最新布加氏综合症-课件(1)课件PPT.ppt 57页

'布加氏综合症-课件(1) 病例：患者，男性，43岁10+年前开始出现双下腿肿胀、腹水，一直为之所痛苦，曾多次在当地及上海某医院治疗，均诊断为“隐源性肝硬化、血液病”长期上腹饱涨不适、不能从事体力劳动，病情逐年加重。双下腿浮肿、腹水加重，血白细胞、血小板明显下降 反复治疗均未见明显好转最后确诊：布加氏综合症治疗：微创介入手术患者治疗后症状明显改善 布加氏综症（in ferior vena cavasyndrome简称IVCS）是由于下腔静脉受邻近病变侵犯、压迫或腔内血栓形成等原因引起的下腔静脉部分或完全性阻塞，下腔静脉血液回流障碍而出现的一系列临床征候群 肝脏血管解剖 布加氏征是一种罕见疑难病，因其无明显特异性症状，常易被误诊误治，因其临床症状及其转归酷似肝炎后肝硬化，故有人称该病是肝炎的“姐妹”病该病的误诊误治率相当高，据统计，该病误诊率高达83.6%有的竟将其当作肝炎肝硬化治疗几十年。还有的将其诊断为肾炎、心包炎、腹膜炎，少数人还被误诊为大隐静脉曲张、精索静脉曲张而做了手术，给患者带来了不必要的痛苦 截至2008年5月国内资料统计，我国已发现、诊断和治疗布加氏综合症病人4000余例随着发现的病例越来越多，目前所指的BuddChiari综合征包括了任何原因引起的肝窦流出道受阻的疾病，可伴有或不伴有下腔静脉高压，即除单纯的肝静脉或肝小静脉梗阻外，还包括肝段下腔静脉梗阻、下腔静脉右心房入口梗阻及多灶性下腔静脉和肝静脉梗阻本病以青年男性多见，男女之比约为(1.2～2)∶1，年龄在2.5～75岁，以20～40岁为多见 病因①血液高凝状态（口服药、红血细胞增多症引起）所致的肝静脉血栓形成②静脉受肿瘤的外来压迫③癌肿侵犯肝静脉（如肝癌）或下腔静脉（如肾癌、肾上腺癌）④下腔静脉先天性发育异常（隔膜形成，狭窄、闭锁）我国与英、美等西方国家以血栓形成病例居多，而在日本则1/3病例是由于肝段下腔静脉隔膜的畸形 血栓堵塞：41％在肝静脉开口之上，40％隔膜从左下斜行至右上，在左、中肝静脉与右肝静脉开口之间，将静脉隔开，19％在肝静脉开口之下在下腔静脉隔膜、狭窄或闭锁畸形，肝静脉可无开口，开口为血栓所堵，或开口通畅。即使肝静脉开口通畅，肝静脉血液回流可因近端的下腔静脉阻塞而受障碍 临床表现单纯肝静脉血栓形成急性期病人有发热、右上腹痛、迅速出现大量腹水、黄疸、肝肿大，肝区有触痛，少尿。数日或数周内可以因循环衰竭（休克）、肝功能衰竭或消化道出血死亡单纯肝静脉血栓形成非急性期的表现是门静脉高压，肝脾肿大，顽固性腹水，食管静脉曲张破裂出血单纯下腔静脉阻塞，则有胸腹壁及背部浅表静脉曲张（静脉血流由下而上）及下肢静脉曲张、浮肿、色素沉着和溃疡因肝静脉和下腔静脉阻塞，心脏回血减少，病人可有气促 依血管受累多少、受累程度和阻塞病变的性质和状态等而殊不相同急性型亚急性型慢性型 急性型：多为肝静脉完全阻塞而引起，病变多为血栓形成多始于肝静脉出口部，血栓可急剧繁衍到下腔静脉起病急骤，突发上腹部胀痛，伴恶心、呕吐、腹胀、腹泻，酷似暴发型肝炎，肝脏进行性肿大，压痛，多伴有黄疸、脾大，腹水迅速增长，同时可有胸腔积液暴发性者可迅速出现肝性脑病，黄疸进行性加重，出现少尿或无尿，可并发弥漫性血管内凝血(DIC)、多器官功能衰竭(MOSF)、自发性细菌性腹膜炎、(SBF)等，多数在数日或数周内可以因循环衰竭（休克）、肝功能衰竭或消化道出血而迅速死亡。腹水、肝肿大和迅速出现的MOSF，是本病的突出表现 亚急性型：多为肝静脉和下腔静脉同时或相继受累，顽固性腹水、肝脏肿大和下肢水肿多同时存在，继而出现腹壁、腰背部及胸部浅表静脉曲张，其血流方向向上，为BuddChiari综合征区别于其他疾病的重要特征黄疸和肝脾肿大仅见于1/3的病人，且多为轻或中度。不少病例腹水形成急剧而持久，腹压升高，膈肌上抬，严重者可出现腹腔间隔室综合征(abdominalcompartmentsyndrome，ACS)，引起全身性生理紊乱如腹压升至25cmH2O和50cmH2O时，则分别出现少尿和无尿。胸腔容积及肺顺应性下降，心排出量减少，肺血管阻力增加，出现低氧血症和酸中毒 慢性型：病程可长达数年以上，多见于隔膜型阻塞的病人，病情多较轻，但多有引人注目的体征，如胸腹壁粗大的蜿蜒的怒张静脉，色素沉着见于足靴区，有的出现慢性溃疡可有不同程度的腹水，但多数趋于相对稳定。尚可有颈静脉怒张，精索静脉曲张，巨大的腹股沟疝、脐疝、痔核等食管静脉曲张常不能引起患者注意，多在突发呕血、黑便或发现脾脏肿大而就医时，经内镜或X线造影才被证实此型病人肝肿大多不如亚急性者明显，且多为半肝大，但硬化程度有所增加，脾大多为中等程度，很少出现象肝内型门脉高压症时的巨脾 晚期病人，由于营养不良、蛋白丢失、腹水增多消瘦 可出现典型的“蜘蛛人”体态 检查实验室检查B超肝静脉、下腔静脉、门静脉及动脉造影CT扫描磁共振（MRI）显像肝脏核素扫描内镜检查肝穿刺活组织检查 股动脉下段、腘动脉及胫前胫后动脉部分闭塞造影图片 诊断急性BuddChiari综合征多以右上腹痛、大量腹水和肝脏肿大为突出症状；慢性病例多以肝脏肿大，门-体侧支循环形成和持续存在的腹水为特征无创的实时超声和多普勒超声及CT扫描可对95%以上的病例提示BuddChiari综合征的临床诊断认真的分析病史和系统的体格检查不容忽视，但BuddChiari综合征的诊断还有赖于下腔静脉、肝静脉造影和肝组织活检而最后确立肝脏超声检查是无创伤且能最早、最快发现本病的方法，故称为“前哨检查” 诊断要点为：“一黑”——下肢皮肤色素沉着“二大”——肝、脾瘀血性肿大“三曲张”——胸腹壁静脉、精索静脉、大隐静脉曲张“二多”——中青年发病多、男性发病多 腹壁静脉曲张 腹壁静脉曲张精索静脉曲张 治疗内科治疗：内科治疗包括低盐饮食、利尿、营养支持、自体腹水回输等急性型肝静脉闭塞症，如由血栓形成引起者应及早做抗凝治疗 对于起病1周内单纯血栓形成的急性期患者，可以用抗凝剂治疗（但大多数病例于血栓形成后几周或几个月才获确诊）对于大多数病例，保守治疗虽可以赢得侧支循环形成的时间，但患者最后仍需手术治疗布-加综合征患者，特别是晚期患者，常有顽固性腹水、严重营养不良作为手术前的支持疗法，内科治疗可以改善患者全身情况，减少手术死亡率，有利于患者术后康复 外科治疗手术适应征：1.下腔静脉血栓形成慢性期病人，经积极内科治疗病情无明显好转者2.下腔静脉隔膜阻塞者3.恶性肿瘤引起，并可能切除原发病灶，保存或重建下腔静脉者 手术禁忌征：1.肝功能衰竭者2.恶性肿瘤无法切除或已转移3.全身情况差不能耐受手术者对症状轻微且病程已较长，全身情况较佳者，手术应慎重考虑。特别是下腔静脉—右心耳旁路移植术创伤大，可发生肝、肾功能衰竭；部分胸壁侧支静脉易遭破坏；凝血机制差可造成纵隔血肿；术后回心血量猛增还可导致急性心力衰竭等 肝段下腔静脉膜性阻塞，可考虑作下腔右心房旁路术不完全梗阻者可行手术或介入治疗，如用带球囊导管腔内成形术、作球囊扩张支架置入术根据病情作门奇静脉断流、脾切除、脾肾静脉分流等，以降低门静脉压力，根治脾机能亢进 外科手术(1)隔膜撕裂术：①带囊导管扩张术：方法是用带囊导管经股静脉插入，在透视下使导管的囊段位于狭窄部位，在囊内注入适量造影剂使囊部膨胀撕裂隔膜。本方法适用于隔膜阻塞型且阻塞远端无血栓形成者。本手术可能产生的并发症有心脏压塞、肺栓塞及导管断裂等。②经右心房隔膜撕裂术：方法是经右前第4肋外胸切口或经胸骨切口进入胸腔，于右膈神经前纵行切开心包 下腔静脉破膜球囊扩张支架置入 (2)下腔静脉-右心房分流术：　经腹正中切口或右侧腹直肌切口进腹，暴露下腔静脉：A.作Kocher切口游离及向左翻起十二指肠显露下腔静脉；B.向上翻起横结肠及其系膜，将小肠推向左侧，在十二指肠水平部下方、肠系膜上静脉的右侧打开后腹膜，向腹主动脉方向解剖下腔静脉至少应显露4cm。经胸切口可采用胸骨切口或右前外胸切口，用直径14或16mm的人造血管一端与下腔静脉行端侧吻合，另一端与右心耳吻合。人造血管通常从横结肠后、胃和肝脏前面再进入胸腔 (3)肠系膜上静脉-右心房分流术：以上腹部正中切口进腹，在横结肠系膜根部、屈氏韧带的右侧寻找肠系膜上静脉进胸切口可采用胸骨切口或右前外胸切口用直径14或16mm的人造血管一端与肠系膜上静脉行端侧吻合，另一端与右心耳吻合 (4)根治性手术：对于腔静脉阻塞位置较高的隔膜型病例，可自右侧第7肋进胸，纵行切开下腔静脉，切除病灶如阻塞病变广泛或远端有大量血栓形成，可在体外循环下，纵向切开肝段下腔静脉，切除隔膜、血栓等病变，探查肝静脉并恢复其通畅，下腔静脉用Gore-Tex或Dacron补片修复根治手术虽然直接去除了原发病灶，但在同时伴有下腔静脉炎症的病例中仍有复发的可能 单纯肝静脉阻塞，下腔静脉通畅可作门体分流术或脾肺固定术单纯肝段下腔静脉阻塞，肝静脉回流无障碍假若是隔膜引起阻塞可作下腔静脉隔膜捅开术肝段下腔静脉阻塞伴肝静脉回流障碍假若三支肝静脉血液回流都受障碍须作右心房下腔静脉肠系膜上静脉T字分流术 如果不能作去除梗阻或降低门静脉或下腔静脉压力的手术，则可做腹腔静脉分流术解决腹水以减轻症状 经颈静脉肝内门体分流术(TIPS)对治疗顽固性腹水有效TIPS控制腹水的疗效比系列放腹水疗效好治疗后似乎更易出现较为严重的肝性脑病不降低病死率 谢谢！ 2014届上海市各区县中考一模英语试卷首字母填空总汇 虹口区Readthepassageandfillintheblankswithproperwords（在短文的空格内填入适当的词，使其内容通顺，每空格限填一词，首字母已给):（14分）IheardastoryaboutanolderwomanwhostoodinlineatthePostOffice.Shec___81___withayoungmannexttoher.Theyoungmann___82___thatshehadnopackagetomail,andaskedwhyshewasstandinginline.Shesaidthatshejustneededafewstamps.“Ma’am,youmustbetiredstandinghere.Doyouknowthere’sastampmachineoverthereinthecorner?”Hep____83____tothemachinebuiltintothewall.“Thankyou,”theladyreplied,“butI’lljustwaitherealittlel____84____.I’mgettingclosetothewindow.”“Butitwouldbesomuche___85___foryounottostandinthislonglineandbuyyourstampsfromthemachine.”Thewomansmiledandanswered,“Oh,Iknow.Butthatoldmachinewouldn___86___askmehowmygrandchildrenaregettingalong.”Shehadaneedgreaterthantheneedf___87___postagestamps－aneedtofeelconnectedtootherpeople.Anditwasaneedthatcouldnotbemetbyastampmachine. 浦东新区C.Readthepassageandfillintheblankswithproperwords.(14分)Youknowthateatingasensibledietandgettingplentyofexercisehelpmakeyourbodyhealthyandstrong.Butdoyouknowthattherearewaystomakeyourbrainhealthierandsmarter?Herearesevenstepstowardasmarterbrain.LimityourTVviewingNeverspendtoomuchtimeonTVviewing,foritn________81_______verylittlebrainactivities.Yourbrainwillbecomeweakjustasyourmusclesdo.IfyoudowatchTV,choosesomethingeducationalandmeaningful.TravelTravellingtoa________82_______countryforcesyoutoseeanddothingsinafreshway,bringingstimulationtothebrain.LearnanewlanguageLearninganewlanguageinvolvesdifferentlearningmethods.Learningalanguagesharpensyourbrainandhelpspreventmemoryp________83_______thatyoumaymeetinlateryears.ReadoftenAsyouread,takethetimetolookuppeopleorplacesthataren’tfamiliar.Readingmakesyourvocabularymuchl________84_______ifyoualwayssearchforwordsanddefinitionsthatyoudon’tknow.Eachweek,chooseananimal,abirdorfish,andreadeverythingyoucanaboutit.Stretchyourbrainasyoubecomeanexpertonthesubject.Calculatew________85_______youshopAsyouputthingsinyourgrocerycart,totaleverythinginyourhead.Seehowcloseyougettotheactualtotal.Useyournon-dominant（不占优势的）handIfyouareright-handed,useyourlefthandforeverydayactivities,oruseyourrighthandifyouareleft-handed.Doingfamiliarthingsinadifferentwaywillmakeyourbrainc________86_______newneural（神经）networks.Wechat（微信）!Readmessagesfrompeoplewhohasdifferentinterests.Andsomesaythatlearningtoexpressy________87_______injust100wordsisagreatbrainchallenge.Haveatryanddotheseeveryday.Littlebylittleyoucangetintothehabitofchallengingyourbrain,andmakeyourbrainsmarter! 长宁区C.Readthepassageandfillintheblankswithproperwords(在短文的空格内填入适当的词，使其内容通顺。每空格限填一词，首字母已给)(14分)Imaginethis:romanceisallaroundyou,youhavemetandfalleninlovewiththemostwonderfulperson.Theonlytroubleis,youarenotathome,youareinacompletelydifferentpartofthew81.Howdoyouletthatspecialpersonknowhowyoufeel?FranceTheonlyplacetosay‘JET"AIME’(Iloveyou)isonaParisbridgeinthemoonlight.IfyoureallywanttogofortrueFrenchstyle,youwillneedtodressverysmartlyandgotoafashionableFrenchrestauranta82youhavesaidthemagicalwords.JapanThecherryblossomseasonisthemostromantictimeofayearinJapan.I83yourboyfriend/girlfriendinthepolitestwaypossible(youshouldalwaysbeaspoliteaspossibleinJapan!),setupanicelittlepicnicu84acherryblossomtreeandsay‘SUKYO’.RussiaItmightbeminus6degreeswhenyousay‘YATYEBYALYUBLYU’,butthes85willbefallingaroundyouinStPetersburg.Thereisnoscenemoreromantic,andyouwon’tevenfeelthecold---yourheatwillbesow86inside!IndonesiaGosurfingontheIndonesiawatersofSumatraandseetheboyorgirlofyourdreams.Wakeuptoabeautifulsunrise,gosurfinginthecoolwatersalldayandr87intheevenings.AnytimeisOKtosay‘SAYACINTAPADAMU’!Whereveryoucomefrom,onlysay‘Iloveyou’whenyoutrulymeanit.Theymayonlybethreelittlewords,buttheyarepowerfulwordsinanylanguage! 松江区C.Readthepassageandfillintheblankswithproperwords(在短文的空格内填入适当的词，使其内容通顺。每空格限填一词，首字母已给)(14分)An8-year-oldMiamiboy,JoshuaWilliams,ispresidentofhisownnon-profitorganization---Joshua’sSavetheWorld.Hisorganizationprovidesfoodandclothesforp81peopleandfamiliesinMiamiandtheneighboringareas.Joshuahasr82thousandsofdollarsforhisorganization.Hestartedtohelpthehungrywhenhewasjust5.Hewasinhismother’scarwhentheypassedabeggar.Joshuaaskedhismothertostopsothathecouldgivehim$20.“It’smym83.Iwanttohelphim,Mum,”Joshuarecalled.Oneyearlater,hecreatedhisorganizationwiththehelpofhismotherandFrancineHanna,alocalbusinesswoman.“Hejustthoughtthatwaswhathewantedtodo,”hismothersaid.“Andtherewasnothingthatcoulds84him.”Theorganizationnowprovidesclothing,furnitureandfoodforthepoorpeopleinAmerica.Atthesametime,Joshuanevermissesac85toencourageotherpeopletofollowwhathedidwhetheratchurchoronthestreets.EarlLairdlosthisjobtwoyearsagoandhasn’tmanagedtogetan86one.Withoutmoney,hecan’tpayfortheflatandhastoliveonthestreet.HedependsonfoodfromJoshua’sSavetheWorld.“Joshuaisanangel(天使)fromGod,”hesaid.JoshuahaswonMiami’s“DotheRightThing”awardandthe“KidsWhoCare”competition,whichawardedhima$1,000note.Eventhoughhehasa87doneplenty,hesaidthathismission(使命)toprovideforthepoorisfarfromfinished.“Iwanttogetateamtogether,”Joshuasaid.“Iwantmyteamtogooutandgivefoodtopeoplewhohaveaneedforit.IwanttospreadlovetocountriesinAfrica.” 闸北区C.Readthepassageandfillintheblankswithproperwords（在短文的空格内填入ThestorybehindtheshoppingcartCharactersSylvanGoldman–ownerofagroceryshopFredYoung–Sylvan’sfriend,amechanic(机械师)Onenightin1936,inanAmericancity.InsideFred’sworkshop,SylvansitsnexttoFred,whoismakingadjustments(调试)totheirnewi81–ashoppingcart.Sylvan:Mycustomersdon’tlikeourshoppingcart.Fred:Really?Sotheyp82shoppingwiththoseheavybaskets?Sylvan:(nods)I’vegotahugecrowdofcustomerseveryday,b83noneofthemwantstousethecart.Fred:Idon’tunderstand.Weinventedthecartsothatpeopledon’tneedtocarryabasketaroundtheshop.Sylvan:(laughs)Andsothattheywillbuymoregroceries!Fred:Sowhydon’ttheyliketheshoppingcart?Sylvan:Youngmenthinkthatpushingacartaroundmakesthemlookw84andslow,andyoungwomenthinkit’sunfashionable.Fred:Ofcourseitisn’tfashionablerightnow.It’sonlyjustbeeninvented!ButI’msureolderpeoplewillappreciateit.Fred:What?Theydon’tlikethecarte85?Sylvan:Well,theythinkpushingitmakesthemlookhelpless!Fred:Ohno.Weneedtodosomething,Fred.Wecan’tjustg86uponthisinvention!Sylvan:Wewon’t.(Hegetsupandwalksaroundtheroom.Suddenly,hestops.)Aha!I’vegotanidea.Fred:Whatisit?Sylvan:I’llhire(雇佣)somegood-lookingguysandgirlstopushthecartsaroundandpretendthey’reshopping.Fred:Oh!Sotherealshopperswillseetheseattractivepeopleusingthecartsandthink,“Hey,ifit’sgoodenoughforthem,it’sgoodenoughforme!”Sylvan:E87.Fred:Hey!Maybeyoucouldgetoneofthegirlstogreetyourcustomersandencouragethemtousethecart.Sylvan:Greatidea! 闵行区C.Readthepassageandfillintheblankswithproperwords（在短文的空格内填入适当的词，使其内容通顺，每空格限填一词，首字母已给)（14分）ChuckWallteachesmanagementandhumanrelationsatBakersfieldCollege.Hewalkedintotheclassonedayandtoldhisstudentsthattheirhomeworkwastoperformoneactofrandom(任意的)kindness.Hisstudentsdidnotc81understandthehomeworkanddidn’tknowwhattodo,buttheprofessorwouldnotanswertheirquestions.Heencouragedhisstudentstoworkitoutbythemselves.Oneweeklater,thestudentsenteredtheclassroomexcitedlytosharetheirs82.Onestudentgaveawayblanketstothehomeless.Anotherreportedonhelpinganoldmancleaningthehouse,andanotherstudenthadbeentryingtof83along,lostfriend.Studentswereenergized(给予活力)bythehomeworkandwantedotherpeopletobekindtoo.Andluckily,thelocalbusinessesprovidedthemwithsomemoneyandmaterials.Withthes84ofthem,thestudentsmadestickerstoputoncarsthatinvitedpeopletodosomethingkindforothers.Theysoldthestickersanddecidedtodonatethemoneytoacenterfortheblind―notsurprisingasProfessorWallisblind.Sincethen,kindnessactivitieshavebeenveryp85inschoolsaroundtheworld.ManyschoolsorganizeaRandomActsofKindnessWeek,aroundNovember13th,tocelebrateWorldKindnessDay.SomeschoolsuseeachdayofRandomActsofKindnessWeektoperformdifferentkindacts,suchasmakinganewfriend,helpingsomeone,doingcommunityservice,orr86moneyforacharity.Studentslearntoconsiderotherpeopleandthinkabouthowsmallactionscanmaketheworldab87place. 徐汇区C.ReadthepassageandfillintheblankswithproperwordsMostpeopleknowthatintelligencequotient(IQ)isimportant,butEQisprobablymoreimportantindailylife.Whenfacinganexam,EQhelpsustomanageourfeelings.Whengettingalongwithfriendsorparents,EQhelpsustoc81well.EQisshapedpartlybygenetics（基因）.Youcanseesomebabiesarequiet,whileothersarenot.B82,EQissomethingyoucanlearnforyourself.Youcanlearnwhatdifferentfeelingsmightmeanandhowtheyrelatetoyourselfandothers.Ifwelearnintherightway,ourEQcangetbetteraswegetolder.ChildrenwithahighEQusuallyhavegreatersuccesswithmakingfriends.HavingahighEQneedsafewdifferentskills.Learningabouttheseskillscanhelpustoi83ourEQ.Butwhatarethey?Let’stakealook!1.KnowyourselfMostpeoplefeelmanydifferentfeelingst84theday.Somefeelingslikesurpriselastjustafewseconds.Others,likehappinessandsadness,maystayaroundmuchl85.BeingabletorecognizetheseeverydayfeelingsisthemostbasicofallEQskills.2.ManageyourselfWeallgetangry.Weallhavedisappointments.Butweneedtocontrolit.Itisnotalwaystherighttimeorplacetoexpressourfeelings.Whenyouareangrywithsomeone,takeadeepbreathands86countto10.Thisway,youcancalmdown.3.EncourageyourselfWhenyoufailanexam,youmaybedisappointed.Butthereissomethingmoreeffectiveyoucando—learntoencourageyourself.Itgivesyoutheenergyandc87tomoveon.Ithelpsyoutobuildastrongheart. 宝山区C.Readthepassageandfillintheblankswithproperwords(在短文的空格内填入适当的词,使内容通顺,每空格限填一词，首字母已给):(14分)Therearedifferentwaysoftellingastory.Itcanbetoldinwords,inpictures,inmusic,andactedo81,oritcanbetoldbystillanotherway---bydancing.Dancingthattellsastoryiscalledaballet（芭蕾舞).Thedancinginaballetisdonetomusic,butthestoryistoldbythemovementsofthedancers.Thereisnosingingandspeakinginit.Aballetisaworkofartjustasabeautifulpicture.Theorigin(起源)ofballetd82backabout600yearsago,whichbeganasakindofentertainmentinthecourtsoftherulersinItaly.TwohundredyearslaterballetwadpopularintheFrenchcourt.TheFrenchKingLouisXIVfoundedaballetschool.LatertherulersofRussiabecameinterestedinballet.TheyofferedlargeamountsofmoneytothebestballetmastersanddancersofFrance.Theyalsosetuptheirownballetschoolsanddancecompanies(舞蹈团).SoonRussiansproducedmanyfamousballets.“SwanLake”wasoneofthem.Russianstransformedtheworlddance,music,art,theatreandevenf83.Thebasicpositions(姿势)andtechniquesofballetweredevelopedlongago.Overthecenturies,choreographers（编舞者）haverevised（修改）theclassicaltechniques,butthebasicpositionshaveremainedthesame.Whenyoubeginlearningthestepsandposes（舞姿）ofballet,youwillrealizethatmostofthemhaveFrenchnames.Forexample,apartofaballetthatisdancedbyjusttwopeopleiscalledpas-de-deux(芭蕾双人舞).MostoftheFrenchtermshavebeenc84throughouttheyears.Balletdancingisknownforitsgraceandelegance,asballerinas(芭蕾舞女演员)seemtoglide（滑行）acrossthestagealmosteffortlessly（不费力地）.Balletdancersstrivetoappeartallandlightontheirfeet.Femaledancersraisethemselvesevenhigherbygoingupontheirtoeswithpointeshoes（足尖鞋）.Probablythemostimportantpartofaballetdancer"sequipmentisballetshoes.Afterseveralyearsofpropert85,somefemaleballetdancerswearpointeshoestomakethemappearlighterandmoredelicate.Pointeshoesmakeitpossibleforballerinastodanceonthetipsoftheirtoes.Thefirstballetwasperformedover500yearsago.Ment86dancedtheleadingroles,aswomenwereconsideredtooweaktoperformthechallengingandsometimesdaringchoreography（大胆的舞蹈动作）.Butnowagirlhasasgoodachanceasaboyofbeingafamousballetdancer.Manyofthemostfamousballetswereadaptedfromfairytalesandfolkstories.Someballetsarebasedonhistoricaleventsandbiblestories.Inaballetyoucanfindthemostbeautifulandgracefulofalldancestyles.Ifyou"veeverseenal87balletonstage,youareawareofaballerina"samazingabilitytotransportanentireaudienceintoanotherworld.Allballetdancershaveonethingincommon:aloveofgrace,beautyanddiscipline(有素养)ofballet. 崇明区C)Readthepassageandfilltheblankswithproperwords(在短文的空格内填入适当的词，使内容通顺，每空格限填一词，首字母已给)(14分)MaketheskiesblueTHEstreetsofDalian,LiaoningwerecoveredbysnowaweekbeforeSpringFestival.However,insteadofstayingathome,LiChunyuan,aJunior1studentatNo42MiddleSchool,wentoutwithherclassmates.Theymadepostersbyt____81___andcalledonpeoplenottosetofffireworks.Thestudentdidthisinordertor___82___airpollution.SinceJanuary,manycitiesinchinahaveseenalotoffoggydays.InBeijing,onlyfivedaysinJanuarywerefreeofsmog(雾霾)。AnofficialfortheMinistryofEnvironmentProtectiontoldBeijingNewsthatPM2.5pollutionisthem__83___problemwithairpollution.Poorairhasdoneharmtopeople’shealth.Childrenandtheelderlyaremoreatrisk.AreportfromBeijingChildren’sHospitalshowsthathalfofthep____84__hadrespiratory(呼吸道的)problemsfromJan.5to11.Torespondtotheairproblem,theChinesegovernmentandmanyChinesepeoplehavestartedtotakeaction.Beijingannouncedaplantousecleanfuelingovernmentvehiclesandplanttrees.Ita___85____askedcitizenshiptosetofffewerfireworksfortheSpringFestivalcelebrations.Theysuggestedthatcarswithlargeemissions（排放）shouldbebanned（禁止）andfactoriesshouldbecloselywatched.ThreestudentsfromNo.4HighSchoolinBeijingwroteareporttoadviseh___86____tofighttheairpollution.“Wehopemorepeoplewillj___87____ustoprotectourenvironment.Withallefforts,theblueskieswillcertainlyreturnsoon,”saidShiyucong,oneofthethreestudents. 金山区C.Readthepassageandfillintheblankswithproperwords.（在短文的空格内填入适当的词，使其内容通顺，每空格限填一词，首字母已给。)（14分）ButterflyfairlyTherewasoncealittlegirl.Shehadnofamily,andnoonelovedher.Oneday,whenshewaswalkingthroughafield,shenoticedasmallbutterflyc_____inathornbush(荆棘丛).Themorethebutterflytriedtofreetofreeitself,thedeeperthethornscutintoitsbody.Thelittlegirlc____letgothebutterfly.Insteadofgoingaway,thebutterflychangedintoabeautifulfairy.Foryourkindness,thebutterflyfairysaidtothelittlegirl,“Iwillgiveyouanyw____youwouldliketohave.”Thelittlegirlthoughtforamomentandthenreplied,”Iwanttobeh____.”Thefairysaid,”verygood.”Thenshegotclosetothegirl’searandsaidsomethingtoherinalowvoice.Asthelittlegirlgrewup,therewasnooneinthevillages_____happyasshe.Therewasnooneinthevillages______happyasshewas.Everyoneaskedherthesecretofthehappiness.Shewouldsmileandonlyanswer “ThesecretofmyhappinessisthatIlistenedtoakindfairlywhenIwasalittlegirl.”Whenshewasveryold,theneighborsallcametovisither.Theywerea_____thathersecretofhappinesswoulddiewithher.“Tellus,please,”theybegged,“telluswhatthefairysaid.”Theoldwomansmiledandsaid,“Shetoldmethateveryone,nomatterhowoldoryoung,nomatterhowrichorpoor,n_____me.”shesaidthatalwayshelpingotherswouldmakemydreamcometrue.” 嘉定区Airpollution,asweknowittoday,startedwiththeIndustrialRevolutioninEuropeinthe19thcentury.Inthelastfewdecades,ithasb______aseriousproblemforourenvironment.Whenharmfulelementsgetintotheair,theymaycausehealthproblemsandcanalsod_____theenvironment,buildingandsoil.Theymaketheozonelayer(臭氧层)muchthinnerandtheclimatemorechangeable.Ourmodernlifestylehasledtodirtierairovertheyears.Factories,allkindsofvehicles,thegrowingnumberofpeoplearethethingsthatarer______forairpollutiontoday.Butnotallairpollutioniscausedbypeople.Smog,forestfires,duststormsandvolcaniceruptionscanalsoleadtothepollutionoftheatmosphere.Smog(雾霾)isam________ofsmokeandfog.Itoccurswhengasesfromhurtfuelgettogetherwithfogontheground.Whenheatandsunlightgettogetherwiththesegases,theyformdangerousparticlesintheair.Smogoccursinbigcitieswithalotoftraffic,e_____inthesummertime.Whenitisveryhot.Smogstaysneartheground.Itcauseslungdiseasesandbreathingproblemsandinsmogareas,wecan’tseewell.Today,citieswithalargep______havethebiggestsmogproblems-LosAngeles,MexicoCityorCairo.Thesmogoftenstaysoverthecitiesformanydays.ThousandsofpeopledieinLondoneveryyear.Alotofmeasureshavebeentakentopreventsmogsofar.Driversarenota______todriveonsmogdaysinsomecities.Factoriesusecoalthatdoesn’thavemuchsulfur(硫磺)init.Socarsaremuchenvironmentallyfriendlytoday. 黄浦和卢湾区Doyougetangrywhenyourfriendssingloudlywhileyouaretryingtoworkorwhenyourbestfrienddoesnotwaitforyouafterschool?Ifyoudo,youneedtotakecontrolofyourfeelings.Gettingangrywithotherscancauseyoutol_81___friends.CaryEgeberg,anAmericanhighschoolteacher,haswrittenabooknamedMyFeelingsAreJustLikeWildAnimalstohelpyoucontrolyourfeelings.Thebooktellshowtostaycoolwhenb_82___thingshappen.Thebooksaysthatgettingangryonlymakesproblemsw_83___.Itcannevermakethembetter.“Gettingangryisnotanaturalwaytoact,”thebooksays.“Itisjustahabit,likesmoking.’’Thebooksaysyoucancontrolyoufeelingse_84___---allyouhavetodoistotellyourselfnottobeangry.Thebookgivesmanytipstohelpyouifyougetangryfrequently.Herearethetopthree:●Keepar_85___.Everytimeyougetangry,writedownwhyyouareangry.Lookatitlaterandyouwillseeyougetangrysooften.●Askyourfriendstos_86___talkingtoyouwhenyougetangry.Leaveyoualone.Thiswillteachyounottobeangry.●Dosomethingd_87___.Whenyougetangry,walkawayfromtheproblemandgosomewhereelse.Trytolaugh. 静安和青浦区C)Readthepassageandfilltheblankswithproperwords(在短文的空格内填入适当的词，使内容通顺，每空格限填一词，首字母已给)(14分)Whoismanagingthingsinyourtownorcity？Someonerepairsabrokenwindowinthelibrary.Someonemakessurethetrafficlightswork.Someonepumpscleanwaterintopipes.Someone81fortheanimalsinthezoo.Thepeoplewhodothesejobsarepartofthegovernment.Inmosttownsorcities,theyworkforthemayor(市长).Themayorworkswithother82.Theymanagethecityandmakesurethattheworkgetsdone.Theyfixoldthings,likeroadsandbridges.Theybuildnewthings,likeschoolsandparks.Ifpeople83,theylistencarefully.Thentheychangethingsthatarewrong.Forexample,ifalawisn’t84tosomepeople,theychangeit.Theytrytodowhatthepeoplewant.ElectionDayisreportcardtime!Ifpeoplethinkthecitygovernmentisdoingfine,theymight85thesamemayor.Ifthereareproblems,theymightelectanewmayor.OnElectionDay,peoplegotodifferentplacestovote(投票).Thenallthevotesare86.Themayormaywinorlose.Forthewinner,thereislotsofexcitement!Thereisabigpartywithballoons87intheair.Thenextday,it’stimetorunthecityortownagain.Themayormustdoagoodjob.Theofficemembersmustworkhard,too.Afterall,inafewyears,therewillbeanotherElectionDay. 松江区(C)81.poor82.raised83.money84.stop85.chance86.new87.Already2.闸北区C)81.invention82.prefer83.but84.weak85.either86.give87.Exactly3.长宁区C.81.world82.after83.invite84.under85.snow86.warm87.relax4.浦东新区81.needs82.another83.problems84.larger85.while/when86.create87.yourself/yourselves5.虹口区chatted82.noticed83.pointed84.longer85.easy/easier86.never87.for6.闵行区81.completely/clearly82.stories83.find84.support85.popular86.raising87.better徐汇区(C)81.communicate82.Besides83.improve84.throughout/through85.longer86.slowly/silently/simply87.confidence/courage宝山区81-87out,dates/dated,fashion,carried,training,traditionally,live崇明区81-87：themselves,reduce,main,also,people,how,join金山区81.caught82.carefully83.wish84.happy85.so86.afraid87.needs嘉定区81.become82.destroy83.responsible84.mixtrue85.especially86.population87.allowed黄浦和卢湾区C.81-87lose,bad,worse,easily,record,stop,different静安和青浦区81.cares82.officials83.complain84.fair85.keep86.counted87.flying'