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Passage Two Being a man has always been dangerous. There are about 105 males born for every 100 females, but this ratio drops to near balance at the age of maturity, and among 70-year-olds there are twice as many women as men. But the great universal of male mortality is being changed. Now boy babies survive almost as well as girls do. This means that, for the first time, there will be an excess of boys in those crucial years when they are searching for a mate. More important, another chance for natural selection has been removed. Fifty years ago, the chance of a baby (particularly a boy baby) surviving depended on its weight. A kilogram too light or too heavy meant almost certain death. Today it makes almost no difference. Since much of the variation is due to genes, one more agent of evolution has gone. There is another way to commit evolutionary suicide: stay alive, but have fewer children. Few people are as fertile as in the past. Except in some religious communities, very few women have 15 children. Nowadays the number of births, like the age of death, has become average. Most of us have roughly the same number of offspring. Again, differences between people and the opportunity for natural selection to take advantage of it have diminished. India shows what is happening. The country offers wealth for a few in the great cites and poverty for the remaining tribal peoples. The grand mediocrity of today everyone being the same in survival and number of offspring means that natural selection has lost 80% of its power in upper-middle-class Indian compared with other tribes. For us, this means that evolution is over; the biological Utopia has arrived. Strangely, it has involved little physical change. No other species fills so many places in nature. But in the past 100,000 years--even the past 100 years--our lives have been transformed but our bodies have not. We did not evolve, because machines and society did it for us. Darwin had a phrase to describe those ignorant of evolution; they "look at an organic being as a savage looks at a ship, as at something wholly beyond his comprehension". No doubt we will remember a 20th century way of life beyond comprehension for its ugliness. But however amazed our descendants may be at how far from Utopia we were, they will look just like us. What used to be the danger of a man according to the first paragraph

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男性,43岁,3年采周期性发作上腹痛,疼痛多在餐后0.5~1小时出现,进食后疼痛缓解不明显。6小时前饱食后突发右上腹持续刀割样疼痛,迅速转移至右下腹和下腹部,伴有恶心、呕吐,吐后腹痛不减轻,急送急诊室。查体:体温37.7℃,脉搏120次/min,呼吸18次/min,血压80/50mmHg。腹式呼吸消失。全腹肌紧张,压痛反跳痛明显,以上腹部为重。肝浊音界缩小,肠鸣音消失,腹腔穿刺抽出血性液体 立即给病人快速补充血容量,宜首先输注

A. 5%葡萄糖等渗氯化钠溶液
B. 10%葡萄糖溶液
C. 右旋糖酐溶液
D. 血浆
E. 全血

女性,58岁,农民,小学文化,已婚。因“肝内外胆管结石”于二年前行胆管空肠吻合术。三天前突然发生右上腹剧痛并伴恶心、呕吐、寒战、高热 (T.39.4℃)、全身皮肤及巩膜重度黄染,经当地医院抗炎治疗未见明显好转,转入一综合医院急诊科。查体发现:T.35.0℃、P.140次/min、R.36次/ min、BP.64/48mmHg。病人神志恍惚,表情淡漠,肢体冰凉,口唇及指端发绀,6小时尿量15ml。实验室检查:WBC23.6×109/L。诊断为急性重症胆管炎、感染性休克 其处理原则为

A. 以抗休克为主同时抗感染
B. 应用收缩血管药物
C. 补充能量药物
D. 应用抗组胺药物
E. 补充水分

男性,43岁,3年采周期性发作上腹痛,疼痛多在餐后0.5~1小时出现,进食后疼痛缓解不明显。6小时前饱食后突发右上腹持续刀割样疼痛,迅速转移至右下腹和下腹部,伴有恶心、呕吐,吐后腹痛不减轻,急送急诊室。查体:体温37.7℃,脉搏120次/min,呼吸18次/min,血压80/50mmHg。腹式呼吸消失。全腹肌紧张,压痛反跳痛明显,以上腹部为重。肝浊音界缩小,肠鸣音消失,腹腔穿刺抽出血性液体 应采取的治疗原则是

A. 立即手术剖腹探查
B. 先快速补液,待血压正常后手术
C. 快速补液、输血,用止血药,暂不手术
D. 先积极抗休克治疗,病情无好转再手术
E. 积极抗休克治疗,同时迅速手术

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