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女性患者，32岁，肥胖多毛。24小时尿17－羟皮质类固醇增高，小剂量地塞米松不能抑制，大剂量地塞米松能抑制。最可能的诊断是
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What is making the world so much older There are two long-term causes and a temporary blip that will continue to show up in the figures for the next few decades. 11 The first of the big causes is that people everywhere are living far longer than they used to, and this trend started with the industrial revolution and has been slowly gathering pace. In 1900 average life expectancy at birth for the world as a whole was only around 30 years, and in rich cotmtries under 50. The figures now are 67 and 78 respectively, and still rising. For all the talk about the coming old-age crisis, that is surely something to be grateful for-especially since older people these days also seem to remain healthy, fit and active for much longer. 12 A second, and bigger, cause of the ageing of societies is that people everywhere are hang far fewer children, so the younger age groups are much too small to counterbalance the growing number of older people. This trend emerged later than the one for longer lives, first in developed countries and now in poor countries too. In the early 1970s women across the world were still, on average, having 4.3 children each. The current global average is 2.6, and in rich countries only 1.6. 13 The UN predicts that by 2050 the global figure will have dropped to just two, so by mid-century the world’s population will begin to level out. The numbers in some developed countries have already started shrinking. Depending on your point of view, that may or may not be a good thing, but it will certainly turn the world into a different place. The temporary blip that has magnified the effects of lower fertility and greater longevity is the babyboom that arrived in most rich countries after the Second World War. 14 The tinting varied slightly from place to place, but in America-where the effect was strongest-it covered roughly the 20 years from 1945, a period when nearly 80 million Americans were born. The first of them are now coming up to retirement. For the next 20 years those baby-boomers will be swelling the ranks of pensioners, which will lead to a rapid drop in the working population all over the rich world. As always, the averages mask considerable diversity. 15 Most developing countries do not have to worry about ageing-yet, in the longer term, however, the same factors as in the rich world-fewer births, longer lives-will cause poorer countries to age too.
It was an admission of cultural defeat; but then Hong Kong is nothing if not pragmatic about such things. 21 On June 6th its education minister lifted restrictions that forced four-fifths of the territory’s more than 500 secondary schools to teach in the "mother tongue", i.e. Cantonese, the main language of its residents. Schools may switch to English, the language of the former colonial oppressor, from next year. Tiffs reverses a decade-old policy adopted after Hong Kong’s reversion to China in 1997, in an assertion of independence from both formre and present sovereign powers. Emotion may have played a large role in the decision. But it made some sense. Students speak Cantonese at home, and so using it is the easiest way to impart information and promote discussion. 22 It is also the first language of most teachers: a study done at the time concluded that schools labeled "English-medium" were actually teaching in Cantonese but using English-language textbooks. 23 After much bureaucratic rearrangement, 20% of schools were permitted to continue teaching in English, which may have made sense to teachers and administrators, but not to ambitious parents. They know that their offspring will need English to get ahead. Those who could flee the public system for costly private schools, or for the eight semi-private schools run on the British system, did so. The rest made extraordinary efforts to enter the minority of English-language schools. They have huge waiting lists; Cantonese ones gaping holes. That helps explain the minister’s change of heart, for which no reason was given. 24 So does a survey published last year, which concluded that students from the Cantonese schools did far worse than their peers in getting into universities-a result that would horrify Hong Kong’s achievement-obsessed parents. And whatever the educators think, employers from coffee bars to banks either require people to be bilingual or pay more to those who are. Private schools offering supplementary English tuition have mushroomed. 25 Hong Kong’s educational bureaucracy has devoted much thought to how English could be offered without harming other studies, and without sacrificing a generation of teachers with strong interest in a system based on their first language. The minister has skirted these difficult issues. A much debated but still undisclosed formula will allow an increasing number of subjects to be taught in English. Every step is controversial. Pragmatists want Hong Kong to drop Cantonese entirely in favor of English and Mandarin. But that may demand a level of cultural indifference which even Hong Kong cannot muster.
Every immigrant leads a double life. Every immigrant has a double identity and a double vision, being suspended between an old and a new home, an old and a new self. 1 The very notion of a new home, of course, is in a sense as impossible as the notion of new parents: parents are who they are; home is what it is. Yet home, like parentage, must be legitimized through love; otherwise, it is only a fact of geography or biology. 2 Most immigrants to America found their love of their old homes betrayed: They did not really abandon their countries; their countries abandoned them, and in America, they found the possibility of a new love, the chance to nurture new selves. Not uniformly, not without exceptions. Every generation has its Know-Nothing movement. 3 Its understandable fear and hatred of alien invasion is as true today as it always was, but in spite of all this, the American attitude remains unique. Throughout history, exile has been a calamity; America turned it into a triumph and placed its immigrants in the center of a national epic. The epic is possible because America is an idea as much as it is a country. 4 America has nothing to do with loyalty to a dynasty and very little to do with loyalty to a particular place, but everything to do with loyalty to a set of principles. To immigrants, those principles are especially real because so often they were absent or violated in their native lands. It was no accident in the ’60s and ’70s, when alienation was in flower, that it often seemed to be "native" Americans who felt alienated, while aliens or the children of aliens upheld the native values. "Home is where you are happy." Sentimental, perhaps, and certainly not conventionally patriotic, but is appropriate for a country that wrote the pursuit of happiness into its founding document. That pursuit continues for the immigrant in America, and it never stops, but it comes to rest at a certain moment. 5 The moment occurs perhaps when the immigrant’s double life and double vision converge toward a single state of mind, when the old life, the old home fade into a certain unreality: places one merely visits, practicing the tourism of memory. It occurs when the immigrant learns his ultimate lesson: above all countries, America, if loved, returns love.
At this time of year especially, weather is on everyone’s mind-and on everyone’s tongue. 6 It is the material for the conversation of board chairman and bored cleaning woman, of young and old, of the bright, the dull, the rich and the poor. As ff this basic coin of conversation needed to be gilded, the average American constantly reads about the weather in his newspapers and magazines, listens to regular forecasts of it on the radio and watches while some TV prophet milks it for cuteness on the evening news. 7 Since the weather is to man what the waters are to fish, his preoccupation with it serves a unique purpose, constituting a social phenomenon all its own. Far from arising merely to pass the time or bridge a silence, "weathertalk," as it might be called, is a sort of code by which people confirm and salute the sense of community they discover in the face of the weather’s implacable influence. Inspired by exceptional weather, otherwise immutable strangers suddenly find themselves in communion. 8 As victims, people hate to cancel a picnic on account of rain, and yet they often cheer when the weather brings human activity to an abrupt stop. Most feel that the weather indeed affects their moods. If man sees the weather differently according to his circumstance, healthy fear works at the hub of his obsession with it. Through human history, weather has altered the march of events and caused some mighty cataclysms. Every year brings fresh reminders of the weather’s power over human life and events in the form of horrifying tornadoes, hurricanes and floods. No wonder, then, that man’s great dream has been some day to control the weather. 9 With computers on tap and electronic eyes in the sky, modern man has thus come far in dealing with the weather, alternately his enemy and benefactor, yet man’s difficulty today is not too far removed from that of his remote ancestors. For all the advances of scientific forecasting, in spite of the thousands of daily bulletins and advisories that get flashed about, the weather is still ultimately unstable and unpredictable. Man’s dream of controlling it is still just that-a dream. The very idea of control, in fact, raises enormous and troublesome questions. 10 The vision of scheduled weather also raises ambiguous feelings among the world’s billions of weather fans and poses at least one irresistible question: If weather were as predictable as holidays and eclipses, what in the world would everyone talk about
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