und Augenjucken verbunden, oder bekommen Sie auch Atemprobleme wie Luftnot? Vor allem die laufende",German
+aus wenn man die selbstpräsentation gut übt und viele informationen über die firma gesammelt hat und deshalb weiß worauf die wert legen hat man schon viel gewonnen könnten sie noch einmal,German
+geschäftsführung untergebracht die übrigens die räume nicht wechselt natürlich nicht hallo carsten hier ist ulf ich habe ein kleines problem ich muss dringend zu einem kunden der hat seit heute,German
+akzeptabel also er ist dazu bereit manchmal welche zu machen yakin findet aber dass die überstunden dann natürlich auch bezahlt werden müssen oder er möchte dafür ein ausgleich durch mehr freizeit zum,German
+"Die Eltern sind auch gerade angekommen … Oh, Mist. Lass die nich rein … ja … ok? Bitte! Du bleibst jetzt erst einmal hier und ich rede mit deinen Eltern … und dann sehen wir weiter.",German
+"Hier, mit diesem Rezept gehen Sie in die Apotheke. Ich danke Ihnen.",German
+"was ich hier vorgestellt habe. So ein Grundmodell. Ich bin draufgekommen, weil ich meist dann den Laptop aufladen muss, wenn gerade keine Steckdose in der Nähe ist. Das hat mich schon oft genervt",German
+aber ich habe ehrlich gesagt keine ahnung wie das geht er hat keine zeit mir das zu zeigen aber ich muss das unbedingt bis zum feierabend hinkriegen vielleicht kannst du mich zurückrufen,German
+"Wir fangen immer so ungefähr um 6:45 Uhr an. Dann geht es halt los, die Patienten zu wecken, Vitalzeichen zu kontrollieren.",German
+der hintergrundfarbe des bildschirms an die in meinem unternehmen hellblaue war und ging bis zu den programmen die der mitarbeiter oder die mitarbeiterin für ihre arbeit benutzen musste im,German
+"Beispiel. braucht man für den Anbau von Baumwolle sehr viel Wasser. Da stellt sich dann die Frage, ob Baumwolle wirklich immer nachhaltiger ist als Kunstfasern. Das Problem ist meiner Meinung",German
+Unter notfallmäßigen Bedingungen ist ein Herzinfarkt von einem Angina-pectorisAnfall nicht einfach zu unterscheiden. Beim Angina-pectoris-Anfall sistiert der Brustschmerz meist nach weniger,German
+an mir firma auch fragen ob das in anderen hotels auch passiert ist stimmt die antwort würde mich auch interessieren meinst du es wäre besser gleich nach einem neuen programm zu fragen,German
+kaum gefüllte Jugularvenen. Wir haben sofort mit einer intravenösen Flüssigkeitstherapie begonnen. Dürfen meine Angehörigen bei der Untersuchung dabei sein?,German
+"was dann so angeboten wird. Also gerade an Speisen erstmal vor allen Dingen, zu essen. BeckerCo. bietet warmes Menü an, beim Freiberger ein kaltes Büfett,",German
+"Tim atmet durch den Mund ein und aus. sich hinsetzen ""Setz dich bitte hin!""",German
+"heutigen QZ-Treffen, das dem Thema gewidmet ist: Wie kommuniziere ich eingetretene Komplikationen patientengerecht? Dabei ist es erst einmal unerheblich, welche möglichen, auch juristischen,",German
+"Schicksalsgemeinschaft. Man hat sich nicht füreinander entschieden und lebt dennoch in räumlicher Nähe. Da gibt es automatisch mal Konflikte. Da ist es wichtig, Rücksicht zu nehmen und tolerant zu sein. Viele Konflikte lassen sich schon im Vorfeld dadurch vermeiden,",German
+im Sauerstoffüberschuss. Damit Sie 1000 Prozent mehr Sauerstoff in Ihren Körper bekommen. Und 100 Prozent mehr in Ihr Gehirn. Das verjüngt Körper und Geist. Die zweite Säule:,German
+"Roboter und künstliche Intelligenz auf einen vollkommen neuen Wandel einstellen, der unsere Gesellschaft stark verändert. In vielen Arbeitsprozessen wird der Mensch plötzlich",German
+"typisches Gericht ist Sarmale – das sind kleine Röllchen aus Reis, Gemüse und Fleisch, die mit Kohlblättern umwickelt sind. Das wird traditionell zu besonderen Anlässen wie Weihnachten,",German
+"Alles klar. Vielen Dank, Herr Doktor. Dialog 2, Niveau A2. Was fehlt Ihnen, Frau Bolsinger?",German
+fachinformatikerin machen danach möchte ich mich selbstständig machen ich hoffe das klappt für computer habe ich mich schon immer interessiert ich finde es spannend wie sie funktionieren und,German
+"Raphael prüft die Vitalwerte und muss dann den Urologen suchen. Der soll ein Schmerzmittel verordnen. Raphael checkt den Raum, in dem der Hoden-Patient lag.",German
+und ein Dieselfahrzeug ist der VW Touareg. Ja dann mach ich am besten eine Probefahrt mit allen. Vielen Dank! Sehr gerne. Zimmer reservieren Gespräch,German
+"im rechten Oberschenkelbereich klagt. Hat er anamnestisch über ein Trauma oder eine ungewöhnliche Belastung berichtet? Nein, die Anamnese ist dahin gehend völlig leer. Vom Orthopäden wurde schon eine konventionelle Aufnahme gemacht,",German
+"weswegen wir gleich noch einmal bei Ihnen Blut abnehmen werden. So, dann schau ich mal weiter durch Ihre Befunde. Das EKG haben wir und eine Lungenfunktion ist auch dabei, wunderbar. Der",German
+"Pupillenreaktion. … Das ist alles in Ordnung. Sättigung 96 Prozent. Hier ist das EKG, das die draußen gemacht haben. Ok. Rhythmisch … kein Vorhofflimmern.",German
+planen wir wollen dort ja vor allem unsere neue maschine präsentieren und das müssen wir natürlich entsprechend vorbereiten und jetzt möchte ich von ihnen hören wieder der,German
+"weil man viel zu lernen hat und auch arbeiten muss. Man weiß, wenn man in diesem Pflegeberuf ist, dass man an seine Grenzen kommen wird.",German
+"Sie kommen jetzt... Okay, gut... Ich dachte, das wird vielleicht hart, aber das ist mir schon zu viel. Und dann ruft mich Raphael auch noch zur Hilfe.",German
+"Ich komme trotzdem gleich zu Ihnen und korrigiere den Eintrag. Frau Doktor Tahiri, Sie haben mir doch heute die Spritzen wegen der Blutverdünnung mitgegeben. Stimmt, Frau Langer, wegen der Venenentzündung. Und wie kann ich Ihnen helfen?",German
+"Mir halten das die Schüler manchmal vor, dass ich morgens schon so gute Laune hätte. Knapp 40.000 Azubis fehlen im Handwerk.",German
+"Zum Beispiel mit dem Physiotherapeuten gemeinsam den Patienten aufsuchen, und das weitere Vorgehen besprechen. Aus verschiedenen Studien weiß man, dass es den Patienten außerdem sehr",German
+"Wenn man das theoretisch lernt, denkt man, dass kann alles. Aber wenn man in der Praxis steht, dann vielleicht sieht man, dass man das nicht gut gelernt hat.",German
+"Bauchschmerzen, dass ich es kaum noch aushalte. Seit wann haben Sie diese Beschwerden denn schon? Seit gestern Abend. Ich war noch bei meiner Schwester und auf dem Nachhauseweg in der",German
+besser wenn ich alleine im büro sitze wir sind ja sonst zu dritt das verstehe ich könnte mit mehreren leuten im zimmer auch nicht gut arbeiten deine kollegen telefonieren manchmal so laut dass,German
+"bzw. jede Kandidatin in der Eröffnungsrunde zwei Minuten Zeit, seine beziehungsweise ihre Position zum Thema darzulegen. Dabei wechseln die Pro- und Kontra-Positionen ab. Dann folgt",German
+"Mit dieser Aufgabe zog sich nun die dreiköpfige Jury in ein Hinterzimmer zurück, um die Leistung jedes Debattanten nach vier Kriterien zu bewerten Erstens die Sachkenntnis,",German
+"Ich soll es aber machen. Da muss ich überlegen, wie ich das mache. Ich muss mal kurz auf den Flur. So Jungs, hey. - Wir müssen...",German
+"deutet auf einen Volumenmangel hin. Wir sollten aufgrund der neu aufgetretenen absoluten Arrhythmie eine Echokardiografie durchführen. 1973, als Kind wurden ihr die Rachenmandeln entfernt.",German
+quả gần như không có thế giới ghi nhận,Vietnamese
+bạn là một người rất là quan tâm đến vấn đề này khi mà hỏi đến cái vấn đề chuyên sâu như vậy kính thưa quý vị là khi một,Vietnamese
+rất là nhiều nguyên nhân là do rất là nhiều nguyên nhân trong đó có thể có như là mất ngủ chẳng hạn hay căng thẳng hay,Vietnamese
+có cái vấn đề tương tự như thế này chúng tôi khuyên là chúng ta nên đi khám bệnh để có một cái đánh giá có một cái chẩn,Vietnamese
+nó không còn được như người trẻ nữa ví dụ như tình trạng chức năng thận sẽ bị suy giảm đi ví dụ như là đường hô hấp dễ,Vietnamese
+việc tăng nguy cơ mắc bệnh alzheimer không nhất thiết có nghĩa là nó khiến tỷ lệ bệnh alzheimer tăng có nhiều biến số,Vietnamese
+vẫn đang uống thuốc mà các cái thuốc trước khi phẫu thuật người bệnh vẫn đang sử dụng do đó nếu sau một phần,Vietnamese
+thiên nhiên hay là đông trùng hạ thảo chúng ta nuôi cấy bởi vì cái giá trị của nó rất lớn cùng với cordycepin và,Vietnamese
+rất là nặng và càng về sau mà mình càng muộn phát hiện thì cái việc điều trị nó lại càng khó khăn hơn chính vì thế cho,Vietnamese
+thân của mình rồi thất vọng vì chính bản thân của mình tức là ngoáy sâu vào cái nỗi,Vietnamese
+những người xung quanh đối với những thành viên những người thân trong gia đình thì tôi nghĩ rằng là làm sao để cho,Vietnamese
+tránh các loại thực phẩm nào không ạ đây là một cái câu hỏi rất hay thì,Vietnamese
+sự thiếu hiểu biết đã khiến cho nhiều người bệnh béo phì rơi vào tình trạng xấu hơn cả thì mặt thể chất lẫn về mặt,Vietnamese
+nhiên mà nó đóng góp vào cho cái ngành da liễu thẩm mỹ nói chung rất nhiều những cái,Vietnamese
+sâu sắc niềm đam mê khoa học có thể là một sợi dây gắn kết mạnh mẽ mặt khác một,Vietnamese
+làm cho cái chân tóc cũng như sợi tóc của em nó yếu và nó khô rồi sau khi thăm,Vietnamese
+mà đang được sử dụng nhân dịp tháng lễ vu lan thì chúng tôi cũng có rất là nhiều những cái chương trình khuyến mãi,Vietnamese
+như trong khoảng thời gian năm đến mười năm đó thì chúng ta phải có những cái biến chứng liên quan với thuốc chúng ta,Vietnamese
+được hay không thì từ hồi đó nay sức khỏe của ông mới mổ cho nên là tôi và,Vietnamese
+huyết áp của mình nó cũng đột ngột tăng cao nên là nếu mà không chưa không cần thiết thì bác cũng không nên dùng nữa bác nhé cái này phải có đơn của các bác,Vietnamese
+retinoic acid hoặc là chúng ta sử dụng những phương pháp như là tái tạo da bằng hóa chất để mà chúng ta loại bỏ đi,Vietnamese
+hai tháng sử dụng không thấy hiệu quả và không khắc phục được cái tình trạng đau nhức các xương khớp đặc biệt là trong,Vietnamese
+sáu trăm triệu cho tới khoảng tám trăm triệu đó là toàn bộ điện cực dây nối và cái bộ,Vietnamese
+vi sinh vật đó chúng sẽ lấp đầy một thùng chứa gần hai lít cho đến nay các nhà,Vietnamese
+những cái giải pháp là rất là hữu hiệu và xác đáng cho những trường hợp như của bác vừa là an toàn vừa nó cũng có những,Vietnamese
+như các bác sĩ vừa nói đó thì chúng ta thấy rụng tóc nhiều nguyên nhân lắm rất nhiều nguyên cá nhân nhưng ở cái lứa,Vietnamese
+dịch và nội tiết có nghĩa là vi khuẩn tốt có thể tắt phản ứng trình diễn của hệ miễn dịch chúng cũng có thể giúp kiểm,Vietnamese
+bệnh nhân hay không thưa bác sĩ,Vietnamese
+người ta thấy rõ ràng là nó ảnh hưởng trên cả thể chất tinh thần và xã hội luôn thì rõ ràng là người béo phì đó,Vietnamese
+những ai là người cao tuổi người trung niên đang thắc mắc về bệnh lý nền tim mạch huyết áp cao mỡ máu cao chúng ta,Vietnamese
+loạn này thì mình sẽ báo ngay để người ta có thể điều chỉnh và một một vài cái,Vietnamese
+tốt cho sức khỏe của chúng ta nữa cho nên là nếu những ai bị huyết áp những ai bị đái tháo đường những ai bị các bệnh,Vietnamese
+nếu mà chúng ta không điều trị cường giáp kịp thời và đúng lúc khác thì có thể xảy ra tình trạng rung nhĩ và từ đó,Vietnamese
+những trường hợp chúng ta lên vào viện để chúng ta càng sớm càng tốt tức là về cái cái cái bệnh lý thì có thể nó sẽ,Vietnamese
+hàng đầu và trung tâm trong khoa học thần kinh ngày nay nhưng không có thuốc men nào có thể so sánh được với một chế,Vietnamese
+cứu đột xuất và những cái bệnh mà cần phải cấp cứu trong giờ vàng thì không biết là nếu mà chờ đến một cái giấy xét,Vietnamese
+chúng ta phải sốt cao trở lại chẳng hạn mà họ bắt đầu vì rất có thể chúng ta sẽ bị mắc biến chứng của cúm a,Vietnamese
+sao hậu phẫu hoặc là hồi sức trong vòng hai bốn giờ đầu để mình theo dõi các biến chứng ngắn hạn của việc phẫu thuật sau,Vietnamese
+chẳng hạn nhưng mà nếu tắc kè biết đuôi thì nó không có tác dụng nữa mà không hiểu vì sao ngày xưa các cụ lại,Vietnamese
+biệt là cái phần đau gót chân của mình thì bác sĩ cũng đã tư vấn đặc biệt là bác phải nâng niu cái bàn chân của mình để có thể khắc phục được cái khó chịu mà,Vietnamese
+chương trình ngày hôm nay những ai mắc phải những cái bệnh lý về tim mạch nào huyết áp cao bệnh lý về tiểu đường hoặc là những cái bệnh lý về thần kinh chúng,Vietnamese
+với sự căng thẳng qua các tác động của hệ vi khuẩn lên hệ nội tiết hormone hỗ,Vietnamese
+của chúng ta cần phải đến cái thời điểm chúng ta phải chữa trị cũng như là đến khám bác sĩ rồi ạ cảm ơn cái câu hỏi của,Vietnamese
+chúng ta biết vậy cho nên ngay gội đầu thôi các chị cũng phải chú ý đừng có chà mạnh vì tóc thứ chúng ta chạm mạnh khi,Vietnamese
+sẽ bị tự ti nhiều hơn có thể gia tăng cái sự mà phán xét vào chính bản,Vietnamese
+sản phẩm sẽ được tặng thêm một gói nấm linh chi việt nam thái lát có tác dụng là bồi dưỡng cơ thể của chúng ta điều hòa,Vietnamese
+những cái thứ thuốc trong đó có thuốc thái lan thuốc này kia vân vân thì thật sự là có một vài cái thuốc là thấy cân nặng,Vietnamese
+cái việc an toàn thì những cái bài tập là phù hợp thì cái khuyến cáo chung của,Vietnamese
+máu của chúng ta mà không làm không không được đến một cách đầy đủ không dồi dào thì từ dưỡng chất này từ canxi này,Vietnamese
+hay là có thường xuyên không ạ,Vietnamese
+người thân trong chế biến và cái hiểu biết và nghị lực của người bị ung thư thì tôi tin rằng bệnh nhân ung thư sẽ có thể,Vietnamese
+nang tóc nó sẽ làm cho cái tế bào hắc tố không cho tạo ra sắc tố hoặc giảm tạo ra,Vietnamese
+hoạt chất cấp ẩm như là axit hyaluronic hoặc glycerin đây là những cái thành phần cấp ẩm mà vừa có tác dụng làm mềm,Vietnamese
+khớp xương lúc làm hay bị chuột rút hai vắt chân hai bắp chân là chuột rút và nó móng cái bắp chân,Vietnamese
+cục huyết khối đó thì nó sẽ gây ra tình trạng tắt mạch và nếu mà tình trạng tắt mạch ở bất cứ một cơ quan nào thì có thể,Vietnamese
+dục ngủ và quản lý căng thẳng ảnh hưởng đến sự biểu hiện gen của chúng ta và ảnh,Vietnamese
+cho người ta cả không muốn ăn nữa cho nên là cái tâm lý ấy cũng làm ảnh hưởng rất lớn đến kế chế độ dinh dưỡng với đến,Vietnamese
+chương trình để cho các dược sĩ của chúng tôi sẽ thường trực và sẽ tư vấn giúp cho quý vị và các bạn chúng ta khắc,Vietnamese
+mục tiêu để can thiệp cái cái sức khỏe của mình theo các bác sĩ theo cái đội,Vietnamese
+sản phẩm để mà điều trị cái tình trạng tăng sắc tố đó tuy nhiên chúng ta lưu ý đó là chúng ta chọn l��a những các sản,Vietnamese
+thì những cái loại thuốc này nó có một cái ưu điểm là nó ít có tương tác hay là ảnh hưởng bởi các,Vietnamese
+chúng tôi đang được phát trực tiếp trên cả hai nền tảng của bất kỳ những câu hỏi nào của quý vị liên quan đến chủ đề ngày hôm nay và phù hợp,Vietnamese
+thuốc này thì ta phải dùng một cái xét nghiệm máu để tính ra các chỉ số gọi là số inr gì để mà xem xem cái tác,Vietnamese
+không có nguy cơ lây nhiễm thì dĩ nhiên chúng ta phải giữ khoảng cách và cái môi trường ở cái nơi mà cách ly f1 này mà,Vietnamese
+lá thì hút thuốc lá thì là làm mất đi nhiều cái chất dinh dưỡng của cơ thể chúng ta đã sinh ra nhiều chất độc đối,Vietnamese
+phù hợp đi nữa thì cũng có một số lượng cơ tim nó đã bị thiếu máu và đã bị chết,Vietnamese
+giống nhau về căn nguyên về các yếu tố nguy cơ nó cũng giống nhau thì có cả là nếu nó tắc lại và nó thông được,Vietnamese
+sẽ làm thiếu máu nuôi cơ quan đó thậm chí là cái mô cơ quan đó sẽ bị hoại tử,Vietnamese
+khám bác thì tư vấn cho em một số dầu gội nó giúp ích cho tóc và chân tóc mình,Vietnamese
+thiếu vi khuẩn hoặc ngược lại cho chúng tiếp xúc với một số chủng nhất định và xem điều gì xảy ra những con chuột vô,Vietnamese
+duy hiện tại cho rằng thời điểm chúng ta di chuyển qua âm đạo và tiếp xúc với các sinh vật trong âm đạo hệ vi sinh của,Vietnamese
+hợp mà chị mới có rối loạn đường huyết thì nếu như chúng ta giảm cân tốt thì có thể là sẽ đẩy lùi được cái bệnh lý này,Vietnamese
+người đó trong cái quãng đường đi của họ là có lúc họ xao nhãng có lúc họ cảm,Vietnamese
+cũng như trong công việc và sự nghiệp của mình thứ nhất là họ hạn chế do cái,Vietnamese
+như là hoặc để những cái chiết xuất từ đậu nành thì sẽ giúp là giảm có sự vận chuyển của những túi sắc,Vietnamese
+của các nhà khoa học cũng như những kết quả phi thường mà tôi đã thấy đi thấy lại hoặc nghe nói đến tại các hội nghị y,Vietnamese
+bệnh và đặc biệt là nó cũng còn có một cái tỷ lệ âm tính giả tức là âm tính giả,Vietnamese
+yêu làn da của mình nên đã dành rất nhiều thời gian để mà chăm sóc cho làn da của mình thì thật sự đó là như hồi,Vietnamese
+chắc chắn rằng không sớm thì muộn có thể là hình thành những cái huyết khối ở trong buồng tâm nhĩ và từ đó gây ra tắc,Vietnamese
+chương trình khuyên với bệnh nhân đã đặt câu hỏi về chương trình là phải nhớ là,Vietnamese
+gia đình thì cũng rất mong là tất cả các thành viên trong gia đình đừng coi người ung thư coi như là một dấu chấm hết đừng,Vietnamese
+tim mà hậu quả thì như đã nói đó rất là nghiêm trọng vậy thì khi người bệnh rung nhĩ họ đã,Vietnamese
+bởi vì chúng ta cũng nhận thấy rằng là có nhiều vấn đề chứ không phải là một vấn đề và cái thứ hai nữa là thực sự là,Vietnamese
+trọng lắm bởi vì chúng ta biết là với người đái tháo đường thực sự thì hba1c bao giờ nó cũng sẽ lớn hơn sáu phẩy năm phần trăm nhưng mà khi,Vietnamese
+xạ trị có nghĩa là chúng ta giết tế bào ung thư và đồng thời cũng giết cả các tế bào lành và nếu như cái vị trí và xạ trị,Vietnamese
+sự sống còn của chúng ta giống như những tế bào của chính chúng ta chúng ta cần chúng cho cuộc sống và sức khỏe thật,Vietnamese
+thể của cơ thể nhưng thay vì cư trú lâu dài chúng thiết lập các quần thể nhỏ,Vietnamese
+như vậy rồi thì nó sẽ bất ổn mình dùng các phương pháp trị liệu không thành,Vietnamese
+tình trạng thâm nám thì chúng ta ngăn chặn đừng có cho cái túi sắc tố vận chuyển lên tế bào sừng thì bằng cách đó là chúng ta sử dụng những các hoạt chất,Vietnamese
+rằng chúng ta chẳng may cũng có cái rủi ro trong cuộc sống chúng ta gặp phải những cái rủi ro như vậy bệnh vật thì không chừa ai cả nhưng khi chúng ta đã,Vietnamese
+là cái mốc mà người ta đã nghiên cứu và người ta thấy rằng là thời là cái mốc mà,Vietnamese
+trường hợp nếu mà thành mạch bình thường thì có việc mà chúng ta lấy cục máu đông ra như vậy đó nó không làm tổn thương,Vietnamese
+cũng có một số chất có thể giúp cho chúng ta là làm cho cái việc giảm cái việc tăng sinh mạch máu của khối u mà rõ,Vietnamese
+trong một bài báo gần đây họ viết một cách thuyết phục rằng chúng ta có thể đang gặp phải sự không tương thích giữa,Vietnamese
+phần quà hấp dẫn trong các tháng vu lan ngày hôm nay chỉ cho một trăm khách hàng đầu tiên thôi những ai mà chúng ta,Vietnamese
+mình bị méo cười nó bị méo đi thứ ba là yếu liên quan đến cái cái cái cái,Vietnamese
+sĩ như đã nói nhiều lần cho quý vị cũng nắm được đó là phẫu thuật kích não sâu,Vietnamese
+ép quả nước ép quả ngọt đừng có ngọt ngọt quá cũng xót ngọt vừa vừa thôi và không,Vietnamese
+nghe nói về tập tục vùng thôn quê và những câu chuyện từ các quốc gia khác về cách chủng ngừa đậu mùa nhưng chi tiết,Vietnamese
+những thách thức tâm lý mà bệnh nhân béo phì phải đối mặt cùng với những hướng dẫn để cho người bệnh có thể giữ vững,Vietnamese
+hà nội thì bác sĩ cũng đã tư vấn khá là chi tiết rồi và bác cũng nên tìm ra cái nguyên nhân sâu xa hơn của bệnh lý của,Vietnamese
+biến chứng về lâu dài của bệnh nhân như những cái lợi ích mà tôi vừa kể vì vậy thì các khuyến cáo trên thế giới,Vietnamese
+như này thì người ta lại hoàn toàn có thể làm tất cả những cái việc như vậy thế cho nên là cái việc mà chúng ta đến thăm khám để có cái phác đồ điều trị,Vietnamese
+lại ít có bị kỳ thị còn những người lâu lâu trong một cái lớp học như vậy nguyên một cái lớp học như vậy có,Vietnamese
+ngưỡng mà chấp thuận dành cho các hiệp hội trên thế giới khi mà xem xét một lưu hành những cái thuốc điều trị béo phì thì phải cũng phải giảm được ít nhất là,Vietnamese
+hạn giống như cách mà da có thể được coi là rào cản đơn giản chống lại tất cả các,Vietnamese
+mệt mỏi nếu cũng như là những cái buồn lo của người bệnh bị ung thư cả thì chúng tôi cũng rất mong là đối với người,Vietnamese
+kính thưa tất cả quý vị và các bạn thông,Vietnamese
+trước để có những cái thăm dò có những cái đánh giá trước sau đó thì khi mà tham khám như vậy các bác sĩ người ta sẽ,Vietnamese
+hiểm ở những cái người mà những cái trẻ em đặc biệt là trẻ em dưới sáu tháng tuổi,Vietnamese
+ạ trong trường hợp này của anh có lẽ anh vẫn cần phải đến khám với các bác sĩ chuyên khoa về bệnh bệnh lý cơ xương,Vietnamese
+cũng được nhưng mà đừng có là nước ngọt ạ bởi vì nước ngọt thì chứa rất là nhiều đường đơn đừng đôi không có lợi cho sức,Vietnamese
+uống thuốc vào có thể hôm nay nó hấp thu tốt mai nó sẽ tăng lên ngày mai mình ăn uống,Vietnamese
+chứng nó đi hay không thì tôi nghĩ rằng là khi đã xảy ra các biến chứng do rung,Vietnamese
+cũng được chú ý như thế thông qua các cuộc phỏng vấn với các nhà khoa học có liên quan và việc tìm đọc các tài liệu,Vietnamese
+bạn là một người bác sĩ tim mạch thì không có rành rẽ về cái chuyện của thận nhiều lắm đâu mà chúng ta muốn là chất,Vietnamese
+cũng đã cho làm một số các cái thăm dò rồi chụp phim vân vân và sơ bộ thì chúng ta biết rằng là bác đã có cái khảo sát,Vietnamese
+parkinson hay là bệnh alzheimer bệnh trầm cảm nữa vâng ạ rất là tốt cho cơ thể của chúng ta ngày hôm nay thì những,Vietnamese
+sĩ chúng ta cũng nhận được câu hỏi với nội dung là những tác động tiêu cực hoặc là hậu quả của sự kỳ thị đối với tâm lý,Vietnamese
+người nhắc thật là có những cái phương tiện hiện tại như là chúng ta dùng điện thoại nhắc giờ chẳng hạn thì đó để chúng ta,Vietnamese
+hay là suy tim hoàn toàn có thể có thì nó sẽ hỗ trợ trong việc phòng ngừa cho mình chị nhé và đây là một cái sản phẩm,Vietnamese
+trùng này với cả nấm hầu thủ với cả đẳng sâm việt nam thì đó chính là một cái,Vietnamese
+liên kết với các phân tử khác bao gồm các protein khác đều hoàn thành nhiệm vụ của chúng và hình dạng chính xác của,Vietnamese
+da nào khiến cho da bạn cảm giác là căng kéo khô rát đỏ ngứa hoặc là da của,Vietnamese
+mà mình đang mong muốn có thể là một cái tương lai nó như gần như là sụp đổ nhưng nếu chúng ta còn thì tất cả những,Vietnamese
+vật lý chống lại những kẻ xâm nhập như các vi khuẩn có hại vi sinh vật gây bệnh các virus xấu và các ký sinh trùng gây,Vietnamese
+là các biến chứng đi kèm thì cái việc điều trị phẫu thuật tỏ ra rất là có hiệu quả đối với những cái bệnh,Vietnamese
+và quan trọng hơn hết là mình sẽ lựa chọn được cái một cái loại sữa rửa mặt nó thật là phù hợp với làn da nó dịu,Vietnamese
+hay có đờm rồi dọc sống mũi lên trán vùng trán này rất đau mà lại chóng mặt,Vietnamese
+thế này thứ hai nữa là chị cũng cái dấu hiệu tê bì chân tay này đây nó cũng có,Vietnamese
+như là phẫu thuật thì những cái phẫu thuật là nguyên cái phẫu thuật đó đã đủ là một sang chấn tinh thần đối với người,Vietnamese
+vệ được sự vẹn nguyên của tế bào ấy thì sẽ giúp cho tế bào ấy không trở nên bất bình thường và không bất bình thường thì,Vietnamese
+là chúng ta uống bốn viên một ngày chia hai lần sáng chiều và khi mà chúng ta,Vietnamese
+rồi nhưng tôi nghĩ rằng là cũng chưa phải là các quý vị khán giả nào chúng ta cũng tường tận đâu cho nên chương,Vietnamese
+pháp trị liệu một số lý do hàng đầu khiến mà việc hỗ trợ tâm lý không thể,Vietnamese
+tăng huyết áp trong những năm gần đây bệnh lý tăng huyết áp đang trẻ hóa có gần sáu mươi phần trăm người bị tăng huyết áp ở việt,Vietnamese
+hành phòng chống thoái hóa khớp đấy thì chính là những cái lời khuyên mà chúng tôi cứ nghĩ rằng là mặc dù nó rất là,Vietnamese
+có hai bộ phận thứ nhất là phần quả thể và phần thứ hai là phần đế thế thì ngày,Vietnamese
+đoán sớm và lại được dinh dưỡng hợp lý cộng với điều trị một cách tích cực và phù hợp nữa thì tôi tin chắc rằng quý,Vietnamese
+chúng ta đã hạn chế về mặt sử dụng số lượng thực phẩm cũng như là chủng loại thực phẩm chục loại thực phẩm hạn chế do,Vietnamese
+không tốt chức năng của tế bào không đảm nhận được như bình thường nó làm ảnh hưởng đến chức năng của cơ thể thế và,Vietnamese
+đau khớp và viêm khớp huyết áp cao xơ vữa động mạch các bệnh nhiễm nấm mạn,Vietnamese
+gì hoàn toàn bằng thảo dược thôi thế cho nên rằng là đấy là cái lý để chúng ta và những công ty dược người ta mới tìm,Vietnamese
+dại vì họ cho rằng thì khi mà tiêm,Vietnamese
+mới sạch được nhưng mà lại dễ gây kích ứng em nên chọn sữa rửa mặt thành phần nào vừa dịu nhẹ vừa không gây kích ứng,Vietnamese
+cứ một cái biện pháp kết hợp nào khác thứ hai nữa là cái hầu hết những bệnh,Vietnamese
+đi càng ít đi,Vietnamese
+trong một cái tâm thế là nếu chẳng may bây giờ mình bị ngã thì mình bám vào đâu thì như thế thì mình mới có cái cái cái,Vietnamese
+chúng ta bó cái cái chân của chúng ta lại rồi nữa là chúng ta nên tập luyện là,Vietnamese
+trị ấy có thể làm cho bệnh nhân là không thích những cái vị như vị chua vị đạm có,Vietnamese
+giúp và giữ sáng khi chúng ta cần phải biết rằng các quá trình sản sinh sắc tố diễn ra như thế nào và những cái,Vietnamese
+bằng cách nhân tạo hoặc thậm chí thông qua việc bú sữa mẹ hoặc chế độ ăn các số,Vietnamese
+tố chưa cải thiện thì tôi khuyến khích bạn là chúng ta nên kết hợp với những cách sản phẩm những mà thoa dưỡng da tại chỗ,Vietnamese
+tháo đường mà có kèm béo phì thì chúng ta phải rất là quan tâm để ý đến cái vấn đề mà cân nặng nên lựa chọn những cái,Vietnamese
+chứng nguy hiểm tăng sức đề kháng sức khỏe cho tim mạch thì ngày hôm nay chúng tôi đã mời đến trường quay sự có mặt của,Vietnamese
+với người dân và nâng cao được ý thức của người dân kêu gọi được ý thức của người dân đặc biệt là những người đang,Vietnamese
+được chiết xuất từ đậu tương lên men đây là một một cái món ăn cổ truyền của người nhật bản xưa kia đây là một món ăn,Vietnamese
+ngoài những cái bất lợi về mặt sức khỏe đó thì bệnh nhân béo phì nó có thể gặp những khó khăn ở trong cái cuộc sống,Vietnamese
+thế nào đối với trường hợp của bác không những là đau ở cái vùng lưng thắt lưng mà nó còn lan xuống chân lan xuống mông thấy chính vì vậy cho nên là khi mà,Vietnamese
+một vấn đề và bao giờ ai cũng đặt ra là gì là dùng cái đó là dùng bao nhiêu lâu hiệu quả của nó thế nào bây giờ thì là,Vietnamese
+dại thôi thấy bác sĩ là do những nguyên,Vietnamese
+vâng thưa quý vị và các bạn chủ đề mà chúng tôi lựa chọn trong chương trình ngày hôm nay sẽ là một chủ đề liên quan,Vietnamese
+giữa các tế bào sừng đó cũng giảm điều này thì chúng ta thấy là nếu mà sẽ là những cái sự là giảm ở các thành phần,Vietnamese
+thay vì cái việc ngày xưa chúng ta phải đi nhiều chúng ta vận động nhiều chúng ta phải đạp xe đạp hiện nay chúng ta là,Vietnamese
+một trăm phần trăm nấm đông trùng hạ thảo dạng quả thể chứa hàm lượng adenosine cordycepin và,Vietnamese
+đang có thức ăn trong miệng chẳng hạn thì khi khi đó có thể là cái thức ăn,Vietnamese
+tiêm chủng là dựa trên ý tưởng quen thuộc rằng sự nhiễm trùng do virus hay,Vietnamese
+chứng về đột quỵ não này những cái tình trạng nhồi máu cơ tim những cái tình trạng suy tim hoặc là những cái hoại tử,Vietnamese
+trong suốt cuốn sách này bạn sẽ tìm hiểu về nhiều chức năng sinh học trong các chương sắp tới tất cả đều liên quan đến,Vietnamese
+thể sử dụng và tính đương nhiên là những người thuốc mới với những ưu điểm vượt trội như vậy thì giá thành ở sẽ cao hơn,Vietnamese
+đấy là cái quan trọng cái thứ tư là với những người có tuổi và cao tuổi thì tôi khuyên là chúng ta không được quên cái,Vietnamese
+cho tất cả những khán giả mắc những vấn đề liên quan tới chủ đề của chương trình ngày hôm nay vâng thưa quý vị giao mùa thì,Vietnamese
+thống nhỏ đan cài vào nhau một trong những ranh giới hiểu biết khoa học phức tạp và quan trọng nhất chúng ta biết như,Vietnamese
+hàng ngày để có thể cải thiện được cái tình trạng của mình để tránh tái đi tái lại cũng như là khi mà trở trời thì nó,Vietnamese
+thống kê và cũng đã báo cáo ba triệu chứng vận động mà người bệnh parkinson,Vietnamese
+thừa cân với các bệnh liên quan đến béo phì bên cạnh những vấn đề về tinh thần của họ đau đầu bao gồm chứng đau nửa đầu,Vietnamese
+thì trong các quá trình mà khi mà thăm khám và điều trị cho những cái bệnh nhân thì tôi cũng nhận được những chia sẻ của,Vietnamese
+biến chứng nguy hiểm thế thì của bác có vấn đề gì huyết áp này đái tháo đường này phải không ạ và cái nữa là liên quan đến,Vietnamese
+dịch được lập trình để chống lại bất cứ thứ gì không thuộc cơ thể chúng ta nhưng,Vietnamese
+sẽ được thay mới một lần đối với những người mà trưởng thành chúng ta thì quy trình thay da sẽ kéo dài ra trung bình,Vietnamese
+bệnh nhân mà đái tháo đường mà không có kèm bệnh lý béo phì và cũng đã có rất là,Vietnamese
+chứng của rung nhĩ rất là trầm trọng có thể ảnh hưởng đến tính mạng của người,Vietnamese
+năng lên là lây nhiễm từ người nhà rất là thấp nếu như cô giữ tốt cái khoảng cách giữ tốt cây,Vietnamese
+độ ăn hợp lý cho việc quản lý vi khuẩn đường ruột của bạn tôi sẽ về chế độ ăn đó từng bước một rất may cộng đồng vi,Vietnamese
+trội của hoạt chất kga1 là được chiết xuất chuẩn hóa từ thảo dược đảm bảo tính an toàn cho người bệnh khi kga1 kết,Vietnamese
+đổi trạng thái của hệ vi sinh vật và số phận sức khỏe của họ thông qua các lựa chọn chế độ ăn uống gần đây tôi đã có cơ,Vietnamese
+trường hợp mà cắn mà không có virus,Vietnamese
+khi mà bị lạnh thì người ta thường phải ăn nhiều ăn nhiều quá thì nó dễ béo phì và nhiều khi là người ta nóng quá thì,Vietnamese
+uống ra sao tôi thậm chí sẽ đưa bạn qua những gì tổ tiên chúng ta đã ăn hàng,Vietnamese
+điều trị thuốc nó phải đúng chứ không phải là mình thích cái thuốc nào là mình dùng thuốc đó hay là mình nghe cái mách,Vietnamese
+nước cũng được nhưng mà chỉ một tí thôi tập dần tập dần chúng ta khi mà sau ung thư đôi khi chúng ta lấy lại những cảm giác,Vietnamese
+hỏi về cách thức hoạt động của chất bổ trợ và bằng cách đồng thời suy nghĩ về hai vấn đề mà ông ấy có một ý,Vietnamese
+người bệnh béo phì,Vietnamese
+đây là một thảo dược mà chứa một cái lượng đạm rất lớn nó từ hai lăm đến ba mươi hai phần trăm và,Vietnamese
+an toàn nó không có tác dụng không mong muốn cho nên là với trường hợp của bác về xương khớp thì chương trình cũng nên là,Vietnamese
+nữa thế nên là cái việc tuân thủ theo đơn bác sĩ này để kiểm soát tốt con số huyết áp này cũng như là các cái bệnh lý,Vietnamese
+tốt để phối hợp làm sao đối với cái y lệnh đó thì mình tối ưu được cái hiệu quả điều,Vietnamese
+còn ảnh hưởng rất nhiều thậm chí là đến tâm lý của bệnh nhân và giờ đây thì chúng tôi xin được mời,Vietnamese
+khả năng chống lại bệnh tật và tự chữa lành của cơ thể là một trong những,Vietnamese
+bằng mắt thường nhưng đừng đánh giá thấp chúng một mặt vi khuẩn đơn giản đánh,Vietnamese
+bị bệnh viêm khớp và thoái hóa khớp và khi đó thì những người bệnh này cần dùng rất,Vietnamese
+nghĩa là tổn thương các thành mạch máu mà chúng ta đã đưa dụng cụ nha để kéo đó thì nó rất là nhẹ nhàng và nó không có,Vietnamese
+việc thứ hai như chúng ta đã nói nó khi mà rung nhĩ thì có thể là tạo thành,Vietnamese
+một số trục trặc về tóc kể cả bạc tóc thế cho nên là những hoạt chất từ thiên nhiên này tỏ ra rất là an toàn và trong,Vietnamese
+bệnh mạn tính từ bệnh tim và các chứng rối loạn tự miễn tới ung thư và sa sút,Vietnamese
+cũng trong một thời gian dài nó có thể dẫn đến những cái tổn thương các cái mạch máu lớn và các mạch máu nhỏ bác ạ,Vietnamese
+không làm gì hết thì chắc chắn là sẽ không có kết luận về nguyên nhân còn nếu chúng ta có đủ các phương tiện như,Vietnamese
+được cân bằng tức là cái cái cái chỗ stress mình là nãy mình nói nó kiểm soát cho nó tốt trước một số những thay đổi,Vietnamese
+ra rằng ranh giới giữa vi khuẩn tốt và xấu không rõ ràng như bạn nghĩ một lần,Vietnamese
+phiên bản xơ vữa và nếu mà nó đã có rồi cái mảng xơ vữa rồi thì nó sẽ làm giảm và nó sẽ cải thiện dần thứ hai nữa là từ đó,Vietnamese
+ví dụ như là vã mồ hôi tụt huyết áp thậm chí có thể tử vong ngay tức khắc luôn như vậy ngoài cái biến chứng gây ra suy,Vietnamese
+thời gian thì nó cũng có những các cái biểu hiện như là đau đầu chóng mặt hoa,Vietnamese
+chắc chắn rồi cũng giống như việc bạn có thể thay đổi điểm mốc cho trọng lượng cơ thể và chỉ số khối cơ thể bmi thông qua,Vietnamese
+hoặc nguyên nhân không rõ ràng và cũng có thể là nhiều nguyên nhân nó sinh ra một cái rụng tóc thì trong đó có thể kể,Vietnamese
+nhiều các bác sĩ các chuyên gia đã chia sẻ cho chúng ta những thông tin về bệnh béo phì và tất cả quý vị chúng ta có thể,Vietnamese
+tới là cái gì bao nhiêu cân là họ phù hợp thứ tư nữa là đánh giá được coi cái,Vietnamese
+sẽ phải tiếp xúc này sẽ phải xử lý này và sẽ phải đào thải những câu chuyện đó chính vì vậy tất cả những cái nội tạng,Vietnamese
+hệ thần kinh bảo vệ các tế bào thần kinh luôn được khỏe mạnh cải thiện chức năng nhận thức giảm trầm cảm lo âu cải thiện,Vietnamese
+nguy hiểm thế nên là bác nên có thể ở các cơ sở y tế ngay gần nhà đấy bác đi,Vietnamese
+với cái thuốc điều trị của các bác sĩ tuy nhiên thì chúng ta nên uống cách ra ví dụ thuốc theo đơn của các bác sĩ chúng ta uống đúng giờ đúng liều đúng,Vietnamese
+nghiên cứu này đã chỉ ra rằng có mối tương quan rõ ràng giữa những gì nằm trong ruột của em bé và những gì được,Vietnamese
+quá trình cơ bản của sự sống ba lực lượng chống lại những vi sinh vật,Vietnamese
+cái quan hệ của họ với lại những người khác đó sẽ bị bị gói gọn lại cô lập lại thì đó là những dấu hiệu mà mình có khả,Vietnamese
+thiết yếu cho cuộc sống thầy thuốc người hy lạp và cha đẻ của y học hiện đại,Vietnamese
+kiết lỵ bạch hầu tả hoặc sốt ban đỏ chúng ta đã đạt được những bước tiến lớn,Vietnamese
+thường hay lập đó là thứ nhất tại run thứ hai là chậm và thứ ba là đơ cứng thì nói một cách chung như thế này,Vietnamese
+tôi muốn nói đến khía cạnh dinh dưỡng hạt gồm có từ hạt đậu nành tốt với một số ung thư nhưng riêng ung thư tuyến,Vietnamese
+tiếp xúc với các chất giết hoặc thay đổi theo hướng bất lợi cấu trúc của các quần thể vi khuẩn trong đó bao gồm mọi thứ từ,Vietnamese
+tôi bị huyết áp cao bị rối loạn mỡ máu hơn mười năm nay tôi vẫn sống theo đơn điều trị hết thì lại lấy theo đơn đề,Vietnamese
+đấy sau đó chúng ta nấu cháo cho bệnh nh��n thì hoặc là chúng ta ví dụ như là umami ở trong cà chua cũng khá là,Vietnamese
+là là không không không có những điểm đối với người bình thường nhưng mà vẫn cái biến chứng của nó thì có thể dẫn đến,Vietnamese
+người ta thích ăn đi thì có khi là nó sẽ ảnh hưởng lại tốt hơn làm cho cái cân nặng nó có thể giảm hơn là thì cái đó là,Vietnamese
+ứng đầu tiên của cơ thể đổi lại vi khuẩn đường ruột giúp giữ cho hệ miễn dịch,Vietnamese
+như vậy chính vì cái nhận thức đó nó mới đưa đến cái tâm trạng của người ta là buồn phiền chán nản tâm trạng của người,Vietnamese
+nổi lên trong lúc đó trong cuộc phiêu lưu khoa học đầy khó nhọc làm thay đổi cuộc chơi đã mở ra những hiểu biết về,Vietnamese
+sau của cuốn sách tôi sẽ cung cấp thông tin rõ ràng cho cả những bà mẹ đang mang thai và những người đã sinh con về cách,Vietnamese
+giả là nó cũng rất là rõ ràng và cái đau này của chúng ta nó không phải chỉ là những cái đau lướt thoáng qua hay chỉ là,Vietnamese
+điều khiển bằng một cái thiết bị bên ngoài đến màn hình điều chỉnh được cái cường độ mà mình phát ra mong muốn,Vietnamese
+nhiều đến chất lượng cuộc sống cũng như là kinh tế của gia đình người ta thì tôi vừa trình bày cái mức độ nguy hiểm của,Vietnamese
+do đó trong trường hợp mà thuốc không hiệu quả với run thì phẫu thuật kích thích não sâu vẫn có hiệu quả và kiểm,Vietnamese
+giảm bị ảnh hưởng về sự căng thẳng tuổi già thời gian trong ngày và trạng thái,Vietnamese
+những cái ngày mà bị bệnh của chú thì chú cảm thấy là bây giờ nó như trở lại thời thanh niên đấy phấn khởi lắm ngày,Vietnamese
+sống của bạn tới đây bạn hẳn đã có một cái nhìn sơ qua về những gì chống lại,Vietnamese
+chưa bị nhưng những lần sau là sẽ bị tai biến đấy ạ nên là bác phải dùng thuốc ngay để kiểm soát tốt không cho nó bị tăng huyết áp bác nhé và bên cạnh đó thì,Vietnamese
+mà nhiều khi nhiều khi bởi vì là có những người thì chúng ta cứ quan điểm một cái điều là thuốc chỉ thích dùng cái,Vietnamese
+đặc biệt là cho những khoảng thời gian đầu tiên trong hai ngày bảy ngày ba mươi ngày đầu tiên thì sẽ rất là cao do đó nên khi,Vietnamese
+không để lại di chứng thôi chứ thông thường là có để lại những di chứng và di chứng đó có thể rất là nặng nề,Vietnamese
+parkinson các bạn rồi những các bác sĩ liên quan khác mà nó có vấn đề về,Vietnamese
+cái giai đoạn này bác ăn uống thì bác không nên ăn mặn bác nhá vì ăn mặn nó giữ nước và nó làm cho huyết áp tăng cao ăn nhạt đi này thế và tăng cường rau,Vietnamese
+chống lại nó không vắcxin làm việc như thế nào và chúng ta có thể làm cho chúng,Vietnamese
+ăn nữa và rất là khó chịu khó để chấp nhận thức ăn bên cạnh cái việc mà buồn nôn đấy thì đối với việc và sử dụng hóa,Vietnamese
+phì chứ không chỉ riêng về cái rối loạn về cái hành vi ăn uống thế thì họ cần,Vietnamese
+bối cảnh chung cùng với các chuyên khoa khác chứ không tách rời ra thứ hai trong cái việc mà điều trị bằng thuốc,Vietnamese
+tế bào sắc tố của chúng ta sang sản sinh ra melanin hay chúng ta còn gọi là hạt sắc tố thì khi mà tế bào sắc tố,Vietnamese
+ta sẽ đánh giá cả hai vấn đề một cách đầy đủ rồi mà không cần phải làm thêm chẳng hạn thì nó sẽ có cái chẩn đoán,Vietnamese
+phẫu thuật kích thích não sâu mặc dù rằng nó là một phương pháp ít xâm lấn ít tai,Vietnamese
+hao đi đối với bệnh ung thư cho nên chính vì thế sẽ làm đến sụt cân thì cái cái việc mà có thể gây đến sụt cân đầu,Vietnamese
+buộc phải tập trung từ chú ý bảo họ và vì thế mà bỏ qua những người mà đáng ra,Vietnamese
+nghìn năm trước và điều này liên quan như thế nào đến việc nghiên cứu mới về hệ vi sinh chúng ta sẽ xem xét khái niệm,Vietnamese
+nên chúng ta cũng cần phải quan tâm là như vậy thì mình phải bớt đi cái gì mà ăn tăng cái gì thì vậy thì mình sẽ tăng,Vietnamese
+động mạch và từ đó nó sẽ gây ra rất rất nhiều hậu họa thậm chí nó có thể gây ra,Vietnamese
+nay thì mình đã uống thuốc huyết áp và đo huyết áp đã duy trì được khoảng một trăm hai mươi một trăm ba mươi như vậy là rất tốt bây gi��� cái thuốc,Vietnamese
+thuật cũng không có ngăn sự tiến triển của bệnh được và dĩ nhiên hiệu quả của,Vietnamese
+chúng ta có thể nhận thấy khá là rõ là bệnh nhân cảm thấy mệt mỏi thì là ai,Vietnamese
+đến và chúng ta không không nhận biết được cái điều đó cho nên chúng ta chỉ nghĩ là à thôi thì đau khớp chúng ta có,Vietnamese
+có thể nói rằng là cái đời sống vật chất cái mức sống của người việt nam chúng ta,Vietnamese
+đồng hồ là nó không còn trong người mình nữa rồi như vậy khi mà chúng ta ngưng thuốc hai ngày đối với noark hoặc là bốn năm,Vietnamese
+năng sinh lý của cơ thể hiện không thể phủ nhận rằng các sinh vật đường ruột của chúng ta tham gia bằng nhiều hoạt,Vietnamese
+khác nhau gây ra các biểu hiện trên phải tùy vào nguyên nhân cụ thể thì thầy thuốc mới có thể có những chỉ định dùng,Vietnamese
+nấu cháo rất đặc xong rồi chúng ta có thể lấy giá đỗ bởi vì trong giá khá nhiều cái amylase chúng ta có thể xay giá,Vietnamese
+thống tích hợp thành các yếu tố riêng biệt bằng cách này không làm cho nó trở nên buồn tẻ như người bạn nghệ sĩ của,Vietnamese
+không ảnh hưởng cái gì cả chúng ta cứ tuân thủ theo đúng giờ đủ liều của các cái thuốc kê đơn theo đơn bác sĩ ngoài,Vietnamese
+mười năm và có một số nguyên cứu báo cáo lên đến mười lăm năm phẫu thuật thích não sâu,Vietnamese
+con tim của chúng ta nó hoạt động rất là tốt và làm cho chất lượng cuộc sống cũng như chất lượng công tác của chúng ta nó,Vietnamese
+người bệnh ung thư có thể sử dụng được các cái liệu trình điều trị tốt nhất,Vietnamese
+thiết cho nuôi dưỡng về nang tóc cái thứ hai là những cái hoạt chất từ từ thiên,Vietnamese
+nhưng mà tôi tin rằng tất cả nhân viên y tế khi mà thực hiện cái kỹ thuật này đều đã được tập huấn rất là kỹ tập huấn quá,Vietnamese
+tăng cường sức đề kháng nè nâng cao thể trạng nè ngăn ngừa xơ vữa động mạch điều hòa được nhịp tim cải thiện tuần,Vietnamese
+nó cũng làm cho mình có những cái dấu hiệu như là những cái cái hồi hộp trống,Vietnamese
+lựa chọn được những sản phẩm phù hợp thưa quý vị chúng tôi vẫn đang tiếp tục nhận những câu hỏi của quý vị gửi về cho,Vietnamese
+bệnh nhân sẽ có cải thiện về chất lượng cuộc sống cũng như là kéo dài cái thời gian kiểm soát triệu chứng tốt cho người,Vietnamese
+rau họ họ cải có thể nhất đặc biệt là đối với những bệnh nhân ung thư tuyến giáp thì chúng,Vietnamese
+lại các chất lượng cuộc sống của mình họ gặp phải thường gặp tất nhiên là có những cái vấn đề khác nữa trong đó có,Vietnamese
+chất của nó là vấn đề gì là vấn đề những cái thành phần hóa học đặc biệt là cái,Vietnamese
+trường hợp không tốt thì có thể giảm khoảng hai ba mươi phần trăm mà thôi trung bình là giảm khoảng năm mươi phần trăm,Vietnamese
+thì ở trong một môi trường mà có nhiều cái người mà phì béo phì quá thì có khi,Vietnamese
+đầu tôi phát hiện ra là tôi uống thì tôi thấy có tác dụng thì bắt đầu là tôi mới dùng đến cái viên nang ấy bác sĩ có nói,Vietnamese
+trạng xơ vữa mạch và nó có tác dụng hỗ trợ trong việc hạ huyết áp vâng đây cũng là một cái thành phần rất là hay sử dụng,Vietnamese
+lại toa cũ hay không nếu mà qua lại ở cái cái bệnh viện đó để thăm khám thì yêu,Vietnamese
+nghiệm này khi mà chúng ta xét nghiệm mà chúng ta phát hiện có cái trường hợp nghi ngờ thì lập tức các cơ sở y tế đó,Vietnamese
+để tìm vắcxin huyết thanh kháng dại là,Vietnamese
+vật có khả năng lây bệnh dại tấn công trường,Vietnamese
+từ oxy này với tất cả các thứ nó sẽ không đến được với xương khớp của chúng ta một cách đầy đủ và chính vì vậy cho,Vietnamese
+sáu tư tuổi tôi tôi bị tai nạn bốn năm nay rồi nhưng mà đi lại nó khó nhưng mà bây mấy,Vietnamese
+sau dbs thì nó cũng tương tự như cái nguyên lý của cái việc phá hủy thì người ta,Vietnamese
+sở cái thành phần hóa học như vậy thì cái tác dụng dược lý của đông trùng hạ thảo đã chất lượng các nhà khoa học ở trung,Vietnamese
+lực lượng số ba sự căng thẳng mặc dù nghe có vẻ sáo rỗng khi nói căng thẳng có hại,Vietnamese
+bị bệnh vấn đề quan trọng là không buồn chán và chúng ta suy nghĩ là chỉ có làm thế nào để có thể nhanh chóng nhất thoát,Vietnamese
+so với lại cái những cái người mà không bị béo phì nghiên cứu về những tác động béo phì lên cái chất lượng cuộc sống thì,Vietnamese
+ích của phẫu thuật kích thích não sâu ở người bệnh parkinson chúng ta biết,Vietnamese
+lành mạnh tôi sẽ giải thích mọi yếu tố này đóng vai trò như thế nào đối với sức khỏe của hệ vi sinh vật vì lợi ích của,Vietnamese
+thì chắc chắn cái tình trạng huyết áp tình trạng vữa xơ động mạch tim vân vân và sức khỏe chung của bệnh nhân sẽ được,Vietnamese
+một cái sản phẩm mà nó rất tốt là vì làm sao ạ vì nó tác động vào cái cơ chế,Vietnamese
+ở dưới da và nó nối nó nối vào thành một cái hệ thống thống nhất và sau đó mình sẽ có một,Vietnamese
+những cái tên dài này trong cuốn sách này bạn sẽ được nghe và nhiều loại vi khuẩn có tên tiếng latin phức tạp nhưng,Vietnamese
+của xã hội như vậy đó nó sẽ ảnh hưởng tới cái cái người béo phì như vậy thì tóm,Vietnamese
+là một trong dẫn chứng rối loạn phổ biến nhất của hệ thần kinh gần một nửa dân số,Vietnamese
+phương pháp đặt điện cực thích não sâu đó là kể chi phí điều trị tức là cái giá thành thì hiện tại thì cái giá thành,Vietnamese
+đặc hiệu là các đoạn ngắn của protein được gọi là peptit đã được xác định trong bướm,Vietnamese
+dùng mà mấy cái thuốc rồi mà sao không cảm thấy đỡ bác sĩ thành ra là thôi bây,Vietnamese
+mạch nhánh có lại nhiều ở đâu ở trong thịt ức gà này có rất nhiều ở trong hạt vừng này thì chúng ta có thể sử dụng những,Vietnamese
+iod thì chúng ta cũng rất cần lưu tâm đặc biệt là đối với bệnh ung thư tuyến giáp là chúng ta cần phải tránh là chúng,Vietnamese
+bị ngã ta phải đỡ ngay giữa ngay để người bệnh không có bị ngã không bị chấn thương rồi nếu mà bệnh nhân đang ăn ăn,Vietnamese
+cải thiện tuần hoàn não là cải thiện cái chức năng của dạ dày của tá tràng và của,Vietnamese
+cùng với tân dược để làm tăng cái tác dụng điều chỉnh làm cho huyết áp ổn định,Vietnamese
+hoặc là các vật nuôi mà có khả năng lây,Vietnamese
+immunesoyz hòe hoa rồi đan sâm hoàng liên l-carnitine fumarate đã được chứng,Vietnamese
+ra là vô là nằm bẹp luôn ở lại đi chụp hình cột sống thì bác sĩ kết luận nói là,Vietnamese
+thể dẫn đến hậu quả gì hậu quả thứ nhất là tâm nhĩ đó không còn được đọc một cách đều đặn nhẹ nhàng nữa mà nó đập rất,Vietnamese
+loạn tâm thần của người già mặc với chúng ta biết là bây giờ tuổi thọ thì cao phải không ạ thế nhưng mà nếu như mà,Vietnamese
+hoạt động của máy và bắt buộc là sau khi đi vào mri mình không có chống chỉ,Vietnamese
+cái hành động mà chúng ta có thể làm cho virus không lây lan được là chúng ta phải không tiếp xúc gần với nhau và,Vietnamese
+người máu não nhưng mà nếu mà để nó cao quá thì nó sẽ gây ra các biến chứng là,Vietnamese
+thì sau đó thì tốt rồi lại một năm xét nghiệm một lần nhưng tôi chỉ nghĩ rằng xét nghiệm đi khám định kỳ để kiểm tra,Vietnamese
+nhất của chế độ ăn là cung cấp đủ các chất dinh dưỡng thứ hai là trong các chất dinh dưỡng đó thì cần phải đảm bảo,Vietnamese
+mà cũng có một vài các cái điều mà chúng tôi muốn chia sẻ thứ nhất là để cùng cùng mình mình cùng hiểu cái vấn đề và,Vietnamese
+bệnh thì chính cũng là những cái lúc mà chúng tôi đang vận động kính là những cái những cái lúc mà chúng tôi đang thực,Vietnamese
+pháp truyền miệng rồi mà là trên mạng nó nó không có lợi ích mà thậm chí nó còn gây hại cho người bệnh thí dụ như,Vietnamese
+như là câu hỏi anh đã đặt cho chương trình vâng chúc anh thật là nhiều sức khỏe rất là nhiều những khán giả đã đọc gọi,Vietnamese
+chống lại bệnh tật và những gì cơ thể cần để nó được khỏe mạnh điều sau đúng,Vietnamese
+có thể nhanh chóng thấy rõ ràng có nhiều tiến bộ y học quan trọng xuất phát từ những khám phá về khả năng miễn dịch bẩm,Vietnamese
+đón nhận thức ăn tiêu hóa thức ăn và thậm chí là cả những vấn đề tiết dịch để,Vietnamese
+và bồi bổ sức khỏe cho mình và sử dụng đúng cách thì không phải ai cũng biết được hi vọng là quý vị và các bạn chúng,Vietnamese
+tim tốt hơn cải thiện được các cái triệu chứng khó chịu của bác và nữa là nó phòng hỗ trợ trong việc phòng ngừa các,Vietnamese
+cập đến bức tranh tổng thể hơn làm thế nào và tại sao hoạt động của hệ miễn dịch khác nhau cách lắp được điều tiết,Vietnamese
+là chắc chắn giảm cân nè có được cái thể hình nó sau bao nhiêu ngày thì nó rất là đẹp đẹp,Vietnamese
+những biến chứng vô cùng nguy hiểm như là đột quỵ não đột quỵ tim và suy tim để giúp cho quý vị và các bạn đặc biệt là,Vietnamese
+chất quý báu của đông trùng hạ thảo để mục đích là gì để cho cái hiệu quả dự,Vietnamese
+làm sao cho những người thực hiện cái kỹ thuật này tránh được giảm được tối đa,Vietnamese
+nếu nó đã có những cái biểu hiện như vậy một lần hai lần nếu mình không phát hiện ra có nghĩa là những lần tiếp theo nó sẽ,Vietnamese
+được thế thì chương trình thì khuyên bác thế này thôi ạ thứ nhất là bác vẫn nên,Vietnamese
+ta uống rất là nhanh như là uống khoáng thì không không đúng đối với những người bị ung thư mà chúng ta uống từ từ,Vietnamese
+chính trong cái việc phẫu thuật đối với cái bệnh parkinson hay lịch sử nó để lại tức là ngày xưa người ta sẽ tìm,Vietnamese
+này trí nhớ giảm sút đấy là trong một thời gian dài và ngoài ra nữa thì khi mà các cái thiểu năng vành hoặc là những,Vietnamese
+sự hiểu biết sâu sắc hơn về mối quan hệ giữa những gì chúng ta tiếp xúc từ những năm đầu đời và sức khỏe ngắn hạn cũng,Vietnamese
+triệu chứng của người bệnh để giúp cho người bệnh có một cái cuộc sống hoàn toàn độc lập do đó phẫu thuật kích thích,Vietnamese
+sẽ tiến triển nặng hơn người bệnh cần phải có sự trợ giúp của người thân cũng,Vietnamese
+để độ khoảng năm bảy phút và mình có thể để khoảng mười phút thì mình nhớ là bát cháo,Vietnamese
+đây là một tiêu chuẩn kiểm nghiệm mà không phải dễ dàng gì một công ty nào ở miền bắc có được thế cho nên là chúng,Vietnamese
+từ thực vật ví dụ như là các bạn có thể nghe tới như là chiết xuất từ hoa lan được cam thảo này từ bạch quả lá dâu tầm,Vietnamese
+khoảnh khắc mà nó rất là khó khăn trong cuộc sống họ bế tắc lắm và họ nhưng khi,Vietnamese
+cái tình trạng suy giãn tĩnh mạch có thể là suy giãn tĩnh mạch nông hoặc là suy giãn,Vietnamese
+nhanh thoái hóa cho nên là chúng ta phải lựa chọn tùy theo cái thể chất của mình tùy theo tuổi tác tùy theo cái mức độ,Vietnamese
+đưa đến cái trầm cảm mà stress đó chính là cái sự mất cân bằng giữa cái nhu cầu và cái,Vietnamese
+chỉ dành riêng cho giới khoa học về hệ vi sinh những tế bào miễn dịch nhận tín hiệu từ vi khuẩn đường ruột là kẻ đáp,Vietnamese
+mở google ra các bạn sẽ thấy là nhiều cái loại thức ăn mà có thể chứa nhiều vitamin k có một loại thuốc chúng ta,Vietnamese
+giảm cân một cách lành mạnh thì giống như hồi nãy tôi nói và đồng thời là nếu như trong quá trình đó mà nó xuất hiện,Vietnamese
+da chúng ta cũng hay là sạm da thì mấy bạn thường là phải mong muốn là da chúng ta sáng thì lời khuyên của bác sĩ trong,Vietnamese
+cái suy nghĩ như thế thì khi mình buồn bực nè lo âu thì cơ thể mình sẽ,Vietnamese
+ta ăn và những gì chúng ta ăn thể hiện thách thức môi trường lớn nhất đối với bộ gen và hệ vi sinh của chúng ta thật,Vietnamese
+rồi là những cái thuốc tiêm phòng vắcxin thì đối với những các bệnh nhân mà bị các bệnh lý nền này thì chúng ta,Vietnamese
+là cái tính an toàn của nó rất là cao đấy là chưa kể cái chuyện là nó lại còn,Vietnamese
+địa đấy thì chúng ta có thể hiểu rằng là do cái cơ địa của mình nó như vậy nhưng nếu cái đau của chúng ta nó lặp đi lặp,Vietnamese
+thể chia sẻ là những cái lợi ích của phẫu thuật kích thích não sau dành cho người bệnh parkinson là gì và có phải là,Vietnamese
+nó phù hợp nó thích hợp với lại cái người người bệnh béo phì làm cho người ta cảm thấy là mình bị phân biệt đối xử làm,Vietnamese
+rồi là đi cấy chỉ rồi làm cái nào cái kia chứ khỏi hoàn toàn huyết áp chứ không phải đái tháo đường không có đâu,Vietnamese
+uống thuốc cứ một thói quen như vậy đều đặn hoặc là có những cái loại thuốc là gì sau khi đánh răng xong là phải,Vietnamese
+tiêu hóa cái hoàn hoàn hảo nhất và những cái tổn thương ấy cũng có thể đến xảy ra liên quan để gan là cơ quan khử độc ạ khi,Vietnamese
+cả da nhưng lĩnh vực nghiên cứu rộng lớn nhất tập trung vào ruột vì đây là nơi,Vietnamese
+vâng thế và cái hiện tượng mà cái bàn tay mình mình,Vietnamese
+chiều hướng tích cực đó thì họ mừng lắm họ phấn khích lắm họ cảm thấy hưng phấn nè họ mà để họ đi tiếp nhưng mà ngược lại,Vietnamese
+cộng gộp lại với nhau thì nó sẽ làm ảnh hưởng đến cái vận chuyển khí huyết ở bên trong máu rất là nhiều chính vì vậy cho,Vietnamese
+rất nhiều người là gì ạ chảy máu dạ dày thậm chí là thủng dạ dày thậm chí là ngày xưa thì cái tỷ lệ những cái người,Vietnamese
+đến những hậu quả là nó co bóp không tốt như vậy rung nhĩ đã xảy ra thì nó có,Vietnamese
+thậm chí gây tử vong bạn có thể không quen được với phía bên kia của câu chuyện rằng mỗi nhịp tim nhịp thở và sợ,Vietnamese
+tôi lúc nào cũng ê ẩm và không thể ngồi lâu được cứ ngồi một lúc lại phải đứng dậy ưỡn lưng ra thì mới chịu được bác sĩ,Vietnamese
+hai nghìn tư cho đến với một chế độ ăn thậm chí ăn như bình thường nhưng bệnh nhân vẫn cứ sụt cân thì đây là một vấn đề rất khó,Vietnamese
+không có ở phần đế vâng thế rồi thì hai hoạt chất quan trọng khác là cordycepin,Vietnamese
+là chúng ta không bị làm sao cả đấy cái chuyện này nó hết sức là rõ ràng vì sao sau khi mà đi đi thăm khám rất là nhiều,Vietnamese
+của vi khuẩn này dẫn đến bệnh đe dọa tính mạng tin tốt là hiện nay chúng ta,Vietnamese
+như là vôi hóa chẳng hạn thì nó sẽ như thế nào ngay sau đây thì chúng tôi sẽ được kết nối với một vị khán giả đến từ,Vietnamese
+ta bị các bệnh lý nền ví dụ cao huyết áp rối loạn lipid máu đái tháo đường rối,Vietnamese
+tới ba nhưng mà tốt nhất là khoảng hai phẩy năm thì nó tốt nhất trong đó thì chúng ta phải thử nó liên tục để mà chúng ta có,Vietnamese
+việc truy tìm hơn do đó nên có những trường hợp mình tìm thì sẽ đăng nguyên,Vietnamese
+cái này cứ tưởng chừng như vô hình cho chị em biết sao nè có một số chị em là,Vietnamese
+đúng và chế độ dinh dưỡng cho người bị ung thư này đã gây ra những cái hậu quả như thế nào ạ vâng và bạn thân,Vietnamese
+các tế bào thần kinh trong ruột của bạn trên thực tế bộ não ở ruột của bạn tạo,Vietnamese
+trị sớm đủ đúng cách thì bạn có thể khỏi hoàn toàn được có nghĩa là gì sau đó hoàn toàn có thể không còn tê không còn,Vietnamese
+viêm loét đại tràng và ung thư chúng ta sẽ khám phá quá trình này chi tiết hơn,Vietnamese
+tốt đối với người ung thư bởi vì trong trong dừa thì cái chất béo nó là chất béo axit béo chuỗi ngắn thì nó cũng khá,Vietnamese
+việc mà tổn hại chức năng của gan mà tổn hại chức năng của gan thì nó sẽ giảm đi khả năng khử độc của cơ thể tức là giảm,Vietnamese
+có kèm suy tim chẳng hạn thì cái bài tập ta sẽ khác và cả còn nếu mà trị rung,Vietnamese
+ra khi hệ miễn dịch bị định hướng sai nó có thể không nhận ra các protein bình,Vietnamese
+con sâu hút chất dinh dưỡng để rồi chờ rằng khi bắt đầu mùa hạ đến thì nấm mới trồi lên,Vietnamese
+biến nhưng so với lại thu nhập của người việt nam thì một cái chi phí bỏ ra,Vietnamese
+thích não sâu này đối với bệnh nhân được bao nhiêu phần trăm một cách tương đối như vậy đó là những cái khâu chuẩn bị,Vietnamese
+bị tổn thương hơn đường tiêu hóa chúng ta dễ bị tổn thương hơn như vậy đó ở những người lớn tuổi chúng ta rất là,Vietnamese
+mà nó vẫn rụng như vậy em xin hỏi bác sĩ nên là nguyên nhân do đâu và cách khắc phục như thế nào rồi cảm ơn câu hỏi của em,Vietnamese
+bạn bè của mình có thể biết đến chương trình quý vị nhá còn bây giờ đây xin mời tất cả quý vị chúng ta sẽ cùng đến với,Vietnamese
+nhỏ từ viêm tai mãn tính cho tới viêm họng và xoang và được chữa bằng thuốc kháng sinh cô bé dùng thuốc kháng sinh,Vietnamese
+và cái thất vọng lại càng lúc nó càng tăng lên và khi mà họ làm như vậy không được rồi thì họ cảm thấy là khó chịu lắm,Vietnamese
+nó sau đó nó được thông lại một cách tự động là tự cơ thể đã thông lại được thì sau,Vietnamese
+được tự ý sử dụng đấy là một cái việc đầu tiên quan trọng việc thứ hai nữa là khi mình sử dụng quá nhiều với liều,Vietnamese
+khăn thì làm cho cái việc tiêu hóa các cái chất bột đường thì khó hơn thế rồi nếu như dạ dày bị tổn thương thì không,Vietnamese
+cái bệnh lý này mà mình lại chỉ đi tìm ở những cái chỗ mà nó hay gặp thì đôi khi mình bỏ sót những cái biểu hiện chính vì,Vietnamese
+thời gian khoảng từ ba đến sáu tháng sau thì các triệu chứng đó các triệu chứng của người bệnh mới được kiểm soát tốt,Vietnamese
+miễn dịch trái ngược với những gì bạn tưởng ruột là cơ quan lớn nhất của hệ miễn dịch hơn nữa vi khuẩn có thể hướng,Vietnamese
+những cái dự trữ của cơ thể mình để bởi vì tế bào ung thư nó khỏe lắm ạ nó khỏe hơn tế bào thường rất nhiều cho nên,Vietnamese
+sĩ đã giải đáp thắc mắc dành cho tất cả quý vị khán giả với những câu hỏi gửi về cho chương trình và đến đây thì,Vietnamese
+bệnh thì tôi nghĩ rằng tất nhiên là không ai khổ bằng người bệnh không ai có thể đau đớn và hoặc là chia sẻ những cái,Vietnamese
+cấu trúc cho cái tóc của mình từ góc tới ngọn và qua đây thì cho em xin gửi lời,Vietnamese
+thế nào ví dụ như đối với kháng vitamin k thì khi mà bệnh nhân bị tác dụng phụ là hay là biến chứng là chảy máu do dùng,Vietnamese
+yếu tố giàu có các quốc gia giàu có hơn và sạch sẽ hơn có tỷ lệ mắc bệnh,Vietnamese
+ông không thể có được kinh nghiệm làm việc thực tế trong phòng thí nghiệm và phải dành thời gian suy nghĩ và đọc,Vietnamese
+nguy hiểm đến tính mạng tức thì nhưng lại gây trở ngại rất lớn trong quá trình sinh hoạt của người bệnh và nếu như không được chẩn,Vietnamese
+thiết kế để khớp vào các mầm bệnh thiếu mẫu phân tử sẽ thoát khỏi sự phát hiện,Vietnamese
+cái thứ hai nữa là mình sẽ cùng tìm một cái cái hướng đi nào đó để có thể góp,Vietnamese
+cái trường hợp là năm năm bảy năm đây là những cái nghiên cứu ở nước ngoài là những cái nước phát triển là người ta cũng nhận thấy rằng là phần lớn là mọi người được,Vietnamese
+ngay cả sự biểu hiện của các gen trong mỗi tế bào của chúng ta cũng bị ảnh hưởng ở một mức độ nào đó bởi những vi,Vietnamese
+tái diễn nữa mà nó trở lại là chú thích nào cái gì chú làm cái đấy chú thể thao,Vietnamese
+thể là họ đang bị stress rồi bây giờ là các phương pháp trị liệu nó không có phù hợp không hiệu quả họ càng bị stress hơn,Vietnamese
+mà không có bị trầm cảm và các chất lượng cuộc sống của cái người mà béo phì đó thì nó giảm rõ rệt,Vietnamese
+thôi là cái tỷ lệ đột quỵ nó khoảng bảy phần trăm có nghĩa là một trăm người sẽ có bảy người bị đột quỵ thiệt nếu mà trong vòng ba mươi,Vietnamese
+nào thì nó nguyên lý của nó là bệnh này là do những cái rối loạn hoạt động của,Vietnamese
+các chị em phải lo lắng rồi đó là chưa kể áp lực công việc vân vân các thứ thì,Vietnamese
+diễn tiến của người bệnh parkinson là hai mươi năm thì khoảng thời gian từ năm đến mười,Vietnamese
+quay trở lại với chương trình trò chuyện,Vietnamese
+liệu của một cái tổng thể trong cái can thiệp hành vi nhận thức hành vi mà đa,Vietnamese
+cho người bệnh có thể ăn được một cách dễ dàng hơn dễ tiêu hóa hơn tuy nhiên,Vietnamese
+loại bỏ nghĩa là chúng sẵn sàng hành động nếu chúng gặp lại một mầm bệnh và,Vietnamese
+cả cái nấm đó cả cái đầu con sâu cả thân con sâu để chúng ta làm ra cái gọi là,Vietnamese
+cái ảnh hưởng của môi trường về tự nhiên môi trường mà tự nhiên mà tốt ở những,Vietnamese
+quá trình mà mình vẫn đang phải làm việc như thế này vâng và bác sĩ cũng đã chia sẻ với mình về,Vietnamese
+bác thì cũng sẽ cân nhắc cái việc điều trị cho nó phù hợp tránh cái tình trạng là là mình không có hình dung được cái,Vietnamese
+chính vì vậy cho nên là mình mới loạng choạng rồi mình mới ngã mình mới không điều khiển được tất cả các cái vận động đấy cũng chưa chắc là hệ xương khớp của,Vietnamese
+bón người thường thì trong trường hợp đó thì phẫu thuật kích thích não sâu nó cũng không cải thiện được tình trạng táo bón,Vietnamese
+những cái nhân xám lấy não và mình sẽ đưa một cái điện cực từ ở ngoài da vào vô,Vietnamese
+quỵ và phải đi cấp cứu thì triệu chứng như nãy giờ tôi đã trình bày đó là cả đó,Vietnamese
+đóng vai trò trung tâm trong việc hỗ trợ mọi khía cạnh có thể hình dung được của sức khỏe và bạn không chỉ tương tác với,Vietnamese
+ngày của chúng ta nó cũng sẽ là những cái nguyên nhân mà nó có thể gây lên một số các cái bệnh lý xương khớp cụ thể ở,Vietnamese
+thời gian quanh năm thì rất là khỏe mạnh nhưng mà khi mà thay đổi thời tiết thì tự nhiên cơ thể mình trở nên lại rất là,Vietnamese
+biến chứng thế nên mình uống thuốc kiểm soát tốt và kể cả huyết áp bình thường trở về bình thường mình vẫn uống thuốc,Vietnamese
+bạn có khi nào mà dễ bị dị ứng khi mà thay đổi với nhiệt độ môi trường từ nóng sang lạnh từ lạnh sang nóng hoặc đơn,Vietnamese
+tế ở tại chỗ cũng như những người bệnh xung quanh ở ngay cái chỗ mà họ sẽ tới hi vọng là,Vietnamese
+cái bộ đôi cặp đôi sát thủ mà đang cần cái mức độ gia tăng rất là cao trong,Vietnamese
+liệu pháp chuyên sâu nhưng hệ vi sinh bị rối loạn chức năng có thể là căn nguyên của chứng đau đầu khó chịu lo lắng mất,Vietnamese
+người ta cũng sẽ đặt ra hai cái câu chuyện là cân nhắc giữa cái câu chuyện là mổ thì được lợi gì và không được lợi,Vietnamese
+ngày thôi nhưng mà đến khi mà bị ung thư thì có thể nó tăng lên tới tận hai nghìn ba,Vietnamese
+kháng vitamin k để chúng ta chống đông mà bây giờ chúng ta ăn nhiều thức ăn có nhiều vitamin k quá thì dĩ nhiên đó là,Vietnamese
+alo alo rồi chúng tôi đang lắng nghe đây ạ mời cô trình bày,Vietnamese
+cùng là nói những cái biến chứng của nó kính thưa quý vị tim của chúng ta đó thì được chia làm hai phần chính đó là,Vietnamese
+bên trong kem dưỡng hoặc là chúng ta chưa đủ làm sạch cái thành phần mà bã nhờn được bài tiết trong một cái đêm mà,Vietnamese
+tố này sẽ được vận chuyển từ ở lớp tế bào đáy đi dần lên phía trên bề mặt của,Vietnamese
+khá là nóng hổi ở ở ngoài bắc đặc biệt là hà nội đó là cái dịch cúm a và,Vietnamese
+có thể là một yếu tố rất quan trọng rồi người ta còn nói nữa là trong cái giai,Vietnamese
+công nghệ sinh học những thành tựu đó đã cho ra đời rất nhiều các cái hoạt chất các sản phẩm mà có nguồn gốc từ thiên,Vietnamese
+yếu tố giảm đau giảm viêm và nuôi dưỡng sụn khớp đồng thời an toàn khi sử dụng,Vietnamese
+chúng ta biết là về cái cơ bản thì khi mà bị huyết áp cao ấy nó sẽ làm cho tổn thương các cái tế bào nội mạc của của,Vietnamese
+tí đồng cũng liên quan rất tốt đặc biệt là selen vitamin a vitamin e vitamin c là,Vietnamese
+đề như là tương tác giữa những sản phẩm với nhau hoặc là gây ra các tình trạng,Vietnamese
+điều kiện sinh sôi nảy nở và mỗi lần mà sinh sôi như vậy thì nó có thể nó sẽ có những cái biến thể và chính những cái,Vietnamese
+thì cái cách để chúng ta khắc phục là thế nào có chứ đây là những cái cách cũng rất đơn giản thôi chị em à đơn,Vietnamese
+nơron thần kinh ôi khủng khiếp đấy và nếu như chúng ta tuổi càng cao thì cái lượng,Vietnamese
+thường xuyên bị căng thẳng hoặc nghĩ là như vậy hiếm khi chúng ta thấy mình liên tục,Vietnamese
+trong dinh dưỡng cũng có rất nhiều yếu tố để giúp chúng ta có thể giảm bớt kể,Vietnamese
+gây tổn thương cái thành mạch máu của người bệnh của chúng ta tuy nhiên thì cũng có một số ít trường hợp là cái,Vietnamese
+lắng nghe phần tư vấn sau đây của bác sĩ,Vietnamese
+là không có hương liệu không có chất bảo quản còn đối với kem dưỡng ẩm thì đối với lại dưỡng ẩm ban ngày thì sau khi,Vietnamese
+thể điều chỉnh được có những người mà thay đổi chế độ ăn thường xuyên quá thì làm cái inr này nó nhảy,Vietnamese
+cái bằng chứng để khẳng định được là mình bị cái nhóm bệnh lý này hay không bởi vì sao cái nhóm bệnh lý cột sống này,Vietnamese
+lứa văn phòng á thì cái bệnh cơ xương khớp nó thường là nó sẽ gặp nhiều ở đốt sống cổ này đốt sống thắt lưng đúng,Vietnamese
+thư vẫn ăn bởi vì chúng ta biết rằng không có một cái thực phẩm nào là tốt nhất cả mỗi thực phẩm có một giá trị riêng,Vietnamese
+parkinson mà những cái bệnh khác đó thì việc đặt điện cực kích thích não sâu nó lại không hiệu quả do đó cái mốc thời gian,Vietnamese
+thêm tăng huyết áp đái tháo đường là các xơ vữa động mạch nó cũng có thể cùng hiện diện trên người bệnh và ta cũng cần,Vietnamese
+não thì có thể gây ra chảy máu một khi chảy máu hoặc là đụng chạm vào nhu mô não thì có thể gây ra động kinh và,Vietnamese
+tiếp xúc gần với lại f0 và những người f1 này sẽ được cách ly tập trung theo,Vietnamese
+là yếu tay yếu chân méo miệng thăng bằng có thể về mắt nữa thì thế mà có những triệu,Vietnamese
+một thời gian dài nó sẽ dẫn đến những cái tình trạng xơ vữa mạch vì chúng ta biết là khi mà huyết áp tăng cao thì nó,Vietnamese
+trực tiếp cùng với bác sĩ của chúng tôi ngày hôm nay và bác sĩ sẽ tham gia tư vấn tận tình cho quý vị và các bạn ngay,Vietnamese
+nhất là đối với những khách hàng mà lại có trên một cơ địa bị viêm gan b trước chẳng hạn này rồi có những,Vietnamese
+người béo phì mà người ta đã từng trị liệu được mổ rồi nè được điều trị tốt nè được tập luyện tốt giữ được,Vietnamese
+để cho nó xuống một cách bền vững và xuống một cách khỏe khoắn không ảnh,Vietnamese
+mạch cũng rất cao ở trên người bị tăng huyết áp nên là chính vì vậy mà bên cạnh cái thuốc điều trị này một cái chế độ ăn,Vietnamese
+những cái vấn đề mà trong cái chăm sóc dưỡng sáng da nhạy cảm đó là chúng ta phải tuân thủ ba bước làm sạch dưỡng ẩm,Vietnamese
+lại được là rõ ràng có vấn đề rồi chúng ta cần phải tìm cách để điều trị ở đây chúng ta sẽ phải nhận định hai cái việc,Vietnamese
+hệ vi sinh khỏe mạnh ví dụ một quý ông bị đa xơ cứng nặng đến mức phải ngồi xe,Vietnamese
+rằng tổng thể hệ miễn dịch của chúng ta mặc dù vẫn chưa được xác định là dành cho mục đích này và ông thậm chí,Vietnamese
+không may cơ thể không đủ thông minh để phân biệt giữa hai điều này đó là lý do,Vietnamese
+bệnh nhân sẽ có như là các cái triệu chứng như đau đầu này hoa mắt chóng mặt này ở chếnh choáng này rồi là ngủ kém,Vietnamese
+trong các trường hợp mà cần áp dụng những biện pháp phẫu thuật thì hỗ trợ tâm lý trong cái điều trị phẫu thuật các,Vietnamese
+rất là phức tạp cần thiết phải được hỗ trợ tâm lý nó có ý nghĩa đặc biệt quan,Vietnamese
+trọng nhất đối với hóa trị đó là rất dễ làm cho bệnh nhân có cảm giác buồn nôn và nôn làm cho người ta không muốn,Vietnamese
+cái hiệu quả điều trị cao nhất hạn chế tác dụng phụ của điện cực cũng như là kéo dài cái thời gian lâu nhất của cục,Vietnamese
+là bác bị đau lưng cũng đã lâu rồi và đau cả hai đầu gối nữa đúng không ạ vâng dạ vâng vậy thì với những cái triệu,Vietnamese
+một số trường hợp thì lại không đem đến cái kết quả theo mong muốn vậy thì ta ta,Vietnamese
+sĩ các cái thuốc điều trị nền như là huyết áp này rối loạn mỡ máu hay là các bệnh lý về tim mạch hoàn toàn chúng ta,Vietnamese
+không may chúng ta đối xử với hệ vi khuẩn đường ruột một cách thiếu tôn trọng chúng đang làm công việc quan,Vietnamese
+ta cao tuổi rồi chúng ta lú lẫn hay quên hoặc là những ai đang gặp phải những cái tình trạng là mất ngủ nè rồi chúng ta bị,Vietnamese
+mạc dạ dày rồi đến tất cả các niêm mạc ruột thì đều bị tổn thương và chính vì vậy làm cho bệnh nhân ung thư rất dễ sụt,Vietnamese
+tiếp xúc trực tiếp về phía trước để tránh cái tình trạng có thể có giọt bắn,Vietnamese
+như vậy thế tại sao bây giờ mới đặt ra cái câu chuyện là tác dụng phụ thế chính vì vậy cho nên là người ta quay ngược trở lại nghiên cứu những cái loại,Vietnamese
+ví dụ rau và tương đương với khoảng độ và chúng ta bình thường ăn bốn lạng bây giờ chúng ta hai lạng rưỡi rồi chúng ta tăng,Vietnamese
+tiên là chúng ta phải nói đến là gì là các thành phần hóa học của nó có thể nói,Vietnamese
+nhiều nhưng hiện nay rất may là chúng ta có những cái can thiệp tim mạch với kỹ thuật rất là hiện đại ở việt nam chúng,Vietnamese
+đúng không ạ không phải đi ra ngoài nhiều tuy nhiên chúng ta lại phải gặp phải một cái vấn đề là gì ạ thứ nhất là,Vietnamese
+đặt ở trong một cái bối cảnh chung luôn luôn tâm niệm rằng cái điều trị tâm lý béo phì nó là một phần ở trong một cái,Vietnamese
+nhất định mà nó mở rộng ra hơn và cái thứ ba là nó hỗ trợ với nhau để nó đảm,Vietnamese
+đẩy viện y tế quốc gia hoa kỳ nis khởi động dự án hệ vi sinh vật ở người vào,Vietnamese
+tiết tố mà còn sản xuất ra một thứ thực sự quan trọng các loại thuốc chống trầm,Vietnamese
+thì người ta mới tìm thấy rằng là bộ đôi hoạt chất này à bộ đôi thảo dược này,Vietnamese
+dấu hiệu mà nó sớm của những cái tình trạng xơ vữa động mạch và mình nên sử dụng sớm đi để nó ngăn ngừa cái sự phát,Vietnamese
+là khó chịu chịu không được cho nên là cái việc dư da đó có những người họ muốn gấp họ phải đi làm phẫu thuật thẩm,Vietnamese
+làm cho cái việc mà cái tuyến nước bọt đấy cũng bị teo đi rồi cũng cái việc tiết nước bọt không,Vietnamese
+của người ta nặng hơn thì đó là một số những cái mà vấn đề tâm lý lớn khi mà,Vietnamese
+trong não rốt cuộc thì khi bị đau bụng bạn không đến gặp bác sĩ tim mạch hay,Vietnamese
+chuyên sâu thì các bác sĩ sẽ giúp thêm cho bệnh nhân của mình sẽ phải học cái cách,Vietnamese
+vâng là ông bị suy tim độ hai ba và rung nhĩ và huyết áp cao là một trăm bảy mươi,Vietnamese
+cũ hãy để đồ ăn là thuốc và thuốc là đồ ăn của bạn bất kỳ ai cũng có thể thay,Vietnamese
+buồn bực lo âu nghịch cảnh tạo ra như thế thì các thành phần oxy hóa tấn công,Vietnamese
+phải đều hỏi ý kiến của bác sĩ điều trị trước khi mà chúng ta quyết định dùng thì có như vậy đó thì có việc mà chỉ,Vietnamese
+mà thuộc họ cánh bướm mùa đông thì con sâu nằm dưới đất nấm ký sinh vào thân,Vietnamese
+ở trong các cái bài thuốc xưa kia của cha ông ta và một cái thành phần tiếp theo đó chính là hoàng liên hoàng liên,Vietnamese
+trị liệu có thể làm gia tăng của nhiệt độ của những thiết bị đó là có thể làm tổn thương mô thì cái này là được xem,Vietnamese
+đau tức ngực tê bì nhức mỏi chân tay dùng lâu dài kết hợp với thuốc điều trị theo đơn cùng chế độ dinh dưỡng luyện,Vietnamese
+chất bảo quản hay là ví dụ như là các bạn thấy cụ thể trên cái sữa rửa mặt của,Vietnamese
+chúng có thể được coi là lá gan thứ hai do vậy khi giảm lượng vi khuẩn có lợi,Vietnamese
+chẳng hạn như tế bào miễn dịch của bạn làm gì và tuyến tụy của bạn bơm ra bao nhiêu insulin bạn sẽ sớm hiểu rằng chúng,Vietnamese
+có đi kèm ví dụ như những người này có thể có tăng huyết áp có đái tháo đường có tình trạng bị lão hóa có tình trạng,Vietnamese
+nhân lớn thứ hai là các xơ vữa động mạch xơ vữa động mạch nó làm cái mạch nó nó bị xơ nó bị hẹp dần dần lại là cuối cùng nó,Vietnamese
+nhiều rồi thức ăn sẵn quá nhiều là không tốt nhưng rõ ràng dinh dưỡng hợp lý trong ung thư là vô cùng cần thiết để,Vietnamese
+trầm cảm táo bón với những triệu chứng này mà khi mà uống các thuốc điều trị,Vietnamese
+cho cái lượng máu nó sẽ dồn ngược lại nhưng mà ở những người suy giãn tĩnh mạch thì những van đó đóng không kín và từ đó,Vietnamese
+đó là một cái bệnh lý mà có thể đó là nguy cơ tái phát của nó rất là cao hãy,Vietnamese
+khuẩn tốt này một cách nghĩ về quá trình sinh nở là hiểu rằng nó giống như việc cung cấp cho,Vietnamese
+lại tính thẩm mỹ như bông hoa nhưng sự lộng lẫy của nó đi lên từ những chi tiết,Vietnamese
+ra với hệ miễn dịch trong buổi đêm khi cơ thể chúng ta bước vào một trạng thái hoạt động và sử dụng năng lượng khác và,Vietnamese
+có thể không thích thì chúng ta có thể hoặc có thể thay đổi bữa thì chúng ta có thể sử dụng các cái bữa ăn cao năng,Vietnamese
+ti thường thường nó liên quan đến tăng huyết áp mà chúng ta điều trị không có tốt thì cái mạch nó sẽ bị tổn thương thì,Vietnamese
+nhưng mà tôi rất là sợ phải đi lấy mẫu vì sợ lây nhiễm lẫn nhau ở tại các khu,Vietnamese
+ascorbic không phải vitamin c đâu ạ thế cho nên là khối lượng vitamin c ở trong chanh còn thua xa so với bưởi rồi,Vietnamese
+người thân hay không may em lại mang những cái virus sarscov2 làm ảnh,Vietnamese
+sẽ phải tìm đến bác sĩ chuyên khoa về da để khám coi có một nguyên nhân nào hay,Vietnamese
+thời gian gần đây không chỉ ở việt nam mà cũng như là trên toàn cầu thì tại sao lại có cái sự phát triển song song của,Vietnamese
+loạn mỡ máu dẫn đến cái tình trạng xơ vữa động mạch và cây xơ vữa động mạch nó sẽ có thể ở xuất hiện ở rất nhiều nơi trong,Vietnamese
+bị nhồi máu cơ tim cũng rất là cao nếu mà chúng ta vẫn không có một cái chế độ ở sinh hoạt điều trị một cách khoa học,Vietnamese
+cho cái gì cái lượng máu đến nuôi nó suy giảm và từ đó chúng ta với trái tim của chúng ta chúng ta có thể bị cơn đau thắt,Vietnamese
+hoặc cực nhỏ hệ sinh vật chỉ một cộng đồng sinh vật có mặt tự nhiên chiếm giữ,Vietnamese
+cái huyết áp thì mình vẫn sử dụng thuốc huyết áp này và nếu được nữa thì mình ngày nào mình cũng nên đo huyết áp ít,Vietnamese
+nó sẽ rất là dễ làm cho cái việc mà tăng các cái gốc tự do ở trong cơ thể chúng,Vietnamese
+chúng ta đều bị xâm chiếm từng khoảnh khắc bởi các sinh vật có khả năng đe dọa tính mạng nếu không có hệ miễn dịch hoạt,Vietnamese
+bác sĩ nói rằng nhé bác sĩ không có phán xét về các chuyện các cái sản phẩm liên quan đến đông trùng hạ thảo khác nhưng,Vietnamese
+tử điều chỉnh quá trình này giải quyết những bí ẩn và sự phức tạp này cho phép,Vietnamese
+là trong một số chế độ ăn thì thường đưa ra lời khuyên là bệnh nhân đang cần phải ăn nhạt và bớt dầu ăn lại tuy nhiên thì,Vietnamese
+động nhưng không nên đi lại nhiều nghĩa là gì chúng ta nên tập tại chỗ thôi bác ngồi tại chỗ bác tập bác nằm tại chỗ bác,Vietnamese
+sử dụng các thuốc để mà tân dược để mà điều trị huyết áp điều trị đái đường,Vietnamese
+nào về cái trước trong và sau vào phẫu thuật họ hiểu được những kiến thức liên quan tới cuộc phẫu thuật này,Vietnamese
+nhĩ còn gây ra cái cái cái có khả năng gây ra những biến chứng đó thì chúng ta vẫn còn dùng như vậy thì chỉ trừ khi nào,Vietnamese
+ra đột biến tế bào đúng ạ thế rồi là đặc biệt là đối với việc mà cung cấp đủ nước,Vietnamese
+này có có tốt không thì ở đây phải nói bác là ở phần vừa nãy cũng có một khán,Vietnamese
+cách can thiệp vào giai đoạn cuối của quá trình kết quả là không có bất kỳ đột biến gen đơn giản nào cho phép vi,Vietnamese
+những cái câu chuyện tiếp theo mà chúng tôi cũng muốn cảnh báo trước để thứ nhất là các quý vị khán giả cũng như là của,Vietnamese
+cái người bệnh béo phì đi kiếm tìm những cái phương pháp trị liệu nó không có phù hợp ví dụ như họ sẽ cố gắng là,Vietnamese
+sắc tố melanin giúp cho da bệnh nhân cải thiện nhanh xin được cảm ơn những chia sẻ vô cùng,Vietnamese
+chắn sẽ dẫn tình trạng cơ thể tình trạng cơ thể chúng ta dẫn đến suy kiệt và chúng ta không còn được cả cái sức đề,Vietnamese
+trợ về vận động vẫn phải tiếp tục và theo các lời khuyên đúng mực của các bác sĩ chuyên khoa để cho các chất lượng,Vietnamese
+được nhận được từ người bệnh khi mà đến khám tại khoa bởi vì chúng ta thấy rằng,Vietnamese
+cái hiệu quả của mình mình cũng không dám chắc một trăm phần trăm hoặc là nó cũng có những cái rủi ro nhất định cho,Vietnamese
+dụng lâu dài mà dùng lâu dài thì nó lại không có tác dụng phụ thì có thể nói rằng là nó giúp cho bổ não của chúng ta,Vietnamese
+trở lại cũng như là nó hỗ trợ cho vấn đề đường tiêu hóa của mình vâng,Vietnamese
+thì đã có thể là giúp giảm rất là nhiều những cái biến chứng và những cái bệnh lý đi kèm như là có thể giảm được tới,Vietnamese
+của môi trường hơn mình đi từ ngoài nóng vào trong môi trường lạnh cũng đã cảm thấy da mình có khó chịu hoặc là sau,Vietnamese
+của con người nó là gì cách thức hoạt động và mối quan hệ đáng kinh ngạc giữa,Vietnamese
+mặn quá hoặc là đắng quá hoặc là cảm thấy chua quá không thể mà ăn được không thể chấp nhận được món ăn đi qua,Vietnamese
+đông trùng hạ thảo thì thấy rằng là cái hiệu quả của nó với tim mạch với thần kinh cũng rất là tốt ở đây tôi không,Vietnamese
+bác thì hoàn toàn đây nó là một cái nguyên nhân mà dẫn đến cái mảng xơ vữa của bác đấy ạ thứ hai nữa là từ đó nó,Vietnamese
+cách để không ảnh hưởng tới những vấn đề khác và giải đáp ngày hôm nay thì chúng ta cũng sẽ nghe những chia sẻ của bác sĩ,Vietnamese
+nhạy và độ đặc hiệu của các chẩn đoán da nhạy cảm lên nhà thôi thì mình làm ở các vùng rảnh mũi tại vì chỗ này nó nhạy,Vietnamese
+điểm chốt chặn ở các tỉnh ở các ranh giới giữa tỉnh này với bên kia thì thường có những chốt chặn và ở đây thì,Vietnamese
+giai đoạn hai giai đoạn ba giai đoạn bốn và giai đoạn năm thế ở giai đoạn một thì,Vietnamese
+hỗ trợ đồng nghiệp trong thời gian họ làm việc ở phòng thí nghiệm của ông và trong sự nghiệp tương lai độc lập của họ,Vietnamese
+quan trọng có lợi cho sức khỏe nhìn chung chính vi khuẩn là những nhân tố,Vietnamese
+của bệnh do đó nhiều hướng hiện nay nhiều hướng nghiên cứu về vấn đề về dược lý về vấn đề về phẫu,Vietnamese
+vui mừng chào đón tất cả quý vị đang,Vietnamese
+luôn cảm thấy là không hề bình yên xung quanh mình luôn luôn có thể sẽ gặp phải f0 lang thang ở ngoài đường,Vietnamese
+bạn đang muốn cải thiện cái vấn đề về màu sắc da chúng tôi khuyến khích bạn là mình nên nếu phải chọn lựa giữa mình bổ,Vietnamese
+áp nè về tiểu đường hoặc là những ai đang gặp bệnh lý về thần kinh nè rồi nhớ nhớ quên quên bệnh lý về alzheimer những,Vietnamese
+khi cảm thấy rất là phiền đối với thành viên trong gia đình thì họ có thể chủ động hơn lấy cái gói đó bóc ra và mình,Vietnamese
+da và đến với lớp sừng gây ra cái tình trạng là như chúng ta thấy là thâm nám,Vietnamese
+của trình độ của bệnh viện đó làm được những gì nếu mình chỉ làm được một vài cái khảo sát đơn giản thôi hoặc là,Vietnamese
+nó có khả năng tăng hơn nữa như vậy thì với nhiều cái phương pháp trị liệu họ đã cố gắng kiếm tìm họ đã,Vietnamese
+cơ hội nó tăng hơn vì lý do là khi mà họ bị stress bị căng thẳng bị đơn độc họ lo lắng vậy stress tăng thì nó khuyến khích,Vietnamese
+nhân parkinson nó cũng là một quá trình lâu dài từ sau mổ cho đến suốt,Vietnamese
+thiếu ở trong cái cái cái điều trị béo phì lý do thứ nhất là tâm lý tiêu cực,Vietnamese
+là do chính bệnh parkinson hay là do thuốc gây ra tại vì một số trường hợp người bệnh parkinson mà có táo bón,Vietnamese
+ví dụ như phẫu thuật chẳng hạn mà không được chuẩn bị tốt thì họ cũng sẽ bị nặng thêm như vậy thì cái nỗ lực của bản thân của,Vietnamese
+bệnh nhân đó tôi đã đầu hàng về căn bệnh đã trở nên quá khó kiểm soát và không có,Vietnamese
+liền với lại cái thứ tiếp cận can thiệp thay đổi cái lối sống như vậy thì hồi trước đây thì mình chủ,Vietnamese
+hỏi với tôi rằng là vậy thì nó còn bản chất của đông thảo hay không thế thì tôi phải nói một điều như thế này à cái bản,Vietnamese
+bộ khoa học hiện nay thì chúng ta làm chậm quá trình lão hóa cái thứ nhất cái,Vietnamese
+trình thì quý vị có thể đoán theo dõi lại chương trình của chúng tôi sau ngày hôm nay sẽ được phát sóng trên các kênh,Vietnamese
+mà giúp cho hỗ trợ trong việc ngăn ngừa cái nguy cơ mà hình thành các cái mảng xơ vữa và chúng ta biết cái mảng xơ vữa,Vietnamese
+trường hợp này đó là chúng ta phải đảm bảo trước là da chúng ta đủ ẩm trước đã phải đảm bảo cho chúng ta được cái,Vietnamese
+chuyện là gì ạ mặc dù cái tác dụng thì rất là mạnh đấy và khi mà chúng ta sử dụng kể cả cái nhóm thuốc corticoid,Vietnamese
+á nó cũng không có được hiểu mình lắm và họ cảm thấy là cái sự tác động từ những,Vietnamese
+mặt kỹ thuật về mặt chỉ định điều trị bệnh thì nó không có sự khác biệt nó chỉ khác biệt về cái việc mà duy trì cái,Vietnamese
+selen thì sẽ giúp cho ví dụ như các chức năng nói chuyện với bình thường đặc biệt là chức năng của hệ tiêu hóa,Vietnamese
+bước để mà giúp cân bằng lại cái độ ph trên da hoặc là làm sạch sâu những cái,Vietnamese
+phải vừa sức mình nữa thì nếu mà cho phù hợp với lứa tuổi của mình luôn thì bạn,Vietnamese
+phổ biến đặc biệt là khi thay đổi thời tiết thì với cái cơ địa của những người ví dụ như có những người là cái cái thể,Vietnamese
+dụng là ức chế vào trong một trong những quy trình sản sinh sắc tố ở trong da thì,Vietnamese
+của bác rất tốt nhưng nếu bác ngã một cái thì có khi tất cả nó lại quay trở lại với vạch xuất phát thì cái điều đấy,Vietnamese
+tên như một tập hợp các gen trong đó mỗi gen mã hóa cho một protein thụ thể tương,Vietnamese
+dự phòng và hỗ trợ điều trị các bệnh lý về tim mạch còn ngoài ra các cái tác dụng khác của nó cũng rất là lớn cho nên,Vietnamese
+tuổi ta lớn mà đâu phải người ta còn trẻ ta còn trẻ ta ăn cái gì đó thì ta hấp thu đầy đủ chất nhưng khi ta lớn tuổi,Vietnamese
+loạn nhịp tim thì khi chúng ta sử dụng kết hợp cùng với viên nang đông trùng hạ thảo thì chúng ta nên uống cách nhau ra,Vietnamese
+tôi do kênh truyền thông tư vấn sức khỏe,Vietnamese
+vị giác làm cho chúng ta mất đi cảm giác chúng ta nhận biết vị ví dụ chúng ta ăn rất là bình thường thì người bệnh kêu,Vietnamese
+từ mỗi thành viên trong cộng đồng chung của chúng ta và bây giờ đây thì xin mời tất cả quý vị chúng ta sẽ cùng đến với,Vietnamese
+bác còn có cái bệnh gì khác không ạ tiểu đường huyết áp,Vietnamese
+những vi khuẩn khác phát triển mạnh ở những nơi dưới nhiệt độ đông lạnh một loài thậm chí có thể chịu được mức độ,Vietnamese
+việc mà tại sao sau mà chúng tôi lại khuyên cái câu chuyện thần kinh trước là vì như vậy bởi vì cái đấy nó rất là căn,Vietnamese
+và đã chuyển ra ngoài hậu phẫu thì thông thường những cái trường hợp mà can thiệp vào não thì mình sẽ lưu lại theo dõi sát,Vietnamese
+các hoạt động và đặc biệt là trong cái giai đoạn hiện nay ngoài cái việc người lớn tuổi có thể bị parkinson có,Vietnamese
+lại thì mình nhắc lại đây cái nhóm thứ hai là người ta tiến bộ hơn tức là người ta cũng đưa một cái dụng cụ nhỏ vào bên,Vietnamese
+giác này nó liên quan rất là nhiều yếu tố nhưng mà cái yếu tố đầu tiên đó những cái thay đổi bản thân chúng ta phải thấy,Vietnamese
+cũng như là dự phòng và hỗ trợ điều trị những bệnh lý mãn tính nhất là những,Vietnamese
+có tác dụng làm hỗ trợ cho việc giảm nguy cơ hình thành các cái mảng xơ vữa động mạch đối với những bệnh lý nền của,Vietnamese
+trong người của chúng ta đó thì nó không có tích tụ ở trong người ví dụ như với loại thuốc kháng đông đó kháng,Vietnamese
+sinh ngành học này nghiên cứu cách lựa chọn lối sống như chế độ ăn uống tập thể,Vietnamese
+chống viêm này có cái nhóm chống viêm liên quan đến corticoid và có cái những cái thuốc chống viêm mà không có corticoid,Vietnamese
+nó sẽ thúc đẩy cái tình trạng béo phì nó nặng hơn cái thứ hai về mặt tâm lý và hành vi đó,Vietnamese
+chướng hơi chán ăn cái nhóm phút thứ hai đó là cái nhóm thuốc mà tác động lên hệ thần kinh trung ương như là ở các,Vietnamese
+stress mà càng bị stress thì họ lại càng ăn nhiều như vậy cho nó trở thành một cái vòng lẩn quẩn bên cạnh đó thì ngoài cái,Vietnamese
+người bệnh béo phì đang gặp phải và để giúp cho tất cả quý vị chúng ta có cái nhìn rõ hơn và khách quan hơn ngay bây,Vietnamese
+cái vấn đề có tình trạng tăng sắc tố của da của chúng ta nặng nề hơn khi chúng ta quay trở lại bác sĩ điều trị thì lại trở,Vietnamese
+hỏi thường xuyên được gửi đến cho chương trình cũng như là các bác sĩ của chúng ta hãy đó là về cách dưỡng sáng khi,Vietnamese
+một người một ngày thôi còn lại chúng ta có thể sử dụng cá rất tốt đối với người bệnh ung thư bởi vì trong trong,Vietnamese
+triệu chứng đó và bắt đầu nó xuất hiện các biến chứng do thuốc như là biến chứng,Vietnamese
+dụng các sản phẩm mà có chứa những hoạt chất tẩy rửa bề mặt này lâu dài thì sẽ vô tình làm rửa trôi cả cái lớp,Vietnamese
+họ cảm thấy hoang mang hơn họ cảm thấy là tự sa lánh với mọi người họ cảm thấy cô độc cô đơn rồi công việc của họ là họ,Vietnamese
+với phần chia sẻ của bác sĩ lại càng cảm thấy bị cuốn vào các nội dung và cảm thấy rất là hào hứng với những gì mà,Vietnamese
+chế độ ăn uống và sinh hoạt nó lành mạnh giúp cho việc nâng cao hiệu quả tuân thủ,Vietnamese
+cảm thấy là thiếu tôn trọng bị phân biệt đối xử vân vân thì cái đó là cái ảnh hưởng về,Vietnamese
+mất đi cái lớp màn mỏng trên bề mặt da của chúng ta hay như là chúng ta chọn lựa các thành phần dưỡng sáng như hồi nãy,Vietnamese
+cần thiết phải được thông cảm cần thiết phải được sự hỗ trợ cần thiết phải được,Vietnamese
+cho quý vị khán giả đã hiểu hơn về bệnh của mình cũng như là những cái thông tin,Vietnamese
+miễn dịch các tế bào và mô khỏe mạnh sẽ bị phá hủy và nếu chúng ta bất hoạt nó,Vietnamese
+sắc tố thì sẽ gây rất là mất thẩm mỹ trên khuôn mặt thì đối với lại cái việc dưỡng sáng thì chúng ta sử dụng những,Vietnamese
+chứng nó trở nặng hơn người bệnh bắt đầu đi đứng khó khăn đương nhiên là người bệnh sẽ phải dùng thêm dùng thuốc để,Vietnamese
+đối với lại cái cuộc sống họ cũng cảm thấy là họ bị mặc cảm về cái giá trị của chính mình họ cảm thấy là họ sống,Vietnamese
+nhân không có hiệu quả thì cái tổn thương là vĩnh viễn vào nó không có khả năng hồi phục lại như bình thường,Vietnamese
+yếu tố là nó liên quan nhiều đó ở việt nam mình đó là cái việc,Vietnamese
+khán giả quan tâm và tin tưởng lựa chọn các liệu trình này để chăm sóc và phục hồi cho cái mái tóc của mình thì trên,Vietnamese
+viện các bác sĩ sẽ có những cái biện pháp điều trị đặc hiệu cho từng cái bệnh nhưng mà sau khi mà qua những cái giai đoạn như vậy mà chúng ta điều trị duy,Vietnamese
+thứ hai là nó nó nó có rất là nhiều cái nguyên nhân khác và nó nó không có kèm theo,Vietnamese
+nhiên điều mang lại cho tôi hy vọng là một lĩnh vực nghiên cứu đang phát triển mà cuối cùng đã mang lại cho tôi những,Vietnamese
+là triệu chứng của thiếu máu não thoáng qua thì như tôi nó lần đầu đó là đột quỵ,Vietnamese
+chống mệt mỏi và thanh trừng gốc tự do và kéo dài tuổi thọ cho,Vietnamese
+vừa rồi thì sẽ rất là tốt cho bệnh nhân ung thư đấy cũng là một giải pháp mà cũng bớt đi cái cái mà người ung thư đôi,Vietnamese
+dại chích ngừa dại vô nó cũng tại mình,Vietnamese
+tim thì rung nhĩ cũng có thể gây ra biến chứng thiếu máu cơ tim nhồi máu cơ,Vietnamese
+nhận thức ăn ăn vào rồi tiêu hóa và đồng hóa thức ăn thì đó cũng là một cái làm,Vietnamese
+nó mềm nó ôm được cái chân của chúng ta nó nâng đỡ cho cái chân của chúng ta và chúng tôi vẫn thường dùng một cái khẩu,Vietnamese
+thiết bị lắp cận lâm sàng người ta chú ý đó là cái mri một khi khi mà vào,Vietnamese
+thoái hóa khớp đáp ứng tốt trên các bệnh viêm khớp thoát vị đĩa đệm gai vôi hóa,Vietnamese
+nữa thì cái cái câu chuyện mà tác dụng phụ nó trở nên rất là hiện hữu rất là phổ biến rất là thường gặp và tại sao nó,Vietnamese
+phức tạp hơn nhiều so với sự mường tượng trước đây hệ miễn dịch bẩm sinh không,Vietnamese
+cứu ngay nên bạn có thể giám sát thêm bằng các phương tiện hiện đại hơn ví dụ như là bạn sẽ gắn camera ở nhà để mình,Vietnamese
+làm sao mềm lỏng nấu nhạt để đỡ xót đỡ đau và trong khi bữa ăn đó cũng bớt đi,Vietnamese
+có đi tham khảo và tìm hiểu trên mạng các sản phẩm để trị về vấn đề rụng tóc,Vietnamese
+những cái khó chịu đơn thuần mà nó ảnh hưởng đến cái việc vận động này không thể ngồi được lâu này đứng lên ngồi xuống nó cũng khó khăn như vậy này thì,Vietnamese
+sẽ đón nhận nó khi có và sẽ thông báo một cách chính xác những cái rối,Vietnamese
+hoạt động tẩy rửa bề mặt để có ph cao ph da và làn da của chúng ta chỉ lâu dần sẽ làm tổn thương hàng rào bảo vệ da làm,Vietnamese
+cái việc mà trong tương lai là có thể là chúng ta sẽ phải điều trị là những các biện pháp dùng những các giống thuốc hạ,Vietnamese
+bệnh nếu bệnh nhân có thể thoát qua những cái bệnh cảnh cấp tính về những biến chứng đó thì có thể sẽ để lại những,Vietnamese
+vấn đề về tim mạch rối loạn thần kinh thậm chí là béo phì cuốn sách đầu tiên,Vietnamese
+sao vậy chắc chắn không sinh vật sống nào có thể tồn tại mà không có chúng kể,Vietnamese
+uống phù hợp như thế nào thì thì cái câu hỏi của bác đặt ra rất phù hợp là ở khía cạnh như vậy cho nên lời khuyên đầu tiên,Vietnamese
+ta đi xuống không có một cái cái hưng phấn để mà có thể làm việc được hay,Vietnamese
+mà đã được kiểm chứng lâm sàng an toàn cho da nhạy cảm và đặc biệt là một lưu ý nhà mình cần tránh những cái sản phẩm,Vietnamese
+tương đương các thuốc tân dược đang được sử dụng phổ biến trong điều trị bệnh xương khớp hiện nay ưu điểm vượt,Vietnamese
+giác chán ăn không có còn cảm giác mà thèm ăn thì bên cạnh cái việc mà điều trị thì như chúng ta biết thì những cái,Vietnamese
+có nghĩa là bác bác uống cái thuốc đề kháng chống lại covid và xịt họng xịt họng là bác sĩ dùng loại nào ở betadine,Vietnamese
+bạn có đặt câu hỏi là cho tôi hỏi đa số những thuốc cho người bệnh parkinson có phải dễ gây táo bón phải không ạ và,Vietnamese
+đối với các bệnh phương tây điều không thường thấy trong các xã hội truyền thống chủ yếu làm nông nghiệp,Vietnamese
+với thuốc chúng ta nhớ rằng người bệnh vẫn còn hiệu quả với thuốc nhưng có điều là hiệu quả với thuốc nó ngắn nó gây ra những,Vietnamese
+tư thế rồi các triệu chứng và đông cứng dáng đi mà không đáp ứng với thuốc vân vân nó xuất hiện nhiều hơn do đó ở khi,Vietnamese
+này nó quá tải làm nhiều người quá tụ tập đông người thì bao giờ trong cái,Vietnamese
+bên cạnh thì chế độ ăn như vậy thì chúng ta cũng có thể có thêm những cái thực phẩm bổ sung để giúp cho cái việc mà,Vietnamese
+nam chưa được phát hiện trên tám mươi phần trăm chưa được điều trị đồng thời tại việt nam có tới ba mươi phần trăm người trưởng,Vietnamese
+và không tự thân là chưa đủ hệ miễn dịch phải có khả năng để nhận biết khi nào một cái gì đó có khả năng trở thành một,Vietnamese
+triệu chứng về vận động cho người bệnh khá là tốt và tốt là bao nhiêu phần trăm thì các nghiên cứu trên thế giới cũng đã,Vietnamese
+xung hay là kinh quý đây nó chính là những cái bệnh lý về tim mạch đấy ạ thế và trong những cái cái trường hợp này,Vietnamese
+kính thưa quý vị trước tiên là tôi cũng muốn nói rõ về tâm nhĩ là gì và rung nhĩ là gì và cuối,Vietnamese
+tốt cho những các cái bệnh lý về tim mạch cũng như là những cái cái huyết áp nó có tác dụng hỗ trợ trong việc ngăn,Vietnamese
+bác sĩ đã nhận lời tham gia chương trình,Vietnamese
+thân thiện có lẽ không có hệ thống nào trong cơ thể nhạy cảm với những thay đổi của vi khuẩn,Vietnamese
+chất dẫn truyền thần kinh trong đó có acetylcholine và từ đó nó tạo ra cái gì tăng,Vietnamese
+cái tinh thần thoải mái rồi ăn uống dinh dưỡng đầy đủ thì chúng ta sẽ có một cái,Vietnamese
+tàn phế thì nó cũng rất là cao thế cho nên là hầu như những người bị tai biến xong thì chúng ta phải chịu rất nhiều,Vietnamese
+là vấn đề các cái chất cái vitamin và chất khoáng đến từ rau và củ quả thì,Vietnamese
+rất là nhiều người là đặc biệt là những người mà có những thành viên trong gia,Vietnamese
+ở các cái bệnh viện đặc biệt là ở chuyên khoa nếu mà bác có bảo hiểm thì có thể bác đi khám ở các cái bệnh viện gần nhà,Vietnamese
+cá có rất nhiều axit béo omega3 mà axit béo omega3 thì giúp cho các,Vietnamese
+trạng ốm yếu đau khổ cá nhân chất lượng cuộc sống bị tổn hại và tiêu tốn về tài,Vietnamese
+thể chữa khỏi thực hư vấn đề này như thế,Vietnamese
+một cuốn sách về cách những ý tưởng khoa học phát triển hành trình khám phá để hiểu về hệ miễn dịch là một trong những,Vietnamese
+chúng ta lại không tìm hiểu được và điều chăm sóc trước trong và sau điều trị rất quan trọng quay trở lại câu chuyện đó,Vietnamese
+lành và nuôi dưỡng một hệ vi sinh vật khỏe mạnh qua những thứ mà bạn ăn những gì bạn tiếp xúc trong môi trường và lối,Vietnamese
+căn cứ gạch đầu dòng những cái như thế để chúng ta lựa chọn các sản phẩm cho nên là nếu như có điều kiện thì bác,Vietnamese
+đối với sau điều trị ung thư là cần thiết để chúng ta phát hiện sớm những cái dấu hiệu rất có thể chúng ta có ung,Vietnamese
+mãn tính như chứng mất trí nhớ căn bệnh hiếm thấy ở trên hòn đảo hy lạp kia,Vietnamese
+bệnh xuất hiện các dây ở đến giai đoạn ba và có các biến chứng như vật dao động,Vietnamese
+bệnh parkinson hoặc là các phương pháp hoặc là những lưu ý trước và sau khi tiếp nhận điều trị trong phần bình luận,Vietnamese
+thiện những cái thông số rối loạn chuyển hóa mỡ ở những cái bệnh nhân như vậy cải thiện giảm những cái mỡ,Vietnamese
+loại thuốc mà kháng vitamin k và một cái loại thuốc kháng đông trực tiếp hay là thuốc kháng đông mà không kháng vitamin,Vietnamese
+chúng ta như khi lựa chọn sản phẩm thì em thấy một trong những cái điều mình nên làm là phải đọc kỹ sẽ bản thành phần nó sẽ ra chúng ta tiếp tục với một câu,Vietnamese
+cái chuyện mà chúng ta đã biết được là bệnh nhân có rung nhĩ nhịp chậm parkinson covid19 rồi thì mà mình phải,Vietnamese
+cứng lại nó không còn cái sự đàn hồi mềm dẻo như trước nữa và nó là điều kiện để,Vietnamese
+vậy đó còn trường hợp thứ hai loại những bạn mà da khô thì những bạn này là do là,Vietnamese
+cái điện cực vào trong não và một cái cục pin vùng trước ngực và khi đó bác sĩ thần kinh bác sĩ về bệnh parkinson sẽ,Vietnamese
+thứ ba là lúc nào cũng kêu chán hết trơn sao mà chán quá đi chán quá đi và hổng,Vietnamese
+phẩm để nuôi cơ thể chúng ta thôi thì không thể đủ được hai thực phẩm ấy thuộc,Vietnamese
+sẽ phải cần để làm những cái thăm dò để có thể khẳng định xem là liệu mình có các cái cái cái nghi ngờ hoặc là là một,Vietnamese
+mà có thể có đông người đến một cái nơi mà chúng ta phải sử dụng các cái dịch vụ,Vietnamese
+thuốc chống viêm giảm đau của y học hiện đại thì cái đó là cái mà chúng ta phải uống nhưng mà chúng ta phải biết rằng là,Vietnamese
+kiều được lo lắng được quan tâm thế thì nó giải quyết là một câu chuyện là cái tinh thần các chị cho thoải mái thì đây,Vietnamese
+vấn như thế nào đó về sức khỏe bởi vì hiện nay là công nghệ nó rất là rất làm,Vietnamese
+thần kinh kiểm tra nhưng người ta có điện tâm đồ tất cả các thứ về thần kinh,Vietnamese
+khuẩn tránh được tác dụng của penicillin trên thực tế vi khuẩn có thể kháng thuốc,Vietnamese
+cũng do những cái sở thích cá nhân nữa thì cũng rất là khó bởi vì nó đã thành thói quen rồi vậy thì phó giáo sư có thể,Vietnamese
+rất nhiều loại độc tố xuống tới ruột của bạn trên thực tế bởi vì chúng vô hiệu hóa nhiều loại độc tố trong thức ăn,Vietnamese
+trở ngại mà họ hay gặp phải bên cạnh đó thì chúng ta thấy rằng cái người mà bị,Vietnamese
+nhiều sức khỏe và bây giờ xin mời tất cả quý vị và các bạn cùng theo dõi chuỗi chương trình tư vấn trực tuyến cùng,Vietnamese
+nhiều các cái lý do khác nhau một trong những cái lý do đấy mà chúng ta thấy rằng là rất là phổ biến đấy là những cái,Vietnamese
+đời có một ca sinh mổ theo nguyện vọng và được uống sữa công thức hoàn toàn cô bé mắt nhiều bệnh nhiễm trùng khi còn,Vietnamese
+kháng sinh và các điều kiện khử trùng quá mức có thể giải thích cho việc vì sao chúng ta phải hứng chịu sự gia tăng,Vietnamese
+dụng về chống oxy hóa rất tuyệt vời và chúng ta vừa nghe đó khi có một stress oxy hóa nghĩa là mất cân bằng giữa oxy,Vietnamese
+cho tới hiện nay trên thế giới,Vietnamese
+báo phần còn lại của hệ miễn dịch phải đề phòng một trong những chủ đề bao quát mà bạn,Vietnamese
+sau đó thì cũng không nhắc bởi vì nó,Vietnamese
+tay cổ tay cổ tay bên trái cũng khi mình giơ lên thì nó đau ngay cổ tay mà cũng có,Vietnamese
+thực tế chúng ta ghi nhận có nhiều trường hợp người bệnh cho rằng là chỉ cần phẫu thuật là có khả năng điều trị,Vietnamese
+các phương tiện thì lúc đó cái việc mà điều trị của chúng ta nói thật là chuẩn xác và người bác sĩ cũng an tâm và bệnh,Vietnamese
+nền ví dụ như cao huyết áp ví dụ như đái tháo đường tất nhiên đái tháo đường của bác mới bị thôi thế thì ở đây phải nói,Vietnamese
+thì cái câu chăm sóc lại rất quan trọng tại vì khi ta điều trị như tại ta tác,Vietnamese
+vậy thì sau khi bị những loài động,Vietnamese
+làm cho các tế bào ung thư nó rất là có ái lực với sắt và nó nhân lên khá là nhanh nhưng mà cơ thể chúng ta không,Vietnamese
+trệ ở trong tâm nhĩ của chúng ta một khi mà đã có tình trạng ứ trệ trong tâm nhĩ,Vietnamese
+còn tình trạng rung nhĩ nữa để mà những cái biến chứng nó không xảy ra việc thứ,Vietnamese
+trùng hạ thảo cũng như là về những cái nguyên nhân triệu chứng phương pháp cải thiện sức khỏe tim mạch và hệ thần kinh,Vietnamese
+đấy thì triệu chứng nó sẽ giảm dần và hết tuy nhiên cúm a sẽ đặc biệt nguy,Vietnamese
+vì là nếu như có nhiều ký những cái thực phẩm những cái sắt từ thịt đỏ như vậy thì,Vietnamese
+không đáng quan tâm còn những người khác lại có những yếu tố nguy cơ mà như là,Vietnamese
+cái phương thức điều trị mà gọi là phù hợp nhất hiệu quả nhất cho cái người thân của anh thôi cho nên nếu mà chỉ có,Vietnamese
+là như lời khuyên ban đầu của chúng tôi là nên hạn chế một cách tối đa chính vì vậy cho nên là tối đa thôi chứ còn cái,Vietnamese
+thuật kích thích não sâu thì khi mà chúng ta phẫu thuật kích thích não sâu khi đó chúng ta sẽ giảm được cái thuốc thì rõ,Vietnamese
+mặt hồi hộp trống ngực và hỗ trợ trong việc phòng ngừa các biến chứng nhồi máu cơ tim hoặc là cái biến chứng,Vietnamese
+xem các hệ thống khác trong cơ thể ví dụ như đường tiêu hóa như các thực thể rời rạc không liên quan đến những gì diễn ra,Vietnamese
+yếu tố này cực kỳ quan trọng là nó có rất hiệu quả trong vấn đề là gì là khi,Vietnamese
+tôi hứa rằng cuối cùng bạn sẽ có thể phân biệt được nhiều chủng khác nhau mặc,Vietnamese
+tìm hiểu luôn khi mà mình tới mình tư vấn của bác sĩ nội thần kinh mình sẽ hỏi thêm những cái trang thiết bị mà cần,Vietnamese
+trải qua những thay đổi căn bản trong hơn hai triệu năm qua chúng ta đã tiến hóa để có mối quan hệ cộng sinh mật thiết,Vietnamese
+các bạn vừa rồi chúng ta đã được lắng nghe các bác sĩ chia sẻ và hướng dẫn cụ thể hơn về tâm lý của người bệnh béo phì,Vietnamese
+khả năng tập trung hoặc cái nhìn tiêu cực về cuộc sống của bạn dựa trên các nghiên cứu lâm sàng và phòng thí nghiệm,Vietnamese
+tục duy trì một cái đơn thuốc cũ thì chúng ta biết là trong các cái điều trị của các cái vấn đề xương khớp từ các cái,Vietnamese
+một thời gian theo dõi và điều trị thì cái diễn tiến nó thay đổi và nó lại là một cái bệnh khác giống như là các bệnh,Vietnamese
+cơ thể làm cho người lúc nào cũng háo các tế bào niêm mạc nó cũng khô và chính cái cũng lại gây nên những cái vấn đề,Vietnamese
+phát sóng pin ở dưới da ở cái vùng ngực thì cái này thì cái gây mê toàn thân cái cái cái công,Vietnamese
+từ khi đó đến nay huyết áp của ông thì thường xuyên tôi cũng cho dùng thuốc,Vietnamese
+khảo sát thêm chức năng thận của người này như thế nào chức năng gan như thế,Vietnamese
+với một làn da thường và cái lớp lipid mà nằm giữa các lớp tế bào sừng đó nó cũng giảm hàm lượng ngoài ra thì có cái,Vietnamese
+đối với da nhạy cảm chúng ta lưu ý là chọn lựa những cái sản phẩm mà chứa những cái thành phần lành tính ví dụ như là,Vietnamese
+với sức khỏe của chúng ta để sớm phục hồi và đặc biệt là bên cạnh cái việc tuân thủ theo đơn của các bác sĩ là rất,Vietnamese
+được cái tình trạng của anh hiện tại đúng không ạ chứ ở đây thì chúng tôi cũng chỉ thăm khám qua những cái lời,Vietnamese
+hay là cái mùi ngửi nó làm cho mình không có cưỡng nổi vân vân thì những thứ đó nó sẽ làm cho cái người béo phì,Vietnamese
+giúp mà cải thiện được các biến chứng gia tăng chất lượng cuộc sống cũng như là về đường dài sau này của họ thì,Vietnamese
+thật sự nghĩ vậy phải dự phòng thật là sớm càng sớm càng tốt,Vietnamese
+hoa quả thức ăn chúng ta gặp rất là nhiều các bạn có thể mở google ra để thấy là những ở đâu mà chứa nhiều,Vietnamese
+mình tức là không tự mất đi khối cơ vốn đã ít ỏi của người bệnh sau ung thư rồi thì bây giờ chúng ta ăn đủ chất béo thì sẽ,Vietnamese
+protein quyết định loại phân tử nào có thể kết nối với nó giống như cách mà hai,Vietnamese
+thuộc đến nỗi gây ấn tượng sai lệch về những điều kỳ diệu đang diễn ra bên dưới da nơi các tế bào di chuyển đến để chống,Vietnamese
+dạ vâng và cái việc mà bác nói khó như này nó đã có lâu chưa ạ,Vietnamese
+mà tốt cho cả bệnh lý sơ cấp của bác nữa ạ vâng rất cảm ơn bác đã đặt câu hỏi về,Vietnamese
+ngoài cái thoái hóa cột sống ra còn chẩn đoán bệnh gì khác không ạ,Vietnamese
+bằng phương pháp mổ lấy thai hoặc nuôi bằng sữa công thức có thể có nhiều nguy cơ mắc nhiều bệnh khác nhau về sau cả,Vietnamese
+người bệnh cần phải làm gì mới an toàn và bệnh viện có những cái chính sách gì để mà giúp cho người dân có thể lấy,Vietnamese
+dùng cao đông trùng hạ thảo có thể viên nang đông trùng hạ thảo vân vân nhưng mà cái hay ở chỗ là gì là các công ty dược,Vietnamese
+cái hay của sản phẩm mà chúng tôi giới thiệu ngày hôm nay đó là không chỉ giúp giảm đau tức thời mà còn đem lại một cái,Vietnamese
+do một số các cái nguyên nhân khác nhau có những người là có cái trường hợp là bị loãng xương thì nó dẫn đến cái tình,Vietnamese
+nó cao thì lại tốt bác ạ tức là cái cholesterol có trọng lượng phân tử cao ấy thì nó lại tốt khi mà nó tăng cao ở,Vietnamese
+có tình trạng như vậy thì cái thuốc này nó hấp thu vào trong người mình nó rất,Vietnamese
+chúng ta tăng lên một cách rõ rệt và khi mà tuổi thọ tăng lên như vậy đó thì những cái bệnh mà,Vietnamese
+ta không nên sờ nắn bóp vào đấy đấy có một cái câu chuyện rất là nhiều người đấy là khi chúng ta đau ở đâu chúng ta hãy bóp vào đấy nhưng mà trong trường,Vietnamese
+tiêu hóa của bạn và trong khi chúng bao gồm nấm và virus có vẻ như các loại vi khuẩn trú ngụ bên trong bàn thống trị và,Vietnamese
+ta cũng tránh lo lắng quá và đến cơ sở y tế để tìm đến cái xét nghiệm này làm cho quá tải ở các cơ sở y tế ra còn trên địa,Vietnamese
+và khoáng chất trong đó có ba cái vitamin đấy cộng với lại có thể bổ sung thêm kẽm nữa thì sẽ tốt hơn cho bố nhà mình và hi,Vietnamese
+mốc cao hơn nghĩa làm mức nhiệt độ cao hơn tình trạng viêm và như tôi vừa đề,Vietnamese
+hiểu gì cái chuyện là gì là cái giá của quả thể nó cao gấp hai mươi đến hai mươi tư lần so với,Vietnamese
+phải điều chỉnh thêm nữa thì chúng ta cần phải tuân thủ những điểm đó thì chúng ta mới có thể giảm thiểu được các nguy cơ bị đột quỵ hoặc là bị nhồi máu cơ tim liên,Vietnamese
+ví dụ như là nếu chúng ta bị chấn thương thì sẽ dễ bị chảy máu chảy máu khó,Vietnamese
+dễ có những cái ảnh hưởng đến vừa là các cái khớp ở gót chân vừa là các cái dây chằng và gân ở gót chân chính vì vậy cho,Vietnamese
+một người bạn đời đường để chúng ta có thể là dự phòng và hỗ trợ điều trị những căn bệnh mà nó nguy hiểm đặc biệt là,Vietnamese
+câu hỏi để mà đánh giá cái người này có khả năng bị trầm cảm hay không nhưng mà mình lưu ý một số những cái,Vietnamese
+là hai loại tế bào bạch cầu được gọi là tế bào t và tế bào v những,Vietnamese
+pháp của y học cổ truyền trong đó có châm cứu có xoa bóp có thể là chúng ta,Vietnamese
+giữa cái vị của người bị ung thư chiều một tí nhưng mà cũng phải liên quan đến cái bệnh để người bản thân người bị ung thư,Vietnamese
+thể tử vong ngay lập tức hay hoặc ở não thì chúng ta có thể bị xuất huyết não có,Vietnamese
+ngừa bệnh dại và trường hợp nào cần sử,Vietnamese
+quá trình lão hóa lại đấy là cái rất cần thiết mà nhiều khi chúng ta không để ý,Vietnamese
+dụng cái chế độ ăn cháo và súp thì bao giờ nó cũng mềm lỏng hơn so với cơm giúp,Vietnamese
+trở nên quan trọng một vài ngày sau khi cơ thể đã bị viêm nhiễm nhiễm trùng được,Vietnamese
+khớp gối này bây giờ đi lại không có được này phải ngồi một chỗ này bảy mươi tuổi thì nó cũng là nhiều nhưng không phải là,Vietnamese
+đa vitamin và khoáng chất để chúng ta mỗi thứ một tí ví dụ như trong đó có một,Vietnamese
+lắm nôn nóng là cố gắng làm sao phải cho giảm cân nặng rất là nhanh tức là từ,Vietnamese
+chúng ta sẽ phải sử dụng thuốc và đến các giai đoạn mà xuất hiện các cái biến chứng thì vấn đề phẫu thuật,Vietnamese
+vi khuẩn đường ruột có lợi giúp trưởng thành niêm mạc ruột nhanh chóng hơn mặt khác trẻ sinh mổ thường thiếu loại vi,Vietnamese
+gọi là những cái bụi mịn từ ngoài môi trường xâm nhập vào trong da và cho chúng ta sẽ xảy ra những cái phản ứng,Vietnamese
+chẩn đoán muộn ở trung bình là năm năm đấy có nghĩa là gì năm năm đầu là cứ chạy hết,Vietnamese
+theo như bộ phận tiếp nhận của chúng tôi vừa mới chia sẻ thì có vẻ là anh bị thoái hóa đốt sống đúng không ạ vâng vậy,Vietnamese
+và táo bón cũng là một trong những cái tác dụng phụ mà do thuốc điều trị bệnh,Vietnamese
+và nếu như chúng ta không chịu đựng được quá trình điều trị trong điều trị ung thư thì cái cái khối u đó nó cứ tiếp tục,Vietnamese
+nó sẽ có giúp ích liền mà nó đòi hỏi sẽ có một cái khoảng thời gian để các bác sĩ chuyên khoa về thần kinh,Vietnamese
+nhấn mạnh với anh là có thể có nguy cơ tuy nhiên các nguy cơ này không xảy ra nếu,Vietnamese
+ràng và có khả năng mã hóa một protein thụ thể ở bề mặt tế bào miễn dịch bên,Vietnamese
+dụng một số các cái thuốc để hạn chế cái quá trình viêm của cái phổi và một trong những cái thuốc đó là corticoid thì nó,Vietnamese
+thế nào để hỗ trợ cho người bệnh một cách tốt nhất thưa tất cả quý vị còn bây giờ đây thì xin mời tất cả quý vị chúng,Vietnamese
+bệnh viện bảy ngày và cách ly ở nhà bảy ngày thì nay tôi khỏi rồi ạ dạ vâng ạ vâng ạ,Vietnamese
+với adenosine thì nó có một tác dụng là điều hòa cái nhịp tim cái này quan trọng lắm,Vietnamese
+thấy là ghi dưới hình thức là paraben nè hoặc là formaldehyde hoặc là chúng ta về sản phẩm sữa rửa mặt chúng ta không,Vietnamese
+mà tất cả những ai là bệnh nhân những ai là người tiêu dùng chúng ta phải rất là,Vietnamese
+thị trường hiện nay có rất nhiều các sản phẩm để mà chăm sóc tóc nhưng riêng về cái bộ đôi sản phẩm là viên uống và bộ,Vietnamese
+giúp cho chúng ta không những chỉ tiêu hóa tốt hơn không chỉ giúp cho chúng ta có sức đề kháng tốt hơn mà còn giúp cho,Vietnamese
+gián tiếp của chúng lên nhiều cơ quan và hệ thống nói đơn giản chúng chịu trách nhiệm về sức khỏe của bạn một số vi,Vietnamese
+vắcxin như một thủ thuật y khoa đã có từ lâu trước khi có bất kỳ kiến thức khoa học nào về cách thức hoạt động của quy,Vietnamese
+chúng ta là rất rất ít khi uống nước và bị uống thuốc nó chỉ là rất đơn giản thôi là nó giúp cơ thể chúng ta giúp cơ,Vietnamese
+phát hiện này là cha ông hình mẫu của ông vốn là một nhà khoa học lỗi lạc và là người luôn nhấn mạnh và những điều,Vietnamese
+k thì đối với các loại thuốc mà kháng đông mà không phải là vitamin k không,Vietnamese
+định người ta bị có rung nhĩ phân loại xem đó là đúng nghĩa cơn thôi hay là rung nhĩ thường xuyên rồi và tiếp theo,Vietnamese
+các dấu hiệu nhận biết khi người bệnh bị trầm cảm là gì ạ,Vietnamese
+thích não sâu thì trong khi giai đoạn đầu người bệnh sẽ được giảm thuốc mà cái,Vietnamese
+những trường hợp này nhiễm cúm a có nguy cơ rất nặng và những cái được hợp với chúng ta phải đi vào viện để mình khám,Vietnamese
+có sức khỏe tốt hơn lại vừa làm cho chúng ta giảm đi cái tác dụng của hóa trị xạ trị và ngăn ngừa cái ung thư tái phát,Vietnamese
+sẽ quay trở lại mà nhiều người họ cảm thấy là họ buồn bã họ chán nản rồi họ,Vietnamese
+tế bào ung thư cũng đã tốt rồi nhưng rõ ràng chúng ta rất cần phải nuôi dưỡng một cái cơ thể để làm sao nó phục hồi,Vietnamese
+thậm chí là cái tăng huyết áp nó cũng có thể là nguồn cơn gây ra cái rung nhĩ nữa và nó có liên quan nhiều nữa do,Vietnamese
+như vậy và làm ảnh hưởng đến sức khỏe của mình bác hoàn toàn có thể là yên tâm sử dụng sản phẩm này và thưa quý vị và,Vietnamese
+nữa thì nếu có các tình trạng này thì mình phải phối hợp chế độ ăn và phối hợp,Vietnamese
+rau từ khu vườn của gia đình những loại thịt cá địa phương sữa chua tự làm các,Vietnamese
+vấn đề bệnh da chính đó bệnh da nền đó thì da bệnh nhân cũng đã cải thiện các triệu chứng nhạy cảm rồi còn nếu nhưng mà bệnh,Vietnamese
+như là mất thăng bằng rồi yếu tay chân nói khó này kia thì cái khả năng đột quỵ nữa là cảm ơn những,Vietnamese
+cách phản ứng chống lại các phân tử không tự thân không phải từ cơ thể sau khi tiếp xúc với các phân tử xa lạ với,Vietnamese
+đang được chi cho những bệnh này và những căn bệnh nguy hiểm khác liên quan đến não tuy nhiên chúng ta đang chỉ thấy,Vietnamese
+thể dục nhẹ nhàng và bác nên đi đến các cơ sở y tế ở gần nhà cũng được để các,Vietnamese
+giáp thì cũng lại cần phải quan tâm hơn bởi vì là nếu chúng ta sử dụng đậu nành đối với ung thư tuyến giáp tất nhiên kể,Vietnamese
+cái lượng hormone đấy nó cũng không phải là cao cho nên là chúng ta cũng chú ý có thể loại bớt đi thế rồi đối với,Vietnamese
+rụng tóc và một số các hậu quả về trục trặc về tóc đó là chưa kể khi các chị em,Vietnamese
+mỏng nhẹ ví dụ như là chọn lựa những cái sản phẩm này gel gel lotion,Vietnamese
+hành của hai vị bác sĩ là những chuyên gia y tế giàu kinh nghiệm đại diện cho các chuyên khoa trong điều trị bệnh béo,Vietnamese
+cảm là thường là người bệnh sẽ đầu tiên tức là và các triệu chứng chủ quan rồi chúng ta cảm thấy là da chúng ta có,Vietnamese
+nói tỷ lệ tử vong của bệnh nhân được giảm nhưng mà vấn đề chỗ là cái tỷ lệ,Vietnamese
+đường uống thì về mặt kinh điển từ xưa đến giờ đó thì cái thuốc mà các,Vietnamese
+cần có những cái tham khảo như vậy và cái việc mà chúng ta điều trị theo đúng cái phác đồ theo đúng cái bệnh lý của,Vietnamese
+tính điều trị như thế thì đôi khi da chúng ta sẽ trở nên khô ngứa bong tróc và các quá trình khô ngứa bong tróc đó thì,Vietnamese
+sao ngày xưa các cụ làm cách nào để mà các cụ biết được rằng là những bộ phận đấy nó lại có những cái tính gọi là ưu,Vietnamese
+kích thích não sâu ví dụ lần những người bệnh có triệu chứng về nói khó những,Vietnamese
+nó gây ra thiếu máu não nếu nó không lại được ngay đây là tự cơ thể có cái,Vietnamese
+thì khi đã phát cơn dậy liệu có cách nào,Vietnamese
+chương trình ngày hôm nay và chương trình ngày hôm nay của chúng ta có chủ đề là cảnh báo nội tạng bị phá hủy vì,Vietnamese
+người bệnh sẽ được trở về giai đoạn hai giai đoạn một và như vậy nếu mà chúng ta,Vietnamese
+vi sinh đường ruột của bạn có liên quan mật thiết đến tình trạng viêm và việc liệu bạn có thể chống lại các gốc tự do,Vietnamese
+sử dụng đông trùng hạ thảo nó có thành phần selen thì nó là giảm cái chỉ số đó xuống đấy là cái vô cùng quan trọng thế còn,Vietnamese
+thở đau tức ngực tim đập nhanh là do mảng xơ vữa động mạch gây hẹp tắc lòng,Vietnamese
+chuyên khoa và phải có sự theo dõi vì thế là chúng ta không có nên tự ý sử dụng những cái nhóm thuốc này bên cạnh,Vietnamese
+trị nội khoa bên cạnh những cái mà điều trị về dinh dưỡng và tập luyện thể lực thì điều trị nội khoa gồm có hai cái,Vietnamese
+phòng mổ để mình gắn cố định vào trong đầu của mình thành một khối nguyên một khối đó sẽ di chuyển bệnh nhân xuống,Vietnamese
+này cái mức độ loãng xương nặng như thế nào để chúng ta có những cái biện pháp điều trị phối hợp vừa an toàn mà lại vừa,Vietnamese
+quyết này uống nước này chế biến thực phẩm làm sao cho nó mềm lỏng nó phù hợp để dễ ăn này thế còn đối với việc khô,Vietnamese
+bác ơi bác có thể vui lòng là bác đừng nghe tivi hoặc là bác đừng bác đừng xem tivi bác bác nói chuyện vào điện thoại,Vietnamese
+nhanh chóng và kết nối và sẽ chia sẻ giúp cho quý vị và các bạn chúng ta khắc phục được cái tình trạng bệnh lý đặc biệt là ở những cái bệnh lý người cao,Vietnamese
+thì có đầy đủ được cái dịch tiêu hóa thì chúng ta mới có thể có được một cái sự,Vietnamese
+thi thì mình phải tập trung giữ mình thôi mình coi những lời mà người ta nói giống như gió thoảng qua bay đi mình,Vietnamese
+cứng trầm cảm hoặc sa sút trí tuệ họ sẽ nói rằng không có phương pháp nào tồn,Vietnamese
+người thân cũng như là người chăm sóc và khi đến khi đó thì các phương pháp điều trị dùng thuốc vật lý trị liệu nó vẫn,Vietnamese
+nó ảnh hưởng rất lớn đến cái tim mạch của chúng ta nữa nên là chúng ta nên tiêm vì khi chúng ta tiêm nếu mà không,Vietnamese
+chúng ta liên tục bị đe dọa bởi các hóa chất và mầm bệnh chúng ta có một hệ thống phòng thủ tuyệt vời đó là khả năng,Vietnamese
+chúng ta sau sau vụ mất trộm chẳng hạn thì chúng ta đuổi trộm đi hết rồi thì,Vietnamese
+thành viên trong gia đình cũng làm được ba điều về phần mình thì tôi tin rằng là cái vấn đề nếu ung thư chúng ta chẩn,Vietnamese
+pháp liên quan đến tân dược các biện pháp mà liên quan đến sinh hoạt đi đứng vân vân thì cô cũng nên nên chương trình,Vietnamese
+thì chúng ta cũng nên thường xuyên là giữ vệ sinh ở cái khu vực mà mình sinh sống như là lau các bề mặt rồi là nhà,Vietnamese
+tuy nhiên thì có rất là nhiều người chúng ta nghĩ à nó cũng chỉ giống như là cảm cúm thôi có rất là nhiều thông tin thì cho rằng là nó rất là nguy hiểm,Vietnamese
+các đơn vị nhớ và làm cho bộ não người già của chúng ta mặc dù có thể là tám mươi,Vietnamese
+tử không ạ muốn nói gì thì nói thì chúng ta sinh ra lớn lên tuổi già đi và chúng,Vietnamese
+trọng của phòng thí nghiệm của ông để sàng lọc một lượng lớn các điều kiện thí nghiệm tìm cách làm cho độc tố bạch hầu,Vietnamese
+thực phẩm nếu như nó chỉ kéo dài một vài ngày chúng ta có thể bù đắp được nhưng nếu nó kéo dài hàng tháng như vậy chắc,Vietnamese
+với khi mà huyết áp cao thì chúng ta cũng biết là nó sẽ làm tổn thương các cái tế bào nội mạc của động mạch nên là,Vietnamese
+hồi phục nó chưa hồi phục thì đó là đột quỵ như vậy thì như vậy thì cái chuyện,Vietnamese
+các người đang sử dụng sản phẩm đó thì nếu những mà cái sản phẩm này mà chúng,Vietnamese
+một số vi khuẩn trong ruột thực sự có thể giải phóng các thông điệp hóa học giống như các tế bào thần kinh nói với,Vietnamese
+lâu đời nhưng luôn được coi là lĩnh vực khoa học hiện đại bởi tính phức tạp cũng như những kiến thức mới về miễn dịch,Vietnamese
+chúng ta luôn luôn định kỳ tái khám và sử dụng đầy đủ các,Vietnamese
+như bác sĩ chia sẻ là rất là tốt đối với những người mà gặp và sức khỏe về những cái bệnh lý như là huyết áp cao mỡ,Vietnamese
+là các triệu chứng như là đau đầu hoa mắt chóng mặt của bác này hay là những cái dấu hiệu tim đập hồi hộp trống,Vietnamese
+trọng với ba bước trong các quá trình dưỡng da thì ba bước đó như các bạn cũng biết đó là ba bước căn bản đó là,Vietnamese
+nguồn từ việc tình trạng viêm vượt khỏi tầm kiểm soát và hệ miễn dịch của bạn kiểm soát tình trạng viêm vậy hệ vi sinh,Vietnamese
+triển của cái xơ vữa động mạch vì khi mà xơ vữa động mạch nó đã phát triển nhiều rồi thì cái việc điều trị nó cũng sẽ rất khó khăn nên là mình sử dụng sớm đi thế,Vietnamese
+và những gì thường được mong đợi chúng có vẻ gần như kỳ diệu tôi chứng kiến,Vietnamese
+cái bệnh lý của mình đặc biệt là đối với những ai mà chúng ta đang gặp phải cái tình trạng bệnh lý về tim mạch nè bệnh huyết áp cao nè mỡ máu cao nè đây là,Vietnamese
+trầm cảm thì nó sẽ ảnh hưởng đến tình trạng béo,Vietnamese
+mong muốn thì chắc chắn nó vẫn xảy ra nhưng nếu dinh dưỡng hợp lý sẽ giúp cho chúng ta bớt đi được những cái tác,Vietnamese
+tình trạng thiểu năng vành ở động mạch cảnh động mạch đi lên nuôi não thì chúng ta thấy sẽ có các cái dấu hiệu như là,Vietnamese
+thứ nhất là tăng phối hợp cùng với tân dược làm tăng hiệu quả trong vấn đề làm,Vietnamese
+tượng vẫn một cái khối u thì nó nặng bao nhiêu ạ cũng có khối u lớn nhưng có khối u chỉ vài chục gam vài trăm gam trong khi,Vietnamese
+đề mà nuôi chó mèo tại nhà rất là nhiều,Vietnamese
+thì chúng ta phải đánh giá tổng quát như vậy đó nói như vậy thì tôi xin thưa với,Vietnamese
+mà đã cải thiện được cái triệu chứng cho người bệnh rồi thì cái triệu chứng nó giảm đi thì người bệnh có thể sinh hoạt độc lập và có thể làm việc lại bình,Vietnamese
+nghiêm chỉnh chỉ định của bác sĩ này thứ ba là chúng ta phải có một cái chuẩn bị cho mỗi cái lộ trình điều trị mỗi đợt,Vietnamese
+thấp hơn cũng như ít đa dạng hơn về sinh vật đường ruột tỷ lệ lưu hành bệnh alzheimer đã tăng vọt ở các quốc gia có,Vietnamese
+biết về tiêm chủng rõ ràng là quan trọng không khác gì việc cung cấp nước an toàn thậm chí không cần kháng sinh đã từng,Vietnamese
+với những phương pháp đó cho nên là cái hướng mà tiếp cận khác nhau do những mà,Vietnamese
+mạch này dẫn máu đến nuôi trái tim đó thì nó có thể làm hẹp làm tắt cái động mạch vành tim mà khi mà hẹp tắc,Vietnamese
+như xã hội khác,Vietnamese
+trong chương tiếp theo nhưng bây giờ hãy hiểu rằng tất cả các loại bệnh đều bắt,Vietnamese
+việc của năng lượng một bát cơm sẽ nhiều hơn bát cháo vậy thì chúng ta sẽ làm tăng đậm độ năng lượng của bát cháo này,Vietnamese
+da chúng ta là mất màu trắng hoàn toàn luôn ra từ nâu hoặc là màu vàng chuyển sang màu trắng luôn ngoài ra còn có thể,Vietnamese
+chúng ta không nên chọn những loại kem mà nó có cái chất dày đặc quá thì,Vietnamese
+hệ vi sinh vật não bộ mặc dù có nhiều yếu tố ảnh hưởng đến sức khỏe hệ vi sinh của chúng ta và do đó là sức khỏe của,Vietnamese
+tiên mà phẫu thuật kích thích não sau được xem là có hiệu quả nhất đó là triệu chứng run kích thích não sâu nó sẽ cải,Vietnamese
+một vòng lặp đơn giản liên quan đến một vài loại tế bào miễn dịch mà là một mạng lưới đa tầng luôn chuyển dịch của các hệ,Vietnamese
+là những quý vị khán giả có thể theo dõi được chương trình hôm nay thì có thể được lan tỏa những cái tinh thần vô cùng,Vietnamese
+ta quan tâm bậc nhất thế thì đông trùng hạ thảo tại sao nó lại quý giá điều đầu,Vietnamese
+những cái những cái việc mà mình phải phòng tránh nó là mình tráng những cái những cái,Vietnamese
+tác động một cách liên tục nó không được thay đổi không được tăng giảm cái thứ hai cơ gân của chúng ta nó bị căng mà,Vietnamese
+trạng đau nhức xương khớp lại không thuyên giảm vâng và đặc biệt trong ngày hôm nay thì khách hàng có câu hỏi hay,Vietnamese
+và để giúp cho tất cả chúng ta có thể hiểu rõ hơn về những lưu ý cho người bệnh khi áp dụng các phương pháp điều,Vietnamese
+việc là cái pin sạc rồi những cái tuổi thọ của nó sẽ cao hơn nhưng tránh được cái mỗi cái thay pin lại lần hai chẳng hạn như vậy còn nếu nó kỳ vọng,Vietnamese
+hiện nay thì sẽ hỗ trợ cho việc mà khỏi bệnh được nhanh nhất và vấn đề thứ ba đó,Vietnamese
+thế cho nên là sản phẩm nào có đông trùng hạ thảo cũng tốt nhưng mà vấn đề,Vietnamese
+cùng các bài thuốc là độc hoạt tăng ký sinh giúp cho giảm đau an toàn hiệu quả mà nó rất an toàn trên đường tiêu hóa,Vietnamese
+với bác một điều như thế này chúng ta khi các cụ nói là sinh lão bệnh,Vietnamese
+nam mình thì hiện tại là ở những đâu thì mình phải tìm hiểu ví dụ như hiện tại việt nam mình sẽ có nhiều trung tâm có,Vietnamese
+như là các nhà khoa học đó không phải,Vietnamese
+trước đến nay thì chúng ta đã trải qua đến hơn năm đợt dịch cúm trên toàn,Vietnamese
+tình trạng bệnh lý hiện nay của bác đầu tiên là chúng ta nói về cái đái tháo,Vietnamese
+độc lập tuy nhiên không thể phủ nhận những khám phá này xứng đáng với sự ca ngợi cao nhất khoảnh khắc bước ngoặt này,Vietnamese
+phì như vậy khi mà mình điều trị tốt cái tình trạng lo âu điều trị tốt cái tình,Vietnamese
+kem dưỡng sử dụng nó nhiều quá nên thành ra là sẽ tạo ra như một lớp màng làm,Vietnamese
+là phải gọi là bứt phá về mặt thời gian để chúng ta có một cái chẩn đoán chính xác cuối cùng sau đó thì chúng ta sẽ có,Vietnamese
+chất xơ thực vật dùng làm nhiên liệu cho vi khuẩn đường ruột dẫn đến ít loại vi khuẩn và các sản phẩm phụ có lợi mà vi,Vietnamese
+được cho những cái thiết bị cấy ghép vào cơ thể họ chỉ thanh toán theo cái khung,Vietnamese
+bệnh nhân bỏ dở cái quá trình hóa trị ví dụ như phải chịu đến năm sáu đợt hóa trị nhưng,Vietnamese
+cũng phải giữ khoảng cách và đặc biệt là giữ khoảng cách đối với cái người mà đang được thực hiện lấy mẫu và không,Vietnamese
+đấy chính là những cái hàng rào để giúp chúng ta ngăn chặn lại những cái tác động của cái việc mà thời tiết nó thay,Vietnamese
+mà loại da của mình là da nhạy cảm là dễ bị nhạy cảm thì từ các câu hỏi này chương trình nhận ra là cái khái niệm,Vietnamese
+cách nào trước khi mà chúng ta đi vào cái cái cái cái cái vấn đề này khi nhiều nhà chia sẻ về cái cái cái clip cúm a,Vietnamese
+chứng và cái thứ ba là dự phòng tốt các cái tình trạng biến chứng của nó đấy là cái điều mà mà rất là quan trọng cho nên,Vietnamese
+hơn nhưng mà chúng ta vẫn phải theo dõi tùy theo cái mức độ về đặc tính của cơ thể mình ví dụ như mình đang có cái vấn đề,Vietnamese
+trị viêm xương khớp vâng và chúng tôi cũng xin được thông tin thêm tới quý vị và với cái thành phần là kga1 kết hợp,Vietnamese
+trở thành dạng nước là cái thứ hai nữa là chúng ta có thể sử dụng một số chất hóa lỏng ví dụ như chúng ta có thể,Vietnamese
+giàu kẽm này giàu vitamin a vitamin c và vitamin e thì đó là những cái điểm rồi là,Vietnamese
+hiện các dấu hiệu nhận biết của mầm bệnh hay không tất cả những gì họ cần chỉ là,Vietnamese
+từ từ rồi lưa thưa cấp tính rụng tóc từng vùng nghĩa là một cái vùng nó trụi,Vietnamese
+một cái chiều hướng tiêu cực và câu hỏi tiếp theo có nội dung là người bệnh béo,Vietnamese
+nó cũng có thể cải thiện với phương pháp phẫu thuật kích thích não sâu cái thứ hai,Vietnamese
+động mạch thì mình vẫn hoàn toàn có thể sử dụng sớm để ngăn ngừa cái tình trạng xơ vữa động mạch nó có thể xuất hiện rất,Vietnamese
+cần thiết để có thể bổ sung đúng đất dinh dưỡng cho mình thì có một cái quan niệm mà vô cùng sai lầm về ăn chay và thực dưỡng,Vietnamese
+cũng làm cho cái những cái tổn thương ở trên niêm mạc miệng của chúng ta cũng lâu lành hơn và chúng ta sẽ chú ý đặc,Vietnamese
+ta bao nhiêu và cholesterol chúng ta bao nhiêu chị đó chúng ta phải bắt buộc phải nhớ chứ không thể nào mà chúng ta,Vietnamese
+và ít có khả năng thích ứng cụ thể ở đây đó là chúng ta có thể chọn lượng ở đây là một cái thành phần và như tôi,Vietnamese
+gánh đàn ông nghĩa là có cái trách nhiệm cái trọng trách của người đàn ông đối với phụ nữ của mình trong giai đoạn này vì ta nói cái giai đoạn này mà được yêu,Vietnamese
+những cơ thể nữa thành ra cái việc dùng thuốc này rất là khó khăn và thực tế là,Vietnamese
+đấy ạ vâng rồi một số các sản phẩm khác ở trên thị trường ví dụ như là chúng ta có,Vietnamese
+thiết cho sự tồn tại của mình trong phần một chúng ta sẽ khám phá hệ vi sinh vật,Vietnamese
+liệu trình điều trị của mình bởi vì khi khi điều trị chẳng hạn thì người ta thường tính đến cái cân nặng để mà tính kỹ liều thế,Vietnamese
+mắt nó tiêu cực về chính cái ngoại hình của mình và họ cảm thấy là luôn luôn bị thua kém những người khác và họ bị thiệt,Vietnamese
+việc duy trì sức khỏe do đó là những cái bài tập nói chung là nó nhẹ nhàng và nó kéo dài thì sẽ tốt hơn là,Vietnamese
+họ dùng một số những cái thuốc nghe người này mách người kia bảo thì họ sẽ dùng,Vietnamese
+qua chủ đề của chúng ta tối ngày hôm nay thì nó sẽ là một cái lĩnh vực nó đang,Vietnamese
+khuẩn đường ruột của chúng ta tạo ra giúp kiểm soát tình trạng viêm cũng như đáp ứng có hệ miễn dịch hai yếu tố quan,Vietnamese
+nó chậm cho nên là các cụ vẫn nói là thuốc đông y thì nó ngấm chậm mà cho nên là chúng ta dùng được chúng ta phải kiên,Vietnamese
+chúng ta đã thoa dưỡng ẩm rồi thì chúng ta nên nhớ là phải thoa thêm một lớp kem chống nắng để bảo vệ da dưới tác hại của,Vietnamese
+phẫu thuật giảm cân thì có những cái vấn đề liên quan tới sức khỏe về mặt,Vietnamese
+xin được cảm ơn bác sĩ rất là nhiều và ngày hôm nay thì chúng tôi vẫn đang liên tục nhận được những cuộc gọi của quý vị,Vietnamese
+là đột quỵ hay không thì những cái triệu chứng đó hết nó ít ít là đột quỵ và,Vietnamese
+hợp thứ nhất vấn đề thứ nhất mà chúng tôi muốn chia sẻ trường hợp thứ hai chúng ta muốn chia sẻ ở đây là gì ạ khi mà chúng ta bị ngã như vậy thì cái quá,Vietnamese
+cáo hội thảo về công việc của mình bằng thứ tiếng anh bồi với sự tham dự của chủ tịch hiệp hội miễn dịch học mỹ lúc đó,Vietnamese
+vitamin và khoáng chất cho cơ thể chúng ta thì chúng ta không thể nào mà có sức để mà chúng ta duy trì cuộc sống của,Vietnamese
+ta đôi khi lại không có đạt được hiệu quả dưỡng sáng mà da chúng ta sẽ lại sạm chỗ đi nếu chúng ta không chống nắng tốt một,Vietnamese
+nó cũng là tâm tư của rất r��t nhiều những người có tuổi và những người cao tuổi mà khi chúng ta bị các bệnh lý,Vietnamese
+như vậy thì khi một khi mà đã uống thuốc đặc biệt uống thuốc kháng đông rồi thì,Vietnamese
+giả đã hỏi về cái chuyện là đông trùng hạ thảo đối với vấn đề đái tháo đường thì ở đây thì bác sĩ nói rất là nhiều,Vietnamese
+khuẩn này và các sinh vật khác sống trong chúng ta tầm quan trọng của hệ vi sinh đã thúc,Vietnamese
+kháng insulin chính vì vậy và những cái bệnh nhân này sẽ có nguy cơ phát triển về những cái bệnh lý đái tháo đường,Vietnamese
+vấn đề sức khỏe khó khăn nhất của chúng ta mặc dù dự án đang nghiên cứu một số bộ phận của cơ thể chứa vi khuẩn bao gồm,Vietnamese
+cầu người bệnh đi theo đó là cần phải làm những cái điều gì và có nhất thiết là phải đi thăm khám lúc mẹ không có,Vietnamese
+thay đổi sự phân bổ vi khuẩn trong ruột hệ miễn dịch là nguyên nhân khiến một bệnh nhân ghép tạng từ chối thứ được cho,Vietnamese
+các cái tế bào nội mạc của động mạch và từ những cái tổn thương đó thì nó sẽ dẫn đến hàng loạt như các cái phản ứng và,Vietnamese
+ta sẽ cùng bắt đầu chương trình ngày hôm nay à còn một thông tin nữa chương trình của chúng ta được diễn ra với hình thức là tương,Vietnamese
+như tình trạng dinh dưỡng của bệnh nhân không tốt thì rất khó có thể giúp cho bệnh nhân có thể chịu đựng được hết cái,Vietnamese
+bù đắp cho một ca sinh mổ bạn có thể làm rất nhiều điều để hỗ trợ hệ vi sinh đang,Vietnamese
+thăm khám và làm xem là những cái tình trạng về tim của mình nó có vấn đề gì không ạ tình trạng xơ vữa chưa đi và,Vietnamese
+rung nhĩ này sẽ thúc đẩy cái tình trạng suy tim đó trở nên rõ hơn hoặc là suy,Vietnamese
+thì có cần phải dùng kem chống nắng hay không nhưng mà rõ ràng chúng ta làm việc trong văn phòng nè chúng ta ngồi trước à,Vietnamese
+tìm thấy trong âm đạo của người mẹ một nghiên cứu đặc biệt hấp dẫn được thực hiện bởi một nhóm các nhà nghiên cứu vào,Vietnamese
+chân nâng tay ví dụ như vậy hoặc nếu mà bác có thể ngồi dậy được thì bác cũng có thể tập ở cái tư thế thế ngồi nhưng mà,Vietnamese
+đau thì chính vì vậy cho nên là với cơ địa của những cái người hàn những cái người mà lạnh chẳng hạn hoặc là cái khí,Vietnamese
+nhức đầu nè hoa mắt chóng mặt mất ngủ tê bì chân tay bất luận vì nguyên nhân gì họ cũng đã vội vàng nghe theo lời quảng,Vietnamese
+cái bệnh lý thoái hóa khớp và cái thoái hóa khớp này nó cũng có thể liên quan đến công việc hàng ngày này tư thế vận,Vietnamese
+tinh thần trong suốt quá trình điều trị và hướng đến một cuộc sống khỏe mạnh với chất lượng cao hơn thưa tất cả quý vị việc,Vietnamese
+fortamine và hoặc là melatonin cái thứ ba là chúng ta sẽ tác động ngay vào trong cái quy trình sản sinh melanin của tại,Vietnamese
+nguyên nhân đó nó sẽ làm giảm thiểu còn khi mà đã có cái đánh giá đúng cái nguy cơ và có cái chỉ định dùng thuốc thì lúc,Vietnamese
+cao gấp đôi so với những cái chủng khác và đặc biệt cái đáng lo đó là cái độc,Vietnamese
+hba1c xuống đó thế cho nên là rất mong rất mong là bác tìm đến cái đông trùng,Vietnamese
+họ cảm thấy là ủa hình như là mình bị thất bại vậy thì cái việc mà tự ti đó họ,Vietnamese
+có thể kết hợp được để giúp cho tăng cường cái cái hiệu quả và tác dụng lên thế nên là các quý vị hoàn toàn có thể,Vietnamese
+cực mà thôi thứ nhất là họ sẽ càng thấy là tự ti hơn khi bị kỳ thị là nó,Vietnamese
+cùng ủng hộ cùng đồng hành với họ trên hành trình đầy cam go để chống lại những ảnh hưởng tiêu cực của bệnh béo phì và,Vietnamese
+động thích hợp có thể dễ dàng dẫn đến tử vong đồng thời điều quan trọng là phải,Vietnamese
+yếu đã dùng là thuốc thì thuốc để và điều trị mà phù hợp nhất cho cái cái,Vietnamese
+khả năng tiếp nhận của thức ăn của bệnh nhân rất là khó khăn vấn đề thứ hai nữa đối với hóa trị và xạ trị thì có thể làm,Vietnamese
+thường gặp khá là phổ biến thì như thế này cái người bị rung nhĩ,Vietnamese
+ngành y tế của chúng tôi rằng là em muốn về thăm mẹ em muốn về thăm ba em muốn này kia thì như vậy thì em sẽ đi làm sao,Vietnamese
+điện cực rồi hai bên rồi thì bệnh nhân sẽ được gỡ khung và khi đó bệnh nhân sẽ chuyển qua gây mê toàn thân tức là đặt,Vietnamese
+khác về cái câu chuyện mà chúng ta biết rằng là những người cao tuổi thì cái cái biểu hiện đau nhức xương khớp nó rất là,Vietnamese
+tim nhịp tim đấy là cái điều cực kỳ quan trọng ngoài ra nữa là đông trùng hạ thảo còn,Vietnamese
+ra tất cả phỏng đoán với các đề xuất được trình bày trong cuốn sách này tôi đã thấy những thay đổi đáng kể về sức,Vietnamese
+bệnh sẽ có một cái bộ điều khiển riêng của người bệnh và bác sĩ sẽ giúp cho người bệnh cũng như người nhà người bệnh,Vietnamese
+thương nhưng đối tượng chỉ được đưa ra trong một vài trang trong sách giáo khoa bao gồm cả cuốn sách bán chạy nhất được,Vietnamese
+cơ thể với vết cắt hay nhiễm trùng các triệu chứng đỏ nhạy cảm và viêm quen,Vietnamese
+dấu hiệu nhận biết rõ rệt trong thời điểm mà bệnh mới tiến triển người bệnh chỉ tìm tới phương pháp điều trị khi mà,Vietnamese
+có cái phương pháp nào điều trị được xem như là chữa lành bệnh do đó thì cái việc,Vietnamese
+tế lâm sàng thì vẫn chưa có được ứng dụng cho người bệnh parkinson mà chỉ ứng dụng cho một số bệnh lý khác mà thôi do,Vietnamese
+thưa là cái nấm hầu thủ đã được các nhà khoa học ở nhật bản ở trung quốc người ta nghiên cứu là nó cực kỳ tốt cho vấn,Vietnamese
+ta với lời kêu gọi tha thiết hãy cùng lắng nghe hãy thấu hiểu và đồng cảm với người bệnh béo phì và hơn thế nữa là hãy,Vietnamese
+ta sử dụng bỏ cái dùng liều cao thì chúng ta sẽ dễ xảy ra những cái tác dụng,Vietnamese
+thức để chúng ta lựa chọn những sản phẩm mà có đông trùng hạ thảo bởi vì hiện nay để mà đáp ứng cái nhu cầu nâng cao,Vietnamese
+phải mang nịt rồi phải đi châm cứu rồi cho uống thuốc kết hợp đông tây luôn,Vietnamese
+ừ thì chúng ta biết rằng f1 là người mà,Vietnamese
+không bình thường thì đó là những cái dấu hiệu chủ quan còn có những ví dụ khách quan ví dụ là những cái bạn có,Vietnamese
+gắng là phải tuân thủ đầy đủ các cái điều trị đó không nên bỏ dở tôi biết là nhất là những bệnh ung thư trong điều,Vietnamese
+thì ta có gây thuốc tê nhưng mà cũng sẽ hơi khó chịu và khi chụp ct thành một cái khối như vậy có thể mri hoặc ct,Vietnamese
+chúng ta phải biết cách làm sao làm chậm quá trình lão hóa thế thì ngoài cái việc chúng ta đi khám chúng ta chụp chiếu chúng,Vietnamese
+những người già trên sáu lăm tuổi hay những người bệnh nền những người bệnh nền bao gồm những người có,Vietnamese
+thì chúng ta phải giải quyết những yếu tố nguy cơ đó để chúng ta đừng bị rung nhĩ và một khi mà đã bị rung nhĩ rồi đó,Vietnamese
+phẩm mà nó tác động vào cái mảng xơ vữa nên là nó cần phải có thời gian nên là bác nên sử dụng kéo dài từ ba đến sáu tháng,Vietnamese
+nhưng mà tối ngủ dậy thì sáng sau bạn vẫn thấy da đổ dầu rất là nhiều thì bác sĩ sẽ xin phép được trả lời câu hỏi đầu tiên,Vietnamese
+những cái thực phẩm khác mà cung cấp với chất đạm mà không phải là từ thịt đỏ thì mình hoàn toàn cũng có thể được vấn đề,Vietnamese
+sử dụng cái bộ điều khiển của mình để mà có thể thay đổi cũng có thể theo dõi được hoạt,Vietnamese
+dẫn và hỗ trợ hệ miễn dịch bằng cách điều khiển một số tế bào miễn dịch nhất định và ngăn chặn sự tự miễn một trạng,Vietnamese
+xét vấn đề các điều trị như vậy đến giai đoạn bốn người bệnh sẽ trở nặng hơn thì còn phải trợ giúp của người thân,Vietnamese
+các nghiên cứu mới đầy bất ngờ cho thấy mối quan hệ giữa môi trường sống ngày càng vô trùng và tỷ lệ mắc mới của các,Vietnamese
+kinh phí tiền bạc trong gia đình hỗ trợ cho,Vietnamese
+người có tuổi và người cao tuổi như bệnh lý về thần kinh bị bệnh lý về tim mạch về nội tiết vân vân và vân đó là điều,Vietnamese
+cả những loại chỉ tồn tại thời gian ngắn cũng có tác dụng quan trọng vi khuẩn nhất thời di chuyển qua đường tiêu hóa,Vietnamese
+nếu mà mình không để thì nó lại đi ngược với lại cái mục tiêu của cái việc mà,Vietnamese
+cái điều trị không chính thống bởi vì là bên cạnh cái việc điều trị như vậy nó có tiềm ẩn rất là nhiều những cái nguy hiểm và thiếu bằng chứng khoa học xin được,Vietnamese
+bản và rất là quan trọng và cái thứ hai nó cũng giống như một số các bệnh nhân lúc nãy chúng tôi tư vấn là gì ạ chúng,Vietnamese
+thực phẩm lên men thực phẩm ít carbohydrate thực phẩm không chứa gluten và chất béo,Vietnamese
+chia nhỏ ra để chúng ta làm ẩm cái niêm mạc miệng thì chúng ta đỡ bị khô miệng thế rồi muốn tránh cái khô miệng thì,Vietnamese
+vâng thế bây giờ mà bác muốn hỏi cái điều gì nhất ạ,Vietnamese
+dơi tuy nhiên đa số là chó và mèo,Vietnamese
+người bệnh thì chậm thấy lúc nào chậm gây ra tình trạng thiếu máu não chưa chậm có thể thúc đẩy tình trạng suy tim,Vietnamese
+nhưng mà cái bất lợi đối với người bệnh thì cho tới hiện tại thì cái bảo hiểm y tế người ta vẫn chưa thanh toán,Vietnamese
+cái gì cho nên là ở một mức độ nào đó phải đến một cái cỡ nào đó cái lợi nó nhiều hơn rất là nhiều thì người ta mới,Vietnamese
+lên mà thôi cho nên lời khuyên đầu tiên là đối với với quý vị khán giả này ý cũng như là những cái quý vị khán giả mà,Vietnamese
+hiện tại như thế nào và mình đã có những cái tác dụng phụ gì đáng kể đó là hình tự hiểu và cái người quyết định,Vietnamese
+bệnh lý của tiền đình thì nó có triệu chứng choáng váng hoặc là chóng mặt,Vietnamese
+khuẩn đường ruột ở những người đến từ các quốc gia này và thứ hai họ xem xét tỷ lệ mắc bệnh alzheimer những gì họ tìm,Vietnamese
+sao chúng ta ngoài cái việc mà để thu xếp cuộc sống ổn định của mình vốn đã khó lại còn đủ cái chi phí để điều trị,Vietnamese
+thòi và họ luôn luôn là so sánh với lại những cái mẫu hình khác ở mỗi ngày hôm mở tivi,Vietnamese
+giúp quý vị chiến thắng ung thư và vấn đề là chúng ta phải thay đổi chế độ ăn ấy không chỉ có gạo lứt không chỉ có muối,Vietnamese
+người ta không chỉ sử dụng đông trùng hạ thảo riêng mà người ta còn tìm những cái,Vietnamese
+nghiên cứu đã cho thấy rằng là phẫu thuật kích thích não sâu có thể giúp cho người bệnh hiệu quả kéo dài lên đến,Vietnamese
+những cái lời khuyên về các cái bệnh lý cụ thể của người bệnh thì chúng tôi cũng rất là mong muốn có những cái lời khuyên,Vietnamese
+trường hợp đầu tiên đó là đối với những bạn mà có cái tiếp da là dầu nhờn đổ dầu rất là nhiều thì đôi khi đó là cái lượng,Vietnamese
+có những cái biến chứng của cái việc sử dụng chống viêm corticoid rồi đó là chảy máu dạ dày đó là viêm loét dạ dày,Vietnamese
+ta ăn ngon ngủ ngon tốt hơn ngon hơn ngủ tốt hơn và đồng thời nó cũng cùng với,Vietnamese
+thì người ta mới thấy rằng là phần quả thể chính là phần tinh túy nhất của đông,Vietnamese
+điều trị hiện ta cũng vẫn phải khám để hỏi ý kiến bác sĩ xem chúng ta không được tự ý ngưng thuốc đôi khi có một số,Vietnamese
+trong việc giảm các nguy cơ các cái xơ vữa động mạch thứ hai nữa là nó giúp cho máu lên não lên tim tốt và từ đó thì,Vietnamese
+cái lượng chất béo nhiều nhất quý vị thấy hơi khó ăn những điều quan trọng là chúng ta chọn trộn làm sao để cho cái,Vietnamese
+rất là là sức khỏe của tôi bây giờ lại ổn định,Vietnamese
+mà xung quanh tức là tóm lại là chúng ta phải giữ thực hiện 5k tốt để tránh là dễ,Vietnamese
+có trộm chưa bao giờ thức giấc xem trộm đó vào chưa thì điều ý cũng là cần thiết nhưng điều ấy là là chưa đủ nếu như,Vietnamese
+cần thấy các chất dinh dưỡng để nó sinh ra tế bào đó thì mình phải cung cho nó thế bây giờ mình lại cứ nhịn ăn thì nó sẽ lấy tất cả,Vietnamese
+dụng là gia tăng sự phục hồi của tế bào thần kinh và có thể là cải thiện được cái tình trạng thiếu máu cục bộ nè bệnh,Vietnamese
+nên là cái cái chuyện mà tai biến mạch máu não là một trong những cái bệnh lý rất là quan trọng cũng như là các cái,Vietnamese
+hôm nay rét hai cái gót của tôi nó đau đi lại nó khó chứ tôi hỏi xem có cái,Vietnamese
+lối sống cũng như thay đổi những cái hành vi ăn uống cũng như là vận động để giúp cho cái việc mà tuân thủ trị liệu,Vietnamese
+được hiển thị phía dưới màn hình ạ bây giờ chúng ta sẽ cùng kết nối với một,Vietnamese
+rằng là sau mười năm bắt đầu cái bệnh parkinson nó đã xuất hiện nhiều các cái tách biến chứng cũng như là các triệu,Vietnamese
+bình thường thì người ta có thể đổi thuốc khác người ta có thể tăng liều người ta có thể kết hợp các cái thuốc tân,Vietnamese
+sau mười năm tuy nhiên thời gian tốt nhất do phẫu thuật vẫn là khoảng năm đến mười năm,Vietnamese
+hiểu thông qua phần hai của chương trình điều trị kích thích não sâu ở người bệnh parkinson,Vietnamese
+giúp cho gìn giữ được cái khối cơ ấy nó săn chắc hơn nó tốt hơn nó không bị mất đi thế vào vấn đề cái nhóm thứ ba nữa đó,Vietnamese
+mỡ động vật này những cái đạm thịt đỏ tuy nhiên thì chúng ta vẫn phải tăng cường cung cấp năng lượng này cũng như,Vietnamese
+dưỡng cho bệnh nhân ung thư hi vọng rằng là qua những tư vấn vô cùng chi tiết của chuyên gia thì quý vị và các bạn cũng,Vietnamese
+nên nó có thể giết cả các cái tế bào lành và chính vì vậy làm cho các chức năng của cơ quan bị tổn thương và đặc,Vietnamese
+sau đó phải đối mặt với những trường hợp không mong muốn cần phải sinh mổ cô ấy không bao giờ nên cảm thấy tội lỗi hoặc,Vietnamese
+những năm vừa qua các nhà khoa học đã miệt mài nghiên cứu dẫn đến những tiến bộ lớn trong khám phá về hệ miễn dịch từ,Vietnamese
+những cái cholesterol có trọng lượng phân tử thấp là cái loại máu xấu đấy nó ra khỏi nó không bám vào cái thành mạch,Vietnamese
+và theo dõi một thế giới bí ẩn của thứ mà ông gọi là vi động vật ngày nay ông,Vietnamese
+là bổ nhưng uống xong rồi thì cùng là bệnh nó nặng lên thế thì nó chỉ làm gì thế cho nên những cái tâm tư của bác thì,Vietnamese
+những cái chất đó nó sẽ dễ gây với nguy cơ là kích ứng và dị ứng trên làn da của chúng ta cái thứ hai đó là để làm sao mà chọn lựa,Vietnamese
+nơron đó nối nơron kia qua các sinapse đã bị suy giảm ví dụ acetylcholine chẳng hạn thế,Vietnamese
+hơn nữa nếu mà không có cắt đứt cái cái cái cái cái tình trạng stress này cái,Vietnamese
+cáo tự ý tìm mua các sản phẩm thuốc đau giảm đau thông thường hay là những cái thực phẩm chức năng để có thể là cải,Vietnamese
+chúng ta cũng gây ra những cái tình trạng sạm nám khi đó chúng ta vẫn không phải bảo vệ da trước những cái tia uv,Vietnamese
+nghi ngờ đột quỵ thì ta không làm những biện pháp thừa những cái biện pháp như tôi vừa trình bày đó thì những cái biện,Vietnamese
+thiện chức năng tuần hoàn của não với niềm tin là uống thì sẽ khỏi bệnh ngay vâng và có rất nhiều những nguyên nhân,Vietnamese
+lợi hơn trong cái việc mà trị liệu và đồng thời khi mà họ được tiếp cận tới,Vietnamese
+hiểm là cực kỳ nguy hiểm nhưng mà bên cạnh cái việc mà chúng ta tuân thủ những,Vietnamese
+việc mà các bác sĩ mà thăm khám trực tiếp chính là cái người người ta sẽ có cái câu trả lời một cách xác đáng nhất và bác rất là,Vietnamese
+khoa học ứng dụng chỉ có những ứng dụng của khoa học thật vậy có rất,Vietnamese
+xưa cái đôi tay của mình và cái vai của mình nó đau đớn thế nào thì bây giờ nó không,Vietnamese
+thuốc thậm chí là đi khám rất đầy đủ tuy nhiên khi mà qua cái những cái giai đoạn đấy rồi thì người ta lại không còn đi,Vietnamese
+ta cũng nên hạn chế những loại mà liên quan đến họ cải vì vì nó cũng có thể làm,Vietnamese
+và sắp xếp mã di truyền một lĩnh vực nghiên cứu mới tại thời điểm đó điều quan trọng là ông trình bày một báo,Vietnamese
+rồi trong các quá trình đó có thể là chúng ta có nguy cơ tôi cũng xin,Vietnamese
+không ngẫu nhiên được tạo ra và sau đó được chọn thay vào đó chúng có hình dạng,Vietnamese
+nhưng mà cái khó khăn là cái cái thuốc này không phải là tôi uống đúng liều,Vietnamese
+ung thư trong hỗ trợ trong cái bổ sung dinh dưỡng cho bệnh nhân ung thư cũng là khá đắt cũng là giá thành không nói đắt,Vietnamese
+cuốn sách này sẽ chỉ ra nhiều khám phá được tạo ra từ cuộc phiêu lưu này dẫn,Vietnamese
+là một cái bệnh lý là xơ vữa động mạch vành vâng chúng ta biết là rồi thiếu máu cơ tim vâng thế và bác cũng đang điều,Vietnamese
+nhĩ thì cái việc mà điều trị dứt điểm đó thì tôi nghĩ là rất là khó rất khó và,Vietnamese
+ăn đối bệnh nhân ung thư thì chúng tôi khuyên bớt dầu đấy là bớt cái dầu chiên rán chứ còn chúng ta nên tăng cái chất,Vietnamese
+đặc biệt là họ có một cái thái độ né tránh né tránh họ không dám tiếp cận với,Vietnamese
+lớn thì cây độ ph nó càng tăng ph là kiềm tính nó càng tăng theo tuổi tác và,Vietnamese
+dụ đối với cái lúc mà những loại thuốc nào mà chúng ta tập thành thói quen đó là sau khi ăn buổi chiều thì chúng ta,Vietnamese
+đấy đúng và chỉ định chính cho việc phòng ngừa huyết khối mà liên quan đến,Vietnamese
+nhưng mà nếu chúng ta tính về cái chi phí hiệu quả và kể thuận lợi cho cái việc theo dõi chăm sóc người bệnh thì,Vietnamese
+thưa quý vị và đây là câu hỏi gửi về cho chương trình với nội dung ngoài những bất lợi về sức khỏe người bệnh béo phì,Vietnamese
+trị dài chính vì vậy cho nên cái việc mà nó an toàn như thế này lại hết sức là quan trọng cảm ơn bác sĩ vâng,Vietnamese
+bằng phương pháp kích thích não sâu do đó thì sau khi phẫu thuật chúng ta cũng,Vietnamese
+chúng ta bắt đầu phát triển và mặc dù mọi người có thể không muốn hình dung điều này nhưng ngay cả vật liệu phân của,Vietnamese
+thuật cũng như về các vấn đề về điều trị gen điều trị tế bào gốc vân vân nhằm để tìm ra,Vietnamese
+các khía cạnh trong cuộc sống mà bạn có thể không bao giờ đoán được có ảnh hưởng đến sức khỏe của não bộ mình tôi sẽ thảo,Vietnamese
+vấn dinh dưỡng về tập luyện thể lực về nội khoa cũng như là về phẫu thuật về,Vietnamese
+liên quan đến các cái bệnh lý hoặc là các cái biểu hiện của câu nói cuộc sống giống như bác mô tả đấy thì thực ra là,Vietnamese
+học cũng sẽ chúc mừng giải thưởng của những người khác trong lĩnh vực nghiên cứu hoặc không hòa thuận với nhau,Vietnamese
+đặc biệt là tăng cường rau xanh hoa quả tươi hạn chế các cái thực phẩm mà nó có từ mỡ động vật đồ xào rán bác cũng nên,Vietnamese
+nghĩ rằng gen cho phép hệ miễn dịch phản ứng với vi khuẩn có tầm quan trọng rõ,Vietnamese
+mình sẽ kiểm tra những các thiết bị bên ngoài đảm bảo có thể thống nhất rồi thì lúc đó là kết thúc phẫu thuật,Vietnamese
+với vai trò đa dạng đối với sức khỏe và bệnh tật trong bài bình luận liên quan,Vietnamese
+là chuỗi dài của các nguyên tử có thể gấp lại thành các hình dạng phức tạp để,Vietnamese
+thích về tần số kích thích về độ dài của kích thích vân vân để tạo một cái thông số,Vietnamese
+và xuất hiện các dấu hiệu của bệnh,Vietnamese
+phải tập một cái thói quen bẻ mà chúng ta uống thuốc đúng giờ và hàng ngày ví,Vietnamese
+trong y khoa đó thì chẩn đoán lâm sàng là chưa đủ chúng ta còn còn những cái xét nghiệm và cận lâm sàng thì đối,Vietnamese
+chúng ta sẽ không có cho vào đấy nữa mà để cái bát nước mắm để cho bệnh nhân tự,Vietnamese
+triển cũng như là chữa lành bệnh chứ còn hiện tại thì các phương pháp điều trị cũng như là phương pháp điều trị phẫu,Vietnamese
+cái thảo dược hoặc là các cái dược liệu có thể là động vật có thể là thực vật để,Vietnamese
+chính là về chế độ dinh dưỡng thì làm sao mà cái chế độ dinh dưỡng có thể khẩu vị không thích cố gắng một chút có thể,Vietnamese
+bệnh đã gặp phải trước đây tất nhiên đây là mấu chốt về cách thức hoạt động của tiêm chủng điều quan trọng là bản thân,Vietnamese
+đến chủ đề này vâng thưa quý vị và các bạn tình trạng lưu thông máu kém gây ra có rất nhiều những cái tình trạng thiếu,Vietnamese
+hại một bên là thành phần chống oxy hóa là có lợi thế thì bây giờ nếu mà chúng,Vietnamese
+quan với những người cao tuổi và và có tuổi cao có tuổi và cao tuổi thì nó là cái đương nhiên nhưng mà chúng ta phải,Vietnamese
+của não lại cũng rất là cao cho nên người ta cũng sẽ phải cân nhắc cái câu chuyện là chúng ta phải phòng tránh những cái nguy cơ đó phòng tránh những,Vietnamese
+điều quan trọng nhất là chúng ta phải làm thế nào chúng ta phải trang bị nhà cửa khóa thế nào để cho trộm nó không vào chứ ạ chứ còn năm giờ thức giấc xem nó,Vietnamese
+những cái tác động từ phía bên ngoài trong gia đình cũng như là ở trong cái,Vietnamese
+đánh giá tự bác thì cũng có thể là điều chỉnh lại cái chế độ ăn để xem xem là mình có ăn thiếu chất không mình có thể,Vietnamese
+thấy được nhưng có những trường hợp nó chỉ là thoáng qua nó ví dụ như mạch máu não nó bị co vào như thế này sau độ ba,Vietnamese
+là thiếu canxi máu và khi mà thiếu canxi máu thì rất dễ có cái chuyện mà chuột rút và khi thiếu canxi máu thì nó có thể,Vietnamese
+dạ vâng cái vấn đề của bác cũng là vấn đề của rất rất nhiều người hiện nay hiện,Vietnamese
+tiêu hóa gan mật và không gặp phải tình trạng phù người bệnh hoàn toàn có thể sử dụng lâu dài ưu đãi đặc biệt trong ngày,Vietnamese
+mỗi một cái thực phẩm có những cái ưu riêng chỉ có một cái bữa ăn đa dạng mới,Vietnamese
+nhập chúng ta không cao lắm nhưng mà chúng ta vẫn có điều kiện để chúng ta tiếp cận với đông trùng hạ thảo cái đó,Vietnamese
+chúng ta ngồi nhiều thứ hai nữa là chúng ta phải gần như là khi mà chúng ta làm việc với máy tính hoặc là các cái công,Vietnamese
+những thói quen vệ sinh của bạn ví dụ việc bạn sử dụng dung dịch sát khuẩn tay tôi sẽ khám phá xem vi khuẩn đường ruột,Vietnamese
+thì tôi đi làm chạy xe máy nhiều thì thì cho chị đau lưng xong đi,Vietnamese
+nhưng cái điều mà tôi đã nói như vừa nãy tôi đã nói cái làm nên bản sắc của đông trùng,Vietnamese
+một ngàn chín trăm chín bảy cho nên là nó tương đối an toàn đối với đối với người bệnh cái thứ hai là đây là,Vietnamese
+mà chúng ta lưu ý cũng như là duy trì các cái biện pháp điều trị duy trì của chúng ta là hết sức là quan trọng bởi,Vietnamese
+người bệnh về thì về mặt cơ bản thì người bệnh vẫn chưa được lập chương trình một cách hoàn hảo người bệnh,Vietnamese
+thiết phải giao tiếp với ai khi mà làm riêng như vậy đó thì họ lại càng ăn nhiều họ lại càng ăn nhiều rồi ở riêng một cái,Vietnamese
+lên đến mức như vậy trong cơ thể con người bởi vì mức tăng trưởng như vậy đòi hỏi một lượng tài nguyên không giới hạn,Vietnamese
+tình trạng rung nhĩ như vậy bạn đã cường giáp mà điều trị ổn định rồi thì mình sẽ,Vietnamese
+ý là cái bệnh gút của bác là một trong những cái vấn đề mà nó đã thường trực rồi nó đã xảy ra năm sáu năm nay rồi mặc,Vietnamese
+dịch của cơ thể điều này nói lên một điều về tầm quan trọng và tính dễ bị tổn,Vietnamese
+tôi đang nghĩ đến một số các cái nhóm bệnh lý khác mà chúng tôi gọi là những nhóm bệnh lý cột sống huyết thanh âm,Vietnamese
+cái sự không hiểu đó là mình tội nghiệp người ta thôi chứ mắc gì mà phải buồn mình cứ tập trung vào cái cái cái cái,Vietnamese
+có thể được chọn lựa người bệnh tốt nhất cho các phẫu thuật kích thích não sâu mà không nên sớm hơn một vài nghiên cứu gần,Vietnamese
+với tôi rằng chắc chắn yếu tố quan trọng nhất liên quan đến sức khỏe và sự đa dạng của hệ vi sinh là thực phẩm chúng,Vietnamese
+chức năng đông máu của mình mỗi bốn đến sáu tuần một lần có nghĩa là các chị sẽ được,Vietnamese
+thông nên các chi được tốt hơn sẽ cải thiện được các triệu chứng như là tê bì chân tay của chị này cũng như là những,Vietnamese
+vậy chúng ta thấy rằng hiện nay có rất là nhiều những cái phương pháp điều trị mà có thể giúp cho những bệnh nhân béo phì để đạt được cái việc mà quản lý cân,Vietnamese
+này cho thấy một cách đơn giản hơn nhiều để các tế bào miễn dịch phát hiện mầm bệnh so với quá trình phức tạp của việc,Vietnamese
+ta phải mắc bệnh rồi chúng ta cũng lại về với cát bụi thế thì cái chuyện mà bệnh lý các cái bệnh lý liên,Vietnamese
+bạn có thể sẽ không phải ở đó để canh gác và bảo vệ nó lý do hầu hết hay miễn,Vietnamese
+của mình nó có đảm bảo được cái việc như những tài liệu người ta nói không,Vietnamese
+thì nó có thể có một số hiệu quả trong những trường hợp sau đây là số một những,Vietnamese
+cũng như là các hoạt động trị liệu phối hợp thêm vào và khi mà bệnh tiến triển,Vietnamese
+là phần tinh túy người ta gọi là phần chứa hoạt chất còn phần đế người ta gọi là dưỡng chất cho nên không phải khó,Vietnamese
+động qua lại giữa bệnh béo phì và tình trạng stress căng thẳng và trầm cảm ạ,Vietnamese
+những triệu chứng như đau đầu hoa mắt chóng mặt mất ngủ hay quên rối loạn tiểu,Vietnamese
+để giúp cho quý vị và các bạn những ai mà đang gặp phải cái triệu chứng như là huyết áp cao nè mỡ máu cao nè tê bì,Vietnamese
+nên ăn các cái thực phẩm là chế biến sẵn bởi vì trong đó một là giàu các cái chất,Vietnamese
+tế bào của chính bạn khoảng mười lần may mắn thay các tế bào của chúng ta lớn hơn,Vietnamese
+cái biểu hiện bác mô tả chúng tôi chưa nghĩ là bệnh lý thoái hóa chưa nghĩ là bệnh lý viêm khớp dạng thấp nhưng cái,Vietnamese
+không còn có máu lên nuôi nữa thì cái tế bào não ta sẽ không sống được nó sẽ tập lập tức mà ngừng hoạt động nhưng,Vietnamese
+cập cách bạn được sinh ra sẽ ảnh hưởng đến cách hệ vi sinh của bạn phát triển ban đầu từ đó ảnh hưởng đến điểm mốc bẩm,Vietnamese
+dưỡng để giúp cho phục hồi cái cơ thể chúng ta để trở lại bình thường các cái gì,Vietnamese
+chính vì thế mình dùng kẽm và selen đối bệnh nhân ung thư thì nó cung cấp cái chất chống oxy hóa nó bảo toàn được,Vietnamese
+xuyên và chấp hành nghiêm chỉnh cái chuyện những cái đơn thuốc về tân dược thì bệnh nhân nên tìm đến những cái giải,Vietnamese
+vậy khi thì mà khi mà lỡ bị chó hoặc,Vietnamese
+những thông tin này sẽ giúp cho rất là nhiều người bệnh béo phì cũng như là những người đang chăm sóc cho người bệnh,Vietnamese
+đến hệ miễn dịch của chúng ta nó có thể liên đới tới hiện tượng mất ngủ làm cho việc nhận biết ảnh hưởng của mỗi yếu tố,Vietnamese
+mảng xơ vữa tức là nó tác động vào nguyên nhân cơ chế bệnh sinh của các cái dấu hiệu của bác nên là khi sử dụng thì,Vietnamese
+sách gì một điều thế này là nó đi cùng một trong nguyên nhân rất quan trọng là quá trình lão hóa thế còn cộng thêm với,Vietnamese
+cách là bình thường khỏe mạnh thì tất cả các cái thành phần hữu hình của máu di,Vietnamese
+mặt rất là dữ dội quay mòng không thể nào đứng dậy nổi tuy nhiên thì nghĩ,Vietnamese
+tế cũng như của gia đình là không đem lại kết quả thì rất mong các bệnh nhân ung thư chúng ta cố gắng còn chế độ ăn,Vietnamese
+mà giữ sáng để mà chúng ta cảm thấy được là có cái hiệu quả trên làn da của chúng ta thì cần tối thiểu là một tháng đến,Vietnamese
+hoặc kết hôn các nhà khoa học chỉ mới biết được rằng mỗi quan hệ mật thiết,Vietnamese
+khi là mình cứ dùng hết cái nọ dùng hết cái kia mà không có một cái chẩn đoán cuối cùng thì sẽ sẽ mất đi cái thời gian,Vietnamese
+mà điều trị biến chứng rất là khó và thông thường hầu như á là hên lắm nó mới,Vietnamese
+mình để có thể sử dụng thuốc một cách an toàn cũng như là cụ thể để có thể đánh trúng vào bệnh của mình khắc phục sớm được cái tình trạng mà mình đã gặp phải,Vietnamese
+cơ quan sinh dục và mọi nơi trên da của bạn nếu bạn có thể tách riêng tất cả các,Vietnamese
+là cái người mà bị rối loạn về béo phì họ cũng có thể có những cái trở ngại,Vietnamese
+cái sự vẹn nguyên của các tế bào và chính sự vẹn nguyên ấy sẽ giúp cho cái việc mà,Vietnamese
+những ai mà chúng ta đang gặp phải những cái bệnh lý về tim mạch nào rồi rối loạn thần kinh nè bị xơ vữa động mạch hoặc,Vietnamese
+đình mà có béo phì thì họ cũng khuyên bệnh nhân đến khám và điều trị chuyên khoa tuy nhiên thì thường là nhận được,Vietnamese
+chưa để có được cái chỉ định là chúng ta đặt một cái máy tạo nhịp cho người bệnh và nếu mà bị covid thì bị covid bao,Vietnamese
+thể bạn luôn đề phòng mọi mối đe dọa đi xuống đường ruột có thể tác động xấu đến,Vietnamese
+yếu nó cũng sẽ dẫn đến cái việc mà bác đứng lên đứng xuống nó giảm cho nên cái việc đầu tiên chính là mình phải điều,Vietnamese
+nhiều lớp kiểm tra và cân bằng sinh học được điều hành bởi vô số tế bào và phân,Vietnamese
+dịch bẩm sinh tạo thành tuyến phòng thủ đầu tiên của chúng ta một phản ứng ngay lập tức với sự hiện diện của mầm bệnh,Vietnamese
+trái gió trở trời tức là thời ti���t nó đang nắng mà nó chuyển mưa hoặc là đang lạnh mà chuyển ấm hoặc là đang ấm và,Vietnamese
+các cái vận động nặng trong cái các cái tình huống như này đôi khi có một số quý vị là lại cố tập luyện các thứ các cái,Vietnamese
+làm giãn các cái mạch máu để tăng cường lưu thông máu đến nuôi dưỡng cơ tim qua,Vietnamese
+được rất ít tiến bộ quý báu giờ tới tin tốt lành tri thức mới đến từ,Vietnamese
+các chiết xuất từ thực vật hai đáp án ha nghe kỹ mọi người đáp án c là tránh sản phẩm chứa xà phòng,Vietnamese
+càng nặng hơn rồi là các cái chu trình về mặt trao đổi chất ở trong cơ thể nó sẽ bị xáo trộn vì lý do như vậy cho nên là cái,Vietnamese
+cách thụ động cần đánh giá một cách thực tế ở trên người bệnh bật cái máy lên điện cực tới nơi rồi bật cái máy lên,Vietnamese
+chúng ta cứ phải đòi hỏi như là lúc chúng ta chưa bị bệnh thì khó lắm ạ bởi vì hiện giờ chúng ta có phải là người,Vietnamese
+cao và với những các triệu chứng của bác thì mặc dù bác cũng chưa đi khám để chẩn đoán chính xác nhưng mà cái nguy cơ bị,Vietnamese
+quỵ như vậy thì ta phải đánh giá toàn diện để mà kiểm tra hết mọi thứ và chúng,Vietnamese
+ổi cũng là kem dưỡng thì chúng ta có thể sử dụng một cái loại kem dưỡng thôi dành cho buổi sáng vào ban đêm luôn tuy,Vietnamese
+đề về sắc tố da cho người bệnh thì đối với sắc tố da cho người bệnh chúng tôi có thể là kê toa thuốc uống và thuốc thoa,Vietnamese
+khi mà nghe đến những cái quy trình dưỡng da rồi chờ đợi một thời gian lâu thì đa số là mọi người thấy hơi phiền sau đó tìm đến những phương pháp tẩy,Vietnamese
+cái muốn nói về vấn đề sụt cân thì nguyên tắc đầu tiên tức là dù là nguyên nhân gì đi chăng nữa thì bản chất vấn đề,Vietnamese
+giờ chế độ ăn uống cân đối các thành phần và đặc biệt là huyết áp cao không nên ăn mặn không nên ăn nhiều mỡ đặc,Vietnamese
+kịp thời thì nếu chúng ta làm cái cứu kịp thời thì chúng ta có thể giảm thiểu được cái hậu quả do đột quỵ gây ra,Vietnamese
+là trong trường hợp này hoàn toàn là bác nên cân nhắc để sử dụng nhưng chúng ta cần phải có cái tiếp tục thăm khám cũng,Vietnamese
+đến tim mạch giải pháp giảm xơ vữa động mạch ổn định được huyết áp giảm đau đầu chóng mặt mất ngủ tê bì chân tay ở những,Vietnamese
+chuyên khoa về bệnh parkinson điều chỉnh cài đặt các cái thông số và một khoảng,Vietnamese
+trạng bệnh lý là xơ vữa động mạch nạp huyết áp cao mỡ máu cao và bệnh lý thần kinh nữa có hiệu quả hơn vậy thì đó là,Vietnamese
+bệnh nhân có dinh dưỡng tốt thì mới chóng lành vết thương sau phẫu thuật rồi sau phẫu thuật bà nếu bệnh nhân không có,Vietnamese
+giờ hãy tới bất kỳ thành phố nào ở mỹ nơi một bé gái được sinh ra cô bé chào,Vietnamese
+cả côn trùng chúng ta có thể suy luận rằng côn trùng nhận thấy bông hoa dễ chịu về mặt thẩm mỹ từ đó đặt ra tất cả,Vietnamese
+cho da nhạy cảm chúng ta có muốn đáp án đáp án a chăm da đủ ba bước cơ bản mỗi,Vietnamese
+điểm cần thiết phải lưu tâm rõ ràng là cái người là bị béo phì đó,Vietnamese
+bệnh lý nền mà nó nó nó là những cái cái mà nó sẽ tác động vào cái sức khỏe của bác thứ nhất là đối với những người mà,Vietnamese
+tháng lễ vu lan ngập tràn khuyến mãi để tất cả chúng ta có cơ hội thể hiện tình cảm hiếu hạnh của mình đối với những,Vietnamese
+dùng thuốc cũng như là các phương pháp khác để mà mình có thể giúp cho cái người bệnh béo phì nó sẽ tốt hơn và như,Vietnamese
+trùng hạ thảo thì chúng ta có thể sử dụng độc vị à nghĩa là chúng ta có thể,Vietnamese
+phì cảm thấy thế nào nếu bị tăng cân trở lại sau khi đã nỗ lực rất nhiều để giảm cân xin mời các bác sĩ ạ,Vietnamese
+khi mà rung nhĩ thì tâm nhĩ không có giãn ra bớt nhẹ nhàng nữa mà từng thế cơ,Vietnamese
+có đặt thiết bị này đây là một cái hoạt động điện cho nên là về mặt nguyên tắc tất cả những cái việc,Vietnamese
+đôi khi cũng khác nhau rồi nó có sẹo teo ở vùng da đầu hay không có sẹo teo tất cả thì đều có chỉ định riêng và như vậy,Vietnamese
+tiếng hai tiếng gì đấy nó lại giãn được ra thì cái cái cơn nó lại có thể hồi phục được chính vì vậy chụp không thấy gì cả,Vietnamese
+rồi nhưng mà chỉ nói một cái vấn đề thế này này là trong đông trùng hạ thảo nó có một cái nguyên tố vi lượng nó gọi là selen,Vietnamese
+nhiên thì mình có những cái biến chứng xuất huyết ở ngoài bên phía ngoài mà mình cần phải tránh trong cái cuộc sống,Vietnamese
+tối thì chúng ta chọn lượng một cái quy trình dưỡng da đơn giản thôi là chúng ta,Vietnamese
+nhiên thì các bạn đưa ý điều này tức là cái thành phần mà kem dưỡng dành cho,Vietnamese
+thấy cái hiệu quả của mình mong muốn của mình tốt mong muốn của mình đạt được cái hài lòng cao khi mà cái thời hạn với pin,Vietnamese
+nó khác trước đây chị cũng có dùng những đây hoạt huyết dưỡng não khi hoạt huyết dưỡng não thì nó cũng có có cái tác dụng,Vietnamese
+là bác sĩ ngoại thần kinh là những cái nơi mình tìm tới những trung tâm y tế nên tìm tới là mình phải hội đủ những,Vietnamese
+tôi bây giờ như vậy đó có thể là dùng cái sản phẩm mà đang quảng cáo trên mạng hay không và vấn đề thứ hai là muốn hỏi,Vietnamese
+người thân trong nhà nó sẽ giảm đi và một điều chúng tôi cũng muốn nhắn nhủ rằng là tất cả những người mà có những,Vietnamese
+theo dõi lại chương trình theo đường link được chia sẻ trong phần bình luận ở phần video này còn ngày hôm nay thì,Vietnamese
+người chúng ta đó lúc cần lúc trẻ thì cái ph da là axit nhưng khi đến tuổi càng,Vietnamese
+màu sắc của cái vùng là tăng sắp tố đó thì chúng ta sử dụng những cái sản phẩm giữ sáng này với hi vọng là sẽ trả lại,Vietnamese
+được chuyển hóa bình thường để duy trì cái sinh tồn của cơ thể mình thứ hai là,Vietnamese
+những ổ chứa tinh vi để vi khuẩn sinh sôi thực sự là một câu hỏi hay,Vietnamese
+dụng của cái sản phẩm đó à nó không chỉ là khó gọi ghẹo gói trong một số bệnh lý,Vietnamese
+nên vận động tại chỗ mà thôi ví dụ như bác nằm ở trên giường bác dùng các cái động tác như đạp xe đạp này hoặc là nâng,Vietnamese
+tế bào trong cơ thể chúng ta được bình thường cho nên bổ sung kẽm và selen từ các loại rau này là rất tốt khán,Vietnamese
+nó sẽ giúp cải thiện các triệu chứng như như vậy nhưng ta thấy rằng là phẫu thuật kích thích não sâu,Vietnamese
+thành bị rối loạn mỡ máu có khoảng hai trăm nghìn người mắc bệnh mỗi năm hơn năm mươi phần trăm trong số đó tử vong vì phát hiện bệnh,Vietnamese
+trên mặt và chúng ta vẫn đảm bảo là do chúng ta được làm sạch sau một cái giấc ngủ dài dạ vâng ạ lựa chọn những cái,Vietnamese
+rằng là những người mà điều trị cường giáp mà trở về bình giáp rồi đó đặc biệt là điều,Vietnamese
+cái sản phẩm là mang là nó có cái tác dụng đấy là immunesoyz thứ hai nữa là chúng,Vietnamese
+công thế này thì thì thì hổng biết làm sao sức khỏe của,Vietnamese
+thể là những cái dấu hiệu của những cái tình trạng những cái tình trạng xơ vữa động mạch trên người huyết áp cao về,Vietnamese
+này có chỉ định sử dụng thuốc kháng đông để được phòng ngừa đột quỵ do rung nhĩ rồi cái tình trạng nhịp chậm cho,Vietnamese
+viêm ví dụ biểu hiện ra sẽ dễ bị đỏ khô ngứa hoặc là bong vảy và có thêm một cái,Vietnamese
+là các quý vị khi sử dụng thì chúng ta nên sử dụng kéo dài từ ba đến sáu tháng để mang lại cái hiệu quả cao nhất và bên,Vietnamese
+biết là có vai trò trong hệ miễn dịch hơn nữa một số gen nhất định có ở cả ruồi giấm và người với tên gọi các yếu,Vietnamese
+hành để chúng ta đi sang các tỉnh khác khi mà có nhu cầu cần thiết thì cũng là một cái bị chúng ta làm tuy nhiên thì,Vietnamese
+những cái cái biến chứng về các cái mạch máu chi nữa và khi sử dụng đối với sản phẩm này thì chúng ta nên sử dụng để,Vietnamese
+cho từng phù hợp cho từng bệnh nhân để làm sao mà đạt được cái hiệu quả tốt nhất cho người bệnh và đem lại các chất,Vietnamese
+điều ấy sẽ còn cho nên chúng tôi rất mong là đối với về mặt tinh thần thì đối với người bệnh ung thư thì hãy cố gắng,Vietnamese
+tử mà nó chưa gặp phải trước đây nói cách khác hệ miễn dịch hoạt động bằng,Vietnamese
+với lại chẳng nói da nhạy cảm chúng ta sẽ sử dụng một cái gọi là các biện pháp lại nghiệm pháp kích thích và chúng ta,Vietnamese
+rằng cái khó ấy sẽ cho chúng ta sức khỏe thì tôi nghĩ rằng là chúng ta sẽ có thể cố gắng được vượt qua được chứ còn nếu,Vietnamese
+cân đối mà đây chúng tôi thì quan niệm cân đối ở đây thì quan trọng nhất đó là cân đối giữa chất đạm động vật và thực,Vietnamese
+những bệnh lý về tim mạch rồi chúng ta có những cái triệu chứng như là tê bì chân tay nè hoa mắt nè đau đầu nè chóng,Vietnamese
+với tình trạng rung nhĩ tim đập nó quá nhanh thì chúng ta phải có biện pháp nào để kiểm soát các tần số đó đừng cho đập,Vietnamese
+ra trong cơ thể khi ai đó bị một vết cắt hoặc nhiễm trùng họ nhận ra rằng họ,Vietnamese
+đông trùng hạ thảo làm chủ dược nhưng mà kết hợp thêm nấm hầu thủ với đẳng sâm việt nam ở đây cũng là phải nói thêm một,Vietnamese
+sống khỏe mạnh đến già hay không đến mức tự bản thân nó nên được coi là một cơ quan nội tạng và đó là một cơ quan đã,Vietnamese
+ngay nhưng mà chúng ta không biết rằng là cái mà quan trọng là gì mặc dù tác dụng có thể nó hơi chậm nhưng mà nó lại,Vietnamese
+chất nữa và trong đó có cái chất chống oxy hóa ví dụ như trong rau xanh có rất,Vietnamese
+chống lại cái sự chê bai chống lại với sự chế nhạo chống lại cái sự bất công chống lại cái sự từ chối của những cái,Vietnamese
+sao bởi vì là cái lượng máu lên não để mà cung cấp dưỡng chất và dưỡng khí đặc biệt là vấn đề oxy và,Vietnamese
+hay không như là chúng ta đang bị tim mạch nè bị huyết áp cao nè bị mỡ máu cao hay là bị tiểu đường rồi ban đêm chúng,Vietnamese
+của bạn trên một cái làn da mà nhạy cảm mà có mụn thì chúng ta cũng phải tôn theo những cái nguyên tắc là làm sao,Vietnamese
+dịch khi chúng tương tác với nhau quan sát sự tiếp xúc của các tế bào miễn dịch với các tế bào khác để quyết,Vietnamese
+của chúng ta thì khi đó rõ ràng chúng ta biết rằng là chúng ta cần phải điều chỉnh cái bệnh của chúng ta chứ không,Vietnamese
+là vắt hoặc là làm một số các cái động tác như vậy có những người không lái xe được nhưng mà khi chúng ta điều trị khỏi,Vietnamese
+chữa thuốc vân vân không có phù hợp thì nó sẽ làm cho ảnh hưởng tới sức khỏe chung ví dụ như họ uống giấm quậy,Vietnamese
+lời đây là thế thì làm thế nào để chúng ta biết đâu là vấn đề và cái cách xử lý của chúng ta là như thế nào khi nào thì,Vietnamese
+trưởng thành bị đau đầu ít nhất một lần mỗi tháng và chúng không chỉ là một sự bất tiện chúng có liên quan đến tình,Vietnamese
+mỡ máu cũng là một trong những nguyên nhân ví dụ như là những cái lượng mỡ cholesterol có trọng lượng phân tử thấp,Vietnamese
+giả đã lắng nghe và theo dõi và chúng tôi cũng xin được gửi lời cảm ơn và rất,Vietnamese
+có cái nền tảng từ sâu ở bên trong có những cái trường hợp liên quan đến cái hệ miễn dịch có những trường hợp nó liên,Vietnamese
+các nhà nghiên cứu cũng lưu ý rằng sự gia tăng nhanh chóng này thứ đang ảnh,Vietnamese
+như là các phương tiện hỗ trợ và đến giai đoạn năm thì gần như là người bệnh,Vietnamese
+ta đôi khi chúng ta cứ không để ý đến mặc dù là là chúng ta có ai bắt chúng ta kiêng nước đâu nhưng mà rất dễ trong,Vietnamese
+mặc dù để hiểu biết đầy đủ về mối liên kết ruột và não bộ đòi hỏi bạn phải có,Vietnamese
+đang bị vôi hóa đốt sống lưng cũng như là lồng ngực của bác cũng đang có một vài vấn đề đúng không ạ,Vietnamese
+máu cao của mình thưa quý vị có những người mà có những cái bệnh lý về huyết áp cao hay là mỡ máu cao thì họ,Vietnamese
+ta mới có thể tiến hành một bước tiến nghiêm túc có ý nghĩa chống lại những phiền não hiện đại của mình,Vietnamese
+nhưng sau cùng bất kỳ sự đóng góp của người nào đó cũng chỉ là nhỏ nhoi ngay,Vietnamese
+cuối cùng em xin kính chúc quý vị diễn giả chị mc và cũng như là khán giả có,Vietnamese
+béo phì đó những lúc này nè càng phải nỗ lực nhiều hơn nữa thì cái tình trạng của họ nó sẽ tốt hơn và một trong những,Vietnamese
+vẻ đẹp của bông hoa nhưng với tư cách là một nhà khoa học ông biết rằng cấu trúc bên trong của bông hoa cũng rất,Vietnamese
+khi người bệnh ung thư thì các chức năng đó đều không tốt cả đặc biệt là chức năng của hệ tim mạch thế thì chúng ta có,Vietnamese
+quần thể được chọn bởi hàng trăm nghìn năm tiến hóa của con người hoặc thậm chí lâu hơn các nghiên cứu cũng đã chứng,Vietnamese
+hưởng trực tiếp cũng như gián tiếp đến có sức khỏe não bộ tôi cũng sẽ chia sẻ với bạn vai trò của ti thể trong các rối,Vietnamese
+cũng không có gì phải suy nghĩ nhiều và vấn đề của chúng ta đã mắc bệnh rồi chúng ta phải nghĩ đến làm sao giải quyết điều,Vietnamese
+đủ mũi vắcxin rồi nhưng vẫn phát bệnh,Vietnamese
+mua theo các cái như vậy hoặc đôi khi là do người nọ người kia có kinh nghiệm rồi mách thế và khi mà người ta cứ sử dụng,Vietnamese
+kết hợp niacinamide bởi vì là vừa có tác dụng là dưỡng ẩm nha vừa có tác dụng là khôi phục hàng rào bảo vệ da rồi vừa có tác,Vietnamese
+những năm gần đây với điều kiện kinh tế được cải thiện cuộc sống chúng ta tốt hơn,Vietnamese
+nhiều betacarotene trong các cái gia vị thì có khá là nhiều các phytoncide,Vietnamese
+trung vào cái hướng khuyến khích khen thưởng hỗ trợ đồng hành cùng với lại cái,Vietnamese
+thì thông thường đó là chúng tôi sẽ sử dụng cái cái bảng câu hỏi hay còn gọi là,Vietnamese
+cái nguyên tố vi lượng nó làm gì nó làm giảm cái chỉ số hba1c cái này quan,Vietnamese
+điện cực này sẽ kết nối với cái máy phát sóng phát điện và cái máy này được,Vietnamese
+do đó chúng ta sẽ phải đánh giá một cách đầy đủ như vậy rằng là nếu táo bón ở,Vietnamese
+nó hỗ trợ trong việc cải thiện các cái triệu chứng ung thư của bác đấy tức là những triệu chứng như là đau mệt mỏi này,Vietnamese
+nhau này có ảnh hưởng như thế nào đến sức khỏe có thể cực kỳ khó khăn vì gần,Vietnamese
+thì cũng không phải nhưng mà giá thành cũng là cao nhưng nếu chúng ta có thể làm được tốt nhất tức là chúng ta dành,Vietnamese
+động này cũng như là do cái cái tư thế đi lại của mình đôi khi là cái tư thế đi lại của mình mà nó không có cân đối thì,Vietnamese
+bác sĩ cho thuốc điều trị rồi đúng không bác thế và ngoài ra thì bác còn có những cái dấu hiệu như là hồi hộp này trống,Vietnamese
+là sau khi mà điều trị ung thư thì rõ ràng được bây giờ chúng ta trở về cuộc,Vietnamese
+tiến xa hơn nữa thì các phương pháp trị liệu về tâm lý,Vietnamese
+những cái dấu hiệu này em ạ nhé thế thì mình mình nên đi thăm khám này để sớm phát hiện ra bệnh của mình và sẽ điều,Vietnamese
+tăng khoảng hai ký thì như vậy thì như chúng ta biết rằng là khi mà mình chọn lựa thuốc cho những cái bệnh nhân mà đái,Vietnamese
+nó cũng khá lớn hai phẩy năm mươi bốn là là cái cái cái mức độ tăng so với lại tự tử trước khi mà phẫu,Vietnamese
+sắp xếp và tổ chức tốt cuộc sống một mình trong ngôi nhà rộng rãi luôn sạch,Vietnamese
+phì rất là nhiều và khi mà bị như vậy đó thì nếu mà cải thiện không tốt cái tâm lý,Vietnamese
+đấy sẽ làm cho quý vị cung cấp cho chúng ta được một cái không chỉ nước mà nó còn có các vitamin và khoáng,Vietnamese
+loạn nhịp tim sau đó thì những cái biến chứng rất là trầm trọng ví dụ như là đã bị nhồi máu não thì một phần mô não đã,Vietnamese
+dụng thì chúng ta sẽ hỗ trợ trong việc ổn định cái huyết áp của chúng ta nữa và hỗ trợ trong việc phòng ngừa cái,Vietnamese
+thích hợp và giúp cho cái máy nó hoạt động nó kích thích cho các cái nhân ở trong não và cải thiện được các triệu,Vietnamese
+mừng là bác đã có đi thăm khám ở bệnh viện cũng đã có những cái chụp chiếu để có cái khẳng định và cái triệu chứng của,Vietnamese
+thời tiết mà nó giao mùa như thế này một số các cái lời khuyên mà chúng tôi cho rằng nó rất là quan trọng và hữu ích cho,Vietnamese
+rằng là tất cả những cái thông tin này thực ra mới chỉ là những cái thông tin ban đầu mà thôi kể cả là mình đã chụp,Vietnamese
+tác động tiêu cực của cái khi người bệnh nhân béo phì khi mà gặp những cái,Vietnamese
+cái covid thì là chúng ta nên tăng cường các chế độ ăn uống khoa học nếu mà trừ,Vietnamese
+tình trạng làm bít tắc l��� chân lông còn về cái phần thứ hai bạn hỏi là tại sao mà da mình đã dưỡng ẩm rồi nhưng mà ban,Vietnamese
+thần kinh học và tâm thần học hiện đang nhận ra rằng đây có thể là một lý do tại sao thuốc chống trầm cảm thường kém hiệu,Vietnamese
+này đã làm thế nào để chúng ta điều trị từ gốc rễ thì lúc đấy chúng ta sẽ có một cái phác đồ cụ thể để có thể khắc phục,Vietnamese
+tưởng toàn cầu về khoa học hệ vi sinh chúng tôi đã nói về các yếu tố làm thay đổi vi khuẩn đường ruột và ông đã nói rõ,Vietnamese
+sức mạnh tôi sẽ chỉ cho bạn cách prebiotic sinh ra từ thực phẩm nguồn dinh,Vietnamese
+cái thay đổi khẩu vị của bản thân người ung thư thay đổi vị giác khứu giác của người ung thư rồi những cái sản phẩm là,Vietnamese
+bạn đề cập đến những các sản phẩm dưỡng sáng da từ bên trong tức là bạn đang muốn nhắc đến những cái thuốc uống,Vietnamese
+ta sẽ có thể ăn nhà được tốt hơn và hiện nay thì cái lượng muối tiêu thụ trung bình của người việt nam đang gấp đôi,Vietnamese
+cái việc chính của mình là mình phải tiêm vắcxin phòng bệnh này bằng cách 5k này và mình tiêm vắcxin chống covid,Vietnamese
+giọng nói lời nói như vậy ba triệu chứng mà phổ biến nhất nó sẽ là,Vietnamese
+bệnh lý của mình để có thể điều trị chính vì vậy thì qua trước chương trình của bệnh,Vietnamese
+đường huyết huyết áp vô cùng tốt cho những người cao tuổi nhân dịp tháng vu lan báo hiếu ngày hôm nay vâng và chúng,Vietnamese
+trường sống này mình sẽ nhắm tới mấy cái chuyện môi trường thứ nhất là môi trường tự nhiên và môi trường thứ hai là môi,Vietnamese
+nhân hàng đầu gây ốm yếu trên toàn thế giới và các chẩn đoán đang gia tăng với tốc độ đáng kinh ngạc các loại thuốc như,Vietnamese
+tiên đó là khi người bệnh mà mắc ung thư thì người ta rất là lo lắng một cái tâm lý lo lắng và buồn chán và thậm chí làm,Vietnamese
+hãy đặt câu hỏi cho chúng tôi nhá và thời lượng chương trình vẫn còn nhiều bác sĩ ở đây vẫn còn đủ sức trả lời thêm,Vietnamese
+thần kinh và nó tiến triển ngày càng nặng dần và cho đến hiện nay vẫn chưa,Vietnamese
+bệnh và rối loạn chức năng đỉnh cuối phần này bạn sẽ có một sự trân trọng mới,Vietnamese
+máu não và thông thường là nó thoáng qua chính vì vậy cho nên những cái trường hợp như vậy thì rất là dễ gây cho chúng,Vietnamese
+phải thực hiện vì những cái bệnh lý khác hoặc là những cái thăm khám định kỳ ví dụ những cái siêu âm ví dụ như những cái,Vietnamese
+vì là ngoài cái tác dụng là như là làm dịu những các triệu chứng da nhạy cảm thì còn giúp dưỡng ẩm nè,Vietnamese
+họ tiếp xúc với bệnh đậu mùa bò một loại nhiễm virus nhẹ mà con người có thể mắc,Vietnamese
+giữ được thăng bằng hoặc là có rối loạn thị giác,Vietnamese
+thật sự rất là tốt cho chúng ta trong việc bảo vệ cơ thể chúng ta chống ung thư mà không thể tìm thấy ở trong các,Vietnamese
+lượng cuộc sống tốt nhất cho người bệnh nó được có một cái lợi thế là khi giả sử mình có vấn đề gì đó trục trặc trong quá,Vietnamese
+bạn sẽ nhanh chóng nắm bắt được là thực phẩm thực sự quan trọng,Vietnamese
+đầu tiên là chúng ta không cần phân biệt giữa đột quỵ thiếu máu não thoáng qua bởi vì bản chất nó là một là chỉ khác về,Vietnamese
+khuyên là nên tìm đến đông viên nang đông trùng hạ thảo và cô sử dụng tất nhiên là,Vietnamese
+chúng tôi có thể làm cái chụp các mạch máu não trên ct trên mri hoặc là,Vietnamese
+hoặc cơ bản của cơ thể sẽ hữu ích khi nghĩ về điểm mốc của bạn như một bộ điều,Vietnamese
+ruột không khỏe mạnh và chúng ta có thể nói chắc chắn rằng cũng giống như bệnh,Vietnamese
+ngực đấy ạ và ngoài ra nữa khi chúng ta sử dụng lâu dài thì nó sẽ có cái tác động phòng ngừa hỗ trợ trong việc phòng ngừa,Vietnamese
+có chỉ định sử dụng thuốc kháng đông cho người bệnh của chúng ta để phòng ngừa đột quỵ cho rung nhĩ và các bác sĩ về,Vietnamese
+cái axit amin mạch nhánh nó rất là tốt cho việc tạo khối cơ nó cũng có chất béo nhưng mà chúng ta rõ ràng chỉ hai thực,Vietnamese
+đông trùng hạ thảo nhưng mà các cụ chúng ta vẫn tìm cách là gì l�� kết hợp thêm,Vietnamese
+thiện các triệu chứng của người bệnh do đó khi mà người bệnh được phẫu thuật,Vietnamese
+gánh hết đó là cảm thấy buồn mà tuyệt vọng nữa hàng triệu việt nam đang phải,Vietnamese
+bề mặt da nhạy cảm mỏng hơn và cái số lượng của tế bào sừng cũng như là kích thước của tế bào sừng nó cũng giảm so,Vietnamese
+hệ vi sinh vật phương tây bị rối loạn sinh học và là điều kiện khiến các cá thể dễ mắc nhiều loại bệnh,Vietnamese
+trống trong não cái cục pin đang cấy dưới ngực khi mình lựa chọn những cái điều trị nhiệt trị liệu đối với vật lý,Vietnamese
+dây ngọc linh người ta gọi là đẳng sâm việt nam nếu chúng ta dùng với cái liều cao thì chúng ta cũng đạt được hiệu quả như là sâm ngọc linh nói như thế để cũng,Vietnamese
+mình dần thay thế những cái hạn chế các tiêu cực về bản thân bằng cách là xây,Vietnamese
+tăng hơn gấp đôi tỷ lệ tử vong cũng tăng vọt phần lớn là do sự xuất hiện của một,Vietnamese
+máu đó ra ngoại biên để nuôi tất cả những cơ quan trong cơ thể của chúng ta còn tâm nhĩ thì có nhiệm vụ gì tâm nhĩ thật,Vietnamese
+những gì chúng ta chi cho điều trị ung thư rối loạn tâm trạng và lo âu cũng đang,Vietnamese
+ấy thì ở một mức độ nào đó chúng tôi cũng có thể nói rằng là rất là mừng mừng cho bác là bởi vì nếu mà nó có bị tổn,Vietnamese
+bí ẩn đối với các nhà khoa học và cũng là một điều kỳ diệu của tự nhiên trong,Vietnamese
+thấy có cái cơ chế tác dụng và có cái hiệu quả nó tương đương với nhau nhưng mà kga1 thì nó lại không gây ra các cái,Vietnamese
+người bệnh parkinson đối với phương pháp điều trị gen cũng như là phương pháp điều trị tế bào gốc hiện nay các trung,Vietnamese
+thiện được tức là nó giảm được các biến chứng dao động vận động chúng ta biết là biến chứng dao động vận động lúc bật,Vietnamese
+nói rằng là khi người ta càng nghiên cứu để người ta càng thấy rằng là đông trùng hạ thảo nó có một cái phổ tác dụng dược,Vietnamese
+trầm cảm thì họ rút vào riêng cái thế giới của mình chứ còn ít có muốn giao tiếp với những người khác mà chính vì,Vietnamese
+chả có cơ hội để chúng ta tiếp cận được đâu nhưng mà bây giờ thì chúng ta vẫn có điều kiện để chúng ta tiếp cận được vậy,Vietnamese
+điều kiện mà chúng ta đến địa bàn tỉnh vĩnh long là phải có cái giấy xét nghiệm sarscov2 như vậy thì chị có thể,Vietnamese
+chuyện đó là chuyện chúng ta phải biết đến rồi nữa là cái chuyện mà chúng ta bị các bệnh đi đường tiêu hóa trong đó về,Vietnamese
+một cái mri để xác định lại cái vị trí thứ nhất là nhìn cho rõ hoặc là rõ,Vietnamese
+trong tế bào của chúng ta nó có dna riêng tách biệt với dna trong nhân tế bào trên thực tế ti thể có thể được coi,Vietnamese
+duy trì các cái chức năng của các hệ cơ quan trong chúng ta được tốt thứ hai là bảo,Vietnamese
+tác động không chỉ có ở nhà tâm lý trị liệu mà là những cái người khác ở chung,Vietnamese
+lên một cái quá mức của các tế bào một cách không kiểm soát của cái khối u đó và chính điều ấy làm cho bệnh nhân đi,Vietnamese
+nếu mà họ nỗ lực nhiều rồi khi mà đạt được như vậy rồi mà bây giờ á mà nó tự,Vietnamese
+có những cái dấu hiệu gì về về về tim không ví dụ như những cái thiểu năng vành đối với những người huyết áp cao thì có,Vietnamese
+nhất đó là cái tình trạng trầm cảm thì đây là một cái hệ quả mà khó tránh của một cái người phải chịu quá nhiều áp lực,Vietnamese
+bác ơi vâng bây giờ thì với cái tình trạng hiện nay của bác này thứ nhất là huyết áp đang tăng cao thì bác nên bác,Vietnamese
+hôm nay thì người thân và người chăm sóc của người bệnh chúng ta sẽ cùng được hướng dẫn sẽ giúp cho chúng ta biết cách làm,Vietnamese
+phẫu thuật kích thích não sâu thưa tất cả quý vị lo lắng trước các ca phẫu thuật là tâm lý thường thấy ở bất kỳ người,Vietnamese
+nào sử dụng đông trùng hạ thảo cũng giống sản phẩm nào,Vietnamese
+người khác cũng như bản thân của họ đó phải đối mặt đó nó sẽ bị ảnh hưởng theo,Vietnamese
+lượng và tôi nghĩ rằng cái tiêu chuẩn để chọn bữa ăn cao năng lượng đây thì chúng ta phải tính ra là nếu như chúng ta phải,Vietnamese
+tiếp tục uống các cái thuốc với cái lượng gần như gần bằng so với trước trước khi mà phẫu thuật và sau một tháng,Vietnamese
+bệnh từ đó giúp cho người bệnh parkinson có chất lượng sống tốt hơn trong đó có phương pháp điều trị kích thích não sâu,Vietnamese
+để có thể mà lấy lại được cái vị giác tốt đấy thì chúng ta nên cung cấp cho cơ,Vietnamese
+biết là nhất là trong cái buổi những cái cái lúc mà dịch dã như thế này kinh tế chúng ta ai cũng rất hạn hẹp thế thì làm,Vietnamese
+huyết áp trở về bình thường để tránh là gây nên những các cái tai biến những cái biến chứng của tăng huyết áp thế và đối,Vietnamese
+đồng thời nó cũng nâng cao sức khỏe của chúng ta và đặc biệt đặc biệt nhé là nó còn dự phòng cái chuyện mà chúng ta bị,Vietnamese
+mặc cảm rằng là chúng ta là người mắc bệnh bởi vì chúng ta đang thực hiện một cái nghĩa vụ đối với gia đình đối với,Vietnamese
+một cách khác để quan sát mối liên hệ giữa lối sống phương tây sạch sẽ ít chất xơ và tỷ lệ mắc bệnh mãn tính là xem xét,Vietnamese
+chúng ta cả các siêu âm nữa rồi khảo sát về tim siêu âm tim bình thường ở,Vietnamese
+sau khi mổ để chữa cái béo phì mà không có kiểm soát tốt với tâm lý cũng như các,Vietnamese
+tính bệnh đa xơ cứng một bệnh tự miễn gây tàn tật làm gián đoạn khả năng giao tiếp của hệ thần kinh hiện ảnh hưởng đến,Vietnamese
+từ trước đến nay chúng ta được dạy rằng hãy coi vi khuẩn là tác nhân gây chết người rốt cuộc thì bệnh dịch hạch đã,Vietnamese
+chúng tôi xin mời tất cả vì chúng ta sẽ cùng tiếp tục theo dõi chương trình và cùng đến với chủ đề bệnh béo phì yên tâm,Vietnamese
+định cân bằng được cái stress ổn định này rồi thì cái việc mà cái điều trị tích cực đó,Vietnamese
+hoạt động trong điều kiện lý tưởng rồi nó tăng cường yếu tố tăng từ thần kinh cái ngf rồi thì nó làm tăng cường các,Vietnamese
+nữa đó là phải đánh giá nguy cơ cho người đó coi là có,Vietnamese
+khuyên rằng là bác nên đi tìm cái bệnh lý chính xác của mình trước khi mà mình điều trị bất kỳ một cái thuốc gì hay là,Vietnamese
+giá thêm đúng là rung nhĩ đánh giá đến mức độ của nó đánh giá nguy cơ là như thế nào và thậm chí đánh giá các nguyên,Vietnamese
+mạch vành huyết áp cao nhiều khi nhớ nhớ quên quên bị tiền đình đau đầu chóng mặt và đã từng dùng rất là nhiều sản phẩm,Vietnamese
+khớp của chúng ta chắc chắn là nó phải có vấn đề rồi thì nó mới đau như vậy chỉ có là khi thay đổi thời tiết khi trời nó,Vietnamese
+khỏe thì em muốn hỏi bác sĩ là sau này khi em tiếp tục em nhuộm như vậy thì,Vietnamese
+đi lặp lại nhiều lần rồi cho nên là lời khuyên đầu tiên của chúng tôi là gì ạ bệnh gút của bác không phải là chưa phá,Vietnamese
+cũng cần phải hỏi lại như vậy và trước khi chúng ta có một số các cái lời khuyên đương nhiên chúng ta cần biết,Vietnamese
+ta đỏ thì khi đó các bác sĩ của chúng tôi phải điều trị cái vấn đề bệnh da chính trước và đôi khi chúng ta điều trị,Vietnamese
+lắng nghe và thấu hiểu được làn da của mình như các bạn nhé tùy đúng không ạ có làn da thì cũng sẽ,Vietnamese
+cái mà chúng ta khám trên lâm sàng thì đôi khi chúng ta chưa đủ để chuẩn đoán một da nhạy cảm chính xác thì chúng ta,Vietnamese
+người chúng ta lượng đường trong máu khi chúng ta xét nghiệm khi đói nó dưới bảy mươi,Vietnamese
+mà di chuyển bệnh nhân nên để nằm để sẽ tốt hơn là tư thế ngồi ở trên xe máy chẳng hạn không tốt ngoài những gì nó ra thì gần,Vietnamese
+trong khoa học những cuộc đụng độ kiểu này không phải là hiếm trong khoa học bởi vì rất khó để tách,Vietnamese
+cũng không phải là không có đặc biệt như ở bác sĩ vừa tư vấn đầu chương trình cũng như là những cái người trung tuổi cũng không phải là không có và bây giờ,Vietnamese
+phần lớn những gì chúng ta biết về hệ vi sinh đến từ việc nghiên cứu chuột vô trùng đây là những con chuột đã được,Vietnamese
+thấy làm sao cả nhưng mà bây giờ nó lại nặng như thế này thì chúng ta cũng cần phải hiểu rằng là rất nhiều trường hợp sau khi ngã xong sau khi thế nọ thế kia,Vietnamese
+bao giờ có nhưng mà vấn đề chỗ là mặc dù chúng ta không ngăn ngừa được cái quá,Vietnamese
+trộn không cần phải đun để chúng ta có thể trộn vào để chúng ta ăn thì chúng,Vietnamese
+việc rồi là tất cả các yếu tố khác cho nên là cũng là một cái khó để chúng ta nói một chính xác xem là bệnh lý như thế,Vietnamese
+trên thực tế kiến thức mới này có thể giúp ích cho hầu hết mọi tình trạng thoái hóa hoặc viêm trong các nội dung,Vietnamese
+những trải nghiệm đầu đời và hiểu được làm thế nào mà phương pháp sinh đẻ sinh,Vietnamese
+con đường để mà làm giảm sản sinh những cái tín hiệu đến tế bào sắc tố ví dụ như lại những cái hoạt chất thoa có chút,Vietnamese
+vậy cho nên là nếu trong trường hợp của bác mà chúng ta khẳng định được chính xác là sọ não của chúng ta có vấn đề gì,Vietnamese
+tình trạng của người béo phì cũng như là ung thư rồi tim mạch nội tiết đồ này kia vân vân,Vietnamese
+thể uống sữa được bác có thể ăn phô mai hoặc là một số các cái sản phẩm như vậy,Vietnamese
+lại cái xã hội cũng như là cái sự tương tác với trong gia đình của mình,Vietnamese
+tình trạng bình giáp đó đó thì rất ít khả năng là nó sẽ có cái tình trạng rung nhĩ xảy ra sau đó tuy nhiên tôi xin nói,Vietnamese
+là nó dẫn đến tình trạng như là hồi hộp trống ngực này nhịp tim nhanh này hoặc là đau tức ngực này ở chân tay thì nó sẽ,Vietnamese
+rồi cô ơi cô chia sẻ với chương trình đi ạ cô đang gặp phải tình trạng như thế nào,Vietnamese
+của nó không có cao nhưng mà rất là hình thức thì rất là may mắn là những năm gần đây thì mình có một cái nhóm thuốc khác,Vietnamese
+khác nhau như thế nào giữa các quần thể trên khắp thế giới và sự khác nhau này gây ra bởi sự khác biệt trong chế độ ăn,Vietnamese
+da của mình khô nên bị thiếu nước thì sẽ có cái tình trạng nào phản hồi ngược lại giờ nên da sẽ tăng bài tiết bã nhờn để,Vietnamese
+ta mang con virus đi và chúng ta có thể lây truyền cho những người khác và như thế là virus nó sẽ lại vào một cái cơ,Vietnamese
+khác biệt trong vệ sinh có thể giải thích một phần các mô hình toàn cầu về tỷ lệ bệnh alzheimer sự phơi nhiễm với vi,Vietnamese
+mình còn gọi là mất tự tin vì họ cảm thấy là cái ngoại hình của họ đó nó không có đẹp ngoại hình của họ sao mà xấu quá đi,Vietnamese
+bổ sung cái serum vào trong các chu trình sóc da của mình,Vietnamese
+chúng ta sau khi mà điều trị ung thư chẳng hạn như là phẫu thuật hóa trị xạ trị đó cũng là những nguyên nhân ví dụ,Vietnamese
+loạn não bộ từ quan điểm của hệ vi sinh vật ti thể là những cấu trúc nhỏ xíu bên,Vietnamese
+lớn tuổi thì cái cái nguy cơ đột quỵ là sẽ rõ ràng là sẽ tăng lên và như vậy,Vietnamese
+các cái câu chuyện liên quan đến cái hệ hô hấp và hệ mạch máu như thế nào thì các cái nguy cơ lên lên lên cái mạch máu,Vietnamese
+tìm một cái phương pháp điều trị thật là đúng thì mời quý vị hãy cùng gọi về số điện thoại tổng đài miễn cước của chúng,Vietnamese
+không phải là không xâm lắm cho nên là chắc chắn khi mà có đụng chạm vào trong trong não là những cái rủi ro đều có thể,Vietnamese
+thấy thực sự đáng chú ý ở những nước có điều kiện vệ sinh kém nhất tỷ lệ lưu,Vietnamese
+là những cái mà tăng huyết áp đái tháo đường mỡ trong máu rối loạn nhịp tim,Vietnamese
+trong giai đoạn mang thai thì cái estrogen nó phát triển nó tăng lên và chị em tốt sẽ dày và mượt rồi sau khi,Vietnamese
+tin từ tổng đài của chúng tôi cho biết là hiện nay chúng tôi chỉ còn khoảng bốn mươi phần quà nữa thôi có nghĩa là quý vị và,Vietnamese
+rất là quan trọng trong cái việc mà điều chỉnh cái nhận thức của cái người bệnh béo phì để giúp cho họ có thể là hiểu rõ,Vietnamese
+với những cư dân vi sinh vật này những kẻ đã tham gia tích cực vào việc định hình quá trình tiến hóa của chúng ta kể,Vietnamese
+và bên cạnh đó thì bạn cũng chú ý cung cấp đủ nước cho bố bởi vì cái việc mà,Vietnamese
+dạng bốn mươi phần trăm tăng huyết áp cũng như là những cái bệnh mạch vành thì ngoài ra thì thấy được kiểm soát mà béo,Vietnamese
+tinh thần tốt hơn bên cạnh đó một cái điều mà tôi cũng rất muốn đó là sự chia sẻ không nhỏ về mặt kinh tế chúng tôi,Vietnamese
+động mạch vành tim thì gây ra thiếu máu cơ tim nhồi máu cơ tim và lúc đó bệnh nhân sẽ có bệnh cảnh của nhồi máu cơ tim,Vietnamese
+tiên của chúng tôi cũng có hiệu quả cho tới bây giờ người ta vẫn còn thấy rõ ràng,Vietnamese
+hợp này đó chính là tế bào ung thư thì đó sẽ sử dụng các cái chất dinh dưỡng dự trữ,Vietnamese
+các trường hợp do đó chúng ta biết rằng là sau phẫu thuật kích thích não sâu thì thuốc vẫn phải tiếp tục chứ không thể,Vietnamese
+và polysaccharide nó cũng nằm ở quả thể rồi thì các chất dinh dưỡng các nguyên,Vietnamese
+với một bệnh về não bộ nghiêm trọng nào như trầm cảm hay alzheimer thực tế cậu,Vietnamese
+ngừa dại hay không và nếu được tiêm thì,Vietnamese
+là tế bào bình thường cơ thể chúng ta trở thành không bình thường thì tế bào rất có thể là cái tuổi thọ của tế bào sẽ,Vietnamese
+bác sĩ điều trị để mà có thể là có nhận định chính xác chọn lựa liều thuốc chọn lựa,Vietnamese
+này nhưng mà sử dụng em vẫn cảm thấy không có hiệu quả cũng không có cải thiện tình trạng này được bao nhiêu hết thì em muốn xin bác sĩ tư vấn cho em,Vietnamese
+cũng bị loạn nó cũng bị yếu thì tất cả những yếu tố đấy nó cũng sẽ làm cho các khớp yếu và đặc biệt là khớp gối nó sẽ,Vietnamese
+khác nhau và theo như lời chia sẻ của các bác sĩ thì khi thuốc không còn kiểm,Vietnamese
+ung thư các nhà nghiên cứu đã nhấn mạnh tác động của trải nghiệm ra đời sinh thường hay sinh mổ của một em bé và việc,Vietnamese
+như vậy ở trong lớp thượng bì thì da của chúng ta sẽ làm tăng do sự mất nước qua da hay là tăng mức nước qua thượng bì,Vietnamese
+giảm nhanh chóng trong các hình ảnh minh họa mối tương quan giữa độ vệ sinh với bệnh alzheimer,Vietnamese
+số chị em người ta dùng là lạm dụng cái cái tàu cao tốc quá nhiều tiếp xúc với nhiệt độ trên da đầu chúng,Vietnamese
+nó không phải là một cái vật thể sống mà nó chỉ sống được khi mà nó có một cái cơ,Vietnamese
+chế độ ăn uống và tập thể dục bạn có thể thay đổi điểm mốc cho tình trạng viêm thông qua các biện pháp can thiệp lối,Vietnamese
+và có tạo sự khác biệt trên thị trường với những sản phẩm trên thị trường hiện nay về cái bảng thành phần và độ an toàn,Vietnamese
+lipid mà tự nhiên trên bề mặt da khiến cái hàng rào bảo vệ da của chúng ta bị tổn thương da chúng ta sẽ trở nên là,Vietnamese
+hướng dẫn cái phẫu thuật viên để đưa cái điện cực vào và khi mình đưa xuống,Vietnamese
+và ủng hộ chân thành hướng đến những người bệnh béo phì quanh ta và bây giờ thì xin mời tất cả quý vị chúng ta cùng,Vietnamese
+căn bệnh mà nó làm cho chất lượng cuộc sống cũng như là nó có thể gây ra những,Vietnamese
+biệt là nội thần kinh nội về bệnh parkinson và rối loạn vận động cũng sẽ hỗ trợ rất nhiều trong khi việc mà làm,Vietnamese
+thì chúng ta sẽ cho dầu dầu vào trong cháo để mà chúng ta có thể ăn được một,Vietnamese
+tóc còn đang ướt thì cái biểu bì tóc nó ảnh hưởng và tóc xoăn sẽ không đẹp không bóng mượt và rồi dùng cái lượt mềm chảy cái này,Vietnamese
+ta nói rằng tóc nó sẽ phục hồi có khi khoảng từ sáu tháng đến mười hai tháng sau nó,Vietnamese
+trường thế giới cũng như việt nam có rất nhiều và rất nhiều các cái các cái cái đơn vị sản xuất các sản phẩm có chất,Vietnamese
+tính cảm lạnh hay các bệnh nhiễm khuẩn thường gặp rối loạn đường ruột bao gồm,Vietnamese
+tháng bỗng nhiên không biết làm sao mà tóc mình nó cứ rụng càng lúc càng nhiều nhưng mà cũng có cái hay thế này người,Vietnamese
+lưu ý sử dụng thì cái thuốc tăng đông đặc biệt là thuốc tăng đông tăng đông thế hệ,Vietnamese
+chán ăn này thì tất cả những cái điều ấy đều dẫn đến cái việc mà tiếp nhận cái,Vietnamese
+cái động tác giúp cải thiện cái tuần hoàn của các cái vùng của cơ thể của chúng ta thì bản thân bác sĩ nhiều khi,Vietnamese
+thì đang nghe nói đến là đông trùng hạ thảo được sử dụng rất là nhiều rồi thế nhưng mà không phải ai trong chúng ta cũng hiểu rõ hơn về cái tác dụng của,Vietnamese
+niệm về dưỡng sáng dưỡng sáng đó là khi mà chúng ta chọn lựa những cái sản phẩm mà có chứa những cái thành phần có tác,Vietnamese
+đến cái đoạn là tại sao mình sụt cân nhiều thế đi kiểm xem là có đái tháo đường không có ung thư không thì hóa ra,Vietnamese
+người nổi tiếng có ảnh hưởng rất lớn đến thái độ của công chúng đối với các ý tưởng khoa học mới mặc dù vậy quy trình,Vietnamese
+tâm lý ở chính bản thân của họ và đồng thời do những cái người khác hay là,Vietnamese
+nãy bác sĩ chia sẻ đó là chúng ta cố gắng chọn lựa một cái chu trình chăm sóc da làm sao mà đơn giản nhất để chúng,Vietnamese
+tôi đang có rất nhiều những cái chương trình khuyến mãi đang chờ đợi bác ở tổng đài này bác nha vâng thưa quý vị và các bạn như chúng ta chia sẻ từ đầu chương,Vietnamese
+đổi như thế này hoặc là có những cái đợt nhất định nào đó bệnh người ta nặng lên người ta sẽ tập trung chữa rồi là dùng,Vietnamese
+kinh ở vâng thưa quý vị thưa các bạn khi mà chúng ta nhắc đến đông trùng hạ thảo thì quý vị và các bạn nên nhớ đây là,Vietnamese
+cô ha vâng ạ ngày hôm nay thì những ai mà chúng ta đang gặp phải cái tình trạng bệnh lý là huyết áp cao mỡ máu cao bệnh,Vietnamese
+quá vậy thì cái tình trạng tự ti đó sẽ càng rõ hơn rồi là họ họ đã cố gắng rồi,Vietnamese
+chiều cái vị giác của bản thân cái người bị ung thư đó của của ví dụ như,Vietnamese
+thay đổi cái lối sống từ cái thái độ đưa đến những cái hành vi để mà mình tiếp,Vietnamese
+lên não được tiếp thì như vậy thì chúng ta sẽ có cái trường hợp đột quỵ vậy về mặt bản chất của nó là gần như là,Vietnamese
+giúp người bệnh ung thư có thể chiến thắng được ung thư và tôi tin rằng nếu bệnh nhân ung thư làm được ba điều đó và các,Vietnamese
+luận cuối cùng chính vì vậy cho nên trong trường hợp này của anh thì chúng tôi nghĩ là của anh cũng gần được năm năm rồi đấy thế cho nên là anh phải cố gắng,Vietnamese
+gian có thể thoái lui được các bệnh lý rất là có thể đẩy lùi được bệnh đái tháo đường luôn đặc biệt đó là những cái bệnh,Vietnamese
+nguy cơ cao là mặc dầu là có thể là bây giờ thì chưa có biểu hiện mắc bệnh nhưng,Vietnamese
+truyền xung quanh sẽ lại cho nhân viên y tế thì đó là một điều đáng một điều là luôn luôn là phải thực hiện ở tại cái,Vietnamese
+cường sức khỏe cho bản thân mình cũng như cho người thân dạ vâng ạ hy vọng đọc qua các phần chia sẻ vừa rồi thì quý vị,Vietnamese
+thứ hai là người ta tiên liệu được cái khả năng thành công của khi mình đặt cái điện cực,Vietnamese
+người bệnh parkinson nhưng đây thì chúng tôi cũng xin mời các bác sĩ có thể chia sẻ thêm về phương pháp này trong,Vietnamese
+công ty dược phẩm đắt thay đổi quan điểm của họ về nghiên cứu vắc xin từ một lĩnh vực có triển vọng tương đối thấp về lợi,Vietnamese
+chúng ta thực hiện tức là muốn thực hiện các quy trình công nghệ thì chắc chắn rồi các bác sĩ sẽ phải thực hiện đúng,Vietnamese
+khớp ở chân tay là bị hết và hôm nay câu hỏi của bác là gì ạ thì tôi muốn hỏi bác sĩ đấy nó là tôi thế thì nó có phải,Vietnamese
+khoa học mới cũng tiết lộ rằng vi khuẩn xấu có thể thay đổi cách chúng ta cảm nhận cơn đau thật sự là những người có,Vietnamese
+rằng chúng ta phải cố gắng cái sự thay đổi ấy đó chính là cái không bình thường của cơ thể chúng ta và chúng ta cũng,Vietnamese
+này chữa bệnh cái xong rồi tôi uống trở lại thì cái đó là cái hoàn toàn sai lầm chúng ta phải duy trì và tất cả mọi thứ,Vietnamese
+những giải pháp những thứ thuốc mà có thể điều trị căn bệnh này thế thì rất,Vietnamese
+nguy cơ so với động mạch hỗ trợ giảm đau đầu chóng mặt mất ngủ tê bì nhức mỏi chân tay,Vietnamese
+rồi ngày hôm nay những ai mà khán giả nào đang bị huyết áp cao nằm mỡ máu cao những bệnh lý về tim mạch thì đừng ngần,Vietnamese
+gây ra ảnh hưởng đến các cái chất lượng và về lâu về dài khi mà chúng ta cứ tích lũy đi tích lũy lại như vậy thì bản thân,Vietnamese
+hậu điều kiện thổ nhưỡng nó rất thuận lợi để cho gọi là cái loại thảo d��ợc này nó,Vietnamese
+thì phó giáo sư có những đánh giá như thế nào hóa chất này ạ và vâng đối với vai trò của kẽm,Vietnamese
+là cái tư thế vận động của người ta như thế nào vì sao vì tất cả những cái chuyện này là những cái yếu tố nó có tác,Vietnamese
+ràng khối u không được nuôi không có mạch máu đến thế là không được nuôi sẽ ra đi thế rồi dinh dưỡng sẽ giúp cho cung cấp,Vietnamese
+loại thảo dược hiện nay đang được bày bán trên thị trường với rất nhiều những cái công dụng khác nhau thì việc chúng ta lựa chọn đúng và hiểu đúng về cái sản,Vietnamese
+những người bị đái tháo đường sử dụng đông trùng hạ thảo với cái gọi là nguyên tố vi lượng là selen thì nó sẽ giảm cái,Vietnamese
+đó như là enzyme immunesoyz này kết hợp với hòe hoa đan sâm hoàng liên l-carnitine,Vietnamese
+cột sống thắt lưng người mắc bệnh viêm khớp thoát vị đĩa đệm gai vôi hóa cột sống đau vai gáy đau thần kinh tọa thần,Vietnamese
+thể hoàn toàn ứng phó với sự nhiễm trùng thì đáp ứng miễn dịch thích ứng hành động của các tế bào t và tế bào b mới,Vietnamese
+trường rất lại chật hẹp như vậy thực hiện đúng 5k chúng ta đang giúp cộng đồng mà không bị tăng cái cả kia tỷ số,Vietnamese
+của tuyến giáp cho nên là nó không có lợi còn đối với ung thư vú thì đậu nành lại tốt với ung thư vú là chúng ta phải,Vietnamese
+nhưng mà đương nhiên cái hiệu quả sẽ không bằng những người mà lên sớm đó là cái hoạt động cấp cứu,Vietnamese
+khoa học viễn tưởng vậy nhưng nghiên cứu đã chỉ rõ những vi sinh vật trong ruột bạn cũng có thể được coi là một nội tạng,Vietnamese
+có khả năng là nó trầm cảm và cái tâm lý mà họ bị kỳ thị bản thân họ bị tự ti họ,Vietnamese
+để mà nhằm đánh giá cái hiệu quả của nó tuy nhiên cho tới hiện nay thì vẫn chưa,Vietnamese
+thâm sau mụn nè hoặc là mụn ẩn mà có kèm theo là nám và tàn nhang thì khi đó chúng ta vẫn có thể sử dụng những cái,Vietnamese
+những người cao tuổi rất dễ chuyển thành những cái tình trạng xơ vữa mạch và đặc biệt là khi các cái xơ vữa động mạch ở,Vietnamese
+những cái khó khăn mà bác gặp phải thì cũng rất là nhiều người bệnh người ta cũng đang gặp phải tuy nhiên là người ta,Vietnamese
+thân não đến vùng bụng chỉ đạo nhiều quá trình của cơ thể mà chúng ta không kiểm soát một cách có ý thức chúng có các,Vietnamese
+không có hồi phục lại trên được nữa tế bào não nó đã chết rồi nó không tái sinh thì như vậy thì,Vietnamese
+tĩnh mạch nó đưa về tim thì các cái van đó nó phải đóng kín lại và nó không để,Vietnamese
+qua các chỉ số trên cho thấy hoạt chất kga1 có khả năng giảm đau chống viêm,Vietnamese
+trong tỷ lệ của những vi khuẩn này có thể thay đổi biểu hiện thực tế dna của bạn hai chủng lợi khuẩn được nghiên cứu,Vietnamese
+đó nữa thì bác cũng có hỏi là một số những các cái thuốc như là chống đột quỵ,Vietnamese
+axit clohidric của dạ dày chính lại yếu tố kích thích tuyến tụy bài viết ra,Vietnamese
+và dẫn đến tình trạng xơ vữa mạch đấy thế và cái rối loạn mỡ máu của bác thì chắc là cũng không rõ là bác cũng đã được các,Vietnamese
+sao bởi vì khi mà bác bị huyết áp cao bác bị đái tháo đường mà thậm chí có,Vietnamese
+thể nào chịu đựng được quá trình điều trị tiếp theo để có thể hoàn tất được cái lộ trình trong cái điều trị ung thư,Vietnamese
+một cái cái thoái hóa cột sống thắt lưng bác có đau cột sống thắt lưng tuy nhiên ngoài ra lại có cái câu chuyện là đau,Vietnamese
+viện và nhiều lần như thế này cũng là một cái câu chuyện rất là có ý nghĩa có rất nhiều người khi mà đến thăm khám với,Vietnamese
+chúng ta cũng phải nói lại với nhau để chúng ta hiểu thế nào là đông trùng hạ thảo đông trùng có nghĩa là mùa đông vì,Vietnamese
+giữa ruột và não của bạn thực sự là hai chiều giống như não bộ của bạn có thể gửi sự phấn khích đánh dạ dày ruột của,Vietnamese
+hơn cái cục pin không sạc chút xíu đó là mình phải sạc vào ban đêm sạc như thế nào và theo dõi cái cái cái cái cái cái,Vietnamese
+mà gọi là xây xẩm choáng váng hoặc là chóng mặt thì thực sự nó nó nó gặp,Vietnamese
+đúng cái chỉ định và tái khám định kỳ theo đúng cái là cái cái lịch hẹn của bác sĩ để bác sĩ mình sẽ đánh giá xem,Vietnamese
+đều có bệnh nền mãn tính người thì bị huyết khối hệ tĩnh mạch người thì,Vietnamese
+nhận ra rằng hệ miễn dịch hoạt động tối ưu khi nó ở trạng thái cân bằng hệ miễn,Vietnamese
+giả tại phim trường nêu câu hỏi tiếp theo ạ xin nghe câu hỏi của em em xin hỏi là hiện nay đã có những cái công,Vietnamese
+máu đặc biệt là những cái cái lượng mà cholesterol có trọng lượng phân tử thấp hay còn gọi là mỡ xấu ấy khi nó tăng cao,Vietnamese
+máu cơ tim nhồi máu não hoặc là những cái tình trạng như là các cái tê bì và là những cái viêm tác động mạch chi thế,Vietnamese
+tác động của hóa trị và xạ trị thì thực sự là rất là lớn đối bộ máy tiêu hóa và,Vietnamese
+trùng trong phòng thí nghiệm đã cho thấy là có biểu hiện lo âu cấp tính không có khả năng xử lý căng thẳng viêm ruột mạn,Vietnamese
+alo bác sĩ thực hiện được phát sóng trên,Vietnamese
+rồi ảnh hưởng đến khả năng sinh sản,Vietnamese
+cái yếu tố về máy móc để xác định cái dẫn đường cái điện cực đi vào đã là một,Vietnamese
+khối lượng và trọng lượng cơ thể của chúng ta là vài chục kilogam và nếu như chúng ta không nuôi dưỡng cơ thể chúng ta thì,Vietnamese
+cách đầy đủ cũng là đứng là một cái biện pháp để hạn chế các cái tác động của cái thời tiết và cái thứ ba nữa là cái việc,Vietnamese
+chính là các cái tác động về mặt vật lý nghĩa là bị quá tải bị chấn động bị các cái vi chấn thương tất cả những cái,Vietnamese
+dạ cháu có nghe nói là sau khi mà bác tiêm vắc xin hay là bác uống cái gì đó,Vietnamese
+vẫn đang rất nặng vẫn có những trường hợp rất nặng đặc biệt là đời những người ở trẻ em trẻ nhỏ tuổi những người già và,Vietnamese
+nhóm thuốc hiện nay mà để phổ biến trong cái điều trị bệnh lý béo phì đó là thứ nhất đó làm có nhóm thuốc mà điều trị,Vietnamese
+mà em chỉ bổ sung một sản phẩm về em nên chọn được sản phẩm nào thì bác sĩ cũng đã có chia sẻ để chúng ta nên chọn bổ,Vietnamese
+cái quả cao nhất chứ còn nếu mà chúng ta chỉ thấy rằng là ghi đông trùng hạ tống chung chung thôi mà chúng ta không tiểu,Vietnamese
+cao tuổi hiện nay gặp phải cái tình trạng bệnh lý nền nè sức khỏe giảm sút và gây ảnh hưởng đến chất lượng của cuộc sống như là cái câu chuyện sau đây của,Vietnamese
+loại sữa rửa mặt nào mà sau khi chúng ta rửa mặt xong mình thấy da mình nó vẫn mềm vẫn dịu nhẹ và mình có cảm giác mà nó sạch đó chứ không cần là nó phải quá,Vietnamese
+một thế giới riêng của mình không có muốn tiếp xúc với ai và họ cảm thấy là,Vietnamese
+gáy nó mới đau nó chèn lên thần kinh tê liệt tay thế uống thuốc nó đỡ làm nhiều lúc mà rét,Vietnamese
+đoạn này thì nó không không có quá phức tạp nó khoảng tầm tầm khoảng bốn mươi bốn lăm phút thôi sau khi mình kết nối thành công,Vietnamese
+nhiệt để mà hủy những cái tế bào mà mình được xem như là cái nguyên nhân gây bệnh thì nó cái bất lợi của các phương hai,Vietnamese
+trung là bởi vì cái người f1 này nguy cơ mắc bệnh mà truyền từ cái người f0 là,Vietnamese
+đường huyết hiện nay tân dược là càng ngày nó càng phát triển càng ngày nó càng phong phú và rất nhiều loại rất là,Vietnamese
+da bị bít tắc lỗ chân lông nhiều do đó nên dù chúng ta chọn lựa cái chu trình chăm sóc da nào đi nữa thì chúng ta cũng phải,Vietnamese
+vân vân một số người thì họ bản thân của họ bị cái chứng rối loạn về ăn uống ăn họ cưỡng không nổi vân vân,Vietnamese
+là làm việc hàng ngày để phần nào có thể khắc phục được cái tình trạng mà bác phải di chuyển nhiều như vậy mà cái bệnh,Vietnamese
+soát được triệu chứng run cái triệu chứng thứ hai mà kích thích não sau có thể giúp ích được đó là cải thiện được triệu chứng,Vietnamese
+toàn một trăm phần trăm từ thảo dược thiên nhiên từ những cái như là thành phần như enzyme immunesoyz này từ đường món đậu tương lên men của,Vietnamese
+các cường độ cho nó phù hợp nhất để điều chỉnh cái gia giảm cả lượng thuốc thì làm cái quá trình rất là dài và có thể,Vietnamese
+mong manh rất là dễ có những cái biểu hiện là như như vậy thế và cái câu hỏi đặt ra của mc mà mà chúng ta sẽ phải trả,Vietnamese
+chi phí bệnh nhân nếu mà đặt điện cực kích thích não sâu tùy vào cái loại pin,Vietnamese
+vâng chào bác xin lỗi bác vì đã để bác chờ hơi lâu vâng bác ơi ngày hôm nay thì bác có vấn đề gì liên quan tới xương,Vietnamese
+mình thì vẫn có thể là làm lây nhiễm vi trùng vào tuy nhiên thì mọi người cũng là cũng không quá lo lắng tại,Vietnamese
+khi mở sọ ra người ta đi tới thời điểm đó để người ta cắt tuy nhiên thì nó tàn phá rất là nhiều và vì cái lịch sử nó để,Vietnamese
+parkinson gây ra do đó nếu mà một người bệnh parkinson mà có táo bón chúng ta sẽ xem xét là cái táo bón này,Vietnamese
+dội đến mức dẫn đến sốc phản vệ một phản ứng cực đoan có thể gây chết người ngoài,Vietnamese
+ngoài nghĩa từ phân phối như vậy thì nếu mà nó chạy lên chân mạch máu não thì gây ra đột quỵ,Vietnamese
+ra tắc động mạch não và khi tắc động mạch não đó sẽ gây tình trạng nhồi máu não như vậy đó là những cái hậu quả những biến,Vietnamese
+kém hơn trong việc phát hiện bệnh cùng với những thách thức của lão hóa là thực tế rằng người cao tuổi thường phải vật,Vietnamese
+mạch máu lên lên não ví dụ như mạch cảnh chẳng hạn đây là một cái bệnh lý ở mạch cảnh hẹp mạch cảnh rất là nhiều người bị cái các,Vietnamese
+lại hiệu quả tốt cho làn da của mình chúng ta sẽ dành thêm thời gian cho khoảng ba câu hỏi nếu như quý vị bởi vì,Vietnamese
+một sự khác biệt lớn hệ vi sinh vật phương tây thiếu sự đa dạng đáng kể và,Vietnamese
+gia đình và những người ở trong xã hội càng tốt thì sẽ ở trong cái môi trường đó cái người béo phì nó sẽ được thuận,Vietnamese
+đau của người ta hơn ngoáy sâu vào cái sự tự ti của họ hơn rồi họ làm cảm cho làm cho,Vietnamese
+về dinh dưỡng thì tất cả những việc như vậy đó là mình phải tiếp tục mình điều trị,Vietnamese
+các thực phẩm mà có chứa vitamin và khoáng chất rồi có thể uống bổ sung thêm,Vietnamese
+về tâm lý giống như đã nêu trên và người ta thấy rằng từ hai chục cho đến bảy chục phần trăm người béo phì đã hoặc là đang,Vietnamese
+thì thì nếu không cần quá quan trọng thì mình sẽ dùng những cái cho thiết bị như vậy sau khi đi chụp mri xong thì bắt,Vietnamese
+rồi thứ hai lên đừng có kỳ thị tôi quá hãy coi tôi cũng giống như những người khác thôi chứ đừng có cho là tôi là mập,Vietnamese
+những cái bài tập mà nó dùng cái sức mạnh nhiều quá mà nó trong thời gian ngắn ví dụ nôm na cụ thể như,Vietnamese
+lực do virus chủng delta này gây ra nó có thể làm cho các tỷ lệ mà cái người mắc bệnh do cái virus sarscov2 chủng,Vietnamese
+không được phép phải chờ xem nó có nó có hồi phục hay không mà ta thấy có triệu chứng thì phải coi như đó là đột,Vietnamese
+vào đó thì thật sự là các cái đó là những rào cản rất lớn đối với lại các,Vietnamese
+máu trong đó đặc biệt là tĩnh mạch của chúng ta thế thì cái viên nang đông trùng hạ thảo nó cũng có rất hữu ích cho,Vietnamese
+cơ thể chiết xuất nhiều calo hơn từ thức ăn và hỗ trợ hấp thu chất béo do đó chúng liên quan đến việc tăng cân khi,Vietnamese
+là đơn đơn độc như vậy thì nó sẽ làm cho cái tình trạng mà béo phì đó nó có,Vietnamese
+chỉ định điều trị thuốc đó rồi thì bệnh viện phải chuẩn bị đầy đủ sẵn sàng các,Vietnamese
+như vậy thì nó có đạt cái hiệu quả hay chưa có thấp quá hay có cao quá hay không để điều chỉnh kịp thời một cái rắc rối là,Vietnamese
+học serotonin tạo cảm giác dễ chịu trong não bạn có thể ngạc nhiên khi phát hiện,Vietnamese
+chúng ta thế ngoài ra thì những cái ví dụ như là đối với những người bị ung thư thì rượu bia thì chắc chắn là chúng,Vietnamese
+khiến cho máu lưu thông kém đến não tim và các chi đồng thời nếu không được phát hiện sớm và điều trị kịp thời sẽ dẫn đến,Vietnamese
+giới ngày nay nhưng đã đến lúc phải đón nhận một khía cạnh khác của câu chuyện vi khuẩn trong cuộc sống của chúng ta,Vietnamese
+cho sức khỏe tôi sẽ giải thích vì sao nó thậm chí tệ hơn những gì chúng ta từng nghĩ,Vietnamese
+các loại rau mầm mà mình đang nói ở đây đấy ví dụ như là những cái rau mà quý vị đưa ra thì đúng là những cái loại rau đó,Vietnamese
+chúng ta có thể chế biến các món ăn món ăn bị có canh món ăn nấu thành súp món ăn nấu thành cháo thì sẽ làm cho,Vietnamese
+tâm nhĩ nó sẽ tăng lên mà một khi mà huyết khối đã được hình thành trong tâm,Vietnamese
+thấy là những người có bệnh lý nền về huyết áp cao mỡ máu cao thì họ chưa chia sẻ là thường xuyên họ sẽ gặp phải các,Vietnamese
+kích thích não sâu thì phương pháp này sẽ giúp cải thiện cho người bệnh dao động trung bình khoảng từ năm mươi cho tới tám mươi phần,Vietnamese
+phục một cách phù hợp nhưng mà việc đầu tiên chúng tôi khuyên ngay lập tức bây giờ thì là bác,Vietnamese
+hay là các bệnh lý về tim mạch cũng như là các cái tuần hoàn não trong đó như là trong chương trình hôm nay đó chính,Vietnamese
+cuộc hẹn với bệnh viện trước khi mình muốn đến đó để thực hiện điều gì khám bệnh hay là làm bất cứ vấn đề gì,Vietnamese
+đầu chương trình ngày hôm nay xin hỏi,Vietnamese
+hoạt động những cái chất tẩy rửa bề mặt như là và quý vị khán giả có thể nghe qua như là sls hay còn gọi là sodium,Vietnamese
+ngừa cái giảm cái xơ vữa động mạch này giúp cho cải thiện các triệu chứng như máu lên não lên tim để hỗ trợ khi sử,Vietnamese
+mà con tôi sang thăm thì tôi có bảo con tôi mua cho tôi mười hộp để dùng thử sau,Vietnamese
+cái tác động trực tiếp đó bằng cách là gì ạ chúng ta mặc đủ ấm này bằng cách là chúng ta che chắn vào những cái vùng mà,Vietnamese
+sếp cả hai tình huống đều được coi là căng thẳng với cơ thể mặc dù chỉ một,Vietnamese
+người ta lại không hiểu sao mà người ta lại tìm ra được rằng là à phải nên kết hợp thêm viên đá màu thủ với cả đằng sơn,Vietnamese
+gia đình cũng như cộng đồng cái sự hiểu biết chung không chỉ riêng người bệnh béo phì mà cái sự hiểu biết chung của,Vietnamese
+phục thì là không tham nhũng não không hồi phục thì nó mới là đột quỵ thì nó cũng phải chờ như vậy ta mất,Vietnamese
+cơ của những người đã bị đột quỵ não thì đợt sau vẫn hoàn toàn có thể và nó cũng rất là cao thế nên là mình hoàn toàn là,Vietnamese
+cơ thể hoặc hệ thống riêng lẻ hầu hết các đồng nghiệp của tôi sẽ nói những gì xảy ra trong ruột sẽ ở trong ruột quan,Vietnamese
+cái thứ hai là cái dinh dưỡng ở sau ung thư nó còn có vai trò vô cùng quan trọng đó,Vietnamese
+bao giờ đối tượng được việc thấu hiểu các mối liên hệ giữa ruột và não giúp,Vietnamese
+hai nhóm trẻ này họ đã nghiên cứu các tác động sức khỏe liên quan và đưa ra nhiều kết luận đáng báo động những,Vietnamese
+động mạch cải thiện lưu lượng tuần hoàn vành tuần hoàn não những sản phẩm đó hiện nay rất là nhiều và tại sao người,Vietnamese
+tôi đã có chia sẻ là chúng ta nên chọn những cái sản phẩm này mà có chứa những cái thành phần hoạt chất dưỡng sáng lành,Vietnamese
+rất là sống khép kín tự ti và họ không có đủ can đảm để có thể đến gặp các bác sĩ để nhìn nhận trực tiếp vào cái vấn đề,Vietnamese
+có thể hiểu phẫu thuật kích thích não sâu là đặt một dụng cụ vào trong não người bệnh vậy về lâu dài thì có ảnh hưởng gì,Vietnamese
+mang lại cái hiệu quả cao nhất vì chúng ta biết là cái quá trình để làm giảm cho các cái mảng xơ vữa là một cái quá trình,Vietnamese
+cái cái mức độ tối đa của từng người nó sẽ khác cái công việc của mình đòi hỏi nó vẫn phải vận động thì đương nhiên là,Vietnamese
+rằng là sữa là không có lợi nhưng mà tuy nhiên chúng ta thấy trên thị trường rất nhiều loại sữa mà đặc biệt nếu chúng ta,Vietnamese
+lượng chất béo cho mỗi bữa ăn của ung thư thì nó tùy vào rất là nhiều ví dụ như trong một số cái ung thư dạ dày,Vietnamese
+bằng cách nào và cách thứ nhất là chúng ta bình thường trong ở nhà quý vị có thể cho thêm dầu ăn bát cơm không cho dầu,Vietnamese
+là đỏ rát ngứa trên các vùng da mà chúng ta mới thử bằng axit lactic thì chúng ta,Vietnamese
+tinh thần và với mục tiêu chính của chương trình hôm nay đó là đi sâu vào các khía cạnh tâm lý của người bệnh béo,Vietnamese
+uống thuốc như vậy có một cái thói quen như vậy khi tập được cái thói quen như vậy á thì có việc mà chúng ta không bỏ,Vietnamese
+hạ thảo cũng như nấm hầu thủ cũng như đẳng sâm việt nam nó thanh trừ gốc tự do à nó chống quá trình lão hóa nó làm chậm,Vietnamese
+thiểu năng vành vâng chúng ta biết đầu tiên phải nói đấy là immunesoyz immunesoyz nó chính là một cái loại enzym mà,Vietnamese
+nguy cơ làm nhiễu hoạt động của máy thì mình sẽ phải quay trở lại cái bác sĩ,Vietnamese
+khu như vậy thì không có tiếp cận với ai kể cả những người trong gia đình thì họ cảm thấy rất là lạc lỏng cảm thấy rất,Vietnamese
+thương của ruột nếu các sự kiện diễn ra trong ruột không quá quan trọng đối với sự sống thì phần lớn hay miễn dịch của,Vietnamese
+công nghệ bốn chấm không như thế này chúng ta có thể tiếp xúc được với rất nhiều nguồn nhưng không phải là nguồn nào cũng đúng và trong số đó thì có những cái nghiên,Vietnamese
+nhóm tế bào trong não bị thoái hóa không thể kiểm soát được vận động của cơ bắp khiến cho con người đi lại khó khăn cử,Vietnamese
+nơron thần kinh nó mất đi và đó không hồi phục nó càng lớn và nữa là gì là kết,Vietnamese
+phần tiếp theo của chương trình chúng ta sẽ cùng đến với phần giải đáp câu hỏi thắc mắc của tất cả quý vị khán giả gửi,Vietnamese
+các bác sĩ sẽ tham gia giao lưu và trực tiếp tư vấn trong chương trình ngày hôm nay gồm có xin được trân trọng giới,Vietnamese
+nên phổ biến trong nhiều sản phẩm thực phẩm và có thể được tìm thấy trong các cửa hàng tạp hóa thông thường biết cách,Vietnamese
+vì vậy cũng dẫn đến sụt cân một nguyên nhân thứ ba nữa cho ở trong điều trị đó chính là khi chúng ta sử dụng xạ trị khi,Vietnamese
+cơ thể hệ miễn dịch sẵn sàng phản ứng nhanh nếu gặp lại các phân tử không tự thân nhưng một thí nghiệm được thực hiện,Vietnamese
+được xem là không có chỉ định y khoa tức do sản phụ yêu cầu vì vậy mối quan tâm,Vietnamese
+lan bệnh dại thì chúng ta cần làm gì để,Vietnamese
+đi bài kiểm tra sắp tới sẽ cho bạn biết các yếu tố nào về lối sống và quan điểm,Vietnamese
+nhức mỏi chân tay quý vị và các bạn chúng ta đang quay trở lại với chương trình tư vấn trực tiếp,Vietnamese
+những loại thảo dược nào mà có tác dụng như thế nào đối với những người gặp bệnh lý như thế này thưa bác sĩ có thể nói là,Vietnamese
+chúng ta cho dầu là dầu mà chúng ta cho vào cuối bữa ăn để mà cũng không,Vietnamese
+quan trọng là bác nên đi thăm khám luôn để sử dụng các thuốc huyết áp ngay bây giờ bác nhé không chần chờ còn nếu mà,Vietnamese
+trong khi một số loại thuốc chẳng hạn như penicillin tiêu diệt mầm bệnh trực,Vietnamese
+có tăng cao không và khi mà ở cái lúc đó mà huyết áp vẫn cao thì như vậy là mình đã bị tăng huyết áp rồi thế và lúc đó là,Vietnamese
+đường miệng và thậm chí chúng ta về sử dụng các phương pháp nuôi dưỡng khác như là thậm chí có thể phải là hỗ trợ bắt,Vietnamese
+những triệu chứng như là ở các cái hồi hộp trống ngực này hoặc là nhịp tim nhanh những cái rối loạn nhịp tim hoặc,Vietnamese
+trị trong cái điều trị của y học hiện đại để làm sao giúp cho chúng ta có thể tiêu diệt được cái khối u đó các tế bào,Vietnamese
+các cái bệnh lý như là đau tức ngực này hồi hộp trống ngực này đấy thế và và,Vietnamese
+và bởi vì sao bao giờ khi mà cái vấn đề mà phẫu thuật sọ não hoặc là bất kỳ một cái phẫu thuật nào bao giờ các bác sĩ,Vietnamese
+cần thiết để giúp kiểm soát tốt huyết áp này kiểm soát tốt các cái mỡ máu của mình cũng như kiểm soát tốt các cái tình,Vietnamese
+đấy thì cái câu chuyện là gì ạ đạp xe ở trong nhà nó rất là an toàn nhưng mà đạp xe ra ngoài thì nó lại rất nhiều chuyện,Vietnamese
+cái cái cái người bệnh béo phì bên cạnh đó thì người bệnh béo phì chưa được cung cấp hay là chưa được tiếp cận những cái,Vietnamese
+ngừa dại xong thì bị suy giảm trí nhớ,Vietnamese
+các bác sĩ phụ trách trên nhiều lĩnh vực sức khỏe khác nhau để cùng giúp cho người dân giải quyết những vấn đề mà,Vietnamese
+chúng ta cho cái nước giá đấy vào chúng ta trộn đều lên chúng ta để chỉ khoảng năm mười phút thôi bát cháo loãng ra như,Vietnamese
+trụ bên trong cơ thể chúng ta hệ miễn dịch của con người những người yêu khoa,Vietnamese
+có chỉ định mà lấy cục máu đông đó trong cái mạch máu với chúng ta mà làm nghẽn mạch máu trên não đó thì chúng ta,Vietnamese
+virus sinh vật đơn bào và các ký sinh trùng nhân thực mà cũng đóng vai trò,Vietnamese
+thêm những triệu chứng của trầm cảm hay là lo âu thì mình cũng cần thiết phải điều trị không chỉ có điều trị bằng tâm,Vietnamese
+sẽ hoàn toàn cách mạng hóa việc điều trị các bệnh lý thần kinh và tôi không thể diễn tả bằng lời rằng tôi cảm thấy vinh,Vietnamese
+như là hoa thủy tiên biển cũng rất là có hiệu quả trong cái dưỡng sáng da dành cho da nhạy cảm và đã lắng nghe rõ câu,Vietnamese
+ung thư thì thứ nhất chanh không điều trị được ung thư như cách bạn nói thứ hai là nếu mình cứ duy trì như thế trong vài,Vietnamese
+phần trao đổi của các bác sĩ tham gia đồng hành trong chương trình ngày hôm nay đầu tiên thì chúng tôi sẽ được mời,Vietnamese
+ngày hôm nay khách hàng có nhu cầu cũng như là có những cái câu hỏi hay nhất gọi về chương trình thông qua số tổng đài,Vietnamese
+người bệnh sẽ có triệu chứng nhẹ thường là ở một bên và người bệnh vẫn còn sinh,Vietnamese
+mua toner hay là serum thì món nào nó cận hơn ạ và trước tiên mà chúng ta trả,Vietnamese
+hay đường ruột của con bạn trong trường hợp được kê đơn kháng sinh cho một nhiễm trùng trong thai kỳ tốt nhất có thể theo,Vietnamese
+bây giờ thì ở đầu dây bên kia chúng tôi cũng xin được kết nối với vị khán giả tiếp theo xin được kết nối cho tôi với,Vietnamese
+tỉnh tuy nhiên cũng không có ổn định lý do rằng là cái đặc tính của cái xét,Vietnamese
+hoặc là bị đốt điện để cho không còn rung nhĩ nữa mà nếu không còn rung nhĩ thì không còn biến chứng và chắc chắn,Vietnamese
+cho sức khỏe của chúng ta đặc biệt là đối với những người có nguy cơ bị xơ vữa động mạch,Vietnamese
+khoa trong đó tâm lý là một cái tác nhân tâm lý là một cái bộ phận để giúp cho,Vietnamese
+tuyệt vời với các tế bào các quá trình hóa học và sinh học của nó tất cả các hệ,Vietnamese
+áp nè xơ vữa động mạch nè huyết áp cao rối loạn nhịp tim suy tim lú lẫn hay quên alzheimer thì chúng ta cũng có thể gọi,Vietnamese
+chó nhưng mà những động vật,Vietnamese
+cái rung nhĩ đó đi chúng ta phải điều trị bằng thuốc hoặc là bằng sốc điện,Vietnamese
+nhiều hơn thì rất cần cái đai đó cái thứ hai nữa là chúng ta cũng nên hạn chế cái việc mà đi lại nhiều đây là trả lời,Vietnamese
+các nền tảng của alo bác sĩ ngày hôm,Vietnamese
+kinh nên đi lại khó thì cái việc mà bác sử dụng các cái thuốc mà chống viêm theo cái biện pháp như kga1 như chúng tôi,Vietnamese
+thì chúng tôi sẽ tiến hành điều chỉnh lập chương trình để nó cải thiện nó hỗ,Vietnamese
+tham gia vào câu chuyện về viêm trong cơ thể bạn hãy để tôi phân tích điều này một chút cho bạn mặc dù mỗi người trong,Vietnamese
+ta thoa lại bạn nên nó trước là một lớp kem dưỡng ẩm mỏng nhẹ sau đó thì bạn hãy thoa kem chống nắng lên bề mặt da,Vietnamese
+người nhật bản này kết hợp với cả hòe hoa đan sâm rồi là hoàng liên và l-carnitine,Vietnamese
+phì cân nặng thể sẽ giúp được tới giảm tới năm mươi phần trăm đường huyết ở những cái bệnh nhân đái tháo đường bên cạnh đó cải,Vietnamese
+tố đi lên phía trên bề mặt da và cuối cùng khi mà cái hàm lượng melanin trên bề mặt da của chúng ta đã quá nhiều đã,Vietnamese
+chúng ta bao phủ bên trong và bên ngoài của chúng ta mà còn giúp cơ thể chúng ta thực hiện một loạt các chức năng cần,Vietnamese
+người ung thư một điều rất quan trọng đó làm việc mình bổ sung thêm kẽm kẽm làm thay đổi vị giác của người ung thư,Vietnamese
+số công nhận rằng là sự đa dạng và chủng loại là điểm then chốt tôi cũng đành chỉ,Vietnamese
+lắng đọng những chất mỡ hoặc giảm là những chất khác nữa để nó tạo ra những,Vietnamese
+khi chúng ta dùng vào ban ngày đó mà một một cái nguyên một ngày của chúng ta làm việc thì có thể gây ra những cái,Vietnamese
+sao chất bổ trợ là cần thiết khi làm như vậy ông đã tìm một cách tiếp cận hoàn,Vietnamese
+có thể là do quá phấn khích có thể đó là trước khi làm một bài kiểm tra quan trọng phát biểu trước một nhóm người,Vietnamese
+quyết định ở một mức độ phi thường bởi những gì diễn ra trong ruột đúng vậy,Vietnamese
+như vậy thì thực ra nó chỉ là hai cái hai cái mức độ khác nhau của một tình trạng,Vietnamese
+chính vì vậy đối bệnh ung thư do chính bản thân khối u có liên quan đến việc không chỉ giảm cân mà còn giảm mất khối cơ tức,Vietnamese
+phân tích dữ liệu thí nghiệm thu được tự viết chương trình máy tính để thúc đẩy quá trình này buổi tối ngày năm,Vietnamese
+mà chưa phải mổ đúng không ạ mổ,Vietnamese
+động mạch và nó gây nên tổn thương như vậy là hai cái tác nhân nó chính là đái tháo đường và cái rối loạn mỡ máu đã làm,Vietnamese
+bác có thể chia sẻ cụ thể hơn về cái tình trạng bệnh của mình được không ạ vâng,Vietnamese
+tẩy trắng và dưỡng sáng vẫn chưa được phân biệt rõ ràng vào mọi người hay nhầm lẫn hay tưởng là chung với ạ nên là,Vietnamese
+cái cường độ lên trở lại theo cái thời gian diễn tiến của bệnh chứ không thể là ngưng thuốc được cái này cảm ơn bác sĩ,Vietnamese
+dùng sản phẩm có thành phần làm sáng da an toàn như niacinamide kết hợp với các chiết xuất từ thực vật đáp án c đó là,Vietnamese
+giúp cho máu không lên não lên tim tốt này giúp cho cải thiện các triệu chứng của bác đang có đấy ạ đau đầu hoa mắt,Vietnamese
+là một sự tán thành lớn cho quan điểm rằng thực phẩm quan trọng vượt trội hơn hoàn cảnh khác trong cuộc sống mà chúng,Vietnamese
+sức đề kháng cái thứ hai là nó bồi bổ cho tất cả các tạng phủ trong cơ thể,Vietnamese
+đến một trăm sáu mươi lần một phút và đồng thời tim không còn đập một cách đều đặn nhịp nhàng nữa mà đập lộn xộn thì chính,Vietnamese
+dịch bệnh và bây giờ giãn cách thì cô không thể đi lấy thuốc được thì cô có thể sử dụng cái toa thuốc này đi ra ngoài,Vietnamese
+nhắc lại là ngày hôm nay những ai mà đang có thắc mắc liên quan đến bệnh lý về tim mạch nè huyết áp cao nè mỡ máu,Vietnamese
+phải như thế này tức là phải phải có sữa để nuôi con mình mà và người ta nói là,Vietnamese
+với cả các cái chi trong đó là nó dẫn đến tê bì chân tay thứ hai cũng có thể do những các cái rối loạn ví dụ như,Vietnamese
+bác sĩ tóc mà bị tổn thương người bị gãy rụng hư tổn á thì mình cần nên tìm những,Vietnamese
+những cái nỗi được trị liệu hay là những cách thức trị liệu nó chưa có phù,Vietnamese
+cuộc đời của người bệnh cũng giống như là quá trình điều trị thuốc vậy,Vietnamese
+chứng tai biến mạch máu não hoặc là di chứng của chấn thương chống trầm cảm chống các cái vấn đề liên quan đến rối,Vietnamese
+hơn người bệnh nếu mầm có không may mắc bệnh ung thư ạ khán giả có số điện thoại,Vietnamese
+khả năng giảm sưng viêm của kga1 duy trì ở ngưỡng bảy mươi tám phần trăm,Vietnamese
+mong là cô là nên định kỳ tái khám thường xuyên trong đó mình được làm đốt,Vietnamese
+phát triển của trẻ sơ sinh và chống lại những tác động tiêu cực tiềm ẩn từ các can thiệp y tế được thực hiện trong quá,Vietnamese
+cách chữa trị nhanh chóng hay loại thuốc nào để thậm chí kìm hãm sự phát triển nhanh chóng của nó đó là một việc đau,Vietnamese
+chuyển lạnh thì là nó rất là buốt và nó rất là đau nhức không thể làm được cái,Vietnamese
+nhưng nó theo một nguyên tắc thế này cái nang tóc mình nó tốt phát triển nó chuyển,Vietnamese
+bệnh lý về dạ dày nữa thế thì cái quan trọng đầu tiên chúng ta lưu ý là huyết áp với đái tháo đường đây là hai cái căn,Vietnamese
+bệnh nhân đến bệnh viện cấp cứu và đặc biệt là những bệnh viện có điều trị đột quỵ và có thể là có thể gọi hệ thống,Vietnamese
+khác cấu trúc chỉ điểm của một mầm bệnh sẽ phải là một cái gì đó rất quan trọng đối với vòng đời của nó để mầm bệnh cực,Vietnamese
+thành phần như immunesoyz này hòe hoa này l-carnitine fumarate để hoàng liên này với cả đan sâm nữa thì rất tốt,Vietnamese
+bào tim trong điều kiện thiếu oxy cho nên có thể nói rằng là với hệ thống tim,Vietnamese
+thành các mảng xơ vữa giúp cho máu thông lên não lên tim tốt này đấy tức là giúp cho cái tuần hoàn máu trao đổi chất của,Vietnamese
+miễn dịch một số ít các gen ảnh hưởng đến đáp ứng cá nhân của chúng ta đối với,Vietnamese
+hệ tác động qua lại hai chiều giữa tâm lý người bệnh và cái căn bệnh béo phì này đó nó thường khiến cho cái tình,Vietnamese
+của tia uv thì sẽ kê ra những cái tín hiệu đuôi đến các tế bào sắc tố làm cho,Vietnamese
+dụng rất nhiều trong một số các cái sản phẩm hay là những cái thuốc ví dụ như rutinc để giúp tăng cường cái sức bền,Vietnamese
+này họ tự làm vật lộn với việc làm sao để giảm cân như là tự coi những cái phương pháp ở trên mạng hoặc là làm theo,Vietnamese
+đúng là nếu mình coi thiếu máu não thoáng qua đột quỵ là một thì vẫn là rất là phù hợp đặc,Vietnamese
+điều trị nhiệt đó người ta sẽ làm cho thay đổi cái nhiệt độ mà đặc biệt là đối với những các kim loại sau điện cực đang,Vietnamese
+các cái biến chứng như là các cái đột quỵ não hay là những cái cái hoại tử ở vùng chi và như vậy thì bác nên sử dụng,Vietnamese
+thứ đó nó có thể làm cho tình trạng béo phì nó sẽ càng nặng thêm và thực sự đó làm,Vietnamese
+kiểm tra để phòng trừ gặp các biến chứng của cúm a,Vietnamese
+phần tâm nhĩ và phần tâm thất tâm thất á được đảm nhận một cái chức năng rất là,Vietnamese
+là vừa được làm sạch mà vẫn bảo đảm được cái lớp màn ẩm tự nhiên trên bề mặt da làm tránh đi các tình trạng là da chúng,Vietnamese
+tuổi và bác cũng đã bị đột quỵ là cũng tính đến bây giờ là cũng được được mười năm hơn mười năm rồi đúng không chị vâng,Vietnamese
+nguyện và hoạt bát những câu chuyện này không phải là trường hợp ngoại lệ đối với tôi nhưng theo thước đo tiêu chuẩn,Vietnamese
+đó siêu âm hoặc là mri cái gì đó thì người ta sẽ tắt máy hoặc là đưa về cường,Vietnamese
+đó giúp tạo ra các giải pháp đột phá trong nâng cao tình trạng miễn dịch của cơ thể giúp chống lại nhiều căn bệnh,Vietnamese
+lại có cái tác động phụ lên cái hệ xương khớp của chúng ta đặc biệt là gây ra các cái loãng xương và bản thân bác cũng đã,Vietnamese
+vân vân vậy thì thực hư thông tin này,Vietnamese
+nghĩa là chúng tôi vẫn hay khuyên là gì ạ chúng ta có thể sau một thời gian ba mươi phút một tiếng chúng ta sẽ dậy đi vệ,Vietnamese
+điều thứ hai cái điều thứ ba là dù là tân dược hay là các sản phẩm có nguồn,Vietnamese
+đường huyết như là insulin hoặc là các nhóm thuốc hạ đường huyết uống như là sulfonylurea thì,Vietnamese
+bị tiểu đường tiểu đường thì tức là mặc dù là bác cũng đã kiểm soát tốt rồi nhưng tuy nhiên thì là cái tiểu đường nó,Vietnamese
+đến những kết quả tốt hơn trong quá trình điều trị,Vietnamese
+cũng phải hỏi với bệnh nhân là là là là bản thân bác sĩ nhiều khi trong cái lúc mà chúng tôi hướng dẫn cho người,Vietnamese
+của chúng ta nó đã bị suy giảm sức đề kháng rất nhiều rất là mệt mỏi và từ đó thì các bệnh lý nền nó sẽ nổi trội nên,Vietnamese
+của nó về nhiễm trùng trong quá khứ được gọi là miễn dịch thích ứng thuật ngữ,Vietnamese
+người bệnh để có cái cái cái cái sự hiểu biết hơn trong các nhận thức thay đổi cho nó tốt hơn để có thể cải thiện chất,Vietnamese
+can thiệp nếu mà cái kì vọng sống còn của mình kéo dài lâu thì mình có thể mình cân nhắc cái,Vietnamese
+giáp tái phát thì có thể đẩy vào rung nhĩ như vậy thì những cái người mà đã bị cường giáp điều trị ổn định rồi thì,Vietnamese
+tóm tắt nhanh về những gì việc sinh bằng phương pháp mổ có thể chứa đựng dựa trên một quần thể lớn và các nghiên cứu có,Vietnamese
+đồng thời nó làm giảm nhanh các triệu chứng thế thì cái với trường hợp của bác ví dụ có cao huyết áp có đái tháo đường,Vietnamese
+loại thảo dược có rất nhiều những công dụng tuyệt vời trong việc là chúng ta tăng cường sức đề kháng sức khỏe dùng,Vietnamese
+phương pháp này được thực hiện như thế nào trên người bệnh ta hi sinh như quý vị hãy cùng chúng tôi chúng ta cùng tìm,Vietnamese
+sản phẩm để cân bằng da chúng ta gọi là toner và một cái kem dưỡng ẩm và lưu ý là nhớ là phải chống nắng nhé vào buổi,Vietnamese
+polysaccharide đấy là một tỷ lệ mà trong một cái viên nang mà nó được như thế là,Vietnamese
+ghi là ban đêm chúng ta sẽ sử dụng vào ban đêm không phải tự dưng mà người ta phân ra ban ngày ban đêm cái gì cũng có lý do,Vietnamese
+loại thực phẩm và chế phẩm bổ sung đảm bảo sức khỏe của hệ vi sinh và theo đó là não bộ,Vietnamese
+những cái thành tựu rất có ý nghĩa thì trong cái cái sản phẩm mà chỉ sử dụng đó,Vietnamese
+cho cái niêm mạc suốt cả của từ niêm mạc thực quản cho đến niêm mạc dạ dày dưới niêm mạc đường tiêu hóa có thể bị teo bị,Vietnamese
+về cái chế độ ăn uống sinh hoạt thì sau khi bị covid thì đây là một cái cơ thể,Vietnamese
+sẽ giảm cái hiệu suất làm việc cũng như là những hoạt động khác thì họ sẽ giảm và họ tăng những cái nguy cơ cũng như là,Vietnamese
+trình trao đổi chất đó là nó biến đổi cho nên là nó không còn bình thường nữa và,Vietnamese
+được lượm lặt từ vẻ đẹp của tự nhiên thì những gì họ đã khám phá sự phức tạp tinh,Vietnamese
+thể phát hiện một loại mầm bệnh khác nhau mỗi loại cũng được định vị khác nhau trong cơ thể phân bố chiến,Vietnamese
+thương hay không rồi nó bị thưa xương hay không rồi là nó có bọc gai không thì chúng ta ngoài cái việc sử dụng các,Vietnamese
+trị liệu và hỗ trợ tâm lý trong quá trình điều trị béo phì,Vietnamese
+trong cơ thể chúng ta chất dinh dưỡng ít ỏi từ nguồn thức ăn thực vật mà chúng ta bảo là thực dưỡng để cho vào mà thậm chí,Vietnamese
+thế nào chúng ta có thể tận dụng kiến thức này tôi cũng sẽ đưa ra những hướng dẫn mang tính thực tiễn cao và toàn diện,Vietnamese
+axit amin mà trong đó có những axit amin mà chúng ta biết là cơ thể chúng ta không tổng hợp được hơn nữa thì các cái,Vietnamese
+thần có tá có xứ đấy là những cái vị thuốc mà nó làm gì nó làm hỗ trợ để tăng,Vietnamese
+và những hậu quả là nó có thể xảy ra đầu tiên về mặt tâm lý mà mình thấy rõ,Vietnamese
+đường thì có thể nói rằng hiện nay cái tỷ lệ những người bị đái tháo đường việt nam chúng ta tăng rất nhanh tăng mức độ,Vietnamese
+chính là cái dấu hiệu đầu tiên để khiến bệnh nhân của chúng ta tức là đang sống một cuộc sống bình thường và thấy sụt cân,Vietnamese
+nhân rồi theo nhiều nguyên nhân lắm mặc dù hiện nay chúng ta có rất nhiều công nghệ rất nhiều công nghệ nhưng mà có khi,Vietnamese
+biến chứng đó là như vậy chúng ta phải tuân thủ được điều trị theo dõi tái khám bệnh ta dùng ở cho nó tốt và nếu mà có,Vietnamese
+thì đương nhiên là cái người lớn tuổi thì có nguy cơ bệnh đều cao và đối với rung nhĩ thì là có rung nhĩ cộng với,Vietnamese
+và tự tin hơn và sau đây xin nhường lời lại cho cô một tràng pháo tay cho các,Vietnamese
+tại là khoảng sáu trăm người rồi thì chúng ta sẽ không để cho mọi người chờ lâu thì sẽ mời vị khách mời chúng ta ngày hôm nay,Vietnamese
+parkinson hay alzheimer ở mỹ dẫn sát thủ hàng đầu đều có liên quan đến các bệnh,Vietnamese
+động chân tay chậm chạp và chân tay bị rung cứng tuy là bệnh này không gây,Vietnamese
+mại mượt da mà cũng rất là thích hợp cho da nhạy cảm ít gây kích ứng và dị ứng và một cái lưu ý như hồi nãy tôi có chia sẻ,Vietnamese
+các nhà khoa học khi mà người ta nghiên cứu chính là để đi tìm câu trả lời cho cái câu hỏi này thì người ta cũng bắt,Vietnamese
+hiểu ở phần đầu chương trình ngay sau đây,Vietnamese
+cái được xem như là cái trình độ của người bệnh tại vì cái khi mà xài cái cục,Vietnamese
+sống của hầu hết các vi khuẩn trong cơ thể và như bạn sắp khám phá là cơ quan quan trọng nhất chi phối toàn bộ chức,Vietnamese
+giàu iod chẳng hạn thì chúng ta cũng rất cần lưu tâm nhất là các chế phẩm từ biển này hoặc là các cái loại về muối,Vietnamese
+động mạch lớn và động mạch vừa nó bắt đầu vào quá trình lão hóa khi đó nó xơ,Vietnamese
+mang tính thực tiễn cao này bao gồm sáu chìa khóa thiết yếu prebiotic probiotic,Vietnamese
+từng bị đột quỵ chưa vân vân nếu mà có những cái điều đó thì có nguy cơ xảy ra đột quỵ rất là cao như vậy cứ bước tiếp,Vietnamese
+tố vi lượng các vitamin cũng nằm phần lớn ở phần quả thể cho nên phần quả thể,Vietnamese
+chúng ta nên để nguội đi khoảng độ nhiệt độ nó rộng khoảng độ sáu mươi bảy mươi độ thôi xong,Vietnamese
+não sâu để cho nó có hiệu quả hoặc là tốt mà có thể đi làm thì nó đòi hỏi sẽ,Vietnamese
+khi suy giảm cái lượng máu lên não thì lập tức là chúng ta sẽ phải đối diện với các mặt như vậy thế cho nên là cái,Vietnamese
+và cái vấn đề cuối cùng là thuốc mà người bệnh người bệnh vẫn nên uống thuốc,Vietnamese
+là đi dbs đây là một cái phẫu thuật mà trước tiên tôi nói là cái tính an toàn,Vietnamese
+nước và là thuộc dự án thuộc chương trình quốc gia và đây là một cái sản phẩm đã được chứng minh rằng thứ nhất nó,Vietnamese
+chẳng hạn thì sau khi mà cắt dạ dày rồi hóa trị xạ trị xong rồi thì thậm chí chúng tôi có thể cho lượng chất béo lên đến ba mươi ba,Vietnamese
+thư di căn ở đâu đó chúng ta có thể bị tái phát lại tại có thể tại chính nơi đấy thế nhưng mà cái điều quan trọng,Vietnamese
+tôi sẽ giúp bạn làm điều đó giải thích khoa học đằng sau lợi khuẩn và cách chọn,Vietnamese
+là nó có thể được sử dụng như một loại vắcxin an toàn chống lại căn bệnh này tuy nhiên điều ngạc nhiên là khi phân tử,Vietnamese
+trình sinh nở mặc dù hợp lý khi cho rằng việc truyền vi khuẩn từ mẹ sang con của âm đạo là,Vietnamese
+chúng ta khi mà chưa có tây y đến đất nước chúng ta từ thế kỷ mười bảy mười tám thì cha ông chúng ta điều trị người ta bằng cái,Vietnamese
+quan điểm mới tiên tiến của của trị liệu tâm lý cũng như là béo phì hiện,Vietnamese
+chuẩn bị một cái tâm lý tốt và được tư vấn một cách rõ ràng thì là một cái điều rất,Vietnamese
+nếu như chúng ta không có biết đọc mà hoặc là không hiểu rõ về các thành phần nó,Vietnamese
+đôi khi mình mình có thể ví da nhạy cảm giống như một cô người yêu nũng nịu chị khó chiều lắm dạ nhưng mà có,Vietnamese
+trong giai đoạn một thì thường chúng ta sẽ sử dụng thuốc nhưng mà mức độ cái thuốc,Vietnamese
+bệnh béo phì để có được chất lượng cuộc sống của cả cộng đồng ngày càng được nâng cao hơn và mang nhiều ý nghĩa nhân,Vietnamese
+người ở trong gia đình cũng như trong xã hội thì cái sự kỳ thị này đây là một cái vấn đề rất là lớn rất là lớn từ hồi đứa,Vietnamese
+cả những cái chuyện đó đối với người bình thường đã nặng nhưng mà đối với bác có nguy cơ nặng lên rất nhiều và nếu cái,Vietnamese
+nguyên của bệnh đó chính là tạo thành trên bảng xơ vữa vì từ những các cái huyết áp cao này nhưng các cái bệnh lý,Vietnamese
+cái sản phẩm mà có chứa nhiều các thành phần dưỡng ẩm nguồn gốc từ dầu khoáng hoặc là lanolin bởi vì những cái,Vietnamese
+do parkinson đa xơ cứng trầm cảm và sa sút trí tuệ đến các rối loạn tự miễn,Vietnamese
+xã hội như vậy thì cái việc mà chúng ta đi đến một cái tỉnh khác hoặc đi đến nơi khác thì chúng ta cũng nên cân nhắc rằng,Vietnamese
+virus và nó là một cái virus lây qua đường hô hấp và nó thì thực ra thì từ,Vietnamese
+nó bị thiếu và nếu mà những cái chuyện đó mà nó không giúp được nhiều thì rõ ràng chúng ta cần những cái thăm khám một cách chính xác xét nghiệm xem cụ thể,Vietnamese
+hello xin chào tất cả mọi người và tiếp tục cái chương trình đồng hành cùng vấn đề liên quan đến sức khỏe,Vietnamese
+soát cortisol và adrenaline hai hormone liên quan đến căng thẳng có thể tàn phá,Vietnamese
+dạ dày rồi đại tràng rồi là thoái hóa các thứ thì cháu cũng điều trị cũng đỡ,Vietnamese
+tôi nghĩ là cũng đã quá trễ để mà chúng ta điều trị cho người bệnh của chúng ta ví dụ như là nếu mà cái chuyện biến,Vietnamese
+cái thuốc mà mình lúc đó nó còn phù hợp hay không có cần phải xét nghiệm gì để kiểm tra hay không đồng thời thì ngoài,Vietnamese
+sáng nếu mà bạn lo ngại là cái việc bạn tiếp xúc có hóa chất nhiều quá thì khi đó là bạn nên chọn lựa những cái sản,Vietnamese
+thể ảnh hưởng ứng dụng những gần đây có những tiến bộ về vật lý trị liệu đó là những cái điều kiện nhiệt thì những cái,Vietnamese
+hơn về diễn tiến bệnh cũng như là biết được các phương pháp điều trị tư tưởng như thế nào chúng ta sẽ cùng đi vào tìm,Vietnamese
+luôn được cập nhật từng giờ từng ngày việc nghiên cứu và viết sách về miễn,Vietnamese
+khi phẫu thuật để có được kết quả như mong đợi ngoài ra thì người bệnh parkinson cần phải chuẩn bị những vấn đề,Vietnamese
+chuyện là huyết áp cao mỡ máu cao cũng như là những bệnh lý về tim mạch ngay bây giờ thì chúng tôi xin được kết nối,Vietnamese
+việc sử dụng đồng thời là cái hiệu quả của thuốc cũng đã được chứng minh rằng nó có hiệu quả ít nhất là tương,Vietnamese
+nhuận tài chính đến một lĩnh vực có thể sinh lời điều này cùng với nỗ lực của các tổ chức từ thiện,Vietnamese
+đoạn chi và đặc biệt quan trọng nhất là đó là nếu mà những cục máu đông này di chuyển trên động mạch não thì có thể gây,Vietnamese
+phải phải phải điều trị và giúp cho uống thuốc suốt gần như là suốt đời đấy chị ạ nhé chị nhé thế vâng thế thế thứ nhất là,Vietnamese
+biểu hiện bệnh hạn chế được các cái triệu chứng của bệnh và hạn chế được các cái diễn biến của bệnh chính vì vậy cho,Vietnamese
+biểu hiện đau nhức xương khớp nó ở từ những cái lứa tuổi rất là sớm tránh nó,Vietnamese
+ba là khi chúng ta phải đi lại nhiều hoặc chúng ta đứng làm làm bếp nấu ăn thì chúng ta phải mua lấy cái tất thun,Vietnamese
+cái quy trình lấy mẫu thì cũng có hướng dẫn cho các nhân viên y tế là chúng,Vietnamese
+không phải là một sớm một chiều rồi bác có thể kết được nhiều bài tập này rồi là kết hợp trong cái thói quen sinh hoạt,Vietnamese
+mạnh này có thể trở thành một trong những món quà quan trọng nhất mà khoa học dành cho sức khỏe của loài người,Vietnamese
+ạ vâng xin chào bác ạ vâng nghe thì cũng không rõ lắm nhưng có lẽ là thứ nhất là bác là đã đi khám và đã được chẩn đoán,Vietnamese
+cả những tác dụng không mong muốn của nó nhưng mà những cái sản phẩm mà có nguồn gốc từ thảo dược thì thưa quý vị là gì,Vietnamese
+những người mà có bị béo phì rồi đó thì họ có nhiều,Vietnamese
+trị bệnh nhân sụt cân sụt cân thì thậm chí người ta không chịu được suốt quá trình hóa trị và xạ trị cho nên và,Vietnamese
+cơ thể thực phẩm chức năng mà nó không có phù hợp nó vừa tốn tiền nhiều mà nhiều khi nó lại ảnh hưởng tới sức,Vietnamese
+phần trước đây đó thì cái thành phần tocotrienol này nó có tác dụng chống,Vietnamese
+bình luận bên dưới các bác sĩ của chương trình sẽ giải đáp câu hỏi của quý vị trong phần cuối của chương trình quý vị nha thưa tất cả quý vị khi nói đến,Vietnamese
+con số mà từ năm đến mười phần trăm cân nặng như vậy thì như chúng ta đã biết cái lợi ích của cái việc giảm cân nó,Vietnamese
+thể chia sẻ kỹ hơn một chút là bác bị tai nạn cách đây lâu chưa tai nạn như thế nào và sau bốn năm rồi ạ vâng và tai,Vietnamese
+thần kinh của chúng ta hệ miễn dịch của chúng ta ở trong sự thay đổi liên tục sức khỏe của chúng ta như nghệ sĩ xiếc,Vietnamese
+lại càng cần phải tiêm bác ạ tại vì là khi mà chúng ta không tiêm ấy mà khi mắc bệnh là bệnh sẽ rất rất nặng thế và,Vietnamese
+ngoại hình của họ nó tệ quá đi cho nên là họ luôn luôn nhìn với một cái cái cặp,Vietnamese
+trước những khám phá này khả năng miễn dịch bẩm sinh chỉ đơn thuần được xem là một cách phòng thủ mơ hồ chẳng,Vietnamese
+đối với vi khuẩn đường ruột của mình và cảm thấy được tiếp thêm sức mạnh cho tương lai sức khỏe của bạn,Vietnamese
+các cái người bệnh thì chúng tôi cũng nhận thấy rằng là những người mà đã có những cái tiền sử chấn thương từ trước thì người ta lại có những cái sự ảnh,Vietnamese
+chúng ta cung cấp oxy cho cơ thể là tốt nhất và một cái giải pháp phòng chống ung thư quá quá là đơn giản là mà chúng,Vietnamese
+tim nhưng khi bạn xem xét các bệnh và rối loạn liên quan đến não bộ bức tranh,Vietnamese
+bệnh bị ung thư thì phải vượt lên chính mình và đôi khi chúng ta cũng bảo là ví dụ chúng ta có những câu rất hay như là,Vietnamese
+đấy nó đều có thể bị ảnh hưởng đầu tiên nhất là cái dạ dày nó tiếp nhận nó bị ảnh hưởng bởi nó bị viêm nó bị loét và,Vietnamese
+thắt lưng trước rồi sau đó thì mình cũng nên thu xếp một cái thời gian phù để để đi thăm khám nhớ tránh cái tình trạng bị,Vietnamese
+với trung bình là khoảng hai mươi năm tuy nhiên thì chúng ta cũng biết rằng là có,Vietnamese
+tính thì mới được đi đến các cái tỉnh khác thì ngày hôm nay thì vĩnh long của,Vietnamese
+trạng ở trong người là hàn chẳng hạn thì rõ ràng khi mà gặp cái thời tiết lạnh thì ở bên trong lạnh ở bên ngoài lạnh nó,Vietnamese
+vận động cũng như là loạn động thì khi đó ngoài cái việc là điều chỉnh thuốc chúng ta cũng phải kết hợp với vật lý,Vietnamese
+khem cái thứ ba là phải tập luyện muốn nói gì thì nói cuộc sống là vận động sự sống mà không có vận động thì nó sẽ càng,Vietnamese
+gốc thảo dược thì chúng ta phải nhớ rằng là không có một cái thứ nào nó là thánh dược mà duy nhất nó có thể giải quyết,Vietnamese
+phải vịn mình sẽ phải luôn luôn phòng tránh luôn luôn nghĩ rằng là nó sắp ngã rồi thì mình phải cẩn thận nếu mà ngã,Vietnamese
+với cái cách giải thích lúc nãy tôi có nói về cái stress liên quan tới là sức khỏe,Vietnamese
+khớp về bây giờ tôi xin trình bày cái vấn đề tiểu đường trước nha bác sĩ cũng,Vietnamese
+chúng ta nó đều bị lão hóa nhưng cái quan trọng là gì là bộ não của chúng ta nó bị teo dần lại nó bị thoái hóa các tế,Vietnamese
+nhau và mỗi thành phần chỉ có ý nghĩa khi được xem như là một phần của tổng thể sách giáo khoa về hệ miễn dịch có xu,Vietnamese
+là do cái những cái rối loạn khác ví dụ như bệnh lý của huyết áp,Vietnamese
+sử dụng phương pháp kích thích não sâu thì dĩ nhiên người bệnh cũng không thể nào mà ngưng thuốc hoàn toàn được thì đó,Vietnamese
+nhiều các phương pháp điều trị được được điều trị áp dụng chẩn đoán sớm vân vân thì tuổi thọ của người việt nam của,Vietnamese
+và có cái nhận định là thoái hóa cột sống thắt lưng tuy nhiên ở đây thì chúng ta có nhiều vấn đề chứ không phải chỉ có,Vietnamese
+như là thận trọng cách tối đa đối với những người bệnh đã có mang những thiết bị này và những cái những cái việc điều,Vietnamese
+bào phát triển mang lại cho mỗi tế bào một thụ thể với hình dạng độc nhất nhưng,Vietnamese
+có tư vấn lại có cơ hội nhận được những phần quà giá trị khuyến mại chỉ diễn ra trong ngày vì vậy quý vị hãy nhanh tay,Vietnamese
+những người mà lớn tuổi chúng ta nó cao có nghĩa là trong cộng đồng của chúng ta nhiều người cao tuổi thì chắc chắn là sẽ,Vietnamese
+về về về về tim mạch của bác hoàn toàn là có thể là tạo thành những mảng xơ vữa và khi là mảng xơ vữa thì nó làm cho bệnh,Vietnamese
+mạch máu não rồi nó bị thiếu máu não rồi bị nhồi máu não rồi hoặc một số các cái vấn đề như vậy hẹp mạch máu hoặc là rối,Vietnamese
+lên thì đây cũng là một trong những cái thành phần mà nó sẽ bám vào ở các cái tế bào nội mạc và nó dẫn làm tổn thương,Vietnamese
+thể sử dụng cái vị ngọt ngọt một chút thì sẽ bớt đi cảm giác là thèm khát khao,Vietnamese
+thì huyết khối rất dễ hình thành vì dòng máu chúng ta lưu thông một cách liên tục,Vietnamese
+năm năm tại vì nếu mà dưới năm năm thì thứ nhất nó vẫn còn hiệu quả với thuốc thứ hai,Vietnamese
+làm thế nào các tế bào miễn dịch giao tiếp với nhau và làm thế nào chúng phát hiện các dấu hiệu bệnh lý ở các tế bào,Vietnamese
+lưu ý làm sao có được là đủ các cái chất dinh dưỡng mà đủ ở đây thì nó liên quan,Vietnamese
+tỷ lệ trầm cảm nếu mà mình kiểm soát không tốt đó nó vẫn có thể là gia tăng tỷ lệ tự tử nó cũng có thể gia tăng nếu,Vietnamese
+hormone stress đó là cortisol trong máu và cái catecholamine trong máu hai các chất đó nó tăng lên và mình biết riêng,Vietnamese
+với bác sĩ để từ đó thì chúng ta sẽ nhận được cái sự kết nối nhanh nhất bởi vì càng về cuối chương trình khi mà số,Vietnamese
+quả trong điều trị trầm cảm hơn so với thay đổi về chế độ ăn uống trên thực tế nghiên cứu gần đây đang phát hiện rằng,Vietnamese
+bạn không phản ứng lại bên mọi thứ mà bạn ăn tinh tế hơn hệ miễn dịch của bạn,Vietnamese
+thuần là khi mà chúng ta đi ra ngoài gió da chúng ta có cảm thấy khó chịu không thì nếu như mà bệnh nhân có trả,Vietnamese
+chưa bị bệnh đau cho nên chúng ta phải cố gắng người bệnh cố gắng và những người chăm sóc cố gắng cộng với lại,Vietnamese
+châm cứu rồi thời gian sau không đỡ thì nên là đi khám ở khoa trị liệu và bệnh,Vietnamese
+là ngắn hơn và ngay từ lúc khởi đầu xuất hiện các triệu chứng của người bệnh parkinson thì chúng ta thấy bắt đầu,Vietnamese
+dưỡng vai trò của dinh dưỡng đối với ung thư thì thứ nhất là dinh dưỡng giúp quý vị nuôi dưỡng cơ thể mình để cơ thể mình,Vietnamese
+cân nặng tốt nè có thành công trong chuyện này chuyện nọ trong cuộc sống nè thì có thể là cùng nhau chia sẻ cho cái,Vietnamese
+được tự ý bỏ đâu vì là những cái cái thức cái huyết áp này là cái việc điều,Vietnamese
+cũng như là các phương pháp điều trị thuốc trong bệnh parkinson hiện nay chỉ là điều trị triệu chứng mà cứ quá trình bệnh,Vietnamese
+trong mọi vấn đề sinh học của con người quá trình được nghiên cứu nhiều nhất trực tiếp đào sâu nhất là phản ứng của,Vietnamese
+dẫn đến cái tình trạng xơ vữa mạch vì chúng ta biết được là khi mà cái tế bào nội mạc của động mạch của chúng ta một,Vietnamese
+cái chuyện đó và nếu mà chúng ta sử dụng các biện pháp phòng tránh để nó không bị nghẽn mạch máu não thì ít nhất là nó sẽ,Vietnamese
+nào hết khoảng chừng hai tháng là mình thấy cái cơn đau khớp gối với lưng là nó bớt,Vietnamese
+phải chú chú trọng trong cái chế độ ăn uống chị ạ thế thì đối với trường hợp của chị thì thứ nhất,Vietnamese
+chất bã nhờn những cái bụi bẩn còn sót lại sau khi chúng ta đã làm sạch da rồi còn serum đó là những cái sản phẩm mà,Vietnamese
+tiết được pepsin và tiết không tiết được pepsin của dạ dày chỉ liên quan đến một phần kể,Vietnamese
+thậm chí là chúng tôi có một cái cái hội chứng rất hay gặp là gọi là hội chứng ống cổ tay có nghĩa là tất cả các cái,Vietnamese
+đúng theo như là cái chẩn đoán của bác sĩ thì hầu như là không có một cái nguy cơ về kích ứng hoặc dị ứng nặng và một,Vietnamese
+chúng ta cách chúng ta cảm nhận bề mặt cảm xúc lẫn thể chất đều phụ thuộc vào trạng thái của hệ vi sinh nó có lành,Vietnamese
+là không tốt đối với gan đối với các chức năng khác trong cơ thể rồi chúng ta ăn chất béo bão hòa quá,Vietnamese
+gây nhiễm có chủ ý để cung cấp sự bảo vệ sự chủng ngừa đã được thực hành ở trung,Vietnamese
+bác vẫn đang điều trị theo đơn bác sĩ tuy nhiên thì cái thời gian gần đây thì bác thấy là có những biểu hiện như là,Vietnamese
+mái hơn mọi sự cố gắng thì đều có thể đạt được kết quả đúng không ạ ngay bây,Vietnamese
+giản lắm trước tiên đó là chúng ta phải giữ một trạng thái tinh thần cho nó thoải mái thì nói đến điều này thì chúng,Vietnamese
+điều đó là điều có thể gây ra những cái hậu quả rất là nghiêm trọng,Vietnamese
+thư như hóa trị hóa chất lại không phân biệt được đâu là tế bào ung thư và đâu là tế bào của chính cơ thể chúng ta cho,Vietnamese
+về cho chương trình liên quan đến chủ đề là cùng hiểu rõ hơn về tâm lý của người bệnh béo phì,Vietnamese
+mà quản lý cân nặng còn quản lý cả các biến chứng và vận động mắt đi kèm vì thế điều trị béo phì cần một sự phối hợp,Vietnamese
+cái thảo dược đã được chứng minh rằng nó làm giảm nguy cơ hình thành các mảng xơ vữa động mạch giúp máu thông lên não lên,Vietnamese
+là uống từ hai đến ba tháng thế là tôi mua liền ba tháng tôi uống luôn buổi trưa,Vietnamese
+cái người béo phì đó hai cái này có một cái mối liên hệ hai chiều với nhau một cái người béo phì thì họ dễ xảy ra cái trầm,Vietnamese
+chỗ là thế này khi mà chúng ta có kiến thức khi mà chúng ta có những cái chúng,Vietnamese
+thuốc kháng đông đó nhiều quá quá liều vân vân thì lúc đó sẽ có những phương tiện cấp cứu có những phương tiện điều,Vietnamese
+người rất là trẻ cũng đã có thể là mắc cái bệnh cơ xương khớp rồi nhất là ở cái,Vietnamese
+tự thông thì chúng ta có thiếu máu não thoáng qua đúng như là vậy thông sớm thì nó cũng khi nào cũng phải chết thì,Vietnamese
+trường hợp ví dụ khi thuốc kháng sinh có thể cứu mạng và rất cần thiết sau đây,Vietnamese
+có thể nói là nó phát triển rất là dữ dội và nếu như người già thì chúng ta có thể nhờ con cháu của mình để có thể phối,Vietnamese
+thưa tất cả quý vị và các bạn qua đoạn clip vừa rồi thì chúng ta có thể hiểu và thông cảm hơn với những khó khăn mà,Vietnamese
+vận động thì tình trạng béo phì nó tăng lên mà mình béo phì nó tăng lên rồi thì gặp tình trạng kỳ thị nữa hay là gặp,Vietnamese
+một số loại tế bào miễn dịch lưu thông trong máu ít hơn bình thường một điều nữa là các tế bào miễn dịch ở người già,Vietnamese
+trí sau đó là,Vietnamese
+một số những cái vấn đề mà liên quan tới cái việc điều trị tâm lý ở trong cái,Vietnamese
+khi đó thì dễ gây cái tình trạng làm bít tắc lỗ chân lông và hình thành theo những dòng mụn trứng cá và các bạn nhớ,Vietnamese
+bằng thuốc hoặc là cả hai thì rõ chúng ta sẽ phải kiểm tra xem là nó có đạt được kết quả mong muốn hay chưa thì có,Vietnamese
+thì chúng ta phải có cái cách điều trị cách điều trị đó là chúng ta phải xóa,Vietnamese
+chưa rõ nguyên nhân thì thật ra cái khả năng mà nó do rung nhĩ vẫn có,Vietnamese
+kinh phế vị dây thần kinh dài nhất trong số mười hai dây thần kinh sọ là kênh thông tin chính giữa hàng trăm triệu thần kinh,Vietnamese
+những quan điểm đó là khi mà chúng ta tiếp nhận người bệnh ung thư mà tiếp nhận quá nhiều dinh dưỡng thì nó cũng,Vietnamese
+nguyên nhân nào đó thế và cố gắng là tinh thần thư giãn thoải mái này tránh căng thẳng này ngủ đủ giấc này thế và trong,Vietnamese
+với những cái người cách ly xung quanh của chúng ta tránh ngồi trò chuyện rồi tâm sự rồi ăn uống cùng vui đồ bắt tay,Vietnamese
+thực phẩm chức năng tức là người người nhật bản đã sử dụng cái món ăn này để giúp hỗ trợ trong việc điều trị như các,Vietnamese
+ngày hôm nay đối với sản phẩm đông trùng hạ thảo đây là sản phẩm một trăm phần trăm được chiết xuất từ quả thể nấm đông trùng kết hợp,Vietnamese
+khi mà chúng ta khỏe mạnh như thế này mà chúng ta gặp một cái vấn đề gì đấy về mặt tinh thần thì chúng ta cũng đã rất là chán ăn rồi và hiện nay thì có một số,Vietnamese
+lại chúng cố gắng giảm thiểu số lượng và tác động của những vi khuẩn xấu đồng thời tương tác tích cực mới cả hệ miễn,Vietnamese
+ngoài là phải thực hiện tốt khi 5k để chúng ta giảm các nguy cơ lây nhiễm và không phải chỉ cái nguy cơ này ảnh hưởng,Vietnamese
+khi nó không đủ chất đủ cân bằng vân vân thế cho nên là cái việc mà hỏi là điều trị khỏi hẳn bệnh huyết áp hoặc là khỏi,Vietnamese
+một cái hóa trị hoặc xạ trị thì nó đều liên quan đến khử độc tại gan và khi chức năng gan bị giảm như vậy thì nay lại bị,Vietnamese
+chúng ta phải cung cấp cái gì ẩm ẩm để cho nó nó không khô thì cái đấy có thể chúng ta sử dụng nước cũng được nước quả,Vietnamese
+cho tổn thương các cái mạch máu của bác và dẫn đến tình trạng xơ vữa mạch và từ cái xơ vữa mạch xơ vữa mạch não thì dẫn,Vietnamese
+chứng sau đột quỵ ví dụ như liệt nửa người mất vận ngôn có thể thậm chí,Vietnamese
+trị em ạ em nhé thế còn đối với trong cái trường hợp này thì em cũng có thể là,Vietnamese
+biến chứng tiếp theo mà chúng tôi cũng muốn cảnh báo với bác là gì ạ sau khi đã bị năm năm bốn năm sáu năm như của bác ấy là ở,Vietnamese
+trong số đó không thể nuôi cấy được trong phòng thí nghiệm bằng các phương pháp truyền thống trong thảo luận này,Vietnamese
+thì tôi cũng thường nói rằng là em hãy cân nhắc cái việc mà em về thăm em mang lại niềm vui em mang lại sức khỏe cho,Vietnamese
+giày thì nó sẽ giữ được cái chân ấm hơn chúng ta sẽ đi cái tất dày hơn đi cái tất dài hơn như thế cũng sẽ rất là hữu,Vietnamese
+bác sĩ có chia sẻ lúc nãy thì thời điểm mổ đặt điện cực kích thích não sâu tốt nhất,Vietnamese
+dụng những cái hoạt chất như là aha bha hoặc là những hoạt chất như là,Vietnamese
+giữ vững tinh thần và quyết chiến đấu bởi vì nếu mà bản thân người bệnh không,Vietnamese
+dụng phụ khác nhau và chúng ta cũng cần nhớ rằng là bệnh xương khớp nó cũng không phải là bệnh nhẹ và nó cũng cần,Vietnamese
+chính của nó là cái gì và sau đó thì chúng ta mới tìm cái cách để điều trị cũng như là có cái phác đồ hoặc là có,Vietnamese
+tới mình tư vấn để mình mình biết mình đúng là bệnh rồi cái giai đoạn này là mình đã xem xét cân nhắc tới cái,Vietnamese
+qua cái đường mà can thiệp nội mạch thì hiện nay đó thì người ta đã chế tạo,Vietnamese
+xã hội ở trong cộng đồng tương tác với họ và đặc biệt là những cái,Vietnamese
+gốc dầu những các thành phần xà phòng hương liệu hoặc là gây dị ứng bít tắc lỗ chân lông đúng không ạ,Vietnamese
+cái tình trạng đó là đột quỵ thật sự thì như vậy hai cái đó nó gần như là một và,Vietnamese
+lại tài sản đã bị trộm lấy mất đấy là những cái tổn thất về về sức khỏe của cơ thể chúng ta trước và trong ung thư những,Vietnamese
+đấu thì mới trở về bình thường được còn nếu mà chính các bệnh nhân ung thư đầu hàng thì tất cả sự hỗ trợ của đội ngũ y,Vietnamese
+theo cái chỉ định và hướng dẫn sử dụng của bác sĩ của chị xin chúc mừng chị cảm,Vietnamese
+chúng tôi khi mà khám bệnh thì cũng có nhận được những khách hàng những bệnh,Vietnamese
+là cái mà mình cố sửa nó nhỏ thôi nhưng mà cái động tác mà mình vào đấy để mình sửa thì nó lại ảnh hưởng nhiều hơn chính,Vietnamese
+có cùng một mẫu số chung đó là cư dân của đường ruột theo nhiều cách chúng là,Vietnamese
+cái cân nặng lại không có xuống có nghĩa là kết quả không được như mong muốn của họ và không mong muốn tiền thì mất,Vietnamese
+cái người bệnh có gắn kết được tốt hơn và nó có thể đưa đến cái thành công trong cái điều trị sống khỏe mạnh nó là,Vietnamese
+quan đến các vitamin nhóm b đặc biệt chú ý đến vitamin rồi vitamin c vitamin pp,Vietnamese
+khá là cao do đó để mà hiểu rõ mình có được lựa chọn cho tốt cho cái việc phẫu,Vietnamese
+viên và chia lần sáng chiều và chúng ta sử dụng càng dài càng tốt đấy là cái,Vietnamese
+dày của bác là hết sức là quan trọng tuy nhiên chúng ta cũng cần phải nói rằng là mặc dù cái cái thuốc chống viêm corticoid,Vietnamese
+ung thư bằng cách là vắt nước chanh vào một cốc nước ấm xong rồi mình uống lại uống vào lúc đói thì thực sự là khi,Vietnamese
+đó có thể dễ bị sặc làm bệnh nhân khó thở hay là ngột thì ta sẽ làm sạch,Vietnamese
+thanh long cho nên là chúng ta sử dụng là chanh như vậy thì thực sự là chưa không,Vietnamese
+dứt da của mình nó căng da đôi khi một số loại sữa rửa mặt nó khiến cho mình cảm giác là khi mình rửa xong cái da,Vietnamese
+động một cách trực tiếp chúng ta cần nhớ rằng là những người làm việc văn phòng mặc dù là không phải là gặp mưa gặp nắng,Vietnamese
+mọi người nếu như mà chúng ta vào rồi thì giúp cho mình một cái lượt chia sẻ cái để cho mọi người vào đầy đủ trước,Vietnamese
+dưỡng và cũng như là thực phẩm nào để hiệu quả tốt nhất thưa bác sĩ cảm ơn câu,Vietnamese
+chí nó nặng dần lên như vậy nếu mà bác chưa có điều kiện để đi thăm khám nhiều chẳng hạn vậy thế thì bác cũng nên có,Vietnamese
+thời gian đầu là mình uống là một ngày là bốn viên sáng hai viên chiều hai viên,Vietnamese
+không tốt nhưng chỉ gạo lứt với muối mè thôi không đủ nuôi cơ thể chúng ta quý vị ạ và nhất là trong khi chúng ta lại bị,Vietnamese
+mà tại thời điểm hiện tại chủng mà tại điểm so với những cái chủng trước đây của chúng ta thì nó có giống như thế hay không,Vietnamese
+mà nó rất là hữu ích cho những cái trường hợp mà điều trị thoái hóa khớp như của bác mà nó lại sử dụng một cách,Vietnamese
+trong thời gian nằm viện cho phẫu thuật kích thích não sâu thì người bệnh sẽ trải qua những can thiệp gì trên cơ thể,Vietnamese
+trợ cho cái việc kiểm soát các triệu chứng thì khi đó các triệu chứng của người bệnh ổn định hơn và người bệnh có thể đi làm tốt hơn nói tóm lại thì sau một,Vietnamese
+dụng này ở đặc biệt là đối với cái hàm lượng adenosine và polysaccharide cao vượt trội so với thị trường thì đông trùng hạ,Vietnamese
+nghĩa rằng là tất cả b���nh nhân đều nên phẫu thuật trong cái giai đoạn từ năm đến mười năm mà hầu hết bệnh nhân sẽ,Vietnamese
+trước đây có thể làm chúng ta khó có được cái nhìn sâu sắc cần thiết cho những bước nhảy vọt trong tương lai các,Vietnamese
+không có cái tương tác không mong muốn gì cả nên bác yên tâm bác cứ kết hợp sử dụng bác nhé vâng ạ,Vietnamese
+luận về tầm quan trọng của câu chuyện ra đời của bạn về chế độ dinh dưỡng và các loại thuốc được kê khi còn nhỏ cũng,Vietnamese
+chúng ta bị trục trặc mà chẳng qua là cái hệ thần kinh ở trung ương tức là ở sọ não đấy nó không điều khiển được một,Vietnamese
+trị của bác sĩ cũng như là bảo vệ được sức khỏe của người bệnh ung thư hi vọng là những cái chia sẻ của,Vietnamese
+ta thì bởi vì nhân viên y tế thì thật sự lúc đó cũng đã có che chắn kỹ rồi làm sao vấn đề thứ hai nữa là ở tại đó thì cũng,Vietnamese
+ảnh hưởng một cách nặng nề nên là chính vì vậy mà từ những cái huyết áp cao rối,Vietnamese
+dù bác bảo là nó chưa phá ra nhưng mà chúng tôi thấy là nó phá ra rất nhiều phá ra cái gì ạ bác đã dùng corticoid,Vietnamese
+biến chứng về loạn động dao động vận động thì lúc đó chúng ta mới xem xét phẫu thuật kích thích não sâu,Vietnamese
+đã có một cái chương trình đặc biệt là ưu đãi cũng như là để khẳng định cái giá trị của sản phẩm đó chính là hoàn lại,Vietnamese
+phương pháp trị liệu nó có hiệu quả thì cũng có thể làm cho tình trạng mà tự tử nó tăng lên đây là một nghiên cứu ở anh,Vietnamese
+hai trường hợp cơ thể bạn sẽ tràn ngập steroid và adrenaline tự nhiên và hệ,Vietnamese
+bàn tỉnh vĩnh long của chúng ta thì cũng có nhiều cái cơ sở y tế và thực hiện các việc xét nghiệm này ví dụ như bệnh viện,Vietnamese
+như số lượng ngôi sao chọn vũ trụ trên thực tế mầm bệnh không thể nhân,Vietnamese
+người huyết áp áp cao không nên ăn mặn không nên ăn những cái thức ăn nó có nhiều dầu mỡ này đặc biệt là mỡ động vật,Vietnamese
+sướng và tự hào là mình đã sức khỏe coi như là quá tốt rồi chú sử dụng cái sản,Vietnamese
+máu thông lên não lên tim đến các chi được tốt này thế và cải thiện được các,Vietnamese
+chế sinh lý bệnh chung với nhau ở những cái bệnh nhân béo phì thì nó có cái tình trạng đó là gây ra cái tình trạng đề,Vietnamese
+thuật kích thích não sâu cũng chưa có giúp ích được kí việc này ở chúng ta phải hiểu được chuyện đó tuy nhiên cũng như các phương,Vietnamese
+biệt nhất và đáng tiếc nhất đó là những trường hợp mà bị đột quỵ rồi mới được phát hiện rung nhĩ thì đó là những cái,Vietnamese
+phát hiện các loại mầm bệnh cụ thể và kích hoạt phản ứng phù hợp với mối đe dọa rõ ràng là hệ miễn dịch bẩm sinh,Vietnamese
+tác dụng của thuốc và các tương tác thuốc tương tác với thức ăn uống rất là ít thì mình sẽ rất là thuận lợi cho,Vietnamese
+coi một cái người ung thư trong thành viên trong gia đình là một sự sầu não trong cả một gia đình thì rất khó có thể,Vietnamese
+tác động lên toàn bộ cơ thể và tác động lên tất cả các cơ quan trong đó đặc biệt là cơ quan tiêu hóa và cái điều quan,Vietnamese
+muốn hỗ trợ giảm đau xương khớp thoái hóa nói chung thì phải đáp ứng được ba,Vietnamese
+sẽ giúp cho cái hệ thống mạch máu của chúng ta trong đó có cái tình trạng suy giãn tĩnh mạch nó sẽ được cải thiện và,Vietnamese
+tác dụng phụ của hóa trị xạ trị đối bệnh nhân thì thực sự là rất là nhiều chúng,Vietnamese
+chúng ta dùng hóa trị thì cũng liên quan đến chức năng gan rất là nhiều cũng tổn thương chức năng gan và lại trên cơ địa,Vietnamese
+giúp cho tôi hỗ trợ tôi đừng có giúp cho tôi mà thèm thuồng quá hay là kích thích tôi quá thì thôi cũng không nên,Vietnamese
+một điểm chúng ta cũng cần hiểu được rằng là phẫu thuật kích thích não sâu không phải là một phương pháp điều trị,Vietnamese
+này chúng ta chiến thắng được virus thì virus nó bị tiêu diệt thì nói không xét nghiệm không thấy hoặc là cũng có,Vietnamese
+được đồng cảm cái người béo phì họ được hỗ trợ được cái sự gắn kết được cái sự,Vietnamese
+trạng sạm nám tăng sắc tố do đó nên chúng ta phải nhớ là chúng ta luôn phải thoa kem chống nắng đúng cách đúng liều đủ,Vietnamese
+rất là nhiều các cái thuốc mạnh và chính vì vậy cho nên là song song với cái việc mà chúng ta sử dụng những cái thuốc mạnh như thế này người bệnh lại vô hình chung,Vietnamese
+xin được khám được không được sàng lọc yếu tố về dịch tể thì một trong những cái,Vietnamese
+thì nó sẽ rất là tốt cho bệnh nhân ung thư cái thứ hai mà,Vietnamese
+ánh sáng mặt trời và lưu huỳnh vi khuẩn là nền tảng của mọi sự sống trên trái,Vietnamese
+trong người đang đang sử dụng đang đang bị rất nhiều những các cái bệnh lý nữa thế nên là bác nên cho bác trai tiêm bác,Vietnamese
+chất bột đường nhiều này các vitamin khoáng chất thì ít này và đặc biệt là hay,Vietnamese
+cái triệu chứng sốt ho đau họng ngạt mũi những triệu chứng mà rất thông thường thôi và thường thì mất 3 ngày đấy sau,Vietnamese
+rối loạn tăng động giảm chú ý cậu bé có thân hình cân đối và mảnh khảnh nhờ hoạt động thường xuyên các gia đình không ngồi,Vietnamese
+phải là kháng vitamin k đó hay là khác kháng đông mới trực tiếp là gọi là,Vietnamese
+hành trình hướng đến một cuộc sống khỏe mạnh hạnh phúc và viên mãn thưa quý vị và các bạn vào đến đây thì thời lượng,Vietnamese
+bệnh lý nền có thể là tác dụng tốt nhất với thuốc đông trùng hạ thảo ạ có thể nói là câu trả lời luôn là,Vietnamese
+thầm trong các tài liệu y khoa bạn sẽ trân trọng việc hệ vi sinh vật của mình sau cùng chính là tạo hóa của não bộ các,Vietnamese
+phải sử dụng một thời gian dài mỗi ngày tháng đầu tiên chúng ta phải tháng đầu tiên tháng thứ hai chúng ta uống bốn viên,Vietnamese
+đây là một cái sản phẩm mà cũng đã được thừa kế cái đề tài nghiên cứu cấp nhà,Vietnamese
+sớm còn lại là nên kiên trì sử dụng trong bao lâu đi bởi vì nhiều người cũng đang cũng đang có một câu hỏi thắc mắc như vậy ạ vì chúng ta biết là đối với,Vietnamese
+tôi nói đến chuyện cấp cứu thì khi mà vào bệnh viện cấp cứu thì các bác sĩ sẽ,Vietnamese
+mỡ máu cao nếu thường xuyên gặp các biểu hiện là đau đầu chóng mặt xây xẩm khó thở nhịp tim đập nhanh mất ngủ tê bì,Vietnamese
+chỉ sử dụng các thụ thể gắn vào dấu hiệu nhận biết của mầm bệnh đối với chúng ta đây chỉ là một trong những cách mà,Vietnamese
+thiểu năng vành chúng ta thấy sẽ có các cái triệu chứng như là bệnh nhân có thể như là các cái hồi hộp trống ngực này,Vietnamese
+nguyên nhân tổng quát thông thường bạn đã dùng các thuốc chống tiểu cầu cụ thể là aspirin chẳng hạn và sẽ cùng với những cái kiểm,Vietnamese
+nguy cơ cao mất những bệnh chết người liên quan đến não bao gồm rối loạn tâm trạng và lo âu đau nửa đầu và các chứng,Vietnamese
+những cái tình trạng xơ vữa mạch thì là những cái việc đó sau covid thì người cũng rất mệt cũng cái việc phục hồi nó,Vietnamese
+gọi là dinh dưỡng trong chế độ ung thư chế độ dinh dưỡng trong ung thư,Vietnamese
+cái bệnh lý đái tháo đường muốn nói gì thì nói nó vẫn cứ âm thầm nó tiến triển và chính vì thế cho nên hiện nay người,Vietnamese
+trợ tinh thần cho những người bệnh béo phì trên hành trình vượt qua nghịch cảnh hướng đến một cuộc sống với chất lượng,Vietnamese
+biệt là ví dụ đối với gan thì làm cho cái chức năng khử độc của gan kém đi bên cạnh đó thì gan còn có chức năng liên,Vietnamese
+bệnh lý về hen những người bệnh lý về bệnh phổi tắc nghẽn mãn tính này những bệnh xơ gan này tiểu đường là,Vietnamese
+loại thức ăn khi mà uống các loại thuốc này thì chúng ta không quan tâm lắm cái chuyện là chúng ta ăn nhiều thức ăn gì,Vietnamese
+khi rồi nó sẽ có những cái đợt virus nó phát tán lên nó thì chúng ta có thể lấy ở cái dịch tỵ hầu họng thì chúng ta có,Vietnamese
+thủ chống lại vi sinh vật nó chuẩn bị để cơ thể bạn phản ứng nhanh chóng thì gặp,Vietnamese
+xuống phòng mổ và được gắn vào một cái khung như tui nói nói tức là cái khung định vị cái khung này nó sẽ,Vietnamese
+liên quan đến chủ đề ngày hôm nay những ai mà chúng ta đang gặp phải cái tình trạng là đau đầu hoa mắt chóng mặt là,Vietnamese
+mình cần phải uống thuốc và khi đã uống thuốc huyết áp là bác cố gắng là mình sẽ duy trì thường xuyên bác nhé mình không,Vietnamese
+dưỡng ban đêm sẽ có những các hoạt chất giữ sáng mà làm cho da chúng ta tăng nhạy cảm với ánh nắng mặt trời thì đôi,Vietnamese
+nên là chính vì vậy mà nó sẽ làm tổn thương các cái mạch máu và nó dẫn đến cái mảng xơ vữa thứ hai là cái rối loạn,Vietnamese
+cho người bệnh một cái làn da vốn có của họ theo như cái màu sắc nguyên thủy của họ và không có bị những cái đốm trong,Vietnamese
+thì người ta vẫn nói là ưu tiên hàng đầu vẫn là điều trị nội khoa tuy nhiên thì tới một lúc nào đó là cái giai,Vietnamese
+đó gần những cái tuyến tiêu hóa thì ảnh hưởng trực tiếp đến với chức năng của bộ máy điều hòa tất cả đến khả năng ăn chấp,Vietnamese
+bây giờ sau sau sau khi mà trộm đi rồi thì chúng ta phải làm gì ạ chúng ta phải ngoài việc mà lao động để làm sao mà bù,Vietnamese
+nhau và cái lứa tuổi mà trung niên là cái lứa tuổi gặp khá là phổ biến còn,Vietnamese
+rằng trong tương lai gần có thể giúp các bệnh nhân bị bệnh tự miễn bằng các loại thuốc mới giúp ngăn chặn hoạt động của,Vietnamese
+như là thậm chí ở những các bệnh nhân béo phì mà nếu chúng ta quản lý được cái mức cân nặng tốt quá thì không một thời,Vietnamese
+mô cơ tim của chúng ta sẽ bị hoại tử nếu mà cái cục máu đông đó di chuyển đến,Vietnamese
+sẽ giúp cho cái người bị là béo phì đó họ sẽ giữ được cái mục tiêu của họ đi,Vietnamese
+đánh giá và xem xem bản thân bệnh nhân lại có bao nhiêu cái yếu tố nguy cơ,Vietnamese
+những cái việc quan trọng cho cái việc mà người bệnh phẫu thuật thích não sâu có hiệu quả sau điều trị đó là lập,Vietnamese
+vị đấy ạ quý vị và các bạn muốn đặt câu hỏi xem là hôm nay cái bệnh lý của tôi có sử dụng được đông trùng hạ thảo,Vietnamese
+bác phải trung thành với cả các đơn thuốc các thầy thuốc tây y đã kê nhưng bên cạnh đó thì bác nên tìm đến một cái,Vietnamese
+trong đó có phẫu thuật kích thích não sâu là bắt đầu được xem xét cho các vấn đề về phẫu thuật như vậy thì trong tất cả,Vietnamese
+là hai mũi thì cái cái mức độ mà cái miễn nhiễm của cơ thể sau khi tiêm,Vietnamese
+chẳng hạn ăn uống kẽm vào ăn ngon miệng hơn uống selen thì người ung thư rất hay rụng tóc ạ thì selen vào tóc,Vietnamese
+cuốn sách này được dành cho bạn giống như hàng loạt thể sống bên trong cơ thể,Vietnamese
+chuyện hình thành phát triển của mảng vữa xơ cũng như là tình trạng suy giãn tĩnh mạch cho nên là bên cạnh các cái biện,Vietnamese
+sẽ đọc hoặc nghe trong số cuốn sách là tầm quan trọng của việc duy trì tính toàn vẹn của thành ruột mỏng manh chỉ,Vietnamese
+những là bệnh nhân càng hỗ trợ về tâm lý thì mình còn cần thiết phải được điều trị tốt hơn ngay cả khi mà tiến hành bất,Vietnamese
+nhắc một cái câu chuyện cũng không phải là do số má gì đâu mà đôi khi là do gì ạ các bác sĩ trước người ta đã làm hết,Vietnamese
+đợt vừa rồi là tôi lại bị covid thì tôi đi cách ly ở,Vietnamese
+tháng thì mình làm mất đi cơ hội điều trị ung thư sớm và trong cái ba tháng đấy,Vietnamese
+lúc hoảng loạn lên hét tướng lên thế là tôi vùng dậy mà làm thế nào tôi vùng dậy xong tôi cứ,Vietnamese
+thuốc thật là phù hợp và theo nghiên cứu của các chuyên gia y tế thì ở những người bệnh có bệnh lý nền huyết áp cao,Vietnamese
+dinh dưỡng về vấn đề về cơ xương khớp và vân vân và tất cả những bác sĩ này phải,Vietnamese
+ngay cả cấp cứu chúng ta vẫn có thể gọi trước để chi để được hướng dẫn một cách cụ thể nhất để giúp cho người bệnh có,Vietnamese
+và nó giảm đi cái sự nứt giòn vỡ của thành mạch và từ đó thì nó sẽ cải thiện rất tốt giúp cho tăng cường cái sức khỏe,Vietnamese
+khác nó là sự ký sinh hợp hợp sinh của hai một loại nấm mà mọc trên một con sâu,Vietnamese
+cái gì là cái lớn nhất thì ở đây tôi muốn nói đến một điều là cái tác động đến hệ thống tim mạch là điều quan trọng,Vietnamese
+chứng của người bệnh parkinson thì đó được gọi là lập chương trình kích thích não sâu thế thì với trường hợp mà lập,Vietnamese
+bị trầm cảm nhiều hơn và mình thấy rõ ràng đó là cái người bị trầm cảm đó và,Vietnamese
+hợp lý rau xanh trái cây tươi đó là câu chuyện thường ngày và tất cả ai ai cũng có thể làm được rồi chúng ta bổ sung vì,Vietnamese
+gót chân này khi chúng ta phải mang vác nặng nhiều này chúng ta phải đi lại nhiều này chúng ta phải leo trèo nhiều,Vietnamese
+thứ mà nó dễ tăng cân quá mà để trước mặt tôi tức là điều chỉnh cái chế độ ăn,Vietnamese
+hoàn toàn chúng ta sẽ trở nên nhạy cảm với tất cả các loại mầm bệnh ngay cả với loại thường được xử lý dễ dàng lợi ích,Vietnamese
+là nhiều bạn đã tìm đến những cái sản phẩm để treatment thì trong các quá trình mà chúng ta sẽ sản phẩm mà có,Vietnamese
+chia sẻ tâm thông cảm từ những người kế cận đó thì cái việc điều trị nó sẽ,Vietnamese
+trị cũng không thể nào là những các sản phẩm đã thông thấu sâu bên dưới da được do đó này chúng ta phải biết rằng là,Vietnamese
+khả năng không lại được mạch máu đó và máu lên nuôi não được bình thường,Vietnamese
+tiêu hóa thức ăn ví dụ như là tổn thương ung thư ở các tuyến nước bọt chẳng hạn thì cái men tiết men amylase rất là khó,Vietnamese
+của họ nó càng bị bất ổn hơn và nếu ngược lại nếu mà mình được lắng nghe,Vietnamese
+sau mười năm thì triệu chứng các triệu chứng ngoài vận động nó xuất hiện nhiều hơn sa sút trí tuệ rồi táo bón rồi mất ổn định,Vietnamese
+nhưng mình biết là coi chừng có thể sau đó có khả năng sẽ bị đột quỵ thiệt tới,Vietnamese
+viêm da cơ địa rồi là trào ngược dạ dày khi mà bị khi bệnh về thoát vị đĩa đệm,Vietnamese
+kích thích não sau ví dụ như là truyền levodopa hoặc là truyền apomorphine bắt đầu ở các giai đoạn ba là chúng ta đã xem,Vietnamese
+màn hàng rào bảo vệ da của chúng ta được hồi phục trước đã còn nếu như mà bạn vẫn mong muốn là giữ sáng da vì da mình,Vietnamese
+được thông lên đó và sinh dưỡng tốt hơn và khi mà chúng ta sử dụng lâu dài thì nó hỗ trợ trong việc phòng ngừa các,Vietnamese
+khỏe chung cái thứ hai nữa là có những trường hợp là hoàn toàn dùng thuốc như vậy tốn tiền thiệt là nhiều luôn nhưng mà,Vietnamese
+kính chào quý vị và các bạn đang theo dõi chương trình tư vấn sức khỏe trực tiếp sống khỏe mỗi ngày được phát vào,Vietnamese
+không có mang thai thì mắc cúm a đa phần là nhẹ nhàng và triệu chứng thường nó sẽ chỉ kéo dài khoảng tầm ba ngày với,Vietnamese
+đặc thù đối với động vật có vú nhưng chúng ta có bằng chứng cho thấy các loài khác thực sự truyền di sản vi sinh vật,Vietnamese
+khỏe của cơ thể các chức năng bình thường của cơ thể thì việc mà sử dụng các cái các cái chế độ ăn cũng như là một,Vietnamese
+định như là sử dụng những cái laser hoặc là những cái phương pháp tiêm mesotherapy để,Vietnamese
+bác sĩ chuyên khoa bị rối loạn vận động sẽ có một cái quan điểm khám và đánh giá để người ta tiên lượng được thứ nhất,Vietnamese
+đơn giản là cái giai đoạn tập trung vào trong việc dùng thuốc hay là phẫu thuật hay là chỉ riêng một cái chuyên khoa,Vietnamese
+xem xét phản ứng chung của cơ thể đối với căng thẳng cả về thể chất ví dụ chạy trốn khỏi một kẻ đột nhập có vũ trang,Vietnamese
+giải thích cho ý tưởng này chúng ta thậm chí còn không biết vi khuẩn tồn tại cho đến khi nhà khoa học và thương nhân,Vietnamese
+kiểm soát cân nặng cũng như cái tình trạng kiểm soát cái béo phì chung đó nó,Vietnamese
+bắt đầu từ ruột điều này xảy ra rất lâu trước khi nền văn minh có bất kỳ bằng chứng hoặc lý thuyết vững vàng nào để,Vietnamese
+thuật kích thích não sâu thì nó sẽ kéo dài trung bình khoảng từ năm cho tới bảy ngày ở trong bệnh viện và sau khi bảy ngày,Vietnamese
+gốc này tuy nhiên chúng ta hiểu rằng là hiện tại kể cả ở mỹ người ta cũng chưa,Vietnamese
+kháng tốt nhất có một sự chuyển hóa tốt nhất để chúng ta có thể không những sinh tồn mà sinh tồn như là lúc ta chưa từng,Vietnamese
+đơn thuốc bẻ điều trị về huyết áp cái gì về mỡ máu điều trị về vấn đề là,Vietnamese
+một xét nghiệm có thể nói rằng là cái tính gọi là nhạy cảm cái tính chính xác của n�� rất là cao cho nên là không ít,Vietnamese
+bệnh nhân bị đậu mùa và cậu bé đã không bị nhiễm bệnh thí nghiệm này thường được,Vietnamese
+cửa hiệu quần áo để mà họ chọn họ không dám nói chuyện với những người khác về cái,Vietnamese
+đấy là những hoạt chất cực kỳ quan trọng ở đây cũng phải nói một điều là trên cơ,Vietnamese
+đô thị hóa nó đã thay đổi cộng đồng sinh thái bên trong của chúng ta như thế nào liệu về các thành phố được vệ sinh có,Vietnamese
+ruột khỏe mạnh không phải là những kẻ ăn sẵn hưởng thụ đồ ăn và chỗ ở miễn phí chúng có ảnh hưởng đến nguy cơ không chỉ,Vietnamese
+trình nói chúng ta nên thêm câu hỏi về cái phần phân biệt khái niệm tẩy trắng dưỡng sáng để quý vị khán giả có thể nhớ,Vietnamese
+trong đó những người chơi cờ có kinh nghiệm được cho xem một ván cờ có thể giành chiến thắng bằng cách sử,Vietnamese
+hai cái nhóm thuốc này thì nó lại có cái tác dụng đó là làm tăng cân như qua các nghiên cứu thì đã ghi nhận rằng là cái điều trị,Vietnamese
+cho cái câu hỏi của bác là gì ạ chúng ta có nên tăng cường vận động không câu trả lời là gì ạ chúng ta nên tăng cường vận,Vietnamese
+mãn tính ở tại tỉnh vĩnh long cũng phải hàng tháng đến bệnh viện lấy thuốc mà trong cái đợt giãn cách như thế này thì,Vietnamese
+chúng ta cần phải nắm rõ các triệu chứng của đột quỵ nếu lỡ nó có xảy ra thì chúng ta sẽ phát hiện ta đưa đi cấp cứu,Vietnamese
+khám nữa người ta không được theo dõi nữa mà người ta hoặc là người ta dùng theo kinh nghiệm hoặc là người ta tiếp,Vietnamese
+mà xung quanh thì quá đông người như vậy thì nguy cơ lây nhiễm là rất cao phải không có cách nào để đảm bảo an,Vietnamese
+khác máu lạnh khác thì vẫn có thể khác,Vietnamese
+khác đến giai đoạn các triệu chứng nặng hơn thì thuốc chúng ta cũng sẽ phải tăng liều lên chúng ta sẽ phải tập thể dục,Vietnamese
+cái gì nặng không ạ,Vietnamese
+yên tâm được việc là nó rất ít khả năng để xảy ra rung nhĩ nhưng mà bạn lưu ý một điều là phải theo dõi tiếp tới tình,Vietnamese
+tăng thêm một số các cái chất mà nó có nhiều canxi hơn ví dụ như một số loài thịt cá,Vietnamese
+động mạch vành cũng như là nó nâng cao cái sức chịu đựng của tế bào oxy tế,Vietnamese
+liệu đầu vào cho đến đầu ra nó đảm bảo chất lượng hay không thì cái đó là cái,Vietnamese
+trắng hơn rồi bạn nghe bạn bè rồi những người thân xung quanh em á cũng nói là tóc em ngày càng mỏng dần đi thì em cũng,Vietnamese
+câu hỏi của bác trước hết thì chúng ta sẽ chia sẻ một vài các cái lời khuyên và phân tích về cái vấn đề sức khỏe của,Vietnamese
+là liệu rằng phẫu thuật kích thích não sâu có bị biến chứng gì hay không ạ đây là một phẫu thuật ít xâm lấn chứ,Vietnamese
+hai loại sâm một là sâm ngọc linh sâm ngọc linh thì được thế giới công nhận là,Vietnamese
+ngày hôm nay thời lượng của chúng ta cũng đã hết rồi nên là chúng ta sẽ giải đáp những cái câu hỏi này trong các phần inbox từ fanpage của bệnh viện cũng như,Vietnamese
+trước tôi đến ngã hai lần thì người ta khuyên gửi tôi sang cái bệnh viện tâm thần kiểm tra mà,Vietnamese
+cách đây khoảng mười năm trong một lần đi khám sức khỏe,Vietnamese
+về tâm lý và tinh thần cho thật tốt trước khi mà thực hiện phẫu thuật kích thích não sâu đã chuẩn bị như thế nào,Vietnamese
+chất trong cơ thể như vậy thì mình sẽ có thể dùng với liều đã cố định luôn là không có không có cần phải xét nghiệm,Vietnamese
+hỏi là sau cái điều trị điều trị này mà cô chuyển sang uống cái thuốc đấy có được không vâng,Vietnamese
+biết là gì là bên cạnh việc dùng thuốc thì có thể nói rằng là những cái thuốc tân dược thì bao giờ chúng ta sử dụng nó,Vietnamese
+mạch ở đây cũng phải nói với bác quý vị khán giả là thế này mặc dù chúng ta có,Vietnamese
+nhiên từ thực vật người ta liên trích ra và người ta đã chứng minh rằng đó có nhiều cái công dụng trong đó có công,Vietnamese
+ung thư và bị khối u nó đang ăn một cách với một tốc độ rất là nhanh ăn các chất,Vietnamese
+cholesterol thì nếu mà những cái kiểm tra sức khỏe thông thường của mình mà nó nó không có bất thường không có,Vietnamese
+phẩm sữa rửa mặt lành tính thôi dịu nhẹ thôi thì khi đó là bạn không có lo là mình phải sử dụng quá nhiều hóa chất,Vietnamese
+muốn di chuyển qua cái địa bệnh khác thì chúng ta cũng nên có một cái kết quả xét nghiệm cầm theo để chúng ta có thể là,Vietnamese
+bị kết án và họ đã được thả tự do hệ miễn dịch của họ đã cứu họ thoát khỏi,Vietnamese
+kiến thức về miễn dịch học bệnh lý học thần kinh học và nội tiết học nhưng tôi,Vietnamese
+phẩm mà có chứa những cái thành phần không có chứa cồn không có chứa hương liệu không có chứa chất bảo quản thì,Vietnamese
+nó huyết áp nó tăng cao vì khi chúng ta biết càng huyết áp tăng cao vâng nó càng bị bị dễ bị tai biến chị nhé các cái,Vietnamese
+não nữa bác ạ thế nên là khi sử dụng thì bác nên kéo dài từ ba đến sáu tháng bác nhé để mang lại cái hiệu quả cao nhất ạ và,Vietnamese
+khi mà bị đột quỵ thì thường các bác sĩ đột quỵ tôi sẽ phải khảo sát toàn bộ để,Vietnamese
+lượng quốc gia thế cho nên là cái đó là cái mà chúng ta có thể tin tưởng được đấy à chỉ nói với bác một vài điểm như,Vietnamese
+ta có thêm một chút thông tin gì đó bổ ích để ai đó bị rụng tóc thì bớt lo đi,Vietnamese
+hỏi cách nhanh nhất để giành chiến thắng trong ván cờ các chuyên gia thường chỉ ra phương án năm nước đi quen thuộc bỏ,Vietnamese
+người mà quyết định cái thành bại của cái lộ trình điều trị ung thư ấy chiến thắng,Vietnamese
+ở giai đoạn ba mà chúng ta sử dụng các thuốc kiểm soát tốt cũng như là các phương tiện điều trị hỗ trợ tốt thì,Vietnamese
+nếu mình có nguy cơ thì mình có cái máy đo huyết áp tại nhà là mình có thể theo dõi rất là thường xuyên còn đối với,Vietnamese
+vitamin b2 đây là ba cái vitamin quan trọng nhất trong cái loét miệng còn tốt nhất là mình cứ bổ sung một gói multivitamin,Vietnamese
+bác nên sử dụng kéo dài từ ba đến sáu tháng để mang lại cái hiệu quả cao nhất bác ạ vâng và chúng ta biết là đối với sản,Vietnamese
+để duy trì các hoạt động bình thường để cho chúng ta có cơ hội để chịu những cái chịu đựng được những cái đợt hóa trị xạ,Vietnamese
+lạ với cơ thể thì về tùy vào cơ địa đó có thể bệnh nhân chấp nhận hoặc không chấp nhận hoặc là cái môi trường của,Vietnamese
+bác có thể vâng bác đang gặp bệnh lý như thế nào bác,Vietnamese
+trọng hơn là cái người chấp nhận món ăn đó phải cố gắng lên và để dần dần chúng,Vietnamese
+lo âu bồn chồn và có đôi khi ảo giác và có thể có ý định tự tử thì tất,Vietnamese
+thực hành được dinh dưỡng chăm sóc người bệnh được tốt nhất thì đối với người,Vietnamese
+khán giả của chúng ta cũng đã hiểu hơn về những cái công dụng những cái hoạt chất những cái dược chất có trong sản,Vietnamese
+và các bạn và trong ngày hôm nay thì bác sĩ sẽ ở đây để có thể tư vấn trực tiếp,Vietnamese
+mức độ nghiêm trọng của trầm cảm thì đó là một số những cái ảnh hưởng của cái,Vietnamese
+cái của rất rất nhiều người nói chung là chúng ta bắt đầu có tuổi thì bao giờ,Vietnamese
+một trăm bốn mươi thì không biết là cái này là bác đã đang dùng thuốc hay là chưa dùng thuốc huyết áp nhưng mà khi mà bệnh nhân,Vietnamese
+khi người béo phì trong quá trình điều trị hay là trong quá trình mà cải thiện,Vietnamese
+ta bị ngã đấy có những trường hợp là đang khó thở như này nhưng đồng thời trong lúc mà mình khó thở như vậy thì nó,Vietnamese
+khi ông ghép nội tạng từ côn trùng này sang côn trùng khác và phỏng đoán rằng côn trùng phải có một số dạng,Vietnamese
+là chiều thứ ba đối với hệ vi sinh của chúng ta chúng có mối quan hệ độc đáo với hệ vi sinh vật trong ruột của chúng,Vietnamese
+cảm nhiều hơn và cái này người ta đã có những cái nghiên cứu rất là rõ ràng có số liệu rất,Vietnamese
+nhân thì đột quỵ thiếu máu não nó thực ra có rất là nhiều nguyên nhân nhưng mà,Vietnamese
+sự chuyển giao lớn cuối cùng mà một em bé nhận được từ mẹ sau khi ở trong tử cung trẻ ra đời bằng phương pháp sinh mổ,Vietnamese
+cuộc sống tốt hơn vâng thưa bác sĩ như vậy thì ở từng giai đoạn của mình thì người bệnh sẽ được tiếp nhận điều,Vietnamese
+có thể nói rằng đây là một trong những yếu tố ảnh hưởng rất lớn đến chất lượng cuộc sống của người bệnh cũng như là ảnh,Vietnamese
+thực vật nó quan trọng không chỉ ở chất đạm mà nó còn quan trọng ở chất béo và nó còn quan trọng là cái,Vietnamese
+bao nhiêu tuổi và sau khi đi bộ đội về thì ạ lâu nay thì bác còn làm,Vietnamese
+xong rồi thì cái việc mà dùng thuốc nó nó vẫn tiếp tục của cái trị liệu nó đang có ví dụ liệu trầm cảm chứ không có thể,Vietnamese
+thứ nhất là gì là người ta sử dụng cái bộ phận nào của đông trùng hạ thảo dùng,Vietnamese
+hết chúng ta ở thế giới phát triển phương tây họ thường uống rượu vang và cà phê hàng ngày vẫn năng động trong một,Vietnamese
+xương có khớp chả ai đến cái tuổi cao mà có tuổi mà chúng ta lại không đau xương khớp đâu nhưng mà vấn đề chỗ là gì là,Vietnamese
+làm bài kiểm tra về các vi khuẩn đường ruột mà dna của chúng có thể có tác động lớn tới sức khỏe của bạn hơn cả dna của,Vietnamese
+có những cái xét nghiệm mà đã thấy có thay đổi rồi và mình điều trị bằng chế độ ăn hoặc là,Vietnamese
+học hẳn sẽ yêu thích cuốn sách này nhưng nếu bạn chưa tìm hiểu nhiều về khoa học đặc biệt là y học bạn cũng sẽ,Vietnamese
+vâng và hiện tại thì thời lượng của chương trình cũng không còn nhiều tuy nhiên còn rất là nhiều khán giả đã gọi điện tới và mong đợi được sự tư vấn của,Vietnamese
+tác dụng phụ lên đường tiêu hóa lên các cái hệ nội tạng chính vì vậy cho nên đấy là một trong những cái hướng mà tiếp cận,Vietnamese
+thêm động lực ý chí và quyết tâm tưởng bước trên hành trình vượt qua mọi thử thách để có một cuộc sống chất lượng vui,Vietnamese
+những cái bệnh lý rất là thường gặp ở những người lớn tuổi hoặc là những ai đang bị mất ngủ chúng ta bị đau đầu bị tiền đình bị thần kinh rồi chúng ta gặp,Vietnamese
+lượng và nhớ thay lặp lại sau hai đến ba giờ mỗi lần nếu chúng ta phải thường xuyên ra ngoài nắng cái thứ hai đó là,Vietnamese
+có nhiều người rung nhĩ và khi mà chúng ta lớn tuổi như vậy thì những cái bệnh nền bệnh đồng mắt của rung nhĩ có thể là,Vietnamese
+chất những cái hoạt chất mà điều trị những cái vấn đề về da với một cái nồng độ tương đối là cao do đó sẽ giúp cải,Vietnamese
+lo lắng khi mà người dân đến lấy mẫu mà không biết là liệu nhân viên y tế có thời gian hay không hoặc là có sát khuẩn,Vietnamese
+thuốc mà có thể là không ảnh hưởng đến cân nặng hoặc là thậm chí là có tác dụng giảm cân cho những bệnh nhân như vậy thì điều này cũng đã đưa và các cái,Vietnamese
+đừng có quá lo lắng là tại sao tôi mổ rồi mà triệu chứng của tôi nó chưa cải thiện,Vietnamese
+chứng xảy ra đó là tắt mạch máu tim nhồi máu cơ tim đó thì dù cho chúng ta có điều trị kịp thời đi nữa nhanh chóng và,Vietnamese
+mà vữa xơ động mạch nó sẽ gây ra tình trạng đột quỵ não đột quỵ tim đột quỵ,Vietnamese
+với những cái bệnh lý khác thì điều này không chỉ trong thực tế lâm sàng mà trong những cái nghiên cứu họ,Vietnamese
+béo từ động vật thì nên sử dụng từ mỡ cá thì sẽ tốt hơn và chúng ta cứ nói,Vietnamese
+thầy thuốc người ta xem và từ đó thì có thể nói là các thế hệ mà để điều chỉnh,Vietnamese
+điều kiện kiểm nghiệm để mà đảm bảo rằng là cái chất lượng sản phẩm đó từ nguyên,Vietnamese
+cái cái những cái tâm sự của bác thực sự là cũng rất là là rất là cô đọng rất xúc,Vietnamese
+thận trọng khi dùng thuốc và khi bất kỳ mà muốn dùng một loại thuốc mới nào thì phải có ý kiến của bác sĩ hiểu biết và,Vietnamese
+vị ngọt thậm chí cũng không thích nữa rồi vị tanh không chịu được không thể chấp nhận thức ăn và đặc biệt là làm cho,Vietnamese
+hai tay thế trong trường hợp như thế này chúng ta cũng phải cần phải phân biệt rõ là các cái vùng mà cột sống cổ,Vietnamese
+chọn những cái serum mà có những kế hoạch chất cấp ẩm với nồng độ cao thì đối với lại bạn là tình trạng da bạn là,Vietnamese
+tôi hoàn toàn không nghi ngờ gì rằng bằng cách nắm bắt thông tin này chúng ta,Vietnamese
+những áp lực về mặt tâm lý như đã nêu trên đó nó khiến cho cái người bị bệnh,Vietnamese
+lên tới cái chỗ mà cái cục máu đông đá và chúng ta dùng dụng cụ chúng ta xoáy vậy để chúng ta kéo ra đó nó rất là nhẹ,Vietnamese
+cảnh giác nhưng không ở chế độ phòng thủ hoàn toàn chúng giám sát mà giáo dục hay,Vietnamese
+phương tức là những cái bài thuốc mà đã được tích lũy để chuyên điều trị cho các cái bệnh lý mà đau nhức xương khớp thoái,Vietnamese
+không đúng với khoa học chẳng hạn ở phần đầu của chương trình thì chúng tôi cũng đã nhắc tới là làm thế nào để có thể,Vietnamese
+chúng ta nó bệnh dại,Vietnamese
+hoàn mạch máu bảo vệ phục hồi tế bào thần kinh giảm lo âu căng thẳng cải thiện sa sút trí tuệ suy nhược thần,Vietnamese
+có cái tác dụng là làm vững bền thành mạch và chúng ta biết là qua nghiên cứu dược hiện đại thì người ta thấy trong hòe hoa nó có một cái hoạt chất đó,Vietnamese
+chuyện là chúng ta định kỳ phải tái khám bởi vì nếu chúng ta mà không tái khám thường xuyên thì để đến khi chúng ta có,Vietnamese
+trợ phòng ngừa các cái biến chứng trong đó như là các biến chứng nhồi máu cơ tim như cái biến chứng về đột quỵ não và,Vietnamese
+tiến nó có thể kéo dài trung bình là hai mươi năm có thể là dài hơn và cũng có thể,Vietnamese
+cái quá trình sử dụng không hợp lý như vậy kể cả những cái cơ quan thần kinh như là chúng ta phải điều trị các cái,Vietnamese
+quá thì khả năng phẫu thuật nó sẽ khó khăn nó có sẽ có nhiều biến chứng cái thứ hai người bệnh parkinson nên là hơn,Vietnamese
+loại hạt và rất nhiều dầu ô liu cậu dành những tháng ngày tuổi thơ theo học ở một,Vietnamese
+thì khi tiếp cận với đông trùng hạ thảo thì chúng ta phải hiểu đông trùng hạ thảo nó là cái gì tác dụng của nó ra sao,Vietnamese
+xin hỏi bác sĩ một là vấn đề về tiểu đường đó bác sĩ và hai về là là xương,Vietnamese
+hóa đáp ứng đủ ba mục tiêu này cũng như có một chiếc kiềng ba chân vững chãi giúp,Vietnamese
+cải thiện cái tình trạng sức khỏe của mình nữa và bên cạnh đó nữa thì anh cũng,Vietnamese
+bác sĩ mà chuyên khoa về bệnh xương khớp để theo dõi sát này điều trị sát này điều chỉnh sát và tư vấn sát sao cho bác,Vietnamese
+đến khám thì khi ra điện tâm đồ này phát hiện ra rung nhĩ trường hợp thứ hai là,Vietnamese
+tử vong đó rất là nhanh trong vòng mười,Vietnamese
+thì làm sao mục đích thứ nhất là giúp cho người bệnh tăng đề kháng mục đích thứ hai là giúp cho người bệnh làm sao,Vietnamese
+chia sẻ cũng đã khép lại chương trình,Vietnamese
+ngày đối với các thuốc mà gọi là tháng đó thì không còn thuốc trong người nữa nghĩa là không còn thuốc không,Vietnamese
+là ba triệu chứng chính từ trong tiếng anh hoặc là cái câu của tiếng việt ra làm méo cười ngọng nói xuôi,Vietnamese
+định dùng thuốc liều lượng dùng thuốc tương tác thuốc mới được gọi là xem xét,Vietnamese
+đầu tiên thì chúng ta dễ dàng nhận thấy nó là bệnh nhân béo phì thì họ nôn nóng,Vietnamese
+niacinamide là một các hoạt chất mà giống như mình gọi là một cái hoạt chất bạc đặc biệt đối với làn da nhạy cảm bởi,Vietnamese
+y tế bằng là găng tay bác sĩ đã thay chưa hoặc là sát khuẩn hay chưa chúng ta cũng có thể nhắc nhở một tí thì mình,Vietnamese
+thời gian thôi thứ hai là để phân biệt với những cái cái triệu chứng mà choáng váng xây xẩm chóng mặt khác nó có phải,Vietnamese
+được vấn đề kể cả đông trùng hạ thảo tốt nhất đông trùng hạ thảo tây tạng cũng không giải quyết được vấn đề mà chúng ta,Vietnamese
+lại gì nhiều nữa cái cái việc này cũng rất là là là quan trọng thế và cái cái,Vietnamese
+tuần đến hai tuần thì người bệnh vẫn có thể đi làm được nếu mà người bệnh mong muốn được đi làm sớm xin được cảm ơn các bác,Vietnamese
+toàn về cái việc mà mục tiêu điều trị khi mà,Vietnamese
+phải khoảng sau một tháng do đó tóm lại là nếu mà người bệnh sau phẫu thuật thích não sâu mà người bệnh mong muốn,Vietnamese
+phương tiện để mà khi mà có tác dụng phụ của những cái thuốc đó xảy ra thì chúng ta phải tiếp nhận chúng ta điều trị như,Vietnamese
+một cách đầy đủ ��ể kiểm soát triệu chứng đầy đủ trừ phi mà người bệnh đã uống quá,Vietnamese
+tình trạng và hậu phẫu ổn định thì người bệnh vẫn có thể bắt đầu đi làm trở lại,Vietnamese
+các yếu tố vi lượng như kẽm rồi sắc vân vân đấy thì tất cả những cái đó đều,Vietnamese
+hấp cũng như là các cái hệ cơ xương khớp và kể cả là ăn uống đi chăng nữa thì đặc biệt là đối với cái hệ cơ xương khớp của,Vietnamese
+tia uv còn với kem dưỡng ẩm ban đêm để chúng ta nên chọn lựa những cái sản phẩm mà có chứa thêm những cái thành phần,Vietnamese
+cấy ghép ở dưới cùng da vùng ngực của bệnh nhân và sau đó mình sẽ đều,Vietnamese
+tĩnh mạch sâu hiện nay thì nó có xu hướng gia tăng điều đó nó liên quan rất,Vietnamese
+ta có thể sát khuẩn găng tay sau khi mỗi lần lấy mẫu và thay găng và và thay găng,Vietnamese
+thoa hoặc là chúng ta sử dụng những cái công nghệ như là plasma lạnh cũng giúp làm dịu đi tình trạng da nhạy cảm,Vietnamese
+có giống như cái việc mà chúng ta đang cảm cúm hàng ngày và nó có những cái nguy hiểm hay là những cái đối tượng nào,Vietnamese
+sự suy luận buộc chúng ta ít nhất phải xem xét thực tế rằng hệ vi sinh của chúng ta đang tham gia đáng kể bằng nguy,Vietnamese
+hãy dành một chút thời gian để suy nghĩ về việc thế giới của chúng ta đã thay đổi nhiều như thế nào trong thế kỷ qua,Vietnamese
+đây là một cái sản phẩm mà là kế thừa từ đề tài cấp nhà nước và đề tài nghiên cứu cấp nhà nước và đây cũng là một cái đề,Vietnamese
+đấy là gì ạ do cơ địa của từng người và khi có những cái cơ địa của từng người như vậy thì rất là có thể có những cái,Vietnamese
+hợp rồi họ sẽ dùng một số những thứ thuốc thuốc đông y mà nó không có chính thống họ cũng có thể đưa vào trong các,Vietnamese
+lâu rồi còn nằm trong khoảng tám tuần mà có thể làm tăng những nguy cơ bị tắt,Vietnamese
+các loại hạt khác như là hạt vừng để hạt điều này hạt não óc chó này thì đều,Vietnamese
+trình này các mô tả đầu tiên về phương cách cứu người quan trọng này có thể đạt được tìm thấy trong tri thức dân gian,Vietnamese
+dụng các sản phẩm này đấy là cái mà rất tốt cho sức khỏe của bác đặc biệt là vấn đề dự phòng vấn đề là có thể bị tai biến,Vietnamese
+sinh của bạn đối với chứng viêm bạn có thể thay đổi điểm mốc của mình không có,Vietnamese
+vị thuốc mà có những cái tác dụng bồi bổ để mà mở rộng phạm vi điều trị tôi nói,Vietnamese
+tân dược hỗ trợ làm cho là gì huyết áp ổn định tốt hơn ngăn ngừa được vữa xơ động mạch cải thiện tuần hoàn não từ đó,Vietnamese
+chúng ta không tụ tập đông người đây chúng ta không tạo điều kiện cho virus phát triển thì dĩ nhiên virus nó cũng,Vietnamese
+hiểm của cái chứng tăng huyết áp này trong một lần tình cờ khi mà tôi còn đang ở bên mỹ thì,Vietnamese
+được tốt nhất vai trò thứ ba của đối với lại dinh dưỡng đó là dinh dưỡng thậm chí,Vietnamese
+cứu phòng chống ung thư ở việt nam thì có rất nhiều bệnh nhân ung thư gặp phải tình trạng đó là sụt cân và suy dinh,Vietnamese
+không có các bệnh lý đi kèm ngày bởi vì là bệnh lý đái tháo đường như chúng ta biết nó là một cái bệnh lý mà tiến triển,Vietnamese
+vâng xin chào bác vâng theo thông tin tức là vâng bác cũng đã đi đi khám tim,Vietnamese
+bao giờ tác dụng của nó cũng chậm cho nên ta dùng kéo dài chứ chúng ta đừng có nghĩ rằng là chúng ta uống một ngày hai,Vietnamese
+nhiên chúng ta vẫn hiểu rằng là khoảng thời gian nó chỉ là một yếu tố ngoài ra nó còn có yếu những yếu tố khác ví dụ,Vietnamese
+đồng tiền để cho sức khỏe của chúng ta với đông trùng hạ thảo thì chúng ta phải,Vietnamese
+khám và và và sẽ được bác sĩ kê đơn uống thuốc ngay bác nhé bác không chần chừ không chờ đến một hai ngày nữa nhỡ đâu,Vietnamese
+học chúng ta chọn lựa những cái kem chống nắng có nguồn gốc từ vật lý và lưu ý là chúng ta nên chọn lựa cả kem chống,Vietnamese
+mình cho đến ngày chúng ta khỏi ung thư cho nên cái quan niệm rằng chúng ăn quá nhiều đúng là có những cái ăn quá,Vietnamese
+lâu dài nó còn phòng ngừa hỗ trợ trong việc phòng ngừa các cái biến chứng như là biến chứng các cái nhồi máu cơ tim,Vietnamese
+điều trị của các bác sĩ cũng như là chế độ dinh dưỡng nữa thì sẽ giúp cho người bệnh ung thư sẽ nhanh chóng phục,Vietnamese
+cam kết xem coi mình có giữ được cái cân nặng này không chính cái cam kết đó nó,Vietnamese
+cho tất cả quý vị khán giả biết thêm về lợi ích mà người bệnh nhận được khi thực hiện giảm cân một cách hiệu quả và an,Vietnamese
+ngày sữa rửa mặt toner rồi đáp án tiếp theo đó là đáp án b mọi người đọc kỹ,Vietnamese
+khó khăn hay còn gọi là những thách thức khi mà chúng ta trị liệu về béo phì như vậy thách thức,Vietnamese
+dài đó là những cái chế độ ăn vận động thể lực cũng như là các quá trình thay đổi hành vi thì đã có rất là nhiều,Vietnamese
+chúng ta có thể nhận thấy những dấu hiệu như là khô miệng này như là ăn không ngon miệng này biến đổi vị giác này biến,Vietnamese
+tính các bệnh về da như mụn và chàm hơi thở có mùi hôi bệnh về lợi và răng hội,Vietnamese
+chúng ta phải tuân trị chứ không có được gọi là bỏ trị khi chúng ta phải tuân trị,Vietnamese
+giúp bạn tồn tại ảnh hưởng của mỗi cá nhân đến sức khỏe mạnh của hành tinh chúng ta cũng vậy trên thực tế bạn là,Vietnamese
+vấn đề cân nặng mà nó còn gồm rất là nhiều những cái biến chứng bệnh lý đi kèm theo như là tăng huyết áp rối loạn,Vietnamese
+thì tình trạng mà sức khỏe chung về mặt tinh thần nó sẽ giảm đi,Vietnamese
+giáp thì chưa tốt chưa có bằng chứng để khẳng định rằng là nó tốt và cũng chưa có bằng,Vietnamese
+thuốc hạ huyết áp khẩn cấp từ đấy thì tôi mới lại càng thấy cái mức độ nguy,Vietnamese
+tim mới là thế nào tức là chúng ta có thể bị nhồi máu cơ tim có thể bị các cơn đau thắt ngực và thậm chí là chúng ta có,Vietnamese
+tâm trên thế giới vẫn đang tiếp tục sử dụng phương pháp gen cũng như là tế bào gốc cho thấy việc nghiên cứu trong,Vietnamese
+dự như thế nào khi có thể giới thiệu những khám phá này với công chúng tiết lộ tất cả dữ liệu đang được lưu hành âm,Vietnamese
+sống có liên quan trực tiếp đến sức khỏe và chức năng của hệ vi sinh và một điều,Vietnamese
+chương trình này luôn cái gì ở đây có rất là nhiều tại thời điểm hiện tại chúng ta có rất là nhiều những thông tin về cái bệnh cúm a ở trên mạng xã hội,Vietnamese
+cộng đồng và chúng ta làm giảm các nguy cơ nếu mà có thể ra ngoài cộng đồng khi mà chúng ta ở ngoài như vậy vì việc mà,Vietnamese
+dưới video này các bác sĩ sẽ giải đáp ngay quý vị nhá và quý vị hãy cùng giúp,Vietnamese
+cái tình trạng này không ạ đúng là một cái vấn đề này khá là khá là phổ biến đặc biệt là trong những cái thời gian,Vietnamese
+cuộc phẫu thuật cũng như là sau đó là những đợt hóa trị và xạ trị chúng ta sẽ,Vietnamese
+tôi cũng không có cái tham vọng là có thể trả lời tất cả các cái cái cái cái thắc mắc cũng như là cái câu hỏi nhưng,Vietnamese
+chứng của cái xơ vữa động mạch hay tăng huyết áp đó là cái biến chứng nhồi máu cơ tim như cái biến chứng về đột quỵ não,Vietnamese
+thì bản thân các cái thuốc điều trị bệnh parkinson nó cũng giúp cải thiện táo bón đó,Vietnamese
+fumarate cũng đã được chứng minh rằng thứ nhất là nó tác dụng hỗ trợ trong việc làm giảm nguy cơ hình thành các,Vietnamese
+trong ruột bạn đã tăng cường độ làm việc của gan ảnh hưởng lớn rồi đáp ứng của hệ,Vietnamese
+trường xã hội cái môi trường sống về mặt tự nhiên đó thì nó ảnh hưởng như,Vietnamese
+chất béo cho đến chín kcal mà thể thích ăn vào của một bệnh nhân ung thư là rất là con là hữu hạn cho nên là chúng ta,Vietnamese
+những những cái cộng đồng người ung thư cũng đã có những cái gọi là tổ chức những cái cộng đồng của,Vietnamese
+giữa hệ vi sinh và não bộ chúng ta sẽ biết đến một ngành học mới y học biểu,Vietnamese
+khi có mặt của cái gọi là chất bổ trợ chất bổ trợ xuất phát từ tiếng latin,Vietnamese
+fanpage của bệnh viện y dược thành phố hồ chí minh và cả fanpage của cetaphil việt nam bởi vì chương trình,Vietnamese
+thuốc đột quỵ của hàn quốc được không thì xin bác sĩ cho một lời khuyên vâng,Vietnamese
+động của máy kích thích não sâu của mình cũng có thể thay đổi một vài thông số liên quan tới hoạt động kích thích não,Vietnamese
+học cổ truyền nhưng mà tuy nhiên trước đây chúng ta chắc là những người mà chúng ta người dân lao động thì chúng ta,Vietnamese
+rất sớm người làm đẹp làm đẹp tóc rất là đủ kiểu nói chung là đủ kiểu nên tóc bị,Vietnamese
+hệ vi sinh không lành mạnh có thể nhạy cảm hơn với cơn đau vi khuẩn tốt trong ruột làm đường ngược,Vietnamese
+chương trình kích thích não sau thì nó sẽ có những người tham gia ví dụ như là,Vietnamese
+thể của nó có khả năng gắn với các tế bào khỏe mạnh nếu có thì tế bào t hoặc,Vietnamese
+tóc vậy nhưng mà trên cái da đó thì có có viêm nhiễm hay là trơn láng nó khác nhau ạ nguyên nhân khác nhau điều trị,Vietnamese
+là hưng phấn để mà có thể vượt qua cái tình trạng sức khỏe của một người béo phì và chính vì vậy mà khi mà bị căng,Vietnamese
+thể được chích thuốc điều trị có thể được can thiệp mạch hoặc là làm cả hai luôn thì các cái mốc thời gian cụ thể là,Vietnamese
+chúng ta cũng hạn chế nói chung là không nên tiếp xúc gần,Vietnamese
+thì theo thời gian tuổi tác thì tóc nó lại rụng thì chắc chắn nó có liên quan nhiều yếu tố trong đó có những liên quan,Vietnamese
+vị của người đã bị ung thư nhưng phải chú ý đến yếu tố sức khỏe ví dụ đang bị tăng huyết áp chẳng hạn và sau ung thư,Vietnamese
+chú đá bóng rồi chú trồng cây tưới nước thoải mái không phải lo nghĩ gì về cái,Vietnamese
+của mình nó càng nặng hơn và dẫn đến nhiều biến chứng hơn trong đó như là đột quỵ não bác cũng đã bị rồi và cái nguy,Vietnamese
+trong cái việc mà mình sử dụng thuốc kháng đông thuốc chống đông đó để mà phòng ngừa đột quỵ do rung nhĩ thì như là,Vietnamese
+mang lại hiệu quả tức là chúng ta phải sử dụng kéo dài từ ba đến sáu tháng và đây là một cái sản phẩm mà nó đã tác động,Vietnamese
+bệnh của ở việt nam vẫn chưa được thụ hưởng thưa tất cả quý vị trong quá trình mà bác sĩ chia sẻ thì tất cả quý,Vietnamese
+bệnh lý mà chèn ép thần kinh tọa thế nhưng mà khi mà chúng ta đi lại hoặc đứng lên thì cái cái biểu hiện nó lại,Vietnamese
+hoạt chất này cũng có gây nguy cơ kích ứng và dị ứng rất là cao đó là những cái lưu ý khi mà chúng ta da nhạy cảm,Vietnamese
+bác sĩ nội thần kinh để người ta kiểm tra và người ta điều chỉnh nếu cần trên,Vietnamese
+ta đã có cái chấn thương sọ não như vậy thì nó sẽ ảnh hưởng rất là nhiều cơ quan và thậm chí là ảnh hưởng đến não là một,Vietnamese
+chưa cảm nhận là có dấu hiệu cũng như là hiệu quả giảm rõ rệt nguyên nhân là do sao ạ do cái mảng xơ vữa động mạch gây,Vietnamese
+muốn nói đó là nó không phải là thuốc nó thực phẩm bảo vệ sức khỏe thôi nhưng mà hiệu ứng của nó khi mà chúng ta sử,Vietnamese
+từng phần của tâm nhĩ đó sẽ rung lên à và khi rung lên như vậy đó thì nó dẫn,Vietnamese
+rối loạn mỡ máu không ạ à không không có đúng không chỉ có huyết áp,Vietnamese
+nhé nếu có chua quá thì có thể làm cho bố sẽ xót với rồi thì các axit hữu cơ ở trong nước quả có thể làm những cái tổn,Vietnamese
+khi mà chúng ta đến nơi đây ví dụ như anh đến những cái nơi thì anh thấy đông,Vietnamese
+trên thị trường hiện nay tức là gấp khoảng năm lần so với các chế phẩm trên thị trường nên là tác dụng của đông,Vietnamese
+biến đổi để không có bất kỳ vi khuẩn đường ruột nào do đó cho phép các nhà khoa học nghiên cứu ảnh hưởng của việc,Vietnamese
+cũng như là các cái thảo dược hoặc là các cái bài thuốc độc hoạt tang ký sinh như thế này cũng là những cái giải pháp,Vietnamese
+thường được tìm thấy trong lớp vỏ ngoài của vi khuẩn vấn đề này được xem là quan trọng vì gen liên quan sẽ có khả năng,Vietnamese
+của của chúng ta là nó có những cái tác dụng phụ như vậy nhưng mà trong những trường hợp mà bệnh phổi tắc nghẽn mãn,Vietnamese
+rất là dễ nhầm với các bệnh lý nhiễm virus khác tuy nhiên về trong mặt về mặt lịch sử của nó thì nó đã trải qua đến,Vietnamese
+miệng để cho bệnh nhân dễ thở thì hai cái đó là hai cái chính thôi rồi thì,Vietnamese
+có thể gọi đây l�� thuốc lẫn máu hay là một số cái tên khác mà thì nó có thể,Vietnamese
+trong những cái bài thuốc để điều trị những chứng như là kinh quý chính xung của y học cổ truyền hay còn gọi là những,Vietnamese
+như tất cả các loại bệnh mãn tính rõ ràng các vi khuẩn có lợi trong một đường,Vietnamese
+tham gia vào khi nói đến sự phát triển của bất kỳ căn bệnh nào cũng như tỷ lệ mắc một số bệnh ở các quốc gia khác nhau,Vietnamese
+là phải có đạm phải có chất béo và chúng ta cũng phải chú ý nên chọn đó là trong đó có được selen có được vitamin,Vietnamese
+cuộc phiêu lưu khoa học vĩ đại nhất và những hiểu biết chung mà chúng ta có hiện nay có được,Vietnamese
+còn nặng hơn rất là nhiều và bản thân tai biến mạch máu não lần một lần hai nó có thể nhẹ nhưng những lần sau nó sẽ,Vietnamese
+nãy chúng ta chia sẻ như hoa thủy tiên biển hoặc là bạch quả thì cũng làm tăng hiệu quả dưỡng sáng hơn rồi về cái như kem,Vietnamese
+nhất của mỹ đã được giao nhiệm vụ khám phá những thay đổi trong hệ vi sinh vật liên quan đến sức khỏe và bệnh tật ở,Vietnamese
+cuộc sống của bệnh nhân tốt hơn và bên cạnh điều trị kích thích não sâu thì chúng ta cũng được biết các điều trị can,Vietnamese
+bị ung thư phổi thì cũng đủ can đảm để bỏ thuốc lá nhưng với chúng ta những ai mà may mắn chưa bị ung thư phổi thì,Vietnamese
+chúng ta tìm đến đông trùng hạ thảo và đặc biệt là sản phẩm viên nang đông,Vietnamese
+có cái tình trạng suy tim tiềm tàng thì nếu mà có tình trạng rung nhĩ thì,Vietnamese
+tốt sẽ giúp cho người bệnh ung thư có thể giảm đi cái tác dụng của hóa trị và,Vietnamese
+gần đây bản thân chúng tôi cũng phải đánh giá là như này thực ra là cái công việc văn phòng cũng là một cái công việc,Vietnamese
+ta phải hiểu được thứ nhất là không thể chữa lành bệnh được thứ hai là phẫu,Vietnamese
+cái chuyện là cuộc sống của chúng ta nhiều căng thẳng rồi chúng ta phải lao động vất vả rồi chúng ta ăn uống nhiều,Vietnamese
+vậy khoảng từ bốn đến năm tiếng đồng hồ thì rất là lâu cho nên bệnh nhân rất là mệt mỏi,Vietnamese
+việc điều trị về tâm lý cũng rất là quan trọng thì phần điều trị tâm lý giúp giảm những stress lo âu căng thẳng cho,Vietnamese
+miễn dịch bẩm sinh đã không nghĩ tới các ứng dụng y học có thể có từ những khám phá của họ họ chỉ cố gắng,Vietnamese
+quan trọng mà nói nôm na rằng là tâm thất là cái một cái buồng tim nó tống máu co bóp tống máu ra để đưa những cái,Vietnamese
+nhất một lần trước khi mình uống thuốc đấy ví dụ mình uống thuốc vào cái độ khoảng bảy đến tám giờ sáng thì trước đó mình nên đo huyết áp để xem cái con số,Vietnamese
+nó làm trung hòa đi các gốc tự do mà cái gốc tự do thì lại làm rất hay làm tổn thương,Vietnamese
+để nó đánh giá cái chất lượng của đông trùng hạ thảo dù nó là đông trùng hạ thảo,Vietnamese
+cơ thể chúng ta rồi nhưng mà đặc biệt là đối với những người và bị ung thư phổi nữa thì tôi nghĩ là chắc chắc là ai đó,Vietnamese
+những cái hoạt động điện trong tâm nhĩ đó nó khởi phát và nó rất là lộn xộn và,Vietnamese
+còn không thì mọi người có thể là giúp mình một cái lượt chia sẻ để chúng ta sẽ vào để chúng ta sẽ bắt đầu,Vietnamese
+bảo mình cứ đi theo cái điều trị nó lệch theo cái hướng chung thì nó không trúng mà nó có thể là tiền mất tật mang,Vietnamese
+ra cái tình trạng là hẹp nè tắc lòng mạch khiến cho máu lưu thông kém đến não và tim và bên cạnh đó là đến các chi nữa,Vietnamese
+được phẫu thuật trong giai đoạn đó có một số ít bệnh nhân vì phải sau mười năm mười hai năm người bệnh mới bắt đầu xuất hiện,Vietnamese
+chính là nước trắng vấn đề là cách uống nước trong người ung thư thì chúng ta phải chia nhỏ lượng nước ra để làm sao,Vietnamese
+trình trước là bệnh parkinson nó sẽ tiến triển qua năm giai đoạn giai đoạn một,Vietnamese
+mảng xơ vữa này để giúp cho máu thông lên não lên tim tốt và từ đó cải thiện các triệu chứng như là đau đầu hoa mắt chóng,Vietnamese
+của họ đó nó không có được tự tin họ cảm thấy là cái người bạn đồng hành của mình,Vietnamese
+trong m��t số tình huống nhất định nhưng hầu hết các chuyên gia bao gồm cả nữ hộ sinh tại nhà và bác sĩ sản khoa những,Vietnamese
+tuyệt đối chúng ta không được bỏ thuốc không được tự ý thay thuốc và không được,Vietnamese
+khỏe đường ruột của mình trong cuốn sách này tôi sẽ chỉ cho bạn cách làm thế nào,Vietnamese
+vai trò then chốt trong sức khỏe và chức năng não bộ trong suốt cuộc đời hiển nhiên tôi đã có những quan điểm,Vietnamese
+đáp án b của chúng ta đó chính là dùng sản phẩm có thành phần làm sáng da an toàn như niacinamide kết hợp với,Vietnamese
+phẫu thuật đây là một cái giai đoạn một giai đoạn điều trị bệnh một,Vietnamese
+đột ngột là mình phải có cái phòng ngừa trong trường hợp của bác thì lại càng phải cẩn thận hơn lúc nào mình cũng phải,Vietnamese
+nào thứ nhất là nó ức chế cái sự ngưng tập tiểu cầu và từ đó nó dự phòng vấn đề,Vietnamese
+hứng thú làm bất cứ một thứ gì hết thậm chí là họ mất ngủ kéo dài rồi họ rút vào,Vietnamese
+điều trị dứt điểm thì chúng ta sẽ chia ra làm hai loại một là chúng ta điều trị dứt điểm dứt hết rung nhĩ luôn không,Vietnamese
+tại sao chữa lành các bệnh tự miễn khó hơn và có nhiều khả năng chúng ta là,Vietnamese
+mỗi tế bào t hoặc tế bào b riêng lẻ có hình dạng khác nhau đôi chút cho,Vietnamese
+là những cái thoái hóa cột sống nó cũng có thể tê bì chân tay nhưng trong trường hợp này thì cái nguy cơ bị xơ vữa động,Vietnamese
+khoa học đàng hoàng chứ không phải là mình nói lung tung cái cơ sở khoa học đó là khi người ta bị stress bị căng thẳng,Vietnamese
+chúng ta có các giai đoạn phát triển bệnh với những triệu chứng rất là đặc trưng và để chúng ta có cái nhìn rõ ràng,Vietnamese
+lượng chất lượng mà chẩn đoán điều trị cao nhất là chúng ta phải có được những chuyên gia chương trình lĩnh vực,Vietnamese
+chính càng tăng như vậy nó kéo theo nhiều hệ quả lắm có thể nó gây nên tình trạng da dễ bị nhiễm khuẩn thì,Vietnamese
+như vậy thì cái quá trình lấy mẫu cũng có thể là nhân viên y tế thực hiện nhanh quá mà người dân không thấy được thông,Vietnamese
+rất nhiều các sản phẩm có sử dụng đông trùng hạ thảo nhưng mà lựa chọn sản phẩm nào không ạ để chúng ta có hiệu quả có,Vietnamese
+ngoài ra niacinamide còn có tính kháng viêm do đó nên sẽ giúp làm giảm những cái triệu chứng của da nhạy cảm và để,Vietnamese
+ok thế thì chúng ta chắc là chúng ta sẽ là bắt đầu vào cái,Vietnamese
+bịp có nhu cầu cần phải khám bị đột quỵ tim mạch và một người thì đang uống,Vietnamese
+hoạt lành mạnh chế độ vận động phù hợp tuân thủ dùng thuốc theo điều trị theo đơn thì quý vị hãy sử dụng kết hợp,Vietnamese
+cũng nên là tăng đậm độ năng lượng chất béo đi chất béo lên bình thường là khoảng độ hai mươi đến hai lăm phần trăm bây giờ,Vietnamese
+gây tê bì thế nên là trong trường hợp này thì là cái mảng xơ vữa là cái nguyên nhân chính và đối với của của bác thì,Vietnamese
+trình đến giờ thì rõ ràng là huyết áp cao mở máu cao là những cái bệnh lý vô cùng nguy hiểm bởi vì rất là dễ dẫn đến,Vietnamese
+cuối cùng nhưng mà còn một cái câu chuyện thứ ba nữa là liên quan đến cái vấn đề mạch máu mạch máu ở cái vùng chi,Vietnamese
+ngực nữa thì hiện nay không biết cái tình trạng này là biểu hiện cho cái căn bệnh gì và chúng ta không biết là hiện,Vietnamese
+quá trình nó diễn biến thậm chí là càng ngày nó càng có những cái diễn biến nó nó nó nặng hơn so với trước chính vì thế,Vietnamese
+nhiều vấn đề đúng không ạ cái thứ nhất ấy cũng là một cái tốt rằng là bác đã từng đi khám ở bệnh viện rồi các bác sĩ,Vietnamese
+chúng ta ngồi nó đỡ hơn đấy là một cái bằng chứng nó rất là là là là phù hợp với các cái bệnh lý thoái hóa cột sống,Vietnamese
+chlorin và các loại thuốc như kháng sinh lực lượng số hai sự thiếu các dưỡng chất,Vietnamese
+thế này chúng ta cần phải đánh giá cũng như là cần ghi nhớ ở đây có hai việc nguyên nhân mà nó ngã như này nó là cái,Vietnamese
+cái giấy xét nghiệm covid19 và giấy xét nghiệm covid19 này ở trên địa,Vietnamese
+phần hoặc là khắc phục một phần những cái vấn đề mà mình đang gặp phải thì ở đây trước hết là chúng tôi sẽ muốn là,Vietnamese
+trị họ cảm thấy cái hiệu quả tốt thì cái cân nặng của họ nó chuyển biến tốt theo,Vietnamese
+tôi chắc rằng khi khoa học giải quyết được vấn đề giữa hai nơi khác biệt rõ rệt này và chúng ta có thể chỉ ra nguồn,Vietnamese
+thuốc xong rồi một thời gian thì tôi đi đo tôi đi,Vietnamese
+quan đến hệ gen di truyền ví dụ như vậy có một cái bệnh rất là dễ dễ biết này và,Vietnamese
+chúng ta biết rằng hiện chưa có cách chữa trị tiềm năng nào và còn cả chứng,Vietnamese
+một nửa số ca bệnh tim và gần như không có người mắc chứng mất trí nhớ,Vietnamese
+cho dừng rồi thì thôi mình cũng không cần uống nữa bên cạnh đó nữa thì là mình cũng có một cái chế độ sinh hoạt khoa,Vietnamese
+sức bền thành mạch vâng thế thì cái này là cái mà cô phải nên khám và tái khám,Vietnamese
+thể mình đầy đủ các vitamin và khoáng chất chúng ta có thể sử dụng nhiều rau,Vietnamese
+sẽ kết hợp lại với nhau và sẽ tạo ra huyết khối mà những huyết khối trong buồng tâm nhĩ đó đến một lúc nào đó có,Vietnamese
+một số người thậm chí còn đi từ ý nghĩ tự tử đến lần đầu tiên cảm thấy mãn,Vietnamese
+không không thích đâu vâng thế thường thì bác đi khám bệnh viện có nhiều lần,Vietnamese
+nhiều nghiên cứu cho thấy rằng đó mà can thiệp giảm cân thì có thể làm giảm được cái mức đường huyết có thể giảm tới,Vietnamese
+giữa các trải nghiệm đầu đời của hai đứa trẻ và một phần trong trải nghiệm đó nói rộng ra có ảnh hưởng lớn đến sự phát,Vietnamese
+hiến tự nghiệp của họ và phần lớn cuộc đời họ để hiểu chỉ một phần của tổng thể nhiệm vụ này đã tạo ra nhiều tình bạn,Vietnamese
+bệnh nhân quá trầm trọng hoặc là những các triệu chứng về những thay đổi hành vi như tôi đã chia sẻ trên và tất cả,Vietnamese
+một thành phần tiếp theo đó là hòa hoe hoè hoa hay là chính là hoa hòe đây là,Vietnamese
+cái độ pin ra làm sao thực ra nó không quá khó nhưng mà đối với việt nam cái mặt bằng chung thì nó vẫn là một,Vietnamese
+bảy bạn đã cắt amidan chưa tám bạn đã,Vietnamese
+kiểu đi biển ngày xưa nhưng mà đồng thời chúng ta ta cũng nên tìm đến những cái sản phẩm ví dụ như viên nang đông trùng,Vietnamese
+đó chúng có hiệu quả hơn trong việc trích xuất năng lượng tức là calo từ thức ăn gần đây chúng cũng được phát,Vietnamese
+lộn xộn nó rung lên và có thể dẫn đến tình trạng tim của chúng ta đập rất nhanh một cái hậu quả thứ hai đó là khi,Vietnamese
+ung thư đó đó làm tăng chuyển hóa nó làm thay đổi cái chuyển hóa bình thường của cơ thể của người bệnh nhân lúc bình thường,Vietnamese
+tim mạch nói chung thì các cái biện pháp và khuyến khích vẫn là nên tập thể dục thì tập thể dục thì một cái nguyên tắc,Vietnamese
+có đánh giá ngay trong mổ xem cái hiệu quả như thế nào rồi sau đó mình sẽ nối ra với một cái một cái một bộ phần phát,Vietnamese
+đó là nhiều người chúng ta đang quá lo lắng về cái bệnh này cũng như là chúng ta đang không biết là có rất là nhiều những,Vietnamese
+thì có lẽ là nó sẽ là giống như cái việc mà cảm cúm thông thường đúng không nhở còn đối với những người mà trẻ nhỏ hoặc,Vietnamese
+xơ vữa động mạch cũng như là khắc phục được tình trạng ở hệ hô hấp cũng như là hệ tim thì quý vị và các bạn hãy gọi về,Vietnamese
+góp mỗi người thực hiện những khám phá kỳ diệu về các tế bào hoặc phân tử cụ thể trong hệ miễn dịch của chúng ta,Vietnamese
+trạng trầm cảm thì cái cái béo phì nó có,Vietnamese
+đột quỵ do với tình trạng rung nhĩ của bệnh nhân gây ra,Vietnamese
+thuốc chống trầm cảm thì cái tình trạng tâm lý nó sẽ bị nặng nề hơn và có khi là nó làm cho cái tình trạng tâm lý nó sẽ bị nặng nề hơn,Vietnamese
+người bệnh béo phì viết nên cuộc sống mới thưa quý vị đây là một chương trình hoàn toàn mới do trung tâm truyền thông,Vietnamese
+này trong ngày hôm nay vâng và trong khi mà chờ đợi các khán,Vietnamese
+mạnh và chiếm đa số là cái gọi là vi khuẩn có lợi thân thiện không hay nó bị bệnh mà bị áp đảo bởi vi khuẩn xấu không,Vietnamese
+hướng thảo lu��n về vai trò của lần lượt từng phân tử hoặc tế bào nhưng điều đó,Vietnamese
+nguồn gốc từ thảo dược đây là những cái sản phẩm mà cũng đã hoàn toàn một trăm phần trăm từ các cái thảo dược thiên nhiên mà xưa kia,Vietnamese
+cả được những cái selen rồi kẽm rồi những cái chất betaglucan từ trong nấm cũng,Vietnamese
+việc phòng ngừa cũng như là kiểm soát tốt bệnh lý của mình nâng cao hiệu quả điều trị và chất lượng cuộc sống,Vietnamese
+nhanh nữa đừng có tổn hại thêm trái tim và nếu mà một cái khi đã có rung nhĩ thì,Vietnamese
+dụng phụ nó cũng lại gì ạ không kém phần long trọng chúng tôi vẫn nói là như vậy nghĩa là nó có rất là nhiều các cái tác,Vietnamese
+còn giúp và làm sáng da nữa do đó nếu được thì chúng ta có thể chọn lựa những cái sản phẩm trong các bước chăm,Vietnamese
+năm được xem là cái khoảng thời gian mà có khả năng phẫu thuật parkinson phẫu thuật kích thích não sâu là tốt nhất tuy,Vietnamese
+thời gian hiện nay thì trên thế giới và việt nam đã có những cái thành công rất là lớn đặc biệt là trong các lĩnh vực về,Vietnamese
+sản phẩm nào dành cho ban ngày thì chúng ta ban ngày và sản phẩm nào chúng ta người ta ghi là ban đêm trên nhãn hiệu,Vietnamese
+hướng đến một cuộc sống mạnh khỏe hơn hạnh phúc và thành công chúng tôi sẽ thực sự rất biết ơn về sự ủng hộ quý báu,Vietnamese
+chính vì vậy nó xây xước và nó dẫn đến những tình trạng xơ vữa mạch chưa kể nữa là bác còn có các cái bệnh lý về về tim,Vietnamese
+mình chỉ chịu được hai được thôi là đã buồn nôn rồi khó chịu rồi nôn suốt không,Vietnamese
+chưa có chữa lành bệnh cũng như là chưa có phương pháp làm chậm sự tiến triển,Vietnamese
+người bệnh đấy là gì ạ chúng ta phải làm sao để làm giảm thiểu tối đa những cái tác động của cái việc mà thời tiết lạnh,Vietnamese
+sử dụng cái axit lactic để chúng ta phải lên chất đoạn mũi má và chúng ta coi đáp,Vietnamese
+bệnh nói riêng và cộng đồng nói chung những thông tin hữu ích nhất để chúng ta có thể hiểu rõ hơn cũng như là bảo vệ,Vietnamese
+lành các chứng bệnh suy nhược thần kinh trong suốt vòng đời từ chứng tự kỷ và rối loạn tăng động giảm chú ý adsd đến,Vietnamese
+tính ra năng lượng là chí ít nó cũng phải đạt được khoảng một phẩy hai một đến một phẩy hai kcal trong,Vietnamese
+để thay đổi sức khỏe đường ruột của bạn và theo đó là sức khỏe nhận thức của bạn để cuộc sống của bạn có thể thêm nhiều,Vietnamese
+ngừa những các cái nhồi máu cơ tim hoặc là những các cái kiểu các cái đột quỵ,Vietnamese
+thì lại nên giảm thịt đỏ thịt đỏ là thịt con bốn chân ví dụ như thịt lợn thịt bò thì chúng ta chỉ nên tối đa là năm mươi gam,Vietnamese
+nhân béo phì thì đã từng thử các phương pháp trị liệu và họ đã từng bị thất bại,Vietnamese
+sinh vật có thể có tương quan nghịch biến với nguy cơ mắc bệnh alzheimer những,Vietnamese
+như là người nhà người bệnh chúng ta biết rằng là bác sĩ sẽ có một cái bộ điều khiển riêng của bác sĩ và người,Vietnamese
+hình dung đến não và tủy sống nhưng nó chỉ là hệ thần kinh trung ương bạn cũng,Vietnamese
+bệnh lý thoái hóa cột sống nó đã có từ trước có sẵn rồi và chỉ là những cái thời điểm nhất định thì nó khó chịu tăng,Vietnamese
+kết hợp điều trị với các triệu chứng ngoài vận động mà người bệnh có xuất hiện đi kèm kính thưa tất cả cái vị,Vietnamese
+động mạch khiến máu lưu thông kém tới não tim các chi và là nguyên nhân có thể gây nguy cơ tai biến đột quỵ nhồi máu cơ,Vietnamese
+cuối cùng đó là hiện các bác sĩ chuyên khoa sâu về rối loạn vận động thì nhà mình,Vietnamese
+không biết là vì lý do gì và ngay sau đây thì chúng ta sẽ cùng lắng nghe bác sĩ,Vietnamese
+rồi thì lúc đó nó sẽ để lại di chứng của tình trạng nhồi máu cơ tim ví dụ như là bị suy tim sau đó bị rối,Vietnamese
+rối loạn tự miễn như đa xơ cứng và khi nhiều tuổi hơn nữa cô có thể mắc bệnh,Vietnamese
+phần là cồn hoặc hương liệu thì chúng ta không chọn lựa những cái sản phẩm mà có chứa chất bảo quản và các bạn hay,Vietnamese
+các bác sĩ chuyên khoa cơ xương khớp như chúng tôi chẳng hạn thì là người ta thường thắc mắc thậm chí là phàn nàn là,Vietnamese
+vị giác khứu giác của bệnh nhân làm cho bệnh nhân không thèm ăn nữa không muốn ăn nữa và thậm chí ảnh hưởng đến suốt cả,Vietnamese
+sẽ và ngăn nắp theo dõi những buổi tư vấn trực tiếp của,Vietnamese
+biệt là cái rung nhĩ mà nó không có xảy ra liên tục thành từng cơn vân vân rồi chúng ta có chúng tôi có những cái khảo sát về xét,Vietnamese
+nhân sẽ có những cái rối loạn về mặt cảm xúc đôi khi có những bệnh nhân đã rơi vào trạng thái trầm cảm và đôi khi,Vietnamese
+đấy ví dụ như là cái adenosine đó là một cái hoạt chất cực kỳ quý của đông trùng hạ thảo thế thì bằng cái việc là sử dụng,Vietnamese
+quá họ đã cố gắng quá trời rồi tốn tiền thiệt là nhiều rồi họ làm chuyện nào chuyện,Vietnamese
+hoặc nghi ngờ và vô giá trị thái độ năng nổ nhạy bén này là yếu tố năng lực quan,Vietnamese
+khuẩn ít nhiều là cư dân thường trú chúng tạo thành các quần thể lâu dài những loại khác thì nhất thời nhưng ngay,Vietnamese
+vài lần một tuần trong suốt sự nghiệp của mình tôi đã phải nói với một bệnh nhân hoặc người chăm sóc rằng tôi không,Vietnamese
+cục máu đông nó đi cái khả năng nó không cao sẽ thất bại như vậy thì chúng ta phải tiến đến một cái biện pháp gọi là,Vietnamese
+bệnh lý về tim mạch bị bệnh lý thần kinh thì điều đầu tiên là đời sống tinh thần chúng ta phải rất là quan chúng ta phải,Vietnamese
+thông thoáng giúp cho cải thiện cái cái tuần hoàn não của tim thì nó cũng sẽ cải thiện và giúp cho mình có được một,Vietnamese
+những cái dấu hiệu nào để chúng ta có thể tự theo dõi để mình biết là da mình có thể thụ da nhạy cảm hay không ạ thường nó là chuẩn đoán mình có da nhạy,Vietnamese
+sinh bị rụng tóc hay không cảm ơn em các chị em phụ nữ thân mến,Vietnamese
+nó dễ bị sa ngã ngã về cái phía mà ăn uống một cách vô độ làm cho cái tình trạng mà,Vietnamese
+nữa mầm bệnh tăng số lượng nhanh chóng làm thế nào mầm bệnh nhân lên nhanh chóng là một vấn đề khó hiểu một tế bào,Vietnamese
+chưa từng có là người một lá thư đến tạp chí khoa học hàng đầu thế giới nature nói rằng ủy ban nobel cũng nên,Vietnamese
+và cả hai các cái nhóm thuốc này nó đều trên một cái cơ chế là ức chế các cái men gây viêm tuy nhiên nó có một cái câu,Vietnamese
+sống thắt lưng vận động rất là khó khăn mới đầu bắt đầu phát hiện ra bệnh là tôi không đi được đi dép thấp cũng không,Vietnamese
+việc mà điều trị người bệnh parkinson chứ còn thật sự về mặt ứng dụng trên thực,Vietnamese
+hiện nay thì trên thị trường cũng có những cái muối cái muối nó vẫn có vị mặn nhưng mà cái,Vietnamese
+tôi muốn hỏi chương trình là tôi bị bệnh tim thì giờ là phải rất,Vietnamese
+tế bào bạch cầu có một phân tử thụ thể đặc biệt quan trọng ở bề mặt của chúng được gọi là thụ thể tế bào t và thụ thể,Vietnamese
+ta phải hạn chế rồi bởi vì những cái điều ấy mà nếu như chúng ta sử dụng thì nó sẽ liên quan đến rất nhiều đến cái,Vietnamese
+hiệu quả nó sẽ càng cao và nếu mà để về sau thì cái cơ hội nó sẽ kém hơn sau sáu tiếng chúng tôi vẫn làm được,Vietnamese
+chia sẻ giúp cho chúng ta thì chúng ta phải là hiểu rõ hơn về cái bệnh lý à cúm a này nó như thế nào,Vietnamese
+thiếu máu não thoáng qua với lại đột quỵ thiếu máu thì nó cũng như nhau chỉ còn cãi là nếu nó cái mạch máu nó nó bị tắc nghẽn,Vietnamese
+bức xạ lớn hơn hàng nghìn lần mức bạn có thể chịu được những tế bào sống siêu nhỏ này ăn mọi thứ từ đường và tinh bột đến,Vietnamese
+với những thảo dược khác mục đích là cái gì à thì trong một cái đơn thuốc của y học cổ truyền chúng ta,Vietnamese
+mình mong muốn đấy là cái điều quan trọng mà chương trình hôm nay chúng ta muốn nói đến để các quý vị chúng ta có,Vietnamese
+cái việc này có thật sự cần thiết hay không tôi cũng thường khuyên là những người hay điện thoại đường dây nóng cho,Vietnamese
+liệu em bé ấy bú sữa mẹ hay uống sữa công thức họ gọi một cách chính đáng hay vi sinh đường ruột là một siêu cơ quan,Vietnamese
+trên thế giới người ta đã l��m các nghiên cứu là với những bệnh nhân giống như vậy là không có thấy ra nguyên nhân gì trong,Vietnamese
+rồi đi làm đi làm thì gặp sếp là phân công nó cũng không có phù hợp nói cái,Vietnamese
+tốt nhất và trong cái chế biến nấu nướng thì ngoài cái việc mà hạn chế các thực phẩm rán ra,Vietnamese
+chúng ta phải chờ đợi để mà cái chu trình thay da diễn ra để mà một lớp da mới được thay hoàn toàn nhưng nếu rồi,Vietnamese
+nhiều hơn bên cạnh đó thì họ cần thiết phải đánh giá sức khỏe tâm lý nè mức độ ổn định tâm lý này trong một cái bối,Vietnamese
+nhĩ rồi thì sẽ gây ra các biến chứng tắc mạch trong đó có thể là tắc mạch não tắc mạch chi vân vân nhẹ rất là nguy hiểm,Vietnamese
+ngành y tế của chúng tôi cũng luôn nhắc nhở rằng là nên thực hiện giảng cách trong quá trình thực hiện lấy mẫu này và,Vietnamese
+tránh các sản phẩm chứa xà phòng hương liệu và đáp án d tất cả các ý trên,Vietnamese
+hạ thảo hôm nay chương trình đang đồng hành thì đây chính là một cái sản phẩm nó có tác dụng cả ba thành tố đông trùng,Vietnamese
+nhiều chức năng mà không cần mệnh lệnh hoặc sự trợ giúp của não bộ tôi sẽ giải thích thêm về sinh học của não bộ ở ruột,Vietnamese
+ung thư cổ tử cung có khả năng tôi chỉ đang suy đoán ở đây rằng ủy ban nobel đã,Vietnamese
+là tăng cái hdl cholesterol thì như vậy chúng ta thấy rằng cái việc mà giảm cân nặng bên cạnh cái tác dụng đoạn đầu tiên,Vietnamese
+nên là nó bảo hộ tế bào gan bảo hộ tế bào thận nó có lợi cho tim mạch có lợi,Vietnamese
+rồi và bác cũng có một số những các vấn đề ví dụ như là hở van động mạch chủ này hở van hai lá nhẹ này thế và cái huyết,Vietnamese
+dại không thưa bác sĩ,Vietnamese
+những người cao tuổi chúng ta biết rằng là bản thân họ cũng gặp rất là nhiều các cái vấn đề chứ không phải chỉ riêng mỗi,Vietnamese
+khi mà mình có một cái hiện tượng căng thẳng lo âu thì da của mình cũng cảm giác là sao mà nó căng kéo nó khó chịu,Vietnamese
+biết là càng có tuổi thì các cơ quan cơ thể chúng ta bị thoái hóa mà đặc biệt là hệ thống vận động trong đó có,Vietnamese
+rất là cao và cái cái rủi ro mà nó có thể xảy ra nó là cũng lại rất là đáng lưu ý có thể ngay lập tức bây giờ bác,Vietnamese
+định có thể được phẫu thuật thích não sâu cái thứ nhất là người bệnh nên là dưới bảy mươi lăm tuổi vì người bệnh mà lớn tuổi,Vietnamese
+các nghiên cứu mà người ta đánh giá ta thấy rằng là với một cái khoảng,Vietnamese
+sản sinh sắc tố cụ thể như là những cái chiết xuất từ bạch quả từ lá dâu tằm,Vietnamese
+tự nhiên là đang dùng nó xuống cũng có vẻ giống như cái khá nhanh nhưng mà ngược lại thì nó lại ảnh hưởng đến rất,Vietnamese
+minh tác dụng kết quả cho thấy kga1 có tác dụng ức chế cơn đau lên đến bảy mươi sáu phần trăm,Vietnamese
+với đái tháo đường thì nó có rất rất nhiều các thể lụy những cái biến chứng của nó thế thì khi mà chúng ta bị đái,Vietnamese
+người mà chúng ta đốt thành công như vậy đó vẫn có khả năng tái phát và tái phát,Vietnamese
+vậy thì người ta thấy nếu chỉ riêng cái mặt à điều trị tâm lý thì hay là một,Vietnamese
+trong điều trị ung thư đó khác và sau khi mà bị sau khi mà chúng ta đã điều,Vietnamese
+bệnh đau xương khớp thì nhiều người cũng bị tái phát vậy thì trong cái thời tiết hiện tại thì bác sĩ cũng lời khuyên nào,Vietnamese
+thằng này ú này cho nên không có cho làm những cái những cái vị trí nó mang tính chất năng động hay là cho rằng đây,Vietnamese
+vạch để nuôi nuôi dưỡng cơ tim khi mà cái xơ vữa động mạch vành nó sẽ làm cho máu và mạch vành kém và chị có những cái,Vietnamese
+vừa giúp cho da chúng ta là sáng hơn mịn hơn vâng ạ xin được cảm ơn câu trả lời của bác sĩ thưa quý vị câu hỏi,Vietnamese
+phải là đau lan xuống đùi xuống mông xuống chân đúng không vâng cái thứ hai nữa là cái đau của anh,Vietnamese
+quan trọng nhất đó chính là chúng ta để tránh covid thì chúng ta đã thực hiện sẽ thực hiện năm k cộng vắcxin đúng để,Vietnamese
+tế bào loại ngày ở lại trong cơ thể một thời gian dài đây là những gì mang lại cho hệ miễn dịch một bộ nhớ đối với mầm,Vietnamese
+đồng thời là gì ạ cái việc điều trị của chúng ta đối với các cái bệnh thoái hóa khớp như này là một cái quá trình điều,Vietnamese
+như thế nào như tôi đã nói thì chúng ta biết bệnh parkinson là bệnh thoái hóa,Vietnamese
+gì trong những yếu tố đơn lẻ này được hiểu đúng mà không cần thứ khác ý nghĩa của chúng nằm trong các mối quan hệ giữa,Vietnamese
+nên nghe theo và sẽ có thể là phần nào khắc phục được tình trạng của mình bác nhé điều trị xương khớp thì rõ ràng,Vietnamese
+và vắcxin dại là cái vắcxin,Vietnamese
+một vùng xanh một nơi mà con người sống lâu hơn khỏe mạnh hơn đáng kể so với hầu,Vietnamese
+ta sử dụng tân dược kéo dài thì bao giờ chúng ta rất dễ dàng phải đối diện với,Vietnamese
+ung thư để mà chia sẻ để làm sao thoải mái về mặt tinh thần và tôi nghĩ rằng là chúng ta gọi đúng đấy là những cái hỗ,Vietnamese
+những gì đang diễn ra trong ruột của bạn hôm nay xác định nguy cơ của bạn đối với bất kỳ căn bệnh thần kinh nào tôi nhận,Vietnamese
+biệt là cho vào cái bữa ăn và chế biến đó thì bạn sẽ bổ sung thêm một cái lượng dầu bình thường trong một bát cháo mình,Vietnamese
+được đi làm và tình trạng hậu phẫu sau một tuần là ổn định là có thể đi làm được và trong thời gian đó người bệnh vẫn phải,Vietnamese
+ta thường xuyên quá mức như vậy thì nó cũng gây rụng tóc rồi nó có một cái mà chúng ta không thể nào không để mặc dù,Vietnamese
+là nhiều các cơ quan khác ví dụ như có nhiều người đã bị bệnh gan rất là nặng sau khi mà dùng thuốc không có phù,Vietnamese
+cái chất mỡ cùng một số chất khác nữa nó tạo ra những cái mảng mà nó làm hẹp lòng,Vietnamese
+cho họ hiểu được béo phì nó cũng là một cái bệnh và cũng cần được thăm khám và điều trị quản lý cân nặng cũng như là,Vietnamese
+chỉ là nghỉ được rõ ràng cái đấy cũng là một cái khó đúng không ạ thế chính vì vậy cho nên trong trường hợp này rõ ràng là cái đai thắt lưng lại là một cái,Vietnamese
+thay da diễn ra nhanh hơn từ đó làm sao vô tình chúng ta ép những cái tế bào non bên dưới đó phải ra mặt trận sớm phải đi,Vietnamese
+đó là chúng ta chế biến thì hạn chế cái phần xào rán đi để chúng ta đừng có tạo thành những cái lớp cháy giòn tan như là,Vietnamese
+chết mà xin thưa với quý vị rằng là khi mà tắt cái mạch máu não như vậy chỉ cần bốn năm phút sau mà chúng ta không có thuốc,Vietnamese
+có thể đi làm lại được xin mời bác sĩ thường thì giai đoạn hậu phẫu của phẫu,Vietnamese
+cái việc của bác ít nhất là bác sẽ phải đi khám ba các cái bác sĩ chuyên khoa để có cái đánh giá một cách đầy đủ thứ nhất,Vietnamese
+khoa thu hút các bác sĩ và nhà khoa học giỏi nhất trên khắp thế giới tôi sẽ cho bạn biết những gì chúng tôi biết và làm,Vietnamese
+kia nhưng mà cái cân nặng của họ nó vẫn không có thay đổi cái tình trạng vẫn đâu,Vietnamese
+lại họ thường tranh luận về các vấn đề khoa học trong xe của họ và sau đó chỉ đơn giản là quên những gì đã nói nhưng,Vietnamese
+thế nào đến tâm lý người béo phì ví dụ như là người ta sống ở một cái cái,Vietnamese
+những điều đó lại đặc trưng người dân một cách rất là khó xử không biết phải xử lý như thế nào để vừa an toàn cho bản,Vietnamese
+thần kinh này đi lang thang trong hệ tiêu hóa các tế bào thần kinh trong ruột dồi dào đến mức nhiều nhà khoa học hiện,Vietnamese
+người ta cho rằng mỗi người chúng ta đều đã từng không có vi khuẩn khi còn trong,Vietnamese
+rất là tốt sau khi mà da đã ổn định rồi bớt cái triệu chứng nhạy cảm thì khi đó chúng tôi sẽ tiến tới là cái bước là điều trị các vấn,Vietnamese
+quý vị quý vị đang theo dõi livestream thì hãy nhớ thật kỹ để chúng ta vui cho da nhạy cảm khỏe hơn vừa có thể dưỡng da,Vietnamese
+mình nói là mình có khả năng là có thể vượt qua và người ta không hiểu chứ không mới kỳ thị cho nên mình thấy,Vietnamese
+là suy nhiều thì chúng ta sẽ sử dụng các cái máy thận nhân tạo để lọc thận thay cho kết quả thận đấy ạ thì đấy chính là,Vietnamese
+nên là cái thời gian đầu thì có thể mình sẽ lựa chọn cái cục pin không sạc sau khi mà mình đặt xong mình,Vietnamese
+còn phục hồi sụn khớp thoái có hiệu quả muốn hỗ trợ giảm đau xương khớp thoái hóa nói chung thì phải đáp ứng được ba,Vietnamese
+của thành mạch nó có tác dụng chống viêm này nó còn có cái tác dụng là làm giảm cái nhu cầu oxy của của cơ tim cũng như,Vietnamese
+gì là chúng ta không nên đi bộ nhiều không nên giày nhiều mà chúng ta nên tập ví dụ như là tập những cái biện pháp của,Vietnamese
+mà người ta ghi nhận trên cái nhóm người bệnh kích thích não sâu đó là những thay đổi về mặt cảm xúc là bệnh,Vietnamese
+như là một số khán giả có nội dung tương tự và câu hỏi gửi về cho chương trình thưa bác sĩ nghe nói phẫu thuật đặt điện,Vietnamese
+nên lựa chọn loại nào và theo dõi sau,Vietnamese
+nhiều đến cái chuyện mà chế độ sinh hoạt chế độ tập luyện của chúng ta hiện nay,Vietnamese
+quan trọng lắm vì quan điểm cho rằng các quần thể vi khuẩn được tìm thấy trên trẻ sơ sinh được sinh mổ không phải là những,Vietnamese
+làm cho mình cảm thấy mất thẩm mỹ mất tự tin thì chúng ta lại sử dụng những cái sản phẩm mà có tính lột tẩy hoặc là,Vietnamese
+nói là có sự là giảm phí vận chuyển túi sắc tố đi từ bên dưới da lên bề mặt da,Vietnamese
+để điều trị cho từng bệnh đặc biệt trong đó thì có một cái cơ chế rất là quan trọng là các cái khớp nó bị viêm thì cần,Vietnamese
+không tin nhưng mà có nhiều người bị ung thư sau khi điều trị ung thư xong cảm thấy mình rất là khỏe thế là cứ ăn thật nhiều,Vietnamese
+thảo này nhưng mà tôi không dám uống tại vì là nó không có xuất xứ nguồn gốc mà không có không có tên của công ty cho,Vietnamese
+đó nên mình có đồng ý hay không thì mình vẫn phải theo dõi nhưng phải đánh giá về huyết áp và kể cả cái cholesterol,Vietnamese
+ta tiếp xúc các thành phần chống oxy hóa thì nó sẽ tác động vào cơ thể nói chung,Vietnamese
+nó tai biến ra bác ạ bác nhé vì huyết áp của bác đang tăng lên rất cao đấy thế và tất cả những cái thuốc mà bác bác dùng,Vietnamese
+thì không được cái sự ủng hộ của những người khác trong đó có gia đình trong đó,Vietnamese
+kích thích não sâu nó cũng không có giúp ích được và hơn nữa là khi mà người bệnh,Vietnamese
+một cái giờ định kỳ cái sau đó dùng là các cái lần tái khám thì bác đưa cho các,Vietnamese
+cần phải tìm hiểu thứ nhất là mình có phải parkinson hay không giai đoạn mình là giai đoạn mấy và cái hiệu quả của thuốc,Vietnamese
+trọng đó là mình nên đi thăm khám để sớm phát hiện ra một cái bệnh lý nào đó ở ví dụ ở tim hoặc là về cái huyết áp của,Vietnamese
+mang bệnh có thể gây bệnh nhưng không chỉ vì chúng có liên quan đến một tình trạng cụ thể ví dụ chúng ta biết rằng,Vietnamese
+nhịn ăn nhịn một cách rất là triệt để cho nên là nhịn đến nỗi mà không có,Vietnamese
+rung nhĩ một khi mà có cường giáp thì chúng ta phải điều trị cường giáp tại,Vietnamese
+chứng bắt đầu lan qua phía bên đối diện và người bệnh xuất hiện các triệu chứng hai bên và đến giai đoạn ba thì triệu,Vietnamese
+người rung nhĩ đều phải uống thuốc kháng đông nhưng mà hầu như là đa số sẽ được sử dụng thuốc kháng đông để phòng,Vietnamese
+là viêm đa khớp hay không và tôi sẽ nên sử dụng thuốc gì dạ vâng thời gian nó,Vietnamese
+cái cung của người nấu ăn với lại cái cầu của người ăn sẽ gặp được nhau để,Vietnamese
+thôi chứ còn mình đừng có sử dụng những các cái thuốc vì thực ra hay là những cái sản phẩm hiện nay nó chưa được kiểm,Vietnamese
+cơ thể bạn có nhiều cơ hội gặp vật chất và sinh vật ngoại lai nhất và nó giao tiếp liên tục với mọi tế bào khác của hệ,Vietnamese
+mỗi đêm tương đương với tăng nguy cơ ồ thông thường và viêm phổi trong những,Vietnamese
+và đang điều trị như vậy thì nó làm thay đổi cái vị giác và cái thay đổi ấy nó còn do những cái tổn thương ở miệng nữa ví,Vietnamese
+tắt những cái điểm tiếp xúc của điện cực đó cũng như là điều chỉnh cường độ ở cái mức độ mà mình mong muốn tối ưu để được,Vietnamese
+nó không hình thành nữa là không còn cục máu đông trong tim nữa thì như vậy nó sẽ không có gây ra những cái tắc mạch,Vietnamese
+liệu thống kê về hậu quả sức khỏe của việc sinh mổ chứ không phải sinh thường là hoàn toàn đáng kinh ngạc sau đây là,Vietnamese
+khớp thì chúng ta thường nói tới đối tượng là người già đúng không ạ và nhất là trong cái thời tiết trở trời như thế này vậy thì như chúng ta có vừa chia sẻ,Vietnamese
+chết người và đây là những thứ chúng ta có thể phải đối mặt hàng ngày chỉ qua các lựa chọn chế độ ăn uống mặc dù cơ,Vietnamese
+những cái thuốc mà ức chế được cái quá trình viêm đó khi mà nó chống được quá trình viêm thì nó vừa hạn chế được cái,Vietnamese
+các cái bệnh lý nền ở trong đó như là huyết áp cao này các cái rối loạn mỡ máu này thì rất là có hay có các cái triệu,Vietnamese
+nay do cái thói quen sinh hoạt của chúng ta do việc chúng ta ăn uống vậy thì ngay từ bây giờ những quý vị khán giả nào đang theo dõi chương trình của chúng tôi,Vietnamese
+trong cái câu chuyện mà điều trị các cái bệnh gút vì sao bệnh gút nó sẽ gây ra phá hủy rất là nhiều các cái bệnh khớp,Vietnamese
+tôi thấy là có một số câu hỏi có những nội dung tương tự nhau nên ngay sau đây chúng ta sẽ cùng đến với câu hỏi của bạn,Vietnamese
+cũng đã ghi nhận thấy rằng trung bình cũng khoảng từ ba đến sáu năm sau khi mà những cái bệnh nhân thừa cân béo phì,Vietnamese
+hạ đồi tuyến yên tuyến thượng thận và có hai cái hormone lớn người ta gọi,Vietnamese
+cũng vẫn tốt tuy nhiên nó là các bạn lưu ý là đôi khi là chúng ta thay nhiều lớp quá cũng có thể gây ra những cái vấn,Vietnamese
+từ bên trong do tuổi tác rồi do dinh dưỡng rồi vân vân các thứ rồi do tác,Vietnamese
+hơi chút hoài nghi về tin tức này ông mở laptop ra để kiểm tra và thấy trên,Vietnamese
+chỉ nói đến chuyện rung nhĩ không thôi nhưng mà nếu mà cả chuyện rung nhĩ đó mà đã có những cái biến chứng ví dụ như nó,Vietnamese
+quan đến tiết các cái dịch mật để nó giúp cho chúng ta tiêu hóa chất béo nữa thì cũng lại bị ảnh hưởng và chính vì thế,Vietnamese
+và cách để chúng ta thể chúng ta dự phòng cũng như là để mà điều trị những cái cách để chúng ta là chuẩn bị tại nhà được chắc là,Vietnamese
+trú tạm thời chúng thực hiện một lượng lớn các nhiệm vụ cần thiết một số chất chúng tạo ra rất quan trọng đối với sức,Vietnamese
+năm cái đợt dịch và những cái đợt dịch nó nó khủng khiếp đến như vậy vì thế nên là bây giờ,Vietnamese
+giá là điều trị đó khó khăn với thuốc uống thuốc thoa thôi thì đội ngũ bác sĩ của chúng tôi sẽ có thể kê những cái chỉ,Vietnamese
+kích thích não sâu cũng không được xem là phương pháp ngăn chặn sự tiến triển của bệnh,Vietnamese
+cái béo phì vân vân nhiều nhiều những cái cái cái bệnh có thể đưa đến cái béo,Vietnamese
+chúng ta phải kiểm tra trong máu xem là cái thuốc đó nó vào trong nó nó tác dụng tốt hay không là do đó nên khi mà dùng,Vietnamese
+mình toàn là thất bại không hà nổi chuyện giảm cân không đi mình cũng làm không được nữa thì thật sự là cái tự ti,Vietnamese
+đói rồi họ cứ hưng phấn trong hưng phấn và họ sẽ khó ngủ khi mà khó ngủ họ thức,Vietnamese
+giúp cho bệnh ung thư có thể chấp nhận được bữa ăn nhạt đi hôm nay nhạt một chút mai nhạt một chút thì dần dần chúng,Vietnamese
+đôi khi nó cũng làm cho người phục vụ vất vả hơn và đối với rồi lại đối với cả,Vietnamese
+lại bình thường trước đây tôi cũng có một cô bạn cô mới giới thiệu cho tôi đông trùng hạ,Vietnamese
+khiến nhiều người càng lo lắng hơn mở,Vietnamese
+có vẻ như vệ sinh có tương quan đồng biến đến nguy cơ mắc bệnh alzheimer sự,Vietnamese
+này đặc biệt là các bác sĩ về cơ xương khớp người ta sẽ phải đánh giá xem là cái mức độ thoái hóa nặng như thế nào,Vietnamese
+ảnh hưởng rất lớn sức khỏe cũng như là nó có nguy cơ làm cho giảm cái tuổi thọ,Vietnamese
+tay mà gọi cấp cứu đừng chờ đó là những triệu chứng thường gặp nhất của đột quỵ ngoài ra thì,Vietnamese
+ra những cái dụng cụ rất là tốt thì để cho có việc mà chúng ta luồn cái ống đó,Vietnamese
+thì tôi cũng đã nhận được một câu hỏi của một vị khán giả đến từ bắc giang với cái nội dung như thế này ạ thưa bác sĩ,Vietnamese
+tiến hành phẫu thuật thì đa số các trung tâm được chọn là các phương pháp mổ tỉnh tức là bệnh nhân sẽ biết hết tại vì,Vietnamese
+tôi sợ là uống cái này nó lại ảnh hưởng thật cho nên là tôi lại ngừng ạ vâng ạ tôi muốn xin ý kiến chương trình là,Vietnamese
+này vẫn còn gây tranh cãi một phần bởi vì một số người tuyên bố sự can thiệp này đã đi ngược lại viết tự nhiên hoặc,Vietnamese
+hợp này gót chân mà đau mà chúng ta xoa bóp vào đấy quá nhiều đặc biệt là xoa bóp các cái dầu nóng nữa thì rất rất là,Vietnamese
+đoạn thì sẽ xuất hiện những triệu chứng ra sao ạ như chúng ta biết bệnh parkinson tôi cũng đã nói trong chương,Vietnamese
+học lành mạnh đấy như là tránh căng thẳng stress này ngủ nghỉ đúng giờ chế độ ăn là cân đối các thành phần đối với,Vietnamese
+với cột sống ngực đâu bởi vì là sao bây giờ nó đã có những cái câu chuyện là tê liên quan đến cả tay nữa thậm chí là cả,Vietnamese
+pháp điều trị phẫu thuật kích thích não sâu hay không xin chân thành cảm ơn quý khán,Vietnamese
+đầu tiên chúng tôi khuyên là như vậy và cái thứ hai nữa là có lẽ là bác nên có một cái đai thắt lưng để mình bảo vệ cái,Vietnamese
+cái thực phẩm đó để chúng ta giúp chúng ta tăng khối cơ đối với người bị ung thư,Vietnamese
+cha ông ta rất hay sử dụng trong những các cái bài thuốc để điều trị những các cái bệnh lý về trinh kinh quý chính xung,Vietnamese
+có thể là nó hiện tại thì những triệu chứng của cúm a nó như một cái bệnh lý thông thường cảm cúm thông thường chúng ta,Vietnamese
+nó cực kỳ tốt cho vấn đề là hệ thống thần kinh trung ương của chúng ta đặc,Vietnamese
+là do những người này có nhiều khả năng hút thuốc lạm dụng rượu và ma túy và bị,Vietnamese
+béo phì cao hơn điều này xảy ra ở những người từ khu vực thành thị trong khi điều ngược lại phổ biến hơn ở những,Vietnamese
+cái câu hỏi thêm như thế này câu hỏi thứ nhất ý là cái đau của mình là anh bảo là nó đau lan lên trên đúng không chứ không,Vietnamese
+hướng dẫn là được rồi như vậy thì cái sự kỳ thị nó sẽ càng ngày nó càng càng mất,Vietnamese
+ta sẽ mất nhiều cái chức năng của não sẽ khó hồi phục hơn hơn,Vietnamese
+thời tiết thay đổi nóng lạnh để thất thường đây cũng chính là nguyên nhân mà khiến xương khớp tái phát và đau nhức,Vietnamese
+đôi khi có một số bạn cũng như biết không chia sẻ là em ngủ dậy là coi như mặt em dùng chảo dầu bóng loáng,Vietnamese
+cái chương trình khuyến mãi vô cùng hấp dẫn đó chính là khi mà anh mua sáu hộp thì sẽ được tặng ngay một hộp mua một liệu,Vietnamese
+không đau nhưng mà nếu mà khí huyết mà nó không có thông được thì cái chỗ đấy nó sẽ ứ chạy lại nó sẽ tắc lại nó sẽ gây,Vietnamese
+của người bệnh béo phì là gì ạ,Vietnamese
+dạ thưa bác sĩ cho em hỏi là chị em phụ nữ mình á sau khi mà sanh thì thường hay,Vietnamese
+thực tế và ngoài ra chúng ta cũng lại có thể phối hợp với các cái bài thuốc cổ,Vietnamese
+nhất vâng vừa rồi thì chúng ta đã đến với cái phần nấm đông trùng hạ thảo rồi thế nhưng rõ ràng là trong cái nấm dùng,Vietnamese
+mình tăng hiệu quả của cái sản phẩm dưỡng sáng hay là để giúp chúng ta có thể là với quá trình dưỡng sáng đạt được,Vietnamese
+công việc có cái gì căng thẳng quá cũng là yếu tố hay là mất ngủ cái mất ngủ ở cái người lớn tuổi cũng thường xảy ra,Vietnamese
+thư để hồi phục thậm chí có thể ăn phải đến ba mươi ba mươi lăm phần trăm năng lượng của chất béo để,Vietnamese
+là bốn đến năm năm cũng có thể chấp nhận được chứ còn trước đó nữa thì người ta chưa có khuyến khích và chưa có,Vietnamese
+những thuốc này ở gọi là đắt xắt ra miếng lợi ích,Vietnamese
+xem xét cẩn thận cái tình cái tình trạng của người bệnh xem xem là bệnh nhân này có chỉ định sử dụng thuốc kháng đông,Vietnamese
+loạn vận chuyển mạch máu vân vân thì đôi khi có những cái trường hợp là nó bị sẵn rồi mình chụp ra mình đo ra mình nhìn,Vietnamese
+và khi mà chúng ta là đến để thực hiện những cái dịch vụ kỹ thuật đặc biệt,Vietnamese
+vị và các bạn với rất nhiều những cái người bệnh huyết áp cao mỡ máu cao bị xơ vữa động mạch thì việc mà tìm ra được,Vietnamese
+cái căn nguyên cơ chế bệnh sinh của mình đó chính là những cái mảng xơ vữa bác ạ và rất tốt ở trên những người bị rối,Vietnamese
+công việc chính của các chuyên gia tâm lý trong việc điều trị người bệnh béo phì,Vietnamese
+thích não sâu nó sẽ giúp được cho người bệnh giảm được cái liều thuốc chúng ta biết khi mà bệnh tiến triển người bệnh,Vietnamese
+tâm ở nước ngoài để mà được tham gia các điều trị gen cũng như điều trị tế bào,Vietnamese
+lauryl sulfate hoặc là sodium laureth sulfate thì những cái sản phẩm xà phòng này sẽ có,Vietnamese
+cái chuyên khoa như vậy thì lúc đó cái đánh giá đối với bệnh mình nó mới toàn diện cái thứ ba nữa là những cái nơi đó ở việt,Vietnamese
+thể là bình có thể mới nhưng mà rượu thì nó vẫn là rượu cũ nhưng mà thôi,Vietnamese
+những manh mối quan trọng một trong số đó là một gen từ côn trùng có tên là,Vietnamese
+môn bạn có thể đã đọc sâu tới mức hiệu cách mặt glucose tử đường đi vào các tế,Vietnamese
+cực mạnh về về oxy hóa nó gây hại và khi các thành phần này nó tác động trong cái,Vietnamese
+thấy mầm bệnh có những tính năng như thế này cả hai đều thuộc về bản chất của sự sống còn và cũng như tính dễ bị tấn công,Vietnamese
+tiếp tục song hành trong quá trình diễn tiến của nó và dĩ nhiên nếu mà chúng ta,Vietnamese
+các phương pháp phá hủy này là nếu mà mình làm thì gần như là bệnh nhân có thể có hiệu quả tuy nhiên khi mà bệnh,Vietnamese
+đây người ta thấy rằng là giai đoạn có thể từ bốn năm có thể là chấp nhận được tức,Vietnamese
+thoát khỏi kẻ xâm nhập là mối đe dọa thực sự cho sự sống còn vì vậy trong cả,Vietnamese
+số nội tiết này nó lại ức chế các estrogen và đó cũng là nguyên nhân thứ hai dẫn đến rụng tóc có một điều mà,Vietnamese
+nói rằng gì rõ ràng là chất lượng nó sẽ khác hẳn nếu như mà chúng ta lại dùng toàn thể cả phần đế nữa thì nó khác rồi,Vietnamese
+sử dụng mấy nhôm các chất bổ trợ có thể được thiết kế riêng để kích hoạt phản ứng bẩm sinh bằng cách sử dụng các phân,Vietnamese
+ở một ngôi trường nghiêm khắc nhưng do có phải dùng thuốc chống lo âu mắc nhiều,Vietnamese
+bài tập nặng mạnh để hi vọng rằng nó vượt qua được nhưng mà thực tế mà nói thì chúng tôi rất là khuyên rằng là,Vietnamese
+mạch nào nó bị suy giãn và mức độ của nó là bao nhiêu cái từ đó thì các thầy thuốc,Vietnamese
+soda là những thứ vô cùng lạ lẫm với cậu các bữa ăn của cậu bao gồm chủ yếu là,Vietnamese
+hậu quả nó để lại cũng lại không tốt cho nên là bây giờ xu hướng là người ta muốn tìm lại cho cuống cổ cái mà ngày xưa cha ông,Vietnamese
+thôi do đó thì những cái triệu chứng mà nó sẽ giúp cho người bệnh,Vietnamese
+tim thì có thể sẽ xảy ra bệnh cạnh thiếu máu cơ tim nhồi máu cơ tim có nghĩa là,Vietnamese
+động cảm ơn bác sĩ và thưa tất cả quý vị rõ ràng là chúng ta thấy có rất là nhiều,Vietnamese
+ăn uống thì đối với người huyết áp cao thì chúng ta không nên ăn mặn rồi không nên giảm bớt những cái mỡ đặc biệt là từ,Vietnamese
+bệnh nhân béo phì thì thật sự là có những cái điểm thuận lợi nhưng mà cũng đồng thời là nó có những cái liệu rất là,Vietnamese
+những diễn tiến âm thầm này là tối cần thiết cho sự sống còn của chúng ta cái,Vietnamese
+phải từ bò cung cấp sự bảo vệ chống lại bệnh đầu mùa và do đó mủ từ một nước,Vietnamese
+đồng thời chính cái thành phần đó lại là thành phần điều trị rụng tóc nhưng mà đó là một cái câu chuyện về thông tin y học,Vietnamese
+mình chỉ dám những cái có thể giảm thôi còn những cái vẫn phải làm thì vẫn phải làm đúng không ạ thế thì bằng cách là gì,Vietnamese
+khoảng sáu bảy mươi thì chưa được đấy là những chỉ số để chúng ta đem trọng thứ hai nữa là chúng ta đã gọi là bữa ăn thì,Vietnamese
+quan trọng đối với sự phát triển của một hệ vi sinh khỏe mạnh cũng như những yếu tố có thể phá hủy nó bạn sẽ sớm bắt đầu,Vietnamese
+thường thường nếu mà có đặc biệt nó có kèm theo là các nguy cơ gì khác nữa thì cái cái cái nguy cơ đột quỵ sẽ tăng,Vietnamese
+dưới cũng là một cái vấn đề rất là quan trọng thường nó có thể gây lên những cái đau ở cái vùng cột sống đau lên đỡ cái,Vietnamese
+mà đã xảy ra đột quỵ rồi thì cái việc điều chỉnh huyết áp phải thực hiện ở trong bệnh viện và tại vì đúng và hạ,Vietnamese
+thấy rằng chúng ta có thể mắc các bệnh dịch hiện đại từ béo phì đến bệnh alzheimer khi hệ vi sinh của chúng ta bị,Vietnamese
+về vấn đề này thì như hồi nãy tôi cũng vừa nói thì béo,Vietnamese
+acenocoumarol là vân đó thì nó có những cái ưu điểm đó là ưu điểm về rẻ tiền,Vietnamese
+chính vì vậy cho nên là ngoài những cái đợt mà theo dõi với bác sĩ ra thì người ta cứ tự ý người ta bắt đầu lại sử dụng,Vietnamese
+bệnh lý như là huyết áp cao này các cái rối loạn mỡ máu mặc dù là chúng ta cũng đã có điều trị rồi nhưng tuy nhiên thì,Vietnamese
+độ mà người đi và xét nghiệm ở tại các cơ sở y tế tăng lên đáng kể tuy nhiên,Vietnamese
+tiếp đi bác bác nói tiếp đi bác đừng dừng lại ạ mời mời mời bác nói tiếp đi ạ đừng dừng lại bác,Vietnamese
+dập tắt chúng viêm mạn tính và tổn thương do các gốc tự do là những khái niệm nằm ở vị trí,Vietnamese
+cường cái công dụng của cái vị quân cái thứ hai là nó mở rộng cái phạm vi tác,Vietnamese
+sao để cho người bệnh phẫu thuật kích thích não sâu có hiệu quả tốt nhất do đó chúng ta thấy rằng là trước đây các bác sĩ phẫu,Vietnamese
+không tốt thế nên thế nên là chúng ta mới phải tìm đến những cái giải pháp mà,Vietnamese
+người mẹ ở vùng quanh hậu môn cũng giúp cấy vào trẻ sơ sinh các vi sinh vật duy trì sức khỏe về sự phát triển ban đầu,Vietnamese
+sẽ rất là tốt cho cái việc phòng chống ung thư thế đối với các cái tiếp đến là đối,Vietnamese
+các cái chứng bệnh về các cái tuần hoàn và máu não cũng như là các cái cái cái,Vietnamese
+xác tôi chưa biết là các bác đã lần trước thì khám để các bác sĩ đã khuyên gì chưa nhưng mà đối với những cái,Vietnamese
+ngực này tim đập nhanh này rồi những cái bác cũng đang sử dụng các cái thuốc để giảm nhịp tim của các bác sĩ rồi như,Vietnamese
+nước đi các chuyên gia bình thường bị mắc kẹt với những gì họ đã quen thuộc đó,Vietnamese
+nhiều thuốc có thể chia sẻ một chút được không ạ thật ra thì đối với cúm a với những,Vietnamese
+bệnh nhân béo phì đến thì sẽ đưa ra các mục tiêu điều trị cho bệnh nhân thì các mục tiêu ngắn hạn đó là sẽ giảm từ năm,Vietnamese
+có thể sẽ chuyển thành người f0 và do đó trong cái một cái khu vực mà chúng ta,Vietnamese
+em trông đã tiều tụy hẳn đi thì em có tìm hiểu tình trạng này có thể do thiếu kẽm đúng không ạ chuyên gia có thể tư,Vietnamese
+động bên ngoài như vậy nó có một điều mà chúng ta cần chú ý là thế này mỗi ngày thì cơ thể chúng ta phải đối,Vietnamese
+người ta là sức khỏe và trí tuệ có sức khỏe thì mới có trí tuệ và hiện nay thì,Vietnamese
+mà đi ra ngoài đường là bị ngã cái thì gay cho nên là trường hợp của bác cũng thế thôi nếu bác bắt buộc vẫn phải leo cầu thang đương nhiên là cái công việc,Vietnamese
+thuật thường là chỉ là liên quan tới vấn đề về phẫu thuật nhưng mà với những cái,Vietnamese
+sẽ còn khó hơn rất nhiều thì mình nên là chú ý là mình bổ sung thêm các cái nước,Vietnamese
+phải khắc phục cái tình trạng nhân nên này như thế nào bạn vâng nếu mà nói về khô miệng thì chúng ta thì đầu tiên là,Vietnamese
+nào và tất cả những cái vấn đề khác về cơ xương khớp vân vân như vậy thì đối với một người lớn tuổi mà có bệnh,Vietnamese
+chúng ta mà sử dụng những các sản phẩm mà có tính tẩy trắng hồi nãy bác sĩ có chia sẻ thì nó kích thích đôi khi làm cho chu trình,Vietnamese
+ta điều chỉnh thuốc cho nó phù hợp và khi có chỉ định thuốc thì phải tuân thủ,Vietnamese
+lại ở những cái người trầm cảm đó thì cái khả năng mà xảy ra béo phì thì nó lại cao hơn so với lại những cái người,Vietnamese
+não và có lẽ khía cạnh quan trọng nhất của đường ruột có liên quan mật thiết đến sức khỏe chung và sức khỏe tinh thần,Vietnamese
+ít thức ăn gì chỉ quan tâm đến có những m���t hai cái loại thuốc nào đó thì nó có thể cản trở cái việc mà,Vietnamese
+như lps từ lớp bao bên ngoài của vi khuẩn hoạt động tốt như một chất bổ trợ với sự,Vietnamese
+như là như thế nào đột quỵ não đột quỵ tim và suy tim ngay bây giờ trước khi mà chúng ta tiếp tục kết nối thông qua tổng,Vietnamese
+đừng bị rung nhĩ rung nhĩ có những cái yếu tố nguy cơ có,Vietnamese
+hơi lạ mùi lạ là tôi sẽ không thở được thế nên là rất nguy hiểm như phổi tắc nghẽn mãn tính như bác sĩ ạ tôi tôi,Vietnamese
+chứng khoảng trung bình khoảng năm mươi phần trăm các trường hợp như vậy nói tóm lại là trung bình với người bệnh phẫu thuật,Vietnamese
+nhiệm vụ quan trọng như duy trì nhịp tim và kiểm soát sự tiêu hóa và hóa ra quần,Vietnamese
+ra đó là cái hormone cortisol trong máu cũng như là hormone về catecholamine nó,Vietnamese
+và béo phì cũng như gặp khó khăn trong việc giảm cân các vấn đề về trí nhớ và kém tập trung táo bón và tiêu chảy mạn,Vietnamese
+gội thích hợp các sản phẩm chăm sóc tóc thích hợp cho thì hiện nay trên thị,Vietnamese
+lối sống nó tĩnh tại quá nhiều cho nên là nó đưa đến cái tình trạng là suy giãn,Vietnamese
+chu trình chúng ta giữ sáng ba mức cơ bản và một số những cái lưu ý về thành phần về thời gian hiệu quả của chương trình,Vietnamese
+thương ở bên trong não chảy máu não hoặc là dập não thì nó cũng sẽ ảnh hưởng nhiều hơn rất là nhiều tuy nhiên chúng,Vietnamese
+xin thì cái khả năng miễn nhiễm của cơ cơ thể của chúng ta sẽ tăng lên với,Vietnamese
+trắng nè từ hoa lan hoặc từ cam thảo hoặc là gần đây là có những cái sản phẩm mà có chứa chiết xuất từ thực vật,Vietnamese
+cơ quan trong cơ thể cũng như là có rất gây ra rất nhiều những cái biến chứng bệnh lý đi kèm theo như là tăng,Vietnamese
+cái khảo sát thông thường thì sẽ gắn cái máy đo kéo dài hơn đo với niềm tim kéo dài hơn ba tháng sáu tháng cấy vào trong cơ,Vietnamese
+như vậy thì khi mà đến vĩnh long cái điểm đầu tiên khi mà chúng ta được,Vietnamese
+rồi là khó thở đúng không ạ tức ngực và chị cũng đã đi khám rồi và các bác sĩ cũng có nhiều những cái chẩn đoán như,Vietnamese
+của da và chúng ta thoa kem dưỡng ẩm thì lưu ý đó là trên một cái làn da nhạy cảm,Vietnamese
+nghiên cứu người ta chứng minh được rằng cái việc mà chúng ta giảm được chỉ tượng khoảng năm đến mười phần trăm cân nặng thôi,Vietnamese
+hoặc là ung thư gan thì tất cả những cái điều ấy đều liên quan đến việc bài tiết dịch tiêu hóa và cái bài tiết dịch tiêu,Vietnamese
+vâng ạ tôi thì thấy thực tế là khi mà chúng ta nhận một cái khẩu phần vào và rất,Vietnamese
+mời quý vị và các bạn chúng ta hãy cùng đến với một cái trường hợp đã được chúng tôi thực hiện trong phóng sự ngay sau đây thưa quý vị nha,Vietnamese
+tập trung vào một phần của hệ thống tại một thời điểm việc chúng ta chia một hệ,Vietnamese
+cho cái người người ta bị béo phì đó họ sẽ càng bị stress càng ngày càng nhiều,Vietnamese
+quý vị hãy cùng chúng tôi đồng hành trong suốt khoảng thời gian sắp tới đây của chương trình và thưa tất cả vị chương trình của chúng ta ngày hôm nay,Vietnamese
+chia sẻ theo chúng ta về những trở ngại và thách thức tâm lý mà người bệnh béo phì luôn phải đối mặt,Vietnamese
+cái việc vận động đều nó sẽ giúp cho các cái mạch máu nó nuôi dưỡng các cái xương khớp và mang lại các cái nhiệt lượng một,Vietnamese
+cố định khớp đặc hiệu với mầm bệnh hoặc tế bào nhiễm bệnh hay đúng hơn là mô,Vietnamese
+vì đây nó đây là những người mà tăng huyết áp vô căn tức là chúng ta không tìm thấy nguyên nhân nên là chúng ta,Vietnamese
+thấy rằng là có một cái hoạt chất nó có cái tác dụng mà chống viêm giảm đau chính là để để phát huy cái tác dụng này,Vietnamese
+điều là các giải pháp từ thảo dược bao giờ nó có tác dụng nó chắc chắn nhưng mà,Vietnamese
+chia hai lần sáng chiều còn từ tháng thứ ba trở đi chúng ta có thể uống hai viên chia lần sáng chiều cái điều đó thì nó,Vietnamese
+từ vi khuẩn là không tự thân không phải là một phần của cơ thể con người và như,Vietnamese
+đoạn sau sanh thì mái tóc dễ gọi là nó mềm mại và nó yếu ớt thế cho nên là,Vietnamese
+hợp đó mà nó có thể làm cho cái tâm lý của họ là nó sẽ trở nên khó khăn hơn cụ,Vietnamese
+may mà có bị mắc thì thường là các triệu chứng nó cũng sẽ nhẹ hơn và như vậy thì nó sẽ đỡ ảnh hưởng đến sức khỏe của bác,Vietnamese
+những cái thuốc điều trị của kê đơn theo góc của các bác sĩ thì bác hoàn toàn vẫn sử dụng theo đúng giờ và theo đúng quy,Vietnamese
+không quên ghi lại những đóng góp của các nhà khoa học trong lĩnh vực miễn dịch trong suốt thời gian qua viện y học,Vietnamese
+bệnh bị biến chứng mà thậm chí tử vong do thủng dạ dày do chảy máu dạ dày rất là cao cái thứ hai nữa là các cái hệ mà,Vietnamese
+có nghĩa là não ta bị thiếu máu lên nuôi não và đồng thời,Vietnamese
+thì nhiều chi bộ có thể chia sẻ chúng ta trước không ạ cúm a thì nó là một bệnh,Vietnamese
+đó là nó ra được cơ quan kiểm soát thuốc và dược phẩm của hoa kỳ chấp nhận từ năm,Vietnamese
+nếu mà táo bón mà nó do thuốc gây ra mà bệnh nhân có chỉ định điều trị phẫu,Vietnamese
+nó là bệnh tật khi nào thì nó là do cái cơ địa của chúng ta và ở đây chúng tôi cũng muốn nhấn mạnh một cái khái niệm,Vietnamese
+nhất mà cái điều này bây giờ vẫn là một điều bí ẩn tôi cũng chả hiểu tại sao là ví dụ như là chúng ta dùng con tắc kè,Vietnamese
+điều trị bằng các loại thuốc ức chế miễn dịch mạnh và thường có những mặt trái đáng kể không ít trong số đó bao gồm,Vietnamese
+dự đoán rằng mẫu đã được nhận dạng nên là sản phẩm của một quá trình phức tạp và quan trọng trong vi sinh vật nói cách,Vietnamese
+đó nó lên não trở lại bình thường thì mọi chuyện hồi phục lại trước khi não cái tế bào não là bị tổn thương,Vietnamese
+nên đến bác sĩ điều trị và tuân thủ y lệnh của bác sĩ và có một cái chế độ ăn,Vietnamese
+chúng ta có thể vừa tăng sức đề kháng để tự bảo vệ cơ thể mình ngoài ung thư chúng ta từ ung thư chúng ta sẽ rất dễ,Vietnamese
+cung cấp hay là cái nhu cầu và mức độ thỏa mãn cho nên khi mà mình có cái nhu cầu,Vietnamese
+thì bác sĩ sẽ tiến hành điều trị bằng cách là phải phục hồi da nhạy cảm tức là kết hợp với những cái thuốc uống thuốc,Vietnamese
+thì vẫn có thể là dại mèo thậm chí là con,Vietnamese
+thành phần tự nhiên có tinh chất chiết xuất hoa và có khả năng làm sáng da tự nhiên vâng thì khi nãy tôi đã có chia,Vietnamese
+chích ngừa thì sẽ bệnh dại và tử vong,Vietnamese
+loại virus và cứ thế nhiều nghiên cứu theo sau cũng tiết lộ rằng các chủ thể,Vietnamese
+công tác điều trị parkinson cũng như là mức độ hiệu quả của phương pháp này như thế nào chúng ta biết rằng là bệnh parkinson,Vietnamese
+đây cũng là những các cái dấu hiệu của những cái tình trạng thiểu năng vành nên là bác hoàn toàn có thể sử dụng sản phẩm,Vietnamese
+em bé rất là mềm và mịn tại sao vậy bởi vì trước trung bình 28 ngày da của em bé,Vietnamese
+của bất kỳ tác nhân gây bệnh nào nếu không có hệ miễn dịch hoạt động đầy đủ một sự kiện đơn giản như vết muỗi đốt có,Vietnamese
+áp cao vâng thế và ngoài ra các bệnh viêm dạ dày viêm đại tràng thì đối với các bệnh viêm dạ dày viêm đại tràng,Vietnamese
+ra từ cùng một mô trong quá trình phát triển của thai nhi và chúng được kết nối thông qua dây thần kinh phế vị nó còn,Vietnamese
+nấm thì chúng ta cũng vừa có được cái chất đạm từ nấm và chúng ta lại còn có,Vietnamese
+đông trùng hạ thảo đó thì khi mà dùng đến viên nang kết hợp với lại trà đông trùng hạ thảo thì tôi thấy là rất là tốt,Vietnamese
+ung thư thì nhìn chung thì về quy định về chung thì thứ nhất là mọi người không,Vietnamese
+định xem chúng khỏe mạnh hay bị bệnh những khám phá của tôi đã giúp chỉ ra,Vietnamese
+ý thức trách nhiệm của cái người bệnh cũng như là của bác sĩ cũng như là những cái người nhà và những người đồng hành,Vietnamese
+phức tạp thậm chí tinh vi theo nhiều cách và chúng là một nhóm sinh vật hấp dẫn đừng để kích thước quá nhỏ của chúng,Vietnamese
+chậm cử động cũng như là triệu chứng đơ cứng của người bệnh chúng ta thấy người bệnh parkinson đi lại chậm chạp người,Vietnamese
+tế bào miễn dịch của con người ở những chi tiết nhỏ chính tôi đã nhìn thấy cách khoa học biểu lộ vẻ đẹp dù nó vẫn còn ẩn,Vietnamese
+vấn trực tiếp đến từ bác sĩ của chúng ta ngày hôm nay thì quý vị và các bạn cũng có thể cải thiện phần nào cái tình trạng,Vietnamese
+chúng tôi cũng khuyên là gì ạ bác đã đi thăm khám nhiều nơi này đã đi chụp chiếu nhiều này đã uống nhiều loại thuốc rồi giống như bác mô tả cái điều đấy là tốt,Vietnamese
+và mầm bệnh là một trong những điều kỳ diệu vĩ đại nhất của hệ miễn dịch và nó hoạt động như sau mỗi tế bào t và tế bào,Vietnamese
+chỉnh thật là sát sao và thật là kịp thời cho cái bệnh lý này và cái thứ hai nữa là gì ạ cái thứ hai nữa là với những,Vietnamese
+như là đường huyết của tôi bây giờ chỉ là năm sáu lần thử gần đây là nó chỉ độ năm,Vietnamese
+phòng ngừa để mà nó giải quyết tình trạng khó khăn của họ rồi là cái thói,Vietnamese
+lo lắng càng căng thẳng rồi họ tiếp cận với những thông tin nó không có phù hợp vào trong internet chẳng hạn,Vietnamese
+nó giúp cho máu thông lên não lên tim tốt và chính vì vậy mà nó sẽ cải thiện được các cái triệu chứng của bác đấy ạ,Vietnamese
+hiệu quả nhưng lại tác dụng phụ không có nhiều như vậy không ảnh hưởng đến nội tạng nhiều như vậy và bản thân,Vietnamese
+thuốc sẽ dặn à bác uống cái đơn này cái phác đồ này nó chưa làm hba1c nó trở về,Vietnamese
+như vậy là bạn đã biết là mình nên làm gì rồi đúng không ạ và các bạn thân mến nếu như mà có bất kỳ những cái,Vietnamese
+chúng ta phải rửa mặt tẩy trang tức là chúng ta đã loại bỏ cái lớp kem chống nắng trên bề mặt da rồi thì cái đó chúng,Vietnamese
+thì mình có cái giải pháp ngay lập tức là như nào cá nhân tôi chẳng hạn bây giờ tôi chưa bị như bác đâu nhưng mà đi lúc,Vietnamese
+hơn về cái bệnh lý béo phì trong một cái bối cảnh không chỉ là cái chuyện mà cân,Vietnamese
+loạn tâm thần khác bằng thuốc chẳng hạn nó cũng góp một phần làm cho cái tình trạng rối loạn ở tâm lý họ có khi là,Vietnamese
+nó sẽ không còn hiệu quả nữa hoặc là hiệu quả nó không đủ để kiểm soát các,Vietnamese
+chương trình xin chào và hẹn gặp lại,Vietnamese
+thương thận vân vân và vân vân cho nên là lời khuyên thứ hai của chương trình đối với bác là gì nên tìm đến những giải,Vietnamese
+trùng hạ thảo nơi đó như tôi đã nói là adenosine là cái gọi là các nhà khoa học,Vietnamese
+ngập đồ ăn chế biến sẵn đường tinh luyện và những chất béo thực vật không lành mạnh tới sáu tuổi cô bé thừa cân và được,Vietnamese
+cảm thấy rằng những cách điều trị mà béo phì như thế này làm cho họ bế tắc,Vietnamese
+hòa được nhịp tim của chúng ta khắc phục tình trạng loạn nhịp chậm nhịp và rối loạn nhịp tim ngăn ngừa tắc mạch máu não nhồi máu cơ tim cũng có tác dụng lên,Vietnamese
+bạn tức là bạn muốn hỏi hai phần phần đầu tiên là làm sao để bạn có thể chọn lựa một cái kem dưỡng mà phù hợp với lại làn,Vietnamese
+tiết và phải khắc phục như thế nào để cái tình trạng đau xương khớp nó không bị tái đi tái lại nhiều lần và bây giờ thì ở thông qua số điện thoại không vay,Vietnamese
+khám phá của ông được thực hiện vào thời điểm mà việc trích quyết vẫn còn phổ biến nghiên cứu khoa học ngày càng mang,Vietnamese
+ở các vùng mà có dịch thì nếu mà cái người ở vùng đó đi đến những cái vùng,Vietnamese
+thực sự là khi mà mình phải đang điều trị gì như chúng ta đã chia sẻ với nhau từ đầu chương trình thành những cái điều,Vietnamese
+nó tác động vào những cái mảng xơ vữa nên là nó cải thiện rất tốt thứ nhất là nó làm giảm cái nguy cơ hình thành các,Vietnamese
+thăm khám đối với những cái người mà có các cái vấn đề như thế này bao giờ chúng tôi cũng xem là cái công việc cũng như,Vietnamese
+còn tăng ngược trở lại nữa thì họ rất là bối rối và cái này là nó rất là khó khăn,Vietnamese
+đau nhức nhiều hơn tuy nhiên còn một cái câu chuyện khác mà chúng ta phải phân biệt là thế vậy thì thì cái đau mà do cơ,Vietnamese
+tại sao chúng ta gọi là nhỉ là tại vì cái hình dạng của nó cũng giống như cái vành tai,Vietnamese
+cũng sẽ có những tác dụng không mong muốn à có thể làm chúng ta mệt mỏi có thể làm chúng ta coi như ăn không ngon ngủ,Vietnamese
+là rối loạn mỡ máu đúng không bác thế và bác cũng có hỏi là cái số cái số hát cái,Vietnamese
+kẻ thua cuộc chúng ta đã học được rằng một phần của vấn đề là người cao tuổi có,Vietnamese
+chúng cũng giống như các bộ phận xây dựng nên một hệ thống hệ thống định nghĩa các bộ phận chúng ta choáng ngợp ở,Vietnamese
+trọng trong điều kiện nguy hiểm đã đến lúc dành cho chúng sự quan tâm và chăm sóc mà chúng xứng đáng chỉ khi đó chúng,Vietnamese
+biệt tức là nó tác động vào cái cái nguy cơ tức là nó làm giảm cái mảng xơ vữa,Vietnamese
+hai nhóm khác nhau mà trong một chế độ ăn dinh dưỡng cho các khuyến cáo hợp lý là phải gì phải năm nhóm thực phẩm khác,Vietnamese
+việc chúng ta tuân thủ tân dược thì chúng ta vẫn sử dụng thêm những cái mà,Vietnamese
+cảnh báo rồi thì mình phải lo xử lý nó ngay nếu không thì nó sẽ thành một người,Vietnamese
+nhiều ví dụ về những tiến bộ y khoa lớn lao đến từ những lĩnh vực bị quên lãng một trong những ví dụ điển hình là tia x,Vietnamese
+yếu rồi mình nói thay đổi lối sống thôi nhưng mà bây giờ là người ta nói là một cách tiếp cận tâm lý,Vietnamese
+máu cao này hay là những cái bệnh lý về tim mạch về tiểu đường nữa hi vọng là quý vị và các bạn chúng ta đang theo dõi,Vietnamese
+đổi thái độ họ đẩy mà họ có được một cái hành vi tốt hơn,Vietnamese
+nhầm lẫn với một cái nhóm thuốc khác đó là nhóm thuốc gọi là thuốc chống tiểu cầu tiểu cầu mà cụ,Vietnamese
+trị rồi thì cái nhu cầu nó cũng có khác đi thì chúng ta làm sao có được cái tư vấn rất là sát sao để xác định cái nhu,Vietnamese
+ta thường là tự ti người ta cảm thấy là mình nó dở người ta cảm thấy là mình có,Vietnamese
+cái bệnh lý như là các cái thiểu năng vành này rồi là những cái cái tình trạng đau đầu hoa mắt chóng mặt của các cái,Vietnamese
+ung thư với khả năng giảm tình trạng chán ăn buồn nôn thay đổi vị giác hoặc mất vị giác ở người đang điều trị y học,Vietnamese
+vâng những cái quan trọng nhất là chúng ta cần phải nắm vững được những cái nguyên tắc về dinh dưỡng và đồng thời là,Vietnamese
+tế bào và cái tổn thương tế bào ấy thì làm cho tế bào không bình thường tế bào không bình thường đấy thì nó một là nếu,Vietnamese
+trên mặt đất sinh ra cơ chất người ta gọi là stroma và từ đó thì cổ nhân đã lấy,Vietnamese
+mà chúng ta cả các bác sĩ tim mạch thì bên đây chẳng hạn cho một cái chỉ định ở đó loại trừ hoàn toàn không còn rung nhĩ,Vietnamese
+có chóng mặt mà tỷ lệ đó không có nhiều trong đó thì các triệu chứng đột quỵ chính của mình sẽ là triệu chứng là yếu,Vietnamese
+cái thành phần chính như là immunesoyz này kết hợp với đan sâm hòe hoa rồi là các,Vietnamese
+sống còn của mình không lâu thì mình có thể cân nhắc tới việc làm xài cái cái cái cái cái cục pin không sạc có một cái,Vietnamese
+cái đau thắt lưng thế nhưng mà đối với những cái người ở đặc biệt ở cái lứa tuổi trung niên thì rất là dễ gặp vì,Vietnamese
+về các bệnh về não và tinh thần mà còn cả ung thư hen suyễn dị ứng thực phẩm,Vietnamese
+là chữa lành bệnh parkinson và trong đó điều trị gen cũng như là điều trị tế bào gốc là một trong những cái hướng đó cái,Vietnamese
+sẽ tìm hiểu cái nơi nào làm thường xuyên thì đương nhiên về mặt thủ tục thì làm thường xuyên thì nó sẽ tốt hơn nơi nào,Vietnamese
+giải thích tất cả mọi thứ ông đã dành một nửa tiền chu cấp hàng tháng của mình cho việc sao chụp bài báo háo,Vietnamese
+trăm các trường hợp giúp cải thiện các triệu chứng về vận động xin được cảm ơn bác sĩ và chúng ta sẽ cùng đến với câu,Vietnamese
+bệnh nhân đạt được hiệu quả mong muốn nhất và hạn chế những tác dụng phụ nhiều nhất là khi mà mình đặt vô như vậy mình,Vietnamese
+những thông tin y tế chính thống đến với đông đảo cộng đồng nhằm góp phần nâng cao nhận thức của người dân trong việc,Vietnamese
+người mà bình thường những người khỏe mạnh bình thường những người ở độ tuổi trư���ng thành không có bệnh lý nền,Vietnamese
+đặc biệt là bác cũng có vừa chia sẻ là bác cũng vừa bị covid nữa nên là sau covid thì thường là chúng ta cũng rất hay,Vietnamese
+của mình nó áp vào trong trái tim thì mới gọi là nhĩ thì đó là chúng tôi đã nói về tâm nhĩ bây giờ nói về rung,Vietnamese
+là dễ hơn nhưng chúng ta rất là cần thiết phải phòng tránh bởi vì cái chuyện này chúng tôi nhìn thấy là nó nguy cơ,Vietnamese
+tức ngực khó thở đau ngực hoặc gây triệu chứng bằng những người chúng ta suốt qua ba ngày rồi nghỉ thêm một ngày ngày thể thao,Vietnamese
+có thể sử dụng này rồi là những cái biến chứng như nhồi máu cơ tim cũng hoàn toàn có thể xảy ra nên là bác nên sử dụng,Vietnamese
+thức ăn đó thì nó sẽ làm cho dễ bị béo phì nữa đối với lại môi trường xã hội,Vietnamese
+các yêu cầu của họ thì họ lại càng hoang mang càng khó chịu và như vậy thì một cái vòng lẩn quẩn rồi bên cạnh đó,Vietnamese
+kiểm soát cân nặng rồi khi mà điều trị phẫu thuật khi mà dùng thuốc cải thiện,Vietnamese
+yếu còn liệt còn nói khó còn cái kia thì nó phải coi đó là đột quỵ và ta phải xử lý cấp cứu ngay nhưng mà,Vietnamese
+thuần lại có thể có nguy cơ phá hủy nội tạng thưa bác sĩ câu hỏi này rất là hay ở đây chúng ta khi ta nói đến cái câu,Vietnamese
+các chi tiết nhưng không được quên cái bức tranh tổng thể bởi chỉ khi thực hiện điều này thì chúng ta mới có thể bắt đầu,Vietnamese
+cho các cái thành phần hữu hình nó đi ở trong lòng mạch đáng lẽ bình thường khi mà lòng mạch bình thường ấy thì các cái,Vietnamese
+nhất đâu đó phần bên trong của cơ thể con người có thể không tiến hóa để mang,Vietnamese
+mình thấy rõ ràng mà có nhiều cái ảnh hưởng tới sức khỏe thể chất rất là nhiều bệnh mạn tính nó gắn chặt với lại cái,Vietnamese
+hợp và đồng thời là chích máu nó sẽ kích thích bệnh nữa đột quỵ đang cần để nghỉ ngơi yên tĩnh giữa cái mạch máu,Vietnamese
+trị xạ trị thì sẽ khiến cho bệnh nhân gặp phải cái tình trạng là giảm cân rồi,Vietnamese
+vẫn còn có hiệu quả do đó thì những trường hợp mà được chỉ định đúng cho phẫu thuật thích não sâu thì bản thân và,Vietnamese
+đun sắc thì hiện nay là đã tạo thành dạng viên rồi thì chúng ta kiên trì sử dụng sẽ mang lại được cái hiệu quả tốt,Vietnamese
+mình này rồi là những cái uống nhiều uống đủ nước này tăng cường uống nước những cái nước hoa quả cũng rất là tốt,Vietnamese
+mình cũng mới bị là khỏi covid cách đây xong coi chừng là hai tháng là anh bị khờ,Vietnamese
+chương trình chia sẻ về diễn biến của bệnh parkinson cũng như là các phương pháp điều trị đối với từng giai đoạn,Vietnamese
+thể bạn để tăng cường sự phát triển của đúng loại sinh vật duy trì não bộ chế độ,Vietnamese
+xảy ra các vật khác chỉ có khoảng một tới hai phần trăm cho tổng hết tất cả các loại tai biến nó thôi cho nên là,Vietnamese
+điều trị của bác sĩ chúng ta có một cái sức khỏe tốt nhất tâm thái tốt nhất chúng ta đón nhận cái điều trị ấy đó,Vietnamese
+bác đang dùng mà những cái thuốc kháng covid hay là những cái thuốc gì bác đang dùng đấy thì bác cũng nên thận trọng vì,Vietnamese
+khỏi ra tình trạng bệnh và đây của chúng ta là ung thư thì cái tinh thần của người bị bệnh rất kiên cường cái thứ hai đó là chúng ta,Vietnamese
+để mang lại cái hiệu quả cao nhất bác nhé và bác hoàn toàn vẫn có thể kết hợp thuốc điều trị của các bác sĩ với sử,Vietnamese
+biểu hiện của cái bệnh lý thoái hóa khớp và thoái hóa cột sống ở trong trường hợp này chúng ta thấy cái mô tả của quý khán,Vietnamese
+về khoa học mới xuất hiện cho thấy thai nhi có thể tiếp xúc với vi sinh vật trong tử cung qua nhau thai và hệ vi,Vietnamese
+làm vận động đi lại làm vận động nhiều hay nó có ảnh hưởng gì không ạ vâng cảm ơn,Vietnamese
+chúng ta đi khám một nơi hai nơi ba nơi nó chưa ra vấn đề nó cũng không phải là không có ích mà nó sẽ có ích cho những,Vietnamese
+thời chúng đã thích nghi và thay đổi để đáp ứng với môi trường mà chúng ta đã tạo ra cho chúng bên trong cơ thể mình,Vietnamese
+cũng không có nhiều cho nên xin phép là chúng tôi cũng s�� tư vấn ngắn gọn như này đi vào các vấn đề chính vấn đề số một,Vietnamese
+đã là xơ vữa động mạch rồi thì nó sẽ ảnh hưởng rất lớn đến cái sức khỏe của chúng ta vì chúng ta biết là từ những các cái,Vietnamese
+cho chúng ta có một cái nhìn toàn diện và thông cảm hơn với những thách thức rất lớn mà người bệnh béo phì đang phải,Vietnamese
+hơn rất nhiều so với lại cái ph của da ph mà tốt nhất tối ưu trên da làm ph khoảng bốn chấm năm đến sáu chấm năm do đó nếu chúng ta sử,Vietnamese
+cấp cứu một một năm để mà có thể cấp gỗ được một cách chuyên nghiệp nhất là đưa đến bệnh viện phù hợp và nhanh nhất có thể những,Vietnamese
+phổi gan và não nghiên cứu mới nhất cho chúng ta biết rằng hệ vi khuẩn đường,Vietnamese
+những cái cục máu đông ở trong buồng tâm nhĩ sao mà cục khó đông đã di chuyển xuống vùng tâm thất và được phân phối ra,Vietnamese
+giảm huyết áp à vấn đề làm giảm tiểu đường là vấn đề dự phòng các biến chứng,Vietnamese
+nên là trong đông y chúng tôi vẫn thường có một quan niệm là gì ạ chỗ nào mà nó không thông thì thì nó sẽ đau nghĩa là,Vietnamese
+thành công cuối cùng có nguồn gốc từ một nơi khó ngờ côn trùng giống như chúng ta,Vietnamese
+về xương khớp có được không bác sĩ dạ được luôn ạ mời anh ạ,Vietnamese
+thử nghiệm có thể gây chết người hoặc sẽ phải đối mặt với cái chết do thi hành án,Vietnamese
+thể xảy ra ví dụ như sau khi người ta ghi nhận là có những cái trường hợp sau khi mình đặt xong cái mấy cái máy,Vietnamese
+là nó có cái tác dụng là ức chế cái việc hình thành và các cái cục máu đông do đó,Vietnamese
+tới rồi đối với hóa trị thì có những cái vấn đề là nôn buồn nôn này rồi,Vietnamese
+đáp ứng miễn dịch tóm lại hàm ý của những khám phá này là rất sâu sắc chúng,Vietnamese
+hưởng đến những người ở độ tuổi trẻ hơn như thế nào trái ngược hẳn với việc giảm đáng kể nguy cơ tử vong do tất cả các,Vietnamese
+này nó tích cực hơn điều này nó cực kỳ quan trọng vì như chúng tôi đã trình bày ở trên thì,Vietnamese
+thứ ba là không hết những trường hợp mà bệnh nhân bị béo phì đó nó chịu ảnh hưởng bởi cái sự kỳ thị như là nãy mình nói từ nhiều,Vietnamese
+cái khẩu phần ăn vào của bệnh nhân ung thư và chính vì vậy làm được đó sụt cân thì cái nguyên nhân thứ hai là cái việc mà chính,Vietnamese
+trọng và trong những cái loại nước đó thì bạn có thể cho ông uống sữa và uống sữa không quá ngọt thì sẽ không xót mà sữa,Vietnamese
+ta đánh giá xem là cái khớp gối của mình thế nào khớp cổ tay của mình nó có bị tràn dịch hay không cái sụn khớp với tổn,Vietnamese
+polysaccharide cao gấp bảy lần các cái chế phẩm đông trùng hạ thảo thông thường hiện nay do đó mà các tác dụng tăng,Vietnamese
+mọi cách bạn nâng niu cái bàn chân nâng niu cái gót chân của mình thì cái câu chuyện này của chúng ta nó đã được cải,Vietnamese
+phát triển và vẫn sử dụng năng lượng sử dụng các chất dinh dưỡng của cơ thể chúng ta để mà phát triển một cái nhân,Vietnamese
+trị liệu cũng như là các phương pháp điều trị bắt đầu các phương pháp điều trị can thiệp ví dụ như là phẫu thuật,Vietnamese
+lấy những cục máu đông ra nha nhưng mà nếu có cục máu đông đó nó lớn và nó trôi,Vietnamese
+ta có được cái những cái món canh món súp nấu mềm lỏng và đặc biệt không nên chế,Vietnamese
+toàn cho người đi lấy mẫu hay không anh nói là không mang khẩu trang là,Vietnamese
+như tất cả chúng ta cùng có một cái ý thức rằng là chúng ta đang có thể có nguy cơ thành là chúng ta phải làm gì,Vietnamese
+quan trọng hơn là giải quyết các chi tiết vụn vặt mặc dù cha ông đã liên tục đưa ra các thách thức để con trai mình,Vietnamese
+thì không phải là của riêng ai cả đối tượng nào chúng ta cũng rất là dễ gặp phải và chúng tôi cũng để ý là có những,Vietnamese
+không nên cố đi lại nhiều không nên cố tập luyện không nên cố là vận động để để để để nó nó nó nó với những cái hi vọng,Vietnamese
+vậy một phụ nữ mang thai có thể có ý định tốt là sinh con qua đường âm đạo và,Vietnamese
+cái tình trạng dinh dưỡng của họ nó bất ��n cũng như là nó kéo theo cái sức khỏe chung nó không có phù hợp,Vietnamese
+có thể thực hiện số lượng lớn các kinh nghiệm với hiệu quả cao ông không,Vietnamese
+bác sử dụng thuốc tiểu đường này thuốc rối loạn mỡ máu và tất cả các thuốc điều trị của các bác sĩ là rất cần thiết bác,Vietnamese
+về các cơ chế này và cách chúng bị ảnh hưởng bởi vi khuẩn đường ruột và sức khỏe đường ruột của bạn trên thực tế hệ,Vietnamese
+có ý định tự tử nữa thì những cái trường hợp này mà sẽ điều chỉnh bằng thuốc nếu nếu mà các triệu chứng của,Vietnamese
+nhịp tim nhanh này các cái rối loạn nhịp tim này đấy là những cái dấu hiệu hoặc là đau tức ngực thế còn nếu mà những cái,Vietnamese
+cái vị trí mà tốt nhất là sau khi mà đánh giá một cách gián tiếp bằng cái,Vietnamese
+tôi thì rất là nhiều nhiều nhiều bệnh như là bệnh thoát vị đĩa đệm về cuộc sống và bệnh,Vietnamese
+suy dinh dưỡng vậy thì chính cái tình trạng giảm cân suy dinh dưỡng này nó sẽ ảnh hưởng như thế nào đến cái việc hóa,Vietnamese
+đều biết là có vị quân đó là cái vị chủ chủ dược quan trọng nhất nhưng mà lại có,Vietnamese
+chia sẻ livestream về trang cá nhân để người thân của chúng ta những cô gái xung quanh chúng ta những chàng trai mà,Vietnamese
+có thể giúp cho chúng ta có đủ các chất dinh dưỡng thôi cho nên hôm nay chúng ta không thích vị chua thì chúng ta tập,Vietnamese
+sinh đường ruột của trẻ sơ sinh có liên quan đến nhiều vấn đề về viêm và miễn dịch như dị ứng hen suyễn và thậm chí là,Vietnamese
+bối cảnh và đến lúc mà được chẩn đoán là suy thận thì cái câu chuyện lại quá là muộn để cái việc khắc phục để hồi phục,Vietnamese
+sĩ cho tôi đo áp huyết thì chắc là tôi sợ quá cho nên là áp huyết lên một trăm,Vietnamese
+quan trọng nhất đó là bệnh nhân có đúng chỉ định hay không thì người ta thấy rằng như bác sĩ tại chia sẻ đôi khi mình,Vietnamese
+chải đầu chải tóc tha hồ ngắm nghía bên phải bên trái quay ngược quay xuôi rồi tay mình giơ lên giơ xuống thoải mái,Vietnamese
+huyết thông qua đó là biểu hiện cải thiện các chỉ số hba1c giảm được là từ khoảng là hai mươi phần trăm cái,Vietnamese
+vị chúng ta ai đã đang mắc ung thư đang trong lộ trình điều trị của mình và lại,Vietnamese
+lên vẫn phải duy trì thuốc huyết áp bác nhé vì là với cái tình trạng huyết áp cứ một trăm bảy mươi một trăm tám mươi và có lúc lên hai trăm vậy là vô cùng,Vietnamese
+hệ vi sinh ảnh hưởng đến tâm trạng ham muốn tình dục sự trao đổi chất khả năng,Vietnamese
+bác sĩ ngoại khoa là quan trọng trong các việc thực hiện các thủ thuật nhưng vai trò của bác sĩ chuyên khoa nội đặc,Vietnamese
+nhạy cảm ngoài ra thì chúng ta có thể là kết hợp chọn những cái sản phẩm mà có từ cái chiết xuất từ thực vật như là hồi,Vietnamese
+tác dụng phụ của phẫu thuật của hóa trị của xạ trị những cái tác dụng không,Vietnamese
+bảo vệ được các cái phần cơ thể đặc biệt là các cái khớp của chúng ta và cái thứ hai nữa là chúng ta nên có cái chế độ,Vietnamese
+nếu như bệnh nhân có cái tình trạng dinh dưỡng tốt dạ vâng vậy thì quá trình hóa trị và xạ trị sẽ gây ra những cái,Vietnamese
+chúng ta có thể tăng lên ba mươi thậm chí một số cái chế độ có thể tăng lên được đến ba mươi lăm phần trăm nếu như chức năng gan thật,Vietnamese
+nguyên nhân cơ chế bệnh sinh đó chính là nó không tác động vào được làm mất đi làm giảm cái mảng xơ vữa nên là cái hiệu,Vietnamese
+bào ung thư ăn nhiều sợ tế bào ung thư nó cũng ăn vâng đúng là mình khó ăn nhiều thì tế bào ung thư nó cũng được ăn,Vietnamese
+trong con tắc kè mà cái kẽm mà chúng ta biết là cực kỳ quan trọng cho vấn đề là đến với hệ gọi là sinh dục đến vấn đề là,Vietnamese
+cái chức năng của bộ máy tiêu hóa của một người trước ngay cả trước trong hoặc là ngay cả sau khi bị ung thư thì chúng,Vietnamese
+lại ung thư rồi nhưng có những người bệnh và hồi phục ngoạn mục sau ung thư nhưng cũng không kiểm soát chế độ ăn thì,Vietnamese
+ơn tất cả quý vị đã quan tâm theo dõi,Vietnamese
+được cho những bệnh nhân đến muộn sau sáu tiếng cho tới hai bốn tiếng luôn tuy nhiên thì mình cũng phải lưu ý là thời gian,Vietnamese
+nên là cái này nó gây nên những các cái triệu chứng nên là đau đầu hoa mắt chóng mặt đấy ạ thế nên là nó sẽ giảm những,Vietnamese
+cũng có những trường hợp nó chỉ kéo dài khoảng mười năm cái việc mà thấy các giai đoạn này nó tiến triển ngắn hay dài nó,Vietnamese
+thể bung ra và nếu nó bung ra thì nó sẽ trôi theo dòng máu và được đẩy đến những cái,Vietnamese
+hợp thiếu nữ mười lăm tuổi xuất hiện các triệu,Vietnamese
+gọi là thiếu máu thoáng qua còn nếu nó không tự thông được là nó vẫn tiếp tục tắc nghẽn nó là không,Vietnamese
+cũng từng là nghiên cứu sinh của ông đã bị ảnh hưởng đặc biệt nghiêm trọng nhóm,Vietnamese
+gây mê là phải đánh giá như những cuộc mổ khác cái nhóm thứ hai mình cần phải,Vietnamese
+ta dinh dưỡng một cách hợp lý và trong dinh dưỡng đó người ta chú ý đến các vitamin cần thiết vitamin nhóm b vitamin,Vietnamese
+đầu chương trình chúng ta nói ở những người trung niên từ năm mươi tuổi trở,Vietnamese
+trong não tới cái vị trí mà mình mong muốn là những cái nhân xám sau ở vùng đáy não mà chi phối cái hoạt động phối hợp,Vietnamese
+vân vân thì khi mà điều trị như vậy đó thì cũng phát hiện ra là đột quỵ và đặc,Vietnamese
+để mà xem lại cho khách hàng một sự tin tưởng về hiệu quả cũng như là cái sự tái,Vietnamese
+ta càng cảm thấy được vai trò vô cùng quan trọng của chuyên khoa tâm lý trong điều trị người bệnh béo phì và tiếp theo,Vietnamese
+cái mảng vữa xơ và mảng vữa xơ thì chúng ta cứ tưởng tượng nó là những cái mảng bám ví dụ cái ống nước chẳng hạn nó sẽ,Vietnamese
+được đính kèm trên ứng dụng hãy lưu ý cách mà các quốc gia trong hình đầu tiên có mức ký sinh trùng cao nhất chẳng hạn,Vietnamese
+phải tập dần để chúng ta thích nghi và để chúng ta có thể chấp nhận được những cái món ăn như trước khi chúng ta bị ung,Vietnamese
+làm tắc hay gọi là bóc tách cái thằng mạch đó nhưng mà ta số các,Vietnamese
+delta này nhập viện nhiều gấp đôi so với những cái là chủng virus sarscov2 khác,Vietnamese
+sống bình thường và tất cả những tổn thương của chúng ta từ khi chúng ta trước khi bị ung thư khi đó chúng ta có,Vietnamese
+huyết áp cao mỡ máu cao xơ vữa động mạch tiểu đường rồi những ai gặp phải bệnh lý,Vietnamese
+như là quý vị khán giả biết đó là cái nguyên nhân mà từ tia uv là chiếm bảy mươi đến chín phần trăm các nguyên nhân gây ra tình,Vietnamese
+thì cái lượng máu nó lên trên nó lại dồn xuống dưới thế cho nên là gì nó sẽ gây ra rất nhiều các triệu chứng khác nhau,Vietnamese
+nhận thấy rằng trong cái enzyme immunesoyz này thì nó có các cái tác động thứ nhất,Vietnamese
+thống để có thể kiểm soát tốt nhưng mà việc thứ hai chúng tôi nghĩ rằng trong trường hợp nó lại là quan trọng hơn đấy,Vietnamese
+liệu ruồi với những gen đặc trưng bị bất hoạt có gặp bất kỳ sự khó khăn nào trong việc đối phó với nhiễm trùng hay không,Vietnamese
+trạng của người dân vô cùng lo lắng và luôn nâng cao ý thức phòng chống bên cạnh việc thực hiện nghiêm những chỉ thị,Vietnamese
+không có không có vấn đề gì còn lại thì mình sẽ còn phải đối mặt với những cái tác dụng phụ hoặc là những cái rối loạn,Vietnamese
+toàn mới về cách hệ miễn dịch của con người thực sự hoạt động việc sử dụng,Vietnamese
+đi xuống phía dưới cũng như là cái quá trình trao đổi chất dưỡng máu và các tổ chức qua cái thành mạch đó nó cũng sẽ bị,Vietnamese
+vùng mà nó lạnh vùng nó lạnh thì khi mà lạnh thì người ta sẽ ăn nhiều mục,Vietnamese
+thương ở trong phẫu thuật đấy mà muốn được làm lành thì cũng cần nhiều năng lượng hơn và chính vì vậy cũng làm cho,Vietnamese
+nam cho nên có vị đừng ngần ngại cứ đặt câu hỏi hỏi giùm người thân bạn bè của mình luôn cũng được ạ nhưng mà có một,Vietnamese
+thứ nhất việc thứ hai chúng ta cũng phải kiểm tra về các cái bệnh lý thần kinh đôi khi các bác sĩ cơ xương khớp người,Vietnamese
+loại tốt nhất tất nhiên các thói quen lối sống khác cũng được tính vào phương trình ngoài việc khám phá sự tương tác,Vietnamese
+được tình trạng của mình bác nhé và chúc bác thật là nhiều sức khỏe vâng vừa rồi thì cũng là vị khán giả cuối cùng kết nối,Vietnamese
+cả những cái đó mình phải có một cái chuẩn bị chi tiết như vậy thì cái cuộc mổ của mình cái tâm lý của mình bước vào cuộc mổ nó sẽ thoải mái thì một trong những yếu tố,Vietnamese
+tim ở mức độ nhẹ ví dụ như mức độ hai mà có tình trạng rung nhĩ xuất hiện thì có thể thúc đẩy cái tình trạng là suy,Vietnamese
+cần phải đòi hỏi phải có thời gian nên là chính vì vậy là sản phẩm ở cần phải có một cái quá trình sử dụng lâu dài mới,Vietnamese
+những cái thiết bị định vị định vị thần kinh trong mổ thì mình phải tìm hiểu để mình,Vietnamese
+dinh dưỡng trong cơ thể chúng ta nó sản sinh ra các tế bào thì mỗi một cái tế bào ung thư điều rất cần đến năng lượng,Vietnamese
+sau này đúng không ạ và thế và ở đây thì chúng ta cũng biết rằng là không biết là,Vietnamese
+một số các cái giải pháp điều trị nó vừa tin cậy với mình vừa an toàn với mình mà nó có thể đồng hành với mình trong cái,Vietnamese
+những kẻ canh giữ và cai trị cơ thể của bạn chúng tạo thành trụ sở chính của cơ thể chúng là những anh hùng và đối tác,Vietnamese
+cụ thể hoặc là dễ hiểu hơn đấy là cái bệnh viêm cột sống dính khớp đấy thì rất,Vietnamese
+thuốc men để chúng ta điều trị cho nó tốt cùng giảm được tất cả các nguy cơ gây ra các bệnh tim mạch nói chung và cái đột,Vietnamese
+khớp những cái bệnh lý liên quan tới thể chất về mặt tâm lý thì như nãy mình nói là,Vietnamese
+nó không tốt cho sức khỏe và nó cũng không tốt với cả vị giác của người bệnh ung thư nữa và chúng tôi nghĩ rằng là,Vietnamese
+bù trừ với tình trạng thiếu độ ẩm đó làm cho da chúng ta là sau một cái đêm ngủ dậy da chúng ta đã thay đổi rồi nhiều,Vietnamese
+chủ chốt của cơ thể trong hoạt động cùng với chức năng sinh lý học của bạn đặc biệt là hệ thần kinh xếp cùng nhau các,Vietnamese
+cũng vẫn là ở một cái chế độ ăn vào của người bệnh không đủ với cái năng lượng tiêu,Vietnamese
+thứ ba là chúng ta dự phòng tích cực các tình trạng biến chứng của nó bởi vì làm,Vietnamese
+nhân kích hoạt lên thèm ăn chủ động kiểm soát các tác nhân kích hoạt cảm giác thèm ăn qua đó là mình duy trì được cái,Vietnamese
+huyết áp nhiều quá nhanh quá thì cũng có thể làm hại cho bệnh nhân nữa do đó nên nếu thấy bệnh nhân có những dấu hiệu mà,Vietnamese
+chúng ta nên chọn lựa những cái sản phẩm mà có chứa các thành phần dịu nhẹ lành tính ví dụ như là trên cái bao bì các,Vietnamese
+khỏe với những thay đổi đơn giản trong chế độ ăn uống và đôi khi là các kỹ thuật tích cực hơn để thiết lập lại một,Vietnamese
+các cái hoạt chất như là kga1 như thế này nó vừa có cái tác dụng chống viêm cho cái phần lý gân cũng như là khớp của,Vietnamese
+một kế hoạt chất mà có thể nói được các nhà khoa học trung quốc người ta coi như là một tiêu chí với nồng độ cao hay thấp,Vietnamese
+cho tất cả quý vị khán giả chương trình được biết parkinson thường có tiến triển bệnh như thế nào và ở mỗi giai,Vietnamese
+béo phì này đó họ mất năng lượng mà họ giảm nhiệt tình họ cảm thấy tự ti ở trong cái công việc của mình và do đó,Vietnamese
+chúng ta những thông tin kiến thức hữu ích về bệnh béo phì một căn bệnh phức tạp cần được nhìn nhận đúng đắn thì mới,Vietnamese
+đã chỉ ra không ai tại thời điểm đó chú ý nhiều đến một cách đáp ứng miễn dịch bắt đầu và hầu hết nếu không nói là tất,Vietnamese
+lời có trong những cái câu hỏi này thì mình nghĩ như là bệnh nhân có các tình trạng da nhạy cảm và như chúng ta biết ở,Vietnamese
+cần hỗ trợ mà bệnh đa xơ cứng của ông đã thuyên giảm hoàn toàn hoặc hãy xem xét,Vietnamese
+mảnh ghép hình lồng vào nhau do có hình dạng bổ sung lẫn nhau các thụ thể trên,Vietnamese
+suy nghĩ của họ nó lệch lạc như vậy và cái niềm tin hỏi gắn chặt vào đó thì đó là những cái cái chuyện mà dễ thúc đẩy,Vietnamese
+cả bạn mặc dù có lẽ bạn quen với thực tế là một số vi khuẩn có thể gây bệnh và,Vietnamese
+lý do là cũng chính từ sự kỳ thị đó thôi họ ít có được cái sự tương tác tốt với,Vietnamese
+việc sử dụng đậu nành thì đậu nành thì lại rất là tốt đối với ung thư vú nhưng mà đậu nành mà đối với lại ung thư tuyến,Vietnamese
+kinh nghiệm của cha ông chúng ta từ hàng ngàn năm mà đúc kết để đúc kết làm gì,Vietnamese
+họ đã cố gắng để mà nỗ lực để giảm cân rồi mà bây giờ nó không có đạt được như yêu cầu của họ nữa thì họ cảm thấy của,Vietnamese
+từ đầu chương trình đến giờ thì cái biến chứng gây ra ở các cơ quan đặc biệt là,Vietnamese
+hẳn đái tháo đường hoặc là khỏi hẳn quá trình lão hóa là không bao giờ có không,Vietnamese
+ép thì cũng hỗ trợ chúng ta được một phần để cung cấp cho chúng ta các cái vitamin và khoáng chất và điểm cuối cùng,Vietnamese
+chúng ta cũng muốn tìm đến những cái sản phẩm mà nó có tác dụng bổ dưỡng nhưng mà,Vietnamese
+nhân đến rất là vô cùng suy kiệt luôn sau ba tháng thực hiện chế độ ăn thực,Vietnamese
+các cái biến chứng trong đó như biến chứng nhồi máu cơ tim biến chứng đột quỵ não hay là suy tim bác ạ thế và khi sử,Vietnamese
+được phát hiện tình cờ giúp vắcxin trở nên hiệu quả ở một mức độ nào đó việc,Vietnamese
+tất cả đều có những các tác dụng phụ chính vì vậy mà cái việc điều trị thuốc thì sẽ theo các chỉ dẫn của bác sĩ,Vietnamese
+não sâu nó để giúp hỗ trợ giúp ích cho điều này trước tiên cái triệu chứng đầu,Vietnamese
+vi khuẩn gây ra được xử lý hiệu quả hơn nhiều nếu hệ miễn dịch của bạn đã gặp phải cùng một loại virus hoặc vi khuẩn,Vietnamese
+dịch vận hành theo cách vốn có như vậy nếu nhiễm an ủi hay vui thích có thể,Vietnamese
+chu trình trước chúng ta cũng đã chia sẻ về các bạn câu hỏi này rồi thì hôm nay thì tôi xin được là lược sơ qua là trong,Vietnamese
+khác thì có khả năng là sẽ mang cái virus sarscov2 đó đi đến những cái vùng,Vietnamese
+mức độ nhẹ kết hợp với tập thể dục thường xuyên và các phương pháp hỗ trợ,Vietnamese
+gọi là thiếu máu não thoáng qua thì như vậy thì tình trạng thiếu máu não thoáng qua cụ thể nó sẽ là giống như một tình trạng đột,Vietnamese
+thì nó có thể là do tăng các phản ứng viêm mà khi phản ứng viêm tăng lên thì,Vietnamese
+tránh những cái lo lắng căng thẳng quá này rồi là ngủ nghỉ đúng giờ chế độ ăn uống thì ăn cân đối các thành phần và,Vietnamese
+ta vẫn tiếp tục sử dụng ngâm với củ địa liền để xoa bóp các cái xương khớp như thế này đau nhức xương khớp vào cái mùa,Vietnamese
+hiện tại thì miền bắc cũng đang chuyển mùa rồi đúng không ạ thời tiết nồng ẩm thì khá là nhiều vì vậy là những cái,Vietnamese
+nhau đây chúng ta chỉ có hai nhóm chúng ta khuyến cáo ít nhất là phải mười lăm loại thực phẩm đây chúng ta chỉ có hai loại,Vietnamese
+hợp này thì làm sao cố gắng là cái giữ gìn sức khỏe này ăn ngủ nghỉ sinh hoạt điều độ này tránh những căng thẳng,Vietnamese
+khoảng tám trăm triệu còn nếu mà cũng pin không sạc thì nó khoảng sáu trăm sáu trăm năm mươi triệu,Vietnamese
+mạch máu đấy của cái động mạch và tức là khi mà cứ huyết áp nó tăng cao lên nó sẽ làm xây xước và khi xây xước thì nó làm,Vietnamese
+chuyện đấy khi chúng ta ngồi yên như thế này thì cũng là một cái lúc mà cái cơ và khớp của chúng ta nó chịu một cái lực,Vietnamese
+không dùng thuốc tất cả những cái cái hỗ trợ đó thì nó giúp ích cái hiệu quả cao nhất ngoài ra những cái cái,Vietnamese
+thuốc kháng sinh khi sinh con theo phương pháp sinh mổ và điều đó có nghĩa là tất cả trẻ sơ sinh ra đời bằng phẫu,Vietnamese
+một cái người béo phì đó khi mà họ điều,Vietnamese
+tục mời quý khán giả tại phim trường nêu câu hỏi hiện nay thì chị em phụ nữ nhuộm tóc từ,Vietnamese
+bác sĩ là liệu có trường hợp nào được,Vietnamese
+vấn đề về hành vi mà thường xuyên vật lộn với việc học tập do thiếu khả năng tập trung khi trưởng thành cô bé sẽ có,Vietnamese
+fibrin này các cái tiểu cầu hồng cầu bạch cầu nó đi nó không bám được vào thành mạch vì thành mạch nó nó trơn bóng,Vietnamese
+cho cái sụn khớp đấy chính là cái collagen tuýp 2 thì cái việc mà chúng ta phối hợp các cái thành phần như thế này vừa ph��t huy được cái tác dụng mạnh của,Vietnamese
+cũng không nên hút thuốc lá để mà chúng ta bảo vệ cái lá phổi chúng ta giúp cho,Vietnamese
+thì này bác sĩ sẽ nói nhiều hơn thì mình cũng cần thiết phải lưu ý là mình sẽ,Vietnamese
+dưỡng tức là chỉ có gạo lứt với lại muối mè thôi thì ở đây gạo lứt muối mè có tốt,Vietnamese
+các hóa chất trong môi trường tới những nguyên liệu nhất định trong thực phẩm ví dụ như đường gluten nước ví dụ như,Vietnamese
+đông trùng hạ thảo thế thì có thể nói là đông trùng hạ thảo nhiều loài lắm có tới,Vietnamese
+là tìm ra loại mầm bệnh nào mỗi chủ thể được đánh số có thể nhận diện trong khi,Vietnamese
+nhưng mà có lẽ là chúng ta cũng cần phải đi thăm khám ở những cái bác sĩ chuyên khoa sâu về các cái bệnh lý như thế này,Vietnamese
+bác sĩ và sau đây thì xin được kết nối ngắn với vị khán giả tiếp theo xin kết,Vietnamese
+hoa mắt mất ngủ tê bì chân tay và dự phòng biến chứng trên não và tim đột quỵ não đột quỵ tim suy tim dành cho những,Vietnamese
+cột sống thôi hay là còn có những cái bệnh lý khác mà chúng ta cần phải có những cái chế độ điều trị hoặc là khắc,Vietnamese
+trọng trong miễn dịch không ai thực sự biết được những hoạt động như thế nào cho đến nhà,Vietnamese
+đặc biệt là đối với các nhà sư khi mà ta lên núi người ta tu người ta dùng cái này để làm gì à bởi vì là bên cạnh những,Vietnamese
+bào để tạo ra năng lượng nhưng có lẽ bạn chưa bao giờ nghe về hệ sinh thái đa,Vietnamese
+của bạn là hệ sinh thái bên trong của nó các vi sinh vật khác nhau sống bên trong nó đặc biệt là vi khuẩn,Vietnamese
+cũng thấy rồi nguyên cái mệt mỏi về tinh thần thôi cũng đã đủ làm cho bệnh nhân rất là mệt mỏi rồi thì cái mệt mỏi đấy,Vietnamese
+của năm mươi triệu người trên thế giới đấy là cái dịch cúm a khủng khiếp nhất mà chúng,Vietnamese
+ta khô căng cứng sau rửa mặt và duy trì được cái hàng rào bảo vệ da của chúng ta với những chia sẻ vừa rồi thì chắc,Vietnamese
+tại vì cái này nó phải liên quan đến cái cái đông máu chúng ta phải khi sử dụng thuốc chống đông là chúng ta phải liên,Vietnamese
+ai mà chúng ta đang còn thắc mắc còn băn khoăn về cái đông trùng hạ thảo này thì hãy gọi trực tiếp cho chuyên gia đang có mặt tại trường quay là thạc sĩ bác sĩ,Vietnamese
+chúng không có mắt tai mũi hay răng chúng không có cách chi tim gan phổi hay,Vietnamese
+xin chào tất cả mọi người mình là bác sĩ phạm văn phúc là phó trưởng khoa hồi sức tích cực bệnh viện bệnh nhiệt đới trung ương,Vietnamese
+khi so sánh hệ vi sinh của trẻ em châu phi với của trẻ em châu âu bạn thấy có,Vietnamese
+càng bị stress và đó là một cái vòng lẩn quẩn của một cái người béo phì và cái,Vietnamese
+giống như là một cái tóm tắt lại những cái phần mà tôi nói khi người ta bị căng,Vietnamese
+tình trạng là huyết áp cao mỡ máu cao rồi những cái bệnh lý mà chúng ta khiến cho tim mạch nè chúng ta bị mất ổn định,Vietnamese
+rất là lớn đến sức khỏe của chúng ta hàng ngày vậy thì những ai mà chúng ta đang bị huyết áp cao mỡ máu cao bệnh,Vietnamese
+giai đoạn nó sẽ ngoài các triệu chứng vận động ra thì nó còn xuất hiện các triệu chứng khác với dụ như là triệu,Vietnamese
+này chỉ có những tế bào t và tế bào b không tấn công các tế bào khỏe mạnh được,Vietnamese
+là bát cháo nấu chúng ta nấu loãng chỉ ba mươi gam gạo nó đấy là một cái cách để chúng ta làm tăng đậm độ năng lượng tuy nhiên thì,Vietnamese
+cái vấn đề xạ trị ở cái phần đầu cổ này thì rất dễ làm cho bệnh nhân là khó nuốt,Vietnamese
+luôn để mình chia sẻ vào cái nhóm này cái,Vietnamese
+các chỉ thị mà hướng dẫn cho người dân nào phải thực hiện giãn cách xã hội là,Vietnamese
+vữa động mạch và giúp cải thiện các triệu chứng đau đầu chóng mặt mất ngủ tê bì chân tay dự phòng nguy cơ đột quỵ nữa,Vietnamese
+mắn là không phải tất cả các đồng nghiệp của mình với tư cách là nhà thần kinh học chúng tôi được đào tạo để tập trung,Vietnamese
+của tôi với bác sĩ ạ thì chắc chắn là nhiều người có những cái thắc mắc liên quan tới bệnh xương khớp rồi và vừa rồi,Vietnamese
+tê bì chân tay thì nó cũng là chuyện bình thường nhưng mà cái nguy hiểm ở chỗ là gì là dần theo năm tháng sẽ có lúc,Vietnamese
+nghiên cứu để đánh giá được vấn đề này một cách hiệu quả thế còn sau mười năm thì sao chúng ta thấy,Vietnamese
+lượng cuộc sống của mình tốt hơn,Vietnamese
+cho chúng ta cách tốt nhất trước ung thư cần chuẩn bị trong quá trình điều trị ung thư rất cần chuẩn bị thế và đặc biệt,Vietnamese
+của bác là não thì nó sẽ gây ra rất nhiều triệu chứng khác nhau trong đó có người thì ví dụ như bác là mất ngủ là,Vietnamese
+những có hoạt chất như tôi nó là thuộc các thành phần là sản phẩm tẩy trắng thì tôi khi là sẽ gây ra những cái người ta,Vietnamese
+cho nhờ chúng ta sẽ bị khách mời chúng ta ngày hôm nay chúng ta sẽ cùng nhau chúng ta chia sẻ rồi à chắc là chúng ta sẽ chờ cỡ,Vietnamese
+điều trị để chiến thắng chính bản thân mình giúp mình hồi phục đó là một điều rất là quan trọng vâng trong các cuộc,Vietnamese
+có được cái nhìn thấu đáo hơn và định hướng hành động cụ thể rõ ràng hơn trên,Vietnamese
+tốt rồi đó thì khi chúng ta nghĩ khoảng bốn đến năm ngày thì coi như là không còn một miếng thuốc nào trong người của,Vietnamese
+một phần nào đó quần áo không còn nuôi đồng thời là cái bị tắc nghẽn đó,Vietnamese
+trong cái viên uống đông trùng hạ thảo thì không chỉ có thành phần chính là nấm đông trùng hạ thảo mà sẽ còn rất nhiều những cái loại khác nữa những cái loại,Vietnamese
+cận với các phương pháp trị liệu của các cái bác sĩ khác là ví dụ dinh dưỡng và vật lý trị liệu cũng như là các bác sĩ,Vietnamese
+nguồn từ cái câu chuyện là gì ạ chúng ta đã có kinh nghiệm điều trị hàng ngàn năm nay rồi và chúng ta vẫn đang điều trị,Vietnamese
+nên là cái việc người bệnh phải có một cái một cái thông tin đầy đủ một cái,Vietnamese
+họ cố tình họ tránh né như vậy thì cái sự cố tình tránh né kể cả những việc đi dự tiệc rồi chẳng hạn hay là không muốn,Vietnamese
+chúng ta nó có chính là ba giai đoạn ba giai đoạn chính giai đoạn thứ nhất là giai đoạn mà phát triển hay là giai đoạn,Vietnamese
+cũng có một cái điều là cái hình thức về rối loạn điện học đó nó cũng tương đồng với cái hoạt động về cơ học của tâm nhĩ,Vietnamese
+ta thấy là trong giai đoạn này thì người người phụ nữ phải được thế nào cô qua,Vietnamese
+đến mười phần trăm cân nặng và đây là một thông tin vô cùng quan trọng vì không ít bệnh nhân béo phì đã tìm cách giảm,Vietnamese
+pin sạc đó thì người bệnh cũng như là gia đình người bệnh sẽ được hướng dẫn cũng,Vietnamese
+qua cách đi ba nước tối ưu chỉ những người chơi cờ giỏi nhất các đại kiện tướng mới thấy được chiến thắng trong ba,Vietnamese
+tạo cục máu đông nó tắt nghẽn mạch máu não nguyên nhân thứ hai,Vietnamese
+thư đây mình cân nặng chỉ là cái thước đo để chúng ta nhìn thấy thôi chứ thực ra khi chúng ta duy trì được cân nặng,Vietnamese
+đôi khi là chúng ta cần phải có tới ba tháng lận đối với những tình trạng tăng sắc tố nào mà đã diễn ra khá lâu rồi,Vietnamese
+sóc da như làm sạch nè dưỡng ẩm chống nắng có chứa niacinamide thì đều có mang,Vietnamese
+cấp cho các bác sĩ chuyên khoa để người ta hiểu cách khoảng mười phân hoặc là hai mươi phân ở,Vietnamese
+mình trước sau đó thì chúng ta sẽ sẽ trả lời cho cái câu hỏi của bác là liệu là chúng ta có nên đi lại nhiều không phải,Vietnamese
+tăng huy động tế bào tăng nhiệt độ cơ thể tăng tiêu hao năng lượng như bên cạnh đó thì cái việc mà bị ung thư thì,Vietnamese
+chính xác cũng rất là quan trọng để chúng ta có cái định hướng cũng như là có cái phác đồ điều trị một cách phù hợp,Vietnamese
+rất là vui mừng vì đã mang lại một cái sản phẩm tốt và có hiệu quả cao để hỗ trợ cho hàng triệu người bị đau cơ xương,Vietnamese
+có một cái trung tâm nào mà nghiên cứu về vấn đề này mà tôi chỉ được biết là có một số người bệnh có ra những cái trung,Vietnamese
+các chị sanh xong rồi thì cái estrogen trở về bình thường nghĩa là so với giờ,Vietnamese
+làm những cái công chuyện mà họ được giao như vậy thì sự tránh né đó chính là cái sự thiếu tự tin của họ theo các bác,Vietnamese
+quá nhiều phải không ạ bởi vì bây giờ tám mươi chúng ta là vẫn đi lại bình thường cho nên câu chuyện mà bảy mươi tuổi mà không đi,Vietnamese
+thường thì các cái nhân viên y tế cũng sẽ mang rất là nhiều găng tay và và khi mà,Vietnamese
+nhân không có những cái vấn đề bệnh lý da đi kèm khác thì chúng tôi xác định đó là một các tình trạng da nguyên phát,Vietnamese
+kết nối với thứ gì đó không có trong cơ thể trước đó nó kích hoạt tế bào miễn dịch sau đó trực tiếp tiêu diệt mầm bệnh,Vietnamese
+việc hỗ trợ tâm lý trong quá trình quản lý cân nặng đó thì sau khi phẫu thuật hoặc là cái dùng thuốc theo các,Vietnamese
+thì phải ra cái chỉ định để điều trị phòng ngừa có những người không phải tất cả mọi,Vietnamese
+cải thiện giúp cải thiện các triệu chứng này khoảng năm mươi đến sáu mươi phần trăm các,Vietnamese
+thì ảnh hưởng đến cái hiệu quả làm việc của họ à nó có những cái khó khăn trong các,Vietnamese
+điều trị về mặt chức năng như là phẫu thuật kích thích não sâu này thì cái nhóm điều trị còn gọi là cái team,Vietnamese
+trạng xơ vữa những cái thiểu năng vạch để cải thiện cái sức khỏe cho mình thì bác nên sử dụng thêm các cái sản phẩm có,Vietnamese
+thứ hai nữa là đến cái câu hỏi của khán giả thì chúng ta thấy rằng là với các cái biểu hiện đau lưng như là trong cái,Vietnamese
+tiếp xúc với lại cái vùng từ trường cao là hạn chế tại vì nó sẽ làm sai lệch đi,Vietnamese
+điều chỉnh phù hợp là rất là quan trọng để thứ nhất là xem bây giờ mức độ nó đến đâu rồi nó đã tiến triển đến đâu rồi đấy,Vietnamese
+chưa biết là huyết áp của bác thế nào mỡ máu ra sao có đái tháo đường không nhưng mà khi chúng ta bị tai biến một lần thì,Vietnamese
+chịu được phẫu thuật thì bệnh nhân cũng phải đủ sức để mà có thể chịu đựng được một cuộc gây mê hoặc là chịu được để mà,Vietnamese
+gọi là lợi bất cập hại tức là đôi khi lại lợi thì chưa thấy nhưng mà lại làm tổn thương da nhiều hơn và khi đó thì,Vietnamese
+rối loạn chuyển hóa bao gồm bệnh tiểu đường và béo phì những yếu tố ảnh hưởng đến sức khỏe não bộ lâu dài tôi sẽ mô tả,Vietnamese
+đích ăn nhiều để làm năng lượng nó nó tăng lên để mà làm nóng cơ thể cho nên là,Vietnamese
+tình trạng dinh dưỡng tốt thì liên quan rất nhiều đến vấn đề là hóa trị cũng không được xạ trị cũng được và rất nhiều,Vietnamese
+tăng cường hoặc ức chế trong một số trường hợp hoạt động của hệ miễn dịch,Vietnamese
+trong đó thì là có cái chẩn đoán cho chị là kiểu thiếu máu cơ tim vâng đây nó chính là những cái tình trạng là thiếu máu của,Vietnamese
+vì nó kết hợp cả rối loạn mỡ máu nữa thì và làm cho các dấu hiệu này thì bác biết là trong cái bệnh lý của mình có hai cái,Vietnamese
+chương trình là cam kết hoàn lại một trăm phần trăm tiền cho người bệnh nếu như mà sau hai tháng sử dụng mà tình trạng đau nhức,Vietnamese
+quy tắc cho giải thưởng nobel nói rằng nó không thể được trao tặng sau khi chủ nhân công trình nghiên cứu đã chết cáo,Vietnamese
+luôn bên cạnh đó thì cái việc mà điều trị bệnh lý đái tháo đường ở ở bệnh nhân,Vietnamese
+với bác sĩ ngày hôm nay rồi và ngày hôm nay thì chúng tôi đã có rất là nhiều vị khán giả nhận được sự kết nối trực tiếp từ bác sĩ và rất mong là với những tư,Vietnamese
+đông thì một những cái mình e ngại nhất sẽ là các biến chứng xuất huyết thì mình dùng thuốc mình mong muốn của mình,Vietnamese
+những yếu tố nguyên nhân mà có thể gây rung nhĩ ví dụ chúng ta tăng huyết áp và chúng ta không khống chế thì nó sẽ,Vietnamese
+cái người thân của chúng ta là người lớn tuổi là người có bệnh nền thì càng phải thận trọng hơn khi mà chúng ta là đi ra,Vietnamese
+phẩm ngoài thị trường và vừa rồi thì bác sĩ đã nói rất cụ thể rồi một viên nang đông trùng hạ thảo nó chứa được cái hàm,Vietnamese
+tại sao tim bạn có thể đập mạnh trước khi chuẩn bị chạy trốn khỏi tên trộm cũng như khi bạn bước vào văn phòng của,Vietnamese
+và khả năng của nó trong vấn đề là dự,Vietnamese
+là cái mà rất có ích cho sức khỏe chung của chúng ta cũng như các bệnh lý tim mạch về thần kinh đặc biệt ở những người,Vietnamese
+năm đầy sức sống và lợi ích không dừng lại ở đó tri thức mới này có thể giúp,Vietnamese
+ta cũng cần phải nhớ rằng là nhiều khi chúng ta không phải mổ không có nghĩa là não của chúng ta không bị làm sao cả đấy,Vietnamese
+điểm mốc thấp hơn mặc dù có thể có một số sự khác nhau nhưng nhìn chung điểm,Vietnamese
+tiết ra một số cái cái chất ta gọi các cái nội tiết và các cái chất này nó sẽ,Vietnamese
+cho da vân vân thường nó là một số bạn sẽ thích chọn những cái sản phẩm sữa rửa,Vietnamese
+não nó có khả năng hồi phục trở lại gần như ban đầu về cái việc mà mình điều trị nó như thế,Vietnamese
+nào là đông trùng hạ thảo công dụng của nó ra sao đặc biệt là chúng ta có kiến,Vietnamese
+hạ thảo chính là bộ ba là adenosine cordycepin và polysaccharide adenosine nó là,Vietnamese
+trùng hạ thảo trên môi trường nhộng tằm cũng như gạo lứt thì có thể nói rằng là người dân việt nam chúng ta mặc dù thu,Vietnamese
+nặng mà là cải thiện cái chất lượng cuộc sống bao gồm cái sức khỏe thể chất tinh thần và xã hội để giúp cho họ có thể,Vietnamese
+một đến về lâu dài thì nó lại thành một cái vấn đề lớn vậy thì đó là lời khuyên,Vietnamese
+soát cái cân bằng giữa cái nhu cầu và cái mức độ thỏa mãn thì cái stress nó sẽ được ổn,Vietnamese
+những cái hậu quả những cái di chứng của bệnh lý này bởi vậy bên cạnh cái việc mà,Vietnamese
+lý tim mạch thường xuyên tái phát các triệu chứng đau đầu hoa mắt chóng mặt xây xẩm mất ngủ tê bì chân tay hoặc khó,Vietnamese
+giận nó hay đau đau cả cả ngày đêm nhưng,Vietnamese
+để làm nói như vậy có nghĩa là ở đây phải có sự phối hợp giữa bác sĩ lão khoa bác sĩ tim mạch bác sĩ về thần kinh về,Vietnamese
+trước ngực ngay chỗ cục pin của người bệnh và sẽ điều chỉnh các cái thông số cài đặt các thông số về cường độ kích,Vietnamese
+đó thì cái việc mà điều trị dinh dưỡng và vật liệu thể lực thì nội khoa thì các,Vietnamese
+cơ thể khi chúng liên tục được tiết ra mỗi nhóm lớn vi khuẩn đường ruột gồm nhiều chủng khác nhau và mỗi chúng này,Vietnamese
+cứu chỉ ra rằng là chúng ta chỉ nên bổ sung dinh dưỡng vào trước và trong giai đoạn điều trị ung thư thôi còn sau khi,Vietnamese
+cũng như là những người chăm sóc ngoài các phương pháp điều trị kể trên ví dụ,Vietnamese
+ngày hôm nay những ai chúng ta đang bị mỡ máu cao huyết áp cao những bệnh lý về tim mạch sẽ là những người rất quan tâm,Vietnamese
+thuốc điều trị về tim mạch nhưng mà giờ hết thuốc rồi thì có nên tiếp tục dùng,Vietnamese
+nhiễm nấm cơ hội hoặc vi khuẩn xâm nhập vào vết cắt hoặc vết thương thường được,Vietnamese
+sinh thực sự bắt đầu từ đó hãy theo dõi để biết thêm thông tin về chủ đề này tư,Vietnamese
+vị có thể ung thư không đồng nghĩa với là ung thư là hết hoặc là ung thư đồng nghĩa với là chết thì thực sự không phải,Vietnamese
+về thứ khoa học mới tuyệt vời này và cách bạn có thể tận dụng nó cho sức khỏe của chính,Vietnamese
+trình đang xảy ra ngay bên trong bạn ruột của bạn có hệ miễn dịch của riêng nó đó là mô bạch huyết liên quan đến,Vietnamese
+không không vấn đề gì tôi cứ tự nhiên đang nằm đang truyền thuốc cái này,Vietnamese
+số người mà không tìm ra nguyên nhân đó thì nó cao hay thấp nó tùy thuộc vào cái phương tiện kỹ thuật của bệnh viện đó,Vietnamese
+trong những năm khoảng hai lẻ ba hai lẻ tư đã có những cái nghiên cứu trên người ở pha ba,Vietnamese
+chỗ này là nó ngấm từ từ từ chứ nó không đến một cách trực tiếp được thì chính vì vậy cho nên là rõ ràng là nếu mà mạch,Vietnamese
+thiếu máu là cái dạng và phổ biến nhất là chiếm từ tám mươi đến tám lăm phần trăm cả trường hợp thì các bác sĩ chúng tôi sẽ đánh giá,Vietnamese
+pin có thể xin được cảm ơn bác sĩ và để hiểu rõ hơn về phương pháp này bác sĩ có,Vietnamese
+ta muốn mua cái gì để mua nhưng mà chúng ta phải có hệ thống kiểm nghiệm và hệ thống kiểm đó là được tiến hành bởi gì,Vietnamese
+những cái vitamin mà liên quan rất nhiều đến cái việc mà bớt đi các gốc tự do và chính từ đấy nó có thể dần dần,Vietnamese
+sung toner hay cái serum trong các chương trình chăm sóc da thì bạn nên ưu tiên chọn lựa là bổ sung serum nhưng mà,Vietnamese
+của một hệ miễn dịch khỏe mạnh một yếu tố quan trọng trong việc thiết lập điểm mốc cho chứng viêm có thể là phương pháp,Vietnamese
+chúng ta kiểm tra không thấy gì nhưng mà không có nghĩa rằng không có chuyện gì xảy ra hai chuyện này nó hoàn toàn là,Vietnamese
+thì chứa trong đó là cả một cái buồng máu nhưng mà cơ tim không nhận ở cung cấp máu từ ở các buồng máu đó mà nó,Vietnamese
+đó có cái chuyện liên quan lão hóa về các mạch máu mà đặc biệt là những mạch,Vietnamese
+thời gian ấy lúc mà nó không hồi phục đã phí lãng phí một khoảng thời gian rất là lớn đó và đã cũng lưu ý là,Vietnamese
+cho cái tình trạng xơ vữa động mạch vành và đây đã là một cái tình trạng thiếu máu cơ tim và những cái nguy cơ mà,Vietnamese
+khác đi kèm theo cái gì viêm da cơ địa hoặc là vẩy nến hoặc là viêm da tiết bã chúng,Vietnamese
+đưa về hba1c về bình thường rồi á thì chúng ta có thể duy trì một liều là hai,Vietnamese
+trình điều trị bằng phẫu thuật và hóa trị hiện tại bố em ăn bị đau loét miệng ăn vào là nôn lúc nào cũng cảm thấy vị,Vietnamese
+hàm lượng cordycepin cao thì nó mới có là tác dụng tốt cho sức khỏe của chúng ta vậy thì bác sĩ có thể chi biết cho,Vietnamese
+hưởng đến việc tiêu hóa và đồng hóa các chất dinh dưỡng từ thức ăn ăn vào điều đó cũng làm cho bệnh nhân sụt cân một điểm,Vietnamese
+việt nam tại sao lại như vậy bởi vì chúng ta biết cái nấm màu tủ hay còn gọi,Vietnamese
+kiểm sát phải xét nghiệm thường xuyên rồi tùy theo cái cái giá trị đó phải,Vietnamese
+nhiều sức khỏe vâng mỗi người thì lại có một cái vấn đề khác nhau tuy nhiên thì bệnh xương khớp,Vietnamese
+kháng uống vâng khoảng nửa năm trở lại đây thì hay bị đau đầu khó thở khó khó,Vietnamese
+bệnh viêm khớp thoái hóa khớp và rất nhiều các cái bệnh lý khác thì chúng tôi có rất là nhiều các cái nhóm thuốc khác nhau và nó có những cái cơ chế khác nhau,Vietnamese
+là triệu chứng run nghiên cứu đã cho thấy là hiệu quả của việc cải thiện,Vietnamese
+sức miễn dịch kể cả miễn dịch dịch thể cũng như là miễn dịch về tế bào nâng cao,Vietnamese
+lâu dài một cách an toàn thì đấy là những cái biện pháp những cái lời khuyên đầu tiên là bác nên có thể áp dụng cho,Vietnamese
+thành phần là yếu tố giữ ẩm tự nhiên có trong các tế bào sừng nó cũng giảm số lượng đi và có một điều đó là liên kết,Vietnamese
+theo quy bạch thượng thế thì và một vị đan sâm nó đã có thể thay thế được cả một cái bài thuốc điều huyết hoạt huyết xưa kia của cha ông ta rồi vâng thế và,Vietnamese
+có cây chỉ dùng vỏ thân thôi và có cây chỉ dùng rễ thôi vâng tôi cũng chả hiểu,Vietnamese
+tâm lý người bệnh có thể liên hệ ai ở đâu và thưa quý vị để nhận được sự hỗ trợ chuyên sâu và đáng tin cậy về tâm lý,Vietnamese
+thể khác để ký sinh vào cụ thể là con người chúng ta và nó được mang đi cũng bởi con người của chúng ta khi mà chúng,Vietnamese
+rất mong bác nghe theo những tư vấn của chương trình và tìm đến cái viên nang đông trùng hạ thảo càng sớm càng tốt ạ,Vietnamese
+có mỗi thượng thận đâu mà bản thân cái thận nó cũng sẽ suy nốt cho nên là cái việc mà chúng ta theo dõi sát là một và,Vietnamese
+lập chương trình sau phẫu thuật kích thích nào sau là gì và người bệnh cần phải chuẩn bị những gì ạ chúng tôi xin,Vietnamese
+về bên chuyên chuyên môn chúng tôi thì có bác sĩ thần kinh bác sĩ về bệnh,Vietnamese
+một cái quá trình điều trị một cách phù hợp với cái độ tuổi như thế này với cái biểu hiện như anh mô tả đấy thì chúng,Vietnamese
+tật thì vẫn còn mang cho nên họ rất là phiền ở đó có buồn họ rất là chán nản họ,Vietnamese
+ta sẽ biết là thay đổi thói quen là khó nhưng mà chúng ta cố gắng lên thì chúng ta sẽ dần dần cái cung và cái nhu cầu,Vietnamese
+quan trọng bởi chúng kích hoạt nhánh bẩm sinh của hệ miễn dịch kết quả là thay vì,Vietnamese
+còn phải cam kết giữ cân nặng đó là một chuyện và đồng thời là giữ cho cái người,Vietnamese
+vì là thứ nhất là mình đã có một số những các cái dấu hiệu mà nó liên quan đến những các cái động mạch những cái,Vietnamese
+kín đáp ứng trọn vẹn được mục tiêu hỗ trợ điều trị bệnh xương khớp là giảm đau chống viêm và phục hồi sụn khớp thoái,Vietnamese
+ngực hồi hộp này trống ngực này và ngủ kém thì đây mới là những cái dấu hiệu mà của những các cái về huyết áp của mình,Vietnamese
+sự từ chối hoặc là tức là hẹn là từ từ rồi sẽ mới đi thế thì tại sao những bệnh,Vietnamese
+thầm lặng trong sức khỏe của bạn và chúng là người điều khiển sinh lý của bạn theo những cách mà bạn có lẽ không,Vietnamese
+cái lưu ý đó mà tôi nghĩ là quý vị khán giả cũng nên để cái là một cái quy trình,Vietnamese
+miễn dịch của ruồi giấm dẫn câu hỏi đầu tiên hóa ra khá dễ trả lời các loại phân tử,Vietnamese
+quốc ấn độ và một số nước châu phi từ lâu trước khi có bất kỳ thủ thuật y khoa nào,Vietnamese
+lý nó rất là rộng rãi trong đó thì nó có thể nói rằng là tác động đến toàn bộ các,Vietnamese
+một sự kết hợp rất hài hòa rất khoa học và rất thông thái giữa vấn đề ra gì dùng,Vietnamese
+nếu mà suy giãn tĩnh mạch nông thì nó sẽ nổi như là con giun ấy ở ngay sau cái cẳng chân của chúng ta nếu mà sâu thì,Vietnamese
+sau khi có sự can thiệp sâu của y học và tiếp tục duy trì cái động lực thay đổi,Vietnamese
+chúng ta cần phải nhận ra rằng có một đại dịch mà rõ ràng là bị ảnh hưởng bởi những thay đổi về môi trường và xã hội,Vietnamese
+điều trị thời ban đầu và sau này khi mà nó muộn rồi cột sống nó dính rồi thì chúng ta lại không thể làm thế nào mà nó,Vietnamese
+biệt là trong cái trong cái bối cảnh là chúng ta cần phải cấp cứu nhanh chóng kịp thời đối với trường hợp đột quỵ thì,Vietnamese
+một số các cái bệnh lý đi kèm ví dụ cái viêm da tiết bã nhờn trên da tăng tiết,Vietnamese
+thành phần hầu như rất là lành tính nếu như mà chúng ta sẽ dụng đúng cách chỉ định,Vietnamese
+trở nên rất là rõ ràng lời khuyên chúng tôi đầu tiên việc số một là gì ạ là bác nên thăm khám để đánh giá một cách chính,Vietnamese
+máu liên quan đến vấn đề nuôi dưỡng não và nuôi dưỡng tim bệnh nhân của chúng ta thì đã bị vữa xơ động mạch cho nên có thể,Vietnamese
+nó cũng rất dễ ảnh hưởng đến cái gót chân và cái thứ hai nữa là các cái dây chằng cũng như là các cái gân ở cái vùng,Vietnamese
+sẽ phải chịu cố định nằm một chỗ với cái khung định vị gắn chặt vào không đầu,Vietnamese
+người ta nói ủa sao mà mày lại không được như như cái người kia hay là không được như những hình mẫu như vậy cho nên,Vietnamese
+liên quan rất nhiều đến sự sống còn của bệnh nhân bởi vì chúng ta biết rằng dinh dưỡng thì không phải là quyết định trong,Vietnamese
+nhưng mà bát cháo ấy chúng ta có thể cho dầu một bát cháo một cái chén con này chúng ta có thể cho tới mười mililit dầu cho một,Vietnamese
+và nó còn có cái cái chiều hướng là nó sẽ cải thiện rất tốt nữa thế nên là bác hoàn toàn có thể yên tâm kết hợp sử dụng,Vietnamese
+xin điều trị có nghĩa là bị dại mà không,Vietnamese
+vì những cái rủi ro về xuất huyết rủi ro về động kinh rủi ro về nhiễm trùng thì mình đều xử lý được hết và tỷ lệ,Vietnamese
+trong số đó phản ánh những ca tử vong do sa sút trí tuệ và mỹ dẫn đầu trên thực,Vietnamese
+sinh vật đường ruột rất dễ phục hồi chức năng các nguyên tắc nêu trong cuốn sách này sẽ thay đổi hệ sinh thái bên trong cơ,Vietnamese
+thì có thể chia sẻ một chút được không ạ về cúm thì nó có rất là nhiều ít và dựa,Vietnamese
+không được nghỉ ngơi chính vì vậy cho nên là cái lời khuyên của chúng ta trong trường hợp này thì khi mà chúng ta làm,Vietnamese
+quy huyết áp cứ một trăm bảy mươi một trăm tám mươi là nguy cơ bị tai biến rất cao có thể một vài lần đầu,Vietnamese
+loét miệng như vậy thì khi mình cho thức ăn vào rất dễ bị xót bị xót bị đau thế,Vietnamese
+ta mà còn thắc mắc cũng như là cũng như là chúng ta bị mắc cái tình trạng về huyết áp cao mỡ máu cao lâu năm th��,Vietnamese
+cái việc là chúng ta bị gặp phải cái tình trạng là đau đầu hoa mắt chóng mặt nè rồi đôi khi là chúng ta còn phải gặp,Vietnamese
+nói chung cũng như hoạt động và bảo vệ não bộ nói riêng mặc dù probiotic lợi khuẩn hiện đã trở,Vietnamese
+chóng mặt luôn và thậm chí đã bị trẻ hóa cho nên rằng là mà hai nữa là đi cùng,Vietnamese
+ra là chúng ta bước vào cái quá trình lão hóa nó tiến triển rất nhanh mà trong,Vietnamese
+trong cộng đồng đặc biệt là một trường,Vietnamese
+bình thường nữa làm cho chúng ta luôn luôn cảm thấy khô miệng rồi những cái quá trình xạ trị đó tác động lên cái gai,Vietnamese
+động mạch vành ấy thì nó sẽ làm cho mình là thiếu máu ở cơ tim và khi thiếu máu cơ tim thì nó dễ gây nên những cái rối,Vietnamese
+là như vậy nói cách khác có một giá trị to lớn trong tình trạng không vệ sinh,Vietnamese
+cái phương thức mà có thể làm chậm đi tiến triển của bệnh cũng như là có thể,Vietnamese
+sao mà nó không có đi tới đâu chắc là thôi rồi mình thấy mình béo phì vậy rồi,Vietnamese
+rung nhĩ hay không xin thưa với các bạn rằng là khi mà chúng ta điều trị cắt đốt thành công đó thì nó trở về nhịp,Vietnamese
+một số những cái đặc điểm của một người mất tự tin thì mình có thể dễ thấy và,Vietnamese
+có khuyến cáo cho cái việc mở ứng dụng các phương pháp này mà chỉ là ở tại các trung tâm nghiên cứu do đó khi mà chúng,Vietnamese
+thứ hai cần để bắt đầu một đáp ứng miễn dịch một tín hiệu thứ hai có thể được cung cấp,Vietnamese
+là chúng ta bị những cái bệnh lý về mặt thần kinh chúng ta bị lú lẫn hay quên sa sút trí tuệ mất ngủ aizheimer thì quý vị,Vietnamese
+vâng ạ vâng vâng xin chào bác vâng bác hỏi cho bác trai nhà mình năm nay sáu mươi hai,Vietnamese
+đến cái nhu cầu mà cái nhu cầu ấy là nhu cầu khi chúng ta bị ung thư trước điều trị ung thư thì cái nhu cầu nó khác,Vietnamese
+hướng về ánh mặt trời này ví dụ như thế rồi là chúng ta nói là vượt lên số phận này hoặc là chúng ta có thể nói cái là,Vietnamese
+thường hay sinh mổ hình thành nên có nguy cơ về sức khỏe trong suốt cuộc đời của một người nhiều nghiên cứu nổi tiếng,Vietnamese
+có nguy cơ là bị ung thư da mà kích ứng da rất là nặng thì đối nghịch với lại cái khái niệm về tẩy trắng đó là sẽ khái,Vietnamese
+là những cái người cao tuổi thì nó mới dễ đau nhức xương khớp hoặc là khi mà thay đổi thời tiết như thế này thì nó,Vietnamese
+cũng có thể dẫn đến thừa cân béo phì thiếu bây giờ cũ lại không có lợi cho sức khỏe cho nên chúng ta nguyên tắc thứ,Vietnamese
+parkinson ngoài ra còn có điều dưỡng chuyên về bệnh parkinson sẽ cũng sẽ giúp ích hỗ trợ cho cái việc mà lập chương,Vietnamese
+lại về cái thời gian cái thời gian rất là quan trọng bởi chúng ta biết là dục tóc thì bất đạt chúng ta nên nhớ là chúng ta sử,Vietnamese
+đối với cái hormone tuyến giáp được tốt hơn nó xảy ra làm giúp cho cái việc duy trì các hoạt động của các,Vietnamese
+khám bệnh thì là cái phát hiện ra tôi bị bệnh tim ạ thế hôm qua là tôi ngồi tôi nghe chương trình nói hay quá thì,Vietnamese
+là quan trọng khi mà bệnh nhân bước vào cuộc mổ thì cái việc đầu tiên đối với cái việc đặt điện cực kích thích não sâu dbs này thì,Vietnamese
+điều trị phẫu thuật dành cho những bệnh nhân mà có chỉ số khối cơ thể là cao kèm theo có các với bệnh đồng mắc,Vietnamese
+ngoại hình rồi ảnh hưởng đến các chức năng vận động của cơ thể vận động khó khăn cho nên là họ có thể là có những,Vietnamese
+ích và cái thứ hai cái thứ ba nữa là các bác hoặc là các anh chị em phụ nữ thì chúng ta có thể sử dụng các cái khăn để,Vietnamese
+có thể là giúp điều trị các sắc tố nhanh hơn đẩy nhanh với quá trình dọn dẹp với,Vietnamese
+lên tắc các mạch máu não thì như vậy thì phòng ngừa các biến chứng này thì chúng ta làm sao để cho cái cục máu đông,Vietnamese
+tục ví dụ như là về những cái bài tập ví dụ như những cái hỗ trợ về điều trị,Vietnamese
+đáng kể đến việc chủng ngừa một lời nhắc nhở rằng các nhà lãnh đạo cấp cao hoặc,Vietnamese
+vắcxin dại rất rất là có hiệu quả,Vietnamese
+cực vào ở điện cực này nó có bốn cái điểm tiếp xúc vì sao như vậy vì là nó có trải,Vietnamese
+mươi lăm tuổi tại sao khi chúng ta già đi sự phòng vệ của chúng ta chống lại nhiễm trùng ngày càng yếu hơn,Vietnamese
+trị chưa hiện nay chưa có cái phương pháp nào điều trị khỏi mà chỉ là điều trị để giúp cho mình đưa cái con số,Vietnamese
+ảnh hưởng của môi trường sống đến tâm lý của người bệnh béo phì cái điều này đây là một cái điều rất là hay thì cái môi,Vietnamese
+được cải thiện rất là nhiều cho nên cái chuyện mà chúng ta tiếp cận và tìm hiểu,Vietnamese
+ung thư cái cái vị giác nó lại bị thay đổi nữa thì thực sự là rất là khó nhưng,Vietnamese
+thần kinh cao cấp đó là những những cái trách nhiệm về tâm lý những được được,Vietnamese
+dây thần kinh và mạch máu khi đi xuống cái bàn tay nó sẽ đi qua cái vùng cổ tay như thế này và nếu mà cái chỗ này nó bị,Vietnamese
+đơn giản là mình chỉ cần giảm lo âu thôi phối hợp chung với lại cái cái cái trị,Vietnamese
+có thể là tận hưởng được một cách trọn vẹn nhất cái lộ trình điều trị ung thư mà bác sĩ đã chỉ định cho chúng ta để,Vietnamese
+tổn thương và khó liền hơn vết thương thương ở miệng cho nên mình cung cấp đủ nước cho ông cũng rất là rất là quan,Vietnamese
+thuốc tây thuốc bắc thuốc các thảo dược và vân vân đó khi chúng ta cũng,Vietnamese
+thiệp khác như là điều trị gen hay là điều trị tế bào gốc cũng đã được nghiên cứu và được ứng dụng thành công cho,Vietnamese
+thái nguyên ạ vâng cháu thì trước kia cháu không đi khám bệnh mấy lần rồi thì cháu cũng bị,Vietnamese
+tóc chúng ta sẽ dài và mượt và trong đó có một giai đoạn chuyển tiếp rồi đến,Vietnamese
+vị với những ai mà đã mắc phải các bệnh lý nền mãn tính như là huyết áp cao mỡ máu cao tim mạch thì cái nguy cơ cao,Vietnamese
+khám cho quý vị và các bạn để xem là quý vị và các bạn chúng ta nên sử dụng đông trùng hạ thảo như thế nào cho hợp lý,Vietnamese
+tổng đài này thì sẽ có cơ hội nhận được ưu đãi của chương trình vâng và sẽ quay trở lại với chương trình của chúng ta,Vietnamese
+xanh hoa quả tươi không ăn các cái đồ mỡ không lạm dụng không uống rượu bia cũng như là không hút thuốc lá và vận động,Vietnamese
+tuệ tôi xin nói rõ mổ lấy thai có tác dụng cứu mạng người và cần thiết về mặt y tế,Vietnamese
+như trị liệu về trầm cảm bằng thuốc này kia chẳng hạn hay là trị liệu các cái rối,Vietnamese
+là nhiều loại thuốc một điểm nữa là khi mà chúng ta càng lớn tuổi lên thì các cơ quan các chức năng trong cơ thể chúng ta,Vietnamese
+những cái nhân mà mình dự kiến mà mình sẽ đặt vào và cái ngày phẫu thuật thì đương,Vietnamese
+đoán chính xác là bệnh lý này của chúng ta là đã bị thoái hóa khớp hay chưa thoái hóa ở mức độ nào bệnh nguyên nhân,Vietnamese
+thực phẩm mà từ cá từ thủy hải sản thì có nhiều omega3 rất là tốt thế còn là,Vietnamese
+bào thần kinh nó mất dần đi kể từ năm ba mươi tuổi thì mỗi ngày chúng ta mất đi ba nghìn,Vietnamese
+thường được do đó thì dù không không chữa lành bệnh nhưng mà phẫu thuật kích thích,Vietnamese
+khó để mà có thể chống chọi lại với những tác nhân bên ngoài cụ thể như là tia uv nè hoặc là những cái vi sinh vật,Vietnamese
+cho họ như thế nào và tại khoa thì cũng có những cái ưu điểm gì nổi bật trong việc chăm sóc cũng như là làm đẹp dành,Vietnamese
+lên một cơn tăng huyết áp là đột phát thì nó làm cho,Vietnamese
+máu làm vỡ xơ động mạch ví dụ như là rối loạn nhịp tim suy tim vân vân và vân vân thế thì tác dụng của nó cụ thể như thế,Vietnamese
+chưa mạch máu của chúng ta vấn đề gì chưa tim của chúng ta có vấn đề chưa hoặc là chúng ta có cần có những cái,Vietnamese
+tiếng một tiếng rồi thật nó hồi phục hiện đã gọi là thiếu máu não thoáng qua còn nếu nó xảy ra nó không,Vietnamese
+điểm mà mình thấy dễ dễ dàng nhận diện sau đây đó là mỗi người đang bình thường vui vẻ vậy tự nhiên người ta lúc,Vietnamese
+tôi cũng có nói là mình nó ám thị rồi nó kỳ thị nó cho rằng cái người béo phì,Vietnamese
+trung niên có những người thanh niên đã có những cái dấu hiệu như vậy rồi có nghĩa là khi mà thay đổi thời tiết được,Vietnamese
+bào t hoặc tế bào b gắn với một cái gì đó thì cái đó phải là một phân tử không,Vietnamese
+đẹp đây vân vân thì họ cố gắng họ tìm kiếm để họ làm thử được hay không và khi họ làm như vậy mà không có đạt theo,Vietnamese
+hầu có thể giúp được các quý vị chúng ta bệnh lý về tim mạch bệnh lý thần kinh chúng ta có thêm một thứ vũ khí có thêm,Vietnamese
+và vi khuẩn nguy hiểm có thể làm cho bạn bị bệnh cần phải được xử lý nhận thức,Vietnamese
+nguy hiểm cho não và tim phải kể đến như là đột quỵ não đột quỵ tim hay là suy tim vì vậy ngoài chế độ ăn uống sinh,Vietnamese
+đỉnh điểm vào buổi tối và ở mức thấp nhất vào buổi sáng có nhiều thay đổi xảy,Vietnamese
+có thể nói là chương trình đã hiểu và rất là thông cảm với những cái tình cảnh,Vietnamese
+đó thì chúng ta cũng chưa dám mà nhưng cái thuốc kháng đông chúng ta uống đâu,Vietnamese
+của chúng ta thế thì ở đây cũng phải nói với bác cũng như là các quý vị khán giả rằng là như phần đầu chương trình đã nói,Vietnamese
+thì bớt đi cái khao khát thèm vị mặn của người bệnh nhân ung thư và điều quan,Vietnamese
+trình mà nó ảnh hưởng không phải chỉ có mỗi gãy xương mà nó còn có những cái vi gãy xương có nghĩa là gãy xương rất là,Vietnamese
+trì phải có thời gian ví dụ như viên nang đông trùng hạ thảo thì ít nhất là chúng ta phải sử dụng từ ba tháng trở lên,Vietnamese
+hương liệu và đáp án d chính là tất cả các ý trên hai phút bắt đầu,Vietnamese
+xác và nó hoàn chỉnh theo cái chỉ định về mặt chuyên môn một lần nữa xin cảm ơn,Vietnamese
+miễn dịch rõ ràng cần phải làm nhiều hơn là chỉ đơn thuần phản ứng lại với những thứ chưa từng có trong cơ thể trước đây,Vietnamese
+bụng mẹ một môi trường tương đối vô trùng tôi hi vọng quan niệm này sẽ sớm bị thách thức,Vietnamese
+tôi về cái vấn đề liên quan tới phẫu thuật kích thích não sâu tôi hiểu rằng là,Vietnamese
+giúp giảm bớt các triệu chứng và cải thiện được chất lượng cuộc sống hàng ngày của người bệnh vậy cụ thể thì các,Vietnamese
+người chuyên về các ca sinh có nguy cơ cao đồng ý rằng chỉ một phần nhỏ các ca sinh nở cần được thực hiện bằng phẫu,Vietnamese
+lại là ngày hôm nay chúng tôi sẽ tư vấn giúp cho quý vị và các bạn những ai đang gặp phải bệnh lý về tim mạch nè về huyết,Vietnamese
+thể gặp ngay cái thời gian người ta gọi là tiểu phẫu tức là trong những cái ngày đầu tiên của cuộc mổ nếu mà sau đó mà nó,Vietnamese
+có thể làm cho bố đỡ mệt hơn chỉ có ăn mới làm cho bố được tăng cân tốt hơn,Vietnamese
+trước đây thì tôi bị đau cái phần thắt lưng rất là khó chịu đặc biệt là mấy hôm trời mưa như là mấy hôm trước ạ thì lưng,Vietnamese
+sẽ bớt sinh ra các tế bào ung thư cho nên là việc mà sử dụng kẽm với lại,Vietnamese
+duy trì được cái chuyển hóa bình thường mục đích thứ ba là làm sao giúp cho người bệnh đặc biệt là duy trì được cân nặng để chống cái suy mòn trong ung,Vietnamese
+vi sinh vật khi nói đến điểm mốc tôi đang đề cập đến mức độ viêm trung bình,Vietnamese
+dành cho khán giả để có thể khắc phục được tình trạng khi mà thời tiết chuyển mùa không ạ rất là cảm ơn cái câu hỏi,Vietnamese
+xưa thì các cụ là dùng toàn thể hoặc có thể dùng vỏ quả thể nhưng mà cho đến hiện nay khi mà nghiên cứu các thành,Vietnamese
+để mà quản lý cái stress như nãy mình nói là cái stress nó có thể đưa đến lo âu có thể,Vietnamese
+ta xưa kia đó là bài tứ vật tứ vật gồm có là thuộc địa này rồi là xuyên khung,Vietnamese
+thì nó lại không gây tình trạng mệt mỏi mà thậm chí nó lại còn gì là cho chúng,Vietnamese
+phẩm mà dưỡng sáng cho các làn da có mụn ẩn thì chúng ta nên chọn lựa những cái sản phẩm mà có kết cấu thoáng,Vietnamese
+một đội sẽ có mặt là mọi người làm công việc của mình để đánh giá nhanh nhất tại về thời,Vietnamese
+cũng phải cố gắng lên một chút thì chúng ta mới dần dần cải thiện được sức khỏe mà có cải thiện sức khỏe thì chúng ta,Vietnamese
+cái người bệnh béo phì với một cái chất lượng cuộc sống tốt hơn về mặt sức khỏe,Vietnamese
+một người phiến diện thì có thể là sẽ không được các kết quả toàn diện thì tôi nghĩ là phải khám được nhiều chuyên khoa,Vietnamese
+là phải chẩn đoán đúng nó là bệnh parkinson thật sự tại vì có một số trường hợp người bệnh tới chúng tôi để,Vietnamese
+prozac và zoloft nằm trong số những loại thuốc được kê đơn thường xuyên nhất trên toàn quốc xin lưu ý với bạn những loại,Vietnamese
+nó thiếu như nào hệ xương của chúng ta nó bị loãng xương như thế nào để có bác sĩ có cái biện pháp là cho thuốc một,Vietnamese
+những cái lo lắng từ phía người dân và tự người dân cảm thấy rằng cần phải đi xét nghiệm sarscov2 làm cho cái mật,Vietnamese
+trình trước khi điều trị trong khi điều trị và ngay cả sau khi điều trị cũng là,Vietnamese
+học nào khác từ cấu trúc bên trong của các nguyên tử đến sự ra đời của các vì,Vietnamese
+huyết áp là bác vẫn bác trai vẫn thường xuyên duy trì này rồi là các tất cả các cái thuốc điều trị của các bác sĩ là bác,Vietnamese
+là có thể bây giờ thì mình cũng chưa biết được nhưng mà có thể là đấy là những cái tác nhân mà có thể làm cho,Vietnamese
+con bú bị chó cắn mèo cào có nên tiêm,Vietnamese
+lăn và đặt ống thông bàng quang sau khi điều trị ông không chỉ tạm biệt với ống thông và lấy lại khả năng đi lại không,Vietnamese
+khô hơn đôi khi là từ một cái làn da là thường mà trở thành một cái làn da nhạy cảm dễ gây kích ứng và dị ứng hơn do đó,Vietnamese
+thời lượng chương trình không quá dài và cũng không quá ngắn thì tôi mong muốn rằng là mang lại một chút cái thông tin,Vietnamese
+nó bị lộ ra ngoài ví dụ như là tay áo mình có thể mặc đã áo dài tay nhưng mà,Vietnamese
+di chuyển ở trong lòng mạch đó nó sẽ không bị bám vào thành mạch nhưng mà khi mà các cái thành mạch của chúng ta tổn,Vietnamese
+hôm nay những ai đang mắc phải bệnh lý về tim mạch nè về huyết áp cao mỡ máu cao cũng như là quý vị và các bạn cần,Vietnamese
+phải xây dựng tất cả từ việc chẩn đoán từ việc đánh giá từ việc điều trị và xử lý những cái tác dụng phụ những biến,Vietnamese
+bàn chân của chúng ta vâng thì đấy là những cái dấu hiệu mà rất hay gặp nên là tất cả các bệnh nhân mà khi mình có các,Vietnamese
+chúng ta biết là đến cái giai đoạn năm thì gần như là tất cả các hoạt động của người bệnh đều còn có sợ sự giúp của,Vietnamese
+chúng ta sẽ chờ một chút xíu mọi người vào đầy đủ song đó thì ta sẽ bắt đầu cái chương trình là buổi tối ngày hôm nay,Vietnamese
+được còn trong trường hợp mà người bệnh muốn toàn có cái hiệu quả của kích thích,Vietnamese
+là cái bệnh này nó không có một cái biểu hiện nào cụ thể vậy thì làm thế nào để chúng ta biết là cái đau nhức xương khớp,Vietnamese
+ích với tất cả những bệnh sau rối loạn tăng động giảm chú ý ở người lớn adsd,Vietnamese
+tìm hiểu còn nguyên nhân do đâu mà nếu ta tìm được nguyên nhân này ta hóa giải được thì có nghĩa là nâng tầm cái chất,Vietnamese
+béo trong chế độ ăn để giúp cho bệnh nhân có thể là bù lại cái lượng năng,Vietnamese
+trạng cường giáp của mình coi có bị tái phát hay không vâng ạ xin được cảm ơn câu trả lời giáo sư tiến sĩ,Vietnamese
+đến bất kỳ nhà khoa học nào có đóng góp mà tôi chưa thể gọi tên ở đây hoặc đã đề,Vietnamese
+parkinson nó cũng sẽ càng ngày càng tiến triển do đó về mặt nguyên tắc là thuốc cũng như là phẫu thuật kích thích,Vietnamese
+chứa các axit sunfuric chính là cái vị chua gây nên cái chúng ta cảm nhận cái vị chua của chanh chứ không phải là axit,Vietnamese
+mới có thể có những chèn ép có những cái thoái hóa nặng lên và thậm chí là bây giờ bác đau nhiều quá bác đi lại khó khó,Vietnamese
+biệt với những người có tuổi và cao tuổi bởi vì chúng ta biết là dần theo năm tháng thì các cơ quan trong cơ thể của,Vietnamese
+loại gì đó nó nhanh nó mạnh nó có thể khỏi ngay nhưng mà kỳ thực có những thứ rất nhanh rất mạnh tân dược nhưng mà cái,Vietnamese
+thuốc này điều trị các triệu chứng của bệnh trầm cảm chứ không phải nguyên nhân thứ vốn bị bỏ qua một cách rõ ràng,Vietnamese
+người thì có một trăm năm mươi chín người chẩn đoán mắc mới bệnh ung thư và theo như viện nghiên,Vietnamese
+là cơ quan nội tạng cứu mạng cho họ và chính hệ miễn dịch giúp cơ thể nhận biết và loại bỏ các tế bào ung thư một quá,Vietnamese
+ngoại khoa của bệnh parkinson đó là cái đặt điện cực kích thích não sau được gọi,Vietnamese
+nào cũng cảm thấy trầm buồn thứ hai là họ cảm thấy mất hứng thú họ không làm bất cứ một cái chuyện gì khác,Vietnamese
+sắc tố melanin cho nên bạc tóc trước tuổi đó như vậy thì chúng ta thấy có rất,Vietnamese
+phẫu thuật tiền thuốc tiền nằm viện công với khoảng thời gian bệnh nhân điều trị phẫu thuật thì cái chi phí này nó không,Vietnamese
+cái cái bàn tay chúng ta có thể đeo găng tay hoặc là ví dụ như đi giày đi dép thì thay việc là đi dép thì chúng ta sẽ đi,Vietnamese
+đúng là đến lúc mà chúng ta ốm sẽ ngấm sức khỏe quý như thế nào thì chúng ta phải tuân thủ cái liệu pháp điều trị của,Vietnamese
+vận động khá là đều đặn duy trì hàng ngày để mục đích là gì thứ nhất là lưu thông khí huyết cái thứ hai nữa bản thân,Vietnamese
+cho thấy những gen sâu khác nhau này rất cần thiết cho đáp ứng miễn dịch đối với tất cả các loại vi khuẩn và,Vietnamese
+là chúng ta các công ty dược các nhà khoa học người ta đã tìm và người ta đã,Vietnamese
+có những cái phương tiện rất là hiện đại hỗ trợ để mà có thể can thiệp thêm,Vietnamese
+mình cứng đờ ra em nghĩ là chúng ta lựa chọn cái nào dịu nhẹ thôi sẽ tốt cho da của mình rồi tiếp theo câu hỏi của,Vietnamese
+bệnh nhân sẽ có những cái những cái rối loạn về hành vi mà bệnh nhân sẽ có ví dụ như là ham,Vietnamese
+nắm được hay là nắm nó khó hay là nắm nó không có khỏe chắc chắn lắm không nắm được luôn,Vietnamese
+thể thông qua tác dụng trực tiếp đầu tiên đó là việc giảm năng lượng trong những chế độ ăn nhưng mà về tác dụng lâu,Vietnamese
+chia cho nhau những cái phương thức điều trị mà nó không có phù hợp như vậy thì không hay vậy thì đối với những,Vietnamese
+một cách rất đại khái rằng hệ miễn dịch nhắm vào những gì không phải là một phần của bạn nó cũng trở nên rõ ràng rằng,Vietnamese
+thể bị bất hoạt bởi nhiệt và một lượng nhỏ hóa chất formalin điều này có nghĩa,Vietnamese
+người f1 này với nhau cũng làm sao để giảm các nguy cơ lây chéo bởi vì người,Vietnamese
+cho cái việc chức năng này nó không còn vẹn tròn nữa và chính vì vậy làm cho bệnh nhân bị sụt cân bên cạnh đó thì,Vietnamese
+đó nhưng việc tìm kiếm một đồng xu bị mất trong phòng khách hết sức bực bội vì không bao giờ biết khi nào nó thực sự sẽ,Vietnamese
+nó sẽ giúp cải thiện được rất là nhiều các triệu chứng của người bệnh parkinson đặc biệt là các cái triệu chứng về vận,Vietnamese
+rất là nhiều chúng ta thấy nó có hiệu nghiệm cho nên là mình thấy là mình rất là tin tưởng cái sản phẩm tương tác,Vietnamese
+định huấn luyện triệu chứng kéo dài và cải thiện triệu chứng tốt hơn cho,Vietnamese
+sản phẩm thế và giúp cho máu lên thông lên não lên tim tốt hơn này để tránh những cái dấu hiệu như là hồi hộp trống,Vietnamese
+gọi là vitamin c azelaic acid hoặc là những cái chiết xuất từ thực vật cái giai đoạn thứ,Vietnamese
+giúp ngăn ngừa các vấn đề trong ghép tạng cũng là kết quả của một đáp ứng miễn dịch không mong muốn trong trường,Vietnamese
+thông tin tức là chị bị huyết áp cao này thế và bây giờ hiện nay là hay có triệu chứng như đau đầu hoa mắt chóng mặt này,Vietnamese
+ngày xong rồi hba1c nó trở về bình thường đâu không có đâu mà bác phải dùng ít nhất là từ hai đến ba tháng với cái liều,Vietnamese
+hiện tại mối tương quan như được tìm thấy trong nghiên cứu này không nhất,Vietnamese
+của mình giống như em bé khi mà tập ăn bổ sung mỗi thứ phải tập từ từ và tập,Vietnamese
+không phải là một phần của cơ thể con người không gây nguy hiểm và không nên kích hoạt đáp ứng miễn dịch nhưng như,Vietnamese
+năng tài chính của mình tùy vào cái cái cái mong muốn của mình cũng như là mong,Vietnamese
+bệnh xương khớp mà nó có liên quan đến thần kinh chúng ta cũng phải điều trị nhưng mà dùng những cái nhóm thuốc này,Vietnamese
+phòng ạ đấy là chưa kể cái chuyện là người ta còn công bố rất là rõ là trong,Vietnamese
+f1 nếu mà không không có trở thành f0 thì vẫn là cái người không phải là người mắc bệnh do đó cái điều đầu tiên,Vietnamese
+vẫn là não do đó nên đối với một người cụ thể thì can thiệp càng sớm thì cái,Vietnamese
+lại những cái khi mình tắt những cái thiết bị điện thì bệnh những cái tế bào,Vietnamese
+thể khác và nó lại sinh sôi nảy nở và có cái điều kiện tiếp xúc gần với những khi người khác nữa thì virus đó lại là có,Vietnamese
+xóm và những người xung quanh những người bệnh béo phì chúng ta hãy luôn luôn đồng cảm và luôn đồng hành ở người,Vietnamese
+sắc tố hoặc là mình có thể là mình làm thay đổi luôn cả cái màu sắc vốn có của,Vietnamese
+kết nối mật thiết tới một loạt các bệnh gần như không liên quan đến vai trò của nó trong việc chống lại mầm bệnh các,Vietnamese
+nhiều tên tuổi con cháu chả nhớ địa chỉ nhà mình cũng không nhớ đi ra đường nhiều khi là lạc không về thế thì chất,Vietnamese
+trong tâm nhĩ với chúng ta để mà tránh được những biến chứng phiên tắc thì cái cách mà sử dụng kháng đông như thế nào,Vietnamese
+thị thật sự cái này cũng rất là khó khăn đối với đối với lại cái người nhà đó đối,Vietnamese
+đối với cái bệnh lý của bác thì bác đang phải dùng rất nhiều những các cái thuốc nền các cái thuốc để điều trị các cái,Vietnamese
+huyết liên quan đến ruột quan trọng như thế nào trong việc duy trì sức khỏe tổng thể của cơ thể bạn đó là quân đội của cơ,Vietnamese
+thứ hai là chúng ta làm giảm nhanh các triệu chứng mà chúng ta đã mắc phải cái,Vietnamese
+người bệnh parkinson mà có hiệu quả có cải thiện với thuốc khi mà chúng ta,Vietnamese
+có thể mà đang ngồi nghỉ cũng có thể là khó thở như vậy với tình trạng rung nhĩ xuất hiện nó thể thúc đẩy suy tim,Vietnamese
+đổi nó tác động thêm vào và đó là những cái bác những cái chia sẻ của bác sĩ khi mà chúng ta thay đổi thời,Vietnamese
+nhất nhưng mà vẫn có hiệu quả để giúp cải thiện cái tình trạng tăng sắc tố của người mình cụ thể đó là chúng ta nên chú,Vietnamese
+mới xem xét cho phẫu thuật kích thích não sâu như vậy đó là những cái người bệnh được ưu tiên chọn lựa cho các vấn đề,Vietnamese
+ở người bị nhiễm virus có thể tạo ra một trăm phần tử virus mối điều này có nghĩa là chỉ cần ba bản,Vietnamese
+chẳng có cái khó nào chúng ta không vượt qua nếu như có sự hỗ trợ của những người thân kiến thức dinh dưỡng của những,Vietnamese
+thì như vậy thì tùy cái cái chẩn đoán và khoảng thời gian bệnh nhân có,Vietnamese
+tư vấn quản lý bởi vì là sau khi mà chúng ta điều trị mà có cách đúng bài,Vietnamese
+méo miệng yếu tay chân và giọng lời nói giọng nói có vấn đề thì đó,Vietnamese
+không do đó nên chúng tôi sẽ cố gắng đưa ra một cái chu trình chăm sóc da làm sao mà đơn giản nhất tối giản,Vietnamese
+thông qua tất cả quý vị khán giả đang đồng hành cùng với chúng tôi chúng tôi sẽ được gửi đến cộng đồng lớn của chúng,Vietnamese
+có chứa những các hoạt chất đặc trị giúp điều trị những cái vấn đề chuyên biệt trên da ví dụ chúng ta là sẵn,Vietnamese
+giờ thì chúng ta sẽ dành ít phút để nghe tâm sự của người trong cuộc như thế nào nhé cũng gần một nửa năm trở lại đây thì,Vietnamese
+và đặc biệt là nhiều chuyên khoa đó có ý kiến tham khảo lẫn nhau gặp nhau thì đó mới là cái điều tốt nhất mà có điều cần,Vietnamese
+công bố thì những cái nỗi lòng của những người bệnh béo phì họ rất là có những,Vietnamese
+động vật không xương sống và chúng sống sót qua bệnh tật chỉ bằng kiểu phòng thủ này nghĩa là hệ miễn dịch của chúng,Vietnamese
+căn bệnh đó bác cả chỉ có điều thứ nhất là bác phải nên tái khá thường xuyên và,Vietnamese
+thảo dược từ trước đây ông cha ta dùng mà nó an toàn thì bây giờ liệu là có thể phát triển hay là có thể ứng dụng được,Vietnamese
+bôi kem dưỡng trước khi đi ngủ nhưng ngủ dậy mặt vẫn còn nhiều dầu xưng cháu vậy,Vietnamese
+bệnh lý mà thoái hóa khớp của của bác thì nó cũng có thể là một trong những cái gi��i pháp có thể giới thiệu cho bác,Vietnamese
+hen suyễn tự kỷ dị ứng và mẫn cảm thực phẩm mệt mỏi mạn tính nói rối loạn tâm,Vietnamese
+chỉnh cái chế độ ăn điều chỉnh cái vận động tập phối hợp cho nó nhịp nhàng nó phù,Vietnamese
+ngực và rất là mệt và trước khi còn có cảm giác đau tức ngực nữa thì đây có lẽ là những cái dấu hiệu của thiểu năng,Vietnamese
+bộ với chạy bộ thì cũng phải giữ cho nó vừa sức với mình tuy nhiên thì đối với,Vietnamese
+nhé để mang lại cái hiệu quả cao nhất ạ như vậy đối với những người bị huyết áp cao mà chưa có hình tình trạng xơ vữa,Vietnamese
+chiến đấu thì tất cả mọi sự hỗ trợ đều là vô nghĩa và tất cả mọi người cần biết yếu tố xung quanh chỉ là hỗ trợ thôi còn,Vietnamese
+chúng ta sẽ thấy sau đây việc bị béo phì có liên quan trực tiếp đến tăng nguy cơ bị sa sút trí tuệ nguy cơ mắc tiểu đường,Vietnamese
+có một cái tâm trạng rất đặc biệt như là ngủ đêm sáng thức dậy thì thấy trước mắt mình toàn là nghịch cảnh tức là mình tự,Vietnamese
+vào những gì diễn ra trong hệ thần kinh và cụ thể là trong não theo cách thức tiếp cận gần cuối cùng chúng tôi tự động,Vietnamese
+người bạn đồng hành đáng tin cậy mà lại rất rẻ tiền rất là hợp lý đúng không ạ cái thứ hai nữa là gì ạ cái thứ hai nữa,Vietnamese
+kiện để đi thăm khám thì trong trường hợp này thì bác sử dụng một số các cái giải pháp về mặt thảo dược cũng như là,Vietnamese
+hệ vi sinh vật mặc dù một số thứ có vẻ khác biệt rõ ràng với những thứ khác,Vietnamese
+là có hay không việc đưa một liều nhỏ dịch độ mùa vào ai đó mà không giết chết họ cần phải có một phép thử để xác định,Vietnamese
+bên trong chúng ta và dấu vết di truyền của nó là hệ vi sinh vi có nghĩa là nhỏ,Vietnamese
+cho tới hiện nay thì người ta có thể nói,Vietnamese
+hoặc là người ta có thể dùng laser hoặc là ta dùng bất cứ một cái gì đã để người ta biến cái cái cái cái cái sóng đó thành,Vietnamese
+mệt mỏi và các bệnh lý nền đôi khi chúng ta cũng sẽ không kiểm soát được nên là trong giai đoạn này bác cố gắng bác nhé,Vietnamese
+sĩ có thể là điều trị rất nhiều các bệnh nhân cúm a mà nặng ở khu vực phía bắc hà nội,Vietnamese
+là cái xét nghiệm mà anh muốn tới làm thì tại ngành y tế cũng sẽ có tổ chức để,Vietnamese
+lúc đó thì tôi thấy sướng lắm tung tăng đi lại nhẹ nhàng rồi là mỗi một lần mình,Vietnamese
+cái phương pháp nào đơn lẻ thì trong vòng sáu tháng thì nó cải thiện nhưng,Vietnamese
+cái câu chuyện này đã là cái câu chuyện ảnh hưởng rất là nhiều cái thứ hai nói về mặt vật lý cũng như là cái cơ học đấy,Vietnamese
+ở đây thì nói với bác thế này bác sĩ không gọi là gọi đánh giá sản phẩm khác,Vietnamese
+có thể chống trả với khối u cho nên rất mong quý vị hãy tin rằng là gạo lứt muối,Vietnamese
+trì thì chúng ta chọn những cái giải pháp mà nó lại an toàn thì cái cái kga1,Vietnamese
+cũng như đau tức ngực và những cái dấu hiệu tê bì kiến bò châm chích tay chân thì nó cũng sẽ được cải thiện vì máu đã,Vietnamese
+cho vắcxin sốt rét đã khiến miễn dịch bẩm sinh là một chủ đề luôn nóng hổi kể,Vietnamese
+hoặc là có tụt huyết áp tư thế vân vân thì những cái triệu chứng đó nó sẽ được,Vietnamese
+việc về văn phòng thường là chúng ta phải ngồi rất là yên tĩnh khá lâu lâu thì tất cả những cái chuyện nọ chuyện,Vietnamese
+trình hôm nay chúng tôi dành thời gian để nói đến cái việc chúng ta hiểu thế,Vietnamese
+để hỗ trợ giúp cho cải thiện các triệu chứng ví dụ như là nếu mà chúng ta đang,Vietnamese
+bị đau một cái cái đầu gối phía bên tay phải mà má trong á bác sĩ với một cái cổ,Vietnamese
+định lại cái việc mình cần phải làm cái gì tiếp theo cần phải mổ hay không thì mời,Vietnamese
+nói chung là tổng thể vấn đề vâng chị ơi chị ơi chị đi khám rồi thì,Vietnamese
+mè và trong chế độ ăn thực dưỡng của quý vị có tốt không tốt ạ nhưng nó không đủ để,Vietnamese
+là chúng tôi sẽ đánh giá cái mức độ mà nhận thức của cái người bệnh béo phì là trước phẫu thuật xem coi họ hiểu như thế,Vietnamese
+là nhanh và với một t��� lệ rất cao chị ạ nên là mình nên sử dụng và nên sử dụng kéo dài từ ba đến sáu tháng chị nhé vâng ạ,Vietnamese
+hoàng liên l-carnitine fumarate dùng cho người có bệnh lý nền huyết áp cao mỡ máu cao,Vietnamese
+đình cũng như là mọi người hỗ trợ giùm tôi cái chuyện đó,Vietnamese
+cái sản phẩm mà chị nêu đó thì khi tôi tôi trích ra nó nhiều lắm nhiều thành phần rất rất là là hay từ từ các ứng,Vietnamese
+vấn đề là gì nó làm tăng cường cái sức bền thành mạch vâng cái đó quan trọng lắm cho nên là nó còn ngăn ngừa cái,Vietnamese
+vậy thì với những trường hợp đã tìm vắcxin,Vietnamese
+bởi cái việc gọi là của bộ y tế rồi của gọi là viện gọi là kiểm nghiệm chất,Vietnamese
+cuộc sống cổ tuy nhiên nếu là cái bệnh lý của hội chứng ống cổ tay thì cái việc điều trị của chúng ta lại tập trung ở,Vietnamese
+của tất cả chúng ta gần như giống nhau ngoại trừ một số ít gen mã hóa các đặc điểm cá nhân như màu tóc hoặc nhóm máu,Vietnamese
+mình có thể có ba cái nguyên nhân chính thường gặp nhất nguyên nhân mà chúng ta đang nói ở đây nó là rung nhĩ,Vietnamese
+cột sống thì lên bác sĩ chụp chiếu thì bác sĩ bảo của tôi là bị thoái hóa cột,Vietnamese
+vùng chân và gối thậm chí là nó hạn chế cái việc đi lại thì tất cả ít nhất là ba,Vietnamese
+vâng ạ xin được cảm ơn bác sĩ rất là nhiều và như là chia sẻ của bác sĩ thì rõ ràng là đối với những ai mà chúng ta,Vietnamese
+thể huyết áp bình thường chúng ta không bị đái tháo đường chúng ta không bị rối loạn lipid máu nhưng mà các nhà khoa học,Vietnamese
+bảo cái tính an toàn đấy là cái quan trọng thế cho nên là khi sử dụng đông,Vietnamese
+này là hay bị chuột rút hỏi bác sĩ là uống thuốc gì nó đỡ hay nó khỏi,Vietnamese
+phục hoàn toàn rồi vậy thì chúng ta được báo trước được cảnh báo thì chúng ta phải tận dụng nó tại vì sao tại vì,Vietnamese
+thì lại không những là dân văn phòng mà kể cả nhiều dân khác lại cũng phải ngồi và làm việc online suốt ngày thì những,Vietnamese
+chừng một hai đứa nó béo phì thừa cân thì nó lại trở thành một cái đối tượng của những bạn khác bất ổn thì môi trường,Vietnamese
+cơ thể chúng ta rất mong bác sẽ tìm hiểu thêm và mạnh dạn mạnh dạn đầu tư tài,Vietnamese
+cả các thế giới này,Vietnamese
+những câu chuyện này hàng ngày và tôi biết rằng bạn cũng có thể thay đổi tích cực số phận của bộ não thông qua sức,Vietnamese
+có thể là trùng hợp là nó có thể có xảy ra những biến cố khi mà chúng ta làm cái động tác đó nó có thể làm tổn thương là,Vietnamese
+cho người ta thấy bị căng thẳng hơn làm cho người ta cảm thấy là bị lo lắng hơn bị stress hơn là thậm chí là cái trầm cảm,Vietnamese
+đột quỵ tim đột quỵ não vân vân và vân vân thế cho nên là bác có hỏi như vậy,Vietnamese
+khi sử dụng với những các cái với trên các cái bệnh lý nền như của bác thì hoàn toàn nó không gây ảnh hưởng gì cả,Vietnamese
+nhiều người gặp đấy là bệnh viêm cột sống dính khớp và trong trường hợp này của anh thì chúng tôi nghi rằng là anh,Vietnamese
+trình điều trị duy trì và chính cái việc mà điều trị duy trì này cho nên là chúng ta cũng cần phải tìm những cái biện pháp,Vietnamese
+sẽ tác động lên các cái tế bào nội mạc của động mạch và chính vì vậy mà cứ hàng,Vietnamese
+phì liên quan tới vấn đề rối loạn về mặt sức khỏe tinh thần trong đó trầm cảm những người béo phì có khuynh hướng là,Vietnamese
+huyết áp cao mỡ máu cao và ngày hôm nay thì chúng tôi cũng đang tiếp tục kết nối với các khán giả thông qua tổng đài,Vietnamese
+thuật kích thích não sâu hay không thì thì người bệnh vẫn nên gặp bác sĩ chuyên khoa để được đánh giá một cách đầy đủ để được,Vietnamese
+cả những việc đó thì bệnh nhân sẽ phải hợp tác tốt trong đó quá trình quá trình phẫu thuật thì kết hợp tác tốt đó sẽ,Vietnamese
+mà chúng ta sử dụng chanh như vậy thì trong chanh cũng có chất chống oxy hóa ít thôi ạ và trong đó thì lại chủ yếu là,Vietnamese
+là giai đoạn gần đây là bác bị tê ở cái bàn tay nhiều có đúng không ạ,Vietnamese
+trọng đối với cái sự thành công chung nói đến quá trình điều trị béo phì thì chúng ta cần hiểu đó là không chỉ đơn giản là,Vietnamese
+gian là từ ba đến sáu tháng để mang lại cái hiệu quả cao nhất và đây nó tác động vào căn nguyên cơ chế bị sinh của bệnh nên,Vietnamese
+ràng là nó cũng sẽ giảm được các triệu chứng táo bón còn trong cái trường hợp mà táo bón do bệnh parkinson gây ra mà,Vietnamese
+cơ thể cho đến tận não bộ cả nghiên cứu trên người và động vật đều cho thấy vi khuẩn đường ruột xấu hoặc,Vietnamese
+như dài hạn của bản thân các nhà khoa học đã xem xét kỹ lưỡng các mối liên hệ giữa trạng thái hệ vi sinh trong người,Vietnamese
+hoặc là ở nước ngoài tức là gần như nó đồng đều trên thế giới nó dao động được từ khoảng,Vietnamese
+làm thì yếu tố gây kiềm thì sẽ làm cho cái cảm giác của niêm mạc miệng nó sẽ dễ chịu hơn và như ví dụ của ông bạn có thể,Vietnamese
+chiến ung thư rất là dài như thế thì người bệnh không chỉ có cần có lý trí này rồi là cần có những cái kiến thức,Vietnamese
+trong một thời gian ngắn trước khi bị đào thải hoặc chết đi tuy nhiên khi cư,Vietnamese
+thì nó cũng có cái tác dụng là góp phần là là bổ sung bù lại cái lượng canxi mà,Vietnamese
+giảm triệu chứng rõ rệt thì đó chính là do nguyên nhân đến từ xơ vữa động mạch gây tắc hẹp động mạch động mạch,Vietnamese
+phổ biến là sự hiện diện của mầm bệnh trong cơ thể kích hoạt đáp ứng miễn dịch vì cơ thể sẵn sàng để phát hiện các phân,Vietnamese
+nhiên là bệnh nhân sẽ phải nhịn ăn từ sáng hôm đó và bệnh nhân sẽ được đưa,Vietnamese
+ung thư ấy hoàn toàn là do người bệnh ung thư cho nên chúng tôi rất mong là dù,Vietnamese
+sợ hãi rằng cô đang gây nguy hiểm cho sức khỏe tương lai của con mình ở phần,Vietnamese
+mình ngày hôm nay những ai mà chúng ta đang gặp phải tình trạng bệnh lý về tim mạch nè huyết áp cao nè bệnh lý về tiểu đường hoặc là bệnh lý về thần kinh những,Vietnamese
+hợp bị rung nhĩ có những trường hợp là người bệnh có triệu chứng hồi hộp và,Vietnamese
+muốn về lâu về dài như thế nào thì mình có quyền lựa chọn pin sạc pin không sạc,Vietnamese
+một cái hành trình như vậy thì cái việc điều trị của béo phì ở trong một cái giai đoạn này nó chỉ,Vietnamese
+thành phần đó cùng với các bác sĩ khác cũng một cái cái cái đội đó thì cái hiệu quả nó sẽ tốt hơn tuy nhiên cũng phải,Vietnamese
+cũng gây ra cái thiếu mạch máu não thiếu oxy lên não và thiếu oxy lên não thì nó cũng gây co thắt cái mạch máu não và,Vietnamese
+là chúng tôi hiểu hơn rằng là bác khó nắm chứ không phải là không nắm được đúng không ạ,Vietnamese
+vitamin k những loại thức ăn nào mà chứa ít vitamin k thì chúng ta sẽ biết được và chúng ta không nên ăn quá nhiều loại đó,Vietnamese
+chất bảo quản túm lại là chúng ta nên chọn lựa những cái thành phần mà lành tính,Vietnamese
+khám bệnh người ta gọi là hội chứng áo choàng trắng ấy làm cho huyết áp của mình tăng cao lên hồi hộp quá vâng nhưng mà,Vietnamese
+độ thấp nhất có thể tuy nhiên thì thì thì không phải lúc nào cũng cũng cũng cũng làm được điều đó và đôi khi,Vietnamese
+cái chuyện đó ra thì mình sẽ phải lưu ý bây giờ giấc uống thuốc nó phải ổn định chúng ta không thể nào thay đổi một cách quá nhiều nhiều,Vietnamese
+dịch hoạt động quá mức có thể dẫn đến các biến chứng như dị ứng trong trường hợp nghiêm trọng nó có thể phản ứng dữ,Vietnamese
+cái thứ hai nữa là có lời khuyên chính xác xem là nên vận động sinh hoạt ăn,Vietnamese
+cái tình trạng mà cơ thể nó không có bản thân của người đó nó không có vực dậy để mà có thể vượt qua nữa thì họ lại,Vietnamese
+sĩ sau phẫu thuật thì người bệnh cần chú ý điều gì trong sinh hoạt và tập luyện để có thể tiếp tục cải thiện sau phẫu,Vietnamese
+vật than tức là một vị đan sâm thôi đã có thể là thay thế một cái bài thuốc hoạt huyết rất nổi tiếng của của cha ông,Vietnamese
+tay đau chân mà lại đau ở cái gót chân cơ thì bản thân cái tư thế vận động của chúng ta cũng như là cái sinh hoạt hàng,Vietnamese
+vì vậy cho nên là trong trường hợp này thì chúng tôi vẫn nghĩ rằng là chúng ta vẫn vẫn cần phải biết rằng là khi chúng,Vietnamese
+hiện tượng sẽ được đề cập khác cuốn sách này sẽ khám phá ảnh hưởng của việc làm việc ca đêm đến hệ miễn dịch của chúng,Vietnamese
+sự là một đại dịch thời hiện đại chắc chắn rằng hàng trăm triệu đô la,Vietnamese
+nói rằng là cái lượng máu để mà nuôi tim nuôi náo nó bị suy giảm nếu như chỉ suy,Vietnamese
+hỗ trợ đồng thời là một yếu tố quan trọng nữa là mặc dù chúng ta dự phòng có,Vietnamese
+ăn cái này không muốn như cũng phải cố mà chút được chúng ta bây giờ đang là không bình thường chúng ta chỉ có phấn,Vietnamese
+chọc vào cái động mạch hệ động mạch cho chúng ta trong chúng ta luôn cái dây một,Vietnamese
+chế độ vận động tập thể dục nhẹ nhàng với sức khỏe của mình để giúp cho điều hòa khí huyết lưu thông cho mình để giúp,Vietnamese
+ngày hôm nay xin trân trọng cảm,Vietnamese
+trị béo phì nó rất là ngoạn mục và sau này nó không chỉ về cải thiện cái hình ảnh mà nó giúp làm cho chúng ta,Vietnamese
+có điều trị thuốc rồi thế nhưng tuy nhiên thì hiện trong thời gian gần đây là bác cũng thế hay có những dấu hiệu,Vietnamese
+cấp cứu nhưng mà những biện pháp nào thì trong kia đột quỵ thì cái dạng đột quỵ,Vietnamese
+cái cái cái việc mà kiểm soát này không hề dễ dàng tí nào hết ngoài cái chuyện phiền phức do phải,Vietnamese
+thay vì người ta đưa một cái điện cực vào trong đó người ta phá hủy thì bây giờ người ta đưa một cái điện cực và các,Vietnamese
+béo phì người ta gọi là một cái bệnh chuyển hóa bệnh rối loạn chuyển hóa chúng nhưng mà cái sinh lý hay là cái quá,Vietnamese
+trình kiểm soát nhiễm khuẩn các kỹ thuật lấy mẫu làm sao mà đạt hiệu quả nhất và không không không để lây nhiễm,Vietnamese
+đau đầu hoa mắt chóng mặt ngủ kém cũng như là ở những cái dấu hiệu hồi hộp trống ngực này rồi là tim đập nhanh,Vietnamese
+chương trình ngày hôm nay thì người dân sẽ ý thức hơn trong vấn đề là đi thăm khám hoặc là là mình muốn được tư,Vietnamese
+chúng ta muốn tìm mua đông trùng hạ thảo hoặc là những sản phẩm có đông trùng hạ,Vietnamese
+sẽ không thể tồn tại không thể sinh sôi và không thể lan truyền ra ta xung quanh được là như vậy thì cái chỉ thị mười sáu rõ,Vietnamese
+không thưa bác sĩ vậy thì bác có cái lời tư vấn nào cho những người mà dân văn phòng chẳng hạn để có thể khắc phục được,Vietnamese
+tư vấn cho những người có tuổi và cao tuổi khi mà chúng ta bị bệnh tim mạch cũng thần kinh mà sử dụng cái viên nang,Vietnamese
+thì chúng ta nghĩ đến câu chuyện là sẽ chăm sóc tóc từ bên trong bằng những cái dưỡng chất cần thiết và chăm sóc tóc từ,Vietnamese
+thể tự bảo vệ mình an toàn và đồng thời cũng chính họ sẽ bảo vệ cho lực lượng y,Vietnamese
+người ta vẫn đang tiến tiếp tục nghiên cứu và rất nhiều các phương pháp nghiên cứu để giúp làm sao có thể ngăn sự tiến,Vietnamese
+sao cơm nó cứ dính lên vòm họng bởi vì sao họ bởi vì nó khô hết tất cả các niêm mạc miệng bình thường chúng ta đang có,Vietnamese
+cái cái lượng thuốc giảm trung bình là khoảng năm mươi phần trăm có trường hợp tốt là được ngưng thuốc luôn có,Vietnamese
+chứng này thế thì chúng ta sẽ tìm hiểu là nguyên nhân tại sao mà bệnh nhân lại có những cái triệu chứng này thì chúng,Vietnamese
+mình thì người ung thư cảm thấy mình bị bỏ rơi cảm thấy mình như là tuyệt vọng thì thực sự rất là khó để có thể chiến,Vietnamese
+trọng với tỷ lệ sai một số chủng mà có tác động tích cực đến sức khỏe có thể,Vietnamese
+hai điều đầu tiên họ kiểm tra tỷ lệ nhiễm ký sinh trùng và sự đa dạng của vi,Vietnamese
+tiếp một đợt hóa trị tiếp theo chẳng hạn thì tất cả những điều ấy tôi biết là cũng rất là khó khăn với tất cả các quý,Vietnamese
+ta cũng được biết rằng là sau phẫu thuật kích thích não sau người bệnh còn được lập chương trình cho máy hoạt động nữa vậy,Vietnamese
+này cái thứ hai nữa là thậm chí ảnh hưởng đến các cái chấn thương ở bên trong nội tạng cũng như là ở các cái hệ,Vietnamese
+phát triển và nó tích lũy được những hoạt chất quý giá nhưng mà đương nhiên chúng ta thấy một điều là đông trùng hạ,Vietnamese
+động mạch ở mạch vành thì chúng ta biết mạch vành là một cái mạch mà để nuôi dưỡng cơ tim cơ tim cơ tim của chúng ta,Vietnamese
+giúp bà tìm thấy niềm vui sống lạc quan tích cực hơn mỗi ngày,Vietnamese
+polysaccharide cao nhất thị trường phương pháp sấy đồng khô thăng hoa giúp cho các,Vietnamese
+để mà họ càng ăn nhiều ăn nhiều để giúp cho giải tỏa giải tỏa cái căng thẳng của họ và làm cho cái tình trạng mà béo phì,Vietnamese
+hệ vi sinh đường ruột của tất cả các cặp song sinh giống hệt nhau là rất khác nhau nghiên cứu về y dược hiện đang thừa,Vietnamese
+nhiều trường hợp bị chó tấn công gây,Vietnamese
+thuật thì có thể một số người nó sẽ bị dư da ra và dư da có những người rất,Vietnamese
+trọng lượng phân tử thấp nó sẽ bám vào các cái cái tế bào nội mạc đó và khi bám vào tế bào nội mạc đó sẽ khởi động một cái,Vietnamese
+phân biệt các cái loại ung thư khác nhau thế còn đối với các cái chế phẩm mà,Vietnamese
+thể có những cái rối loạn khác có những bệnh lý khác và có thể phải thăm khám lâm sàng và cận lâm sàng mà những cái,Vietnamese
+bởi vì trong cái kết quả xét nghiệm sarscov2 nếu mà thử pcr thì người ta,Vietnamese
+thắt lưng là một cái rất là đơn giản thông thường mình sẽ đeo những lúc mà mình đi lại nhiều thông thường là mình,Vietnamese
+bát thì chúng ta đã được chín mươi kcal rồi giúp khắc phục đi cái tình trạng thiếu năng lượng của cái nấu nấu từ dạng khô,Vietnamese
+trừ nấm nhiễm đây là một khám phá ngoạn mục chứng minh rõ ràng rằng các gen liên quan đến sự,Vietnamese
+trong những số phát sóng tiếp theo,Vietnamese
+đá như chúng ta chọn các serum dưỡng sáng da chúng ta thiếu ẩm khô chúng ta,Vietnamese
+như thế này và chúng tôi khuyên là bác cũng nên đi thăm khám với các cái bác sĩ,Vietnamese
+có phương pháp nào được xem như là có hiệu quả mà được có thể ứng dụng trên thực tế trong cái việc mà điều trị cho,Vietnamese
+sĩ nội và bác sĩ ngoại thần kinh sẽ làm một cái chương trình là lấy cái hình ảnh mri của ngày trước mổ đó mình sẽ,Vietnamese
+nếu như tính về thể tích nếu cùng một bát cơm mà đổi thành bát cháo thì năng lượng của một bát cháo một bát cơm với,Vietnamese
+là họ hoang mang khi họ mất cái phương hướng họ cảm thấy là cái cái tình trạng sức khỏe của mình ủa,Vietnamese
+lượng một viên nửa viên một phần tư viên vân vân là nó sẽ mang lại cho hiệu quả tốt đâu mà,Vietnamese
+là những cái hạn chế của phẫu thuật kích thích não sâu do đó mà chúng ta cũng,Vietnamese
+cũng xin nhờ bác sĩ có thể cho biết cụ thể hơn về mối quan hệ cũng như là tác,Vietnamese
+chứng này tôi đã bác đã bị lâu chưa ạ,Vietnamese
+trường hợp như của bác chẳng hạn bác bị tê cả hai cái bàn tay thì thông thường chúng tôi rất là cần phải có những cái bác sĩ cơ xương khớp để người ta có,Vietnamese
+những thứ thảo dược để ngõ hầu có thể là tăng cường sức khỏe cho bản thân mình,Vietnamese
+ta đồng ý tham gia cái phương pháp này tức là chúng ta cũng hiểu rằng là chúng ta đang đóng góp vào cái quá trình,Vietnamese
+không giữ gìn tốt là chúng ta có thể phải đối mặt với những tình trạng như vậy rất mong là cô nghe theo đúng tư vấn,Vietnamese
+sẻ rồi là có những cái thành phần và chiết xuất từ thiên nhiên chủ yếu từ thực vật mà có khả năng là ức chế quá trình,Vietnamese
+phải phát hiện virus do đó cái việc mà xét nghiệm cũng không hẳn khẳng định là chúng ta là người mắc bệnh hay không mắc,Vietnamese
+lâu quá trong cái trường hợp này thì chúng tôi,Vietnamese
+trăm nghìn tỷ sinh vật vô hình này bao phủ bên trong và bên ngoài cơ thể bạn phát triển mạnh trong miệng mũi tai ruột,Vietnamese
+tại sao các phân tử protein được tách ra từ mầm bệnh ban đầu không có tác dụng như vắcxin nhưng một phân tử,Vietnamese
+về lâu dài thì phẫu thuật kích thích não sâu được xem như là vẫn tiếp tục có hiệu quả là như vậy một điểm chúng ta cũng,Vietnamese
+trình ngày hôm nay về cái tác dụng của đông trùng hạ thảo đối với sức khỏe của con người chúng ta là như thế nào ạ,Vietnamese
+chế độ ăn thì sau khi mắc covid thì thường chúng ta do cái sức đề kháng của cơ thể giảm sau khi đợt mà bị nhiễm các,Vietnamese
+tới thời gian gần đây với những tiến bộ thì người ta đưa ra những cái phương pháp người ta gọi là không có phá hủy được gọi là cái,Vietnamese
+cái chuyên khoa để có thể khám vậy thì đối với những bệnh nhân như vậy thì thường là béo phì không phải là một cái,Vietnamese
+loại mầm bệnh xâm nhập vào cơ thể nhưng khi vô số các thụ thể nhận dạng mẫu đã được phát hiện mỗi loại được trang bị để,Vietnamese
+phần trăm và khi cái người được tiêm vắcxin đó được miễn nhiễm thì cái người tiêm đó sẽ không có phải nhiễm virus hoặc,Vietnamese
+rất yêu đời đúng như đức phật gọi là phải luôn luôn hoan hỷ cái đó quan trọng lắm cái thứ hai là vấn đề ăn uống là tùy,Vietnamese
+nó tùy theo cái gọi là mức độ các cái chỉ số nhóm máu hay đường máu mà chúng ta kiêng,Vietnamese
+hóa chất trong miệng nên là ăn uống rất là khó khăn mỗi bữa ăn thì chỉ ăn được một chút ít thôi và qua mấy ngày thì bố,Vietnamese
+một cái khối u thế bây giờ chúng ta mất cái khối u đấy đi tốt rồi nhưng mà chúng ta được hóa trị xạ trị để tiêu diệt các,Vietnamese
+thương trên niêm mạc miệng bị kích thích lên và bố sẽ cảm thấy rất là xót rất là khó chấp nhận nhưng mà ăn miếng,Vietnamese
+giới thế thì những cái phần này thì chúng ta cũng cần phải quan tâm hơn chứ rồi những người rất là thích hút thuốc,Vietnamese
+cái chỉ số hdlc mà trên trên một thì nó có cao không thì đối với cái chỉ số hdlc mà,Vietnamese
+nhiên từ một loại nấm như trong trường hợp penicillin và chỉ được phân lập bởi,Vietnamese
+khác từ đó giúp chúng ta hiểu chính xác làm thế nào hệ miễn dịch được điều hòa chúng tôi mỗi lúc nỗ lực thêm một chút,Vietnamese
+hai là khi có rung nhĩ mà nó đã xảy ra các biến chứng rồi thì chúng ta có thể lại điều trị dứt điểm được những biến,Vietnamese
+chúng ta bị bệnh là chúng ta phải đi khám và đi khám như vậy thì chúng ta sẽ nhận được những đơn thuốc của các thầy,Vietnamese
+ta chưa ăn bao giờ bình thường cái năng lượng trong chất béo của chúng ta trong bữa ăn chỉ chiếm vào khoảng từ hai mươi khoảng,Vietnamese
+thường có sức khỏe tốt hơn nghiên cứu cũng chỉ ra rằng họ sống lâu hơn tới một,Vietnamese
+là chị bị huyết áp cao này thế và đối với huyết áp cao thì mình uống thuốc rồi uống thuốc để kiểm soát tốt để không cho,Vietnamese
+chúng ta không có cái khả năng để bảo vệ mình để chịu đựng những cái phần điều,Vietnamese
+dụ như là lở loét miệng thì thực ra mình nói lở loét miệng chỉ do kẽm không thôi thì cũng chỉ là một phần thôi,Vietnamese
+xoang nhịp tim bình thường thì có khả năng mà tạo ra cục huyết khối là không có nhưng chúng ta nên nhớ rằng là những,Vietnamese
+thì như vậy đó thì mới là cái điều tốt như vậy thì cái lời khuyên của tôi là chúng ta cho dù là dùng thuốc gì đi nữa,Vietnamese
+chính bạn tôi biết điều này gần như không thể tin nổi nghe có vẻ điên rồ như,Vietnamese
+ngực của mình thế và những cái dấu hiệu đau đầu nữa anh ạ và khi sử dụng thì anh nên kéo dài sử dụng từ ba đến sáu tháng để,Vietnamese
+vữa xơ động mạch ở vành tất cả những cái đó là chúng ta không được bỏ rất rất,Vietnamese
+nay chúng ta biết rằng là cái tuổi thọ người việt nam chúng ta được cả kéo dài thế nhưng mà các cụ nói là sinh,Vietnamese
+mất do tổn thương đường tiêu hóa không không thể nào tiêu hóa thu được là do ngay cái chính khối u đó cũng làm tăng quá,Vietnamese
+là bình thường thế rồi thì chúng ta cũng thấy nó đỡ rồi thì thôi thế là tự nhiên chúng ta bỏ thuốc cái đó cực kỳ nguy,Vietnamese
+chính là vấn đề ngăn ngừa ung thư tái phát bởi vì đôi khi chúng ta cứ sau khi điều trị ung thư rồi lại yên tâm,Vietnamese
+tăng sản sinh testosterone cũng như là vấn đề điều trị và dự phòng những cái,Vietnamese
+cái thành phần mà xưa kia cha ông ta rất hay sử dụng trong những cái bài thuốc để điều trị như các cái chứng bệnh về chính,Vietnamese
+múc cho vào thì cái cảm giác cái hương vị nước mắm người ta cứ tưởng như là gì cũng được mặn hơn một chút rồi thì để mà,Vietnamese
+thuật này để thực hiện và khi thực hiện như vậy thì sau này khi thực hiện rồi,Vietnamese
+có cường giáp hay không phải cường giáp là một cái yếu tố nó kích động trái tim lên chúng ta và nó sẽ gây ra tình trạng,Vietnamese
+cái xơ vữa xơ vữa động mạch chi thì có thể bệnh nhân có cảm nhận như là các cái tê bì kiến bò châm chích bằng tay bằng,Vietnamese
+còn phải lưu ý được rằng là không phải sau khi phẫu thuật xong là kích thích não sâu,Vietnamese
+thể chia sẻ với bác sĩ của chúng tôi ngay lập tức bây giờ đấy ạ,Vietnamese
+của tôi xoay quanh xu hướng lựa chọn sinh mổ vì những lý do không nhất thiết có lợi cho em bé hoặc người mẹ mặc dù,Vietnamese
+nhìn đơn giản về những gì đang xảy ra ở đây là cơ thể chúng ta tấn công mầm bệnh đối tượng xâm nhập vết thương vì hệ miễn,Vietnamese
+câu chuyện thực phẩm không phải là một phần của cơ thể nhưng hệ miễn dịch của,Vietnamese
+trị của để mà làm sao hết ung thư để tiêu diệt các cái tế bào ung thư nhưng bên,Vietnamese
+lượng điều trị của chúng ta như vậy thì cũng vậy đó chúng ta thấy là cái rụng tóc nó nhiều nguyên nhân lắm nguyên nhân,Vietnamese
+cái người trầm cảm mà đang dùng thuốc này thì nó sẽ phải được điều chỉnh tốt hơn và khi mà qua cái giai đoạn mà mổ,Vietnamese
+vì một lượng thức ăn đưa vào mà không thể nuốt được thì nó không thể đến được dạ dày không thể đi vào được thì bộ máy,Vietnamese
+mười năm là tốt nhất như vậy tại sao người ta không mổ sớm hơn để cho người bệnh parkinson có thể là cải thiện tốt,Vietnamese
+cái đơn thuốc mà sử dụng tân dược thì có thể nói hiện nay rất rất nhiều các,Vietnamese
+ông thật là một ý tưởng hay khi nhìn toàn bộ thế giới quanh bạn bằng con mắt lạc quan vì những bí mật lớn nhất luôn,Vietnamese
+cái lớp da mà khô căng như thế thì thường là sẽ chứa bên trong là các thành phần xà phòng hay là những cái chất mà,Vietnamese
+lên độ tầm từ hơn tám mươi chín mươi thì đấy là nhịp tim bắt đầu là nhanh rồi thì là chúng ta cũng cũng nên chú trọng thứ hai nữa là,Vietnamese
+hỗ trợ cho các nhóm vi khuẩn có lợi đa dạng mà thay vào đó tạo điều kiện cho các vi khuẩn có hại tôi sẽ chia sẻ những,Vietnamese
+xương là vấn đề chắc chắn nó sẽ xảy ra rồi và bây giờ nó đang xảy ra rồi nếu mà vấp ngã lần nữa thì không chắc là lần,Vietnamese
+lượng như thế nào là vừa đủ ạ vâng ạ thực ra thì trong đối với chế độ,Vietnamese
+liên quan đến bệnh lý tim mạch bệnh lý thần kinh mà vốn dĩ ở những người có tuổi và cao tuổi bao giờ chúng ta có mắc,Vietnamese
+chứng cho việc điều trị đó gây ra thì chúng ta tạo thành một cái gọi là liên hoàn với nhau đầy đủ tất cả,Vietnamese
+fumarate sản phẩm đông y mà nhiều sản phẩm như vậy thì không biết là nó có thể là giảm cái việc là xơ vữa mảng,Vietnamese
+mười milimet thủy ngân huyết áp tâm thu cũng như chỉ số huyết áp tâm trương có thể là giúp cải thiện cái việc kiểm soát đường,Vietnamese
+và rùa ý tôi là sự chuyển giao vi khuẩn từ thế hệ này sang thế hệ khác là một,Vietnamese
+như vậy thì có việc mà điều trị lành bệnh cũng như là ngăn sự tiến triển của bệnh ở người bệnh parkinson hiện nay,Vietnamese
+alo vâng chúng tôi đang nghe đây ạ cô chia sẻ đi ạ,Vietnamese
+hợp lý bởi vì là chúng ta hi vọng rằng là cái việc mà chúng ta sử dụng chanh như vậy sẽ giúp cho chúng ta điều trị được,Vietnamese
+và não bộ trong các chương sau nhưng đây là thời điểm tốt để chuyển sang câu hỏi những vi sinh vật anh em của chúng ta,Vietnamese
+phải chắc chắn rằng là cái cái nhu mô não trên đó nó còn mắc mãi nó chưa có chết hết có nghĩa là bệnh nhân phải đến,Vietnamese
+tự nói giờ đây đang dẫn dắt một nhóm các nhà khoa học để nghiên cứu các,Vietnamese
+thế nào để có thể đáp ứng được điều trị tốt cũng như là nâng cao chất lượng cuộc sống cho người bệnh thì ngày hôm nay báo,Vietnamese
+nào như vậy thì bệnh nhân sẽ phải trước đó mình phải được tư vấn trong quá trình phải hợp tác với với bác sĩ ví dụ như,Vietnamese
+người bệnh của chúng ta cũng đang có một cái tha thiết là mình tìm được một cái giải pháp gì đó mà chúng ta điều trị có,Vietnamese
+nào nhưng mà ở đây chúng tôi cũng xin là trình bày theo hai cái vấn đề cái thứ nhất nó liên quan đến cái bệnh lý và cái,Vietnamese
+là cân đối các thành phần và đặc biệt là tăng cường rau xanh hoa quả tươi để cung cấp cho vitamin các khoáng chất cho,Vietnamese
+dụng của thuốc nó đủ hay chưa và nếu mà thuốc này thấp quá là nó,Vietnamese
+quý vị khán giả có thể tới để khi các bác sĩ chuyên khoa để được tư vấn và để đánh giá lại một cách toàn diện thì nó mới chính,Vietnamese
+bệnh lý nền như là các các thuốc để chống đông này những cái thuốc rối loạn nhịp tim này rồi những cái thuốc tất cả,Vietnamese
+rồi nhưng mà hiện tại bây giờ thì cháu đang hay tức ngực,Vietnamese
+chúng ta tập xong chúng ta cảm giác nó thoải mái tinh thần nó đỡ căng thẳng thế rồi là chúng ta thấy là ăn ngon ngủ yên,Vietnamese
+đánh lừa bạn một số vi khuẩn có thể sống ở nhiệt độ có thể đun sôi máu của bạn và,Vietnamese
+trường hợp có tiền sử bệnh dạ dày đại tràng hay là những bệnh về gan nữa và để có thêm thông tin về sản phẩm mà chúng,Vietnamese
+trình viêm rồi nó cũng làm mất cơ đi thì chúng ta tăng trước hết để chúng ta giữ lại khối cơ thì chúng ta bù lại cái năng,Vietnamese
+cái chế độ sinh hoạt một cách phù hợp và dựa trên những cái mô tả như thế này sơ bộ chúng tôi cũng cảm giác rằng là cái,Vietnamese
+thống cảnh giác cao độ này có hiệu quả đối với những khoảnh khắc cưỡng ép theo đợt nhưng điều gì sẽ xảy ra khi cơ thể,Vietnamese
+loạn nhịp tim này có thể nhịp tim nhanh này nhịp tim không đều thế và mình luôn luôn có cảm giác như là hồi hộp trống,Vietnamese
+cái chuyện xuất huyết thì xuất huyết ở bên trong nội tạng thì không nói,Vietnamese
+là nó không có tồn tại kéo dài là nó một thời gian ngắn rồi nó hồi phục thì nó,Vietnamese
+thiện một cách tương đối rồi tránh tình trạng là nó làm cho nó nặng lên và cái thứ hai nữa là nếu mà chúng ta có thể đi,Vietnamese
+nên các cái nhóm thuốc giảm đau trong cái điều trị bệnh lý xương khớp nó có một vai trò hết sức là quan trọng và chúng tôi có hai cái nhóm lớn trong cái,Vietnamese
+bệnh nền thì cúm a vẫn đặc biệt nguy hiểm vâng tức là đối với một người bình thường,Vietnamese
+tính ừ nếu mà được chúng ta chọn cái thành phần dưỡng sáng mà có niacinamide bởi vì là nó sẽ giúp làm,Vietnamese
+trong bụng bạn có ảnh hưởng gì tới não bộ và các bệnh liên quan nhiều hơn bạn,Vietnamese
+nên khó khăn hơn thậm chí là thì các thành phần nào sẽ giúp da của mình dưỡng,Vietnamese
+quả điều trị nó cũng không phù hợp nữa nó sẽ bị nhiều hơn họ bị trầm cảm rồi bây giờ có thêm phương pháp trị liệu,Vietnamese
+rồi đau vùng ngực ở các cái nhịp nhanh rồi là những cái rối loạn nhịp tim đau,Vietnamese
+động mạch được hay không và giảm nhẹ các triệu chứng như là đau đầu hoa mắt chóng mặt được hay không thưa bác sĩ đây là,Vietnamese
+mà tôi đã nói tức là militaris và sinensis đấy là hai loại mà được người,Vietnamese
+để mà giảm xóa bỏ cái chuyện hình thành cái cục máu đông đó hiện ta sẽ dùng một số biện pháp trong đó thì chủ,Vietnamese
+khuyên những cái thiết bị điện ví dụ như lò vi sóng bếp điện từ hay tất tần tật những cái gì nếu mà cần thiết thì mình,Vietnamese
+nghĩa là không phải chỉ những người cao tuổi mới bị đâu còn rất là nhiều người còn rất là trẻ thậm chí là còn chưa đến,Vietnamese
+bộ ba là adenosine cordycepin và polysaccharide đấy là cái làm nên bản chất thế còn rượu có,Vietnamese
+hiểu rằng là chúng ta nên cố gắng dũng cảm đến để có thể được các bác sĩ,Vietnamese
+có làm được thì bây giờ bệnh nhân sau khi cải thiện được triệu chứng của bệnh nhân mà có một cái cái mong muốn làm mà là một cách quá mức thì cái này,Vietnamese
+biệt là trong khoảng thời gian giãn cách vì dịch covid19,Vietnamese
+tất cả những quá trình này ảnh hưởng rất nhiều đến vì chúng ta có bị dị ứng hen,Vietnamese
+trong cái giai đoạn mà mà này đó thì cơ thể cũng có một số các nội tiết và một,Vietnamese
+về em tẩy trang bôi lại kem chống nắng thì nên làm thêm bước nào trong ba bước này nữa ạ vâng nếu mà buổi trưa đó là,Vietnamese
+mà đã bị ung thư thì chú ý là không ăn khi rau về họ cải nhiều này rồi chú ý đặc,Vietnamese
+cảm nhất đúng không mà em hay dị ứng thời tiết em cũng sẽ ngứa hai bên là hai bên cạnh một trong những câu,Vietnamese
+chanh thiệt là chua uống thiệt là nhiều họ không ăn gì trơn như vậy thì làm cho,Vietnamese
+chẹt lại hoặc là nó không bị thông không được thông thoáng thì nó sẽ ảnh hưởng đến cả cái bàn tay và trong những cái,Vietnamese
+thể được cái hiệu quả tốt hơn đặc biệt là một số những thứ thuốc chỉ,Vietnamese
+hộp cũng như là chúng ta sẽ được tặng thêm được một cái bộ kit test covid19 và thông,Vietnamese
+cái tác động tiêu cực của việc kỳ thị đối với lại người béo phì thưa các bác sĩ,Vietnamese
+trong máu thì nó lại tốt cho mình vì là chính nhờ cái cái cholesterol có trọng lượng phân tử cao này nó sẽ giúp kéo,Vietnamese
+văn một lần nữa thay mặt tại chương trình chúng tôi xin được gửi lời cảm ơn đến sự đóng góp đầy tâm huyết của các,Vietnamese
+tự tin hoặc thất vọng về bản thân xin mời các bác sĩ,Vietnamese
+ta và chính vì vậy nó không có lợi đặc biệt là đối với những người ung thư thứ hai nữa là đối với người ung thư thì,Vietnamese
+đậu nành thì đối với ung thư tuyến giáp thì nó giảm quá trình mà sử dụng iod của,Vietnamese
+sẽ gây cho người bệnh khó khăn thì phẫu thuật kích thích não sâu một nó sự cải thiện được một số các được một số các,Vietnamese
+loại thuốc để sau đó nó đừng tương tác với nhau đừng có gây hại thêm những cái cơ quan mà chúng ta không còn tốt nữa,Vietnamese
+là chúng ta cần phải khám các cái bệnh lý về cơ xương khớp xem là cái bệnh lý cột sống gì hoặc là bệnh lý khớp gối gì,Vietnamese
+mình cũng phải có một cái kế hoạch nữa kế hoạch về mặt tài chính và kế hoạch làm việc theo dõi,Vietnamese
+người thì nó sẽ hiệu quả nhanh hơn vì các bạn nữ ai cũng muốn mình trắng muốn trắng cũng trắng nhanh nữa cơ nên,Vietnamese
+khi mà chúng ta bắt đầu cái chương trình của ngày hôm nay nha à mọi người có câu hỏi nào thì bạn có thể,Vietnamese
+quả như thế nào đối với những người bị huyết áp cao nè mỡ máu cao hay là gặp phải những triệu chứng như là đau đầu tê,Vietnamese
+kết nối tế bào thần kinh giúp vi khuẩn duy trì sự sống của con người những vi khuẩn này không chỉ cùng tồn tại với,Vietnamese
+chúng ta đun sắc như ngày nay đã được bào chế trên dây chuyền công nghệ tiên tiến hiện đại và tạo thành dạng viên rồi rất tiện lợi cho mình sử dụng và đối với,Vietnamese
+để làm sáng da tại sao bởi vì trong cái điều trị mà như nãy tôi có chia sẻ quy trình sản sinh sắc tố đó thì trong cái,Vietnamese
+tính bản thân chúng ta mà quan trọng nhất là ảnh hưởng đến những cái người thân của chúng ta và đặc biệt là những cái người bệnh nền những người lớn tuổi,Vietnamese
+sạc pin không sạc thì thật sự là nó có hai cái lựa chọn như vậy thì hai cái lựa chọn đó thì nó sẽ khác nhau về chi phí,Vietnamese
+người huyết áp cao mỡ máu cao tim mạch hỗ trợ giảm nguy cơ xơ vữa động mạch hỗ trợ giảm đau đầu chóng mặt mất ngủ tê bì,Vietnamese
+phải kiêng tuyệt đối nhưng chúng ta chỉ nên ăn dưới năm mươi gam thịt đỏ một người một ngày thôi khi mà chúng ta bị ung thư bởi,Vietnamese
+cái phẫu thuật tương đối an toàn còn về những cái biến chứng về lâu về dài của cái việc mà đặt các thì nó có,Vietnamese
+cá rán giòn tan như mà khi chúng ta rất thích thì bây giờ ung thư không tốt nữa rồi bởi vì cái chất béo đấy vốn đã,Vietnamese
+thưa quý vị và các bạn để mở đầu cho nội dung phần này chúng ta sẽ cùng nhau tìm hiểu về vai trò vô cùng quan trọng của,Vietnamese
+đồng thời nếu không phát hiện sớm và điều trị kịp thời sẽ dẫn đến rất nhiều những biến chứng nguy hiểm phải kể đến,Vietnamese
+điều trị nhưng mà thì cái tâm lý là họ rất là mặc cảm tự ti bởi vì là từ,Vietnamese
+ứng của da cũng như trò chơi thời điểm hai phẩy năm phút hoặc là năm phút mười phút thì cái đó nếu mà người bệnh có cái cảm giác,Vietnamese
+với tất cả những c��i biểu hiện như vậy thì chúng tôi thấy khá là rõ ràng là nó có khả năng là cái biểu hiện của một cái,Vietnamese
+định tức là bệnh nhân vẫn được thăm khám vẫn được thử sử dụng mri tuy nhiên thì khuyến cáo người ta chọn những cái máy,Vietnamese
+phì chúng ta sẽ còn tiếp tục được trao đổi và đón nhận thêm ở thông tin cũng như là sự chia sẻ quan trọng từ thạc sĩ,Vietnamese
+nhân sẽ quay trở lại phòng mổ vài người ta sẽ phải lập một cái chương trình trong lúc bệnh nhân chờ đợi đó thì bác,Vietnamese
+tinh thần đối với người bệnh thì đã làm vào trong cái sự chuyển hóa trong cơ thể chúng ta đã đứng trước một nguy cơ rất,Vietnamese
+ta có thể thấy là nếu như ai đó chúng ta mà trong nhà đã có người mà bị ung thư và phải chịu những cái hóa trị xạ trị,Vietnamese
+là sau khi mắc bệnh từ năm đến mười năm trong khoảng thời gian này và người bệnh có nên mổ sớm hơn hay muộn hơn không ạ ở,Vietnamese
+giúp cho chúng ta có thể à loại bỏ được khối u tiêu diệt được các tế bào ung thư và giúp cho chúng ta dự phòng ung thư,Vietnamese
+rất là vui mừng vì đã mang lại một cái sản phẩm tốt và có hiệu quả cao để hỗ trợ cho hàng triệu người bị đau cơ xương,Vietnamese
+tự tin đối với lại cái người bạn đời của mình cảm thấy là khó khăn hơn ở trong,Vietnamese
+các sản phẩm dành cho da mụn phù hợp thì bạn lưu ý là chúng ta nên chọn được những cái sản phẩm mà có kết cấu như tôi,Vietnamese
+tại và đáng buồn thay chúng ta đang tụt lại nhanh chóng khi tỷ lệ mắc mới những,Vietnamese
+bác đang gặp phải và cái đai thắt lưng này cũng sẽ là một vật để hỗ trợ bác trong cái việc mà bác di chuyển cũng như,Vietnamese
+mật ong địa phương vì không phải lúc nào cũng có thuốc kháng sinh cậu sẽ không bao giờ bị chẩn đoán tự kỷ hen suyễn hay,Vietnamese
+thông dụng thôi nhưng mà mọi người nên để ý để tránh cái tình trạng là các cái tác động nó cứ tích lũy ngày một ngày,Vietnamese
+quan tâm lưu ý trong cái việc mà xử trí các bệnh nhân người thân của anh,Vietnamese
+có những người là còn nhịn ăn một để gọi là thanh lọc cơ thể thì thì chúng ta sẽ,Vietnamese
+giai đoạn sau mười năm cái việc mà phẫu thuật kích thích não sâu nó trở nên kém hiệu quả hơn tuy nhiên điều đó không có,Vietnamese
+cỗ máy khử độc những vi sinh vật trong ruột đóng vai trò ngăn ngừa nhiễm trùng và có tác dụng như một hàng phòng thủ,Vietnamese
+tuy nhiên các bác sĩ người ta sẽ phải cân nhắc ở hai khía cạnh thứ nhất là nó đã bị những cái cơn như vậy rồi cái thứ,Vietnamese
+đối với việc gọi là chế độ ăn để mà kiêng ăn kiêng trong cái việc điều trị,Vietnamese
+người dân đã cho chúng tôi nhiều cái thông tin ví dụ như những trường hợp tai nạn bất ngờ những bệnh tật mà phải cấp,Vietnamese
+đường máu ổn định thế rồi ngăn ngừa cái sự hình thành phát triển của mảng vữa xơ,Vietnamese
+nhĩ rung nhĩ là gì thật ra cái danh từ rung nhĩ đó là một cái danh từ mà,Vietnamese
+điểm này hoàn toàn không phù hợp với khoa học hiện tại hệ tiêu hóa được kết nối mật thiết với những gì diễn ra trong,Vietnamese
+khác là làm lây lan ra cộng đồng là chính vì vậy mà các tỉnh ở tại các cái,Vietnamese
+nhanh nhất sau khi mà đã trước và trong điều trị ung thư thì sau ung thư thứ nhất là dinh,Vietnamese
+dài theo cái chiều dài của cái nhân để mà mình mong muốn sau mổ đó mình sẽ bật lên,Vietnamese
+thể gây nhiễu các hoạt động điện của các thiết bị cấy ghép vào thì nếu mà có vấn đề gì thì mình cứ phải quay trở lại cái,Vietnamese
+đây là cái gót chân của bác ấy thì ở đây chúng tôi sẽ thường gặp hai cái vấn đề chính vấn đề thứ nhất liên quan đến các,Vietnamese
+chiết xuất từ thực vật và chúng ta tránh như các sản phẩm mà có chứa gốc dầu này có chứa hương liệu hoặc là cồn những,Vietnamese
+giống như là một cái người nào từ hành tinh khác tới vậy như vậy thì làm cho cái người bị béo phì đó càng lúc càng bị,Vietnamese
+tương lai là rõ ràng khó có thể thực hiện được về mặt kỹ thuật và nhằm mục đích đạt được mức độ chính xác cao hơn,Vietnamese
+thân của các phương pháp trị liệu tâm lý đó nó là một phần gắn,Vietnamese
+đúng là cái bệnh nhân béo phì thì nó phải đương đầu với rất là nhiều trở ngại cũng như là những thách thức về tâm lý,Vietnamese
+chúng ta có xuất hiện những cái dấu hiệu này thì chúng ta nên cảnh giác đây chính là các cái tình trạng xơ vữa mạch do,Vietnamese
+bệnh nó liên quan đến cái vùng cột sống cổ là chính những có những cái trường hợp liên quan đến cái vùng cổ tay và,Vietnamese
+rồi ta phải làm gì nè cái này quan trọng ta phải chọn lựa cho mình các cái dầu,Vietnamese
+uống mà khi khác là cơ thể chúng ta đã thiếu nước đến khoảng năm phần trăm rồi nó không tốt cho quá trình chuyển hóa bình thường trong cơ thể rất dễ sinh,Vietnamese
+sẽ khám phá cuộc cách mạng đó trong nửa sau của cuốn sách này đầu tiên hệ miễn,Vietnamese
+trong vòng bốn tiếng rưỡi kể từ khi phát thì mình có thể làm được cả hai nếu mà qua,Vietnamese
+trầm cảm hay thậm chí là họ có đang điều trị trầm cảm hay không và họ có một cái,Vietnamese
+thể tốt rồi nhưng mà đôi khi nó vẫn cứ xảy ra tình trạng đột quỵ thì như vậy,Vietnamese
+và đói cái này thì mình sẽ được tư vấn trước rồi sau cái giai đoạn mình cố định,Vietnamese
+tiềm tàng là bất định nhưng hậu quả khi mọi thứ lạc lối có thể là khủng khiếp nỗ,Vietnamese
+à ba mươi giây nữa nếu như mà người xem lại thì chúng ta có thể là chúng ta tới qua để chúng ta sẽ vào chương trình luôn nha,Vietnamese
+quý vị thân mến chúng ta vừa được lắng nghe cuộc trò chuyện với chủ đề dinh,Vietnamese
+đó nên đôi khi là vì tâm lý là chúng ta nóng vội chúng ta mong muốn là làm sao để cải thiện được cái tình trạng tăng sắc tố này nhanh nhất ở các mảng nám này,Vietnamese
+biến chứng của thuốc levodopa nó không không giúp cái việc cải thiện đó được lâu dài được kéo dài suốt ngày thì phẫu,Vietnamese
+cũng không di chuyển đến những nơi có dịch bệnh xảy ra thì vẫn còn đó là những sinh hoạt đời thường rồi,Vietnamese
+cân quá nhanh và quá nhiều trong một khoảng thời gian rất ngắn và điều này không những gây nguy hại cho sức khỏe mà,Vietnamese
+động sinh lý khác nhau bao gồm vận hành hệ miễn dịch giải độc viêm dẫn truyền,Vietnamese
+với người nhà thì mình cố gắng là mình hạn chế sự kỳ thị như tôi nhắc lại là sẽ phải khuyến khích hỗ trợ cho cái người,Vietnamese
+nhân cũng an tâm để mà có thể sử dụng của thuốc chống đông để mà phòng ngừa,Vietnamese
+dày ngang một tế bào nó phải vẫn còn nguyên vẹn trong khi hoạt động như một,Vietnamese
+sự là một cái buồng tim có đảm nhiệm các chức năng là nhận máu từ các ngoại biên,Vietnamese
+nhất chúng ta cần phải làm sau ung thư đó là chúng ta bảo vệ cơ thể chúng ta cho cơ thể chúng ta một cái sức khỏe tốt,Vietnamese
+để mà có thể tương tác để có thể chia sẻ với nhau những thông tin nó phù hợp,Vietnamese
+tình trạng bệnh mà đó cũng chỉ là một cái tình trạng bình thường thôi như là từ nhỏ đến lớn họ đã cũng quen và chấp,Vietnamese
+là cao khá là không lây lan cho người khác như vậy thì khi mà cô chỉ cờ cô là,Vietnamese
+chẩn đoán là người bệnh họ có cái tình trạng da nhạy cảm thì trong lâm sàng là chúng tôi thường phối hợp luôn là cả các,Vietnamese
+tốt cho những người suy giảm chức năng gan thận phổi tim mạch thần kinh suy nhược những người bị tiểu đường bên cạnh,Vietnamese
+dạng sống bên trong đường tiêu hóa của mình mà gần như điều hành toàn bộ hệ thống trong cơ thể bạn cũng không phải,Vietnamese
+bảo vệ và tiêm vắcxin phòng dại có tác,Vietnamese
+cầu của mình như thế nào để cho một cái đủ ấy nó mang tính cá thể tốt nhất có nhiều người bệnh ung thư quý vị có thể,Vietnamese
+là lú lẫn hay quên sa sút trí tuệ aizheimer parkinson rồi là ta di,Vietnamese
+đó là con sâu mùa hè thì nó là thảo thế thì đông trùng hạ thảo vốn dĩ của nó gốc,Vietnamese
+dao động lại vận động hoặc là loạn động do thuốc và đến giai đoạn bốn thì bệnh nó,Vietnamese
+nhiễm khuẩn trên da đầu nó cũng gây rụng tóc dễ bị nhiễm nấm nhiễm nấm cũng là nguyên nhân rụng tóc rồi đó là chưa kể,Vietnamese
+cho những thắc mắc của ông là rất quan trọng bởi vì cấu trúc di truyền của loài côn trùng này đang được nghiên,Vietnamese
+sau bác ngã thì nó không bị gãy xương và không bị nằm liệt giường do gãy xương đấy bây giờ là mình đang chèn ép thần,Vietnamese
+cái va chạm chấn động ở cái vùng đó chúng ta nên đi các cái giày thể thao mà nó có cái đế nó vững chắc và cái thứ hai,Vietnamese
+phải lưu ý cái điều gì mà quan trọng nhất cái điều quan trọng nhất là khi mà chúng,Vietnamese
+cho nên là tựu chung lại lời khuyên của chúng tôi bây giờ là thứ nhất là mình nên đi thăm khám ở cái cơ sở chuyên khoa,Vietnamese
+thì khi khối ung thư của chúng ta lại phát triển lại tiến triển lên làm cho bệnh nặng lên và cả hai điều ấy dẫn đến,Vietnamese
+nữa là nó khi mình sử dụng lâu dài có thể nó sẽ hỗ trợ trong việc phòng ngừa các biến chứng trong đó những các biến,Vietnamese
+giết chết tế bào ung thư bởi quả chanh có chứa chất chống oxy còn mạnh hơn cả hóa trị nếu duy trì thói quen này trong,Vietnamese
+mà chịu và cách tính dung nạp đối với những các sản phẩm nó cũng khắt khe hơn so với những cái làn da thường em thấy,Vietnamese
+không cần làm gì hết nó sống người ta chữa rất là kinh khủng nó là,Vietnamese
+băn khoăn dạ vâng ạ xin được cảm ơn bác rất là nhiều đã gọi về cho chương trình vâng thưa quý vị và các bạn có thể thấy,Vietnamese
+thể nói là kích thích tuyến tụy tăng tiết insulin mà insulin chúng ta biết rồi đó là cái hormone để mà điều hòa đường huyết cái,Vietnamese
+cái bằng chứng bây giờ cũng chưa đủ để kết luận nhưng cũng đâu đó cũng có những bài báo công bố rằng là nếu như sử dụng,Vietnamese
+chữa lành bệnh nó chỉ giúp cải thiện các triệu chứng mà người bệnh mắc phải mà,Vietnamese
+đến các giai đoạn nặng như vậy thì cái việc mà phẫu thuật nó sẽ trở nên khó khăn như vậy thì tóm lại tùy theo cái,Vietnamese
+gì tôi phải đi khám nhiều nơi quá mà chẳng nơi nào chẩn đoán ra bệnh cả thực ra là gì ạ chúng ta cũng cần nhớ rằng là,Vietnamese
+người ta thấy là cái việc dùng thuốc đối với lại cái để cải thiện tâm lý của người bệnh đó,Vietnamese
+là khi chúng ta sử dụng là nó sẽ cải thiện được cái cái các cái triệu chứng các cái hiệu quả nó rất là tốt nên là,Vietnamese
+của đông trùng hạ thảo nó có tác dụng can thiệp vào cái chuyện điều hòa nhịp,Vietnamese
+có thể các bác sĩ cũng sẽ cho bác một số các cái thuốc để giúp ổn định huyết áp huyết áp hơn của mình nữa bác nhé để cải,Vietnamese
+những biện pháp nào bằng những cách nào và nếu mà một khi mà chúng ta đã bị,Vietnamese
+thường mới là chúng ta hay lo lắng rất là nếu nhưng mà mình giữ sáng ra thì quá nhiều bước hay không và thường người,Vietnamese
+hiệu mà ngày xưa chúng ta vẫn hay phổ biến đấy là gì ạ nâng niu bàn chân việt thì trong trường hợp này của bác bác tìm,Vietnamese
+nghiệm lúc đói khi chúng ta làm xét nghiệm đường huyết chuẩn vân vân nhưng mà hiện nay bên cạnh cái việc mà xét nghiệm cái,Vietnamese
+nghiên cứu rất là kỹ để chúng ta tìm được những sản phẩm mà nó có những hoạt,Vietnamese
+là phải đánh giá các cái cái cái bệnh động mạch là cùng trên người lớn tuổi thường có thể có kèm theo nhiều bệnh có,Vietnamese
+tỷ lệ tử vong chung giảm được ba mươi phần trăm đối với lại những các bệnh lý đái tháo đường đi kèm cũng như là một,Vietnamese
+cũng sẽ rất lâu nên là trong giai đoạn này bác lại càng phải chú trọng hơn cái sức khỏe của mình hơn nữa thứ nhất là,Vietnamese
+trở lạnh nhiều hơn thì cái đau nhức nó tăng lên nó khó chịu hơn và nó ảnh hưởng đến cái vận động đến các cái sinh hoạt,Vietnamese
+cái ca mà bên anh,Vietnamese
+mạch máu nuôi các cơ quan của chúng ta vào một khi được đẩy đến một cái mạch máu là đó có kích thước bằng với,Vietnamese
+cảm ơn câu hỏi của quý khán giả ở bắc giang ở đây thì chúng ta cũng không biết chính xác là bác bao nhiêu tuổi rồi công,Vietnamese
+chủ dược của nó là đông trùng hạ thảo thì chỉ riêng bản thân nó thôi đã rất tốt cho những bệnh lý của bác rồi nó góp,Vietnamese
+mà đã có cái cơn thì đó là thiếu máu não thoáng qua như vậy thì như tôi đã nói là mình đã được,Vietnamese
+bị mắc ung thư thì rất là dễ bị sụt cân đồng thời thì cái sụt cân đấy thậm chí đó,Vietnamese
+tiên ấy chúng tôi rất là khuyên rằng là bác cần phải đi kiểm tra về cái vấn đề là thần kinh sọ não bởi vì sao bởi vì,Vietnamese
+thần kinh sẽ có lưu ý thêm về cái việc sử dụng các thuốc điều trị và parkinson coi nó có ảnh hưởng đến các thuốc điều,Vietnamese
+rất là cũng tốn rất là nhiều thì cho em muốn đi là em đã tìm cách trị rồi nhưng,Vietnamese
+như này thì sử dụng lại rất là hiệu quả và khi nghiên cứu cái củ địa liền này thì người ta nghiên cứu người ta nhận,Vietnamese
+vị có thể đặt câu hỏi cho chúng tôi và với một số câu hỏi đã được các bác sĩ trả lời cũng như là đề cập ở trong chương,Vietnamese
+thảo hiện nay mà nếu chúng ta tìm mua được ở tây tạng thì nó hiếm lắm bởi vì,Vietnamese
+mri thì cái từ trường nó rất là mạnh cho nên là nó sẽ làm sai lệch các hoạt động điều trị của các,Vietnamese
+chúng ta đã ngủ do đó nên tôi khuyến khích bạn là bạn nên sử dụng sản phẩm sữa rửa mặt để mà làm sạch da mặt buổi,Vietnamese
+các tổ chức uy tín nhất trên thế giới đang phát hiện ra rằng sức khỏe não bộ và mặt trái là các bệnh về não được,Vietnamese
+họ rơi vào trầm cảm mà người ta thấy ngay cả những người mổ xong rồi thì các,Vietnamese
+dần dần để chúng ta có thể tức là bằng lý trí để chúng ta có thể ăn được cả bên,Vietnamese
+bì nhức mỏi chân tay hay là hoa mắt chóng mặt rồi giảm cái hiệu chứng rồi triệu chứng về xơ vữa động mạch nữa thì,Vietnamese
+nhàng và nó không có gây tổn thương thành mạch ở đây mà bạn nói là đường dẫn thì đúng,Vietnamese
+phẫu thuật thứ ba là cái mục đích hay là cái cân nặng mục tiêu để mà họ hướng,Vietnamese
+sẽ nhận ngay được phần quà của chương trình ngày hôm nay còn những ai mà chúng ta đang mắc phải căn bệnh là cao huyết,Vietnamese
+bác thì nghe như chúng tôi tiếp nhận đây thì chúng tôi thấy rằng bác có cái đau nhức mỏi ở vùng cổ vai gáy và đặc biệt,Vietnamese
+ta phải rất rất là phòng tránh cái chuyện té ngã bởi vì nếu mà chúng tôi điều trị tất cả các vấn đề xương khớp,Vietnamese
+gì rõ lắm nhưng mà về sau này nó lại ảnh hưởng nhiều hơn kể cả cái câu chuyện là gì ạ đôi khi là cái tư thế vận động tư thế,Vietnamese
+những cái dầu mà nó tốt cho chân tóc cũng như dùng những cái cái dược liệu mà,Vietnamese
+khoảng cách rất lớn trong hiểu biết của chúng ta về cách đáp ứng miễn dịch bắt đầu ông cho rằng phân biệt giữa tự thân,Vietnamese
+tình trạng tim đập nhanh và lộn xộn như vậy đó thì nó sẽ ảnh hưởng đến chức năng tim của chúng ta ở những người mà,Vietnamese
+nên tránh các cái động tác mà đứng lên đi lại nhiều bởi vì là bản thân bây giờ đi cũng khó cái thứ hai nữa là cứ đi đó,Vietnamese
+nhắc nhở để cho người thân của mình uống thuốc được tốt đẹp tốt hơn song song đó,Vietnamese
+chiếc máu thì có thể bị chảy máu không cầm được thậm chí bị nhiễm trùng nếu chúng ta không có dịch vụ phù,Vietnamese
+mình đang căng nên nó rút nó mỏng ra đấy dạ vâng thế thì ở đây chúng ta thấy rằng là,Vietnamese
+trong những cái những cái chỉ định được ưu tiên cho người bệnh parkinson trong trường hợp,Vietnamese
+đến một cuộc cách mạng khoa học trong sự hiểu biết của chúng ta về cơ thể con người và được thiết lập để châm ngòi,Vietnamese
+điều đó ông đã cung cấp cho bạn đọc một góc nhìn khoa học nhưng cũng không kém phần thú vị về vai,Vietnamese
+ứng thích hợp mà chúng kích hoạt trên thực tế ước tính mặc dù khó tính toán,Vietnamese
+thời lượng chúng ta cũng không cần nhiều lắm,Vietnamese
+sinh lý thì họ khi mà bị stress thì các cái hormone như hồi nãy tôi kể,Vietnamese
+khiến cho ba mươi phần trăm số người bị suy kiệt tử vong trước khi mà tử vong,Vietnamese
+rối loạn mỡ máu này thế rồi là những cái dấu hiệu như đôi khi nó cũng có cái thỉnh thoảng đau tức ngực các thứ thì,Vietnamese
+chung của cái người béo phì thì bây giờ mọi người có thể nhìn cái sơ đồ này nó,Vietnamese
+giúp trong cái việc hạn chế được những cái biến chứng về khúc sau cũng như đạt được hiệu quả cao hơn nữa ta dò tìm được,Vietnamese
+khác nhau các vị trí khớp khác nhau trong đó có khớp gối và khi mà cái khớp gối cộng với cái tuổi sáu mươi của mình thoái,Vietnamese
+phẫu thuật thì chúng tôi sẽ thực hiện khoảng năm đến sáu câu hỏi câu hỏi số một đó,Vietnamese
+mà tại sao không đi đường này tại sao lại đau thắt lưng nhiều như thế đau gối nhiều như thế đúng không ạ đấy là việc,Vietnamese
+bạch chính xác ý của mỗi cá nhân đã đóng góp cho một khám phá và không ai làm việc hoàn toàn,Vietnamese
+b có được thụ thể của nó khi phát triển trong tủy xương sự biến đổi gen khi tế,Vietnamese
+dụ như hành vi về rối loạn về thèm ăn trong những người bị cuồng ăn chẳng hạn thì bây giờ mình sẽ phải,Vietnamese
+bệnh nhân bị covid cũng có thể nó gây nên những cái rối loạn và làm cho cái một số bệnh nhân cũng có thể là tăng cái,Vietnamese
+biệt là mỡ động vật thế và chúng ta cũng nên tăng cường rau xanh hoa quả tươi để cung cấp các vitamin các khoáng chất và,Vietnamese
+hay không nói cách khác trạng thái của hệ vi sinh vật quyết định liệu có thể bạn có đang thổi bùng ngọn lửa viêm hay,Vietnamese
+tại sao chất bầu trợ làm điều này hiểu,Vietnamese
+máu lên não và thường không tự sinh ra thay vào đó là hậu quả của một số vấn đề về mặt sức khỏe mà cơ thể đang gặp phải,Vietnamese
+cái mà có thể nói rằng là ở cái tuổi sáu mốt mà mình đã phải chịu đựng hai hai cái cái căn bệnh như vậy thì rõ ràng là nó,Vietnamese
+với cơ chế của cái hình thành cục máu đông ở trong tim giờ đó nên thuốc chống tiểu cầu không phải là cái gì,Vietnamese
+hợp giúp cho mình có thể thực hiện những cái công nghệ những cái cuộc gọi như thế này chúng tôi xin được quay trở lại cuộc,Vietnamese
+mặt xong làm cho chúng ta cảm thấy nó khô căng là những cái sữa rửa mặt nó thường có chứa những thành phần các chất,Vietnamese
+tăng sắc tố và ở các vị trí đó thì cái túi sắc tố này sẽ phóng thích ra những cái hạt sắc tố thì để mà chúng,Vietnamese
+tâm thế rất là lo lắng khi mà tìm vắcxin,Vietnamese
+có một số lưu ý như là mình không ăn các thực phẩm chế biến sẵn nhiều này mình không sử dụng các cái rau đối với người,Vietnamese
+mới nói nếu chẳng may mà cục máu đông đó lại chảy vào động mạch vành tim có nghĩa động,Vietnamese
+kè nó chứa phần lớn cái gọi là kẽm ở,Vietnamese
+rung nhĩ không có biện pháp nào có thể xóa bỏ rung nhĩ thì chúng ta phải chấp nhận sống chung với nó mà khi chấp nhận,Vietnamese
+đến bệnh viện để có cái thăm khám cũng như là đánh giá một cách chính xác thì sẽ rất là tốt và nếu mà bác chưa có điều,Vietnamese
+nhất là chúng ta có thể làm một số các cái động tác vươn vai nho nhỏ thì chính những cái động tác như vậy cũng là những,Vietnamese
+trong não với một cái hệ thống định vị xác định chính xác vị trí nhân mà mình muốn vào sau đó mình sẽ đưa các điện,Vietnamese
+nhất là cân bằng cân bằng và cân bằng giúp cho bệnh nhân kiểm soát những tác,Vietnamese
+cột sống đau vai gáy đau thần kinh tọa thần kinh liên sườn tê buồn chân tay,Vietnamese
+sức khỏe cũng như là dự phòng các bệnh lý về tim mạch về thần kinh thì có rất,Vietnamese
+cái giai đoạn mang thai thì các chị em phụ nữ phải đối mặt với nhiều cái thay đổi về nội tiết và người ta cho rằng,Vietnamese
+cùng chuyên gia và thưa tất cả quý vị chương trình của chúng ta người hôm nay rất vui khi nhận được sự tham gia và đồng,Vietnamese
+đeo khẩu trang tuy nhiên thì cái quá trình lấy mẫu thì như hồi nãy trên video,Vietnamese
+trùng nguy hiểm đến tính mạng nếu chúng phát triển quá mức căn bệnh đó đặc trưng bởi triệu chứng tiêu chảy dữ dội vẫn,Vietnamese
+đường huyết rối loạn mỡ máu đột quỵ hoặc nhồi máu cơ tim chính vì vậy mà việc điều trị béo phì đó là bên cạnh cái việc,Vietnamese
+sự là tăng sinh mạch máu của người tăng tính thống của các thành mạch do đó nên những cái sản phẩm chúng ta dùng của đôi,Vietnamese
+không nên chúng ta lại còn ngâm nước nóng nữa thì cũng lại rất là không nên mà chúng ta nên gượng nhẹ nên tránh các,Vietnamese
+tháo đường là điều đầu tiên là chúng ta phải xem là cái chỉ số đường huyết của chúng ta là bao nhiêu à khi chúng ta xét,Vietnamese
+chúng ta ta sống đến tám mươi chín mươi nhưng mà cái hệ thống thần kinh của chúng ta nhớ nhớ quên quên chúng ta chả còn nhớ được,Vietnamese
+chất nào có thể kích thích làm tăng cái vị giác của người bệnh không và chúng ta,Vietnamese
+đúng rồi câu hỏi này nhiều chị em quan tâm cho lắm thế thì chúng ta biết là thế này nè ta thấy cái chu kỳ của của tóc,Vietnamese
+dụng như một loại vắcxin trong khi các phân tử protein như độc tố bạch hầu,Vietnamese
+dịch của bạn được triển khai trong ruột rất đơn giản thành ruột là biên giới với thế giới bên ngoài bên cạnh da đó là nơi,Vietnamese
+giảm cái bệnh tình của mình thì đây cũng như là một cái lời khẳng định cho cái tác dụng của sản phẩm của chúng tôi vừa giới thiệu tới ông và trong thời tiết,Vietnamese
+biết sự tiếp cận dễ dàng với các sách giáo khoa cũ ông thấy khá rối rắm nghiên,Vietnamese
+đến sức khỏe của mình thế còn những cái dấu hiệu hồi hộp trống ngực thì mình cũng xem nếu mà có gì đi thăm khám xem là có mình,Vietnamese
+khuẩn phân chia nó cần xây dựng một thành tế bào để bao bọc hai tế bào con điều quan trọng là quá trình này phức,Vietnamese
+thập niên trước khi mắc các bệnh tim mạch và ung thư và họ không mắc chứng trầm cảm nhiều tỷ lệ suy giảm nhận thức,Vietnamese
+ảnh hưởng gì nữa có những người khi tê không để đi bộ được không thể sử dụng cái tay được kể cả như là cầm nắm hoặc,Vietnamese
+là sự chăm sóc từng bữa ăn từng giấc ngủ từng các cái vui chơi giải trí ở trong,Vietnamese
+ta biết là cái suy giãn tĩnh mạch nó cũng liên quan đến quá trình lão hóa liên quan quá trình thoái hóa các cái mạch,Vietnamese
+động mạch để mà nuôi não và nuôi tim đặc biệt là nuôi tim và từ đó nó có thể làm,Vietnamese
+tất cả đấy là những lời có cánh những cái lời mà nó chả có tính khoa học gì cả thế cho nên là điều đầu tiên khuyên bác là,Vietnamese
+không hiểu đau đớn một tí nào cho đến bây giờ thì mình coi rất là là sung,Vietnamese
+sinh của một cá nhân đây là một trong những sự kiện có ảnh hưởng nhất trong việc xác định kết quả chức năng của hệ,Vietnamese
+trước và chúng ta sẽ phải đương đầu với nó cái vấn đề xương khớp của chúng ta bây giờ khi nó bị loãng xương cho nên nó,Vietnamese
+ngày nó có một cái áp lực lên đó nó sẽ làm tổn thương các tế bào nội mạc cũng như là những cái tình trạng rối loạn mỡ,Vietnamese
+các cái nguy cơ xơ vữa động mạch đấy vì rồi vì là những người rối loạn mỡ máu thì cứ nguy cơ xơ vữa động mạch cũng rất,Vietnamese
+còn có hai cái thuốc khác mới vào đang vào thị trường nữa mình có những cái lựa chọn như vậy có,Vietnamese
+nó giúp cho cái gì thứ nhất là nó thanh trừ các gốc tự do nó làm chậm quá,Vietnamese
+là với cái tầm tuổi của bác cũng như bệnh lý như vậy thì chương trình rất mong là bác tìm đến đông trùng hạ thảo,Vietnamese
+mái để nhân viên lấy mẫu và nhân viên y tế lúc đó thì đứng sang một bên là không,Vietnamese
+không biết là cái rối loạn mỡ máu là của bác có không ạ có à đấy,Vietnamese
+nhiều cái trục trặc lắm và một trong những trục trặc thường gặp là rụng tóc và tất nhiên rồi có rất nhiều nguyên,Vietnamese
+hầu hết các nghiên cứu dựa trên sự tò mò nhận được tài trợ từ chính phủ chứ không,Vietnamese
+tiêu hóa của chúng ta để mà có thể đi vào quá trình tiêu hóa được cho nên là vấn đề khô miệng này rồi khó nuốt này,Vietnamese
+não đột quỵ đó thì nó liên quan đến việc hình thành các cục máu đông và việc cục máu đông đã nó trôi ra là đi,Vietnamese
+nghệ gì trong việc điều trị rụng tóc thưa bác sĩ cảm ơn câu hỏi của em giới trẻ thì thường hay bắt đầu tìm đến với,Vietnamese
+lượng và các sản phẩm này phần lớn từ thiên nhiên đó và giúp cho ổn định cái mái tóc của chị em bên cạnh vấn đề chúng,Vietnamese
+bên cạnh đó thì không chỉ có người bệnh mà cả người nhà nữa cũng cần phải động viên vừa hạt qua một chút những cái sở,Vietnamese
+ở người lớn tuổi đó thì nó có rất là nhiều ví dụ như là các tỷ lệ rung nhĩ ở,Vietnamese
+dụng là bảo vệ tim mạch lạc vừa phục hồi tế bào thần kinh và ít có sản phẩm nào thực hiện được đồng thời hai cái tác,Vietnamese
+là một cái yếu tố có một số những cái yếu tố rất là quan trọng giúp cho chúng ta có thể giúp cho tế bào ung thư chết,Vietnamese
+là bốn tuần tại sao lại là thời điểm bốn tuần bởi vì chúng ta biết là da của,Vietnamese
+năng dự đoán nhiều điều từ nhiều năm trước những người khác ông trả lời một cách tự tin rằng,Vietnamese
+sâu như vậy thì cái quá trình lập chương trình kích thích não sâu sau mổ ở bệnh,Vietnamese
+muốn đi mua sắm một cách quá mức ham muốn những cái hoạt động khác mà trước đây bệnh nhân đang bị ức chế bệnh nhân,Vietnamese
+đau gối ạ nói chung là đau hai gối này lưng này,Vietnamese
+viêm tắc chúng ta bị viêm tĩnh mạch đấy là những biến chứng mà những người bị suy giãn tĩnh mạch nhiều khi mà chúng ta,Vietnamese
+daflon hay dùng rutinc hay dùng các vitamin c vân vân để chúng ta tăng cường,Vietnamese
+các ph là khoảng chín đến mười tức là một cái ph ở mức độ kiềm thì cái ph này cao,Vietnamese
+thì những cái nhóm thuốc này nó đều có những cái tác dụng phụ lên đường tiêu hóa như là bệnh nhân có thể đầy bụng,Vietnamese
+của chương trình và vấn đề về tập luyện thể lực thì sẽ có các bác sĩ về phục hồi chức năng để tư vấn lên chế độ tập luyện,Vietnamese
+nào tôi cũng phải vịn lúc nào tôi cũng phải bán bởi vì sao chẳng may mình sẩy chân chẳng may mình có những câu chuyện,Vietnamese
+trắng hoặc là chiết xuất từ hoa thủy tiên biển nó đều làm tăng với hiệu quả để mà giúp cho quá trình sáng da,Vietnamese
+quốc ở triều tiên ở nhật bản ở hàn quốc người ta nghiên cứu rất là kỹ và có thể,Vietnamese
+thấy điều này có thể khó hiểu nếu bạn hỏi bác sĩ của mình về một phương pháp chữa trị đã biết cho chứng tự kỷ đa xơ,Vietnamese
+vì chúng ta nếu mà ăn các thức ăn nào mà có nhiều vitamin k lắm mà các bạn có thể,Vietnamese
+penicillin vẫn còn hiệu quả trên một số lượng lớn vi khuẩn nó gắn vào các phân,Vietnamese
+thảo thì chúng ta phải rất là thông thái chúng ta phải rất là khôn ngoan ở chỗ là,Vietnamese
+quỵ có nghĩa là máu mạch máu nó có bị tắc nghẽn và não ta không còn nuôi một,Vietnamese
+nguy cơ cao bị xảy ra các biến cố đột quỵ hay không ví dụ như nếu mà người đó bị đột quỵ nhưng mà chúng ta thay không,Vietnamese
+phận người dân chúng ta cũng có cái,Vietnamese
+não bằng ngôn ngữ riêng của chúng thông qua dây thần kinh phế vị khi nghĩ đến hệ thần kinh có lẽ bạn sẽ,Vietnamese
+thần kinh tọa của bác nó bị chèn ép nhiều lên không phải nó sẽ đau nhiều đâu mà nó còn có thể liệt luôn chính vì vậy,Vietnamese
+hoặc là cái tia sáng xanh nó bằng việc sử dụng kem chống nắng họ đầy đủ cụ thể là đối với sữa rửa mặt hoặc là toner để,Vietnamese
+lộn với chứng mất ngủ và căng thẳng điều này cũng ảnh hưởng đến hệ miễn dịch của chúng ta tìm hiểu xem một yếu tố khác,Vietnamese
+dịch bệnh đậu mùa làm cho hoàng gia anh lo lắng đặc biệt cho sự an toàn của con cháu họ những người trong hoàng tộc đã,Vietnamese
+tại phòng cấp cứu và không phải là một người đánh giá đâu huy động một ekip,Vietnamese
+bệnh lý nền mà bác hiện nay đang được đang bị vấp phải và đặc biệt nó còn tốt cho cả sức đề kháng và sức miễn dịch ở,Vietnamese
+béo phì nó là một trong những cái dạng nè bệnh rối loạn chuyển hóa mạn tính,Vietnamese
+cải thiện thêm mà người bệnh sử dụng phương pháp phẫu thuật kích thích não sâu và người bệnh sẽ giảm các cái thuốc đó đi thì,Vietnamese
+dẫn đến tỷ lệ bệnh tự miễn tăng lên không tôi tin rằng bạn sẽ thấy cuộc thảo luận này vừa khai sáng vừa trao cho bạn,Vietnamese
+trong chương trình của chúng ta cũng sẽ gửi đến cho quý vị và các bạn những câu hỏi tương tác để quý vị có thể nhận,Vietnamese
+vai trò của các hoạt chất trong quá trình ức chế sự xuất sắc tố là sao thì như chúng ta thấy đó là dưới tác động,Vietnamese
+cơ quan trong cơ thể của chúng ta à từ cái chuyện đầu tiên là nó nâng cao cái,Vietnamese
+cùng x��y ra và cái thứ hai nữa là liệu là cái việc mà chúng ta giống như bác nói là đi khám ngã rồi đi kiểm tra chẳng,Vietnamese
+biết như vậy nhưng mà sau này khi mà y học hiện đại người ta mới phân tích thì người ta thấy rằng là à cái đuôi có tắc,Vietnamese
+lại ảnh hưởng đến nội tạng là bởi vì khi mà chúng ta sử dụng vào trong thì tất cả những cái cơ quan nội tạng của chúng ta,Vietnamese
+tục sử dụng phẫu thuật vi phẫu thuật sử dụng kích thích não sâu này trong kiểm soát triệu chứng của người bệnh cho nên,Vietnamese
+sự thành công đó là cái tâm lý của mình đã được giải tỏa và thoải mái khi mà bước vào phẫu thuật và nói như vậy thì,Vietnamese
+trước đại dịch như thế này thì thực sự rất là nhiều thách thức nhưng thách thức ấy có vượt qua được hay không thì phần,Vietnamese
+cái mạch vành đấy mà thường cái này là trên những bệnh nhân bị huyết áp cao là thường do xơ vữa động mạch chị ạ những,Vietnamese
+trường hợp của những người bị tăng huyết áp các bệnh lý về tim mạch thì cái nguy cơ hình thành các mảng xơ vữa là rất cao,Vietnamese
+dụng là ức chế sẽ sinh sắc tố nữa như vậy thì chúng ta sẽ vừa phục hồi được cái làn da trong quá trình điều trị mà,Vietnamese
+thì hầu như cũng đồng nghĩa với việc duy trì được các chức năng bình thường của cơ thể và vấn đề thứ tư đó là dinh dưỡng,Vietnamese
+đối với các cái đạm thực vật ở trong đối với người bị ung thư cũng rất là quan trọng mà không chỉ cung cấp đây là nói,Vietnamese
+con chuột đã được tiếp xúc với lipopolysaccharide hoặc lps hợp chất,Vietnamese
+mà cũng bị bệnh gì bác ạ dạ vâng ở đây thì vâng ở đây thì có lẽ,Vietnamese
+quỵ trong cái thời gian tiếp là bao nhiêu sau khi mà đã có được cái nguy cơ đó rồi,Vietnamese
+mạch của những người có tuổi và những người cao tuổi khi mà chúng ta sử dụng đông trùng hạ thảo thì nó có thể nói là,Vietnamese
+xác như vậy thì mình sẽ đặt các điện cực và mình cố định lại thì mình sẽ tiến hành hai bên trên cái thời gian mà bệnh nhân,Vietnamese
+của chúng ta tăng hoạt động như vậy thì sẽ hình thành nên những cái tô vít gọi là túi sắc tố những cái túi chứa sắc,Vietnamese
+thiết bị máy móc vi điện cực vi sóng vi điện cực đó và đánh giá một cách trực tiếp trên thực tế người bệnh một cách chính,Vietnamese
+cái việc mà thoái hóa đốt sống thì gần như là ở người bệnh cao tuổi gặp phải khá là nhiều tuy nhiên thì ở người trẻ,Vietnamese
+dành cho một cái làn da nhạy cảm chẳng hạn chúng ta cố gắng chúng ta không chọn lựa những cái sản phẩm mà rửa,Vietnamese
+trung bình những người mắc bệnh tâm thần nặng chẳng hạn rối loạn lưỡng cực và tâm,Vietnamese
+chuyện gì đang xảy ra ở đây trong vài năm qua nghiên cứu mới đã cho chúng ta,Vietnamese
+khớp gối tê buồn chân tay giảm đáng kể và hết hẳn sau từ một đến ba tháng qua,Vietnamese
+điểm đặc biệt đáng quan tâm ở đây chính là những tác động tiêu cực của tình trạng kỳ thị đối với cái bệnh béo phì,Vietnamese
+sẽ khó thở nhiều hơn có thể lúc trước chúng ta gắng rất nhiều nó khó thở bây giờ chỉ gắng sức nhẹ nó khó thở thôi thậm chí là,Vietnamese
+tuy nhiên điều đó nói lên rằng chúng ta phải thừa nhận các bằng chứng vẫn tiếp,Vietnamese
+triệu chứng nhưng đây nó là một sản phẩm mà nó tác động vào cái nguyên nhân cơ chế vệ sinh của bệnh đó chính là cái,Vietnamese
+của chúng cho con cái mặc dù thông qua các cơ chế khác nhau những loại khác này,Vietnamese
+và một chế độ dinh dưỡng đầy đủ trước khi chúng ta bước vào trận chiến với lại cái khối u đó để được các bác sĩ có thể điều trị,Vietnamese
+dựng và bồi đắp cho cái niềm tin tích cực và lành mạnh cũng như là cái này là mình đã thay đổi nhận thức của họ thay,Vietnamese
+tác động tiêu cực đến một số khía cạnh ở trong công việc nhất là những cái công việc mà đòi hỏi mình phải di chuyển,Vietnamese
+nên kêu gọi một cái sự hỗ trợ chung cho cái người gia đình cũng như là người thân hay bạn bè của mình đối với gia đình thì,Vietnamese
+thể đi được sinh hoạt hàng ngày thì rất là cuộc sống rất là khó khăn m�� nhất là,Vietnamese
+nên là bản thân cái việc nuôi dưỡng kém này nó đã ảnh hưởng đến xương khớp của chúng ta nó đã gây ra đau nhức rồi nó đã,Vietnamese
+ta thấy đối với những người cao tuổi mà khi bị mắc covid đặc biệt là có các cái bệnh lý nền như là huyết áp cao rồi là,Vietnamese
+nó sẽ bị nặng nề hơn hay là nó có khi nó bị xáo trộn trong cái việc mà kiểm,Vietnamese
+hoàn toàn ô thế là mình điều trị xong rồi xong rồi cứ ba tháng xét nghiệm một lần hay là sáu tháng xét nghiệm một lần,Vietnamese
+vành bác đã đặt stent rồi và bác cũng đang dùng thuốc rồi các cái thuốc để để để hỗ trợ cho mình trong cái vấn đề bảo vệ cái,Vietnamese
+ta không sử dụng iod trước khi chúng ta dùng xạ trị hai tuần để làm sao chúng ta bỏ đói cơ thể chúng ta như là tình,Vietnamese
+chất dưỡng ẩm cao hơn ví dụ như là có chứa những cái hoạt chất hyaluronic acid hoặc glycerin nồng độ cao,Vietnamese
+đều và phát sóng trực tiếp nên trong quá trình bác sĩ trao đổi quý vị có thể đặt câu hỏi liên quan về các vấn đề của,Vietnamese
+tập bác có thể đạp xe tại chỗ ví dụ như vậy thế thì nhiều bác lại bảo là bây giờ tôi có cái xe đạp tôi thích đạp ra ngoài,Vietnamese
+dụng công nghệ sinh học đó và trong đó có một thành phần gọi là tocotrienol thì đây là một cái cái thành phần trong,Vietnamese
+béo phì đó cải thiện được cái chất lượng cuộc sống nó tốt hơn và đó cũng chính là không chỉ là cái quyền mà còn là một cái,Vietnamese
+mặt với một cán cân người ta gọi là một bên là các thành phần oxy hóa như là gây,Vietnamese
+bác đang gặp phải cũng như là để giảm thiểu cũng như là hỗ trợ điều trị cái việc đau xương khớp của bác đúng không ạ,Vietnamese
+là nhiều người bị ung thư bị gầy đi hẳn hoi nhưng cứ bảo là chúng ta bỏ đói tế,Vietnamese
+chứa nhiều kẽm và selen thì selen và kẽm đều là hai chất chống oxy hóa là,Vietnamese
+thì người ta đánh giá được là các cái hoạt chất kga1 mà so sánh với các cái hoạt chất chống viêm của y học hiện đại thì,Vietnamese
+dư da đó là dần dần nó sẽ cải thiện người trong quá trình mà quản lý cân nặng đó tiếp tục duy trì cái hiệu quả,Vietnamese
+ngoại khoa thì là cái từ trong chuyên môn nhưng mà để nói cho dễ hiểu đó là mổ thì người ta có chia làm hai cái nhóm,Vietnamese
+đề là dự phòng là hỗ trợ điều trị các bệnh lý đường tiêu hóa đấy là cái rất hay cho nên là cái việc không phải tự,Vietnamese
+phẩm thì sẽ giúp cho quý vị và các bạn chúng ta lựa chọn được một cái thực phẩm bảo vệ sức khỏe tốt nhất cho bản thân,Vietnamese
+cơ quan khác từ tay chân cho đến xương cột sống mặc dù không bị gãy xương nhưng mà điều đấy nó cũng không có nghĩa rằng,Vietnamese
+làm sao cái số lượng nó rất ít cái nhu cầu của cả xã hội của cả thế giới người ta đều muốn như vậy thì làm gì đáp ứng,Vietnamese
+chúng ta mang nó đi chúng ta đưa trao cho người khác và người khác lại trao cho người khác nữa như vậy thì để chúng ta,Vietnamese
+cái bệnh lý nền như là huyết áp cao mỡ máu cao mà một thời gian sau đó,Vietnamese
+đó về phía người bệnh parkinson ở việt nam thì sao ở tại việt nam thì cũng chưa,Vietnamese
+cảm giác châm chích hoặc là cánh kéo hoặc là bỏng rát ngứa sau khi mà tiếp xúc với lại những cái tác nhân vật lý ví,Vietnamese
+một cái phẫu thuật người ta gọi là ít xâm lấn tức là có thể là bệnh nhân đa số là bệnh nhân sẽ được mổ tỉnh bằng một,Vietnamese
+đó điều này sẽ giúp bảo vệ sức khỏe và chức năng não bộ của bạn,Vietnamese
+giác ăn rất là khó khăn thậm chí có bệnh nhân kể với chúng tôi là các em ăn bằng,Vietnamese
+chúng tôi biết thêm là trong cái phần trong cái cái cây nấm đông trùng hạ thảo thì cái thành phần nào có cái giá trị dinh dưỡng cao nhất và được để điều chế,Vietnamese
+dung nạp đối với các chất với giảm do đó nếu chúng ta sẽ hạn chế dùng những cái kem chống nắng mà có nguồn gốc từ hóa,Vietnamese
+trạng là thiếu canxi cái thứ hai nó đôi khi là do chế độ ăn của chúng ta nó cũng thiếu thế cả hai những cái vấn đề này thì chúng ta nên đi khám để có một cái,Vietnamese
+cái hệ cơ xương khớp thật là khỏe mạnh tuy nhiên thì bác cũng đã gặp phải tai nạn rồi cho nên cái việc mà khắc phục,Vietnamese
+chính những yếu tố này cũng đóng góp và làm cho tóc nó rụng vì chúng nghe nói rồi stress mà căng thẳng mà đó như vậy,Vietnamese
+quan trọng cũng như các hóa chất trên não bộ bao gồm các vitamin và các chất dẫn truyền thần kinh giúp bạn đương đầu,Vietnamese
+đổi khứu giác này rồi buồn nôn này nôn này và tiếp đến nữa đó chính là chức năng,Vietnamese
+buộc phải quay trở lại cho bác sĩ mạng kinh để người ta kiểm tra lại cái máy những những cái vấn đề điều trị khác có,Vietnamese
+thì chúng ta phải làm sao hồi phục cái cơ đấy mà đều hồi phục cơ thể rất cần đến các axit amin mạch nhánh axit amin,Vietnamese
+cũng làm sạch da nè khi chúng ta sử dụng toner một cái serum đặc trị nào đó cho các vấn đề của da phù hợp với vấn đề,Vietnamese
+người ta kiểm soát được nhưng nếu khi mà mình tự ý sử dụng hoặc là đôi khi chúng ta có thể gọi là quá lạm dụng đi chăng,Vietnamese
+đất chúng là dạng sống ban đầu của hành tinh và có có thể sẽ là cuối cùng tại,Vietnamese
+rồi nâng cao sức đề kháng cũng như là cô điều trị cái bệnh nền của cô cho ổn định,Vietnamese
+chung đó là tập thể dục vừa sức và nó chạy đều ra thì nó nó sẽ tốt hơn cho sức khỏe của mình hơn là những cái tập,Vietnamese
+chúng ta coi đó đột quỵ với qua nó là một thì vẫn là phù hợp,Vietnamese
+ngón chân ngón tay lại hai khớp ở bả vai hai khớp nói chung các,Vietnamese
+cực có hai loại pin sạc và pin không sạc theo bác sĩ thì tôi nên chọn loại pin,Vietnamese
+cô lập càng xa lánh càng tránh né để mà,Vietnamese
+rất là nhiều đấy là một trong những cái thuốc chống viêm chống chỉ định để điều trị trong các bệnh gút trừ phi những cái,Vietnamese
+là đối với những công dân mà đã được thực hiện cách ly thì chúng ta cũng đừng,Vietnamese
+biểu hiện của cái thoái hóa cột sống của chúng ta dường như nó không phải là quá không phải ở những giai đoạn rất là sớm,Vietnamese
+cô không có nêu các bệnh nền nhưng mà cô lại nói là cái bệnh của cô là phải uống thuốc định kỳ hàng tháng nhưng mà do,Vietnamese
+cũng biết là tóc em bạc sớm á thì em can thiệp về cái thuốc nhuộm tóc nhiều thì,Vietnamese
+người thì anh cũng không nên ghé vào không nên cùng góp phần đông người vào trong đó mà nên giữ cái khoảng cách,Vietnamese
+từ bác sĩ mà thực tế qua sử dụng thì có rất là nhiều các khách hàng của chúng tôi đã phản ánh lại là thì sản phẩm này,Vietnamese
+thiểu năng động mạch cảnh hay là máu đi lên não này cũng như là các cái động mạch chi như tê bì kiến bò ở bàn,Vietnamese
+trình và chúc bác thật là nhiều sức khỏe vâng vừa rồi thì chúng ta thấy là rất là nhiều người bệnh cao tuổi đúng không ạ,Vietnamese
+lẫn xã hội và trong cái điều trị y học những cái bệnh lý phức tạp như là béo,Vietnamese
+sĩ chuyên gia này sẽ giúp cho chúng ta trong cái việc điều trị với chúng ta không nên coi các phạt quảng cáo những,Vietnamese
+viên trong ngày chia được sáng chiều đấy là vấn đề thứ nhất vấn đề thứ hai là bác bị thoái hóa đương nhiên là chúng ta,Vietnamese
+vọng rằng cái cảm giác đau rát miệng loét miệng của bố bạn sẽ nhanh khỏi để bố có thể ăn được và chỉ có ăn thì mới,Vietnamese
+là từ xa xưa đến nay khi cha ông chúng ta sử dụng một loại thảo dược nào mặc dù nó,Vietnamese
+của huyết áp ở tiểu đường là ức chế sự hình thành phát triển của mảng vữa xơ là,Vietnamese
+thương tích gây lên một lối lo ngại,Vietnamese
+được cái chất béo tốt thì nó sẽ tốt cho sức khỏe của hệ tim mạch thế rồi khi chúng ta sử dụng các cái loại hạt đó thì,Vietnamese
+trong hệ thần kinh ruột và hệ thần kinh trung ương của chúng ta còn được gọi là dây thần kinh sọ số mười nó kéo dài từ,Vietnamese
+mạch nơi khác chúng ta phải điều trị làm sao đó để ngăn chặn quá trình hình thành các cục máu đông ở,Vietnamese
+đến kế phần mà gọi là những cái hậu quả nặng nề của ung thư một cách nhanh chóng hơn rất nhiều,Vietnamese
+kiểm soát tốt thì có thể gây ra rung nhĩ vân vân thì việc đầu tiên nhất nếu mà chúng ta chưa phải là một người run nhĩ,Vietnamese
+xạ trị thì để làm được điều đó thì một cách rất là đơn giản đó là trong chế độ ăn của người bị bệnh ung thư thì phải,Vietnamese
+khỏe của người ung thư thì chúng ta sẽ sử dụng nước của trái cây thế rồi chúng ta có thể ví dụ như nước dừa cũng rất là,Vietnamese
+một cái vị thuốc của y học cổ truyền có tác dụng bình gan tiềm dương an thần vâng và rất hay điều trị trong những các,Vietnamese
+những cái rủi ro và liên quan thuần túy về kỹ thuật đôi khi mình sẽ tính toán tọa độ nó không chính xác hoặc là những,Vietnamese
+trợ của cộng đồng thôi như bản thân người ung thư thì phải vượt lên tất cả những cái gì những cái khao khát những cái gì,Vietnamese
+nếu chưa đến được bệnh viện thì chúng ta nên đến cơ sở y tế gần nhà thì được khám và và điều trị thuốc huyết áp ngay tại,Vietnamese
+có những dấu hiệu nghi ngờ mắc bệnh tuy nhiên ở đây thì bác sĩ hà có nhắc đến một vấn đề là cấp cứu thì trong thực tế,Vietnamese
+thì cứng đờ thì triệu chứng những triệu chứng này kích não sâu nó sẽ giúp cải thiện được và,Vietnamese
+có thể tự tin hơn trong cuộc sống và có thể là đưa cuộc sống chúng ta lên một cái tầm cao mới hơn xin được cảm ơn,Vietnamese
+định có thể tiến hóa đầu tiên để chống lại bệnh tật và chỉ sau này khi sự sống,Vietnamese
+là hiện nay thì đông trùng hạ thảo thì rất là tốt cho sức khỏe của mình rồi thế nhưng làm thế nào chúng ta hiểu được cái công dụng của đông trùng hạ thảo ra sao,Vietnamese
+hai quá trình đều làm thay đổi hệ vi sinh đường ruột ở trẻ sơ sinh khỏe mạnh điều có thể là cơ chế làm tăng nguy cơ,Vietnamese
+chọn lựa những cái sản phẩm mà có chứa những chất hoạt động bề mặt như là có chứa các thành phần sls là sodium,Vietnamese
+phòng cũng là hỗ trợ các bệnh lý của chúng ta như thế nào đấy là điều mà tôi,Vietnamese
+nó có hai cái nhóm biểu hiện khác nhau đúng không biểu hiện thứ nhất là liên quan đến cái việc vận động này các cái,Vietnamese
+đang gặp phải cái bệnh lý về tim mạch nè huyết áp cao mỡ máu cao bệnh lý tiểu đường hoặc là bệnh lý về mặt thần kinh,Vietnamese
+ta dùng thuốc tiêu sợi huyết để mà chúng ta có thể tiêu nó được thì thôi chúng ta không có cần phải dùng tới biện pháp mà,Vietnamese
+làm sao để tìm được kem dưỡng sáng da phù hợp với da nhạy cảm nhiều mụn cháu,Vietnamese
+hư tổn rất là nhiều bác sĩ có thể cho biết cách để phục hồi lại mái tóc và nên cung cấp cái dinh,Vietnamese
+co mạch rồi nó gây nhiều ảnh hưởng đến sức khỏe nó chung riêng chỗ nang tóc thì,Vietnamese
+thì người ta thấy rằng những bệnh nhân đó thì họ cũng không có đến với lại các,Vietnamese
+những cái thứ đó thì bao giờ nó có tác dụng không mong muốn nó có thể gây tổn thương dạ dày nó gây tổn thương gan tổn,Vietnamese
+sinh khám phá thích hợp nhất trở lại nơi tất cả bắt đầu là với tiêm chủng hiện,Vietnamese
+có các huyết áp bắt đầu nó lên cái điểm cao và lại có cái rối loạn nhịp tim ở những cái tình trạng rối loạn mỡ máu thì,Vietnamese
+ta đã từng gặp trong trong lịch sử vì thế nên là cúm a thì là một bệnh lý và,Vietnamese
+ta sẽ kéo nó ra hiệu gọi là lấy huyết khối lấy cục máu đông đó bằng dụng cụ,Vietnamese
+loét ở niêm mạc miệng thì nó được dễ dàng hơn thì bố sẽ ăn có cái cảm giác ngon hơn và đặc biệt là khi mà bố bạn bị,Vietnamese
+hưởng tới cái sức khỏe thì thật sự là một cái quá trình dài hơi và nó không có,Vietnamese
+chua thì sẽ cảm giác xót sẽ là đỡ nhất và chú ý bổ sung cho bố các cái vitamin,Vietnamese
+chỉ có còn hỏi gì thêm không à vâng ạ từ đầu chương trình tới giờ thì tôi thấy là rất là nhiều các khán giả đều có chung,Vietnamese
+trình sản sinh sắc tố mà cụ thể đầu tiên đó là chúng ta dùng chống nắng bởi vì,Vietnamese
+được tốt hơn đấy là chưa kể nói chuyện là gì nó còn tăng cường cái sức đề kháng và kéo dài tuổi thọ dạ vâng ạ tăng cường,Vietnamese
+nước nhất là ví dụ như nước và củ cải đỏ rất là tốt nước cà rốt rất là tốt nước ép táo thì tất cả những cái nước,Vietnamese
+thì tâm lý thì mình thấy rõ ràng là cái nhận thức của người ta đó thì người,Vietnamese
+thưa tất cả quý vị trong suốt thời gian phát sóng chương trình nếu như quý vị có những thắc mắc có những câu hỏi băn,Vietnamese
+nếu ta không có động thái gì kịp thời ngăn chặn những chuyện về sau á thì nó sẽ xảy ra đột quỵ sau đó thì tỉ lệ,Vietnamese
+ghi nhận dù đã tiêm đủ mũi hoặc là gần,Vietnamese
+làm sạch dưỡng ẩm và chống nắng thì ví dụ như là buổi sáng thì chúng ta làm sạch da sau đó chúng ta sử dụng một cái,Vietnamese
+về những cái nơi điều trị và có những cái định hướng cho cái việc điều trị sắp tới của mình và đương nhiên là để mình khẳng,Vietnamese
+cho cái việc mà tổng hợp nên hemoglobin khá là nhiều bản thân chúng ta cũng rất dễ bị thiếu sắt nhưng chúng ta không,Vietnamese
+lại sử dụng như bình thường tức là chúng ta chỉ kiêng khi trước khi chúng ta điều trị bằng xạ trị một ba mốt hai tuần thì chúng ta,Vietnamese
+loại rau quả như súp lơ mầm đậu xanh có các chất và kẽm selen tốt cho bệnh nhân,Vietnamese
+đến mình đau đầu rồi hoa mắt chóng mặt này ở kia ở mạch vành hay là ở tim,Vietnamese
+có nghĩa là sẽ có đau ngực dữ dội kéo dài kèm nên những triệu chứng nặng nữa,Vietnamese
+thể là cải thiện được một cách toàn diện cho,Vietnamese
+mắt rồi là có đôi lúc là nó bị tê bì chân tay trong một cái lần là tôi bị một,Vietnamese
+để phục hồi sức khỏe sức đề kháng cho chúng ta cũng như là có một cái chế độ vận động tập thể dục nhẹ nhàng phù hợp,Vietnamese
+những người xung quanh là rất rất là cần thiết và như vậy thì cái đội mà điều trị,Vietnamese
+cuối cùng cho nên cái việc mà anh đi khám nhiều lần như này chúng tôi rất là ủng hộ anh và chúng tôi vẫn khuyên là gì,Vietnamese
+kiểu khó thở này đau tức ngực này huyết áp thì không ổn định này và đi khám thì đã được chẩn đoán là thêm nữa,Vietnamese
+hợp nào chúng ta nên tiêm vắcxin phòng,Vietnamese
+người lấy mẫu cách khoảng những người khác chứ không phải là cùng một cái địa,Vietnamese
+tuyệt đối không nên sử dụng máy lạnh và những người công dân được cách ly lai,Vietnamese
+tốt thế cho nên là mình phải có cái như vậy để tái khám để làm sao thì các thầy,Vietnamese
+sống chung với nó rồi thì chúng ta phải tìm cách hạn chế tối đa phòng ngừa những cái biến chứng bệnh do nó ra ví dụ đối,Vietnamese
+đến cuộc sống thì có cả cột sống cổ này cuộc sống ngực này cột sống lưng này chứ không phải chỉ có mỗi là cuộc sống lưng,Vietnamese
+nữa thì tất cả tất cả đặt điện cực tất cả những cái điều trị,Vietnamese
+nên là cái lời khuyên đối với bác là gì ạ không nên đi lại nhiều không nên để bị tai nạn không nên để bị ngã bởi vì tất,Vietnamese
+những thứ như thức ăn vi khuẩn đường ruột vô hại hoặc bụi từ không khí tất cả,Vietnamese
+cái câu chuyện này nó cũng là những câu chuyện nó ảnh hưởng một cách trực tiếp và cái câu chuyện là thế tại sao mà mình,Vietnamese
+đáo hơn để dành chiến thắng trong cùng ván cờ đó mà chỉ cần ba nước đi khi được,Vietnamese
+thì với trường hợp của bác lại có cái chuyện dạ dày với đường tiêu hóa thì xin,Vietnamese
+cái việc này là cái mà rất dễ gặp thế thì chương trình chỗ có khuyên thế này thôi ạ hiện nay thì là có rất nhiều,Vietnamese
+là hiện nay với cái việc mà chúng ta nuôi trồng nuôi cấy được cái gọi là đông,Vietnamese
+thực phẩm bảo vệ sức khỏe có lợi cho vấn đề tim mạch có lợi cho vấn đề thần kinh mà rất hữu ích với cái việc mà nó hỗ trợ,Vietnamese
+chế độ ăn giảm năng lượng thì cả về vấn đề dinh dưỡng đã có các bác sĩ dinh dưỡng đã tư vấn ở trong các với kỳ trước,Vietnamese
+nào và để trả lời câu hỏi này mời quý vị,Vietnamese
+thì hoàn toàn có thể có và bác cũng vừa cũng có chia sẻ là bác cũng vừa khỏi covid một tháng nay rồi và tuy nhiên chúng,Vietnamese
+xe đạp trên giường chứ tuyệt nhiên là chúng ta không vì thế mà chúng ta lại cứ đi nhiều thế còn cái việc mà hôm nay,Vietnamese
+trăm cân nặng và những cái con số này cũng là những cái ngưỡng có ý nghĩa trong lâm sàng cũng như đây là những cái,Vietnamese
+lượng natri nó có thể giảm đến bốn mươi phần trăm để mà giúp cho cái cái việc mà sử,Vietnamese
+tế bào b những thụ thể đến từ một nhóm các phân tử sinh học được gọi là protein,Vietnamese
+nó sẽ giúp san bằng được cái hiện tượng tắt này nên giúp cho người bệnh lúc nào cũng ở giai đoạn bật cho nên đó là một,Vietnamese
+quan đến cái xét nghiệm đông máu xem nó như thế nào thì các bác sĩ sẽ điều chỉnh liều lượng bác ạ bác nhé thế và bên cạnh,Vietnamese
+ngừa đột quỵ cho những cái bệnh nhân rung nhĩ này đó là cái điều mà chúng ta thấy rằng phải làm mà một khi mà bệnh nhân đã được,Vietnamese
+vào các phương pháp trị liệu đối với lại việc dùng thuốc cũng như là,Vietnamese
+hóa cộng với cái phá hủy do nó bệnh khớp cộng với do do cái quá trình điều trị không phù hợp dẫn đến kể cả xương nó,Vietnamese
+xơ vữa động mạch cũng rất cao thứ hai là từ đó nó sẽ giúp cho máu thông lên não lên tim tốt cải thiện những tình trạng,Vietnamese
+những loại thuốc này phải được điều chỉnh để làm việc với độ chính xác tối đa nếu chúng ta kích hoạt quá mức hệ,Vietnamese
+cần phải lưu ý gì không chúng ta có thể tự điều trị tại nhà hay không và lúc nào thì chúng ta cần phải vào bệnh viện,Vietnamese
+hợp cùng bài thuốc cổ phương độc hoạt tam ký sinh và collagen tuýp 2 không biến tính tạo thành một tam giác khép,Vietnamese
+ra rằng là à vậy thì chúng ta phải đi sâu tìm hiểu những cái giải pháp đó và chúng ta đưa ra những cái sản phẩm ngõ,Vietnamese
+trị và dự phòng tái phát của bệnh ung thư đó một cách tốt nhất dạ vâng hi vọng,Vietnamese
+biện pháp phòng ngừa để giảm thiểu những cái rủi ro hay không thì cái việc đấy tôi cho là nó là còn quan trọng nhất trong cái trường hợp này đấy là trường,Vietnamese
+quan trọng vì lý do là nó sẽ giúp cho những người bệnh hiểu rõ hơn kết nối bền chặt hơn với những phương,Vietnamese
+cái nghịch cảnh mình tạo ra để làm gì chị em biết là nếu mà mình có một cái,Vietnamese
+thiếu máu não thoáng qua nó chỉ khác là nó nó có hồi phục tôi một hồi phục được hay không thôi bây giờ xảy ra được năm mười phút nữa,Vietnamese
+hơn ví dụ như là trước năm năm tại vì cái khoảng thời gian mà trước năm năm người ta,Vietnamese
+mình cần phải cung cấp cho những cái bác sĩ chuyên khoa lân cận nếu mình có vấn đề phối hợp ngoài ra trong sinh hoạt,Vietnamese
+rõ ràng là một vài trong số này đôi khi là không thể tránh khỏi sẽ có những,Vietnamese
+các phần của cơ thể với không tự thần bất cứ thứ gì không phải là một phần của,Vietnamese
+nào để giúp chúng ta những người có bệnh lý nền như là huyết áp cao mỡ máu cao tim mạch có thể là giảm được nguy cơ xơ,Vietnamese
+cố gắng tham gia vào họ đã cố gắng trị liệu theo cái cách của họ chứ không phải là,Vietnamese
+lý về rối loạn lipid máu vân vân chúng ta uống thuốc tây y nhiều khi chúng ta cảm giác mệt mỏi nhưng mà khi sử dụng,Vietnamese
+mươi phần trăm nguyên nhân của các tử vong do ung thư không phải do bệnh ung thư mà,Vietnamese
+thì chúng ta thấy rằng là một trong căn nguyên mà nó làm thúc đẩy hoặc là làm nặng lên cái bệnh lý mà thoái hóa khớp đấy,Vietnamese
+immunesoyz đan sâm hòe hoa hoàng liên l-carnitine fumarate đã được chứng minh rằng thứ nhất là nó có tác dụng làm giảm ở,Vietnamese
+tốt phải nhiều hơn vi khuẩn xấu thật không may hầu hết mọi người ngày nay mang trong mình nhiều vi khuẩn xấu gây,Vietnamese
+thông thái và rất là khôn ngoan để làm gì để chúng ta bỏ đồng tiền ra là chúng,Vietnamese
+chống nắng và chúng ta chọn lựa những cái sản phẩm dưỡng sáng mà có thành phần kết hợp niacinamide với lại những cái,Vietnamese
+truyền miệng thì sau đó thì sau một cái thời gian dài họ thử nghiệm mọi thứ,Vietnamese
+ngại ăn ngại uống thì sẽ việc giảm đầu tiên đó chính là giảm cái lượng nước trong,Vietnamese
+ứng thường chúng ta sẽ chọn lựa những cái thành phần mà không có chứa cồn không chứa hương liệu không chứa nhiều,Vietnamese
+không ta trị theo nguyên nhân nhưng tất nhiên có nhiều cái dạng rụng tóc mà chúng ta rất khó tìm được nguyên nhân,Vietnamese
+cũng không rõ là t���i sao mà trong cái thời gian này huyết áp của bác lên cao thế ạ nó có một cái lý do nào không,Vietnamese
+chúng ta có thể hồi phục cái vị giác của mình nhanh hơn như vậy đối với thay đổi về khô miệng thì chúng ta có cách giải,Vietnamese
+điều trị mà những cái tình trạng tăng sắc tố chúng ta nên kết hợp vừa uống vừa thoa tại chỗ hoặc thậm chí kết hợp cả,Vietnamese
+chuyên khoa để người ta người ta điều chỉnh lại cho nó phù,Vietnamese
+nó không không hiệu quả cao thì thì chúng ta rõ ràng là chúng ta thức thố rồi,Vietnamese
+một số những lời khuyên tâm lý giúp cho bệnh nhân trong cái đối mặt với sự kỳ,Vietnamese
+chẳng may bác ngã mà nó lại gãy xương thì tất cả những cái câu chuyện đó nó lại trở nên là không có ý nghĩa cho nên cái,Vietnamese
+ruột cư trú trên các nếp gấp mỏng manh của thành ruột hỗ trợ tiêu hóa và hấp thụ chất dinh dưỡng tạo nên một rào chắn,Vietnamese
+một tỷ lệ cực kỳ cao so với các sở pháp ngoài thị trường thế cho nên là đấy chương trình của chúng tôi cũng muốn nói,Vietnamese
+thì mình sẽ phải chuyển đổi để làm sao mà giảm cho nó tốt nhất như vậy khi kiểm,Vietnamese
+được điều trị tốt thì nó sẽ người bệnh sẽ có cuộc sống dài hơn và chất lượng,Vietnamese
+như không thể cô lập từng yếu tố một để khảo sát trong khi căng thẳng ảnh hưởng,Vietnamese
+nguy cơ đối với những người bị huyết áp cao nguy cơ xơ vữa mạch cũng rất là cao nên là trong cái trường hợp này mà chị,Vietnamese
+cho nên là rất mong là bác tìm hiểu thêm và rồi mình có thể quyết định có thể sử,Vietnamese
+cái cục máu đông ở trong máu trong tim của mình mà nó trôi lên trên não mạch não đó thì nếu mà nó nhỏ thôi thì chúng,Vietnamese
+đến mười phần trăm cân nặng trong vòng sáu tháng bên cạnh cái những cái mục tiêu lâu dài sau này mà tại sao lại có cái,Vietnamese
+dấu hiệu thiểu năng vành của bác thứ ba nữa là nó có cái cải thiện những các cái triệu chứng và thứ tư là khi bác sử dụng,Vietnamese
+những triệu chứng như là kéo dài quá ba ngày chẳng hạn mà chúng ta vẫn còn sốt rất là cao chúng ta có triệu chứng của,Vietnamese
+sau khi mổ đặt điện cực thì tôi có phải dùng thuốc nữa hay không hay xin mời bác,Vietnamese
+côn trùng cũng đang bị mầm bệnh đe dọa chẳng hạn như vi khuẩn và nấm như nhà,Vietnamese
+bằng bạn sẽ tìm hiểu thêm về hệ vi sinh và mối quan hệ của nó với hệ miễn dịch,Vietnamese
+của con người và tùy thuộc vào loại và đặc điểm riêng biệt của chúng chúng có tiếng nói riêng đối với sức khỏe tổng,Vietnamese
+tác dụng ngăn ngừa cũng như là hỗ trợ trong việc làm tan các cái huyết khối để phòng ngừa những các cái biến chứng vâng,Vietnamese
+vừa rồi cũng đã khép lại phần giải đáp thắc mắc của khán giả ngày hôm nay và còn rất nhiều những câu hỏi nữa nhưng mà,Vietnamese
+chúng ta nên hạn chế các cái tác động vào cái vùng gót chân này cụ thể là gì ạ chúng ta không nên đi bộ nhiều này chúng,Vietnamese
+cạnh đó thì cái việc chế biến thức ăn thì đối với người mà bị thay đổi về mặt vị giác thì chúng ta phải cố gắng chiều,Vietnamese
+nhận được phần thưởng từ chương trình mà thôi vâng ạ như là bác sĩ chia sẻ thì rõ ràng là đông trùng hạ thảo thì có cái,Vietnamese
+chăm sóc dành cho người bệnh béo phì với vai trò của người thân trong gia đình là một trong những điều quan trọng và ngày,Vietnamese
+bị thiếu một vài thứ trong số những hướng dẫn này và chúng có thể không bao giờ lấy lại được chính xác những thứ này,Vietnamese
+phì tiểu đường và thậm chí là bệnh tim mạch hãy nghĩ rằng những thay đổi,Vietnamese
+khỏe và sự khỏe mạnh của các vi khuẩn cư trú lâu dài và theo đó là sức khỏe của,Vietnamese
+thì sự trợ giúp hỗ trợ của người nhà hàng ngày vẫn là những cái điều rất là quan trọng và,Vietnamese
+biểu hiện tê bì dọc theo tay hoặc là cái vùng cổ vai gáy này cái thứ ba nữa là nó lại còn liên quan đến cái câu chuyện là,Vietnamese
+là tránh được cái biến cố bị đột quỵ do tình trạng rung nhĩ gây ra như vậy là,Vietnamese
+họ đã bị trầm cảm rồi khó khăn rồi đang điều trị trầm cảm bây giờ cái hiệu,Vietnamese
+để c��c bác sĩ của chúng tôi giải đáp cho quí vị nha và đừng quên chia sẻ chương trình này để giúp cho bạn bè và người,Vietnamese
+thể bị nhồi máu não và hiện nay thì bằng các cái phương tiện hiện đại thì có thể,Vietnamese
+nên chúng ta nên chọn lựa những cái sản phẩm rửa mặt mà có cái thành phần dịu nhẹ lành tính ví dụ như chúng ta chọn,Vietnamese
+nó có cái tác dụng gì không mong muốn không đúng không ạ bởi vì là sao bởi vì là chúng ta bây giờ mà lại lại uống nó,Vietnamese
+tái phát hay không nếu mà có cường giáp cái phát chúng ta phải điều trị ngay đừng để mà nó ảnh hưởng lên tim gây ra,Vietnamese
+cũng có rất là nhiều những cái ưu đãi dành tặng cho quý vị và các bạn khi mà gọi điện về chương trình ngày hôm nay về,Vietnamese
+lực lớn để hiểu về miễn dịch cũng đã tạo ra những hiểu biết mấy về nhiều lĩnh vực khác của sinh học con người chẳng hạn,Vietnamese
+đặt ra các cái vấn đề mà để cho bệnh nhân được trả lời để mình đánh giá trước,Vietnamese
+càng ngày họ lo lo nhiều thậm chí họ có thể đưa đến cái trầm cảm mà khi họ,Vietnamese
+thể là ba tháng cũng đã phải kiểm tra rồi mình vẫn thì như vậy ta khẳng định là cái rung nhĩ không phải bệnh một,Vietnamese
+tam đại bộ phẩm đó là cái gì thứ nhất là nó là có nhung hươu cái thứ hai là nhân sâm và thứ ba đông trùng hạ thảo cái thứ,Vietnamese
+nhân viên mà thực hiện nhiệm vụ này sẽ yêu cầu cái người đi qua là khai báo y,Vietnamese
+nhận thức và cái sự tuân thủ sau khi cái phẫu thuật đó đã thành công rồi thì họ,Vietnamese
+điều trị ung thư nhưng nó là yếu tố hỗ trợ vô cùng quan trọng để giúp bệnh nhân có thể chịu đựng được các kịch tổn,Vietnamese
+não sâu có đắt không và có được bảo hiểm chi trả không à xin mời tiến sĩ bác sĩ,Vietnamese
+điều trị hoặc là kéo dài thời gian sống cho,Vietnamese
+đây cũng giúp cho họ tăng đậm độ năng lượng thì chúng ta có thể ví dụ như là thường ung thư thì phải nấu mềm lỏng này,Vietnamese
+mình cũng là một có thể nói là một bác,Vietnamese
+sẽ nghiên cứu và tìm hiểu từ rất là nhiều những cái nguồn thông tin khác nhau tuy nhiên thì cũng trong cái thời đại,Vietnamese
+các chất dinh dưỡng để giúp cho chúng ta bớt đi những cái vấn đề như là về thay,Vietnamese
+là chúng tôi cũng sẽ tư vấn thêm một chút là như này này có hai cái câu chuyện giống như lúc nãy chúng tôi nói câu chuyện thứ nhất là nó bị tai biến,Vietnamese
+thuật mà liên quan đến ví dụ ung thư đường tiêu hóa chẳng hạn ví dụ ung thư tuyến tụy bò hay là ung thư tuyến tụy,Vietnamese
+cho một số tiền kinh có lợi cho tổ nội tiết có lợi cho vấn đề về sinh lý nó có thể chống viêm kháng khuẩn chống ung thư,Vietnamese
+cho giảm bớt cái tình trạng xơ vữa thì giúp cho máu đi lên não lên tim sẽ được tốt hơn nên là chính vì vậy mà đây là,Vietnamese
+rất nhiều các cái trường hợp mà cái thận của chức năng thận nó bị ảnh hưởng nhiều và nhiều bệnh nhân bị suy thận do,Vietnamese
+vừa mới khỏi covid một tháng này xin bác sĩ cho hỏi lời khuyên để có thể là tự chăm sóc dự phòng biến chứng nguy hiểm ở,Vietnamese
+đối mặt từng ngày và từng giờ và chính vì vậy ngay lúc này đây thay mặt cho những người thực hiện chương trình và,Vietnamese
+nhức mỏi châm chích chân tay rồi đau đầu qua mắt chóng mặt có thể là khắc phục được cái tình trạng của mình ngay,Vietnamese
+này chúng ta sẽ có thể có thông tin về sản phẩm vâng và tôi cũng xin được nhắc lại tổng đài của chương trình không hai,Vietnamese
+cũng như là các cái gân cơ của chúng ta chính vì vậy cho nên chúng ta phải tìm mọi cách để làm sao mà hạn chế được các,Vietnamese
+thuật là người ta nói là điều diễn thần kinh chứ nó không có mang tính chất phá hủy tất cả nên có khả năng hồi phục trở,Vietnamese
+chỉ là một phần thôi chứ không phải là tất cả cho nên là nó nằm chung trong một cái cái chuỗi của điều trị của các chuyên,Vietnamese
+hóa kém đi chắc chắn cái chế độ ăn ăn vào của bệnh nhân sẽ không cung cấp đủ cái nhu cầu của người ta hàng ngày chính,Vietnamese
+nguy hiểm như ung thư tiểu đường viêm khớp vân vân miễn dịch học là m��t ngành,Vietnamese
+phụ rất nghiêm trọng với có thể là bị bỏng hoặc là có thể là gây thay đổi với cấu trúc của tế bào làm mất sắc tố vĩnh viễn tức là,Vietnamese
+của chúng ta và riêng mái tóc thì sao nè nó tác động vô cái nang tóc nó làm cho cái nang tóc nó phát triển không được,Vietnamese
+như là dùng thuốc phương pháp điều trị ngoại khoa cũng như là các phương pháp điều trị hỗ trợ vật lý trị liệu vân vân,Vietnamese
+tư vấn cho chồng tôi là sáu mươi hai tuổi là ông bị đột quỵ trụy tim bị đột quỵ tai biến,Vietnamese
+thành các cái sợi fibrin cũng như là nó sẽ làm hỗ trợ trong việc làm tan các cái sợi huyết nên là chính vì vậy nó sẽ có,Vietnamese
+nào dùng tốc độ nào cũng biết cách lựa chọn và sử dụng được như vậy và trên thực tế thì qua quá trình mà chúng tôi,Vietnamese
+đoán sớm thì thực sự nó cũng còn cái cuộc sống ở sau khi bị mắc bệnh ung thư có thể lên tới vài chục năm nữa chúng ta,Vietnamese
+cái tình trạng này nó bị lâu chưa em năm nay bao nhiêu tuổi rồi năm nay mình bao nhiêu tuổi cháu,Vietnamese
+tìm hiểu xem mỗi người trong chúng ta có thể làm gì để trở thành những đại sứ hỗ,Vietnamese
+cân và cái điều cuối cùng tôi muốn nói cái nguyên nhân cuối cùng liên quan ung thư do sụt cân tức là bản thân cái việc,Vietnamese
+chứng để khẳng định rằng nó không tốt cho nên là chúng ta tốt nhất là chúng ta cũng nên ăn ở mức rất là hạn chế thế còn,Vietnamese
+chúng ta ở tại cơ sở cách ly tập trung đó thì chúng ta sẽ giữ sao cho có một,Vietnamese
+thiết tại vì các phương tiện để hỗ trợ cho các phẫu thuật này nó rất là nhiều và nó rất là hiện đại như ct nè mấy mri,Vietnamese
+thì mình nhân sẽ được các bác sĩ bên ngoài thần kinh người ta sẽ tư vấn rất là kỹ khi mình có những cái dấu hiệu rối,Vietnamese
+đau nhức ở những mùa rét là nó đau nó kíp ở các,Vietnamese
+thuật các tính năng sau nó sẽ giúp cải thiện được cái triệu chứng dáng đi của người bệnh cái vấn đề thứ tư mà kích thích não sâu cải,Vietnamese
+dụng phụ đó và chính vì bớt đi được cái tác dụng phụ đó sẽ giúp cho quý vị có thể vượt qua được cái liệu trình điều,Vietnamese
+vào và mình tính toán các tọa độ để mình đi vào sau đó là bệnh nhân sẽ được tiến hành phẫu thuật thì bệnh nhân,Vietnamese
+kính thưa quý vị khán giả khi chúng ta đã biết béo phì đó là một cái tình trạng bệnh lý mãn tính mà không chỉ là vì cái,Vietnamese
+trình tư vấn với sự tham gia của các bác sĩ các chuyên gia đầu ngành từ đó giúp cho người dân có thể chủ động hơn trong,Vietnamese
+một loại mầm bệnh cụ thể đã nhân lên và tồn tại trong cơ thể trong một thời gian dài rất lâu sau khi mầm bệnh này đã bị,Vietnamese
+khắp nơi đấy nhưng mà không chẩn đoán ra bệnh hoặc là điều trị tất cả các kiểu khác nhau nhưng mà không ra được cái kết,Vietnamese
+và tình trạng sức khỏe của một người câu trả lời cho câu hỏi nằm ở sự khác biệt,Vietnamese
+dưỡng sáng thường là mình hay bị nhầm lẫn do đó nên tôi nghĩ là trong cái phòng minigame phía sau của chương,Vietnamese
+khi protein bạch hầu được tinh chế bằng quá trình hóa học có liên quan đến việc kết hợp nó với các muối nhôm nó trở,Vietnamese
+rồi mình lựa chọn sản phẩm này chúng ta đọc kỹ cái bảng thành phần thấy có luôn bỏ ra ngay cho bạn nhé bây giờ thì,Vietnamese
+biệt đối với ung thư tuyến giáp thì lưu ý đối với đậu nành này đối với các cái sản phẩm có chứa iod và mỗi một bệnh,Vietnamese
+cường miễn dịch nè phòng chống các bệnh lý có liên quan đến sự suy giảm miễn dịch ở người cao tuổi cũng rất là tốt như là chúng ta bị nhiễm vi khuẩn nè,Vietnamese
+mạch hay không còn nếu trong giai đoạn cấp này mà có rung nhĩ nữa mà người lớn tuổi nữa thì chắc chắn là chúng ta phải,Vietnamese
+hoạt và làm việc bình thường khi mệt tiến triển đến giai đoạn hai thì triệu,Vietnamese
+cách mà mình dùng những hoạt chất mà có tính tẩy mặt ví dụ như là có thành phần là hydroxyl peroxide hoặc là,Vietnamese
+chúng ta rất dễ bị tai biến lần thứ hai lần thứ ba và mỗi một lần như vậy thì cái mức độ của nó cái độ nguy hiểm của,Vietnamese
+thiết có sự cảm thông với sự thấu hiểu sự ủng hộ từ những người thân bạn bè và,Vietnamese
+nhận rằng trạng thái của hệ vi sinh vật rất quan trọng đối với sức khỏe con người với ý nghĩa sâu sắc về việc bạn có,Vietnamese
+chúng ta chưa sắm được những cái công cụ để chúng ta ngăn ngừa cái kẻ trộm vào ăn trộm trong cơ thể chúng ta mà cái trộm,Vietnamese
+khớp tại việt nam để sản xuất nên cái thực phẩm bảo vệ sức khỏe viêm xương,Vietnamese
+nhờ vào nghiên cứu y học chúng ta không còn lo lắng về việc chết vì bệnh đầu mùa,Vietnamese
+thì cũng chú ý là thì thì cũng chú ý để làm sao mà chúng,Vietnamese
+như là enzyme immunesoyz kết hợp với hòe hoa đan sâm hoàng liên l-carnitine fumarate,Vietnamese
+tác dụng phụ nào ảnh hưởng đến việc ăn uống của bệnh nhân vâng nói về cái,Vietnamese
+sự thật không thể tránh khỏi là chúng ta đã tiến hóa với những vi sinh vật này qua hàng triệu năm chúng là một phần của,Vietnamese
+fanpage của bệnh viện đại học y dược thành phố hồ chí minh và fanpage của cetaphil việt nam nên quý vị đừng ngại,Vietnamese
+lâu để một đáp ứng miễn dịch phát triển nhưng không ai biết về quá trình có thể giải thích được làm thế nào hoặc,Vietnamese
+cái quy trình kỹ thuật về chuyên môn thì rất có nhiều yếu tố lắm thì yếu tố đầu tiên quan trọng là chúng ta phải có một,Vietnamese
+bốn tiếng rưỡi rồi cho tới sáu tiếng nhưng mà chỉ còn làm được thì can thiệp nội mạch khối thôi và gần đây thì,Vietnamese
+trầm cảm bị lo âu hay bị căng thẳng bị stress thì rõ ràng là nó có một cơ sở,Vietnamese
+các cái phương pháp trị liệu tâm lý thì nó có rất là nhiều nhưng mà lúc đầu tôi,Vietnamese
+ta nói rất là nặng ở bên tay phải ấy và cái vấn đạo cô đã kiểm tra cả tổng thể,Vietnamese
+chúng ta như vậy là đã rửa sạch rồi tuy nhiên thì những cái sản phẩm sữa rửa mặt mà sau khi mà rửa xong mà để lại một,Vietnamese
+như vậy thì khi mà xảy ra về một cơn não thì người nào có não thì coi như giống như là được may mắn là,Vietnamese
+thì chắc là bác cũng đã điều trị ổn định rồi đúng không ạ thế còn các cái bệnh lý về tim mạch thì chắc là chúng ta vẫn,Vietnamese
+các thụ thể trên tế bào t và tế bào b không tự tạo ra được liên kết với mầm bệnh những thụ thể này có hình dạng ngẫu,Vietnamese
+người mà bị bị lo âu quá mức đến nỗi mà mất ngủ những người mà bị,Vietnamese
+thứ tư dẫn đến sụt cân nữa đó là nếu như chúng ta sử dụng hóa trị ở trong cái việc mà điều trị ung thư thì hóa trị và,Vietnamese
+khán giả liên quan đến bệnh lý về quyết áp cao nè mỡ máu cao là bệnh lý tiểu đường tim mạch hoặc là những ai đang gặp,Vietnamese
+tức ngực thì tất cả những dấu hiệu của cái thiểu năng vành cũng như là khi chúng ta sử dụng lâu dài sẽ giúp cho hỗ,Vietnamese
+tác trực tiếp nên trong quá trình mà các bác sĩ trao đổi với những nội dung hấp dẫn và thú vị thì quý vị có bất kỳ những,Vietnamese
+là nó đỡ nhiều hơn thì trong trường hợp này chúng tôi khuyên là bác nên tạm nghỉ đã bác sẽ tập thể dục nhưng mà bác chỉ,Vietnamese
+của mình dạ vâng ạ xin được cảm ơn bác sĩ rất là nhiều và quý vị khán giả thân mến qua cái phần,Vietnamese
+cả những cái thông tin này nó phải được truyền tải tới người bệnh quan trọng nhất là người bệnh biết là người bệnh,Vietnamese
+tóc em nó rụng nhiều hơn đợt trước rất là nhiều cái rãnh ở trên đầu em nó xuất hiện nó,Vietnamese
+cùng chuyên gia chương trình của chúng,Vietnamese
+những cái cái thức ăn mà chúng ta phải kiêng khem do bệnh lý nền thì chúng ta vẫn phải cố gắng tăng cường dinh dưỡng,Vietnamese
+còn phục hồi sụn khớp thoái hóa hiệu quả cứ mười người dùng thì chín người thấy hiệu quả,Vietnamese
+đi cái hàng rào bảo vệ của cơ thể chúng ta để chúng ta cũng thấy mặc dù chúng ta rất là thích nhất là đối với các anh nam,Vietnamese
+khi trễ bệnh và ngăn chặn quá trình tiến triển bệnh không biết là quan niệm này đúng hay sai xin được hỏi bác sĩ,Vietnamese
+chứng tiền đình bị rối loạn vận động mạch máu não này và đôi khi là có những cái trường trường hợp là tai biến mạch,Vietnamese
+dùng thuốc đấy và cái huyết áp thì liệu có như thế nào bác ơi cũng muốn hỏi bác là tại vì nghe,Vietnamese
+hôn mê không có nuốt được luôn và thậm chí tử vong luôn như vậy một khi mà biến chứng đã xảy ra rồi đó thì có việc,Vietnamese
+ngực chúng ta có thể bị rối loạn nhịp tim chúng ta có thể suy tim và đặc biệt là chúng ta có thể bị nhồi máu cơ tim,Vietnamese
+lại không phải chỉ có mỗi thời tiết thì nó mới đau thì rõ ràng là trong cơ thể của chúng ta đã có vấn đề rồi các cái,Vietnamese
+thì nó cũng có những cái tác dụng phụ lên cái hệ thần kinh trung ương ảnh hưởng đến cái các vấn đề về tâm thần về,Vietnamese
+cũng như là cổ để vai cánh tay vân vân ấy thì chúng ta rất là gặp trong nhiều các cái nhóm bệnh khác nhau có những,Vietnamese
+não bộ nuôi dưỡng hệ vi sinh lành mạnh ngày nay dễ dàng hơn bạn nghĩ tôi đã đưa,Vietnamese
+trở nên hoàn toàn khác những tiến bộ trong việc ngăn ngừa điều trị và chữa,Vietnamese
+ngay cả khi bị cảm lạnh thông thường tuy được tiếp cận chuyển nguồn dinh dưỡng tốt nhất thế giới chế độ ăn của bé tràn,Vietnamese
+lượng cuộc sống của người bệnh với mục đích cung cấp cho bạn đọc ở những kiến thức khoa học về chế độ dinh dưỡng làm,Vietnamese
+vitamin rồi là các nguyên tố vi lượng đặc biệt là kẽm đặc biệt là selen ở trong đông trùng hạ thảo rất phong phú,Vietnamese
+thuật này cũng đã trang bị rất là kỹ để tránh lây cho thấy người sử dụng dịch vụ cũng như là để tránh cái rồi sự lan,Vietnamese
+cho mình không sử dụng rượu bia cà phê và có hút thuốc lá đặc biệt ở trong cái giai đoạn này thế và như có những cái,Vietnamese
+thành của mỹ mắc chứng rối loạn tâm trạng cần kê đơn thuốc liều cao bệnh trầm cảm ảnh hưởng đến một trên mười,Vietnamese
+sử dụng một cái dụng cụ điều khiển cái dụng cụ này sẽ được áp lên cái phần,Vietnamese
+chương trình nhân đây thì chỉ có tư vấn với bác hai vấn đề thôi thứ nhất là,Vietnamese
+khuya nhiều thì họ ăn nhiều ăn nhiều thì lại lên cân mà càng lên cân như nữa thì họ lại càng khó chịu hơn càng bị,Vietnamese
+cái thức ăn động vật thế thì cái việc mà đặt vấn đề cân đối giữa protein động vật và,Vietnamese
+người còn kết hợp thêm với cái rối loạn lipid máu nữa thì đấy là bộ ba bộ ba mà nó có thể gây ra cái tình trạng vữa xơ,Vietnamese
+xảy ra nếu sự hiện diện của một thứ chưa từng có trong cơ thể bạn trước đây không phải là dấu hiệu duy nhất cho việc đáp,Vietnamese
+nó làm chân tóc da đầu mình mềm và cái chân tóc mình khỏe thì mình có thể nhuộm bình thường được phải không bác,Vietnamese
+nguyên nhân cơ chế bệnh sinh của bệnh đó chính là nó tác động vào cái mảng xơ vữa nên là chính vì vậy mà nó sẽ cải thiện,Vietnamese
+là cái vấn đề mà về cái vấn đề rối loạn chuyển hóa đường huyết mà chúng ta thường biết trong thời gian gần đây đó,Vietnamese
+cải thiện mà cái điều này là chúng tôi cũng nói đi nói lại rất là nhiều nhưng,Vietnamese
+trường hợp như này thì có lẽ là mình nên có một cái áo đai thắt lưng để mình đeo ở vùng ngang thắt lưng đấy cái áo đai,Vietnamese
+tôi sẽ cho bạn một vài hướng dẫn để xử lý những tình huống như vậy để bạn có thể bảo vệ sức khỏe đường ruột của mình,Vietnamese
+trước và sau khi phẫu thuật điều trị béo phì thì mình cũng lưu ý là sẽ phải điều,Vietnamese
+theo dõi chó mèo và thời gian theo dõi,Vietnamese
+trong phòng thí nghiệm của ông là xây dựng một nhóm những người có chuyên môn và kinh nghiệm khác nhau,Vietnamese
+chúng ta có thể là chăm sóc ở điều trị tại nhà tuy nhiên là chúng ta cũng không chủ quan nếu trong trường hợp mà này ví dụ,Vietnamese
+khoảng cỡ năm đến mười phần trăm trọng lượng cơ thể thôi còn lại là mình sẽ phải đặt ở trong một cái cái chương trình tổng,Vietnamese
+ra mà nó phá rất nhiều đấy là cái việc thứ nhất mà chúng tôi cần phải khuyên cho nên là bác cần đi thăm khám ở các,Vietnamese
+mục đích là gì đó là để mà chúng ta điều trị những cái vấn đề và tăng sắc tố như làm mình có những cái vấn đề như là thâm,Vietnamese
+bậc nhất của đông trùng hạ thảo mà cái này thì chúng ta biết với những người có tuổi và những người cao tuổi thì bao giờ,Vietnamese
+bậc công tắc trên hệ thống phản ứng với căng thẳng của cơ thể để nó nghĩ rằng chúng ta đang bị một con sư tử săn đuổi,Vietnamese
+động trực tiếp ở giai đoạn đó nhưng còn cái nguyên nhân có khi có rất nhiều nguyên nhân dẫn đến rụng tóc mà đôi khi,Vietnamese
+新加坡国家心脏中心 占地面积五万平方米。 每年接待十多万名门诊病人 预计到了2030年,Chinese
+求诊人数将增至二十万人。 现年七十二岁的退休人士郑友进,Chinese
+这天到新加坡国家心脏中心 准备要动手术。 我们年轻的时候 心门非常薄,Chinese
+开得很好。 可是一旦年纪大了之后 就会有钙化。 这个白色的就代表它的钙化。,Chinese
+一旦钙化了之后 你就可以想象那个心门 开得没有这样好。 心门也会变厚 也会变硬。,Chinese
+但去年 他感到情况有点不妙。 因为本身有时呼吸比较困难， 因为上一次,Chinese
+就是说心脏的跳动比较大声， 所以查到心脏的问题。 心门是我们心脏很重要的一部分。,Chinese
+所以通常心脏挤的时候 那个心门会打开 那个充满氧气的血可以跑去全身。 心门狭窄 血从心脏跑出来会比较难，,Chinese
+可以造成肺积水。 如果他们不动手术的话， 过一段时间 这个心门会越来越狭窄， 这可能造成他心脏衰弱，,Chinese
+也在不断地增长。 主动脉瓣关闭不全， 以及像郑友进一样患上主动脉瓣狭窄， 是较为常见的两种病种。,Chinese
+郑友进的扫描结果显示 他的心脏有钙化的现象 因而导致心门狭窄。 医生于是建议他动一个手术。,Chinese
+TAVI 或者Transcatheter Aortic Valve Implantation 是一个微创手术， 会从腿部的主动脉输入一个导管。,Chinese
+把一个架子放在心门狭窄的位置。 这个架子就会把旧狭窄的心门 挤到旁边。,Chinese
+血就会容易从心脏出到全身。 这个架子里有一个生物的心瓣叶。 这心瓣叶就会代替,Chinese
+旧狭窄心瓣叶的那个功能。 TAVI的风险 有包括 第一 死亡的风险，,Chinese
+它的几率差不多三到四巴仙， 但不做TAVI 心门继续狭窄,Chinese
+死亡的风险一年有差不多五十巴仙。 那时 我母亲还在 跟我住在一起,Chinese
+所以会比较麻烦一点 但是 去年我母亲去世了。 我十二月多的时候才跟Dr Yap讲,Chinese
+动手术了。 那时开始心情比较紧张 然后想 想到最后 放松 尽量放松。,Chinese
+因为人生短短几十年 紧张也没有用。 就是坦然地面向这个情况 就是这样。,Chinese
+新加坡国家心脏中心里 共有三十八个专科门诊部。 除了心内科外 心胸外科也是其中一个重要的专科护理。,Chinese
+这一天在中心里等着动手术的 还有现年六十八岁 患有肺部结节的伍振玮。,Chinese
+这是他过去两年来接受的第二台手术。 伍振玮是一名企业管理顾问。,Chinese
+近几年 他积极筹备 创立新的企业管理顾问公司。 但这个计划却在一年前被迫搁置。 因为他被诊断出患有鳞状细胞癌，,Chinese
+一种常见的皮肤癌。 他因此接受了肿瘤切除手术和放疗， 以根除癌细胞。,Chinese
+医生提供给伍振玮三个选项各有利弊。 选择继续观察病情的话 病人无需进行不必要的手术及活检。,Chinese
+一年前被诊断患有心瓣狭窄的郑友进， 这一天到国家心脏中心 准备接受经导管主动脉瓣植入术,Chinese
+简称TAVI。 他不想劳烦家人， 因此拒绝他们陪他前来。 手术预计一个小时内能够完成。,Chinese
+但如果出现状况的话 有可能延长到五 六个小时。 这手术的难度是 需要病患的腿的主动脉，,Chinese
+没有狭窄或钙化。 一旦主动脉有钙化或狭窄的情况， 做这个TAVI 就要考虑到有什么其他的途径,Chinese
+可以介入这个新的心瓣。 我们就要考虑到可能需要用到 他的手臂的血管， 或者颈项的血管,Chinese
+来介入这个新的心瓣。 最后几点吃的饭呢？ 昨晚大概五 六点。,Chinese
+五 六点钟。 你今天早上有吃药吗？ 有。 我们做TAVI首选 是从腿部的主动脉,Chinese
+介入这个新的心瓣。 因为它的侵略度 没有比开胸或者从颈项的血管 或手臂的血管来得这样侵入。,Chinese
+在TAVI研发之前 病患只能接受开胸换瓣手术。 过程中 患者需要经历全身麻醉 切开胸骨 心脏停跳,Chinese
+体外循环支持等过程。 对于年纪大 有开胸病史 肝肾 或心肺功能较差等情况的患者来说,Chinese
+风险比较高。 手术正式开始了， 医生通过大腿根部的股动脉,Chinese
+将一个带有支架的瓣膜， 通过导管植入到主动脉瓣膜的位置。 这个手续是有它的风险的 包括中风。,Chinese
+我们插管的时候可能会流��� 那个血管破。 严重流血的风险差不多十巴仙 如果真的是发生的话,Chinese
+可能需要紧急的输血 或者从一个微创的手术 变成一个大手术来止血。 最后 我们心脏会跳动,Chinese
+是有电波叫心脏跳动。 在放这个架子的时候 有可能会干扰或压到那个电波 心脏就会跳太慢。,Chinese
+可能额外的需要放一个起搏机。 我们通常做这个手续之前 会让他们进行不同的扫描来知道,Chinese
+比如他们的脚的血管够不够大， 也是看这个心门多大， 让我们选比较正确的size。,Chinese
+所以如果我们计划跟准备的好的话 通常我们能预料， 我们会遇到什么风险 就可以早点来预备了。,Chinese
+让这个手续进行得比较安全。 另一边 患有肺结节的伍振玮 在接受全身麻醉后,Chinese
+手术也要开始了。,Chinese
+电磁导航支气管镜简称ENB 是目前最新的微创临床技术。,Chinese
+手术步入第三个小时， 王医生终于成功切除了 伍振玮的肺结节， 以及周围的器官组织。,Chinese
+郑友进的手术已经进行了一个小时。 医生尝试在心脏里打开支架 让原有病变的瓣膜贴到血管壁上。,Chinese
+这样 新的生物瓣膜 就能开始发挥正常功能。 这种手术方式的创伤较小,Chinese
+不需要体外循环。 患者术后会恢复得较快 更适合老年瓣膜病患者。 手术非常成功。,Chinese
+接受了这个TAVI的手术你 病患的症状就会完全消除 进医院的那个次数也会几乎变零。,Chinese
+新的心门也可以至少耐八年到十年。 而患有肺结节的伍振玮的肺部组织,Chinese
+已经送到中心的病理科进行检验。 为了更快得到检验结果， 王雯贤医生亲自到病理科,Chinese
+去等待检验报告。 不幸的是，,Chinese
+检验结果并不如王医生所愿。,Chinese
+膝盖的损伤看起来只是膝盖而已， 但是其实会对他们 造成很多方面的影响。,Chinese
+现年五十五岁的Royston 在过去两年里 一直因为一个问题而饱受困扰。 他的颈部几乎天天都会疼痛。,Chinese
+颈部疼痛的导因很多， 不过 经过诊断 医生发现Royston的问题 其实牵涉到身体两个非常重要的组织，,Chinese
+神经系统和颈椎。 颈椎指的就是我们头或脑 接到身体的那个部位。,Chinese
+椎间盘突出 它的问题主要是因为 骨和骨之间的那个椎间盘 也称为软骨，,Chinese
+它因为损坏过后 破裂 往后移 所以压到了我们的脊髓， 或者是压到我们的神经线造成疼痛。,Chinese
+Royston起初有些担心， 但经过再三考虑后 他决定要动手术。,Chinese
+除了颈部疼痛以外 因为神经受影响 Royston的左上臂在这两年 也一直处于发麻状态。,Chinese
+他几乎每一晚 都得叫儿子帮他按揉颈部和肩膀。,Chinese
+过去两年 Royston也睡得不好， 经常半夜被痛醒 必须吃药止痛。 他还尝试过针灸和物理治疗,Chinese
+但一直没有好转。,Chinese
+脊椎外科医生 夏辉颖医生 今天要在Royston的颈椎上开刀。 他得非常的小心和专注,Chinese
+因为颈椎容纳脊髓 也就是人体中枢神经系统的重要部位。 脊椎骨的手术本身是一种挑战。,Chinese
+如果有偏差的话 就会给病人带来很大的不便， 或者是危险。 所以 在我们决定与病人,Chinese
+同走这条路的时候呢 都会感觉到有重任在身。,Chinese
+这天早上 新加坡国立大学医院的手术中心里 一台手术刚完成 医疗团队就得马上为下一台手术做准备。,Chinese
+现年二十六岁的Afendi 今天也来到医院 准备进行人生中第一次手术。,Chinese
+要不是三个月前的一场意外， 向来健康的Afendi 不需要开刀动手术。,Chinese
+从小就爱踢足球的Afendi， 自从成家立业以后 就很少再上球场了。 不过三个月前 同事的邀约,Chinese
+再次激起他对这项运动的热爱。 在一场友谊赛中 Afendi才上场没多久 腿部就发出一声巨响。,Chinese
+经过诊断 医生发现 Afendi的前交叉韧带撕裂了， 而这是一种相当常见的伤势。 前交叉韧带是在膝盖当中,Chinese
+最重要的一条韧带之一。 它位于膝盖的内部 在这边 它的功能是防止这个膝盖 在前后的移动,Chinese
+所以保持一个关节的稳定。,Chinese
+患有颈椎病的Royston 今早来到医院动手术。 因为开刀部位非常接近脊髓，,Chinese
+而脊髓如果受伤的话 将可能影响手脚功能， 甚至导致患者瘫痪。 因此手术团队必须在手术当中,Chinese
+时时刻刻检测患者的神经功能。,Chinese
+一切准备就绪后 夏医生划下了第一刀。,Chinese
+手术的第一部分 就是切除损坏的椎间盘， 以解除椎间盘对神经的压迫。,Chinese
+我们手术的时候呢 都会遇到跟生活好比一般的事件。 遇到骨头的话 就等于在生活当中,Chinese
+遇到了一些挫折 需要去奋斗 需要去强行的去面对， 那是因为骨头是一个很硬的结构。,Chinese
+遇到神经线 是一个很软的具体。 所以 就好比我们在人生呢 遇到一些必须要细心,Chinese
+因为踢足球 而不小心撕裂韧带的Afendi， 正在另一间手术室里 进行韧带重建手术。,Chinese
+前交叉韧带重建手术 其实拥有超过百年历史。 为了取代撕裂的韧带 早期的医生甚至尝试过使用丝带,Chinese
+碳纤维。 不过 现在许多手术 都会利用病患自体的移植物来取代 前交叉韧带的手术基本的步骤是,Chinese
+先把病人自己的hamstring tendon进行采取。 采样之后 我们进行准备。 腘绳肌腱的功能,Chinese
+主要是把腿部的肌肉连接到骨头上， 取出后一般能重新生长。 王鸣医生把这个移植物取出后，,Chinese
+便交由助理进行准备。 这样他能继续进行手术的下一个环节， 就是修补半月板。,Chinese
+这两块是半月板。 半月板是大腿骨和小腿骨之间的软骨。 许多韧带撕裂的病人,Chinese
+同时也会有半月板损伤的问题。 现在这个半月板是关闭的情况， 我们会采取一个动作,Chinese
+这样 就可以把这个空间打开 这样我们可以看得更清楚。 在膝关节窄小的空间里开刀,Chinese
+不是那么的直接。 所以如果我们要在大腿骨上面钻洞 我们需要弯曲他的膝盖。,Chinese
+这样的话 我们可以在通过内测 在这里进行打洞。 其实 前交叉韧带一旦撕裂后,Chinese
+一般病人的症状 如疼痛 肿胀会慢慢自然地减轻。 不过 如果没有进行重建手术的话，,Chinese
+病患今后很难再参与一些运动。 膝盖的损伤看起来只是膝盖而已 但是其实会对他们造成,Chinese
+很多方面的影响。 因为比方说一个病人非常喜欢踢足球， 他就会觉得人生会失去一些乐趣， 而且整体的身体也会变得更差。,Chinese
+在另一间手术室里， 夏辉颖医生 正小心翼翼地切除颈椎间盘。 因为他越来越靠近,Chinese
+藏在脊椎里的脊髓。,Chinese
+经过一番努力， 椎间盘终于安全地被切除了。 夏医生的下一个任务 就是置入人工椎间盘。,Chinese
+在置入人工椎间盘之前， 手术团队必须检查 Royston的神经系统。 原本忙碌的手术室,Chinese
+顿时如时光静止一般。 检测显示 椎间盘被切除后,Chinese
+Royston的神经功能 已经出现改善的现象。 获得好消息后 夏医生二话不说 继续埋头苦干。,Chinese
+Royston其实共有两个椎间盘 必须切除和置换， 因此到目前为止 手术只完成了一半。 而今天 夏医生,Chinese
+还有另外两台手术得进行。 我们本身都是已经习惯了 这一些手术的步骤。,Chinese
+所以也不会感觉到 肌肉酸痛 疼痛等等的一些症状。 特别是在精神关注在手术的时候。,Chinese
+颈椎间盘问题很多时候 是由不良姿势所造成的。 因此外科医生其实往往也是 患上颈椎病的高风险群组。,Chinese
+的确我们很多医生都会有这些症状。 甚至有几位 都有曾经动过手术的一些经历。 其实这个问题,Chinese
+我想了很多次了。 如果我有颈椎的问题 我究竟会如何去面对。 除了得面对手术风险， 颈椎间盘切除和置换手术,Chinese
+Royston是一个喜欢动手劳作的人 他大半辈子的职业 离不开餐饮业和服务业。 不过 或许就是他所做的“粗活儿”，,Chinese
+导致他伤到了颈椎。,Chinese
+对Royston来说 后悔已经太迟了， 而在拿定主意要动手术之后， 他只能从容地面对一切未知。,Chinese
+我们也是有点担心。 这么老了才来动手术。,Chinese
+这边 这边 这边。,Chinese
+高龄八十岁的蔡永恒 向来都保持健康的生活。 不过两个星期前 他的腹股沟部位开始出现剧痛。,Chinese
+他很痛 他还不要跟我们说。 他还叫我妈妈不要跟我们说。 可是我妈妈说他痛到晕倒。 蔡永恒育有四个孩子,Chinese
+大家会轮流探望和照料他和妻子。,Chinese
+两个星期前 孩子们好不容易成功说服蔡永恒 来医院看病。 那时他们才发现,Chinese
+原来父亲有隐情瞒着他们。 吸气 憋住。 蔡永恒不时发疼的腹股沟区,Chinese
+原来有个大肿块。 而且早在十年前就出现了。 腹股沟疝是一种相当常见的疾病,Chinese
+往往随着患者年龄增长 肌肉变得薄弱而导致的。,Chinese
+一般患者如果病情不严重 可以选择保守治疗法。 不过 如果问题严重的话 肠管会有坏死的可能。,Chinese
+甚至会给患者带来生命危险。 一直很抗拒来医院的蔡永恒被告知 他必须尽快动手术。,Chinese
+有痛吗？ 没有。 没有。,Chinese
+外科医生Sujith Wijerathne 为蔡永恒提议的锁孔手术 主要通过三个小切口进行。 但是因为蔡永恒的肿块特别大,Chinese
+锁孔手术如果不成功的话 有可能需要在手术当中 做一个更长的切口。,Chinese
+亚历山大医院在上世纪四十年代 ��英国殖民政府兴建。 经过几次改革,Chinese
+这家医院奇迹般 屹立不倒地运作到了今天。 并且在二十一世纪找到了新生命。,Chinese
+近年来 亚历山大医院把重心放在 年长者常见疾病所需要的手术治疗 例如疝气 关节置换和眼科手术。,Chinese
+九个月前 王振兴发现自己的视力变得模糊 经过医生诊断 他的右眼患有白内障。,Chinese
+这就是我们的那个晶体。 那晶体跟着时间 它会变成没有那么透明了。,Chinese
+现年七十四岁的王振兴 其实在去年十月 已经做过左眼的白内障手术。 右眼的白内障问题虽然不严重,Chinese
+不过 他还是决定动手术。,Chinese
+白内障手术 主要是把浑浊的晶体取出 再植入人造晶体。 手术前 医护人员,Chinese
+会先测量患者的眼睛 为他们量身定做人造晶体。 而这个手术 同时也能矫正患者的近视和远视问题。,Chinese
+人造晶体是很细小的。 它有分成它的晶体的脚襻 跟晶体的中央那个部分。,Chinese
+白内障手术通常只需大约 二十分钟就能完成。 虽然程序相当直接 但万一出差错的话,Chinese
+也会给眼睛造成伤害。 做白内障手术那个范围 大概只有十毫米阔 四毫米深。,Chinese
+患有腹股沟疝的蔡永恒 今天要动手术了。 休息。 放松。 陪同他前来的有二女儿和女婿,Chinese
+以及大女儿。 一路来 他一直讲 不要紧 有时我们家的那个洗衣机坏,Chinese
+他也要扛去楼下。 虽然父亲说不怕,Chinese
+但孩子们却还是感到不安。 因为这毕竟是父亲有生以来 第一次动大手术。 年轻他没有做过手术,Chinese
+所以我们也是有点担心 也这么老了 这个年纪才来动手术。 没事的 是简单的手术。,Chinese
+退休前 王振兴是在航空业上班 经常到处飞 在不同国家生活。 退休后 想要环游世界的欲望,Chinese
+仍未熄灭。,Chinese
+王振兴已经进行过一次白内障手术 但他还是感到些许紧张。 而对他的主治医生伦承志医生而言,Chinese
+为病人的另一只眼睛开刀 也往往更加有压力。 第一台手术 效果可能是挺好的,Chinese
+这样他们一定有一种渴望说 这个手术跟另外一个一样顺利。,Chinese
+所以在做这个手术的时候 可能这些会带给你多多少少一些压力。 但是你在做手术中 就要把全部的这些东西都放在一边,Chinese
+专心地只是面对你面前的那个问题。 手术的第一部分,Chinese
+就是在眼角膜割开一个约 2.7毫米的小切口。 我觉得最主要就是你的手不能抖,Chinese
+这个是很重要 很重要的。 通过小切口 医生接着会把超声乳化探头插入 把晶体液体化 然后吸出来。,Chinese
+手术进行时 医生必须小心翼翼 但病人也扮演着重要角色。,Chinese
+整个手术内 我们的病人都是要动弹不得的。 所以我们医师就是术前 就要衡量你的病人,Chinese
+可不可以配合一下。 假如其实他们心情是比较紧张的。 我可能就对病人建议一下 可能我们就做全身麻醉。,Chinese
+所以虽然我们是眼科医生 但是很重要的 也要用到我们的耳朵来“看” 病人是有什么要求。,Chinese
+靠你了。 靠我。 很多高龄病患在决定动手术时 最担心的其中一个问题,Chinese
+就是需要全身麻醉。 因此 在手术之前 高风险病患 都会被安排和麻醉师见面进行检查,Chinese
+一般的腹股沟疝修补手术 只需要约一个半小时就能完成。 不过 已经过了两个小时,Chinese
+蔡永恒的手术还在进行中。 我妹妹又急 又说一直要来 要来。 我说 你等 因为我觉得,Chinese
+虽然每一种手术都有风险 但白内障手术属于高成功率手术 一般患者的视力在手术后的几天内,Chinese
+现年四十一岁的林凤留和丈夫 是新加坡永久居民。 多年来 两人为了工作 每一天都来回新马两地。,Chinese
+我们都每天这样子在一起出门 一起下班 五 六点下班 回到来七 八点。 就有时候看到什么东西,Chinese
+我们都可以聊的。 比如啊 怎么突然间这边有起这个屋子这样子。,Chinese
+就普通的生活这样。 这一天 夫妻俩如往常一早就出发。 但是 他们却不是去上班。,Chinese
+今天是妻子林凤留动手术的日子。,Chinese
+林凤留在六个月前 被诊断患有第三期乳癌。 因为癌细胞扩散了 因此 她必须动手术切除左侧乳房。,Chinese
+我最害怕什么啊？ 我最害怕是醒不来而已。 你先走 你做工。,Chinese
+医生叫我放心。 只要你跟着配合我们一步一步慢慢来 你会好的。,Chinese
+在林凤留踏入医院的那一刻 手术室也开始忙起来了。 林凤留除了进行乳房切除术之外,Chinese
+也会做乳房重建手术。 因此 手术室里 聚集了两支不同的团队。,Chinese
+乳房切除术将由伍长泰医生带领。 而乳房重建手术则由许静仪医生带领。 这种二合为一的手术也称为,Chinese
+整型式乳癌切除手术。,Chinese
+不要担心。 重建乳房的方式有很多种。 包括假体植入手术。 不过 林凤留最终选择,Chinese
+用腹部的组织来重建乳房。 用自体的组织 外表和触摸上会比较自然。,Chinese
+随着时间 皮瓣也会慢慢地垂下。 这是比较自然的。 然而 这是一项复杂的手术。,Chinese
+预计需要八个小时完成。 做皮瓣手术呢 因为它的手术时间会比较长 所以会有相对的麻醉风险。,Chinese
+手术的第一部分总共有六位医生参与。 为了避免阻挡彼此的视线和动作 每一位医生都井然有序地站着,Chinese
+或坐在预先安排好的位置。 除此之外 切除团队因为必须保留,Chinese
+完好的乳房皮肤给整形团队使用 因此手术相对来说更具挑战性。,Chinese
+据统计 随着现代疗法的发展 乳癌患者的存活率有上升的趋势。 即便如此,Chinese
+一旦被诊断患有癌症 仍然会让大多人充满恐惧。,Chinese
+最放不下的不是我老公 是我孩子。 林凤留和丈夫育有一儿一女 两个孩子都还在念书。,Chinese
+为了工作 夫妇两人周日都早出晚归。 到了周末 他们便会争取时间陪伴孩子。,Chinese
+我的女儿是那种很像 她的情绪不会表达在她的脸上。 她都是会放在心里面的。 我的儿子呢就会上网去找乳癌的资料啊,Chinese
+乳癌第三期患者林凤留 一早来到医院 进行乳房切除和重建手术。,Chinese
+经过两个小时 林凤留左侧乳房的组织样本 已经完全取出。 这个样本会被送往实验室,Chinese
+以检验组织的边缘是否有癌细胞。 若检测呈阳 就代表肿瘤切除得不干净。,Chinese
+那么患者可能得进行多一次手术 以避免癌症复发。,Chinese
+在乳癌治疗里 外科医生往往也是患者的主治医生。 从化疗到手术 陪伴病人走过漫长的治疗过程。,Chinese
+乳房切除团队离开之后 整形团队的其他医生随即进入手术室 为带头的许医生助阵。,Chinese
+重建手术的病人都希望疤痕最美 重建也是要完美的效果。 所以我觉得这一方面是最有挑战性的。,Chinese
+手术开始之前 我会有一种好像去打仗的感觉。 好像这个奋斗力和决心 想把手术做得最好。,Chinese
+取出皮瓣后 整型团队会用荧光仪器 检查皮瓣是否血液循环正常 才把皮瓣转移到胸部。,Chinese
+这时 来到了手术的关键一步。 利用皮瓣形成新的乳房丘。,Chinese
+我们在手术当中会调整手术台 让病人坐起来。 她们坐起来的时候 她的乳房是在最自然的姿势。,Chinese
+我们才可以看得出 让乳房形状对称。 对刚被诊断患有乳癌的病人来说,Chinese
+整型或许完全 不在她们的主要考虑范围内。 不过 随着患者的康复率越来越高 越来越多人也开始考虑,Chinese
+进行乳房重建手术。 这通常也是病人在恢复的过程 最后的一个部分。,Chinese
+所以做过重建手术后 她们可以慢慢回去 她们从前的日常生活。,Chinese
+就不要一直想着那个话题这样子。 林凤留是个运动爱好者 喜欢游泳 跑步 爬山 打球,Chinese
+如果穿戴义乳的话 将会给她造成许多不便 不过 她决定重建乳房 也基于别的考量。,Chinese
+你可以吃吗？ 我怕你等下要吐。 刚从手术苏醒过来的林凤留,Chinese
+仍然有些虚弱。 看到她醒来后 丈夫戴瑋澔心里的大石头 总算放了下来。,Chinese
+不过很淡？ 不会淡。 其实 这并不是戴瑋澔 第一次看到妻子躺在医院里,Chinese
+林凤留十五年前 遭遇过一场可怕的车祸。 她甚至当场口吐白沫 经过一番抢救后 才保住了性命。,Chinese
+做好了 就推出去病房。 最难忘的就是我老公 紧紧抱住我那一刻。 那个是最难忘的。,Chinese
+要试一下汤吗？ 每次我生病的时候 都是他在服侍着我。 也是很感激他。,Chinese
+自己的老婆 不会累。 娶到这样的太太 肯一起吃苦,Chinese
+一起坐摩托车进出新加坡 有时唠叨两句。 不过唠叨过后 大家开开心心。,Chinese
+这个日子算满足 不敢要求太多。 你要走了。 我要抓你的手。,Chinese
+晨运是Steven每个早上 开启新的一天的方式。 高龄七十一岁的他 看起来和一般乐龄人士一样健康,Chinese
+但他其实患有第三期直肠癌 并将在一个星期后进行一项 预计长达九个小时的大手术。,Chinese
+吴先生得了第三期的直肠癌 因为它的位置 我们一定要先做化疗跟电疗 把它缩小才能开刀。,Chinese
+那如果不及时开刀的话 它会慢慢地变大 也可以侵犯到旁边的一些重要的器官 比如前列腺跟膀胱,Chinese
+也是可以扩散到别的器官 比如肺跟肝。 对吴先生来讲 这个手术是一定要开的。,Chinese
+早上六点三十分 六十岁的Manikam 因为不久前在家中意外摔倒 导致肩胛骨破裂 因此这天,Chinese
+Manikam是��休人士， 几年前丈夫去世后 就开始独居生活。 这个病人的案例是比较特殊,Chinese
+因为她是有右关节复发性的脱臼 而我已经尝试的关节复位 但是两次都失败了,Chinese
+因为她的肱骨有一个很大的缺口。,Chinese
+Manikam的身体质量指数 BMI值高达三十七 体重过重 邬医生无法用一般的软组织,Chinese
+替她填补缺口。 而开创性的手术 也会为Manikam带来更长的复原期。 所以最好的方式就是植骨填补缺口。,Chinese
+如果她不及时动手术的话 病人会承受长期的疼痛 而且不能抬高她的手。 邬医生决定为Manikam进行的,Chinese
+肩关节镜手术是一项微创手术。 病人在手术前需要进行全身麻醉。 为了确保手术的安全性,Chinese
+这项手术还结合了3D打印技术。 我们事先打印两个模型， 一个是她本身的肱骨的模型，,Chinese
+第二是她所需要填补的 骨头缺陷的模型。 我们是用这个模型 来打磨所需要植入进去的替代骨。,Chinese
+这项微创手术为病人带来许多便利 也减少了手术的风险。 但却大大地延长了手术的时间，,Chinese
+这项手术估计要花七个小时才能完成。 这个骨头如果放进去是不吻合的话 那我们就没办法,Chinese
+我们就要转换成开放性的手术。,Chinese
+两天后将进行 直肠癌切除手术的Steven 来到了医院。 他今天来是要在腹部先做记号,Chinese
+以便在需要的时候打造结肠造口。 因为要是直肠或肛门 被发现有恶性肿瘤,Chinese
+需要全部切除的话 那会导致肛门封闭。 病人就必须在腹部 开一道新的结肠造口让粪便排出。,Chinese
+由于Steven的癌症肿瘤 处于靠近骨盆的位置， 这大大增加了手术的难度 一年多来 Steven便经历了多次化疗,Chinese
+和放射性治疗 以缩小肿瘤。 为了关爱他的家人 不让他们担心,Chinese
+Steven不断告诉自己要勇敢面对。,Chinese
+Sharil的父亲 高龄七十一岁的Satar 除了患有心脏病及糖尿病 最近又被诊断患有第五期慢性肾脏病，,Chinese
+洗肾虽然是不方便， 但是能够延长生命。 我们现在医药比较先进 有办法能够缓解。,Chinese
+需要长期洗肾的人必须先动手术 在手臂的动脉和静脉之间 建立一个血管通路。,Chinese
+但手术容易导致血栓形成 于是 新加坡中央医院 展开了三年试验计划 采用动静脉内瘘的非手术性方式,Chinese
+替代传统手术。 传统的动静脉瘘手术需要切口 这个手术只需要一个小的针孔。,Chinese
+这个手术减少病人需要长期内 回来医院疏通血管的次数。 张医生向Satar提议,Chinese
+尽快安排进行这项手术 以做好洗肾的准备。 独居的Manikam在家里不小心跌倒，,Chinese
+导致肩胛骨破裂。 这一天必须到医院接受肩关节镜手术。 邬耀乐医生正尝试把,Chinese
+她这个是属于比较复杂的手术， 因为我们所可以看到的 缺骨的地方会比较小。 如果放进螺丝了过后替代骨断裂的话,Chinese
+就会导致整个关节不稳定。 所以她的脱臼的复发可能性 将会是更高。,Chinese
+经过几次的打磨 邬医生终于把替代骨置入正确的位置。 这个模型是以一比一的比例打印出来,Chinese
+所以基本上是很吻合 病人真正有的缺口。 为了发展和推广3D打印技术，,Chinese
+新加坡中央医院在2022年 成立了3D打印中心。 但这项技术其实仍存在不同的挑战。,Chinese
+例如说这个手术 从断层扫描转换成3D打印的模型 其实总共需要二十四个小时。,Chinese
+患有第五期慢性肾脏病的Satar， 今天要接受非手术性 动静脉内瘘医疗方案。 因为估计只需耗时三十分钟，,Chinese
+Satar原本不愿麻烦家人 想要自己前往医院， 但儿子Sharil却坚持陪他来。,Chinese
+这个医疗方案虽说是非手术性 但是在开始之前 Satar还是得先进行全身麻醉。 整个过程只需通过一个针孔就能进行。,Chinese
+在没切口的情况下 医生需采用超声波 来确定瘘管的正确位置。,Chinese
+接下来 医生把一个小号的插针 通过针孔插进静脉。 张医生接着在动静脉之间,Chinese
+建立一个闭合性的导管。 这个手术跟其他手术一样 都有一定的风险，,Chinese
+可能有感染 并发症 比如需要回来疏通血管。,Chinese
+四十五分钟过去了 手术比预期的稍长， 但幸运的是Satar在手术过程中 没有出现任何状况。,Chinese
+这一天 让Steven既期待 又担心害怕的日子终于到了。 患有第三期直肠癌的他 即将进行他有生以来的一次大手术。,Chinese
+预计长达九个小时的手术 在Steven进入麻醉状态后 正式开始。,Chinese
+一般的结直肠手术 是在腹部开一条很长的纵切口 才可以接触和切除大肠。 手术后的疼痛会相对增加,Chinese
+复原也比较缓慢。 但是 这台手术是微创手术， 伤口会比较小 病人的���比较少,Chinese
+可以比较快康复。 我们的目的就是把整个直肠跟癌症 包括旁边的组织全部拿掉。,Chinese
+萧医生首先通过腹部 四个0.5公分大的切口 将医疗仪器插入腹腔内 然后全程透过腹腔镜,Chinese
+能够更清楚显示体内组织的细微结构。 护士将手术室里的灯改为蓝光，,Chinese
+因为外科医生长时间做腹腔镜手术 看到的都是一片血红色的画面， 大脑会出现一种饱和现象,Chinese
+而更难分辨出红色区域的细微差别。 而蓝色是红色的相对色 改用蓝灯能有助于改善这现象。,Chinese
+要是无法从这个位置 彻底切除肿瘤组织的话 医生将通过肛门的部位完成手术。,Chinese
+萧医生决定改由肛门的位置继续手术。 Steven的肿瘤处于直肠下段,Chinese
+骨盆腔的底部 空间狭小 这大大的加深了手术的难度。 但萧医生坚毅的 一刀一刀地把肿瘤给切除，,Chinese
+以避免手术 需要改为传统开腹方式进行。,Chinese
+皇天不负有心人。 手术在第七个小时有了突破。 萧医生成功地将直肠癌的组织去除。,Chinese
+手术室内分秒必争 萧医生立即把肿瘤组织 拿到刷手间进行解剖。 而医疗团队的另一名外科医生,Chinese
+则接手清除遗留在病人体内的淋巴瘤。 很多人都以为 开刀只是外科医生的功劳。,Chinese
+但是 要成功开刀其实 是每个医护人员的付出跟功劳 才能成功的。 无论那个手术长短,Chinese
+开完刀一般不会觉得很累。 可能是因为我充满了肾上腺素， 也是会觉得自己会有很多满足感,Chinese
+可以完成一个很有意义的事情。 不过 Steven的手术还未算完成。,Chinese
+先不拍了 现在发烧太厉害得去医院。 刚才大家看到带孩子看病这个,Chinese
+实际上是发生在圣诞节之前。 那么现在孩子也好了 然后心里也踏实多了。 不过当时看着我们家弟弟发烧,Chinese
+痛苦的样子 心里真的是特别着急。 我相信很多为人父母的朋友都有 同样的感受。 正好去年我带着孩子回国度假的,Chinese
+时候 这弟弟也演绎出了一个一模一样 的看病过程。 只不过当时是在北京看的病。,Chinese
+我们去的是那个新世纪儿童医院。 所以说这一期我就根据我自己 切身体会来聊一聊,Chinese
+就是在澳洲和在中国带孩子看病 那些不同。 一定要看到最后 因为不论是看病流程也好,Chinese
+还是最后的花费也好 真的是挺让人吃惊的。 其实要说这个感冒发烧 在澳洲这边对于孩子来讲,Chinese
+真的是常事 几乎每年冬天都有 所以我们都习惯了。 那么今年冬天还是我们家弟弟 但是我们家弟弟跟其他的孩子是,Chinese
+不太一样 什么地方呢？ 就是他吃不进去药。 不论是什么样的方式 哪怕你逼他吃,Chinese
+他吃进去之后一样会吐出来 是身心都会去抗拒。 然后很多人出招 比如说你把药加到一些吃的里去,Chinese
+那都没有用。 为什么 因为弟弟练就出来抗拒吃药的能力。 那是几年时间积累出来的。 而且现在真的是能力暴增啊。,Chinese
+你把这个药放到别管味道多大的饮料里 还是吃的里 他的舌头就堪比世界上最精美的 探测仪一样,Chinese
+能够探测出来。 什么奶昔什么各种饮料 这都弱爆了 我记得去年弟弟和我们回国度假,Chinese
+信心的话。 这里面有药？ 那么圣诞节前就是学校放假了 然后在放假前的几天,Chinese
+有一天弟弟回来一看就是不太精神 有点打蔫的样子。 这不出意外肯定是要发烧的节奏 就到了晚上果真没让我们失望,Chinese
+39度高烧烧起来了。 虽然一次次把被弟弟不吃药的 残酷现实所打击。 但是你还要得尝试,Chinese
+因为人生总要去尝试。 结果这一尝试真的是没想到 经过非常耐心的解说之后,Chinese
+这弟弟居然配合吃了一次药 而且把药吃进去 还没有吐 就真的是把我们高兴的不要不要的。,Chinese
+然后我们就此以为弟弟长大了 不吃药的日子再也没有了 从此以后真的会配合吃药 我们的解放日子也从此到来了。,Chinese
+然而这个后面残酷的现实 把我们浪在九霄云暗的希望又 重重的摔回到地上了。,Chinese
+让我们觉得我们自己真的是 Too Young Too Naive了。 那么第二天弟弟又恢复了原样 仍旧开始不吃药了。,Chinese
+然后是发烧 这个一烧就是四天 这期间给他做了很多物理降温 也喝了很多水,Chinese
+但是到第四天的时候 我们就觉得有必要要去一趟医院了。 为什么 因为烧的时间比较长 你要查一下有没有其他的症状或,Chinese
+想一下办法去退烧。 那么就像刚才说的 其实去年弟弟一模一样的演绎出 了这么一个发病过程,Chinese
+但是在国内除了发烧之外 还有一些咳嗽的症状。 所以说这一次我就跟大家聊聊我 自己的切身体验和感受啊。,Chinese
+首先说一下医院的选择 因为我是住在澳大利亚的墨尔本 因此想到的第一个医院就是 Royal Children Hospital 就是 皇家儿童医院。,Chinese
+皇家儿童医院真的不愧是全世界 最棒的儿童医院之一。 每天都要监测像这种空气的流动,Chinese
+含菌量这些微指标 而且门诊里你猜做了一个什么 给小朋友做了一个水族馆啊。 所以说弟弟得病,Chinese
+我们就不远万里驱车来到 皇家儿童医院。 但是来到医院之后呢。 经过一番检查就被告知,Chinese
+像弟弟这种只有发烧没有其他 症状的这种病患 在今天晚上等待时间最少要四个 小时以上。,Chinese
+所以说我也没说什么 抱起弟弟就回家了。 那么第二天早晨弟弟还在发烧 因为早晨通常都不应该是很烧的,Chinese
+所以说我们二话没说带着弟弟就 来到离家不太远这个叫 莫那什儿童医院。 这里的设施看起来也是非常棒的。,Chinese
+但只不过在澳洲这边医院的选择 可能没有国内那么多。 然后再对比一下国内上次回北京,Chinese
+弟弟也是一模一样的 感冒发烧 而且还有咳嗽 也是几天之后我们就不得不去医院。 但因为弟弟是澳大利亚的国籍,Chinese
+所以能去的医院只是这些保险上 指定的医院。 因此我们就选了一个名气比较大 然后离我们家不太远的儿童医院,Chinese
+国际部。 还有一个名字叫新世纪儿童医院。 然后去了之后我发现医院不论是 设施也好,Chinese
+规模也好 还是整体环境也好呢 真的是比墨尔本医院差了很多。 然后我也是出于好奇,Chinese
+就去旁边的儿童医院普通门诊看 了一眼。 挺大的 厅里全都是抱着孩子,Chinese
+的那些家庭 就感觉全中国的 儿童都集中在这儿了。 这场面真的是真还挺壮观的。 那么第二个我们就来说说整个,Chinese
+看病的流程 对比一下 这个部分真的是非常有意思。 先说澳洲这边 我们进了医院之后呢,Chinese
+第一步先到一个柜台录入各种 数据 可能就相当于国内的挂号啊。 然后挂完号之后,Chinese
+然后会到一个护士的分诊台。 这个分诊台什么意思呢。 就是他来给你检查一下基本的,Chinese
+一些病症 然后测一下体温啊 问一下基本的情况 然后根据这些情况来决定你等待 的时间。,Chinese
+那么急症的话你可能不用等待 很快就会见医生。 那么如果没有那么急的话呢 他可能就让你等待时间长一点,Chinese
+因为毕竟儿童医院里去等急诊的 病患的孩子还是挺多的。 这也是为什么我们第一次去到 皇家儿童医院就会等很长时间。,Chinese
+因为根据他的分诊 弟弟没有症状的发烧 属于那种不是很着急的 所以等的时间就长一些。,Chinese
+我们来到这个莫纳什儿童医院 实际上是早晨 所以没有那么忙。 我们之前只有一个小朋友在等待。,Chinese
+但即便如此 我们也是等了45分钟才进去 看上病。 那么近去看病的时候,Chinese
+孩子是被带到一个设施一应俱全 的病房里 然后坐在病床上 医生开始给孩子们检查。,Chinese
+我们家弟弟就属于那种就窝里横 然后初来乍到新环境属于那种 适应型,Chinese
+就观察 不敢太造次的。 所以说就比较配合的医生各种检查。 然后医生看到这么配合孩子就 一口一个nice boy,Chinese
+good boy。 但是后面呢当医生企图为他吃药的时候 估计肯定是特别后悔说了多说了 这么多赞美的话。,Chinese
+那么医生的检查流程就是先给 弟弟看看耳朵有没有中耳炎 然后再看看鼻腔,Chinese
+口腔有没有上呼吸道感染。 接着再听一听肺部呼吸音是不是 有肺炎的可疑。 然后再去检查问一下这个这个大小便,Chinese
+看看有没有这个泌尿系感染的 这种可能性。 然后经过一番检查之后发现没有 任何症状,Chinese
+只是一个就是发烧 那么医生就很肯定的判断这是 一个病毒性的这么一个感冒。,Chinese
+病毒引起来的 尤其是经常会在短时间内就烧的 温度非常高 所以说医生就建议还是以吃,Chinese
+退烧药 喝水为主 然后自己就开始尝试弟弟吃药。 结果是直接喂也不行 把药放在冰激凌里,Chinese
+胃也不行 我心想不用试了 我们这几年跟他作战的经验总结下来 就是你用什么方法都没用的。 后来经过多方尝试无果之后,Chinese
+医生建议让弟弟躺在这儿好好 休息一下 多喝点水 稍微观察一段时间,Chinese
+然后就走了。 然后等了好久医生终于又回来了 然后就问他说 你看孩子烧的挺厉害 是不是要处理一下。,Chinese
+后来医生跟我们说 就是说像这种病毒引起来的没有 其他症状 这种发热的 其实不吃药也可以。,Chinese
+但前提是要做好水分的补充。 只要在水分充足 电解质充足的前提下的 这孩子其实是不会烧坏的,Chinese
+绝对没有任何问题。 也���你会看到可能有3%这种这个发热 癫痫的出现 但这个多半也出现在有一些病史,Chinese
+的孩子情况下。 所以说跟我们说只要是补充水分 然后呢做好物理降温 基本就没有任何问题。 然后在临走之前就建议我们让,Chinese
+弟弟在病房里好好的睡一觉 休息一下 然后留下来再观察一下。 我现在明白为什么在外面等时间,Chinese
+那么长了好嘛 和还有睡觉的呢。 我们再说说国内的 国内真的是让我挺感慨的。 我们当时印象特别深,Chinese
+然后带弟弟去了医院 交完费 做完前期的手续之后 就坐在那 等很快大概也就三五分钟的样子,Chinese
+就被医生叫到办公室了。 就跟这边的全科医生一样 医生是有一个自己的办公室 然后你是坐在办公桌旁边,Chinese
+然后医生给你看病。 除了像这种常规检查之外呢 医生一定要给你做各种辅助的检查， 比如说验一下血,Chinese
+然后弟弟还要拍一个胸片等等 就各种各样的检查。 然后整个过程非常短暂 大概也就不到七八分钟的样子吧,Chinese
+然后就去主要是做各种检查去了。 然后这一圈检查做下来之后呢 也没有别的什么再去做的,Chinese
+就在那等着结果。 然后结果出来之后我印象特别深 这个医生看了一下验血什么都没有 太大问题,Chinese
+应该也是病毒的。 然后他看了一下胸片上的写这个 结果模棱两可 就等于是把诊断最后推给临床的医生,Chinese
+然后我问临床医生这是肺炎吗？ 临床医生说什么呢 说“疑似” 也不跟我说出明确结果 就是“疑似”。,Chinese
+但是他建议以防发展成比较严重 的情况 他建议还是进驻住院输液治疗。,Chinese
+就是因为我们从来没有弟弟输过液 因为我在澳洲生活时间很长 我知道输液在澳洲来讲就跟小,Chinese
+手术一样 所以我很犹豫。 但是禁不住国内这些亲人们的这个劝 再加上孩子当时确实也很难受,Chinese
+所以说我们就办了入院手续 然后准备给弟弟就是输液治疗。 然后再说一说第三点就是 在国内和澳洲都是如何最终离开,Chinese
+医院的。出院的这些特征指征。 那么在澳洲我说句实话 这次带弟弟看病确实是感觉医生 非常耐心。,Chinese
+最后出院是我们申请的。 因为如果我们感觉我们不说出来的话 弟弟可以一直在医院里睡觉。睡觉,Chinese
+喝水 观察。睡觉喝水观察。 然后弟弟在医院又睡不好 所以说我们就想如果确定没有 什么问题 是不是可以回家去睡觉。,Chinese
+然后医生也是 他呢需要跟他自己的上级医生去请示 看了所有的症状之后 然后确保无误,Chinese
+然后他就同意了我们的请求可以回家。 但是走之前也是嘱咐了 很多事情就是你该怎么去护理弟弟,Chinese
+然后如果出现了什么样症状 你要马上回来 然后等等不拉就很多嘱咐嘛。 那么在中国给我感觉这个病,Chinese
+得一定完全好了才能出院。 其实我们最终也没有住院 只不过是在医院里进行治疗 因为弟弟不愿住在医院里了吧,Chinese
+所以我们也是回家住的。 但是好像是四天之后 弟弟基本上没有任何症状了 就是完全恢复了,Chinese
+然后这个时候彻底可以出院走了。 不过出院时的心情是完全不一样的。 在澳洲还是提心吊胆的,Chinese
+还是比较焦虑比较着急的。 那么在中国可以说是笑口颜开的出院。 因为孩子们完全已经恢复了。 那么第四点,Chinese
+我来说说医护人员的态度。 在澳洲真的是不愧是孩子的天堂 就是我不太清楚其他,Chinese
+就我个人的经历来看 你别说这个服务不好的了 就连态度很平淡的医护人员几乎 都看不到。,Chinese
+医生和护士基本上都是非常的友善 非常地热情 而且特别会鼓舞和鼓励孩子,Chinese
+让孩子配合治疗。 然后面挂微笑可以说是最常见的 事情了。 当然也不是说全部啊,Chinese
+我也碰到过那些比较走程序化 这种年轻护士。 当然这个真的是极个别的少数。 然后再说国内医生的态度啊。,Chinese
+我没有太多这方面的经验和经历 所以我只能拿这个新世纪儿童医院这 次看病经历来讲一讲。,Chinese
+我就觉得这医生你说这态度不好 也不是 但是非常的平淡似水 而且不是很热情,Chinese
+就给我感觉最深的一个地方是哪儿呢 就是医生似乎生怕去说错了些 什么或者做错些什么事儿。,Chinese
+所以他的行为和举止特别的谨慎。 那么这四天期间也碰到过特别 喜爱弟弟,Chinese
+我们家弟弟挺可爱的 胖乎乎的。 然后也特别喜爱弟弟的医生也逗一下。 但这感觉远没有澳洲医院里这些,Chinese
+医生就那么放松。 后来我也很纳闷。 你说这个孩子也挺可爱的 而且确实也非常配合医生的这个检查,Chinese
+医生为什么一个个都这么紧张 或者是这么��放松呢。 后来我们家父母也跟我讲说 因为我在澳洲时间特别长,Chinese
+没有经历过国内这么多年来的 这些发展。 因为现在国内的医患关系确实是 不太好。,Chinese
+因为前一段刚出现吗 在急诊里就一个98岁老人的 家属砍死了一个急诊医生。 所以说这些医生都是特别谨慎。,Chinese
+尤其像在这种新世纪儿童医院。 那么弟弟因为是澳洲国籍 所以必须来这儿看。 但是国内来这看病的这些患者,Chinese
+基本上家庭条件都非常好。 对孩子也特别重视 都视为掌上明珠。 所以说医生说话做事真的是要,Chinese
+非常的小心。 所以说这个可能就是把医疗行业 放入市场中的这么一个副作用吧。 因此有些行业它是不能放进市场的,Chinese
+比如像医疗 比如说像教育。 那么第5点我们再聊聊看病的费用。 那么在澳洲呢孩子只要是孩子在,Chinese
+医院里看病 检查 用药 住院 所有的费用全部由政府来出 自己是一分钱不用来花的。,Chinese
+那么可能出院时候医生会给你 一些处方药 那么这个处方药你是拿着医生的 处方可以去药店来买的 但也非常便宜,Chinese
+因为澳洲全民医疗保险叫 Medicare 能报销大部分的花销。 当然这个是你必须是澳洲公民,Chinese
+或者是澳洲绿卡才有全民医疗保险啊。 如果你是没有绿卡的话 你也要到私人保险里买这么一个 和Medicare相当的这么一个,Chinese
+保险才行。 然后我们再说说中国啊。 我就两个字天啊 这我都不多说了,Chinese
+我把四天看病的账单我放在屏幕上 大家可以看一眼。 这个是第一天的。,Chinese
+因为里面有检查 各种检查所以费用高一点。 那么这个是第二天。,Chinese
+这个是第三天的。 其实最后一天好像没有输液 只做一些雾化,Chinese
+这是第四天的。 四天下来 12000多人民币啊。 呵呵。,Chinese
+对 我就只能呵呵了 最后我们再聊聊在中国和澳洲 带孩子看病各自的优点和缺点。 先从澳洲说起,Chinese
+先说说优点 那么在澳洲看病不用花一分钱 这肯定是一个优点了。 而且澳洲医院的环境也好,Chinese
+设施也好 医护人员的态度也好呢 真的是非常棒。 就感觉大家是在一个彬彬有礼的 环境下进行这种工作的,Chinese
+急诊也是如此。 但是很多朋友这里面有个误区 就觉得似乎在澳洲看病 给孩子看病,Chinese
+医生总是不去治病 让孩子这个喝水 生扛。 然后尤其是父母这一辈就总是,Chinese
+抱怨澳洲的医护人员无所作为。 然后你像我们家弟弟去了医院 你也不给治病就让回来了。 其实这个真的是一个误区。,Chinese
+你像弟弟这次得的病 它是一个病毒性的这个感冒 然后没有其他症状。 那么这个时候实际上这个病是,Chinese
+完全可以自愈的。 那么你让他从头到尾自己自愈 会对孩子免疫系统有一个巨大的 提升。,Chinese
+相反你在中间进行人为干预之后 反而不好。 所以说这里最好的处理就是不去处理。 而且世界公认的一个治疗原则,Chinese
+能不吃药就不吃药 能吃药就不要打针 能打针就不要去输液。 那么通过这次看病呢,Chinese
+其实也感觉到并非是澳洲医护 人员无所作为 而他们非常严格的按照这种世界 公认的治疗程序来进行的。,Chinese
+相反澳洲的医学也是非常发达的。 那么在急诊的时候 这个医护人员也是根据小朋友疾病的,Chinese
+轻重缓急来安排等待时间的长短。 你比如说两年前还是我们家弟弟 也是一次感冒,Chinese
+但引发了一些哮喘的症状 有点喘不上气来。 然后我们去到急诊之后真的是 没有任何等待,Chinese
+直接进去看医生。 因为这种症状确实是比较急的症状。 那么这次看病虽然医生没有给 弟弟开药,Chinese
+但是也做了一个非常详细的检查 而且嘱咐我们怎么去护理弟弟。 最后也告诉我们 如果我们有任何就觉得不放心的,Chinese
+地方 不要犹豫 马上带孩子来医院。 那么尽管澳洲医院的设施环境 非常棒,Chinese
+然后医护人员态度也非常好 然后整体也是按照公认的医学 流程来治病。 但是缺点也是很明显的,Chinese
+有些缺点甚至还是很致命的。 首先真的是让人很着急啊。 你自己想想你家最亲爱的宝贝在,Chinese
+急诊上烧得红呼呼的 而且还要等待几个小时 你当时是什么样的心情。 还有这种尽量减少干预的治疗,Chinese
+方式固然是好。 但这其中出现这种人为的判断 失误所造成的贻误病情 甚至死亡的病例也是非常多。,Chinese
+观众朋友你好。 今天的疫情 今天新增本土病例1万7千 801例。 有不幸3个人 新增是死亡个案。 那回到各县市 那台北市今天新增了3718例，,Chinese
+新北市是6584例， 桃园市 呢，也到2577例。 每一个县市 的新增的病例都是很多的��� 今天呢，是1万 7801例。 除了3例新增死亡,Chinese
+之外， 另外今天增加重症有 14个人， 中症有14个人， 重症有 7个人， 加起来是21个人。 那轻症跟无症状那这个比例依然是99.75%。,Chinese
+那今天呢比较大 的问题是说 除了这3个死亡个案呢， 大概一个是超过90岁， 一个超过80岁， 一 个超过70岁， 那有一个打一剂 有一个打了,Chinese
+剂 有另外一个70几岁是没有打疫苗的， 当然也许我们等一下会比较多来谈一谈。 今天新增重症的部分 有1名20多岁的女性,Chinese
+打了三剂疫苗 没有任何的慢性病史， 但是呢他今天是重症的 那 另外也有一个没有满5岁的小朋友 是女性 也是重症 那她,Chinese
+因为还没有五岁 所以当然没打疫苗， 不过他是有神经系统疾病。 那我们再来看看 这是我们长期是整理的。 蓝色这一块就是新增本土 那其实已经接连好几天突破万例 今天是,Chinese
+17000多例。 那重点还是看红色 这条曲线。 昨天中重症是增加 47例 今天是21例 不过相较及1 2个礼拜之前 中重症的人数,Chinese
+呢确实也有明显的增加的情形。 今天再来好好谈一下 包括整体现在在医院 急诊的医疗资源该如何分配 包括 是不是真的可以用快筛来替代PCR。,Chinese
+今天陈时中部长讲得很清楚 现在政策 要再做调整 就是说你必须快筛 阳性 而且是没有症状的这些人才可以,Chinese
+去做PCR。 那当然你如果有症状 的话当然要去做PCR， 可是呢 因此这所谓的快筛 阳性再做PCR 可以希望 降低整个急诊,Chinese
+主持人好 观众朋友 大家好。 感染科医师林氏璧 孔医师你好。 有话好说各位观众大家好。 还是先来看看今天的最新 疫情。 国内新冠本土疫情持续升温 2号周一新增,Chinese
+17801例 已经连续5天破万例 也创疫情以来单日新高 其中以新北市新增 6584例最多 其次是台北市三千多例 桃园市有2000多例。 疫情指挥中心,Chinese
+指挥官陈时中表示 疫情高峰的单日确诊 高推估为20万例。 我们大概用10万15万20万做低高中 低中高的一个推估，然后在设定一个特别的计划以防它万一超出,Chinese
+我们这样的一个推估数。另外也新增21例中 重症个案 其中重症有3人死亡年龄为七十 到90多岁高龄长者 都有慢性病史。,Chinese
+值得注意的是重症当中有 1名20多岁女性 没有慢性病史 打过三剂 疫苗 确诊居家照护时 因为腹痛呕吐恶化 目前插管及呼吸器。,Chinese
+另外有1名未满1岁女婴 有神经系统疾病 因为发烧到诊所就医 当时未筛检 2天后 呼吸困难送医采检阳性 目前插管 并使用瑞德西韦治疗中 成为国内年纪最小,Chinese
+的重症个案。年纪小的小朋友确实就是说可能病情变化会比较快速因为免疫系统不够成熟 所以在这个部分要特别的小心来注意。随着,Chinese
+确诊人数越来越多 陈时中首度透露 如果 国内第三剂疫苗涵盖率 达到某种程度 未来其实确诊也可以免居隔 就跟欧美国家 一样。这信息有可能的 在国外在最后像美国,Chinese
+最后都是自己快筛也不用，如果你觉得想要去做pcr你就去做，那不想做你就在家里休息五天。 那五天后你戴口罩就可以出门。至于国内口服抗,Chinese
+病毒药物部分 指挥中心表示辉瑞口服 抗病毒药物已经使用669人份 3日 会在配送到各地应变医院 4号再配送到 各地药局 以提供居家照护使用 到时不仅,Chinese
+门急诊医师可以开药 居家照护团队 也可以远距开药 再让药师送药到宅。 副院长还是先请教 你如何看待现在 整个趋势 1万7801例今天。专责病房将满载？洪子仁：应做好轻重症分流,Chinese
+我想目前的整个 的发展 事实上之前大家都讨论过了 然后我想这个确诊个案数应该 好。 还会再增加。 我想这个大,Chinese
+但是我觉得经过这里4月份 以来 到现在差不多经过一个月的时间 我觉得在某种程度上 民众也慢慢 有一些开始在调整 包含心态上的调整 好 以及行动上的调整。,Chinese
+但是我必须要讲 就是学习跟病毒共存的这件事 是需要 一点时间的 然后 就是说就像以这个新加坡 为例 他也是从去年8月份开始 好 才开始学习与病毒共存。,Chinese
+但是新加坡在8月份开始 的时候 一开始他们也遇到跟我们一样 这个情况 包含就是说这个1922 打不通啦 这个政府的这个专线被打到爆 等等 但是呢后来 就是说经过他们的一个调整之后 他们慢慢,Chinese
+才渐渐地适应在居家康复的这件事。 所以事实上新加坡后来他们统计 他们居家 康复的比例大概 在七十九percent 将近八十 percent 人几乎几乎都在 居家里面 就完成他们所有的这个这个程序。,Chinese
+而且他们后来也才发现到说 在居家这个 康复有好处 ��是那个心理支持的这个因素 占了很重要一个 就是说在家里面有归属感 然后有亲人可以来帮忙 而不是说你一确诊,Chinese
+就把你移走 一确诊就移走 他说那种感受 跟在家里面的感觉是完全不一样。 但是我必须讲 以台湾目前的状况 我们 我觉得我们还在学习那样的一个过程 还在学习的过程 就像这两天大家一直问说 急诊被塞爆的问题 确实啊我统计了一下我们,Chinese
+"新光医院最近的急诊 大概有三十 % 的人 他就是属于比较轻症的, 或者他只是要来做PCR检验。 比如说是 晚上 社区筛检站都关门了",Chinese
+那他是要来他要来做 PCR的采检 的时候他可能就来急诊 那当然他的一方面 是来做PCR的采检 一方面他是来 他虽然是轻症 可是他来急诊他起码可以,Chinese
+拿到药物 要回去就是说 有药物回去可以治疗等等， 但是这30% 的 这样一个轻症的一个一些人到急诊来 其实 某种程度就影响到 急诊能够收治真的最critical,Chinese
+病人的那样的情况。 有关于急诊塞爆 二个问题 第一个我们台北市 或是各县市 不都有社区的筛检站吗？对。 那理论上这些人应该都是到社区筛检站 而不是到医院的急诊 这是一个。 第二个当然我知道说筛检站他有,Chinese
+那个晚上就没办法有这个量能 那可能 你如果是三更半夜 不过我也不太清楚 为什么三更半夜要做 快筛。 现在。 台北筛检。对 台北市 的七大的社区筛检站 其实几乎都是,Chinese
+医院附设的比较多啦 比如说某个医院 他就是急诊 旁边就社区筛检站。 所以他几乎跟医院的急诊 也都是几乎是 联动在一起的了。 所以并不是说好像有个社区筛检站是,Chinese
+完全脱离医院的筛检站。 社区筛检站也是属于 医院的？对啊 他就是设在医院里面嘛？ 比如由新光医院 社区筛检站 联合医院他也是他的他的 社区筛检站也在医院旁边， 它只是,Chinese
+户外的另外一个区块， 所以这都是连在一起的嘛， 所以现在的我们有二个瓶颈 就是说大家在这个学习与病毒共存 病毒 共存的过程中要经过阵痛期。 阵痛期,Chinese
+就是要一些学习 就像我举一个是除了 急诊以外 第二个例子是什么？ 我今天来的时候特别盘点一下我们医院 的这个专责病房。 那我们有七十七张的专责 病房已经开出， 到目前也住了69个人，,Chinese
+占床率已经到89.6。 那现在 现在的人数是1万七千多。 那如果哪一天变成是5万以上的时候 那 势必我们医院的这个 已经开到将近,Chinese
+15% 的专责病房。可能又不够用再往上开。 大家问说奇怪 为什么中重症的人没有那么多 这个专 则病房会有这么多人挤在这个专责 病房 需要去接受照顾跟治疗 其中有,Chinese
+一个因素 我这边还是要利用节目跟民众 来就是跟大家来做沟通。 就是说很多人他到了这个专责病房 其实事实上 来讲 经过5天或7天他的这个病毒量,Chinese
+已经下来了， 然后他也不需要再氧气的协助， 其实这样的病人是可以下转到集中 检疫所 甚至回家。 可是很多病人他 一方面是可能是担心。 是。 不了解。,Chinese
+他会要求说不行 我要采检到阴性 完全阴性我才要回去。 那就变成说 有时候医生如果要去请他出院 的时候就会 遭遇到一些病人的方面的困难。,Chinese
+他会说我回去我家里人很担心 住医院最安心。是。 家里面的人可能也觉得说 你最好在医院 都阴性 你再回来。 所以我要讲 就是说 我们在从清零到与病毒共存的过程,Chinese
+中 我觉得我们民众也在学习 那个学习 就包含民众心理面的那种担忧。 我们也要去考虑 就是说今天虽然他在 新光医院以经住到医生认定可以解隔离，对不对，,Chinese
+检查CT值都大于三十四。 可是你这时候让他回家 他现在还是属于 阳性 因为CT值大于三十四 还有CT 值 只是说他的病毒量已经很低 低到对社区 已经几乎没有影响。 可是你请他回去之后 家人会担心哪,Chinese
+他说你这个还没完全到零的时候 你回来我也会很担心。 但是问题是说 那这样问题就来了 专责病房 如果我们事实上这些已经 已经 就是说可以解隔的 或者他病毒量已经极低,Chinese
+的人 去占用的时候 那我们后面有些真正需要的 中重症的病人怎么又住进来。是。 对不对？ 但是就是 所以我在讲说我要跟民众讲 就是说要拜托大家 专责病房是一个很珍贵,Chinese
+的医疗资源 大家要发挥互相互助合作 的精神 就是说医生如果一旦认定你 可以下转或者你回家 我拜托大家 还是要按照医生的医嘱去执行。,Chinese
+我常常讲说2020年到现在 台湾防疫 成功的3个要素里面 其中一个就是 我们台湾民众的公民素质 我们台湾人 水准全世界���流的。 这个时候,Chinese
+我拜托大家再拿出这个公民素质出来 能够配合医院的医疗的计画。 医生不会说 不能让你出院 让你出院 不可能 但是医生认定你可以出院,Chinese
+就拜托大家配合一下 因为你出院了 我后面的人就可以进来 我们可以把中重症的 这样一个病床留给 更需要的人入住进来。 这是要在这节目上特别拜托大家。 不过也呼应副院长刚刚讲的 第一个,Chinese
+就是说我们以为说社区筛检站是 独立的 是源源不绝的 这个量能 恐怕不是因为社区筛检站也是要 医院体系去支持 而且常常是设在医院急诊旁边 这个叫 社区筛检站。 所以如果急诊塞爆恐怕,Chinese
+那个社区筛检站早就也塞爆了 那社区筛检站耗的还是医疗的人力资源 所以这部分应该想 另外一个办法。 第二个刚刚我们如果来看这个呢,Chinese
+目前我们中症是大概240个 重症大概是35个 那理论上 这大概是那个300个人呢 应该都是在 医院里面 说如果全台湾300个 怎么可能光新光,Chinese
+85%以上 的这些专责病房都占满了呢？ 恐怕不是这样子。 第一个呢 是这是现在中重症的 第二个呢 有一些轻症,Chinese
+但是高风险的 他也要住院。 譬如说他有癌症 他有什么的 其实他看起来症状是轻微 但是他是高风险 这些人也要住院。 那更重要,Chinese
+就是他直接在家里面， 好 像我这几天 遇到 好 我在诊所里面有遇到一些那个病人 打电话来了 好。 其实他是确诊者 但他是轻症 或是无症状的 他就打电话要,Chinese
+到 病 医 这个诊所来说 他因为有症状他想要吃药这样子了哈。 那其实我们现在政府 其实他有一个 居家照护的一个计画 是要基层医师来做负责。 那在4月中旬的时候已经定调下来的。,Chinese
+但是因为定调下来的时候 没有一个很好 的规则 现在各县市它处理方法都不一样。那 处理那尤其是台北市 它给联医系统去做 那联医他自己很忙 他他有人要照顾照护中,Chinese
+重症 而且他做这个筛检 其实他量吃不下来。 所以我接获到的都是卫生局丢丢给他 一个视讯诊察的这个诊所的名单， 他自己找上门来。 那我们当然就是帮他看诊以后 我们有,Chinese
+诊所一个 APP 那我们也是就是义务的哈， 就是每天在问候他 看他有没有什么变化 其实我也接到有很多小孩子 是3岁以下的 啊有好几个 还有的是老人。,Chinese
+其实这些都是高风险的 然后 那说刚刚讲到说 我们的这个 急诊的筛检。 其实像在去年 去年5月的 时候 那时候也是一样的 状况 就是急诊都爆量。 所以那时候就启动了所谓的社区筛检站， 就是另外再独立出来的。 那时候我们,Chinese
+基层医师也是动员出来去支援。 就是在医院以外的 我们再去设立 一些比较热点的地方 多设几个， 然后我们可以去把它承接下来 做一些排班 这个我们可以做得到 因为这个已经过去的,Chinese
+有run的经验。 还有就是在机构里面 台北市的某个机构 他里面其实有确诊病人 那你就变成其他的 住民都要去做采检 其实他们 医院现在也没办法去做这件事情 我们 台北市医师公会 跟台北市卫生局也有,Chinese
+这样的一个这个机制。 其实过2天 这2天 明天后天我们也有医师 会进驻进入到 到机构去帮他做采检好。 是。再来第3个就是 我本身是耳鼻喉科医师,Chinese
+我们耳鼻喉科医学会好 就我们对这个 我们是呼吸道的专家 对这个筛检我们是 最最专精的。是。 所以其实我们在4月下旬的时候 我们有去,Chinese
+一个文哈 给那个指挥中心 说我们愿意来承担这个 这个分担这个筛 筛检的这个量能。 那指挥中心已经给我们回文了 然后,Chinese
+因为之前我们要在诊所里面做这个筛检的 时候 其实 他那个规定是非常严格 几乎我们的诊所 都没有办法达到 譬如说他的一些感染管控 或是有一些空间的规划 其实我们诊所,Chinese
+大概都达不到 只有少数比较大型 的诊所 他有办法达到。 但是因为随着疫情的变化 大家疫苗也打了 然后现在这个Omicron也是一种其他轻症化。 所以这次他给我们这个指引其实有放宽,Chinese
+那我们现在就是在调查说 我们 这个耳鼻喉科诊所 有哪些他符合这个条 件 他认为他的诊所可以承接的。 我们在 5月5号之前会把他调查完 然后把这个名单 会送回去指挥中心。 到时候 这些诊所 如果说符合条件者,Chinese
+那也可以在诊所里面帮 这个病人做PCR。 那这样子的话 可能可以分担一些这个我们 这个医院的医疗。 就是说三个方面 第一个就是社区采检站 多设一点我们可以去 第二个是诊所里面,Chinese
+有些人可以做 那 第三个 就是机构里面这个我们可以来承接 其实这 个在我们���年 那次大流行爆发的时候 我们都已经有 这个经验 随时都可以上手。 是。 换句话说希望,Chinese
+很快的时候 就可以在理想上 我们有 医院急诊的PCR 我们也会有更多的社区 PCR的 筛检站。 希望这些所谓的,Chinese
+基层社区 可以落实到更多的诊所。 诊所的医师就可以直接应该也是 PCR筛检 而不是快筛。 是。我们就跟那个 检验所还有一些医院合作 然后检体,Chinese
+送到那边去一样。 是是是。 不过我们来看看 今天指挥中心也宣布为了 要缓解急诊的这个塞爆的问题呢 要几个作法。 第一个各地方政府要加设社区 的筛检站，,Chinese
+第二个呢 急救责任医院要开设防疫 发烧门诊来分流病人 还有最最最重要 的啦 如果你没有症状你必须要 快筛阳性 他没有讲几次,Chinese
+再来决定要不要PCR 免得那边耗那些 PCR 的量能。 那当然如果你有其他症状 或者是说高风险 的你当然还是可以直接去做 PCR。 那鼓励基层诊所投入采检,Chinese
+无症状的话 因为强调无症状要抓出 无症状感染者的隐形传播链 我觉得比较清零时候的思维跟作法。 现在其实我觉得大家一个原则 就是有症状再去检查就好了。 不要,Chinese
+可能会有蛮多问题的。 因为快筛这些东西 本来就是有症状 病毒量高才容易出来 然后才容易陈其迈市长上有po脸书嘛。 阳性率 预测率,Chinese
+会比较高 然后你其实就比较没有伪阳性 的问题。 那像是双北目前盛行率这么高 上礼拜五指挥中心有show出一个各县市 那个盛行率可以差非常多。 大家可以看到,Chinese
+平均上个礼拜7日的 这个阳性率 新北已经超过二十， 台北十几。 那有一些比较不严重的地方 还大概只有 二到三 所以我觉得每一个地方可能要各自,Chinese
+的原因是因为 我们已经发现了 很多民众 他就是快筛阳 然后他就跑来急诊。 塞爆急诊要做PCR。 那可是我们看起来 目前双北这种盛行率,Chinese
+之下 有症状并在家里快筛阳之后， 非常非常高比例就PCR 就是阳了。 它就是了。 那 所以假如因为我们现在一定要快筛阳,Chinese
+反正他也不会住院。 那他没有风险因子 其实他也不需要给用药。 那些人在很多像国外 我们今天有话好说 有整理一张国外怎么做的啊。 因为国外很多地方其实也是面临 omicron,Chinese
+什么顺时钟逆 时中这个 所谓的比较政治问题我请教 你阿中部长讲了一个。 第一个 其他国家都是在整个疫情往下 的时候 才用快筛替代PCR。,Chinese
+第二个 快筛它的伪阳性 你以为他是阳 其实他是阴 大概有10% 如果是 10%这么高 那可能我们会在人权上 有疑虑 或者是会耗费更多的医疗,Chinese
+阳。 那有一个很极端的例子 跟人家 不一样 我今天特别想讲一下。 英国不是啊。 英国 他的这一波尖端发生在1月4号 可是他1月11号 他说快筛阳就不用再去,Chinese
+你就直接开始居家照护 你不用 再去做PCR。 好 他的确不是在到山头之前做的。 可是大家看一下英国的状态 跟我们完全 不一样。 大家看一下这个是每天 每1000人,Chinese
+你会做多少的检测。 大家看到英国 是数一数二的 PCR做的超高的国家。 所以他们可以撑到他的 omicron wave的山头 他的PCR 还相对都可以撑得住 大家看一下,Chinese
+这个蓝色的 就是PCR阳性率三到五。 他其实撑得很不错。 可是我下面特别抓了我们 跟友好的日本。 我们是摊在下面 我们的PCR量能其实,Chinese
+跟别人比 天差地别。 所以我觉得我们现在已经看到状况是 我们 过去这个礼拜 大概1天做的 PCR 是6到7万。 然后我们的阳性率已经 这一个礼拜,Chinese
+节节上升。 那就代表你其实检测已经 不够了你做得不够了。 散坐在 外面很多。 各国的经验恐怕那个模式不在于 说他是在疫情的往上,Chinese
+或是高峰 或是往下 而是在于说你究竟的 PCR量能。对。 能不能跟上现在疫情发展。 没错。 最重要的 跟不上 你恐怕就得改。 这些重症容易重症,Chinese
+他们在家是没有办法取得快筛的。 所以如果我没有被匡列 政府不知道我是个 确诊者 我也没有办法匡列的朋友 我的同事们 他们就没有足够的资源可以协助他们,Chinese
+来解隔离 这样的一个状况。 那包含我 自己 我其实现在都不知道 政府到底是不是到是 一个确诊者 那知不知道 我有什么样子相关 的照护上的需求。,Chinese
+他是大概隔了3天 就已经拿到相关的 通知书 也收到了啊这个确诊 这个 居家关怀照护箱。 是 是 不过潘仪我请教你 其实我们今天的一个重要的 点是在于说 是不是可以大量地,Chinese
+政府一旦知道PCR 是阳性 我们应该每个人都要有 相关的医疗 上面的资讯。 而不是像我一开始确诊之后 要自己不断地在网路上,Chinese
+着这个病毒的时候 一边要自己再上网找 这些相关资讯。 甚至还要一边 烦恼 我的 被我居家隔离的这些同事们 他们 有没有办法快速得到他们相关的资源。,Chinese
+可不可以拿到快筛 相关的事情。 对。 所以希望政府有一个比较统一 快速的管道 让我们得知 相关的资讯 而不是我 我们这些病人不断地,Chinese
+还是要在那边做确认。 如果 社区诊所能recruit 进来 我觉得慢慢的 我们才能够提高我们的 量能 就是确诊的量能。 刚刚周医师有谈到说 那个就筛检的部分 社区 基层诊所愿意 而且应该很快就可以投入这个能量。,Chinese
+但医治的部分。是。 我想说不管是 你快筛阳 甚至PCR 阳确诊之后 那些轻症的 譬如说刚刚潘仪那个例子,Chinese
+社区诊所能不能帮上忙。 所以我 如果大家前两天有看到一个报告 就 是我们目前本土个案有6万多例 对不对。 是。 6万 多例里面 中重症目前是189位。 你把,Chinese
+那个189位 你 去分析一下 你就会发现说 目前的6万 多位的确诊者里面 其实确诊人数最多 是集中在20岁到50岁这个族群 这3个族群加起来就占了确诊者,Chinese
+的比例差不多是6成左右。 如果你再加计20岁以下 的 大概就80% 的人。 都是在50岁以下的人确诊。 可是50岁以下的确诊 他在中重症的人数,Chinese
+10% 不到。 189 个 大概只有27个人。 27人 10几趴的这个 这个中症跟重症是在50岁以下。 相反 的 我们看一下60岁以上,Chinese
+的60 70 80 90以上的 染疫 的比例只占10%啊 10% 可是他的中重症的人数是189个人 就占到148。 148个都在,Chinese
+60岁以上 所以这里面已经告诉我们一个 很重要的讯息。 目前的这整个的感染 的分布状况 不是最严峻的时候。 因为目前看起来。 是。 就是年轻人的染疫是为主,Chinese
+可是我们不能太乐观的是说 这个流行继续 往下走的时候 慢慢的 50岁 60岁以上 的 染疫的比例会逐渐增加。 尤其是你看到 那 个报表 你真的会很担心 你看90岁以上的,Chinese
+就是说 他现在 他的条件 比如说你的那个 感染管控什么 他过于严格 我们在里面 没有办法 就是说 譬如说 我如果说 是不是 我做完一个以后 我要看 去看别的病人 的时候 我整套防护设备都要去把他换掉。,Chinese
+衣服都要换一遍。 因为我做完快筛以后 我要看一般病人 那是不能一起。 因为 可能会被污染嘛。 所以如果说 到时候有 有可能会越来越松啦 因为我看到这一版的这个 他的,Chinese
+这个指引他有越来越松的。 不过我们就是在期待 现在能够已经符合 条件的人 就赶快去加入。 你如果有那个 专责基层诊所 我就专门来看Covid-19的不可以吗？,Chinese
+像新加坡他其实是有这样 不过那个政府就对他们很好。 包括他们的 装备 他们的给付 都非常非常好 因为其实在疫情一开始 的时候 新加坡就有这样的专责的诊所。,Chinese
+随着人口不断老龄化， 骨质疏松症是越来越常见了。 我们两位现在是属于中壮年， 也是要开始积极地预防啊。,Chinese
+没错。 防治不可以怠慢， 这一集我们来聊一聊骨质疏松症。 我们可否从一个人的外表看出来 他是否患上骨质疏松症呢？,Chinese
+个子矮小患病的几率比较高 是迷思还是事实？ 穴位刺激有帮助吗？ 患者能够进行推拿吗？,Chinese
+中西医有哪些检测 还有治疗方法呢？ 通通在这一集的 《医聊大小事》 一起长知识。,Chinese
+哇 一讲到骨质疏松症， 我就想到好像是女性比较容易得到。 诶 那年长女性的风险不是更高？ 不然这样 问问嘉宾好不好？,Chinese
+好。 欢迎向云姐 黄炯耀。 以及骨科运动医学高级顾问 李洸辉医生。 欢迎三位。 来来来 有请。,Chinese
+今天我们的嘉宾啊 不知道对这个课题了不了解啊？ 应该蛮了解的 来 请坐。 这个课题你们请我来,Chinese
+是因为知道我。 真的 你看 演技 演技派。 演技派就是这样。 你们身边有没有人,Chinese
+或者是担心自己会获得这个骨质疏松症？ 我真的很害怕。 因为我有亲戚就是因为跌倒了 她年长了嘛？ 后来就不能动。,Chinese
+也听说过一些跌倒了之后 有特生命的危险。 那炯耀哥呢？ 我会比较担心我妈妈还有我太太，,Chinese
+因为就是听说女性会比较容易患上 骨质疏松症。 所以都会很勤劳地叫她们补钙 趁年轻要多补一下。,Chinese
+其实我个人是蛮好奇啊。 有没有可能从一个人的外表 就知道说他是不是有 骨质疏松症的问题？,Chinese
+看不出的。 骨质疏松是看不出的。 因为骨质疏松症有一个名称 叫做无声疾病。 通常是因为他们跌伤有骨折，,Chinese
+帮他们开刀过后发现 他们其实有骨质疏松症。 所以很多患者可能自己都不知道。 对啊。 有这个问题 可是为什么察觉不到？ 对啊。,Chinese
+骨质疏松症是骨头结构上的问题， 所以虽然你的骨头是完整的。 完整的。 可是它的质地不好了 钙质流失。,Chinese
+导致你的骨头产生很多那个。 空洞是不是？对。 所以一旦你的骨头有很多空洞， 它就不强壮。,Chinese
+一撞伤 轻微的撞伤 你就会骨折。 那对于骨质疏松症 我们其实也是有些迷思。,Chinese
+不然这样 我来考考你们 好不好？ 看你们对这个了解有多少。 来 第一题。 男女患上骨质疏松症的风险,Chinese
+是相等 一样的。 真还是假？ 来 三 二 一 请举牌。 三位都选假。 为什么？,Chinese
+因为女生会生孩子嘛？ 对。 所以很多东西都会流失。 女性通常在更年期的时候 都有骨质疏松症的现象。,Chinese
+一般都说女生钙质流失比较快。 风险相等肯定不对。 好 那我们请医生来揭晓. 答案是什么呢?,Chinese
+对 是假的。 三位 牛刀小试 热身题。 从30岁到40岁左右，,Chinese
+男女失去钙质的巴仙率 是差不多一样的。 每一年我们会失去大概1%到2%。 女孩子呢 到了50岁 更年期的时候，,Chinese
+流失的那个钙质的就是会比较快。 2%到3%一年。 这个会持续大概十年左右。 十年啊？,Chinese
+过了60岁呢？ 男女流失那个钙质的 就差不多一样。 好 第一题大家都不错。,Chinese
+那第二题哈。 跑步比游泳更能够预防骨质疏松症。 真还是假？,Chinese
+假 假 真。 向云姐 你觉得是游泳啊 还是跑步？ 我觉得游泳是全身好啦， 但是我只知道要用力的话，,Chinese
+是对骨质的密度比较好， 但是会对膝盖不好啦。 对 因为跑步我们就是一直施压在,Chinese
+我们的膝盖， 我觉得那是对骨头的伤害 对关节的伤害 会比游泳来得大。 当你没有那多伤害的时候,Chinese
+你就不会那么容易流失。 是吗？ 预防。 来 问一下李医生 答案是真还是假？ 是真。,Chinese
+答案是真啊。 因为跑步算是一个gravity的exercise运动。 抗地心引力的运动 我们身体才会吸收那些钙质。,Chinese
+就像NASA太空人。 他们上了太空 半年一年左右 回到地球了过后,Chinese
+医生会发现到他们都有 骨质疏松症。 所以要有重力 我们才能够吸收钙质。 那那些举重的选手,Chinese
+本身钙质就很多咯。 对。 来 第三题。 定时地补充钙片 就不用担心会患上骨质疏松症。,Chinese
+真还是假？ 来 三 二 一 请举牌。 我是这么做啦。 我是这么做 所以我相信它是。 你说假 为什么？,Chinese
+天底下没有绝对的事情。 不是说没有用 肯定会有帮助， 可是钙质流失还有很多各方面的因素了。 了解。,Chinese
+我就是因为这个原因 我定期吃这个钙片。 对 但是我也因为这样子 我有定期去做一点点运动啊 快走。,Chinese
+我觉得有吃就不用担心 没吃一定要担心。 来 医生 答案是真还是假？ 是假的。 假的？,Chinese
+如果你没有运动 没有做那些抗地心引力的运动， 你吃多少的钙片 它也不会吸收。 我听说长期吃钙片是不好的。,Chinese
+不正确。不正确。 这个除非你是长期吃很高数量的的钙质 你没有喝水 就会导致肾结石。,Chinese
+结石 kidney stone。 医生 我有肾结石 但是我这几年都每天补充钙片 请问会更加重肾结石吗？,Chinese
+如果你喝多一点 够水分 是不用担心这个问题的。 比如像我们这种年龄的 应该吃多少量的钙片？,Chinese
+从30岁到50岁 男女基本上一天 最好是可以吃到1000克 mg。 男孩子到70岁就 就增加到1200。,Chinese
+可是女性就要比较早一点 因为更年期的问题。 所以在50岁左右 最好是可以增加到1200。,Chinese
+所以你看 钙片还是要补充哈。 好 那我们来问下一个迷思 OK? 体格娇小又瘦的人 更有机会患上骨质疏松症。,Chinese
+真还是假？ 假？ 我觉得体格没有影响 不管你是高还是矮 只要你的骨密度是对的话,Chinese
+就没问题了。 炯耀哥哩 我们就以这张桌子来比喻 因为你可能是比较大的桌子 你用来支撑的那个脚就比较粗。,Chinese
+那比较细的 就可能需要比较细的。 所以跟这个size是没有关系的。 答案是真还是假？ 是真。,Chinese
+是真的啊。 真的啊。 为什么 为什么是真的啊？ 大只的病人 你们的骨量就会比较高。比较高。 娇小玲珑的病人 你们的骨量比较少。比较少。,Chinese
+"我们打个比方 就好像你们的存款。 如果你们的存款很高的话 每一年你们失去1% 1%,",Chinese
+你需要更长的时间 才会失去到骨质疏松症的程度。 好 最后一个迷思 请听清楚。 身材变矮呢 就是可能患上骨质疏松症。,Chinese
+真还是假？ 真。 我跟你讲 这个答错 叫Mark哥回来。 来 为什么？,Chinese
+小只比较容易得到 所以你会慢慢地缩水 缩到没有去。 好 向云姐呢,Chinese
+说的是真的。 因为当你骨质疏松的时候 你的骨支撑力越来越低了， 然后可能会慢慢地驼下来。,Chinese
+就缩下来了。 就是我们常说老人家会缩水。 据我所知 应该就是我们的骨质 流失的意思。,Chinese
+所以就是会影响。 好 答案是真还是假？ 是真的。 Mark哥不要回来了。,Chinese
+OK 怎么说呢？ 在骨质疏松症的病人 他们会变矮， 其实是因为他的骨头被压扁了。 所以每一节失去几公分几公分,Chinese
+累积下来就是一两公分。 就变矮？对。 那有没有什么风险因素 是我们要注意的？ 有些病人长期要吃药 类固醇的药。,Chinese
+不良的生活饮食方面 就好像喝很多酒 抽烟。 吸烟跟喝酒 你的身体 它吸收钙质的功能就比较差了。,Chinese
+那还有一个族群 比如说很早绝经的女生。 比如说40岁之前 提早绝经。 这一群人也会容易得到吗？,Chinese
+100% 因为她们的荷尔蒙中断了。 打个比方 如果她40岁前就开始了 过后的十年失去大量的钙质。,Chinese
+这样她的风险当然就 就提高很多。 简单来说 不管是男女 都是要早一点预防。,Chinese
+好 广告过后 我们继续深入了解 骨质疏松症。 还有中医师会加入讨论呢 我们稍后见。,Chinese
+另外呢它没有自觉症状 也就是说自己感觉不到。 所以它是导致很多老年人 比如腰背痛啊 脊柱弯 驼背,Chinese
+还有骨折的一个很主要的原因。 因为它的发病比较慢。 所以中医把它成为骨萎啦 就是骨头萎缩 那么功能失去了。,Chinese
+那它的病因有哪些？ 病因来讲 一般上跟我们中医说的 肝脾肾的不足 还有那个血瘀有关。,Chinese
+我们先来说说肾。 它包括了我们的肾这个器官这个肾。 不过很多时候它还有包括很多 我们的生理功能,Chinese
+例如我们人的生长 发育 还有衰老。 另外中医也认为我们的头发啦 牙齿啊 骨骼啊 都是属于这个肾的系统。,Chinese
+因为中医说肾是先天之本 然后呢它主骨 藏精 精是指精华。 所以当一个人的精血不足的时候,Chinese
+骨头就会显得比较容易脆弱。 现代的流行病学 它们有一个研究就发现 属于肾虚型的那种骨质疏松症的病人，,Chinese
+他们的尺骨，桡骨， 他的骨头矿物质的含量呢 是比同年龄健康的， 或者是没有肾虚的骨质疏松的病人啊,Chinese
+是来得比较低。 也就是说他们的症状呢会比较严重一点。 那么从中医的角度来看 脾是后天之本 气血的生化之源。,Chinese
+所以它是负责汲取我们食物当中 的营养跟一些精微的物质。 中医说这个脾呢 它也主四肢肌肉。,Chinese
+脾也相当于现在医学当中 我们说的消化吸收的系统。 所以如果一个人的脾胃功能比较差， 那么得不到所需要的营养物质，,Chinese
+那么当然也会造成骨骼肌肉 都比较衰弱。 至于肝呢 中医是说肝藏血 主筋。 这个筋就是我们骨头上面的韧带。,Chinese
+所以很多时候 筋的病变 也会影响到骨头。 所以当筋骨出现问题的时候， 人的骨头就会变得脆弱，,Chinese
+就会引起关节疼痛啊 活动不利啊 跟引起骨萎缩。 然后我们最后有提到一个 跟血瘀有关。,Chinese
+血瘀从现代的语言来了解 它就是血液的流变异常。 如果这个血瘀的情况出现的话，,Chinese
+它会影响到我们的血液变得比较粘稠， 那么就会出现微循环的障碍。 那么这个对我们的身体的细胞,Chinese
+还有组织， 它的物质交换是不利的， 比较不好的。 而且它也会导致,Chinese
+我们对钙 胶原的吸收也比较差。 那么就会增加骨头的脆弱性 引起骨质疏松。,Chinese
+所以其实都是。息息相关的。对。 有没有什么一个诊断的方法？ 诊断的方法通常我们是可以用 DEXA Scan。,Chinese
+X光的机器。 仪器就会衡量你的盆骨 跟你的脊椎骨的骨密度。 为什么只针对盆骨跟脊椎骨？,Chinese
+因为一旦一个病人 有骨质疏松症的时候， 这两个是最普遍受伤的部分。 那比如说他们跌倒 你们帮忙开刀，,Chinese
+他们的恢复能力怎么样 还是可以恢复到行动自如吗？ 打个比方 就会好像在跌伤之前 你完全是可以走路自如。,Chinese
+你跌伤了过后 复原了过后 有些病人他们必须用拐杖呢 来帮他们走路。 所以如果你在跌倒之前,Chinese
+你需要用拐杖来走路的话呢， 你跌倒 开刀 康复过后 大高数有限他们。,Chinese
+坐轮椅。坐轮。对不对？ 所以是一步一步地。 退化？ 对。 那最严重的后果会是怎么样？,Chinese
+最严重就是死亡。 百分比会高吗？ 打个比方 100个老人家跌倒 盆骨裂 在一年过后,Chinese
+20%都会死亡。 其实20%这个数字蛮惊人的。 听起来很可怕 所以其实真的是要提早，,Chinese
+如果你怀疑自己有 快去check一下。 那刚才我们玩迷思小游戏 现在多一个小挑战。,Chinese
+因为我们的医生有准备了 这个X-ray的照片。 脊椎骨的X-ray。 你们猜猜看 哪一张照片 是有骨质疏松症？,Chinese
+答案可能超过一个。 OK 来 你的答案是？ A和C。 Why？ 因为A和C看起来比较空洞,Chinese
+而B呢里头还是比较有密度的。 OK。 我也是选择A跟C。 因为B一看就好像很年轻的。,Chinese
+然后A跟C是它已经有一点弯曲了。弯曲。 所以就比较老一点。 制作组哪有这么简单 对不对？ 一定是A B C。,Chinese
+为什么呢？ 因为它们中间那些空隙啊。 我觉得太大了。 好 医生的答案是什么呢？,Chinese
+正确答案是A跟C。 所以B看起来是正常的哦。 正常的。 一旦病人有,Chinese
+骨质疏松症的时候 你看他的骨头 它的厚度比较矮小。 第二是它的密度,Chinese
+没有了。 所以看起来 好像一个空洞一样。 可是你比较这个年轻人的脊椎骨 他骨头里面是很多钙质，,Chinese
+所以出现好像白色的影子。是这样的。 骨质疏松症的病人通常也有。 蛮严重的退化,Chinese
+所以你可以看得出很多骨刺 在他的脊椎。 C呢？我们也可以看得出这个病人 他的脊椎骨已经有一点弯曲了。,Chinese
+骨头的密度也是比较少。 OK。 好 那谢谢李医生的解释 都清楚了。 这个药我是可以吃大概五年左右。,Chinese
+不然的话 我们骨头会变得太硬 就好像一块大理石一样 你一跌倒 它整个就会碎掉。 骨质疏松症呢我们可以通过,Chinese
+按压这个穴位来协助缓解。 也能够缓解腰背疼痛 还有头痛等等。,Chinese
+我想问一下医师。 就是你有没有遇过一些病患 他是有骨质疏松 同时有脊椎侧弯的问题？ 脊椎侧弯其中一部分的原因,Chinese
+也是因为骨质疏松引起的了。 严重的脊椎侧弯会整个人 比如说伸不直腰 半倾倒地这样走路。,Chinese
+不过脊椎侧弯其实有一部分 也是比如说有一些是生理性的 像一些年轻人的脊椎侧弯。 它不一定是骨质疏松造成的。,Chinese
+你一切就断 它就断了。 我很想知道什么情况下 你们要切骨？ 因为我们骨科医生,Chinese
+我们在做换膝盖的手术了 换大腿的手术。都需要？ 都需要切掉那些不好的骨头 已经退化的骨头,Chinese
+我们会放铁进去。 所以我们必须切那些骨头。 了解。 OK。 那治疗方法还有哪一些呢？ 治疗方法有两种,Chinese
+非药物性跟药物性。 非药物性 第一 更改生活方式 不要喝酒 不要抽烟 要做多一点运动 抗地心引力的运动。,Chinese
+晨运 跑步 饮食。 尽量吃高钙质的食物 比如牛奶,Chinese
+芝士 Ikan Bilis soy products。 豆类的？ 豆类的东西。 说到喝牛奶 吃芝士,Chinese
+像我现在都会鼓励我老婆 就是多多喝牛奶啊。 然后零食可能吃一些芝士相关的。 对 所以最重要的就是从我们饮食中,Chinese
+摄取到足够的钙。对。 那就会降低骨质疏松症的风险。风险。 那如果说你刚刚讲的这些,Chinese
+还是没有办法改善 那就是得用药物治疗了。 那个药物我们分成大概两种。 第一个是针对成骨细胞,Chinese
+另外一个是针对破骨细胞。 我们普通的人到了35岁 到40岁 我们的成骨细胞比破骨细胞更活跃。,Chinese
+12月25日晚10点，北京协和医院急诊室外，救护车陆续把患者送过来。 北京协和医院通过内部改造，已经对急诊和发热门诊晋级扩容，现在拥有两个发热门诊区，一个急诊区。,Chinese
+在第一发热门诊区晚上八点多，急诊科副主任李毅教授正在出门诊。他今天已经连续接诊7个多小时。 那现在感觉有没有往下走的这样一个趋势呢？,Chinese
+目前我感觉还感觉不太出来。我们尽自己最大的力量去跟病人服务。我们只要有能力接待 我们都会尽自己最大的力量。 在第二发热门诊区，大部分患者都是白发苍苍的老人。因为连日的高烧，老年患者的血管状态已经非常不好。护士们蹲在老人身边仔细查看，希望能够一针就能扎准，让老人家尽快输液，制住病情。,Chinese
+是来复诊输液的吗？第一次来是吗？来。看着这个回答一下问题。 93年出生的护士江西英正在分诊台快速处置各项工作。本月中旬，她感染了新冠病毒后，烧一退，身体允许的情况下，她立刻返回工作岗位。,Chinese
+仅25日这一天，北京协和医院发热门诊就接诊了340多位患者其中老年人占到大多数。几乎每一位患者都要及时夕阳处治。 我们是有岗位职责的 但是真忙起来的时候呢， 并不能说每一个就固定在自己的岗位去干什么。大家都是穿插着来的。可能这个岗位它需要的人正在忙别的事儿，那我肯定就会顶上去 去干这���事 大家都是相互帮助的。,Chinese
+临日来前来就诊的患者普遍年龄偏大，病情严重让临床一线的医生真经地感受到了前所未有的压力和巨大的挑战。 最紧张的时候可能还是这个月月中的时候。 现在是慢慢的 我觉得跟之前还是不太一样。之前是可能明显感觉到更多人刚开始发烧比较紧张就来看。现在更多可能还是年纪大的，真正有肺炎的这些病人来的会很多。,Chinese
+年龄都在这 基本你可以看都是六七十岁的，对。还有就是多的很多。因为他们确实是比较重的病人 需要去密切监测 需要去观察 需要去治疗。 希望现在是最难的时候 我们一边去一边看。 后面我觉得可能还是重症病人会为主，也是比较有挑战的。我觉得随着大家对这个病毒 对这个疫情了解更深 然后治疗也更有经验 应该会是越来越好。,Chinese
+记者在急诊科看到，一位医生ging着氧气瓶，对患者和家属快速地交代着病情后，转身又往发热门诊跑。 记者跟到诊室后发现了原因，这里有等待就诊的患者。,Chinese
+病人他就是他基础是一个慢性肾衰竭，然后现在又出现一个急性心衰加重。他就是有急诊透析指征的 可能要做血滤的，所以我就联系了抢救室的二线。然后他们就说让他去急诊那边就给他进一步地处理。,Chinese
+那边有一个位置我们让他把东西让一下好吗？ 再难再辛苦也不能少了对患者地关爱。在虎坊桥居住的这位老人今年79岁。她一个人来协和看病。医护人员帮着老人家拿氧气瓶 找座位。输液结束后，医护人员还要给她测一下血氧，才放心让她离开。,Chinese
+您现在比前两天舒服了一点了吗？ 啊，舒服一点了。 您问问医生 您是在这再观察观察 还是先回家明天再过来输液呀？我明天过来。,Chinese
+我想开刀房哈 是一个很 就是一个很专业很严肃的场合。 那我们通常可以把里面的人员 分成两个大部分啊。,Chinese
+就是手术团队跟麻醉团队两个团队。 麻醉团队通常会含有一位麻醉科医师 在配搭配一个麻醉科的护士。,Chinese
+那他们的职责是保护病人 在麻醉当中的安全，因为 病人在睡着的过程之中不是只有睡着， 他的血压、他的心跳可能血氧浓度,Chinese
+都会有一些些改变。 所以这个部分的监控跟药物上面的微调 是很重要的。 因为手术毕竟是身体上面的一个压力嘛。,Chinese
+他可能会有一些生命迹象改变的状况 永远都还是要准备可能会有紧急状况 会需要急救或者会需要进一步的处理。,Chinese
+所以这个时候有麻醉科医师和护士 在这里把关就是会增加 我们手术当中病人的安全度。 手术团队通常成员会包含一位外科医师。,Chinese
+那可能会包含一位外科的助手。 这位助手可能是医师也可能是护士。 刀台上还会有另外一位是刷手护士。,Chinese
+所谓刷手是他上到刀台上 然后手是不能够染污的。 这三位人员我们刚刚叙述的是 固定在刀台上在我们的开刀视野当中,Chinese
+就是负责进行手术的部分。 那其中可能会有一到两位的流动护士是 他不会上到刀台上面 他会是在开刀房的开放空间里面，,Chinese
+做麻醉科跟手术团队当中的协调。 他会做一个病人身分的核对。 然后在病人睡着之前确认病人的病史，,Chinese
+过敏史以及他的身分， 这个是最重要的部分。 进入外科这个领域其实每一支器械,Chinese
+它都有自己的名字。 每一个外科医师他人生之中的 第一个学习就要了解每一支器械的名字。 对民众来讲大家可能觉得,Chinese
+外科医师就是动刀嘛。 事实上我们用比较多的可能不是刀 而是剪刀。 光是刀的话通常我们使用的,Chinese
+除了一般我们印象中 手术当中的手术刀之外。 最常使用的其中一个是电烧刀。 那电烧刀它通常就会有一个就是看起来,Chinese
+像是一个塑胶介面的一个 一个连接器 然后它会连接到一台机器上面。 最主要使用上面是做切割止血的动作。 那除此之外的话还有剪刀。,Chinese
+剪刀除了大家觉得分长短以外 它还有各种不同的头， 有尖头跟普通的头 这样子。 其它器械方面有一些长得很像剪刀，,Chinese
+有这样子圆圈圈的米老鼠头的东西， 其实它不是剪刀。 像这个是我们外科医师的好朋友 它是持针器。,Chinese
+持针器的重点是你切割了一定要做缝合， 缝合的时候我们不是用手直接直针缝。 我们会用弯针然后用持针器。,Chinese
+持这个针去做缝合的动作。 有长短的差别是因为伤口有深跟有浅， 浅的时候我们就是用短的持针器， 那深的地方我们会用长的持针器，,Chinese
+所以用途会在不同的地方。 右手拿持针器或者是刀或者是剪刀， 左手一定要有一个���组织的东西， 那就会用到我们的镊子。,Chinese
+每种镊子也是会有不一样， 我们会有长镊子跟短镊子。 但长镊子短镊子之外， 每一支镊子的长相跟名字也都不一样。,Chinese
+镊子有分是尖头的或是平头的。 那这个对组织的伤害都不一样， 那也会用在不同的地方。 除此之外的话还有就是夹子，,Chinese
+夹子很重要的地方是 这个夹子除了可以夹组织 跟我们手术当中的视野做配合之外，,Chinese
+它最主要是出血的时候我们可以 做夹住血管止血的动作。 所以虽然长得很像剪刀， 但它不是剪刀它是一支夹子。,Chinese
+那夹子当然有自己的名字，像手中的这支 我们常常使用的我们叫做Pean。 除此之外大家如果看过医龙的话,Chinese
+就会听到说他们有时候会叫器械的名字。 那因为发明器械的人很多都是德国的 或是英美的人士。 所以他们会用他们的名字来命名啊。,Chinese
+像常常会听到我们会叫一个Metz。 Metz是什么东西它是Metzenbaum 它其实是指剪刀的名字。 就是我手上这把剪刀,Chinese
+它其实是组织剪。 这每一支器械我们了解它的名字之后,Chinese
+在器械台上有的时候如果大手术， 我们就会藉由外科医师叫这个器械来， 由刷手护士递到我们手上。 为什么一定要人家递不是为了很大牌。,Chinese
+是因为你在手术的时候 你会专注在手术的视野当中， 你没有办法回头去挑选你的器械。 所以你叫了器械之后人家递给你,Chinese
+就可以不间断地在手术视野之中做动作。 比较特别的是在台湾，因为,Chinese
+台湾是传承于日式的教育， 所以我们在刀台上面的老Sensei 就我们的老老师大概都是,Chinese
+日式教育传承下来的， 他们会讲台语。 所以在刀台上常常都是台语跟英文交杂， 比较少听到国语。,Chinese
+所以你听到他们叫他们通常都不会说 就是除了器械的名字之外， 有的时候它只是叫一支普通的剪刀 来剪线的时候,Chinese
+它会直接叫「剪刀」 gato。 然后叫刀子来的时候 他也不会用英文的Scalpel 或者是中文的刀他会直接叫「刀子来」。,Chinese
+所以这个就是我们台湾比较特别的地方。 有很多人会强调正压或者是,Chinese
+我是一名心血管内科的医生。 从2016年的9月份开始拍摄 一共前前后后拍摄了405位患者，,Chinese
+“惧怕死亡吗”？ 2016年的某一天， 我正在查房的时候， 有一个老人家，在聊他过去的一些往事。,Chinese
+然后突然间就想到其实每一个老人就是一部历史。 那么我想去挖掘一下这样一个宝库。 我拍摄的第一位患者，,Chinese
+因为肺癌这个情况住院的。 每天看到他都是笑呵呵的。 他在十年前就已经确诊为肾癌了。,Chinese
+当时手术特别成功。 已经死过一次了，余生的每一天他都是赚的 这是他的原话跟我说的。 他的女儿在参加中考的时候发挥失利了，,Chinese
+后来得了精神分裂症。 这是让老人家特别特别遗憾， 也是特别特别自责的一件事情。 两个月左右，老人家就离世了。,Chinese
+然后我就郑重地把这张照片交到了他家里。 每个人给的答案都不一样。 一个小学的老师,Chinese
+最遗憾的一件事就是他没有像别人一样能够著书立作。 上海的一个老裁缝,Chinese
+最遗憾的事情就是没有能到台湾去给他的哥哥送终。 我之前在急诊上接诊了一个病人。,Chinese
+他是一个结肠癌伴全身转移的一个病人。 他遗书已经写好了，这次来就是因为他服药自杀了。 我今天会拍到这位女儿，,Chinese
+她作为我的第406位受访者。 从父亲生癌症到现在这个情况，已经有三年的这个时间。 他本人化疗30多次，两个大刀。,Chinese
+所以饱受艰苦，煎熬。 老爷子也跟我讲过，中国为什么没有安乐死。 你有没有看到他当时写遗书的场景？,Chinese
+写遗书的场景没有看到， 但是他写完的那个场景在那边， 就是一个小板凳上面，还放着他一支笔和一只老花眼镜。,Chinese
+那是什么时候写的？ 应该就是病危前一个晚上吧。 他就是自己觉得可能安详走掉的时候 他把那张纸就放在自己的胸前。,Chinese
+“不要抢救我”。 所有的人对自己的死亡，每个人都说“不怕”。 有很多病人是肿瘤晚期的病人，,Chinese
+没有一个人说“是金钱”。 但是对钱那种依赖或对钱的一种渴望 其实还是存在的。,Chinese
+在三个月的时间里面 从一个活蹦乱跳的，生龙活虎的一个中年男性 到瘦骨嶙峋，最后离开我们。,Chinese
+他没有留下任何一句遗言。 他的妻子然后也是在全程的拍摄过程当中，都是在流泪。 拍照只是一个结果，,Chinese
+Mark哥 今天聊这个课题 跟我们两位是息息相关。 没错 新加披男性第二大常见��癌症 就是前列腺癌了。,Chinese
+我记得十年前是排名第三， 怎么突然间变第二？ 这个我也不懂 我有很多的疑问。 所以今天这一集 就跟大家好好谈,Chinese
+这个前列腺癌。 房事频密 是否会增加 患上前列腺癌的风险呢？ 如果说有前列腺癌,Chinese
+是不是一定要做切除手术呢？ 又或者是有什么其他的治疗方法呢？ 如何提早发现 中医治疗有哪一些优势。,Chinese
+是 请跟我们一起 《医聊大小事》一起长知识。 来 李腾 量个腰。,Chinese
+不过 的确 有些男人啊。 连前列腺在什么位置都不知道。 不会吧 一个男人对前列腺一无所知 怎么可能？,Chinese
+所以我们今天邀请的艺人朋友们 对前列腺是非常了解啊。 马上欢迎艺人嘉宾 姚彣隆 苏梽诚。,Chinese
+还有我们的泌尿外科 高级顾问林诗杰医生。 欢迎林医生。 欢迎 来。,Chinese
+雄赳赳 气昂昂的一集。 来 各位 请坐。 问一下两位啊 你们对前列腺到底了解多少？,Chinese
+来 林医生。 林医生 到底前列腺有什么用途？是。 OK 前列腺其实是看不到 也摸不到的。 它是在我们盆腔的深处，,Chinese
+膀胱之下 环绕着尿道。 尿就由膀胱经过前列腺 由阴茎排出。 它最主要的功能就是分泌前列腺液。,Chinese
+提供精子所需要的养分 还有环境。 可以让它如果去到女性体内的时候 能力争上游。,Chinese
+与受精卵结合 提高怀孕的几率。 还有另外一个功能 就是高潮时， 前列腺的肌肉会收缩，,Chinese
+那时候有助于射精， 同时也把那个泌尿道的出口 把它关闭起来。 这使得精子不会倒流进膀胱，,Chinese
+完全没有？完全没有。 那如果是夜尿多啊 频尿啊 是不是跟前列腺也有关系？ 对 这一个就是前列腺。是。,Chinese
+是在前列腺的周围产生的， 所以如果要压到尿道的话， 通常它得要有一定的体积。 相反的 良性的前列腺增生,Chinese
+那个前列腺肿大的部位 是在尿道的周围。对。 如果是开始有良性增生的话 就比较早会有小便的症状。,Chinese
+就是像我们刚才提过的 就是小便的这些症状。是。 差不多小便 慢啊 频尿啊之类的。 另外一组症状就是,Chinese
+因为癌症转移到其他的器官 而导致的症。 如果癌症扩散到骨头的话， 骨头就会变得脆弱， 很容易骨折。,Chinese
+如果前列腺癌扩散到脊椎， 如果扩散到脊椎， 压到神经线的话， 那可以导致大便 小便不顺 失禁，,Chinese
+甚至可以影响到脚 变成没有力， 无法行走。 这些是非常后期。 如果病情这么严重的话,Chinese
+就少不了要住医院啊 那医药费 吃药 手术之类的嘛。 没错 所以你看 现在我们都常提倡 有病就要治疗。,Chinese
+所以最好是买一个医疗保险。没错。 可以保障自己跟家人 这个很重要。 那我们应该要怎么 怎么预防呢,Chinese
+怎么预防。 那就要筛查了 我们叫screening。 screening。 以前列腺癌来说的话 通常我们是检查血液中的,Chinese
+前列腺特异性抗原。 我们英文叫做PSA。 抽血。抽血。对。抽血。 前列腺特异性抗原其实是前列腺,Chinese
+生产的一个蛋白质之一。 可以在男性的血液找到， 所以通过抽血就可以验到 前列腺的指标了。,Chinese
+精准度如何？ 通常如果是PSA 在四到十之间的话， 它有前列腺癌的几率是差不多30%。,Chinese
+就是说有其他的原因 有可能导致到PSA上升 最常见的就是前列腺增生啊。 当然前列腺发炎,Chinese
+也有可能导致PSA上升。 所以前列腺特异性抗原超标 不一定是代表肯定是前列腺癌。 如果做PSA有问题的话,Chinese
+可以先做MRI 我们叫做磁力共振扫描。 看看有什么不寻常。 你刚刚说什么活体检验,Chinese
+你不要跟我讲这一根是。 这个是用来拿细胞来的， 然后是从哪一个部位进去？,Chinese
+OK你看到这个粉红色的 这个我们叫L1的地方。 就是那个不正常的部位。 现在你有看到两个颜色。,Chinese
+这个粉红色的就是MRI的影像。 OK这个青色的就是我们在病人麻醉以后 用超音波得到的影像。OK。,Chinese
+我们把两个影像结合在一起。 这两个白点就是我们事先已经断定 这两个地方是不正常的。,Chinese
+有可能有前列腺癌的部位。OK。 这个是二维的 你看到这个粉红色的 就是不正常的部位。是。 OK我们就由机器帮我们定位。,Chinese
+你就看到我们要验的地方。是。 所以要扎很多针啊。 对 所以。 这么多？这么多？,Chinese
+这个就是那个机器叫我们验的地方。 那如何进行这个活体组织的检测啊？ 那我就示范一下。是。,Chinese
+所以病人会全身麻醉了？ 这个部位就是我们放进病人的肛门。 这个是超音波 可以让我们能即时地知道,Chinese
+那个位置在哪里。 机器已经���我们定位了。 这一支针由这个部位 放进去。OK。,Chinese
+然后拿细胞。 拿了那个机器就会去到下一个位置。 医生 我听说直肠指检也可以 是吗？ 诶？可以检查看看你有没有前列腺癌了。,Chinese
+通常医生会用他的食指 进入你的直肠摸那个前列腺。 正常的前列腺的触感 像是橡皮胶的触感一样。,Chinese
+不过如果有前列腺癌的话 你可能会摸到像石头般的硬块。 所以那时候你就可以断定 病人是否有没有前列腺癌。,Chinese
+不过这个指检也不是100%准确的， 因为你用指检的时候 其实只能摸到前列腺的后方， 那个靠近肛门的地方。,Chinese
+如果在前列腺的侧边或者前面的话 其实你的 手指是摸不到的。 第二个就是有些前列腺癌,Chinese
+是完全没有硬块的， 所以可能也摸不到。 所以一般来说的话 指检的准确性也只有30%。 明白。 好。,Chinese
+这个时候我们应该喘一口气 轻松一下啊。 没错。 广告之后 还有中医师加入讨论 我们稍后见。 稍后见。,Chinese
+欢迎李广军医师加入我们的讨论。 欢迎 欢迎 欢迎。 欢迎李医师啊。 这个前列腺癌 以你的角度来说,Chinese
+是怎么看待的？ 肿瘤一类的疾病 其实在中医看来 原因都类似。 一个就是邪气盛 这个邪气它可能包括的就是瘀血呢,Chinese
+痰湿呢 热毒这些了。 那另外一个呢就是正气虚 对于前列腺癌的患者呢 他的虚主要表现为肝肾的不足。OK。,Chinese
+其实中医呢没办法很准确地诊断癌症。 这个是要依靠西医的手段来做的。 检验？ 对。,Chinese
+但是对一些邪气的存在呢 在非常初期的时候 我们就可以通过一些观察 能够了解到它在什么地方。,Chinese
+那比如说这个人有瘀血的话 他的气血就会不顺畅 那这个时候 他的舌头有可能会偏暗。 对 舌头上有的人会有一些瘀斑。,Chinese
+对 如果看他的舌下静脉的话 他的静脉会比较容易曲张。 就会变得比较粗 比较长。 那当然 这个前列腺癌,Chinese
+我们就会聊到风险因素。 是。 到底有哪一些呢？ 其实前列腺癌有几个风险因素啦。 第一 可以算是家族史。,Chinese
+如果是说你的父亲 你的兄弟 有前列腺癌的话， 那你有前列腺癌的几率可能高出一倍。 ok。 第二个风险因素就是饮食啦。,Chinese
+跟吃有关系。 有研究显示 假设说你常常摄取高动物脂肪啊 高饱和脂肪 或者油炸的食物，,Chinese
+那你患有前列腺癌的几率 可能会比较高。 OK。 相反地 假设说你的饮食 主要是植物类 像谷粮啊 坚果啊,Chinese
+鱼类之类的话 那你得前列腺癌的几率 可能会比较低一点。 其实有研究显示 如果是说你每天吃十份以上的西红柿，,Chinese
+我们俗称番茄， 不过这个番茄一定是要煮过 还是加工后的， 那些生吃的番茄没有太大的用处。,Chinese
+对 那你患有前列腺癌的几率 可能会降低18%。 也有其他的研究是显示 如果你的腰围超过102cm,Chinese
+大约是40寸的话 那你患有前列腺癌的几率 也可能会上升。 那想请问一下这个中医师，,Chinese
+可以跟我们分享一个 你印象很深刻的这个病患 有吗？ 最近啊碰到一个 比较有挑战性的一个案例。,Chinese
+这个人差不多有六十岁出。 他是手术后来找你？ 手术后 手术后四个月 他也做了电疗。 OK。 当时他来的时候,Chinese
+他主要的不舒服就是漏尿。 漏尿。 就是他平躺的时候还好， 要他站起来 就会小便会漏出来。,Chinese
+他是因为手术才会漏尿？ 之前是没有。 因为会影响生活 所以他做工的时候 就要穿着一个纸尿裤。,Chinese
+如果天气太热的话 他不舒服 就要 他用一个夹子 夹着他的阴茎。 对 一段时间以后,Chinese
+就去卫生间把小便放掉。 那他是找你做调整 调理是不是？ 是 我帮他针灸 希望通过针灸呢,Chinese
+可以帮他摆脱纸尿裤这个问题。 成效OK吗？ 还好。 能目前漏尿的量会少。 OK。 好 当然我们也利用这个机会,Chinese
+去了解一下 关于一位前列腺癌患者的一位故事。是。 他已经康复了 我们一起来看一下啊。 好。 很多人说前列腺就好像一粒核桃。,Chinese
+前列腺癌的生还者都教主是核桃勇士。 在2017年 我自己也成为了一位核桃勇士。,Chinese
+57岁那一年， 我去了医院 做了检查。 医生发现我的前列腺肿大，,Chinese
+建议我做一次的PSA血验。 结果result出来就是六 比一般的4.0还要高。,Chinese
+所以我又拖。 过了两个月以后 我回去再做一次 PSA test。,Chinese
+Result出来 升到八。 那时候医生就建议我一定要做 活体组织检验。 结果就确认了我得了前列腺癌。,Chinese
+什么是前列腺 我都不知道。 前列腺癌是什么？ 很严重吗？ 我会活多久？,Chinese
+我有太多太多的疑问 不知道要问谁才好。 那时候我还在做工。,Chinese
+治疗需要多久呢？ 这样的情况之下 我真的是很烦躁 真的是无助。 医生很快就帮我安排了,Chinese
+切除前列腺的手术。 幸好癌细胞没有扩散到， 所以就不需要做电疗。,Chinese
+手术后当然有一点后遗症。 尿失禁就必须要多做 凯格尔运动 把它控制。,Chinese
+康复了之后 我就被安排去 rehab center 做一些复健的运动， 把全身的肌肉都锻炼起来。,Chinese
+得了这个病之后， 我更加了解健康的重要。 而且我也知道很多新的病患者 都应该跟我一样，,Chinese
+发现病的时候不知道要怎么做才好。 所以我就参加了新加披防癌协会的 核桃勇士活动。,Chinese
+现在每个星期 我都和其他的勇士 一起运动 参加活动 讲讨会。 我也成为了前列腺癌的大使，,Chinese
+用我的经验来帮助新的病患者， 鼓励他们， 陪他们走过这段很难走的路。,Chinese
+你肯定不会孤单， 肯定会有人陪你走完这条路。 哇 真的。,Chinese
+他是有做这个切除的手术。是是是。 那当然除了这个切除手术， 还有什么样其他的治疗方法？ 近几年了 绝大多数的前列腺手术,Chinese
+都是那个用机器人辅助了。 动了手术过后 他还有生育能力吗？ 切除了前列腺过后。 耳穴就是一个很好的治疗方法。,Chinese
+除了这个切除手术 还有什么样其他的治疗方法吗？ 其实不是每个前列腺癌 都需要做治疗的。,Chinese
+那些比较早期 特别是第一期的 前列腺癌来说的话， 可能我们可以做观察。 因为这类的前列腺癌,Chinese
+可能它的病发 还有生长 会非常的缓慢。 所以不一定会带来生命的危险。 不过 我们也要再定期地检查，,Chinese
+预防它有病变 那时候要及时做治疗。 治疗方法大致上有分两种 第一种是电疗。,Chinese
+电疗又分近距离电疗 和远距离电疗 近距离电疗就是把有辐射的东西， 把它直接放在前列腺里面,Chinese
+往外辐射。 扩散。 对。 扩散。 对。 一般上切除是整个切掉啊。 就是把整个前列腺拿出来。,Chinese
+开刀方面的话呢 有不同的方法。 是。 最传统的方法就是我们说的开大刀。 就是从肚脐到阴茎 开一个大刀。,Chinese
+这个的好处就是医生可以把他的手 放进那个病人的体内。 所以手的灵活性非常的高。 是。 对。 不过 前列腺在盆腔的内部，,Chinese
+所以视线可能看得不是很清楚。 传统的腹腔镜手术来说的话呢， 它的好处就是它可以看到整个前列腺,Chinese
+还有那个位置。 它的坏处呢就是它的灵活性不高啊， 而且传统的腹腔镜手术呢 就是用二维的影像 它没有那个深度。,Chinese
+对 昨天打完了5天。 今天第六天 就要先去拍一个胸部CT看一下。 就这一个疗程。,Chinese
+打激素对肺的吸收啊。 肺的治疗是不是对症。 是往好的方面发展呢还是,Chinese
+现在都有劲了。 看他说话这个 语气。语气就是语速也快了， 声音也大了，,Chinese
+走路也带点风了。 原来每天去那个 医院都是打的这个实在是走不动。,Chinese
+走不动。 而且跑了5天说实话有点贵。 正好趁着身体好呢 我们今天决定去坐地铁。,Chinese
+省点钱哈哈哈。 是的嘛。 打个的很贵啊 从我们这里打到 人民医院然后来回。,Chinese
+120。 是吧。 100 120 （单边）55差不多在堵车120。 每天打针250。,Chinese
+"370。 然后打了5天 就是去了1,800。 今天要去做那个",Chinese
+一个星期治疗的话 也得也得三千多块钱。 所以为了省钱啊省一点是一点。 刚才小孩今天周末嘛也上课。,Chinese
+打个车先把他送到学校。 然后我们再走到地铁站。 坐地铁。,Chinese
+到了。 可换乘4号线。 这个门口出来就蛮好吧。 刚刚坐电梯上。,Chinese
+今天人啊 这是下的。 今天人好少啊这边这边。 复兴路。,Chinese
+今天是周末 所以坐地铁人少。,Chinese
+这边是CT室。 我今天拿到了排号。 36号。 然后,Chinese
+不能够先去打针要先做CT。 放射科的袋子也挂号等着了。这边 呃我排的是40号。,Chinese
+如果没有一点点小小的变化 你都会着急 你别说恶化 要是恶化的话就更 更是着急了。,Chinese
+所以有才有这样的话 然后今天正好在等着这个过程中呃 找个安静的地方去聊一聊。,Chinese
+我今天想说一下 呃这个 阿兹夫丁片呢啊 包括我后来打的现在打的激素啊,Chinese
+的一些反应吧。 因为很多人都说反应特别大嘛。 OK这里个环境还不错后面还有个亭子。 是吧。,Chinese
+唉 我老婆也在看病她说她在4楼。 呃。 其实那个抗病毒的阿兹夫定片啊。,Chinese
+包括那些（激素） 确实是有一定的反应或者是 疗效就不说了吧。 我当然说了,Chinese
+立竿见影 这个疗效还是很肯�� 副作用啊。 我自己自身体验啊 我最先开始觉得很奇怪的一些现象啊,Chinese
+就是给大家分享一下 我也不知道他是不是 呃副作用或者是什么。 只是说一下我个人啊身体的一些 表现。,Chinese
+我最先开始到发病的时候啊。 那时候还没吃阿兹夫定片啊。 我就 住院当时住院的时候那个,Chinese
+住院大夫就问我除了这个发高烧啊 然后阳了呀 双肺感染了你还有什么基础病。 我说我啥病都没有,Chinese
+可能就是有点高血压。 去年和今年的测的血压都比较高 但是我没吃药 大部分平均在140,Chinese
+高压140左右低压90几啊。 这样的但没吃药好 他就住院后,Chinese
+他就跟我做一个全身检查嘛。 后来一测让我觉得很奇怪 我当时的血压降到了126 80几就是非常正常的血压。,Chinese
+我这几年从来就没有这么正常的血压 就在我发病的过程中啊。 就很奇怪 那几天 天天有跟我测 第二天要跟我测还是一百二十几,Chinese
+这非常漂亮的血压值。 我当时都不相信我说我有血压呀 搞得医生也很郁闷。,Chinese
+好到第三天我就 呃吃了那个阿兹夫丁片之后 就血压就发生变化 就血压就恢复正常了。,Chinese
+我认为是恢复正常了 其实他本身比平均值是要高的。 所以那个大夫当时一测 出现了144,Chinese
+106。 我当时就特别开心。 我说对这个血压值就是我真正的 真实的每年测出来的那个血压值。,Chinese
+本来血压有点高我还很开心。 我是认为血压正常了 就 一码是一码是吧。这个可能,Chinese
+呃新冠这个 影响到我的血压了还是咋的。 那个阿兹夫定片我吃了3天 但是因为网络很多回复,Chinese
+包括有很多人给我看那些连接 国外的一些专家 关于阿兹夫定片的这个药呢 他的,Chinese
+用药安全这个问题。没有得到 公公就是一个认可吧。 所以当时我也很害怕吧,Chinese
+所以没有得到专业人士 就是到处乱投医 到处看一些信息吗 自己判断自己诊断。,Chinese
+所以我吃了 所以我吃了3天这个药就停下来了。 有人说激素有骨坏死我不知道啊 不知道会不会有骨坏死。,Chinese
+但是还有一个问题 我发现打完激素以后 我的血压会变得更高。 我刚才说了 吃完,Chinese
+阿兹夫定片之后我的血压是变成144 就是趋向于正常哈 就是我平时的一个血压状态。 但是打完激素以后,Chinese
+我嗯前天和昨天有测血压就变成168了 就接近170的血压。 低压都有110几。,Chinese
+这个血压就 就比我平时的那个血压要高很多了。 但比正常值就高更多了。 像这种血压应该就是吃药了对不对。,Chinese
+所以我有时候打完 激素以后晚上就还是有昏睡。 当时我想是不是体温没有降下来 所以我就量了体温。,Chinese
+量了多次啊。 都只有36度7。 但是 没有想我的血压的问题 是后来到我父母家那边好了吗。,Chinese
+到父母家 去探访的时候正好他那边有 我就测了一下我的血压就168。 这个就让我,Chinese
+挺害怕的。 还包括心跳我平时的心跳是60多下。 呃不会超过70下。 但是自从打完激素以后,Chinese
+我的心跳就是80多下。 就心跳一直跳的很快。 然后还有人说打 激素或者这个病啊,Chinese
+大半个月了吧 就完全没有 下面完全没反应哈哈哈。 哈哈哈哈。,Chinese
+真的是这样的包括那个 小便啊什么的都无力。 那可能是不是跟身体虚弱有一定关系啊,Chinese
+希望后期会有所改善啊。 这这个让我很很很很让我很糟心 很糟心。这让我 什么血压高我觉得,Chinese
+都都觉得 还不是特别害怕血压高 到时吃药呗。 你看这个这个这个接受不了 希望他这个后遗症,Chinese
+能够通过后面的好转有所有所改变 啊哈哈啊。 然后刚才说的那个血压高的事 等会拍完片了以后,Chinese
+要找 急诊的内科医生也跟他去反应一下 看一下他怎么说。 这是不是 打完激素的一些自然的反应,Chinese
+或者是什么。 然后其他的可能就没有了。 好吧。 就跟大家说一下这个嗯。,Chinese
+然后再进去看看多少号了。 请到13检查室检查。,Chinese
+请到13检查室检查。 看一下。 现在人是不是少多了是不是。,Chinese
+我今天 呃现在已经10:40了刚刚吊上了针。 你想想10:40现在就这多人。 所以 第一波已经快结束了接近尾声了。,Chinese
+然后呢我现在还在吊针啊。 告诉大家一个好消息。 那个拍片出来了 结果非常非常的好。,Chinese
+听医生说呢 我的肺吸收啊恢复都非常好。 就证明这个 呃激素的治疗还是非常对症的。,Chinese
+我已经迫不及待的给大家分享一下 这个片子哈。 给大家看一下 我到底是怎么样子一个情况。,Chinese
+就是从（坏）到（好）的一个过程 我告诉你。 我现在成看片高手了啊我来来来 给大家���单的说一下。,Chinese
+这是我前期发现这个肺炎的情况 这个和我之前所说的 你看这是左肺。 看这里这个,Chinese
+左肺这里一点两点3点四点看。 像不像那个靶 靶子打穿了。 白的像洞一样的。,Chinese
+这也有一点点。 你看。 这里 它是不同的角度在转吗。 你看这边都像都是洞。看到没,Chinese
+这左边比右肺要严重很多对不对。 啊 好我们再来看一下今天的 你看,Chinese
+他如果正常的影片的话 它应该是照出的是黑色的 黑色的这个肺 为什么叫白肺呢,Chinese
+就是因为 它不是肺是白的 而是嗯有有那个叫炎症的时候呢。 拍出就是偏白， 你看这个片子拍你看这个肺是白的。,Chinese
+然后呢你看这里 这个有的白的是那个血管 就像那个支流一样的 这这这里,Chinese
+这里还有一点点一点2点3点4点是吧 但是明显比之前是不是要好很多。 你看这边。,Chinese
+比之前的那个我说像靶子打穿的 是不是要好很多。 你看这个,Chinese
+这个也是的 这个就是血管 这就是这 这就是比较 比之前要吸收好很多,Chinese
+就这里还有一点点看到没这里12344个 啊对不对这这就好。 这里白的还有一点点,Chinese
+这下面看不懂了啊 我相信就刚才我简单介绍 大家能够看得出来这个 靶场的肺,Chinese
+靶场的肺 就和现在就已经淡化了很多是吧。 呃 所以啊有时候啊身体他是不会骗人的。,Chinese
+你看我现在说话呀 语气呀那个包括就是有气吧 之前都没气啊现在有气有力的哈 原来是没气没力的那种感觉。,Chinese
+所以身体身体不会骗人的。 所以肺就有一定的好转 然后那个大夫也非常呃 跟我叮嘱说我现在打了5天,Chinese
+还让我再打两天吧。 打两天以后就可以停药了 就不用不用再去医院了。 自己在家调养 或者自己,Chinese
+嗯吃点那个化痰的药给我开了。 或者你自己操作 你可以用那个中医调理一下这个肺啊。 也是可以的那。,Chinese
+但是也不用着急拍片。 他说一个月以后再来复检 就看一下肺的吸收。 就和今天的,Chinese
+刚才隐隐约约上面还有接近四五个那个 燥点的那个白色的毛玻璃样的点 就看一个月以后看能不能够恢复吸收。,Chinese
+这就挺好的对不对哎。 就很开心排两天吧。 今天的药好像有所变化 那个呃激素好像跟我换了。,Chinese
+激素 原来打了个叫什么尼龙玻璃 尼龙什么玻璃琥珀 什么钠酸什么玩意的。,Chinese
+现在换成了。 来还是和大家继续分享我 用药的一个过程啊。 这个也是激素这个叫,Chinese
+地塞米松。 然后下面这个盐酸溴 它是化痰用的。 之前没打的。 今天给我打了3只。,Chinese
+还继续在打这个莫西沙星继续在打。 炎琥宁也继续在打。 但是炎琥宁这一次给我加了3只,Chinese
+之前只有2只的哈。 然后这下面是那个医师啊。 这个叫袁珊。 这个医生非常的过细（认真负责）,Chinese
+非常非常好一个女的。 好。 谢谢您。,Chinese
+给我滚一个。 没得法。 磨死人。 脑淤血。 瘫痪。,Chinese
+这是ECMO主包？对。七十天前 王维俊到雷神山医院的第一个任务 就是拆ECMO的箱子。,Chinese
+这个都是捐的 是吧？ 捐的。而且都是新的。这个很贵。我估计大概要一百多万。 这个一百多万肯定要的。王维俊是上海顶尖的ECMO医生。,Chinese
+我们要动下脑筋怎么装。因为这个不一样。现在他要抓紧一切的时间，把两台临时捐赠的ECMO组装好 以备救人时用。我总归希望越早准备好越好。,Chinese
+心里踏实。你没有准备好，万一半夜来一个病人， 你东西没有只能眼睁睁地看着。既然来了总归想把它做好。,Chinese
+上海第八批援鄂医疗队接管的ICU里，病情最严重的是5床和15床。 15床已经不明原因地持续高烧了七天。仅靠呼吸器,Chinese
+已经很难支撑得住。 5床地新冠病毒显示始终是阳性。 他的肺部功能正在一步步丧失。有反应吗？,Chinese
+好像没反应。针对新冠肺炎没有特效药。医生能做的， 就是在病人最危险的时候撑他一把 共度难关。,Chinese
+ECMO的道理也是一样。它是生命支持系统， 可以暂时替代人的心肺功能，为治疗赢取时间。,Chinese
+我已见里面的人都是这样的。我们都是要给他们争取时间，因为你这儿不给他时间，他可能就没有转机的。 给了他时间他也许会有转机。那你怎么办？我们一定是要努力一把。,Chinese
+如果5床和15床继续恶化下去，能救他们的 只有王维俊的ECMO了。你帮我压住。我压住了 不会动的。,Chinese
+高度不够。这个也太细了。 太细了 也不行。他没有给我们备那个车。我就说他没有车。,Chinese
+你又没有车你哪有杆子，你怎么装这个东西呢？让我想一想。 机器拼装到最后，王维���才发现ECMO只有机身，,Chinese
+各种管路配件一个都没有。它还缺一样东西。 还缺一个混合静脉血氧饱和度监视仪。关键还缺东西。,Chinese
+那你先把东西装起来。还缺一样东西。这个就帮不上忙了。对对对 还缺一样东西。 先装起来再说吧。关键的问题现在缺几个，缺这个 这个机器设备的对应的套包。,Chinese
+就是人工肺和管路。这个是最缺的，没有。手上一套都没有。 ECMO要工作起来 需要大量配件支持。此时，全国都在驰援武汉。,Chinese
+但物资的抵达总有先后。再不行的话再紧急的话，我会叫东航飞机跟着运到武汉。 我们去拿过来。这个你放心。只要你机器配套够用 可以用,Chinese
+紧张 仓促 各种意想不到。这种新冠的病人和以前我们碰到的ARDS 明显不一样。早发现早处理 不能拖 一拖的话 你不知道什么时候就变了,Chinese
+一变了你就再也拉不回来了。就做我们尽可能相互之间 一个能互相帮助点 多面手。 测ACT 抽血气 护士我们是不搭手的 都是医生在做。那你现在没办法。都是医生在。,Chinese
+现在我们到了雷神山这里来，我们就没办法。你不可能又做这个ACT做个血气 我们医生再进去。 你这只是采血 那你还要吸痰啊 那你还要翻身 那你还要观察伤口,Chinese
+那事情多了。因为按照道理来说我们护士是否有这个资格来做这个操作？ 那我还是异地执业了对吧？我指业地点在上海，那这是非常时期。,Chinese
+这个时候不强调专业范围了嘛。这个没什么。这个时候你就是要强调我们团队的有效性。 急的时候你只要能做就上来 这个没办法 这叫救灾嘛护难 这个没办法。,Chinese
+这种时候我们尽量商量 来协调好。这种交情是过命交情。 你说是吧？这是在玩命 这个事情。,Chinese
+因为这个时候万一再来一个 或者两个 我们就没力量了。 那就可能会丢失啊。跟打仗一样也有重点的。,Chinese
+目前王维俊仅有一台可用的ECMO。 但这个时候 他必须要去面对ICU里5床和15床的现实。,Chinese
+5床患有恶性肿瘤 抵抗力低下 氧合指数正在持续下降。 15床已经插了两周的呼吸机 仍然持续高烧，二氧化碳潴留 潮气量很高。,Chinese
+这些医学词汇专业 复杂 但都指向生命的危险。 1台ECMO， 5床， 15床 都需要。这让人难以抉择。,Chinese
+"你现在设备有几套了？只有一套。拼装三套只拼出一套。我只有一套ECMO系统,我希望两个病人一块讨论。 只有一套系统 我们看看哪个病人更 更合适一点 更合适一点。",Chinese
+来自呼吸科 神经外科 普外科 心血管外科 心内科 麻醉科 超声科 总共12名上海的医生,Chinese
+参与了讨论。这事关5床和15床 未来的生命走向。 然后这个病人至于是不是做ECMO 这个人我从昨天开始 我就在琢磨这个人。,Chinese
+怎么琢磨来 怎么琢磨去？ 昨天二氧化碳分压上来了。肺的问题对他的威胁是紧迫的。 马上就要不行的了。这个病人每天都不稳定。上午是挺稳定的，到了晚上和夜分总是出点问题。,Chinese
+上这个ECMO的终点我们要想好。到底是救还是延长时间。 这个我们要想好的。我们上ECMO讲起来只是一个辅助 但是归根结底还是一个病因学的治疗。,Chinese
+在临时的雷神山医院 医生们这时的选择更为纯碎。 标准只有一个。这个时候 5床和15床 谁更适合上ECMO的指征。谁的呼吸系统更需要ECMO的支持。,Chinese
+但这道选择题到决断的时候却异常艰难。 人家是做的 但我们肯定也要做。人家没做的那我们想办法怎么样做。这就是我们的特色啊。,Chinese
+反正已经到这个地步了吧，无所不用其极了。你还留什么后手 别留了。 从8点30分到9点50分 这场讨论持续了整整80分的。,Chinese
+我现在看了看 这是我们上个星期讨论过的 唯一这个病人 还是有点可能。所以说这个病人的措施采取的方法要积极。,Chinese
+要采取的措施要提前 要提前做 不要考虑到 这个不行了再去做 那就来不及了。,Chinese
+讨论的结果就是15床先上ECMO。根据当时的情况 医生判断 5床的窗口期相对更长 或许5床还能够挺到,Chinese
+第二台ECMO的到来。15床装上了以后 没有什么其他的风险？没有什么其他的风险吧？ 就是炎症反应。,Chinese
+还有这个人 现在血色素已经六点几了 血怎么解决？ 你今天可能做不成。 做不成的话 你800毫升血能拿得到吗？800 毫升的血 400毫升血浆,Chinese
+1个血小板。申请呗。 接下来就是等待15床的ECMO手术用血。,Chinese
+也就是从这晚开始 王维俊闯进了5床和15床的生命漩涡。,Chinese
+推肾上腺素 肾上腺素推了 好吗？仅仅过了8个小时 5床的肺功能突然急剧衰竭。这打乱了王维俊所有的计划。,Chinese
+5床拖到明天的概率不大。等到明天机器来了 东西都装好了 说不定他就撑不住了。 所以这个5床我觉得更急迫一点。如果明天就来机器。 那就先做5床。,Chinese
+我会打电话再确认一下？真的？ 15床无论如何撑到明天。是没问题的。对啊 你这个。。。5床成不成得到明天真不知道了。,Chinese
+他随时都有可能走掉的。这个病变化很快的。 不接电话 可能进舱了。我们这里有一套索林的ECMO机器。,Chinese
+但是没有。索林的机器。没有插管 没有套包。没有。所有的都没有 是吧？除了机器有 有一套索林的。 就是所有的耗材都没有。都没有。还缺一个套包的支架。套包的支架？就是膜肺的支架。,Chinese
+你看看他那里能不能凑一套给我。那我记一下。因为机器也没有装起来 你也不知道能不能做。那我们现在先把那套装起来？,Chinese
+先把机器装掉，然后套包来了以后我们再弄。 兄弟啊 我先把第二套ECMO准备好。,Chinese
+耗材大概今天晚上可能会到。我保证15床也有的用。 完美。,Chinese
+王维俊想赶快再拼出第二台ECMO给5床和15床 同时争取一个活下去的机会。中午一点钟啊？再让他们给15床做个血气。,Chinese
+但拼到一半 王维俊才发现 第二台ECMO不但没有套包耗材， 连水箱管路都有了问题。,Chinese
+没有水箱的管道。没水箱的管道了。 再打电话 看看能不能借到。,Chinese
+你想好吧。,Chinese
+现实再次把王维俊推回了选择的原点。 王维俊今年53岁。他从2003年开始接触ECMO技术,Chinese
+到现在17年的时间，他做了数十例ECMO手术，从来没有一刻 像在雷神山医院这样纠结。我们做这个东西从来没把握。,Chinese
+只是争取创造机会。 现在 摆在王维俊面前的现实更为残酷了。很明显，5床今天危在旦夕,Chinese
+急需生命支持。从常识判断，5床应该得到这台ECMO。 因为救急就是救命。但从现实来讲，仅有一台ECMO，,Chinese
+如果给了5床，医生们完全没有把握 能撑住他度过这关。,Chinese
+而相比较于5床，15床的情况稍好一些， 他最有条件脱机 康复。15床这个时候如果不上ECMO,Chinese
+他可能会错过做ECMO手术的最佳窗口期。 明天会怎么样 谁都吃不准。新冠病人和以前的病人不一样的。 好像外面成功率总的成功率只有百分之十几。这百分之十几还要看,Chinese
+时机的选择，指征的选择。 王维俊的纠结并非孤例，尤其是在疫情的早期。,Chinese
+口罩，呼吸机，防护服 等医疗资源严重短缺。结果我们进来以后， 只有床和床头柜。抢救的设备也都缺乏，唯一的呼吸机被我们上掉了。 后面都没有呼吸机了。,Chinese
+这往往会把医生推向一个伦理的困境。生命都要挽救， 但先救哪一个。今天15床还是要上ECMO。没问题。我们就更积极一点。,Chinese
+希望能够保护性的救一个是一个。 那我就准备了。没有时间留给医生犹豫了。,Chinese
+他们选择了那个最可能救活的人，15床。 你进去还是按照步骤来。你自己想好了步骤，一步步来 不着急。好 那你进吧。,Chinese
+成功。 现在血压多少？慢点慢点。,Chinese
+1000毫升的生理盐水。这是B区ICU的第一台ECMO手术。 已经被深度镇静的15床不会清楚这场救命的手术来得有多么艰难。,Chinese
+仅有的一套耗材被小心地一件件拆开。再拆。 此时医生们都清楚这些耗材有多么珍贵。,Chinese
+红色的管路把15床的生命和ECMO机器连接了起来。 达甫，我们开始。现在几点钟？6点48分。,Chinese
+已经有二十天没有见面了。那你自己加油 好不好？是不是特别想你老伴？ 所以你自己要乖一点。不要摇头 要点头。你会好好表现吗？,Chinese
+能坚持吗？要点头。要对自己有信心。 说你自己会努力的。点点头。自己点点头。,Chinese
+雷神山医院 32个病区 1600张床位。 在这些人类和疾病抗争的故事中，我们看到的不应该仅仅是悲伤和艰难。,Chinese
+其中还有我们冲破困境的决心和力量。再吃一点点。 我不想再吃了。我不想吃了。我不想吃了。,Chinese
+再吃两口。我不想吃了。不想吃不想吃。 完全不吃。,Chinese
+这个稀饭是他们特地为你。我不想吃了。 就像这对母子，儿子在做血透时 感染了新冠肺炎。,Chinese
+母亲为了陪他执意进入红区，和儿子同吃，同住。还要吃点稀饭。 你别吵。先拍。,Chinese
+你觉得拍上面舒服还是拍下面舒服？中间最舒服。中间？ 他本来身体就不好，基础病又多。,Chinese
+现在这样又不能吃。吃了又吐。我觉得状况不太好。 我肯定蛮担心的。,Chinese
+因为我儿子有特殊情况，他是精神残疾啊。所以我自己一直陪着我儿子。 怎么说呢？作为我��个正常人，我肯定害怕这个冠状病毒。,Chinese
+但是我作为母亲我不怕。我当时在医院陪护的时候， 他们医生当时不让我陪。不让我陪我就把我儿子特殊情况和他们说。他说那我们要请示领导。,Chinese
+后来他们领导同意了。你说作为母亲，儿子这种情况我还怕啥啊？ 我有时候觉得我儿子要是死了，我就活不下去了。所以我不怕。他走到哪我就跟到哪。,Chinese
+再大的风险我都承担。刚才查老师给我查了那个抗体， 他告诉我说我没有被感染。那我非常幸运。我这么长时间陪着我儿子嘛，,Chinese
+我还没被感染。,Chinese
+套包我在外面装好，不要到里面去装。到时候找东西又找不到。 我把东西都在外面准备好。第二台ECMO的耗材终于配齐了。,Chinese
+我怕撑不到。那么现在反正是不计一切后果，不计一切代价来抢救了， 但是反正你家里其他人，包括你的其他兄弟姐妹，那么要有这个思想准备，,Chinese
+还好 ECMO上去后 能站住。如果真的是循环衰竭，他的血压站不住的。 站不住就没了。,Chinese
+你先去休息一会。我不休息 我天天这样。 这两三个星期基本上没休息过。心吊着。我来了以后就没好好睡过。,Chinese
+我昨天夜里11点不到睡的。到今天早上3点就醒了。醒了就睡不着了。 从成功拼装出第一台ECMO到决定先给15床上机，再到今天用ECMO,Chinese
+把5床从死亡线上拉回来。这一路 曲折坎坷。 它不光讲述了灾难之下人类的局限，还有我们在困境中表现出的勇气。,Chinese
+每天都有点心 是吧？这个点心是我们带来给他们的。,Chinese
+命丢了。你问问她。 不想了。确确实实觉得,Chinese
+将近一个小时的情况下面，我们所监测的两次血气。 氧合指数都大于两百。血压平稳。心率在一百次左右。,Chinese
+前二十四到四十八个小时开刀。 小肠里面破了一个洞， 不赶紧动手术的话,Chinese
+病人会很快地死亡。,Chinese
+现年六十四岁的洪美金 八年前被诊断患有干燥综合征。 一种慢性自身免疫性炎性疾病。,Chinese
+多年来洪美金总是开朗地面对病情， 但一个月前 她却因为右下腹突然疼痛不已，,Chinese
+这个病人呢 她患了盲肠炎 只是她的病情是比普通盲肠炎复杂啊。 因为她有一个auto immune condition叫做Sjögren's disease。,Chinese
+她的身体会产生血块， 所以她有吃血薄的药。 所以动这个手术之前 最大的问题就是说,Chinese
+因为她有吃血薄的药 血比较难凝固起来。 所以我们要给她一些药呢 去correct她的coagulability。,Chinese
+位于裕廊东的黄廷方综合医院 是一所拥有七百张床位的综合医院。 除了提供一般的医疗护理,Chinese
+治疗和康复服务以外， 医院也设立一个急诊外科部 提供全年无休且二十四小时,Chinese
+急诊外科部平均每年接待六千名病患。 当中 约有四千名 是来自医院的急诊部。,Chinese
+医院里的所有外科医生 每个月都必须在急诊外科部轮值四天。 这一天轮到胡瀚文医生值班，,Chinese
+穿梭在不同的病房。 而胡医生在完成巡房后 即将进入手术室进行一个紧急手术。,Chinese
+这个病人呢早上开始肚子疼痛 来到了紧急部门。 当我们看她的验血报告 还有肝胆指数,Chinese
+其实都是蛮正常的 也是没有发烧。 可是 当我们临场检查的时候 其实 肚子是蛮疼痛的。,Chinese
+所以开始让我们怀疑 这个是不是一种早期的胆囊发炎。 所以接着我们就跟她安排了 紧急的超声波。,Chinese
+看一下肝胆有没有发炎。 到来求诊的病人 是现年四十四岁的房地产经纪,Chinese
+黄丽晶。 她因为工作忙碌 饮食习惯长期不良， 因而造成许多大大小小的胃肠道问题。,Chinese
+我一向以为就是我是胃痛。 假如说不是很痛的话 我就是去二十四小时门诊。 我那天大概是凌晨五点多进来。,Chinese
+因为我前一晚 十一点多已经开始觉得不舒服， 但是我开始吃一些药， 到了四 五点还是不行,Chinese
+我就告诉我的丈夫 说我一定要进来了。 就好像那个肚子好像要烧坏了。 然后你会感觉好像一直反胃。,Chinese
+然后有时候痛到连后面那个背 都好像拉得很紧。 你感觉好像要死掉了。,Chinese
+比生孩子还痛。 我们做了超声波之后， 显示其实有很多胆结石。,Chinese
+所以我们就建议 可能应该在这个时候 做腹腔的胆囊切除手术。,Chinese
+胆结石有时候可能会造成许多问题。 如果胆结石太大， 可能会造成胆囊发炎。 胆结石小的话,Chinese
+那很容易掉进去胆管 可能造成胆管发炎 还有黄疸。 胆结石 掉入太深的话 也是会造成胰脏阻塞。,Chinese
+如果胰脏发炎得太严重的话 会造成呼吸困难， 或者其他的器官受到损伤。 死亡的病率,Chinese
+也是有可能高达50%。 所以当我们有怀疑是早期的胆囊发炎。 那我们就应该在,Chinese
+前二十四到四十八个小时开刀。,Chinese
+被发现有胆结石的黄丽晶 在进入全身麻醉后 手术正式开始。 这项手术将使用小型器械,Chinese
+和一个摄像机来完成。 有些时候 十二指肠 胃 肝 甚至大肠 可能连接到发炎的胆。,Chinese
+所以我们就需要很小心地 把周围的肠还有胃解剖下来。 之后呢 我们就会开始解剖胆囊管,Chinese
+还有胆管之间的那个胆囊血管。 最大的难度 我们要确保 不能够损伤到这些器官。,Chinese
+如果损伤到胆管的话 那病人就有可能需要第二个 或者第三个手术。 在切除胆囊时 必须截断胆囊管,Chinese
+但如果过程中伤及总胆管 造成胆汁渗漏 或胆管阻塞 可能会导致腹膜炎或黄疸等严重问题。,Chinese
+胡医生在胆囊管和胆囊动脉之处 确定解剖构造位置后 便开始用夹子 缝合等方式,Chinese
+手术后 胡医生马上为病人 进行内窥镜检查， 以确保病人没有同时患上 跟胆囊发炎有相似症状的胃发炎,Chinese
+或胃溃疡。 那很幸运的 这个病人的胃 其实是很正常 没什么问题。,Chinese
+被诊断患有阑尾炎的洪美金 在急诊手术室里 准备接受腹腔镜阑尾切除术。,Chinese
+这个手术预计在半个小时内便可完成。 我们是用那针孔的方式 动这个盲肠炎的手术。,Chinese
+肚子有开三个小洞 最大的洞大概有一公分左右。 主要就是说要先把盲肠的血管切除,Chinese
+让它止血 然后把这个盲肠切除。 汤医生将特殊手术工具和摄像机 置入病患的腹内 以切除阑尾。,Chinese
+腹腔镜手术一般来说 可以让病患恢复得更快 愈合时疼痛也减少 疤痕较不明显,Chinese
+但腹腔镜手术并不适用于所有人。 如果阑尾破裂 感染已经扩散到阑尾以外,Chinese
+或者有脓肿 病患可能需要进行开放性阑尾切除术 以方便清理腹腔。 盲肠炎这种手术,Chinese
+主要最关键的就是说 把那个盲肠切除掉 把那个血管切除掉 不要让它流血。 第二个就是要把盲肠附近的周围,Chinese
+清洗干净了 确保以后不会有细菌感染。 这是两个最关键的地方。 手术步入第二十分钟,Chinese
+汤医生最担心的情况 不幸发生了。 因为她的盲肠有点破洞,Chinese
+然后盲肠里面那些肮脏的水都跑出来呢 会有细菌感染。 如果太迟的话也会有死亡的机会。,Chinese
+洪美金的手术 在第二十分钟出现了状况 医生发现她有阑尾穿孔的现象。,Chinese
+我们要把肚子里面的周围洗干净啊 然后把那些肮脏水抽出来啊。 如果太迟的话 也会有死亡的机会。,Chinese
+幸运的是 经过汤医生 和急诊外科团队的一番抢救 病患在无需改以进行 开放性手术的情况下 完成了手术。,Chinese
+所以我们已经把病人的盲肠切除了。 一旦把盲肠切除了 通常很快就会进步。 所以这个就是病人的盲肠。,Chinese
+通常病人现在就可以去普通病房 休养多一 两天 就可以回家。,Chinese
+通常盲肠炎 这个是我们无法控制的。 不是说吃饱后乱跳 乱跑会造成的。 所以在这种情况下,Chinese
+就必须来医院求医了。 不要等到病情很严重才来。,Chinese
+因为患有胆结石 而在前一天动了手术的房地产经纪 黄丽晶 一早睁开眼睛,Chinese
+就迎来替她开刀的胡瀚文医生 和一份礼物。 我第一个想法就是,Chinese
+你是不是去花园里面捡回来的石头。 我没有想到这么大。 自己也吓到。,Chinese
+所以我第一个想法就是问他 你 这个东西酝酿了多久。 他跟我讲至少好几年了。,Chinese
+以前我做房地产的时候， 生活都是很急促， 所以很少定时吃饭。,Chinese
+然后又常常得出去应酬。 所以当你出去应酬的时候 你都通常会吃挺多油炸的食物。 会觉得好像一直消化不良。,Chinese
+现在觉得消化得很好 很快， 就是全部很顺畅。 所以我觉得他真的解决了我的问题。,Chinese
+这天是汤永贤医生这个月 在急诊外科部轮值的第四天。 空档时间 汤医生最喜欢,Chinese
+待在医院的露天花园里待命。 因为在这里能呼吸到新鲜空气， 可以纾解一下紧张的工作压力。,Chinese
+但是 他的片刻宁静很快就被打断。 在病房等着他的,Chinese
+是一名七十九岁的老妇Seetharam。 退休多年的Seetharam 为了不给孩子添麻烦 自丈夫去世后便选择独居。,Chinese
+这一天她因关节脱臼而被送入医院， 却意外发现她其实患有更严重的疾病。,Chinese
+我们跟她做了个扫描呢 扫描里面显示说肚子里面有很多气。 然后小肠里面也有打结啊,Chinese
+这打结造成了小肠不够血 导致小肠里面有个穿孔和洞。 这个病情算是很紧急的,Chinese
+是算一个P1的手术 Priority 1的手术。 急诊外科部一般根据病情危重程度 将病患分为P1 P2 P3,Chinese
+三种级别。 最轻微的为P3 而最严重的为P1。 这类病患往往必须在两个小时内 进行手术。,Chinese
+当小肠的肮脏水全部跑进肚子里面呢 会造成细菌感染。 如果不赶紧动手术的话,Chinese
+病人会很快地死亡。 所以我们在两小时内把她带入手术房 把这个这部分的小肠切除了。,Chinese
+然后再连接起来。,Chinese
+"这个手术大概有六 七个小时, 是比较难做的手术。 每次都是会觉得肚子痛啊",Chinese
+有时候一直头晕 又呕吐啊。 她以前有胰脏发炎过,Chinese
+2015年开始投入使用的 黄廷方综合医院 占地面积约5.5万平方米， 设有急诊科 内科,Chinese
+肝胆胰外科等多个部门， 大大缓解了西部居民的就医压力。 现年五十岁的陈美萍,Chinese
+这一天到黄廷方综合医院 准备要动手术。 性格独立的她不想麻烦家人，,Chinese
+独自一个人前来办理入院手续。 之前会感觉到一直肚子不舒服， 然后每次去看那个邻里的那个医生,Chinese
+还有公司的那些医生 他们都是说我有那个胃痛。 然后我就觉得 好 这样是胃痛,Chinese
+这样说可能是因为工作压力 还是太过忙碌 导致到胃痛。,Chinese
+陈美萍是一名销售培训师， 一向热爱户外活动 三不五时便会和亲友出游 或一起环岛骑行，,Chinese
+也是马拉松的常客。 透过公司每年的体检， 她最近才发现她患上的,Chinese
+并不是一般的胃痛。 她的病情 其实是原发性甲状旁腺功能亢进。 英文我们叫做primary,Chinese
+hyperparathyroidism 是我们说血高钙最普遍的因素。 所以她为什么会有这个问题呢，,Chinese
+就是因为在她的脖子里面， 右边下面有一个甲状旁腺的肿瘤。,Chinese
+普通的甲状旁腺呢其实是看不到的。 连我们做扫描超声波也是看不到的。 因为它们真的是很小，,Chinese
+连一粒米都没有这么大。 通常我们说其中一个 可能会开始肿变成了一个肿瘤 然后造成激素亢进。,Chinese
+过多的甲状旁腺激素 会导致血液内的钙含量过高。 高钙血症有可能危及病人的生命。,Chinese
+所以呢 长期如果我们不来 治好这个功能亢进的问题的话。 当然第一点 骨质会越来越疏松，,Chinese
+所以那就是说骨折的可能性就会更高。 另外一点也是我们知道 长期高钙的问题,Chinese
+也是对身体其他的部分会有影响。 可能会有心脏病的问题。 因为之前我不晓得,Chinese
+为什么我每次都是会觉得肚子痛啊 然后背一直痛啊 然后我就还是会去那个中医，给我做那个cupping。 还有做那个acupuncture。,Chinese
+我也不晓得为什么有时候 一直头晕啊 又呕吐啊 每到晚上半夜就一直睡不着 只能睡两 三个小时。,Chinese
+那这个病人也是十年前 已经有过胃溃疡， 因素也可能是因为高钙的问题。 有些病人可能也是会觉得,Chinese
+比较疲劳 疲倦 都是很普遍的症状。 我们说长期的症状 也是会导致骨质疏松。,Chinese
+那这位病人也是两年前 其实只是轻微的跌倒。 那造成脚的骨头都有一个骨折了。,Chinese
+这一天在医院里 等着动手术的还有现年五十六岁 患有胰脏癌的Rosna。,Chinese
+她在丈夫的陪伴下办理入院手续， 准备进行长达七个小时的 胰十二指肠切除术。,Chinese
+Rosna是一名英文教师， 过去有高血压， 高血脂症和糖尿病的病史。 一直以来 她都以药物来控制病情。,Chinese
+扫描显示说呢胆管有阻塞。 这个胆管阻塞的主要原因 是因为她有胰脏癌导致胆管阻塞了。,Chinese
+所以我们先做了其他扫描 确保癌症没有扩散， 然后跟她安排手术。,Chinese
+胰脏癌是目前 较为难以治愈的癌症之一。 但是 对于早期的胰脏癌 如果以手术方式切除胰脏,Chinese
+患有胰脏癌的Rosna 这天在黄廷方综合医院 准备接受胰十二指肠切除术。 Rosna接受全身麻醉后，,Chinese
+医生马上为她展开 预计长达七个小时的手术。 胰十二指肠切除术,Chinese
+是一项极为复杂的手术， 因为胰脏的所在位置 是腹腔最为深入的部位。 它处于胃脏的后面，,Chinese
+在大动脉及脊髓的前面。 Rosna的肿瘤就长在胰脏头部 这才导致她有黄疸的症状。,Chinese
+把那个胰脏切除后呢 有很多地方需要连接起来 所以时间比较长了。 在手术的最后部分，,Chinese
+汤医生必须重新 将小肠和剩余的胰脏 胃部以及胆管进行连接。 这使得手术变得更为复杂。,Chinese
+另一边 两个星期前被诊断患有 原发性甲状旁腺功能亢进症的陈美萍。 在接受全身麻醉后，,Chinese
+也要开始进行手术了。 我们通常是采用两种扫描 来去察觉是哪一个甲状旁腺有肿瘤。,Chinese
+所以第一个就是超声波 超声波是需要看 这四个哪��个可能是开始有肿。 因为普通的甲状旁腺,Chinese
+超声波是看不到的 因为小过一粒米。 第二个扫描就是我们做所称的 Sestamibi或者Parathyroid scan。,Chinese
+那这个是特别看这个甲状旁腺的功能 哪一个有亢进。 那这个病人,Chinese
+两个扫描都显示是右边下面 只有一个肿瘤， 所以也能够让我们可以让这个病人呢 做一个比较小一点的手术。,Chinese
+微创的手术 胡医生采用开放性的方式 为陈美萍进行手术。,Chinese
+他首先在胸骨切迹上的弧形低领 作一个约两公分的小切口， 以人工拉钩,Chinese
+并在头灯辅助下切除甲状旁腺。 大部分的甲状腺都是蛮小的， 所以第一点我们是要确保,Chinese
+我们真的是能够找到这个肿瘤， 然后帮她切除。 这类手术的优势是操作距离近,Chinese
+手术时间短 而且 有机会损伤的面积也比较少。 此外 手术的切口痕迹在手术后,Chinese
+可轻易掩盖。 但这样的手术也存在着一定的挑战。 所以我们做这个手术,Chinese
+也是不会超过两公分的那个疤痕。 所以你可以想象 小的疤痕 那我们也是比较更仔细的,Chinese
+需要用比较小一点的那些工具 然后来把这个肿瘤切除。,Chinese
+Rosna的手术已经进行了两个小时。 在六 七十年代 像这种复杂的手术的死亡率,Chinese
+为百分之三十三。 但随着医学研究的日新月异 这项手术的死亡率 已降低到百分之二至三左右。,Chinese
+手术的风险 第一个最大的风险就是流血了。 病人流血我们通常都是 可以在手术房止血的。,Chinese
+第二个风险就是连接的部位， 有时如果病人愈合的能力 不是很好的话呢，,Chinese
+可能会有漏水的迹象。 就会导致病人有发炎的迹象。 也是会发烧,Chinese
+白血球会升高 需要打抗生素 甚至需要放新的管 让那个肮脏的水出来或重新动手术了。,Chinese
+陈美萍的手术已经进行了一个半小时。 胡瀚文医生正小心翼翼地 为她切除甲状旁腺。,Chinese
+手术当中 胡医生最担心的是 意外损伤到喉返神经。 这将使病人彻底丧失正常呼吸的能力，,Chinese
+即便获救 也将难以过上正常人的生活。 其实病人是有蛮多症状的。 不过她也是很担心,Chinese
+开刀之后会不会影响到她的生活素质。 她的工作也是需要利用嗓子 来和很多人沟通。,Chinese
+所以我们也是要确保手术安全， 希望也是能够减少 对声音还有嗓子受损伤的风险。,Chinese
+她也是觉得那些症状也是蛮困扰她。 所以我们也是希望开刀之后 她的症状都慢慢开始消失。,Chinese
+也是给骨骼比较强壮一点点， 所以能够回去做一些 可能爬山这些之类那些活动。,Chinese
+两个小时后 胡医生成功地 将陈美萍的甲状旁腺切除。 切除了之后 我们其实看得出,Chinese
+那个肿瘤比我们从超声波看的 还比较大一点点。 那可能也是会解释 为什么还没有开之前,Chinese
+那个甲状旁腺激素会这么高。 那一切除之后,Chinese
+而患有胰脏癌的Rosna 还在手术台上接受手术。 汤永贤医生 除了切除肿瘤所在的胰头之外,Chinese
+也必须同时切除 环绕胰脏头颈部的十二指肠。 麻烦的是,Chinese
+十二指肠又连接着胃和小肠。 在破坏十二指肠的过程中 往往也得将一部份的胃切除。,Chinese
+袖状胃切除术 就是去除掉五 六十 七十巴仙的胃。,Chinese
+这一天 鹰阁医院的手术室里 医生和护士们正忙得团团转。,Chinese
+现年三十七岁的Siddique 患有肥胖症 重达190公斤。 医疗团队在为他动手术之前 必须进行一些特别准备。,Chinese
+手术的时候 我就需要他的头偏高。 他的体重就会压在他的脚上 所以我们需要保护他的脚。,Chinese
+躺在手术台上的Siddique 原本还很轻松。 但随着时间的推移 他的表情渐渐显得有些凝重。,Chinese
+尽管此刻心情七上八下 但Siddique其实在这之前 是非常期待这一天的到来的。 为了登上这个手术台,Chinese
+Siddique自小就爱吃 在资讯科技公司上班的他 十年前成立了家庭后 体重就一直有增无减。,Chinese
+最高记录曾飙升到204公斤。,Chinese
+Siddique的主治医生陈俊海医生 在几年里 已经为超过五百个肥胖症患者 进行过减肥手术。,Chinese
+对于肥胖这个普遍现象 许多人的理解仍然有所欠缺。 你看这张椅子没有旁边的handle。,Chinese
+他们在外面都会有这样的问题， 好像你坐下去就被那个手把夹住， 所以他们就会有一点尴尬，,Chinese
+还有一点恐惧感来看医生。,Chinese
+一般人或许能够靠运动和节食来减重， 但是 对于像Siddique这样的 第三级别肥胖症患者来说，,Chinese
+他们往往需要的是医疗帮助。 等级三肥胖率的病人， 他们要开始运动的时候,Chinese
+受伤的机会就比较高。 他受伤过�� 他又不能移动。 他们的体重就越来越严重。,Chinese
+袖状胃切除术 就是五 六十 七十巴仙的胃会把它切除掉。 过后留一个比较细的一个袖子，,Chinese
+给你的食物能够进到小肠去。 胃部容量一旦缩小后 病患吃少量食物就会有饱足感。,Chinese
+陈医生在替Siddique开刀之前 必须先检查看他的胃部 是否有什么异常。 不过 这只是Siddique必须进行的,Chinese
+其中一项术前常规检查而已。 手术前 Siddique还必须减重,Chinese
+以减低手术风险。 这是为什么他必须提前两个星期入院。,Chinese
+入院后 Siddique几乎每天 都会参与一系列为他量身定做的运动。 他在这之前其实是很久没有运动了,Chinese
+所以我们就选择他平常日常生活中 会做的一些活动， 像半蹲 其实他家里有一个两岁的女儿。,Chinese
+那他可以用半蹲来蹲下去 然后再把女儿举起来。 其实这是普通的亲子活动。 不到五分钟,Chinese
+Siddique就开始气喘吁吁了。 虽然吃力,Chinese
+体重将近两百公斤的Siddique 为了逆转人生 在两个星期前便住院 为一项减重手术进行准备。,Chinese
+一般接受这类手术的患者 其实无需进行那么多准备。 不过由于Siddique的肥胖症 特别严重 不减重的话,Chinese
+将会为手术带来风险。,Chinese
+为了减重 Siddique除了积极运动之外 也必须放弃他最爱的美食， 改以极低热量饮食取代。,Chinese
+什么味道？ 这个水？ 没有味道的。 是甜甜的。 很香。 Siddique坦诚自开始节食后,Chinese
+有时看到美食 仍然会禁不住诱惑而想要“破戒”。 但庆幸的是 身旁有人一直跟他同甘共苦。,Chinese
+在切除胃之前 外科团队必须先牵开肝脏， 一些肥胖病患在进行这项手术时， 所面临的其中一个风险,Chinese
+就在于这个步骤。 当时 他是204公斤。 他的肝应该是会有脂肪肝的现象。,Chinese
+然后要把肝移上 才能够看到你的胃。 危险性就是有流血的现象。,Chinese
+Siddique过去两个星期的努力 看来没有白费。 今天的手术算是说很顺利 他的肝瘦得比较能够,Chinese
+没有问题地把它移开。 袖状胃切除术的目的 就是将病患大部分的胃切除,Chinese
+只保留一小部分。 为此 在开刀之前 外科团队会将一个叫做 胃校准管的管子置入食道,Chinese
+一直到胃里。 手术当中 外科医生 陈俊海医生要衡量切除的部位时,Chinese
+就得靠这个管子。 而操控这个管子的人 其实是手术室里另一位重要的人物。,Chinese
+麻醉科医生的主要职责 是确保病人在手术中的安全。 除了帮助病人在无痛 无知觉的情况下进行手术。,Chinese
+麻醉科医生也必须在手术中 时时刻刻监测他们的生命体征。,Chinese
+短短一个小时内 Siddique的胃已经开始被分成两段。 袖状胃切除术,Chinese
+其实是一种减重代谢手术。 这类手术主要通过改造 病患的消化系统 帮助患者长期减肥。,Chinese
+减重代谢手术 不单单只是限量你的食物， 你的荷尔蒙， 你的代谢率也是会有调整。,Chinese
+手术后 荷尔蒙的改变 会让病患的食欲减少。 代谢率的改变 也会让体重更容易逐步下降。,Chinese
+不过 这并不代表病患的肥胖症 就治愈了。,Chinese
+虽然说这个手术能够帮助病患 在节食和运动后更容易减重 然而 如果病人过后,Chinese
+还是暴饮暴食的话 最终还是有可能复胖的。 我通常都是跟病人讲 这个旅程算是一万步,Chinese
+我帮你踏出的第一步 就是帮你做这个手术。 手术过后 体重一定会降。 降多少 降多久,Chinese
+今早接受了减重手术的Siddique 清醒后 发现自己躺在 高度依赖病房里。,Chinese
+由于Siddique患有 阻塞性睡眠呼吸暂停综合征， 手术后可能会出现呼吸困难 因此需要小心观察。,Chinese
+在高度依赖病房里 病人的心率 血压 氧气饱满度 会传输至一个中央监护站。 一旦出现偏差 就会引发警铃响。,Chinese
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+네 자기 전 카페인과 알코올 너무 많이 섭취하면 그럴 수 있습니다.,Korean
+네 동네 병원 중에 화상 상처 보는 곳에 가시면 됩니다.,Korean
+네. 코로나가 감염성이 커서 같이 검사하셔야 합니다.,Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+장운동을 확인 후 물을 드셔야 됩니다.,Korean
+어느 쪽이 안 좋아서 내원하신 건가요?,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+약 이름이 뭐였는지 까먹은 것 같아요.,Korean
+네. 알레르기 증세 중 하나입니다.,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+네. 감염에 취약한 상태이니 상당히 주의해 주셔야 합니다.,Korean
+통증이 ���껴지는 부위가 있나요?,Korean
+"변이 검붉은색 일 때 있어요.
+",Korean
+"원래 변비가 조금 있어요.
+",Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+"길 가다 자빠져서 머리를 다쳤어요.
+",Korean
+육안으로도 불룩한 게 보이신다고요 정말 그러네요 암인지는 검사를 해봐야 알 것 같습니다.,Korean
+"안녕하세요. 저희 애 항문에 좀 문제가 있는 것 같아서 왔어요.
+",Korean
+"소변이 나올 때 찔끔찔끔 나와서요.
+",Korean
+한 번이라도 흡연을 하신 적이 있나요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+네. 손발이 차가워지고 떨렸어요.,Korean
+가족 중 당뇨 환자 있나요?,Korean
+그래도 내시경으로 돌이 잘 제거되어야 퇴원하실 수 있으시잖아요. 조금만 힘을 내세요.,Korean
+약은 따로 보관해 드릴게요.,Korean
+"혈압이 너무 상승돼 가지고요.
+",Korean
+소변량이 체중에 맞게 잘 나오는 것이 확인되고 수액 치료를 통해 질환의 치료가 적절히 이뤄질 때까지 지속적인 소변량 검사가 필요합니다.,Korean
+대장암 걸린 적 있습니다.,Korean
+특정 시기에 통증이 생기나요?,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+어디가 불편하셔서 진료를 받으셨나요?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+작년에 맞은 파상풍이 끝이에요.,Korean
+"뭘 잘못 밟았나 봐요. 발에서 피나요. 따끔따끔하고.
+",Korean
+작은 볼일이 잘 안 나오나요?,Korean
+계속해서 심장이 빨리 뛰나요?,Korean
+검사 후에 수술 없이 치료할 수 있을 정도인지 다시 안내드릴게요.,Korean
+"흡연이랑 술 둘 다 자주 해요.
+",Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+두드러기가 나면 정상은 아닙니다.,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+"네. 목 안이 너무 견딜 수 없게 아파요.
+",Korean
+네. 입원생활 안내문을 확인하셨다는 서류가 필요해요.,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+아니요. 약은 전혀 안 먹어요.,Korean
+비염이 환절기만 되면 더 심해져요.,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+당이 부족해서인지 뇌 신경 쪽인지는 검사를 통해 알아봐야 할 것 같습니다.,Korean
+약간 예민한 상태라 지금 아프다 보니.,Korean
+"불면증도 있었고. 너무 밤잠을 설쳤죠.
+",Korean
+통증이 어떤 거 같으세요?,Korean
+최근엔 따로 약 같은 거 먹인 건 없어요.,Korean
+심장 뛰는 게 불편한가요?,Korean
+"밥을 먹고 나서 거의 한 오 분에서 십 분 정도 뒤에 토를 한 경우가 많아서 일부러 계속 앉혀놔요.
+",Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+흡연 한지 오래 되셨나요?,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+기능성 변비라면 변비 치료를 통해 배변을 유도해 볼 수 있습니다.,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+지금 갑자기 아프기 시작하신 건가요?,Korean
+네 원인균 중에서는 증상이 서서히 나타나게 하는 것도 있습니다.,Korean
+담배는 몇 살부터 피우기 시작한 거예요?,Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+질병 약물로 치료하고 계시나요?,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+"버스 타려고 달려가다가 넘어져서 다리를 다쳤어요.
+",Korean
+그냥 이석증이라고 약 먹으라고 했는데요.,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+대변을 며칠에 한 번 보나요?,Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+"목이 바늘로 찌르는 거처럼 아프네요.
+",Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+음식을 보고 토한 적이 있나요?,Korean
+키랑 몸무게가 잴 때마다 조금씩 달라요.,Korean
+결핵으로 진단받은 적 있나요?,Korean
+아니요. 환자분의 현재 몸 상태를 확인하기 위해서 질문을 드린 것입니다.,Korean
+암 때문에 병원에 오셨나요?,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+성공적으로 제균치료를 받고 박멸된 이후에는 재발 가능성은 있긴 하나 낮습니다.,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+네. 지금 누른 곳도 아픈가요?,Korean
+예방 접종은 요즘 너무 아파서 맞았고 해외는 다음 달에 갈 예정이에요.,Korean
+"중독된 건 이 년 정도 되었어요.
+",Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+"담배는 힘들 때 하나씩 태워요
+",Korean
+아픈 기간은 어느 정도일까요?,Korean
+간염 치료로 복용 중인 약 있어요?,Korean
+집 먼지 진드기는 천식을 대표하는 알레르기성 질환의 원인이 됩니다.,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+정형외과에 뼈가 부러져서 입원한 적이 있네요.,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+통증의 지속 여부를 말씀해 주시겠어요?,Korean
+진단서 한 부만 좀 떼 주실래요?,Korean
+길지만 그 정도는 금식해줘야 돼요.,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+그런 경우 먹는 약보다는 다른 경로를 통한 약물 투여가 효과적인 것 같습니다.,Korean
+약품 분석 의뢰 숫자에 따라 달라져서 얼마나 걸린다고 확답 드리기 힘듭니다.,Korean
+건대병원에서 투석 받고 있다니까요?,Korean
+심근경색은 가장 위중한 응급 질환에 해당하고 환자분처럼 다른 원인으로 가슴 통증이 있는 경우가 더 많습니다.,Korean
+입원 방법도 알아둬야 해서요.,Korean
+소변에 피가 많이 나오셨나요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+아무래도 진통제이기 때문에 속이 울렁거리거나 어지러운 증상을 호소하는 환자들이 있긴 합니다.,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+수술 준비 들어가셔서 지금은 못 오세요.,Korean
+"애가 열이 많이 나서 약을 먹였는데도 그 순간만 잠깐 내렸다가 다시 올라요.
+",Korean
+네 가슴이 마구 두근거리고 식은땀이 나기도 했어요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+"벌에 쏘인 후로 호흡이 어려워요.
+",Korean
+"오른쪽 팔에 투석관이 있어요.
+",Korean
+"요도염인 것까지만 알고 있는데요.
+",Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+치료 내역을 알면 저희에게 도움이 돼서 여쭤보는 거예요.,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+네. 음성반응 나왔다고 하셨어요.,Korean
+혈압이 낮으면 순환이 잘 되지 않아 신장에도 문제가 생길 수 있습니다.,Korean
+현재 다양한 질병에 제대혈 임상이 진행되고 있으며 산모가 판단하여 신청하시면 됩니다.,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+"다리에 힘이 빠져서 걷거나 뛰는 게 힘들어요.
+",Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+예를 들어 어떤 통증인가요?,Korean
+신경과 외래 진료는 인터넷으로도 예약 가능한가요?,Korean
+그 상태로 수액 공급은 한 시간 동안 이뤄지게 될 겁니다.,Korean
+"전에 기관지 확장증이라고 진단받았어요.
+",Korean
+여기 보시면 음낭 쪽에 물이 고여 부풀어 올라 있는 것이 있는데 이것이 음낭 수종이에요.,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+가장 흔한 경우는 헬리코박터균 감염증입니다. 이외에 유전적 요인 환경적 요인 식습관 등이 있습니다.,Korean
+결핵 문제는 그동안 없었고요?,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+언제부터 간염을 앓고 계셨나요?,Korean
+몸 전체에 힘이 없나요?,Korean
+검사 결과가 나온 이후 좀 더 효과 있는 치료법으로 가는 방법으로 하죠.,Korean
+그 부분은 간호사분이 아실 듯한데요.,Korean
+대장암으로 진행할 수 있는 종양성 병변입니다.,Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+"아파서 한참 동안 뒤척거리다 잤습니다.
+",Korean
+피를 토할 때 위도 아픈가요?,Korean
+허리 디스크 수술을 받은 적이 있습니다.,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+오른쪽이 상처 난 곳이에요.,Korean
+신경과 진료 예약하고 가도 되나요?,Korean
+네 병원은 전체 금연지역입니다.,Korean
+약 알레르기 있는 거 있으실까요?,Korean
+치아 몇 개 빠지셨나요?,Korean
+질병마다 기준이 다르지만 현재 환자 분께서 가지고 계신 질병 상태는 경증으로 구분되고 있습니다.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+통증 특성이 있다면 어떤 특성이 있을까요?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+배의 어느 부위가 아픈가요?,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+"통증이 수면 시간을 많이 단축시켰습니다.
+",Korean
+"어깨가 아파 생활이 힘들어요. 봐주세요.
+",Korean
+통증이 있다 없다 하나요?,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+보습제를 잘 발라도 그러는지요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+천식이 있어서 항상 흡입기를 들고 다녀요.,Korean
+추후 치료 계획에 반영됩니다.,Korean
+소변하고 혈뇨랑 함께 나오나요?,Korean
+약은 확인 후에 다시 돌려드리겠습니다.,Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+네 다른 병원에서 처방받은 게 있는지 알아야 해서요.,Korean
+혈압 관련해서 많이 불편하셨군요. 상담을 원하신다면 진료과로 안내 해드릴까요?,Korean
+몸에 바르고 있는 약이나 화장품이 있을까요?,Korean
+"귀가 항상 조금씩 아팠어요. 저번에 병원에 왔을 때는 중이염이라고 진단을 받았는데 오늘도 마찬가지인 것 같아요. 귀에서 진물이 나오고 귀가 엄청 아파요.
+",Korean
+병원에 방문하시게 된 원인이 뭐라고 생각하시나요?,Korean
+환자분이 수술하러 가시면 문자 가게 해드릴까요? 수술 끝나고 회복실에 들어갔다는 문자가 가게 해드릴 수 있어요.,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+흡연 여부는 필수 정보입니다.,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+운동하고 나면 부기가 빠져 있나요?,Korean
+네. 일찍 병원을 와볼 걸 그랬어요.,Korean
+그 부분은 다른 검사를 해 봐야 알 수 있습니다.,Korean
+검사 결과 약물 알레르기 반응 없으시다고요.,Korean
+그럴 가능성이 높으니 초음파 검사 등 추가 검사가 필요합니다.,Korean
+수면 비용에는 건강보험이 적용되지 않아 만 원이 추가됩니다.,Korean
+그렇다면 잠시 여기서 대기해 주시겠어요? 처방전 드릴게요.,Korean
+금연 약 말고는 없어요.,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+"턱이 부드럽게 움직이질 않고 아프네요.
+",Korean
+물에 닿았다면 거즈를 빼고 말리신 후에 소독하고 다시 새 거즈를 붙이셔야 합니다.,Korean
+아까 말씀드렸듯 감염의 위험 때문입니다.,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+연고는 하루에 서너 번 깨끗한 상태에서 발라주세요.,Korean
+스스로 열이 있다고 느껴지나요?,Korean
+소변볼 때 출혈이 있나요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+대장 내시경보다 더 적게 들어가는 검사입니다. 에스 상 결장까지만 들어가는 검사로 더 수월합니다.,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+보호자에게도 설명 후 서명 할 동의서가 있습니다.,Korean
+결핵약은 어떤 거 드세요?,Korean
+아까 이름 호명 했는데 진료실 들어가지 못하셨나요?,Korean
+네. 아침에도 관장약 먹고 화장실 갔다가 왔어요.,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+물집이 잡힌 경우 이 주에서 사 주 가량 통증을 호소할 수 있습니다.,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+평소 앓는 질환은 없었습니다.,Korean
+환자분 상체 조금 낮춰 드릴게요.,Korean
+통증 지속시간이 십 초 이내인가요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+입원은 이번이 처음이라는 거죠?,Korean
+고혈압으로 먹고 있는 약이 있을까요?,Korean
+감사합니다. 환자분 혈관이 곧아서 한 번에 놓을 수 있었어요. 여기 팔에 잘 고정시켜 둘게요. 이제 항생제 반응 검사만 하고 가겠습니다.,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+혈액 검사 결과 상 칼슘이 너무 많네요.,Korean
+"아뇨 그 뒤로 단백질 셰이크를 먹었습니다.
+",Korean
+"요즘 팔꿈치에 통증이 있어서요.
+",Korean
+진단과 치료 계획에 도움이 되기 때문에 기억하실 수 있으면 좋을 것 같습니다.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+지금도 배가 벙벙한 느낌이 있나요?,Korean
+복용 중인 위장약은 없나요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+소화가 안 된 건가요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+평소에 복용하는 약이 ���나요?,Korean
+이 년전에 허리 수술하고 나서 이 주정도 입원했었어요.,Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+부작용 얘기 듣고 무서워서 한 번도 안 해봤어요.,Korean
+네 구토나 구역감 또는 호흡 곤란 등의 증상이 나타날 수 있습니다.,Korean
+처방받고 드시는 약 있나요?,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+"기침을 하면 피가 섞여서 나오는 거 같아요.
+",Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+간염 판정은 언제 받았나요?,Korean
+다 나을 때까지 매일 발라주세요.,Korean
+피임약이 상관이 있을 수 있습니다.,Korean
+마취까지 필요하진 않지만 아이가 힘들어하면 필요할 수도 있죠.,Korean
+네 수면도 건강에 중요한 요소입니다.,Korean
+하루에 담배 타임은 몇 번 정도 가지세요?,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+불면증이 있는 것 같나요?,Korean
+위궤양은 모르겠고 평소에 위염을 종종 앓았어요. 그래서 작년에도 내시경을 받았고요.,Korean
+"식욕이 떨어져서 예전에 비해 많이 못 먹어요.
+",Korean
+"침 삼킬 때마다 목이 너무 따가워요.
+",Korean
+그거 가져가면 저 약 못 먹는 건데요?,Korean
+이전 검사에서 대장은 특이사항이 없었습니다. 원하는 병변을 관찰하기에는 직장 내시경으로도 충분할 것 같고 환자분께도 수월할 것으로 판단되어 처방하였습니다.,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+기침할 때 가래도 같이 나오나요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+비뇨기과와 협업하여 진료할 수 있도록 도와드릴게요.,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+평소에 대변을 보기가 힘든가요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+암이라고 진단받으신 적 있나요?,Korean
+"오른쪽 이빨 중에 윗부분이오.
+",Korean
+"속이 너무 안 좋은데요?
+",Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+진통제 없으면 밤에 잠을 못 자니 꼬박꼬박 복용했어요.,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+요새 머리가 어지럽진 않나요?,Korean
+현재 상태로 봐서는 자주 체위 변경해 주고 욕창이 더 생기지 않도록 해 줘야 빨리 회복 가능합니다.,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+이번에는 전신마취를 해야 돼서 감각이 느리게 돌아올 겁니다.,Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+환절기 때 한번씩 아프기는 해요.,Korean
+종양 있었던 가족이 있으신가요?,Korean
+네. 지금 당뇨 때문에 계속 약을 먹고 있어요.,Korean
+시기에 따라서 진단과 치료가 바뀔 수 있습니다.,Korean
+"생리를 안 한 지 너무 오래돼서 왔어요.
+",Korean
+아무래도 피부질환이 심한 분들은 호흡곤란도 올 수 있어요.,Korean
+"소변볼 때마다 통증이 너무 세게 느껴져요.
+",Korean
+네. 검사를 통해서 알 수 있습니다.,Korean
+검사 부위에 피가 나더라도 심하지 않을 테니 꼭 밴드를 붙이실 필요는 없습니다.,Korean
+수술 중에 위 내용물이 역류하실 수 있습니다.,Korean
+혈압이 낮으면 순환이 잘 되지 않아 신장에도 문제가 생길 수 있습니다.,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+환자분은 그런 운동이 도움이 되지 않습니다.,Korean
+네 그냥 약 처방 시 참고하기 위해 드린 질문입니다.,Korean
+동의하셔야 해당 약품을 쓸 수 있어요 조금 비싸긴 합니다.,Korean
+"매우 급하게 마려운 적 많아요.
+",Korean
+케이에프 마스크가 효과가 가장 좋습니다.,Korean
+빈 속에서도 나타날 수 있는 증상이지만 흔히 식후에 나타나는 경우가 많습니다.,Korean
+일단 봉합된 부위는 이틀마다 외과에 가셔서 소독 받으셔야 합니다.,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+지금 환아 몸무게가 몇 킬로그램인지 얘기해 주시면 됩니다.,Korean
+혈중 지방 수치에 영향을 미치는 식이요법의 영향이 크며 비만 운동량 부족이 혈중 지방 수치를 올릴 수 있습니다.,Korean
+우선 원인을 찾은 후 맞는 약을 처방해드리겠습니다.,Korean
+상처의 소독 후 사용하는 소독된 붕대를 지칭합니다.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+아픈 게 어느 정도 지났나요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+종양 있었던 가족이 있으신가요?,Korean
+취침 시에도 자주 소변이 마려운가요?,Korean
+하루에 몇 개비나 피우세요?,Korean
+유전성 질환으로 고생하는 가족이 계신가요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+통증과 관련해서 병원은 다니시고 계신가요?,Korean
+네. 보호자분들에게 수술이 끝나면 수술실 전광판을 통해 알려드리고 있습니다.,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+잠시 후 담당 선생님께서 회진을 오십니다.,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+약을 과다복용하면 부작용이 있을 수 있군요.,Korean
+약 처방과 관련하여 여쭤봤습니다.,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+고혈압약 먹고 예전보다 증상이 호전된 것 같나요?,Korean
+하루에 몇 시간 주무시나요?,Korean
+네 너무 힘드시면 참지 말고 주사를 맞으셔도 됩니다.,Korean
+하루에 음주량이 얼마나 되세요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+검사 부위는 일시적으로 붉게 올라올 수 있어요.,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+구급차를 이용하셨을 경우 비용 청구 관련하여 확인이 필요하여 여쭈어보았습니다.,Korean
+심장이 빨리 뛰어서 아프신가요?,Korean
+국가예방접종이나 기타예방 접종 포함 모든 예방접종이요.,Korean
+독감 예방접종을 맞으러 갔었습니다.,Korean
+혈압이 평소에 많이 높은가요?,Korean
+그리고 빠른 시일 내에 경정맥신우조영술이라는 조영술과 복부초음파 예약을 잡아 드릴 테니 검사하고 일주일 뒤에 보시죠.,Korean
+환자분 흥분하지 마세요 치료를 잘하기 위한 겁니다.,Korean
+환자와 관련해서 안내해 드릴 게 있습니다.,Korean
+"허리랑 다리 위주로 아파요. 움직일 수가 없어요.
+",Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+현재 복용 중인 약이 있으신가요?,Korean
+제가 볼 때는 뇌진탕 같진 않아요.,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+아직은 필요한 검사들이 남아 정확한 진단이 어렵습니다.,Korean
+설사는 몇 번 하셨나요?,Korean
+최근에 당뇨 검사를 받은 적이 있나요?,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+말씀드린 레이저 시술이 가장 빠르게 제거 가능합니다.,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+대부분 입원하시는 경우가 치료 또는 수술이 목적이기 때문에 전부 말씀해 주시면 됩니다.,Korean
+"어젯밤부터 열이 올라서 왔어요.
+",Korean
+"화상 입었었는데 가라앉질 않아서 왔어요.
+",Korean
+식욕 부진 증상이 언제부터 나타났었나요?,Korean
+수혈 거부 시 의사 상담 후 동의서 작성이 필요합니다.,Korean
+병원 차원에서 추가되는 비용으로 임의로 제외할 수는 없습니다.,Korean
+가슴이 자주 벌렁거리는 것 같나요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+빈속에도 구토 증상이 있나요?,Korean
+"허리 디스크가 있어서 수술해야 한다고 하셔서요.
+",Korean
+"하루 염분 섭취량을 넘지는 않는 것 같은데요?
+",Korean
+아이가 바이러스나 세균감염에 걸리지 않으면 더 빨리 좋아질 수 있습니다.,Korean
+바늘로 찌르는 듯한 통증인가요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+아니요. 산소 수치를 주기적으로 확인 후 내일 회진 시 결정할 예정입니다.,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+결핵 때문에 내원하신 적이 있나요?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+배가 부른 느낌이 없으십니까?,Korean
+마스크가 너무 꽉 끼는데 조절 좀 해주세요.,Korean
+상충 작용이 되는 약을 드시는지 체크하려고 합니다.,Korean
+검사 결과 상에도 문제가 있으니 식단 조절을 하셔야 해요.,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+어떤 암인지 알고 있나요?,Korean
+검사를 해봐야겠지만 진료 가능한 수준으로 보이네요.,Korean
+입원치료 혹은 수술받으신 적이 있으시다면 함께 말씀해 주세요.,Korean
+주에 몇 번 아픈가요?,Korean
+결핵 접종 하셨나요 ?,Korean
+감각이상이 동반될 수 있어 확인하였습니다.,Korean
+식욕이 떨어지신 것 같나요?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+아니요. 의료진들이 환자분에게 적합한 치료를 진행하고 있으니 걱정하지 않으셔도 됩니다.,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+체온이 떨어진 것 같나요?,Korean
+예. 독감 백신 맞았어요.,Korean
+항히스타민제는 두드러기 발적 소양감 등의 알레르기성 반응에 관여하는 히스타민의 작용을 억제하는 약물입니다.,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+두드러기도 나고 몸도 가려워요.,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+결핵 치료를 받기 시작한 것은 언제부터였나요?,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+지금 서거나 걷는 게 힘들지는 않나요?,Korean
+예 잘하면 해산물로 인해 증상이 일어났을 수도 있습니다.,Korean
+그 민간요법으로 상처 부위가 악화되었습니다.,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+네 오늘 포함해서 최근까지 드신 약 모두 말씀해주세요.,Korean
+호흡곤란이 일어날 수는 있으나 오래 지속되지 않도록 잘 모니터링하며 검사 시행하도록 하겠습니다.,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+알레르기 증상 발생 시 치료를 받거나 약을 드셨나요?,Korean
+아버지가 당뇨 어머니가 고혈압이 있으세요.,Korean
+심장 박동이 빠르게 뛰는 거 아니에요?,Korean
+최근에 체중에 변화가 있었나요?,Korean
+예약을 나중에 취소할 수 있지만 되도록 예약 때 내원해주세요.,Korean
+결핵 백신 접종을 언제 하신 거예요?,Korean
+따로 드시는 약 있으신가요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+일주일 기준 몇 번의 술을 섭취하시나요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+수액을 좀 더 맞으신 뒤 검사 진행할 예정입니다.,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+가능한 질환들을 감별하기 위해 추가적인 검사가 필요합니다.,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+"열이 며칠째 계속되고 있어요.
+",Korean
+아니요. 고혈압 같은 병력 있으신 분은 없어요.,Korean
+수면제든 보조제든 술과 함께 먹으면 위험합니다.,Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+지금 약간 머리가 어지러워요.,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+"산후우울증인 것 같아 오게 되었습니다.
+",Korean
+통증 속성이 어떤 식인 가요?,Korean
+콜레스테롤 조금 높아서 식이요법으로 정상으로 돌아왔어요.,Korean
+우리나라 여성의 경우 유방에 지방 조직이 적고 치밀한 섬유 조직으로 이루어진 치밀 유방이 많아 유방 촬영술만으로 검사가 불충분하기 때문입니다.,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+네. 추가 혈액검사 소변검사 엑스레이 촬영은 준비되는 대로 바로 진행할 예정입니다.,Korean
+"기침은 일주일 됐고 통증은 삼 일 전부터 있었어요.
+",Korean
+환자분 상태에 따라 다르기 때문에 어깨랑 목이 다 나으려면 얼마나 걸린다고 함부로 말씀드리기가 그렇네요.,Korean
+학생 때 교통사고로 입원했던 거 말고는 없어요.,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+"소변볼 때마다 너무 따가워요.
+",Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+소변을 보고 닦으면 휴지에 피가 묻어 나오나요?,Korean
+필요할 경우 피부를 이식하는 수술이 진행될 수 있습니다.,Korean
+가족 중에 유전성 질환을 가진 분이 있나요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+네. 독감 예방 주사 맞은 지 얼마 안 됐어요.,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+복부 전체에 통증을 느��어요?,Korean
+암 수술한 적 있으세요?,Korean
+네. 범계에 있는 병원 다녀왔어요.,Korean
+약은 따로 보관해 드릴게요.,Korean
+자연분만하다가 위험해서 수술로 바꿨어요.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+환자분 상태에 따라 달라요.,Korean
+특별한 건강상에 문제가 발생하지 않는다면 예정대로 진행할 수 있습니다.,Korean
+가족분들 중에 유전성 질환으로 고생하신 분이 있나요?,Korean
+네 바로 진통이 없어질 거예요.,Korean
+수술시간은 확인하고 알려 드릴게요.,Korean
+종양 치료는 다 끝났나요?,Korean
+접종도 맞았고 이 주 전에 포상 휴가로 해외에 다녀왔어요.,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+술을 얼마나 자주 음용하시나요?,Korean
+귀에서 멍한 소리가 나나요?,Korean
+이약은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+한 번이라도 흡연을 하신 적이 있나요?,Korean
+할아버지가 여러 가지 병이 다 있으셨어요. 당뇨 고혈압 갑상선도 안 좋으셨고요.,Korean
+눈이 뻑뻑해서 동네에 있는 안과를 갔었어요.,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+감염성 장 질환 감별을 위해 대변 배양 검사 등 시행할 수 있습니다.,Korean
+머리에 외상은 없는데 충격이 있으셨다면 진료를 따로 받아 보시는 게 좋을 것 같네요.,Korean
+붓고 빠지는 주기가 있나요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+최근에 체중에 변화가 있었나요?,Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+수술은 딱히 해본 적 없는 것 같고. 입원은 한두 번 정도 해봤어요.,Korean
+발이 부어 신발이 안 맞을 때가 있습니까?,Korean
+치과 치료도 당연히 포함됩니다.,Korean
+시술은 안 해봤고 허리 아파서 침은 맞아봤어요.,Korean
+단기간에 체중이 많이 늘었나요?,Korean
+통증으로 인해 얼마나 자주 아프세요?,Korean
+통증이 오는 곳이 있나요?,Korean
+암은 언제 어디서 진단받았나요?,Korean
+의료진의 지시를 따라주는 게 빠른 치료를 위한 길입니다.,Korean
+주치의 회진 시 설명 들으실 수 있습니다.,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+심계항진 증상을 설명해 주실래요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+현재 가족 중에 유전성 질환을 치료 중인 분 있나요?,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+입원 절차를 밟으셔야 해서 죄송하지만 바로 입원 진행은 어렵습니다.,Korean
+다른 원인에 의해 저린감이 있을 수도 있습니다.,Korean
+침 흘리면 닦아주면 되나요?,Korean
+간염 치료 복용 약 있으시죠?,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+지금까지 몇 번 피를 토했나요?,Korean
+네 과도한 운동으로 복압이 올라가서 증상이 나타날 수 있습니다.,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+아이가 외래 진료와 검사 결과 탈수 증상이 조금 있네요. 처방된 수액으로 바꿔 달아드릴게요.,Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+아이 열이 계속 떨어지지 않으면 더 위험할 거예요.,Korean
+주먹의 감각 혹은 운동 이상을 확인하기 위해 검사했습니다.,Korean
+호흡곤란 증상이 자주 나타나나요?,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+통증 지속력이 어느 정도인가요?,Korean
+통증이 있는 곳 어디예요?,Korean
+당이 부족해서인지 뇌 신경 쪽인지는 검사를 통해 알아봐야 할 것 같습니다.,Korean
+걱정이 많으실 것 같습니다. 우선 주사제 투여를 병행하면서 증상 양상을 확인해 보겠습니다.,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+통증이 멈출 때도 있는 건가요?,Korean
+비타민제에 과일에 들어가는 비타민 이상을 담을 수는 있지만 체내 흡수율에서 차이가 납니다.,Korean
+주로 성관계에 의해 전파되는 것도 있습니다.,Korean
+"""설사를 유발하는 특정 음식��나, 환경 요인이 있나요?""",Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+원래 앓고 계시던 병변이신가요?,Korean
+그런 건 아니고요. 어떤 약 드시는지 확인을 해야 해서요.,Korean
+흡연 여부는 엑스레이와는 관계없습니다.,Korean
+다른 위염과 비슷하게 식습관과 생활습관 관리하시고 지속적인 진료를 받으시면 됩니다.,Korean
+약은 잘 먹고 있어요. 혈당은 엉망이지만요.,Korean
+입원이나 수술받으신 적 있으면 말씀해 주세요.,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+최근에 수술 언제 받으셨나요?,Korean
+"네. 밤에 깨면 다시 잠들기 어려워요.
+",Korean
+이 약물은 정확한 용량이 들어가야 하기 때문에 기존 수액과 다른 혈관으로 투여해야 하고 기계를 사용하여 정확한 시간동안 정확한 용량이 들어가도록 조절할 것입니다.,Korean
+손목 보호대를 착용하시는 것도 좋은 예방법이 되실 수 있습니다.,Korean
+고혈압 진단 받은적 있나요?,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+앓고 계신 알레르기 증상이 있을까요?,Korean
+증상이 없는 사람에게서 옮았을 경우 어디에서 옮았는지 알 수 없습니다.,Korean
+결핵 때문에요. 입원 치료받았습니다.,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+문제없이 허리는 잘 지키고 있습니다.,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+조영제 검사가 아니면 씨티는 일반 엑스레이 촬영과 비슷해요 기계만 다르지.,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+예전에는 어떤 병을 앓으셨어요?,Korean
+몇 년 전에 미주 신경성 실신으로 응급실에 입원한 적이 있어요.,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+통증이 가까운 부위에서 나타나네요 경과를 지켜보는 것이 좋겠습니다.,Korean
+소독 후에 연고를 꼭 바르시고 위에 거즈로 덮어줘야 덧나지 않습니다.,Korean
+저위험 유형은 생식기 사마귀를 유발할 수 있습니다.,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+"아 저 왼쪽 손가락이 아프고 붓고 고름도 나오더라고요. 그래서 왔어요.
+",Korean
+"귀 표피 부분이 전체적으로 간지럽고 수포 증상이 있어요.
+",Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+아이 열이 오르게 되면 다른 검사 진행 여부는 그때 다시 말씀드릴게요.,Korean
+아까 간호사 선생님께 이야기했어요.,Korean
+성 기능 장애가 있으신가요?,Korean
+선천적으로 면역 체계가 상당히 약하대요.,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+변기에 앉으면 한참 있다가 소변이 나오나요?,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+광견병은 반려견이 사람을 물었을 때 감염시킬 수 있어요.,Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+통증이 멈추지 않나 봐요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+"원래 열두 시간쯤 잤는데 요새는 한두 시간 줄었어요.
+",Korean
+결핵 치료는 어디에서 받았나요?,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+스스로 열이 있다고 느껴지나요?,Korean
+가래 특징을 말씀해 주세요.,Korean
+처방받은 약인가요? 약국에서 사 드신 약인가요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+막대로 살짝만 스쳐도 통증이 느껴지나요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+크라운보다 얇은 두께의 도자기를 씌운 게 라미네이트입니다.,Korean
+이번 주에 구토를 얼마나 자주 하셨어요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+계단에서 떨어지셨지요. 검사는 곧 시작할 거예요.,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+아픈 곳이 더 있나요?,Korean
+무슨 일로 수술받았는지 아세요?,Korean
+종양성 병변으로 대장암으로 진행할 위험성이 있습니다.,Korean
+표준 일 차 치료는 항생제로 아목시실린 및 클라리쓰로마이신을 투약하며 이외 위산분비억제제 한 가지를 투약합니다.,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+간염 치료에 ��떤 약 처방받으셨어요?,Korean
+음주는 얼마나 자주 하시죠?,Korean
+현재 당뇨 앓고 계신 분이 있나요?,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+많이 아프셨다니 정밀 검사를 해 봐야 정확히 알겠네요.,Korean
+암 수술한 적 있으세요?,Korean
+"의식 잃을 정도로 치이진 않았어요.
+",Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+결핵 접종 하셨나요 ?,Korean
+일반적인 부작용으로는 속 쓰림 발열 두드러기나 간 기능 이상 등의 증상이 나타나기도 합니다.,Korean
+검사는 한 시간에서 두 시간 정도 소요됩니다.,Korean
+음주 빈도는 어느 정도인가요?,Korean
+네. 세 명 다 수술로 낳았어요.,Korean
+팔에 힘이 안 들어가서 들기가 어려워요.,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+"배는 아픈데 앉으면 똥은 또 안 나오고 그래요.
+",Korean
+현재 구토 증상이 있나요?,Korean
+네 모든 검사 완료됐습니다.,Korean
+수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+"가스 불에 손이 닿으면서 팔에 화상 입었어요.
+",Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+힘을 줘서 근육통이 생길 수 있습니다.,Korean
+"음 저희 아기가 비슷한 개월 수 아기들보다 키도 크고 덩치도 크거든요. 그래서 검사 한 번 받아볼까 하고 왔어요.
+",Korean
+하루에 한 번씩은 혈뇨 증상이 나타나나요?,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+"흡연을 하면 가정에 불화가 생기기 때문에 금연하고 있습니다.
+",Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+지금 진찰받기 전에 건강은 어떠셨나요?,Korean
+네 이젠 곧 통증이 없을 거예요.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+네. 허리디스크 수술 후 입원 치료 했습니다.,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+어느 쪽 어금니가 흔들거리시나요?,Korean
+보철 중에 틀니나 임플란트 브릿지라는 연결해서 하는 보철 중에 가짜치가 들어가 있는 것들을 말합니다.,Korean
+회복이 빠르면 이틀 만에 퇴원도 가능하세요.,Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+증세가 악화된 때가 언제인가요?,Korean
+지금 혹시 변비가 있나요?,Korean
+네. 항문이나 대장에 문제가 있을 수 있습니다.,Korean
+종양 치료받은 적 있으세요?,Korean
+독감 주사 같은 경우는 매년 일 회 맞는 게 좋아요.,Korean
+네. 입원까지 안 해도 되는군요.,Korean
+토할 것 같을 때 어떻게 하셨나요?,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+응급실에서 이루어지는 혈액검사와 치료 중에는 음압 격리실에 계실 예정입니다.,Korean
+숨을 쉬는 양상이 이상하지는 않았었나요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+숙면을 푹 취하기 어려우신가요?,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+"네. 흡연은 하고 음주는 안 해요.
+",Korean
+아이의 열을 떨어트리기 위해 뭔가로 닦는 것보다 일단 시원한 상태를 유지해 지켜보도록 하죠.,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+통증 때문에 일부러 소변을 안 보신 적이 있나요?,Korean
+금연 약 말고는 없어요.,Korean
+"애가 허리를 펴지 못할 정도로 배가 아프다고 하더라고요. 그래서 찾아왔어요.
+",Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+네 주사 때문에 복통은 곧 호전되실 것입니다.,Korean
+특정 음식에 알레르기가 있습니까?,Korean
+아프신 정도가 얼마나 되시나요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+가슴이 벌렁거리는 건 괜찮으신가요?,Korean
+"대략 하루에 일곱 시간 정도 자요.
+",Korean
+비뇨기과를 찾아보신 적은 있으신가요?,Korean
+약물 관련 쇼크는 없으셨나요?,Korean
+예방주사 맞은 날짜를 알려주실래요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+소변줄을 안 차시려면 시간당 소변량 체크가 끝나야 합니다.,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+병원에서 큰 수술을 받으셨나요?,Korean
+배액관은 배액량을 확인 후 제거할 것입니다.,Korean
+격리 필요 여부를 위해 일단 검사를 받으세요.,Korean
+"이번엔 두통이랑 속 울렁거림이 같이 온 것 같아요.
+",Korean
+후유증이 없을 순 없습니다.,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+갖고 계신 약 있나요?,Korean
+어떤 음식을 먹고부터 복부 팽만감을 느꼈나요?,Korean
+"점점 편두통이 심해지고 어지러워서 내원했습니다.
+",Korean
+마지막으로 주사 맞은 병원에 전화해서 문의해보세요.,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+빈혈 때문에 장시간 여행도 못 하고 있어요.,Korean
+평소에도 열이 자주 났었나요?,Korean
+체온이 떨어진 것 같나요?,Korean
+복부 팽만감이 있던 적 있나요?,Korean
+외래 진료 때 만나셨던 선생님을 말씀하시는 건가요?,Korean
+결핵 때문에 병원 다닌 적 있으신가요?,Korean
+소변을 볼 때 따가운가요?,Korean
+셀라인이라고 상처 부위를 씻어내기 위한 물입니다.,Korean
+다른 질병 치료 중인 것 있나요?,Korean
+네. 발열이 가장 큰 증상입니다.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+지금 아버지가 고혈압약 드시고 계세요.,Korean
+최근에 살이 많이 빠지시진 않았나요?,Korean
+국소마취 후 등 쪽에서 바늘을 찔러서 시행합니다.,Korean
+약마다 복용 방법이 다릅니다.,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+네 부작용이 심하면 측정이 불가할 수 있습니다.,Korean
+네 삼 개월 때 수술할 수 있으나 주로 육 개월 이후에 합니다.,Korean
+아픈 게 얼마 안 됐나요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+보청기 틀니 액세서리 외의 소지품 없으신가요?,Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+"네. 최근 들어 통 소변이 안 나와요.
+",Korean
+주로 하부 요로계인 방광 요도 전립선 등에 출혈이 있으면 선홍색으로 보이고 상부 요로계에 많은 양의 출혈이 있을 경우에는 붉은 색깔을 띨 수 있습니다.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+미리 검사하면 수술할 때 문제를 미리 예방할 수 있으니까요.,Korean
+음식을 보고 토한 적이 있나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+심장 박동이 느껴질 정도로 심장이 뛰나요?,Korean
+"목 안쪽은 그렇게 아프진 않아요.
+",Korean
+"머리도 지끈거리고 속도 울렁거립니다.
+",Korean
+"""설사를 유발하는 특정 음식이나, 환경 요인이 있나요?""",Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+하루에 담배는 몇 갑 피우세요?,Korean
+필수는 아니지만 약물에도 알레르기가 있을 수 있어서 검사하는 걸 권장하고 있습니다.,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+몸에 열나는 것 같나요?,Korean
+완치가 힘들지만 최대한 후유증이 남지 않도록 하겠습니다.,Korean
+단지 화상 입어서 흉이 진거 말고 몸 움직이기가 불편하시다거나 신체에 변화가 생겼나요?,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+독감 접종은 어디서 하셨나요?,Korean
+배가 아픈지 얼마나 되었는지 알 수 있을까요?,Korean
+따끔거림이 심하신가요 어떤 연관이 있는지는 자세한 검사가 필요할 것 같네요.,Korean
+입원 치료 혹은 수술받으신 적이 있으면 말씀해 주세요.,Korean
+누워 있는 상태에서 쟀을 땐 백십 센티미터였는데 서서 재면 다를까요?,Korean
+비수면 시 더 불편감을 느낄 수 있지만 수면 마취로 인한 위험성은 없습니다.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+약품 확인 후 바로 드릴게요.,Korean
+네. 환자분의 증상을 종합해 보았을 때 바이러스성 장염이 의심됩니다.,Korean
+"복부 통증 때문에 왔는데 충수염인 거 같대요.
+",Korean
+다른 방법을 사용했는데 잠이 안 올 경우 수면 보조제를 한번 사용해 보는 것도 추천해드립니다.,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+현재 손목터널 증후군이 얼마�� 진행되었는지에 따라 달라집니다.,Korean
+"소변볼 때 성기가 아파서요.
+",Korean
+드레싱은 매일 해야 하는 치료이고 이제 상처 회복을 위한 다른 치료가 들어갑니다.,Korean
+숨쉬기 불편하거나 어려운 점이 있으신가요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+통증이 있는 부위가 있으세요?,Korean
+신경계통 약 투약 중이죠.,Korean
+통증은 주로 언제 오나요?,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+"어깨에 외상도 좀 있는데 대충 집에서 치료했고 돌리는 게 아무래도 불편해요.
+",Korean
+인후통이 오면 어떻게 하세요?,Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+수술한 후에 후유증이 있나요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+철심은 요새는 안 박는 추세라고 하더라고요 그래서 무슨 수술을 하긴 했는데 철심은 안 박았을 거예요.,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+네 수치상으로는 정상 범위가 맞습니다.,Korean
+제가 볼 때는 뇌진탕 같진 않아요.,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+올해는 예방접종 안 할 생각이에요.,Korean
+허리 아픈 것 때문에 진통제 몇 알 먹은 것 말고는 없어요.,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+예를 들어 어떤 통증인가요?,Korean
+네. 비형간염 환자가 있어요.,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+"흡연은 안 하고 술 마신 지는 십 년 조금 넘었습니다.
+",Korean
+맥박이 빨리 뛰는 느낌 나나요?,Korean
+독감 주사 언제 맞았어요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+당뇨약을 꾸준히 먹어야 하는데 자꾸 까먹네요.,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+상해로 입원하신 적이 있나요?,Korean
+길지만 그 정도는 금식해줘야 돼요.,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+소화 불량이 자주 나타나나요?,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+동의서에 지금 사인을 하셔야 비급여 진통제를 바로 사용할 수 있습니다.,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+간염은 약물로 계속 치료하시나요?,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+거기 기록 안 나오나 보네요. 에이형 간염 주사 맞았어요.,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+수술이 필요한 정도는 아닙니다.,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+최근에 오한을 느낀 적이 있나요?,Korean
+과식은 비만과 더불어 여러 영향을 미쳐요.,Korean
+네 오늘 포함해서 최근까지 드신 약 모두 말씀해주세요.,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+유전적인 발기 부전으로 치료받고 있는 가족이 있나요?,Korean
+소화가 잘 안 되고 속이 답답하신가요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+야간 근무가 필수인 직장이시면 주기적으로 건강 검진을 받으세요.,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+두통이 가장 심할 때가 언제인가요?,Korean
+"생선 뼈가 목에 걸려서요.
+",Korean
+아니요. 치료 약이 적합한지 검사하는 것일 뿐입니다.,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+기저에 위장관 질환이 있다면 과식으로 통증이 발생할 수 있습니다.,Korean
+어떤 부위 검사를 받고 싶으세요?,Korean
+독감 주사랑 간염 예방주사 두 종류 맞았어요.,Korean
+붓기 있는 곳을 알려 주시겠어요?,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+식사하실 때 입맛이 없으신가요?,Korean
+아이가 바이러스나 세균감염에 걸리지 않으면 더 빨리 좋아질 수 있습니다.,Korean
+네. 저번 주에 보라카이 갔다 왔고요. 가기 전에 접종하고 갔습니다.,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+네 우선 대기실에서 약품명 검색하신 후 알게 되신다면 간호사에게 알려주시기 바랍니다.,Korean
+피로가 회복이 안 되시나요?,Korean
+통증이 있는 부위가 어디죠?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+"아기가 자석을 삼킨 것 같아요.
+",Korean
+약 알레르기 있는 거 있으실까요?,Korean
+입으��� 피가 나온 적이 있으신가요?,Korean
+철심 박는 수술 했는데 몇 번 뼈인지는 몰라요.,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+"아니요. 수면제만 먹으면 몽롱한 느낌이 하루가 가서 안 먹어요.
+",Korean
+수술하시는 부위 주변으로 표시합니다.,Korean
+사랑니 제외 다른 치아를 뽑은 경우만 말씀해 주시면 됩니다.,Korean
+네 소변줄 삽입을 해야 검사할 수 있습니다.,Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+배가 빵빵한 느낌은 없으신가요?,Korean
+며칠 전에 감기 앓았던 것 말곤 없어요. 그것도 거의 다 나았고요.,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+가족 구성원 중에 당뇨인 사람이 있나요?,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+"요새 속이 너무 안 좋아서 왔어요.
+",Korean
+정확히는 알 수 없으나 육안상으로는 새로 발생한 욕창으로 보입니다.,Korean
+배에 가스가 차서 힘드신가요?,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+코로나 때문에 물어보는 겁니다.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+"검진 결과상 간 수치가 높게 나왔는데 지금 빨리 다른 대형병원 가래서 왔어요.
+",Korean
+당뇨약 먹고도 효과가 없거나 하지는 않나요?,Korean
+그래도 내시경으로 돌이 잘 제거되어야 퇴원하실 수 있으시잖아요. 조금만 힘을 내세요.,Korean
+금연 약 말고는 없어요.,Korean
+"아까 쟀을 때는 삼십칠 도였어요. 한 오 일 정도요.
+",Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+혹시 기력이 떨어졌다고 느끼세요?,Korean
+한 사오 일 더 입원했다 퇴근해도 될까요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+간염 치료 기간 알 수 있을까요?,Korean
+수술실 세팅이 빨리 되면요.,Korean
+네 수혈받아보신 적 있으신가요?,Korean
+어떤 주사인지 알 수 있나요?,Korean
+가슴 두근거리는 정도는 어떤가요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+네 그것 또한 민간요법입니다.,Korean
+"차 타고 가고 있었는데 앞에 새 때문에 급정거했는데 허리가 너무 아프네요.
+",Korean
+"멸치 먹으면 뼈가 튼튼해진다고 들어서 하루에 한 번씩은 반드시 먹죠.
+",Korean
+최근에 체중에 변화가 있었나요?,Korean
+"얼마 전에 일하다가 오른쪽 어깨에 담이 온 것처럼 아팠는데 계속 그러네요.
+",Korean
+요즘 기력이 많이 빠진 거 같나요?,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+병원 입원 경험이 있으신가요?,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+심하고 급성적 알레르기 반응의 경우 기도 수축에 의한 호흡 곤란이 오기도 합니다.,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+"방광에 출혈이 있다고 대충 들었어요.
+",Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+한의원에서 처방받아서 드시는 건가요?,Korean
+만성 위염의 한 종류로 만성 위염은 흔하지만 그 중 비후성 위염이 흔한 종류는 아닙니다.,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+네 혈액형은 우측 하단에 작성하시면 돼요.,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+진단 받은 다른 질병이 있나요?,Korean
+네 지금 없으시지만 나중에는 생길 수 있으니 꼭 한번 검사받아 보세요.,Korean
+통증이 한번 오기 시작하면 얼마 동안 지속되나요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+치질 진단받으신 적 있으신가요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+네 수술 스케쥴에 문제가 생깁니다.,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+통증 발현 빈도가 어떻게 되세요?,Korean
+통증이 한 번씩 오나요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+대변에 피가 같이 나옵니까?,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+음주량 좀 알려 줘요.,Korean
+가족 중에 당뇨 치료 이력이 있으면 말해 주세요.,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+서초역 앞에 있는 이비인후과인데 이름은 잘 모르겠어요.,Korean
+상대적으로 혈압이 높은 편이세요?,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+염증성 장 질환의 경우 대장 출혈과 배변 장애가 함께 일어날 수도 있습니다.,Korean
+흡연은 입원 중에는 못 하시게 돼 있어요.,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+최근 들어 살이 갑자기 찐다거나 하진 않나요?,Korean
+언제부터 결핵으로 병원 다니셨죠?,Korean
+사출성 구토의 원인은 대부분 빠르게 회복되지 않는 경우가 많습니다.,Korean
+"기흉 때문에 금연을 했었어요.
+",Korean
+"어떻게 하다 보니 입원을 하게 되었어요.
+",Korean
+"다리가 조금 찢어져서 피가 계속 나요. 꿰매야 할 것 같아요.
+",Korean
+통증 원인 확인을 위해 추가적인 검사가 필요합니다.,Korean
+현기증 정도를 말씀해 주세요.,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+네 체중 변화가 원래 생깁니다.,Korean
+아니요. 뭐 검사받아야 되나요?,Korean
+오한 증상 나타난지 며칠 되었죠?,Korean
+"식사를 잘 못하시니까 조금씩 살이 빠지시는 것 같아요. 식욕은 원체 없으세요.
+",Korean
+소변볼 때 불편감이 있나요?,Korean
+지금 환자분이 가장 불편한 데를 짚어주시겠어요?,Korean
+발열 증상은 언제 처음이셨죠?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+어린데도 불구하고 편두통이 굉장히 심해요.,Korean
+드셔도 되지만 익히지 않은 해산물은 몸에 해로울 수 있습니다.,Korean
+하루에 얼마나 담배 피우세요?,Korean
+이전에 관장약 드시고 부작용 있으셨나요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+진료받아보시고 증상에 따라 가능할 수도 있습니다.,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+"지금 갑자기 애가 기절을 해서요.
+",Korean
+지금 받는 게 처음 받는 수술이에요.,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+알레르기 증상이 음식이나 약 말고도 있었던 적 있어요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+수술 동의서 받을 때 자세히 설명드리겠습니다.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+약물로 고혈압 치료 중이신 건가요?,Korean
+약 용량이 많을 경우 오래 지속될 수도 있습니다.,Korean
+입원 환자 관리를 위한 사항입니다. 그 이외 흉터가 있는지 확인 협조 부탁드립니다.,Korean
+통증이 사라지지 않고 계속 유지되나요?,Korean
+네. 다 들었습니다. 동의서도 썼구요.,Korean
+혈압 맥박 호흡 체온 모두 기계를 이용해서 이루어지게 됩니다.,Korean
+검사 다 하려면 얼마나 걸립니까?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+그럼 우선 아픈 부위 사진 먼저 찍고 오세요.,Korean
+식후 소화가 잘 안되어 일상생활이 불편하신가요?,Korean
+네. 그래서 비염이 생겼어요.,Korean
+환자분의 치료 계획을 진행하기 위해서입니다.,Korean
+통증이 언제부터 시작되었는지 알려주세요.,Korean
+씨티 찍어서 환자분의 내부 상태를 보는 게 좋겠어요.,Korean
+그 약을 드시는 이유가 뭔지 여쭤봐도 될까요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+가벼운 수술이라면 어떤 것 말씀이세요?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+간염은 언제 진단 받으셨나요?,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+알레르기 진단을 언제 받았나요?,Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+통증이 자주 생기는 편인가요?,Korean
+가족 중에 고혈압이 있는 분이 계신가요?,Korean
+매일 수차례 통원 치료하시겠어요?,Korean
+의사 상담 후 처방받은 대로 진통제를 복용하시는 게 좋아요.,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+환자분은 객혈 때문에 응급실로 내원하셨는데 객혈은 결핵 의심 증상이므로 음압격리실로 입실하셔서 검사와 치료를 받��실 예정입니다.,Korean
+암 치료 기간이 어떻게 되나요?,Korean
+통증이 있다 없다 하나요?,Korean
+"저 밀가루 알러지 있어요.
+",Korean
+동의서는 검사를 통해 발생할 수 있는 부작용과 검사의 이득을 제시하여 검사 진행 여부를 선택할 수 있도록 도와줍니다.,Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+예방 접종은 맞은 지는 꽤 됐고 해외는 이번 달에 다녀왔어요.,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+네 알겠습니다. 주사 놔드릴게요.,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+"소변 때문에 화장실도 자주 가는데 갔다 오면 덜 싼 거처럼 찝찝해요.
+",Korean
+몸이 부을 때가 있나요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+"어깨가 아파서 응급실 왔는데 탈골이라고 해서요.
+",Korean
+초반에는 약물 치료부터 해야 합니다.,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+협심증의 경우 재발이 흔하고 진행할 수 있기 때문에 정밀검사가 필요하고 지속적인 관리가 필요합니다.,Korean
+현재 복용하는 진통제가 있나요?,Korean
+통증이 느껴지시는 부위가 어디인가요?,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+다른 방향 보고 계시면 주사 최대한 천천히 놓도록 노력해 볼게요.,Korean
+정상적인 소변에는 요산과 암모니아 성분이 들어 있기 때문에 어느 정도 냄새가 나는 것은 정상입니다.,Korean
+정상 조직에 비해 위암 발생 위험성이 있어서 향후 지속적인 검사가 필요합니다.,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+고혈압 치료하려고 약 드시나요?,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+혈압약이랑 당뇨약을 드셨던 거 같아요.,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+산소마스크를 쓰고 있으면 제가 자가 호흡을 안 해도 되는 거예요?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+구토를 많이 하지는 않으시나요?,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+복통이 나타난 건 언제가 처음이죠?,Korean
+소변줄을 삽입하여 시간당 소변량을 정확히 측정하는 것이 필요합니다.,Korean
+새벽 세 시 타이레놀 먹였어요.,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+수술 일정이 나오면 입원 후 수술하시고 회복 후 퇴원하시게 될 겁니다.,Korean
+사고로 상해를 입은적이 있나요?,Korean
+아직은 필요한 검사들이 남아 정확한 진단이 어렵습니다.,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+이십 일에 소풍 갔다가 감기에 옮아서 왔더라고요.,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+네. 문진표 이외에 입원생활에 필요한 정보를 수집하기 위한 절차입니다.,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안됩니다.,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+네 중복되는 약물이 있을 수도 있어서요.,Korean
+아니요 최근에 생긴 흉터만 보여주시면 될 것 같습니다.,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+네. 외래 처방받기 전에는 감기인 줄 알았거든요.,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+검사상 여섯 시간에서 여덟 시간 정도는 공복을 하고 받을 수 있어서 여쭤봤어요.,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+"대학 들어가면서부터 피웠는데 올해 금연을 목표로 하고 있어서 지금 안 피운 지 몇 개월 됐어요.
+",Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+"구토는 안 하는데 속이 계속 매슥거려요.
+",Korean
+진짜 어릴 때 수술한 것도 말씀드려야 하나요.,Korean
+아직 복부에 붓기가 남아있나 봅니다.,Korean
+"걸을 때 내 몸 어딘가 고장 난 듯한 느낌이 들어요.
+",Korean
+비염이 심해져서 업체 찾아서 맡기고 있어요.,Korean
+"방광 쪽으로 출혈이 있다고 들었던 것 같은데요.
+",Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+"누워만 있어도 잘 붓더라고요.
+",Korean
+암을 진��� 받으신 적 있나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+"소변 색이 녹빛 이에요.
+",Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+병원 직원은 환자 개인정보를 열람할 수가 없습니다.,Korean
+통증은 주로 언제 오나요?,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+그렇죠. 요양원으로 바로 가죠.,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+성생활에 어려운 점이 있으세요?,Korean
+가슴이 찌를 듯이 아픈가요?,Korean
+정확한 진단을 위해 몇 가지 여쭤봐야 합니다.,Korean
+제일 덜 오는 통증 부위가 어디예요?,Korean
+과거에는 엑스레이를 찍었으나 씨티가 더 정확한 검사입니다.,Korean
+입속에 있는 모든 기관들을 구조물이라 칭합니다.,Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+네. 연고는 끝까지 다 바르세요.,Korean
+"혈당 측정 해보니 너무 높아서요.
+",Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+아직은 회복 상태이니 조금만 더 쉬시면 될 겁니다.,Korean
+네 육안으로 보는 것보다 엑스레이를 찍고 정확히 확인하는 게 좋습니다.,Korean
+네 혹시 부작용이 있으신 적 있나요?,Korean
+바코드 인식으로 병동 출입 처음 해봐요.,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+향정신성 의약품은 취급이 제한됩니다.,Korean
+종종 구토 증상이 있으세요?,Korean
+삼투성 하제의 경우 내성이 적고 장기적 사용이 가능합니다.,Korean
+"탄수화물을 최소로 해 주시겠어요?
+",Korean
+드레싱 후에 몇 가지 치료가 남아있습니다.,Korean
+네 수술한 지는 얼마나 됐나요?,Korean
+네. 사생활 보호를 요구하시나요? 사생활 보호를 신청하시면 입원해 계신 병실 호수가 비밀로 되고 다른 입원 정보들도 비밀로 됩니다.,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+집안에 고혈압 환자분 계세요?,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+묽은 변을 보시지는 않나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+"뭘 먹으면 속이 안 좋아서 입맛이 없어요.
+",Korean
+생식기의 인유두종 바이러스 감염은 대부분 성접촉을 통하여 전파됩니다.,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+그 민간요법으로 상처 부위가 악화되었습니다.,Korean
+휠체어에 앉아서 기다리시면 됩니다.,Korean
+통증 텀이 얼마나 되나요?,Korean
+"왼쪽 귀가 오른쪽 귀보다 심해요.
+",Korean
+아니요. 알레르기 비염 때문에 털 있는 동물을 키울 수가 없어요.,Korean
+담배 언제 처음 피웠어요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+황달 증상이 심해지면 얼굴 전신에서 관찰됩니다.,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+네. 엑스레이상으로 결석이 보이진 않아서 씨티와 요로조영술 검사를 더 진행해 볼게요.,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+콜라 같은 색의 소변인가요?,Korean
+"전에 병원에서는 조직검사가 힘들다고 해서요. 조직검사를 받아야 해서 왔습니다.
+",Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+어떤 종류의 진통제에 알레르기가 있으신가요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+통증과 관련해서 드시고 있는 약은 어떤 게 있죠?,Korean
+숙면을 취하기 어렵진 않나요?,Korean
+검사 결과 나오려면 한두 시간은 기다리셔야 합니다.,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+하루에 두 갑은 피우세요?,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+낫는 게 최우선이니까 최대한 효과적인 치료만 신경 써주시면 됩니다.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+장기기증 서약은 어디서 할 수 있나요?,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+배 아플 때 화장실 가도 대변이 잘 안 나오시나요?,Korean
+네 약품명도 알면 알려주세요.,Korean
+담배를 많이 피우기 시작한 게 언제부터인가요?,Korean
+"일에 대한 강박감이 심해지고 일 안 하고 있을 때도 불안한 증세가 점점 커져 왔어요.
+",Korean
+음주 빈도는 얼마나 되시나요?,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+통증이 한 번씩 오나요?,Korean
+피검사와 수액 보충 먼저 하면서 다시 설명드릴게요.,Korean
+대변을 못 본 지 오래되셨나요?,Korean
+"안녕하세요. 저 요즘에 속도 안 좋고 토도 하루에 두 번 이상하고 헛구역질도 계속해서 왔어요.
+",Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+기존에 질환이나 질병이 있으셨나요?,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+약물 처방으로 치료를 시작하면 금방 나을 수 있을겁니다.,Korean
+현재 아픈 부분이 있을까요?,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+고혈압 관련해서 어떤 약을 드시고 계신가요?,Korean
+정말 조금 부어올랐네요 통증이 있으신가요?,Korean
+"군대에 있을 때부터 피웠어요.
+",Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+심장이 터질 것 같은 느낌이 드시나요?,Korean
+응급 수술할 정도인지 검사를 몇 가지 진행하겠습니다.,Korean
+간염 때문에 병원에서 치료받고 계세요?,Korean
+설명 다 들었습니다. 주사 좀 빨리 놔주세요.,Korean
+"변비약 먹은 지 꽤 됐어요.
+",Korean
+다리가 안 좋아서 운동은 못 해요.,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+아닙니다. 약에 의한 효과를 제거하기 위해 추적 검사는 치료 종료 사 주 후에 시행합니다.,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+진료시간 중으로 말씀해주실 수 있으신가요?,Korean
+가래 상태가 많이 심한가요?,Korean
+환자 팔찌 채워드리겠습니다. 약물 투약 혹은 간호 처치가 필요한 때에 환자 확인을 하기 위함이니 제거하지 마시고 차고 계시길 바랍니다.,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+지금 아픈 곳 말하세요.,Korean
+"기저귀 갈아주려고 보니까 아기 사타구니 쪽에 볼록한 게 튀어나와 있어서요.
+",Korean
+네. 혹시 특이 혈액형에 포함되시나요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+"배탈이 난 것 같아요.
+",Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+피 소변을 보시진 않나요?,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+전에는 내시경 도중에 깬 적이 없거든요.,Korean
+진통제 없으면 밤에 잠을 못 자니 꼬박꼬박 복용했어요.,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+걱정이 되신다면 시티 촬영해 보세요.,Korean
+혹시 기력이 떨어졌다고 느끼세요?,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+주로 어디가 가장 아프세요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+피부에 발진 물집 흉터 상처 반점 욕창이 있나요?,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+다른 심장 관련 질환은 없나요?,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+일주일 내내 통증이 있으셨어요?,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+환자 혼자서는 이동이 불가한 거 맞죠?,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+통증의 원인인 질환은 치료를 통해 개선될 겁니다.,Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+네 언제부터 피임약을 드셨나요?,Korean
+피부에 두드러기 올라와서 처치 받았어요.,Korean
+몸 전체에 힘이 없나요?,Korean
+"멸치 먹으면 뼈가 튼튼해진다고 들어서 하루에 한 번씩은 반드시 먹죠.
+",Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+흡연이나 음주나 일상적으로 접하는 것이라 익숙하지만 건강에 큰 영향을 끼치죠.,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+"방광 쪽에 출혈이 있다고 들었던 것 같네요.
+",Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+"아니요. 저는 담배를 혐오하는 사람입니다.
+",Korean
+"네. 열 좀 나는 것 빼고는 문제없었어요.
+",Korean
+"하루 흡연량��� 반 갑 정도 됩니다.
+",Korean
+"변 색깔이 푸르딩딩한 게 이상해요.
+",Korean
+약 먹고 물리치료를 꾸준히 하면 회복이 될 겁니다.,Korean
+아프기 시작한 지 좀 됐나요?,Korean
+가슴 통증이 있진 않으신가요?,Korean
+아니요. 음성 판정이 나왔네요.,Korean
+영양수액 말고 병 때문에 꾸준히 맞는 주사나 복용 중인 약 있으세요?,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+이 병원 처음 왔습니다.,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+음식을 먹으면 토를 하나요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+한 달 동안 체중이 얼마나 변했나요?,Korean
+어쩔 수 없는 경우 손 소독과 마스크 착용이 필수입니다.,Korean
+병원 입원 경험이 있으신가요?,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+진단서 더 뽑으려면 만 원의 추가 비용이 듭니다.,Korean
+다른 아이는 자연 분만이었고요?,Korean
+체온이 몇 도인지 아세요?,Korean
+예약을 나중에 취소할 수 있지만 되도록 예약 때 내원해주세요.,Korean
+아픈 부위를 가리켜 보세요.,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+의심되는 부위를 손가락으로 짚어 보시겠어요?,Korean
+"이 부분 드레싱 해주실 수 있으세요?
+",Korean
+하루에 몇 개비나 태우세요?,Korean
+진통제 먹으면 어디서 쥐어터지고 들어온 것처럼 얼굴이 부어요.,Korean
+기침할 때 증상이 어떤가요?,Korean
+"물에 빠졌다 겨우 살아났는데 물만 보면 가슴이 심하게 뛰고 숨쉬기도 불편하네요.
+",Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+올해 독감 예방 주사는 어떻게 하셨어요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+술 먹고 넘어져 손목 수술했어요.,Korean
+예방 접종과 관련된 부작용이 있으셨는지 여부를 기록해 둬야 해서요.,Korean
+그럼요. 맥박 이상 없습니다.,Korean
+배가 불러 불편하지는 않으세요?,Korean
+"가슴이 답답하고 숨이 잘 안 쉬어져요.
+",Korean
+여기서 접종하신 거면 내역 확인해 드릴게요.,Korean
+약은 어떤 약을 드시나요?,Korean
+수액 양을 줄여 드릴게요. 나아지는지 확인해서 말씀해 주시겠어요?,Korean
+혈압이 조금 높은 편인데 혹시 평소에 혈압이 높다는 얘기를 들으신 적이 있나요?,Korean
+검사 결과는 그렇게 나왔네요.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+잘 때도 기침을 하나요?,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+그때 증상이 있었던 기간이 어떻게 되나요?,Korean
+아이 열이 오르게 되면 다른 검사 진행 여부는 그때 다시 말씀드릴게요.,Korean
+힘드셨던 점 이해합니다. 동의서는 여기 보이는 전자동의서 형태로 작성할 예정입니다.,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+하루에 몇 개 피우시죠?,Korean
+통증이 어느 정도로 심하죠?,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+깊은 호흡이 잘 안되시나요?,Korean
+어디가 부은 느낌 있나요?,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+"오늘 내시경 하기로 예약했었는데요.
+",Korean
+결핵 문제는 그동안 없었고요?,Korean
+운동하고 나면 부기가 빠져 있나요?,Korean
+무엇 때문에 병원에 왔나요?,Korean
+손목 터널을 넓혀주는 것이지만 완전 치료는 불가능한 방법입니다.,Korean
+오한이 있어서 춥고 떨리나요?,Korean
+"목에 걸린 치킨 뼈 때문에 왔어요.
+",Korean
+속이 메슥거릴 때가 많나요?,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+감기 예방 주사는 맞았나요?,Korean
+네 재발이 가능한 질환이기 때문에 꾸준한 관리가 필요합니다.,Korean
+"손가락이 저리는데 제가 목 디스크가 있거든요. 아무래도 목디스크 때문인 것 같아요.
+",Korean
+병원 입원 경험이 있으신가요?,Korean
+국소마취면 국소부위만 마취 하신 건가요?,Korean
+친구가 의사로 있는 연세대학교 세브란스 병원에 방문했었습니다.,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+특이 혈액형인지 확인해본 적 없어요.,Korean
+하루 담배 얼마나 피우세요?,Korean
+온몸에 열이 계속 나는지 알려주세���.,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+가족 중 한 명이 요로결석으로 수술했어요.,Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+가족 중에 당뇨이신 분 있어요?,Korean
+피를 토한 적이 또 있나요?,Korean
+고혈압 기간이 어떻게 되세요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+통증이 아직도 안 나았나요?,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+물만 먹어도 설사가 나오나요?,Korean
+어떤 마취제였는지 기억하고 계세요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+불편하시겠지만 환자 확인을 위한 절차이니 양해 부탁 드립니다.,Korean
+배도 같이 아프신 거죠?,Korean
+잠을 잘 자지 못하시나요?,Korean
+혹시 심장 쪽으로 시술을 받거나 페이스메이커 같은 보조 장비를 착용하고 계신가요?,Korean
+수술 전 환자나 의사가 알아야 할 사항을 꼼꼼히 읽어볼 수 있도록 해주세요.,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+통증이 아예 안 느껴질 수는 없습니다.,Korean
+고혈압약과 관련된 약을 전부 알려주세요.,Korean
+고혈압 관련해서 과거에 이야기 들으신 게 있나요?,Korean
+네. 그런데 옆으로 눕혀서 팔이나 옆구리 라인으로도 발병될 가능성도 있을까요?,Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+죽을 만큼 아프시다고요? 상태 한번 살펴보도록 할게요.,Korean
+우리 집 가족 내력으로 신장이 안 좋아요.,Korean
+약 가져오는 건 언제쯤 가능할까요?,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+통증 부위가 머리 쪽 맞나요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+현재 건강상태에서 항생제를 세게 투약하면 면역체계가 무너집니다.,Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+구역질이 날 때가 있나요?,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+간혹 과거 입원치료 방법에 따라 치료방식이 변경되는 경우도 있습니다.,Korean
+지금 어디가 아픈 건가요?,Korean
+네 건강검진 때 질병이 있다고 나왔나요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+손 소독 철저히 해야죠.,Korean
+비용은 의료 행위에 따라 달라지므로 계획이 결정된 후 다시 상의드리겠습니다.,Korean
+혹시 어떻게 하다가 다치셨나요?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+집 근처 병원에서 소독하시는 게 편하실 거예요.,Korean
+"네. 약간 변비가 있어서 보는데 힘들더라고요.
+",Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+건강검진 받으셨을 때와 지금 상태가 달라졌을 수도 있어서 다시 해야 합니다.,Korean
+"담배 한 대 피웠는데.
+",Korean
+네. 혈압이 살짝 높대요.,Korean
+내시경 일정은 밖에서 잠시 기다리시면 간호사가 안내 드릴거에요.,Korean
+수액을 좀 더 맞으신 뒤 검사 진행할 예정입니다.,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+부종이 있는 곳이 있나요?,Korean
+"발에 피가 많이 나서요. 정확히 어디에 상처 났는지를 모르겠어요.
+",Korean
+얼마나 아픈지 표현해 주세요.,Korean
+지금 받으신 환자복과 침대 위에 놓은 물품이 다입니다.,Korean
+혹시 다른 병원에서 씨티 찍고 오셨나요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+토를 한 적이 있나요?,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+간염 보균자로 진단받은건 언제인가요?,Korean
+유전적 질환은 다른 사람들보다 유전인자를 더 갖고 있어 질환 발병률이 높습니다.,Korean
+흡연을 시작하게 된 게 언제부터일까요?,Korean
+계절에 따른 영향으로 입술이 건조할 수도 있습니다.,Korean
+아예 병원 근처에 가본 적도 없습니다.,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+가슴에 통증이 있으면 말씀해 주세요.,Korean
+약효가 어떤지 봐야 돼서요.,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+잇몸치료 한 적 있어요.,Korean
+속이 많이 안 좋으신가요?,Korean
+"코치님이 정밀검사를 받아보라고 해서요.
+",Korean
+"애가 처음에 쟀을 땐 삼십팔 점오 도였고요. 그때 약을 먹여서 열이 좀 떨어졌었는데 완전히 떨어지진 않더라고요.
+",Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+사고당해서 입원한 적 있으세요?,Korean
+"아이가 소변보는 게 어렵다고 해서요.
+",Korean
+보통 내시경은 일 년에서 삼 년 정도 주기를 잡습니다.,Korean
+"혈액검사에서 지방 수치가 높게 나온 건 왜 그러는 거예요?
+",Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+구토가 일어난 것은 언제부터인가요?,Korean
+호흡하기 힘들 때가 많나요?,Korean
+아. 군대에서 치질 수술했습니다.,Korean
+"원래 변비가 조금 있어요.
+",Korean
+담배를 얼마나 오래 피셨나요?,Korean
+"설사 때문에요. 애가 설사를 해요.
+",Korean
+제일 덜 오는 통증 부위가 어디예요?,Korean
+통증이 어떤지 설명해 보실래요?,Korean
+"""가볍게 접촉사고가 났지만, 혹시 몰라서 검사받으려고 다른 병원에 방문한 적이 있어요.""",Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+네. 다녀온 후 검사 결과 모두 정상입니다.,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+"모유를 수유하는데 노란 물을 자주 토해요.
+",Korean
+아무래도 특이 혈액형이다 보니 혈액이 부족할 수 있습니다.,Korean
+담배에 든 니코틴 성분이 혈관을 수축시킵니다.,Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+죽을 만큼 아프시다고요? 상태 한번 살펴보도록 할게요.,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+"당뇨병 약물치료를 몇 년째 받고 있는데 저혈당이 오면 식은땀이 날 때가 있습니다.
+",Korean
+몇 년 전에 중풍이 와서 하반신 불수고 그래서 요양원에 계세요.,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+음주 빈도가 주 몇 회 정도예요?,Korean
+이석증 같으니 약 먹고 지켜보자고 했어요.,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+애완견 접종 유무 상태를 알기 위해 여쭤보는 겁니다.,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+"자고 일어났는데 머리가 아프고요 조금 쌀쌀한 기운이 느껴져서요 감기약 받으러 왔습니다.
+",Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+음식이나 약을 잘못 드신 경우 증상이 발병할 수도 있습니다.,Korean
+하루 종일 무력한 느낌인가요?,Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+대략적으로 질병에 대해 알고 계신지 확인 차 여쭤본거고 검사결과는 이제부터 설명드릴게요.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+메밀 들어간 거에 알레르기 있어요.,Korean
+검사를 해봐야 할 것 같아서 조금만 참아주세요.,Korean
+통증이 얼마나 자주 오나요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+남성 호르몬제를 좀 먹어요. 제가.,Korean
+변이 잘 안 나오나요?,Korean
+통증 있는 부위를 말해 보세요.,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+고혈변 오육 년 이월 십이 일.,Korean
+배뇨 활동이 원활하지 않나요?,Korean
+기존에 옷에 쓸려서 아토피 증상이 유발된 적이 있으신가요?,Korean
+약 먹은 지는 오 개월 째고 지금 없어요.,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+다른 위염과 비슷하게 식습관과 생활습관 관리하시고 지속적인 진료를 받으시면 됩니다.,Korean
+약 복용 방법을 제 아들한테 보내주시겠어요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+그렇죠 입원하면 집에 있는 거랑은 다르죠.,Korean
+보통 현기증을 자주 느끼나요?,Korean
+복통도 함께 있다면 원인을 알기 위해 검사를 더 해 보아야 할 것 같습니다.,Korean
+혈중 지방 수치에 영향을 미치는 식이요법의 영향이 크며 비만 운동량 부족이 혈중 지방 수치를 올릴 수 있습니다.,Korean
+"속이 아주 쓰리고 불편해요.
+",Korean
+초기에는 눈의 흰자 부분에서 잘 관찰됩니다.,Korean
+금식 기간에 대해서는 정확한 답변이 불가합니다.,Korean
+검사 결과 심근경색은 아니네요.,Korean
+"군대에서 삽질하다가 갑자기 우측 어깨에서 톡 소리가 나더니 어깨가 아파져서 ��게 되었습니다.
+",Korean
+"안녕하세요. 감기몸살 걸린 것 같아요.
+",Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+금속이 있으면 씨티 화질에 영향을 줘서 그래요.,Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+아니요. 치료하면 백 퍼센트 완치가 됩니다.,Korean
+애가 자꾸 우니까 최대한 더 빠르게 입원실 예약 좀 부탁드립니다.,Korean
+토할 것 같을 때 어떻게 하셨나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+네 뜸이나 부항 뜨신 적 있으신가요?,Korean
+고환이 복막을 통과해 음낭의 위치로 내려오면 복막이 닫혀야 하는데 이 것이 닫히지 않으면 이를 통해 탈장이 됩니다.,Korean
+심장이 빨리 뛰는 느낌이 있나요?,Korean
+어느 부위에 통증이 있어요?,Korean
+배가 부글거리는 경우가 있나요?,Korean
+통증 있는 부분이 어디예요?,Korean
+목에 이물감이 있어서 그럴 수 있습니다.,Korean
+면역력은 치료와 밀접한 관련이 있습니다.,Korean
+입원 중에는 빠른 회복을 위해 금연하는 것을 권장 드리고 있습니다.,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+목에 가래가 끼신 거 같나요?,Korean
+피부를 자세히 볼 수 있게 제 쪽으로 좀 더 가까이 와주세요.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+종양이 있어서 추적 관찰하고 있어요.,Korean
+복용 중인 약은 가지고 오셔서 저희에게 꼭 보여주셔야 합니다.,Korean
+어떤 약 처방 받으셨어요?,Korean
+간염과 관련된 약물 드시는 것 있나요?,Korean
+알고 계신 혈액형이랑 일치합니다.,Korean
+"임신 중인데 지나가던 사람이 제 배를 팔로 치고 갔는데 그 후로 통증이 느껴져 왔습니다.
+",Korean
+최근에 오한이 있던 적이 있나요?,Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+하반신이랑 수면 마취 이렇게 했던 것 같아요.,Korean
+아픈 게 사라지지 않나요?,Korean
+얼마나 아픈지 간단하게 설명 좀 해주시겠어요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+잘 때 어려움이 있으신가요?,Korean
+오늘은 안 드셨어도 평소 드시던 약이면 말씀해주십시오.,Korean
+결핵 예방접종 이력이 있나요?,Korean
+금연 기간은 빼셔도 됩니다.,Korean
+네. 현재 질병과 관계없이 모든 입원 치료 및 수술 경험 알려주세요.,Korean
+멍이 크게 들은 걸 보니 연관이 있어 보이네요.,Korean
+두통이 얼마나 자주 느껴져요?,Korean
+종종 전조증상이 있기도 해요.,Korean
+환자분이 수술하시는 이유는 둔위 때문입니다.,Korean
+혈이 섞인 소변을 보시나요?,Korean
+수술 중 과다출혈의 경우 수혈을 해야 할 수도 있습니다.,Korean
+하루 종일 무력한 느낌인가요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+목으로 피가 조금 올라오나요?,Korean
+"아프기만 아프고 소변이 잘 안 나와서 걱정이에요.
+",Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+숨이 찬 증상은 없나요?,Korean
+하루 동안 몇 갑을 피시나요?,Korean
+"네. 다른 건 괜찮고 소변이 잘 안 나와서 고역입니다.
+",Korean
+가래에 피가 섞여 있나요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+그 각도가 산소 공급에 가장 좋습니다.,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+"아이가 발달 속도가 느린 거 같아서요.
+",Korean
+다친 적은 없고 삐끗해서 한의원에서 침 맞은 적은 있어요.,Korean
+종양 확인된 적 있으신가요?,Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+"담배 자체를 너무 싫어해요.
+",Korean
+그때부터 계속 알레르기를 갖고 계신 거죠?,Korean
+흡연량이 정확하지 않아도 대략 알려주세요.,Korean
+멸균기 처리를 미리 한 붕대로 균의 감염을 막을 수 있습니다.,Korean
+"정밀검사를 받아보래서 엠알아이 하려고요.
+",Korean
+제 입원이나 병명을 절대 노출시키고 싶지 않아서요.,Korean
+검사 받고 오시면 최대한 빨리 진료 봐 드릴 테니 검사 먼저 받고 오세요.,Korean
+가끔 고기가 식중독 원인이 될 수 있습니다.,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+섬유질이 많이 포함된 잡곡 야채 등을 섭취하시는 것이 도움이 됩니다.,Korean
+두통약보다는 띵한 느낌이 사라지지 않으면 정밀 검사가 필요합니다.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+네. 지금 누른 곳도 아픈가요?,Korean
+조금 더 치료하고 퇴원하고 싶어요.,Korean
+때때로 먹는 약도 포함해서 알려주세요.,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+입원해 계시는 동안 변화 사항이 있는지 확인하기 위해서입니다.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+"방광에 출혈이 있다고 했던 것 같습니다.
+",Korean
+무력감이 온몸을 휩싼 증상이 있나요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+"혈변을 계속 보는데 어디가 문제인 건지 감이 안 오네요.
+",Korean
+뱉은 가래 색이 어떤가요?,Korean
+오른쪽 다리를 구부리고 누운 자세를 취하면 통증이 더 한가요 아니면 덜해지나요?,Korean
+어떤 질병 때문에 드시는 약인가요?,Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+청진할 때 옷 안으로 하는 게 정확해요.,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+요로감염 등 세균에 감염된 경우 탁한 소변이 자주 나타납니다. 소변에 단백질이 함께 섞여 나오기 때문입니다.,Korean
+무리를 하게 되면 면역력이 떨어지게 되어 질병이 발생할 확률이 높아집니다.,Korean
+가슴이 아프거나 하지는 않으셨어요?,Korean
+"새벽에 특히 아파서 계속 깨게 돼요.
+",Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+입으로 피 토한 증상 있나요?,Korean
+장기 기증 홈페이지를 이용하셔도 되고 어플을 이용하셔도 됩니다.,Korean
+요즘 혹시 오한이 있나요?,Korean
+수면 보조제 복용 중이시면 말씀해 주세요.,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+어느 부위에 통증이 있을까요?,Korean
+평소에도 목이 잘 부어요.,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+"수술한 다리가 너무 뻐근해서요.
+",Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+자연 치아에 비해 기능이 부족한 치아를 확인하려 합니다.,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+신장 요관 또는 방광 출혈로 파괴된 혈색소 때문에 갈색 소변이 나타날 수 있습니다.,Korean
+지금 드시고 있는 약은 무슨 약입니까?,Korean
+"네. 담배 안 피우고는 못살 정도로 중독됐어요.
+",Korean
+언제부터 알레르기 있다는 거를 아셨어요?,Korean
+"다른 때와는 다르게 소변 색이 진하게 나왔어요.
+",Korean
+담배를 피운 기간을 알려주세요.,Korean
+통증은 움직일 때마다 오나요?,Korean
+첫 번째 마취 크림으로 부족할 경우 추가로 마취 크림을 발라 드리겠습니다.,Korean
+"말하거나 기침할 때마다 아픈 게 이틀 정도 된 것 같아요.
+",Korean
+아니요. 환자분은 무통 주사를 달지 않았습니다.,Korean
+"유리 조각이 발에 박혔는데요.
+",Korean
+어느 부위에 통증이 있을까요?,Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+배액량을 확인 후 빼도록 하겠습니다.,Korean
+"심장에 문제가 생긴 거로 알아요.
+",Korean
+집안에 당뇨 환자 있나요?,Korean
+전신무력증이 온 것 같습니다.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+네. 맞습니다. 약 가져왔어요.,Korean
+검사 결과 약물 알레르기 반응 없으시다고요.,Korean
+네 이 방법이 환자분이 가장 불편하지 않은 방법입니다.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+"간 수치가 이상하다고 큰 병원 가래서 급히 왔습니다.
+",Korean
+네 삼 년 이내에 검사를 받으시는 것이 적절합니다.,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+피로로 인해 일상이 힘든 적 있나요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+으흠 제가 발기부전이 있어서 관련 병원을 갔었습니다.,Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+제가 지난번에 여기 왔을 때에는 바로 입원 수속 해주셨는데요?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+아프다 안 아프다 하나요?,Korean
+"폐에 문제가 있다고 큰 병원에서 검사해보라고 하네요.
+",Korean
+"네. 특히 약을 먹으면 구토 증상이 더 있는 것 같아요.
+",Korean
+엄마 뱃속에 있는 동안 고환이 복��� 내 있다가 서혜관을 따라 음낭으로 내려오게 되는데 음낭으로 완전히 내려오면 늘어났던 복막이 대부분 닫혀요.,Korean
+마지막 검사가 얼마 안 됐다면 다시 안해도 됩니다.,Korean
+긁지 마시고 보습제 잘 사용해 주세요.,Korean
+따로 드시는 약 있으신가요?,Korean
+삼십 분 이전에 변을 보시면 관장의 효과가 떨어지기 때문에 잘 막아주셔야 합니다.,Korean
+네 기본적인 네 개 혈액형 제외한 혈액형을 말합니다.,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+컨디션이 안 좋은 경우 수면에 영향을 줄 수가 있어 검사는 미루는 것이 좋겠습니다.,Korean
+"머리 아프면서 속이 좀 메스꺼울 때가 있었어요. 소화도 잘 안 되는 거 같고요.
+",Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+암 환자가 가족 중에 있을까요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+이상 증상이 있으면 응급실로 오란 말씀이시죠?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+기침 소리가 어떻게 나오나요?,Korean
+네. 확인되었습니다. 우선 키와 몸무게 재고 병실로 안내해드릴게요. 오늘 수술하시고 내일 퇴원 예정이신 거 설명들으셨나요?,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+"대변은 잘 보던 것 같아요.
+",Korean
+삼 개월 후에 금식하시고 피검사 하시러 오시면 됩니다.,Korean
+"코피가 많이 나와서 왔어요.
+",Korean
+네. 자연 분만이 아기한테도 좋다고 해서요.,Korean
+네 임플란트는 언제 받으셨어요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+일주일 내내 통증이 있으셨나요?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+입원 치료까지는 필요 없습니다.,Korean
+간염 치료 병력이 있나요?,Korean
+주의사항에 기재되어 있지 않은 증상이 나타나면요?,Korean
+듣는 것에 문제가 있으신가요?,Korean
+"군대에서 삽질 작업 중에 오른쪽 어깨 부위에서 똑 소리가 나더니 어깨에 통증이 생겨 오게 되었습니다.
+",Korean
+"잠을 잘 못 자고 계속 보채기는 했어요.
+",Korean
+"눈이 다쳐서 아주 아파서 내원했어요.
+",Korean
+처음 간염 판정받은 게 언제예요?,Korean
+위식도역류질환의 가능성이 가장 높습니다.,Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+현기증 느낀 적 있었어요?,Korean
+맞아요. 악화를 막기 위해 식단 조절을 바로 시작해 주세요.,Korean
+"전기장판에 불이 나면서 팔을 데었어요.
+",Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+"밥 한 숟가락만 먹어도 토해요.
+",Korean
+며칠 주기로 통증이 왔다가 사라지나요?,Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+배가 무언가 꽉 찬 느낌이 있나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+"작년 봄에 피우고 지금까지 안 피웠어요.
+",Korean
+평소에 먹는 약이 있나요?,Korean
+빈뇨 문제는 언제부터 있었죠?,Korean
+네. 급성 편도선염에 걸려서 열이 삼십구 도에서 사십 도까지 오른 적이 있었어요.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+마스크를 쓰시는 게 가장 좋습니다.,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+"지난주부터 조금씩 했는데 오늘은 계속 설사를 하고 있어요.
+",Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+고통이 얼마나 자주 오나요?,Korean
+네 혈압과 고지혈증은 따로 생각하시는 게 좋을 것 같습니다.,Korean
+가족 중에 유전병 치료를 위해 병원에 다니시는 분이 계신가요?,Korean
+환자분 정보를 얻기 위함입니다.,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+위산 분비가 증가하여 발생할 수 있습니다.,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+자연스러운 갱년기 증상일 수 있습니다.,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+열 때문에 몸이 달아오르나요?,Korean
+아니요. 제왕절갠데 무슨 문제 있나요?,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+배에 가스가 차서 힘드신가요?,Korean
+혹시 팔이 다 회전이 안되시는지 여쭤본 겁니다.,Korean
+"혀에 뭐가 난 것 같아요.
+",Korean
+병원 방문 이유가 뭘 까���?,Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+마취 풀린 이후에는 상관없습니다.,Korean
+일단 봉합된 부위는 이틀마다 외과에 가셔서 소독 받으셔야 합니다.,Korean
+요즘 혹시 두통이 있나요?,Korean
+이상한 것이 보이거나 하는 증상이 있습니까?,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+네 요즘 코로나 때문에 매일 보호자분도 열 체크해야 해서요.,Korean
+통증이 시작된 것이 언제인가요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+통증 지속시간이 십 초 이내인가요?,Korean
+세 번째 순서여서 오전 중으로 예상하지만 앞에 분들 다 끝나면 수술방에서 부를 거라 정확한 시간은 알 수 없어요.,Korean
+검사하고 바로 수술 들어가실 거예요.,Korean
+일도 화상의 경우 특별한 처치 없이도 일주일 내에 낫는 경우가 많습니다.,Korean
+지금 들고 계신 자료는 다른 병원에서 가져오신 건가요?,Korean
+"애 엉덩이가 빨갛게 되면서 붓고 또 움직이면 아프다고 자지러져요.
+",Korean
+소화불량 때문에 오신 건가요?,Korean
+큰 문제는 아니라서요. 처방해 드린 약을 꾸준히 복용하고 바르도록 해 보세요.,Korean
+네. 발열이 가장 큰 증상입니다.,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+"설사가 멈추니 변비가 생겼어요.
+",Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+집에 타이레놀밖에 없어서 그거 먹었어요.,Korean
+통증이 있는 부위가 있으세요?,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+통증이 좀 강한 편이에요?,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+"아기가 팔을 움직이거나 제가 팔을 조금만 건드려도 막 자지러지게 울어요. 팔도 많이 부었고요. 혹시 팔 부러진 건 아니겠죠?
+",Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+네 아토피로 먹는 약은 따로 없나요?,Korean
+네. 가슴 통증의 원인은 심장 쪽 문제 외에도 다양하기 때문에 환자분처럼 심전도나 심근효소 수치는 정상으로 나올 수 있습니다.,Korean
+환자분 같은 경우는 위장 쪽 출혈이 의심되고 명치통증도 있다고 하시니 위궤양이나 십이지장 궤양이 의심됩니다.,Korean
+아까 말씀드린 것처럼 변비가 있었습니다.,Korean
+지금 환자분이 가장 불편한 데를 짚어주시겠어요?,Korean
+하루에 다섯 개비 이상 피세요?,Korean
+흡연 시작하신 지 얼마나 되셨어요?,Korean
+아마 담당 선생님이 회진 오시면 설명해 주실 거예요 다른 불편사항은 없으시죠?,Korean
+"일주일 전에 수술받은 팔에 고름이 찼어요.
+",Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+성북구에 있는 희망 산부인과입니다.,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+간염 처방 약 알 수 있나요?,Korean
+물처럼 나오는 변이 잦을 경우 배변 장애에 해당합니다.,Korean
+점액질이 동반된 대변은 장내 감염 여부 확인의 지표가 됩니다.,Korean
+주기적으로 충분히 휴식해야 질병 관리가 잘 됩니다.,Korean
+어제보다 배가 많이 부어올랐나요?,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+"기침 소리가 좀 이상해요.
+",Korean
+혈변의 원인에는 다양한 원인들이 있어서 일단은 말씀드리기 힘듭니다.,Korean
+환자와 관련해서 안내해 드릴 게 있습니다.,Korean
+현기증 느낀 적 있었어요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+검사 결과 상 몸에 수분이 부족하네요. 물을 좀 더 드세요.,Korean
+백퍼센트 치료는 어렵지만 증상 조절 등 치료는 가능합니다.,Korean
+요즘 인간의 독감이 변형되어 개한테 유행입니다.,Korean
+"자주 토하고 싶고 그렇습니다.
+",Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+가족 중에 암을 앓으신 분들이 많은가요?,Korean
+모든 예방 접종 다 하신 건가요?,Korean
+일반적인 기능성 소화불량 때문이라면 투약이 효과적��니다.,Korean
+네 약 처방해 드릴 때까지 조금만 더 기다리세요.,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+앰뷸런스에서 병상으로 이동할 때 어떻게 하셨나요?,Korean
+통증 유무 확인 부탁드려요.,Korean
+결핵 치료는 꾸준히 받고 계신가요?,Korean
+"네, 살짝만 스쳐도 너무 아파요.",Korean
+발기 지속시간이 얼마나 돼요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+네 우선 키와 몸무게를 재고 병실로 안내하겠습니다.,Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+"어제저녁부터 열이 펄펄 나서요.
+",Korean
+혈액검사는 간호사분께서 도와주실 거예요. 의사 선생님께 직접 검사받고 싶으신가요?,Korean
+"밤에 배 아프다고 울고불고 뒤척였어요.
+",Korean
+환자분이 다시 오셔야 측정이 가능합니다.,Korean
+"통증이 있긴 하지만 수면 시간에 변동을 줄 정도는 아닙니다.
+",Korean
+현재 담배를 피우고 계신건가요?,Korean
+설사가 시작된 후 날마다 몇 번 정도 다녀오셨는지 알려주시면 더 도움이 됩니다.,Korean
+평소에 식이 섬유 위주의 식단은 챙겨 드시나요?,Korean
+피를 토할 때 위도 아픈가요?,Korean
+당뇨 치료를 위해 어떤 약을 드시나요?,Korean
+이 부위가 아픔을 느끼시는 거죠?,Korean
+드물게 출혈 혈종 등이 발생할 수 있으나 의료진이 관찰하니 너무 걱정하지 마십시오.,Korean
+성 기능 장애가 있으신가요?,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+"요새 혈변을 자주 눠서요.
+",Korean
+첫째는 자연 분만을 하신 거예요?,Korean
+"다음 주가 출산 예정일인데 갑자기 배가 너무 아파요.
+",Korean
+아프기 시작한 게 언제부터예요?,Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+피가 많이 필요한 검사가 아니라서 걱정 안 하셔도 됩니다.,Korean
+네 팔도 엑스레이 찍었고 결과 나오면 처치 진행하겠습니다.,Korean
+고혈압 약을 지금 두 해째 복용 중입니다.,Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+목이 많이 부은 것 같은데요?,Korean
+"네. 금연은 정말로 어려운 일인 것 같아요.
+",Korean
+국소 피부염을 일으킬 가능성이 있습니다.,Korean
+보톡스는 치료 목적으로 맞으신 건가요?,Korean
+지금 몸 기본 상태를 알기 위해서입니다.,Korean
+삼 개월간 몸무게가 얼마나 빠졌죠?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+병의 정도는 검사 결과와 말씀하신 증상을 바탕으로 알려 드릴 수 있습니다.,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+일반적으로 장운동을 촉진시켜주는 약물이 효과적이지만 장폐색이 없는지 먼저 확인해야 합니다.,Korean
+하루에 몇 개비나 태우세요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+몸에 힘이 없고 무력한가요?,Korean
+발목에 어떤 증상이 있으신 건지 자세히 말씀해 주실 수 있나요?,Korean
+증상 판별과 검사를 통해 알 수 있습니다.,Korean
+어디가 부은 느낌 있나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+오염된 환경에서 채취한 해산물을 먹었을 경우 심하면 목숨을 잃을 수도 있습니다.,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+소변에 피가 같이 나온 적이 있을까요?,Korean
+"혈액 검사는 언제 하나요?
+",Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+집에 있는 해열제 먹였습니다.,Korean
+가스가 장 안에서 차는 것이기 때문에 다른 장기를 누르는 경우는 드뭅니다.,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+간염은 약으로 치료하시는 거예요?,Korean
+통증은 얼마 동안 이어지나요?,Korean
+온몸에 기운이 없다고 느껴지나요?,Korean
+몸에 힘이 없고 무력한가요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+네 입원하셔야 진행할 수 있는 검사가 있습니다.,Korean
+입안이 따끔한 증상이 심했나요?,Korean
+처방할 때 관련된 문제를 피할 수 있거든요.,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+시간 맞춰 먹는 약이 있어요.,Korean
+��석 진행 후 신기능이 호전을 보이면 투석하지 않을 수 있습니다.,Korean
+영양제 제외하고 드시는 약은 없나요?,Korean
+밤에 통증이 있을 때 보호대가 증상 완화에 도움이 될 수 있습니다.,Korean
+심장 쪽이 안 좋아서 시술했습니다.,Korean
+보통의 네 개 혈액형 말고 다른 거요.,Korean
+출산 기록하는 데 필요한 사항이 있어서요.,Korean
+형제분 중 몇 분이 같은 질환이 있나요?,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+피부가 언제부터 두꺼워졌다고 생각하셨나요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+네 카페인 과다 섭취는 건강에 좋지 않아요. 카페인 의존을 줄이셔야겠어요.,Korean
+"소변보는 게 편하지 않아서 약 먹고 있어요.
+",Korean
+통증이 어느 정도 심한가요?,Korean
+소변보고 닦을 때 피가 묻어나오진 않나요?,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+"일하다가 전에 다쳤던 팔을 또 다쳤어요.
+",Korean
+아침에 복용해야 하는 약이세요.,Korean
+피임약이 상관이 있을 수 있습니다.,Korean
+탯줄에서 대략 구십에서 백십 미리의 혈액을 채취합니다.,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+약은 없고 영양제 쭉 먹어요.,Korean
+아뇨. 보조 기구나 수술받은 적 없어요.,Korean
+가래에서 냄새가 많이 나나요?,Korean
+친가 쪽이 다 고혈압이랑 당뇨를 앓고 있습니다.,Korean
+빈혈은 지속 적으로 있나요?,Korean
+환자 개인에 맞춰서 치료하는 방법이 다르니까요.,Korean
+외래 예약은 진료예약센터를 통해서 가능합니다.,Korean
+네 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+더 나빠지지 않을 거고 이미 생긴 욕창은 계속 치료하셔야 합니다.,Korean
+"벌에 쏘이고 나서 어지럽고 온몸이 가렵고 해서 왔어요.
+",Korean
+예전 아토피 진단을 받은 적 이 있으신가요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+구토를 많이 하지는 않으시나요?,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+회복 기간은 사람마다 달라요.,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+수술적 치료 시행과 합병증 발생 여부에 따라 차이가 생길 수 있지만 짧으면 삼일에서 오일 정도 예상할 수 있습니다.,Korean
+혈액검사 결과는 확인 후 이상 소견이 있을 시 설명드리겠습니다.,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+"요즘 뭘 먹어도 소화가 안 돼서 다 잘 안 먹습니다.
+",Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+수술 스케줄은 정해져 있어서 변경은 어려워요.,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+암 판정받으신 적 있나요?,Korean
+손목 관절의 움직임을 최소화할 수 있도록 보호대를 착용하는 것이 좋습니다.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+암 진단받은 게 언제인가요?,Korean
+지금은 산소 수치가 정상이라 산소마스크를 벗기는 하였지만 우선 수치가 정상으로 유지되는지 확인할 필요가 있습니다.,Korean
+결핵 치료는 잘 되었나요?,Korean
+"결혼하면서 금연하기로 했었는데 육아하면서 종종 가끔 피워요.
+",Korean
+가족 중에 당뇨 치료 이력이 있으면 말해 주세요.,Korean
+가족 중에 유전성 질환 치료 받으시는 분 계세요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+무슨 일이 생기면 여기 침상 위에 있는 간호사 호출 벨을 누르세요,Korean
+무슨 간염 약 드세요?,Korean
+안 될 것 같아서 안 먹고 바로 병원으로 왔어요.,Korean
+네. 혹시 특이 혈액형에 포함되시나요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+저희가 먼저 소독하고 항생제 연고 포함하여 처방하겠습니다.,Korean
+종교적인 이유로 수혈을 거부하시는 분들도 계십니다.,Korean
+네 음주는 건강에 영향을 미치는 주요 요소입니다.,Korean
+위내시경 할 때 헬리코박터 있는지도 같이 봐주세요.,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+원인을 찾는 것이 가장 중요하기 때문에 몇 가지 검사 후 바로 통증을 조절 해드리겠습니다.,Korean
+스트레스를 받으면 메슥거림이 더하나요?,Korean
+네 상처 보호 혹은 지혈을 위해 쓰입니다.,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+하루에 피우는 담배는 얼마큼이죠?,Korean
+배가 너무 팽팽해져서 불편한가요?,Korean
+항생제는 식후에 위산분비 억제제는 식전에 드세요.,Korean
+"커피를 한 잔만 먹어도 속이 뒤집혀서 잘 안 찾게 되네요.
+",Korean
+요 근래 식욕이 비정상적으로 떨어지셨나요?,Korean
+목이 아픈 적 있으셨어요?,Korean
+증상을 고려할 때 식중독 가능성이 있어서 그렇습니다.,Korean
+혹시 아이가 구토 시 분수처럼 확 쏟아내지는 않았나요?,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+어떤 혹인지 추가 검사가 필요할 것 같습니다.,Korean
+재작년 건강검진 때 제가 고혈압이라는 것을 알게 됐어요.,Korean
+통증이 있는 부위가 어디죠?,Korean
+술을 한 달에 몇 번이나 자주 드세요?,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+가슴 통증이 어느 때 자주 나타나요?,Korean
+배에 가스가 많이 차있나요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+과식을 해서 위에 자극을 줬다면 통증이 있을 수 있습니다.,Korean
+수면마취는 하반신 마취를 할 때도 시행 가능합니다.,Korean
+더 큰 병원으로 가보셔야 합니다.,Korean
+술을 과하게 먹는 편인 가요?,Korean
+"움직일 수는 있는데 통증이 심해요.
+",Korean
+"밤에 오줌이 자꾸 마려워요. 엄청 심한 건 아닌데 지금 안 일어나면 자다가 마려워서 깰 것 같고 그래서 화장실을 갔다 오면 잠이 또 다 달아나요.
+",Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+약 부작용이 있을 수 있습니다.,Korean
+잇몸이 아파서 상담만 받았어요.,Korean
+알레르기 검사에 혈액 체취는 기본적인 검사라 피 뽑기 싫으셔도 하셔야 합니다.,Korean
+최근에 몸무게 변화가 있나요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+피가 섞인 소변이 나오나요?,Korean
+자기 전에 먹을 수 있는 진통제가 있는지 주치의와 면담을 해보죠.,Korean
+가족 중에 고혈압 환자인 분이 누구셨나요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+항생제 내성균이 뭔지 정확히 모르겠습니다. 설명 부탁드려도 되겠습니까.,Korean
+상급종합병원이 아닌 작은 병원으로 가셔도 됩니다.,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+근처에 가까운 병원이 있으시면 다시 입원하세요.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+소변하고 혈뇨랑 함께 나오나요?,Korean
+"오른쪽 다리에 감각이 없어요.
+",Korean
+일단 진료 대기자들이 있어서 그분들부터 진료해야 합니다.,Korean
+발기 부전 증상이 있으세요?,Korean
+네. 통증이 심하거나 새로운 증상 있을 시 바로 이 벨을 누르시면 됩니다.,Korean
+현재 주사 부위에 이상 소견은 관찰되지 않습니다.,Korean
+평소 소화가 잘 안 되나요?,Korean
+붓기가 제일 심한 때를 알려 주세요.,Korean
+네. 수술 후 통증도 나아지고 있어요.,Korean
+알레르기를 일으킨 약 있나요?,Korean
+과거 입원경험이 있으시다면 의료진이 알아야 할 내용이 있을 수도 있기 때문입니다.,Korean
+질병 약물로 치료하고 계시나요?,Korean
+주로 어디가 자주 붓나요?,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+너무 어릴 때라 잘 기억은 나지 않는데 할아버지가 암으로 돌아가셨다고 했던 것 같아요.,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+전립증 비대증 진단받은 적 없어요.,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+네 간단한 사고였는데 정신을 잃으셨다고 했습니다.,Korean
+간염 여부 알려 주세요.,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가���?,Korean
+몸이 차가운 증상이 있나요?,Korean
+계속 먹고 있는 항결핵제가 있나요?,Korean
+대장 내시경까지 시행할 시에 수면으로 하지 않으면 환자 본인이 힘드실 수 있습니다.,Korean
+알레르기를 언제부터 치료받고 있나요?,Korean
+약 먹는 것은 절대 안 잊지.,Korean
+수술 시간은 세 시에 들어갑니다.,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+수술에 대해 설명 들으셨겠지만 척추마취로 진행되고 수술은 십오 분 정도로 짧게 소요 됩니다. 끝나고 열두 시간은 누워서 안정을 취하셔야 하세요.,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+환자분이 수술하시는 이유는 둔위 때문입니다.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+구토를 언제 한 적 있나요?,Korean
+동의서에 포함된 검사의 목적 부작용 등을 설명해 드린 후 그에 대해 이해하시고 검사를 진행하기 원하신다면 동의서에 서명을 해 주시면 됩니다.,Korean
+"머리가 좀 어지럽고 가끔 시야가 흐리다고만 말했어요.
+",Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+소변을 볼 때 피가 보이나요?,Korean
+우선 치료를 먼저 하신 후에 흉터 치료를 병행하시면 됩니다.,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+네 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+네. 알레르기 약도 먹어요.,Korean
+가족 중 유전성 질환자 계세요?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+동의하셔야 적절한 치료를 할 수 있습니다.,Korean
+약 처방과 관련하여 여쭤봤습니다.,Korean
+"전기장판에 불이 나면서 팔을 데었어요.
+",Korean
+두통이 있는지 말씀해 주세요.,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+어떤 질병 때문에 드시고 계신 건가요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+심장 박동이 여전히 빠른가요?,Korean
+수액 속도는 처방에 맞게 잘 들어가고 있어요.,Korean
+열 기운 있을 때마다 시럽으로 된 거 먹였어요.,Korean
+따로 주신 약은 없었어요.,Korean
+네 독감 예방주사 및 대상포진 주사 등이 있습니다.,Korean
+수술받은 적 있으면 알려주세요.,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+기침 감기 콧물 열 등의 감기 증상이 있으셨나요?,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+"몸이랑 얼굴에 알레르기 같은 게 올라왔어요.
+",Korean
+배 통증 부위가 어딘가요?,Korean
+난청이라 청력이 거의 없어요.,Korean
+잘 때 어려움이 있으신가요?,Korean
+고혈압과 관련된 약을 평소 복용 중이세요?,Korean
+투약 양을 조금 더 올려야 할 것 같아요.,Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+법적 보호자의 서명이 있어야만 수술이 가능합니다.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+위산 분비가 증가할 시에 위 점막 변성이 일어나면서 발생할 수 있습니다.,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+상충 작용이 되는 약을 드시는지 체크하려고 합니다.,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+초기에는 눈의 흰자 부분에서 잘 관찰됩니다.,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+아직 복부에 붓기가 남아있나 봅니다.,Korean
+부종이 발생한 곳이 있나요?,Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+언제부터 가슴 통증이 있나요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+과거에 수술이나 입원한 적이 있으신지요?,Korean
+현재 영양 불균형 증상을 보이고 계시네요.,Korean
+배에 가스가 많이 차있나요?,Korean
+두통약 처방받으려고 갔다 온 적 있어요.,Korean
+온몸에 좀 오한이 있으세요?,Korean
+통증이 오는 곳이 이쪽 부분인 거죠?,Korean
+자궁문이 조금 더 열리면 올려야 될 것 같습니다.,Korean
+혈변을 보시면 피가 얼만큼 섞여 나오는 거 같나요?,Korean
+수술 끝나고 맞을 수 있는 무통 주사에 대한 설명은 들으셨나요?,Korean
+네 일반적인 해열제 종류가 여러 개여서 구체적으로 알려 주셔야 합니다.,Korean
+대변을 볼 때 피가 나오나요?,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+소��을 누실 때 소변 발이 어떠신 거 같아요?,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+수술한 선생님의 진료가 필요할 수도 있겠습니다.,Korean
+언제 주로 현기증을 느끼나요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+피는 보통 혈액검사 시에 하셨던 양만큼 뽑으실 거예요.,Korean
+아픈 게 얼마 안 됐나요?,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+"아니요. 금연한 적 있습니다. 짧지만 있어요.
+",Korean
+천구백구십 년 오 월 일 일.,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+퇴원 후 증상이 생기거나 불편한 점이 발생하면 비뇨기과 외래 혹은 응급실로 내원하셔야 합니다.,Korean
+최근에 몸무게 변화가 있나요?,Korean
+먹었던 음식을 다 토하시나요?,Korean
+시술은 안 해봤고 허리 아파서 침은 맞아봤어요.,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+평소에 손목 운동하는 게 도움이 될 것 같네요.,Korean
+주로 성관계에 의해 전파되는 것도 있습니다.,Korean
+그건 신체에 해롭기 때문에 안 됩니다.,Korean
+도수 정복 자체가 위험하지는 않으므로 먼저 시도해본 다음 수술적 치료를 고려하는 것이 바람직할 것입니다.,Korean
+며칠 전에 입국했어요. 접종은 해외에 오래 있어서 맞지를 못했고요.,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+"가습기 꼭 사야 해요?
+",Korean
+평소에 복용하는 약이 있나요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+"이유 없이 불안하고 우울감이 들어 병원을 찾게 되었습니다.
+",Korean
+"진우 진찰 끝나고 나오면 물어보고 말씀드릴게요.
+",Korean
+파인애플을 좀 많이 먹으면 입안이 따가운데 그것도 알레르기예요?,Korean
+오늘 저녁에 입원 예정입니다.,Korean
+"수술한 곳이 터질 듯 아프고 진물이 나네요.
+",Korean
+네 바로 진통이 없어질 거예요.,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+피부가 많이 예민한 편이 아니면 접촉성 피부염이 나타나는 경우는 극히 드뭅니다.,Korean
+기침이 심할 때는 언제인가요?,Korean
+네 엑스레이 촬영으로 잇몸의 상태를 알 수 있습니다.,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+선홍색이면 정밀 검사를 해봐야 할 것 같습니다.,Korean
+네. 앞니가 깨져서 뽑고 새로 해 넣었습니다. 석 달 됐네요.,Korean
+"소변을 봐도 잔뇨가 늘 남고 거의 바로 화장실을 또 가게 하네요.
+",Korean
+휠체어에 앉아서 기다리시면 됩니다.,Korean
+"변 보고 나면 빨간 피가 많이 묻어 나와요.
+",Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+"날개뼈 쪽이 자꾸 결리고 담이 오네요.
+",Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+보통 하루에 몇 개비나 피우시나요?,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+복통이 나타난 건 언제가 처음이죠?,Korean
+"흡연은 스무 살 무렵에 시작했는데요. 요새는 건강 생각해서 하루 두세 대만 피웁니다.
+",Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+"다리가 후들거리고 힘이 없어요.
+",Korean
+환자분은 오늘 두부 열상으로 오셨고 퇴원 안내문에는 두부 외상 환자 주의사항이 있습니다. 뒷장에는 열상 환자 주의사항도 있으니 읽어보시면 됩니다.,Korean
+처방받는 데 얼마 안 걸려서 오래 기다리시지 않아도 돼요.,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+결핵 진단 후 치료는 잘 받으셨나요?,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+혈변에 피가 많이 보였나요?,Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+네 혹시 부작용이 있으신 적 있나요?,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+기침 증세가 악화하고 있나요?,Korean
+네 약을 알면 좋을 것 같습니다.,Korean
+"소화가 잘 안되는 거 같으면서 토하면 시원해질 거 같아서 더 자주 해요.
+",Korean
+네 검사 후 필요하다면 약을 변경하도록 하겠습니다.,Korean
+"대소변을 잘 못 보냐는 말씀이세요?
+",Korean
+사람의 각질 있�� 곳에 진드기가 나타납니다.,Korean
+그렇군요 구급차로 입원하셨다고 알겠습니다.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+병원으로 바로 오셔서 소독하셔야 해요.,Korean
+입원 절차를 밟으셔야 해서 죄송하지만 바로 입원 진행은 어렵습니다.,Korean
+"왜 그런지 잘 모르겠는데 입맛도 없고 안 먹게 되네요.
+",Korean
+간염은 앓으신 지 얼마나 되셨어요?,Korean
+오십 넘어서 고혈압 진단받았어요.,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+크게 걱정하지 않으셔도 되는 피부 변화예요 빨갛고 부어오르고 뜨거운 건 약물 치료 잘하시면 됩니다.,Korean
+연고 바르시다 따가운 증상이 생기시면 바르지 마시고 병원으로 연락 부탁드립니다.,Korean
+제 키가 백육십이고 몸무게는 오십육이요.,Korean
+내일 진료받으러 오셔야 할 진료 장소입니다.,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+집에 있어요. 다리가 안 좋아서 잘 못 움직여요.,Korean
+딱히 약물 알레르기는 없었던 것 같아요.,Korean
+없으며 혹시 다른 증상이 발견될 경우 즉시 상담을 받거나 병원으로 오시면 됩니다.,Korean
+소변이 나올 때 피가 나오나요?,Korean
+이번에 입원하신 날짜 말씀해 주세요.,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+잠을 못 잘 정도로 배가 아픈가요?,Korean
+예방 접종 후 열이 나거나 두통이 있거나 하시지 않으셨어요?,Korean
+사람마다 다른데 마취 깨고 의식을 회복하는데 한 시간이면 됩니다.,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+토를 심하게 한 적이 있나요?,Korean
+흡연 상태 유지 중이신가요?,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+느낌상 괜찮아도 건강에 변화가 있을 수 있습니다.,Korean
+오한이 있는 것 같나요?,Korean
+알레르기 있는 음식 아시나요?,Korean
+"잠이 잘 안 와서 힘듭니다.
+",Korean
+발기를 아예 못 하시는 건가요?,Korean
+"아이가 너무 왜소해서 따돌림을 당하는 것 같더라고요. 성장 검사해 보려고요.
+",Korean
+피부가 손상받을 수 있습니다.,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+가족 중에 대장암 앓으신 분은 없나요?,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+검사 결과가 나와야 알 수 있을 것 같네요.,Korean
+"소변을 너무 잘 안 봐요
+",Korean
+"입원 전주에 수면제를 처방받았는데 그거 먹기 시작하면서부턴 여덟시간 넘게 잘 잤어요.
+",Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+아니요. 조금 불편하시더라도 수술 후 위장관의 운동이 완전히 돌아올 때까지 계속 하고 계셔야 됩니다.,Korean
+암 치료했었던 가족이 있나요?,Korean
+울렁거리면서 토할 것 같았어요?,Korean
+소변을 봐도 시원하지 않고 불편한 느낌이 있나요?,Korean
+결핵으로 약 드시고 계세요?,Korean
+감염성 질환의 경우 설사가 자주 나올 수 있습니다.,Korean
+실제로 토하신 적 없으세요?,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+"식중독 때문에 병원에 입원했어요.
+",Korean
+최근에 수술 언제 받으셨나요?,Korean
+소변을 다 보고 나서 마지막에 혈뇨가 나오는 경우는 방광경부 또는 전립선 요도 부위가 원인일 가능성이 높습니다.,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+민간요법과 병원 치료를 병행하는 분들이 있어서 그럽니다.,Korean
+"비염약 좀 받으려고 왔어요.
+",Korean
+진료받는데 거리가 멀면 위급 상황 시 문제가 될 수 있어서 여쭈어봤습니다.,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+수술은 약해진 근막 주위로 인공 막을 대주는 거고 전신마취로 진행합니다. 수술 시간은 한 시간 정도이고 자세한 수술 설명은 입원하시는 날 다시 해드릴게요.,Korean
+척추마취 후 흔하게 두통 등 부작용이 있을 수 있습니다.,Korean
+결핵 치료가 오래전 일인가요?,Korean
+고통이 얼마나 오래 지속되나요?,Korean
+최근 몸무게에 변화가 혹시 많으셨나요?,Korean
+통증 진행 양상이 어떤가요?,Korean
+혈압이 높은 거 안 지 얼마나 되셨어요?,Korean
+얼굴이 창백해지고 쓰러질 것 같았어요.,Korean
+통증이 주에 몇 번 있나요?,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+평소에도 계속 거칠게 숨을 쉬나요?,Korean
+결핵 진단 언제 받으셨어요?,Korean
+숨 쉴 때 힘드신가요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+약이 처방한 다른 약과 충돌하는 건 아닌지 확인하기 위해 약을 보여주셔야 합니다.,Korean
+항암 치료한 지 얼마나 되었나요?,Korean
+모유에 비해 분유는 철분을 강화 제품이므로 육 개월 이후 철분 결핍에 대한 우려가 적은 장점이 있습니다.,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+중풍 때문에 고생 좀 하셨어요.,Korean
+저희 집안 전부 혈압약을 먹어요.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+환자분이 느끼시기에 기능상 문제 없다 하시니 다행이지만 저희가 간호를 제공해 드리기 위해서는 유의점이 될 수 있어요.,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+오분 전후로 걸리실 거고 혈압이 조금 이상하다고 판단되면 재검사 하실 수도 있어요.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+따로 주신 약은 없었어요.,Korean
+약 여분 없으면 다른 약 처방해드릴 테니 그거 드세요.,Korean
+전체적으로 아프지만 그래도 가만히 있으면 통증이 더 많은 부위가 있을 텐데요.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+손목을 받쳐주는 보호대도 있습니다.,Korean
+"위암 수술한 곳이 좀 아픈 것 같아서 왔어요.
+",Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+몸에 열이 나거나 뜨겁지 않나요?,Korean
+아이가 외래 진료와 검사 결과 탈수 증상이 조금 있네요. 처방된 수액으로 바꿔 달아드릴게요.,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+체온이 몇 도인지 아세요?,Korean
+"지쳐서 기절하듯이 잠들기도 하는데 정말 통증 때문에 잠을 못 자요.
+",Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+증상이 생긴 날에 처음 먹어본 음식이나 해산물이나 상한 음식 드신 건 없나요?,Korean
+"시골 할머니 집에서 수돗물을 마셨는데 배가 아파 왔어요.
+",Korean
+아니요. 칼 댄 수술은 한 번도 한 적 없어요.,Korean
+소량의 마취제로도 마취가 가능하니 참고하겠습니다.,Korean
+"소변 색이 녹빛 이에요.
+",Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+짠 걸 드시면 붓기가 평소보다 심할 수 있습니다.,Korean
+당뇨 가족력을 갖고 있나요?,Korean
+반응 테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+"아기가 딸꾹질이 안 멈춰서 왔어요.
+",Korean
+설사 증세가 심해진 적이 있나요?,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+두 시간 전에 맥시부펜 먹였어요.,Korean
+복수가 찬 적 있나요?,Korean
+"손가락으로 짚으며 떨어졌는지 손가락을 만지면 아파해요.
+",Korean
+치료방법이 달라질 수도 있어서 질문 드렸습니다.,Korean
+부정맥 관련 진단받은 바 없어요.,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+통증이 어떤 거 같으세요?,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+검사 부위는 일시적으로 붉게 올라올 수 있어요.,Korean
+아들이 데려가서 저번 주에 독감 예방 주사 맞았지.,Korean
+정신과 약 먹고 있어요.,Korean
+고혈압약 먹고 예전보다 증상이 호전된 것 같나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+많지 않으나 부작용을 호소하시는 분들도 계시니 증상이 있는 경우 바로 말씀 주세요.,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+"무릎에 문제가 생긴 것 같아요.
+",Korean
+얼마나 자주 통증이 발생하나요?,Korean
+사람마다 다른데 마취 깨고 의식을 회복하는데 한 시간이면 됩니다.,Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+입원하신 날짜가 어떻게 되시나요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+수술한 적은 한 번도 없는 건가요?,Korean
+호흡��� 조금 가빠 오면 간호사 선생님께 말하세요.,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+환자분 술에 취해서 자는 건 제대로 된 수면이 아닙니다.,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+가장 걱정되는 증상이 무엇인가요?,Korean
+수술실에는 수술복 외에는 입고 가시면 오염될 수 있어서요.,Korean
+아픈 증세를 얘기해 보세요.,Korean
+평소에 숨이 안 쉬어질 때가 언제인가요?,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+네. 결혼 전에 여성 질환 때문에요.,Korean
+네 객혈을 한 시기에 따라 병명이 달라질 수도 있습니다.,Korean
+어느 부분이 가장 아픈지 말씀해 주세요.,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+무슨 간염 약 드세요?,Korean
+"양쪽 다 아픈 데요. 둘 다요.
+",Korean
+아마 전신마취로 했을 거예요.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+현재 고혈압 치료는 언제부터 시작하셨나요?,Korean
+의사 선생님이 최선의 방법을 알려주시면 저는 그에 최대한 따를게요.,Korean
+통증이 어디서 느껴지시는 건가요?,Korean
+산소가 몸 구석구석까지 전달이 되지 않아서 그렇습니다.,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+콕 찍은 정도여서 흉터라고 보기에는 애매하네요.,Korean
+아니요. 노산이라 무조건 제왕 절개였어요.,Korean
+보호자분 열은 삼십 육 점 사 도로 정상이시네요. 당분간 환자분 옆에 계실 건가요?,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+갑자기 기도가 부풀어서 응급처치받았었어요.,Korean
+현재 몸에 종양이 있어요?,Korean
+기침할 때 다른 증상이 있나요?,Korean
+잠을 쉬이 못 드나요?,Korean
+무면허 진료 및 치료는 민간요법입니다.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+그것보다는 생활 행태 개선과 수면 환경 개선이 필요합니다.,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+네 헌혈 말고 수혈받아보신 적 있나요?,Korean
+"두통이 멈추지 않고 이상하게 먹으면 울렁거려서 토하고 반복돼서 찾아오게 되었습니다. 가장 불편한 점은 두통입니다.
+",Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+유전적인 요인이나 잘못된 배변습관 등으로 항문 및 직장에 존재하는 치핵 조직이 항문 밖으로 빠져나오는 것입니다.,Korean
+통증이 자주 생기는 편인가요?,Korean
+간염 약 복용 중이십니까?,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+저희 병원이 아닌 타 병원에서 진료한 것은 알 수가 없기 때문입니다.,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+"차에 박아서 걸을 때 아파요.
+",Korean
+미리부터 겁먹으실 필요는 없고 검사를 몇 가지 해 보도록 하겠습니다.,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+통증의 지속 여부를 말씀해 주시겠어요?,Korean
+네 산소 수치 확인 후 필요 시 착용하도록 하겠습니다.,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+"네. 자려고 하면 잠이 안 와요.
+",Korean
+암 치료 기간이 어떻게 되나요?,Korean
+과식을 하지 않아도 소화가 되질 않나요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+네 피부병으로 볼 수 있겠네요.,Korean
+다행히 아직 아이가 심각한 상태가 아닙니다.,Korean
+출혈을 최소화해서 치료할 겁니다.,Korean
+"가만히 누워 있어도 머리가 핑핑 돌아요.
+",Korean
+통증이 한 번씩 오나요?,Korean
+이번 기회에 담배 한 번 끊어보죠.,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+네 수술 부위 정확히 인지하고 계세요.,Korean
+환자 환인을 위해 이용되고 있습니다.,Korean
+토할 때 피가 같이 나오나요?,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+발기 부전 증상이 있으세요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+결핵은 어떻게 하고 계시���?,Korean
+음식을 먹으면 토를 하나요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+언제부터 소변을 누기가 힘이 드셨어요?,Korean
+소변줄이 걸리는 곳이 있는지 제가 잠시 보겠습니다.,Korean
+어떤 종류의 비타민을 드시나요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+먹으면 부작용이 있거나 불편한 약 있으세요?,Korean
+식구들 중에 다른 유전성 질환 환자가 있나요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+병원 직원은 환자 개인정보를 열람할 수가 없습니다.,Korean
+"예전부터 술을 좋아했었는데요 요즘에는 힘든 일이 있을 때마다 먹다 보니까 이젠 저 스스로 조절이 안 돼요. 정신과에 오면 도움을 좀 받을 수 있다고 하여 방문하게 되었어요.
+",Korean
+어디가 불편하셔서 진료를 받으셨나요?,Korean
+물에 많이 닿았다면 드레싱 다시 해야 합니다.,Korean
+아니요. 치료 끝난 지 일 년 정도 된 것 같아요.,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+통증이 어떤지 설명해 보실래요?,Korean
+네. 워낙 몸이 안 좋아서.,Korean
+"아니요. 중간에 끊었었는데 최근 다시 피우기 시작했어요.
+",Korean
+네. 교정 때문에 윗니 두 개 아랫니 두 개 발치했습니다.,Korean
+발열이 있던 적 있나요?,Korean
+네 음주는 건강에 영향을 미치는 주요 요소입니다.,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+부종이 발생한 곳이 있나요?,Korean
+얼굴이 붉어지는 부작용이 있었던 것 같아요.,Korean
+그런 부작용을 방지하기 위해 자세히 모니터링하며 지켜보도록 하겠습니다.,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+틀니 빼고 저희에게 넘겨주세요.,Korean
+"네. 속이 자주 울렁거려요.
+",Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+가슴 통증이 있지는 않나요?,Korean
+정형외과 진료실 들어오실 때입니다.,Korean
+마취를 하더라도 환아가 완전히 안정되지는 않아 보호자분들의 도움이 필요합니다.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+통증 시작 날 알려주세요.,Korean
+아침에 먹였는데 열이 안 떨어져요.,Korean
+"통풍 있으니 고려해서 주세요.
+",Korean
+간염 치료 복용 약 있으시죠?,Korean
+입원이나 수술하신 적 있어요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+가족 중에 위 질환 진단을 받으신 분이 있나요?,Korean
+청소와 빨래를 자주 하는 것이 진드기를 없애는 데에 많은 도움이 됩니다.,Korean
+애완견이 광견병 접종을 제때 못한 상태에서 사람을 물면 사람에게 감염시킬 수도 있어요.,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+종양 치료는 다 끝났나요?,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+평소에 변비 증상이 있으신가요?,Korean
+통증을 참을 수 있나요?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+네. 소독도 자주 해줘야 하고 아이 상태를 확인하기 위해서는 입원 치료하는 게 좋아요.,Korean
+고혈압과 관련하여 받은 치료는 모두 알려주세요.,Korean
+"소변 중 통증이 있었어요.
+",Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+검사 장면을 보는 것이 쉽지는 않겠지만 보호자분들의 협조 없이 의료진만으로 검사를 하면 아이가 더 힘들어하는 경우가 많습니다.,Korean
+"위가 안 좋은 편이라 과식은 안 해요.
+",Korean
+배뇨 장애가 있으신 거예요?,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+피부가 언제부터 두꺼워졌다고 생각하셨나요?,Korean
+키는 백 육십이고 몸무게는 오십이요.,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+내시경 검사 시 위장관 내부를 더 잘 볼 수 있도록 장을 비우기 위함입니다.,Korean
+"수면장애 증상은 딱히 없는 듯해요.
+",Korean
+담배는 언제 피우기 시작했을까요?,Korean
+음식을 토한 적이 있으신지요?,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+레이저 시술로 몸에 무리가 가는 경우는 거의 없습니다.,Korean
+혈압이 높은 거 안 지 얼마나 되셨어요?,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+주사 부위 한번 봐 드릴게요.,Korean
+아직은 입원 지시가 없어서 금식 여부를 알 수 없습니다.,Korean
+네. 누나가 우울증으로 치료받았던 것 같아요.,Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+원인을 찾는 것이 가장 중요하기 때문에 몇 가지 검사 후 바로 통증을 조절 해드리겠습니다.,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+"으슬으슬 춥고 기침을 해요.
+",Korean
+배에 더부룩한 느낌이 있나요?,Korean
+보통 일주일에서 한 달은 그렇게 유지하는데 수술 끝나고 다음 외래 내원시 의사 선생님이 자세히 말씀해드릴 거예요.,Korean
+틀니가 흔들리지는 않고 깨질 수는 있습니다.,Korean
+"무릎이 아픈 뒤로는 변도 잘 안 나옵니다.
+",Korean
+통증이 얼마나 자주 오나요?,Korean
+의료기 상사에는 뭘 파는 거예요?,Korean
+어디 다른 병을 갖고 계신가요?,Korean
+"기름진 음식은 피하고 있어요.
+",Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+"운동 아예 안 해요.
+",Korean
+몸에 안 받는 음식이 있나요?,Korean
+"이전에 열이 났었냐고 여쭤 보셨었는데요.
+",Korean
+특정 음식에 알레르기가 있습니까?,Korean
+아니요 혈액형이 다르게 나오시네요.,Korean
+기형 예방을 위해 하는 검사입니다.,Korean
+"스물에 피우기 시작해서 이삼 년 피우다가 끊었습니다.
+",Korean
+지금 배가 빵빵하고 불편한 증상이 있다면 가스가 차는 것은 아닌지 신체 검사로 감별하겠습니다.,Korean
+배의 어느 부위가 아프세요?,Korean
+진통제를 복용한 지 얼마 안 됐으니 조금만 더 경과를 보겠습니다.,Korean
+아픈 증세를 얘기해 보세요.,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+사용하는 약이나 재료에 따라 조금씩 차이가 날 수는 있습니다.,Korean
+치료를 받고 나서 몸의 이상에 대해서 자각하게 되는 것은 치료 이후에 신체상태에 대한 관심이 올라가서 일 수 있습니다.,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+지금 혹시 변비가 있나요?,Korean
+소독을 꾸준히 해 주세요.,Korean
+"칼로 손목을 그었는데 피가 너무 많이 나요.
+",Korean
+몸이 피로하다는 생각을 해보신 적 있나요?,Korean
+아직은 응급수술로 예정되어있기 때문에 언제 수술을 하러 가실지 모르는 상황입니다. 수술 시간이 결정되면 알려드리겠습니다.,Korean
+당은 잘 관리 되고 있나요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+하루에 보통 몇 개비 피우시나요?,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+내시경 자체는 사후 통증이 없습니다,Korean
+병의 정도는 검사 결과와 말씀하신 증상을 바탕으로 알려 드릴 수 있습니다.,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+소독 후에 연고를 꼭 바르시고 위에 거즈로 덮어줘야 덧나지 않습니다.,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+"네. 지방 수치는 어떤 경우에 높게 나오나요?
+",Korean
+하루에 몇 개비나 태우세요?,Korean
+약은 먹고 있는데 아침에 한 혈당검사에서는 비정상으로 나왔어요.,Korean
+"자꾸 설사하셔서 모시고 왔어요.
+",Korean
+통증이 월 단위로 있나요?,Korean
+어느 정도 수치가 정상 수치인 거죠?,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+"손발이 요즘 너무 차고 가슴 통증이 있어서요.
+",Korean
+"몸을 움직일 수 없을 정도로 옆구리랑 가슴이 당겨요.
+",Korean
+네 검사 결과 기억하시나요?,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+자궁경부암 그거 예방 접종 맞았어요.,Korean
+배가 불러 불편하지는 않으세요?,Korean
+물 먹고 소변 보면 증상이 괜찮아지나요?,Korean
+"검사 결과 확인해야 한다고 병원 오라고 문자 받았어요.
+",Korean
+수혈 거부 시 의사 상담 후 동의서 작성이 필요합니다.,Korean
+우리 아이는 어디가 아플까요?,Korean
+얼마��� 자주 가래를 뱉나요?,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+토를 심하게 한 적이 있나요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+오심은 신물이 올라오는 것과 같은 형태로 나타날 수도 있지만 토할 것처럼 속이 울렁거리는 형태로 나타나는 경우도 많습니다.,Korean
+의사가 아들에게 상태에 관련하여 설명하였습니다.,Korean
+소변에 피가 섞여서 나온 적이 있으신가요?,Korean
+아프기 시작한 지 좀 됐나요?,Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+코르티코스테로이드란 약물에 알레르기가 심하게 일어나요.,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+혈압 수치 알고 계세요?,Korean
+따로 드시는 약 있으신가요?,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+매일 드시는 약이 있어요?,Korean
+혈압약이랑 당뇨약을 드셨던 거 같아요.,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+"소변이 덜 나온 느낌이 들어요.
+",Korean
+흉터 연고 같은 거 바르면 좀 나아질까요?,Korean
+"소화되기 전에 거의 토하는 거 같아요. 한 시간 이내로.
+",Korean
+고혈압을 앓은 경험이 있나요?,Korean
+"음주하고 주량은 소주 2병 이하입니다.
+",Korean
+저희 병원의 경우 만 원이 추가됩니다.,Korean
+소화 기능이 안 좋으세요?,Korean
+"다름이 아니라 제가 지금 군 복무 중에 삽질하다가 오른쪽 어깨에서 툭 하는 소리가 났는데 그 이후로 어깨가 계속 아파서 오게 됐습니다.
+",Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+약이 세서 오래 드시면 안 돼요.,Korean
+가족 중에 누군가 고혈압이 있나요?,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+이 년 전에 턱 때문에 양악 수술했었어요.,Korean
+마지막 검사가 얼마 안 됐다면 다시 안해도 됩니다.,Korean
+바늘로 찌르는 듯한 통증인가요?,Korean
+소변보고 닦을 때 피가 묻어나오진 않나요?,Korean
+또 아픈 곳 없나요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+몸에 힘이 없고 무력한가요?,Korean
+혈뇨를 볼 때 통증이 동반되나요?,Korean
+살아생전 수술해 본 적 없네요.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+운동이나 외상으로 근육 손상이 생겨 독성 물질이 쌓이는 것을 횡문근 융해증이라고 합니다.,Korean
+결핵을 오래 앓으신 거예요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+종양 확인된 적 있으신가요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+이십 년 전 철분 결핍성 빈혈을 진단받고 꾸준히 철분제를 복용하고 있습니다.,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+집 앞 병원에 비염 치료하러 간 적 있어요.,Korean
+아니요. 아이 상태가 안 좋아서 수술로 꺼냈어요.,Korean
+칼슘을 피해야 하는 질병을 앓으시는 환자분들도 계시지만 환자분은 충분히 드시면 됩니다.,Korean
+반응테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+"신장 기능이 안 좋아졌다고 얘기 들었어요.
+",Korean
+하루에 몇 개비나 태우세요?,Korean
+어떤 증상이 견디기 힘들던가요?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+체온이 몇 도인지 아세요?,Korean
+"대변 형태 모두 좋습니다.
+",Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+언제부터 그 증상이 나타났나요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+전에 크게 다쳐서 내원하신 적 있으세요?,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+음식으로만 감염되는 것은 아니지만 오염된 음식으로도 감염될 수 있습니다.,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+형이 옆구리 통증이 심했어요.,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+비후성 위염이 아니었어도 다른 원인에 의해서 나타날 수 있는 병변입니다.,Korean
+욕창이 생기지 않도록 체위 변경 잘 해주시면 더 빨리 나으실 거예요.,Korean
+항문 출혈 가능성이 높고 그 경우 심각한 질환의 가능성은 낮습니다.,Korean
+"토가 계속돼서 너무 힘들어요.
+",Korean
+"네. 상처 난 듯이 아파요.
+",Korean
+만졌을 때 통증은 없나요?,Korean
+구십일 연도에 당뇨 확진을 받았었죠.,Korean
+부작용이 있을 경우 말씀해 주시면 저희가 조치를 취할 거예요.,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+목에 아픈 증세가 있나요?,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+피로한 느낌을 받은 적이 있으신가요?,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+병원비 결제 영수증 좀 뽑아 주세요.,Korean
+이동침대였는지 보호자분한테 다시 확인해보겠습니다.,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+꼭 피곤해서 코피가 났다고 볼 수만은 없습니다.,Korean
+대변볼 때 피가 묻어나나요?,Korean
+카페인 때문에 검사 결과가 잘 나오지 않는 경우도 있습니다.,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+키는 백칠십 센티 몸무게는 오십팔이요.,Korean
+"의식 잃을 정도로 치이진 않았어요.
+",Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+"계속 소변이 나올 것 같은 느낌이 들어요.
+",Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+원인을 빨리 찾기 위해 검사를 해 보고 힘드시면 증상 조절을 조금 해드리겠습니다.,Korean
+장에 신경이 분포 되지 않아 이로 인해 정상적인 변을 보지 못하는 질환입니다,Korean
+확실한 치료를 원하시면 약물보다 수술을 추천합니다.,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+"변비가 심하다가 생리 때 설사가 심하고 그래요.
+",Korean
+검사 결과가 어떻게 나오셨는지 말씀해보시겠어요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+어릴 때 귀 성형수술받고 나서는 없었어요.,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+몸살 기운이 있는 것 같나요?,Korean
+광견병은 반려견이 사람을 물었을 때 감염시킬 수 있어요.,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+소화가 잘되지 않거나 더부룩할 수 있습니다.,Korean
+당뇨가 집안 내력인 거죠?,Korean
+잠을 잘 못 자서 불편한 적이 있으신가요?,Korean
+가족 중에 당뇨 환자 있으신가요?,Korean
+배가 무언가 꽉 찬 느낌이 있나요?,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+어디가 아픈지 진단이 돼야 처방이 가능합니다.,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+네. 입원 처음 해 보는 거라 좀 긴장되네요.,Korean
+십이지장 궤양 받았을 거예요.,Korean
+귀 뒤에 통증이 있나요?,Korean
+암 수술한 적 있으세요?,Korean
+아무래도 피부질환이 심한 분들은 호흡곤란도 올 수 있어요.,Korean
+전에 크게 다쳐서 내원하신 적 있으세요?,Korean
+알레르기가 나는 음식이 있으시다면 알려주시겠어요?,Korean
+통증이 시작되면 계속 아파요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+혈뇨를 보신 적이 언젠가요?,Korean
+"소변을 보려면 힘을 많이 줘야 돼요.
+",Korean
+흡연 한지 오래 되셨나요?,Korean
+네 약을 알면 좋을 것 같습니다.,Korean
+카페인 섭취가 좋지 않죠.,Korean
+네. 독감 예방 주사 맞은 지 얼마 안 됐어요.,Korean
+집안에 고혈압 환자분 계세요?,Korean
+동물 근처에 가면 알레르기 반응이 나타나나요?,Korean
+아니요 약 드시는 거에 문제는 없습니다.,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+약 복용이 증상 완화를 시켜 줄 수 있습니다.,Korean
+평소 앓는 질환은 없었습니다.,Korean
+몸무게의 변화가 의심될 때만 시간대별로 체크합니다.,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+고통이 몇 시간 동안 있나요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+몸에 계속 열이 나나요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+통증의 원인을 얼른 잡을 수 있도록 노력해 봅시다.,Korean
+입원하실 때 무슨 수단 이용하셨는지 물어보는 거예요.,Korean
+목 아픈 건 나으셨어요?,Korean
+귀에서 멍한 소리가 나나요?,Korean
+검사를 하시려면 더 큰 병원을 추천하고 싶습니다.,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+통증이 얼마 동안 ��으셨죠?,Korean
+담배를 경험해 본 적 있으신가요?,Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+입원했던 적이 몇 번일까요?,Korean
+"아뇨. 최근에는 한 다섯 시간 정도 자고 있어요.
+",Korean
+혈압 맥박 호흡 체온 측정이 동시에 이루어지는 거예요?,Korean
+느낌상 심박수가 올라가는 것 같았어요?,Korean
+평소에 변비 증상이 있으신가요?,Korean
+"집에 불나는 바람에 크게 화상을 입어서 왔어요.
+",Korean
+소변줄을 안 차시려면 시간당 소변량 체크가 끝나야 합니다.,Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+주사 공포증이 있어서 주사를 맞을 수가 없어요.,Korean
+과한 육류 섭취를 피하고 섬유소가 많은 음식을 드시는 것이 좋습니다.,Korean
+어떤 약 처방 받으셨어요?,Korean
+보호자분 혹시 환자분 옆에 계속 상주하시나요?,Korean
+"십 년 됐습니다. 하루에 담배 두 갑 피웁니다.
+",Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+암 수술한 적 있으세요?,Korean
+몸에서 기력이 달리는 느낌이 나요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+입원은 한두 시간 기다리셔야 할 겁니다.,Korean
+손발 피부 표피가 벗겨지는 건 습진이나 무좀 때문일 수도 있어요.,Korean
+장염이라. 없었던 것 같은데요.,Korean
+대변보는 주기가 어떻게 되나요?,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+"제가 이십 대일 때부터 피웠으니 이십 년은 넘었네요. 하루에 한 갑 정도만 피우는 편이에요.
+",Korean
+평소보다 요즘이 더 피로하신 것 같나요?,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+감사합니다. 환자분 혈관이 곧아서 한 번에 놓을 수 있었어요. 여기 팔에 잘 고정시켜 둘게요. 이제 항생제 반응 검사만 하고 가겠습니다.,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+다른 종류의 알레르기는 가지고 계세요?,Korean
+통증이 아예 안 느껴질 수는 없습니다.,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+전에 수술한 경험 있으세요?,Korean
+"치즈 먹고 설사를 심하게 한 경험이 떠올라서 손이 쉽게 가지 않네요.
+",Korean
+네. 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+진통제를 습관적으로 먹고 있어요.,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+얼마 전에 교통사고로 입원했었습니다.,Korean
+잠에 잘 들지 못하고 있나요?,Korean
+혹시 안 먹거나 탈수 증상이 있으면 병원에 방문해 주세요.,Korean
+네 금식 유지 하셔야 합니다.,Korean
+유전성 질환 가족력 있나요?,Korean
+감기인 줄 알았는데요. 천식은 감기랑은 다른 건가요?,Korean
+"열은 삼십칠 도 정도로 아침에 살짝 있었어요.
+",Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+동의하셔야 해당 약품을 쓸 수 있어요 조금 비싸긴 합니다.,Korean
+너무 아프시면 진통제 처방해드릴게요.,Korean
+그보다 환자 상태에 맞춰 진행합니다.,Korean
+"실수로 약 봉투를 삼켜버려서 왔습니다.
+",Korean
+네 아주 어렸을 때 받으신 수술까지도 말씀해주세요.,Korean
+불면증이 심하신 거 같아요.,Korean
+"고기 오돌뼈를 안 씹고 삼켜서 걸렸어요.
+",Korean
+어느 부위에 통증이 있으세요?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 꾸준한 추적 검사가 요구됩니다.,Korean
+"나이 들어서 힘줘서 똥 싸면 안 된다고 들어서 난 힘 안 줘. 차라리 변비약을 먹고 말지.
+",Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+컴퓨터를 오래 하거나 손목에 무리가 가는 일을 오래 하면 그럴 수 있습니다.,Korean
+현재 약 드시는 거 있어요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+앓고 있는 병 있나요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+평소에 드시는 약을 말씀해보실래요?,Korean
+부어오르고 가려우면서 아프다고 하시는 분들도 계세요.,Korean
+월경이 규칙적이더라도 자궁 내 기타 질환이 있��� 수 있으므로 초음파 검사 등 기본 검사를 시행하겠습니다.,Korean
+표준 이차 치료제는 네 종류입니다.,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+진료비 관련해서 원무과 가서 문의하면 되나요?,Korean
+아직 호흡한 마취 가스가 혈액에 남아있어 폐에 전해져서요.,Korean
+저 입원은 안 하고 싶어요.,Korean
+네. 간접흡연도 몸에 안 좋은 영향을 많이 끼쳐요.,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+당은 잘 관리 되고 있나요?,Korean
+사출성 구토는 위장으로 들어간 음식이 바로 뿜어져 나오듯이 나오는 구토입니다.,Korean
+계속 기침 증상이 있나요?,Korean
+언제 심장 박동이 불편하세요?,Korean
+"목 안에 작은 유리 조각이 굴러가는 것처럼 통증이 있어요.
+",Korean
+"물리적인 충격이라 하긴 그렇고 삼 일 전에 친구들하고 놀이터에서 놀다 왔는데 그때 자기도 모르게 다친 게 아니냐고 짐작하고 있긴 해요.
+",Korean
+한의사가 행한 것은 민간요법이라 칭하지 않습니다.,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+"혈압이 높아서 그런지 머리가 너무 지끈거려요.
+",Korean
+모유에 비해 분유는 철분을 강화한 제품이므로 육 개월 이후 철분 결핍에 대한 우려가 적은 장점이 있습니다.,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+부모님께서 특정 질환이 있으신가요?,Korean
+청진 시에 평소처럼 편안하게 있으시면 되세요.,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+심혈관 계통으로는 문제 없었습니다.,Korean
+술 마시는 날이 잦나요?,Korean
+면역요법에 주로 사용되는 성분으로 이루어져 있습니다.,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+호흡 곤란이 발생하지 않도록 투약 용량을 잘 조절하겠습니다.,Korean
+"잠들기 어렵고 잠에 들어도 지나치게 일찍 깹니다.
+",Korean
+암인지는 검사 후에 결과가 나오기까지 시간이 좀 걸려서요 다시 안내 도와드리도록 하겠습니다.,Korean
+정확히 아픈 부위가 어디예요?,Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+현재 증상은 관절 문제와 무관합니다.,Korean
+아픔이 며칠 주기로 찾아오나요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+구십일 연도에 당뇨 확진을 받았었죠.,Korean
+요즘 같은 계절에는 입술이 많이 건조하긴 합니다.,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+소변볼 때마다 피가 나오나요?,Korean
+복막 투석이라 매일 하고 있습니다.,Korean
+예전에 아팠던 곳 있어요?,Korean
+흡연 시작한 지 얼마나 되었어요?,Korean
+결핵 앓은 적 있으신가요?,Korean
+흡연 시작 연령을 기억하세요?,Korean
+일주일에 몇 번이나 아프세요?,Korean
+제가 지금 임신 초기라서요. 약을 함부로 쓰면 안 돼요.,Korean
+젖은 상태의 거즈로 상처를 보호할 수 있습니다.,Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+식구들 중에 다른 유전성 질환 환자가 있나요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+"네. 손가락에 화상이 지금 너무 심해요. 얼른 처치 좀 부탁드려요.
+",Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+심한 경우 약만으로는 못 막아요.,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+"구토감이 때때로 올라와서 참기 힘듭니다.
+",Korean
+스트레스 완화에 좋은 약은 없어요.,Korean
+네. 진료기록 보시면 나와요.,Korean
+눈을 뜨고 있을 때 따끔거리는 느낌인가요?,Korean
+가스는 장 안에서 차는 것이라서 장이 풍선처럼 빵빵해질 수는 있지만 이로 인해서 주변 장기가 눌리는 경우는 드뭅니다.,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+이후에 대변을 보실 때 경과를 확인해볼 수 있을까요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+유전적 질환은 다른 사람들보다 유전인자를 더 갖고 있어 질환 발병률이 높습니다.,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+큰 문제가 아닐 수도 있지만 우선 자세한 검사는 필요할 것 같습니다.,Korean
+잠을 못 잘 정도로 배가 아픈가요?,Korean
+"혈��검사를 또 하다니. 살살 해주세요.
+",Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+"수상스키 타다가 넘어졌는데 이가 부러져 버렸어요.
+",Korean
+네. 그 약 맞습니다.,Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+숨 쉴 때 통증이 있나요?,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+편하게 숨을 쉬기가 힘든가요?,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+"손목을 커터 칼로 그어버렸어요.
+",Korean
+"집에 불나는 바람에 크게 화상을 입어서 왔어요.
+",Korean
+배만 아팠나요? 다른 곳은 아프지 않았나요?,Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+대변 관련 증상을 확인하기 위해 대변이 마려울 때 말씀해 주시는 것이 좋습니다.,Korean
+오한 증상이 있다고 생각하나요?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+일주일에 몇 갑 정도 흡연하시나요?,Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+사고당해서 입원한 적 있으세요?,Korean
+오랜 공복기나 과식 해도 증상이 있을 수 있습니다.,Korean
+네. 위생 관리 철저하게 할게요.,Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+세 종류의 약을 하루 이 회씩 복용하게 되는데 처방하는 의사에 따라 조금씩 다를 수 있습니다.,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+고혈압과 관련된 약을 평소 복용 중이세요?,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+고혈압 약 혹시 드시고 계세요?,Korean
+어릴 때 간단하게 탈장 수술받은 거 말고는 없었어요.,Korean
+수면제 복용보다 수면 위생을 잘 지키고 있는 지부터 파악해야 합니다.,Korean
+"대변 볼 때마다 항상 어려워요.
+",Korean
+암 치료는 언제부터 받으셨나요?,Korean
+네 마취 특이사항 없다고 알고 있겠습니다.,Korean
+정맥이나 동맥을 천자해서 하는 검사이다 보니 출혈의 위험성이 있습니다.,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+현재 의치나 렌즈 보조기 의안 가발 목발 보청기 심박조율기와 같은 보조 기구 사용하시는 게 있으신가요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+네. 이번 달에 해외 가기 전에 접종도 다 맞고 갔습니다.,Korean
+알레르기 반응 보이시는게 있으신가요?,Korean
+성인이 된 후 음주 습관에 대해 말씀해 주시죠.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+최대로 느낄 수 있는 통증 점수가 십 점이라고 한다면 몇 점 정도였나요?,Korean
+복강경과 개복술 중 어느 방법으로 수술하셨나요?,Korean
+네. 상처 회복이 더 빠를 것입니다.,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+감염 대비를 잘하고 계십니다.,Korean
+"잠잘 시간이 없이 바쁘기도 하고 잠도 잘 안 와서 틈틈이 눈만 붙이고 있어요.
+",Korean
+최근에 스트레스를 많이 받으셨나요?,Korean
+아 그거 이외에 드시는 약은 없으시고요?,Korean
+소독 거즈를 교체하는 경우라면 동네 병원에 가셔도 됩니다.,Korean
+"아뇨.  요새는 수면 시간에 변동이 커요.
+",Korean
+따로 알아 둘 알레르기가 있을까요?,Korean
+"몸을 전체적으로 세로로 나눈다면 반쪽에 마비가 오는 듯해서요.
+",Korean
+토혈 후 어지럽지는 않았나요?,Korean
+야간 약국은 본원 후문에 있습니다.,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+그 말도 맞지만 어디를 통해서 입원을 하셨는지에 대해 환자분의 기본정보가 필요하여 질문을 드린 것입니다.,Korean
+주사를 천천히 놓는 것보다 빨리 놓는 게 더 빨리 끝나고 좋지 않으시겠어요?,Korean
+배를 눌렀을 때와 가만히 있을 때 통증이 어떻게 다른 가요?,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+문제가 생기진 않았는데 약 때문에 가려운 증상이 생길 수도 있습니다.,Korean
+무화과에 반응 있었던 것 같���요.,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+지금 같은 날씨에 회는 식중독을 일으킬 수 있습니다.,Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+육안적 혈뇨가 있는 경우 비뇨기계에 중대한 질환이 있을 가능성이 높으므로 반드시 검사가 필요합니다.,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+"물 설사를 했는데 녹색에 가까운 색이었어요.
+",Korean
+추가 검사를 받으시고 결과에 따라 같이 방법을 모색하면 됩니다.,Korean
+"공예작업 중에요. 피도 나고 쓰리고 욱신거리네요.
+",Korean
+네 수면도 건강에 중요한 요소입니다.,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+알러지 피검사는 일주일에서 열흘까지 걸립니다.,Korean
+사고로 수술 받은 적 있나요?,Korean
+잠을 쉬이 못 드나요?,Korean
+"자주 울고 변을 보는데 힘들어해요.
+",Korean
+간염 증상이 이전에도 있었나요?,Korean
+과민성 방광과 유사한 증상을 일으킬 수 있는 요로감염 요로결석 간질성 방광염 방광암 등 다른 요로계 이상이 없는 경우 과민성 방광 진단을 내릴 수 있습니다.,Korean
+언제부터 피우셨는지 생각나시는 대로 말씀해 주세요.,Korean
+심했다가 나은 건데 처음 진단받은 건 한 육 년 됐어요.,Korean
+복용 중인 수면 보조제의 용량과 복용 기간부터 알려주세요.,Korean
+암은 언제 어디서 진단받았나요?,Korean
+이대로 놔두면 염증이 생겨 열이 나고 균이 퍼질 수 있습니다.,Korean
+몸살 기운이 있으신 거죠?,Korean
+통증은 움직일 때마다 오나요?,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+보통 증상은 일주일이면 낫긴 합니다 하지만 환자분이 오랫동안 걸렸었기 때문에 다른 사람들보다 증상이 오래갈 수밖에 없습니다.,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+환자분 앉아 계실 때 이 베개를 흉부에 가져다 대시고 지지하시면 좀 더 심호흡하기 편하실 거예요.,Korean
+수면 비용은 보험 적용이 되지 않아 만 원이 추가됩니다.,Korean
+네. 그럼 입원 치료는 어떠실까요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+"오한 가슴 답답 가슴 통증 기침 가래가 있어서 병원에 왔어요.
+",Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+어디가 가장 아픈 곳이에요?,Korean
+환자분 주치의께서는 보통 아홉 시 전에는 환자 보러 돌아다니셔요.,Korean
+일주일 전부터 생 음식이나 상하기 쉬운 음식을 드신 적이 있으신가요?,Korean
+작년에 당뇨 진단받아서 요즘 계속 식단 관리 중입니다.,Korean
+"아니요. 뭘 먹어도 목이 따끔거려요.
+",Korean
+햇빛이 닿으면 장기적인 색소침착이 일어날 수 있습니다.,Korean
+부작용이라기보다는 진료 후에 잠이 많이 올 수도 있어요.,Korean
+지금 혹시 변비가 있나요?,Korean
+수유 중이나 수유 후 한 번씩 해 주시면 됩니다.,Korean
+때로는 대소변을 잘 보지 못하는 증상도 해당합니다.,Korean
+네. 수술 방금 끝났어요.,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+"발을 좀 삐끗한 것 같아서요.
+",Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+알약 대신 가루약은 어떠세요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+치료과정 중 약간의 출혈이 있을 수 있습니다.,Korean
+혈압 측정기가 여기 있어서 다시 이곳으로 오셔야 합니다.,Korean
+환자분은 오늘 두부 열상으로 오셨고 퇴원 안내문에는 두부 외상 환자 주의사항이 있습니다. 뒷장에는 열상 환자 주의사항도 있으니 읽어보시면 됩니다.,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+환자분의 기억력 테스트를 위함이므로 다시 한번 말씀 부탁드립니다.,Korean
+백신 접종은 매년 하고 계신가요?,Korean
+월경이 규칙적이더라도 자궁 내 기타 질환이 있을 수 있으므로 초음파 검사 등 기본 검사를 시행하겠습니다.,Korean
+"식사량도 없고 컨디션도 난조라 그런지 물똥 같은 변을 보시더니 일주일 전부터 혈변을 봤대요.
+",Korean
+아까 너무 높게 나와서요 다시 재측정 예정입니다.,Korean
+아니요 여행 이력이나 접종 이력 따로요.,Korean
+네. 사랑니 때문에 이가 아파서 뽑았어요.,Korean
+발기 지속시간이 얼마나 돼요?,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+금방 확인하실 수 있잖아요? 챙겨 먹어야 하는 약이 있으니 오전 중에 돌려주셨으면 좋겠어요.,Korean
+"윗배��� 아파서 허리를 못 펴겠어요.
+",Korean
+보이는 현상만으로 출혈 정도를 평가하기는 어렵습니다.,Korean
+자세한 건 모르겠는데 의사 선생님께서 계속 먹으라고 해서 먹고 있어.,Korean
+마취제 부작용은 심장마비 섬망 증상 마비 시각장애 구토 등이 있습니다.,Korean
+주로 어디가 자주 붓나요?,Korean
+감염 경로 확인차 하는 질문이었습니다.,Korean
+언제부터 결핵인 거 알았어요?,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+투석 진행 후 신기능이 호전을 보이면 투석하지 않을 수 있습니다.,Korean
+열 때문에 몸이 달아오르나요?,Korean
+무조건 큰 병원으로 해주세요.,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+따로 드시는 약 있으신가요?,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+"식욕이 떨어져서 예전에 비해 많이 못 먹어요.
+",Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+이마가 뜨거운 것 같으세요?,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+"코가 막혀 계속 깨서 울었어요.
+",Korean
+손발이 차고 메스꺼운 증상이 많이 심하신가요? 진통제를 드시면 간혹 그런 분들이 계세요.,Korean
+알레르기 때문에 피하는 음식이 있으세요?,Korean
+독감 백신을 맞은 적이 있으신가요?,Korean
+몸이 안 좋다는 게 통증을 말씀하시는 건가요?,Korean
+독감 백신을 맞은 적이 있으신가요?,Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+위에는 증상이 발견되지 않았는데 위산제는 왜 필요하시죠?,Korean
+목이 많이 부을 땐 어떻게 하면 좋을까요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+감염 증상 외의 특이 증상에는 무엇이 있나요?,Korean
+가슴 통증 느끼신 지 얼마나 되신 거죠?,Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+올 초에 파상풍 주사 맞았습니다.,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+"전에 기관지 확장증이라고 진단받았어요.
+",Korean
+일주일만 저희 집에 있다가 요양원으로 가실 예정이에요.,Korean
+"먹긴 먹었는데 다 토해냈어요.
+",Korean
+전반적인 환자분의 상태를 확인 하고 곧 빼 드리도록 하겠습니다.,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+"배는 계속 아팠고 색은 모르겠네요.
+",Korean
+취침 시에도 자주 소변이 마려운가요?,Korean
+일반인들 보다 회복이 더뎌서 오래 걸립니다.,Korean
+"머리 아프면서 속이 좀 메스꺼울 때가 있었어요. 소화도 잘 안 되는 거 같고요.
+",Korean
+약물로 당뇨 치료받고 계세요?,Korean
+진물 등이 차기 때문에 주기적으로 붕대를 갈고 소독해주어야 합니다.,Korean
+"영양소를 음식으로 섭취하려고 많이 먹습니다.
+",Korean
+최근에 수술 언제 받으셨나요?,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+안 됩니다. 기계에 의존하는 호흡은 회복에 도움이 되지 않습니다.,Korean
+"소화가 안 돼서 억지로 토했어요.
+",Korean
+가족 중에 고혈압 질환을 진단받으신 분이 있으세요?,Korean
+진료 센터에서 모두 해드립니다.,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+지금까지 먹었던 약은 별문제 없었어요.,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+우선 약 이름부터 알려 주세요.,Korean
+오메가 쓰리는 중성지방을 떨어뜨리는 역할을 해서 같이 드시면 혈관 건강에 도움이 됩니다.,Korean
+관련하여 의사 면담이 있을 예정이니 자리에서 기다려주시기 바랍니다.,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+태어나서 한 번도 피부과 가 본 적 없어요.,Korean
+발기부전을 겪은 경험이 있으세요?,Korean
+"어깨 쪽에 쏘인 것 같아요.
+",Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+아버지도 유전성 질환을 앓으셨나요?,Korean
+가족 내 암 판정받은 분은요?,Korean
+필요에 의해 처방드린 약이니 꼭 복용하세요.,Korean
+"속이 좀 안 좋으시다더니 구토를 계속하시네요.
+",Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+자주 재발하는 분들은 면역치료를 하시는 것이 장기적으로 도움이 많이 됩니다.,Korean
+의심되는 부위를 손가락으로 짚어 보시겠어요?,Korean
+��번 분기 독감 예방 접종하셨나요?,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+욕창 관리만 잘해 주시면 피부가 더 아프진 않을 거에요.,Korean
+식후 소화가 잘 안되세요?,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+얼마나 아픈지 간단하게 설명 좀 해주시겠어요?,Korean
+시간 맞춰 복용하고 왔습니다.,Korean
+어느 부위에 통증이 심한가요?,Korean
+기능성 소화 장애인 경우가 많으나 기질적 원인일 수도 있습니다.,Korean
+지금 발기 부전으로 문제가 있나요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+태위가 자연분만을 하기 어려우시겠군요.,Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+다 떨어져 가니까 소화제 좀 넉넉히 주세요.,Korean
+네 독감 예방주사 및 대상포진 주사 등이 있습니다.,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+허리가 완전히 회복되기까지는 오랜 시간이 걸립니다.,Korean
+혹시 지금 두통이 있으세요?,Korean
+"최근 한 달 사이에 오 킬로 정도 늘었어요.
+",Korean
+다른 사람의 피가 몸속에 들어가는 게 수혈이에요.,Korean
+진단서 한 부 더 받으시려면 추가 비용이 발생하는데 괜찮으세요?,Korean
+변기에 앉으면 한참 있다가 소변이 나오나요?,Korean
+예를 들면 처방받아서 복용 중인 약이나 주사 맞은 거요.,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+소변량이 체중에 맞게 잘 나오는 것이 확인되고 수액 치료를 통해 질환의 치료가 적절히 이뤄질 때까지 지속적인 소변량 검사가 필요합니다.,Korean
+"급체했는데 속이 답답하다더니 토를 하길래 왔습니다.
+",Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+통증 진행 양상이 어떤가요?,Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+예전에 다쳐서 여기 오신 적이 있으세요?,Korean
+통증이 어느 부위에 있나요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+석 달 전에 이틀 정도 입원했어요.,Korean
+네 전반적으로 다들 아프셨어요.,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+고혈압은 삼 년 넘게 갖고 있었는데 뒷목 잡고 쓰러지신 건 이번이 처음이에요.,Korean
+알약을 가루약으로 조제해 드리겠습니다.,Korean
+치료는 동네 치과에서 받으셨나요?,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+머리는 다른 과에서 검사 받아 보셔야겠어요.,Korean
+부종이 있는 곳이 있나요?,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+추후 분만 시 분만방법이 변경될 수 있기 때문입니다.,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+"배에 가스가 찬 것처럼 빵빵해진 적 있어요.
+",Korean
+입원하신 날짜로 말씀해 주시겠어요?,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+"딱딱한 것 씹다 이가 부러졌어요.
+",Korean
+언제쯤 독감 주사 맞았나요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+이맘때 꽃가루 알레르기가 생기긴 해요.,Korean
+흉터가 아예 안 남지는 않을 거예요. 그렇지만 잘 보이지 않을 만큼 최선을 다해보겠습니다.,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+진료 예약 센터 운영 시간은 어떻게 되나요?,Korean
+전신 마취보다는 하반신으로 하는 게 낫다고 해서 하반신 했었어요.,Korean
+급성 정맥류 출혈의 경우 출혈이 멈춘 후 백 명이 있으면 오십 명 내지 육십 명넘게 일 년 이내에 재출혈 발생확률이 높습니다.,Korean
+복부 팽만감이 있지는 않나요?,Korean
+네 그것 또한 민간요법입니다.,Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+호흡하기 힘들 때가 많나요?,Korean
+"꿰맨 곳 소독하러 왔어요.
+",Korean
+"안에 말고 바깥이 아파요.
+",Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+네 약 처방해 드릴 때까지 조금만 더 기다리세요.,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+언제 통증이 처음 나타나셨어요?,Korean
+피가 섞인 소변을 보신 적이 있나요?,Korean
+피부가 전보다 어두워진 느낌이시라고요? 한번 살펴볼게요.,Korean
+���물 알레르기가 나타나는 약이 있나요?,Korean
+아이가 커 감에 따라 재생속도나 경과를 지켜보고 최대한 후유증이 덜 남도록 해보겠습니다.,Korean
+침을 삼킬 때마다 아프신가요?,Korean
+저희 병원에서 하신 수술이 전부인가요?,Korean
+힘이 나질 않고 무기력함만 느끼시나요?,Korean
+전체적인 구강 체크를 위해 엑스레이를 통해서 확인하는 것도 좋아요.,Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+"얼굴에 좁쌀 여드름이 너무 많이 생겨서 왔습니다.
+",Korean
+귀 뒤에 통증이 있나요?,Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+심장에 문제가 있으면 응급 상황이 발생할 수 있습니다.,Korean
+재발 가능성은 있으나 치료 후 박멸이 확인된 이후의 재발률은 낮습니다.,Korean
+검사 전날 하제를 복용합니다.,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+얼마나 심하게 오한이 느껴지나요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+물리치료 진행하면서 경과를 조금 더 지켜보겠습니다.,Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+네. 입원해서 항생제 치료하자고 하셨어요.,Korean
+의료진이 곧 오니 너무 걱정하지 마시고 침상에서 안정을 취하십시오.,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+카페인을 섭취 후 심계항진 증상은 없었나요?,Korean
+네. 부종이 원인일 수도 있으나 혈관 문제나 허리 디스크 등 여러 가지 문제가 있을 수 있습니다.,Korean
+종양 치료는 다 끝났나요?,Korean
+가족 중에서 고혈압이신 분 계신가요?,Korean
+네 빼고 촬영해야 씨티 화질이 좋아요.,Korean
+동의서에는 검사와 관련된 사항들이 포함됩니다.,Korean
+또 아픈 곳 없나요?,Korean
+그럼요 증상은 말씀해 주세요.,Korean
+동의서에는 검사와 관련된 사항들이 포함됩니다.,Korean
+부정맥 판정은 받았지만 치료는 아직이에요.,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+"무릎을 갑자기 펴기 어려웠던 적이 있어요. 마비는 아니고 그냥 펴지질 않았어요.
+",Korean
+통증이 얼마 만에 오나요?,Korean
+고혈압 진단 받으신 적은 과거에 없으신 거죠?,Korean
+"뼈가 약해서 칼슘 관련 음식 매일 섭취해요.
+",Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+평소에 변의 형태는 어떠셨나요? 색이나 형태가 정상이셨나요? 설사를 하시거나 변비가 있지는 않으신가요?,Korean
+토할 거 같은 증상이 있으세요?,Korean
+당뇨 진단 후에 하시는 운동이 있으신가요?,Korean
+씨티 촬영전에 혈관으로 주입하는 약물입니다.,Korean
+언제 처음 치매 증상이 나타나셨어요?,Korean
+치료에 따라서 부작용이 따라올 수 있죠.,Korean
+부종이 있는 곳이 있나요?,Korean
+독감 주사 같은 경우는 매년 일 회 맞는 게 좋아요.,Korean
+"아니요. 한 번 체온 좀 다시 재 주세요.
+",Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+집 먼지 진드기는 천식을 대표하는 알레르기성 질환의 원인이 됩니다.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+"배변 횟수도 그렇고 상태도 양호한 편입니다.
+",Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+환자분께 직접 확인해야 정확합니다.,Korean
+가래에 피도 같이 나온적 있나요?,Korean
+다음 주 월요일 진료받고 싶은데 몇 시에 가능한가요?,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+"발에 피가 많이 나서요. 정확히 어디에 상처 났는지를 모르겠어요.
+",Korean
+환자분 복용 중이신 약물에 대해 저희가 알고 있어야 해서요.,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+"신장 기능에 문제가 생겼다고 들었던 것 같네요.
+",Korean
+입에서 피 맛이 나나요?,Korean
+사랑니는 제외하고 다른 발치 경험이 있나요?,Korean
+초음파상에 태위가 둔위로 자연분만은 불가능합니다.,Korean
+비형 간염이 양성인지 알려주세요.,Korean
+같은 영양분 용량을 포함하고 있다고 하더라도 흡수율에서 차이가 납니다.,Korean
+복부가 부은 느낌이 있나요?,Korean
+통증이 나타난 곳이 어디신가요?,Korean
+네 물이 차서 무릎을 못 굽히는 거면 무릎 부종입니다.,Korean
+"구토 한번 한 적 있어요. 분수 토.
+",Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+아픈 신체 부위 말씀해주세요.,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+이비인후과에 진료를 받아보시는 것은 어떨까요?,Korean
+네 바로 진통이 없어질 거예요.,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+암 증세가 시작된 건 언제부터인가요?,Korean
+네 문제는 없지만 약 안 드셔도 괜찮으세요?,Korean
+수술 동의서 받을 때 자세히 설명드리겠습니다.,Korean
+간단히 말하면 근육에 손상이 가서 신장 기능에 문제가 생긴겁니다.,Korean
+네 체중 변화가 빨리 올 경우 몸에 피해가 있을 수 있습니다.,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+결핵 주사를 최근에 맞았나요?,Korean
+간염 약 복용 중이십니까?,Korean
+네 중복되는 약물이 있을 수도 있어서요.,Korean
+잘 보셨습니다. 위의 변성 소견으로 정상에 비해 위암 발생 위험성이 높지만 당장 위암이 발생하는 것은 아닙니다.,Korean
+"뭘 먹지도 않았는데 팽만감이 들 때가 있어요.
+",Korean
+네. 지금 바로 퇴원할 수 있게 도와주세요.,Korean
+환자분이 입원하실 자리가 저녁이 늦게 준비가 됩니다.,Korean
+대신 차가운 물보다는 미지근한 물로 드세요.,Korean
+네. 입원을 특히 많이 했죠.,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+"어제 오후부터는 쭉 금식이라 안 마셨습니다.
+",Korean
+일주일 동안 매일 술을 먹나요?,Korean
+"자려고만 하면 여러 가지 생각이 나서 자꾸 잠을 못 자요.
+",Korean
+병원 규정으로 연락가능한 사람이 일인 이상 있어야 합니다.,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+업체 부르는데 집먼지진드기가 살면 안 되죠.,Korean
+"생선 뼈가 목에 걸려서요.
+",Korean
+퇴원 수속하실 때 원무과에 말씀해 주세요.,Korean
+집 먼지 진드기는 습기 있는 침구나 의자 같은 곳에서 사람의 피부를 먹고사는 벌레입니다.,Korean
+내일 산부인과 외래 진료 볼 수 있을까요?,Korean
+오전 외래가 있는 날짜로 잡아드리겠습니다.,Korean
+네 전반적으로 다들 아프셨어요.,Korean
+진단과 치료 계획에 도움이 되기 때문에 기억하실 수 있으면 좋을 것 같습니다.,Korean
+시간 맞춰 복용하고 왔습니다.,Korean
+음식 알레르기 진단을 받은 적이 있나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+"아이가 예전보다 소변볼 때 아파했어요.
+",Korean
+"십 년 전쯤 금연했고 그전에는 하루 한 갑 피웠었습니다.
+",Korean
+입원하는 게 치료에는 더 낫습니다.,Korean
+제 인생 첫 입원입니다.,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+전에 크게 다쳐서 내원하신 적 있으세요?,Korean
+필요하시다면 협진 진료 의뢰 드리겠습니다.,Korean
+이맘때 꽃가루 알레르기가 생기긴 해요.,Korean
+심호흡해도 심장이 빨리 뛰나요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+체온이 몇도 정도 인가요?,Korean
+네 금식을 오래 유지하셔야 해서 수액은 달고 계실게요.,Korean
+퇴원 후 증상이 생기거나 불편한 점이 발생하면 비뇨기과 외래 혹은 응급실로 내원하셔야 합니다.,Korean
+난청이라 청력이 거의 없어요.,Korean
+의학적으로 검증되지 않은 경우이긴 해서 염려되어서요. 효과 보셨던 게 어떤 것이었나요?,Korean
+부종이 있는 곳이 있나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+시간 맞춰 먹는 약이 있어요.,Korean
+결핵 주사를 최근에 맞았나요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+통증은 얼마나 자주 생기세요?,Korean
+지도 길 찾기 기록 좀 확인해볼게요. 서울성심병원에 방문했었네요.,Korean
+대충 한 달 이내에 드신 약 기억나는 게 있으신가요?,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+몸에 부은 곳이 있나요?,Korean
+"다른 덴 안 아파요.
+",Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+현재 통증이 있는 곳은 없으시나요?,Korean
+두통이 계속 지속되고 있나요?,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+식후 계속 속이 불편하신가요?,Korean
+약물 복용 중인 거 있으신가요?,Korean
+정신과 약 먹고 있어요.,Korean
+담배를 피우신 경험이 있나요?,Korean
+몇 년 전에 저온 화상을 입어서 입원해서 치료했었죠.,Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+동의서에 지금 사인을 하셔야 비급여 진통제를 바로 사용할 수 있습니다.,Korean
+음주 기간 얼마나 되셨어요?,Korean
+대변을 매일 보지는 않으시나요?,Korean
+심계항진이 있거나 그러진 않으신가요?,Korean
+"엉덩이 쪽 쏘인 것 같아요.
+",Korean
+안전을 위해서 수술동의서와 마취 동의서를 한 번 더 확인하겠습니다.,Korean
+"오늘 아침에 혈변이 나오고부터 통증이 심했어요.
+",Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+공복 혈당이 어느 정도이죠?,Korean
+"아뇨. 최근에는 한 다섯 시간 정도 자고 있어요.
+",Korean
+보험사에서 진단서랑 입원비 등 서류 달라고 해서요. 관련 서류 부탁드려요.,Korean
+맞아요. 악화를 막기 위해 식단 조절을 바로 시작해 주세요.,Korean
+신체 검진 후 정확한 진단을 위해 복부 씨티 등 검사가 필요할 수 있습니다.,Korean
+담배를 하루에 몇 개비 피우세요?,Korean
+검사를 진행해 봐야 알겠지만 수술이 필요한 케이스 같습니다.,Korean
+이상 증상이 있으면 응급실로 오란 말씀이시죠?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+소변보고 닦을 때 피가 묻어나오진 않나요?,Korean
+여기서는 처음인데 다른 병원에서는 촬영한 적이 없으시나요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+네. 그저께 독감 주사 맞았어요.,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+잘 협조해 주셔서 감사합니다. 예정대로 검사 진행하겠습니다.,Korean
+언제부터 지루성 두피염이 있었나요?,Korean
+아이가 요즘 소변 대변을 통 못 보는데요.,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+검사 결과 나오려면 한두 시간은 기다리셔야 합니다.,Korean
+이 약이 바닥에 떨어져 있었어요.,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+신장 결석 염증 종양을 의심할 수 있습니다.,Korean
+척추 있는 쪽이 좀 저릿저릿해요.,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+복부 팽만감이 있던 적 있나요?,Korean
+수술은 잘되었으니 이제 남은 건 환자에게 달렸습니다.,Korean
+그 약만 먹으면 몸이 너무 나른해지고 힘이 없어져요.,Korean
+통증 주기가 어느 정도 될까요?,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+암이 있다는 것을 언제 알게 되었나요?,Korean
+소화가 어렵거나 하진 않나요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+결핵 때문에 병원 간 적 있으세요?,Korean
+간염 때문에 병원 치료받고 계신가요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+칼슘을 피해야 하는 질병을 앓으시는 환자분들도 계시지만 환자분은 충분히 드시면 됩니다.,Korean
+"가래가 요즘 부쩍 많아졌어요.
+",Korean
+피부반응으로 대체하면 시간도 오래 걸리고 정확한 원인을 찾기 위해 반복해서 검사해야 합니다.,Korean
+급성 담낭염으로 일주일 전에 수술을 한 적이 있어요.,Korean
+당뇨 나온 적 있으세요?,Korean
+가래에 피도 같이 나온적 있나요?,Korean
+"여기 가장 끝의 이빨이요.
+",Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+몸살 난 것처럼 몸이 으슬으슬 떨리나요?,Korean
+"혈변은 이번에 처음 누는 거 같아요.
+",Korean
+그럼 전에 검사하셨을 때 문제 없으셨던 건가요?,Korean
+건강 검진도 주기적으로 받는 게 중요해서요 받은 지 오래 되었으면 한 번 더 해보시죠.,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+혈압이나 심전도 상태를 보고 저희가 옮겨드릴거에요.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+심호흡해도 심장이 빨리 뛰나요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+아이가 태어나고 난 뒤 탯줄에서 채취하기 때문에 아이에게 영향은 없습니다.,Korean
+부어오른 증상 외에 다른 증상은 없으세요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+식사 후에 소화는 잘되시나요?,Korean
+덩어리를 만졌을 때 맥박 뛰는 느낌이 느껴지는지 여쭤보는 것이지 꼭 느껴져야 하는 건 아니에요.,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+독감 주사 언제 맞았어요?,Korean
+과식을 하지 않아도 소화가 되질 않나요?,Korean
+빈속에도 구토 증상이 있나요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+네 수술이 제일 효과적이긴 합니다.,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+"냄새나는 액체가 눈에서 나와요.
+",Korean
+단순히 접촉성 피부염일 수도 있습니다.,Korean
+침 삼킬 때 아픈가요?,Korean
+요즘 이용하신 병원을 알아야 하거든요.,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+네 아니면 지금 혈액 검사받으시겠어요?,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+흡연 기간은 어느 정도이신가요?,Korean
+잠을 잘 못 자거나 몸에 상처가 있거나 발진은 없나요?,Korean
+건들지 않으시면 피는 안 나요.,Korean
+아니요 지금 상태에서는 담배를 피우면 안 됩니다.,Korean
+휠체어 있는 곳으로 안내해드릴게요.,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+간염 언제부터 앓고 계신가요?,Korean
+오늘 드실 약은 남겨 놓고 주세요.,Korean
+"아주 잘 눠요. 군 고구마 같아요.
+",Korean
+겨드랑이 쪽 시술을 한 번 받고 일주일 정도 입원했던 적이 있어요.,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+흉부에 불편한 곳이 있나요?,Korean
+환부를 씻어내고 소독약을 바른 후 테라마이신 바세린 거즈 등을 붙입니다.,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+가족 중에 암 판정을 받으셨던 분이 있나요?,Korean
+수면 보조제를 드시고 계시네요. 변화는 있었나요?,Korean
+코에다 하루 한두 번씩 뿌려 주는 약물이 비강 스테로이드입니다.,Korean
+흡연 기간이 얼마나 될까요?,Korean
+밤에 잠이 잘 안 오세요?,Korean
+네. 사랑니 한 개 뺐어요.,Korean
+"몇 달 전부터 숨이 턱턱 막히고 숨을 쉴 수가 없을 것 같다는 느낌이 있었거든요. 처음엔 별일 아니겠거니 했는데 요새 들어서 자주 그런 증상이 있어서 검색해봤더니 공황장애 뭐 이런 게 아닌가 싶어서 와봤습니다.
+",Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+물집이 잡힌 경우 이 주에서 사 주 가량 통증을 호소할 수 있습니다.,Korean
+"두통이 심해지니깐 처음엔 어지럽기만 했는데 이제는 몸까지 아픈 느낌이 들어요.
+",Korean
+입으로 피를 토한 적이 있나요?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+"뼈가 약해서 칼슘 관련 음식 매일 섭취해요.
+",Korean
+"해산물 먹으면 토해서 아예?못 먹어요.
+",Korean
+아픈 것을 점수로 매길 거에요. 하나도 안 아프면 영점 자다 깰 정도로 아프면 오점 죽을 만큼 아프면 십 점이라고 했을 때 몇 점 정도로 아프신가요?,Korean
+드시고 계신 약과 처방한 약이나 주사의 성분이 충돌하지 않게끔 조절하기 위해 성분을 분석하는 겁니다.,Korean
+정확히 검사를 해보는 게 낫겠네요.,Korean
+네. 유방암 치료 중이에요.,Korean
+기침할 때 다른 증상이 있나요?,Korean
+얼마나 아픈지 표현해 주세요.,Korean
+하루에 가래를 얼만큼 뱉으시나요?,Korean
+소화될 때 어려움이 있나요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+수면과 관련하여 드시는 약이 있는지 확인이 필요한 부분이라 여쭤봤습니다.,Korean
+일단 육안으로는 아무 이상 없습니다.,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+진통제 넣은 지 얼마 안 됐으니 효과가 나타날 겁니다.,Korean
+아픈 신체 부위 말씀해주세요.,Korean
+정확한 병원명 알고 계시면 말씀해 주세요.,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+고혈압 진단 받은적 있나요?,Korean
+"소화도 잘 안 되고 계속 신물이 넘어와요.
+",Korean
+약 먹은 지는 오 개월 째고 지금 없어요.,Korean
+네 뜸이나 부항 뜨신 적 있으신가요?,Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+오늘 코로나 검사 결과 나올 때까지 마스크는 벗지 않으실께요.,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+주로 어디가 자주 붓나요?,Korean
+"아니요. 임신 계획이 있어�� 피지 않아요.
+",Korean
+"네. 밥 먹을 때마다 그랬어요.
+",Korean
+우선은 이틀 치까지만 처방 됩니다.,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+따로 드시는 약 있으신가요?,Korean
+가족 중에 암 진단받은 식구가 있을까요?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+안검하수 교정 수술을 몇 년 전에 받았습니다.,Korean
+"코가 막혀 계속 깨서 울었어요.
+",Korean
+간염으로 치료 받고 있나요?,Korean
+의식상태를 파악하기 위한 검사입니다.,Korean
+"눈이 침침하고 잘 안 보여.
+",Korean
+어떤 수술 했는지 알려주세요.,Korean
+무엇 때문에 병원에 왔나요?,Korean
+아니요 약 드시는 거에 문제는 없습니다.,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+사람의 각질 있는 곳에 진드기가 나타납니다.,Korean
+마취부터 회복까지 세 시간 걸릴 예정입니다.,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+"분유 말고는 먹은 게 없는데 설사를 해서요.
+",Korean
+피를 토할 때 위도 아픈가요?,Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+네 수술 때문에 입원하시는 거예요.,Korean
+발기가 평상시에 안 되시나요?,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+통증이 자주 생기는 편인가요?,Korean
+가스가 차면서 방귀를 못 뀌고 변을 못 본다면 장이 막혔을 수 있습니다. 하지만 방귀도 나오고 변도 보면서 가스가 찬다면 증상 조절 약을 드릴 수 있습니다.,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+정밀 검사 더 받아보셔야겠어요.,Korean
+결핵으로 약 드시고 계세요?,Korean
+유제품 알러지가 있어서 식단 제한이 필요합니다.,Korean
+남성 호르몬제를 좀 먹어요. 제가.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+주사뿐 아니라 복용 중이신 약도 말씀해 주시면 됩니다.,Korean
+"잘은 모르고 식도에 문제 있다는 건 알아요.
+",Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+"얼굴 근육에 장애가 있는 것 같아서요.
+",Korean
+피 수치가 많이 떨어져 있어서 수혈받으셔야 합니다.,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+가족 중에 고혈압이신 분 있어요?,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+가족 중에 누가 당뇨 있으시죠?,Korean
+진단서 한 장 더 뽑으려면 만 원의 추가 비용이 듭니다.,Korean
+얼마 동안 비슷한 증상이 나타났나요?,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+결핵 증상이 언제부터 나타났나요?,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+아직 온몸에 열 기운이 있어요.,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+전에 수술한 경험 있으세요?,Korean
+들이 마시고 내쉬는 심호흡을 해주셔야 합니다.,Korean
+간혹 마취크림에 민감한 반응을 일으키는 분들이 있습니다.,Korean
+네. 보호자분 우선 아이가 많이 힘들어 보여서 병실 안내부터 도와드리겠습니다.,Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+뜨겁게 아파요? 아니면 욱신거리세요?,Korean
+삼 년 전인가 야구공에 코를 잘 못 맞아서 코뼈가 부러진 거예요. 그래서 수술했었어요.,Korean
+"가습기 안 사용하는 집도 있나요.
+",Korean
+"말도 어눌해지고 남이 하는 말도 알아듣기가 힘들어요 요새는.
+",Korean
+언제부터 알레르기 약을 복용하기 시작했어요?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+목 아픈 건 나으셨어요?,Korean
+잠을 쉬이 못 드나요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+곧 병실 들어가실 거예요.,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+환자분 의식이 없으면 연락드려야 합니다.,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+흉터의 크기를 보려고 말씀드렸는데 보여주실 수 있으신가요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+호흡곤란이 많이 심했나요 그때?,Korean
+어느 부위가 만지면 아프신가요?,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+고혈압은 어떻게 ��료 중이세요? 약물 복용을 하고 계신가요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+편하신 팔로 내밀어 보세요 혈압 측정하겠습니다.,Korean
+지금은 약을 꾸준히 바르는 방법밖에 없어요.,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+그런 약은 어디에도 없습니다.,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+추가 검사는 환자분 상태에 따라 추가할 예정입니다.,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+요의는 있는데 소변이 나오지는 않았던 적이 있었나요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+인후통의 통증 정도를 말씀해 주세요.,Korean
+입으로 피를 토한 적이 있나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+몸이 많이 피로하다고 느끼시나요?,Korean
+가슴 통증이 있지는 않나요?,Korean
+일주일 음주량이 어떻게 되세요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+네. 수술 후 특별한 문제가 없으시다면 빠른 시일 내에 퇴원이 가능합니다.,Korean
+아프신 이유가 암 때문인가요?,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+술은 며칠 간격으로 마시나요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+멸균된 붕대를 감아야 상처 부위가 보호됩니다.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+아이가 편안하게 숨 쉴 수 있도록 앉은 자세로 두세요.,Korean
+설사를 하신 경험이 있나요?,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+"다리가 후들거리고 힘이 없어요.
+",Korean
+전자담배 핀 적 있습니까?,Korean
+수술이 끝난 후 퇴원 날짜가 정해집니다.,Korean
+특별히 혈액형 검사를 원하시는 이유가 있나요?,Korean
+얼마 동안 비슷한 증상이 나타났나요?,Korean
+아니요. 방광을 채워야 가능한 검사가 예정되어 있습니다.,Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+알약을 삼키기 힘들어하시는 건가요?,Korean
+"선생님. 저희 아기 고환이 이상한 것 같아요. 맞나요?
+",Korean
+어느 부위에 통증이 있어요?,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+청진이 끝날 때까지 심호흡 반복해 주세요.,Korean
+"삼 일 전서부터 아이가 열이 안 떨어져요.
+",Korean
+아니요 퇴원 수속 다 하신 후에 하셔야 해요.,Korean
+월경량이 보통 패드로 얼마나 되나요?,Korean
+최근 들어 아프기 시작했나요?,Korean
+혹시 입원 생활에 대한 궁금하신 부분 있으실까요?,Korean
+통증이 어떤지 설명해 보실래요?,Korean
+선생님께서 보시고 타과 협진이 필요하신 경우 같이 진료를 보실 수 있습니다.,Korean
+잇몸치료 한 적 있어요.,Korean
+가족 중에 암을 앓으신 분들이 많은가요?,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+숨을 쉴 때 기도가 따가워요.,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+담배는 하루에 몇 갑 피시나요?,Korean
+다른 병원에서 진료받으려는 이유가 있을까요?,Korean
+위의 내용물이 식도로 넘어오는 위식도역류증이 흔한 원인입니다.,Korean
+"심하게 아프면 열도 나요.
+",Korean
+휠체어는 안 타도 될 것 같은데 꼭 타야 하나요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+"소변 냄새가 고약해서 가족들이 제가 화장실에 간 다음 화장실에 안 가려고 해요.
+",Korean
+너무 걱정하실 필요는 없습니다 수술을 통해 신경세포가 있는 장을 항문까지 내리게 됩니다.,Korean
+"뱃속에 뭔가 차 있는 느낌이어서요.
+",Korean
+평상시 음주 여부 말입니다.,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+일단은 반복적으로 손목 움직임을 피하셔야 합니다.,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+"고환이 퉁퉁 부어 있네요.
+",Korean
+얼마나 아프신지 표현해주실 수 있을까요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+고혈압과 관련하여 받은 치료는 모두 알려주세요.,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+통증이 가장 잘 느껴지는 부위가 어디예요?,Korean
+"네. 열 시 이후로 금식했습니다.
+",Korean
+결핵 수치가 높은 편이신가요?,Korean
+과학적으로 입증되지 않은 민간요법의 경우 오히려 간 독성을 초래해서 크게 위험할 수 있으니 자제하세요.,Korean
+현재 수술시간은 점심시간 전후로 잡혀 있습니다.,Korean
+알레르기를 오래 앓고 있었나요?,Korean
+아픈 건 어느 정도인가요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+결핵이 발병하신 적이 있나요?,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+또 아픈 곳 없나요?,Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+입원 전까지 정밀검사를 도와드릴게요 잠시만요.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+대변볼 때 피가 묻어나나요?,Korean
+피 소변을 보시진 않나요?,Korean
+주로 어디가 가장 아프세요?,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+약 성분에 알레르기 반응을 일으키는 게 있었다면 그럴 수도 있겠네요.,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+"위가 너무 아파서 배까지 아파요.
+",Korean
+식후 계속 속이 불편하신가요?,Korean
+눈에 띄는 증상이 있나요?,Korean
+현재 간 수치가 높은 편인가요?,Korean
+사출성 구토의 원인 중 감염이나 식중독에 의한 경우 호전까지 시간이 걸리는 경우가 많습니다.,Korean
+꾸준히 치료한다면 몇 개월 내로 좋아질 겁니다.,Korean
+과거에 수술받으신 적 있나요?,Korean
+간염약을 드시고 부작용이 있으신가요?,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+많이 아프셨다니 정밀 검사를 해 봐야 정확히 알겠네요.,Korean
+시간이 지나면서 약에 효과가 떨어질 수도 있고요.,Korean
+몸에 열이 있지는 않으세요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+유전성 질환 가족력 있나요?,Korean
+"밥 먹고 나서 십 분에서 십오 분쯤 지나면 거의 토를 해서 항상 주시했어요.
+",Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+수술 후 빨리 폐를 펴주는 것이 중요합니다.,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+담배는 자제하시는 게 좋아요,Korean
+혹시 다른 수술하신 적이 있다면 수술할 때 참고해야 하기 때문입니다.,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+소변볼 때 문제 있으셨어요?,Korean
+어떠한 치료를 하는가에 따라 병원비는 달라질 수 있습니다.,Korean
+"열이 며칠째 계속되고 있어요.
+",Korean
+통증이 지속되는 시간이 긴가요?,Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+아니요. 예정 된 수술은 수혈을 꼭 필요로하지 않습니다.,Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+전원 가실 병원을 알아보고 있으니 기다려주시기 바랍니다.,Korean
+알레르기로 조심하시는 음식 있나요?,Korean
+암은 언제 어디서 진단받았나요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+"기침이 자주 나고 가래가 끓는데 가래에 피가 섞여 있어요.
+",Korean
+전원을 가게 되면 전원 가신 병원에서도 다시 진료를 보셔야 하고 그에 따른 비용이 발생하실 수 있습니다.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+화상 상처부위를 소독하기 위한 약의 이름입니다.,Korean
+난소 기능을 확인하는 검사를 해보겠습니다.,Korean
+비수면내시경이지만 수월한 편이며 사람에 따라 차이는 있을 수 있습니다. 대장 내시경보다는 수월합니다.,Korean
+입원치료는 아니셨나요? 가벼운 열상치료는 괜찮습니다.,Korean
+식도의 문제일 수 있습니다.,Korean
+성형외과는 무슨 일로 가셨나요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+외래 진료받고 선생님께서 입원 권유하셔서 입원했어요.,Korean
+위궤양과 같은 질환이 원인이 되기도 합니다.,Korean
+삼 개월 후에 금식하시고 피검사 하시러 오시면 됩니다.,Korean
+통증이 느껴진다면 어떤 느낌인가요?,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+어느 정도로 아프신지 표현이 가능하세요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+아니요 진통제가 위험한 게 아니라 치료 과정에서 진통제를 투여하겠다는 동의를 받는 겁니다.,Korean
+알레르기 진단받은 연도는 어떻게 되나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+두통 때문에 잠들기 어렵지는 않나요?,Korean
+"사람이 많은 자리에 가면 식은땀이 나고 손발이 차가워���는 현상이 최근 들어 자주 나타나 오게 되었어요.
+",Korean
+저 마취가 너무 잘 들어서 잠을 잘 못 깨 가지고 저보고 수면 마취 같은 거 안 하는 게 좋을 것 같다고 했었어요.,Korean
+아직 복부에 붓기가 남아있나 봅니다.,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+퇴원 수속 관련 설명을 들으셨다는 동의서입니다.,Korean
+긁지 마시고 보습제 잘 사용해 주세요.,Korean
+의사 선생님 소견서랑 진단서 좀 주세요.,Korean
+네 확인하고 엑스레이 찍으러 가는 게 좋겠네요.,Korean
+맥박이 얼마나 빨리 뛰죠?,Korean
+배도 같이 아프신 거죠?,Korean
+보호대 착용은 손목의 움직임을 줄이고 손목터널 내 압력을 줄여주어 신경 압박에 의한 증상을 줄일 수 있습니다.,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+천식을 앓으신 적이 있으시다고요?,Korean
+주치의와 상담 받으시고 필요시 처방대로 복용하시면 됩니다.,Korean
+우선 심전도 검사를 진행한 후 말씀드리겠습니다.,Korean
+체위변경을 자주 해주시면 욕창이 진행되는 것은 막으실 수 있습니다.,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+"우울한 날엔 과식을?하게 돼요.
+",Korean
+아니요 기형에 관련된 수술이 아니라면 괜찮습니다.,Korean
+변에 피가 섞여 나오나요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+"군대에서 작업 시간에 삽질하게 되었는데 오른쪽 어깨에서 톡 하는 소리가 들리더니 그 이후로 어깨가 자꾸 아프게 되어 오게 되었습니다.
+",Korean
+"요즘 들어 기력이 자꾸 빠지는 것 같아요.
+",Korean
+검진 이후에 또 몸 상태가 달라졌을 수도 있어서 재차 검사가 필요합니다.,Korean
+네 그럼 환자 팔찌 오른손에 하겠습니다.,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+눈 좀 붙여도 될까요?,Korean
+모계 쪽 자궁 질환이 있어요.,Korean
+혈압 안 높아지게 잘 유지하고 있나요?,Korean
+발기 지속시간이 얼마나 돼요?,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+"여덟 시간은 자는 것 같아요.
+",Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+가족 중에 누가 고혈압 당뇨 질환이 있나요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+간염 검사 관련 양성인가요?,Korean
+아니요 기형에 관련된 수술이 아니라면 괜찮습니다.,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알콜 솜으로 눌러 보세요.,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+입원이 꼭 필요한 검사입니다.,Korean
+"천식이 있는 것도 아닌데 쌕쌕거려요.
+",Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+이따가 좀 더 쉽게 설명해 드릴게요 지금 초음파 설명 일단 간략하게 하고 나서요.,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+"배가 약간 아프긴 했었어요.
+",Korean
+네. 엑스레이 찍으면 보여요.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+아니요 민간요법보다는 의학적인 치료법이 정확한 거니까요.,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+음식을 토한 적이 있으신지요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+이십 년 전에 입원했었는데 굉장히 오래됐어요.,Korean
+아니요. 병력은 없는 것 같아요.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+어머니가 요양원에 계셔서 다녀왔어요.,Korean
+"왼쪽과 오른쪽의 붓기가 달라요.
+",Korean
+"배탈이 난 것 같아요.
+",Korean
+삼 개월 후에 금식하시고 피검사 하시러 오시면 됩니다.,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+당뇨 처음 치료받은 게 언제시죠?,Korean
+하루에 한 번도 대변을 못 보시나요?,Korean
+진통제는 정말 견디기 힘들 때 처방해 드리겠습니다.,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+소화제가 거의 떨어졌어요. 소화제도 넉넉히 처방해주세요.,Korean
+아니요. 수술 부위에 염증이 생겼는지 아프고 상처가 잘 아물지 않던데요.,Korean
+"각막 상처 때문에 눈이 붓고 쓰라려요.
+",Korean
+어디가 부은 느낌이 있으세요?,Korean
+"약에는 의존 안 하려고 노력하고 있어요.
+",Korean
+네 맞습니다. 환자분 본인도 수술부위에 대해 인지하고 계셔야 합니다.,Korean
+씨티 뿐만 아니라 엠알아이도 찍어야 할지 몰라요.,Korean
+아이가 귀에 문제가 좀 있���요.,Korean
+몸살 난 것처럼 몸이 으슬으슬 떨리나요?,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+너무 오랜 기간 저염식을 하시게 되면 오히려 전해질 이상을 초래할 수 있어요.,Korean
+"예민해서 잠을 깊게 들 수가 없어요.
+",Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+일단 봉합된 부위는 이틀마다 외과에 가셔서 소독 받으셔야 합니다.,Korean
+가스 활명수 외에 다른 소화제 같은 건 안 드시고요?,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+현재 가족 중에 유전성 질환을 치료 중인 분 있나요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+네 진료 센터에서 모두 해드립니다.,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+혈압 수치 알고 계세요?,Korean
+검사에 걱정되는 점이 있으신가요?,Korean
+식사 후 음식이 소화가 잘 안되시나요?,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+몸에 열나는 것 같나요?,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+기능성 소화불량의 경우 보존적 치료로 개선되는 경우가 많습니다.,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+대변에 물이 많이 섞여 나오나요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+최근 두 달 안에 급격한 체중 변화가 있었나요?,Korean
+배 안에 가스가 많다는 것을 의미합니다.,Korean
+네. 감기 기운이 있어서 감기약을 좀 먹였어요.,Korean
+"아버지가 정신을 잃으신 것 같아요.
+",Korean
+"코피가 몇 시간째 흘러서 왔어요.
+",Korean
+네 아주 어렸을 적부터 기억나시는 모든 입원 말씀해 주세요.,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+어떤 약에 알레르기가 있으시죠?,Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+처음에는 마취 때문에 잘 모르다가 마취가 풀리면 많이 아픕니다.,Korean
+통증 부위가 머리 쪽 맞나요?,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+심각하게 피로감을 느끼시진 않나요?,Korean
+"배가 찢어질 것 같이 아파서 왔어요.
+",Korean
+많지 않으나 부작용을 호소하시는 분들도 계시니 증상이 있는 경우 바로 말씀 주세요.,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+변이 묽게 나오는 정도인가요?,Korean
+혹시 가려움증도 같이 느껴지시나요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+어떤 약 처방 받으셨어요?,Korean
+언제 이런 통증을 느끼셨어요?,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+결핵 접종 하셨나요 ?,Korean
+"잘 때 숨쉬기가 힘들어서 자꾸 깨서 왔어.
+",Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+"변을 보면 기름이 살짝 떠요.
+",Korean
+입원하여 필요한 검사들을 하고 치료를 할 예정입니다.,Korean
+요즘 코로나 때문에 아무 데도 안 갔다 왔어요.,Korean
+몇 년이나 담배 피웠나요?,Korean
+침 삼킬 때 아픈가요?,Korean
+계속 토할 것 같은 느낌이 있으신건가요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+당뇨 증세가 시작된 건 언제부터인가요?,Korean
+가족 중에 치료가 필요할 정도의 당뇨를 진단 받으신 분이 계신가요?,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+"아프기 전 며칠간 몸이 피로하고 잠도 깊이 자질 못 하긴 했어요.
+",Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+혈뇨의 원인 중 가장 흔한 것이긴 합니다. 우선 검사해보기 전이니까 걱정하지 마시고 여러 가지 케이스를 설명해 드리려 합니다.,Korean
+어떨 때 설사를 하나요?,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+간염으로 인해 병원에 방문한 적이 있나요?,Korean
+처방받는 데 얼마 안 걸려서 오래 기다리시지 않아도 돼요.,Korean
+얼마나 아픈��를 말해 줄 수 있으십니까?,Korean
+입원 및 통원 치료 결정은 의사와 상의하셔야 합니다.,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+"눈에 핏줄이 터져서 눈이 온통 빨개서 왔어요.
+",Korean
+네 그러면 여기 입원 생활 안내문 아래에 사인해 주세요.,Korean
+정확한 병원명이 기억이 안 나요.,Korean
+종교적인 이유로 수혈을 거부하시는 분들도 계십니다.,Korean
+병원의 지시를 잘 따르시면 흉터가 덧나지 않습니다.,Korean
+치료 전 비슷한 증상을 호소하는 다른 질환들을 감별하고 질병의 진행 정도를 확인하기 위한 검사가 필요합니다.,Korean
+"네 맞습니다. 요새 계속 살이 빠져요.
+",Korean
+당뇨 가족력을 갖고 있나요?,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+피와 소변이 함께 나오나요?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+몸이 붓는 건 그대론가요?,Korean
+흡연 상태 유지 중이신가요?,Korean
+작년에 파상풍 주사 맞았어요.,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+입원이나 수술하신 적 있어요?,Korean
+현재까지 유전성 질환 진단받은 분이 있나요?,Korean
+네. 그냥 증상을 참고 지내시다가 심한 위장관계 증상으로 응급실에 방문하는 경우도 많이 있습니다.,Korean
+네. 감기약 약국 가서 사 먹었어요.,Korean
+대변볼 때 피가 나오나요?,Korean
+네. 비형 간염 맞으셔야 합니다.,Korean
+"아니요. 몸에서 술을 못 받아서요.
+",Korean
+통증이 생기면 얼마나 가나요?,Korean
+통증 양상의 특징점이 있나요?,Korean
+"아 네. 고름이 잡힐 때마다 집에서 가능하면 짜려고 하는데 그러면 더 번지는 것 같아요.
+",Korean
+칼슘을 피해야 하는 질병을 앓으시는 환자분들도 계시지만 환자분은 충분히 드시면 됩니다.,Korean
+체중 증가가 어느 정도죠?,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+독감 예방 주사는 이미 맞으신 거죠?,Korean
+"자꾸 목에서 피 맛이 느껴져요.
+",Korean
+얼마나 자주 통증이 발생하나요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+"애가 백 원짜리 동전을 삼켰어요.
+",Korean
+"아니요. 목 근육 부분이오.
+",Korean
+몇 살 때부터 피우셨나요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+네. 저희 가족이 다 비염이 있어서 자주 그렇게 해요.,Korean
+"어. 무슨 소변보는 쪽에 염증이 났다고 그러셨던 것 같은데.
+",Korean
+네 그냥 흉터가 있는지 말씀해 주시면 돼요.,Korean
+현재 간 수치가 높은 편인가요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+통증이 어떤 거 같으세요?,Korean
+간염 치료 병력이 있나요?,Korean
+항상 두드러기 증상이 있나요?,Korean
+아마도 타이레놀이었던 것 같아요.,Korean
+네. 작년에 감기가 너무 심해서 입원했었어요.,Korean
+"소화가 잘 안돼서 불편해요. 요즘.
+",Korean
+"아이고. 온몸이 다 쑤셔요.
+",Korean
+약물 알레르기 있는 거 있으세요?,Korean
+네. 내과 선생님 맞습니다.,Korean
+아니요. 수술 부위에 염증이 생겼는지 아프고 상처가 잘 아물지 않던데요.,Korean
+안녕하세요. 김지현님! 수술하고 잘 지내셨나요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+"코에 피가 나가지고 왔어요.
+",Korean
+대부분 심각한 합병증 없이 회복이 가능하여 단기간 입원 후 퇴원 가능합니다.,Korean
+혹시 기력이 떨어졌다고 느끼세요?,Korean
+치과 치료 외에 병원에 가 본 기억이 없어요.,Korean
+"대변볼 때마다 아랫배에 통증이 매우 심하네요.
+",Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+수술한 후에 후유증이 있나요?,Korean
+"병원 오기 세 시간 전부터 계속 아프더라고요.
+",Korean
+위의 내용물이 식도로 역류되어 시큼한 것이 올라오는 느낌으로 나타나기도 합니다.,Korean
+토할 때 피도 나왔나요?,Korean
+엑스레이 하기 전에는 흡연은 삼가주세요.,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+"집에 일이 생겼는데 놀란 이후로 가슴이 두근거리고 불안해요.
+",Korean
+방광염 등 요로감염이 있을 경우에도 급박뇨가 발생할 수 있습니다.,Korean
+단순 신우염은 극히 드물고 대부분 신우신염이며 임상적으로 감별하기 어렵습니다.,Korean
+침 삼킬 때 아픈가요?,Korean
+병원 내 게시판이나 입원 안내문에 확인 가능하십니다.,Korean
+���변이 나올 때 피가 나오나요?,Korean
+통증이 많이 심한가 봐요?,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+언제부터 손이 저림증상이 있었나요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+그냥 대변도 여기 병실에서 봐도 되는 건가요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+암을 진단받은 가족이 있습니까?,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+알레르기 있는 음식 아시나요?,Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+기존 병원이 지금 휴진 상태라 이쪽으로 옮기려고요.,Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+일주일에 술 몇 번 드시는 거 같아요?,Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+가족 중 유전성 질환을 경험하신 분이 있으십니까?,Korean
+기침할 때 피가 터져 나오나요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+얼마나 자주 아픔을 느끼나요?,Korean
+"금연했는데 술 마시면 한두 개비 피우게 되더라고요.
+",Korean
+몸이 뜨거운 적이 있나요?,Korean
+수술 부위 피부 바로 위에 해주시면 됩니다.,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+네 증상이 재발하지 않는 한 지금은 이 검사로 충분합니다.,Korean
+몸살이 있었다면 예방접종 후 면역력이 떨어져서 더 안 좋을 수도 있습니다.,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+"귀 표피 부분이 전체적으로 간지럽고 수포 증상이 있어요.
+",Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+기간은 길지만 집에서 가끔 경구투여 약물을 사용하는 거라 큰 부담은 없으실 겁니다.,Korean
+수술했던 병원 명을 알고 계시다면 알려주세요.,Korean
+성형 수술이라고 생각하시면 됩니다.,Korean
+당뇨 있는 건 아니시죠?,Korean
+아픈 게 어느 정도 지났나요?,Korean
+보통은 더부룩하고 가스가 찬 느낌을 많이 호소합니다.,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+가래에서 냄새가 많이 나나요?,Korean
+혈액검사는 간호사분께서 도와주실 거예요. 의사 선생님께 직접 검사받고 싶으신가요?,Korean
+생리 식염수를 이용해서 화상 부위를 닦아내고 있습니다.,Korean
+오른쪽 무릎 전방십자인대 파열로 수술 예정입니다.,Korean
+백신 접종은 매년 하고 계신가요?,Korean
+얼마 전까지 우울증을 앓았는데 최근에 완치했어요.,Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+집 먼지 진드기는 사람들이 사는 곳 어디든 존재한다고 보시면 됩니다.,Korean
+통증이 한 번씩 오나요?,Korean
+원래 알고 계신 혈액형이 어떻게 되세요?,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+얼마나 받느냐에 따라 다르지만 주기적으로 받아야 하는 치료이기 때문에 비용 면에서 부담이 되실 수 있어요.,Korean
+"변을 잘 못 본 지 며칠 됐어요.
+",Korean
+아니요. 예방접종 안 받았어요.,Korean
+간염으로 무슨 약 드세요?,Korean
+네 혹시 두통이 있으신가요?,Korean
+"그냥 좀 몸에 열이 오르는 정도구나 했었는데 점점 심해지더라고요.
+",Korean
+객혈을 한 시기에 따라 병명이 달라질 수가 있어서입니다.,Korean
+"방광 쪽으로 출혈이 있다고 들었던 것 같은데요.
+",Korean
+혈액검사 소변검사 엑스레이 촬영 조직 검사가 진행될 겁니다.,Korean
+소변을 볼 때 피가 보이나요?,Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+발기 부전 증상이 있으세요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+통증 반응이 있는 부위가 어디에요?,Korean
+그건 환자분의 주치의와 상담 후 결정해봐야겠네요.,Korean
+당뇨 관리 언제 시작하셨어요?,Korean
+어떤 증상이 견디기 힘들던가요?,Korean
+목에 아픈 증세가 있나요?,Korean
+"움직이기만 하면 허리가 찌릿거리고 아파서 소름이 끼쳐요.
+",Korean
+식사 후 음식이 소화가 잘 안되시나요?,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+위 점막이 부분적으로 두꺼워져 있고 그로 인해 주름이 두꺼워져 보이는 것입니다.,Korean
+꾸준한 드레싱과 청결유지가 필요합니다.,Korean
+"가래가 너무 끼고 말을 못 하겠어요.
+",Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+운동을 할 때 이외에도 증상이 있나요?,Korean
+가족의 동의가 없어도 제 의지로 수술할 수 있나요?,Korean
+아침에 복용해야 하는 약이세요.,Korean
+"이 부분 드레싱 해주실 수 있으세요?
+",Korean
+지금 빈혈 증상을 호소하는 것 같아서.,Korean
+유전 질환 가진 식구는 없습니다.,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+실제로 토하신 적 없으세요?,Korean
+손목 때문에 진통제 몇 알 먹은 거 말곤요.,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+수술하는 질병이 예방접종과 관련 있을 수도 있습니다.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+변비약도 유형에 따라 달라서 다른 약을 섭취해 보시겠어요?,Korean
+이젠 병실로 올라가는 건가요?,Korean
+어떤 약을 드시고 계신지 말씀해 주실 수 있으세요?,Korean
+제가 지금 환자분 상태를 설명해 드릴게요.,Korean
+진피 이하의 깊은 부위 손상으로 보입니다.,Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+아니에요. 치료하면 충분히 완치 가능합니다.,Korean
+"우유만 마시면 이상하게 설사를 해서 마시는 게 두려워요.
+",Korean
+지난주에 다른 병원 내원한 적 있을 거예요.,Korean
+어느 부위에 통증이 있으신가요?,Korean
+체중이 증가한 이유가 있을까요?,Korean
+"아뇨 몸이 힘들어서 그런지 기절한 듯이 잘 자요.
+",Korean
+구토를 하면 속이 아픈가요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+네. 웬만해선 자연 분만으로 낳고 싶었거든요.,Korean
+"당뇨병 약물치료를 몇 년째 받고 있는데 저혈당이 오면 식은땀이 날 때가 있습니다.
+",Korean
+몸에 열나는 것 같나요?,Korean
+참고해야 할 병력이 있을까요?,Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+"네. 기침할 때마다 복통이 너무 심해 오게 되었습니다.
+",Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+한 삼 개월 정도요 약을 드셨나요?,Korean
+아뇨 환자분 특성 파악을 위해 여쭤본 거예요.,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+경우에 따라 수술할 수도 있어 속단하기에는 이릅니다.,Korean
+몸이 안 좋다는 게 통증을 말씀하시는 건가요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+"수술하고는 바로 물먹을 수 있나요?
+",Korean
+현재로서는 특별한 치료 방법이 없습니다.,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+처방받고 드시는 약 있나요?,Korean
+붕대에 멸균 처리가 되어 있는 것을 소독붕대라고 부릅니다.,Korean
+암 치료했었던 가족이 있나요?,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+어느 부위가 제일 아프세요?,Korean
+소변을 보고 닦으면 휴지에 피가 묻어 나오나요?,Korean
+헛구역질도 포함됩니다. 그 외 다른 증상은 없으셨나요?,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+급여 비급여를 떠나서 환자분에게 가장 잘 드는 진통제입니다.,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+"고삼 때부터 하루 한 갑 피우는 편이에요.
+",Korean
+소변을 볼 때 통증이 있나요?,Korean
+현재와 같은 증상일 경우 삼투압성 하제 사용이 바람직합니다.,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+"네. 그전엔 잘 자다가 아픈 이후로는 못 잤어요.
+",Korean
+네 영양제 잘 챙겨드세요.,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+아니요. 약을 주입하거나 레이저로 치료를 하는 등 수술이 아닌 치료 방법도 있습니다.,Korean
+다른 병원에서 진단받은 게 있나 해서요.,Korean
+잠을 잘 자지 못하시나요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+통증이 시작된 것이 언제인가요?,Korean
+통증 시작하면 얼마나 가요?,Korean
+"왼쪽 코 쪽에서 피나요.
+",Korean
+"소변 냄새가 악취처럼 느껴질 때가 있어요.
+",Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+귀에서 소리도 같이 나나요?,Korean
+입술 부은 것도 문제가 될 수 있습니다.,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+통증이 있다 없다 하나요?,Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+제가 방금 퇴원 설명 해드렸습니다.,Korean
+"엄지발가락 통증 때문에 신발을 못 신어요.
+",Korean
+위중한 질환일 수 있지만 지금 속단하긴 이릅니다.,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+소변이 쉽게 안 나오나요?,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+간에 있는 염증이 딱딱해져서 간 경화까지 진행될 수 있습니다.,Korean
+숙모가 코로나에 감염됐다가 완치하셨어요.,Korean
+특별히 혈액형 검사를 원하시는 이유가 있나요?,Korean
+소화하는데 불편한 건 없나요?,Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+아니요. 의료진이 해 드립니다.,Korean
+독감 주사 같은 경우는 매년 일 회 맞는 게 좋아요.,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+결핵으로 약 드시고 계세요?,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+평소에 드시는 약이 어떤 병 때문에 드시는 건가요?,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+한 번 주무실 때 몇 시간 주무세요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+불면증으로 언제부터 잠을 못 잤나요?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+네. 고정핀 박는 수술을 했었어요.,Korean
+항생제 과용은 부작용을 일으킬 수 있어 조심해야 합니다.,Korean
+조금 더 살펴볼게요. 많이 가렵나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+수혈을 거부하는 이유가 있을까요?,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+소변검사는 이십사 시간 시행이 필요합니다.,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+금식을 해서 이렇게 나오면 이상이 있다는 뜻입니다.,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+소변 보는 주기가 어떻게 되나요?,Korean
+수술부위에 대해서 전공의 선생님이 동의서 받으실 때 자세히 알려주실 겁니다.,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+코로나 때문에 해외 나간 적은 한 번도 없어요.,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+진통제를 매번 먹고 있었어요.,Korean
+아니요. 아빠도 증상이 있어요.,Korean
+변비가 어느 정도로 심하신 거죠?,Korean
+보통 하루에 몇 개비나 피우시나요?,Korean
+"반복적으로 공황발작이 와서 가슴 압박도 심하고 질식할 것 같은 느낌이 들어요.
+",Korean
+집 먼지 진드기는 사람의 피부 세포나 곰팡이 같은 유기물을 먹고 삽니다.,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+환자분의 경우 회복은 한 달이면 충분합니다.,Korean
+"턱이 갑자기 빠진 듯 아귀가 안 맞고 통증도 있어요.
+",Korean
+네. 혹시라도 혜준이가 구토 양이 많다거나 못 먹으면 탈수가 되서 또 열이 날 수도 있어요. 그럴 땐 꼭 응급실로 오세요. 집은 가깝나요?,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+말씀드렸다시피 도수정복은 실패할 확률도 있습니다. 만약 손으로 만져 밀려 들어가지 않으면 수술로 탈장 된 부위를 교정해야 완치가 됩니다.,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+복용 중인 약 외에도 사용하는 의료용품이 있다면 같이 가지고 오세요.,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+통증이 어느 정도 심해요?,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+흡연 시작 연령을 기억하세요?,Korean
+저 마취해 본 적이 없어서요.,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+병원에서 처방받아서 먹는 약은 없으세요?,Korean
+간염 약 복용 중이십니까?,Korean
+결핵 치료는 언제부터 시작하셨어요?,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+"네. 얕은 잠을 자서 자고 일어나도 개운하지가 않아요.
+",Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+생식기의 인유두종 바이러스 감염은 대부분 성접촉을 통하여 전파됩니다.,Korean
+밤에 통증이 있을 때 보호대가 증상 완화에 도움이 될 수 있습니다.,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+아직 주변 림프 조직과 폐나 다른 장기에 전이 소견이 없기 때문에 치료 잘 받으시면 예후가 좋을 겁니다.,Korean
+"배가 약간 아프긴 했었어요.
+",Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+뇌졸중 오신 적 있으세요.,Korean
+오늘도 허리가 아파서 오신 거죠?,Korean
+피부반응으로 대체하면 시간도 오래 걸리고 정확한 원인을 찾기 위해 반복해서 검사해야 합니다.,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+실비 보험이 안 되어 있으신가요?,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+체온이 떨어진 것 같나요?,Korean
+"마비된 듯한 느낌은 느낀 적 없어요.
+",Korean
+숨을 헐떡일 때가 있나요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+에이형인데 혈액형 검사 다시 해보고 싶어요.,Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+"작업 중 그라인더에 깊이 긁혀서 상처가 났어요.
+",Korean
+식단 조절이 필요해 보여요.,Korean
+가족분들 중에 유전성 질환으로 고생하신 분이 있나요?,Korean
+결핵 증상이 언제부터 나타났나요?,Korean
+부작용이 거의 없지만 경우에 따라 생길 수도 있습니다.,Korean
+예방 접종과 관련된 부작용이 있으셨는지 여부를 기록해 둬야 해서요.,Korean
+거의 매일 설사를 하시나요?,Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+약을 세 알씩 매일 드셨나요?,Korean
+욕창을 방지하는 것은 피부 합병증을 생기지 않게 하는 것이지 다른 병까지 낫게 하는 것은 아닙니다.,Korean
+교수님께 여쭐 것이 있어 삼 주 전에 고려 병원을 갔었습니다.,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+대변 활동이 원활하지 않나요?,Korean
+병문안 시간이 정해져 있습니다.,Korean
+가끔 드시는 건 괜찮지만 되도록 고열량 고지방 식품보다는 찐 달걀이나 닭 가슴살로 드시도록 해보세요.,Korean
+약품 검사는 오래 안 걸려요.,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+석 달 전에 이틀 정도 입원했어요.,Korean
+"아버지가 정신을 못 차리셔서요.
+",Korean
+네. 엑스레이를 통해 대략적인 가스와 변의 양상은 확인이 가능합니다.,Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+가족의 동의가 없어도 제 의지로 수술할 수 있나요?,Korean
+약도 먹고 식단 관리도 하고 있어서 그런지 유지가 나름 잘되고 있습니다.,Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+멸균 처리해서 균을 없앤 거라고 보시면 됩니다.,Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+대장 내시경과 기본적인 절차는 유사하지만 에스 상 결장까지만 들어가는 검사입니다.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+목이 건조하면 통증이 더 심해집니다.,Korean
+가족 중 암이 있으신 분 있을까요?,Korean
+한의원 방문 외에 개별적으로 지인에 의해 진행하거나 했던 경험은 없으신가요?,Korean
+결핵 수치가 높은 편이신가요?,Korean
+변비가 심하게 있으셨던 것 같은데 무엇 때문에 변비가 생겼는지 검사 후 말씀드리겠습니다.,Korean
+피부가 언제부터 두꺼워졌다고 생각하셨나요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+"자궁 초음파를 했는데 자궁근종이 있다고 해서 왔어요.
+",Korean
+두통을 느끼신 적이 있으신가요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+재수술 후 미용수술을 하더라도 완치가 된다고 말씀드리기는 어렵습니다.,Korean
+현재 고혈압 치료 받은 지는 얼마나 되었나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+환자 분의 건강 상태를 확인하기 위함입니다.,Korean
+입원 관련 사항은 환자에게 알려 드렸습니다.,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+네. 수술 후 꾸준히 치료 중입니다.,Korean
+아직 검사도 남았고 입원 가능성도 있어서요.,Korean
+변비약 어떤 걸 드셨나요?,Korean
+혹시 식단을 짜주실 수 있어요?,Korean
+위염 중에 그렇게 흔하지는 않습니다.,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+통증 발병하면 얼마 동안 가나요?,Korean
+입에서 피 맛이 나나요?,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+수술 걱정 안 하셔도 돼요. 환자분 건강하세요.,Korean
+발목 염좌 때문에 정형외과 갔다 왔어요.,Korean
+"몸이 좀 안 좋은데 당뇨 때문인가 해서요.
+",Korean
+병원에서 처방 약 어떤 거 받으셨어요?,Korean
+친가에 암 병력이 있어요.,Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+어릴 때부터 고혈압 위험군이었다가 삼 년 전부터는 혈압약 챙겨 먹습니다.,Korean
+치과에서 수술이 아니라 치료하신 거 아닌가요?,Korean
+"잠들기가 어려워서 수면 유도 음악 들으면서 자요.
+",Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+저는 제 혈액형 오에이치형으로 들었어요.,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+처방 받으신 연고를 잘 바르고 계시나요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+가족 중에 누가 고혈압 당뇨 질환이 있나요?,Korean
+질병이 진행한 경우에는 단순히 쉬는 것으로 증상이 자연적으로 좋아지지는 않습니다.,Korean
+그래도 발열과 관련해서 검사를 진행하시는 걸 권유드립니다.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+간염으로 처음 진료 받은 날이 언제인가요?,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+울렁거리고 토할 것 같이 느껴지세요?,Korean
+얼굴 말고 팔도 아프시다고요? 어디가 어떻게 아프신지 설명해 주시겠어요?,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+네 금주 금연을 꼭 하셔야 합니다.,Korean
+매일 드시는 약이 있어요?,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+알레르기 검사를 해보신 적은 없나요?,Korean
+휠체어 꼭 타야 해요?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+할아버지가 여러 가지 병이 다 있으셨어요. 당뇨 고혈압 갑상선도 안 좋으셨고요.,Korean
+네 만성이라 치료가 오래 걸릴 겁니다.,Korean
+수술 동의서 사본은 드리겠습니다.,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+수속 후 병실로 가세요.,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+카페인 때문에 검사 결과가 잘 나오지 않는 경우도 있습니다.,Korean
+가족 중에 고혈압 질환을 진단받으신 분이 있으세요?,Korean
+지금 측정 가능하세요 환아 몸무게는 이쪽으로 오셔서 측정하시면 됩니다.,Korean
+기존에 옷에 쓸려서 아토피 증상이 유발된 적이 있으신가요?,Korean
+살짝 아플 수는 있지만 많이 아프지는 않을 겁니다.,Korean
+흡연 상태 유지 중이신가요?,Korean
+주로 어디가 가장 아프세요?,Korean
+요즘 몸무게가 자주 바뀌셔서 몸무게는 재 봐야 할 것 같아요. 키는 백오십팔 정도 되세요.,Korean
+진단�� 필요할 것 같아요.,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+지금 위험하진 않은데 열이 지속된다면 위험할 수도 있어요.,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+환자분의 의식이 회복되고 적절한 반사반응이 오는 것을 확인한 뒤에 의사 확인 후 금식을 해제할 수 있습니다.,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+수술적 치료 이후 호전 양상에 따라 다를 수 있으나 큰 수술은 아니기 때문에 입원 기간은 길지 않을 것으로 보입니다.,Korean
+척추마취입니다. 하반신 신경차단을 위해 척추에 마취약을 투약한 겁니다.,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+처방받지 않는 약은 뭔가요?,Korean
+네. 지금 누른 곳도 아픈가요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+신체 부위를 마사지 해주시는 게 좋을 것 같네요.,Korean
+신장 결석 염증 종양을 의심할 수 있습니다.,Korean
+평소에 드시는 약을 말씀해보실래요?,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+"소변이 너무 자주 마려워서 큰일이에요.
+",Korean
+금식을 안 하시고 수술을 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+큰 문제 없을 것으로 생각되지만 일단 진료를 받고 확인해 보시는 편이 좋을 것 같습니다.,Korean
+소화가 안 된 건가요?,Korean
+"네. 평균 일곱 시간 정도 자는 것 같아요.
+",Korean
+"내성 발톱 때문에 통증도 너무 심하고 최근에는 곪는 것 같아요.
+",Korean
+하루 담배 얼마나 피우세요?,Korean
+바늘이 들어가는 시간은 길지 않습니다.,Korean
+네. 중요한 검사이니 꼭 찍어야 합니다.,Korean
+소화가 안 된 건가요?,Korean
+요즘 먹고 있는 약이 있나요?,Korean
+네 수면 패턴 체크를 희망하시는군요.,Korean
+밤에 통증이 있을 때 보호대가 증상 완화에 도움이 될 수 있습니다.,Korean
+평소 생활습관이 건강에 큰 영향을 미치거든요.,Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+"설사뿐 아니라 변을 볼 때마다 아랫배가 쿡쿡 아파요.
+",Korean
+이 약물은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+검사 결과 수술이 필요한 것으로 나왔습니다.,Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+어디가 가장 통증이 강하죠?,Korean
+환자 등록 팔찌 확인하겠습니다.,Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+증세가 악화된 때가 언제인가요?,Korean
+"어제 저녁 한 여덟 시쯤부터 왼쪽 가슴이 쥐어짜는 듯한 통증이 너무 심해서요.
+",Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+식사 후 음식이 소화가 잘 안되시나요?,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+난소의 프로게스테론이라는 호르몬 불균형이 월경주기에 영향을 미칠 수 있습니다. 호르몬 수치를 검사해볼게요.,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+배 통증 부위가 어딘가요?,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+다낭성 낭종이 있다고 하셨고 초음파 하신지도 이년이 넘었으니 한 번 더 검사 받아보는 게 좋을 것 같네요.,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+가만히 있을 때도 흉통이 있나요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+갑각류 알레르기 이외에 다른 알레르기는 없나요?,Korean
+신경계통 약 투약 중이죠.,Korean
+무엇 때문에 병원에 왔나요?,Korean
+알레르기 유발 성분이 있는지 확인을 위해서 가져가는  것입니다.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+"뜨거운 그릇을 손으로 잡는 바람에 물집이 심하게 졌어요.
+",Korean
+먼저 왜 밥을 못 먹는지 검사를 해 보겠습니다.,Korean
+주로 어디가 가장 아프세요?,Korean
+별 효과가 없으셨군요 수면제가 부작용이 많다 보니 처방이 가능할지 주치의 선생님과 상의를 해보시는 게 좋겠습니다.,Korean
+약 종류가 워낙 많아서요.,Korean
+"무릎을 굽히거나 앉을 ���가 없어서 왔어요.
+",Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+수치가 바뀌는 수준까지 감안해도 환자분은 혈당이 안정적입니다.,Korean
+뼈가 부러지는 바람에 철심 박았어요.,Korean
+어느 쪽 어금니가 많이 흔들리시나요?,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+"고환이 많이 부어서 왔어요.
+",Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+어린이병동에서는 보호자분이 계속 옆에 계시길 권장합니다.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+그저께 감기 때문에 검사 권유해서 받았어요.,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+네 틀니가 있으면 검진이 어려워요.,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+고혈압 약물치료를 하고 계신가요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+복숭아 알레르기가 있어서 복숭아 향 첨가된 것도 못 먹어요.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+반응 테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+마취는 좀 더 기다려야 풀려요.,Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+"아이 성기 부분이 빨갛고 부어 있어요.
+",Korean
+불안해할 수 있으니 전신 마취를 권장합니다.,Korean
+발이 부어 신발이 안 맞을 때가 있습니까?,Korean
+가끔 같이 복용하면 안 되는 약들이 있어서 그래요.,Korean
+통증이 얼마 만에 발생하는지 말해볼래요?,Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+일주일 치만 처방 드리겠습니다. 증상 지속 시 내원하세요.,Korean
+통증이 어느 정도 심해요?,Korean
+이동식 혈압 측정기 들고 찾아가겠습니다.,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+소화가 안 되면서 동반되는 다른 증상이 있나요?,Korean
+그렇게 하겠습니다. 용종이 있으면 떼어내야죠.,Korean
+복부 내 염증이 있는 경우 그러실 수 있습니다.,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+혈액검사에서 이상 소견이 발견되어 입원해서 검사를 진행하셔야 합니다.,Korean
+가족 중에 고혈압 판정받은 분 있나요?,Korean
+몸이 안 좋은지는 확답하기가 곤란하네요 검사를 해봐야 알 수 있어요.,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+한약 외에 다른 약 드시는 건 없나요?,Korean
+우선은 혈액검사를 진행해서 갑상선 호르몬과 갑상선 자극 호르몬 수치 등을 확인해 보는 것이 좋겠습니다.,Korean
+언제 당뇨 얘기를 들으셨나요?,Korean
+신체가 부은 데가 있나요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+흡연 시작 연령을 기억하세요?,Korean
+입천장 코 쪽 점막과 입천장 근육 그리고 구강 쪽 점막을 적절히 분리해 주어 다시 재건해 주는 작업입니다.,Korean
+혈압 수치 알고 계세요?,Korean
+간염 처방 약 알 수 있나요?,Korean
+아까는 수술 부위만 체크했습니다.,Korean
+"제 친구인데 의식이 없어요.
+",Korean
+아프기 시작한 게 언제부터예요?,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+약 드리기 전에 몇 가지 검사를 진행하려 하는데 괜찮으신가요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+최근 열이 많이 오르진 않았나요?,Korean
+아버지가 혈압이 좀 높으셨어요.,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+장미라고 장내 미생물 관련한 식단 공부 모임을 오래 해왔거든요. 덕분에 그쪽으로는 별문제 없이 지냈어요.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+제가 한 세 살 때쯤 입원한 것으로 알고 있어요.,Korean
+이 부위가 아픔을 느끼시는 거죠?,Korean
+몸이 안 좋다는 게 통증을 말씀하시는 건가요?,Korean
+지금 아픈 곳이 있으세요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+예전부터 소화 불량이 있었나요?,Korean
+이번 주 내로 연락이 가면 그때 외래 날짜 잡으세요.,Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+최근 몇 달 동안 체중 변화는 없었나요?,Korean
+두통약보다는 띵한 느낌이 사라지지 않으면 정밀 검사가 필요합니다.,Korean
+발기부전으로 처방받은 약이 있으세요?,Korean
+스트레스로 인해 심해질 수 있으나 정도가 심하거나 빈도가 잦을 시 자세한 검사가 필요합니다.,Korean
+흉터가 약간은 ��을 거예요.,Korean
+"코에서 목까지 쑤시고 아파요.
+",Korean
+종양 있었던 가족이 있으신가요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+"아랫배를 만지면 딱딱하고 통증이 있어서 왔어요.
+",Korean
+간호사님에게 문의해 주시기 바랍니다.,Korean
+네. 혈당 수치가 일정해요.,Korean
+판독결과는 영상의학과 전문의가 확인이 필요해서 금방 나오지는 않습니다.,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+움직이라고 시키지 않으면 미동도 없나요?,Korean
+소변이 잘 안 나온지 얼마나 되신 거 같아요?,Korean
+복부 통증이 많이 심한가요?,Korean
+아니요. 저는 가족력도 없어요.,Korean
+최근에 당뇨도 와서 당뇨약도 먹어요.,Korean
+주사 부위가 뻐근할 수 있는데 더 심해지거나 감각 이상이 생기면 말씀해 주세요.,Korean
+암을 진단받은 가족이 있습니까?,Korean
+"먹은 게 없어서 그런지 그냥 끈적한 물 같은 토를 했어요.
+",Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+대변을 며칠에 한 번 보나요?,Korean
+진료시간 중으로 말씀해주실 수 있으신가요?,Korean
+다른 질환과 유사한 내시경적 소견을 가지고 있어 필요시 이에 대한 감별진단이 필요할 수 있습니다.,Korean
+부루펜을 먹인지 얼마나 됐나요?,Korean
+흉터가 남지 않으리라는 보장은 할 수 없습니다.,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+"네. 그런 증세가 있는지도 몰랐어요.
+",Korean
+면역 요법도 일 년 이상 걸립니다.,Korean
+일주일에 몇 갑 정도 흡연하시나요?,Korean
+소변보는 데 문제 있으세요?,Korean
+네. 증상이 나타나면 전화만 하면 되죠?,Korean
+"가습기 안 사용하는 집도 있나요.
+",Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+사고를 당한 것이 언제셨죠?,Korean
+때로는 대소변을 잘 보지 못하는 증상도 해당합니다.,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+암에 대한 가족력이 있을까요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+열만 나는 것 같아요?,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+요새 약 먹는 걸 자주 잊어버려서 잘 기억이 안 나요.,Korean
+"손발이 저리고 잘 안 구부러져요.
+",Korean
+네 치주가 안 좋아지면 치아를 충분히 지지해주지 못해 흔들릴 수 있습니다.,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+어린데도 불구하고 편두통이 굉장히 심해요.,Korean
+수면제 복용하신 지 얼마나 됐는지 알려주세요.,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+운동하고 나면 부기가 빠져 있나요?,Korean
+입원 경험이 있는지 없는지 알기 위해 여쭤봤습니다.,Korean
+내일 진료받으러 오셔야 할 진료 장소입니다.,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+네 통증이 좀 있을 텐데 환자분은 잘 참으시네요.,Korean
+"깊게 못 자니 몸이 회복이 잘 안 되는 것 같아요.
+",Korean
+철심 박는 수술까지는 아니었고 그냥 사 번 뼈 수술받은 걸로 알고 있어요.,Korean
+"안면 마비가 온 거 같아요.
+",Korean
+네. 부작용이나 평소와 다른 컨디션이었던 거요.,Korean
+호흡곤란이 일어날 수는 있으나 오래 지속되지 않도록 잘 모니터링하며 검사 시행하도록 하겠습니다.,Korean
+"잠을 잘 못 자고 계속 보채기는 했어요.
+",Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+구토를 언제 한 적 있나요?,Korean
+무슨 간염 약 드세요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+재활 기간은 사람마다 매우 다릅니다.,Korean
+원인에 따라 다른 약제 사용이 필요할 수 있습니다.,Korean
+대소변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+마취 안 하고 했어요.,Korean
+고혈압으로 신경 쓰고 계신가요?,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+염증 수치는 몸에 이상반응이 있음을 의미합니다.,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+과거 아픈 경험이 있으신가요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+네 ��전 증상이랑 비교해서 말씀해 주시면 됩니다.,Korean
+지금 질환의 위험요인 중 하나가 기름진 음식입니다.,Korean
+"오줌 쌀 때 아프고 괴로워요.
+",Korean
+아침 약 맞는데 가져오는 걸 까먹었네요.,Korean
+음주 빈도는 어느 정도인가요?,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+고유량 산소법은 환자의 흡기 시의 최고 유량에 필요한 전체 가스 유량을 공급함으로써 지속적인 흡입 분율을 제공합니다.,Korean
+산소마스크 쓰면 호흡이 좀 편해지나요?,Korean
+러시아 여행 다녀왔고 비형 간염 예방접종했습니다.,Korean
+재작년 건강검진 때 제가 고혈압이라는 것을 알게 됐어요.,Korean
+먼저 전화드리고 응급실로 가나요?,Korean
+네. 원래 있었는데 약 먹으면서 나아졌어요.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+평소에 변은 잘 보세요?,Korean
+통증이 언제부터 시작했는지 말씀해주세요.,Korean
+배뇨 장애가 있으신 거예요?,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+화상 부위 보습을 강화합니다.,Korean
+목뼈 육 번 칠 번에 수술했어요.,Korean
+"먹긴 먹는데 약에도 내성이 생겼는지 안 들어요.
+",Korean
+주사도 수액 줄로 맞으시고 식사하실 때까지는 식사 대용이라고 보시면 됩니다.,Korean
+평소에 부종이 좀 있으세요?,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+"허리가 뻐근하다 못해 끊어진 거 같이 아파요.
+",Korean
+잠들기 두 시간 전에는 물을 안 드시는 거죠?,Korean
+복부에 가스 찬 느낌이 있진 않나요?,Korean
+성형외과는 무슨 일로 가셨나요?,Korean
+지금 복용 중인 항결핵제가 있나요?,Korean
+"예전에 비해 소화 능력이 많이 떨어진 걸 느껴요.
+",Korean
+"얼마 전에 작업하다가 그라인더에 긁혀가지고 대충 약 바르고 끝냈거든요. 그러다 한 삼일 전부터 진물이 나더니 지금은 좀 아파요.
+",Korean
+과거에 수술하거나 마취한 경험이 있나요?,Korean
+가래의 상태를 말해 주세요.,Korean
+심하지 않아도 피부 증상이 나타난 적이 있다면 전부 말씀해 주시겠어요?,Korean
+흉통 유무를 말씀해 주세요.,Korean
+안면 홍조인 것 같네요.,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+"넘어졌는데 팔에 가시가 박힌 것 같아요.
+",Korean
+"평소처럼 하루 한 번 변 봅니다.
+",Korean
+종양 치료는 다 끝났나요?,Korean
+결핵 때문에 병원 다닌 적 있으신가요?,Korean
+맹장으로 입원하신 게 처음이셨나요?,Korean
+배의 어느 부분이 아프신가요?,Korean
+알레르기로 기피하는 음식 있나요?,Korean
+어디가 제일 많이 부었나요?,Korean
+"오토바이 타다가 다리를 다쳐서요.
+",Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+"핀 지는 십 년 됐는데 전자담배로 바꾼 지 이 년 됐어요. 그 이후로는 하루에 세 개비씩 핍니다.
+",Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+그럼요. 맥박 이상 없습니다.,Korean
+"머리 아프면서 속이 좀 메스꺼울 때가 있었어요. 소화도 잘 안 되는 거 같고요.
+",Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+고혈압약 먹고 혈압이 조금 안정됐나요?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+허리 재활 치료 중이라 재활병원에 갔다 왔었습니다.,Korean
+네. 수술 방금 끝났어요.,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+"얼굴에 마비가 온 듯해서 왔어요.
+",Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+아니면 퇴원 설명이 적힌 종이를 드릴까요?,Korean
+약을 오래 드시면 안 됩니다.,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+혹시 아스피린이나 혈전용해제를 드시고 있나요?,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+하루에 한 번씩은 혈뇨 증상이 나타나나요?,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+통증은 움직일 때마다 오나요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+지금까지 몇 번 피를 토했나요?,Korean
+���구하다가 코뼈 부러져서 수술했었어요.,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+고혈압인 것을 안 게 언제부터죠?,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+마취제 부작용은 심장마비 섬망 증상 마비 시각장애 구토 등이 있습니다.,Korean
+검사를 진행하려면 금식이 준비되 있어야 해서요.,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+당뇨랑 고혈압약 복용 중이에요.,Korean
+힘드시겠지만 격리여부를 판단해야 해서 검사를 하셔야 합니다.,Korean
+호흡할 때 어려움이 있나요?,Korean
+건강한 사람의 소변은 거품이 많지 않고 소변을 볼 때 순간적으로 거품이 일어나다 곧 사라집니다.,Korean
+어떤 자극에 의해서 위를 이루는 상피세포들이 장을 이루는 상피세포의 성격을 띠게 되는 것입니다.,Korean
+"아이 소변에 피가 섞여 있습니다.
+",Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+씨티 찍어서 환자분의 내부 상태를 보는 게 좋겠어요.,Korean
+"잔뇨감을 느껴 본 적이 없네요.
+",Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+네 맞습니다 입원 날짜요.,Korean
+고혈압 관련해서 과거에 이야기 들으신 게 있나요?,Korean
+"변 볼 때 온몸이 찌릿합니다.
+",Korean
+식은땀을 동반한 오한이 있으세요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+알레르기 유발 성분이 있는지 확인을 위해서 가져가는  것입니다.,Korean
+아직 수술이나 입원 같은 거 못 해봤어요.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+가족 중 유전성 질환을 진단받거나 치료 중인 분 있나요?,Korean
+판독결과는 영상의학과 전문의 확인이 필요해서 금방 나오지는 않습니다.,Korean
+"제가 저혈압이 좀 있는데 오늘따라 더 낮은 것 같아요.
+",Korean
+지금 전신 무력감을 느끼시나요?,Korean
+"투석 관에 문제가 있는 것 같아요.
+",Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+알러지 치료는 언제 시작하셨어요?,Korean
+식습관은 건강행태를 알 수 있는 여러가지 척도 중 하나지요.,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+"가스가 많이 차서 더부룩해서 못 자는 것 같아요.
+",Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+아니요. 지금은 수술 부위가 덧날 수가 있어서 조심하셔야 됩니다.,Korean
+가슴만 따끔거리시나요. 아니면 등이나 어깨 등 다른 부위도 불편하신가요?,Korean
+복부 통증이 있는데 변이 안 나오나요?,Korean
+의료법상 특정 병원을 소개해 드리는 것이 금지되어 있어서 곤란합니다.,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+디피시피 치료는 통증을 유발하는 치료는 아닙니다.,Korean
+아픈 곳 말씀해 주세요.,Korean
+"고양이 발톱에 할큄 당했어요.
+",Korean
+우선 통증이 있으니까 이렇게 진행하도록 하십시다.,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+몇 월부터 아프셨던 거예요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+상한 조개는 익혀 먹어도 위험해요.,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+고혈압 있는 건 언제 아셨나요?,Korean
+독감주사를 올해 맞으신 거죠?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+암을 치료받은 적이 있나요?,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+맥박은 팔십 회로 정상범위 안에 드시고요.,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+"신장 기능 이상으로 알고 있어요.
+",Korean
+약은 확인 후에 다시 돌려드리겠습니다.,Korean
+"강아지랑 놀아주는데 갑자기 공격하더라고요. 긁히고 이빨에 찍히고 피도 많이 나고요.
+",Korean
+약물치료 시작되고 이 주 정도 지나면 기침이나 열감 느끼시는 거는 많이 줄어들거에요. 그때 검사해서 격리 해제하고 퇴원하시는 게 결정될 거고요.,Korean
+"갑자기 아침에 일어나는데 허리가 굳은 느낌이었어요.
+",Korean
+혈액검사와 소변검사는 두세 시간 정도 소요되며 신장 조직 검사 결과는 오에서 칠일 정도 소요됩니다.,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+네. 기관지나 후두에 문제가 있을 때 주로 나는 소리이기 때문에 건강한 아이들에게는 쌕쌕거리는 소리가 나지 않습니다.,Korean
+담배 피운 기간이 오래되었나요?,Korean
+아니요 임플란트와 자기 치아를 확인하는 과정입니다.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+"소화가 다 되고 해서 두세 시간 뒤요.
+",Korean
+가족 중에 암수치가 높으셔서 문제였던 분이 있나요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+그 외 알레르기가 생겼던 것이 있나요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+"한 시간에 한 번씩 토하고 있어요.
+",Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+"사타구니 쪽에 살이 튀어나왔는데 장이 튀어나온 것처럼 모양이 이상해서 왔어요.
+",Korean
+야간 근무자분들은 수면 장애를 비롯해서 다양한 질환에 걸릴 위험이 높아요.,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+흡연 기간이 어떻게 되세요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+단순 소독은 동네 병원에서 하셔도 무방하지만 상처를 확인하고 진료를 보시기로 하신 것이라면 병원으로 내원하시는 것이 좋습니다.,Korean
+다른 치료하신 거도 있으신가요?,Korean
+어른들이 주신 약주는 몇 살부터 드신건가요? 보통은 성인이 되고 마신 걸 말합니다.,Korean
+환자분의 상태에 대해 설명을 들으신 후 잠시 집에 다녀온다고 하셨습니다.,Korean
+계단에서 떨어지셨지요. 검사는 곧 시작할 거예요.,Korean
+대변에 물이 많이 섞여 나오나요?,Korean
+주에 몇 번 아픈가요?,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+지금이 아침 여덟 시니까 검사 전까지 금식을 꼭 해야 해요.,Korean
+변비로 인한 증상이므로 배변 완화제 사용을 할 수 있습니다.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+머리가 띵한 느낌이 있나요?,Korean
+수술 곧 들어가실 것 같아요.,Korean
+검사 결과는 내일 오전에 나올 겁니다.,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+경우에 따라 구역감이나 구토를 하는 분들이 계세요.,Korean
+간염 치료 복용 약 있으시죠?,Korean
+횡문근 융해증은 근 손상으로 인한 근육 통증과 경직 근 무력감이 나타나며 근 손상이 심한 경우 근육 쇠약이 나타나기도 합니다.,Korean
+두통이 얼마나 자주 느껴져요?,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+네. 여기 있어요. 수술은 잘 된 건가요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+네 혹시 메스꺼움이 발생하면 담당 간호사에게 꼭 말씀해 주세요.,Korean
+통증 지속기간이 얼마나 되세요?,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+입원 당일에 어떻게 이동하셨는지 여쭤보는 거예요.,Korean
+네 무슨 이유로 보약을 드셨나요?,Korean
+소화가 어떻게 잘 안 되나요?,Korean
+아니요 약 드시는 거에 문제는 없습니다.,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+무지외반증 같은데 정형외과에서 치료하는 질환이니 더 늦기 전에 병원 가셔서 치료나 필요하면 수술도 하셔야 해요.,Korean
+안 드시는 약은 버려 드릴까요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+의사 선생님과 상의 후 결정하는 게 좋을 것 같네요.,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+다음 외래는 다음 주 화요일입니다.,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+가족들 중에 유전성 질환 때문에 아��� 사람 있나요?,Korean
+현재 고혈압 치료 받은 지는 얼마나 되었나요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+대변볼 때 안 힘든가요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+일 년 전에 맹장 수술했어요.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+아니요 환자분은 동물 키우는 것과는 증상이 관련 없습니다.,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+"담배 끊으면서 같이 끊었어요.
+",Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+정신건강의학과에서 면담을 해본 적 있습니까?,Korean
+발기부전으로 처방받은 약이 있으세요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+경정맥신우조영술은 조영제가 신장을 통해 배설되는 것을 촬영하여 신장기능을 확인하는 검사입니다.,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+크라운보다 얇은 두께의 도자기를 씌운 게 라미네이트입니다.,Korean
+고혈압 관련해서 과거에 이야기 들으신 게 있나요?,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+어릴 때 수술을 받은 흔적을 없애줄 수 있습니다.,Korean
+마취를 하더라도 환아가 완전히 안정되지는 않아 보호자분들의 도움이 필요합니다.,Korean
+대부분 심각한 합병증 없이 회복이 가능하여 단기간 입원 후 퇴원 가능합니다.,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+항히스타민제 처방받고 드시는 건가요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+네. 언제 외래 잡을까요?,Korean
+소변볼 때마다 피가 나오나요?,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+진료받아보시고 증상에 따라 가능할 수도 있습니다.,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+"네. 그냥 팔에 통증만 있어요.
+",Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+"충돌사고로 인해 목에 충격이 간 것 같아요.
+",Korean
+알레르기 나는 상황 알려주세요.,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+당뇨 치료 이력은 아직 없으신 건가요?,Korean
+구급차를 이용하셨을 경우 비용 청구 관련하여 확인이 필요하여 여쭈어보았습니다.,Korean
+동의서에는 검사와 관련된 사항들이 포함됩니다.,Korean
+"네. 소변에서 퀴퀴한 냄새가 나는 것 같아요.
+",Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+대장 내시경과 기본적인 절차는 유사하지만 에스 상 결장까지만 들어가는 검사입니다.,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+흉부 엑스레이 등 검사를 시행하도록 하겠습니다. 검사항목과 일정 관련해서는 담당직원이 설명해 드리도록 하겠습니다.,Korean
+정확한 결과를 알기 위해서 우선 엑스레이를 찍어볼게요.,Korean
+"대변을 못 눠서 칭얼거려요.
+",Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+네 산소 수치 확인 후 필요 시 착용하도록 하겠습니다.,Korean
+피가 섞인 변을 보셨나요?,Korean
+통증을 처음 느낀 게 언제죠?,Korean
+환자분은 완치된 상황이라 퇴원하셔야 합니다.,Korean
+팔을 지금 움직일 수 있나요?,Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+"엄지와 검지가 유독 마비된 듯 감각이 이상해요.
+",Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+"갑자기 화장실을 많이 가고 소변이 마려워 잠자는 중간에도 계속 깹니다.
+",Korean
+배에 가스 차는 느낌이 자주 있나요?,Korean
+식사 후 음식이 소화가 잘 안되시나요?,Korean
+변을 잘 보고 계신가요?,Korean
+고통이 몇 시간 동안 있나요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+마취가 이루어진 수술은 모두 말씀해 주시면 됩니다.,Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+"유독 피부가 건조한 것 같아서 오게 되었습니다.
+",Korean
+하반신 마취도 수면 마취가 가능합니다.,Korean
+복부 팽만감이 있던 적 있나요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+그건 이비인후과에 가야 해요.,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+덩어리가 있다고 전부 암세포인 건 아니에요.,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+보다시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요,Korean
+그 외 대변을 보신 적이 없다면 화장실 다녀오신 횟수를 알려주시면 됩니다.,Korean
+네 모든 검사 완료됐습니다.,Korean
+부작용이 있는지 보려고 방금 검사하신 거예요.,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+오한이 있는 것 같나요?,Korean
+얼마나 자주 가슴 두근거림이 있었나요?,Korean
+네. 검사를 통해서 알 수 있습니다.,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+간염이 활동성인지 비 활동성인지 들으신 적 없으시군요.,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+"변비가 있어서 참 힘드네요.
+",Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+통증이 사라지지 않고 계속 유지되나요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+삼 개월 전까지 드신 보약이 있다면 말씀해 주세요.,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+"힘이 없고 입도 계속 말라요.
+",Korean
+그 외에 다른 의약외품을 드시는 게 또 있나요?,Korean
+점점 몸 기능들이 퇴화해가네. 고마워요.,Korean
+증상이 생긴 날에 처음 먹어본 음식이나 해산물이나 상한 음식 드신 건 없나요?,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+"몸이 전체적으로 뻣뻣해졌다는 느낌 정도는 있는데요.
+",Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+가족 중에 암수치가 높으셔서 문제였던 분이 있나요?,Korean
+한 달 동안 방문한 의료기관을 확인해야 합니다.,Korean
+접종 기록을 조회해 볼까요?,Korean
+위내시경도 후두 내시경처럼 관에 있는 카메라를 통해 병변을 확인하는 거지만 위내시경은 위 안으로 들어가기 때문에 더 힘드실 수도 있습니다.,Korean
+수혈 부작용이요? 예를 들면 어떤 걸 말하는 거예요?,Korean
+어떤 치료제를 드시고 계세요?,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+환자분의 건강한 신체 대사 활동을 위해서 중요한 부분이죠.,Korean
+"오늘 갑자기 여기 이쪽에 이상한 게 만져져요. 이게 뭐죠? 선생님 종양인가요?
+",Korean
+지금은 산소 수치가 정상이라 산소마스크를 벗기는 하였지만 우선 수치가 정상으로 유지되는지 확인할 필요가 있습니다.,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+사람에게 유해할 정도의 조사량은 아닙니다.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+잠 잘 때 자주 깨시나요?,Korean
+그때는 소변줄이 잘 위치하고 있는지 확인해야 합니다.,Korean
+보호자가 상처 부위를 함께 확인해야 합니다.,Korean
+"다리가 칼로 찌르는 듯이 심하게 쑤셔요.
+",Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+접촉성 피부염이 발생할 경우 약물 투여를 중지하면 증상이 개선되니 걱정 안 하셔도 됩니다.,Korean
+약은 따로 보관해 드릴게요.,Korean
+손목 터널을 넓혀주는 것이지만 완전 치료는 불가능한 방법입니다.,Korean
+언제 심장 박동이 불편하세요?,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+처방받지 않는 약은 뭔가요?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+네. 증상을보니 손목터널 증후군이군요. 손목을 지나가는 신경이 압박을 받아서 그런증상이 생깁니다.,Korean
+담당간호사로서 환자분의 스케쥴을 진행하기 위함입니다.,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+약물과 음식을 제외��고 다른 알레르기가 있으신가요?,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+아 예전에 부정맥 진단을 받으셨군요.,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+소독을 할 때에는 멸균적으로 해야 하기 때문에 되도록 동네 병원에서 치료받으시길 권고드립니다.,Korean
+비염이 있긴 한데 알레르기성인지는 모르겠어요.,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+병도 없었고 꾸준히 운동하고 식이요법에도 정성을 들이는 편이라서 별문제 없었어요.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+배액량을 확인 후 빼도록 하겠습니다.,Korean
+욕창이 안 생기도록 체위 변경 자주 해주시고 신경 써 주시면 피부 재생 속도도 빠를 겁니다.,Korean
+지금 아픈 게 느껴지실까요?,Korean
+얼마나 자주 기침이 나오나요?,Korean
+우선 숨쉬기는 편한가요. 환자분?,Korean
+열이 나거나 구역질이 나는 등 이상 증상이요.,Korean
+대변이 잘 나오지 않으시나요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+몸에 기운이 싹 빠진 느낌이 드나요?,Korean
+작년에 자주 가는 병원에서 고혈압이라고 알려주더라고요.,Korean
+아니면 퇴원 설명이 적힌 종이를 드릴까요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+독감이 현재 대유행이라 빠르게 맞을수록 좋습니다.,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+모유 수유는 엄마와 아기에게 모두 도움이 되므로 여쭤보았습니다.,Korean
+"수면 유도제를 먹고 잤어요.
+",Korean
+환자에게 위급한 상황이 있을 때 연락하기 위함입니다.,Korean
+아침마다 혈압을 재는데 오늘 아침엔 평소보다 높게 나왔는데요.,Korean
+대변에 피가 같이 나옵니까?,Korean
+배액량을 확인 후 빼도록 하겠습니다.,Korean
+암은 몇 기 진단 받으셨나요?,Korean
+가렵지 않더라도 완전히 나으려면 아직 더 치료를 받아야 합니다.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+아픔이 느껴진 게 언제가 처음이죠?,Korean
+네 환자 번호 불러주세요.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+덩어리가 있다고 전부 암세포인 건 아니에요.,Korean
+입안이 얼얼한 느낌이나 손발 끝 저림 등이 조금 더 오래 남아있을 수는 있으나 몇 시간 내에 사라집니다.,Korean
+불면증이 심하신 거 같아요.,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+"왼쪽 팔 부은 것 말고는 따로 뭐 그런 건 없었던 것 같아요.
+",Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+네 필요하신 보호대 드릴게요.,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+암인 거 언제 아셨나요?,Korean
+"배가 너무 꼬이듯이 아파서 힘들어요.
+",Korean
+최대한 감염 방지를 위해 소독해 두었지만 언제든 감염 위험성은 높습니다.,Korean
+차트 내역을 보니 반응 검사한 곳에 특별한 이상 소견은 보이지 않네요.,Korean
+정확한 진단이 있어야 치료를 할 수 있습니다.,Korean
+항문 주위가 헐거나 물집이 생기셨나요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+"속이 좋지 않아 아무것도 넘기지 못했어요.
+",Korean
+병원 내 게시판이나 입원 안내문에 확인 가능하십니다.,Korean
+항암 치료제를 복용 중이신가요?,Korean
+육안으로 전혀 부은 게 보이지 않습니다.,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+한약 드시는 것도 말씀해 주세요.,Korean
+약물과 음식을 제외하고 다른 알레르기가 있으신가요?,Korean
+정확한 확인을 위해 검사를 진해하겠습니다.,Korean
+사람에게 유해할 정도는 아니니 걱정 마세요.,Korean
+"해요. 설사할 때마다 배가 아파요.
+",Korean
+담배 대신 껌 씹으시는 걸 추천합니다.,Korean
+알레르기 반응이 언제 보이나요?,Korean
+식중독은 여러가지 원인에 의해 발생할 수 있습니다. 원인을 찾기보다는 현재 증상 조절이 더 중요합니다.,Korean
+통증이 월 단위�� 있나요?,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+다행이네요. 요즘은 식습관이 서구화돼서 대장 용종이 젊은 층에서도 많이 생겨요. 내시경 사진 보면서 설명해드릴게요.,Korean
+당신의 병력을 확인하기 위해서입니다.,Korean
+갖고 계신 약 있나요?,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+"간 수치가 매우 높다고 검사한 병원에서 여길 가보랬어요.
+",Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+자세가 안 좋아서 허리도 아프죠.,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+알레르기 있다는 거 언제 아셨죠?,Korean
+방법은 수면 유도하여 오른쪽 사타구니에 관을 꽂아 심장으로 가는 정맥과 동맥을 뚫고 조영제를 투여하면서 심장혈관을 관찰하는 것입니다.,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+"어우 속이 더부룩해서 밤늦게는 안 먹죠.
+",Korean
+진통제는 약국에서 구매 가능합니다.,Korean
+아뇨. 줄이셔야 합니다. 고칼로리 식단은 각종 소화기 질환. 내분비 질환을 일으켜요.,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+"말하거나 기침할 때마다 아픈 게 이틀 정도 된 것 같아요.
+",Korean
+소화가 안 된 건가요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+네 하지만 좀 더 정확한 검사들이 추가로 필요합니다.,Korean
+진통제 필요하면 추가 처방 드릴 수 있어요,Korean
+마취 크림만으로도 마취 잘 돼요.,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+환자분의 경우 회복은 한 달이면 충분합니다.,Korean
+지금 알려주셔야 곧 입원이 가능합니다.,Korean
+결핵이 발병하신 적이 있나요?,Korean
+소변은 보통 연한 노란색이나 황갈색을 띠게 됩니다.,Korean
+"요즘 들어서 가만히 있어도 어지럽고 앉았다 일어나면 어지럼증이 더 심해요.
+",Korean
+네. 그래서 맨날 다리도 붓고 피곤하고 그래요.,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+네 여러 가지 결과가 있으니 내원해서 상세한 결과는 알려 드리겠습니다.,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+발기부전약 드시고 계신 거에요?,Korean
+언제 처음 알레르기가 생겼어요?,Korean
+어깨가 어떤 식으로 아픈가요?,Korean
+가족 중에 당뇨 치료 이력이 있으면 말해 주세요.,Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+한달에 한번씩 이렇게 통증이 있으신가요?,Korean
+입원 치료한 적 있으신가요?,Korean
+초음파는 간단한 검사이므로 금식만 주의하시면 됩니다.,Korean
+통증이 있을 수 있습니다. 통증이 심하여 배에 힘을 많이 주는 경우 정복이 어려울 수 있어 필요하다면 진통제를 드리겠습니다.,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+"온몸이 으슬으슬하고 열이 나요.
+",Korean
+결핵약 아직 복용하고 계신가요?,Korean
+결핵 접종 하셨나요 ?,Korean
+"일주일 새에 살이 급격하게 오 킬로가 쪘어요.
+",Korean
+담배 하루에 몇 갑 피나요?,Korean
+알레르기 반응 검사로 진단받으셨나요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+입원 생활 설명 자세히 해주세요.,Korean
+현재 제왕절개로 인한 후유증이 발견됩니다.,Korean
+그 각도가 산소 공급에 가장 좋습니다.,Korean
+결핵 때문에 병원 다닌 적 있으신가요?,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+통증이 느껴지시는 부위가 어디인가요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+약을 과다복용하면 부작용이 있을 수 있군요.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+저랑 제 아버지가 고지혈증을 동시��� 앓고 있어요.,Korean
+아 그거 이외에 드시는 약은 없으시고요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+우선 금식을 유지하시는 게 좋습니다.,Korean
+오한이 든 건 아니고요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+복부 통증이 있는데 변이 안 나오나요?,Korean
+당뇨 처방 약은 어떤 걸 갖고 계세요?,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+삼십 분 이전에 변을 보시면 관장의 효과가 떨어지기 때문에 잘 막아주셔야 합니다.,Korean
+등에 베개를 받쳐서 옆으로 눕게 도와주세요.,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+과민성 장 증후군 가능성이 있습니다.,Korean
+병실로는 언제쯤 이동할 수 있을지요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+수혈하는 상황만 아니라면 상관없습니다.,Korean
+설명서에 적힌 용량 먹였어요.,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+발기가 평상시에 안 되시나요?,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+네 문제는 없지만 약 안 드셔도 괜찮으세요?,Korean
+어른용 약 반 쪼개서요.,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+네. 감염에 취약한 상태이니 상당히 주의해 주셔야 합니다.,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+기능성 소화불량이 맞다면 소화를 도울 수 있는 약물 치료를 하겠습니다.,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+탄산음료나 카페인 음료는 피해 주세요.,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+따로 드시는 약 있으신가요?,Korean
+염증 수치가 정상수치보다 많이 높네요.,Korean
+열만 나는 것 같아요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜보세요.,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+제가 좀 마취 깨는 게 오래 걸린다고 되도록 수면 마취 같은 것도 안 하는 게 좋을 것 같다고 했었어요.,Korean
+네 빼고 촬영해야 씨티 화질이 좋아요.,Korean
+아이 몸무게 측정할 때 옷은 입은 상태로 눕히시면 됩니다.,Korean
+수면 내시경의 경우 보호자와 함께 오시는 것이 가장 안전합니다.,Korean
+비급여면 비싸긴 하지만 꼭 필요한 경우가 있으니 동의해 주셔야 합니다.,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+"변에 하얀 점액질이 섞여 나왔어요.
+",Korean
+현재 복용 중인 약이 있으신가요?,Korean
+술 먹는 빈도가 빈번한가요?,Korean
+상처에서 나오는 진물 등을 그대로 두면 위험하기 때문에 자주 갈아줘야 합니다.,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+아니요 하지만 무릎 부종이 맞을 수도 있어서 한번 검사해 보는걸 추천해 드립니다.,Korean
+모든 병원 내 검사 진료 등에서 환자 본인 확인을 위해 사용합니다.,Korean
+기력이 빠진 것 같은 느낌을 받으신 적 있나요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+수프만 드신 기간이 어느 정도인가요? 영양 균형에 문제가 생길 수 있는 사항입니다.,Korean
+큰 병은 아닌 걸로 보여집니다. 너무 걱정하지 않으셔도 됩니다.,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+저희병원 기록이 아니면 확인할 수 없습니다.,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+목에 가래가 끼신 거 같나요?,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+네 알에이치 마이너스처럼 특이 혈액형이 있습니다.,Korean
+통증을 참을 수 있나요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+위에 붕대를 감을 테니 아이가 풀지 않도록 해주세요.,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+발기 부전으로 ���해 부부관계에 문제가 있나요?,Korean
+감염성 질환이란 다른 환자로부터 옮을 수 있는 질환입니다.,Korean
+거의 어제저녁부터 굶었는데 또 금식해야 되나요?,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+당뇨약 드시는 거 있으면 말해주세요.,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+환자분은 혈액검사결과에서 칼륨 수치가 매우 높게 나왔습니다. 이 수치가 높으면 심장에 무리가 가고 심정지까지 올 수 있습니다.,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+"우유랑 치즈가 뼈에 좋다고 해서 자주 먹으려고 해요.
+",Korean
+약 복용으로 인한 어지럼증이 발생되는 건 있을 수 있는 증상 중 하나인데 어지럼증이 많이 심하시면 다른 약성분으로 변경 고려해보겠습니다.,Korean
+결핵 백신 주사를 맞았나요?,Korean
+알레르기가 생기는 이유를 뜻하는 겁니다.,Korean
+"네. 잠들기가 어려워서 백색 소음 들으면서 잡니다.
+",Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+앞서 말씀드렸듯이 침상에서 안정을 취하시고 곧 혈액검사 수액치료 소변량 측정을 할 예정입니다.,Korean
+입원 치료 시 의료진이 알고 있어야 하는 내용이 있을 수도 있기 때문입니다.,Korean
+결핵약을 처방받은 적이 있으실까요?,Korean
+"발을 밟혔는데 너무 아파요.
+",Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+"배달 알바하다가 사고가 났는데 그 이후로 다리고 계속 아프고 붓기도 안 빠지네요.
+",Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+쌕쌕거리는 숨소리가 꼭 천식일 가능성만 있나요?,Korean
+갑상선 쪽으로 문제가 생겨서 치료를 받았던 적이 있어요.,Korean
+가족 중에 누군가 고혈압이 있나요?,Korean
+모유는 아기의 면역체계를 만들고 강화시킵니다.,Korean
+주의 사항에 나와 있지 않은 증상이 발현되면요?,Korean
+"배가 조금 쓰린 느낌이어서 왔어요.
+",Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+평소보다 요즘이 더 피로하신 것 같나요?,Korean
+성교 시 문제가 있나요?,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+배가 너무 팽팽해져서 불편한가요?,Korean
+아팠다 말았다 하나요? 아니면 계속 아픈가요?,Korean
+알레르기 진단받은 시기가 언제예요?,Korean
+네. 빈속에 먹으면 안 좋을 것 같아서 밥도 꼬박꼬박 챙겨 먹고서 바로 약 먹고 그랬어요.,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+"혈압이 너무 상승돼 가지고요.
+",Korean
+현재 아픈 부분이 있을까요?,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+통증은 없더라도 불편한 느낌이 있을 수 있습니다.,Korean
+병원으로 바로 오셔서 소독하셔야 해요.,Korean
+"이명도 있고 청력 저하도 있네요.
+",Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+현재까지 복용 중인 약이 있나요?,Korean
+어디가 부은 느낌 있나요?,Korean
+"아니요. 수면장애 생긴 지 오래됐어요.
+",Korean
+"아니요. 예전에는 흡연자였는데 아이 생기고 나서는 끊었죠.
+",Korean
+"체중이 요즘 엄청 늘긴 했어요.
+",Korean
+"코 막혀서 잠을 못 자는 거 같아요.
+",Korean
+대변검사 일정은 좀 미뤄도 될까요?,Korean
+네 헌혈 말고 수혈받아보신 적 있나요?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+현재 구토 증상이 있나요?,Korean
+과민성 방광은 방광 근육과 신경에 문제가 생겨 소변을 자주 보게 됩니다.,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+젖은 상태의 거즈로 상처를 보호할 수 있습니다.,Korean
+"원래 빈혈이 좀 있는데 요즘 너무 심해져서요.
+",Korean
+지금 혹시 오한이 있나요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+"혈변을 계속 보는데 어디가 문제인 건지 감이 안 오네요.
+",Korean
+"발을 좀 삐끗한 것 같아서요.
+",Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+단순 음낭수종으로 인하여 감염 가능성은 거의 없습니다.,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+알레르기 때문에 피하는 음식이 있으세요?,Korean
+복통과 복부팽만이 있지만 방귀가 나오므로 장폐색은 아닌 것으로 보입니다.,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+네. 풍진 주사 맞았어요.,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+흉터가 아예 안 남지는 않을 거예요. 그렇지만 잘 보이지 않을 만큼 최선을 다해보겠습니다.,Korean
+퇴원하기 전까지 그럼 약 못 먹어요?,Korean
+요즘 이용하신 병원을 알아야 하거든요.,Korean
+네 언제 어떤 시술을 받으셨나요?,Korean
+흑색변을 보셨으면 위궤양일 가능성이 높지만 정확히 알기 위해 내시경검사를 좀 해볼께요.,Korean
+추후 골수이식 등의 상황이 걱정되신다면 신청하시면 됩니다.,Korean
+통증이 있는 부위가 있으세요?,Korean
+뭐 때문에 약을 드시고 계세요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+컨디션이 안 좋으시면 검사를 미루는 것을 추천드립니다.,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+십이지장 궤양 받았을 거예요.,Korean
+실제로 토하신 적 없으세요?,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+최근에 독감 주사 맞으셨나요?,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+현기증이 생긴 적 있나요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+결핵은 언제 처음 발병하였나요?,Korean
+손은 항상 깨끗하게 씻어주세요.,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+또 아픈 곳 없나요?,Korean
+복수가 차거나 염증이 생긴 경우 발생할 수 있습니다.,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+"어깨를 일정한 각도로 돌린다거나 팔을 좀 심하게 쓸 때면 어깨가 빠진 것처럼 느껴질 때가 있습니다.
+",Korean
+멸균 처리가 된 소독 붕대가 화상 부위가 아물 때까지 환부를 외부 균으로부터 보호하는 역할을 하는 겁니다.,Korean
+"머리 아프면서 속이 좀 메스꺼울 때가 있었어요. 소화도 잘 안 되는 거 같고요.
+",Korean
+그냥 지금은 기존에 가지고 계셨던 피부질환 여부만 여쭙는 거예요.,Korean
+"기저귀 갈아주려고 보니까 아기 사타구니 쪽에 볼록한 게 튀어나와 있어서요.
+",Korean
+주사 부작용으로 약간의 통증은 있을 수 있지만 걱정하실 정도는 아닙니다.,Korean
+전에 수술한 경험 있으세요?,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+통증 원인 확인을 위해 추가적인 검사가 필요합니다.,Korean
+수술시간은 확인하고 알려 드릴게요.,Korean
+네 원래 체중 변화가 생기는데 너무 빠져서 한번 검사는 해봐야 될 거 같습니다.,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장 드립니다.,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+"아이의 허벅지 안쪽에 뭐가 들어갔다 나왔다 해서요.
+",Korean
+토마토 같은 경우는 갈아 드셔도 영양소가 거의 파괴되지 않지만 사과 같은 경우는 파괴되어서 이 부분 고려해서 말씀해 주세요.,Korean
+암을 치료받은 적이 있나요?,Korean
+경과가 좋으면 일주일 후에 퇴원하셔도 됩니다.,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+예전에 쓰러지신 적 있나요?,Korean
+빈뇨 때문에 여러 번 깨시는군요. 잔뇨감이나 통증도 있으신가요?,Korean
+참아보려고 했는데 약이 너무 역해서 토했어요.,Korean
+그 약만 먹으면 기분이 울적해요.,Korean
+당뇨 있어서 식단도 관리 중이에요.,Korean
+"종이 자르는 재단 일을 하는데 재단기에 손가락을 잘려서요.
+",Korean
+아직 호흡한 마취 가스가 혈액에 남아있어 폐에 전해져서요.,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+수술은 진짜 받은 지 오래됐어요.,Korean
+통증이 얼마나 가는 거예요?,Korean
+수술 스케줄은 정해져 있어서 변경은 어려워요.,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+네 진료 센터에서 모두 해드립니다.,Korean
+맥박이 빨리 뛰는 느낌 나나요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+네 책상 위에 약 올려주세요.,Korean
+정확한 수술부위는 전공의 선생님이 수술동의서 작성할 때 설명해주실 겁니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+고통이 얼마나 자주 오나요?,Korean
+애완견과 관련된 접종은 어느 것이든 말씀해 ��시면 됩니다.,Korean
+어머니가 고혈압이 있으시고 다른 가족은 잘 모르겠습니다.,Korean
+통증이 몇 분마다 오나요?,Korean
+일단은 약물치료와 주사 치료를 병행해서 진행하도록 하겠습니다.,Korean
+종양이 발견된 지 오래됐어요?,Korean
+네 바로 혈액형 검사 가능합니다.,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+하루 담배 얼마나 피우세요?,Korean
+이제 관장하실 거예요. 바지 내려주시고 아까처럼 엎드려주세요.,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+통증 생긴 지는 얼마나 됐나요?,Korean
+그럼 이따 드실 약만 가지고 계시고 나머지는 확인 후 돌려드리겠습니다.,Korean
+평소에 먹는 약이 있나요?,Korean
+"네. 평균 일곱 시간 정도 자는 것 같아요.
+",Korean
+아침 저녁 식전에 위산분비억제제와 식후에 항생제 두 종류를 복용하시면 됩니다.,Korean
+통증 진행 양상이 어떤가요?,Korean
+보통 하루에 몇 개비나 피우시나요?,Korean
+잘 모르시겠다면 병원에 입원한 모든 내용 알려주세요.,Korean
+통증이 가장 잘 느껴지는 부위가 어디예요?,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+"쥐어짜는 것 같은 통증이 왼쪽 가슴에 있어서 병원에 왔어요.
+",Korean
+상대적으로 혈압이 높은 편이세요?,Korean
+신장 조직 일부를 얻어서 현미경으로 관찰하는 것인데 그 조직을 얻기 위해 바늘을 넣게 됩니다.,Korean
+출혈을 최소화해서 치료할 겁니다.,Korean
+"목 안이 아픈 거 아니에요.
+",Korean
+웻 거즈는 젖어 있는 거즈라는 뜻이에요.,Korean
+특정한 것에 알레르기가 있나요?,Korean
+약을 드시고 나면 잠이 많이 온다는 건가요?,Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+다행이네요 고열량의 야식을 드시고 몸의 움직임이 적으면 고혈압 당뇨 고지혈증 비만 등 질병에 걸릴 위험이 높아져요.,Korean
+평소에 변은 잘 보세요?,Korean
+시술 부위 통증이나 시술 후 누워있어야 하는 등의 불편함은 있겠지만 장기적으로 문제가 되지는 않습니다.,Korean
+홍삼만 먹고 있는 거죠?,Korean
+조금 전에 항생제를 투여하기 위해서는 사전에 환자분에게 문제가 없는지 확인이 필요하다고 설명을 드렸습니다.,Korean
+변에 피가 함께 나오나요?,Korean
+현재 검사 소견은 모두 정상이라 추후에 가슴 통증이 재발할 경우 그때 임상적 상황에 맞춰 필요한 검사들을 진행하시면 됩니다.,Korean
+담배를 피우신 적 있으세요?,Korean
+혈압 수치 알고 계세요?,Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+암은 몇 기 진단 받으셨나요?,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+제대혈 채취 후 삼십육 시간 이내에 이송되므로 분만 전에 결정해주세요.,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+검사 후에 치료가 필요하다면 진행 될 겁니다.,Korean
+간염으로 약을 드시고 계세요?,Korean
+특정 시기에 통증이 생기나요?,Korean
+간헐적으로 아픈가요? 지속적으로 아픈가요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+"애가 먹으면 바로 다 토해요.
+",Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+이 밖에 다른 알레르기 있으실까요?,Korean
+환자분 의식이 없으면 연락드려야 합니다.,Korean
+제가 약에 알레르기가 있는데 뺄 수 있나요?,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+조산이라 태어나서 세 달 동안 인큐베이터에 있었어요.,Korean
+"엘리베이터에서 내리고 쓰러져서 의식이 없었어요.
+",Korean
+"고양이한테 다친 곳이 염증이 생긴 것 같아요.
+",Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+대변이 잘 안 나오고 그러나요?,Korean
+제 때 약을 드시고 건강 관리에 힘써주시면 점점 좋아질 거라 생각합니다.,Korean
+집안에 고혈압 환자분 계세요?,Korean
+피와 소변이 함께 나오나요?,Korean
+민감성 피부의 여부에 따라 다릅니다.,Korean
+대부분은 그렇습니다만 통증이 있으면 시술 시 말씀해주세요.,Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+아마 공에 부딪히면서 왼쪽 늑골 갈비뼈라고 하죠. 골절이 있는 거 같아요. 정확한 건 엑스레이 검사를 해볼게요.,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+그때 약을 처방받았던 병원 이름을 알려주세요.,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+입원은 한두 시간은 대기하셔야 해요.,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+"거의 잠을 못 잤어요. 하루에 네 시간 자면 많이 잔 거예요.
+",Korean
+네. 저번 주에 보라카이 갔다 왔고요. 가기 전에 접종하고 갔습니다.,Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+최근 체중 변화가 눈에 띄게 있었을까요?,Korean
+"원래 늦게까지 잘 잤는데 요새는 일찍 눈이 떠져요.
+",Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+네. 다행이네요. 대장내시경 도중에 오 밀리미터 이상의 큰 용종이 발견되면 대장용종 제거술을 하게 될 수도 있습니다.,Korean
+복통이나 다른 증상은 같이 있지 않았나요?,Korean
+무릎 관절 수술을 받았습니다.,Korean
+"시비 붙은 사람이 손으로 제 얼굴을 때렸어요.
+",Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+증상이 언제쯤 시작됐는지 알려 주세요.,Korean
+그 증상 말곤 없나요?,Korean
+또 다른 증상은 없나요?,Korean
+잠을 쉬이 못 드나요?,Korean
+"아니요. 전에 잠깐 금연했었어요.
+",Korean
+알약으로 된 해열제요. 병원 오기 전에 먹였습니다.,Korean
+사람에 따라 감염에 대한 반응이 다를 수 있습니다.,Korean
+통증이 지속되는 부위가 어딘가요?,Korean
+아 그거 이외에 드시는 약은 없으시고요?,Korean
+특정 마취 약물에 대해 부작용이 있으시면 약물을 변경하려고 합니다.,Korean
+보호대도 도움은 되지만 주사치료가 필요합니다.,Korean
+"아니요. 목 근육 부분이오.
+",Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+요즘 인간의 독감이 변형되어 개한테 유행입니다.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+몸에 붓기는 차도가 있나요?,Korean
+"고환이 부은 것 같아서요.
+",Korean
+"아니요. 체중엔 변화 없는 것 같아요.
+",Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+아프거나 병원에 다닌 적 있으신가요?,Korean
+"아이 성기 부분이 빨갛게 부어올랐는데 아이도 거기가 자꾸 간지러운지 계속 긁으려고 손을 가져다 대요.
+",Korean
+과거에 혹시 질병이 있었습니까?,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+근전도 검사를 통해 신경 손상 정도를 평가해보고 말씀드리겠습니다.,Korean
+혹시 처방받은 약이 있나요?,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+"아파서 한참 동안 뒤척거리다 잤습니다.
+",Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+입원 또는 수술 경험이 있나요?,Korean
+"소변볼 때마다 아랫배가 아파요.
+",Korean
+통증이 있는지 알고 싶어요.,Korean
+통증이 나타난 곳이 어디신가요?,Korean
+"잠이 잘 안 와서 힘듭니다.
+",Korean
+다음 달에 이사를 가려고 하는데요. 혹시 새로운 병원을 좀 소개해 주실래요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+최근 두 달 안에 급격한 체중 변화가 있었나요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+현재 주사 부위에 이상 소견은 관찰되지 않습니다.,Korean
+약물 알레르기 있는 거 있으세요?,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+통증으로 인해 얼마나 자주 아프세요?,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+약물에 대한 알레르기가 있습니까?,Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+병원 입원 경험이 있으신가요?,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+진료 센터에서 모두 해드립니다.,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+대략적으로 질병에 대해 알고 계신지 확인 차 여쭤본거고 검사결과는 이제부터 설명드릴게요.,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+구토가 나아질 기미가 있나요?,Korean
+"기침 콧물이 나고 열이 나서 단순한 감기인 줄만 알았는데 가래에 피가 섞여 나오더라고요.
+",Korean
+"편도가 부은 것 같아요. 침도 못 삼키게 아파요.
+",Korean
+도대체 어디가 아픈 거예요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+검사를 빨리할수록 만약에 병을 찾을 경우 다양한 치료 방법을 적용할 수 있습니다.,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+욕창이 안 생기도록 체위 변경 자주 해주시고 신경 써 주시면 피부 재생 속도도 빠를 겁니다.,Korean
+예전에 아팠던 곳 있어요?,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+주사 부작용으로 약간의 통증은 발생할 수 있습니다.,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+네. 아침에도 관장약 먹고 화장실 갔다가 왔어요.,Korean
+갖고 계신 약 있나요?,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+아랫배 통증을 호소하시는 분들은 종종 있습니다.,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+오전 아홉 시 시작이니 여덟 시 사십 분까지 병원으로 오시면 됩니다.,Korean
+심장 박동이 불규칙하게 뛰는데 괜찮으세요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+심장 뛰는 속도가 빠르게 느껴지시나요?,Korean
+약 냄새 때문에 어지럽다는 건가요? 약 드신 직후에 그런가요?,Korean
+"오른쪽 고환 쪽이 아파요.
+",Korean
+소화가 안 되어서 속이 불편해요?,Korean
+잠을 자지 못해서 힘드신가요?,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+"집사람이 죽으려고 약을 잔뜩 털어먹었어요.
+",Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+통증 부위는 어디신 거죠?,Korean
+헬리코박터로 인한 것일 수도 있지만 아닌 것일 수도 있어 상황에 맞춰 검사를 시행하도록 하겠습니다.,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+뇌 손상 때문일 수 있어요.,Korean
+자연 치아에 비해 기능이 부족한 치아를 확인하려 합니다.,Korean
+통증 정도는 어느 정도 되십니까?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+아침 약 맞는데 가져오는 걸 까먹었네요.,Korean
+변에 피가 함께 나오나요?,Korean
+법적 보호자의 서명이 있어야만 수술이 가능합니다.,Korean
+약물치료로 호전될 가능성이 높지만 환부를 자주 확인해볼 필요가 있습니다.,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+"사람이 많은 자리에 가면 식은땀이 나고 손발이 차가워지는 현상이 최근 들어 자주 나타나 오게 되었어요.
+",Korean
+먼저 침상에 누워 안정을 취하시고 두 번째로 금식을 유지하시고 세 번째로 혈액검사 소변량 검사하시면서 수액치료를 받으시면 됩니다.,Korean
+통증이 제일 처음 나타난 게 언제인가요?,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+담배를 피우신 적 있으세요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+복통 증상은 언제부터 있었나요?,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+수분 섭취 정도는 검사에 영향을 미치지 않으나 경우에 따라 흡인 등 부작용 발생 위험성이 증가할 수 있습니다.,Korean
+약국서 감기약 사 먹었었는데요.,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+얼마 전에 골다공증 때문에 병원에 왔었어요.,Korean
+토할 거 같은 증상이 있으세요?,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+필요하시다면 협진 진료 의뢰 드리겠습니다.,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+"아 네. 고름이 잡힐 때마다 집에서 가능하면 짜려고 하는데 그러면 더 번지는 것 같아요.
+",Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+소아암으로 초등학교 들어가기 전에 병원에 오래 있었습니다.,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+"심장이 안 좋은 거로 알고 있어요.
+",Korean
+빈속에도 구토 증상이 있나요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+소변이 쉽게 안 나오나요?,Korean
+통증이 어떤 형태로 옵니까?,Korean
+아침에 먹어야 하는데 잘 까먹어서 생각날 때 먹어요. 약은 비상으로 챙겨 둔 게 있어요.,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+병원비랑 관련된 상담은 어디서 받을 수 있을까요?,Korean
+하반신 마취여도 안정을 위해 수면마취를 시행하는 경우도 있습니다.,Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+원래는 안 그랬는데 최근에 무릎이 아프다고 계속 그러셨어요.,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+숨 쉴 때 통증이 있나요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+통증의 지속 여부를 말씀해 주시겠어요?,Korean
+그 민간요법으로 상처 부위가 악화되었습니다.,Korean
+잠들기 두 시간 전에는 물을 안 드시는 거죠?,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+"""아직 여쭈어볼 거랑 입원생활 안내해 드려야 하는데, 일단은 통증이 가라앉을 때까지 먼저 필요한 사항은 보호자분한테 여쭤보도록 하겠습니다.""",Korean
+원래 앓고 계시던 병변이신가요?,Korean
+음 특별히 따로 먹는 약은 없습니다.,Korean
+비타민이랑 루테인 먹고 있습니다.,Korean
+최근에 체중 변화가 급격하게 있었어요?,Korean
+혹시 환자분 음식이나 약에 알레르기가 있을까요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+진단서 등 다양한 서류가 필요합니다.,Korean
+"적어요. 너무 아파서 물 자체를 별로 안 마시거든요.
+",Korean
+네 꾸준히 복용 중이시거나 추가로 복용 시작한 약물요.,Korean
+상처 부위에 붓기도 있나요?,Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+"자궁 초음파를 했는데 자궁근종이 있다고 해서 왔어요.
+",Korean
+네 병원은 전체 금연지역입니다.,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+혹시 안 먹거나 탈수 증상이 있으면 병원에 방문해 주세요.,Korean
+삼십육 점 사 도 정상이시네요. 여기 체크리스트 서랍장에 붙여둘께요. 퇴원할 때까지 매일 보호자분도 체온 체크할게요.,Korean
+간접흡연의 부분으로 기록해 두겠습니다.,Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알코올 솜으로 눌러 보세요.,Korean
+술 드시고 배가 아프셨나요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+속이 안 좋은 증상의 기간과 양상을 좀 더 설명해 주시겠어요?,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+진료 후 처방전이 나갈 예정입니다.,Korean
+당뇨를 앓은 지 얼마나 되셨어요?,Korean
+통증이 어떤 거 같으세요?,Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+마치 미라처럼요 그럼 외부에서 다른 물질이 상처에 직접 닿지 않겠죠?,Korean
+"술�� 줄이고 있고 담배는 피웁니다.
+",Korean
+몸이 붓는 증상이 있나요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+담배 피우신 기간이 얼마나 되나요?,Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+눈이 안 좋아서 루테인 챙겨 먹어요.,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+"소변이 자꾸 마렵고 잔뇨가 늘 남아요.
+",Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+딱히 약물 알레르기는 없었던 것 같아요.,Korean
+처음 간염 왔던 게 언제예요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+"눈 주변이 몹시 가렵고 작은 두드러기가 나고요 눈도 붓고 씻고 나와서는 진물이 납니다.
+",Korean
+약도 보고 영상의학과 찾아가시겠어요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+어제부터 열이 나신 게 맞는가요?,Korean
+피부 내부의 신경이 손상을 받아 통증을 크게 느끼지는 못할 가능성이 큽니다.,Korean
+배 안에 가스가 많다는 것을 의미합니다.,Korean
+갑자기 혈압의 변화가 있거나 열이 나는 증상 등이 발생하지 않는다면 문제없습니다.,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+간에 있는 염증이 딱딱해져서 간 경화까지 진행될 수 있습니다.,Korean
+피부 알레르기 반응으로 호흡곤란이 유발되기도 합니다.,Korean
+통증이 많이 심한가 봐요?,Korean
+소변을 보고 싶을 때 자주 참나요?,Korean
+진단 받은 다른 질병이 있나요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+마취약에 알러지 반응이 있으신가요?,Korean
+아까 너무 아파서 진통제 두 알 먹었어요.,Korean
+불편함이 있으시면 언제든지 병원으로 연락주세요.,Korean
+환자의 필요에 따른 간호 제공을 위해 중요한 질문입니다.,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+이름 끝이 병원이 아니라 의료원이었는데 아 경희의료원에 방문했었습니다.,Korean
+최근 몇 달 동안 살이 급격히 빠지지는 않았나요?,Korean
+무릎 쪽에 통증이 있나요?,Korean
+다른 병원 입원 포함 모든 입원경험을 알려주세요.,Korean
+아니요. 따로 진단받은 적도 없지만 한 번도 빈혈기가 있다고 생각한 적은 없는데요.,Korean
+저혈압이 유전이면 저도 아마 있을 거예요.,Korean
+결핵이 있다는 것을 언제 알게 됐나요?,Korean
+드물게 출혈 혈종 등이 발생할 수 있으나 의료진이 관찰하니 너무 걱정하지 마십시오.,Korean
+통증은 없더라도 불편한 느낌이 있을 수 있습니다.,Korean
+흡연 기간은 어떻게 되나요?,Korean
+간염은 언제 진단 받으셨나요?,Korean
+네. 작년 이맘때쯤 내원했었어요.,Korean
+"장염 같아요. 속도 안 좋고 배도 부글부글 끓어요.
+",Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+참고해야 할 병력이 있을까요?,Korean
+아닙니다. 만성위염에 걸리면 보통 표재성 위염이나 미란성 위염이 많습니다.,Korean
+식염수로 적시거나 항생제를 추가하여 감염 방지의 목적으로 활용할 수 있습니다.,Korean
+네 협심증 및 심부전 소견으로 의뢰서가 쓰였네요.,Korean
+언제 처음 결핵을 앓았나요?,Korean
+가족 중에 당뇨 환자 있으신가요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+"변의 형태나 색깔은 이상 없었어요.
+",Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+잠 때문에 일상생활이 어려우신가요?,Korean
+위 내용물이 구강 내로 역류할 수 있고 이로 인해 위 내용물이 기도를 폐쇄하여 질식을 초래할 수 있기 때문이에요.,Korean
+보철물이 있는지 확인하는 거예요.,Korean
+알레르기 증상이 나타난 게 언제 처음이죠?,Korean
+기침 가래 콧물 피가 섞인 가래가 나온다거나 하는 호흡기계 증상은 없으셨나요?,Korean
+"똑바로 걷지를 못하고 비틀거려요. 말도 어눌하고.
+",Korean
+결핵 치료는 약으로 하셨나요?,Korean
+알레르기가 음식이나 털 이외에도 다양한 원인이 있어서요. 정확하게 기억은 안 나시는 건가요?,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+통증 특성이 있다면 어떤 특성이 있을까요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+금식을 안 하시고 수술�� 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+요즘 혹시 두통이 있나요?,Korean
+열이 나면 해열제 치료를 하고 감염 조절을 할 것입니다.,Korean
+네. 칼슘 수치도 약간 낮고 충분히 드셔야 뼈 손실이 덜해요.,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+요로조영술은 십만 구천구백 원 정도 씨티는 십만 오천팔백십 원 정도입니다.,Korean
+교정이 어려우시겠지만 과식은 잘못된 습관입니다.,Korean
+하루에 가래를 얼만큼 뱉으시나요?,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+단기로 작용하는 수면약을 사용하긴 하지만 어지러우실 수 있으니 보호자 꼭 동반하셔서 댁에 가셔야 합니다.,Korean
+결핵 주사 맞은 적 있으세요?,Korean
+알겠습니다. 수술하시거나 입원하신 경험은 없으신가요?,Korean
+암 치료받으신 기간 알려주세요.,Korean
+지금 부종이 있는 상태인가요?,Korean
+얼마나 통증이 심하게 느껴지고 있나요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+바이러스에 대한 저항력이 꾸준히 높게 유지된다면 증상을 완화시킬 수 있습니다.,Korean
+비타민이 건강보조식품인가요? 비타민을 먹고 있어요.,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+열은 원래 조금 있으셨어요.,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+네 보호자분이 아니라 환자분한테 하는 거 맞습니다.,Korean
+"밤새 배가 아프다며 뒤척이며 잠을 못 잤어요.
+",Korean
+아픈 느낌 표현해 주세요.,Korean
+간염은 언제 진단 받으셨나요?,Korean
+당뇨로 검사받으신 지 얼마 되었나요?,Korean
+"영화 보느라 화장실을 오래 참았더니 아파요.
+",Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+잔뇨감이 느껴지면 저 병일 수도 있어요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+네. 담배 종류에 상관없이 말씀해 주세요.,Korean
+마취 크림을 안 바르면 통증이 느껴질 겁니다.,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+피가 나올 정도면 연고를 처방받으셔야 합니다.,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+가족 중에 치료가 필요할 정도의 당뇨를 진단 받으신 분이 계신가요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+발열이 심하면 어느 정도로 나타나죠?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+가족 내 암 판정받은 분은요?,Korean
+알레르기 때문에 주의해야 하는 것이 있나요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+"군대에서 삽질하다가 갑자기 우측 어깨에서 톡 소리가 나더니 어깨가 아파져서 오게 되었습니다.
+",Korean
+흡연 여부는 엑스레이와는 관계없습니다.,Korean
+"시원하게 못 보는데 싸고 나면 똥꼬가 아파요.
+",Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+손목 관절의 움직임을 최소화할 수 있도록 보호대를 착용하는 것이 좋습니다.,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+장염이 심해서 며칠 입원했었어요.,Korean
+감염의 위험 없이 일상생활이 가능한 상태로 회복하는 것입니다.,Korean
+감염을 모르고 있다가 증상이 지금 나타난 것이라면 감염 시기와 정확한 감염경로는 모르실 수 있어요.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+네 간질환 또한 유전적 질환일 수 있기 때문에 위험도가 높긴 합니다.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+당뇨 약 먹고 계세요?,Korean
+혹시 가래는 주로 삼키시나요? 아니면 뱉으시나요?,Korean
+"안녕하세요. 다름이 아니라 제가 왼쪽 손가락이 빨갛게 붓고 아프고 한 번은 고름도 나오더라고요 그래서 왔어요.
+",Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+아니요 빈혈 안 옵니다.,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+잠을 깊게 잘 수 있나요?,Korean
+얼마나 아픈지 간단하게 설명 좀 해주시겠어요?,Korean
+소변이 잘 누어지지 않으세요?,Korean
+독감 같은 경우에는 매년 겨울 전에 맞는데 혹시 접종한 적 있으신가요?,Korean
+청력이 좀 안 좋아요.,Korean
+네 가슴 쪽에 문제가 있는 것 같습니다.,Korean
+"혀를 잘못 깨물어서 통증이 심해요.
+",Korean
+대체적으로는 처방되는 변비약의 효과가 좋은 편입니다.,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+약물로 고혈압 치료 중이신 건가요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+지금 바로 눕혀주시면 몸무게 측정 시작하겠습니다.,Korean
+복용 중인 위장약은 없나요?,Korean
+움직이라고 시키지 않으면 미동도 없나요?,Korean
+이송요원을 따라가시면 엑스레이 실로 안내받으실 겁니다.,Korean
+네 수술 시 참고해야 하기 때문입니다.,Korean
+"마렵기만 하고 오줌은 안 나와요.
+",Korean
+알레르기 원인이 뭐가 있죠?,Korean
+네. 그럼 일단 진료받는 것으로 하고 한번 찾아뵐게요.,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+항암 치료제를 복용 중이신가요?,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+대소변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+몸에 붓기는 차도가 있나요?,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+제왕절개 하면서 추가로 하는 거라 가족계획이 없으시면 결정해서 알려주세요.,Korean
+통증 주기가 몇 주인가요?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+간염으로 약을 드시고 계세요?,Korean
+"혈압이 턱없이 낮은 것 같아서요.
+",Korean
+네. 현재 질병과 관계없이 모든 입원 치료 및 수술 경험 알려주세요.,Korean
+"사과 알러지가 있어서 과일 주실 때 빼고 주세요.
+",Korean
+결핵이라고 느낀 적 있으세요?,Korean
+철심 박는 수술까지는 아니었고 그냥 사 번 뼈 수술받은 걸로 알고 있어요.,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+결핵으로 인해 수술받으신 이력이 있는지 말씀해 주세요.,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+병원 내원객의 필수 질문사항이라 질문드렸습니다.,Korean
+영양제 유산균이랑 비타민 먹고 있어요.,Korean
+흡연 상태 유지 중이신가요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+우선 환부를 씻어내는 게 우선입니다.,Korean
+사 주 이내에 진료받은 병원이 있는지 알아야 해서요.,Korean
+평소에 팔을 들어 올린다거나 하는 동작은 할 수 있나요?,Korean
+최근 들어서 몇 개월 동안 급격히 체중 변화가 있었나요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+대소변을 잘 못 보는 것 뿐 아니라 대소변을 볼 때 불편감이 있는 경우도 포함됩니다.,Korean
+제거하는 거라 약간의 통증은 발생할 수 있어요,Korean
+영양제는 약물에 속하지 않지만 어떤 영양제를 드시는지 말씀해 주시겠습니까?,Korean
+결핵은 약물로 치료받고 계세요?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+그럼 잠깐만 보여주시면 약은 오늘 안에 돌려 드릴게요.,Korean
+네 수술하게 될 부위 피부 위에 표시하면 됩니다.,Korean
+"심장이 좋지 않아서 그런 거라고 전해 들었어요.
+",Korean
+통증은 계속 나타나고 지속되세요?,Korean
+"통증이 있긴 하지만 수면 시간에 변동을 줄 정도는 아닙니다.
+",Korean
+네. 꾸준히 약 복용만 잘한다면 조기에 치료할 수 있습니다.,Korean
+"눈에 띄게 열이 난 건 아니라 자세히 기억은 안 나요. 한 한 달?
+",Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+체내에 이산화탄소가 많아진 경우 만성 폐쇄성 폐질환이나 상기도 폐쇄 환기를 위한 근육기능 감소 신경전달 이상 중추성 호흡 기능 감소를 의심할 수 있습니다.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+"아니요. 목이 좀 쓸려서 아픈 것 같아요.
+",Korean
+말씀드린 레이저 시술이 가장 빠르게 제거 가능합니다.,Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+괜찮습니다. 입원치료 혹은 수술 관련하여 입원하신 적이 있으신가요?,Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+평소보다 숨이 잘 안 쉬어지시나��?,Korean
+바로 말씀드리기는 어려우니 상부위장관 내시경 검사가 필요합니다.,Korean
+혹시 기력이 떨어졌다고 느끼세요?,Korean
+하루 평균 얼마나 피우시나요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안됩니다.,Korean
+제가 만질 때 아픈 곳 있으면 말씀해 주세요.,Korean
+음주 빈도는 얼마나 되시나요?,Korean
+집에 가도 봐줄 사람이 없어서요. 입원할게요.,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+그럼 소화기 증상은 전혀 없으신건가요?,Korean
+혈압 측정이 끝나면 좋아졌는지 말씀드릴게요.,Korean
+병원에서 처방 약 어떤 거 받으셨어요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+"다리를 위로 올려놓고 신경안정제를 먹으면 좀 낫더라고요.
+",Korean
+"오른쪽 무릎 부분에 화상을 또 크게 입었어요.
+",Korean
+상처에 습윤이 유지되는 효과가 있습니다.,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+간호사님에게 문의해 주시기 바랍니다.,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+주사를 살살 놓으면 더 아프실 수도 있어요. 얼른 끝내 드릴게요.,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+통증이 얼마 동안 지속되나요?,Korean
+투약하고 있는 약이 지금 약이랑 겹칠 수 있어 여쭤보는 겁니다.,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+아니요. 영양제 말고 질병 진단 으로 드시는 약이 있나요?,Korean
+환자에게 위급한 상황이 있을 때 연락하기 위함입니다.,Korean
+우울증이 있어서 정신과에서 약 받아먹어요.,Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+피가 많이 필요한 검사가 아니라서 걱정 안 하셔도 됩니다.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+"의자가 부러져서 엉덩이를 바닥에 찧었어요.
+",Korean
+우선 통증 부위와 초진 기록지를 작성해 주세요.,Korean
+면역력이 떨어져 생긴다고 할 수 있습니다.,Korean
+가래에 피가 섞여 있나요?,Korean
+지금 들고 계신 자료는 다른 병원에서 가져오신 건가요?,Korean
+조금 따끔하는 정도예요. 그래도 걱정되시면 치료 전에 한 번 더 말씀해 주세요.,Korean
+내시경 검사 시 위장관 내부를 더 잘 볼 수 있도록 장을 비우기 위해 금식이 필요합니다.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+복부 팽만감 때문에 불편함을 느끼시나요?,Korean
+"하루 다섯 시간 자는 듯한데요?
+",Korean
+기침을 얼마나 자주 하나요?,Korean
+"아기가 숨을 쌕쌕거리면서 쉬어요.
+",Korean
+비뇨기과와 협업하여 진료할 수 있도록 도와드릴게요.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+저번보다 검사 결과가 많이 좋아졌네요.,Korean
+흡연량이 정확하지 않아도 대략 알려주세요.,Korean
+"아랫배가 아프고 항문에서 피가 나요.
+",Korean
+"애가 몸이 아주 뜨거워요. 내릴 생각을 안 해서요.
+",Korean
+"네. 근데 애가 머리가 자꾸 어지럽다고 해서요.
+",Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+심장 박동이 느껴질 정도로 심장이 뛰나요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+결핵 치료는 언제부터 시작하셨어요?,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+"두 가지 증상 다 없었어요.
+",Korean
+코로나 검사 대상자인 적 없습니다.,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+더운 날 회를 드시는 것은 권유 드리지 않습니다.,Korean
+목 안에서 통증이 느껴지나요?,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+그냥 마취한 것밖엔 없어요.,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+입원하신 날짜로 말씀해 주시겠어요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+심장 박동이 불규칙하게 뛰는데 괜찮으세요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+오한이 있는 것 같나요?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+접촉성 피부염이 발생할 경우 약물 투여를 중지하면 증상이 개선되니 걱정 안 하셔도 됩니다.,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+네. 여기 있어요. 수술은 잘 된 건가요?,Korean
+두통이 있는지 말씀해 주세요.,Korean
+이전에 심장 리듬이 불규칙하다는 소견을 들으신 적이 있나요?,Korean
+어제 저녁 먹고 어른용 해열제 반쪽 먹었어요.,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+초반에는 물리적으로 제거를 하고 추후 예방을 위해 면역치료를 동반하기도 합니다.,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+네. 그럼 외래 진료 예약도 오늘 하겠습니다.,Korean
+불면증 진단받아서 드시는 거예요?,Korean
+알레르기 때문에 갑각류 근처에도 안 갑니다.,Korean
+독감 접종은 어디서 하셨나요?,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+채혈은 임상 병리 선생님이 전문으로 해주십니다.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+처방받지 않는 약은 뭔가요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+"원래 심장이 안 좋아서 자주 부어요.
+",Korean
+검사 부위는 일시적으로 붉게 올라올 수 있어요.,Korean
+열상 치료는 해봤는데 수술은 아닌 거죠?,Korean
+"""입원, 수술 경험 있으시면 말씀해주세요.""",Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+검사결과가 나와봐야지 알 수 있겠네요.,Korean
+조금이라도 의식이 남아있다면 주변에 빠른 도움을 요청하세요.,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+지금까지 열은 안 났나요?,Korean
+아이가 나중에도 키가 안 클까 봐 걱정이에요.,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+아침부터 혈압이 올랐던 것 같은데요.,Korean
+쉬고 계실 때에도 심장 박동이 빨랐나요?,Korean
+불면증 치료받아도 잘 못 주무시나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+열이 나는 증상이 있나요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+수유 중이나 수유 후 한 번씩 해 주시면 됩니다.,Korean
+주사 부작용으로 약간의 통증은 있을 수 있지만 걱정하실 정도는 아닙니다.,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+입원 준비 물품 목록 저한테 아직 안 주셨어요.,Korean
+복용 중인 약은 가지고 오셔서 저희에게 꼭 보여주셔야 합니다.,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+썩은 것 같지는 않아요 우선 저희가 앞니 뿌리를 튼튼하게 해주는 주사를 놓아드릴게요.,Korean
+네 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+치료방법이 달라질 수도 있어서 질문 드렸습니다.,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+진단서 여러 장 발급 가능한가요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+네 모든 검사 완료됐습니다.,Korean
+심했다가 나은 건데 처음 진단받은 건 한 육 년 됐어요.,Korean
+진료받는데 거리가 멀면 위급 상황 시 문제가 될 수 있어서 여쭈어봤습니다.,Korean
+네. 원래 심장 부근이 상당히 약했어요.,Korean
+담배를 피운 기간을 알려주세요.,Korean
+비수면 시 불편함을 더 느낄 수 있지만 비교적 짧은 검사라 괜찮��� 수 있습니다. 수면 마취 시에는 수면 마취에 따른 위험성이 따라옵니다.,Korean
+여러 가지 원인에 의하여 몸속 빌리루빈이 상승하여 몸이 노랗게 변하며 가려움증 등을 동반합니다.,Korean
+"변의 형태가 거의 없어요.
+",Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+불면증이 심하신 거 같아요.,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+항히스타민제는 두드러기 발적 소양감 등의 알레르기성 반응에 관여하는 히스타민의 작용을 억제하는 약물입니다.,Korean
+청진할 때 옷을 올려 주시는 게 좋아요.,Korean
+잇몸 한 번 볼게요.,Korean
+마취 방법에 따라 부작용이 달라집니다. 마취부작용 있었나요?,Korean
+통증 발병하면 얼마 동안 가나요?,Korean
+네. 아스피린 약은 못 먹겠어요.,Korean
+간염 여부 알려 주세요.,Korean
+가슴이 찌를 듯이 아픈가요?,Korean
+네. 빈혈로 쓰러진 적도 몇 번 있어요.,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+언제부터 혈뇨 증상이 있으셨어요?,Korean
+통증이 어느 부위에 있나요?,Korean
+엑스레이 찍는 게 좋죠.,Korean
+수술받은 곳 통증은 어때요?,Korean
+흡연을 시작하게 된 게 언제부터일까요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+가족 중에 유전성 질환을 가진 가족이 있으세요?,Korean
+콩팥기능이 안 좋은 분은 조영제 사용이 주의가 필요한데 환자분은 괜찮으신 것 같아요.,Korean
+구급차에서 이동 침대로 이동하셨군요.,Korean
+네. 소아마비로 인해 지금까지도 거동이 매우 힘듭니다.,Korean
+두 시간 전에 맥시부펜 먹였어요.,Korean
+"무거운 거 들다가 손목이 아팠어요.
+",Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+단순한 치료의 부작용으로 마비가 오는 경우는 드물기 때문에 다른 이상에 대한 선별이 먼저 필요합니다.,Korean
+잘 기억하고 계시네요 검사는 안정을 좀 취하시고 시작하겠습니다.,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+코로나라고 의심하시는 이유가 있으신지요?,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+가슴통증을 유발하는 허혈성 심질환에는 안정형 허혈성 심질환과 급성 관동맥 증후군이 있습니다.,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+네. 태아 시기에 신경세포 이동 과정에 문제가 생겨 발생한 질환입니다.,Korean
+"아침에 일어나면 손이 부어서 잘 안 구부러지더라고요.
+",Korean
+제일 염려되는 증상이 뭐죠?,Korean
+당뇨 검사받아보신 적 있으세요?,Korean
+무턱대고 가져가시면 안 되죠. 약 복용 중단으로 문제 생기면 책임 지실 거예요?,Korean
+통증은 없고 띵한 느낌만 있으세요?,Korean
+당뇨 있는 건 아니시죠?,Korean
+환자분은 완치된 상황이라 퇴원하셔야 합니다.,Korean
+"네. 혈변 양이 좀 돼요.
+",Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+토를 심하게 한 적이 있나요?,Korean
+예전에 병원에서 처방받아서 약병에 담긴 거라 이름이 안 적혀 있어요.,Korean
+"잘 때 발 다리에 쥐가 나서 잘 못 자요.
+",Korean
+할아버지가 당뇨도 있고 고혈압도 있으셨어요.,Korean
+치아와 잇몸 상태를 체크하고 있어야 앞으로 정기 검진하실 때 저희가 환자의 치아 상태를 알 수 있습니다.,Korean
+결핵으로 진단받은 적 있나요?,Korean
+혹시 환자분 음식이나 약에 알레르기가 있을까요?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+"깨진 유리를 처리하다가 베였어요.
+",Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+네 임플란트는 언제 받으셨어요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+당뇨는 언제부터 알게 되셨어요?,Korean
+진통제를 매번 먹고 있었어요.,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+구토는 자주 나오지 않나요?,Korean
+"걸을 때 내 몸 어딘가 고장 난 듯한 느낌이 들어요.
+",Korean
+몸에 열 기운이 느껴지세요?,Korean
+코로나 의심 증상은 없으셨죠?,Korean
+당뇨 치료받으신지는 얼마나 돼셨나요?,Korean
+피로한 느낌을 받은 적이 있으신가요?,Korean
+그런 경우 어느 정도 장이 쉬어줄 수 있도록 금식을 시행하는 것이 바람직합니다. 주사제로 변경하여 투여하겠습니다.,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+약을 어느 병원에서 받으신 거죠?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+부기는 잘 빠지고 있네요.,Korean
+심근경색 검사 결과 정상으로 조금 전 확인되었기 때문에 재검사는 불필요합니다.,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+통증이 얼마 만에 발생하는지 말해볼래요?,Korean
+"아 저 귀가 좀 간질간질하고 물집이 잡힌 것 같아서 진료 보려고 왔어요.
+",Korean
+콜라겐 말고 다른 약 드시는 건 없으신가요?,Korean
+발기가 충분히 오래 지속되지 않나요?,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+정상 수치보다 엘 디 엘 콜레스테롤이 높으면 진단할 수 있습니다.,Korean
+소변볼 때 불편감이 있나요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+고지혈증 당뇨 신기능 검사 간기능 갑상선 기능 등에 대해 알 수 있습니다.,Korean
+"관절염 때문에 걷지 못하겠어요.
+",Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+"열이 꽤 올랐는데 왜 이러는지 모르겠어요.
+",Korean
+"코 막혀서 잠을 못 자는 거 같아요.
+",Korean
+네. 요로 조영술은 어떻게 진행되나요?,Korean
+지금 움직이는 데 불편하거나 지팡이 등 보조 기구의 도움이 필요하지는 않나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+그 정도의 화상으로 보입니다.,Korean
+통증이 하루에 자주 일어났어요?,Korean
+종교적인 이유로 수혈을 거부하시는 분들도 계십니다.,Korean
+"음식 냄새만 맡아도 자꾸 토해서요.
+",Korean
+아. 퇴원 절차도 까다롭군요.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+구토를 지금도 하시고 오셨나요?,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+"술은 입에도 못 댈 정도로 간이 안 좋아요.
+",Korean
+수프만 드신 기간이 어느 정도인가요? 영양 균형에 문제가 생길 수 있는 사항입니다.,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+"금연 중이라 아침 점심 저녁 딱 세 번만 피우려고 노력 중이에요. 이제 육 년 됐어요.
+",Korean
+아이들의 경우 증상이 비특이적인 경우가 많습니다. 일단은 원인에 대한 검사를 해 보겠습니다.,Korean
+가래를 뱉을 때 목 아픈가요?,Korean
+그런 약은 어디에도 없습니다.,Korean
+그러면 이쪽에서 처방전 받아가시고 결제하시면 되세요.,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+눈이 좀 가렵던데 상관있는 건가요?,Korean
+초음파 검사는 진료 중에 잠깐 하는 거기 때문에 미리 말씀드리지 않은 것 같네요.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+결핵 치료를 받기 시작한 것은 언제부터였나요?,Korean
+다행히 다른 수술은 없었어요.,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+알레르기 진단받은 연도는 어떻게 되나요?,Korean
+"폐에 문제가 있는지 더 큰 병원을 가보라 해서 왔습니다.
+",Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+잘 때 어려움이 있으신가요?,Korean
+결핵으로 약 드시고 계세요?,Korean
+네 수액은 유지하실 거에요.,Korean
+소변을 볼 때 피가 보이나요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+언제부터 그 증상이 나타났나요?,Korean
+네. 의사 선생님께 먼저 들었습니다.,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+잠을 자도 피곤함이 계속 느껴지는 것처럼 불면증이 있으신가요?,Korean
+"네. 체온은 매일 재는데 비슷했어요.
+",Korean
+숨쉬기 어려운 것도 알레르기 증상입니다.,Korean
+면담 위해 진료실 다녀오신 거 아닌가요?,Korean
+우선 병실에 가서 누워계시면 됩니다.,Korean
+네 여러 가지 결과가 있으니 내원해서 상세한 결과는 알려 드리겠습니다.,Korean
+검사의 목적 검사로 인한 합병증 등의 내용이 포함됩니다.,Korean
+"혈뇨면 소변 색이 불그스름한 것 맞나요?
+",Korean
+혈압이 좀 있는 편이신가요?,Korean
+"위가 쥐어짜지는 것처럼 아파서 왔어요.
+",Korean
+제때제때 대변을 잘 못 보는 편인가요?,Korean
+하반신 마취도 수면 마취가 가능합니다.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+"나뭇가지에 찔렸는데 그때 팔에 가시가 박힌 것 같아요.
+",Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+노산의 경우 분만 과정에 어려움이 있을 수 있어 제왕절개를 추천해드리고 있어요.,Korean
+정형외과에 뼈가 부러져서 입원한 적이 있네요.,Korean
+아픈 곳을 말씀해 보실래요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+몸이 많이 피로하다고 느끼시나요?,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+네. 원래 통증이 조금 있어요.,Korean
+네 연고만 따로 처방해 드릴 수는 없어요.,Korean
+대장에 감염이나 염증이 있을 시 동반될 수 있는 점액성 물질입니다.,Korean
+담배는 당분간 피우지 않는 편이 좋겠습니다 환자분 건강도 그렇고 약도 효과가 있으려면 흡연은 좋지 않습니다.,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+일주일 내내 통증이 있으셨나요?,Korean
+"졸다가 책상에 턱을 부딪혔는데 그 뒤로 계속 아파서요.
+",Korean
+암 치료를 언제부터 받으셨나요?,Korean
+현기증 있으신 적 있나요?,Korean
+일단 반복적으로 손목을 움직이는 것은 피하셔야 합니다.,Korean
+다른 동반 증상에 따라 원인이 다를 수 있지만 위식도역류질환이 가장 흔합니다.,Korean
+혈류 개선에 좋지만 출혈에 영향을 줄 수도 있어요.,Korean
+간헐적으로 통증이 왔다 가나요?,Korean
+소변의 정상 경로를 막는 겁니다.,Korean
+오늘을 포함해서 설사가 시작된 후 날마다 몇 번 정도 다녀오셨는지 알려주시면 더 도움이 됩니다.,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+처방 나면 뭐 검사해요?,Korean
+지금 상황에선 계속 약물을 먹고 생활습관을 바르게 하여 경과를 지켜보는 수밖에 없습니다.,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+네 삼 년 이내에 검사를 받으시는 것이 적절합니다.,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+요로감염 등 세균에 감염된 경우 탁한 소변이 자주 나타납니다. 소변에 단백질이 함께 섞여 나오기 때문입니다.,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+따로 먹으면 안 되는 약이 있으신지 알기 위해서 여쭤보는 겁니다.,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+"싸웠는데 얼굴이 많이 다쳤어요.
+",Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+약물로 당뇨 치료받고 계세요?,Korean
+"감기 기운이 있는 것 같아서요.
+",Korean
+접종시기에 따라 접종하실 주사가 있다면 말씀드릴게요.,Korean
+현재 환자분 질병은 치료법을 명확히 구분 지을 수 없어서 중증으로 분류되는데 현재 상황에선 치료법이 있기 때문에 경증으로 구분됩니다.,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+혹시 안 먹거나 탈수 증상이 있으면 병원에 방문해 주세요.,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+"아니요. 목구멍이 좁아져서 삼키기가 힘든 느낌이요.
+",Korean
+"최근 들어서 소변량 꽤 늘어난 것 같이 느껴져요.
+",Korean
+"다리에 쥐가 안 풀려요.
+",Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+약 복용 시 졸음을 유발하는 성분이 함유되어 있어 잠이 쏟아지실 수도 있어요.,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+이번에 검사한 심전도는 정상으로 나왔습니다.,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+전에는 내시경 도중에 깬 적이 없거든요.,Korean
+귀 뒤에 통증이 있나요?,Korean
+체중이 증가한 이유가 있을��요?,Korean
+복부 통증이 많이 심한가요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+복통과 두통이 같이 시작되셨나요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+어떤 약물을 복용하고 계시나요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+"아니요. 임신 계획이 있어서 피지 않아요.
+",Korean
+항암 치료한 지 얼마나 되었나요?,Korean
+복수가 차거나 염증이 생긴 경우 발생할 수 있습니다.,Korean
+치료 기간은 얼마나 되었나요?,Korean
+아픈 신체 부위 말씀해주세요.,Korean
+또 아픈 곳 없나요?,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+식사 후에 소화는 잘되시나요?,Korean
+골육종이 폐로 전이가 잘 되는 병이긴 합니다만 정밀 검사를 해봐야 압니다.,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+혈류 개선에 좋지만 출혈에 영향을 줄 수도 있어요.,Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+알러지 치료는 언제 시작하셨어요?,Korean
+네 수술 후 회복실에 누워 계십니다.,Korean
+"네. 그쪽이 제일 아파요.
+",Korean
+혈압 결과는 환자분의 상태에 따라 계속 달라질 수도 있어요.,Korean
+타인에게 수혈을 해 준 적이 있으신 지 여쭤봤습니다.,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+혈압이 조금 높은 편인데 혹시 평소에 혈압이 높다는 얘기를 들으신 적이 있나요?,Korean
+"신장 기능이 안 좋아졌다고 들은 것 같은데요.
+",Korean
+침을 삼킬 때마다 아프신가요?,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+"아기가 아픈지 하루 종일 우네요.
+",Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+꿰매는 수술에는 흉터를 피할 수 없습니다.,Korean
+환자복과 병상에 침대. 이불. 베개입니다.,Korean
+가족 중에 당뇨 진단을 받아보신 분이 있으세요?,Korean
+숨이 찬 증상이 나타납니까?,Korean
+알러지 반응 검사에서는 아무것도 안 나왔어요.,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+암 치료받으신 기간 알려주세요.,Korean
+결핵 질환과 관련된 처방받은 약이 따로 있나요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+통증이 심할 겁니다. 담당 선생님 통해서 진통제 투여를 준비하겠습니다.,Korean
+부모님 중 김신우님과 비슷한 증상이 있으신 분이 있으신가요?,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+피를 토할 때 위도 아픈가요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+마취크림 안 바르면 아픕니다.,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+네. 갑상선 기능저하증이 있어요.,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+모든 것에는 부작용이 존재합니다. 수혈은 받아보신 적 없으신 거죠?,Korean
+결핵의 경우 가족분들께 전파됐을 가능성이 있어서요.,Korean
+배의 어느 부분이 아프신가요?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+빈혈은 지속 적으로 있나요?,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+"여기 이쪽 발가락에 고름도 나오고 통증이 심해져서 병원에 오게 되었습니다.
+",Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+체온이 몇 도인지 아세요?,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+많은 질환을 혈액검사로 알 수 있습니다.,Korean
+"요즘 팔꿈치에 통증이 있어서요.
+",Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+빨리 낫는 것보다는 장기적 재발을 막는 방법이 동반되어야 합니다.,Korean
+갑상선암 의심된다고 입원해서 정밀 검사받았었어요.,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+첫째는 자연 분만을 하신 거예요?,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+아니요. 그냥 동네 소아과 가서 진료만 받아봤지. 입원이나 수술은 한 번도 해본 적 없어요.,Korean
+암 환자가 가족 중에 있을까요?,Korean
+"일주일 새에 살이 급격하게 오 킬로가 쪘어요.
+",Korean
+지금은 항생제가 들어가고 있어서 아플 수 있어요.,Korean
+항생제 반응 검사를 진행해볼 수 있는데 해보시겠어요?,Korean
+"배가 아픈데 너무 아파서 움직이기가 힘들어요.
+",Korean
+네. 확인하고 다음에 약 이름 알려주세요.,Korean
+꼭 금식을 유지하고 계셔야 하고 물 혹은 사탕 껌 등 어떤 것도 드시면 안 됩니다.,Korean
+이 부위가 아픔을 느끼시는 거죠?,Korean
+손목을 오래 사용하실 때에는 자주 손목 스트레칭을 해주시는 것이 좋습니다.,Korean
+거의 물 같은 변을 보셨나요?,Korean
+가족 중에 고혈압인 분이 있으면 알려주세요.,Korean
+검사결과가 나와봐야지 알 수 있겠네요.,Korean
+혈액검사 결과가 나오는 데는 시간이 걸립니다.,Korean
+치과 치료는 받았는데 다른 건 없었어요.,Korean
+"칼로 손목을 그었는데 피가 너무 많이 나요.
+",Korean
+네 오전 몇 시에 내원 가능하신가요?,Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+네. 처방 더 받으려면 또 내원해야 되나요?,Korean
+전문의 선생님은 야간에는 부재중이라 일단 통증 억제 치료를 받으시고 내일 아침에 진료를 받으실 수 있도록 해드릴게요.,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+"약이랑 한 시에 마셨어요.
+",Korean
+독감 접종 후 집에만 계셨나요?,Korean
+퇴원 관련 안내는 이미 알고 있습니다.,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+피로감은 어느 정도 심한가요?,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+네. 혈소판 수치가 모자란다고 하더라고요.,Korean
+소변이 나올 때 피가 나오나요?,Korean
+네 재채기는 코의 신경이 자극을 받아서 나오는 것입니다.,Korean
+과도한 운동은 그럴 수 있죠.,Korean
+움직일 때 불편한 점이 있으신가요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+가슴 통증이 있으셨는지 알려주세요.,Korean
+갈비뼈가 부러져 폐를 건드린 적이 있었는데 그때 수술을 받았습니다.,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+근처에 가까운 병원이 있으시면 다시 입원하세요.,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+언제 숨 쉬기가 힘든가요?,Korean
+지금 알려주셔야 곧 입원이 가능합니다.,Korean
+이전에 입원하셨던 적 있나요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+채혈은 이번만 진행한 것이라 다음에는 따로 채혈 안 하셔도 돼요.,Korean
+여러 원인이 있을 수 있어서 검사 결과가 나와봐야 알 것 같습니다.,Korean
+얼마나 통증이 심하게 느껴지고 있나요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+특별히 아픔을 느끼는 곳이 있나요?,Korean
+검사 결과 확인 후 말씀드리겠습니다. 검사가 끝나더라도 임의로 식사하시는 것은 위험할 수 있으니 자제 부탁드리겠습니다.,Korean
+검사 결과가 어떻게 나오셨는지 말씀해보시겠어요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+"분유 빼고 아무것도 안 먹었습니다.
+",Korean
+필요한 서류 있으시면 오늘 내로 말씀해 주셔야 내일 퇴원하실 때 서류 받아보실 수 있으세요. 안 그러면 다음 외래 오실 때 서류 받을 수 있어요.,Korean
+통상 계절 독감의 백신 효과는 사십에서 육십 퍼센트 정도 됩니다.,Korean
+네 그 당시에는 증상이 없었나요?,Korean
+"집에 불나는 바람에 크게 화상을 입어서 왔어요.
+",Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+작년에 외할아버지가 당뇨에 걸리셨어요.,Korean
+예전에 갑상선에 문제가 있었다고 들었습니다.,Korean
+네 아마 하반신 마취를 하신 것 같습니다.,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+"복부 쪽이 계속 낫질 않네요.
+",Korean
+"윗배가 살살 아픈 게 한 번 시작되면 꽤 오래가요.
+",Korean
+담배 피운 기간이 오래됐나요?,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+통증이 얼마 만에 발생하는지 말해볼래요?,Korean
+복수가 찬 적 있나요?,Korean
+입원 치료한 적 있으신가요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+"네. 열만 오른 것 같고 보기엔 이상 없어요.
+",Korean
+응급내시경인 경우 내시경실로 전화하시면 되고 정규 내시경은 일정 잡고 받으시면 됩니다.,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+고혈압약 약명이 어떻게 되나요?,Korean
+"아내가 세상 살기 싫다고 유서를 써 놓고 약을 먹은 것 같아요.
+",Korean
+평소보다 통증이 더 강한가요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+네. 갑상선호르몬이 높게 측정됐네요. 갑상선 관련해서 초음파나 다른 검사는 해보셨나요?,Korean
+혹시 기력이 떨어졌다고 느끼세요?,Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+"아니요. 그냥 머리만 어지럽다고 하고 어제 온종일 누워 있었어요.
+",Korean
+수술이 가장 좋은 방법입니다만 고민하고 계신 이유가 있으신가요?,Korean
+위암 수술받고 빈혈이 생겼습니다.,Korean
+팔 통증 이외에 다른 증상은 없으신가요?,Korean
+휠체어에 앉아서 기다리시면 됩니다.,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+통증이 발현되는 시기가 있나요?,Korean
+고혈압으로 신경 쓰고 계신가요?,Korean
+머리 쪽 씨티 같은 경우는 뼈를 중심으로 촬영하기 때문에 조영제를 투여하지는 않습니다. 검사는 오 분이면 끝납니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+그렇게 드셔도 소화 잘 되던가요?,Korean
+소변 보는 주기가 어떻게 되나요?,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+어떤 재료로 만든 한약인지 알 수 있을까요?,Korean
+"혀를 잘못 깨물어서 통증이 심해요.
+",Korean
+"가끔 대변볼 때 항문이 찢어지는 느낌이 들어요.
+",Korean
+타이레놀 때문에 증상이 생긴 걸 수도 있습니다.,Korean
+평소에 변은 잘 보세요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+빈속에도 구토 증상이 있나요?,Korean
+아니요 일주일 이내에 드신 약만 말씀해주세요.,Korean
+"유독 피부가 건조한 것 같아서 오게 되었습니다.
+",Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+네 치과 수술 치료하신 거면 다 말씀해주세요.,Korean
+한달에 술을 얼마나 드시나요?,Korean
+고혈압 때문에 먹는 약물 있으세요?,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+"아파서 누워 있다가 갑자기 토하더라고요.
+",Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+"염분 얼마나 섭취하는지 어떻게 알죠?
+",Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+자주 재발하는 분들은 면역치료를 하시는 것이 장기적으로 도움이 많이 됩니다.,Korean
+진단까진 모르겠는데 혈당 문제가 늘 있으셨어요.,Korean
+입속에 있는 모든 기관들을 구조물이라 칭합니다.,Korean
+건강 보험 이외 실손보험 등 사보험 적용이 필요하시다면 진단서 혹은 소견서를 작성하여 드리겠지만 실제 적용 여부는 보험사와 상의해야 합니다.,Korean
+"엄지발가락 때문에 왔어요. 빨갛게 붓고 아프고 가끔 고름도 나와요.
+",Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+몇 월부터 아프셨던 거예요?,Korean
+감염예방 치료를 할 거예요.,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+수면제 안 드시곤 잠을 못 주무세요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+네. 몇 가지 문진과 신체검사 이후에 바로 해열제 드리도록 하겠습니다.,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+"오줌 마려운 느낌이 계속 드는데요.
+",Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+얼마나 자주 가슴이 조이는 느낌이 있었나요?,Korean
+"체중 조절 때문에 절대 안 먹어요.
+",Korean
+목에 인후통 증상이 있나요?,Korean
+실제로 토하신 적 없으세요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+얼마나 ���느냐에 따라 다르지만 주기적으로 받아야 하는 치료이기 때문에 비용 면에서 부담이 되실 수 있어요.,Korean
+살을 빼긴 해야 하는데 살 빼는 게 세상에서 제일 어렵네요.,Korean
+어떤 약 드시는지 알아야 중복 처방이 안 돼요.,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+소화가 안 된 건가요?,Korean
+큰 문제는 아니라서요. 처방해 드린 약을 꾸준히 복용하고 바르도록 해 보세요.,Korean
+술은 한 달 중에 며칠 정도 드세요?,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+요즘 혹시 흉통이 있나요?,Korean
+위내시경 할 때 헬리코박터 있는지도 같이 봐주세요.,Korean
+실제 불편감이 있다면 소화불량으로 볼 수 있습니다.,Korean
+치과 치료도 당연히 포함됩니다.,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+흉터가 약간은 남을 거예요.,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+약이 과다하게 들어가면 산모에게 좋지 않을 수 있습니다.,Korean
+고혈압과 관련된 약을 평소 복용 중이세요?,Korean
+얼마나 자주 구토를 하시나요?,Korean
+알레르기 반응이 언제 보이나요?,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+아픈 곳이 더 있나요?,Korean
+특이사항이라면 보통 마취 부작용을 말합니다.,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+현재 추가 증상이 없다면 같은 결과가 나올 확률이 큽니다.,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+네 위산이 역류되서 그런 증상이 나타날 수 있습니다.,Korean
+근 삼 개월간 살이 빠지셨어요?,Korean
+병이라고 하긴 애매한데 과민성 대장 증후군이에요.,Korean
+"아뇨 대변을 볼 때 너무 힘을 많이 주게 됩니다.
+",Korean
+통증 위치를 손가락으로 짚어주세요.,Korean
+"가슴 오른쪽이 점점 아파지더라고요. 참을만하면 그냥 있겠는데 아무래도 검사를 받아봐야 할 것 같아서요.
+",Korean
+소변에 피가 섞여 나오나요?,Korean
+이전에도 똑같은 증상을 겪은 적이 있으신가요?,Korean
+수술 날짜는 언제로 잡아 드릴까요?,Korean
+허리가 완전히 회복되기까지는 오랜 시간이 걸립니다.,Korean
+잠깐 약을 볼 수 있나요?,Korean
+겉으로 봐서는 알 수 없으니 진료 후 확인해 보겠습니다.,Korean
+식사 후에만 속이 안 좋으세요?,Korean
+그 증상은 정밀하게 진단을 해보고 결정할게요.,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+네. 방역 수칙에 따라 진행하고 있습니다.,Korean
+"설사를 자주 해서 외출할 때도 항상 화장실이 어딨는지 알아줘야 해요.
+",Korean
+일단 드레싱을 하면 끝이긴 한데 주기적으로 와서 치료를 받아야 해요.,Korean
+어떨 때 구토를 하나요?,Korean
+네 부작용이나 후유증 겪으신 내용 모두 말씀해주세요.,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+"아니요. 하루 절반은 자는 것 같은데요.
+",Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+보훈병원에 갔었어요. 강동구에 있는 거요.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+체중이 한 달에 몇 킬로 쪘나요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+식후 소화가 잘 안 되나요?,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+누워있거나 앉아있다가 일어나실 때에는 바로 일어나시지 마시고 천천히 일어나시길 권유 드립니다.,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+아이 혼자 병원에 있는 것은 위험하므로 다른 보호자분께서 짐을 챙겨오셔야합니다.,Korean
+저번에 입원하신 적이 있으신가요?,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+"교통사고 때문에 머리를 다쳤어요.
+",Korean
+이��에 금연 한 번 해보죠.,Korean
+환자분 이제 씨티실로 내려가실게요. 이송 요원분이랑 같이 가실게요.,Korean
+그 약은 그럼 안 먹어도 돼요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+주먹의 감각 혹은 운동 이상을 확인하기 위해 검사했습니다.,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+집이랑 가까운 병원으로 다시 좀 가보려고요.,Korean
+통증으로 인해 얼마나 자주 아프세요?,Korean
+"네. 특히 해산물 먹으면 바로 설사해요. 그래서 해산물을 전혀 안 먹어요.
+",Korean
+환자복과 병상에 침대. 이불. 베개입니다.,Korean
+"금연할 생각은 항상 있지만 실천으로 옮기지는 못 하고 있어요.
+",Korean
+"엄지발가락 통증 때문에 신발을 못 신어요.
+",Korean
+자연분만하다가 위험해서 수술로 바꿨어요.,Korean
+그러면 외래 안내해 드리도록 하겠습니다.,Korean
+어떤 것에 알레르기가 있나요?,Korean
+네. 요로 조영술은 어떻게 진행되나요?,Korean
+"엄마가 그저께부터 화장실만 가면 피가 섞인 변을 본대요.
+",Korean
+구토가 나아질 기미가 있나요?,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+간혹 마취크림에 민감한 반응을 일으키는 분들이 있습니다.,Korean
+또 아픈 곳 없나요?,Korean
+자주 피로하다는 느낌이 드나요?,Korean
+가래가 얼마나 많이 나오나요?,Korean
+병실로는 삼십 분 정도 지나야 이동할 수 있을 것 같습니다.,Korean
+언제 독감 예방 접종을 했나요?,Korean
+"사 년 정도 피우고 재작년에 끊었어요.
+",Korean
+소독한 붕대를 감아 외부와 차단시킬 겁니다.,Korean
+흡연을 시작한 나이를 아세요?,Korean
+"끓는 물에 화상을 입었어요.
+",Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+네. 일찍 진단을 정확히 받았어야 했는데.,Korean
+아픈 기간은 어느 정도일까요?,Korean
+암 진단을 받아보신 적 있나요?,Korean
+엽산이란 말을 처음 들어 봅니다.,Korean
+그건 제대로 된 검사를 하지 않고는 확실히 말씀드리기 힘드네요.,Korean
+네 혈압과 고지혈증은 따로 생각하시는 게 좋을 것 같습니다.,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+그럼 알레르기 검사를 진행하겠습니다.,Korean
+당뇨와 관련된 가족력은 없나요?,Korean
+간단한 수술부터 큰 수술까지 모든 수술 알려주세요.,Korean
+따로 먹으면 안 되는 약이 있으신지 알기 위해서 여쭤보는 겁니다.,Korean
+"왼쪽 무릎이 아팠는데 이젠 오른쪽까지 아파요.
+",Korean
+계속 기침 증상이 있나요?,Korean
+목에 이물감이 있어서 그럴 수 있습니다.,Korean
+네. 교정 때문에 윗니 두 개 아랫니 두 개 발치했습니다.,Korean
+진료 차트 확인 후에 도와드릴게요.,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+이번 검사에서는 정상수치 확인했습니다.,Korean
+이물질 제거 제균 환부 보호 순으로 합니다.,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+네 가셔도 됩니다. 걷기 힘드시면 말씀하십시오. 휠체어를 가져다드리겠습니다.,Korean
+네 전에 했던 마취 방법에 대해 기록 조회해볼게요.,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+후유증이 없을 순 없습니다.,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+웬만하면 입원 치료를 하는 것이 좋습니다.,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+증상이 지금까지 얼마 동안 있던 거예요?,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+여드름 부위를 중심으로 전체 얼굴에 도포하세요.,Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+무슨 병 때문에 복용하는 약인지는 기억나시나요?,Korean
+선천적으로 장의 특정 부위에 신경이 제대로 분포되지 않아 정상적으로 움직이지 못하는 질환입니다.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+"예전에 비해 소화 능력이 많이 떨어진 걸 느껴요.
+",Korean
+"여기 드레싱 해 주세요.
+",Korean
+종양 치료받은 적 있으세요?,Korean
+네 저희가 수시로 환자분의 상태를 알려드리고 있습니다.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+투약 등을 통해 개선해야 하는 병변은 아니며 지속적인 추적검사가 요구됩니다.,Korean
+기침에 피�� 안 나왔어요?,Korean
+"네. 전반적으로 왼쪽 팔다리에 힘이 빠지는 느낌이 있어요.
+",Korean
+계속 조금씩 통증이 나타나시는 거죠?,Korean
+아니요. 전 세계적으로 유행이라 나라 상관없습니다.,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+상처에 물이 닿으면 지체 마시고 바로 병원으로 내원 부탁드립니다.,Korean
+독감 예방 주사는 만 육십오 세 이상에게 우선 접종을 권장하고 있습니다.,Korean
+"헌혈 많이 할 만큼 좋았어요. 전반적으로.
+",Korean
+아니요. 아이가 너무 안 나와서 결국엔 제왕 절개로 했어요.,Korean
+"아침에 열이 살짝 있긴 했는데 지금은 모르겠어요.
+",Korean
+"깊게 잠들면 열 시간까지도 자는데 보통 여덟아홉 시간 잡니다.
+",Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+네 주사 들어갈 때 약간은 뻐근할 수 있어요.,Korean
+통증이 한번 오면 얼마나 지속되나요?,Korean
+아무래도 레이저 시술은 통증이 동반될 수밖에 없어요.,Korean
+결핵 진단 언제 받으셨어요?,Korean
+머리 부분에 통증은 없는지 말해주세요.,Korean
+지금 먹고 있는 약 있어요?,Korean
+기저 질환이 없으면 보존적 치료로 충분합니다.,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+손발이 차고 메스꺼운 증상이 많이 심하신가요? 진통제를 드시면 간혹 그런 분들이 계세요.,Korean
+병원에 규정이 있어서 그렇게는 힘들어요.,Korean
+알레르기 때문에 주의해야 하는 것이 있나요?,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+어머니 쪽 어른 쪽에 혈압 관련 질환이 많으세요.,Korean
+마취하고 마취가 잘 안 깬 적이 있나요?,Korean
+진료 예약 센터 운영 시간은 어떻게 되나요?,Korean
+암 치료 기간이 어떻게 되나요?,Korean
+제왕절개 여부에 따라 앞으로의 치료방식이 달라집니다.,Korean
+토할 때 피가 자주 보이시나요?,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+호흡이 조금 가빠 오면 간호사 선생님께 말하세요.,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+"공장에서 시멘트 나르다가요. 포대를 들다가 허리를 삐끗한 거 같은데 그 이후로 허리를 숙이거나 제대로 피질 못하겠어요.
+",Korean
+병원비 지불과 관련된 어려움이 있으시면 사회사업팀과 상담을 연결해 드릴 수 있어요. 필요하면 말씀해 주세요.,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+언제부터 알레르기 약을 복용하기 시작했어요?,Korean
+상처 부위에 진물이 찰 수 있기 때문에 소독은 자주 해야 합니다.,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+당뇨약을 아직 안 드시고 계세요?,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+응급 및 수술상황에서 수혈할 때 위험할 수 있습니다.,Korean
+유산소 운동은 무리하지 않도록 하는 게 제일 좋습니다.,Korean
+의사 처방 없이 드시는 건 위험합니다.,Korean
+대변볼 때 불편하지 않으세요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+종양이 발견된 지 오래됐어요?,Korean
+병동에 입원 가능 여부를 확인해봐야 할 것 같습니다.,Korean
+"콧물 때문에 자다 깨다 해서 컨디션이 좋지 않아요.
+",Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+치료 방법이나 처치에 따라 입원 기간이 수개월 이상 걸릴 수 있습니다.,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+어디가 부은 느낌이 있으세요?,Korean
+암을 치료받은 적이 있나요?,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+"아침에 토 한 번 했었어요.
+",Korean
+고혈압 약물치료를 하고 계신가요?,Korean
+발열 증상은 언제 처음이셨죠?,Korean
+발기 지속시간이 얼마나 돼요?,Korean
+알레르기 유발하는 음식 말해봐요.,Korean
+"숨 쉴 때 허리가 너무 아파요.
+",Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+당뇨 측정을 해 보셨나요?,Korean
+암 치료 이력이 있나요?,Korean
+"가래가 계속 나오고 머리가 너무 지끈거려요.
+",Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+몸이 엄청 나른해지고 무기력해져요.,Korean
+"네. 우리 아기가 다른 아기들보다 키도 크고 몸이 빨리 자라는 것 같아서 검사받고 싶어서 왔어요.
+",Korean
+요즘 먹고 있는 약이 있나요?,Korean
+모니터상에 수축이 보이는데 강하지는 않군요.,Korean
+네 수술부위는 어느 쪽으로 알고 있나요?,Korean
+아뇨. 먹고 나서 속이 메스껍더니 바로 토가 나왔어요.,Korean
+신체검진 후 진통제 달아드리도록 하겠습니다.,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+네 항문으로 들어가서 에스 상 결장까지 보고 나오는 검사입니다.,Korean
+수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+당뇨 있는 건 아니시죠?,Korean
+소변보는 내내 혈뇨가 보이면 신장 요관 방광 등 상부 요로계 질환일 가능성이 높습니다.,Korean
+네. 간접흡연도 몸에 안 좋은 영향을 많이 끼쳐요.,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+경정맥신우조영술을 통해 신장에 장애가 있는지를 확인할 수 있습니다.,Korean
+"우느라 땀은 계속 났고요. 열감은 약간 아주 약간 있었어요.
+",Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+많이 아프시면 진통제 드릴 수 있으니 참지 마시고 말씀해 주세요.,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+다친 적은 없고 삐끗해서 한의원에서 침 맞은 적은 있어요.,Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+의식상태를 파악하기 위한 검사입니다.,Korean
+힘드셨겠네요. 휠체어는 따로 말씀하셔야 합니다.,Korean
+공복 혈당이 어느 정도이죠?,Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+"수포 올라온 부분에 가려움증이 너무 심해서요.
+",Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+네 혈관이 터져서 조금 멍이 들었습니다.,Korean
+피가 소변에 섞여 나옵니까?,Korean
+대변을 볼 때 피가 나오나요?,Korean
+먹으면 부작용이 있거나 불편한 약 있으세요?,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+입원 치료한 적 있으신가요?,Korean
+철심 박는 수술까지는 아니었고 그냥 사 번 뼈 수술받은 걸로 알고 있어요.,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+저희 아버지가 간암을 앓았네요.,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+작년에 폐렴을 한 번 앓았어요.,Korean
+"어깨를 돌리거나 팔을 좀 심하게 쓰면 어깨가 이렇게 톡 하고 빠지는 느낌이 있는 것 같습니다.
+",Korean
+당뇨 치료를 위해 어떤 약을 드시나요?,Korean
+"밤에 잠을 잘 못 자서 그런가 밤에 소변도 자주 마렵고요. 잠을 못 자니까 좀 업무적으로 실수할 때도 있고요. 사람도 좀 신경질적으로 변한 것 같고요.
+",Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+치료 때문에 이틀에 한 번은 오셔야 하거든요.,Korean
+과거에 입원한 적 없고 수술도 역시 없죠.,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+어떤 부위에 국소마취를 하셨나요? 수술하신 건가요?,Korean
+네 자가 격리 마쳤어도 알아야 합니다.,Korean
+네. 편도선염이 심해져 두통까지 오는 바람에 엄청 고생했어요.,Korean
+"위액이 역류하는 느낌이 자주 들었어요.
+",Korean
+그 약만 먹으면 자꾸 구토 증상이 있어요.,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+"배가 아프다고 울길래 데려왔어요.
+",Korean
+간호사 호출기 위급 시 시간 상관없이 누르면 오시나요?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+"이가 아파서 검사 받고 싶어요.
+",Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+주말에도 병원에 찾아오셔야 합니다.,Korean
+급성기가 꼭 병의 심각성과 관련된 것은 아닙니다. 그보다는 지금 치료가 필요한 단계로 이해하시면 됩니다.,Korean
+온몸에 좀 오한이 있으세요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+아니요. 먼저 의사와 상담 후 계획을 정해 보는 게 좋습니다.,Korean
+최근에 복용하는 약 처방이 ���뀌어서 제가 정확히는 이름을 모르겠어요.,Korean
+"이천이십 년 일 월 일 일부터 담배 끊었습니다.
+",Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+일주일 기준 몇 번의 술을 섭취하시나요?,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+"머릿속 어딘가를 세게 두드리는 듯하고 계속 아프다는 신호가 와요. 그럼 그다음엔 거의 무조건 토를 했어요.
+",Korean
+환자분이 어떤 약을 드시는지 파악을 해야 해서요.,Korean
+어떤 종류의 소염제인지 알고 계시나요?,Korean
+경정맥신우조영술은 조영제가 신장을 통해 배설되는 시간을 확인하는 검사입니다.,Korean
+꼭 해야 하는 건 아니지만 알레르기 유무 확인을 위해서 권장하고 있습니다.,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+원인은 다양해서 검사 해봐야 할 것 같습니다.,Korean
+아뇨 식습관을 여쭤본 것이에요.,Korean
+수술이 끝나면 회복실로 가실 것 같아요.,Korean
+아니요 최근에 수술이나 치료하신 적 있으신가요?,Korean
+가래가 얼마나 많이 나오나요?,Korean
+약이 지금 없는 건가요?,Korean
+간염은 약물로 계속 치료하시나요?,Korean
+추가 검사를 진행하고 정확히 설명드릴게요.,Korean
+변이 묽게 나오는 등 배변 습관 변화는 장의 기질적 변화를 시사하는 소견입니다.,Korean
+알레르기가 음식이나 털 이외에도 다양한 원인이 있어서요. 정확하게 기억은 안 나시는 건가요?,Korean
+네 정확한 무게 측정을 위해서는 신발을 벗으셔야 합니다.,Korean
+당뇨 치료받아본 가족 분이 있으신가요?,Korean
+"소변 색 외엔 특별한 것 없어요.
+",Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+요즘 피지 조절 약 먹고 있어요.,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+원래는 그런 증상이 없으셨나요?,Korean
+"견과류 먹고 치아가 부러진 적 있어서 피하게 되네요.
+",Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+토할 것 같을 때 어떻게 하셨나요?,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+"스트레칭으로 몸을 풀어주면 잠이 잘 와요.
+",Korean
+음주 빈도는 얼마나 되시나요?,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+소변에 피가 많이 나오셨나요?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+건조하면 기침을 자주 하시나요?,Korean
+임플란트나 틀니 빼고 본인 치아만 말해주세요.,Korean
+"종종 토가 나오려고 할 때가 있어요.
+",Korean
+식후 계속 속이 불편하신가요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+엄마가 끌어주는 휠체어 타고 왔어요.,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+"생각해보니 소변을 볼 때마다 전립선이 아파요.
+",Korean
+측정 기록이 없어서 그런데 아까 하셨더라도 지금 아이 몸무게 다시 한 번 측정해볼게요.,Korean
+네 확인해 보니 검사 부위가 붉게 부어있습니다.,Korean
+갑자기 멍이 든다거나 살짝만 부딪혀도 아픈 적 없으셨어요?,Korean
+관련하여 의사 면담이 있을 예정이니 자리에서 기다려주시기 바랍니다.,Korean
+꾸준히 치료를 받고 잘 관리하면 되니 너무 걱정하지 마세요.,Korean
+추워서 몸이 덜덜 떨리고 있어요.,Korean
+물리치료 진행하면서 경과를 조금 더 지켜보겠습니다.,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+간염은 앓으신 지 얼마나 되셨어요?,Korean
+하지정맥류 수술 치료로 입원했었습니다.,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+네. 점심 식사 이후 세 시간 금식을 한 뒤 검사를 진행할 수 있습니다.,Korean
+혹시 약 가지고 오셨으면 저한테 보여주세요.,Korean
+피부 연고는 피부과 진료받으시고 처방받으실 수 있어요.,Korean
+네 수술치료 후 예후가 좋은 질환입니다.,Korean
+네. 생리 불순으로 갔다가 다낭성 물혹 진단받았는데 몇 년 뒤에 다시 가보니 줄어들었다고 하시더라고요.,Korean
+긴급 수술할 수 있다고 하니 무섭네요.,Korean
+소변에 피가 같이 나온 적이 있을까요?,Korean
+병실로 빨리 옮기고 싶어요.,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+어떤 약을 빼 드리면 되나요?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+"변은 안 나오는데 가스만 자꾸 차서 걱정이에요.
+",Korean
+지금 바로 눕혀주시면 몸무게 측정 시작하겠습니다.,Korean
+자의로 판단하지 마시고 병원에서 처방받은 대로 하시면 됩니다.,Korean
+통증이 월 단위로 있나요?,Korean
+아픈 느낌 표현해 주세요.,Korean
+통증이 오는 곳이 있나요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+"간암 검사를 해야 할 것 같아서 왔습니다.
+",Korean
+통증 지속 여부를 알려주세요.,Korean
+통증을 진정시키기 위해서 하는 목적이니 걱정하지 않으셔도 됩니다.,Korean
+피를 토해낸 적 있어요?,Korean
+심장이 두근거리고 빨리 뛰나요?,Korean
+동생이 조금 우울증이 있어요.,Korean
+진통제에 대한 거부감을 버리고 심한 날은 도움을 받으세요.,Korean
+담배에 든 니코틴 성분이 혈관을 수축시킵니다.,Korean
+수술 후 고통이 너무 심해서 핀 제거하려면 또 마취해야 한다길래 아직 안 갔어요.,Korean
+혹시 대변이 무르거나 점액질이 섞여 나오지는 않나요?,Korean
+상처 부위에 염증이 발생합니다.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+전에 혈액형 검사 하신 적 있으신가요?,Korean
+네. 저희가 위중도와 순서에 맞춰 진료를 보고 있으니 조금만 기다려 주세요.,Korean
+도대체 어디가 아픈 거예요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+시간당 소변량이 필요하기 때문에 한 시간마다 측정할 것입니다.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+암은 언제 어디서 진단받았나요?,Korean
+복통 증상은 언제부터 있었나요?,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+크게 다쳐서 입원한 적이 있나요?,Korean
+급성기라는 말이 병이 심각하다는 의미는 아니며 치료가 필요한 단계로 볼 수 있습니다.,Korean
+피 소변을 보시진 않나요?,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+"십 년 된 위스키를 마셨는데 급격히 속이 메스꺼워져서 왔어요.
+",Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+일반적으로 적절한 치료를 할 경우 이전처럼 걸으실 수 있을 겁니다.,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+"소변을 보고도 시원하지가 않고 항상 뭔가 찜찜해요.
+",Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+생리 때 아픈 건 예외죠?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+보조제를 복용하신지는 얼마나 되셨어요?,Korean
+검사를 통해 원인을 찾아봐야 합니다.,Korean
+새벽 다섯 시에 먹은 약이 마지막으로 먹은 거예요.,Korean
+다리가 안 좋아서 운동은 못 해요.,Korean
+우선 저희 병원 기록이 없으니 검사를 받아 보고 진단이 내려지면 그때 말씀드리겠습니다.,Korean
+현재 추가 증상이 없어 재검사는 의미가 없어 권해드리지 않습니다.,Korean
+소변이 잘 누어지지 않으세요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+최근에 몸무게 변화가 있나요?,Korean
+자연 분만으로 쌍둥이 낳았어요.,Korean
+"살짝 열도 나고 감기 기운이 있는 것 같아요.
+",Korean
+통증의 강도가 얼마나 될까요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+"머리가 좀 어지럽고 가끔 시야가 흐리다고만 말했어요.
+",Korean
+코로나 때문에 물어보는 겁니다.,Korean
+수면 검사로 인한 부작용이나 중요한 문제가 있을 수 있습니다.,Korean
+진료 시 참고하시도록 기록해두겠습니다.,Korean
+환자분이 느끼는 통증의 정도가 얼마나 되나요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+신경 치료받은 부분을 짚어주세요.,Korean
+틀니 임플란트 등 자연적으로 난 치아에서 의학적인 기술이 들어간 치아 상태를 모두 말씀드리는 거예요.,Korean
+네. 갑자기 태반이 박리돼서 어쩔 수 없었어요.,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+하루에 피우는 담배는 얼마큼이죠?,Korean
+오분 전후로 걸리실 거고 혈압이 조금 이상하다고 판단되면 재검사 하실 수도 있어요.,Korean
+부은 증상이 어디에 나타났나요?,Korean
+"설사는 딱 한 번 했었어요.
+",Korean
+흉통 유무를 말씀해 주세요.,Korean
+언제 암 발병했는지 기억하세요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+각갑류 알레르기가 있다고 하셨어요.,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+통증 지속시간이 십 초 이내인가요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+제때제때 대변을 잘 못 보는 편인가요?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+손발 피부 표피가 벗겨지는 건 습진이나 무좀 때문일 수도 있어요.,Korean
+"대신 영양제 먹는데 괜찮나요?
+",Korean
+그거 포함해서 먹고 있는 약이나 꾸준히 맞는 주사 같은 거 있나요?,Korean
+"오늘 아침에 소변보니까 피가 섞여 나와 있었어요.
+",Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+네. 우선 검사를 하실 수도 있어 금식을 유지하셔야 할 것 같습니다.,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+증상 때문에 불편하셨던 기간이 어떻게 되죠?,Korean
+응급상황일 수 있습니다. 응급실로 안내해드릴게요.,Korean
+속이 좋지 않은 증상은 있으셨어요?,Korean
+"제가 소화기관이 약해서 안 해요.
+",Korean
+최근에 오한이 있던 적이 있나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+몸에 힘이 없고 무력한가요?,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+약 복용 방법을 제 아들한테 보내주시겠어요?,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+집에 다른 암 환자는 없으시고요?,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+저번에 주신 그 혈압약 맞죠?,Korean
+아주 발열이 심한 경우에는 패혈증으로 확대 될 수도 있습니다. 입원하여 원인균 검사 등 다양한 검사와 추가적 처치를 요합니다.,Korean
+하루에 설사를 자주 하시나요?,Korean
+독감 예방 주사는 이미 맞으신 거죠?,Korean
+미량의 방사선이기 때문에 걱정 많이 안 하셔도 됩니다. 방사선 조사 걱정 대비 필요성이 더 큰 검사 입니다.,Korean
+"아기 항문이 붓고 애가 간지러워해서요.
+",Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+야간 약국은 본원 후문에 있습니다.,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+"차바퀴에 깔려서 발을 다쳤어요.
+",Korean
+그럴 땐 약을 드시는 편이 나아요.,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+환자분이 수술하러 가시면 문자 가게 해드릴까요? 수술 시작과 끝났고 회복실에 들어갔다는 문자가 오게 해드릴 수 있어요.,Korean
+가족들 중에 유전질환으로 고생하는 사람 있나요?,Korean
+혈압은 정상 수치를 벗어나게 되면 모두 문제라고 할 수 있어요 너무 높거나 너무 낮으면 둘 다 문제입니다.,Korean
+계속 먹고 있는 간염약이 있나요?,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+네 그거 말고는 꾸준히 복용하고 계신 약은 없으신가요?,Korean
+환자 정보 관련하여 가족 관계는 필수 질문 사항입니다.,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+독감 주사 언제 맞으실 건가요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+입원 및 통원 치료 결정은 의사와 상의하셔야 합니다.,Korean
+네. 다낭성 물혹이 있다고 했는데 이 년 뒤에 다시 검사했을 땐 좋아졌다고 했어요.,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+영부터 십 중에 통증이 얼마나 되세요?,Korean
+옆구리나 배의 참을 수 없는 통증은 요로결석이 원인일 가능성이 높습니다.,Korean
+이 부위가 아픈 곳이에요?,Korean
+"목에 숨구멍이 줄어든 것 같이 답답해요. 이틀 전부터요.
+",Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+"아니요. 소변 색이 그렇진 않아요.
+",Korean
+대변볼 때 피가 나오지는 않던가요?,Korean
+왜 여드름이라고 생각하시는지 이유를 여쭤봐도 될까요?,Korean
+제왕절개 하면서 추가로 하는 거라 물어보는 겁니다.,Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+하루에 몇 개비나 피우세요?,Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+"코가 막혀 계속 깨서 울었어요.
+",Korean
+설사를 하신 경험이 있나요?,Korean
+같은 영양분 용량을 포함하고 있다고 하더라도 흡수율에서 차이가 납니다.,Korean
+알약으로 된 해열제요. 병원 오기 전에 먹였습니다.,Korean
+지금 해외에서 치료받으러 들어온 건데 어디서 지내게 될지 모르겠어요.,Korean
+하루에 담배를 얼마나 태우세요?,Korean
+식습관 조사 겸 여쭤보았네요.,Korean
+소변보는 데 문제 있으세요?,Korean
+두통이 계속 지속되고 있나요?,Korean
+"열은 안 재어봤는데 계속 낑낑거리고 말도 못 하는 거 보니 열이 나는 것 같아요.
+",Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+환자분의 건강 상태를 확인하기 위한 질문입니다.,Korean
+혈뇨는 언제 처음 보셨나요?,Korean
+퇴원해서 통원치료 받는 게 편하시겠어요?,Korean
+아직 수술이나 입원해 본 적은 없습니다.,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+"자기 전 요가를 간단하게 해요.
+",Korean
+메밀이 들어간 음식을 먹으면 어떤 반응이 있나요?,Korean
+당뇨 이외 복용 약은 없습니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+몸에 계속 열이 나나요?,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+고유량의 산소를 투여하면 괜찮아질 겁니다.,Korean
+열이 내리고 혈액검사 수치가 좋아지면 퇴원하실 수 있습니다.,Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+"아무래도 손목이 탈골된 것 같아서 왔어요.
+",Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+보통 일주일에 며칠이나 음주하세요?,Korean
+여기서 처방받은 약 이외에 다른 약 드시는 게 있을까 해서 여쭤봤습니다.,Korean
+가래 때문에 잠에서 깬 적이 있나요?,Korean
+여드름 부위에만 바르는 게 맞아요.,Korean
+"아니요. 그냥 머리만 어지럽다고 하고 어제 온종일 누워 있었어요.
+",Korean
+요즘 당뇨를 치료 중인가요?,Korean
+언제 첫 증상이 나왔나요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+"아기가 기침을 하는데 그 소리가 평상시랑은 다르게 이상해요.
+",Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+아픈 느낌 표현해 주세요.,Korean
+어머님이 걱정하시는 응급상황은 아니니 진료실을 나가시면 간호사가 예약을 잡아 드릴 겁니다.,Korean
+예약하고 가시면 예약시간에 최대한 맞춰 진료 보실 수 있도록 해드리겠습니다.,Korean
+지속적으로 기침을 하고 계신가요?,Korean
+통원 치료하셔도 되지만 거리가 멀어서 오기 힘드시면 입원하시는 것이 편할 것입니다.,Korean
+언제부터 혈압이 좀 높다고 들으셨나요?,Korean
+수면제 안 드시곤 잠을 못 주무세요?,Korean
+두 시간 전에 맥시부펜 먹였어요.,Korean
+오한이 든 건 아니고요?,Korean
+"과일은 과당 때문에 살찐다고 해서 안 먹죠.
+",Korean
+하루 몇 갑의 흡연을 하시나요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+가래에서 냄새가 많이 나나요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+"성기 부분이 평소와 다릅니다.
+",Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+고통이 몇 시간 동안 있나요?,Korean
+네 금식 준비를 잘 해주셨군요.,Korean
+흉터가 생긴 부위를 자르고 예쁘��� 봉합할 수 있습니다.,Korean
+크기가 좀 되는 흉터들만 말씀해 주시면 될 것 같습니다.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+간호사가 이십사 시간 케어해주는 곳으로 알아봐 주세요.,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+통증이 자주 지속 되나요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+"항문 쪽은 아무런 이상 없습니다.
+",Korean
+네. 수분 부족 현상이에요.,Korean
+건강한 임신 준비를 위해 진행하는 검사입니다.,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+"그제 밤에 마지막으로 봤고 소변이 잘 안 나와요.
+",Korean
+"볼이 부어서 아픈 데 검사받고 싶어요.
+",Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환 생리 기능에 따라 달라집니다.,Korean
+독감 접종 후 집에만 계셨나요?,Korean
+몇 월부터 아프셨던 거예요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+네. 코로나가 감염성이 커서 같이 검사하셔야 합니다.,Korean
+금연 기간은 어떻게 되시나요?,Korean
+비뇨기과 전문의가 있고 수술이 가능한 병원으로 가셔야 합니다.,Korean
+남들은 장염 한 번씩 걸리나 본데 난 여태 없었어요.,Korean
+애가 자꾸 우니까 최대한 더 빠르게 입원실 예약 좀 부탁드립니다.,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+처방하는 약에 따라 다르지만 표준치료 기준 세 종류의 약을 하루 이 회 복용합니다.,Korean
+"가만히 누워 있어도 머리가 핑핑 돌아요.
+",Korean
+통증이 느껴지는 부위가 있나요?,Korean
+질병을 진단받고 복용 중인 약이나 주사 있으신가요?,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+통증은 일주일에 몇 번 정도 느끼세요?,Korean
+아프신 이유가 암 때문인가요?,Korean
+통증이 월 단위로 있나요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+새로 처방하는 약에 다 들어가 있을 거예요.,Korean
+네 검사 후 필요하다면 약을 변경하도록 하겠습니다.,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+통증 특성이 있다면 어떤 특성이 있을까요?,Korean
+"평소랑 변 색깔이 너무 달라서 걱정돼서 왔어요.
+",Korean
+네. 원래 숨쉬기 불편하게 만듭니다.,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+"멸치가 뼈 건강에 좋다고 해서 하루에 여러 번 먹어요.
+",Korean
+지금 전신 무력감을 느끼시나요?,Korean
+어떻게 입원하게 됐는지 기억나지 않으세요 환자분은 오늘 공사장 인근을 지나시다 낙하물에 머리를 맞고 의식을 잃으셔서 입원하게 되셨어요.,Korean
+암 때문에 위를 다 들어냈어요.,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+아니요. 청진을 하도록 하겠습니다.,Korean
+통증이 느껴진다면 어떤 느낌인가요?,Korean
+환자분의 경우 이미 간 경화를 진단받은 상황이셔서 앞으로 또 출혈이 일어난다 하더라도 이상할 게 없어요.,Korean
+셀라인이라고 상처 부위를 씻어내기 위한 물입니다.,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+마취 후 언제쯤 통각이 돌아왔나요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+식사는 최소 열두 시간 물은 여덟 시간 이상 금식하셔야 합니다.,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+네 상황에 따라 마취약을 바꾸거나 양을 조절할 수 있습니다.,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+병원비 수납에 대한 문의는 수납처에 하시기를 바랍니다.,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+결석이 너무 크거나 체외 충격파 쇄석술이 불가능할 경우는 수술적 방법으로 치료를 해야 합니다.,Korean
+네 연고만 따로 처방해 드릴 수는 없어요.,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+강북삼성병원 옆에 있는 종합병원이었는데 이름을 잊어버렸네요.,Korean
+언제부터 가슴 통증이 있나요?,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+한달에 한번씩 이렇게 통증이 있으신가요?,Korean
+어느 부위에 통증이 있을까요?,Korean
+수술적 치료는 손목터널을 덮고 있는 인대를 잘라주는 방법이 있습니다.,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+"어제 팔꿈치를 부딪쳤는데 그 이후로 팔 전체를 못 쓰겠어요.
+",Korean
+키랑 몸무게가 잴 때마다 조금씩 달라요.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+복통 등의 소화기계 부작용이 있을 수는 있습니다. 하지만 정도는 사람에 따라 차이가 있습니다.,Korean
+응급실은 언제든 가도 되는 거죠?,Korean
+근데 지금 아이가 너무 힘들어하는데 쉬다가 해도 될는지요?,Korean
+전신에 작용하는 약물이 아니기 때문에 몸의 부담을 걱정하실 필요는 없습니다.,Korean
+남성은 전립선 비대증 여성은 과민성 방광이 빈뇨의 가장 흔한 원인입니다.,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+투약 양을 조금 더 올려야 할 것 같아요.,Korean
+지금 상처가 아물고 있으니 며칠은 지켜봐야 할 거 같습니다.,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+설사를 며칠 동안 하셨나요?,Korean
+"정확히 기억이 잘 안 나네요. 나이가 있다 보니까 언제부터였는지 기억이 잘 안 나요. 최근엔 끊었습니다.
+",Korean
+그러면 외래 안내해 드리도록 하겠습니다.,Korean
+"아니요. 잠을 잘 못 자서 더 아픈 것 같아요.
+",Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+최근에 어지럽거나 창백해지지 않았나요?,Korean
+꾸준히 약을 복용하시고 발라야 빨리 낫습니다.,Korean
+아마 그렇게 말씀하셨으면 종합 감기약을 줬을 것 같습니다.,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+통증 발병하면 얼마 동안 가나요?,Korean
+암을 앓고 계시는 가족분이 계시나요?,Korean
+일주일에 몇 회 정도 음주하세요?,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+혈압약은 삼 개월 정도 드셨나요?,Korean
+결핵 진단받으신 지 얼마나 되셨나요?,Korean
+독감 주사 맞은 시기가 언젠가요?,Korean
+발기 부전으로 어려움이 있나요?,Korean
+알레르기를 일으키는 원인 음식이나 약 말고 뭐 있으세요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+"어제 저녁 때부터 갑자기 왼쪽 가슴이 쥐어짜듯이 아파서 왔어요.
+",Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+접촉성 피부염이 발생할 경우 약물 투여를 중지하면 증상이 개선되니 걱정 안 하셔도 됩니다.,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+배에 가스가 차서 힘드신가요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+간염 처방 약 알 수 있나요?,Korean
+그렇게 대변을 보기 어려운 경우뿐 아니라 대변이 너무 자주 마려운 증상도 포함됩니다.,Korean
+"숨 쉬는 게 너무 힘들어요.
+",Korean
+약물에 혹시 알레르기 있으세요?,Korean
+그런 경우와는 달리 본인이 통제하지 못하는 구토인 경우가 많습니다.,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+금식하느라 많이 힘드셨겠지만 검사 결과 확인 시까지는 잠시 기다려주시기를 바랍니다.,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+"심장이 안 좋다는 얘기는 전해 들었어요.
+",Korean
+최대한 빠른 시일 내에 치료를 시작해야 합니다.,Korean
+공복 혈당이 백 이상인가요?,Korean
+기침 증세가 악화하고 있나요?,Korean
+부작용이라기보다는 진료 후에 잠이 많이 올 수도 있어요.,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+아픈 게 쭉 아파요?,Korean
+배에 가스 차는 느낌이 자주 있나요?,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+피를 토 한 적 있으세요?,Korean
+잠 잘 때 자주 깨시나요?,Korean
+부작용 중증도에 따라서 의사 선생님이 판단하실 거예요.,Korean
+꾸준히 ���는 약이 있으신가요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+"비타민 섭취를 위해 오렌지 같은 과일을 자주 먹어요.
+",Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+네 지금 바로 교정 치료랑 약물 치료할까요?,Korean
+알레르기 때문에 멀리해야 하는 것이 있나요?,Korean
+처방받지 않는 약은 뭔가요?,Korean
+오한 증상이 있다고 생각하나요?,Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+부분마취일 경우 마취가 금방 풀리거나 하는 경우도 있기 때문입니다.,Korean
+결핵 문제는 그동안 없었고요?,Korean
+혈변을 유발할 위궤양 증상이 있나요?,Korean
+피를 토할 때가 많이 있나요?,Korean
+증상이 시작된 게 언제부터예요?,Korean
+또한 손가락 인대가 손상되었으니 되도록이면 움직이지 마시고 적용한 부목은 제거하지 말아 주세요.,Korean
+내시경 검사한지 한 달 밖에 안되셨지만 그동안의 추이를 관찰하고 치료를 해야 하기 때문에 불편하시겠지만 내시경을 한 번 더 합시다.,Korean
+대변을 보고 나서도 꺼림칙한가요?,Korean
+지금 몸 기본 상태를 알기 위해서입니다.,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+네. 한약 하루도 안 거르고 먹고 있어요.,Korean
+소변에 피가 섞여 있으세요?,Korean
+그냥 약국에서 파는 진통제 먹고 있습니다.,Korean
+아픈 부위를 가리켜 보세요.,Korean
+네. 건강 습관 잘 확인하고 지키려고 해요.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+가족 중에 유전성 질환 치료 받으시는 분 계세요?,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+실제로 토하신 적 없으세요?,Korean
+협심증이 확진된다면 약물 치료로 조절할 수 있습니다.,Korean
+증상과 원인에 따라 가장 좋은 방법으로 치료하게 됩니다.,Korean
+계속 밤에 잠에 들지 못하나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+소변이 잘 안 나온지 얼마나 되신 거 같아요?,Korean
+이전에 심장 관련 검사를 받은 적이 있으신가요?,Korean
+"동네 병원에서 요관 결석이 의심된다고 해서 대학병원에 왔어요.
+",Korean
+환자분이 직접 집에 다녀오신다는 말씀이세요?,Korean
+아뇨. 비타민 섭취를 위해 잘 드시는 게 좋습니다.,Korean
+그냥 보약 먹는 것 말고는 없어요.,Korean
+육류보다 섬유소가 풍부한 야채를 많이 드시는 게 좋습니다.,Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+"어제 아이가 낮잠 자다가 침대에서 떨어졌는데 계속 울고 보채서 검사받으러 왔어요.
+",Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+화상을 심하게 입은 터라 감염 위험이 높기 때문에 소독 자주 해주시고 물에 닿지 않도록 조심해 주세요.,Korean
+몸에서 특별한 반응이 없었나요?,Korean
+"소변 색이 녹빛 이에요.
+",Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+무릎 관절이 좋지 않은 상태에서 체중이 증가하면 연골이 더 닳게 되서 관절이 버티기가 힘듭니다.,Korean
+어지러워 병원 가서 입원 치료했어요.,Korean
+독감 주사 언제 맞았어요?,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+현기증을 처음 느끼신 건가요?,Korean
+평소에도 두드러기가 자주 나는 편이었나요?,Korean
+두통으로 불편한 점은 없나요?,Korean
+기침이 심할 때는 언제인가요?,Korean
+대변볼 때 피가 나오나요?,Korean
+"혈당이 많이 오른 거 같아요.
+",Korean
+통증 때문에 잠을 못 자시나요?,Korean
+간염으로 먹는 약이 있습니까?,Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+간염 시작된 나이가 언제인가요?,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+당뇨 침 단계를 낮춰서 그렇게 아프지는 않을 테니까 걱정하지 마세요.,Korean
+약 처방할 때같이 처방하면 안 되는 약이 있는지 확인하려고 여쭤봤습니다.,Korean
+이전에 약을 처방받아 드신 적은 있으신가요?,Korean
+소변이 쉽게 안 나오나요?,Korean
+복부가 볼록 튀어나온 정도가 심한가요?,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+간염으로 복용 중인 약이 ���으신가요?,Korean
+지금 몸 기본 상태를 알기 위해서입니다.,Korean
+어깨 관절에 이상이 있나 봅니다.,Korean
+약 여분 없으면 다른 약 처방해드릴 테니 그거 드세요.,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+소변이 내려오는 길을 조영제로 조영하여 결석의 위치를 확인하기 위함입니다.,Korean
+간염은 약으로 치료하시는 거예요?,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+대변볼 때 피가 나오지는 않던가요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+확진이면 격리 후 진료를 진행해야 합니다.,Korean
+통증 양상이 어떻게 돼나요?,Korean
+공복 상태에 따라서 피 검사 결과가 좀 달라질 수가 있어서요.,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+제가 등 쪽을 좀 살살 두드려 볼게요. 오른쪽이 아프시다 하셨죠? 어떠세요?,Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+암 증세가 시작된 건 언제부터인가요?,Korean
+뭔가로 닦아 주는 건 아이 열이 심할 때 하는 거라 지금은 옷을 벗기고 있는 것만으로도 충분할 것 같습니다.,Korean
+방광염으로 소변검사 상 염증이 있을 경우에는 항생제 치료를 해야 합니다.,Korean
+당뇨약 드시는 것이 현재 있나요?,Korean
+"목에 치킨 뼈가 걸렸습니다.
+",Korean
+통증이 오는 특정 상황이 있나요?,Korean
+지난주 위 왼쪽 어금니를 뺐어요.,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+네. 외할머니가 간암으로 돌아가셨어요.,Korean
+아픈 게 사라지지 않나요?,Korean
+말씀하신 것처럼 환절기라 건조하다고 생각될 수도 있고 피부에 다른 질환이 생긴 것일 수도 있어요.,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+"성기 쪽이 빨갛고 가려운지 자꾸 만지네요.
+",Korean
+약 복용 방법을 제 아들한테 보내주시겠어요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+"머리가 너무 아프니까 약간 헛구역질이 나더라고요.
+",Korean
+만졌을 때 통증은 없나요?,Korean
+간혹 약물이 안 맞는 경우가 있으니 지켜봅시다.,Korean
+혈액형이 다르게 나왔나 확인해볼까요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+"""콕콕 찌르는 듯이 아픈가요, 쑤시듯이 아픈가요, 묵직하게 아픈가요, 날카롭게 아픈가요?""",Korean
+네. 위생에 신경 쓰도록 하겠습니다.,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+약을 과다복용하면 부작용이 있을 수 있군요.,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+담배 끊으셨을 때는 제외하고요.,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+"반복적으로 공황발작이 와서 가슴 압박도 심하고 질식할 것 같은 느낌이 들어요.
+",Korean
+결핵 백신 맞은 적이 있나요?,Korean
+몸에 이상이 생겼다는 게 어떤 의미인가요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+약에 따라 같이 먹으면 안 되는 약이 있어서요.,Korean
+동의서에 지금 사인을 하셔야 비급여 진통제를 바로 사용할 수 있습니다.,Korean
+영양분 제공을 위해 수액 맞는 거예요.,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+"어우 속이 더부룩해서 밤늦게는 안 먹죠.
+",Korean
+"아이가 콧물 기침이 심해요.
+",Korean
+언제부터 소변을 볼 때 피가 같이 나오나요?,Korean
+내원하신 이유가 어떻게 되죠?,Korean
+"공복 열 시간 지났어요.
+",Korean
+"아이가 원래는 열 시면 잤는데 요즘은 쉽게 안 자네요.
+",Korean
+약 여분 없으면 다른 약 처방해드릴게요.,Korean
+아버지가 퇴직 후에 우울증으로 잠깐 고생하실 때 정신과 다니셨죠.,Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+진단에 도움이 될 수 있기 때문입니다.,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+최근 체중 변화가 눈에 띄게 있었을까요?,Korean
+일 점부터 십 점까지의 통증 중 삼 점 정도 느끼신다고 합니다.,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+"코 막혀서 잠을 못 자는 거 같아요.
+",Korean
+"기침도 나오고 가래도 껴요.
+",Korean
+예전에 쓰러지신 적 있나요?,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+가슴 통증이 있진 않으신가요?,Korean
+상처가 빨리 나을 수 있도록 단계별로 치료를 진행하게 됩니다.,Korean
+수분 섭취가 적어 농도가 짙은 소변은 진한 노란색으로 보이는데 간혹 이를 오인하여 내원하는 경우가 있습니다.,Korean
+소변을 볼 때 피가 보이나요?,Korean
+무엇 때문에 병원에 왔나요?,Korean
+"금식인 걸 까먹고 좀 전에 이유식을 먹였어요.
+",Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+약이 들어갈 때 뻐근할 수 있으니 불편하시면 말씀해 주세요.,Korean
+"기운도 없고 근육통이 많이 심하네요.
+",Korean
+배변 횟수가 많음은 주관적 불편감도 야기할 수 있습니다.,Korean
+알레르기로 조심하시는 음식 있나요?,Korean
+힘드시겠지만 수술이 잘되기 위함이니 협조 부탁드립니다.,Korean
+아픈 부위를 가리켜 보세요.,Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+언니가 작년에 유방암 수술을 받았어요.,Korean
+네. 혈당 수치가 일정해요.,Korean
+아픈 기간은 어느 정도세요?,Korean
+환자와의 관계도 작성 부탁드리겠습니다.,Korean
+숨 쉬는 법 좀 보여주세요.,Korean
+앞으로 주사나 약 투여할 때 꼭 확인해야 하니까 빼거나 잃어버리면 말씀해 주세요.,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+하루에 몇 개비 정도 태우세요?,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+아픈 곳 좀 말해 주세요.,Korean
+한번 두드러기가 올라온 적이 있었어요.,Korean
+"숨 쉬는 게 이상한 거 같아요.
+",Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+가장 통증이 많이 느껴지는 곳이 어딘지 아세요?,Korean
+당뇨 증세가 시작된 건 언제부터인가요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+"허리가 굽힐 때 너무 힘들어요.
+",Korean
+과다한 양의 지질이 혈액 내에 있을 경우 지방 성분이 동맥 벽에 침착되어 혈관이 좁아지게 되고 심장과 뇌의 혈관질환 발생위험이 높아지게 됩니다.,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+"좀 오래 자요 열다섯 시간 정도예요.
+",Korean
+폐렴을 앓았었는데 지금은 치료가 됐습니다.,Korean
+"윗부분 어금니 있어요. 거기요.
+",Korean
+중추 신경계 통증을 둔화시키는 대신 간혹 어지러울 수 있습니다.,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+지금처럼 약물치료 받으시면 곧 나아질 거예요.,Korean
+사람마다 다른데 마취 깨고 의식을 회복하는데 한 시간이면 됩니다.,Korean
+결핵 진단 언제 받으셨어요?,Korean
+네. 아버지랑 할아버지 모두 암으로 돌아가셨습니다.,Korean
+제균치료를 중간에 임의로 중단 시 오히려 더 심해질 수 있고 항생제 내성이 생길 수 있습니다.,Korean
+네. 점심을 드신 시간에서부터 세 시간 금식을 한 뒤 검사가 진행 가능합니다.,Korean
+증상이 지금까지 얼마 동안 있던 거예요?,Korean
+네 연고는 안 바르셔도 됩니다.,Korean
+혈변 본 적 있어요?,Korean
+부비동염으로 병원 꽤나 다녔습니다.,Korean
+증상이 야간에 심해지지는 않나요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+토를 한 적이 있나요?,Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+불면증으로 언제부터 잠을 못 잤나요?,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+병이라고 하긴 애매한데 과민성 대장 증후군이에요.,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+나이가 어려 흉터가 옅어질 가능성도 있습니다.,Korean
+혈압이 높게 나오는 편인가요?,Korean
+따로 알아 둘 알레르기가 있을까요?,Korean
+환자분은 오늘 손가락 열상으로 오셨고 퇴원 안내문에는 열상 환자 주의사항이 있습니다.,Korean
+"흡연은 안하구요. 술은 가끔식 합니다.
+",Korean
+숨이 좀 안 쉬어져서 한참 누워있었어요.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+소변량 검사는 소변이 얼마나 나오는지에 따라 검사 지속시간이 달라집니다.,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+몇일에 한번 대변을 보시나요?,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+네. 의사 선생님께서 잘 해주실 거라고 믿어요.,Korean
+단순 음낭수종으로 인하여 감염 가능성은 거의 없습니다.,Korean
+출혈을 최소화해서 치료할 겁니다.,Korean
+그럼요. 중단 없이 계속 복용 중이죠.,Korean
+"빛이랑 소리 같은 거에 되게 예민해져서 어두운 곳에서 조용히 혼자 누워있어야 돼요.
+",Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+결핵 백신 주사는 안 맞으셨나요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+환자분 주치의께서는 보통 아홉 시 전에는 환자 보러 돌아다니셔요.,Korean
+"갑자기 배가 너무 아프고 계속 화장실 왔다 갔다 해서 급하게 왔어요.
+",Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+진료 차트 확인 후에 도와드릴게요.,Korean
+잠을 못 잘 정도로 배가 아픈가요?,Korean
+아뇨 식습관을 여쭤본 것이에요.,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+"드레싱 좀 해주실 수 있나요?
+",Korean
+"생각해 보니 대소변 둘 다 어려워요.
+",Korean
+알러지 치료는 언제 시작하셨어요?,Korean
+수면 마취는 더 편하지만 수면 마취로 인한 위험성은 있습니다. 비수면 시에는 더 불편감을 느낄 수 있습니다.,Korean
+가족 병력에 대해서 여쭙겠습니다.,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+입원 치료가 저번 주에 끝났었거든요.,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+휴식이 회복에 중요한데 진통제 처방받고 푹 주무시는 게 좋겠습니다.,Korean
+"아니요. 체중이 한 십 퍼센트 갑자기 줄었어요.
+",Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+언제 갑상선 치료를 받았나요?,Korean
+장염에는 걸린 적이 없는데.,Korean
+당분간은 수액으로 체액 불균형을 해소할 거라서 일단은 금식이라고 생각하시면 되세요.,Korean
+부루펜을 먹인지 얼마나 됐나요?,Korean
+호흡할 때 어려움이 있나요?,Korean
+"눈이 엄청 건조하고 따가운 뒤로 시력도 좀 낮아진 거 같아요.
+",Korean
+복부 쪽으로 팽만이 있나요?,Korean
+배가 아파 병원에 다녀왔어요.,Korean
+통증이 조절되는 요로결석은 대부분 응급 처치를 하지 않습니다.,Korean
+전에 수술한 경험 있으세요?,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+"심장이 안 좋아서 그런 거라 하셨어요.
+",Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+맨날 파스 붙이고 사는데요 뭘.,Korean
+이 약품들 외에는 복용 안 하시나요?,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+전에 병원에 입원한 적 있으신가요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+암을 진단 받으신 적 있나요?,Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+통증이 어떤 거 같으세요?,Korean
+"급체했는데 속이 답답하다더니 토를 하길래 왔습니다.
+",Korean
+암 때문에 병원에 오셨나요?,Korean
+신체적인 반응이나 부작용이 일어났었나요?,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+"어제 저녁 이후로 가슴이 쥐어짜는 듯한 통증이 있습니다.
+",Korean
+마취가 필요하면 알려 드리겠습니다.,Korean
+과거 수술 여부 말씀해주세요.,Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+"네. 기침을 너무 오래 해서 왔어요.
+",Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+혈압 재겠습니다. 혈압이 언제 떨어졌나요?,Korean
+술은 당연히 몸에 나쁩니다.,Korean
+대소변을 잘 못 보는 것 뿐 아니라 대소변을 볼 때 불편감이 있는 경우도 포함됩니다.,Korean
+특정 시기에 통증이 생기나요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+몸살 난 것처럼 몸이 으슬으슬 떨리나요?,Korean
+정확한 원인이나 유발인자는 밝혀지고 있지 않지만 특정한 원인을 통해 손목에 터널이 좁아지면서 신경이 압박되어 발생합니다.,Korean
+종교적 신념 때문에 여의사님이 봐주셨으면 좋겠어요.,Korean
+마취가 잘 안 들었다든지 그런 거요.,Korean
+종양 치료는 다 끝났나요?,Korean
+약물 알레르기 있던 적 있으세요?,Korean
+먹는 건 괜찮은데 동물 털에 알레르기가 있어요.,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+피부가 간지럽다거나 두드러기 같은 게 올라오거나 붓지는 않았는가요?,Korean
+관절운동 범위에 제한이 있나요?,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+환자분의 치료 스케쥴에 매우 중요한 사항입니다.,Korean
+담배는 몇 살부터 피우기 시작한 거예요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+햇빛이 닿으면 장기적인 색소침착이 일어날 수 있습니다.,Korean
+현재 욕창 부위 피부가 파열되어 찰과상 물집이 보이며 부종이 심하네요.,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+"구토감이 많이 드는데 못 참을 때는 어쩔 수 없이 게워냈죠.
+",Korean
+오늘도 허리가 아파서 오신 거죠?,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+그보다 환자 상태에 맞춰 진행합니다.,Korean
+네. 처방받은 약은 아니고 약국에서 사 먹은 적은 있어요.,Korean
+가래 상태가 많이 심한가요?,Korean
+그럼 머리가 살짝 아프신 거 빼고는 다른 증상은 없었나요?,Korean
+자연분만하다가 위험해서 수술로 바꿨어요.,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+무슨 일 때문에 병원에 오셨나요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+가슴 통증이 어느 때 자주 나타나요?,Korean
+고통이 얼마나 자주 오나요?,Korean
+간염 검사 관련 양성인가요?,Korean
+속이 많이 울렁거려서 토하고 싶으신가요?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+소변볼 때 통증이 있나요?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+"아기가 오늘 하루 종일 울고 이유식도 안 먹으려고 해서요.
+",Korean
+간염으로 약을 드시고 계세요?,Korean
+영양제 유산균이랑 비타민 먹고 있어요.,Korean
+하루에 설사를 몇 번 했나요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+다치셔서 외래 진료 보러 오실 때요.,Korean
+열만 나는 것 같아요?,Korean
+"애가 점점 열이 오르더라고요.
+",Korean
+"네. 편두통을 앓은지도 오래되었으니까요. 여러 번 했죠.
+",Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+"어. 무슨 소변보는 쪽에 염증이 났다고 그러셨던 것 같은데.
+",Korean
+"하루에 다섯 개 이상 안 피우기로 정해놨어요.
+",Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+몸에 부은 곳이 있나요?,Korean
+이번 주에 구토를 얼마나 자주 하셨어요?,Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+"볼이 많이 부어서요. 왜 이러는 거죠?
+",Korean
+약 이름이 뭐였는지 까먹은 것 같아요.,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+빠르게 할 경우 혈관통이 발생할 수 있습니다.,Korean
+"혈뇨가 있어서 병원에 왔어요.
+",Korean
+진통제 처방은 해드리는데 대부분 안 드시고 견딜 만하다고 하시더라고요.,Korean
+가슴에는 심전도를 측정하느라 패치를 부착할게요.,Korean
+혹시 제가 말씀드린 증상 외 다른 증상은 없으셨나요?,Korean
+선생님 진찰 후 약 처방받으실 거예요.,Korean
+"오른쪽 무릎 통증 때문에 도저히 걷지를 못하겠어서요.
+",Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+발열이 심하면 어느 정도로 나타나죠?,Korean
+"몇 주째 설사가 계속되고 있습니다.
+",Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+알레르기 반응을 일으키는 약은 없나요?,Korean
+어떤 무리를 말씀하시는 거죠? 부작용을 말씀하시는 건가요?,Korean
+"왼쪽 무릎이 아팠는데 이젠 오른쪽까지 아파요.
+",Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+독감 예방 접종은 올해 하셨는지요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+처음 통증 있었던 게 언제죠?,Korean
+"방광은 어느 정도 높이에 있어요?
+",Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+"손가락에 수포가 생기면서 빨개지더니 나중에는 점점 가려워지더라고요.
+",Korean
+네 부작용이나 후유증 겪으신 내용 모두 말씀해주세요.,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+크게 어려운 것들은 없고 혈압 체크나 혈액 검사 수술 전 필요한 검사 몇 가지 하게 되실 거예요.,Korean
+"무릎에 문제가 생긴 것 같아요.
+",Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+"네. 다른 데는 별문제 없고 왼쪽 발만 그래요.
+",Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+"요새 귀가 간지럽고 물집이 생겨서요.
+",Korean
+"몸을 움직일 수 없을 정도로 옆구리랑 가슴이 당겨요.
+",Korean
+질문 필수 사항으로 모든 내원객 기준으로 물어봐야 합니다.,Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+현재도 통증이 계속 느껴지나요?,Korean
+"자세가 안 좋긴 한데 그것 때문인지 얼마 전부터 움직이는 게 너무 힘들더라고요.
+",Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+식욕이 떨어지신 것 같나요?,Korean
+편도선 많이 안 부었어요?,Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+"불면증도 있었고. 너무 밤잠을 설쳤죠.
+",Korean
+"다리에 쥐가 안 풀려요.
+",Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+최근 구토한 적 있으세요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+당뇨 질환으로 드시는 약이 있으면 알려주세요.,Korean
+입원하신 날짜가 어떻게 되시나요?,Korean
+네 따뜻한 곳에 계시면 제가 병실이 나오면 말씀드리러 가겠습니다.,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+대변볼 때 안 힘든가요?,Korean
+그런 약은 어디에도 없습니다.,Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+피로가 회복이 안 되시나요?,Korean
+하루에 설사를 자주 하시나요?,Korean
+그렇기 때문에 이를 예방하기 위해 내시경 요법을 사용합니다.,Korean
+혹시 지금 두통이 있으세요?,Korean
+그 약을 드시는 이유가 뭔지 여쭤봐도 될까요?,Korean
+통증이 많이 심한가 봐요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+위에는 증상이 발견되지 않았는데 위산제는 왜 필요하시죠?,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+가루약보다는 알약으로 드시는 게 더 효과가 좋습니다.,Korean
+대략 통증 부위가 어느 정도 되는 것 같나요?,Korean
+결핵 증상이 언제부터 나타났나요?,Korean
+귀에서 소리도 같이 나나요?,Korean
+가족 중에 당뇨이신 분 있어요?,Korean
+네. 수술 과정 한 번 설명 부탁드려요.,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+제가 환자분 과거력과 초음파를 보고 다시 설명드릴게요.,Korean
+당연히 소독 붕대 있죠.,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+질병 약물로 치료하고 계시나요?,Korean
+오른쪽 무릎 전방십자인대 파열로 수술 예정입니다.,Korean
+환자분 몸 상태를 더 잘 이해하기 위해 필요합니다.,Korean
+언제 처음 결핵을 앓았나요?,Korean
+네 약통에 라벨 보여주세요.,Korean
+죽을 만큼 통증이 심한가요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+종양 치료받은 적 있으세요?,Korean
+제일 신경 쓰이는 증상이 뭔가요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+친가에 암 병력이 있어요.,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+병원에 해당 기관으로 안내를 도와드리겠습니다.,Korean
+다른 주의사항은 없고 다음 외래 전에 엑스레이 찍으시고 피검사 하시는 거 잊으시면 안 됩니다.,Korean
+올해 예방접종은 아직 안 하셨죠?,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+부작용이라기보다는 진료 ���에 잠이 많이 올 수도 있어요.,Korean
+응급상황일 수 있습니다. 응급실로 안내해드릴게요.,Korean
+하루에 담배는 몇 갑 피우시죠?,Korean
+필요에 의해 처방드린 약이니 꼭 복용하세요.,Korean
+잠을 깊게 잘 수 있나요?,Korean
+"기침할 때 쇳소리가 심하게 나요.
+",Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+문제 없습니다. 입원 당시를 기록할 필요가 있어 질문하였습니다.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+한 시간 전에 배 아픈 것 때문에 진경제 한 알 먹었어요. 부스코판.,Korean
+"네. 피부 올라온 곳 주변으로도 아파요.
+",Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+마취통증의학과 선생님이 약물 조절 해주실 겁니다.,Korean
+변에 피가 함께 나오나요?,Korean
+"네 맞습니다. 요새 계속 살이 빠져요.
+",Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+담배 시작하신 게 언제예요?,Korean
+특별한 건강상에 문제가 발생하지 않는다면 예정대로 진행할 수 있습니다.,Korean
+"귀가 윙윙거리면서 소리가 잘 안 들려요.
+",Korean
+아니요. 치료 약이 적합한지 검사하는 것일 뿐입니다.,Korean
+통증은 얼마 동안 이어지나요?,Korean
+소화가 어렵거나 하진 않나요?,Korean
+오한이 있어서 춥고 떨리나요?,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+네 옆 병실에도 환자들이 있습니다.,Korean
+지금 상태를 정확하게 판단하고 치료를 진행하기 위해 몇 가지 검사를 추가적으로 진행한 이후에 말씀드리도록 하겠습니다.,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+속이 울렁거린 후에 구토가 나오나요?,Korean
+어깨 마비를 유발할 수 있는 질병에 대해서 검사해볼게요.,Korean
+네 수치상으로는 정상 범위가 맞습니다.,Korean
+다른 아픈 곳은 없으신가요?,Korean
+크게 어려운 것들은 없고 혈압 체크나 혈액 검사 수술 전 필요한 검사 몇 가지 하게 되실 거예요.,Korean
+"아침에 하품을 하다 턱에서 딱 소리가 나고 아파서 왔어요.
+",Korean
+지금 복용 중인 간염약 있나요?,Korean
+아니요. 무조건 수액을 처방하지는 않습니다.,Korean
+삼일 정도 먹는 건 괜찮아요 우선 변비약 처방해 드릴게요.,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+아니요. 알레르기 비염 때문에 털 있는 동물을 키울 수가 없어요.,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+큰일을 보시면 항문이 아프신가요?,Korean
+"밥 먹으면 소화가 엄청 더디고 속이 울렁거려요.
+",Korean
+갑자기 정상 체중을 벗어났나요?,Korean
+심한 경우 약만으로는 못 막아요.,Korean
+처방받고 바로 진행될 거예요.,Korean
+어느 곳이 아파서 오셨어요?,Korean
+네 검사 결과 기억하시나요?,Korean
+혹시 출혈이 실제로 있나요?,Korean
+그렇게 부담스러운 검사는 아닌걸요?,Korean
+환자분 상태에 따라 다른데 보통 한 시간 전후로 풀립니다.,Korean
+"머리에 누가 술병을 깨서 피가 났어요.
+",Korean
+마취 안 하고 했어요.,Korean
+나가실 때 약국에서 약 받아가세요.,Korean
+입원하실 때 무슨 수단 이용하셨는지 물어보는 거예요.,Korean
+전에 수술한 경험 있으세요?,Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+입에서 피 맛이 나나요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+지난번 치료 이후에 신체적으로 다른 특이사항은 없었나요?,Korean
+"생선 뼈가 목에 걸려서요.
+",Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+무릎이 많이 안 좋은 상태여서 인공 무릎으로 교체한 것 같아요.,Korean
+"소변 색이 녹빛 이에요.
+",Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+가래에 피가 섞여 있나요?,Korean
+"네. 기흉 가지고 있어요.
+",Korean
+검사 결과는 원하시면 문자나 이메일로도 발송 가능합니다.,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+제가 오늘 처방해 드리는 약과 서로 상충되는 성분이 있을까 봐 여쭤보는 거예요.,Korean
+알레르기 약 먹고 있는데 이거 항히스타민제 맞나요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+소변볼 때 통증이나 불편감이 있으신가요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+아뇨. 비타민 섭취를 위해 잘 드시는 게 좋습니다.,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+마취가 잘 안 들었다든지 하는 점 없으실까요?,Korean
+변이 잘 안 나오나요?,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+혹시 지금 체온을 측정해볼 수 있나요?,Korean
+소화는 평소에 잘 되시나요?,Korean
+이쪽 말고 우리 동네 약국으로 가도 되나요?,Korean
+"네. 수면제 챙겨 먹고 있습니다.
+",Korean
+지금 먹고 있는 약 있어요?,Korean
+보습만 잘 해 주시면 가려움증은 많이 좋아질 거예요.,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+"오늘 팔꿈치 물 빼는 시술 있다고 해서요.
+",Korean
+운동 강도와 시간이 중요하지요.,Korean
+"저녁에는 하체 쪽이 붓습니다.
+",Korean
+통증 정도는 어느 정도 되십니까?,Korean
+보호대 착용은 손목의 움직임을 줄이고 손목터널 내 압력을 줄여주어 신경 압박에 의한 증상을 줄일 수 있습니다.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+네 집중해서 치료하면 빨리 낫겠지요.,Korean
+과민성과 관련된 약도 드시나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+네. 수술복 외에는 전부 벗으셔야 합니다.,Korean
+가슴이 찌를 듯이 아픈가요?,Korean
+암 수술한 적 있으세요?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+오늘 의사선생님이 수술부위와 수술 방법에 대해 설명해주러 오실 거에요.,Korean
+"아니요. 며칠째 잠을 제대로 못 자요.
+",Korean
+앓으신 지 일주일 정도 되셨나요?,Korean
+처방되는 약을 꾸준히 드신다면 증상이 호전될 겁니다.,Korean
+언제부터 가슴 통증이 있나요?,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+"손가락이 저리는데 제가 목 디스크가 있거든요. 아무래도 목디스크 때문인 것 같아요.
+",Korean
+그 후에는 같은 증상이 발생하지 않았나요?,Korean
+전에 드셨던 변비 약 이름이 뭔가요?,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+네 삼 개월 후에 수술할 수 있습니다.,Korean
+하지정맥류 진단받고 여기 온 거예요.,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+가족 중 고혈압 당뇨 결핵 간 질환 등 유전성 질환을 앓고 계시거나 앓으셨던 분이 있으신가요?,Korean
+통증 지속시간이 십 초 이내인가요?,Korean
+대부분은 그렇습니다만 통증이 있으면 시술 시 말씀해주세요.,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+피를 뽑아서 좀 어지러운데 자도 될까요?,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+현재 약 드시는 거 있어요?,Korean
+"그동안 약간 설사 식이라곤 하셨는데 일주일 전부터 혈변이었데요.
+",Korean
+제가 한 세 살 때쯤 입원한 것으로 알고 있어요.,Korean
+금식이 꼭 필요한 검사예요. 다음에 다시 예약하고 오셔야 해요.,Korean
+네 발열이나 근육통 및 두통 등이 있으셨나요?,Korean
+많이는 아니지만 빨리 입원하는 게 아이에게 좋습니다.,Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+속이 많이 안 좋으신가요?,Korean
+속이 울렁거린 후에 구토가 나오나요?,Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+이번 주에 구토를 얼마나 자주 하셨어요?,Korean
+진물 등이 차기 때문에 주기적으로 붕대를 갈고 소독해주어야 합니다.,Korean
+뼈가 자라지 않은 다지증이기 때문에 전신마취는 안 해도 됩니다. 대신 주사제로 전신마취제를 투여하고 마취과 의사가 있는 상태에서 수술합니다.,Korean
+흉부에서 통증이 크게 느껴지나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+통증이 느껴진다면 어떤 느낌인가요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+소변보는 내내 혈뇨가 보이면 신장 요관 방광 등 상부 요로계 질환일 가능성이 높습니다.,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+통증이 어느 정도 심해요?,Korean
+그럼 최근 몇 달 동안 체중이 그만큼 오른 건가요?,Korean
+"아이 눈에서 자꾸 진물 같은 게 나와요.
+",Korean
+지금 컨디션이 저하되어 있나요?,Korean
+현재까지 간염 치료 받은 지는 얼마나 되었나요?,Korean
+온몸이 다 쑤시고 아픈가요?,Korean
+가족 중에 누군가 고혈압이 있나요?,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+일반적인 서혜부 탈장은 통증이 없는 경우가 대부분입니다.,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+이 부위가 아픈 곳이에요?,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+마취 크림을 안 바르면 통증이 느껴질 겁니다.,Korean
+불면증이 심하신 거 같아요.,Korean
+아까 말씀드렸듯 감염의 위험 때문입니다.,Korean
+수면 내시경이 있습니다. 하지만 대장 내시경보다 검사가 수월하여 비수면으로 하기도 합니다.,Korean
+소화불량 때문에 오신 건가요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+부모님께서 어떤 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+한 달 동안 체중이 얼마나 변했나요?,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+일주일 내내 통증이 있으셨나요?,Korean
+환자분은 격리실 밖으로 나오시면 안 되고 필요하신 것이 있으시면 콜벨을 눌러 간호사를 호출해 주세요.,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+거대결장은 장의 운동을 담당하는 신경세포의 문제로 발생하는 질환입니다.,Korean
+배의 어느 부분이 아프신가요?,Korean
+병원 입원 경험이 있으신가요?,Korean
+통증 지속력이 어느 정도인가요?,Korean
+몸 여기저기 안 아픈 곳이 없어요.,Korean
+네 의사 선생님께서 말씀해 주실 거예요.,Korean
+"예. 조금 미열이 있던 것 같아요.
+",Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+발목에 어떤 증상이 있으신 건지 자세히 말씀해 주실 수 있나요?,Korean
+어떤 질병 때문에 드시는 약인가요?,Korean
+네. 수술 과정 한 번 설명 부탁드려요.,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+서혜부탈장은 보통 복압이 증가하면서 복강 내 장기들이 서혜관으로 내려오면서 생깁니다.,Korean
+예방주사 외에 다른 약을 복용하신 적은 없으시고요?,Korean
+담배를 피우신 적 있으세요?,Korean
+음주는 얼마나 자주 하시죠?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+응급조치부터 하고 확인해 드릴 게요.,Korean
+아이들도 위염에 걸리는 경우가 있습니다.,Korean
+피로로 인해 일상이 힘든 적 있나요?,Korean
+진료받기 전에 응급처치부터 하도록 하겠습니다.,Korean
+배가 불러 불편하지는 않으세요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+고혈압약처럼 지속적으로 드시는 다른 종류의 약이 있을까요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+"동네병원에서 간 수치가 높다고 큰 병원으로 가보라고 해서 왔습니다.
+",Korean
+수혈하는 상황만 아니라면 상관없습니다.,Korean
+담배 언제 처음 피웠어요?,Korean
+오늘 의사선생님이 수술부위와 수술 방법에 대해 설명해주러 오실 거에요.,Korean
+통증이 시작된 것이 언제인가요?,Korean
+"검진에서 초음파에 근종이 보입니다.
+",Korean
+알레르기 유발하는 음식 말해봐요.,Korean
+변에 피가 함께 나오나요?,Korean
+다행히 아직 아이가 심각한 상태가 아닙니다.,Korean
+병원이다 보니 개인정보 제공에 동의해 주셔야 합니다.,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+배를 눌렀을 때와 가만히 있을 때 통증이 어떻게 다른 가요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+꼬리뼈 부위에 욕창이 생겼습니다.,Korean
+네. 손발이 차가워지고 떨렸어요.,Korean
+무조건 담배 때문에 기침이 나는 것이라고 단정할 수는 없습니다.,Korean
+느낌상 심박수가 올라가는 것 같았어요?,Korean
+음주나 비만이 가장 흔한 원인입니다.,Korean
+"갑자기 하혈을 심하게 하고 있어요.
+",Korean
+"소변볼 때 아래가 따끔거리고 아파서요.
+",Korean
+약은 곧 처방전이 나올 겁니다.,Korean
+네 혈액 검사를 해야 알 수 있습니다.,Korean
+동의하셔야 해당 약품을 쓸 수 있어요 조금 비싸긴 합니다.,Korean
+네 가슴이 마구 두근거리고 식은땀이 나기도 했어요?,Korean
+외상력도 없으시다고 하신 것으로 보아 퇴행성 무릎 관절염으로 보이는데 최근 체중이 많이 늘진 않으셨나요?,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+어떠한 치료를 하는가에 따라 병원비는 달라질 수 있습니다.,Korean
+담배를 피우기 시작한 게 언제예요?,Korean
+"네. 부작용이 심해서 안 먹습니다.
+",Korean
+네 수치 확인 후 다시 마스크를 쓰게 됩니다.,Korean
+음주 빈도는 얼마나 되시나요?,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+무통 주사 맞아도 효과가 없는 것 같아요.,Korean
+소변에 피가 섞여 나오나요?,Korean
+특별히 원하시는 병원이 있으신가요?,Korean
+가족 중에 누가 당뇨 있으시죠?,Korean
+성대 수술 경험 있습니다.,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+"대상포진인 것 같아요. 너무 아프네요.
+",Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+"군대에서 작업하면서 삽질을 했는데 오른쪽 어깨에서 톡 하는 소리가 들리더니 그 이후로 오른 어깨에 통증이 심해져 오게 됐습니다.
+",Korean
+"머릿속 어딘가를 세게 두드리는 듯하고 계속 아프다는 신호가 와요. 그럼 그다음엔 거의 무조건 토를 했어요.
+",Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+턱 쪽 피부가 찢어져서요.,Korean
+자연배출의 가능성이 있으면 경과 관찰할 수 있지만 크기가 크거나 좁은 곳을 꽉 막고 있을 경우 신기능 손상 등의 우려가 있어 긴급한 치료가 필요할 수 있습니다,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+불편하시겠지만 환자 확인을 위한 절차이니 양해 부탁드립니다.,Korean
+팔에 힘이 안 들어가서 들기가 어려워요.,Korean
+이런 증상은 굉장히 흔합니다.,Korean
+어떤 약물을 복용하고 계시나요?,Korean
+"먹는 양은 똑같은데 살이 급격하게 쪘어요.
+",Korean
+통증에 반응 좀 보여 주시겠어요?,Korean
+지금 저 따라서 심호흡하세요.,Korean
+토를 심하게 한 적이 있나요?,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+난소에서 난자가 나오면 나팔관을 통해 이동하는데 이 길을 막는 것입니다.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+네. 그러면 수술을 위해 입원해야 하나요?,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+양 무릎이 다 다쳤어요.,Korean
+퇴원 안내문에 복통 환자 주의사항이 있으니 잘 읽어보시고 배가 많이 아프시나 증상이 생기면 소화기 내과 외래나 응급실로 내원하셔서 진료 보시면 됩니다.,Korean
+잠드는 게 어렵지는 않으신가요?,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+네. 그리고 그 외 대변을 볼 때 있어 불편감이 있는 경우도 말씀해 주십시오.,Korean
+"변비가 꽤 오랫동안 있어요.
+",Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+앓고 있는 병 있나요?,Korean
+하루에 몇 번 정도 아픈가요?,Korean
+그럼 제가 눌러 볼 테니 더 아픈 곳을 말씀해 보세요.,Korean
+최근 독감 백신 맞았나요?,Korean
+네. 그렇습니다. 그리고 마취 가스가 몸에 오래 남아있으면 어지러움과 메스꺼움 등이 발생할 수도 있습니다.,Korean
+"가끔 왼팔이 힘이 빠질 때가 있어요.
+",Korean
+"피가 좀 섞여 있었죠.
+",Korean
+"최근 의자를 바꾸고 이주 정도 됐나 어느 순간 등이 계속 아프더라고요. 자세 문젠가 싶어 계속 허리를 펴고 앉았는데도 그래요. 허리가 아니라 등이 아픈 게 이상해 입원했습니다.
+",Korean
+독감 접종한 게 언제죠?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+가래 상태가 많이 심한가요?,Korean
+혈압이 좀 높은 편이라고 들었어요.,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+무리를 하셨네요. 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+수술이 필요한 정도는 아닙니다.,Korean
+전신무력증이 온 것 같습니다.,Korean
+고혈압 관련해서 어떤 약을 드시고 계신가요?,Korean
+아니요 민간요법보다는 의학적인 치료법이 정확한 거니까요.,Korean
+환자 번호는 조금 있다 알려 주시겠어요?,Korean
+화장실에 갔는데 소변이 안 나오나요?,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+네 예약하시고 그날 내원하시면 검사 진행하겠습니다.,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+금식을 할 때는 물도 드시면 안 됩니다.,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+항히스타민제는 두드러기 발적 소양감 등의 알레르기성 반응에 관여하는 히스타민의 작용을 억제하는 약물입니다.,Korean
+최근에 수술 언제 받으셨나요?,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+움직임에 제한은 있지만 심각한 상황은 아닌 듯합니다.,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜 보세요.,Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+건강차 같은 건 마셔요.,Korean
+다른 부위 암 수술받았었죠.,Korean
+정말 조금 부어올랐네요 통증이 있으신가요?,Korean
+태어나고 몇 개월 동안 예방 접종하신 게 다일까요?,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+네 예방적 항생제는 미리 항생제를 놓는 겁니다.,Korean
+성형 수술이라고 생각하시면 됩니다.,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+아니요 빈혈 안 옵니다.,Korean
+십 분 뒤에 수술 진행하겠습니다.,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+"요새 귀가 간지럽고 물집이 생겨서요.
+",Korean
+소아암으로 초등학교 들어가기 전에 병원에 오래 있었습니다.,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+외가 친척 중에 있는 유전 질환이 어떤 건가요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+모든 부위에서 통증이 발생하긴 하지만 마취 크림 도포 후 진행하기 때문에 덜하실 거예요.,Korean
+"항암을 사흘 전에 했는데 열이 나요.
+",Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+지금도 통증이 심한데 진통제만 좀 추가로 받고 싶어요.,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+수면 보조제 복용 중이시면 말씀해 주세요.,Korean
+객혈을 한 시기에 따라 병명이 달라질 수가 있어서입니다.,Korean
+"잠은 잘 자구요. 하루에 여섯 일곱 시간은 자요.
+",Korean
+만성폐쇄성 폐 질환이 있네요.,Korean
+그렇게 부담스러운 검사는 아닌걸요?,Korean
+혈압은 정상 수치를 벗어나게 되면 모두 문제라고 할 수 있어요 너무 높거나 너무 낮으면 둘 다 문제입니다.,Korean
+환자분 상태에 따라 입원 가능 여부가 달라집니다.,Korean
+매일 혈압을 재고 있나요?,Korean
+통증은 어떤 느낌으로 오나요?,Korean
+"아니요. 체중이 한 십 퍼센트 갑자기 줄었어요.
+",Korean
+지금 어디가 아픈 건가요?,Korean
+덕분에 입원하며 수술 회복도 잘하고 갑니다. 감사해요 정말.,Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+기침 외에 다른 증상은 없나요?,Korean
+입원 경험이 있는지 없는지 알기 위해 여쭤봤습니다.,Korean
+소변에 피가 함께 나오나요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+혈압이 높았던 건 좀 오래됐어요. 건강검진 할 때마다 고혈압 위험군이라고 하셨는데 한 일년 정도 된 것 같네요.,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+감염을 일으키는 원인균에 따라 가래 색이 달라질 수 있습니다.,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+식사가 우선 건강 회복에 제일 중요해요.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+"하루에 한 개에서 두 개 정도 핍니다.
+",Korean
+팔도 골절이 의심되어서 현재 부목을 대 드릴 거예요.,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+종종 구토 증상이 있으세요?,Korean
+어릴 때 좀 몸이 약했던 것 말고는 어떤 질병을 앓아 본 적은 없어요.,Korean
+네. 수술 후 특별한 문제가 없으시다면 빠른 시일 내에 퇴원이 가능합니다.,Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+첫째 애 낳고 유산했었습니다.,Korean
+자세한 건 모르겠는데 의사 선생님께서 계속 먹으라고 해서 먹고 있어.,Korean
+관절운동 범위에 제한이 있나요?,Korean
+아직은 입원 지시가 없어서 금식 여부를 알 수 없습니다.,Korean
+수액부터 놔 드릴게요. 그리고 항생제랑 마취제 검사하러 오겠습니다.,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+소화 기능이 안 좋으세요?,Korean
+알레르기 나는 상황 알려주세요.,Korean
+맞아요. 악화를 막기 위해 식단 조절을 바로 시작해 주세요.,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+하루 동안 얼마나 피워요?,Korean
+헬리코박터가 위에 있으면 염증을 일으킬 수도 있다고 하던데. 저 그 검사도 할 수 있나요?,Korean
+"흡연은 하는데 음주는 안 합니다.
+",Korean
+위랑 장이 별로 안 좋았어요.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+혹시 제가 말씀드린 증상 외 다른 증상은 없으셨나요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+간염은 앓으신 지 얼마나 되셨어요?,Korean
+"소화 기능도 전반적으로 떨어졌고 속도 자주 쓰려요.
+",Korean
+무슨 증상이 있어 드셨던 소염제인가요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+빈혈 같은 건 평생 있었어요.,Korean
+죄송하지만 수면 비용에는 보험 적용이 되지 않습니다.,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+간염으로 언제 치료 받으셨나요?,Korean
+치료 효과가 떨어질 수 있으니 바로 챙겨드시는 것이 좋습니다.,Korean
+할머니가 신장이 안 좋으셨는데 수술받을 정도는 아니셨어요.,Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+하지정맥류 진단받고 여기 온 거예요.,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+감염성 질환이란 다른 환자로부터 옮을 수 있는 질환입니다.,Korean
+환자 분 현재 질환과 연관성이 높은 사항입니다.,Korean
+아니요. 비뇨기과에 온 건 처음입니다.,Korean
+암 진단을 받아보신 적 있나요?,Korean
+심장 관련된 검사들을 진행하고 그에 따른 치료를 하겠습니다.,Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+하루 동안 얼마나 피워요?,Korean
+"매일 아홉 시간 이상 자 줘야 개운해요.
+",Korean
+천식을 앓으신 적이 있으시다고요?,Korean
+알레르기 나는 상황 알려주세요.,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+암에 대한 가족력이 있을까요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+보다시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요,Korean
+제가 가지고 온 약 있는데 한 번 봐주시겠어요?,Korean
+네 상처 보호 혹은 지혈을 위해 쓰입니다.,Korean
+얼마나 자주 아픔을 느끼나요?,Korean
+어깨에도 이상이 있어 보이네요.,Korean
+"한 달째 기침이 ��추지를 않아요. 검사해보자고 하셔서 입원했어요.
+",Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+통증은 주로 언제 오나요?,Korean
+네. 독감 예방 주사 맞은 지 얼마 안 됐어요.,Korean
+목에 이물감이 있어서 그럴 수 있습니다.,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+"가슴에 통증이 심해서 외래 진료로 왔다가 입원했네요.
+",Korean
+"열도 나는 것 같고 배도 아프고 여기저기 불편합니다.
+",Korean
+운동을 할 때 이외에도 증상이 있나요?,Korean
+마취 약물 때문에 구토 및 오심 등 알레르기 반응이 있을 수도 있습니다.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+"오줌 누듯이 물만 나오는 느낌이었어요.
+",Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+수면 내시경이 있습니다. 하지만 대장 내시경보다 검사가 수월하여 비수면으로 하기도 합니다.,Korean
+지도 길 찾기 기록 좀 확인해볼게요. 서울성심병원에 방문했었네요.,Korean
+목에 아픈 증세가 있나요?,Korean
+입원 경험이 있는지 없는지 알기 위해 여쭤봤습니다.,Korean
+대변에 피가 같이 나옵니까?,Korean
+약을 오래 드시면 안 됩니다.,Korean
+고유량의 산소를 투여하면 괜찮아질 겁니다.,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+암을 진단 받으신 적 있나요?,Korean
+네. 비뇨기 계통이 안 좋아서요.,Korean
+숨쉬기가 어려운 느낌이 드세요?,Korean
+손 소독 철저히 해야죠.,Korean
+한 달 동안 방문한 의료기관을 확인해야 합니다.,Korean
+입원 날짜 확인해서 말씀해 주세요.,Korean
+담배 대신 껌 씹으시는 걸 추천합니다.,Korean
+그럼 전에 검사하셨을 때 문제 없으셨던 건가요?,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+"소변볼 때마다 쓰라려서 왔습니다.
+",Korean
+어떤 것에 알레르기가 일어나나요?,Korean
+소변을 잘 못 보시나요?,Korean
+속이 많이 안 좋으신가요?,Korean
+당뇨 치료를 위해 어떤 약을 드시나요?,Korean
+어떤 부위 검사를 받고 싶으세요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+"네. 밤에 깨면 다시 잠들기 어려워요.
+",Korean
+제일 신경 쓰이는 증상이 뭔가요?,Korean
+네. 생리 불순으로 갔다가 다낭성 물혹 진단받았는데 몇 년 뒤에 다시 가보니 줄어들었다고 하시더라고요.,Korean
+몸이 지금도 춥고 떨리나요?,Korean
+잠을 잘 못 자거나 몸에 상처가 있거나 발진은 없나요?,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+테라마이신 연고를 두껍게 도포하면 효과가 더 좋습니다.,Korean
+완치가 힘들지만 최대한 후유증이 남지 않도록 하겠습니다.,Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+문제가 생기진 않았는데 약 때문에 가려운 증상이 생길 수도 있습니다.,Korean
+네 입원하셔야 진행할 수 있는 검사가 있습니다.,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+아프거나 증상이 없어도 경과 보러 내원 예약 미리 잡아도 될까요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+정말요? 아이가 너무 아팠겠어요.,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+항생제와 위산분비억제제로 치료를 합니다.,Korean
+통증이 얼마나 가는 거예요?,Korean
+병실에 여분 환의가 있나요?,Korean
+알레르기 반응에 또 다른 반응이 있나요?,Korean
+환자분이 느끼시기에 기능상 문제 없다 하시니 다행이지만 저희가 간호를 제공해 드리기 위해서는 유의점이 될 수 있어요.,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+통증을 말로 어떻게 표현할 수 있나요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+철심 박는 수술 했는데 몇 번 뼈인지는 몰라요.,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+목에 통증 있은지는 얼마나 되셨어요?,Korean
+이 병원에서 해서 기록�� 있을 텐데요.,Korean
+멸균 처리해서 균을 없앤 거라고 보시면 됩니다.,Korean
+복부가 가득 찬 느낌이신가요?,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+작년에 맞은 파상풍이 끝이에요.,Korean
+통증이 멈추지 않나 봐요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+검사 결과가 나온 이후 좀 더 효과 있는 치료법으로 가는 방법으로 하죠.,Korean
+암 판정받으신 적 있나요?,Korean
+"""일주일에 삼에서 사 회 삼십 분에서 한 시간씩 걷기, 자전거타기 등산 같은 유산소 운동을 권합니다.""",Korean
+통원치료도 가능하지만 계속 소독과 환부 확인이 필요해서 입원하시는 게 좋습니다.,Korean
+체중이 증가한 이유가 있을까요?,Korean
+드시는 약은 어떤 것들이 있을까요?,Korean
+허리가 완전히 회복되기까지는 오랜 시간이 걸립니다.,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+최근에 체중에 변화가 있나요?,Korean
+검사 결과 나오면 정확히 말씀드릴게요.,Korean
+그런 경우가 많지만 경우에 따라 배가 부른 원인이 가스가 차는 것 이외의 원인일지도 모릅니다.,Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+"배가 아파서 대변을 보면 피가 같이 나와요.
+",Korean
+혹시 병원 치료비가 얼마인가요?,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+아프다 안 아프다 하나요?,Korean
+이번에 입원하신 날짜 말씀해 주세요.,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+일부 환자는 유전적 이상으로 발생하며 당뇨병 갑상선기능저하증 간질환 신장질환 비만 등이 있는 경우 고지혈증이 발생하기 쉽습니다.,Korean
+네. 저희 집에서 가까운 요양원으로 들어가기로 하셨어요.,Korean
+어느 부위에 통증이 있으신가요?,Korean
+머리 부분에 통증은 없는지 말해주세요.,Korean
+네 과거에 다른 입원치료 받으신적이 있으신가요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+속이 불편하다고 자주 느끼시나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+당뇨와 관련된 가족력은 없나요?,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+잘못된 치실 사용법은 오히려 잇몸이나 치아에 안 좋을 수 있습니다 치실 사용법 좀 알려드리겠습니다.,Korean
+현재 발작 증상이 심해서 진정 시키는 중이라 진정이 되지 않을 시에는 추가 진정 주사를 놔야 합니다.,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+다른 증상이라면 레이저 수술로 나타날 수 있는 또 다른 증상을 의미하는 걸까요?,Korean
+다양한 질환이 복통과 오한을 동반할 수 있어서 검사가 필요합니다.,Korean
+틀니가 흔들리지는 않고 깨질 수는 있습니다.,Korean
+독감 같은 경우에는 매년 겨울 전에 맞는데 혹시 접종한 적 있으신가요?,Korean
+통증이 한번 오면 얼마나 지속되나요?,Korean
+영양 불균형이 신체 증상으로 나타나고 있네요.,Korean
+최근에 오한이 있던 적이 있나요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+피가 섞인 소변이 나오나요?,Korean
+항생제가 자기 몸에 맞는지 여부를 알 수 있는 검사입니다.,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+통증이 자주 있는 편인가요?,Korean
+오메가 쓰리도 지방 아닌가요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+과민성과 관련된 약도 드시나요?,Korean
+예전에 다쳐서 여기에 방문하신 적이 있으세요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+네. 혹시라도 혜준이가 구토 양이 많다거나 못 먹으면 탈수가 되서 또 열이 날 수도 있어요. 그럴 땐 꼭 응급실로 오세요. 집은 가깝나요?,Korean
+오늘 컨디션 좋고말고. 주사 놔주쇼.,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+심장이 빨리 뛰는 느낌이 있나요?,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+네. 그러실 수 있으세요. 이제 외래 다녀오실게요. 밖으로 나가시면 이송 요원분이 안내해 주실 거고 보호자분도 함께 다녀오세요.,Korean
+"금연 중이라 아침 점심 저녁 딱 세 번만 피우려고 노력 중이에요. 이제 육 년 됐어요.
+",Korean
+나 약 먹어야 되는데.,Korean
+혹시 소변에 피가 나왔나요?,Korean
+위선암 위림프종과 연관성이 있으나 높지는 않습니다.,Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+위의 내용물이 식도로 넘어오는 위식도역류증이 흔한 원인입니다.,Korean
+삼 개월 후에 금식하시고 피검사 하시러 오시면 됩니다.,Korean
+"지금 갑자기 애가 기절을 해서요.
+",Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+그때부터 아직 안 낫고 계속 앓고 계신 거죠?,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+네 좀 아픈 주사예요.,Korean
+장에 신경이 제대로 분포하지 않아 생기는 질환입니다.,Korean
+일차 치료 시 약을 시간에 맞춰 빠짐없이 복용하고 끝까지 치료받는다면 성공률을 높일 수 있습니다.,Korean
+오십 넘어서 고혈압 진단받았어요.,Korean
+네. 수술 후 특별한 문제가 없으시다면 빠른 시일 내에 퇴원이 가능합니다.,Korean
+독감 백신을 맞은 적이 있으신가요?,Korean
+예전에 아팠던 곳 있어요?,Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+통증을 말로 어떻게 표현할 수 있나요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+간염 치료 병력이 있나요?,Korean
+"어릴 적부터 태워서 하루에 한 갑 정도 태우네요.
+",Korean
+어느 부위에 통증이 있어요?,Korean
+당뇨약 드시는 것이 현재 있나요?,Korean
+"갑자기 이빨이 너무 아파요.
+",Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+"오른쪽 무릎 통증 때문에 도저히 걷지를 못하겠어서요.
+",Korean
+보통 이런 경우에는 혈압은 조절하지 않고 장기간 지속되거나 다른 질환을 불러올 경우 조절합니다.,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+갑자기 어지러워서 쓰러질 수 있으니 침대에서 볼일을 보시기 바랍니다.,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+네. 특이 혈액형 씨아이 뭐라고 그랬던 것 같아요,Korean
+요즘 발기는 잘 되시나요?,Korean
+이가 빠지고 새로 심은 부위들은 모두 자연치가 아니죠.,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+"숨을 들이쉬고 내쉬는 게 어려워요.
+",Korean
+현재 투약 중인 약이 있으신가요?,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+식중독은 여러가지 원인에 의해 발생할 수 있습니다. 원인을 찾기보다는 현재 증상 조절이 더 중요합니다.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+"분유 토하다가 색이 점점 연해지는 토를 했어요.
+",Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+"눈이 너무 아프고 뜨기 힘들 정도로 부었어요.
+",Korean
+혈압이나 심전도 상태를 보고 저희가 옮겨드릴거에요.,Korean
+네 환자분들의 전반적인 진료 상황을 알아야 도움이 되거든요.,Korean
+욕창은 지속적으로 압박받은 신체 부위에 혈액순환 장애가 일어나서 산소와 영양 공급이 부족해짐에 따라 발생합니다.,Korean
+현재 약 드시는 거 있어요?,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+알레르기 반응은 예방 접종 후의 반응이라 검사로 미리 알아볼 수는 없습니다.,Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+다른 약도 안 먹고 수액 같은 것도 맞은 적 없어요.,Korean
+나이가 어려 흉터가 옅어질 가능성도 있습니다.,Korean
+"네. 근데 애가 머리가 자꾸 어지럽다고 해서요.
+",Korean
+병원 이름만 필요해서 동네는 안 알려주셔도 될 것 같습니다.,Korean
+매번 소변이 빨갛게 나오시나요?,Korean
+아니요 안면 홍조는 아니지만 다른 병일 수도 있어서 한번 확인해 보겠습니다.,Korean
+약을 드신지 얼마나 되셨죠?,Korean
+의료보험처리가 되니 크게 부담되지 않을 거예요.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+가족 중에 당뇨 진단을 받아보신 분이 있으세요?,Korean
+술은 며칠 간격으로 마시나요?,Korean
+계속 먹고 있는 간염약이 있나요?,Korean
+병원 방문 이유가 뭘 까요?,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+"아이가 고열인데 해열제를 먹여도 열이 떨어지지 않아서요.
+",Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+네. 공복 지방 수치나 공복 혈당 수치 같은 경우에는 금식 여부에 따라 수치가 변하게 되므로 검사 전 금식을 꼭 하셔야 합니다.,Korean
+수혈받아 보셨는지 여쭤 보는 거예요.,Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+네. 올해 건강검진 있는데 진단 나오더라고요.,Korean
+"작업할 땐 하루에 한 다섯 대 이상은 피우는 것 같은데 작업 안 하면 안 피워요.
+",Korean
+제일 아픈 곳 말씀해주세요.,Korean
+체중 감량이 얼마나 있었죠?,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+청진으로도 호흡기 관련 질환은 진찰이 가능합니다.,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+수술 당일은 전혀 거동하실 수가 없어서 보호자분이 꼭 같이 계셔야 합니다.,Korean
+집 안에 있어도 가족들 간 전염력이 있으므로 성실히 답변 부탁드립니다.,Korean
+소변보는 데 문제 있으세요?,Korean
+"늘 설사를 하고 변이 얇아요.
+",Korean
+인슐린을 맞아야 할 수도 있어요.,Korean
+저 마취 잘 안 먹혀요.,Korean
+검사 전에는 금식을 유지하셔야 하고 수액을 놔드리도록 하겠습니다.,Korean
+"겨우 두 시간 자요. 잠도 안 오고 오래 못 잡니다.
+",Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+기력이 빠진 것 같은 느낌을 받으신 적 있나요?,Korean
+술 주량이 어떻게 되시나요?,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+응급실에 구급차 타고 오셨나요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+두통약보다는 띵한 느낌이 사라지지 않으면 정밀 검사가 필요합니다.,Korean
+"점액 덩어리가 조금 보였어요.
+",Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+지방종 제거 수술한 적 있어요.,Korean
+장상피화생 자체가 심각한 병변은 아니지만 위암 발생 가능성이 높아질 수 있기 때문에 꾸준한 관리는 필요합니다.,Korean
+바셀린 거즈로 상처를 보호하고 지혈할 수 있습니다.,Korean
+알고 계신 혈액형을 말씀해 주세요.,Korean
+"앉았다가 일어나려면 다리에 힘이 안 들어가요.
+",Korean
+다 떨어져 가니까 소화제 좀 넉넉히 주세요.,Korean
+아니요 수액은 따로 놓지 않고 약을 드리고 있어요.,Korean
+"씨 형 간염이 의심된다고 해서 검사받아봐야 할 것 같아요.
+",Korean
+같은 병실이 아니었으면 좋겠습니다.,Korean
+체내에 이산화탄소가 많아진 경우 만성 폐쇄성 폐질환이나 상기도 폐쇄 환기를 위한 근육기능 감소 신경전달 이상 중추성 호흡 기능 감소를 의심할 수 있습니다.,Korean
+유전성 질환 가족력 있나요?,Korean
+그건 환자분의 주치의와 상담 후 결정해봐야겠네요.,Korean
+언제 주로 현기증을 느끼나요?,Korean
+고혈압이랑 당뇨는 십 년 전에 받았고요. 뇌졸중은 작년에 진단받았어요.,Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+그 정도의 화상으로 보입니다.,Korean
+검사를 진행하고 약을 드리려는데 동의하시나요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+수술적 치료 이후 호전 양상에 따라 다를 수 있으나 큰 수술은 아니기 때문에 입원 기간은 길지 않을 것으로 보입니다.,Korean
+잠을 푹 주무실 수 없나요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+틀니 보청기 안경 렌즈 보조기나 심박동기 등 가지고 계신 것이 있으신가요?,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+아직 어떤 병을 진단받았다는 얘기를 듣지 못했어요.,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+"엉덩이 쪽 쏘인 것 같아요.
+",Korean
+서초역 앞에 있는 이비인후과인데 이름은 잘 모르겠어요.,Korean
+소화 장애가 함께 있지는 않나요?,Korean
+치료 기간은 얼마나 되었나요?,Korean
+약물 복용으로 치료 가능하세요.,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+네 마취 풀리고 통증 심하면 진통제 드릴 테니 언제든 말씀하세요.,Korean
+약은 잘 먹고 있어요. 혈당은 엉망이지만요.,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+재생 정도에 따라 수술이나 추가 시술이 필요하여 정확히 말씀드릴 수는 없습니다.,Korean
+통증의 강도가 얼마나 될까요?,Korean
+장염은 세균성과 바이러스성으로 나눌 수 있는데 세균성 장염은 복통이 훨씬 심할 수 있습니다.,Korean
+통증이 한번 오기 시작하면 얼마 동안 지속되나요?,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+"담배는 하루 한 갑 정도 피우고 술은 일주일에 두세 병씩 마셔요.
+",Korean
+"생각해보니 변을 볼 때마다 너무 오래 앉아있어서 다리에 쥐가 날 정도예요.
+",Korean
+약은 잘 복용 중이세요?,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+"지쳐서 기절하듯이 잠들기도 하는데 정말 통증 때문에 잠을 못 자요.
+",Korean
+가스와 변이 차 있는 원인은 검사를 해봐야 합니다.,Korean
+처음 간염 왔던 게 언제예요?,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+한 번에 잠에 들기가 어려우실까요?,Korean
+마취가 풀리면서 통증이 조금 심해질 수는 있습니다.,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+원인은 다양해서 검사 해봐야 할 것 같습니다.,Korean
+예전에도 비슷한 병을 앓으셨나요?,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+전신마취 경험은 없으신가 해서요.,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+지금 알려주셔야 곧 입원이 가능합니다.,Korean
+"설사는 안 했어요. 체온은 몇 도인가요?
+",Korean
+어떻게 입원하게 됐는지 기억나지 않으세요? 환자분은 오늘 사고 나서 입원하게 됐다고 알고 계신 게 맞아요.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+의학적인 도움만 받으신 거죠?,Korean
+피부나 다른 곳에 알레르기가 생긴 적이 있나요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+어릴 때 수술을 받은 흔적을 없애줄 수 있습니다.,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+"머리가 조금 아픈 것 같아요.
+",Korean
+전신 마취 상태로 수술받았습니다.,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+아픈 간격이 어떻게 되시나요? 한 번 아프고 난 다음에 다음 통증까지의 시간을 말씀해 주시면 됩니다.,Korean
+그럴 수도 있어요 상처를 치료하면서 생기는 현상일 수 있어요.,Korean
+지난 달에 쓰러지고 나서 처방받아 먹고 있어요.,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+"요즘 들어 기력이 자꾸 빠지는 것 같아요.
+",Korean
+경정맥신우조영술이란 조영제를 정맥에 주사하여 신장으로 배설되는 것을 확인하는 검사입니다.,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+네 칼슘은 몸에서 중요하죠.,Korean
+배 아플 때 화장실 가도 대변이 잘 안 나오시나요?,Korean
+"사타구니 부근에 통증과 열감이 느껴져요.
+",Korean
+영양제나 비타민 같은 거 말고 처방받아서 드시는 약 없으세요?,Korean
+수술 시 상태가 얼마나 돌아오는지에 대한 말씀을 다시 듣고 싶어요.,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+"식사량은 비슷한데 보기에 살이 엄청나게 빠지셨어요.
+",Korean
+지금 혈압 측정 중이니 말씀하지 말고 잠시만 계세요. 끝나면 결과 알려드릴게요.,Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+검사 자체에도 시간이 걸리고 환자도 많으니 양해를 부탁드립니다.,Korean
+영양을 고려한 식단을 드시나요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+"잠잘 때마다 가위에 눌려요.
+",Korean
+항생제 치료를 받으면 일주일이면 많이 좋아지십니다.,Korean
+본원에서 수술한 기록만 조회가 되기 때문입니다.,Korean
+타 병원으로 전원 수속 도와드리도록 하겠습니다.,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+이마가 뜨거운 것 같으���요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+삼일 정도 먹는 건 괜찮아요 우선 변비약 처방해 드릴게요.,Korean
+어떤 음식을 먹으면 목이 막히시나요?,Korean
+"혈당 수치가 안 좋아서요.
+",Korean
+고혈압과 당뇨약을 복용 중이세요.,Korean
+"군대에서 작업하면서 삽질을 했는데 오른쪽 어깨에서 톡 하는 소리가 들리더니 그 이후로 오른 어깨에 통증이 심해져 오게 됐습니다.
+",Korean
+지금 움직이는 데 불편하거나 지팡이 등 보조 기구의 도움이 필요하지는 않나요?,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+드물게 출혈 혈종 등이 발생할 수 있으나 의료진이 관찰하니 너무 걱정하지 마십시오.,Korean
+가족분 중에 고혈압 당뇨 결핵 간 질환 종양 그 외 유전성 질환이나 감염성 질환을 앓거나 수술한 분이 있나요?,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+"변비 있어서 마그밀 복용해요.
+",Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+방문 국가가 감염병 지역인지 알아보기 위해서요.,Korean
+피부관리실은 다녀봤는데 피부과 치료는 처음 받아봐요.,Korean
+최인하 선생님이 담당 의사입니다.,Korean
+알레르기 진단을 언제 받았나요?,Korean
+수술했거나 치료 중인 병이 있나요?,Korean
+"밥을 많이 드시는데도 살이 자꾸 빠지더라고요.
+",Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+최근에 예방 접종은 따로 받으셨어요?,Korean
+스트레스 받으면 설사 하나요?,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+가래가 어느 정도로 심하신 거죠?,Korean
+"음식 먹다 뼈를 삼켰는데 그 뒤로 목이 불편해요.
+",Korean
+네. 상부위장관 내시경으로 출혈 여부와 정도를 확인하고 지혈을 시도할 수 있습니다.,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+심장 터질 것 같은 느낌은 얼마나 자주 있나요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+해당 부위가 얼마나 아프세요?,Korean
+과거에 했던 수술 방법에 따라 이번 수술 방법이 변경될 수도 있습니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+보통 증상은 일주일이면 낫긴 합니다 하지만 환자분이 오랫동안 걸렸었기 때문에 다른 사람들보다 증상이 오래갈 수밖에 없습니다.,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+항결핵제를 복용한 지는 얼마나 되셨어요?,Korean
+발기가 평상시에 안 되시나요?,Korean
+고혈압 관련해서 과거에 이야기 들으신 게 있나요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+네. 지금 상태로 봐서는 테라마이신 연고가 많이 필요할 거로 보입니다.,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+낮에 이비인후과 진료 본 것 말고는 없습니다.,Korean
+네 메슥거림도 약 때문에 그럴 수 있습니다.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+부모님께서 어떤 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+평소보다 현저히 음식을 섭취하는 양이 줄었나요?,Korean
+어머니가 고혈압이 있으시고 다른 가족은 잘 모르겠습니다.,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+환자 개인에 맞춰서 치료하는 방법이 다르니까요.,Korean
+알레르기 검사 받으신적 있나요?,Korean
+일상생활이 가능하려면 최소 일주일은 입원해서 회복하셔야 합니다.,Korean
+열 내리면 괜찮아지는 건가요?,Korean
+"식욕이 떨어져서 예전에 비해 많이 못 먹어요.
+",Korean
+환부를 씻어내고 소독약을 바른 후 테라마이신 바세린 거즈 등을 붙입니다.,Korean
+네 혈액형은 우측 하단에 작성하시면 돼요.,Korean
+"윗배가 변을 봐도 계속 아파요.
+",Korean
+일주일 기준 몇 번의 술을 섭취하시나요?,Korean
+다른 병원이라면 어느 과로 가면 될까요?,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+이번 연도엔 아직 예방 접종 안 했어요.,Korean
+면회 가능 시간은 정해져 있습니다.,Korean
+현재 고혈압 치료 받은 지는 얼마나 되었나요?,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+통증을 진정시키기 위해서 하는 목적이니 걱정하지 않으셔도 됩니다.,Korean
+어디가 가장 아픈 곳이에요?,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+당뇨가 살짝 높긴 해도 전반적으로 괜찮습니다.,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+걱정이 되신다면 시티 촬영해 보세요.,Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+목에 통증 있은지는 얼마나 되셨어요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+간염 검사 관련 양성인가요?,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+음주 빈도가 주 몇 회 정도예요?,Korean
+"소화가 안 돼서 목에 손을 넣어서 토를 했어요.
+",Korean
+영유아 때 잠깐 입원했었어요.,Korean
+집에 다른 암 환자는 없으시고요?,Korean
+기침이 심할 때는 언제인가요?,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+네. 다낭성 물혹이 있다고 했는데 이 년 뒤에 다시 검사했을 땐 좋아졌다고 했어요.,Korean
+멸균된 거즈와 소독 도구들이 집에 구비되어 있다면 가능하지만 그런 경우는 거의 없지요.,Korean
+숨을 헐떡일 때가 있나요?,Korean
+궁금한 것은 주치의가 환자에게 설명했으니 직접 안내받으시면 됩니다.,Korean
+"목 안이 너무 아픕니다.
+",Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+술을 언제부터 마셨는지를 알아야 음주 기간을 파악할 수 있기 때문에 중요합니다.,Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+"네. 그래서 병원도 겨우 왔어요.
+",Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+혈관이 터진 것 같아요.,Korean
+소변보는 데 불편한 점이 있나요?,Korean
+젖은 거즈는 입술을 촉촉하게 만드는 용도입니다.,Korean
+혈액 내 지방 성분이 증가했습니다.,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+대부분의 환자는 생활습관의 문제가 원인이 됩니다.,Korean
+아픈 기간은 어느 정도일까요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+"잘 때 발 다리에 쥐가 나서 잘 못 자요.
+",Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+특이한 혈액형에 대해서는 전혀 들어 보지 않았어요.,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+소화는 평소에 잘 되시나요?,Korean
+결핵 치료 이력이 있나요?,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+"소변볼 때 통증이 있던 것 빼고 다른 문제는 없습니다만.
+",Korean
+소아 당뇨로 치료받고 있습니다.,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+네 만성이라 치료가 오래 걸릴 겁니다.,Korean
+코로나바이러스 검사를 위하여 선별진료소를 다녀왔습니다.,Korean
+굳이 엑스레이를 원하시면 찍을 수 있겠으나 환자분의 경우 다시 씨티를 찍을 가능성이 높습니다.,Korean
+암을 치료하기 위해 내원하신 적 있으세요?,Korean
+"네. 부종이랄 건 없었네요.
+",Korean
+네 모든 입원 경험 알려주세요.,Korean
+병원비 청구를 위해 필요합니다.,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+검사의 목적과현재 병변으로는 대장 내시경까지 볼 필요가 없습니다.,Korean
+네 많이 아프지만 진통제가 주입되고 있어서 참을만할 겁니다.,Korean
+십 밀리씩 두 번.,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+비급여 진통제가 필요한 이유는 환자분에게 가장 잘 맞는 진통제이기 때문입니다.,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+국소마취로는 아이가 힘들 수 있습니다.,Korean
+네. 원래 심장 부근이 상당히 약했어요.,Korean
+"벌에 쏘인 뒤로 몸이 간지러워서요.
+",Korean
+흡연 기간이 얼마나 돼시죠?,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+처방받아서 꾸준히 복용하고 계신 약이 있으신가요?,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+환자분이 직접 집에 다녀오신다는 말씀이세요?,Korean
+우선 무엇 때문에 열과 오한이 있는지 알아봐야 할 것 같습니다.,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+식사량이 평소보다 많이 줄었나요?,Korean
+네. 시간이 지나면 돌아오지만 증상이 생기는 즉시 말씀 주셔야 합니다.,Korean
+피와 소변이 함께 나오나요?,Korean
+환자분은 지금 면역력이 너무 낮기 때문에 면역력을 높여 바이러스 저항력을 높여줘야 증상이 악화되지 않을 수 있어요.,Korean
+아. 담당 간호사가 따로 있는 건가요?,Korean
+고혈압을 관리하는 다른 가족분이 ���신가요?,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+통증 반응이 있는 부위가 어디에요?,Korean
+담배를 피웠던 기간이 얼마나 될까요?,Korean
+후두 암을 앓고 있어요.,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+응급실에는 어떤 증상 때문에 방문하셨나요?,Korean
+"물에 빠졌다 겨우 살아났는데 물만 보면 가슴이 심하게 뛰고 숨쉬기도 불편하네요.
+",Korean
+허리에 바로 진통제를 소량 놔드릴게요.,Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+간염약이 치료에 도움이 됐나요?,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+네 저희가 흡연력 같은 환자분의 생활 습관도 파악하고 있어야 합니다.,Korean
+"속이 좀 쓰리고 아파요.
+",Korean
+그 약만 먹으면 우울증이 오는 것 같아요.,Korean
+네. 사생활 보호를 요구하시나요? 사생활 보호를 신청하시면 입원해 계신 병실 호수가 비밀로 되고 다른 입원 정보들도 비밀로 됩니다.,Korean
+술을 먹는 빈도수가 얼마나 되나요?,Korean
+물 마실 때 목이 아픈가요?,Korean
+통증 위치를 손가락으로 짚어주세요.,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+저희 병원에서 처방받아서 드시는 약이 전부인가요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+근처 병원도 알아봐야겠네요. 감사합니다.,Korean
+변비 증상이 처음이신 건가요?,Korean
+지금 약간 숨이 막혀요.,Korean
+천자를 하는 데에는 시간이 오래 걸리지 않지만 뇌척수액을 수렴하는 데에는 시간이 걸립니다.,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+시야나 감각 이상 땀을 흘리거나 하는 다른 증상은 없나요?,Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+보통은 양성반응이 나온 항생제를 쓸 수 없어요.,Korean
+"숨도 못 쉬겠고 배가 쪼였다 풀렸다 하는 느낌이에요.
+",Korean
+발기가 안 될 때가 있나요?,Korean
+요새 피곤해서 비타민 디만 먹고 있어요.,Korean
+피부 붉어짐 가려움 붓기 등 알레르기 증상을 경험한 적도 없으세요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+언제 첫 증상이 나왔나요?,Korean
+통증 반응이 있는 부위가 어디에요?,Korean
+당뇨 가족력을 갖고 있나요?,Korean
+네. 통증이 오면 부를게요.,Korean
+네 이삼 년 사이에 대장 내시경 검사가 권고됩니다.,Korean
+갖고 계신 약 있나요?,Korean
+저번에 혈압이 안 좋다고 했던 거 같은데. 지금은요?,Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+그 외에 다른 의약외품을 드시는 게 또 있나요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+네. 덕분에 수술이 잘 되었나 봐요. 훨씬 좋아졌네요.,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+네 어느 발가락 수술하셨어요?,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+"감기 기운이 있어서 방문했습니다.
+",Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+"두 증상 전부 없었던 것 같아요.
+",Korean
+"오줌 싸는 게 어려워요. 아프고요.
+",Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+간염 약 복용 중이십니까?,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+복부가 볼록 튀어나온 정도가 심한가요?,Korean
+꾸준한 물리치료로 손목 통증을 줄일 수 있습니다.,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+더부룩한 느낌은 자주 있나요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+소변을 볼 때 통증이 있나요?,Korean
+"다리가 종종 안 움직여요.
+",Korean
+긴장되는 상황이 아닌데도 심장이 빨리 뛰나요?,Korean
+수술 후 회복 경과를 지켜보고 말씀드리겠습니다.,Korean
+항생제가 환자분 몸에 사용가능한지 보는 검사입니다.,Korean
+"당뇨병 약물치료를 몇 년째 받고 있는데 저혈당이 오면 식은땀이 날 때가 있습니다.
+",Korean
+통증이 어떤 형태로 옵니까?,Korean
+"세 시간도 못 자요. 불면증이 심해졌어요.
+",Korean
+네 모든 피부질환은 말씀해 주십시오.,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+관절운동 범위에 제한이 있나요?,Korean
+가족 중 유전성 질환을 진단받거나 치료 중인 분 있나요?,Korean
+암 수술한 적 있으세요?,Korean
+약을 먹고 구토를 한 적은 있는데 그건 약이 독한 걸 제가 빈속에 먹어서 그래서 그런 거 말곤 없었어요.,Korean
+가슴이 벌렁거리는 건 괜찮으신가요?,Korean
+작년 겨울에 스키 타다가 다쳐서 입원한 적이 있었습니다.,Korean
+어느 정도의 강도로 통증이 느껴지나요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+하루에 얼마나 담배 피우세요?,Korean
+"허리 때문에 힘든 일은 안 해요.
+",Korean
+"어깨를 돌리거나 팔을 좀 많이 쓰면 어깨가 빠지는 느낌이 듭니다.
+",Korean
+속이 메슥거릴 때가 많나요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+치료할 때 알아야 하는 내용이 있을 수도 있어서요.,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+네. 다른 병원에 가볼게요,Korean
+평소보다 현저히 음식을 섭취하는 양이 줄었나요?,Korean
+보통은 양성반응이 나온 항생제를 쓸 수 없어요.,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+어제부터 열이 나신 게 맞는가요?,Korean
+피부가 붉게 변하고 가려워요.,Korean
+한 번 주무실 때 몇 시간 주무세요?,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+사 주 이내에 진료받은 병원이 있는지 알아야 해서요.,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+외래를 통해서요 진료받은 후 입원을 하게 된 건가요?,Korean
+약이 지금 없는 건가요?,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+통증이 있는 부위가 어디죠?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+변비약 처방이 필요한 수준이라서요. 드시는 게 있는지 확인차 질문드린 겁니다.,Korean
+"보통 한 달에 네 번은 마시고 주로 와인을 많이 마셔요.
+",Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+치아를 씌운 지 오래됐군요.,Korean
+언제부터 소변을 볼 때 피가 같이 나오나요?,Korean
+최근엔 따로 약 같은 거 먹인 건 없어요.,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+오늘은 쓸개와 방광의 문제가 있는지 확인하기 위해 검사합니다.,Korean
+의료진의 지시를 따라주는 게 빠른 치료를 위한 길입니다.,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+맹장으로 입원하신 게 처음이셨나요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+피검사만으로 진단이 정확하지 않을 수 있어 씨티 검사가 필요합니다.,Korean
+모유에 비해 분유는 철분을 강화한 제품이므로 육 개월 이후 철분 결핍에 대한 우려가 적은 장점이 있습니다.,Korean
+환자분의 체질량지수가 약간 정상 범위를 벗어났네요. 조금 줄여봅시다.,Korean
+만약 입이 심하게 마르시다면 거즈에 물을 적셔서 입에 대어드리도록 하겠습니다.,Korean
+"몸이 아프고 기력이 없고 점점 쳐져서요.
+",Korean
+의사 선생님이 있다고 하셨어요.,Korean
+발기 부전 때문에 많이 스트레스이신가요?,Korean
+목 안에서 통증이 느껴지나요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+대변을 자주 보게 되는 증상도 포함됩니다. 그리고 그 외 대변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+혹시 화학 약품이나 환경에 따른 알레르기 반응은 없으세요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+없는데 먼 친척이 심장 질환 있어요.,Korean
+알고 계신 환아 몸무게 대략적으로 말씀해 주시면 됩니다.,Korean
+통증이 사라지는 데 얼마나 걸리나요?,Korean
+당신의 병력을 확인하기 위해서입니다.,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 ��습니다.,Korean
+평소에도 열이 자주 났었나요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+목이 따갑거나 하지는 않았어요?,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+음식을 보고 토한 적이 있나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+시도 때도 없이 가슴이 벌렁거리나요?,Korean
+배의 어느 부분이 아프신가요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+"귀 겉 부분 전체적으로 간지럽고요. 수포는 제가 만져봤을 땐 이 부분이었어요.
+",Korean
+통증 오는 시간이 대략 어떻게 되시나요?,Korean
+약 여분 없으면 다른 약 처방해드릴게요.,Korean
+"벌한테 쏘여서 독이 몸에 퍼지는 것 같아요.
+",Korean
+네 자가 격리 마쳤어도 알아야 합니다.,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+이전 검사에서 대장은 특이사항이 없었습니다. 원하는 병변을 관찰하기에는 직장 내시경으로도 충분할 것 같고 환자분께도 수월할 것으로 판단되어 처방하였습니다.,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+대변볼 때 피가 보이나요?,Korean
+그럼 수술이나 입원 치료 경험은 없으신 건가요?,Korean
+매일 흡연량이 어떻게 되세요?,Korean
+응급한 순서대로 진료를 보고 있으니 조금만 더 대기해 주십시오.,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+공복 상태에 따라서 피 검사 결과가 좀 달라질 수가 있어서요.,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+나가실 때 약국에서 약 받아가세요.,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+"네. 약간 변비가 있어서 보는데 힘들더라고요.
+",Korean
+가족력이 있는지는 알아봐야 할 것 같아요.,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+암 진단받아본 적 있으세요?,Korean
+"싸웠는데 얼굴이 많이 다쳤어요.
+",Korean
+네 그렇군요 우선 검사를 정확히 받아봐야 알 것 같아요.,Korean
+잘 못 주무시는 이유를 알아야 환자분께 필요한 약을 알 수 있습니다.,Korean
+어느 부위가 만지면 아프신가요?,Korean
+정확히 어떤 음식이나 약에 두드러기가 나는거죠?,Korean
+아니요 문제가 될 가능성은 낮지만 어떤 약을 드시는지 말씀해주시겠습니까?,Korean
+일주일에 대변은 몇 번 보시는 편이에요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+상처 크기와 깊이에 따라 다르므로 경과를 지켜보다 말씀드리겠습니다.,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+열상 치료는 해봤는데 수술은 아닌 거죠?,Korean
+소독하고 드레싱을 했지만 가장 좋은 것은 체위변경을 자주 해주는 것입니다.,Korean
+모든 시술에는 위험성이 동반됩니다.,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+어떤 음식을 먹고부터 복부 팽만감을 느꼈나요?,Korean
+테라마이신 연고를 두껍게 도포하면 효과가 더 좋습니다.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+"두 다리 다 저려요.
+",Korean
+최근에 체중 변화가 있었나요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+아프신 정도가 얼마나 되시나요?,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+재작년 초에 쌍둥이 출산했습니다.,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+가족 중에 고혈압 질환을 진단받으신 분이 있으세요?,Korean
+그럼 잠깐만 보여주시면 약은 오늘 안에 돌려 드릴게요.,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+무리를 하게 되면 면역력이 떨어지게 되어 질병이 발생할 확률이 높아집니다.,Korean
+잔뇨감이 느껴지면 저 병일 수도 있어요?,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+네. 위의 변성 소견은 정상 조직에 비해 위암 발생 위험성이 높을 수 있습니다.,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+토혈이 나타난 건 언제인가요?,Korean
+아니요. 코막힘 소리와는 다릅니다.,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+병원에 방문하시게 된 원인이 뭐라고 생각하시나요?,Korean
+최근에 어지럽거나 창백해��지 않았나요?,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+진통제는 약국에서 구매 가능합니다.,Korean
+그 검사는 안 했는데?,Korean
+신진대사가 증진되고 과식과 폭식할 확률이 낮아집니다.,Korean
+환자분의 현재 검사 수치를 보면 균형잡힌 식사를 하고 계시네요.,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+가래의 상태를 말해 주세요.,Korean
+한 번 시작된 통증은 언제까지 가나요?,Korean
+활동을 하지 않아도 숨차는 증상이 있나요?,Korean
+뼈 골절도 없고 무릎에만 암이 국한되어 있어서 다행입니다.,Korean
+소변볼 때 잘 안 나오나요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+네. 야간근무자들은 대부분 수면 문제를 호소하는 경우가 많습니다.,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+설사나 구토 등 위장관계 증상이 동반되지는 않았나요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+"배가 찢어질 것 같이 아파서 왔어요.
+",Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+"자궁 초음파를 했는데 자궁근종이 있다고 해서 왔어요.
+",Korean
+소변보는 데 불편한 점이 있나요?,Korean
+없는데 먼 친척이 심장 질환 있어요.,Korean
+네 일단은 비뇨기과에서 진료 볼 수 있도록 해드릴게요.,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+가족 중에 유전성 질환 치료 받으시는 분 계세요?,Korean
+통증 시작된 날짜 기억나요?,Korean
+드물게 일어날 수 있으므로 증상을 느끼는 즉시 병원에 오셔야 합니다.,Korean
+투석을 하려면 투석을 하는 혈관이 필요한데 혈관 확보가 아프실 수 있습니다.,Korean
+아이의 안색이 창백하거나 파래지거나 붉거나 노랗게 변하지는 않았나요?,Korean
+"허리가 아프니 자세가 불편해서 배변이 힘듭니다.
+",Korean
+네. 환자분의 증상을 종합해 보았을 때 바이러스성 장염이 의심됩니다.,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+먼지 알레르기가 있어서 환기를 중요시해요.,Korean
+통상 계절 독감의 백신 효과는 사십에서 육십 퍼센트 정도 됩니다.,Korean
+네. 그저께 독감 주사 맞았어요.,Korean
+그냥 이 약물이 안 맞는다 보시면 돼요.,Korean
+혈압 재겠습니다. 혈압이 언제 떨어졌나요?,Korean
+담당간호사로서 환자분의 스케쥴을 진행하기 위함입니다.,Korean
+가족 중에 암 환자분이 계세요?,Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+의사 처방 없이 임의 복용하는 건 위험합니다.,Korean
+매일 드시는 약이 있어요?,Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+전신 마취 상태로 수술받았습니다.,Korean
+설사를 하는 시기가 있나요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+수면마취는 하반신 마취를 할 때도 시행 가능합니다.,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+"탈수가 걱정돼서 자꾸 물을 먹이긴 했어요.
+",Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+어느 정도 수치가 정상 수치인 거죠?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+"관절염 때문에 걷지 못하겠어요.
+",Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+배가 무언가 꽉 찬 느낌이 있나요?,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+네 건강검진 때 질병이 있다고 나왔나요?,Korean
+손목 보호대를 착용하시는 것도 좋은 예방법이 되실 수 있습니다.,Korean
+소변이 시원하게 나오지 않나요?,Korean
+"대변 지금 보고 올 수 있나요?
+",Korean
+설사는 몇 번 하셨나요?,Korean
+가족 중 고혈압을 앓는 분이 있나요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+아뇨. 영양제 말곤 없어요.,Korean
+심한 경우 약만으로는 못 막아요.,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+아이 성장 속도에 맞춰 동일하게 해줄 겁니다.,Korean
+응급실로 입원할 때 같이 온 보호자는 없으신가요?,Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+대변볼 때 불편하지 않으세요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+통증이 자주 생기는 편인가요?,Korean
+당뇨로 어떤 약을 드시고 계세요?,Korean
+근육이 많이 놀란 상태여서 그럴 수 있습니다.,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+네. 암은 아닌 거 같네요.,Korean
+고통이 얼마나 오래 지속되나요?,Korean
+암 판정받으신 적 있나요?,Korean
+손가락 습진이 심하신가요? 처방 내리고 치료 도와드릴게요.,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+아픈 곳이 더 있나요?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+혹시 지금 체온을 측정해볼 수 있나요?,Korean
+최근에 검사를 했다면 안 하셔도 됩니다.,Korean
+네. 스테로이드요. 오기 전에 확인했어요.,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+보조용 치아가 있는지 확인하는 거예요.,Korean
+네 다른 부위는 불편하신 곳 없나요?,Korean
+만성 부비동염을 갖고 있어요.,Korean
+보통은 양성반응이 나온 항생제를 쓸 수 없어요.,Korean
+작년에 건강검진을 받았는데 위궤양 진단을 받고 한창 약도 복용했었거든요.,Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+네 생식기 치료는 산부인과에 해당합니다.,Korean
+환자분 본인은 입원이나 수술경험이 있나요?,Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+실제로 토하신 적 없으세요?,Korean
+복부가 부은 느낌이 있나요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+검사 전날 하제를 복용합니다.,Korean
+평소에 부종이 좀 있으세요?,Korean
+변을 잘 보고 계신가요?,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+네. 많이 부었네요. 오늘은 검사한 후 얼음 찜질 좀 많이 하세요.,Korean
+과거에 수술 경력 있으신가요?,Korean
+네. 수술한 적도 없네요.,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+보조용 치아가 있는지 확인하는 거예요.,Korean
+가슴 통증이 어떻게 있나요?,Korean
+알레르기 유발 물질을 정확히 알고 넘어가야 해서요.,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+아니요. 의료진이 해 드립니다.,Korean
+시월에 독감 주사 맞았었어요.,Korean
+"그렇게 물똥은 안 싸고 그냥 보통요.
+",Korean
+사십 대 들어서 진단받았습니다.,Korean
+평소 소화가 잘 안 되나요?,Korean
+가지고 오신 약 보여 주시겠어요?,Korean
+타이레놀은 가끔 드시는 거죠?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+현재도 통증이 계속 느껴지나요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+가슴이 자주 벌렁거리는 것 같나요?,Korean
+그럼 지금 진료 못 받나요?,Korean
+"소변보러 가면 거의 안 나오고 잔뇨감이 커 왔습니다.
+",Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+금식 지금부터 유지해 주세요.,Korean
+얼마나 자주 기침이 나오나요?,Korean
+우선 심전도를 측정하도록 하겠습니다. 편안하게 누우세요.,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+입원하신 경험이 있다면 알려주세요.,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+진단서 한 부 더 받으시려면 추가 비용이 발생하는데 괜찮으세요?,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+네 아토피로 먹는 약은 따로 없나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+요 근래 식욕이 비정상적으로 떨어지셨나요?,Korean
+결핵 주사를 맞으셨는지 알려 주세요.,Korean
+암 진단받은 게 언제인가요?,Korean
+테라마이신 연고를 두껍게 도포하면 효과가 더 좋습니다.,Korean
+먹은 음식물을 다 토하나요?,Korean
+"단백질로 채운 식단 부탁드려요.
+",Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+지금 처치를 잘해야 예후가 좋으니까 치료에 전념하겠습니다.,Korean
+꾸준한 물리 치료로 손목 통증을 줄일 수 있습니다.,Korean
+몇 시간에 한 번씩 통증이 오나요?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+암을 진단 받으신 적 있나요?,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+"물까진 아니고 좀 질척한 변이 나왔어요.
+",Korean
+최소 여덟 시간 이상은 금식해 주셔야 합니다.,Korean
+"저번에 꿰맨 이마 쪽이요.
+",Korean
+초음파 검사는 진료 중에 잠깐 하는 거기 때문에 미리 말씀드리지 않은 것 같네요.,Korean
+독감 주사 언제 맞으실 건가요?,Korean
+단순히 수액을 맞는다고 수면의 질이 높아지는 건 아닙니다.,Korean
+혈액검사를 통해 횡문근 융해증을 진단하고 수액 치료 기간은 금식 유지가 필요합니다.,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+어떤 무리를 말씀하시는 거죠? 부작용을 말씀하시는 건가요?,Korean
+조금이라도 어지러운 거 같으면 혼자 일어서지 마시고 콜벨 눌러주세요.,Korean
+체중 변화가 급격히 일어나면 문제가 있을 확률이 커요.,Korean
+피부가 좀 두꺼워진 것 같으세요?,Korean
+이후 식사 제한 처방이 나면 말씀 드릴게요.,Korean
+병도 없었고 꾸준히 운동하고 식이요법에도 정성을 들이는 편이라서 별문제 없었어요.,Korean
+마취제가 잘 안 듣는 몸이라고 하더라고요.,Korean
+네. 난소 나이도 알고 싶어요.,Korean
+속이 많이 안 좋으신가요?,Korean
+배뇨 곤란이 언제부터 있었는지 궁금하네요.,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+어느 부위에 통증이 있어요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+당뇨 처방 약 계속 드세요?,Korean
+아기 때 열을 심하게 앓고 청력이 손실되었어요.,Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+하루 몇 갑의 흡연을 하시나요?,Korean
+아무래도 특이 혈액형이다 보니 혈액이 부족할 수 있습니다.,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+저희병원 기록이 아니면 확인할 수 없습니다.,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+꽃가루는 약물 아니잖아요. 그럼 약물 알러지는 없어요.,Korean
+혈변 주기가 어떻게 되나요?,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+발열 증상은 언제 처음이셨죠?,Korean
+현재 목발을 다른 환자분께서 사용하고 계십니다.,Korean
+가족 중에 누가 고혈압 당뇨 질환이 있나요?,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+정확히는 알 수 없으나 육안상으로는 새로 발생한 욕창으로 보입니다.,Korean
+피부에 두드러기 올라와서 처치 받았어요.,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+배 통증 부위가 어딘가요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+"배 아픈 게 뭘 해도 안 나아서 큰 병원으로 온 거예요.
+",Korean
+네 지금은 다이어트보다 컨디션 회복이 우선이라서요.,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+가슴 두근거림이 자주 있으세요?,Korean
+네 둘 다 정상 범위네요.,Korean
+"경과를 보러 오라 하셔서 왔어요.
+",Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+네 맞아요. 흡연으로 칩니다.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+지금까지 알레르기가 나타난 적은 없어요.,Korean
+자연 분만으로 낳은 아이예요.,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+피를 토한 적이 또 있나요?,Korean
+영양제나 비타민 같은 거 제외하고 드시는 약이 있으세요?,Korean
+어머니가 고혈압이 있으시고 다른 가족은 잘 모르겠습니다.,Korean
+초기에 잘 치료하는 것이 중요하니 매일 오세요.,Korean
+간염으로 드시는 약이 있나요?,Korean
+"애가 큰 고기 뼈를 삼켜버렸어요.
+",Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+온몸에 기운이 없다고 느껴지나요?,Korean
+가족분들 중에 고혈압 진단을 받은 분이 계시나요?,Korean
+열이 나는 증상이 있나요?,Korean
+체��이 몇도 정도 인가요?,Korean
+"머리 아픈 거 외에 다른 증상은 없어요.
+",Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+네 맞습니다 오늘 오후에 수술할 예정입니다.,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+네 저희가 환자분의 치료를 위해서 생활 습관도 파악해야 합니다.,Korean
+네. 통증이 심하거나 새로운 증상 있을 시 바로 이 벨을 누르시면 됩니다.,Korean
+담배 처음 핀 게 언제예요?,Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+애완견 접종 유무 상태를 알기 위해 여쭤보는 겁니다.,Korean
+동네 약국에서 수령해도 됩니다.,Korean
+한약 외에 다른 약 드시는 건 없나요?,Korean
+알레르기 진단받은 시기가 언제예요?,Korean
+몸살 기운이 있으신 거죠?,Korean
+영 점 오 센티미터 이상이거나 통증이나 혈뇨가 반복되는 등의 증상이 있는 경우 빨리 시술 하는 것이 좋습니다.,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+"얼마 전에 건강검진 받았는데 위에 염증이 있다고 해서 검진받으려고요.
+",Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+"몇 주째 설사가 계속되고 있습니다.
+",Korean
+현재 진료 보신 분은 내과 선생님 맞습니다.,Korean
+약은 있으나 확인이 필요합니다.,Korean
+환자복 갈아입으시면 바로 진행하도록 하겠습니다.,Korean
+음식이나 약물 말고 다른 알레르기 반응 있는 거 있어요?,Korean
+"수면 중에는 통증에서 벗어나게 되네요. 그래서 평소보다 수면 시간이 길어진 것 같아요.
+",Korean
+그 증상은 정밀하게 진단을 해보고 결정할게요.,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+결핵약은 어떤 거 드세요?,Korean
+처음 입원 시 환자분의 전체적 신체상태를 확인하기 위한 항목 중 하나 입니다.,Korean
+제 판단으로는 삼 개월 때 수술하는 것이 시기상 가장 적절합니다.,Korean
+현재 응급실에 환자가 많아서 한 시간 이상 대기하셔야 합니다.,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+암이 있다는 것을 언제 알게 되었나요?,Korean
+"장이 예민한 편이라 늦게 먹으면 담날 고생해서 안 먹어요.
+",Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+입원해서 치료받은 적 있어요?,Korean
+원하시면 독감 주사 예방 접종 가능한 병원에서도 할 수 있습니다.,Korean
+소변을 보고 닦을 때 피가 묻어 나오나요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+지금 혹시 오한이 있나요?,Korean
+"갑자기는 아닌데 꾸준히 살이 찌고 있어요.
+",Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+진통제 부작용일 수 있어요.,Korean
+목이 많이 부은 것 같은데요?,Korean
+일단 드레싱을 하면 끝이긴 한데 주기적으로 와서 치료를 받아야 해요.,Korean
+검사결과가 나와봐야지 알 수 있겠네요.,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+몇 가지의 알레르기가 있나요?,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+암 환자가 가족 중에 있을까요?,Korean
+"손가락이랑 이어지는 팔 근육도 같이 저려요.
+",Korean
+소변이 많아지는 질환인 당뇨병 요붕증 또는 과도한 수분이나 카페인 섭취 등이 빈뇨를 유발할 수 있습니다.,Korean
+약에 따라 같이 먹으면 안 되는 약이 있어서요.,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+감염이 있는 경우 열과 오한 복통이 동반될 수 있습니다.,Korean
+진통제 알약 형태로 먹는 건가요?,Korean
+알레르기 반응 검사엔 아무것도 없었어요.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+꼭 일일구를 불러 응급실로 내원할 필요는 없는 거죠?,Korean
+네. 만성적으로 무릎이 좀 안 좋아서 심할 땐 입원 치료를 받습니다.,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+열이 나거나 구역질이 나는 등 이상 증상이요.,Korean
+아랫배 통증을 호소하시는 분들은 종종 있습니다.,Korean
+"막상 용변 볼 땐 괜찮은데 변의 상태는 이상한 것 같아요.
+",Korean
+당뇨 약 복용하고 계신가요?,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+아프다 안 아프다 하나요?,Korean
+알레���기 검사를 해보신 적은 없나요?,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+언제 암 발병했는지 기억하세요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+많이 아프세요? 진통제 필요하시면 드릴게요.,Korean
+토할 거 같은 증상이 있으세요?,Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+하루에 음주량이 얼마나 되세요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+"차에 부딪히면서 넘어졌는데 머리에서 자꾸 피가 나요.
+",Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+등산하다가 발목을 삐끗한 적이 있네요.,Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+구토를 언제 한 적 있나요?,Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+"폭행을 당해 여기저기 많이 아프네요.
+",Korean
+어디가 부은 느낌 있나요?,Korean
+두통이 언제 또 느껴진 적 있었나요?,Korean
+지방이나 탄수화물 섭취가 많은 경우 높게 나올 수 있습니다.,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+"심장이 좋지 않다는 건 알고 있어요.
+",Korean
+식사량이 평소보다 많이 줄었나요?,Korean
+경정맥신우조영술은 조영제가 신장을 통해 배설되는 것을 촬영하여 신장기능을 확인하는 검사입니다.,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+검사 결과가 나와야 알 수 있을 것 같네요.,Korean
+"네. 다름이 아니고 손끝에 약간 불편한 감각이 가시질 않아서요.
+",Korean
+위 내용물이 구강 내로 역류할 수 있고 이로 인해 위 내용물이 기도를 폐쇄하여 질식을 초래할 수 있기 때문이에요.,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+체중 증가가 언제부터 있었나요?,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+네. 문진표 이외에 입원생활에 필요한 정보를 수집하기 위한 절차입니다.,Korean
+아이가 태어나고 난 뒤 탯줄에서 채취하기 때문에 아이에게 영향은 없습니다.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+"담배 안 피운 지 까마득하네요.
+",Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+"평소에 소변을 많이 보는 편이라 비슷해요.
+",Korean
+일부 환자는 유전적 이상으로 발생하며 당뇨병 갑상선기능저하증 간질환 신장질환 비만 등이 있는 경우 고지혈증이 발생하기 쉽습니다.,Korean
+언제부터 손이 저림증상이 있었나요?,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+기분이 너무 우울해지는 느낌이 들어요.,Korean
+친척 고모님이 가슴에 양성종양이 있어요.,Korean
+맥박 결과는 어떻게 나와야 좋은 건가요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+그냥 진통제 먹고 쉬었어요.,Korean
+통증이 오는 곳이 있나요?,Korean
+신경치료한 치아에 레진 치료를 하는 경우만 말씀해 주세요.,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+처음 통증 있었던 게 언제죠?,Korean
+단순한 물리치료로 좋아지는지 확인이 필요합니다.,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+주위가 갑자기 빙빙 돈다고 생각한 적 있으세요?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+어떤 약을 드시고 계신지 말씀해 주실 수 있으세요?,Korean
+아니요 환자분은 동물 키우는 것과는 증상이 관련 없습니다.,Korean
+해산물 드시고 증상이 나타나신 거예요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+"술은 줄이고 있고 담배는 피웁니다.
+",Korean
+단순 음낭수종으로 인하여 감염 가능성은 거의 없습니다.,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+재활 기간은 사람마다 매우 다릅니다.,Korean
+정신과 약 먹고 있어요.,Korean
+맹장으로 입원하신 게 처음이셨나요?,Korean
+피가 섞인 변을 보셨나요?,Korean
+얼굴의 모양을 바로잡는 수술이에요.,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+아까 열 체크 했어요. 또 체크 하나요?,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+목 아픈 건 나으셨어요?,Korean
+"실제로 여섯 시간은 자는데 자꾸 잠에서 깨요.
+",Korean
+당뇨 증세가 시작된 건 언제부터인가요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+진료 중간마다 대기시간은 조금씩 생길 수 있습니다.,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+지금 복용 중인 항결핵제가 있나요?,Korean
+그렇죠 입원하면 집에 있는 거랑은 다르죠.,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+선천성 기형이나 후천성 기형이나 상관없이 그냥 기형이라면 무조건 말씀해 주세요.,Korean
+결핵 치료로 처방받은 약이 이게 맞나요?,Korean
+최근에 체중에 변화가 있었나요?,Korean
+치료제가 환자분 몸에 문제를 일으키지는 않는지 확인 하는 검사입니다.,Korean
+밤에 잠이 잘 안 오세요?,Korean
+들이 마시고 내쉬는 심호흡을 해주셔야 합니다.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+재수술을 해야 하는데 거기까지 가면 안 되겠죠.,Korean
+팔부분이 어떻게 불편하신지 정확히 표현해보시겠어요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+네 수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+당뇨로 인한 합병증이 나타난 게 있나요?,Korean
+항문 주위가 헐거나 물집이 생기셨나요?,Korean
+당뇨약 드시는 거 있으면 말해주세요.,Korean
+"무릎에서 소리가 나고 걸음이 불편해져서 왔습니다.
+",Korean
+식후 소화가 잘 안 되나요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+덴탈 마스크보다는 케이에프 마스크를 권장합니다.,Korean
+가렵지 않더라도 완전히 나으려면 아직 더 치료를 받아야 합니다.,Korean
+"지쳐서 기절하듯이 잠들기도 하는데 정말 통증 때문에 잠을 못 자요.
+",Korean
+소변을 봐도 개운하지가 않으신가요?,Korean
+혹시 많이 속이 안 좋은가요?,Korean
+경구 당 부하 검사에서 두 시간 후 측정한 혈당 수치가 이백 밀리그램 퍼 데시리터 미만인 경우입니다.,Korean
+제왕절개 포함해서 말씀해 주시면 됩니다.,Korean
+아픈 신체 부위 말씀해주세요.,Korean
+어떨 때 설사를 하나요?,Korean
+어머님이 암 진단을 받으셨었나요?,Korean
+부정맥 쪽으로는 아무 문제 없어요.,Korean
+평소 생활습관 관리를 해야 하며 지속적인 진료가 필요하다는 점에서 유사합니다.,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+"식은땀이 나고 숨쉬기 어려울 정도로 가슴이 아파요.
+",Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+당뇨 조절이 잘 되는지 다시 검사해보겠습니다.,Korean
+"뜨거운 그릇을 손으로 잡는 바람에 물집이 심하게 졌어요.
+",Korean
+"소리가 잘 안 들려서 몇 번을 되물어야 해요.
+",Korean
+검사의 목적에는 검사로 인한 합병증 등의 내용이 포함됩니다.,Korean
+환자분마다 회복속도가 다르므로 정확히 얼마 만이라고 말씀드리기는 어렵습니다.,Korean
+복부에 가스 찬 느낌이 있진 않나요?,Korean
+무력증을 느낀 적이 있나요?,Korean
+하루에 몇번 정도 토하시나요?,Korean
+결핵 질환과 관련된 처방받은 약이 따로 있나요?,Korean
+통증이 너무 심하니까 잘 못 먹어서 약도 걸렀어요.,Korean
+어느 부위에 통증이 있어요?,Korean
+요새 독감이 유행하던데 저는 안 맞았어요.,Korean
+통증이 있는지 알고 싶어요.,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+네 저희가 수면 다원 검사 외 필요시 추가 검사를 진행 하겠습니다.,Korean
+이차 치료는 복용하는 약의 종류와 횟수가 일차 치료 보다 많아 힘들 수 있습니다.,Korean
+세 번째 순서여서 오전 중으로 예상하지만 앞에 분들 다 끝나면 수술방에서 부를 거라 정확한 시간은 알 수 없어요.,Korean
+네. 중요한 검사이니 꼭 찍어야 합니다.,Korean
+저는 진통도 얼마 없었고 애도 자연 분만으로 그냥 쑥 낳았어요.,Korean
+체중이 한 달에 몇 킬로 쪘나요?,Korean
+"소변 색이 검붉은 게 혈뇨인가요?
+",Korean
+먼지 등 알레르기 요인이 있나요?,Korean
+수혈을 받았냐 물어보시는 거죠?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+요즘 혹시 두통이 있나요?,Korean
+그럼 전에 검사하셨을 때 문제없으셨던 건가요?,Korean
+한달에 한번씩 이렇게 통증이 있으신가요?,Korean
+"볼이 엄청 부었는데 왜 그런지 궁금해요.
+",Korean
+아직 수술이나 입원해 본 적은 없습니다.,Korean
+복부 팽만감이 있지는 않나요?,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+잘 못 주무시는 이유를 알아야 환자분께 필요한 약을 알 수 있습니다.,Korean
+광견병 예방 주사 외에도 사람처럼 여러 가지 예방 접종이 있습니다.,Korean
+평소에도 계속 거칠게 숨을 쉬나요?,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+물집 생긴 곳이 냄비 만진 부위 말고 다른 곳에 또 있나요?,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+당뇨약 먹고도 효과가 없거나 하지는 않나요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+허리에 핀을 박아야 해서 수술했어요.,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+어떤 약제 사용이 바람직할지 증상을 확인해보겠습니다.,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+영양제 섭취로도 가능 하지만 음식 섭취만큼은 아니에요.,Korean
+피부 연고는 피부과 진료받으시고 처방받으실 수 있어요.,Korean
+가래에 피가 섞여 있나요?,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+저희 집이 광주 근처라 그쪽에 병원 있을까요?,Korean
+조직 검사가 필요해 보이네요.,Korean
+항생제가 자기 몸에 맞는지를 알 수 있는 검사입니다.,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+환자분 본인은 입원이나 수술경험이 있나요?,Korean
+눈이 바람만 불어도 아파서 안구 건조증을 치료하려고 동네에 있는 안과에 방문했었어요.,Korean
+피부 건조는 자주 오는 증상 중에 하나입니다.,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+어떠한 이유로 입원을 하셨나요?,Korean
+"저 불면증 증상이 좀 있어서 카페인이 들어 있는 음식은 피하는 편이에요.
+",Korean
+바이러스가 활동하며 신체 증상이 나타나는 시기를 말합니다.,Korean
+두통약이 문제가 될 수도 있어요.,Korean
+아직 검사도 남았고 입원 가능성도 있어서요.,Korean
+네 이 주사 부위가 좀 아파요 살살 놔 드릴게요.,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+우리 몸을 보호해주는 피부에 상처가 난 것이기 때문에 상처로 외부의 균들이 침입하게 되면 감염될 수 있으니 주의해주세요.,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+체하실 때마다 드시는 약이신가요?,Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+약도 잘 먹고 잘 관리하고 있습니다.,Korean
+"기침할 때 쇳소리가 심하게 나요.
+",Korean
+증상이 없을 경우 약은 필요하지 않습니다.,Korean
+"얼굴에 황달기가 좀 있고 얼굴도 누렇게 떠요.
+",Korean
+집 근처 병원에서 소독하시는 게 편하실 거예요.,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+피부반응으로 대체하면 시간도 오래 걸리고 정확한 원인을 찾기 위해 반복해서 검사해야 합니다.,Korean
+주에 몇 번 아픈가요?,Korean
+"알코올 쇼크 때문에 왔습니다.
+",Korean
+"뭘 잘못 먹은 건지 배를 붙잡고 계속 아파하길래 왔어요.
+",Korean
+"손가락이랑 이어지는 팔 근육도 같이 저려요.
+",Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+"요실금 증상을 겪은 적은 없네요.
+",Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+간호사실은 병원 지도를 참고하세요.,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+아 천식은 불치병 아닌가요?,Korean
+예전에는 어떤 병을 앓으셨어요?,Korean
+담배 언제 처음 피웠어요?,Korean
+"며칠 전 교통사고가 있었는데 그 이후부터 몸이 아주 아팠어요.
+",Korean
+성형수술은 받은 적 있는데 이것도 포함돼요?,Korean
+고혈압약 약명이 어떻게 되나요?,Korean
+보통 십 회 정도 치료합니다.,Korean
+병동으로 올라오실 때 걸어오셨나요 혹은 휠체어나 다른 수단을 이용하셨나요?,Korean
+잠이 자꾸 깨서 힘드시나요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으��가요?,Korean
+그 증상 말곤 없나요?,Korean
+화상 치료 초기에는 입원을 권장하고 있습니다.,Korean
+증세가 악화된 때가 언제인가요?,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+음주나 비만이 가장 흔한 원인입니다.,Korean
+"기름진 음식은 피하고 있어요.
+",Korean
+한 달 동안 체중이 얼마나 변했나요?,Korean
+전자 담배와 연초 담배 구분 없이 동일하게 생각해서 말씀해 주세요.,Korean
+"위가 허한 느낌이 자주 들었어요.
+",Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+담배를 피우기 시작한 게 언제예요?,Korean
+하루에 몇 개비 정도 태우세요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+열 때문에 몸이 달아오르나요?,Korean
+하루 동안 몇 개비의 담배를 피우시나요?,Korean
+네. 그럼 입원 치료는 어떠실까요?,Korean
+통증 지속시간이 길면 어느정도 였나요?,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+환자분이 무슨 약을 드시고 계시는지 알아야 치료에 도움이 됩니다.,Korean
+갑자기 주위가 빙빙 도는 증상도 있으신가요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+치료 경과를 봐야 될 것 같습니다.,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+"네. 골목에서 사람하고 부딪히는 바람에 왼쪽으로 넘어지면서 왼쪽 손목을 접질렸어요.
+",Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+흡연을 시작하게 된 게 언제부터일까요?,Korean
+여러 검사를 통해 원인을 찾아봐야 할 것 같습니다.,Korean
+"차 타고 가고 있었는데 앞에 새 때문에 급정거했는데 허리가 너무 아프네요.
+",Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+가족력이 있다곤 못 들었는데요.,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+환자분은 급성 맹장염으로 진단되어 응급수술 예정이십니다.,Korean
+현재 치료하려는 병과 깊은 관련이 있습니다.,Korean
+"손발이 요즘 너무 차고 가슴 통증이 있어서요.
+",Korean
+"아이가 너무 간지럽다고 자꾸 우네요.
+",Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+도대체 어디가 아픈 거예요?,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+네. 비형 간염 맞으셔야 합니다.,Korean
+물에 많이 닿았다면 드레싱 다시 해야 합니다.,Korean
+용종이 좀 많아서 떼어내고 나서 입원했었어요.,Korean
+사람의 독감이 강아지에게 옮기기도 합니다.,Korean
+흉부에서 통증이 크게 느껴지나요?,Korean
+병동 문이 요즘은 다 이렇게 되어 있군요.,Korean
+"왼손 두 번째랑 세 번째 손가락이오.
+",Korean
+당뇨병 앓고 있는 거 언제부터 알았어요?,Korean
+가족 중 고혈압을 앓는 분이 있나요?,Korean
+"쏘인 곳은 왼쪽 팔이에요.
+",Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+근육을 풀어주려면 찜질도 자주 해주세요.,Korean
+약은 최근 삼 개월 이내에 드신 것을 말씀해 주세요.,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+환자분의 치료 스케쥴에 매우 중요한 사항입니다.,Korean
+질병 진행 정도와 보존적 치료에 대한 반응에 따라 다릅니다.,Korean
+"지난번 수술한 후에 경과 보러 왔습니다.
+",Korean
+증상이 심할 경우 연고보다는 약을 복용해야 할 수도 있습니다.,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+몸에 계속 열이 나나요?,Korean
+감염력 때문에 반드시 알아야 하는 자료입니다.,Korean
+혈압 수치 알고 계세요?,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+기침에 피는 안 나왔어요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+그럼 건강 검진 예약해 드릴게요.,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+환자분의 수술을 준비하기 위해서 걸리는 시간입니다.,Korean
+토를 심하게 한 적이 있나요?,Korean
+복용하는 약들에 의한 부작용이 있을 수 있습니다. 치료 실패도 부작용이라고 할 수 있습니다.,Korean
+처방받은 간염약 어떤 건지 아시나요?,Korean
+의사 선생님께 증상을 말씀드리고 진료를 받아 보세요.,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+"열은 삼십칠 도 정도였어요.
+",Korean
+두통약 잘 먹고 있어요?,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+아니요 성형 수술도 얘기해 주세요.,Korean
+통원치료 하신건가요? 어떤 치료 받으셨나요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+약은 곧 처방전이 나올 겁니다.,Korean
+아까보다는 아픈 게 덜하시다는 말씀인가요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+헌혈 말고 수혈받아보신 적 있나요?,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+당뇨 치료 이력은 아직 없으신 건가요?,Korean
+니트로글리세린이 혈관을 확장시켜서 조금 어지러울 수도 있어요.,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+유전 질환 가진 식구는 없습니다.,Korean
+어릴 때 귀 성형수술받고 나서는 없었어요.,Korean
+혹시 가래를 자주 뱉으시나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+네 며칠 동안은 심호흡을 열심히 하셔야 됩니다.,Korean
+"아이 열이 떨어질 생각을 안 하네요.
+",Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+"매일 아침 규칙적으로 변 보는 것 같네요.
+",Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+네 좀 뻐근해요 많이 아프셨지요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+오심 구토 속 쓰림 설사 등의 소화기 증상이 있을 수 있습니다. 두통 및 위통증도 있을 수 있습니다.,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+과거에 장기간 입원한 적이 있나요?,Korean
+가슴 통증의 원인으로는 심혈관 호흡기 소화기 근골격 심인성 등의 다양한 원인이 있을 수 있습니다.,Korean
+도대체 어디가 아픈 거예요?,Korean
+"심장에 이상이 있다고 알고 있습니다.
+",Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+피부를 자세히 볼 수 있게 제 쪽으로 좀 더 가까이 와주세요.,Korean
+"역기 운동하면 어깨가 넓어진다고 해서요.
+",Korean
+"엘리베이터 안에서 호흡이 어려워져요.
+",Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+"네. 잠을 쉽게 들지 못하는 어려움이 있어요.
+",Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+네. 아프면 바로 병원에 가는 편이라서요.,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+네 소변줄을 보시면 노란 소변이 지나가는 것이 보일 겁니다.,Korean
+삼 밀리 먹기는 했는데 다 토했어요.,Korean
+기침할 때 목이 많이 아픈가요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+혹시 제가 말씀드린 증상 외 다른 증상은 없으셨나요?,Korean
+어느 부위에 통증이 있으신가요?,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+콜라겐 말고 다른 약 드시는 건 없으신가요?,Korean
+병상 부족으로 가까운 다른 병원에 입원해야 할 수도 있습니다. 불편 끼쳐드려 죄송합니다.,Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+그럼요 애완견 예방접종 유무를 알아야 하니까요.,Korean
+내과에 저번 주에 아파서 갔었어요.,Korean
+최근 두 달 안에 급격한 체중 변화가 있었나요?,Korean
+마취제 용량 선택 시 참고하도록 하겠습니다.,Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+통증을 점수로 표현해 보실래요?,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+성형외과 외에는 다른 병원은 안 갔나요?,Korean
+목이 많이 부은 것 같은데요?,Korean
+나중이면 모를까 초반에는 무조건 병원에 내원하세요.,Korean
+담배를 피운 기간을 알려주세요.,Korean
+네 병원은 전체 금연지역입니다.,Korean
+네 음주는 건강에 영향을 미치는 주요 요소입니다.,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+그 검사를 받거나 진단받은 적 없어요.,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+입원하신 날짜가 어떻게 되시나요?,Korean
+코로나 유행 지역은 근처에도 안 가요.,Korean
+"치킨 뼈가 있는 줄 모르고 먹다가 목에 걸렸어요.
+",Korean
+"전자 담배로 갈아탄 기간 포함인가요?
+",Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+"몸이 이상해서 혈당을 ��는데 높게 나왔어요.
+",Korean
+이십 년 전 철분 결핍성 빈혈을 진단받고 꾸준히 철분제를 복용하고 있습니다.,Korean
+심장이 빨리 뛰어서 아프신가요?,Korean
+한달에 술을 얼마나 드시나요?,Korean
+어느 손가락이 어떻게 불편하신지 표현해 보실 수 있나요?,Korean
+환자분이 복용하고 계시는 약에 대한 정보가 필요합니다.,Korean
+꾸준한 물리 치료로 손목 통증을 줄일 수 있습니다.,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+몸무게의 변화가 의심될 때만 시간대별로 체크합니다.,Korean
+가렵지 않더라도 완전히 나으려면 아직 더 치료를 받아야 합니다.,Korean
+엑스레이 찍는 게 좋죠.,Korean
+결핵 증상이 있었던 게 언제부터죠?,Korean
+내원하셔서 담당 선생님께 정확한 진료를 받으셔야 합니다.,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+물 마실 때 목이 아픈가요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+증상이 나타난 건 오래됐나요?,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+특이 혈액형인지 확인해본 적 없어요.,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+통증이 있는 이유에 대해서 신체검사와 몇 가지 검사를 해 보겠습니다.,Korean
+약이 겹치게 되면 하루 복용량을 넘어서기 때문에 그런 거예요.,Korean
+담배는 몇 살부터 하셨나요?,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+처방할 때 관련된 문제를 피할 수 있거든요.,Korean
+음주나 비만이 가장 흔한 원인입니다.,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+네. 레이저 치료랑 약을 같이 먹었어요.,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+아니요 국소 마취만 해도 됩니다.,Korean
+약간 예민한 상태라 지금 아프다 보니.,Korean
+소변을 잘 못 보시나요?,Korean
+어느 부위가 제일 아프세요?,Korean
+사람마다 폐경시기는 다르기 때문에 언제라고 말씀드리기는 어려우나 일반적으로 한국 여성은 사십구 세 정도 됩니다.,Korean
+소화 기능이 안 좋으세요?,Korean
+네. 부종이 원인일 수도 있으나 혈관 문제나 허리 디스크 등 여러 가지 문제가 있을 수 있습니다.,Korean
+내시경 검사를 통해 위장관 내부를 더 잘 관찰하기 위해서 금식을 시행합니다. 뭔가 드셨다면 정확한 검사 결과를 얻기 어렵습니다.,Korean
+집안에 암 환자분이 계세요?,Korean
+평소에 손목 운동하는 게 도움이 될 것 같네요.,Korean
+다른 치료와 비교하여 크게 비싸지 않습니다.,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+감염성 질환이란 다른 환자로부터 옮을 수 있는 질환입니다.,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+"변에 하얀 게 군데군데 포함되었던 것 같아요.
+",Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+수술을 무조건 해야 하는 것은 아닙니다 주사와 약물만으로 증상이 개선된다면 충분히 치료가 가능합니다.,Korean
+한번 더 진단을 받으셔야 할 거 같아요.,Korean
+"볼이 부어서 아픈 데 검사받고 싶어요.
+",Korean
+지금 드시고 있는 약은 무슨 약입니까?,Korean
+목으로 피가 조금 올라오나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+식후 계속 속이 불편하신가요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+통증을 참을 수 있나요?,Korean
+독감 주사 언제 맞았어요?,Korean
+수술 부위 흉터 이외에 다른 흉터는 있으실까요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+평소에 혈압이 높다는 이야기를 들으신 적이 있나요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+환자분 상태에 따라 입원 가능 여부가 달라집니다.,Korean
+복부가 가득 찬 느낌이신가요?,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+과거에 크게 다친 곳이 있나요?,Korean
+그 외에 따로 먹거나 투약한 것은 없나요?,Korean
+현재까지 복용 중인 약이 있나요?,Korean
+손목터널을 덮고 있는 인대를 잘라주어 신경이 지나가는 공간을 넓혀주는 수술입니다.,Korean
+몸이 약해서 어렸을 때부터 자주 쓰러졌어요.,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+소변보는 데 문제 있으세요?,Korean
+맥박 측정 후엔 뭐해요?,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+부분마취인 경우 마취가 잘 풀리는 경우도 있습니다. 상황에 따라 마취방법이 변경될 수 있습니다.,Korean
+"벌에 쏘였는데 온몸이 빨개지고 아파서요.
+",Korean
+통증 정도를 얘기하기 힘드시면 어떻게 아픈지 설명해 주실 수는 있으시겠어요?,Korean
+정확한 원인을 찾기 위해 다른 검사를 진행할게요.,Korean
+의료보험 적용 안 돼서 보호자에게 안내가 필요합니다.,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+오전 아홉 시 시작이니 여덟 시 사십 분까지 병원으로 오시면 됩니다.,Korean
+"목에 걸린 치킨 뼈 때문에 왔어요.
+",Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+흉터가 남지 않으리라는 보장은 할 수 없습니다.,Korean
+거대결장은 장의 운동을 담당하는 신경세포의 문제로 발생하는 질환입니다.,Korean
+부딪히시거나 외상 당한 적 없어요.,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+고혈압 치료하려고 약 드시나요?,Korean
+근육통처럼 결리는 증상으로 나타나기도 합니다.,Korean
+병실료와 식비는 하루에 오만 원입니다.,Korean
+전문 의료원이 아닌 곳에서 치료받으신 경우 말씀해 주시면 됩니다.,Korean
+"가고 싶은데 거동이 불편해서요.
+",Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+일 때문에 규칙적으로 드시기 힘드시겠어요 아무래도 제때 식사를 하지 않으면 과식이나 폭식할 가능성이 있고 비만. 고혈압 등의 문제가 발생합니다.,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+네. 다른 알레르기나 약물반응이 있었던 적은 없어요.,Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+비타민제에 과일에 들어가는 비타민 이상을 담을 수는 있지만 체내 흡수율에서 차이가 납니다.,Korean
+수술하는 질병이 예방접종과 관련 있을 수도 있습니다.,Korean
+간에 있는 염증이 딱딱해져서 간 경화까지 진행될 수 있습니다.,Korean
+입원 날짜 확인해서 말씀해 주세요.,Korean
+네 통증이 심했다거나 이상하게 요즘 들어 불편했던 곳이 있었는지 여쭤보는 거예요.,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+결핵 때문에 내원하신 적이 있나요?,Korean
+"비데에 앉아 있다가 감전 되었어요.
+",Korean
+잠깐 쉬었다가 해도 될까요? 숨을 못 쉬겠어요.,Korean
+"몇 주 전부터 자꾸 검은색 변을 보고요. 어떨 때는 혈변도 나오고 그래서요.
+",Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+독감 주사는 언제 맞았나요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+"와이프가 약을 많이 먹었어요.
+",Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 위암 발생 혹은 추가적인 변성 소견 확인을 위해 매년 정기적인 위 내시경 검사가 필요합니다.,Korean
+채식주의자이신가요? 극단적인 채식주의도 주의를 해야 하는 부분이긴 합니다.,Korean
+의사 선생님과 직접 대화를 나눠보셔야 할 것 같습니다.,Korean
+몸에 열이 나거나 뜨겁지 않나요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+통증이 오는 곳이 있나요?,Korean
+"소변이 나올 때 찔끔찔끔 나와서요.
+",Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+암 치료받으신 기간 알려주세요.,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+상처 난 부분을 씻어낼 수 있는 식염수입니다.,Korean
+처음에 일일구 불러서 응급실로 왔다가 침대로 이동했어요.,Korean
+심장 박동이 빠르고 두근거리나요?,Korean
+이 약은 식전에 드셔야 합니다.,Korean
+독감 주사 언제 맞았어요?,Korean
+"급 혈압이 높아져서 왔어요.
+",Korean
+"""어느 순간 눈에 뭐 눈곱 낀 거처럼 잘 안 보이더라고 몇 번 비비면 또 괜찮아져서 내버려 뒀더니만, 요즘 들어 이게 심하고, 시야가 좁아진 거 같은 느낌이 들어. 입원할 수밖에 없었지.""
+",Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+어디가 부은 느낌 있나요?,Korean
+비가 오면 유독 허리 통증이 더 심해요.,Korean
+타이레놀 때문에 증상이 생긴 걸 수도 있습니다.,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+진통제는 정말 견디기 힘들 때 처방해 드리겠습니다.,Korean
+숨을 쉴 때 기도가 따가워요.,Korean
+다른 약물을 함께 복용하는 경우에는 혈당 조절이 안 될 수 있습니다.,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+흉통 유무를 말씀해 주세요.,Korean
+팔다리 힘이 빠지시지는 않나요?,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+한 번이라도 흡연을 하신 적이 있나요?,Korean
+발기부전약 드신 적은 있나요?,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+"눈에 핏줄이 터져서 눈이 온통 빨개서 왔어요.
+",Korean
+절대 누우면 안 됩니다.,Korean
+잠을 푹 자도 피곤한가요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+통원치료도 가능하지만 계속 소독과 환부 확인이 필요해서 입원하시는 게 좋습니다.,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+혹시 다른 병원에서 씨티 찍고 오셨나요?,Korean
+부부관계를 하실 때만 발기 부전이 나타나나요?,Korean
+담배 피운 기간이 오래됐나요?,Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+감염병에 걸린 적 없습니다.,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+네 부작용이 심하면 측정이 불가할 수 있습니다.,Korean
+"아니요. 일단 우유 알러지가 있어요.
+",Korean
+지금도 통증이 계속 있나요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+장에 신경이 제대로 분포하지 않아 생기는 질환입니다.,Korean
+네 다른 부위에도 아토피가 있나요?,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+네 어떤 증상으로 약을 드셨나요?,Korean
+화장실에 오래 있어야만 소변을 보시나요?,Korean
+어떤 약제로 만든 보약인지 알고 계십니까?,Korean
+통증 주기가 몇 주인가요?,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안 됩니다.,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+원인을 찾기 위해 산부인과 협진 진행 예정입니다.,Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+소변을 보고 바로 다시 소변이 보고 싶나요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+"치아가 많이 썩은 것 같아서요.
+",Korean
+천식? 뭐 어떻게 해야 돼요?,Korean
+"대변을 못 눠서 칭얼거려요.
+",Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+매일매일 와서 상처 확인하시면 됩니다.,Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+응급조치부터 하고 확인해 드릴 게요.,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+목에 인후통 증상이 있나요?,Korean
+당뇨에 가족력 없다고 말씀하셨죠?,Korean
+평소 생활습관이 건강에 큰 영향을 미치거든요.,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+통증은 움직일 때마다 오나요?,Korean
+그 전에 열에 대한 검사를 먼저 진행하겠습니다.,Korean
+습진인 것 같긴 한데 될 수 있으면 물에 안 닿게 하는 게 좋을 듯싶어요.,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+아니요 하지만 무릎 부종이 맞을 수도 있어서 한번 검사해 보는걸 추천해 드립니다.,Korean
+병원에 오신 이유가 뭐예요?,Korean
+네. 약 효과를 떨어뜨릴 수 있어서 안 드시는 게 나을 것 같아요.,Korean
+임플란트가 흔들리는 느낌이 있나요?,Korean
+언제부터 결핵인 거 알았어요?,Korean
+사람 간 간격을 넓게 하고 방역도 잘하고 있기 때문에 그러지 않을 것입니다.,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+"신장 기능이 안 좋아졌다고 얘기 들었어요.
+",Korean
+결핵약은 주기적으로 복용 중이신가요?,Korean
+그러면 이쪽에서 처방전 받아 가시고 결제하시면 되세요.,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+피로한 게 안 풀리시나요?,Korean
+식사 후에 소화는 잘되시나요?,Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+몸무게 감소량이 어느 정도 되나요?,Korean
+하반신 마취 후에 수면 마취를 해드릴 예정입니다.,Korean
+저위험 유형은 생식기 사마귀를 유발할 수 있습니다.,Korean
+빈속에도 구토 증상이 있나요?,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+"아침부터 배를 잡고 엉엉 우는 거로 봐서 배가 아픈가 봐요.
+",Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+그러면 이쪽에서 처방전 받아가시고 결제하시면 되세요.,Korean
+혈압이 평소에 많이 높은가요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+전반적인 환자분의 상태를 확인 하고 곧 빼 드리도록 하겠습니다.,Korean
+"밥 먹으면 갑자기 토한 지가 한 삼사일 정도 되었어요.
+",Korean
+복부 쪽으로 팽만이 있나요?,Korean
+아니요. 질병 때문에 드시고 계시는 약이 있나요?,Korean
+간염으로 먹는 약이 있습니까?,Korean
+그거 포함해서 먹고 있는 약이나 꾸준히 맞는 주사 같은 거 있나요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+종양이 발견된 지 오래됐어요?,Korean
+"미끄럼틀에 부딪혀서 이가 부러졌어요.
+",Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+종교적인 이유로 수혈을 거부하시는 분들도 계십니다.,Korean
+우리 집 옆에 있는 이대목동병원에 갔었어요.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+"자꾸 물같이 싸서요. 먹은 건 없는데 자꾸 가게 되네요.
+",Korean
+"둘 다 저려요. 양쪽이요.
+",Korean
+구강 엑스레이를 찍어보면 정확히 알 수 있어요.,Korean
+호흡측정 방법은 제가 기계를 드릴 텐데 계속 불어달라고 하면 숨을 다 내쉴 때까지 힘껏 불어주시면 됩니다.,Korean
+현재 담배를 피우고 계신건가요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+전신 마취 경험은 없으신가 해서요.,Korean
+정말 조금 부어올랐네요 통증이 있으신가요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+통증이 나타난 게 언제인가요?,Korean
+평소에 복용하는 약이 있나요?,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+흡연을 시작하게 된 게 언제부터일까요?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+약물은 없는 것 같은데 견과류 알레르기가 있어서요.,Korean
+기침을 얼마나 자주 하나요?,Korean
+네. 세균성보다는 바이러스성 장염이 의심됩니다.,Korean
+암인지는 검사 후에 결과가 나오기까지 시간이 좀 걸려서요 다시 안내 도와드리도록 하겠습니다.,Korean
+머리가 핑도는 느낌이 있으신가요?,Korean
+그뿐만 아니라 필수 예방접종도 포함해서요.,Korean
+간염으로 드시는 약 있으세요?,Korean
+"요새 왼쪽 팔다리로 힘이 빠지는 것 같은 느낌이 들어요.
+",Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+통증은 얼마나 지속되는지 아시나요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+발톱수술은 왜 받으신 건가요?,Korean
+통증 부위는 어디신 거죠?,Korean
+"네. 변비가 계속 있었어요.
+",Korean
+"어제 새벽 두 시에 깨서 분유 반병 먹이고 안 먹었어요.
+",Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+상처가 큰 부위에 항생제 효능을 주기 위해 테라마이신 연고를 바르는 겁니다.,Korean
+부기는 잘 빠지고 있네요.,Korean
+며칠 밤을 못 주무신건가요?,Korean
+"삼키는 게 힘들어서 유동식 조금만 먹고 있어요.
+",Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+중요한 사항이 아니지만 환자의 안전을 위한 필수 사항입니다.,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+여드름 부위에 발라야 합니다.,Korean
+소변을 볼 때 통증이 있나요?,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+고혈압 환자가 가족 중에 계시나요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+안면 홍조인 것 같네요.,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+처방받지 않는 약은 뭔가요?,Korean
+스트레스 완화에 좋은 약은 없어요.,Korean
+"해열제 먹였더니 좀 자더라고요.
+",Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+시원하게 대변이 안 나오시나요?,Korean
+시월에 독감 주사 맞았었어요.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+두통이 있었던 적은 없나요?,Korean
+소변이 나올 때 피가 나오나요?,Korean
+유전성 질환에 가족력이 없다고 말씀하셨죠?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+���증은 얼마나 자주 생기세요?,Korean
+피는 보통 혈액검사 시에 하셨던 양만큼 뽑으실 거예요.,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+네. 제가 영양실조에 잘 걸려서 입원할 때가 있는데 저번 주에 그랬습니다.,Korean
+네. 입원해서 치료받은 거라면요.,Korean
+잠을 못 자서 힘드세요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+심하지 않다면 식습관 조절이나 좌욕 등을 통해 치료를 할 수도 있습니다.,Korean
+"공장에서 일을 하다가 허리를 좀 다쳤는데 나아지는 기미가 없어서 병원에 오게 됐어요.
+",Korean
+한 번에 잠에 들기가 어려우실까요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+알레르기를 일으킨 약 있나요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+빈 속에서도 나타날 수 있는 증상이지만 흔히 식후에 나타나는 경우가 많습니다.,Korean
+방광 요도 전립선 등 요로에 감염이나 결석 등이 생기는 질환을 말합니다.,Korean
+"좁은 공간에 있으면 숨쉬기가 어려워요.
+",Korean
+민간요법을 받으신 적 없으시면 병원치료에만 집중해주시면 됩니다.,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+체중 증가가 언제부터 있었나요?,Korean
+영양제 추가로 처방해 주세요.,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+빈뇨 말고 소변보실 때 또 불편하신 점이 있으신가요?,Korean
+대변을 매일 보지는 않으시나요?,Korean
+육안으로 봐도 불룩한 게 보이시나요? 위험 여부는 추가 검사 진행 후에 말씀드릴게요.,Korean
+퇴원 후에도 병원에 있으면 안 될까요?,Korean
+검사 후 응급으로 시술이 필요할 수 있습니다.,Korean
+소변을 잘 못 보시나요?,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+도대체 어디가 아픈 거예요?,Korean
+발기 부전이 얼마나 심하신가요?,Korean
+"제 뜻대로 얼굴 근육이 안 움직여서요.
+",Korean
+깨고 난 후 부작용이 없었으면 큰 문제는 아닙니다.,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+네. 다행히도 지금 위암만 있어요.,Korean
+환자분의 건강한 신체 대사 활동을 위해서 중요한 부분이죠.,Korean
+진료시간 중으로 말씀해주실 수 있으신가요?,Korean
+두드러기가 난다면 알레르기인 것 같습니다.,Korean
+대변에 피가 보인적 있나요?,Korean
+최근 두 달 안에 급격한 체중 변화가 있었나요?,Korean
+오늘 아침에 약 먹고 왔고 혈당은 잘 유지하고 있어요.,Korean
+선천적으로 앓았던 질환은 없나요?,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+병실에서 커튼 치고 탈의하시면 돼요.,Korean
+고혈압 치료하려고 약 드시나요?,Korean
+네 복부에 압력이 가해지므로 안 좋습니다.,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+피를 토해서 놀라신 적 있나요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+사출성 구토에는 여러 원인이 있는데 장의 폐쇄로 인한 경우 호전이 쉽지 않습니다.,Korean
+건강검진 받으셨을 때와 지금 상태가 달라졌을 수도 있어서 다시 해야 합니다.,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+"변기가 깨지면서 엉덩이를 다쳤어요.
+",Korean
+입원 기간이 어떻게 되시죠?,Korean
+발이 부어 신발이 안 맞을 때가 있습니까?,Korean
+크라운보다 얇은 두께의 도자기를 씌운 게 라미네이트입니다.,Korean
+몰아서 잔다고 해도 부족했던 수면이 메꿔지지 않습니다.,Korean
+네 그런 증상이 있으셨나요?,Korean
+"평균 하루에 다섯 시간 잡니다.
+",Korean
+가래에 피도 같이 나온적 있나요?,Korean
+환자분의 건강 상태를 확인하기 위한 질문입니다.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+빠르게 할 경우 혈관통이 발생할 수 있습니다.,Korean
+진료 중 주사치료를 받은 적이 있나요? 환자분?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+소변볼 때 문제 있으셨어요?,Korean
+고혈압 약 혹시 드시고 계세요?,Korean
+가슴 통증이 있으셨는지 알려주세요.,Korean
+인후통의 통증 정도��� 말씀해 주세요.,Korean
+식후 소화가 잘 안 되나요?,Korean
+암 진단을 받아보신 적 있나요?,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+어느 부위에 통증이 있을까요?,Korean
+종양 앓았던 가족이 있으셨나요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+증상이 야간에 심해지지는 않나요?,Korean
+수액 연결하면 처음에는 어지러우실 수 있어요.,Korean
+하루에 한 갑은 피우시나요?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+"아프진 않습니다. 어깨가 빠진 것 같은 각도에서 원래 상태로 되돌려 놓으면 다시 팔이 들어온 느낌은 듭니다.
+",Korean
+혈액형이 다르게 나왔나 확인해볼까요?,Korean
+"주말엔 깊이 오래 자는데 평일엔 잠을 잘 못 자요. 늦을까 봐 신경을 곤두세우고 있나 봐요.
+",Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+종양성 병변으로 대장암으로 진행할 위험성이 있습니다.,Korean
+"설사 많이 하면 물처럼 나오듯 했어요.
+",Korean
+배가 부풀어 가득 찬 느낌인가요?,Korean
+그때 증상이 있었던 기간이 어떻게 되나요?,Korean
+지금은 약을 꾸준히 바르는 방법밖에 없어요.,Korean
+다른 질병 치료 중인 것 있나요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+강현아씨는 만성 위염 중에서도 비후성 위염에 속합니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+네. 가족 중에 시각 장애인이 있어서 안내견으로 리트리버 한 마리가 있습니다.,Korean
+어느 부위를 다치신 거예요?,Korean
+"부정하고 싶지만 요실금이 있는 것 같아요.
+",Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+네 수혈받아보신 적 있으신가요?,Korean
+검사 결과는 원하시면 문자나 이메일로도 발송 가능합니다.,Korean
+고혈압 있는 건 언제 아셨나요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+심장이 유독 빨리 뛰는 느낌이 있나요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+언제부터 증상이 나타나기 시작하셨나요?,Korean
+진료 예약 센터는 운영 시간이 어떻게 되나요?,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+어느 부위에 통증이 있으세요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+토를 한 적이 있나요?,Korean
+저랑 제 아버지가 고지혈증을 동시에 앓고 있어요.,Korean
+현재 아픈 부분이 있을까요?,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+배뇨 시 통증이 있고 피가 나오나요?,Korean
+어떤 느낌의 통증이신가요? 바늘로 찌르는 느낌이나 쑤시는 느낌 등 통증 양상을 말씀해 주세요.,Korean
+"가슴에 통증이 심해서 외래 진료로 왔다가 입원했네요.
+",Korean
+독감 예방 접종은 올해 하셨는지요?,Korean
+고혈압과 관련된 약을 평소 복용 중이세요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+몇 월부터 아프셨던 거예요?,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+틀니도 충분히 흔들거릴 수 있습니다.,Korean
+네 혈액 검사하며 함께 진행해 보도록 하겠습니다.,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+언제부터 혈뇨 증상이 있으셨어요?,Korean
+아니요. 질병 때문에 드시고 계시는 약이 있나요?,Korean
+"배뇨 시 통증 때문에요.
+",Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+집 안에 있어도 가족들 간 전염력이 있으므로 성실히 답변 부탁드립니다.,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+식후 소화가 잘 안되세요?,Korean
+지병 때문에 먹는 약이 있어요.,Korean
+"드레싱 다시 받아야 해서요.
+",Korean
+약물 알레르기 있던 적 있으세요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+팔 전체가 가려운 건 여러 가지 ���인이 있을 수 있는데 먼저 검사부터 하고 말씀드릴게요.,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+항생제가 환자분 몸에 사용가능한지 보는 검사입니다.,Korean
+혈뇨를 평소에 자주 보셨나요?,Korean
+만약에 묻어나오는 정도라면 치질과 같은 양성 항문 질환의 가능성이 높습니다.,Korean
+소변이 잘 누어지지 않으세요?,Korean
+지금 결핵 치료 약 드시는 중입니까?,Korean
+아닙니다. 치료 잘 받으시면 회복할 수 있습니다.,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+약 먹어야 잠에 들 정도로 힘드신가요?,Korean
+소변이 쉽게 안 나오나요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+현기증 때문에 어지러우신 거죠?,Korean
+"삼키기 힘들어서 미음 위주로 많이 먹었네요.
+",Korean
+환자분 맞습니다 건강 상태가 좋지 않아요.,Korean
+어떤 종류의 약을 챙겨 드시는 건가요?,Korean
+"혈압약을 먹고 있는데 아직도 너무 높아요.
+",Korean
+입원실이 좀 넓었으면 좋겠어요.,Korean
+네. 걱정하지 마세요. 암은 아니에요.,Korean
+대변을 보는 일이 힘드나요?,Korean
+움직이면 심하게 통증이 오나요?,Korean
+비형 간염이 양성인지 알려주세요.,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+채혈은 임상 병리 선생님이 전문으로 해주십니다.,Korean
+더부룩한 느낌은 자주 있나요?,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+당뇨로 약을 드시고 계신가요?,Korean
+주사뿐 아니라 복용 중이신 약도 말씀해 주시면 됩니다.,Korean
+현재 간 수치가 높은 편인가요?,Korean
+진료받아 보셔야 알 수 있어요.,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+실제 불편감이 있다면 소화불량으로 볼 수 있습니다.,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+"자다가도 계속 깨서 스트레스받아요.
+",Korean
+마비의 전조증상일 수 있습니다.,Korean
+수술한 적은 한 번도 없는 건가요?,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+술 마시는 날이 잦나요?,Korean
+가슴이 빨리 뛰고 요동치시나요?,Korean
+보유하고 계신 약 사진은 없나요?,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+고혈압인 것을 안 게 언제부터죠?,Korean
+네. 병문안은 와 봤어도 제가 입원하게 될 거라는 생각은 한 번도 한 적이 없는데.,Korean
+"파상풍 걸린 것 같아요.
+",Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+암 증세가 시작된 건 언제부터인가요?,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+진통제 주사로 놓아주시는 건가요?,Korean
+네 통증이 있는 곳이 또 있나요?,Korean
+당연히 소독 붕대 있죠.,Korean
+병원비 청구를 위해 필요합니다.,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+"일주일 전에 테니스를 쳤는데 넘어지려고 해서 땅을 한 번 세게 짚고 나니 그때부터 찌릿찌릿 거하면서 아팠어요.
+",Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+새로 받아 가시는 약을 복용하시는 게 좋겠습니다.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+언제 심장 박동이 불편하세요?,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+네 원래 많이 아파요.,Korean
+진통제 처방해 드릴 테니 드시고 오늘 엑스레이 한 장 찍고 갈게요.,Korean
+먹고 있는 것 없고 혈당은 잘 유지돼요.,Korean
+어느 부위가 정확히 아프세요?,Korean
+잘 익히거나 잘 세척해서 드셨나요?,Korean
+간호사님에게 문의해 주시기 바랍니다.,Korean
+결핵 문제는 그동안 없었고요?,Korean
+흡연 상태 유지 중이신가요?,Korean
+암을 앓고 계시는 가족분이 계시나요?,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+의료진이 알아야 할 알레르기가 있나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+"밤에 잠이 안 와서 너무 힘들어요.
+",Korean
+보청기 끼면 안 되는지 몰랐네요.,Korean
+올해 독감 예방 주사 맞으실 예정이신가요?,Korean
+결핵 주사 맞아본 경험 있으세요?,Korean
+몇 분마다 수축이 느껴지시나요?,Korean
+최��에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+"아니요. 최근엔 잘 못 잡니다.
+",Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+지금 수술방으로 이동 중입니다.,Korean
+어떤 증상인지 확인하고 연고나 약 처방해드릴게요.,Korean
+십이 최고 아픈 거라면 어느 정도의 통증인가요?,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+네. 수술복 외에는 전부 벗으셔야 합니다.,Korean
+가래가 얼마나 자주 나오세요?,Korean
+"최근 삼 일 동안 계속 혈변만 봐요.
+",Korean
+담배는 하루에 얼마나 태우세요?,Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+성형외과 외에는 다른 병원은 안 갔나요?,Korean
+금식 지금부터 유지해 주세요.,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+소변이 계속 조금씩 나오나요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+좀 더 세밀한 검사를 해보기 위해서입니다.,Korean
+"변비 증상은 요새 조금 있어요.
+",Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+시술 중 통증이 있을 수 있습니다.,Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+그럼 의사 선생님께 길게 처방 원하신다고 전달해두겠습니다.,Korean
+육안상으로는 판별이 어려우니 검사를 받으러 가시겠습니다.,Korean
+소변보는 데 문제 있으세요?,Korean
+목에 인후통 증상이 있나요?,Korean
+아뇨 평소에 음주를 하시는지 말씀해 주세요.,Korean
+팔다리 힘이 빠지시지는 않나요?,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+"며칠째 열이 나고 있어서 왔어요.
+",Korean
+두 개 다 십 분 정도 전에 복용했어요.,Korean
+네 이제 곧 통증이 없을 거에요.,Korean
+물을 마셨을 경우에도 소화가 진행되기 때문입니다.,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+환자마다 다르지만 보통은 한 시간 안에 효과가 나타납니다.,Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+"소변 색 크게 변함은 못 느꼈었는데요.
+",Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+몸이 부은 적이 없으신가요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+아니요. 타이레놀만 드신 거면 괜찮습니다.,Korean
+그럼 혹시 약 이름은 알고 계실까요?,Korean
+몸이 으슬으슬 떨리지는 않나요?,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+"사흘 전 항암치료 후 발열이 있어서요.
+",Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+신체가 부은 데가 있나요?,Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+"운전하다가 다른 차 피하려고 핸들을 틀면서 가드레일에 박았는데 목이고 가슴이고 전체적으로 너무 아파요.
+",Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+최근 들어 아프기 시작했나요?,Korean
+환자분이 느끼는 통증의 정도가 얼마나 되나요?,Korean
+코로나 때문에 물어보는 겁니다.,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+"요즘 변비 때문에 화장실에 오래 앉아있어야 해요.
+",Korean
+"아이 성기 부분에 뭐가 올라왔어요.
+",Korean
+혹시 가래를 자주 뱉으시나요?,Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+소화기 내과 진료 보러 가셔야 해요.,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+퇴원하시면서 드릴 서류에 사인해 주셔야 합니다.,Korean
+"아니요. 둘 다 클리닉 다니면서 끊었어요.
+",Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+나가실 때 약국에서 약 받아가세요.,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+다른 아픈 곳은 없으신가요?,Korean
+한약과 관련이 아예 없진 않아요.,Korean
+금식을 할 때는 물도 드시면 안 됩니다.,Korean
+손으로 긁으�� 염증이 생겨서 더 안 좋아집니다.,Korean
+간염으로 아팠던 시점을 기억하세요?,Korean
+양성이 나온다면 추가 검사를 진행해야 합니다.,Korean
+연초로 가정해서 대강 흡연량을 말해주시면 돼요.,Korean
+원인을 찾는 것이 가장 중요하기 때문에 몇 가지 검사 후 바로 통증을 조절 해드리겠습니다.,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+"몸 여기저기가 건조하고 가렵다 못해 붉게 되어서 왔어요.
+",Korean
+배변 보기가 많이 힘드신가요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+가려우면 최대 두 알까지 처방해드린 약을 드시면 됩니다.,Korean
+"심장에 문제가 생겼다고 말씀하셨네요.
+",Korean
+당뇨라고 들으신 적이 있나요?,Korean
+있어요. 그래서 심한 운동이나 움직임은 자제하는 중이에요.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+소변보는 데 문제 있으세요?,Korean
+그럼 과거에 흡연과 음주하셨던 기간은 어느 정도인가요?,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+장이 민감해서 장염도 자주 걸려요.,Korean
+소독한 붕대를 감아 외부와 차단시킬 겁니다.,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+"오늘 아침에 일어나다가 갑자기 정신을 잃고 쓰러졌어요.
+",Korean
+"전 허리 아파서 무거운 거 안 들어요.
+",Korean
+십 년 전쯤에 알츠하이머 진단을 받으셨어요.,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+완치가 힘들지만 최대한 후유증이 남지 않도록 하겠습니다.,Korean
+네.정상적인 생활리듬 유지가 어려운 환경이 누적되면 건강에 영향을 줄 수 있지요.,Korean
+통증 주기가 몇 주인가요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+임신하기 전엔 사십구 킬로였고요. 지금은 오십오 킬로예요.,Korean
+언제부터 간염이 있다는 걸 인지 하셨어요?,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+종양 있었던 가족이 있으신가요?,Korean
+혈액 검사할 수 있는 넉넉한 양을 채혈해야 합니다.,Korean
+예전에 병원에서 처방받은 거라 약통에 이름이 안 적혀 있었어요.,Korean
+가족 중에 고혈압약을 먹고 계신 분이 있나요?,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+당뇨 나온 적 있으세요?,Korean
+집안에 암 환자분이 계세요?,Korean
+선생님한테 여쭤보고 처방해 드릴게요.,Korean
+통증이 시작된 것이 언제인가요?,Korean
+가족 중에 대장암 앓으신 분은 없나요?,Korean
+"저 밀가루 알러지 있어요.
+",Korean
+혹시 입원 생활에 대한 궁금하신 부분 있으실까요?,Korean
+네. 수술한 적도 없네요.,Korean
+고혈압 치료하려고 약 드시나요?,Korean
+저희가 먼저 소독하고 항생제 연고 포함하여 처방하겠습니다.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+"음식물을 씹을 때 턱에서 계속 소리가 납니다.
+",Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+유산균을 먹고 있긴 한데 약에 포함되나요?,Korean
+여기 있는 휠체어가 환자분 소유인지 궁금해서요.,Korean
+"눈이 빨갛게 충혈돼서 왔어요.
+",Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+빨리 낫는 것도 중요하지만 재발을 막는 것 역시 중요합니다.,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+코에다 하루 한두 번씩 뿌려 주는 약물이 비강 스테로이드입니다.,Korean
+"위염 때문에 식생활이 불편해서요.
+",Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환 생리 기능에 따라 달라집니다.,Korean
+통증이 자주 생기는 편인가요?,Korean
+꽉 끼는 속옷이나 바지를 입으면 옷에 의해 성기 부위가 과도하게 눌려 통증이 발생할 수 있습니다.,Korean
+지금 복용 중인 항결핵제가 있나요?,Korean
+생각나는 민간요법이면 어떤 것이든 상관없습니다.,Korean
+"무거운 거 들다가 손목이 아팠어요.
+",Korean
+붓기 전 얼굴 상태를 확인할 수 없어 잘 모르겠습니다.,Korean
+"다리가 퉁퉁 부어서 쑤시고 아파요.
+",Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+단기간에 체중이 많이 늘었나요?,Korean
+삼 주 전에 코로나 위험 지역인 국가에 출장을 다녀와 자가 격리를 하고 나왔습니다.,Korean
+"네. 네. 그런 증상이 있는지 몰랐어요.
+",Korean
+대장암 걸린 적 있습니다.,Korean
+통증이 계속 있나요 아니면 아팠다 괜찮았다 하나요?,Korean
+운동하고 나면 부기가 빠져 있나요?,Korean
+이천일 년부터 이 병에 대한 제 고생이 시작됐어요.,Korean
+검사를 진행하려면 금식이 준비되 있어야 해서요.,Korean
+"수면 시 어려움 없어요.
+",Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+요추 일이 번에 수술했어요.,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+고유량 산소법의 특성은 환자의 호흡 양상의 변화와 무관하게 정확하고 계속적으로 일정한 흡입산소분율을 제공해 산소를 투여하는 것입니다.,Korean
+"예전에는 약 먹어야 잠에 들었는데 지금은 바로 잠들지는 못하지만 약 없이 자고 있습니다.
+",Korean
+대변을 매일 보지는 않으시나요?,Korean
+다른 병원에서 입원하신 내용은 저희가 알 수 없습니다. 기억나는 게 있다면 무엇이든 알려주세요.,Korean
+통증 때문에 안녕하지 못했습니다.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+대변 잘 못 보세요?,Korean
+"그냥 아프니까 자꾸 짜증을 내는 것 같은데 다른 데가 아픈지는 모르겠어요.
+",Korean
+지금 들고 계신 자료는 다른 병원에서 가져오신 건가요?,Korean
+고혈압으로 신경 쓰고 계신가요?,Korean
+흉부에 불편한 곳이 있나요?,Korean
+피지 조절하는 약 먹고 있습니다.,Korean
+결핵 진단 언제 받으셨어요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+식습관이 엉망진창이라 장염도 잘 걸려요.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+결핵 치료되는 약 뭐 드세요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+최근에 인플루엔자 백신은 맞으셨나요?,Korean
+앞에 검사가 밀려서 오래 걸립니다.,Korean
+엑스레이 사진 여러 장 찍을 예정입니다. ,Korean
+지금 환자분 상태가 통원 치료로는 좀 힘들어서요.,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+"치질인가 의심될 정도로 고통스러워요.
+",Korean
+양쪽 팔이 모두 가려우세요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+아니요 빈혈 안 옵니다.,Korean
+혹시나 부작용 생기면 바로 병원으로 오세요.,Korean
+다른 증상이 발견될 경우 즉시 상담을 받거나 병원으로 오시면 됩니다.,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+"왼쪽 팔 부은 거 말곤 따로 외관상 다른 건 못 봤고 떨어질 때 왼쪽 팔로 쿵 하고 떨어졌어요.
+",Korean
+통증 정도는 어느 정도 되십니까?,Korean
+병동에 입원 가능 여부를 확인해봐야 할 것 같습니다.,Korean
+취침 시에도 자주 소변이 마려운가요?,Korean
+네. 점심 식사 이후 세 시간 금식을 한 뒤 검사를 진행할 수 있습니다.,Korean
+사람의 각질 있는 곳에 진드기가 나타납니다.,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+보호자에게도 설명 후 서명 할 동의서가 있습니다.,Korean
+소변볼 때마다 피가 나오나요?,Korean
+흉부에 불편한 곳이 있나요?,Korean
+바늘로 찌르는 듯한 통증인가요?,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+네 발열이나 근육통 및 두통 등이 있으셨나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+청소와 빨래를 자주 하는 것이 진드기를 없애는 데에 많은 도움이 됩니다.,Korean
+당뇨 치료 이력은 아직 없으신 건가요?,Korean
+통증이 사라지지 않고 계속 유지되나요?,Korean
+결핵 백신 접종을 하셨나요?,Korean
+판독결과는 영상의학과 전문의 확인이 필요해서 금방 나오지는 않습니다.,Korean
+등산하다가 발목을 삐끗한 적이 있네요.,Korean
+환자분이 복용하고 계시는 약에 대한 정보가 필요합니다.,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+"목 안이 너무 아픕니다.
+",Korean
+사시면서 병원에 입원한 모든 내용 알려주세요.,Korean
+면역력이 떨어져 생긴다고 할 수 있습니다.,Korean
+소변 색이 붉은빛이 도나요?,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+네 자가 격리 마쳤어도 ��아야 합니다.,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+통증이 주에 몇 번 있나요?,Korean
+"구토랑 설사요. 먹기만 하면 토하고 설사도 해서 죽을 것 같아요.
+",Korean
+그럼 주사는 언제 맞으시겠어요?,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+"가만히 누워 있어도 머리가 핑핑 돌아요.
+",Korean
+병원비 결제 영수증 좀 뽑아 주세요.,Korean
+간염과 관련된 약물 드시는 것 있나요?,Korean
+"어제부터 변을 못 보고 있어요.
+",Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+휠체어 꼭 타야 해요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+네. 수분 부족 현상이에요.,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+갑자기 멍이 든다거나 살짝만 부딪혀도 아픈 적 없으셨어요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+네 언제부터 피임약을 드셨나요?,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+피가 섞인 대변을 보고 있으신가요?,Korean
+목에 가래가 끼신 거 같나요?,Korean
+어느 부위에 통증이 있을까요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+환자분이 많이 걱정하셔서 재차 확인했는데 착오는 없었습니다.,Korean
+아니요. 자궁에 혹이 있어서 위험하다고 수술했습니다.,Korean
+몇 시간에 한 번씩 통증이 오나요?,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+비급여면 비싸긴 하지만 꼭 필요한 경우가 있으니 동의해 주셔야 합니다.,Korean
+진통제 자체가 통증을 완화해야 할 때 쓰는 약입니다.,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+가래가 많이 나오는 건가요?,Korean
+"원래 없었는데 요새 변비가 좀 온 거 같기도 하고.
+",Korean
+간염약이 치료에 도움이 됐나요?,Korean
+현기증 느낀 적 있나요?,Korean
+그래서 지금 진료를 안 하신다는 거예요?,Korean
+수술은 잘 끝난 걸로 알고 있어요. 너무 아프시면 진통제 놔 드릴까요?,Korean
+고혈압약 평소에 드시고 있는 거 있으세요?,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+환자분 정보를 얻기 위함입니다.,Korean
+"먹는 양은 똑같은데 살이 급격하게 쪘어요.
+",Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+알레르기가 생기는 이유를 뜻하는 겁니다.,Korean
+비염이 환절기만 되면 더 심해져요.,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+체중이 증가한 이유가 있을까요?,Korean
+"자세가 안 좋긴 한데 그것 때문인지 얼마 전부터 움직이는 게 너무 힘들더라고요.
+",Korean
+"얼굴 빨갛게 뜬 거랑 눈 아픈 것 때문에 왔어요.
+",Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+하루에 한 번씩은 혈뇨 증상이 나타나나요?,Korean
+최근에 예방 접종은 따로 받으셨어요?,Korean
+설사를 종종 하셨구요 배가 빵빵하다거나 하지는 않았어요.,Korean
+"마스크 벗고 들어 올릴까요?
+",Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+가슴이 답답하고 속이 더부룩한가요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+반드시 의사 처방을 받고 드셔야 해요.,Korean
+숨 쉬는 게 힘드신가요?,Korean
+외가 친척 중에 있는 유전 질환이 어떤 건가요?,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+어떤 음식 먹을 때 소화가 잘 안 되나요?,Korean
+환자 번호가 이거 맞나요?,Korean
+다른 증상이 발견될 경우 즉시 상담을 받거나 병원으로 오시면 됩니다.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+요즘 혹시 오한이 있나요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+소화가 어렵거나 하진 않나요?,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+통증은 얼마나 자주 발생해요?,Korean
+"아니요. 몰라서 열을 다시 재야 할 것 같아요.
+",Korean
+아픈 신체 부위 말씀해주세요.,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+특정한 것에 알레르기가 있나요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+"어느 순간 무릎이 시큰거리더니 이제는 걸을 때마다 찌르는듯한 무릎 통증이 있습니다. 살을 빼려고 해도 당장 무릎 때문에 아무��도 할 수 없으니 답답하고 무릎 아픈 게 살 때문인지도 몰라서 입원하게 됐습니다.
+",Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+복부 통증이 많이 심한가요?,Korean
+열이 또 오는 것 같나요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+손목을 받쳐주는 보호대도 있습니다.,Korean
+독감 예방 주사는 꾸준히 맞으셨나요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+불안해할 수 있으니 전신 마취를 권장합니다.,Korean
+가능한 질환들을 감별하기 위해 추가적인 검사가 필요합니다.,Korean
+아이가 키 성장뿐만 아니라 다른 발달까지 느릴까 봐 걱정돼요.,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+부부관계를 하실 때만 발기 부전이 나타나나요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+이건 항생제인데 내일 수술하시기 전에 눈을 깨끗하게 하기 위해서 투여하는 거예요.,Korean
+최근 몇 달 동안 체중 변화는 없었나요?,Korean
+입원 치료를 받았다거나 수술하신 적 있으신가요?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+예 혹시 근육통일 수도 있어서 잠시 대기해 주세요.,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+아까는 수술 부위만 체크했습니다.,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+소변줄이 걸리는 곳이 있는지 제가 잠시 보겠습니다.,Korean
+겨울이면 다시 통증이 오나요?,Korean
+소화가 어렵거나 하진 않나요?,Korean
+"팔 수술한 곳이 이상해요.
+",Korean
+그때 알레르겐이라고 하는 알러지 유발물질 검사하는 항원검사 해보셨나요?,Korean
+환자분 원무에서 정보 보호 요청하셨나요?,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+암 있는 건 언제 아셨나요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+네 검사 결과 기억하시나요?,Korean
+네 산부인과 진료 바로 연결해드리겠습니다.,Korean
+네. 네. 퇴원할 거예요.,Korean
+가족 중 유전성 질환자 계세요?,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+어떤 약 처방 받으셨어요?,Korean
+"실험용 알코올을 물인 줄 알고 마셔서 내원했습니다.
+",Korean
+혈액검사 결과가 나오는 데는 시간이 걸립니다.,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+검사를 할 때 공복이어야 할 수 있는 검사들이 있어서요.,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+위 주름이 오밀리미터 이상으로 두꺼워진 것으로 위 점막 전체가 두터워져 있지는 않습니다.,Korean
+크게 다쳐서 입원한 적이 있나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+모유는 아기에게 필요한 영양분을 모두 포함한 가장 이상적인 음식입니다.,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+통증의 원인을 얼른 잡을 수 있도록 노력해 봅시다.,Korean
+대변볼 때 피가 나오나요?,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+"이사한 후로 층간소음에 시달려요. 그 때문에 이사 한 달 후쯤부터 수면제를 처방받아먹기도 했어요. 처음에는 잘 듣는 것 같더니 요즘 한 달 간은 그마저도 소용이 없네요.
+",Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+대소변을 잘 못 보거나 대소변을 볼 때 있어서 어떤 종류의 불편감이 있는 경우 모두 해당합니다.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+입에서 피 맛이 나나요?,Korean
+어떤 자극에 의해서 위를 이루는 상피세포들이 장을 이루는 상피세포의 성격을 띠게 되는 것입니다.,Korean
+약은 복용 중이고 혈당은 평소 잘 유지되는 편입니다.,Korean
+하루에 담배를 얼마나 피세요?,Korean
+아니요. 음성 판정이 나왔���요.,Korean
+어릴 적에 심장판막 수술을 했어요.,Korean
+복부 초음파를 통해 신장의 구조적인 이상을 확인할 수 있습니다.,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+현재로서는 특별한 치료 방법이 없습니다.,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+"손가락 움직임이 둔하고 붓기에 차갑고 그래요.
+",Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+간호사님에게 문의해 주시기 바랍니다.,Korean
+좀 더 위생에 신경을 써 주신다면 빨리 회복되지 않을까요?,Korean
+가족 중에 유전병 치료를 위해 병원에 다니시는 분이 계신가요?,Korean
+당뇨 측정을 해 보셨나요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+큰 이상은 없는 것 같은데 정밀검사를 받아 보시겠어요?,Korean
+환자분의 경우 회복은 한 달이면 충분합니다.,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+그 약을 드시는 이유가 뭔지 여쭤봐도 될까요?,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+"아이 선생님이 밥 먹을 때 아파 보인다고 병원에 가보라고 하신 거예요.
+",Korean
+호흡곤란 증상이 자주 나타나나요?,Korean
+요도염일 가능성이 있으니 추가 검사를 해보시지요.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+알레르기 반응은 언제 처음 나타났나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+당뇨 있어서 식단도 관리 중이에요.,Korean
+평소에 드시는 약이 어떤 병 때문에 드시는 건가요?,Korean
+집 먼지 진드기는 습기 있는 침구나 의자 같은 곳에서 사람의 피부를 먹고사는 벌레입니다.,Korean
+그 검사만 하면 되나요 오늘은?,Korean
+통증은 주로 언제 오나요?,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+"최근에 십 킬로 정도 빠졌어요.
+",Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+일단은 약물치료와 주사 치료를 병행해서 진행하도록 하겠습니다.,Korean
+통증이 어느 부위에 집중되나요?,Korean
+변비의 정도에 따라 변비약의 효과가 적게 느껴질 수도 있습니다.,Korean
+"아무것도 안 해도 머리만 대면 코 골고 자는데요.
+",Korean
+네 진통제를 맞으면 많이 나타나는 현상입니다,Korean
+이 밖에 다른 알레르기 있으실까요?,Korean
+아니요. 본인이 수혈 받아보신 적 있나요?,Korean
+복용하셨던 약을 체크해야 해서 질문드렸습니다.,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+피부 연고는 피부과 진료받으시고 처방받으실 수 있어요.,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+"전기에 감전되어 너무 아프네요.
+",Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+후에 통증이 있을 수 있으니 아프시면 메모 후 병원에 방문하시어 꼭 말씀해주세요.,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+"얼굴 빨갛게 뜬 거랑 눈 아픈 것 때문에 왔어요.
+",Korean
+"새벽에 특히 아파서 계속 깨게 돼요.
+",Korean
+지금 드시고 계신 고혈압약이 있는지 알려주세요.,Korean
+약은 규칙적으로 드셔 주셔야 효과가 있습니다.,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+네. 갑상선호르몬이 높게 측정됐네요. 갑상선 관련해서 초음파나 다른 검사는 해보셨나요?,Korean
+아프신 이유가 암 때문인가요?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+알고 계신 것처럼 맹장에 약간의 문제가 생겼는데 크게 걱정하실 정도는 아닙니다.,Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+통증이 시작되면 쭉 가나요?,Korean
+배도 같이 아프신 거죠?,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+깊은 호흡이 잘 안되시나요?,Korean
+만졌을 때 통증은 없나요?,Korean
+네 빼고 촬영해야 씨티 화질이 좋아요.,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+결핵 증상이 언제부터 나타났나요?,Korean
+네. 그런데 변비가 계속 있어요.,Korean
+요의는 있는데 소변이 나오지는 않았던 적이 있었나요?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+통증 반응이 있는 부위가 어디에요?,Korean
+레이저 치료 후 마취가 풀리면 조금 아프실 수도 있어요.,Korean
+담배와 전자 담배 동일시하여 알려주세요,Korean
+어��� 식으로 통증이 느껴지나요?,Korean
+특별히 어디가 가장 아프셨나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+위내시경 검사가 필요합니다. 내시경으로 출혈 여부 확인하고 필요 시 지혈을 할 수 있습니다.,Korean
+소변에 피가 함께 나오나요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+약물 알레르기 있던 적 있으세요?,Korean
+소변 보는 주기가 어떻게 되나요?,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+마취 부작용 얘기를 들어 긴장했었는데 아무 일도 없었어요.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+음식 알레르기 진단을 받은 적이 있나요?,Korean
+네. 보호자분이 아니라 환자분한테 하는 거 맞습니다.,Korean
+"어깨가 계속 결려서 병원 왔습니다.
+",Korean
+"""의료용 플라스틱, 실리콘 등으로 만들어져 안전합니다.""",Korean
+환자복은 어떤 사이즈가 필요하세요?,Korean
+네. 덕분에 수술이 잘 되었나 봐요. 훨씬 좋아졌네요.,Korean
+혹시 가려움증도 같이 느껴지시나요?,Korean
+간염 때문에 병원 가신 적 있으세요?,Korean
+아침에 애가 칭얼거리길래 만져보니까 열이 펄펄 끓길래 일단은 약도 안 먹이고 바로 왔어요.,Korean
+인체 수분 전해질 비율은 중요한 사항입니다. 적정량 섭취하셨다니 좋군요.,Korean
+교통사고 후유증으로 비 오는 날이면 무릎이 시큰거려요.,Korean
+네. 호르몬제 먹기가 꺼려지더라고요.,Korean
+대변 잘 못 보세요?,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+소화가 잘 안 되고 속이 답답하신가요?,Korean
+고지혈증 검사의 경우 영향을 줄 수 있습니다.,Korean
+술을 과하게 먹는 편인 가요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+담배와 전자 담배 동일시하여 알려주세요,Korean
+부작용 포함하여 특이사항이 있으셨나요?,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+설사하는 이유가 따로 있으신가요?,Korean
+"고혈압이랑 당뇨 가지고 있어요.
+",Korean
+혈뇨를 보신 지는 몇 일이나 되셨나요?,Korean
+네 구급차로 오셨어요. 도와주셨던 분은 응급실에서 확인할 수 있습니다.,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+네 이 상처는 완전히 낫기 전까지는 통증이 있을 거예요.,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+당뇨라고 들으신 적이 있나요?,Korean
+알레르기 일으키는 원인 있나요?,Korean
+혹시 다른 수술하신 적이 있다면 수술할 때 참고해야 하기 때문입니다.,Korean
+피부 반응으로도 가능하긴 하지만 정확하게 나오지는 않기 때문에 혈액 검사로 하는 걸 추천드립니다.,Korean
+증상이 심할 경우 연고보다는 약을 복용해야 할 수도 있습니다.,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+대변을 며칠에 한 번 보나요?,Korean
+"걸을 때 발목이 너무 아파요.
+",Korean
+원인에 따라서 앞으로의 예후를 예측해볼 수 있습니다.,Korean
+최근에 살이 많이 빠지시진 않았나요?,Korean
+키 백오십팔에 몸무게 육십 킬로요.,Korean
+일 년 전에 가슴뼈 기형으로 수술했어요.,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+검사를 빨리할수록 만약에 병을 찾을 경우 다양한 치료 방법을 적용할 수 있습니다.,Korean
+통증 정도를 평균 내기 어려우시면 표현 가능한 방식으로 말씀해 주시면 됩니다.,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+결핵을 오래 앓으신 거예요?,Korean
+언제부터 가려움이 느껴지셨는지 알려주세요.,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+변에 피가 섞여 나오나요?,Korean
+간염 치료 기간 알 수 있을까요?,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+산부인과 외래 운영 시간 좀 알려주세요.,Korean
+열이 살짝 오르면서 가슴이 답답해져요.,Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+그냥 지금은 기존에 가지고 계셨던 피부질환 여부만 여쭙는 거예요.,Korean
+"가래 때문에 목이 너무 아프고 기침도 자주 해요.
+",Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+혈압이 높�� 진료를 받은 적 있으신가요?,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+평소에 숨이 안 쉬어질 때가 언제인가요?,Korean
+출혈 위험이 있어서 입원하셨나요?,Korean
+네 지금 없으시지만 나중에는 생길 수 있으니 꼭 한번 검사받아 보세요.,Korean
+"고환이 많이 부어 내원했어요.
+",Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+성 기능 장애가 있으신가요?,Korean
+"밤에 배 아프다고 울고불고 뒤척였어요.
+",Korean
+통증이 좀 강한 편이에요?,Korean
+"그럼요. 술은 몸에 좋지 않아서 싫어해요.
+",Korean
+임신 시 분만 방법 그리고 수술력이 추후 본과 수술 방법에 영향을 미칠 수 있어서 확인하였습니다.,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+기침할 때 목이 많이 아픈가요?,Korean
+목이 아픈 적 있으셨어요?,Korean
+구토가 장폐색에 의한 경우라면 우려가 되나 그 외의 경우일 수도 있습니다. 검사 후 다시 말씀드리겠습니다.,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+수술부위에 대해서 전공의 선생님이 동의서 받으실 때 자세히 알려주실 겁니다.,Korean
+아니요 통증 부위를 말씀드리는 거예요.,Korean
+네. 작년 겨울에 교통사고를 당했어요.,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+입원 치료한 적 있으신가요?,Korean
+고유량 산소법은 환자의 흡기 시의 최고 유량에 필요한 전체 가스 유량을 공급함으로써 지속적인 흡입 분율을 제공해 산소를 투여합니다.,Korean
+복부 팽만감이 자주 생기나요?,Korean
+메밀이 들어간 음식을 먹으면 어떤 반응이 있나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+날씨가 추워지거나 습해지면 통증이 달라지나요?,Korean
+환자분이 입원하실 자리가 저녁에 늦게 준비가 됩니다.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+네. 복통이 같이 있어서 어느 정도 시간이 지나야 호전되는 경우가 많습니다.,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+"식사량도 없고 컨디션도 난조라 그런지 물똥 같은 변을 보시더니 일주일 전부터 혈변을 봤대요.
+",Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+일주일 평균 주량이 얼마나 되나요?,Korean
+털이나 먼지 같은 거에 반응하는 알레르기가 있으세요?,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+염증 수치는 우선 지켜보도록 하고 문제는 엑스레이인데 옆에서 찍은 거거든요. 굉장히 부풀어 있고 가스도 많이 차있습니다.,Korean
+검사를 해봐야겠지만 진료 가능한 수준으로 보이네요.,Korean
+언제부터 소변을 볼 때 피가 같이 나오나요?,Korean
+형이 요로 쪽이 안 좋았어요.,Korean
+사출성 구토의 원인은 대부분 빠르게 회복되지 않는 경우가 많습니다.,Korean
+그게 제일 큰 수술이었어요.,Korean
+액세서리도 다 빼고 수술복만 입으셔야 해요.,Korean
+원래 자세로 돌아왔을 때 통증이 몇 분 째 계속 남아있다면 정밀 검사를 받아보는 것이 좋습니다.,Korean
+수면 검사로 인한 부작용이나 중요한 문제가 있을 수 있습니다.,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+치유 확률은 몇 퍼센트 정도 될까요?,Korean
+간염 치료 복용 약 있으시죠?,Korean
+몇일에 한번 대변을 보시나요?,Korean
+암 판정받으신 적 있나요?,Korean
+환자 번호가 이거 맞나요?,Korean
+과식을 해서 위에 자극을 줬다면 통증이 있을 수 있습니다.,Korean
+네 너무 아프시면 부축해드릴까요?,Korean
+매일 드시는 약이 있어요?,Korean
+몸 전체에 힘이 없나요?,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+필요에 의해 처방드린 약이니 꼭 복용하세요.,Korean
+뇌까지 이상이 있을 것 같지는 않습니다 울리는 현상이 가라앉는지 조금 지켜보는 게 좋을 것 같습니다.,Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+환자분은 교통사고가 나서 출혈이 심하셨기 때문에 입원하게 되셨어요.,Korean
+"지난번 상처 부위에서 진물이 너무 많이 나서요.
+",Korean
+네 팔도 엑스레이 찍었고 결과 나오면 처치 진행하겠습니다.,Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+기침을 했는데 피가 나온 적 있나요?,Korean
+"아침에 토 한 번 했었어요.
+",Korean
+마취가 잘 안 들���다든지 그런 거요.,Korean
+"네. 우리 아기가 다른 아기들보다 키도 크고 몸이 빨리 자라는 것 같아서 검사받고 싶어서 왔어요.
+",Korean
+콧물이 계속 흘러서 콧물약 먹었어요.,Korean
+"몸이 좀 안 좋은데 당뇨 때문인가 해서요.
+",Korean
+엄지손가락이요. 멍이 빠지질 않아요.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+심장이 불규칙적으로 뛴다고 생각하시나요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+현재 제왕절개로 인한 후유증이 발견됩니다.,Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+입원은 이번이 처음이라는 거죠?,Korean
+무리해서 계속 손을 사용할 경우 손을 못쓰게 됩니다.,Korean
+키가 아마 백칠십이 센티이고 몸무게는 오십일 킬로요.,Korean
+어떤 약에 알레르기가 있으시죠?,Korean
+수액 치료는 작은 일시적 도움일 뿐입니다. 생활 습관과 수면 환경개선이 중요해요.,Korean
+소변이 나올 때 피가 나오나요?,Korean
+"배뇨 시 통증 때문에요.
+",Korean
+"제가 코를 많이 골아서 코 심하게 골 때는 놀라서 일어나곤 해요.
+",Korean
+아직도 가슴 쪽에서 통증이 올라오나요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+"대변보면 속도 같이 울렁거리네요.
+",Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+"네. 힘들 때마다 담배 생각이 나서요.
+",Korean
+치료제가 환자분 몸에 문제를 일으키지는 않는지 확인 하는 검사입니다.,Korean
+통증이 어떤 거 같으세요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+"임신했는데 갑자기 심한 어지럼증이 생겨 내원했어요.
+",Korean
+꾸준한 드레싱과 청결유지가 필요합니다.,Korean
+아니요. 복부 피부에 젤리를 바르고 시행하는 검사입니다.,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+대변을 볼 때 피가 보이나요?,Korean
+그 검사를 받거나 진단받은 적 없어요.,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+발기가 오랜 시간 지속되지 못하나요?,Korean
+자세한 검사를 해봐야 알겠지만 수술은 꼭 필요할 것 같습니다.,Korean
+"몸무게 오 킬로나 늘었던데요?
+",Korean
+최근 들어 살이 갑자기 찐다거나 하진 않나요?,Korean
+지금으로서는 정확하게 말씀드리기가 어려워서 선생님께서 진료 보시고 알려주실 것 같습니다.,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+시기에 따라서 진단과 치료가 바뀔 수 있습니다.,Korean
+구토를 하면 속이 아픈가요?,Korean
+헬리코박터균 감염 검사를 해야 알 수 있습니다.,Korean
+빈혈은 지속 적으로 있나요?,Korean
+힘이 나질 않고 무기력함만 느끼시나요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+한 달 치 미리 처방을 받아두었어요.,Korean
+"눈이 침침하고 잘 안 보여.
+",Korean
+머리가 자주 아파서 두통약 먹습니다.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+아니요. 갑자기 아침부터 아팠어요.,Korean
+외래 예약은 진료예약센터를 통해서 가능합니다.,Korean
+"살이 꽤 많이 빠졌어요.
+",Korean
+현재 투약 중인 약이 있으신가요?,Korean
+수술 후 입원을 하셔서 회복하시는 것을 권유합니다.,Korean
+당뇨를 앓으시던 가족분이 계시나요?,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+"교대 근무를?하다 보니?식사가 불규칙적이에요.
+",Korean
+환자분은 이마 열상으로 내원하셔서 상처 먼저 세척하고 엑스레이 찍으실 예정입니다.,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+병원비랑 관련된 상담은 어디서 받을 수 있을까요?,Korean
+네. 부정맥 진단받았는데 따로 증상은 없어서 치료는 안 받고 있습니다.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+"무릎에서 소리가 나고 무릎 구부릴 때마다 아파요.
+",Korean
+발기 부전으로 인해 부부관계에 문제가 있나요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+예전에 쓰러지신 적 있나요?,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+"요즘 소화를 너무 못 시키는 것 같아서 속이 안 좋아요.
+",Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+병원에서 결핵 치료 중이신가요?,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+통증이 느껴지는 세기가 어느 정도인가요?,Korean
+네 간단한 검사는 여기서 하도록 하겠습니다.,Korean
+진통제를 복용한 지 얼마 안 됐으니 조금만 더 경과를 보겠습니다.,Korean
+고지혈증 검사의 경우 영향을 줄 수 있습니다.,Korean
+네. 거의 서서 일하고 있어서 맨날 다리도 붓고 그래요.,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+수술적 치료 등 어떤 의료적 행위를 하는가에 따라 병원비가 달라질 수 있어 미리 말씀드릴 수는 없습니다.,Korean
+"걷는 게 영 불편해요.
+",Korean
+"양쪽 무릎에 이상이 생긴 것 같아요.
+",Korean
+식사 후에 소화는 잘되시나요?,Korean
+"글쎄요. 아픈 이후로 붕대를 계속 감아둬서 딱히 모르겠어요.
+",Korean
+"요즘 잠이 잘 안 옵니다.
+",Korean
+특이한 혈액형 그런 게 있어요?,Korean
+오늘 소독하는 방법을 보시고 따라 하시면 됩니다.,Korean
+약 먹고 나서는 열이 떨어졌던 건가요?,Korean
+"산후우울증인 것 같아 오게 되었습니다.
+",Korean
+약을 못 챙겨 왔어요. 약은 삼 년째 먹고 있습니다.,Korean
+"접촉 사고가 났는데 이상하게 전신이 아파요.
+",Korean
+"화상 치료도 받고 물리 치료도 받으려고 왔어요.
+",Korean
+통증이 멈출 때도 있는 건가요?,Korean
+심장에 스텐스 넣는 시술 했습니다.,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+결핵 주사 맞은 적 있으세요?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+약은 집에 있고 처방전 찍어왔어요.,Korean
+첫째는 자연 분만을 하신 거예요?,Korean
+알레르기 반응을 일으키는 약은 없나요?,Korean
+틀니인데 금속이 아닌 걸로 알고 있는데요.,Korean
+몸에서 에너지가 빠져나가는 느낌인가요?,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+"왼쪽 무릎 쪽이 시려요.
+",Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+"아 저 오른쪽 어깨가 움직일 때마다 통증이 있어서요.
+",Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+지금 검사 결과를 보니 좋지 않아서 되도록이면 수술하는 게 좋을 것 같아요.,Korean
+"친구랑 싸우다 맞았는데 눈이 아파서요.
+",Korean
+열이 또 오는 것 같나요?,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+"변비가 심한지 대변을 못 눈 지 오래된 것 같아요. 아마 삼일 정도 아무것도 누지 못했습니다.
+",Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+체온이 몇 도인지 아세요?,Korean
+일단 진료 후 확인해 보는 게 좋겠습니다.,Korean
+암이라는 걸 언제 알았나요?,Korean
+간염 판정은 언제 받았나요?,Korean
+아니요. 타이레놀만 드신 거면 괜찮습니다.,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+네 병원에 입원하신 적 있으시면 전부 말씀해 주세요.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+삼 주 전에 코로나 위험 지역인 국가에 출장을 다녀와 자가 격리를 하고 나왔습니다.,Korean
+장폐색으로 인한 구토라면 약물 치료보다 다른 방법을 고려해 봐야 합니다.,Korean
+음식이나 약물 말고 다른 알레르기 반응 있는 거 있어요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+통증이 얼마 만에 오나요?,Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+바셀린 거즈는 보습과 동시에 상처를 보호하는 역할을 해 줍니다.,Korean
+간염으로 드시는 약이 있나요?,Korean
+지금 너무 아파서 더 빨리 맞고 싶어요.,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+증상이 나타나기 전에 드신 것은 다 말씀해주십시오.,Korean
+원인은 다양할 수 있어 검사 진행 후 정확한 진단을 알려드릴 수 있을 것 같습니다.,Korean
+수술할 정도는 아니라고 해서 이 주 넘게 입원한 적은 있어요.,Korean
+일반적으로 여덟 시간 금식 후 혈당을 측정하였을 때 백이십오 밀리그램 퍼 데시리터 이하로 측정이 될 경우 정상입니다.,Korean
+"하루 종일 서서 일해서 그런지 종아리 아래로 다 붓는 것 같아요.
+",Korean
+"불면증이라는 거를 모르고 살았는데 이거 때문에 최근에 잘 못 자요.
+",Korean
+증���을 느끼기 시작한 건 언제부터였나요?,Korean
+현재 알고 계신 음식 알레르기가 있나요?,Korean
+"운전 중에 뒤차가 차를 박았는데 그 이후로 몸이 아파요.
+",Korean
+몸에서 오한을 느끼진 않나요?,Korean
+수술적 치료 이후 호전 양상에 따라 다를 수 있으나 큰 수술은 아니기 때문에 입원 기간은 길지 않을 것으로 보입니다.,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+종양 치료받은 적 있으세요?,Korean
+몸에 열나는 것 같나요?,Korean
+"대변을 못 눠서 칭얼거려요.
+",Korean
+아버지가 오랫동안 고혈압으로 약을 먹고 계십니다.,Korean
+아침에 혈압을 재 봤는데 그때부터 혈압이 쭉 낮았어요.,Korean
+가벼운 수술이라면 어떤 것 말씀이세요?,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+구내염 약에 항생제가 들어 있었어요.,Korean
+중증을 판단하는 기준이 너무 애매하지 않나요?,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+"정기 건강검진을 했다가 초음파상에 자궁근종이 있다고 해서 입원하게 됐어요.
+",Korean
+지금 결핵 치료 약 드시는 중입니까?,Korean
+숨을 헐떡일 때가 있나요?,Korean
+소변에 피가 많이 나오셨나요?,Korean
+"얼굴 코뼈가 나간 것 같아요.
+",Korean
+종종 재발을 하니 신경 써주셔야 합니다.,Korean
+알레르기로 조심하시는 음식 있나요?,Korean
+"급체했는데 속이 답답하다더니 토를 하길래 왔습니다.
+",Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+네 책상 위에 약 올려주세요.,Korean
+오한이 든 건 아니고요?,Korean
+아까보다는 아픈 게 덜하시다는 말씀인가요?,Korean
+"치즈랑 우유가 저랑 너무 안 맞아요. 소화가 진짜 힘드네요.
+",Korean
+장염 증상은 있었는데 병원에 안 가고 약 먹고 나았었어요.,Korean
+평소보다 통증이 더 강한가요?,Korean
+"파상풍 걸린 것 같아요.
+",Korean
+언제 처음 결핵을 앓았나요?,Korean
+가슴 통증의 원인으로는 심혈관 호흡기 소화기 근골격 심인성 등의 다양한 원인이 있을 수 있습니다.,Korean
+복부초음파는 그냥 배 위에서 보는 거죠?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+이 병원 처음 왔습니다.,Korean
+아프다고 해서 진통제는 먹이긴 했는데 해열제 효과는 없는 약이에요.,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+통증이 아직도 안 나았나요?,Korean
+제 때 약을 드시고 건강 관리에 힘써주시면 점점 좋아질 거라 생각합니다.,Korean
+물을 마셨을 경우에도 소화가 진행되기 때문입니다.,Korean
+네 검사 결과상 문제없이 잘 회복되고 있으십니다.,Korean
+배에 가스 차는 느낌이 자주 있나요?,Korean
+네. 의사 선생님께 먼저 들었습니다.,Korean
+지금 아픈 곳 말하세요.,Korean
+보호대를 착용하고 약물치료와 주사치료를 병행하여 통증 악화를 막을 수 있습니다.,Korean
+그렇군요 통증 세기가 어떻죠? 일에서 십까지 강도를 나타내 주세요.,Korean
+"갑자기 화장실을 많이 가고 소변이 마려워 잠자는 중간에도 계속 깹니다.
+",Korean
+통증이 언제부터 시작했는지 말씀해주세요.,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+채혈은 이번만 진행한 것이라 다음에는 따로 채혈 안 하셔도 돼요.,Korean
+네 많이 아프지만 진통제가 주입되고 있어서 참을만할 겁니다.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+소아 당뇨로 치료받고 있습니다.,Korean
+하루 동안 얼마나 피워요?,Korean
+다른 아이는 자연 분만이었고요?,Korean
+네. 유전적 질환이 있다면 다른 사람들보다 질병에 걸릴 위험이 큽니다.,Korean
+불면증이 심하신 거 같아요.,Korean
+네. 암은 아닌 거 같네요.,Korean
+예전에 식중독에 걸려서 이틀 정도 입원했었어요.,Korean
+전신 마취로 진행했을 거예요. 아마.,Korean
+갖고 계신 약 있나요?,Korean
+"수유 중이라 최근 이 년은 못 마셨어요.
+",Korean
+언제부터 가슴 통증이 있나요?,Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+네 저희가 환자분 상태를 자세히 파악하기 위해 필요합니다.,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+성형외과는 무슨 일로 가셨나요?,Korean
+지금 안 하셔도 수술 준비에 들어간 비용은 모두 청구됩니다.,Korean
+올해 독감 맞으려고 했는데 독감 맞고 사망했다는 뉴스를 봐서 아직 안 했어요.,Korean
+"수술한 다리에 통증이 안 없어져서요.
+",Korean
+약을 세 알씩 매일 드셨나요?,Korean
+마취 풀린 시간인데 아직 괜찮으신 거죠?,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+그리고 식사도 소량씩 자주 하는 게 좋으시고요. 혹시 최근 살이 찌거나 빠지는 변화가 있으신가요?,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+갑자기 가슴이 아프다거나 숨쉬기 어렵지 않으셨고요?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+집 근처 병원에서 소독하시는 게 편하실 거예요.,Korean
+피임약이 상관이 있을 수 있습니다.,Korean
+긁으면 덧날 수 있으니 아이스팩을 드릴게요.,Korean
+아픈 곳 말씀해 주세요.,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+"아파서 병원 간 적도 없어요.
+",Korean
+"집사람이 죽으려고 약을 잔뜩 털어먹었어요.
+",Korean
+얼마나 자주 기침이 나오나요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+연골이 너무 안 좋아서 연골 수술했어요.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+수술 시 과다출혈 등의 문제가 있으면 받아야 할 수도 있습니다.,Korean
+방문 국가가 감염병 지역인지 알아보기 위해서요.,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+지금 드시고 계신 고혈압약이 있는지 알려주세요.,Korean
+현기증 느낀 적 있었어요?,Korean
+네. 최근 건강검진 받을 때 재보았습니다.,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+회복을 위해 단백질 위주의 식단이 필요합니다.,Korean
+유산균이나 영양제나 비타민 제외하고 알려주세요.,Korean
+음식 중에 조심해야 될 음식이 있나요?,Korean
+앞으로도 이렇게 혈압 측정은 좀 힘드실 수도 있어요 참고하시고 너무 힘드시면 지금 잠깐 쉬었다 할까요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+네 마취했던 경험 다 말해주시면 됩니다.,Korean
+간염을 앓은 지 얼마나 되셨죠?,Korean
+병원 홈페이지에서 다시 보실 수 있어요 다운로드는 안 됩니다.,Korean
+영양제 추가로 처방해 주세요.,Korean
+"네. 복부에 불편한 느낌이 있습니다.
+",Korean
+감염 증상 외의 특이 증상에는 무엇이 있나요?,Korean
+가스 활명수 외에 다른 소화제 같은 건 안 드시고요?,Korean
+"몸이 워낙 약해서 칼슘이 풍부한 음식은 찾아서 먹을 정도예요.
+",Korean
+하루 동안 담배를 얼마나 피우시나요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+지금 드시는 약과 상충되지 않는 약을 처방하려고 여쭤봤습니다.,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+"엉덩이가 바닥에 닿을 때마다 아이가 많이 아파하더라고요.
+",Korean
+통증 텀이 얼마나 되나요?,Korean
+식사는 최소 열두 시간 물은 여덟 시간 이상 금식하셔야 합니다.,Korean
+몸이 뜨거운 적이 있나요?,Korean
+환자분은 방금 입원해서 아직 처방이 나질 않았습니다. 처방이 나면 안내해 드리겠습니다.,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+"얼마 전에 일하다가 오른쪽 어깨에서 툭 소리가 났는데 그 이후로 어깨가 뻐근해요.
+",Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+흉통이란 가슴 부위에 나타나는 통증을 의미합니다.,Korean
+장중첩증 말고는 따로 수술한 적 없어요.,Korean
+복부가 부은 느낌이 있나요?,Korean
+되도록 보호자분께서 옆에 상주 해주시고 혹시라도 도움이 필요하시면 콜벨을 눌러 간호사를 호출해주세요. 절대 무리하게 혼자 행동하지 마세요.,Korean
+주로 어디가 자주 붓나요?,Korean
+피가 나올 정도면 연고를 처방받으셔야 합니다.,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+급한 내시경일 경우에는 내시경실에 전화 걸어 급하게 일정을 잡습니다.,Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+수술이 가장 좋은 방법입니다만 고민하고 계신 이유가 있으신가요?,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+가족 중에 당 수치��� 높은 분이 있나요?,Korean
+"애가 헬멧 없이 자전거를 타고 있었는데 그때 애가 넘어지면서 콘크리트 바닥에 머리를 부딪치고 팔도 좀 까지고 다리도 좀 까졌어요.
+",Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+태어나고 몇 개월 동안 예방 접종하신 게 다일까요?,Korean
+언제부터 가슴 통증이 있나요?,Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+평소에 부종이 좀 있으세요?,Korean
+숨을 헐떡일 때가 있나요?,Korean
+아이 혼자 병원에 있는 것은 위험하므로 다른 보호자분께서 짐을 챙겨오셔야합니다.,Korean
+수면 보조제는 너무 오래 드시면 좋지 않아요.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+돌 때 재수술을 하게 되면 분명 호전될 가능성이 높아집니다.,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+코에다 하루 한두 번씩 뿌려 주는 약물이 비강 스테로이드입니다.,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+"요새 귀가 간지럽고 물집이 생겨서요.
+",Korean
+"설사는 어제만 세 번 했어요.
+",Korean
+소변량은 주머니에 얼마나 차야 하나요?,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+토를 심하게 한 적이 있나요?,Korean
+"""설사를 유발하는 특정 음식이나, 환경 요인이 있나요?""",Korean
+모유 수유를 하고 육 개월쯤부터 이유식을 쌀 채소 고기 순으로 시작하시면 됩니다.,Korean
+"소변이 잘 안 나오다 보니까 화장실을 엄청 자주 가요.
+",Korean
+확실히 진단을 받은 건 아닌데 고혈압 당뇨 위험이라고 하셨어요.,Korean
+일단 봉합된 부위는 이틀마다 외과에 가셔서 소독 받으셔야 합니다.,Korean
+"금주 중이고 담배는 가끔 피워요.
+",Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+"위 쓰림이 너무 심해요.
+",Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+네 집중해서 치료하면 빨리 낫겠지요.,Korean
+입원했던 적이 몇 번일까요?,Korean
+구토를 언제 한 적 있나요?,Korean
+숙면을 푹 취하기 어려우신가요?,Korean
+아니요. 청진을 하도록 하겠습니다.,Korean
+진단서 한 부 더 받으시려면 추가 비용이 발생하는데 괜찮으세요?,Korean
+네. 몸무게와 증상에 따라서 몸 상태 측정이 가능해서요.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+"무릎 중에서도 위쪽이 아파요.
+",Korean
+통증이 계속 있나요 아니면 아팠다 괜찮았다 하나요?,Korean
+지하라 좀 습한데 상처에 괜찮을까요?,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+네. 저 포함 기침을 많이 해요.,Korean
+통증이 어느 부위에 집중되나요?,Korean
+네 육안으로 보는 것보다 엑스레이를 찍고 정확히 확인하는 게 좋습니다.,Korean
+피 뽑은 건 해당 안 됩니다.,Korean
+암을 치료받은 적이 있나요?,Korean
+네. 흉터가 안 남아야 할 텐데.,Korean
+현재도 통증이 계속 느껴지나요?,Korean
+네 콧줄을 넣을 때 자극이 되어서 그렇습니다.,Korean
+변에 피가 섞여 나오나요?,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+체질량지수가 비만으로 판단됩니다. 식사량을 조절해 주세요.,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+"네. 체온은 매일 재는데 비슷했어요.
+",Korean
+앓고 있는 병 있나요?,Korean
+문진에 따라 추가 검사는 없을 수도 있습니다.,Korean
+소변과 함께 피가 나오나요?,Korean
+간접흡연이 더 위험하다는 보고가 있을 정도로 영향을 많이 미칩니다.,Korean
+"""네, 주사 흉터도 확인하겠습니다.""",Korean
+아직 검사도 남았고 입원 가능성도 있어서요.,Korean
+어지럽거나 울렁거리는 증상 없으셨나요?,Korean
+콜라와 같은 아주 짙은 갈색이라면 사구체신염을 의심할 수 있습니다.,Korean
+"안녕하세요. 저 요즘에 속도 안 좋고 토도 하루에 두 번 이상하고 헛구역질도 계속해서 왔어요.
+",Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+"입원이 시급한 상황이라고 해서요.
+",Korean
+소독은 동네 병원에서 하셔도 돼요.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+화상 정도에 따라 과산화수소수를 사용할 수 있습니다.,Korean
+부정맥 종류에 따라 치료가 다릅니다.,Korean
+"평소대로 잤고 평균 여섯 시간에 한 시간 정도는 왔다 갔다 해요.
+",Korean
+현기증을 처음 느끼신 건가요?,Korean
+한 가지 방법으로 치료 후 증상 정���에 따라 추가적으로 치료받을 수 있습니다.,Korean
+결핵 치료를 받고 계신가요?,Korean
+암 판정받으신 적 있나요?,Korean
+가슴 통증이 얼마나 가는 거죠?,Korean
+"분유 먹고 토해서 물 같은데 크림 색깔이었어요.
+",Korean
+고혈압 관련해서 어떤 약을 드시고 계신가요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+피부과는 따로 예약하시고 진료받으셔야 합니다.,Korean
+알레르기로 인해 피부약을 먹고 있습니다.,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+만성 부비동염을 갖고 있어요.,Korean
+언제 처음 치매 증상이 나타나셨어요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+말씀드렸다시피 인유두종바이러스도 너무 여러 가지 종류가 있어서 자궁경부암 예방백신과 피부 편평사마귀는 상관관계가 없습니다.,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+복부 내 염증이 있는 경우 그러실 수 있습니다.,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+통증을 참을 수 있나요?,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+배에 가스가 많이 차있나요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+잠들기 전 수면을 방해하는 행동을 하시나요?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+"열이 심하게 나서 어제는 거의 못 잤어요.
+",Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+"얼마 전에 건강검진 결과가 나왔는데 역류성 식도염이 있다고 해서 다시 검사 받으려고 왔어요.
+",Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+네 하지만 적당량의 운동은 권유 드립니다.,Korean
+결핵 때문에 병원 다니신 적이 있나요?,Korean
+알레르기 있는 음식 아시나요?,Korean
+배가 무언가 꽉 찬 느낌이 있나요?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+혈뇨는 언제 처음 보셨나요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+부작용 포함하여 특이사항이 있으셨나요?,Korean
+보통 삼 일 정도 배뇨일지를 작성하게 됩니다.,Korean
+언제 처음 결핵을 앓았나요?,Korean
+사출성 구토에는 여러 원인이 있는데 장의 폐쇄로 인한 경우 호전이 쉽지 않습니다.,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+궁금한 것은 주치의가 환자에게 설명했으니 직접 안내받으시면 됩니다.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+혈뇨는 언제 처음 보셨나요?,Korean
+부종이 발생한 곳이 있나요?,Korean
+몸이 부을 때가 있나요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+결핵 문제는 그동안 없었고요?,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+"배가 아픈데 온몸에서 식은땀이 나더라고요.
+",Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+통증 부위는 어디신 거죠?,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+음식을 삼키기 어렵거나 토할 거 같은 느낌 구토 소화장애와 같은 증상이 있나요?,Korean
+가족 중에 당뇨 치료 이력이 있으면 말해 주세요.,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+알레르기를 언제부터 치료받고 있나요?,Korean
+검사 부위는 일시적으로 붉게 올라올 수 있어요.,Korean
+대변볼 때 안 힘든가요?,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+병원으로 바로 오셔서 소독하셔야 해요.,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+잠을 깊게 잘 수 있나요?,Korean
+질병의 원인이 될 수도 있기 때문입니다.,Korean
+가족 중 유전성 질환을 경험하신 분이 있으십니까?,Korean
+"보름 정도쯤부터 숨이 막히고 호흡이 가쁘고 그런 증상들이 전보다 더 심해졌어요. 그렇게 숨을 몰아쉬고 나면 어지럽고 손발이 덜덜 떨리기도 하고 힘을 줄 수가 없게 되더라고요. 어디가 아픈가 해서 병원에 가봤더니 몸에는 아무런 문제가 없다는 거예요. 근데 의사 선생님이 정신과 진료를 한번 받아보라고 하셔서 와봤어요.
+",Korean
+몸이 안 좋은지는 확답하기가 곤���하네요 검사를 해봐야 알 수 있어요.,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+평소에 가슴이 아프고 그러신가요?,Korean
+재활 교육을 일 회 받아보시는 건 어떠실까요?,Korean
+처방받은 지는 됐는데 아직 한 번도 안 먹었어요.,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+네. 당뇨약 먹고 있고 혈당 검사 정상 수치 나오고 있습니다.,Korean
+마비의 전조증상일 수 있습니다.,Korean
+움직이면 제일 아픈 부분이 어디인가요?,Korean
+소화가 어렵거나 하진 않나요?,Korean
+빈뇨는 여러 질병의 증상이 될 수 있어서 검사를 받아보시는 게 좋겠습니다.,Korean
+"이쪽에 있는 고환이 아파요.
+",Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+네 틀니도 빼셔야 해요.,Korean
+식후 소화가 잘 안 되나요?,Korean
+네 전신 마취는 완전히 잠들어 있는 상태입니다.,Korean
+조직 검사가 필요해 보이네요.,Korean
+"노로바이러스에 걸린 적이 있는데 그 뒤로 해산물은 먹지 않습니다.
+",Korean
+"옆구리 안에 누가 사는 것 같이 아프네요.
+",Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+삼십육 점 사 도 정상이시네요. 여기 체크리스트 서랍장에 붙여둘께요. 퇴원할 때까지 매일 보호자분도 체온 체크할게요.,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+항생제 반응 검사라는 걸 통해서 확인하실 수 있습니다.,Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+보호자에게도 설명 후 서명 할 동의서가 있습니다.,Korean
+보청기 좀 보호자에게 맡겨 주세요.,Korean
+"앞사람 우산 끝에 눈을 찔렸어요.
+",Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+현재 증상 고려할 때 우선 배변을 완화시키는 삼투성 하제를 사용해 보겠습니다.,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+통증이 제일 처음 나타난 게 언제인가요?,Korean
+수면제는 해당 진료과로 가셔야 합니다.,Korean
+입원은 이번이 처음이라는 거죠?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+"두통이 조금 있어요. 열도 나고요.
+",Korean
+언제 첫 증상이 나왔나요?,Korean
+아픔이 몇 분 정도 가나요?,Korean
+풍진에 감염되었는지 알 수 있는 물질입니다.,Korean
+네. 상처 회복이 더 빠를 것입니다.,Korean
+렌즈를 지금 끼고 있어요. 보청기도 있고요.,Korean
+여기가 치료를 잘해주시는 것 같은데 아쉽네요.,Korean
+까스활명수보다 처방받은 약을 추천드립니다.,Korean
+무릎에 부종이 있으면 아무래도 굽히기 힘듭니다.,Korean
+검사를 할 경우 가발을 벗으셔야 한다는 걸 알려드리려고요.,Korean
+틀니로 인해 흔들리는 치아 말입니다.,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+네. 금식은 왜 하나요?,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+횡문근 융해증이란 외상 운동 수술 등의 이유로 근육에 에너지 공급이 충분하지 않아 괴사가 일어나고 이로 인해 생긴 독성 물질이 순환계로 유입되는 질환입니다.,Korean
+우선 회전근개파열을 의심하고 있기 때문에 몇 가지 검사가 필요합니다.,Korean
+"부작용 때문에 안 먹어요.
+",Korean
+흡연 시작한 지 얼마나 되었어요?,Korean
+기침할 때 가래도 같이 나오나요?,Korean
+그 바이러스를 가지고 있으면 어떻게 되는 건가요?,Korean
+네. 그러실 수 있으세요. 이제 외래 다녀오실게요. 밖으로 나가시면 이송 요원분이 안내해 주실 거고 보호자분도 함께 다녀오세요.,Korean
+토를 심하게 한 적이 있나요?,Korean
+네. 소독도 자주 해줘야 하고 아이 상태를 확인하기 위해서는 입원 치료하는 게 좋아요.,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+소변에 피가 묻어 나온 적이 있나요?,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+언제부터 그런 증상이 있었지요?,Korean
+최근에 체중에 변화가 있나요?,Korean
+"고양이가 할퀴었는데 이마에서 피가 나요.
+",Korean
+아프신 이유가 암 때문인가요?,Korean
+네. 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+외관상으로는 상처가 보이지는 않는데 어떻게 아프세요?,Korean
+고혈압이랑 당뇨로 고생하셨는데 지금은 약 안 먹어요.,Korean
+디피시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요.,Korean
+두 병원에서 결과가 다르게 나와서 다시 검사해봐야 할 것 같아요.,Korean
+환자분 건강 문제에 음주가 원인이 될 수 있거든요.,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+환자분은 요로결석이 의심되므로 최대한 빨리 받아주셔야 진단에 도움이 됩니다.,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+근육통 때문에 그때그때 약 사서 먹어요. 게보린 같은 거요.,Korean
+일 층 병원 로비에 있습니다.,Korean
+언제 숨 쉬기가 힘든가요?,Korean
+결핵 때문에 작년 내내 고생했어요.,Korean
+오한이나 재채기 등도 문제에 해당됩니다.,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+불면증이 심하신 거 같아요.,Korean
+예전에 다쳐서 여기 오신 적이 있으세요?,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+오심 구토 증상이 있지는 않았나요?,Korean
+상처 부위에 진물이 찰 수 있기 때문에 소독은 자주 해야 합니다.,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+제 목이랑 왼쪽 팔이요.,Korean
+측정 시에 아이가 깨어 있어야 호흡 측정이 가능합니다.,Korean
+네 병원에 입원한 모든 입원 내용 알려주세요.,Korean
+설사나 구토 등 위장관계 증상이 동반되지는 않았나요?,Korean
+담배 하루에 몇 갑 피나요?,Korean
+"변비가 있어서 참 힘드네요.
+",Korean
+당뇨 치료받아본 가족 분이 있으신가요?,Korean
+치료 기간은 넉넉하게 두세 달 걸립니다.,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+"피곤한 걸로 봐서 요즘 잘 못 자나 봐요.
+",Korean
+소화기 내과 진료 예약하고 가도 되나요?,Korean
+정상적인 소변에는 요산과 암모니아 성분이 들어 있기 때문에 어느 정도 냄새가 나는 것은 정상입니다.,Korean
+통증 정도가 심하시면 진통제 처방해드릴까요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+네 철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+"오늘 기온이 그렇게 낮은 게 아닌데 몸이 으슬으슬 떨리고 두통도 심해요.
+",Korean
+통증이 시작하면 기간이 얼마나 가요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+엑스레이보다 씨티가 정확할 때가 더 많을 수 있어요.,Korean
+통증이 얼마나 자주 생겨요?,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+걱정 마세요 씨티찍어서 문제가 되는 경우는 거의 없어요 특히 조영제를 안 쓰면 더 그렇구요.,Korean
+헬리코박터균 감염 여부는 검사를 해야 합니다.,Korean
+건강 상태가 좋지 않아 유의해 주세요.,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+면회시간이 지나면 병원에 아예 못 들어와요?,Korean
+제대혈은 보통 골수이식이나 희귀 난치성 질환에 사용 가능하다고 알려져 있으며 산모와 가족이 상의하여 결정하십니다.,Korean
+지금 부종이 있는 상태인가요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+아픈 곳이 더 있나요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+지금 나온 백신 맞았죠.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+보호자가 상처 부위를 함께 확인해야 합니다.,Korean
+언제부터 이 증상이 나타났나요?,Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+저희 집 앞에 있는 신설 이비인후과요.,Korean
+"담배 한 대 태웠는데요.
+",Korean
+"샤워하는 중에 갑자기 엄청 뜨거운 물이 나와서 팔이 빨갛게 되었어요.
+",Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+통증 오는 시간이 대략 어떻게 되시나요?,Korean
+초등학생 때 처음 진단받았어요.,Korean
+속이 메슥거릴 때가 많나요?,Korean
+헌혈이 아니라 수혈을 말씀드린 겁니다. 다른 사람의 피로 혈액 보충하신 적 있으신가요?,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+속이 많이 울렁거려서 토하고 싶으신가요?,Korean
+환자분이 수��하시는 이유는 둔위 때문입니다.,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+식후 소화가 잘 안 되나요?,Korean
+그리고 빠른 시일 내에 경정맥신우조영술이라는 조영술과 복부초음파 예약을 잡아 드릴 테니 검사하고 일주일 뒤에 보시죠.,Korean
+피부가 오돌토돌하고 간지러운 증상이 시작된 건 언제인가요?,Korean
+잠시만요 구급차 이송 도와주셨던 분이 메모를 남겨놓고 가셨는데 전해드릴게요.,Korean
+배뇨 장애가 있으신 거예요?,Korean
+통증이 있다 없다 하나요?,Korean
+아픔이 느껴진 게 언제가 처음이죠?,Korean
+소변을 보고 난 후 피가 묻어있나요?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+소독된 환경을 갖추기가 어려우시기 때문에 되도록 병원에 내원해 주세요.,Korean
+서초역 앞에 있는 이비인후과인데 이름은 잘 모르겠어요.,Korean
+사람의 독감이 강아지에게 옮기기도 합니다.,Korean
+해외에서 혹시 코로나 접촉이 있을 수도 있어서요.,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+"어깨 쪽에서 통증이 있는 건 아닌데 계속 뚝 소리가 엄청 크게 나서 관절이나 어디 이상이 있는 게 아닌가 싶어서 왔습니다.
+",Korean
+난임 문제를 해결하기 위해 산부인과를 정기적으로 다니고 있어요.,Korean
+요 근래 식욕이 비정상적으로 떨어지셨나요?,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+그냥 살짝 어지럽던데 이것도 부작용인지 모르겠네요. 그다음 날 괜찮아졌어요.,Korean
+"잔뇨감을 느껴 본 적이 없네요.
+",Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+한의원에서 처방받아서 드시는 건가요?,Korean
+어떤 것에 알레르기가 있나요?,Korean
+갑자기 혈압의 변화가 있거나 열이 나는 증상 등이 발생하지 않는다면 문제없습니다.,Korean
+다른 증상 말씀해 주시면 증상에 따라서 약 처방해 드리겠습니다.,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+담배 하루에 몇 갑 피나요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+약 드시고 알레르기 반응 보인 적 있으세요?,Korean
+"항암제 투여 후에 열이 계속 높아요.
+",Korean
+병실에 계시면 확인 후 바로 연락드릴게요.,Korean
+한번 아프기 시작하면 얼마나 아프시나요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+왜 복통이 생기셨는지 알아봐야 할 것 같습니다.,Korean
+소변을 잘 못 보시나요?,Korean
+"엄지발가락이 양말만 스쳐도 쓰라리고 아려서요.
+",Korean
+급한 내시경일 경우에는 내시경실에 전화 걸어 급하게 일정을 잡습니다.,Korean
+음주 기간 얼마나 되셨어요?,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+"속이 더부룩하고 토할 것 같은 느낌이 있어요.
+",Korean
+통증을 느끼는 부위는 여기가 맞나요?,Korean
+몸에 힘이 없고 무력한가요?,Korean
+약 먹고 물리치료를 꾸준히 하면 회복이 될 겁니다.,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+피부색이 시커멓게 변했다면 장기 이상일 수도 있는데 검사를 해봐야 할 것 같네요.,Korean
+"당뇨로 고생 중인데 요즘 좀 몸이 안 좋아서요.
+",Korean
+무력감이 온몸을 휩싼 증상이 있나요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+"둘 다 하고 있는데 특히 흡연을 더 해요.
+",Korean
+간염 시작된 나이가 언제인가요?,Korean
+"목이 좀 불편한데 호전될 기미를 안 보여서요.
+",Korean
+크기가 좀 되는 흉터들만 말씀해 주시면 될 것 같습니다.,Korean
+네. 알레르기가 원래 심해요.,Korean
+두통이 있어서 병원에 다녀왔어요.,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+제 나이의 정상 키와 몸무게가 얼마쯤 돼요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+감기 예방 주사는 맞았나요?,Korean
+통증 생긴 지는 얼마나 됐나요?,Korean
+아니요. 산모랑 아이가 위험해질 수도 있다고 해서 제왕 절개로 했어요.,Korean
+통증이 자주 있는 편인가요?,Korean
+제 때 약을 드시고 건강 관리에 힘써주시면 점점 좋아질 거라 생각합니다.,Korean
+오한 증상 나타난지 며칠 되었죠?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+"조금만 움직여도 쉽게 피곤해집니다. 특히 오후에 많이 피곤합니다.
+",Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+종종 전조증상이 있기도 해요.,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+통증 강도가 어느 정도 신가요?,Korean
+네. 한 시 전에 해열제 먹였어요.,Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+식후 소화가 잘 안되세요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+"윗니 끝에 있는 어금니요.
+",Korean
+"분유 말고는 안 먹었습니다.
+",Korean
+아니요. 있어도 뭐 감기 정도로 끝났는데요.,Korean
+"먹지도 않는데 몸이 뚱뚱해져서요.
+",Korean
+보철 중에 틀니나 임플란트 브릿지라는 연결해서 하는 보철 중에 가짜치가 들어가 있는 것들을 말합니다.,Korean
+결핵약을 처방받은 적이 있으실까요?,Korean
+수술 전 외출은 가능하시지만 이후 이 주간은 외출 어려우세요.,Korean
+콜라 같은 색의 소변인가요?,Korean
+당뇨 확인은 언제 하셨죠?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+"열은 안 재어봐서 모르겠어요.
+",Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+복부 비만은 건강에 좋지 않습니다.,Korean
+잦은 접종은 면역력 저하를 불러일으킵니다.,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+설사를 며칠 동안 하셨나요?,Korean
+살짝 붓는 거 이외에는 없었어요.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+"어제쯤부터 목이 아파서 왔어요.
+",Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+무릎 연골이 나가서 수술했습니다.,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+다른 심장 관련 질환은 없나요?,Korean
+아니요. 전신마취로 인하여 위장관의 운동이 원활하지가 않으므로 며칠 동안은 유지하셔야 합니다.,Korean
+피부가 제 기능을 다 하는 상태로 돌아가는 것입니다.,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+최근 삼 개월 동안 체중의 변화가 있으셨나요?,Korean
+마취 없이 진행이 됩니다.,Korean
+"왼쪽 코에서만 코피가 나요.
+",Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+이번 연도엔 아직 예방 접종 안 했어요.,Korean
+"탄수화물을 최소로 해 주시겠어요?
+",Korean
+포도당인데 수술하는 도중 주사나 처치할 때 같이 들어갑니다.,Korean
+오늘 받아야 되는 검사 말해주세요.,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+일주일 치만 처방 드리겠습니다. 증상 지속 시 내원하세요.,Korean
+어떤 암인지 알고 있나요?,Korean
+네. 처방 이후에는 어떻게 되는 거죠?,Korean
+"움직이거나 건드리면 막 울어요. 팔도 원래보다 많이 부어 있고요. 혹시 팔 부러진 건가요?
+",Korean
+일단 헌혈도 말씀해 주세요.,Korean
+네 정확한 진단을 하기 위해서는 기침 소리를 잘 구분해야 합니다.,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+통증 있는 부위를 말해 보세요.,Korean
+"아침에 뭘 잘못 먹었는지 배가 계속 아파요.
+",Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+네. 바이러스성 장염은 일반적으로 바이러스 검사 없이 증상과 진찰만으로도 진단하게 됩니다.,Korean
+하루에 설사를 몇 번 했나요?,Korean
+"목에 뭐가 걸렸는데 물을 먹고 해도 안 되네요.
+",Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+혈중 지질 검사 결과를 볼 때 환자분은 고지혈증에 해당합니다.,Korean
+소화는 평소에 잘 되시나요?,Korean
+빈뇨 말고 소변보실 때 또 불편하신 점이 있으신가요?,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+위 내용물이 구강 내로 역류할 수 있고 이로 인해 위 내용물이 기도를 폐쇄하여 질식을 초래할 수 있기 때문이에요.,Korean
+흡연 시작 연령을 기억하세요?,Korean
+위염 때문에 입원한 적이 한 두 번이 아니에요.,Korean
+가족 중에 고혈압 진단이 나오는 분이 있나요?,Korean
+"소변은 다른 때에 비해 소변 색이 진했어요.
+",Korean
+아니요. 무조건 수액을 처방하지는 않습니다.,Korean
+"네. 스무 살즘에 담배 시작했어요.
+",Korean
+그렇습니다. 갑작스럽게 뿜어져 나오듯 나오는 구토입니다.,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+가족들 중에 유전질환으로 고생하는 사람 있나요?,Korean
+약 말고 다른 알레르기는 없나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+"글쎄요 제가 원래 예전부터 머리가 아프면 속이 좀 울렁거리는 거 말고는 없어요.
+",Korean
+틀니가 흔들리지는 않고 깨질 수는 있습니다.,Korean
+정확한 진단을 위해 여쭤보는 거예요.,Korean
+유당이 없는 우유로 대체하시는 건 어떠신가요?,Korean
+만성 부비동염을 갖고 있어요.,Korean
+복통 증상은 언제부터 있었나요?,Korean
+통증 외에 설사나 변비와 같은 증상이 있나요?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+환자분을 위해서도 주위에 전파되는 것을 막기 위해서도 중요합니다.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+아파서 괴롭거나 하지는 않으세요?,Korean
+최근에 당뇨도 와서 당뇨약도 먹어요.,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+"심장이 두근거려서 요새 잠을 잘 못 잡니다.
+",Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+괜찮습니다. 부작용은 흔하게 발생하지는 않습니다.,Korean
+심장이 불규칙적으로 뛴다고 생각하시나요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+흉부 배액관이 없다면 흉부 내에서 출혈액이나 늑막액이 고여 다른 장기 특히 심장을 압박할 경우 상당히 위험할 수 있습니다.,Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+현재까지 복용 중인 약이 있나요?,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+맥박은 아까 따로 재셨나요? 어차피 오래 걸리지 않으니 다시 한번 잴게요.,Korean
+네. 수면 전 신체가 너무 활성화되어 있으면 오히려 수면을 방해합니다.,Korean
+복수가 차거나 염증이 생긴 경우 발생할 수 있습니다.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+설사를 하는 시기가 있나요?,Korean
+귀에서 멍한 소리가 나나요?,Korean
+수술한 지 반 년 정도 지났어요.,Korean
+제 나이의 정상 키와 몸무게가 얼마쯤 돼요?,Korean
+"어제 아이가 낮잠 자다가 침대에서 떨어졌는데 계속 울고 보채서 검사받으러 왔어요.
+",Korean
+한번 아프기 시작하면 얼마나 아프시나요?,Korean
+"생각해보니 변비가 너무 괴로워요.
+",Korean
+"마스크 벗고 들어 올릴까요?
+",Korean
+정확하게 말씀드리기는 힘들지만 증상이 좋아지기까지 일 이주 정도 걸릴 것 같습니다.,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+심장 뛰는 게 불편한가요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+검사 전에는 금식을 유지하셔야 하고 수액을 놔드리도록 하겠습니다.,Korean
+배의 어느 부위가 아프시죠?,Korean
+입원은 이번이 처음이라는 거죠?,Korean
+처방받은 간염약 어떤 건지 아시나요?,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+아니요. 치료부터 받고 면담하기로 돼 있어요.,Korean
+간염은 언제 진단 받으셨나요?,Korean
+암을 진단받은 가족이 있습니까?,Korean
+결핵 주사를 맞으셨는지 알려 주세요.,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+"화장실을 못 가요. 소변을 보지 못하고 있어요.
+",Korean
+입원 관련 안내는 의사 회진 시 확인 가능합니다.,Korean
+가스 차는 원인은 다양하고 일시적인 경우가 많아 지금부터 너무 걱정하실 필요는 없습니다.,Korean
+토를 심하게 한 적이 있나요?,Korean
+아니요. 조영제가 뭔지도 모르는걸요?,Korean
+"네. 술도 그렇고 담배도 아직도 많이 피우네요.
+",Korean
+"몸을 거동하기 힘들 정도로 통증과 함께 힘이 없어요.
+",Korean
+설사를 보시고 나면 속은 좀 어떠세요?,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+기본적으로 수액을 맞긴 합니다.,Korean
+과거에 똑같은 증상이 있었나요?,Korean
+그럴 땐 약을 드시는 편이 나아요.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+멸균 처리해서 ���을 없앤 거라고 보시면 됩니다.,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+지금 바로 퇴원 도와드릴까요?,Korean
+하반신 마취만 한 상태에서 수술했어요.,Korean
+"뼈가 자주 부러져서 우유랑 멸치로 칼슘 보충 매일 합니다.
+",Korean
+어느 부위에 통증을 느끼세요?,Korean
+알레르기 반응에 또 다른 반응이 있나요?,Korean
+기침 소리는 질환을 진단하는데 있어서 기본 정보가 되기 때문입니다.,Korean
+햇빛이 닿으면 장기적인 색소침착이 일어날 수 있습니다.,Korean
+방광염이 좀 있어서 약 먹고 있어요.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+심한 자극을 주거나 전기적 충격을 가한 적이 있으신가요?,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+네 확인하고 엑스레이 찍으러 가는 게 좋겠네요.,Korean
+도수 정복 자체가 위험하지는 않으므로 먼저 시도해본 다음 수술적 치료를 고려하는 것이 바람직할 것입니다.,Korean
+결핵 백신 접종을 언제 하신 거예요?,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+목에 통증이 계속 있나요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+특정한 것에 알레르기가 있나요?,Korean
+"네. 스무 살즘에 담배 시작했어요.
+",Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+지금 어디가 아픈 건가요?,Korean
+기침과 함께 다른 증상도 있으신가요?,Korean
+응급실에 같이 가셔서 체온 검사를 받아보는게 좋을 것 같아요.,Korean
+위에 장에서 보이는 상피세포들이 발견되는 현상입니다.,Korean
+"허리가 아프니 자세가 불편해서 배변이 힘듭니다.
+",Korean
+애완견 접종 유무 상태를 알기 위해 여쭤보는 겁니다.,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+가려움 완화 연고를 처방해 드릴 수 있어요.,Korean
+"제가 변비가 있어서 사일 정도 된 듯싶어요.
+",Korean
+때때로 먹는 약도 포함해서 알려주세요.,Korean
+환자분의 체질량지수가 약간 정상 범위를 벗어났네요. 조금 줄여봅시다.,Korean
+호흡곤란이 온 적 있어요?,Korean
+"팔꿈치 수술을 받았었는데 펼 수가 없어요.
+",Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+"귀에서 삐 소리가 계속해서 들려요.
+",Korean
+수면 비수면은 환자분 선택입니다. 환자분이 원하는 대로 당일에 말씀해 주시면 되고 수면 원하시면 보호자분 함께 오셔야 합니다. 당일날은 운전하시면 안됩니다.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+이 차 감염 등이 없다면 큰 부작용은 없습니다.,Korean
+대변검사 일정은 좀 미뤄도 될까요?,Korean
+구급차를 이용하셨을 경우 비용 청구 관련하여 확인이 필요하여 여쭈어보았습니다.,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+땅콩에 알레르기 반응 있어요.,Korean
+손가락 정도의 두께이며 목 넘김 때에는 불편하실 수 있지만 삽입 후에는 괜찮으실 겁니다.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+이천일 년부터 이 병에 대한 제 고생이 시작됐어요.,Korean
+소화가 안 돼서 까스활명수 하나 먹었어요.,Korean
+고혈압 환자가 가족 중에 있을까요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+"식도에 정맥류 생긴 것 아닌가요?
+",Korean
+수술 전 항생제를 투여하기 위하여 항생제 반응 검사를 시행하겠습니다.,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+네 소변줄을 통해 간호사가 시간별로 소변량을 측정할 거예요.,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+통증이 어느 정도 심한가요?,Korean
+대부분 심각한 합병증 없이 회복이 가능하여 단기간 입원 후 퇴원 가능합니다.,Korean
+고혈압약 요즘 드시는 것이 있나요?,Korean
+겉으로 봐서는 알 수 없으니 진료 후 확인해 보겠습니다.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+"아파서 소변볼 때마다 울먹인 것 말고는 없어요.
+",Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+맹장염에 동반되는 다른 증상들은 없으셨나요? 가스가 찬다거나 배가 부푼다거나 등등이요.,Korean
+얼마에 한 번씩 아픈가요?,Korean
+가족 중에 고혈압이신 분 있어요?,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+기침할 때 목이 많이 아픈가요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+전신 마취 경험은 없으신가 해서요.,Korean
+귀 뒤에 통증이 있나요?,Korean
+외래 진료 때 만나셨던 선생님을 말씀하시는 건가요?,Korean
+네. 약에 너무 의지하시면 안 돼요.,Korean
+환자분 상태가 괜찮아지면 바로 옮겨드릴 거예요.,Korean
+약을 원래 잘 안 먹어요.,Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+마취통증의학과 의사가 참고하여 변경될 수도 있습니다.,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+젊었을 때 결핵 한 번 앓았지.,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+원인을 빨리 찾기 위해 검사를 해 보고 힘들하시면 증상 조절을 조금 해드리겠습니다.,Korean
+소변보는 데 불편한 점이 있나요?,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+아픈 곳 좀 말해 주세요.,Korean
+지속적으로 기침을 하고 계신가요?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+혹시 보청기나 의안 틀니 임플란트 지팡이 등 보조 기구 사용하시는 게 있으실까요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+올해 초에 입원하긴 했는데 삼 개월 이내에는 해본 적 없어요.,Korean
+다리가 어떻게 저린지 상세히 말씀해 주시겠습니까?,Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+목 안쪽으로 풍선 같은 걸 부풀려서 지혈했기 때문에 조금 아프실 수도 있을 거예요.,Korean
+확률은 낮지만 위선암 림프종과의 연관성이 있습니다.,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+"앉았다가 일어나려면 다리에 힘이 안 들어가요.
+",Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+뇌졸중 오신 적 있으세요.,Korean
+예전에 암 수술받은 적 있어요.,Korean
+통증은 없고 띵한 느낌만 있으세요?,Korean
+소변보는 데 불편한 점이 있나요?,Korean
+몸에 갑자기 열이 나나요?,Korean
+현재 간 수치가 높은 편인가요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+현재 추가 증상이 없다면 같은 결과가 나올 확률이 큽니다.,Korean
+진통제를 복용한 지 얼마 안 됐으니 조금만 더 경과를 보겠습니다.,Korean
+혈압이 높은데 고혈압 진단 받은적 있나요?,Korean
+진통제를 맞고도 계속 그런가요?,Korean
+비형 간염 예방접종 맞으셔야 합니다.,Korean
+피검사와 수액 보충 먼저 하면서 다시 설명드릴게요.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+영양제나 비타민 같은 거 말고 처방받아서 드시는 약 없으세요?,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+네. 전 이석증을 앓고 있어요.,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+다른 건 다 괜찮은데 계란이나 우유 들어간 음식을 먹으면 두드러기가 심하게 올라와서요.,Korean
+신장도 안 좋아 신장약도 복용 중입니다.,Korean
+제대혈은 보통 골수이식이나 희귀 난치성 질환에 사용 가능하다고 알려져 있으며 산모와 가족이 상의하여 결정하십니다.,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+대변을 매일 보지는 않으시나요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+가족 중에 고혈압 질환을 진단받으신 분이 있으세요?,Korean
+암인지는 검사 후에 결과가 나오기까지 시간이 좀 걸려서요 다시 안내 도와드리도록 하겠습니다.,Korean
+피가 섞인 소변을 봤나요?,Korean
+빨리 회복하기 위해서는 소독을 주기적으로 해 줘야 균에 감염이 되지 않아요.,Korean
+"대상포진인 것 같아요. 너무 아프네요.
+",Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+"넘어져서 다리 부러지는 거 빼고는 병원에 올 일이 없었죠.
+",Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+예방 접종 성분과 비슷한 성분의 약을 처방 예정입니다.,Korean
+진료가 많이 지연되어 기다리시기 힘드시죠? 조금만 기다리면 설명해주실 겁니다. 검사 결과 설명 후에 퇴원 진행해드려도 괜찮을까요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+일 층 병원 로비에 있습니다.,Korean
+수술 중 위 내용물이 역류해 환자분의 기도를 막을 수 있어요.,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+예방접종 접수하셔서요 부작용이 있었나 해서 여쭤보는 겁니다.,Korean
+일주일에 몇 번 변을 보나요?,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+계속 먹고 있는 간염약이 있나요?,Korean
+담배 피우신 기간이 얼마나 되나요?,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+아픔이 몇 분 정도 가나요?,Korean
+네. 아버지가 신장 쪽에 문제가 있었어요.,Korean
+수술 후 당분간 통증이 있을 수 있습니다.,Korean
+제일 덜 오는 통증 부위가 어디예요?,Korean
+가래에 피도 같이 나온적 있나요?,Korean
+가슴 통증이 있지는 않나요?,Korean
+아픈 곳이 더 있나요?,Korean
+졸린데 눈을 감아도 잠들기 어려우신가요?,Korean
+네. 대부분 약물 치료로 가능하고 일부 시술이 필요할 수도 있습니다.,Korean
+온몸에 좀 오한이 있으세요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+담배를 피우신 경험이 있나요?,Korean
+"얼마 전부터 성기 부분이 좀 가려워서 봤더니 수포 같은 게 있는 것 같아요.
+",Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+아니요 화상은 기형에 포함되지 않습니다.,Korean
+성인 기준 권장 수면 시간이 일곱 여덟 시간 정도이니 잘 주무셨네요.,Korean
+다음 주 월요일 진료받고 싶은데 몇 시에 가능한가요?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+언제 독감 예방 접종 받으셨어요?,Korean
+해열제 먹으면 바로 효과가 오나요?,Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+네. 마스크 절대 벗지 않겠습니다.,Korean
+혈변에 피가 많이 보였나요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+네 정확한 무게 측정을 위해서는 신발을 벗으셔야 합니다.,Korean
+"아이가 자전거를 타다가 옆으로 떨어지면서 왼쪽 어깨를 부딪치고 머리를 부딪친 것 같아요.
+",Korean
+"변 보고 나면 빨간 피가 많이 묻어 나와요.
+",Korean
+하루에 담배 몇 대나 피우세요?,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+흉터가 덧나지 않게 연고를 잘 바르셔야 합니다.,Korean
+식구들 중에 다른 유전성 질환 환자가 있나요?,Korean
+가슴이 찌를 듯이 아픈가요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+입원 수속 후에 질병의 완화를 위한 치료 경험이 있으신지 여쭙는 겁니다.,Korean
+"입원 좀 하려 해요.
+",Korean
+아니요. 우선은 병실로 이동 하고 병실에서 안정을 취하시면 됩니다.,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+"옆구리 부근 통증이 극심해요.
+",Korean
+환자분의 몸에 별다른 이상은 없는지 네 가지 검사를 통해서 알아보려고 하는 겁니다.,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+"아기 사타구니에 혹 같은 게 있어서요.
+",Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+고혈압약 평소에 드시고 있는 거 있으세요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+숨 쉴 때 힘드신가요?,Korean
+몇 가지의 알레르기가 있나요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+비수면 내시경에 수면 비용이 추가됩니다.,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+"아이코스 하루 한 갑 피워요. 스물두 살부터 피운 거 같아요.
+",Korean
+가슴 두근거림이 자주 있으세요?,Korean
+냉동요법으로 사마귀를 제거하기도 합니다.,Korean
+"네. 그래서 병원도 겨우 왔어요.
+",Korean
+전해질 수치에 다소 비정상적인 부분이 있네요.,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+"음식 냄새만 맡아도 자꾸 토해서요.
+",Korean
+"갑자기 알 수 없는 흉통이 있었어요.
+",Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+환자분의 안전을 위해선 정확하게 진행하는 것이 좋죠.,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+지금 혈압 측정 중이니 말씀하지 말고 잠시만 계세요. 끝나면 결과 알려드릴게요.,Korean
+치료방법이나 처치에 따라 입원 기간은 수개월 이상이 걸릴 수 있습니다.,Korean
+"교정 중인데 자꾸 입안을 부딪히다 보니 통증이 있어요.
+",Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+하루에 몇 번 정도 아픈가요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+지금 아토피 치료받고 있어요.,Korean
+소양감은 간지러운 증상을 이야기합니다.,Korean
+등에 베개를 받쳐서 옆으로 눕게 도와주세요.,Korean
+아이 설사가 심해서 지사제 먹었어요.,Korean
+모니터상에 수축이 보이는데 강하지는 않군요.,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+잠시만 입으로 숨을 쉬어 주시면 냄새가 덜 나실 거예요.,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+"검붉은 변이 덩어리 채 나왔네요.
+",Korean
+"아니요. 뭘 먹어도 목이 따끔거려요.
+",Korean
+중간에 자의로 복용을 중단하면 항생제 내성이 생길 수 있으며 치료 실패율이 높아집니다,Korean
+면담 위해 진료실 다녀오신 거 아닌가요?,Korean
+"애가 거의 삼 일 전부터 밥 먹고 나서 계속 토를 해서 왔습니다.
+",Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+소아암으로 초등학교 들어가기 전에 병원에 오래 있었습니다.,Korean
+"신장 기능에 문제가 생겼다고 들었던 것 같네요.
+",Korean
+이전에 고혈압 얘기 들은 적 있나요?,Korean
+"자주 피가 섞여서 나와요.
+",Korean
+네. 손 따는 것도 민간요법이라 할 수 있습니다.,Korean
+혈압 수치 알고 계세요?,Korean
+환자분은 교통사고가 나서 출혈이 심하셨기 때문에 입원하게 되셨어요.,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+오른쪽 무릎 관절이 이상한 것 같아요.,Korean
+가족 중에 고혈압 가지고 있는 분 계신가요?,Korean
+청진할 때 옷을 올려 주시는 게 좋아요.,Korean
+지금 진찰받기 전에 건강은 어떠셨나요?,Korean
+"뺨이 많이 아프고 볼이 많이 부었어요.
+",Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+네 임플란트는 언제 받으셨어요?,Korean
+이 병원 처음 왔을 거예요.,Korean
+요즘 혹시 흉통이 있나요?,Korean
+혈뇨를 볼 때 통증이 동반되나요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+연초로 가정해서 대강 흡연량을 말해주시면 돼요.,Korean
+증세가 악화된 때가 언제인가요?,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+대변을 볼 때 피가 보이나요?,Korean
+"약이랑 봉투를 함께 삼켜서요.
+",Korean
+마취가 필요하면 알려 드리겠습니다.,Korean
+먼저 입원을 위해 간단한 진찰을 진행하도록 하겠습니다.,Korean
+마취가 잘 안 풀렸습니다.,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+아니요 원래 약 효과로 조금은 찌지만 지금은 너무 많이 쪄서 한번 진료를 받아야 할 것 같습니다.,Korean
+몸에 힘이 없고 무력한가요?,Korean
+네. 집 앞에 병원으로 가서 바로 진료받았죠.,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+면역력 증진을 위해 한약을 복용하고 있었습니다.,Korean
+거의 통증은 없다고 생각하시면 됩니다.,Korean
+복수가 차거나 염증이 생긴 경우 발생할 수 있습니다.,Korean
+통증 시작된 날짜 기억나요?,Korean
+심장이 터질 것 같은 느낌이 드시나요?,Korean
+네 그냥 약 처방 시 참고하기 ���해 드린 질문입니다.,Korean
+약은 아침에 드셔야 됩니다.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+육안으로 노랗게 보이며 소양감이 있을 수 있습니다.,Korean
+현재 담배를 피우고 계신건가요?,Korean
+손목 관절의 움직임을 최소화할 수 있도록 보호대를 착용하는 것이 좋습니다.,Korean
+아들이 데려가서 저번 주에 독감 예방 주사 맞았지.,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+십이 최고 아픈 거라면 어느 정도의 통증인가요?,Korean
+몸에 좋다고 아무 약이나 드시면 안 됩니다.,Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+혈압 재겠습니다. 혈압이 언제 떨어졌나요?,Korean
+검사의 목적 검사의 부작용 검사의 대안 등이 동의서의 내용입니다.,Korean
+저희가 드리는 약을 복용하시는 게 좋을 것 같습니다.,Korean
+그전에는 음주와 흡연을 얼마나 하셨나요?,Korean
+언제 이런 통증을 느끼셨어요?,Korean
+최고 아플 때마다 진통제 먹었었어요.,Korean
+증상 발현 직전에 드셨던 음식은 기억하시나요?,Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+"아니요. 위염이 심해서 안 먹어요.
+",Korean
+질병이 진행한 경우에는 단순히 쉬는 것만으로 증상이 자연적으로 좋아지지는 않습니다.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+"생각해보니 변비가 너무 심해서 일상생활이 힘들 정도입니다.
+",Korean
+"통증 발생 후 통증으로 수면 시간이 많이 줄었습니다.
+",Korean
+음주량 좀 알려 줘요.,Korean
+두통이 얼마나 자주 느껴져요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+감염 경로 확인차 하는 질문이었습니다.,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+네. 수술 후 특별한 문제가 없으시다면 빠른 시일 내에 퇴원이 가능합니다.,Korean
+"무릎 뒤쪽도 같이 아프네요.
+",Korean
+네 엑스레이 찍고 확인하겠습니다.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+설사를 하신 경험이 있나요?,Korean
+오늘 퇴원하실 수 있어요.,Korean
+엑스레이 확인 후 제거하도록 하겠습니다.,Korean
+소변은 보통 연한 노란색이나 황갈색을 띠게 됩니다.,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+시력이 안 좋으시군요 다른 책자 드릴게요.,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+"물 같은 설사이긴 한데 양이 적고 색은 처음엔 갈색이었다가 점점 연해졌어요.
+",Korean
+허리를 삐끗해서 한의원 다녔는데.,Korean
+가족 중에 당 수치가 높은 분이 있나요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+네 꾸준히 복용 중이시거나 추가로 복용 시작한 약물요.,Korean
+알레르기 반응을 일으키는 약은 없나요?,Korean
+대변을 매일 보지는 않으시나요?,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+"열이 나서 그런지 새벽에 자주 깨요.
+",Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+아프기 시작하면 얼마나 오래 아프신가요?,Korean
+콜라겐 말고 다른 약 드시는 건 없으신가요?,Korean
+목으로 피가 조금 올라오나요?,Korean
+소변 흐름을 막는 겁니다.,Korean
+혈압은 금방 좋아질 겁니다.,Korean
+암으로 드시는 약 있어요?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+영유아 때 잠깐 입원했었어요.,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+제가 지금 손을 다쳐서 불러드릴 테니까 대신 작성?부탁드릴게요.,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+단기간에 체중이 많이 늘었나요?,Korean
+"숨쉬기가 힘들 때가 있어요.
+",Korean
+종양 치료받은 적 있으세요?,Korean
+약물 치료로 부족하다면 손목 수술 방법도 있습니다.,Korean
+"아프기 전과 후로 수면 시간이 서너 시간 줄었습니다.
+",Korean
+"네. 상처 난 듯이 아파요.
+",Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+고혈압 약물치료를 하고 계신가요?,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+현기증이 생긴 적 있나요?,Korean
+지금 수술방으로 이동 중입니다.,Korean
+아침부터 혈압이 높았던 것 같은데요.,Korean
+수술받은 곳 통증은 어때요?,Korean
+호흡이 조금 가빠 오면 간호사 선생님을 호출하세요.,Korean
+"다리가 칼로 찌르는 듯이 심하게 쑤셔요.
+",Korean
+항생제 과용은 부작용을 일으킬 수 있어 조심해야 합니다.,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+약 용량이 많을 경우 오래 지속될 수도 있습니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+"목 안이 너무 아픕니다.
+",Korean
+일단 검사를 통해서 상태를 보고 말씀드릴게요.,Korean
+아니요 콧줄은 계속 끼고 계셔야 합니다.,Korean
+당뇨로 어떤 약을 드시고 계세요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+관련이 있다고 뚜렷히 말씀드리기는 어렵지만 의료기록에 적어두고 참고하겠습니다.,Korean
+약을 먹기 전 주로 어떤 증상이 나타나나요?,Korean
+네. 급성기의 치료가 중요하기 때문에 지금 시기에 오신 것은 매우 잘 하신 것입니다.,Korean
+수술 중 과다출혈의 경우 수혈을 해야 할 수도 있습니다.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+소변에 피가 묻어 나온 적이 있나요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+통증이 느껴진다면 어떤 느낌인가요?,Korean
+네. 그러면 수술을 위해 입원해야 하나요?,Korean
+가장 중요한 신경학적 검진 중 하나입니다.,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+타고 있는 담배에서 나오는 연기는 입자의 크기가 작아 폐의 깊은 부분까지 들어갈 수 있어 더 안 좋습니다.,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+네. 그래야 처방할 때 도움이 될 것 같아서요.,Korean
+열이 나거나 구역질이 나는 등 이상 증상이요.,Korean
+"어제저녁 먹으면서 삼킬 때마다 계속 엄마 목 아파라고 했어요.
+",Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+환자분 오늘 자정 이후로는 물도 드시면 안 되는 금식인 거 아시죠? 여기 침상 위에 금식 딱지도 붙여놨어요.,Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+보호자분은 아이 열 내릴 동안 옆에 같이 계셔주시기만 하면 됩니다.,Korean
+없어요. 흉터만 안 생기게 해주세요.,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+다친 적은 없고 삐끗해서 한의원에서 침 맞은 적은 있어요.,Korean
+테라마이신을 자주 발라주는 것이 중요하므로 여러 개 필요합니다.,Korean
+계속 밤에 잠에 들지 못하나요?,Korean
+"간을 더 약하게 해주실 수 있나요?
+",Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+흔하지 않지만 대장암과 같은 질환 가능성도 있습니다.,Korean
+네. 마취 풀리고 바로 움직였었거든요.,Korean
+부종이 발생한 곳이 있나요?,Korean
+"소화도 안 되고 계속 먹기만 하면 토해요.
+",Korean
+위중한 질환일 수 있지만 지금 속단하긴 이릅니다.,Korean
+네. 잘하고 계십니다. 폐에 마취 가스가 남아있으면 폐 합병증이 발생할 수 있으니까요 보호자분이 옆에서 계속 주무시지 않게 도와주시고 심호흡과 기침 같이 해주세요.,Korean
+가스는 장 안에서 차는 것이라서 장이 풍선처럼 빵빵해질 수는 있지만 이로 인해서 주변 장기가 눌리는 경우는 드뭅니다.,Korean
+붓기 있는 곳을 알려 주시겠어요?,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+네. 약한 빈혈이 있어요.,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+뾰루지에 된장 바르는 거요.,Korean
+알레르기 진단은 언제 받았나요?,Korean
+목 구멍 쪽엔 통증이 계속되나요?,Korean
+"치즈 먹고 알레르기 생겨서 피하게 되네요.
+",Korean
+좀 더 약한 약으로 바꿉시다.,Korean
+통증 발병하면 얼마 동안 가나요?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+올해 독감 예방 주사는 어떻게 하셨어요?,Korean
+두통이 가장 심할 때가 언제인가요?,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+네. 방역 수칙에 따라 진행하고 있습니다.,Korean
+피부가 입 속에 있는 구조물들이 자라는 속도를 못 따라올 수 있어서 어느 정도 성장 후에 재수술을 진행하는 겁니다.,Korean
+혹시 응급 상황이라면 수술을 해야 해서요.,Korean
+"치질 관련 질병은 없습니다.
+",Korean
+입원 치료한 적 있으신가요?,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+"대변볼 때 뭔가 다 쏟아내지 못하는 듯해요.
+",Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+약은 없고 영양제 쭉 먹어요.,Korean
+약이 과다하게 들어가면 산모에게 좋지 않을 수 있습니다.,Korean
+네 안면 홍조인 것 같네요.,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+혈변을 유발할 위궤양 증상이 있나요?,Korean
+장염 증상이 있어서 내과 들렀던 것 같아요.,Korean
+올해는 예방 접종한 것 자체가 없어요.,Korean
+부정맥이라는데 증상이 없어서 일단 지켜보고 있습니다.,Korean
+오한이 있는 것 같나요?,Korean
+간호사님이 가르쳐 줄 거예요 잠깐 계셔보실래요?,Korean
+당뇨 가족력이 있다면 알려주세요.,Korean
+네 알레르기 특별히 없어요.,Korean
+통증 주기가 몇 주인가요?,Korean
+머리 어느 부분을 부딪히셨나요? 보여 주시겠어요?,Korean
+"먹던 약이 있어서 약만 먹었습니다.
+",Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+약국 가서 엄마가 제 증상 말하고 얻어온 약 먹었는데 뭔지는 모르겠어요.,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+"고환을 차였는데 한쪽 고환이 모양이 변해서 왔어요.
+",Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+발작 증상을 완화하는 데에는 큰 도움이 됩니다.,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+아픈 건 어느 정도인가요?,Korean
+진단받으신 지 얼마나 되셨어요?,Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+레이저 치료가 끝난 뒤에 통증이 유발되는 경우도 가끔 있습니다.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+변비약을 드셔야만 변을 보세요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+"갑자기 심장이 두근거리고 숨이 막힐 것 같고 죽을 것 같고 하는 증상이 반복적으로 나타나서요.
+",Korean
+별로 아프진 않은데 간혹 조영제 들어가는 팔이 뻐근할 수는 있어요.,Korean
+두통으로 불편한 점은 없나요?,Korean
+종합 비타민으로 모든 영양소를 대체할 수는 없어요.,Korean
+제가 이틀 후는 안 되는데 이틀마다 소독 받아야 하면 어떡해요?,Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+"기침 호흡 곤란도 있고요. 심할 때는 가슴이 답답하고 오한도 느껴져요.
+",Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+간염으로 약을 드시고 계세요?,Korean
+자녀가 셋 있는데 다 제왕절개했습니다.,Korean
+"전에 다친 엉덩이가 너무 아파서 왔어요.
+",Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+자세한 검사를 통해 진단을 먼저 해야 할 것 같아서 초음파 후 말씀드리겠습니다.,Korean
+간염 판정은 언제 받았나요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+발기가 오랜 시간 지속되지 못하나요?,Korean
+상처에 습윤이 유지되는 효과가 있습니다.,Korean
+얼마나 심하게 오한이 느껴지나요?,Korean
+집 근처 병원에서 소독하시는 게 편하실 거예요.,Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+"무슨 소변 보는 길 쪽에 염증이 났다고 하셨어요.
+",Korean
+피부가 손상받을 수 있습니다.,Korean
+정말 조금 부어올랐네요 통증이 있으신가요?,Korean
+생리 때 아픈 건 예외죠?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+"혀에 뭐가 난 것 같아요.
+",Korean
+결핵 증상이 언제부터 나타났는지 아시나요?,Korean
+잘 못 자서 힘드세요?,Korean
+네 오염된 식품을 매개로 감염되는 바이러스도 있습니다.,Korean
+손목을 받쳐주는 보호대도 있습니다.,Korean
+소변에 피가 섞여 나오나요?,Korean
+아뇨 식습관을 여쭤본 것이에요.,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+맹장 수술 한적 한 번 있어요.,Korean
+제가 약물 알레르기가 있어요. 그것만 체크해 주세요.,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+네 바이러스가 어떤 원인으로 감염됐는지 확실히 알기 어렵습니다.,Korean
+환자분의 상태를 파악하기 위함입니다. 민감한 부위라면 흉터 크기나 모양이 어떻게 되시나요?,Korean
+통증은 있지만 마취 크림 바르면 덜 하실 겁니다.,Korean
+부모님 중에 암 병력이 있나요?,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+많이 오래 기다려야 하면 다른 병원 갈게요.,Korean
+네. 한 가지 있는데 응급실로만 내원해야 하나요?,Korean
+"성인 되고부터 피웠다가 일 년쯤 지나서 끊었어요.
+",Korean
+증상이 나타나면 약물을 중지하시고 진료받으셔야 합니다.,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+"소변 색은 잘 살펴보지 않았어요. 죄송해요.
+",Korean
+네 무슨 이유로 보약을 드셨나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+발기가 오랜 시간 지속되지 못하나요?,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+그냥 보약 먹는 것 말고는 없어요.,Korean
+약은 있으나 확인이 필요합니다.,Korean
+경정맥신우조영술은 조영제가 신장으로 배설되는 것을 촬영하여 신장 기능을 확인하는 검사입니다.,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+"아까 약 먹을 때요.
+",Korean
+네. 그래서 오자마자 검사받았어요.,Korean
+태어나고 몇 개월 동안 예방 접종하신 게 다일까요?,Korean
+육안으로 전혀 부은 게 보이지 않습니다.,Korean
+겨드랑이 쪽 시술을 한 번 받고 일주일 정도 입원했던 적이 있어요.,Korean
+식중독 발생 위험성을 고려할 때 되도록 익혀서 드시는 것이 바람직합니다.,Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+진통제를 복용한 지 얼마 안 됐으니 조금만 더 경과를 보겠습니다.,Korean
+담배는 하루에 몇 갑 피시나요?,Korean
+평소에도 두드러기가 자주 나는 편이었나요?,Korean
+"표현을 못 하겠는데 허리 디스크가 터진 것처럼 아프네요.
+",Korean
+"어제저녁부터 열이 펄펄 나서요.
+",Korean
+목에 인후통 증상이 있나요?,Korean
+"놀이터에서 놀다 놀이기구에서 떨어졌어요. 그 뒤로 가슴이 아프대요.
+",Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+피가 섞인 소변을 보신 적이 있나요?,Korean
+언제부터 메슥거리는 느낌이 시작됐죠?,Korean
+동생이 어렸을 때부터 인슐린 주사를 맞았어요.,Korean
+카페인 때문에 검사 결과가 잘 나오지 않는 경우도 있습니다.,Korean
+종교 때문에 수혈이 힘들 것 같습니다.,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+피부 진피층이 손상된 경우 회복하는 데에 수개월 이상이 걸릴 수 있습니다.,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+특정 음식에 알레르기가 있습니까?,Korean
+구토의 양상에 따라 다른 약물 사용이 필요합니다.,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+"콘센트 고치다가 전기에 감전되었어요.
+",Korean
+통증이 어느 부위에 집중되나요?,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+지금 환자분이 가장 불편한 데를 짚어주시겠어요?,Korean
+환자 이름은 오나영. 먹은 약 이름은 잘 모르겠어요.,Korean
+암 환자가 가족 중에 있을까요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+코로나 관련 문진표를 채워주세요.,Korean
+계속 먹고 있는 간염약이 있나요?,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+이번 주 내로 연락이 가면 그때 외래 날짜 잡으세요.,Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+네 상황에 따라 마취약을 바꾸거나 양을 조절할 수 있습니다.,Korean
+환자와 관련해서 안내드릴께 있어 여쭤보았습니다.,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+"옛날에는 소변이 마려워도 어느 정도는 거뜬히 참았는데 이제는 바로 해결하지 않으면 도저히 참을 수가 없어요.
+",Korean
+물에 많이 닿았다면 드레싱 다시 해야 합니다.,Korean
+최근에 몸무게가 급격히 바뀌었나요?,Korean
+"꼭 열두 시부터 금식해야 하나요?
+",Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+흔하지 않기만 대장암과 같은 질환 가능성도 있습니다.,Korean
+"왼쪽 손가락이 아프더니 지금은 아예 손 자체가 빨갛게 부었어요.
+",Korean
+토혈 후 어지럽지는 않았나요?,Korean
+몇 시�� 단위로 통증이 지속되나요?,Korean
+수술 후 치료를 다시 받았나요?,Korean
+예방주사 맞은 날짜를 알려주실래요?,Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+지금 아픈 곳 말하세요.,Korean
+할머니가 파킨슨병이 있으셨어요. 할아버지는 암이셨고요.,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+두드러기가 나면 정상은 아닙니다.,Korean
+"잘 때 머리가 너무 아파요.
+",Korean
+"아기 체온을 재봤는데 너무 높게 나왔어요.
+",Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+"쥐어짜는 것 같은 통증이 왼쪽 가슴에 있어서 병원에 왔어요.
+",Korean
+"귀가 좀 안 들립니다.
+",Korean
+부모님 중 김신우님과 비슷한 증상이 있으신 분이 계신가요?,Korean
+"삼키는 게 힘들어서 유동식 조금만 먹고 있어요.
+",Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+주사 치료로 개선이 된다면 수술 치료는 굳이 안 하셔도 됩니다.,Korean
+내시경 검사를 통해 위장관 내부를 잘 관찰하기 위해서 금식이 필요합니다.,Korean
+"애기 기침 소리가 이상하네요.
+",Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+면회 가능 시간은 정해져 있습니다.,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+코에다 하루 한두 번씩 뿌려 주는 약물이 비강 스테로이드입니다.,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+심장이 불규칙적으로 뛴다고 생각하시나요?,Korean
+"어제저녁부터 굶었는데 언제부터 먹을 수 있나요?
+",Korean
+잘 모르겠어요. 그냥 고혈압이 조금 있다 정도였던 것 같아요.,Korean
+때때로 먹는 약도 포함해서 알려주세요.,Korean
+국소마취로는 아이가 힘들 수 있습니다.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+비형간염 예방 접종 후 이상 반응은 없으신가요?,Korean
+하루에 몇 개비 피우시나요?,Korean
+간염으로 드시는 약이 있나요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+마지막으로 주사 맞은 병원에 전화해서 문의해보세요.,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+일일구 타고 병원 와서 이동 침대로 옮겨서 들어왔어요.,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+오한이 있어서 춥고 떨리나요?,Korean
+투석실에서 전문 인력이 진행해 줄 겁니다.,Korean
+빈혈이 상당히 심해서 걷다가 주저앉은 적도 있어요.,Korean
+바늘로 찌르는 듯한 통증인가요?,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+알레르기로 기피하는 음식 있나요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+많은 질환을 혈액검사로 알 수 있습니다.,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+가족 중에 유전성 질환 치료 받으시는 분 계세요?,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+무슨 약인지 전혀 모르겠습니다.,Korean
+음식이 잘 들어가지 않나요?,Korean
+무료 예방 접종 주사 맞았는데 뭔지는 모르겠네.,Korean
+고혈압 환자가 가족 중에 계시나요?,Korean
+"재활 치료보다는 재수술을 받고 싶어요.
+",Korean
+주기적으로 환자분들 수분 섭취 시간을 기록하기 위해서 여쭤본 겁니다.,Korean
+아니요. 그냥 감기 수준 정도로만.,Korean
+호흡하기 힘들 때가 많나요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+네 언제부터 기침이 있으셨나요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+통증을 느끼는 부위는 여기가 맞나요?,Korean
+혹시 전신 무력감이 있나요?,Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+약은 잘 먹고 있어요. 혈당은 엉망이지만요.,Korean
+간호 간병 병동이 아니므로 보호자가 상주하셔야 합니다.,Korean
+아 천식은 불치병 아닌���요?,Korean
+네 바로 금식해 주시면 됩니다.,Korean
+검사 후에 치료가 진행될지 여부는 검사가 끝나야 알 것 같아요.,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+야식을 자주 드시면 뇌혈관 질환 심장 질환 등의 위험이 높아져요.,Korean
+수술 중에 녹음기를 켜놔도 될까요?,Korean
+수면시간이 부족하네요. 그것 때문에 신체적으로 힘든 점은 없나요?,Korean
+경우에 따라서는 조직검사를 결과를 확인하고 영상검사 등 추가적인 검사 후에 치료 방향을 결정할 수도 있습니다.,Korean
+알레르기 유발 성분이 있는지 확인을 위해서 가져가는  것입니다.,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+틀니나 임플란트가 있으시면 말씀해 주세요.,Korean
+"주말이라 병원을 갈 수가 없어서 왔어요.
+",Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+스트레스 받으면 설사 하나요?,Korean
+독감 주사는 언제 맞았나요?,Korean
+변비로 인해 생긴 것인데 혹시 만성적으로 변비가 있다면 검사를 해 보는 것이 좋습니다.,Korean
+아까 말씀드린 것처럼 변비가 있었습니다.,Korean
+네. 입원 처음 해 보는 거라 좀 긴장되네요.,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+중간에 잠이 깨는 원인은 뭐라고 생각하세요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+수술하는 경우도 있고 수술없이 치료만 받는 경우도 있습니다.,Korean
+담당 간호사에게 미리 말씀하시면 준비하겠습니다.,Korean
+점액질이 동반된 대변은 장내 감염 여부 확인의 지표가 됩니다.,Korean
+기침 소리가 어떻게 나오나요?,Korean
+마취가 이루어진 수술은 모두 말씀해 주시면 됩니다.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+두통 때문에 잠들기 어렵지는 않나요?,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+암은 언제 어디서 진단받았나요?,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+아니요 여행 이력이나 접종 이력 따로요.,Korean
+"아니요. 지금은 가렵기만 하다고 했어요.
+",Korean
+복부 통증이 많이 심한가요?,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+입원에 관련된 정보를 표기하는 데 있어 보호받으실 수 있습니다.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+먹었던 음식을 다 토하시나요?,Korean
+최근에 스트레스를 많이 받으셨나요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+드시면 안 되는 음식이 따로 있나요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+식후 소화가 잘 안 되나요?,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+민간요법을 잘못 병행하면 부작용이 발생할 수 있습니다.,Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+귀찮으시겠지만 질환 감별을 위해 몇 가지 더 확인하겠습니다.,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+지난달에 어떤 종류의 약을 복용하셨어요?,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+네 복부 초음파 후 조영술 시행하도록 하겠습니다.,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+네 병원은 전체 금연지역입니다.,Korean
+피로로 인해 일상이 힘든 적 있나요?,Korean
+"이불만 덮어도 무겁게 느껴지며 관절이 아픕니다.
+",Korean
+앓고 있는 병 있나요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+"대변 보고 물 내리는데 보니까 피가 흥건했어요.
+",Korean
+가족 중에 당뇨 치료 이력이 있으면 말해 주세요.,Korean
+아니요 문제가 될 가능성은 낮지만 어떤 약을 드시는지 말씀해주시겠습니까?,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+마취가 필요하면 알려 드리겠습니다.,Korean
+어느 부위가 만지면 아프신가요?,Korean
+"위 수술한 거 검진 때문에요.
+",Korean
+어디가 가장 아픈 곳이에요?,Korean
+오메가 쓰리는 중성지방을 떨어뜨리는 역���을 해서 같이 드시면 혈관 건강에 도움이 됩니다.,Korean
+당분간 상처가 어느 정도 치료될 때까지는 상태를 보기 위해 저희 병원으로 내원하시는 걸 추천드립니다.,Korean
+정확히 아픈 부위가 어디예요?,Korean
+"집에 불나는 바람에 크게 화상을 입어서 왔어요.
+",Korean
+간염으로 병원 내원한 적 있나요?,Korean
+"버스를 타려고 하는데 버스가 막 떠나려는 거예요. 그거 보고 달려가다가 돌부리에 걸려 넘어졌어요. 오른쪽 다리에 찰과상이 생겼는데 낫지 않고 계속 진물이 나와요.
+",Korean
+출혈로 인해서 배가 아프기보다는 출혈을 일으키는 질환이 일반적으로 복통을 유발합니다.,Korean
+목이 너무 마르면 젖은 수건을 입에 대는 것도 좋은 방법입니다.,Korean
+사생활 보호를 원하시나요? 입원한 병실 호수 등 입원 정보를 비밀로 해 드립니다.,Korean
+연고 가격은 정확하진 않지만 시카케어 같은 경우는 십만 원대입니다.,Korean
+항생제처럼 미리 테스트해볼 수 있는 사항이 아니어서요. 특이사항 있을 시 마취방법이 변경될 수 있어요.,Korean
+"빈혈 때문인지 무엇 때문인지 현기증이 너무 심해서요.
+",Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+아니요. 음성 판정이 나왔네요.,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+어디가 제일 많이 붓나요?,Korean
+수술 후 흉막 삼출 무기폐 폐렴 호흡부전이 가장 높은 빈도를 보이고 있습니다.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+소변 색이 검붉은 색인가요?,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+요즘 같은 계절에는 입술이 많이 건조하긴 합니다.,Korean
+수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+검사 결과가 나온 이후 좀 더 효과 있는 치료법으로 가는 방법으로 하죠.,Korean
+네 바셀린 거즈도 많이 사용합니다.,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+몸에서 특별한 반응이 없었나요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+이따가 좀 더 쉽게 설명해 드릴게요 지금 초음파 설명 일단 간략하게 하고 나서요.,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+통증을 참을 수 있나요?,Korean
+갑자기 혈압의 변화가 있거나 열이 나는 증상 등이 발생하지 않는다면 문제없습니다.,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+뼈가 자라지 않은 다지증이기 때문에 전신마취는 안 해도 됩니다. 대신 주사제로 전신마취제를 투여하고 마취과 의사가 있는 상태에서 수술합니다.,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+디피시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요.,Korean
+부위에 자외선 노출 시 색소침착이 있을 수 있습니다.,Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+하루에 한 갑 이상 피우나요?,Korean
+정신과적 치료라면 공황장애 같은 거 말씀하시는 건가요?,Korean
+구토를 언제 한 적 있나요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+결핵 치료는 잘 되었나요?,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+혈압 수치가 높다는 판정은 언제쯤 받았어요?,Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+"기침할 때 휴지에 피가 묻을 정도로 많이 나와요.
+",Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+주에 몇 번 아픈가요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+평소에 가슴이 아프고 그러신가요?,Korean
+목구멍이 아프거나 하진 않으세요?,Korean
+음 네. 이비인후과 다녀왔어요.,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+열뿐만 아니라 알레르기 반응도 포함됩니다.,Korean
+가족 중 유전성 질환을 경험하신 분이 있으십니까?,Korean
+일단 헌혈도 말씀해 주세요.,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+퇴원해서 통원치료 받는 게 편하시겠어요?,Korean
+햇빛에 오래 노출되면 매우 어지러워요.,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+불면증이 있는 것 같나요?,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+"소변볼 때 아랫배 쪽이 통증이 있습니다.
+",Korean
+영양소는 비타민뿐만 아니라 다른 영양소도 섭취해야 해요.,Korean
+겨울이면 다시 통증이 오나요?,Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+담배는 몇 살부터 피우기 시작한 거예요?,Korean
+네. 마취 풀리고 바로 움직였었거든요.,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+진료 중 주사치료를 받은 적이 있나요? 환자분?,Korean
+"양쪽 다 아픈 데요. 둘 다요.
+",Korean
+집 먼지 진드기는 항상 생길 가능성이 존재하므로 자주 세탁해 주는 것이 중요합니다.,Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+입원해서 치료받거나 수술받은 경험입니다. 입원하신 경험이 있다면 알려주세요.,Korean
+대변과 피가 섞여서 나오나요?,Korean
+환자분께 직접 확인해야 정확합니다.,Korean
+아니요. 한약을 무슨 이유로 복용하시나요?,Korean
+피부 가려움 양상이 어떻게 나타나시나요?,Korean
+"제가 소변까진 체크를 못 했네요.
+",Korean
+움직임이 통증에 영향을 주나요?,Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+"코피가 심해 걱정이 되어 왔어요.
+",Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+한 달 내에 배가 아파서 방문했는데요.,Korean
+가끔 부작용으로 토하는 분들이 계셔서요.,Korean
+검사는 대략 두 시간 정도 소요될 예정입니다. 이후에는 식사하셔도 상관없습니다.,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+말씀해주신 병실 입실 가능하면 안내해드리겠습니다.,Korean
+언제 암 진단을 받으셨나요?,Korean
+당뇨 있는 건 아니시죠?,Korean
+음낭 수종 같긴한데 초음파로 좀 볼게요.,Korean
+이 검사는 금식이 필요하기 때문입니다.,Korean
+언제 처음 결핵을 앓았나요?,Korean
+"손가락이 잘려서 급하게 왔어요.
+",Korean
+증상이 나타나기 전에 드신 것은 다 말씀해주십시오.,Korean
+헬리코박터균 감염이 있을 가능성이 높지만 다른 원인에 의해서도 발생할 수 있습니다.,Korean
+이번에 입원하는 게 처음이에요.,Korean
+네 저희가 환자분 상태를 자세히 파악하기 위해 필요합니다.,Korean
+뇌척수액 검사가 현재 상태에서 필수적입니다.,Korean
+"큰 병 없이 수술 한 번 안 받고 건강히 잘 지냈어요.
+",Korean
+"유제품을 좋아하는데 우유는 마시면 설사를 해서 락토프리만 마셔요.
+",Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+네 약간 뽑아서 주로 빈혈이나 다른 피수치를 확인하려고 합니다.,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+언제부터 가슴 통증이 있나요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+최근 감각이 무뎌지거나 저리는 곳 있으신가요?,Korean
+유전적 질환이 남자 형제에게만 나타났나요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+알레르기 반응일 수 있습니다.,Korean
+여기는 다친 상태가 얼굴보다 양호하네요 바로 치료해 드릴게요.,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+네. 집 앞에 병원 갔다가 약 처방 받았었어요.,Korean
+식습관이 최근 변하신 게 있나 확인해야 해서요. 미음으로 드셨던 거는 속이 안 좋거나 입맛이 없으셨던 건가요?,Korean
+네. 처방 더 받으려면 또 내원해야 되나요?,Korean
+어느 부위 위주로 통증이 있나요?,Korean
+알고 있는 알레르기 있으면 말��� 줘요.,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+지난번 환자분은 진단 결과상 입원 치료를 받으셔야 했습니다.,Korean
+일반적으로 장운동을 촉진시켜주는 약물이 효과적이지만 장폐색이 없는지 먼저 확인해야 합니다.,Korean
+수술 전 항생제를 투여하기 위하여 항생제 반응 검사를 시행하겠습니다.,Korean
+상처 보호 및 지혈 등에 쓰입니다.,Korean
+오한이 좀 있는 것 같으세요.,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+아무래도 집에서 하는 소독은 감염 위험성이 큽니다.,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+돌 때 재수술을 하게 되면 분명 호전될 가능성이 높아집니다.,Korean
+아니에요. 치료하면 충분히 완치 가능합니다.,Korean
+환자가 병원 들어오고 나가기 전까지의 모든 행위에는 환자 이름 주민등록상 생년월일 환자번호로 확인이 이루어지고 있습니다.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+"윗배가 변을 봐도 계속 아파요.
+",Korean
+네 우선 대기실에서 약품명 검색하신 후 알게 되신다면 간호사에게 알려주시기 바랍니다.,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+"못질하다가 다쳤는데 깨끗한 못이 아니어서 걱정되네요.
+",Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+다행이네요. 요즘은 식습관이 서구화돼서 대장 용종이 젊은 층에서도 많이 생겨요. 내시경 사진 보면서 설명해드릴게요.,Korean
+여기서 처방받은 약 이외에 다른 약 드시는 게 있을까 해서 여쭤봤습니다.,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+종양이 발견된 지 오래됐어요?,Korean
+혹시 대변은 잘 보시는가요?,Korean
+"""한 달 전에 진행했던 대장 내시경 결과, 대장에는 이상이 없어, 병변에 해당하는 직장 부위만 봐도 충분합니다.""",Korean
+대변이 잘 안 나오고 그러나요?,Korean
+장에 신경이 제대로 분포하지 않아 생기는 질환입니다.,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+"오늘 변을 보긴 했는데 색이 안 좋더라고요.
+",Korean
+간염 때문에 병원 치료받고 계신가요?,Korean
+아니요. 고혈압 같은 병력 있으신 분은 없어요.,Korean
+네 물이 차서 무릎을 못 굽히는 거면 무릎 부종입니다.,Korean
+아픈 게 얼마 안 됐나요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+배뇨 시 통증이 있고 피가 나오나요?,Korean
+연고 바르시다 따가운 증상이 생기시면 바르지 마시고 병원으로 연락 부탁드립니다.,Korean
+그 약만 먹으면 우울증이 오는 것 같아요.,Korean
+여드름 부위보다 조금 넓게 바르셔도 됩니다.,Korean
+아니요. 만성 위염은 흔한 소견입니다.,Korean
+네. 다녀온 후 검사 결과 모두 정상입니다.,Korean
+현재는 양의학 치료를 하고 있으니 스스로 민간요법으로 치료하는 일은 없도록 해주세요.,Korean
+배에 가스는 안 차시나요?,Korean
+몇 년 전에 미주 신경성 실신으로 응급실에 입원한 적이 있어요.,Korean
+최근에 고혈압약을 바꾸거나 용량을 변경하지 않으셨나요?,Korean
+"목이 너무 아파서 불안해서 병원을 왔고 병원에서 입원해야 한다고 해서 입원하게 되었어요.
+",Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+무리를 하셨네요 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+다른 아픈 곳은 없으신가요?,Korean
+주위가 갑자기 빙빙 돈다고 생각한 적 있으세요?,Korean
+발기 부전 증상이 있으세요?,Korean
+심장이 벌렁거린 적 있으세요?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+통증은 주로 언제 오나요?,Korean
+암모니아 수치가 높아서란 말은 지금 처음 듣네요.,Korean
+발생하더라도 치료할 수 있으니 너무 염려하지 않으셔도 됩니다.,Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+수술 일정이 나오면 입원 후 수술하시고 회복 후 퇴원하시게 될 겁니다.,Korean
+입원 치료한 적 있으신가요?,Korean
+대변볼 때 피가 나오지는 않던가요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+음주 빈도가 주 몇 회 정도예요?,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+잠이 들면 중간에 몇 번이나 깨나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+변을 잘 보고 계신가요?,Korean
+"손가락이 저리는데 제가 목 디스크가 있거든요. 아무래도 목디스크 때문인 것 같아요.
+",Korean
+간단히 말하면 근육에 손상이 가서 신장 기능에 문제가 생긴겁니다.,Korean
+숙면을 푹 취하기 어려우신가요?,Korean
+알레르기 진단은 언제 받았나요?,Korean
+할머니가 대장암 수술을 받으셨었어요.,Korean
+깨고 난 후 부작용이 없었으면 큰 문제는 아닙니다.,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+그때부터 아직 안 낫고 계속 앓고 계신 거죠?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+하루에 얼마나 담배 피우세요?,Korean
+편하신 팔로 내밀어 보세요 혈압 측정하겠습니다.,Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+변비를 고치기 위해 어떠한 노력을 하셨나요?,Korean
+검사결과는 보통 빠르면 일주일 소요되기 때문에 그 전에 받기는 힘드세요.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+제가 일하는 곳에서는 항시 마스크를 착용하고 일해야 해요.,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+속이 안 좋고 구역질이 나더라고요.,Korean
+하루 평균 얼마나 피우시나요?,Korean
+어. 그냥 어머니가 주신 약 먹었어요.,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+"복부 상태가 안 좋은 것 같아요.
+",Korean
+평소 식습관이 건강하지 못하거나 먹는 것에 비해 운동이 불충분 한 경우 대개 높게 나옵니다.,Korean
+네 수치 확인 후 다시 마스크를 쓰게 됩니다.,Korean
+최근 급격하게 살이 많이 올랐나요?,Korean
+수술 부위 피부 바로 위에 해주시면 됩니다.,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+통증이 있는지 알고 싶어요.,Korean
+증상이 시작된 게 언제부터예요?,Korean
+키 일 미터 칠십삼 센티에 몸무게 육십구 킬로 나갑니다.,Korean
+"아이가 바퀴 달린 의자 위에 올라가다가 떨어졌어요.
+",Korean
+약에 의한 부작용이 있을 수 있으며 일차 치료 실패도 부작용이라고 할 수 있습니다.,Korean
+소독 후 연고를 바르는 등 치료를 해야 합니다.,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+드시는 간염약 약품명 아시나요?,Korean
+혈액 검사도. 씨티도 안 찍어요.,Korean
+가족 중에 고혈압이신 분 있어요?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+면역치료 외에도 여러 치료법이 있습니다.,Korean
+종양 확인된 적 있으신가요?,Korean
+그 부분은 간호사분이 아실 듯한데요.,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+현재 체중 변화가 심한 가요?,Korean
+가슴이 빨리 뛰고 요동치시나요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+대장암으로 진행할 수 있는 종양성 병변입니다.,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+레이저 시술 후 부작용 사례는 거의 없습니다.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+최대한 감염 방지를 위해 소독해 두었지만 언제든 감염 위험성은 높습니다.,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+"갑자기 이빨이 너무 아파요.
+",Korean
+그 부분은 간호사분이 아실 듯한데요.,Korean
+식사 후 바로 설사하시나요?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+혈압 안 높아지게 잘 유지하고 있나요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+가래에 피가 섞여 있나요?,Korean
+다리에 힘이 안 들어가요.,Korean
+수면 비수면은 환자분 선택입니다. 환자분이 원하는 대로 당일에 말씀해 주시면 되고 수면 원하시면 보호자분 함께 오셔야 합니다. 당일날은 운전하시면 안됩니다.,Korean
+"며칠 입원해 있고 싶어서요.
+",Korean
+움직일 때마다 통증이 있어요.,Korean
+"독감 걸린 것 같아요.
+",Korean
+검사 다 하려면 얼마나 걸립니까?,Korean
+환자분 상태에 따라 증상도 다 다르기 때문에 뭐라고 정확한 답변을 드리기 어렵습니다.,Korean
+"체했는지 ��속 가슴이 답답해서요.
+",Korean
+욕창이 생기지 않기 위해서는 두세 시간에 한 번씩 자세를 바꿔주시는 게 좋습니다.,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+"제가 얼마 전부터 사타구니에 종양 같은 게 생겼거든요. 너무 걱정돼서 병원에 왔어요.
+",Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+소변에 피가 같이 나온 적이 있을까요?,Korean
+"물만 먹어도 토해요. 뱃속에 아무것도 없을 때까지요.
+",Korean
+특히 운동이나 외상 후 자주 생기며 근육 손상으로 인해 생긴 독성 물질들이 쌓이는 질환입니다.,Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+환부에 마취를 하고 진행하여 엄청난 통증이 있지는 않습니다.,Korean
+가슴에 통증이 있으면 말씀해 주세요.,Korean
+"오른쪽 무릎 관절에 통증이 있어서요.
+",Korean
+전자담배 핀 적 있습니까?,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+소변에 피가 많이 섞여 나온다고 생각하세요?,Korean
+아무래도 피부질환이 심한 분들은 호흡곤란도 올 수 있어요.,Korean
+"코가 막혀 계속 깨서 울었어요.
+",Korean
+네. 근데 응급실로만 와야 되나요? 일반 외래는요?,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+허리에 디스크가 있어서 시술받았어요.,Korean
+점점 전문적인 요양이 필요하신 것 같아서요.,Korean
+네 속이 울렁거리고 토하고 그랬어요.,Korean
+"코피가 많이 나와서 왔어요.
+",Korean
+복부 전체에 통증을 느꼈어요?,Korean
+우울증 치료를 육 개월째 받고 있습니다.,Korean
+빈뇨 때문에 여러 번 깨시는군요. 잔뇨감이나 통증도 있으신가요?,Korean
+독감 접종 후 집에만 계셨나요?,Korean
+네 담당 선생님이 환자분을 확인한 후 처방할 것입니다.,Korean
+아픈 곳 말씀해 주세요.,Korean
+암 있는 건 언제 아셨나요?,Korean
+아니요. 자궁에 혹이 있어서 위험하다고 수술했습니다.,Korean
+가족 내 암 판정받은 분은요?,Korean
+"목 디스크가 있긴 했는데 그 동안은 아무렇지 않다가 갑자기 손이 찌릿거리고 힘이 안 들어가요.
+",Korean
+"기침 가래가 심하고 목이 아파서요.
+",Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+수술받은 적 있으면 알려주세요.,Korean
+바로 말씀드리기는 어려우니 상부위장관 내시경 검사가 필요합니다.,Korean
+구토를 많이 하지는 않으시나요?,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+가렵지 않더라도 완전히 나으려면 아직 더 치료를 받아야 합니다.,Korean
+정확하게 진단을 하고 치료를 하려면 혈액 검사를 진행하셔야 합니다.,Korean
+그냥 병원 오면 안 되나요?,Korean
+처방받은 간염약 어떤 건지 아시나요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+목에 통증이 계속 있나요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+"변비가 있어서 변비약을 복용 중이에요.
+",Korean
+"오늘도 목 따가워서 밥 안 먹는다고 난리 쳐서 겨우 먹였어요.
+",Korean
+그렇습니다. 영양 상담이 필요하신 것 같아요.,Korean
+"며칠 전부터 애 항문 부분이 빨갛고 애가 계속 간지러워해서요.
+",Korean
+가족 중에 고혈압이신 분 있어요?,Korean
+어느 곳이 아파서 오셨어요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+한의사가 행한 것은 민간요법이라 칭하지 않습니다.,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+네 발열 및 두통이나 근육통 모두 알레르기 이상 반응이에요.,Korean
+머리가 핑도는 느낌이 있으신가요?,Korean
+아버지가 당뇨 어머니가 고혈압이 있으세요.,Korean
+집에 다른 암 환자는 없으시고요?,Korean
+네. 엽산 먹어야 한다길래 먹고 있어요.,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+통증이 가장 잘 느껴지는 부위가 어디예요?,Korean
+부분마취의 경우 약물에 대해 알레르기가 있을 수 있습니다.,Korean
+독감 접종의 경우 알레르기 반응이 심해서 알레르기 반응이 있으시면 접종을 권장 드리진 않습니다.,Korean
+치료 기간은 얼마나 되었나요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+화상 치료 초기에는 입원을 권장하고 있습니다.,Korean
+식사 여부와 ���관없이 검사는 진행됩니다.,Korean
+애가 자꾸 우니까 최대한 더 빠르게 입원실 예약 좀 부탁드립니다.,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+시간이 지나면서 약에 효과가 떨어질 수도 있고요.,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+유전성 질환 가족력 있나요?,Korean
+하루에 한 갑 이상 피우나요?,Korean
+맹장염에 동반되는 다른 증상들은 없으셨나요? 가스가 찬다거나 배가 부푼다거나 등등이요.,Korean
+식후 삼십분 후 섭취해 주세요.,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+위산이 역류될 때 느껴지는 증상입니다.,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+곧 병실 들어가실 거예요.,Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+어제 약을 두고 가셔서 보관해 드렸습니다.,Korean
+타병원에서 진료한 것은 알 수가 없습니다.,Korean
+유전적 요인 또는 당뇨 등의 기저 질환 영향도 있지만 생활습관이나 식습관 술 비만 등의 영향도 많이 받습니다.,Korean
+다른 아픈 곳은 없으신가요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+통증은 얼마나 자주 발생해요?,Korean
+이사를 멀리 가시면 저희 병원에 올 일이 없으실 테니 놔두셔도 됩니다.,Korean
+최근에 몸무게 변화가 있나요?,Korean
+대표적으로는 소화기 증상이 있을 수 있으며 이외 발진이나 두통 등이 있을 수 있습니다.,Korean
+그냥 지금은 기존에 가지고 계셨던 피부질환 여부만 여쭙는 거예요.,Korean
+아픈 신체 부위 말씀해주세요.,Korean
+제가 말씀드릴 때까지 청진이 계속될 테니 계속 심호흡해 주시면 됩니다.,Korean
+"산후우울증인 것 같아 오게 되었습니다.
+",Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+"목이 부은 느낌이 나고 침 삼킬 때마다 아픕니다.
+",Korean
+소변에 피가 함께 나오나요?,Korean
+우선 심전도 검사를 진행한 후 말씀드리겠습니다.,Korean
+"흡연은 안 하고 술 마신 지는 십 년 조금 넘었습니다.
+",Korean
+홍삼만 먹고 있는 거죠?,Korean
+"계단에서 미끄러졌는데 머리가 부딪쳤어.
+",Korean
+약 말고 다른 알레르기는 없나요?,Korean
+병원비 청구를 위해 필요합니다.,Korean
+심호흡을 안 하시면 폐 깊숙이 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+간염 판정은 언제 받았나요?,Korean
+"아니요. 일곱 시간은 잤었는데 요 며칠 계속 잠을 못 자요.
+",Korean
+혈관이 터지는 것은 얇은 거랑은 상관없습니다.,Korean
+전신 마비가 올 수도 있습니다.,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+병원 입원하려고 하는데 여기 병원에서 입원해도 되나요?,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+비수면 시 더 불편감을 느낄 수 있지만 수면 마취로 인한 위험성은 없습니다.,Korean
+당뇨인지 언제 아신 거에요?,Korean
+그건 이비인후과에 가야 해요.,Korean
+오전 아홉 시 시작이니 여덟 시 사십 분까지 병원으로 오시면 됩니다.,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+근래에 체중 증가가 있으신가요?,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+통증이 생기면 얼마나 가나요?,Korean
+"어깨를 쓰지 못할 만큼 너무 아픈 데 밤에는 쑤셔서 잘 수 없어요.
+",Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+약 성분 확인 후 필요 시 드시도록 하겠습니다.,Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+통증이 어느 정도 심한가요?,Korean
+현재 당뇨 수치가 높으신 편인가요?,Korean
+뇌진탕이 있었을 수도 있으니 검사를 한 번 해봅시다.,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+"네. 갑자기 토할 것 같다더니 토를 하더라고요.
+",Korean
+네 과거에 다른 입원치료 받으신적이 있으신가요?,Korean
+어디가 부은 느낌 있나요?,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+코로나에 감염될 수도 있으니까요.,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+아까 말씀드렸듯 감염의 위험 때문입니다.,Korean
+"혈변이 언제부터 시작됐는지 기억이 안 나네요.
+",Korean
+선천성 기형과 후천성 기형 전부요.,Korean
+네 어디가 불편하셔�� 내원하셨나요?,Korean
+"잔뇨감 때문에 늘 일상이 불편해요.
+",Korean
+소변을 볼 때 불편함이 없나요?,Korean
+가족 중에서 고혈압이신 분 계신가요?,Korean
+"편도가 부은 게 느껴질 정도로 목이 부었어요.
+",Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+통증 말씀이신가요 부기 말씀이신가요?,Korean
+사출성 구토의 원인 중 비교적 심각한 경우가 많습니다. 그 외 다른 형태의 구토 원인도 같이 평가해 보겠습니다.,Korean
+경정맥신우조영술은 조영제가 신장을 통해 배설되는 것을 촬영하여 신장기능을 확인하는 검사입니다.,Korean
+장상피화생의 가장 대표적인 원인이 헬리코박터균 감염이지만 다른 원인도 있을 수 있습니다.,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+복부 통증을 동반한 설사를 하고 계신가요?,Korean
+폐기하실 약은 약국에 가시면 됩니다.,Korean
+확인을 해야 정확하게 말씀드릴 수 있겠지만 꽃가루 알레르기 같네요.,Korean
+식후 계속 속이 불편하신가요?,Korean
+처방전에 맞게 약 꾸준히 드시면 빠른 호전 있을 수 있어요.,Korean
+초음파 이동속도를 더 천천히 보여달라는 말씀이신가요?,Korean
+통증은 얼마나 자주 생기세요?,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+"제가 예전에 알코올 중독이었어서 술은 이제 입에도 안 대요.
+",Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+저 고혈압 있어서 혈압약이요.,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+지금 바로 퇴원 도와드릴까요?,Korean
+그냥 살짝 어지럽던데 이것도 부작용인지 모르겠네요. 그다음 날 괜찮아졌어요.,Korean
+어디 다른 병을 갖고 계신가요?,Korean
+소변에 피가 많이 나오셨나요?,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+결과 확인은 직접 오셔야 해요 다음 내원 일을 지금 예약해 드릴까요?,Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+체중이 변했다면 얼마나 변하셨나요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+건강을 위해 비타민씨랑 영양제 잘 챙겨 먹습니다.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+보통의 네 개 혈액형 말고 다른 거요.,Korean
+입원을 하실 정도의 수술 경험은 없으세요?,Korean
+"아이가 고열인데 해열제를 먹여도 열이 떨어지지 않아서요.
+",Korean
+가슴이 아프거나 하지는 않으셨어요?,Korean
+"아픈 지 일주일 됐어요.
+",Korean
+고유량의 산소를 투여하면 괜찮아질 겁니다.,Korean
+허리에 디스크가 있어서 시술받았어요.,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+"서 있을 땐 괜찮은데 앉았다가 일어나려고 하면 오른쪽 무릎이 너무 아파요.
+",Korean
+위 점막의 모든 부분이 두꺼운 것은 아니고 주름 부위가 두꺼워져 있는 것입니다.,Korean
+대장 내시경과 기본적인 절차는 유사하지만 에스 상 결장까지만 들어가는 검사입니다.,Korean
+피를 토할 때가 많이 있나요?,Korean
+네. 필요하시면 수액도 놔드리겠습니다.,Korean
+오심은 주로 토할 것 같은 느낌으로 나타납니다.,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+아침마다 유산균 챙겨 먹고 있는데 질환 때문에 처방받은 약은 없어요.,Korean
+입술 부은 것도 문제가 될 수 있습니다.,Korean
+대부분 마취크림으로 충분합니다 통증 예방에 도움이 됩니다.,Korean
+아팠다 말았다 하나요? 아니면 계속 아픈가요?,Korean
+주먹의 감각 혹은 운동 이상을 확인하기 위해 검사했습니다.,Korean
+보통 일주일에 며칠이나 음주하세요?,Korean
+허리가 아파서 일을 제대로 할 수가 없어요.,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+네. 교정 때문에 윗니 두 개 아랫니 두 개 발치했습니다.,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+평소에 복용하는 약이 있나요?,Korean
+알고 계신 혈액형을 무엇인가요?,Korean
+알에이치 마이너스��� 많이 특이한 건가요?,Korean
+"드레싱 좀 해주실 수 있나요?
+",Korean
+병도 없었고 꾸준히 운동하고 식이요법에도 정성을 들이는 편이라서 별문제 없었어요.,Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+일주일 평균 주량이 얼마나 되나요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+몸에 열이 나거나 뜨겁지 않나요?,Korean
+무리를 하셨네요. 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+"저희 애가 놀다가 다쳐왔는데 다리를 크게 다친 것 같아요.
+",Korean
+간접흡연이 더 위험하다는 보고가 있을 정도로 영향을 많이 미칩니다.,Korean
+고혈압 환자가 가족 중에 계시나요?,Korean
+네 자정 이후 금식하셨다면 진행 가능합니다.,Korean
+네 몸 상태를 확인 후 제거할 것입니다.,Korean
+항암 치료제를 복용 중이신가요?,Korean
+간헐적으로 통증이 왔다 가나요?,Korean
+"기침이 너무 심해서 밤에 잠을 못 자겠어요.
+",Korean
+"신장 기능이 안 좋아졌다고 얘기 들었어요.
+",Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+장염 증상이 있어서 내과 들렀던 것 같아요.,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+"싸기 전에 배가 살살 아파요.
+",Korean
+지금 몸에 발열증상이 있나요?,Korean
+국소마취면 국소부위만 마취 하신 건가요?,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+네 하부 요로 질환에 해당이 됩니다.,Korean
+네. 피부과 잠깐 다녔어요.,Korean
+가족 중에 당뇨 있으신 분이 한 분이라도 있나요?,Korean
+아니요. 받은 약 따로 없습니다.,Korean
+치아와 잇몸 상태를 체크하고 있어야 앞으로 정기 검진하실 때 저희가 환자의 치아 상태를 알 수 있습니다.,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+난소 기능을 확인하는 검사를 해보겠습니다.,Korean
+"밤에 잠이 안 와서 화장실을 좀 자주 가요. 졸릴 만하면 좀 화장실이 마려운 것 같은 느낌이 자주 들어요.
+",Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+몸 전체에 힘이 없나요?,Korean
+"열이 좀처럼 떨어지지 않아요.
+",Korean
+참기 힘드시면 진통제 주입량을 올려드리겠습니다.,Korean
+수술 후 최소 일주일 후까지요.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+"장이 안 좋으신 편이라 설사를 종종 하시긴 했어요. 평소에도 묽은 변을 자주 보시고요.
+",Korean
+네. 수술 경험이 없어요.,Korean
+음식을 먹으면 토를 하나요?,Korean
+검사 결과 알려드릴게요 기억은 안 나세요?,Korean
+그 외 대변을 보신 적이 없다면 화장실 다녀오신 횟수를 알려주시면 됩니다.,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+조금만 기다리시면 금방 입원 지시가 날 것입니다.,Korean
+현재 증상은 관절 문제와 무관합니다.,Korean
+당뇨 치료받아본 가족 분이 있으신가요?,Korean
+다치셔서 외래 진료 보러 오실 때요.,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+통증이 발현되는 시기가 있나요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+눈으로 봐도 알 수 있지만 지금 상태는 혹시 더 심하지는 않은지 제대로 검사를 해야 하는 상태입니다.,Korean
+지속적으로 먹는 약은 없어요.,Korean
+담배 시작하신 게 언제예요?,Korean
+결핵 수치가 높은 편이신가요?,Korean
+신경 쓰이시겠지만 환자분의 개인정보는 보호 되고 있으니 염려하지 않으셔도 됩니다.,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+진료 예약 센터 운영 시간은 어떻게 되나요?,Korean
+설사는 몇 번 하셨나요?,Korean
+검사를 진행해 봐야 알겠지만 수술이 필요한 케이스 같습니다.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+선천성 기형과 후천성 기형 전부요.,Korean
+필요시 간호사 호출해주시면 됩니다.,Korean
+"코에서 목까지 쑤시고 아파요.
+",Korean
+간염 치료 복용 약 있으시죠?,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+출혈 부위를 명확하게 구분하기 위함입니다.,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+테라마이신 연고를 두껍게 도포하면 효과가 더 좋습니다.,Korean
+통증이 몇 분마다 오나요?,Korean
+감염 대비를 잘하고 계십니다.,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+급성 후두개염이 의심되고 갑자기 후두가 부어서 말도 잘 못하게 됩니다.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+고혈압약처럼 지속적으로 드시는 다른 종류의 약이 있을까요?,Korean
+네. 비형 간염 맞으셔야 합니다.,Korean
+가끔 드시는 건 괜찮지만 되도록 고열량 고지방 식품보다는 찐 달걀이나 닭 가슴살로 드시도록 해보세요.,Korean
+네 간단한 검사는 여기서 하도록 하겠습니다.,Korean
+평소에 가슴이 아프고 그러신가요?,Korean
+방문 국가가 감염병 지역인지 알아보기 위해서요.,Korean
+어느 부위에 통증이 있으세요?,Korean
+"충치 때문에 이가 부러졌어요.
+",Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+고혈압은 약으로 조절하고 있나요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+구역질이 날 때가 있나요?,Korean
+병문안 시간이 정해져 있습니다.,Korean
+유전성 질환 가족력 있나요?,Korean
+가족 중 유전성 질환자 계세요?,Korean
+"구토 이외에는 별다른 증상은 없어요.
+",Korean
+가슴 통증이 있지는 않나요?,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+통증이 어디서 느껴지시는 건가요?,Korean
+어느 부위가 제일 아프세요?,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+병원에 해당 기관으로 안내를 도와드리겠습니다.,Korean
+기침할 때 가래가 같이 나오나요?,Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+식염수인데 상처 부위를 소독할 겁니다.,Korean
+주사 약제에 의해 혈당이 오를 수 있고 주사치료를 자주 반복할 경우 쿠싱증후군 발생 위험이 있습니다.,Korean
+검진한 병원에서와 같이 갑상선호르몬 수치가 높게 나왔고요. 칼시토닌이라는 수치가 좀 높게 나왔어요. 갑상선암에서 특이적으로 높게 측정됩니다.,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+"평소보다 대변볼 때 시간이 많이 걸리더라고요.
+",Korean
+몸에 부은 곳이 있나요?,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+외상력도 없으시다고 하신 것으로 보아 퇴행성 무릎 관절염으로 보이는데 최근 체중이 많이 늘진 않으셨나요?,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+"동네 병원 가서 배가 아프다고 했더니 검사 몇 개 하고 대학 병원에 가라고 해서 오게 되었어요.
+",Korean
+네. 가슴 통증의 원인은 심장 쪽 문제 외에도 다양하기 때문에 환자분처럼 심전도나 심근효소 수치는 정상으로 나올 수 있습니다.,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+"잘 잘 때는 일곱 시간. 불면증이 있을 때는 세 시간 자면 많이 자는 거고요.
+",Korean
+"안녕하세요. 제가 요즘에 귀가 좀 간지러운 거 같고 만져보니까 물집 소포 같은 게 잡히는 것 같아서 왔어요.
+",Korean
+이 병원에서 수술한 적 있는데요.,Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+어릴 때 수술을 받은 흔적을 없애줄 수 있습니다.,Korean
+"네. 저희 아기가 다른 아기보다 성장이 빠른 것 같아서요. 검사받으러 왔습니다.
+",Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+어떤 식으로 아프다 하는 게 있으실까요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+균의 감염이 우려되기 때문에 환부에 넓게 바를 예정입니다.,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+통증이 어떤 거 같으세요?,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+통증이 심했다거나 이상하게 요즘 들어 불편했던 곳이 있었는지 여쭤보는 거예요,Korean
+불면증이 있는 것 같나요?,Korean
+수술 경과에 따라 어디로 갈지 달라집니다.,Korean
+지금 복용 중인 항결핵제가 있나요?,Korean
+치과에서 수술이 아니라 치료하신 거 아닌가요?,Korean
+"숨쉬기 좀 벅차긴 해요.
+",Korean
+당뇨 처음 치료받은 게 언제시죠?,Korean
+네. 웬만해선 자연 분만으로 낳고 싶었거든요.,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+현재 통증이 있는 곳은 없으시나요?,Korean
+괜찮아요. 주사 끝나면 없어지는 느낌이에요.,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+"몸이 좀 안 좋은데 당뇨 때문인가 해서요.
+",Korean
+나중에 생기면 또 항생제를 바꿔야죠.,Korean
+치과 치료는 받았는데 다른 건 없었어요.,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+"아이가 항문 부분이 아프다고 계속 손이 가길래 이상이 있나 해서 왔어요.
+",Korean
+가슴이 벌렁거리는 건 괜찮으신가요?,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+네. 환자분처럼 편도선이 자주 붓고 이렇게 열나는 증상이 반복되다 보면 만성 편도염으로 진행되고 수술을 해야 되는 경우가 있어요.,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+어떤 약물을 복용하고 계시나요?,Korean
+아빠가 신장 이식받으신 적이 있으세요.,Korean
+고통의 정도가 어느 정도일까요?,Korean
+네. 앰뷸런스 타고 오신 것이 맞는지 확인해 볼게요.,Korean
+몸에 열 기운이 느껴지세요?,Korean
+"왼쪽 세 번째 손가락 부분이요.
+",Korean
+위에서 역류해서 신물이 넘어올 수 있습니다.,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+오늘 아침에 약 먹고 왔고 혈당은 잘 유지하고 있어요.,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+제때제때 대변을 잘 못 보는 편인가요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+꼬리뼈 부위에 욕창이 생겼습니다.,Korean
+병원에서 큰 수술을 받으셨나요?,Korean
+네. 일찍 병원을 와볼 걸 그랬어요.,Korean
+흡연 기간은 어떻게 되나요?,Korean
+변에 피가 섞여 나오나요?,Korean
+네. 갑상선호르몬이 높게 측정됐네요. 갑상선 관련해서 초음파나 다른 검사는 해보셨나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+원인에 따라서 앞으로의 예후를 예측해볼 수 있습니다.,Korean
+물리적 시술이다 보니 출혈이 발생할 가능성도 있지만 바로 지혈 들어갈 테니 걱정 안 하셔도 됩니다.,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+체중 증가가 언제부터 있었나요?,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+"길 가다 자빠져서 머리를 다쳤어요.
+",Korean
+결핵 때문에 병원 다니신 적이 있나요?,Korean
+"""일주일에 삼에서 사 회 삼십 분에서 한 시간씩 걷기, 자전거타기 등산 같은 유산소 운동을 권합니다.""",Korean
+치료 계획이나 약물요법이 달라집니다.,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+요즘 당뇨를 치료 중인가요?,Korean
+식사 후 바로 설사하시나요?,Korean
+위암 발생 혹은 추가적인 변성 소견 확인을 위해 매년 정기적인 위내시경 검사가 필요합니다.,Korean
+먼 친척 중에 한 분이 간질 앓으신 적이 있다고 들은 적 있어요.,Korean
+부모님께서 특정 질환이 있으신가요?,Korean
+대변을 보고나면 휴지에 피가 같이 묻어있나요?,Korean
+매일 혈압을 재고 있나요?,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+"이 왼발 뒤꿈치가 땅겨요.
+",Korean
+영양을 고려한 식단을 드시나요?,Korean
+오랜 공복기나 과식 해도 증상이 있을 수 있습니다.,Korean
+하루에 보통 얼마나 피우세요?,Korean
+전반적으로 치아 상태를 다 보는 거예요.,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+"하루 다섯 시간 자는 듯한데요?
+",Korean
+네 둘 다 알레르기일 때 나타날 수 있다는 연관이 있습니다.,Korean
+혈뇨를 볼 때 통증이 동반되나요?,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+"밤에 잠도 잘 오지 않고요. 겨우 잠들어도 중간에 한 두 번씩은 계속 깨서 다시 잠들기가 어려워서요.
+",Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+가래에 피가 섞여서 나온 적이 있으신가요?,Korean
+네. 부모님께서 두 분 다 당뇨세요.,Korean
+알레르기 반응이 언제 보이나요?,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+묽은 변을 보시지는 않나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+접종 안 된 애완견은 사람에게 질병 전파를 할 수 있어요.,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+언제부터 당뇨 증세가 악화��나요?,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+그렇게 하겠습니다. 용종이 있으면 떼어내야죠.,Korean
+오심을 겪어본 적이 있나요?,Korean
+가래에 피도 같이 나온적 있나요?,Korean
+구역질이 날 때가 있나요?,Korean
+너무 추워서 감기 걸리진 않을까요?,Korean
+진통제 이름과 용량을 알려주세요.,Korean
+설사를 며칠 동안 하셨나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+병원에 오신 이유 말씀해 주세요.,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+전립선염일 가능성이 있으니 추가 검사를 해보시지요.,Korean
+투약한 약물이 있거나 복용 중인 약이 있나요?,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+애완견 접종 유무 상태를 알기 위해 여쭤보는 겁니다.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+"변이 냄새가 심하고 색이 이상해요.
+",Korean
+방광기능 저하로 배뇨 후 잔뇨가 많이 남을 경우에는 소변줄을 삽입해야 할 수도 있습니다,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+우선 병실에 가서 누워계시면 됩니다.,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+손으로 이렇게 눌렀을 때 크기 변화가 없으면 이미 복강과의 연결이 없는 상태기 때문에 시간이 지나면 음낭에 고여 있던 체액이 흡수되어 사라져요.,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+얼마에 한 번씩 아픈가요?,Korean
+목이랑 어깨는 잘 스트레칭을 해 주지 않아서 그래요.,Korean
+지난번 환자분은 진단 결과상 입원 치료를 받으셔야 했습니다.,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+배가 너무 팽팽해져서 불편한가요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+가끔 드시는 건 괜찮지만 되도록 고열량 고지방 식품보다는 찐 달걀이나 닭 가슴살로 드시도록 해보세요.,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+"아니요. 평균 여섯 시간인데 잠자리에 예민해서 이사 온 후로 쉽게 잠을 못 자요.
+",Korean
+입원 지시가 났으니 보호자분께서는 원무과에서 입원 수속을 해주시기 바랍니다.,Korean
+사출성 구토는 갑작스럽게 몸 밖으로 튀어나오듯 나오는 구토입니다.,Korean
+"심장 질환이 있어서 숨이 찬 거래요.
+",Korean
+낫는 게 최우선이니까 최대한 효과적인 치료만 신경 써주시면 됩니다.,Korean
+혈전용해제 먹은 지 엿새 정도 된 거 같아요.,Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+고혈압 기간이 어떻게 되세요?,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안됩니다.,Korean
+동네 병원에서 소독만 하시고 이틀에 한번이라도 경과를 보기위해 꼭 내원해 주세요.,Korean
+통증이 월 단위로 있나요?,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+발기 부전으로 인해 고생하신 적 있으신가요?,Korean
+오심은 주로 토할 것 같은 느낌으로 나타납니다.,Korean
+전해질 수치상 몸이 다소 탈수되어 있다고 나와서요.,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+"오늘 변을 보긴 했는데 색이 안 좋더라고요.
+",Korean
+풍진에 걸렸을 경우 양성입니다.,Korean
+어린데도 불구하고 편두통이 굉장히 심해요.,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+"항암 끝난 다음부터 열이 내리질 않아서요.
+",Korean
+어느 부위를 찔러야 하는지 보여주시겠어요?,Korean
+"화장실에 다녀와도 계속 배가 불편해요.
+",Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+혈관이 터지는 것은 얇은 거랑은 상관없습니다.,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+네. 교통사고로 인해 뼈가 부러져서 수술했었습니다.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+병원에서 큰 수술을 받으셨나요?,Korean
+"아이가 아침에 침대에서 굴러 떨어졌는데 좀 다친 것 같아요.
+",Korean
+언제부터 이 증상이 나타났나요?,Korean
+제 혈액형은 그냥 오형이에요.,Korean
+담배는 하루에 몇 갑 피시나요?,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+어느 부위에 통증이 심한가요?,Korean
+대변볼 때 불편하지 않으세요?,Korean
+네 틀니는 여기 앞에다 두고 진료하겠습니다.,Korean
+몸에 기운이 싹 빠진 느낌이 드나요?,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+"변비가 아주 심한 편입니다. 단단한 상태로 보입니다.
+",Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+선천성 기형과 후천성 기형 전부요.,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+간염으로 드시는 약이 있나요?,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+질병이나 특이사항 때문에 하반신 마취를 시행하였는지 알기 위해서입니다.,Korean
+일주일에 몇 번이나 아프세요?,Korean
+어느 부위에 통증이 있을까요?,Korean
+토할 때 피도 나왔나요?,Korean
+아직도 가슴 쪽에서 통증이 올라오나요?,Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+"애가 자전거를 타다가 넘어졌는데 그때 머리를 부딪쳤거든요. 근데 그 이후로 머리에 통증이 있다고 해서 왔습니다.
+",Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+"다리를 다쳤는데 그 뒤로 다친 부위 통증이 계속됩니다.
+",Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+사람의 몸은 물이 칠십 퍼센트 이상으로 구성되어 있습니다. 부족 시 건강 문제가 발생할 수 있어요.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+술과 담배는 안 하시는 게 도움이 되실 거고 스트레스받지 않는 게 중요합니다. 혹시 술 담배 하시나요?,Korean
+일단은 소화가 온전히 완료되기까지 최소한 여덟 시간은 걸리기 때문에 여덟 시간 이상은 금식해 주셔야 합니다.,Korean
+통증 있는 부분이 어디예요?,Korean
+혹시 결핵약 처방 받으셨나요?,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+계속 누워계시다보니 피부가 눌려서 손상을 받았다고 생각하시면 됩니다.,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+"아침에 일어나면 손이 부어서 잘 안 구부러지더라고요.
+",Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+최근에 체중에 변화가 있나요?,Korean
+선천적으로 장의 특정 부위에 신경이 제대로 분포되지 않아 정상적으로 움직이지 못하는 질환입니다.,Korean
+"원래 이명이 가끔 들렸어요.
+",Korean
+가족 중에 암 환자분이 계세요?,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+가슴 통증이 어떻게 있나요?,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+"평소처럼 자다가 중간에 깨는 정도?
+",Korean
+"혈압이 너무 상승돼 가지고요.
+",Korean
+본원에서 수술하셨으면 기록 조회해보겠습니다.,Korean
+"음식 씹을 때마다 턱이 너무 저려서 못 씹겠어요.
+",Korean
+대변볼 때 피가 묻어나나요?,Korean
+"수술 후에 회복하지를 못하고 기력 없이 지냈습니다.
+",Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+미리부터 겁먹으실 필요는 없고 검사를 몇 가지 해 보도록 하겠습니다.,Korean
+성 기능 장애가 있으신가요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+"소변을 하루에 한 번 정도밖에 안 봐서 방광염 걸릴까 봐 걱정이에요.
+",Korean
+갑자기 주위가 빙빙 도는 증상도 있으신가요?,Korean
+등록하시고 진료 보시는 게 낫겠어요.,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+"아기 항문이 빨개지고 애가 간지러워하는 것 같아서요.
+",Korean
+최근에 영양수액 맞은 것도 관련 있나요?,Korean
+제 때 약을 드시고 건강 관리에 힘써주시면 점점 좋아질 거라 생각합니다.,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+처방받지 않는 약은 뭔가요?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+음식 알레르기 있는지 알고 싶어요.,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+아프게 된 계기가 있나요?,Korean
+그 이후에는 안 드신 거죠?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+"윗니 끝에 있는 어금니요.
+",Korean
+지금까지 토한 적이 있나요?,Korean
+찜질을 하면 호전이 될 거니 곧 가져다 드리겠습니다.,Korean
+의사 회진 시 상담 가능할 것 같습니다.,Korean
+조직 검사가 필요해 보이네요.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+혹시 따로 복용하는 약이 있으실까요?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+예전에 쓰러지신 적 있나요?,Korean
+난소는 손상 없이 나팔관을 수술하는 거라 부작용은 거의 없습니다.,Korean
+항생제는 산성도가 너무 높으면 잘 작용하지 못합니다. 잘 작용할 수 있는 산도를 만들기 위해서 복용하셔야 합니다.,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+아니요. 음성 판정이 나왔네요.,Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+한 달 전에 건강검진받았었는데 당뇨가 의심된다고 하더라고요.,Korean
+"다리에 쥐가 안 풀려요.
+",Korean
+혹시 입원 생활에 대한 궁금하신 부분 있으실까요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+마취가 필요하면 알려 드리겠습니다.,Korean
+"친구가 장난치다 휴대폰에 맞아 치아가 부러진 것 같아요.
+",Korean
+그럼요. 중단 없이 계속 복용 중이죠.,Korean
+과거에 장기간 입원한 적이 있나요?,Korean
+통증은 움직일 때마다 오나요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+대장암 걸린 적 있습니다.,Korean
+약이 중복 투여 될 수도 있고 드시는 약을 파악해야 해서요.,Korean
+"아마 사십 년은 넘었을걸요. 하루에 최대 한 갑은 피우는 것 같네요.
+",Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+혈뇨 시 다른 통증은 없었나요?,Korean
+계속해서 심장이 빨리 뛰나요?,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+"스물네 살부터 피기 시작했고 작년에 끊었죠.
+",Korean
+일정 관련된 부분은 간호사께서 안내해 주실 예정입니다.,Korean
+네. 앰뷸런스 타고 오신 것이 맞는지 확인해 볼게요.,Korean
+예약하고 가시면 예약시간에 최대한 맞춰 진료 보실 수 있도록 해드리겠습니다.,Korean
+"아이 눈에서 자꾸 진물 같은 게 나와요.
+",Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+일 회 평균 음주량이 어떻게 됩니까?,Korean
+통증이 어디서 느껴지시는 건가요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+"배에 통증을 느끼는 것 같아서 아침 일찍 병원으로 왔어요.
+",Korean
+금연 약 말고는 없어요.,Korean
+진단 받은 다른 질병이 있나요?,Korean
+수면 내시경으로 하실 수 있습니다. 대장 끝까지 보는 검사가 아니기 때문에 비수면으로 하시는 분들도 많습니다.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+우선 다른 검사를 조금 더 해봐야 알겠지만 선천성 거대결장이라는 질병이 있어요. 신생아에서 간혹 있는 질병인데 이걸 의심할 수 있는 소견이 엑스레이상 보입니다.,Korean
+진단서 여러 장 발급 가능한가요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+아세트아미노펜이 포함된 약 복용하면 눈가가 퉁퉁 부어요.,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+가벼운 수술이라면 어떤 것 말씀이세요?,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+"화장실을 여러 번 갔는데도 잔뇨감이 있어요.
+",Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+통증이 있는지 알고 싶어요.,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+입원 치료한 적 있으신가요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+평소에 부종이 좀 있으세요?,Korean
+네 이젠 곧 통증이 없을 거예요.,Korean
+숨을 헐떡일 때가 있나요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+하반신 마취여도 안정시키기 위해 수면마취를 시행하는 경우도 있습니다.,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+약물과 음식을 제외하고 다른 알레르기가 있으신가요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+혈변을 유발할 위궤양 증상이 있나요?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+혹시 소변에 피가 나왔나요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+아직 검사도 남았고 입원 가능성도 있어서요.,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+"네. 고혈압 때문에 싱겁게 먹어야 되는데 그러면 맛이 없어서 조금 짜게 먹습니다.
+",Korean
+간염 증상이 오래전부터 있었나요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+피부 연고는 피부과 진료받으시고 처방받으실 수 있어요.,Korean
+네 요즘 코로나 때문에 매일 보호자분도 열 체크해야 해서요.,Korean
+"맨날 잠 설치다가 자요.
+",Korean
+응급실에 구급차 타고 오셨나요?,Korean
+"어젯밤부터 열이 올라서 왔어요.
+",Korean
+병원에서 결핵 치료 중이신가요?,Korean
+병도 없었고 꾸준히 운동하고 식이요법에도 정성을 들이는 편이라서 별문제 없었어요.,Korean
+네 민간요법을 따로 하지 않으시는군요.,Korean
+이후에는 레이저나 냉동치료이고 마지막에는 수술밖에 답이 없습니다.,Korean
+오줌에 피가 같이 나왔나요?,Korean
+어떤 음식이나 어떤 경로를 통해 장염에 걸렸는지는 찾기 어려울 것 같습니다.,Korean
+맞습니다. 그런데 비용이 여기 병원만 좀 비싼 것 같네요.,Korean
+일단 드레싱을 하면 끝이긴 한데 주기적으로 와서 치료를 받아야 해요.,Korean
+항생제 과용은 부작용을 일으킬 수 있어 조심해야 합니다.,Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+웻 거즈는 말 그대로 젖은 거즈예요.,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+검사를 하시려면 더 큰 병원을 추천하고 싶습니다.,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+계속 조금씩 통증이 나타나시는 거죠?,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+"무서운 꿈을 많이 꿔서 중간에 많이 깹니다.
+",Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+현기증 있으신 적 있나요?,Korean
+평소 소화가 잘 안 되나요?,Korean
+일단은 치료 들어가면 답변해 드릴게요. 상태가 너무 안 좋아요.,Korean
+검사결과가 나와봐야지 알 수 있겠네요.,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+현재는 열이 떨어진 상태입니다. 검사결과는 들으셨나요?,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+호르몬 요인일 가능성이 높아요.,Korean
+뱉은 가래 색이 어떤가요?,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+진료 기록을 볼 수 있을까 해서요.,Korean
+손목 터널을 넓혀주는 것이지만 완전 치료는 불가능한 방법입니다.,Korean
+약 드시고 알레르기 반응 보인 적 있으세요?,Korean
+병명과 함께 모든 입원경험 말씀해 주세요.,Korean
+독감 주사 언제 맞았어요?,Korean
+근육에 무리가 와서 그런 걸 수도 있어요 선생님이랑 한 번 더 말씀하셔야 할 거 같아요.,Korean
+약을 세 알씩 매일 드셨나요?,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+칼슘은 몸속 전해질 구성 요소 중 하나입니다. 많거나 부족해지면 위험해질 수 있죠.,Korean
+최대한 빨리 다인실로 옮겨만 주세요.,Korean
+투석 받는 건대병원에 갔다 왔죠.,Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+일주일에 몇 번 음주하세요?,Korean
+불편하시겠지만 환자 확인을 위한 절차이니 양해 부탁 드립니다.,Korean
+"수술 몇 시에 해요?
+",Korean
+"별 어려움은 없었는데 변 상태가 이상해요.
+",Korean
+알레르기 반응이 올라오는 다른 원인이 있나요?,Korean
+"아니요. 지금 먹는 약이 있어서 카페인 들어간 식품은 금지예요.
+",Korean
+그럼 의사 선생님께 길게 처방 원하신다고 전달해두겠습니다.,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+심장이 갑자기 빨리 뛰거나 불규칙적으로 뛰지는 않았나요?,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+"뺨이 많이 아프고 볼이 많이 부었어요.
+",Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+소변을 볼 때 피가 보이나요?,Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+수술받은 적 있으면 알려주세요.,Korean
+어긋나거나 골절된 뼈가 폐를 찔러 기흉이 생기지 않는 이상 수술 같은 특별한 치료는 없습니다.,Korean
+네 둘 다 알레르기일 때 나타날 수 있다는 연관이 있습니다.,Korean
+배뇨통이나 빈뇨등의 요로계 증상은 없으시나요?,Korean
+대부분은 그렇습니다만 통증이 있으면 시술 시 말씀해주세요.,Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+하루에 두 갑은 피우세요?,Korean
+힘이 나질 않고 무기력함만 느끼시나요?,Korean
+배가 꼬이는 것 같아요.,Korean
+타 병원에서 분만하였다면 저희 쪽에서 기록을 조회할 수 없습니다.,Korean
+아니요. 병력은 없는 것 같아요.,Korean
+치료를 도중에 중단하고 이후에 재개할 경우 일 년 이상이 걸릴 수도 있습니다.,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+피부 건조는 자주 오는 증상 중에 하나입니다.,Korean
+"통증이 수면 시간을 많이 단축시켰습니다.
+",Korean
+이비인후과에 진료를 받아보시는 것은 어떨까요?,Korean
+네. 풍진 주사 맞았어요.,Korean
+"요즘 소변에서 약 냄새가 좀 나는 것 같아요.
+",Korean
+많이는 아니지만 빨리 입원하는 게 아이에게 좋습니다.,Korean
+"항문에 병이 들어갔는데 안 나와가지고 왔어요.
+",Korean
+고혈압 치료가 진행 중이신가요?,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+"네. 지금 왼쪽 다리에 전체적으로 힘이 빠진 느낌이랄까요.
+",Korean
+복통이 있을 수 있습니다.,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+독감 예방 주사는 이미 맞으신 거죠?,Korean
+"이쪽 귀 청력이 안 좋아지면서 이명도 생겼어요.
+",Korean
+통증과 관련해서 병원은 다니시고 계신가요?,Korean
+통증 지속력이 어느 정도인가요?,Korean
+다른 건 다 괜찮은데 계란이나 우유 들어간 음식을 먹으면 두드러기가 심하게 올라와서요.,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+소화될 때 어려움이 있나요?,Korean
+방광염이 좀 있어서 약 먹고 있어요.,Korean
+잘 모르겠어요. 그냥 고혈압이 조금 있다 정도였던 것 같아요.,Korean
+주로 전립선이나 방광쪽 질환을 말합니다.,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+통원치료도 가능하지만 계속 소독과 환부 확인이 필요해서 입원하시는 게 좋습니다.,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+산소포화도 수치가 정상이고 환자분께서 심호흡을 잘하시니 산소마스크 없이 호흡하도록 하겠습니다.,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+추가적 검사와 진단 이후에 말씀드릴 수 있는 부분입니다.,Korean
+네. 자궁 쪽이라고 하셨던 거 같아요.,Korean
+네. 엄마가 신장이 안 좋으셔서 투석하고 계세요.,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+네 예전에 독감 주사를 맞고 이상 반응이 있던 적 있나요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+"네. 배변 볼 때 너무 아파요.
+",Korean
+건강 보험 이외 실손보험 등 사보험 적용이 필요하시다면 진단서 혹은 소견서를 작성하여 드리겠지만 실제 적용 여부는 보험사와 상의해야 합니다.,Korean
+그냥 살짝 어지럽던데 이것도 부작용인지 모르겠네요. 그다음 날 괜찮아졌어요.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+네. 스테로이드 약 먹었습니다.,Korean
+"코피가 멈출 생각을 안 하네요.
+",Korean
+현기증 느낀 적 있나요?,Korean
+아직 마취가 안 풀려서 그런 거예요.,Korean
+어디 다른 병을 갖고 계신가요?,Korean
+보호자분 열은 삼십 육 점 사 도로 정상이시네요. 당분간 환자분 옆에 계실 건가요?,Korean
+"소변에 거품이 많고 잘 사라지지 않았어요.
+",Korean
+"네. 부종이랄 건 없었네요.
+",Korean
+간염은 약으로 치료하시는 거예요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+���양제는 약물에 속하지 않지만 어떤 영양제를 드시는지 말씀해 주시겠습니까?,Korean
+아픈 곳이 더 있나요?,Korean
+토에 피가 많이 보였나요?,Korean
+소변줄이 걸리는 곳이 있는지 제가 잠시 보겠습니다.,Korean
+소독을 할 때에는 멸균적으로 해야 하기 때문에 되도록 동네 병원에서 치료받으시길 권고드립니다.,Korean
+내시경 자체는 건강보험 적용되지만 수면 비용은 비급여로 적용됩니다.,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+"지난번 상처 부위에서 진물이 너무 많이 나서요.
+",Korean
+네 그럼 안구 건조증만 있는 거죠?,Korean
+암 판정받으신 적 있나요?,Korean
+간염으로 먹는 약이 있습니까?,Korean
+네 수면 패턴 체크를 희망하시는군요.,Korean
+배에 가스가 차 있는 느낌이 드나요?,Korean
+주에 몇 번 아픈가요?,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+환자 번호는 조금 있다 알려 주시겠어요?,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+가급적 빨리 내원하시길 당부드립니다.,Korean
+아무래도 피부질환이 심한 분들은 호흡곤란도 올 수 있어요.,Korean
+소변을 누실 때 소변 발이 어떠신 거 같아요?,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+현기증 정도를 말씀해 주세요.,Korean
+통증이 있는지 알고 싶어요.,Korean
+심장이 유독 빨리 뛰는 느낌이 있나요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+향후 가족계획이 없는 분의 나팔관을 묶는 수술입니다.,Korean
+안면신경을 뇌혈관이 자극해서일 수 있습니다.,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+밤에 잠을 충분히 자지 못하시나요?,Korean
+"보통 한 달에 네 번은 마시고 주로 와인을 많이 마셔요.
+",Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+자기 전 짧은 반신욕이나 샤워는 어떤가요?,Korean
+결핵 백신 주사를 맞았나요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+환자분의 정확한 상태 파악을 위해서 몇 가지 여쭤볼 거예요.,Korean
+이맘때 꽃가루 알레르기가 생기긴 해요.,Korean
+봉합된 부위를 확인해 보겠습니다.,Korean
+그럼요. 검사를 받을 수 있습니다.,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+육안으로 노랗게 보이며 소양감이 있을 수 있습니다.,Korean
+왜 소변검사만 하시려는 건가요?,Korean
+소변을 보는 양은 변화가 있으신 거 같으세요?,Korean
+자세한 건 검사 결과를 봐야 알 수 있습니다.,Korean
+항생제 연고로써 균 감염을 예방해 줄 겁니다.,Korean
+일반적으로 적절한 치료를 할 경우 이전처럼 걸으실 수 있을 겁니다.,Korean
+언제부터 열감이 전신적으로 발현되시나요?,Korean
+종양 치료받은 적 있으세요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+우선 금식을 유지하시는 게 좋습니다.,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+국소마취제를 스테로이드와 넣어 통증을 완화해주는 겁니다.,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+"신장 제 기능을 수행하지 못한다고 들었어요.
+",Korean
+아직은 회복 상태이니 조금만 더 쉬시면 될 겁니다.,Korean
+담배를 피우신 경험이 있나요?,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+"다리에 쥐 난 것 때문에요.
+",Korean
+호흡곤란이 많이 심했나요 그때?,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+"가슴이 수축하면서 무거운 느낌이 들어서요.
+",Korean
+평소에 식이 섬유 위주의 식단은 챙겨 드시나요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+휠체어는 안 타도 될 것 같은데 꼭 타야 하나요?,Korean
+"저희 애가 자꾸 속이 안 좋다고 칭얼거려서요.
+",Korean
+어느 정도의 강도로 통증이 느껴지나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+발열이나 근육통 및 두통 등이 있으셨나요?,Korean
+거동이 불편하신지 확인하려고 합니다.,Korean
+상해로 인하여 입원하여 수술하신 적이 있나요?,Korean
+제가 좀 마취 깨는 게 오래 걸린다고 되도록 수면 마취 같은 것도 안 하는 게 좋을 것 같다고 했었어요.,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+혹시 부모님이 유전적 질환은 가지고 있었나요?,Korean
+하지정맥류 진단받고 여기 온 거예요.,Korean
+약 알레르기 있는 거 있으실까요?,Korean
+네. 갑상선 호르몬 약 매일 먹는 중이에요.,Korean
+병실에는 보호자분 본인께서 주로 함께 계실 건가요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+예전에 다쳐서 여기 오신 적이 있으세요?,Korean
+네. 필요하시면 수액도 놔드리겠습니다.,Korean
+소량의 마취제로도 가능하니 참고하겠습니다.,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+숨 쉴 때 통증이 있나요?,Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+피로감은 어느 정도 심한가요?,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+가스와 변을 없애기 위해서는 변비를 치료해야 합니다.,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+결핵 주사를 맞으셨는지 알려 주세요.,Korean
+수치가 바뀌는 수준까지 감안해도 환자분은 혈당이 안정적입니다.,Korean
+네. 너무 예민하고 그래서 병원에 가보니깐 오래전부터 우울증을 앓고 있었던 것 같대요.,Korean
+간 염증 수치가 높으신가요?,Korean
+집안에 고혈압인 분 있나요?,Korean
+"애기가 숨을 쉴 때 소리가 이상해요.
+",Korean
+대부분 마취크림으로 충분합니다 통증 예방에 도움이 됩니다.,Korean
+속이 좋지 않은 증상은 있으셨어요?,Korean
+대변에 피가 같이 나옵니까?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+복부 팽만감이 언제부터 있으셨나요?,Korean
+목에 아픈 증세가 있나요?,Korean
+아버지가 당뇨 어머니가 고혈압이 있으세요.,Korean
+뼈 스캔은 정맥주사로 검사 약물을 넣고 사진 찍는 거예요.,Korean
+비타민이랑 루테인 먹고 있습니다.,Korean
+"예전처럼 몸이 움직여주질 않아요.
+",Korean
+"숨 쉬는 게 이상한 거 같아요.
+",Korean
+뱃속이 쿡쿡 찌르듯이 아픈가요?,Korean
+목이 너무 마르면 젖은 수건을 입에 대는 것도 좋은 방법입니다.,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+입원 준비 물품을 다 챙겨오지 못했는데 어디서 구입할 수 있나요?,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+암 진단받아본 적 있으세요?,Korean
+수혈을 거부하는 이유가 있을까요?,Korean
+"배가 엄청나게 자주 아파지고 그때마다 화장실에서 설사했어요. 변은 거의 액체 수준으로 흐르듯이 했고요. 색은 좀 묽어 보였어요.
+",Korean
+오한 증상이 언제 시작 되었죠?,Korean
+네 드시는 약 이름 알고 계시나요?,Korean
+실제 잔뇨는 없고 감각이상에 의한 잔뇨감인 경우 과민성 방광으로 약물치료를 기본으로 합니다. 방광 훈련 골반근육 운동 등을 병행하면 더욱 치료 효과를 높일 수 있습니다.,Korean
+따끔거림이 심하신가요 어떤 연관이 있는지는 자세한 검사가 필요할 것 같네요.,Korean
+"근래 들어 음식 삼키기가 힘들어서 식사량이 줄었어요.
+",Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+술은 한 달 중에 며칠 정도 드세요?,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+잘 체해서 소화제 가끔 먹어요. 약 가져와야 되나요?,Korean
+결핵 백신 주사를 맞았나요?,Korean
+몸이 안 좋은지는 확답하기가 곤란하네요 검사를 해봐야 알 수 있어요.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+네. 전에도 이런 증상이 있어서 올해 마음먹고 대장내시경이랑 위내시경 둘 다 받았습니다.,Korean
+오늘은 어디가 아파서 병원에 오셨을까요?,Korean
+처음에는 마취 때문에 잘 모르다가 마취가 풀리면 많이 아픕니다.,Korean
+그랬었죠. 한동안 약 먹었어요.,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+비타민제에 과일에 들어가는 비타민 이상을 담을 수는 있지만 체내 흡수율에서 차이가 납니다.,Korean
+속이 꽉 막힌 것 같나요?,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+어머니가 신장기능 문제로 병원에 다니고 계세요.,Korean
+처방전에 맞게 약 꾸준히 드시면 빠른 호전이 됩니다.,Korean
+온몸에 몸살 기운이 있다는 말씀인가요?,Korean
+"네. 어릴 적 아버지 거 몰래 피우다가 습관이 됐어요.
+",Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+영양상태가 좋으면 더 빨리 자라나기 때문에 잘 먹여주세요.,Korean
+"친구들이랑 농구하다가 다리를 삐끗해서요.
+",Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+에이엘티 수치가 얼마나 되죠?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+강현아씨는 만성 위염 중에서도 비후성 위염에 속합니다.,Korean
+"소변을 너무 자주 보러 가요. 십 분째 한 번씩 갈 때도 있어요.
+",Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+저 마취가 너무 잘 들어서 잠을 잘 못 깨 가지고 저보고 수면 마취 같은 거 안 하는 게 좋을 것 같다고 했었어요.,Korean
+손목터널의 인대를 잘라 신경이 지나가는 공간을 넓히는 수술입니다.,Korean
+마취하고 어디가 아프거나 안 좋았던 적이 있나요?,Korean
+앰뷸런스에서 병상으로 이동할 때 어떻게 하셨나요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+"음 저희 아기가 비슷한 개월 수 아기들보다 키도 크고 덩치도 크거든요. 그래서 검사 한 번 받아볼까 하고 왔어요.
+",Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+"속이 너무 안 좋아요.
+",Korean
+일 회 치료에 약 십만 원 정도 들 겁니다.,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+당뇨 처방 약은 어떤 걸 갖고 계세요?,Korean
+환자분 주치의께서는 보통 아홉 시 전에는 환자 보러 돌아다니셔요.,Korean
+가족력이 있다고 따로 들은 얘기는 없어요.,Korean
+가족들이 비형 간염 보유자예요.,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+과거에 수술받으신 적 있나요?,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+키와 몸무게 측정하겠습니다. 신발 벗고 올라와서 측정하겠습니다.,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+지금 먹고 있는 약 있어요.,Korean
+몸에서 에너지가 빠져나가는 느낌인가요?,Korean
+"실수로 약 봉투를 삼켜버려서 왔습니다.
+",Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+타고 있는 담배에서 나오는 연기는 입자의 크기가 작아 폐의 깊은 부분까지 들어갈 수 있어 더 안 좋습니다.,Korean
+시월에 독감 주사 맞았었어요.,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+부정맥 초기라서 아직 치료할 단계는 아닌가 봐요.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+"옆구리가 영 신통치 않아요.
+",Korean
+통증에 반응 좀 보여 주시겠어요?,Korean
+소변볼 때 잘 안 나오나요?,Korean
+정확히 초음파상 어떤 곳을 재확인하고 싶으신 건가요?,Korean
+세 종류의 약을 하루 이 회씩 복용하게 되는데 처방하는 의사에 따라 조금씩 다를 수 있습니다.,Korean
+"통증이 심해져서 잠이 안 와.
+",Korean
+일단은 발바닥에 보습제를 바르고 양말 등을 덮거나 비닐을 감싸서 최대한 잘 스며들도록 할게요.,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+두통으로 불편한 점은 없나요?,Korean
+약 드시고 간지럽거나 두드러기가 난 적 있나요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+심각하다기보다는 정밀 검사가 필요합니다.,Korean
+지금 혹시 오한이 있나요?,Korean
+현재 검사 소견은 모두 정상이라 추후에 가슴 통증이 재발할 경우 그때 임상적 상황에 맞춰 필요한 검사들을 진행하시면 됩니다.,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+"물로 입안 헹구고 뱉었어요.
+",Korean
+약은 따로 안 주셨어요.,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+네. 세 명 모두 다 자연 분만이요.,Korean
+오한 증상이 있다고 생각하나요?,Korean
+움직이면 제일 아픈 부분이 어디인가요?,Korean
+"복통만 조금 있을 뿐 나머지는 이상 없었어요.
+",Korean
+아이가 체온이 높아 옷을 벗기는 게 좋을 것 같습니다.,Korean
+저희 병원 입원 경험만 확인 가능합니다.,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+몸살 기운이 있는 것 같나요?,Korean
+하루 흡연량이 어떻게 되시는지요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+네 그렇습니다 추후 가슴 통증 증상이 생길 경우 즉시 병원에 다시 내원 해주세요.,Korean
+언제 주로 현기증을 느끼나요?,Korean
+치아를 손으로 잡고 흔들면 치아에 자극을 주기 때문에 좋은 행동은 아닙니다.,Korean
+"통증이 심해져서 잠이 안 와.
+",Korean
+수술이 필요해서 입원하는 것이지 질환이 심각해서 입원하는 것은 아니니 너무 걱정하실 필요는 없습니다.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+아까 너무 아파서 진통제 두 알 먹었어요.,Korean
+"배에 가스가 가득 찬 거 같아서 왔어요.
+",Korean
+아버지가 퇴직 후에 우울증으로 잠깐 고생하실 때 정신과 다니셨죠.,Korean
+엑스레이 확인 후 제거하도록 하겠습니다.,Korean
+흡연 기간이 얼마나 될까요?,Korean
+많이 아프세요? 진통제 필요하시면 드릴게요.,Korean
+흡연 기간이 얼마나 될까요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+동시 접종은 문제가 되지 않습니다.,Korean
+아픈 부위가 있다면 다 말해주세요.,Korean
+어떤 수술 했는지 알려주세요.,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+"입원 좀 하려 해요.
+",Korean
+가래에서 냄새가 많이 나나요?,Korean
+네 입원일수에 맞게 계산되는 것으로 알고 있습니다.,Korean
+몸이 약해서 어렸을 때부터 자주 쓰러졌어요.,Korean
+아니요. 집 근처에 병원이 없어서 참았어요.,Korean
+어머니가 아토피성 피부염이 있습니다.,Korean
+"기침을 심하게 하고 가끔 피가 나와요.
+",Korean
+몸 전체에 힘이 없나요?,Korean
+정확해야 하니까 피검사를 해볼까요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+지금 복용 중인 간염약 있나요?,Korean
+우선 간 곳 알려주세요.,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+암을 진단 받으신 적 있나요?,Korean
+통증이 계속 있나요 아니면 아팠다 괜찮았다 하나요?,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+참기 어려우세요? 수액이 들어가면 좀 나아질 거예요.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+특별히 아픔을 느끼는 곳이 있나요?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+이차 치료는 복용하는 약의 종류와 횟수가 일차 치료 보다 많아 힘들 수 있습니다.,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+알레르기 반응은 예방 접종 후의 반응이라 검사로 미리 알아볼 수는 없습니다.,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+정확히 검사를 해보는 게 낫겠네요.,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+"""한 달 전에 진행했던 대장 내시경 결과, 대장에는 이상이 없어, 병변에 해당하는 직장 부위만 봐도 충분합니다.""",Korean
+"소변이 살짝 탁한 색이었어요.
+",Korean
+통증이 어떤 식으로 느껴졌는지 설명해 주실래요?,Korean
+"목이 너무 아파서 숨만 쉬어도 할퀴는 것 같아요.
+",Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+많이는 아니지만 빨리 입원하는 게 아이에게 좋습니다.,Korean
+네. 체중을 항상 측정하지 않아요.,Korean
+물리치료 진행하면서 경과를 조금 더 지켜보겠습니다.,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+심장이 빨리 뛴다는 느낌이 드세요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+언제부터 가슴 통증이 있나요?,Korean
+약은 어떤 약을 드시나요?,Korean
+벽 반대쪽을 보고 계시면 키와 몸무게 측정 도와드릴게요.,Korean
+수술이 필요해서 입원하는 것이지 질환이 심각해서 입원하는 것은 아니니 너무 걱정하실 필요는 없습니다.,Korean
+통증이 멈출 때도 있는 건가요?,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+보통 십 회 정도 치료합니다.,Korean
+갑자기 알레르기 반응이 일어나면 기도가 막힐 수가 있거든요.,Korean
+순한 화장품 아니면 알레르기 증세가 바로 일어나요.,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+주사 공포증이 있어서 주사를 맞을 수가 없어요.,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+너무 체온이 상승하는 것은 안 좋을 수 있습니다.,Korean
+무리를 하셨네요. 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+두통 때문에 잠들기 어렵지는 않나요?,Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+혹시 대변은 잘 보시는가요?,Korean
+어디가 제일 많이 부었나요?,Korean
+경우에 따라서는 조직검사 결과를 확인하고 영상검사 등 추가적인 검사 후에 치료 방향을 결정할 수도 있습니다.,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+몸이 좋지 않다고 느끼시면서부터 수면 시간이 변한 건가요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+네. 헬리코박터균은 분변 구강 전파가 가능합니다. 가족 간 전파가 흔히 일어나는 것으로 보고되어 있습니다.,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+"걸레를 짜고 난 후 손가락 마디가 많이 아픕니다.
+",Korean
+아스피린이오. 삼사 일 정도 됐네요.,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+간염과 관련된 약물 드시는 것 있나요?,Korean
+네 금주 금연을 꼭 하셔야 합니다.,Korean
+하루 몇 갑의 흡연을 하시나요?,Korean
+키랑 몸무게가 특정 질환과 연관성이 있을 수도 있어서 측정하는 겁니다.,Korean
+코로나바이러스 검사를 위하여 선별진료소를 다녀왔습니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+아니요. 객혈만 가지고는 문제가 있다 없다를 말씀드리기 어렵습니다.,Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+네. 입원생활 안내문을 확인하셨다는 서류가 필요해요.,Korean
+고혈압 기간이 어떻게 되세요?,Korean
+우선 더 자세한 검사를 받아본 후 말씀 나누는 게 좋을 듯합니다.,Korean
+복통이 함께 있지는 않았나요?,Korean
+아니요. 조영제는 주사로 투여합니다.,Korean
+그럴 수도 있고 염증이 생겨서 부종이 있을 수도 있습니다.,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+발기 부전 증상이 있으세요?,Korean
+그전에는 음주와 흡연을 얼마나 하셨나요?,Korean
+당뇨 검사받아보신 적 있으세요?,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+식습관이 엉망진창이라 장염도 잘 걸려요.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+등이 가렵거나 따가우신 건가요?,Korean
+본원에서 한 게 아니라면 어느 병원에서 하셨는지 기억하시나요?,Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+아픔이 느껴진 게 언제가 처음이죠?,Korean
+병원 입원 경험이 있으신가요?,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+오줌에 피가 같이 나왔나요?,Korean
+국소마취제를 스테로이드와 넣어 통증을 완화해주는 겁니다.,Korean
+알레르기 일으키는 원인 있나요?,Korean
+증상이 없는 사람에게서 옮았을 경우 어디에서 옮았는지 알 수 없습니다.,Korean
+오한 증상이 있다고 생각하나요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+배뇨한 후에 잠자리에 드시고 기상 후에는 반드시 삼십 분 이내에 배뇨하여 그 소변량을 기록하여 주십시오.,Korean
+걱정이 되신다면 시티 촬영해 보세요.,Korean
+혈뇨를 볼 때 통증이 동반되나요?,Korean
+아프다 안 아프다 하나요?,Korean
+알고 계신 혈액형은 무엇인가요?,Korean
+"소변보는데 너무 아프고 잔뇨감이 늘 있어요.
+",Korean
+몸의 부기가 어느 정도인가요?,Korean
+네 약에 알레르기 반응이 없습니다.,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+구토가 난 적이 있으세요?,Korean
+통증 느껴지는 곳 짚어보세요.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+"소변볼 때 아랫배 쪽이 통증이 있습니다.
+",Korean
+얼마나 자주 아픔을 느끼나요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+네 삼 개월 때 수��할 수 있으나 주로 육 개월 이후에 합니다.,Korean
+"손가락에 수포가 생기면서 빨개지더니 나중에는 점점 가려워지더라고요.
+",Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+"오른쪽 얼굴부터 발 끝까지가 움직임이 불편해요.
+",Korean
+호흡하기 힘들 때가 많나요?,Korean
+아프신 정도가 얼마나 되시나요?,Korean
+병원에서 결핵 치료 중이신가요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+어떤 종류의 비타민을 드시나요?,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+현기증을 처음 느끼신 건가요?,Korean
+상처 보호 및 지혈 등에 쓰입니다.,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+대충 한 달 이내에 드신 약 기억나는 게 있으신가요?,Korean
+건들지 않으시면 피는 안 나요.,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+사랑니 제외 다른 치아를 뽑은 경우만 말씀해 주시면 됩니다.,Korean
+성교 시 발기가 안 되어 문제가 있나요?,Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+코로나 때문에 물어보는 겁니다.,Korean
+"요즘 변비 때문에 화장실에 오래 앉아있어야 해요.
+",Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+"그냥 여덟 시부터 금식했다고 하면 될 것 같아요. 그전에는 물을 마신 것 같기도 하고 애매해서요.
+",Korean
+하루 이틀 뒤에는 괜찮아지나 나아지지 않으면 내원하세요.,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+"코 막혀서 잠을 못 자는 거 같아요.
+",Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+담배를 피운 기간을 알려주세요.,Korean
+네. 음식이 원인일 수도 있습니다.,Korean
+유산소운동을 얼마나 꾸준히 해왔는데요.,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+"작업하던 중 그라인더에 긁혀 다쳤어요.
+",Korean
+속이 메슥거리고 체할 것 같나요?,Korean
+"안면 마비가 온 거 같아요.
+",Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+아니요. 항생제 치료도 함께 필요합니다.,Korean
+네. 영양제 몇 종 챙겨 먹어요.,Korean
+"장이 예민한 편이라 늦게 먹으면 담날 고생해서 안 먹어요.
+",Korean
+잘 못 자서 힘드세요?,Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+같은 병실이 아니었으면 좋겠습니다.,Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+소화하는데 불편한 건 없나요?,Korean
+지속적으로 같은 부위에 압력이 가해지면 욕창이 생길 수 있습니다.,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+제일 신경 쓰이는 증상이 뭔가요?,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+변에 피가 함께 나오나요?,Korean
+흡연 시작한 지 얼마나 되었어요?,Korean
+네 부작용이 발생할 수 있으나 흔한 부작용은 아닙니다.,Korean
+뱉은 가래 색이 어떤가요?,Korean
+소변에 피가 섞여 나오나요?,Korean
+몇 년 전에 중풍이 와서 하반신 불수고 그래서 요양원에 계세요.,Korean
+대변볼 때 피가 보이나요?,Korean
+구역질이 나면서 피가 올라올 때가 있나요?,Korean
+알레르기 치료는 얼마 동안 받으셨어요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+혈변에 피가 많이 보였나요?,Korean
+아니에요 치료하면 충분히 완치 가능합니다.,Korean
+흉 없이 치료하기까지는 시간이 많이 걸리겠어요.,Korean
+초음파 검사는 진료 중에 잠깐 하는 거기 때문에 미리 말씀드리지 않은 것 같네요.,Korean
+올해 독감 예방 주사는 어떻게 하셨어요?,Korean
+네. 문진표 이외에 입원생활에 필요한 정보를 수집하기 위한 절차입니다.,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+요원분 따라가시면 엑스레이 실로 안내받으실 겁니다.,Korean
+마취 후 언제쯤 통각이 돌아왔나요?,Korean
+멍이 크게 들은 걸 보니 연관이 있어 보이네요.,Korean
+약은 먹고 있고 안 먹었을 때는 유지가 안 되긴 합니���.,Korean
+네 찾으시는 연고가 이거 맞나요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+수술적 치료 이후 호전 양상에 따라 다를 수 있으나 큰 수술은 아니기 때문에 입원 기간은 길지 않을 것으로 보입니다.,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+두드러기가 어느 부위로 올라왔죠?,Korean
+코로나 때문에 어디 못 돌아다녔죠.,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+"병원에서 간 수치가 높다고 큰 병원 가래서 왔어요.
+",Korean
+구급차 타고 오셨는지 해서 여쭤봤습니다.,Korean
+평상시 음주 여부 말입니다.,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+일단 응급처치 후 손상 정도를 확인해 볼 겁니다.,Korean
+"어지러운 느낌이 들어서 커피 안 마셔요.
+",Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+그런 경우와는 달리 본인이 통제하지 못하는 구토인 경우가 많습니다.,Korean
+금식을 할 때는 물도 드시면 안 됩니다.,Korean
+"변은 안 나오는데 가스만 자꾸 차서 걱정이에요.
+",Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+네. 필요하시면 수액도 놔드리겠습니다.,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+환자분이 입원하실 자리가 저녁 늦게 준비가 됩니다.,Korean
+담배를 피운 기간을 알려주세요.,Korean
+언제부터 다른 부위 통증이 있으셨나요?,Korean
+네. 혹시 병실 몇 인실인가요?,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+결핵 주사 맞아본 경험 있으세요?,Korean
+"숨찰 때 두통도 같이 있어요.
+",Korean
+그 기록에 의해 환자분에 대한 또 다른 판단이 가능해서요.,Korean
+진통제를 맞고도 계속 그런가요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+증상이 시작된 부분이 어디인가요?,Korean
+여러 영양제를 먹고 있습니다.,Korean
+보통 성인 기준으로는 일곱 시간 내지 여덟 시간을 권장하고 있기 때문에 적은 편이라고 볼 수 있습니다.,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+이전에 심장 관련 검사를 받은 적이 있으신가요?,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+하루에 한 갑은 피우시나요?,Korean
+지금까지 알레르기가 나타난 적은 없어요.,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+"네. 요즘 더 심해져서 잠을 거의 못 자요.
+",Korean
+소변을 볼 때 불편함이 없나요?,Korean
+질병 약물로 치료하고 계시나요?,Korean
+"벌집을 건드리는 바람에 온몸에 벌이 달라붙어서 쏘였어요.
+",Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+혹시 따로 복용하는 약이 있으실까요?,Korean
+유전성 질환으로 고생하는 가족이 계신가요?,Korean
+현재 건강상태에서 항생제를 세게 투약하면 면역체계가 무너집니다.,Korean
+환자분의 거동 여부 등을 확인하기 위해서입니다.,Korean
+현재 복용 중인 약이 있으신가요?,Korean
+약은 규칙적으로 드셔 주셔야 효과가 있습니다.,Korean
+통증 부위는 어디신 거죠?,Korean
+원인을 단정 짓기는 어렵습니다. 잠에 들기까지가 어려우신 건지 자주 깨셔서 그런 건지 등 수면 패턴도 고려해봐야 합니다.,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+과거에 수술 경력 있으신가요?,Korean
+지금 갑자기 아프기 시작하신 건가요?,Korean
+최근에 체중 변화가 급격하게 있었어요?,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+안 됩니다. 기계 호흡은 폐에 발생한 질병을 치료하거나 낫게 하는 것이 아니라 우리 몸의 호흡기능을 일시적으로 보조할 뿐입니다.,Korean
+아픈 곳이 더 있나요?,Korean
+진단서 더 뽑으려면 만 원의 추가 비용이 듭니다.,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+하루에 담배는 어느 정도나 하시는 거죠?,Korean
+간염은 언제 진단 받으셨나요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+체온이 몇도 정도 인가요?,Korean
+아. 드디어 퇴원하네요. 필요한 서류는 없어요!,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+"발바닥에 박힌 가시가 안 빼져서요.
+",Korean
+과거 암 진단받은 적 있나요?,Korean
+네. 지금 응급실에 진료 보고 계신 분은 안 계세요.,Korean
+해당되지 않지만 어떤 비타민을 드시는지 말씀해 주세요.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+잘 못 주무시는 이유를 알아야 환자분께 필요한 약을 알 수 있습니다.,Korean
+약 냄새 때문에 어지럽다는 건가요? 약 드신 직후에 그런가요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+꼭 피곤해서 코피가 났다고 볼 수만은 없습니다.,Korean
+위암 진단 판정받고 완치했습니다.,Korean
+퇴원하시면서 드릴 서류에 사인해 주셔야 합니다.,Korean
+"허리 디스크가 있어서 수술해야 한다고 하셔서요.
+",Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+수혈이 필요한 상황에 대비해서 혈액을 확보해 두어야 해서요.,Korean
+"얼마 전에 작업하다가 그라인더에 긁혀가지고 대충 약 바르고 끝냈거든요. 그러다 한 삼일 전부터 진물이 나더니 지금은 좀 아파요.
+",Korean
+수액을 맞으면 식사를 안 해도 괜찮고 주사도 수액 통해서 맞으면 덜 아파요.,Korean
+그렇습니다. 주사를 놓을 수 있게 아이 엉덩이를 내려주세요.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+흉터가 남으나 자라면서 옅어질 것입니다.,Korean
+원인을 단정 짓기는 어렵습니다. 잠에 들기까지가 어려우신 건지 자주 깨셔서 그런 건지 등 수면 패턴도 고려해봐야 합니다.,Korean
+평소 앓고 계시는 기저질환이 있습니까?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+소독을 할 때에는 멸균적으로 해야 하기 때문에 되도록 동네 병원에서 치료받으시길 권고드립니다.,Korean
+외가 친척 중에 있는 유전 질환이 어떤 건가요?,Korean
+매일 내원하는 것이 더 귀찮으실 텐데요.,Korean
+그러면 이쪽에서 처방전 받아 가시고 결제하시면 되세요.,Korean
+"소변량은 의식해본 적이 없어서 잘 모르겠어요.
+",Korean
+담배를 피우신 경험이 있나요?,Korean
+가스가 차면서 방귀를 못 뀌고 변을 못 본다면 장이 막혔을 수 있습니다. 하지만 방귀도 나오고 변도 보면서 가스가 찬다면 증상 조절 약을 드릴 수 있습니다.,Korean
+수술받은 적 있으면 알려주세요.,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+환자분 컨디션에 따라 달라집니다.,Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+정확한 결과를 알기 위해서 우선 엑스레이를 찍어볼게요.,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+투 바이 투 사이즈의 거즈를 말합니다.,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+대변을 볼 때 피가 나오나요?,Korean
+우선 더 자세한 검사를 받아본 후 말씀 나누는 게 좋을 듯합니다.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+"근 이십 년 될 것 같아요. 마흔까지 피웠으니.
+",Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+처음 알레르기 반응이 나타난게 언제였나요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+혈압 다시 측정했을 때 뭐 변화가 있나요?,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+하루 평균 얼마나 피우시나요?,Korean
+그런 부작용을 방지하기 위해 자세히 모니터링하며 지켜보도록 하겠습니다.,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+입원해서 치료받거나 수술받은 경험입니다. 입원하신 경험이 있다면 알려주세요.,Korean
+다행히 약은 잘 받아요.,Korean
+혈압만 조금 높게 나오네요.,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+주에 몇 번씩 통증이 느껴지시나요?,Korean
+따로 알아 둘 알레르기��� 있을까요?,Korean
+이 약물은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+주로 어디가 가장 아프세요?,Korean
+예 혹시 근육통일 수도 있어서 잠시 대기해주세요.,Korean
+"살짝 열도 나고 감기 기운이 있는 것 같아요.
+",Korean
+수면 비용은 보험 적용이 되지 않아 만 원이 추가됩니다.,Korean
+인플루엔자 예방 접종은 매년 일 회 맞아주시면 됩니다.,Korean
+다른 문제는 없으니까 당뇨약만요.,Korean
+네 일반적인 해열제 종류가 여러 개여서 구체적으로 알려 주셔야 합니다.,Korean
+고혈압 진단받은 지는 족히 이십 년은 넘었다만.,Korean
+피로한 게 안 풀리시나요?,Korean
+피가 섞인 대변을 보세요?,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+다른 약도 안 먹고 수액 같은 것도 맞은 적 없어요.,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+통증이 시작된 것이 언제인가요?,Korean
+온몸에 열이 계속 나는지 알려주세요.,Korean
+지금까지 열은 안 났나요?,Korean
+도대체 어디가 아픈 거예요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+아까 계절이 바뀌면서 증상이 심해졌다고 하셨는데 꽃가루 알레르기도 있나요?,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+입원이나 수술해 본 적이 아예 없습니다.,Korean
+협진을 받아야 할 정도로 심각한 것인가요?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+가능한 질환들을 감별하기 위해 추가적인 검사가 필요합니다.,Korean
+참고해야 할 병력이 있을까요?,Korean
+현재로서는 심각한지 진단하기 어려우니 검사를 진행하는 겁니다.,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+네 틀니는 여기 앞에다 두고 진료하겠습니다.,Korean
+배가 부글거리는 경우가 있나요?,Korean
+변비 또한 주요한 증상으로 포함됩니다. 그리고 그 외 대변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+마취제 용량 선택 시 참고하도록 하겠습니다.,Korean
+"아니요. 약은 따로 안 먹어요.
+",Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+며칠 전에 치과 갔었어요.,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+평균적으로 담배를 하루에 몇 갑 정도 피우세요?,Korean
+다행이네요 고열량의 야식을 드시고 몸의 움직임이 적으면 고혈압 당뇨 고지혈증 비만 등 질병에 걸릴 위험이 높아져요.,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+"눈을 감은 채로 두 시간이 지났는데도 잠에 들지 못하겠어요.
+",Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+"흡연은 안 하고 술 마신 지는 십 년 조금 넘었습니다.
+",Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+"주말이라 병원을 갈 수가 없어서 왔어요.
+",Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+고환이 복막을 통과할 때 생기는 통로가 막혀야 하는데 막히지 않아 이곳을 통해 탈장이 된 것 입니다.,Korean
+현재는 전혀 술을 안 드시나요?,Korean
+계속 드시던 약이 있나요?,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+"네. 한번 자는 게 어려워서 백색소음 들으면서 자요.
+",Korean
+네. 알겠습니다. 수술 부위 표시해주세요.,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+알레르기 있다는 거 언제 아셨죠?,Korean
+수면 시 어려움이 있으신가요?,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+방귀와 변이 나온다면 일단 증상 조절을 하며 경과 관찰해 볼 수 있을 것 같습니다.,Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+환자가 병원 들어오고 나가기 전까지의 모든 행위에는 환자 이름 주민등록상 생년월일 환자번호로 확인이 이루어지고 있습니다.,Korean
+진통제 넣고 있어서 통증 금방 가라앉아요.,Korean
+코로나 확진자와 밀접 접촉자로 분류되어 선별진료소에 다녀왔어요.,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+혈변이 어떤 색으로 나오던가요?,Korean
+부부관계를 하실 때만 발기 부전이 나타나나요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+힘들긴 하겠지만 대장 내시경보다 시간이 짧게 걸리고 관이 덜 들어가기 때문에 비수면으로도 하실 수 있습니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+지금 복용 중인 간염약 있나요?,Korean
+설사는 몇 번 하셨나요?,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+잘 보셨습니다. 위의 변성 소견으로 정상에 비해 위암 발생 위험성이 높지만 당장 위암이 발생하는 것은 아닙니다.,Korean
+타 병원 내원한 적 있습니다.,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+당뇨 진단 후에 하시는 운동이 있으신가요?,Korean
+입원할 뻔한 적은 있어요.,Korean
+"저 스스로 상담이나 치료가 필요하다고 느꼈어요.
+",Korean
+"비타민 섭취를 위해 오렌지 같은 과일을 자주 먹어요.
+",Korean
+처방받지 않는 약은 뭔가요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+전신 마취에 대한 부작용이 없으셨는지 해서요.,Korean
+네 질환마다 기침 소리가 조금씩 다릅니다.,Korean
+신체부위를 마사지 해주셔야 합니다.,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+만졌을 때 통증은 없나요?,Korean
+환자분마다 느끼는 증상이 달라요.,Korean
+출혈과 연관이 있을 수 있습니다.,Korean
+원인은 다양합니다. 무엇을 드실 때 삼키기 힘드신가요?,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+소변이 쉽게 안 나오나요?,Korean
+아니요. 산소 수치를 주기적으로 확인 후 내일 회진 시 결정할 예정입니다.,Korean
+"변비가 원래 있었는데 요즘 더 심해졌어요.
+",Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+피임약은 최근에도 계속 드시고 계신가요?,Korean
+치밀유방이라고 들으셨죠? 유방초음파 같은 거 해보신 적은 있으세요?,Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+환아가 각성상태로 진행되는 검사이니만큼 보호자분들의 협조가 필요합니다.,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+"애기가 숨을 쉴 때 소리가 이상해요.
+",Korean
+선천적으로 심장이 안 좋아서 뛰질 못해요.,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+집보다는 요양원이 편하실 것 같아서요.,Korean
+네. 아버지가 신장으로 힘드셨어요.,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+"코골이가 심해지고 가끔 숨을 헐떡이며 잠에서 깹니다.
+",Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+"구역질이 난 적은 있는데 구토까지 한 적은 없어요.
+",Korean
+네 수술 시 참고해야 하기 때문입니다.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+암이라고 진단받으신 적 있나요?,Korean
+지난번에 암 치료는 언제 시작하셨나요?,Korean
+"제가 우유를 먹고 토를 심하게 한 적이 있어서 안 마십니다.
+",Korean
+목이랑 어깨 스트레칭을 잘 해주지 않아서 그래요.,Korean
+네 약 이름을 알고 계십니까?,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+수혈을 해봤다는 게 받아봤냐는 말씀이신가요?,Korean
+수술방법에 대해 이상 반응은 없으셨나요?,Korean
+결핵 때문에 아직도 고생이신가요?,Korean
+틀니 보청기 가발 지팡이 렌즈 등 사용하시는 보조 기구가 있나요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+식욕이 떨어지신 것 같나요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+"옆구리 상처 치료하러 왔어요.
+",Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+평소에 ���변을 보기가 힘든가요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+"수상스키 타다가 넘어졌는데 이가 부러져 버렸어요.
+",Korean
+음식 알레르기 있는지 알고 싶어요.,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+수술 부위 피부 바로 위에 해주시면 됩니다.,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+비용은 개당 만 원 정도이고 동네 피부과에서 제거하셔도 무관합니다.,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+잠이 들면 중간에 몇 번이나 깨나요?,Korean
+"목 아프다고 삼 일 내내 밥을 안 먹으려고 해서 애먹었어요.
+",Korean
+네 복원수술받은 것도 말씀해 주세요.,Korean
+환자의 권리와 의무에 대해서 읽어 보시고 입원 시 준비 물품은 슬리퍼 세면도구 수건 휴지 물티슈 속옷 개인용 충전기 물통 물컵 등 입니다.,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+환자분이 어떤 약을 드시는지 파악을 해야 해서요.,Korean
+가장 걱정되는 증상이 무엇인가요?,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+몸이 간지럽거나 하진 않으셨어요?,Korean
+몇일 밤을 못 주무신건가요?,Korean
+네. 충분히 이해합니다. 또 궁금하신 거 있으시면 언제든 말씀해 주세요. 그러면 이어서 질문드릴게요. 지금 왼쪽 눈이 잘 안 보이시는 거 말고 다른 불편하신 거 있으신가요?,Korean
+네. 교정해야 돼서 두 개 뽑았습니다.,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+당뇨 나온 적 있으세요?,Korean
+이런 몸 상태로 어떻게 퇴원하죠? 아직 퇴원 못 합니다.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+"숨을 들이쉬고 내쉬는 게 어려워요.
+",Korean
+"몇 년 전부터 왼쪽 무릎이 아프더니 요즘은 다리가 퉁퉁 붓고 걷기도 힘들고 움직일 때마다 삐걱삐걱 거리는 소리도 나는데 두 달 전부터는 오른쪽 무릎까지 아파서 병원에 왔더니 수술해야 한대요.
+",Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+통증이 한 번씩 오나요?,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+어느 부위에 통증이 심한가요?,Korean
+최소 일주일은 입원하시길 권유드립니다.,Korean
+통증 있는 부분이 어디예요?,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+당뇨가 심해서 합병증까지 생겼습니다.,Korean
+환자분 입원을 위한 조사를 위해 몇 가지 질문하겠습니다.,Korean
+피검사 말고 씨티나 엑스레이 같은 촬영 사진 말이에요.,Korean
+저는 무료 접종 대상이 아니라서 그냥 안 맞았어요.,Korean
+전립선이 비대해서 수술받아야 한다고 하더라고요.,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+당뇨약을 가끔 잊어서 그런지 혈당도 불규칙하네요.,Korean
+알레르기는 언제부터 그런 건지 기억하세요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+"제가 지금 한약을 먹고 있어서 술을 안 먹은 지 육 개월은 돼서요.
+",Korean
+몸에서 오한을 느끼진 않나요?,Korean
+"아기가 사타구니 쪽만 건드리면 울어서요.
+",Korean
+고혈압 약 먹는 거 있으세요?,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+작년 겨울에 스키 타다가 다쳐서 입원한 적이 있었습니다.,Korean
+환자분 식사 패턴을 파악하려고 여쭤봤어요.,Korean
+통증이 일 분 넘게 지속했던 적이 있나요?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+"여기 안쪽에 어금니 있어요.
+",Korean
+간염으로 언제 치료 받으셨나요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+심각성과 급성기임이 꼭 일치하지는 않으며 급성기는 지금 치료가 필요한 단계입니다.,Korean
+"발목을 살짝 삐었는데 물리치료를 받아도 낫질 않네요.
+",Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+네 여기서 치료만 잘하시고 관리만 잘하시면 충분해요.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+저번에는 이렇게 와서 입원 다 했었는데요.,Korean
+기침 가래 콧물 피가 섞인 가래가 나온다거나 하는 호흡기계 증상은 없으셨나요?,Korean
+마취는 좀 더 기다려야 풀려요.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+심장 박동이 빠르고 두근거리나요?,Korean
+혈압 정상 범위로 알고 있어요.,Korean
+혈중 지방 수치에 영향을 미치는 식이요법의 영향이 크며 비만 운동량 부족이 혈중 지방 수치를 올릴 수 있습니다.,Korean
+고통이 얼마나 자주 오나요?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+어제보다 배가 많이 부어올랐나요?,Korean
+"볼이 부어서 아픈 데 검사받고 싶어요.
+",Korean
+아니요 검사하는 데 필요한 양만큼만 뽑습니다.,Korean
+약은 몇 개월이나 드셨어요?,Korean
+언제쯤 체중이 급격히 늘었었나요?,Korean
+네. 괜찮습니다. 부작용 발생률이 높지 않으니 걱정하지 않으셔도 됩니다.,Korean
+결핵 앓았던 적 있으세요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+"늘 비슷한 체중을 유지 중이에요.
+",Korean
+제가 지금 환자분 상태를 설명해 드릴게요.,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+네 수술 스케쥴에 문제가 생깁니다.,Korean
+네 퇴원 자리라 지금 정리를 하고 있습니다.,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+사 주 이내에 진료받은 병원이 있는지 알아야 해서요.,Korean
+네 그렇습니다 추후 가슴 통증 증상이 생길 경우 즉시 병원에 다시 내원 해주세요.,Korean
+혈압이 평소에 많이 높은가요?,Korean
+"방광에 문제가 있다고 들었는데요.
+",Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+우리 몸을 보호해주는 피부에 상처가 난 것이기 때문에 상처로 외부의 균들이 침입하게 되면 감염될 수 있으니 주의해주세요.,Korean
+"팔 수술 부위가 잘못된 것 같아요. 너무 아프고 붓고 붉게 올라와서요.
+",Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+암 치료 이력이 있나요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+배의 어느 부분이 아프신가요?,Korean
+알레르기가 음식이나 털 이외에도 다양한 원인이 있어서요. 정확하게 기억은 안 나시는 건가요?,Korean
+과다한 카페인 섭취가 지금 증상에 관계될 수 있어요.,Korean
+네 그래서 환자분의 음주력을 알아보려고 합니다.,Korean
+입에서 피 맛이 나나요?,Korean
+"담배 아주 가끔씩 피우는 게 다예요.
+",Korean
+입원 시 이동수단에 대해 기록해야 하여 질문하였습니다.,Korean
+그 증상 말곤 없나요?,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+"밥 먹으면 소화가 엄청 더디고 속이 울렁거려요.
+",Korean
+"네. 하루 일곱 시간씩 자는 듯한데요?
+",Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+수술하는 질병이 예방접종과 관련 있을 수도 있습니다.,Korean
+정확한 원인이나 유발인자는 밝혀지고 있지 않지만 특정한 원인을 통해 손목에 터널이 좁아지면서 신경이 압박되어 발생합니다.,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+계속 드시던 약이 있나요?,Korean
+그럼 주사는 언제 맞으시겠어요?,Korean
+하루 술 마시는 양이 어떻게 되나요?,Korean
+목이 얼마나 아프신지 일부터 열까지 숫자로 표현해 주세요.,Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+보통 저 같은 경우는 며칠 입원해요?,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+지금 움직이는 데 불편하거나 지팡이 등 보조 기구의 도움이 필요하지는 않나요?,Korean
+지방 위주의 식사를 할 경우 해당되며 특히 육류 계란 노른자 치즈 등과 같은 동물성 지방 식품을 많이 섭취하는 경우 혈중 콜레스테롤 농도가 높아집니다.,Korean
+항상 가려우신가요? 아니면 건조하다든가 하는 특정 상황에서만 가려우신가요?,Korean
+예전에 이 주 정도 입원했었어요.,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+"구역질이 난 적은 있는데 구토까지 한 적은 없어요.
+",Korean
+증세가 악화된 때가 언제인가요?,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+"도통 입맛도 없고 소화도 잘 안돼요.
+",Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+"하루에 한 갑 십 년 피우다가 최근 한 일 년은 하루에 반 갑으로 줄였습니다.
+",Korean
+내시경을 한지 한 달밖에 안 되었지만 그동안의 변화추이를 봐야 하기 때문에 필요한 검사입니다. 직장 내시경은 대장 내시경보다는 덜 힘든 검사입니다.,Korean
+수면 비용은 내시경 검사와 달리 건강보험이 적용되지 않기 때문입니다.,Korean
+백신 주사 맞은 거 있나요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+반응 테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+간염 여부 알려 주세요.,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+발기 부전으로 어려움이 있나요?,Korean
+요추 일이 번에 수술했어요.,Korean
+혈압 안 높아지게 잘 유지하고 있나요?,Korean
+지금은 수술 순서를 바꾸기 어려워요.,Korean
+필요시 간호사 호출해주시면 됩니다.,Korean
+지금 코로나가 유행이라 집에 머무르셔야 합니다.,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+두 가지 모두 건강의 위험요소이니까요.,Korean
+반려견도 접종 가능하다고 알고 있어요. 동물병원에 문의해보세요.,Korean
+네 바이러스가 어떤 원인으로 감염됐는지 확실히 알기 어렵습니다.,Korean
+몸에 열이 계속 오르나요?,Korean
+"식욕도 없고 가래 나고 기침 나고 해서요.
+",Korean
+네. 얼마 전에 세미나가 있어서 해외에 갔다 오긴 했습니다. 접종은 다음 주에 맞을 예정이고요.,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+정확한 원인이나 유발인자는 밝혀지고 있지 않지만 특정한 원인을 통해 손목에 터널이 좁아지면서 신경이 압박되어 발생합니다.,Korean
+언제 독감 예방 접종 받으셨어요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+"대략 하루에 일곱 시간 정도 자요.
+",Korean
+"갑자기 입술이 마비된 것 같은 적이 있어요. 금방 나아졌고요.
+",Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+하루에 가래를 얼마나 뱉으시나요?,Korean
+네. 수술 후 꾸준히 치료 중입니다.,Korean
+예전에 질병 앓은 적 있으신가요?,Korean
+입원을 하실 정도의 수술 경험은 없으세요?,Korean
+아직은 입원 지시가 없어서 금식 여부를 알 수 없습니다.,Korean
+배변의 어려움이 어떤 식으로 있나요?,Korean
+혈압 측정은 오분도 안 걸립니다.,Korean
+제 때 약을 드시고 건강 관리에 힘써주시면 점점 좋아질 거라 생각합니다.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+위중한 질환일 수 있지만 지금 속단하긴 이릅니다.,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+지난번 입원 때 증상이 어떻다고 설명을 들으셨었나요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+수면제 안 드시곤 잠을 못 주무세요?,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+알겠습니다. 근처 다른 병원으로 빨리 알아봐 주시겠습니까?,Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+"네. 몸이 잘 붓고요. 피부도 푸석해진 것 같고 그래요.
+",Korean
+그건 환자분의 주치의와 상담 후 결정해봐야겠네요.,Korean
+통증이 시작되면 쭉 가나요?,Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+사 번 오 번이 안 좋다고 하셔서. 그쪽 수술했었어요.,Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환이나 생리 기능에 따라 달라집니다.,Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+불행히도 코로나 유행 지역이 출장을 가야 했던 지역이었어요.,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+그냥 무릎 수술로만 이해했었는데요.,Korean
+네 바로 혈액형 검사 가능합니다.,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+시술 부위에 국소마취를 하겠지만 마취 자체도 약간의 통증이 있습니다.,Korean
+약물로 당뇨 치료받고 계세요?,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+어릴 때 수술하느라 입원했었어요.,Korean
+"약을 봉지째 다 먹어버렸어요.
+",Korean
+네 나가서 앉아계시면 간호사가 예약을 잡아드릴 겁니다.,Korean
+복부 비만은 건강에 좋지 않습니다.,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+해 봐야 알겠지만 지금 상태로 봐서는 흉이 남을 수 있습니다.,Korean
+마스크는 항상 쓰고 다니셔야 합니다.,Korean
+꾸준한 물리치료로 손목 통증을 줄일 수 있습니다.,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+"계속 속이 안 좋다고 하고 토도 하고 식사를 못 하시더니 의식을 잃으셨어요.
+",Korean
+사출성 구토는 갑작스럽게 몸 밖으로 튀어나오듯 나오는 구토입니다.,Korean
+장상피화생의 가장 대표적인 원인이 헬리코박터균 감염이지만 다른 원인도 있을 수 있습니다.,Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+혈뇨를 보신 지는 몇 일이나 되셨나요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+전신마취 경험은 없으신가 해서요.,Korean
+발기부전약 드시고 계신 거에요?,Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+뇌종양 수술을 받은 사람이 집에 좀 계세요.,Korean
+통증이 시작된 날은 언제인가요?,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+"친구와 장난치다 휴대폰에 맞아 치아가 부러졌습니다.
+",Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+가래에서 냄새가 많이 나나요?,Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+"""네, 주사 흉터도 확인하겠습니다.""",Korean
+선생님 진찰 후 약 처방받으실 거예요.,Korean
+혹시 처방받은 약이 있나요?,Korean
+어느 부위에 통증이 있으세요?,Korean
+아니요 입원 경험 없음으로 체크해 놓겠습니다.,Korean
+빨리 낫는 것도 중요하지만 재발을 막는 것 역시 중요합니다.,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+어떠한 이유로 입원을 하셨나요?,Korean
+혹시 삼 일 후에 병원에 다시 올 수 있으신가요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+"소변이 마렵기 시작하면 참을 수가 없어요.
+",Korean
+언제 첫 증상이 나왔나요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+네 증상에 맞게 약 처방해드릴게요.,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+반응 테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+일상생활에서 계속 허리에 무리가 가는 일을 하고 계시나요?,Korean
+일주일 동안 증상이 있었기 때문에 더 검사를 해봐야 할 것 같습니다.,Korean
+언제 암 진단을 받으셨나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+어릴 때 수술하느라 입원했었어요.,Korean
+주말에도 병원에 찾아오셔야 합니다.,Korean
+삼 개월간 몸무���가 얼마나 빠졌죠?,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+약을 투여한 정확한 시간을 알면 좋아요.,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+"애가 오줌 눌 때 피가 좀 나오는 것 같아서 찾아왔어요.
+",Korean
+"밤에 잠이 안 와서 화장실을 좀 자주 가요. 졸릴 만하면 좀 화장실이 마려운 것 같은 느낌이 자주 들어요.
+",Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+꽃가루 날리면 너무 괴로워요.,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+친구가 의사로 있는 연세대학교 세브란스 병원에 방문했었습니다.,Korean
+숨쉬기 어려운 것도 알레르기 증상입니다.,Korean
+습진인 것 같긴 한데 될 수 있으면 물에 안 닿게 하는 게 좋을 듯싶어요.,Korean
+수술 방법에 대해 이상반응은 없으셨나요?,Korean
+네. 여드름이 너무 심해서 약 먹으면서 치료했는데 효과는 별로 없었어요.,Korean
+항생제 주사 맞으신 거죠?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+통증이 있다 없다 하나요?,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+"아침에 일어나면 얼굴이 많이 부어요.
+",Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+방광은 골반 내 치골 뒤 쪽에 위치합니다.,Korean
+수면 내시경으로 하실 수 있습니다. 대장 끝까지 보는 검사가 아니기 때문에 비수면으로 하시는 분들도 많습니다.,Korean
+네. 다른 알레르기나 약물반응이 있었던 적은 없어요.,Korean
+일주일에 몇 번 변을 보나요?,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+당뇨 나온 적 있으세요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+평균적으로 담배를 하루에 몇 갑 정도 피우세요?,Korean
+가족 중에서 고혈압이신 분 계신가요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+"물 마시면 손발이 많이 부어서 잘 안 마셔요.
+",Korean
+아픈 게 쭉 아파요?,Korean
+결핵약을 처방받은 적이 있으실까요?,Korean
+약물치료로 호전될 가능성이 높지만 환부를 자주 확인해볼 필요가 있습니다.,Korean
+항상 두드러기 증상이 있나요?,Korean
+환자분한테는 지금 충분한 보습을 해 주는 게 제일 좋은 방법입니다.,Korean
+"담배 한 대 태웠는데요.
+",Korean
+가족 중에 암 판정을 받으셨던 분이 있나요?,Korean
+언제부터 피우셨는지 생각나시는 대로 말씀해 주세요.,Korean
+"제가 소화기관이 약해서 안 해요.
+",Korean
+심장에 문제가 있으면 응급 상황이 발생할 수 있습니다.,Korean
+"이틀 동안 구토가 심해서 아무것도 못 먹었어요.
+",Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+통증이 아예 안 느껴질 수는 없습니다.,Korean
+내외과적인 반응이나 증상이 나타나셨던 적이 있으셨나요?,Korean
+세 시간 동안 통증이 올 때 어느 정도의 통증인가요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+"제가 어릴 때 좀 엇나가서 고등학생 때부터 담배를 피웠어요. 그러다가 중간에 끊었었는데 작년부터 다시 피기 시작했어요. 하루에 다섯 개비는 핍니다.
+",Korean
+기억은 안 나는데 복용법대로 먹였네요.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+숨을 쉬기 힘든 때가 있었나요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+네. 그저께 독감 주사 맞았어요.,Korean
+"목구멍에 무언가 낀 느낌이 들어요.
+",Korean
+현재로서는 건강하신 상태입니다. 다만 너무 심한 저염식도 문제가 될 수 있죠,Korean
+턱에 염증이 있어서 주기적으로 보톡스 맞긴 해요.,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+피를 토했을 때 양은 어느 정도였나요?,Korean
+네. 남동생이 고혈압이 살짝 있는 거로 알아요.,Korean
+양의학과 병행 시 부작용이 날 수도 있으니 입원치료와 병행하지 않도록 해주세요.,Korean
+발기부전으로 관계를 하기 어려우신가요?,Korean
+가슴 통증 느끼신 지 얼마나 되신 거죠?,Korean
+소변줄을 안 차시려면 시간당 소변량 체크가 끝나야 합니다.,Korean
+몸이 부을 때가 있나요?,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+가래는 잘 뱉고 있어요?,Korean
+어떤 간염 약을 처방받으신 건가요?,Korean
+임플란트는 전신마취 중 기관삽관 할 시 문제가 될 수 있어 알고 있어야 합니다.,Korean
+혈변 시 복통이 함께있나요?,Korean
+아침에 먹는 거는 아닌데 약 가져왔어요.,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+꼭 금식을 유지하고 계셔야 하고 물 혹은 사탕 껌 등 어떤 것도 드시면 안 됩니다.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+안약을 많이 넣어야 하네요.,Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+모유 수유를 하고 육 개월쯤부터 이유식을 쌀 채소 고기 순으로 시작하시면 됩니다.,Korean
+네. 동물에게 옮는 질병이 있을 수 있거든요.,Korean
+조직검사는 초음파로 확인하고 국소마취를 한 후에 바늘로 찔러서 검사를 합니다.,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+아이 열이 오르게 되면 다른 검사 진행 여부는 그때 다시 말씀드릴게요.,Korean
+아니요. 콧속이 자극이 되어 재채기가 나려고 하는 것입니다.,Korean
+최대한 손목에 무리가 가지 않도록 휴식을 취하시는 것이 좋습니다.,Korean
+저 특이 혈액형이라고 들었는데 정확히 모르겠어요.,Korean
+약 먹기 시작한 지 칠 년 정도 됐으니깐 진단받은 거는 팔 년 됐네요.,Korean
+진통 효과는 대략 열두 시간 정도인데 사람마다 조금씩 다르긴 해요.,Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+지금부터 수술 부위에 대해서 설명드리겠습니다.,Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+언제 이런 통증을 느끼셨어요?,Korean
+"어떨 땐 먹으면 바로 헛구역질이 나면서 토를 했어요.
+",Korean
+간염 때문에 드시는 약을 전부 알려주세요.,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+헬리코박터균 감염과 연관성이 높은 것으로 알려져 있기 때문에 추가 검사가 필요할 수 있고 위암 발생 가능성도 높아질 수 있어 지속적인 진료가 필요합니다.,Korean
+목이 따갑거나 하지는 않았어요?,Korean
+혈변을 유발할 위궤양 증상이 있나요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+무료 예방 접종 주사 맞았는데 뭔지는 모르겠네.,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+스트레스를 받으면 메슥거림이 더하나요?,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+과거에 똑같은 증상이 있었나요?,Korean
+평소에 복용하는 약이 있나요?,Korean
+"이틀 전부터 오른쪽 위쪽 배와 명치 쪽이 심하게 아프고 구토해서 왔어요.
+",Korean
+마취 약물 때문에 구토 및 오심 등 알레르기 반응이 있을 수도 있습니다.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+의료진이 알아야 할 알레르기가 있나요?,Korean
+"네. 다른 건 괜찮고 소변이 잘 안 나와서 고역입니다.
+",Korean
+"위에서 떨어지는 물건을 잡으려다가 놓치면서 다쳤어요.
+",Korean
+출장 때문에 해외에 가서 자가 격리 이 주 한국에 와서 자가 격리 이 주 도합 한 달을 하고 어제 나왔어요.,Korean
+"안 하던 설사를 최근 들어 계속하네요.
+",Korean
+마취 후 언제쯤 통각이 돌아왔나요?,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+간염약이 치료에 도움이 됐나요?,Korean
+암과 관련된 가족력은 없다고 하셨죠?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+통증 양상을 알 수 있을까요?,Korean
+다른 질병이 있는지 확인 차 여쭈어보는 겁니다.,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+암으로 드시는 약 있어요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+기본적으로 수액을 맞긴 합니다.,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+당뇨로 고생했던 가족분 계신가요?,Korean
+가족 중에 암 진단받은 식구가 있을까요?,Korean
+가슴 두근거림이 자주 있으세요?,Korean
+환자분의 정확한 상태 파악을 위해서 몇 가지 여쭤볼 거예요.,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+검사 결과는 그렇게 나왔네요.,Korean
+병실로는 삼십 분 정도 지나야 이동할 수 있을 것 같습니다.,Korean
+��이 없고 늘 피로한가요?,Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+과거에 똑같은 증상이 있었나요?,Korean
+담배 피운 기간이 어느 정도 되세요?,Korean
+모계 쪽으로 암 투병 사례가 많아요.,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+근처에 가까운 병원이 있으시면 다시 입원하세요.,Korean
+오른쪽에 소변량을 적어주시면 되시는데 제가 소변기를 가져왔어요. 여기에다가 소변보시고 얼마나 소변보셨는지 적어주시면 되세요.,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+수술한 지 반 년 정도 지났어요.,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+두드러기가 아토피 때문일 수도 있지만 다른 원인일 수도 있기 때문에 정확한 건 검사 후에 안내드릴게요.,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+"갑자기 밥 먹다가 이가 뚝 부러져 버렸네요.
+",Korean
+아이들도 위염에 걸리는 경우가 있습니다.,Korean
+아니요 주사 말고 알약 물약처럼 약을 말하는 거예요.,Korean
+네 이젠 곧 통증이 없을 거예요.,Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+아픈 건 어느 정도인가요?,Korean
+"네. 편두통을 앓은지도 오래되었으니까요. 여러 번 했죠.
+",Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+진료받는데 거리가 멀면 위급 상황 시 문제가 될 수 있어서 여쭈어봤습니다.,Korean
+의학적으로 성인은 하루 사에서 육 회 배뇨하는 것은 정상입니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+대부분은 큰 문제 없지만 정확한 내용은 진찰을 받고 확인해 보셔야 합니다.,Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알코올 솜으로 눌러 보세요.,Korean
+"몸이 너무 아프면 잠도 자기 힘들다는 것을 이번에 알게 되었네요.
+",Korean
+만졌을 때 통증은 없나요?,Korean
+"저혈압인데 몸이 갑자기 안 좋아서요.
+",Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+오스몰 농도가 높아질 경우 생기는 혈관 통증입니다.,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+갱년기 증상일 수 있어요.,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+수술이나 입원 치료는 해본 적 없어요.,Korean
+가족 중 유전성 질환을 진단받거나 치료 중인 분 있나요?,Korean
+지금은 수술 순서를 바꾸기 어려워요.,Korean
+증상 발현한 날 직전에 먹은 음식이 무엇인가요?,Korean
+상처는 매일매일 회복속도가 다르기 때문에 꾸준히 체크해 보시는 게 좋습니다.,Korean
+청력에 이상이 생겼거나 이명이 들리지는 않나요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+네. 아플 때마다 꼬박꼬박 챙겨 먹었어요.,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+신체부위를 마사지 해주셔야 합니다.,Korean
+무리해서 계속 손을 사용할 경우 손을 못쓰게 됩니다.,Korean
+빠르게 할 경우 혈관통이 발생할 수 있습니다.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+"아니요. 어제부터 은은하게 팔이 뜨거워진 것 같아요.
+",Korean
+"침 삼킬 때마다 목이 너무 따가워요.
+",Korean
+피임약은 무슨 이유로 드시는 거죠?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+"얼굴로 좀 마비가 온 것 같아요.
+",Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+수술 순서는 두 번 째입니다.,Korean
+대변볼 때 피가 나오나요?,Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+원인에 따라 다른 약제 사용이 필요할 수 있습니다.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+"아. 소변 줄 넣은 데가 불편한데 다시 봐주세요.
+",Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+수면 비용은 보험 적용이 되지 않아 만 원이 추가됩니다.,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+전자담배 핀 적 있습니까?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+하루 평균 술 얼마나 드세요?,Korean
+검사 후 일주일에서 십 일 이내에 나오므로 외래는 검사 후 일주일 후에 잡아드리겠습니다.,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+사출성 구토는 통제되지 않고 뿜어져 나오는듯한 구토입니다.,Korean
+잠에 들기 어렵거나 잘 깬다거나 해서 수면에 도움이 되는 수면제를 복용한 적이 있나요?,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+피임약이 상관이 있을 수 있습니다.,Korean
+담배를 피운 기간을 알려주세요.,Korean
+어쩔 수 없이 추가 검사를 해야 합니다.,Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+항히스타민제 처방받고 드시는 건가요?,Korean
+피부 밑에까지 침범했으므로 전신마취로 진행합니다.,Korean
+어떤 음식을 드셨을 때 알레르기가 나타나나요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+혈관을 확보해서 진행하는 거라 처음에 불편할 수 있습니다.,Korean
+괜찮습니다. 부작용은 흔하게 발생하지는 않습니다.,Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+당뇨를 앓은 지 얼마나 되셨어요?,Korean
+잠자는 습관과 시간이 불규칙적이기 때문에 그럴 수도 있어요.,Korean
+회진 시간은 오전 아홉 시에 있습니다.,Korean
+한번 두드러기가 올라온 적이 있었어요.,Korean
+"제가 운전을 하고 가다가 나무를 받았는데 박으면서 머리를 좀 부딪혔는데 그 이후로 머리가 띵해요.
+",Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+무릎 관절 쪽 아니었나요?,Korean
+네. 전에 심장에 스텐스 시술받았어요.,Korean
+약을 처방받아 드시고 계신가요?,Korean
+중추 신경계 통증을 둔화시키는 대신 간혹 어지러울 수 있습니다.,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+불면증으로 언제부터 잠을 못 잤나요?,Korean
+저녁때까지 마취가 풀리지 않고 불편하시다면 말씀해 주세요.,Korean
+구토가 난 적이 있으세요?,Korean
+나가실 때 약국에서 약 받아가세요.,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+언제부터 결핵인 거 알았어요?,Korean
+"네. 아파서 그런가 잠들기가 힘드네요.
+",Korean
+균의 감염이 우려되기 때문에 환부에 넓게 바를 예정입니다.,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+음식을 통해 골고루 섭취하는 것이 흡수율이 높습니다.,Korean
+수분 섭취가 줄거나 비타민 비를 많이 섭취하면 소변 색이 진해질 수 있습니다.,Korean
+네 저희가 환자분 상태를 자세히 파악하기 위해 필요합니다.,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+"평소와 달리 잘 못 자서 이번 주는 거의 세 시간도 채 못 잔 거 같아요.
+",Korean
+"귀 한쪽이 좀 답답하고 간지러워서요.
+",Korean
+"식은땀을 흘리는데도 열이 나서 그런지 땀이 금방 식더라고요.
+",Korean
+네 지금 환자분 상태가 입원을 꼭 해야 하는 상황이라서요.,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+일주일 내내 통증이 있으셨나요?,Korean
+네 지금 환자분 상태가 입원을 꼭 해야 하는 상황이라서요.,Korean
+"요새 잠이 잘 안 와요.
+",Korean
+혈변에 피가 많이 보였나요?,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+"애가 먹으면 바로 다 토해요.
+",Korean
+특정한 대상에 알레르기가 있나요?,Korean
+이물질 제거 제균 환부 보호 순으로 합니다.,Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+"눈이 침침하고 잘 안 보여.
+",Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+네. 아버지가 신장으로 힘드셨어요.,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+최근 체중 변화가 눈에 띄게 있었을까요?,Korean
+체온은 정상인데 혈압은 조금 높아요.,Korean
+그 바이러스를 가지고 있으면 어떻게 되는 건가요?,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+"폭행 사건에 휘말렸는데 얼굴을 다쳤어요.
+",Korean
+통증 양상이 어떻게 돼나요?,Korean
+오한이 좀 있는 것 같으세요.,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+외가 친척 중에 있는 유전 질환이 어떤 건가요?,Korean
+협심증으로 수술 후 약 먹어요.,Korean
+통증은 얼마나 지속되는지 아시나요?,Korean
+여드름이 아닐 수 있으니 검사를 해보도록 하겠습니다.,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+사고 나서 수술을 받은 경험이 있습니까?,Korean
+네. 제왕 절개할 수밖에 없었답니다.,Korean
+기침할 때 피가 터져 나오나요?,Korean
+예전에 병원에서 처방받아서 약병에 담긴 거라 이름이 안 적혀 있어요.,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+일단은 진정 후 안정이 될 때까지는 입원하셔야 합니다.,Korean
+어떤 느낌의 통증이신가요? 바늘로 찌르는 느낌이나 쑤시는 느낌 등 통증 양상을 말씀해 주세요.,Korean
+알레르기 때문에 주의해야 하는 것이 있나요?,Korean
+"네. 상처 난 듯이 아파요.
+",Korean
+"명치 부근에 불이 붙은 것처럼 뜨겁고 쓰려요.
+",Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+상처 부위에 붓기도 있나요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+네 치료와 함께 금주 금연도 해 주셔야 합니다.,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+담배 시작하신 게 언제예요?,Korean
+"며칠째 고열이 안 떨어져서 왔어요.
+",Korean
+아픈 증세를 얘기해 보세요.,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+알레르기 진단받은 연도는 어떻게 되나요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+제가 결벽증이 있어서 좀 심하게 청소하기는 해요.,Korean
+아니요. 큰 부작용은 못 느꼈어요.,Korean
+무증상 육안적 혈뇨 환자의 일 이 퍼센트 정도에서 악성 질환이 발견되므로 확률적으로 높지는 않지만 반드시 검사가 필요합니다.,Korean
+음식을 보고 토한 적이 있나요?,Korean
+수술시간은 네 시간 정도 걸려요.,Korean
+"계속 어지럽더니 갑자기 정신을 잃고 쓰러져서 응급실 오게 됐어요.
+",Korean
+결핵 때문에 병원 다니신 적이 있나요?,Korean
+네. 엑스레이상으로 결석이 보이진 않아서 씨티와 요로조영술 검사를 더 진행해 볼게요.,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+한 가지 방법으로 치료 후 증상 정도에 따라 추가적으로 치료받을 수 있습니다.,Korean
+소변을 볼 때 통증이 있나요?,Korean
+제가 외과 쪽으로도 문제가 있나요?,Korean
+약을 먹는다고 금방 낫지는 않습니다.,Korean
+허리가 불편하시면 침대를 조금 올려드려볼까요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+암 치료 이력이 있나요?,Korean
+잘 챙겨 드시는 게 어려우시겠지만 영양제는 보충용으로 챙겨드신다 생각하시고 음식으로 챙겨주세요.,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+"소변에서 냄새가 좀 나더라고요.
+",Korean
+간염 보균자로 진단받은건 언제인가요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+한번 아프기 시작하면 얼마나 아프시나요?,Korean
+다양한 질환이 오한을 일으킬 수 있어 원인을 찾아봐야 할 것 같습니다.,Korean
+굳이 엑스레이를 원하시면 찍을 수 있겠으나 환자분의 경우 다시 씨티를 찍을 가능성이 높습니다.,Korean
+증상이 나타나면 약물을 중지하시고 진료받으셔야 합니다.,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+객담이 많은 거 같나요?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+자가격리 후에도 이상 증상이 발생하는 경우가 있어 추적관찰이 필요 합니다.,Korean
+몇 월부터 아프셨던 거예요?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+전립증 비대증 진단받은 적 없어요.,Korean
+결제도 퇴원할 때 안내받으실 수 있어요.,Korean
+두통이 있었던 적은 없나요?,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+"어제 아이가 낮잠 자다가 침대에서 떨어졌는데 계속 울고 보채서 검사받으러 왔어요.
+",Korean
+독감은 매년 꼬박꼬박 맞죠.,Korean
+발기가 평상시에 안 되시나요?,Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+알러지형 비염은 해당 안 됩니다.,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+진료받은 병원을 기재해야 하거든요.,Korean
+최근에 무슨 약을 드셨죠?,Korean
+위장관 내부를 면밀히 관찰하기 위해서는 위장관을 비울 필요가 있어 금식이 필요합니다.,Korean
+평균 시간보다는 적지만 수면의 질이 높다면 괜찮습니다.,Korean
+진통제에 대한 거부감을 버리고 심한 날은 도움을 받으세요.,Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+피를 토해낸 적 있어요?,Korean
+"주 증상은 기침인 것 같아요.
+",Korean
+다른 특이 증상이 없다면 위식도역류질환일 확률이 높습니다.,Korean
+수치가 바뀌는 수준까지 감안해도 환자분은 혈당이 안정적입니다.,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+"그냥 아프니까 자꾸 짜증을 내는 것 같은데 다른 데가 아픈지는 모르겠어요.
+",Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+약도 꼬박꼬박 챙겨 드셔야 해요.,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+네 알레르기 검사를 해보시겠어요?,Korean
+금방 나아지지 않아요. 다시 일어나도 꾸준히 치료해야 합니다.,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+혈액에 중성지방 농도가 정상 기준보다 높은 것입니다.,Korean
+소화 기능이 안 좋으세요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+"네. 속이 안 좋아서 먹을 수가 있어야죠.
+",Korean
+진찰은 해 드릴 수 있지만 환자분이 어디 불편하거나 하지는 않으세요?,Korean
+"탈수가 걱정돼서 자꾸 물을 먹이긴 했어요.
+",Korean
+"구토는 안 하는데 속이 계속 매슥거려요.
+",Korean
+"목이 좀 불편한데 호전될 기미를 안 보여서요.
+",Korean
+암으로 병원 다닌 적 있으세요?,Korean
+"급체했는데 속이 답답하다더니 토를 하길래 왔습니다.
+",Korean
+소변볼 때 통증이 있나요?,Korean
+"아이가 너무 왜소해서 따돌림을 당하는 것 같더라고요. 성장 검사해 보려고요.
+",Korean
+여기 올라가셔서 키와 몸무게 한 번 잴게요.,Korean
+통증 느낀 지 며칠 됐죠?,Korean
+통증 정도가 어느 정도인지 말씀해 주세요.,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+"식도에 무슨 문제가 생겼다고 했는데 기억이 안 나네요.
+",Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+"금연했는데 술 마시면 한두 개비 피우게 되더라고요.
+",Korean
+집안에 고혈압인 분 있나요?,Korean
+앓고 있는 병 있나요?,Korean
+더 큰 병원으로 가보셔야 합니다.,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+통증이 영부터 십까지 있을 때 어느 정도인가요?,Korean
+그 약을 드시는 이유가 뭔지 여쭤봐도 될까요?,Korean
+"네. 잠들기가 어려워서 백색 소음 들으면서 잡니다.
+",Korean
+수술 여부는 담당 선생님 오셔서 말씀해주실 거예요.,Korean
+네 입으로 숨을 쉬셔도 전혀 문제없습니다.,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+잠시 후 담당 선생님께서 회진을 오십니다.,Korean
+마취하고 마취가 잘 안 깬 적이 있나요?,Korean
+알레르기 일으키는 원인 있나요?,Korean
+고혈압약 요즘 드시는 것이 있나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+정확해야 하니까 피검사를 해볼까요?,Korean
+치아를 씌운 지 오래됐군요.,Korean
+입원 수속 후에 질병의 완화를 위한 치료 경험이 있으신지 여쭙는 겁니다.,Korean
+하루 동안 얼마나 피워요?,Korean
+"쓰러지기 전엔 더부룩하고 토할 것 같았어요.
+",Korean
+목이 아픈 적 있으셨어요?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+환자가 병원에 들어오고 나가기 전까지의 모든 행위에는 팔찌로 확인이 이루어지고 있습니다.,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+호흡 측정은 어떻게 하나요?,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+당뇨 나온 적 있으세요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+이송 기사님이 오시면 병실로 옮겨드리겠습니다.,Korean
+예전에 아팠던 곳 있어요?,Korean
+약 먹고 물리치료를 꾸준히 하면 회복이 될 겁니다.,Korean
+과거에 다른 질병으로 치료받거나 수술받은 적이 있으신지 알아야 해서 질문 드렸습니다.,Korean
+빈뇨 말고 소변보실 때 또 불편하신 점이 있으신가요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+수술한 후에 후유증이 있나요?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+숨이 찬 증상은 없나요?,Korean
+수술동의서의 첫 번째 항목이 이해가 안 되는데 설명 좀 해 주시겠어요?,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+오진을 막기 위해 환자 확인용으로 이용되고 있어요.,Korean
+복부가 많이 무겁게 느껴지나요?,Korean
+검사 결과가 나온다면 환자분의 휴대전화로 안내가 갈 겁니다.,Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+속이 편하지 않거나 게워내시나요?,Korean
+아뇨 단순히 적은 수면 시간만으로는 문제가 되지는 않지만 생활에 불편함이 느껴질 정도면 상담을 요청하시는 게 좋겠습니다.,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+입을 크게 벌리면 턱이 아픈데 얼마나 벌려야 하나요?,Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+열 기운 있을 때마다 시럽으로 된 거 먹였어요.,Korean
+네 알레르기의 유발 원인을 의미합니다.,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+갖고 계신 약 있나요?,Korean
+한 시간 정도 전에 부스코판이라는 진경제 먹었습니다.,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+네 이전 증상이랑 비교해서 말씀해 주시면 됩니다.,Korean
+"오른쪽 다리 땅에 딛는데 통증이 좀 있어요.
+",Korean
+어제부터 열이 나신 게 맞는가요?,Korean
+통증이 시작하면 기간이 얼마나 가요?,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+주에 몇 번 아픈가요?,Korean
+사고로 상해를 입은적이 있나요?,Korean
+약은 어떤 약을 드시나요?,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+복부 내 염증이 있는 경우 그러실 수 있습니다.,Korean
+두드러기 등 알레르기 일으키는 성분 아시나요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+현재 간염 치료는 어떻게 받고 있나요?,Korean
+"과식과 절식의 반복인 것 같아요.
+",Korean
+현재 복용 중인 약이 있으신가요?,Korean
+"우선 한 시간 이상 푹 자기가 어렵더라고요.
+",Korean
+"요즘 정말 잠을 못 자고 있긴 해요.
+",Korean
+치아에 문제 있는지는 하나하나 또 볼게요.,Korean
+입원 절차를 밟으셔야 해서 죄송하지만 바로 입원 진행은 어렵습니다.,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+소변보고 닦을 때 피가 묻어나오진 않나요?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+과로로 쓰러져서 입원한 적이 있고 전에 손목이 부러져서 수술하느라 입원한 적도 있습니다.,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+간헐적으로 아픈가요? 지속적으로 아픈가요?,Korean
+단순히 부종 때문이라면 다행이지만 정확한 건 검사를 해본 후 봐야 알 것 같아요.,Korean
+약 하나도 안 먹어요.,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+안 됩니다. 기계 호흡은 폐에 발생한 질병을 치료하거나 낫게 하는 것이 아니라 우리 몸의 호흡기능을 일시적으로 보조할 뿐입니다.,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+"수면 패턴도 바뀌고 수면 시간도 달라졌어요.
+",Korean
+최근에 몸무게 변화가 있나요?,Korean
+"며칠째 변을 못 보고 있어요.
+",Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+"하루 여덟 시간씩 꿀잠 자는 편인데 이러고 나서는 거의 못 자요. 잘 깨고요.
+",Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+환자분 스스로 침대 쪽으로 가실 수 있겠어요?,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+"신장 기능이 떨어진 걸로 알아요.
+",Korean
+고혈압약 먹고 혈압이 조금 안정됐나요?,Korean
+아프다고 해서 진통제는 먹이긴 했는데 해열제 효과는 없는 약이에요.,Korean
+통증이 계속해서 아픈가요 드문드문 아픈가요?,Korean
+큰일을 보시면 항문이 아프신가요?,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+저희가 진통제 투여 후에도 잘 관찰하고 있으니 너무 걱정 안 하셔도 됩니다.,Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+빠른 시일 내로 입원 일정 잡아드리겠습니다.,Korean
+"배는 아프지 않고 항문이 아파요.
+",Korean
+통증이 어느 정도 심한가요?,Korean
+검사에 얼마의 시간이 걸리나요?,Korean
+어떤 재료로 만든 한약인지 알 수 있을까요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+알레르기 반응에 또 다른 반응이 있나요?,Korean
+통증 부위는 어디신 거죠?,Korean
+평소보다 현저히 음식을 섭취하는 양이 줄었나요?,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+최근에 독감 예방 주사 접종하셨어요?,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+가족 중 암이 있으신 분 있을까요?,Korean
+담배를 피우기 시작한 게 언제예요?,Korean
+정확히 어떤 음식이나 약에 두드러기가 나는 거죠?,Korean
+피로가 회복이 안 되시나요?,Korean
+당분간 입원해서 여기 있으려고요.,Korean
+"아니요. 지금은 가렵기만 하다고 했어요.
+",Korean
+의심되는 부위를 손가락으로 짚어 보시겠어요?,Korean
+어머니가 우울증으로 오래 고생하셨어요.,Korean
+음주 횟수는 어떻게 되죠?,Korean
+결과가 괜찮아요 수술은 조금 더 지켜보고 결정하는 게 좋을 것 같아요.,Korean
+집안에 고혈압인 분 있나요?,Korean
+가스가 차서 불편한 증상이 있으신가요?,Korean
+흔히 생각하는 전신마취를 하지는 않습니다.,Korean
+"한 시간에 한 번씩 토하고 있어요.
+",Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+혹시나 퇴원하실 때 필요한 서류는 미리 말씀해주셔야 발급 가능하시니까 편할 때 말씀해 주세요.,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+어 아뇨 못 들었는데요? 중요한 건가요?,Korean
+최근에 다른 예방 접종하신 적 없으신가요?,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+현재는 양의학 치료를 하고 있으니 스스로 민간요법으로 치료하는 일은 없도록 해주세요.,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+당뇨로 불편한 기간이 언제부터일까요?,Korean
+네 어디가 아프셔서 약을 드시고 계시나요?,Korean
+네 수술 끝날 때 오시는 게 좋습니다.,Korean
+"아니요. 잠을 잘 못 자요.
+",Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+과민성과 관련된 약도 드시나요?,Korean
+수면 환경 스트레스 음식 섭취 야뇨증 등이 있지요.,Korean
+욕창은 추가적으로 생긴 질병이기 때문에 다른 병의 치료도 잘 받으셔야지요.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+오늘은 안 드셨어도 평소 드시던 약이면 말씀해주십시오.,Korean
+네 음주력을 파악할 때 음주를 시작한 나이도 중요하게 봅니다.,Korean
+면역요법은 면역반응을 조절하므로 더 오래 걸릴 수 있습니다.,Korean
+가족 중에 고혈압 진단이 나오는 분이 있나요?,Korean
+밤에 잠이 안 온다는 거죠?,Korean
+검사 결과가 어떻게 나오셨는지 말씀해보시겠어요?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+마취크림에 대한 부작용이 있긴 하지만 거의 일시적인 증상입니다.,Korean
+하루에 한 갑 이상 피우나요?,Korean
+뇌에 작은 종양이 있어서 수술해 본 적 있어요.,Korean
+욕창 관리만 잘해 주시면 피부가 더 아프진 않을 거에요.,Korean
+눈이 안 좋아서 루테인 챙겨 먹어요.,Korean
+결핵 백신 접��을 하셨나요?,Korean
+무엇 때문에 병원에 왔나요?,Korean
+"당뇨약 지은 지 한 달 정도 됐는데 아직도 차도가 없는 것 같아서 약에 대해서 상담받아보고 싶어서 왔어요.
+",Korean
+영양제 수액은 제외하고 꾸준히 맞는 주사가 있으실까요?,Korean
+"식도에 정맥류가 생겨서 피 난다고 들었습니다.
+",Korean
+부작용이 있는지 보려고 방금 검사하신 거예요.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+최근에 체중에 변화가 있었나요?,Korean
+네 우선은 이틀 치까지만 처방 됩니다.,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+오늘 내원하신 이유는 뭔가요?,Korean
+복용 중인 위장약은 없나요?,Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+앞으로 진료 방향에 대해 어떻게 할지 판단하기 위해서 입니다.,Korean
+"저번 주에 회 먹었는데 그게 지금 배 아픈 거랑 관계가 있나요?
+",Korean
+"목구멍에서 출혈이 있는 것 같아요.
+",Korean
+웻 거즈는 젖어 있는 거즈라는 뜻이에요.,Korean
+암은 언제 어디서 진단받았나요?,Korean
+독감 예방 접종은 올해 하셨는지요?,Korean
+가슴 통증에는 워낙 다양한 원인이 있어 한번에 말씀드리긴 어렵고 일단 응급질환이 아닌 것을 확인한 겁니다.,Korean
+호흡이 조금 가빠 오면 간호사 선생님을 호출하세요.,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+"엑스레이를 찍었는데 폐에 이상이 있다고 해서요. 조직 검사받으러 왔어요.
+",Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+잘 못 주무시는 편인가요?,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+결핵 치료 이력이 있나요?,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+검사를 하려면 공복 상태가 최소 여섯 시간은 되어야 해서 여쭤봤어요.,Korean
+네 여기가 대장이고 여기 보이시는게 대변입니다.,Korean
+혹시라도 변비가 심해지면 먼저 말씀드려주세요.,Korean
+코로 숨을 쉬는데 너무 힘들어요.,Korean
+얼마나 아픈지 표현해 주세요.,Korean
+담배는 몇 년 피웠어요?,Korean
+환자분의 안전을 위해선 정확하게 진행하는 것이 좋죠.,Korean
+그 약만 먹으면 우울증이 오는 것 같아요.,Korean
+십 분 뒤에 수술 진행하겠습니다.,Korean
+헬리코박터균 감염 여부는 검사를 해야 합니다.,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+"복부 쪽이 아픈 것 같아요.
+",Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+혈압이 금방 돌아온다고 장담하지 못하겠습니다.,Korean
+두통이 있었던 적은 없나요?,Korean
+"무거운 거 들다가 손목이 아팠어요.
+",Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+"교통사고가 난 이후에 외상 후 스트레스 장애가 생겼어요.
+",Korean
+가슴이 갑자기 너무 급하게 두근거린 적이 있나요?,Korean
+홍삼만 먹고 있는 거죠?,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+"며칠째 배변을 못 보고 있습니다.
+",Korean
+"오른쪽 발목 인근이 다 아파요.
+",Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+뱃살을 빼려면 유산소운동을 하셔야 합니다.,Korean
+"잘 때 숨쉬기가 힘들어서 자꾸 깨서 왔어.
+",Korean
+일단 검사 결과 나올 때까지는 안 받으셔도 될 것 같습니다.,Korean
+지금 신장 기능이 좋지 않아서 투석이 꼭 필요합니다.,Korean
+지금 당장 드실 약은 남겨 놓고 나머지만 체크하겠습니다.,Korean
+예상치 못한 조산 등을 고려해서 미리 분만 한 달 전에 신청하시는 것이 좋습니다.,Korean
+다른 심장 관련 질환은 없나요?,Korean
+"대변에 계속 피가 섞여 나옵니다.
+",Korean
+알레르기 반응 있는 음식 있어요?,Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+신체가 부은 데가 있나요?,Korean
+하루 식사량이 어떻게 되나요?,Korean
+몇 시간 단위로 통증이 지속되나요?,Korean
+아버지는 다른 증상 없으신가요?,Korean
+알레르기가 있다는 거는 언제 처음 알게되셨어요?,Korean
+큰 병이 있다고 속단할 필요는 없을 것 같습니다. 일단 원인에 대한 검사를 해 보겠습니다.,Korean
+기저에 위장관 질환이 있다면 과식으로 통증이 발생할 수 있습니다.,Korean
+"그런 건 딱히 없었는데 소변 색이 푸르스름했어요.
+",Korean
+"배가 꼬인 듯이 너무 아파요.
+",Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+통증의 패턴 같은 게 있었나요?,Korean
+암 진단받아본 적 있으세요?,Korean
+많이 걱정되시죠. 보통은 세 시간 정도 걸리나 상황에 따라 달라질 수 있습니다. 금식 해제도 검사 이후 환자분의 상태 확인 후 결정됩니다.,Korean
+가족 중에 고혈압인 분이 있으면 알려주세요.,Korean
+혼자 지내시려면 요양사는 필요할 것 같습니다.,Korean
+대변에 피가 보인적 있나요?,Korean
+네. 생식기 치료는 산부인과에 해당합니다.,Korean
+발기부전약 드신 적은 있나요?,Korean
+화장실에 갔는데 소변이 안 나오나요?,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+"손목 긋고 죽으려고 했어요.
+",Korean
+하루에 담배는 몇 갑 피우시죠?,Korean
+암 진단을 받아보신 적 있나요?,Korean
+"코골이가 심해지고 가끔 숨을 헐떡이며 잠에서 깹니다.
+",Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장드립니다.,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+아픈 증세를 얘기해 보세요.,Korean
+네. 보호자분이 아니라 환자분한테 하는 거 맞습니다.,Korean
+수면 하에 내시경 검사하시기를 권해드리나 원하신다면 비수면으로 진행해 볼 수도 있습니다.,Korean
+어떤 간염 약을 처방받으신 건가요?,Korean
+기분이 너무 우울해지는 느낌이 들어요.,Korean
+네. 콰란틴 끝나고 음성 받아서 나온 겁니다.,Korean
+"아니요. 장염 때 말고는 설사 아예 안 해요.
+",Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+오늘은 제가 빈혈이 심해서요. 다 받아야 하나요?,Korean
+너무 숨쉬기가 힘든데 다른 치료법으로는 안 될까요?,Korean
+아이가 움직이면 큰일 날 수 있어 아이들은 보통 전신마취로 진행합니다.,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+수술 부위 흉터 이외에 다른 흉터는 있으실까요?,Korean
+울렁거리면서 토할 것 같았어요?,Korean
+가족 중에 누가 고혈압 당뇨 질환이 있나요?,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+연골이 너무 안 좋아서 연골 수술했어요.,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+코르티코스테로이드란 약물에 알레르기가 심하게 일어나요.,Korean
+혹시 결핵약 처방 받으셨나요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+몸 전체에 힘이 없나요?,Korean
+"항문이 너무 아픈데 왜 그러는지 알고 싶어요.
+",Korean
+난임 문제를 해결하기 위해 산부인과를 정기적으로 다니고 있어요.,Korean
+몸무게 감소량이 어느 정도 되나요?,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+월경량이 보통 패드로 얼마나 되나요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+수면제든 보조제든 술과 함께 먹으면 위험합니다.,Korean
+네. 비형 간염 맞으셔야 합니다.,Korean
+대장이 아니라 치질과 같은 항문 질환도 흔한 원인입니다.,Korean
+위에서 역류해서 신물이 넘어올 수 있습니다.,Korean
+암 진단을 최초 언제 받았나요?,Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+간염 치료 복용 약 있으시죠?,Korean
+이전에 조영제 알레르기가 없으셨던 분은 크게 문제 되지는 않아요.,Korean
+손목 보호대를 착용하시는 것도 좋은 예방법이 되실 수 있습니다.,Korean
+변비약을 드셔야만 변을 보세요?,Korean
+먹으면 부작용이 있거나 불편한 약 있으세요?,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+네 약 이름을 알고 계십니까?,Korean
+이번 주 내로 연락이 가면 그때 외래 날짜 잡으세요.,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+아니요. 추가검사는 필요하지 않습니다.,Korean
+어떤 알레르기 가지고 계시나요?,Korean
+아직도 심각한 상태에 속합니다 약 복용 꾸준히 시간 맞춰서 해주시고 잘 먹고 충분히 주무셔야 합니다.,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+"약이랑 한 시에 마셨어요.
+",Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+가족 중에 유전성 질환을 가진 분이 있나요?,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+그렇군요 통증 세기가 어떻죠? 일에서 십까지 강도를 나타내 주세요.,Korean
+"소���도 소화지만 속이 많이 쓰리더라고요.
+",Korean
+아까 너무 아파서 진통제 두 알 먹었어요.,Korean
+"평상시엔 아프진 않은데 변만 보면 배가 아파요.
+",Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+영양제나 비타민 제외하고 드시는 약이나 맞는 주사 있으세요?,Korean
+"가슴을 쥐어짜는 것 처럼 아파서 왔어요.
+",Korean
+갑각류 알레르기 이외에 다른 알레르기는 없나요?,Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+컨디션이 안 좋으시면 검사를 미루는 것을 추천드립니다.,Korean
+"밥을 잘 안 먹게 되니깐 이젠 아예 식욕 감퇴까지 된 것 같아요.
+",Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+이전에 고혈압 얘기 들은 적 있나요?,Korean
+치아 개수를 확인하는 거예요.,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+"물을 많이 먹였더니 소변은 좀 옅더라고요.
+",Korean
+집안에 암 환자분이 계세요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+열이 있다면 어떤지 알려주시겠어요?,Korean
+통증이 어느 정도로 심하죠?,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장 드립니다.,Korean
+청진할 때 옷 안으로 하는 게 정확해요.,Korean
+"코피가 몇 시간째 흘러서 왔어요.
+",Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+하루에 한 갑 이상 피우나요?,Korean
+수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+"발을 밟혔는데 너무 아파요.
+",Korean
+약물에 의한 피부염 발생 시 약물 투여를 중단하고 다른 치료법을 시행하게 됩니다.,Korean
+검사결과는 보통 빠르면 일주일 소요되기 때문에 그 전에 받기는 힘드세요.,Korean
+호흡이 힘든 상황이 오나요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+전 병원에서 주로 어떤 치료했어요?,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+검사 다 하려면 얼마나 걸리는지 압니까?,Korean
+이 병원 내원한 적 없는데요.,Korean
+언제 첫 증상이 나왔나요?,Korean
+아니요. 마취가 풀리긴 하겠지만 풀리기까지 시간이 오래 걸릴 수는 있습니다.,Korean
+혈압이 좀 높은 편이라고 들었어요.,Korean
+"어지럽고 울렁거려서 토할 것 같아요.
+",Korean
+고혈압약 먹고 예전보다 증상이 호전된 것 같나요?,Korean
+그러면 병실도 옮기셔야 하고 수술도 다시 잡아야 합니다.,Korean
+현재 최대치로 진통제를 드리고 있어요 다음 처방 때 약을 좀 바꿔 볼게요.,Korean
+하루 동안 몇 개비의 담배를 피우시나요?,Korean
+급성 정맥류 출혈의 경우 출혈이 멈춘 후 백 명이 있으면 오십 명 내지 육십 명넘게 일 년 이내에 재출혈 발생확률이 높습니다.,Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+결핵으로 진단받은 적 있나요?,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+진통제는 선생님 처방이 필요해서요 확인 후 놔 드릴게요.,Korean
+마취크림에 대한 부작용이 있긴 하지만 거의 일시적인 증상입니다.,Korean
+하루에 몇 번 정도 증상이 있나요?,Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+긁지 마시고 보습제 잘 사용해 주세요.,Korean
+독감 접종 언제 맞으신 거죠?,Korean
+진통제에 대한 거부감을 버리고 심한 날은 도움을 받으세요.,Korean
+가래가 묽은 느낌이 나나요?,Korean
+아프기 시작한 게 언제부터였죠?,Korean
+"비염이 심해서 가습기 꼭 써야 해요.
+",Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+가족 중에 고혈압약을 먹고 계신 분이 있나요?,Korean
+약 챙겨 먹는 거 하나도 없어요.,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+일주일 음주량이 어떻게 되세요?,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+해외는 관련 없고 예방 접종만 했네요.,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+"내과에서 대상포진이라고 진단받았는데 못 참게 아파서요.
+",Korean
+암 있는 건 언제 아셨나요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+고혈압 진단 받은적 있나요?,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+"손가락을 심하게 다쳐서 피가 많이 흘러요.
+",Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+해 봐야 알겠지만 지금 상태로 봐서는 흉이 남을 수 있습니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+부모님 중에 암 병력이 있나요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+흉통이 목으로 번지는 느낌이 있나요?,Korean
+당뇨약 꾸준히 복용하시고 당 조절이 잘 되면 의사 선생님이 집에서 검사하는 횟수를 조금 줄여도 될 거라고 할 거예요.,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+이십 일에 소풍 갔다가 감기에 옮아서 왔더라고요.,Korean
+치료하기 전에 환자의 정보들을 알아야 합니다.,Korean
+"최근 삼 일 동안 계속 혈변만 봐요.
+",Korean
+최근에 혈뇨가 처음 나온 것이 언제인지 말씀해 주세요.,Korean
+전 피곤하면 눈에 부종이 생겨 생활하기가 매우 힘듭니다.,Korean
+"오른쪽 위 사랑니가 아파요.
+",Korean
+집안에 고혈압 환자분 계세요?,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+아니요. 서울대 병원에서 받았었어요.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+계속 드시던 약이 있나요?,Korean
+치아가 흔들리는 이유는 여러 가지입니다.,Korean
+통증이 오는 곳이 이쪽 부분인 거죠?,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+"가슴 쪽에서 느껴지는 격통에 정신을 잃고 깨어나 보니 응급실이네요.
+",Korean
+코로나 의심 시에는 격리를 해야 하기 때문에 일단은 검사를 받고 오세요.,Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+"생리 양이 많아져서 검사받으러 갔더니 자궁근종이라고 그래서요.
+",Korean
+"귀가 윙윙거리면서 소리가 잘 안 들려요.
+",Korean
+토할 것 같은 느낌이 오나요?,Korean
+소화하는데 불편한 건 없나요?,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+경미한 경색 증상이나 다른 혈관성 질환이 원인일 수 있습니다.,Korean
+"심장이 두근거려서 요새 잠을 잘 못 잡니다.
+",Korean
+"대소변을 잘 못 보냐는 말씀이세요?
+",Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+두근거림이 안정 시에도 있나요?,Korean
+우선은 이틀 치까지만 처방 됩니다.,Korean
+환자분은 오늘 두부 열상으로 오셨고 퇴원 안내문에는 두부 외상 환자 주의사항이 있습니다. 뒷장에는 열상 환자 주의사항도 있으니 읽어보시면 됩니다.,Korean
+목 아픈 건 나으셨어요?,Korean
+"초콜릿 먹으면 속이 니글거려서 절대로 먹지 않습니다.
+",Korean
+"그런 부류의 통증은 없습니다.
+",Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+"얼굴에 황달이 심해서 와봤어요.
+",Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+예를 들어 어떤 통증인가요?,Korean
+상처 부위에 붓기도 있나요?,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+가족 중에 고혈압 진단이 나오는 분이 있나요?,Korean
+"양쪽 다 아픈 데요. 둘 다요.
+",Korean
+혈압 맥박 호흡 체온 모두 기계를 이용해서 이루어지게 됩니다.,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+네. 다행이네요. 대장내시경 도중에 오 밀리미터 이상의 큰 용종이 발견되면 대장용종 제거술을 하게 될 수도 있습니다.,Korean
+그럼 전에 검사하셨을 때 문제 없으셨던 건가요?,Korean
+몸무게의 변화가 의심될 때만 시간대별로 체크합니다.,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+의심되는 부위를 손가락으로 짚어 보시겠어요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+"아랫배에 통증이 약간 있어요.
+",Korean
+아니요. 청진을 하도록 하겠습니다.,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+선천적으로 장의 특정 부위에 신경이 제대로 분포되지 않아 정상적으로 움직이지 못하는 질환입니다.,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+간염 관련하여 드시는 약이 있나요?,Korean
+예를 들어 어떤 통증인가요?,Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+빨리 낫는 것도 중요하지만 재발을 막는 것 역시 중요합니다.,Korean
+네 필요하면 피검사도 진행 예정입니다.,Korean
+"배가 아픈 것 같은데 이유를 알 수 없어서요.
+",Korean
+언제부터 알레르기 약을 복용하기 시작했어요?,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+치료방법이 달라질 수도 있어서 질문 드렸습니다.,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+가슴 쪽에 문제가 있는 것 같습니다.,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+조금 기다렸다가 소변 마려우시면 검사 진행하겠습니다.,Korean
+"제가 갑각류 알레르기가 있습니다.
+",Korean
+밥을 못 먹는 이유가 다른 것이 있는지를 먼저 알아보겠습니다. 필요하다면 내시경을 할 수도 있습니다.,Korean
+주사 부작용으로 약간의 통증은 발생할 수 있습니다.,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+수면 보조제는 너무 오래 드시면 좋지 않아요.,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+치료과정 중 약간의 출혈이 있을 수 있습니다.,Korean
+자주 대변을 보는 것을 포함하여 대변을 잘 보지 못하는 것도 증상에 해당합니다.,Korean
+요새 머리가 어지럽진 않나요?,Korean
+네 진통제를 맞으면 많이 나타나는 현상입니다,Korean
+통증 양상이 어떻게 돼나요?,Korean
+한달에 한번씩 이렇게 통증이 있으신가요?,Korean
+네 처방받아서 먹는 약 있으세요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+열흘 뒤에 외래 예약하고 외래에서 들으시면 됩니다.,Korean
+급격한 체중 변화를 겪지는 않으세요?,Korean
+아니요. 질병 때문에 드시고 계시는 약이 있나요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+"변이 회색빛이 돌았던 것 같아요.
+",Korean
+"한전에서 일하는데 감전돼서 왔어요.
+",Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+통증이 계속 있나요 아니면 아팠다 괜찮았다 하나요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+주로 어디가 가장 아프세요?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+알레르기 진단은 언제 받았나요?,Korean
+기침할 때 가래가 같이 나오나요?,Korean
+시럽으로 된 해열제였는데 이름은 모르겠어요.,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+피가 섞인 대변을 보고 있으신가요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+박멸 여부 확인은 약 복용 완료 후 사 주 후에 합니다.,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+아니요. 환자분의 식사 습관을 조사하는 중입니다.,Korean
+바이러스성 장염은 전염성이 있어 대변의 접촉으로 전염이 되는 경우도 있습니다.,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+하루에 한 갑 이상 피우나요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+통증이 나타난 곳이 어디신가요?,Korean
+어떤 약을 드시고 계신지 말씀해 주실 수 있으세요?,Korean
+어떤 증상이 견디기 힘들던가요?,Korean
+힘이 없고 늘 피로한가요?,Korean
+과거 아픈 경험이 있으신가요?,Korean
+일 년 전에 맹장 수술했어요.,Korean
+담배를 피우신 적 있으세요?,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+"흡연 음주 둘 다 안 하지만 남편이 흡연을 해요.
+",Korean
+"소화는 괜찮은데 속 쓰린 게 문제예요.
+",Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+"소변 색이 조금 옅어졌어요.
+",Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+발기 부전 증상이 있으세요?,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+배에 아직 부기가 안 빠져서 그런 걸 수도 있습니다.,Korean
+네. 철심 박는 수술 했는데 어딘지는 정확지 않아요.,Korean
+어떤 마취제였는지 기억하고 계세요?,Korean
+통증이 발현되는 시기가 있나요?,Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+"차 사고가 나면서 목을 다쳤나 봐요. 목 부분이 아파요.
+",Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+아프다 안 아프다 하나요?,Korean
+"아이가 몸을 가누다가 침대에서 떨어졌어요.
+",Korean
+사출성 구토인 경우 우려되는 질환이 있으나 그 외의 경우도 있으므로 치료 계획 결정 후 다시 말씀드리겠습니다.,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+금식을 할 때는 물도 드시면 안 됩니다.,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+소화제가 필요한 증상이라면 먹일 수 있습니다.,Korean
+가족 중에 고혈압 판정받은 분 있나요?,Korean
+"최근에 해외를 다녀와서 시차로 고생 중입니다.
+",Korean
+시력이 안 좋으시군요 다른 책자 드릴게요.,Korean
+통증이 월 단위로 있나요?,Korean
+"손에 작은 물집이 나더니 점점 손목에서 팔까지 번지는 것 같아서요.
+",Korean
+피 소변을 보시진 않나요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+언제부터 소변을 볼 때 피가 같이 나오나요?,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+밤에 잠을 충분히 자지 못하시나요?,Korean
+예방접종 접수하셔서요 부작용이 있었나 해서 여쭤보는 겁니다.,Korean
+결핵 치료로 처방받은 약이 이게 맞나요?,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+네 과거 검사하실 때는 불편한 점 전혀 없으셨나요?,Korean
+"평소처럼 잠을 여섯 시간도 못 자요. 새벽에 계속 깨네요.
+",Korean
+몸에서 기력이 달리는 느낌이 나요?,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+"밥은 목이 아파서 못 먹었고 미음 식혀서 먹었어요.
+",Korean
+묽은 변을 보시지는 않나요?,Korean
+아니요. 동거인이 계셔야 간호를 할 수 있어서요.,Korean
+수면제를 드시는지 확인차 문의드렸습니다.,Korean
+숨 쉬는 게 힘드신가요?,Korean
+"얼굴 근육에 장애가 있는 것 같아서요.
+",Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+검진한 병원에서와 같이 갑상선호르몬 수치가 높게 나왔고요. 칼시토닌이라는 수치가 좀 높게 나왔어요. 갑상선암에서 특이적으로 높게 측정됩니다.,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+"오줌을 잘 못 누고 배 안쪽이 탱탱하게 엄청 당겨서 아파서 입원했어요.
+",Korean
+입에서 피를 토한 적 있으세요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+수술 부위의 청결을 유지하기 위함입니다.,Korean
+의사 선생님과 직접 대화를 나눠보셔야 할 것 같습니다.,Korean
+결핵 진단받으신 게 언제죠?,Korean
+갑상선암을 앓은 적이 있어요.,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+치아 정기 검진 때문에 치과요.,Korean
+의사 처방 없이 드시는 건 위험합니다.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+음식 중에 조심해야 될 음식이 있나요?,Korean
+통증이 있는 부위가 어디죠?,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+청진할 때 옷 안으로 하는 게 정확해요.,Korean
+그렇긴 하지만 처방 받아서 드시는 게 아니면 오남용을 할 수 있어서요.,Korean
+지금까지 열은 안 났나요?,Korean
+혹시 고혈압 관련해서 약 드시고 있으세요?,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+마취통증의학과 의사가 참고하여 변경될 수도 있습니다.,Korean
+배에 묵직한 통증이 있나요?,Korean
+통증이 몇 분마다 오나요?,Korean
+항생제 주사 맞으신 거죠?,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+지금 먹고 있는 약 있어요?,Korean
+국가예방접종이나 기타예방 접종 포함 모든 예방접종이요.,Korean
+그저께 동네 병원에서 수액 맞은 게 다에요.,Korean
+그렇습니다. 갑작스럽게 뿜어져 나오듯 나오는 구토입니다.,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+골고루 드셔야 건강에 도움이 됩니다.,Korean
+일주일에 몇 번 음주하세요?,Korean
+"업무 스트레스가 너무 심해요. 스트레스가 심해지니까 식욕도 없고 소화도 안 돼요. 최근에는 살이 십 킬로가 넘게 빠졌는데 정신과적인 치료를 받으면 좋아지지 않을까 싶어서 오게 되었어요.
+",Korean
+잦은 접종은 면역력 저하를 불러일으킵니다.,Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+척추마취 후 두통 등이 부작용으로 있을 수 있습니다.,Korean
+금속이 있으면 씨티 화질에 영향을 줘서 그래요.,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+당뇨 처음 치료받은 게 언제시죠?,Korean
+"복부 팽만감이 들어서 약국에서 여러 제품을 자주 사 먹어요.
+",Korean
+위암 수술 말고는 수술받으신 경험은 없으신 거죠?,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+원래 토혈 증상이 있으신가요?,Korean
+"왼쪽 허벅지부터 다 아파요.
+",Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+마취는 좀 더 기다려야 풀려요.,Korean
+틀니 임플란트 등 자연적으로 난 치아에서 의학적인 기술이 들어간 치아 상태를 모두 말씀드리는 거예요.,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+부정맥이 의심된다고 해서 입원해서 정밀 검사받았어요. 수술은 안 했고요.,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+비타민이랑 루테인 먹고 있습니다.,Korean
+빈혈 있어서 치료받는 중입니다.,Korean
+"아 저 왼쪽 손가락이 아프고 붓고 고름도 나오더라고요. 그래서 왔어요.
+",Korean
+객담이 많은 거 같나요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+"하루에 한 끼만 먹어요. 나머지는 그냥 굶고요.
+",Korean
+일반적으로 대변에 작용하는 하제는 장기적으로 복용 가능합니다.,Korean
+암 치료했었던 가족이 있나요?,Korean
+열 때문에 몸이 달아오르나요?,Korean
+"소변을 봐도 잔뇨가 늘 남고 거의 바로 화장실을 또 가게 하네요.
+",Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+얼마나 자주 구토를 하시나요?,Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+지금 처치를 잘해야 예후가 좋으니까 치료에 전념하겠습니다.,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+검사 결과는 그렇게 나왔네요.,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+"오른쪽 몸 특히 팔다리가 힘이 쭉 빠지는 느낌이 지속해서 있어서요.
+",Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+간염 여부 알려 주세요.,Korean
+성생활에 어려운 점이 있으세요?,Korean
+아니요. 제 혈압은 정상이에요.,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+현재 당뇨 수치가 높으신 편인가요?,Korean
+네 이삼 일 동안은 통증은 계속 있을 거예요 진통제 드시고도 나아지지 않고 아프신 건가요?,Korean
+설사를 며칠 동안 하셨나요?,Korean
+"발에 가시가 박혔는데 못 빼고 있습니다.
+",Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+가족 내 암 판정받은 분은요?,Korean
+이유식 시작 시기에 대해서 여러 의견이 있으나 영양 상태 등에 따라서 결정하고 시작하시면 됩니다.,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+"수술 몇 시에 해요?
+",Korean
+등록하시고 진료 보시는 게 낫겠어요.,Korean
+약 처방 때문에 들렀어요.,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+결핵은 약물로 치료받고 계세요?,Korean
+추후에 트라우마가 생기진 않을지 잘 지켜봐 주세요.,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+소변을 보고 난 후 피가 묻어있나요?,Korean
+따로 보조제는 복용 안 합니다.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+진통제만 먹으면 온몸이 퉁퉁 붓더라고요.,Korean
+네. 동물에게 옮는 질병이 있을 수 있거든요.,Korean
+네 임플란트 한 치아 모두 가르쳐 주세요.,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+콧줄이 불편하시면 간호사를 불러주세요.,Korean
+통증이 좀 강한 편이에요?,Korean
+앉아 있을 때에도 통증이 있으신가요?,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+"폐 때문에 오게 됐어요.
+",Korean
+"소변을 너무 잘 안 봐요
+",Korean
+단지 화상 입어서 흉이 진거 말고 몸 움직이기가 불편하시다거나 신체에 변화가 생겼나요?,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+"비염이 심해서 가습기 꼭 써야 해���.
+",Korean
+꾸준히 먹는 약이 있으신가요?,Korean
+아침저녁 하루 이 회 약 세 종류씩 드시면 됩니다.,Korean
+그때부터 아직 안 낫고 계속 앓고 계신 거죠?,Korean
+마취 크림만으로도 마취 잘 돼요.,Korean
+진단서 무인 발급도 가능한가요?,Korean
+"딱히 그런 건 아니고 그냥 일반적인 기침 소리였던 것 같아요.
+",Korean
+얼마 전에 빈혈 검사를 했는데 아직 결과가 안 나왔어요.,Korean
+약은 어떤 약을 드시나요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+"변비가 워낙 심해요. 딱딱하고 냄새가 심해요.
+",Korean
+처음 아팠던 날 기억나세요?,Korean
+"거즈로 상처 부위 소독하러요.
+",Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+고혈압 환자가 가족 중에 있을까요?,Korean
+"아. 설사 증세도 같이 있어요.
+",Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+"하지. 한 오십 년 됐는데 아직도 건강해.
+",Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+숨 쉬는 게 힘드신가요?,Korean
+"술 담배를 많이 하는 것 말고는 딱히 생각나는 게 없는데 허리가 너무 아파서 한 번 눕거나 일어나거나 자세를 바꿀 때마다 고통스럽더라고요.
+",Korean
+통증이 있는 부위가 어디죠?,Korean
+배뇨일지를 분석하는 데 있어서 소변량 측정이 중요하므로 재차 확인한 것입니다.,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+폐에 문제가 생기면 수술 후 회복이 더딜 수 있습니다.,Korean
+지금 안 하셔도 수술 준비에 들어간 비용은 모두 청구됩니다.,Korean
+항생제를 오래 쓸 경우 내성이 생깁니다.,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+보통은 그 약물을 쓸 수가 없고 다른 약물로 교체합니다.,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+한번 볼게요 부은 부위 좀 보여주실래요?,Korean
+성형수술은 받은 적 있는데 이것도 포함돼요?,Korean
+종교 때문에 수혈은 못 할 것 같아요.,Korean
+암인지는 검사 후에 결과가 나오기까지 시간이 좀 걸려서요 다시 안내 도와드리도록 하겠습니다.,Korean
+"살 빼기 시작하고 과식?안 합니다.
+",Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+손목을 받쳐주는 보호대도 있습니다.,Korean
+최근 체중 변화가 눈에 띄게 있었을까요?,Korean
+잠이 안 오는 이유가 무엇인가요? 그걸 알려주시면 필요한 약이 무엇일지 알 수 있습니다.,Korean
+식사량이 점점 줄고 있나요?,Korean
+아니요. 피부 때문에 병원 갈 정도는 아니었어요.,Korean
+배뇨 곤란이 언제부터 있었는지 궁금하네요.,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+약이 과다하게 들어가면 산모에게 좋지 않을 수 있습니다.,Korean
+뾰루지에 된장 바르는 거요.,Korean
+무슨 병 때문에 복용하는 약인지는 기억나시나요?,Korean
+하루 종일 아프신 건가요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+두 시간 전에 맥시부펜 먹였어요.,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+"머리가 어지러운지 자꾸 휘청휘청해요.
+",Korean
+부모님께서 혹시 외상 외에 큰 수술을 받으신 적이 있나요?,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+이빨 씌운 건 있어도 발치는 없어요.,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+고통이 얼마나 자주 오나요?,Korean
+몸에 무리가 온 게 언제가 마지막인가요?,Korean
+해당 부위가 얼마나 아프세요?,Korean
+네 좀 아픈 주사예요.,Korean
+진단 받은 다른 질병이 있나요?,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+특정 시기에 통증이 생기나요?,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+죄송합니다. 건강보험은 내시경 검사에만 적용되고 수면 비용에는 적용되지 않습니다.,Korean
+비염 말고는 다른 곳은 괜찮습니다.,Korean
+치질 판명이 나신 적 있으신가요?,Korean
+어느 정도로 부기가 심한가요?,Korean
+예상되는 질환은 있으나 몇 가지 검사를 시행한 후 자세히 말씀드리겠습니다.,Korean
+한번 더 진찰을 받으셔야 할 거 같아요.,Korean
+무력증을 느낀 적이 있나요?,Korean
+최근에 수술 언제 받으셨나요?,Korean
+"아내가 약을 먹고 죽을 결심을 한 것 같아요.
+",Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알콜 솜으로 눌러 보세요.,Korean
+증상이 나타나기 전에 드신 것은 다 말씀해주십시오.,Korean
+"전기장판에 불이 나면서 팔을 데었어요.
+",Korean
+발기 부전을 느끼고 계신가요?,Korean
+통증의 원인을 얼른 잡을 수 있도록 노력해 봅시다.,Korean
+유전성 질환 가족력 있나요?,Korean
+수술은 잘되었으니 이제 남은 건 환자에게 달렸습니다.,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+최근 결핵 백신 접종했나요?,Korean
+네. 늘 다니던 병원이 있어서요.,Korean
+심각한 칼슘 부족은 사망하실 수도 있어요.,Korean
+숨 쉴 때도 갈비뼈가 아픈가요?,Korean
+토를 한 적이 있나요?,Korean
+몇 가지 검사를 통해 진단 후 말씀드리겠습니다.,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+결핵 진단받으신 게 언제죠?,Korean
+어린이용 해열제가 없어서 못 먹였어요.,Korean
+잦은 접종은 면역력 저하를 불러일으킵니다.,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+기침 가래가 있거나 호흡 소리가 이상하거나 호흡할 때 도움을 받거나 하지는 않았나요?,Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+치료할 때 주의해야 할 점이 있을 수도 있어서 질문드렸습니다.,Korean
+네. 위의 변성 소견은 정상 조직에 비해 위암 발생 위험성이 높을 수 있습니다.,Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+통증을 참을 수 있나요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+많이 아프세요? 진통제 필요하시면 드릴게요.,Korean
+그 증상은 정밀하게 진단을 해보고 결정할게요.,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+허리에 디스크가 있어서 시술받았어요.,Korean
+혹시 다른 병원에서 씨티 찍고 오셨나요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+선천적으로 피부가 안 좋아서 건선이 있어요.,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+부종이 있는 곳이 있나요?,Korean
+한 가지 검사만으로 무조건 정상이라고 판단할 수는 없습니다.,Korean
+네. 그럼 아래 빈칸에 동의서 설명 들었으며 동의한다고 사인해 주시겠어요?,Korean
+고혈압이 있어서 한의원에서 약 지어다 먹고 있습니다.,Korean
+자연분만하다가 위험해서 수술로 바꿨어요.,Korean
+복부 팽만감이 있지는 않나요?,Korean
+폐경은 여성 호르몬 분비 저하로 발생합니다.,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+네 가정상비약도 말씀해 주세요.,Korean
+심장이 두근대는 게 멈추질 않았어요.,Korean
+"이 일 전부터 목이 부은 것 같기도 하고 불편해서 자꾸 기침하게 되더라고요.
+",Korean
+네 좀 아픈 주사예요.,Korean
+"요즘 속이 너무 안 좋아서 아무것도 못 먹이겠고 토도 하루에 두 번은 해서 왔어요.
+",Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+제균치료를 중간에 임의로 중단 시 오히려 더 심해질 수 있고 항생제 내성이 생길 수 있습니다.,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+대변볼 때 안 힘든가요?,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+환자분 남은 검사가 많으셔서 천천히보다는 좀 빨리 보시는 게 좋겠네요.,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+사시면서 병원에 입원한 모든 내용 알려주세요.,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+백오십오 센티 사십이 키로입니다.,Korean
+대변에 피가 보인적 있나요?,Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+불면증이 심하신 거 같아요.,Korean
+불편하시겠지만 빠른 회복을 위해서는 콧줄을 꼭 해야합니다.,Korean
+코로나 증상으로는 고열 근육통 마른기침 인후통 호흡곤란 미각 또는 후각 이상 등이 있습니다.,Korean
+수혈을 꼭 하지 않아도 되죠?,Korean
+"소변이 잘 안 나오다 보니까 화장실을 엄청 자주 가요.
+",Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+지금 환자분 상태와 인과관계가 있는지를 판단하기 위해서입니다.,Korean
+밀접 접촉자라는 연락이 와서 선별진료소에 다녀왔어요.,Korean
+주무시면 안 됩니다 혹시 다른 증상들도 나타나고 있나요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+환자분마다 느끼는 증상이 달라요.,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+처방이 아직 안 났어요.,Korean
+과로로 쓰러져서 입원한 적이 있고 전에 손목이 부러져서 수술하느라 입원한 적도 있습니다.,Korean
+서혜부탈장은 보통 복압이 증가하면서 복강 내 장기들이 서혜관으로 내려오면서 생깁니다.,Korean
+수술 동의서 받을 때 자세히 설명드리겠습니다.,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+지금 옆구리 아프신 건 어떠세요?,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+욕창은 계속 치료를 하셔야 합니다.,Korean
+아이가 체온이 높아 옷을 벗기는 게 좋을 것 같습니다.,Korean
+한의학 외에 다른 건 없으셨나요?,Korean
+걱정이 많으실 것 같습니다. 우선 주사제 투여를 병행하면서 증상 양상을 확인해 보겠습니다.,Korean
+네 아니면 지금 혈액 검사받으시겠어요?,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+혈압 수치가 높다는 판정은 언제쯤 받았어요?,Korean
+몸무게 감소량이 어느 정도 되나요?,Korean
+혈액검사는 두 세 시간 후 확인 할 수 있으니 그 때 설명드릴게요.,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+"길 가다가 개한테 물렸어요.
+",Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+"아이 이마가 뜨끈뜨끈한 게 열이 나는 것 같아요.
+",Korean
+이번 주까지 독감 접종 아직 안 하신 분 저렴하게 맞을 수 있습니다.,Korean
+통증 감소를 위해 복용 중인 약은 있나요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+배에 아직 부기가 안 빠져서 그런 걸 수도 있습니다.,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+복부가 가득 찬 느낌이신가요?,Korean
+평소에도 자주 입술이 건조해지시나요?,Korean
+"생각해보니 배변은 힘든데 약 먹으면 괜찮아요.
+",Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+네. 저번 주에 감기 때문에 내과 한 번 다녀왔어요.,Korean
+통증 진행 양상이 어떤가요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+당뇨 치료받아본 가족 분이 있으신가요?,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+요도염일 가능성이 있으니 추가 검사를 해보시지요.,Korean
+항히스타민제 처방받고 드시는 건가요?,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+약을 먹고 머리가 아프셨던 거예요?,Korean
+환자분 주치의께서는 보통 아홉 시 전에는 환자 보러 돌아다니셔요.,Korean
+"가끔 눈앞이 뿌옇게 보여서 앞이 잘 안 보여요.
+",Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+안 됩니다. 기계 호흡은 폐에 발생한 질병을 치료하거나 낫게 하는 것이 아니라 우리 몸의 호흡기능을 일시적으로 보조할 뿐입니다.,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+"혈당이 많이 오른 거 같아요.
+",Korean
+통증이나 천자 후 두통 등의 문제 이외에 다른 문제가 발생하는 경우는 드물다고 알려져 있습니다.,Korean
+지금 병실 이동 예정이니 밖에서 대기 부탁드립니다.,Korean
+어느 부위에 통증이 있어요?,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+네. 앰뷸런스 타고 오신 것이 맞는지 확인해 볼게요.,Korean
+화상 상처부위를 소독하기 위한 약의 이름입니다.,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+상해로 인하여 입원하여 수술하신 적이 있나요?,Korean
+피를 토 한 적 있으세요?,Korean
+병원에 해당 기관으로 안내를 도와드리겠습니다.,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+사출성 구토의 원인 중 감염이나 식중독에 의한 경우 호전까지 시간이 걸리는 경우가 많습니다.,Korean
+네. 혈압약만 먹고 있어요.,Korean
+보통 이렇게 오래가지는 않지만 환자분은 지금 심각한 상태라 다른 사람들보다 증상이 오래가는 겁니다.,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+하루 두 번씩. 타이레놀 딸기 맛이오.,Korean
+아. 드디어 퇴원하네요. 필요한 서류는 없어요!,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+통증이 어느 정도 심한가요?,Korean
+오진을 막기 위해 환자 확인용으로 이용되고 있어요.,Korean
+처음 입원 시 환자분의 전체적 신체상태를 확인하기 위한 항목 중 하나 입니다.,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+아픈 곳이 더 있나요?,Korean
+통증이나 천자 후 두통 등의 문제 이외에 다른 문제가 발생하는 경우는 드물다고 알려져 있습니다.,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+흡연 상태 유지 중이신가요?,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+투약 용량을 조절하면 오래 지속되는 경우는 흔치 않습니다.,Korean
+결핵이 발병하신 적이 있나요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+"엄마가 그저께부터 화장실만 가면 피가 섞인 변을 본대요.
+",Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+어제 새벽에 열이 너무 올라서 맥이고 그 이후론 안 먹었어요.,Korean
+목으로 피가 조금 올라오나요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+숨 쉬는 게 힘드신가요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+수액 바로 맞으셔야 합니다.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+예전 아토피 진단을 받은 적 이 있으신가요?,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+"혈액검사에서 지방 수치가 높게 나온 건 왜 그러는 거예요?
+",Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+면역력은 치료와 밀접한 관련이 있습니다.,Korean
+치아에 문제 있는지는 하나하나 또 볼게요.,Korean
+하루에 담배는 몇 갑 피우시죠?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+혈압은 환자분의 상태에 따라서 계속 달라질 수도 있으니 너무 걱정하지 않으셔도 됩니다.,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+네 문진과 검사를 빨리 진행 후 달아드리겠습니다.,Korean
+가족 중에 치료가 필요할 정도의 당뇨를 진단 받으신 분이 계신가요?,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+치료 계획이나 약물요법이 달라집니다.,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+자주 피로하다는 느낌이 드나요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+추적 검사도 저희 병원에서 받기 원하신다면 미리 예약하고 병원에서 검사 시기에 다시 연락드리겠습니다.,Korean
+복부 통증이 있는데 변이 안 나오나요?,Korean
+철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+심계항진 증상을 설명해 주실래요?,Korean
+"산에 갔다가 팔을 가시에 찔렸는데 못 빼냈어요.
+",Korean
+앉아 있을 때에도 통증이 있으신가요?,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+"오늘 갑자기 여기 이쪽에 이상한 게 만져져요. 이게 뭐죠? 선생님 종양인가요?
+",Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+삼 일 뒤에 입원 가능합니다.,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+두통이 가장 심할 때가 언제인가요?,Korean
+"네. 허리가 부서질 듯이 아파요.
+",Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+"어깨가 너무 욱신거리는 느낌이 들어요.
+",Korean
+원래 토혈 증상이 있으신가요?,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+네 통증이 있는 곳이 또 있나요?,Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+좀 더 약한 약으로 바꿉시다.,Korean
+"대상포진인 것 같아요. 너무 아프네요.
+",Korean
+"목에 가시가 걸려서 안 내���가요.
+",Korean
+심장 뛰는 속도가 빠르게 느껴지시나요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+소변에 피가 섞여 나오나요?,Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+팔다리 힘이 빠지시지는 않나요?,Korean
+네. 문진표 이외에 입원생활에 필요한 정보를 수집하기 위한 절차입니다.,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+"아니요. 화상도 화상이지만 허리가 더 아파서 왔어요.
+",Korean
+영부터 십 중에 통증이 얼마나 되세요?,Korean
+결핵 진단 언제 받으셨어요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+최근에 오한이 있던 적이 있나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+복통이 나타난 건 언제가 처음이죠?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+그렇군요 구급차로 입원하셨다고 알겠습니다.,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+네. 속 괜찮아지시면 그때 일반식으로 다시 바꿔드릴게요.,Korean
+수면을 방해하는 원인이라고 생각되는 게 뭐 있죠?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+"선생님 몸에 이상한 게 생겼는데 아무래도 탈장 같아요. 탈장 맞나요?
+",Korean
+임플란트나 틀니 빼고 본인 치아만 말해주세요.,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+감염성 질환이란 다른 환자로부터 옮을 수 있는 질환입니다.,Korean
+"변비 때문에 많이 고생 중이에요. 약을 먹지 않으면 기미가 없어요.
+",Korean
+"아니요. 계속 잠이 안 와요.
+",Korean
+팔도 골절이 의심되어서 현재 부목을 대 드릴 거예요.,Korean
+일단 응급처치 후 손상 정도를 확인해 볼 겁니다.,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+먹는 영양제는 다 말씀해 주세요.,Korean
+네. 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+평소에 식이 섬유 위주의 식단은 챙겨 드시나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+"몸무게 예전보다 오 킬로나 늘었어요.
+",Korean
+약품 의뢰하고 여분 없으면 처방해드릴게요.,Korean
+"과일과 야채를 갈아서 과채 주스를 매일 아침 먹습니다.
+",Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+잘 못 주무시는 편인가요?,Korean
+혹시 약물 음식 제외하고 다른 알레르기도 있으세요?,Korean
+또 아픈 곳 없나요?,Korean
+고유량 산소법의 특성은 환자의 호흡 양상의 변화와 무관하게 정확하고 계속적으로 일정한 흡입산소분율을 제공해 산소를 투여하는 것입니다.,Korean
+흉터가 신경 쓰이겠지만 이 정도면 안 남을 수는 없습니다.,Korean
+보름 전 비형간염 한차례가 전부인가요?,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+"제 친구인데 의식이 없어요.
+",Korean
+"네. 약간 변비가 있어서 보는데 힘들더라고요.
+",Korean
+배가 무언가 꽉 찬 느낌이 있나요?,Korean
+집 먼지 진드기는 천식을 대표하는 알레르기성 질환의 원인이 됩니다.,Korean
+체온이 떨어진 것 같나요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+환자분은 혈액검사에서 간수치가 많이 상승되어 있습니다. 시티 상에서도 명확히 간염이 보이시고요.,Korean
+알레르기 반응이 올라오는 다른 원인이 있나요?,Korean
+취침 시에도 자주 소변이 마려운가요?,Korean
+일상생활 중에 알레르기 반응을 보이는 것이 있었나요?,Korean
+소변 횟수와 함께 소변량도 측정해야 정확한 진단이 가능합니다.,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+어깨 관절에 이상이 있나 봅니다.,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+아픈 기간은 어느 정도일까요?,Korean
+결핵으로 약 드시고 계세요?,Korean
+발기가 충분히 오래 지속되지 않나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+환자분은 오늘 두부 열상으로 오셨고 퇴원 안내���에는 두부 외상 환자 주의사항이 있습니다. 뒷장에는 열상 환자 주의사항도 있으니 읽어보시면 됩니다.,Korean
+"소변에서 냄새가 나고 몸이 안 좋아 보여서요.
+",Korean
+몸이 부을 때가 있나요?,Korean
+유전성 질환으로 고생하는 가족이 계신가요?,Korean
+네. 독감 주사 맞았어요.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+하루에 담배를 얼마나 피세요?,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+대부분은 그렇습니다만 통증이 있으면 시술 시 말씀해주세요.,Korean
+폐렴구균 예방접종을 딱 어제 받았습니다.,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+소변 횟수와 함께 소변량도 측정해야 정확한 진단이 가능합니다.,Korean
+네. 입원까지 안 해도 되는군요.,Korean
+피검사만으로 진단이 정확하지 않을 수 있어 씨티 검사가 필요합니다.,Korean
+왜 소변검사만 하시려는 건가요?,Korean
+습진도 치료를 받아야 합니다.,Korean
+네 감염의 위험성이 높으니 주의해 주세요.,Korean
+"다름이 아니라 우리 애가 좀 빨리 크는 것 같더라고요 그래서 검사 한 번 받아보려고 왔습니다.
+",Korean
+이천일 년 첫 건강검진이었는데 그때 알게 됐던 거죠.,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+당뇨로 약을 드시고 계신가요?,Korean
+메밀이 들어간 음식을 먹으면 어떤 반응이 있나요?,Korean
+주로 하루 중 언제 붓나요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+"대소변 보는 게 어렵냐는 말씀이세요?
+",Korean
+아마 타 병원 가셔도 비슷한 가격일 거예요.,Korean
+전반적으로 치아 상태를 다 보는 거예요.,Korean
+두통으로 불편한 점은 없나요?,Korean
+그럼 약물 사용하는 대신에 다른 방법이 있나요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+네. 비뇨기 계통이 안 좋아서요.,Korean
+치아 불편한 게 있는지 확인하기 위해서요.,Korean
+가족 중에 고혈압인 분이 있으면 알려주세요.,Korean
+네 필요하신 보호대 드릴게요.,Korean
+분유를 통해 영양소를 골고루 섭취할 수 있습니다.,Korean
+토를 심하게 한 적이 있나요?,Korean
+간헐적으로 통증이 왔다 가나요?,Korean
+혹시 설사 자주 하셨나요?,Korean
+하반신 마취도 수면 마취가 가능합니다.,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+"아버지가 정신을 잃으신 것 같아요.
+",Korean
+어쩔 수 없이 추가 검사를 해야 합니다.,Korean
+수술 당일은 전혀 거동하실 수가 없어서 보호자분이 꼭 같이 계셔야 합니다.,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+암 치료를 받고 있으세요?,Korean
+마취약이 잘 듣지 않았다면 교체도 고려해 봐야 할 듯합니다.,Korean
+알약을 가루약으로 조제해 드리겠습니다.,Korean
+통증이 하루에 자주 일어났어요?,Korean
+초음파상 문제는 없는데 정밀검사를 진행해 봐야 알 것 같습니다.,Korean
+알레르기 반응에 또 다른 반응이 있나요?,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+재수술을 해야 하는데 거기까지 가면 안 되겠죠.,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+"안녕하세요. 저번에 지어간 약을 먹으면 자꾸 속이 너무 아파서 약을 바꿔야 할 것 같아서 왔어요.
+",Korean
+환자분이 급여 진통제에 알레르기가 있어서 진료비가 비싸져도 비급여 진통제가 필요합니다.,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+환자분이 수술하시는 이유는 둔위 때문입니다.,Korean
+오한이 든 건 아니고요?,Korean
+금연 약 말고는 없어요.,Korean
+드시고 계신 약과 처방한 약이나 주사의 성분이 충돌하지 않게끔 조절하기 위해 성분을 분석하는 겁니다.,Korean
+숨 쉴 때 통증이 있나요?,Korean
+결핵약 매일 복용하고 있나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+설사를 보시고 나면 속은 좀 어떠세요?,Korean
+얼마 전에 골다공증 때문에 병원에 왔었어요.,Korean
+간염으로 치료 받고 있나요?,Korean
+아직은 장운동이 원활하지 않아 불편하더라도 좀 더 하고 계셔야 됩니다.,Korean
+"자꾸 눈 앞이 흐려져서 혈당을 재 보니 높게 나왔어요.
+",Korean
+"네. 하루에 일고여덟 시간은 꾸준히 자는 편이에요.
+",Korean
+입원 치료를 받았던 적이 있나요?,Korean
+간호 간병 병동이 아니므로 보호자가 상주하셔야 합니다.,Korean
+"손가락 움직임이 둔하고 붓기에 차갑고 그래요.
+",Korean
+진통제를 먹어도 나아지지 않나요?,Korean
+음 여기 보시고 해당하는 혈액형이 있는지 보세요.,Korean
+"아무래도 손목이 탈골된 것 같아서 왔어요.
+",Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+네 검사 결과에 따라 치료 방법과 치료 기간이 달라집니다.,Korean
+맥박 아까 재셨지만 지금 재측정이 필요해서요.,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+아니요. 방향을 바꾸기는 힘들고 걸리적거리지 않도록 배액관 길이를 최대한 조정해 드리겠습니다.,Korean
+알레르기 중에 음식과 약물 외에 다른 것도 있으세요?,Korean
+계속 기침 증상이 있나요?,Korean
+다른 병원 입원 포함 모든 입원경험을 알려주세요.,Korean
+어릴 때 다리가 부러져서 며칠 입원했어요.,Korean
+사고당해서 입원한 적 있으세요?,Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+설사를 종종 하셨구요 배가 빵빵하다거나 하지는 않았어요.,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+네. 필요하시면 수액도 놔드리겠습니다.,Korean
+술을 과하게 먹는 편인 가요?,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+가끔 같이 복용하면 안 되는 약들이 있어서 그래요.,Korean
+채혈은 이번만 진행한 것이라 다음에는 따로 채혈 안 하셔도 돼요.,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+"계속 열이 나고 몸이 아프다 그래서요.
+",Korean
+동네 약국에서 수령해도 됩니다.,Korean
+정확한 건 검사 결과가 나와봐야겠지만 음식이 오염되었을 수도 있어요.,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+네 흡연을 시작한 후로 지금까지입니다.,Korean
+약을 먹였는데 자꾸 토하네요.,Korean
+수술 당일은 전혀 거동하실 수가 없어서 보호자분이 꼭 같이 계셔야 합니다.,Korean
+"구토 이외에는 별다른 증상은 없어요.
+",Korean
+그런 건 아니고요. 어떤 약 드시는지 확인을 해야 해서요.,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+"몸이 신경 쓰여서 잠이 안 와요.
+",Korean
+두통이 심할 때도 있나요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+가족 내 암 판정받은 분은요?,Korean
+가슴 조이는 느낌이 얼마나 자주 있나요?,Korean
+아기가 열이 어젯밤부터 나서 어젯밤 아홉 신가 먹였어요.,Korean
+하루에 설사를 몇 번 했나요?,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+배에 있는 대동맥이 늘어지고 커져서 만져지네요.,Korean
+레이저 치료 후 마취가 풀리면 조금 아프실 수도 있어요.,Korean
+"권투 하다가 이가 부러졌네요.
+",Korean
+평소보다 요즘이 더 피로하신 것 같나요?,Korean
+알레르기 나는 상황 알려주세요.,Korean
+발기부전약 드시고 계신 거에요?,Korean
+네 동네 병원 중에 화상 상처 보는 곳에 가시면 됩니다.,Korean
+무릎 쪽에 통증이 있나요?,Korean
+요즘 혹시 오한이 있나요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+병원으로 바로 오셔서 소독하셔야 해요.,Korean
+금방 확인하실 수 있잖아요? 챙겨 먹어야 하는 약이 있으니 오전 중에 돌려주셨으면 좋겠어요.,Korean
+사실 강직성 척추염의 명확한 원인은 알려지지 않았습니다. 유전적인 원인이나 외상 세균감염 과로 등의 환경적인 요인이 원인일 수 있습니다.,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+뭔가로 닦아 주는 건 아이 열이 심할 때 하는 거라 지금은 옷을 벗기고 있는 것만으로도 충분할 것 같습니다.,Korean
+수술은 잘되었으니 이제 남은 건 환자에게 달렸습니다.,Korean
+"네. 평소랑 변 색깔이 달라요. 평소보다 색깔도 ��이 까맣고 속도 아파요. 쓰리고 토할 것 같아요.
+",Korean
+아픈 기간은 어느 정도세요?,Korean
+통증은 주로 언제 오나요?,Korean
+용종제거술 자체로 인한 통증은 드뭅니다.,Korean
+콕콕 찌른다거나 양상이 어떻게 되시나요?,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+언제부터 결핵으로 병원 다니셨죠?,Korean
+"일주일 전에 수술받은 팔에 고름이 찼어요.
+",Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+"흡연은 스무 살 무렵에 시작했는데요. 요새는 건강 생각해서 하루 두세 대만 피웁니다.
+",Korean
+하루에 몇 개 피우시죠?,Korean
+결핵 증상이 언제부터 나타났는지 아시나요?,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+네. 검사 예약해 드리겠습니다.,Korean
+검사 후 응급으로 시술이 필요할 수 있습니다.,Korean
+"아예 잠이 안 오는 게 제일 큰 문제에요.
+",Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+좀 큰 병원으로만 옮겨주세요.,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+그 뒤에도 아무것도 안 드셨다면 지금 바로 검사하죠.,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+평소에 복용하는 약이 있나요?,Korean
+배뇨 곤란을 느끼신 적이 있나요?,Korean
+타이레놀 때문에 증상이 생긴 걸 수도 있습니다.,Korean
+"새벽부터 아파서 자다 깨다 했는데 누르는 듯한 통증이 낫질 않더라고요.
+",Korean
+체온이 몇 도인지 아세요?,Korean
+뜸이나 침 맞는 걸 좋아해요.,Korean
+음식으로만 감염되는 것은 아니지만 오염된 음식으로도 감염될 수 있습니다.,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+만졌을 때 통증은 없나요?,Korean
+평소에 먹는 약이 있나요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+저는 무료 접종 대상이 아니라서 그냥 안 맞았어요.,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+알레르기로 기피하는 음식 있나요?,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+작년에 건강검진을 받았는데 위궤양 진단을 받고 한창 약도 복용했었거든요.,Korean
+하반신 마취여도 안정시키기 위해 수면마취를 시행하는 경우도 있습니다.,Korean
+피부 상처가 거의 아물게 되면 안정적으로 자리 잡는다고 말씀드릴 수 있겠습니다.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+"소변보는데 너무 아프고 잔뇨감이 늘 있어요.
+",Korean
+주의사항에 기재되어 있지 않은 증상이 나타나면요?,Korean
+혹시 많이 속이 안 좋은가요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+거절하실 경우 최대한 같은 의사를 지닌 분들과 같은 병실에 배정해 드리고 있습니다.,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+혈압 재는 건 금방 하니까 걱정 마세요.,Korean
+다른 종류의 알레르기는 가지고 계세요?,Korean
+최근에 인플루엔자 백신은 맞으셨나요?,Korean
+"추적 검사 받으러 왔어요.
+",Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+"아니요. 저는 담배를 아주 싫어하는 사람이에요.
+",Korean
+"사타구니가 볼록 튀어나와서요. 손으로 밀어 올리면 쏙 들어가고 또다시 튀어나오고 그래요. 집 앞에 병원에 갔더니 탈장 같다고 하시면서 소견서를 써주셨습니다.
+",Korean
+네 일반적인 해열제 종류가 여러 개여서 구체적으로 알려 주셔야 합니다.,Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+혹시 예전에 지속적인 치료를 받은 병이 있나요?,Korean
+환자분이 느끼는 통증의 정도가 얼마나 되나요?,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+두통약이 문제가 될 수도 있어요.,Korean
+가래의 상태를 말해 주세요.,Korean
+그럼 전에 검사하셨을 때 문제없으셨던 건가요?,Korean
+"습관성 탈구 때문에 왔습니다.
+",Korean
+오한 증상이 언제 시작 되었죠?,Korean
+환자 개인 정보 조사를 위해 여쭤보았습니다.,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+환자분 상태에 따라 입원 가능 여부가 달라집니다.,Korean
+"소변 냄새가 심해서 소변볼 때 절대 코로 숨을 못 쉬어요.
+",Korean
+과식을 해서 위에 자��을 줬다면 통증이 있을 수 있습니다.,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+구토가 나아질 기미가 있나요?,Korean
+통증 양상을 알 수 있을까요?,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+매일 혈압을 재고 있나요?,Korean
+피부 상처가 거의 아물게 되면 안정적으로 자리 잡는다고 말씀드릴 수 있겠습니다.,Korean
+"설사약 효과 듣지도 않아요.
+",Korean
+아픈 곳 좀 말해 주세요.,Korean
+"식도 쪽으로 문제가 생겼다고 압니다.
+",Korean
+"네. 다리를 모으고 구부린 자세로 자면 통증이 줄어듭니다.
+",Korean
+아픈 기간은 어느 정도세요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+네. 세 명 다 수술로 낳았어요.,Korean
+약 제조에 도움이 될 것 같아서요.,Korean
+"네 요즘 소변 컨트롤이 잘 안돼요.
+",Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+하루에 담배를 얼마나 태우세요?,Korean
+음식 약물 알레르기가 있나요?,Korean
+병원에 자주 오셔야 돼서요.,Korean
+"네. 얼마 전부터 저희 엄마가 혈변을 보시더라고요. 무슨 문제라도 있나 해서 검사 받으려고요.
+",Korean
+결핵을 오래 앓으신 거예요?,Korean
+결핵 치료는 꾸준히 받고 계신가요?,Korean
+여기가 치료를 잘해주시는 것 같은데 아쉽네요.,Korean
+"귀 한쪽이 좀 답답하고 간지러워서요.
+",Korean
+혹시 다른 병원에서 씨티 찍고 오셨나요?,Korean
+언제부터 결핵인 거 알았어요?,Korean
+쉽게 말해 보험처리가 안 되는 진통제 항생제 등 비급여 물품을 사용하겠다는 동의서입니다.,Korean
+대변을 못 본 지 오래되셨나요?,Korean
+최근에 오한을 느낀 적이 있나요?,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+네. 저번 주에 보라카이 갔다 왔고요. 가기 전에 접종하고 갔습니다.,Korean
+제왕절개 하면서 추가로 하는 거라 물어보는 겁니다.,Korean
+네. 평소대로 호흡을 하면 폐가 완전히 펴지지가 않기 때문에 마취 가스의 배출이 더뎌질 수도 있습니다.,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+죄송하지만 수면 비용에는 보험 적용이 되지 않습니다.,Korean
+"엄지발가락이 빨갛게 부으면서 아프고 가끔 고름이 나와서요.
+",Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+잠을 이루기 쉽지 않나요?,Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+언제부터 혈뇨 증상이 있으셨어요?,Korean
+"눈앞을 끈적한 진물이 가려요.
+",Korean
+혈압이 좀 있는 편이신가요?,Korean
+"열은 재 봤을 때 삼십팔 도였는데 해열제 먹이니 열은 떨어졌어요.
+",Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+과학적으로 입증되지 않은 민간요법의 경우 오히려 간 독성을 초래해서 크게 위험할 수 있으니 자제하세요.,Korean
+몸무게의 변화가 의심될 때만 시간대별로 체크합니다.,Korean
+저 마취해 본 적이 없어서요.,Korean
+뉴트리션 영양제랑 철분제 사 먹고 있어요.,Korean
+항생제 치료를 받으면 일주일이면 많이 좋아지십니다.,Korean
+발열이 있던 적 있나요?,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+한 번에 수술이 안 끝나기 때문에 추가로 하는 수술입니다.,Korean
+"설사하죠. 배도 너무 아프고.
+",Korean
+멸균 처리해 놓은 것이 소독 붕대이기 때문에 이 차 감염 예방에 도움을 줍니다.,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+"엄지발가락이 양말만 스쳐도 쓰라리고 아려서요.
+",Korean
+신체적인 반응이나 부작용이 일어났었나요?,Korean
+그럼요. 중단 없이 계속 복용 중이죠.,Korean
+위산을 비롯한 위의 내용물이 역류되어 식도를 자극하여 그러한 증상이 나타날 수 있습니다.,Korean
+"요새 속이 너무 안 좋아서 왔어요.
+",Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+욕창이 없어도 통증은 있을 수 있습니다.,Korean
+먹은 음식물을 다 토하나요?,Korean
+주먹의 감각 혹은 운동 이상을 확인하기 위해 검사했습니다.,Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+네 맹장 수술도 포함입니다.,Korean
+네 산소포화도를 먼저 확인 하겠습니다.,Korean
+같은 병실이 아니었으면 좋겠습니다.,Korean
+주 증상 외에 불편하��� 곳은 없으신가요?,Korean
+"심장에 이상이 있다고 알고 있습니다.
+",Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+"항문으로 뭔가가 들어갔는데 안 빠져요.
+",Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+기침 외에 다른 증상은 없나요?,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+"소변이 자주 마려울 때가 있어요.
+",Korean
+패혈증이나 다른 합병증이 생길 수 있어요.,Korean
+집 앞 병원에 비염 치료하러 간 적 있어요.,Korean
+만약 잘못 된다면. 더 이상의 치료는 하지 않았으면 좋겠습니다.,Korean
+주에 몇 번 아픈가요?,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+너무 체온이 상승하는 것은 안 좋을 수 있습니다.,Korean
+아니요 지금 상태에서는 담배를 피우면 안 됩니다.,Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+소변 색이 검붉은 색인가요?,Korean
+피검사만으로 진단이 정확하지 않을 수 있어 씨티 검사가 필요합니다.,Korean
+"몸을 거동하기 힘들 정도로 통증과 함께 힘이 없어요.
+",Korean
+"불면증이 있어서 잠을 잘 못 자는 편이에요.
+",Korean
+"정확히 어디가 아픈지 모르겠어요. 전체적으로 몸이 안 좋은 느낌이에요.
+",Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+수술을 들어가기 전 한 번 더 정확히 보고 싶어서요.,Korean
+네. 샘물 병원에 감기 때문에 다녀왔어요.,Korean
+통증이 멈췄다 다시 시작되나요?,Korean
+네 수술 부위 정확히 인지하고 계세요.,Korean
+네 치과 수술 치료하신 거면 다 말씀해주세요.,Korean
+계단을 잘못 내려와서 무릎인대 수술받았었어요.,Korean
+음식이나 약물 말고 다른 알레르기 반응 있는 거 있어요?,Korean
+부작용을 일으키는 약 종류가 있으신가요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+상처에 물이 닿으면 지체 마시고 바로 병원으로 내원 부탁드립니다.,Korean
+"몇 년 전에 진단 받았어요.
+",Korean
+네 틀니가 있으면 검진이 어려워요.,Korean
+최근 급격하게 살이 많이 올랐나요?,Korean
+가래에 피가 섞여 있나요?,Korean
+통증이 일 분 넘게 지속했던 적이 있나요?,Korean
+복부 팽만감이 언제부터 있으셨나요?,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+다음 달에 이사를 가려고 하는데요. 혹시 새로운 병원을 좀 소개해 주실래요?,Korean
+침을 삼킬 때마다 아프신가요?,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+식단 조절이 필요해 보여요.,Korean
+알레르기를 언제부터 치료받고 있나요?,Korean
+통증이 영부터 십까지 있을 때 어느 정도인가요?,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+십오 년 전 우연히 응급실 갔다가 고혈압이라는 것을 알게 됐네요.,Korean
+기침을 했는데 피가 나온 적 있나요?,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+아무래도 레이저 시술은 통증이 동반될 수밖에 없어요.,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+음식을 씹거나 삼키기에 불편하신가요?,Korean
+다른 방향 보고 계시면 주사 최대한 천천히 놓도록 노력해 볼게요.,Korean
+통증의 원인인 질환은 치료를 통해 개선될 겁니다.,Korean
+네. 귀찮으시겠지만 매일 확인을 해야 상처가 덧나지 않고 빨리 아물 수 있습니다.,Korean
+"허리뿐 아니라 이젠 다리까지 아파요.
+",Korean
+당뇨는 언제부터 알게 되셨어요?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+그냥 링거 맞으러 오셨군요.,Korean
+발기가 평상시에 안 되시나요?,Korean
+"기저귀를 세 번 정도는 갈아드려야 해요.
+",Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+목에 아픈 증세가 있나요?,Korean
+지속적으로 기침을 하고 계신가요?,Korean
+"어제 갑자기 토를 해서 오늘 온 거예요.
+",Korean
+네 일단은 비뇨기과에서 진료 볼 수 있도록 해드릴게요.,Korean
+갑자기 일어나면 어지러움이 있어요?,Korean
+배에 가스만 차 있는 것이라면 안심하여도 됩니다.,Korean
+"귀 근처가 간지러워서 긁었더니 상처가 났어요.
+",Korean
+"가슴이 죄어올 때가 있긴 하죠.
+",Korean
+얼마 전에 감기 때문에 동네 병원 갔다 왔어요.,Korean
+과거에 수술 경력 있으신가요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+여기서 접종하신 거면 내역 확인해 드릴게요.,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+일주일에 몇 갑 정도 흡연하시나요?,Korean
+식욕이 떨어지기 시작한 게 언제죠?,Korean
+아니요 수액은 따로 놓지 않고 약을 드리고 있어요.,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+예전에 에이형 간염에 걸렸었어요.,Korean
+제왕절개 여부에 따라 앞으로의 치료방식이 달라집니다.,Korean
+담배 시작하신 게 언제예요?,Korean
+자연분만과 제왕절개에 따라 수술 방법이 달라질 수도 있습니다.,Korean
+대변을 오랫동안 보지 못할 시 가스와 변이 저렇게 차 보일 수 있습니다.,Korean
+검진 이후에 또 몸 상태가 달라졌을 수도 있어서 재차 검사가 필요합니다.,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+입원하실 때 걸어오셨는지 휠체어나 이동침대 등 다른 이동수단을 이용하셨는지 물어보았습니다.,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+약사가 준 거 먹었지 나는.,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+지금 많이 호전된 상태니 그리 심각하진 않습니다.,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+보호대 착용은 손목의 움직임을 줄이고 손목터널 내 압력을 줄여주어 신경 압박에 의한 증상을 줄일 수 있습니다.,Korean
+지금 혹시 오한이 있나요?,Korean
+소변줄의 위치가 올바르게 되어있는지 확인하겠습니다.,Korean
+힘드시겠지만 격리여부를 판단해야 해서 검사를 하셔야 합니다.,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+평소에 가슴이 아프고 그러신가요?,Korean
+고혈압 관련해서 어떤 약을 드시고 계신가요?,Korean
+발기 부전이 얼마나 심하신가요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+예 잘하면 해산물로 인해 증상이 일어났을 수도 있습니다.,Korean
+"어금니보다 안쪽에 있는 이에 음식물이나 칫솔이 닿으면 아픕니다.
+",Korean
+간염은 앓으신 지 얼마나 되셨어요?,Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+가래 상태가 많이 심한가요?,Korean
+복부가 가득 찬 느낌이신가요?,Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+내일 내시경 역행성 담낭 췌장 조영술 있으셔서 오늘 자정부터는 물도 포함해서 금식이세요.,Korean
+아프신 정도가 얼마나 되시나요?,Korean
+"""네, 그렇게 하세요. 약은 잘 챙겨 드시고요.""",Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+비급여 진통제가 필요한 이유는 환자분에게 가장 잘 맞는 진통제이기 때문입니다.,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+심계항진 증상을 설명해 주실래요?,Korean
+계속해서 심장이 빨리 뛰나요?,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+경우에 따라 구역감이나 구토를 하는 분들이 계세요.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+알레르기 있다는 거 언제 아셨죠?,Korean
+결핵 치료를 약으로 하고 계시나요?,Korean
+무통 주사 맞아도 통증이 있는데요?,Korean
+주치의와 상담 받으시고 필요시 처방대로 복용하시면 됩니다.,Korean
+머리가 좀 아프긴 했는데 그냥 두통이었던 것 같습니다.,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+종양 치료받은 적 있으세요?,Korean
+심한 자극을 주거나 전기적 충격을 가한 적이 있으신가요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+통증이 있을 때마다 약을 몇 알 드시는데요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+네 필요하면 피검사도 진행 예정입니다.,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+네 의사 선생님께서 말씀해 주실 거예요.,Korean
+선생님 진찰 후 약 처방받으실 거예요.,Korean
+약을 어느 병원에서 받으신 거죠?,Korean
+결핵약을 처방받은 적이 있으실까요?,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+수술 후 보통은 항암요법을 하게 되는데 항암요법에 쓰이는 약의 부작용으로 탈모가 올 수 있고 구역 구토같이 소화기 장애가 있을 수 있습니다.,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+"네. 저 좀 빨리 치료 좀 해주세요.
+",Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+중간에 자의로 복용을 중단하면 항생제 내성이 생길 수 있으며 치료 실패율이 높아집니다,Korean
+소변줄은 바닥에 끌리지 않도록 유의해주시고 방광보다 높게 들지 않도록 해주세요.,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+네. 뭔지는 모르겠는데 혈압약을 일어나자마자 항상 챙겨 드세요.,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+네. 아세트아미노펜 계열로 먹였어요.,Korean
+"복통이 가라앉지 않아 응급실에 왔습니다.
+",Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+내일 진료받으러 오셔야 할 진료 장소입니다.,Korean
+알레르기 증상이 음식이나 약 말고도 있었던 적 있어요?,Korean
+"기침이 계속 나면서 폐 쪽이 아파요.
+",Korean
+의식상태를 파악하기 위한 검사입니다.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+감염의 우려 때문에 상처는 매일 확인해야 합니다.,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+움직일 때 손가락에 걸릴 수도 있으니 주의를 부탁드립니다.,Korean
+네. 받았어요. 그래서 여드름 치료에 좋다는 프락셀도 같이 받았어요.,Korean
+담배 처음 핀 게 언제예요?,Korean
+아니요. 환자분은 무통 주사를 달지 않았습니다.,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+"여기서 저번에 일주일 전쯤인가 팔 수술을 받았는데 진물이 나고 아파요.
+",Korean
+타고 있는 담배에서 나오는 연기는 입자의 크기가 작아 폐의 깊은 부분까지 들어갈 수 있어 더 안 좋습니다.,Korean
+가족력에 대해 알고 있는 게 없어요.,Korean
+마취 풀리며 통증이 시작될 수 있는데 그땐 진통제 드릴게요.,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+레이저 치료가 끝난 뒤에 통증이 유발되는 경우도 가끔 있습니다.,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+일단은 약물 치료를 하고 경과를 지켜보겠습니다.,Korean
+소변을 보고 난 후 피가 묻어있나요?,Korean
+혹시 설사 자주 하셨나요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+약 외에는 따로 드시는 건 없으신가요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+몸에 안 받는 음식이 있나요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+발열이 있던 적 있나요?,Korean
+최근에 오한을 느낀 적이 있나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+왜 복통이 생기셨는지 알아봐야 할 것 같습니다.,Korean
+과거 아픈 경험이 있으신가요?,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+탄산음료나 카페인 음료는 피해 주세요.,Korean
+피가 섞인 소변을 보신 적이 있나요?,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+지금 가능한 치료가 이것밖에 없어서요.,Korean
+"수술 봉합 부위가 붓더니 염증처럼 아파요.
+",Korean
+혹시 최근에 결핵이나 갑상선 질환을 진단받으신 적이 있나요?,Korean
+가족 중 유전성 질환자 계세요?,Korean
+피가 섞인 소변을 보고 있으세요?,Korean
+가슴에 통증이 있으면 말씀해 주세요.,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+계속 드시던 약이 있나요?,Korean
+네. 찜질하는 거 했어요.,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+"애가 먹으면 바로 다 토해요.
+",Korean
+이비인후과에 진료를 받아보시는 것은 어떨까요?,Korean
+네. 수술 후 통증도 나아지고 있어요.,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+투 바이 투 사이즈의 거즈를 말합니다.,Korean
+검사를 빨리할수록 만약에 병을 찾을 경우 다양한 치료 방법을 적용할 수 있습니다.,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+음주 빈도는 얼마나 되시나요?,Korean
+수술 방법에 대해 이상반응은 없으셨나요?,Korean
+네 전신 마취는 완전히 잠들어 있는 상태입니다.,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+평소 식습관이 건강하지 못하거나 먹는 것에 비해 운동이 불충분 한 경우 대개 높게 나옵니다.,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+부분 마취 약물에 대한 알레르기로 오심과 구토 및 피부 간지러움증이 있을 수 있습니다.,Korean
+"애가 오줌 눌 때 피가 좀 나오는 것 같아서 찾아왔어요.
+",Korean
+속이 메슥거릴 때가 많나요?,Korean
+골육종이 폐로 전이가 잘 되는 병이긴 합니다만 정밀 검사를 해봐야 압니다.,Korean
+병상 부족으로 가까운 다른 병원에 입원해야 할 수도 있습니다. 불편 끼쳐드려 죄송합니다.,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+배가 너무 팽팽해져서 불편한가요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+담배는 몇 살부터 몇 살까지 피우게 되셨나요?,Korean
+귀에서 소리도 같이 나나요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+소화불량 때문에 평소 생활이 힘드셨나요?,Korean
+목에 통증이 계속 있나요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+흡연 기간이 어떻게 되세요?,Korean
+간염 보균자로 진단받은건 언제인가요?,Korean
+다른 질병과 구별이 필요하므로 소아과를 방문해주세요.,Korean
+소량씩 자주 드시는 게 건강에 도움이 됩니다.,Korean
+비슷한 증상을 형이 가지고 있어요.,Korean
+통증이 언제부터 시작했는지 말씀해주세요.,Korean
+간염으로 드시는 약 있으세요?,Korean
+네. 집에 부루펜이 있어요.,Korean
+움직임에 제한은 있지만 심각한 상황은 아닌 듯합니다.,Korean
+거의 매일 설사를 하시나요?,Korean
+유전성 질환 가족력 있나요?,Korean
+보호대 착용은 손목의 움직임을 줄이고 손목터널 내 압력을 줄여주어 신경 압박에 의한 증상을 줄일 수 있습니다.,Korean
+혈압 안 높아지게 잘 유지하고 있나요?,Korean
+지금도 통증이 계속 있나요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+지금까지 열은 안 났나요?,Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+다른 종류의 진통제를 놔드릴게요.,Korean
+당뇨 치료받으신지는 얼마나 돼셨나요?,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+식사를 골고루 하시는 게 건강 관리에 제일입니다.,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+간염으로 처음 진료 받은 날이 언제인가요?,Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+네 흡연 음주 기간에 대해 다 말씀해 주세요.,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+체온이 높은 경우가 많아서 걱정이에요.,Korean
+현재 고혈압 치료 받은 지는 얼마나 되었나요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+네 통증이 있는 곳이 또 있나요?,Korean
+하루에 한 갑 이상 피우나요?,Korean
+최근 독감 백신 맞았나요?,Korean
+녹색 변의 경우 음식물 때문인 경우가 많지만 경우에 따라서는 감염성 질환이 원인이기도 합니다.,Korean
+이전에 조영제 알레르기가 없으셨던 분은 크게 문제 되지는 않아요.,Korean
+간염 때문에 드시는 약을 전부 알려주세요.,Korean
+두 달 전에 아래에 있는 사랑니를 두 개 발치하였습니다.,Korean
+아니요 최근에 수술이나 치료하신 적 있으신가요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+"식도가 말썽이라고 들었는데 정확히는 기억 안 나요.
+",Korean
+"아 저 오른쪽 어깨가 움직일 때마다 통증이 있어서요.
+",Korean
+약물로 당뇨 치료받고 계세요?,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+생활습관 조절 만으로 정상으로 돌아오기도 합니다.,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+수액이 지금보다 늦게 떨어지면 말씀해 주세요.,Korean
+암을 진단받은 가족이 있습니까?,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+식습관은 건강행태를 알 수 있는 여러가지 척도 중 하나지요.,Korean
+"탄수화물을 최소로 해 주시겠어요?
+",Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+"뼈가 약해서 칼슘 관련 음식 매일 섭취해요.
+",Korean
+계단을 잘못 내려와서 무릎인대 수술받았었어요.,Korean
+"보통 소변이 마려우면 한참을 참을 수도 있었는데 너무 급박하게 갑자기 당장 나올 것처럼 마려워서 의아하긴 했어요.
+",Korean
+암 진단받아본 적 있으세요?,Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+지금은 무슨 약 드세요?,Korean
+의사 상담 후 처방받은 대로 진통제를 복용하시는 게 좋아요.,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+가만히 있을 때도 흉통이 있나요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+알레르기가 생기는 이유를 뜻하는 겁니다.,Korean
+손목 터널을 넓혀주는 것이지만 완전 치료는 불가능한 방법입니다.,Korean
+검사에 걱정되는 점이 있으신가요?,Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+호흡측정 방법은 제가 기계를 드릴 텐데 계속 불어달라고 하면 숨을 다 내쉴 때까지 힘껏 불어주시면 됩니다.,Korean
+네. 혹시 특이 혈액형에 포함되시나요?,Korean
+네. 약 처방할 때 도움이 될 것 같아요.,Korean
+네 상황에 따라 마취약을 바꾸거나 양을 조절할 수 있습니다.,Korean
+만약 궤양이 의심된다면 조직검사도 같이 할 거예요.,Korean
+아니요. 조영제는 주사로 투여합니다.,Korean
+"발바닥에 박힌 가시가 안 빼져서요.
+",Korean
+묽은 변을 보시지는 않나요?,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+"금연 중이라 아침 점심 저녁 딱 세 번만 피우려고 노력 중이에요. 이제 육 년 됐어요.
+",Korean
+무슨 간염 약 드세요?,Korean
+소독은 그냥 제가 집에서 해도 되는 거죠?,Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+맥박이 빨리 뛰거나 심장이 빨리 뛴다는 느낌이 드세요?,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+"네. 고혈압 때문에 싱겁게 먹어야 되는데 그러면 맛이 없어서 조금 짜게 먹습니다.
+",Korean
+"좀만 움직여도 심장이 두근거리고 이상해요.
+",Korean
+하루에 몇 개비나 태우세요?,Korean
+부정맥 종류에 따라 치료가 다릅니다.,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+결핵 백신 주사를 맞았나요?,Korean
+네 그러면 검사받기는 어렵고 예약하고 가시면 될 것 같아요.,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+결핵 백신 주사는 안 맞으셨나요?,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+구토를 하면 얼마나 하나요?,Korean
+일단은 진정 후 안정이 될 때까지는 입원하셔야 합니다.,Korean
+내시경 검사한지 한 달 밖에 안되셨지만 그동안의 추이를 관찰하고 치료를 해야 하기 때문에 불편하시겠지만 내시경을 한 번 더 합시다.,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+통증은 얼마나 자주 생기세요?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+배에 더부룩한 느낌이 있나요?,Korean
+"위장을 쥐어짜는 듯한 느낌을 자주 받아요.
+",Korean
+통증은 있지만 마취 크림 바르면 덜 하실 겁니다.,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+증상이 지금까지 얼마 동안 있던 거예요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+빈 속에서도 나타날 수 있는 증상이지만 흔히 식후에 나타나는 경우가 많습니다.,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+통증은 움직일 때마다 오나요?,Korean
+심장이 벌렁거린 적 있으세요?,Korean
+약을 먹였는데 자꾸 토하네요.,Korean
+골절로 입원이나 수술 경험이 다 있으신 건가요?,Korean
+부모님께서 어�� 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+염증의 위험이 커지니 각별히 주의해 주세요.,Korean
+네 치료와 함께 금주 금연도 해 주셔야 합니다.,Korean
+지금 드시고 있는 약은 무슨 약입니까?,Korean
+피부 일부분을 자극하여 공격하는 성분이 포함되어 있습니다.,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜보세요.,Korean
+"술이랑 담배는 보기만 해도 치가 떨려요.
+",Korean
+심계항진 증상을 설명해 주실래요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+얼마나 자주 구토를 하시나요?,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+국소 마취만 해도 된 데서 그렇게 했어요.,Korean
+구역질이 나면서 피가 올라올 때가 있나요?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+예전에 쓰러지신 적 있나요?,Korean
+"전반적으로 어지러운 것 같고 메스꺼워요.
+",Korean
+담배는 몇 살부터 하셨나요?,Korean
+"아픈 후 안 졸린 것 보면 불면증도 따라온 것 같아요.
+",Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+독감 백신을 맞은 적이 있으신가요?,Korean
+간염 처방 약 알 수 있나요?,Korean
+팔도 골절이 의심되어서 현재 부목을 대 드릴 거예요.,Korean
+성모병원 내에 있는 비뇨기과에 다녀왔어요.,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+네. 진통제 안 먹으면 버틸 수가 없거든요.,Korean
+병원내에서는 환자확인이 가능한 팔찌를 항상 차고 계셔야 합니다.,Korean
+계속 토할 것 같은 느낌이 있으신건가요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+"속이 좀 쓰리고 아파요.
+",Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+상처 난 부분을 씻어낼 수 있는 식염수입니다.,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+"군대에 있을 때부터 피웠어요.
+",Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+비정상이라는 표현이 부정확하지만 이런 증상 자체는 굉장히 흔히 있는 증상입니다.,Korean
+하루 담배 얼마나 피우세요?,Korean
+어머니가 옆에서 간호해주실 거예요.,Korean
+대변에 피가 보인적 있나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+백신 주사 맞은 거 있나요?,Korean
+처방받은 간염약 어떤 건지 아시나요?,Korean
+간염으로 무슨 약 드세요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+아니요. 지금 환자분의 상태를 감안할 경우 감기였다고 보기는 어렵습니다.,Korean
+면역요법은 수개월에서 일 년 이상까지 시간이 소요됩니다.,Korean
+가족 중에 유전성 질환을 가진 가족이 있으세요?,Korean
+열두 시간 이상 금식을 하셔야 검사로 인한 합병증 위험성을 최소화하고 검사 결과를 정확히 확인할 수 있습니다.,Korean
+이천십이 년에서 이천십사 년까지 복용했다가 작년부터 다시 복용하기 시작했어요. 약은 다시 처방받아야 해요.,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+"어제 갑자기 토를 해서 오늘 온 거예요.
+",Korean
+"뇌졸중 전조증상이 보인다고 입원하라고 하셔서요.
+",Korean
+드셔도 되지만 익히지 않은 해산물은 몸에 해로울 수 있습니다.,Korean
+혈압 측정이 끝나면 좋아졌는지 말씀드릴게요.,Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+약도 보고 영상의학과 찾아가시겠어요?,Korean
+진단서 무인 발급도 가능한가요?,Korean
+헬리코박터균 감염과 연관성이 높은 것으로 알려져 있기 때문에 추가 검사가 필요할 수 있고 위암 발생 가능성도 높아질 수 있어 지속적인 진료가 필요합니다.,Korean
+"어깨에 외상도 좀 있는데 대충 집에서 치료했고 돌리는 게 아무래도 불편해요.
+",Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+"여기 안쪽에 어금니 있어요.
+",Korean
+결핵 백신 주사는 안 맞으셨나요?,Korean
+온몸에 열이 계속 나는지 알려주세요.,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+네. 웬만해선 자연 분만으로 낳고 싶었거든요.,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴��나요?,Korean
+암으로 병원 다닌 적 있으세요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+네 삼 년 이내에 검사를 받으시는 것이 적절합니다.,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+신장 기능에 문제가 생길 수 있어 주의가 필요합니다.,Korean
+네 검사 예약 잡아 드릴게요.,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+매일 드시는 약이 있어요?,Korean
+어떤 증상이 견디기 힘들던가요?,Korean
+최근 대변 색깔은 어떠했나요?,Korean
+증상 때문에 불편하셨던 기간이 어떻게 되죠?,Korean
+신체 부위를 마사지 해주시는 게 좋을 것 같네요.,Korean
+"오른쪽 눈이 저번부터 너무 아파요.
+",Korean
+지금 복용 중인 간염약 있나요?,Korean
+알레르기는 언제부터 그런 건지 기억하세요?,Korean
+암과 관련된 가족력은 없다고 하셨죠?,Korean
+빨리 회복하기 위해서는 소독을 주기적으로 해 줘야 균에 감염이 되지 않아요.,Korean
+보통 현기증을 자주 느끼나요?,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+가래에서 냄새가 많이 나나요?,Korean
+어느 부분이 붓기가 있나요?,Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+몸에서 기력이 달리는 느낌이 나요?,Korean
+변비 증상이 처음이신 건가요?,Korean
+네 메슥거림도 약 때문에 그럴 수 있습니다.,Korean
+이참에 금연 한 번 해보죠.,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+마취가 잘 안 들었다든지 그런 거요.,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+현기증이 생긴 적 있나요?,Korean
+"코가 계속 막히고 목이 아파서 말을 잘 못하겠어요.
+",Korean
+흡연 한지 오래 되셨나요?,Korean
+독감 예방 주사는 꾸준히 맞으셨나요?,Korean
+"친구와 장난치다 휴대폰에 맞아 치아가 부러졌습니다.
+",Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+"검진 결과상 간 수치가 높게 나왔는데 지금 빨리 다른 대형병원 가래서 왔어요.
+",Korean
+최근에 독감 예방 주사 접종하셨어요?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+혈압이 얼마나 측정되었는지 알 수 있을까요?,Korean
+약물 복용 중인 거 있으신가요?,Korean
+엑스레이 하기 전에는 흡연은 삼가해주세요.,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+오한이 있는 것 같나요?,Korean
+"진우 진찰 끝나고 나오면 물어보고 말씀드릴게요.
+",Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+단순 신우염은 극히 드물고 대부분 신우신염이며 임상적으로 감별하기 어렵습니다.,Korean
+우유를 소화 못 시켜요.,Korean
+주사 맞는 건 언제가 괜찮으세요?,Korean
+애완견이 광견병 접종을 제때 못한 상태에서 사람을 물면 사람에게 감염시킬 수도 있어요.,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+네 원래 많이 아파요.,Korean
+결핵 주사 맞아본 경험 있으세요?,Korean
+암 진단을 받아보신 적 있나요?,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+"아침에 재 봤는데 열은 없어요.
+",Korean
+결핵 앓은 적 있으신가요?,Korean
+대략 하루에 몇 갑 정도 피우시나요?,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+증상 발현한 날 직전에 먹은 음식이 무엇인가요?,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+두 시간 전에 맥시부펜 먹였어요.,Korean
+통증이 오는 곳이 이쪽 부분인 거죠?,Korean
+"해산물 먹으면 토해서 아예?못 먹어요.
+",Korean
+수술했거나 치료 중인 병이 있나요?,Korean
+욕창을 방지하는 것은 피부 합병증을 생기지 않게 하는 것이지 다른 병까지 낫게 하는 것은 아닙니다.,Korean
+일단 검사를 통해서 상태를 보고 말씀드릴게요.,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+되도록 빨리 다시 진찰해 주세요.,Korean
+과격한 운동을 했을 때 심장이 빨리 뛴다고 느껴지세요?,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+약 꼬박꼬박 챙겨 먹어도 평소에도 조금 힘든 것 같아요.,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+신경이 제대로 분포하지 않아 제대로 변을 배출할 수 없고 신경이 제대로 분포된 장에 대변이 고여 장이 늘어나 거대 결장이라고 부릅니다.,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+부작용 포함하여 특이사항이 있으셨나요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+소변보고 나서도 또 마려운 느낌이 드나요?,Korean
+부작용이 있을 경우 말씀해 주시면 저희가 조치를 취할 거예요.,Korean
+네. 상부위장관 내시경으로 출혈 여부와 정도를 확인하고 지혈을 시도할 수 있습니다.,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+어떤 발톱 수술 말씀하시는 건가요?,Korean
+깨셔서 불편하시거나 너무 많이 움직이실 경우 투약을 추가로 할 수 있으나 너무 힘드시지 않을 경우 그대로 진행하려 하는데 괜찮으시겠어요?,Korean
+약국서 감기약 사 먹었었는데요.,Korean
+"예민해서 잠을 깊게 들 수가 없어요.
+",Korean
+"자꾸 목에서 피 맛이 느껴져요.
+",Korean
+피가 섞인 소변이 나오나요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+배도 같이 아프신 거죠?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+다른 병원과 클리닉에서 어떤 걸 하셨나요?,Korean
+면담 위해 진료실 다녀오신 거 아닌가요?,Korean
+골고루 드셔야 건강에 도움이 됩니다.,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+하루에 몇 개 피우시죠?,Korean
+거주하시는 곳 근처에 다른 병원을 알아봐드리려고 그랬습니다.,Korean
+피를 토한 적이 있으시다고요?,Korean
+제일 염려되는 증상이 뭐죠?,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+"팔 수술한 곳에 진물이 나요.
+",Korean
+결핵약은 어떤 거 드세요?,Korean
+"중간에 자주 깨는 편이에요. 하룻밤 사이에 세네 번 정도는요.
+",Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+예전에 아팠던 곳 있어요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+철심 박는 수술 했는데 몇 번 뼈인지는 몰라요.,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+동맥 출혈의 가능성이 있어서요.,Korean
+올해 독감 예방 주사 맞으실 예정이신가요?,Korean
+삼 개월 이전 내용 포함하여 살면서 입원하신 경험이 있으시면 모두 말씀해 주세요.,Korean
+네 야간 근무가 필수인 직장이시면 주기적으로 건강 검진을 받으세요.,Korean
+"좀 쌕쌕거려요. 원래 천식이 있지도 않아요.
+",Korean
+허리에 바로 진통제를 소량 놔드릴게요.,Korean
+비슷한 증상을 형이 가지고 있어요.,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+변에 의한 것일 가능성은 적습니다. 추가 검사를 해야 할 것 같습니다.,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+숨을 헐떡일 때가 있나요?,Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+"시도 때도 없이 토를 해요.
+",Korean
+하루에 설사를 몇 번 했나요?,Korean
+혹시 항문 질환이나 장 질환일 수 있으니 증상이 맞다면 추가 검사가 필요할 수 있습니다.,Korean
+어떤 느낌의 통증이신가요? 바늘로 찌르는 느낌이나 쑤시는 느낌 등 통증 양상을 말씀해 주세요.,Korean
+환자분은 오늘 흉통이 있으셔서 내원하셨고 이 부분을 보시면 흉통 환자 주의사항이 있습니다.,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+원래 좀 변비가 자주 있으신가요?,Korean
+통증이 가까운 부위에서 나타나네요 경과를 지켜보는 것이 좋겠습니다.,Korean
+과식을 하지 않아도 소화가 되질 않나요?,Korean
+네 가족력이 있을 수 있습니다.,Korean
+점차 통증은 호전될 것입니다.,Korean
+소변에 피가 함께 나오나요?,Korean
+환자분께서 불편한 점이 없더라도 이상이 있을 수 있으니 추가 검사가 필요할 것 같습니다.,Korean
+간염약이 치료에 도움이 됐나요?,Korean
+예전에도 비슷한 병을 앓으셨나요?,Korean
+특별한 ���물 알러지가 있나요?,Korean
+아이가 수유 몇 시간 후에도 배가 볼록한가요?,Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+타인의 피로 혈액 보충해보신 적이 있나요?,Korean
+요 근래 체중 변화가 있으세요?,Korean
+어떨 때 구토를 하나요?,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+씨티 촬영전에 혈관으로 주입하는 약물입니다.,Korean
+네. 진료기록 보시면 나와요.,Korean
+다른 병원에서 진단받은 게 있나 해서요.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+네 이젠 곧 통증이 없을 거예요.,Korean
+헬리코터박터균 감염이 있는지 검사를 해야 알 수 있습니다,Korean
+이 주사를 맞으시면 좋아지십니다.,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+열이 나거나 주사 부위에 통증이 있거나 머리가 아프거나 그런 거요.,Korean
+이전 검사에서 대장은 특이사항이 없었습니다. 원하는 병변을 관찰하기에는 직장 내시경으로도 충분할 것 같고 환자분께도 수월할 것으로 판단되어 처방하였습니다.,Korean
+주무시면 안 됩니다 혹시 다른 증상들도 나타나고 있나요?,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+"몸이 많이 허해진 것 같아요.
+",Korean
+부종이 있는 곳이 있나요?,Korean
+무릎 쪽에 통증이 있나요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+그렇지는 않아요. 용종 중에서도 증식성 용종은 많은 사람들이 서구화된 식습관 때문에 갖고 있습니다.,Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+통증이 있는 부위가 있으세요?,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+엑스레이 확인 후 제거하도록 하겠습니다.,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+변에서 피를 보신 적이 있나요?,Korean
+숨이 찬 증상이 나타납니까?,Korean
+여드름이 아닐 수 있으니 검사를 해보도록 하겠습니다.,Korean
+"그냥 서 있을 땐 괜찮은데 걷기만 하면 오른쪽 무릎이 찌릿찌릿해요.
+",Korean
+한달에 술을 얼마나 드시나요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+심장이 안 좋아서 입원했었는데 아마 삼 개월 안 된 것 같은데요?,Korean
+체중 변화도 관련이 있습니다.,Korean
+피부과는 따로 예약하시고 진료받으셔야 합니다.,Korean
+시험관 아기 준비 중이라 아직은 없어요.,Korean
+자연 분만과 제왕 절개 여부에 따라 진단이나 치료 방법이 달라질 수 있어서요.,Korean
+오한 증상이 있다고 생각하나요?,Korean
+어디가 불편하셔서 진료를 받으셨나요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+오늘 코로나 검사 결과 나올 때까지 마스크는 벗지 않으실께요.,Korean
+몸살 기운이 있는 것 같나요?,Korean
+저릿저릿한가요? 아니면 날카롭게 쑤시나요? 아니면 묵직하고 둔한 느낌인가요?,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+뇌진탕이 있었을 수도 있으니 검사를 한 번 해봅시다.,Korean
+소변이 쉽게 안 나오나요?,Korean
+네 우선 하시게 될 검사는 세침 흡인 생검이에요.,Korean
+"온몸에 대상포진이 나서요. 너무 아파서 왔습니다.
+",Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+"누렇고 찐득찐득한 가래가 많이 나와요.
+",Korean
+우선 저희 병원 기록이 없으니 검사를 받아 보고 진단이 내려지면 그때 말씀드리겠습니다.,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+아니요. 빠르게 폐 기능을 회복하는 것이 우선적으로 필요합니다.,Korean
+혈액 내 지방 성분이 증가했습니다.,Korean
+격리 병실인 만큼 방역은 더 신경 써서 하고 있습니다.,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+가끔 복통 같은 증상이 동반되기도 하나 대부분 말씀하신 것과 같이 별다른 느낌 없이 구토가 나올 때가 많습니다.,Korean
+등이 가렵거나 따가우신 건가요?,Korean
+네. 부모님 두 분 다 당뇨가 있으세요.,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+침 삼킬 때 아픈가요?,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+콧줄이 불편하시면 간호사를 불러주세요.,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+지금 제일 아픈 곳이 어디인가요?,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+운동하고 나면 부기가 빠져 있���요?,Korean
+마취제 부작용은 심장마비 섬망 증상 마비 시각장애 구토 등이 있습니다.,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+변비가 어느 정도로 심하신 거죠?,Korean
+어디가 아픈지 정확히 알려주셔야 빠른 치료가 가능합니다.,Korean
+무기력함이 있는지 알려 주세요.,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+어린아이들도 위염 걸릴 수 있습니다.,Korean
+중요한 건 치료이니 잘 따라만 주시면 괜찮을 겁니다.,Korean
+원래 자세로 돌아왔을 때 통증이 몇 분 째 계속 남아있다면 정밀 검사를 받아보는 것이 좋습니다.,Korean
+네. 진료 시 자세히 들으실 수 있을 거예요.,Korean
+종양이 발견된 지 오래됐어요?,Korean
+며칠 주기로 통증이 왔다가 사라지나요?,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+소변하고 혈뇨랑 함께 나오나요?,Korean
+"다리가 저리고 왼쪽 다리에 힘이 안 들어가서 절뚝거립니다.
+",Korean
+본원에서 수술하셨으면 기록 조회해보겠습니다.,Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+아. 드디어 퇴원하네요. 필요한 서류는 없어요!,Korean
+다른 병원에서 받은 수술은 어떤 게 있나요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+담배는 몇 년 피웠어요?,Korean
+"수면 유도제를 먹고 잤어요.
+",Korean
+"뺨이 많이 아프고 볼이 많이 부었어요.
+",Korean
+"몇 주째 설사가 계속되고 있습니다.
+",Korean
+통증이 하루에 자주 일어났어요?,Korean
+어떤 것에 알레르기가 일어나나요?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+네. 종양성 병변인 선종이 확인되어 이후 대장 내시경 추적 검사가 필요합니다.,Korean
+혹시 처방받은 약이 있나요?,Korean
+아무거나 드시면 안 됩니다 약이 겹칠 수도 있고 드시면 안 되는 약을 드실 수도 있으니까요.,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+같은 영양분 용량을 포함하고 있다고 하더라도 흡수율에서 차이가 납니다.,Korean
+"어. 무슨 소변보는 쪽에 염증이 났다고 그러셨던 것 같은데.
+",Korean
+지난번 치료 이후에 신체적으로 다른 특이사항은 없었나요?,Korean
+특별히 어디가 가장 아프셨나요?,Korean
+알레르기는 언제부터 그런 건지 기억하세요?,Korean
+구토를 지금도 하시고 오셨나요?,Korean
+"심장에 이상이 있다고 알고 있습니다.
+",Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+잠을 푹 주무실 수 없나요?,Korean
+"열은 안 재어봤는데 계속 낑낑거리고 말도 못 하는 거 보니 열이 나는 것 같아요.
+",Korean
+간염약이 치료에 도움이 됐나요?,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+먹으면 부작용이 있거나 불편한 약 있으세요?,Korean
+결핵 백신 접종을 하셨나요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+지금 바로 퇴원 도와드릴까요?,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+아파도 약 잘 안 먹습니다.,Korean
+"대변볼 때 배에 통증이 있어요.
+",Korean
+어느 부위에 통증이 있어요?,Korean
+일주일에 몇 회 정도 음주하세요?,Korean
+아니요 주사 말고 알약 물약처럼 약을 말하는 거예요.,Korean
+바셀린 거즈는 보습 효과가 있습니다.,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+목에 아픈 증세가 있나요?,Korean
+"인후통이랑 미열이 있는데 코로나인지 감기인지 모르겠는데 감기 같아서 일단 병원으로 왔어요.
+",Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+네. 증상이 나타나면 전화만 하면 되죠?,Korean
+확실하게 알기 위해서는 대장조영술이나 항문직장내압검사를 해봐야 합니다.,Korean
+"머리 쪽이 욱신욱신 쑤시면 거의 바로 구토감이 올라와요. 그땐 정말 참을 수 없죠.
+",Korean
+혈압이 정상인 것으로 볼 때 혹시나 혈변이 있었다고 해도 다량 실혈은 없었던 것으로 보입니다.,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+네 옆 병실에도 환자들이 있습니다.,Korean
+네. 엄마부터 고혈압이 있어요.,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+피가 섞인 대변을 보세요?,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+수술 잘 다녀오시면 의사 확인 후 금식 해제 안내해 드릴게요.,Korean
+특별히 원하시는 병원이 있으신가요?,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+아침에 먹어야 하는데 잘 까먹어서 생각날 때 먹어요. 약은 비상으로 챙겨 둔 게 있어요.,Korean
+유전성 질환에 가족력이 없다고 말씀하셨죠?,Korean
+설사를 종종 하셨구요 배가 빵빵하다거나 하지는 않았어요.,Korean
+안 그래도 피 모자라다고 의사 선생님이 그러셨는데.,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+치료받을 때 잠깐은 좋았는데 또 안 받으니까 안 좋아졌어요.,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+의학적인 도움만 받으신 거죠?,Korean
+진통제랑 열 내리는 거 그거 해열제도 먹었어요.,Korean
+피를 토했을 때 양은 어느 정도였나요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+여드름이 아닐 수 있으니 검사를 해보도록 하겠습니다.,Korean
+대변을 며칠에 한 번 보나요?,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+더 불편하신 곳이 있나요?,Korean
+"무릎에 문제가 생긴 것 같아요.
+",Korean
+소변이 계속 조금씩 나오나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+처음으로 결핵 진단받으셨던 적이 언제인가요?,Korean
+주에 몇 번 아픈가요?,Korean
+반복적인 감염은 요로계 기형 요로결석 요로계 종양 등을 동반하는 경우가 있으므로 추가적인 검사를 권장드립니다.,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+궤양이 아니어야 할 텐데요. 알겠습니다.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+어디가 제일 많이 부었나요?,Korean
+"몸에 안 좋을걸 알면서 계속해요.
+",Korean
+호흡하기 힘들 때가 많나요?,Korean
+약도 먹고 식단 관리도 하고 있어서 그런지 유지가 나름 잘되고 있습니다.,Korean
+젤리를 넣지는 않고 흐물해진 유리체를 제거하고 빈 공간에 가스나 액체를 넣어줍니다. 환자분은 가스를 넣는 수술을 한다고 해요.,Korean
+항히스타민제 처방받고 드시는 건가요?,Korean
+"일주일 전에 여기서 수술하고 퇴원했는데 수술 부위가 점점 부어오르는 것 같아서요.
+",Korean
+주치의 상담이 필요해 보이니 연결해 드리겠습니다.,Korean
+대변에 피가 보인적 있나요?,Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+이 증상이 이 병 증상이에요?,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+몇 년이나 담배 피웠나요?,Korean
+진통제 먹으면 어디서 쥐어터지고 들어온 것처럼 얼굴이 부어요.,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+으흠 제가 발기부전이 있어서 관련 병원을 갔었습니다.,Korean
+변비일 경우 그런 증상이 잘 나타날 수 있습니다.,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+담배 피운 기간이 오래됐나요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+네 가벼운 열상치료는 수술이 아닙니다.,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+"저녁에 운동을 좀 힘들게 하면 잠이 잘 오더라고요.
+",Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+통증 시작된 날짜 기억나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+알레르기 반응이 올라오는 다른 원인이 있나요?,Korean
+"아이가 고열인데 해열제를 먹여도 열이 떨어지지 않아서요.
+",Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있���요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+환자분이 직접 집에 다녀오신다는 말씀이세요?,Korean
+구역질이 나면서 피가 올라올 때가 있나요?,Korean
+"밥 먹으면 갑자기 토한 지가 한 삼사일 정도 되었어요.
+",Korean
+통증은 얼마나 자주 발생해요?,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+변에 피가 함께 나오나요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+기침 증세가 악화하고 있나요?,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+항상 두드러기 증상이 있나요?,Korean
+"입원 치료를 받으라고 권유받았어요.
+",Korean
+선생님 오시면 약에 대해 설명해 드리겠습니다.,Korean
+간염 관련하여 드시는 약이 있나요?,Korean
+음주 빈도 말씀해 주시겠어요?,Korean
+혹시 화학 약품이나 환경에 따른 알레르기 반응은 없으세요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+전자 담배와 연초 담배 구분 없이 동일하게 생각해서 말씀해 주세요.,Korean
+"붓기가 사라지지 않고 오래가요.
+",Korean
+예전 아토피 진단을 받은 적 이 있으신가요?,Korean
+매일 드시는 약이 있어요?,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+평소 혈액에 중성지방이 높으면 결과가 이렇게 나올 수 있습니다.,Korean
+몇 년 전에 뇌출혈이 와서 지금도 고혈압약 먹고 있습니다.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+"소화가 될 때까지 기다렸다가 누우려고 해요.
+",Korean
+최근 결핵 백신 접종했나요?,Korean
+알레르기 반응 검사로 진단받으셨나요?,Korean
+지금 발기 부전으로 문제가 있나요?,Korean
+"오른 손바닥이 아파서 무언가를 잡고 있기 힘들어요.
+",Korean
+욕창 관리만 잘해 주시면 피부가 더 아프진 않을 거에요.,Korean
+이전에 입원하셨던 적 있나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+"급정거하면서 몸이 쏠리면서 목이 앞뒤로 세게 흔들려서 아픕니다.
+",Korean
+꼭 일일구를 불러 응급실로 내원할 필요는 없는 거죠?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+환자분 맞습니다 건강 상태가 좋지 않아요.,Korean
+항상 발기부전이 있으신 건가요?,Korean
+"눈을 다친 것 같아요. 싸우다 다쳤어요.
+",Korean
+네 드시는 약 이름 알고 계시나요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+심각한 칼슘 부족은 사망하실 수도 있어요.,Korean
+일반적인 기능성 소화불량 때문이라면 투약이 효과적입니다.,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+병원의 지시를 잘 따르시면 흉터가 덧나지 않습니다.,Korean
+하루에 담배는 몇 갑 피우세요?,Korean
+운동 강도 정도가 영향을 줄 수 있습니다.,Korean
+통증이 계속 있나요 아니면 아팠다 괜찮았다 하나요?,Korean
+어깨 관절에 이상이 있나 봅니다.,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+"어제저녁에 아이가 놀다가 침대에서 떨어졌는데 아픈지 계속 울어서 병원에 왔어요.
+",Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+통증의 느낌이 어떠신가요? 통증이 주로 어느 시간대에 어느정도 지속되나요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+네. 입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+"대변을 볼 때 너무 힘을 많이 줘야 해서 힘들다고 해요.
+",Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+처방하는 약에 따라 다르지만 표준치료 기준 세 종류의 약을 하루 이 회 복용합니다.,Korean
+원인에 따라서 앞으로의 예후를 예측해볼 수 있습니다.,Korean
+설사를 하는 시기가 있나요?,Korean
+"평소엔 담배를 안 피우고 술 마시면 담배도 좀 피웁니다.
+",Korean
+치료 효과가 떨어질 수 있으니 바로 챙겨드시는 것이 좋습니다.,Korean
+당뇨 있어서 식단도 관리 중이에요.,Korean
+인체 수분 전해질 비율은 중요한 사항입니다. 적정량 섭취하셨다니 좋군요.,Korean
+"네. 금식하라고 하셔서 금식했습니다.
+",Korean
+"오른쪽 팔에 투석관이 있어요.
+",Korean
+네 둘 다 알레르기일 때 나타날 수 있다는 연관이 있습니다.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+입원 치료 시 의료진이 알고 있어야 하는 내용이 있을 수도 있기 때문입니다.,Korean
+체중이 한 달에 몇 킬로 쪘나요?,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+"깨진 유리를 처리하다가 베였어요.
+",Korean
+전에 수술한 경험 있으세요?,Korean
+눈이 안 좋아서 루테인 챙겨 먹어요.,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+제가 약물 알레르기가 있어요. 그것만 체크해 주세요.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+환자와 관련해서 안내드릴께 있어 여쭤보았습니다.,Korean
+영양수액 말고 병 때문에 꾸준히 맞는 주사나 복용 중인 약 있으세요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+뇌졸중 때문에 다른 대학 병원에 입원한 적이 있어요.,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+혈액검사에서 이상 소견이 발견되어 입원해서 검사를 진행하셔야 합니다.,Korean
+제가 아팠던 건 아니고 병문안 간 적은 있어요.,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+병원 차원에서 추가되는 비용으로 임의로 제외할 수는 없습니다.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+최대한 감염 방지를 위해 소독해 두었지만 언제든 감염 위험성은 높습니다.,Korean
+소독된 환경을 갖추기가 어려우시기 때문에 되도록 병원에 내원해 주세요.,Korean
+"혈당 측정 해보니 너무 높아서요.
+",Korean
+통증이 주에 몇 번 있나요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+"계속 애가 설사를 해서요.
+",Korean
+독감 주사를 최근에 맞았나요?,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+아프기 시작하면 얼마나 오래 아프신가요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+콜라겐 말고 다른 약 드시는 건 없으신가요?,Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+"종종 토가 나오려고 할 때가 있어요.
+",Korean
+제왕 절개해 본 적 없어요.,Korean
+독감이 현재 대유행이라 빠르게 맞을수록 좋습니다.,Korean
+언제 통증이 처음 나타나셨어요?,Korean
+"약은 안 먹이고 소주 약간 먹어요.
+",Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+하루 흡연량이 어떻게 되시는지요?,Korean
+두통이 있었던 적은 없나요?,Korean
+뼈나 근육 그리고 피부 등의 모든 구조를 지칭합니다.,Korean
+수술은 진짜 받은 지 오래됐어요.,Korean
+대변 잘 못 보세요?,Korean
+네. 아니에요. 특이 혈액형이에요.,Korean
+부종이 발생한 곳이 있나요?,Korean
+아닙니다. 너무 걱정하지 마시고 질병에 대한 자세한 설명은 추가 검사 시행 후 다시 한번 설명해 드리도록 하겠습니다.,Korean
+"복부 쪽이 계속 낫질 않네요.
+",Korean
+통증이 시작된 날은 언제인가요?,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+"밥을 못 먹는 게 제일 힘들죠. 물도 잘 못 마시고 기운도 없고.
+",Korean
+"식도 쪽으로 문제가 생겼다고 압니다.
+",Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+간염약을 드시고 부작용이 있으신가요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+"네. 피부 올라온 곳 주변으로도 아파요.
+",Korean
+숨 쉴 때 힘들거나 그러진 않으신지요?,Korean
+놀랐을 때처럼 심장이 빨리 뛰는 느낌이 드나요?,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+치료에 따라서 부작용이 따라올 수 있죠.,Korean
+발기를 아예 못 하시는 건가요?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+환자분 앉아 계실 때 이 베개를 흉부에 가져다 대시고 지지하시면 좀 더 심호흡하기 편하실 거예요.,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+설사를 하는 시기가 있나요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+"근 이십 년 될 것 같아요. 마흔까지 피웠으니.
+",Korean
+몸이 붓는 증상이 있나요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+증상 확인해보고 처방해 드리겠습니다.,Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+그냥 링거 맞으러 오셨군요.,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+제거하는 거라 약간의 통증은 발생할 수 있어요,Korean
+그랬었죠. 한동안 약 먹었어요.,Korean
+네 복원수술받은 것도 말씀해 주세요.,Korean
+편도선 많이 안 부었어요?,Korean
+얼마나 자주 기침이 나오나요?,Korean
+예전에는 어떤 병을 앓으셨어요?,Korean
+"눈앞이 핑핑 도는 게 가만히 서 있기도 힘들어요.
+",Korean
+"소화가 안 돼서 목에 손을 넣어서 토를 했어요.
+",Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+"소화가 잘 안되는 거 같으면서 토하면 시원해질 거 같아서 더 자주 해요.
+",Korean
+마취 풀리며 통증이 시작될 수 있는데 그땐 진통제 드릴게요.,Korean
+걱정이 많으실 것 같습니다. 우선 주사제 투여를 병행하면서 증상 양상을 확인해 보겠습니다.,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+차트 내역을 보니 반응 검사한 곳에 특별한 이상 소견은 보이지 않네요.,Korean
+통증이 걱정되시면 일단은 염증을 가라앉히는 약을 먼저 복용해보셔도 됩니다.,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+"팔팔 끓는 물에 팔을 데었어요.
+",Korean
+네. 간질이 있어서 병원에 입원한 적 많습니다.,Korean
+몸이 차가운 증상이 있나요?,Korean
+지금 혹시 변비가 있나요?,Korean
+"설사를 두 번 정도 한 것 같아요. 둘 다 혈변이었어요.
+",Korean
+현재 구토 증상이 있나요?,Korean
+"어깨가 아파서 응급실 왔는데 탈골이라고 해서요.
+",Korean
+검사 후 응급으로 시술이 필요할 수 있습니다.,Korean
+네 구급차로 오셨어요. 도와주셨던 분은 응급실에서 확인할 수 있습니다.,Korean
+일주일 기준으로 몇 번 정도 대변을 보시나요?,Korean
+"아기가 팔을 움직이거나 제가 팔을 조금만 건드려도 막 자지러지게 울어요. 팔도 많이 부었고요. 혹시 팔 부러진 건 아니겠죠?
+",Korean
+소변 색이 진한 황색일 경우 간질환을 의심해 볼 수 있습니다.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+집에 있는 해열제 먹였습니다.,Korean
+다음 진료가 있어 정확히 얼마나 걸린다고 확답 드리기 힘듭니다.,Korean
+입원 또는 수술 경험이 있나요?,Korean
+허리에 바로 진통제를 소량 놔드릴게요.,Korean
+예방 접종 후 괜찮았나요?,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+환자분은 이마 열상으로 내원하셔서 상처 먼저 세척하고 엑스레이 찍으실 예정입니다.,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+독감 접종한 게 언제죠?,Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+환자분은 저혈당 관리를 위해 고열량 식단이 강제됩니다.,Korean
+"작업하다가 그라인더에 긁혀서요. 약 있는 거로 소독하고 했는데 삼 일 전부터 진물이 나오고 아프기 시작했어요.
+",Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+동맥 출혈의 가능성이 있어서요.,Korean
+소변에 피가 많이 섞여 나온다고 생각하세요?,Korean
+"네. 그래서 병원도 겨우 왔어요.
+",Korean
+힘이 없고 늘 피로한가요?,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+몇 살 때부터 피우셨나요?,Korean
+요즘 허리 물리치료를 다녀요.,Korean
+소변볼 때마다 피가 나오나요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+통증이 일 분 넘게 지속했던 적이 있나요?,Korean
+얼마나 자주 구토를 하시나요?,Korean
+아니요. 제가 몸이 너무 안 좋은 바람에 무조건 제왕 절개밖에 답이 없었어요.,Korean
+암을 치료받은 적이 있나요?,Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+거의 물 같은 변을 보셨나요?,Korean
+움직이면 제일 아픈 부분이 어디인가요?,Korean
+과거에 크게 다친 곳이 있나��?,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+조금만 기다리시면 금방 입원 지시가 날 것입니다.,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+주관적인 배뇨증상을 객관적으로 평가하기 위해 배뇨일지를 작성하여 주십시오.,Korean
+혹시나 부작용 생기면 바로 병원으로 오세요.,Korean
+"항상 소화 불량인 것 같아요.
+",Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+꾸준히 먹는 약이 있으신가요?,Korean
+"오른쪽 부위가 전체적으로 힘주기가 어려워서요.
+",Korean
+입원 치료까지는 필요 없습니다.,Korean
+수술 이전에 보존적 치료로 물리치료와 약물치료에 힘써봅시다.,Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+배에 묵직한 통증이 있나요?,Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+통증이 자주 생기는 편인가요?,Korean
+해외는 관련 없고 예방 접종만 했네요.,Korean
+보통의 네 개 혈액형 말고 다른 거요.,Korean
+호흡할 때 어려움이 있나요?,Korean
+밀접 접촉자라는 연락이 와서 선별진료소에 다녀왔어요.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+"귀에서 윙윙 소리가 나네요.
+",Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+간염은 언제 진단 받으셨나요?,Korean
+혹시 이전에 아토피 진단을 받으신 적이 있나요?,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+종양이 발견된 지 오래됐어요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+"평일에는 기본 네 시간 정도 자는데 주말에는 열두 시간 이상씩 잤어요.
+",Korean
+구토가 장폐색에 의한 경우라면 우려가 되나 그 외의 경우일 수도 있습니다. 검사 후 다시 말씀드리겠습니다.,Korean
+"기침을 할 때 피가 섞여 나옵니다.
+",Korean
+어렸을 때부터 내성 발톱을 앓고 있습니다.,Korean
+알레르기 환자 퇴원 안내문이 있으니 읽어보시고 증상이 생기시거나 불편하신 점이 생기면 호흡기 알레르기내과 외래 혹은 응급실로 내원하셔야 합니다.,Korean
+암이라는 걸 언제 알았나요?,Korean
+다른 병원에서 진료받으려는 이유가 있을까요?,Korean
+소화 기능이 안 좋으세요?,Korean
+몸에 수분이 부족하게 되면 건강 문제가 발생할 수 있습니다.,Korean
+네. 류마티즘 질환이 있습니다.,Korean
+선생님 오시면 약에 대해 설명해 드리겠습니다.,Korean
+하루에 담배는 몇 갑 피우세요?,Korean
+언제부터 메슥거리는 느낌이 시작됐죠?,Korean
+그냥 약국에서 주는 대로 산 거라 모르겠네요.,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+변에 피가 함께 나오나요?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 일 년 간격으로 위내시경 추적 검사가 필요합니다.,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+엽산이란 말을 처음 들어 봅니다.,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+대장의 가장 마지막 부분이고 에스 형으로 구부러져 있습니다. 에스 상 결장 이후에 직장이 이어집니다.,Korean
+입원해서 항생제 치료를 시작하지 않으면 악화되실 거예요.,Korean
+식습관 포함한 생활습관 관리와 지속적인 진료를 받아야 한다는 점에서 크게 다르지 않습니다.,Korean
+지금 혹시 변비가 있나요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+지금 부종이 있는 상태인가요?,Korean
+어떤 약물을 복용하고 계시나요?,Korean
+네. 어릴 때 빈혈이었지만 커서는 정상이었습니다.,Korean
+네. 중요한 검사이니 꼭 찍어야 합니다.,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+네 맞습니다 입원 날짜요.,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+먹었던 음식을 다 토하시나요?,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+심장 박동이 불규칙하게 뛰는데 괜찮으세요?,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+"배가 꼬인 듯이 너무 아파요.
+",Korean
+일단 가장 위중한 질환인 심근경색이 아님을 확인했다고 알고 계시면 됩니다.,Korean
+"아버지가 정신을 잃으신 ��� 같아요.
+",Korean
+가족력이 있는지는 알아봐야 할 것 같아요.,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+통증이 계속해서 아픈가요 드문드문 아픈가요?,Korean
+고지혈증이 좀 있고 골다공증 있어요.,Korean
+알레르기가 있으셨으면 검사 한번 해보시겠어요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+네 아무런 느낌 없다가 갑자기 구토 형태로 나올 때가 많습니다.,Korean
+아픈 곳 좀 말해 주세요.,Korean
+가슴 보호대는 가슴 움직임을 최소화해 통증을 줄여줍니다.,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+병원내에서는 환자확인이 가능한 팔찌를 항상 차고 계셔야 합니다.,Korean
+목 아픈 건 나으셨어요?,Korean
+설사를 얼마나 자주 하시나요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+혹시 대변이 무르거나 점액질이라면 장염과 같은 염증성 질환 때문일 수 있습니다.,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+소화하는 데 문제는 없나요?,Korean
+워낙 약한 아이라 잘 좀 봐주실래요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+체중 변화가 많진 않으셨어요?,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+가래 상태가 많이 심한가요?,Korean
+비타민 아미노산 호르몬 등이 수면 질에 영향을 주죠.,Korean
+많지 않으나 부작용을 호소하시는 분들도 계시니 증상이 있는 경우 바로 말씀 주세요.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+경정맥신우조영술이란 조영제를 정맥에 주사하여 신장으로 배설되는 것을 확인하는 검사입니다.,Korean
+의사 회진 시 상담 가능할 것 같습니다.,Korean
+아니요. 입원도 처음 아니고 삼 개월 이내에 입원하지도 않았어요.,Korean
+고통의 정도가 어느 정도일까요?,Korean
+발기 부전을 느끼고 계신가요?,Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+네 수액은 유지하실 거에요.,Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+"네. 그런 증세들은 없었어요.
+",Korean
+평소에도 열이 자주 났었나요?,Korean
+진단이 필요할 것 같아요.,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+"네. 전반적으로 왼쪽 팔다리에 힘이 빠지는 느낌이 있어요.
+",Korean
+"드레싱 때문에 다시 받으려고요.
+",Korean
+"치질 관련 질병은 없습니다.
+",Korean
+아버지가 고혈압이 있으실 경우 환자분도 고혈압일 확률이 높습니다.,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+결핵 주사를 최근에 맞았나요?,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+일상생활 중에 알레르기 반응을 보이는 것이 있었나요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+아픈 곳이 더 있나요?,Korean
+통증이 많이 심한가 봐요?,Korean
+원래 좀 변비가 자주 있으신가요?,Korean
+네. 상처를 보호해 주는 역할을 하는 거즈입니다.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+현재 목발을 다른 환자분께서 사용하고 계십니다.,Korean
+"잠들기 어려워서 수면제 한 알 먹고 잤어요.
+",Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+잘 때 어려움이 있으신가요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+과민성 방광과 유사한 증상을 일으킬 수 있는 요로감염 요로결석 간질성 방광염 방광암 등 다른 요로계 이상이 없는 경우 과민성 방광 진단을 내릴 수 있습니다.,Korean
+"추적 검사 받으러 왔어요.
+",Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+저 마취가 너무 잘 들어서 잠을 잘 못 깨 가지고 저보고 수면 마취 같은 거 안 하는 게 좋을 것 같다고 했었어요.,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+콩팥기능이 안 좋은 분은 조영제 사용이 주의가 필요한데 환자분은 괜찮으신 것 같아요.,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+"다리가 칼로 찌르는 듯이 심하게 쑤셔요.
+",Korean
+우유를 소화 못 시켜요.,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+꼬리뼈 부위에 욕���이 생겼습니다.,Korean
+숨 쉬는 건 어때요?,Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+"발톱이 자라면서 자꾸 파고들더라고요. 아무리 일자로 잘라도 마찬가지라서요.
+",Korean
+혈압 측정은 일회만 하시면 됩니다.,Korean
+수면 비용은 내시경 검사와 달리 건강보험이 적용되지 않기 때문입니다.,Korean
+환부보다 넓게 그리고 두껍게 발라줘야 해서 연고가 많이 필요합니다.,Korean
+체중이 변했다면 얼마나 변하셨나요?,Korean
+가족 중에 고혈압인 분이 있으면 알려주세요.,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+여러 가지 원인에 따라서 마비증상이 발생할 수 있고 원인에 따라서는 지금보다 증세가 악화될 가능성이 있습니다.,Korean
+가습기를 사용하시면 좀 덜 간지러울 겁니다.,Korean
+잠드는 게 어렵지는 않으신가요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+그 나이대와 성별에서는 키와 몸무게가 표준 범위 안에 드시네요.,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+지금 병실 이동 예정이니 밖에서 대기 부탁드립니다.,Korean
+일도 화상의 경우 특별한 처치 없이도 일주일 내에 낫는 경우가 많습니다.,Korean
+민감성 피부의 여부에 따라 다릅니다.,Korean
+"몸이 이상해서 혈당을 쟀는데 높게 나왔어요.
+",Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+현재 몸에 종양이 있어요?,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+"가습기 꼭 사야 해요?
+",Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+세 종류의 약을 하루 이 회씩 복용하게 되는데 처방하는 의사에 따라 조금씩 다를 수 있습니다.,Korean
+문제 없습니다. 입원 당시를 기록할 필요가 있어 질문하였습니다.,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+당뇨로 어떤 약을 드시고 계세요?,Korean
+어떤 음식이나 약을 드셨나요?,Korean
+감사합니다. 환자분 혈관이 곧아서 한 번에 놓을 수 있었어요. 여기 팔에 잘 고정시켜 둘게요. 이제 항생제 반응 검사만 하고 가겠습니다.,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안됩니다.,Korean
+심장 터질 것 같은 느낌은 얼마나 자주 있나요?,Korean
+혈압이 낮으면 순환이 잘 되지 않아 신장에도 문제가 생길 수 있습니다.,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+우선 회전근개파열을 의심하고 있기 때문에 몇 가지 검사가 필요합니다.,Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+그렇습니다 수혈받으시는 부분만 조심해주세요.,Korean
+아무래도 집에서 하는 소독은 감염 위험성이 큽니다.,Korean
+"아픈 후 안 졸린 것 보면 불면증도 따라온 것 같아요.
+",Korean
+흔하지 않기만 대장암과 같은 질환 가능성도 있습니다.,Korean
+수술 후 최소 일주일 후까지요.,Korean
+소독은 동네 병원에서 하셔도 돼요.,Korean
+지금 제일 아픈 곳이 어디인가요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+넘어졌는데 기절해서 하루 입원한 적이 있어요.,Korean
+통증이 시작되면 계속 아파요?,Korean
+계속 기침 증상이 있나요?,Korean
+정확한 수술부위는 전공의 선생님이 수술동의서 작성할 때 설명해주실 겁니다.,Korean
+알레르기 일으키는 원인 있나요?,Korean
+성생활에 어려운 점이 있으세요?,Korean
+알레르기가 나는 음식이 있으시다면 알려주시겠어요?,Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+담배 피운 기간이 오래됐나요?,Korean
+전반적으로 치아 상태를 다 보는 거예요.,Korean
+그럼요. 맥박 이상 없습니다.,Korean
+아뇨. 수술은 안 받아 봤어요.,Korean
+"제가 지금 한약을 먹고 있어서 술을 안 먹은 지 육 개월은 돼서요.
+",Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+기침을 얼마나 자주 하나요?,Korean
+"전보다는 잘 안 나옵니다. 오줌 줄기가 좀 약해지긴 했습니다.
+",Korean
+광견병 같은 경우는 매년 접종하셔야 해요. 강아지에게 물렸을 때 광견병에 전염될 ��도 있어요.,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+매운 것이나 향신료 강한 음식도 당분간은 드시지 마세요.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+암 환자가 가족 중에 있을까요?,Korean
+외부 물질이 피부로 직접 닿는 것을 막아줍니다.,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+지금 어디가 아픈 건가요?,Korean
+네. 동물에게 옮는 질병이 있을 수 있거든요.,Korean
+네 몸무게가 약 용량에 영향을 주기 때문입니다.,Korean
+"기계에 손가락이 끼어서 손가락이 절단됐어요.
+",Korean
+하루에 얼마나 많이 피운다고 생각하세요?,Korean
+이번 주까지 독감 접종 아직 안 하신 분 저렴하게 맞을 수 있습니다.,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+팔을 지금 움직일 수 있나요?,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+네 삼 개월 후에 수술할 수 있습니다.,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+알레르기 유발 성분이 있는지 확인을 위해서 가져가는  것입니다.,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+증상이 나타나면 약물을 중지하시고 진료받으셔야 합니다.,Korean
+간호사실 앞에 휠체어는 항상 있습니다. 언제든지 사용하세요.,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+속이 쓰려서 제산제 먹었어요.,Korean
+네 과거 병력을 알아야 현재 정확한 진단을 내릴 수 있습니다.,Korean
+어머니가 고혈압약 드시고 계세요.,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+식후 계속 속이 불편하신가요?,Korean
+결핵 진단 후 치료는 잘 받으셨나요?,Korean
+요즘 먹고 있는 약이 있나요?,Korean
+부작용이 딱히 없어서 약에 큰 신경을 안 썼는데 없었던 것 같아요.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+알레르기 진단을 언제 받았나요?,Korean
+네 그렇군요 우선 검사를 정확히 받아봐야 알 것 같아요.,Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+아직은 회복 상태이니 조금만 더 쉬시면 될 겁니다.,Korean
+조영제 맞아본 적이 없어서 잘 몰라요.,Korean
+종양이 있다고 진단받은 적 있나요?,Korean
+네 점차 구역질은 가라앉으실 것입니다.,Korean
+수술 후 입원을 하셔서 회복하시는 것을 권유합니다.,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+치료가 제대로 되지 않을 경우 고열 오심 구토 요통이 발생할 수 있습니다.,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+몸에 계속 열이 나나요?,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+레이저 치료로 할 것 같네요.,Korean
+간염 인지하신 게 언제부터인가요?,Korean
+일주일 전부터 생 음식이나 상하기 쉬운 음식을 드신 적이 있으신가요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+숨 쉴 때도 갈비뼈가 아픈가요?,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+대부분 입원하시는 경우가 치료 또는 수술이 목적이기 때문에 전부 말씀해 주시면 됩니다.,Korean
+약은 복용 중이고 혈당은 평소 잘 유지되는 편입니다.,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+예전에 쓰러지신 적 있나요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+기침 증세가 악화하고 있나요?,Korean
+"세 달 전부터 몸이 붓고 심하게 피곤하더라고요. 무리하였나 싶어 푹 쉬면 괜찮아질 줄 알았는데 일주일 전부터 소변에 피도 섞여서 나오고 정신도 몽롱하고 몸이 이상해서 이 병원 외래를 방문하게 되었습니다.
+",Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+제일 처음 통증을 느꼈던 게 언제인가요?,Korean
+소변을 볼 때 따가운가요?,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+흉통이 목으로 번지는 느낌이 있나요?,Korean
+약��이나 음식 말고 알레르기가 있을까요?,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+네 상황에 따라 마취약을 바꾸거나 양을 조절할 수 있습니다.,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+"소변보는데 너무 아프고 잔뇨감이 늘 있어요.
+",Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+감기 기운이 있어서 종합 감기약 먹었어요.,Korean
+일시적으로 가려움이 가라앉은 것일 수 있습니다 주기적인 관리가 필요합니다.,Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+약이 과다하게 들어가면 산모에게 좋지 않을 수 있습니다.,Korean
+그래도 한 달 이내면 진료가 불가능합니다.,Korean
+"해열제를 먹여도 열이 안 떨어졌어요.
+",Korean
+일주일 동안 매일 술을 먹나요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+"구토는 안 하는데 속이 계속 매슥거려요.
+",Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+저번에 말씀드린 부위랑 같게 수술 진행할 겁니다.,Korean
+양성이 나온다면 추가 검사를 진행해야 합니다.,Korean
+간염으로 무슨 약 드세요?,Korean
+목 아픈 건 나으셨어요?,Korean
+어떠한 이유로 입원을 하셨나요?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+휠체어 사용 신청서 쓰시면 돼요.,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+네. 원무과로 가시면 영수증 및 진료비 세부내역서를 발급받으실 수 있습니다.,Korean
+알레르기 진단을 언제 받았나요?,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+"오히려 원래 몸무게보다 오 킬로가 늘었어요.
+",Korean
+가족 중에 천식이나 아토피가 있는 분 있으신가요?,Korean
+야간 약국은 본원 후문에 있습니다.,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+콜레스테롤 조금 높아서 식이요법으로 정상으로 돌아왔어요.,Korean
+아침 저녁 식전에 위산분비억제제와 식후에 항생제 두 종류를 복용하시면 됩니다.,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+"소변이 평소보다 색이 연해 보였어요.
+",Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+"아이가 너무 고열이라 오게 되었어요.
+",Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+활동을 하지 않아도 숨차는 증상이 있나요?,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+모든 시술에는 위험성이 동반됩니다.,Korean
+통증이 있는 곳 어디예요?,Korean
+본원에서의 수술기록은 조회가 되지만 타병원에서 한 수술은 조회가 되지 않습니다.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+"원래는 여드름이 잘 안 났었는데 갑자기 안 나던 여드름이 올라와서 왔습니다.
+",Korean
+복부 팽만감이 있지는 않나요?,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+"다이어트하느라 셰이크만 먹고 있어요.
+",Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+"손톱에서 피가 나고 곧 빠질 것 같아요.
+",Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+음식 중에 조심해야 될 음식이 있나요?,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+부종이 있는 곳이 있나요?,Korean
+꼭 해야 하는 건 아니지만 알레르기 유무 확인을 위해서 권장하고 있습니다.,Korean
+비형 간염이 양성인지 알려주세요.,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+아니요 원래 약 효과로 조금은 찌지만 지금은 너무 많이 쪄서 한 번 진료를 받아야 할 것 같습니다.,Korean
+무릎 쪽에 통증이 있나요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+다양한 질환이 복통과 오한을 동반할 수 있어서 검사가 필요합니다.,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+약은 잘 복용 중이세요?,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+모든 병원이 요로결석 수술이 가능한 것은 아닙니다.,Korean
+네. 음성반응 나���다고 하셨어요.,Korean
+당뇨 관리 언제 시작하셨어요?,Korean
+"목이 불편해서 잘 챙겨 먹지를 못합니다. 구토도 가끔 있고요. 식욕이 특별히 많이 증가하지는 않았습니다.
+",Korean
+알레르기를 일으킨 약 있나요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+아픈 건 어느 정도인가요?,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+처음으로 결핵 진단받으셨던 적이 언제인가요?,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+네 혹시 무엇으로 입원하셨나요?,Korean
+수술 여부를 확인하는 것입니다.,Korean
+예전부터 소화 불량이 있었나요?,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+환자복과 병상에 침대. 이불. 베개입니다.,Korean
+만성 위염 외 다른 문제는 없어 보이네요.,Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+지금 먹고 있는 약 있어요?,Korean
+먼 친척 중에 한 분이 간질 앓으신 적이 있다고 들은 적 있어요.,Korean
+아니요 화상은 기형에 포함되지 않습니다.,Korean
+병원 방문 이유가 뭘 까요?,Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+어느 부분이 붓기가 있나요?,Korean
+고혈압 처방받으면서 지은 약 드시고 있으세요?,Korean
+현재 체중 변화가 심한 가요?,Korean
+약품 확인은 환자분의 현재 건강상태 파악을 위해 필요한 사항입니다.,Korean
+복통이 있을 수 있습니다.,Korean
+주위가 갑자기 빙빙 돈다고 생각한 적 있으세요?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+종양 치료받은 적 있으세요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+금식을 안 하시고 수술을 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+혈압이 높은 거 안 지 얼마나 되셨어요?,Korean
+피가 묻어 있는 소변을 보신 적 있으신가요?,Korean
+피부관리실은 다녀봤는데 피부과 치료는 처음 받아봐요.,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+소변볼 때 통증이 있나요?,Korean
+아이의 열을 떨어트리기 위해 뭔가로 닦는 것보다 일단 시원한 상태를 유지해 지켜보도록 하죠.,Korean
+최근에 대변에 피가 섞여서 나온 적이 있나요?,Korean
+"엉덩이가 바닥에 닿을 때마다 아이가 많이 아파하더라고요.
+",Korean
+"진물이 나오고 눈곱이 자꾸 껴요.
+",Korean
+"감기 기운이 있는 것 같아서요.
+",Korean
+국가예방접종이나 기타예방 접종 포함 모든 예방접종이요.,Korean
+매일매일 와서 상처 확인하시면 됩니다.,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+설사하는 이유가 따로 있으신가요?,Korean
+네 오래된 약은 복용하지 마세요.,Korean
+가족 대부분 혈압이 높아요.,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+두통으로 불편한 점은 없나요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+수면마취는 하반신 마취를 할 때도 시행 가능합니다.,Korean
+수면 보조제 복용 중이시면 말씀해 주세요.,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+"가슴이 쥐어짜는 듯한 고통이에요.
+",Korean
+최근에 독감 주사 맞으셨나요?,Korean
+피가 나올 정도면 연고를 처방받으셔야 합니다.,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+약도 꼬박꼬박 챙겨 드셔야 해요.,Korean
+현재 담배를 피우고 계신건가요?,Korean
+초기에 잘 치료하는 것이 중요하니 매일 오세요.,Korean
+가지고 있던 질병이라 함은 변비도 해당이 되나요? 매우 심하긴 해서요.,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+수면 마취는 더 편하지만 수면 마취로 인한 위험성은 있습니다. 비수면 시에는 더 불편감을 느낄 수 있습니다.,Korean
+일단 말씀해 주시죠. 약품명이요.,Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+몸에 열이 계속 오르나요?,Korean
+"매일 대변을 보는 건 아니지만 이삼일에 한 번씩 가고 규칙적이라서 변비는 아닌 거 같아요.
+",Korean
+아직도 많이 아프신가요? 많이 아프시면 지금 약이랑 바꾸는 방법도 있습니다.,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+"그 거기 사타구니 있잖아요. 거기가 아파요.
+",Korean
+특이 혈액형인지 확인해본 적 없어요.,Korean
+술을 얼마나 자주 드시나요?,Korean
+알레르기 증상이 음식이나 약 말고도 있었던 적 있어요?,Korean
+어떤 간염 약을 처방받으신 건가요?,Korean
+매일매일 와서 상처 확인하시면 됩니다.,Korean
+몇 년 전에 저온 화상을 입어서 입원해서 치료했었죠.,Korean
+소화장애나 구토 복부 팽만 같은 소화기계장애증상이 있으신가요?,Korean
+제대혈은 주변에서 꼭 하라고 해서요. 신청하고 싶어요.,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+"네. 지방 수치는 어떤 경우에 높게 나오나요?
+",Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+네. 비수면 해 보시고 너무 힘드시면 수면으로 다시 시도 할 수 있습니다.,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+너무 아프지 않게 해주세요.,Korean
+"약 먹기 위해서 죽으로라도 먹어요.
+",Korean
+언제부터 다른 부위 통증이 있으셨나요?,Korean
+간염은 약물로 계속 치료하시나요?,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+"주 증상은 기침인 것 같아요.
+",Korean
+"오른쪽 위 사랑니가 아파요.
+",Korean
+가래 상태가 많이 심한가요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+하루에 소변보는 횟수가 어떻게 되나요?,Korean
+토혈이 나타난 건 언제인가요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+알레르기를 일으킨 약 있나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+꼭 해야 하는 건 아니지만 알레르기 유무 확인을 위해서 권장하고 있습니다.,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+네 금식을 오래 유지하셔야 해서 수액은 달고 계실 거예요.,Korean
+복부가 부은 느낌이 있나요?,Korean
+커피와 같이 위산 분비를 늘리는 음식물을 드실 경우 나타나기 쉽습니다.,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+통증은 움직일 때마다 오나요?,Korean
+저희 병원 입원기록을 조회해 보겠습니다.,Korean
+"눈이 너무 시리다 못해 아파요.
+",Korean
+언제 암을 처음 진단받으셨나요?,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+집안에 고혈압 환자분 계세요?,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+근래에 앓은 적 없어요.,Korean
+통증 지속시간이 길면 어느정도 였나요?,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+수액부터 놔 드릴게요. 그리고 항생제랑 마취제 검사하러 오겠습니다.,Korean
+증상이 어릴 때부터 있었어요. 십 년 좀 넘었네요.,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+혹시 고혈압 관련해서 약 드시고 있으세요?,Korean
+식은땀을 동반한 오한이 있으세요?,Korean
+네. 몇 가지 문진과 신체검사 이후에 바로 해열제 드리도록 하겠습니다.,Korean
+병실료와 식비는 하루에 오만 원입니다.,Korean
+통증의 강도가 얼마나 될까요?,Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+"치아가 안 좋으셔서 힘들어하세요.
+",Korean
+안전성이 입증된 마취 크림을 사용하기 때문에 부작용이 있더라도 미미한 수준입니다.,Korean
+많진 않아도 접종 후 이상 반응을 호소하시는 분들이 계세요.,Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+군대에서 허리를 삐끗한 후 허리 디스크를 달고 살고 있습니다.,Korean
+피를 토 한 적 있으세요?,Korean
+당뇨 처방 약 계속 드세요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+"소화가 잘 안 돼서 죽 반 공기 먹어요.
+",Korean
+밤에도 상관없이 간호사 호출기 눌러주시면 됩니다.,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+감염예방 치료를 할 거예요.,Korean
+임플란트가 본인 치아가 아닌 것에 해당됩니다 말씀해주세요.,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+"평소 자던 대로 자는데 하루 종일 피곤해요. 수면 시간은 그대로인 데도요.
+",Korean
+흉터가 덧나지 않게 연고를 잘 바르셔야 합니다.,Korean
+담배 대신 껌 씹으시는 걸 추천합니다.,Korean
+처음 아팠던 날 기억나세요?,Korean
+기간은 길지만 집에서 가끔 경구투여 약물을 사용하는 거라 큰 부담은 없으실 겁니다.,Korean
+음주 빈도가 주 몇 회 정도예요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+"허리 주변이 아파 죽겠어요.
+",Korean
+그럴 땐 약을 드시는 편이 나아요.,Korean
+결핵 ���았던 적 있으세요?,Korean
+치과에서 수술이 아니라 치료하신 거 아닌가요?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+움직일 때 통증이 더해지는지 다른 곳은 어떤지 확인하는 중이에요.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+"수면 유도제를 먹고 잤어요.
+",Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+몸에 붓기는 차도가 있나요?,Korean
+하루 평균 일 점 오 리터 정도 마시는 것을 권장하고 있습니다.,Korean
+"피까지 나온 적은 없어요.
+",Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+최근에 인플루엔자 백신은 맞으셨나요?,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+자극성 하제 사용을 고려할 수있으나 지속적인 사용은 내성 위험이 있습니다.,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+입원하는 동안 음식 시켜 먹어도 되나요?,Korean
+"사타구니 부근에 통증과 열감이 느껴져요.
+",Korean
+흉통이 목으로 번지는 느낌이 있나요?,Korean
+"잘 때 숨쉬기가 힘들어서 자꾸 깨서 왔어.
+",Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+어떤 음식이나 어떤 경로를 통해 장염에 걸렸는지는 찾기 어려울 것 같습니다.,Korean
+저희한테는 현재 목발이 없습니다.,Korean
+대변을 못 본 지 오래되셨나요?,Korean
+네 수면 패턴 체크를 희망하시는군요.,Korean
+지금 결핵 치료 약 드시는 중입니까?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+약 알레르기 있는 거 있으실까요?,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+상급종합병원이 아닌 작은 병원으로 가셔도 됩니다.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+하루 종일 무력한 느낌인가요?,Korean
+두통이 있는지 말씀해 주세요.,Korean
+아이가 바이러스나 세균감염에 걸리지 않으면 더 빨리 좋아질 수 있습니다.,Korean
+아니요. 오늘 병원 온 게 처음 방문한 거예요.,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+부루펜을 먹인지 얼마나 됐나요?,Korean
+화상 정도에 따라 과산화수소수를 사용할 수 있습니다.,Korean
+"폭행 사건에 휘말렸는데 얼굴을 다쳤어요.
+",Korean
+식욕이 떨어지신 것 같나요?,Korean
+빈혈이 상당히 심해서 걷다가 주저앉은 적도 있어요.,Korean
+아무래도 관절이 아프다 보면 스스로 움직이는 게 무의식적으로 덜 하게 되죠.,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+당뇨 진단을 받은 적이 있는데 치료됐습니다.,Korean
+"어쩌다 다쳤는지도 모르게 일하다 돌아와 보니 상처가 나 있더라고요.
+",Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+동의서 관련 상담은 의사분이 담당하시기에 잠시 기다려주시기 바랍니다.,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+콕 찍은 정도여서 흉터라고 보기에는 애매하네요.,Korean
+배뇨통이나 빈뇨등의 요로계 증상은 없으시나요?,Korean
+최근 급격하게 살이 많이 올랐나요?,Korean
+대변에 피가 보인적 있나요?,Korean
+네 보호자는 보호자 증이 있어야 병원 출입이 가능합니다.,Korean
+당뇨에 가족력 없다고 말씀하셨죠?,Korean
+어제 새벽에 열이 너무 올라서 맥이고 그 이후론 안 먹었어요.,Korean
+제가 주사 부위를 살펴볼게요.,Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+코로나 감염 여부 확인 후 진료를 봐 드릴 테니 검사를 받고 오세요.,Korean
+가슴이 빨리 뛰고 요동치시나요?,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+네. 약 잘 먹어야겠어요.,Korean
+혹시 화학 약품이나 환경에 따른 알레르기 반응은 없으세요?,Korean
+주사 약제에 의해 혈당이 오를 수 있고 주사치료를 자주 반복할 경우 쿠싱증후군 발생 위험이 있습니다.,Korean
+비타민이 건강보조식품인가요? 비타민을 먹고 있어요.,Korean
+간염은 약으로 치료하시는 거예요?,Korean
+뼈가 자라지 않은 다지증이기 때문에 전신마취는 안 해도 됩니다. 대신 주사제로 전신마취제를 투여하고 마취과 의사가 있는 상태에서 수술합니다.,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+간단한 수술부터 큰 수술까지 모든 수술 알려주세요.,Korean
+가래 특징을 말씀해 주세요.,Korean
+원하시면 독감 주사 예방 접종 가능한 병원에서도 가능합니다.,Korean
+구토를 지금도 하시고 오셨나요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+대체로 큰 문제는 ���지만 장의 감염성 질환도 고려해야 합니다.,Korean
+투 바이 투 사이즈의 거즈를 말합니다.,Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+당뇨 치료받아본 가족 분이 있으신가요?,Korean
+작은 신발을 오래 신어서 발가락이 아프죠 발에 맞춰서 신도록 해보세요.,Korean
+최근 술을 자주 드시나요?,Korean
+환자분은 오늘 발열이 있으셔서 내원하셨는데 이 부분을 보시면 발열 환자 주의사항이 있습니다.,Korean
+"조개 먹고?배탈 난 적이?있어서 해산물을 잘 안 먹어요.
+",Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+아니에요 속이 안 좋은지는 얼마나 되었나요?,Korean
+발가락이 많이 아프시면 이동 경로를 좁혀서 다니셔야 할 것 같아요.,Korean
+"수술 부위가 붓다 못해 고름이 나와요.
+",Korean
+식사 후에 소화는 잘되시나요?,Korean
+금식 후 시행한 혈액검사로 진단 내릴 수 있습니다.,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+통증 지속기간이 얼마나 되세요?,Korean
+통증 텀이 얼마나 되나요?,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+통증 발현 빈도가 어떻게 되세요?,Korean
+무슨 간염 약 드세요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+복통이 나타난 건 언제가 처음이죠?,Korean
+오늘은 검사 뭐 받아요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+혈압 수치 알고 계세요?,Korean
+암 수술한 적 있으세요?,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+한 달 후에 오셔서 경과 보시고 괜찮으면 재방문 안 하셔도 됩니다.,Korean
+소변보고 닦을 때 피가 묻어나오진 않나요?,Korean
+콜라 같은 색의 소변인가요?,Korean
+심장이 빨리 뛰어서 아프신가요?,Korean
+검사 시 위급상황 예방을 위해 꼭 필요합니다.,Korean
+점점 전문적인 요양이 필요하신 것 같아서요.,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+"살이 급격히 빠지진 않았고 좀 야위긴 했어요.
+",Korean
+건강검진 받으셨을 때와 지금 상태가 달라졌을 수도 있어서 다시 해야 합니다.,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+환자분이 사용하는 의치 보조기 의안 심박조율기 같은 보조 기구가 있나요?,Korean
+"평균 다섯 시간씩 자는 듯한데요?
+",Korean
+가족 중 고혈압을 앓는 분이 있나요?,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+어릴 때 다리가 부러져서 며칠 입원했어요.,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+오한 증상이 있다고 생각하나요?,Korean
+혹시 아스피린이나 혈전용해제를 드시고 있나요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+네. 저희 애는 알레르기 반응이나 거부 반응은 없었어요.,Korean
+소변볼 때 불편감이 있나요?,Korean
+쌍둥이라도 자연분만이 가능한데 환자분께서 다른 이유는 모르시나요?,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+손목 터널을 넓히는 수술입니다.,Korean
+외래 통해 자세한 안내를 받으시도록 도와드리겠습니다.,Korean
+구급차에서 이동 침대로 이동하셨군요.,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+아. 혈압 체크도 하는구나.,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+요즘도 간염 약을 드시고 계시나요?,Korean
+우리 아이는 어디가 아플까요?,Korean
+암 있는 건 언제 아셨나요?,Korean
+등산하다가 발목을 삐끗한 적이 있네요.,Korean
+남성의 경우에는 전립선 비대증이 전립선 출혈의 원인일 수 있습니다.,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+통증이 심했다거나 이상하게 요즘 들어 불편했던 곳이 있었는지 여쭤보는 거예요,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+"운동하다가 무릎에서 두둑 소리가 나더니 무릎 통증이 심해졌어요.
+",Korean
+처음 암 진단받은 게 언제인가요?,Korean
+일주일 내내 통증이 있으셨��요?,Korean
+열을 떨어뜨리는 게 우선이기 때문에 시원한 상태를 유지한다고 해서 감기에 걸리지는 않을 겁니다.,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+보통 이렇게 오래가지는 않지만 환자분은 지금 심각한 상태라 다른 사람들보다 증상이 오래가는 겁니다.,Korean
+저희 교수님께서 주치의를 맡아주실 거예요.,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+아버지도 유전성 질환을 앓으셨나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+드시는 약이 없으면 대답 안 하셔도 됩니다.,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+복부 통증을 동반한 설사를 하고 계신가요?,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+입천장 코 쪽 점막과 입천장 근육 그리고 구강 쪽 점막을 적절히 분리해 주어 다시 재건해 주는 작업입니다.,Korean
+당뇨 치료받으신지는 얼마나 돼셨나요?,Korean
+하루에 몇 개비나 피우시나요?,Korean
+신체부위를 마사지 해주셔야 합니다.,Korean
+현기증 정도를 말씀해 주세요.,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+심장이 갑자기 빨리 뛰거나 불규칙적으로 뛰지는 않았나요?,Korean
+숨을 쉬기 힘든 때가 있었나요?,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+저한테 얘기해 주시면 따로 말해둘게요. 빨리 퇴원하고 싶어서요.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+무력증을 느낀 적이 있나요?,Korean
+하루 동안 담배를 얼마나 피우시나요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+이마가 뜨거운 것 같으세요?,Korean
+"수술한 다리에 통증이 안 없어져서요.
+",Korean
+"좀 오래 자요 열다섯 시간 정도예요.
+",Korean
+항문 이외 다른 소화기관에서 출혈이 있는 경우 항문 통증은 동반되지 않을 수 있습니다.,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+수분이 부족하면 어지러움이나 기절을 할 수도 있고 심한 경우 사망에도 이를 수 있어요.,Korean
+먹으면 간지럽거나 한 음식 있나요?,Korean
+음식을 보고 토한 적이 있나요?,Korean
+나이가 어림에도 불구하고 고혈압 진단받은 지는 십 년은 됐어요.,Korean
+"기침이 너무 심하고 감기가 아니라 다른 게 의심된다고 동네 병원에서 종합병원 가라고 해서 왔어요.
+",Korean
+수술 후 경과를 봐야 식사 여부를 알 수 있어요.,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+아침에 복용해야 하는 약이세요.,Korean
+가족 중에 암 진단받은 식구가 있을까요?,Korean
+말씀드린 세 가지 중에서 어느 요법이 제일 이해가 안가세요? 세 가지 다 다시 설명드릴까요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+진료받은 병원을 기재해야 하거든요.,Korean
+통증 지속력이 어느 정도인가요?,Korean
+언제부터 간염이 있다는 걸 인지 하셨어요?,Korean
+하루에 몇 번 정도 아픈가요?,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+암에 대한 가족력이 있을까요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+아닙니다. 움직였을 때 통증 부위의 통증 정도를 확인하는 거에요.,Korean
+"성기 부분이 약간 간지럽고 수포가 잡혔어요.
+",Korean
+"원래도 천식 증상이 약간 있었어요.
+",Korean
+호흡할 때 어려움이 있나요?,Korean
+"기침 호흡 곤란도 있고요. 심할 때는 가슴이 답답하고 오한도 느껴져요.
+",Korean
+약국서 감기약 사 먹었었는데요.,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+소독된 환경을 갖추기가 어려우시기 때문에 되도록 병원에 내원해 주세요.,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+입원 수속 후에 질병의 완화를 위한 치료 경험이 있으신지 여쭙는 겁니다.,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+네 집중해서 치료하면 빨리 낫겠지요.,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+가족 중에 암 환자분이 계세요?,Korean
+"아침에 열이 살짝 있긴 했는데 지금은 모르겠어요.
+",Korean
+투약하고 있는 약이 지금 약이랑 겹칠 수 있어 여쭤보는 겁니다.,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+변이 잘 안 나오나요?,Korean
+어느 쪽 어금니가 흔들거리시나요?,Korean
+가장 걱정되는 증상이 무엇인가요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+당장은 피검사랑 소변검사 외의 검사는 없는 건가요?,Korean
+특별히 치료하지 않더라도 시간이 지나면 신체 면역력에 의해 자연스럽게 소멸됩니다.,Korean
+알레르기가 올라오는 음식이 있나요?,Korean
+"속이 메슥거리고 토할 것 같은 느낌이에요.
+",Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+피부 가려움 양상이 어떻게 나타나시나요?,Korean
+밤에 잠이 안 온다는 거죠?,Korean
+"거의 나흘에 한 번 변을 볼 수 있어요.
+",Korean
+가래는 잘 뱉고 있어요?,Korean
+얼마나 자주 술을 드세요?,Korean
+통증이 한번 오면 얼마나 지속되나요?,Korean
+아픈 기간은 어느 정도일까요?,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+충수돌기염 의심이면 아닐 수도 있다는 거네요?,Korean
+통증 강도가 어느 정도 신가요?,Korean
+강서구에 있는 병원으로 해주세요.,Korean
+과거에 했던 수술 방법에 따라 이번에 하는 수술 방법이 변경될 수도 있습니다.,Korean
+약 이름 생각이 안 나시면 사진으로라도 보여주세요.,Korean
+아픈 게 쭉 아파요?,Korean
+혈변에 피가 많이 보였나요?,Korean
+가슴 통증의 원인으로는 심혈관 호흡기 소화기 근골격 심인성 등의 다양한 원인이 있을 수 있습니다.,Korean
+네 바셀린 거즈도 많이 사용합니다.,Korean
+타 병원으로 전원 수속 도와드리겠습니다.,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+어린데도 불구하고 편두통이 굉장히 심해요.,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+본인 치아와 보조 치아가 몇 개인지 확인하는 거예요.,Korean
+가려움이 심해서 알레르기약 먹었습니다.,Korean
+겨울만 되면 편도선이 많이 부어요.,Korean
+꾸준한 추적 검사가 요구됩니다.,Korean
+증상이 시작된 게 언제부터예요?,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+이전에 입원하셨던 적 있나요?,Korean
+"먹으면 위 아픈 걸 아니까 먹는 게 무서워요.
+",Korean
+몸의 부기가 어느 정도인가요?,Korean
+몸에 기운이 싹 빠진 느낌이 드나요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+소화불량 때문에 평소 생활이 힘드셨나요?,Korean
+계속해서 심장이 빨리 뛰나요?,Korean
+근육이 손상되면서 근육 세포 속에 있는 물질들이 체액으로 유입돼 독성을 일으키는 질환입니다.,Korean
+항문 출혈 가능성이 높고 그 경우 심각한 질환의 가능성은 낮습니다.,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+"대변보는 데 어려운 건 없는 것 같아요.
+",Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+"눈에 띄게 열이 난 건 아니라 자세히 기억은 안 나요. 한 한 달?
+",Korean
+갈비뼈 때문에 올해 초에 병원 다녔어요.,Korean
+대변을 못 본 지 오래되셨나요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+"수술 후에 회복하지를 못하고 기력 없이 지냈습니다.
+",Korean
+체중변화가 중요한 요인이 될 수 있어서요.,Korean
+방사선사 지시에 따라 하시면 몇 분 안 걸립니다.,Korean
+하루에 여러 차례 드레싱하며 상태를 볼 겁니다.,Korean
+식사량이 점점 줄고 있나요?,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+괜찮습니다. 입원치료 혹은 수술관련하여 입원하신 적이 있으신가요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+붓기 있는 곳을 알려 주시겠어요?,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+주사도 수액 줄로 맞으시고 식사하실 때까지는 식사 대용이라고 보시면 됩니다.,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+아니요 입원 경험 없음으로 체크해 놓겠습니다.,Korean
+네 원래 이 질환은 치료에 시간이 많이 걸립니다.,Korean
+피부가 많이 예민한 편이 아니면 접촉성 피부염이 나타나는 경우는 극히 드뭅니다.,Korean
+본원에서 수술한 기록만 조회가 되기 때문입니다.,Korean
+숨 쉬는 건 어때요?,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+피부 건조는 자주 오는 증상 중에 하나입니다.,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+"신장이 안 좋다고만 얘기 들었어요.
+",Korean
+약 먹을 때만 그렇고 나중엔 괜찮아요.,Korean
+유전적 질환은 다른 사람들보다 유전인자를 더 갖고 있어 질환 발병률이 높습니다.,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+네 성경험이 없을 경우 처녀막 보호를 위함입니다.,Korean
+환자분 아까 목 아프시다고 하셔서 가글 여기있어요.,Korean
+"가래 기침에 입맛도 없고 체중도 줄었어요.
+",Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+이동 침대 이용 시 비용이 청구되기 때문입니다.,Korean
+소변보고 나서도 또 마려운 느낌이 드나요?,Korean
+치료 전 비슷한 증상을 호소하는 다른 질환들을 감별하고 질병의 진행 정도를 확인하기 위한 검사가 필요합니다.,Korean
+담배 하루에 얼마나 태우세요?,Korean
+할머니께서 간암으로 투병 중이세요.,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+네 복부에 압력이 가해지므로 안 좋습니다.,Korean
+체온이 몇 도인지 아세요?,Korean
+네 민간요법을 따로 하지 않으시는군요.,Korean
+"웨이트 트레이닝을 하는데 그게 문제일까요?
+",Korean
+"오른쪽 다리만 유난히 심해요.
+",Korean
+언제부터 가슴 통증이 있나요?,Korean
+첫째는 자연분만 하셨다는 말씀이신가요?,Korean
+어떤 치료제를 드시고 계세요?,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+알레르기 검사 받으신적 있나요?,Korean
+복부 통증이 많이 심한가요?,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+한 달 동안 다녀온 의료기관을 기록해야 합니다.,Korean
+통증이 어느 부위에 집중되나요?,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+입원 환자 관리를 위한 사항입니다. 그 이외 흉터가 있는지 확인 협조 부탁드립니다.,Korean
+일주일에 몇 회 정도 음주하세요?,Korean
+"기계에 손가락이 끼어서 손가락이 절단됐어요.
+",Korean
+"저번에 치질이 있어서 치료받았는데 다시 재발한 것 같아서요.
+",Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+단순한 물리치료로 좋아지는지 확인이 필요합니다.,Korean
+가족 중에 당뇨이신 분 있어요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+초등학생 때 처음 진단받았어요.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+기침할 때 다른 증상이 있나요?,Korean
+네 바로 혈액형 검사 가능합니다.,Korean
+매번 물어보면 처치가 늦어지기 때문에 지금 동의를 해주셔야 해요.,Korean
+네 지금까지 들어본 거로는 심장병은 아닌 듯 합니다.,Korean
+거의 통증은 없다고 생각하시면 됩니다.,Korean
+결핵 치료는 꾸준히 받고 계신가요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+통증이 어떤지 설명해 보실래요?,Korean
+"어제 잘 때부터 살살 아팠었는데 새벽에 아파서 자꾸 깨게 되더라고요.
+",Korean
+"무릎에서 소리가 나고 걸음이 불편해져서 왔습니다.
+",Korean
+첫째는 자연분만으로 출생하셨고 둘째는 제왕절개로 낳으셨단 말씀이신가요?,Korean
+가슴 조이는 느낌이 심한가요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+일단은 진정 후 안정이 될 때까지는 입원하셔야 합니다.,Korean
+"네. 감기 기운 생기면서 좀 줄었어요.
+",Korean
+만졌을 때 통증은 없나요?,Korean
+네. 제가 마취에 민감해요.,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+십이 최고 아픈 거라면 어느 정도의 통증인가요?,Korean
+수술을 여러 번 해서 다 일일이 기억 못 해요. 죄송합니다.,Korean
+"최근 한 달 사이에 오 킬로 정도 늘었어요.
+",Korean
+통증이 시작된 날이 언제부터예요?,Korean
+"거품 있는 소변은 본 지 꽤 오래됐어요.
+",Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+유산균을 먹고 있긴 한데 약에 포함되나요?,Korean
+"온몸에 여러 방 쏘였어요.
+",Korean
+마취가 잘 안 들었다든지 그런 거요.,Korean
+"음식 냄새만 맡아도 어지러워요.
+",Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+"가래 열 기침 객혈 체중감소가 있어서 병원에 왔습니다.
+",Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+지난 달에 쓰러지고 나서 처방받아 먹고 있어요.,Korean
+평소에도 자주 입술이 건조해지시나요?,Korean
+위 내용물이 구강 내로 역류할 수 있고 이로 인해 위 내용물이 기도를 폐쇄하여 질식을 초래할 수 있기 때문이에요.,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+결핵 치료하신 지 얼마나 되셨나요?,Korean
+결핵 수치가 높은 편이신가요?,Korean
+일 번 오 번 두 개 수술했는데 철심도 박았어요.,Korean
+상처 크기와 깊이에 따라 다르므로 경과를 지켜보다 말씀드리겠습니다.,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+평소에 변비 증상이 있으신가요?,Korean
+"배에 가스가 가득해서 빼내고 싶어요.
+",Korean
+간염 주사였던 것 같아요.,Korean
+네. 음성반응 나왔다고 하셨어요.,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+통증 주기가 몇 주인가요?,Korean
+"오른손도 비슷한 증상이 있었는데 지금은 괜찮아요.
+",Korean
+"어지러운 느낌이 들어서 커피 안 마셔요.
+",Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+울렁거리면서 토할 것 같았어요?,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+네 부작용이 발생할 수 있으나 흔한 부작용은 아닙니다.,Korean
+병실료와 식비는 하루에 오만 원입니다.,Korean
+원래 통증은 있을 수 있긴 한데 얼마나 아프신가요?,Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+밥 먹은 것이 소화가 잘 안 되나요?,Korean
+상처에 습윤이 유지되는 효과가 있습니다.,Korean
+아픈 게 어느 정도 지났나요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+일단 약 복용 및 크림 도포 후 경과를 지켜보겠습니다.,Korean
+몸에 부은 곳이 어디예요?,Korean
+간염으로 인해 병원에 방문한 적이 있나요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+다량의 카페인 섭취는 위험할 수 있습니다.,Korean
+제가 이틀 후는 안 되는데 이틀마다 소독 받아야 하면 어떡해요?,Korean
+이천일 년 여름에 검진받으러 갔다가 우연히 알게 됐죠.,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+결핵은 어떻게 하고 계시죠?,Korean
+"혈압이 높아서 그런지 머리가 너무 지끈거려요.
+",Korean
+어제 기침이 많이 심하셨다고 들었는데 지금은 좀 어떠신가요?,Korean
+변이 잘 안 나오나요?,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+"혈압이 너무 낮아서 자꾸 쓰러져요.
+",Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+부분마취는 보통 더 적은 부위만을 마취하는 것입니다.,Korean
+알레르기 치료는 얼마 동안 받으셨어요?,Korean
+무릎에 무리가 올 정도로 체중이 늘었나요?,Korean
+"갑자기 얼굴에 여드름이 올라와서요.
+",Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+대개 해당 치료는 전신 마취로 진행합니다.,Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+"아기가 숨을 쌕쌕거리면서 쉬어요.
+",Korean
+"수면 패턴은 아홉 시에서 열 시 사이에 잠들어서 다섯 시 정도에 일어나요. 자장가를 안 불러 주면 잠을 안 자서 꼭 불러주고 있습니다.
+",Korean
+최근 몸무게에 변화가 혹시 많으셨나요?,Korean
+"당최 삼킬 수가 없어요.
+",Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+호르몬 억제제 외에 안구건조증 약과 철분제를 복용하고 있습니다.,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+최근에 복통 및 기타 증상은 없으셨나요?,Korean
+"사과 알러지가 있어서 과일 주실 때 빼고 주세요.
+",Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+다른 방향 보고 계시면 주사 최대한 천천히 놓도록 노력해 볼게요.,Korean
+네 수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+기본적인 정보수집이 끝��습니다. 물 포함하여 금식하시고 대기하시면 담당 간호사 선생님께서 안내하실 겁니다.,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+"갑자기 이빨이 너무 아파요.
+",Korean
+가슴 통증 느끼신 지 얼마나 되신 거죠?,Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+먹고 있는 것 없고 혈당은 잘 유지돼요.,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+가장 걱정되는 증상이 무엇인가요?,Korean
+상태가 많이 안 좋아 보여서 바로 응급처치해 드릴게요.,Korean
+그게 제일 큰 수술이었어요.,Korean
+평균적인 시간은 있지만 환자분의 상태에 따라 다릅니다.,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+"어쩔 때는 일주일 동안 변을 못 본 적도 많아요.
+",Korean
+암 진단받아본 적 있으세요?,Korean
+"심장이 원래 약하긴 했어요.
+",Korean
+약물과 음식을 제외하고 다른 알레르기가 있으신가요?,Korean
+통증이 늘 같은 현상으로 오나요?,Korean
+항암 치료제를 복용 중이신가요?,Korean
+혹시 설사 자주 하셨나요?,Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+양성이 나온다면 추가 검사를 진행해야 합니다.,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+현재 발작 증상이 심해서 진정 시키는 중이라 진정이 되지 않을 시에는 추가 진정 주사를 놔야 합니다.,Korean
+네. 결핵 주사 맞았어요.,Korean
+"밥 먹는 중에도 토한 적 있어서요.
+",Korean
+상처의 소독 후 사용하는 소독된 붕대를 지칭합니다.,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+수술 동의서 받을 때 자세히 설명드리겠습니다.,Korean
+통증이 있는지 알고 싶어요.,Korean
+알레르기 반응에 또 다른 반응이 있나요?,Korean
+꾸준히 먹는 약이 있으신가요?,Korean
+아이 성장 속도에 맞춰 동일하게 해줄 겁니다.,Korean
+렌즈를 지금 끼고 있어요. 보청기도 있고요.,Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+앓고 있는 병 있나요?,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+네. 세 명 다 수술로 낳았어요.,Korean
+처방하는 약에 따라 다르지만 표준치료 기준 세 종류의 약을 하루 이 회 복용합니다.,Korean
+예방 접종 성분과 비슷한 성분의 약을 처방 예정입니다.,Korean
+혹시 가래를 자주 뱉으시나요?,Korean
+예전부터 소화 불량이 있었나요?,Korean
+환자 개인정보사항에 필수 사항이라 확인차 여쭤봤습니다.,Korean
+영양제 유산균이랑 비타민 먹고 있어요.,Korean
+네 그래서 환자분의 음주력을 알아보려고 합니다.,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+위암 진단 판정받고 완치했습니다.,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+담배를 피우신 적 있으세요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+숨 쉴 때 힘드신가요?,Korean
+소변을 보는 양은 변화가 있으신 거 같으세요?,Korean
+요즘 기력이 많이 빠진 거 같나요?,Korean
+음주 빈도 말씀해 주시겠어요?,Korean
+당뇨를 앓은 지 얼마나 되셨어요?,Korean
+소화될 때 어려움이 있나요?,Korean
+"네. 이제는 담배 없이 못 살아요.
+",Korean
+소화장애나 구토 복부 팽만 같은 소화기계장애증상이 있으신가요?,Korean
+유전적 요인 또는 당뇨 등의 기저 질환 영향도 있지만 생활습관이나 식습관 술 비만 등의 영향도 많이 받습니다.,Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+종양이 있다고 진단받은 적 있나요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+부천성모병원에서 투석 받고 있어요.,Korean
+"가래 열 기침 객혈 체중감소가 있어서 병원에 왔습니다.
+",Korean
+퇴원 수속 관련 설명을 들으셨다는 동의서입니다.,Korean
+환자분 의식이 없으면 연락드려야 합니다.,Korean
+기능성 소화 장애인 경우가 많으나 기질적 원인일 수도 있습니다.,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+"강아지한테 물려서 긁히고 찍히고 피도 나고 ���래요.
+",Korean
+"늘 소변이 마렵고 가면 안 나오고 계속 잔뇨는 남아요.
+",Korean
+그렇긴 하지만 처방 받아서 드시는 게 아니면 오남용을 할 수 있어서요.,Korean
+"팔팔 끓는 물에 팔을 데었어요.
+",Korean
+네 어떤 이유로 약을 드시고 계시나요?,Korean
+"식욕이 줄 거나 그런 건 없는데 입맛이 좀 짜게 변했어요.
+",Korean
+결핵이라고 느낀 적 있으세요?,Korean
+"약이랑 봉투를 함께 삼켜서요.
+",Korean
+그래도 한 달 이내면 진료가 불가능합니다.,Korean
+"네. 흡연은 하고 음주는 안 해요.
+",Korean
+진단서 한 부 더 받으시려면 추가 비용이 발생하는데 괜찮으세요?,Korean
+사출성 구토는 갑작스럽게 뿜어져 나오는듯한 구토를 말합니다.,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+네. 피부염이 있어서 항생제를 먹고 있어요.,Korean
+평소에 드시는 약이 어떤 병 때문에 드시는 건가요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+알레르기 진단은 언제 받았나요?,Korean
+상처 난 부분을 씻어낼 수 있는 식염수입니다.,Korean
+음주는 얼마나 자주 하시죠?,Korean
+네. 원래 숨쉬기 불편하게 만듭니다.,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+현재는 전혀 술을 안 드시나요?,Korean
+간염으로 무슨 약 드세요?,Korean
+온몸이 기운 빠지 듯 무력하나요?,Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+"알코올성 간암 판정 받아서 큰 병원으로 왔어요.
+",Korean
+복압을 상승시키는 과도한 운동은 오히려 위험 요소입니다.,Korean
+"아니에요. 십 대 시절부터 피웠거든요.
+",Korean
+통상 계절 독감의 백신 효과는 사십에서 육십 퍼센트 정도 됩니다.,Korean
+"네. 매일같이 여섯 시간 정도 자는 것 같네요.
+",Korean
+그럼 그 약을 왜 드시는지 설명해 주실 수 있으실까요?,Korean
+처음 아팠던 날 기억나세요?,Korean
+아프다 안 아프다 하나요?,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+설사를 하는 시기가 있나요?,Korean
+하루에 몇 시간 주무시나요?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+혈변을 보시면 피가 얼만큼 섞여 나오는 거 같나요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+기침 외에 다른 증상은 없나요?,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+"왼쪽 손가락이 아프더니 지금은 아예 손 자체가 빨갛게 부었어요.
+",Korean
+"피곤한 걸로 봐서 요즘 잘 못 자나 봐요.
+",Korean
+예를 들어 병원에서 처방받았다던가 약국에서 구입한 약들이요.,Korean
+알레르기 나는 상황 알려주세요.,Korean
+"어제 소화가 잘 안 돼서 매실액이랑 요구르트 한 잔만 마셨는데.
+",Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+네. 입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+근처 병원도 알아봐야겠네요. 감사합니다.,Korean
+통증은 얼마나 자주 생기세요?,Korean
+횡문근융해증은 근육에 손상이 있어 이로 인한 독성 물질이 쌓이는 질환입니다.,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+잘못된 치실 사용법은 오히려 잇몸이나 치아에 안 좋을 수 있습니다 치실 사용법 좀 알려드리겠습니다.,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+내일 진료받으러 오셔야 할 진료 장소입니다.,Korean
+"아니요. 가족 중에 폐암으로 돌아가신 분들이 많아서 절대 안 해요.
+",Korean
+다른 아이는 자연 분만이었고요?,Korean
+네 권장하는 양만 드신다면 수면제도 나쁜 선택지는 아닙니다.,Korean
+부부관계를 하실 때만 발기 부전이 나타나나요?,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+최근에 살이 많이 빠지시진 않았나요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+일 회 평균 음주량이 어떻게 됩니까?,Korean
+판독결과는 영상의학과 전문의가 확인이 필요해서 금방 나오지는 않습니다.,Korean
+통증이 심하실 때 호출해 주세요.,Korean
+담배는 언제 피우기 시작했을까요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+식욕이 떨어지신 것 같나요?,Korean
+청진할 때 옷 안으로 하는 게 정확해요.,Korean
+과거에 수술이나 입원한 적이 있으신지요?,Korean
+수술 후 빨리 폐를 펴주는 것이 중요합니다.,Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+네. 수술 잘 끝났어요?,Korean
+근 삼 개월간 살이 빠지셨어요?,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+아직은 입원 지시만 되어있는 상태입니다. 원무과에서 확인 후 병실을 배정하고 병실이 배정되면 병동 간호사에게 인계 할 것입니다.,Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+혈압이 좀 있는 편이신가요?,Korean
+통증이 어느 정도로 느껴지나요?,Korean
+네. 비수면 해 보시고 너무 힘드시면 수면으로 다시 시도 할 수 있습니다.,Korean
+레이저 치료가 끝난 뒤에 통증이 유발되는 경우도 가끔 있습니다.,Korean
+앞에 수술 예상 소요시간 있습니다 참고하셔서 오시면 됩니다.,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+언제부터 열감이 전신적으로 발현되시나요?,Korean
+어떤 음식이나 약을 드셨나요?,Korean
+어디가 제일 많이 붓나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+하루에 몇 개 피우시죠?,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+결핵약은 주기적으로 복용 중이신가요?,Korean
+상한 조개는 익혀 먹어도 위험해요.,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+배에 있는 대동맥이 늘어지고 커져서 만져지네요.,Korean
+발기 부전 증상이 있으세요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+"요즘 계속 변이 묽고 냄새도 지독해요.
+",Korean
+체중이 증가한 이유가 있을까요?,Korean
+평소에도 자주 입술이 건조해지시나요?,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+토혈을 하신 경험이 있나요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+"부풀어 오르면서 누르면 들어가서 부종 같아서 왔습니다.
+",Korean
+지금도 통증이 계속 있나요?,Korean
+두드러기가 아토피 때문일 수도 있지만 다른 원인일 수도 있기 때문에 정확한 건 검사 후에 안내드릴게요.,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+생리 주기 돌아오는 간격은 어떤가요?,Korean
+배가 불러 불편하지는 않으세요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+"아니요. 음식이 목구멍에 닿으면 아파요.
+",Korean
+다른 주의사항은 없고 다음 외래 전에 엑스레이 찍으시고 피검사 하시는 거 잊으시면 안 됩니다.,Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+수술시간은 네 시간 정도 걸려요.,Korean
+"아니요. 요즘 두통이 잦아져서 잘 못 자요.
+",Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+손가락 습진이 심하신가요? 처방 내리고 치료 도와드릴게요.,Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+토할 때 피가 같이 나오나요?,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+"무슨 소변 보는 길 쪽에 염증이 났다고 하셨어요.
+",Korean
+과로로 인한 증상은 서서히 나타납니다.,Korean
+연고 가격은 정확하진 않지만 시카케어 같은 경우는 십만 원대입니다.,Korean
+알레르기로 인해 피부약을 먹고 있습니다.,Korean
+"체했는지 계속 가슴이 답답해서요.
+",Korean
+종종 두통이 있어서 아스피린 정도 먹네요.,Korean
+결핵 증상이 있었던 게 언제부터죠?,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+통증이 멈췄다 다시 시작되나요?,Korean
+가끔 드시는 건 괜찮지만 되도록 고열량 고지방 식품보다는 찐 달걀이나 닭 가슴살로 드시도록 해보세요.,Korean
+몸에 이상이 생겼다는 게 어떤 의미인가요?,Korean
+네 맞으세요 일단 오늘 오후 두 시에서 세 시 사이에 수술실 들어가실 거라 지금부터는 물 포함 아무것도 드시면 안 돼요.,Korean
+"애기가 감기가 너무 심해요.
+",Korean
+큰일이 나는 건 아닌데 약물 부작용 위험이 있어요.,Korean
+���주 울렁거림을 느끼시는 건가요?,Korean
+요새 항상 우울해해서 아마 우울증약 처방받았을 거예요.,Korean
+요 근래 식욕이 비정상적으로 떨어지셨나요?,Korean
+외래를 통해서요 진료받은 후 입원을 하게 된 건가요?,Korean
+빨리 회복하기 위해서는 소독을 주기적으로 해 줘야 균에 감염이 되지 않아요.,Korean
+회복을 위해 단백질 위주의 식단이 필요합니다.,Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+네 아무런 느낌 없다가 갑자기 구토 형태로 나올 때가 많습니다.,Korean
+식중독은 여러가지 원인에 의해 발생할 수 있습니다. 원인을 찾기보다는 현재 증상 조절이 더 중요합니다.,Korean
+피부가 오돌토돌하고 간지러운 증상이 시작된 건 언제인가요?,Korean
+그것 말고도 바디바바디바형 등의 혈액형도 포함돼요.,Korean
+"식단하고 있어서 안 먹어요.
+",Korean
+정확한 결과를 알기 위해서 우선 엑스레이를 찍어볼게요.,Korean
+수술 스케줄은 정해져 있어서 변경은 어려워요.,Korean
+간암 걸린 적 있는데요.,Korean
+네 신체 외부 자국은 모두 보여주세요.,Korean
+종암동에 있는 힘찬 비뇨기과요.,Korean
+이젠 퇴원을 해야 할 거 같아요.,Korean
+배가 좀 평소보다 빵빵하신 것 같긴 했어요. 구토는 모르겠구요.,Korean
+속이 메슥거릴 때가 많나요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+유전성 질환 가족력 있나요?,Korean
+"약을 봉지째 다 먹어버렸어요.
+",Korean
+염증성 장 질환이라면 면역억제제를 사용하기도 합니다.,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+상처 부위에 진물이 찰 수 있기 때문에 소독은 자주 해야 합니다.,Korean
+때로는 염증성 대장 질환의 경우도 있습니다.,Korean
+아침에 혈압약이 효과가 있었네요.,Korean
+수술은 한 적이 없는데 한 달 정도 입원 치료한 적은 있어요.,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+발기 부전 문제가 있네요?,Korean
+부종이 있는 곳이 있나요?,Korean
+아들이 데려가서 저번 주에 독감 예방 주사 맞았지.,Korean
+"화상 입었었는데 가라앉질 않아서 왔어요.
+",Korean
+검사상 여섯 시간에서 여덟 시간 정도는 공복을 하고 받을 수 있어서 여쭤봤어요.,Korean
+통증이 얼마나 자주 오나요?,Korean
+"체중 변화 딱히 없었습니다.
+",Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+건강 관리에 많이 힘쓰셨나 보네요. 검사 결과를 보니 좋네요.,Korean
+간염으로 드시는 약이 있나요?,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+어디가 제일 많이 부었나요?,Korean
+연고는 병원에서 판매하는 제품이기 때문에 보험처리가 되지 않아요.,Korean
+갖고 계신 약 있나요?,Korean
+코로나 시작하자마자 갔다 왔습니다.,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+지속적으로 아니면 간헐적으로 저린 느낌이 오나요?,Korean
+그럴 땐 약을 드시는 편이 나아요.,Korean
+마취 부작용 얘기를 들어 긴장했었는데 아무 일도 없었어요.,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+죽을 만큼 아프시다고요? 상태 한번 살펴보도록 할게요.,Korean
+대변볼 때 안 힘든가요?,Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+발기 부전을 느끼고 계신가요?,Korean
+일주일 내내 통증이 있으셨어요?,Korean
+네. 이쪽 근육 떨림이 좀 있었어요.,Korean
+수액 잘 떨어지고 있는 거죠?,Korean
+어떤 식으로 아프다 하는 게 있으실까요?,Korean
+혹시 설사 자주 하셨나요?,Korean
+대변볼 때 불편하지 않으세요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+산소포화도가 정상으로 유지될 때까지는 깨어있으셔야 합니다.,Korean
+빈 속에서도 나타날 수 있는 증상이지만 흔히 식후에 나타나는 경우가 많습니다.,Korean
+"귀에서 윙윙 소리가 나네요.
+",Korean
+아 예전에 부정맥 진단을 받으셨군요.,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+하루에 설사를 자주 하시나요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+최근에 고혈압약 용량이 변화하거나 약을 바꾸��나 하지는 않으셨나요?,Korean
+대변을 볼 때 피가 나오나요?,Korean
+지난주에 머리가 아파서 갔다 온 적 있습니다.,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+치밀유방이라고 들으셨죠? 유방초음파 같은 거 해보신 적은 있으세요?,Korean
+약은 확인 후에 다시 돌려드리겠습니다.,Korean
+현재 발작 증상이 심해서 진정 시키는 중이라 진정이 되지 않을 시에는 추가 진정 주사를 놔야 합니다.,Korean
+네 허혈성 심장질환의 가능성이 있습니다.,Korean
+열 빨리 떨어트릴 땐 뭘 해주면 좋아요?,Korean
+간염으로 치료 받고 있나요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+저는 아픈 게 싫어서 최대한 아프지 않은 방향으로 해주셨으면 해요.,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+이천일 년 여름에 검진받으러 갔다가 우연히 알게 됐죠.,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+평소에 손목 운동하는 게 도움이 될 것 같네요.,Korean
+네. 아이 면역력이나 몸 상태 호전 후에 하는 것이 좋습니다.,Korean
+재발 가능성은 있으나 치료 후 박멸이 확인된 이후의 재발률은 낮습니다.,Korean
+먼지 등 알레르기 요인이 있나요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+흡연 기간은 어느 정도이신가요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+감염을 예방하는 데 있어 가장 중요한 부분입니다.,Korean
+"흡연 기간 확인해 볼게요.
+",Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+"귓구멍 입구에 상처가 나서 수포가 좀 있어요.
+",Korean
+일도 화상의 경우 보통 이틀 이내에 통증이 사라집니다.,Korean
+혈뇨를 볼 때 통증이 동반되나요?,Korean
+네. 우선적으로 수액치료와 필요시 약물 치료로 정상 혈압을 유지할 것입니다.,Korean
+소변 색이 붉은빛이 도나요?,Korean
+네 국가예방접종 같은 거요.,Korean
+제가 어릴 때부터 여기저기 많이 다쳐서 수술도 많이 했어요.,Korean
+현재는 몸살 증상이 어떠신가요?,Korean
+"평소엔 담배를 안 피우고 술 마시면 담배도 좀 피웁니다.
+",Korean
+습진도 치료를 받아야 합니다.,Korean
+진드기는 눈에 안 보이는 아주 작은 벌레죠.,Korean
+체온이 몇 도인지 아세요?,Korean
+두드러기 같은 게 올라왔었어요.,Korean
+우선은 다른 약으로 변경해 보도록 하겠습니다.,Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+저번 주에 내과 갔었어요.,Korean
+팔을 지금 움직일 수 있나요?,Korean
+"다리에 쥐가 안 풀려요.
+",Korean
+일주일 내내 통증이 있으셨나요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+네. 근데 혈중 암모니아 수치가 정확히 뭔가요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+숨이 찬 증상이 나타납니까?,Korean
+코로나 유행 지역이란 게 어느 기관에서 정한 코로나 유행 지역 말씀하시는 건가요?,Korean
+"저한테 그런 증상은 몰랐는데 괜찮았던 거죠?
+",Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+소화 기능이 안 좋으세요?,Korean
+가족 중에 당뇨 환자 있으신가요?,Korean
+몸에 바르고 있는 약이나 화장품이 있을까요?,Korean
+최근에 독감 주사 맞으셨나요?,Korean
+호르몬 검사를 한 번 해볼까요?,Korean
+배에 묵직한 통증이 있나요?,Korean
+"예전에는 자장가 불러주면 잘 잤는데 지금은 재우기 쉽지 않아요. 수면 시간도 줄었고요.
+",Korean
+체중 변화가 많진 않으셨어요?,Korean
+통증이 있는지 알고 싶어요.,Korean
+네 많이 아프지만 진통제가 주입되고 있어서 참을만할 겁니다.,Korean
+몸이 붓는 건 그대론가요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+복부에 가스 찬 느낌이 있진 않나요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+변비 증상이 처음이신 건가요?,Korean
+아스피린 먹으면 한 시간 피부가 벌겋게 달아오릅니다.,Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+네. 집에서 소독도 가능하지만 웬만하면 내원하셔서 소독과 치료를 같이 받는 게 좋을 것 같네요.,Korean
+"담배 자체를 너무 싫어해요.
+",Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+혹시 토혈을 ��� 적 있으세요?,Korean
+암 판정받으신 적 있나요?,Korean
+네. 응급 환자만 없으면 빨리 진료해 주세요.,Korean
+대장에 감염이나 염증이 있을 시 동반될 수 있는 점액성 물질입니다.,Korean
+탈장이라도 항상 통증이 있는 건 아닙니다.,Korean
+간염 진단을 받으신 적이 있으실까요?,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+"이두근이 당기고 힘이 없어요.
+",Korean
+수면 보조제는 너무 오래 드시면 좋지 않아요.,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+콜라 같은 색의 소변인가요?,Korean
+통증 시작된 날짜 기억나요?,Korean
+근육통이 있을 수 있어요.,Korean
+네 수술 끝날 때 오시는 게 좋습니다.,Korean
+"밤에 잘 못 자서 그런지 낮에 졸아요.
+",Korean
+결핵 백신 접종을 하셨나요?,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+씨티 안 찍으면 안 돼요?,Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+일 회 치료에 약 십만 원 정도 들 겁니다.,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+분만방법에 따라 수술방법이 달라지기 때문입니다.,Korean
+심장이 터질 것 같은 느낌이 드시나요?,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+변에 피가 함께 나오나요?,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+"배가 조금 쓰린 느낌이어서 왔어요.
+",Korean
+네 왼팔 내밀어 보세요.,Korean
+"아니요. 가족 중에 폐암으로 돌아가신 분들이 많아서 절대 안 해요.
+",Korean
+"열감이 있어요. 그래서 더 욱신거려요.
+",Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+"오늘따라 혈압이 더 낮아서요.
+",Korean
+검사 과정에서 팔목에 힘이 많이 들어가 저릿한 느낌이 들 수 있습니다 많이 아프시면 말씀해 주세요.,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+"대변 보고 물 내리는데 보니까 피가 흥건했어요.
+",Korean
+한의원에서 처방받아서 드시는 건가요?,Korean
+아니요. 속 쓰릴 때 먹는 약이 뭔지 몰라서요.,Korean
+꾸준히 약을 복용하시고 발라야 빨리 낫습니다.,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+숨쉬기가 어려운 느낌이 드세요?,Korean
+드레싱은 매일 해야 하는 치료이고 이제 상처 회복을 위한 다른 치료가 들어갑니다.,Korean
+고혈압 진단 받은적 있나요?,Korean
+가래의 상태를 말해 주세요.,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+심장 박동이 빠르고 두근거리나요?,Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+평소 음주량을 토대로 환자분의 건강 상태를 파악할 수 있습니다.,Korean
+짜 먹는 위장약은 먹어 봤습니다.,Korean
+먹고 있는 약에 따라 약 처방이 달라질 수도 있어요.,Korean
+저번 주에 회충약 먹었어요.,Korean
+균의 감염이 우려되기 때문에 환부에 넓게 바를 예정입니다.,Korean
+괜찮습니다. 혹시 외래 약 처방 받은 거 드시는 중이신 건가요?,Korean
+"허리를 펴면 날카로운 통증이 느껴져요.
+",Korean
+몸에 힘이 없고 무력한가요?,Korean
+수액 왜 이렇게 빠르게 떨어지나요?,Korean
+"애가 먹는 족족 다 토해서요.
+",Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+네 맞습니다 입원 날짜요.,Korean
+정확한 원인이나 유발인자는 밝혀지고 있지 않지만 특정한 원인을 통해 손목에 터널이 좁아지면서 신경이 압박되어 발생합니다.,Korean
+"일하다 뒤로 굴러서 넘어졌는데 허리가 너무 아파요.
+",Korean
+우선 통증이 있으니까 이렇게 진행하도록 하십시다.,Korean
+진료받은 병원을 기재해야 하거든요.,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+그런 건 아니고요. 어떤 약 드시는지 확인을 해야 해서요.,Korean
+잠시 후 담당 선생님께서 회진을 오십니다.,Korean
+육 개월 이내에 꾸준히 복용 중인 약 있으세요?,Korean
+네. 지금 상태로 봐서는 테라마이신 연고가 많이 필요할 거로 보입니다.,Korean
+"자궁근종이 있어서 수술하러 왔어요.
+",Korean
+지금 혹시 변비가 있나요?,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+담배 하루에 몇 갑 피나요?,Korean
+그 검사를 받거나 진단받은 적 없어요.,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+과거에 크게 질병을 앓은 적이 있나요?,Korean
+네 맞아요. 흡연으로 칩니다.,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+발기 부전으로 인해 고생하신 적 있으신가요?,Korean
+배가 아파 병원에 다녀왔어요.,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+코로나 의심 증상은 없으셨죠?,Korean
+얼마 만에 술을 마시는 건가요?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+"운전하다가 길가에 차를 박으면서 가슴을 운전대에 팍 맞았는데 그 후로 가슴이 답답해요.
+",Korean
+예전부터 소화 불량이 있었나요?,Korean
+그럼 이따 드실 약만 가지고 계시고 나머지는 확인 후 돌려드리겠습니다.,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+한국에서 가장 흔한 만성 위염은 표재성 위염입니다. 비후성 위염은 흔하지 않습니다.,Korean
+수술은 잘 끝난 걸로 알고 있어요. 너무 아프시면 진통제 놔 드릴까요?,Korean
+위암 수술받고 빈혈이 생겼습니다.,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+당뇨 검사받아보신 적 있으세요?,Korean
+보통 손목 보호대를 착용하고 약물치료를 병행합니다.,Korean
+손으로 이렇게 눌렀을 때 크기 변화가 없으면 이미 복강과의 연결이 없는 상태기 때문에 시간이 지나면 음낭에 고여 있던 체액이 흡수되어 사라져요.,Korean
+수술받은 적 있으면 알려주세요.,Korean
+배 통증 부위가 어딘가요?,Korean
+여기가 괴롭다 싶은 부위가 있으세요?,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+"변비 있어서 마그밀 복용해요.
+",Korean
+안구 질환 관련 약 먹는 중입니다.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+"저염 식사 고집하고 있어요.
+",Korean
+비형간염 예방 접종 후 이상 반응은 없으신가요?,Korean
+원래 자세로 돌아왔을 때 통증이 몇 분 째 계속 남아있다면 정밀 검사를 받아보는 것이 좋습니다.,Korean
+"제가 원래 고혈압이 있는데 갑자기 혈압이 높게 나와서 왔어요.
+",Korean
+맞습니다. 검사는 선택 사항입니다.,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+흡연 기간이 어떻게 되세요?,Korean
+어떤 것에 알레르기가 일어나나요?,Korean
+"며칠 입원해 있고 싶어서요.
+",Korean
+일 년 전에 타 병원 내원한 적 있어요.,Korean
+아니요. 약은 안 먹었어요.,Korean
+"배가 아프면 무조건 설사해요.
+",Korean
+물론입니다. 내성이 생길 수 있어요. 수면 유도제 복용을 줄여 보도록 하죠.,Korean
+여행 가기 전에 말라리아 약을 복용했었어요.,Korean
+"소변볼 때 끝부분이 계속 따갑네요.
+",Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+음 특별히 따로 먹는 약은 없습니다.,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+아니요. 방광을 채워야 가능한 검사가 예정되어 있습니다.,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+약 계속 드시면 좋아지실 거예요.,Korean
+두드러기 같은 게 올라왔었어요.,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+코로나 유행 지역 공항에 경유했는데 이것도 방문이라고 친다면 유행 지역에 방문했습니다.,Korean
+하루에 몇 시간 주무시나요?,Korean
+현재로서는 심각한지 진단하기 어려우니 검사를 진행하는 겁니다.,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+갑자기 가슴이 답답한 느낌이 듭니다.,Korean
+피가 섞인 변을 보시나요?,Korean
+간염 검사 관련 양성인가요?,Korean
+"네. 금연을 해야 한다는 생각조차 한 번도 없었습니다.
+",Korean
+근래에 앓은 적 없어요.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+아픈 이유는 여러가지 일 수 있습니다. 일단 신체검사 및 몇 가지 검사를 해 보겠습니다.,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+입원 관련 안내는 의사 회진 시 확인 가능합니다.,Korean
+마지막 호흡곤란이 온 게 언제였죠?,Korean
+이번 주에 술 얼마나 드셨나요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+"아. 저 팔꿈치가 움직일 때마다 통증이 있어서요.
+",Korean
+감기약 삼 일치 받았어요.,Korean
+약 먹고 물리치료를 꾸준히 하면 회복이 될 겁니다.,Korean
+거품뇨는 사람마다 정도가 다르기 때문에 정확한 양을 측정하기는 어려우며 평상시보다 거품이 많이 나오거나 일정 시간이 지나도 거품이 없어지지 않는 경우를 말합니다.,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+환자분 식사 패턴을 파악하려고 여쭤봤어요.,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+병상 부족으로 가까운 다른 병원에 입원해야 할 수도 있습니다. 불편 끼쳐드려 죄송합니다.,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+괜찮아요. 치료만 잘 해주십쇼.,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+결핵은 어떻게 하고 계시죠?,Korean
+약물에 의한 피부염이 일어나게 되면 접촉성 피부염 치료 후 다른 방법으로 치료를 진행하게 됩니다.,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+같은 약이 없을 수도 있으니 가까운 약국으로 가세요.,Korean
+입원 절차 밟기까지 집에 있을 예정입니다.,Korean
+알겠어요. 병원 좀 빨리?확인해 주세요.,Korean
+잠깐 쉬었다가 해도 될까요? 숨을 못 쉬겠어요.,Korean
+두통이 심할 때도 있나요?,Korean
+사람 간 간격을 넓게 하고 방역도 잘하고 있기 때문에 그러지 않을 것입니다.,Korean
+단기간에 살이 많이 빠지는 건 문제가 있는 거예요.,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+"옆구리 통증이 제일 심해요. 칼로 찌르는 것 같아요.
+",Korean
+평소에 복용하는 약이 있나요?,Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+변 전체가 붉거나 검게 나오나요?,Korean
+불면증이 심하신 거 같아요.,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+"손가락에 수포가 생기면서 빨개지더니 나중에는 점점 가려워지더라고요.
+",Korean
+"고환이 많이 부어서 왔어요.
+",Korean
+근육을 무리하셔서 그런 걸 수도 있어요 선생님이랑 한 번 더 말씀하셔야 할 것 같아요.,Korean
+가족의 동의가 없어도 제 의지로 수술할 수 있나요?,Korean
+구토를 많이 하셨으면 검사를 못 할 수도 있어요.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+"큰 개에게 물렸는데 진물 나고 상처가 심해졌어요.
+",Korean
+소변볼 때 불편감이 있나요?,Korean
+"요실금은 아직 안 온 것 같아요.
+",Korean
+벽 반대쪽을 보고 계시면 키와 몸무게 측정 도와드릴게요.,Korean
+"유리 조각이 발에 박혔는데요.
+",Korean
+퇴원하고 나서 진단서 발급하러 와도 괜찮은 거죠?,Korean
+현기증 때문에 어지러우신 거죠?,Korean
+침 삼킬 때 아픈가요?,Korean
+네. 몇 년 전에 교통사고로 허리를 크게 다쳐서 수술을 받았습니다.,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+네. 암 초기 진단받아서 병원 통원 치료하고 있어요.,Korean
+백내장 수술하면 거즈로 눈을 가리는데 앞이 잘 안 보여 넘어질 수 있어서 항상 누가 옆에 있는 게 좋아요. ,Korean
+네. 그것도 부작용이라 할 수 있습니다.,Korean
+고혈압 진단 받은적 있나요?,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+제가 이틀 후는 안 되는데 이틀마다 소독 받아야 하면 어떡해요?,Korean
+어젯밤에 수면제 먹고 잤어요.,Korean
+체중이 한 달에 몇 킬로 쪘나요?,Korean
+되셨습니다. 알코올 솜으로 꾹 누르세요.,Korean
+간호사 선생님께 직접 연락드리는 것 아니죠?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+"아기가 젖도 잘 안 먹고 계속 울어서 어디 아픈 것 같아서 왔어요.
+",Korean
+네 그러면 검사받기는 어렵고 예약하고 가시면 될 것 같아요.,Korean
+"일주일 전에 수술받은 팔에 고름이 찼어요.
+",Korean
+최근 구토한 적 있으세요?,Korean
+"허리랑 다리 위주로 아파요. 움직일 수가 없어요.
+",Korean
+이차 감염을 ��기 위해 쓸 겁니다.,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+몇 년 전에 결핵에 걸려서 입원한 적이 있었거든요.,Korean
+그래도 발열과 관련해서 검사를 진행하시는 걸 권유드립니다.,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+흡연을 시작한 나이를 아세요?,Korean
+욕창이 심해지면 뼈까지 노출될 수 있고 합병증으로 감염이나 골수염이 생길 수도 있습니다.,Korean
+아직도 가슴 쪽에서 통증이 올라오나요?,Korean
+"어제까지는 괜찮았는데 갑자기 옆구리가 너무 아파요.
+",Korean
+숨 쉴 때 불편하진 않으신가요?,Korean
+최대한 수술은 피하도록 합시다.,Korean
+수면내시경이지만 간혹 환자분에 따라 혹은 당일 컨디션에 따라 진정제와 진통제를 투여하여도 검사 도중 깨는 경우가 있습니다.,Korean
+통증이 얼마 만에 오나요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+위산 과다일 수도 있고 지금은 정확한 진단을 내리긴 어려워요.,Korean
+하부 요관결석의 경우 배뇨통 빈뇨 잔뇨감 하복통 외성기 부위 통증을 유발하기도 합니다.,Korean
+의사 처방 없이 임의 복용하는 건 위험합니다.,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+목 안이 아프다는 느낌을 받으셨나요?,Korean
+집안에 당뇨 환자 있나요?,Korean
+주사는 맞긴 했는데 해외 나간 적은 없네요.,Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+검사 결과는 다음 주에 나옵니다. 예약 잡아드릴까요?,Korean
+"귀 안 말고 이 겉에 부분들이 간질간질하고 수포가 있는 것 같아요.
+",Korean
+심장이 두근대는 게 멈추질 않았어요.,Korean
+월경과다는 빈혈을 유발할 수 있으니 원인을 찾아보도록 하죠.,Korean
+언제부터 알레르기 약을 복용하기 시작했어요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+"""입원, 수술 경험 있으시면 말씀해주세요.""",Korean
+천식도 완치될 수 있나요?,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+환자분이 입원하실 자리가 저녁 늦게 준비가 됩니다.,Korean
+보훈병원에 갔었어요. 강동구에 있는 거요.,Korean
+"오른팔이 잘 안 펴져요. 힘이 잘 안 들어가는 것 같기도 해요.
+",Korean
+물 포함하여 금식하시고 소파에 앉아 대기하시면 담당 간호사 선생님께서 안내해 드릴거에요.,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+호흡기 관련 병력 있으세요?,Korean
+정확히 아픈 부위가 어디예요?,Korean
+"술은 하루걸러 하루 마시고 소주 다섯 병정도요.
+",Korean
+입원 치료한 적 있으신가요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+알레르기 치료는 얼마 동안 받으셨어요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+"치아가 안 좋으셔서 힘들어하세요.
+",Korean
+헬리코박터균 감염 검사를 해야 알 수 있습니다.,Korean
+네. 많이 부었네요. 오늘은 검사한 후 얼음 찜질 좀 많이 하세요.,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+가슴 통증이 있진 않으신가요?,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+언제부터 미식거리는 증상이 있었어요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+"몸이 너무 아프면 잠도 자기 힘들다는 것을 이번에 알게 되었네요.
+",Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+몸이 많이 피로하다고 느끼시나요?,Korean
+일반적인 기능성 소화불량 때문이라면 투약이 효과적입니다.,Korean
+통증이 어느 정도 심해요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+에이형인데 혈액형 검사 다시 해보고 싶어요.,Korean
+전에 디스크 때문에 허리 수술 한 적은 있어요.,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+"손목 긋고 죽으려고 했어요.
+",Korean
+네. 약 효과를 떨어뜨릴 수 있어서 안 드시는 게 나을 것 같아요.,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+"대변볼 때 어디가 아프냐는 말씀이세요?
+",Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+술을 한 달에 몇 번이나 자주 드세요?,Korean
+네. 오십 살 때 폐암 수술하고 치료 중에 있어요.,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+특별히 식욕이 없어진 때가 언제인가요?,Korean
+특이사항은 마취가 잘 안 들거나 마취제에 알레르기가 있는 경우입니다.,Korean
+약 복용으로 인한 어지럼증이 발생되는 건 있을 수 있는 증상 중 하나인데 어지럼증이 많이 심하시면 다른 약성분으로 변경 고려해보겠습니다.,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+동의하셔야 해당 약품을 쓸 수 있어요 조금 비싸긴 합니다.,Korean
+오래된 것은 기록이 없기도 해서 수술을 받으신 정확한 내역을 아는 것이 좋습니다.,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+수면제 복용하신 지 얼마나 됐는지 알려주세요.,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+목이 너무 마르면 젖은 수건을 입에 대는 것도 좋은 방법입니다.,Korean
+흡연 기간 대략적으로 알려주세요.,Korean
+수술 시에는 보호자 동의서가 필요해서요.,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+통증으로 인해 얼마나 자주 아프세요?,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+혈압약을 꾸준히 드신 거로 기억해요.,Korean
+요새 약 먹는 걸 자주 잊어버려서 잘 기억이 안 나요.,Korean
+철분제 처방받았는데도 안 먹는 중입니다.,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+"머리가 빙빙 도는 느낌이에요.
+",Korean
+시력이 안 좋아졌거나 흐리게 보이는 증상이 있나요?,Korean
+요즘 발기는 잘 되시나요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+"안녕하세요. 저 요즘에 속도 안 좋고 토도 하루에 두 번 이상하고 헛구역질도 계속해서 왔어요.
+",Korean
+겨울이면 다시 통증이 오나요?,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+항문 출혈 가능성이 높고 그 경우 심각한 질환의 가능성은 낮습니다.,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+"역도 들다가 팔이 어긋난 거 같아요.
+",Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+지금 검사 예약이 밀렸나요?,Korean
+바이러스성 장염은 일반적으로 바이러스 검출 없이 증상과 진찰만으로도 진단하기 때문에 원인을 찾는 것은 어려울 수도 있습니다.,Korean
+몸에 열이 계속 오르나요?,Korean
+통증이 몇 분마다 오나요?,Korean
+특이 혈액형이 뭐죠? 처음 들어봐요.,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+청진 말고 다른 검사도 병행해 주세요.,Korean
+혹시 빠질 때 통증이 더 심하거나 그런 부분은 따로 없으실까요?,Korean
+혹시 다른 수술 하신 적이 있다면 수술할 때 참고해야 하기 때문입니다.,Korean
+주치의 선생님께 진통제 원하신다고 말씀드릴게요.,Korean
+알레르기 반응을 보였던거 있으면 다  말씀해주세요.,Korean
+"길을 가다가 갑자기 토를 하시더니 쓰러지셔서 병원으로 데리고 왔어요.
+",Korean
+통증이 어떤 식으로 반응하나요?,Korean
+"고기 먹다가 뼈가 입 안쪽을 찌른 것 같아요.
+",Korean
+부작용 포함하여 특이사항이 있으셨나요?,Korean
+결핵 치료 기간이 오래된 건가요?,Korean
+아니요 주사 말고 알약 물약처럼 약을 말하는 거예요.,Korean
+당뇨약 끊으신 지 일주일 되었어요.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+네 정리가 되는 대로 일반 병실로 옮겨드리겠습니다.,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+일단 응급처치 후 손상 정도를 확인해 볼 겁니다.,Korean
+갑자기 가슴이 아프다거나 숨쉬기 어렵지 않으셨고요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+간염으로 아팠던 시점을 기억하세요?,Korean
+"네. 배변 볼 때 너무 아파요.
+",Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+기존에 질환이나 질병이 있으셨나요?,Korean
+네. 제균을 위해 드시는 항생제가 독해서 술은 절대 드시면 안 됩니다.,Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+알레르기 때문에 피해야 하는 것이 있으세요?,Korean
+키가 아마 백칠십이 센티이고 몸무게는 오십일 킬로요.,Korean
+무통 주사 맞아도 통증이 있는데요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+절대 누우면 안 됩니다.,Korean
+속이 불편하다고 자주 느끼시나요?,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+예전부터 소화 불���이 있었나요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+"배는 아픈데 앉으면 똥은 또 안 나오고 그래요.
+",Korean
+있어요. 그래서 심한 운동이나 움직임은 자제하는 중이에요.,Korean
+짜 먹는 위장약은 먹어 봤습니다.,Korean
+한 번에 잠에 들기가 어려우실까요?,Korean
+피부가 오돌토돌하고 간지러운 증상이 시작된 건 언제인가요?,Korean
+"두 다리 다 저려요.
+",Korean
+어느 부위가 아파서 오셨나요?,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+혹은 오염된 분변이나 축산물에 접촉한 적이 있나요?,Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+제가 크게 아픈 건 아닌 이상 병원을 안 가서 오랜만에 병원 온 거예요.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+오래 걸립니다 면역요법도 쉽지는 않습니다.,Korean
+술과 담배는 안 하시는 게 도움이 되실 거고 스트레스받지 않는 게 중요합니다. 혹시 술 담배 하시나요?,Korean
+허리 사오 번에 수술했어요.,Korean
+지금 아픈 게 느껴지실까요?,Korean
+통증이 간헐적으로 있는 것입니다.,Korean
+두통이 좀 심하셔서 약을 자주 드세요.,Korean
+병까지는 아니고 장 트러블이 좀 있어요.,Korean
+결핵약으론 어떤 거 드시고 계세요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+건강 검진도 주기적으로 받는 게 중요해서요 받은 지 오래 되었으면 한 번 더 해보시죠.,Korean
+가래를 자주 뱉는 편인가요?,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+아니요 주사 말고 알약 물약처럼 약을 말하는 거예요.,Korean
+"아 네. 고름이 잡힐 때마다 집에서 가능하면 짜려고 하는데 그러면 더 번지는 것 같아요.
+",Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+네. 엽산 먹어야 한다길래 먹고 있어요.,Korean
+언제부터 그 증상이 나타났나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+수술 후 흉막 삼출 무기폐 폐렴 호흡부전이 가장 높은 빈도를 보이고 있습니다.,Korean
+자극성 하제 사용을 고려할 수있으나 지속적인 사용은 내성 위험이 있습니다.,Korean
+하루 몇 갑의 흡연을 하시나요?,Korean
+통증이 자주 생기는 편인가요?,Korean
+자연스러운 갱년기 증상일 수 있습니다.,Korean
+현재 구토 증상이 있나요?,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+문제가 있는 건 아니고 수술 방법이 달라질 수도 있기 때문입니다.,Korean
+염증 수치가 올라갔다는 것은 백혈구가 활발히 활동 중임을 의미합니다.,Korean
+지금은 무슨 약 드세요?,Korean
+영부터 십 중에 통증이 얼마나 되세요?,Korean
+마지막 호흡곤란이 온 게 언제였죠?,Korean
+큰일이 나는 건 아닌데 약물 부작용 위험이 있어요.,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+처음 통증 있었던 게 언제죠?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+"얼굴로 좀 마비가 온 것 같아요.
+",Korean
+성생활에 어려운 점이 있으세요?,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+토할 것 같은데 토하기 힘든 상태인가요?,Korean
+씨티는 아프지 않고 요로조영술시 조영제 주입 시 약간 뻐근하실 수 있습니다,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+네 연고는 안 바르셔도 됩니다.,Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+술을 과하게 먹는 편인 가요?,Korean
+사람의 몸은 물이 칠십 퍼센트 이상으로 구성되어 있습니다. 부족 시 건강 문제가 발생할 수 있어요.,Korean
+단순히 접촉성 피부염일 수도 있습니다.,Korean
+병원에 해당 기관으로 안내를 도와드리겠습니다.,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+네 알겠습니다. 주사 놔드릴게요.,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+이번에 입원하면 제 생에 첫 입원입니다.,Korean
+빈뇨 문제는 언제부터 있었죠?,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+드셔도 되는데 카페인을 너무 많이 드시면 위장에도 안 좋고 줄이시는 게 좋겠습니다.,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환이나 생리 기능에 따라 달라집니다.,Korean
+보통은 통증을 수반하지 않으나 불편하실 수 있습니다.,Korean
+자는 중에 갑자기 토기가 올라와서 급하게 화장실 가서 토했어요.,Korean
+"어깨를 돌리거나 팔을 좀 많이 쓰면 어깨가 빠지는 느낌이 듭니다.
+",Korean
+소화불량 때문에 평소 생활이 힘드셨나요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+당뇨로 병원에서 꾸준히 치료받고 계신가요?,Korean
+"혈뇨 몇 번 있었어요.
+",Korean
+특정 음식에 알레르기가 있습니까?,Korean
+아니요. 연고의 일시적인 효과일 수 있어요.,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+물집이 잡힌 경우 이 주에서 사 주 가량 통증을 호소할 수 있습니다.,Korean
+메스꺼움은 주로 식전에 나타나나요?,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+어디가 아픈지 정확히 알려주셔야 빠른 치료가 가능합니다.,Korean
+배에 가스가 차서 힘드신가요?,Korean
+"아이 소변 색이 푸르딩딩해요.
+",Korean
+일주일 음주량이 어떻게 되세요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+암을 진단받은 가족이 있습니까?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+삼일 정도 먹는 건 괜찮아요 우선 변비약 처방해 드릴게요.,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+"지금 임신 초기인데 급성 빈혈이 온 것 같아요.
+",Korean
+"요로결석 초기 증상이라 알고 있습니다.
+",Korean
+작년부터 어머니께서 고혈압에 걸리셨어요.,Korean
+왼쪽 발을 좀 물렸어요.,Korean
+"확실히 요즘 수면이 어렵긴 합니다.
+",Korean
+이 부위가 아픔을 느끼시는 거죠?,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+비급여 항목으로 전액 본인 부담이기 때문입니다.,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+아무래도 마취크림 바르는 것이 좋으십니다.,Korean
+화상 부위가 완전히 아물 때까지 외부 물질 차단이 가장 중요합니다.,Korean
+언제부터 미식거리는 증상이 있었어요?,Korean
+"아이가 또래보다 키도 많이 크고 성장 속도도 많이 빠른 것 같아서 관련 검사받고 싶어요.
+",Korean
+격리 병실인 만큼 방역은 더 신경 써서 하고 있습니다.,Korean
+진료받아 보셔야 알 수 있어요.,Korean
+"수술 부위가 붓다 못해 고름이 나와요.
+",Korean
+먹고 토한 것도 포함해서 말씀해 주세요.,Korean
+"왜 그런지 잘 모르겠는데 입맛도 없고 안 먹게 되네요.
+",Korean
+시작한 나이뿐 아니라 음주량과 횟수 등도 함께 고려합니다.,Korean
+"무거운 물건을 집으려고 하다가 확 들었는데 팔이 너무 아파서 물건을 놓쳤거든요.
+",Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+혹시 그 후로 구토나 설사가 나타나지는 않았나요?,Korean
+네 수술 부위 정확히 인지하고 계세요.,Korean
+대변을 볼 때 피가 보이나요?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+환자복 갈아입으시면 바로 진행하도록 하겠습니다.,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+통증이 어떤 식으로 느껴졌는지 설명해 주실래요?,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+비형 간염 주사 맞고 있어요. 이제 한 번 남았습니다.,Korean
+복통 증상은 언제부터 있었나요?,Korean
+흉부 엑스레이와 가래검사 등을 시행하도록 하겠습니다.,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+그냥 약국에서 진통제 사 먹었어요.,Korean
+가슴 통증이 얼마나 가는 거죠?,Korean
+벽 반대쪽을 보고 계시면 키와 몸무게 측정 도와드릴게요.,Korean
+결핵은 약물로 치료받고 계세요?,Korean
+통원치료를 꼭 하셔야 한다면 어쩔 수 없지만 댁에서 계속 소독하고 붕대 자주 갈아주셔야 합니다.,Korean
+독감 주사는 언제 맞았나요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+얼굴이 빨간데 몸에서 열이 나나요?,Korean
+"만성신부전 진단을 받았는데 매번 소변볼 때마다 불편함을 느껴요.
+",Korean
+"저번에 왼쪽 다리 수술했는데 원래 이렇게 붓나요? 너무 부어서 검사 다시 한번 해주세요.
+",Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+혈액 검사할 수 있는 넉넉한 양을 채혈해야 합니다.,Korean
+"소화가 잘 안되는 느낌이에요.
+",Korean
+네. 부정맥 진단을 위해서 심전도 검사 등을 받아볼 수 있습니다.,Korean
+새로 처방한 약을 언제 드셔야 하는지 알려 드리려고요.,Korean
+체중 변화가 중요한 요인이 될 수 있어서요.,Korean
+잘 안 나올 때는 우선 모유와 분유를 혼합한 혼합수유를 권해드립니다.,Korean
+혹시 잠을 잘 못 드시나요?,Korean
+"아니요. 소변 색이 그렇진 않아요.
+",Korean
+소화가 어렵거나 하진 않나요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+아직도 소변을 보고 싶은데 잘 안 나오나요?,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+어디에 있는 연세 이비인후과예요?,Korean
+몸이 피로하다는 생각을 해보신 적 있나요?,Korean
+검사의 목적 검사의 부작용 검사를 하지 않을 경우의 대안 등 주요한 정보를 알려드리고 그에 대해 충분히 이해한 후 검사를 진행하고자 동의서 작성을 하고 있습니다.,Korean
+공복기가 오래되거나 식후에 증상이 있을 수 있습니다.,Korean
+이번 검사에서는 정상수치 확인했습니다.,Korean
+다른 사람의 피가 몸속에 들어가는 게 수혈이에요.,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+"복부 쪽이 계속 낫질 않네요.
+",Korean
+아픔이 며칠 주기로 찾아오나요?,Korean
+거절하실 경우 최대한 같은 의사를 지닌 분들과 같은 병실에 배정해 드리고 있습니다.,Korean
+"자궁근종이 있어서 제거하러 왔습니다.
+",Korean
+구토가 나아질 기미가 있나요?,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+네 통증 양상에 따라 달라서 검사 후 알려드리겠습니다.,Korean
+당뇨 약 먹고 계세요?,Korean
+"변비가 워낙 심해요. 딱딱하고 냄새가 심해요.
+",Korean
+하루에 몇 번씩 흡연하세요?,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+격리 병실인 만큼 방역은 더 신경 써서 하고 있습니다.,Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+그거 포함해서 먹고 있는 약이나 꾸준히 맞는 주사 같은 거 있나요?,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+네 저희가 환자분의 치료를 위해서 생활 습관도 파악해야 합니다.,Korean
+지금 알려주셔야 곧 입원이 가능합니다.,Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+일주일 전에 아나필락시스 때문에 다른 병원에 실려 간 적이 있어요.,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+소 대변검사는 뭐 때문에 하는 거예요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+아이들도 위염에 걸리는 경우가 있습니다.,Korean
+면회 가능 시간은 정해져 있습니다.,Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+네. 결핵이랑 연결이 되어 문제가 됩니다.,Korean
+신장 조직 일부를 얻어서 현미경으로 관찰하는 것인데 그 조직을 얻기 위해 바늘을 넣게 됩니다.,Korean
+기침할 때 피가 터져 나오나요?,Korean
+부모님 중에 암 병력이 있나요?,Korean
+네 몇 가지만 더 여쭤보고 신체검사를 시행하겠습니다.,Korean
+"네. 매일같이 여섯 시간 정도 자는 것 같네요.
+",Korean
+통증이 느껴지는 세��가 어느 정도인가요?,Korean
+통증이 느껴지는 세기가 어느 정도인가요?,Korean
+이전 기록을 알아야 앞으로의 진료 방향에 대해 결정할 수가 있어서요.,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+부작용은 어느 주사에나 존재합니다. 만 육십오 세 이상이시면 권장 하고 있으니 접종하시는 게 좋아요.,Korean
+진료받아 보셔야 알 수 있어요.,Korean
+피가 섞인 대변을 보세요?,Korean
+왼쪽 어깨 이외에 다른 곳은 불편한 것이 없으신가요?,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장 드립니다.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+피검사로 풍진 감염 여부를 알아봅니다.,Korean
+네 일반적인 해열제 종류가 여러 개여서 구체적으로 알려 주셔야 합니다.,Korean
+호출 벨을 누르시면 담당 간호사가 병실로 오겠습니다.,Korean
+"고환이 많이 부어 내원했어요.
+",Korean
+저 혼자만 증상 있어요.,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장 드립니다.,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+"아이 콧물이 계속 흘러요.
+",Korean
+가족 중에 고혈압인 분이 있으면 알려주세요.,Korean
+밤에 잠을 충분히 자지 못하시나요?,Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+알레르기 검사에 혈액 체취는 기본적인 검사라 피 뽑기 싫으셔도 하셔야 합니다.,Korean
+내일 저녁 회진 후 빼도록 하겠습니다.,Korean
+아이 몸무게 측정할 때 옷은 입은 상태로 눕히시면 됩니다.,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+불면증으로 언제부터 잠을 못 잤나요?,Korean
+우선 통증이 있으니까 이렇게 진행하도록 하십시다.,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+음식이나 약물 알레르기 있으세요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+네 지금 바로 교정 치료랑 약물 치료할까요?,Korean
+최근에 독감 주사 맞으셨나요?,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+낫는 게 최우선이니까 최대한 효과적인 치료만 신경 써주시면 됩니다.,Korean
+시력에 이상이 있거나 물체가 흐리게 보이거나 초점이 안 잡히거나 하지는 않았나요?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+네 아마 하반신 마취를 하신 것 같습니다.,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+고혈압약 요즘 드시는 것이 있나요?,Korean
+간염 처방 약 알 수 있나요?,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+구토나 구역감 또는 호흡 곤란 등의 증상이 나타날 수 있습니다.,Korean
+환자분이 치료해내고 말겠다는 마음을 잡으셔야 병이 빨리 호전 될 수 있으세요.,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+수분 섭취가 줄거나 비타민 비를 많이 섭취하면 소변 색이 진해질 수 있습니다.,Korean
+과일을 잘 챙겨드시는 건 매우 좋은일이지만 너무 많이 섭취하시게 되면 혈당 문제나 전해질 불균형이 오는 경우도 있습니다.,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+몇 년 전에 저온 화상을 입어서 입원해서 치료했었죠.,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+밤에 통증이 있을 때 보호대가 증상 완화에 도움이 될 수 있습니다.,Korean
+지금은 검사부터 진행하고 그 후에 드시는 걸 추천드립니다.,Korean
+"만성신부전 진단받은 이후 두통이 매우 심하고 어지럽고 속도 안 좋아졌어요.
+",Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+엑스레이보다 씨티가 정확할 때가 더 많을 수 있어요.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+흉부에 불편한 곳이 있나요?,Korean
+다행히 ���직 아이가 심각한 상태가 아닙니다.,Korean
+중간에 자의로 복용을 중단하면 항생제 내성이 생길 수 있으며 치료 실패율이 높아집니다,Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+몸무게 측정하겠습니다. 신발 벗고 체중계 위에 올라와 주세요.,Korean
+통증이 가까운 부위에서 나타나네요 경과를 지켜보는 것이 좋겠습니다.,Korean
+"왼쪽 무릎 쪽이 시려요.
+",Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+소변에 피가 함께 나오나요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+예방접종 접수하셔서요 부작용이 있었나 해서 여쭤보는 겁니다.,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+"양쪽에 있는 고환들이 다 아파요.
+",Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+요즘 혹시 흉통이 있나요?,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+결핵 진단 후 치료는 잘 받으셨나요?,Korean
+틀니 보청기 안경 렌즈 보조기나 심박동기 등 가지고 계신 것이 있으신가요?,Korean
+가스와 변을 없애기 위해서는 변비를 치료해야 합니다.,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+변을 조절하지 못하는 원인은 다양합니다.,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+항생제는 산성도가 너무 높으면 잘 작용하지 못합니다. 잘 작용할 수 있는 산도를 만들기 위해서 복용하셔야 합니다.,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+"네. 다른 증상은 특별히 없었어요.
+",Korean
+난소에서 난자가 나오면 나팔관을 통해 이동하는데 이 길을 막는 것입니다.,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+얼마 전에 감기 약 먹긴 했는데 따로 평소에는 먹는 거 없슈.,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+"오줌을 덜 싼 느낌이 들어요.
+",Korean
+네. 간염 치료하면서 빈혈도 진단받았었어요.,Korean
+심장 박동이 느껴질 정도로 심장이 뛰나요?,Korean
+네 언제부터 피임약을 드셨나요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+경우에 따라 수술할 수도 있어 속단하기에는 이릅니다.,Korean
+"잠을 자도 개운하지 않고 몸에 쉽게 피로해요.
+",Korean
+기침 증세가 악화하고 있나요?,Korean
+테라마이신을 자주 발라주는 것이 중요하므로 여러 개 필요합니다.,Korean
+다른 종류의 진통제를 놔드릴게요.,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+월경량 초음파 검사 피검사 등 검사와 확인이 필요합니다.,Korean
+선천적으로 앓았던 질환은 없나요?,Korean
+급하게 수혈을 해야 되는 상황이 아니라면 크게 걱정 안 하셔도 됩니다.,Korean
+평소에 부종이 좀 있으세요?,Korean
+냉동요법으로 사마귀를 제거하기도 합니다.,Korean
+"아니요. 현재는 빨갛고 간지러움만 얘기하는 것 같아요.
+",Korean
+지팡이 말고 휠체어 빌려서 탈 수 있을까요?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+"네. 그때부터 피우긴 했는데 계속 피우건 아니에요.
+",Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+특별히 아픔을 느끼는 곳이 있나요?,Korean
+"자꾸 목에서 피 맛이 느껴져요.
+",Korean
+제가 알코올 알레르기가 있어서 알코올 솜으로 소독하면 피부가 부풀어 올라요.,Korean
+"입안이 찢어진 것 같아서요. 밥 먹다가 볼을 씹었는데 피가 철철 났어요.
+",Korean
+진료받은 적 있냐는 말도 외래의 한 범위나 마찬가지인데 입원 없이 치료받으시러 내원하신 게 맞냐고 여쭙는 거예요.,Korean
+암 판정받으신 적 있나요?,Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+저희 병원 입원기록을 조회해 보겠습니다.,Korean
+궁금한 것은 주치의가 환자에게 설명했으니 직접 안내받으시면 됩니다.,Korean
+두 시간마다 자세를 바꿔야 하는데 힘드시면 자동으로 체위를 바꿔주는 욕창 방지 매트를 사용해 보셔도 좋을 것 같네요.,Korean
+치료에 있어서 의료진이 알고 있어야 도움이 됩니다.,Korean
+���심 수술은 안 했어요.,Korean
+소변을 보고 싶을 때 자주 참나요?,Korean
+종양 치료는 다 끝났나요?,Korean
+당뇨약 드시는 거 있으면 말해주세요.,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+어떤 약을 빼 드리면 되나요?,Korean
+"왼쪽과 오른쪽의 붓기가 달라요.
+",Korean
+대변볼 때 안 힘든가요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+수면 보조제 복용 중이시면 말씀해 주세요.,Korean
+간염 주사였던 것 같아요.,Korean
+최근에 고혈압약 용량이 변화하거나 약을 바꾸거나 하지는 않으셨나요?,Korean
+네. 어제 아스피린 한 알 먹었어요.,Korean
+토할 때 피가 자주 보이시나요?,Korean
+수액 치료는 작은 일시적 도움일 뿐입니다. 생활 습관과 수면 환경개선이 중요해요.,Korean
+지금 진찰받기 전에 건강은 어떠셨나요?,Korean
+종교 때문에 수혈을 못 할 것 같은데요?,Korean
+건강 상태 파악을 위해 기본 정보 수집이라고 생각하시면 됩니다.,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+그것 포함 여러 형태의 혈액형 종류가 있습니다.,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+살짝 긁어서 부풀어 오르는 것과 켈로이드성 피부와는 관련이 없습니다.,Korean
+네 바로 혈액형 검사 가능합니다.,Korean
+"무기력하고 삶의 의지가 없어요.
+",Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+담배는 몇 살부터 피우기 시작한 거예요?,Korean
+요즘은 대부분 반려견들도 예방 접종을 합니다.,Korean
+수술적 치료 시행과  합병증 발생 여부에 따라 차이가 생길 수 있지만 짧으면 삼일에서 오일 정도 예상할 수 있습니다.,Korean
+"윗부분 어금니 있어요. 거기요.
+",Korean
+혹시 빠질 때 통증이 더 심하거나 그런 부분은 따로 없으실까요?,Korean
+"네. 근데 애가 머리가 자꾸 어지럽다고 해서요.
+",Korean
+"네. 다른 증상은 특별히 없었어요.
+",Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+알레르기 반응 보이시는게 있으신가요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+다른 조영술과 다른 점은 시간별로 조영제가 배설되는 과정을 촬영하여 신장 기능을 확인하는 것 입니다.,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+종양 앓았던 가족이 있으셨나요?,Korean
+간접흡연이 더 위험하다는 보고가 있을 정도로 영향을 많이 미칩니다.,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+잠이 들면 중간에 몇 번이나 깨나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+"자주 토하고 싶고 그렇습니다.
+",Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+피가 섞인 소변을 봤나요?,Korean
+몸이 춥고 떨리는 기분이 드시나요?,Korean
+현재 제왕절개로 인한 후유증이 발견됩니다.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+저번 주에 봤던 반응 검사요.,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+감염 식중독 장폐쇄 등의 원인에 의한 경우 회복까지 시간이 걸립니다.,Korean
+입술 부은 것도 문제가 될 수 있습니다.,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+혹시 머리가 아프시다는 등의 다른 증상은 없으시나요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+방광염이 좀 있어서 약 먹고 있어요.,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+네. 내시경 끝나고는 위에 부담이 될 수 있어 죽 드시는 것을 추천드립니다.,Korean
+약을 먹고 머리가 아프셨던 거예요?,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+네 엑스레이 촬영으로 잇몸의 상태를 알 수 있습니다.,Korean
+혈액형이 다르게 나왔나 확인해볼까요?,Korean
+만약 궤양이 의심된다면 조직검사도 같이 할 거예요.,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+네 신체 외부 자국은 모두 보여주세요.,Korean
+"요관 결석이 의심된다고 하셨어요.
+",Korean
+통증 발현 빈도가 어떻게 되세요?,Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+현기증 느낀 적 있나요?,Korean
+"소변 때문에 화장실 갔는데 안 나오는 경우도 있었어요.
+",Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+"요즘 속이 너무 안 좋아서 아무것도 못 먹이겠고 토도 하루에 두 번은 해서 왔어요.
+",Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+"대변볼 때 피가 주르륵 흘러나왔어요.
+",Korean
+통증 양상의 특징점이 있나요?,Korean
+네. 혈압약 주셔서 먹었어요.,Korean
+가족 이력 외엔 없습니다.,Korean
+잠을 자도 피곤함이 계속 느껴지는 것처럼 불면증이 있으신가요?,Korean
+약물에 대한 알레르기가 있습니까?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+고지방식 등 식습관에도 영향을 받습니다.,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+가슴 두근거림이 자주 있으세요?,Korean
+보호대를 착용하고 약물치료와 주사치료를 병행하여 통증 악화를 막을 수 있습니다.,Korean
+네 병원에 치료 혹은 수술로 입원하신 모든 내용 알려주세요.,Korean
+다행히 약은 잘 받아요.,Korean
+변비 약 어떤 걸 드셨나요?,Korean
+관련이 있다고 뚜렷히 말씀드리기는 어렵지만 의료기록에 적어두고 참고하겠습니다.,Korean
+몇일에 한번 대변을 보시나요?,Korean
+"네. 발 때문에 다른 데까지 아프고 그런 건 없어요.
+",Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+구토를 많이 하지는 않으시나요?,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+몇 가지의 알레르기가 있나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+네 수혈받아보신 적 있으신가요?,Korean
+침상을 보시면 침상 난간이 있는데 이것은 항상 올리시는 게 낙상 예방에 좋습니다. 잘 때는 특히 꼭 올리시고 주무세요.,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+물집 생긴 곳이 냄비 만진 부위 말고 다른 곳에 또 있나요?,Korean
+깨고 난 후 부작용이 없었으면 큰 문제는 아닙니다.,Korean
+"책상에 부딪혀서 멍만 든 줄 알았는데 상처가 나 있더라고요.
+",Korean
+항암 치료제를 복용 중이신가요?,Korean
+심하지 않아도 피부 증상이 나타난 적이 있다면 전부 말씀해 주시겠어요?,Korean
+액세서리도 다 빼고 수술복만 입으셔야 해요.,Korean
+"혈변이 언제부터 시작됐는지 기억이 안 나네요.
+",Korean
+현기증 정도를 말씀해 주세요.,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+부기는 잘 빠지고 있네요.,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+현재 수술시간은 점심시간 전후로 잡혀 있습니다.,Korean
+우선 수액을 멈추고 잠시만 지켜보도록 하겠습니다.,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+이번 검사에서는 정상수치 확인했습니다.,Korean
+의료법상 특정 병원을 소개해 드리는 것이 금지되어 있어서 곤란합니다.,Korean
+"배가 찢어질 것 같이 아파서 왔어요.
+",Korean
+가슴 통증이 어떻게 있나요?,Korean
+"실험용 알코올을 물인 줄 알고 마셔서 내원했습니다.
+",Korean
+네 아마 하반신 마취를 하신 것 같습니다.,Korean
+소화와 관련된 약을 드시고 계시군요.,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+기침할 때 다른 증상이 있나요?,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+발기부전약 드신 적은 있나요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+치료량이 많다 보니 마취크림을 바르더라도 치료 후 통증이 조금 심하실 수도 있습니다.,Korean
+시간당 소변량이 필요하기 때문에 한 시간마다 측정할 것입니다.,Korean
+결핵 치료는 잘 되었나요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+그전에는 음주와 흡연을 얼마나 하셨나요?,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+통증과 관련해서 병원은 다니시고 계신가요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+그러고 보니 장염 걸렸던 적이 없네요.,Korean
+담배도 피우시면 안 됩니다.,Korean
+"밤에 잘 못 자고 계속 깨는 게 좀 불편해서요.
+",Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+수술할 정도는 아니라고 해서 이 주 넘게 입원한 적은 있어요.,Korean
+고혈압 약물치료를 하고 계신가요?,Korean
+"배 잡고 우는 것 보니 배가 아픈 것 같아요.
+",Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+"네. 그런 증상은 못 느꼈습니다.
+",Korean
+모든 병원이 요로결석 수���이 가능한 것은 아닙니다.,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+당뇨 가족력이 있다면 알려주세요.,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+소변볼 때마다 피가 나오나요?,Korean
+가스가 차서 불편한 증상이 있으신가요?,Korean
+아직 다 낫지는 않았습니다.,Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+"꽤 아파서 누기 힘들어요.
+",Korean
+열이 심하지 않다면 외래에서 경구 또는 근육주사 항생제로 염증 치료가 가능 합니다.,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+결핵 수치가 높은 편이신가요?,Korean
+먼저 왜 밥을 못 먹는지 검사를 해 보겠습니다.,Korean
+아니요. 조영제는 주사로 투여합니다.,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+붓고 빠지는 주기가 있나요?,Korean
+피는 변에 묻어 나오는 정도였나요?,Korean
+"아무 음식도 못 먹었어요.
+",Korean
+잇몸 한 번 볼게요.,Korean
+네 아무래도 산소 공급 때문에 코로 숨쉬기가 힘이 들 겁니다.,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+약이 세서 오래 드시면 안 돼요.,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+"감기가 도통 낫지를 않아요.
+",Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+얼마나 자주 기침이 나오나요?,Korean
+비수면으로 해 보시고 힘드시면 잠깐 중단하고 수면을 준비해 보도록 하겠습니다.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+부작용이 거의 없지만 경우에 따라 생길 수도 있습니다.,Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+네 다른 병원에서 처방받은 게 있는지 알아야 해서요.,Korean
+약물 알레르기 있는 거 있으세요?,Korean
+아무래도 특이 혈액형이다 보니 혈액이 부족할 수 있습니다.,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+두드러기가 어느 부위로 올라왔죠?,Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+알레르기가 올라오는 음식이 있나요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+하루에 한 갑은 피우시나요?,Korean
+어디가 제일 심하게 아프시죠?,Korean
+일상생활 중에 알레르기 반응을 보이는 것이 있었나요?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+담배를 피우기 시작한 게 언제예요?,Korean
+"책상 모서리에 눈을 다쳤습니다.
+",Korean
+"감기인지 코로나인지 열이 엄청 높고 온몸에 기운이 하나도 없어요.
+",Korean
+저도 그러면 좋겠지만 펫 시티 검사라고 해서 암 전이 여부를 판단하는 검사라 조직검사 결과가 나와야 처방을 할 수 있는 점 양해 부탁드릴게요.,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+어느 부위에 통증이 심한가요?,Korean
+네 생식기 치료는 산부인과에 해당합니다.,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+"소변을 하루에 한 번 정도밖에 안 봐서 방광염 걸릴까 봐 걱정이에요.
+",Korean
+"생리 양이 많아져서 검사받으러 갔더니 자궁근종이라고 그래서요.
+",Korean
+혈뇨 시 다른 통증은 없었나요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+어느 부분이 붓기가 있나요?,Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+변에 피가 함께 나오나요?,Korean
+"고혈압이랑 당뇨 가지고 있어요.
+",Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+"아이 이마가 뜨끈뜨끈한 게 열이 나는 것 같아요.
+",Korean
+언제 통증이 처음 나타나셨어요?,Korean
+"대변을 볼 때마다 배가 아파요. 그 외의 문제는 없고요.
+",Korean
+틀니도 충분히 흔들거릴 수 있습니다.,Korean
+위에 붕대를 감을 테니 아이가 풀지 않도록 해주세요.,Korean
+"당뇨병 약물치료를 몇 년째 받고 있는데 저혈당이 오면 식은땀이 날 때가 있습니다.
+",Korean
+"아침에 일어나면 얼굴이 많이 부어요.
+",Korean
+장염 증상이 있어서 내과 들렀던 것 ���아요.,Korean
+짠 걸 드시면 붓기가 평소보다 심할 수 있습니다.,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+호흡곤란이 온 적 있어요?,Korean
+치료 기간은 얼마나 되었나요?,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+주사뿐 아니라 복용 중이신 약도 말씀해 주시면 됩니다.,Korean
+"감기인 것 같은데 많이 아파서 왔어요.
+",Korean
+머리가 깨질 듯이 아픈가요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+피를 토할 때가 많이 있나요?,Korean
+아픈 간격이 어떻게 되시나요? 한 번 아프고 난 다음에 다음 통증까지의 시간을 말씀해 주시면 됩니다.,Korean
+"앉지도 서지도 못하게 허리가 아프네요.
+",Korean
+암 증상이 어떤 것이 있었나요?,Korean
+약품 분석 의뢰 숫자에 따라 달라져서 얼마나 걸린다고 확답 드리기 힘듭니다.,Korean
+배의 어느 부위가 아프시죠?,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+"배가 갑자기 아파졌는데 숨 쉬거나 말할 때도 아파요. 한 이틀 된 것 같아요.
+",Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+마취 약물 때문에 구토 및 오심 등 알레르기 반응이 있을 수도 있습니다.,Korean
+암이라는 걸 언제 알았나요?,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+먹었던 음식을 다 토하시나요?,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+어제부터 열이 나신 게 맞는가요?,Korean
+잠에 들기까지 얼마나 걸리시나요?,Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+저 특이 혈액형이라고 들었는데 정확히 모르겠어요.,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+한 시간에 몇 번씩 화장실을 가는 경우는 비정상적인 배뇨 형태이므로 자세한 원인에 대한 검사가 필요합니다.,Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+"역도 들다가 팔이 어긋난 거 같아요.
+",Korean
+마스크를 쓰시는 게 가장 좋습니다.,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+이 코너 돌아가시면 주사실이 있는데 그쪽으로 가 보시겠어요?,Korean
+잠깐 약을 볼 수 있나요?,Korean
+소변을 볼 때 통증이 있나요?,Korean
+네 혈액검사부터 진행할 거예요.,Korean
+독감 접종 언제 맞으신 거죠?,Korean
+속이 불편하다고 자주 느끼시나요?,Korean
+진찰을 하기 위해서는 환자분 상태를 정확하게 파악해야 합니다.,Korean
+평소에 드시는 약이 어떤 병 때문에 드시는 건가요?,Korean
+네 여러 가지 결과가 있으니 내원해서 상세한 결과는 알려 드리겠습니다.,Korean
+환자분 평소 앓고 있는 질환이 있나요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+병이라고 하긴 좀 그런데 평소에 장이 좀 안 좋습니다.,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+가족 중에 유전성 질환을 가진 가족이 있으세요?,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+변비 증상이 처음이신 건가요?,Korean
+재작년 초에 쌍둥이 출산했습니다.,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+심계항진이 있거나 그러진 않으신가요?,Korean
+네 폐 합병증을 예방하기 위해 꼭 심호흡이 필요합니다.,Korean
+결핵으로 약 드시고 계세요?,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+과거에는 엑스레이를 찍었으나 씨티가 더 정확한 검사입니다.,Korean
+우선 주입되고 있는 진통제를 잠시 멈추어 놓겠습니다.,Korean
+아까 주사기로 팔에 찌른거 기억안나세요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+"작업하다가 중간에 그라인더에 긁혔거든요. 약 상자에 있는 걸로 소독하고 약 바르고 밴드 붙이고 있었는데 삼일 전부터였나 진물이 나면서 좀 아파졌어요.
+",Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+"사타구니랑 가까이 있는 허벅지도 아파요.
+",Korean
+어느 ��도로 부기가 심한가요?,Korean
+우선 약효가 있는지 진전을 보고 양을 조절하기 때문입니다.,Korean
+환자분이 통증을 견디실 수 있다면 자연분만을 시도할 수 있어요.,Korean
+생식기에 생긴 사마귀가 있다면 레이저 치료를 시행해볼 수 있습니다.,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+복용 중인 약은 가지고 오셔서 저희에게 꼭 보여주셔야 합니다.,Korean
+타 병원 의사여서 매일 그곳으로 출근합니다.,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+그때 너무 아파서 응급실로 다녀왔어요.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+흔하지 않지만 대장암과 같은 질환 가능성도 있습니다.,Korean
+몸에 안 받는 음식이 있나요?,Korean
+키와 체중에 비교했을 경우 지극히 정상입니다.,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+"혈뇨가 있어서 병원에 왔어요.
+",Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+이 약물은 정확한 용량이 들어가야 하기 때문에 기존 수액과 다른 혈관으로 투여해야 하고 기계를 사용하여 정확한 시간동안 정확한 용량이 들어가도록 조절할 것입니다.,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+초음파 외에는 일반적인 검진 정도의 검사가 이뤄집니다.,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+암 치료 이력이 있나요?,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+"다리가 칼로 찌르는 듯이 심하게 쑤셔요.
+",Korean
+근전도 검사를 통해 신경 손상 정도를 평가해보고 말씀드리겠습니다.,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+"수술 부위에 노란 거 이상한 게 묻어 나와서요.
+",Korean
+고환을 둘러싸고 있는 복막의 일부를 고환 초막이라고 부릅니다.,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+배변 시 혈변 증상을 보이고 계신가요?,Korean
+확인할 테지만 이번 증상은 다시 촬영이 필요할 수 있어요.,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+통증이 나타난 게 언제인가요?,Korean
+통증이 시작된 것이 언제인가요?,Korean
+아스피린 포함이라고 설명해 주신 것만 기억나요.,Korean
+독감 예방 주사는 꾸준히 맞으셨나요?,Korean
+설사를 하는 시기가 있나요?,Korean
+궁금한 것은 주치의가 환자에게 설명했으니 직접 안내받으시면 됩니다.,Korean
+하루 흡연량이 얼마나 되는데요?,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+네 질환마다 기침 소리가 조금씩 다릅니다.,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+네. 이 병이 전파력이 있는 병이라 감염 여부를 확인해 봐야 하거든요.,Korean
+다른 심장 관련 질환은 없나요?,Korean
+검사 결과 아직 통보 안 해주셨어요.,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+복통이나 다른 증상은 같이 있지 않았나요?,Korean
+어디가 가장 통증이 강하죠?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+네. 입원비는 입원일수로 계산됩니다.,Korean
+안과에서 받은 약이고 어디 약 봉투 있을 거야. 가만 있어 봐.,Korean
+통틀어 입원치료라고 말하지만 그 중에서도 수술을 하는 경우도 있어서 질문드렸습니다,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+안정성이 입증된 마취 크림을 사용하기 때문에 부작용이 있더라도 미미한 수준입니다.,Korean
+"뱀에 물리고 다리가 부어 올랐어요.
+",Korean
+예를 들어 병원에서 처방받았다던가 약국에서 구입한 약들이요.,Korean
+일단은 발바닥에 보습제를 바르고 양말 등을 덮거나 비닐을 감싸서 최대한 잘 스며들도록 할게요.,Korean
+통증이 어느 정도 심한가요?,Korean
+음식을 먹고 싶은 생각이 안 들고 식사를 자주 거르나요?,Korean
+그때 너무 아파서 응급실로 다녀왔어요.,Korean
+약을 투여한 정확한 시간을 알면 좋아요.,Korean
+열이 나는 정도나 기간 이런 것에 따라 다릅니다.,Korean
+언제쯤 체중이 급격히 늘었었나요?,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+집 근처 병원에서 소독하시는 게 편하실 거예요.,Korean
+수면제는 너무 많이 드시면 안 됩니다.,Korean
+"어릴 적부터 태워서 하루에 한 갑 정도 태우네요.
+",Korean
+결핵 치료는 꾸준히 받고 계신가요?,Korean
+맹장으로 입원하신 게 처음이셨나요?,Korean
+어떤 음식 먹을 때 소화가 잘 안 되나요?,Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+소변을 보고 닦으면 휴지에 피가 묻어 나오나요?,Korean
+아침 저녁 식전에 위산분비억제제와 식후에 항생제 두 종류를 복용하시면 됩니다.,Korean
+나중에 생기면 또 항생제를 바꿔야죠.,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+부작용은 어느 주사에나 존재합니다. 만 육십오 세 이상이시면 권장 하고 있으니 접종하시는 게 좋아요.,Korean
+동의서에 지금 사인을 하셔야 비급여 진통제를 바로 사용할 수 있습니다.,Korean
+네 간질환 또한 유전적 질환일 수 있기 때문에 위험도가 높긴 합니다.,Korean
+통증이 시작하면 기간이 얼마나 가요?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+덴탈 마스크는 모든 비말을 막기에는 효과가 부족합니다.,Korean
+아니요. 있어도 뭐 감기 정도로 끝났는데요.,Korean
+폐가 완전히 펴지지 않으면 폐렴 등 합병증의 위험이 있습니다.,Korean
+그때부터 아직 안 낫고 계속 앓고 계신 거죠?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+금식을 안 하시고 수술을 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+대변에 물이 많이 섞여 나오나요?,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+언제부터 미식거리는 증상이 있었어요?,Korean
+"담배는 힘들 때 하나씩 태워요
+",Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+지금까지 토한 적이 있나요?,Korean
+어디가 부은 느낌이 있으세요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+"애가 밤새 배를 부여잡고 울었는데 아무래도 배가 아픈 게 아닐까 합니다.
+",Korean
+"네. 요즘 체중이 조금 줄었어요.
+",Korean
+"아이가 밤에 잠을 안 자고 칭얼거려 걱정 되요.
+",Korean
+입으로 피를 토한 적이 있나요?,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+심계항진이 있거나 그러진 않으시는가요?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+네 검사 예약 잡아 드릴게요.,Korean
+아픈 증세를 얘기해 보세요.,Korean
+어떤 약제 사용이 바람직할지 증상을 확인해보겠습니다.,Korean
+심장이 빨리 뛰는 느낌이 있나요?,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+아프신 이유가 암 때문인가요?,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+대변볼 때 불편하지 않으세요?,Korean
+혈압은 정상 수치를 벗어나게 되면 모두 문제라고 할 수 있어요 너무 높거나 너무 낮으면 둘 다 문제입니다.,Korean
+네. 누나랑 어머니가 치료받은 적 있어요.,Korean
+치료받아야 하는 다른 질병이 있으신가요?,Korean
+혹시 저 수술해야 되나요? 왜 물으시는 거예요?,Korean
+"뭘 잘못 먹었는지 설사를 계속해요.
+",Korean
+하루에 몇 개 피우시죠?,Korean
+현기증 때문에 어지러우신 거죠?,Korean
+장운동이 저하되어 단기적으로 자극성 하제 사용을 고려할 수 있을 것 같습니다.,Korean
+복부 팽만감 때문에 불편함을 느끼시나요?,Korean
+기본적으로 수액을 맞긴 합니다.,Korean
+통증 속성이 어떤 식인 가요?,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+의치나 렌즈 보청기 보조기 의안 가발 목발 지��이 심박조율기와 같은 보조 기구 사용하시는 거 있나요?,Korean
+환자분의 경우 이미 간 경화를 진단받은 상황이셔서 앞으로 또 출혈이 일어난다 하더라도 이상할 게 없어요.,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+수액이 지금보다 늦게 떨어지면 말씀해 주세요.,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+"오히려 원래 몸무게보다 오 킬로가 늘었어요.
+",Korean
+암 진단받은 날 언젠지 아세요?,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+어느 정도의 강도로 통증이 느껴지나요?,Korean
+변비 증상이 처음이신 건가요?,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+네 전자 담배를 피우는 것도 흡연의 일종입니다.,Korean
+일단은 소화가 온전히 완료되기까지 최소한 여덟 시간은 걸리기 때문에 여덟 시간 이상은 금식해 주셔야 합니다.,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+네. 확인되었습니다. 우선 키와 몸무게 재고 병실로 안내해드릴게요. 오늘 수술하시고 내일 퇴원 예정이신 거 설명들으셨나요?,Korean
+둘째 낳기 전에 두 번 정도 유산했어요.,Korean
+네 일단 진통제 놔드리기 전에 먼저 검사 진행하도록 하겠습니다.,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+공복기가 오래되면 식후에 증상이 있을 수 있습니다.,Korean
+급성 후두개염이 의심되고 갑자기 후두가 부어서 말도 잘 못하게 됩니다.,Korean
+복부에 많은 고통이 동반되나요?,Korean
+기존에 옷에 쓸려서 아토피 증상이 유발된 적이 있으신가요?,Korean
+네. 음식이 원인일 수도 있습니다.,Korean
+이 병원 와 본 적 있는데요.,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+가족 중에 암 환자분이 계세요?,Korean
+토할 때 피가 같이 나오나요?,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+힘찬 비뇨기과요. 종암동에 있어요.,Korean
+요추 일이 번에 수술했어요.,Korean
+두통약 처방받으려고 갔다 온 적 있어요.,Korean
+평소에 변은 잘 보세요?,Korean
+네 산소 수치 확인 후 필요 시 착용하도록 하겠습니다.,Korean
+네. 해열제를 달아드릴게요. 잠시만요.,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+담배는 대략 피우신 지 얼마나 되셨어요?,Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+몸에 부은 곳이 있나요?,Korean
+대변에 피가 보인적 있나요?,Korean
+만약 세균성일 경우 하루에서 삼 일정도면 후두부종이 가라앉을 거예요.,Korean
+"뒤차가 받아서 목이랑 어깨와 허리에 통증이 옵니다.
+",Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+가족 중에 고혈압 환자인 분이 누구셨나요?,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+일주일만 저희 집에 있다가 요양원으로 가실 예정이에요.,Korean
+현재 간 수치가 높은 편인가요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+어린이 비타민 먹였는데 이것도 말씀드려야 하나요?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+체중 변화가 많진 않으셨어요?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+하루에 담배는 몇 갑 피우세요?,Korean
+침을 삼킬 때마다 아프신가요?,Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+네. 해열제를 달아드릴게요. 잠시만요.,Korean
+변비일 경우 그런 증상이 잘 나타날 수 있습니다.,Korean
+응급실에 같이 가셔서 체온 검사를 받아보는게 좋을 것 같아요.,Korean
+처음 간염 왔던 게 언제예요?,Korean
+"소변 색이 검붉은 게 혈뇨인가요?
+",Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+그럼 머리��� 살짝 아프신 거 빼고는 다른 증상은 없었나요?,Korean
+흉터가 약간은 남을 거예요.,Korean
+약물 용량을 조금 늘리도록 하겠습니다.,Korean
+평소에 비타민씨 챙겨 먹어요.,Korean
+문제가 생기진 않았는데 약 때문에 가려운 증상이 생길 수도 있습니다.,Korean
+보통 내시경은 일 년에서 삼 년 정도 주기를 잡습니다.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+그러면 이쪽에서 처방전 받아가시고 결제하시면 되세요.,Korean
+그때는 소변줄이 잘 위치하고 있는지 확인해야 합니다.,Korean
+시월에 독감 주사 맞았었어요.,Korean
+미리 테스트를 하고 실시하지만 드물게 알레르기 반응은 있을 수 있어서 동의서가 필요합니다.,Korean
+심장이 빨리 뛰는 느낌이 있나요?,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+아픈 곳 좀 말해 주세요.,Korean
+음식이나 약물 말고 다른 알레르기 반응 있는 거 있어요?,Korean
+감염을 예방하는 데 있어 가장 중요한 부분입니다.,Korean
+예전에 아팠던 곳 있어요?,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+식사는 최소 열두 시간 물은 여덟 시간 이상 금식하셔야 합니다.,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+뼈나 근육 그리고 피부 등의 모든 구조를 지칭합니다.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+"소변이 자꾸 마렵고 잔뇨가 늘 남아요.
+",Korean
+지금부터 수술 부위에 대해서 설명드리겠습니다.,Korean
+"차에 살짝 치여서 무릎이 아파요.
+",Korean
+네 간질환 또한 유전적 질환일 수 있기 때문에 위험도가 높긴 합니다.,Korean
+검사 결과 상 몸에 수분이 부족하네요. 물을 좀 더 드세요.,Korean
+횡문근융해증은 근육에 손상이 있어 이로 인한 독성 물질이 쌓이는 질환입니다.,Korean
+우선 더 자세한 검사를 받아본 후 말씀 나누는 게 좋을 듯합니다.,Korean
+가장 아픈 곳이 이 두 군데라는 말씀이신 거죠?,Korean
+환자분의 상태를 파악하기 위함입니다. 민감한 부위라면 흉터 크기나 모양이 어떻게 되시나요?,Korean
+혹시 다음에 증상 재발 시 색 확인을 꼭 해주세요.,Korean
+그럼 최근 몇 달 동안 체중이 그만큼 오른 건가요?,Korean
+통증이 한번 오기 시작하면 얼마 동안 지속되나요?,Korean
+"아이가 원래는 열 시면 잤는데 요즘은 쉽게 안 자네요.
+",Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+암에 대한 가족력이 있을까요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+진료시간 중으로 말씀해주실 수 있으신가요?,Korean
+검사 결과를 통해 정확한 진단과 처방을 내릴 수 있습니다.,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+"머리가 좀 어지럽고 가끔 시야가 흐리다고만 말했어요.
+",Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+진단까진 모르겠는데 혈당 문제가 늘 있으셨어요.,Korean
+지금 환아 몸무게가 몇 킬로그램인지 얘기해 주시면 됩니다.,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+"약 안 먹으면 한 시간도 못 잡니다.
+",Korean
+아프기 시작한 지 좀 됐나요?,Korean
+결핵 진단 후 입원 치료도 받으셨나요?,Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+그럴 수도 있어요 상처를 치료하면서 생기는 현상일 수 있어요.,Korean
+자는 중에 갑자기 토기가 올라와서 급하게 화장실 가서 토했어요.,Korean
+피를 토해낸 적 있어요?,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+암 치료했었던 가족이 있나요?,Korean
+네. 이 병이 전파력이 있는 병이라 감염 여부를 확인해 봐야 하거든요.,Korean
+무릎이 많이 안 좋은 상태여서 인공 무릎으로 교체한 것 같아요.,Korean
+독감 주사 맞은 시기가 언젠가요?,Korean
+"가끔 눈앞이 뿌옇게 보여서 앞이 잘 안 보여요.
+",Korean
+원인은 다양할 수 있어 검사 진행 후 정확한 진단을 알려드릴 수 있을 것 같습니다.,Korean
+항히스타민제는 두드러기 발적 소양감 등의 알레르기성 반응에 관여하는 히스타민의 작용을 억제하는 약물입니다.,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+잠을 못 잘 정도로 배가 아픈가요?,Korean
+네. 체중이 급격하게 찌거나 빠질 경우 몸에 피해가 옵니다.,Korean
+"세 달 전에 친구가 스���로 목숨을 끊었어요. 저는 친구가 힘든지도 모르고 그렇게 보내버린 게 너무 죄책감이 들어요. 아직도 친구 생각이 나서 밤에 잠을 못 이뤄요. 요즘에는 친구가 자꾸 꿈에 나타나서 잠들기도 힘들어요.
+",Korean
+피를 토 한 적 있으세요?,Korean
+지속적으로 소화가 잘되지 않나요?,Korean
+알레르기 검사를 해보신 적은 없나요?,Korean
+이전에 수면 보조제나 수면제를 처방받으신 적은 있으신가요?,Korean
+심장 박동이 느껴질 정도로 심장이 뛰나요?,Korean
+다녀오니까 코로나 유행 지역이 되어 있어서 난감했어요.,Korean
+몇일에 한번 대변을 보시나요?,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+"설사는 여태 딱 한 번 했던 것 같아요.
+",Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+"네. 그런 증상은 느끼지 못했는데.
+",Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+레이저 치료로 할 것 같네요.,Korean
+머리가 찢어질 듯이 아픈가요?,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+타인의 피로 혈액 보충해보신 적이 있나요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+네. 집 앞에 병원 갔다가 약 처방 받았었어요.,Korean
+혈압이 좀 있는 편이신가요?,Korean
+"평소에 소변을 많이 보는 편이라 비슷해요.
+",Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+수술했거나 치료 중인 병이 있나요?,Korean
+소변량 등을 확인 후 빼 드릴게요.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+구역질이 날 때가 있나요?,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+미리 검사하면 수술할 때 문제를 미리 예방할 수 있으니까요.,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+네 예약하시고 그날 내원하시면 검사 진행하겠습니다.,Korean
+사랑니는 제외하고 다른 발치 경험이 있나요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+아무래도 관절이 아프다 보면 스스로 움직이는 게 무의식적으로 덜 하게 되죠.,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+어떠한 치료를 하는가에 따라 병원비는 달라질 수 있습니다.,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+배의 어느 부위가 아프시죠?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+코로 숨을 쉬는데 너무 힘들어요.,Korean
+많이 걱정되시죠. 보통은 세 시간 정도 걸리나 상황에 따라 달라질 수 있습니다. 금식 해제도 검사 이후 환자분의 상태 확인 후 결정됩니다.,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+고혈압 약 말고 다른 약을 드셨거나 주사를 맞으신 적이 있으시면 어떤 이유 때문에 복용하거나 맞은 건지 말씀해 주시면 됩니다.,Korean
+네 이삼일 정도 통증이 더 지속되실 것입니다.,Korean
+현재 아픈 부분이 있을까요?,Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+아니요. 노산이라 무조건 제왕 절개였어요.,Korean
+결핵 치료하신 지 얼마나 되셨나요?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+다른 병원 기록은 저희가 열람할 수 없어서요.,Korean
+약물 관련 쇼크는 없으셨나요?,Korean
+질병 관련한 문의 사항이 있을 경우 설명 간호사를 연결해드릴 수 있습니다.,Korean
+네. 걱정하지 마세요. 암은 아니에요.,Korean
+물인데 상처를 씻어내는 용도입니다.,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+간혹 알레르기 반응을 보이는 분들도 계셔서 먼저 국소부위 테스트를 진행하도록 하겠습니다.,Korean
+막대로 살짝만 스쳐도 통증이 느껴지나요?,Korean
+지금까지 먹었던 약은 별문제 없었어요.,Korean
+"대상포진인 것 같아요. 너무 아프네요.
+",Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+약 제조에 도움이 될 것 같아서요.,Korean
+혈류 이상까지 알 수 있습니다.,Korean
+"아니요. 장염 때 말고는 설사 아예 안 해요.
+",Korean
+위궤양 진단받아 치료했고 지금은 일 년에 한 번씩 추적 검사만 해요.,Korean
+혈압이 좀 있는 편이신가요?,Korean
+정확한 건 검사 결과�� 나와봐야겠지만 음식이 오염되었을 수도 있어요.,Korean
+방문 국가가 감염병 지역인지 알아보기 위해서요.,Korean
+배뇨 곤란을 느끼신 적이 있나요?,Korean
+심장이 불규칙적으로 뛴다고 생각하시나요?,Korean
+간염은 언제 진단 받으셨나요?,Korean
+"냄새 때문에 토할 것 같아요.
+",Korean
+환자분 평소 앓고 있는 질환이 있나요?,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+네 환자분의 기본 정보를 알기 위하여 확인이 필요합니다.,Korean
+암이라고 진단받으신 적 있나요?,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+통증 지속기간이 얼마나 되세요?,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+네. 그 약 맞습니다.,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+교통사고 당했을 때 피를 많이 흘려 수혈받은 적 있습니다.,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+"재활 치료보다는 재수술을 받고 싶어요.
+",Korean
+지금 진찰받기 전에 건강은 어떠셨나요?,Korean
+중간에 자의로 복용을 중단하면 항생제 내성이 생길 수 있으며 치료 실패율이 높아집니다,Korean
+"목이 간질간질하면서 침 삼키면 아파요.
+",Korean
+맥박이 얼마나 빨리 뛰죠?,Korean
+약물과 음식을 제외하고 다른 알레르기가 있으신가요?,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+손목터널이 좁아지거나 내부 압력이 증가하여 손목을 지나가는 신경을 압박할 수 있는 어떤 경우라도 원인이 될 수 있습니다.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+"의자가 부러져서 엉덩이를 바닥에 찧었어요.
+",Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+기본적인 독감 주사를 맞으셨으면 괜찮습니다.,Korean
+틀니는 기공물이기 때문에 본인이 가지고 있는 치아처럼 흔들리지는 않습니다.,Korean
+고혈압을 앓고 있는 가족이 있으신가요?,Korean
+검사 진행 후 약 처방 드리려는데 괜찮으실까요?,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+수혈 부작용이 존재할 수는 있지만 크진 않아요.,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+"눈에 벌레가 돌아다니는 것처럼 그렇습니다.
+",Korean
+네. 저 작년에 위암 있었어요.,Korean
+피부 상처가 거의 아물게 되면 안정적으로 자리 잡는다고 말씀드릴 수 있겠습니다.,Korean
+몸이 엄청 나른해지고 무기력해져요.,Korean
+처방받지 않는 약은 뭔가요?,Korean
+"애가 토하더니 정신도 못 차리고 이래서 데려왔어요.
+",Korean
+입원에 관련된 정보를 표기하는 데 있어 보호 여부를 말씀드리는 것입니다.,Korean
+시술은 안 해봤고 허리 아파서 침은 맞아봤어요.,Korean
+소변볼 때 문제 있으셨어요?,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+치질 판명이 나신 적 있으신가요?,Korean
+발열 증상은 언제 처음이셨죠?,Korean
+혈압이 좀 있는 편이신가요?,Korean
+성인이 된 후 음주 습관에 대해 말씀해 주시죠.,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+"아니에요. 스물두 살부터 담배 피웠어요.
+",Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+네. 너무 예민하고 그래서 병원에 가보니깐 오래전부터 우울증을 앓고 있었던 것 같대요.,Korean
+네 병원은 전체 금연지역입니다.,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+고혈압 환자가 가족 중에 계시나요?,Korean
+고혈압 있는 건 언제 아셨나요?,Korean
+하루에 피우는 담배 양은요?,Korean
+통증이 자주 지속 되나요?,Korean
+평소에 부종이 좀 있으세요?,Korean
+십 분 뒤에 수술 진행하겠습니다.,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+"사타구니 부근에 통증과 열감이 느껴져요.
+",Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+"며칠째 배변을 못 보고 있습니다.
+",Korean
+통증 지속시간이 십 초 이내인가요?,Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+수술은 잘 끝난 걸로 알고 있어요. 너무 아프시면 진통제 놔 드릴까요?,Korean
+"오늘 변을 보긴 했는데 색이 안 좋더라고요.
+",Korean
+그럼 응급실에서는 응급처치만 한다는 말씀이신가요? 이렇게 아픈데 다��� 병원을 또 어떻게 가라는 거죠.,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+혈관 통은 혈관이 아픈 거예요? 많이 아픈가요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+네 알겠습니다. 주사 놔드릴게요.,Korean
+"방광에 문제가 있다고 들었는데요.
+",Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+현기증 때문에 어지러우신 거죠?,Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+흉터의 크기를 보려고 말씀드렸는데 보여주실 수 있으신가요?,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+최근에 오한을 느낀 적이 있나요?,Korean
+다른 질병 치료 중인 것 있나요?,Korean
+"저희 애가 자꾸 속이 안 좋다고 칭얼거려서요.
+",Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+체중이 증가한 이유가 있을까요?,Korean
+아픈 기간은 어느 정도일까요?,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+"어. 무슨 소변보는 쪽에 염증이 났다고 그러셨던 것 같은데.
+",Korean
+동시 접종은 문제가 되지 않습니다.,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+건강에 지장 없을 수준으로 뽑기 때문에 걱정 안 하셔도 돼요.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+여드름 부위에 발라야 합니다.,Korean
+입원 중 피 수치가 떨어지면 진행할 수도 있습니다.,Korean
+네 수술 부위 정확히 인지하고 계세요.,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+통증 지속시간이 길면 어느정도 였나요?,Korean
+"넘어졌는데 팔에 가시가 박힌 것 같아요.
+",Korean
+계절에 따른 영향으로 입술이 건조할 수도 있습니다.,Korean
+"어제부터 먹은 게 없는데 그럼 영양주사는 맞을 수 있나요?
+",Korean
+욕창이 심해지면 뼈까지 노출될 수 있고 합병증으로 감염이나 골수염이 생길 수도 있습니다.,Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+하루에 몇 번 정도 아픈가요?,Korean
+발기 부전 증상이 있으세요?,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+나는 게보린 먹으면 그렇게 구역질이 나더라고.,Korean
+피가 나올 정도면 연고를 처방받으셔야 합니다.,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+언제부터 그 증상이 나타났나요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+담배를 피우신 적 있으세요?,Korean
+엑스레이 상에서 보면 여기가 하행결장이거든요? 이 부분에서 구불결장을 지나 항문으로 이어지는데 여기가 다른 곳보다 유난히 부풀어있는 모양인 거 보이시죠?,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+간호를 할 수 있는 사람이 따로 없는 것 같아요.,Korean
+질병 약물로 치료하고 계시나요?,Korean
+당은 잘 관리 되고 있나요?,Korean
+개인정보 및 입원 후 처치에 대한 것입니다.,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+당뇨 처방 약은 어떤 걸 갖고 계세요?,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+예시로 든 접종 외에 다른 접종은 안 맞아 보셨나요?,Korean
+환자분이 무슨 약을 드시고 계시는지 알아야 치료에 도움이 됩니다.,Korean
+아프다 안 아프다 하나요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+최근 대변 색깔은 어떠했나요?,Korean
+가족 중에 대장암 앓으신 분은 없나요?,Korean
+추가적 검사와 진단 이후에 말씀드릴 수 있는 부분입니다.,Korean
+환자복과 병상에 침대. 이불. 베개입니다.,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+그러면 병실도 옮기셔야 하고 수술도 다시 잡아야 합니다.,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+시력이 안 좋아서 라섹 수술 한번 받았었어요.,Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+배가 빵빵한 느낌은 없으신가���?,Korean
+무슨 간염 약 드세요?,Korean
+방광에 좋지 않으니 주의하셔야 합니다.,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+네. 전신마취인 경우 완전히 잠들기 때문에 소리가 들릴 수 없습니다.,Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+피부가 언제부터 이렇게 빨갛게 올라오셨어요? 오래됐나요?,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+요 근래 체중 변화가 있으세요?,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+제가 지금 환자분 상태를 설명해 드릴게요.,Korean
+아픈 게 쭉 아파요?,Korean
+그럼 최근 몇 달 동안 체중이 그만큼 오른 건가요?,Korean
+네 찾으시는 연고가 이거 맞나요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+입원 중에는 빠른 회복을 위해 금연하는 것을 권장 드리고 있습니다.,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+음주는 얼마나 자주 하시죠?,Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+"변비가 워낙 심해요. 딱딱하고 냄새가 심해요.
+",Korean
+간염 보균자로 진단받은건 언제인가요?,Korean
+무리해서 계속 손을 사용할 경우 손을 못쓰게 됩니다.,Korean
+"요즘 소화시키는 게 힘들어요.
+",Korean
+검진 이후에 또 몸 상태가 달라졌을 수도 있어서 재차 검사가 필요합니다.,Korean
+금식 잘 하고 잰 수치가 이렇기 때문에 고지혈증으로 진단할 수 있습니다.,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+간염으로 아팠던 시점을 기억하세요?,Korean
+"몸이 아프고 기력이 없고 점점 쳐져서요.
+",Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+알레르기가 올라오는 음식이 있나요?,Korean
+최근에 예방 접종은 따로 받으셨어요?,Korean
+입원 시 이동수단에 대해 기록해야 하여 질문하였습니다.,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+"술 담배 전부 합니다.
+",Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+수술 후 재활은 얼마나 걸린다고 확답 드리기 힘듭니다.,Korean
+헬리코터박터균 감염이 있는지 검사를 해야 알 수 있습니다,Korean
+숨을 쉬는 양상이 이상하지는 않았었나요?,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+요즘 소화가 좀 안 돼서 가끔 소화제 먹어요.,Korean
+렌즈를 지금 끼고 있어요. 보청기도 있고요.,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+어떨 때 설사를 하나요?,Korean
+네 열이 나거나 머리가 아팠거나 그러셨나요?,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+다른 약은 없으시고 간염약만 드세요?,Korean
+얼마나 자주 기침이 나오나요?,Korean
+"식은땀을 좀 많이 흘렸는데 그거 이외엔 없습니다.
+",Korean
+"변의 모양은 보통 때랑 같았고 색이 좀 진했어요.
+",Korean
+진통제 알약 형태로 먹는 건가요?,Korean
+고혈압인 것을 안 게 언제부터죠?,Korean
+언제부터 피부 변화가 있으셨나요?,Korean
+미용 목적이라도 실비보험 적용되는 경우가 많습니다.,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+삼 년 정도 전에 잠깐 입원했었어요.,Korean
+"변 볼 때 통증이 있어요.
+",Korean
+"아니요. 태어나서 단 한 번도 피워 본 적 없어요.
+",Korean
+최근에 몸무게가 급격히 바뀌었나요?,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+심각한 정도를 바로 말씀드리기는 어려우므로 상부위장관 내시경 검사가 필요합니다.,Korean
+"항암제 투약 후에 고열 증상이 반복돼서요.
+",Korean
+암이나 백혈병 애디슨병 부신의 기능 장애로 생기는 병 등 만성적으로 혈압이 저하되는 경우가 있습니다.,Korean
+목 안에서 통증이 느껴지나요?,Korean
+"일하다가 전에 다쳤던 팔을 또 다쳤어요.
+",Korean
+"아뇨 대변을 볼 때 너무 힘을 많이 주게 됩니다.
+",Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+현재 약 드시는 거 있어요?,Korean
+멸균된 거즈와 소독 도구들이 집에 구비되어 있다면 가능하지만 그런 경우는 거의 없지요.,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+"토는 안 했는데 쓰러지기 몇 분 전부터 속이 울렁거려서 토할 것 같았어요. 그 전엔 그렇진 않았고.
+",Korean
+약물 ��레르기 있으시면 알려주세요.,Korean
+휴식이 회복에 중요한데 진통제 처방받고 푹 주무시는 게 좋겠습니다.,Korean
+간헐적으로 아픈가요? 지속적으로 아픈가요?,Korean
+간염 시작된 나이가 언제인가요?,Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+현재 고혈압 치료 받은 지는 얼마나 되었나요?,Korean
+위산분비억제제와 항생제 치료가 기본 치료입니다.,Korean
+네. 그러세요. 약을 못 먹겠네요.,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+추가 검사를 진행하고 정확히 설명드릴게요.,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+요의는 있는데 소변이 나오지는 않았던 적이 있었나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+부모님께서 혹시 외상 외에 큰 수술을 받으신 적이 있나요?,Korean
+경우에 따라 수술할 수도 있어 속단하기에는 이릅니다.,Korean
+사고당해서 입원한 적 있으세요?,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+통증이 사라지는 데 얼마나 걸리나요?,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+어릴 때 운동하다 다리를 크게 한 번 다쳐서 입원했던 적 있어요.,Korean
+물 먹고 소변 보면 증상이 괜찮아지나요?,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+고혈압 진단 받은적 있나요?,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+"방광은 어느 정도 높이에 있어요?
+",Korean
+지금 즉각적인 치료가 필요하지는 않으며 꾸준한 추적 검사가 요구됩니다.,Korean
+영양분도 수액으로 보충 가능하니 걱정 마세요.,Korean
+소변보는 데 문제 있으세요?,Korean
+요즘은 혈압이 안 높아서 간혹가다가 먹고 있어요.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+"소변이 자꾸 마렵고 잔뇨가 늘 남아요.
+",Korean
+심부전에 따른 증상은 호흡곤란 부종 등이 있습니다.,Korean
+약을 오래 드시면 안 됩니다.,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+당뇨약 드시는 거 뭔가요?,Korean
+"메스껍고. 헛배 부른 느낌이 들어요.
+",Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+삼도 화상으로 흉터가 생길 가능성이 매우 높습니다.,Korean
+평소보다 통증이 더 강한가요?,Korean
+목에 통증이 계속 있나요?,Korean
+보험사에 제출해야 합니다. 진단서 부탁드릴게요.,Korean
+피부나 다른 곳에 알레르기가 생긴 적이 있나요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+치아 중에 본인 치아가 아니거나 흔들리는 치아가 있나요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+감기가 있어서 감기약 먹고 있어요.,Korean
+근래에 체중 증가가 있으신가요?,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+가족분들 중에 암 진단받으셔서 완쾌하신 분 있나요?,Korean
+배뇨통이나 빈뇨등의 요로계 증상은 없으시나요?,Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+특정 음식에 알레르기가 있습니까?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+가족이 앓았던 질환에 대해 알고 계신 거 있으시면 말씀 부탁드리겠습니다.,Korean
+아픈 게 쭉 아파요?,Korean
+콕 찍은 정도여서 흉터라고 보기에는 애매하네요.,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+복부 팽만감이 들지는 않으세요?,Korean
+치료 방식이 입원하셨던 경험이 있을 경우 좀 더 세밀해집니다.,Korean
+"다이어트하느라 셰이크만 먹고 있어요.
+",Korean
+아니요. 본인 치아가 맞습니다. 치아 위에 보철을 해 넣었을 뿐이에요.,Korean
+숨이 찬 증상이 구체적으로 어땠는지 말씀해주세요.,Korean
+숨 쉴 때 통증이 있나요?,Korean
+여기 말고 다른 부위 치료받은 적은 없으세요?,Korean
+피가 섞인 변을 보시나요?,Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+비용은 의료 행위에 따라 달라지므로 계획이 결정된 후 다시 상��드리겠습니다.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+쉬고 계실 때에도 심장 박동이 빨랐나요?,Korean
+네. 다리를 다쳐서 목발을 짚은 적이 있어요.,Korean
+간염 보균자로 진단받은건 언제인가요?,Korean
+"제가 이십 대일 때부터 피웠으니 이십 년은 넘었네요. 하루에 한 갑 정도만 피우는 편이에요.
+",Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+네 검사 나오는 시간이 있기 때문에 일주일 후 오셔야 해요.,Korean
+결핵약 매일 복용하고 있나요?,Korean
+배뇨 시 치골 및 하복부 통증이 있다면 방광염일 가능성이 높습니다.,Korean
+"스무 살 이전에 시작했는데 중간중간 안 피우는 때도 있었어요.
+",Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+"화장실에 다녀와도 계속 배가 불편해요.
+",Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+매일 혈압을 재고 있나요?,Korean
+가래에 피가 섞여 있나요?,Korean
+환자 아버지가 현재 유전성 치매를 앓고 계세요.,Korean
+"냄새 때문에 토할 것 같아요.
+",Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+요구 사항으로 전달은 드리지만 환자분의 치료 계획 또는 신체 상태에 따라 변경될 수 있습니다.,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+자궁경부암 그거 예방 접종 맞았어요.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+네. 저는 수술밖에 할 수 없더라고요.,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+외래 초음파 검사상 이상 있다는 말을 못 들으셨나요?,Korean
+"요새 걷기 운동한다고 많이 걸었거든요. 그러고 나서 신발이 잘 안 맞았는지 발톱에 멍이 들기 시작하더니 다리 전체가 움직임이 둔하네요.
+",Korean
+입으로 피를 토한 적이 있나요?,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+예전에 에이형 간염에 걸렸었어요.,Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+편도선은 붓는다고 해서 목 바깥 피부에서 만져지지는 않습니다. 우선 갑상선 쪽으로 정밀 검사를 해봐야 할 것 같아요.,Korean
+통증 속성이 어떤 식인 가요?,Korean
+병원이다 보니 개인정보 제공에 동의해 주셔야 합니다.,Korean
+당연히 소독 붕대 있죠.,Korean
+내원하신 이유가 어떻게 되죠?,Korean
+네. 지금 약 처방을 해드릴 건데 복용약에 따라 처방이 달라져요.,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+장기 복용 부작용과 의존성이 생기는 것이 문제가 될 수 있어요.,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+네. 저희 가족이 다 비염이 있어서 자주 그렇게 해요.,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+몸이 간지럽거나 하진 않으셨어요?,Korean
+감염 방지를 위해서는 자주자주 소독을 해 주어야 합니다.,Korean
+열 외에 아프거나 불편하신 점은 무엇이든 말씀해주세요.,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+관련이 있다고 뚜렷히 말씀드리기는 어렵지만 의료기록에 적어두고 참고하겠습니다.,Korean
+"눈앞을 끈적한 진물이 가려요.
+",Korean
+소변볼 때 문제 있으셨어요?,Korean
+대변볼 때 피가 보이나요?,Korean
+이번에 입원하신 날짜 말씀해 주세요.,Korean
+연고는 병원에서 판매하는 제품이기 때문에 보험처리가 되지 않아요.,Korean
+어떤 부위에 국소마취를 하셨나요? 수술하신 건가요?,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+알러지 유발 원인을 일컫는 말입니다.,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+영양제나 비타민 같은 거 말고 처방받아서 드시는 약 없으세요?,Korean
+산소포화도를 먼저 확인 하겠습니다.,Korean
+발기를 아예 못 하시는 건가요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+처음 이 증상이 나온 게 언제인가요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+네 전에 했던 마취 방법에 대해 기록 조회해볼게요.,Korean
+연고 바르시다 따가운 증상이 생기시면 바르지 마시고 병원으로 연락 부탁드립니다.,Korean
+말씀드린 레이저 시술이 가장 빠르게 제거 가능합니다.,Korean
+최고로 아플 때의 점수는 어떻게 되나요?,Korean
+고혈압 환자가 가족 중에 있을까요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+입원은 안 하��� 그냥 영양 부족 때문에 링거만 맞고 간 적은 있어요.,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+말씀하신 것과 같은 증상이면 먹는 약을 드시기도 어려울 것 같습니다. 주사제 사용도 고려해 볼 수 있습니다.,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+"자궁근종이 있어서 제거하러 왔습니다.
+",Korean
+알레르기를 유발하며 주로 침구류에서 발견됩니다.,Korean
+혈액검사는 두 세 시간 후 확인 할 수 있으니 그 때 설명드릴게요.,Korean
+네 마스크 착용이 중요합니다.,Korean
+아니요. 마취가 풀리긴 하겠지만 풀리기까지 시간이 오래 걸릴 수는 있습니다.,Korean
+흡연한 지 몇 년이나 됐는지 알려주세요.,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+변에 피가 섞여 나오나요?,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+배에 가스가 많이 차있나요?,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+환자분께서는 주기적으로 피 검사를 진행해 심장 효소 수치를 확인할 것입니다.,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+아직 다 낫지는 않았습니다.,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+우선 흔들리는 것은 여기서 진료를 받고 추후에 엑스레이 검사를 통하여 부가적인 확인을 하는 것이 좋습니다.,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+"어젯밤에 자전거를 타고 집에 가는데 캄캄해서 내리막길인지 모르고 그대로 자전거랑 같이 굴러 내려갔어요. 자전거에서 떨어져서 넘어졌는데 뼈에 금이 간 건지 이곳저곳 아파요.
+",Korean
+아마 요양원으로 보내드려야 할 거 같아요.,Korean
+수술 전 환자나 의사가 알아야 할 사항을 꼼꼼히 읽어볼 수 있도록 해주세요.,Korean
+지금처럼 약물치료 받으시면 곧 나아질 거예요.,Korean
+네. 점심을 드신 시간에서부터 세 시간 금식을 한 뒤 검사가 진행 가능합니다.,Korean
+네 어디가 아프셔서 약을 드시고 계시나요?,Korean
+"네. 소변량이 크게 줄어든 게 느껴져요.
+",Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+아니요. 그 약 말곤 딱히 먹어야 될 약은 없어요.,Korean
+네 방역 수칙을 철저히 지키고 있습니다.,Korean
+"가슴에 찌르는 듯한 통증이 느껴집니다.
+",Korean
+목에 인후통 증상이 있나요?,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+수액 치료가 끝날 때까지 누워계시면 됩니다.,Korean
+최대한 빨리 진료받아야 해서 아홉시 십분이 좋을 것 같아요.,Korean
+증상이 나타난 건 오래됐나요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+고혈압 기간이 어떻게 되세요?,Korean
+항생제를 오래 쓸 경우 내성이 생깁니다.,Korean
+신장에서 만들어진 소변을 요관으로 전달하는 역할을 합니다.,Korean
+골고루 드셔야 건강에 도움이 됩니다.,Korean
+"제가 식곤증이 있는지 밥만 먹으면 너무 졸려서 저도 모르게 눕게 되네요.
+",Korean
+환자분 상태가 괜찮아지면 바로 옮겨드릴 거예요.,Korean
+어디 아프신 곳이 있나요?,Korean
+하루에 피는 담배양을 알려 주세요.,Korean
+잠이 자꾸 깨서 힘드시나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+초반에는 약물 치료부터 해야 합니다.,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+"치질인가 의심될 정도로 고통스러워요.
+",Korean
+"숨이 잘 안 쉬어져서 왔어요.
+",Korean
+"전신에 너무 통증이 있어요.
+",Korean
+몇 월부터 아프셨던 거예요?,Korean
+입을 크게 벌리면 턱이 아픈데 얼마나 벌려야 하나요?,Korean
+결핵 치료를 받고 계신가요?,Korean
+아무래도 특이 혈액형이다 보니 혈액이 부족할 수 있습니다.,Korean
+오한이 있을 경우 감염이 있을 수 있어 검사가 필요할 것 같습니다.,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+맥 빠지는 느낌이 드나요?,Korean
+네 하루에 카페인 섭취를 얼마나 하시나요?,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+평소에는 화장실을 잘 가는데 약 먹으면 횟수가 줄더라고요.,Korean
+어느 부위에 통증을 느끼세요?,Korean
+병원비 일부가 선불이어서 지불하셔야 해요.,Korean
+엑스레이 하기 전에는 흡연은 삼가해주세요.,Korean
+통증 생긴 지는 얼마나 됐나요?,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+술 먹는 빈도가 빈번한가요?,Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+그 정도의 화상으로 보입니다.,Korean
+삼 개월 전까지 드신 보약이 있다면 말씀해 주세요.,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+상처에 습윤이 유지되게 하는 효과가 있습니다.,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+지금 당장 드실 약은 남겨 놓고 나머지만 체크하겠습니다.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+아직은 증상이 나빴다 좋아졌다 할 수 있는 시기입니다.,Korean
+통증이 발현되는 시기가 있나요?,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+수술할 때 자고 일어난 것 같았으니 수면 마취인가요?,Korean
+통증이 한번 오기 시작하면 얼마 동안 지속되나요?,Korean
+암으로 병원 다닌 적 있으세요?,Korean
+유전적인 발기 부전으로 치료받고 있는 가족이 있나요?,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+"밥 억지로 먹이려 해도 안 먹는 걸로 봐선 목이 좀 아픈 것 같기도 해요.
+",Korean
+무통 주사요? 네네. 말씀해 주신 게 맞아요.,Korean
+그럼 주사는 언제 맞으시겠어요?,Korean
+"대변볼 때 어떤 점을 말씀하시는 거예요?
+",Korean
+변이 잘 안 나오나요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+"죽으려고 약을 많이 먹었습니다.
+",Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+과거에 장기간 입원한 적이 있나요?,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+"앞니 두 개가 아파요.
+",Korean
+아니요. 심혈관계 질환은 전혀 없어요.,Korean
+키와 몸무게 측정하겠습니다. 환아 측정기 위에 올려주시면 측정할게요.,Korean
+"역도 들다가 팔이 어긋난 거 같아요.
+",Korean
+병실로 이동까지 대략적으로 시간이 얼마나 걸리는지 알려주세요.,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+"목 아프다고 삼 일 내내 밥을 안 먹으려고 해서 애먹었어요.
+",Korean
+"애가 먹는 족족 다 토해서요.
+",Korean
+"엉덩이 쪽에 뾰루지가 계속 올라와서 앉아있지를 못하겠어요.
+",Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+수면 지속 시간을 증가시켜 줍니다.,Korean
+성 기능 장애가 있으신가요?,Korean
+"한 시간도 안 돼서 자꾸 소변이 마렵다고 하시더라고요.
+",Korean
+소변을 볼 때 피가 나왔나요?,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+"운동하느라 역기를 많이 드는데 그러면 안 되나요?
+",Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+골고루 드셔야 건강에 도움이 됩니다.,Korean
+흡연이나 음주나 일상적으로 접하는 것이라 익숙하지만 건강에 큰 영향을 끼치죠.,Korean
+윗배랑 아랫배 중에 어느 쪽이 아프세요?,Korean
+자기 전에 술이나 커피를 마신다거나 숙면을 방해하는 요인이 있진 않으신가요?,Korean
+숨 쉴 때도 갈비뼈가 아픈가요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+욕창이 생기지 않도록 체위 변경 잘 해주시면 더 빨리 나으실 거예요.,Korean
+폐경 이후에 건강검진에서 골다공증 소견 있다고 했어요.,Korean
+아니요. 복부 피부에 젤리를 바르고 시행하는 검사입니다.,Korean
+독감 접종의 경우 알레르기 반응이 심해서 알레르기 반응이 있으시면 접종을 권장 드리진 않습니다.,Korean
+"등 부위에 발진이 너무 심해요.
+",Korean
+결핵 때문에 내원하신 적이 있나요?,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+마취약 말고는 꾸준히 복용하시는 약물은 없으신가요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+감염성 질환이란 다른 환자로부터 옮을 수 있는 질환입니다.,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+간염 약 복용 중이십니까?,Korean
+환자의 질환을 파악해야 되기 때문이죠.,Korean
+"고양이가 상처 난 곳을 또 물었어요.
+",Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+가슴 통증이 있으셨는지 알려주세요.,Korean
+네 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+슬기로운 병원 생활에 필요한 정보를 드리려고 합니다.,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+시티 등 판독이 필요한 검사는 결과 나오는 데 시간이 걸립니다.,Korean
+엑스레이를 한번 찍어봐야 알 것 같습니다.,Korean
+"입이 마른 느낌은 없는데요.
+",Korean
+회진 시간은 오후 네 시경입니다.,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+고혈압이랑 당뇨로 고생하셨는데 지금은 약 안 먹어요.,Korean
+일단은 발바닥에 보습제를 바르고 양말 등을 덮거나 비닐을 감싸서 최대한 잘 스며들도록 할게요.,Korean
+심각하다기보다는 정밀 검사가 필요합니다.,Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+짐은 나중에 가져오는 걸로 하고 입원은 지금 하는 거로 하죠.,Korean
+"담배 한 대 피웠는데.
+",Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+"술은 하루걸러 하루 마시고 소주 다섯 병정도요.
+",Korean
+지금 가능한 치료가 이것밖에 없어서요.,Korean
+설사를 얼마나 자주 하시나요?,Korean
+소변에 염증이 있어서 그럴 수 있으므로 소변검사 확인 후 설명드리겠습니다.,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+소독을 할 때에는 멸균적으로 해야 하기 때문에 되도록 동네 병원에서 치료받으시길 권고드립니다.,Korean
+제가 말씀드릴 때까지 청진이 계속될 테니 계속 심호흡해 주시면 됩니다.,Korean
+지금까지 열은 안 났나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+진단서 한 장 더 뽑으려면 만 원의 추가 비용이 듭니다.,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+병원 내 휠체어 대여는 물론 가능하세요.,Korean
+구불결장까지만 관찰 가능해도 충분한 병변입니다.,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+지금 드시는 약과 상충되지 않은 약을 처방하려고 여쭤봤습니다.,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+바이러스에 대한 저항력이 꾸준히 높게 유지된다면 증상을 완화시킬 수 있습니다.,Korean
+환자분의 안전을 위해 보호자 동반을 추천드립니다.,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+겉으로 보이는 증상만으로 그 정도를 짐작하기는 어렵습니다. 우선 혈액 검사를 통해 혈색소 수치를 확인하겠습니다.,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+비수면내시경이지만 수월한 편이며 사람에 따라 차이는 있을 수 있습니다. 대장 내시경보다는 수월합니다.,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+유전성 질환에 가족력이 없다고 말씀하셨죠?,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+"계속 소화불량인 것 같아요.
+",Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+아직까지 먹은 것 중엔 알레르기 없었어요.,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+마취제 부작용은 심장마비 섬망 증상 마비 시각장애 구토 등이 있습니다.,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+혈압이 높았던 건 좀 오래됐어요. 건강검진 할 때마다 고혈압 위험군이라고 하셨는데 한 일년 정도 된 것 같네요.,Korean
+"피곤하면 여덟 시간 자고 아니면 다섯 시간 자요.
+",Korean
+��자 분은 우유를 소화할 수 있는 능력이 부족한 겁니다. 다른 음식으로 칼슘을 보충하는 게 좋겠네요.,Korean
+소독을 해야 이차 감염을 막을 수 있습니다.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+대변 활동이 원활하지 않나요?,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+병원 입원 경험이 있으신가요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+"간 수치가 매우 높다고 검사한 병원에서 여길 가보랬어요.
+",Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+"간 수치가 매우 높다고 검사한 병원에서 여길 가보랬어요.
+",Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+주에 몇 번 아픈가요?,Korean
+네 열 없이 체온 정상입니다.,Korean
+아니요. 고혈압 같은 병력 있으신 분은 없어요.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+네 연고만 따로 처방해 드릴 수는 없어요.,Korean
+열이 나는 증상이 있나요?,Korean
+아무래도 집에서 하는 소독은 감염 위험성이 큽니다.,Korean
+네. 암 초기 진단받아서 병원 통원 치료하고 있어요.,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+소변볼 때 출혈이 있나요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+통증이 몇 분마다 오나요?,Korean
+간염 검사 관련 양성인가요?,Korean
+열 때문에 몸이 달아오르나요?,Korean
+목으로 피가 조금 올라오나요?,Korean
+"저희 애가 어디가 불편한지 계속 아프다고 울어요.
+",Korean
+"오늘 팔꿈치 물 빼는 시술 있다고 해서요.
+",Korean
+"설사가 지속되다가 지금은 혈변을 조금씩 보시는 것 같아요.
+",Korean
+최근 몇 개월 동안 체중이 증가했어요?,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+바이러스가 증식되며 증상이 나타나는 시기를 말합니다.,Korean
+장염이라. 없었던 것 같은데요.,Korean
+비수면 내시경에 수면 비용이 추가됩니다.,Korean
+병원에 오신 이유 말씀해 주세요.,Korean
+"설사로 외출이 겁이 날 정도로 심해요.
+",Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안 됩니다.,Korean
+일 년 전에 뇌수막염 때문에 입원한 적 있어요.,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+환자분은 완치된 상황이라 퇴원하셔야 합니다.,Korean
+약물로 고혈압 치료 중이신 건가요?,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+"무릎이 아파서 앉고 서고 힘들어요.
+",Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+"잘 붓는 편이라 짜게 안 먹어요.
+",Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+제때제때 대변을 잘 못 보는 편인가요?,Korean
+고혈압 관련해서 과거에 이야기 들으신 게 있나요?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+알겠습니다. 소변 받아오고 수액 맞으면서 기다리면 된다는 거네요.,Korean
+"어제저녁부터 열이 펄펄 나서요.
+",Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+결핵 증상이 언제부터 나타났는지 아시나요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+"시커먼 느낌이 나는 설사요.
+",Korean
+담배 하루에 몇 갑 피나요?,Korean
+하루 흡연량은 어떻게 되세요?,Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+그 이후론 수술 안 했어요.,Korean
+"대변볼 때 뭔가 다 쏟아내지 못하는 듯해요.
+",Korean
+지속적으로 아니면 간헐적으로 저린 느낌이 오나요?,Korean
+과거 암 진단받은 적 있나요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+네 주로 면역력이 생기면 재발 위험도가 줄어듭니다.,Korean
+불면증으로 약을 드시고 있나요?,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+경과가 좋으면 일주일 후에 퇴원하셔도 됩니다.,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+알레르기가 있으셨으면 검사 한번 해보시겠어요?,Korean
+네 상처 보호 혹은 지혈을 위해 쓰입니다.,Korean
+복통이 있을 수 있습니다.,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+네. 웬만해선 자연 분만으로 낳고 싶었거든요.,Korean
+발기부전약 드신 적은 있나요?,Korean
+"점점 편두통이 심해지고 어지러워서 내원했습니다.
+",Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+"아니요. 잠을 잘 못 자서 더 아픈 것 같아요.
+",Korean
+"손목 붓고 화끈거리는 건 며칠 지나니까 괜찮아졌는데 찌릿찌릿한 건 계속 있어요.
+",Korean
+"소변 횟수는 잘 세어 보질 않아서요.
+",Korean
+급성기와 병의 심각성 사이에 관련이 있지는 않으며 그보다는 치료가 더 의미를 가지는 시기로 이해하시는 것이 맞습니다.,Korean
+흡연 기간이 얼마나 돼시죠?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+유당이 없는 우유로 대체하시는 건 어떠신가요?,Korean
+아침에 먹는 거는 아닌데 약 가져왔어요.,Korean
+오랜 공복기나 과식 해도 증상이 있을 수 있습니다.,Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+"성기 쪽이 아파서 찾아왔어요. 간지럽고 뭐가 난 것 같아서요.
+",Korean
+알레르기 때문에 피해야 하는 것이 있으세요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+입안이 따끔한 증상이 심했나요?,Korean
+"열은 따로 없었고 식은땀을 꽤 많이 흘렸어요.
+",Korean
+지금 몸에 발열증상이 있나요?,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+간염 시작된 나이가 언제인가요?,Korean
+네 우선 대기실에서 약품명 검색하신 후 알게 되신다면 간호사에게 알려주시기 바랍니다.,Korean
+몸에 부은 곳이 있나요?,Korean
+소리가 들렸다면 하반신 마취였을 겁니다.,Korean
+배의 어느 부분이 아프신가요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+어떤 치료제를 드시고 계세요?,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+비수면 내시경에 수면 비용이 추가됩니다.,Korean
+염증 외 다른 건 크게 문제가 없네요.,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+심장 뛰는 속도가 빠르게 느껴지시나요?,Korean
+통증 때문에 안녕하지 못했습니다.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+감염력 때문에 반드시 알아야 하는 자료입니다.,Korean
+간염으로 드시는 약이 있나요?,Korean
+변에 피가 섞여 나오나요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+둘째 애가 공황장애로 약 먹었었어요.,Korean
+기침할 때 피가 터져 나오나요?,Korean
+평소에 드시는 약을 말씀해보실래요?,Korean
+기침 감기 콧물 열 등의 감기 증상이 있으셨나요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+"허리가 디스크인지 너무 아파요.
+",Korean
+통증 말씀이신가요 부기 말씀이신가요?,Korean
+배뇨일지를 분석하는 데 있어서 소변량 측정이 중요하므로 재차 확인한 것입니다.,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+"갑자기 체중이 확 줄긴 했어요.
+",Korean
+간혹 알레르기 반응을 보이는 분들도 계셔서 먼저 국소부위 테스트를 진행하도록 하겠습니다.,Korean
+암 판정받으신 적 있나요?,Korean
+환자의 권리와 의무에 대해서 읽어 보시고 입원 시 준비 물품은 슬리퍼 세면도구 수건 휴지 물티슈 속옷 개인용 충전기 물통 물컵 등 입니다.,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+검사 다 하려면 얼마나 걸립니까?,Korean
+하루 중 언제 증상이 두드러지게 나타납니까?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+어제는 아무것도 못 먹어서 약도 걸렀죠.,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+심장 박동이 느껴질 정도로 심장이 뛰나요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+일 년 전부터 고혈압 징조가 보였는데 최근에는 혈압이 훅 올랐다가 떨어졌다가 하네요.,Korean
+발병 원인이 음주에 있을 수도 있기 때문에 중요합니다.,Korean
+목 붓는데 잘 듣는 약이 따로 있나요?,Korean
+빈혈 진단을 받은 적은 없는데 앉았다가 일어나면 눈앞이 어질어질할 때가 있었어요.,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+지금은 수술 순서를 바꾸기 어려워요.,Korean
+"수면제 좀 타고 싶어서 왔습니다.
+",Korean
+유전성 질환에 가족력이 없다고 말씀하셨죠?,Korean
+약을 구입한 곳에 문의해보셔도 돼요.,Korean
+얼마나 자주 아픔을 느끼나요?,Korean
+백신 주사 맞은 거 있나요?,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+"변은 안 나오는데 가스만 자꾸 차서 걱정이에요.
+",Korean
+"경련을 일으키면서 뒤로 넘어졌어요.
+",Korean
+"변비는 늘 있는데 설사는 전혀 없어요.
+",Korean
+피가 섞인 소변을 보신 적이 있나요?,Korean
+혈압 관련해서 많이 불편하셨군요. 상담을 원하신다면 진료과로 안내 해드릴까요?,Korean
+체중이 변했다면 얼마나 변하셨나요?,Korean
+하루에 몇 개비나 태우세요?,Korean
+간헐적으로 통증이 왔다 가나요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+체중 증가가 언제부터 있었나요?,Korean
+당신의 병력을 확인하기 위해서입니다.,Korean
+지금 즉각적인 치료가 필요하지는 않으며 일 년 간격으로 위내시경 추적 검사가 필요합니다.,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+담배를 많이 피우기 시작한 게 언제부터인가요?,Korean
+현재는 전혀 술을 안 드시나요?,Korean
+다이어트 한약 복용 중이긴 해요.,Korean
+아픈 곳을 말씀해 보실래요?,Korean
+키 백육십 센티미터이고 몸무게 오십육 킬로그램입니다.,Korean
+마사지는 근육이 풀리는 정도로만 가능해요.,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+네 주사 흉터도 확인하겠습니다.,Korean
+네. 배뇨일지 기입으로 정확한 진단이 가능하고 그에 맞는 치료를 처방 할 수 있으므로 배뇨일지 작성은 중요한 일입니다.,Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+지금 드시는 약 말고 다른 약 한번 드셔보세요.,Korean
+최근에 인플루엔자 백신은 맞으셨나요?,Korean
+"오늘 변을 보긴 했는데 색이 안 좋더라고요.
+",Korean
+입원 및 통원 치료 결정은 의사와 상의하셔야 합니다.,Korean
+네. 요즘 몸이 좀 안 좋아서 영양제 먹었어요.,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+간염 치료 병력이 있나요?,Korean
+마취가 잘 안 들었다든지 그런 거요.,Korean
+멸균된 붕대를 감아야 상처 부위가 보호됩니다.,Korean
+온몸에 기운이 없다고 느껴지나요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+어지럽고 힘들어서요. 계속 재는 거죠?,Korean
+환자분이 입원하실 자리가 저녁 늦게 준비가 됩니다.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+"위 수술한 거 검진 때문에요.
+",Korean
+별다른 약은 먹고 있지 않아요.,Korean
+격리병동에 입원 후 진료 예정입니다.,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+통증이 느껴지는 세기가 어느 정도인가요?,Korean
+반응테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+옛날엔 안 그랬는데 저번에 타이레놀 먹는데 두드러기 나고 그래서 진료받은 적 있어요.,Korean
+금연은 언제부터 하게 되신 건가요?,Korean
+일차 치료제를 꾸준히 빠짐없이 복용 시 박멸 성공률을 높일 수 있습니다.,Korean
+되도록 빨리 다시 진찰해 주세요.,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+평소에 무슨 약 드세요?,Korean
+전에 말씀드린 진단서는 오늘 퇴원 수납하시면서 옆에서 같이 발급받으시면 됩니다.,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+검사 후에 치료가 진행될지 여부는 검사가 끝나야 알 것 같아요.,Korean
+잠이 들면 중간에 몇 번이나 깨나요?,Korean
+혈압은 금방 좋아질 겁니다.,Korean
+질병 관련한 문의 사항이 있을 경우 설명 간호사를 연결해드릴 수 있습니다.,Korean
+사고당해서 입원한 적 있으세요?,Korean
+소변을 보실 때 피가 나오신 적 있으세요?,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+시력에 이상이 있거나 물체가 흐리게 보이거나 초점이 안 잡히거나 하지는 않았나요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+"최근 들어서 소변량 꽤 늘어난 것 같이 느껴져요.
+",Korean
+아니요. 병실로 이동한 후 담당 선생���의 확인 후 물을 드실 수 있습니다.,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+커피 대신 물 섭취량을 늘려보시기를 권해요.,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+네 모든 검사 완료됐습니다.,Korean
+네. 입원비는 입원일수로 계산됩니다.,Korean
+특별히 식욕이 없어진 때가 언제인가요?,Korean
+평소에 가스가 찬 느낌이 있나요?,Korean
+환자 등록 팔찌 확인하겠습니다.,Korean
+대변볼 때 피가 보이나요?,Korean
+"구토 이외에는 별다른 증상은 없어요.
+",Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+머리가 핑도는 느낌이 있으신가요?,Korean
+통증이 아직도 안 나았나요?,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+"운동하다가 한 번 어깨가 빠질듯한 느낌이 든 적이 있는데 그 이후로 무거운 걸 들지 못하겠어요.
+",Korean
+묽은 변을 보시지는 않나요?,Korean
+입원 경로 종류는 여러 가지가 있는데 이쪽 화면 보시면서 말씀드릴게요.,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+"아니요. 왼쪽 팔이 불편한 데예요.
+",Korean
+입원하시지 않는 방향으로 결정 내리셨나요?,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+체온 한 번 재볼게요.,Korean
+언제부터 알레르기 약을 복용하기 시작했어요?,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+밤에 통증이 있을 때 보호대가 증상 완화에 도움이 될 수 있습니다.,Korean
+그냥 병원 오면 안 되나요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+"고양이를 키우는데 고양이가 할퀴어서 상처가 좀 크게 났어요.
+",Korean
+언제 주로 현기증을 느끼나요?,Korean
+어떤 식으로 아프다 하는 게 있으실까요?,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+피부관리실은 다녀봤는데 피부과 치료는 처음 받아봐요.,Korean
+과거에 수술받으신 적 있나요?,Korean
+네. 수분 부족 현상이에요.,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+"소화가 어려워 잘 못 먹어요.
+",Korean
+알레르기 반응이 있었다면 예방 접종은 할 수 없습니다.,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+흔하지 않지만 대장암과 같은 질환 가능성도 있습니다.,Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+배의 어느 부위가 아프시죠?,Korean
+암 치료를 받고 있으세요?,Korean
+지속적으로 아니면 간헐적으로 저린 느낌이 오나요?,Korean
+어젯밤에 먹이고 잤는데 열이 다시 올라서 아침에 또 먹인 거거든요. 아마 아침 열 신가 그럴 거에요.,Korean
+대변이 잘 안 나오나요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+아니요. 만성 위염은 흔한 소견입니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+환자분의 경우 둔위 때문에 수술에 들어가실 겁니다.,Korean
+"몸 여기저기가 건조하고 가렵다 못해 붉게 되어서 왔어요.
+",Korean
+"속 쓰린 게 심합니다.
+",Korean
+대변을 보실 때 많이 아프신가요?,Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+"당뇨가 있어서 되도록이면 야식은 안 먹으려고 하죠.
+",Korean
+설사는 하루에 몇 번 하시나요?,Korean
+피를 토할 때가 많이 있나요?,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+소화될 때 어려움이 있나요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+우선 치료를 먼저 하신 후에 흉터 치료를 병행하시면 됩니다.,Korean
+담배를 피우신 경험이 있나요?,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+원인에 따라 장염을 세균성과 바이러스성으로 나눌 수 있습니다.,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+고지방식 등 식습관에도 영향을 받습니다.,Korean
+입원해서 치료받거나 수술받은 경험입니다. 입원하신 경험이 있다면 알려주세요.,Korean
+아 네 근데 이 부루펜 먹고 내렸다가 다시 올랐는데 이걸로 될까요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+사람마다 폐경시기는 다르기 때문에 언제라고 말씀드리기는 어려우나 일반적으로 한국 여성은 사십구 세 정도 됩니다.,Korean
+혹시 가려움증도 같이 느껴지시나요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+성 기능 장애가 있으신가요?,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+질병에 따라서 달라집니다. 보통 활동성인 경우 전염력이 있어요.,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+수술하는 경우도 있고 수술없이 치료만 받는 경우도 있습니다.,Korean
+가족 중에 암을 앓으신 분들이 많은가요?,Korean
+귀찮으시더라도 병원 규정에 따른 처사이니 이해부탁드립니다.,Korean
+"가끔 배가 아파서 병원 갔더니 정밀검사를 하래서 왔어요.
+",Korean
+"아니요. 속이 안 좋다고 하긴 했는데 토는 하지 않았어요.
+",Korean
+"위내시경을 했는데 많이 안 좋다고 해서요.
+",Korean
+"손 발 뼈 마디마디가 쑤시고 아픕니다.
+",Korean
+일상생활이 가능하려면 최소 일주일은 입원해서 회복하셔야 합니다.,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+"소화도 잘 안 되고 계속 신물이 넘어와요.
+",Korean
+간염 주사였던 것 같아요.,Korean
+통증을 점수로 하면 몇 점 정도 느껴지나요?,Korean
+물만 먹어도 설사가 나오나요?,Korean
+고혈압약 먹고 예전보다 증상이 호전된 것 같나요?,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+그 외 알레르기가 생겼던 것이 있나요?,Korean
+통증을 처음 느낀 게 언제죠?,Korean
+배의 어느 부위가 아프세요?,Korean
+다리 감각이 이상하진 않으신가요?,Korean
+아닙니다. 안정을 취할 때도 증상이 있으신가요?,Korean
+피가 섞인 소변을 봤나요?,Korean
+"제가 예전에 알코올 중독이었어서 술은 이제 입에도 안 대요.
+",Korean
+알레르기 있는 음식이 뭔가요?,Korean
+보호대 착용과 약물치료 및 주사치료가 있습니다.,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+특별히 치료하지 않더라도 시간이 지나면 신체 면역력에 의해 자연스럽게 소멸됩니다.,Korean
+네. 이후 환자분 치료 계획에 따라 식사 처방도 달라질 수 있어요.,Korean
+손 소독 철저히 해야죠.,Korean
+현재로서는 특별한 치료 방법이 없습니다.,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+설사하는 이유가 따로 있으신가요?,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+반드시 의사 처방을 받고 드셔야 해요.,Korean
+"숨찰 때 두통도 같이 있어요.
+",Korean
+"살짝 피가 비치기도 합니다.
+",Korean
+수술하고 재활 치료 중입니다.,Korean
+약으로 간염을 치료 중이세요?,Korean
+그때 증상이 있었던 기간이 어떻게 되나요?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+현기증 있으신 적 있나요?,Korean
+피를 토할 때 위도 아픈가요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+현재 검사도 에이형으로 나왔는데 재검을 원하시나요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+남편 분과 함께 거주하시기 때문에 간접흡연의 영향이 있습니다.,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+"아기 항문이 빨개지고 애가 간지러워하는 것 같아서요.
+",Korean
+기침 소리가 어떻게 나오나요?,Korean
+체온이 높은 경우가 많아서 걱정이에요.,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+혹시 삼 일 후에 병원에 다시 올 수 있으신가요?,Korean
+검사 후에 치료가 진행될지 여부는 검사가 끝나야 알 것 같아요.,Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+약 이름이 정확히 기억나시나요?,Korean
+언제부터 손이 저림증상이 있었나요?,Korean
+알레르기 진단은 언제 받았나요?,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+일반적으로 종양이라고 하는데 정확한 건 검사 결과를 봐야 말씀드릴 수 있습니다.,Korean
+혹시 보청기나 의안 틀니 임플란트 지팡이 등 보조 기구 사용하시는 게 있으실까요?,Korean
+저희 아이가 거대결장이라는 말씀이신 건가요?,Korean
+정확히 검사를 해보는 게 낫겠네요.,Korean
+횡문근융해증은 신장기능에 문제를 일으킬 수 있기 때문에 소변줄을 삽입하여 시간당 소변량을 정확히 측정할 것입니다.,Korean
+목이 부을 때 가라앉히려면 어떻게 하죠?,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+네. 진통제를 찾지 않았으면 좋겠네요. 저도.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+"오른쪽 발 정가운데 부분이요.
+",Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+그 외에 모든 예방 접종 포함입니다.,Korean
+변비로 인한 증상이므로 배변 완화제 사용을 할 수 있습니다.,Korean
+소변에 피가 같이 나온 적이 있을까요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+이쪽 말고 우리 동네 약국으로 가도 되나요?,Korean
+저 암 치료 중이에요.,Korean
+초음파 외에는 일반적인 검진 정도의 검사가 이뤄집니다.,Korean
+허리 재활 치료 중이라 재활병원에 갔다 왔었습니다.,Korean
+수치가 바뀌는 수준까지 감안해도 환자분은 혈당이 안정적입니다.,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+아픔이 느껴진 게 언제가 처음이죠?,Korean
+대변을 볼 때 피가 나오나요?,Korean
+"요즘 들어서 가만히 있어도 어지럽고 앉았다 일어나면 어지럼증이 더 심해요.
+",Korean
+"속이 너무 안 좋아요.
+",Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+비염이 심해져서 업체 찾아서 맡기고 있어요.,Korean
+"머리가 아픈 거 같다고 하셨어요.
+",Korean
+검사 결과가 나온 이후 좀 더 효과 있는 치료법으로 가는 방법으로 하죠.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+이 부위가 아픔을 느끼시는 거죠?,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+체온이 몇 도인지 아세요?,Korean
+우선 충수돌기염 치료를 위해 항생제를 사용해야겠습니다.,Korean
+한번 아프기 시작하면 얼마나 아프시나요?,Korean
+소변하고 혈뇨랑 함께 나오나요?,Korean
+소화기 내과 진료 예약하고 가도 되나요?,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+초등학생 때 처음 진단받았어요.,Korean
+아픈 곳을 말씀해 보실래요?,Korean
+손가락 습진이 심하신가요? 처방 내리고 치료 도와드릴게요.,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+아직 다 안 나았어요.,Korean
+"놀라긴 했지만 의식을 잃을 정도는 아니었어요.
+",Korean
+심근경색 말고도 흉통을 일으킬 수 있는 여러 질환들이 있습니다.,Korean
+몸에 붓기는 차도가 있나요?,Korean
+청력에 이상이 생겼거나 이명이 들리지는 않나요?,Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+결핵 치료 이력이 있나요?,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+혈관을 확보해서 진행하는 거라 처음에 불편할 수 있습니다.,Korean
+어디가 불편하셔서 진료를 받으셨나요?,Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+아픈 증세를 얘기해 보세요.,Korean
+네. 괜찮습니다. 보호자 동의가 없어도 되는 간단한 시술입니다.,Korean
+"열이 처음 쟀을 땐 삼십팔 점이오 도였고요. 지금은 약을 좀 먹인 상태예요.
+",Korean
+심장 박동이 여전히 빠른가요?,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+아직은 입원 지시가 없어서 금식 여부를 알 수 없습니다.,Korean
+당뇨라고 들으신 적이 있나요?,Korean
+결핵 문제는 그동안 없었고요?,Korean
+피부나 다른 곳에 알레르기가 생긴 적이 있나요?,Korean
+가족 다 같이 백신 맞자고 해서 맞았어요.,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+"네. 열 시 이후로 금식했습니다.
+",Korean
+주에 몇 번 아픈가요?,Korean
+근육통 때문에 그때그때 약 사서 먹어요. 게보린 같은 거요.,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+아픈 증상을 자세히 말씀해 주시면 처방하겠습니다.,Korean
+전신 마취에 대한 부작용이 없으셨는지 해서요.,Korean
+네. 외가 쪽으로 당뇨가 있으세요.,Korean
+"식도에 문제 있다는 건 압니��.
+",Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+갑상선암 의심된다고 입원해서 정밀 검사받았었어요.,Korean
+소변을 볼 때 따갑고 타는 듯한 느낌이 있으신가요?,Korean
+원칙적으로 여덟 시간은 물도 마시지 않고 금식을 해야 합니다.,Korean
+나중에 태아에 영향을 주지 않도록 준비하는 것입니다.,Korean
+가정에서는 빨간약이라고 부르는 포비돈 요오드를 사용하기도 합니다.,Korean
+"아기가 젖도 잘 안 먹고 계속 울어서 어디 아픈 것 같아서 왔어요.
+",Korean
+"병원에 안 온 날을 손꼽으라면 드물 정도로.
+",Korean
+"물도 잘 못 삼키겠어요.
+",Korean
+수술시간은 네 시간 정도 걸려요.,Korean
+담배는 몇 년 피웠어요?,Korean
+"혀를 잘못 깨물어서 통증이 심해요.
+",Korean
+생활용품 중에 사용하다 알레르기가 올라왔던 물건이 있었나요?,Korean
+출혈을 최소화해서 치료할 겁니다.,Korean
+코로나 검사받으러 의료원 다녀왔었는데요.,Korean
+통증이 늘 같은 현상으로 오나요?,Korean
+"기침할 때 이상한 소리가 나길래 애기한테 이상이 있나 싶어 왔어요.
+",Korean
+요즘 변비가 있진 않으셨나요?,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+약은 사고 후부터 먹기 시작했고 약은 지금 없어요.,Korean
+"계속 어지러워요. 속도 울렁거리고.
+",Korean
+네 약 한 번에 다 드세요.,Korean
+통증이나 천자 후 두통 등의 문제 이외에 다른 문제가 발생하는 경우는 드물다고 알려져 있습니다.,Korean
+"네. 감기 기운 생기면서 좀 줄었어요.
+",Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+"심하게 넘어져서 무릎이 까졌어요.
+",Korean
+감염병에 의한 증상일 수도 있어서요.,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+음주량 좀 알려 줘요.,Korean
+"공장 일하다가 허리를 삐끗했는데 며칠이 지나도 나아지지 않아서 왔습니다.
+",Korean
+덩어리가 있다고 전부 암세포인 건 아니에요.,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+"열 때문에 자다 깨서 계속 울었어요.
+",Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+인슐린을 맞아야 할 수도 있어요.,Korean
+아물 때까지 약 꾸준히 발라주세요.,Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+"고환이 많이 부어 내원했어요.
+",Korean
+변비로 고생하신 적은 없으시죠?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+"실험용 알코올을 물인 줄 알고 마셔서 내원했습니다.
+",Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+몸에 계속 열이 나나요?,Korean
+"안면 마비가 온 거 같아요.
+",Korean
+알레르기로 기피하는 음식 있나요?,Korean
+네 복용 중인 약 정보는 굉장히 중요합니다.,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+호흡기 관련 병력 있으세요?,Korean
+"아랫배부터 시작해서 항문까지 다 아파요.
+",Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+어떤 음식을 먹으면 목이 막히시나요?,Korean
+입원하여 필요한 검사들을 하고 치료를 할 예정입니다.,Korean
+"불면증이 있기는 하지만 약을 먹을 정도는 아니에요. 잠드는데 시간이 좀 걸리긴 해요.
+",Korean
+네. 저번 주에 감기 때문에 내과 한 번 다녀왔어요.,Korean
+"피 섞인 가래가 나와요.
+",Korean
+당뇨 검사받아보신 적 있으세요?,Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+만약에 묻어나오는 정도라면 치질과 같은 양성 항문 질환의 가능성이 높습니다.,Korean
+한번 볼게요 부은 부위 좀 보여주실래요?,Korean
+설사는 몇 번 하셨나요?,Korean
+암 수술한 적 있으세요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+부정맥 종류에 따라 치료가 다릅니다.,Korean
+멸균 처리해 놓은 것이 소독 붕대이기 때문에 이 차 감염 예방에 도움을 줍니다.,Korean
+결핵 치료되는 약 뭐 드세요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+아버지가 퇴직 후에 우울증으로 잠깐 고생하실 때 정신과 다니셨죠.,Korean
+수술이라고 해봤자 맹장 수술이에요.,Korean
+전반적으로 치아 상태를 다 보는 거예요.,Korean
+"밥 한 숟가락만 먹어도 토해요.
+",Korean
+일주일에 몇 번 변을 보나요?,Korean
+현기증 느낀 적 있나요?,Korean
+"네. 계속 체기가 있어서요.
+",Korean
+네. 제가 영양실조에 잘 걸려서 입원할 때가 있는데 저번 주에 그랬습니다.,Korean
+검사 결과를 확인 후 말씀드리겠습니다.,Korean
+횡문근 융해증은 근 손상으로 인한 근육 통증과 경직 근 무력감이 나타나며 근 손상이 심한 경우 근육 쇠약이 나타나기도 합니다.,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+네. 지금 상태로 봐서는 테라마이신 연고가 많이 필요할 거로 보입니다.,Korean
+혹시 지금 두통이 있으세요?,Korean
+식후 계속 속이 불편하신가요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+"네. 어지러운 부분이나 울렁거리는 그런 증세는 없었어요.
+",Korean
+"얼마 전에 작업하다가 그라인더에 긁혀가지고 대충 약 바르고 끝냈거든요. 그러다 한 삼일 전부터 진물이 나더니 지금은 좀 아파요.
+",Korean
+"밥 먹고 나서 속이 갑자기 뒤집어지는지 토를 해요. 먹은 거 그대로요.
+",Korean
+네 증상이 재발하지 않는 한 지금은 이 검사로 충분합니다.,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+구토를 언제 한 적 있나요?,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+빠른 회복은 어렵기 때문에 시간을 두고 잘 치료해 나가야 합니다.,Korean
+어머니는 고혈압 있으시고 아버지는 당뇨예요.,Korean
+입원하신 날짜로 말씀해 주시겠어요?,Korean
+결핵 진단 후 치료는 잘 받으셨나요?,Korean
+물인데 상처를 씻어내는 용도입니다.,Korean
+피를 하루에 몇 번 토하나요?,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+통증이 한 번씩 오나요?,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+배가 부풀어 가득 찬 느낌인가요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+현재까지 간염 치료 받은 지는 얼마나 되었나요?,Korean
+환자분 컨디션에 따라 달라집니다.,Korean
+"눈이 아파서 눈을 도저히 못 뜨겠어요.
+",Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+"다행히 머리는 피했는데 어깨에 맞았어요.
+",Korean
+응급실 갈 때 연락 없이 가도 되나요?,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+뭐 때문에 약을 드시고 계세요?,Korean
+제산제는 어떤 역할을 하는 거예요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+치료 방식이 입원하셨던 경험이 있을 경우 좀 더 세밀해집니다.,Korean
+기침 감기 콧물 열 등의 감기 증상이 있으셨나요?,Korean
+"뭘 잘못 먹었는지 설사를 계속해요.
+",Korean
+네. 저번엔 연골 문제로 수술했었어요.,Korean
+"육안으로 봐도 왼쪽 팔 부분이 퉁퉁 부어 있어요.
+",Korean
+복부 팽만감이 있지는 않나요?,Korean
+과거에는 엑스레이를 찍었으나 씨티가 더 정확한 검사입니다.,Korean
+그럴 수도 있고 염증이 생겨서 부종이 있을 수도 있습니다.,Korean
+"배가 너무 아파서 움직일 수가 없어요.
+",Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+네. 하반신 마취도 포함입니다.,Korean
+오늘 중으로 약 이름 확인될까요?,Korean
+심장이 벌렁거린 적 있으세요?,Korean
+수술 이튿날까지만 상주할 것 같아요.,Korean
+환자 컨디션마다 다르지만 보통은 여섯 시간 지속됩니다.,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+아니요. 몇 가지 약이 추가가 될 수는 있으나 기존 약이 변경되지는 않습니다.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+식후 소화가 잘 안 되나요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+약물 성분은 면역과 관련된 여러가지 성분으로 이루어져 있습니다.,Korean
+네. 올해 이 월에 수술했었습니다.,Korean
+소양감은 피부가 가려운 증상을 말합니다.,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+네 맞습니다. 환자분 본인도 수술부위에 대해 인지하고 계셔야 합니다.,Korean
+"금연한 지는 삼 년째고 서른부터 피웠습니다.
+",Korean
+환자분의 상태를 파악하기 위함입니다. 민감한 부위라면 흉터 크기나 모양이 어떻게 되시나요?,Korean
+흡연 한지 오래 되셨나요?,Korean
+네. 유전적 질환이 있다면 다른 사람들보다 질병에 걸릴 위험이 큽니다.,Korean
+약물로 고혈압 치료 ��이신 건가요?,Korean
+작년 말에 폐 질환이 있어서 일주일 입원했었죠.,Korean
+네 어느 병원에서 수술을 받았나요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+"왼쪽 가슴을 누가 바늘로 쑤시는 것처럼 아파요.
+",Korean
+당뇨 수치를 재 봤나요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+"고양이 발톱에 할큄 당했어요.
+",Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+통증 주기가 어느 정도 될까요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+"무심코 뼈를 삼켰는데 목에 걸렸어요.
+",Korean
+하루에 몇 개비 정도 태우세요?,Korean
+결핵 관련해서 약 먹고 있나요?,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+입원을 희망하시면 입원 안내 창구에서 바로 도와드리겠습니다.,Korean
+몸이 붓는 증상이 있나요?,Korean
+혈액 검사도. 씨티도 안 찍어요.,Korean
+"배가 엄청나게 자주 아파지고 그때마다 화장실에서 설사했어요. 변은 거의 액체 수준으로 흐르듯이 했고요. 색은 좀 묽어 보였어요.
+",Korean
+피임약이 상관이 있을 수 있습니다.,Korean
+항생제를 오래 쓸 경우 내성이 생깁니다.,Korean
+네 문제는 없지만 약 안 드셔도 괜찮으세요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+아니요. 아직은 약을 줄이면 안 됩니다.,Korean
+편도가 커서 그런가 계절마다 이래요.,Korean
+"아니요. 목 근육 부분이오.
+",Korean
+사시면서 병원에 입원한 모든 내용 알려주세요.,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+혹시 약물 음식 제외하고 다른 알레르기도 있으세요?,Korean
+열이 있다면 어떤지 알려주시겠어요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+"둘 다 하긴 하는데 이게 질환과 관련이 있어요?
+",Korean
+병원비는 상황에 따라 차이가 클 수 있어서 미리 말씀드리기 어렵습니다.,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+어떤 증상이 제일 힘드세요?,Korean
+몸에 바르고 있는 약이나 화장품이 있을까요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+부작용 중증도에 따라서 의사 선생님이 판단하실 거예요.,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+네 팔도 엑스레이 찍었고 결과 나오면 처치 진행하겠습니다.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+"엊그제 아침에 일어나자마자 목이 잠겨서 말하기도 힘들고 헛기침할 때마다 통증이 있어요.
+",Korean
+검사 결과에 따라 격리가 필요할 수 있어서 필요합니다.,Korean
+엑스레이를 한번 찍어봐야 알 것 같습니다.,Korean
+가루약보다는 알약으로 드시는 게 더 효과가 좋습니다.,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+하루에 설사를 자주 하시나요?,Korean
+술은 당연히 몸에 나쁩니다.,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+처음 통증을 느꼈던 때가 언제인가요?,Korean
+네 수술로 치료하면 건강하게 일상생활을 가능합니다.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+체중이 증가한 이유가 있을까요?,Korean
+이상이 있는 경우는 드뭅니다. 하지만 심한 복통이 지속되거나 다량 혈변이 있는 경우 즉시 내원하세요.,Korean
+종양이 있을 수 있는 건가요?,Korean
+가려움증이 특정 부위에만 있었나요? 아니면 몸 전체에 있었나요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+네 전반적으로 다들 아프셨어요.,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+그 각도가 산소 공급에 가장 좋습니다.,Korean
+약을 오래 드시면 안 됩니다.,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+배에 가스가 차서 힘드신가요?,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+통증이 어느 부위에 있나요?,Korean
+전에는 내시경 ���중에 깬 적이 없거든요.,Korean
+비염 약도 같이 먹어요.,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+의사 선생님 보고 왔어요.,Korean
+화상 정도에 따라 과산화수소수를 사용할 수 있습니다.,Korean
+결핵약 매일 복용하고 있나요?,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+무릎도 같이 다치셨군요 보여 주시겠어요?,Korean
+결핵을 앓기 시작한 지 얼마나 되셨죠?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+혹시 가래를 자주 뱉으시나요?,Korean
+검사 결과는 그렇게 나왔네요.,Korean
+씨티와 엠알아이 판독결과 나오면 의사선생님이 다시 설명해주러 오실 거에요.,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+계절에 따른 영향으로 입술이 건조할 수도 있습니다.,Korean
+간염 시작된 나이가 언제인가요?,Korean
+이유식은 늦어도 만 육 개월쯤에는 시작하는 게 좋습니다.,Korean
+"신장 제 기능을 수행하지 못한다고 들었어요.
+",Korean
+네 자가 격리 마쳤어도 알아야 합니다.,Korean
+알레르기 검사 받으신적 있나요?,Korean
+허리랑 목 염좌 때문에 종합병원에 물리치료 다녔어요.,Korean
+최근에 오한이 있던 적이 있나요?,Korean
+파상풍 맞은 적 있어요.,Korean
+둘 다 알레르기로 나타날 수 있고 연관성이 있습니다.,Korean
+환자 환인을 위해 이용되고 있습니다.,Korean
+"네. 하루에 두 번 이상 토했어요.
+",Korean
+알레르기 일으키는 음식은 없어요?,Korean
+처방되는 약을 꾸준히 드신다면 통증이 호전되실 것입니다.,Korean
+아니요. 수술 부위에 염증이 생겼는지 아프고 상처가 잘 아물지 않던데요.,Korean
+지금 아픈 게 느껴지실까요?,Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+네. 동물에게 옮는 질병이 있을 수 있거든요.,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+네 입원일수에 맞게 계산되는 것으로 알고 있습니다.,Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알코올 솜으로 눌러 보세요.,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+평소에 식이 섬유 위주의 식단은 챙겨 드시나요?,Korean
+"좀 오래 자요 열다섯 시간 정도예요.
+",Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+최근에 오한을 느낀 적이 있나요?,Korean
+지금 상황에선 계속 약물을 먹고 생활습관을 바르게 하여 경과를 지켜보는 수밖에 없습니다.,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+네 오늘 예약하시면 더 빠른 시간에 하실 수 있습니다.,Korean
+기침할 때 증상이 어떤가요?,Korean
+정 혈액검사가 싫으시면 피부반응으로 하겠습니다만 정확도가 떨어지고 결과 확인이 늦어집니다.,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+약 외에는 따로 드시는 건 없으신가요?,Korean
+고혈압으로 따로 챙겨 드시는 약 있으세요?,Korean
+"그냥 통증만 계속 유지되는 느낌이에요.
+",Korean
+복용하는 약제에 의해서도 부을 수 있습니다.,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+틀니가 강하게 고정될 경우 안에서 치아가 흔들릴 수가 있어요 확인해보죠.,Korean
+네 삼 개월 때 수술할 수 있으나 주로 육 개월 이후에 합니다.,Korean
+담배는 당분간 피우지 않는 편이 좋겠습니다 환자분 건강도 그렇고 약도 효과가 있으려면 흡연은 좋지 않습니다.,Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+네 간질환 또한 유전적 질환일 수 있기 때문에 위험도가 높긴 합니다.,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+"배달 알바하다가 사고가 났는데 그 이후로 다리고 계속 아프고 붓기도 안 빠지네요.
+",Korean
+맥박이 빨리 뛰는 느낌 나나요?,Korean
+구토가 나오면서 동반되는 다른 증상이 있나요?,Korean
+"오줌을 잘 못 누고 배 안쪽이 탱탱하게 엄청 당겨서 아파서 입원했어요.
+",Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+가족 중 유전성 질환으로 고생하신 분이 있나요?,Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+처방할 때 관련된 문제를 피할 수 있거든요.,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+"금연했었죠. 한 몇 달 안 피웠어요.
+",Korean
+환자분마다 회복속도가 다르므로 정확히 얼마 만이라고 말씀드리기는 어렵습니다.,Korean
+약물 복용 중인 거 있으신가요?,Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+네 수술 부위 정확히 인지하고 계세요.,Korean
+하루 담배 얼마나 피우세요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+소화가 안 된 건가요?,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+수술하고 나오면 바로 마취 풀리는 거죠?,Korean
+"자긴 하는데 숙면은 못 취해요.
+",Korean
+간염은 앓으신 지 얼마나 되셨어요?,Korean
+소변볼 때 잘 안 나오나요?,Korean
+어떤 질병 때문에 드시고 계신 건가요?,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+레진 치료한 치아에 신경치료가 되어있나요?,Korean
+"발목 아래 전체에 통증이 있어요.
+",Korean
+혹시 촬영 중에 구토가 날까 봐 그러거든요.,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+심장 박동이 빠르고 두근거리나요?,Korean
+집에 다른 암 환자는 없으시고요?,Korean
+네. 과거에 혈액형 검사해 보신 적 있으신가요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+독감 예방접종을 맞으러 갔었습니다.,Korean
+얼굴 말고 팔도 아프시다고요? 어디가 어떻게 아프신지 설명해 주시겠어요?,Korean
+상처에 습윤이 유지되게 하는 효과가 있습니다.,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+배뇨 곤란을 느끼신 적이 있나요?,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+숙면을 푹 취하기 어려우신가요?,Korean
+치질 판명이 나신 적 있으신가요?,Korean
+"위 속이 타는 것 같아요.
+",Korean
+"혈당이 정상 범위를 넘어서서 왔어요.
+",Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+하루에 담배를 얼마나 피세요?,Korean
+"식욕만 줄고 체중은 늘어요.
+",Korean
+다른 아픈 곳은 없으신가요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+"움직일 수 없을 정도로 배가 아파서 동네 병원에 갔는데 큰 병원 가보라고 해서 응급실로 왔어요.
+",Korean
+다른 질병 치료 중인 것 있나요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+수술한 후에 후유증이 있나요?,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+정밀검사를 확인해 보도록 하겠습니다.,Korean
+소변에 피가 섞여 나오나요?,Korean
+현재는 전혀 술을 안 드시나요?,Korean
+"갑자기 이빨이 너무 아파요.
+",Korean
+일 년 전에 가슴뼈 기형으로 수술했어요.,Korean
+토할 것 같은 느낌이 오나요?,Korean
+"네. 열 시 이후로 금식했습니다.
+",Korean
+아니요. 치료 끝난 지 좀 됐어요.,Korean
+체위변경을 자주 해주시면 욕창이 진행되는 것은 막으실 수 있습니다.,Korean
+네. 이거는 환자분 수술하시기 전후에 맞으실 항생제 주사인데요. 이 항생제에 부작용이 있나 살피기 위해서 검사하는 거예요.,Korean
+소변이 농축되면 냄새가 더 심해지기 때문에 평소 소변의 냄새가 너무 심하다면 충분한 수분을 섭취하는 것이 도움이 될 수 있습니다.,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+임신 시 분만 방법 그리고 수술력이 추후 본과 수술 방법에 영향을 미칠 수 있어서 확인하였습니다.,Korean
+"경련을 일으키면서 뒤로 넘어졌어요.
+",Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+식후 소화가 잘 안 되나요?,Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+복수가 찬 적 있나요?,Korean
+오늘 저녁에 입원 예정입니다.,Korean
+어떤 것에 알레르기가 있나요?,Korean
+전해질 수치에 다소 비정상적인 부분이 있네요.,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+"갑자기 오 킬로 늘었어요.
+",Korean
+토혈을 하신 경험이 있나요?,Korean
+나중에 태아에 영향을 주지 않도록 준비하는 것입니다.,Korean
+하루에 세 알씩 식후로 꼭 먹고 있습니다.,Korean
+평소에 무슨 약 드세요?,Korean
+기침할 때 목이 많이 아픈가요?,Korean
+단지 화상 입어서 흉이 진거 말고 몸 움직이기가 불편하시다거나 신체에 변화가 생겼나요?,Korean
+"몇 달 전부터 숨이 턱턱 막히고 숨을 쉴 수가 없을 것 같다는 느낌이 있었거든요. 처음엔 별일 아니겠거니 했는데 요새 들어서 자주 그런 증상이 있어서 검색���봤더니 공황장애 뭐 이런 게 아닌가 싶어서 와봤습니다.
+",Korean
+"평소 자던 대로 자는데 하루 종일 피곤해요. 수면 시간은 그대로인 데도요.
+",Korean
+요구 사항으로 전달은 드리지만 환자분의 치료 계획 또는 신체 상태에 따라 변경될 수 있습니다.,Korean
+대변볼 때 피가 묻어나나요?,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+우선 약 이름부터 알려 주세요.,Korean
+영양소는 비타민뿐만 아니라 다른 영양소도 섭취해야 해요.,Korean
+구토를 하면 얼마나 하나요?,Korean
+무증상 육안적 혈뇨 환자의 일 이 퍼센트 정도에서 악성 질환이 발견되므로 확률적으로 높지는 않지만 반드시 검사가 필요합니다.,Korean
+경구 약물 투여가 가능하다면 먹는 약물 사용이 더 바람직합니다.,Korean
+통증 양상의 특징점이 있나요?,Korean
+이번에는 전신마취를 해야 돼서 감각이 느리게 돌아올 겁니다.,Korean
+하루 흡연량이 얼마나 되는데요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+배에 아직 부기가 안 빠져서 그런 걸 수도 있습니다.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+약물이 당뇨 치료에 효과가 있었나요?,Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+평소에 부종이 좀 있으세요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+기침할 때 피가 터져 나오나요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+의식적으로 코만 이용해 숨을 쉬셔야 합니다.,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+호흡이 조금 가빠 오면 간호사 선생님을 호출하세요.,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+심장 박동이 불규칙하게 뛰는데 괜찮으세요?,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+네 보호자 분에게 수술한 병원명 알아보고 말씀해주세요.,Korean
+물만 먹어도 설사가 나오나요?,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+우선은 다른 약으로 변경해 보도록 하겠습니다.,Korean
+예방주사 맞은 날짜를 알려주실래요?,Korean
+무릎 관절이 좋지 않은 상태에서 체중이 증가하면 연골이 더 닳게 되서 관절이 버티기가 힘듭니다.,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+주사를 살살 놓으면 더 아프실 수도 있어요. 얼른 끝내 드릴게요.,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+소량의 마취제로도 마취가 가능하니 참고하겠습니다.,Korean
+"방광 쪽에 문제가 있다고 알고 있는데요.
+",Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+제때제때 대변을 잘 못 보는 편인가요?,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+사전적 의미로는 민간에서 예로부터 전하여 내려오는 치료법을 말하는데요.,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+소변에 피가 많이 나오셨나요?,Korean
+감염병에 걸린 적 없습니다.,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+증상 발생 후 빠른 시간 내에 병원에 오셔야 적절한 치료가 가능합니다.,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+"어깨를 일정한 각도로 돌린다거나 팔을 좀 심하게 쓸 때면 어깨가 빠진 것처럼 느껴질 때가 있습니다.
+",Korean
+가족 중에 당뇨 진단을 받아보신 분이 있으세요?,Korean
+아프기 시작한 게 언제부터였죠?,Korean
+통증이 좀 강한 편이에요?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+검사는 대략 두 시간 정도 소요될 예정입니다. 이후에는 식사하셔도 상관없습니다.,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+흡연 기간은 어느 정도이신가요?,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+심호흡을 안 하시면 폐 깊숙이 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+"얼굴에 유분이 늘고 뭐가 자꾸 나서 더 심해지기 ���에 치료받으려고 왔어요.
+",Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+과거에 크게 질병을 앓은 적이 있나요?,Korean
+방법은 수면 유도하여 주무시게 되면 오른쪽 사타구니에 관을 꽂아 심장으로 가는 정맥과 동맥을 뚫고 조영제를 투여하면서 심장혈관을 관찰합니다.,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+약물 알레르기 있던 적 있으세요?,Korean
+언제 암을 처음 진단받으셨나요?,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+"갑자기 얼굴에 여드름이 올라와서요.
+",Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+몸에 열 기운이 느껴지세요?,Korean
+"간 수치가 이상하다고 큰 병원 가래서 급히 왔습니다.
+",Korean
+침상을 보시면 침상 난간이 있는데 이것은 항상 올리시는 게 낙상 예방에 좋습니다. 잘 때는 특히 꼭 올리시고 주무세요.,Korean
+수술받은 곳 통증은 어때요?,Korean
+알레르기를 오래 앓고 있었나요?,Korean
+네. 진료기록 보시면 나와요.,Korean
+"원래 즐겨 했는데 몸 관리 좀 하려고 금주 금연 한 지 이 주됩니다.
+",Korean
+아니요 틀니는 흔들리지 않습니다.,Korean
+"속이 많이 안 좋으시고 울렁거린대요. 토도 하시고요.
+",Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+이번에는 전신마취를 해야 돼서 감각이 느리게 돌아올 겁니다.,Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+네 약 처방해 드릴 때까지 조금만 더 기다리세요.,Korean
+일단 말씀해 주시죠. 약품명이요.,Korean
+거의 통증은 없다고 생각하시면 됩니다.,Korean
+암 치료했었던 가족이 있나요?,Korean
+정확히 초음파상 어떤 곳을 재확인하고 싶으신 건가요?,Korean
+"손가락 끝에 상처 난 곳이요.
+",Korean
+척추마취 후 흔하게 두통 등 부작용이 있습니다.,Korean
+검사결과가 나와봐야지 알 수 있겠네요.,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+특별히 식욕이 없어진 때가 언제인가요?,Korean
+제가 약물 알레르기가 있어요. 그것만 체크해 주세요.,Korean
+가슴이 답답하고 속이 더부룩한가요?,Korean
+"축구하다가 넘어져서 입 안쪽이 터졌어요.
+",Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+일주일정도 격차두고 맞으시는게 좋아서요.,Korean
+병원 방문 이유가 뭘 까요?,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+네 저희가 환자분 상태를 자세히 파악하기 위해 필요합니다.,Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+"벌에 쏘이니까 온몸이 가렵고 어지럽고 그래요.
+",Korean
+하루에 몇 번 정도 아픈가요?,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+의료진이 알아야 할 알레르기가 있나요?,Korean
+결핵약은 어떤 거 드세요?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+처음 통증 있었던 게 언제죠?,Korean
+"입술 주변이 부어오르고 가려워서 왔어요.
+",Korean
+갑자기 알레르기 반응이 일어나면 기도가 막힐 수가 있거든요.,Korean
+지금 제일 아픈 곳이 어디인가요?,Korean
+"아 담배랑 술은 끊은지 좀 됐어요.
+",Korean
+수술 중에 위 내용물이 역류하실 수 있습니다.,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+정확해야 하니까 피검사를 해볼까요?,Korean
+병원 입원 시 기초적 자료 조사입니다.,Korean
+어머님이 암 진단을 받으셨었나요?,Korean
+수면으로 할 시에는 수면마취 동의서에 서명하셔야 합니다. 비수면으로 할 시 그럴 필요는 없지만 조금 더 불편감을 느낄 수 있습니다.,Korean
+"분유 토하다가 색이 점점 연해지는 토를 했어요.
+",Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+"계속 애가 설사를 해서요.
+",Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+"어제저녁에 구토도 나와서 잠도 제대로 못 잤어요.
+",Korean
+붓기가 제일 심한 때를 알려 주세요.,Korean
+단순 변비 일 수 있지만 우선 신생아에서 구조적인 문제가 아니면 변비는 잘 없다고 이야기는 드렸었어요.,Korean
+체중��� 급격히 늘었다는 말씀이시죠?,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+"요즘 들어서 입맛이 없고 기운 없이 축 처져요.
+",Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+"변이 회색빛이 돌았던 것 같아요.
+",Korean
+"끓는 물에 화상을 입었어요.
+",Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+검사하고 휠체어 이용방법 알려 드리겠습니다.,Korean
+주사를 천천히 놔드리는데 지금도 그러신가요?,Korean
+수면 내시경이 있습니다. 하지만 대장 내시경보다 검사가 수월하여 비수면으로 하기도 합니다.,Korean
+약 말고 다른 알레르기는 없나요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+기존 병원이 지금 휴진 상태라 이쪽으로 옮기려고요.,Korean
+치열 확인을 위해서 엑스레이 촬영을 했어요.,Korean
+여드름 난 부위만 얇게 바르시면 됩니다.,Korean
+몇 년이나 담배 피웠나요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+건조하면 기침을 자주 하시나요?,Korean
+지금 들어가는 약이 혈관 통증을 유발하는 약이라 그럴 수 있어요.,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+숨 쉬는 건 어때요?,Korean
+"어깨가 아파서 응급실 왔는데 탈골이라고 해서요.
+",Korean
+검사 후에 수술 없이 치료할 수 있을 정도인지 다시 안내드릴게요.,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+소양감은 간지러운 증상을 이야기합니다.,Korean
+주사 때문에 뻐근할 수 있는데 통증이 계속 있거나 부으면 말씀해 주세요.,Korean
+수면제 복용보다 수면 위생을 잘 지키고 있는 지부터 파악해야 합니다.,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+네 약품명도 알면 알려주세요.,Korean
+오랜 시간 반복적으로 위의 점막에 염증이 생기면 만성 위염이라고 합니다.,Korean
+형제분 중에 암 환자가 있다는 말씀이죠?,Korean
+진통제 자주 먹었더니 알레르기 생겼어요.,Korean
+하루에 얼마나 자주 술을 음용하시나요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+육안으로 봐도 불룩한 게 보이시나요? 위험 여부는 추가 검사 진행 후에 말씀드릴게요.,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+"아니요. 설사 몇 번 안 해봤어요.
+",Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+퇴원 관련 안내는 이미 알고 있습니다.,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+네 수술부위는 어느 쪽으로 알고 있나요?,Korean
+감기약 삼 일치 받았어요.,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+혈압 측정기가 여기 있어서 다시 이곳으로 오셔야 합니다.,Korean
+"""어느 순간 눈에 뭐 눈곱 낀 거처럼 잘 안 보이더라고 몇 번 비비면 또 괜찮아져서 내버려 뒀더니만, 요즘 들어 이게 심하고, 시야가 좁아진 거 같은 느낌이 들어. 입원할 수밖에 없었지.""
+",Korean
+"당뇨약을 먹고 있는데 음식조절에 관해서 여쭤볼 게 있어서 왔습니다.
+",Korean
+레이저 치료가 끝난 뒤에 통증이 유발되는 경우도 가끔 있습니다.,Korean
+피가 섞인 변을 보셨나요?,Korean
+부은 증상이 어디에 나타났나요?,Korean
+그럼 과거에 흡연과 음주하셨던 기간은 어느 정도인가요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+종양 확인된 적 있으신가요?,Korean
+아직도 많이 아프신가요? 많이 아프시면 지금 약이랑 바꾸는 방법도 있습니다.,Korean
+일단 육안으로는 아무 이상 없습니다.,Korean
+평소 당 수치가 어느 정도신가요?,Korean
+아토피 치료를 받으신 적이 있나요?,Korean
+백신 주사 맞은 거 있나요?,Korean
+얼마나 오랫동안 알레르기가 있었어요?,Korean
+합병증으로는 아무래도 침습적인 시술이다 보니까 감염 위험성이 있을 수 있어요.,Korean
+암으로 병원 다닌 적 있으세요?,Korean
+다른 종류의 진통제를 놔드릴게요.,Korean
+"서 있기 힘들고 다리에 힘이 점점 빠지네요.
+",Korean
+무엇 때문에 병원에 왔나요?,Korean
+혹시 약물 음식 제외하고 다른 알레르기도 있으세요?,Korean
+환자분께서는 주기적으로 피 검사를 진행해 심장 효소 수치를 확인할 것입니다.,Korean
+움직임에 제한은 있지만 심각한 상황은 아닌 듯합니다.,Korean
+종교적인 이유 때문에 수혈을 거부하시는 분들도 계십니다.,Korean
+염증 수치는 몸에 이상반응이 있음을 의미합니다.,Korean
+지금은 무슨 약 드세요?,Korean
+입으로 피 토한 증상 있나요?,Korean
+드시는 약은 어떤 것들이 있을까요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+배도 같이 아프신 거죠?,Korean
+여기 병원에서 수술받은 적 있습니다만.,Korean
+고유량의 산소를 투여하면 괜찮아질 겁니다.,Korean
+고통이 얼마나 오래 지속되나요?,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+아이 몸무게 측정할 때 옷은 입은 상태로 눕히시면 됩니다.,Korean
+"소변은 다른 때에 비해 소변 색이 진했어요.
+",Korean
+네 아주 어렸을 때 받으신 수술까지도 말씀해주세요.,Korean
+손에는 많은 세균이 있어 만지는 것은 좋지 않습니다 환자분도 손으로 만지지 않도록 조심해주세요.,Korean
+대변볼 때 안 힘든가요?,Korean
+"아마 심장 쪽 관련해서일 겁니다. 아버지가 심장병으로 돌아가셔서.
+",Korean
+이차 치료제는 사제 요법을 사용합니다.,Korean
+혹시 시력 청력 관련 된 장애 등급이 있거나 보청기를 착용하시나요?,Korean
+잘 몰랐는데 최근에 봄 되면서 너무 안 좋아서 병원 가서 진단받고 왔어요.,Korean
+피로한 게 안 풀리시나요?,Korean
+환자분이 느끼는 통증의 정도가 얼마나 되나요?,Korean
+아닙니다. 안정을 취할 때도 증상이 있으신가요?,Korean
+언제 당뇨 얘기를 들으셨나요?,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+통증이 어떤 식으로 느껴졌는지 설명해 주실래요?,Korean
+"네. 자다가 아파서 너무 깨요.
+",Korean
+어디가 가장 아픈 곳이에요?,Korean
+심계항진이 있거나 그러진 않으신가요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+통원치료를 꼭 하셔야 한다면 어쩔 수 없지만 댁에서 계속 소독하고 붕대 자주 갈아주셔야 합니다.,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+네. 고카페인 섭취 시 가슴 두근거림이 있을 수 있습니다.,Korean
+피가 섞인 소변을 봤나요?,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+성형외과 외에는 다른 병원은 안 갔나요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+최근 들어 살이 갑자기 찐다거나 하진 않나요?,Korean
+가족들 병력은 저도 모르는데요.,Korean
+"원래 많이 안 먹는데 식욕마저 더 감소한 것 같아요.
+",Korean
+아픔이 며칠 주기로 찾아오나요?,Korean
+예방 접종을 하면 독감에 덜 걸리긴 하지만 아예 안 걸리는 건 아니에요.,Korean
+아니요. 약은 필요 없다 하셔서.,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+대개 해당 치료는 전신 마취로 진행합니다.,Korean
+다른 치료하신 것도 있으신가요?,Korean
+"어제 지하철을 타러 가다가 발목을 접질려서 왔어요.
+",Korean
+특이한 혈액형 그런 게 있어요?,Korean
+네 건강 체크에 중요합니다.,Korean
+마약이나 향정신성 약물을 복용하고 계시나요?,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+"제가 코를 많이 골아서 코 심하게 골 때는 놀라서 일어나곤 해요.
+",Korean
+몸에서 열 감이 느껴지시나요?,Korean
+어느 부위가 제일 아프세요?,Korean
+네. 어릴 때 탈장 수술 했어요.,Korean
+디피시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요.,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+제일 염려되는 증상이 뭐죠?,Korean
+중풍 때문에 고생 좀 하셨어요.,Korean
+콩팥기능이 안 좋은 분은 조영제 사용이 주의가 필요한데 환자분은 괜찮으신 것 같아요.,Korean
+추후 골수이식 등의 상황이 걱정되신다면 신청하시면 됩니다.,Korean
+흉터가 조금 생길 수도 있어요.,Korean
+"구내염이 너무 크게 나서 왔어요.
+",Korean
+코로나 시작하자마자 갔다 왔습니다.,Korean
+약 처방할 때같이 처방하면 안 되는 약이 있는지 확인하려고 여쭤봤습니다.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+당뇨약 꾸준히 복용하시소 당 조절이 잘 되면 의사 선생님이 집에서 검사하는 횟수를 조금 줄여도 될 거라고 할 거예요.,Korean
+다른 치료와 비��하여 크게 비싸지 않습니다.,Korean
+백신 접종은 매년 하고 계신가요?,Korean
+입원 치료 혹은 수술받으신 적이 있으면 말씀해 주세요.,Korean
+암 판정받으신 적 있나요?,Korean
+설사를 얼마나 자주 하시나요?,Korean
+"식사량도 없고 컨디션도 난조라 그런지 물똥 같은 변을 보시더니 일주일 전부터 혈변을 봤대요.
+",Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+빠른 효과를 기대한다면 하제 대신 관장을 하는 것도 방법이 될 수 있습니다.,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+지금 안 하셔도 수술 준비에 들어간 비용은 모두 청구됩니다.,Korean
+"귓구멍 입구에 상처가 나서 수포가 좀 있어요.
+",Korean
+"매일 아침 혈당 체크를 하는데 오늘 높게 나와서 왔어요.
+",Korean
+불면증 치료받아도 잘 못 주무시나요?,Korean
+힘드셨던 점 이해합니다. 동의서는 여기 보이는 전자동의서 형태로 작성할 예정입니다.,Korean
+하루 동안 몇 개비의 담배를 피우시나요?,Korean
+네 맹장 수술도 포함입니다.,Korean
+"운동하다가 한 번 어깨가 빠질듯한 느낌이 든 적이 있는데 그 이후로 무거운 걸 들지 못하겠어요.
+",Korean
+아까 쟀을 때보다 열이 떨어졌는지 체크하려고 또 재는 거니 안심하세요.,Korean
+"손목 붓고 화끈거리는 건 며칠 지나니까 괜찮아졌는데 찌릿찌릿한 건 계속 있어요.
+",Korean
+담배는 당분간 피우지 않는 편이 좋겠습니다 환자분 건강도 그렇고 약도 효과가 있으려면 흡연은 좋지 않습니다.,Korean
+무증상 육안적 혈뇨 환자의 일 이 퍼센트 정도에서 악성 질환이 발견되므로 확률적으로 높지는 않지만 반드시 검사가 필요합니다.,Korean
+수술하긴 했는데 언제인지 몰라요.,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+병실료와 식비는 하루에 오만 원입니다.,Korean
+느낌상 심박수가 올라가는 것 같았어요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+"늘 설사를 하고 변이 얇아요.
+",Korean
+몸살 기운이 있으신 거죠?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+방역 수칙을 지키면서 검사를 진행하고 있기 때문에 그럴 가능성은 굉장히 낮습니다.,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+배가 부풀어 가득 찬 느낌인가요?,Korean
+건강 상태가 좋지 않아 유의해 주세요.,Korean
+"오토바이 타다가 다리를 다쳐서요.
+",Korean
+통증은 움직일 때마다 오나요?,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+음식이 잘 들어가지 않나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+언제부터 간염을 앓고 계셨나요?,Korean
+대변보는 주기가 어떻게 되나요?,Korean
+피부가 입 속에 있는 구조물들이 자라는 속도를 못 따라올 수 있어서 어느 정도 성장 후에 재수술을 진행하는 겁니다.,Korean
+입원 치료한 적 있으신가요?,Korean
+약 이름이 뭐였는지 기억이 통 안 나요.,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+장중첩증 수술한 게 다예요.,Korean
+아스타잔틴이랑 비타민 챙겨 먹어요.,Korean
+투석 꼭 받아야 하는 건가요?,Korean
+"차 타고 가다가 전봇대에 박았는데 그 후로 숨쉬기도 힘들고 너무 숨차요.
+",Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+염증성 질환 관련이 있을 수 있습니다.,Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+집보다는 요양원이 편하실 것 같아서요.,Korean
+통증이 지속되는 부위가 어딘가요?,Korean
+네 헬리코박터균 감염이 있을 시 제균치료가 필요합니다.,Korean
+어머니가 아토피성 피부염이 있습니다.,Korean
+네. 저는 자연분만으로 아이들 낳아서 다행이라고 생각해요.,Korean
+검사를 하려면 공복 상태가 최소 여섯 시간은 되어야 해서 여쭤봤어요.,Korean
+네. 시간이 지나면 돌아오지만 증상이 생기는 즉시 말씀 주셔야 합니다.,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+언제부터 혈압이 좀 높다고 들으셨나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+가끔 고기가 식중독 원인이 될 수 있습니다.,Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+환자 혼자서는 이동이 불가한 거 맞죠?,Korean
+씨티 안 찍으면 안 돼요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+처방할 때 관련된 문제를 피할 수 있거든요.,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+수술 시 상태가 얼마나 돌아오는지에 대한 말씀을 다시 듣고 싶어요.,Korean
+아픈 게 얼마나 아프세요?,Korean
+"무릎에서 소리가 나고 걸음이 불편해져서 왔습니다.
+",Korean
+비뇨기과 전문의가 있고 수술이 가능한 병원으로 가셔야 합니다.,Korean
+"기침이 계속되고 가슴 부분에 압박감이 있고 가슴이 답답한 느낌이 있어서 병원에 왔어요.
+",Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+"위층에서 물건이 떨어졌는데 눈에 떨어졌어요!
+",Korean
+목이 아픈 적 있으셨어요?,Korean
+대변볼 때의 통증 또한 포함됩니다. 그리고 그 외 대변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+피가 섞인 소변이 나오나요?,Korean
+"또래에 비해 발달이 아무래도 느린 거 같아서요.
+",Korean
+손목을 오래 사용하실 때에는 자주 손목 스트레칭을 해주시는 것이 좋습니다.,Korean
+"어깨를 돌리거나 팔을 좀 심하게 쓰면 어깨가 이렇게 톡 하고 빠지는 느낌이 있는 것 같습니다.
+",Korean
+네 입원하셔야 진행할 수 있는 검사가 있습니다.,Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+우선 원인을 찾은 후 맞는 약을 처방해드리겠습니다.,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+발기를 아예 못 하시는 건가요?,Korean
+고통이 얼마나 자주 오나요?,Korean
+통증을 어느 곳에 느끼시나요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+"항문에 병이 들어간 이후로 몸이 이상해서 와봤습니다.
+",Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+가슴 통증이 어떻게 있나요?,Korean
+하루 동안 얼마나 피워요?,Korean
+"몸이 이상해서 혈당을 쟀는데 높게 나왔어요.
+",Korean
+"지금 양손 다 그래요. 오른쪽이 더 심한 것 같아요.
+",Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+예시로 든 접종 외에 다른 접종은 안 맞아 보셨나요?,Korean
+"요즘 잠이 잘 안 옵니다.
+",Korean
+"건강 검진받았는데 자궁근종 있다고 수술해야 한다고 하더라고요.
+",Korean
+금식하시고 설명해 드린 검사들을 진행할 예정입니다.,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+금식은 계속 유지하시고 계시죠?,Korean
+수면제 복용하신 지 얼마나 됐는지 알려주세요.,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+그래도 한 달 이내면 진료가 불가능합니다.,Korean
+관심 병변이 대장내시경까지 볼 필요가 없습니다.,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+"소화가 잘 안 되니까 입맛 자체가 없어요.
+",Korean
+혹시 촬영 중에 구토가 날까 봐 그러거든요.,Korean
+집에서 소독할 경우 감염의 위험성이 크니 권장하지 않습니다.,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+네. 지금 누른 곳도 아픈가요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+"네. 소변에서 퀴퀴한 냄새가 나는 것 같아요.
+",Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+아무래도 진피층까지 손상이 있어 회복하려면 최소 한 달은 걸립니다.,Korean
+"엄마가 말씀하시기를 코골이도 심하고 잠꼬대도 심하다고 하더라고요.
+",Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+뱃속이 쿡쿡 찌르듯이 아픈가요?,Korean
+약 여분 없으면 다른 약 처방해드릴 테니 그거 드세요.,Korean
+네 희귀병이라 할 수 있죠.,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+기침에 피는 안 나왔어요?,Korean
+"눈이 너무 시리다 못해 아파요.
+",Korean
+간호사님이 가르쳐 줄 거예요 잠깐 계셔보실래요?,Korean
+알레르기 때문에 갑각류 근처에도 안 갑니다.,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+소변에 피가 많이 나오셨나요?,Korean
+염증성 질환 관련이 있을 수 있습니다.,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+피검사 말고 씨티나 엑스레이 같은 촬영 사진 말이에요.,Korean
+환자분의 경우 회복은 한 달이면 충분합니다.,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+"요새 왼쪽 팔다리로 힘이 빠지는 것 같은 느낌이 들어요.
+",Korean
+잠이 쉽게 오지 않나요?,Korean
+"운전하다가 다른 차 피하려고 핸들을 틀면서 가드레일에 박았는데 목이고 가슴이고 전체적으로 너무 아파요.
+",Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+"깊은 잠을 못 자고 계속 깨요.
+",Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+풍진에 걸렸을 경우 양성입니다.,Korean
+통증이 시작되면 계속 아파요?,Korean
+하루에 몇 개비나 태우세요?,Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+입으로 피 토한 증상 있나요?,Korean
+독감 예방 주사는 꾸준히 맞으셨나요?,Korean
+수술받은 적 있으면 알려주세요.,Korean
+"아이가 어른들 먹는 알약을 삼켜버렸어요.
+",Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+아니요. 치아는 괜찮아서 치과를 안 갔어요.,Korean
+불면증 치료받아도 잘 못 주무시나요?,Korean
+치료가 늦어질 시 합병증으로 인해 향후 삶의 질에 영향을 미치게 되므로 적절한 시점에 잘 내원하셨습니다.,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+아니요 하지만 무릎 부종이 맞을 수도 있어서 한번 검사해 보는걸 추천해 드립니다.,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+저희가 말씀드리는 주의사항을 잘 지켜주시면 빨리 나으실 수 있을 것입니다.,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+네 중복되는 약물이 있을 수도 있어서요.,Korean
+급여 비급여를 떠나서 환자분에게 가장 잘 드는 진통제입니다.,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+아닙니다 상처가 많지는 않지만 조금 해서 치료해야겠네요.,Korean
+지금처럼 약물치료 받으시면 곧 나아질 거예요.,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+토할 거 같은 증상이 있으세요?,Korean
+평생 받아본 모든 수술이요.,Korean
+아프기 시작한 게 언제부터예요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+바로 병원에 온 거라서요. 따로 먹은 건 없어요.,Korean
+네. 꽃 가까이 가면 눈이랑 코가 엄청 간지럽고 재채기가 나요.,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+"애기 기침 소리가 이상하네요.
+",Korean
+네 모든 검사 완료됐습니다.,Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+아니요 그럼 안과에선 검진만 받으셨나요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+아니요. 정확히 어디를 수술하는 건가요?,Korean
+최근에 체중 변화가 급격하게 있었어요?,Korean
+다른 알레르기 상황 다 설명 부탁해요.,Korean
+지금 병실 이동 예정이니 밖에서 대기 부탁드립니다.,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+붓기 있는 곳을 알려 주시겠어요?,Korean
+네. 골절상 때문에 잠깐 입원한 적 있어요.,Korean
+욕창은 추가적으로 생긴 질병이기 때문에 다른 병의 치료도 잘 받으셔야지요.,Korean
+네. 수술 과정 한 번 설명 부탁드려요.,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+허리에 핀을 박아야 해서 수술했어요.,Korean
+술은 며칠 간격으로 마시나요?,Korean
+네 오전 몇 시에 내원 가능하신가요?,Korean
+저도 그러면 좋겠지만 펫 시티 검사라고 해서 암 전이 여부를 판단하는 검사라 조직검사 결과가 나와야 처방을 할 수 있는 점 양해 부탁드릴게요.,Korean
+독감 예방 주사는 이미 맞으신 거죠?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+언제쯤 체중이 급격히 늘었었나요?,Korean
+"이가 썩었는지 너무 아파서요.
+",Korean
+"아이 팔 쪽이 붓고 빨갛게 변했어요.
+",Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+"이쪽 귀 청력이 안 좋아지면서 이명도 생겼어요.
+",Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+증세가 악화된 때가 언제인가요?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+빠른 효과를 기대한다면 하제 대신 관장을 하는 것도 방법이 될 수 있습니다.,Korean
+종양성 병변으로 선종이 발견될 경우 향후 대장암 발생의 위험성이 높습니다.,Korean
+얼마 전에 중국에 다녀와서 감기 기운이 있어서 동네 내과 진료받았어요.,Korean
+특정한 각도에서 아픈 거면 아직 회전하면서 통증이 있는 거라 무리해서 움직이시면 안 됩니다.,Korean
+네. 혈압약 주셔서 먹었어요.,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+"몸을 움직일 수 없을 정도로 옆구리랑 가슴이 당겨요.
+",Korean
+"혈뇨의 양이 많지는 않아요.
+",Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+소화가 안 된 건가요?,Korean
+술을 과하게 먹는 편인 가요?,Korean
+의식 소실의 원인은 여러 가지가 있습니다.,Korean
+환자분을 위해서도 주위에 전파되는 것을 막기 위해서도 중요합니다.,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+저기 설명서에 드물지만 발생할 수 있는 부작용 안내가 있어요.,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+네 기본적인 네 개 혈액형 제외한 혈액형을 말합니다.,Korean
+말씀드린 세 가지 중에서 어느 요법이 제일 이해가 안가세요? 세 가지 다 다시 설명드릴까요?,Korean
+신물이 넘어오는 이유는 위식도역류질환이 대표적입니다.,Korean
+장운동을 확인 후 물을 드셔야 됩니다.,Korean
+"유리에 얼굴을 부딪혔는데 아파서요.
+",Korean
+간염으로 무슨 약 드세요?,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+의료보험 적용 안 돼서 보호자에게 안내가 필요할 것 같습니다.,Korean
+가스가 잘 배출되도록 트림을 시켜야 하고요.,Korean
+어릴 때 수술하느라 입원했었어요.,Korean
+"허리 근육이 없다는 얘기를 몇 번 들었어요.
+",Korean
+집에 가도 봐줄 사람이 없어서요. 입원할게요.,Korean
+따로 드시는 약 있으신가요?,Korean
+"어깨가 너무 욱신거리는 느낌이 들어요.
+",Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+"아니요. 수분 섭취를 잘 안 합니다.
+",Korean
+말씀드리긴 어렵습니다. 우선 정확한 원인을 찾는게 중요하고 피검사와 갑상선 초음파 검사 그리고 엑스레이 심전도를  처방 하겠습니다.,Korean
+약물 알레르기는 없고 꽃가루 알레르기가 있어요.,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+니트로글리세린이 혈관을 확장시켜서 조금 어지러울 수도 있어요.,Korean
+심부 이도 화상은 회복까지 한 달 남짓 걸릴 수 있습니다.,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+변에 피가 함께 나오나요?,Korean
+네. 결핵 주사 맞았어요.,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+작년 말에 폐 질환이 있어서 일주일 입원했었죠.,Korean
+수술적 치료 등 어떤 의료적 행위를 하는가에 따라 병원비가 달라질 수 있어 미리 말씀드릴 수는 없습니다.,Korean
+치료를 받고 나서 몸의 이상에 대해서 자각하게 되는 것은 치료 이후에 신체상태에 대한 관심이 올라가서 일 수 있습니다.,Korean
+네. 일찍 진단을 정확히 받았어야 했는데.,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+열을 떨어뜨리는 게 우선이기 때문에 시원한 상태를 유지한다고 해서 감기에 걸리지는 않을 겁니다.,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+목이 건조하면 통증이 더 심해집니다.,Korean
+복용하는 약제에 의해서도 부을 수 있습니다.,Korean
+얼마나 자주 아픈지 빈도를 말씀해 주세요.,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+잘 못 주무시는 편인가요?,Korean
+"스트레스성 폭식이라 해야 하나 그런 게 좀 생긴 것 같아요.
+",Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+흑색변을 보셨으면 위궤양일 가능성이 높지만 정확히 알기 위해 내시경검사를 좀 해볼께요.,Korean
+우리 아이는 어디가 아플까요?,Korean
+영양상태가 좋으면 더 빨리 자라나기 때문에 잘 먹여주세요.,Korean
+입원 수술 모두 해본 적 없습니다.,Korean
+"전 치료만 받으면 되는 줄 알았는데 입원을 해야 한다고 그러더라고요.
+",Korean
+양쪽 팔이 모두 가려우세요?,Korean
+어디 다른 병을 갖고 계신가요?,Korean
+"점점 잠에 드는 시간이 늦어지고 일찍 눈 떠져요.
+",Korean
+편도선 많이 안 부었어요?,Korean
+하반신 마취 원하시면 말씀드릴게요.,Korean
+너무 체온이 상승하는 것은 안 좋을 수 있습니다.,Korean
+배가 부르며 심한 경우 복통이 동반될 수도 있습니다.,Korean
+구급차를 이용하셨을 경우 비용 청구 관련하여 확인이 필요하여 여쭈어보았습니다.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+성 기능 장애가 있으신가요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+환자분 상태에 따라 다른데 보통 한 시간 전후로 풀립니다.,Korean
+수혈거부 해도 법적으로 문제없나요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+"변비가 심하다가 생리 때 설사가 심하고 그래요.
+",Korean
+통증을 느끼는 부위는 여기가 맞나요?,Korean
+"오른손으로 젓가락질을 못할 정도로 엄지에 힘이 안 들어가요.
+",Korean
+심한 자극을 주거나 전기적 충격을 가한 적이 있으신가요?,Korean
+심호흡을 해서 폐를 빨리 펴주지 않으면 폐포에 문제가 발생할 수도 있습니다.,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+"복통이 느껴진 적은 없었어요.
+",Korean
+당뇨 약 복용하고 계신가요?,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+앓고 계신 알레르기 증상이 있을까요?,Korean
+편하게 숨을 쉬기가 힘든가요?,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+예를 들어 병원에서 처방받았다던가 약국에서 구입한 약들이요.,Korean
+"원래는 여섯 시간 정도 됐는데 오늘 두시간도 못 잔 것 같아요.
+",Korean
+소독된 환경을 갖추기가 어려우시기 때문에 되도록 병원에 내원해 주세요.,Korean
+피를 토 한 적 있으세요?,Korean
+작년에 폐렴을 한 번 앓았어요.,Korean
+가래가 얼마나 많이 나오나요?,Korean
+검사하는 것 자체는 오래 안 걸립니다.,Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+"허리 근육이 없다는 얘기를 몇 번 들었어요.
+",Korean
+일반적인 상태에선 물이 좋지만 운동을 많이 하는 등 전해질 조절이 필요한 상황에선 이온음료도 좋지요.,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+열이 나는 증상이 있나요?,Korean
+혈압이 너무 높은 거 아닌가요?,Korean
+통증이 시작하면 기간이 얼마나 가요?,Korean
+체온은 정상이에요 혈압이 저혈압이시네요.,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+흔하지 않지만 대장암과 같은 질환 가능성도 있습니다.,Korean
+질병으로 약을 드시고 계시나요?,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+현재 알고 계신 음식 알레르기가 있나요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+"속이 너무 안 좋아요.
+",Korean
+네 모든 입원 경험 알려주세요.,Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+아니요. 많이 아프지 않습니다.,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+초음파를 통해서는 구조적인 문제를 확인할 수 있으며 경정맥신우조영술을 통해서는 신장 기능을 확인할 수 있습니다.,Korean
+그렇죠 입원하면 집에 있는 거랑은 다르죠.,Korean
+예를 들면 처방받아서 복용 중인 약이나 주사 맞은 거요.,Korean
+씨티를 좀 더 잘 보이도록 해주는 약물이라고 할 수 있어요.,Korean
+얼마에 한 번씩 아픈가요?,Korean
+"소변이 시도 때도 없이 나와서요.
+",Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+가족이 앓고 있는 질병이 있나요?,Korean
+아이 열이 계속 떨어지지 않으면 더 위험할 거예요.,Korean
+아픔이 몇 분 정도 가나요?,Korean
+고혈압이랑 당뇨를 진단받은 건 십 년은 훌쩍 넘었고 뇌졸중은 작년이요.,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+"목 안이 아픈 거 아니에요.
+",Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+최근에 독감 주사 맞으셨나요?,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+통증이 일 분 넘게 지속했던 적이 있나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+괜찮지만 고혈압은 유전적으로 발생하기에 한 번 검사를 받는걸 추천합니다.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+수술 여부를 확인하는 것입니다.,Korean
+체내에 이산화탄소가 많아진 경우 만성 폐쇄성 폐질환이나 상기도 폐쇄 환기를 위한 근육기능의 감소 신경전달 이상 및 중추성 호흡 감소를 의심할 수 있습니다.,Korean
+두통이 계속 지속되고 있나요?,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+체내에 이산화탄소가 많아진 경우 만성 폐쇄성 폐질환이나 상기도 폐쇄 환기를 위한 근육기능 감소 신경전달 이상 중추성 호흡 기능 감소를 의심할 수 있습니다.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+복부 통증을 동반한 설사를 하고 계신가요?,Korean
+약을 어느 병원에서 받으신 거죠?,Korean
+결핵 백신 접종을 언제 하신 거예요?,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+중요한 사항이 아니지만 환자의 안전을 위한 필수 사항입니다.,Korean
+초음파 검사는 진료 중에 잠깐 하는 거기 때문에 미리 말씀드리지 않은 것 같네요.,Korean
+어머니가 작년에 에이형 간염에 걸리셨어요.,Korean
+환자분은 지금 면역력이 너무 낮기 때문에 면역력을 높여 바이러스 저항력을 높여줘야 증상이 악화되지 않을 수 있어요.,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+갑각류 알레르기 이외에 다른 알레르기는 없나요?,Korean
+식단 조절이 필요해 보여요.,Korean
+평소에 부종이 좀 있으세요?,Korean
+이틀에서 삼 일 정도는 수액 공급이 필요합니다.,Korean
+먹는 영양제는 다 말씀해 주세요.,Korean
+알레르기 반응으로 피하는 특정 조건이 있어요?,Korean
+이쪽으로 움직였을 때도 통증이 그대로 있다는 말씀이군요.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+대변에 피가 보인적 있나요?,Korean
+보통 이런 경우에는 혈압은 조절하지 않고 장기간 지속되거나 다른 질환을 불러올 경우 조절합니다.,Korean
+평소 피로감이 심하셔서 드시고 계시는 건가요?,Korean
+드물게 일어날 수 있으므로 증상을 느끼는 즉시 병원에 오셔야 합니다.,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+소변에 피가 섞여 있으세요?,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+꽃가루는 약물 아니잖아요. 그럼 약물 알러지는 없어요.,Korean
+컨디션이 안 좋으시면 검사를 미루는 것을 추천드립니다.,Korean
+비염이 일주일 전부터 심해졌어요.,Korean
+일 년 전부터 고혈압 징조가 보였는데 최근에는 혈압이 훅 올랐다가 떨어졌다가 하네요.,Korean
+네 음주력을 파악할 때 음주를 시작한 나이도 중요하게 봅니다.,Korean
+피를 하루에 몇 번 토하나요?,Korean
+"밤에 잠도 잘 안 오는데 겨우 잠들었다 싶으면 다시 깨고 다시 자는 게 너무 힘들어져서요.
+",Korean
+네. 우울증 약을 먹은 지 좀 됐어요.,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+"왼쪽과 오른쪽의 붓기가 달라요.
+",Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+종종 재발을 하니 신경 써주셔야 합니다.,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+한국에서 가장 흔한 만성 위염은 표재성 위염입니다. 비후성 위염은 흔하지 않습니다.,Korean
+"아이가 항문 부분이 아프다고 계속 손이 가길래 이상이 있나 해서 왔어요.
+",Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+응급실에서 이루어지는 혈액검사와 치료 중에는 음압 격리실에 계실 예정입니다.,Korean
+입원해본 적도 수술해본 적도 전혀 없어요.,Korean
+지금 상처가 아물고 있으니 며칠은 지켜봐야 할 거 같습니다.,Korean
+체중이 증가한 이유가 있을까요?,Korean
+의료진이 알아야 할 알레르기가 있나요?,Korean
+피부 내부의 신경이 손상을 받아 통증을 크게 느끼지는 못할 가능성이 큽니다.,Korean
+식사는 물론 물도 금지입니다.,Korean
+환부에 마취를 하고 진행하여 엄청난 통증이 있지는 않습니다.,Korean
+통증이 나타난 곳이 어디신가요?,Korean
+디스크 터져서 수술. 시술했었어요. 입원도 했죠.,Korean
+"애가 상태가 안 ��아 보여요.
+",Korean
+얼마나 자주 가래를 뱉나요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+손으로 긁으면 염증이 생겨서 더 안 좋아집니다.,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+"지붕 보수하다가 미끄러져 떨어졌어요. 뇌진탕이 온 거 같아요.
+",Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+강남 쪽에 투석 병원이요. 지금 이름이 잘 기억이 안 나네.,Korean
+아 맞다 환자분 오늘 오후에 백내장 수술 예정이죠?,Korean
+변비가 심하게 있으셨던 것 같은데 무엇 때문에 변비가 생겼는지 검사 후 말씀드리겠습니다.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+"이틀 전부터 말하거나 기침할 때마다 아프더니 지금은 숨을 좀 크게 들이마셨다 내쉴 때도 아파요.
+",Korean
+"코에 피가 나가지고 왔어요.
+",Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+"식은땀 약간 하고 열은 삼십팔 도 정도 났어요.
+",Korean
+처음 통증을 느낀건 언제인가요?,Korean
+신체부위를 마사지 해주셔야 합니다.,Korean
+대변볼 때 피가 묻어나나요?,Korean
+"대변 안 눈 것 빼고는 괜찮아요.
+",Korean
+지금도 앓고 계시죠 당뇨?,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+타고 있는 담배에서 나오는 연기는 입자의 크기가 작아 폐의 깊은 부분까지 들어갈 수 있어 더 안 좋습니다.,Korean
+평소 식습관이 건강하지 못하거나 먹는 것에 비해 운동이 불충분 한 경우 대개 높게 나옵니다.,Korean
+낯선 동네에 있던 내과라 이름이 잘 기억이 안 나네요.,Korean
+"잠들기 어렵지는 않은데 아침에 자꾸 일찍 깨요.
+",Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+레이저 치료로 할 것 같네요.,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+"이두근이 당기고 힘이 없어요.
+",Korean
+검사결과는 보통 빠르면 일주일 소요되기 때문에 그 전에 받기는 힘드세요.,Korean
+실제로 토하신 적 없으세요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+통증이 자주 생기는 편인가요?,Korean
+"어떻게 하다 보니 입원을 하게 되었어요.
+",Korean
+위장관 환경이나 몸의 상태에 따라 평소대로 먹어도 몸의 반응이 다를 수 있습니다.,Korean
+과거에 똑같은 증상이 있었나요?,Korean
+"저 스스로 상담이나 치료가 필요하다고 느꼈어요.
+",Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+그러면 이쪽에서 처방전 받아 가시고 결제하시면 되세요.,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+해외에서 혹시 코로나 접촉이 있을 수도 있어서요.,Korean
+배에 아직 부기가 안 빠져서 그런 걸 수도 있습니다.,Korean
+초기에 잘 치료하는 것이 중요하니 매일 오세요.,Korean
+네. 시간이 지나면 돌아오지만 증상이 생기는 즉시 말씀 주셔야 합니다.,Korean
+복부 통증이 있는데 변이 안 나오나요?,Korean
+아니요 혈액형이 다르게 나오시네요.,Korean
+십이 최고 아픈 거라면 어느 정도의 통증인가요?,Korean
+"멸치를 먹으면 복통이 와서 절대 안 먹죠.
+",Korean
+증상이 지금까지 얼마 동안 있던 거예요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+피가 섞인 변을 보셨나요?,Korean
+혈변이 처음 시작된 것이 언제인가요?,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+네 국가예방접종 같은 거요.,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+하루에 몇번 정도 토하시나요?,Korean
+정확한 원인은 아직 밝혀지지 않았습니다만 손을 많이 사용하면 발생합니다.,Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+알레르기가 있다는 것을 언제 알았나요?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+현재 제왕절개로 인한 후유증이 발견됩니다.,Korean
+속이 많이 울렁거려서 토하고 싶으신가요?,Korean
+종양이 있다고 진단받은 적 있나요?,Korean
+복부에 가스 찬 느낌이 있진 않나요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+"소변을 눠도 마렵고 누고 나서도 잔뇨가 남고 지퍼를 올리고 소변이 새요.
+",Korean
+"네. 담배 안 피우고는 못살 정도로 중독됐어요.
+",Korean
+식후 계속 속이 불편하신가요?,Korean
+제왕절개 여부에 따라 수술방법이 달라질 수도 있습니다.,Korean
+"목이 너무 아파요. 말도 못 하겠어요.
+",Korean
+육안으로 전혀 부은 게 보이지 않습니다.,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+통증은 얼마 동안 이어지나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+알레르기가 올라오는 물건이 있나요?,Korean
+복부가 부은 느낌이 있나요?,Korean
+원래 머리가 많이 울리는 건 아닌데 드문 경우긴 하지만 가끔 있어요.,Korean
+손은 항상 깨끗하게 씻어주세요.,Korean
+"구토가 계속되면 나중엔 노란색 물까지 나오는 것 같아요.
+",Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+그 뒤에도 아무것도 안 드셨다면 지금 바로 검사하죠.,Korean
+생활습관 조절 만으로 정상으로 돌아오기도 합니다.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+"소화가 잘 안 되고 토를 하고 며칠 전 쓰러지기도 했어요.
+",Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+새로 처방한 약을 언제 드셔야 하는지 알려 드리려고요.,Korean
+쓸개와 방광의 문제가 있는지 확인하기 위해 검사합니다.,Korean
+수술 부위 주변이 같이 아플 수 있습니다.,Korean
+다른 병원에서 진단받은 게 있나 해서요.,Korean
+당뇨약 끊으신 지 일주일 되었어요.,Korean
+현재 당뇨 앓고 계신 분이 있나요?,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+흔히 생각하는 전신마취를 하지는 않습니다.,Korean
+"어깨를 돌린다거나 팔을 좀 심하게 쓸 일이 생기면 어깨에 이렇게 툭 하고 빠지는 증상이 있는 것 같습니다.
+",Korean
+네 만성위염의 원인으로는 다양한 요인들이 있습니다.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+"항암제 투약 중인데 열이 꽤 나는 것 같아요.
+",Korean
+어떤 질병 때문에 드시고 계신 건가요?,Korean
+환자분 원무에서 정보 보호 요청하셨나요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+가래 특징을 말씀해 주세요.,Korean
+"양쪽에 있는 고환들이 다 아파요.
+",Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+네. 상부위장관 내시경으로 확인 가능한 병변이 있을 시에 지혈도 함께 시행하겠습니다.,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+장운동이 저하되어 단기적으로 자극성 하제 사용을 고려할 수 있을 것 같습니다.,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+흔히 발열이나 두통 및 근육통 호소하시는 경우도 있어요.,Korean
+어떨 때 구토를 하나요?,Korean
+"가슴을 쥐어짜는 것 처럼 아파서 왔어요.
+",Korean
+평소 생활습관 관리를 해야 하며 지속적인 진료가 필요하다는 점에서 유사합니다.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+경정맥신우조영술은 조영제가 신장으로 배설되는 것을 시간별로 촬영하는 방법입니다.,Korean
+이전에도 똑같은 증상을 겪은 적이 있으신가요?,Korean
+오늘은 혈액만 뽑고 다음에 오시면 결과 알려 드릴게요.,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+알레르기는 언제부터 그런 건지 기억하세요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+네. 혈압이 살짝 높대요.,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+아닙니다. 움직였을 때 통증 부위의 통증 정도를 확인하는 거에요.,Korean
+네 너무 멀면 치료받고 귀가하기가 어려울 수 있어서요.,Korean
+온몸에 기운이 없다고 느껴지나요?,Korean
+결핵 예방접종 이력이 있나요?,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+대변을 보고 나서도 꺼림칙한가요?,Korean
+대변볼 때 불편하지 않으세요?,Korean
+네. 처방 더 받으려면 또 내원해야 되나요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+처방받은 간염약 어떤 건지 아시나요?,Korean
+지속적으로 기침을 하고 계신가요?,Korean
+"배가 아프고 설사와 구토 증상이 있어서요.
+",Korean
+퇴원 수속 관련 설명을 들으셨다는 동의서입니다.,Korean
+"뭘 잘못 먹었는지 계속 토가 나오려고 해요.
+",Korean
+약 알레르기 있는 거 있으실까요?,Korean
+숨이 찬 증상이 구체적으로 어땠���지 말씀해주세요.,Korean
+언제 독감 예방 접종을 했나요?,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+과식은 비만과 더불어 여러 영향을 미쳐요.,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+"속이 너무 안 좋고 체한 것 같아요.
+",Korean
+어떤 알레르기를 앓고 계세요?,Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+검사 부위에 피가 나더라도 심하지 않을 테니 꼭 밴드를 붙이실 필요는 없습니다.,Korean
+당뇨 측정을 해 보셨나요?,Korean
+제 판단으로는 삼 개월 때 수술하는 것이 시기상 가장 적절합니다.,Korean
+"뱀 잡으려다가 손을 물렸어요.
+",Korean
+이 코너 돌아가시면 주사실이 있는데 그쪽으로 가 보시겠어요?,Korean
+간염 약 복용 중이십니까?,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+치료 효과가 떨어질 수 있으니 바로 챙겨드시는 것이 좋습니다.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+그저께 감기 때문에 검사 권유해서 받았어요.,Korean
+처음 치료 받을 때에는 일주에서 이주 약 복용을 합니다.,Korean
+사고당해서 입원한 적 있으세요?,Korean
+현재 가족 중에 유전성 질환을 치료 중인 분 있나요?,Korean
+"일주일에 한두 번 체한 것처럼 소화가 잘 안됩니다.
+",Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+동네 병원에서 소독만 하시고 이틀에 한번이라도 경과를 보기위해 꼭 내원해 주세요.,Korean
+진통제 필요하면 추가 처방 드릴 수 있어요.,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+가족 중에 고혈압약을 드시는 분이 계신가요?,Korean
+약국에서 조재가 끝나는 대로 지급해 드리겠습니다.,Korean
+아니요. 변비약 안 좋다고 해서 물이랑 야채를 많이 먹었어요.,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+그냥 미열 좀 있었는데 그것 말고는 괜찮았어요.,Korean
+전신 마취로 진행했을 거예요. 아마.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+바이러스 검사를 해 보실 수는 있으나 어떤 원인으로 바이러스에 감염됐는지 찾는 것은 어려울 수 있습니다.,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+"오줌 쌀 때 아프고 괴로워요.
+",Korean
+마취 후 언제쯤 통각이 돌아왔나요?,Korean
+"아니요. 몰라서 열을 다시 재야 할 것 같아요.
+",Korean
+숨 쉬는 법 좀 보여주세요.,Korean
+"전자 담배 피워요. 반 갑 정도라 할 수 있을 거 같아요. 고등학교부터 피웠어요.
+",Korean
+검사 결과는 원하시면 문자나 이메일로도 발송 가능합니다.,Korean
+환자분 상태가 괜찮아지면 바로 옮겨드릴 거예요.,Korean
+잠이 쉽게 오지 않나요?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+음주는 질병에 방해되는 요소입니다.,Korean
+고유량 산소법은 환자의 흡기 시의 최고 유량에 필요한 전체 가스 유량을 공급함으로써 지속적인 흡입 분율을 제공합니다.,Korean
+"머리가 아픈 거 같다고 하셨어요.
+",Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+많이 드시는 것은 해로우실 수 있습니다,Korean
+통증 진행 양상이 어떤가요?,Korean
+"서서히 살이 빠지고 예전보다 식사량도 줄었다고 하셨어요.
+",Korean
+양이 많지 않다면 항문 출혈 가능성이 높고 그런 경우 심각한 질환의 가능성은 낮습니다.,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+심장이 빨리 뛰어서 아프신가요?,Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+정확한 원인은 아직 밝혀지지 않았습니다만 손을 많이 사용하면 발생합니다.,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+숨 쉬는 게 힘드신가요?,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+"몸은 피곤한데 잠이 잘 안 와요. 요새.
+",Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+헬리코박터 검사라는 것도 있다던데 여기서도 해주나요?,Korean
+종종 구토 증상이 있으세요?,Korean
+언제 이런 통증을 ���끼셨어요?,Korean
+진통제를 먹어도 계속 아프셨나요?,Korean
+주기적으로 환자분들 수분 섭취 시간을 기록하기 위해서 여쭤본 겁니다.,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+복부 통증이 많이 심한가요?,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+"담배는 일 평균 반 갑 피고 술은 자주는 안 마시는데 마시면 두 병 이상 마셔요.
+",Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+"왼쪽 팔다리에 문제가 있는 것 같아요. 힘이 쫙 퍼지는 느낌이 계속 있습니다.
+",Korean
+네. 이제 다 끝나셨고요. 혈압이랑 체온 체크하시고 나서 식사하시면 됩니다.,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+"자다 깨서는 항문이 많이 가렵다고 울어요. 자주.
+",Korean
+제가 볼 때는 뇌진탕 같진 않아요.,Korean
+환자의 필요에 따른 간호 제공을 위해 중요한 질문입니다.,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+"네. 한 달 전보다 오 킬로나 빠졌어요.
+",Korean
+결핵약 아직 복용하고 계신가요?,Korean
+"배가 엄청 아프고 설사도 심해요.
+",Korean
+성 기능 장애가 있으신가요?,Korean
+몇 년이나 담배 피웠나요?,Korean
+네 지금 바로 교정 치료랑 약물 치료할까요?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+규칙적인 식사는 소화력과 흡수력을 극대화시켜 영양분 소비 효율을 높일 수 있어요.,Korean
+지금 혹시 오한이 있나요?,Korean
+동의서에는 검사의 방법 목적 부작용 등 꼭 아셔야 하는 내용이 포함되어 있어 이에 대한 이해 후 검사를 진행하고자 합니다,Korean
+교정 중이라서 치과 갔었어요.,Korean
+일주일 안으로 다른 약물을 복용하거나 투약한 적 있으세요?,Korean
+환자분은 이전에 검사하신 것 중에서 항생제 내성 균이 발견이 되었습니다.,Korean
+요추 어디에 철심을 넣었다고 했는데 정확히 어딘지 모르겠어요.,Korean
+아니요. 자궁에 혹이 있어서 위험하다고 수술했습니다.,Korean
+천식을 앓으신 적이 있으시다고요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+약 냄새 때문에 어지럽다는 건가요? 약 드신 직후에 그런가요?,Korean
+발기가 평상시에 안 되시나요?,Korean
+부분마취일 경우 마취가 금방 풀리거나 하는 경우도 있기 때문입니다.,Korean
+발이 부어 신발이 안 맞을 때가 있습니까?,Korean
+원래 자세로 돌아왔을 때 통증이 몇 분 째 계속 남아있다면 정밀 검사를 받아보는 것이 좋습니다.,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+당뇨 약 먹고 계세요?,Korean
+당뇨나 기타 기저질환이 있나요?,Korean
+관련하여 의사 면담이 있을 예정이니 자리에서 기다려주시기 바랍니다.,Korean
+가슴이 빨리 뛰고 요동치시나요?,Korean
+통증이 월 단위로 있나요?,Korean
+암을 치료하기 위해 내원하신 적 있으세요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+지금도 통증이 심한데 진통제만 좀 추가로 받고 싶어요.,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+통증은 얼마나 자주 생기세요?,Korean
+결핵 백신 주사는 안 맞으셨나요?,Korean
+그런 경우 먹는 약보다는 다른 경로를 통한 약물 투여가 효과적인 것 같습니다.,Korean
+네 소아 탈장은 수술로 탈장 주머니를 묶어줘야 합니다.,Korean
+콜라 같은 색의 소변인가요?,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+어떤 것에 알레르기가 일어나나요?,Korean
+배액량이 거의 없을 때 제거하도록 하겠습니다.,Korean
+혹시 대변은 잘 보시는가요?,Korean
+예방접종 여부를 확인하려고 합니다.,Korean
+네 이번 입원 포함해서 다 알려주세요.,Korean
+지금 어디가 아픈 건가요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+물 먹고 소변 보면 증상이 괜찮아지나요?,Korean
+혈압약 먹은 지는 이년 정도 된 것 같고 아침에 한 ��씩 챙겨 먹고 있어요.,Korean
+"유산균을 먹이는 데도 변이 잘 안 나오더라고요.
+",Korean
+네. 귀찮으시겠지만 매일 확인을 해야 상처가 덧나지 않고 빨리 아물 수 있습니다.,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+가족분들 중에 유전성 질환으로 고생하신 분이 있나요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+"삼 일 전서부터 아이가 열이 안 떨어져요.
+",Korean
+언제부터 피부 변화가 있으셨나요?,Korean
+일 점부터 십 점까지의 통증 중 삼 점 정도 느끼신다고 합니다.,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+"항문에 오이가 들어가서 안 나와요.
+",Korean
+담배 하루에 몇 갑 피나요?,Korean
+술은 일주일에 어느 정도 드시나요?,Korean
+네. 입원비는 입원일수로 계산됩니다.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+피부에 두드러기 올라와서 처치 받았어요.,Korean
+육안으로 볼 땐 이상 없으시네요. 기존 피부질환이 있거나 이상 있으셨던 적은 없으셨나요?,Korean
+수술 부위 흉터 이외에 다른 흉터는 있으실까요?,Korean
+"소변보는 게 편하지 않아서 약 먹고 있어요.
+",Korean
+그래도 한 달 이내면 진료가 불가능합니다.,Korean
+식구들 중에 다른 유전성 질환 환자가 있나요?,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+꾸준히 약을 복용하시고 발라야 빨리 낫습니다.,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+목 구멍 쪽엔 통증이 계속되나요?,Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+자연 유산한 적 있어요.,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+검사를 진행하시면 자세한 진단이 가능합니다.,Korean
+"오줌 쌀 때 아프고 괴로워요.
+",Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+일단 응급처치 후 손상 정도를 확인해 볼 겁니다.,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+말씀드렸다시피 약 성분이 겹치게 되면 복용량을 넘어서요.,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+허리에 디스크가 있어서 시술받았어요.,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+최근에 독감 예방 주사 접종하셨어요?,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+"점점 복수가 차고 있는 것 같아요.
+",Korean
+호흡곤란이 온 적 있어요?,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+아니요 국소 마취만 해도 됩니다.,Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+애완견이 광견병 접종을 제때 못한 상태에서 사람을 물면 사람에게 감염시킬 수도 있어요.,Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+간염 때문에 병원에서 치료받고 계세요?,Korean
+"변비가 아주 심한 편입니다. 단단한 상태로 보입니다.
+",Korean
+아니요. 수술적 치료와 비수술적 치료가 있습니다.,Korean
+암을 진단 받으신 적 있나요?,Korean
+흡연 기간이 어떻게 되세요?,Korean
+알고 계시는 것처럼 위내시경 할 때 조직을 조금 떼어내서 병리과로 보내 검사를 합니다.,Korean
+간염으로 드시는 약이 있나요?,Korean
+집 먼지 진드기는 습기 있는 침구나 의자 같은 곳에서 사람의 피부를 먹고사는 벌레입니다.,Korean
+하루에 몇 개비나 피우시나요?,Korean
+환자분 검사 결과 상 나트륨 수치가 너무 높아요. 조절을 하셔야겠네요.,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+"아이가 숨을 쉬는데 매우 불편해요.
+",Korean
+네. 어디가 아프거나 하진 않았어요.,Korean
+고혈압 처방받으면서 지은 약 드시고 있으세요?,Korean
+"허리부터 무릎까지 저린 느낌이 들어요.
+",Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+수술 후 당분간 통증이 있을 수 있습니다.,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+통증 때문에 일부러 소변을 안 보신 적이 있나요?,Korean
+네. 검사 예약해 드리겠습니다.,Korean
+아픈 게 쭉 아파요?,Korean
+이 병원 처음 왔을 거예요.,Korean
+혈액 검사 ��과가 정상 수치랑 차이가 있으셨나요?,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+상대적으로 혈압이 높은 편이세요?,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+두드러기나 수포가 올라오진 않으셨나요?,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+현재도 통증이 계속 느껴지나요?,Korean
+병원에 자주 오셔야 돼서요.,Korean
+상해로 입원하신 적이 있나요?,Korean
+소변이나 대변은 잘 보시나요?,Korean
+평소에 변은 잘 보세요?,Korean
+화상을 심하게 입은 터라 감염 위험이 높기 때문에 소독 자주 해주시고 물에 닿지 않도록 조심해 주세요.,Korean
+다른 날이면 다시 예약해 드릴까요? 근데 오늘 촬영을 해야 치료가 가능 할 거 같은데요.,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+"제가 식곤증이 있는지 밥만 먹으면 너무 졸려서 저도 모르게 눕게 되네요.
+",Korean
+할아버지가 심장이 안 좋으셨다고 들었습니다.,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+치료가 제대로 되지 않을 경우 고열 오심 구토 요통이 발생할 수 있습니다.,Korean
+"목은 원래 좀 약한 편이고 이틀 전엔가 자려고 누웠는데 목이 아파서 못 자서 왔어요.
+",Korean
+담배를 피웠던 기간이 얼마나 될까요?,Korean
+약은 먹고 있는데 아침에 한 혈당검사에서는 비정상으로 나왔어요.,Korean
+독감 접종 후 집에만 계셨나요?,Korean
+응급실에 구급차 타고 오셨나요?,Korean
+종양 확인된 적 있으신가요?,Korean
+체중 변화가 많진 않으셨어요?,Korean
+간염 인지하신 게 언제부터인가요?,Korean
+네. 아이가 알아서 나와서 자연 분만해도 충분했어요.,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+어디 부은 데가 있나요?,Korean
+형이 요로 쪽이 안 좋았어요.,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+이따 약 처방 드릴 건데 여러 개 잘못 드시면 부작용이 있을 수 있어서요.,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+목에 가래가 끼신 거 같나요?,Korean
+네 심계항진 증상이 있으셨군요.,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+전 병원에서 주로 어떤 치료했어요?,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+알레르기 반응 검사로 진단받으셨나요?,Korean
+네. 이상 없다고 담당 선생님께 들었어요.,Korean
+당뇨 증세가 시작된 건 언제부터인가요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+진통제 필요하면 추가 처방 드릴 수 있어요.,Korean
+지금은 전신마취하고 난 직후라서 세 시간 후에 물을 조금 드셔 보고 괜찮으시면 그때부터 물은 더 드셔도 되세요.,Korean
+잠 때문에 일상생활이 어려우신가요?,Korean
+요즘 혹시 오한이 있나요?,Korean
+우선 흔들리는 것은 여기서 진료를 받고 추후에 엑스레이 검사를 통하여 부가적인 확인을 하는 것이 좋습니다.,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+혈압만 조금 높게 나오네요.,Korean
+셀라인이라고 상처 부위를 씻어내기 위한 물입니다.,Korean
+오늘은 쓸개와 방광의 문제가 있는지 확인하기 위해 검사합니다.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+"불면증이 좀 있는 것 같아요. 한 세 시간밖에 못 자요.
+",Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+특히 운동이나 외상 후 자주 생기며 근육 손상으로 인해 생긴 독성 물질들이 쌓이는 질환입니다.,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+약도 보고 영상의학과 찾아가시겠어요?,Korean
+네 출산 포함해서 모든 입원 치료 및 수술 알려주세요.,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+입원에 관련된 정보를 표기하는 데 있어 보호 여부�� 말씀드리는 것입니다.,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+속이 메스껍거나 토한 적이 있으신가요?,Korean
+네 그 당시에는 증상이 없었나요?,Korean
+부기가 생기는 게 부종이에요.,Korean
+가슴 조이는 느낌이 얼마나 자주 있나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+금식을 해서 이렇게 나오면 이상이 있다는 뜻입니다.,Korean
+건조하면 기침을 자주 하시나요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+하루 평균 얼마나 피우시나요?,Korean
+그렇기 때문에 이를 예방하기 위해 내시경 요법을 사용합니다.,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+수술 설명은 담당 의사가 직접 설명해주실 예정이니 자리에 머물러 주세요.,Korean
+이 약은 일 차 치료 항생제이며 위산분비억제제도 함께 투약합니다.,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+"숨이 잘 안 쉬어지는 것 같아요.
+",Korean
+빨리 낫는 것보다는 장기적 재발을 막는 방법이 동반되어야 합니다.,Korean
+급성기라는 말이 병이 심각하다는 의미는 아니며 치료가 필요한 단계로 볼 수 있습니다.,Korean
+환자분을 위해서도 주위에 전파되는 것을 막기 위해서도 중요합니다.,Korean
+거의 매일 설사를 하시나요?,Korean
+구토를 많이 한다면 식도 손상 가능성도 있습니다.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+소화와 관련된 약을 드시고 계시군요.,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+"요새 걷기 운동한다고 많이 걸었거든요. 그러고 나서 신발이 잘 안 맞았는지 발톱에 멍이 들기 시작하더니 다리 전체가 움직임이 둔하네요.
+",Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+물 포함하여 금식하시고 소파에 앉아 대기하시면 담당 간호사 선생님께서 안내해 드릴거에요.,Korean
+오한이 있을 경우 감염이 있을 수 있어 검사가 필요할 것 같습니다.,Korean
+진통제 처방해 드릴 테니 드시고 오늘 엑스레이 한 장 찍고 갈게요.,Korean
+상황에 따라 임플란트도 검사에 영향을 미칩니다.,Korean
+"하루 반 갑 정도 피워요. 초등학교부터 피웠어요.
+",Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+여드름 부위에만 바르는 게 맞아요.,Korean
+배의 어느 부위가 아프시죠?,Korean
+어느 정도로 아프신지 표현이 가능하세요?,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+하루에 몇 번 정도 아픈가요?,Korean
+정확한 진단을 위해 몇 가지 여쭤봐야 합니다.,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+자궁 쪽에 이상이 있으셔서 수술을 진행하게 될 것 같습니다.,Korean
+대소변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+다른 병원에서는 얼마로 시행받으셨나요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+환자분이 느끼는 통증의 정도가 얼마나 되나요?,Korean
+가족 중에 암 판정을 받으셨던 분이 있나요?,Korean
+하지정맥류 수술 치료로 입원했었습니다.,Korean
+열만 나는 것 같아요?,Korean
+네 원래 체중 변화가 생기는데 너무 빠져서 한번 검사는 해봐야 될 거 같습니다.,Korean
+마취 후 언제쯤 통각이 돌아왔나요?,Korean
+소변에 피가 섞여 나오나요?,Korean
+검사를 빨리할수록 만약에 병을 찾을 경우 다양한 치료 방법을 적용할 수 있습니다.,Korean
+부종이 있는 곳이 있나요?,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+물집 생긴 곳이 냄비 만진 부위 말고 다른 곳에 또 있나요?,Korean
+얼굴 감각에는 차이가 없나요?,Korean
+입원치료는 아니셨나요? 가벼운 열상치료는 괜찮습니다.,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+"혈당이 많이 오른 거 같아요.
+",Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+네 모든 검사 완료됐습니다.,Korean
+잠에 잘 들지 못하고 있나요?,Korean
+정형외과 가서 자주 치료받는데도 허리는 늘 아픕니다.,Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+밤에도 상관없이 간호사 호출기 눌러주시면 됩니다.,Korean
+살짝 아플 수는 있지만 많이 아프지는 않을 겁니다.,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+네 아니면 지금 혈액 검사받으시겠어요?,Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+일 이도 화상에 비해 진피 손상은 회복기간이 매우 깁니다.,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+단순 신우염은 극히 드물고 대부분 신우신염이며 임상적으로 감별하기 어렵습니다.,Korean
+가족 병력에 대해서 여쭙겠습니다.,Korean
+어떤 음식을 드셨을 때 알레르기가 나타나나요?,Korean
+"눈이 침침하고 잘 안 보여.
+",Korean
+한국에서 가장 흔한 만성 위염은 표재성 위염입니다. 비후성 위염은 흔하지 않습니다.,Korean
+먹었던 음식을 다 토하시나요?,Korean
+일일구 통해 내원하셨는지 재확인 필요하여 질문하였습니다.,Korean
+검사결과 나왔으니 오늘 오후에 담당 의사선생님이 환자분께 수술부위 및 내용에 대해 설명해주실 거에요.,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+"음 팔을 심하게 쓸 때 어깨가 아픈 거 같기도 해요.
+",Korean
+마취 풀린 이후에는 상관없습니다.,Korean
+네. 지금 당뇨 때문에 계속 약을 먹고 있어요.,Korean
+아 천식은 불치병 아닌가요?,Korean
+가슴이 갑자기 너무 급하게 두근거린 적이 있나요?,Korean
+깊은 호흡이 잘 안되시나요?,Korean
+계속 먹고 있는 항결핵제가 있나요?,Korean
+환자분 상태에 따라 다른데 보통 한 시간 전후로 풀립니다.,Korean
+백신 접종은 매년 하고 계신가요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+상처는 매일매일 회복속도가 다르기 때문에 꾸준히 체크해 보시는 게 좋습니다.,Korean
+예전에 다쳐서 여기에 방문하신 적이 있으세요?,Korean
+통증은 어떠할 때에 있으세요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+배의 어느 부분이 아프신가요?,Korean
+"어느 날 오한이 들면서 열이 나는 거 같아 병원에 찾아갔더니 정상체온이라고 몸에는 이상이 없다고 하시더라고요. 검사해주신 선생님께서 신체적인 문제가 아니라 마음의 병일 수도 있다고 상담을 권유하시기에 찾아왔습니다.
+",Korean
+지금 즉각적인 치료가 필요하지는 않으며 위암 발생 혹은 추가적인 변성 소견 확인을 위해 매년 정기적인 위 내시경 검사가 필요합니다.,Korean
+아버지가 고혈압 때문에 약을 드시고 계세요.,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+열만 나는 것 같아요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+한의원에서 지은 한약을 매일 먹고 있어요.,Korean
+이참에 금연 한 번 해보죠.,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+"갑자기 손이 가려우면서 수포가 생겼는데 어제부터 빨갛게 붓기 시작했어요.
+",Korean
+고혈압 환자인 가족분 있으세요?,Korean
+알약 대신 가루약은 어떠세요?,Korean
+외래 진료 후 병동 입원하셨을 때 이동수단에 대해 알려주시면 됩니다.,Korean
+아니요. 가벼운 감기만 여러 번이요.,Korean
+아이가 요즘 소변 대변을 통 못 보는데요.,Korean
+고위험군의 경우 자궁경부암을 비롯한 여러 암을 유발할 수 있습니다.,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+화장실에 오래 있어야만 소변을 보시나요?,Korean
+아니요. 이전에 먹던 약들 다 끊었어요.,Korean
+제가 혈액 응고가 잘 안 돼서 지혈하는 데 좀 어려움이 있어요.,Korean
+결핵 주사 맞은 적 있으세요?,Korean
+몇 살 때부터 피우셨나요?,Korean
+전에 수술한 경험 있으세요?,Korean
+부루펜을 먹인지 얼마나 됐나요?,Korean
+욕창을 방지하는 것은 피부 합병증을 생기지 않게 하는 것이지 다른 병까지 낫게 하는 것은 아닙니다.,Korean
+발기 부전 관련해서 치료를 받으신 적이 있나요?,Korean
+가족 중 한 명이 요로결석으로 수술했어요.,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+담�� 피우신 기간이 얼마나 되나요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+근래에 체중 증가가 있으신가요?,Korean
+환자분은 교통사고가 나서 출혈이 심하셨기 때문에 입원하게 되셨어요.,Korean
+현재 앓고 있는 질병 없습니다.,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+"얼굴을 한 방 맞았어요.
+",Korean
+두통이 계속 지속되고 있나요?,Korean
+어머 진짜 저게 변인가요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+그 증상 말곤 없나요?,Korean
+통증 강도가 어느 정도 신가요?,Korean
+예전 아토피 진단을 받은 적 이 있으신가요?,Korean
+국소 마취만 해도 된 데서 그렇게 했어요.,Korean
+이석증 같으니 약 먹고 지켜보자고 했어요.,Korean
+몇 년 전에 중풍이 와서 하반신 불수고 그래서 요양원에 계세요.,Korean
+소변에 피가 많이 섞여 나온다고 생각하세요?,Korean
+섭취 후 별다른 증상이 없다면 하루에 하나 정도는 현재로선 괜찮아 보이네요.,Korean
+금연 기간은 빼셔도 됩니다.,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+최종적인 검진 결과를 위해 기본적으로 시행하는 검사들입니다.,Korean
+아까 말씀드린 것처럼 변비가 있었습니다.,Korean
+술과 담배는 안 하시는 게 도움이 되실 거고 스트레스받지 않는 게 중요합니다. 혹시 술 담배 하시나요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+헬리코박터균 감염은 제균치료 후 호전하는 경우도 있으나 기본적으로 만성 위염은 장기간 꾸준한 관리가 필요하고 재발할 수 있습니다.,Korean
+숨이 잘 안 쉬어져요.,Korean
+"아뇨. 고혈압이 가족력이라 완전 싱겁게 먹어요.
+",Korean
+보통은 통증을 수반하지 않으나 불편하실 수 있습니다.,Korean
+입원 또는 수술 경험이 있나요?,Korean
+"원래는 여드름이 잘 안 났었는데 갑자기 안 나던 여드름이 올라와서 왔습니다.
+",Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+일단 피 검사만 합니다.,Korean
+"기침할 때 가래 낀 소리가 계속 나요.
+",Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+주로 하루 중 언제 붓나요?,Korean
+삼 일 뒤에 병원에 방문하실 거면 이 일치가 더 낫지요.,Korean
+네 하지만 적당량의 운동은 권유 드립니다.,Korean
+매일 상처를 살펴보면서 치료 받게 됩니다.,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+"힘이 없고 입도 계속 말라요.
+",Korean
+어느 부분이 가장 아픈지 말씀해 주세요.,Korean
+"제가 원래 장염이 있었는데 생각 못 하고 탄산음료랑 우유를 마셨더니 복통이 심해서 달려왔어요.
+",Korean
+입원 기간과 상관없이 입원하셨던 모든 내용 알려주세요.,Korean
+"오늘 선생님이 병원 오라고 하셔서 왔습니다.
+",Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+부풀어 오르거나 발적이 없는 걸로 보아 이 항생제에 대한 알레르기는 없어 보입니다. 수고하셨습니다.,Korean
+수면 보조제는 너무 오래 드시면 좋지 않아요.,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+주치의 선생님께 진통제 원하신다고 말씀드릴게요.,Korean
+흡연을 시작한 나이를 아세요?,Korean
+한의원 방문 외에 개별적으로 지인에 의해 진행하거나 했던 경험은 없으신가요?,Korean
+"만성신부전 진단받은 이후 두통이 매우 심하고 어지럽고 속도 안 좋아졌어요.
+",Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+코로나 관련 문진표를 채워주세요.,Korean
+병원비 청구를 위해 필요합니다.,Korean
+"왼쪽 팔다리가 계속 뻐근해요.
+",Korean
+배 통증 부위가 어딘가요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+주에 몇 번 아픈가요?,Korean
+몸에 붓기는 차도가 있나요?,Korean
+"노로바이러스에 걸린 적이 있는데 그 뒤로 해산물은 먹지 않습니다.
+",Korean
+부작용이 있는지 보려고 방금 검사��신 거예요.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+평소 시력이 어떻게 되세요?,Korean
+"네. 소변볼 때마다 피가 조금씩 섞여 나와요.
+",Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+"무릎 뒤쪽도 같이 아프네요.
+",Korean
+약은 몇 개월이나 드셨어요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+"급성 방광염인 것 같아요.
+",Korean
+찬 바람 불고 감기 기운이 있었으니까 한 사나흘 됐어요.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+아픈 게 쭉 아파요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+네. 교통사고로 인해 뼈가 부러져서 수술했었습니다.,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+혹시 시력 청력 관련 된 장애 등급이 있거나 보청기를 착용하시나요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+동의서 관련 상담은 의사분이 담당하시기에 잠시 기다려주시기 바랍니다.,Korean
+특정 음식에 알레르기가 있습니까?,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+열 때문에 몸이 달아오르나요?,Korean
+아니요. 수술적 치료와 비수술적 치료가 있습니다.,Korean
+"속이 너무 안 좋고 체한 것 같아요.
+",Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+네 환자분의 치료 스케쥴에 매우 중요한 사항입니다.,Korean
+무력감이 온몸을 휩싼 증상이 있나요?,Korean
+배가 부른 느낌이 없으십니까?,Korean
+최근에 고혈압약을 바꾸거나 용량을 변경하지 않으셨나요?,Korean
+증상 때문에 불편하셨던 기간이 어떻게 되죠?,Korean
+아직 검사도 남았고 입원 가능성도 있어서요.,Korean
+"왼쪽 귀가 오른쪽 귀보다 심해요.
+",Korean
+결핵 때문에 병원 간 적 있으세요?,Korean
+큰 문제 없을 것으로 생각되지만 일단 진료를 받고 확인해 보시는 편이 좋을 것 같습니다.,Korean
+경우에 따라 같은 음식이라도 반응이 다를 수 있습니다.,Korean
+먹는 영양제는 다 말씀해 주세요.,Korean
+"네. 허리가 부서질 듯이 아파요.
+",Korean
+흡연 기간은 어떻게 되나요?,Korean
+아픔이 몇 분 정도 가나요?,Korean
+평소 소화가 잘 안 되나요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+"하루 일곱 시간 수면은 그대로지만 중간에 깨니까 잘 잔다고 볼 수 없죠.
+",Korean
+"요새 입맛이 없어서 그런지 근?한 달 동안?잘?안 챙겨?먹은 것 같아요.
+",Korean
+언제 당뇨 진단을 받았나요?,Korean
+당뇨약 먹고도 효과가 없거나 하지는 않나요?,Korean
+어떨 때 구토를 하나요?,Korean
+신체가 부은 데가 있나요?,Korean
+구토와 복통은 오늘부터 시작되었나요?,Korean
+마취부터 회복까지 세 시간 걸릴 예정입니다.,Korean
+검사는 무슨 이유로 해보신 건가요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+아니요. 만성 위염은 흔한 소견입니다.,Korean
+컨디션이 안 좋으시면 검사를 미루는 것을 추천드립니다.,Korean
+피를 토할 때가 많이 있나요?,Korean
+코로나라고 의심하시는 이유가 있으신지요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+"술 멀리한지 꽤 됩니다. 금연하려고 지난봄부터 노력 중이고요.
+",Korean
+결핵 치료를 받고 계신가요?,Korean
+병원에서 치료는 했지만 입원한 적은 없어요.,Korean
+치아가 흔들리는 이유는 여러 가지입니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+하루에 몇 개비 정도 피우시나요?,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+아까는 수술 부위만 체크했습니다.,Korean
+그 기록에 의해 환자분에 대한 또 다른 판단이 가능해서요.,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+해당되는 게 많네요. 담배. 미세먼지. 곰팡이.,Korean
+턱에 염증이 있어서 주기적으로 보톡스 맞긴 해요.,Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+알레르기를 오래 앓고 있었나요?,Korean
+목에 아픈 증세가 있나요?,Korean
+이전에 혹같은 게 만져졌던 적이 있나요?,Korean
+얼마 전에 빈혈 검사를 했는데 아직 결과가 안 나왔어요.,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+네. 간질이 있어서 병원에 입원한 적 많습니다.,Korean
+아니요. 치아는 괜찮아서 치과를 안 갔어요.,Korean
+체온은 정상인데 혈압은 조금 높아요.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+몸살 난 것처럼 몸이 으슬으슬 떨리나요?,Korean
+현재 체중 변화가 심한 가요?,Korean
+네 맞습니다 오늘 오후에 수술할 예정입니다.,Korean
+"아프기 전과 후로 수면 시간이 두 시간가량 줄어들었어요.
+",Korean
+아픈 게 어떤 식으로 아파요?,Korean
+전신에 작용하는 약물이 아니기 때문에 몸의 부담을 걱정하실 필요는 없습니다.,Korean
+그럼 알레르기 검사를 진행하겠습니다.,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+피부에 발진 물집 흉터 상처 반점 욕창이 있나요?,Korean
+혈압의 경우 이회 측정 결과 모두 백이십에서 팔십으로 정상 혈압에 해당합니다.,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+피부가 많이 예민한 편이 아니면 접촉성 피부염이 나타나는 경우는 극히 드뭅니다.,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+최근 몸무게에 변화가 혹시 많으셨나요?,Korean
+부목 항상 해야 하나요?,Korean
+알레르기는 언제부터 그런 건지 기억하세요?,Korean
+간 수치가 언제부터 높게 올라갔나요?,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+아니요 한 달 전에 드신 약은 말씀 안 해주셔도 됩니다.,Korean
+네. 전신마취인 경우 완전히 잠들기 때문에 소리가 들릴 수 없습니다.,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+진물 등이 차기 때문에 주기적으로 붕대를 갈고 소독해주어야 합니다.,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+"여기 이쪽 발가락에 고름도 나오고 통증이 심해져서 병원에 오게 되었습니다.
+",Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+겉으로 봐서는 알 수 없으니 진료 후 확인해 보겠습니다.,Korean
+근육에 무리가 와서 그런 걸 수도 있어요 선생님이랑 한 번 더 말씀하셔야 할 거 같아요.,Korean
+네 기본적인 네 개 혈액형 제외한 혈액형을 말합니다.,Korean
+종종 구토 증상이 있으세요?,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+종양성 병변으로 선종이 발견될 경우 향후 대장암 발생의 위험성이 높습니다.,Korean
+갑자기 주위가 빙빙 도는 증상도 있으신가요?,Korean
+"네. 그래서 운동을 할 수가 없어요.
+",Korean
+하반신 마취를 위해 척추에 마취약을 투약한 겁니다.,Korean
+암 진단받은 게 언제인가요?,Korean
+"기저귀 갈아주려고 보니까 아기 사타구니 쪽에 볼록한 게 튀어나와 있어서요.
+",Korean
+보청기나 틀니 액세서리 등 착용하시고 오신 것은 없나요?,Korean
+일반 붕대나 거즈로 덮으면 상처에 붙어서 아플 수 있는데 바셀린 거즈는 상처를 덮어주니까 보호가 됩니다.,Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+"삼 년 정도 흡연했습니다.
+",Korean
+제일 불편한 증상이 무엇인가요?,Korean
+"제 친구인데 의식이 없어요.
+",Korean
+아픈 게 심하게 느껴지나요?,Korean
+네. 내과 선생님 맞습니다.,Korean
+어느 부위가 제일 아프세요?,Korean
+평소에 변비 증상이 있으신가요?,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+통증 양상이 어떻게 돼나요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+소아암으로 초등학교 들어가기 전에 병원에 오래 있었습니다.,Korean
+네. 괜찮습니다. 보호자 동의가 없어도 되는 간단한 시술입니다.,Korean
+여러 검사를 통해 원인을 찾아봐야 할 것 같습니다.,Korean
+변비 증상이 처음이신 건가요?,Korean
+병원 이름만 필요해서 동네는 안 알려주셔도 될 것 같습니다.,Korean
+그냥 살짝 어지럽던데 이것도 부작용인지 모르겠네요. 그다음 날 괜찮아졌어요.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+외래 진료 후 병동 입원하셨을 때 이동 수단에 대해 말씀해 주시면 됩니다.,Korean
+지금부터 수술 부위에 대해서 설명드리겠습니다.,Korean
+통증을 말로 어떻게 표현할 수 있나요?,Korean
+시력이 안 좋아졌거나 흐리게 보이는 증상이 있나요?,Korean
+미용 목적 시술도 다 말씀드려야 하나요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+통증이 멈췄다 다시 ��작되나요?,Korean
+언제부터 미식거리는 증상이 있었어요?,Korean
+부작용이 있을 경우 말씀해 주시면 저희가 조치를 취할 거예요.,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+불면증을 느끼신 적이 있으신가요?,Korean
+고혈압약 먹고 혈압이 조금 안정됐나요?,Korean
+복부 팽만이 없고 압통도 없어 별다른 문제는 없는 것으로 보입니다.,Korean
+병문안 시간이 정해져 있습니다.,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+결핵 증상이 언제부터 나타났는지 아시나요?,Korean
+무거운 거를 들다 어깨가 아파 입원 치료했어요.,Korean
+기본적으로 수액을 맞긴 합니다.,Korean
+최근에 체중이 눈에 띄게 빠진 적 있나요?,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+다른 질병이 있는지 확인 차 여쭈어보는 겁니다.,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+네. 검사가 굉장히 많네요.,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+감염을 예방하는 데 있어 가장 중요한 부분입니다.,Korean
+그럼요. 중단 없이 계속 복용 중이죠.,Korean
+"자궁근종이 있어서 제거하러 왔습니다.
+",Korean
+약 복용으로 인한 어지럼증이 발생되는 건 있을 수 있는 증상 중 하나인데 어지럼증이 많이 심하시면 다른 약성분으로 변경 고려해보겠습니다.,Korean
+치과 치료도 당연히 포함됩니다.,Korean
+네. 야간근무자들은 대부분 수면 문제를 호소하는 경우가 많습니다.,Korean
+장담은 할 수 없지만 괜찮아질 확률이 높습니다.,Korean
+알레르기 때문에 죽을 정도로 고통스러웠던 적 있나요?,Korean
+얼마나 통증이 심하게 느껴지고 있나요?,Korean
+아니요. 먼저 의사와 상담 후 계획을 정해 보는 게 좋습니다.,Korean
+배에 가스가 많이 차있나요?,Korean
+네. 당 높은 음식 적당히 먹으라고 하셨어요.,Korean
+방역 수칙을 지키면서 검사를 진행하고 있기 때문에 그럴 가능성은 굉장히 낮습니다.,Korean
+"변비가 좀 오려는 것 같기도 했어요.
+",Korean
+네 금식 중에는 약도 복용하시면 안 됩니다.,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+처음 통증 있었던 게 언제죠?,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+기침할 때 가래가 같이 나오나요?,Korean
+환자분의 상태를 파악하기 위함입니다. 민감한 부위라면 흉터 크기나 모양이 어떻게 되시나요?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+발작 증상을 완화하는 데에는 큰 도움이 됩니다.,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+움직이기 전보다 더 아프다는 말씀이죠?,Korean
+아니요. 아직 마취가 남아있어서 물을 드시면 안 됩니다.,Korean
+고혈압 치료는 꾸준히 받고 계신가요?,Korean
+아직은 증상이 나빴다 좋아졌다 할 수 있는 시기입니다.,Korean
+기간 상관 없이 모든 입원내용 알려주세요.,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+네? 탈장이요? 수술해야 하나요?,Korean
+저릿저릿한가요? 아니면 날카롭게 쑤시나요? 아니면 묵직하고 둔한 느낌인가요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+평소 피로감이 심하셔서 드시고 계시는 건가요?,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+방금 검사하신 게 부작용 여부 확인을 위해서 하신 거예요.,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+아니요. 두 번 다 자연분만이에요.,Korean
+질병이나 특이사항 때문에 하반신 마취를 시행하였는지 알기 위해서입니다.,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+"삼일 정도 됐는데 시간이 지날수록 점점 더 아파요.
+",Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+마취약에 알러지 반응이 있으신가요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+과거에 했던 수술 방법에 따라 이번 수술 방법이 변경될 수도 있습니다.,Korean
+"투석 관에 문제가 있는 것 같아요.
+",Korean
+만약 궤양이 의심된다면 조직검사도 같이 할 거예요.,Korean
+우선 수술보다는 상부위장관 내시경 검사가 필요합니다. 내시경으��� 출혈 여부와 정도를 확인하고 지혈을 시도할 수 있습니다.,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+통증은 얼마 동안 이어지나요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+"이삼일 전부터 식욕이 뚝 떨어졌어요.
+",Korean
+침 삼킬 때 아픈가요?,Korean
+감기 예방 주사는 맞았나요?,Korean
+네. 그런데 혹시 집에서는 깁스 풀고 있어도 되나요?,Korean
+제가 어릴 때부터 여기저기 많이 다쳐서 수술도 많이 했어요.,Korean
+병원 규정으로 연락가능한 사람이 일인 이상 있어야 합니다.,Korean
+성형 수술이라고 생각하시면 됩니다.,Korean
+피와 소변이 함께 나오나요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+"일어나 운동할 때 호흡이 정말 안 될 정도로 불편해서 오게 됐어요.
+",Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+그러면 외래 안내해 드리도록 하겠습니다.,Korean
+흡연 기간은 어떻게 되나요?,Korean
+기침할 때 다른 증상이 있나요?,Korean
+"계단 내려가는데 발을 헛디뎌서 굴렀는데 어깨를 다친 것 같아요.
+",Korean
+눈으로 보는 것에 문제는 없나요?,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+잠시만 의자에 앉아 계세요. 처방 나면 예약 도와드릴게요.,Korean
+다른 증상이라면 레이저 수술로 나타날 수 있는 또 다른 증상을 의미하는 걸까요?,Korean
+귀에서 소리도 같이 나나요?,Korean
+통증이 자주 있는 편인가요?,Korean
+겉옷 올려주시면 청진 가능합니다.,Korean
+필수는 아니지만 약물에도 알레르기가 있을 수 있어서 검사하는 걸 권장하고 있습니다.,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+네 원래 많이 아파요.,Korean
+헛구역질도 포함됩니다. 그 외 다른 증상은 없으셨나요?,Korean
+당뇨 처방 약 계속 드세요?,Korean
+"네. 피가 섞여 있는 거 말곤 문제없습니다.
+",Korean
+최근 들어서 몇 개월 동안 급격히 체중 변화가 있었나요?,Korean
+멸균된 붕대를 감아야 상처 부위가 보호됩니다.,Korean
+피가 안 멈추면 혈종이 생길 수 있습니다.,Korean
+"새벽 내내 설사를 했어요.
+",Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+음주 빈도는 얼마나 되시나요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+소변을 보고 닦을 때 피가 묻어 나오나요?,Korean
+양 무릎이 다 다쳤어요.,Korean
+변을 잘 보고 계신가요?,Korean
+수혈 부작용이 존재할 수는 있지만 크진 않아요.,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+치아가 썩어서 치과에 다녀왔어요.,Korean
+아버지도 유전성 질환을 앓으셨나요?,Korean
+"잠들기 어려워서 수면제 한 알 먹고 잤어요.
+",Korean
+속이 토할 것 같고 그러진 않나요?,Korean
+네. 지금 아픈 곳과 상관없이 지금까지 모든 입원 경험 말씀해 주세요.,Korean
+병원 입원 중에는 간호사분들이 주기적인 소독을 도와주실 거예요 댁에 가셔서도 꼼꼼히 소독 자주 부탁드립니다.,Korean
+그때 약 먹고 많이 좋아졌죠.,Korean
+나이가 어려 흉터가 옅어질 가능성도 있습니다.,Korean
+보통 십 회 정도 치료합니다.,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+마지막 검사가 얼마 안 됐다면 다시 안해도 됩니다.,Korean
+자궁과 난소를 더 자세히 볼 수 있습니다.,Korean
+진료받기 전에 응급처치부터 하도록 하겠습니다.,Korean
+일단 헌혈도 말씀해 주세요.,Korean
+의학적으로 성인은 하루 사에서 육 회 배뇨하는 것은 정상입니다.,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+언제 첫 증상이 나왔나요?,Korean
+네 선천성 거대결장이 의심됩니다.,Korean
+꽉 끼는 속옷이나 바지를 입으면 옷에 의해 성기 부위가 과도하게 눌려 통증이 발생할 수 있습니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+장염이라. 없었던 것 같은데요.,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+가슴 통증이 있진 않으신가요?,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+방사선사 지시에 따라 하시면 몇 분 안 걸립니다.,Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+소변을 잘 못 보시나요?,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+눈을 뜨고 있을 때 따끔거리는 느낌인가요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+점막의 비후가 발생할 수 있는 다른 질환들이 있어 이에 대한 추가 검사가 필요할 수 있습니다.,Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+환부보다 넓게 그리고 두껍게 발라줘야 해서 연고가 많이 필요합니다.,Korean
+방금 검사하신 게 부작용 여부 확인을 위해서 하신 거예요.,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+"붓기가 있는지 감이 잘 안 오네요. 제 몸이 어떤지.
+",Korean
+고혈압약 외에 당뇨약 같은 약 드시는 거 있나요?,Korean
+피곤하다고 느껴지실 때가 있으신가요?,Korean
+위험지역 방문 시에 헌혈이 제한될 수도 있습니다.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+그러니까 사출성 구토는 뭔가 먹자마자 바로 나오는 구토를 말합니다.,Korean
+지난주에 배가 아파서 방문한 적 있어요.,Korean
+아직도 많이 아프신가요? 많이 아프시면 지금 약이랑 바꾸는 방법도 있습니다.,Korean
+몸이 부을 때가 있나요?,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+알레르기를 유발하며 주로 침구류에서 발견됩니다.,Korean
+모든 시술에는 위험성이 동반됩니다.,Korean
+정확한 날짜는 알기 어렵지만 일단 열이 떨어져야 퇴원 날을 잡을 수 있을 것 같습니다.,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+두통으로 불편한 점은 없나요?,Korean
+"몸을 움직일 수 없을 정도로 옆구리랑 가슴이 당겨요.
+",Korean
+하루 흡연량이 어떻게 되시는지요?,Korean
+가려움 완화 연고를 처방해 드릴 수 있어요.,Korean
+편하게 숨을 쉬기가 힘든가요?,Korean
+네. 근데 지금 수액이 막 떨어지는데 괜찮나요?,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+용종제거술로 인한 통증 보다는 대장 내시경 후 가스로 인한 통증이 있을 것 입니다.,Korean
+간염 때문에 드시는 약을 전부 알려주세요.,Korean
+보청기나 틀니 액세서리 등 착용하시고 오신 것은 없나요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+소양감은 간지러운 증상을 이야기합니다.,Korean
+숨 쉬는 건 안 힘들어요?,Korean
+이 부위가 아픈 곳이에요?,Korean
+"아픈 것보다 열이 좀 나요.
+",Korean
+결핵 접종 하셨나요 ?,Korean
+증상이 시작된 게 언제부터예요?,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+그런 일이 생기면 보통은 치료를 일시 중단합니다.,Korean
+아니요. 의료진이 해 드립니다.,Korean
+언제 독감 예방 접종을 했나요?,Korean
+음식이나 약을 제외한 알레르기가 있으신가요?,Korean
+결핵 치료로 처방받은 약이 이게 맞나요?,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+일 회 평균 음주량이 어떻게 됩니까?,Korean
+"식도에 이상이 있다고 알려주셨어요.
+",Korean
+소변에 피가 묻어 나온 적이 있나요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+관심 병변이 대장내시경까지 볼 필요가 없습니다.,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+가급적 빨리 내원하시길 당부드립니다.,Korean
+언제 당뇨 진단을 받았나요?,Korean
+아픈 곳 말씀해 주세요.,Korean
+중성지방은 정상수치가 이백 아래인데 이보다 높습니다.,Korean
+씨티를 좀 더 잘 보이도록 해주는 약물이라고 할 수 있어요.,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+말씀해주신 병실 입실 가능하면 안내해드리겠습니다.,Korean
+설사를 며칠 동안 하셨나요?,Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+"근래 들어 몸이 붓고 두통이 심해요.
+",Korean
+아프신 정도가 얼마나 되시나요?,Korean
+어떨 때 구토를 하나요?,Korean
+증상이 시작된 부분이 어디인가요?,Korean
+"다이어트를 시작한 이후로 변비에 걸렸어요.
+",Korean
+네. 항생제 알레르기를 가진 사람이 있어서요.,Korean
+제가 이틀마다 받으라고 하셨는데 이번 주는 삼 일 뒤에 받아도 괜찮을까요?,Korean
+"보통 소변이 마려우면 한참을 참을 수도 있었는데 너무 급박하게 갑자기 당장 나올 것처럼 마려워서 의아하긴 했어요.
+",Korean
+"저희 애가 자꾸 속이 안 좋다고 칭얼거려서요.
+",Korean
+통증 감소를 위해 복용 중인 약은 있나요?,Korean
+검사 자체에도 시간이 걸리고 환자도 많으니 양해를 부탁드립니다.,Korean
+음식 알레르기 있는지 알고 싶어요.,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+결핵 치료는 잘 되었나요?,Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+알레르기로 기피하는 음식 있나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+조금 따끔하는 정도예요. 그래도 걱정되시면 치료 전에 한 번 더 말씀해 주세요.,Korean
+잠을 못 자서 힘드세요?,Korean
+구역질이 날 때가 있나요?,Korean
+"헬스를 다니면서 운동을 하는 게 문제가 됩니까?
+",Korean
+치료 경과를 봐야 될 것 같습니다.,Korean
+구역질이 나면서 피가 올라올 때가 있나요?,Korean
+다낭성 낭종이 있다고 하셨고 초음파 하신지도 이년이 넘었으니 한 번 더 검사 받아보는 게 좋을 것 같네요.,Korean
+특정 시기에 통증이 생기나요?,Korean
+이 검사는 금식이 필요하기 때문입니다.,Korean
+네 혈색이 도는 점막의 색입니다.,Korean
+오염된 음식이나 음료를 마실 경우 발생할 수 있으며 바이러스에 감염된 사람과 접촉한 경우에도 발생할 수 있습니다.,Korean
+몸에 부은 곳이 있나요?,Korean
+흉터가 남으나 자라면서 옅어질 것입니다.,Korean
+약물 처방으로 치료를 시작하면 금방 나을 수 있을겁니다.,Korean
+"갑자기 하혈을 심하게 하고 있어요.
+",Korean
+결핵약은 어떤 거 드세요?,Korean
+밤에 잠을 충분히 자지 못하시나요?,Korean
+아닙니다. 움직였을 때 통증 부위의 통증 정도를 확인하는 거예요.,Korean
+"저혈압인데 몸이 갑자기 안 좋아서요.
+",Korean
+속이 메슥거리고 체할 것 같나요?,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+레이저 치료 후 마취가 풀리면 조금 아프실 수도 있어요.,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+가족 중에 암 진단받은 식구가 있을까요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+어떤 다른 알레르기가 있으신가요?,Korean
+혹시 모를 감염을 예방하기 위해서 되도록 일회용 구매하셨다가 퇴원하실 때 버리고 가시는 걸 권유해드리고요.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+"지쳐서 기절하듯이 잠들기도 하는데 정말 통증 때문에 잠을 못 자요.
+",Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+잘 때 어려움이 있으신가요?,Korean
+"유제품을 좋아하는데 우유는 마시면 설사를 해서 락토프리만 마셔요.
+",Korean
+통증이 시작된 날이 언제부터예요?,Korean
+메밀 들어간 거에 알레르기 있어요.,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+"네. 한 시간 전엔 약 먹어서 삼십칠 도로 내려갔어요.
+",Korean
+아니요. 영양제 말고 질병 진단 으로 드시는 약이 있나요?,Korean
+환자분 의식이 없으면 연락드려야 합니다.,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+두통이 언제 또 느껴진 적 있었나요?,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+종양 관련해서 치료 받으셨던 적 있나요?,Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+네 문제는 없지만 약 안 드셔도 괜찮으세요?,Korean
+금주를 하셨어도 음주 습관을 알면 치료에 도움이 됩니다.,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+네 선천성 거대결장이 의심됩니다.,Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+당뇨로 인한 합병증이 나타난 게 있나요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+병원비 청구를 위해 필요합니다.,Korean
+"요 근래에 어지럽고 숨 막히고 답답하고 한데 이게 정신적 스트레스 때문에 그런 건가 해서요.
+",Korean
+수술부위에 대해서 전공의 선생님이 동의서 받으실 때 자세히 알려주실 겁니다.,Korean
+"약 끊으려고 노력하고 있어요.
+",Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+"네. 거의 예전 몸무게 그대로예요.
+",Korean
+힘이 없고 늘 피로한가요?,Korean
+"수술하고 재활을 해도 움직임이 불편합니다.
+",Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+염증 수치가 정상수치보다 많이 높네요.,Korean
+배변 완화제 사용이 효과적입니다.,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+어느 쪽 어금니가 흔들거리시나요?,Korean
+수술 순서는 두 번 째입니다.,Korean
+일주일에 몇 갑 정도 흡연하시나요?,Korean
+네 흡연을 시작한 후로 지금까지입니다.,Korean
+시작한 나이뿐 아니라 음주량과 횟수 등도 함께 고려합니다.,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+치질 판명이 나신 적 있으신가요?,Korean
+한 번 시작된 통증은 언제까지 가나요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+멸균된 거즈와 소독 도구들이 집에 구비되어 있다면 가능하지만 그런 경우는 거의 없지요.,Korean
+통증 양상이 어떻게 돼나요?,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+하루에 얼마나 많이 피운다고 생각하세요?,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+허리 관련 치료 이력 없습니다.,Korean
+"과식이?습관이 돼서?이제?고치기 힘이 듭니다.
+",Korean
+지금 옆구리 아프신 건 어떠세요?,Korean
+염증 외 다른 건 크게 문제가 없네요.,Korean
+복부 팽만감이 언제부터 있으셨나요?,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+네 병원에 입원한 모든 입원 내용 알려주세요.,Korean
+어디가 제일 많이 붓나요?,Korean
+담배 시작하신 게 언제예요?,Korean
+네. 원래 심장 부근이 상당히 약했어요.,Korean
+네 환자분들의 전반적인 진료 상황을 알아야 도움이 되거든요.,Korean
+방광에 좋지 않으니 주의하셔야 합니다.,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+수면 내시경 시행 시 끝나고 보호자와 함께 귀가하는 것이 안전합니다.,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+네 대장 내시경과 마찬가지로 항문으로 들어가는 검사입니다.,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+"악몽을 너무 잘 꿔서 잠을 잘 수가 없네요.
+",Korean
+혈압 측정이 끝나면 좋아졌는지 말씀드릴게요.,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+기간을 넉넉히 해서 처방받을 수 있을까요?,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+"손가락에 수포가 생기면서 빨개지더니 나중에는 점점 가려워지더라고요.
+",Korean
+확실한 치료를 원하시면 약물보다 수술을 추천합니다.,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+부모님께서 어떤 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+감염력 확인을 위한 조치이오니 문제가 발생할 경우 연락을 취할 수 있습니다.,Korean
+지금 드시고 계신 고혈압약이 있는지 알려주세요.,Korean
+마취약 말고는 꾸준히 복용하시는 약물은 없으신가요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+네 부작용이 심하면 측정이 불가할 수 있습니다.,Korean
+안전하고 깨끗하게 시술이 진행된다면 검사 이후에 합병증이 발생할 가능성은 높지 않습니다.,Korean
+"아니요. 좀 고통스러워하는 것 같다고 느꼈어요.
+",Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+지금 아픈 게 느껴지실까요?,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+물 마실 때 목이 아픈가요?,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+잘 때도 기침을 하나요?,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+"욱신욱신한 정도의 통증이 있어요.
+",Korean
+부정맥 종류에 따라 치료가 다릅니다.,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+일도 화상의 경우 특별한 처치 없이도 일주일 내에 낫는 경우가 많습니다.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+삼 일 동안 하루 두 번 정도 진통제 먹었던 것 같아요.,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+한번 더 진찰을 받으셔야 할 거 같아요.,Korean
+정상적인 치아도 그렇게 손으로 잡고 강하게 흔들면 흔들릴 수 있어요 흔들린다고 생각되시면 치과에 오셔서 바로 검진하는 게 좋습니다.,Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+소변은 장시간 참지 말아야 하고 배뇨장애가 있는 경우 잔뇨를 줄이기 위한 노력이 필요합니다.,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+"평상시엔 아프진 않은데 변만 보면 배가 아파요.
+",Korean
+숨이 찬 증상은 없나요?,Korean
+질로 넣기 때문에 조금 불편할 수 있습니다.,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+이전에 약을 처방받아 드신 적은 있으신가요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+대변볼 때 안 힘든가요?,Korean
+결핵이 발병하신 적이 있나요?,Korean
+틀니가 강하게 고정될 경우 안에서 치아가 흔들릴 수가 있어요 확인해보죠.,Korean
+간염 처방 약 알 수 있나요?,Korean
+종양 확인된 적 있으신가요?,Korean
+위내시경 검사가 필요합니다. 내시경으로 출혈 여부 확인하고 필요 시 지혈을 할 수 있습니다.,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+붓고 나면 붓기가 잘 안 빠지나요?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+열이 또 오는 것 같나요?,Korean
+방사선이란 게 일상생활에서도 수시로 알게 모르게 방사선에 노출되나 실제 건강에 위험을 초래하는 경우는 극히 일부입니다.,Korean
+하루 담배 얼마나 피우세요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+"구토 증상도 있는데 변비도 있어요.
+",Korean
+다시 가려워질 수도 있습니다.,Korean
+"차랑 부딪혀서 무릎 양쪽 다 찧었어요.
+",Korean
+결핵 주사 맞은 적 있으세요?,Korean
+이동 침대 이용 시 비용이 청구되기 때문입니다.,Korean
+상한 조개는 익혀 먹어도 위험해요.,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+의사 선생님 소견서랑 진단서 좀 주세요.,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+첫째는 자연분만으로 출산하셨고 둘째는 제왕절개로 낳으셨단 말씀이신가요?,Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+하루에 담배는 어느 정도나 하시는 거죠?,Korean
+살이 떨리는 한기가 느껴지나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+아이 열이 계속 떨어지지 않으면 더 위험할 거예요.,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+자세한 설명 원하시면 의사 면담 연결해드리겠습니다.,Korean
+세 달 전이랑 비교해서 몇 킬로 빠졌는지 혹시 아세요?,Korean
+최근에 몸무게 변화가 있나요?,Korean
+설사를 하신 경험이 있나요?,Korean
+"무릎에 피멍이 들고 다리에 찰과상이 생겼어요.
+",Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+양쪽 팔이 모두 가려우세요?,Korean
+독감 접종 후 집에만 계셨나요?,Korean
+네 코점막이 자극이 되어 콧물이 나올 수 있습니다.,Korean
+과거에 수술 경력 있으신가요?,Korean
+어디가 제일 많이 부었나요?,Korean
+흡연을 시작한 나이를 아세요?,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+정확한 입원비는 원무과에 문의해보시면 됩니다. 원무과는 일 층에 있습니다.,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+"수면시간이 전보다 월등히 늘었죠.
+",Korean
+"네. 담배 안 피우고는 못살 정도로 중독됐어요.
+",Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+복부 팽만감이 자주 생기나요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+일단은 약물 치료를 하고 경과를 지켜보겠습니다.,Korean
+결핵은 지금 어떻게 치료받고 계세요?,Korean
+담배를 경험해 본 적 있으신가요?,Korean
+혹시 화학 약품이나 환경에 따른 알레르기 반응은 없으세요?,Korean
+말씀하신 것처럼 환절기라 건조하다고 생각될 수도 있고 피부에 다른 질환이 생긴 것일 수도 있어요.,Korean
+아픈 게 얼마 안 됐나요?,Korean
+어느 부분이 붓기가 있나요?,Korean
+초음파 이동속도를 더 천천히 보여달라는 말씀이신가요?,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+어쩔 수 없는 경우 손 소독과 마스크 착용이 필수입니다.,Korean
+부종이 있는 곳이 있나요?,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+고혈압 때문에 먹는 약물 있으세요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+"대변은 아니고 오줌만 싸려고요.
+",Korean
+처음 며칠간은 매일 오시거나 입원하셔야 됩니다.,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+수술 후에도 방귀가 나올 때까진 금식하셔야 돼요.,Korean
+어느 부분이 가장 아픈지 말씀해 주세요.,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+잠이 들면 중간에 몇 번이나 깨나요?,Korean
+소변이 나올 때 피가 나오나요?,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+검사 결과가 생각보다 좋지 않게 나왔어요 위험한 상태라고는 할 수는 없지만 그렇다고 좋은 상황도 아닙니다.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+사랑니 제외 다른 치아를 뽑은 경우만 말씀해 주시면 됩니다.,Korean
+특정 시기에 통증이 생기나요?,Korean
+암을 치료하기 위해 내원하신 적 있으세요?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+흉터가 신경 쓰이겠지만 이 정도면 안 남을 수는 없습니다.,Korean
+알레르기 반응이 올라오는 다른 원인이 있나요?,Korean
+아니요. 가진 질병 따위 하나도 없습니다.,Korean
+이젠 병실로 올라가는 건가요?,Korean
+거의 매일 설사를 하시나요?,Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+목에 아픈 증세가 있나요?,Korean
+네. 수면 전 신체가 너무 활성화되어 있으면 오히려 수면을 방해합니다.,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+구토가 장폐색에 의한 경우라면 우려가 되나 그 외의 경우일 수도 있습니다. 검사 후 다시 말씀드리겠습니다.,Korean
+그 외에 따로 먹거나 투약한 것은 없나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+간염 치료로 복용 중인 약 있어요?,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+네. 부었을 때 나오는 증상입니다.,Korean
+종종 구토 증상이 있으세요?,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+격리 병실에 계시는 동안은 보호자와의 접촉은 힘듭니다.,Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+소변보는 횟수는 어떤가요? 평소보다 자주 보시나요?,Korean
+폐기하실 약은 약국에 가시면 됩니다.,Korean
+결핵 치료하신 지 얼마나 되셨나요?,Korean
+주사 때문에 뻐근할 수 있는데 통증이 계속 있거나 부으면 말씀해 주세요.,Korean
+아뇨. 비타민 섭취를 위해 잘 드시는 게 좋습니다.,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+"어젯밤부터 잠을 못 잘 정도로 계속 아팠어요.
+",Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+최근에 몸이 안 좋으셔서 약을 드시는 건가요?,Korean
+"스무 살부터 한 십 년 피우다가 서른에 끊어야겠다 마음먹고 끊었습니다.
+",Korean
+한의학 외에 다른 건 없으셨나요?,Korean
+온몸이 다 쑤시고 아픈가요?,Korean
+목이 많이 부은 것 같은데요?,Korean
+오한이 있어서 춥고 떨리나요?,Korean
+예전에 아팠던 곳 있어요?,Korean
+환자분은 이마 열상으로 내원하셔서 상처 먼저 세척하고 엑스레이 찍으실 예정입니다.,Korean
+어떤 검사를 하는가에 따라 검사 시간이 달라 정확히 말씀드리기 어렵습니다.,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+오줌에 피가 같이 나왔나요?,Korean
+드시는 간염약 약품명 아시나요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+입원 하실 때 걸어오셨는지 휠체어나 이동침대 등 다른 이동수단을 이용하셨는지 물어보았습니다.,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+절대 누우면 안 됩니다.,Korean
+회진 시간은 오전 아홉 시에 있습니다.,Korean
+발기 부전을 느끼고 계신가요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+키랑 몸무게가 잴 때마다 조금씩 달라요.,Korean
+환자분 몸 상태를 더 잘 이해하기 위해 필요합니다.,Korean
+청진할 때 옷을 올려 주시는 게 좋아요.,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+어린아이들도 위염 걸릴 수 있습니다.,Korean
+숨이 찬 증상이 나타납니까?,Korean
+진료기록 한 번 살펴보시겠어요?,Korean
+"요로 결석 때문에 병원에 왔어요.
+",Korean
+네. 한 번 유산 경험 있어요.,Korean
+네 체중 측정하시고 말씀해 주세요.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+키랑 몸무게는 왜 물어보시는 거예요?,Korean
+술 마시는 날이 잦나요?,Korean
+잠을 잘 자지 못하시나요?,Korean
+안 그래도 피 모자라다고 의사 선생님이 그러셨는데.,Korean
+네. 지금 당뇨 때문에 계속 약을 먹고 있어요.,Korean
+피가 섞인 변을 보시나요?,Korean
+네 뜸이나 부항 뜨신 적 있으신가요?,Korean
+간염은 약물로 관리 중이신가요?,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+"왼쪽 팔 피부가 찢어졌습니다.
+",Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+결핵으로 진단받은 적 있나요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+제가 알코올 알레르기가 있어서 알코올 솜으로 소독하면 피부가 부풀어 올라요.,Korean
+"갑자기 오 킬로 늘었어요.
+",Korean
+폐와 심장 기능이 떨어져서 산소 공급이 원활하지가 않아 그렇습니다.,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+아니요 배가 아프다거나 하는 증세요.,Korean
+다른 질병이 있는지 확인 차 여쭈어보는 겁니다.,Korean
+변비 증상이 처음이신 건가요?,Korean
+특이 혈액형에는 뭐가 있어요?,Korean
+소변볼 때 통증이 있나요?,Korean
+"애가 헬멧을 쓰고 있었는데 자전거가 옆으로 넘어지면서 머리 먼저 박고 그다음에 어깨 팔꿈치 다리 이렇게 다쳤어요.
+",Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+네. 원래 숨쉬기 불편하게 만듭니다.,Korean
+음주 기간과 양은 건강에 지대한 영향을 끼치니까요.,Korean
+배가 빵빵한 느낌이 불편한가요?,Korean
+목이 건조하거나 삼키기가 힘들거나 하는 통증은요?,Korean
+간염으로 처음 진료 받은 날이 언제인가요?,Korean
+"무릎뼈랑 다리가 아파서 계단 오를 생각을 못 해요.
+",Korean
+"고환을 다쳤나 엄청 아파요.
+",Korean
+네 보호자에게도 설명 후 서명할 동의서가 있습니다.,Korean
+첫째 애 낳고 유산했었습니다.,Korean
+아니요 진단서 여기 있습니다.,Korean
+콜라 같은 색의 소변인가요?,Korean
+수술이 끝나면 회복실로 가실 것 같아요.,Korean
+결핵 예방접종 경험이 있으신가요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+무리를 하셨네요 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+원하시면 독감 주사 예방 접종 가능한 병원에서도 할 수 있습니다.,Korean
+환자 개인 정보 조사를 위해 여쭤보았습니다.,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+네 체중 변화가 빨리 올 경우 몸에 피해가 있을 수 있습니다.,Korean
+"해요. 설사할 때마다 배가 아파요.
+",Korean
+"탄단지 비율 맞춰서 잘 먹어요.
+",Korean
+네. 다른 병원에 가볼게요,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+의학적으로 검증되지 않은 경우이긴 해서 염려되어서요. 효과 보셨던 게 어떤 것이었나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+혹시 가래는 주로 삼키시나요? 아니면 뱉으시나요?,Korean
+두통이 심할 때도 있나요?,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+편하신 팔로 내밀어 보세요 혈압 측정하겠습니다.,Korean
+받을 수 있는 시술 프로그램이 다양해서 설명 들으시고 선택하시면 됩니다.,Korean
+소화기관 어디선가 출혈이 있다는 의미이므로 원인 파악이 중요합니다.,Korean
+두 달 전에 다른 종합 병원에서 암 수술한 적이 있어요.,Korean
+통증이 얼마 만에 발생하는지 말해볼래요?,Korean
+"안녕하세요. 요 근래에 편두통이 너무 심하고 증상이 거의 매일매일 있어서 왔어요.
+",Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+네 불편하시더라도 소변줄 삽입을 권유드립니다.,Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+한 달 이내 타 병원 방문을 했었어요.,Korean
+세균 감염은 제가 어떻게 조심하면 괜찮았을까요?,Korean
+결핵 백신 접종 여부 알려주세요.,Korean
+알레르기로 인해 피부약을 먹고 있습니다.,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+네. 올해 이 월에 수술했었습니다.,Korean
+"엄지와 검지가 유독 마비된 듯 감각이 이상해요.
+",Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+둘째 낳기 전에 두 번 정도 유산했어요.,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+"아기가 속이 안 좋은지 밥을 잘 먹으려고 하지 않고 겨우 먹으면 토를 하네요.
+",Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+일을 하다 보니까 시간 맞춰 먹는 약에 좀 제때 지키지 못한 경우가 있어요.,Korean
+당뇨 있는 건 아니시죠?,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+지난번 검사와 수치를 비교하기 위해 같은 검사를 했습니다.,Korean
+"대소변 보는데 어려움이 있냐고요?
+",Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+"수면 질이 너무 떨어져서 얼굴에 다크서클이 진하게 내려왔어요.
+",Korean
+입원했던 적이 몇 번일까요?,Korean
+여드름약 먹는데 가져올 걸 그랬나요?,Korean
+바셀린 거즈는 보습과 동시에 상처를 보호하는 역할을 해 줍니다.,Korean
+하루에 결핵 약 몇 번 먹고 있나요?,Korean
+잠이 쉽게 오지 않나요?,Korean
+종양인데 악성일지 양성일지는 아직 알 수 없습니다.,Korean
+"이두근이 당기고 힘이 없어요.
+",Korean
+구역질이 날 때가 있나요?,Korean
+네 욕창이 나은 후에도 재발하지 않도록 주의해 주세요.,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+면역요법은 수개월에서 일 년 이상까지 시간이 소요됩니다.,Korean
+신경 치료 치아가 몇 개인가요?,Korean
+"씨 형 간염이 의심된다고 해서 검사받아봐야 할 것 같아요.
+",Korean
+원래 토혈 증상이 있으신가요?,Korean
+아이 몸무게가 얼마나 달라졌는지 여쭤보시는 건가요?,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+당뇨 나온 적 있으세요?,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+"네. 다름이 아니고 손끝에 약간 불편한 감각이 가시질 않아서요.
+",Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+네. 전조증상 있는 병입니다.,Korean
+"소변 때문에 도저히 잠을 잘 수가 없어서요.
+",Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+결핵 치료는 언제부터 시작하셨어요?,Korean
+네. 소독도 자주 해줘야 하고 아이 상태를 확인하기 위해서는 입원 치료하는 게 좋아요.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+"야식 자주 먹을 때 역류성 식도염으로 고생한 적이 있어서 잘 안 먹어요.
+",Korean
+당뇨 처방 약 계속 드세요?,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+"배 아프다고 운 뒤로는 아무것도 먹은 게 없어요.
+",Korean
+수면과 관련하여 드시는 약이 있는지 확인이 필요한 부분이라 여쭤봤습니다.,Korean
+결핵 예방접종 이력이 있나요?,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+"이틀 전부터 말하거나 기침할 때마다 아프더니 지금은 숨을 좀 크게 들이마셨다 내쉴 때도 아파요.
+",Korean
+숨이 찬 증상이 나타납니까?,Korean
+치료는 동네 치과에서 받으셨나요?,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+배가 아픈지 얼마나 되었는지 알 수 있을까요?,Korean
+"서서히 울렁거리는 것 같더니 지금은 너무 어지러워요.
+",Korean
+병원 규정은 환자 확인 시 이름 주민등록상 생년월일 환자 번호를 확인하고 있습니다.,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+오빠는 자연분만으로 하시고 동생은 제왕절개로 하셨다고 했어요.,Korean
+콕 찍은 정도여서 흉터라고 보기에는 애매하네요.,Korean
+알레르기 있는 음식 아시나요?,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+저 지금 좀 컨디션이 안 좋은데 맥박 측정 결과 제대로 나올까요?,Korean
+"코에 피가 나가지고 왔어요.
+",Korean
+계속 드시던 약이 있나요?,Korean
+종양이 발견된 지 오래됐어요?,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+담배를 피우신 적 있으세요?,Korean
+시력이 안 좋아서 안경을 가지고 다닙니다.,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+항생제는 퇴원하시고 일주일 정도 드셔야 해요.,Korean
+"소변보는 게 편하지 않아서 약 먹고 있어요.
+",Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+현재 환자분 질병은 치료법을 명확히 구분 지을 수 없어서 중증으로 분류되는데 현재 상황에선 치료법이 있기 때문에 경증으로 구분됩니다.,Korean
+소화 불량이 자주 나타나나요?,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+최근 급격하게 살이 많이 올랐나요?,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+언제부터 이 증상이 나타났나요?,Korean
+갖고 계신 약 있나요?,Korean
+"어제부터 계속 장이 안 좋아서요. 구토가 심해요.
+",Korean
+아니요. 비수술적인 치료 방법도 많습니다.,Korean
+수술 시 보호자의 동의서 작성이 꼭 필요하니 입원 시 보호자 한 분이 동행하셔야 합니다.,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+불편함이 있으시면 언제든지 병원으로 연락주세요.,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+"요새 혈변을 자주 눠서요.
+",Korean
+어떤 종류의 백신 맞으셨어요?,Korean
+화상 치료 초기에는 입원을 권장하고 있습니다.,Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+치료가 늦어질 시 합병증으로 인해 향후 삶의 질에 영향을 미치게 되므로 적절한 시점에 잘 내원하셨습니다.,Korean
+배가 아픈지 얼마나 되었는지 알 수 있을까요?,Korean
+심장이 유독 빨리 뛰는 느낌이 있나요?,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+처음 담배를 접한 게 언젠지 기억하시나요?,Korean
+암 있는 건 언제 아셨나요?,Korean
+아니요. 코막힘 소리와는 다릅니다.,Korean
+통증 양상을 알 수 있을까요?,Korean
+"제가 갑각류 알레르기가 있습니다.
+",Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+참기 힘들 땐 손으로 긁지 마시고 차가운 멸균 알콜 솜으로 눌러 보세요.,Korean
+아니요 국소 마취만 해도 됩니다.,Korean
+예방효과는 안 맞으신 분들보다는 뛰어납니다. 하지만 독감 예방 접종 후에도 독감에 걸리실 수 있습니다.,Korean
+가슴이 아프거나 하지는 않으셨어요?,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+"동네 병원에서 요관 결석이 의심된다고 해서 대학병원에 왔어요.
+",Korean
+"차끼리 부딪쳐서 병원에 왔어요.
+",Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+물 많이 드시고 침상 안정 해주세요.,Korean
+오분 전후로 걸리실 거고 혈압이 조금 이상하다고 판단되면 재검사 하실 수도 있어요.,Korean
+"소화불량이 지속되다 보니 소식하고 있습니다.
+",Korean
+"며칠 입원해 있고 싶어서요.
+",Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+디피시피 치료는 통증을 유발하는 치료는 아닙니다.,Korean
+"물 조금만 마시는 것도 안 되나요? 입안이 텁텁해서.
+",Korean
+"아니요. 다른 증상은 아직 없어요.
+",Korean
+심한 흉터에서부터 표가 잘 안 나는 흉터까지 매우 다양합니다.,Korean
+과거에 전반적인 건강 상태가 어떠셨나요?,Korean
+검사상 여섯 시간에서 여덟 시간 정도는 공복을 하고 받을 수 있어서 여쭤봤어요.,Korean
+가족 중에 고혈압 환자인 분이 누구셨나요?,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+저기 소아과 선생님과 상의해 볼게요.,Korean
+"오늘 아침에 책상 모서리에 오른쪽 새끼발가락을 세게 찧었거든요. 피도 좀 봤는데 시간이 지나고 보니까 발가락뼈도 다친 건지 걷기도 힘들어요.
+",Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+전에 암을 앓은 적이 있나요?,Korean
+처방받고 바로 진행될 거예요.,Korean
+음식 알레르기 앓은 적 있어요?,Korean
+암 환자가 가족 중에 있을까요?,Korean
+"네. 설사약은 달고 삽니다.
+",Korean
+약이 처방한 다른 약과 충돌하는 건 아닌지 확인하기 위해 약을 보여주셔야 합니다.,Korean
+통증 오는 시간이 대략 어떻게 되시나요?,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+"약을 다시 지어야 한다고 하셔서 왔습니다.
+",Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+이 코너 돌아가시면 주사실이 있는데 그쪽으로 가 보시겠어요?,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+"엄지 발가락 쪽이 많이 붓고 고름까지 나와서 오게 되었어요.
+",Korean
+올해 독감 예방 주사 맞으실 예정이신가요?,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+주기적으로 환자분들 수분 섭취 시간을 기록하기 위해서 여쭤본 겁니다.,Korean
+네. 흉터는 살짝 남겠지만 이 정도면 만족해요.,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+갑자기 가슴이 아프다거나 숨쉬기 어렵지 않으셨고요?,Korean
+아니요. 마스크는 항상 써주세요.,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+통증이 계속되는 부위가 어디인가요?,Korean
+작년에 폐렴을 한 번 앓았어요.,Korean
+처음 아팠던 날 기억나세요?,Korean
+상처는 매일매일 회복속도가 다르기 때문에 꾸준히 체크해 보시는 게 좋습니다.,Korean
+"고환이 너무 많이 부은 거 같아요.
+",Korean
+아직 복부에 붓기가 남아있나 봅니다.,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+"어제저녁부터 계속 설사만 해요.
+",Korean
+"식은땀이 나고 숨쉬기 어려울 정도로 가슴이 아파요.
+",Korean
+네 그렇지만 욕창이 감염의 위험원이 될 수 있습니다.,Korean
+주위에 혹시 확진자나 자가격리자가 있나요?,Korean
+"저희 애가 자꾸 속이 안 좋다고 칭얼거려서요.
+",Korean
+경우에 따라서는 조직검사 결과를 확인하고 영상검사 등 추가적인 검사 후에 치료 방향을 결정할 수도 있습니다.,Korean
+철심 수술은 안 했어요.,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+아뇨. 비타민 섭취를 위해 잘 드시는 게 좋습니다.,Korean
+질병으로 약을 드시고 계시나요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+얼마나 자주 술을 드세요?,Korean
+"복부 팽만이 조금 있는 것 같아요.
+",Korean
+담배 피운 기간이 오래됐나요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+지금 아픈 곳 말하세요.,Korean
+"적어도 여섯 시간 자는 것 같습니다.
+",Korean
+이름처럼 가슴을 보호해 주는 게 가슴 보호대입니다.,Korean
+자세한 건 검사 결과를 봐야 알 수 있습니다.,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+진료 시 담당 선생님이 체크할 수 있도록 하겠습니다.,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+"벌에 쏘인 후로 호흡이 어려워요.
+",Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+수액 양을 줄여 드릴게요. 나아지는지 확인해서 말씀해 주시겠어요?,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+숨 쉴 때 힘들거나 그러진 않으신지요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+오빠가 몇 년 전에 위암으로 수술을 받았어요.,Korean
+소변을 볼 때 소변량은 어느 정도인가요?,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+아픈 건 어느 정도인가요?,Korean
+화장실에 갔는데 소변이 안 나오나요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+불편하시다면 병실 이동도 가능하십니다.,Korean
+밴드는 검사 부위에 피가 계속 나면  붙여 드릴게요.,Korean
+지속적으로 소화가 잘되지 않나요?,Korean
+네 검사 후 필요하다면 약을 변경하도록 하겠습니다.,Korean
+타인에게 수혈을 해 준 적이 있으신 지 여쭤봤습니다.,Korean
+약을 처방받아 드시고 계신가요?,Korean
+"무릎 뒤쪽도 같이 아프네요.
+",Korean
+집에 엘리베이터가 없어서 어떻게 병원에 다녀야 할지 걱정돼요.,Korean
+첫째는 자연분만 하셨다는 말씀이신가요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+환자분마다 느끼는 증상이 달라요.,Korean
+요새 머리가 어지럽진 않나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+"자꾸 눈 앞이 흐려져서 혈당을 재 보니 높게 나왔어요.
+",Korean
+"밥을 못 먹는 게 제일 힘들죠. 물도 잘 못 마시고 기운도 없고.
+",Korean
+"계단에 턱을 박았는데 깨진 것 같아요.
+",Korean
+가슴 통증의 원인으로는 심혈관 호흡기 소화기 근골격 심인성 등의 다양한 원인이 있을 수 있습니다.,Korean
+치료를 받고 나서 몸의 이상에 대해서 자각하게 되는 것은 치료 이후에 신체상태에 대한 관심이 올라가서 일 수 있습니다.,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+하루에 몇 개비 정도 ���우시나요?,Korean
+졸린데 눈을 감아도 잠들기 어려우신가요?,Korean
+"하루에 한 갑 넘게 피웠어요.
+",Korean
+기침 증세가 악화하고 있나요?,Korean
+"네. 한번 자는 게 어려워서 백색소음 들으면서 자요.
+",Korean
+간호사 콜 버튼이 여기 있는지도 몰랐어요.,Korean
+"기침을 할 때 피가 섞여 나옵니다.
+",Korean
+딱 삼 밀리요. 그게 권장량이었어요.,Korean
+네 둘 다 알레르기일 때 나타날 수 있다는 연관이 있습니다.,Korean
+입원 경로 종류는 여러 가지가 있는데 이쪽 화면 보시면서 말씀드릴게요.,Korean
+되도록 컨디션 관리에 힘써주시고 약을 잘 복용하는 방법밖에 없습니다.,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+네 철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+"집사람이 죽으려고 약을 잔뜩 털어먹었어요.
+",Korean
+소변이 잘 누어지지 않으세요?,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+입원이나 수술받으신 적 있으면 말씀해 주세요.,Korean
+"술을 좋아하는 편이라 일주일에 네 번 정도 한 번에 세 병 정도는 마시는 것 같아요.
+",Korean
+두통 때문에 잠들기 어렵지는 않나요?,Korean
+통증이 멈췄다 다시 시작되나요?,Korean
+기계에 따라 검사의 오류가 있을 수는 있으나 대부분의 경우는 검사 결과에 오류가 있을 가능성은 적습니다.,Korean
+만성폐쇄성 폐 질환이 있네요.,Korean
+"숨 쉴 때마다 아파요. 허리가.
+",Korean
+아팠다 말았다 하나요? 아니면 계속 아픈가요?,Korean
+"아니요. 여섯 시간이었는데 아픈 탓에 얼마 못 자고 있어요.
+",Korean
+환아 몸무게가 살이 빠지기 전엔 얼마였고 지금은 얼마인가요?,Korean
+"날개뼈 쪽이 자꾸 결리고 담이 오네요.
+",Korean
+쓰러지시는 증상은 검사 결과 처음이 아니신 걸로 보여서요.,Korean
+혈변 시 복통이 함께있나요?,Korean
+한의원 방문 외에 개별적으로 지인에 의해 진행하거나 했던 경험은 없으신가요?,Korean
+"타는듯한 속 쓰림이 있어요.
+",Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+간염 치료받은 지 오래되셨나요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+아이 상태는 의사분께서 직접 설명해주실 예정입니다. 자리에 머물러 주십시오.,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+"뺨이 많이 아프고 볼이 많이 부었어요.
+",Korean
+통증이 나타난 곳이 어디신가요?,Korean
+"통증이 오래되니 삶이 무기력해서 입원 치료받으려고요.
+",Korean
+우선 회전근개파열을 의심하고 있기 때문에 몇 가지 검사가 필요합니다.,Korean
+설사는 하루에 몇 번 하시나요?,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+"묽은 토가 자꾸 나와요.
+",Korean
+아픈 이유는 여러가지 일 수 있습니다. 일단 신체검사 및 몇 가지 검사를 해 보겠습니다.,Korean
+피부가 전보다 어두워진 느낌이시라고요? 한번 살펴볼게요.,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+얼마 전에 예방접종은 했습니다.,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+물만 먹어도 설사가 나오나요?,Korean
+"숨쉬기 좀 벅차긴 해요.
+",Korean
+대변을 볼 때 피가 보이나요?,Korean
+"아이가 열이 나서 잠을 못 자요.
+",Korean
+"아니요. 금연했었어요. 반년 정도요.
+",Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+음주는 환자분의 건강에 영향을 끼치는 주요 요소입니다.,Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+흉통이란 가슴 부위에 나타나는 통증을 의미합니다.,Korean
+이전에 조영제 알레르기가 없으셨던 분은 크게 문제 되지는 않아요.,Korean
+"제가 코를 많이 골아서 코 심하게 골 때는 놀라서 일어나곤 해요.
+",Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+디피시피 약물은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+"네. 목에 뭐가 걸린 거 같아서 삼키기 조금 힘들어요.
+",Korean
+어떤 증상이 제일 힘드세요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+숨을 쉬는 양상이 이상하지는 않았었나요?,Korean
+무슨 약인지 전혀 모르겠습니다.,Korean
+열이 있다면 어떤지 알려주시겠어요?,Korean
+일단 봉합된 부위는 이틀마다 외과에 가셔서 소독 받으셔야 합니다.,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+수술 중에 위 내용물이 역류하실 수 있습니다.,Korean
+수술 후 재활은 얼마나 걸리나요?,Korean
+당뇨로 병원에 처음 오신 건 언제였나요?,Korean
+심한 급성 알레르기 반응의 경우 기도 수축에 의한 호흡 곤란이 오기도 합니다.,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+안 그래도 소화기 증상이 있는 와중에 금식하느라 더 힘드셨을 것 같습니다. 검사 진행 가능합니다.,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+코로나 유행 지역이 어디인지 구체적으로 알 수 있을까요? 다녀온 곳 중에 코로나 유행 지역이 있을 수도 있어서요.,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+피가 섞인 소변을 봤나요?,Korean
+움직이기 전보다 더 아프다는 말씀이죠?,Korean
+네. 한약을 먹은 지 육 개월 됐습니다.,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+"골반이 쑤시듯이 아프고 오른쪽 엉덩이부터 발끝까지 힘이 잘 들어가지 않아요.
+",Korean
+검사 전날 하제를 복용합니다.,Korean
+환자분 성함도 계속 물어볼 텐데 정확한 환자에게 약물을 투여하기 위해 필요한 절차이니까 협조 잘 부탁드릴게요.,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+대부분 입원하시는 경우가 치료 또는 수술이 목적이기 때문에 전부 말씀해 주시면 됩니다.,Korean
+네 금식 준비를 잘 해주셨군요.,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+부모님 중에 암 병력이 있나요?,Korean
+습진인 것 같긴 한데 될 수 있으면 물에 안 닿게 하는 게 좋을 듯싶어요.,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+"손목을 날카로운 걸로 그어버렸거든요.
+",Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+통증이 멈추지 않나 봐요?,Korean
+네 원래 이 질환은 치료에 시간이 많이 걸립니다.,Korean
+독감 주사 언제 맞으실 건가요?,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+저 지금 좀 컨디션이 안 좋은데 맥박 측정 결과 제대로 나올까요?,Korean
+알레르기 일으키는 원인 있나요?,Korean
+약 들어가는 속도를 좀 낮췄는데 그래도 같은 증상이면 말씀해주세요.,Korean
+"손목 관절이 안 좋아졌어요.
+",Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+통증이 있는 부위가 있으세요?,Korean
+외래 진료 때 만나셨던 선생님을 말씀하시는 건가요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+부분마취인 경우 마취가 잘 풀리는 경우도 있습니다. 상황에 따라 마취방법이 변경될 수 있습니다.,Korean
+"제 친구인데 의식이 없어요.
+",Korean
+약물 복용 중인 거 있으신가요?,Korean
+협심증이 확진된다면 약물 치료로 조절할 수 있습니다.,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+"소화불량이 지속 되다 보니 적게 먹고 있습니다.
+",Korean
+매일 상처를 살펴보면서 치료 받게 됩니다.,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+머리 쪽 씨티 같은 경우는 뼈를 중심으로 촬영하기 때문에 조영제를 투여하지는 않습니다. 검사는 오 분이면 끝납니다.,Korean
+수술 후 경과를 봐야 식사 여부를 알 수 있어요.,Korean
+어떤 알레르기를 앓고 계세요?,Korean
+가슴 두근거리는 정도는 어떤가요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+소변과 함께 피가 나오나요?,Korean
+간염과 관련된 약물 드시는 것 있나요?,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+목이 건조하거나 삼키기가 힘들거나 하는 통증은요?,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+얼마 동안 결핵 치료를 계속하고 계시나요?,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+증상과 관련해서 확인해 본 것입니다.,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+"제가 비염이 있어서 좀 코가 막혀서 그런가 이상한 낌새는 없었는데 딱히.
+",Korean
+아버지도 유전성 질환을 앓으셨나요?,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+"배에 뭔지 모를 가스가 가득 찬 것 같아요.
+",Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+"약을 먹은 지 꽤 됐는데도 소변보는 게 조금 버거워요.
+",Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+한 번 시작된 통증은 언제까지 가나요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+손목 보호대를 착용하시는 것도 좋은 예방법이 되실 수 있습니다.,Korean
+질병 약물로 치료하고 계시나요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+오늘 내원하신 이유는 뭔가요?,Korean
+네 복원수술받은 것도 말씀해 주세요.,Korean
+신경이 손상되면 그럴 수 있습니다. 검사해봅시다.,Korean
+정확히 어떤 음식이나 약에 두드러기가 나는거죠?,Korean
+작년 여름에 교통사고가 크게 나서 한 삼 개월 누워있었고. 다리 부러진 거 수술했었어요.,Korean
+검사를 하시려면 더 큰 병원을 추천하고 싶습니다.,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+네 건강검진 때 질병이 있다고 나왔나요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+소화제는 늘 먹는데 위가 안 좋아서요.,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+"목 쪽이 건조해서 긁으면 상처가 나고 뭘 발라도 낫질 않아요.
+",Korean
+구토가 난 적이 있으세요?,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+호르몬 검사를 한 번 해볼까요?,Korean
+다른 병원에서 진료받으려는 이유가 있을까요?,Korean
+종양 있었던 가족이 있으신가요?,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+통증을 느끼는 부위가 어디예요?,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+약물에 의한 피부염이 일어나게 되면 접촉성 피부염 치료 후 다른 방법으로 치료를 진행하게 됩니다.,Korean
+신체적인 반응이나 부작용이 일어났었나요?,Korean
+"제가 아마 고등학생 때부터 담배 피웠을 거예요.
+",Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+"네. 변비가 심한데 오늘 병원 온다고 어제 약을 먹었더니 아침에 봤어요.
+",Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+"기침하고 가래가 이주 이상 계속됐어요.
+",Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+전신 마비가 올 수도 있습니다.,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+혈압은 금방 좋아질 겁니다.,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+"아뇨. 치질을 겪은 적은 없습니다.
+",Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안 됩니다.,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+네. 수분 부족 현상이에요.,Korean
+네 기침은 기관지 쪽이 자극을 받아서 나오는 것입니다.,Korean
+식사 후에만 속이 안 좋으세요?,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+가족 중에 당뇨이신 분 있어요?,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+약품 의뢰하고 여분 없으면 처방해드릴게요.,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+"식욕도 없고 기운도 없는 거 같아요.
+",Korean
+"밥 먹으면 갑자기 토한 지가 한 삼사일 정도 되었어요.
+",Korean
+결핵은 어떻게 하고 계시죠?,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+알레르기 진단받은 연도는 어떻게 되나요?,Korean
+통증이 걱정되시면 일단은 염증을 가라앉히는 약을 먼저 복용해보셔도 됩니다.,Korean
+"배가 장이 꼬인 것처럼 배배 꼬이고 뒤틀린 기분이라서 왔어요.
+",Korean
+가슴 통증이 있진 않으신가요?,Korean
+네 저희가 처방 전에 확인을 해야 하는 거라서요.,Korean
+천식 때문에 입원한 적 있었어요.,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+"변비는 늘 있는데 설사는 전혀 없어요.
+",Korean
+원래 수액 들어갈 때 뻐근하고 차가운 느낌 드나요?,Korean
+"어젯밤에 내리막길에서 자전거를 타다가 크게 굴러서 여기저기가 쑤셔요.
+",Korean
+"오전에 재 봤는데 딱히 열이 있거나 하진 않았어요.
+",Korean
+강남 쪽에 투석 병원이요. 지금 이름이 잘 기억이 안 나네.,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+소화가 안 되어서 속이 불편해요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+"네. 평소랑 변 색깔이 달라요. 평소보다 색깔도 많이 까맣고 속도 아파요. 쓰리고 토할 것 같아요.
+",Korean
+뇌진탕이 있었을 수도 있으니 검사를 한 번 해봅시다.,Korean
+병원 내에서는 휠체어를 이용해 주시고 목발은 필요하시면 의료기기 상점에서 구매하셔야 합니다.,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+제거하는 거라 약간의 통증은 발생할 수 있어요,Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+과거 병력을 알고 싶어요.,Korean
+네 당연히 통증 완화에 도움이 됩니다.,Korean
+매일 드시는 약이 있어요?,Korean
+자궁경부암 검사 때문에 최소 일 년에 한 번씩은 가요.,Korean
+"기침을 너무 많이 해서 그런지 이젠 심장까지 아픈 것 같아요.
+",Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+지난번에 암 치료는 언제 시작하셨나요?,Korean
+"자고 일어났는데 머리가 아프고요 조금 쌀쌀한 기운이 느껴져서요 감기약 받으러 왔습니다.
+",Korean
+체중이 한 달 동안 얼마나 늘었나요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+"오늘 약 먹은 시간과 같아요.
+",Korean
+과거 수술 이력이 있는지 알려주세요.,Korean
+"소변 보고 나면 욱신거려요.
+",Korean
+여기가 더워서 체온이 높으면 어떻게 하죠?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+알레르기 치료는 얼마 동안 받으셨어요?,Korean
+딱히 약물 알레르기는 없었던 것 같아요.,Korean
+평소에 숨이 안 쉬어질 때가 언제인가요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+검사 결과는 원하시면 문자나 이메일로도 발송 가능합니다.,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+피부에 국소 자극을 일으켜 항체가 그곳 세포를 공격하게 하는 성분입니다.,Korean
+가족 중에 암을 앓으신 분들이 많은가요?,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+담배 대신 껌 씹으시는 걸 추천합니다.,Korean
+"아니요. 장염 때 말고는 설사 아예 안 해요.
+",Korean
+침 삼킬 때 아픈가요?,Korean
+대변볼 때 피가 나오나요?,Korean
+의사 상담 후 처방받은 대로 진통제를 복용하시는 게 좋아요.,Korean
+환자와 관련해서 안내해 드릴 게 있습니다.,Korean
+피가 섞인 소변을 보신 적이 있나요?,Korean
+소변 보는 주기가 어떻게 되나요?,Korean
+네. 주사 맞을 때가 걱정이긴 한데 봉합만 잘 된다면야.,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+평소보다 요즘이 더 피로하신 것 같나요?,Korean
+현재 간염약 드시고 계신 게 있나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+"이가 아파서 검사 받고 싶어요.
+",Korean
+예전에 암 수술받은 적 있어요.,Korean
+머리 아픔이 어느 정도인가요?,Korean
+또한 손가락 인대가 손상되었으니 되도록이면 움직이지 마시고 적용한 부목은 제거하지 말아 주세요.,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+저번 달에 통증이 왔다가 오늘 다시 온 거예요?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+네 산소치료를 하여서 코가 많이 건조하실 것입니다.,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+병원비 비용 납부한 내역도 같이 주실래요?,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+가정에서는 빨간약이라고 부르는 포비돈 요오드를 사용하기도 합니다.,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+배가 부른 느낌을 가지고 계신가요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+독감 예방 주사 맞고 동남아 여행 다녀왔어요.,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+현재 치료하려는 병과 깊은 관련이 있습니다.,Korean
+몸에 힘이 안 들어 가요?,Korean
+아니요. 현재 호흡기계 증상이 없다고 다 나은 것이라고 말씀드리기는 어렵습니다.,Korean
+"화장실에 가도 변이 해결이 안 돼요.
+",Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+아직까지 먹은 것 중엔 알레르기 없었어요.,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+어떤 경우에 알레르기 반응이 나타나나요?,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+여드름약 먹는데 가져올 걸 그랬나요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+난소에서 난자가 나오면 나팔관을 통해 이동하는데 이 길을 막는 것입니다.,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+체중이 갑자기 늘면 좋지 않은 거에요.,Korean
+한 번 시작된 통증은 언제까지 가나요?,Korean
+덴탈 마스크보다는 케이에프 마스크를 권장합니다.,Korean
+"변비 있어서 마그밀 복용해요.
+",Korean
+네 마스크 착용이 중요합니다.,Korean
+몸살 기운이 있는 것 같나요?,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+네 언제부터 기침이 있으셨나요?,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+손목 터널을 넓히는 수술입니다.,Korean
+머리 부분에 통증은 없는지 말해주세요.,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+약 드시고 알레르기 반응 보인 적 있으세요?,Korean
+평균 대략 얼마나 담배 피우시나요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+혹시 결핵약 처방 받으셨나요?,Korean
+보유 질환이나 만성 질환 같은 거 없습니다.,Korean
+결핵 예방접종 이력이 있나요?,Korean
+"싸웠는데 얼굴이 많이 다쳤어요.
+",Korean
+장운동을 확인 후 물을 드셔야 됩니다.,Korean
+가족 중에 누군가 고혈압이 있나요?,Korean
+약국도 예약을 하고 가야 하나요?,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+최근 몇 개월 동안 체중이 증가했어요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+"매일 유산균 먹고 있어서 배변 활동은 아무 문제 없습니다.
+",Korean
+속이 쓰리는 느낌은 없나요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+이틀에서 삼 일 정도는 수액 공급이 필요합니다.,Korean
+더 나빠지지 않을 거고 이미 생긴 욕창은 계속 치료하셔야 합니다.,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+복통과 두통이 같이 시작되셨나요?,Korean
+위산분비억제제와 항생제 치료가 기본 치료입니다.,Korean
+복용으로 인한 이득이 위험보다 클 것으로 보입니다.,Korean
+목에 인후통 증상이 있나요?,Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+자궁경부암 그거 예방 접종 맞았어요.,Korean
+콜라겐 말고 다른 약 드시는 건 없으신가요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+"기침 가래가 심하고 목이 아파서요.
+",Korean
+마취는 하지 않고 진통제를 드립니다.,Korean
+항생제 주사 맞으신 거죠?,Korean
+도대체 어디가 아픈 거예요?,Korean
+위내시경 수면 없이 해보셨나요? 내시경 관이 목으로 넘어갈 때 힘들어하시는 분들이 많아요.,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+담배를 피운 기간을 알려주세요.,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+장중첩증 수술한 게 다예요.,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+통증은 주로 언제 오나요?,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+저 마취해 본 적이 없어서요.,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+피가 많이 필요한 검사가 아니라서 걱정 안 하셔도 됩니다.,Korean
+"운동 시 호흡곤란이 ���서 입원하게 되었어요.
+",Korean
+"손목을 유리 조각으로 그었어요.
+",Korean
+담배 얼마나 태우고 계신가요?,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+수액 좀 천천히 들어가게 해 드릴게요.,Korean
+이참에 금연 한 번 해보죠.,Korean
+부분 마취 약물에 대한 알레르기로 오심과 구토 및 피부 간지러움증이 있을 수 있습니다.,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+"엉덩이 쪽에 뾰루지가 계속 올라와서 앉아있지를 못하겠어요.
+",Korean
+일단 진료 후 확인해 보는 게 좋겠습니다.,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+가스 활명수 외에 다른 소화제 같은 건 안 드시고요?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+구급차에서 이동 침대로 이동하셨군요.,Korean
+고혈압 때문에 먹는 약물 있으세요?,Korean
+정상 수치보다 백 정도 상승됐습니다.,Korean
+소변에 섞여 나오는 피의 양은 얼마나 되는 거 같으세요?,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+간호 간병 병동이 아니므로 보호자가 상주하셔야 합니다.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+외래 통해 자세한 안내를 받으시도록 도와드리겠습니다.,Korean
+약이 잘 안 맞을 수 있어요.,Korean
+재활 기간은 사람마다 매우 다릅니다.,Korean
+네. 저희가 위중도와 순서에 맞춰 진료를 보고 있으니 조금만 기다려 주세요.,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+현기증을 처음 느끼신 건가요?,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+레이저 시술 후 부작용 사례는 거의 없습니다.,Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+젖은 상태의 거즈로 상처를 보호할 수 있습니다.,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+"식욕이 많이 떨어져서 그런지 음식 먹을 때마다 깨작거려요.
+",Korean
+"얼굴을 한 방 맞았어요.
+",Korean
+하루에 여러 차례 드레싱하며 상태를 볼 겁니다.,Korean
+통증 때문에 잠을 못 자시나요?,Korean
+가슴 통증 느끼신 지 얼마나 되신 거죠?,Korean
+큰일이 나는 건 아닌데 약물 부작용 위험이 있어요.,Korean
+사고로 상해를 입은적이 있나요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+부종이라는 게 어느 한 부위가 붓는 경우를 말해요.,Korean
+어지러울 때 머리가 아프진 않나요?,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+"아랫배 통증이 심하고 계속 설사를 해요.
+",Korean
+머리 아픔이 어느 정도인가요?,Korean
+식습관은 건강행태를 알 수 있는 한 가지 척도 중 하나지요.,Korean
+암 치료 이력이 있나요?,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+마취 약물 때문에 구토 및 오심 등 알레르기 반응이 있을 수도 있습니다.,Korean
+네 입으로 충분히 심호흡을 하셔야 됩니다.,Korean
+결핵을 오래 앓으신 거예요?,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+회진시간 외 의사선생님은 만날 수 없는 거예요?,Korean
+요새 항상 우울해해서 아마 우울증약 처방받았을 거예요.,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+다이어트 때문에 보조제 도움받고 있어요.,Korean
+통증 있는 부위를 말해 보세요.,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+장기 복용 부작용과 의존성이 생기는 것이 문제가 될 수 있어요.,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+산부인과 외래 운영 시간 좀 알려주세요.,Korean
+네 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+"아기가 잠을 깊이 못 자고 누가 조금만 움직여도 바로 깨요.
+",Korean
+청진할 때 옷을 올려 주시는 게 좋아요.,Korean
+많이 불편하시거나 재채기가 나면 말씀해 주세요.,Korean
+욕창 치료는 아마도 좀 더딜 거예요.,Korean
+간염 치료 병력이 있나요?,Korean
+삼 개월 이전에 무엇으로 입원하셨나요?,Korean
+간염 치료로 복용 중인 약 있어요?,Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+소장에서 대장으로 연결되는 부위에 붙어있는 충수돌기라는 곳에��� 생기는 염증을 의미합니다.,Korean
+"아이 성기 부분이 빨갛고 부어 있어요.
+",Korean
+고혈압을 앓은 경험이 있나요?,Korean
+얼굴뿐만 아니라 다 부으셨네요.,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+음식은 새우 알레르기 있는데 약물은 딱히 없었어요.,Korean
+상해로 입원하신 적이 있나요?,Korean
+"네. 하루에 두 번 이상 토했어요.
+",Korean
+"소변볼 때 피가 섞여 나왔던 것 같은데요.
+",Korean
+수술적 치료 이후 호전 양상에 따라 다를 수 있으나 큰 수술은 아니기 때문에 입원 기간은 길지 않을 것으로 보입니다.,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+몸에 열나는 것 같나요?,Korean
+알레르기 진단받은 연도는 어떻게 되나요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+수술 부위 주변이 같이 아플 수 있습니다.,Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+당뇨약 드시는 거 있으면 말해주세요.,Korean
+아픈 기간은 어느 정도세요?,Korean
+최근 한 달 이내에 투약하고 있던 약이 있으신가요?,Korean
+약물치료 받으시고 시간이 좀 지나면 괜찮아지실 거예요.,Korean
+질병으로 약을 드시고 계시나요?,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+"집에 일이 좀 있었거든요. 그것 때문에 좀 놀라서인지 그 이후로 가슴이 막 콩닥콩닥 뛰고 막 불안해요.
+",Korean
+종교 때문에 수혈이 불가할 것 같습니다.,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+"우리 아기가 정말 잠을 못 자는 거 같아 걱정이에요.
+",Korean
+집먼지 진드기는 항상 생길 가능성이 존재하므로 자주 세탁해 주는 것이 중요합니다.,Korean
+아니요. 위암에는 걸리지 않았습니다.,Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+어디가 제일 많이 붓나요?,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+상처에 물이 닿으면 지체 마시고 바로 병원으로 내원 부탁드립니다.,Korean
+삼사 년 전에 골다공증 검사를 받은 적이 있는데 뼈가 약하다는 이야기는 들었지만 치료할 정도는 아니라고 했습니다.,Korean
+고혈압으로 따로 챙겨 드시는 약 있으세요?,Korean
+더 불편하신 곳이 있나요?,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+통증 양상의 특징점이 있나요?,Korean
+알레르기 중에 음식과 약물 외에 다른 것도 있으세요?,Korean
+붓고 빠지는 주기가 있나요?,Korean
+당뇨약 먹고도 효과가 없거나 하지는 않나요?,Korean
+최대한 수술은 피하도록 합시다.,Korean
+골절이 있거나 심하게 다치신 건 아니신가요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+피가 섞인 소변을 봤나요?,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+목 안이 아프다는 느낌을 받으셨나요?,Korean
+"네. 사실 몸에 그런 증상이 있는지 몰랐어요. 증상 없었어도 되는 거죠?
+",Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+아니요. 있어도 뭐 감기 정도로 끝났는데요.,Korean
+"소화가 잘 안되는 거 같으면서 토하면 시원해질 거 같아서 더 자주 해요.
+",Korean
+"깊게 못 자니 몸이 회복이 잘 안 되는 것 같아요.
+",Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+침상을 보시면 침상 난간이 있는데 이것은 항상 올리시는 게 낙상 예방에 좋습니다. 잘 때는 특히 꼭 올리시고 주무세요.,Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+타이레놀 때문에 증상이 생긴 걸 수도 있습니다.,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+"왼쪽 발이요. 뒤꿈치 쪽에.
+",Korean
+청진하실 때 편안하게 있으시면 됩니다.,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+"네. 한 시간 전엔 약 먹어서 삼십칠 도로 내려갔어요.
+",Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+메밀 들어간 거에 알레르기 있어요.,Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+"제가 원래 화장실 문제가 없었는데 요즘 들어 변비로 일주일을 고생하고 있어요.
+",Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+지금은 산소 수치가 정상이라 산소마스크를 벗기는 하였지만 우선 수치가 정상으로 유지되는지 확인할 필요가 있습니다.,Korean
+아랫배 통증을 호소하시는 분들은 종종 있습니다.,Korean
+"입맛이 없고 기운이 영 없어요.
+",Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+몸이 부을 때가 있나요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+사출성 구토의 원인 중 비교적 심각한 경우가 많습니다. 그 외 다른 형태의 구토 원인도 같이 평가해 보겠습니다.,Korean
+약을 한꺼번에 복용하지 마세요.,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+네 주로 면역력이 생기면 재발 위험도가 줄어듭니다.,Korean
+갑자기 알레르기 반응이 일어나면 기도가 막힐 수가 있거든요.,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+가족 중 유전성 질환을 진단받거나 치료 중인 분 있나요?,Korean
+일 회 주량이 어느 정도죠?,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+환자분의 경우에는 자연스러운 노화현상으로 생각이 돼요.,Korean
+하루 동안 얼마나 피워요?,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+타 병원 기록은 볼 수 없습니다. 부모님이 아실 수도 있으니 물어보고 알려주세요.,Korean
+울렁거리고 토할 것 같이 느껴지세요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+아닙니다. 선천적으로 발생하며 약 십 퍼센트는 가족력을 가지고 있습니다. 남자아기가 여자아기보다 다섯 배 정도 더 많이 발생합니다.,Korean
+어쩌다가 병원에 오게 된 건가요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+구토가 통제되지 않고 뿜어져 나오기 때문에 입 코 구분 없이 나올 때가 많습니다.,Korean
+"계단 내려가는데 발을 헛디뎌서 굴렀는데 어깨를 다친 것 같아요.
+",Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+기침을 얼마나 자주 하나요?,Korean
+옛날엔 안 그랬는데 저번에 타이레놀 먹는데 두드러기 나고 그래서 진료받은 적 있어요.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+"버스 타려고 달려가다가 넘어져서 다리를 다쳤어요.
+",Korean
+몇 년 전에 항암치료 때문에 항암제를 복용했지만 현재는 완쾌해서 안 먹습니다.,Korean
+아버지가 당뇨약 드시고 계세요.,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+급성 정맥류 출혈의 경우 출혈이 멈춘 후 백 명이 있으면 오십 명 내지 육십 명넘게 일 년 이내에 재출혈 발생확률이 높습니다.,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+금연 기간은 빼셔도 됩니다.,Korean
+이번 기회에 담배 한 번 끊어보죠.,Korean
+아프신 이유가 암 때문인가요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+환자분이 복용하고 계시는 약에 대한 정보가 필요합니다.,Korean
+목이 부을 때 가라앉히려면 어떻게 하죠?,Korean
+"일곱 시간 안쪽으로 자는 거 같아요.
+",Korean
+"요새 좀 지속해서 오른쪽 팔다리가 힘이 잘 안 들어가지는 것 같아서요.
+",Korean
+공복 혈당이 백 이상인가요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+구역질이 나면서 피가 올라올 때가 있나요?,Korean
+통증은 얼마나 자주 발생해요?,Korean
+기침 소리가 어떻게 나오나요?,Korean
+연고 처방이 필요한 환부인지 확인해보겠습니다.,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+필요할 경우 피부를 이식하는 수술이 진행될 수 있습니다.,Korean
+네. 혈소판 수치가 모자란다고 하더라고요.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+독감 주사 언제 맞으실 건가요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+저희 병원 입원 경험만 확인 가능합니다.,Korean
+환아 몸무게가 살이 빠지기 전엔 얼마였고 지금은 얼마인가요?,Korean
+통증 양상을 알 수 있을까요?,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+덩어리를 만졌을 때 맥박 뛰는 느낌이 느껴지는지 여쭤보는 것이지 꼭 느껴져야 하는 건 아니에요.,Korean
+두통이 가장 심할 때가 언제인가요?,Korean
+식습관 포함한 생활습관 관리와 지속적인 진료를 받아야 한다는 점에서 크게 다르지 않습니다.,Korean
+"술은 스무 살 될 때 딱 한 달 먹었고 담배는 지금까지 계속 피고 있습니다.
+",Korean
+이천십오 년 여름에 진단받았던 거니깐 벌써 오 년이나 지났네요.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+우선 회전근개파열을 의심하고 있기 때문에 몇 가지 검사가 필요합니다.,Korean
+항암 치료제를 복용 중이신가요?,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+최근에 예방 접종은 따로 받으셨어요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+음식이 소화가 안 된 듯 답답한가요?,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+어디가 제일 많이 붓나요?,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+네. 위내시경은 위 안으로 삽입하는 것이기 때문에 다르다고 볼 수 있습니다.,Korean
+숨 쉬는 게 힘드신가요?,Korean
+"이전에 다리를 다쳤는데 다리가 계속 아파요.
+",Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+아마 타 병원 가셔도 비슷한 가격일 거예요.,Korean
+아이 혼자 병원에 있는 것은 위험하므로 다른 보호자분께서 짐을 챙겨오셔야합니다.,Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+약 성분에 알레르기 반응을 일으키는 게 있었다면 그럴 수도 있겠네요.,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+퇴원 수속 관련 설명을 들으셨다는 동의서입니다.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+내시경 할 때 헬리코박터 검사도 할 수 있나요?,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+두통약보다는 띵한 느낌이 사라지지 않으면 정밀 검사가 필요합니다.,Korean
+어지럽거나 울렁거리는 증상 없으셨나요?,Korean
+체온이 몇도 정도 인가요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+일주일에 몇 갑 정도 흡연하시나요?,Korean
+아니요 배가 아프다거나 하는 증세요.,Korean
+가끔 발생하기 때문에 치료 초반에는 주의하셔야 합니다.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+하루에 담배를 얼마나 태우세요?,Korean
+말초동맥 산소포화도 측정하는 거예요.,Korean
+"눈에 이물질이 들어갔는데 눈이 잘 안 떠져요.
+",Korean
+네 그러면 검사 받기는 어렵고 예약하고 가시면 될 것 같아요.,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+병실에서 커튼 치고 탈의하시면 돼요.,Korean
+두통이 심할 때도 있나요?,Korean
+혈변 주기가 어떻게 되나요?,Korean
+네 삼 개월 후에 수술할 수 있습니다.,Korean
+자연 치아에 비해 기능이 부족한 치아를 확인하려 합니다.,Korean
+보청기 한쪽만 끼고 있어요.,Korean
+가려움 완화 연고를 처방해 드릴 수 있어요.,Korean
+진통제는 약국에서 구매 가능합니다.,Korean
+"기침이 계속 나면서 폐 쪽이 아파요.
+",Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+영 점 오 센티미터 이상이거나 통증이나 혈뇨가 반복되는 등의 증상이 있는 경우 빨리 시술 하는 것이 좋습니다.,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+고혈압약 평소에 드시고 있는 거 있으세요?,Korean
+내과에 저번 주에 아파서 갔었어요.,Korean
+일반적으로 여덟 시간 금식 후 혈당을 측정하였을 때 백이십오 밀리그램 퍼 데시리터 이하로 측정이 될 경우 정상입니��.,Korean
+네. 당 높은 음식 적당히 먹으라고 하셨어요.,Korean
+"몸이 예전 같지 않았는데 갑자기 컨디션이 심하게 다운되어서요.
+",Korean
+약 알레르기 있는 거 있으실까요?,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+혹시 병원 치료비가 얼마인가요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+네 콧줄 때문에 점막이 자극이 되어 그럴 수 있습니다.,Korean
+검사 시간은 어떤 검사를 추가로 하게 되는지에 따라 시간이 달라집니다.,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+보조제를 복용하신지는 얼마나 되셨어요?,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+치아 뿌리가 원래 조금 약하지 않으셨나요?,Korean
+대변에 피가 보인적 있나요?,Korean
+환자분 상태에 따라 다르기 때문에 어깨랑 목이 다 나으려면 얼마나 걸린다고 함부로 말씀드리기가 그렇네요.,Korean
+최근 삼 개월 동안 체중의 변화가 있으셨나요?,Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+가슴 두근거림이나 맥이 빠진 듯한 느낌 어지러움 실신 피로감이 있었던 적 있나요?,Korean
+혈뇨 시 다른 통증은 없었나요?,Korean
+"뱀한테 물려서 바로 왔어요.
+",Korean
+맥박 불규칙해 보이는데 괜찮으세요?,Korean
+검사 결과가 나온다면 환자분의 휴대전화로 안내가 갈 겁니다.,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+신경 눌리는지 확인하는 거예요.,Korean
+어깨 마비를 유발할 수 있는 질병에 대해서 검사해볼게요.,Korean
+고혈압약을 꾸준히 먹고 있어요.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+약간 혈압이 낮은 편인데 혹시 평소에 혈압이 낮다는 얘기를 들으신 적이 있나요?,Korean
+의학적으로 검증되지 않은 경우이긴 해서 염려되어서요. 효과 보셨던 게 어떤 것이었나요?,Korean
+통증이 어느 정도 심해요?,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+카페인 섭취량을 조절하시고 계신 건 좋은 거죠.,Korean
+투 바이 투 사이즈의 거즈를 말합니다.,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+수술을 여러 번 해서 다 일일이 기억 못 해요. 죄송합니다.,Korean
+숨을 쉬기 힘든 때가 있었나요?,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+몸에 안 받는 음식이 있나요?,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+수술 전 미리 혈액을 확보해야 해서 여쭤보는 거지 크게 걱정 안 하셔도 괜찮습니다.,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+네 투약 뒤에 붓기가 있었던 건가요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+"안녕하세요. 오늘 아침에 아들이 침대에서 떨어졌는데 계속 아프다고 해서 왔습니다.
+",Korean
+현재 입원하신 진료과 상관없이 알려주세요.,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+가족 중에 암 판정을 받으셨던 분이 있나요?,Korean
+네. 그 약 맞습니다.,Korean
+"기침 호흡 곤란도 있고요. 심할 때는 가슴이 답답하고 오한도 느껴져요.
+",Korean
+가래는 잘 뱉고 있어요?,Korean
+통원 치료는 감염 위험과 제대로 된 치료 효과를 보장할 수 없습니다.,Korean
+"비위가 약해져서 먹질 못했지.
+",Korean
+간염 치료 이력 말씀해 주세요.,Korean
+여기서는 처음인데 다른 병원에서는 촬영한 적이 없으시나요?,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+회복이 빠르면 이틀 만에 퇴원도 가능하세요.,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+네 재발이 가능한 질환이기 때문에 꾸준한 관리가 필요합니다.,Korean
+보통 이렇게 오래가지는 않지만 환자분은 지금 심각한 상태라 다른 사람들보다 증상이 오래가는 겁니다.,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+잠이 쉽게 오지 않나요?,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+한번 아프기 시작하면 통증이 오��� 지속되나요?,Korean
+언제부터 이 증상이 나타났나요?,Korean
+설사가 시작된 후 날마다 몇 번 정도 다녀오셨는지 알려주시면 더 도움이 됩니다.,Korean
+우선 저희 병원 기록이 없으니 검사를 받아 보고 진단이 내려지면 그때 말씀드리겠습니다.,Korean
+어디가 제일 심하게 아프시죠?,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+손목 터널을 넓히는 수술입니다.,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+조영제 맞아본 적이 없어서 잘 몰라요.,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+할머니가 암 진단을 받으신 것 같아요.,Korean
+구토를 많이 한다면 식도 손상 가능성도 있습니다.,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+평소에 무슨 약 드세요?,Korean
+"통증이 너무 심해서 화장실을 제대로 못가가지고 잘 모르겠네요.
+",Korean
+면역치료 이외에 방법을 모색해 볼 수 있습니다.,Korean
+통증 주기가 어느 정도 될까요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+급성기는 치료가 더 의미를 가지는 시기로 이해하시는 것이 맞습니다.,Korean
+환자가 알고 있는 혈액형과 일치 여부를 확인하는 과정입니다.,Korean
+아니요 약물 알레르기 반응이 있으면 다른 약을 써야죠.,Korean
+중풍이 있으셔서 거동을 전혀 못 하시거든요. 아무래도 일상생활이 전혀 안 되니까 요양원에 계시죠.,Korean
+알레르기 때문에 피하는 음식이 있으세요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+그 나이대와 성별에서는 키와 몸무게가 표준 범위 안에 드시네요.,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+"대변볼 때마다 피가 보여서 화장실 가기 무서워요.
+",Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+최근 들어 아프기 시작했나요?,Korean
+무릎이 아파서 엑스레이 찍고 왔어요.,Korean
+입원 조사 시 내원 방법에 대해 필요하여 물어봤습니다.,Korean
+추적 검사도 저희 병원에서 받기 원하신다면 미리 예약하고 병원에서 검사 시기에 다시 연락드리겠습니다.,Korean
+귀찮으시더라도 병원 규정에 따른 처사이니 이해부탁드립니다.,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+아이가 아프니 얼마나 힘드셨겠어요. 일주일 동안 잘 먹었나요? 토는 안 했고요?,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+네. 제가 영양실조에 잘 걸려서 입원할 때가 있는데 저번 주에 그랬습니다.,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+아니요. 영양상담은 추가 비용 나오지 않습니다.,Korean
+보통 숨쉬기 힘들어하시면 이게 정상수치에서 벗어납니다.,Korean
+콧줄이 불편하시면 간호사를 불러주세요.,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+한번 아프기 시작하면 통증이 오래 지속되나요?,Korean
+"대변은 잘 보던 것 같아요.
+",Korean
+"담배 자체를 너무 싫어해요.
+",Korean
+피가 섞인 대변을 보고 있으신가요?,Korean
+의료법상 특정 병원을 소개해 드리는 것이 금지되어 있어서 곤란합니다.,Korean
+양팔의 운동이 잘 안되거나 감각이 이상했던 적은 없었나요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+과거 검사 결과를 보니 부정맥 진단을 받으셨네요.,Korean
+네. 사출성 구토가 있는 경우 먹은 음식을 소화시키기 어려워 식욕 저하가 함께 동반되기 쉽습니다.,Korean
+"묽고 피가 좀 섞여 있어요.
+",Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+식사 후에만 속이 안 좋으세요?,Korean
+스트레스 받으면 설사 하나요?,Korean
+"한 몇 주 전부터 살이 많이 빠지기 시작해서 얼굴이 야위어가는 게 보였어요. 체중은 오 킬로정도 빠지셨구요.
+",Korean
+환자분이 생각하기에 피부 버짐을 유발하는 요인이 뭐라고 생각하세요? 특정 지을 수 있을만한 것이 있나요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+꾸준히 먹는 약이 있으신가요?,Korean
+담배 피운 기간이 오래되었나요?,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+최대한 손목에 무리가 가지 않도록 휴식을 취하시는 것이 좋습니다.,Korean
+소변을 보고 또 화장실을 가고 싶으신가요?,Korean
+갖고 계신 약 있나요?,Korean
+음주량 좀 알려 줘요.,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+야간근무자들은 대부분 수면 문제를 호소하는 경우가 많습니다.,Korean
+그 이후론 수술 안 했어요.,Korean
+바늘이 들어갈 때 통증을 느끼실 수 있습니다.,Korean
+복부가 많이 무겁게 느껴지나요?,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+담배는 하루에 몇 갑 피시나요?,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+문진에 따라 추가 검사는 없을 수도 있습니다.,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+수술은 한 적이 없는데 한 달 정도 입원 치료한 적은 있어요.,Korean
+이런 증상은 굉장히 흔합니다.,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+그저께 감기 때문에 검사 권유해서 받았어요.,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+네. 생식기 치료는 산부인과에 해당합니다.,Korean
+음주 기간 얼마나 되셨어요?,Korean
+기침이 심할 때는 언제인가요?,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+보통 일주일에서 한 달은 그렇게 유지하는데 수술 끝나고 다음 외래 내원시 의사 선생님이 자세히 말씀해드릴 거예요.,Korean
+혈액 검사 결과 상 칼슘이 너무 많네요.,Korean
+약 제조에 도움이 될 것 같아서요.,Korean
+의심되는 부위를 손가락으로 짚어 보시겠어요?,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+잠을 잘 못 자서 불편한 적이 있으신가요?,Korean
+간염약이 치료에 도움이 됐나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+다행히 아직 아이가 심각한 상태가 아닙니다.,Korean
+"발톱이 안쪽으로 나면서 통증이 심해져서요.
+",Korean
+결핵 치료 이력이 있나요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+진료 후 처방전이 나갈 예정입니다.,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+치료량이 많다 보니 마취크림을 바르더라도 치료 후 통증이 조금 심하실 수도 있습니다.,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+아니요 진통제가 위험한 게 아니라 치료 과정에서 진통제를 투여하겠다는 동의를 받는 겁니다.,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+확인을 해야 정확하게 말씀드릴 수 있겠지만 꽃가루 알레르기 같네요.,Korean
+약은 몇 개월이나 드셨어요?,Korean
+수술 후 입원을 하셔서 회복하시는 것을 권유합니다.,Korean
+"네. 약을 먹는데도 소변이 잘 안 나오는데 왜 그런가요?
+",Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+병원에서 검진 결과 빈혈 있다고 나오더라고요.,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+간염 약 복용 중이십니까?,Korean
+지금 말씀해 주시면 진료 때 큰 도움이 됩니다.,Korean
+소독을 무조건 해야 해요.,Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+결핵 때문에 내원하신 적이 있나요?,Korean
+경우에 따라서는 조직검사 결과를 확인하고 영상검사 등 추가적인 검사 후에 치료 방향을 결정할 수도 있습니다.,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+혈뇨를 보신 지는 몇 일이나 되셨나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+어느 정도로 부기가 심한가요?,Korean
+고통을 느끼신다면 어느 정도의 고통인가요?,Korean
+"금식 시간 알려주신 대로 다 지켜서 왔습니다.
+",Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+수술이 필요할 경우 기간이 늘어날 수도 있으니 지켜보아야 합니다.,Korean
+"가슴 중앙이 조여오듯 통증이 심해요.
+",Korean
+결핵을 앓기 시작한 지 얼마나 되셨죠?,Korean
+의료진이 알아야 할 알레르기가 있나요?,Korean
+간염 ���료 언제부터 받으셨어요?,Korean
+하루에 몇 개비나 피우시나요?,Korean
+현재 증상이 평소 드시던 약이나 음식과 관련이 있습니다.,Korean
+잘 못 주무시는 이유를 알아야 환자분께 필요한 약을 알 수 있습니다.,Korean
+"뛰어가다가 전봇대에 눈을 받았어요.
+",Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+통증이 어떻게 오는지 말해주세요.,Korean
+치아를 씌운 지 오래됐군요.,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+씨티를 좀 더 잘 보이도록 해주는 약물이라고 할 수 있어요.,Korean
+네. 하지만 열이 났기 때문에 혈액검사를 포함한 기본검사는 하시는 것이 좋습니다.,Korean
+외래 예약은 진료예약센터를 통해서 가능합니다.,Korean
+여기가 제일 가까운 병원이라 여기서 했어요.,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+요새 몸이 많이 피곤한가요?,Korean
+"전 치료만 받으면 되는 줄 알았는데 입원을 해야 한다고 그러더라고요.
+",Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+배가 부른 느낌을 가지고 계신가요?,Korean
+어떤 수술 했는지 알려주세요.,Korean
+"아마 사십 년은 넘었을걸요. 하루에 최대 한 갑은 피우는 것 같네요.
+",Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+전체적으로 몸이 무기력해진다고 느껴지세요?,Korean
+환자분께서 불편한 점이 없더라도 이상이 있을 수 있으니 추가 검사가 필요할 것 같습니다.,Korean
+요즘 혹시 두통이 있나요?,Korean
+이전에 진단받으신 이력에 대해서는 문진을 통해 확인해야 하는 부분입니다.,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+항문 출혈의 경우 적은 양으로 나오며 심각한 원인이 아닌 경우가 많습니다.,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+현기증 느낀 적 있나요?,Korean
+수혈을 거부하는 이유가 있을까요?,Korean
+검사를 진행하려면 금식이 준비되 있어야 해서요.,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+네 수술 내내 잠들지 않았다면 부분 마취였을 것 같네요.,Korean
+입원했거나 입원 치료 경험이 전에 있으셨나요?,Korean
+멸균 처리해 놓은 것이 소독 붕대이기 때문에 이 차 감염 예방에 도움을 줍니다.,Korean
+삼 일 동안 하루 두 번 정도 진통제 먹었던 것 같아요.,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+통증이 멈출 때도 있는 건가요?,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+네 혈색이 도는 점막의 색입니다.,Korean
+밤에 잠이 안 온다는 거죠?,Korean
+어떤 음식이나 어떤 경로를 통해 장염에 걸렸는지는 찾기 어려울 것 같습니다.,Korean
+피 소변을 보시진 않나요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+평소에도 간지러운지 얼마나 되셨나요?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+과민성과 관련된 약도 드시나요?,Korean
+네. 열 재고 한번 먹였더니 열 떨어졌어요.,Korean
+네. 동물에게 옮는 질병이 있을 수 있거든요.,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+"머리만 아팠고 다른 데는 다 이상 없어요.
+",Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+"공장에서 일을 하다가 허리를 좀 다쳤는데 나아지는 기미가 없어서 병원에 오게 됐어요.
+",Korean
+결핵 치료는 약으로 하셨나요?,Korean
+"어제저녁에 아이가 놀다가 침대에서 떨어졌는데 아픈지 계속 울어서 병원에 왔어요.
+",Korean
+우측 엉치뼈 부위에 병변이 관찰됩니다.,Korean
+어느 부위가 만지면 아프신가요?,Korean
+매일 흡연량이 어떻게 되세요?,Korean
+생리통 약 빼고는 없습니다.,Korean
+네. 진료상 다 알려주셔야 합니다.,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+"붉어진 뒤로 많이 따가워해요.
+",Korean
+야간 근무자분들은 수면 장애를 비롯해서 다양한 질환에 걸릴 위험이 높아요.,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+언제부터 가슴 통증이 있나요?,Korean
+어느 부위에 통증이 있으세요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+"네. 양쪽이 다 저리고요. 특히 왼쪽은 감각이 없는 것 같아요.
+",Korean
+알레르기 때문에 죽을 정도로 고통스러웠던 적 있나요?,Korean
+"���면 장애 때문에 뒤죽박죽이에요.
+",Korean
+햇빛이 닿으면 장기적인 색소침착이 일어날 수 있습니다.,Korean
+"검색해 보니 기흉이라고 하더라고요.
+",Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+급한 내시경일 경우에는 내시경실에 전화 걸어 급하게 일정을 잡습니다.,Korean
+최근에 몸무게 변화가 있나요?,Korean
+"배가 너무 꼬이듯이 아파서 힘들어요.
+",Korean
+사고당해서 입원한 적 있으세요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+아마 그렇게 말씀하셨으면 종합 감기약을 줬을 것 같습니다.,Korean
+치아 뿌리가 원래 조금 약하지 않으셨나요?,Korean
+그럼 잠깐만 보여주시면 약은 오늘 안에 돌려 드릴게요.,Korean
+현재 당뇨 앓고 계신 분이 있나요?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+수액 지금 떨어지는 것보다 느려져요.,Korean
+네 철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+아니요 그거 제외하고 처방받아서 꾸준히 먹는 약이나 주사있나요?,Korean
+아직 입원 결정된 거 못 들으셨어요?,Korean
+입원 중에는 빠른 회복을 위해 금연하는 것을 권장 드리고 있습니다.,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+네 혹시나 수혈이 필요한 상황이 있을 수 있어 물어보는 거예요.,Korean
+물만 먹어도 설사가 나오나요?,Korean
+"숨 쉴 때마다 목이 따갑고 찌르듯 아픕니다.
+",Korean
+가족 중에 고혈압 환자인 분이 누구셨나요?,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+일단 가장 위중한 질환인 심근경색이 아님을 확인했다고 알고 계시면 됩니다.,Korean
+한 살 이후에도 음낭수종이 지속되는 경우는 대부분 자연적으로 없어지지 않습니다.,Korean
+"기침 소리가 좀 이상해요.
+",Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+틀니도 충분히 흔들거릴 수 있습니다.,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+네 감염력 확인으로 거짓 없이 답변주셔야 합니다.,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+발톱수술은 왜 받으신 건가요?,Korean
+머리가 아파서 내원한 적 있습니다.,Korean
+최근 한 달 이내에 투약하고 있던 약이 있으신가요?,Korean
+배뇨 시 통증이 있고 피가 나오나요?,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+입원 환자 관리를 위한 사항입니다. 그 이외 흉터가 있는지 확인 협조 부탁드립니다.,Korean
+앉아 있을 때에도 통증이 있으신가요?,Korean
+하반신 마취를 위해 척추에 마취약을 투약한 겁니다.,Korean
+소변줄은 바닥에 끌리지 않도록 유의해주시고 방광보다 높게 들지 않도록 해주세요.,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+혹시 휠체어를 가져다드려도 될까요?,Korean
+밤에 잠이 잘 안 오세요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+지금 아픈 게 느껴지실까요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+면역요법은 면역반응을 조절하므로 더 오래 걸릴 수 있습니다.,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+부모님께서 어떤 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+금연 기간은 빼셔도 됩니다.,Korean
+편도를 제거하는 게 가장 확실한 치료가 되기는 하죠. 환자분처럼 편도가 크고 자주 부으면 고생하고 힘드니까 수술을 고려해보는 것도 필요할 것 같네요.,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+평소와 비교해 식욕이 줄지는 않으셨어요?,Korean
+그럼요. 검사를 받을 수 있습니다.,Korean
+알레르기 중에 음식과 약물 외에 다른 것도 있으세요?,Korean
+가족 중 유전성 질환자 계세요?,Korean
+아픈 기간은 어느 정도일까요?,Korean
+암으로 병원 다닌 적 있으세요?,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+장염은 원인에 따라 바이러스성과 세균성으로 나누는데 말씀주신 증상을 종합해 봤을 때는 바이러스성이 더 의심이 됩니다.,Korean
+피를 토할 때 위도 아픈가요?,Korean
+엑스레이 하기 전에는 흡연은 삼가해주세요.,Korean
+혹시 무슨 약인지 확인할 수 있는 방법 없으실까요?,Korean
+통증이 어떤 식으로 느껴��는지 설명해 주실래요?,Korean
+일 회에 오만 원이고 다른 치료도 추가되면 비용은 달라집니다.,Korean
+아이가 움직이면 큰일 날 수 있어 아이들은 보통 전신마취로 진행합니다.,Korean
+피부과 약 처방받은 거 먹고 있어요.,Korean
+소변이 시원하게 나오지 않나요?,Korean
+외래 초음파 검사상 이상 있다는 말을 못 들으셨나요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+항생제 치료 후에도 호전이 없으면 수술적 치료를 고려하겠습니다.,Korean
+"으슬으슬 춥고 기침을 해요.
+",Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+가족 병력에 대해서 여쭙겠습니다.,Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+"그렇게 아프진 않았던 것 같아요.
+",Korean
+요새 약 먹는 걸 자주 잊어버려서 잘 기억이 안 나요.,Korean
+가족 중에 당 수치가 높은 분이 있나요?,Korean
+"아이가 대변볼 때 너무 힘들어해서요.
+",Korean
+발기 부전 증상이 있으세요?,Korean
+환자와 관련해서 안내해 드릴 게 있습니다.,Korean
+"자궁초음파에서 자궁에 있는 혹이 이상하게 보인다고 왔어요.
+",Korean
+이번에 독감 접종 맞으셨나요?,Korean
+"편두통이 자주 와서 병원에 오게 되었습니다.
+",Korean
+특별한 건강상에 문제가 발생하지 않는다면 예정대로 진행할 수 있습니다.,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+"수술 봉합 부위가 붓더니 염증처럼 아파요.
+",Korean
+복부 쪽으로 팽만이 있나요?,Korean
+결핵으로 약 드시고 계세요?,Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+소양감은 간지러운 증상을 이야기합니다.,Korean
+검사를 하시려면 더 큰 병원을 추천하고 싶습니다.,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+결핵 때문에 병원 다닌 적 있으신가요?,Korean
+네. 흉터가 안 남아야 할 텐데.,Korean
+특정 시기에 통증이 생기나요?,Korean
+구토가 일어난 것은 언제부터인가요?,Korean
+네. 항생제 알레르기를 가진 사람이 있어서요.,Korean
+비뇨기과와 협업하여 진료할 수 있도록 도와드릴게요.,Korean
+약은 아침에 드셔야 됩니다.,Korean
+흉터가 덧나지 않게 연고를 잘 바르셔야 합니다.,Korean
+몇 시쯤 피검사 하나요?,Korean
+관련이 있다고 뚜렷히 말씀드리기는 어렵지만 의료기록에 적어두고 참고하겠습니다.,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+"추적 검사 받으러 왔어요.
+",Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+네 당뇨병과 연결되어 문제가 생길 수 있습니다.,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+네. 안약 종류에 대해 설명드릴게요.,Korean
+가족 중 당뇨 환자 있나요?,Korean
+네 물이 차서 무릎을 못 굽히는 거면 무릎 부종입니다.,Korean
+"대학생 때부터 피기 시작했는데 지금 거의 십 년이 다 돼가네요. 하루에 다섯 개비는 기본으로 펴요. 그 이상으로 필 때도 있고요.
+",Korean
+당뇨로 인한 합병증이 나타난 게 있나요?,Korean
+사람의 각질 있는 곳에 진드기가 나타납니다.,Korean
+"혈당이 많이 오른 거 같아요.
+",Korean
+환자분이 어떤 약을 드시는지 파악을 해야 해서요.,Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+"설사가 심해서 탈수증세가 올 때가 있습니다.
+",Korean
+수혈 관련해서는 주치의 상담 할 수 있도록 하겠습니다.,Korean
+예상치 못한 조산 등을 고려해서 미리 분만 한 달 전에 신청하시는 것이 좋습니다.,Korean
+가스가 많이 차도 주변 장기를 누르는 경우는 흔치 않습니다.,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+전자담배 핀 적 있습니까?,Korean
+"무기력증이 예전보다 심해져서 왔습니다.
+",Korean
+특정 음식에 알레르기가 있습니까?,Korean
+환자분의 치료 계획에 따라 변경될 순 있어요.,Korean
+"아랫배에 통증이 약간 있어요.
+",Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+무통 주사 들어가도 아프면 어떡하죠?,Korean
+결핵 진단받으신 지 얼마나 되셨나요?,Korean
+숨 쉴 때 힘들거나 그러진 않으신지요?,Korean
+"엊그제 아침에 일어나자마자 목이 잠겨서 말하기도 힘들고 헛기침할 때마다 통증이 있어요.
+",Korean
+시야가 흐려지거나 소변을 자주 본 적이 있나요?,Korean
+혈액검사와 소변검사가 정상 수치를 벗어나 추가 검사가 필요합니다.,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+몸무게 최근에 재셨더라도 다시 한번 측정할게요.,Korean
+확실한 치료를 원하시면 약물보다 수술을 추천합니다.,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+"여덟 시간은 자는 것 같아요.
+",Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+오한이 있는 것 같나요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+통원 치료는 감염 위험과 제대로 된 치료 효과를 보장할 수 없습니다.,Korean
+속이 더부룩한 적은 없으신가요?,Korean
+기침할 때 피가 터져 나오나요?,Korean
+환자분은 요로결석이 의심되므로 최대한 빨리 받아주셔야 진단에 도움이 됩니다.,Korean
+아픈 게 어느 정도 지속 시간이 있나요?,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+체중 변화가 급격히 일어나면 문제가 있을 확률이 커요.,Korean
+아무래도 정부에서 지원하지 않다 보니 금액이 조금 더 나가는데 충수돌기염은 포괄수가제라서 높은 금액은 나오지 않을 거예요.,Korean
+빈혈이 심하다는 진단을 최근에 받았네요.,Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+토혈이 나타난 건 언제인가요?,Korean
+암을 치료하기 위해 내원하신 적 있으세요?,Korean
+피 소변을 보시진 않나요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+"이십 년 정도 마셨는데 십 년 전부터는 아예 마시지 않아요.
+",Korean
+"아이가 소변보는 걸 불편해해요.
+",Korean
+사고로 수술 받은 적 있나요?,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+발기 부전으로 인해 부부관계에 문제가 있나요?,Korean
+통증이 있는 곳 어디예요?,Korean
+"일어나 운동할 때 호흡이 정말 안 될 정도로 불편해서 오게 됐어요.
+",Korean
+보통 성인 기준으로는 일곱 시간 내지 여덟 시간을 권장하고 있기 때문에 적은 편이라고 볼 수 있습니다.,Korean
+아니요. 지금은 환자분들의 자세 변경 시간이라 조금 곤란합니다.,Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+"왼 발. 왼 발 뒤꿈치요.
+",Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+맨날 파스 붙이고 사는데요 뭘.,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+가끔 위장약 정도 약국에서 사 먹는 정도입니다.,Korean
+"요즘 귀가 가렵고 물집이 잡혀서 왔어요.
+",Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+소변이 나올 때 피가 나오나요?,Korean
+약물 복용으로 치료 가능하세요.,Korean
+조금 기다렸다가 소변 마려우시면 검사 진행하겠습니다.,Korean
+너무 아픈데 주사량 좀 더 늘려주실 수 있어요?,Korean
+"최근에 잠을 정말 못 잤어요.
+",Korean
+육안으로 볼 땐 이상 없으시네요. 기존 피부질환이 있거나 이상 있으셨던 적은 없으셨나요?,Korean
+"요새 좀 지속해서 오른쪽 팔다리가 힘이 잘 안 들어가지는 것 같아서요.
+",Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+얼마나 자주 그런 증상이 있으셨나요?,Korean
+검사 결과를 기다리는 중이니 확인 후 말씀드리겠습니다.,Korean
+스트레스로 인해 심해질 수 있으나 정도가 심하거나 빈도가 잦을 시 자세한 검사가 필요합니다.,Korean
+통증이 언제부터 시작했는지 말씀해주세요.,Korean
+"잠은 잘 잤어요. 기본적으로 여덟 시간은 자니까요.
+",Korean
+당뇨인지 언제 아신 거에요?,Korean
+요로감염이 있을 경우에는 항생제 치료를 해야 합니다.,Korean
+최근 몇 달 동안 체중 변화는 없었나요?,Korean
+병원에 오신 이유 말씀해 주세요.,Korean
+"간암 검사를 해야 할 것 같아서 왔습니다.
+",Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+체온은 정상이에요 혈압이 저혈압이시네요.,Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+보호대 착용은 손목의 움직임을 줄이고 손목터널 내 압력을 줄여주어 신경 압박에 의한 증상을 줄일 수 있습니다.,Korean
+과거에 크게 다친 곳이 있나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+일주일에 몇 번 통증이 있나요?,Korean
+삼 년 정도 전에 잠깐 입원했었어요.,Korean
+신경계통 약 투약 중이죠.,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+맥 빠지는 느낌이 드나요?,Korean
+"세 달 전에 친구가 스스로 목숨을 끊었어요. 저는 친구가 힘든지도 모르고 그렇게 보내버린 게 너무 죄책감이 들어요. 아직도 친구 생각이 나서 밤에 잠을 못 이뤄요. 요즘에는 친구가 자꾸 꿈에 나타나서 잠들기도 힘들어요.
+",Korean
+성형수술 중에 저희가 알아야 하는 게 있을 수도 있으니 말씀해주세요.,Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+"상처가 나서 피가 나고 부어올라서요.
+",Korean
+머리가 띵한 느낌이 있나요?,Korean
+"생선 뼈가 목에 걸려서요.
+",Korean
+네. 대부분 약물 치료로 가능하고 일부 시술이 필요할 수도 있습니다.,Korean
+앓고 있는 병 있나요?,Korean
+대장 내시경보다 덜 불편하고 시간도 짧게 걸립니다.,Korean
+몸에 붓기는 좀 빠지셨나요?,Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+"죄송하지만 단백질 위주로 해 주세요.
+",Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+오늘 병원에 방문하신 이유가 어디 때문인가요?,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+귀에서 멍한 소리가 나나요?,Korean
+체온이 몇 도인지 아세요?,Korean
+"며칠째 고열이 안 떨어져서 왔어요.
+",Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+처방이 언제 나올지 궁금합니다.,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+네 탈장 가능성도 있습니다.,Korean
+최근 들어서 몇 개월 동안 급격히 체중 변화가 있었나요?,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+안녕하세요. 김지현님! 수술하고 잘 지내셨나요?,Korean
+수술받은 곳 통증은 어때요?,Korean
+"오른쪽 왼쪽 다 부은 거 같은데요.
+",Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+어떤 약 처방 받으셨어요?,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+하루에 보통 얼마나 피우세요?,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+언제부터 메슥거리는 느낌이 시작됐죠?,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+급성기는 지금 치료가 필요한 단계로 이해하시면 됩니다.,Korean
+피를 토했을 때 양은 어느 정도였나요?,Korean
+투석 진행 후 신기능이 호전을 보이면 투석하지 않을 수 있습니다.,Korean
+"아니요. 침만 삼켜도 아픈 것 같아요.
+",Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+약 말고 다른 알레르기는 없나요?,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+아직은 회복 상태이니 조금만 더 쉬시면 될 겁니다.,Korean
+"네. 이것저것 해보고 있는데 잠이 잘 안 오는 건 매한가지네요.
+",Korean
+의사 진료 후에 상담 가능하십니다.,Korean
+통증이 어떤 식으로 느껴졌는지 설명해 주실래요?,Korean
+고혈압인 것을 안 게 언제부터죠?,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+종교적인 이유 때문에 수혈을 거부하시는 분들도 계십니다.,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+심장이 두근거리고 빨리 뛰나요?,Korean
+부은 증상이 어디에 나타났나요?,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+그렇죠 환자 상황에 따라 치료 방법을 달리하면서요.,Korean
+비뇨기과를 찾아보신 적은 있으신가요?,Korean
+혈변 주기가 어떻게 되나요?,Korean
+가슴이 답답하거나 아픈 적이 있으신가요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+검사 결과는 일 이 주 정도 소요됩니다.,Korean
+"애가 열이 많이 올랐는데 나을 기미가 보이질 않네요. 한 번 봐주세요.
+",Korean
+복통이나 복부팽만이 없다면 지켜볼 수 있습니다.,Korean
+소변줄이 걸리는 곳이 있는지 제가 잠시 보겠습니다.,Korean
+소화불량에 대한 원인 확인이 필요하겠습니다.,Korean
+"소변 냄새가 고약해서 가족들이 제가 화장실에 간 다음 화장실에 안 가려고 해요.
+",Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+들어 마시고 내쉬는 심호흡을 해주셔야 합니다.,Korean
+결핵약은 어떤 거 드시고 있으세요?,Korean
+밤에 잠이 안 온다는 거죠?,Korean
+흡연 기간 동안 잠시 끊으셨던 기간이 있나요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+독감 맞는데 또 뭘 적어요? 알레르기는 없습니다.,Korean
+남성의 경우에는 전립선 비대증이 전립선 출혈의 원인일 수 있습니다.,Korean
+피가 섞인 소변이 나오나요?,Korean
+초기에 잘 치료하는 것이 중요하니 매일 오세요.,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+네. 부모님 쪽에서 폐가 좋지 않다고 조심해야 한다고 했어요.,Korean
+네 드시고 계신 약 포함해서 전부 말씀해주세요.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+다행이네요. 지금 피 검사할 건데 시술이 잘돼서 췌장이 잘 기능하는지 보기 위해 하는 거예요.,Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+백신 주사 맞은 거 있나요?,Korean
+어느 부위에 통증이 있으신가요?,Korean
+"아침에 하품을 하다 턱에서 딱 소리가 나고 아파서 왔어요.
+",Korean
+안구 질환 관련 약 먹는 중입니다.,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+헌혈은 해당 안 돼요.,Korean
+살을 뺄 수 있게 도움을 드리겠습니다.,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+통증을 말로 어떻게 표현할 수 있나요?,Korean
+꾸준히 약을 복용하시고 발라야 빨리 낫습니다.,Korean
+평소 소화가 잘 안 되나요?,Korean
+조금이라도 의식이 남아있다면 주변에 빠른 도움을 요청하세요.,Korean
+토할 것 같은 느낌이 오나요?,Korean
+대변볼 때 피가 보이나요?,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+부종으로 어떤 상황이 일어날지 모르니 전부 제거해 주세요.,Korean
+"서서히 살이 빠지고 예전보다 식사량도 줄었다고 하셨어요.
+",Korean
+소변볼 때 피는 안 나왔어요?,Korean
+힘드시겠지만 수술이 잘되기 위함이니 협조 부탁드립니다.,Korean
+"건강과 거리가 먼 편이었죠.
+",Korean
+진료 잘 하시는 의사 선생님 있는 병원으로 해주세요.,Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+시술이 안전하게 시행되면 큰 문제가 발생하는 경우는 드뭅니다.,Korean
+앞서 말씀드렸지만 대부분 생활습관이 고지혈증의 원인이 됩니다.,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+대장암 걸린 적 있습니다.,Korean
+먹은 음식물을 다 토하나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+오늘 코로나 검사 결과 나올 때까지 마스크는 벗지 않으실께요.,Korean
+갑자기 주위가 빙빙 도는 증상도 있으신가요?,Korean
+흡연 여부는 필수 정보입니다.,Korean
+간염 검사 관련 양성인가요?,Korean
+네. 앞으로도 금연할 생각이 있으시다면 중요합니다.,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+통증 유무 확인 부탁드려요.,Korean
+"물도 잘 못 삼키겠어요.
+",Korean
+주로 어디가 가장 아프세요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+통증이 생기면 얼마나 가나요?,Korean
+대변을 못 본 지 ��래되셨나요?,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+악화되면 진행속도가 빨라질 수도 있습니다.,Korean
+체온을 한 번 재볼게요.,Korean
+심계항진이 있거나 그러진 않으신가요?,Korean
+네. 걱정하지 마세요. 암은 아니에요.,Korean
+담배는 몇 년 피웠어요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+흉부에 불편한 곳이 있나요?,Korean
+얼마나 자주 기침이 나오나요?,Korean
+헬리코박터균 감염 여부는 검사를 해야 합니다.,Korean
+"소변은 다른 때에 비해 소변 색이 진했어요.
+",Korean
+뱉은 가래 색이 어떤가요?,Korean
+수면제는 먹어 본도 없어요.,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+저희 병원엔 비뇨기과가 없어서 다른 시술과 처치를 받기 원하시면 다른 병원으로 가셔야 됩니다,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+스트레스와 같은 환경적 요인 식습관 흡연 여부 등 다양한 원인이 있습니다.,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+검진 이후에 또 몸 상태가 달라졌을 수도 있어서 재차 검사가 필요합니다.,Korean
+통증 발현 빈도가 어떻게 되세요?,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+얼굴이 빨간데 몸에서 열이 나나요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+"오른쪽 다리 쪽이 제 마음대로 안 되는 것 같은데요.
+",Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+수술은 약해진 근막 주위로 인공 막을 대주는 거고 전신마취로 진행합니다. 수술 시간은 한 시간 정도이고 자세한 수술 설명은 입원하시는 날 다시 해드릴게요.,Korean
+피부연고를 바른 뒤로 발진이 일어났어요.,Korean
+암 치료 이력이 있나요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+허리 통증 때문에 몸 쓰는 일은 전혀 할 수가 없어요.,Korean
+네. 감염에 취약한 상태이니 상당히 주의해 주셔야 합니다.,Korean
+피로감은 어느 정도 심한가요?,Korean
+하루에 피는 양이 어떻게 돼요?,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+자세한 건 검사 결과를 봐야 알 수 있습니다.,Korean
+원래 병원으로 가기엔 너무 아픈데. 대기 시간 긴가요?,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+소변보는 횟수는 어떤가요? 평소보다 자주 보시나요?,Korean
+저희 아버지가 간암을 앓았네요.,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+변에서 피를 보신 적이 있나요?,Korean
+검사 결과를 기다리는 중이니 확인 후 말씀드리겠습니다.,Korean
+간호사실 앞에 휠체어는 항상 있습니다. 언제든지 사용하세요.,Korean
+아니요. 먼저 의사와 상담 후 계획을 정해 보는 게 좋습니다.,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+가래는 주로 어느 시간에 많이 나오나요?,Korean
+소변볼 때 잘 안 나오나요?,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+처음 치료 받을 때에는 일주에서 이주 약 복용을 합니다.,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+최근에 수술 언제 받으셨나요?,Korean
+"소변 때문에 화장실 갔는데 안 나오는 경우도 있었어요.
+",Korean
+"성기 부분에 가려움증이 있고 약간 물집이 잡혔어요.
+",Korean
+방귀가 나오지 않는 자체는 문제될 것이 없으나 복통이나 복부 팽만이 있다면 장 운동 장애나 장폐색 가능성도 고려해 볼 수 있습니다.,Korean
+"배탈이 난 것 같아요.
+",Korean
+소변볼 때마다 피가 나오나요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+분만방법에 따라 후유증이 다르기 때문입니다.,Korean
+소변을 잘 못 보시나요?,Korean
+보통 이런 경우에는 혈압은 조절하지 않고 장기간 지속되거나 다른 질환을 불러올 경우 조절합니다.,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+혈압이 좀 있는 편이신가요?,Korean
+초음파 외에는 일반적인 검진 정도의 검사가 이뤄집니다.,Korean
+알레르기 반응을 보였던 대���이 있다면 말해주세요.,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+드시면 안 되는 음식이 따로 있나요?,Korean
+평소 소화가 잘 안 되나요?,Korean
+드시는 약은 어떤 것들이 있을까요?,Korean
+약품 의뢰하고 여분 없으면 처방해드릴게요.,Korean
+간 이식 수술받고 약물 중이에요.,Korean
+뱉은 가래 색이 어떤가요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+식염수인데 상처 부위를 소독할 겁니다.,Korean
+간호사실은 병원 지도를 참고하세요.,Korean
+몇 분마다 수축이 느껴지시나요?,Korean
+아니요. 담당 선생님에게 확인 후 추가로 진통제를 놔드리도록 하겠습니다.,Korean
+알레르기 약 매일 복용하고 있어요.,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+호르몬 변화 때문에 그럴 거예요.,Korean
+"윗배가 살살 아픈 게 한 번 시작되면 꽤 오래가요.
+",Korean
+몸이 부은 적이 없으신가요?,Korean
+원래 디스크가 있어서 튀어나온 디스크를 지지는 수술을 했어요.,Korean
+시술이 안전하게 시행되면 큰 문제가 발생하는 경우는 드뭅니다.,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+혈뇨 시 다른 통증은 없었나요?,Korean
+식염수인데 상처 부위를 소독할 겁니다.,Korean
+네 연고만 따로 처방할 수는 없습니다.,Korean
+오늘 중에 수술 관련 준비하실 거 추가 안내드릴게요.,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+특이 혈액형이 뭐죠? 처음 들어봐요.,Korean
+집안에 당뇨 환자 있나요?,Korean
+아닙니다. 선천적으로 발생하며 약 십 퍼센트는 가족력을 가지고 있습니다. 남자아기가 여자아기보다 다섯 배 정도 더 많이 발생합니다.,Korean
+소변 색이 붉은빛이 도나요?,Korean
+제가 이틀 후는 안 되는데 이틀마다 소독 받아야 하면 어떡해요?,Korean
+통증에 동반된 다른 증상이 있을까요?,Korean
+음주 빈도는 어느 정도인가요?,Korean
+"세 달 전에 친구가 스스로 목숨을 끊었어요. 저는 친구가 힘든지도 모르고 그렇게 보내버린 게 너무 죄책감이 들어요. 아직도 친구 생각이 나서 밤에 잠을 못 이뤄요. 요즘에는 친구가 자꾸 꿈에 나타나서 잠들기도 힘들어요.
+",Korean
+발기 부전 문제가 있네요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+성생활에 어려운 점이 있으세요?,Korean
+가족이 앓았던 질환에 대해 알고 계신 거 있으시면 말씀 부탁드리겠습니다.,Korean
+숨이 찬 증상이 나타납니까?,Korean
+몸에 붓기는 차도가 있나요?,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+머리가 띵한 느낌이 있나요?,Korean
+구역질이 날 때가 있나요?,Korean
+다른 가족분들 중에 유전성 질환 환자가 있나요?,Korean
+에이엘티 수치가 얼마나 되죠?,Korean
+통증이 오는 곳이 있나요?,Korean
+녹색 변의 경우 음식물 때문인 경우가 많지만 경우에 따라서는 감염성 질환이 원인이기도 합니다.,Korean
+네. 팔 년 전에 당뇨로 입원했었습니다.,Korean
+그 부분은 간호사분이 아실 듯한데요.,Korean
+집 먼지 진드기는 사람들이 사는 곳 어디든 존재한다고 보시면 됩니다.,Korean
+"그러다 치질 걸리면 더 골치 아프죠.
+",Korean
+복용 중인 약 있으면 말해주세요.,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+음식이나 약물 알레르기 있으세요?,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+별로 아프진 않은데 간혹 조영제 들어가는 팔이 뻐근할 수는 있어요.,Korean
+"매일 유산균 먹고 있어서 배변 활동은 아무 문제 없습니다.
+",Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+"아이가 대변볼 때 너무 힘들어해서요.
+",Korean
+통증이 어떤 형태로 옵니까?,Korean
+비타민도 수면질에 영향을 주지만 그 이외 수면을 방해하는 요소가 있을까요?,Korean
+"삼 개월 정도 된 것 같은데 갑자기 숨이 가빠지고 숨을 내뱉고 들이마시는 게 잘 안 되더라고요. 그땐 자주 있지 않아서 별 대수롭지 않게 생각했었는데 요새는 제가 주체할 수 없을 정도로 호흡곤란이 오고 그러고 나면 온몸에 진이 빠지고 아무것도 할 수 없게 돼서 오게 되었습니다.
+",Korean
+"계속 어지럽고 지금도 계속 토할 거 같아요.
+",Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+"임신 삼십육 주차인데 갑자기 하혈이 나와요.
+",Korean
+간염약을 드시고 부작용이 있으신가요?,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+양상이 버짐이 아니여서 조직검사 시행해 보겠습니다.,Korean
+수술 중 과다출혈의 경우 수혈을 해야 할 수도 있습니다.,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+치료가 늦어질 시 합병증으로 인해 향후 삶의 질에 영향을 미치게 됩니다.,Korean
+제일 처음 통증을 느꼈던 게 언제인가요?,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+진물 등이 차기 때문에 주기적으로 붕대를 갈고 소독해주어야 합니다.,Korean
+도대체 어디가 아픈 거예요?,Korean
+암 증세가 시작된 건 언제부터인가요?,Korean
+통증이 한 번씩 오나요?,Korean
+"요새 화장실 가기가 좀 어려워요.
+",Korean
+지금 아픈 곳 말하세요.,Korean
+"열 때문인지 새벽에 계속 깨서 보채더라고요.
+",Korean
+"손가락이랑 손바닥이 같이 아플 때가 있어요.
+",Korean
+"아직까지 그런 증상들은 없었어요.
+",Korean
+제가 외과 쪽으로도 문제가 있나요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+네 카페인 과다 섭취는 건강에 좋지 않아요. 카페인 의존을 줄이셔야겠어요.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+그리고 면역력 저하 외에 다른 원인들도 있습니다.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+고유량 산소법은 환자의 흡기 시의 최고 유량에 필요한 전체 가스 유량을 공급함으로써 지속적인 흡입 분율을 제공해 산소를 투여합니다.,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+결핵 증상이 있었던 게 언제부터죠?,Korean
+수술받은 적 있으면 알려주세요.,Korean
+할머니가 암 진단을 받으신 것 같아요.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+통증이 월 단위로 있나요?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+지금 아픈 곳이 있으세요?,Korean
+혈변 주기가 어떻게 되나요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+"예. 오른쪽 팔이랑 오른쪽 다리도 힘이 떨어지셨어요.
+",Korean
+외관상으로는 초기지만 혹시 교액이 생긴 경우에는 도수정복 시 염증이 생길 수 있습니다.,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+입속에 있는 모든 기관들을 구조물이라 칭합니다.,Korean
+인간에게 옮는 동물의 질병은 치명적일 수 있습니다.,Korean
+배뇨 곤란이 언제부터 있었는지 궁금하네요.,Korean
+정확히 어떤 원인으로 바이러스성 설사가 발생했는지는 알기 어려울 수 있습니다.,Korean
+약물 복용 중인 거 있으신가요?,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+아직 다 낫지는 않았습니다.,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+"목이 부은 느낌이 나고 침 삼킬 때마다 아픕니다.
+",Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+체온은 정상인데 혈압은 조금 높아요.,Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+"한쪽 눈이 황달이 돼서 왔습니다.
+",Korean
+아이가 편안하게 숨 쉴 수 있도록 앉은 자세로 두세요.,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+다양한 질환이 복통과 오한을 동반할 수 있어서 검사가 필요합니다.,Korean
+각갑류 알레르기가 있다고 하셨어요.,Korean
+식욕이 떨어지신 것 같나요?,Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+통증 느껴지는 곳 짚어보세요.,Korean
+절대 간 적 없어요.,Korean
+"어제 저녁 때부터 갑자기 왼쪽 가슴이 쥐어짜듯이 아파서 왔어요.
+",Korean
+속이 좋지 않은 증상은 있으셨어요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+"수면 패턴은 아홉 시에서 열 시 사이에 잠들어서 다섯 시 정도에 일어나요. 자장가를 안 불러 주면 잠을 안 자서 꼭 불러주고 있습니다.
+",Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+네 저희가 흡연력 같은 환자분의 생활 습관도 파악하고 있어야 합니다.,Korean
+괜찮지만 고혈압은 유전적으로 발생하기에 한 번 검사를 받는걸 추천합니다.,Korean
+정확한 확인을 위해 검사를 진행하겠습니다.,Korean
+아니요. 병실로 이동한 후 담당 선생님의 확인 후 물을 드실 수 있습니다.,Korean
+네. 꾸준히 약 복용만 잘한다면 조기에 치료할 수 있습니다.,Korean
+감염 예방을 위해서라도 반드시 입원이 필요합니다.,Korean
+술 드시고 배가 아프셨나요?,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+폐경 증상을 파악하기 위함입니다.,Korean
+배에 있는 대동맥이 늘어지고 커져서 만져지네요.,Korean
+흡연 한지 오래 되셨나요?,Korean
+혹시 최근에 결핵이나 갑상선 질환을 진단받으신 적이 있나요?,Korean
+일상생활이 가능하려면 최소 일주일은 입원해서 회복하셔야 합니다.,Korean
+수술하시는 부위 주변으로 표시합니다.,Korean
+네 진통제 때문에 그런 현상이 올 수 있어요.,Korean
+통증 유무 확인 부탁드려요.,Korean
+환자복이랑 침구 제공해 드려요.,Korean
+하루에도 여러 번 환부를 체크해야 하니 매일 오셔야 합니다.,Korean
+"잘 때 숨쉬기가 힘들어서 자꾸 깨서 왔어.
+",Korean
+통증이 한 번씩 오나요?,Korean
+결핵 치료를 받기 시작한 것은 언제부터였나요?,Korean
+부정맥이 약간 있으시다고 들었어요.,Korean
+통증의 정도가 어떻게 되나요?,Korean
+몇 살 때부터 피우셨나요?,Korean
+소화불량에 대한 원인 확인이 필요하겠습니다.,Korean
+상처 크기와 깊이에 따라 다르므로 경과를 지켜보다 말씀드리겠습니다.,Korean
+어떤 다른 알레르기가 있으신가요?,Korean
+특정한 것에 알레르기가 있나요?,Korean
+당은 잘 관리 되고 있나요?,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+몇 살 때부터 피우셨나요?,Korean
+선천성 기형이나 후천성 기형이나 상관없이 그냥 기형이라면 무조건 말씀해 주세요.,Korean
+환자 이름은 오나영이에요. 약은 여기 가져왔어요.,Korean
+제대혈 은행에 보관해야 하므로 최소 분만 일주일 전에 알려주세요.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+네 그것 포함하여 다른 입원 경험이 있는지도 알려주세요.,Korean
+아무래도 관절이 아프다 보면 스스로 움직이는 게 무의식적으로 덜 하게 되죠.,Korean
+광견병 주사는 매년 맞혀야 하는 걸로 알고 있는데요.,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+병원에서 처방 약 어떤 거 받으셨어요?,Korean
+상처에 된장을 바르는 요법 같은 거요.,Korean
+간헐적으로 아픈가요? 지속적으로 아픈가요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+자녀 모두 제왕절개로 낳으신 건가요?,Korean
+심장 박동이 불규칙하게 뛰는데 괜찮으세요?,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+피부나 다른 곳에 알레르기가 생긴 적이 있나요?,Korean
+약 가져오는 건 언제쯤 가능할까요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+"수면 장애는 없고 피부가 좀 예민한 편이에요.
+",Korean
+경구 당 부하 검사에서 두 시간 후 측정한 혈당 수치가 이백 밀리그램 퍼 데시리터 미만인 경우입니다.,Korean
+"네. 담배 안 피우고는 못살 정도로 중독됐어요.
+",Korean
+통증이 성기 오른쪽만 있다는 건가요?,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+알러젠은 알레르기를 일으키는 것을 말합니다.,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+저는 제 혈액형 오에이치형으로 들었어요.,Korean
+증상 판별과 검사를 통해 알 수 있습니다.,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+"""수술 부위의 청결을 유지하고, 회복을 촉진하기 위해서는 배액관 적용 후 지속적인 관리가 필요합니다.""",Korean
+네. 마취 풀리고 바로 움직였었거든요.,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+네. 의사 선생님이 처방해 주셨어요.,Korean
+"비타민 한 개 먹었어요.
+",Korean
+간염 판정은 언제 받았나요?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+독감 주사 말고는 없어요.,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+네 그런 증상이 있으셨나요?,Korean
+"일주일에 한두 번 체한 ��처럼 소화가 잘 안됩니다.
+",Korean
+저번 달에 병원 검사에서 당뇨로 나왔습니다.,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+"일주일 전에 테니스 하다가 땅을 세게 짚어서 그런 것 같아요.
+",Korean
+입원 치료 혹은 수술받으신 적이 있으면 말씀해 주세요.,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+비타민 정도만 먹는 중이에요.,Korean
+코 입술 잇몸 등의 모양에 변형이 오면 바로잡기 위해서 합니다.,Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+말씀드렸다시피 약 성분이 겹치게 되면 복용량을 넘어서요.,Korean
+"갑자기 알 수 없는 흉통이 있었어요.
+",Korean
+"생리통이 심한 편인데 얼마 전에 하혈을 좀 했어요. 생리 전 증후군도 심해서 괴롭고요.
+",Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+공복 혈당이 백 이상인가요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+치료받아야 하는 다른 질병이 있으신가요?,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+목 아픈 건 나으셨어요?,Korean
+꼭 해야 하는 건 아니지만 알레르기 유무 확인을 위해서 권장하고 있습니다.,Korean
+처방받은 진통제는 복용하셔도 됩니다.,Korean
+"여기 밑에 이빨 어금니요.
+",Korean
+마비의 전조증상일 수 있습니다.,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+예방 접종한 거 혹시 있으면 알려주세요.,Korean
+아뇨. 복용하지 않고 있습니다.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+어떤 부위에 국소마취를 하셨나요? 수술하신 건가요?,Korean
+혹시 모를 감염을 예방하기 위해서 되도록 일회용 구매하셨다가 퇴원하실 때 버리고 가시는 걸 권유해드리고요.,Korean
+"가슴 여기가 많이 아파요.
+",Korean
+소화불량 때문에 평소 생활이 힘드셨나요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+"요새 속이 너무 안 좋아서 왔어요.
+",Korean
+"우선 한 시간 이상 푹 자기가 어렵더라고요.
+",Korean
+심장 박동이 빠르고 두근거리나요?,Korean
+"소변이 밝은 노란빛을 띠고 있었어요.
+",Korean
+그래도 내시경으로 돌이 잘 제거되어야 퇴원하실 수 있으시잖아요. 조금만 힘을 내세요.,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+오한이 있는 것 같나요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+네 흔하지 않은 종류의 위염입니다.,Korean
+최근 구토한 적 있으세요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+"어깨가 아파서 응급실 왔는데 탈골이라고 해서요.
+",Korean
+심호흡을 안 하시면 폐 깊숙이 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+혈뇨는 언제 처음 보셨나요?,Korean
+네 입원경로 여쭤본 거예요.,Korean
+속이 쓰리는 느낌은 없나요?,Korean
+큰일이 나는 건 아닌데 약물 부작용 위험이 있어요.,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+"묽은 토가 자꾸 나와요.
+",Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+토할 것 같은 느낌이 있으신가요?,Korean
+처방되는 약을 꾸준히 드신다면 통증이 호전되실 것입니다.,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+등에 알레르겐을 찔러서 확인하는 피부 반응 검사가 있습니다.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+비염이나 아토피 천식 같은 알레르기 질환을 가지고 계시나요?,Korean
+아직 검사 몇 개가 남아서 검사 다 받으시고 주무셔도 되세요.,Korean
+담배 피우신 기간이 얼마나 되나요?,Korean
+"안녕하세요. 요즘에 속이 너무 좋지 않고 배도 아프고 토도 하루에 두 번씩 해서 왔어요.
+",Korean
+코로나 때문에 물어보는 겁니다.,Korean
+수술한 후에 후유증이 있나요?,Korean
+"엑스레이를 찍었는데 폐에 이상이 있다고 해서요. 조직 검사받으러 왔어요.
+",Korean
+결핵 진단받으신 게 언제죠?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+피부 가려움 양상이 어떻게 나타나시나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+정확하게 진단을 하고 치료를 하려면 혈액 검��를 진행하셔야 합니다.,Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+설사를 얼마나 자주 하시나요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+암인 거 언제 아셨나요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+어떤 약을 드시고 계신지 말씀해 주실 수 있으세요?,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+치료하기 전에 환자의 정보들을 알아야 합니다.,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+"손발이 저리고 잘 안 구부러져요.
+",Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+아까 이름 호명 했는데 진료실 들어가지 못하셨나요?,Korean
+당뇨 측정을 해 보셨나요?,Korean
+통증이 일 분 넘게 지속했던 적이 있나요?,Korean
+보통 십 회 정도 치료합니다.,Korean
+환부보다 넓게 그리고 두껍게 발라줘야 해서 연고가 많이 필요합니다.,Korean
+"대변이 이틀에 한 번 나올까 말까 합니다.
+",Korean
+발기 부전 때문에 많이 스트레스이신가요?,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+마취하고 수술한 건 두 번 이요. 작년에.,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+면역치료라는 게 좀 무서워요.,Korean
+"벌에 쏘인 후로 호흡이 어려워요.
+",Korean
+가족 중 당뇨 환자 있나요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+어긋나거나 골절된 뼈가 폐를 찔러 기흉이 생기지 않는 이상 수술 같은 특별한 치료는 없습니다.,Korean
+"얼굴에 황달이 심해서 와봤어요.
+",Korean
+"열을 재 보진 않았는데 열은 없었고 식은땀이 좀 났어요.
+",Korean
+"소변을 하루에 한 번 정도밖에 안 봐서 방광염 걸릴까 봐 걱정이에요.
+",Korean
+"뭘 잘못 먹은 건지 배를 붙잡고 계속 아파하길래 왔어요.
+",Korean
+제일 덜 오는 통증 부위가 어디예요?,Korean
+언니가 작년에 유방암 수술을 받았어요.,Korean
+무엇 때문에 병원에 왔나요?,Korean
+네. 하지만 열이 났기 때문에 혈액검사를 포함한 기본검사는 하시는 것이 좋습니다.,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+식은땀을 동반한 오한이 있으세요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+확실하게 알기 위해서는 대장조영술이나 항문직장내압검사를 해봐야 합니다.,Korean
+최소 여덟 시간 이상은 금식해 주셔야 합니다.,Korean
+"여기 안쪽 어금니에 있어요.
+",Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+"검사해야 정확한 걸 알 수 있다고 하던데요.
+",Korean
+지금 아픈 곳이 있으세요?,Korean
+술을 한 달에 몇 번이나 자주 드세요?,Korean
+가슴이 답답하고 속이 더부룩한가요?,Korean
+대장 내시경은 대장 전체를 보는 검사라면 직장 내시경은 직장과 에스 상 결장까지만 관찰하는 검사입니다.,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+산소 수치가 정상이어서 안 쓰셔도 됩니다.,Korean
+네. 결핵이랑 연결이 되어 문제가 됩니다.,Korean
+음식 알레르기 앓은 적 있어요?,Korean
+전국 어느 병원에 가더라도 사전에 책정된 동일 진료비를 내도록 하는 제도인데 대상은 백내장 편도 맹장 탈장 항문 자궁 제왕절개가 있어요.,Korean
+네. 이전에 기침이 심해서 병원에 갔더니 결핵이라더군요.,Korean
+"학생 때부터 계산해 보면 음주는 팔 년 흡연은 칠 년입니다.
+",Korean
+집에서는 꼭 가습기 틀어주시고 건조하지 않게만 하시면 괜찮을겁니다.,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+네 여러 가지 결과가 있으니 내원해서 상세한 결과는 알려 드리겠습니다.,Korean
+알레르기 나는 상황 알려주세요.,Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+병동으로 올라오실 때 걸어오셨나요 혹은 휠체어나 다른 수단을 이용하셨나요?,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+머리가 자꾸 빠져서 탈모약을 처방받아 먹긴 했었어요.,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+담배 시작하신 게 언제예요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+소화가 잘 안 되는 느낌이 드나요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+"소변볼 때 아랫배 쪽이 통증이 있습니다.
+",Korean
+평소 잠이 안 와서 수면제 먹는 중입니다.,Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+항암 치료한 지 얼마나 되었나요?,Korean
+"제가 소변까진 체크를 못 했네요.
+",Korean
+네 재채기는 코의 신경이 자극을 받아서 나오는 것입니다.,Korean
+정확한 수술부위는 전공의 선생님이 수술동의서 작성할 때 설명해 주십니다.,Korean
+항암 치료제를 복용 중이신가요?,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+지금도 물리 치료 받고 있어요.,Korean
+전원을 가게 되면 전원 가신 병원에서도 다시 진료를 보셔야 하고 그에 따른 비용이 발생하실 수 있습니다.,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+네. 결핵 여부도 알려주세요.,Korean
+네. 종양성 병변인 선종이 확인되어 이후 대장 내시경 추적 검사가 필요합니다.,Korean
+머리는 다른 과에서 검사 받아 보셔야겠어요.,Korean
+온몸에 기운이 빠지는 느낌인가요?,Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+폐기하실 약은 약국에 가시면 됩니다.,Korean
+네. 우선 검사는 이 정도 진행해 보고 결과에 따라 추가적인 검사도 고려해 보도록 하겠습니다.,Korean
+"위에서 떨어지는 물건을 잡으려다가 놓치면서 다쳤어요.
+",Korean
+살모넬라나 대장균 등 세균에 의한 장염과 바이러스성으로 나눌 수 있는데 세균성 장염은 훨씬 더 아프고 혈변 등을 동반할 수 있습니다.,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+피를 입으로 뱉은 적이 있나요?,Korean
+네. 약 효과를 떨어뜨릴 수 있어서 안 드시는 게 나을 것 같아요.,Korean
+네 약 복용만 잘 한다면 치료할 수 있습니다.,Korean
+코로나 때문에 어디를 갈 엄두가 안 나서 올해에는 집과 회사만 오가고 있어요.,Korean
+"목 쪽이 건조해서 긁으면 상처가 나고 뭘 발라도 낫질 않아요.
+",Korean
+알레르기 일으키는 원인 있나요?,Korean
+온몸에 기운이 없다고 느껴지나요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+가슴 통증이 어느 때 자주 나타나요?,Korean
+수면제 복용을 먼저 권하진 않고요 잘못된 수면 습관을 파악해야 합니다.,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+네. 지금 상태로 봐서는 테라마이신 연고가 많이 필요할 거로 보입니다.,Korean
+확실하게 알기 위해서는 대장조영술이나 항문직장내압검사를 해봐야 합니다.,Korean
+"결혼하면서 금연하기로 했었는데 육아하면서 종종 가끔 피워요.
+",Korean
+배 아플 때 화장실 가도 대변이 잘 안 나오시나요?,Korean
+보호대는 원내 약국에 가시면 구매하실 수 있습니다.,Korean
+어제 저녁부터 금식을 하셨다면 검사 진행에 있어서는 더 바람직합니다.,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+올해 독감 예방 주사는 어떻게 하셨어요?,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+국소 마취만 해도 된 데서 그렇게 했어요.,Korean
+"생리 양이 많아져서 검사받으러 갔더니 자궁근종이라고 그래서요.
+",Korean
+"어제저녁부터 열이 펄펄 나서요.
+",Korean
+치료량이 많다 보니 마취크림을 바르더라도 치료 후 통증이 조금 심하실 수도 있습니다.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+"열도 조금 나고 목이 아파요.
+",Korean
+"하루에 세 번 정도 설사해요.
+",Korean
+"선생님 아기 고환이 이상해요. 색깔도 어두워지고 고환이 세 개가 되었는데 이거 심각한 거 아닌가요?
+",Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+"탄수화물 줄이려고 밥 안 먹고 닭가슴살 한 덩이 먹어요.
+",Korean
+처방이 아직 안 났어요.,Korean
+오분 전후로 걸리��� 거고 혈압이 조금 이상하다고 판단되면 재검사 하실 수도 있어요.,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+네 마스크 착용이 중요합니다.,Korean
+소변을 볼 때 피가 보이나요?,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+중추 신경계 통증을 둔화시키는 대신 간혹 어지러울 수 있습니다.,Korean
+두통이 있어서 병원에 다녀왔어요.,Korean
+통증이 한번 오면 얼마나 지속되나요?,Korean
+어떤 음식 먹을 때 소화가 잘 안 되나요?,Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+"삼 년 정도 흡연했습니다.
+",Korean
+며칠 전에 감기 앓았던 것 말곤 없어요. 그것도 거의 다 나았고요.,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+갑자기 일어나면 어지러움이 있어요?,Korean
+검사 결과가 나오면 담당 선생님께서 설명할 겁니다.,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+"강아지한테 물려서 긁히고 찍히고 피도 나고 그래요.
+",Korean
+심호흡 계속하니까 머리가 핑 도는 느낌이에요.,Korean
+네 욕창이 나은 후에도 재발하지 않도록 주의해 주세요.,Korean
+소 대변검사는 뭐 때문에 하는 거예요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+"치질은 걸려 본 적 없어요.
+",Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+"아기가 다리 사이 사타구니 근처에서 이상한 게 만져져서요.
+",Korean
+알레르기의 원인 물질을 말합니다.,Korean
+"수면시간은 평소보다 훨씬 적죠. 요즘은 세 시간 자도 많이 잔 건데요.
+",Korean
+"병원에서 간 수치가 높다고 큰 병원 가래서 왔어요.
+",Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+낯선 동네에 있던 내과라 이름이 잘 기억이 안 나네요.,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+무슨 일이 생기면 여기 침상 위에 있는 간호사 호출 벨을 누르세요,Korean
+병원에 방문하시게 된 원인이 뭐라고 생각하시나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+그러니까 사출성 구토는 뭔가 먹자마자 바로 나오는 구토를 말합니다.,Korean
+저는 방역수칙을 잘 지키는 시민이라 그런 곳 안 가요.,Korean
+아프기 시작한 게 언제부터였죠?,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+표준 이차 치료제는 네 종류입니다.,Korean
+산소마스크를 오래 쓰고 있으시면 코와 목 등이 건조해지고 감염의 위험이 증가합니다.,Korean
+가족 중 고혈압을 앓는 분이 있나요?,Korean
+입원했던 적이 몇 번일까요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+두통 때문에 잠들기 어렵지는 않나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+"오늘 아침에는 좀 덜 아픈 것 같더니 얼마 안 가서 다시 아프더라고요.
+",Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+아픈 부위를 가리켜 보세요.,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+"지방이 좀 많고 혈당도 높고. 안 좋단 얘기 많이 들었습니다.
+",Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+통증이 몇 분마다 오나요?,Korean
+아닙니다. 움직였을 때 통증 부위의 통증 정도를 확인하는 거예요.,Korean
+시술 어떤 것 받으셨나요?,Korean
+가래 특징을 말씀해 주세요.,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+혹시 예전에 지속적인 치료를 받은 병이 있나요?,Korean
+"네. 상처 난 듯이 아파요.
+",Korean
+술을 얼마나 드시고 있으신가요?,Korean
+자궁경부암 주사 및 비형간염 등이 있습니다.,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+짠 걸 드시면 붓기가 평소보다 심할 수 있습니다.,Korean
+네 이 상처는 완전히 낫기 전까지는 통증이 있을 거예요.,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+그렇습니다. 영양 상담이 필요하신 것 같아요.,Korean
+언제부터 결핵으로 병원 다니셨죠?,Korean
+검사 장면��� 보는 것이 쉽지는 않겠지만 보호자분들의 협조 없이 의료진만으로 검사를 하면 아이가 더 힘들어하는 경우가 많습니다.,Korean
+환자분 몸 상태를 더 잘 이해하기 위해 필요합니다.,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+통증이 있는지 알고 싶어요.,Korean
+당뇨 약 복용하고 계신가요?,Korean
+"밥 먹다 목에 뭐가 걸린 거 같고 불편해서 왔어요.
+",Korean
+"얼굴 근육에 장애가 있는 것 같아서요.
+",Korean
+측정 결과 이상 없으셔서 다시 재실 필요는 없는데 원하시면 그렇게 해드릴까요?,Korean
+"글쎄요. 아픈 이후로 붕대를 계속 감아둬서 딱히 모르겠어요.
+",Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+목에 인후통 증상이 있나요?,Korean
+가족 중 암이 있으신 분 있을까요?,Korean
+신경 안정제를 처방받아 먹은 지 반년쯤 돼 갑니다.,Korean
+소변볼 때 잘 안 나오나요?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+혹시 고혈압 관련해서 약 드시고 있으세요?,Korean
+통증 느낀 지 며칠 됐죠?,Korean
+매일 혈압을 재고 있나요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+아니요. 아차차 영양제를 먹고 있긴 한데 그것도 약물에 속하나요?,Korean
+대장에 감염이나 염증이 있을 시 동반될 수 있는 점액성 물질입니다.,Korean
+지금 측정 가능하세요 환아 몸무게는 이쪽으로 오셔서 측정하시면 됩니다.,Korean
+"외래 진료 때 교수님이 제거 수술 빨리 해야 한대요. 그래서요.
+",Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+호흡이 조금 가빠 오면 간호사 선생님께 말하세요.,Korean
+양쪽 통증이 차이가 많이 나나요?,Korean
+제가 장이 좀 예민한데 회가 장에 안 좋나요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+아니요 수액은 따로 놓지 않고 약을 드리고 있어요.,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+네. 이 동네에서 제일 진료 잘 보는 병원으로요.,Korean
+"한 시간도 안 돼서 자꾸 소변이 마렵다고 하시더라고요.
+",Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+진통제 처방은 해드리는데 대부분 안 드시고 견딜 만하다고 하시더라고요.,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+그런 약은 어디에도 없습니다.,Korean
+지금 아토피 치료받고 있어요.,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+"일주일 전에 테니스를 쳤는데 넘어지려고 해서 땅을 한 번 세게 짚고 나니 그때부터 찌릿찌릿 거하면서 아팠어요.
+",Korean
+하루에 담배 몇 갑 정도 펴요?,Korean
+검사를 통해 원인을 찾아봐야 합니다.,Korean
+불면증 치료받아도 잘 못 주무시나요?,Korean
+씨티 검사 확인 후 응급으로 시술 또는 수술을 요할 경우 금식이 길어질 수 있습니다.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+환자복과 병상에 침대. 이불. 베개입니다.,Korean
+틀니로 인해 흔들리는 치아 말입니다.,Korean
+통증은 움직일 때마다 오나요?,Korean
+씨티 찍어서 환자분의 내부 상태를 보는 게 좋겠어요.,Korean
+"아니요. 제 남편이 담배 많이 피워서 지금 아프거든요. 저는 절대 안 필 거예요.
+",Korean
+잠이 안 오는 이유가 무엇인가요? 그걸 알려주시면 필요한 약이 무엇일지 알 수 있습니다.,Korean
+한약 외에 다른 약 드시는 건 없나요?,Korean
+동네 병원도 무관하지만 당분간 상처가 어느정도 치료될 때까지는 상태를 보기위해 저희 병원으로 내원하시는 걸 추천 드립니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+지금 처치를 잘해야 예후가 좋으니까 치료에 전념하겠습니다.,Korean
+네 손과 피부에는 많은 세균이 있기 때문에 긁으면 상처가 생기면서 세균이 들어가 염증을 유발할 수 있습니다.,Korean
+담배 하루에 몇 갑 피나요?,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+"하루 다섯 시간 자는 듯한데요?
+",Korean
+기본정보를 상세히 알면 진단과 치료에 있어 도움이 되기 때문입니다.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+치료받아야 하는 다른 질병이 있으신가요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+"방광 쪽으로 출혈이 있다고 들었던 것 같은데요.
+",Korean
+입원 방법을 아는 게 도움이 되는데 혹시 확인할 수 있는 방법 없으신가요?,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+작년 말에 폐 질환이 있어서 일주일 입원했었죠.,Korean
+불편하신 증상은 언제부터 일어났나요?,Korean
+"교통사고가 나면서 이를 꽉 깨물었더니 턱이 아프고 움직임이 부자연스러워요.
+",Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+"걸을 때 발목이 너무 아파요.
+",Korean
+열이 나면 해열제 치료를 하고 감염 조절을 할 것입니다.,Korean
+척주 전방 전위증이 있어서 도수치료받고 있어요.,Korean
+일단은 약물치료와 주사 치료를 병행해서 진행하도록 하겠습니다.,Korean
+내원 중에는 빠른 회복을 위해서 금연을 권장하고 있습니다.,Korean
+"잘 때 머리가 너무 아파요.
+",Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+치열 확인을 위해서 엑스레이 촬영을 했어요.,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+조영제를 사용하면 드물게 부작용이 있지만 거의 없다고 봐도 됩니다.,Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+"진한 갈색 변으로 조금씩 나오더니 마지막엔 거의 장이 비었는지 방귀만 나오는 식이었어요.
+",Korean
+다른 아픈 곳은 없으신가요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+쉬고 계실 때에도 심장 박동이 빨랐나요?,Korean
+고환이 복막을 통과해 음낭의 위치로 내려오면 복막이 닫혀야 하는데 이 것이 닫히지 않으면 이를 통해 탈장이 됩니다.,Korean
+대변볼 때 피가 묻어나나요?,Korean
+첫째는 자연 분만을 하신 거에요?,Korean
+"수면 시간 전혀 안 지켜지는데요.
+",Korean
+유전성 질환으로 고생하는 가족이 계신가요?,Korean
+아니요 복용 중인 약 이름을 알아야 해서요.,Korean
+검사 결과는 다음 주에 나옵니다. 예약 잡아드릴까요?,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+전신 마취에 대한 부작용이 없으셨는지 해서요.,Korean
+"전 허리 아파서 무거운 거 안 들어요.
+",Korean
+어제 치과 진료 받았어요.,Korean
+네 지금 환자분 상태가 입원을 꼭 해야 하는 상황이라서요.,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+요즘 이용하신 병원을 알아야 하거든요.,Korean
+현재까지 유전성 질환 진단받은 분이 있나요?,Korean
+통증 정도가 심하시면 진통제 처방해드릴까요?,Korean
+앞으로도 이렇게 혈압 측정은 좀 힘드실 수도 있어요 참고하시고 너무 힘드시면 지금 잠깐 쉬었다 할까요?,Korean
+"네. 왼쪽 손가락 다 그래요 근데 지금 이거 때문에 일상생활하는 게 좀 어려워졌어요.
+",Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+"며칠째 열이 나고 있어서 왔어요.
+",Korean
+"혈당이 많이 오른 거 같아요.
+",Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+병원에서 처방받아서 먹는 약은 없으세요?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+갑작스러운 체중 증가가 있나요?,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+네. 자연분만이에요. 왜 그러시죠?,Korean
+그래도 한 달 이내면 진료가 불가능합니다.,Korean
+얼마나 자주 술을 드세요?,Korean
+네. 진통제밖에 없어서 다른 거 먹고 싶어도 진통제만 복용했어요.,Korean
+소화가 안 된 건가요?,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+"혈변은 이번에 처음 누는 거 같아요.
+",Korean
+평소에 변비 증상이 있으신가요?,Korean
+환자의 질환을 파악해야 되기 때문이죠.,Korean
+결핵 예방 접종을 지금 하셨나요?,Korean
+수액 바늘 위로 테이프 하나만 더 붙여 주세요.,Korean
+하루 흡연량이 얼마나 되는데요?,Korean
+혹시 촬영 중에 구토가 날까 봐 그러거든요.,Korean
+통증 지속력이 어느 정도인가요?,Korean
+네. 평소대로 호흡을 하면 폐가 완전히 펴지지가 않기 때문에 마취 가스의 배출이 더뎌질 수도 있습니다.,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+배가 부푼 것 같이 느껴지세요?,Korean
+흡연 한지 오래 되셨나요?,Korean
+꽃가루로 인한 계절성 알레르기를 앓은 적이 있나요?,Korean
+혈액에 중성지방 농도가 정상 기준보다 높은 것입니다.,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+다른 알레르기 상황 다 설명 부탁해요.,Korean
+혈압은 환자분의 상태에 따라서 계속 달라질 수도 있으니 너무 걱정하지 않으셔도 됩니다.,Korean
+"왼쪽 팔다리에 문제가 있는 것 같아요. 힘이 쫙 퍼지는 느낌이 계속 있습니다.
+",Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+조영제 검사가 아니면 씨티는 일반 엑스레이 촬영과 비슷해요 기계만 다르지.,Korean
+아직 다 낫지는 않았습니다.,Korean
+현재도 천식 관련하여 약물치료 중이신가요?,Korean
+속이 토할 것 같고 그러진 않나요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+소화 기능이 안 좋으세요?,Korean
+네 삼 개월 후에 수술할 수 있습니다.,Korean
+그렇다면 환자분은 유당 불내증이 있으 실 것 같네요. 다른 음식으로 칼슘을 보충하는 게 좋아요.,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+"소변은 문제없이 누고 있어요.
+",Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+혈압 관련하여 질병은 없으신가요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+최소 일주일은 입원하시길 권유드립니다.,Korean
+십 분 뒤에 수술 진행하겠습니다.,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+네 비타민을 드시는 이유가 있으신가요?,Korean
+"아픈 건 딱히 없는 것 같습니다. 단지 어깨가 빠졌다는 느낌에 놀라곤 하는데 원래 각도로 되돌려 놓으면 다시 들어오는 느낌을 받습니다.
+",Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+"손목 무릎 등 관절들이 아픕니다.
+",Korean
+검사를 받기까지 시간이 조금 걸릴 수 있는데 괜찮으신가요?,Korean
+"볼이 부어서 아픈 데 검사받고 싶어요.
+",Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+지금 위험하진 않은데 열이 지속된다면 위험할 수도 있어요.,Korean
+네. 큰 이상 없다고 하시더라고요.,Korean
+"아 제가 오른쪽 어깨가 요 며칠 계속 아파서 왔어요.
+",Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+소변의 정상 경로를 막는 겁니다.,Korean
+제 판단으로는 삼 개월 때 수술하는 것이 시기상 가장 적절합니다.,Korean
+간 염증 수치가 높으신가요?,Korean
+기능성 소화불량이 맞다면 소화를 도울 수 있는 약물 치료를 하겠습니다.,Korean
+최근에 독감 주사 맞으셨나요?,Korean
+대변을 보고나면 휴지에 피가 같이 묻어있나요?,Korean
+드셔도 되지만 익히지 않은 해산물은 몸에 해로울 수 있습니다.,Korean
+네 보호자에게도 설명 후 서명할 동의서가 있습니다.,Korean
+처방받고 드시는 약 있나요?,Korean
+비후성 위염과 비슷한 모습을 가진 다른 질환들이 있어 필요시 이에 대한 감별진단이 필요할 수 있습니다.,Korean
+입으로 피 토한 증상 있나요?,Korean
+오한이 있는 것 같나요?,Korean
+"아이가 눈이 뒤집히고 몸을 떨어서요.
+",Korean
+고혈압약이 많이 도움 됐나요?,Korean
+아픈 증세를 얘기해 보세요.,Korean
+과거 수술 여부 말씀해주세요.,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+혈압약을 아예 먹지 않습니다만.,Korean
+구급차 타고 오셨는지 해서 여쭤봤습니다.,Korean
+"팔 봉합 부위가 문제가 있어요.
+",Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+배의 어느 부위가 아프시죠?,Korean
+약물 알레르기는 없고 꽃가루 알레르기가 있어요.,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+종양 있었던 가족이 있으신가요?,Korean
+네 전화 후에 약품명 알게 되면 알려주세요.,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+수술 준비 들어가셔서 지금은 못 오세요.,Korean
+네. 하지만 열이 났기 때문에 혈액검사를 포함한 기본검사는 ��시는 것이 좋습니다.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+"하루 일곱 시간 수면은 그대로지만 중간에 깨니까 잘 잔다고 볼 수 없죠.
+",Korean
+알레르기가 나는 음식이 있으시다면 알려주시겠어요?,Korean
+모든 부위에서 통증이 발생하긴 하지만 마취 크림 도포 후 진행하기 때문에 덜하실 거예요.,Korean
+"혈뇨면 정확히 증상이 어떻죠?
+",Korean
+"변비가 상당히 심해서 늘 약을 먹어요.
+",Korean
+"""설사를 유발하는 특정 음식이나, 환경 요인이 있나요?""",Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+"오른쪽 귀가 간지럽고 귀 뒤쪽 피부가 그래요.
+",Korean
+도대체 어디가 아픈 거예요?,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+분유를 통해 영양소를 골고루 섭취할 수 있습니다.,Korean
+중환자들이 많아서 진료 대기가 길다는 말씀이신가요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+네. 오늘도 정상 수치가 나왔고요 약 먹는 거 혹시 몰라서 가져와 봤어요.,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+변비약도 유형에 따라 달라서 다른 약을 섭취해 보시겠어요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+어느 부위에 통증이 있어요?,Korean
+"머리가 깨질 듯이 아파서 왔어요.
+",Korean
+변비의 정도에 따라 변비약의 효과가 적게 느껴질 수도 있습니다.,Korean
+흡연 시작하신 지 얼마나 되셨어요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+우리 몸을 보호해주는 피부에 상처가 난 것이기 때문에 상처로 외부의 균들이 침입하게 되면 감염될 수 있으니 주의해주세요.,Korean
+아니요 최근 한 달 이내에 복용한 약 모두요.,Korean
+틀니 제외 남아 있는 치아를 말씀드린 거예요.,Korean
+통증이 자주 생기는 편인가요?,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+일주일에 몇 번 음주하세요?,Korean
+진통제만 뺀 거라 처방 받은 약은 다 드셔야 합니다.,Korean
+몸에 안 받는 음식이 있나요?,Korean
+퇴원 안내문 읽어보시고 혹시라도 기재 되어있는 증상이 생기거나 불편하신 점이 생기면 척추센터 외래 혹은 응급실로 오시면 됩니다.,Korean
+"깨진 유리를 처리하다가 베였어요.
+",Korean
+이전에 혈액형 검사 하신 적 있으신가요?,Korean
+입원 수속 후에 질병의 완화를 위한 치료 경험이 있으신지 여쭙는 겁니다.,Korean
+수면 비용은 내시경 검사와 달리 건강보험이 적용되지 않기 때문입니다.,Korean
+네 아니면 지금 혈액 검사받으시겠어요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+네 구토나 구역감 또는 호흡 곤란 등의 증상이 나타날 수 있습니다.,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+영양을 고려한 식단으로 식사 하시나요?,Korean
+입원 중에는 빠른 회복을 위해 금연하는 것을 권장 드리고 있습니다.,Korean
+네. 약에 너무 의지하시면 안 돼요.,Korean
+"금연했는데 술 마시면 한두 개비 피우게 되더라고요.
+",Korean
+"이 주 정도 스트레스를 많이 받아서 그런지 어지럽고 가슴이 답답하고 숨이 막히고 해서 왔습니다.
+",Korean
+확진이면 격리 후 진료를 진행해야 합니다.,Korean
+가족들 중에 유전질환으로 고생하는 사람 있나요?,Korean
+배가 부글거리는 경우가 있나요?,Korean
+수술은 잘 끝난 걸로 알고 있어요. 너무 아프시면 진통제 놔 드릴까요?,Korean
+집 안에 있어도 가족들 간 전염력이 있으므로 성실히 답변 부탁드립니다.,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+처방되는 약을 꾸준히 드신다면 증상이 호전될 겁니다.,Korean
+네. 대대로 고혈압이 있어요.,Korean
+현재 구토 증상이 있나요?,Korean
+이 년전에 허리 수술하고 나서 이 주정도 입원했었어요.,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+어느 부위에 통증이 심한가요?,Korean
+입원 당일에 어떻게 이동하셨는지 여쭤보는 거예요.,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+"화장실 가면 오래 앉아 있어야 되니까 변비가 맞는 거겠죠?
+",Korean
+변이 묽게 나오는 정도인가요?,Korean
+요새 몸이 많이 피곤한가요?,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+"귀 안 말고 이 겉에 부분들이 간질간질하고 수포가 있는 것 같아요.
+",Korean
+제일 염려되는 증상이 뭐죠?,Korean
+당분간 상처가 어느 정도 치료될 때까지는 상태를 보기 위해 저희 병원으로 내원하시는 걸 추천드립니다.,Korean
+통증이 지속 되면 응급 체외충격파나 더블제이 삽입술 등이 필요할 수 있어요,Korean
+육안으로 볼 땐 이상 없으시네요. 기존 피부질환이 있거나 이상 있으셨던 적은 없으셨나요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+"속이 더부룩하고 토할 것 같은 느낌이 있어요.
+",Korean
+담배 처음 핀 게 언제예요?,Korean
+치료가 늦어질 시 합병증으로 인해 향후 삶의 질에 영향을 미치게 됩니다.,Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+하루에 보통 얼마나 피우세요?,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+두드러기 등 알레르기 일으키는 성분 아시나요?,Korean
+이차 감염을 막기 위해 쓸 겁니다.,Korean
+나이가 어려 흉터가 옅어질 가능성도 있습니다.,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+혹시 뜨거운 곳에 오래 있었거나 사우나를 하지는 않으셨나요? 생각보다 많이 올라와서요.,Korean
+네 필요하면 피검사도 진행 예정입니다.,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+검사를 먼저 진행하고 이후 자세히 설명해 드리도록 하겠습니다.,Korean
+평소에 숨이 안 쉬어질 때가 언제인가요?,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+소변에 피가 많이 나오셨나요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+아니요. 수술 일정이 다 잡혀있어서 변경 가능한 시간이 없습니다.,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+체온이 떨어진 것 같나요?,Korean
+"죄송하지만 단백질 위주로 해 주세요.
+",Korean
+흡연 시작하신 지 얼마나 되셨어요?,Korean
+병원비랑 관련된 상담은 어디서 받을 수 있을까요?,Korean
+아픈 증상을 자세히 말씀해 주시면 처방하겠습니다.,Korean
+검사 결과 상에도 문제가 있으니 식단 조절을 하셔야 해요.,Korean
+위 주름이 오밀리미터 이상으로 두꺼워진 것으로 위 점막 전체가 두터워져 있지는 않습니다.,Korean
+"근 이 주 동안 이유 없이 갑자기 숨이 막히고 질식할 것 같고 가슴이 아팠어요. 어지럽기도 했고요. 처음에는 몸에 문제가 있나 해서 내과에서 심전도도 찍어보고 여러 검사들을 했는데 몸에는 아무런 문제가 없다고 하더라고요. 진료를 맡았던 선생님이 정신과적 문제일 수도 있으니 적절한 치료자를 찾아 상담을 받아보는 게 어떻겠냐고 권하셨고 그래서 오게 되었습니다.
+",Korean
+진통제는 약국에서 구매 가능합니다.,Korean
+네 치주가 안 좋아지면 치아를 충분히 지지해주지 못해 흔들릴 수 있습니다.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+며칠 주기로 통증이 왔다가 사라지나요?,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+"하루 다섯 시간 자는 듯한데요?
+",Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+결핵 약 지금도 드시나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+속이 쓰려서 제산제 먹었어요.,Korean
+당뇨가 심해서 합병증까지 생겼습니다.,Korean
+질병으로 약을 드시고 계시나요?,Korean
+"갑자기 밥 먹다가 이가 뚝 부러져 버렸네요.
+",Korean
+목이 부을 때 가라앉히려면 어떻게 하죠?,Korean
+네 빼고 촬영해야 씨티 화질이 좋아요.,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+통증이 있는 부위가 어디죠?,Korean
+"소변 때문에 화장실도 자주 가는데 갔다 오면 덜 싼 거처럼 찝찝해요.
+",Korean
+오한을 느꼈는지 알려 주세요.,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+오래 앉아있어도 똥이 잘 안 나오나요?,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+"배가 아픈 것 같은데 이유를 알 수 없어서요.
+",Korean
+수술 후 이 주간은 외출하기 힘드십니다.,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+배에 묵직한 통증이 있나요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+왜 ��핵 약을 중단 하셨나요?,Korean
+진통제만 뺀 거라 처방 받은 약은 다 드셔야 합니다.,Korean
+주사 약제에 의해 혈당이 오를 수 있고 주사치료를 자주 반복할 경우 쿠싱증후군 발생 위험이 있습니다.,Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+설사를 하신 경험이 있나요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+네 체중 변화가 빨리 올 경우 몸에 피해가 있을 수 있습니다.,Korean
+약을 투여하고 통증이 완화되어도 병원에 들려야 한다고요?,Korean
+괜찮습니다. 혹시 약 외래 처방받은 거 드시는 중이신 건가요?,Korean
+맥박은 아까 따로 재셨나요? 어차피 오래 걸리지 않으니 다시 한번 잴게요.,Korean
+"네. 기침을 너무 오래 해서 왔어요.
+",Korean
+"따뜻한 목욕을 하거나 다른 방법으로 잠을 유도해요.
+",Korean
+담배를 몇 년 만에 끊은 건가요?,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+"아파서 병원 간 적도 없어요.
+",Korean
+지금 치료 중인 다른 질환이 있나요?,Korean
+스트레스 완화에 좋은 약은 없어요.,Korean
+시술 부위가 멍들거나 부종이 생길 수 있구요. 검사하다가 심정지 등의 응급상황이 발생할 수도 있습니다.,Korean
+네. 겨울에 독감 예방주사 맞았어요.,Korean
+통증이 있는 이유에 대해서 신체검사와 몇 가지 검사를 해 보겠습니다.,Korean
+전자담배 핀 적 있습니까?,Korean
+언제부터 그 증상이 나타났나요?,Korean
+현재 환아 몸무게 알려주세요.,Korean
+혹시 소변에 피가 나왔나요?,Korean
+고혈압과 관련하여 받은 치료는 모두 알려주세요.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+첫 번째 마취 크림으로 부족할 경우 추가로 마취 크림을 발라 드리겠습니다.,Korean
+"허리를 펴면 날카로운 통증이 느껴져요.
+",Korean
+변비약 어떤 걸 드셨나요?,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+내원하시게 된 이유가 무엇인가요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+"앉기 힘들 정도로 허리가 아파요.
+",Korean
+"네. 자려고 하면 잠이 안 와요.
+",Korean
+"혼자 병원에 오기가 힘들어서요.
+",Korean
+전문의 선생님은 야간에는 부재중이라 일단 통증 억제 치료를 받으시고 내일 아침에 진료를 받으실 수 있도록 해드릴게요.,Korean
+저희가 드리는 약을 복용하시는 게 좋을 것 같습니다.,Korean
+어떤 재료로 만든 한약인지 알 수 있을까요?,Korean
+고려대 병원으로 알아봐 주세요.,Korean
+머리가 좀 아팠는데 그건 늘 있는 편두통이었어요.,Korean
+배변 활동에 어려움이 없으시면 안 드셔도 됩니다.,Korean
+아까는 수술 부위만 체크했습니다.,Korean
+목요일에는 해당 교수님이 휴진이셔서 다른 날에 진료받으셔야 합니다.,Korean
+"열은 삼십칠 도 정도로 아침에 살짝 있었어요.
+",Korean
+요즘 혈변 보신 적이 있으신가요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+가족 중에 과거에 암 치료받으셨던 분 있어요?,Korean
+의사 처방 없이 임의 복용하는 건 위험합니다.,Korean
+담배는 몇 살부터 피우기 시작한 거예요?,Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+피를 입으로 뱉은 적이 있나요?,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+항생제는 퇴원하시고 일주일 정도 드셔야 해요.,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+숨 쉴 때 힘드신가요?,Korean
+결핵 때문에 아직도 고생이신가요?,Korean
+발열이 난 적이 있어요?,Korean
+오 년 전에 교통사고가 나서 여기 뼈가 금이 갔었어요. 수술은 안 했지만.,Korean
+주로 어디가 자주 붓나요?,Korean
+염증성 장 질환이라면 면역억제제를 사용하기도 합니다.,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+구토를 언제 한 적 있나요?,Korean
+한 달 전에 해외에서 돌아와서 자가 격리하고 왔습니다.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+측정은 보통 경험하셨던 것과 같이 이루어집니다 먼저 혈압부터 어떻게 측정하는지 설명드릴게요.,Korean
+통원치료를 꼭 하셔야 한다면 어쩔 수 없지만 댁에서 계속 소독하고 붕대 자주 갈아주셔야 합니다.,Korean
+가족분들 중에 고혈압 진단을 받은 분이 계시나요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+호흡곤란이 온 적 있으신가요?,Korean
+화상 부위에 균이 감염되지 않도록 멸균한 붕���를 씁니다.,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+나중에 생기면 또 항생제를 바꿔야죠.,Korean
+그렇군요 통증 세기가 어떻죠? 일에서 십까지 강도를 나타내 주세요.,Korean
+설사를 하는 시기가 있나요?,Korean
+앰뷸런스에서 병상으로 이동할 때 어떻게 하셨나요?,Korean
+"와이프가 약을 많이 삼켰는데 의식이 안 돌아와요.
+",Korean
+"붓기가 사라지지 않고 오래가요.
+",Korean
+소변볼 때 통증이 있나요?,Korean
+체온이 떨어진 것 같나요?,Korean
+구역감이 심하시면 촬영 중이라도 손을 드시기 바랍니다.,Korean
+동네 병원도 무관하지만 당분간 상처가 어느정도 치료될 때까지는 상태를 보기위해 저희 병원으로 내원하시는 걸 추천 드립니다.,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+네. 지금 아픈 곳과 상관없이 지금까지 모든 입원 경험 말씀해 주세요.,Korean
+"몇 달 전부터 숨이 턱턱 막히고 숨을 쉴 수가 없을 것 같다는 느낌이 있었거든요. 처음엔 별일 아니겠거니 했는데 요새 들어서 자주 그런 증상이 있어서 검색해봤더니 공황장애 뭐 이런 게 아닌가 싶어서 와봤습니다.
+",Korean
+과거에 크게 질병을 앓은 적이 있나요?,Korean
+수면제 안 드시곤 잠을 못 주무세요?,Korean
+통증이 어떤 형태로 옵니까?,Korean
+다른 환자분의 수술이 예정되어 있어 수술 시간을 앞당길 수가 없습니다.,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+"네. 구토 이외엔 괜찮아요.
+",Korean
+진료받으러 산부인과 온 건 처음이에요.,Korean
+배에 가스가 차서 힘드신가요?,Korean
+하루에 두 갑은 피우세요?,Korean
+"생리를 안 한 지 너무 오래돼서 왔어요.
+",Korean
+상처가 큰 부위에 항생제 효능을 주기 위해 테라마이신 연고를 바르는 겁니다.,Korean
+투 바이 투 사이즈의 거즈를 말합니다.,Korean
+고혈압인 걸로 알고 있어요.,Korean
+혈액검사 결과는 확인 후 이상 소견이 있을 시 설명드리겠습니다.,Korean
+진료가 많이 지연되어 기다리시기 힘드시죠? 조금만 기다리면 설명해주실 겁니다. 검사 결과 설명 후에 퇴원 진행해드려도 괜찮을까요?,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+"생각해보니 배변은 힘든데 약 먹으면 괜찮아요.
+",Korean
+네. 여드름이 너무 심해서 약 먹으면서 치료했는데 효과는 별로 없었어요.,Korean
+식사 여부와 상관없이 검사는 진행됩니다.,Korean
+일 회에 오만 원이고 다른 치료도 추가되면 비용은 달라집니다.,Korean
+어떨 때 구토를 하나요?,Korean
+타이레놀인가? 그런 비슷한 이름이었어요.,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+수술 동의서 받을 때 자세히 설명드리겠습니다.,Korean
+잠을 쉬이 못 드나요?,Korean
+수액 연결하면 처음에는 어지러우실 수 있어요.,Korean
+담배 처음 핀 게 언제예요?,Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+관절염 진단 받은 지 꽤 됩니다. 집안 전체적으로 뼈가 약해서요.,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+"진통제 잔뜩 먹고 겨우 잠들었어요.
+",Korean
+어떨 때 구토를 하나요?,Korean
+앉아 있을 때에도 통증이 있으신가요?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+체온이 몇도 정도 인가요?,Korean
+올해 예방접종은 아직 안 하셨죠?,Korean
+네 물이 차서 무릎을 못 굽히는 거면 무릎 부종입니다.,Korean
+독감 주사 맞은 시기가 언젠가요?,Korean
+오 년 전부터 빈혈약 꾸준히 먹고 있어요.,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+저번 달에 코 수술했습니다.,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+오늘 내원하신 이유는 뭔가요?,Korean
+빈혈에 고혈압이 있으신데 쓰러지신 건 처음이에요.,Korean
+조금만 뛰어도 호흡하기가 힘든가요?,Korean
+입원 하실 때 걸어오셨는지 휠체어나 이동침대 등 다른 이동수단을 이용하셨는지 물어보았습니다.,Korean
+피검사만으로 진단이 정확하지 않을 수 있어 씨티 검사가 필요합니다.,Korean
+"배가 ���글부글 끓어서 밥을 먹기가 두렵다니까요.
+",Korean
+지금까지 열은 안 났나요?,Korean
+빈뇨 말고 소변보실 때 또 불편하신 점이 있으신가요?,Korean
+평소 양치 후 물로 헹구어 뱉으실 때 피가 많이 났나요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+친구가 교통사고로 입원해서 한 번 다녀왔었어요.,Korean
+해당 증상은 변비 증상에 속합니다.,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+알레르기 반응이라고 제가 확 느낀 적은 없었던 것 같아요.,Korean
+전신 마비가 올 수도 있습니다.,Korean
+"왼쪽 아래에 사랑니가 난 것 같아요.
+",Korean
+몇 시간 내에 마취는 풀릴 거에요.,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+졸린데 눈을 감아도 잠들기 어려우신가요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+현기증을 처음 느끼신 건가요?,Korean
+새벽 다섯 시에 먹은 약이 마지막으로 먹은 거예요.,Korean
+저희 병원 입원기록을 조회해 보겠습니다.,Korean
+잠을 깊게 잘 수 있나요?,Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+하루에 한 번도 대변을 못 보시나요?,Korean
+몸에 열 기운이 느껴지세요?,Korean
+저희 병원에서 하신 수술이 전부인가요?,Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+네 일단 진통제 놔드리기 전에 먼저 검사 진행하도록 하겠습니다.,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+화상은 눈으로만 판단해서는 안 됩니다.,Korean
+배가 불러 불편하지는 않으세요?,Korean
+통증은 주로 언제 오나요?,Korean
+"삼키는 게 힘들어서 유동식 조금만 먹고 있어요.
+",Korean
+통증이 가까운 부위에서 나타나네요 경과를 지켜보는 것이 좋겠습니다.,Korean
+저번 주에 회충약 먹었어요.,Korean
+내시경 일정은 밖에서 잠시 기다리시면 간호사가 안내 드릴거에요.,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+"무릎이 아픈 뒤로는 변도 잘 안 나옵니다.
+",Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+가까운 병원으로 연결도 해주시나요?,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+간염 인지하신 게 언제부터인가요?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+그냥 청진만으로 진단이 완벽하게 내려지는 건가요?,Korean
+검사 결과가 나와봐야 알 수 있습니다.,Korean
+피 소변을 보시진 않나요?,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+"그냥 통증만 계속 유지되는 느낌이에요.
+",Korean
+평소에 가슴이 아프고 그러신가요?,Korean
+최근에 체중이 눈에 띄게 빠진 적 있나요?,Korean
+약을 먹는 것이 보통이지만 약을 먹지 못하는 환자나 응급 시에는 약을 먹지 않은 상태에서 진행할 수 있는 검사입니다.,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+간염으로 언제 치료 받으셨나요?,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+네 다만 소화가안 되거나 자극적인 음식은 자제해 주세요.,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+석회화에도 양성 석회화와 악성 석회화가 있는데 환자분의 경우는 영상이 또렷하지가 않고 미세한 석회화가 많아 보이는 경우 이십 퍼센트 정도 악성으로 진단 됩니다.,Korean
+예방 접종이 안 된 애완견은 사람을 물었을 때 질병을 전파 할 수 있어요.,Korean
+"오줌이 자꾸 마렵고 아랫배가 묵직한 느낌이 들어요.
+",Korean
+네. 삼 개월 전 맹장수술했어요.,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+네. 수술경과를 보호자분께 알려드릴게요.,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+해열제를 먹으면 안 될까요?,Korean
+지금 아픈 게 느껴지실까요?,Korean
+평소 시력이 어떻게 되세요?,Korean
+네 열 없이 체온 정상입니다.,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+만성위염은 완치가 어려운 질환입니다. 지속적이고 규칙적인 관리가 필요합니다.,Korean
+언제부터 그런 증상이 있었지요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+언제 암을 처음 진단받으��나요?,Korean
+소변보는 데 문제 있으세요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+양지병원에 갔었어요. 원래 정확한 병원 이름은 양지병원 앞에 뭐가 붙어 있었는데 그건 잘 기억 안 나요.,Korean
+체중 변화가 많진 않으셨어요?,Korean
+당뇨에 가족력 없다고 말씀하셨죠?,Korean
+간헐적으로 통증이 왔다 가나요?,Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+부종이 발생한 곳이 있나요?,Korean
+혹시 입원해서 치료받은 적 있으세요?,Korean
+지금 아픈 곳 말하세요.,Korean
+아픔이 몇 분 정도 가나요?,Korean
+보호자분은 장갑 끼고 이쪽으로 오세요. 제가 관장액을 주입하면 삼십 분 동안 막아주셔야 합니다.,Korean
+식염수로 적시거나 항생제를 추가하여 감염 방지의 목적으로 활용할 수 있습니다.,Korean
+입원 지시가 났으니 보호자분께서는 원무과에서 입원 수속을 해주시기 바랍니다.,Korean
+당뇨 관리 언제 시작하셨어요?,Korean
+심장 뛰는 속도가 빠르게 느껴지시나요?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+골육종은 악성종양이기 때문에 반드시 항암이나 수술 제거가 필요한 나쁜 암입니다.,Korean
+과민성 장 증후군 가능성이 있습니다.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+현재 당뇨 앓고 계신 분이 있나요?,Korean
+"애기가 지금 삼 일 동안 열이 펄펄 끓는데 해열제도 소용이 없고 도저히 안 되겠기에 왔습니다.
+",Korean
+"아니요. 체중이 한 십 퍼센트 갑자기 줄었어요.
+",Korean
+먹은 음식물을 다 토하나요?,Korean
+결핵이 있다는 것을 언제 알게 됐나요?,Korean
+간염 때문에 병원에서 치료받고 계세요?,Korean
+입천장 코 쪽 점막과 입천장 근육 그리고 구강 쪽 점막을 적절히 분리해 주어 다시 재건해 주는 작업입니다.,Korean
+어떤 것에 알레르기가 있나요?,Korean
+부종이 발생한 곳이 있나요?,Korean
+참지 마시고 토가 나올 것 같으면 여기에 하시면 됩니다.,Korean
+"떨어지면서 턱을 부딪치는 바람에 통증이 심해요.
+",Korean
+네 아주 어렸을 적부터 기억나시는 모든 입원 내용 말씀해 주세요.,Korean
+꾸준히 치료한다면 몇 개월 내로 좋아질 겁니다.,Korean
+설사를 며칠 동안 하셨나요?,Korean
+"채식주의 식단으로 해 주세요.
+",Korean
+"왼쪽 팔에서 피도 나고 붓기도 하고요. 놀라서 그런 건지 아파서 그런 건지 계속 우네요.
+",Korean
+최근에 당뇨 검사를 받은 적이 있나요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+수혈이 필요한 상황에 대비해서 혈액을 확보해 두어야 해서요.,Korean
+대변이 잘 안 나오나요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+통증 지속시간이 길면 어느정도 였나요?,Korean
+최근에 대변에 피가 섞여서 나온 적이 있나요?,Korean
+"기침할 때 이상한 소리가 나길래 애기한테 이상이 있나 싶어 왔어요.
+",Korean
+"네. 골목에서 사람하고 부딪히는 바람에 왼쪽으로 넘어지면서 왼쪽 손목을 접질렸어요.
+",Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+약 먹은 지는 오 개월 째고 지금 없어요.,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+이제 무슨 검사를 할 거냐에 따라 다릅니다.,Korean
+아직도 가슴 쪽에서 통증이 올라오나요?,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+이쪽으로 움직였을 때도 통증이 그대로 있다는 말씀이군요.,Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+결핵 백신 접종을 하셨나요?,Korean
+한 번에 먹는 술의 양이 정해져 있나요?,Korean
+발기 부전으로 인해 부부관계에 문제가 있나요?,Korean
+"자주 울고 변을 보는데 힘들어해요.
+",Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+무슨 간염 약 드세요?,Korean
+독감 주사 언제 맞으실 건가요?,Korean
+피를 토 한 적 있으세요?,Korean
+아프게 된 계기가 있나요?,Korean
+수술 후 치료를 다시 받았나요?,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+언제부터 가려움이 느껴지셨는지 알려주세요.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+자연분만�� 제왕절개에 따라 수술 방법이 달라질 수도 있습니다.,Korean
+대체로 큰 문제는 없지만 장의 감염성 질환도 고려해야 합니다.,Korean
+결핵 백신 접종을 하셨나요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+진피 이하의 깊은 부위 손상으로 보입니다.,Korean
+심하지 않아도 피부 증상이 나타난 적이 있다면 전부 말씀해 주시겠어요?,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+검사를 하시려면 더 큰 병원을 추천하고 싶습니다.,Korean
+따로 보조제는 복용 안 합니다.,Korean
+병원에 오신 과정을 확인하려고 합니다.,Korean
+통증이 제일 처음 나타난 게 언제인가요?,Korean
+알레르기를 일으킨 약 있나요?,Korean
+체내에 이산화탄소가 많아진 경우 만성 폐쇄성 폐질환이나 상기도 폐쇄 환기를 위한 근육기능의 감소 신경전달 이상 및 중추성 호흡 감소를 의심할 수 있습니다.,Korean
+기력이 빠진 것 같은 느낌을 받으신 적 있나요?,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+어머님 아버님 형제자매 관련하여 가족력 있으신가요?,Korean
+"어깨가 아파서 응급실 왔는데 탈골이라고 해서요.
+",Korean
+모유는 아기에게 필요한 영양분을 모두 포함한 가장 이상적인 음식입니다.,Korean
+"식도에 문제가 있다고 들었던 거 같아요.
+",Korean
+약 처방 때문에 들렀어요.,Korean
+그 외 알레르기가 생겼던 것이 있나요?,Korean
+발기 부전을 느끼고 계신가요?,Korean
+"싸기 전에 배가 살살 아파요.
+",Korean
+당뇨 가족력을 갖고 있나요?,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+"요즘 음식을 먹으면 소화도 잘 안되고 몸도 아프고 두통도 있습니다.
+",Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+그럼 코로나 검사를 받으시겠어요?,Korean
+가족 중 고혈압 치료 중이신 분이 있을까요?,Korean
+초기 집중적인 치료가 예후에 매우 중요하기 때문에 입원을 권장드립니다.,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+통증이 느껴지시는 부위가 어디인가요?,Korean
+오심 구토 증상이 있지는 않았나요?,Korean
+어느 것이 더 적합한지는 진료받아야 알 수 있습니다.,Korean
+"식은땀이 나면서 가슴이 옥죄여와요.
+",Korean
+"그냥 이쪽이 다 아파요. 여기 허리랑 등이요.
+",Korean
+면역요법에 주로 사용되는 성분으로 이루어져 있습니다.,Korean
+진료 예약 센터 운영 시간은 어떻게 되나요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+측정 시에 아이가 깨어 있어야 호흡 측정이 가능합니다.,Korean
+장기적으로 봤을 때 입원하시는 것이 좋습니다.,Korean
+동거 가족의 흡연도 상세 정보로 기록해 두겠습니다.,Korean
+산부인과는 어떤 일 때문에 가셨는지 알려주실 수 있을까요?,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+기존에 옷에 쓸려서 아토피 증상이 유발된 적이 있으신가요?,Korean
+가끔 드시는 건 괜찮지만 되도록 고열량 고지방 식품보다는 찐 달걀이나 닭 가슴살로 드시도록 해보세요.,Korean
+담배 언제 처음 피웠어요?,Korean
+"가바라는 보조제를 추천받아서 먹고 있어요.
+",Korean
+과식을 해서 위에 자극을 줬다면 통증이 있을 수 있습니다.,Korean
+손목 관절 주위 골절이나 염증성 질환 등이 관련이 있을 수 있습니다.,Korean
+기침을 얼마나 자주 하나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+어머님이 걱정하시는 응급상황은 아니니 진료실을 나가시면 간호사가 예약을 잡아 드릴 겁니다.,Korean
+"변비 때문에 많이 고생 중이에요. 약을 먹지 않으면 기미가 없어요.
+",Korean
+아니요. 합병증 때문에 몇 가지 더 있어요.,Korean
+힘을 줘서 근육통이 생길 수 있습니다.,Korean
+내원해서 수술받으신 경험이 있으세요?,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+키는 백팔십 정도고 몸무게는 아마 한 육십칠 킬로 정도?,Korean
+단기간에 살이 많이 빠지는 건 문제가 있는 거예요.,Korean
+"허리를 펴면 날카로운 통증이 느껴져요.
+",Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+"음. 식욕도 식사 섭취량도 평소와 비슷해요.
+",Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+"고양이한테 할퀴어서 피가 나요.
+",Korean
+아이 몸무게가 언제보다 얼마나 차이 날지 여쭤보시는 건가요?,Korean
+입원 조사 시 내원 방법에 대해 필요하여 물어봤습니다.,Korean
+"허리부터 무릎까지 저린 ��낌이 들어요.
+",Korean
+코로나 관련 문진표를 채워주세요.,Korean
+구토가 장폐색에 의한 경우라면 우려가 되나 그 외의 경우일 수도 있습니다. 검사 후 다시 말씀드리겠습니다.,Korean
+어머님이 걱정하시는 응급상황은 아니니 진료실을 나가시면 간호사가 예약을 잡아 드릴 겁니다.,Korean
+팔다리가 많이 부어서. 이 주 정도 입원해서 치료받은 적이 있어요.,Korean
+이 밖에 다른 알레르기 있으실까요?,Korean
+네 여기가 대장이고 여기 보이시는게 대변입니다.,Korean
+담당의사와 상의 후 다시 준비를 하겠습니다.,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+재활 치료 안내 부탁드릴게요.,Korean
+만약 잘못 된다면. 더 이상의 치료는 하지 않았으면 좋겠습니다.,Korean
+"오늘 기온이 그렇게 낮은 게 아닌데 몸이 으슬으슬 떨리고 두통도 심해요.
+",Korean
+"떨어지면서 턱을 부딪치는 바람에 통증이 심해요.
+",Korean
+"기계에 손이 껴서 손가락이 잘렸어요.
+",Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+독감 주사를 최근에 맞았나요?,Korean
+심근경색 말고도 흉통을 일으킬 수 있는 여러 질환들이 있습니다.,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+최근에 다른 예방 접종하신 적 없으신가요?,Korean
+"귀에 벌레가 있는 것처럼 간지러워요.
+",Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+부작용이 딱히 없어서 약에 큰 신경을 안 썼는데 없었던 것 같아요.,Korean
+오늘 몸 상태 좋아요.,Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+한의원에서 처방받아서 드시는 건가요?,Korean
+아이 성장 속도에 맞춰 동일하게 해줄 겁니다.,Korean
+집 먼지 진드기는 사람의 피부 세포나 곰팡이 같은 유기물을 먹고 삽니다.,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+따로 약을 먹어야 생활이 가능하다던가 그랬나요?,Korean
+그럼 이따 드실 약만 가지고 계시고 나머지는 확인 후 돌려드리겠습니다.,Korean
+토할 때 피도 나왔나요?,Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+네 수술 부위는 감염 없이 깨끗이 잘 아물고 있어요.,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+전체적으로 아프지만 그래도 가만히 있으면 통증이 더 많은 부위가 있을 텐데요.,Korean
+수술하고 재활 치료 중입니다.,Korean
+위궤양 진단받아 치료했고 지금은 일 년에 한 번씩 추적 검사만 해요.,Korean
+퇴원 수속은 환자분이나 보호자분이 계셔야 해요.,Korean
+"평소랑 변 색깔이 너무 달라서 걱정돼서 왔어요.
+",Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+평소에 변은 잘 보세요?,Korean
+취침 시에도 자주 소변이 마려운가요?,Korean
+"여기 진료의뢰서와 검사 결과입니다.
+",Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+당뇨는 언제부터 알게 되셨어요?,Korean
+도대체 어디가 아픈 거예요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+통증 시작된 날짜 기억나요?,Korean
+네. 십 대 때 여드름이 너무 심해서 한 번 받아봤어요.,Korean
+예전에도 체중에 변화가 크게 있었나요?,Korean
+"하루 여덟 시간씩 꿀잠 자는 편인데 이러고 나서는 거의 못 자요. 잘 깨고요.
+",Korean
+정확한 진단명은 검사 결과를 보고 말씀드리겠습니다.,Korean
+네. 수술경과를 보호자분께 알려드릴게요.,Korean
+암 진단받은 게 언제인가요?,Korean
+통증이 어느 정도로 심하죠?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+상처에 습윤이 유지되기 하는 효과가 있습니다.,Korean
+"고환을 다쳤나 엄청 아파요.
+",Korean
+다른 곳들은 큰 이상 없습니다.,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+혈뇨를 보신 적이 언젠가요?,Korean
+수액부터 놔 드릴게요. 그리고 항생제랑 마취제 검사하러 오겠습니다.,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+"가습기 잘 안 사용하는데요.
+",Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+가슴 보호대는 가슴 움직임을 최소화해 통증을 줄여줍니다.,Korean
+꾸준히 약을 복용하시고 발라야 빨리 낫습니다.,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+상처의 경과에 따라 치료 방법이 상이할 수 있습니다.,Korean
+어떤 건지 알아야 찾아봐 드릴 텐데 병원에서 처방받은 약이 아니라 그냥 따로 영양제처럼 복용하신 약이신 거죠?,Korean
+"아니요. 장염 때 말고는 설사 아예 안 해요.
+",Korean
+아버지가 당뇨약 드시고 계세요.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+가족계획을 잘 세우시고 알려주세요.,Korean
+수술 후 재활은 얼마나 걸린다고 확답 드리기 힘듭니다.,Korean
+어머니가 고혈압을 앓고 계십니다.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+진통제 먹으면 어디서 쥐어터지고 들어온 것처럼 얼굴이 부어요.,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+제가 방금 퇴원 설명 해드렸습니다.,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+약효가 어떤지 봐야 돼서요.,Korean
+유전적인 병은 집안 내력으로 이어집니다.,Korean
+언제 숨 쉬기가 힘든가요?,Korean
+네. 근데 혈중 암모니아 수치가 정확히 뭔가요?,Korean
+"명치 부근이 항상 쓰리거나 답답해요.
+",Korean
+입원해서 치료받은 적 있어요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+토할 때 피가 같이 나오나요?,Korean
+빈속에도 구토 증상이 있나요?,Korean
+"불면증이 있어서 잠을 잘 못 자는 편이에요.
+",Korean
+검진 이후에 또 몸 상태가 달라졌을 수도 있어서 재차 검사가 필요합니다.,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+아뇨. 영양제 말곤 없어요.,Korean
+녹색 변의 경우 음식물 때문인 경우가 많지만 경우에 따라서는 감염성 질환이 원인이기도 합니다.,Korean
+하루 흡연량이 어떻게 되시는지요?,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+담배 하루에 몇 갑 피나요?,Korean
+눈에 좋다고 해서 먹는 영양제예요.,Korean
+입원 치료를 받았다거나 수술하신 적 있으신가요?,Korean
+삼사 년 전에 골다공증 검사를 받은 적이 있는데 뼈가 약하다는 이야기는 들었지만 치료할 정도는 아니라고 했습니다.,Korean
+오한 증상 나타난지 며칠 되었죠?,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+알레르기가 나는 음식이 있으시다면 알려주시겠어요?,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+흔한 위염 종류는 아닙니다.,Korean
+담배는 하루에 얼마나 태우세요?,Korean
+"몸이 워낙 약해서 칼슘이 풍부한 음식은 찾아서 먹을 정도예요.
+",Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+위 점막의 모든 부분이 두꺼운 것은 아니고 주름 부위가 두꺼워져 있는 것입니다.,Korean
+콜라 같은 색의 소변인가요?,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+처방 받으신 연고를 잘 바르고 계시나요?,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+방역 수칙을 잘 지키고 있어서 그런 일은 없을 것입니다.,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+"죄송하지만 단백질 위주로 해 주세요.
+",Korean
+결핵약 아직 복용하고 계신가요?,Korean
+"배가 자꾸 꾸륵꾸륵하고 장이 뒤틀린 느낌이 들어요.
+",Korean
+환자와의 관계도 작성 부탁드리겠습니다.,Korean
+네 그러면 월요일 열한시 십분까지 병원으로 오시면 됩니다.,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+아버지가 위암 진단을 받으셨어요.,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+고혈압 당뇨 심장 질환 신장 질환 호흡기 질환 갑상선 질환이 있나요?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+피가 묻어 있는 소변을 보신 적 있으신가요?,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+"수면 시간 전혀 안 지켜지는데요.
+",Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+"뛰다가 헛디뎌서 발을 삐었어요.
+",Korean
+고혈압 치료��� 진행 중이신가요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+통증은 얼마나 지속되는지 아시나요?,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+상급종합병원이 아닌 작은 병원으로 가셔도 됩니다.,Korean
+네 전반적으로 다들 아프셨어요.,Korean
+독감 접종은 어디서 하셨나요?,Korean
+식후 계속 속이 불편하신가요?,Korean
+오늘은 검사 어떤 거 맡나요?,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+기침을 했는데 피가 나온 적 있나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+목 안에서 통증이 느껴지나요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+부부관계를 하실 때만 발기 부전이 나타나나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+보통 가글이랑 방법은 똑같습니다.,Korean
+"어릴 적부터 태워서 하루에 한 갑 정도 태우네요.
+",Korean
+식염수로 적시거나 항생제를 추가하여 감염 방지의 목적으로 활용할 수 있습니다.,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+네. 체중이 급격하게 찌거나 빠질 경우 몸에 피해가 옵니다.,Korean
+아픈 증상을 자세히 말씀해 주시면 처방하겠습니다.,Korean
+네 모든 피부질환은 말씀해 주십시오.,Korean
+배액관이 밖으로 조금 빠져나왔습니다.,Korean
+"애가 먹으면 바로 다 토해요.
+",Korean
+병동으로 올라오셔서 입원하실 때 이동 수단을 알려주시면 됩니다.,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+물집 생긴 곳이 냄비 만진 부위 말고 다른 곳에 또 있나요?,Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+네 저희가 처방 전에 확인을 해야 하는 거라서요.,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+아니요. 영양상담은 추가 비용 나오지 않습니다.,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+가다가 넘어져 무릎이 깨졌어요.,Korean
+"계속 혈압이 낮게 나와서요.
+",Korean
+소변을 보고 난 후 피가 묻어있나요?,Korean
+"코피가 안 멈추고 계속 나와요.
+",Korean
+감염 예방과 균형 잡힌 식사가 이루어진다면 몇 주 안에 빠르게 회복하기 시작할 겁니다.,Korean
+특정 시기에 통증이 생기나요?,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+운동 강도 정도가 영향을 줄 수 있습니다.,Korean
+혹시 짐작하고 있는 감염 경로가 있을까요?,Korean
+퇴원 후 보호자와 함께 거주하시나요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+알고 있는 알레르기 있으면 말해 줘요.,Korean
+석회화에도 양성 석회화와 악성 석회화가 있는데 환자분 같이 영상이 또렷하지가 않고 미세한 석회화가 많이 보이는 경우 이십 퍼센트 정도 악성으로 진단 됩니다.,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+처음 간염 판정받은 게 언제예요?,Korean
+오늘까지는 많이 아프실 수 있어요.,Korean
+네 피부병으로 볼 수 있겠네요.,Korean
+아니요. 교정치과 외에는 간 적 없어요.,Korean
+네 바로 진통이 없어질 거예요.,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+특정 약은 알러지 반응 때문에 못 먹어요.,Korean
+둘째까지는 자연분만했는데 셋째 낳을 때는 임신중독이 있어서 제왕절개 했어요.,Korean
+통증을 점수로 하면 몇 점 정도 느껴지나요?,Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+검사 결과가 나온 이후 좀 더 효과 있는 치료법으로 가는 방법으로 하죠.,Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+���레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+어느 정도의 울렁증인지 알려 주세요.,Korean
+소변줄 삽입요? 꼭 해야 하는 거에요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+여드름 부위를 중심으로 전체 얼굴에 도포하세요.,Korean
+배변 장애의 진단 기준에 포함됩니다.,Korean
+약물 알레르기 알고 계신 것 있어요?,Korean
+진통제 주신 거 다 먹으면 되나요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+하루 동안 몇 개비의 담배를 피우시나요?,Korean
+병원비 수납에 대한 문의는 수납처에 하시기를 바랍니다.,Korean
+측정 결과 이상 없으셔서 다시 재실 필요는 없는데 원하시면 그렇게 해드릴까요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+월경량 초음파 검사 피검사 등 검사와 확인이 필요합니다.,Korean
+혈압은 단순한 검사고 오 분도 안 걸릴 겁니다.,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+네 약통에 라벨 보여주세요.,Korean
+얼마나 아픈지 간단하게 설명 좀 해주시겠어요?,Korean
+응급내시경인 경우 내시경실로 전화하시면 되고 정규 내시경은 일정 잡고 받으시면 됩니다.,Korean
+내원하신 이유가 어떻게 되죠?,Korean
+네. 건강 검진받았었는데 혈당이 매우 높게 나왔네요.,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+"왼쪽은 버틸만한데 오른쪽은 너무 심하게 저려서요.
+",Korean
+필요할 경우 피부를 이식하는 수술이 진행될 수 있습니다.,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+전 병원에서 주로 어떤 치료했어요?,Korean
+네 삼 개월 후에 수술할 수 있습니다.,Korean
+목에 통증 있은지는 얼마나 되셨어요?,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+통증 시작 날 알려주세요.,Korean
+병실로 이동한 후 심호흡을 계속하시면 됩니다.,Korean
+묽은 변을 보시지는 않나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+잠을 깊게 잘 수 있나요?,Korean
+치료 방법이나 처치에 따라 입원 기간이 수개월 이상 걸릴 수 있습니다.,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+"그냥 팔꿈치에만 통증이 있어요.
+",Korean
+독감 접종은 어디서 하셨나요?,Korean
+통증이 발현되는 시기가 있나요?,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+피를 토해낸 적 있어요?,Korean
+정확히 아픈 부위가 어디예요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+그 외 알레르기가 생겼던 것이 있나요?,Korean
+발기가 오랜 시간 지속되지 못하나요?,Korean
+"네. 무릎에 힘이 안 들어가서 앉았다 일어날 때 매우 힘들어요.
+",Korean
+네. 위내시경은 위 안으로 삽입하는 것이기 때문에 다르다고 볼 수 있습니다.,Korean
+우측 엉치뼈 부위에 병변이 관찰됩니다.,Korean
+그렇긴 하지만 처방 받아서 드시는 게 아니면 오남용을 할 수 있어서요.,Korean
+입원하시지 않는 방향으로 결정 내리셨나요?,Korean
+최근 소변에 피가 섞여 나온 적이 있었나요?,Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+"목이 너무 아파요. 말도 못 하겠어요.
+",Korean
+영양분 제공을 위해 수액 맞는 거예요.,Korean
+"안녕하세요 선생님 다름이 아니라 저희 애가 삼 일 전부터 밥을 먹고 나면 다 토를 하더라고요.
+",Korean
+간호를 할 수 있는 사람이 따로 없는 것 같아요.,Korean
+예방 접종 후 괜찮았나요?,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+가슴 통증 느끼신 지 얼마나 되신 거죠?,Korean
+"저희 애가 놀다가 다쳐왔는데 다리를 크게 다친 것 같아요.
+",Korean
+몸에 열나는 것 같나요?,Korean
+예전에도 비슷한 병을 앓으셨나요?,Korean
+네 임플란트 한 치아 모두 가르쳐 주세요.,Korean
+"기침이 계속 나면서 폐 쪽이 아파요.
+",Korean
+바이러스가 피부에 접촉했다고 해서 체액이나 혈액 등을 통해 전파되는 것은 아닙니다.,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+한 달 내에 배가 아파서 방문했는데요.,Korean
+가래가 얼마나 많이 나오나요?,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+심장 빨리 뛰는 건 괜찮으세요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+따로 드시는 약 있으신가요?,Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+무조건 큰 병원으로 해주세요.,Korean
+빈혈 같은 건 평생 있었어요.,Korean
+가슴이 갑자기 너무 급하게 두근거린 적이 있나요?,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+"아니요. 태어나서 단 한 번도 피워 본 적 없어요.
+",Korean
+"불면증이 좀 있어요. 네 시간 정도 자요.
+",Korean
+간암 걸린 적 있는데요.,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+따로 알아 둘 알레르기가 있을까요?,Korean
+배가 좀 평소보다 빵빵하신 것 같긴 했어요. 구토는 모르겠구요.,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+혈압이 높은데 고혈압 진단 받은적 있나요?,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+면역 요법에 사용되는 단일 성분입니다.,Korean
+네. 골다공증이 있어서 칼슘 많이 먹어요.,Korean
+마취가 잘 안 들었다든지 하는 점 없으실까요?,Korean
+아니요. 먼저 의사와 상담 후 계획을 정해 보는 게 좋습니다.,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+아니요. 심혈관계 질환은 전혀 없어요.,Korean
+어떤 음식을 드셨을 때 알레르기가 나타나나요?,Korean
+이 부위가 아픈 곳이에요?,Korean
+"지나가다 튀어나와 있는 곳에 손등을 긁혔는데 상처가 자연적으로 낫질 않고 곪아 버리네요.
+",Korean
+네 수술 전에 무조건 쓰셔야 해요.,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+아픔이 몇 분 정도 가나요?,Korean
+"네. 심장 쪽이 또 조여드는 것처럼 아팠어요.
+",Korean
+항암 치료제를 복용 중이신가요?,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+언제 이런 통증을 느끼셨어요?,Korean
+불면증이 있는 것 같나요?,Korean
+잇몸치료 한 적 있어요.,Korean
+종양성 병변으로 대장암으로 진행될 위험성이 있습니다.,Korean
+입맛이 부쩍 줄어든 건가요?,Korean
+입원 치료를 하셔야 하기 때문에 전원 가시는 것이 좋습니다.,Korean
+제일 신경 쓰이는 증상이 뭔가요?,Korean
+첫 번째 마취 크림으로 부족할 경우 추가로 마취 크림을 발라 드리겠습니다.,Korean
+마취제가 잘 안 듣는 몸이라고 하더라고요.,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+"아랫배가 아프다고 하더라고요. 이제는 만지지도 못하게 해요.
+",Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+호흡곤란이 온 적 있어요?,Korean
+속이 메스꺼운 원인에 따라 차이가 있습니다.,Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+거즈를 어디서 구할 수 있을까요?,Korean
+죽을 만큼 통증이 심한가요?,Korean
+직접 퇴원 수속을 하셔야 해요.,Korean
+스트레스를 받으면 메슥거림이 더하나요?,Korean
+"저혈압인데 몸이 갑자기 안 좋아서요.
+",Korean
+소변이 잘 누어지지 않으세요?,Korean
+할아버지와 아버지 두 분 다 탈모였습니다.,Korean
+결핵 치료받은 지는 얼마나 되신 거예요?,Korean
+계단에서 떨어지셨지요. 검사는 곧 시작할 거예요.,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+성생활을 하는 데 있어 문제가 있으신가요?,Korean
+"생각해보니 대소변 볼 때 통증이 있어서 어려워요.
+",Korean
+숨 쉬는 게 힘드신가요?,Korean
+입으로 피를 토한 적이 있나요?,Korean
+붓��� 나면 붓기가 잘 안 빠지나요?,Korean
+치료 내역을 알면 저희에게 도움이 돼서 여쭤보는 거예요.,Korean
+"가끔이지만 계속 두통이 있어요.
+",Korean
+최근 몇 개월 동안 몸무게가 갑자기 변하지는 않았어요?,Korean
+네. 어렸을 때 맹장염으로 왔었어요.,Korean
+약물 관련 쇼크는 없으셨나요?,Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환 생리 기능에 따라 달라집니다.,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+네 몸 상태를 확인 후 제거할 것입니다.,Korean
+약마다 복용 방법이 다릅니다.,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+네. 건강 신경 써야죠.,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+신경으로 주삿바늘을 집어넣기 때문에 위험할 수 있기는 합니다.,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+구토를 언제 한 적 있나요?,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+"몇 달 전부터 숨이 턱턱 막히고 숨을 쉴 수가 없을 것 같다는 느낌이 있었거든요. 처음엔 별일 아니겠거니 했는데 요새 들어서 자주 그런 증상이 있어서 검색해봤더니 공황장애 뭐 이런 게 아닌가 싶어서 와봤습니다.
+",Korean
+과거에 결핵을 앓은 적이 있나요?,Korean
+인후통의 통증 정도를 말씀해 주세요.,Korean
+약은 병원에서 처방 받았나요?,Korean
+"기침할 때 쇳소리가 심하게 나요.
+",Korean
+무료 예방 접종 주사 맞았는데 뭔지는 모르겠네.,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+"숨쉬기 좀 벅차긴 해요.
+",Korean
+당뇨 나온 적 있으세요?,Korean
+아픈 건 어느 정도인가요?,Korean
+"소변이 시도 때도 없이 나와서요.
+",Korean
+피부 질환은 없으신데 팔 전체가 많이 가려우세요? 언제부터 그러셨나요? 자세한 건 진찰 후 알려드릴게요.,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+물 안 먹고 약 먹기가 어려워서 안 먹었어요.,Korean
+체온이 떨어진 것 같나요?,Korean
+피부과 치료 때문에 피지 조절약 먹고 있어요.,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+척추 있는 쪽이 좀 저릿저릿해요.,Korean
+소변줄을 삽입하여 시간당 소변량을 정확히 측정하는 것이 필요합니다.,Korean
+일시적으로 가려움이 가라앉은 것일 수 있습니다 주기적인 관리가 필요합니다.,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+"탄단지 비율 맞춰서 잘 먹어요.
+",Korean
+언제부터 가슴 통증이 있나요?,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+오른쪽 정강이랑 허벅지 다 아파요.,Korean
+자연 유산한 적 있어요.,Korean
+주사 부작용으로 약간의 통증은 있을 수 있지만 걱정하실 정도는 아닙니다.,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+아침부터 혈압이 올랐던 것 같은데요.,Korean
+자다가 긁는 것으로 소양감을 평가할 수 있습니다.,Korean
+알레르기 증상 발생 시 치료를 받거나 약을 드셨나요?,Korean
+네. 입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+대변을 볼 때 피가 보이나요?,Korean
+호흡할 때 어려움이 있나요?,Korean
+디피시피 치료는 통증을 유발하는 치료는 아닙니다.,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+"이 정도 통증은 수면 시간에 영향을 못 미칩니다.
+",Korean
+백신 주사 맞은 거 있나요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+환자분께 직접 확인해야 정확합니다.,Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+"할머니가 의식이 없으신 것 같아요.
+",Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+네. 제가 호흡기에 문제가 좀 많습니다.,Korean
+검사의 목적에는 검사로 인한 합병증 등의 내용이 포함됩니다.,Korean
+통증 양상의 특징점이 있나요?,Korean
+네 환자분들의 전반적인 진료 상황을 알아야 도움이 되거든요.,Korean
+예 잘하면 해산물로 인해 증상이 일어났을 수도 있습니다.,Korean
+당뇨 나온 적 있으세요?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+하루에 몇 개비나 태우세요?,Korean
+수프만 드��� 기간이 어느 정도인가요? 영양 균형에 문제가 생길 수 있는 사항입니다.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+입원 또는 수술 경험이 있나요?,Korean
+"집사람이 죽으려고 약을 잔뜩 털어먹었어요.
+",Korean
+"말이 어눌하게 나와서 응급실에 왔다가 입원했어요.
+",Korean
+"아이가 욕실에서 미끄러져서 머리를 부딪쳤어요.
+",Korean
+결핵은 지금 어떻게 치료받고 계세요?,Korean
+과식은 비만과 더불어 여러 영향을 미쳐요.,Korean
+오심을 겪어본 적이 있나요?,Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+그 외에 모든 예방 접종 포함입니다.,Korean
+혈류 이상까지 알 수 있습니다.,Korean
+보험사에서 진단서랑 입원비 등 서류 달라고 해서요. 관련 서류 부탁드려요.,Korean
+"평소 자던 대로 자는데 하루 종일 피곤해요. 수면 시간은 그대로인 데도요.
+",Korean
+집안에 유전성 질환이 있으신가요?,Korean
+맥박이 빨리 뛰거나 심장이 빨리 뛴다는 느낌이 드세요?,Korean
+수면 보조제 복용 중이시면 말씀해 주세요.,Korean
+제균치료를 중간에 임의로 중단 시 오히려 더 심해질 수 있고 항생제 내성이 생길 수 있습니다.,Korean
+"점액 덩어리가 조금 보였어요.
+",Korean
+엠알아이 검사 시 가발을 착용하시면 안 돼서요.,Korean
+"소변 색이 조금 옅어졌어요.
+",Korean
+"열이 삼십팔 점 오 도였고요. 약을 먹였는데도 지금까지 열이 좀 있더라고요.
+",Korean
+식사 후에만 속이 안 좋으세요?,Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+집안에 암 환자분이 계세요?,Korean
+다른 심장 관련 질환은 없나요?,Korean
+간염으로 드시는 약이 있나요?,Korean
+어느 부위가 정확히 아프세요?,Korean
+"할머니가 깨어나질 않고 누워만 계셔서요.
+",Korean
+의사 선생님께 증상을 말씀드리고 진료를 받아 보세요.,Korean
+바이러스 검사를 해 보실 수는 있으나 어떤 원인으로 바이러스에 감염됐는지 찾는 것은 어려울 수 있습니다.,Korean
+가족들이 대부분 혈압이 높나요?,Korean
+치아와 잇몸 상태를 체크하고 있어야 앞으로 정기 검진하실 때 저희가 환자의 치아 상태를 알 수 있습니다.,Korean
+근전도 검사를 통해 신경 손상 정도를 평가해보고 말씀드리겠습니다.,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+배를 눌렀을 때와 가만히 있을 때 통증이 어떻게 다른 가요?,Korean
+주에 몇 번씩 통증이 느껴지시나요?,Korean
+여기 병원 처음 온 건 아닐 겁니다.,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+통증 느껴지는 곳 짚어보세요.,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+"목도 부은 거 같고 콧물도 나요.
+",Korean
+상해 치료를 받은 적 있으신가요?,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+만졌을 때 통증은 없나요?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+광견병 예방 주사 외에도 사람처럼 여러 가지 예방 접종이 있습니다.,Korean
+그렇군요 구급차로 입원하셨다고 알겠습니다.,Korean
+"네. 선생님. 감기를 옮은 것 같은데요. 열도 나고 기침도 나고 목도 아파요.
+",Korean
+몸이 차가운 증상이 있나요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+통증이 계속해서 아픈가요 드문드문 아픈가요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+"통증이 있긴 하지만 수면 시간에 변동을 줄 정도는 아닙니다.
+",Korean
+마지막으로 주사 맞은 병원에 전화해서 문의해보세요.,Korean
+진찰은 해 드릴 수 있지만 환자분이 어디 불편하거나 하지는 않으세요?,Korean
+"흑변을 보는데 이게 혈변이라고 해서 검진받으려고 왔습니다.
+",Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+화상이 심할 경우 화상 입은 부위가 하얗게 됩니다.,Korean
+"온몸이 퉁퉁 부어서 왔어요.
+",Korean
+할아버지가 여러 가지 병이 다 있으셨어요. 당뇨 고혈압 갑상선도 안 좋으셨고요.,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+몸살이 있으셨다면 예방접종 후 면역력이 떨어져서 더 안 좋으실 수도 있어요.,Korean
+네 바로 진통이 없어질 거예요.,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+약이 세서 오래 드시면 안 돼��.,Korean
+어떤 음식이나 어떤 경로를 통해 장염에 걸렸는지는 찾기 어려울 것 같습니다.,Korean
+수면제 안 드시곤 잠을 못 주무세요?,Korean
+붓고 빠지는 주기가 있나요?,Korean
+가족 중에 유전성 질환을 가진 분이 있나요?,Korean
+화상은 눈으로만 판단해서는 안 됩니다.,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+한 달 동안 체중이 얼마나 변했나요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+어떤 자극에 의해서 위를 이루는 상피세포들이 장을 이루는 상피세포의 성격을 띠게 되는 것입니다.,Korean
+심장이 마구 빨리 뛰나요?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+원래 앓고 계시던 병변이신가요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+"견과류 먹고 치아가 부러진 적 있어서 피하게 되네요.
+",Korean
+오심은 주로 토할 것 같은 느낌으로 나타납니다.,Korean
+암 환자가 가족 중에 있을까요?,Korean
+"선생님 몸에 이상한 게 생겼는데 아무래도 탈장 같아요. 탈장 맞나요?
+",Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+어떤 질병 때문에 드시고 계신 건가요?,Korean
+"머리도 지끈거리고 속도 울렁거립니다.
+",Korean
+통증이 있는지 알고 싶어요.,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+초음파가 처음이세요? 원하시는 대로 천천히 보여드릴게요.,Korean
+통증이 심하실 때 호출해 주세요.,Korean
+"오른쪽 손이 다 다친 것 같아요.
+",Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+어렸을 때부터 내성 발톱을 앓고 있습니다.,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+토를 심하게 한 적이 있나요?,Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+알레르기를 유발하는 다른 이유가 있나요?,Korean
+일단은 반복적으로 손목 움직임을 피하셔야 합니다.,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+가족 중에 고혈압 가지고 있는 분 계신가요?,Korean
+가슴 통증이 있진 않으신가요?,Korean
+"잠에 잘 못 들고 잠이 잘 안 와요. 그래서 얼마 전에 수면제 처방받았어요.
+",Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+화장실에 오래 있어야만 소변을 보시나요?,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+간염 판정은 언제 받았나요?,Korean
+당뇨 증세가 시작된 건 언제부터인가요?,Korean
+보호자분이 따로 하실 건 없고 아이 열 떨어질 수 있도록 시원한 상태 계속 유지해 주세요.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+화상 정도에 따라 과산화수소수를 사용할 수 있습니다.,Korean
+네 집중해서 치료하면 빨리 낫겠지요.,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+배의 어느 부분이 아프신가요?,Korean
+바셀린 거즈는 보습과 동시에 상처를 보호하는 역할을 해 줍니다.,Korean
+결핵이 있다는 것을 언제 알게 됐나요?,Korean
+병문안 시간이 정해져 있습니다.,Korean
+언제부터 이 증상이 나타났나요?,Korean
+어떤 방식의 통증이 느껴지는지 설명해주세요.,Korean
+네 원래 이 질환은 치료에 시간이 많이 걸립니다.,Korean
+"네. 편두통을 앓은지도 오래되었으니까요. 여러 번 했죠.
+",Korean
+권장 섭취량을 지켜서 복용해 주세요.,Korean
+대변볼 때 안 힘든가요?,Korean
+팔에 있는 상처가 언제부터 있는 건가요? 상처 때문에 감염되었을 수도 있어요.,Korean
+과민성 장 증후군이나 장염 시에 비슷한 증상이 나타날 수 있습니다.,Korean
+문제가 생기진 않았는데 약 때문에 가려운 증상이 생길 수도 있습니다.,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+장내 감염 여부 확인의 지표가 됩니다.,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+경우에 따라 구역감이나 구토를 하는 분들이 계세요.,Korean
+병실로는 삼십 분 정도 지나야 이동할 수 있을 것 같습니다.,Korean
+최대한 빨리 다인실로 옮겨만 주세요.,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+사고로 상해를 입은적이 있나요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+패혈증이나 다른 합병증이 생길 수 있어요.,Korean
+어떤 예방주사 맞고 싶으세요?,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+"양쪽 볼이 다 부은 것 같아요.
+",Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+환자분이 사용하는 의치 보조기 의안 심박조율기 같은 보조 기구가 있나요?,Korean
+토하고 싶은 증상이 나타납니까?,Korean
+환자분의 체질량지수가 약간 정상 범위를 벗어났네요. 조금 줄여봅시다.,Korean
+네 수술 전에 무조건 쓰셔야 해요.,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+가족 중에 고혈압 판정받은 분 있나요?,Korean
+최근 한 달 동안 체중 변화가 급격히 있었나요?,Korean
+잘 모르겠습니다. 가벼운 고혈압 정도?,Korean
+상해로 인하여 입원하여 수술하신 적이 있나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+잘 모르시겠다면 병원에 입원한 모든 내용 알려주세요.,Korean
+"자기 전에 담배 피웠어요.
+",Korean
+네 연고만 따로 처방해 드릴 수는 없어요.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+"식욕이 많이 떨어져서 그런지 음식 먹을 때마다 깨작거려요.
+",Korean
+아주 발열이 심한 경우에는 패혈증으로 확대 될 수도 있습니다. 입원하여 원인균 검사 등 다양한 검사와 추가적 처치를 요합니다.,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+홍삼만 먹고 있는 거죠?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+심장 뛰는 속도가 빠르게 느껴지시나요?,Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+배도 같이 아프신 거죠?,Korean
+치료 기간은 얼마나 되었나요?,Korean
+"다리에 힘이 빠져서 걷거나 뛰는 게 힘들어요.
+",Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+오한이나 재채기 등도 문제에 해당됩니다.,Korean
+"얼마 전에 작업하면서 그라인더에 긁혔거든요. 그냥 작업실에 있는 약으로 소독하고 약 바르고 있었는데 삼일 전부터 진물이 나더니 지금은 좀 아프네요.
+",Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+마취하고 어디가 아프거나 안 좋았던 적이 있나요?,Korean
+숨이 찬 증상이 구체적으로 어땠는지 말씀해주세요.,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+제 혈액형은 그냥 오형이에요.,Korean
+전신 마취였던 걸로 기억하고 있습니다.,Korean
+소화 불량이 자주 나타나나요?,Korean
+열흘 뒤에 외래 예약하고 외래에서 들으시면 됩니다.,Korean
+육안으로 노랗게 보이며 소양감이 있을 수 있습니다.,Korean
+변비 증상이 처음이신 건가요?,Korean
+언제부터 간염을 앓고 계셨나요?,Korean
+"두 시간마다 깨서 다섯 시간을 못 자요.
+",Korean
+보호자가 상처 부위를 함께 확인해야 합니다.,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+몸에 열이 있지는 않으세요?,Korean
+심할 경우에는 신장 농양 및 패혈증이 생길 수 있습니다.,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+접촉성 피부염이 발생할 경우 약물 투여를 중지하면 증상이 개선되니 걱정 안 하셔도 됩니다.,Korean
+배가 아픈지 얼마나 되었는지 알 수 있을까요?,Korean
+"소변을 너무 자주 봐서 왔습니다.
+",Korean
+붉거나 짓무른 곳이 없습니다.,Korean
+주로 하루 중 언제 붓나요?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+아직 안 먹였어요. 어제 그냥 감기 기운만 있길래 그 약만 타고 먹이고 잤는데 아침에 갑자기 열이 나길래 병원에서 준 약을 먹여야겠다 하고 바로 온 거거든요.,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+저희가 치료할 때 알아야하는 내용이 있을 수도 있기 때문입니다.,Korean
+"이상하게 요즘 들어 잘 때 화장실이 자주 가고 싶어요.
+",Korean
+많이 울렁거리고 어지러우시면 말씀해주시기 바랍니다. 진통 효과가 나오려면 삼십 분에서 한 시간 정도는 기다려야 하니 조금만 참아주시기 바랍니다.,Korean
+혈압이 높게 나오는 편인���요?,Korean
+네. 이모가 갑상선암 수술을 받으셨어요.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+알레르기 유발하는 음식 말해봐요.,Korean
+복통과 두통이 같이 시작되셨나요?,Korean
+아. 드디어 퇴원하네요. 필요한 서류는 없어요!,Korean
+저희가 추가로 진통제를 드리겠습니다.,Korean
+덴탈 마스크보다는 케이에프 마스크를 권장합니다.,Korean
+투약 양을 조금 더 올려야 할 것 같아요.,Korean
+처방받고 드시는 약 있나요?,Korean
+환자분한테는 지금 충분한 보습을 해 주는 게 제일 좋은 방법입니다.,Korean
+타고 있는 담배에서 나오는 연기는 입자의 크기가 작아 폐의 깊은 부분까지 들어갈 수 있어 더 안 좋습니다.,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+환자 등록 팔찌 확인하겠습니다.,Korean
+진통제는 선생님 처방이 필요해서요 확인 후 놔 드릴게요.,Korean
+입원 및 통원 치료 결정은 의사와 상의하셔야 합니다.,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+소변을 볼 때 통증이 있나요?,Korean
+예방 주사 맞은 지 일주일 됩니다.,Korean
+목이 너무 부어서 음식물 삼키는 것도 불편해요.,Korean
+우선 다른 검사를 조금 더 해봐야 알겠지만 선천성 거대결장이라는 질병이 있어요. 신생아에서 간혹 있는 질병인데 이걸 의심할 수 있는 소견이 엑스레이상 보입니다.,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+수술은 잘 마쳤으니 이제 남은 건 환자분에게 달렸습니다.,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+의료비 영수증 하나 뽑아주세요. 회사 제출용으로 필요합니다.,Korean
+구토를 지금도 하시고 오셨나요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+배랑 눈 중에는 어디가 더 아픈가요?,Korean
+저번 달에 자궁경부암 예방주사 맞았어요.,Korean
+언제부터 발기 부전이라고 생각하게 됐나요?,Korean
+약 처방 때문에 들렀어요.,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+환부를 씻어내고 소독약을 바른 후 테라마이신 바세린 거즈 등을 붙입니다.,Korean
+지금 제일 아픈 곳이 어디인가요?,Korean
+심장이 마구 빨리 뛰나요?,Korean
+네 오전 몇 시에 내원 가능하신가요?,Korean
+언제부터 알레르기 있다는 거를 아셨어요?,Korean
+결핵 때문에 병원에 방문하신 적 있습니까?,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+통증의 정도는 크지 않겠지만 아이에 따라서 통증을 심하게 느낄 수 있습니다.,Korean
+매일 상처를 살펴보면서 치료 받게 됩니다.,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+알레르기가 있다는 것을 언제 알았나요?,Korean
+어디가 제일 많이 부었나요?,Korean
+전신에 힘이 없는 증상을 느끼시나요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+암을 앓고 계시는 가족분이 계시나요?,Korean
+네 기침은 기관지 쪽이 자극을 받아서 나오는 것입니다.,Korean
+잠을 잘 자지 못하시나요?,Korean
+소변이 계속 조금씩 나오나요?,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+네 진료 센터에서 모두 해드립니다.,Korean
+아픈 게 심하게 느껴지나요?,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+하루에 한 번씩은 혈뇨 증상이 나타나나요?,Korean
+하반신 마취도 수면 마취가 가능합니다.,Korean
+반려견도 접종 가능하다고 알고 있어요. 동물병원에 문의해보세요.,Korean
+당뇨 있는 건 아니시죠?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+"아무것도 안 해도 머리만 대면 코 골고 자는데요.
+",Korean
+네. 알에이치 플러스 에이형입니다.,Korean
+변비로 인해 항문이 막힌 경우 범람성 설사가 나타나기도 합니다.,Korean
+필요에 의해 처방드린 약이니 꼭 복용하세요.,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+그럼 의사 선생님께 길게 처방 원하신다고 전달해두겠습니다.,Korean
+금연 기간은 어떻게 되시나요?,Korean
+"변에 하얀 게 군데군데 포함되었던 것 같아요.
+",Korean
+수술하는 질병이 예방접종과 관련 있을 수도 있습니다.,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+어느 쪽 어금니가 많이 흔들리시나요?,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+어. 그냥 어머니가 주신 약 먹었어요.,Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+현기증을 처음 느끼신 건가요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+통증 말씀이신가요 부기 말씀이신가요?,Korean
+혈당 확인을 집에서 하시나요?,Korean
+"네. 막 어지럽거나 울렁거리거나 그런 건 없었어요.
+",Korean
+첫째 임신까지 유산이 잦아서 인공수정 했어요.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+다른 아이는 자연 분만이었고요?,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+암 진단받아본 적 있으세요?,Korean
+혈변을 보시면 피가 얼만큼 섞여 나오는 거 같나요?,Korean
+소변에 피가 함께 나오나요?,Korean
+소변보는 데 불편한 점이 있나요?,Korean
+부부간에 성생활에 영향을 끼치시나요?,Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+아니요. 저는 수술해본 적이 태어나서 단 한 번도 없어요.,Korean
+"방광 쪽에 문제가 있다고 알고 있는데요.
+",Korean
+네 진통제 때문에 그런 현상이 올 수 있어요.,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+결핵 치료를 받고 계신가요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+"진료받다가 입원해야 된다고 그래서요.
+",Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+"위쪽에 있는 안쪽 이빨이오.
+",Korean
+어떤 약에 알레르기가 있으시죠?,Korean
+제가 눈이 잘 안 보이는데 병동 생활 안내문 읽어주시면 안 될까요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+최근 들어 아프기 시작했나요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+육안으로도 불룩한 게 보이신다고요 정말 그러네요 암인지는 검사를 해봐야 알 것 같습니다.,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+결핵 증상이 언제부터 나타났나요?,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+"배가 트는 느낌이 나게 아프고 설사해요.
+",Korean
+십이 최고 아픈 거라면 어느 정도의 통증인가요?,Korean
+"흡연 매일 하고 음주는 주말마다 마십니다. 주종 상관없이 취할 때까지 마셔요.
+",Korean
+"살이 빠지긴 했는데 다이어트 중이라서요.
+",Korean
+맨날 파스 붙이고 사는데요 뭘.,Korean
+잠이 들더라도 오래 못 주무시나요?,Korean
+고혈압 약을 먹은지 얼마나 되었나요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+네 준비 후 혈당검사를 하도록 하겠습니다.,Korean
+"소화가 잘 안 되니까 입맛 자체가 없어요.
+",Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+신체가 부은 데가 있나요?,Korean
+네. 최근에 귀 때문에 항생제 받았어요.,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+아픈 느낌 표현해 주세요.,Korean
+몸이 뜨거운 적이 있나요?,Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+소변을 봐도 시원하지 않고 불편한 느낌이 있나요?,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+병원 내에서는 휠체어를 이용해 주시고 목발은 필요하시면 의료기기 상점에서 구매하셔야 합니다.,Korean
+검사 결과는 일 이 주 정도 소요됩니다.,Korean
+네 많이 아프지만 진통제가 주입되고 있어서 참을만할 겁니다.,Korean
+소변볼 때 통증이 있나요?,Korean
+열이 나면 해열제 치료를 하고 감염 조절을 할 것입니다.,Korean
+식사량이 평소보다 많이 줄었나요?,Korean
+예를 들어 어떤 통증인가요?,Korean
+"열도 나는 것 같고 배도 아프고 여기저기 불편합니다.
+",Korean
+"며칠 전부터 자꾸 성기가 가려워서 자세히 봤는데 물집 같은 게 잡힌 것처럼 보여서요.
+",Korean
+하루에 몇 개비나 피우시나요?,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+컨디션에 대해 조금 더 자세히 여쭤보고 내시경 진행에 대해 결정하도록 할게요.,Korean
+배가 부푼 것 같이 느껴지세요?,Korean
+동의하셔야 해당 약품을 쓸 수 있어요 조금 비싸긴 합니다.,Korean
+불임 수술을 한다고 백 프로 불임이 되는 것이 아니지만 일반적으로 임신 가능성은 거의 없을 겁니다.,Korean
+흡연 여부는 엑스레이와는 관계없습니다.,Korean
+내원하셔서 담당 선생님께 정확한 진료를 받으셔야 합니다.,Korean
+"소변보는 게 편하지 않아서 약 먹고 있어요.
+",Korean
+지금 처치를 잘해야 예후가 좋으니까 치료에 전념하겠습니다.,Korean
+음주는 얼마나 자�� 하시죠?,Korean
+다른 의사 선생님 수술이 늦게 끝나면 환자분 수술도 밀립니다.,Korean
+제가 채식을 해서 그러는데 식단에서 육류를 뺄 수 있을까요?,Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+"다리가 후들거리고 힘이 없어요.
+",Korean
+맥박이 너무 빠른 느낌인가요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+그건 신체에 해롭기 때문에 안 됩니다.,Korean
+통증이 몇 분마다 오나요?,Korean
+과거에는 어떤 질병이 있으셨나요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+가래에 피도 같이 나온적 있나요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+당뇨로 검사받으신 지 얼마 되었나요?,Korean
+틀니 제외 남아 있는 치아를 말씀드린 거예요.,Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+목이 건조하거나 삼키기가 힘들거나 하는 통증은요?,Korean
+"토를 너무 자주 해요.
+",Korean
+부분 마취를 추천하시길래 그렇게 했어요.,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+고 스테로이드 용량 치료를 하는 경우에는 대상포진 접종을 맞으면 안됩니다.,Korean
+일반적으로 알러지가 있는 물질에 따라 다릅니다.,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+언제부터 당뇨 진료를 받으셨는지 말씀해 주세요.,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+크기가 좀 되는 흉터들만 말씀해 주시면 될 것 같습니다.,Korean
+"왼쪽 팔 부은 거 말곤 따로 외관상 다른 건 못 봤고 떨어질 때 왼쪽 팔로 쿵 하고 떨어졌어요.
+",Korean
+네 과거 병력을 알아야 현재 정확한 진단을 내릴 수 있습니다.,Korean
+"요새 토를 너무 자주 해서 왔어요.
+",Korean
+치과 싫어해서 웬만해서는 안 가요.,Korean
+배의 어느 부위가 아프세요?,Korean
+혈압 측정은 일회만 하시면 됩니다.,Korean
+그 약 드시지 말고 이거 드시면 돼요.,Korean
+가족력 여쭈어볼게요 친가 쪽에 고혈압 당뇨 고지혈증 등의 질환을 앓고 계신 분 있으신가요?,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+목에 아픈 증세가 있나요?,Korean
+"기침 호흡 곤란도 있고요. 심할 때는 가슴이 답답하고 오한도 느껴져요.
+",Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+위암 수술 이외에는 다른 수술 하신 적 없으신 거죠?,Korean
+"""네. 무슨 마취를 하셨는지, 어느 정도 못 깨어나셨는지 여쭤보시고 알려주세요.""",Korean
+체온이 떨어진 것 같나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+약을 드신지 얼마나 되셨죠?,Korean
+삼 년 전부터 고혈압과 고지혈증을 진단받아서 약물치료를 받고 있었어요.,Korean
+알레르기 증상이 음식이나 약 말고도 있었던 적 있어요?,Korean
+과거 암 진단받은 적 있나요?,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+아니요. 교정할 때도 저는 발치 안 했어요.,Korean
+혈압만 조금 높게 나오네요.,Korean
+"네. 자려고 하면 잠이 안 와요.
+",Korean
+맹장으로 입원하신 게 처음이셨나요?,Korean
+부작용이 거의 없지만 경우에 따라 생길 수도 있습니다.,Korean
+최근에 살이 많이 빠지시진 않았나요?,Korean
+당뇨 약 먹고 계세요?,Korean
+몇 살부터 흡연을 시작했어요?,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+가슴이 답답하고 속이 더부룩한가요?,Korean
+얼마나 통증이 심하게 느껴지고 있나요?,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+네 입으로 숨을 쉬셔도 전혀 문제없습니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+"복통이 느껴진 적은 없었어요.
+",Korean
+어떤 음식을 드셨을 때 알레르기가 나타나나요?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+통증이 어떤지 설명해 보실래요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+가래 때문에 잠에서 깬 적이 있나요?,Korean
+일주일 내내 통증이 있으셨나요?,Korean
+허리디스크 수술한 적 있긴 해요.,Korean
+우선 흔들리는 것은 여기서 진료를 받고 추후에 엑스레이 검사를 통하여 부가적인 확인을 하는 것이 좋습니다.,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+결핵 진단받으신 지 얼마나 되셨나요?,Korean
+알레르기 증상이 나타난 게 언제 처음이죠?,Korean
+언제부터 미식거리는 증상이 있었어요?,Korean
+암에 대한 가족력이 있을까요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+접종이 안 된 애완견은 사람을 물었을 때 문제가 될 수 있어요.,Korean
+잠을 잘 못 주무시나요?,Korean
+같은 감염원을 접하더라도 사람에 따라 다른 반응이 나타날 수 있습니다.,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+오늘은 어디가 아파서 병원에 오셨을까요?,Korean
+소변이 마려울 때 시원하게 잘 나오나요?,Korean
+네 우선 키와 몸무게를 재고 병실로 안내하겠습니다.,Korean
+네 콧줄을 꽂으면 정상적으로 나타나는 증상입니다.,Korean
+호흡할 때 어려움이 있나요?,Korean
+피를 토할 때 위도 아픈가요?,Korean
+하루에 가래를 얼만큼 뱉으시나요?,Korean
+사람의 몸은 물이 칠십 퍼센트 이상으로 구성되어 있습니다. 부족 시 건강 문제가 발생할 수 있어요.,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+검사 전에 식사를 하시면 결과에 오류가 발생할 수 있습니다.,Korean
+네. 귀찮으시겠지만 매일 확인을 해야 상처가 덧나지 않고 빨리 아물 수 있습니다.,Korean
+첫째 아이는 자연분만하고 둘째 아이는 제왕절개 한 거로 기억해요.,Korean
+면역력이 떨어져 생긴다고 할 수 있습니다.,Korean
+장에 신경 분포가 되지 않아 이로 인해 정상적인 변을 보지 못하는 질환입니다.,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+통증이 어떤 거 같으세요?,Korean
+네 지금 바로 교정 치료랑 약물 치료할까요?,Korean
+복용하는 약제에 의해서도 부을 수 있습니다.,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+가래 특징을 말씀해 주세요.,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+"네. 약간 변비가 있어서 보는데 힘들더라고요.
+",Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+네. 아버지가 결핵 진단을 받으셨어요.,Korean
+자기 전에 술이나 커피를 마신다거나 숙면을 방해하는 요인이 있진 않으신가요?,Korean
+계속 먹고 있는 항결핵제가 있나요?,Korean
+붓기가 제일 심한 때를 알려 주세요.,Korean
+사고 나서 수술을 받은 경험이 있습니까?,Korean
+간염 치료에 어떤 약 처방받으셨어요?,Korean
+가래를 자주 뱉는 편인가요?,Korean
+"열을 처음 쟀을 땐 삼십팔 점 오 도였어요. 그래서 바로 부루펜을 먹였더니 시간이 좀 지나니까 삼십칠 도로 떨어졌는데 그 이후로 더 떨어지진 않더라고요.
+",Korean
+청소와 빨래를 자주 하는 것이 진드기를 없애는 데에 많은 도움이 됩니다.,Korean
+혹시 보청기나 의안 틀니 임플란트 지팡이 등 보조 기구 사용하시는 게 있으실까요?,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+갑자기 체중변화가 있지는 않았나요?,Korean
+네. 응급 환자만 없으면 빨리 진료해 주세요.,Korean
+꽃가루 날리면 너무 괴로워요.,Korean
+체온은 정상인데 혈압은 조금 높아요.,Korean
+"칼로 손목을 그었는데 피가 너무 많이 나요.
+",Korean
+"검진 초음파상 근종이 있대요.
+",Korean
+수분 섭취량이 중요해서요 하루에 기본적으로 오백 미리는 넘게 마셔야 하거든요.,Korean
+진통제를 먹으면 얼굴이 퉁퉁 부어요.,Korean
+접종은 안 맞은 횟수를 세는 것이 어려울 정도로 오래됐고 해외에서는 얼마 전에 돌아온 거예요.,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+구토를 할 때 피가 같이 나오나요?,Korean
+주사로 투여하는데 과거에 조영제 투여하신적 있으신가요?,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+약 먹고 물리치료를 꾸준히 하면 회복이 될 겁니다.,Korean
+발목 인대가 늘어나셔서 발목보호대 하나 사셔야 합니다.,Korean
+사탕을 먹었다면 흡인 위험성이 있고 검사 결과가 정확하지 않을 수 있어 검사를 연기하겠습니다.,Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+지금도 가슴에 통증이 있나요?,Korean
+장중첩증 말고는 따로 수술한 적 없어요.,Korean
+도대체 어디가 아픈 거예요?,Korean
+정형외과 가서 자주 치료받는데도 허리는 늘 아픕니다.,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+"육 년 동안 일주일에 한 갑씩 피웠어요.
+",Korean
+"이유 없이 오 킬로가 빠졌어요.
+",Korean
+"대변볼 때 뭔가 다 쏟아내지 못하는 듯해요.
+",Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+맥박이 빨리 뛰는 느낌 나나요?,Korean
+재작년 건강검진 때 제가 고혈압이라는 것을 알게 됐어요.,Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+"여드름 같은 거 원래 잘 안 나는 피부 였는데 하루 아침에 여드름이 심해져서 왔습니다.
+",Korean
+알약을 가루약으로 조제해 드리겠습니다.,Korean
+"속이 너무 안 좋아요.
+",Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+구토를 많이 한다면 식도 손상 가능성도 있습니다.,Korean
+틀니가 본인 잇몸과 맞지 않네요.,Korean
+제가 이틀 후는 안 되는데 이틀마다 소독 받아야 하면 어떡해요?,Korean
+약 알레르기 있는 거 있으실까요?,Korean
+토할 때 피도 나왔나요?,Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+네 욕창이 나은 후에도 재발하지 않도록 주의해 주세요.,Korean
+통증이 자주 생기는 편인가요?,Korean
+최근에 독감 예방 주사 접종하셨어요?,Korean
+약물 관련 쇼크는 없으셨나요?,Korean
+근래에 앓은 적 없어요.,Korean
+술은 며칠 간격으로 마시나요?,Korean
+간접흡연도 영향이 몹시 크죠.,Korean
+가만히 있을 때도 만져지신다면 종양일 수 있는데 자세히 검사가 필요할 것 같네요.,Korean
+턱 쪽 피부가 찢어져서요.,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+통증 때문에 일부러 소변을 안 보신 적이 있나요?,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+수술했던 병원 명을 알고 계시다면 알려주세요.,Korean
+무력증을 느낀 적이 있나요?,Korean
+갖고 계신 약 있나요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+응급실로 입원할 때 같이 온 보호자는 없으신가요?,Korean
+잠을 깊게 잘 수 있나요?,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+대변을 보고나면 휴지에 피가 같이 묻어있나요?,Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+위염의 한 종류이기 때문에 다른 위염과 유사하게 관리하시면 되지만 조금 더 지속적인 관찰이 필요합니다.,Korean
+네. 저와 같은 증상을 보이는 사람은 없어요.,Korean
+"윗배가 변을 봐도 계속 아파요.
+",Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+대변볼 때 피가 나오나요?,Korean
+결핵을 앓고 계시는 기간을 알 수 있을까요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+강서구에 있는 병원으로 해주세요.,Korean
+"묽은 편이고 혈변에다 변비도 있어요.
+",Korean
+혹시 생리량이 몇 개월 전부터 줄었나요?,Korean
+"쉽게 피로감을 느끼긴 합니다.
+",Korean
+소독 후에 연고를 꼭 바르시고 위에 거즈로 덮어줘야 덧나지 않습니다.,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+방광염 결석 종양 등에 의해 방광이 자극을 받거나 골반 내에 종양이 생긴 경우 혹은 방광을 외부에서 압박하는 임신시에도 나타날 수 있습니다.,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+그렇습니다만 피부 변화로 가장 먼저 나타납니다.,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+약을 세 알씩 매일 드셨나요?,Korean
+"아니요. 체중이 한 십 퍼센트 갑자기 줄었어요.
+",Korean
+"열이 꽤 올랐는데 왜 이러는지 모르겠어요.
+",Korean
+대변볼 때 피가 나오나요?,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+운동을 열심히 해서 허리는 좋아요.,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+소독을 무조건 해야 해요.,Korean
+진찰을 하기 위해서는 환자분 상태를 정확하게 파악해야 합니다.,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+발기 부전으로 인해 부부관계에 문제가 있나요?,Korean
+몇 시간 단위로 통증이 지속되나요?,Korean
+되셨습니다. 알코올 솜으로 꾹 누르세요.,Korean
+피가 섞인 소변을 보고 있으세요?,Korean
+네 원래 체중 변화가 생기는데 너무 빠져서 한번 검사는 해봐야 될 거 같습니다.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+소변은 장시간 참지 말아야 하고 배뇨장애가 있는 경우 잔뇨를 줄이기 위한 노력이 필요합니다.,Korean
+수유 중에 가스가 함께 들어가는데요.,Korean
+"가래가 너무 끼고 말을 못 하겠어요.
+",Korean
+타인에게 수혈을 해 준 적이 있으신 지 여쭤봤습니다.,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+검사 결과 상 몸에 수분이 부족하네요. 물을 좀 더 드세요.,Korean
+"제가 이십 대일 때부터 피웠으니 이십 년은 넘었네요. 하루에 한 갑 정도만 피우는 편이에요.
+",Korean
+결핵 관련해서 약 먹고 있나요?,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+"변이 냄새가 심하고 색이 이상해요.
+",Korean
+아 치료 목적으로는 안 되는 거군요.,Korean
+고혈압 치료하려고 약 드시나요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+"걸을 때마다 오른쪽 무릎에 통증이 있습니다.
+",Korean
+새로 처방하는 약에 다 들어가 있을 거예요.,Korean
+어떤 치료제를 드시고 계세요?,Korean
+"기침이 심하게 나고 가슴이 아프다고 하니 선생님이 입원을 권유하셔서요.
+",Korean
+알레르기 일으키는 원인 있나요?,Korean
+먼저 전화드리고 응급실로 가나요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+검사를 통해 심각한지 확인하기 위해서니 검사를 오늘 해주시기를 바랍니다.,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+그럼요. 약에 대해 꼭 알아야 합니다.,Korean
+통증이 주에 몇 번 있나요?,Korean
+하루에 담배는 몇 갑 피우시죠?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+그런 일이 생기면 보통은 치료를 일시 중단합니다.,Korean
+수술은 잘되었으니 이제 남은 건 환자에게 달렸습니다.,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+마취크림 전 후 차이가 크게 납니다.,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+투석 꼭 받아야 하는 건가요?,Korean
+통증이 얼마나 간헐적으로 나타나시죠?,Korean
+몸이 지금도 춥고 떨리나요?,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+"손가락이 잘려서 급하게 왔어요.
+",Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+아프다고 생각하는 부위들을 다 말씀해보실래요?,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+"여기 안쪽에 어금니 있어요.
+",Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+과격한 운동을 했을 때 심장이 빨리 뛴다고 느껴지세요?,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+그럼 그 약을 왜 드시는지 설명해 주실 수 있으실까요?,Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+마찬가지 이유로 침상 난간도 항상 올려주세요.,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+적정 수면량 변화에 따른 것일 수 있어요.,Korean
+갑자기 일어나면 어지러움이 있어요?,Korean
+약의 종류와 복용 횟수가 늘어나 힘들 수 있습니다. 하지만 약에 대한 부작용은 사람에 따라 차이가 있을 수 있습니다.,Korean
+치료받아야 하는 다른 질병이 있으신가요?,Korean
+"오른쪽 무릎 통증 때문에 도저히 걷지를 못하겠어서요.
+",Korean
+주사로 투여하는데 과거에 조영제 투여하신적 있으신가요?,Korean
+금주를 하셨어도 음주 습관을 알면 치료에 도움이 됩니다.,Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+약 여분 없으면 다른 약 처방해드릴 테니 그거 드세요.,Korean
+붉어졌던 증상 외에 다른 증상은 없으셨나요?,Korean
+네 가루약으로 처방해 드리겠습니다.,Korean
+출혈 위험이 있어서 입원하셨나요?,Korean
+현재 아픈 부분이 있을까요?,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+"이번 주 내내 밥도 잘 못 먹고 먹은 것도 토하기만 해서 왔어요.
+",Korean
+또한 환자분의 검사 결과에 따라 격리로 인해 면회 제한이 될 수 있음을 미리 알려드립니다.,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+약 먹을 때만 그렇고 나중엔 괜찮아요.,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+금연 ��간은 빼셔도 됩니다.,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+소변을 보실 때 피가 나오신 적 있으세요?,Korean
+아픈 느낌 표현해 주세요.,Korean
+"머리 전체가 어지러운 느낌이에요.
+",Korean
+네. 삼 월달에 수술했어요.,Korean
+치통 때문에 약을 좀 먹었었는데.,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+보호자분 혹시 환자분 옆에 계속 상주하시나요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+병원에 방문하시게 된 원인이 뭐라고 생각하시나요?,Korean
+비급여로 적용되기 때문에 비용이 높게 생각될 수 있습니다.,Korean
+검사 결과를 통해 정확한 진단과 처방을 내릴 수 있습니다.,Korean
+간염 치료 복용 약 있으시죠?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+몸에 열나는 것 같나요?,Korean
+가래가 어느 정도로 심하신 거죠?,Korean
+어릴 때 다리가 부러져서 며칠 입원했어요.,Korean
+"목 안쪽이 건조해서 침 삼킬 때도 아파요.
+",Korean
+"정기 건강검진을 했다가 초음파상에 자궁근종이 있다고 해서 입원하게 됐어요.
+",Korean
+빈뇨는 여러 질병의 증상이 될 수 있어서 검사를 받아보시는 게 좋겠습니다.,Korean
+"소변에 피도 섞여 나오는 것 같고 거품도 끼는 것 같은데요.
+",Korean
+일도 화상의 경우 특별한 처치 없이도 일주일 내에 낫는 경우가 많습니다.,Korean
+"귀에 상처가 났는지 계속 피가 나요.
+",Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+식사가 우선 건강 회복에 제일 중요해요.,Korean
+집에 다른 암 환자는 없으시고요?,Korean
+가족 중 유전성 질환을 경험하신 분이 있으십니까?,Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+최근 들어 체중이 얼마나 많이 불었나요?,Korean
+심한 급성 알레르기 반응의 경우 기도 수축에 의한 호흡 곤란이 오기도 합니다.,Korean
+다리에 힘이 안 들어가요.,Korean
+그냥 지금은 기존에 가지고 계셨던 피부질환 여부만 여쭙는 거예요.,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+설사는 몇 번 하셨나요?,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+간염으로 드시는 약이 있나요?,Korean
+네 투약 뒤에 붓기가 있었던 건가요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+가래를 뱉을 때 목 아픈가요?,Korean
+시력이 안 좋아서 안경을 가지고 다닙니다.,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+예전 아토피 진단을 받은 적 이 있으신가요?,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+통증이 사라지지 않고 계속 유지되나요?,Korean
+네. 입원 며칠 동안 해요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+지금 몸에 발열증상이 있나요?,Korean
+"일주일 전에 수술받은 팔에 고름이 찼어요.
+",Korean
+네 환자분의 치료 스케쥴에 매우 중요한 사항입니다.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+언제부터 메슥거리는 느낌이 시작됐죠?,Korean
+염증 수치가 올라갔다는 것은 백혈구가 활발히 활동 중임을 의미합니다.,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+"신경 쓰는 일이 있어서 그런가 편두통이 심해졌어요.
+",Korean
+간염 증상이 이전에도 있었나요?,Korean
+집중이 안 되고 멍했어요.,Korean
+소변볼 때 피가 같이 나와 붉진 않은가요?,Korean
+예전에도 비슷한 병을 앓으셨나요?,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+정말 조금 부어올랐네요 통증이 있으신가요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+네 무슨 이유로 보약을 드셨나요?,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+"움직일 수야 있지만 아파요.
+",Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+내일모레 수술이 예정되어 있으니 내일 자정 이후로는 물 포함 금식하셔야 하시고 내일 저녁에는 관장 한 번 하러 제가 다시 올 거예요.,Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+종교적인 이유 때문에 수혈을 거��하시는 분들도 계십니다.,Korean
+몸이 붓는 증상이 있나요?,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+통증은 얼마 동안 이어지나요?,Korean
+"악몽을 너무 잘 꿔서 잠을 잘 수가 없네요.
+",Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+소변에 피가 섞여 있으세요?,Korean
+현재도 통증이 계속 느껴지나요?,Korean
+담배를 피우신 경험이 있나요?,Korean
+손발 피부 표피가 벗겨지는 건 습진이나 무좀 때문일 수도 있어요.,Korean
+어떤 음식 먹을 때 소화가 잘 안 되나요?,Korean
+"술은 줄이고 있고 담배는 피웁니다.
+",Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+코로나 관련 문진표를 채워주세요.,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+네 전화 후에 약품명 알게 되면 알려주세요.,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+"한 시간에 한 번씩은 소변보러 가는 것 같아요.
+",Korean
+평소에 변비 증상이 있으신가요?,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+체중이 몇 개월 동안 어떻게 변화했나요?,Korean
+"지금 임신 초기인데 급성 빈혈이 온 것 같아요.
+",Korean
+가족 중에 고혈압이신 분 있어요?,Korean
+배에 가스 차는 느낌이 자주 있나요?,Korean
+통증 지속기간이 얼마나 되세요?,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+흡연 상태 유지 중이신가요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+간염 치료 병력이 있나요?,Korean
+매일 혈압을 재고 있나요?,Korean
+약이 지금 없는 건가요?,Korean
+몸에 부은 곳이 어디예요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+아니요 그거 제외하고 처방받아서 꾸준히 먹는 약이나 주사있나요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+네 바로 금식해 주시면 됩니다.,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+알겠습니다. 제 건강 좋아지라고 하는 건데 협조해야죠.,Korean
+어깨 마비를 유발할 수 있는 질병에 대해서 검사해볼게요.,Korean
+간염이 활동성인지 비 활동성인지 들으신 적 없으시군요.,Korean
+"식은땀을 흘리는데도 열이 나서 그런지 땀이 금방 식더라고요.
+",Korean
+등에 알레르겐을 찔러서 확인하는 피부 반응 검사가 있습니다.,Korean
+약이 처방한 다른 약과 충돌하는 건 아닌지 확인하기 위해 약을 보여주셔야 합니다.,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+복통 증상은 언제부터 있었나요?,Korean
+약 먹는 것은 절대 안 잊지.,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+일주일에 술 몇 번 드시는 거 같아요?,Korean
+전신 마취 상태로 수술받았습니다.,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+발기 부전으로 인해 부부관계에 문제가 있나요?,Korean
+아픈 부위가 있다면 다 말해주세요.,Korean
+전에 병원에 입원한 적 있으신가요?,Korean
+깨고 난 후 부작용이 없었으면 큰 문제는 아닙니다.,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+"주먹을 휘두르다가 유리창에 다쳤어요.
+",Korean
+혈우병이 있어요. 저희 아이가.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+변이 묽게 나오는 등 배변 습관 변화는 장의 기질적 변화를 시사하는 소견입니다.,Korean
+"일정했다가 요새 또다시 수면 패턴이 꼬였어요.
+",Korean
+평소보다 현저히 음식을 섭취하는 양이 줄었나요?,Korean
+알레르기를 일으킨 약 있나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+현기증 있으신 적 있나요?,Korean
+발목에 어떤 증상이 있으신 건지 자세히 말씀해 주실 수 있나요?,Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+심하지 않아도 피부 증상이 나타난 적이 있다면 전부 말씀해 주시겠어요?,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+당뇨 약 복용하고 계신가요?,Korean
+맥박이나 심장이 빨리 뛰는 느낌이 있으셨나요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+"발에 가시가 박힌 것 같은데 빠져나오질 않아요.
+",Korean
+여기서 처방 받았던 약과 정확히 일치하나요?,Korean
+두 가지 모두 건강의 위험요소이니까요.,Korean
+신체 검진 후 정확한 진단을 위해 복부 씨티 등 검사가 필요할 수 있습니다.,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+네 맞습니다 오늘 오후에 수술할 예정입니다.,Korean
+"싸웠는데 얼굴이 많이 다쳤어요.
+",Korean
+오한이 든 건 아니고요?,Korean
+피곤해서 몸이 허한가 싶어 한약 먹고 있긴 한데요.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+선생님. 저 최대한 이 병원에 있고 싶은데 정말 안 될까요?,Korean
+휴식이 회복에 중요한데 진통제 처방받고 푹 주무시는 게 좋겠습니다.,Korean
+대변을 며칠에 한 번 보나요?,Korean
+삼 개월간 몸무게가 얼마나 빠졌죠?,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+씨티 검사 확인 후 응급으로 시술 또는 수술을 요할 경우 금식이 길어질 수 있습니다.,Korean
+산소 수치가 정상이어서 안 쓰셔도 됩니다.,Korean
+발목 인대가 늘어나셔서 발목보호대 하나 사셔야 합니다.,Korean
+일주일 기준 몇 번의 술을 섭취하시나요?,Korean
+씨티를 좀 더 잘 보이도록 해주는 약물이라고 할 수 있어요.,Korean
+"벌에 쏘였는데 어지럽기도 하고 간지럽기도 해서요.
+",Korean
+몇 살부터 흡연을 시작했어요?,Korean
+밤에 두세 시간 밖에 못 자는 이유는 뭐 때문인가요?,Korean
+두통약보다는 띵한 느낌이 사라지지 않으면 정밀 검사가 필요합니다.,Korean
+심장이 두근대는 게 멈추질 않았어요.,Korean
+"왼쪽 네 번째 손가락이 없어졌어요.
+",Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+네. 네! 우리 아이 수술 끝났나 보네요.,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+"물 설사였고요. 초록색 느낌이오.
+",Korean
+고혈압 진단을 받은 가족이 있는지 알려주세요.,Korean
+누구 휠체어 타고 오셨나요?,Korean
+따로 드시는 약 있으신가요?,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+그것은 영상검사 및 신체검사를 해봐야 합니다.,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+"하루 흡연량은 반 갑 정도 됩니다.
+",Korean
+몸에 열이 안 빠지시는 거 같으세요?,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+"뭘 조금 먹으면 토하고 해서 못 먹었어요.
+",Korean
+"변이 검붉은색 일 때 있어요.
+",Korean
+약은 곧 처방전이 나올 겁니다.,Korean
+"점점 편두통이 심해지고 어지러워서 내원했습니다.
+",Korean
+구역감이 심하시면 촬영 중이라도 손을 드시기 바랍니다.,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+혈압이 높게 나오는 편인가요?,Korean
+환자 보관용 처방전 가져왔어요.,Korean
+경구 약제 투여에 어려움이 있으니 주사제를 비롯한 다른 약물로 교체해 드리겠습니다.,Korean
+수술이 가장 좋은 방법입니다만 고민하고 계신 이유가 있으신가요?,Korean
+어디 부은 데가 있나요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+약이 좀 독한 편이에요. 물을 많이드세요.,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+검사 결과로 바로 진단을 내리기는 어렵습니다.,Korean
+체중 변화도 관련이 있습니다.,Korean
+통증이 시작하면 기간이 얼마나 가요?,Korean
+두통이 심할 때도 있나요?,Korean
+여기 있는 휠체어가 환자분 소유인지 궁금해서요.,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+"운전하다가 다른 차 피하려고 핸들을 틀면서 가드레일에 박았는데 목이고 가슴이고 전체적으로 너무 아파요.
+",Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+네 검사 결과 기억하시나요?,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+네. 근데 혈중 암모니아 수치가 정확히 뭔가요?,Korean
+평소에 변은 잘 보세요?,Korean
+네. 주사 맞고 푹 쉴게요.,Korean
+복부가 많이 무겁게 느껴지나요?,Korean
+객담이 많은 거 같나요?,Korean
+몸이 피로하다는 생각을 해보신 적 있나요?,Korean
+지금 결핵 치료 약 드시는 중입니까?,Korean
+"다른 때와는 다르게 소변 색이 진하게 나왔어요.
+",Korean
+"지나가던 뱀한테 손을 물렸어요.
+",Korean
+영양제 수액 말고 다른 수액 맞으신 적 있으세요?,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+주위에 혹시 확진자나 자가격리자가 있나요?,Korean
+"네. 토만 하고 다른 증상은 없었어요.
+",Korean
+암 진단받아본 적 있으세요?,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+전에도 수액은 몇 번 맞은 적 있습니다.,Korean
+네 수술치료 후 예후가 좋은 질환입니다.,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+알레르기 반응일 수 있습니다.,Korean
+가슴 통증이 있진 않으신가요?,Korean
+금식을 하더라도 간혹 구역질이 날 수는 있어요.,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+"배에 통증을 느끼는 것 같아서 아침 일찍 병원으로 왔어요.
+",Korean
+숨 쉬는 건 안 힘들어요?,Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+"그냥 일반적인 변이였는데 일주일 전부터 혈변을 봤대요.
+",Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+금방 증상이 완화될 것입니다.,Korean
+수면 비용에는 건강보험이 적용되지 않아 만 원이 추가됩니다.,Korean
+"일주일 전에 테니스를 치다가 땅을 좀 세게 짚었는데 그때 뭐가 잘 못 됐는지 그때부터 아프더라고요.
+",Korean
+소독한 붕대를 감아 외부와 차단시킬 겁니다.,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+몸에 좋다고 아무 약이나 드시면 안 됩니다.,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+대변을 못 본 지 오래되셨나요?,Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+"목구멍이 사막일 정도로 물 한 모금도 안 먹었습니다.
+",Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+속이 메스꺼운 원인에 따라 차이가 있습니다.,Korean
+무릎 쪽에 통증이 있나요?,Korean
+"턱이 부드럽게 움직이질 않고 아프네요.
+",Korean
+약물로 당뇨 치료받고 계세요?,Korean
+테라마이신 연고를 두껍게 도포하면 효과가 더 좋습니다.,Korean
+일주일 기준 몇 번의 술을 섭취하시나요?,Korean
+체중 증가가 어느 정도죠?,Korean
+상처는 매일매일 회복속도가 다르기 때문에 꾸준히 체크해 보시는 게 좋습니다.,Korean
+통증이 나타난 게 언제인가요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+약 먹는 거 따로 없어요.,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+심장이 불규칙적으로 뛴다거나 한 적 있으세요?,Korean
+현재 건강상태에서 항생제를 세게 투약하면 면역체계가 무너집니다.,Korean
+"꼭 열두 시부터 금식해야 하나요?
+",Korean
+최근에 독감 주사 맞은 적 있나요?,Korean
+숨쉬기가 어려운 느낌이 드세요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+"사람이 많은 자리에 가면 식은땀이 나고 손발이 차가워지는 현상이 최근 들어 자주 나타나 오게 되었어요.
+",Korean
+"혈변은 아니었고 복통이 좀 있었어요.
+",Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+양치하실 때 피가 많이 나는 편이던가요?,Korean
+듣는 것에 문제가 있으신가요?,Korean
+알레르기 증상이 나타난 게 언제 처음이죠?,Korean
+결핵 검사 수치가 높은 편이신가요?,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+올해 초도 최근에 들어가면 독감 주사요.,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+네 헌혈 말고 수혈받아보신 적 있나요?,Korean
+"머리 전체가 어지러운 느낌이에요.
+",Korean
+작년에 출산했는데 그것도 상관이 있나요?,Korean
+한번 더 진단을 받으셔야 할 거 같아요.,Korean
+근 삼 개월간 살이 빠지셨어요?,Korean
+"기운이 없고 거동하기조차 힘들어요.
+",Korean
+유전적 질환은 다른 사람들보다 유전인자를 더 갖고 있어 질환 발병률이 높습니다.,Korean
+"아니요. 위가 안 좋아서 커피를 잘 못 마셔요.
+",Korean
+"위염 때문에 식생활이 불편해서요.
+",Korean
+넘어졌는데 기절해서 하루 입원한 적이 있어요.,Korean
+"소변볼 때 성기가 아파서요.
+",Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+과거에 결핵 진단받으신 적 있나요?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+아프기 시작한 지 좀 됐나요?,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+자연분만과 제왕절개에 따라 수술 방법이 달라질 수도 있습니다.,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+항생제는 식후에 위산분비 억제제는 식전에 드세요.,Korean
+예방주사 맞은 날짜를 알려주실래요?,Korean
+잠을 충분히 못 주무시나요?,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+"서 있기 힘들고 다리에 힘이 점점 빠지네요.
+",Korean
+"아기 낳고 산후조리원에서 나온 뒤로 쭉 집에만 있었거든요. 근데 어느 날부터인가 멍한 상태에서 갑자기 숨이 막혀서 죽을 것 같은 느낌이 들더라고요. 그래서 병원에 가봤는데 정신과 진료 한번 받아보라고 해서 오게 되었습니다.
+",Korean
+"변 모양은 유심히 살펴보지 않았는데 검붉은 색이더라고요.
+",Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+네. 항문이나 대장에 문제가 있을 수 있습니다.,Korean
+아니요. 지금은 수술 부위가 덧날 수가 있어서 조심하셔야 됩니다.,Korean
+일상생활 중에 알레르기 반응을 보이는 것이 있었나요?,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+일단은 진정 후 안정이 될 때까지는 입원하셔야 합니다.,Korean
+절대 간 적 없어요.,Korean
+언제 첫 증상이 나왔나요?,Korean
+맥 빠지는 느낌이 드나요?,Korean
+한 시간 전에 배 아픈 것 때문에 진경제 한 알 먹었어요. 부스코판.,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+손가락만이라도 움직인다면 회복 가능성이 있습니다.,Korean
+입원 외에 진찰이나 치료를 받기 위해 병원에서 방문한 곳을 말합니다.,Korean
+약도 꼬박꼬박 챙겨 드셔야 해요.,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+암을 앓고 계시는 가족분이 계시나요?,Korean
+뾰루지에 된장 바르는 거요.,Korean
+독감 백신 맞으러 내과 갔었어요.,Korean
+처음 통증 있었던 게 언제죠?,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+욕창은 오랜 병환의 상처이지 환자의 주요 질환이 아니지요.,Korean
+따로 약을 먹어야 생활이 가능하다던가 그랬나요?,Korean
+하루 담배 얼마나 피우세요?,Korean
+후에 필요하다면 재수술을 할 수도 있습니다.,Korean
+네. 지금 응급실에 진료 보고 계신 분은 안 계세요.,Korean
+날짜가 정확하지 않아도 됩니다. 무엇때문에 입원 하셨나요?,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+입원해서 치료받은 적 있어요?,Korean
+네 칼슘은 몸에서 중요하죠.,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+"기저귀 갈아주려고 보니까 아기 사타구니 쪽에 볼록한 게 튀어나와 있어서요.
+",Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+토할 때 피가 같이 나오나요?,Korean
+힘이 없고 늘 피로한가요?,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+환자분이 수술하러 가시면 문자 가게 해드릴까요? 수술 끝나고 회복실에 들어갔다는 문자가 가게 해드릴 수 있어요.,Korean
+몸살 기운이 있으신 거죠?,Korean
+어떤 약 처방 받으셨어요?,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+감기약 먹고 난 뒤에 그랬어요.,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+"소변볼 때 끝부분이 계속 따갑네요.
+",Korean
+원래는 안 그랬는데 최근에 무릎이 아프다고 계속 그러셨어요.,Korean
+목으로 피가 조금 올라오나요?,Korean
+"넘어지면서 손을 잘못 짚었어요.
+",Korean
+담배 피는 사람 있으면 말씀드리면 되는 거죠?,Korean
+네. 간접흡연도 몸에 안 좋은 영향을 많이 끼쳐요.,Korean
+"움직일 수 없을 정도로 배가 아파서 동네 병원에 ��는데 큰 병원 가보라고 해서 응급실로 왔어요.
+",Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+무릎 관절 쪽 아니었나요?,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+음주 빈도 말씀해 주시겠어요?,Korean
+의사분 호출하겠으니 잠시 기다려주세요.,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+흉터가 약간은 남을 거예요.,Korean
+가족들 중에 유전성 질환 때문에 아픈 사람 있나요?,Korean
+입원에 관련된 정보를 표기하는 데 있어 보호 여부를 말씀드리는 것입니다.,Korean
+"혈뇨의 양이 많지는 않아요.
+",Korean
+수술 걱정 안 하셔도 돼요. 환자분 건강하세요.,Korean
+통증 느낀 지 며칠 됐죠?,Korean
+예를 들어 어떤 통증인가요?,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+통증이 시작되면 쭉 가나요?,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+용종제거술 자체로 인한 통증은 드뭅니다.,Korean
+암을 진단 받으신 적 있나요?,Korean
+몸에서 거부반응이 일어나는 화학성분이 있나요?,Korean
+격리가 필요한 상황인지 판단해야 해서 검사를 받으셔야 합니다.,Korean
+환자분의 치료를 위해 사용되는 주사나 주사재료 중에 비급여 항목이 껴있을 수 있다는 걸 동의하는 거에요.,Korean
+저희 아이 피가 잘 안 멈춰요.,Korean
+암인 거 언제 아셨나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+네. 알레르기 약도 먹어요.,Korean
+의식 소실의 원인은 여러 가지가 있습니다.,Korean
+환자에 따라 다르지만 명시된 평균 권장 수면시간은 여덟 시간입니다.,Korean
+절대 누우면 안 됩니다.,Korean
+아프기 시작한 게 언제부터예요?,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+통증이 오는 곳이 있나요?,Korean
+보약이라면 어떤 것을 드시는지 여쭤봐도 될까요?,Korean
+스스로 열이 있다고 느껴지나요?,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+"배가 쑤시는 것처럼 아파요.
+",Korean
+흔히 맹장염이라고 하는 질환이고 충수돌기에 염증이 생긴 것을 말합니다.,Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+"이가 아파서인지 머리까지 아파요.
+",Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+"전자 담배로 바꿔 피운 것까지 포함이면 일 년이에요.
+",Korean
+약 먹고 속이 안 좋은 적은 있었어요.,Korean
+중간에 깨거나 잠 들기가 어려워서 수면 보조제의 도움을 받은 적 있으신가요?,Korean
+그런 일이 생기면 보통은 치료를 일시 중단합니다.,Korean
+알레르기 반응이 언제 보이나요?,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+혈액형이 다르게 나왔나 확인해볼까요?,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+"요즘 복통이 계속 있기도 하고 사람들이 안색이 너무 안 좋다고 해서 왔어요.
+",Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+아이 열이 이도 이상 떨어질 때까지 지금 상태 유지해 주세요.,Korean
+네 붉거나 부어오르지 않았습니다.,Korean
+"뭘 먹으면 소화가 안 돼서 병원 왔다가 입원했어요.
+",Korean
+이번 연도엔 예방 접종한 거 없어요.,Korean
+배뇨 장애가 있으신 거예요?,Korean
+가족 중에 누가 당뇨 있으시죠?,Korean
+급하게 수혈을 해야 되는 상황이 아니라면 크게 걱정 안 하셔도 됩니다.,Korean
+"요 근래 잠을 거의 못 자고 있어요. 약은 따로 안 먹고 있고요.
+",Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+금식은 계속 유지하시고 계시죠?,Korean
+힘드셨던 점 이해합니다. 동의서는 여기 보이는 전자동의서 형태로 작성할 예정입니다.,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+환자분의 의식이 회복되고 적절한 반사반응이 오는 것을 확인한 뒤에 의사 확인 후 금식을 해제할 수 있습니다.,Korean
+"어제는 혈변이나 그런 거 없었는데 오늘 피 나고 나서는 안 봐서 모르겠어요.
+",Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+아프다 안 아프다 하나요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+혹시 심장 장관계로 따로 시술을 받거나 페이스메이커 같은 보조 장비를 착용하고 계신가요?,Korean
+타 병원에서 분만하였을 시 저희 쪽에서 기록을 조회할 수 없습니다.,Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+수혈이란 게 남의 혈액을 자신의 몸속에 주입하는 치료법이라 할 수 있습니다.,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+안됩니다. 수액을 통해 수분이 공급되고 있으니 질환 치료를 위해 치료 과정에 잘 따라주세요.,Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+이제 무슨 검사를 할 거냐에 따라 다릅니다.,Korean
+불면증이 있는 것 같나요?,Korean
+머리에 외상은 없는데 충격이 있으셨다면 진료를 따로 받아 보시는 게 좋을 것 같네요.,Korean
+네. 갑상선 때문에 신지로이드 복용 중이에요.,Korean
+피부 상처 치료가 더 이상 필요 없을때 안정적이라고 할 수 있겠네요.,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+현기증 느낀 적 있었어요?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+감염 예방을 위해서라도 반드시 입원이 필요합니다.,Korean
+아니요 원래 약 효과로 조금은 찌지만 지금은 너무 많이 쪄서 한 번 진료를 받아야 할 것 같습니다.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+"잔뇨감이 심한 것 외에는 문제가 없어요.
+",Korean
+이번 분기 독감 예방 접종하셨나요?,Korean
+선생님 오시면 약에 대해 설명해 드리겠습니다.,Korean
+기침 가래 콧물 피가 가래가 나온다거나 하는 호흡기계 증상은 없으셨나요?,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+항생제 반응 검사를 진행해볼 수 있는데 해보시겠어요?,Korean
+"분유 토하다가 색이 점점 연해지는 토를 했어요.
+",Korean
+약을 먹고 있긴 한데 별 효과가 없어요.,Korean
+흔하지 않지만 대장암과 같은 질환 가능성도 있습니다.,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+악성종양으로 진단 받으신적이 언제인가요?,Korean
+병원에 입원 및 수술로 방문한적 있으신가요?,Korean
+수술적 치료도 우선 고려해 볼 수 있지만 위험성이 낮은 도수 정복으로 해결하는 것이 바람직합니다.,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+안면신경과 연관 있을 수 있습니다.,Korean
+간염으로 드시는 약 있으세요?,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+"""아직 정확한 진단이 되지 않았으니, 미리 걱정하지 않으셔도 됩니다.""",Korean
+"두 번째랑 세 번째 손가락이요.
+",Korean
+결핵약 지금도 드시고 계시나요?,Korean
+"네. 제발 처방해주세요. 너무 힘들어요.
+",Korean
+알레르기 반응으로 피하는 특정 조건이 있어요?,Korean
+위중한 질환일 수 있지만 지금 속단하긴 이릅니다.,Korean
+아픈 게 심하게 느껴지나요?,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+입으로 피를 토한 적이 있나요?,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+기침할 때 가래가 같이 나오나요?,Korean
+가래가 얼마나 많이 나오나요?,Korean
+토할 때 피도 나왔나요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+염증 수치는 많이 안 좋은가요?,Korean
+최근에 당뇨 검사를 받은 적이 있나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+알레르기 때문에 피하는 음식이 있으세요?,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+"왼쪽 세 번째 손가락 부분이요.
+",Korean
+가래에 피도 같이 나온적 있나요?,Korean
+여태껏 체크했던 것 이외의 알레르기가 있다면 말해주세요.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+저희 아버지가 간암을 앓았네요.,Korean
+통증 생긴 지는 얼마나 됐나요?,Korean
+네. 제가 영양실조에 잘 걸려서 입원할 때가 있는데 저번 주에 그랬습니다.,Korean
+몸에 계속 열이 나나요?,Korean
+수술하는 경우도 있고 수술없이 치료만 받는 경우도 있습니다.,Korean
+"저 소변에 거품이 껴요.
+",Korean
+"냉장고에 부딪혀서 그 후로 쭉 어깨가 너무 아픈 것 같아요.
+",Korean
+하부 요관결석의 경우 배뇨통 빈뇨 잔뇨감 하복통 외성기 부위 통증을 유발하기도 합니다.,Korean
+아니요. 가능합니다. 잠시 후 소변 줄을 제거하고 소변을 보시면 됩니다.,Korean
+심각하다기보다는 정밀 검사가 필요합니다.,Korean
+네. 여�� 시간 금식 후 혈당을 측정하였을 때 백이십오 밀리그램 퍼 데시리터였어요.,Korean
+민간요법이 병원에서 행해지는 양의학에 방해가 될 수 있어서 여쭤보았습니다.,Korean
+변비로 고생하신 적은 없으시죠?,Korean
+그 몸살 때문에 무슨 주사 놔주시긴 했는데 그거 말곤 없어요.,Korean
+담배 피운 기간이 오래됐나요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+"소변을 보면 색이 붉은 빛이 돌더라고요.
+",Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+본인 치아와 보조 치아가 몇 개인지 확인하는 거예요.,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+최대한 빠른 시일 내에 치료를 시작해야 합니다.,Korean
+아니요 아직 붓기가 있는 거 같네요.,Korean
+당은 잘 관리 되고 있나요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+흡연 기간 대략적으로 알려주세요.,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+야간 약국은 본원 후문에 있습니다.,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+병의 정도는 검사 결과와 말씀하신 증상을 바탕으로 알려 드릴 수 있습니다.,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+"배도 안 아프고 혈변도 없어요. 변 색깔은 황갈색이에요.
+",Korean
+선천적으로 장의 특정 부위에 신경이 제대로 분포되지 않아 정상적으로 움직이지 못하는 질환입니다.,Korean
+지금 드시는 약과 상충되지 않는 약을 처방하려고 여쭤봤습니다.,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+소화될 때 어려움이 있나요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+동네 약국에서 수령해도 됩니다.,Korean
+평소에도 자주 입술이 건조해지시나요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+독감 접종 언제 맞으신 거죠?,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+혈변을 보시면 피가 얼만큼 섞여 나오는 거 같나요?,Korean
+환자분 남은 검사가 많으셔서 천천히보다는 좀 빨리 보시는 게 좋겠네요.,Korean
+발기부전약 드신 적은 있나요?,Korean
+"목이 좀 불편한데 호전될 기미를 안 보여서요.
+",Korean
+통증은 주로 언제 오나요?,Korean
+최근 몇 달 동안 체중 변화는 없었나요?,Korean
+오한 증상 나타난지 며칠 되었죠?,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+수술적 치료 시행과  합병증 발생 여부에 따라 차이가 생길 수 있지만 짧으면 삼일에서 오일 정도 예상할 수 있습니다.,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+최근 몸무게가 어떻게 달라졌나요?,Korean
+배에 가스가 많이 차있나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+당뇨 확인은 언제 하셨죠?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+한 세 달 전 쯤에 독감 주사 맞았어요.,Korean
+담배 언제 처음 피웠어요?,Korean
+"열이 며칠째 지속되고 있어서 왔습니다.
+",Korean
+네 희귀병이라 할 수 있죠.,Korean
+철저한 무염식은 반대로 위험한 상황을 초래할 수 있습니다. 너무 장기간 하지는 말아 주세요.,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+수술 후 재활은 얼마나 걸리나요?,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+계속 고혈압약 먹고 있습니다.,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+소변을 보고 싶어도 못 보신 적이 있으신가요?,Korean
+네 비타민을 드시는 이유가 있으신가요?,Korean
+두드러기 등 알레르기 일으키는 성분 아시나요?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+음주량 좀 알려 줘요.,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+이제 퇴원하네요. 덕분에 편하게 입원 생활하다가 나갑니다.,Korean
+전 병원에서 주로 어떤 치료했어요?,Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+원래 앓고 계시던 병변이신가요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+치과 치료는 받았는데 다른 건 없었어요.,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+대변을 자주 보게 되는 증상도 ��함됩니다. 그리고 그 외 대변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+배뇨일지를 분석하는 데 있어서 소변량 측정이 중요하므로 재차 확인한 것입니다.,Korean
+새로 처방하는 약에 다 들어가 있을 거예요.,Korean
+당뇨 약 복용하고 계신가요?,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+변비로 인해 항문이 막힌 경우 범람성 설사가 나타나기도 합니다.,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+"배변이 늘 어려워요. 웬만한 변비약도 안 들고.
+",Korean
+이전 기록을 알아야 앞으로의 진료 방향에 대해 결정할 수가 있어서요.,Korean
+혈압 측정은 시급한 문제라 오늘 해야 합니다.,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+최근 들어 아프기 시작했나요?,Korean
+사람에 따라 감염에 대한 반응이 다를 수 있습니다.,Korean
+"지금 항문이 제일 아파요.
+",Korean
+심장이 마구 빨리 뛰나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+네 마스크 착용이 중요합니다.,Korean
+요즘 독감 유행인데 백신은 접종하셨나요?,Korean
+똥을 그냥 여기서 싸라는 건가요?,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+"다른 곳 아픈 데는 없는 것 같아요.
+",Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+주사를 맞아야 치료가 가능한데 저번에 어떤 부작용이 있으셨죠?,Korean
+한달에 술을 얼마나 드시나요?,Korean
+약 효과가 나오려면 여섯 시간 이상은 기다려야 해요.,Korean
+여기 빨간색 호출 벨을 누르셔서 간호사를 불러주세요.,Korean
+대변 잘 못 보세요?,Korean
+검사 진행 후 약 처방 드리려는데 괜찮으실까요?,Korean
+심장이 안 좋아서 페이스메이커 달았어요.,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+우유를 소화 못 시켜요.,Korean
+퇴원 수속하실 때 원무과에 말씀해 주세요.,Korean
+"누렇고 찐득찐득한 가래가 많이 나와요.
+",Korean
+어떤 식으로 통증이 있으신지 설명해 주실 수 있나요?,Korean
+최근에 체중에 변화가 있나요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+"대변 보고 물 내리는데 보니까 피가 흥건했어요.
+",Korean
+가슴이 아프거나 하지는 않으셨어요?,Korean
+담배 피운 기간이 어느 정도 되세요?,Korean
+드셔도 되는데 카페인을 너무 많이 드시면 위장에도 안 좋고 줄이시는 게 좋겠습니다.,Korean
+통증이 좀 강한 편이에요?,Korean
+처방이 언제 나올지 궁금합니다.,Korean
+한의학 외에 다른 건 없으셨나요?,Korean
+호르몬 검사를 한 번 해볼까요?,Korean
+수면제는 꾸준히 드시는 건가요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+현재 당뇨 앓고 계신 분이 있나요?,Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+삼 개월 전까지 드신 보약이 있다면 말씀해 주세요.,Korean
+"신물을 토할 때까지 구토를 해요.
+",Korean
+몸에 힘이 없고 무력한가요?,Korean
+약품 검사는 오래 안 걸려요.,Korean
+"아무것도 안 해도 머리만 대면 코 골고 자는데요.
+",Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+복부에 많은 고통이 동반되나요?,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+항상 두드러기 증상이 있나요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+병원 옮길 수밖에 없네요.,Korean
+결핵은 어떻게 하고 계시죠?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+"애가 밤새 배 잡고 울었거든요. 아무래도 배에 이상이 생긴 것 같아요.
+",Korean
+우측 엉치뼈 부위에 병변이 관찰됩니다.,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+"뱀이 제 왼쪽 손을 물어서요.
+",Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+가슴 통증의 원인으로는 심혈관 호흡기 소화기 근골격 심인성 등의 다양한 원인이 있을 수 있습니다.,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+객담이 많은 거 같나요?,Korean
+간염이 활동성인지 비 활동성인지 들으신 적 없으시군요.,Korean
+배에 아직 부기가 안 빠져서 그런 걸 수도 ��습니다.,Korean
+"수면 시간도 늘어나고 안 자던 낮잠도 시간만 나면 자네요.
+",Korean
+상부위장관 내시경 검사가 필요합니다. 내시경으로 출혈 여부와 정도를 확인하고 지혈을 시도할 수 있습니다.,Korean
+빠르게 할 경우 혈관통이 발생할 수 있습니다.,Korean
+"식중독 때문에 병원에 입원했어요.
+",Korean
+그럼 그 약을 왜 드시는지 설명해 주실 수 있으실까요?,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+어제보다 배가 많이 부어올랐나요?,Korean
+진통제 없으면 밤에 잠을 못 자니 꼬박꼬박 복용했어요.,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+오늘 아직 아침밖에 못 먹었는데 얼마나 더 금식해야 할까요?,Korean
+"요즘은 대소변 보는 게 비교적 힘든 것 같아요.
+",Korean
+"종종 대변볼 때 피가 보여요.
+",Korean
+"허리 등 다리 다 아파요. 허리는 욱신거립니다.
+",Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+확인 결과 오형 맞습니다.,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+변을 볼 때마다 피가 묻어나나요?,Korean
+수술 시 과다출혈 등의 문제가 있으면 받아야 할 수도 있습니다.,Korean
+기침을 얼마나 많이 하시죠?,Korean
+네. 알러지가 꽤 자주 납니다.,Korean
+드시는 결핵약 이름이 뭔가요?,Korean
+재활 교육을 일 회 받아보시는 건 어떠실까요?,Korean
+"변비가 있어서 변비약을 복용 중이에요.
+",Korean
+염증 수치가 다소 높게 나왔습니다.,Korean
+네. 여기 보시는 이 부분이 변이 차있는 부분입니다.,Korean
+각 병실 문 앞에 소화전이 비치되어 있고 낙상 예방을 위해서 항상 사이드 레일은 올려주세요.,Korean
+"흡연 음주 둘 다 하는데 술을 더 많이 마셔요.
+",Korean
+일 년 전부터 고혈압 징조가 보였는데 최근에는 혈압이 훅 올랐다가 떨어졌다가 하네요.,Korean
+최근 결핵 백신 접종했나요?,Korean
+네 건강에 해를 끼칠 수 있는 위험요소가 배제된 거니까요.,Korean
+아니요. 의료진들이 환자분에게 적합한 치료를 진행하고 있으니 걱정하지 않으셔도 됩니다.,Korean
+한달에 술을 얼마나 드시나요?,Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+"분유 토하다가 색이 점점 연해지는 토를 했어요.
+",Korean
+다른 원인에 의해 저린감이 있을 수도 있습니다.,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+물만 먹어도 설사가 나오나요?,Korean
+장폐색으로 인한 구토라면 약물 치료보다 다른 방법을 고려해 봐야 합니다.,Korean
+"애가 열이 많이 올랐는데 나을 기미가 보이질 않네요. 한 번 봐주세요.
+",Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+수혈 관련해서는 주치의 상담 할 수 있도록 하겠습니다.,Korean
+재생 정도에 따라 수술이나 추가 시술이 필요하여 정확히 말씀드릴 수는 없습니다.,Korean
+"요관 결석이 의심된다고 하셨어요.
+",Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+검사를 해봐야 할 것 같아서 조금만 참아주세요.,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+담배는 몇 살부터 하셨나요?,Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+음주나 비만이 가장 흔한 원인입니다.,Korean
+알코올성 간 질환으로 한동안 입원했었어요.,Korean
+수면 환경 스트레스 음식 섭취 야뇨증 등이 있지요.,Korean
+당이 좀 높다고 하더라고요.,Korean
+네 그럼 안구 건조증만 있는 거죠?,Korean
+기능성 소화불량의 경우 보존적 치료로 개선되는 경우가 많습니다.,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+약이 너무 역해서 참을 수가 없더라고요. 살짝 했어요.,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+전신 마취로 진행했을 거예요. 아마.,Korean
+가슴이 벌렁거리는 건 괜찮으신가요?,Korean
+죽을 만큼 통증이 심한가요?,Korean
+스트레스 받으면 설사 하나요?,Korean
+거품뇨는 사람마다 정도가 다르기 때문에 정확한 양을 측정하기는 어려우며 평상시보다 거품이 많이 나오거나 일정 시간이 지나도 거품이 없어지지 않는 경우를 말합니다.,Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+출혈과 연관이 있을 수 있습니다.,Korean
+발기 부전 관련해서 치료를 받으신 적이 있나요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+혈액검사는 간호사분께서 도와주실 거예요. 의사 선생님께 직접 검사받고 싶으신가요?,Korean
+어디가 제일 많이 붓나요?,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+혈압 수치가 높다는 판정은 언제쯤 받았어요?,Korean
+다른 마취제를 쓰도록 하겠습니다.,Korean
+알레르기 반응은 언제 처음 나타났나요?,Korean
+"네. 잠이 잘 안 드네요.
+",Korean
+다른 약은 없으시고 간염약만 드세요?,Korean
+치료 방법이나 처치에 따라 입원 기간이 수개월 이상 걸릴 수 있습니다.,Korean
+"아마 심장 쪽 관련해서일 겁니다. 아버지가 심장병으로 돌아가셔서.
+",Korean
+진료 중 주사치료를 받은 적이 있나요? 환자분?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+간염으로 치료 받고 있나요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+신물이 넘어오는 이유는 위식도역류질환이 대표적입니다.,Korean
+토혈이 나타난 건 언제인가요?,Korean
+피는 변에 묻어 나오는 정도였나요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+몇 년도에 제왕절개 하셨나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+영양제 유산균이랑 비타민 먹고 있어요.,Korean
+네 주로 면역력이 생기면 재발 위험도가 줄어듭니다.,Korean
+담배는 몇 살부터 몇 살까지 피우게 되셨나요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+통증이 있는지 알고 싶어요.,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+환자분께 직접 확인해야 정확합니다.,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+네. 암 초기 진단받아서 병원 통원 치료하고 있어요.,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+조금이라도 어지러운 거 같으면 혼자 일어서지 마시고 콜벨 눌러주세요.,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+가래 상태가 많이 심한가요?,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+생리 식염수를 이용해서 화상 부위를 닦아내고 있습니다.,Korean
+통증이 중간에 괜찮아지지 않나요?,Korean
+변이 잘 안 나오나요?,Korean
+나팔관을 자르고 묶는 수술입니다.,Korean
+담당 간호사에게 미리 말씀하시면 준비하겠습니다.,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+치료 당일에 오시면 됩니다.,Korean
+"가족들이 다 비염이 있어서 애용하고 있어요.
+",Korean
+"교통사고가 나서 다리뼈가 으스러진 거 같아요.
+",Korean
+입원 외에 진찰이나 치료를 받기 위해 병원에서 방문한 곳을 말합니다.,Korean
+항암 치료한 지 얼마나 되었나요?,Korean
+네 예방적 항생제는 미리 항생제를 놓는 겁니다.,Korean
+얼굴 모양의 변형이 오면 그걸 바르게 잡아 주는 수술을 말합니다.,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+홍길동인데 환자 번호랑 맞는지 봐 주세요.,Korean
+피부가 제 기능을 다 하는 상태로 돌아가는 것입니다.,Korean
+가족 중에 암수치가 높으셔서 문제였던 분이 있나요?,Korean
+네 보호자에게도 설명 후 서명할 동의서가 있습니다.,Korean
+건강 상태 파악을 위해 기본 정보 수집이라고 생각하시면 됩니다.,Korean
+네 병원에 몇 시쯤 도착하셨나요?,Korean
+할머니가 암 진단을 받으신 것 같아요.,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+담배 하루에 얼마나 태우세요?,Korean
+"무릎 중에서도 위쪽이 아파요.
+",Korean
+오늘 내원하신 이유는 뭔가요?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+"자꾸 끊기면서 소변이 나오네요.
+",Korean
+근래에 체중 증가가 있으신가요?,Korean
+지난달에 저는 파상풍 예방주사 접종 받았습니다.,Korean
+소변량이 체중에 맞게 잘 나오는 것이 확인되고 수액 치료를 통해 질환의 치료가 적절히 이뤄질 때까지 지속적인 소변량 검사가 필요합니다.,Korean
+기침할 때 증상이 어떤가요?,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+수술해준 병원에 물어봐야 알죠.,Korean
+작년에 건강검진을 받았는데 위궤양 진단을 받고 한창 약도 복용했었거든요.,Korean
+목으로 피가 조금 올라오��요?,Korean
+"심장에 이상이 있다고 알고 있습니다.
+",Korean
+"목이 아파서 사과 주스만 마시고 왔어요.
+",Korean
+아니요 일주일 이내에 드신 약만 말씀해주세요.,Korean
+온몸이 기운 빠지 듯 무력하나요?,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+검사 결과를 통해 정확한 진단과 처방을 내릴 수 있습니다.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+수혈 거부 시 의사 상담 후 동의서 작성이 필요합니다.,Korean
+당뇨 수치가 얼마 나왔죠?,Korean
+"치아 교정 중이어서 미음을 좀 자주 먹었어요.
+",Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+몸에서 알레르기 반응 일으키는 음식이 있나요?,Korean
+암 있는 건 언제 아셨나요?,Korean
+간염 관련 약을 드시고 계시나요?,Korean
+"벌에 쏘인 곳이 빨갛게 부풀어 올랐어요.
+",Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+기타 다른 알레르기 질환 있으신가요?,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+소독 부위는 절대 만지면 안 됩니다.,Korean
+평소대로 숨을 쉬면 폐포에 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+요즘 먹고 있는 약이 있나요?,Korean
+병원이다 보니 개인정보 제공에 동의해 주셔야 합니다.,Korean
+네. 결핵이랑 연결이 되어 문제가 됩니다.,Korean
+내시경 검사와 증상을 종합적으로 판단하여 병의 정도를 판단합니다.,Korean
+원래 좀 구토 증상이 자주 있으신가요?,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+가스가 많이 차도 주변 장기를 누르는 경우는 흔치 않습니다.,Korean
+배변의 어려움이 어떤 식으로 있나요?,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+혈압약이랑 당뇨약을 드셨던 거 같아요.,Korean
+배에 가스 차는 느낌이 자주 있나요?,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+소변이 시원하게 나오지 않나요?,Korean
+진통제 부작용일 수 있어요.,Korean
+"술은 자주 마시는데 흡연은 주변에서 권하면 못 이겨 하는 편이에요.
+",Korean
+지금도 가슴에 통증이 있나요?,Korean
+혈액 내에 필요 이상의 지방 성분이 있다는 뜻이고 이제 이 문제를 어떻게 해결할지 저와 상의해 봅시다.,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+처음 이 증상이 나온 게 언제인가요?,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+"움직이고 싶어도 못 움직이겠어요.
+",Korean
+가슴 통증이 있지는 않나요?,Korean
+뇌 관련 진단은 받아본 적이 없어요.,Korean
+통증이 생긴 지 오래되셨어요?,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+부끄럽지만 삼 년째 탈모 약 복용하고 있습니다.,Korean
+네. 아버지가 혈압이 매우 높으세요.,Korean
+간염약이 치료에 도움이 됐나요?,Korean
+"만성신부전인데 요즘 또 증상이 있어서요.
+",Korean
+통증 때문에 잠을 못 자시나요?,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+다른 종류의 진통제를 놔드릴게요.,Korean
+"저도 자세히 모르겠는데 환자에게 물어보고 와도 될까요?
+",Korean
+"혼자 병원에 오기가 힘들어서요.
+",Korean
+한 달 동안 다녀온 의료기관을 기록해야 합니다.,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+"배가 너무 아파서 생활이 안 돼요.
+",Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+별다른 약은 먹고 있지 않아요.,Korean
+연고는 병원에서 판매하는 제품이기 때문에 보험처리가 되지 않아요.,Korean
+토를 심하게 한 적이 있나요?,Korean
+토혈을 하고 통증이 있나요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+가족 중에 고혈압이 있는 분이 계신가요?,Korean
+그럼 최근 몇 달 동안 체중이 그만큼 오른 건가요?,Korean
+약품 확인 후 바로 드릴게요.,Korean
+최근에 체중에 변화가 있나요?,Korean
+어디가 제일 많이 붓나요?,Korean
+네. 삼 월달에 수술했어요.,Korean
+숨이 찬 증상이 나타납니까?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+결핵 백신 주사를 맞았나요?,Korean
+네 복용 중인 약 정보는 굉장히 중요합니다.,Korean
+얼마 동�� 아팠다가 괜찮아지나요?,Korean
+대장항문외과 외래로 방문 시 진료를 얼마나 기다려야 할까요?,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+지방 위주의 식사를 할 경우 해당되며 특히 육류 계란 노른자 치즈 등과 같은 동물성 지방 식품을 많이 섭취하는 경우 혈중 콜레스테롤 농도가 높아집니다.,Korean
+목 안에서 통증이 느껴지나요?,Korean
+네. 약한 빈혈이 있어요.,Korean
+목이 자주 붓긴 하는데요.,Korean
+복통 증상은 언제부터 있었나요?,Korean
+속이 쓰려서 제산제 먹었어요.,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+수술 방법과 수술 후 통증 관리에 대해 설명 들으시고 질문하시면 됩니다. 혹시라도 설명을 들었는데도 모르겠거나 궁금한 사항이 있으시면 다시 설명해드리겠습니다.,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+어디가 제일 많이 붓나요?,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+부모님께서 앓으시는 병이 있나요?,Korean
+피를 토해서 놀라신 적 있나요?,Korean
+"짠 게 건강에 안 좋다고 해서 싱겁게 먹어요.
+",Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+사람의 독감이 강아지에게 옮기기도 합니다.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+요의는 있는데 소변이 나오지는 않았던 적이 있었나요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+지금은 무슨 약 드세요?,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+검사 전에 식사를 하시면 결과에 오류가 발생할 수 있습니다.,Korean
+재수술 후 미용수술을 하더라도 완치가 된다고 말씀드리기는 어렵습니다.,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+"네. 왼쪽 눈 윗부분입니다.
+",Korean
+당뇨로 검사받으신 지 얼마 되었나요?,Korean
+스스로 열이 있다고 느껴지나요?,Korean
+"자기 전 요가를 간단하게 해요.
+",Korean
+평상시에는 배가 아픈 일이 없었나요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+알레르기 유발하는 음식 말해봐요.,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+코로나 관련 문진표를 채워주세요.,Korean
+검사를 해서 정확한 상태를 알아야 답변을 드릴수가 있을 것 같습니다.,Korean
+긁으면 덧날 수 있으니 아이스팩을 드릴게요.,Korean
+속이 더부룩해서 식사를 못 할 정도인가요?,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+아마 전신마취로 했을 거예요.,Korean
+"혈뇨가 있어서 병원에 왔어요.
+",Korean
+가글은 가능하지만 삼키지 않도록 매우 주의해주세요.,Korean
+가정에서는 빨간약이라고 부르는 포비돈 요오드를 사용하기도 합니다.,Korean
+퇴원 후 증상이 생기거나 불편한 점이 발생하면 비뇨기과 외래 혹은 응급실로 내원하셔야 합니다.,Korean
+"얼마 전에 고혈압 진단받았는데 이젠 귀까지 아파서요.
+",Korean
+환자분의 기억력 테스트를 위함이므로 다시 한번 말씀 부탁드립니다.,Korean
+딱히 약물 알레르기는 없었던 것 같아요.,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+기간 상관 없이 모든 입원내용 알려주세요.,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+초음파상으로 보이는 가운데 부위가 알고 계신 부위와 동일합니다.,Korean
+술 먹는 빈도가 빈번한가요?,Korean
+현재 검사도 일치하는데 재검을 원하시는 이유가 있으신가요?,Korean
+드시는 간염약 약품명 아시나요?,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+네. 입원생활 안내문을 확인하셨다는 서류가 필요해요.,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+괜찮습니다. 혹시 약 외래 처방받은 거 드시는 중이신 건가요?,Korean
+간 염증 수치가 높으신가요?,Korean
+피부관리실은 다녀봤는데 피부과 치료는 처음 받아봐요.,Korean
+오늘 오후 중으로 퇴원가능합니다.,Korean
+접종도 맞았고 이 주 전에 포상 휴가로 해외에 다녀왔어요.,Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+약을 끊은 이유가 있으세요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+통증을 참을 수 있나요?,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+요새 피곤해서 비타민 디만 먹고 있어요.,Korean
+간염은 언제 진단 받으셨나요?,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+장염은 세균성과 바이러스성으로 나눌 수 있는데 세균성 장염은 복통이 훨씬 심할 수 있습니다.,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+결핵치료는 어떤 치료를 하셨나요?,Korean
+여기 보시면 음낭 쪽에 물이 고여 부풀어 올라 있는 것이 있는데 이것이 음낭 수종이에요.,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+입으로 피 토한 증상 있나요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+"아이가 항문 부분이 아프다고 계속 손이 가길래 이상이 있나 해서 왔어요.
+",Korean
+바이러스 때문에 확인을 해야 해서요.,Korean
+그것은 헌혈입니다. 수혈을 질문 드렸어요.,Korean
+담배 피운 기간이 오래되었나요?,Korean
+몸에 갑자기 열이 나나요?,Korean
+가슴 조이는 느낌이 얼마나 자주 있나요?,Korean
+"기침을 심하게 하고 가끔 피가 나와요.
+",Korean
+불면증이 생긴 이유가 있을까요?,Korean
+일주일에 몇 번이나 아프세요?,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+최근에 오한이 있던 적이 있나요?,Korean
+피가 섞인 소변이 나오나요?,Korean
+"변비가 심해서 배가 가스가 가득해요.
+",Korean
+가족 중 고혈압을 앓는 분이 있나요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+네. 진료 시 자세히 들으실 수 있을 거예요.,Korean
+일주일 치 처방해드리고 다음 주에 뵙겠습니다.,Korean
+확인 차 질문 드린 겁니다. 수술 여부 결정은 담당 주치의 통해 결정 납니다.,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+입원이나 수술받으신 적 있으면 말씀해 주세요.,Korean
+당뇨가 집안 내력인 거죠?,Korean
+옆 사람이 본인의 심장 소리가 들릴 정도인가요?,Korean
+밴드는 검사 부위에 피가 계속 나면  붙여 드릴게요.,Korean
+인플루엔자 백신은 마지막으로 맞으신 게 언제인지 알 수 있을까요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+먼지 등 알레르기 요인이 있나요?,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+통증이 얼마나 가는 거예요?,Korean
+의사 처방 없이 드시는 건 위험합니다.,Korean
+추워서 몸이 덜덜 떨리고 있어요.,Korean
+"항상 과민반응하는 경향이 있었어요.
+",Korean
+집안에 당뇨 환자 있나요?,Korean
+수술받은 적 있으면 알려주세요.,Korean
+신경 치료 치아가 몇 개인가요?,Korean
+"전 허리 아파서 무거운 거 안 들어요.
+",Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+대변 잘 못 보세요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+다른 치료하신 거도 있으신가요?,Korean
+면역요법은 기간은 길지만 치료방법이 힘들지는 않습니다.,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+혹시 소변에 피가 나왔나요?,Korean
+"소화가 잘 안 되고 토를 하고 며칠 전 쓰러지기도 했어요.
+",Korean
+통증을 느끼는 부위가 어디예요?,Korean
+이런 증상은 굉장히 흔합니다.,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+레이저 치료가 끝난 뒤에 통증이 유발되는 경우도 가끔 있습니다.,Korean
+"밤에 오래 못 자니. 낮에 자야 해요.
+",Korean
+상해로 입원하신 적이 있나요?,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+아까 열 체크 했어요. 또 체크 하나요?,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+마지막 호흡곤란이 온 게 언제였죠?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+맥박이 비정상��으로 빨리 뛰나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+키와 체중에 비교했을 경우 지극히 정상입니다.,Korean
+팔도 골절이 의심되어서 현재 부목을 대 드릴 거예요.,Korean
+"계속 어지럽더니 갑자기 정신을 잃고 쓰러져서 응급실 오게 됐어요.
+",Korean
+의사 선생님 보고 왔어요.,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+잠이 쉽게 오지 않나요?,Korean
+팔부분이 어떻게 불편하신지 정확히 표현해보시겠어요?,Korean
+지난 금요일에 눈병에 걸려서 병원 갔었어요.,Korean
+이 약이 바닥에 떨어져 있었어요.,Korean
+입으로 숨 쉬는 것에는 무리가 없으신가요?,Korean
+검사 결과는 일 이 주 정도 소요됩니다.,Korean
+최근에 입원 치료를 받은 적이 있나요?,Korean
+네. 친가 쪽으로 암 진단받을 확률이 높대요.,Korean
+수면 내시경이 있지만 직장 내시경은 대장 내시경보다 수월하여 비수면으로 하기도 합니다.,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+통증이 오는 곳이 있나요?,Korean
+결핵 백신 접종을 하셨나요?,Korean
+간염 판정은 언제 받았나요?,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+"하루에 세 번 정도 설사해요.
+",Korean
+네. 우선 검사를 하실 수도 있어 금식을 유지하셔야 할 것 같습니다.,Korean
+오전 열 시쯤인가 그때 먹이고 열이 안 떨어져서 왔어요.,Korean
+그것 말고도 바디바바디바형 등의 혈액형도 포함돼요.,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+"무언가 넘어 삼키고는 괴로워하는데 뭘 삼켰는지를 모르겠어요.
+",Korean
+현재 당뇨 수치가 높으신 편인가요?,Korean
+아니요. 저는 수술해본 적이 태어나서 단 한 번도 없어요.,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+암으로 치료 중인 분이 가족 중에 있으세요?,Korean
+알레르기가 올라오는 음식이 있나요?,Korean
+변이 묽게 나오는 등 배변 습관 변화는 장의 기질적 변화를 시사하는 소견입니다.,Korean
+자연분만과 제왕절개에 따라 수술 방법이 달라질 수도 있습니다.,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+"울렁거리는 증상도 있고 처음엔 감기 증상인 거 같아서 해열진통제만 먹었는데 열이 안 떨어지고 옆구리가 계속 아파서 왔어요.
+",Korean
+입원에 관련된 정보를 표기하는 데 있어 보호 여부를 말씀드리는 것입니다.,Korean
+검사를 할 때 공복이어야 할 수 있는 검사들이 있어서요.,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+네. 중학생 때부터 빈혈로 정기검진받고 있어요.,Korean
+술은 며칠 간격으로 마시나요?,Korean
+"하루 종일 서서 일해서 그런지 종아리 아래로 다 붓는 것 같아요.
+",Korean
+예방 접종 부작용이 보통 일주일 이내 나타나기 때문에 간격을 두고 주사를 맞아야 합니다.,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+지금 상태를 정확하게 판단하고 치료를 진행하기 위해 몇 가지 검사를 추가적으로 진행한 이후에 말씀드리도록 하겠습니다.,Korean
+저희 큰형이 결핵으로 작년에 사망했습니다.,Korean
+네. 엑스레이를 통해 대략적인 가스와 변의 양상은 확인이 가능합니다.,Korean
+알레르기 반응을 일으키는 약은 없나요?,Korean
+"작업 중에 그라인더에 긁혔거든요. 그냥 작업실에 있는 약 바르고 다시 작업했는데 사흘 전부터 인가 거기서 진물이 나오더니 지금은 좀 아파요.
+",Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+담배를 피우기 시작한 게 언제예요?,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+네. 얼마 전에 건강 검진받다가 당뇨가 있다는 걸 알게 됐어요.,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+입맛이 없어 음식물 섭취에 어려움이 있으신가요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+알레��기 반응으로 피하는 특정 조건이 있어요?,Korean
+통증이 언제부터 시작되었는지 알려주세요.,Korean
+마취 풀린 이후에는 상관없습니다.,Korean
+네. 연고는 끝까지 다 바르세요.,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+대변이 잘 안 나오나요?,Korean
+소화하는 데 문제는 없나요?,Korean
+네. 전조증상 있는 병입니다.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+"갑자기 하혈을 심하게 하고 있어요.
+",Korean
+결핵약은 어떤 거 드세요?,Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+수술 일정이 나오면 입원 후 수술하시고 회복 후 퇴원하시게 될 겁니다.,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+고통이 몇 시간 동안 있나요?,Korean
+혹시 궁금하시거나 걱정되시는 부분이 있으시면 내시경 진행 전에 물어보세요.,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+"가래 동반한 기침이 나고요. 목도 심하게 아파요.
+",Korean
+보통 지속적인 치료를 위해서 경구약제를 사용하지만 급성기에는 다른 계통의 약물 투여도 고려해 볼 수 있습니다.,Korean
+금식을 하지 않으면 수술 중 위 내용물이 역류할 수 있습니다.,Korean
+어느 정도로 아프신지 표현이 가능하세요?,Korean
+심장이 벌렁대는 느낌이 있나요?,Korean
+수술은 해본 적이 없고 입원만 해봤습니다.,Korean
+"손가락이 심하게 꺾여서 왔어요.
+",Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+"약으로는 증상이 호전될 기미가 안 보여서 오게 됐어요.
+",Korean
+평소보다 통증이 더 강한가요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+몸무게 최근에 재셨더라도 다시 한번 측정할게요.,Korean
+당연히 소독 붕대 있죠.,Korean
+"쓰러지기 전엔 더부룩하고 토할 것 같았어요.
+",Korean
+휠체어에 앉아서 기다리시면 됩니다.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+당뇨라고 들으신 적이 있나요?,Korean
+"뭘 잘못 먹었는지 계속 토가 나오려고 해요.
+",Korean
+호흡할 때 산소가 부족한 느낌이 드시나요?,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+"아 저 오른쪽 어깨가 움직일 때마다 통증이 있어서요.
+",Korean
+선천성 기형이나 후천성 기형 상관없이 기형이라면 말씀해 주세요.,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+"아기가 팔을 움직이거나 제가 팔을 조금만 건드려도 막 자지러지게 울어요. 팔도 많이 부었고요. 혹시 팔 부러진 건 아니겠죠?
+",Korean
+장기이식 수술을 받은 적이 있어요. 이제 겨우 두 달 정도 되었네요.,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+치료받아야 하는 다른 질병이 있으신가요?,Korean
+간염 언제부터 앓고 계신가요?,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+혹시 환자분이 내방하신 이유의 원인이 될 소지가 있는지 판가름하기 위해서 여쭤보는 겁니다.,Korean
+요즘 발기는 잘 되시나요?,Korean
+고혈압약과 관련된 약을 전부 알려주세요.,Korean
+독감주사를 올해 맞으신 거죠?,Korean
+혹시 설사 자주 하셨나요?,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+고혈압 기간이 어떻게 되세요?,Korean
+항상 발기부전이 있으신 건가요?,Korean
+아이가 외래 진료와 검사 결과 탈수 증상이 조금 있네요. 처방된 수액으로 바꿔 달아드릴게요.,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+초음파가 처음이세요? 원하시는 대로 천천히 보여드릴게요.,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+선천성 거대결장은 신경세포가 장의 아래쪽에 도달하지 못해서 운동기능을 상실하며 생기는 질환입니다.,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+네 체중 측정하시고 말씀해 주세요.,Korean
+네. 저희 병원에 구순구개열 수술 잘하시는 선생님이 계십니다. 그 교수님 외래를 잡아드릴게요.,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+남성은 전립선 비대증 여성은 과민성 방광이 빈뇨의 가장 흔�� 원인입니다.,Korean
+환자분이 생각하기에 피부 버짐을 유발하는 요인이 뭐라고 생각하세요? 특정 지을 수 있을만한 것이 있나요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+한 번이라도 흡연을 하신 적이 있나요?,Korean
+드레싱은 매일 해야 하는 치료이고 이제 상처 회복을 위한 다른 치료가 들어갑니다.,Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+계속 조금씩 통증이 나타나시는 거죠?,Korean
+현재 고혈압 치료는 언제부터 시작하셨나요?,Korean
+네 책상 위에 약 올려주세요.,Korean
+종교적인 이유로 수혈을 거부하시는 분들도 계십니다.,Korean
+고혈압 약 혹시 드시고 계세요?,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+수술 준비 들어가셔서 지금은 못 오세요.,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+음식 중 못 드시는 거 있나요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+"""음식, 약물 말고 다른 알레르기 있으신가요?""",Korean
+당뇨 약 복용하고 계신가요?,Korean
+약을 먹는다고 금방 낫지는 않습니다.,Korean
+어. 그냥 어머니가 주신 약 먹었어요.,Korean
+틀니 보청기 가발 지팡이 렌즈 등 사용하시는 보조 기구가 있나요?,Korean
+"오른쪽 팔에 투석관이 있어요.
+",Korean
+"엄지발가락이 빨갛게 부으면서 아프고 가끔 고름이 나와서요.
+",Korean
+"아이가 개월 수 맞춰서 잘 크고 있는지 확인해보려고요.
+",Korean
+수술받은 적 있으면 알려주세요.,Korean
+피를 하루에 몇 번 토하나요?,Korean
+저번 주까지 먹었던 약이 있긴 한데.,Korean
+통증은 얼마나 자주 발생해요?,Korean
+고위험군의 경우 자궁경부암을 비롯한 여러 암을 유발할 수 있습니다.,Korean
+"아니요. 삼킬 때 음식이 목구멍에 닿아서 아파요.
+",Korean
+제일 불편한 증상이 무엇인가요?,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+씨티도 조영제를 안 쓰는 경우 건강보험이 적용돼서 비싸지 않습니다.,Korean
+국가예방접종이나 기타예방 접종 포함 모든 예방접종이요.,Korean
+"어깨에 통증이 느껴져서 왔어요.
+",Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+통증 지속 여부를 알려주세요.,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+앉아 있을 때에도 통증이 있으신가요?,Korean
+국소마취제를 스테로이드와 넣어 통증을 완화해주는 겁니다.,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+지속적으로 기침을 하고 계신가요?,Korean
+아니요. 아픈 적 없어요.,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+다른 치료하신 거도 있으신가요?,Korean
+"복통에 설사 때문에 통 먹지를 못하겠어요.
+",Korean
+네 모든 입원 치료 내용 알려주세요.,Korean
+감염 방지를 위해서는 자주자주 소독을 해 주어야 합니다.,Korean
+열이 있다면 어떤지 알려주시겠어요?,Korean
+확진이면 격리 후 진료를 진행해야 합니다.,Korean
+만약 헤모필루스 인플루엔자로 인한 후두개염일 경우 기관 내에 관을 넣고 지켜보기도 합니다.,Korean
+일상생활이 가능하려면 최소 일주일은 입원해서 회복하셔야 합니다.,Korean
+어떤 약을 드시고 계신지 말씀해 주실 수 있으세요?,Korean
+꼬리뼈 부위에 욕창이 생겼습니다.,Korean
+성 기능 장애가 있으신가요?,Korean
+"요즘 속이 너무 안 좋아서 아무것도 못 먹이겠고 토도 하루에 두 번은 해서 왔어요.
+",Korean
+물 마실 때 목이 아픈가요?,Korean
+소변에 피가 함께 나오나요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+네. 지금 바로 퇴원할 수 있게 도와주세요.,Korean
+가만히 있을 때도 흉통이 있나요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+네. 혹시 병실 몇 인실인가요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+전에 크게 다쳐서 내원하신 적 있으세요?,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+병원 한 번 안 가시다가 이렇게 되시니 저도 당황스러워요.,Korean
+간염으로 먹는 약이 있습니까?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+결핵 때문에 내원하신 적이 있나요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+검사를 통해 알레르기의 원인이 되는 것과 환자분의 상태를 확인하고 그에 따른 치료를 계획하실 겁니다.,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+가래 상태가 많이 심한가요?,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+금연은 언제부터 하게 되신 건가요?,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+흡연은 하신 적 있어요?,Korean
+지혈이 잘 되지 않을 경우 혈종이 생길 수 있습니다.,Korean
+처음 약 먹은 지 한 달 돼가는데 부작용으로 두어 번 먹고 바로 이 약으로 바꿨습니다.,Korean
+담배 끊으셨을 때는 제외하고요.,Korean
+병원에서 당뇨 관련해서 이야기 들으신 것 있어요?,Korean
+열이 나는 증상이 있나요?,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+한 달 동안 체중이 얼마나 변했나요?,Korean
+아픈 게 심하게 느껴지나요?,Korean
+혹시 처방받은 약이 있나요?,Korean
+"녹변을 봤는데 철분제 때문이 아닌가요?
+",Korean
+아닙니다. 선천적으로 발생하며 약 십 퍼센트는 가족력을 가지고 있습니다. 남자아기가 여자아기보다 다섯 배 정도 더 많이 발생합니다.,Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+"안녕하세요. 어제 운동하다 팔을 다쳤는데 움직이는 데 무리가 있는 것 같아서 왔습니다.
+",Korean
+"원래 안 그랬는데. 처음으로 변비가 생겼어요.
+",Korean
+배가 더부룩한 느낌은 없나요?,Korean
+"술은 스무 살 될 때 딱 한 달 먹었고 담배는 지금까지 계속 피고 있습니다.
+",Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+질병 관련한 문의 사항이 있을 경우 설명 간호사를 연결해드릴 수 있습니다.,Korean
+수술 경과에 따라 어디로 갈지 달라집니다.,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+발기 부전 증상이 있으세요?,Korean
+변을 조절하지 못하는 원인은 다양합니다.,Korean
+입으로 피를 토한 적이 있나요?,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+보험사에서 진단서랑 입원비 등 서류 달라고 해서요. 관련 서류 부탁드려요.,Korean
+정신이 어지러웠던 적이 있나요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+네 소변 배출에 문제가 없다면 금방 빼 드리겠습니다.,Korean
+입원 후 며칠이 지나면 통증이 호전되실 것입니다.,Korean
+이 병원에서 해서 기록이 있을 텐데요.,Korean
+자극성 변비약의 경우 비교적 빠르게 작용하여 곧 변을 보게 할 수 있습니다.,Korean
+금식을 안 하시고 수술을 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+통증 있는 부분이 어디예요?,Korean
+"치질 때문에 고통받고 있어요.
+",Korean
+소화기 증상이 있는 상태에서 금식하셔서 그런 증상이 있을 수도 있습니다.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+우선 현재는 항생제 치료를 하며 경과를 보는 것이 좋겠습니다.,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+목뼈 삼번 사번에 수술했어요.,Korean
+양성이면 보통 항생제 변경을 고려합니다.,Korean
+가족 중에 유전성 질환 진단받으신 분이 있나요?,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+당뇨는 언제부터 앓고 계신 건가요?,Korean
+그러면 이쪽에서 처방전 받아 가시고 결제하시면 되세요.,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+당뇨와 관련된 어떤 약을 드시고 계시나요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+그 바이러스를 가지고 있으면 어떻게 되는 건가요?,Korean
+"온몸이 퉁퉁 부어서 왔어요.
+",Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+이전에 조영제 알레르기가 없으셨던 분은 크게 문제 되지는 않아요.,Korean
+욕창이 생기지 않도록 체위 변경을 해주는 게 제일 중요하기 때문에 신경 써 주세요.,Korean
+언제 당뇨 진단을 받았나요?,Korean
+매일 드시는 약이 있어요?,Korean
+"주변에서 황달이 심하다고 해서 왔습니다.
+",Korean
+일주일에 몇 번 통증이 있나요?,Korean
+평상시에도 숨쉬기가 좀 힘든가요?,Korean
+알레르기 증상 발생 시 치료를 받거나 약을 드셨나요?,Korean
+알레르기가 나는 음식이 있으시다면 ��려주시겠어요?,Korean
+소변에 피가 섞여 있으세요?,Korean
+약물 알레르기 있던 적 있으세요?,Korean
+독감 주사 언제 맞았어요?,Korean
+숨 쉬는 건 어때요?,Korean
+열이 나서 갔다 온 적 있습니다만.,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+잠을 자도 피곤함이 계속 느껴지는 것처럼 불면증이 있으신가요?,Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+하루에 몇 개비나 태우세요?,Korean
+네. 그저께 독감 주사 맞았어요.,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+통증이 어느 정도 심해요?,Korean
+딸 애가 우울증이 있었어요.,Korean
+"식욕이 줄어서 예전만큼 못 먹어요.
+",Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+"의자에 십 분만 앉아 있어도 엉덩이 위 허리 통증이 심해집니다.
+",Korean
+담배를 얼마나 오래 피셨나요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+처방받고 바로 진행될 거예요.,Korean
+먹은 음식물을 다 토하나요?,Korean
+"오른쪽 얼굴부터 발 끝까지가 움직임이 불편해요.
+",Korean
+결핵 치료를 받고 계신가요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+"무릎에 고통이 심해 내원했어요.
+",Korean
+혹시 지금 체온을 측정해볼 수 있나요?,Korean
+출혈과 연관이 있을 수 있습니다.,Korean
+한 가지 방법으로 치료 후 증상 정도에 따라 추가적으로 치료받을 수 있습니다.,Korean
+본인 치아와 보조 치아가 몇 개인지 확인하는 거예요.,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+마취가 안 풀려서 그래요.,Korean
+"잘 때 발 다리에 쥐가 나서 잘 못 자요.
+",Korean
+알레르기를 일으키는 약물을 알고 있나요?,Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+네 이젠 곧 통증이 없을 거예요.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 꾸준한 추적 검사가 요구됩니다.,Korean
+미열이라서 아직 해열제 안 먹였어요.,Korean
+감각을 확인하기 위해 한 검사입니다.,Korean
+아 예전에 부정맥 진단을 받으셨군요.,Korean
+아니요. 생각보다 수술 부위가 회복이 안 돼서 걷지도 못하고 힘들었어요.,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+"잘은 모르고 식도에 문제 있다는 건 알아요.
+",Korean
+그 보라색 해열제 먹였어요.,Korean
+"네. 피가 섞여 있는 거 말곤 문제없습니다.
+",Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+"변에 하얀 점액질이 섞여 나왔어요.
+",Korean
+통증이 월 단위로 있나요?,Korean
+환자복이랑 침구 제공해 드려요.,Korean
+소변에 피가 많이 나오셨나요?,Korean
+"아침부터 배를 잡고 엉엉 우는 거로 봐서 배가 아픈가 봐요.
+",Korean
+일단 진료 후 확인해 보는 게 좋겠습니다.,Korean
+"소화가 잘 안돼서 불편해요. 요즘.
+",Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+감기약 먹고 난 뒤에 그랬어요.,Korean
+붓기가 제일 심한 때를 알려 주세요.,Korean
+손목 보호대를 착용하시는 것도 좋은 예방법이 되실 수 있습니다.,Korean
+유산소 운동은 무리하지 않도록 하는 게 제일 좋습니다.,Korean
+어깨 관절에 이상이 있나 봅니다.,Korean
+마지막으로 쟀을 때 백팔십오 센티미터에 칠십오 킬로그램이었습니다.,Korean
+암으로 드시는 약 있어요?,Korean
+팔도 골절이 의심되어서 현재 부목을 대 드릴 거예요.,Korean
+"등 있는 부분에 알레르기가 계속 올라와요.
+",Korean
+알레르기 유발 물질을 정확히 알고 넘어가야 해서요.,Korean
+아뇨. 줄이셔야 합니다. 고칼로리 식단은 각종 소화기 질환. 내분비 질환을 일으켜요.,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+"비타민 한 개 먹었어요.
+",Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+살이 떨리는 한기가 느껴지나요?,Korean
+대변이 잘 안 나오고 그러나요?,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+통증이 얼마 동안 있으셨죠?,Korean
+아픈 곳 말씀해 주세요.,Korean
+결핵 수치가 높은 편이신가요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+가끔 고기가 식중독 원인이 될 수 있습니다.,Korean
+엠알아이 검사 시 가발을 착용하시면 안 돼서요.,Korean
+"킥보드를 타다 차랑 부딪혀서 여기랑 여기가 아픕니다.
+",Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+"엄지발가락에 상처는 없는데 아리고 통증이 있어서요.
+",Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+양의학과 병행 시 부작용이 날 수도 있으니 입원치료와 병행하지 않도록 해주세요.,Korean
+수면 위생에 문제가 없는지부터 살펴야겠습니다.,Korean
+가스가 잘 배출되도록 트림을 시켜야 하고요.,Korean
+간염약을 드시고 부작용이 있으신가요?,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+마취 방법에 따라 부작용이 달라집니다. 마취부작용 있었나요?,Korean
+환부를 씻어내고 소독약을 바른 후 테라마이신 바세린 거즈 등을 붙입니다.,Korean
+대변 잘 못 보세요?,Korean
+"요새 화장실 가기가 좀 어려워요.
+",Korean
+통증이 있는 부위가 어디죠?,Korean
+현재 발작 증상이 심해서 진정 시키는 중이라 진정이 되지 않을 시에는 추가 진정 주사를 놔야 합니다.,Korean
+독감 주사 같은 경우는 매년 일 회 맞는 게 좋아요.,Korean
+목이 너무 마르면 젖은 수건을 입에 대는 것도 좋은 방법입니다.,Korean
+변에 피가 섞여 나오나요?,Korean
+이후에는 레이저나 냉동치료이고 마지막에는 수술밖에 답이 없습니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+"어쩌다 다쳤는지도 모르게 일하다 돌아와 보니 상처가 나 있더라고요.
+",Korean
+성 기능 장애가 있으신가요?,Korean
+안약에 대해서도 저녁에 함께 설명드리고 우선 오늘 자정부터는 물 포함 금식을 잘 지켜주시면 됩니다.,Korean
+그때 알레르겐이라고 하는 알러지 유발물질 검사하는 항원검사 해보셨나요?,Korean
+대충 한 달 이내에 드신 약 기억나는 게 있으신가요?,Korean
+화장실에 갔는데 소변이 안 나오나요?,Korean
+여드름 부위보다 조금 넓게 바르셔도 됩니다.,Korean
+마스크는 항상 쓰고 다니셔야 합니다.,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+우선 약효가 있는지 진전을 보고 양을 조절하기 때문입니다.,Korean
+결핵을 오래 앓으신 거예요?,Korean
+과거에 장기간 입원한 적이 있나요?,Korean
+고혈압으로 먹고 있는 약이 있을까요?,Korean
+"윗니 끝에 있는 어금니요.
+",Korean
+입원을 희망하시면 입원 안내 창구에서 바로 도와드리겠습니다.,Korean
+통증을 점수로 하면 몇 점 정도 느껴지나요?,Korean
+방귀가 나오지 않는 이외 다른 증상은 없나요?,Korean
+치료 때문에 이틀에 한 번은 오셔야 하거든요.,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+가족 중에 당뇨 진단을 받아보신 분이 있으세요?,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+요즘 혹시 두통이 있나요?,Korean
+허리 재활 치료 중이라 재활병원에 갔다 왔었습니다.,Korean
+암 판정받으신 적 있나요?,Korean
+호흡곤란이 온 적 있어요?,Korean
+자세한 건 검사를 해봐야겠지만 식도 쪽에 혈관이 많이 부어있네요. 그게 터지면서 어제 출혈도 있으셨어요.,Korean
+지금 혹시 오한이 있나요?,Korean
+언제부터 열감이 전신적으로 발현되시나요?,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+처방받은 용량과 용법으로 드시고 계신 거지요?,Korean
+재수술을 해야 하는데 거기까지 가면 안 되겠죠.,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+암 환자가 가족 중에 있을까요?,Korean
+오늘 오후 중으로 퇴원가능합니다.,Korean
+"수포 올라온 부분에 가려움증이 너무 심해서요.
+",Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+네 철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+언제 암을 처음 진단받으셨나요?,Korean
+메스꺼움은 주로 식전에 나타나나요?,Korean
+최근 두 달 안에 급격한 체중 변화가 있었나요?,Korean
+"열이 심하게 나서 어제는 거의 못 잤어요.
+",Korean
+혈액검사 결과가 나오면 설명 드리겠습니다.,Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+수혈 거부하면 위급상황 때 다른 조치 방법이 있어요?,Korean
+특이 혈액형인지 확인해본 적 없어요.,Korean
+기능성 변비라면 변비 치료를 통해 배변을 유도해 볼 수 있습니다.,Korean
+설사하는 이유가 따로 있으신가요?,Korean
+배가 더부룩하신 느낌이 드세요?,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+부부간에 성생활에 영향을 끼치시나요?,Korean
+대변이 잘 안 나오고요?,Korean
+배의 어느 부위가 아프시죠?,Korean
+"전혀 그런 게 없었는데 숨이 불편하니 편히 잘 수가 있나.
+",Korean
+약을 세 알씩 매일 드셨나요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+응급 수술할 정도인지 검사를 몇 가지 진행하겠습니다.,Korean
+하루에 한 갑 이상 피우나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+알레르기 유발 요인의 종류에 따라 다릅니다.,Korean
+두근거림이 안정 시에도 있나요?,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+지금보다 많이 아파서 참지 못하겠다 싶을 때 얘기해 주시면 됩니다.,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+많이 어지러우시면 되도록 돌아다니지 않으시는 편이 좋습니다.,Korean
+성모병원 내에 있는 비뇨기과에 다녀왔어요.,Korean
+"저 스스로 상담이나 치료가 필요하다고 느꼈어요.
+",Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+네? 탈장이요? 수술해야 하나요?,Korean
+통증의 패턴 같은 게 있었나요?,Korean
+상대적으로 혈압이 높은 편이세요?,Korean
+담배는 대략 피우신 지 얼마나 되셨어요?,Korean
+"네. 통증이 계속 있어서 불편했습니다.
+",Korean
+욕창을 방지하는 것은 피부 합병증을 생기지 않게 하는 것이지 다른 병까지 낫게 하는 것은 아닙니다.,Korean
+사고가 나셔서 구급차 타고 병원으로 오게 되셨어요.,Korean
+네 검사 예약 잡아 드릴게요.,Korean
+통증 시작된 날짜 기억나요?,Korean
+"오랜 시간 기다려야 소변을 봐요.
+",Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+목에 통증이 계속 있나요?,Korean
+하루에 두 갑은 피우세요?,Korean
+그러면 주말에 물리치료를 받도록 하세요.,Korean
+아직은 장운동이 원활하지가 않아 불편하더라도 좀 더 하고 계셔야 됩니다.,Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+통증 양상이 어떻게 돼나요?,Korean
+현재 당뇨 수치가 높으신 편인가요?,Korean
+환자분은 지금 면역력이 너무 낮기 때문에 면역력을 높여 바이러스 저항력을 높여줘야 증상이 악화되지 않을 수 있어요.,Korean
+음주는 하신 적 있어요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+통증이 느껴지는 세기가 어느 정도인가요?,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+특별히 혈액형 검사를 원하시는 이유가 있나요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+빈뇨 문제는 언제부터 있었죠?,Korean
+"기침이 자주 나고 가래가 끓는데 가래에 피가 섞여 있어요.
+",Korean
+"모유를 수유하는데 노란 물을 자주 토해요.
+",Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+음식이 잘 들어가지 않나요?,Korean
+비염이 환절기만 되면 더 심해져요.,Korean
+고려대 병원으로 알아봐 주세요.,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+그럼 우선 아픈 부위 사진 먼저 찍고 오세요.,Korean
+"하루에 보통 두 개비 정도 피워요.
+",Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+척주 전방 전위증이 있어서 도수치료받고 있어요.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+혈액검사를 통해 횡문근 융해증을 진단하고 수액 치료 기간은 금식 유지가 필요합니다.,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+알레르기로 기피하는 음식 있나요?,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+"원래 변비가 조금 있어요.
+",Korean
+전에 크게 다쳐서 내원하신 적 있으세요?,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+알레르기 시작��� 지 얼마나 되었나요?,Korean
+저희가 알고 있으면 마취할 시에 참고할 수 있습니다.,Korean
+입원이나 수술하신 적 있어요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+현재는 괜찮지만 예전에 앓았던 병이 있으신가요?,Korean
+"투석 관에 문제가 있는 것 같아요.
+",Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+알약을 가루약으로 조제해 드리겠습니다.,Korean
+과민성 방광과 유사한 증상을 일으킬 수 있는 요로감염 요로결석 간질성 방광염 방광암 등 다른 요로계 이상이 없는 경우 과민성 방광 진단을 내릴 수 있습니다.,Korean
+신경은 죽었지만 본인 치아입니다.,Korean
+담배 언제 처음 피웠어요?,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+뚜렷한 예방 방법은 없습니다.,Korean
+네 피부병으로 볼 수 있겠네요.,Korean
+종양 있었던 가족이 있으신가요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+통증이 시작되면 쭉 가나요?,Korean
+조영제 검사가 아니면 씨티는 일반 엑스레이 촬영과 비슷해요 기계만 다르지.,Korean
+현기증 때문에 어지러우신 거죠?,Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+최근에 무슨 약을 드셨죠?,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+요즘 혹시 오한이 있나요?,Korean
+네. 병원비에 대한 자세한 것은 원무과에 문의하세요.,Korean
+최근에 체중이 어떻게 변화했을까요?,Korean
+옆 사람이 본인의 심장 소리가 들릴 정도인가요?,Korean
+특이사항은 마취가 잘 안 들거나 마취제에 알레르기가 있는 경우입니다.,Korean
+"시원하게 못 봐서 치질 걸릴 것 같아요.
+",Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+"얼굴에 마비가 와서 왔어요.
+",Korean
+팔을 지금 움직일 수 있나요?,Korean
+네 영양제를 매일 드시나요?,Korean
+"오늘 갑자기 여기 이쪽에 이상한 게 만져져요. 이게 뭐죠? 선생님 종양인가요?
+",Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+"교통사고로 인한 통증으로 인해 누워서 잘 수가 없어서 얼마 못 자요.
+",Korean
+음식물로도 감염될 수 있고 침이나 분비물을 통해 전염되기도 합니다.,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+알레르기 때문에 안 드시는 음식 있으세요?,Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+마지막으로 한 독감 예방 접종은 언제죠?,Korean
+현재 가족 중에 유전성 질환을 치료 중인 분 있나요?,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+"기침이 너무 심해서 밤에 잠을 못 자겠어요.
+",Korean
+"어깨가 아픈데 밤에 잘 때 더 아픈 것 같아요.
+",Korean
+전신 마취 경험은 없으신가 해서요.,Korean
+최근 구토한 적 있으세요?,Korean
+주사 부작용으로 약간의 통증은 있을 수 있지만 걱정하실 정도는 아닙니다.,Korean
+병원비 지불과 관련된 어려움이 있으시면 사회사업팀과 상담을 연결해 드릴 수 있어요. 필요하면 말씀해 주세요.,Korean
+담배를 피웠던 기간이 얼마나 될까요?,Korean
+"배가 조금 쓰린 느낌이어서 왔어요.
+",Korean
+토혈 후 어지럽지는 않았나요?,Korean
+혈압은 단순한 검사고 오 분도 안 걸릴 겁니다.,Korean
+하루에 담배를 몇 갑 피시나요?,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+몸이 붓는 건 그대론가요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+드시는 약물들이 많을 경우 다른 문제가 동반될 수 있어 확인차 여쭤보았습니다.,Korean
+골절로 입원이나 수술 경험이 다 있으신 건가요?,Korean
+"심장이 안 좋아 그런 거라고 하셨습니다.
+",Korean
+잘 익히거나 잘 세척해서 드셨나요?,Korean
+큰일을 보시면 항문이 아프신가요?,Korean
+"복부팽만 증상 겪은 적 있어요.
+",Korean
+배에 더부룩한 느낌이 있나요?,Korean
+피 소변을 보시진 않나요?,Korean
+보조용 치아가 있는지 확인하는 거예요.,Korean
+대변볼 때의 통증 또한 포함됩니다. 그리고 그 외 대변과 관련된 불편한 증상이 있다면 모두 해당됩니다.,Korean
+"머리 아프면서 속이 좀 메스꺼울 때가 있었어요. 소화도 잘 안 되는 거 같고요.
+",Korean
+피부색이 시커멓게 변했다면 장기 이상일 수도 있는데 검사를 해봐야 할 것 같네요.,Korean
+"아니요. 담배 연기조차 싫어요.
+",Korean
+대신 차가운 물보다는 미지근한 물�� 드세요.,Korean
+알레르기로 인한 동반 질환도 있나요?,Korean
+결핵 질환과 관련된 처방받은 약이 따로 있나요?,Korean
+다이어트를 하지 않는데 살이 빠지진 않았나요?,Korean
+걱정이 크시겠습니다. 증상의 원인을 찾기 위해 검사를 더 해 보겠습니다.,Korean
+그런데 갑작스러운 통증이 발생한다면 꼭 말씀해주십시오.,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+저희가 알아야 이상 반응이 나타날 시 대처할 수 있어요.,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+말씀드린 세 가지 중에서 어느 요법이 제일 이해가 안가세요? 세 가지 다 다시 설명드릴까요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+간단한 시술로 끝날 수도 있지만 환자가 이십사 개월 된 아기이기 때문에 응급상황을 대비하고 시행하는 게 좋겠습니다.,Korean
+하루에 담배는 어느 정도나 하시는 거죠?,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+네. 저희가 위중도와 순서에 맞춰 진료를 보고 있으니 조금만 기다려 주세요.,Korean
+보호대를 착용하고 약물치료와 주사치료를 병행하여 통증 악화를 막을 수 있습니다.,Korean
+"아침에 토 한 번 했었어요.
+",Korean
+내시경 자체는 사후 통증이 없습니다,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+암 질환을 가진 가족분들 있나요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+회사가 코로나 위험 지역에 있어서 어쩔 수 없이 갔어요.,Korean
+"저도 모르게 막 웃다가 새어 나와서 요실금이 왔나 했다니까요.
+",Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+수술 당일엔 보호자분이 와 주시는 게 좋습니다.,Korean
+내시경 검사를 통해 위장관 내부를 더 잘 관찰하기 위해서 금식을 시행합니다. 뭔가 드셨다면 정확한 검사 결과를 얻기 어렵습니다.,Korean
+치료 내역을 알면 저희에게 도움이 돼서 여쭤보는 거예요.,Korean
+암과 관련된 가족력은 없다고 하셨죠?,Korean
+물에 닿았다면 거즈를 빼고 말리신 후에 소독하고 다시 새 거즈를 붙이셔야 합니다.,Korean
+발기 부전 증상이 있으세요?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+"물도 잘 못 삼키겠어요.
+",Korean
+매우 드물지만 모체로부터 아기로의 수직 감염이 있었을 수도 있습니다.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+하루에 보통 얼마나 피우세요?,Korean
+비수면 시 불편함을 더 느낄 수 있지만 비교적 짧은 검사라 괜찮을 수 있습니다. 수면 마취 시에는 수면 마취에 따른 위험성이 따라옵니다.,Korean
+소변에 피가 섞여 나오나요?,Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+네. 겨울에 독감 예방주사 맞았어요.,Korean
+집먼지 진드기는 항상 생길 가능성이 존재하므로 자주 세탁해 주는 것이 중요합니다.,Korean
+남성의 경우에는 전립선 비대증이 전립선 출혈의 원인일 수 있습니다.,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+쌍둥이라도 자연분만이 가능한데 환자분께서 다른 이유는 모르시나요?,Korean
+"""콕콕 찌르는 듯이 아픈가요, 쑤시듯이 아픈가요, 묵직하게 아픈가요, 날카롭게 아픈가요?""",Korean
+"왼 발. 왼 발 뒤꿈치요.
+",Korean
+급성기의 치료가 향후 예후를 결정하게 됩니다.,Korean
+통증 시작하면 얼마나 가요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+입원 치료한 적 있으신가요?,Korean
+"소변 냄새 나지 않아요.
+",Korean
+만성 변비로 진행될 수도 있습니다.,Korean
+"귀에 통증이 너무 심해서 확인해봤는데 휴지로 닦았을 때 고름이 나왔어요.
+",Korean
+통증은 있지만 마취 크림 바르면 덜 하실 겁니다.,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+당뇨로 병원에서 꾸준히 치료받고 계신가요?,Korean
+주로 어디가 가장 아프세요?,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+최근 일 년 동안 십 킬로가 감소했어요?,Korean
+심근경색 검사 결과 정상으로 조금 전 확인되었기 때문에 재검사는 불필요합니다.,Korean
+속이 메슥거리고 체할 것 같나요?,Korean
+"살이 꽤 많이 빠졌어요.
+",Korean
+배가 부푼 것 같이 느껴지세요?,Korean
+"소변이 너무 자주 마려워서 큰일이에요.
+",Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+어릴 때 고열이 심하게 난 적이 있어서 입원 치료받은 적 있어요.,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+오염된 물에 이차 감염이 발생할 수 있습니다.,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+알레르기 중에 음식과 약물 외에 다른 것도 있으세요?,Korean
+그전에는 음주와 흡연을 얼마나 하셨나요?,Korean
+국소마취로는 아이가 힘들 수 있습니다.,Korean
+네. 무거운 걸 들게 되면 더 안 좋은 영향이 미치는가요?,Korean
+배가 부글거리는 경우가 있나요?,Korean
+모든 것에는 부작용이 존재합니다. 수혈은 받아보신 적 없으신 거죠?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+고유량 산소법의 특성은 환자의 호흡 양상의 변화에 무관하게 정확하고 계속적으로 일정한 흡입산소분율을 제공해 산소를 투여합니다.,Korean
+앓고 있는 병 있나요?,Korean
+소변 색이 검붉은 색인가요?,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+"소변은 문제없이 누고 있어요.
+",Korean
+"관절염 때문에 걷지 못하겠어요.
+",Korean
+일시적으로 가려움이 가라앉은 것일 수 있습니다 주기적인 관리가 필요합니다.,Korean
+필요하다면 소화제를 먹일 수는 있습니다.,Korean
+후에 통증이 있을 수 있으니 아프시면 메모 후 병원에 방문하시어 꼭 말씀해주세요.,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+결핵 치료 이력이 있나요?,Korean
+"아니요. 예전에는 흡연자였는데 아이 생기고 나서는 끊었죠.
+",Korean
+소변을 보는 양은 변화가 있으신 거 같으세요?,Korean
+약 드시고 간지럽거나 두드러기가 난 적 있나요?,Korean
+뇌진탕이 있었을 수도 있으니 검사를 한 번 해봅시다.,Korean
+항원 검사는 하지 않았고요.,Korean
+가족 중에 당뇨이신 분 있어요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+"엄지발가락 통증 때문에 신발을 못 신어요.
+",Korean
+어디가 제일 많이 붓나요?,Korean
+보이는 현상만으로 출혈 정도를 평가하기는 어렵습니다.,Korean
+"어제부터 먹은 게 없는데 그럼 영양주사는 맞을 수 있나요?
+",Korean
+"아니요. 십 대 때부터 피웠거든요.
+",Korean
+"재활 치료보다는 재수술을 받고 싶어요.
+",Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+"계단 내려가는데 발을 헛디뎌서 굴렀는데 어깨를 다친 것 같아요.
+",Korean
+지금 드시는 약과 상충되지 않는 약을 처방하려고 여쭤봤습니다.,Korean
+"옆구리가 영 신통치 않아요.
+",Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+토를 한 적이 있나요?,Korean
+병원 옮길 수밖에 없네요.,Korean
+"근래 들어 몸이 붓고 두통이 심해요.
+",Korean
+최근 술을 자주 드시나요?,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+현재 통증이 있는 곳은 없으시나요?,Korean
+네. 손에 힘이 잘 안 들어가서 젓가락질도 어려워요.,Korean
+발기가 충분히 오래 지속되지 않나요?,Korean
+"약으로는 증상이 호전될 기미가 안 보여서 오게 됐어요.
+",Korean
+하루에 피는 담배양을 알려 주세요.,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+"아니요. 과식하면 소화도 안 되고 위에 부담돼서 절대 안 해요.
+",Korean
+"오늘 선생님이 병원 오라고 하셔서 왔습니다.
+",Korean
+진료받는데 거리가 멀면 위급 상황 시 문제가 될 수 있어서 여쭈어봤습니다.,Korean
+하루 술 마시는 양이 어떻게 되나요?,Korean
+"아. 오늘은 약만 처방 받아 가려고 왔어요.
+",Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+하루에 몇 개 피우시죠?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+네 통증이 심하게 아팠다���나 이상하게 요즘 들어 불편했던 곳이 있었는지 여쭤보는 거예요.,Korean
+통증은 움직일 때마다 오나요?,Korean
+네. 진료기록 보면 나와있을걸요?,Korean
+폐기하실 약은 약국에 가시면 됩니다.,Korean
+"물도 잘 못 삼키겠어요.
+",Korean
+몸 전체에 힘이 없나요?,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+아니요. 복부 피부에 젤리를 바르고 시행하는 검사입니다.,Korean
+통증 유무 확인 부탁드려요.,Korean
+대변에 피가 섞인 경우가 있지 않나요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+"기침하면서 숨쉬기 힘들 때 있고요. 눈도 엄청 빨갛게 부어올랐어요.
+",Korean
+발기를 아예 못 하시는 건가요?,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+토할 것 같이 메스꺼우셨나요?,Korean
+아니요. 구토 증상이 있으셨다면 부작용이 있을 수 있어요.,Korean
+평소에 무슨 약 드세요?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+소변량은 주머니에 얼마나 차야 하나요?,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+지금까지 총 세 번 정도 입원했어요.,Korean
+예약을 나중에 취소할 수 있지만 되도록 예약 때 내원해주세요.,Korean
+네 찢어져서 출혈이 있어요.,Korean
+담배를 피우신 적 있으세요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+담배 하루에 얼마나 태우세요?,Korean
+조영제를 사용하면 드물게 부작용이 있지만 거의 없다고 봐도 됩니다.,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+알레르기 때문에 죽을 정도로 고통스러웠던 적 있나요?,Korean
+가슴 통증이 어느 때 자주 나타나요?,Korean
+막대로 살짝만 스쳐도 통증이 느껴지나요?,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+미음식을 할 경우 영양소가 부족할 수 있어 확인을 드리는 질문입니다.,Korean
+"십 년 전쯤 금연했고 그전에는 하루 한 갑 피웠었습니다.
+",Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+크게 어려운 것들은 없고 혈압 체크나 혈액 검사 수술 전 필요한 검사 몇 가지 하게 되실 거예요.,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+숨 쉬는 게 힘드신가요?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+만약 어지러움을 느끼신다면 앉아서 고개를 다리 사이에 푹 숙이세요.,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+동의하셔야 해당 약품을 쓸 수 있어요. 조금 비싸긴 합니다.,Korean
+네. 독감 주사 맞았어요.,Korean
+잠을 잘 자지 못하시나요?,Korean
+이 밖에 다른 알레르기 있으실까요?,Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+"왼쪽 팔다리가 계속 뻐근해요.
+",Korean
+주사나 먹는 약 둘 다 알려주세요.,Korean
+보통은 그 약물을 쓸 수가 없고 다른 약물로 교체합니다.,Korean
+장 운동의 정도에 따라 차이가 생길 수 있습니다.,Korean
+한 번이라도 흡연을 하신 적이 있나요?,Korean
+결핵 치료 기간이 오래된 건가요?,Korean
+담배 피운 기간이 오래됐나요?,Korean
+발기부전약 드시고 계신 거에요?,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+"한 시간에 한 번씩 토하고 있어요.
+",Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+파상풍 주사 맞았는데 한 달은 넘었을 거예요.,Korean
+고통이 몇 시간 동안 있나요?,Korean
+네 예방접종 포함하여 다른 주사 맞으신 건 없으신가요?,Korean
+네 질환 때문에 챙겨 드시는 게 있나요?,Korean
+미리 테스트를 하고 실시하지만 드물게 알레르기 반응은 있을 수 있어서 동의서가 필요합니다.,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+응급실은 아니니까 외래였을 거예요.,Korean
+꾸준한 물리 치료로 손목 통증을 줄일 수 있습니다.,Korean
+해 봐야 알겠지만 지금 상태로 봐서는 흉이 남을 수 있습니다.,Korean
+혹시 소변을 보기가 힘든가요?,Korean
+몸이 아파서 아직 못 입었어요.,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+"배도 아프고 안색도 안 좋아졌어요.
+",Korean
+주치의 선생님께 진통제 원하신다고 말씀드릴게요.,Korean
+술을 얼마나 자주 음용하시나요?,Korean
+복부초음파는 그냥 배 위에서 보는 거죠?,Korean
+한 가지 방법으로 치��� 후 증상 정도에 따라 추가적으로 치료받을 수 있습니다.,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+소변볼 때 통증이 있나요?,Korean
+철분제와의 관련성은 크지 않습니다.,Korean
+"소변을 봐도 잔뇨가 늘 남고 거의 바로 화장실을 또 가게 하네요.
+",Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+가슴이 아프거나 하지는 않으셨어요?,Korean
+간염 진단받고 치료하신 지는 얼마나 되셨나요?,Korean
+하루 흡연량은 어떻게 되세요?,Korean
+간염 치료받은 지 오래되셨나요?,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+"어제저녁에 아이가 놀다가 침대에서 떨어졌는데 아픈지 계속 울어서 병원에 왔어요.
+",Korean
+도대체 어디가 아픈 거예요?,Korean
+아픈 곳 좀 말해 주세요.,Korean
+통증 있는 부위를 말해 보세요.,Korean
+네 치료 내역 찾아볼게요.,Korean
+치료 계획이나 약물요법이 달라집니다.,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+처음으로 간염 진단받은 게 언제일까요?,Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환 생리 기능에 따라 달라집니다.,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+수면 위생에 문제가 없는지부터 살펴야겠습니다.,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+앓고 계신 지병이나 꾸준히 복용하는 약이 있나요?,Korean
+가래 상태가 많이 심한가요?,Korean
+혹시 많이 속이 안 좋은가요?,Korean
+"폐에서 바람 빠지는 듯한 소리요.
+",Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+가만히 있을 때도 만져지신다면 종양일 수 있는데 자세히 검사가 필요할 것 같네요.,Korean
+독감 예방 접종은 올해 하셨나요?,Korean
+저희 집 앞에 있는 신설 이비인후과요.,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+청소와 빨래를 자주 하는 것이 진드기를 없애는 데에 많은 도움이 됩니다.,Korean
+진통제 넣은 지 얼마 안 됐으니 효과가 나타날 겁니다.,Korean
+우선 두 손가락을 뼈 모양에 맞게 절개하고 절개한 단면에는 피부가 없습니다. 그 부분은 다른 부위 피부를 떼어 내서 이식해야 합니다.,Korean
+환자분이 입원하실 자리가 저녁 늦게 준비가 됩니다.,Korean
+배뇨 곤란을 느끼신 적이 있나요?,Korean
+처방이 언제 나올지 궁금합니다.,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+결핵 앓은 적 있으신가요?,Korean
+열을 떨어뜨리는 게 우선이기 때문에 시원한 상태를 유지한다고 해서 감기에 걸리지는 않을 겁니다.,Korean
+치료 기간은 얼마나 되었나요?,Korean
+고통이 얼마나 자주 오나요?,Korean
+"콘센트 고치다가 전기에 감전되었어요.
+",Korean
+숨이 찬 증상은 없나요?,Korean
+간염으로 드시는 약 있으세요?,Korean
+계속 드시던 약이 있나요?,Korean
+주의 사항에 나와 있지 않은 증상이 발현되면요?,Korean
+돌 때 재수술을 하게 되면 분명 호전될 가능성이 높아집니다.,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+구토를 지금도 하시고 오셨나요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+진통제 주신 거 다 먹으면 되나요?,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+통증이 멈췄다 다시 시작되나요?,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+통증 시작하면 얼마나 가요?,Korean
+아니요 진통제가 위험한 게 아니라 치료 과정에서 진통제를 투여하겠다는 동의를 받는 겁니다.,Korean
+"목이 불편해서 잘 챙겨 먹지를 못합니다. 구토도 가끔 있고요. 식욕이 특별히 많이 증가하지는 않았습니다.
+",Korean
+우리 아이는 어디가 아플까요?,Korean
+"많이 좋아지긴 했는데 가끔 구토를 해요.
+",Korean
+고혈압으로 따로 챙겨 드시는 약 있으세요?,Korean
+잠이 안 오는 이유가 무엇인가요? 그걸 알려주시면 필요한 약이 무엇일지 알 수 있습니다.,Korean
+아뇨 단순��� 적은 수면 시간만으로는 문제가 되지는 않지만 생활에 불편함이 느껴질 정도면 상담을 요청하시는 게 좋겠습니다.,Korean
+어떤 간염 약을 처방받으신 건가요?,Korean
+부종이 발생한 곳이 있나요?,Korean
+네 엔에스티 검사를 시행하고 초음파를 다시 봐드릴게요.,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+네 혈색이 도는 점막의 색입니다.,Korean
+담낭입니다. 담낭 내 결석 제거 예정입니다.,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+등이 가렵거나 따가우신 건가요?,Korean
+네 알에이치 마이너스처럼 특이 혈액형이 있습니다.,Korean
+수술하는 경우도 있고 수술없이 치료만 받는 경우도 있습니다.,Korean
+예전에는 어떤 병을 앓으셨어요?,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+수혈이란 게 남의 혈액을 자신의 몸속에 주입하는 치료법이라 할 수 있습니다.,Korean
+부작용 얘기 듣고 무서워서 한 번도 안 해봤어요.,Korean
+"아랫배에 통증이 약간 있어요.
+",Korean
+혈압은 환자분의 상태에 따라서 계속 달라질 수도 있으니 너무 걱정하지 않으셔도 됩니다.,Korean
+미주신경성 실신 때문에 쓰러지면서 다쳐서 바로 얼마 전인 일주일 전에 다른 병원에 입원했었습니다.,Korean
+"네. 선생님. 감기를 옮은 것 같은데요. 열도 나고 기침도 나고 목도 아파요.
+",Korean
+"걷는 게 영 불편해요.
+",Korean
+"평소 자던 대로 일곱 시간 언저리이고 주말에 세 시간 정도 더 자죠.
+",Korean
+혈당 수치가 얼마부터 정상이죠?,Korean
+아직 검사 몇 개가 남아서 검사 다 받으시고 주무셔도 되세요.,Korean
+위산분비억제제와 항생제 치료가 기본 치료입니다.,Korean
+"네. 배가 빵빵하고 너무 불편해요.
+",Korean
+당뇨 가족력을 갖고 있나요?,Korean
+대변 잘 못 보세요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+지금 부종이 있는 상태인가요?,Korean
+감각이 둔한 손이 어느 쪽이신가요?,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+최근에 당뇨 검사를 받은 적이 있나요?,Korean
+잠을 쉬이 못 드나요?,Korean
+손목을 받쳐주는 보호대도 있습니다.,Korean
+하루에 가래를 얼만큼 뱉으시나요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+순환기계 사정이 무슨 뜻이에요?,Korean
+고혈압약 약명이 어떻게 되나요?,Korean
+네 가족력이 있을 수 있습니다.,Korean
+평소에 숨이 안 쉬어질 때가 언제인가요?,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+대장 내시경과 기본적인 절차는 유사하지만 에스 상 결장까지만 들어가는 검사입니다.,Korean
+큰 병이 있다고 속단할 필요는 없을 것 같습니다. 일단 원인에 대한 검사를 해 보겠습니다.,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+통증이 한번 오면 얼마나 지속되나요?,Korean
+네 출산 포함해서 모든 입원치료 및 수술 알려주세요.,Korean
+수술 시 상태가 얼마나 돌아오는지에 대한 말씀을 다시 듣고 싶어요.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+몸살 기운이 있으신 거죠?,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+헬리코박터균 감염이 있을 가능성이 높지만 다른 원인에 의해서도 발생할 수 있습니다.,Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+맥 빠지는 느낌이 드나요?,Korean
+네 드시는 약 이름 알고 계시나요?,Korean
+많은 경우 눈 떨림은 영양이나 전해질 미량영양소의 결핍으로 인해 발생합니다.,Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+검사 시간은 어떤 검사를 추가로 하게 되는지에 따라 시간이 달라집니다.,Korean
+의사 선생님과 상의 후 결정하는 게 좋을 것 같네요.,Korean
+군대에서 허리를 삐끗한 후 허리 디스크를 달고 살고 있습니다.,Korean
+다른 의사 선생님 수술이 늦게 끝나면 환자분 수술도 밀립니다.,Korean
+가족 중에 유전성 질환을 가진 분이 있나요?,Korean
+"경련 때문에 의식이 없어요.
+",Korean
+아픔이 며칠 주기로 찾아오나요?,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+귀가 들리는 것이나 맛을 느끼는 것에는 이상이 없나요?,Korean
+평소 소화가 잘 안 되나요?,Korean
+양성이 나온다면 추가 검사를 진행해야 합니다.,Korean
+복부에 통증이 심한 곳이 ���딘가요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+당뇨 약 먹고 계세요?,Korean
+다른 알레르기 상황 다 설명 부탁해요.,Korean
+무조건 큰 병원으로 해주세요.,Korean
+언제부터 증상이 나타나기 시작하셨나요?,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+결핵약으론 어떤 거 드시고 계세요?,Korean
+옛날에도 아픈 적 있었어요.,Korean
+느끼시는 통증의 특징이 있을까요?,Korean
+가래 상태가 많이 심한가요?,Korean
+과거 암 진단받은 적 있나요?,Korean
+오심이 있던 적 있으세요?,Korean
+혹시 발기에 문제가 있으신가요?,Korean
+배뇨 장애가 있으신 거예요?,Korean
+네. 결핵 여부도 알려주세요.,Korean
+입을 크게 벌리면 턱이 아픈데 얼마나 벌려야 하나요?,Korean
+"치아가 안 좋으셔서 힘들어하세요.
+",Korean
+가래의 원인이 뭐가 있을까요?,Korean
+"기계에 손가락이 끼어서 이렇게요.
+",Korean
+알레르기 때문에 주의해야 하는 것이 있나요?,Korean
+통증을 느끼는 부위는 여기가 맞나요?,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+크기가 좀 되는 흉터들만 말씀해 주시면 될 것 같습니다.,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+"수술 부위가 잘못된 거 같아요.
+",Korean
+네 임플란트는 언제 받으셨어요?,Korean
+원래는 혈압이 백십에 칠십인데 혈압이 이상한 것 같아요.,Korean
+치아가 썩어서 치과에 다녀왔어요.,Korean
+과거 수술 여부 말씀해주세요.,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+당뇨 진단 시 수치가 얼마나 나왔었나요?,Korean
+네 약품명도 알면 알려주세요.,Korean
+"제가 기관지가 안 좋아서 흡연은 못 하고 술도 제가 안 받아서 못 마셔요.
+",Korean
+외래를 통해서요 진료받은 후 입원을 하게 된 건가요?,Korean
+저기 설명서에 드물지만 발생할 수 있는 부작용 안내가 있어요.,Korean
+마사지는 근육이 풀리는 정도로만 가능해요.,Korean
+통증이 느껴지시는 곳이 어느 쪽인가요?,Korean
+"네. 흉통이 생길 정도로 기침이 너무 심해서 왔어요.
+",Korean
+암 진단받은 날 언젠지 아세요?,Korean
+"등 뒤쪽이 너무 아파요.
+",Korean
+잘 때 어려움이 있으신가요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+"일에 대한 강박감이 심해지고 일 안 하고 있을 때도 불안한 증세가 점점 커져 왔어요.
+",Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+아니요 여행 이력이나 접종 이력 따로요.,Korean
+팔이 부러져서 깁스 한 적 있는데요.,Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+흉터가 덧나지 않게 연고를 잘 바르셔야 합니다.,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+"어제저녁 여덟 시부터 심장 부근이 쥐어짜는 듯이 아프고 호흡이 곤란해요.
+",Korean
+갑작스러운 체중 증가가 있나요?,Korean
+두드러기나 수포가 올라오진 않으셨나요?,Korean
+지금 검사 결과를 보니 좋지 않아서 되도록이면 수술하는 게 좋을 것 같아요.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+다리 감각이 이상하진 않으신가요?,Korean
+여기는 다친 상태가 얼굴보다 양호하네요 바로 치료해 드릴게요.,Korean
+"처음에는 허리만 아팠는데 지금은 등이랑 다리까지 아파요.
+",Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+아프기 시작한 게 언제부터예요?,Korean
+"입맛이 없고 기운 없이 축 처져요.
+",Korean
+현재 추가 증상이 없다면 같은 결과가 나올 확률이 큽니다.,Korean
+어디가 부은 느낌이 있으세요?,Korean
+오늘 아침에 약 먹고 왔고 혈당은 잘 유지하고 있어요.,Korean
+과민성 장 증후군 가능성이 있습니다.,Korean
+덥고 습한 환경에서는 식중독을 일으키기 쉽습니다.,Korean
+아니요 성형 수술도 얘기해 주세요.,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+비급여면 비싸긴 하지만 꼭 필요한 경우가 있으니 동의해 주셔야 합니다.,Korean
+수술이 필요해서 입원하는 것이지 질환이 심각해서 입원하는 것은 아니니 너무 걱정하실 필요는 없습니다.,Korean
+네 수술 끝날 때 오시는 게 좋습니다.,Korean
+약은 집에 있고 처방전 찍어왔어요.,Korean
+피로한 느낌을 받은 적이 있으신가요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+허리 때문에 진통제만 먹었어요.,Korean
+마취가 잘 안 풀렸습니다.,Korean
+알약 대신 가루약은 어떠세요?,Korean
+언제 처음 당뇨 문제가 나타났나요?,Korean
+���물이나 음식 말고 다른 알레르기 있으세요?,Korean
+"다른 의사 선생님이 꼭 와보라고 해서 왔습니다.
+",Korean
+아. 더 못 움직이겠네요.,Korean
+우선 바이러스에 노출된 과거력이 있어야합니다.,Korean
+건강 상태 파악을 위해 기본 정보 수집이라고 생각하시면 됩니다.,Korean
+상처 부위에 붓기도 있나요?,Korean
+무릎도 같이 다치셨군요 보여 주시겠어요?,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+전신에 힘이 빠지는 듯한 기분이 드세요?,Korean
+하루 두세 잔 까지는 권장량 안에 듭니다만 증상이 나타난다면 조절이 필요합니다.,Korean
+지금 몸 상태는 어떠세요?,Korean
+과민성 방광과 유사한 증상을 일으킬 수 있는 요로감염 요로결석 간질성 방광염 방광암 등 다른 요로계 이상이 없는 경우 과민성 방광 진단을 내릴 수 있습니다.,Korean
+예전에 조개류나 해산물을 드시고 이상 반응을 보인 적이 있으신가요?,Korean
+가족 내 암 판정받은 분은요?,Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+독감은 매년 꼬박꼬박 맞죠.,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+"양쪽 허벅지가 화상 증세처럼 너무 뜨겁고 따가워요!
+",Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+심장이 빨리 뛴다는 느낌이 드세요?,Korean
+병원 오기 전에 삼십팔 도여서 바로 데려온 거예요.,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+아픈 증상이 나타난 건 언제부터일까요?,Korean
+당뇨를 앓으시던 가족분이 계시나요?,Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+수술 순서는 두 번 째입니다.,Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+틀니인데 금속이 아닌 걸로 알고 있는데요.,Korean
+변비로 인해 항문이 막힌 경우 범람성 설사가 나타나기도 합니다.,Korean
+통증을 점수로 하면 몇 점 정도 느껴지나요?,Korean
+진통제 놔드렸으니 곧 괜찮아지실 거예요.,Korean
+"아이 다리에 발진이 생겼는데 원인을 모르겠어요.
+",Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+제가 오늘 처방해 드리는 약과 서로 상충되는 성분이 있을까 봐 여쭤보는 거예요.,Korean
+네 응급실 입원시에는 보호자가 있어야 합니다.,Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+간염 치료 병력이 있나요?,Korean
+언제 통증이 처음 나타나셨어요?,Korean
+네. 엄마가 신장이 안 좋으셔서 투석하고 계세요.,Korean
+신경이 제대로 분포하지 않아 제대로 변을 배출할 수 없고 신경이 제대로 분포된 장에 대변이 고여 장이 늘어나 거대 결장이라고 부릅니다.,Korean
+불면증을 느끼신 적이 있으신가요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+수술이라고 해봤자 맹장 수술이에요.,Korean
+네. 올해 초에 받았고 검진 결과도 가지고 있습니다.,Korean
+네. 입원비와 관련하여 궁금한 점이 있으시면 원무과에 문의하시면 됩니다.,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+열이 또 오는 것 같나요?,Korean
+환자분의 설명만을 듣고는 무엇 때문이다라고 말씀드리기는 아직 어렵습니다.,Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+아니요 배가 아프다거나 하는 증세요.,Korean
+"금주 중이고 담배는 가끔 피워요.
+",Korean
+초음파상 문제는 없는데 정밀검사를 진행해 봐야 알 것 같습니다.,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+입원해서 치료받은 적 있어요?,Korean
+깊은 호흡이 잘 안되시나요?,Korean
+많진 않아도 접종 후 이상 반응을 호소하시는 분들이 계세요.,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+"흡연은 거의 매일 하구요 음주는 아주 가끔 합니다.
+",Korean
+"계단에 턱을 박았는데 깨진 것 같아요.
+",Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+"새벽마다 잠을 잘 못 자고 너무 예민해져서요.
+",Korean
+잘 모르겠는데 집에 가면 처방전이 있어요.,Korean
+어디가 가장 아픈 곳이에요?,Korean
+그리고 수술 갔다 오시면 항상 고개를 숙여 아래를 바라보셔야 해요.,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+네. 칼슘 수치도 약간 낮고 충분히 드셔야 뼈 손실이 덜해요.,Korean
+복부 내 염증이 있는 경우 그러실 수 있습니다.,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+심할 경우에는 신장 농양 및 패혈증이 생길 수 있습니다.,Korean
+"잠들기가 쉽지 않고 일어나기 힘드네요.
+",Korean
+암 진단받은 게 언제인가요?,Korean
+"얼굴에 황달기가 있는 느낌이고 복통도 있어요.
+",Korean
+저희 병원이 아닌 타 병원에서 진료한 것은 알 수가 없기 때문입니다.,Korean
+체중 증가가 어느 정도죠?,Korean
+여드름 부위에만 바르는 게 맞아요.,Korean
+응급내시경인 경우 내시경실로 전화하시면 되고 정규 내시경은 일정 잡고 받으시면 됩니다.,Korean
+잠을 못 잘 정도로 배가 아픈가요?,Korean
+혈액검사는 간호사분께서 도와주실 거예요. 의사 선생님께 직접 검사받고 싶으신가요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+발기 부전 증세 유무를 알려 주세요.,Korean
+감염 경로 확인차 하는 질문이었습니다.,Korean
+"고환이 퉁퉁 부어 있네요.
+",Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+신장 조직 검사는 국소마취 후 초음파로 검사 위치를 확인하고 가는 바늘을 이용해 신장 조직을 떼어냅니다.,Korean
+우선 금식을 유지하고 몇 가지 검사 후 수액을 달아드리겠습니다.,Korean
+네 현재까지 알고 계신 알레르기는 없으시단 거죠?,Korean
+언제부터 간염이 있다는 걸 인지 하셨어요?,Korean
+임플란트나 틀니 빼고 본인 치아만 말해주세요.,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+언제부터 피우셨는지 생각나시는 대로 말씀해 주세요.,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+식사는 최소 열두 시간 물은 여덟 시간 이상 금식하셔야 합니다.,Korean
+정상 체온으로 돌아오려면 얼마 있어야 돼요?,Korean
+"아니요. 뭘 삼킬 때 침을 삼켜도 아파요.
+",Korean
+결핵 앓은 적 있으신가요?,Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+"지붕 보수하다가 미끄러져 떨어졌어요. 뇌진탕이 온 거 같아요.
+",Korean
+피를 토할 때가 많이 있나요?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+알레르기가 나는 음식이 있으시다면 알려주시겠어요?,Korean
+몸 전체에 힘이 없나요?,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+"아니요. 따로 통증이 있는 부위는 없어요.
+",Korean
+통증이 좀 강한 편이에요?,Korean
+기침을 평소에 자주 하세요?,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+네 맞습니다. 환자분 본인도 수술부위에 대해 인지하고 계셔야 합니다.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+"몸이 워낙 약해서 칼슘이 풍부한 음식은 찾아서 먹을 정도예요.
+",Korean
+얼마나 아프신 건지 말할 수 있겠어요?,Korean
+통증이 자주 있는 편인가요?,Korean
+"요즘 다이어트 식단을 먹느라 염분 섭취를 굉장히 낮췄어요.
+",Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+평소 수면을 적정량 일정하게 취하셨다는 말씀이시죠?,Korean
+현재 알고 계신 음식 알레르기가 있나요?,Korean
+요 근래 체중 변화가 있으세요?,Korean
+저랑 제 아버지가 고지혈증을 동시에 앓고 있어요.,Korean
+암 치료 기간이 어떻게 되나요?,Korean
+"두 다리 다 저려요.
+",Korean
+평상시에 혈압 측정은 해보셨나요?,Korean
+"네. 울렁거리거나 어지러운 건 없었어요.
+",Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+약 부작용이 있을 수 있습니다.,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+약 먹고 나서 목이 부었어요.,Korean
+속이 메스꺼워서 구토를 할 경우 가끔 빠지기도 합니다.,Korean
+"유제품을 먹으면 탈이 나서요.
+",Korean
+계속 드시던 약이 있나요?,Korean
+"아빠 한쪽 얼굴이 무너지는 거 같아요.
+",Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+질병으로 약을 드시고 계시나요?,Korean
+"소변에서 냄새가 나고 몸이 안 좋아 보여서요.
+",Korean
+어느 부위에 통증을 느끼세요?,Korean
+"열이 나서 몸이 계속 추워요.
+",Korean
+피부나 다른 곳에 알레르기가 생긴 적이 있나요?,Korean
+하루에 보통 얼마나 피우세요?,Korean
+네. 헬리코박터균은 분변 구강 전파가 가능합니다. 가족 간 전파가 흔히 일어나는 것으로 보고되어 있습니다.,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+고혈압약 드시고 계신 게 어떤 건가요?,Korean
+수혈 관련해서는 주치의 상담 할 수 있도록 하겠습니다.,Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+가까운 병원으로 연결도 해주시나요?,Korean
+어떤 치료제를 드시고 계세요?,Korean
+작년에 자주 가는 병원에서 고혈압이라고 알려주더라고요.,Korean
+입원했던 적이 몇 번일까요?,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+목에 통증이 계속 있나요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+네 횡문근 융해증의 경우 입원치료가 필요합니다.,Korean
+가족 구성원 중 암 치료받은 분이 계시나요?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+대변을 보실 때 많이 아프신가요?,Korean
+고혈압은 약으로 조절하고 있나요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+종합 비타민으로 모든 영양소를 대체할 수는 없어요.,Korean
+당뇨약을 아직 안 드시고 계세요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+마취약이 잘 듣지 않았다면 교체도 고려해 봐야 할 듯합니다.,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+전신이 피로하거나 쇠약감이 있나요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+고혈압 처방받으면서 지은 약 드시고 있으세요?,Korean
+응급실에 온 적이 있어요.,Korean
+토할 때 피도 나왔나요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+통증을 느끼는 빈도를 말씀해 주세요.,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+하루에 피우는 담배는 얼마큼이죠?,Korean
+발생하더라도 치료할 수 있으니 너무 염려하지 않으셔도 됩니다.,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+"딱딱하고. 점액질 같은 것이 붙어있어요.
+",Korean
+어패류에 제가 알레르기 증세가 나타나요.,Korean
+"목 안이 아픈 거 아니에요.
+",Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+내시경 검사와 증상을 종합적으로 판단하여 병의 정도를 판단합니다.,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+주사나 복용 중인 약물 전부 포함해서요.,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+최근 결핵 백신 접종했나요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+약은 있으나 확인이 필요합니다.,Korean
+유산균이 포함되어 있어 혹시 지장이 있을 수 있습니다.,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+통증이 아직도 안 나았나요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+고혈압 약물치료를 하고 계신가요?,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+갑자기 혈압의 변화가 있거나 열이 나는 증상 등이 발생하지 않는다면 문제없습니다.,Korean
+"해열제를 먹여도 열이 안 떨어졌어요.
+",Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+수혈이 필요한 상황에 대비해서 혈액을 확보해 두어야 해서요.,Korean
+네. 주사 맞을 때가 걱정이긴 한데 봉합만 잘 된다면야.,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+환자에 따라 다르지만 명시된 평균 권장 수면시간은 여덟 시간입니다.,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+결핵으로 입원하신 기간은 얼마인가요?,Korean
+수술 후 환자분의 상태에 따라 다르지만 평균적으로 한 시간 정도 걸립니다.,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+진통제를 맞고도 계속 그런가요?,Korean
+지금 발기 부전으로 문제가 있나요?,Korean
+통증 시작하면 얼마나 가요?,Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+고혈압 당뇨 두 가지 있어요.,Korean
+암 치료 이력이 있나요?,Korean
+화상을 심하게 입은 터라 감염 위험이 높기 때문에 소독 자주 해주시고 물에 닿지 않도록 조심해 주세요.,Korean
+붓기가 제일 심한 시간이 언제인가요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+가족력에 대해 아는 게 없습니다.,Korean
+당뇨에 가족력 없다고 ���씀하셨죠?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+대변을 보는 일이 힘드나요?,Korean
+이번 주 내로 연락이 가면 그때 외래 날짜 잡으세요.,Korean
+고혈압으로 치료중이신 분이 가족 중에 있나요?,Korean
+아니요. 구토 증상이 있으셨다면 부작용이 있을 수 있어요.,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+오늘은 어디가 아파서 병원에 오셨을까요?,Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+바이러스 장염은 침이나 대변 분비물을 통해서도 걸릴 수 있습니다.,Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+숙면을 푹 취하기 어려우신가요?,Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+간염으로 처음 진료 받은 날이 언제인가요?,Korean
+"차가 치고 지나가서 팔이 아파요.
+",Korean
+"어떨 땐 먹으면 바로 헛구역질이 나면서 토를 했어요.
+",Korean
+소변을 볼 때 따가운가요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+주로 전립선이나 방광쪽 질환을 말합니다.,Korean
+"병원 오기 세 시간 전부터 계속 아프더라고요.
+",Korean
+구토가 난 적이 있으세요?,Korean
+"손가락에 수포가 생기면서 빨개지더니 나중에는 점점 가려워지더라고요.
+",Korean
+통증이 어떤지 설명해 보실래요?,Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+암 수술한 적 있으세요?,Korean
+몸에 열나는 것 같나요?,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+네 결석은 씨티나 요로조영술로 확인하는 게 가장 정확합니다.,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+언제까지 재나요? 숨이 안 쉬어지는데요.,Korean
+몸살이 있으셨다면 예방접종 후 면역력이 떨어져서 더 안 좋으실 수도 있어요.,Korean
+따로 약을 먹어야 생활이 가능하다던가 그랬나요?,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+그렇다면 잠시 여기서 대기해 주시겠어요? 처방전 드릴게요.,Korean
+예방주사 외에 다른 약을 복용하신 적은 없으시고요?,Korean
+큰 이상은 없는 것 같은데 정밀검사를 받아 보시겠어요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+흡연은 하신 적 있어요?,Korean
+마취약이 잘 듣지 않았다면 교체도 고려해 봐야 할 듯합니다.,Korean
+어떤 알레르기 가지고 계시나요?,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+"소화가 안 돼서 목에 손을 넣어서 토를 했어요.
+",Korean
+"식은땀 약간 하고 열은 삼십팔 도 정도 났어요.
+",Korean
+음식을 먹을 때 목이 불편한가요?,Korean
+구역감이 심하시면 촬영 중이라도 손을 드시기 바랍니다.,Korean
+"폭행을 당해 여기저기 많이 아프네요.
+",Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+조금 특이한 혈액형이긴 하지요.,Korean
+많이 힘드시면 말씀해 주세요. 약을 드리도록 하겠습니다.,Korean
+"동네 병원에서 성조숙증이 의심된다고 큰 병원에 가보라고 해서 왔어요.
+",Korean
+약국 위치 좀 다시 알려주세요.,Korean
+알레르기 반응 보이시는게 있으신가요?,Korean
+변에 피가 함께 나오나요?,Korean
+발기부전으로 처방받은 약이 있으세요?,Korean
+"소변 색이 조금 옅어졌어요.
+",Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+"평균 여섯 시간 자는 것 같은데요?
+",Korean
+심호흡 계속하니까 머리가 핑 도는 느낌이에요.,Korean
+"취해서 싸웠다가 다쳐서 왔어요.
+",Korean
+네 바셀린 거즈도 많이 사용합니다.,Korean
+약으로 간염을 치료 중이세요?,Korean
+양치하실 때 피가 많이 나는 편이던가요?,Korean
+일단 약 복용 및 크림 도포 후 경과를 지켜보겠습니다.,Korean
+술 먹는 빈도가 빈번한가요?,Korean
+사고당해서 입원한 적 있으세요?,Korean
+입원 어떻게 하면 하죠?,Korean
+아무래도 수술이다 보니 위험성은 있지만 이 수술은 위험성이 높은 수술이 아니라 안심하셔도 됩니다.,Korean
+"눈을 감은 채로 두 시간이 지났는데도 잠에 들지 못하겠어요.
+",Korean
+"네. 금연한 적 없이 쭉 피웠습니다.
+",Korean
+"귀 안쪽이 너무 간지럽다 못해 아파요.
+",Korean
+혈변에 피가 많이 보였나요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+환자분의 상태를 파악하기 위함입니다. 민감한 부위라면 흉터 크기나 모양이 어떻게 되시나요?,Korean
+아니요. 의료진이 해 드립니다.,Korean
+요즘 혹시 피로감이 있나요?,Korean
+우선은 이틀 치까지만 처방 됩니다.,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+네 감기로 인한 것은 기침입니다.,Korean
+환자분 검사 결과 상 나트륨 수치가 너무 높아요. 조절을 하셔야겠네요.,Korean
+휠체어 있는 곳으로 안내해드릴게요.,Korean
+불편하신 곳을 정확히 알려주셔야 진료가 가능합니다.,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+목이 너무 마르면 물 한 입만 드시는 건 괜찮아요.,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+네 지금 없으시지만 나중에는 생길 수 있으니 꼭 한번 검사받아 보세요.,Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+흡연 시작하신 지 얼마나 되셨어요?,Korean
+알레르기를 일으키는 약이 있을까요?,Korean
+암인지는 검사 후에 결과가 나오기까지 시간이 좀 걸려서요 다시 안내 도와드리도록 하겠습니다.,Korean
+에이엘티 수치가 얼마나 되죠?,Korean
+유당이 없는 우유로 대체하시는 건 어떠신가요?,Korean
+입원 중에는 빠른 회복을 위해 금연하는 것을 권장 드리고 있습니다.,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+네 복부 초음파 후 조영술 시행하도록 하겠습니다.,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+몇 달 전에 다른 병원 내원했죠.,Korean
+"갑자기 귀가 안 들리는 것 같아요.
+",Korean
+근데 지금 아이가 너무 힘들어하는데 쉬다가 해도 될는지요?,Korean
+오전 아홉 시 시작이니 여덟 시 사십 분까지 병원으로 오시면 됩니다.,Korean
+해당 치료만 일 회에 오만 원입니다.,Korean
+김승수 님 선생님이 지금부터 숨소리를 들을 거예요.,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+할아버지가 여러 가지 병이 다 있으셨어요. 당뇨 고혈압 갑상선도 안 좋으셨고요.,Korean
+"항암주사 맞은 뒤로 열이 오르는 것 같아서요.
+",Korean
+"손가락이 심하게 꺾여서 왔어요.
+",Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+지금 아픈 곳이 있으세요?,Korean
+평소 음주량을 토대로 환자분의 건강 상태를 파악할 수 있습니다.,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+암은 몇 기 진단 받으셨나요?,Korean
+식후 소화가 잘 안되어 일상생활이 불편하신가요?,Korean
+치료는 동네 치과에서 받으셨나요?,Korean
+통증 주기가 몇 주인가요?,Korean
+쓰러지시는 증상은 검사 결과 처음이 아니신 걸로 보여서요.,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+뇌척수액 천자 후 두통 등의 합병증이 발생할 수 있지만 영구적 합병증을 초래할 가능성은 낮습니다.,Korean
+물 마실 때 목이 아픈가요?,Korean
+네. 입원해서 치료받은 거라면요.,Korean
+"저희 아빠가 피가 섞인 토를 하면서 정신을 잃으셨어요.
+",Korean
+지금 들어가는 약이 혈관 통증을 유발하는 약이라 그럴 수 있어요.,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+"아기가 다리 사이 사타구니 근처에서 이상한 게 만져져서요.
+",Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+"화장실 가면 오래 앉아 있어야 되니까 변비가 맞는 거겠죠?
+",Korean
+"빈혈 검사를 한 번 해보려고요.
+",Korean
+"눈 주변이 몹시 가렵고 작은 두드러기가 나고요 눈도 붓고 씻고 나와서는 진물이 납니다.
+",Korean
+네. 그런데 혹시 집에서는 깁스 풀고 있어도 되나요?,Korean
+해당되는 게 많네요. 담배. 미세먼지. 곰팡이.,Korean
+네 병원은 전체 금연지역입니다.,Korean
+주의하고 ���는 알레르기가 있나요?,Korean
+"스트레스성 폭식이라 해야 하나 그런 게 좀 생긴 것 같아요.
+",Korean
+예전에 암 수술받은 적 있어요.,Korean
+배변의 어려움이 어떤 식으로 있나요?,Korean
+형제분 중 몇 분이 같은 질환이 있나요?,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+대부분 입원하시는 경우가 치료 또는 수술이 목적이기 때문에 전부 말씀해 주시면 됩니다.,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+혹시 전신 무력감이 있나요?,Korean
+염증성 장 질환의 경우 대장 출혈과 배변 장애가 함께 일어날 수도 있습니다.,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+혈압 측정기가 여기 있어서 다시 이곳으로 오셔야 합니다.,Korean
+"목 안쪽이 건조해서 침 삼킬 때도 아파요.
+",Korean
+인후통에 따끔거리는 느낌도 있나요?,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+"소변볼 때 찌릿찌릿 아픈 것 외엔 없었어요.
+",Korean
+혈변을 볼 때 통증도 느끼시나요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+"발꿈치 바닥 쪽을 다친 것 같아요.
+",Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+어느 부위에 통증이 있을까요?,Korean
+콜라 같은 색의 소변인가요?,Korean
+통증 시작된 날짜 기억나요?,Korean
+"소변볼 때 피가 섞여 나왔던 것 같은데요.
+",Korean
+어느 부위에 통증이 있어요?,Korean
+전해질 수치상 몸이 다소 탈수되어 있다고 나와서요.,Korean
+두통이 있는지 말씀해 주세요.,Korean
+"눈이 안 떠질 정도로 진물이 났어요.
+",Korean
+고환이 음낭 위치로 내려오면서 복막이 막혀야 하는데 이 과정이 제대로 이루어지지 않아 탈장이 발생하는 것 입니다.,Korean
+방귀와 변이 나온다면 일단 증상 조절을 하며 경과 관찰해 볼 수 있을 것 같습니다.,Korean
+테라마이신을 자주 발라주는 것이 중요하므로 여러 개 필요합니다.,Korean
+아니요 그거 제외하고 처방받아서 꾸준히 먹는 약이나 주사있나요?,Korean
+그냥 제일 기본 해열제라고 했어요.,Korean
+환자분 본인은 입원이나 수술경험이 있나요?,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+"일을 그만둔 이후로 낮잠을 자다 보니까 밤에 잠이 잘 안 와요.
+",Korean
+퇴원하고 집에 가서도 가정용 혈당기로 계속 검사해야 할 거예요.,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+결핵 치료를 약으로 하고 계시나요?,Korean
+최근 결핵 백신 접종했나요?,Korean
+하루에 몇번 정도 토하시나요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+향후 가족계획이 없는 분의 나팔관을 묶는 수술입니다.,Korean
+요즘 당뇨를 치료 중인가요?,Korean
+암과 관련된 가족력은 없다고 하셨죠?,Korean
+위염 있어서 약 먹고 있어요.,Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+소장에서 대장으로 연결되는 부위에 붙어있는 충수돌기라는 곳에서 생기는 염증을 의미합니다.,Korean
+웻 거즈는 말 그대로 젖은 거즈예요.,Korean
+통증이 있는지 알고 싶어요.,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+"혈압 확인 좀 하려고요.
+",Korean
+한달에 술을 얼마나 드시나요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+얼마나 아프신지 표현해주실 수 있을까요?,Korean
+"계속 혈변을 본 지 몇 개월이 돼서요 어디가 안 좋은 건지 한 번 봐주셨으면 좋겠어요.
+",Korean
+간만에 병원 온 것 같아요.,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+"가슴 오른쪽이 점점 아파지더라고요. 참을만하면 그냥 있겠는데 아무래도 검사를 받아봐야 할 것 같아서요.
+",Korean
+붓기 있는 곳을 알려 주시겠어요?,Korean
+아. 담당 간호사가 따로 있는 건가요?,Korean
+현재 검사도 에이형으로 나왔는데 재검을 원하시나요?,Korean
+머리가 핑도는 느낌이 있으신가요?,Korean
+소변을 봐도 시원하지 않고 불편한 느낌이 있나요?,Korean
+주사나 복용 중인 약물 전부 포함해서요.,Korean
+수술 전 외출은 가능하시지만 이후 이 주간은 외출 어려우세요.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+친구들 따라 요양원에 가셨어요.,Korean
+마취를 하더라도 환아가 완전히 안정되지는 않아 보호자분들의 도움이 필요합니다.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+"대변볼 때마다 피가 보여서 화장실 가기 무서워요.
+",Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+소화될 때 어려움이 있나요?,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+암이라고 진단받으신 적 있나요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+"컵이 깨진 것 치우다가 피부가 베였습니다.
+",Korean
+"변비 때문에 힘들어 죽겠어요.
+",Korean
+새우 알레르기 때문일 수도 있어요 어떻게 금방 가라앉았나요?,Korean
+상처에 습윤이 유지되는 효과가 있습니다.,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+"네. 몸이 잘 붓고요. 피부도 푸석해진 것 같고 그래요.
+",Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+아픈 곳 말씀해 주세요.,Korean
+환자분의 시술 스케쥴을 잡기 위한 사항입니다.,Korean
+제왕절개 여부에 따라 복강경 및 개복술 여부가 결정 날 수도 있기 때문입니다.,Korean
+"소변 횟수가 는 것 같아요.
+",Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+"기침을 좀 한 뒤로 아기 숨소리가 이상해서요.
+",Korean
+통증이 어느 정도로 느껴지나요?,Korean
+최근 몇 달 동안 살이 급격히 빠지지는 않았나요?,Korean
+통증 정도가 심하시면 진통제 처방해드릴까요?,Korean
+독감 예방 접종은 꾸준히 하시나요?,Korean
+빠른 회복은 어렵기 때문에 시간을 두고 잘 치료해 나가야 합니다.,Korean
+식욕부진으로 인해 불편함을 느끼시나요?,Korean
+금식은 계속 유지하시고 계시죠?,Korean
+수술을 받으면 건강하게 생활할 수 있으니 걱정 마세요.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+퇴원 안내문에 복통 환자 주의사항이 있으니 잘 읽어보시고 배가 많이 아프시나 증상이 생기면 소화기 내과 외래나 응급실로 내원하셔서 진료 보시면 됩니다.,Korean
+하루에 여러 차례 드레싱하며 상태를 볼 겁니다.,Korean
+어떤 검사를 하는가에 따라 검사 시간이 달라 정확히 말씀드리기 어렵습니다.,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+한 달에 몇 번이나 통증이 있어요?,Korean
+상태가 많이 안 좋아 보여서 바로 응급처치해 드릴게요.,Korean
+호흡할 때 어려움이 있나요?,Korean
+아니요 진료받았던 것 말고 입원 경로가 외래 후 입원이었는지 확인하는 것입니다.,Korean
+담배를 핀 기간은 어느 정도 되나요?,Korean
+어떤 자극에 의해서 위를 이루는 상피세포들이 장을 이루는 상피세포의 성격을 띠게 되는 것입니다.,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+기침에 피는 안 나왔어요?,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+검사를 빨리할수록 만약에 병을 찾을 경우 다양한 치료 방법을 적용할 수 있습니다.,Korean
+소독된 환경을 갖추기가 어려우시기 때문에 되도록 병원에 내원해 주세요.,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+불면증으로 약을 드시고 있나요?,Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+약물 외에 다른 것에 알레르기가 있지는 않으신가요?,Korean
+항생제 반응 검사라는 걸 통해서 확인하실 수 있습니다.,Korean
+결핵 예방접종 이력이 있나요?,Korean
+어떤 마취제였는지 기억하고 계세요?,Korean
+주에 몇 번씩 통증이 느껴지시나요?,Korean
+큰일을 보시면 항문이 아프신가요?,Korean
+간염 치료받은 지 오래되셨나요?,Korean
+피부 상처 치료가 더 이상 필요 없을때 안정적이라고 할 수 있겠네요.,Korean
+현재 복용하는 진통제가 있나요?,Korean
+당뇨약 드시는 거 있으면 말해주세요.,Korean
+구급차를 타고 입원하셨는지를 확인하는 것입니다.,Korean
+본관 일 층 진료 지원센터에 있어요.,Korean
+며칠째 몸이 부은 느낌인가요?,Korean
+결핵약 매일 복용하고 있나요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+네 상황에 따라 마취약을 바꾸거나 양을 조절할 수 있습니다.,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+병의 정도는 검사 결과와 말씀하신 증상을 바탕으로 알려 드릴 수 있습니다.,Korean
+"얼굴에 마비가 와서 왔어요.
+",Korean
+구토는 어떤 식으로 하시나요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+속이 쓰리는 느낌은 없나���?,Korean
+콜라와 같은 아주 짙은 갈색이라면 사구체신염을 의심할 수 있습니다.,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+하루에 담배 타임은 몇 번 정도 가지세요?,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+"아니에요. 십 대 시절부터 피웠거든요.
+",Korean
+네. 알에이치 플러스 에이형입니다.,Korean
+비수면 시 불편함을 더 느낄 수 있지만 비교적 짧은 검사라 괜찮을 수 있습니다. 수면 마취 시에는 수면 마취에 따른 위험성이 따라옵니다.,Korean
+청진이 끝날 때까지 심호흡 반복해 주세요.,Korean
+아픈 데가 너무 많아요.,Korean
+틀니로 인해 흔들리는 치아 말입니다.,Korean
+"지금 삼 일째 금연 중입니다. 처음 피기 시작한 건 스물두 살입니다.
+",Korean
+최근 들어 아프기 시작했나요?,Korean
+간염 때문에 병원 가신 적 있으세요?,Korean
+통증이 멈출 때도 있는 건가요?,Korean
+힘이 나질 않고 무기력함만 느끼시나요?,Korean
+통증이 나타난 게 언제인가요?,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+치료 기간은 얼마나 되었나요?,Korean
+맥박은 팔십 회로 정상범위 안에 드시고요.,Korean
+칼슘을 피해야 하는 질병을 앓으시는 환자분들도 계시지만 환자분은 충분히 드시면 됩니다.,Korean
+기록 조회에 동의하시는 건가요?,Korean
+몸이 부을 때가 있나요?,Korean
+변이 묽게 나오는 정도인가요?,Korean
+언제 암을 처음 진단받으셨나요?,Korean
+환자분이 통증을 견디실 수 있다면 자연분만을 시도할 수 있어요.,Korean
+백신 주사를 맞은 내역이 있으면 알려주세요.,Korean
+두드러기가 난다면 알레르기인 것 같습니다.,Korean
+결핵 때문에 병원 간 적 있으세요?,Korean
+치통 때문에 약을 좀 먹었었는데.,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+고혈압 진단 받은적 있나요?,Korean
+네. 올해 초에 받았고 검진 결과도 가지고 있습니다.,Korean
+배 아플 때 화장실 가도 대변이 잘 안 나오시나요?,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+가족 중에 위 질환 진단을 받으신 분이 있나요?,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+배가 너무 팽팽해져서 불편한가요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+사고당해서 입원한 적 있으세요?,Korean
+야식을 자주 드시면 뇌혈관 질환 심장 질환 등의 위험이 높아져요.,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+수술에 대해 설명 들으셨겠지만 척추마취로 진행되고 수술은 십오 분 정도로 짧게 소요 됩니다. 끝나고 열두 시간은 누워서 안정을 취하셔야 하세요.,Korean
+감염 식중독 장폐쇄 등의 원인에 의한 경우 회복까지 시간이 걸립니다.,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+국소 피부염을 일으킬 가능성이 있습니다.,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+언제 암 진단을 받으셨나요?,Korean
+지금 몇 주째 간염 치료 중이신가요?,Korean
+치료하지 않으면 위선암 위림프종과의 연관성이 있습니다.,Korean
+여행 가느라 장티푸스 맞았어요.,Korean
+어떤 종류의 진통제에 알레르기가 있으신가요?,Korean
+투석실에서 전문 인력이 진행해 줄 겁니다.,Korean
+관계 시 발기 부전 증상으로 곤란함을 느끼고 계신가요?,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+소변 누는 주기가 어떻게 되시나요?,Korean
+면역치료 이외에 방법을 모색해 볼 수 있습니다.,Korean
+오늘도 허리가 아파서 오신 거죠?,Korean
+여기가 치료를 잘해주시는 것 같은데 아쉽네요.,Korean
+통증이 멈출 때도 있는 건가요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+복부가 부은 느낌이 있나요?,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+네. 독감 예방주사 맞은 지 얼마 안 됐어요.,Korean
+알고 계신 환아 몸무게 대략적으로 말씀해 주시면 됩니다.,Korean
+알레르기 검사는 언제 받아보신 거예요?,Korean
+소변줄이 걸리는 곳이 있는지 제가 잠시 보겠습니다.,Korean
+식욕이 떨어지기 시작한 게 언제죠?,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+현재 구토 증상이 있나요?,Korean
+네 알레르기의 유발 원인을 의미합니다.,Korean
+허리랑 목 염좌 때문에 종합병원에 물리치료 다녔어요.,Korean
+기침할 때 가래도 같이 나오나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+움직이면 제일 아픈 부분이 어디인가요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+대변보는 주기가 어떻게 되나요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+네. 거의 서서 일하고 있어서 맨날 다리도 붓고 그래요.,Korean
+혹시 이전에 아토피 진단을 받으신 적이 있나요?,Korean
+네 어느 곳에 있는 병원인가요?,Korean
+가능합니다만 환자가 아이이므로 입원 치료를 권장합니다.,Korean
+유방을 엑스레이 기계로 압박한 후에 상하측 및 내외측 방향으로 엑스선 사진을 찍는 검사로 유방암을 발견하는데 가장 기본적인 검사입니다.,Korean
+욕창이 없어도 통증은 있을 수 있습니다.,Korean
+마취하고 어디가 아프거나 안 좋았던 적이 있나요?,Korean
+과격한 운동을 했을 때 심장이 빨리 뛴다고 느껴지세요?,Korean
+아이가 키 성장뿐만 아니라 다른 발달까지 느릴까 봐 걱정돼요.,Korean
+여드름 부위에 발라야 합니다.,Korean
+처음으로 결핵 진단받으셨던 적이 언제인가요?,Korean
+소독을 할 때에는 멸균적으로 해야 하기 때문에 되도록 동네 병원에서 치료받으시길 권고드립니다.,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+첫째는 자연 분만을 하신 거에요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+어머니가 고혈압약 드시고 계세요.,Korean
+예방접종 한 지 오래됐는데요?,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+목 아픈 건 나으셨어요?,Korean
+네. 열 재고 한번 먹였더니 열 떨어졌어요.,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+음식을 먹으면 토를 하나요?,Korean
+진통제에 대한 거부감을 버리고 심한 날은 도움을 받으세요.,Korean
+네 금식 중에는 약도 복용하시면 안 됩니다.,Korean
+기침할 때 증상이 어떤가요?,Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+아랫배 통증을 호소하시는 분들은 종종 있습니다.,Korean
+"물을 많이 먹였더니 소변은 좀 옅더라고요.
+",Korean
+"촛불에 팔이 닿아서 그을렸어요.
+",Korean
+"평소엔 전혀 문제없었는데 그땐 토할 것 같았어요.
+",Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+통증이 한번 오기 시작하면 얼마 동안 지속되나요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+여성도 과민성 방광 증상이 심해지면 절박성 요실금 증상이 나타날 수 있습니다.,Korean
+통증 진행 양상이 어떤가요?,Korean
+피가 섞인 소변을 보고 있으세요?,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+네. 확인되었습니다. 환자분께서 배가 많이 아프시다고 하셔서 진통제를 드리려고 하는데 아직도 많이 아프신가요?,Korean
+투석은 혈관에 관을 연결하여 진행하게 됩니다.,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+사고로 수술 받은 적 있나요?,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+환자분은 교통사고가 나서 출혈이 심하셨기 때문에 입원하게 되셨어요.,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+감기 정도로만 아팠고 크게 아픈 적은 없었어요.,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+"글쎄요 제가 원래 예전부터 머리가 아프면 속이 좀 울렁거리는 거 말고는 없어요.
+",Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+부위에 자외선 노출 시 색소침착이 있을 수 있습니다.,Korean
+네. 입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+부풀어 오르거나 발적이 없는 걸로 보아 이 항생제에 대한 알레르기는 없어 보입니다. 수고하셨습니다.,Korean
+"며칠 전부터 사타구니 쪽에 뭐가 튀어나왔는데 인터넷에 찾아보니까 탈장 같더라고요.
+",Korean
+담배를 경험해 본 적 있으신가요?,Korean
+한번 아프기 시작하면 통증이 오래 지속되나요?,Korean
+병원에서 간염 진단을 받았나요?,Korean
+환자분은 진료받을 권리 알 권리 및 자기 결정권이 있고 비밀을 보호받을 권리 상담 조정을 신청할 권리가 있습니다.,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+"약 먹기 위해서 죽으로라도 먹어요.
+",Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+그때 증상이 있었던 기간이 어떻게 되나요?,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+간염 처방 약 알 수 ��나요?,Korean
+간염 치료 복용 약 있으시죠?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+예방접종 일정대로 다 맞았어요.,Korean
+피부 연고는 피부과 진료받으시고 처방받으실 수 있어요.,Korean
+처방받은 용량과 용법으로 드시고 계신 거지요?,Korean
+종양 치료는 다 끝났나요?,Korean
+이름처럼 가슴을 보호해 주는 게 가슴 보호대입니다.,Korean
+우선 무엇 때문에 열과 오한이 있는지 알아봐야 할 것 같습니다.,Korean
+통증은 얼마나 자주 생기세요?,Korean
+간염으로 치료 받고 있나요?,Korean
+네 여러 가지 결과가 있으니 내원해서 상세한 결과는 알려 드리겠습니다.,Korean
+심장 뛰는 게 불편한가요?,Korean
+담배를 많이 피우기 시작한 게 언제부터인가요?,Korean
+입원 기간은 짧지만 이주 정도는 손을 사용하실 때 주의하셔야 합니다.,Korean
+며칠에 한 번 통증이 오나요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+과음도 건강에 좋지 않아요.,Korean
+오늘 소독하는 방법을 보시고 따라 하시면 됩니다.,Korean
+피부 상처 치료가 더 이상 필요 없을때 안정적이라고 할 수 있겠네요.,Korean
+숨 쉬는 건 어때요?,Korean
+현재 구토 증상이 있나요?,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+지금 배가 빵빵하고 불편한 증상이 있다면 가스가 차는 것은 아닌지 신체 검사로 감별하겠습니다.,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+"저 소변에 거품이 껴요.
+",Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+네 요즘 코로나 때문에 매일 보호자분도 열 체크해야 해서요.,Korean
+올해로 흡연한 지 얼마나 되셨어요?,Korean
+몇 시간에 한 번씩 통증이 오나요?,Korean
+"폐에서 바람 빠지는 듯한 소리요.
+",Korean
+"머리에 혹이 난 거 보니 엄청 세게 부딪혔나 봐요.
+",Korean
+"속이 메슥거리고 토할 것 같은 느낌이에요.
+",Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+"기본 두세 번은 연달아 토했어요.
+",Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+통증이 있는 곳 어디예요?,Korean
+체온이 몇도 정도 인가요?,Korean
+언제쯤 체중이 급격히 늘었었나요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+몸살감기에 걸려서 내과에 간 적 있어요.,Korean
+피멍 들 것 같아요.,Korean
+약은 집에 있고 처방전 찍어왔어요.,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+심호흡하면 청진이 더 잘 되나요?,Korean
+주사가 들어갈 때는 아프지만 다 들어가고 나면 주사 부위 통증은 금방 사라집니다.,Korean
+목구멍이 아프거나 하진 않으세요?,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+소장에서 대장으로 연결되는 부위에 붙어있는 충수돌기라는 곳에서 생기는 염증을 의미합니다.,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+언제부터 간염을 앓고 계셨나요?,Korean
+네 치료 내역 찾아볼게요.,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+소변에 피가 섞여 나오나요?,Korean
+예방적 항생제는 감염이 존재하지 않지만 수술 후 감염의 위험이 있는 환자에 대하여 감염 예방 목적으로 사용되는 항생제이기 때문에 피부에 놓습니다.,Korean
+필요하시다면 협진 진료 의뢰 드리겠습니다.,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+소독도 해야하고 상처를 확인해야 상처가 악화되었을 때에 적절히 치료받으실 수 있습니다.,Korean
+네 개인 정보 때문에 내원하셔야 결과 들을 수 있습니다.,Korean
+통증 부위는 어디신 거죠?,Korean
+소화가 안 되면서 동반되는 다른 증상이 있나요?,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+응급 수술할 정도인지 검사를 몇 가지 진행하겠습니다.,Korean
+환자 본인 확인을 위해서요.,Korean
+결핵 증상이 있었던 게 언제부터죠?,Korean
+몸에 열나는 것 같나요?,Korean
+계속 먹고 있는 항결핵���가 있나요?,Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+요즘 혹시 오한이 있나요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+네 복용 중인 약 다 얘기해 주세요.,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+병원에서 큰 수술을 받으셨나요?,Korean
+"어제 아기가 기침한 후로 숨소리가 이상해요.
+",Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+이후 식사 제한 처방이 나면 말씀 드릴게요.,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+숙모가 코로나에 감염됐다가 완치하셨어요.,Korean
+설사를 하거나 대변 볼 때 피가 나오진 않나요?,Korean
+"원래 없었는데 요새 변비가 좀 온 거 같기도 하고.
+",Korean
+몸에 열 기운이 느껴지세요?,Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+앞으로 진료 방향에 대해 어떻게 할지 판단하기 위해서 입니다.,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+아프신 이유가 암 때문인가요?,Korean
+아침에 혈압약이 효과가 있었네요.,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+병원에 오래 입원하셨던 때가 있으세요?,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+통증이 얼마 만에 오나요?,Korean
+"소화도 안 되고 계속 먹기만 하면 토해요.
+",Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+경정맥신우조영술은 조영제가 신장을 통해 배설되는 시간을 확인하는 검사입니다.,Korean
+정확히 아픈 부위가 어디예요?,Korean
+"피부 건조가 심하고 착색이 돼서요.
+",Korean
+정상 수치보다 엘 디 엘 콜레스테롤이 높으면 진단할 수 있습니다.,Korean
+그 바이러스를 가지고 있으면 어떻게 되는 건가요?,Korean
+요즘 코로나 때문에 아무 데도 안 갔다 왔어요.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+지금 상처가 아물고 있으니 며칠은 지켜봐야 할 거 같습니다.,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+진피 이하의 깊은 부위 손상으로 보입니다.,Korean
+과거에 다른 질병으로 치료받거나 수술받은 적이 있으신지 알아야 해서 질문 드렸습니다.,Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+네 질환마다 기침 소리가 조금씩 다릅니다.,Korean
+혈변은 얼마나 자주 보시는 편인가요?,Korean
+현재 구토 증상이 있나요?,Korean
+수액을 좀 더 맞으신 뒤 검사 진행할 예정입니다.,Korean
+정확히 아픈 부위가 어디예요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+심부 이도 화상은 회복까지 한 달 남짓 걸릴 수 있습니다.,Korean
+심하지 않다면 식습관 조절이나 좌욕 등을 통해 치료를 할 수도 있습니다.,Korean
+"세네 시간 전부터 계속 뭔가 뭉친 듯이 아프더라고요.
+",Korean
+하루 동안 담배는 얼마나 하시죠?,Korean
+오한 증상이 있다고 생각하나요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+네. 손 따는 것도 민간요법이라 할 수 있습니다.,Korean
+금식이 꼭 필요한 검사예요. 다음에 다시 예약하고 오셔야 해요.,Korean
+알레르기가 있다는 걸 언제 아셨나요?,Korean
+통증 지속 여부를 알려주세요.,Korean
+상처 부위에 붓기도 있나요?,Korean
+"볼이 많이 부어서요. 왜 이러는 거죠?
+",Korean
+결핵인지 언제 알게 되셨나요?,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+소변을 잘 못 보시나요?,Korean
+네 위염 때문에 더부룩한 증상이 있으셨던 것 같습니다.,Korean
+토할 때 피도 나왔나요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+조금 따끔하는 정도예요. 그래도 걱정되시면 치료 전에 한 번 더 말씀해 주세요.,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+왜 바로 검사 안 하고 병실로 가는 거죠?,Korean
+"살이 꽤 많이 빠졌어요.
+",Korean
+흉부에 불편한 곳이 있나요?,Korean
+가슴 두근거림이 자주 있으세요?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+잇몸 한 번 볼게요.,Korean
+어렸을 때부터 빈혈이 있었어요.,Korean
+"엉덩이가 빨갛게 붓더니 움직일 때마다 아파서 자지러져요.
+",Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+이 약품들 외에는 복용 안 하시나요?,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+지방 수치가 기준치보다 높으면 진단 가능합니다.,Korean
+지금 상처가 아물고 있으니 며칠은 지켜봐야 할 거 같습니다.,Korean
+네 진료 센터에서 모두 해드립니다.,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+"얼굴에 마비가 온 느낌이에요.
+",Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+"길 가다가 교통사고가 났는데 다리를 다쳤어요.
+",Korean
+"아 담배랑 술은 끊은지 좀 됐어요.
+",Korean
+퇴원 안내문에 복통 환자 주의사항이 있으니 잘 읽어보시고 배가 많이 아프시거나 증상이 생기면 소화기 내과 외래나 응급실로 내원하셔서 진료 보시면 됩니다.,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+"숨쉬기 좀 힘들다고 했어요.
+",Korean
+네 많이 아프지만 진통제가 주입되고 있어서 참을만할 겁니다.,Korean
+언제 당뇨 얘기를 들으셨나요?,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+약물 알레르기 있는 거 있으세요?,Korean
+가장 최근 입원이 언제죠?,Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+어떤 약재가 들어가 있는지 몰라서 혹시 약재 적힌 종이 같은 거 가지고 계시나요?,Korean
+수혈은 힘들 것 같아요.,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+기침할 때 증상이 어떤가요?,Korean
+토할 때 피가 자주 보이시나요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+설사가 나올 때 감정적으로 힘든 점이나 스트레스 있으셨어요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+네. 이 동네에서 제일 진료 잘 보는 병원으로요.,Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+만약 헤모필루스 인플루엔자로 인한 후두개염일 경우 기관 내에 관을 넣고 지켜보기도 합니다.,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+언제부터 소변을 누기가 힘이 드셨어요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+퇴원 후에 필요한 서류 말씀해 주셔도 상관없습니다.,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+변비 약 어떤 걸 드셨나요?,Korean
+환자분 정보를 얻기 위함입니다.,Korean
+제가 크게 아픈 건 아닌 이상 병원을 안 가서 오랜만에 병원 온 거예요.,Korean
+꽃가루는 약물 아니잖아요. 그럼 약물 알러지는 없어요.,Korean
+"친구가 장난치다 휴대폰에 맞아 치아가 부러진 것 같아요.
+",Korean
+예전에 아팠던 곳 있어요?,Korean
+허리에 핀을 박아야 해서 수술했어요.,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+"팔꿈치 수술을 받았었는데 펼 수가 없어요.
+",Korean
+결핵약 매일 복용하고 있나요?,Korean
+진통제 자체가 통증을 완화해야 할 때 쓰는 약입니다.,Korean
+네. 당뇨약 먹고 있고 혈당 검사 정상 수치 나오고 있습니다.,Korean
+"가슴이랑 옆구리 통증이 너무 심해서 허리를 펴고 걸을 수가 없어요.
+",Korean
+인플루엔자 백신 언제 맞으셨나요?,Korean
+"가래가 계속 나오고 머리가 너무 지끈거려요.
+",Korean
+네. 콰란틴 끝나고 음성 받아서 나온 겁니다.,Korean
+움직일 때 불편한 점이 있으신가요?,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+어디를 치료하고 싶어서 왔나요?,Korean
+평소에 대변을 보기가 힘든가요?,Korean
+작년에 잇몸 치료한 게 다예요.,Korean
+하루에 두 갑은 피우세요?,Korean
+간염 치료로 복용 중인 약 있어요?,Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+네. 에스트로겐 들어간 거 먹고 있어요.,Korean
+"""설사를 유발하는 특정 음식이나, 환경 요인이 있나요?""",Korean
+다음 방문 시 약 이름 찾아오세요.,Korean
+결핵 주사 맞아본 경험 있으세요?,Korean
+"대략 다섯 시간 자는 것 같아요.
+",Korean
+가족 중에서 고혈압이신 분 계신가요?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+제가 주사 부위를 살펴볼게요.,Korean
+석회화에도 양성 석회화와 악성 석회화가 있는데 환자분의 경우는 영상이 또렷하지가 않고 미세한 석회화가 많아 보이는 경우 이십 퍼센트 정도 악성으로 진단 됩니다.,Korean
+"네. 혈변도 누고 배도 조금 아팠어요.
+",Korean
+친구 분이 어떤 이동수단으로 입원 시켜주셨나요?,Korean
+일 년 전에 타 병원 내원한 적 있어요.,Korean
+과식을 하지 않아도 소화가 되질 않나요?,Korean
+마취약 말고는 꾸준히 복용하시는 약물은 없으신가요?,Korean
+소변을 보실 때 피가 나오신 적 있으세요?,Korean
+네 철을 잇몸에 박은 것인데 자연 치아로 분류되지 않습니다.,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+그럼 전에 검사하셨을 때 문제 없으셨던 건가요?,Korean
+불면으로 어려움을 겪고 계신가요?,Korean
+지금은 항생제가 들어가고 있어서 아플 수 있어요.,Korean
+복부 팽만감이 들지는 않으세요?,Korean
+얼굴이 빨간데 몸에서 열이 나나요?,Korean
+그 약만 먹으면 자꾸 구토 증상이 있어요.,Korean
+감기 예방 주사는 맞았나요?,Korean
+어떤 부위에 국소마취를 하셨나요? 수술하신 건가요?,Korean
+생리식염수를 사용하여 적셔준 후 웻거즈를 사용하고 테라마이신 연고를 쓴 다음 바셀린 거즈로 최종 마무리를 합니다.,Korean
+가족 중 암이 있으신 분 있을까요?,Korean
+네 교정 치료랑 약물 치료 병행해야 합니다.,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+구역질이 날 때가 있나요?,Korean
+변에 피가 섞여 나오나요?,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+"머리가 빙빙 도는 느낌이에요.
+",Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+발목 인대가 늘어나셔서 발목보호대 하나 사셔야 합니다.,Korean
+"""한 달 전에 진행했던 대장 내시경 결과, 대장에는 이상이 없어, 병변에 해당하는 직장 부위만 봐도 충분합니다.""",Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+나중에 다 낫고 흡연 생각나더라도 재발할 수도 있으니까 참아주세요.,Korean
+헌혈말고 수혈을 한 달에 한 번씩 하시는 건가요?,Korean
+"안녕하세요. 저 요즘에 손가락이 계속 붓고 통증도 있고 고름도 좀 나오더라고요. 그래서 왔어요.
+",Korean
+숨 쉬는 건 어때요?,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+부모님 중 암을 진단받은 분이 있나요?,Korean
+"몸이 쳐지는 게 저혈압인 거 같아요.
+",Korean
+"울렁거리는 증상도 있고 처음엔 감기 증상인 거 같아서 해열진통제만 먹었는데 열이 안 떨어지고 옆구리가 계속 아파서 왔어요.
+",Korean
+네 지금까지 들어본 거로는 심장병은 아닌 듯 합니다.,Korean
+요즘 혹시 두통이 있나요?,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+감염 예방과 함께 진피층 회복을 촉진할 처치가 진행될 예정입니다.,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+"발꿈치 바닥 쪽을 다친 것 같아요.
+",Korean
+혈압이 평소에 비해 많이 높아지셨어요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+"아무 이유 없이 배가 갑자기 너무 아파요.
+",Korean
+복부에 많은 고통이 동반되나요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+통증 말씀이신가요 부기 말씀이신가요?,Korean
+네 언제 증상이 있으셨나요?,Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+약물과 음식 외에 또 알레르기원이 있나요?,Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+알레르기 반응이라고 제가 확 느낀 적은 없었던 것 같아요.,Korean
+아이가 엄살이 심한데 마취로 재워버리면 안 될까요?,Korean
+척추마취 후 흔하게 두통 등 부작용이 있습니다.,Korean
+독감 주사 같은 경우는 매년 일 회 맞는 게 좋아요.,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+객혈을 한 시기에 따라 병명이 달라질 수도 있습니다.,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+때운 치아는 본인 치아입니다.,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+통증 시작하면 얼마나 가요?,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+아픈 게 사라지지 않나요?,Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+"식도에 이상이 있다고 알려주셨어요.
+",Korean
+"분유 말고는 먹은 게 없는데 설사를 해서요.
+",Korean
+설사 할때 다른 불편한 것도 있나요?,Korean
+술은 일주일에 어느 정도 드시나요?,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+예 혹시 모르니 약은 꾸준히 드세요.,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+숨 쉴 때 힘드신가요?,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+혈변 주기가 어떻게 되나요?,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+하루에 몇 개비나 피우세요?,Korean
+한 삼 개월 정도요 약을 드셨나요?,Korean
+편도선 많이 안 부었어요?,Korean
+그렇습니다. 갑작스럽게 뿜어져 나오듯 나오는 구토입니다.,Korean
+가려움이 더 심해졌다거나 한 부위만 유독 가려운 느낌은 없었나요?,Korean
+평소보다 현저히 음식을 섭취하는 양이 줄었나요?,Korean
+소독을 꾸준히 해 주세요.,Korean
+출장이 있어서 어쩔 수 없이 코로나 유행 지역에 갔었죠.,Korean
+알레르기 진단받은 시기가 언제예요?,Korean
+추가로 아프신 곳이나 불편하신 곳 있으신가요?,Korean
+"목이 너무 아파요. 말도 못 하겠어요.
+",Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+속이 꽉 막힌 것 같나요?,Korean
+"어제부터 애기 소변에서 피가 섞여 나와서요.
+",Korean
+언제부터 피부 변화가 있으셨나요?,Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+암 판정을 받으시면 산정 특례 도와드리겠습니다. 그게 아니더라도 병원비가 부담되신다면 사회 지원실에 연결해드릴 수 있으니 언제든 말씀해 주세요.,Korean
+언제 당뇨 얘기를 들으셨나요?,Korean
+산소 공급이 몸 전체에 원활하게 되지 않아서 그렇습니다.,Korean
+부종이 발생한 곳이 있나요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+간 이식 수술받고 약물 중이에요.,Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+입안이 따끔한 증상이 심했나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+네. 네. 퇴원할 거예요.,Korean
+이 음식에서 알레르기 반응이 나타나나요?,Korean
+환자 컨디션마다 다르지만 보통은 여섯 시간 지속됩니다.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+제가 한 세 살 때쯤 입원한 것으로 알고 있어요.,Korean
+치료를 도중에 중단하고 이후에 재개할 경우 일 년 이상이 걸릴 수도 있습니다.,Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+피부에 놓는 이유는 세균 포도상 구균 연쇄상 구균 등의 감염을 예방하기 위해서죠.,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+가스가 장 안에서 차는 것이기 때문에 다른 장기를 누르는 경우는 드뭅니다.,Korean
+알레르기 때문에 죽을 정도로 고통스러웠던 적 있나요?,Korean
+입원하는 게 치료에는 더 낫습니다.,Korean
+유전적 질환이 남자 형제에게만 나타났나요?,Korean
+"키우던 뱀한테 손을 물렸어요.
+",Korean
+네. 혈압약 먹고 정기점검받고 있어요.,Korean
+약 챙겨 먹는 거 하나도 없어요.,Korean
+상처 부위에 진물이 찰 수 있기 때문에 소독은 자주 해야 합니다.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+"약을 많이 먹었어요. 의식이 없어요.
+",Korean
+사고로 상해를 입은적이 있나요?,Korean
+미주신경성 실신 때문에 쓰러지면서 다쳐서 바로 얼마 전인 일주일 전에 다른 병원에 입원했었습니다.,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+이거 먹기만 하고 주사 같은 건 안 놔 주시는 거예요?,Korean
+딱히 약물 알레르기는 없었던 것 같아요.,Korean
+통증이 좀 강한 편이에요?,Korean
+몸이 부을 때가 있나요?,Korean
+평소에도 계속 거칠게 숨을 쉬나요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+콜라 같은 색의 소변인가요?,Korean
+네. 대부분 약물 치료로 가능하고 일부 시술이 필요할 수도 있습니다.,Korean
+하루 흡연량이 얼마나 되는데요?,Korean
+현재 투약 중인 약이 있으신가요?,Korean
+어떤 치료제를 드시고 계세요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+대장암과 같은 기질적 문제가 있을 시에 그러한 변화가 나타날 수 있습니다.,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+무력감이 온몸을 휩싼 증상이 있나요?,Korean
+다쳐서 수술을 받거나 입원치료를 받으�� 적 있나요?,Korean
+아빠가 신장 이식받으신 적이 있으세요.,Korean
+약이 들어갈 때 뻐근할 수 있으니 불편하시면 말씀해 주세요.,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+산소 공급이 몸 전체에 원활하게 되지 않아서 그렇습니다.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+몸이 덜덜 떨리는 증상은 없는지 말씀해 주실래요?,Korean
+요의는 있는데 소변이 나오지는 않았던 적이 있었나요?,Korean
+한 번에 먹는 술의 양이 정해져 있나요?,Korean
+폐경 증상을 파악하기 위함입니다.,Korean
+혈변에 피가 많이 보였나요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+알레르기 진단을 받은 후 다른 반응에도 나온 적이 있으신가요?,Korean
+통증이 하루에 몇 번씩 오세요?,Korean
+대략 언제부터 이런 고통이 있었나요?,Korean
+통증 느껴지는 곳 짚어보세요.,Korean
+속이 많이 울렁거려서 토하고 싶으신가요?,Korean
+두통이 계속 지속되고 있나요?,Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+자극성 변비약의 경우 비교적 빠르게 작용하여 곧 변을 보게 할 수 있습니다.,Korean
+목이 자주 붓긴 하는데요.,Korean
+식후 소화가 잘 안되어 일상생활이 불편하신가요?,Korean
+틀니가 아니라 틀니로 인해 본인의 치아가 흔들릴 가능성이 있습니다.,Korean
+알레르기 때문에 먹으면 안 되는 약이 있으세요?,Korean
+"밤에 잠이 안 와서 너무 힘들어요.
+",Korean
+입으로 피를 토한 적이 있나요?,Korean
+환자분의 약을 알아야 처방한 약이나 주사의 성분이 충돌하지 않게끔 조절하기 위해 성분을 분석할 수 있습니다.,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+"아니요. 적어도 아홉 시간 정도 자는 것 같아요.
+",Korean
+지금 아픈 게 느껴지실까요?,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+검사결과는 보통 빠르면 일주일 소요되기 때문에 그 전에 받기는 힘드세요.,Korean
+눈으로 봐도 알 수 있지만 지금 상태는 혹시 더 심하지는 않은지 제대로 검사를 해야 하는 상태입니다.,Korean
+"목에 통증이 있어서 왔어요.
+",Korean
+네 아니면 지금 혈액 검사받으시겠어요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+가스와 변을 없애기 위해서는 변비를 치료해야 합니다.,Korean
+혹시 고혈압 관련해서 약 드시고 있으세요?,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+"제가 우유를 먹고 토를 심하게 한 적이 있어서 안 마십니다.
+",Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+흡연을 시작한 나이를 아세요?,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+휠체어 꼭 타야 해요?,Korean
+"숨쉬기가 힘들 때가 있어요.
+",Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+"물만 먹어도 토해요. 뱃속에 아무것도 없을 때까지요.
+",Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+네. 하반신 마취도 포함입니다.,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+제가 아픈 걸 못 참아서 그러는데 무통 주사 꼭 바로 넣어 주시겠어요?,Korean
+얼마나 자주 현기증을 느끼시나요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+결핵 약 지금도 드시나요?,Korean
+"변비 증세가 있고 배가 부풀어 있어요.
+",Korean
+항생제를 복용하시면서 음주를 하실 경우 부작용이 발생할 수 있습니다.,Korean
+혈압이 높은 거 안 지 얼마나 되셨어요?,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+"어깨를 좀 돌린다거나 팔을 심하게 쓴다거나 하면 좀 툭 빠지는 느낌이 있습니다.
+",Korean
+숨쉬기가 어려운 느낌이 드세요?,Korean
+"소화가 잘 안되는 거 같으면서 토하면 시원해질 거 같아서 더 자주 해요.
+",Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+금식을 하지 않으면 수술 중 위 내용물이 역류할 수 있습니다.,Korean
+건강 검진도 주기적으로 받는 게 중요해서요 받은 지 오래 되었으면 한 번 더 해보시죠.,Korean
+고혈압으로 약을 드신다거나 병원에 다니신���거나 하는 게 있나요?,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+틀니 임플란트 등 자연적으로 난 치아에서 의학적인 기술이 들어간 치아 상태를 모두 말씀드리는 거예요.,Korean
+일단은 치료 들어가면 답변해 드릴게요. 상태가 너무 안 좋아요.,Korean
+"배가 엄청나게 자주 아파지고 그때마다 화장실에서 설사했어요. 변은 거의 액체 수준으로 흐르듯이 했고요. 색은 좀 묽어 보였어요.
+",Korean
+"자꾸 목에서 피 맛이 느껴져요.
+",Korean
+"수술한 곳이 터질 듯 아프고 진물이 나네요.
+",Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+암 수술한 적 있으세요?,Korean
+네 뜸이나 부항 뜨신 적 있으신가요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+네 흔하지 않은 종류의 위염입니다.,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+아이가 바이러스나 세균감염에 걸리지 않으면 더 빨리 좋아질 수 있습니다.,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+"발목 아래 전체에 통증이 있어요.
+",Korean
+대변볼 때 피가 난 적 있어요?,Korean
+응급실에서 피 검사하면서 동시에 작은 엔에스 달고 올라오긴 하셨는데 피검사 다시 해야 한다고 합니다.,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+어디가 부은 느낌 있나요?,Korean
+까스활명수보다 처방받은 약을 추천드립니다.,Korean
+담배 피운 기간이 오래되었나요?,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+"네. 너무 아파서 그 이후로 눈도 못 붙였습니다.
+",Korean
+수술 후 출혈 또는 늑막액의 배출을 원활히 하기 위해서는 배액관이 꼭 필요합니다.,Korean
+발기 지속시간이 얼마나 돼요?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+검사를 받기까지 시간이 조금 걸릴 수 있는데 괜찮으신가요?,Korean
+처음 통증 있었던 게 언제죠?,Korean
+호흡곤란이 온 적 있어요?,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+"좀 오래 자요 열다섯 시간 정도예요.
+",Korean
+담배를 처음 핀 게 언제죠?,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+가려우면 최대 두 알까지 처방해드린 약을 드시면 됩니다.,Korean
+하루에 소변보는 횟수가 어떻게 되나요?,Korean
+오심은 신물이 올라오는 것과 같은 형태로 나타날 수도 있지만 토할 것처럼 속이 울렁거리는 형태로 나타나는 경우도 많습니다.,Korean
+몸이 약해서 제왕 절개했어요.,Korean
+입원해서 치료한 경험 모두 다 맞습니다.,Korean
+"소변볼 때 통증이 있던 것 빼고 다른 문제는 없습니다만.
+",Korean
+대변을 보실 때 많이 아프신가요?,Korean
+요구 사항으로 전달은 드리지만 환자분의 치료 계획 또는 신체 상태에 따라 변경될 수 있습니다.,Korean
+심전도는 정상으로 나왔는데 혈액검사 수치 중에 혈액내 지방 수치가 높게 나왔네요. 피검사 하는 날 금식 잘 하고 시행하셨죠?,Korean
+"할머니가 깨어나질 않고 누워만 계셔서요.
+",Korean
+안 됩니다. 기계에 의존하는 호흡은 회복에 도움이 되지 않습니다.,Korean
+빈혈이 상당히 심해서 걷다가 주저앉은 적도 있어요.,Korean
+객담이 많은 거 같나요?,Korean
+가슴이 아픈 곳이 있으십니까?,Korean
+"살이 조금 빠지시긴 했어요.
+",Korean
+"저희 오빠가 갑자기 쓰러졌어요.
+",Korean
+빈뇨 때문에 여러 번 깨시는군요. 잔뇨감이나 통증도 있으신가요?,Korean
+최근 들어 살이 갑자기 찐다거나 하진 않나요?,Korean
+이석증이라고 약 먹으라고 해서 약 복용 중이었습니다.,Korean
+전반적으로 치아 상태를 다 보는 거예요.,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+흡연량이 정확하지 않아도 대략 알려주세요.,Korean
+수술의 종류는 여러 가지가 있는데 체외충격파 쇄석술을 할 수 있는 병원에선 시술이 가능합니다.,Korean
+가족 중에 고혈압 치료를 받는 분은 안 계시죠?,Korean
+통증이 얼마 만에 오나요?,Korean
+당뇨 측정하면 높은 편이신가요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+"차 사고가 나면서 목을 다쳤나 봐요. 목 부분이 아파요.
+",Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+혈액검사 결과는 확인 후 이상 소견이 있을 시 설명드리겠습니다.,Korean
+상처의 경과에 따라 치료 방법이 상이할 수 있습니다.,Korean
+메스꺼움은 주로 식��에 나타나나요?,Korean
+"무릎이 아픈 뒤로는 변도 잘 안 나옵니다.
+",Korean
+염증 수치는 왜 올라가는 건가요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+반려견이 주사 맞는 게 아닌가요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+환부에 마취를 하고 진행하여 엄청난 통증이 있지는 않습니다.,Korean
+"소변 횟수가 는 것 같아요.
+",Korean
+암 수술한 적 있으세요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+전신무력증이 온 것 같습니다.,Korean
+발진이 살짝 나긴 했는데 금방 가라앉았어요.,Korean
+"고혈압도 있고 당뇨도 있어요.
+",Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+"제가 소화기관이 약해서 안 해요.
+",Korean
+"변 보고 나면 선홍색 피가 같이 묻어나요.
+",Korean
+암 치료받으신 기간 알려주세요.,Korean
+백신 접종은 매년 하고 계신가요?,Korean
+"가만히 있어도 어지럽고 토가 나와요.
+",Korean
+지금 알려주셔야 곧 입원이 가능합니다.,Korean
+약물 알레르기가 있으면 가려움증이나 붓는 증상이 나타날 수도 있습니다.,Korean
+아직 검사 결과 안 나온 거 아니었나요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+"입원 치료를 받으라고 권유받았어요.
+",Korean
+결핵 치료하신 지 얼마나 되셨나요?,Korean
+평소에 대변을 보기가 힘든가요?,Korean
+아니요 복용 중인 약 이름을 알아야 해서요.,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+최근에 어지럽거나 창백해지지 않았나요?,Korean
+당뇨약 어떤 거 처방받으셨어요?,Korean
+"변의 상태가 썩 좋진 않은 것 같아요.
+",Korean
+"엉덩이 쪽 쏘인 것 같아요.
+",Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+검사하고 휠체어 이용방법 알려 드리겠습니다.,Korean
+다른 아픈 곳은 없으신가요?,Korean
+환자복이랑 침구 제공해 드려요.,Korean
+코로나 검사받으러 의료원 다녀왔었는데요.,Korean
+아픈 부위가 있다면 다 말해주세요.,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+사출성 구토의 원인 중 장폐색과 같은 심각한 원인일 수 있지만 식중독도 의심되므로 원인 파악 후 다시 말씀드리겠습니다.,Korean
+통원치료 하신건가요? 어떤 치료 받으셨나요?,Korean
+흉통 유무를 말씀해 주세요.,Korean
+네 알레르기 특별히 없어요.,Korean
+검사를 해봐야 어디가 문젠 지 알 수 있겠어요.,Korean
+부목 항상 해야 하나요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+가슴 조이는 느낌이 심한가요?,Korean
+하루에 소변보는 횟수가 어떻게 되나요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+한 달 내에 머리가 아파서 다녀왔어요.,Korean
+며칠에 한 번 통증이 오나요?,Korean
+아닙니다. 가슴 통증을 유발하는 비심인성 원인도 다양하기 때문에 심근경색 이외에 다른 질환에 의한 가슴 통증일 가능성이 커 보입니다.,Korean
+피부가 손상받을 수 있습니다.,Korean
+가슴이 빨리 뛰고 요동치시나요?,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+수면제 복용하신 지 얼마나 됐는지 알려주세요.,Korean
+독감은 매년 꼬박꼬박 맞죠.,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+여러 가지 이유로 자주 깰 수 있는데 환자분은 통증 때문이니까 진통제를 복용하시는 게 좋겠습니다.,Korean
+혈우병이 있어요. 저희 아이가.,Korean
+치료 당일에 오시면 됩니다.,Korean
+고지혈증 당뇨 신기능 간기능 갑상선 기능 등에 대해 알 수 있습니다.,Korean
+태아 시기에 고환이 음낭 위치로 내려오게 되는데 이 때 복막이 닫혀야 하는데 닫히지 않아 이곳으로 탈장이 일어난 것 입니다.,Korean
+하루에 설사를 자주 하시나요?,Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+삼 일 뒤에 입원 가능합니다.,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+간 이식 수술받고 약물 중이에요.,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+통증이 하루에 자주 일어났어요?,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+당뇨로 어떤 약을 드시고 계세요?,Korean
+네 흡연을 시작한 후로 지금까지입니다.,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+파상풍 맞은 적 있어요.,Korean
+"많이 자야 여섯 시간일 거예요.
+",Korean
+몸이 부을 때가 있나요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+자연스러운 갱년기 증상일 수 있습니다.,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+하루에 담배를 얼마나 피시죠?,Korean
+종양 앓았던 가족이 있으셨나요?,Korean
+체중 감량이 얼마나 있었죠?,Korean
+"계단에 턱을 박았는데 깨진 것 같아요.
+",Korean
+현재도 결핵 치료를 받고 계신가요?,Korean
+수술이 끝나면 회복실로 가실 것 같아요.,Korean
+"화장실을 자주 가고 소변도 많이 나와요.
+",Korean
+수술하기 전 동의서 작성 시 자세한 설명 들으실 수 있습니다.,Korean
+식사는 최소 열두 시간 물은 여덟 시간 이상 금식하셔야 합니다.,Korean
+욕창이 생기지 않기 위해서는 두세 시간에 한 번씩 자세를 바꿔주시는 게 좋습니다.,Korean
+대변볼 때 피가 나오나요?,Korean
+소독 붕대는 상처가 아물 때까지 갈아주는 게 좋습니다.,Korean
+"다름이 아니라 우리 애가 좀 빨리 크는 것 같더라고요 그래서 검사 한 번 받아보려고 왔습니다.
+",Korean
+결핵 치료 기간이 오래된 건가요?,Korean
+흉터가 조금 생길 수도 있어요.,Korean
+과거 수술 이력이 있는지 알려주세요.,Korean
+"폭행 사건에 휘말렸는데 얼굴을 다쳤어요.
+",Korean
+대변 활동이 원활하지 않나요?,Korean
+가족 중에 누군가 고혈압이 있나요?,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+피가 섞인 변을 보시나요?,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+계속 아픈데 잘못 바늘이 들어온 것이 아닌가요?,Korean
+예방 접종한 거 혹시 있으면 알려주세요.,Korean
+당뇨 측정을 해 보셨나요?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+언제부터 발기부전이 생겼는지 알고 싶어요.,Korean
+약간 따가울 거예요. 정상적인 반응입니다.,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+평소 생활습관 관리를 해야 하며 지속적인 진료가 필요하다는 점에서 유사합니다.,Korean
+내시경 검사를 통해 위장관 내부를 더 잘 관찰하기 위해서 금식을 시행합니다. 뭔가 드셨다면 정확한 검사 결과를 얻기 어렵습니다.,Korean
+욕창은 추가적으로 생긴 질병이기 때문에 다른 병의 치료도 잘 받으셔야지요.,Korean
+피가 섞인 소변을 봤나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+"조개 먹고?배탈 난 적이?있어서 해산물을 잘 안 먹어요.
+",Korean
+혈압이 평소에 많이 높은가요?,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+"아니요. 어느 순간부터 수면 시간이나 패턴이 일정해 본 적이 없어요.
+",Korean
+병원비 청구를 위해 필요합니다.,Korean
+"가려움증이 너무 심해요. 머리부터 발끝까지. 심지어 눈 속도 가려운 느낌이에요.
+",Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+몸에 갑자기 열이 나나요?,Korean
+"""콕콕 찌르는 듯이 아픈가요, 쑤시듯이 아픈가요, 묵직하게 아픈가요, 날카롭게 아픈가요?""",Korean
+이 검사는 금식이 필요하기 때문입니다.,Korean
+대변볼 때 피가 보이나요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+평소 소화가 잘 안 되나요?,Korean
+통증 시작 날 알려주세요.,Korean
+"아침에 토 한 번 했었어요.
+",Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+장염? 한 번도 없는데요.,Korean
+네 혈액 검사를 해야 알 수 있습니다.,Korean
+자연 치아에 비해 기능이 부족한 치아를 확인하려 합니다.,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+같은 감염원을 접하더라도 사람에 따라 다른 반응이 나타날 수 있습니다.,Korean
+그냥 이 약물이 안 맞는다 보시면 돼요.,Korean
+알레르기 반응하는 음식은 뭔가요?,Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+지난번에 암 치료는 언제 시작하셨나요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+여기서 처방받은 약 이외에 다른 약 드시는 게 있을까 해서 여쭤봤습니다.,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+"저도 자세히 모르겠는데 환자에게 물어보고 와도 될까요?
+",Korean
+최근��� 오한을 느낀 적이 있나요?,Korean
+"정밀검사를 받아보래서 엠알아이 하려고요.
+",Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+아니요 임플란트와 자기 치아를 확인하는 과정입니다.,Korean
+"변을 잘 못 본 지 며칠 됐어요.
+",Korean
+독감 접종 언제 맞으신 거죠?,Korean
+평소에 변은 잘 보세요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+맥박이 빨리 뛰지는 않으세요?,Korean
+하루에 소변보는 횟수가 어떻게 되나요?,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+소변볼 때마다 피가 나오나요?,Korean
+암 치료받으신 기간 알려주세요.,Korean
+"세 시간도 못 자요. 불면증이 심해졌어요.
+",Korean
+결핵 수치가 높은 편이신가요?,Korean
+네. 혹시 항생제도 좀 세게 넣어주실 수 있나요?,Korean
+"한 달째 기침이 멈추지를 않아요. 검사해보자고 하셔서 입원했어요.
+",Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+지금은 약을 꾸준히 바르는 방법밖에 없어요.,Korean
+혼자 지내시려면 요양사는 필요할 것 같습니다.,Korean
+마취약 말고는 꾸준히 복용하시는 약물은 없으신가요?,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+소변에 피가 함께 나오나요?,Korean
+부정맥으로 오래 고생 좀 했어요.,Korean
+상해로 입원하신 적이 있나요?,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+요즘은 대부분 반려견들도 예방 접종을 합니다.,Korean
+심호흡을 잘하시니 굳이 산소마스크를 쓰고 계실 필요는 없습니다.,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+제가 지금 환자분 상태를 설명해 드릴게요.,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+다행히 약은 잘 받아요.,Korean
+수술했던 병원 명을 알고 계시다면 알려주세요.,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+당뇨약을 가끔 잊어서 그런지 혈당도 불규칙하네요.,Korean
+토혈이 나타난 건 언제인가요?,Korean
+자누메트엑스알 서방정. 당뇨때문에 먹고 있어요.,Korean
+깊이 못 주무시고 자주 깨시나요?,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+갑자기 일어나면 어지러움이 있어요?,Korean
+관련 검사를 추가로 해봅시다.,Korean
+결핵은 약물치료를 받고 계시나요?,Korean
+약 드리기 전에 몇 가지 검사를 진행하려 하는데 괜찮으신가요?,Korean
+잠을 푹 주무실 수 없나요?,Korean
+음식 알레르기 어떤 거 있으세요?,Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+오늘은 안 드셨어도 평소 드시던 약이면 말씀해주십시오.,Korean
+심각성과 급성기임이 꼭 일치하지는 않으며 급성기는 지금 치료가 필요한 단계입니다.,Korean
+통증이 느껴지는 곳이 어느 곳인가요?,Korean
+하루 동안 몇 개비의 담배를 피우시나요?,Korean
+결핵약 드시는 것이 있다면 말씀해 주세요.,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+보호자분이 따로 하실 건 없고 아이 열 떨어질 수 있도록 시원한 상태 계속 유지해 주세요.,Korean
+암을 치료하기 위해 내원하신 적 있으세요?,Korean
+네 우선 대기실에서 약품명 검색하신 후 알게 되신다면 간호사에게 알려주시기 바랍니다.,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+어디가 제일 많이 부었나요?,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+최대한 빨리 진료받고 싶어서 아홉 시 십 분이 좋을 것 같아요.,Korean
+"체한 것처럼 꽉 막힌 느낌을 자주 받아요.
+",Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+"결혼하면서 금연하기로 했었는데 육아하면서 종종 가끔 피워요.
+",Korean
+그때 너무 아파서 응급실로 다녀왔어요.,Korean
+이 병원에서 수술해서 아마 차트에 있을 거예요.,Korean
+"아니요. 한 번 체온 좀 다시 재 주세요.
+",Korean
+"폐렴 기가 심해져서 호흡곤란이 왔어요.
+",Korean
+"선생님. 저희 아기 고환이 이상한 것 같아요. 맞나요?
+",Korean
+고혈압인 것을 안 게 언제부터죠?,Korean
+수술적 제거가 어려울 경우 항암치료 방사선 치료 등을 고려할 수 있습니다.,Korean
+지금 아픈 곳 말하세요.,Korean
+폐경 이후에 건강검진���서 골다공증 소견 있다고 했어요.,Korean
+지난달보다 체중이 몇 킬로 늘었나요?,Korean
+몸에 열이 나는 게 느껴지세요?,Korean
+"편도 쪽으로 염증이 생긴 것 같아요.
+",Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+"만성신부전 진단을 받았는데 매번 소변볼 때마다 불편함을 느껴요.
+",Korean
+대변이 잘 안 나오고 그러나요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+"네. 최근에 계속 뭘 조금만 먹어도 토해요.
+",Korean
+지난달에 다래끼 수술을 받긴 했어요.,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+몸이 안 좋다는 게 통증을 말씀하시는 건가요?,Korean
+그 이후에는 안 드신 거죠?,Korean
+혈액검사 소변검사 엑스레이 촬영 조직 검사가 진행될 겁니다.,Korean
+따로 드시는 약 있으신가요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+약물 알레르기 있는 거 있으세요?,Korean
+불편하시다면 병실 이동도 가능하십니다.,Korean
+"거의 다른 증상은 없긴 한데 속이 좀 울렁거린다고 한 적은 있어요.
+",Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+기침을 얼마나 자주 하나요?,Korean
+"마감 때문에 밤을 새우는 게 버릇이 돼서 수면 패턴이 엉망이 됐어요.
+",Korean
+암 종양을 유전적으로 갖고 있는 게 있나요?,Korean
+바셀린 거즈를 사용할 필요는 없습니다.,Korean
+"왼쪽 귀 부분에만 그런 것 같아요.
+",Korean
+당뇨약을 아직 안 드시고 계세요?,Korean
+알레르기 때문에 피해야 하는 것이 있으세요?,Korean
+대변 활동이 원활하지 않나요?,Korean
+수술 다녀오신 뒤 환자분의 상태에 따라 다르지만 평균적으로 한 시간 정도 걸립니다.,Korean
+"이천이십 년 일 월 일 일부터 담배 끊었습니다.
+",Korean
+꽃가루는 약물 아니잖아요. 그럼 약물 알러지는 없어요.,Korean
+배뇨통이나 빈뇨등의 요로계 증상은 없으시나요?,Korean
+네. 응급차 타고 갔어요.,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+통증이 멈추지 않나 봐요?,Korean
+처음 암 진단받은 게 언제인가요?,Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+멸균 처치를 위해 제거해야 합니다.,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+엑스레이 상에서 골절이나 이물질이 발견되지 않으면 봉합을 진행할 예정입니다.,Korean
+최근 체중 변화가 있었던 적이 있으세요?,Korean
+일단은 반복적으로 손목 움직임을 피하셔야 합니다.,Korean
+보호대를 착용하고 약물치료와 주사치료를 병행하여 통증 악화를 막을 수 있습니다.,Korean
+"계단을 오르내릴 때 무릎이 많이 아픕니다.
+",Korean
+간염 치료 언제부터 받으셨어요?,Korean
+체온이 몇도 정도 인가요?,Korean
+흉부 배액관이 없다면 흉부 내에서 출혈액이나 늑막액이 고여 다른 장기 특히 심장을 압박할 경우 상당히 위험할 수 있습니다.,Korean
+"혀를 잘못 깨물어서 통증이 심해요.
+",Korean
+응급실은 언제든 가도 되는 거죠?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+통증 부위는 어디신 거죠?,Korean
+지금으로서는 정확하게 말씀드리기가 어려워서 선생님께서 진료 보시고 알려주실 것 같습니다.,Korean
+네. 자연 분만이 위험한 상태였어요.,Korean
+당뇨 치료 이력은 아직 없으신 건가요?,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+숨이 찬 증상은 없나요?,Korean
+"양쪽 무릎이 다 아파요.
+",Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+이마가 뜨거운 것 같으세요?,Korean
+호흡곤란이 많이 심했나요 그때?,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+통증이 시작되면 몇 시간 정도 가나요?,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+손은 항상 깨끗하게 씻어주세요.,Korean
+설명서에 적힌 용량 먹였어요.,Korean
+결핵의 경우 가족분들께 전파됐을 가능성이 있어서요.,Korean
+다리가 아프거나 저리는 증상이 있으신가요?,Korean
+우선 더 자세한 검사를 받아본 후 말씀 나누는 게 좋을 듯합니다.,Korean
+흡연 기간이 얼마나 될까요?,Korean
+독감 주사 언제 맞았어요?,Korean
+검사 진행을 위해서 열두 시간 이상 금식을 하시는 ��이 가장 바람직합니다.,Korean
+담배 끊으셨을 때는 제외하고요.,Korean
+"편도 쪽으로 염증이 생긴 것 같아요.
+",Korean
+통증 주기가 몇 주인가요?,Korean
+약 가져오는 건 언제쯤 가능할까요?,Korean
+의료진의 지시를 따라주는 게 빠른 치료를 위한 길입니다.,Korean
+뇌졸중 때문에 다른 대학 병원에 입원한 적이 있어요.,Korean
+항문 출혈의 경우 적은 양으로 나오며 심각한 원인이 아닌 경우가 많습니다.,Korean
+초기의 경우 보존적인 치료들을 먼저 시행해보고 진행된 경우나 보존적인 치료에 효과가 없는 경우 수술적 치료를 고려하게 됩니다.,Korean
+마취가 이루어진 수술은 모두 말씀해 주시면 됩니다.,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+음낭에 빛을 투과해 봄으로 진단 가능합니다.,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+기침 증세가 악화하고 있나요?,Korean
+"자기 전 스트레칭을 간단하게 해요.
+",Korean
+무엇 때문에 병원에 왔나요?,Korean
+네. 중요한 검사이니 꼭 찍어야 합니다.,Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+일단 말씀해 주시죠. 약품명이요.,Korean
+숨 쉴 때 통증이 있나요?,Korean
+병원 입원 시 기초적 자료 조사입니다.,Korean
+가슴이 벌렁거리는 건 괜찮으신가요?,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+당뇨로 고생했던 가족분 계신가요?,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+"무거운 물건에 발이 눌려버렸어요.
+",Korean
+"왼쪽 무릎이 시리게 아픈 것 같아요.
+",Korean
+네. 저는 굉장히 특이한 혈액형이에요.,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+응급실에 같이 가셔서 체온 검사를 받아보는게 좋을 것 같아요.,Korean
+술 먹는 빈도가 빈번한가요?,Korean
+숨이 찬 증상이 나타납니까?,Korean
+몸에 좋다고 아무 약이나 드시면 안 됩니다.,Korean
+마취가 이루어진 수술은 모두 말씀해 주시면 됩니다.,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+토할 때 피가 자주 보이시나요?,Korean
+식사 후에만 속이 안 좋으세요?,Korean
+통증이 지속되는 부위가 어딘가요?,Korean
+응급실로 입원할 때 같이 온 보호자는 없으신가요?,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+주사뿐 아니라 복용 중이신 약도 말씀해 주시면 됩니다.,Korean
+호르몬 요인일 가능성이 높아요.,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+검사 결과 알려드릴게요 기억은 안 나세요?,Korean
+알레르기 유발 음식은 어떤건가요?,Korean
+불면증이 있는 것 같나요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+손발 피부 표피가 벗겨지는 건 습진이나 무좀 때문일 수도 있어요.,Korean
+간염으로 인해 병원에 방문한 적이 있나요?,Korean
+복통이 나타난 건 언제가 처음이죠?,Korean
+증상이 나타난 당일에 드셨던 음식 모두 기억나지 않으세요?,Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+열만 나는 것 같아요?,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+네 아주 어렸을 적부터 기억나시는 모든 입원 내용 말씀해 주세요.,Korean
+확인을 해야 정확하게 말씀드릴 수 있겠지만 꽃가루 알레르기 같네요.,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+기능은 문제없으나 외관상 예쁘게 보이기 위한 수술입니다.,Korean
+병명과 함께 모든 입원경험 말씀해 주세요.,Korean
+현기증이 날 때 어떻게 움직이나요?,Korean
+"아기 항문이 빨개지고 애가 간지러워하는 것 같아서요.
+",Korean
+급성기라는 말이 병이 심각하다는 의미는 아니며 치료가 필요한 단계로 볼 수 있습니다.,Korean
+약이 들어갈 때 뻐근할 수 있으니 불편하시면 말씀해 주세요.,Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+본인 말고 종양으로 고생하신 집안 분이 또 있나요?,Korean
+이전 기록을 알아야 앞으로의 진료 방향에 대해 결정할 수가 있어서요.,Korean
+얼마만에 한 번씩 아픈가요?,Korean
+종교 때문에 수혈은 못 할 것 같아요.,Korean
+"빈뇨 때문에 병원에 왔어요.
+",Korean
+수술받은 적 있으면 알려주세요.,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+삼 개월이 지나야 수술할 수 있습니다.,Korean
+진물 등이 차기 때문에 주기적으로 붕대를 갈고 소독해주어야 합니다.,Korean
+"약을 다시 지어야 한다고 하셔서 왔습니다.
+",Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+이전에 혈액 관련 이상 있다고 설명 들으신 적은 없으신가요?,Korean
+"항암 끝난 다음부터 열이 내리질 않아서요.
+",Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+목에 침 삼킬 때 고통이 있나요?,Korean
+타이레놀은 가끔 드시는 거죠?,Korean
+아직은 필요한 검사들이 남아 정확한 진단이 어렵습니다.,Korean
+예방 접종하신 사항이 있으신가요?,Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+아니요. 치료하면 백 퍼센트 완치가 됩니다.,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+독감 예방 접종은 올해 하셨나요?,Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+하루에 몇 개비 정도 피우시나요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+통증이 생긴지 얼마나 되었나요?,Korean
+큰 이상은 없는 것 같은데 정밀검사를 받아 보시겠어요?,Korean
+알레르기 때문에 못 먹는 음식이 있는지 알려주세요.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+낫는 게 최우선이니까 최대한 효과적인 치료만 신경 써주시면 됩니다.,Korean
+전에 병원에 입원한 적 있으신가요?,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+혹시 약물 음식 제외하고 다른 알레르기도 있으세요?,Korean
+아니요 지금 상태에서는 담배를 피우면 안 됩니다.,Korean
+마취제 부작용은 심장마비 섬망 증상 마비 시각장애 구토 등이 있습니다.,Korean
+대장암과 같은 기질적 문제가 있을 시에 그러한 변화가 나타날 수 있습니다.,Korean
+"배에 가스가 찬 것처럼 빵빵해진 적 있어요.
+",Korean
+환자분은 눈 수술하시고 거동이 불편하실 텐데 상주하실 보호자분이 안 계신가요?,Korean
+네 혹시 무엇으로 입원하셨나요?,Korean
+복부 팽만감 때문에 불편함을 느끼시나요?,Korean
+"잠을 어떻게 자긴 했는데 잠드는 데까지 너무 오래 걸렸어요.
+",Korean
+사출성 구토의 원인은 대부분 복통을 동반하는 경우가 많습니다.,Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+두 개 다 십 분 정도 전에 복용했어요.,Korean
+예전에 아팠던 곳 있어요?,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+소화가 어떻게 잘 안 되나요?,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+네 소변줄 삽입을 해야 검사할 수 있습니다.,Korean
+일주일 내내 통증이 있으셨어요?,Korean
+몸이 붓는 건 그대론가요?,Korean
+"대변은 아니고 오줌만 싸려고요.
+",Korean
+피를 토해서 놀라신 적 있나요?,Korean
+"변비가 아주 심한 편입니다. 단단한 상태로 보입니다.
+",Korean
+몸이 차가운 증상이 있나요?,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+어떤 것에 알레르기가 있나요?,Korean
+얼마나 아프신지 표현해주실 수 있을까요?,Korean
+그러면 이쪽에서 처방전 받아 가시고 결제하시면 되세요.,Korean
+"며칠 전부터 목이 칼칼하면서 아픈 거 같아요.
+",Korean
+그럼 의사 선생님께 길게 처방 원하신다고 전달해두겠습니다.,Korean
+식단 조절이 필요해 보여요.,Korean
+혈압이 낮은 이유는 환자 개개인의 나이 동반 질환 생리 기능에 따라 달라집니다.,Korean
+"오 년 넘게 금연했었어요.
+",Korean
+술은 한 달 중에 며칠 정도 드세요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+"속옷에 피가 계속 묻어 나와요.
+",Korean
+아픈 증세를 얘기해 보세요.,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+담배를 핀 기간이 얼마나 되나요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+배뇨 곤란이 언제부터 있었는지 궁금하네요.,Korean
+아이용 해열제밖에 없어서 그거 먹었어요.,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+네 담당 선생님이 환자분을 확인한 후 처방할 것입니다.,Korean
+알레르기 때문에 피하는 요소가 있나요?,Korean
+모유는 아기에게 필요한 영양분을 모두 포함한 가장 이상적인 음식입니다.,Korean
+통풍이 심한 곳은 아니었으면 해요.,Korean
+피부 알레르기 반응으로 호흡곤란이 유발되기도 합니다.,Korean
+수술 후 치료를 다시 받았나요?,Korean
+가스 차는 원인은 다양하고 일시적인 경우가 많아 지금부터 너무 걱정하실 필요는 없습니다.,Korean
+네 수치 확인 후 다시 마스크를 쓰게 됩니다.,Korean
+대변을 잘 못 보거나 배변이 드물 때 드시면 됩���다.,Korean
+아직 검사 결과 안 나온 거 아니었나요?,Korean
+대변을 잘 못 보거나 배변이 드물 때 드시면 됩니다.,Korean
+흡연 한지 오래 되셨나요?,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+약물 알레르기 있던 적 있으세요?,Korean
+대변볼 때 피가 보이나요?,Korean
+수술한 지 하루 지난 거라 아직 많이 아플 때에요.,Korean
+아니요 안면 홍조는 아니지만 다른 병일 수도 있어서 한번 확인해 보겠습니다.,Korean
+인플루엔자 예방 접종은 매년 일 회 맞아주시면 됩니다.,Korean
+토혈 후 어지럽지는 않았나요?,Korean
+하루 평균 일 점 오 리터 정도 마시는 것을 권장하고 있습니다.,Korean
+현재도 천식 관련하여 약물치료 중이신가요?,Korean
+유전적인 발기 부전으로 치료받고 있는 가족이 있나요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+거의 매일 설사를 하시나요?,Korean
+간호사 선생님께 직접 연락드리는 것 아니죠?,Korean
+"장이 더부룩한 것 같은 느낌이고요. 속에 가스가 많이 찬 느낌이에요.
+",Korean
+목에 가래가 끼신 거 같나요?,Korean
+본인이 판단하기보다는 비뇨기과 전문의와 상의해 보세요.,Korean
+예방효과는 안 맞으신 분들보다는 뛰어납니다. 하지만 독감 예방 접종 후에도 독감에 걸리실 수 있습니다.,Korean
+토를 심하게 한 적이 있나요?,Korean
+"얼굴에 반점이랑 함께 통증이 있어서 왔어요.
+",Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+무기력함이 있는지 알려 주세요.,Korean
+피가 섞인 변을 보시나요?,Korean
+제가 방금 퇴원 설명 해드렸습니다.,Korean
+수면 지속 시간을 증가시켜 줍니다.,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+앓으신 지 일주일 정도 되셨나요?,Korean
+발달 장애를 앓고 있어요.,Korean
+네 다른 주사보다 진통제가 들어갈 때가 많이 아픈 편입니다.,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+간염 때문에 병원 치료받고 계신가요?,Korean
+네. 아이 면역력이나 몸 상태 호전 후에 하는 것이 좋습니다.,Korean
+효과는 사람마다 달라 명확히 말하기 어렵지만 완전히 없앴을 때 재발 가능성은 더 낮습니다.,Korean
+혈압약은 삼 개월 정도 드셨나요?,Korean
+간염 시작된 나이가 언제인가요?,Korean
+어떤 종류의 소염제에 알레르기가 있으신가요?,Korean
+"신장 기능이 안 좋아졌다고 얘기 들었어요.
+",Korean
+원래 좀 변비가 자주 있으신가요?,Korean
+간염 판정은 언제 받았나요?,Korean
+"오늘 농구를 하다가 손가락이 꺾였는데 통증이 심해서요.
+",Korean
+여기 오기 전에 병원에서 감기로 처방받은 약이니까 외래 처방 약 아닌가요?,Korean
+시간 맞춰 복용하고 왔습니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+기침할 때 목이 많이 아픈가요?,Korean
+"아이가 개월 수 맞춰서 잘 크고 있는지 확인해보려고요.
+",Korean
+통증이 생기면 얼마나 가나요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+적정량 이상 드실 시 문제가 될 수 있어요.,Korean
+식중독은 여러가지 원인에 의해 발생할 수 있습니다. 원인을 찾기보다는 현재 증상 조절이 더 중요합니다.,Korean
+알레르기가 올라오는 음식이 있나요?,Korean
+당뇨와 관련해서 처방받으신 약이 있으신가요?,Korean
+알레르기를 일으킨 약 있나요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+국소 마취만 해도 된 데서 그렇게 했어요.,Korean
+피가 섞인 변을 보셨나요?,Korean
+네. 귀찮으시겠지만 매일 확인을 해야 상처가 덧나지 않고 빨리 아물 수 있습니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+비염 약도 같이 먹어요.,Korean
+아 예전에 부정맥 진단을 받으셨군요.,Korean
+"""환자분의 증상과 상황으로 보아 결혼 이후 환경 변화로 인한 불안, 공황발작과 관련된 수면장애 같은 공황발작 또는 공황장애가 있는 것으로 보입니다.""",Korean
+어떤 약들과 같이 복용하시나요?,Korean
+잠을 잘 못 주무시나요?,Korean
+틀니는 기공물이기 때문에 본인이 가지고 있는 치아처럼 흔들리지는 않습니다.,Korean
+네. 그제 독감 주사 맞았어요.,Korean
+눈에 띄는 증상이 있나요?,Korean
+항생제 내성균이 뭔지 정확히 모르겠습니다. 설명 부탁드려도 되겠습니까.,Korean
+결핵 앓았던 적 있으세요?,Korean
+아침 저녁 식전에 위산분비억제제와 식후에 항생제 두 종류를 복용하시면 됩니다.,Korean
+네. 이모가 갑상선암 수술을 받으셨어요.,Korean
+처음으로 결핵 진단받으셨던 적이 언제인가요?,Korean
+임플란트가 본인 치아가 아닌 것에 해당됩니다 말씀해주세요.,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+간염은 약물로 치료하고 계시는 건가요?,Korean
+잠을 잘 자지 못하시나요?,Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+토할 때 피가 같이 나오나요?,Korean
+환자분은 복압을 높이는 행동을 하면 위험할 수 있어요.,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+얼마 전에 감기 때문에 처방받아서 감기약 먹은 적은 있어요.,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+보통 숨쉬기 힘들어하시면 이게 정상수치에서 벗어납니다.,Korean
+배가 이유 없이 가스찬적 있나요?,Korean
+현재는 몸살 증상이 어떠신가요?,Korean
+연고가 따가운 증상이 나타나면 하루 정도 휴식 후 발라주세요.,Korean
+치료를 시작해야 할 것 같아요 오늘 주사를 맞고 가시는 게 좋겠습니다.,Korean
+죄송하지만 수면 비용에는 보험 적용이 되지 않습니다.,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+어떨 때 구토를 하나요?,Korean
+술을 언제부터 마셨는지를 알아야 음주 기간을 파악할 수 있기 때문에 중요합니다.,Korean
+"내내 설사만 하니 죽겠습니다.
+",Korean
+입원치료는 아니셨나요? 가벼운 열상치료는 괜찮습니다.,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+결핵 치료 이력이 있나요?,Korean
+일단 말씀해 주시죠. 약품명이요.,Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+통증 부위 좀 가리켜 주시겠어요?,Korean
+병원에 오신 이유 말씀해 주세요.,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+통증은 얼마나 지속되는지 아시나요?,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+가슴 두근거리는 정도는 어떤가요?,Korean
+가장 통증이 심한 부위가 어디인가요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+삼 개월 이전에 무엇으로 입원하셨나요?,Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+"어느 날 비행기를 타기가 너무 무섭다는 경험을 한 뒤 정신과적 문제인 것 같아 찾아왔습니다.
+",Korean
+"발에 가시가 박혔어요. 못 빼요.
+",Korean
+여기서는 처음인데 다른 병원에서는 촬영한 적이 없으시나요?,Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+"엄지와 검지가 유독 마비된 듯 감각이 이상해요.
+",Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+통증이 어떤 형태로 옵니까?,Korean
+알레르기가 생긴 원인이 있으신가요?,Korean
+주로 어디가 자주 붓나요?,Korean
+문제가 있는 건 아니고 수술 방법이 달라질 수도 있기 때문입니다.,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+통증이 어떤 형태로 옵니까?,Korean
+혈압이 평소에 많이 높은가요?,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+현재 면역력이 약해서 최대한 집에 머무르셔야 합니다.,Korean
+체질적으로 건조한 환경 탓에 연세에 따라 건조증이 올 수도 있지요.,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+엄마가 치매도 있고 중풍 때문에 몸도 못 움직이시거든요. 저희가 엄마를 모셔야 하는데 다들 너무 바빠서 어쩔 수가 없었네요.,Korean
+"네. 오른쪽 전체 힘이 안 들어가는 느낌이에요.
+",Korean
+똑같은 병으로 입원한 적 있으신 거죠?,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+손이나 발 몸의 어떤 부위 중에 감각이 떨어지거나 저리거나 아픈 부위가 있으신가요?,Korean
+임신 전에는 오십 킬로 초반 지금은 육십 킬로 좀 넘어요.,Korean
+"커피 먹으면 속이 안 좋아서 못 먹은 지 몇 개월 되었어요.
+",Korean
+문제가 있어서가 아니라 진찰을 위해서입니다.,Korean
+당뇨와 관련해서 처방받으신 약이 있으신가요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+언제 독감 예방 접종을 했나요?,Korean
+어머니가 고혈압을 앓고 계십니다.,Korean
+갑상선 항진증이 있어서 꼬박꼬박 챙겨 먹고 있어요.,Korean
+"어떤 다른 증상 말씀이신지 예를 들어서 설명해 주실 수 있나요?
+",Korean
+알레르기 검사 받으신적 있나요?,Korean
+"배가 아프거나 대변을 볼 때 아픈 건 아닌데 혈변이 나온 게 벌써 반년은 넘은 것 같습니다.
+",Korean
+판독 결과는 영상의학과 전문의가 확인이 필요해서 금방 나오지는 않습니다.,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+"아기가 분유만 먹으니까 물 토를 해요.
+",Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+호흡 문제는 뭐가 있죠?,Korean
+호르몬 요인일 가능성이 높아요.,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+암 진단을 받아보신 적 있나요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+"눈이 빨갛게 충혈돼서 왔어요.
+",Korean
+최근에 독감 예방 주사 접종하셨어요?,Korean
+간염 약 복용 중이십니까?,Korean
+결핵 백신 접종을 언제 하신 거예요?,Korean
+간염약 복용을 중단하신 이유가 뭐죠?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+"원래 저염식으로 먹는 편이라 그렇게 해서 먹었어요.
+",Korean
+"갑자기는 아닌데 꾸준히 살이 찌고 있어요.
+",Korean
+환자분에 대해 파악하기 위해 알고 있어야 해요.,Korean
+"눈에 부종이 또 생겨서 왔어요.
+",Korean
+아픈 건 어느 정도인가요?,Korean
+혹시 토혈을 한 적 있으세요?,Korean
+속이 계속 메슥거리는지 궁금합니다.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+토마토 같은 경우는 갈아 드셔도 영양소가 거의 파괴되지 않지만 사과 같은 경우는 파괴되어서 이 부분 고려해서 말씀해 주세요.,Korean
+복용 중인 약 꼭 보여주셔야 해요.,Korean
+현재 체중 변화가 심한 가요?,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+네. 제가 고혈압일 거라는 생각은 꿈에도 못 했기 때문에 팔 년 전 그날을 아직도 잊지를 못합니다.,Korean
+중풍 때문에 고생 좀 하셨어요.,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+네 이번 연도에 접종하셨나요?,Korean
+아픈 곳이 더 있나요?,Korean
+정신이 어지러웠던 적이 있나요?,Korean
+환자분 상태에 따라 다르지만 보통 불편해하십니다.,Korean
+통증 시작된 날짜 기억나요?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+통틀어 입원 치료라고 말하지만 그중에서 수술 때문에 입원하는 경우도 있어서 질문드렸습니다.,Korean
+외가 친척 중에 있는 유전 질환이 어떤 건가요?,Korean
+의사 상담 후 처방받은 대로 진통제를 복용하시는 게 좋아요.,Korean
+변비 약 어떤 걸 드셨나요?,Korean
+현기증이 생긴 적 있나요?,Korean
+소변에 피가 섞여 있으세요?,Korean
+하루 흡연량이 어떻게 되시는지요?,Korean
+가족 중에 암수치가 높으셔서 문제였던 분이 있나요?,Korean
+약 여분 없으면 다른 약 처방해드릴게요.,Korean
+오심은 신물이 올라오는 것과 같은 형태로 나타날 수도 있지만 토할 것처럼 속이 울렁거리는 형태로 나타나는 경우도 많습니다.,Korean
+석회화에도 양성 석회화와 악성 석회화가 있는데 환자분 같이 영상이 또렷하지가 않고 미세한 석회화가 많이 보이는 경우 이십 퍼센트 정도 악성으로 진단 됩니다.,Korean
+네 결석은 씨티나 요로조영술로 확인하는 게 가장 정확합니다.,Korean
+주무시면 안 됩니다 혹시 다른 증상들도 나타나고 있나요?,Korean
+"고혈압이랑 당뇨 가지고 있어요.
+",Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+혈뇨를 본 것은 처음이세요?,Korean
+환자분 상태에 따라 다른데 보통 한 시간 전후로 풀립니다.,Korean
+커피가 몸에 안 좋죠.,Korean
+발기 부전으로 약 복용하신적 있으신가요?,Korean
+혹시 전신 무력감이 있나요?,Korean
+고혈압 진단 여부는 과거에 없으신 거죠?,Korean
+아니에요 치료하면 충분히 완치 가능합니다.,Korean
+대변이 잘 안 나오나요?,Korean
+일주일에 두 번 이상 술을 마시나요?,Korean
+"생각해보니 변이 초��릿색 같았어요.
+",Korean
+언제부터 움직이는 게 불편했어요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+"소변볼 때 피가 섞여 나왔던 것 같은데요.
+",Korean
+저희가 드리는 약을 복용하시는 게 좋을 것 같습니다.,Korean
+통증이 제일 처음 나타난 게 언제인가요?,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+배변 횟수가 많음은 주관적 불편감도 야기할 수 있습니다.,Korean
+복용 중인 약은 가지고 오셔서 저희에게 꼭 보여주셔야 합니다.,Korean
+갑자기 가슴이 답답한 느낌이 듭니다.,Korean
+혈액형을 알아야 수술을 진행해서 지금 알려주실 수 없나요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+알레르기 반응을 보였던거 있으면 다  말씀해주세요.,Korean
+두통약이 문제가 될 수도 있어요.,Korean
+네 가루약으로 처방해 드리겠습니다.,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+가족들 중에 유전질환으로 고생하는 사람 있나요?,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+일차 치료제를 꾸준히 빠짐없이 복용 시 박멸 성공률을 높일 수 있습니다.,Korean
+과거에 크게 질병을 앓은 적이 있나요?,Korean
+당뇨나 기타 기저질환이 있나요?,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+가족 중에 혹시 암 판정받으신 분 있는지 아세요?,Korean
+"요즘 들어 기력이 자꾸 빠지는 것 같아요.
+",Korean
+계속 먹고 있는 간염약이 있나요?,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+"살이 십 킬로나 넘게 빠졌어요
+",Korean
+네 알레르기 특별히 없어요.,Korean
+회복 기간은 사람마다 달라요.,Korean
+질병 약물로 치료하고 계시나요?,Korean
+얼마나 아프신지 표현해주실 수 있을까요?,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+이차 치료제는 사제 요법을 사용합니다.,Korean
+부종이 발생한 곳이 있나요?,Korean
+진통제를 늘릴 수는 없습니다.,Korean
+이번 주에 구토를 얼마나 자주 하셨어요?,Korean
+"단백질로 채운 식단 부탁드려요.
+",Korean
+전에 병원에 입원한 적 있으신가요?,Korean
+역한 느낌이 나며 구토가 나올 것 같나요?,Korean
+과거에 크게 질병을 앓은 적이 있나요?,Korean
+필요하시다면 협력 진료 의뢰드리겠습니다.,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+"약만 먹는다는 게 그만 약 봉투까지 다 먹어버렸네요.
+",Korean
+지금 혹시 오한이 있나요?,Korean
+비염이 일주일 전부터 심해졌어요.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+베타딘류의 소독액을 사용할 예정입니다.,Korean
+비타민 종류 제외하고는 없으신가요?,Korean
+"아기 항문이 빨개지고 애가 간지러워하는 것 같아서요.
+",Korean
+이 부위가 아픈 곳이에요?,Korean
+통증이 어느 정도 심한가요?,Korean
+몇 시간 단위로 통증이 지속되나요?,Korean
+네. 손 따는 것도 민간요법이라 할 수 있습니다.,Korean
+치료하지 않으면 위선암 위림프종과의 연관성이 있습니다.,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+배가 부글거리는 경우가 있나요?,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+팔다리가 많이 부어서. 이 주 정도 입원해서 치료받은 적이 있어요.,Korean
+우선은 추가적인 검사를 진행 후 말씀드리도록 하겠습니다.,Korean
+죄송하지만 수면 비용에는 보험 적용이 되지 않습니다.,Korean
+혈관이 터지는 것은 얇은 거랑은 상관없습니다.,Korean
+스트레스를 평소에 많이 받으시나요?,Korean
+좀 더 위생에 신경을 써 주신다면 빨리 회복되지 않을까요?,Korean
+환자 번호가 이거 맞나요?,Korean
+상충 작용이 되는 약을 드시는지 체크하려고 합니다.,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+최근에 스트레스를 많이 받으셨나요?,Korean
+조심해야 할 다른 알레르기 알 수 있을까요?,Korean
+음주는 질병에 방해되는 요소입니다.,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+귀가 들리는 것이나 맛을 느끼는 것에는 이상이 없나요?,Korean
+통증은 주로 언제 오나요?,Korean
+흡연 기간은 어느 정도이신가요?,Korean
+약물에 알레르기 증상이 있으신가요?,Korean
+제가 등 쪽을 좀 살살 두드려 볼게요. 오른쪽이 아프시다 하셨죠? 어떠세요?,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+장기적으로 봤을 때 입원하시는 것이 좋습니다.,Korean
+오늘은 어디가 아파서 병원에 오셨을까요?,Korean
+복통 증상은 언제부터 있었나요?,Korean
+"여기 가장 끝의 이빨이요.
+",Korean
+알레르기 일으키는 원인 있나요?,Korean
+복부에 통증이 심한 곳이 어딘가요?,Korean
+대변볼 때 안 힘든가요?,Korean
+락토프리 우유로 대체하시는 게 좋겠습니다.,Korean
+"눈이 아파서 눈을 도저히 못 뜨겠어요.
+",Korean
+객담이 많은 거 같나요?,Korean
+"심장이 안 좋다는 얘기는 전해 들었어요.
+",Korean
+알레르기 반응 있는 음식 있어요?,Korean
+정확히 아픈 부위가 어디예요?,Korean
+가슴 통증이 어떻게 있나요?,Korean
+소화가 잘 안 돼서 힘드신가요?,Korean
+아뇨. 보조 기구나 수술받은 적 없어요.,Korean
+호흡곤란 때문에 일상생활에 지장이 있으신가요?,Korean
+소변을 볼 때 통증이 있나요?,Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+한 달 평균 몇 번씩 술을 드시나요?,Korean
+지금도 앓고 계시죠 당뇨?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+아스피린 들어가 있다고만 하셨어요.,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+언제 갑상선 치료를 받았나요?,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+피가 묻어 있는 소변을 보신 적 있으신가요?,Korean
+전문 간병인을 두시는 게 좋을 거 같습니다.,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+약물 투약으로 얻을 수 있는 이득이 크지 않을 것으로 보입니다. 우선 금식하면서 주사제와 수액제 등으로 약물 투여를 시도해 보겠습니다.,Korean
+기침을 평소에 자주 하세요?,Korean
+복숭아 알맹이는 괜찮은데 껍질만 만지면 두드러기가 납니다.,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+입원 치료를 받았다거나 수술하신 적 있으신가요?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+독감 주사 언제 맞았어요?,Korean
+척추에 마취약 맞았는데 그건 뭐죠?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+장중첩증 말고는 따로 수술한 적 없어요.,Korean
+가끔 같이 복용하면 안 되는 약들이 있어서 그래요.,Korean
+소변을 보실 때 피가 나오신 적 있으세요?,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+많이 다쳐서 병원에 방문하신 경험이 있으세요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+네 약 한 번에 다 드세요.,Korean
+걱정이 많으실 것 같습니다. 우선 주사제 투여를 병행하면서 증상 양상을 확인해 보겠습니다.,Korean
+"허리부터 무릎까지 저린 느낌이 들어요.
+",Korean
+피부가 많이 예민한 편이 아니면 접촉성 피부염이 나타나는 경우는 극히 드뭅니다.,Korean
+간염 치료 복용 약 있으시죠?,Korean
+네. 상처 회복이 더 빠를 것입니다.,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+"네. 흉통이 생길 정도로 기침이 너무 심해서 왔어요.
+",Korean
+네. 암은 아닌 거 같네요.,Korean
+예전에 갑상선에 문제가 있었다고 들었습니다.,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+소변볼 때 문제 있으셨어요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+"몸이 이상해서 혈당을 쟀는데 높게 나왔어요.
+",Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+예전에 아팠던 곳 있어요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+"네. 고혈압 때문에 싱겁게 먹어야 되는데 그러면 맛이 없어서 조금 짜게 먹습니다.
+",Korean
+경과가 좋으면 일주일 후에 퇴원하셔도 됩니다.,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+집에 다�� 암 환자는 없으시고요?,Korean
+평소 잠이 안 와서 수면제 먹는 중입니다.,Korean
+알레르기 있다는 거 언제 아셨죠?,Korean
+언제부터 열감이 전신적으로 발현되시나요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+네. 나가서 앉아 계시면 저희 직원이 안내해주실 겁니다. 그럼 수술 당일에 뵙겠습니다. 큰 걱정은 안 하셔도 됩니다.,Korean
+"네. 미열 약간 있었어요.
+",Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+어디가 아픈지 짚어주실 수 있어요?,Korean
+알에이치 마이너스가 많이 특이한 건가요?,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+변에 피가 함께 나오나요?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+피가 묻어 있는 소변을 보신 적 있으신가요?,Korean
+맨날 파스 붙이고 사는데요 뭘.,Korean
+제거하는 거라 약간의 통증은 발생할 수 있어요,Korean
+통증이 하루에 자주 일어났어요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+당뇨 침 단계를 낮춰서 그렇게 아프지는 않을 테니까 걱정하지 마세요.,Korean
+갑자기 살이 찌는 것은 건강에 좋지 않습니다.,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+가래를 자주 뱉으시는 편입니까?,Korean
+많이 아프셨다니 정밀 검사를 해 봐야 정확히 알겠네요.,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+"손에 물집이 너무 심하게 잡혀서요. 몇 번 터트렸는데도 같은 자리에 나네요.
+",Korean
+마사지는 근육이 풀리는 정도로만 가능해요.,Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+건강에 지장 없을 수준으로 뽑기 때문에 걱정 안 하셔도 돼요.,Korean
+지금 결핵 치료 약 드시는 중입니까?,Korean
+당뇨 약 복용하고 계신가요?,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+어떤 약을 빼 드리면 되나요?,Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+어디 아프신 곳이 있나요?,Korean
+심장 뛰는 게 불편한가요?,Korean
+항생제 반응 검사라는 걸 통해서 확인하실 수 있습니다.,Korean
+"기침할 때 소변 살짝 지리기도 합니다.
+",Korean
+처음 느낀 통증은 언제였나요?,Korean
+말씀해주신 병실 입실 가능하면 안내해드리겠습니다.,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+저희가 먼저 소독하고 항생제 연고 포함하여 처방하겠습니다.,Korean
+혈압이 좀 높은 편이라고 들었어요.,Korean
+맥박이 빨리 뛰거나 심장이 빨리 뛴다는 느낌이 드세요?,Korean
+네. 애가 빨리 나올 것 같아서 바로 자연 분만했어요.,Korean
+가족 중에 암 확진을 받은 분이 있나요?,Korean
+몸이 피로하다는 생각을 해보신 적 있나요?,Korean
+"지난번 수술한 후에 경과 보러 왔습니다.
+",Korean
+배가 부풀어 가득 찬 느낌인가요?,Korean
+문제가 생기진 않았는데 약 때문에 가려운 증상이 생길 수도 있습니다.,Korean
+재작년 초에 쌍둥이 출산했습니다.,Korean
+입원이나 수술하신 적 있어요?,Korean
+소변에 피가 함께 나오나요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+피가 섞인 소변을 봤나요?,Korean
+결핵 앓은 적 있으신가요?,Korean
+소독 후 연고를 바르는 등 치료를 해야 합니다.,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+생각나는 민간요법이면 어떤 것이든 상관없습니다.,Korean
+항암 치료한 지 얼마나 되었나요?,Korean
+간접적인 검사로 확인 불가능 하기 때문에 확정검사가 반드시 필요합니다.,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+알레르기 반응이 언제 처음으로 나왔나요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+이번 주까지 독감 접종 아직 안 하신 분 저렴하게 맞을 수 있습니다.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+지금도 통증이 계속 있나요?,Korean
+원인을 찾기 위해 검사를 해 보겠습니다. 너무 힘드시다면 증상 조절을 위한 약을 드리겠습니다.,Korean
+네. 예전에 한 번 진료 봤어요.,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+네. 레이저 치료랑 약을 같이 먹었어요.,Korean
+속이 메슥거리면 어지럽기도 하나요?,Korean
+검사결과는 보통 빠르면 일주일 소요되기 때문에 그 전에 받기는 힘드세요.,Korean
+수술시간은 확인하고 알려 드릴게요.,Korean
+손목을 오래 사용하실 때에는 자주 손목 스트레칭을 해주시는 것이 좋습니���.,Korean
+첫째는 자연분만 하셨다는 말씀이신가요?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+일일 평균 흡연량 얘기해 주세요.,Korean
+언제부터 알레르기가 있었는지 기억하시나요?,Korean
+"수술한 다리가 너무 뻐근해서요.
+",Korean
+고혈압은 약으로 조절하고 있나요?,Korean
+산부인과는 어떤 일 때문에 가셨는지 알려주실 수 있을까요?,Korean
+유전성 질환 때문에 관련 약을 복용 중인 식구가 있으세요?,Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+"아픈 후 불면증이 생겼는지 아침이 다 돼서야 졸리기 시작합니다.
+",Korean
+가래가 묽은 느낌이 나나요?,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+기존에 먹던 약은 어떤 건가요?,Korean
+"매일 대변을 보는 건 아니지만 이삼일에 한 번씩 가고 규칙적이라서 변비는 아닌 거 같아요.
+",Korean
+수술 동의서를 보호자에게 꼭 문서화해서 주셨으면 합니다.,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+약물 알레르기 정보를 알 수 있을까요?,Korean
+목에 통증이 계속 있나요?,Korean
+어떤 증상인지 확인하고 연고나 약 처방해드릴게요.,Korean
+가족 중에 암 진단받은 분이 계신가요?,Korean
+"촛불에 팔이 닿아서 그을렸어요.
+",Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+아직 온몸에 열 기운이 있어요.,Korean
+사 번이 안 좋다고 하셨었는데 그냥 물리치료만 받았어요.,Korean
+"약으로는 증상이 호전될 기미가 안 보여서 오게 됐어요.
+",Korean
+병원비 결제 영수증 좀 뽑아 주세요.,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+오메가 쓰리는 중성지방을 떨어뜨리는 역할을 해서 같이 드시면 혈관 건강에 도움이 됩니다.,Korean
+평소 앓고 계시는 기저질환이 있습니까?,Korean
+결핵 진단받으신 지 얼마나 되셨나요?,Korean
+무릎 관절이 좋지 않은 상태에서 체중이 증가하면 연골이 더 닳게 되서 관절이 버티기가 힘듭니다.,Korean
+"기침 호흡 곤란도 있고요. 심할 때는 가슴이 답답하고 오한도 느껴져요.
+",Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+그거 한 번 받고 나면 한 달 가까이 집에서 요양해야 해요.,Korean
+"손 발 뼈 마디마디가 쑤시고 아픕니다.
+",Korean
+평소 당 수치가 어느 정도신가요?,Korean
+"침 삼킬 때마다 목이 너무 따가워요.
+",Korean
+어린아이들도 위염 걸릴 수 있습니다.,Korean
+아픈 증세를 얘기해 보세요.,Korean
+저희 병원이 아닌 타 병원에서 진료한 것은 알 수가 없기 때문입니다.,Korean
+잠시 후 담당 선생님께서 회진을 오십니다.,Korean
+너무 걱정하실 필요는 없습니다 수술을 통해 신경세포가 있는 장을 항문까지 내리게 됩니다.,Korean
+소화 불량이 자주 나타나나요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+주의 사항에 나와 있지 않은 증상이 발현되면요?,Korean
+어떤 종류의 소염제인지 알고 계시나요?,Korean
+비타민 종류 제외하고는 없으신가요?,Korean
+뭘 먹으면 속이 더부룩하신가요?,Korean
+이름은 잘 모르겠어요. 수면제 처방받으면 빈 통에 다 털어서 넣거든요.,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+상해로 인하여 입원하여 수술하신 적이 있나요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+소변을 보고 난 후 피가 묻어있나요?,Korean
+내시경 자체는 건강보험 적용되지만 수면 비용은 비급여로 적용됩니다.,Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+건대병원에서 투석 받고 있다니까요?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+우선 저희 병원 기록이 없으니 검사를 받아 보고 진단이 내려지면 그때 말씀드리겠습니다.,Korean
+"몸 상태가 술을 마시면 안 되는 상태라 삼 개월 넘게 못 마시고 있어요.
+",Korean
+현재 복용 중인 약이 있으신가요?,Korean
+멸균 처리가 된 소독 붕대가 화상 부위가 아물 때까지 환부를 외부 균으로부터 보호하는 역할을 하는 겁니다.,Korean
+"수면 시간 전혀 안 지켜지는데요.
+",Korean
+어떤 약물에 알레르기가 있었나요?,Korean
+몸이 피곤하고 쳐진다는 느낌이 드세요?,Korean
+어느 부위에 통증이 있으신가요?,Korean
+네 음주나 흡연은 건강에 큰 영향을 끼치는 부분이니까요.,Korean
+네. 좀 경련이 있었습니다.,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+어디가 제일 많이 붓나요?,Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+처음 통증이 ���기 시작한 게 언제죠?,Korean
+발기 부전을 느끼고 계신가요?,Korean
+이 수술은 대개는 돌 때쯤 재수술을 진행하지만 아이에 따라 약간의 차이는 있습니다.,Korean
+지난번에 암 치료는 언제 시작하셨나요?,Korean
+간 염증 수치가 높으신가요?,Korean
+"아이가 숨을 쉬는데 매우 불편해요.
+",Korean
+소변볼 때 잘 안 나오나요?,Korean
+코로나 때문에 물어보는 겁니다.,Korean
+흡연을 시작하게 된 게 언제부터일까요?,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+온몸이 기운 빠지 듯 무력하나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+계속 드시던 약이 있나요?,Korean
+네 지금부터 두 시간 금식하겠습니다. 물도 드시면 안 돼요.,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+시월에 독감 주사 맞았었어요.,Korean
+덩어리지거나 딱딱한 변이 나오나요?,Korean
+"손에 작은 물집이 나더니 점점 손목에서 팔까지 번지는 것 같아서요.
+",Korean
+소변에 피가 함께 나오나요?,Korean
+전에는 내시경 도중에 깬 적이 없거든요.,Korean
+통증이 구체적으로 어떻게 느껴지세요?,Korean
+암 증세가 시작된 건 언제부터인가요?,Korean
+교수님 회진 때 직접 환부를 보시겠다고 하시면 다 열어버릴 것이고 그 이후 다시 새로 드레싱 할 겁니다.,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+약이 환자분에게 알레르기 반응을 일으키는지 확인하기 위한 검사입니다.,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+환자분은 지금 면역력이 너무 낮기 때문에 면역력을 높여 바이러스 저항력을 높여줘야 증상이 악화되지 않을 수 있어요.,Korean
+네 주사 들어갈 때 약간은 뻐근할 수 있어요.,Korean
+토할 것 같을 때 어떻게 하셨나요?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+처방받으신 연고는 잘 바르고 계시나요?,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+정확히 아픈 부위가 어디예요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+신체가 부은 데가 있나요?,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+가래가 얼마나 많이 나오나요?,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+네. 삼 년 후 대장 내시경 검사로 새로운 병변 발생 여부 확인하겠습니다.,Korean
+네 마스크 착용이 중요합니다.,Korean
+어떤 알레르기를 앓고 계세요?,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+이렇게 통증 느낀 건 얼마나 된 거예요?,Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+집안에 암 환자분이 계세요?,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장 드립니다.,Korean
+주로 어디가 가장 아프세요?,Korean
+"걸을 때마다 오른쪽 무릎에 통증이 있습니다.
+",Korean
+감염부위는 깨끗하고 따로 감염소견은 없습니다.,Korean
+구토를 많이 하셨으면 검사를 못 할 수도 있어요.,Korean
+네. 속 괜찮아지시면 그때 일반식으로 다시 바꿔드릴게요.,Korean
+사람마다 다른데 마취 깨고 의식을 회복하는데 한 시간이면 됩니다.,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+삼투성 하제의 경우 내성이 적고 장기적 사용이 가능합니다.,Korean
+알레르기를 언제부터 치료받고 있나요?,Korean
+아픈 기간은 어느 정도세요?,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+네 무리했을 경우 복압에 피해가 갑니다.,Korean
+이거 먹기만 하고 주사 같은 건 안 놔 주시는 거예요?,Korean
+피검사만으로 진단이 정확하지 않을 수 있어 씨티 검사가 필요합니다.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+아니요. 우선은 병실로 이동 하고 병실에서 안정을 취하시면 됩니다.,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+종양 있었던 가족이 있으신가요?,Korean
+알레르기 치료로 병원에 다닌 지 얼마나 되었나요?,Korean
+네 혈액 검사를 해야 알 수 있습니다.,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+환자와 관련해서 설명 드릴게 있어 여쭤보았습니다.,Korean
+아프기 시작한 게 언��부터예요?,Korean
+횡문근 융해증이 의심되지만 정확한 것은 검사 결과가 나오면 말씀드리겠습니다.,Korean
+심장 뛰는 게 불편한가요?,Korean
+호흡곤란이 많이 심했나요 그때?,Korean
+균의 감염이 우려되기 때문에 환부에 넓게 바를 예정입니다.,Korean
+응급실에 온 적이 있어요.,Korean
+병원 내 게시판이나 입원 안내문에 확인 가능하십니다.,Korean
+"자세가 안 좋긴 한데 그것 때문인지 얼마 전부터 움직이는 게 너무 힘들더라고요.
+",Korean
+변에 피가 섞여 나오나요?,Korean
+통증이 계속해서 아픈가요 드문드문 아픈가요?,Korean
+수혈 거부 시 의사 상담 후 동의서 작성이 필요합니다.,Korean
+소변이 잘 누어지지 않으세요?,Korean
+전문 의료원이 아닌 곳에서 치료받으신 경우 말씀해 주시면 됩니다.,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+그러니까 사출성 구토는 뭔가 먹자마자 바로 나오는 구토를 말합니다.,Korean
+"수면장애 증상은 딱히 없어요.
+",Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+호흡 측정은 어떻게 하나요?,Korean
+고혈압과 관련하여 치료받고 있으신가요?,Korean
+마취가 잘 안 들었다든지 그런 거요.,Korean
+두통으로 불편한 점은 없나요?,Korean
+"그제 밤요. 소변이 계속 마려운데 안 나옵니다.
+",Korean
+최근 육개월 동안 체중이 얼마나 올랐나요?,Korean
+지금까지 약은 계속 드시고 계셨던 거죠?,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+어지럽거나 울렁거리는 증상 없으셨나요?,Korean
+삼 개월간 몸무게가 얼마나 빠졌죠?,Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+환자분한테는 지금 충분한 보습을 해 주는 게 제일 좋은 방법입니다.,Korean
+간염은 약물로 계속 치료하시나요?,Korean
+전에 혈액형 검사 하신 적 있으신가요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+수혈이란 게 남의 혈액을 자신의 몸속에 주입하는 치료법이라 할 수 있습니다.,Korean
+대변에 물이 많이 섞여 나오나요?,Korean
+"아프기 전과 후로 수면 시간이 두 시간가량 줄어들었어요.
+",Korean
+잠이 쉽게 오지 않나요?,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+결핵 치료받은 지 꽤 되셨어요?,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+네. 점심을 드신 시간에서부터 세 시간 금식을 한 뒤 검사가 진행 가능합니다.,Korean
+가래를 자주 뱉는 편인가요?,Korean
+아무래도 관절이 아프다 보면 스스로 움직이는 게 무의식적으로 덜 하게 되죠.,Korean
+맥박 아까 재셨지만 지금 재측정이 필요해서요.,Korean
+언제부터 소변을 누기가 힘이 드셨어요?,Korean
+간염 진단은 언제 처음 받으셨어요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+설사를 하신 경험이 있나요?,Korean
+암 치료를 받고 있으세요?,Korean
+알레르기 반응을 보였던거 있으면 다  말씀해주세요.,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+손목 터널을 넓혀주는 것이지만 완전 치료는 불가능한 방법입니다.,Korean
+대체로 큰 문제는 없지만 장의 감염성 질환도 고려해야 합니다.,Korean
+대부분 이 주 정도 뒤면 통증에서 어느 정도 회복됩니다.,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+암을 앓고 계신 가족이 있으신가요?,Korean
+심장이 유독 빨리 뛰는 느낌이 있나요?,Korean
+"오늘 아침에는 좀 덜 아픈 것 같더니 얼마 안 가서 다시 아프더라고요.
+",Korean
+퇴원하시면서 드릴 서류에 사인해 주셔야 합니다.,Korean
+혈변 시 복통이 함께있나요?,Korean
+의학적인 도움만 받으신 거죠?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+네. 간단한 부분마취 수술도 저희가 알아야 하니 모두 알려주세요.,Korean
+현재 검사 소견은 모두 정상이라 추후에 가슴 통증이 재발할 경우 그때 임상적 상황에 맞춰 필요한 검사들을 진행하시면 됩니다.,Korean
+열뿐만 아니라 알레르기 반응도 포함됩니다.,Korean
+"감기가 도통 낫지를 않아요.
+",Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+"밥을 못 먹는 게 제일 힘들죠. 물도 잘 못 마시고 기운도 없고.
+",Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+물만 먹어도 설사가 나오나요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+통원 치료 꾸준히 받았던 거 뭐 있어요?,Korean
+암 치료 이력이 있나요?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+현재 환아 몸���게 알려주세요.,Korean
+수면 환경을 조절해서 더 오래 잘 잘 수 있게 해볼까요?,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+약을 투여한 정확한 시간을 알면 좋아요.,Korean
+어떤 알레르기 가지고 계시나요?,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+어디가 불편해서 진료 보러 오셨어요?,Korean
+내일 내시경 역행성 담낭 췌장 조영술 있으셔서 오늘 자정부터는 물도 포함해서 금식이세요.,Korean
+네. 원래 자궁이 좋지 않았어요.,Korean
+환자분 입원을 위한 조사를 위해 몇 가지 질문하겠습니다.,Korean
+예 혹시 근육통일 수도 있어서 잠시 대기해주세요.,Korean
+네 입원하여 수술을 준비해야 할 것 같습니다.,Korean
+최근에 몸이 안 좋으셔서 약을 드시는 건가요?,Korean
+네 어떤 증상으로 약을 드셨나요?,Korean
+최근 물 같은 변을 보시기도 했을까요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+변비가 어느 정도로 심하신 거죠?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+이번 주에 구토를 얼마나 자주 하셨어요?,Korean
+통증이 몇 분 동안 계속 남아 있나요?,Korean
+환자분 스스로 침대 쪽으로 가실 수 있겠어요?,Korean
+많이 오래 걸리면 원래 다니던 병원으로 가는 게 나을까요?,Korean
+수술 부위의 청결을 유지하기 위함입니다.,Korean
+환자분은 요로결석이 의심되므로 최대한 빨리 받아주셔야 진단에 도움이 됩니다.,Korean
+네 드시고 계신 약 포함해서 전부 말씀해주세요.,Korean
+발열 증상은 언제 처음이셨죠?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+술을 한 번에 드실 때 양을 얼만큼 드시는지요?,Korean
+가족 중에 고혈압 진단이 나오는 분이 있나요?,Korean
+가족 중에 암 환자분이 계세요?,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+네. 괜찮습니다. 보호자 동의가 없어도 되는 간단한 시술입니다.,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+네. 괜찮습니다. 부작용 발생률이 높지 않으니 걱정하지 않으셔도 됩니다.,Korean
+피 소변을 얼마나 자주 보시나요?,Korean
+잘 못 주무시는 편인가요?,Korean
+지금 당장 드실 약은 남겨 놓고 나머지만 체크하겠습니다.,Korean
+"네. 이제는 중독돼서 없으면 불안하더라고요.
+",Korean
+질병이 진행한 경우에는 단순히 쉬는 것으로 증상이 자연적으로 좋아지지는 않습니다.,Korean
+약물 알레르기 없으시다고 하셨죠?,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+그 보라색 해열제 먹였어요.,Korean
+진통제는 잠시 후에 달아드리도록 하겠습니다. 잠시만 기다려주시겠어요?,Korean
+검사 결과는 안정적으로 나왔습니다.,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+어디가 가장 통증이 강하죠?,Korean
+네. 여기 있어요. 수술은 잘 된 건가요?,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+독감주사를 올해 맞으신 거죠?,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+다른 방법을 사용했는데 잠이 안 올 경우 수면 보조제를 한번 사용해 보는 것도 추천해드립니다.,Korean
+"전신에 너무 통증이 있어요.
+",Korean
+엄마가 아프신데 정확한 병명은 모르겠어요.,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+결핵 백신 주사는 안 맞으셨나요?,Korean
+그런 건 아니고요. 어떤 약 드시는지 확인을 해야 해서요.,Korean
+복부에 많은 고통이 동반되나요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+한 번 더 검사를 해야 할 것 같아요.,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+혈압은 단순한 검사고 오 분도 안 걸릴 겁니다.,Korean
+스트레스와 같은 환경적 요인 식습관 흡연 여부 등 다양한 원인이 있습니다.,Korean
+"오줌 마려운 느낌이 계속 드는데요.
+",Korean
+조산 등의 상황을 고려해서 분만 한 달 전이므로 가능합니다.,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+혹시 가래 뱉을 때 목이 아프신가요?,Korean
+흡연 한지 오래 되셨나요?,Korean
+암 치료 기간이 어떻게 되나요?,Korean
+결핵약 매일 복용하고 있나요?,Korean
+네 혈압과 고지혈증은 따로 생각하시는 게 좋을 것 같습니다.,Korean
+하루 평균 ��연량이 얼마나 되나요?,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+외관상으로는 상처가 보이지는 않는데 어떻게 아프세요?,Korean
+"어젯밤에 심하게 났다가 오늘 아침엔 좀 내렸어요.
+",Korean
+초기의 경우 보존적인 치료들을 먼저 시행해보고 진행된 경우나 보존적인 치료에 효과가 없는 경우 수술적 치료를 고려하게 됩니다.,Korean
+산소가 몸 구석구석까지 전달이 되지 않아서 그렇습니다.,Korean
+"어제까지는 괜찮았는데 오늘은 아예 대변을 안 본 것 같아요.
+",Korean
+배가 더부룩한 적 있나요?,Korean
+"소화불량이 지속 되다 보니 적게 먹고 있습니다.
+",Korean
+약간 알러지 반응 올라왔었어요.,Korean
+"심리적으로 쫓기고 있는 것 같아요. 진정도 안 되고 심장도 빨리 뛰고 목도 아픕니다.
+",Korean
+숨이 찬 증상이 나타납니까?,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+하루 흡연량은 어느 정도인가요?,Korean
+부분마취인 경우 마취가 잘 풀리는 경우도 있습니다.,Korean
+급격한 체중 변화 때문에 힘드신가요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+진료 확인차 여쭤 보는 거라서요.,Korean
+손이나 발가락 등에 피부색이 창백해졌나요?,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+최근에 체중 변화가 있었나요?,Korean
+그렇죠. 요양원으로 바로 가죠.,Korean
+네. 평소대로 호흡을 하면 폐가 완전히 펴지지가 않기 때문에 마취 가스의 배출이 더뎌질 수도 있습니다.,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+네. 교통사고로 인해 뼈가 부러져서 수술했었습니다.,Korean
+제 혈액형은 그냥 오형이에요.,Korean
+"담배 처음 시작한 건 스물한 살 정도였는데 끊은 건 서른 살로 한 십 년 정도 피웠네요.
+",Korean
+소화가 어떻게 잘 안 되나요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+질병마다 기준이 다르지만 현재 환자 분께서 가지고 계신 질병 상태는 경증으로 구분되고 있습니다.,Korean
+응급상황일 수 있습니다. 응급실로 안내해드릴게요.,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+소변볼 때 출혈이 있나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+발기부전 증상이 언제부터 나타났나요?,Korean
+알레르기 있다는 거 언제 아셨죠?,Korean
+수술 날짜는 언제로 잡아 드릴까요?,Korean
+다른 약물과의 상호작용에 의해 영향을 받을 수 있습니다.,Korean
+수술 당일엔 보호자분이 와 주시는 게 좋습니다.,Korean
+평소에도 두드러기가 자주 나는 편이었나요?,Korean
+"구토 한번 한 적 있어요. 분수 토.
+",Korean
+"손가락 끝에 상처 난 곳이요.
+",Korean
+추적 검사도 저희 병원에서 받기 원하신다면 미리 예약하고 병원에서 검사 시기에 다시 연락드리겠습니다.,Korean
+눈이 좀 가렵던데 상관있는 건가요?,Korean
+"아이가 너무 간지럽다고 자꾸 우네요.
+",Korean
+위의 내용물이 식도로 역류되어 시큼한 것이 올라오는 느낌으로 나타나기도 합니다.,Korean
+오늘도 허리가 아파서 오신 거죠?,Korean
+언제부터 그런 증상이 있었지요?,Korean
+작년에 어떤 예방 접종을 맞으셨나요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+네. 환자분의 증상을 종합해 보았을 때 바이러스성 장염이 의심됩니다.,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+알레르기 반응 검사로 진단받으셨나요?,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+약 여분 없으면 다른 약 처방해드릴 테니 그거 드세요.,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+다른 병원에서 진단받은 게 있나 해서요.,Korean
+네. 알러지가 꽤 자주 납니다.,Korean
+초음파 사진을 받고 싶으시다고요? 왜 필요하신가요?,Korean
+언제부터 당뇨 증세가 보이기 시작하셨죠?,Korean
+수혈 해야 할 수도 있어요. 무 수혈 원하시나요?,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+피와 소변이 함께 나오나요?,Korean
+검사 받고 오시면 최대한 빨리 진료 봐 드릴 테니 검사 먼저 받고 오세요.,Korean
+지난주에 머리가 아파서 갔다 온 적 있습니다.,Korean
+"요즘 소변에서 약 냄새가 좀 나는 것 같아요.
+",Korean
+"꼭 열두 시부터 금식해야 하나요?
+",Korean
+환자분이 생각하기에 피부 버짐을 유발하는 요인이 뭐라고 생각하세요? 특정 지을 수 있을만한 것이 있나요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+잠깐 쉬었다가 해도 될까요? 숨을 못 쉬겠어요.,Korean
+잘 안 나올 때는 우선 모유와 분유를 혼합한 혼합수유를 권해드립니다.,Korean
+일 회 치료에 약 십만 원 정도 들 겁니다.,Korean
+종교적인 이유 때문에 수혈을 거부하시는 분들도 계십니다.,Korean
+아들이 데려가서 저번 주에 독감 예방 주사 맞았지.,Korean
+구역질이 날 때가 있나요?,Korean
+눈에 띄는 증상이 있나요?,Korean
+"일주일 전에 수술받은 팔에 고름이 찼어요.
+",Korean
+입으로 피 토한 증상 있나요?,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+오한이 든 건 아니고요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+위에 붕대를 감을 테니 아이가 풀지 않도록 해주세요.,Korean
+"변비가 있어서 좀 오래 걸리더라고요.
+",Korean
+숨이 찬 증상이 나타납니까?,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+소화에 지장이 없나 해서 여쭤봤습니다.,Korean
+혈압 측정은 오분도 안 걸립니다.,Korean
+그리고 식사도 소량씩 자주 하는 게 좋으시고요. 혹시 최근 살이 찌거나 빠지는 변화가 있으신가요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+과거에 크게 다쳐서 수술한 적이 있나요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+어떤 치료를 받게 될지는 내시경 검사 후 말씀드리겠습니다.,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+갱년기 증상일 수 있습니다.,Korean
+통증 지속 시간은 어느 정도인가요?,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+병원 내 흡연 구역은 어디에 있어요?,Korean
+한 시간 전에 배 아픈 것 때문에 진경제 한 알 먹었어요. 부스코판.,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+기침 가래 콧물 피가 섞인 가래가 나온다거나 하는 호흡기계 증상은 없으셨나요?,Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+다시 가려워질 수도 있습니다.,Korean
+마취부터 회복까지 세 시간 걸릴 예정입니다.,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+퇴원 후에 필요한 서류 말씀해 주셔도 상관없습니다.,Korean
+아이가 아프니 얼마나 힘드셨겠어요. 일주일 동안 잘 먹었나요? 토는 안 했고요?,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+얼마나 지나야 통증이 가라앉나요?,Korean
+몇 달 전에 다른 병원 내원했죠.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+중환자들이 많아서 진료 대기가 길다는 말씀이신가요?,Korean
+전신이 피로하거나 쇠약감이 있나요?,Korean
+"통증 발생 후에도 수면 시간은 변화가 없어요.
+",Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+처방이 아직 안 났어요.,Korean
+꽃가루 알레르기가 있으신지 알려주실래요?,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+"점점 잠에 드는 시간이 늦어지고 일찍 눈 떠져요.
+",Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+과민성 대장 증후군도 질병으로 볼 수 있나요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+다리 감각이 이상하진 않으신가요?,Korean
+결핵약으론 어떤 거 드시고 계세요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+아픈 게 사라지지 않나요?,Korean
+현재 건강상태에서 항생제를 세게 투약하면 면역체계가 무너집니다.,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+가족 중에 누가 암 환자셨을까요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+소변이 시원하지 않다는 말씀이세요?,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+약을 사진으로 보여주셔도 됩니다.,Korean
+결핵약으론 어떤 거 드시고 계세요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+하루에 담배 몇 갑 정도 펴요?,Korean
+"다른 곳도 치료하러 겸사겸사 왔습니다.
+",Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+통증이 영부터 십까지 있을 때 어느 정도인가요?,Korean
+고혈압약 평소에 드시고 있는 거 있으세요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+일반적으로 여덟 시간 금식 후 혈당을 측정하였을 때 백이십오 밀리그램 퍼 데시리터 이하로 측정이 될 경우 정상입니다.,Korean
+조영제를 사용하면 드물게 부작용이 있지만 거의 없다고 봐도 됩니다.,Korean
+통증이 좀 강한 편이에요?,Korean
+자연 치아에 비해 기능이 부족한 치아를 확인하려 합니다.,Korean
+거기가 아팠던 게 언제부터죠?,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+네. 입원해서 치료받은 거라면요.,Korean
+"작업 도중에 그라인더에 긁혀서요. 별로 큰 상처는 아니라 구급상자에 있는 약 대충 바르고 다시 일했는데 한 삼 일 전부터 진물이 나기 시작하더니 지금은 좀 아파요.
+",Korean
+응급실로 내원하는 게 더 좋다고 생각하세요?,Korean
+"요새 귀가 간지럽고 물집이 생겨서요.
+",Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+머리가 핑도는 느낌이 있으신가요?,Korean
+관련 검사를 추가로 해봅시다.,Korean
+콩팥기능이 안 좋은 분은 조영제 사용이 주의가 필요한데 환자분은 괜찮으신 것 같아요.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+증상과 원인에 따라 가장 좋은 방법으로 치료하게 됩니다.,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+암을 진단받으신지가 얼마나 되었나요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+네 환자분 과거에 부정맥 진단을 받으신 적은 없으신가요?,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+아이가 키 성장뿐만 아니라 다른 발달까지 느릴까 봐 걱정돼요.,Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+"배가 자꾸 꾸륵꾸륵하고 장이 뒤틀린 느낌이 들어요.
+",Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+네 검사 예약 잡아 드릴게요.,Korean
+약병에 적혀있는 대로 오 밀리 먹였어요.,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+"아랫배를 만지면 딱딱하고 통증이 있어서 왔어요.
+",Korean
+"수상스키 타다가 넘어졌는데 이가 부러져 버렸어요.
+",Korean
+참아보려고 했는데 약이 너무 역해서 토했어요.,Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+환자분의 약을 알아야 처방한 약이나 주사의 성분이 충돌하지 않게끔 조절하기 위해 성분을 분석할 수 있습니다.,Korean
+"약을 먹어본 적은 없어요.
+",Korean
+다른 알레르기 상황이 어떤 거죠?,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+지속적으로 소화가 잘되지 않나요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+가족 중에 고혈압 진단을 받으신 분이 있다면 말씀해 주세요.,Korean
+오전 회진끝나고 응급수술없으면 그때 봴 수 있을 거예요,Korean
+경정맥신우조영술은 조영제를 이용하여 신장의 기능을 확인 할 수 있는 검사입니다.,Korean
+"귀에서 삐 소리가 나더니 갑자기 어지러움을 느꼈어요.
+",Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+가만히 있을 때도 흉통이 있나요?,Korean
+"지금 얼굴에서 감각이 없어요.
+",Korean
+네. 현재 질병과 관계없이 모든 입원 치료 및 수술 경험 알려주세요.,Korean
+네. 종양성 병변인 선종이 확인되어 이후 대장 내시경 추적 검사가 필요합니다.,Korean
+소화가 잘 안 되고 속이 답답하신가요?,Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+간접흡연도 영향이 몹시 크죠.,Korean
+아니요 한 달 전에 드신 약은 말씀 안 해주셔도 됩니다.,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+���에 열 기운이 느껴지세요?,Korean
+열이 나거나 구역질이 나는 등 이상 증상이요.,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+"열이 좀처럼 떨어지지 않아요.
+",Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+오늘 검사 스케줄이 널널해서 바로 받으실 수 있으세요.,Korean
+통증 양상의 특징점이 있나요?,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+현재 구토 증상이 있나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+간염 검사 관련 양성인가요?,Korean
+현재도 천식 관련하여 약물치료 중이신가요?,Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+신경학적 상태를 파악하는 중요한 질문입니다.,Korean
+이천십이 년에서 이천십사 년까지 복용했다가 작년부터 다시 복용하기 시작했어요. 약은 다시 처방받아야 해요.,Korean
+직장 내시경은 에스 상 결장까지만 본다는 점에서 대장 내시경과 차이가 있으나 기본적으로는 유사한 검사 방법으로 진행합니다.,Korean
+"일을 그만둔 이후로 낮잠을 자다 보니까 밤에 잠이 잘 안 와요.
+",Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+수속 후 병실로 가세요.,Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+이전에 약을 처방받아 드신 적은 있으신가요?,Korean
+상처 부위에 붓기도 있나요?,Korean
+검사 후에 수술 없이 치료할 수 있을 정도인지 다시 안내드릴게요.,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+현재 욕창 부위 피부가 붉고 찰과상과 물집이 보입니다.,Korean
+"음 음식 냄새만 맡아도 속에서 메슥거리는 느낌이 나고 음식물이 들어가면 결국 토하더라고요.
+",Korean
+아직 호흡한 마취 가스가 혈액에 남아있어 폐에 전해져서요.,Korean
+소변에 피가 묻어 나온 적이 있나요?,Korean
+"생리를 안 한 지 너무 오래돼서 왔어요.
+",Korean
+집안에 암 환자분이 계세요?,Korean
+대변볼 때 피가 묻어나나요?,Korean
+당뇨 측정을 해 보셨나요?,Korean
+통증이 하루에 자주 일어났어요?,Korean
+구토나 구역감 또는 호흡 곤란 등의 증상이 나타날 수 있습니다.,Korean
+오래 앉아있어도 똥이 잘 안 나오나요?,Korean
+결핵 치료로 처방받은 약이 이게 맞나요?,Korean
+"아니요. 술만 먹으면 몸이 붓기 때문에 잘 안 먹어요.
+",Korean
+"네. 그런 증상은 못 느끼고 없었던 거 같아요.
+",Korean
+제일 염려되는 증상이 뭐죠?,Korean
+혹시 고혈압 당뇨 심장질환 신장 질환 호흡기 질환 갑상선 질환이 있으신가요?,Korean
+애기 몸무게 몇 킬로인지 아세요?,Korean
+아직도 가슴 쪽에서 통증이 올라오나요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+네 상처 보호 혹은 지혈을 위해 쓰입니다.,Korean
+심장 두근거리는 증상도 있으시기 때문에 심전도나 필요한 피검사는 해보아야 알 수 있지만 전형적인 갑상선기능항진증 증상입니다.,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+만성폐쇄성 폐 질환이 있네요.,Korean
+"작업하던 중 그라인더에 긁혀 다쳤어요.
+",Korean
+"잠들기가 어려워서 수면 유도 음악 들으면서 자요.
+",Korean
+검사 결과 상 몸에 수분이 부족하네요. 물을 좀 더 드세요.,Korean
+"""콕콕 찌르는 듯이 아픈가요, 쑤시듯이 아픈가요, 묵직하게 아픈가요, 날카롭게 아픈가요?""",Korean
+통증은 어떠할 때에 있으세요?,Korean
+우선은 이틀 치까지만 처방 됩니다.,Korean
+알레르기 유발하는 음식 말해봐요.,Korean
+"소변볼 때마다 시원하게 보지를 못 해요.
+",Korean
+가래의 상태를 말해 주세요.,Korean
+약의 종류와 복용 횟수가 늘어나 힘들 수 있습니다. 하지만 약에 대한 부작용은 사람에 따라 차이가 있을 수 있습니다.,Korean
+최근 동안 체중에 심한 변화가 있나요?,Korean
+통증이 대략 하루에 몇 번 정도 오나요?,Korean
+통증이 나타나는 곳을 보여 주시겠어요?,Korean
+오늘까지는 많이 아프실 수 있어요.,Korean
+방금 검사하신 게 부작용 여부 확인을 위해서 하신 거예요.,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+전신 마취 상태로 수술받았습니다.,Korean
+약을 먹으면서 당뇨 치료를 하고 있나요?,Korean
+간 염증 수치가 높으신가요?,Korean
+현기증이 생긴 적 있나요?,Korean
+주 증상 외에 불편하신 곳은 없으신가요?,Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+암 질환�� 있는 가족이 있으신가요?,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+네. 우선적으로 수액치료와 필요시 약물 치료로 정상 혈압을 유지할 것입니다.,Korean
+아니요. 치료 끝난 지 일 년 정도 된 것 같아요.,Korean
+아침을 드신 시간부터 금식시간을 계산해 검사 일정이 정해 집니다.,Korean
+평소에도 열이 자주 났었나요?,Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+이제 무슨 검사를 할 거냐에 따라 다릅니다.,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+대변을 볼 때 피가 보이나요?,Korean
+"숨이 많이 차서 숨쉬기도 어렵고 기침도 발작하듯이 나요.
+",Korean
+결핵이 있다는 것을 언제 알게 됐나요?,Korean
+통증을 점수로 표현해 보실래요?,Korean
+수술 전 외출은 가능하시지만 이후 이 주간은 외출 어려우세요.,Korean
+"일하다가 전에 다쳤던 팔을 또 다쳤어요.
+",Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+초음파 상에서는 종양인 것 같고 두 개의 덩어리 즉 결절이 보입니다. 성질이 양성인지 악성인지는 추가로 검사를 해봐야 압니다.,Korean
+심장이 터질 것 같은 느낌이 드시나요?,Korean
+그렇군요 구급차로 입원하셨다고 알겠습니다.,Korean
+약국 가서 엄마가 제 증상 말하고 얻어온 약 먹었는데 뭔지는 모르겠어요.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+회복실에서 상태확인 뒤에 가실 수 있어요.,Korean
+조금 쉬시면 울림은 사라질 거예요.,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+배액관 삽입 부위가 젖어있습니다.,Korean
+간염 치료는 약물로 하고 계시죠?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+고혈압약과 관련된 약을 전부 알려주세요.,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+"눈에 이물질이 들어갔는데 눈이 잘 안 떠져요.
+",Korean
+멍이 크게 들은 걸 보니 연관이 있어 보이네요.,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+"씨 형 간염이 의심된다고 해서 검사받아봐야 할 것 같아요.
+",Korean
+나이도 있고 해서 그냥 하반신이 좋을 것 같다길래 아래만 마취하고 했었던 것 같은데요.,Korean
+종양 치료는 다 끝났나요?,Korean
+네 알에이치 마이너스처럼 특이 혈액형이 있습니다.,Korean
+대변을 보기 어렵다거나 잘 나오지 않는 증상도 포함됩니다.,Korean
+"헛구역질이 너무 심해서 왔어요.
+",Korean
+변비 증상이 처음이신 건가요?,Korean
+팔을 지금 움직일 수 있나요?,Korean
+집에 타이레놀밖에 없어서 그거 먹었어요.,Korean
+타이레놀은 가끔 드시는 거죠?,Korean
+검사의 목적 검사의 부작용 검사를 하지 않을 경우의 대안 등 주요한 정보를 알려드리고 그에 대해 충분히 이해한 후 검사를 진행하고자 동의서 작성을 하고 있습니다.,Korean
+설명서에 적힌 용량 먹였어요.,Korean
+언제 처음 결핵을 앓았나요?,Korean
+집안에 당뇨 환자 있나요?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+위 내의 상피세포가 장 내에서 발생하는 상피세포로 변화한 것을 말합니다.,Korean
+실제로 토하신 적 없으세요?,Korean
+해당 증상의 경우 경구 약제보다 다른 약제의 사용이 권장됩니다. 그에 따라 약제 변경을 해드리겠습니다.,Korean
+네. 열은 다 내렸어요.,Korean
+간 염증 수치가 높으신가요?,Korean
+마취 없이 진행이 됩니다.,Korean
+가족 중에 유전 질환을 앓고 계신 분이 따로 있나요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+언제쯤 독감 주사 맞았나요?,Korean
+선천성 기형과 후천성 기형 전부요.,Korean
+다른 날이면 다시 예약해 드릴까요? 근데 오늘 촬영을 해야 치료가 가능 할 거 같은데요.,Korean
+"이틀 전부터 말을 하거나 기침하거나 숨을 좀 크게 쉬거나 하면 목이 아팠어요.
+",Korean
+대표적으로는 소화기 증상이 있을 수 있으며 이외 발진이나 두통 등이 있을 수 있습니다.,Korean
+피를 토한 적이 있으시다고요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+호흡곤란이 온 적 있어요?,Korean
+소화가 잘 안 되고 속이 답답하신가요?,Korean
+드시면 알레르기 생기는 약이 있��까요?,Korean
+네. 혈당이 조금씩 내려가고 있는 것 같아요.,Korean
+수술받은 적 있으면 알려주세요.,Korean
+그런 건 아니고요. 어떤 약 드시는지 확인을 해야 해서요.,Korean
+후두 암을 앓고 있어요.,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+그럼 의사 선생님께 길게 처방 원하신다고 전달해두겠습니다.,Korean
+어느 부위에 통증이 있으신가요?,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+가슴이 답답하거나 아픈 적이 있으신가요?,Korean
+면역요법은 수개월에서 일 년 이상까지 시간이 소요됩니다.,Korean
+청소와 빨래를 자주 하는 것이 진드기를 없애는 데에 많은 도움이 됩니다.,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+결핵 수치가 높은 편이신가요?,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+오늘 어떤 진료를 받으실 건가요?,Korean
+"알코올중독이 있었거든요. 그래서 절대 안 마시죠.
+",Korean
+약 먹고 나서는 혈당 유지되고 있어요.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+피부가 입 속에 있는 구조물들이 자라는 속도를 못 따라올 수 있어서 어느 정도 성장 후에 재수술을 진행하는 겁니다.,Korean
+"제가 원래 장염이 있었는데 생각 못 하고 탄산음료랑 우유를 마셨더니 복통이 심해서 달려왔어요.
+",Korean
+몸에 부은 곳이 있나요?,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+얼마에 한 번씩 아픈가요?,Korean
+오늘 밤에 금식하는 거랑 수술 전 준비하실 거 안내해 드릴게요.,Korean
+수술해준 병원에 물어봐야 알죠.,Korean
+간염으로 언제 치료 받으셨나요?,Korean
+"심장이 안 좋아 그런 거라고 하셨습니다.
+",Korean
+독감 예방 접종은 올해 하셨는지요?,Korean
+오빠가 몇 년 전에 위암으로 수술을 받았어요.,Korean
+반드시 의사 처방을 받고 드셔야 해요.,Korean
+집안에 고혈압인 분 있나요?,Korean
+일반인들 보다 회복이 더뎌서 오래 걸립니다.,Korean
+심장이 안 좋아서 입원했었는데 아마 삼 개월 안 된 것 같은데요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+단순히 수액을 맞는다고 수면의 질이 높아지는 건 아닙니다.,Korean
+"몸이 이상해서 혈당을 쟀는데 높게 나왔어요.
+",Korean
+묽은 변을 보시지는 않나요?,Korean
+심하고 급성적 알레르기 반응의 경우 기도 수축에 의한 호흡 곤란이 오기도 합니다.,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+몸에 좋다고 아무 약이나 드시면 안 됩니다.,Korean
+고혈압 때문에 복용 중인 약이 있으신가요?,Korean
+계속 기침 증상이 있나요?,Korean
+심장 관련된 검사들을 진행하고 그에 따른 치료를 하겠습니다.,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+지금 제일 아픈 곳이 어디인가요?,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+대장 중 직장과 가장 가까운 대장 부위입니다. 에스 자를 그리고 있어 에스 상 결장 또는 구불 결장이라고 부릅니다.,Korean
+한 자세로 오래 앉아있으면 몸에 무리가 오게 돼요.,Korean
+디피시피 치료 효과는 다른 치료방법에 비해서 높은 편이지만 효과를 보지 못하시는 분들도 더러 있어요.,Korean
+대변을 보고나면 휴지에 피가 같이 묻어있나요?,Korean
+알레르기 때문에 사용하지 못하는 약물이 있으신가요?,Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+네. 입원비와 관련하여 궁금한 점이 있으시면 원무과에 문의하시면 됩니다.,Korean
+결핵 때문에 병원 간 적 있으세요?,Korean
+복부가 빵빵해서 불편한 점이 있나요?,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+네 헌혈 말고 수혈받아보신 적 있나요?,Korean
+치료과정 중 약간의 출혈이 있을 수 있습니다.,Korean
+변에 의한 것일 가능성은 적습니다. 추가 검사를 해야 할 것 같습니다.,Korean
+지금 아이는 화상이 심각한 상태라고 할 수 있어 빠른 치료를 해야 합니다.,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+술은 며칠 간격으로 마시나요?,Korean
+아 예전에 부정맥 진단을 받으셨군요.,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+대변이 잘 안 나오고 그러나요?,Korean
+오심을 겪어본 적이 있나요?,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+배를 만지면 터질 것 같은 느낌이 드시나요?,Korean
+목이 얼마나 아프신지 일부터 열까지 숫자로 표현해 주세요.,Korean
+속이 체한 것처럼 더부룩한 느낌이세요?,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+"옆구리 안에 누가 사는 것 같이 아프네요.
+",Korean
+장기적으로 봤을 때 입원하시는 것이 좋습니다.,Korean
+체중 변화가 급격히 일어나면 문제가 있을 확률이 커요.,Korean
+네. 위생 관리 철저하게 할게요.,Korean
+"흡연 음주 둘 다 안 하지만 남편이 흡연을 해요.
+",Korean
+그냥 비타민디 먹이고 있어요.,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+속이 꽉 막힌 것 같나요?,Korean
+아니요. 아이가 너무 안 나와서 결국엔 제왕 절개로 했어요.,Korean
+대변 잘 못 보세요?,Korean
+소변에 피가 함께 나오나요?,Korean
+병원에서는 아예 담배 안 되나요?,Korean
+앞으로 검사를 해서 문제점을 발견해야 합니다.,Korean
+"흡연은 안하구요. 술은 가끔식 합니다.
+",Korean
+담배를 피웠던 기간이 얼마나 될까요?,Korean
+그럼요 애완견 예방접종 유무를 알아야 하니까요.,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+최소한 두 시간마다 자세를 바꾸어 주셔야만 합니다.,Korean
+속이 많이 안 좋으신가요?,Korean
+한 달 치 미리 처방을 받아두었어요.,Korean
+"대변 볼 때마다 항상 어려워요.
+",Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+식후 소화가 잘 안되어 일상생활이 불편하신가요?,Korean
+암인 거 언제 아셨나요?,Korean
+음식과 약물 말고 어떤 것이 알레르기를 일으키나요?,Korean
+"변색이 요새 좀 짙어진 것 같아요.
+",Korean
+가족분들 중에 유전성 질환 갖고 계신 분 있으세요?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+약물이 당뇨 치료에 효과가 있었나요?,Korean
+언제 주로 현기증을 느끼나요?,Korean
+전신 마취 상태로 수술받았습니다.,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+결핵 치료를 약으로 하고 계시나요?,Korean
+가족 중에 고혈압 판정받은 분 있나요?,Korean
+고혈압에 대한 가족력 확인 부탁드릴게요.,Korean
+어릴 때 허약해서 몇 번 쓰러졌었어요.,Korean
+"네네. 그때부터 피우기 시작했지만 중간에 몇 번 끊었다 피웠다 그랬어요.
+",Korean
+네 혹시나 수혈이 필요한 상황이 있을 수 있어 물어보는 거예요.,Korean
+바이러스가 피부에 접촉했다고 해서 체액이나 혈액 등을 통해 전파되는 것은 아닙니다.,Korean
+"혈뇨가 있어서 병원에 왔어요.
+",Korean
+알러지 유발 원인을 일컫는 말입니다.,Korean
+네 신체 외부 자국은 모두 보여주세요.,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+초음파 사진을 받고 싶으시다고요? 왜 필요하신가요?,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+면역력은 치료와 밀접한 관련이 있습니다.,Korean
+호흡할 때 어려움이 있나요?,Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+흡연 기간이 어떻게 되세요?,Korean
+수면제 복용하신 지 얼마나 됐는지 알려주세요.,Korean
+고혈압이라고 얘기 들으신 적 있으세요?,Korean
+"넘어질 때 턱을 부딪혔어요.
+",Korean
+간염 보균 기간이 어떻게 되나요?,Korean
+네 검사 결과 기억하시나요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+복부가 팽팽해지는 걸 자주 느끼시나요?,Korean
+정확하게 진단을 하고 치료를 하려면 혈액 검사를 진행하셔야 합니다.,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+본원에서의 수술기록은 조회가 되지만 타병원에서 한 수술은 조회가 되지 않습니다.,Korean
+가장 최근에 잰 체중이 어떤가요?,Korean
+최대한 손목에 무리가 가지 않도록 휴식을 취하시는 것이 좋습니다.,Korean
+올해 독감 예방 주사 맞으신 적 있으세요?,Korean
+탈장이 맞는 건가요? 그럼 또 수술을 받아야 하는 거죠?,Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+미용 목적이라도 실비보험 적용되는 경우가 많습니다.,Korean
+다음 외래는 다음 주 화요일입니다.,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+당뇨 측정을 해 보셨나요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+"네. 아파서 그런가 잠들기가 힘드네요.
+",Korean
+처음 통증 있었던 게 언제죠?,Korean
+자궁과 난소를 더 자세히 볼 수 있습니다.,Korean
+"잠을 더 오래 자고 싶은데 새벽만 되면 잠이 깨요.
+",Korean
+통증 양상의 특징점이 있나요?,Korean
+통증이 오는 곳이 이쪽 부분인 거죠?,Korean
+암은 몇 기 진단 받으셨나요?,Korean
+머리가 깨질 것 같은 느낌이 있어요?,Korean
+가래 때문에 잠에서 깬 적이 있나요?,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+간염으로 복용 중인 약이 있으신가요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+아파하는 것보다도 불안이나 초조 두려움에 대한 안정도 필요합니다.,Korean
+심장이 벌렁거린 적 있으세요?,Korean
+식사량이 평소보다 많이 줄었나요?,Korean
+과거부터 앓는 질환이 있으신가요?,Korean
+항원 검사는 하지 않았고요.,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+아픈 곳이 가슴 쪽인가요?,Korean
+고양이 키우는 집에 갔다 오면 재채기가 나요.,Korean
+몇 년이나 담배 피웠나요?,Korean
+소변을 볼 때 피가 섞여 나오나요?,Korean
+무릎에서 찰랑거리는 느낌이 나나요?,Korean
+소변을 봐도 시원하지 않고 불편한 느낌이 있나요?,Korean
+언제부터 결핵인 거 알았어요?,Korean
+"다리가 칼로 찌르는 듯이 심하게 쑤셔요.
+",Korean
+최근에 독감 주사 맞으셨나요?,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+당뇨 관련해서 약 먹고 있나요?,Korean
+사타구니라고도 하며 좌우의 대퇴부의 옆에 있는 하복부의 삼각형 모양의 부분을 말합니다.,Korean
+피는 변에 묻어 나오는 정도였나요?,Korean
+하루 흡연량이 얼마나 되는데요?,Korean
+유전적인 발기 부전으로 치료받고 있는 가족이 있나요?,Korean
+저번에 혈압이 안 좋다고 했던 거 같은데. 지금은요?,Korean
+생식기의 인유두종 바이러스 감염은 대부분 성접촉을 통하여 전파됩니다.,Korean
+"복부 팽만감이 있고 통증이 있어서 입원하게 되었습니다.
+",Korean
+구체적인 치료 방안은 담당 선생님과 상의하신 후에 결정하시면 됩니다.,Korean
+전립선이 비대해서 수술받아야 한다고 하더라고요.,Korean
+"식도가 문제라는 것 외엔 잘 기억이 안 납니다.
+",Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+선생님한테 여쭤보고 처방해 드릴게요.,Korean
+암 치료를 받고 있는 환자가 가족 중에 있나요?,Korean
+약국 가서 엄마가 제 증상 말하고 얻어온 약 먹었는데 뭔지는 모르겠어요.,Korean
+통증이 있는 부위가 어디죠?,Korean
+그러세요? 신경외과 진료도 같이 받으셔야 하겠네요.,Korean
+어릴 때 골골 앓더니 커서는 병원에 입원한 적도 수술한 적도 없어요.,Korean
+결핵 약 지금도 드시나요?,Korean
+평소에 물을 많이 드셔도 변비가 있으신 거죠?,Korean
+"혈당 수치가 안 좋아서요.
+",Korean
+채혈은 임상 병리 선생님이 전문으로 해주십니다.,Korean
+알레르기 증상이 나타난 게 언제 처음이죠?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+입원은 한두 시간 기다리셔야 할 겁니다.,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+변이 잘 안 나오나요?,Korean
+정서 장애를 초래할 수 있으므로 보호자의 세심한 관찰이 필요합니다.,Korean
+"검진에서 초음파에 근종이 보입니다.
+",Korean
+네. 여기 병원에서 준 약 먹고 있어요.,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+"투석 관에 문제가 있는 것 같아요.
+",Korean
+심장이 너무 빨리 뛴다고 느끼나요?,Korean
+통증 정도를 얘기하기 힘드시면 어떻게 아픈지 설명해 주실 수는 있으시겠어요?,Korean
+토에 피가 많이 보였나요?,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜 보세요.,Korean
+요즘도 간염 약을 드시고 계시나요?,Korean
+언제 수술을 하셨는지 알려 주세요.,Korean
+약물 복용 중인 거 있으신가요?,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+"걷기 힘들 만큼 다리 힘이 없네요.
+",Korean
+자주 피로하다는 느낌이 드나요?,Korean
+어깨 이외에 팔꿈치나 손가락의 이상은 없나요?,Korean
+마취통증의학과 선생님이 약물 조절 해주실 겁니다.,Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+정 혈액검사가 싫으시면 피부반응으로 하겠습니다만 정확도가 떨어지고 결과 확인이 늦어집니다.,Korean
+무리를 하셨네요. 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+몸이 뜨거운 느낌이 있으신가요?,Korean
+"변비가 있어 고생하는 편이에요
+",Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+환자분 상태에 따라 다르지만 보통 불편해하십니다.,Korean
+아니요. 입원이나 수술 같은 건 받아본 적 없습니다.,Korean
+"저번에 왼쪽 다리 수술했는데 원래 이렇게 붓나요? 너무 부어서 검사 다시 한번 해주세요.
+",Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+소변을 볼 때 피가 나왔나요?,Korean
+피로감은 어느 정도 심한가요?,Korean
+이동침대였는지 보호자분한테 다시 확인해보겠습니다.,Korean
+가족력이 있으면 질환 발병률이 높아 위험합니다.,Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+간염 관련해서 주의받으신 것 있으신가요?,Korean
+복부가 많이 무겁게 느껴지나요?,Korean
+아뇨. 환기도 잘 되는 편입니다.,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+알레르기 때문에 먹으면 안 되는 음식이 있을까요?,Korean
+"속이 많이 안 좋으시고 울렁거린대요. 토도 하시고요.
+",Korean
+간염은 약물로 관리 중이신가요?,Korean
+어떤 알레르기를 가지고 계신가요?,Korean
+아니요. 한약을 무슨 이유로 복용하시나요?,Korean
+고통이 몇 시간 동안 있나요?,Korean
+발기부전약 드시고 계신 거에요?,Korean
+검사 결과 나오려면 한두 시간은 기다리셔야 합니다.,Korean
+네 물이 차서 무릎을 못 굽히는 거면 무릎 부종입니다.,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+혈압을 자주 측정하느라 팔이 조일 수 있습니다.,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+며칠에 한 번 통증이 오나요?,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+통증 부위는 어디신 거죠?,Korean
+상처의 소독 후 사용하는 소독된 붕대를 지칭합니다.,Korean
+그뿐만 아니라 필수 예방접종도 포함해서요.,Korean
+"소변에 피 본 적이 있어요.
+",Korean
+결핵 치료를 받고 계신가요?,Korean
+우선 다른 검사를 조금 더 해봐야 알겠지만 선천성 거대결장이라는 질병이 있어요. 신생아에서 간혹 있는 질병인데 이걸 의심할 수 있는 소견이 엑스레이상 보입니다.,Korean
+검사를 진행해 봐야 알겠지만 수술이 필요한 케이스 같습니다.,Korean
+몸에서 열 감이 느껴지시나요?,Korean
+약이 세서 오래 드시면 안 돼요.,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+"아픈 발을 잘 사용 안 하려고 하다 보니까 다른 발 쪽에 무리가 갔는지 아프지 않은 쪽 발목까지 아프더라고요.
+",Korean
+알레르기 때문에 특별히 피해야 하는 것들이 있을까요?,Korean
+약을 복용하면서 반응이 있는지 보고 반응이 없다면 추가적으로 검사를 해 보겠습니다.,Korean
+환자 분은 우유를 소화할 수 있는 능력이 부족한 겁니다. 다른 음식으로 칼슘을 보충하는 게 좋겠네요.,Korean
+오심을 겪어본 적이 있나요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+술을 한 달에 몇 번이나 자주 드세요?,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+질병이 진행한 경우에는 단순히 쉬는 것만으로 증상이 자연적으로 좋아지지는 않습니다.,Korean
+"최근 의자를 바꾸고 이주 정도 됐나 어느 순간 등이 계속 아프더라고요. 자세 문젠가 싶어 계속 허리를 펴고 앉았는데도 그래요. 허리가 아니라 등이 아픈 게 이상해 입원했습니다.
+",Korean
+네. 엠알아이 검사 때문에 조영제를 맞은 적이 있었는데 문제없었습니다. 알레르기는 없어요.,Korean
+체중 증가가 언제부터 있었나요?,Korean
+혹시 결핵약 처방 받으셨나요?,Korean
+"아무래도 치킨 뼈가 목에 걸린 거 같아요.
+",Korean
+네. 유전적 질환이 있다면 다른 사람들보다 질병에 걸릴 위험이 큽니다.,Korean
+성교 시 발기��� 안 되어 문제가 있나요?,Korean
+오늘 내원하신 이유는 뭔가요?,Korean
+혹시 혈뇨를 보신 적 있으신가요?,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+어떤 것에 알레르기가 있나요?,Korean
+"어쩌다 다쳤는지도 모르게 일하다 돌아와 보니 상처가 나 있더라고요.
+",Korean
+몸에 힘이 없는 느낌인가요?,Korean
+네 하지만 재발을 했을 수도 있기 때문에 한 번 검사는 추천해 드립니다.,Korean
+입원하는 것이 아이에게 좋습니다.,Korean
+분유도 연령에 필요한 영양소를 적절한 비율로 만든 제품이기 때문에 안 좋은 것은 아닙니다.,Korean
+상한 조개는 익혀 먹어도 위험해요.,Korean
+어느 부위에 통증이 있으신가요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+해외에서 혹시 코로나 접촉이 있을 수도 있어서요.,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+감염 때문에 어쩔 수 없습니다.,Korean
+정신이 어지러웠던 적이 있나요?,Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+"변비가 좀 오려는 것 같기도 했어요.
+",Korean
+"소변에 피도 섞여 나오는 것 같고 거품도 끼는 것 같은데요.
+",Korean
+이전에 고혈압 얘기 들은 적 있나요?,Korean
+소변 때문에 화장실을 자주 가시나요?,Korean
+배가 아파 병원에 다녀왔어요.,Korean
+진단 받은 다른 질병이 있나요?,Korean
+검사는 한 시간에서 두 시간 정도 소요됩니다.,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+음식 알레르기 있는지 알고 싶어요.,Korean
+처음 통증이 오기 시작한 게 언제죠?,Korean
+가족 중에 유전성 질환이신 분이 계신가요?,Korean
+네 그런 증상이 있으셨나요?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+배가 아픈지 얼마나 되었는지 알 수 있을까요?,Korean
+해외에서 혹시 코로나 접촉이 있을 수도 있어서요.,Korean
+복부 쪽으로 부풀어 오르는 느낌이 있나요?,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+결핵 약 지금도 드시나요?,Korean
+"왼손 두 번째랑 세 번째 손가락이오.
+",Korean
+뇌척수액 검사가 현재 상태에서 필수적입니다.,Korean
+네. 접촉 사고로 심하게 다쳐서 수술한 적이 있네요.,Korean
+육 개월 이내에 꾸준히 복용 중인 약 있으세요?,Korean
+통증이 가까운 부위에서 나타나네요 경과를 지켜보는 것이 좋겠습니다.,Korean
+마취 과정이니 조금만 참아주세요.,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+"보호 기구를 아무것도 착용하지 않은 상태에서 자전거에서 떨어졌다고 하더라고요. 다리를 아예 접질린 것 같아요.
+",Korean
+"설사를 좀 했던 것 같아요.
+",Korean
+며칠 동안 수술 부위의 경과를 확인 후 퇴원하실 수 있습니다.,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+"음 저희 아기가 비슷한 개월 수 아기들보다 키도 크고 덩치도 크거든요. 그래서 검사 한 번 받아볼까 하고 왔어요.
+",Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+면역이 약해지면 종종 재발하기도 합니다.,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+어느 정도로 아프신지 표현이 가능하세요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+아니요 진통제가 위험한 게 아니라 치료 과정에서 진통제를 투여하겠다는 동의를 받는 겁니다.,Korean
+"엑스레이를 찍었는데 폐에 이상이 있다고 해서요. 조직 검사받으러 왔어요.
+",Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+"네. 혈변도 누고 배도 조금 아팠어요.
+",Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+혈압 체크 시에 높게 나오나요?,Korean
+아니요 최근에 수술이나 치료하신 적 있으신가요?,Korean
+정력이 원래 좀 안 좋으셨나요?,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+소변에 피가 섞여 있으세요?,Korean
+타 병원으로 전원 수속 도와드리겠습니다.,Korean
+약 말고 다른 것에 알레르기 나타난적 있으신가요?,Korean
+대변볼 때 피가 나오나요?,Korean
+"발톱이 자라면서 자꾸 파고들더라고요. 아무리 일자로 잘라도 마찬가지라서요.
+",Korean
+가래의 원인이 뭐가 있을까요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+과거에 다쳐서 입원까지 한 적 있으신가요?,Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+"고기 먹다가 뼈가 입 안쪽을 찌른 것 같아요.
+",Korean
+오한이 있어서 춥고 떨리나요?,Korean
+네 팔을 움직이시면 안 됩니다.,Korean
+가래에 피가 섞여 있나요?,Korean
+진통제 주사로 놓아주시는 건가요?,Korean
+통증 반응이 있는 부위가 어디에요?,Korean
+과음도 건강에 좋지 않아요.,Korean
+특정한 것에 알레르기가 있나요?,Korean
+"벌에 쏘였는데 온몸이 빨개지고 아파서요.
+",Korean
+통증이 어느 정도 심해요?,Korean
+"아무리 집중을 해도 눈앞이 흐려요.
+",Korean
+소변볼 때 통증이 있나요?,Korean
+네. 내과 선생님 맞습니다.,Korean
+몇 살 때부터 피우셨나요?,Korean
+체중이 증가한 이유가 있을까요?,Korean
+피부 내부의 신경이 손상을 받아 통증을 크게 느끼지는 못할 가능성이 큽니다.,Korean
+숨 쉴 때 가슴도 아프세요?,Korean
+최근 한 달 동안 몇 킬로 증가하셨어요?,Korean
+혈압이나 심전도 상태를 보고 저희가 옮겨드릴거에요.,Korean
+통증이 시작된 날은 언제인가요?,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+통증이 얼마나 가는 거예요?,Korean
+"검진 초음파상 근종이 있대요.
+",Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+육안으로 전혀 부은 게 보이지 않습니다.,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+혹시 심장 쪽으로 시술을 받거나 페이스메이커 같은 보조 장비를 착용하고 계신가요?,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+특정 시기에 통증이 생기나요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+객담이 많은 거 같나요?,Korean
+결핵약을 처방받은 적이 있으실까요?,Korean
+심호흡해도 심장이 빨리 뛰나요?,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+네. 그럼 입원 치료는 어떠실까요?,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+병실에서 커튼 치고 탈의하시면 돼요.,Korean
+혈압이 평소에 많이 높은가요?,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+근육에 무리가 와서 그런 걸 수도 있어요 선생님이랑 한 번 더 말씀하셔야 할 거 같아요.,Korean
+환자분께 직접 확인해야 정확합니다.,Korean
+감기 예방 주사는 맞았나요?,Korean
+큰 병이 있다고 속단할 필요는 없을 것 같습니다. 일단 원인에 대한 검사를 해 보겠습니다.,Korean
+우선 검사 전에 진통제를 약하게 놔드릴게요.,Korean
+식중독 발생 위험성을 고려할 때 되도록 익혀서 드시는 것이 바람직합니다.,Korean
+최근에 볼일 볼 때 피가 난적 있으면 말해주세요.,Korean
+하루에 한 갑 이상 피우나요?,Korean
+간염으로 먹는 약이 있습니까?,Korean
+"소변보는데 너무 아프고 잔뇨감이 늘 있어요.
+",Korean
+처방받으신 연고는 잘 바르고 계시나요?,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+이천일 년부터 이 병에 대한 제 고생이 시작됐어요.,Korean
+치료를 시작해야 할 것 같아요 오늘 주사를 맞고 가시는 게 좋겠습니다.,Korean
+절대로 임의로 중단하시면 안 되고 꾸준히 육 개월 이상 의사 선생님이 그만 복용해도 된다고 할 때까지 복용해주셔야 합니다.,Korean
+네 이 방법이 환자분이 가장 불편하지 않은 방법입니다.,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+키와 몸무게 측정하겠습니다. 신발 벗고 올라와서 측정하겠습니다.,Korean
+피를 토해낸 적 있어요?,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+얼마 전에 예방접종은 했습니다.,Korean
+항생제량은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+통증의 정도가 어떻게 되나요?,Korean
+첫째 아이는 자연분만하고 둘째 아이는 제왕절개 한 거로 기억해요.,Korean
+네. 공복 지방 수치나 공복 혈당 수치 같은 경우에는 금식 여부에 따라 수치가 변하게 되므로 검사 전 금식을 꼭 하셔야 합니다.,Korean
+약을 먹으면 입이 계속 쓰다고 울었어요.,Korean
+통증이 발현되는 시기가 있나요?,Korean
+힘이 빠지는 느낌을 받나요?,Korean
+고혈압 진단받은 지는 족히 이십 년은 넘었다만.,Korean
+설사를 하신 경험이 있나요?,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+네 폐 합병증을 예방하기 위해 꼭 심호흡이 필요합니다.,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+네. 아버지가 혈압이 매우 높으세요.,Korean
+제가 약물 알레르기가 있어요. 그것만 체크해 주세요.,Korean
+일도 화상의 경우 보통 이틀 이내에 통증이 사라집니다.,Korean
+잠을 푹 주무실 수 없나요?,Korean
+잠 잘 때 자주 깨시나요?,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+무통 주사 들어가도 아프면 어떡하죠?,Korean
+환자복은 어떤 사이즈가 필요하세요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+기침을 많이 한 경우 가슴 근육이 땅기고 아플 수 있습니다.,Korean
+여기 병원에서 진료받은 적 있을 거예요.,Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+지금 환자를 면회할 수 없습니다.,Korean
+맥박이 빨리 뛰는 느낌 나나요?,Korean
+"말씀해 주신대로예요. 정말 못 자고 있어요.
+",Korean
+"수술한 곳이 터질 듯 아프고 진물이 나네요.
+",Korean
+여기서 처방받았던 약 말고 다른 약은 드시는 거 없으신가요?,Korean
+어떤 곳이 아프신지 알려주세요.,Korean
+약물에 대한 알레르기가 있습니까?,Korean
+집안에 당뇨 환자 있나요?,Korean
+지금 환자분이 가장 불편한 데를 짚어주시겠어요?,Korean
+병원 입원 경험이 있으신가요?,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+"좀 머리가 빙빙 도는 것 같아요.
+",Korean
+단순한 관절 이상이라면 호전될 가능성이 있지만 신경계 이상이라면 아직 예후를 말씀드리기에는 이릅니다.,Korean
+저번 주까지 먹었던 약이 있긴 한데.,Korean
+흡연한 게 언제부턴지 기억하세요?,Korean
+네 진료 센터에서 모두 해드립니다.,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+"배 아파서 못 먹어요.
+",Korean
+속이 쓰리는 느낌은 없나요?,Korean
+"하루에 많이 자야 네 시간 정도 자고 있어요.
+",Korean
+남편 분과 함께 거주하시기 때문에 간접흡연의 영향이 있습니다.,Korean
+고혈압을 가지고 있는 가족이 있으세요?,Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+하루 동안 얼마나 피워요?,Korean
+"양쪽 무릎이 다 아파요.
+",Korean
+병원에 자주 오셔야 돼서요.,Korean
+기침을 했는데 피가 나온 적 있나요?,Korean
+언제 독감 예방 접종을 했나요?,Korean
+당뇨 가족력을 갖고 있나요?,Korean
+"살이 급격히 빠지진 않았고 좀 야위긴 했어요.
+",Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+피로로 인해 일상이 힘든 적 있나요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+지금도 가슴에 통증이 있나요?,Korean
+삼 개월간 몸무게가 얼마나 빠졌죠?,Korean
+당뇨로 약을 드시고 계신가요?,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+휠체어에 앉아서 기다리시면 됩니다.,Korean
+배에 묵직한 통증이 있나요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+"평소때보다는 확실히 좀 아파하더라고요.
+",Korean
+요즘 혹시 두통이 있나요?,Korean
+기침을 해도 계속 걸려있는 듯한 느낌이 드나요?,Korean
+입원해서 치료한 경험 모두 다 맞습니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+털이나 먼지 같은 거에 반응하는 알레르기가 있으세요?,Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+다른 약은 없으시고 간염약만 드세요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+네. 유전된 건 없댔어요.,Korean
+통증이 나타난 게 언제인가요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+아침 저녁 식전에 위산분비억제제와 식후에 항생제 두 종류를 복용하시면 됩니다.,Korean
+통증이 얼마 동안 지속되나요?,Korean
+통증은 한번 시작되면 어느 정도 아프세요?,Korean
+네 입원하여 수술을 준비해야 할 것 같습니다.,Korean
+"머리가 좀 어지럽고 가끔 시야가 흐리다고만 말했어요.
+",Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+알레르기 주 증상이 어떻게 되세요?,Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+간염으로 드시는 약이 있나요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+병원에서 큰 수술을 받으셨나요?,Korean
+대변을 볼 때 피가 나오나요?,Korean
+현재로서는 말씀드리기 어렵고 확인을 위해 위내시경 검사가 필요합니다.,Korean
+"허리가 굽힐 때 너무 힘들어요.
+",Korean
+모자란 젖의 양으로 수유하는 것보다는 분유 수유를 하는 것이 아이의 영양상태를 위해 좋을 수 있습니다.,Korean
+먹었던 음식을 다 토하시나요?,Korean
+흡연 시작 연령을 기억하세요?,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+코디바드랑 노바모핀 같이 먹고 있어요.,Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+"안경 쓰다가 잘못 써서 눈가를 찔렀어요.
+",Korean
+몇 분마다 수축이 느껴지시나요?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+"다른 증상은 보이지 않았습니다.
+",Korean
+사람마다 폐경시기는 다르기 때문에 언제라고 말씀드리기는 어려우나 일반적으로 한국 여성은 사십구 세 정도 됩니다.,Korean
+집안에 고혈압인 분 있나요?,Korean
+겨드랑이 쪽 시술을 한 번 받고 일주일 정도 입원했던 적이 있어요.,Korean
+처방받아서 복용 중인 약이 있으신가요?,Korean
+이번 달에 체중 변화가 있었나요?,Korean
+가족 중 당뇨 환자 있나요?,Korean
+"설사는 세 번 했습니다.
+",Korean
+"견과류가 뇌에 좋다 해서 하루도 빠짐없이 먹어요.
+",Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+큰 병은 아닌 걸로 보여집니다. 너무 걱정하지 않으셔도 됩니다.,Korean
+결핵 치료는 잘 되었나요?,Korean
+네 독감 예방 접종 후 알레르기는 따로 없으셨단 거죠?,Korean
+결핵 백신 곧 나온다는 건 알고 계시죠?,Korean
+통증이 오는 곳이 있나요?,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+잘 때도 기침을 하나요?,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+두통 때문에 내과 다녔어요.,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+심장이 터질 것 같은 느낌이 드시나요?,Korean
+발기 부전은 언제부터 있으셨어요?,Korean
+암 진단받아본 적 있으세요?,Korean
+커피 대신 물 섭취량을 늘려보시기를 권해요.,Korean
+"자주 토하고 싶고 그렇습니다.
+",Korean
+퇴원 후 보호자와 함께 거주하시나요?,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+결핵 치료를 받고 계신가요?,Korean
+"살기 싫어서 목을 맸어요.
+",Korean
+배가 이유 없이 가스찬적 있나요?,Korean
+통증이 느껴지는 특징이 어떤가요?,Korean
+아니요 움직이시면 속이 울렁거리거나 혹은 어지러움이 올 수 있습니다.,Korean
+아뇨. 환기도 잘 되는 편입니다.,Korean
+고혈압약을 현재도 복용 중이신가요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+수술은 잘 끝난 걸로 알고 있어요. 너무 아프시면 진통제 놔 드릴까요?,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+연고는 하루에 서너 번 깨끗한 상태에서 발라주세요.,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+"안녕하세요. 다름이 아니라 제가 왼쪽 손가락이 빨갛게 붓고 아프고 한 번은 고름도 나오더라고요 그래서 왔어요.
+",Korean
+약 알레르기 있는 거 있으실까요?,Korean
+약을 복용하신 지는 얼마나 되셨어요?,Korean
+겨울만 되면 편도선이 많이 부어요.,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+"걸레를 짜고 난 후 손가락 마디가 많이 아픕니다.
+",Korean
+통증이나 감각 이상 등 다른 이상은 동반되고 있지 않나요?,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+배가 많이 아픈 적은 없었나요?,Korean
+저희 병원엔 비뇨기과가 없어서 다른 시술과 처치를 받기 원하시면 다른 병원으로 가셔야 됩니다,Korean
+침 삼키기 힘들 정도로 목이 아픈가요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+일단은 피 색을 통해 출혈 부위를 알아보기 위한 것이지 좋고 나쁘고는 없습니다.,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+배 어느 쪽이 가장 아픈가요?,Korean
+"약으로는 증상이 호전될 기미가 안 보여서 오게 됐어요.
+",Korean
+통증 지속력이 어느 정도인가요?,Korean
+결핵으로 진단받은 적 있나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+증상이 시작된 건 언제부터였나요?,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+상처 보호 및 지혈 등에 쓰입니다.,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+호흡이 힘든 증상이 있으실까요?,Korean
+"소변을 눠도 마렵고 누고 나서도 잔뇨가 남고 지퍼를 올리고 소변이 새요.
+",Korean
+어느 부위에 통증을 느끼세요?,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+약물로 당뇨 치료받고 계세요?,Korean
+아버지가 당뇨약 드시고 계세요.,Korean
+결핵 치료를 약으로 하고 계시나요?,Korean
+환절기 때 한번씩 아프기는 해요.,Korean
+통증 양상의 특징점이 있나요?,Korean
+어떤것 때문에 병원에 오셨나요?,Korean
+감기 예방 주사는 맞았나요?,Korean
+매우 드물지만 모체로부터 아기로의 수직 감염이 있었을 수도 있습니다.,Korean
+환자분이 어떤 약을 드시는지 파악을 해야 해서요.,Korean
+네 연고와 시트 둘 다 환자분 마음대로 하셔도 됩니다.,Korean
+아픈 게 쭉 아파요?,Korean
+소변볼 때마다 피가 나오나요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+내원하신 이유가 어떻게 되죠?,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+검사를 여기서 했으니 여기서 진료받는 게 좋은데요.,Korean
+동네 병원에서 소독만 하시고 이틀에 한번이라도 경과를 보기위해 꼭 내원해 주세요.,Korean
+치아 불편한 게 있는지 확인하기 위해서요.,Korean
+네. 나가서 앉아 계시면 저희 직원이 안내해주실 겁니다. 그럼 수술 당일에 뵙겠습니다. 큰 걱정은 안 하셔도 됩니다.,Korean
+종양 제거 수술을 받은 적이 있나요?,Korean
+"가슴에 통증이 있고 호흡이 힘들어서요.
+",Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+피부 상처가 거의 아물게 되면 안정적으로 자리 잡는다고 말씀드릴 수 있겠습니다.,Korean
+케이에프 마스크가 효과가 가장 좋습니다.,Korean
+네 재발이 가능한 질환이기 때문에 꾸준한 관리가 필요합니다.,Korean
+스트레스 완화에 좋은 약은 없어요.,Korean
+알레르기 치료 시작은 언제부터 했나요?,Korean
+근래에 체중 증가가 있으신가요?,Korean
+피를 토해낸 적 있어요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+감염 예방과 함께 진피층 회복을 촉진할 처치가 진행될 예정입니다.,Korean
+소변이 내려오는 길을 조영제로 조영하여 결석의 위치를 확인하기 위함입니다.,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+"턱이 부드럽게 움직이질 않고 아프네요.
+",Korean
+목에 통증 있은지는 얼마나 되셨어요?,Korean
+원래 병원으로 가기엔 너무 아픈데. 대기 시간 긴가요?,Korean
+대부분 심각한 합병증 없이 회복이 가능하여 단기간 입원 후 퇴원 가능합니다.,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+통증이 쭈욱 계속 이어지나요?,Korean
+"등 뒤쪽이 너무 아파요.
+",Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+통증이 오면 어느 정도 이어지나요?,Korean
+"요즘은 설사만 하는 것 같아요.
+",Korean
+어릴 때 간단하게 탈장 수술받은 거 말고는 없었어요.,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+말씀드린 세 가지 중에서 어느 요법이 제일 이해가 안가세요? 세 가지 다 다시 설명드릴까요?,Korean
+몸무게 최근에 재셨더라도 다시 한번 측정할게요.,Korean
+암으로 드시는 약 있어요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+불면증이 있는 것 같나요?,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+담배를 피운 기간을 알려주세요.,Korean
+"목 쪽이 건조해서 긁으면 상처가 나고 뭘 발라도 낫질 않아요.
+",Korean
+이비인후과에 진료를 받아보시는 것은 어떨까요?,Korean
+패혈증이나 다른 합병증이 생길 수 있어요.,Korean
+"아니요. 뭘 삼킬 때 침을 삼켜도 아파요.
+",Korean
+네. 입원해서 항생제 치료하자고 하셨어요.,Korean
+자극성 하제의 사용은 주의가 필요합니다.,Korean
+저는 무료 접종 대상이 아니라서 그냥 안 맞았어요.,Korean
+환자 혼자서는 이동이 불가한 거 맞죠?,Korean
+피가 섞인 소변을 보신 적이 ���나요?,Korean
+체온이 몇 도인지 아세요?,Korean
+어떤 경우에 알레르기가 생기나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+요 근래 식욕이 비정상적으로 떨어지셨나요?,Korean
+초기에는 눈의 흰자 부분에서 잘 관찰됩니다.,Korean
+소변에 피가 많이 나오셨나요?,Korean
+평소에 재는 혈압이 얼마나 높은가요?,Korean
+치아 뿌리가 원래 조금 약하지 않으셨나요?,Korean
+꽃가루로 인한 계절성 알레르기를 앓은 적이 있나요?,Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+현재로선 아이 상태가 좋다고 할 수는 없습니다.,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+"골목에서 차가 튀어나오는 바람에 놀라서 뒤로 자빠지면서 꼬리뼈 부근을 다친 것 같아요.
+",Korean
+"네. 사실 몸에 그런 증상이 있는지 몰랐어요. 증상 없었어도 되는 거죠?
+",Korean
+"나이가 먹어서 그런 거라 막연히 생각해왔는데요. 귀가 잘 안 들리긴 해요.
+",Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+어디가 제일 많이 부었나요?,Korean
+과거 수술 여부 말씀해주세요.,Korean
+검사실로 이동할 예정이오니 잠시 기다려주시길 바랍니다.,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+"코가 막혀 계속 깨서 울었어요.
+",Korean
+동남아로 여행 가려고 장티푸스 맞았어요.,Korean
+의사 선생님께 고혈압 관련 진료를 처음 받으신 것은 언제였나요?,Korean
+흡연 기간이 얼마나 될까요?,Korean
+"계속 소변이 나올 것 같은 느낌이 들어요.
+",Korean
+두통이 계속 지속되고 있나요?,Korean
+고혈압 진단 받으신 적은 과거에 없으신 거죠?,Korean
+네. 갑상선호르몬이 높게 측정됐네요. 갑상선 관련해서 초음파나 다른 검사는 해보셨나요?,Korean
+토혈이 나타난 건 언제인가요?,Korean
+지금까지 토한 적이 있나요?,Korean
+다른 질환과 유사한 내시경적 소견을 가지고 있어 필요시 이에 대한 감별진단이 필요할 수 있습니다.,Korean
+약물 꾸준히 복용하고 계세요?,Korean
+어떤 행동을 했을 때 통증이 오나요?,Korean
+생리 식염수를 이용해서 화상 부위를 닦아내고 있습니다.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+발기 부전 때문에 많이 스트레스이신가요?,Korean
+원인을 찾는 것이 가장 중요하기 때문에 몇 가지 검사 후 바로 통증을 조절 해드리겠습니다.,Korean
+통증을 점수로 표현해 보실래요?,Korean
+권장 섭취량을 지켜서 복용해 주세요.,Korean
+병원에서 암 진단받으신 적 있으실까요?,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+당뇨가 집안 내력인 거죠?,Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+편도선 많이 안 부었어요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+"그냥 좀 몸에 열이 오르는 정도구나 했었는데 점점 심해지더라고요.
+",Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+다른 종류의 알레르기는 가지고 계세요?,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+어디에 있는 연세 이비인후과예요?,Korean
+정상 신생아의 일 에서 오 퍼센트 정도가 닫히지 않은 초상 돌기로 인하여 서혜부 탈장이 발생합니다.,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 지속적인 추적검사가 요구됩니다.,Korean
+흉터가 남으나 자라면서 옅어질 것입니다.,Korean
+타이레놀 종류 중 하나였어요.,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+"몇 년 전에 진단 받았어요.
+",Korean
+수술이 가장 좋은 방법입니다만 고민하고 계신 이유가 있으신가요?,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+우유를 소화 못 시켜요.,Korean
+오한이 좀 있는 것 같으세요.,Korean
+보통 이렇게 오래가지는 않지만 환자분은 지금 심각한 상태라 다른 사람들보다 증상이 오래가는 겁니다.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+간염이라는 사실을 몇 년도에 아셨어요?,Korean
+검사하고 바로 수술 들어가실 거예요.,Korean
+"수술한 다리에 통증이 안 없어져서요.
+",Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+처음으로 결핵 진단받은 게 언제예요?,Korean
+마지막으로 검사를 해보신 적은 언제인가요?,Korean
+약은 집에 있고 처방전 찍어왔어요.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+소독 후에 연고를 꼭 바르시고 위에 거즈로 덮어줘야 덧나지 않습니다.,Korean
+가족분 중에 당뇨 질환을 앓는 분이 또 계세요?,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+"네. 수면제 챙겨 먹고 있습니다.
+",Korean
+여기 병원에서 진료받은 적 있을 거예요.,Korean
+"넘어져서 책상에 머리를 부딪혔어요.
+",Korean
+구토는 자주 나오지 않나요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+애완동물 털이나 배설물로 인해서 비염 증상이 악화될 수 있기 때문에 앞으로도 집에 애완동물은 안 키우는 걸 권장합니다.,Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+조금 불편할 수 있습니다. 견딜 수 없이 아프시면 다시 말씀해 주십시오.,Korean
+아이가 외래 진료와 검사 결과 탈수 증상이 조금 있네요. 처방된 수액으로 바꿔 달아드릴게요.,Korean
+간염으로 아팠던 시점을 기억하세요?,Korean
+갑자기 혈압의 변화가 있거나 열이 나는 증상 등이 발생하지 않는다면 문제없습니다.,Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+그렇다면 환자분은 유당 불내증이 있으 실 것 같네요. 다른 음식으로 칼슘을 보충하는 게 좋아요.,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+"원래 이명이 가끔 들렸어요.
+",Korean
+환자와 관련해서 안내드릴께 있어 여쭤보았습니다.,Korean
+진료 기록을 볼 수 있을까 해서요.,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+발기가 오랜 시간 지속되지 못하나요?,Korean
+작년에 출산했는데 그것도 상관이 있나요?,Korean
+결핵 앓은 적 있으신가요?,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+초음파가 처음이세요? 원하시는 대로 천천히 보여드릴게요.,Korean
+"허옇고 묽은 변을 봐요.
+",Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+뼈나 근육 그리고 피부 등의 모든 구조를 지칭합니다.,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+두통약 처방받으려고 갔다 온 적 있어요.,Korean
+고혈압은 어떻게 치료 중이세요? 약물 복용을 하고 계신가요?,Korean
+빠른 회복은 어렵기 때문에 시간을 두고 잘 치료해 나가야 합니다.,Korean
+소변 색이 붉은빛이 도나요?,Korean
+"고기 오돌뼈를 안 씹고 삼켜서 걸렸어요.
+",Korean
+네.정상적인 생활리듬 유지가 어려운 환경이 누적되면 건강에 영향을 줄 수 있지요.,Korean
+호흡이 조금 가빠 오면 간호사 선생님께 말하세요.,Korean
+맥박 아까 재셨지만 지금 재측정이 필요해서요.,Korean
+가래 때문에 어떤 약을 복용하세요?,Korean
+따끔거림이 심하신가요 어떤 연관이 있는지는 자세한 검사가 필요할 것 같네요.,Korean
+몸에 열이 계속 오르나요?,Korean
+통증이 생기면 얼마나 가나요?,Korean
+"어느 정도 안 피워야 금연했다고 보는 거죠?
+",Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+일주일만 저희 집에 있다가 요양원으로 가실 예정이에요.,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+환자분 맞습니다 건강 상태가 좋지 않아요.,Korean
+피를 토해서 놀라신 적 있나요?,Korean
+원래 바이러스에 자주 노출되는 편이었나요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+네 질환 때문에 챙겨 드시는 게 있나요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+소변 보는 주기가 어떻게 되나요?,Korean
+형이 요로결석에 걸린 적 있어요.,Korean
+그거 한 번 받고 나면 한 달 가까이 집에서 요양해야 해요.,Korean
+대변을 보는 일이 힘드나요?,Korean
+틀니 말고 환자분 본인 치아가 흔들리지는 않나요?,Korean
+평소대로 숨을 쉬면 폐포에 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+당뇨로 병원에서 꾸준히 치료받고 계신가요?,Korean
+"어깨가 움직이는 게 힘들어요. 마비까진 아니어도.
+",Korean
+"네. 어지러운 부분이나 울렁거리는 그런 증세는 없었어요.
+",Korean
+제가 방금 퇴원 설명 해드렸습니다.,Korean
+당뇨가 있다는걸 언제 알게 되셨나요?,Korean
+가족분들 중에 고혈압이신 분 있나요?,Korean
+"네 맞습니다. 요새 계속 살이 빠져요.
+",Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+목이 많이 부은 것 같은데요?,Korean
+"배도 아프고 안색도 안 좋아졌어요.
+",Korean
+진료 후 처방전이 나갈 예정입니다.,Korean
+네 연고는 안 바르셔도 됩니다.,Korean
+현재까지 유전성 질환 진단받은 분이 있나요?,Korean
+네 집중해서 치료하면 빨리 낫겠지요.,Korean
+약으로 간염을 치료 중이세요?,Korean
+심할 경우에는 신장 농양 및 패혈증이 생길 수 있습니다.,Korean
+어제 과다한 나트륨 섭취를 하신 게 원인인 것 같습니다.,Korean
+네 삼 개월 때 수술할 수 있으나 주로 육 개월 이후에 합니다.,Korean
+소변을 보고 싶어도 못 보신 적이 있으신가요?,Korean
+"소화불량이 지속 되다 보니 적게 먹고 있습니다.
+",Korean
+어깨가 어떤 식으로 아픈가요?,Korean
+전에도 이렇게 열이 났나요?,Korean
+"가슴이 두근대고 불안한 느낌이 지속돼요.
+",Korean
+몸에 기운이 싹 빠진 느낌이 드나요?,Korean
+"컨디션은 별로 상관없이 혈뇨만 보게 된 거예요.
+",Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+항생제가 환자분 몸에 사용가능한지 보는 검사입니다.,Korean
+천식이 있어서 항상 흡입기를 들고 다녀요.,Korean
+목이 많이 부은 것 같은데요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+"기름진 음식은 피하고 있어요.
+",Korean
+어떤 약 처방 받으셨어요?,Korean
+약도 꼬박꼬박 챙겨 드셔야 해요.,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+재활 교육을 일 회 받아보시는 건 어떠실까요?,Korean
+암 진단받은 지 얼마나 지났죠?,Korean
+네. 집에서 소독도 가능하지만 웬만하면 내원하셔서 소독과 치료를 같이 받는 게 좋을 것 같네요.,Korean
+분유를 통해 영양소를 골고루 섭취할 수 있습니다.,Korean
+검사 결과 나오면 정확히 말씀드릴게요.,Korean
+힘이 나질 않고 무기력함만 느끼시나요?,Korean
+항문 주위가 헐거나 물집이 생기셨나요?,Korean
+암 진단을 받으신 지 얼마나 되셨을까요?,Korean
+같은 감염원을 접하더라도 사람에 따라 다른 반응이 나타날 수 있습니다.,Korean
+약이 좀 독한 편이에요. 물을 많이드세요.,Korean
+"손이 저리고 힘이 안 들어가요. 목 디스크는 있습니다.
+",Korean
+네. 증상 발생한 후 빠른 시간 내에 병원에 오셔야 적절한 치료가 가능합니다.,Korean
+"변비 때문에 오래 고생했어요.
+",Korean
+고혈압이 있어서 한의원에서 약 지어다 먹고 있습니다.,Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+피부과 치료 때문에 피지 조절약 먹고 있어요.,Korean
+갑자기 알레르기 반응이 일어나면 기도가 막힐 수가 있거든요.,Korean
+네. 간호사실 옆에 체중계가 있습니다. 체중을 재고 알려주세요.,Korean
+"간 수치가 이상하다고 큰 병원 가래서 급히 왔습니다.
+",Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+암이라는 걸 언제 알게 되셨나요?,Korean
+"수면장애 증상은 딱히 없는 듯해요.
+",Korean
+심한 흉터에서부터 표가 잘 안 나는 흉터까지 매우 다양합니다.,Korean
+피로감은 어느 정도 심한가요?,Korean
+부모님께서 어떤 병을 앓으신 적이 있다면 다 말씀해 주시겠어요?,Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+혹시 고혈압 당뇨 심장질환 신장 질환 호흡기 질환 갑상선 질환이 있으신가요?,Korean
+입원 중 수혈 가능성이 있어 여쭤보았습니다.,Korean
+일주일만 저희 집에 있다가 요양원으로 가실 예정이에요.,Korean
+입퇴원시 환자분의 신체상태 변화가 있는지 확인 하기 위함입니다.,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+당뇨로 약을 드시고 계신가요?,Korean
+부작용 중증도에 따라서 의사 선생님이 판단하실 거예요.,Korean
+검사 결과가 어떻게 나오셨는지 말씀해보시겠어요?,Korean
+요새 약 먹는 걸 자주 잊어버려서 잘 기억이 안 나요.,Korean
+뇌전증의 정도에 따라 달라요.,Korean
+"의식은 깨어 있는데 몸이 안 움직이는 마비 상태를 느껴봤습니다.
+",Korean
+결핵 치료 이력이 있나요?,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+혈관이 얇지만 주사 맞을 수 있습니다.,Korean
+상대적으로 혈압이 높은 편이세요?,Korean
+약효는 사람마다 다 달라요.,Korean
+"코너를 돌던 차가 제 골반을 들이받았어요.
+",Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+심각하게 피로감을 느끼시진 않나요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+내원하신 이유가 어떻게 되죠?,Korean
+"분유 토하다가 색이 점점 옅어졌어요.
+",Korean
+부작용을 일으키는 약 종류가 있으신가요?,Korean
+대변보는 주기가 어떻게 되나요?,Korean
+"��� 쉴 때마다 아파요. 허리가.
+",Korean
+호흡이 달린다는 느낌 없으셨어요?,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+통증의 패턴 같은 게 있었나요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+아프기 시작하면 얼마나 오래 아프신가요?,Korean
+면역력은 치료와 밀접한 관련이 있습니다.,Korean
+간염 때문에 병원 치료받고 계신가요?,Korean
+암을 진단 받으신 적 있나요?,Korean
+구토가 장폐색에 의한 경우라면 우려가 되나 그 외의 경우일 수도 있습니다. 검사 후 다시 말씀드리겠습니다.,Korean
+아뇨 평소에 음주를 하시는지 말씀해 주세요.,Korean
+근데 지금 아이가 너무 힘들어하는데 쉬다가 해도 될는지요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+실제로 토하신 적 없으세요?,Korean
+"공장에서 일을 하다가 허리를 좀 다쳤는데 나아지는 기미가 없어서 병원에 오게 됐어요.
+",Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+네 팔도 엑스레이 찍었고 결과 나오면 처치 진행하겠습니다.,Korean
+"식은땀 약간 하고 열은 삼십팔 도 정도 났어요.
+",Korean
+"가습기의 효과를 잘 모르겠어요.
+",Korean
+내원하셔서 담당 선생님께 정확한 진료를 받으셔야 합니다.,Korean
+가루 캡슐 형태 중 어떤 걸 더 선호하세요?,Korean
+인후통이 오면 어떻게 하세요?,Korean
+방광에 좋지 않으니 주의하셔야 합니다.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+소화불량 증상이 나타나진 않으신가요?,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+저희 집이 광주 근처라 그쪽에 병원 있을까요?,Korean
+주치의와 상담 받으시고 필요시 처방대로 복용하시면 됩니다.,Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+속이 토할 것 같고 그러진 않나요?,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+혈압약 따로 챙겨 먹는 게 없습니다만.,Korean
+엑스레이는 검사 안 받았어요.,Korean
+통원 치료하셔도 되지만 거리가 멀어서 오기 힘드시면 입원하시는 것이 편할 것입니다.,Korean
+네 과거 검사하실 때는 불편한 점 전혀 없으셨나요?,Korean
+"수술하고는 바로 물먹을 수 있나요?
+",Korean
+독감 예방 접종은 올해 하셨나요?,Korean
+복통으로 인해 동반되는 증상일 수도 있지만 자세히 검사 해봐야 알 수 있습니다.,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+자세한 통증 부위를 말씀해주시겠어요?,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+환자마다 다르지만 보통은 한 시간 안에 효과가 나타납니다.,Korean
+결핵 치료 시작한 지 얼마나 되었어요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+통증이 자주 생기는 편인가요?,Korean
+마취가 필요하면 알려 드리겠습니다.,Korean
+알레르기 유발 물질을 정확히 알고 넘어가야 해서요.,Korean
+"군 복무 중 작업 때 삽질을 하다가 어깨에서 톡 하는 소리가 나면서 어깨가 빠지는 것 같아서 왔습니다.
+",Korean
+부천성모병원에서 투석 받고 있어요.,Korean
+부종이 있는 곳이 있나요?,Korean
+식후에 속이 더부룩한 느낌이 잦나요?,Korean
+입원 치료한 적 있으신가요?,Korean
+"어제 고기 먹었고요. 지금도 여전히 아파요.
+",Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+결핵 백신 맞은 적이 있나요?,Korean
+몸에 바르고 있는 약이나 화장품이 있을까요?,Korean
+평소보다 통증이 더 강한가요?,Korean
+당뇨 있어서 식단도 관리 중이에요.,Korean
+언제 암 진단을 받으셨나요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+당신의 병력을 확인하기 위해서입니다.,Korean
+과거 암 진단받은 적 있나요?,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+"아 저 오른쪽 어깨가 움직일 때마다 통증이 있어서요.
+",Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+"열 시쯤 잠들어서 세시에 일어나요. 수면 패턴은  좀 일정한 편으로 변하지 않았습니다.
+",Korean
+숨을 내쉴 때 흉통이 있나요?,Korean
+방사선 치료 받으신 지 얼마나 되었나요?,Korean
+정확한 진단이 있어야 치료를 할 수 있습니다.,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+통증이 어느 부위에 있나요?,Korean
+최근��� 독감 예방 주사 접종하셨어요?,Korean
+통증을 처음 느낀 게 언제죠?,Korean
+호흡할 때 어려움이 있나요?,Korean
+하루에 담배를 얼마나 태우세요?,Korean
+"아파서 요즘 잠을 거의 못 자고 있습니다.
+",Korean
+"다른 게 아니라 저희 아기가 평균보다 좀 성장이 빠른 것 같아서 검사 좀 받으려고요.
+",Korean
+우선 현재는 항생제 치료를 하며 경과를 보는 것이 좋겠습니다.,Korean
+환부에 마취를 하고 진행하여 엄청난 통증이 있지는 않습니다.,Korean
+언제부터 피부 변화가 있으셨나요?,Korean
+소독을 해야 이차 감염을 막을 수 있습니다.,Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+일주일 평균 주량이 얼마나 되나요?,Korean
+가루약보다는 알약으로 드시는 게 더 효과가 좋습니다.,Korean
+흡연 시작한 지 얼마나 되었어요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+"온몸이 뜨겁고 토하고 설사를 자꾸 해요.
+",Korean
+갑자기 목소리가 쉬고 기침을 했었어요.,Korean
+"과일과 야채를 갈아서 과채 주스를 매일 아침 먹습니다.
+",Korean
+기침 증세가 악화하고 있나요?,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+마지막으로 수술한 게 언제인가요?,Korean
+고혈압약 평소에 드시고 있는 거 있으세요?,Korean
+가족 중에 고혈압 확진을 받은 분이 있나요?,Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+매우 드물지만 모체로부터 아기로의 수직 감염이 있었을 수도 있습니다.,Korean
+둘째까지는 자연분만했는데 셋째 낳을 때는 임신중독이 있어서 제왕절개 했어요.,Korean
+대변볼 때 피가 나오지는 않던가요?,Korean
+아마 공에 부딪히면서 왼쪽 늑골 갈비뼈라고 하죠. 골절이 있는 거 같아요. 정확한 건 엑스레이 검사를 해볼게요.,Korean
+혹시 무슨 약인지 확인할 수 있는 방법 없으실까요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+드시고 있는 약이 따로 있으신가요?,Korean
+거의 물 같은 변을 보셨나요?,Korean
+여드름 부위를 중심으로 전체 얼굴에 도포하세요.,Korean
+몇 시간에 한 번씩 통증이 오나요?,Korean
+환자분이 생각하기에 피부 버짐을 유발하는 요인이 뭐라고 생각하세요? 특정 지을 수 있을만한 것이 있나요?,Korean
+통증이 몇 분 정도 지속되죠?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+올해 독감 백신은 맞으셨을까요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+금식 후 시행한 혈액검사로 진단 내릴 수 있습니다.,Korean
+네. 전에 심장에 스텐스 시술받았어요.,Korean
+소변볼 때 통증이 있나요?,Korean
+정확한 원인을 찾기 위해 다른 검사를 진행할게요.,Korean
+통증은 얼마나 자주 발생해요?,Korean
+회복이 빠르면 이틀 만에 퇴원도 가능하세요.,Korean
+혈변 주기가 어떻게 되나요?,Korean
+효과는 사람마다 달라 명확히 말하기 어렵지만 완전히 없앴을 때 재발 가능성은 더 낮습니다.,Korean
+"네. 술 담배 모두 없어선 안 될걸요.
+",Korean
+"거즈로 상처 부위 소독하러요.
+",Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+배가 부르며 심한 경우 복통이 동반될 수도 있습니다.,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+"일하다가 전기에 감전 당했습니다.
+",Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+크게 어려운 것들은 없고 혈압 체크나 혈액 검사 수술 전 필요한 검사 몇 가지 하게 되실 거예요.,Korean
+당뇨 진단 후에 하시는 운동이 있으신가요?,Korean
+네. 여기 보시는 이 부분이 변이 차있는 부분입니다.,Korean
+가족 중에 당 수치가 높은 분이 있나요?,Korean
+오늘 중으로 약 이름 확인될까요?,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+피부 일부분을 자극하여 공격하는 성분이 포함되어 있습니다.,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+해당되지 않지만 어떤 비타민을 드시는지 말씀해 주세요.,Korean
+가슴 통증이 있으셨는지 알려주세요.,Korean
+묽은 변을 보시지는 않나요?,Korean
+"원래는 여드름이 잘 안 났었는데 갑자기 안 나던 여드름이 올라와서 왔습니다.
+",Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+거의 매일 설사를 하시나요?,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+몸에 열 기운이 느껴지세요?,Korean
+알레르기 진단받은 지는 얼마나 됐나요?,Korean
+입원했거나 입원 치료 경험이 전에 있으셨나요?,Korean
+수술 전에 장을 비워야 해서 관장시켜주는 약물을 항문을 통해 주입하고 십 분 정도 참으셨다가 화장실 가서 대변보시면 끝이에요.,Korean
+몸이 피로하다는 생각을 해보신 적 있나요?,Korean
+통증이 어느 정도 지속된다고 할 수 있나요?,Korean
+보호자분은 장갑 끼고 이쪽으로 오세요. 제가 관장액을 주입하면 삼십 분 동안 막아주셔야 합니다.,Korean
+환자분 스스로 침대 쪽으로 가실 수 있겠어요?,Korean
+당뇨 환자가 가족들 중에 더 있어요?,Korean
+기침할 때 피가 터져 나오나요?,Korean
+독감 백신 최근에 나온 것 접종하셨나요?,Korean
+지금 아픈 곳 말하세요.,Korean
+손 소독제 여분 더 받을 수 있어요?,Korean
+편도가 커서 그런가 계절마다 이래요.,Korean
+일단은 약물 치료를 하고 경과를 지켜보겠습니다.,Korean
+지금은 수술 순서를 바꾸기 어려워요.,Korean
+하루에 몇 개비 정도 태우세요?,Korean
+피가 섞인 소변이 나오나요?,Korean
+"열이 있어서 그런지 새벽에 자주 깨서 보챕니다.
+",Korean
+회복이 빠르면 이틀 만에 퇴원도 가능하세요.,Korean
+토를 심하게 한 적이 있나요?,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+지금 질환의 위험요인 중 하나가 기름진 음식입니다.,Korean
+알레르기로 먹으면 안 되는 약이 따로 있나요?,Korean
+다른 병원에서 진료받으려는 이유가 있을까요?,Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+"뭐든 들어가기만 해도 토하는 바람에 그냥 밥에다 국만 말아서 먹었어요.
+",Korean
+어젯밤 열두 시 이후로 금식하셨나요?,Korean
+약 가져오는 건 언제쯤 가능할까요?,Korean
+"식사하다가 갑자기 토를 하시고는 몸져누우셨어요.
+",Korean
+"고환이 많이 부어 내원했어요.
+",Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+네 힘드시겠지만 환자분의 치료를 위해 필요한 금식입니다.,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+수술의 종류는 여러 가지가 있는데 체외충격파 쇄석술을 할 수 있는 병원에선 시술이 가능합니다.,Korean
+선생님 오시면 약에 대해 설명해 드리겠습니다.,Korean
+이마가 뜨거운 것 같으세요?,Korean
+마지막으로 쟀을 땐 미열이라 약을 따로 먹이진 않았는데 지금 이제 먹으면 네 시간 간격은 지났어요.,Korean
+수술적 치료는 손목터널을 덮고 있는 인대를 잘라주는 방법이 있습니다.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+"감기처럼 기침 가래에 열도 나요.
+",Korean
+저번에 말씀드린 부위랑 같게 수술 진행할 겁니다.,Korean
+약효는 사람마다 다 달라요.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+타이레놀 종류 중 하나였어요.,Korean
+"네. 그래서 운동을 할 수가 없어요.
+",Korean
+몇 년 전에 결핵에 걸려서 입원한 적이 있었거든요.,Korean
+"변이 자주 묽게 나와요. 설사는 아닌 거 같은데요.
+",Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+하루에 몇 개비나 태우세요?,Korean
+이빨 씌운 건 있어도 발치는 없어요.,Korean
+알레르기가 날씨 영향을 받나요?,Korean
+암은 언제 완치 판정 받으셨나요?,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+조금 특이한 혈액형이긴 하지요.,Korean
+"혈변을 계속 보는데 어디가 문제인 건지 감이 안 오네요.
+",Korean
+음주를 하시는 빈도가 어떻게 되세요?,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+허리가 아프니까 다리까지 아프더라고요.,Korean
+통증 양상의 특징점이 있나요?,Korean
+"병원 오기 세 시간 전부터 계속 아프더라고요.
+",Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+이차 치료는 복용하는 약의 종류와 횟수가 일차 치료 보다 많아 힘들 수 있습니다.,Korean
+육 개월 전에 진단받았어요.,Korean
+유전성 질환 가족력 있나요?,Korean
+어떤 알레르기 가지고 계시나요?,Korean
+집보다는 요양원이 편하실 것 같아서요.,Korean
+"몸이 좀 안 좋은데 당뇨 때문인가 해서요.
+",Korean
+왜 소변검사만 하시려는 건가요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+하루 평균 얼마나 피우시나요?,Korean
+무거운 거를 들다 어깨가 아파 입원 치료했어요.,Korean
+몸 전체에서 피로감이 느껴지나���?,Korean
+결핵약 복용하신지는 얼마나 되었나요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+이전에도 똑같은 증상을 겪은 적이 있으신가요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+"끓던 냄비를 엎어서 팔에 쏟았어요.
+",Korean
+치아에 문제 있는지는 하나하나 또 볼게요.,Korean
+원래 아토피가 있어서 종종 약 먹긴 했는데 최근에 먹진 않았어요.,Korean
+"졸린데 잠은 안 와요.
+",Korean
+이외에 알레르기가 올라오는 것이 있나요?,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+폐렴은 폐 합병증 중 높은 확률로 나타납니다.,Korean
+소변을 볼 때 피가 얼마나 나오나요?,Korean
+아이가 바이러스나 세균감염에 걸리지 않으면 더 빨리 좋아질 수 있습니다.,Korean
+엑스레이 찍는 게 좋죠.,Korean
+오일이 많이 들어간 오메가쓰리 같은 것 먹으면 속이 더부룩하더라고요.,Korean
+혹시 결핵 백신 아직 안 맞으신 거 아니죠?,Korean
+다른 종양을 가진 가족들이 있나요?,Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+소변을 보고 닦을 때 피가 묻어 나오나요?,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+고혈압을 얼마나 오래 앓으셨나요?,Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+고통이 얼마나 오래 지속되나요?,Korean
+통증을 처음 느낀 게 언제인가요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+결핵 질환과 관련된 처방받은 약이 따로 있나요?,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+우리 몸을 보호해주는 피부에 상처가 난 것이기 때문에 상처로 외부의 균들이 침입하게 되면 감염될 수 있으니 주의해주세요.,Korean
+예전에도 배뇨곤란 증상이 있었나요?,Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+최근에는 더블유에이치오 기준에 맞춘 분유가 나오기 때문에 모유에 비해 나쁘다고 할 수 없어요.,Korean
+"무릎뼈랑 다리가 아파서 계단 오를 생각을 못 해요.
+",Korean
+"소화도 안 되고 입맛도 없으니까 뭘 먹는 게 너무 고역이야. 정말.
+",Korean
+가족 중에 암 판정을 받으셨던 분이 있나요?,Korean
+피가 섞인 변을 보시나요?,Korean
+최근에 어지럽거나 창백해지지 않았나요?,Korean
+일반적으로 적절한 치료를 할 경우 이전처럼 걸으실 수 있을 겁니다.,Korean
+면역력이 떨어져 생긴다고 할 수 있습니다.,Korean
+몸에서 에너지가 빠져나가는 느낌인가요?,Korean
+아이가 아프니 얼마나 힘드셨겠어요. 일주일 동안 잘 먹었나요? 토는 안 했고요?,Korean
+유산균을 먹고 있긴 한데 약에 포함되나요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+네. 간질이 있어서 병원에 입원한 적 많습니다.,Korean
+삼 일 뒤에 병원에 방문하실 거면 이 일치가 더 낫지요.,Korean
+많이 아프셨다니 정밀 검사를 해 봐야 정확히 알겠네요.,Korean
+과거에 크게 다친 곳이 있나요?,Korean
+언제부터 혈뇨 증상이 있으셨어요?,Korean
+결핵 진단을 받은 적 있으신가요?,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+계속 그런 증상이 있으시면 바로 말씀해 주세요.,Korean
+환자 번호는 조금 있다 알려 주시겠어요?,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+환자 혼자서는 이동이 불가한 거 맞죠?,Korean
+집에서 소독할 경우 감염의 위험성이 크니 권장하지 않습니다.,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+생활습관 식습관 등의 환경적 요인이 원인이 될 수 있습니다.,Korean
+처방받지 않는 약은 뭔가요?,Korean
+처방 받으신 연고를 잘 바르고 계시나요?,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+아니요 퇴원 수속 다 하신 후에 하셔야 해요.,Korean
+그렇습니다. 갑작스럽게 뿜어져 나오듯 나오는 구토입니다.,Korean
+만성폐쇄성 폐 질환이 있네요.,Korean
+어떤 약들과 같이 복용하시나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+"팔을 못 움직이니까 병원에 왔죠.
+",Korean
+"손톱에서 피가 나고 곧 빠질 것 같아요.
+",Korean
+혹시 지금 체온을 측정해볼 수 있나요?,Korean
+병동으로 올라오셔서 입원하실 때 이동 수단을 알려주시면 됩니다.,Korean
+작년 여름에 교통사고가 크게 나서 한 삼 개월 누워있었고. 다리 부러진 거 수술했었어요.,Korean
+"평일이어도 기본 여덟 시간은 자려고 하는 편이에요.
+",Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+호흡곤란이 온 적 있어요?,Korean
+가족분 중에 당��� 질환을 앓는 분이 또 계세요?,Korean
+만약에 붉은색보다 검은색으로 나온다면 대장이 아닌 위장의 문제일 수 있습니다.,Korean
+발기 부전으로 인해 고생하신 적 있으신가요?,Korean
+첫째는 자연분만으로 출생하셨고 둘째는 제왕절개로 낳으셨단 말씀이신가요?,Korean
+배가 좀 꾸르륵거리는 것 같아요.,Korean
+통증이 있다 없다 하나요?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+탯줄에서 대략 구십에서 백십 미리의 혈액을 채취합니다.,Korean
+처방받은 약 중에 당뇨약도 있나요?,Korean
+간염으로 언제 치료 받으셨나요?,Korean
+숨이 찬 증상은 없나요?,Korean
+속이 메슥거리고 체할 것 같나요?,Korean
+복부 통증을 동반한 설사를 하고 계신가요?,Korean
+암 진단을 최초 언제 받았나요?,Korean
+오래된 것은 기록이 없기도 해서 수술을 받으신 정확한 내역을 아는 것이 좋습니다.,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+오늘은 혈액만 뽑고 다음에 오시면 결과 알려 드릴게요.,Korean
+"무릎이 아파서 앉고 서고 힘들어요.
+",Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+"새벽에 깨서 분유 반병 먹였어요.
+",Korean
+음식을 보고 토한 적이 있나요?,Korean
+신장 기능에 문제가 생길 수 있어 주의가 필요합니다.,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+간염 치료 병력이 있나요?,Korean
+입원 날짜는 환자분 상태에 따라 길어질 수도 짧아질 수도 있습니다.,Korean
+잠을 쉬이 못 드나요?,Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+결핵 백신 예방 접종하셨나요?,Korean
+어떤 약을 복용하고 계신지 알려 주실 수 있으신가요?,Korean
+소변을 보고 닦으면 휴지에 피가 묻어 나오나요?,Korean
+독감 주사는 언제 맞았나요?,Korean
+간염 치료 기간 알 수 있을까요?,Korean
+수액이 지금보다 늦게 떨어지면 말씀해 주세요.,Korean
+아니요. 의료진들이 환자분에게 적합한 치료를 진행하고 있으니 걱정하지 않으셔도 됩니다.,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+대변볼 때 불편한 점이 있으신가요?,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+마취 가스가 잔류효과가 있어서요.,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+"벌에 쏘였는데 어지럽기도 하고 간지럽기도 해서요.
+",Korean
+병원에 자주 오셔야 돼서요.,Korean
+임플란트 치아에 불편함은 없으신 가요?,Korean
+가장 통증이 많이 느껴지는 곳이 어딘지 아세요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+하루에 몇 개비 피우시나요?,Korean
+네 감염력 확인으로 거짓 없이 답변주셔야 합니다.,Korean
+복용하는 약제에 의해서도 부을 수 있습니다.,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+담배는 몇 살부터 하셨나요?,Korean
+"네. 소화가 잘 안 되는지 속이 계속 울렁거리더라고요.
+",Korean
+간염이라고 언제 얘기 들으셨어요?,Korean
+우리 집이 좀 대대적으로 혈압이 높은 편이라서 저도 조심하고 있어요.,Korean
+알레르기가 있으셨으면 검사 한번 해보시겠어요?,Korean
+술을 얼마나 드시고 있으신가요?,Korean
+이비인후과에 진료를 받아보시는 것은 어떨까요?,Korean
+가슴이 평소보다 빨리 뛰는 것 같지 않고요?,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+암 있는 건 언제 아셨나요?,Korean
+혹시 지금 두통이 있으세요?,Korean
+소변이 잘 안 나왔던 적이 있나요?,Korean
+배뇨 장애가 있으신 거예요?,Korean
+"어깨에 외상도 좀 있는데 대충 집에서 치료했고 돌리는 게 아무래도 불편해요.
+",Korean
+아픈 게 심하게 느껴지나요?,Korean
+참고해야 할 병력이 있을까요?,Korean
+화장실을 가도 소변을 보지 못하나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+면역력이 높아야 감염도 쉽게 안 됩니다.,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+최근에 몸무게 변화가 있나요?,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+집 먼지 진드기는 사람의 피부 세포나 곰팡이 같은 유기물을 먹고 삽니다.,Korean
+육안으로 볼 땐 이상 없으시네요. 기존 피부질환이 있거나 이상 있으셨던 적은 없으셨나요?,Korean
+소화 기능이 안 좋으세요?,Korean
+소독을 해야 이차 감염을 막을 수 있습니다.,Korean
+네 금주 금연을 꼭 하셔야 합니다.,Korean
+매우 드물지만 모체로부터 아기로의 수직 감염이 있었을 수도 있습니다.,Korean
+유전적 질환이 남자 형제에게만 나타났나요?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+어쩔 수 없는 경우 손 소독과 마스크 착용이 필수입니다.,Korean
+육안으로 노랗게 보이며 소양감이 있을 수 있습니다.,Korean
+당뇨 가족력 여부 알고 계신가요?,Korean
+독감 예방 주사는 꾸준히 맞고 계세요?,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+숨쉬기 불편하거나 어려운 점이 있으신가요?,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+기침을 얼마나 많이 하시죠?,Korean
+먼지 알레르기가 있어서 환기를 중요시해요.,Korean
+관절의 이상이 있거나 다른 원인일 수도 있습니다.,Korean
+바셀린 거즈는 보습 효과가 있습니다.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+"네. 사실 그런 증상이 있는지 몰랐어요. 전혀 증상 없었어요.
+",Korean
+네 현재 검사상 투석이 꼭 필요한 상황으로 보입니다.,Korean
+네. 괜찮습니다. 보호자 동의가 없어도 되는 간단한 시술입니다.,Korean
+네 혈액형은 우측 하단에 작성하시면 돼요.,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+"수면 장애 때문에 뒤죽박죽이에요.
+",Korean
+고환이 복막을 통과할 때 생기는 통로가 막혀야 하는데 막히지 않아 이곳을 통해 탈장이 된 것 입니다.,Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+알레르기 반응을 일으키는 약은 없나요?,Korean
+환자분 흥분하지 마세요 치료를 잘하기 위한 겁니다.,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+통증이 멈춘 적은 아예 없나요?,Korean
+"네. 사실 몸에 그런 증상이 있는지 몰랐어요. 증상 없었어도 되는 거죠?
+",Korean
+고혈압약 드시는 것이 이것이 맞나요?,Korean
+특정 시기에 통증이 생기나요?,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+평소에 가스가 찬 느낌이 있나요?,Korean
+메스꺼움은 주로 식전에 나타나나요?,Korean
+다른 병원이라면 어느 과로 가면 될까요?,Korean
+"옆구리가 영 신통치 않아요.
+",Korean
+결핵 때문에 드시고 계시는 약이 있으신가요?,Korean
+삼 개월 전에는 통증이 왔나요?,Korean
+통증 부위가 머리 쪽 맞나요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+최근 술을 자주 드시나요?,Korean
+특정 공간이나 사물에 대한 공포감이 극도로 심한 편이에요.,Korean
+몸 전체에 힘이 없나요?,Korean
+다행이네요. 요즘은 식습관이 서구화돼서 대장 용종이 젊은 층에서도 많이 생겨요. 내시경 사진 보면서 설명해드릴게요.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+배에 가스만 차 있는 것이라면 안심하셔도 됩니다.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+위의 내용물이 식도로 역류되어 쓰린 느낌이 나타나기도 합니다.,Korean
+"최근에 어지럼증이 너무 심해져요.
+",Korean
+숨 쉴 때 얼마나 불편하세요?,Korean
+정밀 검사를 해봐야 알 수 있습니다.,Korean
+"대변볼 때 뭔가 다 쏟아내지 못하는 듯해요.
+",Korean
+수술 걱정 안 하셔도 돼요. 환자분 건강하세요.,Korean
+아픔이 몇 분 정도 가나요?,Korean
+"네. 이제는 담배 안 피우면 금단현상이 너무 심하게 와요.
+",Korean
+부종이 있는 곳이 있나요?,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+"실제로 여섯 시간은 자는데 자꾸 잠에서 깨요.
+",Korean
+소변검사는 이십사 시간 시행이 필요합니다.,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+언제부터 가려움이 느껴지셨는지 알려주세요.,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+알코올 도수가 높은 술을 드시나요?,Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+그럼 엑스레이 찍는 건가요?,Korean
+네 기침은 기관지 쪽이 자극을 받아서 나오는 것입니다.,Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+일 회에 오만 원이고 다른 치료도 추가되면 비용은 달라집니다.,Korean
+선홍색이면 정밀 검사를 해봐야 할 것 같습니다.,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+약이 처방한 다른 약과 충돌하는 건 아닌지 ���인하기 위해 약을 보여주셔야 합니다.,Korean
+속이 메슥거리고 체할 것 같나요?,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+"하루 종일 너무 아파해서 응급차 타고 왔어요.
+",Korean
+"복부에 통증이 있어서 왔어요.
+",Korean
+독감 접종 맞으신 거 맞죠?,Korean
+"요새 좀 찔끔찔끔 나오는 느낌이에요.
+",Korean
+며칠에 한 번 통증이 오나요?,Korean
+최대한 빠른 시일 내에 치료를 시작해야 합니다.,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+"군 복무 중 작업에서 삽질하다가 어깨에서 톡 하는 소리가 났고 그 후에 어깨가 계속 아파서 왔어요.
+",Korean
+지난번 환자분은 진단 결과상 입원 치료를 받으셔야 했습니다.,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+금식이 꼭 필요한 검사예요. 다음에 다시 예약하고 오셔야 해요.,Korean
+의식적으로 코만 이용해 숨을 쉬셔야 합니다.,Korean
+오늘 드실 약은 남겨 놓고 주세요.,Korean
+보름 전 비형간염 한차례가 전부인가요?,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+대변과 피가 섞여서 나오나요?,Korean
+후유증이 없을 순 없습니다.,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+대변을 규칙적으로 보지 않으시나요?,Korean
+원래 토혈 증상이 있으신가요?,Korean
+"일주일 전에 테니스를 치다 땅을 세게 짚었어요. 그때부터 팔이 좀 아프더라고요.
+",Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+진피 이하의 깊은 부위 손상으로 보입니다.,Korean
+지금 많이 호전된 상태니 그리 심각하진 않습니다.,Korean
+통증이 생긴 지 오래되셨어요?,Korean
+염증 수치가 다소 높게 나왔습니다.,Korean
+수술은 최대한 안 했으면 좋겠는데 어쨌든 감사합니다. 선생님!,Korean
+네. 사십 세 이후 육안적 혈뇨의 경우 요로계 암에 의한 혈뇨 가능성이 있으므로 반드시 검사가 필요합니다.,Korean
+과음도 건강에 좋지 않아요.,Korean
+이마가 뜨거운 것 같으세요?,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+불면증으로 언제부터 잠을 못 잤나요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+이 년전에 허리 수술하고 나서 이 주정도 입원했었어요.,Korean
+"대변 안 눈 것 빼고는 괜찮아요.
+",Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+항상 발기부전이 있으신 건가요?,Korean
+복부 팽만감이 들지는 않으세요?,Korean
+하루에 담배는 몇 갑 피우시죠?,Korean
+알겠습니다. 수술하시거나 입원하신 경험은 없으신가요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+아니요. 소변검사를 시행할 수도 있습니다.,Korean
+결핵과 관련된 약물 드시는 것 있나요?,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+담배를 하루에 얼마나 피는지 말씀해주세요.,Korean
+집안에 고혈압인 분 있나요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+심장 뛰는 게 불편한가요?,Korean
+알레르기 반응이 심하게 나타난적이 있나요?,Korean
+소변에 피가 섞여 있지는 않은가요?,Korean
+요즘 먹고 있는 약이 있나요?,Korean
+격리는 안 하고 마스크만 잘 쓰면 되나요?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+네. 당뇨가 있어서 단 음식은 잘 먹지 않아요.,Korean
+진료받게 되신 이유가 있으신가요?,Korean
+우선은 혈액검사를 진행해서 갑상선 호르몬과 갑상선 자극 호르몬 수치 등을 확인해 보는 것이 좋겠습니다.,Korean
+두드러기나 수포가 올라오진 않으셨나요?,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+"얼마 전에 고혈압 진단받았는데 이젠 귀까지 아파서요.
+",Korean
+당뇨약을 아직 안 드시고 계세요?,Korean
+불편하시다면 병실 이동도 가능하십니다.,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+일단 진료 대기자들이 있어서 그분들부터 진료해야 합니다.,Korean
+이전검사에서 문제가 없었다고 무조건 아무 이상이 없다고는 할 수 없지만 너무 걱정 마시고 저희가 말씀드리는 대로 따라와 주시면 됩니다.,Korean
+"배에 전체적으로 통증이 있어요.
+",Korean
+변에서 피를 보신 적이 있나요?,Korean
+정확한 진단이 있어야 치료를 할 수 있습니다.,Korean
+일상생활이 불편할 정도로 기침을 하시나요?,Korean
+당뇨 증상이 나타난 지 얼마나 됐나요?,Korean
+무릎 쪽에 통증이 있나요?,Korean
+아팠다 말았다 하나요? 아니면 계속 아픈가요?,Korean
+최인하 선생님이 담당 의사입니다.,Korean
+밴드는 검사 부위에 피가 계속 나면  붙여 드릴게요.,Korean
+"서서히 살이 빠지고 예전보다 식사량도 줄었다고 하셨어요.
+",Korean
+네 진통제 때문에 그런 현상이 올 수 있어요.,Korean
+그 몸살 때문에 무슨 주사 놔주시긴 했는데 그거 말곤 없어요.,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+암을 진단받은 가족이 있습니까?,Korean
+아니요 화상은 기형에 포함되지 않습니다.,Korean
+예전에 병원에서 처방받아서 약병에 담긴 거라 이름이 안 적혀 있어요.,Korean
+"일주일 전에 테니스를 치다 땅을 세게 짚었어요. 그때부터 팔이 좀 아프더라고요.
+",Korean
+항생제 양은 정해져 있기 때문에 더 드릴 수 없습니다.,Korean
+소변이 계속 조금씩 나오나요?,Korean
+뱃살을 빼려면 유산소운동을 하셔야 합니다.,Korean
+계절에 대한 알레르기가 있으신가요?,Korean
+가려움이 더 심해졌다거나 한 부위만 유독 가려운 느낌은 없었나요?,Korean
+"오른팔이 어깨 위로 잘 안 올라가요.
+",Korean
+경구 당 부하 검사에서 두 시간 후 측정한 혈당 수치가 이백 밀리그램 퍼 데시리터 미만인 경우입니다.,Korean
+독감 같은 경우에는 매년 겨울 전에 맞는데 혹시 접종한 적 있으신가요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+고혈압으로 처음 병원을 방문한 날짜는 언제인가요?,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+약은 아침에 드셔야 됩니다.,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+관련이 있다고 뚜렷히 말씀드리기는 어렵지만 의료기록에 적어두고 참고하겠습니다.,Korean
+항문 통증이 있다면 경과가 양호할 수 있으나 항문 열상과 같은 문제가 없는지 확인하는 것이 중요합니다.,Korean
+복통이 한 번 오면 얼마나 지속되나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+먼저 침상에 누워 안정을 취하시고 두 번째로 금식을 유지하시고 세 번째로 혈액검사 소변량 검사하시면서 수액치료를 받으시면 됩니다.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+소독은 동네 병원에서 하셔도 돼요.,Korean
+요즘 소변볼 때 어려운 점이 없으세요?,Korean
+지금 혹시 변비가 있나요?,Korean
+가래가 많이 나오는 건가요?,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+태위가 자연분만을 하기 어려우시겠군요.,Korean
+언제 통증이 처음 나타나셨어요?,Korean
+일단 초기 치료 반응을 보고 결정하게 됩니다.,Korean
+따로 알레르기가 있는 음식이 있나요?,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+혈변을 언제부터 보신 거 같으세요?,Korean
+환자분 같은 경우는 개수가 많아요. 만성으로 진행된 형태라서 치료가 쉽지는 않습니다.,Korean
+성생활에 어려운 점이 있으세요?,Korean
+코르티코스테로이드란 약물에 알레르기가 심하게 일어나요.,Korean
+생활용품 중에 사용하다 알레르기가 올라왔던 물건이 있었나요?,Korean
+네 저희가 수면 다원 검사 외 필요시 추가 검사를 진행 하겠습니다.,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+주사를 맞아야 치료가 가능한데 저번에 어떤 부작용이 있으셨죠?,Korean
+가슴 통증이 주로 어느 시간에 있나요?,Korean
+흡연 기간은 어떻게 되나요?,Korean
+그런 약은 어디에도 없습니다.,Korean
+"혈뇨량이 점점 많아지는 것 같아요.
+",Korean
+"네. 선생님! 아기가 음낭이 커 보이고 색깔도 검푸른 색을 띄어서요. 원래 안 그랬던 것 같은데 얼마 전부터 갑자기 그러네요.
+",Korean
+알레르기가 있다는 것을 언제 알았나요?,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+두통이 가장 심할 때가 언제인가요?,Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+결핵으로 병원 치료받고 계신가요?,Korean
+어느 부위가 아파서 오셨나요?,Korean
+몸에 붓기는 잘 안 빠지나요?,Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+복부 팽만감이 있던 적 있나요?,Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+가족 중에 암 확진을 받��� 분이 있나요?,Korean
+수술한 후에 후유증이 있나요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+"알코올 중독 때문에 술에 내성이 생기고 금단 증상을 보이는 듯해서 찾아와 봤습니다.
+",Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+배가 불러 불편하지는 않으세요?,Korean
+올해 독감 예방 접종은 완료하셨나요?,Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+병원비 청구를 위해 필요합니다.,Korean
+묽은 변을 자주 보신다는 건가요?,Korean
+정확히 어떤 음식이나 약에 두드러기가 나는 거죠?,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+정확히 어떤 원인으로 바이러스성 설사가 발생했는지는 알기 어려울 수 있습니다.,Korean
+약을 한꺼번에 복용하지 마세요.,Korean
+알레르기 반응이 시작된 지 오래됐나요?,Korean
+움직이라고 시키지 않으면 미동도 없나요?,Korean
+지금 아픈 게 느껴지실까요?,Korean
+더운 날 회를 드시는 것은 권유 드리지 않습니다.,Korean
+목이 건조하면 통증이 더 심해집니다.,Korean
+주로 어디가 가장 아프세요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+담배는 대략 피우신 지 얼마나 되셨어요?,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+무엇 때문에 병원에 왔나요?,Korean
+언제부터 그런 증상이 있었지요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+아무래도 피부질환이 심한 분들은 호흡곤란도 올 수 있어요.,Korean
+"소변이 원치 않을 때도 찔끔 나와서 당황스러워요.
+",Korean
+네. 작년 겨울에 스키장에서 다쳐서 입원했었어요.,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+부작용 중증도에 따라서 의사 선생님이 판단하실 거예요.,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+결핵 치료제로 겪고 있는 부작용이 있으신가요?,Korean
+"유치원에서 놀다가 볼펜 뚜껑을 삼켜버렸어요.
+",Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+"네. 흉통이 생길 정도로 기침이 너무 심해서 왔어요.
+",Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+통증이 어디서 느껴지시는 건가요?,Korean
+하루 동안 담배를 얼마나 피우시나요?,Korean
+욕창이 생기지 않도록 체위 변경 잘 해주시면 더 빨리 나으실 거예요.,Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+통증을 점수로 표현하면 십점 만점에 어느정도 인가요?,Korean
+지금까지 토한 적이 있나요?,Korean
+근전도 검사를 통해 신경 손상 정도를 평가해보고 말씀드리겠습니다.,Korean
+피부가 간지럽다거나 두드러기 같은 게 올라오거나 붓지는 않았는가요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+검사를 통해 알레르기의 원인이 되는 것과 환자분의 상태를 확인하고 그에 따른 치료를 계획하실 겁니다.,Korean
+평소에도 두드러기가 자주 나는 편이었나요?,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+"배달 알바하다가 사고가 났는데 그 이후로 다리고 계속 아프고 붓기도 안 빠지네요.
+",Korean
+삼월에 코로나 걸려서 입원 치료받았었어요.,Korean
+소변과 함께 피가 나오나요?,Korean
+통증이 발생하는 양상을 여쭤볼게요.,Korean
+마지막 호흡곤란이 온 게 언제였죠?,Korean
+전에 암을 앓은 적이 있나요?,Korean
+공복 혈당이 백 이상인가요?,Korean
+암 치료하려고 병원에 입원한 적 있나요?,Korean
+통증이 처음 시작된 건 언제죠?,Korean
+생리통 말고 다른 질병은 없으신가요?,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+"담배는 한 개비 피웠는데요.
+",Korean
+소변을 볼 때 어떻게 힘드신지 설명해주세요.,Korean
+방귀와 변이 나온다면 일단 증상 조절을 하며 경과 관찰해 볼 수 있을 것 같습니다.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+잠을 자도 피곤함이 계속 느껴지는 것처럼 불면증이 있으신가요?,Korean
+단순 변비 일 수 있지만 우선 신생아에서 구조적인 문제가 아니면 변비는 잘 없다고 이야기는 드렸었어요.,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+심장이 유전적으로 조금 약해요.,Korean
+아 맞다 환자분 오늘 오후에 백내장 수술 예정이죠?,Korean
+"폐에 문제가 있다고 큰 병원에서 검사해보라고 하네요.
+",Korean
+뼈나 근육 그리고 피부 등의 모든 구조를 지칭합니다.,Korean
+골고루 드셔야 건강에 도움이 됩니다.,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+입원하신 경험이 있다면 알려주세요.,Korean
+이부프로펜 들은 거라고 설명해 주셨던 기억이 나네요.,Korean
+알레르기 치료는 얼마 동안 받으셨어요?,Korean
+"아이 성기 부분이 빨갛고 부어 있어요.
+",Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+혈변을 보는 빈도를 알 수 있을까요?,Korean
+세균 감염은 제가 어떻게 조심하면 괜찮았을까요?,Korean
+결핵약 매일 복용하고 있나요?,Korean
+맥박이 빨리 뛰는 걸 언제 느꼈나요?,Korean
+"벌에 쏘인 곳에 빨갛게 피부가 올라왔어요.
+",Korean
+결핵약은 주기적으로 복용 중이신가요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+수면 검사로 인한 부작용이나 중요한 문제가 있을 수 있습니다.,Korean
+지금 발기 부전으로 문제가 있나요?,Korean
+특별히 복용하면 안 되는 약이 있으실까요?,Korean
+꽃가루로 인한 계절성 알레르기를 앓은 적이 있나요?,Korean
+주사 부위가 뻐근할 수 있는데 더 심해지거나 감각 이상이 생기면 말씀해 주세요.,Korean
+면역치료 외에도 여러 치료법이 있습니다.,Korean
+병원 규정은 환자 확인 시 이름 주민등록상 생년월일 환자 번호를 확인하고 있습니다.,Korean
+통증 강도를 어느 정도로 느끼세요?,Korean
+네. 응급실도 여러 번 갔다 왔어요.,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+걱정이 되신다면 시티 촬영해 보세요.,Korean
+숨이 찬 증상이 나타납니까?,Korean
+"막상 용변 볼 땐 괜찮은데 변의 상태는 이상한 것 같아요.
+",Korean
+호흡 곤란 증상이 있으신 거죠?,Korean
+평상시보다 체온이 높다고 느끼나요?,Korean
+언제 첫 증상이 나왔나요?,Korean
+"담배는 하루 한 갑 정도 피우고 술은 일주일에 두세 병씩 마셔요.
+",Korean
+대변을 보고 싶으시다면 혼자 가셔도 괜찮습니다.,Korean
+유전성 질환에 가족력이 없다고 말씀하셨죠?,Korean
+발기 부전으로 어려움이 있나요?,Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+과거에는 엑스레이를 찍었으나 씨티가 더 정확한 검사입니다.,Korean
+통증은 얼마나 자주 발생해요?,Korean
+씨티 촬영 때문에 조영제를 맞은 적이 있는데 어지럽고 구토 반응이 일어난 적이 있었어요.,Korean
+여기가 괴롭다 싶은 부위가 있으세요?,Korean
+네. 편도선염이 심해져 두통까지 오는 바람에 엄청 고생했어요.,Korean
+매번 소변이 빨갛게 나오시나요?,Korean
+귀 뒤에 통증이 있나요?,Korean
+예를 들면 뭐가 특이 혈액형이에요?,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+수술한 후에 후유증이 있나요?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+알레르기 치료 받으신 지는 얼마나 되셨나요?,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+"이젠 좀 괜찮아졌어요. 어제는 아파서 아무것도 못 먹었어요.
+",Korean
+씨티는 아프지 않고 요로조영술시 조영제 주입 시 약간 뻐근하실 수 있습니다,Korean
+피부과 치료 때문에 피지 조절약 먹고 있어요.,Korean
+비슷한 증상을 형이 가지고 있어요.,Korean
+"통증이 시작된 후부터예요. 한 삼 개월 전부터요.
+",Korean
+실제 잔뇨는 없고 감각이상에 의한 잔뇨감인 경우 과민성 방광으로 약물치료를 기본으로 합니다. 방광 훈련 골반근육 운동 등을 병행하면 더욱 치료 효과를 높일 수 있습니다.,Korean
+중요한 건 치료이니 잘 따라만 주시면 괜찮을 겁니다.,Korean
+이전에는 그런 증상이 없으셨나요?,Korean
+꼭 일일구를 불러 응급실로 내원할 필요는 없는 거죠?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+이런 증상은 굉장히 흔합니다.,Korean
+가족력이 있으면 암 걸릴 확률이 높은 가요?,Korean
+네 다칠 때 충격이 가해져서 그런 것 같네요.,Korean
+소화제가 거의 떨어졌어요. 소화제도 넉넉히 처방해주세요.,Korean
+담배 언제 처음 피웠어요?,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+"목이 계속 불편한데 아무래도 뼈 같아요.
+",Korean
+가래가 얼마나 자주 나오세요?,Korean
+유전성 질환을 앓고 계신 가족분이 계신가요?,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+알레르기를 처음 발견한 건 언제인가요?,Korean
+야간 근무자분들은 수면 장애를 비롯해서 다양한 질환에 걸릴 위험이 높아요.,Korean
+보통 위식도역류질환에서 그런 증상이 있을 수 있습니다.,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+지속적으로 압력이 가해져서 피부와 그 밑에 있는 조직에 손상이 생기면 피부가 벗겨지거나 궤양이 생길 수 있고 심하면 뼈까지 노출될 수 있습니다.,Korean
+꼬리뼈 부위에 욕창이 생겼습니다.,Korean
+치과에서 받은 진통제가 영 나랑 안 맞는 것 같던데. 뭔 지는 몰라.,Korean
+토에 피가 많이 보였나요?,Korean
+담배 시작한 지 얼마나 됐나요?,Korean
+알레르기를 일으키는 원인 음식이나 약 말고 뭐 있으세요?,Korean
+잘 보셨습니다. 위의 변성 소견으로 정상에 비해 위암 발생 위험성이 높지만 당장 위암이 발생하는 것은 아닙니다.,Korean
+헛구역질도 포함됩니다. 그 외 다른 증상은 없으셨나요?,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+습진도 치료를 받아야 합니다.,Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+암 치료는 언제부터 받으셨나요?,Korean
+토에 피가 많이 보였나요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+하루에 한 갑 이상 피우나요?,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+가능한 안 닿는 것이 상처의 회복에 더 낫습니다.,Korean
+"네. 꿈 한번 안 꾸고 잠은 잘 자는 편이에요.
+",Korean
+"네. 부작용이 심해서 안 먹습니다.
+",Korean
+소변을 누실 때 통증이 있다거나 그런 일은 없으신지요?,Korean
+혹시 전신 무력감이 있나요?,Korean
+초기에는 눈의 흰자 부분에서 잘 관찰됩니다.,Korean
+최근에 귀에 상처가 나서 항생제만 복용 중이에요.,Korean
+이전에도 같은 질환으로 입원하셨던 적 있으셨나요?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+어디가 가장 아픈 곳이에요?,Korean
+부작용 얘기 듣고 무서워서 한 번도 안 해봤어요.,Korean
+결핵으로 약물치료 받으신 지 얼마나 됐나요?,Korean
+최근에 예방 접종은 따로 받으셨어요?,Korean
+"뺑소니를 당해서 팔이 너무 아파요.
+",Korean
+아침에 이비인후과 갔다가 왔어요.,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+통증이 있는 부위가 있으세요?,Korean
+교정기 한 지 얼마 안 돼서 그때 한 개 발치했어요.,Korean
+청진을 위해서 심호흡 지금 시작해 주시고 계속 유지해 주시면 됩니다.,Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+체온이 떨어진 것 같나요?,Korean
+"변비약 더 먹어도 문제가 안 될까요?
+",Korean
+오염된 환경에서 채취한 해산물을 먹었을 경우 심하면 목숨을 잃을 수도 있습니다.,Korean
+항생제 주사 맞으신 거죠?,Korean
+네 약 복용만 잘 한다면 치료할 수 있습니다.,Korean
+"우유를 마시면 배탈이 나서 자주 먹진 않습니다.
+",Korean
+소변볼 때마다 피가 나오나요?,Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+통증 유무 확인 부탁드려요.,Korean
+이전 수술 이력에 대한 말 좀 해주세요.,Korean
+아이 아빠가 주로 병원에 있을 거라서요. 주 보호자는 아이 아빠로 하는 게 좋겠어요.,Korean
+결핵 주사 맞아본 경험 있으세요?,Korean
+과거에 병원에 입원했던 기록이 남아있어요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+결핵을 앓기 시작한 지 얼마나 되셨죠?,Korean
+가스 차는 원인은 다양하고 일시적인 경우가 많아 지금부터 너무 걱정하실 필요는 없습니다.,Korean
+"평소처럼 자다가 중간에 깨는 정도?
+",Korean
+입원 치료한 적 있으신가요?,Korean
+호흡할 때 더 힘들거나 그러진 않으세요?,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+병원비 수납에 대한 문의는 수납처에 하시기를 바랍니다.,Korean
+흡연 기간이 얼마나 돼시죠?,Korean
+친구 동네에 있는 건국대학교병원에 갔어요.,Korean
+환자분은 급성 맹장염으로 진단되어 응급수술 예정이십니다.,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+당뇨 질환으로 드시는 약이 있으면 알려주세요.,Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+"목에 담이 온 것 같아요.
+",Korean
+육안으로 전혀 부은 게 보이지 않습니다.,Korean
+네 복부에 압력이 가해지므로 안 좋습니다.,Korean
+혈압이 정상치보다 높아진 게 언제라고요?,Korean
+"영화 보느라 화장실을 ���래 참았더니 아파요.
+",Korean
+복부가 많이 무겁게 느껴지나요?,Korean
+"""네. 무슨 마취를 하셨는지, 어느 정도 못 깨어나셨는지 여쭤보시고 알려주세요.""",Korean
+네 뜸이나 부항 뜨신 적 있으신가요?,Korean
+담낭입니다 담낭 내 결석 제거 예정입니다.,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+무지외반증 같은데 정형외과에서 치료하는 질환이니 더 늦기 전에 병원 가셔서 치료나 필요하면 수술도 하셔야 해요.,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+어머니가 고혈압을 앓고 계십니다.,Korean
+생리통 약 빼고는 없습니다.,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+혹시 다른 알레르기가 있는지 알 수 있을까요?,Korean
+최근 몇 달 동안 체중 변화는 없었나요?,Korean
+"허리 디스크가 있어서 수술해야 한다고 하셔서요.
+",Korean
+복부 내 염증이 있는 경우 그러실 수 있습니다.,Korean
+불면증 때문에 어떤 약 복용하세요?,Korean
+혈변에 피가 많이 보였나요?,Korean
+잘 안 나올 때는 우선 모유와 분유를 혼합한 혼합수유를 권해드립니다.,Korean
+간염 처방 약 알 수 있나요?,Korean
+독감 접종의 경우 알레르기 반응이 심해서 알레르기 반응이 있으시면 접종을 권장 드리진 않습니다.,Korean
+고혈압 약 먹는 거 있으세요?,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+흡연이나 음주나 일상적으로 접하는 것이라 익숙하지만 건강에 큰 영향을 끼치죠.,Korean
+예 혹시 근육통일 수도 있어서 잠시 대기해 주세요.,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+피를 토 한 적 있으세요?,Korean
+종양 앓았던 가족이 있으셨나요?,Korean
+최근에 체중은 어떻게 변화하셨을까요?,Korean
+밤에 두세 시간 밖에 못 자는 이유는 뭐 때문인가요?,Korean
+입원하는 게 치료에는 더 낫습니다.,Korean
+입원 기간이 어떻게 되시죠?,Korean
+"항문에 병이 들어간 이후로 몸이 이상해서 와봤습니다.
+",Korean
+소화가 안 되어서 속이 불편해요?,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+드시면 알레르기 생기는 약이 있을까요?,Korean
+쓰러지시는 증상은 검사 결과 처음이 아니신 걸로 보여서요.,Korean
+팔에 좀 심하게 부어오르고 가려웠던 적 있어요.,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+통증은 얼마나 자주 생기세요?,Korean
+가래가 얼마나 많이 나오나요?,Korean
+평소에 변은 잘 보세요?,Korean
+허리디스크 수술한 적 있긴 해요.,Korean
+심각성과 급성기임이 꼭 일치하지는 않으며 급성기는 지금 치료가 필요한 단계입니다.,Korean
+숨을 헐떡일 때가 있나요?,Korean
+"설사를 자꾸 하고 배도 계속 아파요.
+",Korean
+목에 가래가 끼신 거 같나요?,Korean
+저릿저릿한가요? 아니면 날카롭게 쑤시나요? 아니면 묵직하고 둔한 느낌인가요?,Korean
+위 상피세포가 장 상피세포로 변화한 것이며 전암성 병변이므로 꾸준한 관리가 필요합니다.,Korean
+숨이 찬 증상은 없나요?,Korean
+"갑자기 손이 가려우면서 수포가 생겼는데 어제부터 빨갛게 붓기 시작했어요.
+",Korean
+"다행히 머리는 피했는데 어깨에 맞았어요.
+",Korean
+향정신성 의약품은 취급이 제한됩니다.,Korean
+"목 안쪽은 그렇게 아프진 않아요.
+",Korean
+얼마에 한 번씩 아픈가요?,Korean
+어제 기침이 많이 심하셨다고 들었는데 지금은 좀 어떠신가요?,Korean
+토할 거 같은 증상이 있으세요?,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+네. 부모님 쪽에서 폐가 좋지 않다고 조심해야 한다고 했어요.,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+팔에 좀 심하게 부어오르고 가려웠던 적 있어요.,Korean
+앓고 있는 병 있나요?,Korean
+결핵 때문에 병원 간 적 있으세요?,Korean
+잠 잘 때 자주 깨시나요?,Korean
+"어머니께서 다리에 통증을 호소하셔서요.
+",Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+매일 혈압을 재고 있나요?,Korean
+피부 건조는 자주 오는 증상 중에 하나입니다.,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+통증에 반응 좀 보여 주시겠어요?,Korean
+언제부터 알레르기 있다는 거를 아셨어요?,Korean
+그 증상 말곤 없나요?,Korean
+"귀 표피 부분이 전체적으로 간지럽고 수포 증상이 있어요.
+",Korean
+증상 판별과 검사를 통해 알 수 있습니다.,Korean
+"소변 눌 때 아파해요.
+",Korean
+"상처 났던 데가 아프고 진물이 나와요.
+",Korean
+설사는 하루에 몇 번 하시나요?,Korean
+오한이 있어서 춥고 떨리나요?,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+대충 한 달 이내에 드신 약 기억나는 게 있으신가요?,Korean
+네. 좀 센 약물에 알러지 있어요.,Korean
+사람의 각질 있는 곳에 진드기가 나타납니다.,Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+먼저 입원을 위해 간단한 진찰을 진행하도록 하겠습니다.,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+적은 수면 시간이 지속되더라도 환자 분의 생활에 크게 문제가 없다면 너무 걱정하지 않으셔도 됩니다.,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+드시는 간염약 약품명 아시나요?,Korean
+의사 처방 없이 드시는 건 위험합니다.,Korean
+진료 후 처방전이 나갈 예정입니다.,Korean
+"네. 한 달 전보다 오 킬로나 빠졌어요.
+",Korean
+"발톱이 곧게 자라지 않고 살을 파고들어서 아파서 찾아왔어요.
+",Korean
+"얼굴 빨갛게 뜬 거랑 눈 아픈 것 때문에 왔어요.
+",Korean
+평소에 손목 운동하는 게 도움이 될 것 같네요.,Korean
+간염으로 인해 병원에 방문한 적이 있나요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+생명 연장을 위한 치료는 거부하고 싶어요.,Korean
+병원에 오신 과정을 확인하려고 합니다.,Korean
+네 일반적인 해열제 종류가 여러 개여서 구체적으로 알려 주셔야 합니다.,Korean
+복용 시 알레르기 반응 나타나는 약 있어요?,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+"어깨를 언제 다쳤나 봐요.
+",Korean
+혈압 높다는 얘기 들어보신 적 있을까요?,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+소독 부위는 절대 만지면 안 됩니다.,Korean
+"가스 불에 손이 닿으면서 팔에 화상 입었어요.
+",Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+바셀린 거즈를 사용할 필요는 없습니다.,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+병원에서 언제부터 암을 치료 중인가요?,Korean
+속이 메슥거릴 때가 많나요?,Korean
+일일구 타고 병원 와서 이동 침대로 옮겨서 들어왔어요.,Korean
+며칠에 한 번 통증이 오나요?,Korean
+"입원 좀 하려 해요.
+",Korean
+독감 주사 맞은 지 얼마나 됐죠?,Korean
+"의자에 십 분만 앉아 있어도 엉덩이 위 허리 통증이 심해집니다.
+",Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+여드름약 먹는데 가져올 걸 그랬나요?,Korean
+어떤 주사인지 알 수 있나요?,Korean
+환자분 흥분하지 마세요 치료를 잘하기 위한 겁니다.,Korean
+암을 진단 받으신 적 있나요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+감염이나 뇌척수액 누수 등의 문제가 발생할 수 있으나 빈도는 매우 낮은 것으로 알려져 있습니다.,Korean
+음식을 삼키기 어렵거나 토할 거 같은 느낌 구토 소화장애와 같은 증상이 있나요?,Korean
+"쓰러지기 한 몇 분 전에 토할 것 같긴 했는데 토는 안 했어요.
+",Korean
+얼마나 자주 구토를 하시나요?,Korean
+"안녕하세요 선생님. 우리 아이가 소아 탈장 증상을 보입니다. 한번 봐주시겠어요 고환이 하나 더 생긴 것 같아요.
+",Korean
+네. 저 작년에 위암 있었어요.,Korean
+평소보다 요즘이 더 피로하신 것 같나요?,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+통증 정도를 평균 내기 어려우시면 표현 가능한 방식으로 말씀해 주시면 됩니다.,Korean
+부모님께서는 아직도 치료 중이신가요?,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+잠을 잘 자지 못하시나요?,Korean
+"엄청 노란 소변이 나오곤 하는데 이것도 무슨 병입니까?
+",Korean
+어떤 식품 때문에 알레르기가 나나요?,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+통증이 언제부터 시작되었는지 알려주세요.,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+피를 토할 때 위도 아픈가요?,Korean
+혹시 안 먹거나 탈수 증상이 있으면 병원에 방문해 주세요.,Korean
+야간근무자들은 대부분 수면 문제를 호소하는 경우가 많습니다.,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+소화가 안 된 건가요?,Korean
+가족 중 당뇨는 환자 본인 만이세요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+그 증상은 정밀하게 진단을 해보고 결정할게요.,Korean
+대변이 잘 안 나오나요?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+해외는 다녀온 적 없는데 이 병원 오기 전에 다른 병원에서 진료를 받았어요.,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+"업무 상 수면 패턴이 불규칙할 수밖에 없어요.
+",Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+체온이 몇 도인지 아세요?,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+가스가 장 안에서 차는 것이기 때문에 다른 장기를 누르는 경우는 드뭅니다.,Korean
+통증은 얼마나 자주 생기세요?,Korean
+배뇨 시 통증이 있고 피가 나오나요?,Korean
+몸에 갑자기 열이 나나요?,Korean
+되도록 빨리 다시 진찰해 주세요.,Korean
+네. 혹시 특이 혈액형에 포함되시나요?,Korean
+수액으로 보충이 되므로 걱정 안 하셔도 됩니다.,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+처음 간염 왔던 게 언제예요?,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+"아기가 침대에서 머리부터 떨어졌어요.
+",Korean
+"네. 저는 담배 못 끊을 것 같아요.
+",Korean
+일단은 치료 들어가면 답변해 드릴게요. 상태가 너무 안 좋아요.,Korean
+약 처방은 안 해주세요?,Korean
+변이 묽게 나오는 정도인가요?,Korean
+예 혹시 근육통일 수도 있어서 잠시 대기해주세요.,Korean
+항생제 주사 맞으신 거죠?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+먹는 즉시 바로 구토를 하시나요?,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+네 건강 체크에 중요합니다.,Korean
+검사 결과가 나와봐야 알 수 있습니다.,Korean
+빈뇨 문제는 언제부터 있었죠?,Korean
+과로로 인한 증상은 서서히 나타납니다.,Korean
+삼십육 점 사 도 정상이시네요. 여기 체크리스트 서랍장에 붙여둘께요. 퇴원할 때까지 매일 보호자분도 체온 체크할게요.,Korean
+악화되면 진행속도가 빨라질 수도 있습니다.,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+현기증이 나면 몸 중심을 잡을 수 있나요?,Korean
+정확한 원인이나 유발인자는 밝혀지고 있지 않지만 특정한 원인을 통해 손목에 터널이 좁아지면서 신경이 압박되어 발생합니다.,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+괜찮아요. 주사 끝나면 없어지는 느낌이에요.,Korean
+결핵약 드시면서 치료하고 계시죠?,Korean
+요즘에 소변에 피가 섞여 있진 않으셨어요?,Korean
+얼마나 아프신지 표현해주실 수 있을까요?,Korean
+알레르기 때문에 절대 피해야 하는 약 있으세요?,Korean
+고혈압으로 신경 쓰고 계신가요?,Korean
+사랑니 발치는 수술이 아닙니다.,Korean
+재작년 초에 쌍둥이 출산했습니다.,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+재발 가능성은 있으나 치료 후 박멸이 확인된 이후의 재발률은 낮습니다.,Korean
+검사 결과는 일 이 주 정도 소요됩니다.,Korean
+환자분 병동 안내 들으시겠어요? 아니면 넘어가시겠어요?,Korean
+"전자 담배로 바꿔 피운 기간 포함하면 일 년 될 거 같아요.
+",Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+머리가 깨질 듯이 아픈가요?,Korean
+병명과 함께 모든 입원경험 말씀해 주세요.,Korean
+단기로 작용하는 수면약을 사용하긴 하지만 어지러우실 수 있으니 보호자 꼭 동반하셔서 댁에 가셔야 합니다.,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+"""열을 떨어뜨리는 게 우선이고 시원한 상태를 유지한다고 해서 감기에 걸리지는 않을 겁니다,""",Korean
+갖고 계신 약 있나요?,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+발기 부전으로 심리적 신체적 변화가 있었나요?,Korean
+"구토는 몇 번 했었어요.
+",Korean
+마취약 말고는 꾸준히 복용하시는 약물은 없으신가요?,Korean
+입원 환자 관리를 위한 사항입니다. 그 이외 흉터가 있는지 확인 협조 부탁드립니다.,Korean
+첫 돌이 될 때까지는 기다려보는 것이 좋고 만약 그 이후에도 음낭수종이 지속되는 경우에는 수술적 교정이 필요합니다.,Korean
+작년에 어떤 예방 접종을 맞으셨나요?,Korean
+네. 수분 부족 현상이에요.,Korean
+가족 중 암 질환이 있는 사람이 있나요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+사고가 나셔서 구급차 타고 병원으로 오게 되셨어요.,Korean
+간염 증상이 오래전부터 있었나요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+저는 영양 상담 필요 없을 것 같은데 꼭 받아야 돼요?,Korean
+"여기 드레싱 해 주세요.
+",Korean
+"삼일 전부터 열이 났는데 해열제를 먹여도 내렸다 올랐다 해서요.
+",Korean
+우선 충수돌기염 치료를 위해 항생제를 사용해야겠습니다.,Korean
+가족 중에 고혈압 판정받은 분 있나요?,Korean
+며칠 주기로 통증이 왔다가 사라지나요?,Korean
+혹시 해당 부위를 긁었던 적이 있나요?,Korean
+알레르기 검사 받으신적 있나요?,Korean
+토할 때 피까지 나온 적 있어요?,Korean
+부종이 있는 곳 좀 보여주실래요?,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+담배를 많이 피우기 시작한 게 언제부터인가요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+네. 소독도 자주 해줘야 하고 아이 상태를 확인하기 위해서는 입원 치료하는 게 좋아요.,Korean
+독감 백신을 맞은 적이 있으신가요?,Korean
+활동을 하지 않아도 숨차는 증상이 있나요?,Korean
+그 정도의 화상으로 보입니다.,Korean
+보통 현기증을 자주 느끼나요?,Korean
+정확한 입원비는 원무과에 문의해보시면 됩니다. 원무과는 일 층에 있습니다.,Korean
+알레르기 반응을 보였던 대상이 있다면 말해주세요.,Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+여기 말고 다른 부위 치료받은 적은 없으세요?,Korean
+그럼요. 검사를 받을 수 있습니다.,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+"당최 목구멍으로 음식이 넘어가지 않아요.
+",Korean
+다른 치료하신 것도 있으신가요?,Korean
+입원 또는 수술 경험이 있나요?,Korean
+아픈 게 사라지지 않나요?,Korean
+통증이 계속해서 아픈가요 드문드문 아픈가요?,Korean
+"뭘 안 드셔서 살이 빠졌죠.
+",Korean
+지루성 피부염이 다른 데로 퍼진 걸로 보여요.,Korean
+흉터가 조금 생길 수도 있어요.,Korean
+드시는 약물이나 앓고 계신 지병이 있으신가요?,Korean
+무엇 때문에 병원을 찾으셨을까요?,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+"소변이 잘 안 나와서 쥐어짜듯 힘을 줘야 나와요.
+",Korean
+고혈압약 당뇨약 먹고 있어요.,Korean
+영양 불균형이 신체 증상으로 나타나고 있네요.,Korean
+수면제를 복용해도 잘 못 자나요?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+"헛구역질이 너무 심해서 왔어요.
+",Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+팔의 마비증상은 오십견일 수 있습니다만 다른 신경학적 원인에 대한 검사도 필요합니다.,Korean
+최근에 식욕 변화가 있으신가요?,Korean
+타 병원에서 분만하였을 시 저희 쪽에서 기록을 조회할 수 없습니다.,Korean
+소변을 보고 싶을 때 자주 참나요?,Korean
+혹시 수술 혹은 입원 치료 경험 있으세요?,Korean
+아니요. 그냥 동네 소아과 가서 진료만 받아봤지. 입원이나 수술은 한 번도 해본 적 없어요.,Korean
+설사를 며칠 동안 하셨나요?,Korean
+"네. 아파서 화장실을 거의 참다시피 했죠.
+",Korean
+밴드는 검사 부위에 피가 계속 나면  붙여 드릴게요.,Korean
+꾸준한 물리치료로 손목 통증을 줄일 수 있습니다.,Korean
+무릎 쪽에 통증이 있나요?,Korean
+"대변에 피가 묻어 있더라고요.
+",Korean
+과거 수술 이력이 있는지 알려주세요.,Korean
+다른 병원 입원 포함 모든 입원경험을 알려주세요.,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+복부 팽만감이 언제부터 있으셨나요?,Korean
+환자분은 오늘 발열이 있으셔서 내원하셨는데 이 부분을 보시면 발열 환자 주의사항이 있습니다.,Korean
+약국 가서 엄마가 제 증상 말하고 얻어온 약 먹었는데 뭔지는 모르겠어요.,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+다른 아픈 곳은 없으신가요?,Korean
+현기증이 나면 그대로 앉아 계시나요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+구강 엑스레이를 찍어보면 정확히 알 수 ���어요.,Korean
+약물 관련 쇼크는 없으셨나요?,Korean
+상해로 입원하신 적이 있나요?,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+네. 수면 지속 시간을 증가시켜 줍니다.,Korean
+소변이 붉은 것은 소변에 혈액이 섞여 나오는 혈뇨를 의심할 수 있습니다.,Korean
+붓고 빠지는 주기가 있나요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+현재까지 간염치료를 받은 지는 얼마나 되었나요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+잠을 충분히 못 주무시나요?,Korean
+통증 양상을 알 수 있을까요?,Korean
+낫는 게 최우선이니까 최대한 효과적인 치료만 신경 써주시면 됩니다.,Korean
+엑스레이 찍는 게 좋죠.,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+가끔 발생하기 때문에 치료 초반에는 주의하셔야 합니다.,Korean
+지금 바로 치료 받으시겠어요?,Korean
+"소화도 안 되고 입맛도 없으니까 뭘 먹는 게 너무 고역이야. 정말.
+",Korean
+그래도 발열과 관련해서 검사를 진행하시는 걸 권유드립니다.,Korean
+"아니요. 요새는 세 시간도 제대로 못 자요.
+",Korean
+어떨 때 호흡곤란 증상이 있나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+"이쪽 귀 청력이 안 좋아지면서 이명도 생겼어요.
+",Korean
+토에 혈액이 섞여 나왔나요?,Korean
+힘을 줘도 대변이 잘 안 나오시나요?,Korean
+오한 증상이 있다고 생각하나요?,Korean
+당뇨약 먹고도 효과가 없거나 하지는 않나요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+진통제만 먹으면 온몸이 퉁퉁 붓더라고요.,Korean
+속이 좋지 않은 증상은 있으셨어요?,Korean
+통원치료를 꼭 하셔야 한다면 어쩔 수 없지만 댁에서 계속 소독하고 붕대 자주 갈아주셔야 합니다.,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+통증은 움직일 때마다 오나요?,Korean
+지금 암 관련 약 드시고 계세요?,Korean
+숨쉬기 불편하거나 어려운 점이 있으신가요?,Korean
+토마토 같은 경우는 갈아 드셔도 영양소가 거의 파괴되지 않지만 사과 같은 경우는 파괴되어서 이 부분 고려해서 말씀해 주세요.,Korean
+잠깐 쉬었다가 해도 될까요? 숨을 못 쉬겠어요.,Korean
+네 최근에 다른 병원에서 예방 접종하신 건 없나요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+습진도 치료를 받아야 합니다.,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+항상 가려우신가요? 아니면 건조하다든가 하는 특정 상황에서만 가려우신가요?,Korean
+"어깨를 쓰지 못할 만큼 너무 아픈 데 밤에는 쑤셔서 잘 수 없어요.
+",Korean
+과거에 수술하거나 마취한 경험이 있나요?,Korean
+네. 골절상 때문에 잠깐 입원한 적 있어요.,Korean
+흡연 기간은 어느 정도이신가요?,Korean
+언제 독감 예방 접종 받으셨어요?,Korean
+"계속 열이 나고 몸이 아프다 그래서요.
+",Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+부작용 중증도에 따라서 의사 선생님이 판단하실 거예요.,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+그럼 전에 검사하셨을 때 문제 없으셨던 건가요?,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+현기증은 어떤 상황에 나타났었나요?,Korean
+"아니요. 요새는 세 시간도 제대로 못 자요.
+",Korean
+통증 있는 부위를 말해 보세요.,Korean
+제대혈은 산모의 선택 사항입니다.,Korean
+"잘 안 들리고 귀에서 소리가 나요.
+",Korean
+아프기 시작한 게 일주일 정도 됐나요?,Korean
+수혈을 해봤다는 게 받아봤냐는 말씀이신가요?,Korean
+현기증이 나면 어떻게 대처하시죠?,Korean
+상해로 인하여 입원하여 수술하신 적이 있나요?,Korean
+매일매일 와서 상처 확인하시면 됩니다.,Korean
+삼도 화상으로 흉터가 생길 가능성이 매우 높습니다.,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+간염과 관련된 약을 처방받은 적 있으세요?,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+네 당뇨식이어도 잘 나옵니다.,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+"고환이 많이 부어서 왔어요.
+",Korean
+통증이 나타난 곳이 어디신가요?,Korean
+항생제 치료를 받으면 일주일이면 많이 좋아지십니다.,Korean
+기침 소리가 어떻게 나오나요?,Korean
+물에 많이 닿았다면 드레싱 다시 해야 합니다.,Korean
+네 그걸 확인하려고 검사한 거고요 부작용이 있었으면 몸에 나타날 거예요.,Korean
+예전부터 소화 불량이 있었나요?,Korean
+결핵약 드신 지는 얼마나 되셨어요?,Korean
+치료가 늦어질 시 합병증으로 인해 향후 삶의 질에 영향을 미치게 됩니다.,Korean
+전신에 무기력한 느낌이 있으세요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+얼마나 아픈지를 말해 줄 수 있으십니까?,Korean
+허리에 디스크가 있어서 시술받았어요.,Korean
+반드시 의사 처방을 받고 드셔야 해요.,Korean
+네 옆 병실에도 환자들이 있습니다.,Korean
+피가 섞인 변을 보시나요?,Korean
+약으로 간염을 치료 중이세요?,Korean
+특정 음식에 알레르기가 있습니까?,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+당뇨 약 먹고 계세요?,Korean
+혈뇨를 볼 때 통증이 있나요?,Korean
+가족 중에 누가 당뇨 있으시죠?,Korean
+"좁은 공간에 있으면 숨쉬기가 어려워요.
+",Korean
+"네. 일부러 챙겨 먹어요. 뼈 튼튼해지라고.
+",Korean
+소화가 안 된 건가요?,Korean
+"둘 다 하지 않지만 남편이 담배를 피워서 간접흡연에 노출되어 있습니다.
+",Korean
+현기증 느낀 적 있나요?,Korean
+알레르기 반응이 나타난 건 못 봤던 것 같아요.,Korean
+암을 치료받은 적이 있나요?,Korean
+어디가 불편하셔서 진료를 받으셨나요?,Korean
+알코올성 간 질환으로 한동안 입원했었어요.,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+일단 말씀해 주시죠. 약품명이요.,Korean
+일주일 동안 매일 술을 먹나요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+퇴원하기 전까지 그럼 약 못 먹어요?,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+두드러기가 난다면 알레르기인 것 같습니다.,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+"아기가 아픈지 하루 종일 우네요.
+",Korean
+용종제거술로 인한 통증 보다는 대장 내시경 후 가스로 인한 통증이 있을 것 입니다.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+머리 아픔이 어느 정도인가요?,Korean
+"소변 색은 잘 살펴보지 않았어요. 죄송해요.
+",Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+네 증상이 재발하지 않는 한 지금은 이 검사로 충분합니다.,Korean
+담배 하루에 얼마나 태우세요?,Korean
+어떤 운동이 도움이 될까요?,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+그냥 집에 소화제라고 적어 두고 먹어서 잘 모르겠어요.,Korean
+당뇨가 심하신데 약을 안 드신 진 일주일 정도 됐어요.,Korean
+병원에 처음 내원하셨을 때입니다.,Korean
+두통이 있는지 말씀해 주세요.,Korean
+메슥거림은 없고 어지럽기만 하셨나요?,Korean
+환절기에 특히 피부 가려움이 심하신가요? 완화시켜 줄 수 있는 약을 처방해 드릴 수 있습니다.,Korean
+복부가 부은 느낌이 있나요?,Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+일주일에 술을 얼마나 많이 드세요?,Korean
+"수면 패턴은 이상 없어요.
+",Korean
+금주를 하셨어도 음주 습관을 알면 치료에 도움이 됩니다.,Korean
+아직까지 먹은 것 중엔 알레르기 없었어요.,Korean
+상처가 큰 부위에 항생제 효능을 주기 위해 테라마이신 연고를 바르는 겁니다.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+발기 부전 증상이 있으세요?,Korean
+"얼굴 피부가 우툴두툴하고 간지러워요.
+",Korean
+처방받아 드시는 약을 얘기해 주세요.,Korean
+"변이 냄새가 심하고 색이 이상해요.
+",Korean
+사시면서 병원에 입원한 모든 내용 알려주세요.,Korean
+빈혈이 평소에 있기는 한데 어지러워요.,Korean
+"귓구멍이 너무 가렵고 진물이 나는 듯한 느낌이 들어가지고 방문하게 되었어요.
+",Korean
+천식 때문에 입원한 적 있었어요.,Korean
+위암 발생 위험성이 증가할 수 있기 때문에 추가적인 변성 소견을 확인하기 위해 일 년 간격으로 위 내시경 검사가 필요합니다.,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+"우리 애가 자전거 타다가 넘어져서요.
+",Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+네. 현재 환자분의 질환은 결핵을 앓은 적이 있는 경우에 발생할 확률이 높습니다.,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+호르몬 요인일 가능성이 높아요.,Korean
+네 대부분의 환자분들이 같은 증상을 호소하십니다.,Korean
+네. 검사 예약해 드리겠습니다.,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+흉부에서 올라오는 통증이 있나요?,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+"저 술 매일 마시는 편입니다.
+",Korean
+생활용품 중에 사용하다 알레르기가 올라왔던 물건이 있었나요?,Korean
+당뇨약 어떤 건지 기억하세요?,Korean
+배뇨 장애가 있으신 거예요?,Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+소변에 섞여 나오는 피의 양은 얼마나 되는 거 같으세요?,Korean
+통증 지속력이 어느 정도인가요?,Korean
+지금 아토피 치료받고 있어요.,Korean
+과거 혹은 지금 간염이 있으신지요?,Korean
+통증 주기가 몇 주인가요?,Korean
+"변에 하얀 게 군데군데 포함되었던 것 같아요.
+",Korean
+혈액 내 지방 성분이 증가했습니다.,Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+예방적 항생제 투여와 매일 드레싱 교환 등이 필요하셔서 입원을 권장드립니다.,Korean
+대변이 잘 나오지 않아 힘드셨나요?,Korean
+아니요 검사실에서 피 뽑으실 겁니다.,Korean
+"귀 뒤가 짓무르고 아파요.
+",Korean
+빈혈 진단을 받긴 했는데 무리하게 움직이지만 않으면 일상생활은 문제없을 거라서요.,Korean
+아프기 시작하면 보통 통증이 얼마나 가나요?,Korean
+위험지역 방문 시에 헌혈이 제한될 수도 있습니다.,Korean
+가급적 빨리 내원하시길 당부드립니다.,Korean
+호흡할 때 어려움이 있나요?,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+삼 개월 이전 내용 포함하여 살면서 입원하신 경험이 있으시면 모두 말씀해 주세요.,Korean
+수술 부위에서 진물이 나고 고름이 생기는데요.,Korean
+변비 약 어떤 걸 드셨나요?,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+통증 주기가 몇 주인가요?,Korean
+가슴 통증으로 잠에서 깬 적도 있나요?,Korean
+진통소염제 정확한 이름은 모르겠고 아무튼 진통제요.,Korean
+최근 열이 많이 오르진 않았나요?,Korean
+등이 가렵거나 따가우신 건가요?,Korean
+이전검사에서 문제가 없었다고 무조건 아무 이상이 없다고는 할 수 없지만 너무 걱정 마시고 저희가 말씀드리는 대로 따라와 주시면 됩니다.,Korean
+어느 부분이 붓기가 있나요?,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+간염 여부 알려 주세요.,Korean
+"다리가 자주 붓고 저려요.
+",Korean
+최근 구토한 적 있으세요?,Korean
+예방 접종에 따라 향후 일정이 변경될 수 있어서요.,Korean
+상한 음식을 드신적이 있으신가요?,Korean
+"다이어트를 시작한 이후로 변비에 걸렸어요.
+",Korean
+소변에 피가 섞여 나오나요?,Korean
+태어나고 몇 개월 동안 예방 접종하신 게 다일까요?,Korean
+반드시 의사 처방을 받고 드셔야 해요.,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+식사 후에 소화는 잘되시나요?,Korean
+네. 지금 처방받은 약은 꼭 식후에 드셔야 합니다.,Korean
+변이 묽게 나오는 정도인가요?,Korean
+알러지라는 게 여러 군데서 반응할 수 있나 봐요?,Korean
+갑상선 약 매일 먹고 있어요.,Korean
+"죽 몇 숟가락 먹고 토했습니다.
+",Korean
+자세한 건 검사 결과를 봐야 알 수 있습니다.,Korean
+동의서 내용을 설명해 드리겠습니다. 충분히 이해하신다면 동의서에 서명해 주시면 됩니다.,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+두통이 있는지 말씀해 주세요.,Korean
+갑자기 체중변화가 있지는 않았나요?,Korean
+병원 입원하려고 하는데 여기 병원에서 입원해도 되나요?,Korean
+치료할 범위가 따로 정해져 있기보다는 전신적 치료를 시행해야 할 가능성이 높습니다.,Korean
+제일 처음 통증을 느꼈던 게 언제인가요?,Korean
+결핵 치료를 위해 약물 처방을 받으셨나요?,Korean
+복부 팽만감이 자주 생기나요?,Korean
+라식도 하고 디스크 수술도 했습니다.,Korean
+뭘 먹으면 속이 더부룩하신가요?,Korean
+하루에 담배 몇 대나 피우세요?,Korean
+필수는 아니지만 약물에도 알레르기가 있을 수 있어서 검사하는 걸 권장하고 있습니다.,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+검사 부위에 피가 나더라도 심하지 않을 테니 꼭 밴드를 붙이실 필요는 없습니다.,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+통증은 움직일 때마다 오나요?,Korean
+자주 재발하는 분들은 면역치료를 하시는 것이 장기적으로 도움이 많이 됩니다.,Korean
+치료 기간은 얼마나 되었나요?,Korean
+질병에 따라서 달라집니다. 보통 활동성인 경우 전염력이 있어요.,Korean
+네. 지금 당뇨 때문에 계속 약을 먹고 있어요.,Korean
+통증이 어느 정도 심해요?,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+성형외과는 무슨 일로 가셨나요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+소화불량 때문에 오신 건가요?,Korean
+사고로 수술 받은 적 있나요?,Korean
+소변에 피가 묻어 나오진 않나요?,Korean
+배가 부르며 심한 경우 복통이 동반될 수도 있습니다.,Korean
+아니요 지금 상태에서는 담배를 피우면 안 됩니다.,Korean
+통증 양상의 특징점이 있나요?,Korean
+삼십팔도 넘어가면 해열제 드리겠습니다.,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+알레르기를 일으키는 음식이 있습니까?,Korean
+사고를 당한 것이 언제셨죠?,Korean
+정해진 프로토콜에 따라 의료진이 환자분을 치료할 겁니다.,Korean
+비급여면 비싸긴 하지만 꼭 필요한 경우가 있으니 동의해 주셔야 합니다.,Korean
+아닙니다. 약에 의한 효과를 제거하기 위해 추적 검사는 치료 종료 사 주 후에 시행합니다.,Korean
+네 콧줄 때문에 점막이 자극이 되어 그럴 수 있습니다.,Korean
+확률은 낮지만 위선암 림프종과의 연관성이 있습니다.,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+격리가 필요한 대상인지 확인해야 합니다.,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+"일주일에 대변을 본 횟수요? 삼사일은 될 거예요.
+",Korean
+가래 상태가 많이 심한가요?,Korean
+몸에 힘이 안 들어 가요?,Korean
+암 증상이 어떤 것이 있었나요?,Korean
+몸이 부을 때가 있나요?,Korean
+메슥거림은 없고 어지럽기만 하셨나요?,Korean
+"재채기를 너무 많이 해요.
+",Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+이번 해에 인플루엔자 백신 주사를 맞으셨나요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+그럼 건강 검진 예약해 드릴게요.,Korean
+고유량의 산소를 투여하면 괜찮아질 겁니다.,Korean
+하루에 피우는 담배 양은요?,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+반려견이 주사 맞는 게 아닌가요?,Korean
+구토 증상이 얼마나 자주 있나요?,Korean
+애완견과 관련된 접종은 어느 것이든 말씀해 주시면 됩니다.,Korean
+이전 검사에서 대장은 특이사항이 없었습니다. 원하는 병변을 관찰하기에는 직장 내시경으로도 충분할 것 같고 환자분께도 수월할 것으로 판단되어 처방하였습니다.,Korean
+독감 풍진 예방 접종처럼 병원에서 주사 맞으신 거 있으실까요?,Korean
+소화가 잘 안 되는 느낌이 드나요?,Korean
+기침할 때 피가 터져 나오나요?,Korean
+변비약도 유형에 따라 달라서 다른 약을 섭취해 보시겠어요?,Korean
+"이 일 전부터 목이 부은 것 같기도 하고 불편해서 자꾸 기침하게 되더라고요.
+",Korean
+배에 가스가 차서 힘드신가요?,Korean
+술과 담배는 안 하시는 게 도움이 되실 거고 스트레스받지 않는 게 중요합니다. 혹시 술 담배 하시나요?,Korean
+어제 기침이 많이 심하셨다고 들었는데 지금은 좀 어떠신가요?,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+특정 마취 약물에 대해 부작용이 있으시면 약물을 변경하려고 합니다.,Korean
+"제가 코를 많이 골아서 코 심하게 골 때는 놀라서 일어나곤 해요.
+",Korean
+발생하더라도 치료할 수 있으니 너무 염려하지 않으셔도 됩니다.,Korean
+용량은 늘려드릴 수 있습니다.,Korean
+통증 시작 후 어느 정도 아프신가요?,Korean
+간염으로 드시는 약 있으세요?,Korean
+가족 중 유전성 질환을 진단받거나 치료 중인 분 있나요?,Korean
+통증을 유발하는 염증물질을 줄이는 치료입니다.,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+어머니 모시고 정형외과 간 적이 있습니다.,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+원래 좀 기침이 자주 있으신가요?,Korean
+부작용을 일으키는 약 종류가 있으신가요?,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+"식도에 정맥류가 어쩌고 했던 것 같습니다.
+",Korean
+발기부전약 드시고 계신 거에요?,Korean
+눈앞이 캄캄해서 쓰러질 거 같은가요?,Korean
+네 발열 및 두통이나 근육통 모두 알레르기 이상 반응이에요.,Korean
+외래 진료 후 병동 입원하셨을 때 이동 수단에 대해 말씀해 주시면 됩니다.,Korean
+처음 느낀 통증은 언제였나요?,Korean
+일단 반복적으로 손목을 움직이는 것은 피하셔야 합니다.,Korean
+통증 느껴지는 곳 짚어보세요.,Korean
+배에 가스만 차 있는 것이라면 안심하셔도 됩니다.,Korean
+입을 벌릴 때 통증이 있나요?,Korean
+지방종 제거 수술한 적 있어요.,Korean
+어디가 부은 느낌이 있으세요?,Korean
+타인의 피로 혈액 보충해보신 적이 있나요?,Korean
+여기서는 외래진료 예약이 어렵습니다.,Korean
+원래 앓고 계시던 병변이신가요?,Korean
+최고로 아플 때의 점수는 어떻게 되나요?,Korean
+진통제가 많이 들어가면 구토 증상이 나타납니다.,Korean
+증상을 느끼기 시작한 건 언제부터였나요?,Korean
+결핵인지 언제 알게 되셨나요?,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+흡연하신 지 얼마나 되셨나요?,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+통증이 어디서 느껴지는지 알려주세요.,Korean
+아니요 통증 부위를 말씀드리는 거예요.,Korean
+구체적인 치료 방안은 담당 선생님과 상의하신 후에 결정하시면 됩니다.,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+이상한 것이 보이거나 하는 증상이 있습니까?,Korean
+"다른 의사 선생님이 꼭 와보라고 해서 왔습니다.
+",Korean
+네. 약 처방할 때 도움이 될 것 같아요.,Korean
+"네. 아픈 건 없는 것 같아요.
+",Korean
+질병으로 약을 드시고 계시나요?,Korean
+우울증 치료를 육 개월째 받고 있습니다.,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+목 안에서 통증이 느껴지나요?,Korean
+"소변을 보고 난 후에도 소변이 새어 나옵니다.
+",Korean
+공복 혈당이 백 이상인가요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+"대소변 보는 게 어렵냐는 말씀이세요?
+",Korean
+아픈 게 심하게 느껴지나요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+전에 해산물을 드시고 이상 반응 있었나요?,Korean
+부기는 잘 빠지고 있네요.,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+네. 낮에는 괜찮은데 밤에 유난히 아프더라고요.,Korean
+갑상선 기능 항진증 진단받았어요.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+일 회 평균 음주량이 어떻게 됩니까?,Korean
+환자분 건강에 개별적 상대적으로 다른 영향을 주는 요소입니다. 좋다 나쁘다라고 표현할 수 없어요.,Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+보통 당뇨 잴 때 높게 나오지는 않으세요?,Korean
+특정 마취 약물에 대해 부작용이 있으시면 약물을 변경하려고 합니다.,Korean
+통증의 정도는 크지 않겠지만 아이에 따라서 통증을 심하게 느낄 수 있습니다.,Korean
+소변에 피가 묻어 나온 적이 있나요?,Korean
+몸이 떨리고 추위를 느꼈나요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+유전성 질환을 가진 가족분 계세요?,Korean
+"걷기 힘들 만큼 다리 힘이 없네요.
+",Korean
+잘 못 주무시는 이유를 알아야 환자분께 필요한 약을 알 수 있습니다.,Korean
+당뇨는 언제부터 알게 되셨어요?,Korean
+"""설사를 유발하는 특정 음식이나, 환경 요인이 있나요?""",Korean
+평소 식습관이 건강하지 못하거나 먹는 것에 비해 운동이 불충분 한 경우 대개 높게 나옵니다.,Korean
+올해는 예방 접종한 것 자체가 없어요.,Korean
+토할 것 같은 느낌이 오나요?,Korean
+혹시 못 먹는 약 있으면 알려주세요.,Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+"안녕하세요 선생님 다름이 아니라 저희 애가 삼 일 전부터 밥을 먹고 나면 다 토를 하더라고요.
+",Korean
+소화가 안 되면서 동반되는 다른 증상이 있나요?,Korean
+환자분 복용 중이신 약물에 대해 저희가 알고 있어야 해서요.,Korean
+몸에 갑자기 열이 나나요?,Korean
+"술 담배 전부 스무 살 넘어서 시작했어요.
+",Korean
+통증이 오면 얼마나 계속되나요?,Korean
+몸살이 있었다면 예방접종 후 면역력이 떨어져서 더 안 좋을 수도 있습니다.,Korean
+항생제를 맞아야 하는데 부작용이 있으면 안 돼서요.,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+갖고 계신 약 있나요?,Korean
+담당의사와 상의 후 다시 준비를 하겠습니다.,Korean
+대변 잘 못 보세요?,Korean
+피가 입쪽으로 얼마나 올라오나요?,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+약 외에는 따로 드시는 건 없으신가요?,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+물에 많이 닿았다면 드레싱 다시 해야 합니다.,Korean
+여기서 처방받았던 약 말고 다른 약은 드시는 거 없으신가요?,Korean
+속이 많이 울렁거려서 토하고 싶으신가요?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+알레르기를 처음 발견한 것은 언제인가요?,Korean
+알레르기 때문에 못 먹는 음식 있나요?,Korean
+암 검사를 주기적으로 받고 있나요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+드시면 안 되는 음식이 있으신가요?,Korean
+"팔 수술 부위가 잘못된 것 같아요. 너무 아프고 붓고 붉게 올라와서요.
+",Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+몸에 열 기운이 느껴지세요?,Korean
+흡연한 기간을 말씀해 주실래요?,Korean
+네. 알레르기 증세 중 하나입니다.,Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+변을 다 누고서도 피가 안 멈추나요?,Korean
+"배가 너무 아파서 생활이 안 돼요.
+",Korean
+오이 먹으면 두드러기가 올라와요.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+가족 구성원 중 당뇨 치료 중이신 분 있으세요?,Korean
+아침과 저녁을 비교해서 가슴에 통증이 더 자주 나타나는 시간이 언제예요?,Korean
+물론입니다. 내성이 생길 수 있어요. 수면 유도제 복용을 줄여 보도록 하죠.,Korean
+바이러스성 장염은 전염성이 있어 대변의 접촉으로 전염이 되는 경우도 있습니다.,Korean
+"다리가 저리고 왼쪽 다리에 힘이 안 들어가서 절뚝거립니다.
+",Korean
+평소에 복용하는 약이 있나요?,Korean
+결핵 치료되는 약 뭐 드세요?,Korean
+음식을 먹으면 토를 하나요?,Korean
+당뇨와 관련된 가족력은 없나요?,Korean
+통증을 진정시키기 위해서 하는 목적이니 걱정하지 않으셔도 됩니다.,Korean
+손가락만이라도 움직인다면 회복 가능성이 있습니다.,Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+환자분은 지금 면역력이 너무 낮기 때문에 면역력을 높여 바이러스 저항력을 높여줘야 증상이 악화되지 않을 수 있어요.,Korean
+유전성 질환으로 돌아가신 가족분이 계신가요?,Korean
+환자 개인에 맞춰서 치료하는 방법이 다르니까요.,Korean
+최소한 두 시간마다 자세를 바꾸어 주셔야만 합니다.,Korean
+전신에 무기력함이 언제부터 시작했어요?,Korean
+네. 그럼 담에 오자마자 검사부터 받고 기다리면 되는 거죠?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+음식 알레르기 진단을 받은 적이 있나요?,Korean
+네 나가서 앉아계시면 간호사가 예약을 잡아드릴 겁니다.,Korean
+변비 증상이 처음이신 건가요?,Korean
+네 찢어져서 출혈이 있어요.,Korean
+아침마다 스테로이드 먹고 있어요.,Korean
+"요즘처럼 날이 추워지면 왼쪽 팔이 살짝 시리면서 감각이 없어지는 느낌이 들어요.
+",Korean
+장기 기증 홈페이지를 이용하셔도 되고 어플을 이용하셔도 됩니다.,Korean
+어떤 증상인지 확인하고 연고나 약 처방해드릴게요.,Korean
+몸에 열감이 평소보다 심하신 거죠?,Korean
+건강 검진 받은지 오래됐으면 한 번 받아보는 것도 좋겠네요.,Korean
+항히스타민제는 두드러기 발적 소양감 등의 알레르기성 반응에 관여하는 히스타민의 작용을 억제하는 약물입니다.,Korean
+"제 항문에 문제가 생긴 거 같아요. 한번 진찰해 주세요.
+",Korean
+신 과일을 먹으면 입안이 아려와서 안 먹어요.,Korean
+계속 밤에 잠에 들지 못하나요?,Korean
+피부 밑에까지 침범했으므로 전신마취로 진행합니다.,Korean
+지금보다 많이 아파서 참지 못하겠다 싶을 때 얘기해 주시면 됩니다.,Korean
+네. 아침에도 관장약 먹고 화장실 갔다가 왔어요.,Korean
+소변볼 때 통증이 있나요?,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+요즘 당뇨를 치료 중인가요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+네. 복잡하거나 오래 걸리는 시술이 아니니 미리부터 겁먹을 ���요는 없습니다.,Korean
+현재 치료하려는 병과 깊은 관련이 있습니다.,Korean
+암인 거 언제 아셨나요?,Korean
+초음파 외에는 일반적인 검진 정도의 검사가 이뤄집니다.,Korean
+엑스레이 하기 전에는 흡연은 삼가해주세요.,Korean
+여기 있는 휠체어가 환자분 소유인지 궁금해서요.,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+식사하실 때 입맛이 없으신가요?,Korean
+한 번 공황장애 때문에 실신해서 입원한 적은 있었어요.,Korean
+당뇨 진단받고 얼마나 되었어요?,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+어느 정도로 아픔이 느껴지시나요?,Korean
+속이 답답하며 구토 증상이 있나요?,Korean
+지금까지 열은 안 났나요?,Korean
+숨 쉬는 것이 부자연스럽나요?,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+입원이나 수술해 본 적이 아예 없습니다.,Korean
+크기가 좀 되는 흉터들만 말씀해 주시면 될 것 같습니다.,Korean
+피부 질환은 없으신데 팔 전체가 많이 가려우세요? 언제부터 그러셨나요? 자세한 건 진찰 후 알려드릴게요.,Korean
+어제부터 열이 나신 게 맞는가요?,Korean
+알레르기 나는 상황 알려주세요.,Korean
+심각하게 피로감을 느끼시진 않나요?,Korean
+기침 소리는 질환을 진단하는데 있어서 기본 정보가 되기 때문입니다.,Korean
+점점 전문적인 요양이 필요하신 것 같아서요.,Korean
+"신장 기능이 안 좋다고 들었어요.
+",Korean
+갱년기 증상일 수 있어요.,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+입원하신 날짜가 어떻게 되시나요?,Korean
+심각하게 피로감을 느끼시진 않나요?,Korean
+발목 인대가 늘어나셔서 발목보호대 하나 사셔야 합니다.,Korean
+속이 자꾸만 안 좋으신가요?,Korean
+네 지금부터 두 시간 금식하겠습니다. 물도 드시면 안 돼요.,Korean
+직장내시경은 여기 모형에 보이는 구불결장이라고 부르는 에스상결장 또는 그 윗 부분까지만 보기 때문에 비수면으로 하시는 분들도 많습니다.,Korean
+일주일이면 가라앉긴 하는데 생각보다 통증이 오래 지속된다면 연락 주세요.,Korean
+평소 수면을 적정량 일정하게 취하셨다는 말씀이시죠?,Korean
+그 검사는 안 했는데?,Korean
+부분 마취 약물에 대한 알레르기로 오심과 구토 및 피부 간지러움증이 있을 수 있습니다.,Korean
+상처 보호 및 지혈 등에 쓰입니다.,Korean
+소변과 함께 피가 나오나요?,Korean
+주의하고 있는 알레르기가 있나요?,Korean
+잠시 연고를 바르지 마세요.,Korean
+당뇨 관리 언제 시작하셨어요?,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+유전적 질환이 남자 형제에게만 나타났나요?,Korean
+고혈압약 요즘 드시는 것이 있나요?,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+알레르기 증상을 보이는 특정 환경이 있나요?,Korean
+가슴 통증이 얼마나 가는 거죠?,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+통증이 어떤 거 같으세요?,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+어릴 적에 간염을 앓은 적이 있나요?,Korean
+동물 근처에 가면 알레르기 반응이 나타나나요?,Korean
+암인 거 언제 아셨나요?,Korean
+특이사항이라면 보통 마취 부작용을 말합니다.,Korean
+욕창은 계속 치료를 하셔야 합니다.,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+병원에서 큰 수술을 하신 적 있으시면 말해주세요.,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+복부 통증이 많이 심한가요?,Korean
+"가습기 꼭 사야 해요?
+",Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+알레르기 있는 음식 아시나요?,Korean
+목에 인후통 증상이 있나요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+알레르기 반응은 언제 처음 나타났나요?,Korean
+의사 선생님과 상의 후 결정하는 게 좋을 것 같네요.,Korean
+배가 더부룩하신 느낌이 드세요?,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+이전에 아팠던 적 또 있었나요?,Korean
+항문이 아프면서 출혈이 있는 경우는 치질과 같은 양성 항문 질환일 가능성이 높습니다.,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+사���성 구토는 갑작스럽게 몸 밖으로 튀어나오듯 나오는 구토입니다.,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+"수면 장애였던 적이 없어요.
+",Korean
+아니요. 아직 마취가 남아있어서 물을 드시면 안 됩니다.,Korean
+처방받아서 꾸준히 복용하고 계신 약이 있으신가요?,Korean
+묽은 변을 보시지는 않나요?,Korean
+"시커먼 느낌이 나는 설사요.
+",Korean
+"요즘 귀가 가렵고 물집이 잡혀서 왔어요.
+",Korean
+고혈압으로 병원에서 약 받아먹는 거 있나요?,Korean
+병동에 입원 가능 여부를 확인해봐야 할 것 같습니다.,Korean
+"아이 눈에서 자꾸 진물 같은 게 나와요.
+",Korean
+"대변볼 때마다 피가 보여서 화장실 가기 무서워요.
+",Korean
+오심이란 토할 것 같은 느낌을 말합니다. 이런 증상이 있나요?,Korean
+혈압 높게 확인된 건 언제부터인가요?,Korean
+내성발톱이 원인일 수 있습니다.,Korean
+"숨 쉬는 게 이상한 거 같아요.
+",Korean
+아니요. 큰 부작용은 못 느꼈어요.,Korean
+어제 저녁부터 금식을 하셨다면 검사 진행에 있어서는 더 바람직합니다.,Korean
+일주일 내내 통증이 있으셨어요?,Korean
+환자분께서 원하시는 종교를 말씀해 주시면 그 종교인이 방문하는 병실로 안내해 드릴 겁니다.,Korean
+고혈압 치료가 진행 중이신가요?,Korean
+약물 음식 외 알레르기가 생겼던 적이 있으신가요?,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+네. 수분 부족 현상이에요.,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+"혈변을 계속 보는데 어디가 문제인 건지 감이 안 오네요.
+",Korean
+지속적으로 소화가 잘되지 않나요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+성형 수술이라고 생각하시면 됩니다.,Korean
+"네. 그런 증세가 있는지도 몰랐어요.
+",Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+배에 가스가 많이 차있나요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+계속 밤에 잠에 들지 못하나요?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+음주를 하시고 다음 음주까지 얼마나 걸리시나요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+"애가 점점 열이 오르더라고요.
+",Korean
+하루에 태우는 담배양은 어떻게 되나요?,Korean
+제가 방금 퇴원 설명 해드렸습니다.,Korean
+알레르기가 있다는 거는 언제 처음 알게되셨어요?,Korean
+간염으로 드시는 약이 있나요?,Korean
+결핵 약 지금도 드시나요?,Korean
+특별히 아픔을 느끼는 곳이 있나요?,Korean
+괜찮습니다. 혹시 외래 약 처방 받은 거 드시는 중이신 건가요?,Korean
+평소에 대변을 잘 못 보시나요?,Korean
+식습관 조사 겸 여쭤보았네요.,Korean
+처음 며칠간은 매일 오시거나 입원하셔야 됩니다.,Korean
+가족 중에 유전적 질환으로 약을 드시는 분 있나요?,Korean
+기능성 변비일 수도 있으니 미리 걱정하실 필요는 없습니다.,Korean
+고혈압이 있으시거나 뒷골이 자주 당기세요?,Korean
+통증 정도가 어느 정도인가요?,Korean
+입원 기간이 어떻게 되시죠?,Korean
+사출성 구토는 갑작스럽게 뿜어져 나오는듯한 구토를 말합니다.,Korean
+혈압 측정이 끝나면 좋아졌는지 말씀드릴게요.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+하루에 배뇨를 몇 번 정도 하시나요?,Korean
+"기침할 때 소변 살짝 지리기도 합니다.
+",Korean
+네 복부 초음파 후 조영술 시행하도록 하겠습니다.,Korean
+주로 하루 중 언제 붓나요?,Korean
+흡연은 하신 적 있어요?,Korean
+허리는 비만 오면 늘 아프죠.,Korean
+현재 면역력이 약해서 최대한 집에 머무르셔야 합니다.,Korean
+다리가 아프거나 저리는 증상이 있으신가요?,Korean
+"물리적인 충격이라 하긴 그렇고 삼 일 전에 친구들하고 놀이터에서 놀다 왔는데 그때 자기도 모르게 다친 게 아니냐고 짐작하고 있긴 해요.
+",Korean
+네 상담 후 치료하면 될 것 같아요.,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+통증이 어떻게 오는지 말씀해 주세요.,Korean
+"갑자기 알 수 없는 흉통이 있었어요.
+",Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+약품이나 식품 외에 알레르기 현상 나타나는 경우는요?,Korean
+아니요. 음성 판정이 나왔네요.,Korean
+심장 뛰는 게 불편하진 않으세요?,Korean
+입원 치료는 언제 뭐 때문에 받으신 건가요?,Korean
+집안에 당뇨 환자 있나요?,Korean
+치질과 같은 항문 질��인 경우 심각하지 않습니다.,Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+목에 가래가 끼신 거 같나요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+아버지가 고혈압 때문에 약을 드시고 계세요.,Korean
+최근에 입원 치료를 받은 적이 있나요?,Korean
+정확한 건 검사 결과가 나와봐야겠지만 음식이 오염되었을 수도 있어요.,Korean
+네 괜찮지만 유전적으로 고혈압은 발생하기에 한 번 검사 받는 걸 추천 합니다.,Korean
+수면 검사로 인한 부작용이나 중요한 문제가 있을 수 있습니다.,Korean
+환자 혼자서는 이동이 불가한 거 맞죠?,Korean
+두드러기도 나고 몸도 가려워요.,Korean
+성 기능 장애로 발기에 어려움을 느끼고 계신가요?,Korean
+음식 중에 알러지 반응 나는 게 있나요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+결핵을 앓기 시작한 지 얼마나 되셨죠?,Korean
+통증을 진정시키기 위해서 하는 목적이니 걱정하지 않으셔도 됩니다.,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+"수술한 다리에 힘이 안 들어가요.
+",Korean
+증상과 원인에 따라 가장 좋은 방법으로 치료하게 됩니다.,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+혹시 대변 보시고 사진을 남겨놓으신 것이 있나요?,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+그런 경우 어느 정도 장이 쉬어줄 수 있도록 금식을 시행하는 것이 바람직합니다. 주사제로 변경하여 투여하겠습니다.,Korean
+당뇨약 복용 유무 알려 주세요.,Korean
+결핵 예방을 위한 주사 맞으셨어요?,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+지금부터 수술 부위에 대해서 설명드리겠습니다.,Korean
+사고로 상해를 입은적이 있나요?,Korean
+"새벽 내내 설사를 했어요.
+",Korean
+이 약은 일 차 치료 항생제이며 위산분비억제제도 함께 투약합니다.,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+최근에 혈뇨가 처음 나온 것이 언제인지 말씀해 주세요.,Korean
+통증이 어느 정도이신지 알아야 처방이 가능합니다.,Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+검사 자체는 그렇게 오랜 시간이 소요되지는 않지만 검사가 밀려 있다면 그런 경우에는 오래 걸릴 수 있습니다.,Korean
+발기 부전 관련 약을 드셨어요?,Korean
+"어깨를 돌리거나 팔을 좀 심하게 쓰면 어깨가 이렇게 톡 하고 빠지는 느낌이 있는 것 같습니다.
+",Korean
+수혈 거부 시 의사 상담 후 동의서 작성이 필요합니다.,Korean
+몸에 갑자기 열이 나나요?,Korean
+네. 소아마비로 인해 지금까지도 거동이 매우 힘듭니다.,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+통증이 오는 곳이 있나요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+최근에 수술 언제 받으셨나요?,Korean
+당뇨나 기타 기저질환이 있나요?,Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+소변볼 때 잘 안 나오나요?,Korean
+부어오르고 가려우면서 아프다고 하시는 분들도 계세요.,Korean
+"시원하게 못 봐서 치질 걸릴 것 같아요.
+",Korean
+수면제 복용을 먼저 권하진 않고요 잘못된 수면 습관을 파악해야 합니다.,Korean
+아니요. 전에는 산부인과 간 적 없습니다.,Korean
+얼마나 자주 아픈지 말씀해 주실래요?,Korean
+아이가 수유 몇 시간 후에도 배가 볼록한가요?,Korean
+약은 병원에서 처방 받았나요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+목으로 피가 조금 올라오나요?,Korean
+"어깨가 심하게 결렸나 봐요.
+",Korean
+요새 머리가 어지럽진 않나요?,Korean
+일반 대장내시경을 할 때 사용하지 않는 액세서리와 기계들을 사용하게 되기 때문에 추가 비용이 있습니다. 용종제거술에 동의하시나요?,Korean
+다른 종류의 알레르기는 가지고 계세요?,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+혹시 새벽에 입원하셔서 입원 생활 안내 들으셨나요?,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+복부 비만은 건강에 좋지 않습니다.,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+초음파로 본 부분을 더 자세히 설명 듣길 원하시는 건가요?,Korean
+오늘 아침에 약 먹고 왔고 혈당은 잘 유지하고 있어요.,Korean
+결핵 때문에 많이 힘드시죠?,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+알레르기 있는 음식이 뭔��요?,Korean
+뱃살을 빼려면 유산소운동을 하셔야 합니다.,Korean
+"마라톤 연습한다고 평상시보다 많이 뛰었는데 발에 경련이 와서요.
+",Korean
+"예. 소변에는 별다른 이상이나 문제가 없었어요.
+",Korean
+측정 시에 아이가 깨어 있어야 호흡 측정이 가능합니다.,Korean
+발열이 있던 적 있나요?,Korean
+네. 검사 예약해 드리겠습니다.,Korean
+입원 및 통원 치료 결정은 의사와 상의하셔야 합니다.,Korean
+치료는 동네 치과에서 받으셨나요?,Korean
+"말이 어눌하게 나와서 응급실에 왔다가 입원했어요.
+",Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+삼투성 하제의 경우 장기적으로 복용해도 큰 문제는 없습니다.,Korean
+주의해야 하는 알레르기 약이 있나요?,Korean
+기침하면 피가 같이 나오는지 궁금하네요.,Korean
+본원에서 수술하셨으면 기록 조회해보겠습니다.,Korean
+숨 쉴 때 아파요.,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+"움직이고 싶어도 못 움직이겠어요.
+",Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+알고 계신 혈액형은 무엇인가요?,Korean
+어떤 약 처방 받으셨어요?,Korean
+저희 병원이 처음이신지 기록 조회를 통해 알아보겠습니다.,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+진료받은 적 있냐는 말도 외래의 한 범위나 마찬가지인데 입원 없이 치료받으시러 내원하신 게 맞냐고 여쭙는 거예요.,Korean
+발기 부전 증상이 있으세요?,Korean
+대장 내시경과는 달리 약을 반드시 먹을 필요는 없지만 약을 먹고 하면 더 자세히 관찰할 수 있습니다.,Korean
+고혈압 치료 차원에서 복용하시는 약이 있나요?,Korean
+돌 때 재수술을 하게 되면 분명 호전될 가능성이 높아집니다.,Korean
+아무 때나 측정한 혈당 수치가 이백 밀리그램 퍼 데시리터 미만이어야 합니다.,Korean
+약물 처방으로 치료를 시작하면 금방 나을 수 있을겁니다.,Korean
+혹시 현재 사용하고 있는 보조 기구가 있을까요? 예를 들면 의치나 렌즈 목발 같은 거요.,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+어떤 약 처방 받으셨어요?,Korean
+당뇨 질환으로 드시는 약이 있으면 알려주세요.,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+대변이 잘 안 나오나요?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+병원이나 보건소에서 결핵 치료 받으셨나요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+"소변 색 크게 변함은 못 느꼈었는데요.
+",Korean
+약을 처방받아 드시고 계신가요?,Korean
+우선 응급처치가 먼저인 것 같습니다.,Korean
+숨이 가빠져서 힘든 적이 있나요?,Korean
+한기가 들 만큼 추운 증상이 있나요?,Korean
+소변을 보고 또 화장실을 가고 싶으신가요?,Korean
+"겨우 두 시간 자요. 잠도 안 오고 오래 못 잡니다.
+",Korean
+흡연 기간 대략적으로 알려주세요.,Korean
+네 무슨 입원 치료를 하셨나요?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+기존에 질환이나 질병이 있으셨나요?,Korean
+처방받으신 연고는 잘 바르고 계시나요?,Korean
+사출성 구토인 경우 우려되는 질환이 있으나 그 외의 경우도 있으므로 치료 계획 결정 후 다시 말씀드리겠습니다.,Korean
+"위에서 떨어지는 물건을 잡으려다가 놓치면서 다쳤어요.
+",Korean
+얼마나 통증이 심하게 느껴지고 있나요?,Korean
+삼일 정도 먹는 건 괜찮아요 우선 변비약 처방해 드릴게요.,Korean
+육안으로 봐도 불룩한 게 보이시나요? 위험 여부는 추가 검사 진행 후에 말씀드릴게요.,Korean
+항히스타민제 처방받고 드시는 건가요?,Korean
+언제부터 당뇨 증세가 악화됐나요?,Korean
+통증 때문에 일부러 소변을 안 보신 적이 있나요?,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+이후에는 레이저나 냉동치료이고 마지막에는 수술밖에 답이 없습니다.,Korean
+독감 예방 주사 어떤 거로 맞았나요?,Korean
+아프기 시작한 지 좀 됐나요?,Korean
+다른 치료하신 거도 있으신가요?,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+음식이나 약물 알레르기 있으세요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+배에 가스가 찬 느낌은 없나요?,Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+당뇨 때문에 병원 치료를 받은 경험이 있나요?,Korean
+알러지 피검사는 일주일에서 열흘까지 걸립니다.,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+치료를 받고 나서 몸의 이상에 대해서 자각하게 되는 것은 치료 이후에 신체상태에 대한 관심이 올라가서 일 수 있습니다.,Korean
+질병에 따라서 달라집니다. 보통 활동성인 경우 전염력이 있어요.,Korean
+복수가 찬 적 있나요?,Korean
+"폐 때문에 오게 됐어요.
+",Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+"변비가 원래 있었는데 요즘 더 심해졌어요.
+",Korean
+얼마나 아픈지 표현해 주세요.,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+먹으면 부작용이 있거나 불편한 약 있으세요?,Korean
+맞습니다. 검사는 선택 사항입니다.,Korean
+네 그러면 검사받기는 어렵고 예약하고 가시면 될 것 같아요.,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+다른 질환 때문에 복용하는 약이 있나요?,Korean
+사고 나서 수술을 받은 경험이 있습니까?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+"속이 더부룩하고 토할 것 같은 느낌이 있어요.
+",Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+"대변을 못 눠서 칭얼거려요.
+",Korean
+입원해서 치료받은 적 있어요?,Korean
+"저는?두 끼?이상 먹으면 위가 더부룩해서 싫더라고요. 그래서 잘?안 먹어요.
+",Korean
+통증이 언제부터 시작했는지 말씀해주세요.,Korean
+형제분 중 몇 분이 같은 질환이 있나요?,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+거기가 아팠던 게 언제부터죠?,Korean
+갱년기 증상일 수 있습니다.,Korean
+검사 진행을 통해 원인을 찾아보겠습니다.,Korean
+요즘 혹시 두통이 있나요?,Korean
+소화 불량이 생긴 지 얼마나 되셨나요?,Korean
+맞아요. 자연 분만으로 낳았어요.,Korean
+"아니요. 저는 초등학교 때부터 피웠습니다.
+",Korean
+동의서에는 검사와 관련된 사항들이 포함됩니다.,Korean
+심박 수에 문제가 있었던 적은 없을까요?,Korean
+오늘은 어디가 아파서 병원에 오셨을까요?,Korean
+고혈압 처방받으면서 지은 약 드시고 있으세요?,Korean
+합병증이 있을 수 있지만 잘 치료하면 예후가 좋으니까 걱정 마시고 일단 치료에 전념해 주시기 바랍니다.,Korean
+"하루에 반 갑 정도 피운 지 벌써 삼십 년은 됐네.
+",Korean
+지금은 한 달 정도 입원하는 걸로 보고 있습니다.,Korean
+배가 콕콕 찌르는 듯이 아픈가요?,Korean
+통증이 나타나는 빈도가 어떻게 돼요?,Korean
+나팔관을 자르고 묶는 수술입니다.,Korean
+질병의 원인이 될 수도 있기 때문입니다.,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+결핵 치료로 처방받은 약이 이게 맞나요?,Korean
+여기 말고 다른 부위 치료받은 적은 없으세요?,Korean
+"코로 숨을 쉬지 못해요.
+",Korean
+현재 체중 변화가 심한 가요?,Korean
+재수술을 해야 하는데 거기까지 가면 안 되겠죠.,Korean
+최근에 백신 접종은 맞으셨나요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+부작용이나 알레르기 반응이 있었던 약이 있으세요?,Korean
+입원해서 초반 처치를 받으시는 게 좋습니다.,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+네. 코로나가 감염성이 커서 같이 검사하셔야 합니다.,Korean
+대부분은 그렇습니다만 통증이 있으면 시술 시 말씀해주세요.,Korean
+토에 피가 섞여나오는 느낌이 있나요?,Korean
+간염으로 치료 받고 있나요?,Korean
+일주일 평균 주량이 얼마나 되나요?,Korean
+"기침하고 가래가 이주 이상 계속됐어요.
+",Korean
+네 만성이라 치료가 오래 걸릴 겁니다.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+"물 마시면 많이 붓더라고요. 그래서 안 마십니다.
+",Korean
+비염성 알레르기를 가지고 계신가요?,Korean
+부은 증상이 어디에 나타났나요?,Korean
+몸에 힘이 없는 느낌인가요?,Korean
+어떤 증상이 견디기 힘들던가요?,Korean
+심장이 언제 빨리 뛴다고 느껴지세요?,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+저번 주까지 먹었던 약이 있긴 한데.,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+어느 쪽이 안 좋아서 내원하신 건가요?,Korean
+과거에 치료받으신 질환이 있으신가요?,Korean
+음식을 먹고 싶은 생각이 안 들고 식사를 자주 거르나요?,Korean
+유전성 질환 가족력이 있으신가 봐요?,Korean
+통증의 정도가 어떻게 되나요?,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+고혈압약을 드시고 계시는 분이 있나요?,Korean
+움직임이 통증에 영향을 주나요?,Korean
+"묽고 피가 좀 섞여 있어요.
+",Korean
+환자분이 결핵을 앓고 있다고 알게 되신 게 언제예요?,Korean
+입원 치료를 받았던 적이 있나요?,Korean
+꼬박꼬박 챙겨 드시는 약 있나요?,Korean
+초음파 검사는 진료 중에 잠깐 하는 거기 때문에 미리 말씀드리지 않은 것 같네요.,Korean
+소화가 안 되면서 동반되는 다른 증상이 있나요?,Korean
+자세한 검사를 통해 진단을 먼저 해야 할 것 같아서 초음파 후 말씀드리겠습니다.,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+복부에 팽만감을 자주 느끼나요?,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+증상이 시작되었던 것은 며칠 전이었나요?,Korean
+"음식 냄새만 맡아도 어지러워요.
+",Korean
+방사선이란 게 일상생활에서도 수시로 알게 모르게 방사선에 노출되나 실제 건강에 위험을 초래하는 경우는 극히 일부입니다.,Korean
+작년에 건강검진을 받았는데 위궤양 진단을 받고 한창 약도 복용했었거든요.,Korean
+심전도는 정상으로 나왔는데 혈액검사 수치 중에 혈액내 지방 수치가 높게 나왔네요. 피검사 하는 날 금식 잘 하고 시행하셨죠?,Korean
+소독을 무조건 해야 해요.,Korean
+대변볼 때 피가 난 적 있어요?,Korean
+혈당 확인을 집에서 하시나요?,Korean
+심장박동이 갑자기 빨라진다거나 하진 않으시죠?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+정확한 금액은 병변의 개수에 따라 달라 진료 후 말씀드리겠습니다.,Korean
+금방 확인하실 수 있잖아요? 챙겨 먹어야 하는 약이 있으니 오전 중에 돌려주셨으면 좋겠어요.,Korean
+통증이 한 번 나타나면 얼마나 지속되나요?,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+혈액검사를 통한 알레르기 수치에 따라 치료 방법이 달라집니다.,Korean
+우선 바이러스에 노출된 과거력이 있어야합니다.,Korean
+혈압이 너무 높은 거 아닌가요?,Korean
+몇일에 한번 대변을 보시나요?,Korean
+과거에 다른 질병으로 치료받은 적 있나요?,Korean
+네. 알러지가 꽤 자주 납니다.,Korean
+예전에도 비슷한 병을 앓으셨나요?,Korean
+가족 중에 유전성 질환을 겪고 계신 분이 있나요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+외래 진료 때 만나셨던 선생님을 말씀하시는 건가요?,Korean
+알레르기 반응이 올라오는 다른 원인이 있나요?,Korean
+통증이 오는 곳이 있나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+혈액검사를 통해 횡문근 융해증을 진단하고 수액 치료 기간은 금식 유지가 필요합니다.,Korean
+담배 피운 기간이 어느 정도 되는지 알려주실래요?,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜 보세요.,Korean
+호흡할 때 어려움이 있나요?,Korean
+네. 헬리코박터균은 분변 구강 전파가 가능합니다. 가족 간 전파가 흔히 일어나는 것으로 보고되어 있습니다.,Korean
+막대로 살짝만 스쳐도 통증이 느껴지나요?,Korean
+자세한 설명은 의사 선생님께 들으실 수 있어요.,Korean
+가족분들 당뇨 수치는 어떠세요?,Korean
+숨이 잘 안 쉬어져요.,Korean
+전신에 에너지가 결핍된 느낌인가요?,Korean
+담당의사와 상의 후 다시 준비를 하겠습니다.,Korean
+"금식하는 거 진짜 힘들더라고요. 동의서 작성 종이로 하나요?
+",Korean
+"친구랑 싸우다 맞았는데 눈이 아파서요.
+",Korean
+매일 상처를 살펴보면서 치료 받게 됩니다.,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+최근에 오한이 들지는 않으셨나요?,Korean
+초반에는 본원에서 치료받으시고 나중에 환부가 안정되면 동네 병원 치료 권장드립니다.,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+암 치료받으신 기간 알려주세요.,Korean
+무리를 하셨네요 평소보다 다리가 부은 느낌은 있지 않으신가요?,Korean
+환자분의 정확한 상태 파악을 위해서 몇 가지 질문드려야 하는데 가능하시겠어요?,Korean
+잠이 자꾸 깨서 힘드시나요?,Korean
+웻 거즈는 말 그대로 젖은 거즈예요.,Korean
+네. 본��적으로 겨울 오기 전에 독감 주사 맞았습니다.,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+불편함이 있으시면 언제든지 병원으로 연락주세요.,Korean
+요즘도 약 복용 없이는 힘드신가요?,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+힘드셨겠네요. 휠체어는 따로 말씀하셔야 합니다.,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+혈압의 경우 이회 측정 결과 모두 백이십에서 팔십으로 정상 혈압에 해당합니다.,Korean
+통증을 느낄 때 어떻게 아픈가요?,Korean
+치료 내역을 알면 저희에게 도움이 돼서 여쭤보는 거예요.,Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+반려견이 주사 맞는 게 아닌가요?,Korean
+수혈하는 상황만 아니라면 상관없습니다.,Korean
+휠체어 꼭 타야 해요?,Korean
+평소에 먹는 약이 있나요?,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+얼마나 자주 아픈지 빈도를 말씀해 주세요.,Korean
+흡연이나 음주나 일상적으로 접하는 것이라 익숙하지만 건강에 큰 영향을 끼치죠.,Korean
+소변에 섞여 나오는 피의 양은 얼마큼 되는 거 같으세요?,Korean
+몸에 부어 있는 곳이 어디죠?,Korean
+음식 알레르기를 앓았던 적 있으세요?,Korean
+피로감은 어느 정도 심한가요?,Korean
+욕창 상태를 육안으로 확인해보겠습니다.,Korean
+그 약만 먹으면 우울증이 오는 것 같아요.,Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+전립선염일 가능성이 있으니 추가 검사를 해보시지요.,Korean
+구급차를 이용하셨을 경우 비용 청구 관련하여 확인이 필요하여 여쭈어보았습니다.,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+"마지막으로 소변본 게 조금 오래돼서 잘 기억이 안 나요.
+",Korean
+간호사 콜 버튼이 여기 있는지도 몰랐어요.,Korean
+독감 주사만 한번 맞았는데요.,Korean
+다른 질환이나 약 같은 참고 사항이 있는지 확인하려고요.,Korean
+이천일 년 여름에 검진받으러 갔다가 우연히 알게 됐죠.,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+건강보험은 내시경 검사에만 적용됩니다.,Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+소변을 볼 때 따가운가요?,Korean
+원래 수액 들어갈 때 뻐근하고 차가운 느낌 드나요?,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+어느 부위에 통증을 느끼세요?,Korean
+속이 불편하다고 자주 느끼시나요?,Korean
+전에 다른 곳 때문에 수술받은 적은 없으세요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+감기약 오전에 먹고 왔는데요.,Korean
+특정 시기에 통증이 생기나요?,Korean
+소변의 색이 적색이나 갈색으로 나타납니다.,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+내성발톱이 원인일 수 있습니다.,Korean
+현기증이 생긴 적 있나요?,Korean
+"제가 기관지가 안 좋아서 흡연은 못 하고 술도 제가 안 받아서 못 마셔요.
+",Korean
+제가 드린 약만 드세요.,Korean
+저번 병원 왔을 때요.,Korean
+오늘 검사 스케줄이 널널해서 바로 받으실 수 있으세요.,Korean
+하루에 담배 피는 양 알려주세요.,Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+고혈압약 외에 당뇨약 같은 약 드시는 거 있나요?,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+검사를 몇 가지 진행해봐야 할 것 같습니다.,Korean
+아직 어떤 병을 진단받았다는 얘기를 듣지 못했어요.,Korean
+양치하실 때 피가 많이 나는 편이던가요?,Korean
+가까운 병원으로 연결도 해주시나요?,Korean
+당뇨 검사받아보신 적 있으세요?,Korean
+음주 횟수는 어떻게 되죠?,Korean
+간염으로 무슨 약 드세요?,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+암으로 드시는 약 있어요?,Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+알레르기 때문에 고생한 지 얼마나 되었나요?,Korean
+"아파서 병원 간 적도 없어요.
+",Korean
+주사가 들어갈 때는 아프지만 다 들어가고 나면 주사 부위 통증은 금방 사라집니다.,Korean
+가래의 색이 어떤지 알려주시겠어요?,Korean
+"계속 찌릿찌릿 찌르는 듯한 통증이 반복돼서요. 일어나자마자 그랬어요.
+",Korean
+현재 구토 증상이 있나요?,Korean
+심장이 빨리 뛴다는 느낌이 드세요?,Korean
+"얼마 전 교통사고 이후에 허리와 목이 아파 내원하게 되었습니다.
+",Korean
+변을 조절하지 못하는 원인은 다양합니다.,Korean
+하루에 여러 차례 드레싱하며 상태를 볼 겁니다.,Korean
+"여기 안쪽에 어금니 있어요.
+",Korean
+현재 복용 중인 약이 있으신가요?,Korean
+나팔관을 자르고 묶는 수술이라서 부작용이 거의 없어요.,Korean
+복부 쪽으로 팽만이 있나요?,Korean
+결핵 확진을 받은 지는 얼마나 되었나요?,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+대체적으로는 처방되는 변비약의 효과가 좋은 편입니다.,Korean
+아니요. 항생제 치료도 함께 필요합니다.,Korean
+배에 가스가 많이 차있나요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+"강아지에서 다리를 물려서 피가 계속 나요.
+",Korean
+"소화가 잘 안되니까 식사량도 줄고 체중도 줄고 있어요.
+",Korean
+마취부터 회복까지 세 시간 걸릴 예정입니다.,Korean
+토혈은 어느 정도의 양이었나요?,Korean
+혈당이 관리가 안 되기 시작한 게 얼마나 되었나요?,Korean
+주로 어디가 가장 아프세요?,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+통증 시작된 날짜 기억나요?,Korean
+체중이 변했다면 얼마나 변하셨나요?,Korean
+"왼쪽 눈에서 하얀 진물이 나옵니다.
+",Korean
+예방효과는 안 맞으신 분들보다는 뛰어납니다. 하지만 독감 예방 접종 후에도 독감에 걸리실 수 있습니다.,Korean
+바이러스성 장염은 일반적으로 바이러스 검출 없이 증상과 진찰만으로도 진단하기 때문에 원인을 찾는 것은 어려울 수도 있습니다.,Korean
+고혈압약 꾸준히 복용하고 계세요?,Korean
+소화와 관련된 약을 드시고 계시군요.,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+증상이 시작된 게 언제부터예요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+피 수치가 많이 떨어져 있어서 수혈받으셔야 합니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+감기 약 먹고 있습니다.,Korean
+"소변 나오는 게 영 시원치 않아서 입원했어요.
+",Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+매번 검진받을 때마다 건강하다고 나와서요.,Korean
+나가실 때 약국에서 약 받아가세요.,Korean
+소변보는 횟수는 어떤가요? 평소보다 자주 보시나요?,Korean
+식욕 부진 증상이 언제부터 나타났었나요?,Korean
+앓고 있는 병 있나요?,Korean
+"갑자기 걷다가 통증을 너무 호소해서 왔어요.
+",Korean
+하루에 몇 시간 주무시나요?,Korean
+당은 잘 관리 되고 있나요?,Korean
+네 이제는 맥박수와 호흡수 측정하겠습니다.,Korean
+"건강관리에 신경 쓰는 편이라 건강했습니다.
+",Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+전에 병원에 입원한 적 있으신가요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+저 막 뛰어와서 호흡이 안정하지 않은데 잠시만 기다려주세요.,Korean
+애완견과 관련된 접종은 어느 것이든 말씀해 주시면 됩니다.,Korean
+당뇨와 관련된 가족력은 없나요?,Korean
+치료를 시작해야 할 것 같아요 오늘 주사를 맞고 가시는 게 좋겠습니다.,Korean
+통증 시작된 날짜 기억나요?,Korean
+피가 섞인 대변을 보세요?,Korean
+"아 저 왼쪽 손가락이 아프고 붓고 고름도 나오더라고요. 그래서 왔어요.
+",Korean
+독감 접종 언제 맞으신 거죠?,Korean
+제일 덜 오는 통증 부위가 어디예요?,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+욕창이 생기지 않도록 체위 변경 잘 해주시면 더 빨리 나으실 거예요.,Korean
+알레르기 때문에 숨쉬기 힘든 적이 있으신가요?,Korean
+"모르겠어요. 눈 떠보니 응급실이었어요.
+",Korean
+네. 엑스레이를 통해 대략적인 가스와 변의 양상은 확인이 가능합니다.,Korean
+바셀린 거즈를 사용할 필요는 없습니다.,Korean
+"배는 아팠었는데 설사는 안 했어요.
+",Korean
+결핵 치료받으면서 어려운 점은 없으세요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+검사 부위는 일시적으로 붉게 올라올 수 있어요.,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+"네. 목에 뭐가 걸린 거 같아서 삼키기 조금 힘들어요.
+",Korean
+아니요. 저는 수술해본 적이 태어나서 단 한 번도 없어요.,Korean
+통증 유무 확인 부탁드려요.,Korean
+평소대로 숨을 쉬면 폐포에 쌓인 노폐물이 완전히 배출되지 않습니다.,Korean
+몸에 종양이 발견되신 적이 있나요?,Korean
+흡연 시작 연령을 기억하세요?,Korean
+알레르기가 있으셨으면 검사 한번 해보시겠어요?,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+가래 뱉을 때 찐득하게 나오나요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+아픈 게 어느 정도 지났나요?,Korean
+아이 몸무게 아까 측정하셨었나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+경우에 따라서는 조직검사 결과를 확인하고 영상검사 등 추가적인 검사 후에 치료 방향을 결정할 수도 있습니다.,Korean
+암만 빼고 고혈압 당뇨 있습니다.,Korean
+알레르기 있는 음식 아시나요?,Korean
+올해 체중 관리를 따로 하셨나요?,Korean
+알레르기가 음식이나 털 이외에도 다양한 원인이 있어서요. 정확하게 기억은 안 나시는 건가요?,Korean
+먼저 알레르기 물질을 회피해 주시면 됩니다.,Korean
+몸살이 있었다면 예방접종 후 면역력이 떨어져서 더 안 좋을 수도 있습니다.,Korean
+결핵 약 지금도 드시나요?,Korean
+네 이삼일 정도 통증이 더 지속되실 것입니다.,Korean
+운동하다가 다쳐서 팔뚝을 꿰맨 적이 있습니다.,Korean
+혹시 생리량이 몇 개월 전부터 줄었나요?,Korean
+이 부위가 아픈 곳이에요?,Korean
+국소마취로는 아이가 힘들 수 있습니다.,Korean
+네. 몸무게와 증상에 따라서 몸 상태 측정이 가능해서요.,Korean
+네 따뜻한 곳에 계시면 제가 병실이 나오면 말씀드리러 가겠습니다.,Korean
+변에 피가 섞여 나오나요?,Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+화장실에 갔는데 소변이 안 나오나요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+예전에 병원에서 처방받은 거라 약통에 이름이 안 적혀 있었어요.,Korean
+하루 술 마시는 양이 어떻게 되나요?,Korean
+온몸이 기운이 빠진 듯하나요?,Korean
+"아이 성기 부분에 뭐가 올라왔어요.
+",Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+가족분들이 공통적으로 있는 질환이 있나요?,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+사고로 상해를 입은적이 있나요?,Korean
+유전성 질환으로 현재 치료받는 가족분이 있나요?,Korean
+최근 몇 개월 동안 체중이 많이 감소했나요?,Korean
+발밑이 울렁거리는 느낌을 받은 적이 있나요?,Korean
+지금 옆구리 아프신 건 어떠세요?,Korean
+"얼굴을 한 방 맞았어요.
+",Korean
+환자분 의식이 없으면 연락드려야 합니다.,Korean
+현재 유전병을 앓고 계신 가족분이 계신가요?,Korean
+가족 중에 항암 치료 중이신 분이 있나요?,Korean
+그렇지 않습니다. 장상피화생은 다른 만성 위염에서도 발생할 수 있습니다.,Korean
+암 치료 시작한 지 얼마나 되셨죠?,Korean
+"그냥 통증만 계속 유지되는 느낌이에요.
+",Korean
+"식도에 정맥류가 어쩌고 했던 것 같습니다.
+",Korean
+신물이 넘어오는 이유는 위식도역류질환이 대표적입니다.,Korean
+손목 관절의 움직임을 최소화할 수 있도록 보호대를 착용하는 것이 좋습니다.,Korean
+얼마나 아픈지 표현해 주세요.,Korean
+객담이 많은 거 같나요?,Korean
+어디 부은 데가 있나요?,Korean
+결핵 때문에 먹는 약이 있나요?,Korean
+지금은 무슨 약 드세요?,Korean
+독감 주사를 최근에 맞았나요?,Korean
+우선 충수돌기염 치료를 위해 항생제를 사용해야겠습니다.,Korean
+하루에 설사를 자주 하시나요?,Korean
+당뇨 진단 언제 받았는지 기억하실까요?,Korean
+부작용을 일으키는 약 종류가 있으신가요?,Korean
+통증 발병하면 얼마 동안 가나요?,Korean
+"목 쪽이 건조해서 긁으면 상처가 나고 뭘 발라도 낫질 않아요.
+",Korean
+오늘 밤에 금식하는 거랑 수술 전 준비하실 거 안내해 드릴게요.,Korean
+암이 있다는 것을 언제 알게 되었나요?,Korean
+과식을 하지 않아도 소화가 되질 않나요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+결핵 치료는 언제부터 시작하셨어요?,Korean
+"시험이나 중요한 행사같이 스트레스받을 만한 상황에 놓이면 배��� 아프면서 화장실에 가고 싶습니다.
+",Korean
+지금 발기 부전으로 문제가 있나요?,Korean
+복부 팽만감이 있지는 않나요?,Korean
+결석이 너무 크거나 체외 충격파 쇄석술이 불가능할 경우는 수술적 방법으로 치료를 해야 합니다.,Korean
+네. 그런데 변비가 계속 있어요.,Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+"무거운 짐을 옮기다가 제 다리에 떨어뜨렸어요.
+",Korean
+처음 통증을 느낀건 언제인가요?,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+장상피화생의 가장 대표적인 원인이 헬리코박터균 감염이지만 다른 원인도 있을 수 있습니다.,Korean
+입원 또는 수술 경험이 있나요?,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+드레싱은 매일 해야 하는 치료이고 이제 상처 회복을 위한 다른 치료가 들어갑니다.,Korean
+위의 내용물이 식도로 역류되어 쓰린 느낌이 나타나기도 합니다.,Korean
+암 치료를 받은 기간이 얼마나 되나요?,Korean
+현재 손목터널 증후군이 얼마나 진행되었는지에 따라 달라집니다.,Korean
+통증이 몇 분 단위로 오고 있어요?,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+네 가족력이 있을 수 있습니다.,Korean
+최근 독감 백신 맞았나요?,Korean
+레이저 시술로 몸에 무리가 가는 경우는 거의 없습니다.,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+체중 관리를 안 했는데도 최근 체중 변화가 있었나요?,Korean
+검사가 빨리 시작했으면 좋겠네요.,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+피부가 손상받을 수 있습니다.,Korean
+따로 먹으면 안 되는 약이 있으신지 알기 위해서 여쭤보는 겁니다.,Korean
+욕창이 생기지 않도록 체위 변경 잘 해주시면 더 빨리 나으실 거예요.,Korean
+헛구역질도 포함됩니다. 그 외 다른 증상은 없으셨나요?,Korean
+화상 정도에 따라 과산화수소수를 사용할 수 있습니다.,Korean
+"고등학생 때 피우고 최근 들어 끊으려고 노력하고 있어요.
+",Korean
+그 외에 갖고 계신 알레르기가 있나요?,Korean
+체중이 급격히 늘진 않았나요?,Korean
+본원에서 분만하셨다면 기록 조회해보도록 하겠습니다.,Korean
+"반복적으로 공황발작이 와서 가슴 압박도 심하고 질식할 것 같은 느낌이 들어요.
+",Korean
+혈뇨의 상태를 자세히 말씀해 주세요.,Korean
+결핵 치료 기간이 오래된 건가요?,Korean
+"아니요. 소변을 좀 보고 싶어서요.
+",Korean
+진료받게 되신 이유가 있으신가요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+기침을 하는 빈도가 어떻게 되나요?,Korean
+"공장 일하다가 허리를 삐끗했는데 며칠이 지나도 나아지지 않아서 왔습니다.
+",Korean
+네 옆 병실에도 환자들이 있습니다.,Korean
+소변량 등을 확인 후 빼 드릴게요.,Korean
+"눈에 벌레가 들어가서 비볐더니 충혈이 심해요.
+",Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+당뇨 치료 이력은 아직 없으신 건가요?,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+직접 퇴원 수속을 하셔야 해요.,Korean
+혈액검사에서 이상 소견이 발견되어 입원해서 검사를 진행하셔야 합니다.,Korean
+앞으로 환자분 치료에 도움이 될지 판단하는 자료로 사용될 거라서요.,Korean
+복부 팽만감이 있던 적 있나요?,Korean
+오늘 왜 병원에 다녀오셨나요?,Korean
+얼굴 말고 팔도 아프시다고요? 어디가 어떻게 아프신지 설명해 주시겠어요?,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+"허리를 펴면 날카로운 통증이 느껴져요.
+",Korean
+최근에 체중이 급격히 변하셨나요?,Korean
+최근 술을 자주 드시나요?,Korean
+아직은 장운동이 원활하지가 않아 불편하더라도 좀 더 하고 계셔야 됩니다.,Korean
+여기 병원에서 수술받은 적 있습니다만.,Korean
+평소 생활습관이 건강에 큰 영향을 미치거든요.,Korean
+암 질환을 가진 가족분들 있나요?,Korean
+유전성 질환 가족력 있나요?,Korean
+"걸을 때마다 오른쪽 무릎에 통증이 있습니다.
+",Korean
+확실한 치료를 원하시면 약물보다 수술을 추천합니다.,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+배뇨 시 치골 및 하복통 부위 통증이 있다면 방광염일 가능성이 높습니다.,Korean
+메슥거림의 정도가 어느 정도인가요?,Korean
+결핵 치료 이력이 있나요?,Korean
+현재 간염 치료는 어떻게 받고 있나요?,Korean
+네. 사출성 구토가 있는 경우 먹은 음식을 소화시키기 어려워 식��� 저하가 함께 동반되기 쉽습니다.,Korean
+네 이번 입원 포함해서 다 알려주세요.,Korean
+"그런 건 이상 없는데 소변볼 때 너무 아파요.
+",Korean
+네. 해외에서도 코로나가 문제가 돼서요.,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+아니요 주사 말고 알약 물약처럼 약을 말하는 거예요.,Korean
+심계항진 증상을 설명해 주실래요?,Korean
+삼십팔도로 발열이 있습니다. 설사를 하지 않으셨다면 다른 감염 원인도 생각해 봐야 할 것 같습니다.,Korean
+객담이 많은 거 같나요?,Korean
+"소고기 알레르기가 있어서 빼 주세요.
+",Korean
+간염을 앓은 지 얼마나 되셨죠?,Korean
+"애가 헬멧을 쓰고 있었는데 자전거가 옆으로 넘어지면서 머리 먼저 박고 그다음에 어깨 팔꿈치 다리 이렇게 다쳤어요.
+",Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+추후에 트라우마가 생기진 않을지 잘 지켜봐 주세요.,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+통증이 어떤 식으로 나타나나요?,Korean
+하루 소변 횟수가 얼마나 됩니까?,Korean
+심장이 유독 빨리 뛰는 느낌이 있나요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+네 손과 피부에는 많은 세균이 있기 때문에 긁으면 상처가 생기면서 세균이 들어가 염증을 유발할 수 있습니다.,Korean
+"눈이 안 떠질 정도로 진물이 났어요.
+",Korean
+"네. 평소랑 변 색깔이 달라요. 평소보다 색깔도 많이 까맣고 속도 아파요. 쓰리고 토할 것 같아요.
+",Korean
+복부가 부은 느낌이 있나요?,Korean
+약품 확인은 환자분의 현재 건강상태 파악을 위해 필요한 사항입니다.,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+혈압을 떨어트리는 약은 드시나요?,Korean
+배 통증 부위가 어딘가요?,Korean
+당뇨를 진단받은 가족분이 계신가요?,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+네 검사 후 필요하다면 약을 변경하도록 하겠습니다.,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+최근 체중이 많이 감소하신 편인가요?,Korean
+팔이 많이 조이는데 괜찮은 건가요?,Korean
+구역질하는 느낌이 들기도 하세요?,Korean
+네 구급차로 오셨어요. 도와주셨던 분은 응급실에서 확인할 수 있습니다.,Korean
+간호사 콜 버튼이 여기 있는지도 몰랐어요.,Korean
+이상이 있는 경우는 드뭅니다. 하지만 심한 복통이 지속되거나 대량 혈변이 있는 경우 즉시 내원하세요.,Korean
+대변을 보는 일이 힘드나요?,Korean
+심장이 급하게 뛴다는 느낌이 있나요?,Korean
+가래 증상이 많이 심각하다고 느끼시나요?,Korean
+시원하게 대변이 안 나오시나요?,Korean
+처음 아팠던 날 기억나세요?,Korean
+기침을 많이 한 경우 가슴 근육이 땅기고 아플 수 있습니다.,Korean
+네 수술 끝날 때 오시는 게 좋습니다.,Korean
+제일 아픈 곳 말씀해주세요.,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+씨티와 엠알아이 판독결과 나오면 의사선생님이 다시 설명해주러 오실 거에요.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+담배 피운 기간이 어느 정도 되세요?,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+벽 반대쪽을 보고 계시면 키와 몸무게 측정 도와드릴게요.,Korean
+건강한 사람은 대체로 후유증 없이 회복됩니다.,Korean
+"아 저 오른쪽 어깨가 움직일 때마다 통증이 있어서요.
+",Korean
+최근에 혈뇨가 처음 나온 것이 언제인지 말씀해 주세요.,Korean
+어떤 식으로 통증이 느껴지나요?,Korean
+"저희 집 고양이가 팔을 할퀴어서 상처가 났어요.
+",Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+호흡하기 힘들 때가 많나요?,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+결핵 치료를 목적으로 드시는 약이 있나요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+위내시경 검사를 오일 날 하셨네요. 우선 피검사랑 엑스레이는 특별한 소견이 없네요.,Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+당뇨약 드시는 거 뭔가요?,Korean
+보통 수술 후 일주일 정도가 되면 많이 호전되십니다.,Korean
+복용 중인 약 꼭 보여주셔야 해요.,Korean
+약은 따로 보관해 드릴게요.,Korean
+통증이 주에 몇 번 있나요?,Korean
+구토가 나아질 기미가 있나요?,Korean
+기침 소리가 어떻게 나오나요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+현재 가족 중에 유전성 질환을 치료 중인 분 있나요?,Korean
+피부 알레르기 반응으로 호흡곤란이 유발되기도 합니다.,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+약품 확인 후 바로 드릴게요.,Korean
+올해는 예방 접종한 것 자체가 없어요.,Korean
+군대에서 허리를 삐끗한 후 허리 디스크를 달고 살고 있습니다.,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+처음 알레르기 반응이 나타난게 언제였나요?,Korean
+입원이나 수술하신 것 다 알려주시면 감사하겠습니다.,Korean
+상급종합병원이 아닌 작은 병원으로 가셔도 됩니다.,Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+자연분만했고 입원하다 산후조리원에서 몸조리했어요.,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+열이 나거나 주사 부위에 통증이 있거나 머리가 아프거나 그런 거요.,Korean
+수액 양을 줄여 드릴게요. 나아지는지 확인해서 말씀해 주시겠어요?,Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+"아이 소변에 거품이 껴요.
+",Korean
+입맛이 없어서 식사를 잘 안 하시나요?,Korean
+피가 소변에 섞여 나옵니까?,Korean
+간단한 시술로 끝날 수도 있지만 환자가 이십사 개월 된 아기이기 때문에 응급상황을 대비하고 시행하는 게 좋겠습니다.,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+통증이 느껴지는 부위가 있나요?,Korean
+네. 외래 검사비에 포함됩니다.,Korean
+간염으로 처음 진료 받은 날이 언제인가요?,Korean
+목 이 외에 다른 부위에도 통증이 있으신가요?,Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+"네. 붓기가 조금 있어서 찜질했더니 가라앉았어요.
+",Korean
+종교 때문에 수혈이 힘들 것 같습니다.,Korean
+피를 토해서 놀라신 적 있나요?,Korean
+"애가 점점 열이 오르더라고요.
+",Korean
+뇌척수액에 대한 검사는 현재로서는 다른 검사법이 없습니다.,Korean
+"급성 방광염인 것 같아요.
+",Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+"목이 아파 걱정돼서 왔습니다.
+",Korean
+지금 혹시 변비가 있나요?,Korean
+"설사 한 적은 없었어요.
+",Korean
+병원 직원은 환자 개인정보를 열람할 수가 없습니다.,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+유전성 질환으로 치료받은 적이 있는 가족이 있다면 알려주세요.,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+일에서 십점 중 통증 점수를 매겨주실 수 있나요?,Korean
+"네. 전반적으로 왼쪽 팔다리에 힘이 빠지는 느낌이 있어요.
+",Korean
+음식 먹고 알레르기 일으킨 적 있을까요?,Korean
+평소에도 속이 울렁거리는 증상이 있나요?,Korean
+알레르기 반응이 언제 보이나요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+몸에 열 기운이 느껴지세요?,Korean
+간염 치료 기간이 어떻게 되나요?,Korean
+이 병원 처음 왔을 거예요.,Korean
+어떤 알레르기 가지고 계시나요?,Korean
+과거에 간염 치료를 받은 적이 있으신가요?,Korean
+혹시 가래는 주로 삼키시나요? 아니면 뱉으시나요?,Korean
+통증이 몇 단계 정도 되나요?,Korean
+대변을 보고 싶으시다면 혼자 가셔도 괜찮습니다.,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+동네 병원도 무관하지만 당분간 상처가 어느정도 치료될 때까지는 상태를 보기위해 저희 병원으로 내원하시는 걸 추천 드립니다.,Korean
+"매운 걸 먹은 것도 아닌데 위장이 타는 것처럼 쓰려요.
+",Korean
+몸에 바르고 있는 약이나 화장품이 있을까요?,Korean
+네 약물 이름 알고 계시면 알려주세요.,Korean
+네. 입원을 특히 많이 했죠.,Korean
+잠을 푹 주무실 수 없나요?,Korean
+지금 혹시 변비가 있나요?,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+결핵을 주의하라는 이야기를 들어보셨나요?,Korean
+말씀드렸다시피 도수정복은 실패할 확률도 있습니다. 만약 손으로 만져 밀려 들어가지 않으면 수술로 탈장 된 부위를 교정해야 완치가 됩니다.,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+전체적인 구강 체크를 위해 엑스레이를 통해서 확인하는 것도 좋아요.,Korean
+시작한 나이뿐 아니라 음주량과 횟수 등도 함께 고려합니다.,Korean
+어떨 때 구토를 하나요?,Korean
+이 주 전에 타 병원 방문한 적 있을 겁니다.,Korean
+다리가 아프거나 저리는 증상이 있으신가요?,Korean
+최근 ���안 체중에 심한 변화가 있나요?,Korean
+입원 지시가 났으니 보호자분께서는 원무과에서 입원 수속을 해주시기 바랍니다.,Korean
+네. 외가 쪽으로 당뇨가 있으세요.,Korean
+하루에 피우는 담배는 얼마큼이죠?,Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+대부분 마취크림으로 충분합니다 통증 예방에 도움이 됩니다.,Korean
+목에 아픈 증세가 있나요?,Korean
+통증이 늘 같은 현상으로 오나요?,Korean
+배뇨 곤란이 언제부터 있었는지 궁금하네요.,Korean
+발기 지속시간이 얼마나 돼요?,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+병원에서 결핵 치료 중이신가요?,Korean
+우선 수술보다는 상부위장관 내시경 검사를 통해서 출혈 여부와 정도를 확인하고 필요시 지혈을 하는 것이 필요합니다.,Korean
+하루에 얼마나 많이 피운다고 생각하세요?,Korean
+육안적 혈뇨가 있는 경우 비뇨기계에 중대한 질환이 있을 가능성이 높으므로 반드시 검사가 필요합니다.,Korean
+지금 다른 곳 불편한 곳은 없으신가요?,Korean
+저희가 어떤 약을 드시고 계신지 알고 있어야 해서요.,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+통증이 생기면 가라앉기까지 얼마나 걸리나요?,Korean
+입원 외에 진찰이나 치료를 받기 위해 병원에서 방문한 곳을 말합니다.,Korean
+네 수술 전에 무조건 쓰셔야 해요.,Korean
+배에 가스가 차서 힘드신가요?,Korean
+담배 피운 지 얼마나 되셨나요?,Korean
+마찬가지 이유로 침상 난간도 항상 올려주세요.,Korean
+전신 마취는 아니었던 것 같아요.,Korean
+가족 중에 고혈압이 있는 분이 계신가요?,Korean
+"기침을 심하게 하다가 허리를 삐끗해서 왔어요.
+",Korean
+암모니아 수치가 높아서란 말은 지금 처음 듣네요.,Korean
+"수술 몇 시에 해요?
+",Korean
+"어금니보다 안쪽에 있는 이에 음식물이나 칫솔이 닿으면 아픕니다.
+",Korean
+"네. 수면의 질은 높은 편이에요.
+",Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+"복부 팽만이 조금 있는 것 같아요.
+",Korean
+어젯밤에 수면제 먹고 잤어요.,Korean
+일상생활이 가능하려면 최소 일주일은 입원해서 회복하셔야 합니다.,Korean
+지속적으로 압력이 가해져서 피부와 그 밑에 있는 조직에 손상이 생기면 피부가 벗겨지거나 궤양이 생길 수 있고 심하면 뼈까지 노출될 수 있습니다.,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+다음 추가 검진 때 뵙겠습니다.,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+이 밖에 다른 알레르기 있으실까요?,Korean
+"네. 혈변도 누고 배도 조금 아팠어요.
+",Korean
+"설사는 여태 딱 한 번 했던 것 같아요.
+",Korean
+통증 때문에 일부러 소변을 안 보신 적이 있나요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+네. 이제 다 끝나셨고요. 혈압이랑 체온 체크하시고 나서 식사하시면 됩니다.,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+약물에 혹시 알레르기 있으세요?,Korean
+네. 근데 지금 수액이 막 떨어지는데 괜찮나요?,Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+네. 진료기록 보시면 나와요.,Korean
+얼마나 자주 가래를 뱉나요?,Korean
+그래도 숨이 잘 안 쉬어지는데요.,Korean
+최대한 수술 없이 끝낼 수 있으면 좋겠어요.,Korean
+간염은 얼마 동안 치료받으셨나요?,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+알레르기 진단은 언제 받으셨나요?,Korean
+통증이 며칠 간격으로 찾아오는 건가요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+목에 통증 있은지는 얼마나 되셨어요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+애완동물 털이나 배설물로 인해서 비염 증상이 악화될 수 있기 때문에 앞으로도 집에 애완동물은 안 키우는 걸 권장합니다.,Korean
+"전혀 삼킬 수가 없어요.
+",Korean
+아니요 민간요법보다는 의학적인 치료법이 정확한 거니까요.,Korean
+"아. 저 귓불 부분이 간질간질하고 이 부분이 수포가 있는 것 같아요.
+",Korean
+목 구멍 쪽엔 통증이 계속되나요?,Korean
+그때부터 계속 알레르기를 갖고 계신 거죠?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+수술로 치료하면 건강하게 일상생활이 가능합니다.,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+요새 몸이 많이 피곤한가요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+통증 지속 기간을 말씀해 주실래요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+잠을 푹 주무실 수 없나요?,Korean
+"식도에 무슨 문제가 생겼다고 했는데 기억이 안 나네요.
+",Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+아마 키는 백육십일이고 몸무게는 육십 정도일 거예요.,Korean
+혈압 맥박 호흡 체온 모두 기계를 이용해서 이루어지게 됩니다.,Korean
+소변이 계속 조금씩 나오나요?,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+약마다 복용 방법이 다릅니다.,Korean
+소변을 자주 보는 것은 생명에 큰 지장은 없으나 이로 인하여 일상생활에 어려움을 겪고 있다면 적극적인 치료를 요합니다.,Korean
+입원을 해서 치료나 수술을 받은 적 있으십니까?,Korean
+암 질환을 가진 가족분들 있나요?,Korean
+팔 전체가 가려운 건 여러 가지 원인이 있을 수 있는데 먼저 검사부터 하고 말씀드릴게요.,Korean
+진드기 알레르기 같은 다른 알레르기가 있나요?,Korean
+결핵 치료용으로 복용 중인 약이 있을까요?,Korean
+담배 하루에 몇 갑 피나요?,Korean
+몸에 계속 열이 나나요?,Korean
+네 여러 가지 증상들이 복합적으로 나타나는 경우가 있습니다.,Korean
+헌혈은 해당 안 돼요.,Korean
+네 혹시나 수혈이 필요한 상황이 있을 수 있어 물어보는 거예요.,Korean
+가족 중에 암을 진단 받으신 분이 계신가요?,Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+"네. 그전엔 잘 자다가 아픈 이후로는 못 잤어요.
+",Korean
+병원에 입원하시거나 수술받으신 경험 있으신가요?,Korean
+야간 근무자분들은 수면 장애를 비롯해서 다양한 질환에 걸릴 위험이 높아요.,Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+출혈 부위를 명확하게 구분하기 위함입니다.,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+통증이 얼마 만에 한 번씩 느껴지나요?,Korean
+몸이 부은 것 같은 느낌이 있나요?,Korean
+삼 개월이 지나야 수술할 수 있습니다.,Korean
+수액 연결하면 처음에는 어지러우실 수 있어요.,Korean
+고혈압과 관련하여 받은 치료는 모두 알려주세요.,Korean
+다른 원인에 의해 저린감이 있을 수도 있습니다.,Korean
+배가 좀 평소보다 빵빵하신 것 같긴 했어요. 구토는 모르겠구요.,Korean
+잠을 잘 자지 못하시나요?,Korean
+배가 더부룩하신 느낌이 드세요?,Korean
+검사받을 환자 수가 몇 명인지에 따라 다릅니다.,Korean
+두드러기나 수포가 올라오진 않으셨나요?,Korean
+호흡곤란 증상이 자주 나타나나요?,Korean
+심각한 정도를 바로 말씀드리기는 어려우므로 상부위장관 내시경 검사가 필요합니다.,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+피가 섞인 대변을 보고 있으신가요?,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+몸에 붓기는 차도가 있나요?,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+몇 분 단위로 통증이 지속되고 있나요?,Korean
+팔다리가 많이 부어서. 이 주 정도 입원해서 치료받은 적이 있어요.,Korean
+통증이 오는 곳이 있나요?,Korean
+최근 체중이 얼마나 늘었나요?,Korean
+설사를 보시고 나면 속은 좀 어떠세요?,Korean
+당뇨라고 들으신 적이 있나요?,Korean
+다른 종류의 진통제를 놔드릴게요.,Korean
+과거에 담배를 얼마나 피셨는지가 중요해요.,Korean
+간염 얘기는 언제 들으셨나요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+"갑자기 밥 먹다가 이가 뚝 부러져 버렸네요.
+",Korean
+위암 발생률은 낮고 약을 복용하면 치료할 수 있습니다.,Korean
+신체 진찰로는 충분치 않아 초음파와 복부 씨티 검사가 필요할 수도 있습니다.,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+검사받아보셔야 확실히 알 수 있겠네요.,Korean
+일단 응급처치 후 손상 정도를 확인해 볼 겁니다.,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+하루에 설사를 몇 번 했나요?,Korean
+어느 쪽이 안 좋아서 내원하신 건가요?,Korean
+여기 보시면 음낭 쪽에 물이 고여 부풀어 올라 있는 것이 있는데 이것이 음낭 수종이에요.,Korean
+출산 당시에 선생님께서 자연분만해도 된다고 하셔서 자연분만했어요.,Korean
+약을 꾸준히 챙겨 드시나요?,Korean
+진단이 필요할 것 같아요.,Korean
+네 언제부터 기침이 있으셨나요?,Korean
+통증을 처음 느낀 게 언제죠?,Korean
+무릎에 부종이 있으면 아무래도 굽히기 힘듭니다.,Korean
+결핵 백신 접종을 하셨나요?,Korean
+한 번에 잠에 들기가 어려우실까요?,Korean
+드시는 약은 병원에서 처방받으신 건가요?,Korean
+몇 월부터 아프셨던 거예요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+과거에 암 진단을 받으신 적이 있나요?,Korean
+마지막으로 주사 맞은 병원에 전화해서 문의해보세요.,Korean
+부위에 자외선 노출 시 색소침착이 있을 수 있습니다.,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+가족 중에 당뇨를 가지신 분이 있는지 알려주세요.,Korean
+통증이 가장 잘 느껴지는 부위가 어디예요?,Korean
+네. 아침에도 약 먹고 왔어요.,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+검사 전에 식사를 하시면 결과에 오류가 발생할 수 있습니다.,Korean
+네. 얼마 전에 세미나가 있어서 해외에 갔다 오긴 했습니다. 접종은 다음 주에 맞을 예정이고요.,Korean
+소변볼 때 출혈이 있나요?,Korean
+"침 삼킬 때마다 목이 너무 따가워요.
+",Korean
+아토피 치료를 받으신 적이 있나요?,Korean
+알레르기 현상을 불러 일으키는 것을 알러젠이라고 합니다.,Korean
+현재 다양한 질병에 제대혈 임상이 진행되고 있으며 산모가 판단하여 신청하시면 됩니다.,Korean
+소화불량 증상이 있었는지 알려주시겠어요?,Korean
+"근래 들어 몸이 붓고 두통이 심해요.
+",Korean
+네 약간 뽑아서 주로 빈혈이나 다른 피수치를 확인하려고 합니다.,Korean
+담배 대신 껌 씹으시는 걸 추천합니다.,Korean
+"왼 손목이 힘이 안 들어가고 컵을 못 쥐겠어요.
+",Korean
+검사 결과는 그렇게 나왔네요.,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+이동식 혈압 측정기 들고 찾아가겠습니다.,Korean
+입원 지시가 났으니 보호자분께서는 원무과에서 입원 수속을 해주시기 바랍니다.,Korean
+간염약은 꾸준히 복용 중인 거죠?,Korean
+"좀 오래 자요 열다섯 시간 정도예요.
+",Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+학교에 낼 진단서 부탁드립니다.,Korean
+통증이 어떤 형태로 옵니까?,Korean
+혈당 체크를 매일 하는 편인가요?,Korean
+담배도 피우시면 안 됩니다.,Korean
+배에 어느 부위가 제일 아픈지 알려 주세요.,Korean
+아무래도 집에서 하는 소독은 감염 위험성이 큽니다.,Korean
+물 마실 때 목이 아픈가요?,Korean
+"길을 가다가 갑자기 토를 하시더니 쓰러지셔서 병원으로 데리고 왔어요.
+",Korean
+흡연 시작 연령을 기억하세요?,Korean
+토할 거 같은 느낌이 들면 말해주세요.,Korean
+우선 충수돌기염 치료를 위해 항생제를 사용해야겠습니다.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+자주 울렁거림을 느끼시는 건가요?,Korean
+그뿐만 아니라 필수 예방접종도 포함해서요.,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+소변에 피가 많이 섞여 나온다고 생각하세요?,Korean
+처음에 응급실로 오신 건 아니죠?,Korean
+귀 뒤에 통증이 있나요?,Korean
+사 주 이내에 진료받은 병원이 있는지 알아야 해서요.,Korean
+소변을 잘 못 보시나요?,Korean
+한의원 방문 외에 개별적으로 지인에 의해 진행하거나 했던 경험은 없으신가요?,Korean
+"변을 보면 기름이 살짝 떠요.
+",Korean
+자세가 안 좋아서 허리도 아프죠.,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+먹으면 알레르기 올라오는 음식이 있어요?,Korean
+네. 얼마 전 당뇨 판정받았어요.,Korean
+황달 증상이 심해지면 얼굴 전신에서 관찰됩니다.,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+금방 확인하실 수 있잖아요? 챙겨 먹어야 하는 약이 있으니 오전 중에 돌려주셨으면 좋겠어요.,Korean
+부모님이나 친척 중에 암이신 분 있으신가요?,Korean
+통증을 점수로 하면 몇 점 정도 느껴지나요?,Korean
+매일 상처를 살펴보면서 치료 받게 됩니다.,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+하루에 소변보는 횟수가 어떻게 되나요?,Korean
+아니요. 우선은 병실로 이동 하고 병실에서 안정을 취하시면 됩니다.,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+"오른쪽 다리에 감각이 없어요.
+",Korean
+구토 때문에 음식을 못 드시는 정도인가요?,Korean
+혈압만 조금 높게 나오네요.,Korean
+어떤 부위 검사를 받고 싶으세요?,Korean
+체온은 정상이에요 혈압이 저혈압이시네요.,Korean
+하루에 한 갑 이상 피우나요?,Korean
+알레르기 치료 하신 지 오래되셨나요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+대변검사 일정은 좀 미뤄도 될까요?,Korean
+오한을 느꼈는지 알려 주세요.,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+맹장���에 동반되는 다른 증상들은 없으셨나요? 가스가 찬다거나 배가 부푼다거나 등등이요.,Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+네. 혹시 병실 몇 인실인가요?,Korean
+현재 앓고 계신 질병 있으세요?,Korean
+"다른 증상 어떤 거 말씀이세요?
+",Korean
+예전에 아파서 병원에서 치료받은 적이 있나요?,Korean
+몸에 열이 나거나 뜨겁지 않나요?,Korean
+"그저께부터 혈변을 보기 시작했어요.
+",Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+입으로 피가 나온 적이 있으신가요?,Korean
+정기적으로 결핵 치료를 하신지는 얼마나 되셨나요?,Korean
+침 삼킬 때 아픈가요?,Korean
+"당뇨병 약물치료를 몇 년째 받고 있는데 저혈당이 오면 식은땀이 날 때가 있습니다.
+",Korean
+오한이 든 건 아니고요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+호흡하실 때 불편하신 점은 없으세요?,Korean
+알러지 치료는 언제 시작하셨어요?,Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+당뇨로 고생했던 가족분 계신가요?,Korean
+저희 병원을 어떻게 방문하게 되셨나요?,Korean
+네 결과지를 가져오시거나 혈액 검사를 하시거나 선택하셔야 합니다.,Korean
+"소변은 평소랑 다름이 없는데 가끔 거품이 좀 보여요.
+",Korean
+불면증을 겪으신 지 얼마나 오래되었죠?,Korean
+결핵 때문에 병원에 방문하셨어요?,Korean
+항암 치료제를 복용 중이신가요?,Korean
+그 외 다른 알레르기 유발 요인이 있을까요?,Korean
+아까 계절이 바뀌면서 증상이 심해졌다고 하셨는데 꽃가루 알레르기도 있나요?,Korean
+시작한 나이뿐 아니라 음주량과 횟수 등도 함께 고려합니다.,Korean
+소독을 무조건 해야 해요.,Korean
+환자분의 건강 상태를 확인하기 위한 질문입니다.,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+환자 등록 팔찌 확인하겠습니다.,Korean
+친할머니 외할머니 두 분 다 당뇨가 있으셨어요.,Korean
+흉부에서 통증이 크게 느껴지나요?,Korean
+호흡 문제는 뭐가 있죠?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+과거 진단받은 질환이 있으신가요?,Korean
+흔한 부작용이 아니니 걱정마시고 증상 발현 시 말씀주세요.,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+재활 치료 때문에 계속 병원 다녔는데.,Korean
+"기름진 음식은 피하고 있어요.
+",Korean
+네 혹시 두통이 있으신가요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+그저께 감기 때문에 검사 권유해서 받았어요.,Korean
+손목 때문에 진통제 먹은 거 빼고는 없어요.,Korean
+의료진도 항상 회복실에 상주하며 아이를 보고 있을 것인데요?,Korean
+약물이나 음식 말고 알레르기가 있을까요?,Korean
+코로나 바이러스가 있기에 전부 말씀해 주셔야 합니다.,Korean
+아니요 입원 경험 없음으로 체크해 놓겠습니다.,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+상처가 깊어서 그 정도로 필요할 것 같아요.,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+결핵 치료는 잘 되었나요?,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+수술 경력이 있다면 말해 주세요.,Korean
+참고해야 할 병력이 있을까요?,Korean
+통증의 지속 여부를 말씀해 주시겠어요?,Korean
+네. 사십 세 이후 육안적 혈뇨의 경우 요로계 암에 의한 혈뇨 가능성이 있으므로 반드시 검사가 필요합니다.,Korean
+"딱히 그런 건 아니고 그냥 일반적인 기침 소리였던 것 같아요.
+",Korean
+진통제 필요하면 추가 처방 드릴 수 있어요.,Korean
+치료를 받지 않으면 빨리 낫지 않을 겁니다.,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+"소리가 잘 안 들려서 몇 번을 되물어야 해요.
+",Korean
+암 증상이 의심된 게 언제부터인가요?,Korean
+네 수술치료 후 예후가 좋은 질환입니다.,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+"어쩔 때는 일주일 동안 변을 못 본 적도 많아요.
+",Korean
+두통을 느끼신 적이 있으신가요?,Korean
+기본적으로 혈액검사를 하고 의식이 명확하지 않으셔서 머리에 문제가 있는지 시티도 찍으실 것 같은데 진행 하실 건가요?,Korean
+거품뇨는 사람마다 정도가 다르기 때문에 정확한 양을 측정하기는 어려우며 평상시보다 거품이 많이 나오거나 일정 시간이 지나도 거품이 없어지지 않는 경우를 말합니다.,Korean
+손목 때문에 진통제 몇 알 먹은 거 말곤요.,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+질환으로 인하여 꾸준히 복용 중인 약이 있으신가요?,Korean
+언제부터 다른 부위 통증이 ��으셨나요?,Korean
+환자분 보호자께서 지금 방금 연락 주셨었고요. 바로 병원으로 오신다고 하셨습니다.,Korean
+복부에 가스 찬 느낌이 있진 않나요?,Korean
+당뇨 앓으신 지 얼마나 되었나요?,Korean
+다른 질병이 있는지 확인 차 여쭈어보는 겁니다.,Korean
+갑작스럽게 뿜어져 나오는 듯한 구토를 말합니다.,Korean
+얼마 동안 아팠다가 괜찮아지나요?,Korean
+하루에 흡연은 몇 번 하세요?,Korean
+최근에 체중이 눈에 띄게 빠진 적 있나요?,Korean
+신체적인 반응이나 부작용이 일어났었나요?,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+꼭 내원을 해야만 하나요?,Korean
+처음으로 결핵 진단받으셨던 적이 언제인가요?,Korean
+초음파 외에는 일반적인 검진 정도의 검사가 이뤄집니다.,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+암을 진단 받으신 적 있나요?,Korean
+제가 다른 병원 식당 영양사라 매일 다른 병원에 가요.,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+네 이전에 예방 접종 후 이상 반응이 있었던 적 있나요?,Korean
+토혈을 하고 통증이 있나요?,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+간염으로 아팠던 시점을 기억하세요?,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+숨 쉴 때도 갈비뼈가 아픈가요?,Korean
+설사를 얼마나 자주 하시나요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+"어깨에 힘이 잘 안 들어가요.
+",Korean
+어쩔 수 없이 추가 검사를 해야 합니다.,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+네 헬리코박터균 감염이 있을 시 제균치료가 필요합니다.,Korean
+암으로 병원 다니시는 가족 있으세요?,Korean
+"아니요. 어느 순간부터 수면 시간이나 패턴이 일정해 본 적이 없어요.
+",Korean
+두근거림이 안정 시에도 있나요?,Korean
+장 천공으로 수술하신 적 있습니다.,Korean
+최근에 체중 변화가 생긴 이유가 있으신가요?,Korean
+"제가 이십 대일 때부터 피웠으니 이십 년은 넘었네요. 하루에 한 갑 정도만 피우는 편이에요.
+",Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+"배에 가스가 가득 찬 거 같아서 왔어요.
+",Korean
+가슴이 갑자기 너무 급하게 두근거린 적이 있나요?,Korean
+응급실은 언제든 가도 되는 거죠?,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+고혈압으로 병원에 가신 적 있나요?,Korean
+네. 내시경 끝나고는 위에 부담이 될 수 있어 죽 드시는 것을 추천드립니다.,Korean
+하루에 담배를 몇 갑 정도 피우시나요?,Korean
+약은 몇 개월이나 드셨어요?,Korean
+욕창이 안 생기도록 체위 변경 자주 해주시고 신경 써 주시면 피부 재생 속도도 빠를 겁니다.,Korean
+퇴원 전까지 계속 수액을 맞으셔야 됩니다.,Korean
+드시는 간염약 약품명 아시나요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+초기 이유식부터 단계별로 아기가 적응할 수 있도록 시작하시면 됩니다.,Korean
+피 섞인 변을 보신 적 있으세요?,Korean
+우선 통증이 있으니까 이렇게 진행하도록 하십시다.,Korean
+연고를 수시로 바르시고 차가운 걸로 살짝 대서 간지러움을 완화시켜 보세요.,Korean
+암 진단을 최초 언제 받았나요?,Korean
+종양 수술이나 치료를 받은 가족이 있으신가요?,Korean
+"무기력하고 삶의 의지가 없어요.
+",Korean
+"주먹을 휘두르다가 유리창에 다쳤어요.
+",Korean
+목이 많이 부은 것 같은데요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+소화가 잘 안 돼서 아프신가요?,Korean
+아이 상태는 의사분께서 직접 설명해주실 예정입니다. 자리에 머물러 주십시오.,Korean
+병원 규정대로 환자 확인 시에는 이름과 주민등록상 생년월일과 환자 번호로 확인하고 있습니다.,Korean
+결핵 관련해서 예방 접종하신 적 있을까요?,Korean
+애완견과 관련된 접종은 어느 것이든 말씀해 주시면 됩니다.,Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+발기 부전을 느끼고 계신가요?,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+"계속 애가 설사를 해서요.
+",Korean
+장폐색으로 인한 구토라면 약물 치료보다 다른 방법을 고려해 봐야 합니다.,Korean
+잠을 잘 못 자서 힘드신가요?,Korean
+알고 계신 음식 알레르기 있으면 알려주세요.,Korean
+당뇨 진단 받으신적 있으신가요?,Korean
+기침 외에 다른 증상은 없나요?,Korean
+"왼쪽은 버틸만한데 오른쪽은 너무 심하게 저려서요.
+",Korean
+진통제만 뺀 거라 처방 받은 약은 다 ��셔야 합니다.,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+제가 지금 손을 다쳐서 대신 작성 부탁드려도 될까요?,Korean
+한약 포함해서 말씀해 주세요.,Korean
+당뇨 치료는 언제부터 받으신 거예요?,Korean
+여러 가지 원인에 의하여 몸속 빌리루빈이 상승하여 몸이 노랗게 변하며 가려움증 등을 동반합니다.,Korean
+지금 가족분 중 유전성 질환으로 치료 중인 분이 계신가요?,Korean
+두들겨 맞은 듯한 통증인가요?,Korean
+가족분들 중에 고혈압으로 고생하시는 분 있나요?,Korean
+새벽 세 시 타이레놀 먹였어요.,Korean
+아니요 빈혈 안 옵니다.,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+가족 중에 당뇨 환자가 혹시 있을까요?,Korean
+알레르기로 고생했던 음식이 있나요?,Korean
+"열이 조금 있어서 그런가 잠투정이 심했어요.
+",Korean
+간호사는 바로 앞에 간호사 스테이션에 있어요.,Korean
+복부 팽만감이 자주 생기나요?,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+토혈 경험 여부를 말씀해주세요.,Korean
+아이가 편안하게 숨 쉴 수 있도록 앉은 자세로 두세요.,Korean
+다들 몸 관리 열심히 해서 건강합니다.,Korean
+약품 확인은 환자분의 현재 건강상태 파악을 위해 필요한 사항입니다.,Korean
+알레르기 때문에 피해야 하는 것이 있으세요?,Korean
+아니요 빈혈 안 옵니다.,Korean
+숨이 깊게 안 쉬어지시나요?,Korean
+소화제를 먹어도 소화불량이 계속되나요?,Korean
+식사량이 평소보다 많이 줄었나요?,Korean
+당뇨와 관련해서 처방받으신 약이 있으신가요?,Korean
+어렸을 때부터 혈당이 높은 편이었나요?,Korean
+당뇨약도 같이 먹긴 했어요.,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+급성 담낭염으로 일주일 전에 수술을 한 적이 있어요.,Korean
+필수는 아니지만 위생 상 일회용품을 사용하는 게 더 안전할 겁니다.,Korean
+혈뇨가 언제 시작되셨는지 말씀해 주시겠어요?,Korean
+복부에 많은 고통이 동반되나요?,Korean
+간염 증상이 이전에도 있었나요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+그렇군요 구급차로 입원하셨다고 알겠습니다.,Korean
+다른 데서 고혈압이라고 진단받으신 적 있으세요?,Korean
+당뇨로 병원에서 꾸준히 치료받고 계신가요?,Korean
+수술 여부를 확인하는 것입니다.,Korean
+따로 알레르기 있는 음식 있으신가요?,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+당뇨 환자가 집에 더 있으신가요?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+"오른쪽 발목 인근이 다 아파요.
+",Korean
+가족 중에 고혈압이 있는 분이 계신가요?,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+증상이 시작된 게 언제부터예요?,Korean
+배에 있는 가스 때문에 일상생활이 불편하신가요?,Korean
+당뇨약 꾸준히 복용하시고 당 조절이 잘 되면 의사 선생님이 집에서 검사하는 횟수를 조금 줄여도 될 거라고 할 거예요.,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+여기 보시면 음낭 쪽에 물이 고여 부풀어 올라 있는 것이 있는데 이것이 음낭 수종이에요.,Korean
+고혈압 관련 약은 어떤 거 복용 중이신가요?,Korean
+심장이 튀어나올 듯이 뛰나요?,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+통증이 있다 없다 반복하나요?,Korean
+검사 결과는 내일 오전에 나올 겁니다.,Korean
+갑각류 알레르기 이외에 다른 알레르기는 없나요?,Korean
+소변을 보고 싶을 때 자주 참나요?,Korean
+음식이나 약물 말고 다른 알레르기 반응 있는 거 있어요?,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+유전 질환 가진 식구는 없습니다.,Korean
+당뇨약 먹고 있고 전보다 확실히 낫습니다.,Korean
+알레르기 반응이 언제 보이나요?,Korean
+통증이 얼마나 가는 거예요?,Korean
+간염으로 복용하던 약 있으면 알려주세요.,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+상부위장관 내시경 검사를 시행하여 출혈 확인 한 후 실제 출혈이 있을 경우 지혈을 시도할 계획입니다.,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+진단서 더 뽑으려면 만 원의 추가 비용이 듭니다.,Korean
+암 치료를 언제부터 받으셨나요?,Korean
+약을 세 알씩 매일 드셨나요?,Korean
+최근에 급격하게 체중이 변화됐다고 느낀 적 있었나요?,Korean
+네. 그럼 일단 진료받는 것으로 하고 한번 찾아뵐게요.,Korean
+네 햇빛 알레르기도 포함입니다.,Korean
+혹시 응급 상황이라면 수술을 해야 해서요.,Korean
+환자분 틀니 보청기 렌즈 등 보�� 기구를 사용하시는 것이 있나요?,Korean
+몸이 많이 피로하다고 느끼시나요?,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+일시적으로는 그럴 수 있으나 지속되는 경우에는 검사를 해 보는 것이 필요합니다.,Korean
+당뇨가 있다는 것을 언제쯤 알게 됐나요?,Korean
+몸에 열이 있지는 않으세요?,Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+네. 지금 응급실에 진료 보고 계신 분은 안 계세요.,Korean
+종양이 있다고 진단받은 적 있나요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+어떤 질병 때문에 드시고 계신 건가요?,Korean
+언제부터 아픈 걸 느꼈나요?,Korean
+어떤 종류의 약을 드시고 있나요?,Korean
+네. 그 약 먹느라 혼났어요.,Korean
+액세서리도 다 빼고 수술복만 입으셔야 해요.,Korean
+그냥 약국에서 진통제 사 먹었어요.,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+무턱대고 가져가시면 안 되죠. 약 복용 중단으로 문제 생기면 책임 지실 거예요?,Korean
+약 냄새 때문에 어지럽다는 건가요? 약 드신 직후에 그런가요?,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+고혈압 앓던 가족이 있으세요?,Korean
+배의 어느 부위가 아프세요?,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+상처 보호 및 지혈 등에 쓰입니다.,Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+이런 증상이 생긴 지 며칠 됐나요?,Korean
+"아니요. 음식을 좀 못 삼켰어요.
+",Korean
+어떤 질병 때문에 드시는 약인가요?,Korean
+토할 때 피가 같이 나오나요?,Korean
+열이 또 오는 것 같나요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+통증이 주에 몇 번 있나요?,Korean
+고혈압으로 신경 쓰고 계신가요?,Korean
+통증의 정도는 크지 않겠지만 아이에 따라서 통증을 심하게 느낄 수 있습니다.,Korean
+암 앓은 지 얼마나 오래됐나요?,Korean
+외래 초음파 검사상 이상 있다는 말을 못 들으셨나요?,Korean
+"임신 삼십육 주차인데 갑자기 하혈이 나와요.
+",Korean
+갑상선암 의심된다고 입원해서 정밀 검사받았었어요.,Korean
+"기침 가래가 심하고 목이 아파서요.
+",Korean
+언제 처음 알레르기가 생겼어요?,Korean
+불면증이 생긴 이유가 있을까요?,Korean
+하루에 가래를 얼만큼 뱉으시나요?,Korean
+"애가 큰 고기 뼈를 삼켜버렸어요.
+",Korean
+언제부터 열감이 전신적으로 발현되시나요?,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+지금 드시고 계신 고혈압약이 있는지 알려주세요.,Korean
+"살이 급격히 빠지진 않았고 좀 야위긴 했어요.
+",Korean
+"대변볼 때마다 아랫배에 통증이 매우 심하네요.
+",Korean
+"언제부턴지 모르겠는데 저희 아가 다리 사이에 이상한 게 생겨서요.
+",Korean
+속이 많이 불편하고 울렁거리나요?,Korean
+진료기록 한 번 살펴보시겠어요?,Korean
+아니요. 아차차 영양제를 먹고 있긴 한데 그것도 약물에 속하나요?,Korean
+치아가 얼마나 있는지 제가 확인하겠습니다.,Korean
+한약 드시는 것도 말씀해 주세요.,Korean
+오한이 있는 것 같나요?,Korean
+수술이 필요한 질환이 있으셨나요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+피로가 회복이 안 되시나요?,Korean
+정확한 진단명은 검사 결과를 보고 말씀드리겠습니다.,Korean
+통증이 늘 같은 현상으로 오나요?,Korean
+복통이 함께 있지는 않았나요?,Korean
+변비가 어느 정도로 심하신 거죠?,Korean
+비염이 환절기만 되면 더 심해져요.,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+검사할 때 약물 관련 알레르기 검사도 하신 건가요?,Korean
+"배가 너무 아파서 움직일 수가 없어요.
+",Korean
+알레르기 나는 상황 알려주세요.,Korean
+심계항진 증상은 어떨 때 느끼시나요?,Korean
+당뇨로 어떤 약을 드시고 계세요?,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+최근 한 달 동안 몇 킬로 감소했나요?,Korean
+청력이 좀 안 좋아요.,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+몸이 많이 피로하다고 느끼시나요?,Korean
+거의 물 같은 변을 보셨나요?,Korean
+통증이 나타난 게 언제인가요?,Korean
+네 저희가 수면 다원 검사 외 필요시 추가 검사를 진행 하겠습니다.,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+너무 아픈데 주사량 좀 더 늘려주실 수 있어요?,Korean
+고혈압으로 쓰러지신 적 있어요?,Korean
+간염 치료 목적으로 약을 먹고 있나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+동시 접종은 문제가 되지 않습니다.,Korean
+발기 부전이 느껴지신 적은 없으신가요?,Korean
+기침약 드시고 계신 거 있으신가요?,Korean
+입원 치료한 적 있으신가요?,Korean
+과다 출혈의 경우 수혈을 받으셔야 하는데도 안 받으실 건가요?,Korean
+건강한 배변 습관에 해당합니다.,Korean
+혈뇨 시 다른 통증은 없었나요?,Korean
+이 약물은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+시력에 이상이 있거나 물체가 흐리게 보이거나 초점이 안 잡히거나 하지는 않았나요?,Korean
+지금 환자분이 가장 불편한 데를 짚어주시겠어요?,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+몸에서 거부반응 일으키는 물건이 있나요?,Korean
+이제 무슨 검사를 할 거냐에 따라 다릅니다.,Korean
+검사 결과는 일 이 주 정도 소요됩니다.,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+정확한 치료를 위해 체액 양의 측정이 필수적입니다.,Korean
+다음 추가 검진 때 뵙겠습니다.,Korean
+"새끼손가락이 잘 안 움직여요.
+",Korean
+발기부전약 드신 적은 있나요?,Korean
+담배는 하루에 몇 갑 피시나요?,Korean
+양쪽 발 다 심하게 다쳐서 휠체어로 왔어요.,Korean
+간염으로 드시는 약이 있나요?,Korean
+맥박이 비정상적으로 빨리 뛰나요?,Korean
+아직 입원 결정된 거 못 들으셨어요?,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+처음 며칠간은 매일 오시거나 입원하셔야 됩니다.,Korean
+피부 상처 치료가 더 이상 필요 없을때 안정적이라고 할 수 있겠네요.,Korean
+언제부터 간염이 있다는 걸 인지 하셨어요?,Korean
+알레르기 일으키는 원인 있나요?,Korean
+목 안이 아프다는 느낌을 받으셨나요?,Korean
+암 치료 마지막으로 받으신 게 언제예요?,Korean
+소변에 피가 함께 나오나요?,Korean
+약에 대해 알레르기가 있으신가요?,Korean
+피부 붉어짐 가려움 붓기 등 알레르기 증상을 경험한 적도 없으세요?,Korean
+토할 때 피도 나왔나요?,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+"안녕하세요. 다름이 아니라 제가 며칠 전부터 귀 부분이 좀 가렵고 물집 같은 게 잡히는 것 같더라고요. 그래서 왔어요.
+",Korean
+배에 공기가 찬 느낌이 있나요?,Korean
+임플란트나 틀니 빼고 본인 치아만 말해주세요.,Korean
+머리가 깨질 듯이 아팠나요?,Korean
+"다 아파요. 다. 머리 부터 발 끝까지.
+",Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+빈혈은 지속 적으로 있나요?,Korean
+"네. 목 안이 너무 견딜 수 없게 아파요.
+",Korean
+체중이 변했다면 얼마나 변하셨나요?,Korean
+"설사는 했었는데 멈췄고요. 배가 아프지는 않아요.
+",Korean
+고혈압약 외에 당뇨약 같은 약 드시는 거 있나요?,Korean
+민간요법과 병원 치료를 병행하는 분들이 있어서 그럽니다.,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+통증이 있는지 알고 싶어요.,Korean
+두근거림으로 불편한 느낌이 있나요?,Korean
+네 저희가 흡연력 같은 환자분의 생활 습관도 파악하고 있어야 합니다.,Korean
+식사 후에 소화는 잘되시나요?,Korean
+자궁경부암 그거 예방 접종 맞았어요.,Korean
+통증 텀이 얼마나 되나요?,Korean
+고혈압이 가족력인지 의심해 보셨나요?,Korean
+한 시간에 몇 번씩 화장실을 가는 경우는 비정상적인 배뇨 형태이므로 자세한 원인에 대한 검사가 필요합니다.,Korean
+가족 중에 고혈압이 있는 분이 계신가요?,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+한 달 동안 십 킬로나 체중이 감소했나요?,Korean
+결핵 대비로 예방 주사 맞으셨어요?,Korean
+얼굴 모양의 변형이 오면 그걸 바르게 잡아 주는 수술을 말합니다.,Korean
+환자분 맞습니다 건강 상태가 좋지 않아요.,Korean
+첫째는 자연 분만을 하신 거에요?,Korean
+"발에 가시가 박혔어요. 못 빼요.
+",Korean
+보통 혈압 잴 때 높게 나오지는 않으세요?,Korean
+일도 화상의 경우 특별한 처치 없이도 일주일 내에 낫는 경우가 많습니다.,Korean
+암으로 병원 다닌 지 얼마나 됐죠?,Korean
+근육에 무리가 와서 그런 걸 수도 있어요 선생님이랑 한 번 더 말씀하셔야 할 거 같아요.,Korean
+입원이나 수술하신 적 있어요?,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+약효가 어떤지 봐야 돼서요.,Korean
+간헐적으로 아픈가요? 지속적으로 아픈가요?,Korean
+고지혈증 당뇨 신기능 간기능 갑상선 기능 등에 대해 알 수 있습니다.,Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+당뇨로 약을 드시고 계신가요?,Korean
+먼저 침상에 누워 안정을 취하시고 두 번째로 금식을 유지하시고 세 번째로 혈액검사 소변량 검사하시면서 수액치료를 받으시면 됩니다.,Korean
+흉터가 약간은 남을 거예요.,Korean
+마취 가스가 잔류효과가 있어서요.,Korean
+어떤 상황에서 토혈을 하시나요?,Korean
+약물로 간염 치료 중이신지 말씀해 주세요.,Korean
+일단 약 복용 및 크림 도포 후 경과를 지켜보겠습니다.,Korean
+어떤 종류의 약을 챙겨 먹고 있어요?,Korean
+자녀가 셋 있는데 다 제왕절개했습니다.,Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+복부 통증이 있는데 변이 안 나오나요?,Korean
+알레르기 때문에 드시면 안 되는 약물 있나요?,Korean
+목이 건조하거나 삼키기가 힘들거나 하는 통증은요?,Korean
+네. 증상을보니 손목터널 증후군이군요. 손목을 지나가는 신경이 압박을 받아서 그런증상이 생깁니다.,Korean
+아니요 수액은 따로 놓지 않고 약을 드리고 있어요.,Korean
+어떤 혈압약을 드시고 계시죠?,Korean
+입원할 정도로 아팠던 적 있으세요?,Korean
+대부분 입원하시는 경우가 치료 또는 수술이 목적이기 때문에 전부 말씀해 주시면 됩니다.,Korean
+일단은 반복적으로 손목 움직임을 피하셔야 합니다.,Korean
+증상이 언제쯤 시작됐는지 알려 주세요.,Korean
+중간에 자의로 복용을 중단하면 항생제 내성이 생길 수 있으며 치료 실패율이 높아집니다,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+"금연했는데 술 마시면 한두 개비 피우게 되더라고요.
+",Korean
+분수처럼 뿜어내는 듯한 양상의 구토를 이야기 합니다.,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+알레르기 일으키는 다른 원인을 알고 있나요?,Korean
+설사를 하는 시기가 있나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+최근 몇 달 동안 체중의 급격한 증가가 있었나요?,Korean
+통증이 좀 강한 편이에요?,Korean
+지금 환자분 상태와 인과관계가 있는지를 판단하기 위해서입니다.,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+저희가 드리는 약을 복용하시는 게 좋을 것 같습니다.,Korean
+말씀해주신 병실 입실 가능하면 안내해드리겠습니다.,Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+"밥은 목이 아파서 못 먹었고 미음 식혀서 먹었어요.
+",Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+팔다리에는 이상한 느낌이 없나요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+유전적인 병은 집안 내력으로 이어집니다.,Korean
+입원이나 수술받으신 적 있으면 말씀해 주세요.,Korean
+체중이 급격히 늘었다는 말씀이시죠?,Korean
+지금 즉각적인 치료가 필요하지는 않으며 위암 발생 혹은 추가적인 변성 소견 확인을 위해 매년 정기적인 위 내시경 검사가 필요합니다.,Korean
+무엇 때문에 병원에 왔나요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+복용 중인 수면 보조제의 용량과 복용 기간부터 알려주세요.,Korean
+소변보는 데 불편한 점이 있나요?,Korean
+혹시 설사 자주 하셨나요?,Korean
+알레르기가 있다는 거는 언제 처음 알게되셨어요?,Korean
+두통이 언제 또 느껴진 적 있었나요?,Korean
+문제없이 허리는 잘 지키고 있습니다.,Korean
+간염이 있다는 걸 언제 아셨나요?,Korean
+날짜가 정확하지 않아도 됩니다. 무엇때문에 입원 하셨나요?,Korean
+"수면의 질이 많이 떨어졌어요.
+",Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+심장 뛰는 게 불편한가요?,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+드시는 간염약 약품명 아시나요?,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+네. 고혈압이 있어 약을 꾸준히 복용하고 있습니다.,Korean
+목이 부을 때 가라앉히려면 어떻게 하죠?,Korean
+아뇨 평소에 음주를 하시는지 말씀해 주세요.,Korean
+술은 며칠 간격으로 마시나요?,Korean
+흉부에서 통증이 크게 느껴지나요?,Korean
+수술 중 위 내용물이 역류해 환자분의 기도를 막을 수 있어요.,Korean
+독감 주사는 언제 맞았나요?,Korean
+알약으로 된 해열제요. 병원 오기 전에 먹였습니다.,Korean
+네 맞습니다. 환자분 본인도 수술부위에 대해 인지��고 계셔야 합니다.,Korean
+부분마취는 보통 더 적은 부위만을 마취하는 것입니다.,Korean
+항상 발기부전이 있으신 건가요?,Korean
+발기를 아예 못 하시는 건가요?,Korean
+종양일 수 있다는 이야기를 들어보신 적은 없나요?,Korean
+"어깨가 뒤틀리는 것 같아요.
+",Korean
+당뇨 질환으로 드시는 약이 있으면 알려주세요.,Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+혈뇨를 보신 지 오래되셨나요?,Korean
+몸에 열나는 것 같나요?,Korean
+통증이 좀 강한 편이에요?,Korean
+가족 중에 당이 높으신 분 계신가요?,Korean
+결핵 증상으로 어떤 게 나타났나요?,Korean
+네 치료와 함께 금주 금연도 해 주셔야 합니다.,Korean
+지금 측정 가능하세요 환아 몸무게는 이쪽으로 오셔서 측정하시면 됩니다.,Korean
+알레르기에 대해 알게 되신 건 언제부터였어요?,Korean
+현기증 정도를 말씀해 주세요.,Korean
+치료량이 많다 보니 마취크림을 바르더라도 치료 후 통증이 조금 심하실 수도 있습니다.,Korean
+네 병원은 전체 금연지역입니다.,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+이차 치료제는 사제 요법을 사용합니다.,Korean
+환자복이랑 침구 제공해 드려요.,Korean
+"코너를 돌던 차가 제 골반을 들이받았어요.
+",Korean
+원래는 그런 증상이 없으셨나요?,Korean
+통증 지속 여부가 어떻게 되나요?,Korean
+요즘 먹고 있는 약이 있나요?,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+혹시 약물이나 음식 외에 언제 알레르기가 나타나는지 아세요?,Korean
+"몇 주 전부터 주변에서 힘든 일이 있어 보인다는 소리를 자주 들을 정도로 살이 급격히 많이 빠졌어요.
+",Korean
+혹시 삼 일 후에 병원에 다시 올 수 있으신가요?,Korean
+가스가 차서 불편한 증상이 있으신가요?,Korean
+결핵약 매일 복용하고 있나요?,Korean
+통증의 강약을 숫자로 표현해 주세요.,Korean
+아니요. 제왕 절개가 제일 안전했어요.,Korean
+방광에 좋지 않으니 주의하셔야 합니다.,Korean
+결핵 치료를 받기 시작한 날을 말해주세요.,Korean
+"전자 담배로 바꾼 기간도 포함되나요?
+",Korean
+기침 증세가 악화하고 있나요?,Korean
+체중 변화가 급격히 일어나면 문제가 있을 확률이 커요.,Korean
+바른 뒤 햇빛에 노출되면 좋지 않으니 자기 전에 바르세요.,Korean
+"고기 오돌뼈를 안 씹고 삼켜서 걸렸어요.
+",Korean
+그랬었죠. 한동안 약 먹었어요.,Korean
+변기에 앉으면 한참 있다가 소변이 나오나요?,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+네. 오늘 아침에 잰 혈당 수치는 정상이었어요.,Korean
+가슴이 콕콕 찌르듯이 아픈가요?,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+당뇨 여부가 어떻게 되시나요?,Korean
+혈압이 어느정도로 높게 나오시나요?,Korean
+"동네 병원 가서 배가 아프다고 했더니 검사 몇 개 하고 대학 병원에 가라고 해서 오게 되었어요.
+",Korean
+혹시 많이 속이 안 좋은가요?,Korean
+네 질환마다 기침 소리가 조금씩 다릅니다.,Korean
+회복실에서 상태확인 뒤에 가실 수 있어요.,Korean
+갑작스러운 체중 변화가 있으셨나요?,Korean
+키 백육십 센티미터이고 몸무게 오십육 킬로그램입니다.,Korean
+가슴 통증이 얼마나 가는 거죠?,Korean
+요즘 변비가 있진 않으셨나요?,Korean
+"수술 부위에 노란 거 이상한 게 묻어 나와서요.
+",Korean
+혈뇨를 보신 후에 활동하기는 어렵지 않나요?,Korean
+따로 알아 둘 알레르기가 있을까요?,Korean
+혈압이 높게 나오는 편인가요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+발기가 되지 않아 부부생활이 어렵나요?,Korean
+어떤 약인지 알 수 있을까요?,Korean
+고혈압약이 많이 도움 됐나요?,Korean
+"애가 처음에 쟀을 땐 삼십팔 점오 도였고요. 그때 약을 먹여서 열이 좀 떨어졌었는데 완전히 떨어지진 않더라고요.
+",Korean
+알레르기가 있으셨으면 검사 한번 해보시겠어요?,Korean
+부부간에 성생활에 영향을 끼치시나요?,Korean
+청진할 때 옷을 올려 주시는 게 좋아요.,Korean
+통증이 어느 부위에 느껴지세요?,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+어떤 식으로 아프다 하는 게 있으실까요?,Korean
+아픔의 정도를 말로 표현해주시겠어요?,Korean
+통증이 쿡쿡 쑤시는 느낌인가요?,Korean
+어떨 때 구토를 하나요?,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+알레르기 원인이 뭐가 있죠?,Korean
+환자분��� 산부인과적 진단을 위해 필수적인 질문입니다.,Korean
+술을 얼마나 드시고 있으신가요?,Korean
+가족 중 당뇨 환자가 있나요?,Korean
+코로나 때문에 물어보는 겁니다.,Korean
+면역력이 높아야 감염도 쉽게 안 됩니다.,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+암을 치료받은 적이 있나요?,Korean
+머리가 띵한 느낌이 있나요?,Korean
+환절기에 특히 피부 가려움이 심하신가요? 완화시켜 줄 수 있는 약을 처방해 드릴 수 있습니다.,Korean
+숙면을 취하기 어렵진 않나요?,Korean
+알레르기 반응을 일으키는 음식 종류가 있나요?,Korean
+네. 수술 경험이 없어요.,Korean
+"사타구니랑 가까이 있는 허벅지도 아파요.
+",Korean
+결핵 치료를 위하여 병원을 다닌 적 있으신가요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+네. 목 수술받고 회복 중이에요.,Korean
+이 약은 식전에 드셔야 합니다.,Korean
+검사 결과를 기다리는 중이니 확인 후 말씀드리겠습니다.,Korean
+고혈압 치료는 꾸준히 받고 계신가요?,Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+최근에 몸무게가 급격히 바뀌었나요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+"비형 간염이 의심된다는 진단을 받아서요.
+",Korean
+치아 통증이 언제부터 생겼나요?,Korean
+친구분이 어떤 이동 수단으로 입원시켜주셨나요?,Korean
+복부에 가스 찬 느낌은 어떠세요?,Korean
+환의 한 장만 더 주세요.,Korean
+원래부터 알레르기를 갖고 있었나요?,Korean
+알레르기 완치가 안될 경우 평생 치료를 병행하셔야 할 수도 있습니다.,Korean
+"그제 밤에 소변봤는데 계속 마려워도 나오진 않아요.
+",Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+음주 기간 얼마나 되셨어요?,Korean
+"어제 잘 때부터 살살 아팠었는데 새벽에 아파서 자꾸 깨게 되더라고요.
+",Korean
+이제 관장하실 거예요. 바지 내려주시고 아까처럼 엎드려주세요.,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+아픈 강도를 표현하실 수 있으시겠어요?,Korean
+통증 발현 빈도가 어떻게 되세요?,Korean
+설사를 하신 경험이 있나요?,Korean
+"머리도 지끈거리고 속도 울렁거립니다.
+",Korean
+"교통사고 때문에 머리를 다쳤어요.
+",Korean
+사고당해서 입원한 적 있으세요?,Korean
+최대한 빨리 진료받아야 해서 아홉시 십분이 좋을 것 같아요.,Korean
+며칠에 한 번씩 혈변이 나타나나요?,Korean
+제대혈 은행에 보관해야 하므로 최소 분만 일주일 전에 알려주세요.,Korean
+어깨의 어느 쪽이 아픈가요?,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+네 치주가 안 좋아지면 치아를 충분히 지지해주지 못해 흔들릴 수 있습니다.,Korean
+어느 부위가 만지면 아프신가요?,Korean
+팔다리 힘이 빠지시지는 않나요?,Korean
+"탄수화물 줄이려고 밥 안 먹고 닭가슴살 한 덩이 먹어요.
+",Korean
+동시 접종은 문제가 되지 않습니다.,Korean
+끝나고 약간 호흡곤란이 있었어요.,Korean
+지금 어디가 아픈 건가요?,Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+알레르기 때문에 꺼리는 것이 있으신가요?,Korean
+언제부터 그런 증상이 있었지요?,Korean
+부작용 얘기 듣고 무서워서 한 번도 안 해봤어요.,Korean
+위암 수술 이외에는 다른 수술 하신 적 없으신 거죠?,Korean
+입원이나 수술해 본 적이 아예 없습니다.,Korean
+피가 섞인 소변을 보고 있으세요?,Korean
+고혈압은 본인만 앓고 계신 건가요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+간염과 관련해서 약을 복용한 적 있나요?,Korean
+소독 붕대는 어느 정도 진물이 더 흡수되지 못할 경우 갈아줘야 합니다.,Korean
+수술한 지 하루 지난 거라 아직 많이 아플 때에요.,Korean
+아니요. 받은 약 따로 없습니다.,Korean
+최초로 알레르기 진단받았을 때가 언제인가요?,Korean
+구토를 하신지 얼마나 되셨나요?,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+통증 속성이 어떤 식인 가요?,Korean
+처음 느낀 통증은 언제였나요?,Korean
+고혈압을 치료하기 위해 복용 중인 약물이 있나요?,Korean
+네 수유 후에 트림을 시켜주시면 아이가 편안할 거예요.,Korean
+니트로글리세린이 혈관을 확장시켜서 조금 어지러울 수도 있어요.,Korean
+가래는 잘 뱉고 있어요?,Korean
+불면증이 있는 것 같나요?,Korean
+"한의원에서 배에 침을 맞았는데 피가 안 멎어요.
+",Korean
+구토나 구역감 또는 호흡 곤란 등의 증상이 나타날 수 있습니다.,Korean
+뼈가 부러지는 바람에 철심 박았어요.,Korean
+처음 증상이 나타난 건 언제부터였을까요?,Korean
+풍진에 감염되었는지 알 수 있는 물질입니다.,Korean
+약물 치료로 부족하다면 손목 수술의 방법도 있습니다.,Korean
+"진짜 힘들 때만 피우는데 그런 날에는 하루에 다섯 개요.
+",Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+혈뇨가 점액성 인지 궁금해요.,Korean
+조영제를 사용하면 드물게 부작용이 있지만 거의 없다고 봐도 됩니다.,Korean
+발기 부전 약은 따로 안 드시나요?,Korean
+술을 언제부터 마셨는지를 알아야 음주 기간을 파악할 수 있기 때문에 중요합니다.,Korean
+직계 가족 중 유전 질환 판정받은 분이 있어요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+통증이 있는 부위가 있으세요?,Korean
+발기 부전 관련해서 치료를 받으신 적이 있나요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+심장이 비정상적으로 뛰는 것 같나요?,Korean
+네. 어제 임플란트 했어요.,Korean
+피는 보통 혈액검사 시에 하셨던 양만큼 뽑으실 거예요.,Korean
+"장이 예민해서 화장실에 자주 가요.
+",Korean
+청진이 끝날 때까지 심호흡 반복해 주세요.,Korean
+무통 주사 들어가도 아프면 어떡하죠?,Korean
+담배를 피우신 경험이 있나요?,Korean
+설사를 며칠 동안 하셨나요?,Korean
+수술 또는 입원 치료를 받은 기록이 있으신가요?,Korean
+"말씀해 주신대로예요. 정말 못 자고 있어요.
+",Korean
+가벼운 수술이라면 어떤 것 말씀이세요?,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+"제가 지금 한약을 먹고 있어서 술을 안 먹은 지 육 개월은 돼서요.
+",Korean
+결핵 때문에 입원하신 적 있으신가요?,Korean
+소변을 보시고 잔뇨가 있으신가요?,Korean
+평소에도 자주 입술이 건조해지시나요?,Korean
+초반에는 약물 치료부터 해야 합니다.,Korean
+"허리도 아프고 등이랑 척추 쪽도 아파요. 누가 망치로 때리듯이요.
+",Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+환자분 응급실은 입원하러 오는 곳이 아닙니다. 입원을 원한다고 입원이 되지는 않습니다.,Korean
+결핵은 언제부터 앓으셨던 거예요?,Korean
+목이 간지러워서 기침을 하는 건가요?,Korean
+지금 아이는 화상이 심각한 상태라고 할 수 있어 빠른 치료를 해야 합니다.,Korean
+알레르기 때문에 병원을 가신 게 언제인가요?,Korean
+간염약으로 꾸준하게 치료 중이신가요?,Korean
+복부 통증이 많이 심한가요?,Korean
+환자분 체질 때문에 비급여 진통제가 필요합니다.,Korean
+가슴 두근거림에 변화는 없나요?,Korean
+검사를 받아 보라는데 내가 안 했어.,Korean
+고혈압 환자분이 가족 중에 계신가요?,Korean
+독감 예방 접종 언제 맞으셨나요?,Korean
+주치의 선생님께 진통제 원하신다고 말씀드릴게요.,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+평균적인 통증 지속 시간을 말씀해 주세요.,Korean
+의사 선생님께 증상을 말씀드리고 진료를 받아 보세요.,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+혈압이 정상인 것으로 볼 때 혹시나 혈변이 있었다고 해도 다량의 실혈은 없었던 것으로 보입니다.,Korean
+통증이 사라지지 않고 계속 유지되나요?,Korean
+약물 알레르기 있는 거 있으세요?,Korean
+통증을 느끼기 시작한 때가 언제예요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+다쳐서 병원에 온 적 있으신가요?,Korean
+미음식을 할 경우 영양소가 부족할 수 있어 확인을 드리는 질문입니다.,Korean
+"아빠 한쪽 얼굴이 무너지는 거 같아요.
+",Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+"네. 배탈 난 것처럼 배가 많이 아팠어요. 변은 이상 없던 것 같아요.
+",Korean
+이젠 좀 퇴원을 할 때가 된 것 같아요.,Korean
+"네. 물은 많이 마시려고 하죠.
+",Korean
+진료받아보시고 증상에 따라 가능할 수도 있습니다.,Korean
+결핵약을 얼마나 드시고 있으신가요?,Korean
+청진 시에 평소처럼 편안하게 있으시면 되세요.,Korean
+턱 쪽 피부가 찢어져서요.,Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+그때 증상이 있었던 기간이 어떻게 되나요?,Korean
+목이 아픈 적 있으셨어요?,Korean
+"오토바이 타다가 다리를 다쳐서요.
+",Korean
+저희 병원에서 저번 달에 마지막으로 대장 내시경 한 것으로 확인됩니다.,Korean
+몸이 오한으로 힘든 상태이신가요?,Korean
+네. 선천적으로 뼈가 많이 약하대요.,Korean
+"제가 약 봉투를 삼켰어요.
+",Korean
+당뇨 측정을 해 보셨나요?,Korean
+피 뽑은 건 해당 안 됩니다.,Korean
+어느 정도의 강도로 통증이 느껴지나요?,Korean
+검사 결과가 나오면 바로 진행합니다.,Korean
+고혈압과 관련된 약을 평소 복용 중이세요?,Korean
+암 진단받은 날 언젠지 아세요?,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+수면 내시경 시행 시 끝나고 보호자와 함께 귀가하는 것이 안전합니다.,Korean
+먼지 등 알레르기 요인이 있나요?,Korean
+진통제 이름과 용량을 알려주세요.,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+가족 중에 천식이나 아토피가 있는 분 있으신가요?,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+네 보호자는 보호자 증이 있어야 병원 출입이 가능합니다.,Korean
+저 마취 잘 안 먹혀요.,Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+손으로 긁으면 염증이 생겨서 더 안 좋아집니다.,Korean
+뭐 때문에 약을 드시고 계세요?,Korean
+담배를 하루에 몇 개비 피우세요?,Korean
+처방받으신 후 복용 중인 결핵약이 있나요?,Korean
+"소변볼 때 뚝 뚝 끊깁니다.
+",Korean
+그렇게 긴장 푸시고 편안하게 있으시면 청진하겠습니다.,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+가슴에 통증이 있으면 말씀해 주세요.,Korean
+"예. 조금 미열이 있던 것 같아요.
+",Korean
+용변 보신 후에 변기에 혈흔이 남아 있나요?,Korean
+인슐린 외에 사용하는 약물이 또 있나요?,Korean
+예전에 아팠던 곳 있어요?,Korean
+성기에 혈액이 원활하게 공급이 되지 않나요?,Korean
+몇 년 동안 당뇨로 투병 중이시죠?,Korean
+그것은 영상검사 및 신체검사를 해봐야 합니다.,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+네. 저도 하겠지만 의료진 분들도 좀 더 신경 써주시면 감사하겠습니다.,Korean
+"진물이 나오고 눈곱이 자꾸 껴요.
+",Korean
+고혈압 있다는 소리 들으셨나요?,Korean
+가만히 눈을 감고 있어도 잠에 잘 못 드시나요?,Korean
+가족 중에 고혈압을 앓고 계신 분이 있으실까요?,Korean
+당뇨 때문에 드시는 약이 이게 맞나요?,Korean
+다른 병원에서 받은 수술은 어떤 게 있나요?,Korean
+피로로 인해 일상이 힘든 적 있나요?,Korean
+일단 진료 후 확인해 보는 게 좋겠습니다.,Korean
+어제 새벽에 열이 너무 올라서 맥이고 그 이후론 안 먹었어요.,Korean
+가족 중에 누가 유전병을 앓고 있나요?,Korean
+흡연 기간이 얼마나 돼시죠?,Korean
+코에 고정되어 있는 반창고가 많이 젖어서 교환하도록 하겠습니다.,Korean
+계단에서 떨어져서 입원하게 되셨나요 검사는 삼십분 이내로 시작할 겁니다.,Korean
+하루치로 했는데 의사 선생님이 보시기엔 어떠신지?,Korean
+평소에 바디로션이라던가 보습을 잘 해주시나요?,Korean
+피가 섞인 대변을 보세요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+평소 음주를 하시는지 여쭤보는 거예요.,Korean
+혈압이 높을 때마다 약은 꾸준히 챙겨 드세요?,Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+감염을 예방하는 데 있어 가장 중요한 부분입니다.,Korean
+심부전에 따른 증상은 호흡곤란 부종 등이 있습니다.,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+간염으로 언제 치료 받으셨나요?,Korean
+만졌을 때 통증은 없나요?,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+최근 일 년간 수술하신 적이 있으신가요?,Korean
+아이 열이 이도 이상 떨어질 때까지 지금 상태 유지해 주세요.,Korean
+지금 아픈 게 느껴지실까요?,Korean
+네 전반적인 건강상태 확인을 위해 필요합니다.,Korean
+측정 여러 번 해보셨죠? 움직이면 검사 결과가 다르게 나올 수도 있어요.,Korean
+"동네병원에서 간 수치가 높다고 큰 병원으로 가보라고 해서 왔습니다.
+",Korean
+보호대도 도움은 되지만 주사치료가 필요합니다.,Korean
+"목이 너무 아파서 불안해서 병원을 왔고 병원에서 입원해야 한다고 해서 입원하게 되었어요.
+",Korean
+"오늘 갑자기 여기 이쪽에 이상한 게 만져져요. 이게 뭐죠? 선생님 종양인가요?
+",Korean
+증상이 지금까지 얼마 동안 있던 거예요?,Korean
+통증이 월 단위로 있나요?,Korean
+알레르기 반응이 발생하는 기타 사항이 있나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+"넘어져서 책상에 머리를 부딪혔어요.
+",Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+혹시 머리가 아프시다는 등의 다른 증상은 없으시나요?,Korean
+결핵 앓았던 적 있으세요?,Korean
+뇌척���액에 대한 검사는 현재로서는 다른 검사법이 없습니다.,Korean
+소변을 자주 보는 것은 생명에 큰 지장은 없으나 이로 인하여 일상생활에 어려움을 겪고 있다면 적극적인 치료를 요합니다.,Korean
+통증은 어떤 식으로 느껴지시나요?,Korean
+알레르기 유무와 어떤 항원이 알레르기를 유발하는지 확인하는 검사입니다.,Korean
+구토하고 싶은 느낌은 없었나요?,Korean
+현기증 느낀 적 있나요?,Korean
+소변에 피가 섞여 나오나요?,Korean
+"가슴이 지끈지끈 계속 아파서 병원에 왔어요.
+",Korean
+소변을 봤는데 또 보고 싶나요?,Korean
+어머님이 암 진단을 받으셨었나요?,Korean
+독감 접종한 게 언제죠?,Korean
+통증이 어디서 느껴지시는 건가요?,Korean
+토할 것 같을 때 어떻게 하셨나요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+"아랫배가 찌릿하면서 소변이 나오더라고요. 그리고 소변을 보고 나면 아프진 않고요.
+",Korean
+소변을 봐도 시원하지 않고 불편한 느낌이 있나요?,Korean
+간접흡연도 영향이 몹시 크죠.,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+하루 중 언제 증상이 두드러지게 나타납니까?,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+네. 유전적 질환이 있다면 다른 사람들보다 질병에 걸릴 위험이 큽니다.,Korean
+네. 배뇨일지 기입으로 정확한 진단이 가능하고 그에 맞는 치료를 처방 할 수 있으므로 배뇨일지 작성은 중요한 일입니다.,Korean
+토할 것 같은 느낌이 오나요?,Korean
+"만성신부전을 앓고 있는데 며칠 전부터 혈압이 오르고 어지러워서 왔어요.
+",Korean
+오 년 전에 교통사고가 나서 여기 뼈가 금이 갔었어요. 수술은 안 했지만.,Korean
+네. 이 병이 전파력이 있는 병이라 감염 여부를 확인해 봐야 하거든요.,Korean
+소화될 때 어려움이 있나요?,Korean
+진통제를 매번 먹고 있었어요.,Korean
+음식 알레르기 때문에 문제 있었던 적은 없나요?,Korean
+의사 선생님 소견서랑 진단서 좀 주세요.,Korean
+자연 분만으로 쌍둥이 낳았어요.,Korean
+"군 복무 중 작업 때 삽질을 하다가 어깨에서 톡 하는 소리가 나면서 어깨가 빠지는 것 같아서 왔습니다.
+",Korean
+네 그럼 머리가 살짝 아픈 신 거 빼고는 다른 증상은 없었나요?,Korean
+결핵 백신 주사를 맞았나요?,Korean
+식은땀을 동반한 오한이 있으세요?,Korean
+병원 내에서 약은 개인 소지가 안 됩니다.,Korean
+실비보험 적용도 가능하니 실비보험 있으시면 사용하세요,Korean
+교통사고가 심하게 나서 여러 곳 수술했어요.,Korean
+"폐에 문제가 있는지 더 큰 병원을 가보라 해서 왔습니다.
+",Korean
+지압이나 안마 그리고 음식으로 행해지는 치료법입니다.,Korean
+고혈압과 관련하여 받은 치료는 모두 알려주세요.,Korean
+"스무 살부터 담배 시작했습니다. 요새는 하루 한 갑 정도 피우는 것 같네요.
+",Korean
+최근 몸무게에 변화는 없으세요?,Korean
+암 진단받은 게 언제인가요?,Korean
+이 약이 바닥에 떨어져 있었어요.,Korean
+"수면제 좀 타고 싶어서 왔습니다.
+",Korean
+최근 어지러움을 자주 느끼나요?,Korean
+약물 치료로 부족하다면 손목 수술의 방법도 있습니다.,Korean
+여기가 제일 가까운 병원이라 여기서 했어요.,Korean
+현기증을 처음 느끼신 건가요?,Korean
+살이 떨리는 한기가 느껴지나요?,Korean
+피가 묻은 대변이 있다는 말씀이시네요?,Korean
+정확하게 진단을 하고 치료를 하려면 혈액 검사를 진행하셔야 합니다.,Korean
+그 부분은 간호사분이 아실 듯한데요.,Korean
+다른 병원 기록은 저희가 열람할 수 없어서요.,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+출혈 부위를 명확하게 구분하기 위함입니다.,Korean
+"요도염 말곤 아는 거 없네요.
+",Korean
+수분 섭취가 적어 농도가 짙은 소변은 진한 노란색으로 보이는데 간혹 이를 오인하여 내원하는 경우가 있습니다.,Korean
+아니요. 고혈압약만 꾸준히 먹고 있어요.,Korean
+독감 주사는 잘 챙겨 접종하고 계시죠?,Korean
+두근거려서 잠을 잘 못 주무시나요?,Korean
+처음 통증을 느낀건 언제인가요?,Korean
+결핵 치료는 끝까지 받으셨나요?,Korean
+금연 기간은 어떻게 되시나요?,Korean
+드시는 결핵 약 이름 기억하시나요?,Korean
+아픈 부위가 있다면 다 말해주세요.,Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+"소화된 후에도 토를 해서 그런지 약간 노���색의 토였어요.
+",Korean
+"아파서 잠을 자기 어려운데 막상 잠자면 오래 자서 수면 시간은 증가했어요.
+",Korean
+추후 치료 계획에 반영됩니다.,Korean
+부종이라는 게 어느 한 부위가 붓는 경우를 말해요.,Korean
+알레르기 반응을 보였던거 있으면 다  말씀해주세요.,Korean
+하루에 보통 얼마나 피우세요?,Korean
+드시면 알레르기 반응이 있는 음식이 있으신가요?,Korean
+토할 거 같은 증상이 있으세요?,Korean
+운동하고 나면 부기가 빠져 있나요?,Korean
+전문 간병인을 두시는 게 좋을 거 같습니다.,Korean
+소변볼 때 피가 나오지는 않던가요?,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+"신물을 토할 때까지 구토를 해요.
+",Korean
+"이가 흔들리는 것 같아요.
+",Korean
+안과를 매주 다니고 있어요.,Korean
+우선 심전도 검사를 진행한 후 말씀드리겠습니다.,Korean
+네 병원에 몇 시쯤 도착하셨나요?,Korean
+변이 잘 안 나오나요?,Korean
+결핵 치료는 잘 되었나요?,Korean
+입원 후 며칠이 지나면 통증이 호전되실 것입니다.,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+고혈압약처럼 지속적으로 드시는 다른 종류의 약이 있을까요?,Korean
+입원해 계시는 동안 변화 사항이 있는지 확인하기 위해서입니다.,Korean
+암 치료는 언제부터 받으셨죠?,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+통증 유무 확인 부탁드려요.,Korean
+장에 신경 분포가 되지 않아 이로 인해 정상적인 변을 보지 못하는 질환입니다.,Korean
+요즘 당뇨를 치료 중인가요?,Korean
+"자주 토하고 싶고 그렇습니다.
+",Korean
+피부가 환절기에 더 건조해지기 때문에 보습을 잘 하시는 게 효과적입니다.,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+환자분이 흡연을 한 기간을 말씀해 주세요.,Korean
+혈뇨는 언제 처음 보셨나요?,Korean
+결핵 앓은 적 있는지 여쭤봐도 될까요?,Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+"잠이 안 올 거 같은 날만 수면유도제 먹고 평소엔 잘 자요.
+",Korean
+위산제는 어디에 쓰려고 하시죠?,Korean
+"전혀 삼킬 수가 없어요.
+",Korean
+대변 잘 못 보세요?,Korean
+결핵 치료 이력이 있나요?,Korean
+최대한 빨리 진료받고 싶어서 아홉 시 십 분이 좋을 것 같아요.,Korean
+소변을 볼 때 불편함이 없나요?,Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+지금 즉각적인 치료가 필요하지 않으나 위암 발생 위험성이 증가할 수 있기 때문에 일 년 간격으로 위내시경 검사가 필요합니다.,Korean
+"혈압약을 먹고 있는데 아직도 너무 높아요.
+",Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+병실에는 보호자분 본인께서 주로 함께 계실 건가요?,Korean
+"강아지한테 물려서 긁히고 찍히고 피도 나고 그래요.
+",Korean
+과거에 똑같은 증상이 있었나요?,Korean
+신체 부위를 마사지 해주시는 게 좋을 것 같네요.,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+식후 소화가 잘 안 되나요?,Korean
+별다른 약은 먹고 있지 않아요.,Korean
+우선 흔들리는 것은 여기서 진료를 받고 추후에 엑스레이 검사를 통하여 부가적인 확인을 하는 것이 좋습니다.,Korean
+몸이 기운을 못 내고 축 처지나요?,Korean
+잠을 자기가 많이 힘드신가요?,Korean
+연고 바르시다 따가운 증상이 생기시면 바르지 마시고 병원으로 연락 부탁드립니다.,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+간염 시작된 나이가 언제인가요?,Korean
+소변을 보실 때 피가 나오신 적 있으세요?,Korean
+"여기 밑에 이빨 어금니요.
+",Korean
+대변이 잘 안 나오고 그러나요?,Korean
+소변이 내려오는 길을 조영제로 조영하여 결석의 위치를 확인하기 위함입니다.,Korean
+커피와 같이 위산 분비를 늘리는 음식물을 드실 경우 나타나기 쉽습니다.,Korean
+몇 년 전에 중풍이 와서 하반신 불수고 그래서 요양원에 계세요.,Korean
+장에 신경이 제대로 분포하지 않아 생기는 질환입니다.,Korean
+물집이 잡힌 경우 이 주에서 사 주 가량 통증을 호소할 수 있습니다.,Korean
+통증이 쑤시는 듯한 느낌으로 올까요?,Korean
+입원 수속 후에 질병의 완화를 위한 치료 경험이 있으신지 여쭙는 겁니다.,Korean
+피부반응으로 대체하면 시간도 오래 걸리고 정확한 원인을 찾기 위해 반복해서 검사해야 합니다.,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+알레르기 때문에 고생하신 적 있어요?,Korean
+목 안에서 통증이 느껴지나요?,Korean
+부루펜을 먹인지 얼마나 됐나요?,Korean
+당뇨약 하루에 몇 번 드시나요?,Korean
+네. 그럼 입원 치료는 어떠실까요?,Korean
+배액관 삽입 부위가 젖어있습니다.,Korean
+통증이 오면 얼마나 계속되나요?,Korean
+음식 알레르기 앓은 적 있어요?,Korean
+통증이 하루에 자주 일어났어요?,Korean
+처음 이 증상이 나온 게 언제인가요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+둘 다 알레르기로 나타날 수 있고 연관성이 있습니다.,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+대변을 볼 때 피가 보이나요?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+음주는 언제 처음 시작하셨죠?,Korean
+"소변을 봐도 잔뇨가 늘 남고 거의 바로 화장실을 또 가게 하네요.
+",Korean
+요새 갑자기 체중이 늘어난 적이 있나요?,Korean
+잠을 깊게 잘 수 있나요?,Korean
+"담배 끊은 지 거의 일 년 다 되어가요.
+",Korean
+급성기가 꼭 병의 심각성과 관련된 것은 아닙니다. 그보다는 지금 치료가 필요한 단계로 이해하시면 됩니다.,Korean
+재생 정도에 따라 수술이나 추가 시술이 필요하여 정확히 말씀드릴 수는 없습니다.,Korean
+알레르기로 어떤 약을 복용하고 계신가요?,Korean
+알레르기 중에 음식과 약물 외에 다른 것도 있으세요?,Korean
+흉터는 어쩔 수 없이 남을 겁니다.,Korean
+보통 이런 경우에는 혈압은 조절하지 않고 장기간 지속되거나 다른 질환을 불러올 경우 조절합니다.,Korean
+예를 들어 어떤 통증인가요?,Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+언제부터 혈당이 높게 측정되었나요?,Korean
+소변의 정상 경로를 막는 겁니다.,Korean
+연고는 병원에서 판매하는 제품이기 때문에 보험처리가 되지 않아요.,Korean
+아니요. 엽산은 안 먹고 있어요.,Korean
+과거 병력에 대해 얘기해 주세요.,Korean
+외래를 통해서요 진료받은 후 입원을 하게 된 건가요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+지금 처방하려는 약 중에 빼야 하는 약이 있나요?,Korean
+건강 검진도 주기적으로 받는 게 중요해서요. 받은 지 오래되었으면 다시 검진을 해보시죠.,Korean
+아니요. 시간이 지나면 폐에 염증이 생길 수 있습니다. 최대한 빨리 심호흡을 하는 것이 좋습니다.,Korean
+고통이 얼마나 오래 지속되나요?,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+암 때문에 병원에 오셨나요?,Korean
+"입원이 시급한 상황이라고 해서요.
+",Korean
+알레르기 반응 있는 음식 있어요?,Korean
+아빠가 신장 이식받으신 적이 있으세요.,Korean
+평소보다 호흡이 잘 안 되시나요?,Korean
+간은 언제부터 안 좋으셨어요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+가래 상태가 많이 심한가요?,Korean
+당분간은 수액으로 체액 불균형을 해소할 거라서 일단은 금식이라고 생각하시면 되세요.,Korean
+심장 소리가 느껴지시는 거 같으세요?,Korean
+오른쪽 하복부로 통증이 옮겨갔나요?,Korean
+치료를 도중에 중단하고 이후에 재개할 경우 일 년 이상이 걸릴 수도 있습니다.,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+잠시 후 담당 선생님께서 회진을 오십니다.,Korean
+진피층이 보일 정도로 화상을 입은 거라 회복하려면 상당한 시간이 걸릴 것 같아요.,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+움직일 수 없을 정도로 어지러우신가요?,Korean
+방금 검사하신 게 부작용 여부 확인을 위해서 하신 거예요.,Korean
+콕 찍은 정도여서 흉터라고 보기에는 애매하네요.,Korean
+"네. 붓기는 없는 것 같아요.
+",Korean
+아니요. 엽산은 안 먹고 있어요.,Korean
+물 마실 때 목이 아픈가요?,Korean
+통증이 시작되면 몇 시간 동안 아프세요?,Korean
+증상이 심할 경우 연고보다는 약을 복용해야 할 수도 있습니다.,Korean
+어느 부위에 통증이 심한가요?,Korean
+잠을 푹 주무실 수 없나요?,Korean
+혹시 안면홍조 등 동반되는 증상이 있으신가요?,Korean
+"다리에 힘이 빠져서 걷거나 뛰는 게 힘들어요.
+",Korean
+"고혈압약을 먹고 있는데 그것 때문인지 붓기가 좀 있는 것 같아요.
+",Korean
+이 병원에서 해서 기록이 있을 텐데요.,Korean
+어디가 가장 아픈 곳이에요?,Korean
+"아내가 죽으려는지 약을 다 먹었어요. 빨리 좀 봐주세요.
+",Korean
+하반신 마취여도 안정시키기 위해 수면마취를 시행하는 경우도 있습니다.,Korean
+체중 증가가 언제부터 있었나요?,Korean
+결핵 때문에 병원 다니신 적이 있나요?,Korean
+종양 치료는 다 끝났나요?,Korean
+소화는 평소에 잘 되시나요?,Korean
+설사하고 나면 수분이 부족함을 느끼나요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+몸에 붓기는 차도가 있나요?,Korean
+마취제를 투여할 거라 통증은 심하지 않으실 겁니다.,Korean
+네 입원경로 여쭤본 거예요.,Korean
+소화가 어떻게 잘 안 되시나요?,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+복용하셨던 약을 체크해야 해서 질문드렸습니다.,Korean
+결핵 때문에 정기적으로 복용하는 약이 무엇인가요?,Korean
+배가 빵빵하게 가스차는 느낌이 있나요?,Korean
+통증이 있다 없다 반복하나요?,Korean
+육 년 전에 유방암 진단받았어요.,Korean
+입원 조사 시 내원 방법에 대해 필요하여 물어봤습니다.,Korean
+그냥 이 약물이 안 맞는다 보시면 돼요.,Korean
+평균 하루 수면 시간은 어떻게 되나요?,Korean
+보청기 틀니 액세서리 외의 소지품 없으신가요?,Korean
+종양 치료는 다 끝났나요?,Korean
+친척중에 유전성 질환을 치료 중인 분이 있나요?,Korean
+"폐렴 기가 심해져서 호흡곤란이 왔어요.
+",Korean
+종양으로 현재 병원 다니고 있어요?,Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+드레싱 후에 몇 가지 치료가 남아있습니다.,Korean
+병원에 입원 치료를 받아본 적 있나요?,Korean
+"요새 계속 혈변을 봐서요.
+",Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+변의 양이 매우 가벼운 편인가요?,Korean
+피부에 국소 자극을 일으켜 항체가 그곳 세포를 공격하게 하는 성분입니다.,Korean
+"다른 덴 이상 없어요.
+",Korean
+심장 쪽에 문제 있으신거 있나요?,Korean
+피를 토한 적이 있으시다고요?,Korean
+아직 주변 림프 조직으로나 폐나 다른 장기에 전이 소견이 없는 일 기이기 때문에 치료 잘 받으시면 예후가 좋습니다.,Korean
+평소 소화가 잘 안 되나요?,Korean
+담배 개수 전자 담배 횟수로 설명해주시겠어요?,Korean
+제왕절개 여부에 따라 복강경 또는 개복술 여부가 결정 날 수 있습니다.,Korean
+"여드름 치료받고 싶어서 왔습니다.
+",Korean
+네. 예전에 한 번 진료 봤어요.,Korean
+한 달에 몇 번정도 아픈가요?,Korean
+관련 검사를 추가로 해봅시다.,Korean
+네 수면 패턴 체크를 희망하시는군요.,Korean
+"뒤차가 들이박아서 머리가 다친 것 같아요.
+",Korean
+"오줌 누듯이 물만 나오는 느낌이었어요.
+",Korean
+알레르기 검사에 혈액 체취는 기본적인 검사라 피 뽑기 싫으셔도 하셔야 합니다.,Korean
+흡연을 언제 처음 시작하셨나요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+주로 하부 요로계인 방광 요도 전립선 등에 출혈이 있으면 선홍색으로 보이고 상부 요로계에 많은 양의 출혈이 있을 경우에는 붉은 색깔을 띨 수 있습니다.,Korean
+약에 따라 같이 먹으면 안 되는 약이 있어서요.,Korean
+몸살감기에 걸려서 내과에 간 적 있어요.,Korean
+고혈압약이랑 따로 또 복용하고 있는 약이 있나요?,Korean
+"기운도 없고 근육통이 많이 심하네요.
+",Korean
+"생각해보니 대소변 둘 다 잘 안 나와요.
+",Korean
+수술해준 병원에 물어봐야 알죠.,Korean
+지금 상처가 아물고 있으니 며칠은 지켜봐야 할 거 같습니다.,Korean
+조금이라도 의식이 남아있다면 주변에 빠른 도움을 요청하세요.,Korean
+몸살 기운이 있는 것 같나요?,Korean
+어떤 음식을 드셨을 때 알레르기가 나타나나요?,Korean
+구토 시 피가 나온 적이 있으신가요?,Korean
+혈액형이 다르게 나왔나 확인해볼까요?,Korean
+배가 이유 없이 가스찬적 있나요?,Korean
+불편함이 있으시면 언제든지 병원으로 연락주세요.,Korean
+지난 금요일에 눈병에 걸려서 병원 갔었어요.,Korean
+간염 처방 약 알 수 있나요?,Korean
+암 환자가 가족 중에 있을까요?,Korean
+부모님께서 앓으시는 병이 있나요?,Korean
+간염 치료 이력 말씀해 주세요.,Korean
+갖고 계신 알레르기가 있으면 알려주세요.,Korean
+"입원 좀 하려 해요.
+",Korean
+언제쯤 설사를 시작했는지 알 수 있을까요?,Korean
+독감 예방 접종 후 계속 출근하셨나요?,Korean
+그때부터 아직 안 낫고 계속 앓고 계신 거죠?,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+아픈 게 심하게 느껴지나요?,Korean
+상처의 소독 후 사용하는 소독된 붕대를 지칭합니다.,Korean
+아픈 게 어떤 식으로 아파요?,Korean
+당뇨 때문에 고생하시게 된 지는 얼마나 되었나요?,Korean
+감염력 확인을 위한 조치이오니 문제가 발생할 경우 연락을 취할 수 있습니다.,Korean
+물혹 제거 때문에 복강경으로 수술받은 적 있습니다.,Korean
+막대로 살짝만 스쳐도 통증이 느껴지나요?,Korean
+어디 부분이 특히 많이 아픈가요?,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+한 번에 드시는 술의 양은 어느 정도세요?,Korean
+가슴이 쥐어짜듯이 아프지는 않나요?,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+혈변을 보시면 피가 얼만큼 섞여 나오는 거 같나요?,Korean
+평균적으로 하루에 피우는 양이 어느 정도죠?,Korean
+소변 색이 붉은빛이 도나요?,Korean
+간염약 지금 어떤 걸 드시나요?,Korean
+"항문으로 뭔가가 들어갔는데 안 빠져요.
+",Korean
+방사선사 지시에 따라 하시면 몇 분 안 걸립니다.,Korean
+"좀만 움직여도 심장이 두근거리고 이상해요.
+",Korean
+결핵 치료는 잘 되었나요?,Korean
+염증 수치가 다소 높게 나왔습니다.,Korean
+동의서 한번 읽어보시고 이해되셨으면 서명란에 작성해 주세요.,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+복부 전체에 통증을 느꼈어요?,Korean
+갑자기 머리가 도는 느낌이 드세요?,Korean
+네. 엑스레이를 통해 대략적인 가스와 변의 양상은 확인이 가능합니다.,Korean
+"이전에 열이 났었냐고 여쭤 보셨었는데요.
+",Korean
+먹으면 안 되는 약물 알려 주세요.,Korean
+통증이 언제 생겼는지 알려주세요.,Korean
+결핵 투병 기간이 어느 정도 됐어요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+그렇게 부담스러운 검사는 아닌걸요?,Korean
+지금 어디가 아픈 건가요?,Korean
+"요새 잠이 잘 안 와요.
+",Korean
+독감 주사 언제 맞았어요?,Korean
+아플 때 보통 어떤 방식으로 아프던가요?,Korean
+검사 후에 치료가 진행될지 여부는 검사가 끝나야 알 것 같아요.,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+혈변 시 복통이 함께있나요?,Korean
+담배를 피운 기간을 알려주세요.,Korean
+네. 지금 바로 퇴원할 수 있게 도와주세요.,Korean
+대변을 며칠에 한 번 보나요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+"매운 걸 안 먹었는데도 속이 쓰려요.
+",Korean
+통증이 발생하면 얼마나 계속되나요?,Korean
+내시경 자체는 사후 통증이 없습니다,Korean
+액세서리도 다 빼고 수술복만 입으셔야 해요.,Korean
+과거에 치료를 받으셨거나 케어를 받았나요?,Korean
+철분제와의 관련성은 크지 않습니다.,Korean
+가슴이 답답하거나 메스꺼울 수 있습니다.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+담배 하루에 몇 갑 피나요?,Korean
+한 번 주무실 때 몇 시간 주무세요?,Korean
+등에 알레르겐을 찔러서 확인하는 피부 반응 검사가 있습니다.,Korean
+참기 힘드시면 진통제 주입량을 올려드리겠습니다.,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+하루 술 마시는 양이 어떻게 되나요?,Korean
+어떨 때 심장이 빨리 뛰나요?,Korean
+아뇨. 먹고 십오 분 후 정도에 토했습니다.,Korean
+배가 너무 부풀어서 답답한 느낌이 있나요?,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+몸에 소름 끼칠 듯한 오한이 있나요?,Korean
+알레르기 반응은 음식이나 약물에만 나타나나요?,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+음낭에 빛을 투과해 봄으로 진단 가능합니다.,Korean
+이번 독감 주사는 맞으셨나요?,Korean
+심전도는 정상으로 나왔는데 혈액검사 수치 중에 혈액내 지방 수치가 높게 나왔네요. 피검사 하는 날 금식 잘 하고 시행하셨죠?,Korean
+수액이 안 떨어진다거나 지금보다 천천히 떨어지고 있다면 간호사를 불러주세요.,Korean
+비급여면 비싸긴 하지만 꼭 필요한 경우가 있으니 동의해 주셔야 합니다.,Korean
+제일 처음 통증을 느꼈던 게 언제인가요?,Korean
+정 혈액검사가 싫으시면 피부반응으로 하겠습니다만 정확도가 떨어지고 결과 확인이 늦어집니다.,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+주의해야 하는 알레르기 음식이 있나요?,Korean
+앓고 계신 지병이나 꾸준히 복용하는 약이 있나요?,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+"전혀 그런 게 없었는데 숨이 불편하니 편히 잘 수가 있나.
+",Korean
+코 입술 잇몸 등의 모양에 변형이 오면 바로잡기 위해서 합니다.,Korean
+하루에 담배 타임은 몇 번 정도 가지세요?,Korean
+검사 부위에 피가 나면 집에 가지고 계신 밴드 붙이시면 됩니다.,Korean
+이거 먹기만 하고 주사 같은 건 안 놔 주시는 거예요?,Korean
+통증이 어느 부위에 집중되나요?,Korean
+콕콕 찌르는 느낌으로 아프신가요?,Korean
+수혈을 받아본 적이나 하신 적이 있습니까?,Korean
+제가 환자분 과거력과 초음파를 보고 다시 설명드릴게요.,Korean
+제일 염려되는 증상이 뭐죠?,Korean
+통증은 어떤 느낌으로 오나요?,Korean
+수술받은 곳 통증은 어때요?,Korean
+네 현재까지 알고 계신 알레르기는 없으시단 거죠?,Korean
+숙면을 취하기 어렵진 않나요?,Korean
+통증이 시작된 것이 언제인가요?,Korean
+그냥 미열 좀 있었는데 그것 말고는 괜찮았어요.,Korean
+대변볼 때 피가 나오지는 않던가요?,Korean
+약물 알레르기 있으면 알려주시겠어요?,Korean
+원하시면 바이러스 검사를 해 보실 수는 있으나 어떤 원인으로 바이러스에 감염됐는지 찾는 것은 어렵습니다.,Korean
+한 번 시작된 통증은 언제까지 가나요?,Korean
+"배가 쑤시는 것처럼 아파요.
+",Korean
+담배 처음 핀 게 언제예요?,Korean
+대변 보실 때 피가 같이 나오나요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+장에 신경이 분포 되지 않아 이로 인해 정상적인 변을 보지 못하는 질환입니다,Korean
+항문 출혈을 일으키는 치질과 같은 질환이 있는 경우 배변 장애가 동반됩니다.,Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+맥 빠지는 느낌이 드나요?,Korean
+"어젯밤부터 가슴이 쥐어 짜듯 아픕니다.
+",Korean
+보통 내시경은 일 년에서 삼 년 정도 주기를 잡습니다.,Korean
+아니요. 질병 때문에 드시고 계시는 약이 있나요?,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+네 복용 중인 약 다 얘기해 주세요.,Korean
+애기 위치가 별로라 제왕 절개했어요.,Korean
+통증이 얼마나 자주 있는 것 같나요?,Korean
+결핵의 경우 가족분들께 전파됐을 가능성이 있어서요.,Korean
+환자분 상태에 따라 다르게 나타납니다.,Korean
+대장 내시경과 검사 방법은 유사한데 대장 끝까지가 아니라 에스 상 결장까지만 보는 검사입니다.,Korean
+다른 안약들은 투여해도 괜찮은 건가요?,Korean
+아니요. 처방에 따라 곧 검사를 할 것입니다.,Korean
+간염으로 치료 받고 있나요?,Korean
+아니요. 수술 부위에 염증이 생겼는지 아프고 상처가 잘 아물지 않던데요.,Korean
+시야가 흐릿해졌던 적이 있나요?,Korean
+알레르기 반응을 보였던거 있으면 다  말씀해주세요.,Korean
+아픈 곳을 말씀해 보실래요?,Korean
+"가래가 요즘 부쩍 많아졌어요.
+",Korean
+"오래 걸으면 피로감이 심하게 왔었어요.
+",Korean
+평소 음주량을 토대로 환자분의 건강 상태를 파악할 수 있습니다.,Korean
+언제부터 혈뇨를 누기 시작하셨나요?,Korean
+대변이 잘 안 나오나요?,Korean
+질병이 진행한 경우에는 단순히 쉬는 것만으로 증상이 자연적으로 좋아지지는 않습니다.,Korean
+피가 섞인 변을 보셨나요?,Korean
+당뇨 가족력이 있다면 알려주세요.,Korean
+의사의 처방이나 진단을 받지 않는 경우를 말씀드리는 겁니다.,Korean
+몸에 힘이 안 들어 가요?,Korean
+복용하는 약제에 의해서도 부을 수 있습니다.,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+진통 있을 때만 좀 진통제 먹고 머리 아파서 두통약도 따로 먹었는데.,Korean
+올해 독감 예방 주사 맞으실 예정이신가요?,Korean
+네. 혈압약만 먹고 있어요.,Korean
+신경 쓰이시겠지만 환자분의 개인정보는 보호 되고 있으니 염려하지 않으셔도 됩니다.,Korean
+어디가 부은 느낌 있나요?,Korean
+혈뇨를 언제부터 보신건지 말씀해주세요.,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+혈압약 당뇨약같이 지속적으로 약을 복용해야 하는 병이 있나요?,Korean
+알고 계시는 음식 알레르기가 있나요?,Korean
+언제 통증이 처음 나타나셨어요?,Korean
+흉통이란 가슴 부위에 나타나는 통증을 의미합니다.,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+알레르기가 심하게 올라왔던 상황이 있나요?,Korean
+간염 때문에 병원 치료받고 계신가요?,Korean
+알레르기를 유발하는 상황이 있나요?,Korean
+그렇군요. 그럼 빈속에 약 먹으면 안 좋으니까 그전에 뭐라도 꼭 드신 다음에 약 복용 바랍니다.,Korean
+"스물한 살쯤 피기 시작해서 오 년 정도 전에 끊었습니다.
+",Korean
+네.정상적인 생활리듬 유지가 어려운 환경이 누적되면 건강에 영향을 줄 수 있지요.,Korean
+통증은 없더라도 불편한 느낌이 있을 수 있습니다.,Korean
+네. 주사 맞고 푹 쉴게요.,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+"저번에 치질이 있어서 치료받았는데 다시 재발한 것 같아서요.
+",Korean
+결핵 때문에 병원 다닌 적 있으신가요?,Korean
+"운동해서 이 킬로 정도 뺐어요.
+",Korean
+다른 알레르기가 있으시면 미리 알려줘야 해요.,Korean
+지금은 무슨 약 드세요?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+비급여 주사제가 많이 쓰여요?,Korean
+아픈 곳 말씀해 주세요.,Korean
+가족 중에 고혈압약을 먹고 계신 분이 있나요?,Korean
+가래의 원인이 뭐가 있을까요?,Korean
+요새 몸이 많이 피곤한가요?,Korean
+그래도 횟수를 세면서 조절하려고 노력하고 계시는군요. 조금 더 힘내서 과식 습관을 없애볼까요?,Korean
+"물도 잘 못 삼키겠어요.
+",Korean
+당뇨가 안 좋을 때 무슨 약 드세요?,Korean
+몸살이 있으셨다면 예방접종 후 면역력이 떨어져서 더 안 좋으실 수도 있어요.,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+아니요 민간요법보다는 의학적인 치료법이 정확한 거니까요.,Korean
+"계속 열이 나고 몸이 아프다 그래서요.
+",Korean
+"배가 좀 아팠는데 혈변인지는 모르겠어요.
+",Korean
+처방받고 드시는 약 있나요?,Korean
+환자분은 갑상선 문제 때문에 오셨고 정밀 검사 결과 초기 갑상선암으로 판단됩니다.,Korean
+손발 피부 표피가 벗겨지는 건 습진이나 무좀 때문일 수도 있어요.,Korean
+가슴 통증이 있지는 않나요?,Korean
+결핵약 아직 복용하고 계신가요?,Korean
+알레르기 반응 있는 음식 있어요?,Korean
+통증이 시작된 날이 언제부터예요?,Korean
+특정 상황에서 알레르기 생기는 경우도 있을까요?,Korean
+대변보고 닦을 때 피가 묻어 나온 적은 없나요?,Korean
+진료가 모두 끝날 때까지 금식하셔야 합니다.,Korean
+약물 알레르기가 있다면 알려주세요.,Korean
+그 말도 맞지만 어디를 통해서 입원을 하셨는지에 대해 환자분의 기본정보가 필요하여 질문을 드린 것입니다.,Korean
+처방받은 고혈압약 이름이 뭔가요?,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+어떤 약물을 복용했을 때 알레르기가 일어나나요?,Korean
+가슴 쪽 통증은 어떤가요?,Korean
+"다른 증상 어떤 거 말씀이세요?
+",Korean
+진통제를 먹어도 나아지지 않나요?,Korean
+통증의 패턴 같은 게 있었나요?,Korean
+작은 신발을 오래 신어서 발가락이 아프죠 발에 맞춰서 신도록 해보세요.,Korean
+이번에 독감 접종 맞으셨나요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+어디 부위가 아파서 오신 건가요?,Korean
+다이페닐 사이클로 프로판온이라는 국소 투여제이자 민감제입니다.,Korean
+결핵으로 인해 수술받으신 이력이 있는지 말씀해 주세요.,Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+간염 주사였던 것 같아요.,Korean
+아뇨. 수술은 안 받아 봤어요.,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+가래 특징을 말씀해 주세요.,Korean
+완치가 거의 되긴 하지만 극소수 아이들은 완전히 치료가 안 되는 경우도 있긴 합니다.,Korean
+토할 것 같으셨는지 알려주세요.,Korean
+평소에도 계속 거칠게 숨을 쉬나요?,Korean
+간염으로 치료 받고 있나요?,Korean
+또 아픈 곳 없나요?,Korean
+수술 부위에 대해 이해하는 것이 좋으니 설명해 드리겠습니다.,Korean
+얼마에 한 번씩 아픈가요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+증세가 악화된 때가 언제인가요?,Korean
+"제가 평소 간이 안 좋아서 검사 받으러 왔습니다.
+",Korean
+벌레 물렸을때 통증 정도로 생각하시면 됩니다.,Korean
+좀 더 위생에 신경을 써 주신다면 빨리 회복되지 않을까요?,Korean
+가족 중에 누가 암을 앓았었나요?,Korean
+케이에프 마스크만 써야 하는 건 아니지만 케이에프 마스크가 가장 효과가 좋습니다.,Korean
+한 시간에 몇 번씩 화장실을 가는 경우는 비정상적인 배뇨 형태이므로 자세한 원인에 대한 검사가 필요합니다.,Korean
+암과 관련하여 검사한 적 있으신가요?,Korean
+주로 어떨 때 손가락이 불편하게 느껴지시나요?,Korean
+얼마나 자주 심계항진이 있으시죠?,Korean
+치료를 시작해야 할 것 같아요 오늘 주사를 맞고 가시는 게 좋겠습니다.,Korean
+"백숙을 먹다가 닭 뼈가 목에 걸렸어요.
+",Korean
+통증이 좀 강한 편이에요?,Korean
+일반인들 보다 회복이 더뎌서 오래 걸립니다.,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+거즈를 어디서 구할 수 있을까요?,Korean
+보통 현기증을 자주 느끼나요?,Korean
+"기침�� 때마다 가슴이 너무 아프고 가래에 피가 좀 섞여 나와요.
+",Korean
+"모래사장에서 맨발로 걷다가 조개껍질에 발을 다쳤어요.
+",Korean
+불규칙함에 적응하셨나 보네요. 수면과 관련해서 신체적 증상은 없었나요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+과거에 수술받으신 적 있나요?,Korean
+결핵은 언제 처음 발병하였나요?,Korean
+부부생활 할 때 발기는 정상적으로 잘 되시나요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+네. 이후 환자분 치료 계획에 따라 식사 처방도 달라질 수 있어요.,Korean
+면역요법은 수개월에서 일 년 이상까지 시간이 소요됩니다.,Korean
+잠깐 어지러웠고 느낌이 없어요.,Korean
+어떤 무리를 말씀하시는 거죠? 부작용을 말씀하시는 건가요?,Korean
+"아기가 다리 사이 사타구니 근처에서 이상한 게 만져져서요.
+",Korean
+바늘이 들어갈 때 통증을 느끼실 수 있습니다.,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+아버지도 유전성 질환을 앓으셨나요?,Korean
+"사흘 전 항암치료 후 열이 나서요.
+",Korean
+현재 불편한 증상은 없나요?,Korean
+이차 치료의 표준요법은 하루 사 회 투약 요법입니다.,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+양쪽 팔이 모두 가려우세요?,Korean
+고혈압 판정받으신 적 있으실까요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+제가 약에 알레르기가 있는데 뺄 수 있나요?,Korean
+법적 보호자의 서명이 있어야만 수술이 가능합니다.,Korean
+암을 치료받은 게 언제쯤인가요?,Korean
+두통 때문에 펜잘 먹었어요.,Korean
+한두 시간 간격으로 통증이 하루 종일 있나요?,Korean
+네 여러 연구결과에서도 밝혀졌듯이 미성년자일 때의 음주가 더 위험합니다.,Korean
+네. 맞아요. 그래서 그 이후로 장에 좋은 영양제 챙겨 먹고 있어요.,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+발열이 있던 적 있나요?,Korean
+당뇨와 관련해서 처방받으신 약이 있으신가요?,Korean
+결핵을 진단받은 시기가 언제인가요?,Korean
+체중이 그렇게 빠지는 데 몇 주일이 걸렸나요?,Korean
+"엄지발가락이 양말만 스쳐도 쓰라리고 아려서요.
+",Korean
+이상이 있는 경우는 드뭅니다. 하지만 심한 복통이 지속되거나 다량 혈변이 있는 경우 즉시 내원하세요.,Korean
+"얼굴에 홍조가 점점 심해지고 가라앉지 않아 왔습니다.
+",Korean
+증상이 없을 경우 약은 필요하지 않습니다.,Korean
+한 달 이상 입원한 적이 있나요?,Korean
+최근에 복용하는 약 처방이 바뀌어서 제가 정확히는 이름을 모르겠어요.,Korean
+당연하죠 운동과 충분한 휴식 그리고 영양도 중요하고요.,Korean
+상해로 입원하신 적이 있나요?,Korean
+다양한 질환이 오한을 일으킬 수 있어 원인을 찾아봐야 할 것 같습니다.,Korean
+약물에 대한 알레르기가 있습니까?,Korean
+일단은 혈변과 복통의 원인에 대해 조금 더 알아보겠습니다.,Korean
+"십 년 되었네요. 건강을 위해 이제는 슬슬 줄여야겠어요.
+",Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+몸이 뜨거운 적이 있나요?,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+결핵 치료가 오래전 일인가요?,Korean
+병원 차원에서 추가되는 비용으로 임의로 제외할 수는 없습니다.,Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+"빈혈 검사를 한 번 해보려고요.
+",Korean
+암 관련 약은 언제부터 드시기 시작했나요?,Korean
+체중 증가세가 삼 개월간 있었나요?,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+소변보고 나서도 또 마려운 느낌이 드나요?,Korean
+몸이 붓는 증상이 있나요?,Korean
+이후에는 레이저나 냉동치료이고 마지막에는 수술밖에 답이 없습니다.,Korean
+"구토는 안 하는데 속이 계속 매슥거려요.
+",Korean
+어떤 치료제를 드시고 계세요?,Korean
+수술적 치료 시행과  합병증 발생 여부에 따라 차이가 생길 수 있지만 짧으면 삼일에서 오일 정도 예상할 수 있습니다.,Korean
+처방받은 고혈압약이 효과가 있는 것 같나요?,Korean
+통증이 어떤 식으로 반응하나요?,Korean
+알레르기 반응이 언제 보이나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+알레르기로 인해 피부약을 먹고 있습니다.,Korean
+통증이 느껴진다면 어떤 느낌인가요?,Korean
+밖에서 담배 피면 안 되나요?,Korean
+아니요. 다른 걸 복용한 적은 없어요.,Korean
+알레르기가 있다는 사실은 언제 아셨어요?,Korean
+언제부터 ���핵으로 병원 다니셨죠?,Korean
+치료 목적으로 처방받은 약이 있나요?,Korean
+"애가 배가 꼬여서 갑자기 거의 기절했어요.
+",Korean
+대변을 볼 때 피가 보이나요?,Korean
+매번 변을 볼 때마다 피가 묻어 있나요?,Korean
+신체 검진 후 정확한 진단을 위해 복부 씨티 등 검사가 필요할 수 있습니다.,Korean
+혹시 새벽에 입원하셔서 입원 생활 안내 들으셨나요?,Korean
+잘 때 어려움이 있으신가요?,Korean
+평소 배가 잘 안 고픈가요?,Korean
+복부 통증이 많이 심한가요?,Korean
+먹으면 간지럽거나 한 음식 있나요?,Korean
+과거 수술 또는 질환으로 입원하신 적이 있으신가요?,Korean
+배의 어느 부위가 아프시죠?,Korean
+통증 정도는 어느 정도 되십니까?,Korean
+"엉덩이가 붓고 엉덩이가 바닥에 닿을 때마다 아파했어요.
+",Korean
+스트레스와 같은 환경적 요인 식습관 흡연 여부 등 다양한 원인이 있습니다.,Korean
+"숨쉬기가 힘들고 창백해지고 있어요.
+",Korean
+조직 검사가 필요해 보이네요.,Korean
+심계항진 증상을 설명해 주실래요?,Korean
+네 그냥 약 처방 시 참고하기 위해 드린 질문입니다.,Korean
+주변에서도 의식을 잃었다고 말씀하시던가요?,Korean
+"기침을 심하게 하다 보니 폐까지 아파서요.
+",Korean
+"네. 열 시 이후로 금식했습니다.
+",Korean
+가족 중 유전성 질환을 경험하신 분이 있으십니까?,Korean
+어느 정도의 강도로 통증이 느껴지나요?,Korean
+알레르기 때문에 치료받은 건 언제부터였어요?,Korean
+"당뇨 조절 문제 때문에요.
+",Korean
+잠자는 데 문제를 겪고 계신가요?,Korean
+현재는 열이 떨어진 상태입니다. 검사결과는 들으셨나요?,Korean
+"배 아프다고 울고 난 뒤로부터는 아무것도 안 먹었습니다.
+",Korean
+철심 수술은 안 했어요.,Korean
+피가 섞인 변을 보시나요?,Korean
+네 주로 면역력이 생기면 재발 위험도가 줄어듭니다.,Korean
+입원 또는 수술 경험이 있나요?,Korean
+가래가 얼마나 자주 나오세요?,Korean
+숨이 가빠 보이는데 괜찮을까요?,Korean
+담배 피운 기간이 오래됐나요?,Korean
+허리 외에 다른 곳이 아프진 않으세요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+통증이 시작된 날은 언제인가요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+화장실에 오래 있어야만 소변을 보시나요?,Korean
+간염으로 무슨 약 드세요?,Korean
+과거 치료받았던 병이 있다면 말씀해 주세요.,Korean
+소독도 해야하고 상처를 확인해야 상처가 악화되었을 때에 적절히 치료받으실 수 있습니다.,Korean
+통증이 돌아오는 시간을 알려주세요.,Korean
+숨쉬기 버거웠던 적이 얼마나 자주 있으신가요?,Korean
+네. 그래서 비염이 생겼어요.,Korean
+삼 개월 전까지 드신 보약이 있다면 말씀해 주세요.,Korean
+부종이 있는 곳이 있나요?,Korean
+"삼일 정도 됐는데 시간이 지날수록 점점 더 아파요.
+",Korean
+약간 예민한 상태라 지금 아프다 보니.,Korean
+간염 치료로 복용 중인 약 있어요?,Korean
+언제부터 결핵인 거 알았어요?,Korean
+"목에 모래가 낀 듯이 까끌까끌하게 느껴져요.
+",Korean
+어젯밤 열두 시 이후로 금식하셨나요?,Korean
+수면 환경을 조절해서 더 오래 잘 잘 수 있게 해볼까요?,Korean
+입원해서 정밀 검사를 받아 원인을 알아야 재발을 막을 수 있기 때문에 입원이 필요합니다.,Korean
+특이 혈액형인지 전 잘 모르겠어요.,Korean
+정밀 검사를 해봐야 알 수 있습니다.,Korean
+걱정이 크시겠습니다. 증상의 원인을 찾기 위해 검사를 더 해 보겠습니다.,Korean
+비수면내시경이지만 수월한 편이며 사람에 따라 차이는 있을 수 있습니다. 대장 내시경보다는 수월합니다.,Korean
+그냥 잠깐 영양실조 때문에 링거 맞느라 하루 입원한 거 말곤 없어요.,Korean
+신물이 넘어오는 이유는 위식도역류질환이 대표적입니다.,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+네 어떻게 바이러스에 감염됐는지를 찾는 것은 어렵습니다.,Korean
+평소에도 열이 자주 났었나요?,Korean
+식사 후에만 속이 안 좋으세요?,Korean
+삼사 년 전에 골다공증 검사를 받은 적이 있는데 뼈가 약하다는 이야기는 들었지만 치료할 정도는 아니라고 했습니다.,Korean
+현재 당뇨 수치가 높으신 편인가요?,Korean
+언제 처음 알레르기가 생겼어요?,Korean
+저랑 제 아버지가 고지혈증을 동시에 앓고 있어요.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+언제부터 고혈압인 걸 알게 되었나요?,Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+통증 특성이 있다면 어떤 특성이 있을까요?,Korean
+며칠 전에 입국했어요. 접종은 해외에 오래 있어서 맞지를 못했고요.,Korean
+가족 중에 유전성 질환을 가진 분이 있나요?,Korean
+이 약은 식전에 드셔야 합니다.,Korean
+콧물 나올 때 가래도 같이 나오나요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+소변을 잘 못 보시나요?,Korean
+알레르기 반응이 언제 보이나요?,Korean
+네 발열 및 두통이나 근육통 모두 알레르기 이상 반응이에요.,Korean
+할아버지랑 아버지 모두 간암으로 돌아가셨어요.,Korean
+설사를 하거나 변비가 있거나 변을 볼 때 아프거나 색깔이 특이하지는 않나요?,Korean
+아픈 곳이 더 있나요?,Korean
+검사 결과에 따라 격리가 필요할 수 있어서 필요합니다.,Korean
+암이 있다고 진단 받은 거는 언제인가요?,Korean
+배가 불러 불편하지는 않으세요?,Korean
+평균 일 이 주 걸립니다. 하지만 치료가 되지 않았을 때는 추가 십이 주 걸릴 수 있습니다.,Korean
+자의로 판단하지 마시고 병원에서 처방받은 대로 하시면 됩니다.,Korean
+정확히 어느 부위에서 통증을 느끼나요?,Korean
+작년 겨울에 내시경 하신 것 아닌가요?,Korean
+"움직이기는 하는데 위로 못 올려요.
+",Korean
+수술 부위 주변이 같이 아플 수 있습니다.,Korean
+병원비랑 관련된 상담은 어디서 받을 수 있을까요?,Korean
+"오늘 아침에 일어나다가 갑자기 정신을 잃고 쓰러졌어요.
+",Korean
+과거에 오랜 기간 동안 치료한 병이 있나요?,Korean
+결핵 앓은 적 있으신가요?,Korean
+속이 울렁거리며 구토 증상이 있나요?,Korean
+"고환이 많이 부어 내원했어요.
+",Korean
+설사를 하는 시기가 있나요?,Korean
+투약 등을 통해 개선해야 하는 병변은 아니며 지속적인 추적검사가 요구됩니다.,Korean
+같이 복용하는 약물의 영향이 있어 꼭 필요한 부분입니다.,Korean
+네 그럼 환자 팔찌 오른손에 하겠습니다.,Korean
+검사를 통해 심각한지 확인하기 위해서니 검사를 오늘 해주시기를 바랍니다.,Korean
+음식 알레르기 갖고 계신 거 있나요?,Korean
+진료받는데 거리가 멀면 위급 상황 시 문제가 될 수 있어서 여쭈어봤습니다.,Korean
+네 필요하신 보호대 드릴게요.,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+알레르기를 언제부터 치료받고 있나요?,Korean
+수면제 복용에 앞서 잘못된 수면 습관이 있는지 파악하고 고치는 것이 필요합니다.,Korean
+가족 중에 암으로 돌아가신 분이 있나요?,Korean
+식염수인데 상처 부위를 소독할 겁니다.,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+네 기본적인 네 개 혈액형 제외한 혈액형을 말합니다.,Korean
+아픈 건 어느 정도인가요?,Korean
+붉어졌던 증상 외에 다른 증상은 없으셨나요?,Korean
+"냄새나는 액체가 눈에서 나와요.
+",Korean
+언제 알레르기라는 것을 처음 알게 되셨나요?,Korean
+원인에 따라서 앞으로의 예후를 예측해볼 수 있습니다.,Korean
+구토를 많이 하지는 않으시나요?,Korean
+수액 연결하면 처음에는 어지러우실 수 있어요.,Korean
+네. 만성 질병 외에도 특이하게 앓았던 병이 있으면 알려주세요.,Korean
+일부 환자는 유전적 이상으로 발생하며 당뇨병 갑상선기능저하증 간질환 신장질환 비만 등이 있는 경우 고지혈증이 발생하기 쉽습니다.,Korean
+"매운 걸 안 먹었는데도 속이 쓰려요.
+",Korean
+치과에서 수술이 아니라 치료하신 거 아닌가요?,Korean
+푸룬도 좋지만 확실한 효과를 원하시면 약을 드시는 게 좋습니다.,Korean
+소변을 봐도 뭔가 찝찝하신가요?,Korean
+독감 주사 말고는 없어요.,Korean
+가족 중에 치료가 필요할 정도의 당뇨를 진단 받으신 분이 계신가요?,Korean
+개인 병원에서 촬영한 사진 있으신가 해서요.,Korean
+알고 있는 음식 알레르기를 말씀해 주세요.,Korean
+소변이 잘 누어지지 않으세요?,Korean
+당뇨 처방 약은 어떤 걸 갖고 계세요?,Korean
+숨이 찬 증상은 없나요?,Korean
+몸 전체에서 피로감이 느껴지나요?,Korean
+다른 증상 말씀해 주시면 증상에 따라서 약 처방해 드리겠습니다.,Korean
+가족 중 당뇨 환자가 계신지 말씀해주세요.,Korean
+결핵 진단을 받은 적 있으세요?,Korean
+반려견이 주사 맞는 게 아닌가요?,Korean
+그럼 이따 드실 약만 가지고 계시고 나머지는 확인 후 돌려드리겠습니다.,Korean
+욕창이 심해지면 뼈까지 노출될 수 있고 ��병증으로 감염이나 골수염이 생길 수도 있습니다.,Korean
+임플란트 치아에 불편함은 없으신 가요?,Korean
+부모님이나 형제 중에 암환자가 있으신가요?,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+두 시간마다 자세를 바꿔야 하는데 힘드시면 자동으로 체위를 바꿔주는 욕창 방지 매트를 사용해 보셔도 좋을 것 같네요.,Korean
+하루 동안 피우는 담배의 양은 얼마나 되나요?,Korean
+팔이 부러져서 깁스 한 적 있는데요.,Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+수분 섭취가 줄거나 비타민 비를 많이 섭취하면 소변 색이 진해질 수 있습니다.,Korean
+검사 결과는 내일 오전에 나올 겁니다.,Korean
+치아 통증이 언제부터 생겼나요?,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+정 힘들면 그때 간병인 부를 것 같아요.,Korean
+수면제는 해당 진료과로 가셔야 합니다.,Korean
+네. 부정맥 진단받았는데 따로 증상은 없어서 치료는 안 받고 있습니다.,Korean
+"소변 색이 좀 다른 거 외엔 모르겠는데요.
+",Korean
+대변을 며칠에 한 번 보나요?,Korean
+"넘어져서 책상에 머리를 부딪혔어요.
+",Korean
+음주는 하신 적 있어요?,Korean
+항문 출혈의 경우 적은 양으로 나오며 심각한 원인이 아닌 경우가 많습니다.,Korean
+결핵으로 약 드시고 계세요?,Korean
+증상이 언제쯤 시작됐는지 알려 주세요.,Korean
+해당 부위가 얼마나 아프세요?,Korean
+이후 식사 제한 처방이 나면 말씀 드릴게요.,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+현재도 천식 관련하여 약물치료 중이신가요?,Korean
+네 소변줄을 통해 간호사가 시간별로 소변량을 측정할 거예요.,Korean
+집 먼지 진드기는 항상 생길 가능성이 존재하므로 자주 세탁해 주는 것이 중요합니다.,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+성공적으로 제균치료를 받고 박멸된 이후의에는 재발 가능성은 있긴 하나 낮습니다.,Korean
+가래에 피가 섞여 나오지는 않나요?,Korean
+"물을 잘못 마신 것 같아요. 세제 맛이 났어요. 그 뒤로 어지럽고 계속 토하고 그래서 왔어요.
+",Korean
+과거 수술 여부 말씀해주세요.,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+올해 독감 예방 주사 맞으셨나요?,Korean
+오한 증상이 있다고 생각하나요?,Korean
+"보름 정도쯤부터 숨이 막히고 호흡이 가쁘고 그런 증상들이 전보다 더 심해졌어요. 그렇게 숨을 몰아쉬고 나면 어지럽고 손발이 덜덜 떨리기도 하고 힘을 줄 수가 없게 되더라고요. 어디가 아픈가 해서 병원에 가봤더니 몸에는 아무런 문제가 없다는 거예요. 근데 의사 선생님이 정신과 진료를 한번 받아보라고 하셔서 와봤어요.
+",Korean
+혹시 고혈압 관련해서 약 드시고 있으세요?,Korean
+주로 성관계에 의해 전파되는 것도 있습니다.,Korean
+어떤 것에 알레르기가 일어나나요?,Korean
+혹시 현재 사용하고 있는 보조 기구가 있을까요? 예를 들면 의치나 렌즈 목발 같은 거요.,Korean
+오심은 주로 토할 것 같은 느낌으로 나타납니다.,Korean
+어렸을 때부터 내성 발톱을 앓고 있습니다.,Korean
+"변비가 좀 있는데 찢어졌는지 닦을 때 보면 피가 묻어 나오는 때도 있습니다.
+",Korean
+어떤 약재가 들어가 있는지 몰라서 혹시 약재 적힌 종이 같은 거 가지고 계시나요?,Korean
+최근 급격한 체중 감소가 있었나요?,Korean
+대변을 보기 어렵다거나 잘 나오지 않는 증상도 포함됩니다.,Korean
+네 원래 이 질환은 치료에 시간이 많이 걸립니다.,Korean
+이약은 면역력을 높여주는 데 사용되고 있습니다.,Korean
+"오늘 여태까지 아직 대변을 안 봤어요.
+",Korean
+구토를 언제 한 적 있나요?,Korean
+당뇨 관련해서 드시고 있는 약 있나요?,Korean
+네 병원은 전체 금연지역입니다.,Korean
+평소에도 간지러운지 얼마나 되셨나요?,Korean
+최근에 언제쯤 체중이 급격히 줄었었나요?,Korean
+통증의 원인을 얼른 잡을 수 있도록 노력해 봅시다.,Korean
+합병증이 발병할 위험성이 향후 예후에 영향을 미칠 수 있습니다.,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+네 우선 하시게 될 검사는 세침흡인생검이에요.,Korean
+혹시 고혈압 가족력이 있습니까?,Korean
+의학적으로 검증되지 않은 경우이긴 해서 염려되어서요. 효과 보셨던 게 어떤 것이었나요?,Korean
+진료받은 병원을 기재해야 하거든요.,Korean
+네. 여드름이 너무 심해서 약 먹으면서 치료했는데 효과는 별로 없었어요.,Korean
+현재 체중 변화가 심한 가요?,Korean
+치밀유방��라고 들으셨죠? 유방초음파 같은 거 해보신 적은 있으세요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+몸에 좋다고 아무 약이나 드시면 안 됩니다.,Korean
+맥박 측정하면서 핸드폰 해도 돼요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+검사 결과가 생각보다 좋지 않게 나왔어요 위험한 상태라고는 할 수는 없지만 그렇다고 좋은 상황도 아닙니다.,Korean
+"어제 고기 먹었고요. 지금도 여전히 아파요.
+",Korean
+"기흉인 걸로만 알고 있어요.
+",Korean
+담배를 얼마나 오래 피셨나요?,Korean
+숨을 헐떡일 때가 있나요?,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+토혈 후 어지럽지는 않았나요?,Korean
+고혈압과 관련된 약은 전혀 안 드셨나요?,Korean
+알레르기로 조심하시는 음식 있나요?,Korean
+과거에 했던 수술 방법에 따라 이번에 하는 수술 방법이 변경될 수도 있습니다.,Korean
+복부가 가스로 가득 찬 것 같은 느낌이 드나요?,Korean
+"아이 눈에서 자꾸 진물 같은 게 나와요.
+",Korean
+몸에 계속 열이 나나요?,Korean
+물 같은 변을 처음 본 것은 언제인가요?,Korean
+"눈앞을 끈적한 진물이 가려요.
+",Korean
+"상처가 났던 부위에서 진물이 나오면서 아파요.
+",Korean
+휠체어 탔던 걸로 기억이 나요.,Korean
+아프다고 해서 진통제는 먹이긴 했는데 해열제 효과는 없는 약이에요.,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+약을 구입한 곳에 문의해보셔도 돼요.,Korean
+어떤 부위 검사를 받고 싶으세요?,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+네. 현재 질병과 관계없이 모든 입원 치료 및 수술 경험 알려주세요.,Korean
+"소변 나오는 게 영 시원치 않아서 입원했어요.
+",Korean
+도대체 어디가 아픈 거예요?,Korean
+간염약 처방받으신 것이 이것인가요?,Korean
+환부보다 넓게 그리고 두껍게 발라줘야 해서 연고가 많이 필요합니다.,Korean
+종양 확인 후 치료는 잘 받으셨나요?,Korean
+몸에 열이 나거나 뜨겁지 않나요?,Korean
+그러니까 사출성 구토는 뭔가 먹자마자 바로 나오는 구토를 말합니다.,Korean
+더 이상 감염 걱정을 하지 않아도 되는 상태를 말합니다.,Korean
+가슴 쪽이 아프거나 하지는 않으세요?,Korean
+약은 곧 처방전이 나올 겁니다.,Korean
+과거 병력을 알고 싶어요.,Korean
+자극적인 음식을 피하시고 현재는 금식을 유지하며 항생제 치료를 진행해야 합니다.,Korean
+네 모든 검사 완료됐습니다.,Korean
+편도선 많이 안 부었어요?,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+"소변볼 때 성기가 아파서요.
+",Korean
+대변을 보실 때 피가 묻거나 통증이 있으세요?,Korean
+네. 생식기 치료는 산부인과에 해당합니다.,Korean
+미리 검사하면 수술할 때 문제를 미리 예방할 수 있으니까요.,Korean
+보유하고 계신 약 사진은 없나요?,Korean
+발열 증상이 있었던 적이 있나요?,Korean
+결핵을 앓았던 기간이 어떻게 되세요?,Korean
+피로가 회복이 안 되시나요?,Korean
+하루에 음주량이 얼마나 되세요?,Korean
+삼 개월 전까지 드신 보약이 있다면 말씀해 주세요.,Korean
+혹시 호흡곤란이 있는 편이세요?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+"수면제 없이는 잠을 못 자요.
+",Korean
+어떤 이유로 병원에 오게 되셨나요?,Korean
+집안에 유전성 질환이 있으신가요?,Korean
+지금도 대변을 보고 싶으신가요?,Korean
+기침할 때 증상이 어떤가요?,Korean
+위산제는 어디에 쓰려고 하시죠?,Korean
+"코 막혀서 잠을 못 자는 거 같아요.
+",Korean
+병원 오시게 된 목적은 무엇인가요?,Korean
+고혈압약 뭐 먹고 계세요?,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+수술 후 경과를 봐야 식사 여부를 알 수 있어요.,Korean
+"어제 새벽부터인데 열은 못 쟀어요.
+",Korean
+"최근에 어지럼증이 너무 심해져요.
+",Korean
+배가 더부룩할 때 통증도 같이 있나요?,Korean
+항문 출혈 가능성이 높고 그 경우 심각한 질환의 가능성은 낮습니다.,Korean
+식후 계속 속이 불편하신가요?,Korean
+소독 거즈를 교체하는 경우라면 동네 병원에 가셔도 됩니다.,Korean
+아직 온몸에 열 기운이 있어요.,Korean
+"왼쪽 눈 위를 다쳐서요.
+",Korean
+코로나 검사 대상자인 적 없습니다.,Korean
+부작용 있는 약 있으시면 말해주세요.,Korean
+얼마나 자주 구토를 하시나요?,Korean
+환자분의 정확한 상태 파악을 위해서 몇 가지 질문드려야 하는데 가능하시겠어요?,Korean
+소화제가 필요한 증상이라면 먹일 수 있습니다.,Korean
+휠���어 사용 신청서 쓰시면 돼요.,Korean
+어떤 것에 알레르기 반응이 나타날까요?,Korean
+"벌집을 건드리는 바람에 온몸에 벌이 달라붙어서 쏘였어요.
+",Korean
+과민성과 관련된 약도 드시나요?,Korean
+검사를 해봐야 할 것 같아서 조금만 참아주세요.,Korean
+주사뿐 아니라 복용 중이신 약도 말씀해 주시면 됩니다.,Korean
+소변보고 싶은 느낌이 계속 있나요?,Korean
+몸이 부은 느낌은 안 받으시나요?,Korean
+입원이나 수술하신 적 있어요?,Korean
+숨이 찬 증상이 구체적으로 어땠는지 말씀해주세요.,Korean
+본원이 아니더라도 이틀마다 꼭 병원에 가셔서 소독을 받으셔야 합니다.,Korean
+"네. 약을 먹는데도 소변이 잘 안 나오는데 왜 그런가요?
+",Korean
+언제부터 다른 부위 통증이 있으셨나요?,Korean
+가래가 묽은 느낌이 나나요?,Korean
+몸살처럼 몸이 뜨겁고 춥나요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+두통이 계속 지속되고 있나요?,Korean
+제대혈에는 조혈 모세포가 풍부하여 희귀 난치성 질환 치료에 사용할 수 있습니다.,Korean
+알레르기 때문에 복용 금지된 약이 있으세요?,Korean
+예를 들면 대상포진 예방접종 같은 거요.,Korean
+정상적인 치아도 그렇게 손으로 잡고 강하게 흔들면 흔들릴 수 있어요 흔들린다고 생각되시면 치과에 오셔서 바로 검진하는 게 좋습니다.,Korean
+"아. 설사 증세도 같이 있어요.
+",Korean
+통증 진행 양상이 어떤가요?,Korean
+주사 맞는 건 언제가 괜찮으세요?,Korean
+독감 예방 주사는 왜 안 맞으셨어요?,Korean
+간세포 손상이나 담도 폐색으로 황달이 생기면 노란빛을 띠는 빌리루빈이라는 색소가 소변에 녹아들어 소변의 색이 짙은 갈색으로 보일 수도 있습니다.,Korean
+몸의 부기가 어느 정도인가요?,Korean
+아픈 정도를 비유하자면 어느 정도일까요?,Korean
+술을 과하게 먹는 편인 가요?,Korean
+"소변은 잘 누고 있어요.
+",Korean
+두통이 심할 때도 있나요?,Korean
+고혈압 앓으셨던 가족분이 계신가요?,Korean
+"네. 설사약은 달고 삽니다.
+",Korean
+시간이 지나면서 약에 효과가 떨어질 수도 있고요.,Korean
+가족분들 중에 유전성 질환이신 분 계신가요?,Korean
+"가끔 토하고 싶고 그렇습니다.
+",Korean
+목으로 피가 조금 올라오나요?,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+알레르기 반응이 몇 가지가 되는지 말씀해주시겠어요?,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+간염이라고 언제 처음 알았습니까?,Korean
+지금 환자분 상태가 통원 치료로는 좀 힘들어서요.,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+당뇨 처방 약 계속 드세요?,Korean
+가족 중에 유전성 질환 환자 있는지 궁금합니다.,Korean
+통증이 가장 잘 느껴지는 부위가 어디예요?,Korean
+다리 저림이 부종 때문에 발생할 수도 있지만 자세한 건 환자분 검사 후에 다시 말씀드릴게요.,Korean
+독감 접종 맞으신 거 맞죠?,Korean
+보유 질환이나 만성 질환 같은 거 없습니다.,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+혈압이 높아진 지는 얼마나 되었나요?,Korean
+월경의 주기와 양이 규칙적이신가요?,Korean
+음식을 먹기 힘들 정도로 구토하나요?,Korean
+혈압 측정 시 편안하게 계시면 됩니다.,Korean
+부모님 중에 고혈압 있는 분 계신가요?,Korean
+결핵 치료는 어느 정도의 기간 동안 받고 있는 중인가요?,Korean
+통증이 어떤지 설명해 주시겠어요?,Korean
+다른 이유로 알레르기가 일어난 적 있나요?,Korean
+네. 우선적으로 수액치료와 필요시 약물 치료로 정상 혈압을 유지할 것입니다.,Korean
+정확한 진단을 위해서는 진료의가 직접 문진하여 확인하는 과정이 필요합니다.,Korean
+간염 치료 중이면 말씀해 주세요.,Korean
+가슴 통증의 양상은 어땠나요?,Korean
+결핵 문제는 그동안 없었고요?,Korean
+결핵을 오래 앓으신 거예요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+중요한 건 치료이니 잘 따라만 주시면 괜찮을 겁니다.,Korean
+네 예약하시고 그날 내원하시면 검사 진행하겠습니다.,Korean
+유전적인 병은 집안 내력으로 이어집니다.,Korean
+아니요. 하지정맥류가 아닌가 해서 병원에 오게 되었습니다.,Korean
+알레르기 때문에 피해야 될 음식 있나요?,Korean
+당뇨 치료 위해 드시는 약 있으세요?,Korean
+정확히 어떤 음식이나 약에 두드러기가 나는거죠?,Korean
+통증 강도를 숫자로 표현하면 얼마나 되나요?,Korean
+혹시 못 먹는 약 있으면 알려주세요.,Korean
+해외에서 혹시 코로나 접촉이 있을 수도 있어서요.,Korean
+꾸준한 물리 치료로 손목 통증을 줄일 수 있습니다.,Korean
+고혈압약 말고 당뇨약이나 심장질환약 같은 거요.,Korean
+알레르기 시작된 지 얼마나 되었나요?,Korean
+왜 소변검사만 하시려는 건가요?,Korean
+어릴 때 불주사 맞으셨나요?,Korean
+두통이 있었던 적은 없나요?,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+저희가 환자분 몸 상태를 더 잘 이해하기 위해 질문드렸어요.,Korean
+입원 절차를 밟으셔야 해서 죄송하지만 바로 입원 진행은 어렵습니다.,Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+인후통의 통증 정도를 말씀해 주세요.,Korean
+지금 가족 중에 암 치료받는 분 있어요?,Korean
+약물이나 음식 말고 알레르기 있으세요?,Korean
+특별한 약물 알러지가 있나요?,Korean
+가족력 때문에 당뇨 위험이 있나요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+약에 의한 부작용이 있을 수 있으며 일차 치료 실패도 부작용이라고 할 수 있습니다.,Korean
+고혈압에 관련된 약을 드시고 계시는지 말씀해 주세요.,Korean
+평소에 숙면 드시는 게 어려우시나요?,Korean
+혈압으로 인해 쓰러진 적이 있나요?,Korean
+증상이 생긴 건 언제부터인가요?,Korean
+일부 과일에만 알레르기가 있을 것으로 예상되는데 알레르기 항원 검사로 정확한 진단을 먼저 받아보시겠어요?,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+네 소아 탈장은 수술로 탈장 주머니를 묶어줘야 합니다.,Korean
+급하게 응급실로 갔는데 입원이 필요할 것 같다고 해서 입원하게 됐습니다.,Korean
+예방 접종 성분과 비슷한 성분의 약을 처방 예정입니다.,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+환자분이 느끼시는 통증의 정도를 알고 싶어요.,Korean
+소변 보는 데 불편한 느낌이 있으세요?,Korean
+흉터는 어쩔 수 없이 남을 겁니다.,Korean
+"아이가 원래는 열 시면 잤는데 요즘은 쉽게 안 자네요.
+",Korean
+주로 어디가 가장 아프세요?,Korean
+만졌을 때 통증은 없나요?,Korean
+또 탈장인 건가요. 재수술은 정말 하기 싫은데요.,Korean
+젖은 거즈는 입술을 촉촉하게 만드는 용도입니다.,Korean
+세 시간 단위로 수액 놔드릴게요.,Korean
+"책상 모서리에 눈을 부딪혔습니다.
+",Korean
+최근 들어 살이 갑자기 찐다거나 하진 않나요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+요즘 당뇨를 치료 중인가요?,Korean
+오한 증상이 언제 시작 되었죠?,Korean
+잠에 들기까지 얼마나 걸리시나요?,Korean
+예를 들면 인플루엔자 및 대상포진 예방접종같은 거요.,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+가슴이 답답하고 속이 더부룩한가요?,Korean
+건들지 않으시면 피는 안 나요.,Korean
+목이 좀 따가운 정도였어요.,Korean
+입원하신 날짜를 확인하는 겁니다.,Korean
+최근 몸무게 변화 말씀해주세요.,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+네 바로 금식해 주시면 됩니다.,Korean
+통증이 오는 특정 상황이 있나요?,Korean
+휴지로 닦으면 검붉은 피가 같이 닦여나오나요?,Korean
+평소 앓고 계시는 기저질환이 있습니까?,Korean
+대변보는 주기가 어떻게 되나요?,Korean
+틀니 보청기 가발 지팡이 렌즈 등 사용하시는 보조 기구가 있나요?,Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+생각나는 민간요법이면 어떤 것이든 상관없습니다.,Korean
+"오줌을 잘 못 누고 배 안쪽이 탱탱하게 엄청 당겨서 아파서 입원했어요.
+",Korean
+네 위염 때문에 더부룩한 증상이 있으셨던 것 같습니다.,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+손으로 긁으면 염증이 생겨서 더 안 좋아집니다.,Korean
+환자분의 혈압 상태를 알고 계신가요?,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+원인에 따라 다른 약제 사용이 필요할 수 있습니다.,Korean
+어느 것이 더 적합한지는 진료받아야 알 수 있습니다.,Korean
+과거에 혹시 질병이 있었습니까?,Korean
+하루에 담배 타임은 몇 번 정도 가지세요?,Korean
+호흡이 힘든 상황이 오나요?,Korean
+결핵약 지금도 드시고 계시나요?,Korean
+앓고 계신 지병이나 꾸준히 복용하는 약이 있나요?,Korean
+제왕절개 하면서 추가로 하는 거라 물어보는 겁니다.,Korean
+네. 이후 환자분 치료 계획에 따라 식사 처방도 달라질 수 있어요.,Korean
+소변을 보고 닦을 때 피가 묻어 나오나요?,Korean
+평소에도 기침을 자주 하는 편인가요?,Korean
+수액으로 보충이 되므로 걱정 안 하셔도 됩니다.,Korean
+꾸준한 물리치료로 손목 통증을 줄일 수 있습니다.,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+약제에는 더 많은 비타민을 함축시킬 수는 있는데 체내에 흡수되는 것은 과일 같은 자연식품이 효과적입니다.,Korean
+콜라 같은 색의 소변인가요?,Korean
+병원 내에서는 휠체어를 이용해 주시고 목발은 필요하시면 의료기기 상점에서 구매하셔야 합니다.,Korean
+최근 어지러움을 자주 느끼나요?,Korean
+목이 건조하거나 삼키기가 힘들거나 하는 통증은요?,Korean
+결핵 때문에 병원 다니신 적이 있나요?,Korean
+통증은 얼마나 자주 생기세요?,Korean
+위산제는 어디에 쓰려고 하시죠?,Korean
+간염은 약으로 치료하시는 거예요?,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+가족 중에 암 병력이 있는 분이 계신가요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+드시는 당뇨약 이름이 뭔가요?,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+몸에 이상이 생겼다는 게 어떤 의미인가요?,Korean
+상해 치료를 받은 적 있으신가요?,Korean
+아픈 게 얼마 안 됐나요?,Korean
+치과에서 수술이 아니라 치료하신 거 아닌가요?,Korean
+지금 몸에 발열증상이 있나요?,Korean
+어느 부위에 통증이 있어요?,Korean
+"좀 쌕쌕거려요. 원래 천식이 있지도 않아요.
+",Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+최근에 입원 치료를 받은 적이 있나요?,Korean
+가족 중에 치료가 필요할 정도의 당뇨를 진단 받으신 분이 계신가요?,Korean
+일상생활 중에 알레르기 반응을 보이는 것이 있었나요?,Korean
+주에 몇 번씩 통증이 느껴지시나요?,Korean
+면역력은 치료와 밀접한 관련이 있습니다.,Korean
+"몸무게가 십 킬로그램 이상 줄었어요.
+",Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+결핵 치료로 어떤 약 드세요?,Korean
+어떨 때 통증이 가장 크게 느껴지나요?,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+가래가 무슨 색인지 말씀해 주세요.,Korean
+치아 몇 개 빠지셨나요?,Korean
+여드름 부위에 발라야 합니다.,Korean
+당뇨는 몇 년 전부터 발병했나요?,Korean
+이맘때 꽃가루 알레르기가 생기긴 해요.,Korean
+최근에 무슨 약을 드셨죠?,Korean
+알레르기를 가지고 계시면 전부 알려주세요.,Korean
+일단 진료 대기자들이 있어서 그분들부터 진료해야 합니다.,Korean
+"푹 못 자요. 아파서.
+",Korean
+통증 지속시간이 일 분을 넘어가나요?,Korean
+약물 치료로 부족하다면 손목 수술의 방법도 있습니다.,Korean
+배액관이 밖으로 조금 빠져나왔습니다.,Korean
+통증이 나타난 게 언제인가요?,Korean
+최근 한달이내에 예방 주사 맞으신 적 있나요?,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+입원 절차를 밟으셔야 합니다.,Korean
+요새 머리가 어지럽진 않나요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+수면 보조제를 드시고 계시네요. 변화는 있었나요?,Korean
+"혈액검사에서 지방 수치가 높게 나온 건 왜 그러는 거예요?
+",Korean
+식구 중에 고혈압이신 분 또 있나요?,Korean
+배가 더부룩한 느낌은 없나요?,Korean
+독감 예방 주사는 꾸준히 맞으셨나요?,Korean
+하루에 대변을 얼마나 보시나요?,Korean
+제가 말씀드릴 때까지 청진이 계속될 테니 계속 심호흡해 주시면 됩니다.,Korean
+심장이 빨리 뛰어서 아프신가요?,Korean
+몸이 부은 느낌을 자주 느끼시나요?,Korean
+먼저 입원을 위해 간단한 진찰을 진행하도록 하겠습니다.,Korean
+담배를 얼마나 오래 피셨나요?,Korean
+"요실금은 아직 안 온 것 같아요.
+",Korean
+"귀에서 윙윙 소리가 나네요.
+",Korean
+몸이 엄청 나른해지고 무기력해져요.,Korean
+고혈압을 앓고 있는 가족이 있으신가요?,Korean
+하루 평균 흡연량이 얼마나 되나요?,Korean
+네 개인 정보 때문에 내원하셔야 결과 들을 수 있습니다.,Korean
+통증이 나타나는 빈도를 말씀해 주세요.,Korean
+암인 걸 언제 처음 알게 되셨나요?,Korean
+몸에 힘이 빠지는 듯한 증상이 있으세요?,Korean
+어제 저녁 먹고 어른용 해열제 반쪽 먹었어요.,Korean
+증상이 없는 사람에게서 옮았을 경우 어디에서 옮았는지 알 수 없습니다.,Korean
+며칠에 한 번 통증이 오나요?,Korean
+아프기 시작한 게 언제부터였죠?,Korean
+군대에서 허리를 삐끗한 후 허리 디스크를 달고 살고 있습니다.,Korean
+하루 섭취 권장량은 칠백에서 천 밀리그램입니다. 우유를 기준으로는 일 미리 리터당 칼슘 일 밀리그램이 들어있습니다.,Korean
+"옆구리 상처 치료하러 왔어요.
+",Korean
+네 그건 가족력에 기록해 놓을게요.,Korean
+부작용은 드물지만 천공으로 인한 복막염이 발생할 수 있습니다.,Korean
+금주를 하셨어도 음주 습관을 알면 치료에 도움이 됩니다.,Korean
+"소변에서 냄새가 나고 몸이 안 좋아 보여서요.
+",Korean
+네 무리했을 경우 복압에 피해가 갑니다.,Korean
+담배 몇 살 때부터 피우셨나요?,Korean
+치료 때문에 이틀에 한 번은 오셔야 하거든요.,Korean
+눈에 좋다고 해서 먹는 영양제예요.,Korean
+많은 약물이 의식 소실을 유발할 수 있습니다.,Korean
+알레르기 일으키는 원인 있나요?,Korean
+피를 토한 적이 있다면 말씀해 주세요.,Korean
+종양 확인된 적 있으신가요?,Korean
+"네. 전체적으로 힘이 없어서 서 있는 것도 버거워요.
+",Korean
+물만 먹어도 설사가 나오나요?,Korean
+바로 말씀드리기는 어려우니 상부위장관 내시경 검사가 필요합니다.,Korean
+혹시 유전성 질환이 다른 가족분에게 있나요?,Korean
+검사 결과를 확인 후 말씀드리겠습니다.,Korean
+위에는 증상이 발견되지 않았는데 위산제는 왜 필요하시죠?,Korean
+혹시 가래를 자주 뱉으시나요?,Korean
+현재 구토 증상이 있나요?,Korean
+현재 따로 먹고 있는 약이 있나요?,Korean
+정신과적 치료라면 공황장애 같은 거 말씀하시는 건가요?,Korean
+"하루에 한 갑 십 년 피우다가 최근 한 일 년은 하루에 반 갑으로 줄였습니다.
+",Korean
+틀니나 임플란트가 있으시면 말씀해 주세요.,Korean
+"네. 어지러운 부분이나 울렁거리는 그런 증세는 없었어요.
+",Korean
+결핵약 지금도 드시고 계시나요?,Korean
+암 치료 기간이 어떻게 되나요?,Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+식품 알레르기로 인해 구토나 설사를 한 적이 있나요?,Korean
+최근 몸무게 증가 추이를 말씀해주세요.,Korean
+의사 처방 없이 더 드리는 건 어려워요.,Korean
+발기 부전으로 인해 고생하신 적 있으신가요?,Korean
+수술했거나 치료 중인 병이 있나요?,Korean
+당뇨를 앓았던 친인척들이 있나요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+"지금 아까보다는 나은데 여전히 아파요. 어제 식사요? 뭐 먹었더라.
+",Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+몸에 갑자기 열이 나나요?,Korean
+알약을 삼키기 힘들어하시는 건가요?,Korean
+건강검진 받으셨을 때와 지금 상태가 달라졌을 수도 있어서 다시 해야 합니다.,Korean
+"모유를 수유하는데 노란 물을 자주 토해요.
+",Korean
+"접촉 사고가 났는데 이상하게 전신이 아파요.
+",Korean
+일주일 내내 통증이 있으셨나요?,Korean
+간염 관련해 아무 문제 없으셨나요?,Korean
+오진을 막기 위해 환자 확인용으로 이용되고 있어요.,Korean
+"요 근래 얼굴이 계속 빨갛게 뜨고 눈에도 통증이 있어서 왔습니다.
+",Korean
+뉴트리션 영양제랑 철분제 사 먹고 있어요.,Korean
+결핵 주사는 이미 맞으셨나요?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+약을 먹고 머리가 아프셨던 거예요?,Korean
+약 먹고 알레르기 난 경험 있나요?,Korean
+소변보는 게 평소보다 오랜 시간이 소요되나요?,Korean
+엑스레이 하기 전에는 흡연은 삼가해주세요.,Korean
+간염 치료받은 지 오래되셨나요?,Korean
+네 진료 도와드릴 수 있게 초진 기록지 한 장 작성해 주세요. 저희 병원 처음이신가요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+따로 앓고 계신 암은 없으신 거죠?,Korean
+암을 진단 받으신 적 있나요?,Korean
+일 점부터 십 점까지의 통증 중 삼 점 정도 느끼신다고 합니다.,Korean
+몸이 안 좋은지는 확답하기가 곤란하네요 검사를 해봐야 알 수 있어요.,Korean
+암 치료받으신 기간 알려주세요.,Korean
+"애가 밤새 배를 부여잡고 울었는데 아무래도 배가 아픈 게 아닐까 합니다.
+",Korean
+아니요. 근데 이번 주에 독감 주사 맞으려고 하는 데 문제 되는 건 없겠죠?,Korean
+도대체 어디가 아픈 거예요?,Korean
+고혈압이라고 진단받은 적이 있으신가요?,Korean
+"아니요. 삼킬 때 좀 어려워해요.
+",Korean
+증상이 심해 보이니 바로 치료 들어가시죠.,Korean
+가족 중에 유전성 질환 관련 질병을 앓고 계신 분이 있을까요?,Korean
+"밤에 열이 펄펄 나고 추웠어요. 진통제를 먹었는데도 열이 안 떨어지고 온몸이 망치로 맞은 것처럼 아팠어요.
+",Korean
+과거에 유전성 질환 진단을 받은 가족이 있을까요?,Korean
+고혈압을 앓고 있는 가족이 있으신���요?,Korean
+"""입원, 수술 경험 있으시면 말씀해주세요.""",Korean
+응급상황일 수 있습니다. 응급실로 안내해드릴게요.,Korean
+아프신 곳과 증상을 설명해주세요.,Korean
+상처 소독도 해야하고 추후 경과를 봐야하기 때문에 입원을 하자고 하셨습니다.,Korean
+벌레 물렸을때 통증 정도로 생각하시면 됩니다.,Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+통증이 길게 가는 부위가 어디세요?,Korean
+성생활에 어려운 점이 있으세요?,Korean
+묽은 변을 보시지는 않나요?,Korean
+하루에 얼마나 자주 흡연하시나요?,Korean
+수액 바로 맞으셔야 합니다.,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+몸에 계속 열이 나나요?,Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+연고는 하루에 서너 번 깨끗한 상태에서 발라주세요.,Korean
+소변이 시원하게 나오지 않나요?,Korean
+복용 중인 약 있으면 말해주세요.,Korean
+피를 토할 때 위도 아픈가요?,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+입원이나 수술하신 적 있어요?,Korean
+편하게 숨을 쉬기가 힘든가요?,Korean
+"열이 나서 몸이 계속 추워요.
+",Korean
+수술은 잘되었으니 이제 남은 건 환자에게 달렸습니다.,Korean
+고혈압 환자인 가족분 있으세요?,Korean
+과거에 수술받으신 적 있나요?,Korean
+"대변볼 때 어떤 점을 말씀하시는 거예요?
+",Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+투석하는 요일은 월 수 금이오.,Korean
+알레르기 반응이 있는 상황이 있을까요?,Korean
+두 달 동안 몇 킬로나 증가했나요?,Korean
+수술 후 회복 경과를 지켜보고 말씀드리겠습니다.,Korean
+전에 수술한 경험 있으세요?,Korean
+예방 접종하고 관찰 후 귀가하실 거라 크게 걱정 안 하셔도 돼요.,Korean
+"코를 벽에 세게 부딪쳤어요.
+",Korean
+일주일에 몇 번이나 통증이 있나요?,Korean
+"시골 할머니 집에서 수돗물을 마셨는데 배가 아파 왔어요.
+",Korean
+가족 중에도 당뇨 환자가 있어요?,Korean
+네. 그저께 독감 주사 맞았어요.,Korean
+배가 부른 느낌을 가지고 계신가요?,Korean
+제대혈은 산모의 선택 사항입니다.,Korean
+정 혈액검사가 싫으시면 피부반응으로 하겠습니다만 정확도가 떨어지고 결과 확인이 늦어집니다.,Korean
+암 몇 기인지 언제 들으셨나요?,Korean
+대변보는 데 시간이 오래 걸리시나요?,Korean
+전에도 이런 증상으로 병원에 방문한 적이 있었나요?,Korean
+가족력이 있으면 질환 발병률이 높아 위험합니다.,Korean
+혈변 본 적 있어요?,Korean
+종양 확인된 적 있으신가요?,Korean
+통증의 강도가 얼마나 될까요?,Korean
+"걷는 게 영 불편해요.
+",Korean
+통증을 진정시키기 위해서 하는 목적이니 걱정하지 않으셔도 됩니다.,Korean
+하루에 몇 개비 정도 태우세요?,Korean
+종양 치료받은 적 있으세요?,Korean
+네 혈관이 터져서 조금 멍이 들었습니다.,Korean
+통증이 몇 단계 정도 되나요?,Korean
+"새벽 세네 시 까지 잠을 못 들어서 너무 괴로워요.
+",Korean
+"정확히 뭐라고 표현해야 할진 모르겠지만 속이 안 좋긴 하네요.
+",Korean
+뭐 때문에 약을 드시고 계세요?,Korean
+뇌전증의 정도에 따라 달라요.,Korean
+수면제 처방받아 복용하고 있습니다.,Korean
+언제부터 결핵인 거 알았어요?,Korean
+전에 혈액형 검사 하신 적 있으신가요?,Korean
+심호흡을 해서 폐를 빨리 펴주지 않으면 폐포에 문제가 발생할 수도 있습니다.,Korean
+식욕 부진 증상이 언제부터 나타났었나요?,Korean
+혹시 화학 약품이나 환경에 따른 알레르기 반응은 없으세요?,Korean
+음식 알레르기 외에 다른 것도 있나요?,Korean
+통증은 계속 나타나고 지속되세요?,Korean
+체중이 한 달에 몇 킬로 쪘나요?,Korean
+치료에 반응하는 정도에 따라 여러 전략을 바꿔가며 치료하기도 합니다.,Korean
+중요한 건 치료이니 잘 따라만 주시면 괜찮을 겁니다.,Korean
+배의 어느 부위가 아프시죠?,Korean
+약도 먹고 식단 관리도 하고 있어서 그런지 유지가 나름 잘되고 있습니다.,Korean
+이 병원 와 본 적 있는데요.,Korean
+두통이 얼마나 자주 느껴져요?,Korean
+발기 부전 관련해서 치료를 받으신 적이 있나요?,Korean
+현재 간염으로 어떤 약을 드시고 계신가요?,Korean
+소변에 피가 섞여나오는지 말씀해 주세요.,Korean
+대변을 보고 나서도 꺼림칙한가요?,Korean
+금주를 하셨어도 음주 습관을 알면 치료에 도움이 됩니다.,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+격리는 안 하고 마스크만 잘 쓰��� 되나요?,Korean
+소화가 어떻게 잘 안 되나요?,Korean
+구토를 하면 속이 아픈가요?,Korean
+알레르기 반응이 어떤 약에 일어났나요?,Korean
+위에서 역류해서 신물이 넘어올 수 있습니다.,Korean
+움직일 때 불편한 점이 있으신가요?,Korean
+가슴 쪽에 어떤 통증이 느껴지나요?,Korean
+토할 것 같은 느낌이 오나요?,Korean
+아닙니다. 안정을 취할 때도 증상이 있으신가요?,Korean
+"숨 쉬는 게 어려워요. 온몸이 저리고요.
+",Korean
+"그런 건 괜찮고 소변볼 때 미친 듯이 아파요.
+",Korean
+나팔관을 자르고 묶는 수술입니다.,Korean
+네. 저 작년에 위암 있었어요.,Korean
+심장이 두근거림을 언제 느끼셨나요?,Korean
+시력에 이상이 있거나 물체가 흐리게 보이거나 초점이 안 잡히거나 하지는 않았나요?,Korean
+욕창 상태를 육안으로 확인해보겠습니다.,Korean
+아니면 퇴원 설명이 적힌 종이를 드릴까요?,Korean
+발기 부전으로 곤란한 적은 없었나요?,Korean
+이직 문제 이사 문제 등으로 스트레스받아서 유산을 했었어요.,Korean
+고혈압으로 검진 결과가 나온 적 있나요?,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+마비의 전조증상일 수 있습니다.,Korean
+약 알레르기 있는 거 있으실까요?,Korean
+정확히 아픈 부위가 어디예요?,Korean
+틀니 임플란트 등 자연적으로 난 치아에서 의학적인 기술이 들어간 치아 상태를 모두 말씀드리는 거예요.,Korean
+어떤 종류의 진통제에 알레르기가 있으신가요?,Korean
+예전에는 어떤 병을 앓으셨어요?,Korean
+통증은 얼마나 지속되는지 아시나요?,Korean
+대변에 피가 많이 묻어 나옵니까?,Korean
+당뇨로 검사받으신 지 얼마 되었나요?,Korean
+광견병 인플루엔자 등 애완견 관련 접종 어느 것이든요.,Korean
+하루에 보통 몇 개비 피우시나요?,Korean
+치료 방법에 도움이 될 수 있습니다.,Korean
+아이가 태어나고 난 뒤 탯줄에서 채취하기 때문에 아이에게 영향은 없습니다.,Korean
+과거 수술 여부 말씀해주세요.,Korean
+과거 진단받거나 치료받은 적 있으신가요?,Korean
+잠을 잘 못 주무시나요?,Korean
+담배 피우신 기간이 얼마나 되나요?,Korean
+간염 치료 약을 드시는 중인가요?,Korean
+당뇨를 치료 받은 기간을 물어봐도 될까요?,Korean
+통증이 성기 오른쪽만 있다는 건가요?,Korean
+배뇨 주기가 어떻게 되시나요?,Korean
+최근에 체중이 눈에 띄게 빠진 적 있나요?,Korean
+약국 가면 주는 약 있잖아요. 한 알씩 들어 있는 거 말고 환처럼 생긴 거 그거 먹었어요.,Korean
+한 번에 잠에 들기가 어려우실까요?,Korean
+"식도가 말썽이라고 들었는데 정확히는 기억 안 나요.
+",Korean
+어떨 때 구토를 하나요?,Korean
+약은 있으나 확인이 필요합니다.,Korean
+혈압이 높게 나오는 편인가요?,Korean
+가족 중에 누가 유전성 질환 있으신가요?,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+유전성 질환으로 치료받고 있는 가족분이 있나요?,Korean
+아프거나 병원에 다닌 적 있으신가요?,Korean
+수면 시 어려움이 있으신가요?,Korean
+원래 좀 변비가 자주 있으신가요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+최근에 체중에 변화가 있었나요?,Korean
+음식 알레르기 진단받은 적이 있나요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+입에서 피를 토한 적 있으세요?,Korean
+접종 외에 치료나 처방에 참고할만한 내용이 있는지 해서요.,Korean
+"아 우리 아이가 다른 아이들보다 유독 더 크고 그래서 검사 한 번 받으려고요.
+",Korean
+통증의 특성을 말씀해 주시겠어요?,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+잔뇨감이 느껴지면 저 병일 수도 있어요?,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+약효는 사람마다 다 달라요.,Korean
+고혈압약을 꾸준히 먹고 있어요.,Korean
+당뇨진단을 받은지 얼마나 되셨죠?,Korean
+기침만 있으신가요 아니면 누렇고 끈적한 가래도 있으신가요?,Korean
+처방받은 당뇨약 이름을 알고계시나요?,Korean
+혹시 모를 감염을 예방하기 위해서 되도록 일회용 구매하셨다가 퇴원하실 때 버리고 가시는 걸 권유해드리고요.,Korean
+음식이나 약물 말고 다른 알레르기 원인이 있나요?,Korean
+간염으로 병원 통원하신 경험이 있으세요?,Korean
+네 하지만 적당량의 운동은 권유 드립니다.,Korean
+네 혈압과 고지혈증은 따로 생각하시는 게 좋을 것 같습니다.,Korean
+"목도 부은 거 같고 콧물도 나요.
+",Korean
+"오른쪽 몸 특히 팔다리가 힘이 쭉 빠지는 느낌이 지속해서 있어서요.
+",Korean
+손 소독 철저히 해야죠.,Korean
+잠에 들기가 매우 힘드신 편인가요?,Korean
+호흡기 관련 병력 있으세요?,Korean
+간접흡연도 경우에 따라 다른 결과가 나와요.,Korean
+"며칠 동안 잠을 제대로 못 자네요.
+",Korean
+암이 발견된 지는 얼마나 되었나요?,Korean
+뱉은 가래 색이 어떤가요?,Korean
+아픈 곳이 더 있나요?,Korean
+이석증 같으니 약 먹고 지켜보자고 했어요.,Korean
+알레르기 때문에 피해야하는 원인이 뭐가 있을까요?,Korean
+입원해서 치료하신 경험 다 말씀해 주세요.,Korean
+증상에 따라 약물 치료를 선택하겠습니다.,Korean
+안약에 대해서도 저녁에 함께 설명드리고 우선 오늘 자정부터는 물 포함 금식을 잘 지켜주시면 됩니다.,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+네 다른 병원에서 처방받은 게 있는지 알아야 해서요.,Korean
+암 진단을 받은지 얼마나 되셨나요?,Korean
+질병 약물로 치료하고 계시나요?,Korean
+어느 부분이 붓기가 있나요?,Korean
+복부가 부은 느낌이 있나요?,Korean
+평소보다 몸이 더 피곤하신가요?,Korean
+고혈압약 먹은 지 얼마나 됐나요?,Korean
+"기계에 손가락이 끼어서 이렇게요.
+",Korean
+네. 이후 환자분 치료 계획에 따라 식사 처방도 달라질 수 있어요.,Korean
+독감 접종 언제 마지막으로 했는지 아시나요?,Korean
+네 수술하게 될 부위 피부 위에 표시하면 됩니다.,Korean
+"가끔 토하고 싶고 그렇습니다.
+",Korean
+"소변볼 때 찌릿찌릿 아픈 것 외엔 없었어요.
+",Korean
+당뇨를 앓으시던 가족분이 계시나요?,Korean
+알레르기로 먹으면 안 되는 약이 있나요?,Korean
+가족 중에 예전에 고혈압가지고 계셨던 분 있나요?,Korean
+음식 알레르기 있는지 알고 싶어요.,Korean
+암을 앓은 기간이 어떻게 되나요?,Korean
+알레르기를 일으키는 원인 음식이나 약 말고 뭐 있으세요?,Korean
+먼저 알레르기 물질을 회피해 주시면 됩니다.,Korean
+평소 소화가 잘 안 되나요?,Korean
+네 수면 패턴 체크를 희망하시는군요.,Korean
+"다리가 너무 부어서 신발을 잘 못 신겠어요.
+",Korean
+현재 앓고 계신 질병 있으세요?,Korean
+어느 부위에 통증이 있으세요?,Korean
+투약 양을 조금 더 올려야 할 것 같아요.,Korean
+두통을 느끼신 적이 있으신가요?,Korean
+최근 몇 년 동안 예방접종 아예 한 적 없어요.,Korean
+당뇨약 챙겨 드시고 계세요?,Korean
+"배가 쑤시는 것처럼 아파요.
+",Korean
+우리 아이는 어디가 아플까요?,Korean
+본인 말고 고혈압으로 고생하신 집안 분이 또 있나요?,Korean
+"간 질환이 좀 있는데 컨디션이 많이 떨어져서요.
+",Korean
+욕창은 추가적으로 생긴 질병이기 때문에 다른 병의 치료도 잘 받으셔야지요.,Korean
+검사 결과 약물 알레르기 반응 없으시다고요.,Korean
+제가 말씀드릴 때까지 청진이 계속될 테니 계속 심호흡해 주시면 됩니다.,Korean
+상부 요로계인 신장 신우 요관 등에 출혈이 있으면 검붉은 색깔의 소변이 나올 수 있습니다.,Korean
+철심 박는 수술 했는데 몇 번 뼈인지는 몰라요.,Korean
+언제 암 진단을 받으셨나요?,Korean
+최근에 소화가 잘 안 된다고 느끼시나요?,Korean
+복용하고 계신 약이 있는지 알려 주세요.,Korean
+음식이 잘 들어가지 않나요?,Korean
+처방받고 드시는 약 있나요?,Korean
+호흡곤란 증상이 자주 나타나나요?,Korean
+케이에프 마스크만 써야 하는 건 아니지만 케이에프 마스크가 가장 효과가 좋습니다.,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+"뭘 잘못 먹었는지 계속 토가 나오려고 해요.
+",Korean
+지속적으로 약을 먹어야 하는 병을 가지고 있으신가요?,Korean
+예전에 식중독에 걸려서 이틀 정도 입원했었어요.,Korean
+몸이 떨리는 증상이 있으세요?,Korean
+그럼요. 맥박 이상 없습니다.,Korean
+통증이 얼마 만에 오나요?,Korean
+수술 후 치료를 다시 받았나요?,Korean
+"잠은 깊게 푹 잘 잡니다.
+",Korean
+혹시 결핵을 앓고 계시진 않나요?,Korean
+영양을 고려한 식단을 드시나요?,Korean
+통증 주기가 어느 정도 될까요?,Korean
+가래 상태가 많이 심한가요?,Korean
+식사 후 바로 설사하시나요?,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+"진료받다가 입원해야 된다고 그래서요.
+",Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+코로나 때문에 그런 거죠?,Korean
+하반신 마취여도 안정시키기 위해 수면마취를 시행하는 경우도 있습니다.,Korean
+애완동물 털이나 배설물로 인해서 비염 증상이 악화될 수 있기 때문에 앞으로도 집에 애완동물은 안 키우는 걸 권장합니다.,Korean
+배뇨 시 힘들 때가 있나요?,Korean
+속이 많이 안 좋으신가요?,Korean
+장중첩증 수술한 게 다예요.,Korean
+스테로이드제를 근육 증가 목적으로 복용 중입니다.,Korean
+"아니요. 체중엔 변화 없는 것 같아요.
+",Korean
+"배 아프다고 울고 나서부터는 아무것도 안 먹였어요.
+",Korean
+청진할 때 옷 안으로 하는 게 정확해요.,Korean
+통증이 어떤 식으로 오게 되나요?,Korean
+당뇨 처방 약 계속 드세요?,Korean
+제일 불편한 증상이 무엇인가요?,Korean
+혈압이 높은데 고혈압 진단 받은적 있나요?,Korean
+결핵이라고 느낀 적 있으세요?,Korean
+통증을 느끼는 부위가 어디예요?,Korean
+초음파 상에서는 종양인 것 같고 두 개의 덩어리 즉 결절이 보입니다. 성질이 양성인지 악성인지는 추가로 검사를 해봐야 압니다.,Korean
+"열은 안 재어봤는데 계속 낑낑거리고 말도 못 하는 거 보니 열이 나는 것 같아요.
+",Korean
+유전적인 요인이나 잘못된 배변습관 등으로 항문 및 직장에 존재하는 치핵 조직이 항문 밖으로 빠져나오는 것입니다.,Korean
+약 먹고 알레르기 일으킨 적 있나요?,Korean
+"기본 두세 번은 연달아 토했어요.
+",Korean
+식욕이 최근 들어 많이 줄어들었나요?,Korean
+약물치료로 알레르기 반응 관리를 하기 시작한 게 언제부터인가요?,Korean
+복부가 부은 느낌이 있나요?,Korean
+네. 소독도 자주 해줘야 하고 아이 상태를 확인하기 위해서는 입원 치료하는 게 좋아요.,Korean
+미주신경성 실신 때문에 쓰러지면서 다쳐서 바로 얼마 전인 일주일 전에 다른 병원에 입원했었습니다.,Korean
+통증 진행 양상이 어떤가요?,Korean
+"네. 다름이 아니고 손끝에 약간 불편한 감각이 가시질 않아서요.
+",Korean
+배 아프신 건 좀 괜찮으세요?,Korean
+환자분 지금 입원실 들어가면 되세요.,Korean
+이전에 혈액형 검사 하신 적 있으신가요?,Korean
+"따뜻한 목욕을 하거나 다른 방법으로 잠을 유도해요.
+",Korean
+몸에 열이 계속 오르나요?,Korean
+결핵 백신 접종을 언제 하신 거예요?,Korean
+통증이 얼마나 자주 생겨요?,Korean
+가족 내 암 판정받은 분은요?,Korean
+저 마취해 본 적이 없어서요.,Korean
+작은 볼일이 잘 안 나오나요?,Korean
+마취가 풀리면서 통증이 조금 심해질 수는 있습니다.,Korean
+고혈압약을 꾸준히 먹고 있어요.,Korean
+어제 기침이 많이 심하셨다고 들었는데 지금은 좀 어떠신가요?,Korean
+진단받으신 지 얼마나 되셨어요?,Korean
+약간 토할 것 같은 느낌 정도 있었어요.,Korean
+오한 증상 나타난지 며칠 되었죠?,Korean
+오심이 있던 적 있으세요?,Korean
+여기는 다친 상태가 얼굴보다 양호하네요 바로 치료해 드릴게요.,Korean
+증상이 시작된 부분이 어디인가요?,Korean
+"위염 때문에 식생활이 불편해서요.
+",Korean
+"건강검진 결과에 이상 소견이 있어서 왔습니다.
+",Korean
+반응테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+가래를 뱉어도 계속 목에 무언가가 느껴지나요?,Korean
+네 만성이라 치료가 오래 걸릴 겁니다.,Korean
+질병으로 약을 드시고 계시나요?,Korean
+식욕 부진 증상이 언제부터 나타났었나요?,Korean
+현재 복용하시는 약물이나 음식 외에 다른 알레르기가 있나요?,Korean
+대변이 잘 나오지 않으시나요?,Korean
+아니요. 전신마취로 인하여 위장관의 운동이 원활하지가 않으므로 며칠 동안은 유지하셔야 합니다.,Korean
+혈당 관련 피검사 결과에서 당뇨라고 진단받으셨나요?,Korean
+"소변은 다른 때에 비해 소변 색이 진했어요.
+",Korean
+멸균 처리가 된 소독 붕대가 화상 부위가 아물 때까지 환부를 외부 균으로부터 보호하는 역할을 하는 겁니다.,Korean
+통증이 하루에 몇 번씩 오는 거죠?,Korean
+피를 토할 때 위도 아픈가요?,Korean
+아니요. 먼저 의사와 상담 후 계획을 정해 보는 게 좋습니다.,Korean
+아픈 곳을 말씀해 보실래요?,Korean
+갑자기 어지러운 증상은 없으세요?,Korean
+"아픈 지 일주일 정도 됐어요.
+",Korean
+몇 개월에 한 번씩 아픈가요?,Korean
+얼마만큼 통증이 심한지 알려줄래요?,Korean
+이천십이 년에서 이천십사 년까지 복용했다가 작년부터 다시 복용하기 시작했어요. 약은 다시 처방받아야 해요.,Korean
+"아니요. 손가락 말고도 팔 전체가 아프기도 했어요.
+",Korean
+어떤 수술 했는지 알려주세요.,Korean
+발기 부전이 언제부터 시작했나요?,Korean
+암 진단받아본 적 있으세요?,Korean
+객담이 많은 거 같나요?,Korean
+네 저희가 환자분 상태를 자세히 파악하기 위해 필요합니다.,Korean
+"요즘 우울감이 심해서 많이 힘들어서 오게 되었어요.
+",Korean
+"변은 아침마다 꼭 봐요.
+",Korean
+환아도 힘들고 보호자분 또한 힘들 것이니 최대한 빨리 검사 진행하겠습니다.,Korean
+하루에 몇 번씩 흡연하세요?,Korean
+"요즘 들어 악몽 꾸는 횟수가 증가해서 그때마다 깨요.
+",Korean
+현재 응급실에 환자가 많아서 한 시간 이상 대기하셔야 합니다.,Korean
+왜 결핵 약을 중단 하셨나요?,Korean
+"갑자기 겹쳐 보이고 갑자기 말이 어눌해져서 입원했어요.
+",Korean
+뜸 치료를 받고 있어요.,Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+입원 하실 때 걸어오셨는지 휠체어나 이동침대 등 다른 이동수단을 이용하셨는지 물어보았습니다.,Korean
+잠이 쉽게 오지 않나요?,Korean
+부작용이 있는지 보려고 방금 검사하신 거예요.,Korean
+하루에 가래를 얼마나 뱉으시나요?,Korean
+배의 어느 부위가 아프시죠?,Korean
+"붉어진 뒤로 많이 따가워해요.
+",Korean
+다른 약은 없으시고 간염약만 드세요?,Korean
+알레르기 반응이 있었다면 예방 접종은 할 수 없습니다.,Korean
+응급실에서 이루어지는 혈액검사와 치료 중에는 음압 격리실에 계실 예정입니다.,Korean
+일주일에 몇 번이나 통증을 느끼시나요?,Korean
+호흡하기 힘들 때가 많나요?,Korean
+가만히 있어도 가슴 맥박이 빨라졌나요?,Korean
+부모님 중에 고혈압이신 분 있으신가요?,Korean
+아픈 게 얼마 안 됐나요?,Korean
+병원에 진료 받으러 왔다가 입원하신건가요?,Korean
+어머니는 고혈압 있으시고 아버지는 당뇨예요.,Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+간염 치료 관리를 꾸준히 받고 계세요?,Korean
+사고로 상해를 입은적이 있나요?,Korean
+진단 받았던 병 있으면 알려주세요.,Korean
+아니요. 처방에 따라 곧 검사를 할 것입니다.,Korean
+가족 중에 고혈압 가지고 있는 분 계신가요?,Korean
+몸에 열이 계속 오르나요?,Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+감염 증상 외의 특이 증상에는 무엇이 있나요?,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+네 액체류를 언제 마지막으로 드셨는지 말씀해 주세요.,Korean
+통증을 점수로 표현해 보실래요?,Korean
+두통이 심할 때도 있나요?,Korean
+피부 상처 치료가 더 이상 필요 없을때 안정적이라고 할 수 있겠네요.,Korean
+통증이 시작되면 멈추기까지 오래 걸리나요?,Korean
+몸에서 오한을 느끼진 않나요?,Korean
+회복을 위해 단백질 위주의 식단이 필요합니다.,Korean
+정확한 치료를 위해 체액 양의 측정이 필수적입니다.,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+일단 육안으로는 아무 이상 없습니다.,Korean
+간염으로 따로 약은 챙겨 드시나요?,Korean
+하루 담배 얼마나 피우세요?,Korean
+통증이 어떤 식으로 아프게 느껴지나요?,Korean
+간염으로 치료 받고 있나요?,Korean
+약물 알레르기 반응 약이 있으면 말해 주세요.,Korean
+회가 장에 안 좋다기보다는 덥고 습한 환경에서 쉽게 변하기 때문에 식중독을 유발하기 쉽습니다.,Korean
+오늘을 포함해서 설사가 시작된 후 날마다 몇 번 정도 다녀오셨는지 알려주시면 더 도움이 됩니다.,Korean
+어느 부분이 부은 느낌이 나세요?,Korean
+결핵을 앓기 시작한 지 얼마나 되셨죠?,Korean
+잠드는 게 어렵지는 않으신가요?,Korean
+오한이 든 건 아니고요?,Korean
+"시골 할머니 집에서 수돗물을 마셨는데 배가 아파 왔어요.
+",Korean
+수술시간은 얼마 안 걸리는데 마취하고 깨는 시간까지 한 시간에서 한시간 반정도 생각하시면 되십니다.,Korean
+알레르기 유발 요인의 종류에 따라 다릅니다.,Korean
+다른 병원에서 진료받으려는 이유가 있을까요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+수술 끝나고 맞을 수 있는 무통 주사에 대한 설명은 들으셨나요?,Korean
+네. 철심 박는 수술했는데 몇 번인진 모르겠어요.,Korean
+약 처방 할 때 필요해서요.,Korean
+네. 다행이네요. 대장내시경 도중에 오 밀리미터 이상의 큰 용종이 발견되면 대장용종 제거술을 하게 될 수도 있습니다.,Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+식사를 골고루 하시는 게 건강 관리에 제일입니다.,Korean
+아니요. 제왕절갠데 무슨 문제 있나요?,Korean
+이마가 뜨거운 것 같으세요?,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+기침 가래가 있거나 호흡 소리가 이상하거나 호흡할 때 도움을 받거�� 하지는 않았나요?,Korean
+"갑자기 기침을 엄청나게 하고 숨이 찰 때가 있습니다.
+",Korean
+언제 암 진단을 받으셨나요?,Korean
+작년에 어떤 예방 접종을 맞으셨나요?,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+요새 점점 눈이 안 좋아져 가는데 무슨 병이 있는 건 아닌지 모르겠어요.,Korean
+유전적으로 유전성 질환에 걸릴 확률이 높은 편인가요?,Korean
+진통제를 먹으면 입술도 붓고 눈도 부어요.,Korean
+다른 위염과 비슷하게 식습관과 생활습관 관리하시고 지속적인 진료를 받으시면 됩니다.,Korean
+"네. 네. 어지러운 건 없었습니다.
+",Korean
+아예 병원 근처에 가본 적도 없습니다.,Korean
+암을 처음 진단받은 게 언제인가요?,Korean
+과거에 수술을 여기서 받으셨어요?,Korean
+네. 세균성보다는 바이러스성 장염이 의심됩니다.,Korean
+담배를 경험해 본 적 있으신가요?,Korean
+속이 메스껍거나 토한 적이 있으신가요?,Korean
+왼쪽 발목 인대가 늘어났었어요.,Korean
+대변에 피가 같이 나옵니까?,Korean
+통증이 있을 때마다 약을 몇 알 드시는데요?,Korean
+숨이 찬 증상은 없나요?,Korean
+고혈압 증상 나타난 게 언젠가요?,Korean
+오랜 시간 수면을 취해도 피로감이 지속되나요?,Korean
+약물 음식 외에 알레르기 반응 일어나는 것이 있나요?,Korean
+알레르기 일으키는 음식은 없어요?,Korean
+집안에 고혈압을 진단받은 적이 있는 분이 계실까요?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+온몸에 좀 오한이 있으세요?,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+네. 나가서 앉아 계시면 저희 직원이 안내해주실 겁니다. 그럼 수술 당일에 뵙겠습니다. 큰 걱정은 안 하셔도 됩니다.,Korean
+퇴원해도 괜찮은 거면 부탁드립니다.,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+이차 치료는 복용하는 약의 종류와 횟수가 일차 치료 보다 많아 힘들 수 있습니다.,Korean
+많이 힘드시면 구토 억제제를 드리도록 하겠습니다.,Korean
+최근에 혈뇨가 처음 나온 것이 언제인지 말씀해 주세요.,Korean
+술을 한 번에 드실 때 양을 얼만큼 드시는지요?,Korean
+아니요 문제가 될 가능성은 낮지만 어떤 약을 드시는지 말씀해주시겠습니까?,Korean
+하루 평균 술 얼마나 드세요?,Korean
+통증이 얼마 만에 발생하는지 말해볼래요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+숨 쉴 때 가슴이 아프거나 하진 않아요?,Korean
+혈압 수치가 높다는 판정은 언제쯤 받았어요?,Korean
+네. 앞니가 깨져서 뽑고 새로 해 넣었습니다. 석 달 됐네요.,Korean
+언제부터 대변에 피가 섞여 나오나요?,Korean
+지금 드시고 계신 고혈압약이 있는지 알려주세요.,Korean
+"글쎄요. 사람 평균 수면 시간 정도 자지 않을까요?
+",Korean
+"발가락에 문제가 있는 것 같아 검사받으러 왔어요.
+",Korean
+이 병원에서 제거는 아예 못하는 건가요 그럼?,Korean
+하루에 흡연은 몇 번 하세요?,Korean
+열이 나는 증상이 있나요?,Korean
+몸이 피곤해도 잠이 안 오나요?,Korean
+지금도 가슴에 통증이 있나요?,Korean
+검사를 할 때 공복이어야 할 수 있는 검사들이 있어서요.,Korean
+설사를 얼마나 자주 하시나요?,Korean
+제 인생 첫 입원입니다.,Korean
+"요도에 염증이 있다고 들었는데요.
+",Korean
+지금까지 얼마 동안 흡연해오셨나요?,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+현기증 느낀 적 있나요?,Korean
+최근 감각이 무뎌지거나 저리는 곳 있으신가요?,Korean
+숨이 턱 막히는 느낌인가요?,Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+술과 담배는 안 하시는 게 도움이 되실 거고 스트레스받지 않는 게 중요합니다. 혹시 술 담배 하시나요?,Korean
+걱정 마세요 씨티찍어서 문제가 되는 경우는 거의 없어요 특히 조영제를 안 쓰면 더 그렇구요.,Korean
+예를 들면 독감 주사나 대상포진 주사요.,Korean
+아프기 시작한 게 언제부터였죠?,Korean
+어떤 약물을 처방받아 결핵을 치료 중이신가요?,Korean
+붕대를 소독해서 상처 부위에 자극이 없도록 하였습니다.,Korean
+과거 고혈압이었던 적 있으면 말해주세요.,Korean
+간염 검사 관련 양성인가요?,Korean
+한번 아프기 시작하면 통증이 오래 지속되나요?,Korean
+음주 또한 질환의 원인이기 때문에 과음하지 않는 것이 중요합니다.,Korean
+소변에 피가 같이 나온 적이 있을까요?,Korean
+테라마이신 연고는 화상 부위에 세균 감염을 방지하는 역할을 합니다.,Korean
+항생제��� 복용하시면서 음주를 하실 경우 부작용이 발생할 수 있습니다.,Korean
+도수 정복 자체가 위험하지는 않으므로 먼저 시도해본 다음 수술적 치료를 고려하는 것이 바람직할 것입니다.,Korean
+발기 부전 문제를 겪으신 적이 있나요?,Korean
+작은 신발을 오래 신어서 발가락이 아프죠 발에 맞춰서 신도록 해보세요.,Korean
+고혈압 가족력 있으시면 알려주세요.,Korean
+수술 여부를 확인하는 것입니다.,Korean
+괜찮습니다. 부작용은 흔하게 발생하지는 않습니다.,Korean
+"변색은 정상이었는데 배가 좀 많이 아파요.
+",Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+"안녕하세요. 저 요즘에 속도 안 좋고 토도 하루에 두 번 이상하고 헛구역질도 계속해서 왔어요.
+",Korean
+어릴 때 수술을 받은 흔적을 없애줄 수 있습니다.,Korean
+"저번에 치질이 있어서 치료받았는데 다시 재발한 것 같아서요.
+",Korean
+내가 눈이 나빠서 좀 봐 줄 수 있나?,Korean
+최근 술을 자주 드시나요?,Korean
+그동안 담배는 몇 살부터 몇 살까지 피우셨나요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+혈액 검사 결과가 정상 수치랑 차이가 있으셨나요?,Korean
+지난달에 어떤 종류의 약을 복용하셨어요?,Korean
+담배 피운 지 몇 년 되었을까요?,Korean
+토할 때 피도 나왔나요?,Korean
+하루에 담배 몇 개비 피우는지 아세요?,Korean
+알레르기 검사에 혈액 체취는 기본적인 검사라 피 뽑기 싫으셔도 하셔야 합니다.,Korean
+피 토하는 걸 토혈이라고 하는 데 그런 증상은 없으세요?,Korean
+지난번에 암 치료는 언제 시작하셨나요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+협심증으로 수술 후 약 먹어요.,Korean
+어떤 이유로 이 약을 드시고 있으신가요?,Korean
+머리 뒷부분에서 통증이 있나요?,Korean
+주기적으로 복용해야 하는 약이 있나요?,Korean
+네. 수술 후 통증도 나아지고 있어요.,Korean
+네 생식기 치료는 산부인과에 해당합니다.,Korean
+고혈압 증상이 있으시네요. 알고 계셨나요?,Korean
+가족 중에 고혈압 가지고 있는 분 계신가요?,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+술을 일주일에 다섯 번 이상 드신 적이 있으세요?,Korean
+아픈 곳이 더 있나요?,Korean
+네. 혈압약만 먹고 있어요.,Korean
+아이 할머니가 유전되는 병이 많으셔서 노심초사하긴 하는데 아직은 진단받은 건 없습니다.,Korean
+결핵 백신 접종을 하셨나요?,Korean
+평소보다 숨이 잘 안 쉬어지시나요?,Korean
+통증 오는 시간이 대략 어떻게 되시나요?,Korean
+현재 최대치로 진통제를 드리고 있어요 다음 처방 때 약을 좀 바꿔 볼게요.,Korean
+지금 복용 중인 간염약 있나요?,Korean
+증상에 따라 약물 치료를 선택하겠습니다.,Korean
+간단히 말하면 근육에 손상이 가서 신장 기능에 문제가 생긴겁니다.,Korean
+네 부작용이 심하면 측정이 불가할 수 있습니다.,Korean
+가족 중 고혈압 환자가 있나요?,Korean
+온몸에 좀 오한이 있으세요?,Korean
+아 그래서 아픈 거였군요.,Korean
+환자분이 알고 계시는 약물 알레르기가 있나요?,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+소화불량이 비교적 심하지 않지만 불편함을 느끼 실 수도 있습니다.,Korean
+의식적으로 코만 이용해 숨을 쉬셔야 합니다.,Korean
+네. 이후 환자분 치료 계획에 따라 식사 처방도 달라질 수 있어요.,Korean
+궤양이 아니어야 할 텐데요. 알겠습니다.,Korean
+아니요 약 드시는 거에 문제는 없습니다.,Korean
+아픈 게 얼마나 아프세요?,Korean
+레이저 치료로 할 것 같네요.,Korean
+알레르기 반응이 일어나는 음식이 있나요?,Korean
+아무래도 집에서 하는 소독은 감염 위험성이 큽니다.,Korean
+심장 박동이 빨라진 것 같은 느낌을 받은 적이 있나요?,Korean
+고혈압 치료는 꾸준히 받고 계신가요?,Korean
+숨 쉴 때 힘드신가요?,Korean
+"만성 폐쇄성 폐 질환인가 폐기종으로 알고 있어요.
+",Korean
+천식을 지금도 치료받고 계시나요?,Korean
+사고로 수술 받은 적 있나요?,Korean
+지금이 아침 여덟 시니까 검사 전까지 금식을 꼭 해야 해요.,Korean
+"아무 음식도 못 먹었어요.
+",Korean
+질병 진행 정도와 보존적 치료에 대한 반응에 따라 다릅니다.,Korean
+"약을 봉지째 다 먹어버렸어요.
+",Korean
+"가슴에 통증이 심해서 외래 진료로 왔다가 입원했네요.
+",Korean
+"왼쪽 세 번째랑 네 번째 손가락이요.
+",Korean
+침을 삼킬 때마다 아프신가요?,Korean
+안녕하세요. 김지현님! 수술하고 잘 지내셨나요?,Korean
+여러 가지 이유로 자주 깰 수 있는데 환자분��� 통증 때문이니까 진통제를 복용하시는 게 좋겠습니다.,Korean
+암을 가지고 있는 가족분들이 있나요?,Korean
+아이 몸무게 아까 측정하셨었나요?,Korean
+수술 시간은 두 시간이라고 하셨는데 맞는 거죠?,Korean
+"귀가 먹먹해서 잘 안 들려요.
+",Korean
+작은 볼일이 잘 안 나오나요?,Korean
+혈압 낮추는 약 뭐 드세요?,Korean
+사람의 독감이 강아지에게 옮기기도 합니다.,Korean
+뭐 때문에 약을 드시고 계세요?,Korean
+알레르기 있는 음식이 뭔가요?,Korean
+고혈압으로 약을 드신다거나 병원에 다니신다거나 하는 게 있나요?,Korean
+현기증 느낀 적 있었어요?,Korean
+최근에 오한이 있던 적이 있나요?,Korean
+척추마취 후 흔하게 두통 등 부작용이 있을 수 있습니다.,Korean
+간염 때문에 드시는 약을 전부 알려주세요.,Korean
+병원에서 간염 진단을 받았나요?,Korean
+"계속 죽었으면 좋겠다고 생각이 들어요.
+",Korean
+"아이가 아침에 침대에서 굴러 떨어졌는데 좀 다친 것 같아요.
+",Korean
+평소에 대변을 잘 못 보시나요?,Korean
+최근 들어서 몇 개월 동안 급격히 체중 변화가 있었나요?,Korean
+가슴 통증이 있지는 않나요?,Korean
+통증 시간이 주기적으로 어떻게 돼요?,Korean
+"식욕은 늘 별로 없는데 살은 많이 안 빠졌어요.
+",Korean
+토할 것 같다는 느낌이 계속해서 있나요?,Korean
+결핵 치료는 약으로 하셨나요?,Korean
+언제 첫 증상이 나왔나요?,Korean
+알레르기 때문에 복용에 신경 쓰는 약이 있으세요?,Korean
+"아기가 목감기에 걸린 것 같아서요.
+",Korean
+이천일 년 여름에 검진받으러 갔다가 우연히 알게 됐죠.,Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+비형 간염이 양성인지 알려주세요.,Korean
+먼지 등 알레르기 요인이 있나요?,Korean
+아침을 드신 시간부터 금식시간을 계산해 검사 일정이 정해 집니다.,Korean
+간염으로 드시는 약 있으세요?,Korean
+네. 평소대로 호흡을 하면 마취 가스가 충분히 배출되지 않아 몸에 남아있을 수도 있습니다.,Korean
+밥 먹고 트림을 많이 하나요?,Korean
+느낌상 괜찮아도 건강에 변화가 있을 수 있습니다.,Korean
+증상 발생 후 빠른 시간 내에 병원에 오셔야 적절한 치료가 가능합니다.,Korean
+삼일 정도 먹는 건 괜찮아요 우선 변비약 처방해 드릴게요.,Korean
+저기 소아과 선생님과 상의해 볼게요.,Korean
+금연은 언제부터 하게 되신 건가요?,Korean
+예방 접종에 따라 향후 일정이 변경될 수 있어서요.,Korean
+알고 있는 알레르기 있으면 말해 줘요.,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+따로 드시는 약 있으신가요?,Korean
+원래 좀 배뇨 곤란이 자주 있으신가요?,Korean
+전반적으로 건강 상태는 어떤 거 같으세요?,Korean
+정확한 치료를 위해 체액 양의 측정이 필수적입니다.,Korean
+혹시 가족 중에 유전병 있으신 분이 있나요?,Korean
+알레르기 때문에 피해야 하는 약물이 있을까요?,Korean
+우선 금식을 유지하시는 게 좋습니다.,Korean
+"다름이 아니라 저희 애가 또래보다 성장도 빠르고 그래서 검사를 좀 받을까 해서요.
+",Korean
+대장 내시경까지 시행할 시에 수면으로 하지 않으면 환자 본인이 힘드실 수 있습니다.,Korean
+배에 가스가 찬 느낌이 있을까요?,Korean
+가족 중에 고혈압이신 분이 계신가요?,Korean
+통증 양상이 어떻게 돼나요?,Korean
+올해 독감 예방 주사는 맞으셨나요?,Korean
+계속 조금씩 통증이 나타나시는 거죠?,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+마취가 풀리면서 통증이 조금 심해질 수는 있습니다.,Korean
+영양제나 비타민 같은 거 제외하고 드시는 약이 있으세요?,Korean
+기침 얼마 정도 하시는 거예요?,Korean
+하루에 몇 개비 피우시나요?,Korean
+"오한이 들어서 잠이 안 들더라고요.
+",Korean
+당뇨 얼마나 오래되셨어요? 시기가?,Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+약 이름 생각이 안 나시면 사진으로라도 보여주세요.,Korean
+제거하는 거라 약간의 통증은 발생할 수 있어요,Korean
+통증이 있는 부위 좀 짚어 줄래요?,Korean
+그랬었죠. 한동안 약 먹었어요.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+유전성 질환으로 고생 중인 식구가 있어요?,Korean
+가래가 어느 정도로 심하신 거죠?,Korean
+만성 부비동염을 갖고 있어요.,Korean
+통증이 월 단위로 있나요?,Korean
+동물 근처에 가면 알레르기 반응이 나타나나요?,Korean
+금식을 안 하시고 수술을 할 경우 장기 속 음식물로 인한 오염이 일어날 수 있습니다.,Korean
+간염은 약으로 치료하시는 거예요?,Korean
+얼마나 자주 아픈지 빈도를 말씀해 주세요.,Korean
+죄송하지만 수면 비용에는 보험 적용이 되지 않습니다.,Korean
+어디 불편해서 드시는 약 있으세요?,Korean
+키 일 미터 칠십삼 센티에 몸무게 육십구 킬로 나갑니다.,Korean
+네 병원 내원 당시 시간을 알려주세요.,Korean
+항암 치료제를 복용 중이신가요?,Korean
+심장에 문제가 있으면 응급 상황이 발생할 수 있습니다.,Korean
+결핵약 처방받은 거 있으신가요?,Korean
+가족분들 중에 고혈압 진단을 받은 분이 계시나요?,Korean
+네 당연히 통증 완화에 도움이 됩니다.,Korean
+"소변에 피 본 적이 있어요.
+",Korean
+가족 중에 당뇨 치료받은 분 계시나요?,Korean
+고혈압 진단받은지 꽤 되셨죠?,Korean
+통증 발현 빈도가 대략 얼마쯤인가요?,Korean
+알레르기 진단을 언제 받았나요?,Korean
+겨울이면 다시 통증이 오나요?,Korean
+"요즘 들어 기력이 자꾸 빠지는 것 같아요.
+",Korean
+수술적 제거가 어려울 경우 항암치료 방사선 치료 등을 고려할 수 있습니다.,Korean
+알레르기 약 처방은 언제 받으셨나요?,Korean
+외조부님이 간암을 앓은 적이 있어요.,Korean
+"귓구멍이 너무 가렵고 진물이 나는 듯한 느낌이 들어가지고 방문하게 되었어요.
+",Korean
+증상이 야간에 심해지지는 않나요?,Korean
+알레르기가 있다는 것을 언제 알았나요?,Korean
+통증이 걱정되시면 일단은 염증을 가라앉히는 약을 먼저 복용해보셔도 됩니다.,Korean
+통증이 보통 얼마나 이어지나요?,Korean
+원래 자세로 돌아왔을 때 통증이 몇 분 째 계속 남아있다면 정밀 검사를 받아보는 것이 좋습니다.,Korean
+"복통을 느껴본 적은 없어요.
+",Korean
+몸살 난 것처럼 몸이 으슬으슬 떨리나요?,Korean
+어떤 식의 통증이 계속 나타났었나요?,Korean
+고혈압으로 인한 위험이 있나요?,Korean
+불안해할 수 있으니 전신 마취를 권장합니다.,Korean
+결핵은 어떻게 하고 계시죠?,Korean
+지금 아픈 곳 말하세요.,Korean
+통증 있는 부분이 어디예요?,Korean
+가족 중에 유전성 질환을 가진 가족이 있으세요?,Korean
+알레르기 반응이 있는 것이 있나요?,Korean
+어떤 식으로 복통을 느끼시나요?,Korean
+이쪽 부위에 통증이 오는 건가요?,Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+과거에 수술 경력 있으신가요?,Korean
+처음 아팠던 날 기억나세요?,Korean
+"의사 선생님이 쓰지 말랬는데.
+",Korean
+예를 들어 어떤 통증인가요?,Korean
+흡연 한지 오래 되셨나요?,Korean
+네. 허리 사 번에서 육 번까지 철심 박았어요.,Korean
+전체적으로 신체 검진을 하는 것입니다.,Korean
+"네. 항상 같은 체중 유지 중이에요.
+",Korean
+이마가 뜨거운 느낌이 드세요?,Korean
+죽을 만큼 통증이 심한가요?,Korean
+예전에 앓았던 질병 있으시면 말씀해 주시겠어요?,Korean
+몇 개월 동안 체중 변화는 어떻게 되시나요?,Korean
+지금 이전 수술이 지연되어 정확한 시간이 나오면 말씀드릴게요.,Korean
+소화하는 데 문제는 없나요?,Korean
+하지정맥류 진단받고 여기 온 거예요.,Korean
+당 관리를 위해 복용 중인 약이 있나요?,Korean
+장운동이 원활해질 때까지 하고 있으셔야 됩니다.,Korean
+장 내 가스 때문이라면 별 문제 없습니다.,Korean
+당뇨 약 복용하고 계신가요?,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+네. 열은 다 내렸어요.,Korean
+"요 며칠은 계속 묽은 변이 나와서 고생하고 있습니다.
+",Korean
+케이에프 마스크만 써야 하는 건 아니지만 케이에프 마스크가 가장 효과가 좋습니다.,Korean
+화상 상처부위를 소독하기 위한 약의 이름입니다.,Korean
+드시는 간염약 약품명 아시나요?,Korean
+수액 양을 줄여 드릴게요. 나아지는지 확인해서 말씀해 주시겠어요?,Korean
+"배를 누가 칼로 찌르듯이 아파서 왔어요.
+",Korean
+언제부터 알레르기를 앓은 걸 아셨나요?,Korean
+어디가 가장 통증이 강하죠?,Korean
+수술 일정이 나오면 입원 후 수술하시고 회복 후 퇴원하시게 될 겁니다.,Korean
+가족분들 중에 당뇨 갖고 계신 분 있으세요?,Korean
+코로나 의심 증상은 없으셨죠?,Korean
+유전적인 요인이나 잘못된 배변습관 등으로 항문 및 직장에 존재하는 치핵 조직이 항문 밖으로 빠져나오는 것입니다.,Korean
+배가 불러 불편하지는 않으세요?,Korean
+통증이 생기는 부분이 어느 부위인가요?,Korean
+요즘엔 하루에 설사 몇 번이나 하세요?,Korean
+아니요 기형에 관련된 수술이 아니라면 괜찮습니다.,Korean
+고혈압을 처음 진단받은 적이 언제인가요?,Korean
+심장이 안 좋아서 어릴 적부터 입퇴원을 반복하며 지내요.,Korean
+"아니요. 뭘 삼키려고 하면 목구멍이 쓸리는 느낌이에요.
+",Korean
+빈혈이 있는데 낫질 않아요.,Korean
+잘못된 치실 사용법은 오히려 잇몸이나 치아에 안 좋을 수 있습니다 치실 사용법 좀 알려드리겠습니다.,Korean
+일단 진료 대기자들이 있어서 그분들부터 진료해야 합니다.,Korean
+음주 횟수는 어떻게 되죠?,Korean
+항생제를 오래 쓸 경우 내성이 생깁니다.,Korean
+바셀린 거즈는 보습 효과가 있습니다.,Korean
+세 시간 동안 통증이 올 때 어느 정도의 통증인가요?,Korean
+숨 쉬는데 문제 있으신 거 아니죠?,Korean
+네. 아들이 우울증 치료받고 약 먹고 그랬어요.,Korean
+혹시 삼 일 후에 병원에 다시 올 수 있으신가요?,Korean
+당뇨를 진단받은 가족이 있나요?,Korean
+수술 곧 들어가실 것 같아요.,Korean
+네. 그러세요. 약을 못 먹겠네요.,Korean
+입원 당일에 어떻게 이동하셨는지 여쭤보는 거예요.,Korean
+결핵으로 진단받은 적 있나요?,Korean
+네 언제 어떤 시술을 받으셨나요?,Korean
+아픔이 며칠 주기로 찾아오나요?,Korean
+복부 쪽에 아픔이 느껴지나요?,Korean
+잠을 잘 못 자서 불편한 적이 있으신가요?,Korean
+"생각해보니 변을 볼 때마다 너무 오래 앉아있어서 다리에 쥐가 날 정도예요.
+",Korean
+항문 이외 다른 소화기관에서 출혈이 있는 경우 항문 통증은 동반되지 않을 수 있습니다.,Korean
+토혈을 하고 통증이 있나요?,Korean
+네. 선생님. 퇴원하고 싶어요.,Korean
+소화불량 증상이 어떻게 되죠?,Korean
+증세가 뚜렷해진 때는 언제인가요?,Korean
+가능성이 많다고는 할 수 없지만 간혹 위선종이나 위림프종이 진행되는 분들이 계십니다.,Korean
+"아니요. 수면제만 먹으면 몽롱한 느낌이 하루가 가서 안 먹어요.
+",Korean
+통증이 제일 처음 나타난 게 언제인가요?,Korean
+가슴에 통증이 있으면 말씀해 주세요.,Korean
+피를 토할 때 어디에 통증이 있나요?,Korean
+"열이 며칠째 계속되고 있어요.
+",Korean
+예방접종 접수하셔서요 부작용이 있었나 해서 여쭤보는 겁니다.,Korean
+통증이 왔던 시기가 언제인가요?,Korean
+환자분 입원을 위한 조사를 위해 몇 가지 질문하겠습니다.,Korean
+"손 옆쪽으로 수포가 생긴 것 같아요.
+",Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+결핵 치료는 어디에서 받았나요?,Korean
+간염 치료 언제부터 받으셨어요?,Korean
+지금까지 몇 년 동안 흡연하셨나요?,Korean
+"저번에 수술한 곳 소독해 주세요.
+",Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+통증이 크지 않더라도 환아들은 불안이나 두려움으로 인해 불편함을 크게 호소할 수 있습니다.,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+결핵 증상이 있었던 게 언제부터죠?,Korean
+어느 것이 더 적합한지는 진료받아야 알 수 있습니다.,Korean
+통증이 얼마나 가는지 알려주세요.,Korean
+고통이 몇 시간 동안 있나요?,Korean
+전신에 힘이 소진된 듯한 느낌이 있나요?,Korean
+"얼마 전에 건강검진 결과가 나왔는데 역류성 식도염이 있다고 해서 다시 검사 받으려고 왔어요.
+",Korean
+네 독감예방주사 및 대상포진 주사 등이 있습니다.,Korean
+온몸이 다 쑤시고 아픈가요?,Korean
+소화불량 때문에 속이 안 좋으시죠?,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+과거에 배가 아프신 적이 있으세요?,Korean
+아마 붓기가 아직 안 빠져서 그런 걸 수도 있습니다.,Korean
+스트레스와 같은 환경적 요인 식습관 흡연 여부 등 다양한 원인이 있습니다.,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+배변 완화제 사용을 고려해 보겠습니다.,Korean
+약이 겹치게 되면 하루 복용량을 넘어서기 때문에 그런 거예요.,Korean
+만성질환 진단받아 계속해서 복용하는 약이 있으신가요?,Korean
+하루 종일 아프신 건가요?,Korean
+암 치료를 받고 있으세요?,Korean
+숨 쉴 때 어려움이 있나요?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+소화가 어떻게 잘 안 되나요?,Korean
+숨을 쉬기 힘든 때가 있었나요?,Korean
+배의 어느 부위가 아픈가요?,Korean
+알레르기 반응은 예방 접종 후의 반응이라 검사로 미리 알아볼 수는 없습니다.,Korean
+가족분들 중에 유전성 질환으로 고생하신 분이 있나요?,Korean
+여러 번 피 뽑으면 건강에 안 좋을 것 같은데.,Korean
+평소에 무슨 약 드세요?,Korean
+간염으로 무슨 �� 드세요?,Korean
+"네. 시금치 먹고 건강해지려고 샐러드에 꼭 넣어 먹어요.
+",Korean
+척추에 마취약 맞았는데 그건 뭐죠?,Korean
+가족 중 당뇨 진단 받으신 분이 있나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+토에 피가 섞여 나온 적이 있나요?,Korean
+최소 여덟 시간 이상은 금식해 주셔야 합니다.,Korean
+레이저 치료 후 마취가 풀리면 조금 아프실 수도 있어요.,Korean
+하루에 담배 몇 개비 피우시나요?,Korean
+고혈압 있다고 언제부터 알게 되었어요?,Korean
+앞에 환자분 시술이 길어지는 경우 조금 대기하실 수도 있어 양해 부탁드리겠습니다.,Korean
+"네. 음주를 주로 하세요.
+",Korean
+평소에 약을 드시는 게 어떤 거 때문에 드시는 건가요?,Korean
+의사 상담 후 처방받은 대로 진통제를 복용하시는 게 좋아요.,Korean
+어머니가 요양원에 계셔서 다녀왔어요.,Korean
+통증 부위가 머리 쪽 맞나요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+발기부전이 생긴 지 얼마나 되셨어요?,Korean
+"다이어트하느라 변비가 생겨서 요즘 화장실을 잘 못 가요.
+",Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+팔찌에 적혀 있는 환자번호 알려주시면 됩니다.,Korean
+"업무 스트레스가 너무 심해요. 스트레스가 심해지니까 식욕도 없고 소화도 안 돼요. 최근에는 살이 십 킬로가 넘게 빠졌는데 정신과적인 치료를 받으면 좋아지지 않을까 싶어서 오게 되었어요.
+",Korean
+비형 간염이 양성인지 알려주세요.,Korean
+그럼요. 검사를 받을 수 있습니다.,Korean
+설사를 얼마나 자주 하시나요?,Korean
+혹시 머리가 아프시다는 등의 다른 증상은 없으시나요?,Korean
+현재로서는 말씀드리기 어렵고 확인을 위해 위내시경 검사가 필요합니다.,Korean
+알레르기 때문에 드시면 안 되는 게 있나요?,Korean
+흉통이 목으로 번지는 느낌이 있나요?,Korean
+당뇨 확인은 언제 하셨죠?,Korean
+항암치료 관련된 것 전부 다 부탁드립니다.,Korean
+수술받은 곳 통증은 어때요?,Korean
+검사 결과는 다음 주에 나옵니다. 예약 잡아드릴까요?,Korean
+결핵 치료는 다 끝나셨습니까?,Korean
+네 힘드시겠지만 환자분의 치료를 위해 필요한 금식입니다.,Korean
+가족 중에 당뇨 지병이 있으신 분이 계신가요?,Korean
+가려움 완화 연고를 처방해 드릴 수 있어요.,Korean
+복부 팽만감이 들지는 않으세요?,Korean
+항생제처럼 미리 테스트해볼 수 있는 사항이 아니어서요. 특이사항 있을 시 마취방법이 변경될 수 있어요.,Korean
+집 먼지 진드기는 습기 있는 침구나 의자 같은 곳에서 사람의 피부를 먹고사는 벌레입니다.,Korean
+현재 혈압약으로 조절 중이신가요?,Korean
+치료량이 많다 보니 마취크림을 바르더라도 치료 후 통증이 조금 심하실 수도 있습니다.,Korean
+가족 중에 폐암이나 위암 같은 암 판정받으신 분이 있어요?,Korean
+고혈압약 당뇨약 먹고 있어요.,Korean
+유전성 질환으로 수술받은 가족분이 계세요?,Korean
+원하시면 독감 예방 접종 가능한 병원에서 하셔도 됩니다.,Korean
+요구 사항으로 전달은 드리지만 환자분의 치료 계획 또는 신체 상태에 따라 변경될 수 있습니다.,Korean
+"소변을 너무 잘 안 봐요
+",Korean
+통증 감소를 위해 복용 중인 약은 있나요?,Korean
+저기 소아과 선생님과 상의해 볼게요.,Korean
+언제부터 특정 알레르기가 발현되었나요?,Korean
+한 번 간질로 쓰러져서 입원 치료받은 적 있어요.,Korean
+김포 투석 무슨 병원인데 지금 기억이 잘 안 나는데 다음에 알려드려도 될까요?,Korean
+기침을 얼마나 자주 하나요?,Korean
+앓으신 지 일주일 정도 되시나요?,Korean
+아니요. 갑자기 아침부터 아팠어요.,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+얼마나 자주 통증이 발생하나요?,Korean
+대부분 심각한 합병증 없이 회복이 가능하여 단기간 입원 후 퇴원 가능합니다.,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+"한쪽 고환이 더 커요.
+",Korean
+암이라고 판정을 받은 적이 있나요?,Korean
+재생 정도에 따라 수술이나 추가 시술이 필요하여 정확히 말씀드릴 수는 없습니다.,Korean
+"아니요. 원래 설사 잘 안 해요.
+",Korean
+네. 생식기 치료는 산부인과에 해당합니다.,Korean
+수면으로 할 시에는 수면마취 동의서에 서명하셔야 합니다. 비수면으로 할 시 그럴 필요는 없지만 조금 더 불편감을 느낄 수 있습니다.,Korean
+"머리가 깨질 듯 아프면서 코 위쪽 부비동이 엄청나게 저릴 때가 있죠.
+",Korean
+심장 뛰는 게 불편한���요?,Korean
+"다른 큰 질병은 없어요.
+",Korean
+"일주일에 하루 빼고 술 마셔요.
+",Korean
+그래도 횟수를 세면서 조절하려고 노력하고 계시는군요. 조금 더 힘내서 과식 습관을 없애볼까요?,Korean
+아니요. 조영제가 뭔지도 모르는걸요?,Korean
+실비 보험이 안 되어 있으신가요?,Korean
+내시경을 한지 한 달밖에 안 되었지만 그동안의 변화추이를 봐야 하기 때문에 필요한 검사입니다. 직장 내시경은 대장 내시경보다는 덜 힘든 검사입니다.,Korean
+네 맹장 수술도 포함입니다.,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+상해로 인하여 수술하신 적 있나요?,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+환자 정보 관련하여 문의드렸습니다.,Korean
+마취 크림만으로도 마취 잘 돼요.,Korean
+면역 치료가 잘 안될 경우에는 레이저 시술에 들어갈 수밖에 없습니다.,Korean
+발기 부전으로 인해 불편함을 겪은 적이 있나요?,Korean
+"네. 잠은 충분히 자는데 깊이 못 자는 거 같아요.
+",Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+결핵을 치료한 지 얼마나 됐죠?,Korean
+손목 터널을 넓히는 수술입니다.,Korean
+전신무력증이 온 것 같습니다.,Korean
+네. 감기 기운이 있어서 감기약을 좀 먹였어요.,Korean
+"아픈 지 일주일 됐어요.
+",Korean
+심호흡해도 심장이 빨리 뛰나요?,Korean
+육안상으로는 판별이 어려우니 검사를 받으러 가시겠습니다.,Korean
+"오줌 싸는 게 어려워요. 아프고요.
+",Korean
+흡연은 몇 살부터 시작하셨어요?,Korean
+지금 몸에 부종이 오른 데가 어디죠?,Korean
+"팔 수술한 곳이 이상해요.
+",Korean
+밤에 잠을 잘 못 주무셔서 힘들지 않나요?,Korean
+아픈 부위를 가리켜 보세요.,Korean
+가슴이 답답하고 통증이 있나요?,Korean
+그럼 건강 검진 예약해 드릴게요.,Korean
+다낭성 낭종 약 처방을 위해서 들렀어요.,Korean
+아니요. 누워 계셔야 합니다.,Korean
+"안녕하세요 건강검진 받다가 혈액 수치에 문제가 있어서 추가 검진을 받으라고 안내 받았어요. 그래서 정밀 검진 받고 싶어서 내원했습니다.
+",Korean
+어지러운 정도를 말씀해 주실래요?,Korean
+가족 중에 유전성 질환으로 치료받았던 분이 계시나요?,Korean
+"밝은 곳에 가면 눈이 너무 부셔서 거의 눈을 뜰 수가 없어요.
+",Korean
+흡연 기간은 어떻게 되나요?,Korean
+특이 혈액형이 뭐죠? 처음 들어봐요.,Korean
+암 치료를 몇 살 때부터 받으셨나요?,Korean
+목이 아픈 적 있으셨어요?,Korean
+당뇨 치료를 위해 어떤 약을 드시나요?,Korean
+통증의 정도를 숫자로 알려 줄래요?,Korean
+위염 때문에 입원한 적이 한 두 번이 아니에요.,Korean
+소화제는 늘 먹는데 위가 안 좋아서요.,Korean
+"삼키기 힘들어졌어요. 일주일 전부터요.
+",Korean
+감기 아니에요? 감기인 줄 알았는데 천식이라뇨.,Korean
+어떠한 상황에 알레르기가 일어나시나요?,Korean
+환자분이 생각하기에 한번 통증이 오면 얼마나 가나요?,Korean
+위내시경도 후두 내시경처럼 관에 있는 카메라를 통해 병변을 확인하는 거지만 위내시경은 위 안으로 들어가기 때문에 더 힘드실 수도 있습니다.,Korean
+흉 없이 치료하기까지는 시간이 많이 걸리겠어요.,Korean
+혹시 언제부터 배가 빵빵한 느낌인가요?,Korean
+간염 치료받은 지 오래되셨나요?,Korean
+"가슴 중앙이 조여오듯 통증이 심해요.
+",Korean
+언제부터 가슴 통증이 있나요?,Korean
+영부터 십 중에 통증이 얼마나 되세요?,Korean
+피 소변을 보시진 않나요?,Korean
+설사를 하신 경험이 있나요?,Korean
+소화불량이 원래 있으셨는지 궁금하네요.,Korean
+재채기는 여러 가지 원인에 의해 나올 수 있어요.,Korean
+대변을 볼 때 피가 묻어 나온 적이 있었나요?,Korean
+"기침이 계속 나면서 폐 쪽이 아파요.
+",Korean
+얼마나 심하게 오한이 느껴지나요?,Korean
+복부 팽만감 때문에 불편함을 느끼시나요?,Korean
+계속 토할 것 같은 느낌이 드나요?,Korean
+철심 수술은 안 했어요.,Korean
+그 기록에 의해 환자분에 대한 또 다른 판단이 가능해서요.,Korean
+피부 붉어짐 가려움 붓기 등 알레르기 증상을 경험한 적도 없으세요?,Korean
+암 치료했었던 가족이 있나요?,Korean
+일단 육안으로는 아무 이상 없습니다.,Korean
+네. 입원 며칠 동안 해요?,Korean
+현재로서는 건강하신 상태입니다. 다만 너무 심한 저염식도 문제가 될 수 있죠,Korean
+통증 주기가 몇 주인가요?,Korean
+검사를 통해 알레르기의 원인이 되는 것과 환자분의 상태를 확인하고 그에 따른 치료를 계획하실 겁니다.,Korean
+"십 년 되었네요. 건강을 위해 이제는 슬슬 줄여야겠어요.
+",Korean
+혈압약을 드시고 계신 것이 있습니까?,Korean
+혈변 시 복통이 함께있나요?,Korean
+가족 중에 유전성 질환 약을 드시고 계시는 분이 있나요?,Korean
+열이 또 오는 것 같나요?,Korean
+배뇨곤란 증상이 많이 심한가요?,Korean
+검사 결과는 그렇게 나왔네요.,Korean
+움직이지 못할 만큼 아프신가요?,Korean
+네. 그럼 일단 진료받는 것으로 하고 한번 찾아뵐게요.,Korean
+당을 낮추는데 당뇨 약이 도움이 되나요?,Korean
+과거 암 진단받은 적 있나요?,Korean
+네 힘드시겠지만 환자분의 치료를 위해 필요한 금식입니다.,Korean
+혈압이 높게 나오는 편인가요?,Korean
+이후에 대변을 보실 때 경과를 확인해볼 수 있을까요?,Korean
+약을 어느 병원에서 받으신 거죠?,Korean
+세 종류의 약을 하루 이 회씩 복용하게 되는데 처방하는 의사에 따라 조금씩 다를 수 있습니다.,Korean
+네 맞습니다 오늘 오후에 수술할 예정입니다.,Korean
+수술 곧 들어가실 것 같아요.,Korean
+"어깨에 힘이 잘 안 들어가요.
+",Korean
+체중 증가가 언제부터 있었나요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+통증이 안 없어지는 것 같아요.,Korean
+"당연히 금연한 적 있죠. 그렇지만 다시 피웠고 지금도 피고 있어요.
+",Korean
+잠을 깊게 잘 수 있나요?,Korean
+필요시 간호사 호출해주시면 됩니다.,Korean
+몇 년 전에 항암치료 때문에 항암제를 복용했지만 현재는 완쾌해서 안 먹습니다.,Korean
+무릎 쪽에 통증이 있나요?,Korean
+"아니요. 저는 담배를 아주 싫어하는 사람이에요.
+",Korean
+변이 잘 안 나오나요?,Korean
+고혈압 진단을 받은 뒤로 쭉 앓고 계신 건가요?,Korean
+가까운 약국이 어디 있죠?,Korean
+뼈가 자라지 않은 다지증이기 때문에 전신마취는 안 해도 됩니다. 대신 주사제로 전신마취제를 투여하고 마취과 의사가 있는 상태에서 수술합니다.,Korean
+담배 피우신 지는 얼마나 되셨을까요?,Korean
+네. 원래 자궁이 좋지 않았어요.,Korean
+진단서 여러 장 발급 가능한가요?,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+붓기가 제일 심한 때를 알려 주세요.,Korean
+지금까지 먹어본 약물에는 없었어요.,Korean
+빈속에도 구토 증상이 있나요?,Korean
+진단에 도움이 될 수 있기 때문입니다.,Korean
+네. 어렸을 때 수술 기록이 있었어요.,Korean
+어디 기대어 있어야 할 정도로 어지럽나요?,Korean
+식욕부진 증상을 언제부터 느꼈나요?,Korean
+몸에서는 어떤 통증이 느껴지나요?,Korean
+처음 호흡곤란을 겪은건 언제인가요?,Korean
+"고양이가 할퀴었는데 이마에서 피가 나요.
+",Korean
+"삼일 전부터 열이 났는데 해열제를 먹여도 내렸다 올랐다 해서요.
+",Korean
+치료를 시작해야 할 것 같아요 오늘 주사를 맞고 가시는 게 좋겠습니다.,Korean
+"입이 마를 것 같은데 물로 헹구는 건 괜찮죠?
+",Korean
+같이 복용하는 약물의 영향이 있어 꼭 필요한 부분입니다.,Korean
+경구 약물 투여가 가능하다면 먹는 약물 사용이 더 바람직합니다.,Korean
+틀니 임플란트 등 자연적으로 난 치아에서 의학적인 기술이 들어간 치아 상태를 모두 말씀드리는 거예요.,Korean
+몇 분에 한 번씩 통증이 생기던가요?,Korean
+언제부터 가슴 통증이 있나요?,Korean
+"몸 여기저기가 건조하고 가렵다 못해 붉게 되어서 왔어요.
+",Korean
+"기저귀 갈아주려고 보니까 아기 사타구니 쪽에 볼록한 게 튀어나와 있어서요.
+",Korean
+혈액검사를 했을 때 당 수치가 높았나요?,Korean
+통증은 일주일에 몇 번 정도 느끼세요?,Korean
+제가 혼자 살아서 좀 나중에 퇴원하고 싶은데요.,Korean
+어느 손가락이 어떻게 불편하신지 표현해 보실 수 있나요?,Korean
+"술에 너무 의존하게 돼서 끊고 싶어서 찾아왔습니다.
+",Korean
+최근 몇 개월간 체중이 급격히 변하셨나요?,Korean
+소변이 잘 누어지지 않으세요?,Korean
+가슴 통증이 어떻게 있나요?,Korean
+자의로 판단하지 마시고 병원에서 처방받은 대로 하시면 됩니다.,Korean
+"가려워서 보니깐 색소가 침착됐어요.
+",Korean
+"심하게 넘어져서 무릎이 까졌어요.
+",Korean
+이 검사는 금식이 필요하기 때문입니다.,Korean
+네 감염력 확인으로 거짓 없이 답변주셔야 합니다.,Korean
+목 안쪽으로 풍선 같은 걸 부풀려서 지혈했기 때문에 조금 아프실 수도 있을 거예요.,Korean
+혈변을 보신 후 항문이 불편하진 않나요?,Korean
+간 수치 측정하면 높은 편인가요?,Korean
+피부 진피층이 손상된 경우 회복하는 데에 수개월 이상이 걸릴 수 있습��다.,Korean
+우선은 면역 반응 조절부터 할게요.,Korean
+기침할 때 피가 터져 나오나요?,Korean
+특이사항은 마취가 잘 안 들거나 마취제에 알레르기가 있는 경우입니다.,Korean
+과도한 힘주기를 해도 배변이 안 나오나요?,Korean
+당뇨약을 드셨거나 항암주사를 맞았거나 그런 거요.,Korean
+제일 고통스러운 증상이 뭐죠?,Korean
+그 이후론 수술 안 했어요.,Korean
+"요도염인 것까지만 알고 있는데요.
+",Korean
+혈관이 터진 것 같아요.,Korean
+혈압이 높은 거 안 지 얼마나 되셨어요?,Korean
+대장 내시경보다 덜 들어가기 때문에 비수면으로 하시는 분들도 많습니다.,Korean
+통증을 점수로 표현하면 몇 점일까요? 십 점 만점 기준으로요.,Korean
+환자 개인에 맞춰서 치료하는 방법이 다르니까요.,Korean
+변을 보고 나면 딱딱한 느낌이 있으신가요?,Korean
+"요즘 들어 환청이 들려요. 계속 귓가에서 여자의 목소리가 맴돌고 한 번은 사람들 있는 데서도 이상한 소리가 들려서 정말 곤란했어요. 이젠 이 목소리가 진짜인지 가짜인지 구별도 안 되는 상황이 와서 찾아오게 되었어요.
+",Korean
+"고환이 부은 것 같아서요.
+",Korean
+소변 닦을 때 휴지에 피가 묻어 나오진 않나요?,Korean
+아니에요 속이 안 좋은지는 얼마나 되었나요?,Korean
+통증이 이어지는 시간이 몇 분인가요?,Korean
+네. 해외에서도 코로나가 문제가 돼서요.,Korean
+어떤 음식 먹을 때 소화가 잘 안 되나요?,Korean
+네 검사 예약 잡아 드릴게요.,Korean
+약을 투여한 정확한 시간을 알면 좋아요.,Korean
+현기증 느낀 적 있었어요?,Korean
+"검붉은 변이 덩어리 채 나왔네요.
+",Korean
+일주일에 몇 번 통증이 있나요?,Korean
+네. 그럼 아래 빈칸에 동의서 설명 들었으며 동의한다고 사인해 주시겠어요?,Korean
+통증 강도가 어느 정도 신가요?,Korean
+아프신 정도가 얼마나 되시나요?,Korean
+약을 처방받아 드시고 계신가요?,Korean
+혹시 가족 중에 유전성 질환 증세 있는 분은요?,Korean
+당뇨 진단을 받은 가족이 있나요?,Korean
+어떤 음식 드시고 알레르기가 나셨어요?,Korean
+약품 검사는 오래 안 걸려요.,Korean
+수술받은 이력을 말씀해 주세요.,Korean
+소변이 잘 누어지지 않으세요?,Korean
+"네. 아직 귀는 멀쩡합니다.
+",Korean
+밥 먹은 것이 소화가 잘 안 되나요?,Korean
+진통제 주사로 놓아주시는 건가요?,Korean
+추가 검사를 진행하고 정확히 설명드릴게요.,Korean
+둘째 딸네 있는데 몸이 많이 불편해요.,Korean
+어떻게 아프신지 확인해 보겠습니다.,Korean
+당뇨 수치를 재 봤나요?,Korean
+정확하게 진단을 하고 치료를 하려면 혈액 검사를 진행하셔야 합니다.,Korean
+약물 알레르기가 나타나는 약이 있나요?,Korean
+"아내가 약을 먹고 죽을 결심을 한 것 같아요.
+",Korean
+통증이 한 달에 몇 번 정도 있나요?,Korean
+숨 쉴 때 힘이 많이 드세요?,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+배뇨 곤란이 어느 정도 심한가요?,Korean
+지금 아픔이 느껴지는 게 어느 정도예요?,Korean
+증상이 없을 경우 약은 필요하지 않습니다.,Korean
+네 가슴이 마구 두근거리고 식은땀이 나기도 했어요?,Korean
+알레르기 나타내는 약물 말해주세요.,Korean
+혈압이 높은데 고혈압 진단 받은적 있나요?,Korean
+담배 피운 경력이 얼마나 되시나요?,Korean
+수술 후 회복 경과를 지켜보고 말씀드리겠습니다.,Korean
+고혈압약 드시는 것에 대해 말씀해 주세요.,Korean
+목에 음식물이 넘어갈 때마다 통증이 느껴지세요?,Korean
+머리가 아프고 구토가 나오나요?,Korean
+혹시 머리가 아프시다는 등의 다른 증상은 없으시나요?,Korean
+독감 예방 주사는 언제 맞았을까요?,Korean
+환자의 질환을 파악해야 되기 때문이죠.,Korean
+무통 주사 맞아도 효과가 없는 것 같아요.,Korean
+수술을 비롯하여 입원 중 시행하는 대부분의 의료 행위에 건강보험이 적용되며 실손보험과 같은 사보험 적용 여부에 대해서는 보험사와 상의해야 합니다.,Korean
+네. 송아 수술 잘 끝났나요?,Korean
+소변볼 때 피는 안 나왔어요?,Korean
+평소에 복용하는 약이 있나요?,Korean
+네. 최근 건강검진 받을 때 재보았습니다.,Korean
+암으로 고생하게 된 지는 얼마나 되었나요?,Korean
+최근에 체중이 눈에 띄게 빠진 적 있나요?,Korean
+어떤 음식을 먹고부터 복부 팽만감을 느꼈나요?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+밥을 못 먹는 이유가 다른 것이 있는지를 먼저 알아보겠습니다. 필요하다면 내시경을 할 수도 있습니다.,Korean
+증상이 생긴 날에 처음 먹��본 음식이나 해산물이나 상한 음식 드신 건 없나요?,Korean
+유전성 질환과 관련해서 진단을 받은 가족이 있나요?,Korean
+통증이 오는 곳이 있나요?,Korean
+결핵 주사는 이번 주에 맞으실 예정인가요?,Korean
+갑자기 가슴이 아프다거나 숨쉬기 어렵지 않으셨고요?,Korean
+갑자기 음식물을 먹고 토하진 않았나요?,Korean
+배에 가스가 찬 느낌은 안드세요?,Korean
+"잠이 잘 안 와서 힘듭니다.
+",Korean
+약물이나 음식 말고 다른 알레르기 있으세요?,Korean
+최근 한달 이내에 예방 접종을 하신적이 있나요?,Korean
+체중이 눈에 띄게 늘진 않았나요?,Korean
+"아기가 지금 한 삼 일 동안 열이 나는데 해열제를 먹여도 열이 안 내려가고 별것 다 해봤는데도 안 돼서요.
+",Korean
+횡문근 융해증 치료에서 무엇보다 중요한 것은 빠르고 적절한 수액치료로 급성 신부전을 예방하는 것입니다.,Korean
+최근에 입원 치료를 받은 적이 있나요?,Korean
+골육종이 폐로 전이가 잘 되는 병이긴 합니다만 정밀 검사를 해봐야 압니다.,Korean
+피부에 국소 자극을 일으켜 항체가 그곳 세포를 공격하게 하는 성분입니다.,Korean
+조금 더 살펴볼게요. 많이 가렵나요?,Korean
+현재 치료 중인 다른 병이 있나요?,Korean
+소변을 볼 때 따가운가요?,Korean
+입원 치료까지는 필요 없습니다.,Korean
+어디가 제일 많이 붓나요?,Korean
+아닙니다. 환자분의 몸 상태를 전반적으로 확인하는 중입니다.,Korean
+신경 손상이 의심되니 근전도 검사를 먼저 해보겠습니다.,Korean
+환자분이 직접 집에 다녀오신다는 말씀이세요?,Korean
+아직 간병인을 구하지 못하셨나요?,Korean
+알레르기가 언제부터 시작됐는지 기억나세요?,Korean
+몸의 부기가 어느 정도인가요?,Korean
+아픈 부위를 가리켜 보세요.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+최근 몸무게에 변화는 없으세요?,Korean
+견디기 힘들 정도의 통증인가요?,Korean
+아니요. 교정치과 외에는 간 적 없어요.,Korean
+위장 쪽 트러블은 없습니다.,Korean
+지금 전신 무력감을 느끼시나요?,Korean
+대변을 보실 때 아프면서 피가 나왔나요?,Korean
+아픈 곳이 얼마 동안 계속 아팠나요?,Korean
+눈에 띄는 증상이 있나요?,Korean
+급하게 수혈을 해야 되는 상황이 아니라면 크게 걱정 안 하셔도 됩니다.,Korean
+"변비 때문에 항문에 혹 같은 게 났어요.
+",Korean
+흔한 부작용이 아니니 걱정마시고 증상 발현 시 말씀주세요.,Korean
+한의원에서 지어온 약재가 좀 있어요.,Korean
+시간 맞춰 먹는 약이 있어요.,Korean
+간염으로 병원 내원한 적 있나요?,Korean
+피 뽑은 건 해당 안 됩니다.,Korean
+가족들 중에 유전질환으로 고생하는 사람 있나요?,Korean
+하루에 담배 얼마나 피우시나요?,Korean
+여기서는 처음인데 다른 병원에서는 촬영한 적이 없으시나요?,Korean
+어디에 있는 연세 이비인후과예요?,Korean
+가족 중에 당뇨 치료를 받고 있는 분이 계시나요?,Korean
+알레르기 반응이 나타나는 음식이 무엇인가요?,Korean
+토할 때 피가 자주 보이시나요?,Korean
+변비를 고치기 위해 어떠한 노력을 하셨나요?,Korean
+암 때문에 주의하시는 부분이 있나요?,Korean
+알레르기 반응을 보이는 음식이 있나요?,Korean
+대변 잘 못 보세요?,Korean
+"사타구니 백선 증상 진단받았어요.
+",Korean
+가슴이 갑자기 너무 급하게 두근거린 적이 있나요?,Korean
+전부터 기침 증상이 자주 있었나요?,Korean
+고혈압을 관리하는 다른 가족분이 계신가요?,Korean
+투석하면서 통증이 수반될 수 있습니다.,Korean
+"어제 아기가 기침한 후로 숨소리가 이상해요.
+",Korean
+환절기 때 한번씩 아프기는 해요.,Korean
+담배 하루에 몇 갑이나 피우는지 알 수 있을까요?,Korean
+알레르기와 관련된 병력을 말씀해주세요.,Korean
+성교 시 문제가 있나요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+이마가 뜨거운 것 같으세요?,Korean
+혈압 관련해서 많이 불편하셨군요. 상담을 원하신다면 진료과로 안내 해드릴까요?,Korean
+손목에 있는 환자 팔찌에 쓰여있을 거예요.,Korean
+가족 내에 당뇨 앓고 계신 분 있나요?,Korean
+질병으로 인해 수술을 받게 된 적이 있으신가요?,Korean
+"혈압도 지금 높고 약간 뒤 목도 당기는 것 같아서 왔어요.
+",Korean
+제일 불편한 증상이 무엇인가요?,Korean
+피부 건조는 자주 오는 증상 중에 하나입니다.,Korean
+네. 여기 병원에서 준 약 먹고 있어요.,Korean
+진통제는 정말 견디기 힘들 때 처방해 드리겠습니다.,Korean
+종양약을 드신 지 얼마나 되셨나요?,Korean
+"아니요. 숨쉬기 운동��� 합니다.
+",Korean
+통증이 자주 있는 편인가요?,Korean
+발기 부전 증상이 있으세요?,Korean
+앰뷸런스에서 병상으로 이동할 때 어떻게 하셨나요?,Korean
+음식 알레르기 있는지 확인 부탁해요.,Korean
+네 독감 예방 접종 후 알레르기는 따로 없으셨단 거죠?,Korean
+애완견도 인플루엔자 접종 등 다양한 예방 접종이 있습니다 사람처럼 필수는 아니더라도 미리 예방해 주시면 좋죠.,Korean
+알레르기 때문에 피해야 하는 음식이 있나요?,Korean
+부기는 잘 빠지고 있네요.,Korean
+고혈압 진단받은 날짜 기억하시나요?,Korean
+"불면증도 있었고. 너무 밤잠을 설쳤죠.
+",Korean
+"하루 전부터 금식이니까 딱 하루 됐네요.
+",Korean
+경과가 좋으면 일주일 후에 퇴원하셔도 됩니다.,Korean
+잠 잘 때 자주 깨시나요?,Korean
+혈액검사로 총 콜레스테롤 중성지방 착한 콜레스테롤인 고밀도 콜레스테롤 나쁜 콜레스테롤인 저밀도 콜레스테롤을 검사합니다.,Korean
+하루에 얼마나 피우는지 알려주실래요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+비수면으로 해 보시고 힘드시면 잠깐 중단하고 수면을 준비해 보도록 하겠습니다.,Korean
+배에 가스가 많이 차지는 않나요?,Korean
+"네. 잠이 잘 안 드네요.
+",Korean
+어떤 약 처방 받으셨어요?,Korean
+언제부터 알레르기 있다는 거를 아셨어요?,Korean
+음주량이 대략 얼마나 되세요?,Korean
+"아기가 목감기에 걸린 것 같아서요.
+",Korean
+네 그냥 약 처방 시 참고하기 위해 드린 질문입니다.,Korean
+어떤 부위에 아픈 느낌이 드시나요?,Korean
+종양 확인된 적 있으신가요?,Korean
+약국에서 급하게 해열진통제 약 사서 먹였었어요. 한 아홉 시 정도에.,Korean
+최소 일주일은 입원하시길 권유드립니다.,Korean
+일반 소독 의약품은 합병증을 유발할 수 있기 때문에 가정에서는 조심해야 합니다.,Korean
+혹시 토에 피가 섞여 나왔나요?,Korean
+꼭 하실 필요는 없지만 트림을 시켜주지 않으면 수유 중 헛공기를 들이마실 수 있습니다.,Korean
+질로 넣기 때문에 조금 불편할 수 있습니다.,Korean
+소변이 계속 조금씩 나오나요?,Korean
+설사 증세가 심해진 적이 있나요?,Korean
+언제부터 소변을 볼 때 피가 같이 나오나요?,Korean
+아직 호흡한 마취 가스가 혈액에 남아있어 폐에 전해져서요.,Korean
+호흡곤란으로 쓰러진 적은 없나요?,Korean
+응급실을 오신 이유가 무엇이죠?,Korean
+네 이번 연도에 접종하셨나요?,Korean
+"가슴 중앙이 조여오듯 통증이 심해요.
+",Korean
+통증 양상이 어떻게 돼나요?,Korean
+몇 년 전에 간염 진단받으셨나요?,Korean
+가슴 통증을 어떻게 느끼는지 얘기해 보세요.,Korean
+어렸을 때부터 빈혈이 있었어요.,Korean
+통증을 점수로 말씀해 주실 수 있나요?,Korean
+일차 치료 시 약을 시간에 맞춰 빠짐없이 복용하고 끝까지 치료받는다면 성공률을 높일 수 있습니다.,Korean
+몇 년도에 제왕절개 하셨나요?,Korean
+몸이 차가운 증상이 있나요?,Korean
+토에 혈액이 섞여 나왔나요?,Korean
+일반적으로 알러지가 있는 물질에 따라 다릅니다.,Korean
+환자분 맥박이 너무 빠르다고 느껴진 적이 있나요?,Korean
+혹시 암 진단받은 적 있으세요?,Korean
+두통 때문에 일상생활에 불편함이 있으신지요?,Korean
+몸에 힘이 빠지는 게 느껴지시나요?,Korean
+네. 암 초기 진단받아서 병원 통원 치료하고 있어요.,Korean
+몸 전체에 힘이 없나요?,Korean
+소화가 잘 안 되고 속이 답답하신가요?,Korean
+지금 어떤 느낌의 통증이 느껴지세요?,Korean
+부끄럽지만 삼 년째 탈모 약 복용하고 있습니다.,Korean
+나중에 태아에 영향을 주지 않도록 준비하는 것입니다.,Korean
+평소에도 심장이 빠르게 뛰나요?,Korean
+간염을 앓은 지 어느 정도 지났나요?,Korean
+당뇨 처음 치료받은 게 언제시죠?,Korean
+언제 처음 결핵을 앓았나요?,Korean
+최근에 수술 언제 받으셨나요?,Korean
+대변을 며칠에 한 번 보나요?,Korean
+가족 중에 대장암 앓으신 분은 없나요?,Korean
+기분이 너무 우울해지는 느낌이 들어요.,Korean
+말초동맥 산소포화도 측정하는 거예요.,Korean
+입원은 하고 싶지 않은데요.,Korean
+구역감이 심하시면 촬영 중이라도 손을 드시기 바랍니다.,Korean
+통증 강도를 숫자로 말씀해 주세요.,Korean
+언제부터 그 증상이 나타났나요?,Korean
+기침을 얼마나 많이 하시죠?,Korean
+당뇨 투병 생활이 얼마나 되었나요?,Korean
+털이나 먼지 같은 거에 반응하는 알레르기가 있으세요?,Korean
+최근에 식욕 변화가 있으신가요?,Korean
+네. 원래 통증이 조금 있어요.,Korean
+부어오른 증상 외에 다른 증상은 없으세요?,Korean
+"걸을 땐 괜찮은데 계단 오르거나 내려갈 때 무릎이 욱신거립니다.
+",Korean
+가족 중에 유전성 질환 있는 분은요?,Korean
+"맞아요 정말 너무 아파서 잠도 설칠 때가 참 많아요.
+",Korean
+흡연을 시작한 나이를 아세요?,Korean
+일주일에 몇 번 변을 보나요?,Korean
+괜찮지만 고혈압은 유전적으로 발생하기에 한 번 검사를 받는걸 추천합니다.,Korean
+대변을 언제부터 잘 못 보시나요?,Korean
+가장 아픈 곳이 이 두 군데라는 말씀이신 거죠?,Korean
+온몸에 열이 계속 나는지 알려주세요.,Korean
+올해 들어서 독감 예방 주사 맞으신 적 있나요?,Korean
+면역력이 저하되면 감염된 바이러스가 활동을 시작하여 증상이 나타나기도 합니다.,Korean
+어떤 다른 알레르기가 있으신가요?,Korean
+평상시 음주 여부 말입니다.,Korean
+기존에 간염 관련으로 진단받거나 하신 게 있으세요?,Korean
+결핵 앓은 지 몇 년이나 되셨나요?,Korean
+"소변볼 때 아래가 따끔거리고 아파서요.
+",Korean
+구토 후에는 속이 많이 아픈가요?,Korean
+자연 분만으로 둘 다 낳았죠.,Korean
+물에 닿았다면 거즈를 빼고 말리신 후에 소독하고 다시 새 거즈를 붙이셔야 합니다.,Korean
+병이라고 하긴 좀 그런데 평소에 장이 좀 안 좋습니다.,Korean
+환자분 남은 검사가 많으셔서 천천히보다는 좀 빨리 보시는 게 좋겠네요.,Korean
+암으로 인한 증상은 언제부터 나타났나요?,Korean
+네. 혹시 병실 몇 인실인가요?,Korean
+복통도 함께 있다면 원인을 알기 위해 검사를 더 해 보아야 할 것 같습니다.,Korean
+통증이 지속되는 시간이 긴가요?,Korean
+가족 중에 유전성 질환 치료 받으시는 분 계세요?,Korean
+네 체중 변화가 빨리 올 경우 몸에 피해가 있을 수 있습니다.,Korean
+"깊게 못 자니 몸이 회복이 잘 안 되는 것 같아요.
+",Korean
+가족 중에 당뇨 환자 있으신가요?,Korean
+다른 병원에서 입원하신 내용은 저희가 알 수 없습니다. 기억나는 게 있다면 무엇이던 알려주세요.,Korean
+결핵약은 주기적으로 복용 중이신가요?,Korean
+어떤 약으로 간염 치료 중이신가요?,Korean
+혈압이 높아 진료를 받은 적 있으신가요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+아침에 복용해야 하는 약이세요.,Korean
+통증이 느껴지는 곳이 어디죠?,Korean
+입원 경험이 있는지 없는지 알기 위해 여쭤봤습니다.,Korean
+결핵 치료는 언제부터 받으셨나요?,Korean
+타 병원 기록은 볼 수 없습니다. 부모님이 아실 수도 있으니 물어보고 알려주세요.,Korean
+"왼쪽은 버틸만한데 오른쪽은 너무 심하게 저려서요.
+",Korean
+어떤 마취제였는지 기억하고 계세요?,Korean
+맥박이 빨라지는 느낌이 있나요?,Korean
+통증이 생기면 얼마나 가나요?,Korean
+발기 부전이 문제이신 건가요?,Korean
+손 붓는 현상은 언제부터 있었죠?,Korean
+최근에 인플루엔자 백신은 접종했나요?,Korean
+특정한 대상에 알레르기가 있나요?,Korean
+요즘 혹시 두통이 있나요?,Korean
+하루에 반갑 이상 담배를 피우세요?,Korean
+암 때문에 병원에 오셨나요?,Korean
+십 점 만점에 몇 점 정도로 아프신가요?,Korean
+당뇨로 복용 중인 약 있죠?,Korean
+"가슴이랑 옆구리 통증이오. 몸을 조금만 움직여도 아파요. 걷지도 못하겠어요.
+",Korean
+코로나 바이러스가 있기에 전부 말씀해 주셔야 합니다.,Korean
+오늘 밤에 금식하는 거나 수술 전 준비하실 거 안내해 드릴게요.,Korean
+십 점 만점에 몇 점으로 통증이 오나요?,Korean
+"설사가 멈추니 변비가 생겼어요.
+",Korean
+음식 알레르기 경험해보신 적 있나요?,Korean
+지금까지 약을 복용하고 계시나요?,Korean
+결핵 치료를 위한 관리 중이신가요?,Korean
+네. 최근에 짐을 들고 가다가 허리를 다쳤어요.,Korean
+문제 없습니다. 입원 당시를 기록할 필요가 있어 질문하였습니다.,Korean
+고혈압 발병 기간은 얼마나 되셨나요?,Korean
+간염 언제부터 앓고 계신가요?,Korean
+대변에 피가 섞여 있거나 물 내리고 혈흔이 남아 있나요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+과거에 걸렸던 질병이나 병력 말해봐요.,Korean
+고혈압약 먹고 혈압이 조금 안정됐나요?,Korean
+가족이 앓고 있는 질병이 있나요?,Korean
+네. 보호자분들에게 수술이 끝나면 수술실 전광판을 통해 알려드리고 있습니다.,Korean
+혈액검사와 소변검사는 두세 시간 정도 소요되며 신장 조직 검사 결과는 오에서 칠일 정도 소요됩니다.,Korean
+머리가 어지러워서 누워 있어야 하나요?,Korean
+음식 알레��기 외에 다른 것도 있나요?,Korean
+고혈압을 앓게 된 지 얼마나 되셨죠?,Korean
+통증이 느껴지는 세기가 어느 정도인가요?,Korean
+병원은 어떻게 오시게 되셨나요?,Korean
+당 수치 혹시 어떻게 되는지 아시나요?,Korean
+암 때문에 방사선 치료한 적이 있나요?,Korean
+내시경 검사 시 위장관 내부를 더 잘 볼 수 있도록 장을 비우기 위해 금식이 필요합니다.,Korean
+"소변 색이 녹빛 이에요.
+",Korean
+다른 가족 중에 고혈압 진단받은 사람은 없나요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+여드름 부위에 발라야 합니다.,Korean
+특별히 알레르기가 일어났던 상황이 있었나요?,Korean
+당뇨 관리 언제 시작하셨어요?,Korean
+거의 통증은 없다고 생각하시면 됩니다.,Korean
+몸의 특정 부위가 부어오른 적 있나요?,Korean
+불면증 때문에 밤새 못 주무시나요?,Korean
+결핵 진단 후 치료는 잘 받으셨나요?,Korean
+지금 고통스러운 부위는 어디신가요?,Korean
+가족 중에 유전성 질환을 판정받으신 분 계시나요?,Korean
+대변이 배출될 것 같은 신호는 오는데 안 나오나요?,Korean
+흡연 시작한 지 얼마나 되었어요?,Korean
+심근경색이라면 검사 결과가 정상으로 나올 수 없기 때문에 안심하셔도 됩니다.,Korean
+결핵 앓았던 적 있으세요?,Korean
+흡연이나 음주나 일상적으로 접하는 것이라 익숙하지만 건강에 큰 영향을 끼치죠.,Korean
+어떤 약을 드셨는지 말씀해주실래요?,Korean
+오늘 낮에 이비인후과 다녀온 것 빼곤 없어요.,Korean
+토를 한 적이 있나요?,Korean
+아픈 곳이 어딘지 알려주시겠어요?,Korean
+소화가 잘 안 되는 느낌이 드나요?,Korean
+"식욕이 줄어서 예전만큼 못 먹어요.
+",Korean
+증상 발현한 날 마지막으로 드신 음식이 무엇인가요?,Korean
+"사타구니 근처 전체적으로 좀 아파요.
+",Korean
+아직도 당뇨로 통원 치료하시나요?,Korean
+보통 약은 일주일 정도 복용하긴 합니다.,Korean
+통증이 어느 정도로 느껴지나요?,Korean
+몸이 부을 때가 있나요?,Korean
+최근 한달 안에 통증을 느낀 적이 언제인가요?,Korean
+암과 관련된 병 있으셨던 적 있어요?,Korean
+발이 부어 신발이 안 맞을 때가 있습니까?,Korean
+정서 장애를 초래할 수 있으므로 보호자의 세심한 관찰이 필요합니다.,Korean
+먹은 것을 소화시키지 못하고 올라온 적이 있나요?,Korean
+고혈압을 앓은 경험이 있나요?,Korean
+약을 먹고 있긴 한데 별 효과가 없어요.,Korean
+두통으로 불편한 점은 없나요?,Korean
+심장이 빨리 뛰는 느낌이 드나요?,Korean
+그냥 약국에서 진통제 사 먹었어요.,Korean
+피 소변을 보시진 않나요?,Korean
+잠을 잘 못 주무시나요?,Korean
+증상을 앓은 기간이 얼마나 되나요?,Korean
+환자분한테는 지금 충분한 보습을 해 주는 게 제일 좋은 방법입니다.,Korean
+몸살 기운이 있으신 거죠?,Korean
+치과 치료 중인데 이것도 말씀드려야 하나요?,Korean
+입원이나 수술해 본 적이 아예 없습니다.,Korean
+저번에 왔을 때 보다 체중이 늘었나요?,Korean
+환자분이 수술하러 가시면 문자 가게 해드릴까요? 수술 끝나고 회복실에 들어갔다는 문자가 가게 해드릴 수 있어요.,Korean
+알레르기 반응 보이는 음식이 있는지 알려주세요.,Korean
+접종 안 된 애완견은 사람에게 질병 전파를 할 수 있어요.,Korean
+시력이 안 좋아졌거나 흐리게 보이는 증상이 있나요?,Korean
+밤에도 상관없이 간호사 호출기 눌러주시면 됩니다.,Korean
+따로 암 증상이 나타난 게 있나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+수술 비용에 관해서는 병원 행정처에 문의하시는 게 가장 정확합니다.,Korean
+처음에 응급실로 오신 건 아니죠?,Korean
+현재 다른 알레르기를 갖고 계신가요?,Korean
+당뇨 치료받은 지 꽤 되셨어요?,Korean
+"팔팔 끓는 물에 팔을 데었어요.
+",Korean
+그전에는 음주와 흡연을 얼마나 하셨나요?,Korean
+몰아서 잔다고 해도 부족했던 수면이 메꿔지지 않습니다.,Korean
+하루에 몇 개 피우시죠?,Korean
+지금 너무 급해서요. 응급실 자리 있을까요?,Korean
+아니요. 방향을 바꾸기는 힘들고 걸리적거리지 않도록 배액관 길이를 최대한 조정해 드리겠습니다.,Korean
+척주 전방 전위증이 있어서 도수치료받고 있어요.,Korean
+오늘 토한 적이 두 번 이상인가요?,Korean
+고혈압으로 약 어떤 거 먹나요?,Korean
+병원에서 혹시 처방 받아서 드신 약이 있으실까요?,Korean
+가족 중에 당뇨 진단을 받아보신 분이 있으세요?,Korean
+만졌을 때 통증은 없나요?,Korean
+환자 개인에 맞춰서 치료하는 방법이 다���니까요.,Korean
+언제부터 고혈압 약을 먹기 시작했나요?,Korean
+복부에 다른 증상이 나타나진 않나요?,Korean
+예방주사 맞은 날짜를 알려주실래요?,Korean
+"원래 담배는 안 피워요.
+",Korean
+아버지가 고혈압이셨고 환자분은 없으시다고요?,Korean
+"기침을 너무 많이 해서 그런지 이젠 심장까지 아픈 것 같아요.
+",Korean
+유산소 운동은 무리하지 않도록 하는 게 제일 좋습니다.,Korean
+결핵 주사 맞으신 적 있으신가요?,Korean
+"네. 우리 아기가 다른 아기들보다 키도 크고 몸이 빨리 자라는 것 같아서 검사받고 싶어서 왔어요.
+",Korean
+네 찢어져서 출혈이 있어요.,Korean
+결핵 진단받으신 지 얼마나 되셨나요?,Korean
+네. 발열이 가장 큰 증상입니다.,Korean
+며칠에 한 번씩 통증이 있으신가요?,Korean
+변에 피가 많이 묻어 나오나요?,Korean
+최근에 발기 부전이 느껴지진 않으신가요?,Korean
+"지금 아까보다는 나은데 여전히 아파요. 어제 식사요? 뭐 먹었더라.
+",Korean
+약에 대해 알레르기가 있으신가요?,Korean
+지금 몸 상태는 어떠세요?,Korean
+원래 평소에도 식욕이 없으셨나요?,Korean
+아까 열 체크 했어요. 또 체크 하나요?,Korean
+어디 아프신 곳이 있나요?,Korean
+기침 한 번 하면 얼마나 많이 해요?,Korean
+간염으로 드시는 약 있으세요?,Korean
+해 봐야 알겠지만 지금 상태로 봐서는 흉이 남을 수 있습니다.,Korean
+네. 근데 지금 수액이 막 떨어지는데 괜찮나요?,Korean
+얼마나 아픈지 상세히 알려주세요.,Korean
+알레르기가 시작된 게 최근인가요?,Korean
+유전성 질환 때문에 치료받고 있는 가족이 있나요?,Korean
+토할 거 같이 속이 안 좋으신가요?,Korean
+암으로 아팠던 경험이 있으신가요?,Korean
+폐렴은 여러 가지 요인으로 발생할 수 있습니다. 기침을 한다고 무조건 폐렴에 걸린 것은 아닙니다.,Korean
+흡연 시작 연령을 기억하세요?,Korean
+진통제 필요하면 추가 처방 드릴 수 있어요.,Korean
+과거 병력을 알고 싶어요.,Korean
+"기침을 심하게 하다가 허리를 삐끗해서 왔어요.
+",Korean
+온몸에 좀 오한이 있으세요?,Korean
+일 점부터 십 점까지의 통증 중 삼 점 정도 느끼신다고 합니다.,Korean
+헬리코박터균 감염 여부에 대한 검사해야 알 수 있습니다.,Korean
+주로 성관계에 의해 전파되는 것도 있습니다.,Korean
+가래가 얼마나 자주 나오세요?,Korean
+좀 더 약한 약으로 바꿉시다.,Korean
+흡연량이 정확하지 않아도 대략 알려주세요.,Korean
+통증이 시작되면 언제까지 아픈가요?,Korean
+둘 다 알레르기로 나타날 수 있고 연관성이 있습니다.,Korean
+여기가 괴롭다 싶은 부위가 있으세요?,Korean
+혹시 약물 음식 제외하고 다른 알레르기도 있으세요?,Korean
+가족 중에 당뇨 환자 있으신가요?,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+몇 시간에 한 번씩 통증이 오나요?,Korean
+약물 복용 중인 거 있으신가요?,Korean
+아이 몸무게 측정할 때 옷은 입은 상태로 눕히시면 됩니다.,Korean
+아픈 간격이 어떻게 되시나요? 한 번 아프고 난 다음에 다음 통증까지의 시간을 말씀해 주시면 됩니다.,Korean
+거의 물 같은 변을 보셨나요?,Korean
+알레르기 때문에 멀리해야 하는 것이 있나요?,Korean
+결핵 관련해서 예방 접종하신 적 있을까요?,Korean
+짠 걸 드시면 붓기가 평소보다 심할 수 있습니다.,Korean
+그보다 환자 상태에 맞춰 진행합니다.,Korean
+측정 기록이 없어서 그런데 아까 하셨더라도 지금 아이 몸무게 다시 한 번 측정해볼게요.,Korean
+암과 관련한 가족력이 해당되시나요?,Korean
+환자와 관련해서 안내드릴께 있어 여쭤보았습니다.,Korean
+이 병원 와 본 적 있는데요.,Korean
+지금 컨디션이 저하되어 있나요?,Korean
+약물에 알레르기가 있다고 들으신 적이 있나요?,Korean
+작년에 파상풍 맞은 이후로 예방 접종은 아직 안 했어요.,Korean
+예를 들어 병원에서 처방받았다던가 약국에서 구입한 약들이요.,Korean
+"전자 담배로 갈아탄 기간 포함인가요?
+",Korean
+약물치료로 호전될 가능성이 높지만 환부를 자주 확인해볼 필요가 있습니다.,Korean
+목 아플 때 먹는 약 같이 먹고 계세요?,Korean
+근래에 발기 부전을 느끼신 적은 없나요?,Korean
+고혈압 약은 드시다가 현재 중단하셨다는 건가요?,Korean
+당뇨와 관련된 치료 약을 드시고 있나요?,Korean
+건강 보험 이외 실손보험 등 사보험 적용이 필요하시다면 진단서 혹은 소견서를 작성하여 드리겠지만 실제 적용 여부는 보험사와 상의해야 합니다.,Korean
+영양제 종류도 말씀해 주세요.,Korean
+소변에 피가 섞여 있지는 않으세요?,Korean
+구토할때 피가 섞여 나온 적이 많은가요?,Korean
+몸이 떨리고 열도 나는 것 같은가요?,Korean
+다른 병원에서 간염 진단을 받으셨나요?,Korean
+기침이 심할 때는 언제인가요?,Korean
+뇌척수액 천자 후 두통 등의 합병증이 발생할 수 있지만 영구적 합병증을 초래할 가능성은 낮습니다.,Korean
+혹시 약물 부작용 검사 같은 거 받고 더 등록해 줄 수 있어요?,Korean
+"아이가 대변볼 때 너무 힘들어해서요.
+",Korean
+하루에 태우는 담배가 얼마나 되나요?,Korean
+간염 진단받은 후 음주하고 있나요?,Korean
+퇴원 수속은 환자분이나 보호자분이 계셔야 해요.,Korean
+"하루 일곱 시간 수면은 그대로지만 중간에 깨니까 잘 잔다고 볼 수 없죠.
+",Korean
+당 수치가 어떻게 되는지 아세요?,Korean
+"얼굴로 마비가 와서 왔어요.
+",Korean
+네. 삼 년 후 대장 내시경 검사로 새로운 병변 발생 여부 확인하겠습니다.,Korean
+가족 중에 고혈압 환자가 있으십니까?,Korean
+그렇긴 하지만 처방받아서 드시는 게 아니면 오남용이 우려되네요.,Korean
+약물 알레르기 있으시면 알려주세요.,Korean
+"어릴 때부터 마신 거라. 매일인 거 같아요.
+",Korean
+질병에 따라 마취방법이 달라질 수 있기 때문입니다.,Korean
+네 보호자분이 아니라 환자분한테 하는 거 맞습니다.,Korean
+"코피가 도저히 안 멈춰 서요.
+",Korean
+동물과 관련된 알레르기가 있으신가요?,Korean
+발기부전인 것 같다고 생각한 적이 있으세요?,Korean
+속이 토할 것 같고 그러진 않나요?,Korean
+알레르기 치료는 언제부터 했나요?,Korean
+네. 치료하는 데 오래 걸릴까요?,Korean
+배가 부글거리는 경우가 있나요?,Korean
+혹시 종양이 발견된 적 있나요?,Korean
+손발이 차고 메스꺼운 증상이 많이 심하신가요? 진통제를 드시면 간혹 그런 분들이 계세요.,Korean
+복부가 빵빵하게 부푸는 느낌이 있나요?,Korean
+"아이 성기 부분이 빨갛고 부어 있어요.
+",Korean
+암과 관련된 가족력은 없다고 하셨죠?,Korean
+단단한 변 말고 묽은 변을 보시나요?,Korean
+결핵 백신을 맞은 자국이 있으신가요?,Korean
+"잘 안 들리고 귀에서 소리가 나요.
+",Korean
+건강한 소변은 냄새가 없거나 가벼운 냄새만을 풍기는 것이 정상입니다.,Korean
+다른 사람들보다 몸이 허약한 편이었나요?,Korean
+독감 주사 맞고 불편한 건 없으셨나요?,Korean
+혹시 영양제도 같이 처방해 주실 수 있나요?,Korean
+다른 알레르기 상황 다 설명 부탁해요.,Korean
+비염만 문제지 다른 건 모르겠어요.,Korean
+최근에 체중이 얼마나 늘었나요?,Korean
+혹시 결핵약 처방 받으셨나요?,Korean
+"요 근래에 어지럽고 숨 막히고 답답하고 한데 이게 정신적 스트레스 때문에 그런 건가 해서요.
+",Korean
+그리고 식사도 소량씩 자주 하는 게 좋으시고요. 혹시 최근 살이 찌거나 빠지는 변화가 있으신가요?,Korean
+장이 민감해서 장염도 자주 걸려요.,Korean
+입원이나 수술받으신 적 있으면 말씀해 주세요.,Korean
+고혈압약을 현재 복용 중인가요?,Korean
+증상이 한 번 오면 얼마 동안 유지되나요?,Korean
+비급여는 가격이 어떻게 되나요?,Korean
+갖고 계신 약 있나요?,Korean
+"최근에 계속 잘 못 잤어요.
+",Korean
+가래에 피가 섞여 나온 적은 없나요?,Korean
+결핵 치료받은 지 꽤 되셨어요?,Korean
+숨 쉴 때 통증이 있나요?,Korean
+담배 몇 년째 피우고 계시나요?,Korean
+통증이 어느 부위쯤에 있나요?,Korean
+"다른 건 없고 변비가 좀 있네요.
+",Korean
+병원 입원 경험이 있으신가요?,Korean
+보통 수술 후 일주일 정도가 되면 많이 호전되십니다.,Korean
+네 가족력이 있을 수 있습니다.,Korean
+최근에 백신 접종받은 적 있으세요?,Korean
+혹시 음식이나 약으로 인해 증상이 발병했을 수도 있어서요.,Korean
+진통제 처방해 드릴 테니 드시고 오늘 엑스레이 한 장 찍고 갈게요.,Korean
+교통사고 나서 입원은 했었는데 수술은 안 했어요.,Korean
+유전성 질환으로 고생하는 가족이 계신가요?,Korean
+설사로 배변 횟수가 잦아지셨나요?,Korean
+복부 팽만감이 언제부터 있으셨나요?,Korean
+하부 요관결석의 경우 배뇨통 빈뇨 잔뇨감 하복통 외성기 부위 통증을 유발하기도 합니다.,Korean
+혈뇨가 나오는 시기도 원인을 감별하는데 도움이 됩니다.,Korean
+보호자분은 치료실 왼쪽에 있는 보호자 대기실에서 대기해 주시면 됩니다.,Korean
+입원 치료까지는 필요 없습니다.,Korean
+금식에 잘 협조해 주셔서 감사합니다. 빠른 시간 내에 검사 진행하겠습니다.,Korean
+소화가 잘 안 되는 느낌이세요?,Korean
+변을 보기 위해 화장실을 가는 횟수와 변을 보는 횟수의 차이가 많이 나나요?,Korean
+기형 정도가 심하시진 않아서 상관없을 것 같습니다.,Korean
+언제 처음으로 암 치료를 시작하셨어요?,Korean
+회진 시간은 오후 네 시경입니다.,Korean
+통증 시작 후 얼마나 걸리죠?,Korean
+결핵으로 병원 다니는 곳 있나요?,Korean
+증상이 생긴 날에 특별하게 드신 음식은 없으신가요?,Korean
+영에서 십 중에서 통증 정도를 골라 보세요.,Korean
+"갑자기 다리에 힘이 빠지고 서 있기 어려웠어요.
+",Korean
+투약하고 있는 약이 지금 약이랑 겹칠 수 있어 여쭤보는 겁니다.,Korean
+"수면장애 증상은 딱히 없는 듯해요.
+",Korean
+소변에 염증이 있어서 그럴 수 있으므로 소변검사 확인 후 설명드리겠습니다.,Korean
+소화가 잘 안 되는 느낌이 드나요?,Korean
+소화가 안 되어서 속이 불편해요?,Korean
+"발톱이 안쪽으로 나면서 통증이 심해져서요.
+",Korean
+"입맛이 없고 기운 없이 축 처져요.
+",Korean
+시도 때도 없이 가슴이 벌렁거리나요?,Korean
+수술 준비 들어가셔서 지금은 못 오세요.,Korean
+주로 어떤 음식을 드시면 구토 증상이 나오나요?,Korean
+삼십 분 이전에 변을 보시면 관장의 효과가 떨어지기 때문에 잘 막아주셔야 합니다.,Korean
+소변에 피가 묻어나온걸 보신건가요?,Korean
+복수가 찬 적 있나요?,Korean
+고혈압 판정받으신 지는 얼마나 되셨나요?,Korean
+얼마나 오랫동안 당뇨를 앓고 있었나요?,Korean
+위에 장에서 보이는 상피세포들이 발견되는 현상입니다.,Korean
+흉부에 불편한 곳이 있나요?,Korean
+얼마에 한 번씩 아픔을 느끼시나요?,Korean
+머리가 자꾸 빠져서 탈모약을 처방받아 먹긴 했었어요.,Korean
+맥박은 아까 따로 재셨나요? 어차피 오래 걸리지 않으니 다시 한번 잴게요.,Korean
+"생리를 안 한 지 너무 오래됐어요.
+",Korean
+흡연을 얼마나 오래 하셨나요?,Korean
+네. 우선적으로 수액치료와 필요시 약물 치료로 정상 혈압을 유지할 것입니다.,Korean
+혈압이 평소에 많이 높은가요?,Korean
+한번 아프기 시작하면 통증이 오래 지속되나요?,Korean
+수술한 지 반 년 정도 지났어요.,Korean
+구토를 하면 얼마나 하나요?,Korean
+현재 담배를 피우고 계신건가요?,Korean
+약 이름 생각이 안 나시면 사진으로라도 보여주세요.,Korean
+피부가 패여 들어가서 감염이 발생할 수 있습니다.,Korean
+"심장이 좋지 않아서 그런 거라고 전해 들었어요.
+",Korean
+다쳐서 수술을 받거나 입원치료를 받으신 적 있나요?,Korean
+네 자정 이후에만 금식 유지해 주시면 됩니다.,Korean
+"치아가 많이 썩은 것 같아서요.
+",Korean
+불편함이 있으시면 언제든지 병원으로 연락주세요.,Korean
+병원에서 처방받지 않고 구비해서 드시는 약이 있으신가요?,Korean
+혈압 쪽 진단받은 적이 있나요?,Korean
+어딘가 좀 부었거나 하지는 않으세요?,Korean
+통증이 얼마 동안 지속되나요?,Korean
+종양 앓았던 가족이 있으셨나요?,Korean
+암 질환이 있는 가족이 있으신가요?,Korean
+결핵 치료받은 지는 그동안 얼마나 되었나요?,Korean
+깨질 듯이 머리가 아픈가요?,Korean
+흉부 배액관이 없다면 흉부 내에서 출혈액이나 늑막액이 고여 다른 장기 특히 심장을 압박할 경우 상당히 위험할 수 있습니다.,Korean
+네 수술 가운만 걸쳐주세요.,Korean
+안됩니다. 수액을 통해 수분이 공급되고 있으니 질환 치료를 위해 치료 과정에 잘 따라주세요.,Korean
+아 상반신마취도 있어요? 전 전신마취한 것 같네요.,Korean
+독감 주사 언제 맞았어요?,Korean
+네. 알레르기 약도 먹어요.,Korean
+아이 혼자 병원에 있는 것은 위험하므로 다른 보호자분께서 짐을 챙겨오셔야합니다.,Korean
+간염을 언제 처음 진단받으셨나요?,Korean
+처음 알레르기 반응이 나타난게 언제셨나요?,Korean
+담배는 하루에 얼마나 피우시죠?,Korean
+통증의 강도가 일에서 십으로 봤을 때 어느 정도인가요?,Korean
+붓기가 잘 안 빠지는 곳이 있을까요?,Korean
+열이 나는 증상이 있나요?,Korean
+"오늘 약 먹은 시간과 같아요.
+",Korean
+"사흘 전 항암치료 이후 열이 나요.
+",Korean
+고혈압 관련해서 어떤 약을 드시고 계신가요?,Korean
+결핵이라고 진단받아 본 적 있으신가요?,Korean
+"열이 있어서 그런지 새벽에 자주 깨서 보챕니다.
+",Korean
+몸에 갑자기 열이 나나요?,Korean
+현재 목발을 다른 환자분께서 사용하고 계십니다.,Korean
+지금 위험하진 않은데 열이 지속된다면 위험할 수도 있어요.,Korean
+당뇨병 걸리신 가족이 있나요?,Korean
+아이��� 키 성장뿐만 아니라 다른 발달까지 느릴까 봐 걱정돼요.,Korean
+한 번 마실 때 음주량이 평균 어느 정도입니까?,Korean
+반응테스트 음성으로 나오면 별문제 없을 거예요 드물게 구역질이 날 수는 있습니다.,Korean
+엑스레이보다 씨티가 정확할 때가 더 많을 수 있어요.,Korean
+집안에 고혈압인 분 있나요?,Korean
+음식에 대해서 알레르기 증상이 나타난 적이 있으세요?,Korean
+가족 중에 당뇨가 높아서 약을 드시고 계시는 분이 있나요?,Korean
+퇴원 후 증상이 생기거나 불편한 점이 발생하면 비뇨기과 외래 혹은 응급실로 내원하셔야 합니다.,Korean
+조금 쉬시면 울림은 사라질 거예요.,Korean
+일일구 타고 병원 와서 이동 침대로 옮겨서 들어왔어요.,Korean
+"아랫배 통증이 심하고 계속 설사를 해요.
+",Korean
+우선 환부를 씻어내는 게 우선입니다.,Korean
+야간 근무를 줄이시는 것이 좋겠지만 어렵다면 주기적인 건강검진으로 질병을 예방하려고 노력해야 합니다.,Korean
+약 드시고 알레르기 반응 보인 적 있으세요?,Korean
+사실 강직성 척추염의 명확한 원인은 알려지지 않았습니다. 유전적인 원인이나 외상 세균감염 과로 등의 환경적인 요인이 원인일 수 있습니다.,Korean
+통증을 말로 어떻게 표현할 수 있나요?,Korean
+소변에 피가 섞여 나온 적은 없나요?,Korean
+항생제 주사 맞으신 거죠?,Korean
+결핵 치료는 어떻게 하셨어요?,Korean
+실례지만 하루 흡연량을 알려주실래요?,Korean
+"네. 일부러 챙겨 먹어요. 뼈 튼튼해지라고.
+",Korean
+하루 담배 얼마나 피우세요?,Korean
+약 먹고 알레르기 반응을 일으켰던 적이 없어요.,Korean
+보통 손목 보호대를 착용하고 약물치료를 병행합니다.,Korean
+기침을 했는데 피가 나온 적 있나요?,Korean
+암이라는 걸 언제 알았나요?,Korean
+두통이 계속 지속되고 있나요?,Korean
+올해 예방접종은 아직 안 하셨죠?,Korean
+수혈거부 해도 법적으로 문제없나요?,Korean
+투석을 하려면 투석을 하는 혈관이 필요한데 혈관 확보가 아프실 수 있습니다.,Korean
+통증이 처음 시작된 건 언제인가요?,Korean
+특이 혈액형이 뭐예요? 처음 들어봐요.,Korean
+전에도 식욕부진 증상이 있었나요?,Korean
+가슴이 찌를 듯이 아픈가요?,Korean
+약마다 복용 방법이 다릅니다.,Korean
+언제 어쩌다가 아프기 시작했나요?,Korean
+하루 동안 얼마나 피워요?,Korean
+당뇨 치료받은 기간이 얼마나 됩니까?,Korean
+고혈압약 먹고 혈압이 조금 안정됐나요?,Korean
+주기적으로 드시고 있는 약이 있나요?,Korean
+언제 암 발병했는지 기억하세요?,Korean
+오늘 중으로 약 이름 확인될까요?,Korean
+발기 부전 때문에 비아그라를 복용하신 적 있으세요?,Korean
+최근 한 달 사이에 극심한 체중 변화가 있었나요?,Korean
+소변과 함께 피가 나오나요?,Korean
+직장 내시경은 에스 상 결장까지만 본다는 점에서 대장 내시경과 차이가 있으나 기본적으로는 유사한 검사 방법으로 진행합니다.,Korean
+이번 달에 체중이 얼마나 줄었죠?,Korean
+통증이 느껴지는 부위를 설명해주세요.,Korean
+만성 위염 외 다른 문제는 없어 보이네요.,Korean
+종양 때문에 병원 간 적 있어요?,Korean
+"콘센트 고치다가 전기에 감전되었어요.
+",Korean
+일주일 평균 주량이 얼마나 되나요?,Korean
+한 번 통증이 올 때 얼마나 지속되나요?,Korean
+당뇨약 어떤 거 드시는지 말씀해주실 수 있나요?,Korean
+최근에 몸무게가 얼마나 줄었나요?,Korean
+어디가 아픈지 진단이 돼야 처방이 가능합니다.,Korean
+물만 마셔도 구토 증상이 오나요?,Korean
+수술한지 얼마 지나지 않아 아직까지 통증이 있을 수 있어요.,Korean
+하루 동안 대변을 못 보실 때가 있나요?,Korean
+설사하는 이유가 따로 있으신가요?,Korean
+변을 볼 때 피가 섞여 나오나요?,Korean
+환자분이 수술하시는 이유는 둔위 때문입니다.,Korean
+혈압이 높게 나오는 편인가요?,Korean
+알레르기가 나서 먹으면 안 되는 음식이 있나요?,Korean
+배의 어느 부위가 아프세요?,Korean
+내원하시게 된 이유가 무엇인가요?,Korean