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病历摘要：患者男性，53岁，农民。因反复眼睑及双下肢浮肿4年，肾功能减退4月入院。4年前患者无明显诱因出现眼睑及双下肢浮肿，查尿蛋白3+～4+，红细胞3～5/HP，血压升高达145/95mmHg，当地医院初步诊断为“原发性肾小球肾炎”，予强的松60mg/d治疗2个月，尿检异常无明显改善，于起病半年后第一次入住本院。当时无发热、皮疹、关节疼痛等，测血压150/95mmHg。

根据病人的肾穿刺结果，临床上可考虑的诊断？（）提示：1993年9月23日第一次肾活检。光镜下见26个肾小球，其中6个为节段硬化（26％），肾小球体轻度肿胀，毛细血管袢部分开放，管壁僵硬，偶见“白金耳”，部分塌陷，偶见白细胞浸润，包曼氏囊壁层上皮细胞节段增生；PASM染色见肾小球基底膜上皮侧“钉突”形成，其间有较大团块状嗜复红物，节段“双轨”，可见系膜区嗜复红物。肾小管间质病变轻，间质弥漫炎细胞浸润；间质小血管可见纤维样变性。免疫荧光：IgG++、IgA+、IgM++、C3++、C4++、C1q++，弥漫分布，呈颗样沉积于肾小球系膜区和毛细血管袢，肾小管阴性。

A.系统性红斑狼疮

B.狼疮性肾炎

C.继发性膜性肾病

D.肿瘤相关性肾炎

答案

参考答案：C

单项选择题

临床上会表现出巨脾的是

A．自身免疫性溶血
B．急性淋巴细胞白血病
C．慢性粒细胞白血病
D．多发性骨髓瘤
E．MDS
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多项选择题

Graduates from under-privileged backgrounds are to challenge the elitism of the barristers’ profession, under plans outlined today. Reforms aimed at challenging the dominance of the rich and privileged classes which are disproportionately represented among the membership of the Bar will tackle the decline in students from poorer backgrounds joining the profession. They include financial assistance as well as measures to end the "intimidating environment" of the barristers’ chambers which young lawyers must join if they want to train as advocates.
The increasing cost of the Bar and a perception that it is run by a social elite has halted progress in the greater inclusion of barristers from different backgrounds. A number of high- profile barristers, including the prime minister’s wife, Cherie Booth QC, have warned that without changes, the Bar will continue to be dominated by white, middle-class male lawyers.
In a speech to the Social Mobility Foundation think tank in London this afternoon, Geoffrey Vos QC, Bar Council chairman, will say. The Bar is a professional elite, by which I mean that the Bar’s membership includes the best-quality lawyers practicing advocacy and offering specialist legal advice in many specialist areas. That kind of elitism is meritocratic, and hence desirable.
"Unfortunately, however, the elitism which fosters the high-quality services that the Bar stands for has also encouraged another form of elitism. That is elitism in the sense of exclusivity, exclusion, and in the creation of a profession which is barely accessible to equally talented people from less privileged backgrounds."
Last month, Mr. Vos warned that the future of the barristers’ profession was threatened by an overemphasis on posh accents and public school education. Mr. Vos said then that people from ordinary backgrounds were often overlooked in favour of those who were from a "snobby" background. People from a privileged background were sometimes recruited even though they were not up to the job intellectually, he added. In his speech today, Mr. Vos will outline the "barriers to entry," to a career at the Bar and some of the ways in which these may be overcome.
The Bar Council has asked the law lord, Lord Neuberger of Abbotsbury, to examine how these barriers can be overcome, and he will publish his interim report and consultation paper before Easter. He is expected to propose a placement programme to enable gifted children from state schools to learn about the Bar, the courts and barristers at first hand.
The Bar Council is also working towards putting together a new package of bank loans on favourable terms to allow young, aspiring barristers from poorer backgrounds to finance the Bar vocational course year and then have the financial ability to establish themselves in practice before they need to repay.
These loans would be available alongside the Inns of Court’s scholarship and awards programmes. Mr. Vos will say today: "I passionately believe that the professions in general, and the Bar in particular, must be accessible to the most able candidates from any background, whatever their race, gender, or socioeconomic group. The Bar has done well in attracting good proportions of women and racial minorities and we must be as positive in attracting people from all socioeconomic backgrounds.\

What are the barriers for graduates from under-privileged families to become barristers
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