男,58 岁,患有慢性支气管炎并阻塞性肺气肿。近日因感冒咳喘加重,并有低热。就诊前 2 小时突然喘息加剧,出大汗,用解痉止喘药均不能缓解。体检:喘憋状态,口唇紫绀,左肺叩诊过清音,右肺鼓音,右肺呼吸音消失,左侧呼吸音增粗并有少量干啰音、右肺的病情变化可能是发生了
A、肺不张E
暂无解析
Whattypesofsportsdoyoulikewatchingorplaying?(Why?)
Wewishtoexpressourdesiretotradewithyouinleathershoes.
InItaly,whenpeopletouchtheireyes,itrepresents:
1.Thefailureofahigh-profilecholesteroldrughasthrownaspotlightonthecomplicatedmachinerythatregulatescholesterollevels.Butmanyresearchersremainconfidentthatdrugstoboostlevelsof'good'cholesterolarestilloneofthemostpromisingmeanstocombatspirallingheartdisease.
2.DrugcompanyPfizerannouncedon2Decemberthatitwascancellingallclinicaltrialsoftorcetrapib,adrugdesignedtoraiseheart-protectivehigh-densitylipoproteins(HDLs).Inatrialof15000patients,asafetyboardfoundthatmorepeoplediedorsufferedcardiovascularproblemsaftertakingthedrugplusacholesterol-loweringstatinthanthoseinacontrolgroupwhotookthestatinalone.
3.Thenewscameasakickintheteethtomanycardiologistsbecauseearliertestsinanimalsandpeoplesuggesteditwouldlowerratesofcardiovasculardisease."Therehavebeennoredflagstomyknowledge,"saysJohnChapman,aspecialistinlipoproteinsandatherosclerosisattheNationalInstituteforHealthandMedicalResearch(INSERM)inPariswhohasalsostudiedtorcetrapib."Thiscancellationcameasacompleteshock."
4.TorcetrapibisoneofthemostadvancedofanewbreedofdrugsdesignedtoraiselevelsofHDLs,whichferrycholesteroloutofartery-cloggingplaquestotheliverforremovalfromthebody.Specifically,torcetrapibblocksaproteincalledcholesterolestertransferprotein(CETP),whichnormallytransfersthecholesterolfromhigh-densitylipoproteinstolowdensity,plaque-promotingones.Statins,incontrast,mainlyworkbyloweringthe'bad'low-densitylipoproteins.
Underpressure
5.Researchersarenowtryingtoworkoutwhyandhowthedrugbackfired,somethingthatwillnotbecomeclearuntiltheclinicaldetailsarereleasedbyPfizer.Onehintliesinevidencefromearliertrialsthatitslightlyraisesbloodpressureinsomepatients.Itwasthoughtthatthismildproblemwouldbeoffsetbytheheartbenefitsofthedrug.Butitispossiblethatitactuallyprovedfatalinsomepatientswhoalreadysufferedhighbloodpressure.Ifbloodpressureistheexplanation,itwouldactuallybegoodnewsfordrugdevelopersbecauseitsuggeststhattheproblemsarespecifictothiscompound.OtherprototypedrugsthatarebeingdevelopedtoblockCETPworkinaslightlydifferentwayandmightnotsufferthesamedownfall.
6.ButitisalsopossiblethatthewholeideaofblockingCETPisflawed,saysMotiKashyap,whodirectsatherosclerosisresearchattheVAMedicalCenterinLongBeach,California.WhenHDLsexcretecholesterolintheliver,theyactuallyrelyonLDLsforpartofthisprocess.SoinhibitingCETP,whichpreventsthetransferofcholesterolfromHDLtoLDL,mightactuallycauseanabnormalandirreversibleaccumulationofcholesterolinthebody."You'reblockingaphysiologicmechanismtoeliminatecholesterolandeffectivelyconstipatingthepathway,"saysKashyap.Goingup
7.Mostresearchersremainconfidentthatelevatinghighdensitylipoproteinslevelsbyonemeansoranotherisoneofthebestroutesforhelpingheartdiseasepatients.ButHDLsarecomplexandnotentirelyunderstood.Oneapproveddrug,calledniacin,isknowntobothraiseHDLandreducecardiovascularriskbutalsocausesanunpleasantsensationofheatandtingling.Researchersareexploringwhethertheycanbypassthissideeffectandwhetherniacincanlowerdiseaseriskmorethanstatinsalone.Scientistsarealsoworkingonseveralothermeanstobumpuphigh-densitylipoproteinsby,forexample,introducingsyntheticHDLs."Theonlythingweknowisdeadinthewateristorcetrapib,notthewholeideaofraisingHDL,"saysMichaelMiller,directorofpreventivecardiologyattheUniversityofMarylandMedicalCenter,Baltimore.
Questions7-13
Matchtorcetrapib,HDLs,statinandCETPwiththeirfunctions(Questions8-13)..WritethecorrectletterA,B,CorDinboxes8-13onyouranswersheet.NBYoumayuseanylettermorethanonce.
7.Ithasbeenadministeredtoover10,000subjectsinaclinicaltrial.
8.Itcouldhelpridhumanbodyofcholesterol.
9.Researchersareyettofindmoreaboutit.
10.Itwasusedtoreducethelevelofcholesterol.
11.AccordingtoKashyap,itmightleadtounwantedresultifit'sblocked.
12.Itproducedcontradictoryresultsindifferenttrials.
13.ItcouldinhibitLDLs.Listofchoices
A.TorcetrapicB.HDLSC.StatinD.CETP
Employeeswhodon’thavetheenergytopreparemealsafteralongordifficultworkdaycantakehomeapreparedmeal.