2010 TEM-4 DIC

血栓弹力图的临床应用评价王学锋【摘要】血栓弹力图(thromboelastograph,TEG)是描述因纤维蛋白聚合而导致血液粘弹性(viscoelasticity,VE)变化而产生的图形,通过监测凝血全过程整体评价凝血功能.自1948年德国人Hellmut Harter首次报道以来,TEG已成功应用于对患者出凝血状态的评估.近年来,TEG除用于指导手术中成分输血外,还广泛应用于检测凝血功能障碍和监测抗栓治疗等.【期刊名称】《临床检验杂志》【年(卷),期】2017(035)012【总页数】5页(P887-891)【关键词】血栓弹力图;出血;凝血;血栓;围手术期;肝移植;脓毒症【作者】王学锋【作者单位】上海交通大学医学院附属瑞金医院检验科,上海200025【正文语种】中文【中图分类】R446.11出血是临床常见症状，无论内科或外科，均要及时处置出血。

其中，出血原因检查尤为关键，明确原因才能分而治之。

目前，传统凝血检查已相当精确，对止血缺陷的检测往往可以发现分子水平的缺陷，为精准治疗打下扎实基础。

血液(血块)粘弹性(viscoelasticity，VE)检测仪的发明和临床应用，将血液凝固过程作为一个整体动态检测，结合了物理和化学原理，囊括血栓形成的各种要素，为判断出血原因乃至监测抗栓治疗提供了更直观的依据。

自1948年德国人Hellmut Harter首次报道以来[1]，血栓弹力图(thromboelastograph，TEG)已成功应用于对患者止凝血状态的评估。

目前，VE检测设备主要有Thromboelastography(TEG®，美国Haemonetics公司)、ROTEM(德国TEM公司)和Sonoclot(美国Sienco公司)等。

鉴于国内TEG使用范围较广，本文主要评述其临床应用价值。

按激活剂不同分类，TEG主要有普通TEG、快速TEG(r-TEG)2种。

普通TEG以高岭土为激活剂，主要用于评估凝血全貌和判断凝血状态，指导成分输血，判断促凝和抗凝等药物的疗效以及评估患者血栓发生几率。

H3C三层交换机配置命令技术教程2022-03-0116:16:53阅读655评论0字号：大中小订阅一、write是cico的H3C的保存配置的命令是ave查看保存的配置文件为diave查看当前运行的配置是dicu清空配置为reetave需要重启生效重启为reboot二、ytem-view：进入配置模式[Quidway]dicur；显示当前配置[Quidway]diplaycurrent-configuration；显示当前配置[Quidway]diplayinterface；显示接口信息[Quidway]diplayvlanall；显示路由信息[Quidway]diplayverion；显示版本信息[Quidway]uperpaword；修改特权用户密码[Quidway]yname；交换机命名[Quidway]interfaceethernet0/1；进入接口视图[Quidway]interfacevlan某；进入接口视图[Quidway-Vlan-interface某]ipaddre10.65.1.1255.255.0.0；配置VLAN的IP地址[Quidway]iproute-tatic0.0.0.00.0.0.010.65.1.2；静态路由＝网关[Quidway]rip；三层交换支持[Quidway]local-uerftp增加用户名[Quidway]uer-interfacevty04；进入虚拟终端[S3026-ui-vty0-4]authentication-modepaword；设置口令模式[S3026-ui-vty0-4]etauthentication-modepawordimple222；设置口令[S3026-ui-vty0-4]uerprivilegelevel3；用户级别说明：必须要配置虚拟终端用户名、密码等相关信息，否则将无法通过RJ－45端口telnet到交换机。

ytem-view[Syname]local-ueradmin[Syname-luer-admin]ervice-typetelnetlevel3[Syname-luer-admin]pawordimpleadmin说明：以上命令用于设置web管理页面的登录用户名和密码，必须要设置上述信息，否则将无法登录到web配置页面。

人教版英语教材高二重难点总结人教英语版教材二高难重总点结nitU 1Maki ng ad iffeercen一、重难点解1析It.ta eksa v ry eunuusa mindlt oudnresatdna naylis so thf eovious. 分析b明存在显的物事要非需的头凡脑。

2.(Tehe dri dnt oeems)mu c hoipt nni wokring o nmy PD -h- - didI nt oxeect pt sourive vthtal nog .得取博士位学对来说似乎没有我么意什了义，没有期望活我那久么。

PhD (ocDtr ofoPhi lsopoh) y指博"士位"。

学1)herTe sin o opnit i donnigsth. 表 "做某事没示作用有或没意义"有例如:T。

her is neo piontin aruiggnf urther. 续争辩下继没有去义意。

了here's Tevyrlitt l peiot nnip rteostni. gIt wn'o thlepmuc h.抗议没有什么，用事无补于。

2)tha在此t处副词，意为作那"么"，可以修饰形容词。

hist也类有似用的。

法如例: Iidnd' expectth ewa thsta ure.d 没料我他会那到粗鲁么。

Plaee sctu m yahriabou tthi musc.h请我的把发头掉这剪长。

么3.Ye ttwo year hsa goden bya d nI aws otntha mtuhcwo rse.但两过年了，我的去况情没却有么那恶化。

o gy意思是b"时()间过去"。

如例:Tme ientw y sob uickqyl.W e reaa lerday a tth een df our osumme rolhdiya 时.间过得快，真眼转我就们过要完暑了。

Although I am in perfect health, and in possession of a valid class-one California driving license, I am running 31 problems getting employment in the trucking industry because I am 32.You may have heard that in recent years, more and more women have been entering the trucking 33 . But here’s the catch; in most 34 , women are able to enter the trucking profession 35 as part of a husband-wife driving team. As for putting a single woman 36 with a male co-driver for long-distance hauling, the companies that I’ve been 37 , on the 38 that they could get 39 for condoning fornication and adultery. 40 two drivers sharing long-distance hauling are expected to 41 driving and sleeping shifts to keep running 20 or 22 hours a day, employers have told me they feel that inevitably I and a male co-driver would wind up spending all our time in the sleeper berth! In short, it’s 42 that because I’m a woman, I’m incapable of behaving responsibility on the road, of 43 any responsible attitude in my co-driver who, of course, would be incapable of regarding me as anything 44 a sex object, placed conveniently 45 his disposal by the firm while he’s on the road. I’ve also been told that I could be hired by the company in 46 if only they had another woman driver to put me on with; but the company doesn’t hire woman anyway, 47 there’s no 48 driver to put me on with, so…There you have a nice circular argument 49 firms use to protect themselves 50 up pity woman who dare to stay single, try to gross $14000 to $50000 income yearly. God forbid!31. A. for B. on C. with D. into32. A. pregnant B. married C. female D. divorced33. A. profession B. job C. vacation D. employment34. A. scopes B. situations C. Countries D. cases35. A. if B. only C. besides D. what36. A. on B. up C. by D. off37. A. declined B. refused C. abolished D. abandoned38. A. premise B. grounds C. hypothesis D. crisis39. A. trouble B. court C. jail D. sentence40. A. If only B. Only when C. Unless if D. Even though41. A. Changeable B. Alternate C. Flexible D. substitutive42. A. presumed B. resumed C. consumed D. assumed43. A. enforcing B. adapting C. using D. performing44. A. other than B. besides C. but than D. not45. A. by B. with C. at D. for46. A. problem B. question C. America D. business47. A. and B. so C. nonetheless D. but48. A. woman B. professional C. perfect D. managing49. A. if B. many C. trucking D. certified50. A. for B. / C. against D. withPART IV GRAMMAR & VOCABULARY [15 MIN]There are thirty sentences in this section. Beneath each sentence there are four words or phrases marked A, B, C and D. Choose one word or phrase that best completes the sentence. Mark your answers on Answer Sheet Two.51 _________native to North America, corn has now spread all over the world.A In spite ofB That it isC It wasD although52 Our civilization cannot be thought of as_______in a short period of time.A to have been createdB to be createdC having been createdD being created53 We feel it is high time that the Government _______something to check the inflation.A didB doC should doD would do54 It has been proposed that we _______our decision until the next meeting.A delayedB delayC can delayD are to delay55 Hurricanes are severe cyclones with winds over seventy-five miles an hour________originate over tropical ocean waters.A whichB whoC whereD how to56 ________is announced in the papers, our country has launched a large scale movementagainst smuggling and fraudulent activities in foreign currency exchange deals.A WhatB AsC WhichD That57 All the flights_______because of the snowstorm, we had to take the train instead.A were canceledB had been canceledC having canceledD having been canceled58 Once _________, this power station will supply all the neighboring towns and villageswith electricity.A it being completedB it completedC completedD it completes59 He might have been killed _______the timely arrival of the ambulance.A but forB except forC besidesD except60 If you have never planted anything, you won’t be able to know the pleasure of watching thething you have planted ________.A growB to growC growingD to be growing61 Every means __________ tried out but never with success, as far as my knowledge goes.A isB areC has beenD have been62 One of the requirements for a fire is that the material ________to its burning temperatureA be heatedB is heatedC would be heatedD is heated63 ________ will Mr. Forbes be able to regain control of the company.A With hard workB Only if he works hardlyC In spite of his hard workD Only if he works hardly64 ________ is no reason for discharging her.A Because she was a few minutes lateB Owing to a few minutes being lateC The fact that she was a few minutes lateD Owing to a few minutes being late65 __________ what may, we’re not going to make any concessions to his unreasonabledemands.A ComeB CameC ComingD Came66 Mac’s close_______to his brother made people mistake them for one another.A resemblanceB identityC appearanceD identity67 The thieves________the waste paper all over the room while they were searching for thediamond ring.A spreadB scratchedC scatteredD scratched68 The sight of the fruit salad made our daughter Kit’s mouth ________.A wetB waterC soakD water69 The________problem of bringing a space ship back from the moon has been solved.A technicalB technologicalC techniqueD technologe70 A large part of a person’s memory is________words and combination of words.A by means ofB in terms ofC in connection withD in terms of71 At her word she stood up and walked away, stopping at the window to pull back the curtainand ________.A look roundB look outC look upD look out72 Their happiness was very________.A crispB brittleC delicateD brittle73 I was awfully tired when I got home from work, but a half hour nap ________me.A revivedB releasedC relievedD released74 We should always keep in mind that________decisions often lead to bitter regrets.A hastyB instantC promptD instant75 Information and opinion gap exercises have to have some content ________talking about.A worthwhileB worthilyC worthD worthily76 “If we fail to act now,” said Tom, “We’ll find ourselves ________in action later on.”A paid backB paid forC paid upD paid for77 The first step in the study of any language is observing and ________precisely whathappens when native speakers speak it.A setting offB setting aboutC setting upD setting down78 As the pressure________, the liquid rock is forced up through channels in the resistantrock to the earth’s surface.A intensifiesB magnifiesC heightensD deviates79 Poll is an example of a severely disabled person who has become________at manysurvival skills.A efficientB proficientC persistentD transient80 Rumors are everywhere, spreading fear, damaging reputations, and turning calm situationsinto _________ ones.A tragicB .turbulentC vulnerableD viciousPART V READING COMPREHENSION [25 MIN]In this section there are four passages followed by questions or unfinished statements, each with four suggested answers marked A, B, C and D. Choose the one that you think is the best answer. Mark your answers on Answer Sheet Two.TEXT AThere seems never to have been a civilization without toys, but when and how they de-veloped is unknown. They probably came about just to give children something to do.In the ancient world, as is today, most boys played with some kinds of toys and most girls with others. In societies where social roles are rigidly determined, boys pattern their play after the activities of their fathers and girls after the tasks of their mothers. This is true because boys and girls are being prepared, even in play, to step into the roles and re-sponsibilities of the adult world.What is remarkable about the history of toys is not so much how they changed over the centuries but how much they have remained the same. The changes have been mostly in terms of craftsmanship, mechanics, and technology. It is the universality of toys with regard to their development in all parts of the world and their persistence to the present that is amazing. In Egypt, the Americas, China, Japan and among the Arctic peoples, generally the same kinds of toys appeared. Variations depended on local customs and ways of life because toys imitate their surroundings. Nearly every civilization had dolls, little weapons, toy sol-diers, tiny animals and vehicles.Because toys can be generally regarded as a kind of art form, they have not been subject to technological leaps that characterize inventions for adult use. The progress from the wheel to the oxcart to the automobile is a direct line of ascent. The progress from a rattle used by a baby in 3000 BC to one used by an infant today, however, is not characterized by inventiveness. Each rattle is the product of the artistic tastes of the times and subject to the limitations ofavailable materials.81. T he reason why the toys most boys play with are different from those that girls playwith is that ________ .[A] their social roles are rigidly determined[B] most boys would like to follow their fathers' professions[C]boys like to play with their fathers while girls with their mothers[D] they like challenging activities82. One aspect of "the universality of toys" lies in the fact that ___________ .[A]technological advances have greatly improved the durability of toys[B]the improvement of craftsmanship in making toys depends on the efforts of universities[C] the exploration of the universe has led to the creation of new kinds of toys[D] the basic characteristics of toys are the same the world over83. Which of the following is the author's view on the historical development of toys?[A] The craftsmanship in toy-making has remained essentially unchanged.[B] Toys have remained basically the same all through the centuries.[C] The toy industry has witnessed great leaps in technology in recent years.[D] Toys are playing an increasingly important role in shaping a child's character.84. Regarded as a kind of art form, toys ___________ .[A]follow a direct line of ascent[B]also appeal greatly to adults[C] are not characterized by technological progress[D] reflect the pace of social progress85. The author uses the example of a rattle to show that ___________ .[A]in toy-making there is a continuity in the use of materials[B]even the simplest toys can reflect the progress of technology[C]it often takes a long time to introduce new technology into toy-making[D]even a simple toy can mirror the artistic tastes of the times.TEXT BHow do we get more young people to increase their consumption of iron-rich foods? Many nutritionists are advocating the fortification of a number of foods. This may help, but I contend that we should also intensify our efforts in nutrition education among our young people. I simply do not buy the argument that it is futile to try to change eating habits. Once an intelligent person—and this includes adolescents—understands the need for a healthy diet, I think he or she will act accordingly. As for specific actions, I suggest that blood hemoglobin should be checked as a routine part of a youngster's yearly physical checkup. It should contain at least 11 grams per 100 milliliters of blood for a girl and at least 12 grams for a boy. If it is any lower, the physician probably will prescribe an easily absorbed iron supplement.Adolescents—and everyone else—should cut out highly processed foods and drinks, which may be low in iron and other nutrients. Read the labels for iron content. Especially make sure that all bakery products are made with enriched flour or whole grains. Try adding liver, chicken, beef, veal or any other variety to the weekly menu.Finally, even when you are trying to lose weight, always eat a sensible, well-balanced diet made up of a variety of fresh or very lightly processed foods. In this way, you stand a good chance of getting not only enough iron, but also adequate amounts of all the other essential nutrients.86. The author recommends that young people __________ .[A] check blood hemoglobin yearly[B] be on a strictly vegetarian diet[C] lose weight[D] do some more studies on hemoglobin87. What kind of bakery products do young people have to eat?[A] Bread made with good vegetable oil.[B] Bread made with wheat.[C] Bread made with enriched flour or whole grains.[D] Bread containing less calories.88. The passage is mainly about ________ .[A] the importance of diet[B] the need of iron[C] adolescents eating habits[D] blood hemoglobin89. When the author says that we should intensify our efforts in nutrition education amongour young people, he means that we __________ .[A]should force young people to eat well-balanced meals[B]should tell young people to eat liver, chicken, beef or veal[C]should teach adolescents about nutrition in home economics class[D]should try to change eating habits to get enough iron and other essential nutrients90. The author says that the appropriate way to lose weight is ___________ .[A]to cut our highly processed foods and drinks[B]to eat a variety of fresh or every lightly processed foods[C]to eat vegetables and eggs[D]to eat foods recommended by a physicianTEXT CPeople can be addicted to different things—e. g.,alcohol, drugs, certain foods, or even television. People who have such an addiction are compulsive, i. e., they have a very powerful psychological need that they feel they must satisfy. According to psychologists, manypeople are compulsive spenders: they feel they must spend money. This compulsion, like most others, is irrational—impossible to explain reasonably. For compulsive spenders who buy on credit, charge accounts are even more exciting than money. In other words, compulsive spenders feel that with credit, they can do anything. Their pleasure in spending enormous amounts is actually greater than the pleasure that they get from the things they buy.There is a special psychology of bargain hunting. To save money, of course, most people look for sales, low prices and discounts. Compulsive bargain hunters, however, often buy thingsthey don't need just because they are cheap. They want to believe that they are helping their budgets, but they are really playing an exciting game: when they can buy something for less than other people, they feel that they are winning. Most people, experts claim, have two reasons for their behavior: a good reason for things that they do and the real reason.It is not only scientists, of course, who understand the psychology of spending habits, but also business people. Stores, companies, and advertisers use psychology to increase business: they consider people's needs for love, power, or influence, their basic value, their beliefs and opinions, and so on in their advertising and sales methods.Psychologists can often use a method called "behavior therapy" to help individuals solve their personality problems. In the same way, they can help people who feel that they have problems with money.91. According to the psychologists, a compulsive spender is one who spends large amountsof money _______ .[A] and takes great pleasure from what he or she buys[B] in order to satisfy his or her basic needs in life[C] just to meet his or her strong psychological need[D]entirely with an irrational eagerness92. According to the author, compulsive bargain hunters are in constant search of the lowestpossible price ________ .[A] because they want to save money to help their budgets[B] because they can openly boast of their triumph over others in getting things for lessmoney[C] and will not have money problems if they can keep to their budgets[D] but they seldom admit they r eel satisfied if they can get things for less money thanothers93. Which of the following is TRUE?[A]All people spend money for exactly the same reason that they need to buy things.[B]Business people and advertisers use the psychology of spending habits toincrease sales.[C] Business people understand the psychology of compulsive buying better than scientistsdo.tists do.[D] Compulsive bargain hunters do not have problems with money.94. The article is mainly about _______ .[A ] the psychology of money-spending habits[B]the purchasing habits of compulsive spenders[C] a special psychology of bargain hunting[D] the use of the psychology of spending habits in business95. From the passage, we can safely conclude that compulsive spenders or compulsive bargain hunters ________.[A] are really unreasonable[B] need special treatment[C] are really beyond remedies[D] can never get any help to solve their problems with moneyTEXT DIn the 1960s, medical researchers Thomas Holmes and Richard Rahe developed a checklist of stressful events. They appreciated the tricky point that any major change can be stressful. Negative events like "serious illness of a family member" were high on the list, but so were some positive life-changing events, like marriage. When you take the Holmes-Rahe test you must remember that the score does not reflect how you deal with stress—it only shows how much you have to deal with. And we now know that the way you handle these events dramatically affects your chances of staying healthy.By the early 1970s, hundreds of similar studies had followed Holmes and Rahe. And millions of Americans who work and live under stress worried over the reports. Somehow, the research got boiled down to a memorable message. Women's magazines ran headlines like "Stress causes illness!" "If you want to stay physically and mentally healthy," the articles said, "avoid stressful events. "But such simplistic advice is impossible to follow. Even if stressful events are dangerous many—like the death of a loved one—are impossible to avoid. Moreover, any warning to avoid all stressful events is a prescription for staying away from opportunities as well as trouble. Since any change can be stressful, a person who wanted to be completely free of stress would never marry, have a child, take a new job or move.The notion that all stress makes you sick also ignores a lot of what we know about people. It assumes we're all vulnerable and passive in the face of adversity. But what about human initiative and creativity? Many come through periods of stress with more physical and mental vigor than they had before. We also know that a long time without change or challenge can lead to boredom, and physical and mental strain.96. The result of Holmes-Rahe' s medical research tells us _______ .[A] the way you handle major events may cause stress[B] what should be done to avoid stress[C] what kind of event would cause stress[D] how to cope with sudden changes in life97. The studies on stress in the early 1970's led to _________ .[A] widespread concern over its harmful effects[B] great panic over the mental disorder it could cause[C] an intensive research into stress-related illnesses[D] popular avoidance of stressful jobs98. The score of the Holmes-Rahe test shows _______ .[A] how much pressure you are under [B] how positive events can change your life [C]how stressful a major event can be [D] how you can deal with life-changing events99. Why is "such simplistic advice" (Para. 3) impossible to follow?[A] No one can stay on the same job for long.[B] No prescription is effective in relieving stress.[C] People have to get married someday.[D] You could be missing opportunities as well.100. According to the passage people who have experienced ups and downs may become _________________[A] nervous when faced with difficulties[B]physically and mentally strained[C] more capable of coping with adversity[D] indifferent toward what happens to themSECTION A COMPOSITION [35 MIN]Is it necessary to make an occupational plan? Different persons have different answers to this question. If your answer is “Yes”, can you list some important steps to follow for the plan or put forward some good suggestions?Write on ANSWER SHEET TWO a composition of about 200 words on the following topic:THE NECESSITY OF OCCUPATION PLANNINGYou are to write in three parts.In the first part, state specifically what your idea is.In the second part, provide one, two or more reasons to support your idea OR describeyour idea.In the last part, bring what you have written to a natural conclusion or a summary.Marks will be awarded for content, organization, grammar and appropriateness. Failure to follow the instructions may result in a loss of marks.SECTION B NOTE-WRITING [10 MIN] Write on ANSWER SHEET THREE a note of about 50-60 words based on the following situation:You have promised to join your friend on a trip to Dalian during the summer vacation, but now you can’t go. Write to apologized and explain why.Marks will be awarded for content, organization, grammar and appropriateness.。

透射电镜培训‐操作步骤总结先看冷却水水箱温度。

设定值是18℃。

正常在27℃以下都可以，高于27℃的时候，最好灭灯丝关lens，等一段时间，等到水箱温度降低之后，再接着做，以免电镜过热停机。

记录初始真空值以及各种附件。

上样品准备工作：样品杆分为单倾和双倾。

使用V栅样品时，要保证在电镜中V栅正面朝上。

单倾台上V栅的时候，正面朝上；双倾台上V栅的时候，反面朝上。

V栅反面边缘是亮的。

操作步骤：先用洗耳球将工作台面吹干净，将电镜纸摊开，放在合适的位置（离桌面边缘15厘米左右），左手按住纸的中心下部边缘，用洗耳球吹净。

将样品盒拿到合适的位置，打开，左手拿出样品杆，右手将支架取出，注意支架放的位置，支架右端位于电镜纸偏右3/4处，下边缘压住电镜纸的上边缘。

然后将样品杆放在支架上。

注意密封圈要在右边支架外面。

左手拿样品杆尾部，右手抬着样品杆中部，左手放手之后，攀到右手右边，左手抬着样品杆，然后右手扶住托盘，调整位置。

注意事项：样品杆上的帽要拔，不要转，拔的时候右手虎口冲向样品杆，以免拔掉帽之后手碰到样品杆，造成污染。

样品杆放在架子上的时候，不要碰到密封圈。

样品杆的盒子要锁好，移动之前先检查是否锁上。

上下样品的时候要坐着，坐稳。

每做一步都要将用完的东西整理好再做下一步。

怎么稳当怎么做，不要怕麻烦。

样品杆的帽拔掉之后，手不要再从样品杆上面过，要从旁边绕。

上样品杆：条件：1.看零；2.6灯OK；3.各个皮拉尼规的示数位于平衡值；4.离子泵运行指示灯亮。

动作即相应变化：第1步：将测角台上的开关置于pump，真空表置于SPEC 位置，准备好倒计时。

将样品杆上的销与测角台上的槽对好位，缓慢将样品杆送入预抽室，等销进去之后，用右手手掌将样品杆推进去，推到黄灯指示灯亮。

然后等到听到机械泵工作的响声之后，放手。

这时看真空表读数，指针从右向左移动，开始计时20分钟，看绿色指示灯是否亮，这两个条件都满足后，进行下一步。

这一步阀门变化：首先是机械泵抽预抽室，V2,V5B,V13关闭，V14,V12,V21开，之后扩散泵抽预抽室，V14，V12关，V8，V13开。