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患者，女，46岁，反复右上腹疼痛伴寒战发热3年，2天前再次发作并较前加重。查体：嗜睡状，体温40℃，脉搏126次/分，血压6.7/4kPa(50/30mmHg)，巩膜黄染，右上腹压痛、反跳痛和肌紧张，肝区明显叩击痛。 如该病人经输液扩容及应用血管活性药物后情况好转，下列治疗措施中最重要的是
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阅读下面一段文言文，完成第16～18题。 昔者齐桓公与鲁庄公为柯之盟。鲁大夫曹刿谓庄公曰：“齐之侵鲁，至于城下，城坏压境，君不图与”庄公曰：“嘻，寡人之生不若死。”曹刿曰：“然，则君请当其君，臣请当其臣。”及会，两君就坛，两相相揖。曹刿手剑援刃而进，迫桓公于坛上，曰：“城坏压境，君不图与”管仲曰：“然，则君何求”曹刿曰：“愿请汶阳田。”管仲谓桓公曰：“君其许之。”桓公许之。曹刿请盟，桓公遂与之盟，已盟，弃剑而去。左右曰：“要盟可倍，曹刿可仇，请倍盟而讨曹刿。”管仲曰：“要盟可负，而君不负；曹刿可仇，而君不仇，著信天下矣。”遂不倍。天下诸侯翕然而归之。为鄄之会，幽之盟，诸侯莫不至焉；为阳谷之会，贯泽之盟，远国皆来。南伐强楚，以致菁茅之贡；北伐山戎，为燕开路。三存亡国，一继绝世，尊事周室，九合诸侯，一匡天下，功次三王，为五伯长，本信起于柯之盟也。(《新序·杂事四》)1.用现代汉语写出以下句子的大意。 三存亡国，一继绝世，尊事周室，九合诸侯，一匡天下，功次三王，为五伯长，本信起于柯之盟也。
健康成人每天由肝脏分泌胆汁
患者，女，52岁，上腹部持续性疼痛伴腰背部放射痛12小时，伴呕吐，吐后腹痛不减轻。既往有胆总管结石病史。查体：体温38℃，腹略膨隆，上腹正中压痛，轻度肌紧张，反跳痛。移动性浊音(+)，肠鸣音减弱。血白细胞20×109/L，尿胆红素(-)，血清钾4mmol/L，血清钠135mmol/L，血清氯106mmol/L。 此病人最可能的诊断
Inspiration for Your Kids A parent, or anyone else who interacts regularly with kids, knows that communicating effectively with them can be difficult. If you want children to grow up into the best possible versions of themselves, it’s crucial to replace damaging words in your vocabulary with alternatives that help build character. Some of the things parents say to kids seem harmless or even constructive on the surface, but, experts say, they may hurt more than help. Here are some aspects under our consideration.1. When the kid deserves praise For years, we’ve been told that boosting a child’s self-esteem is important to his or her success in life. But child experts are now learning that too much praise can backfire (事与愿违). Praise-aholic tykes who expect it at every turn may become teens who seek the same kind of approval from their friends when offered a joint or asked if they want to go in the backseat of the car. The implication of saying "You’re the prettiest girl in class," or talking about the goals she scored but not her overall effort, is that you love her only when she looks the best, scores the highest, achieves the most. And this carries over to the classroom. Social psychologist Carol Dweck, PhD, tested the effects of overpraise on 400 fifth graders while she was at Columbia University. She found that kids praised for "trying hard" did better on tests and were more likely to take on difficult assignments than those lauded for being "smart" "Praising attributes or abilities makes a false promise that success will come to you because you have that trait, and it devalues effort, so children are afraid to take on challenges," says Dweck, now at Stanford University. "They figure they’d better quit while they’re ahead."2. When the kid asks more to take back home Does your child really need one more video game or doll Of course not. But by repeatedly saying money is the only reason he or she can’t have something, the parent may be sending the message that money is the source of all things good in life. Couple that with the marketing blitz everywhere they turn, and children will never get the meaning of excess or gratitude. "You want your children to have the sense of abundance until the age of five—not in a material way, but in the sense that what you do have brings joy," says Marcy Axness, PhD, a child development specialist and founder of quantumparenting. com. Finances are one of the few topics parents shouldn’t feel a duty to discuss or explain, especially with younger kids, Axness says. "If every request is met with a legal brief as to why they can’t have it or go there, you will end up with a child who is going to negotiate with you." Don’t be afraid to say to your little one, confidently and cheerfully, "No, sorry. Case closed." If it’s your older, money-wise child who’s asking Sit down with tier and Work out together how she can make the purchase happen—as a reward for improved grades, say, or by buying it with an allowance for doing extra chores. The process of talking it through matters more than how much each contributes.3. When the kid is upset When a child comes home upset about being teased by classmates or not winning a medal at the swim meet, it’s only natural for parents to overlook his disappointment and offer consolation (安慰). Adults know that such setbacks are minor. "But kids need to learn how to express feelings, work through them and move on, as opposed to trying to make them go away without expression," says Panaccione, an expert on children development. If children feel that they shouldn’t have feelings or that their feelings are bad, they’ll start to lock them inside and fail to adopt healthy coping strategies, she says. On the other hand, kids shouldn’t wallow in bad feelings. A question like "Why do you think this happened" or "Do you have any ideas about what you can do to make it better" may give them encouragement they need to deal with situations on their own. Says Mel Levine, MD, a professor of pediatrics at the University of North Carolina at Chapel Hill: "A parent gives more comfort by listening than by talking. If you simply resonate with your child’s mood, then you’ll have a child who’s always willing to come to you and bare her soul."4. When the kid talks to strangers Kids today need to, and do, talk to strangers all the time—at the store checkout, on the bus, in the doctor’s office. This antiquated catchphrase is no substitute for a serious one-on-one about the real risks. First, parents need a reality check: Despite the sensational stones, eases of children snatched off the sidewalk by total strangers and never seen again are extremely rare. Just 1 percent or fewer of all abductions happen that way. Meanwhile, children are frequently victimized by people they know well, including authority figures. That’s why it makes more sense to tell kids to be watchful of anyone, stranger or acquaintance, who makes them feel at all uncomfortable. Parents of kids who spend time on the Internet should warn them against giving information that would identify their whereabouts, such as their last name, address or school name, advises James Beasley, an expert on child predators for the FBI. And kids should always tell their parents about new online buddies, especially those who ask if the child is willing to keep a secret.5. When the kid doesn’t want to share You’d never hand the keys to your sports car to the guy next door. But that’s what you’re asking your children to do when you tell them to share a toy. "Young kids don’t distinguish clearly between themselves and the objects they own, like their teddy bear or favorite toy train," says psychologist David Elkind, PhD, a professor at Tufts University and the author of The Hurried Child. "So in effect you’re asking them to give away part of themselves." In extreme cases, if a child is forced to give up prized possessions over and over, the separation becomes so painful that he may avoid forming attachments to people, Elkind says. Kids don’t really begin to grasp the concept of sharing until age eight or so. Before then, it’s still important to begin conveying nuggets (至理名言) of selflessness. One solution is to put your child’s name on the toy before you take it out of his hands, so he knows you’re not forcing him to give up ownership. Children don’t want to share their toys because they can’t tell clearly the difference between ______.
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