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男性，62岁，急性重症胰腺炎患者，于保守治疗中，尿量逐渐减少，无尿2日，出现气促、全身水肿，血压180/92mmHg，心率120次/分，听诊闻及两下肺布满细湿啰音，查血钾3.9mmol/L，BUN25.2mmol/L，肌酐577mmol/L，目前应采取的最有效治疗手段是
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Questions 1 to 5 are based on an interview. At the end of the interview you will be given 10 seconds to answer each of the following five questions. Now listen to the interview. According to the interview, chemicals contained in green tea actually help
We have to admire Suzanne Somers’s persistence. She doesn’t give up--even when virtually the entire medical community is lined up against her. Three years ago, Somers wrote a best-selling book called The Sexy Years in which she promoted so-called bioidentical hormones as a more natural alternative to hormones produced by drug companies for menopausal women. Somers, now 60, claimed that these individually prepared doses of estrogen and other hormones, sold via the Internet or by compounding pharmacies, made her look and feel half her age. As the popularity of bioidenticals soared, major medical organizations like the American College of Obstetricians and Gynecologists grew so alarmed that they mounted publicity campaigns to convince Somers’s readers that these alternative treatments, which are usually custom made for each patient, haven’t been proven safe or more effective than traditional hormone therapy for symptoms like hot flashes. This month Somers is at it again with her latest book, Ageless. Subtitled The Naked Truth About Bioidentical Hormones, the cover features a coquettish shot of the actress unclothed from the collarbone up. Inside, she calls bioidenticals "the juice of youth" and also promotes the questionable dosage advice of a former actress and "independent researcher" named T.S. Wiley who thinks menopausal women should have as much estrogen in their bodies as 20-year-olds. Now, even some of the pro-bioidentical doctors Somers quotes in her books are screaming foul. "Many of the claims throughout the book are scientifically unproven and dangerous," three of these doctors assert in a letter sent a few weeks ago to Somers’s publisher, Crown. Somers adamantly defends her book and bioidenticals. "From a woman’s standpoint, this is the first time we’ve gotten some relief in a non-drug way," she says in an interview with NEWSWEEK. "Doctors are embarrassed that they don’t know about this," Somers says. "When doctors don’t have an answer, they like to pooh-pooh it." The word bioidentical is a marketing term, not a scientific one, and it means different things to different people. To most doctors, bioidentical refers to a wide variety of FDA-approved drugs that are virtually identical to the hormones produced by women’s ovaries. They come in many forms and doses, some of which have been used for years. Somers uses the term to refer to made-to-order treatments created by compounding pharmacies with dosages usually determined by the results of blood tests every two weeks (the method Somers herself uses), or regular saliva tests, a method most experts say is an unreliable way to measure a women’s specific hormone needs. Somers claims that she is so "in touch" with her body’s needs that she can "tweak" her hormones even without the benefit of these tests. Proponents of Somers’s program say only hormones prepared specifically for each woman can meet her unique needs. But since the Women’s Health Initiative, the FDA has approved many new hormone products, including some in very low doses. While the FDA process isn’t perfect, it’s certainly better than what consumers get with compounding products: no black box warning about side effects, no package insert, no data on relative safety, no check on advertising claims and no manufacturing oversight. Somers says these custom-made treatments are natural and not really drugs. That’s just not true. Bioidenticals may start out as wild yams or soybeans, but by the time this plant matter has been converted into hormone therapy, it is in fact a drug. All of these products--whether or not they’re approved by the FDA--are chemicals synthesized in a lab. Another thing you should know, there are only a few labs in the world that synthesize these hormones. Everyone--from small compounding pharmacies to big pharmaceutical companies--gets their ingredients from the same places. Somers argues that bioidenticals are safer than FDA-approved hormones even though there are no high-quality studies to prove that assertion. In the absence of any reliable research to the contrary, most women’s health experts say it’s prudent to assume that all hormone products (FDA-approved or not) carry the same heart disease and cancer risks. Which of the following statements is TRUE about some doctors Somers quotes in her books
There were a number of carved stone figures placed at intervals along the parapets of the old Cathedral; some of them represented angels, others kings and bishops, and nearly all were in attitudes of pious exaltation and composure. But one figure, low down on the cold north side of the building, had neither crown, mitre, nor nimbus, and its face was hard and bitter and downcast; it must be a demon, declared the fat blue pigeons that roosted and sunned themselves all day on the ledges of the parapet; but the old belfry jackdaw, who was an authority on ecclesiastical architecture, said it was a lost soul. And there the matter rested. One autumn day there fluttered on to the Cathedral roof a slender, sweet-voiced bird that had wandered away from the bare fields and thinning hedgerows in search of a winter roosting-place. It tried to rest its tired feet under the shade of a great angel-wing or to nestle in the sculptured folds of a kingly robe, but the fat pigeons hustled it away from wherever it settled, and the noisy sparrow-folk drove it off the ledges. No respectable bird sang with so much feeling they cheeped one to another, and the wanderer had to move on. Only the effigy of the Lost Soul offered a place of refuge. The pigeons did not consider it safe to perch on a projection that leaned so much out of the perpendicular, and was, besides, too much in the shadow. The figure did not cross its hands in the pious attitude of the other graven dignitaries, but its arms were folded as in defiance and their angle made a snug resting-place for the little bird. Every evening it crept trustfully into its corner against the stone breast of the image, and the darkling eyes seemed to keep watch over its slumbers. The lonely bird grew to love its lonely protector, and during the day it would sit from time to time on some rainshoot or other abutment and trill forth its sweetest music in grateful thanks for its nightly shelter. And, it may have been the work of wind and weather, or some other influence, but the wild drawn face seemed gradually to lose some of its hardness and unhappiness. Every day, through the long monotonous hours, the song of his little guest would come up in snatches to the lonely watcher, and at evening, when the vesper-bell was ringing and the great grey bats slid out of their hiding-places in the belfry roof, the brighteyed bird would return, twitter a few sleepy notes, and nestle into the arms that were waiting for him. Those were happy days for the Dark Image. Only the great bell of the Cathedral rang out daily its mocking message, "After joy... sorrow." The folk in the verger’s lodge noticed a little brown bird flitting about the Cathedral precincts, and admired its beautiful singing. They were poor, but they understood the principles of political economy. So they caught the bird and put it in a little wicker cage outside the lodge door. That night the little songster was missing from its accustomed haunt, and the Dark Image knew more than ever the bitterness of loneliness. When morning came there floated up to him, through the noise and bustle of the Cathedral world, a faint heart-aching message from the prisoner in the wicker cage far below. And every day, at high noon, the song of the little bird came up to the parapets—a song of hunger and longing and hopelessness, a cry that could never be answered. The pigeons remarked, between mealtimes, that the figure leaned forward more than ever out of the perpendicular. One day no song came up from the little wicker cage. There was a crackling sound in the night on the Cathedral roof and a noise as of falling masonry. The belfry jackdaw said the frost was affecting the fabric, and as he had experienced many frosts it must have been so. In the morning it was seen that the Figure of the Lost Soul had toppled from its cornice and lay now in a broken mass on the dustheap outside the verger’s lodge. A new bird flied on to the Cathedral roof immediately because
"I wouldn’t want to have someone take my daughter to a hospital for an abortion or something and not tell me. I would kill him if they do that." So much for Arnold Schwarzenegger’s typically expressive support for Proposition 73, a constitutional amendment requiring doctors to give parents 48 hours’ notice before carrying out an abortion on a girl under 18. Will the voters agree with the governor His own status erstwhile hedonist turned responsible father of two teenage girls and two pre-teen boys--reflects his state’s mixed feelings about sexual politics. California is one of the most sexually liberated states in the nation. It also boasts the fifth-worst rate for teenage abortions and the seventh for teenage pregnancies. In 2000, some 116,000 teenagers in California became pregnant, and almost 44,000 of them chose to have an abortion--including 1,620 under the age of 15. A recent Field Poll showed 45% of respondents in favour of the amendment, 45% against and 10% undecided. The proposition’s advocates are careful to argue that supporting parental notification is not the same as opposing abortion full stop. Mr. Schwarzenegger is a "pro-choice Republican" and the proposition would al-tow a minor to petition a court to allow her an abortion without notifying a parent. The real point, they say, is that a 17-year-old girl "can’t get an aspirin from the school nurse, get a flu shot, or have a tooth pulled without a parent knowing", but a 13-year-old can have a surgical or chemical abortion without her parents’ knowledge. And since a majority of the prospective fathers are over 21, the current system in effect condones statutory rape. Opponents, including the California Nurses Association and Planned Parenthood, are unconvinced. As an editorial in the Los Angeles Times argued: "It’s nice to think that all girls feel comfortable talking to their parents about sex, birth control and abortion. Nice, but absurd. "Equally absurd, add other opponents, is the notion that a pregnant teenager from an abusive family will have the gumption to go to court--rather than to some backstreet operator--to seek her abortion. And they suspect the proposition is the start of an effort to ban all abortions: instead of speaking of a fetus, the proposition defines abortion as causing the "death of the unborn child". Just how parental notification would affect the rate of teen pregnancies and abortions is an open question. Some 34 states require some parental involvement in a minor’s decision to end a pregnancy, but there is no hard-and-fast correlation with the number of abortions. For example, New Mexico and New Hampshire require no parental notification, but according to the Alan Guttmacher Institute, which studies reproductive health, they ranked 18th and 25th in the rate of teen abortions in 2000. By contrast, Wyoming and Florida, which do have notification laws, ranked 14th and 7th. And even if notification laws deter abortions, they do not seem to deter teen pregnancies: Texas, for example, is ranked 26th in abortions for girls aged 15--19 but fifth in pregnancies for that age group. This last statistic matters for California, where the main problem is teens getting pregnant in the first place. Roughly a quarter of California’s 14-year-olds and three-fifths of its 17-year-olds have had sex. True, according to the Public Policy Institute of California, birth rates fell from 73 for every 1,000 15—19-year- olds in 1991 to just 44 in 2001. But California’s teenage girls become mothers at between 4 and 12 times the rate of their peers in France, Spain, Italy, the Netherlands and Japan; the figures for blacks and Latinas in the state are particularly appalling. Whatever your views on abortion, these statistics add up to an awful lot of heartache. Those who are against the proposition suspect that it may lead to
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