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2017年10月19日 19:09:52 | 作者:驱动咨询 | 来源:新华社
A fanatic capital city, one of the largest the most densely populated anywhere in the world, also famous for its tireless workers for salary men.一座令人狂热的首府城市,世界上人口最为稠密的大城市之一,同时也因为男人们不知疲倦的工作而闻名全世界。And here in Tokyos A district a place thats known for corky ideas, one former salary man himself has come out with a very unique business, a co-sleeping specialty shop.这便是东京的A区,以产生各种新奇的想法而著名。曾经的男性工薪者自己开创了一个非常独特的生意,陪睡专卖店。Yes, people come here to cuddle. M tells me.是的,这位先生告诉我,人们来这里是来享受拥抱的。Before you let your mind run wild, he says, it is just cuddling, nothing more.他说,在你的乱思乱想之前,我先申请,只是拥抱,没有其他。Customers pay about forty dollars to sleep next to a girl for twenty minutes. Some customers are young men looking for simple companionship.为了睡在一个女孩身边20分钟,顾客需付大约50美元。有些年轻的男性来这儿只是为了看一看睡在一旁的陪睡女郎。21-year-old L visits the shop almost everyday. He tells me I like coming here, its unique and relaxing. I tried to stay awake, because I enjoy talking with the girls.21岁的L先生每天都是光顾这里。他告诉我,他喜欢来这儿,这里既特别又放松。我尽量不睡着,因为我喜欢和这些女孩谈话。Do you have a girl friend?你有女朋友吗?No, I dont, he says , I never have a lot chance to meet girls. So this is refreshing for me.没,我没有,他说,我没有太多机会可以认识女孩。因此这对我来说很新鲜。19 year old H is a student, she works here part-time.19岁的H陪睡女孩是个学生,在这儿兼职。She says most guys come here to relax and rest after working hard all day.她说大多数顾客来这儿只是在一天辛苦的工作之后放松一下。They clearly hit a nerve. It is about 9 Oclock on Thursday night right now. And just about every room is taken and you can see the place is not big, its about four hundred square feet in total.这是一个深入人意,抓住市场的创意。现在是周四晚上9点钟左右。但是每个房间都客满,你可以看到每间房间都不大,总共却有400平方英尺。There are add services as well, but again dont get any ideas.这里没有其他务,不要想别的!One thousand Yen about thirteen dollars, if you want to rest your head on the girls knees for three minutes, another thirteen dollars for a five-second hug.1000日元也就是13美元,如果你想把头在哪个女孩的膝盖上靠三分钟。如果想要一个五分钟的拥抱,再加13美元。M says he is surprised at all the attention his business is getting, and yes he is thinking of a possible expansion.M老板说他很吃惊他的生意越做越火,同时,他也想出了一个可能的原因。We might move to a bigger and cleaner space but maybe the simplicity is part of our charm, he adds.我们可能在走向更大更干净的空间,他补充到,但是可能简单正是我们的魅力所在。A simple idea in a stress out and sometimes lonely city.在一个充满压力,有时颇感孤独的城市的一个简单想法。201211/208602Books and Arts; Book Review;Terminal care;文艺;书评;临终关怀; Go gentle into that good night;温和地走入那个良夜; The Best Care Possible: A Physicians Quest to Transform Care Through the End of Life. By Ira Byock.《可能是最好的医护手段:一位内科医生试图改革生命尽头的医护方法。》Ira Byock著作。 Asked where they would like to spend their last days, Americans almost always say at home, surrounded by people they love. In real life, though, only one in five achieves that. More than 30% die in a nursing home, where almost no one wants to be, and over half end up in a hospital, often in an intensive-care unit, heavily sedated and attached to life-saving equipment until their doctors give up the battle.对大多数美国人来说,倘若最后的时光能在家中度过,周围环绕着挚爱亲朋,便是走也能走得称心了。然而,只有五分之一的人能实现这个愿望。谁也不想去疗养院,可却有超过三成的人死在那里;另外有超过半数的人死在医院的重症监护室里,身上注射了大量镇定剂,连接在生命维持设备上,直到医生宣布投降。Death is a difficult subject for anyone, but Americans want to talk about it less than most. They have a cultural expectation that whatever may be wrong with them, it can be fixed with the right treatment, and if the first doctor does not offer it they may seek a second, third or fourth opinion. Litigation is a constant threat, so even if a patient is very ill and likely to die, doctors and hospitals will still persist with aggressive treatment, paid for by the insurer or, for the elderly, by Medicare. That is one reason why America spends 18% of its GDP on health care, the highest proportion in the world.死亡对所有人来说都是个难题,相比之下美国人却很少谈起死亡。在他们的文化里,大家都觉得不管生了什么病,只要医治得当就能安然无恙;如果一个医生不行,他们就会去找第二个,第三个,第四个……他们还常常威胁着要起诉医生,所以就算有人病入膏肓,行将就木,医院和医生也会坚持实施高强度治疗,反正年轻人有保险公司付账,老人也有医疗保险撑腰。所以,美国的医疗出占GDP的18%,高居全球之首。That does not mean that Americans are getting the worlds best health care. For the past 20 years doctors at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire have been compiling the “Dartmouth Atlas of Health Care”, using Medicare data to compare health-spending patterns in different regions and institutions. They find that average costs per patient during the last two years of life (when health spending is heaviest) in some regions can be almost twice as high as in others, yet patients in the high-spending areas do not survive any longer or enjoy better health as a result.花了最多的钱,未必就能得到最好的卫生保健务。20年来,新罕布什尔州达特茅斯卫生政策与临床实践学院一直在编纂《达特茅斯卫生保健地图册》。该学院使用医保数据,比较了不同的地区和医疗机构卫生保健出之间的差异。研究者发现,虽然在生命最后两年中(医疗出最大),有些地区病人的平均出可达其它地区的两倍,但是他们的寿命没有延长,健康状况也不比其它地方好。Ira Byock is the director of palliative medicine at Dartmouth-Hitchcock Medical Centre and a professor at Dartmouth Medical School. His book is a plea for those near the end of their life to be treated more like individuals and less like medical cases on which all available technology must be let loose. With two decades experience in the field, he makes a good case for sometimes leaving well alone and helping people to die gently if that is what they want.Ira Byock是美国达特茅斯希契科克医疗中心的姑息疗法主管,也是达特茅斯医学院教授。他在书中恳请人们把那些生命尽头的人当做“人”来看待,别把他们当成冷冰冰的医疗个案,也别把他们当成各种医疗措施的跑马场。Ira Byock从业已有二十载,在书中为姑息疗法做了强有力的辩护。如果人们只想走得安详些,便不应该徒生枝节,而应该帮助他们满足心愿。That does not include assisted suicide, which he opposes. But it does include providing enough pain relief to make patients comfortable, co-ordinating their treatment among the different specialists, keeping them informed, having enough staff on hand to see to their needs, making arrangements for them to be cared for at home where possible—and not officiously keeping them alive when there is no hope.但是要满足病人的心愿,并不意味着帮助他们自杀,Ira Byock也反对自杀。相反,姑息疗法应该为遭受剧痛折磨的病人缓解痛苦,与其它医疗专家协同合作治疗病人,让病人了解治疗情况,保有充足的人手为病人务,还尽可能为病人提供上门务。当大限到来之时,也不将病人强留于世。This is slippery territory. The Medicare Hospice Benefit act, passed by Congress 30 years ago, offers palliative care to those expected to die within six months, but requires that once they take it up, treatment for their condition must stop. That puts many patients off. And when they hear “palliative care” and “hospice”, their usual reaction is, “Im not that far gone yet.” Yet hospice patients typically last only two or three weeks. As Dr Byock says, this has become “brink-of-death care”.姑息疗法处境尴尬。美国国会30年前通过了《临终关怀医疗保障法案》,为那些预期寿命只有6个月的病人提供姑息疗法。但是根据该法案,病人一旦选择了姑息疗法,就不得再接受对其病症的治疗,使得许多病人望而却步。而且人们听到“姑息疗法”或者“临终关怀”,总会觉得:“我的情况还没有那么糟吧。”所以,大多数接受临终关怀的病人往往只能生存两到三周。正如Byock所说,这成了“死亡边缘的关怀”。Nor is it easy to decide when to stop making every effort to save someones life and allow them to die gently. The book es the case of one HIV-positive young man who was acutely ill with multiple infections. He spent over four months in hospital, much of the time on a ventilator, and had countless tests, scans and other interventions. The total bill came to over m. He came close to death many times, but eventually pulled through and has now returned to a normal life. It is an uplifting story, but such an outcome is very rare.究竟何时可以不再尽一切努力挽救病人的生命,而是放手让他们从容走向死亡?很难判断。书中便举出了一个例子:从前,有一位青年身患艾滋病,病情危重,并发多种感染。他在医院里度过了四个月,大多数时间都连在呼吸机上,做了许多次检测、扫描和其它干预治疗,最后医疗总账单超过了100万美元之巨。他曾一次次濒临死亡,最终却挺了过来,过上了正常的生活。这是个让人振奋的故事,但是如此美好的结局很少出现。Dr Byocks writing style is not everybodys cup of tea. The patients personal stories are told in minute detail, leaving the er gagging at the degree of physical and psychological suffering that is most peoples lot towards the end of their lives. And the author gets rather messianic, advocating a more caring society that shows no sign of materialising. But he is surely right to suggest better management of a problem that can only get worse. As life expectancy keeps on rising, so will the proportion of old people in the population. And with 75m American baby-boomers now on the threshold of retirement, there is a limit to what the country can afford to spend to keep them going on and on.Byock士的写作风格可能不会合所有人的胃口。他把病人的故事事无巨细地一一写出,让读者对多数人死亡前将要面对的心理和生理折磨感到窒息。作者也有些以救世主自居,在书里宣扬一个不太可能出现的更有爱心的社会。不过,他说要妥善处理一个必将越来越严重的问题,这是对的:随着预期寿命不断提高,老年人口的比重也会越来越大。如今,美国婴儿潮中出生的7500万人即将退休,国家财力有限,无法在生命的路途中将他们送上一程一程又一程。 /201210/203127

CHEERS greeted Barack Obamarsquo;s hiring of Cass Sunstein away from the University of Chicago. Mr Sunstein, a lawyer, now head of the Office of Information and Regulatory Affairs, is in charge of lifting the heavy hand of regulation from Americarsquo;s economy. Known for his clever economics, Mr Sunstein favours a ;libertarian paternalism;; policies that nudge, but do not force, people to do the right things. For example, making people opt out instead of opting in to pension plans makes many more sign up, to their benefit. And Mr Sunstein has been involved in redesigning dietary recommendations and fuel-efficiency stickers for cars, making formerly confusing information more useful.奥巴马从芝加哥大学挖来了凯斯bull;桑斯坦,此举让人欢欣鼓舞。桑斯坦律师现在是白宫信息和监管事务办公室主任,负责降低监管对美国经济的干预力度。桑斯坦因其睿智的经济学思想而名满天下,并且信奉对经济应持;家长式的自由管理;态度;他认为政策应该引导,而不是强制人民去做正确的事情。比如说,让人民选择是否放弃而不是选择是否加入退休金计划使得更多人参与该计划,并最终让他们自身受益。桑斯坦还参与了饮食建议与汽车燃油效能标签的重新设计,使得之前混乱的信息更易于理解。Mr Sunstein is now in charge of overseeing a year-old executive order from Mr Obama telling every agency to slimits rule book. Mr Sunstein says every one has complied, with 580 proposals received from the departments under his purview. (Independent agencies like the Securities and Exchange Commission are not among them.) And he says real savings are on the way. Lifting a requirement for states to require pollution vapour-recovery systems will save 0m in five years. Making it easier for doctors and hospitals to participate in the Medicare programme for the elderly will save billion. He adds that agencies have responded not grudgingly (the old stereotype of bureaucrats loth to surrender cash or power), but eagerly.桑斯坦现在负责监督一年前奥巴马总统颁布的行政命令(的执行情况),该命令要求各有关部门精简其规章制度。桑斯坦表示所有部门都执行了该法令,并且他管辖的部门已经上交了580份提案(不包括券交易委员会等独立机构)。他表示更切实有效的节省计划即将展开。要求各州配备污染蒸汽回收系统的措施可以在未来五年内节约4亿美元。让医生和医院更方便参与老年人的美国联邦医疗计划的举措可以节约约50亿美元。桑斯坦补充说,各级部门并不是勉强应付该行政令(旧官僚体制往往不愿意交出资金和权力),而是予以积极配合。But the Obama administration has added to the rulebook at the same time as it is trimming. And many of the rules are big: 194 of them, each with an economic impact (not necessarily a net cost) of 0m or more, have been published in the Federal Register. In George Bushrsquo;s first three years, 141 hit the books. Even if most have more benefits than costs, as the agenciesrsquo; economists calculate, the scope of regulation is not shrinking. The overall cost of regulation is unknown, and measurement controversial. One study for the Small Business Administration found that regulation cost .75 trillion a year in 2008, though many object to the analysis. It relies on a methodology, invented at the World Bank, which one of the bankrsquo;s researchers says was misused, and Mr Sunstein dismisses it as ;an urban myth;.但是奥巴马政府在精简法规的同时又在对法规进行增补,增补的许多法规都规模甚大:其中有194项经济影响(不一定是净成本)超过1亿美元的法规都已在联邦公报上公布。在乔治布什政府上台的前三年,类似的法规有141项。甚至即使大多数法规带来的利益都高于其成本(根据各级部门的经济学家计算),监管的范围仍然没有缩减。监管的总成本仍是个未知数,计算方法也饱受争议。一项对于小型企业的研究表明2008年仅不完全统计分析的监管成本就高达1.75万亿美元,该统计基于世界研究出的分析方法,但该的研究人员表示该方法其实并不适用于此,桑斯坦也反对该结果,认为这是个;都市传说;(意即认为此事并不可信)。Meanwhile, the executive agencies are accused of minimizing costs by counting only hours spent on paperwork or money spent on kit to comply with regulation. The real costs may be found in the hard-to-calculate perversion of behaviour that over-regulation causes. At the same time, the benefits tallied up by regulators may be overvalued (see article). The agencies calculate their own numbers, using their own methodologies. But what no one doubts is that compliance with the ever-expanding rule book is wearisome and hard.与此同时,行政部门被指控通过仅计算文案工作时间和设备成本来最小化成本以迎合监管要求。真实成本可能体现在由于监管过度导致人们为了应付政策而表现出来的反常行为中,而这些成本是难以量化的。同时,各部门可能过高估计了监管所带来的收益(参考此文),因为各部门都使用自己的数据和计算方法来计算收益。但是唯一可以确定的是,想要符合日渐繁杂的规章制度已经是难上加难了。Furthermore, the politics of removing regulations is harrowing. Each removal must go through the same cumbersome process it took to put the regulation in place: comment periods, internal reviews and constant behind-the-scenes lobbying. Ironically, regulated industries may actually not want regulations removed. They have sunk costs into compliance, and do not want those costs taken away to the benefit of upstart competitors.而且,降低监管力度的政策同样难以实施。法规的精简需要和增加法规走同样复杂冗长的流程:评估阶段,内部评审,不停的幕后游说。讽刺的是,饱受法规监管折磨的工业企业实际上反而可能希望保留这些法规监管,因为他们不希望他们由于遵守法规所带来的沉没成本因为法规的消失而变成新兴竞争对手的利益。Many proposals are floated to deal with this last problem. One, supported by the Republican candidate Mitt Romney, is to remove one regulation for each new one that is proposed. A second idea is to create a truly independent scorer for regulatory costs and benefits, modelled on the widely respected Congressional Budget Office. A third is to create a board of outside grandees to help break political deadlocks, like the Base Realignment and Closure commission, which was able to prod Congress to shut down military bases. And yet another is creating a full-time advocate for regulatory rollback: one state, Kansas, has created an ;Office of the Repealer;, which aggregates complaints and suggests repeals to the governor and legislature. Lastly, automatic ;sunsets; of laws have their fans, though Congress could mindlessly reauthorise laws gathered up in omnibus bills (and a bitterly divided Congress might allow good laws to lapse).为了应对上述最后一个问题,许多提案纷纷浮出水面。其中一个是由共和党候选人Mitt Romney所持的提案,内容为每当有一项新提案提出时,就废除一项对应的旧法规。第二个办法是以广受尊崇的国会预算办公室为蓝本,成立一个真正独立的评判机构来裁定法规的成本与利益。第三个办法是成立一个由外界知名人士组成的;董事会;,以帮助打破政治僵局,比如说就像之前的军事基地重组与关闭委员会一样,可以督促国会关闭军事基地。但是还有一个办法是成立一个全职机构负责回审监管法规:堪萨斯州率先成立了;废止议案办公室;,功能是汇总对于议案的反对意见并向政府和立法机关提交议案的废止建议。除此之外,还有人持法律的定期自动;终结;,当然国会还是可能会无脑地重新为各项议案中提及的即将到期的法律延期的(而且加入自动;终结;条文后,国会内部的分歧也可能会让一些好法律在到期后无法被延期而流产)。Finally, one bad idea is the REINS bill. Passed by the House, it would involve Congress more heavily in rule-making. If there is a body worse than the executive agencies at this kind of thing, it is Congress. A 1999 study by the OECD found that poorly written laws, not subsequent rule-writing, were at the heart of Americarsquo;s regulatory woes. (No one has been foolish enough to suggest that Congress has become wiser since then.) Jim Cooper, a Democratic House member from Tennessee, says of his colleagues: ;People vote on things they have not , do not have the time to , and cannot .; He further despairs of the power of special interests to bend Congressrsquo;s will: ;There is a pimento lobby,; he says of those who fight for the interests of those who grow the small red peppers served inside olives. ;You do not want to cross the pimento people.; In such an environment, getting things undone is at least as hard as getting them done, and perhaps harder still.最后不得不说,REINS法案(详细审查法案)是个糟糕的决定。众议院通过了该法案,国会可以越俎代庖地更多地参与规章制定环节。还有什么比行政部门更烂的类似机构吗?舍国会其谁!经济合作与发展组织(OECD)在1999年的研究表明,美国监管困境的核心问题是那些写的很烂的法律,而不是随后的规则制定。(没有人会天真到认为国会会吸取这份研究的经验而变得更加明智)来自田纳西州的民主党下议院议员Jim Cooper对他的同事表示:;国会那些家伙根本不去看他投了什么一票,也没时间看,更看不懂那些玩意儿。;他更对国会的意愿屈于特殊利益集团之事表示失望:;有一个关于辣椒的游说,;他指的是那些为了争取那些种小红辣椒(餐馆里放在橄榄里的那种辣椒)的人的利益的人,;你们(国会)都不敢得罪那些;辣角色;。;在这样的环境里,要把现有法规取消不比建立新法规更简单,甚至有可能更难。201202/172552

So in some ways, a voyage to Mars could be a voyage home.所以在某些方面,火星之旅可能是一次回家的旅程。Our ancestors have made such bold trips before,我们的祖先之前已经进行了如此大胆的旅行,when we walked at Africa,当我们走过非洲,when we sailed over the horizon.当我们走过地平线。If it’s technically possible,如果是在技术上可行,our ships will held out again.我们的船将再次出行。“We both want to see what’s over the next year,“我们都想看到在未来的几年里,and Mars is that makes all over the hell.火星像地球一样被人熟知。Sure, you gonna have to be in the soon, we can’t have to be in return, but it’s a planet.当然,你能在不久之后,我们可以不需要返回,但它是一颗行星。You got on surface, you can see, you can walk, you can explore.你在表面上,你可以看,你可以行走,你可以探索。“My self about 30 years now that we can go to Mars and usually when people ask me how long you will take,“我自己大约30岁,现在,我们能去火星,而通常当人们问我多久的时候,I say 15 years, because we’ve been same 15 years for the last about 4 decades.”我说15年,因为我们一直在用相同的15年,而最后大约用了40年”。“Our human machine on Mars can have seen enough for me.“在火星上我们人类的机器已经看的够多。I’m, you know, I’m a robot guy.我,你知道,我是一个机器人。That’s what I do in my career, as build robots and send them tomorrow,这就是我在职业生涯中做的,作为建筑机器人,我明天会去送他们,but I also think that we same things tomorrow for reasons other than science.但是我也认为明天同样的事情是原因而不是科学。Our robots, spirited in opportunity were built by people,我们的机器人是由人类建造,who like me, grow up in the 1960s, watching Mercury,polar on TV,他像我一样,在20世纪60年代长大, 在电视上看着水星,看着各种各样的东西,as look as in dreaming, we’ll sending spaceships tomorrow someday.看起来像在做梦一样,我们有一天将发射飞船。注:听力文本来源于普特201205/182742

A test run before attempting the fuel hungry and risky trip to the planet below.在这次危险的旅途前会进行测试检验燃料。Dreaming about Mars and actually going there are two very different things.幻想火星会有两个很不一样的东西。Mars may be our neighbour,火星可能是我们的邻居,but 35 million miles to the closest point is still a very long way from home.但到最近点的3500万英里仍然对于回家来说是一段很长的路。To put him on the surface of Mars,为了要把他放在火星表面,someone once joked therere only three issues:有人曾开玩笑说会有三个问题:getting them there, keeping them alive while they are there and getting them back.让他们到那里,让他们在那里活着,之后让他们活着回来。Our space age dreams of off-world colonies on the moon and Mars faded with the cancellation of the Apollo Program and the last trip to the lunar surface in 1972.我们在月球和火星殖民的太空梦想随着阿波罗计划取消和1972年最后一次去月球表面而最终不了了之。It didnt stop us from travelling,但这并不妨碍我们旅行,we simply switched from astronauts to lower cost, lower risk robotic explores.我们只是由宇航员到降低成本,低风险的机器人进行探索。And when it comes to Mars, its probably just as well.当谈到火星,这可能只是。Getting to Mars is just unbelievably hard.到达火星是不可想像的。Weve learned that the hard way before certainly get to go back to the days before the robots launch 2/3 in the missions that they fall in the Mars and fail.我们已经了解到,之前的艰难的方法, 有2/3的发射任务的机器人在火星的任务最终以失败而告终。And they fail for all kinds of reasons,它们失败的理由各种各样,rockets that blew up and spacecraft just vanished partly without a trace.火箭爆炸和宇宙飞船就这样部分消失的无影无踪。注:听力文本来源于普特201204/178607

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