Shadowing Practice: Artificial Liver Program: Mayo Clinic Radio - Learn English Speaking with Video
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Welcome back to Mayo Clinic Radio.
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I'm Dr. Tom Shives.
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And I'm Tracy McRae.
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Tracy, every year, 40 ,000 people die of liver disease in the U .S.
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And the only proven therapy for end -stage liver disease is still a liver transplant.
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Unfortunately, there aren't enough organs to go around for those who need them.
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In fact, there are more than 150 ,000 people who are on the waiting list for a donor liver.
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Now, hopefully, treatment for liver disease is about to change for the better.
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Research at Mayo Clinic is focusing on new regenerative liver therapies to help repair diseased livers
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and improve the treatment options for liver disease patients.
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Here to discuss is Dr. Scott Nyberg, a transplant surgeon at Mayo Clinic.
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Dr. Nyberg is the director of the liver program at the Mayo Clinic Center for Regenerative Medicine
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and head of Mayo Clinic's artificial liver program.
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Welcome to the program, Dr. Nyberg.
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It's nice to meet you.
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It's great to be here, Tracy and Tom.
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Thank you for having me.
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Yeah, you bet.
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You have been studying the liver and liver disease for a long time, long enough to get all those titles, right?
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I started back in the early 80s, probably.
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I was both a chemical engineer and then a biomedical engineer.
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Had a mentor who said with that engineering background, why don't you build a liver dialysis machine?
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I asked him, how should I do that?
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That was in 1989, and he said, you figure it out.
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You're the engineer.
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So I've been working on this for almost 30 years.
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Well, I want to learn a lot more about the artificial liver program, but before we go there, we should probably just set the table.
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What is liver disease?
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What causes liver disease?
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I mean, there are many causes.
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They can range from Tylenol overdose, a common drug like Tylenol, alcohol.
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People are familiar with that, along with genetic causes.
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In the United States, I would say obesity is becoming a number one cause.
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Overweight contributes to a disease called NASH.
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It had been hepatitis C.
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Now there are pretty effective treatments for hepatitis C, so we're seeing a decrease.
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But the number one cause would be NASH, followed by alcohol, and then these others.
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Now explain NASH to us.
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And you mentioned that obesity is becoming a more common cause of liver disease.
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How does obesity cause liver disease?
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And I suspect that NASH is the answer.
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Right.
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It's not fully understood as far as the mechanisms, but there has been this association with as Americans and people around the world become heavier,
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there's more liver disease.
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If a pathologist looks at a biopsy of a NASH liver, it looks similar to an alcoholic liver, so it's probably a nutritional problem.
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Where too many calories cause an inflammatory response and do this over a long period of time,
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there becomes scarring and eventually cirrhosis and the manifestations of end -stage liver disease.
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And cirrhosis is pretty much just scarring of the liver.
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Advanced scarring to a point where the liver isn't able to regenerate.
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Fortunately, a healthy liver, if we cut it in half, will grow back to a full size within a couple of weeks.
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That's a normal response, but due to the scarring of fibrosis and cirrhosis,
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that regenerative response is impaired and the only real treatment for those end -stage livers is a liver transplant currently.
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Does NASH stand for something?
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Non -alcoholic steatohepatitis.
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So it looks pathologically like alcoholic liver injury,
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but it's non -alcoholic related presumably to diet and weight.
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How long can people live with liver disease before they need a transplant?
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well we have a scoring system now
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that was developed here at mayo called the meld score initially
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it was called the mayo end -stage liver disease score to
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predict how long people would survive what's their likelihood of being alive in two months
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it's been adopted nationally for organ allocation
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because it's very good at predicting the name was changed they took mayo out of the name
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and now it's just the model for end -stage liver disease so that's probably the best predictor.
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And in transplant, we use that score to determine who has highest priority.
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So it ranges from zero to 40, where if you have a score of 40, it's unlikely you're going to survive more than a few weeks.
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What can make if a patient is not eligible for transplant?
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I mean, there's being on the list means that you're eligible, but why would patients not be eligible for transplant?
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I mean, there's a variety of reasons.
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If you're an alcoholic that continues to drink
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and haven't recovered you wouldn't be eligible
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that wouldn't be a wise use of an organ
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if you have a disease that may involve other organs that's not corrected by a liver transplant
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or if you have a cancer that's spread outside of the liver that we wouldn't be able to help you and
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transplant an immunosuppressive patient you could actually shorten their life and that
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so there are a number
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you can be too old though we don't have a cutoff as far as age goes
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so you're still doing a lot of liver transplant right and
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and a fair number of those are from deceased donors
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but also you're using live donors yeah here at mayo
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we have a large living donor program one of the largest in the united states
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which means we do over 20 per year of the 130 liver transplants that we do.
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So that's a living donor, a family member, our friend who donates half of their liver.
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Two weeks later, the liver has regenerated, did you say, to its normal size?
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Probably two weeks in the donor, we do CAT scans to measure the volume.
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And they're within 90 % of the original volume within two weeks.
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So it's very rapid.
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In my lab, we have a number of animal models studying regeneration
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and we see this very quickly also all right what's new
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and regenerative medicine
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and artificial liver well here at mayo the the biggest problem in transplant is the shortage of organs
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so the things we do in regenerative medicine are to address
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that shortage of organs one option is a liver dialysis machine to allow the the liver to regenerate
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and hopefully avoid a liver transplant so that would be
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that would save the liver it could be used for someone else
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and avoid big surgery
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and all the immunosuppression lifelong immunosuppression for a patient that'd be a patient maybe with a tylenol overdose
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we also have a special pig that we've developed a genetically engineered pig
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and the goal there is to grow transplantable human livers in this pig sounds science fiction
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but in my lab we recently had a pig named eddie who beautiful a little piggy
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if you look at my instagram site
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you'll see a picture of eddie who essentially was created by a stem cell transplant into a day four embryo
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and this is sort of the future i see of organ production
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and then we're also
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so this is hopefully someday eddie's liver can be transplanted into a human eddie will eddie
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and pigs like eddie will be incubators to grow human livers.
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The concept would be to take a cell, reprogram it into a cell from a patient liver disease, reprogram it into a stem cell,
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fuse it with an embryo, and then grow a liver from that human stem cell.
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Whoa.
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I got to sit down.
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Oh, I am sitting down.
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Good.
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That's good.
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How are you using the patient's own liver cell?
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Is that what you're saying when you take a cell to help?
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In this case, you could even take a blood sample, like a white blood cell from just a blood sample.
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The Nobel Prize for Medicine about four years ago was a way to reprogram cells, adult cells, to become stem cells.
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And the theory would be that you could use those stem cells to grow livers.
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Well, hopefully you and Eddie will get the Nobel Prize next year.
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I think we're still a little ways off.
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eddie and pigs like eddie the other option that we're working with a local company is to take
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livers decellularize them and then repopulate them with cells from a patient
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so again you could avoid the need for immunosuppression
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so these would be a tissue engineered liver
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that would be identical to the patient so they wouldn't need an anti -rejection drug after the transplant
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If it works using your own cells, you shouldn't need to.
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We had a paper recently published in one of the science journals, Science Translational Medicine, showing that this concept would work in pigs,
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and it's a matter of scaling it up to humans.
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It's all really exciting.
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Thanks so much for being with us.
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Thank you very much.
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An update on the treatment of liver disease with Dr. Scott Nyberg,
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transplant surgeon and director of the liver program at the Mayo Clinic Center for Regenerative Medicine
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and head of Mayo Clinic's artificial liver program.
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Thanks, Dr. Nyberg.
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Yeah, thank you, Tom, Tracy.
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אוצר מילים והערות הגייה לשיעור הזה
שיעור הדיבור הזה מבוסס על הסרטון “Artificial Liver Program: Mayo Clinic Radio”. המילים שחוזרות הכי הרבה: liver, disease, transplant, cell, mayo. בסרטון הזה יש 136 משפטים ו-1533 מילים לתרגול Shadowing. הדיבור נמשך 9:08. הדובר מדבר בקצב טבעי של כ-168 מילים בדקה, קרוב לשיחה יומיומית. רק 76% מהמילים נמצאות בין 3,000 המילים הנפוצות ביותר באנגלית, כך שאוצר המילים מאתגר.
אוצר מילים מרכזי בסרטון הזה
15 מילים מהסרטון שכדאי ללמוד, עם ההגייה והמשמעות שלהן:
| מילה | הגייה | משמעות |
|---|---|---|
| organ שם עצם | /ˈɔːɡən/ | אֵיבָר |
| liver שם עצם | /ˈlɪvɚ/ | כָּבֵד |
| donor שם עצם | /ˈdəʊnə/ | תורם, תורמת |
| artificial שם תואר | /ˌɑː.tɪˈfɪʃ.əl/ | מְלָאכוּתִי |
| scar שם עצם | /skɑɹ/ | צַלֶּקֶת |
| pig שם עצם | /ˈpɪɡ/ | חֲזִיר |
| obesity שם עצם | /ə(ʊ)ˈbiːsɪti/ | שׁוֹמֶן, השמנת יתר חולנית |
| surgeon שם עצם | /ˈsɝd͡ʒən/ | מְנַתֵּחַ |
| shortage שם עצם | /ˈʃɔː(ɹ)tɪd͡ʒ/ | מַחְסוֹר |
| overdose שם עצם | /ˈəʊvə(ɹ)ˌdəʊs/ | מנת יתר |
| contribute פועל | /kənˈtɹɪb.jut/ | תרם |
| tissue שם עצם | /ˈtɪʃ.(j)u/ | רקמה |
| mechanism שם עצם | /ˈmɛk.ə.nɪ.zəm/ | מַנְגָּנוֹן |
| adopt פועל | /əˈdɑpt/ | אִמֵּץ |
| decrease פועל | /dɪˈkɹiːs/ | פחת |
Phrasal verbs שתשמעו
| מילה | משמעות |
|---|---|
| sit down פועל | התיישב \ הִתְיַשֵּׁב |
משפטים שכדאי לחזור עליהם
משפטים קצרים ושלמים מהסרטון שאפשר להשתמש בהם בשיחה יומיומית:
- It's nice to meet you.
- I asked him, how should I do that?
- I mean, there's a variety of reasons.
- How are you using the patient's own liver cell?
- Is that what you're saying when you take a cell to help?
דקדוק בסרטון הזה
המבנים שהדובר משתמש בהם הכי הרבה, עם המילים המדויקות מהסרטון:
| מבנה | בסרטון |
|---|---|
| הווה מושלם ממושך (Present perfect continuous) have/has been + -ing — פעולה שהתחילה בעבר ועדיין נמשכת עכשיו | have been studying · I've been working |
| סביל (Passive voice) be + past participle — הדגש הוא על מה שקורה, לא על מי שעושה את הפעולה | is impaired · was developed · was called |
| הווה מושלם (Present perfect) have/has + past participle — פעולה שקרתה בעבר ועדיין יש לה חשיבות או השפעה עכשיו | has been · it's been adopted · haven't recovered |
| משפטי זיקה (Relative clauses) who / which + clause — מידע נוסף על אדם או דבר | those who need · people who are · friend who donates |
הגייה ששווה לשים לב אליה
הדובר משתמש ב-28 קיצורים וצורות מקוצרות, כמו you're, we're, wouldn't. אמרו אותם בצורה הקצרה, כפי שאתם שומעים אותם.
- הצלילים של “sh” ו-“zh”: artificial /ˌɑː.tɪˈfɪʃ.əl/, shortage /ˈʃɔː(ɹ)tɪd͡ʒ/, fiction /ˈfɪkʃən/, essentially /ɪˈsɛnʃəli/, tissue /ˈtɪʃ.(j)u/
- מילים ארוכות — שימו לב להטעמה: alcoholic /ˌæl.kəˈhɔ.lɪk/, eligible /ˈɛl.ɪ.d͡ʒɪ.bəl/, artificial /ˌɑː.tɪˈfɪʃ.əl/, obesity /ə(ʊ)ˈbiːsɪti/, hepatitis /ˌhɛpəˈtaɪ̯tɪs/
צלילים שדוברי עברית מתקשים בהם:
- /w/ — שפתיים מעוגלות, לא /v/: whoa /woʊ/, overweight /ˌoʊvɚˈweɪt/
- /æ/ — פתוח יותר מה-“אֶ” העברית, לא כמו “a” ב-“cup”: transplant /tɹænzˈplænt/, alcoholic /ˌæl.kəˈhɔ.lɪk/, rapid /ˈɹæp.ɪd/, scan /skæn/, nationally /ˈnæʃənəli/
- /r/ — הלשון לא נוגעת בשום מקום, לא ה-“ר” הגרונית: transplant /tɹænzˈplænt/, scar /skɑɹ/, predict /pɹɪˈdɪkt/, shortage /ˈʃɔː(ɹ)tɪd͡ʒ/, overdose /ˈəʊvə(ɹ)ˌdəʊs/
איך לתרגל עם הסרטון הזה
- הקשיבו לכל הסרטון פעם אחת בלי לדבר, ורשמו את המילים שאתם לא מכירים.
- התחילו במהירות 0.75×, תרגלו Shadowing משפט אחר משפט, וחזרו למהירות רגילה כשזה מרגיש קל.
- הקליטו את עצמכם והשוו למקור, תוך תשומת לב למילים כמו organ, liver, donor.
מהי טכניקת השאדואינג?
שאדואינג היא טכניקת למידת שפה מבוססת מדע שפותחה במקור להכשרת מתורגמנים מקצועיים ופופולרית על ידי הפוליגלוט ד"ר אלכסנדר ארגואלס. השיטה פשוטה אך עוצמתית: אתה מקשיב לאודיו באנגלית ילידית וחוזר עליו בקול רם מיד — כמו צל העוקב אחרי הדובר עם עיכוב של 1–2 שניות בלבד. בניגוד להאזנה פסיבית או תרגילי דקדוק, שאדואינג מכריח את המוח והשרירים בפה לעבד ולשחזר דפוסי דיבור אמיתיים בו זמנית. מחקרים מראים שזה משפר משמעותית את דיוק ההגייה, האינטונציה, הקצב, הדיבור המחובר, הבנת השמיעה ושטף הדיבור — מה שהופך אותו לאחת השיטות היעילות ביותר להכנה לIELTS Speaking ולתקשורת באנגלית בעולם האמיתי.