Prática de Shadowing: Artificial Liver Program: Mayo Clinic Radio - Aprenda a falar inglês com vídeo
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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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Vocabulário e dicas de fala para esta lição
Esta aula de conversação usa o vídeo “Artificial Liver Program: Mayo Clinic Radio”. As palavras que mais se repetem: liver, disease, transplant, cell, mayo. Este vídeo tem 136 frases e 1533 palavras para praticar shadowing. A fala dura 9:08. O falante fala em ritmo natural, cerca de 168 palavras por minuto, próximo de uma conversa do dia a dia. Apenas 76% das palavras estão entre as 3.000 mais comuns do inglês, por isso o vocabulário é exigente.
Vocabulário principal deste vídeo
15 palavras do vídeo que vale a pena aprender, com pronúncia e significado:
| Palavra | Pronúncia | Significado |
|---|---|---|
| transplant verbo | /tɹænzˈplænt/ | transplantar |
| organ substantivo | /ˈɔːɡən/ | órgão |
| liver substantivo | /ˈlɪvɚ/ | fígado |
| donor substantivo | /ˈdəʊnə/ | doador |
| stem substantivo | /stɛm/ | ramo |
| alcoholic substantivo | /ˌæl.kəˈhɔ.lɪk/ | alcoólatra, alcoólico |
| eligible adjetivo | /ˈɛl.ɪ.d͡ʒɪ.bəl/ | elegível |
| artificial adjetivo | /ˌɑː.tɪˈfɪʃ.əl/ | artificial |
| scar substantivo | /skɑɹ/ | cicatriz |
| pig substantivo | /ˈpɪɡ/ | porco, suíno |
| obesity substantivo | /ə(ʊ)ˈbiːsɪti/ | obesidade |
| surgeon substantivo | /ˈsɝd͡ʒən/ | cirurgião |
| predict verbo | /pɹɪˈdɪkt/ | prever |
| shortage substantivo | /ˈʃɔː(ɹ)tɪd͡ʒ/ | falta, carência |
| overdose substantivo | /ˈəʊvə(ɹ)ˌdəʊs/ | overdose, superdose |
Phrasal verbs que você vai ouvir
| Palavra | Significado |
|---|---|
| sit down verbo | sentar-se |
Frases que vale a pena repetir
Frases curtas e completas do vídeo que você pode usar na conversa do dia a dia:
- 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?
Gramática neste vídeo
As estruturas que o falante mais usa, com as palavras exatas do vídeo:
| Estrutura | No vídeo |
|---|---|
| Present perfect continuous have/has been + -ing — uma ação que começou antes e continua | have been studying · I've been working |
| Voz passiva be + particípio passado — o foco está no que acontece, não em quem faz | is impaired · was developed · was called |
| Present perfect have/has + particípio passado — uma ação passada que ainda importa agora | has been · it's been adopted · haven't recovered |
| Orações relativas who / which + oração — informação extra sobre uma pessoa ou coisa | those who need · people who are · friend who donates |
Pronúncia para ficar de olho
O falante usa 28 contrações e formas reduzidas, como you're, we're, wouldn't. Diga-as na forma curta, do jeito que você ouve.
- Os sons de “sh” e “zh”: artificial /ˌɑː.tɪˈfɪʃ.əl/, shortage /ˈʃɔː(ɹ)tɪd͡ʒ/, fiction /ˈfɪkʃən/, essentially /ɪˈsɛnʃəli/, tissue /ˈtɪʃ.(j)u/
- Palavras longas — acerte a sílaba tônica: alcoholic /ˌæl.kəˈhɔ.lɪk/, eligible /ˈɛl.ɪ.d͡ʒɪ.bəl/, artificial /ˌɑː.tɪˈfɪʃ.əl/, obesity /ə(ʊ)ˈbiːsɪti/, hepatitis /ˌhɛpəˈtaɪ̯tɪs/
Sons difíceis para falantes de português:
- Consoante final — sem acrescentar um “i” depois: transplant /tɹænzˈplænt/, alcoholic /ˌæl.kəˈhɔ.lɪk/, pig /ˈpɪɡ/, predict /pɹɪˈdɪkt/, rapid /ˈɹæp.ɪd/
- /l/ final — a língua toca o céu da boca, não vira “u”: eligible /ˈɛl.ɪ.d͡ʒɪ.bəl/, artificial /ˌɑː.tɪˈfɪʃ.əl/, nutritional /njuːˈtɹɪʃ.ə.nəl/, tylenol /ˈtaɪləˌnɑl/, biomedical /ˌbaɪəʊˈmɛdɪk(ə)l/
- /h/ — um sopro suave, diferente do “r”: alcoholic /ˌæl.kəˈhɔ.lɪk/, hepatitis /ˌhɛpəˈtaɪ̯tɪs/, likelihood /ˈlaɪklihʊd/
Como praticar com este vídeo
- Ouça o vídeo inteiro uma vez sem falar e anote as palavras que você não conhece.
- Comece na velocidade 0,75×, faça shadowing frase por frase e volte à velocidade normal quando ficar fácil.
- Grave a sua voz e compare com o original, prestando atenção a palavras como transplant, organ, liver.
O que é a Técnica de Shadowing?
Shadowing é uma técnica de aprendizado de idiomas com base científica, originalmente desenvolvida para o treinamento de intérpretes profissionais. O método é simples, mas poderoso: você ouve áudio em inglês nativo e repete imediatamente em voz alta — como uma sombra seguindo o falante com 1-2 segundos de atraso. Pesquisas mostram melhora significativa na precisão da pronúncia, entonação, ritmo, sons conectados, compreensão auditiva e fluência na fala.