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女患者，45岁，以“双手近端指间关节、掌指关节、腕关节肿痛3个月”来诊，无发热、皮疹及脱发，有晨僵，关节无畸形。化验ESR 62mm/1h，RF 460kU/L，ANA阴性，血常规、尿常规正常。 如要进一步明确诊断，哪项检查最有意义
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男性，30岁。因与人争吵被人用刀刺伤右胸部半小时入院。查体：血压90/45mmHg，呼吸32/min，脉搏110/min，烦躁不安，颜面苍白，口唇发绀，右前胸靠外侧可见2～3cm长刀伤破裂口，随患者呼吸闻及气体从破裂口出入的声响。胸部透视右肺压缩70%，右侧肋脯角消失。 下一步的处理措施主要包括
血清脂肪酶持续时间是（）
男性患者，75岁，1年前开始家人发现其常记不起刚刚发生的事，逐渐加重，现语言运用能力下降，不能说完整的句子，不能进行简单的计算，不会用筷子，而且常怀疑家人偷自己钱物，夜间有谵妄。余查体无异常体征。既往无相关疾病病史。头MRI示轻度脑萎缩。 该患者最可能的诊断是
Almost everyone agrees that America’s health-care system has the incentives all wrong. Under the present system, doctors and hospitals get paid for doing more, even if added tests, operations and procedures have little chance of improving patients’ health. So what happens when someone proposes that we alter the incentives to reward better care, not more care Well, Rep. Paul Ryan and Republicans found out. No surprise: Democrats slammed them for "ending Medicare as we know it. "This predictably partisan reaction preying upon the anxieties of retirees—must depress anyone who cares about the country’s future. It is only a slight exaggeration to say that unless we end Medicare "as we know it," America "as we know it" will end. Spiraling health spending is the crux of our federal budget problem. In 1965—the year Congress created Medicare and Medicaid—health spending was 2.6 percent of the budget. In 2010, it was 26.5 percent. The Obama administration estimates it will be 30.3 percent in 2016. By contrast, defense spending is about 20 percent; scientific research and development is 4 percent.Uncontrolled health spending isn’t simply crowding out other government programs; it’s also dampening overall living standards. Health economists Michael Chernew, Richard Hirth and David Cutler recently reported that higher health costs consumed 35.7 percent of the increase in per capita income from 1999 to 2007. They also project that, under reasonable assumptions, it could absorb half or more of the gain between now and 2083.Ryan proposes to change that. Beginning in 2022, new (not existing) Medicare beneficiaries would receive a voucher, valued initially at about $ 8,000. The theory is simple. Suddenly empowered, Medicare beneficiaries would shop for lowest-cost, highest-quality insurance plans providing a required package of benefits. The health-care delivery system would be forced to restructure by reducing costs and improving quality. Doctors, hospitals and clinics would form networks; there would be more "coordination" of care, helped by more investment in information technology; better use of deductibles and co-payments would reduce unnecessary trips to doctors’ offices or clinics.It’s shock therapy. Would it work No one knows, but two things are clear. First, as Medicare goes, so goes the entire health-care system. Medicare is the nation’s largest insurance program, with 48 million recipients and spending last year of $ 520 billion. Second, few doubt that today’s health-care system has much waste: medical care that does no good.Under Ryan’s plan, incentives would shift. Medicare would no longer be an open ATM; the vouchers would limit total spending. Providers would face pressures to do more with less; there would certainly be charges that essential care was being denied. The Obama administration argues that better results can be achieved by modifying incentives within the existing system. Perhaps. But history suggests skepticism. It’s Ryan’s radicalism vs. President Obama’s remedy policy. Which is realistic and which is wishful thinking Burdened by runaway spending, Medicare "as we know it" is going to end. The only questions are when and on whose terms. Which of the following areas is not seriously affected by budget on health care（）
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