患者女性,58岁,因“食欲缺乏、腹部不适1周,咳嗽5日;双下肺炎、双侧胸腔积液、淋巴结肿大原因待查、原发性高血压(1级中危)、精神分裂症”来诊。诊断: ①肺炎; ②转移性低分化腺癌并多发淋巴结转移。 入院第5日患者因自服过量多塞平片,呼吸、心搏骤停,给予气管插管、呼吸机辅助呼吸、锁骨下静脉穿刺、持续导尿及硫酸依替米星预防感染;同时给予肠内营养对症支持治疗。第11日患者脱机,但出现持续发热,最高体温39.2℃,双下肺可闻及湿啰音,经验选择“亚胺培南-西司他丁钠0.5g,每8小时1次,静脉滴注”抗感染治疗。第16日尿液培养出奇异变形杆菌,对亚胺培南敏感。第18日患者仍发热,体温38℃以上,加用万古霉素0.5g,每8小时1次,静脉滴注。第21日2次痰培养见耐甲氧西林金黄色葡萄球菌(MRSA),对万古霉素、替考拉宁、利奈唑胺敏感。第23日患者体温无下降,停用亚胺培南后仍然持续发热,体温38℃以上。第27日停用万古霉素,换用利奈唑胺0.6g,每12小时1次,静脉滴注。第28日患者仍发热,体温在39℃以上,痰培养见光滑球拟酵母菌,对氟胞嘧啶敏感,对氟康唑、伊曲康唑、伏立康唑均耐药。根据痰培养结果,结合患者病史和症状,加用卡泊芬净50mg抗真菌治疗,每日1次,静脉滴注。第32日患者仍发热,行纤维支气管镜保护毛刷刷检。第35日痰培养见阴沟肠杆菌,对亚胺培南、左氧氟沙星、多西环素敏感;保护性毛刷刷检见嗜麦芽窄食单胞菌,对头孢哌酮舒巴坦、左氧氟沙星敏感。遂静脉滴注头孢哌酮舒巴坦3g,每8小时1次及左氧氟沙星0.5g,每日1次,联合抗感染治疗4日,患者体温下降至37℃以下,继续应用10余日,病情稳定出院。出院诊断: ①呼吸机相关性肺炎; ②转移性低分化腺癌并多发淋巴结转移。 该患者应用万古霉素9日,最不可能发生的不良反应是()
A. 耳毒性
B. 肾毒性
C. 肝损伤
D. 变态反应
E. 粒细胞减少
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Questions 21 to 25 are based on the following passage. Lead deposits, which accumulated in soil and snow during the 1960’s and 70’s, were primarily the result of leaded gasoline emissions originating in the United States. In the twenty years that the Clean Air Act has mandated unleaded gas use in the United States, the lead accumulation worldwide has decreased significantly. A study published recently in the journal Nature shows that air-borne leaded gas emissions from the United States were the leading contributor to the high concentration of lead in the snow in Greenland. The new study is a result of the continued research led by Dr. Charles Boutron, an expert on the impact of heavy metals on the environment at the National Center for Scientific Research in France. A study by Dr. Boutron published in 1991 showed that lead levels in arctic (北极的) snow were declining. In his new study, Dr. Boutron found the ratios of the different forms of lead in the leaded gasoline used in the United States were different from the ratios of European, Asian and Canadian gasolines and thus enabled scientists to differentiate (区分) the lead sources. The dominant lead ratio found in Greenland snow matched that found in gasoline from the United States. In a study published in the journal Ambio, scientists found that lead levels in soil in the Northeastern United States had decreased markedly since the introduction of unleaded gasoline. Many scientists had believed that the lead would stay in soil and snow for a longer period. The authors of the Ambio study examined samples of the upper layers of soil taken from the same sites of 30 forest floors in New England, New York and Pennsylvania in 1980 and in 1990. The forest environment processed and redistributed the lead faster than the scientists had expected. Scientists say both studies demonstrate that certain parts of the ecosystem (生态系统) respond rapidly to reductions in atmospheric pollution, but that these findings should not be used as a license to pollute. How did scientists discover the source of lead pollution in Greenland? ()
A. By analyzing the data published in journals like Nature and Ambio.
By observing the lead accumulations in different parts of the arctic area.
C. By studying the chemical elements of soil and snow in Northeastern America.
D. By comparing the chemical compositions of leaded gasoline used in various countries.
某建设单位和施工单位签订了施工合同,合同中约定:建筑材料由建设单位提供;由于非施工单位原因造成的停工,机械补偿费为200元/台班,人工补偿费为50元/日工;总工期为120天;竣工时间提前奖励为3000元/天,误期损失赔偿费为5000元/天。经项目监理机构批准的施工进度计划如下图所示(单位:天)。 施工进度计划 施工过程中发生如下事件: 事件1:工程进行中,建设单位要求施工单位对某一构件作破坏性试验,以验证设计参数的正确性。该试验需修建两间临时试验用房,施工单位提出建设单位应该支付该项试验费用和试验用房修建费用。建设单位认为,该试验费属建筑安装工程检验试验费,试验用房修建费属建筑安装工程措施费中的临时设施费,该两项费用已包含在施工合同价中。 事件2:建设单位提供的建筑材料经施工单位清点入库后,在专业监理工程师的见证下进行了检验,检验结果合格。其后施工单位提出,建设单位应支付建筑材料的保管费和检验费;由于建筑材料需要进行二次搬运,建设单位还应支付该批材料的二次搬运费。 事件3:①由于建设单位要求对B工作的施工图纸进行修改,致使B工作停工3天(每停一天影响30工日,10台班);②由于机械租赁单位调度的原因,施工机械未能按时进场,使C工作的施工暂停5天(每停一天影响40工日,10台班);③由于建设单位负责供应的材料未能按计划到场,E工作停工6天(每停一天影响20工日,5台班)。施工单位就上述三种情况按正常的程序向项目监理机构提出了延长工期和补偿停工损失的要求。 事件4:在工程竣工验收时,为了鉴定某个关键构件的质量,总监理工程师建议采用试验方法进行检验,施工单位要求建设单位承担该项试验的费用。该工程的实际工期为l22天。 逐项说明事件3中施工单位提出索赔的合理性并说明理由。
在台湾,制鞋业较发达,因而竞争也激烈。台北市的金华皮鞋公司在经营上常出别人不敢轻易尝试的新招,并取得了意想不到的成绩。 一天,地处延平北路的金华皮鞋公司门口,挂出了“不二价”的特大招牌。所谓“不二价”即不还价。这在当时的延平北路可谓风险冒得太大。因为人们到延平北路买东西,即使打心眼里喜欢某物,也还要还点价,否则就觉得吃了亏。人们已形成概念:买东西照标价付钱是最傻不过的。久而久之,厂商们索性把售价提高两倍左右,以便顾客还价时,交易折扣能让买卖双方满意。 金华公司实施“不二价”后,很多顾客对某双皮鞋非常中意,可就是由于根深蒂固的“怕吃亏”心理,总觉得照标价付钱亏了,许多眼见成交的生意都吹了。 金华遇到了历史上最冷清的时期。许多职工抱怨:“创什么新,干脆恢复原先的做法,制定虚泛价格,来满足顾客捡便宜的心理。”公司老板叫杨金彬,主意是他出的。听到职工们的抱怨,杨考虑:“以自己多年经营皮鞋的经验来看,此次打出‘不二价’新招,是有点令人发寒;但从价格上看,本公司售价是依据皮鞋质料、做工、市场状况而确定的,且比别人的标价低一倍,自己没有亏待顾客。”经再三权衡,他认为“顾客会货比数家,再来金华的。”便决定挺一阵子。 果然不出杨老板所料,时隔不久,金华公司门庭若市,许多顾客到可以讨价的商店购买,打折后,皮鞋价格往往仍比“金华”为高。因此,顾客们纷纷回头光顾金华。不二价的真正用意,总算被顾客了解并接受了。职员们愁眉锁眼的脸上也露出笑颜。许多厂商看到“金华”的成功,纷纷效法,渐渐地搞起了不二价和公开标价。现在到延平北路,再也不见以往那种漫天要价和顾客大杀价的现象了。 公司经理对“不二价”的推出之所以自信,是因为他依据了()
A. 成本导向定价法
B. 需求导向定价法
C. 竞争导向定价法
D. 所有上述
[内蒙古自治区蒙古语言文字工作条例]第()条规定:蒙古语言文字是自治区的通用语言文字,是行使自治权的重要工具。