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青岛无痛人流哪里能做妙手诊疗青岛无痛人流一般多少钱

来源:安心社区    发布时间:2019年08月20日 18:14:05    编辑:admin         

For the first time since statins have been regularly used, a large study has found that another type of cholesterol-lowering drug can protect people from heart attacks and strokes.自从他汀类成为常规药物以来,专家首次在一项大规模研究中发现,另一种降胆固醇的药物,也可以预防心肌梗死和脑卒中。The finding can help millions at high risk of heart attacks who cannot tolerate statins or do not respond to them sufficiently. And it helps clarify the role of LDL cholesterol, the dangerous form. Some had argued that statins reduced heart attack risk not just by lowering LDL levels but also by reducing inflammation. The new study indicates that the crucial factor is LDL, and the lower, the better.无数患者可能会从该发现中受益。这些人心肌梗死的风险较高,但又不能耐受他汀,或者摄入他汀的效果不明显。这一发现还有助于研究者进一步认识危险的低密度脂蛋白(LDL)胆固醇的作用。一些人认为,他汀类药物之所以能减少心肌梗死的风险,是因为它不仅降低了LDL水平,而且还减少了炎症。而这项新的研究表明,LDL才是关键因素,并且它的水平越低越好。The six year study, reported Monday at the annual meeting of the American Heart Association, involved 18,000 people who had had heart attacks or episodes of chest pain so severe they went to a hospital. They were randomly assigned to take a statin or a combination of a statin and the alternative drug to further reduce LDL levels. Both groups ended up with very low LDL levels – those taking the statin, simvastatin, had an average LDL of 69, and those taking simvastatin and the other drug, ezetimibe, or Zetia, in a combination pill sold as Vytorin, had an average LDL of 54. No clinical trial had ever asked what happened when LDL levels get below 70 because, said Dr. Robert Califf, a Duke cardiologist and the study chairman, ;many people were nervous about going this low and imagined a lot of possible toxicities.;本周一,相关研究人员在美国心脏协会(American Heart Association)的年会上做了报告。这项研究耗时六年,涵盖1.8万名患者。他们均曾经历过心肌梗死,或者严重到需要到医院就诊的胸痛发作。研究人员随机向他们分配了他汀,或者他汀和替代药物组成的复方药,以便进一步降低他们的LDL水平。结果两组患者的LDL都减至非常低的水平——用他汀类药物辛伐他汀的患者,LDL的平均水平为69,而用复方药的患者,LDL的平均水平为54。该复方药的商品名为葆至能(Vytorin),由辛伐他汀和依折麦布组成,而后者又称为艾泽庭(Zetia)。这项研究的主管、杜克大学的心脏病学家罗伯特·卡里夫(Robert Califf)士说,之前没人通过临床试验来研究LDL水平低于70时会发生什么状况,因为“LDL降到这么低的水平令很多人感到紧张,觉得可能会产生很多坏处。”Statins lower LDL by preventing it from being made. Ezetimibe lowers LDL by preventing cholesterol from being absorbed in the gut.他汀降低LDL的方式是防止它生成,而依折麦布降低LDL的方式是防止肠道吸收胆固醇。The drugs were so effective that there were few cardiac events among the participants but eventually a difference emerged: 6.4 percent fewer heart disease deaths, heart attacks, strokes, bypass surgery, stent insertion and severe chest pain leading to hospitalization in those assigned to take Vytorin. The amount corresponded to what was predicted from the extra degree of cholesterol lowering with the combination drug.两种药物均非常有效,参与实验的患者出现心血管意外的次数不多,但差别最终浮现了出来:在心脏疾病死亡、心肌梗死、脑卒中、搭桥手术、架置入和导致住院的严重胸痛方面,摄入葆至能的患者相对低6.4%。考虑到葆至能可以把胆固醇水平降得更低,据此预测的水平与以上实验数据相符。Those results translate into 2,742 events in those taking simvastatin and 2,572 in those taking the combination drug. That means, said Dr. Christopher Cannon, a principal investigator and cardiologist at Brigham and Women’s Hospital, that two out of every 100 people who would have had a heart attack or stroke by taking the statin avoided those outcomes by taking the combination drug.这些结果对应的数据是,用辛伐他汀的患者中出现了2742次心血管意外,而用葆至能的患者中有2572次。布莱根妇女医院(Brigham and Women’s Hospital)的首席研究员、心脏病学专家克里斯托弗·坎农(Christopher Cannon)士说,这意味着,在100个用了他汀但仍会心肌梗死或中风的患者,如果用的是复方药,本来应该可以避免2例这种情况。And, adds Dr. Califf, the study found absolutely no side effects from ezetimibe — no excess cancer, no muscle aches no headaches. “It looks like placebo,” he said.卡里夫士称,该研究还发现,依折麦布完全没有副作用——不会增加罹患癌症的风险,不会造成肌肉酸痛或头痛。“看上去就像安慰剂,”他说。The study was sponsored by Merck, the maker of Vytorin, but the investigators had the right to publish what they wanted, with final say over what they wrote.这项研究由葆至能的生产商默克公司(Merck)赞助,但研究人员有权按照自己的意愿来发布内容,对报告的撰写拥有最后决定权。“Fantastic,” said Dr. Sekar Kathiresan of the Broad Institute and Massachusetts General Hospital who studies the genetics of heart disease but had no part in the study. “A truly spectacular result for patients.”“这项研究太棒了,对于患者来说,这是一大福音,”在德研究所(Broad Institute)和马萨诸塞州综合医院(Massachusetts General Hospital)研究心脏疾病基因的谢卡尔·卡斯瑞斯安(Sekar Kathiresan)士说。他本人并未参与这项研究。Dr. Harlan M. Krumholz, a Yale cardiologist not associated with the study, said he wished there was a peer-reviewed journal article instead of a presentation of the results at a meeting — the data analysis was completed just last week — but, assuming the result holds up, “this is the result we were hoping for.”耶鲁大学心脏病学专家哈伦·M·克鲁姆霍尔茨(Harlan M. Krumholz)士也没有参与该研究。他表示,希望这项成果以同行评议的期刊文章方式发表,而不是在会议上做演示——研究的数据分析上周刚刚完成——但是,假设这个结果经得起推敲,“这会是我们希望看到的结果。”At the same time, and by sheer coincidence, two other groups of researchers reported genetic studies that supported the trial’s conclusions. One, led by Dr. Brian A. Ference of Wayne State University School of Medicine found that gene mutations mimicking the effect of ezetimibe and ones mimicking the effect of statins had the same effect on heart disease risk for a given reduction in cholesterol. The implication, he said, is that “lowering cholesterol with ezetimibe, or a statin, or both, should each lower the risk of heart disease by about the same amount.”纯属巧合的是,另外两个研究团队也在同时发布了遗传学领域的成果,持了该临床研究的结论。其中一个团队由韦恩州立大学(Wayne State University)医学院的布莱恩·A·费伦斯(Brian A. Ference)领导。他们发现,对于给定的胆固醇减少量,模仿依折麦布效果的基因突变,和模仿他汀效果的突变,对心脏疾病风险产生了相同的效果。这意味着,“用依折麦布降低胆固醇,或者用他汀,或两者都用,应该都可以同等程度地降低心脏疾病风险,”他说。The other, led by Dr. Kathiresan, examined mutations that disabled one copy of the cholesterol absorption gene, producing the same effect as ezetimibe. The result was a 50 percent reduction in cholesterol absorption — the same as produced by ezetimibe — and an LDL reduction of 12 milligrams per deciliter of blood, also the same amount as produced by ezetimibe. The mutation, which gave people the equivalent of a lifelong exposure to ezetimibe, reduced the heart attack rate by 50 percent.另外一个团队则在卡斯瑞斯安士的领导下,研究了让一个胆固醇吸收基因拷贝无法发挥作用的突变,获得了和使用依折麦布相同的效果。他们的结论是,胆固醇吸收量减少了50%——与依折麦布效果相同——每100豪升血液的LDL降低了12毫克,也与依折麦布的效果相同。这个突变相当于终生摄入依折麦布,可让心肌梗死几率降低50%。The study’s results are making many wonder about the latest cholesterol guidelines, which did not mention any drug other than a statin. And instead of providing goals for cholesterol levels, they simply advised those at high risk to take a statin. Period.得知这项研究的结果后,很多人对最新的胆固醇指南产生了困惑。文中没有提及他汀之外的任何药物,也没有提供胆固醇水平的目标值,只是劝高风险人群摄入他汀。别无其他。“The guidelines didn’t say they didn’t believe in cholesterol, but they made it clear that the evidence is for a statin, not for any agent that lowers cholesterol,” said Dr. Eugene Braunwald, a study chairman who is a cardiologist at Brigham and Women’s and a longtime leader in the field.“指南没有说他们不相信胆固醇的作用,但他们明确表示,相关据只涉及他汀,不涉及其他降胆固醇的药物,”该领域长期以来的领军人物尤金·布朗瓦德(Eugene Braunwald)士说。他是一个研究会的主席,也是布莱根妇女医院的心脏病学专家。Dr. Neil Stone, the head of the guidelines committee and a cardiologist at Northwestern University, has a more nuanced view of what the guidelines say, but adds that the study result “gives doctors another option if they have a patient who can’t tolerate a high-intensity statin.”西北大学(Northwestern University)心脏病学专家尼尔·斯通(Neil Stone)士是胆固醇指南委员会的主管。对于指南内容的含义,他认为比布朗瓦德的说法更为微妙。但他也表示,“如果遇到无法耐受大剂量他汀的患者”,这项研究结果“给医生提供了另一个选择”。 /201411/343584。

Low-risk pregnancy cases are being urged to avoid hospital birth under new NHS guidelines Photograph: Katie Collins/PA根据英国国家医疗务体系指引,低风险妇敦促避免住院分娩Women with low-risk pregnancies are to be encouraged to have non-hospital births under new NHS guidelines, which could see almost half of mothers-to-be planning to deliver their baby away from traditional labour wards.根据新的NHS指引,鼓励低风险妇不在医院分娩,这就意味着半数左右的准妈妈们将不在传统的产房分娩。Guidance from National Institute for Health and Care Excellence (Nice) says that midwife-led care has been shown to be safer for women and recommends that all women with low-risk pregnancies – 45% of the total – should be advised that giving birth in a midwifery-led unit, whether attached to a hospital or not, is “particularly suitable”.Nice(国家临床医学研究所)指引表明由助产士护理更安全,建议那些占总数45%的低风险妇在助产士机构分娩是极为妥当的,无论这些助产士机构是否附属于医院。The changes, published on Wednesday , have been made because women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and use of forceps or ventouse.星期三发布了新的指引,由于在助产士的护理下分娩的女性,被询问实施诸如会阴切开术,剖腹产,产钳产以及吸引产的医疗干预的机会较少。Susan Bewley, professor of complex obstetrics at King#39;s College, London, and chair of the Nice advisory group, added that infections were more common on hospital wards.伦敦国王学院综合妇产科教授兼国家临床医学研究所咨询小组主席Susan Bewley补充道,感染在医院病房更常见。;We#39;re supporting an individual calm conversation about what is right for each individual in her circumstances,; Bewley said. ;They may choose any birth setting and they should be supported in those choices as that#39;s their right.;我们持那些根据自己的情况做出适合她们的选择。Bewley说道,应该持她们选择分娩环境的权力。The NHS body also advised midwives not to clamp and cut a baby#39;s umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.NHS还建议在没有并发症的情况下,助产士应在一分钟以上五分钟内剪断婴儿的脐带。The announcement reverses decades of NHS policy and its own advice from 2007 recommending ;early clamping and cutting of the cord;.这条指引的宣布颠覆了数十年来的NHS制度以及2007年推崇尽早剪断脐带的建议。Research suggests that early clamping and cutting may leave newborn babies deprived of vital blood from the placenta, risking anaemia.研究表明尽早剪断脐带会使新生儿过早失去胎盘血,导致有贫血的风险。In separate guidance on postnatal care, Nice said parents should also be informed about the association between falling asleep with their baby on a bed, sofa or chair and sudden infant death syndrome until the baby is 12 months old.关于产后护理的指引,NICE指出父母应知晓在婴儿满12个月之前,和婴儿同睡与婴儿猝死综合征之间有关联。The change represents another significant change to the guidelines, issued in 2006, which only applied to babies up to the age of six to eight weeks. Parents should also be informed that the association may be greater if parents use drugs or have recently drunk alcohol, or if the baby was of low birth weight or premature. 这项新的指引对2006年公布的适用于6-8周大的婴儿身上的指引作出了显著的修改。应告知父母,在期药或饮酒,还有婴儿出生时体重过轻,早产和婴儿猝死综合征的联系更大。Nine out of 10 of the 700,000 babies born in England and Wales each year are currently delivered in hospital under the supervision of obstetricians. Nice added that commissioners should ensure that women have all four possible options for giving birth available to them: hospital care, midwifery units in hospitals, midwifery units based in the community and at home.每年有700,000的婴儿在英格兰和威尔士出生,其中90%的婴儿在产科医生的监护下出生。NICE补充道 应确保女性有四种分娩环境的选择,即选择在医院,医院附属助产士机构,社区助产士机构以及在家中分娩。Professor Mark Baker, Nice#39;s clinical practice director, said: ;It#39;s very difficult to explain why this is happening but the closer you are to hospital, and indeed if you are in hospital, the more likely you are to receive hospital care and surgical interventions.;Nice临床实践主任Mark Baker教授说道“离医院越近以及已入院,接受医院护理以及外科手术的可能就更大,很难解释为什么会这样。”;Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies.;因为外科手术费用昂贵,当产妇在可控范围内分娩健康宝宝时,助产士护理会物超所值。The outcome for the baby is the same in different settings except in the case of first-time mothers giving birth at home, where there is a ;small increase; in risk of serious complications – nine in every 1,000 compared with five in every 1,000 in the other settings – which the guidance says mothers should be advised about. Home births are the cheapest, followed by midwife-led units and then hospitals but Bewley said costs did not come into the equation.在不同环境分娩婴儿结果是相同的,但不包括初产妇在家分娩,因为会有小部分人有严重的并发症-千分之九的概率,而在其他环境分娩的概率为千分之五- 在家分娩花费最少,其次是助产士机构,医院花费最多,但是Bewley说费用不是作出选择的关键。Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: ;For low-risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.;皇家助产士学会首席执行官Cathy Warwick说:对低风险妇来说,在助产士机构或在家分娩是安全的,减少医疗干预。“We hope this will focus commissioners#39; and providers#39; of maternity services attention on ensuring that women have a real choice about where they give birth.”我们希望这会使妇产科机构的管理层关注于确保女性能选择适合他们分娩的环境。The RCM has been campaigning for about 5,000 extra midwives to be recruited. Warwick said the new guidance would not stretch existing medical staff further but ensure they were better employed, as more women would have births without interventions, which require more resources.RCM正致力于再招收5000名助产士。Warwick说:在新的指引中,现有的医务人员不再扩增,但会被安排在更合适的岗位,因为更多的女性将在没有医疗干预的环境中分娩,这将需要更多的资源。Elizabeth Duff, senior policy adviser for the NCT (National Childbirth Trust), welcomed the advice and urged the NHS to ;put these guidelines into practice as soon as possible and make home and community birth, a real, not just theoretical, option;.国家剩余信托基金会高级策略顾问Elizabeth Duff对这个指引表示欢迎并敦促NHS尽早将指引落实,在家和社区分娩将会是个真实的选择而不光是理论的。Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently. For women not giving birth for the first time they also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.相对医院来说,在社区助产士机构中医疗干预和转到产科病房发生率较低,但是最近很多社区助产士机构已经关闭。比起那些打算在家分娩的妇来说,经产妇转移到产科病房的发生率更低。 /201412/347641。

There is something ofa misconception that all the good things in life are bad for us while all thebad things are too good to resist long term.人们有种误解,好像良药总是苦口,什么东西越是让人喜欢,就越是有害。Dieters#39; meals inparticular are renowned for being insipid and bland, so we tend to eat them fora while then indulge in sugar and fat- laden treats.减肥餐就是这样一个典型,大家总是认为减肥食品肯定寡淡无味,所以往往吃不了几天,就又回到大糖大油狂嚼的生活中了……But food that is good for you does not have to be dull and tasteless if you follow the advice ofLorraine Clissold in Why the Chinese Don#39;t Count Calories– in fact, the diet that she discovered after 10 years of living and working inChina is so tasty and satisfying that it puts an end to cravings for junk food.不过,对你身体有好处事物也不一定就那么难吃。洛林·克里索德是一位在中国生活并工作了10年的作者,在其著作《中国人为什么不计算卡路里》一书中,洛林列举了健康美味的中国菜,足以让你从此告别对垃圾食品的渴望。It is the use of five flavours that makes the real Chinese diet so delicious and nourishing. Sour,bitter, sweet, spicy and salty, will sometimes be found in a single recipe butmore often in the combinati、on of dishes thatmake up a Chinese meal.中国菜之美味,在于运用酸甜苦辣咸五味,这五味有时能同时融合到一张菜谱上,不过更常见的还是以各式菜肴的形式组合成一套大餐。After eating five flavours you will find yourself comfortably full. Chinese dietary therapy(which is a branch of Chinese medicine) explains that the five flavours keepthe five different organs (the liver, heart, stomach, lungs and kidneys) in thebody in balance.食此五味,定会让你感到心满意足。作为中医的一个分,中国的食疗认为这五味能够帮你体内五个器官(肝、心、胃、肺、肾)处于平衡的状态。Our Western diet, onthe other hand, is based on sweet and bland flavours, which feed the stomach atthe expense of other organs, with disastrous results.而我们西方的菜肴用糖居多,调味寡淡,胃中饱足却让其他脏器受损,最后大大不利于身体。It is easier to incorporate five flavours in your diet than you might think. The most difficult to find isbitter (which is why most medicines are bitter) but Chinese people drink plentyof green tea as for their bitter fix, especially in the summer when it isparticularly important to eat bitter foods.如何在饮食中包含这五味呢?其实没有你想象的那么难。其中苦味是最难得的(这也就是为什么大多数药物都是苦的),而中国人常饮绿茶,夏天饮茶尤多,此时吃“苦”尤为重要,而茶就为他们补上了“苦”之一味。In China, people avoid cold drinks and raw food, because they believe they are hard to digestand can lead to something known as dampness in the body which makes itdifficult to shift unwanted weight. In the stifling West of China (Sichuanprovince) the diet is based on spicy food to keep the body in tune with theclimate. If you do choose salads for summer eating, then be sure to dress themwith a spicy dressing (see Romaine lettuce with sesame sauce) as these createthe fire needed to digest them.在中国,人们会避免喝冷水、吃生食,因为中国人认为这些东西不好消化,会令身体积累湿气,让体重居高不下。在中国潮湿闷热的西部省份四川,为了与当地气候协调,当地饮食以辣味居多。如果你想在夏天吃些沙拉,可以试着加一些辛香作为调味(比如油麦菜拌麻酱),这样这种搭配就能产生“火”以便消化食物。Try these simple but flavour some recipes as part of your summer eating plan. They are all deliciousenough to be eaten alone, with rice or homemade b, or serve them as part ofa Chinese style multi-course meal or to accompany Western dishes.让我们来试做一下这些简单美味,适用在夏季食用的菜肴吧,他们不仅可以单独吃,配上米饭或是自制面包,乃至与其他中餐或西餐搭配也十分美味。Rice noodles with chilli and prawns辣味大虾米线In China ;soup noodles; are actually more popular than the stir-fried variety and areparticular favourites in the summer months.在中国“汤面”甚至比各种炒菜还流行,在夏季尤其受人青睐。This recipe looks complicated but is really just a case of throwing everything in the pan (oreven better – use a wok). You can vary the amounts of the different ingredientsin this recipe if you prefer some to others. These quantities will provide ahearty meal for two or a starter or side dish for four.这道菜看上去复杂,但实际上只要把各种材料往平底锅里一倒(如果有条件的话最好用中式炒菜锅)就行了。你也可以根据个人喜好对原材料进行一些调整。下面这些是按照两个人的量定的,也可以当做四个人吃饭时的配菜前菜。6 Chinese dried mushrooms(Shitake) – soaked overnight6个中国干蘑菇(香菇),泡发一整晚2 spring onions –finely chopped2勺小葱,切末1 red chilli –deseeded, halved and sliced thinly1根红辣椒,去籽剖开切成薄片1 cm piece knob ofginger – finely chopped姜切成1厘米的薄片250g raw prawns250克的生虾250g butter nut squash– peeled, sliced and cut into 2 cm pieces250克的奶油南瓜,去皮切成2厘米大小的片8 asparagus tips8根芦笋150g beansprouts150克豆芽1 litre water orlight fish or vegetable stock1升水或高汤200 ml coconut milk200毫升椰奶2 tsp palm or brown sugar or honey2茶勺香椰糖或红糖或蜂蜜1 tbsp fish sauce1茶勺鱼露1 tbsp lemon or limejuice1茶勺柠檬汁或酸橙汁100 g dried ricestick noodles or 300g fresh100克干米线,或是300克新鲜米线1 tbsp oil forstir-frying1茶勺油If you are using dried rice noodles, place them in a heatproof bowl, pour over boiling water and leave for about five minutes until they are just tender, then drain before theygo too soft.如果你用的是干米线,请把米线放到耐热的碗里,倒上滚水,放置五分钟让它自然泡开,然后在面条软过头之前捞出来沥干。Heat a pan or wok,add the oil, and when it is hot throw in the spring onions, chilli, ginger and mushrooms.把锅烧热,倒油,油热后倒入小葱、辣椒、姜和香菇。Stir briefly to let them change colour but not burn, add the fish sauce, water or stock and coconut milk.简单翻炒一下,变色后加入鱼露、水或高汤,还有椰奶。Bring to the boil then add the butter nut squash slices, simmer for a few minutes then add the prawns and asparagus, followed by the noodles and bean sprouts. Stir in thesugar or honey and lime juice, mix well, and taste adjusting seasonings ifliked.汤料煮沸后放入南瓜片,炖上几分钟后加入虾和芦笋,然后放入面条和豆芽。如果你喜欢的话,还可以加入红糖、蜂蜜和柠檬汁搅拌均匀,或是加入你喜欢的调味品。As soon as the prawns are pink, the asparagus is bright green and the beansprouts begin to wilt, thesoup is y to serve.虾变成浅红,笋变成亮绿,豆芽变软的时候,汤就做好了。Do not over cook as the rice noodles will break up.注意掌握火候,不要煮过头把面条煮烂。Garnish with chopped fresh coriander.还可撒上一些切碎的新鲜香菜作为配料。Romaine lettuce withsesame sauce麻酱拌油麦菜Salad is not atraditional Chinese food; modern chefs will occasionally include it on a but only if accompanied by a suitably spicy dressing. This sauce can also beused to top poached chicken mixed with spring onions, or cold noodles mixedwith shredded blanched vegetable.沙拉并不是传统中国食物,但现代厨师有时也会做一做沙拉,并配上适当的辣味增色。这种酱也会用来和小葱一起浇到清蒸鸡肉上,或是和焯过切碎的蔬菜拌冷面吃。For the salad制作沙拉所用材料:Two heads romainelettuce2颗油麦菜4-5 cloves garlic(authentic but not absolutely necessary)4-5瓣大蒜(正宗做法是这样的但是不加也可以)100g raw peanuts(Alternatively use roasted unsalted peanuts or even lightly toasted pine nuts)100克生花生(或者也可以用烤过的新鲜花生,甚至是被稍微烤过的松子)1 piece Star Anise1片八角茴香1 teaspoon of Sichuan peppercorns1茶勺花椒tsp salt盐For the sauce制作酱料所用材料:3 tsp. chilli oil3茶勺辣椒油2 tsp. Chinese black vinegar (or use Balsamic)2茶勺中国黑醋(意大利香醋也行)2 tsp. sugar2茶勺糖1 tbsp. soy sauce1茶勺酱油1 tbsp. sesame oil1茶勺芝麻油1 tbsp smooth peanut butter1茶勺花生酱2 tbsp. dark sesame paste (tahini)2茶勺黑芝麻酱(中东芝麻酱也行)2-3 tbsp. water2-3茶勺水Soak the raw peanutsovernight then place in a small saucepan with enough water to cover, adding thespices and salt. Bring to the boil and simmer for 20 minutes or until the nutsare soft. Drain and remove the spices. Slice the garlic.生花生泡水一晚,放到小锅内,倒入足够量的水,加入各种调料和盐。水烧开后煮20分钟直到花生变软,沥干捞出调味料。大蒜切片。Wash the lettuce,drain well and chop into 2cm pieces. Place in a bowl with the nuts and garlicslices. To make the sauce mix together the chilli oil, the vinegar, the sugar,the soy sauce, and the sesame oil; stir until the sugar is dissolved. Usechopsticks to stir in the sesame paste and peanut butter, gradually add thewater, stopping when the sauce has reached the consistency you desire. Mix thesauce into the lettuce, nuts and garlic and transfer into a clean dish for thetable. Serves four.洗干净油麦菜,但不要沾水,切成2厘米宽,放到碗里,加入花生和大蒜片。把上面辣椒油、醋、糖、酱油、香油这些搅拌均匀,让糖充分溶解。用筷子搅拌芝麻酱和花生酱,缓缓倒入水,稀释程度看你个人喜好。将酱料拌入油麦菜、花生和大蒜,最后装盘上桌。可以让4个人分享哟。Hot, sweet and sourchicory酸甜辣菊苣Chicory is now widelyavailable in Western supermarkets. The beauty of this recipe is that itcomplements the bitter flavour of the leaves with four other flavours. Twoheads will feed two people with other dishes and you can double the quantitieswithout overcrowding the wok.菊苣如今在西方超市也相当多见了。这道菜的美妙之处在于叶子的苦味与其他四味的组合,堪称五味俱全。两颗的话足够作为配菜让两个人吃,不过你加量的话照样可以做,不用担心锅装不下。Two heads of chicory2颗菊苣1-2 pieces dried red chilli1-2片干红辣椒1 tsp. minced ginger1茶勺姜末1 tsp. minced spring onion1茶勺葱末1 tsp. light soy sauce1茶勺生抽1 tsp. vinegar1茶勺醋1 tsp. sugar or honey1茶勺糖或蜂蜜pinch salt or to taste按口味加少量盐1-2 tbsp. of groundnut oil1-2茶勺花生油Quarter the chicoryvertically. Then chop the long pieces horizon tally to create small squarepieces of roughly even size. Heat the wok, add the oil and heat until the oiljust starts to move. Throw in the chillies and let them sizzle but not burn,stirring briefly.把菊苣竖着切成四分,然后横着切成大小基本一致,烧热锅,倒入油烧热,加入辣椒,简单翻炒一下,炒的发出嘶嘶声时即可。Add the chicory,ginger and spring onion. Toss and fry, keeping the pieces moving so that theycook quickly and evenly. Then, as the leaves start to soften, add the vinegarand sugar/honey and stir-fry for another minute. Add the soy sauce and thesalt, stir, and fry for another minute or so. Test for seasoning and adjust if necessary.加入菊苣、姜末和葱末。不断翻炒让它们受热均匀,等叶片变软后加入糖和醋,然后煸炒个几分钟。再加入酱油、盐,继续翻炒个几分钟。尝一尝感觉味道合适即可。 /201501/353367。

MOSCOW — After a law went into effect last summer banning obscenities in public performances, the playwright and director Ivan Vyrypaev excised the curse words from one of his plays, “The Drunks,” for its Russian debut at the prestigious Moscow Art Theater. Some actors played the new version straight, he said, while others winked to make clear what was cut.莫斯科——去年夏天,俄罗斯开始实施一项禁止公共表演中出现脏话的法律。为了自己的剧作《酒鬼》(The Drunks)能在著名的莫斯科艺术剧院举行俄罗斯首演,编剧兼导演伊万·维里帕夫(Ivan Vyrypaev)也删除了剧中的脏话。他说,新版本上演时,有些演员不动声色,也有些演员在脏话被删除的地方挤眼示意。A quiet man of 40, Mr. Vyrypaev was circumspect about the law. “Of course my plays lost something, but my artistic life hasn’t been ruined,” he said in an interview, adding that he also had to pull three plays by other playwrights from the Praktika Theater here, where he is artistic director.40岁的维里帕夫生性温和,他对这项法律极为慎重。“当然,我的剧本失去了某种味道,但我的艺术生命还没被毁掉,”他在采访中说。维里帕夫是莫斯科普拉克提卡剧院(Praktika Theater)的艺术总监。他补充说,他还不得不撤掉该剧院其他编剧创作的三部话剧。Later, Mr. Vyrypaev said, Praktika presented other plays with curse words after President Vladimir V. Putin said in a meeting with writers that while Tolstoy and Chekhov didn’t need cursing, “You, the writers, know best.”维里帕夫说,弗拉基米尔·V·普京总统(Vladimir V. Putin)在一次与编剧的座谈会上说,托尔斯泰和契诃夫不需要使用脏话,“你们这些编剧最了解这一点”。不过,在那之后,普拉克提卡剧院还是上演了其他一些含有脏话的剧目。The advance and retreat was telling. Cultural figures in Russia today describe a climate of confusion and anxiety in which the law banning obscenities, as well as a 2013 law that criminalizes acts offending religious believers, are often ignored unless someone wants them applied. Critics say the new laws are stifling free expression and pulling the country backward.这种时进时退的做法很说明问题。俄罗斯的文化名人们认为当前的文化气候令人困惑和忧虑。2013年,俄罗斯一项法律宣布冒犯宗教信徒的行为属于违法,然而这项法律以及这项禁止使用脏话的法律经常被民众忽视,除非有人想要执行。批评者认为,这些新法律扼杀自由言论,导致国家走向倒退。During Soviet times, “At least we knew the rules,” said Irina Prokhorova, a publisher and vocal critic of the government. “This is a little bit different, because there are no rules, no official censorship.” Ms. Prokhorova likened the climate to the 1930s, when the Nazis labeled art degenerate. “This is aesthetic fundamentalism,” she said. The law on religious believers is particularly slippery. “Who are those believers? What do they believe in? No one talks about this,” she added.出版人伊琳娜·普罗霍罗娃(Irina Prokhorova)经常直言不讳地批评政府。她说,在苏联时期,“至少我们知道有哪些规定”,“现在这种情况有点不同,因为没有规定,没有官方审查”。普罗霍罗娃把目前的文化气候比作20世纪30年代,当时纳粹认为艺术是堕落的。“这是审美上的原教旨主义,”她说。她补充说,关于宗教信徒的那项法律尤其模糊。“那些信徒是谁?他们信奉的是什么?没人说明这些。”This week, a debate has been raging after it emerged on Sunday that Russia’s culture minister had ousted the director of a state-run theater in Siberia on the grounds that a production of Wagner’s “Tannh#228;user,” with a backdrop in which an image of Christ was placed in the crotch of a naked woman, had run afoul of the law against offending religious believers — even after a judge last month dropped the case as groundless.周日,俄罗斯文化部长罢黜了西伯利亚一个国营剧院的经理,理由是该剧院排演的瓦格纳(Wagner)作品《唐怀瑟》(Tannh#228;user)的布景将耶稣形象放在一个裸体女人的胯部。文化部长认为这冒犯了宗教信徒,触犯了法律。不过上个月,一位法官判定该案理由不足。该案引发热烈争论。Russia has a thriving theater scene and a constitution that bans top-down, Soviet-style censorship. But in a time of economic turmoil and growing nationalism, with society polarized in unpredictable and emotional ways over the new laws and the war in Ukraine, cultural figures say the message from the government is clear: Fall in line with the emphasis on family and religious values, or lose funding, or worse.俄罗斯的舞台艺术蓬勃发展,宪法禁止自上而下的苏联式审查制度。但是如今俄罗斯经济动荡,民族主义情绪高涨。面对新法律和乌克兰战争,整个社会出现不可预料的分化情绪。文化名人们说,政府的信号很明确:文化界要与政府强调家庭和宗教价值观的政策保持一致,否则会失去资金持,甚至遇到更糟的状况。“It’s about betrayal — those who betray are put in the Ninth Circle of Hell, like in Dante,” Kirill Serebrennikov, a prominent theater and film director and the director of the Gogol Center, a cornerstone of Moscow’s theater scene, said in a recent interview here. The result, he said, was to put writers and directors “between Scylla and Charybdis — between censorship or self-censorship.”“这其实是在惩罚背叛,就像但丁(Dante)的《神曲》那样,背叛者被打入第九层地狱,”著名戏剧和电影导演、果戈里中心(Gogol Center)主管、莫斯科戏剧界巨擘基里尔·谢列布连尼科夫(Kirill Serebrennikov)前不久在莫斯科接受采访时说。他说,结果是将剧作家和导演们置于“腹背受敌的境地,既要接受审查,又要自我审查”。That day, Mr. Serebrennikov was puzzling over a report in Izvestia, a newspaper seen as close to the Kremlin, that scholars from a research institute were evaluating whether recent theater productions had “distorted” classic Russian texts. They included his production of Gogol’s “Dead Souls” at the Gogol Center and productions of “Boris Godunov” and “The Karamazovs,” based on the Dostoyevsky novel, both mounted by the popular director Konstantin Bogomolov at other theaters.接受采访当天,谢列布连尼科夫正为《消息报》(Izvestia,该报被认为与政府关系密切)上的一则报道感到迷惑:一家研究机构的学者们正在评估近期的上演的戏剧是否“歪曲”了俄罗斯经典文学著作。遭到评估的作品包括谢列布连尼科夫在果戈里中心排演的果戈里《死魂灵》(Dead Souls),以及著名导演康斯坦丁·戈莫洛夫(Konstantin Bogomolov在其他剧院排演的《鲍里斯·戈杜诺夫》(Boris Godunov)和根据陀思妥耶夫斯基(Dostoyevsky)的同名小说改编的《卡拉马佐夫兄弟》(The Karamazovs) 。“The goal is to show us that we can’t interpret classical Russian literature at all, or to say that it’s not Russian literature, it’s Kirill Serebrennikov’s fantasy,” Mr. Serebrennikov said. He added that if theaters were to lose public funding, they would be unlikely to find it from private sources.“这项研究的目的是向我们表明,我们完全不能阐释经典俄罗斯文学,或者是说这些作品不是俄罗斯文学,而是基里尔·谢列布连尼科夫的幻想,”谢列布连尼科夫说。他补充说,如果剧院失去公共资金持,也不可能得到私人资助。In an interview last month in his office here, Vladimir Medinsky, Russia’s culture minister, said it was the prerogative of experts at the research institute to look into Russian culture, such as the plays in question. “Maybe, that’s their right to do this,” Mr. Medinsky said. But he said the academics’ findings wouldn’t have repercussions for the theaters.上个月,俄罗斯文化部长弗拉基米尔·梅金斯基(Vladimir Medinsky)在自己的办公室接受采访时说,那所研究院的专家们有天然的权利研究俄罗斯文化,包括大家讨论的这些戏剧。“也许那是他们的权利,”梅金斯基说。不过,他说学者们的发现不会对剧院造成影响。Holding a mobile phone whose case had a picture of Mr. Putin in sunglasses and a camouflage parka above the pop song lyrics “they can’t catch us,” Mr. Medinsky dismissed criticism that the ministry was effectively stifling free expression by funding only projects that it believes meet family- and religious-values standards or that portray Putin’s Russia in a positive light.当时梅金斯基手上拿着一部手机,外壳上印有普京戴墨镜、穿迷大衣的照片,下面还有一句流行歌曲歌词“他们抓不到我们”。有人批评说,文化部只资助那些它认为符合家庭和宗教价值观标准、或者正面歌颂普京统治下的俄罗斯的项目,因此严重扼制了自由言论。梅金斯基否定了这种批评。“The less they spend their life on Facebook, the less garbage they will have in their heads,” he said of government critics. (Anti-government dissent has been concentrated on social media after the Duma passed a law in 2012 restricting public rallies.)“他们在Facebook上花的时间越少,头脑中的垃圾就越少,”在提到政府批评者时,他这样说(从2012年俄议会下院杜马通过了限制公开集会的法律后,反政府异见主要集中出现在社交媒体上)。In the interview, which took place before he ousted the Siberian theater director, Mr. Medinsky was aly highly critical of the “Tannh#228;user” production. It played four performances to sold-out houses of 1,700 at the Novosibirsk State Academic Opera and Ballet Theater before representatives of the local Russian Orthodox Church complained in February.接受采访时,梅金斯基尚未罢黜西伯利亚剧院经理,不过对《唐怀瑟》演出非常不满。该剧在新西伯利亚国家学术剧院(Novosibirsk State Academic Opera)和芭蕾舞剧院(Ballet Theater)共演出四场,场场满座,共有1700名观众观看了演出。2月份,当地的俄罗斯东正教教会代表提出抗议。This week, Mr. Medinsky replaced the theater’s director with a loyalist, Vladimir Kekhman, who said he would remove “Tannh#228;user” from the repertory. (Before becoming the director of a theater he renovated in St. Petersburg, Mr. Kekhman was a business magnate who imported bananas to Russia.)本周,梅金斯基任命忠于政府的弗拉基米尔·凯科曼(Vladimir Kekhman)担任西伯利亚剧院的新主管。凯科曼称,他将把《唐怀瑟》从演出剧目中除去(凯科曼曾在圣彼得堡修复一家剧院,担任主管,之前是往俄罗斯香蕉进口行业的巨头)。While that case has resonated, with supporters rallying around the theater and critics rallying in support of the Russian Orthodox Church, the law banning obscenities has had a more concrete effect on theater and film. Introduced by a group of lawmakers including Stanislav Govorukhin, a member of Parliament and a popular film and television director during the Soviet period, the law sets fines and 90-day suspensions for violations.这起事件引起了很大反响,该剧的持者在剧院外集会,而该剧的批评者们也集会持俄罗斯东正教教会。不过,禁止脏话的法律对剧院和电影业有更切实的影响。这项法律规定,违反者将受到处罚并被勒令停业90天。提出这项法律的立法者包括下议院议员斯坦尼斯拉夫·戈沃鲁欣(Stanislav Govorukhin)。他是苏联时期的著名电影和电视导演。In the interview, Mr. Medinsky defended the law and said there were no plans to revise or revoke it.在采访中,梅金斯基维护了这项法律,称没有计划修改或废除它。Unlike the average English-language expletive thrown into everyday conversation, in Russian, cursing resonates as extremely crude; it has its own grammar and is never used in polite conversation. It is not uncommon for some older theatergoers to gasp when curses are uttered onstage.不像英语,脏话在俄语日常对话中极少出现,被认为极其粗鲁。脏话有自己的语法,在礼貌的交谈中从不出现。当舞台上出现脏话时,年长观众感到惊讶的情况并不罕见。Some directors see the anti-obscenity law as a distraction from far more worrisome issues. “Imagine Tony Soprano ruling the country, and Tony Soprano issues a law against obscenities,” said Alexander Zeldovich, the director of the critically acclaimed 2011 dystopian film “Target.”有些导演认为,禁止脏话的法律是在转移人们对其他严重问题的关注。“想像一下,如果是托尼·索普拉诺(Tony Soprano)统治这个国家,而他颁布法律禁止说脏话会是什么情形,”导演亚历山大·泽利多维奇(Alexander Zeldovich)说。他2011年的反乌托邦影片《标靶》(Target)广受好评。But film professionals are divided. The director Valeria Gai Germanika, 31, known for her coming-of-age films, said she didn’t mind cutting the cursing from her 2014 film “Yes and Yes.”但是电影专业人士对此意见不一。31岁的导演瓦列里娅·加伊·(Valeria Gai Germanika)以成长电影闻名。她说,她不介意去除她2014年影片《是的是的》(Yes and Yes)中的脏话。“We dubbed it again, and I actually think it became even better,” she said in a telephone interview. Asked if such choices should be made by artists themselves or the government, Ms. Gai Germanika said: “There’s a law, and I’m not going to fight against it. Actually, all those great films made in the Soviet era had no swearing, and people learned about the country through them.”“我们重新配音,实际上我觉得修改之后反而变得更好了,”她在电话采访中说。当被问及这样的选择应该由艺术家还是政府做出时,她说,“有这样的法律,我不打算对抗法律。实际上,苏联时期所有精的电影都没有脏话,人们通过那些电影去了解那个时代。”Some theaters say they’re simply ignoring the law. “We don’t abide by it, because we think it’s anti-constitutional,” said Yelena Gremina, a co-founder of Moscow’s scrappy Teatr.doc, known for its politically charged productions inspired by real-life events.有些剧院称,他们不理会这项法律。“我们不遵守它,因为我们认为它违反宪法,”敢作敢为的莫斯科Teatr.doc剧团的联合创始人叶连娜·格里米娜(Yelena Gremina)说。该剧团以上演受真实事件启发创作的政治剧目闻名。But there is genuine concern, especially after members of the performance group Pussy Riot were jailed in 2012 on charges of hooliganism after singing an anti-Putin song in a Moscow church.不过,人们的确感到忧虑,尤其是在2012年表演团队Pussy Riot在莫斯科一座教堂演唱反普京歌曲被判处流氓罪入狱之后。“After Pussy Riot, everything is serious; they put those girls in jail for two years,” said Alexander Rodnyansky, a leading film producer, most recently of the Oscar-nominated “Leviathan,” which Mr. Medinsky had criticized for its negative portrayal of Putin’s Russia. (Before it was shown last fall, the film was redubbed to remove the curses.)“在Pussy Riot事件之后,一切都变得很严肃。他们判那些女孩入狱两年,”著名电影制片人亚历山大·罗德尼扬斯基(Alexander Rodnyansky)说。他最新制作的影片《利维坦》(Leviathan)获得了奥斯卡提名。梅金斯基批评该片对普京统治下的俄罗斯的描绘过于负面(去年秋季该片上映前,重新配音,去除了脏话)。Creative artists say they are deeply worried about the direction of the country, but they find no shortage of material.创意艺术家们说,他们为俄罗斯的未来感到极为担忧,但他们绝不缺乏素材。“Putin is a process,” said Mr. Vyrypaev, the director. “I treat him like hydrogen sulfide. If you breathe too much, you’ll die. But it’s still part of nature.”“普京是一个过程,”导演维里帕夫说,“我把他看做硫化氢。吸入过多硫化氢,人会死。但它是大自然的一部分。” /201504/370013。

Low-risk pregnancy cases are being urged to avoid hospital birth under new NHS guidelines Photograph: Katie Collins/PA根据英国国家医疗务体系指引,低风险妇敦促避免住院分娩Women with low-risk pregnancies are to be encouraged to have non-hospital births under new NHS guidelines, which could see almost half of mothers-to-be planning to deliver their baby away from traditional labour wards.根据新的NHS指引,鼓励低风险妇不在医院分娩,这就意味着半数左右的准妈妈们将不在传统的产房分娩。Guidance from National Institute for Health and Care Excellence (Nice) says that midwife-led care has been shown to be safer for women and recommends that all women with low-risk pregnancies – 45% of the total – should be advised that giving birth in a midwifery-led unit, whether attached to a hospital or not, is “particularly suitable”.Nice(国家临床医学研究所)指引表明由助产士护理更安全,建议那些占总数45%的低风险妇在助产士机构分娩是极为妥当的,无论这些助产士机构是否附属于医院。The changes, published on Wednesday , have been made because women who give birth under midwife-led care have less chance of being asked to undergo medical interventions such as episiotomies, caesareans and use of forceps or ventouse.星期三发布了新的指引,由于在助产士的护理下分娩的女性,被询问实施诸如会阴切开术,剖腹产,产钳产以及吸引产的医疗干预的机会较少。Susan Bewley, professor of complex obstetrics at King#39;s College, London, and chair of the Nice advisory group, added that infections were more common on hospital wards.伦敦国王学院综合妇产科教授兼国家临床医学研究所咨询小组主席Susan Bewley补充道,感染在医院病房更常见。;We#39;re supporting an individual calm conversation about what is right for each individual in her circumstances,; Bewley said. ;They may choose any birth setting and they should be supported in those choices as that#39;s their right.;我们持那些根据自己的情况做出适合她们的选择。Bewley说道,应该持她们选择分娩环境的权力。The NHS body also advised midwives not to clamp and cut a baby#39;s umbilical cord until at least a minute after birth in the absence of complications, and generally within five minutes.NHS还建议在没有并发症的情况下,助产士应在一分钟以上五分钟内剪断婴儿的脐带。The announcement reverses decades of NHS policy and its own advice from 2007 recommending ;early clamping and cutting of the cord;.这条指引的宣布颠覆了数十年来的NHS制度以及2007年推崇尽早剪断脐带的建议。Research suggests that early clamping and cutting may leave newborn babies deprived of vital blood from the placenta, risking anaemia.研究表明尽早剪断脐带会使新生儿过早失去胎盘血,导致有贫血的风险。In separate guidance on postnatal care, Nice said parents should also be informed about the association between falling asleep with their baby on a bed, sofa or chair and sudden infant death syndrome until the baby is 12 months old.关于产后护理的指引,NICE指出父母应知晓在婴儿满12个月之前,和婴儿同睡与婴儿猝死综合征之间有关联。The change represents another significant change to the guidelines, issued in 2006, which only applied to babies up to the age of six to eight weeks. Parents should also be informed that the association may be greater if parents use drugs or have recently drunk alcohol, or if the baby was of low birth weight or premature. 这项新的指引对2006年公布的适用于6-8周大的婴儿身上的指引作出了显著的修改。应告知父母,在期药或饮酒,还有婴儿出生时体重过轻,早产和婴儿猝死综合征的联系更大。Nine out of 10 of the 700,000 babies born in England and Wales each year are currently delivered in hospital under the supervision of obstetricians. Nice added that commissioners should ensure that women have all four possible options for giving birth available to them: hospital care, midwifery units in hospitals, midwifery units based in the community and at home.每年有700,000的婴儿在英格兰和威尔士出生,其中90%的婴儿在产科医生的监护下出生。NICE补充道 应确保女性有四种分娩环境的选择,即选择在医院,医院附属助产士机构,社区助产士机构以及在家中分娩。Professor Mark Baker, Nice#39;s clinical practice director, said: ;It#39;s very difficult to explain why this is happening but the closer you are to hospital, and indeed if you are in hospital, the more likely you are to receive hospital care and surgical interventions.;Nice临床实践主任Mark Baker教授说道“离医院越近以及已入院,接受医院护理以及外科手术的可能就更大,很难解释为什么会这样。”;Surgical interventions can be very costly, so midwifery-led care is value for money while putting the mother in control and delivering healthy babies.;因为外科手术费用昂贵,当产妇在可控范围内分娩健康宝宝时,助产士护理会物超所值。The outcome for the baby is the same in different settings except in the case of first-time mothers giving birth at home, where there is a ;small increase; in risk of serious complications – nine in every 1,000 compared with five in every 1,000 in the other settings – which the guidance says mothers should be advised about. Home births are the cheapest, followed by midwife-led units and then hospitals but Bewley said costs did not come into the equation.在不同环境分娩婴儿结果是相同的,但不包括初产妇在家分娩,因为会有小部分人有严重的并发症-千分之九的概率,而在其他环境分娩的概率为千分之五- 在家分娩花费最少,其次是助产士机构,医院花费最多,但是Bewley说费用不是作出选择的关键。Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said: ;For low-risk women, giving birth in a midwife-led unit or at home is safe and reduces medical interventions.;皇家助产士学会首席执行官Cathy Warwick说:对低风险妇来说,在助产士机构或在家分娩是安全的,减少医疗干预。“We hope this will focus commissioners#39; and providers#39; of maternity services attention on ensuring that women have a real choice about where they give birth.”我们希望这会使妇产科机构的管理层关注于确保女性能选择适合他们分娩的环境。The RCM has been campaigning for about 5,000 extra midwives to be recruited. Warwick said the new guidance would not stretch existing medical staff further but ensure they were better employed, as more women would have births without interventions, which require more resources.RCM正致力于再招收5000名助产士。Warwick说:在新的指引中,现有的医务人员不再扩增,但会被安排在更合适的岗位,因为更多的女性将在没有医疗干预的环境中分娩,这将需要更多的资源。Elizabeth Duff, senior policy adviser for the NCT (National Childbirth Trust), welcomed the advice and urged the NHS to ;put these guidelines into practice as soon as possible and make home and community birth, a real, not just theoretical, option;.国家剩余信托基金会高级策略顾问Elizabeth Duff对这个指引表示欢迎并敦促NHS尽早将指引落实,在家和社区分娩将会是个真实的选择而不光是理论的。Community midwife units have lower medical intervention rates and rates of transfer to obstetric wards than those in hospitals but many have been closing recently. For women not giving birth for the first time they also have a lower rate of transfer to an obstetric ward than mothers who planned to give birth at home.相对医院来说,在社区助产士机构中医疗干预和转到产科病房发生率较低,但是最近很多社区助产士机构已经关闭。比起那些打算在家分娩的妇来说,经产妇转移到产科病房的发生率更低。 /201412/347641。