Research question: Are there any differences between conjoined twin fetuses at the molecular level?Design: Skin tissues were collected from thoracopagus conjoined twins at 15+4 weeks of gestation. The skin tissues were collected from the thigh side of conjoined twins after the abortion procedure. All specimens were obtained after written informed patient consent and were fully anonymized. All relevant ethical regulations were followed. Every specimen underwent multiomics sequencing analysis to determine associations among the DNA methylome, transcriptome and mutations in the exon regions in the conjoined twins.Results: The global methylation pattern was similar in the two fetuses of conjoined twins, while significant differences were seen in local regions such as CpG islands (P = 0.026), enhancers (P < 0.001) and various repetitive elements (P < 0.05), which showed significant differences. The conjoined twins also differed in genes related to growth and development, cellular component morphogenesis and cellular stress, both in terms of DNA methylation levels and gene expression levels. Exon data analysis revealed that the common mutations in conjoined twins mainlyoccurred in neural development, lipid metabolism and microtubule morphogenesis. Specific mutations were associated with cellular component biosynthesis, behaviour and germ cell development.Conclusion: Conjoined twins were similar to each other globally, but there were significant differences related to growth and development, cellular component morphogenesis and cellular stress. The current study reveals the molecular features of conjoined twins for the first time, laying the foundation for future exploration of the mechanism of conjoined twins.

PURPOSE:The purpose of this study was to evaluate patient-related attitudinal barriers and identify associated factors in Chinese cancer inpatients receiving opioids and to explore relationships between patient-related attitudinal barriers, analgesic adherence and pain relief.METHODS:A cross-sectional study was conducted. A total of 146 participants completed face-to-face surveys, including information about demographics, the Barriers Questionnaire-Chinese (BQ-C), analgesic adherence, average pain and breakthrough pain in the past 24 h. The Mann-Whitney U test and Kruskal-Wallis test were performed to test the differences in the attitudinal barrier scores between the adherence and nonadherence groups, the complete and incomplete pain relief groups and the groups based on demographics.RESULTS:The majority of participants in this study were men (67.8%), over half of all participants were less than 60 years old, gastrointestinal cancer (47.3%) was the most common diagnosis and 59 (40.4%) acquired comprehensive pain education from the last discharge guidance procedure. The total BQ-C mean (SD) score was 1.61 ± 0.94. A total of 87 (59.6%) patients with cancer pain were completely relieved. Most of the patients (73.3%) completely took analgesics by orders. There was no significant difference in the total BQ-C score between the adherence group and the nonadherence group (P > 0.05), but the difference was significant between the complete pain relief group and the incomplete pain relief group (P < 0.05).CONCLUSION:The findings of this study support unsatisfactory pain management and moderate analgesic adherence for Chinese inpatients. It is suggested that patient-related attitudinal barriers do not play an undermining role in pain management by negatively affecting patients' analgesic adherence. Conversely, patients' beliefs are more likely to be shaped by under treatment rather than as a cause.

目的 通过对比分析健康管理对心血管危险因素的聚集情况,评价健康管理的干预效果.方法 以471名体检人群为研究对象,分析12种(吸烟、饮酒、少活动、体质指数、血压、血脂、血糖、血尿酸、同型半胱氨酸、脂肪肝、骨密度异常及动脉硬化检测异常)心血管危险因素的分布与聚集情况,同时对健康管理干预前后的效果进行分析,并提出相应的健康管理方案建议.结果 (1)干预前、后均存在严重的心血管危险因素聚集现象,研究人群中0～2项危险因素分别为21.44％、19.32％,同时具有3种及以上危险因素的分别占有78.56％、80.68％;(2)干预后空腹血糖受损、血压正常高值检出率明显降低,高血压治疗达标率显著增高,均P＜0.05;高尿酸、活动少略有增加,但差异无统计学意义(P＞0.05);高同型半胱氨酸增加(P＜0.05),其他吸烟、饮酒、脂肪肝、新发高血压、高血糖等干预前后均无统计学意义(P＞0.05).结论 开展健康管理是预防和遏制心血管危险因素发生、发展的有效途径,尤其对血压、血糖的改善更为显著.

Objective This study investigated the application value of waist-to-height ratio (WHtR), body mass index (BMI), and waist-to-hip ratio (WHR) in screening for type 2 diabetes mellitus (T2DM) and high risk of T2DM. Methods A total of 7 582 subjects aged 40-75 years were randomly selected and stratified based on the results of an oral glucose tolerance test (OGTT) administered during a standard screening for T2DM in the Shougang community.Three anthropometric indices(WHtR,BMI,and WHR) were compared, with the optimal cutoffs for WHtR, BMI, and WHR identified using receiver operating characteristic curve (ROC) analysis. Using multivariate logistic regression analysis and the area under the curve(AUC)of ROC,the associations between BMI,WHR,and WHtR and T2DM were analyzed by group: normal glucose tolerance group (n= 3 080), T2DM high-risk group (n= 2 992 cases), and T2DM group(n=1 510).Results Logistic regression analysis showed that BMI,WHR,WHtR,and family history of diabetes were positively correlated with T2DM and high risk of T2DM(P<0.05 and P<0.01,respectively);WHtR was most significant, with odds ratios of 90.409 and 69.285, respectively. WHtR had the greatest AUC under the ROC in men,whereas BMI had the greatest AUC in women.The optimal cutoffs values for the detection of T2DM were 0.51, 25.47 kg/m2, and 0.91 for WHtR, BMI, and WHR in men, respectively, and 0.52, 24.95 kg/m2, and 0.86 for WHtR, BMI, and WHR in women, respectively. WHtR was more efficient than WHR and BMI based on the AUC. The optimal cutoff values for detecting a high risk for T2DM were 0.51,25.30 kg/m2,and 0.91 for WHtR,BMI,and WHR in men and 0.51,24.81 kg/m2,and 0.86 for WHtR, BMI, and WHR in women, respectively. Conclusion Waist-to-height ratio may be a more effective index for diagnosing type 2 diabetes mellitus and identifying individuals at high risk for T2DM than BMI or WHR.

随着信息技术的发展,医疗和健康咨询服务已经成为互联网经济中的新生力量,加快实现了健康管理进程,各种健康管理软件、健康信息平台应运而生[1～3],但目前尚缺少适宜企业的健康管理模式与体系.首钢总公司党委高度重视集团员工的健康状况,提出了建立覆盖全集团12万职工的健康管理体系;首钢集团下属北京首钢自动化信息技术有限公司、北京大学首钢医院及集团公司相关部门,充分发挥资源的综合优势,共同设计开发了首钢职工健康管理信息系统.

我回国做建筑的这十几年，最大的感触就是大到工程项目，小到房屋改造，听到最多的话便是：这样不可能，那样不能做，这种做法我不会等等，不胜枚举。但是，当大家都畏畏缩缩地不愿尝试和接受挑战，只会推脱说“不能、不行”时，宝贵却“敢为天下先”。如果我们能够早几年认识的话，作为一名建筑师，在面对很多事情时心态也不会像现在一般萧索。

齐欣:中国教育的问题不光是建筑教育的问题,而是从幼儿园开始,都是老师灌输的多,而学生自己的想法少,老师总在给学生一个特别明确的标准,什么是对的,什么是错的,所以就变得学生不需耍思考,按照老师的说法去做就对了.从这点来讲,我和梁井宇的观点都是让学生自己去评判,逐渐地培养自己批判的思维.这样的做法又有一点颠覆国内的教学形式,但好处是能够让学生培养自己的鉴别能力、观念等.我跟梁井宇在教学过程中,让学生从头去想,对与不对不重耍,而是你认为他对或者饼的基本逻辑.梁井宇实际上是让学生重新去感知建筑,为什么耍做设计,不是上来就上一些手法,而是特别简单的一些感知.

目的 探讨SpO2/FiO2替代氧合指数作为评价ARDS金标准指标的可行性及其之间的量化关系.方法 随机抽取笔者所在科室(急诊科)符合中重度诊断标准的ARDS病员共72名,按照7∶3比例随机分为模型组和验证组,均予监护、吸氧、抽动脉血气分析、记录SpO2,及吸氧流量等措施,根据如上指标分别计算P/F及S/F.结果 模型组(n=49):Y(S/F)=74.609(b)+0.522(a) X(P/F),P＜0.001.r=0.625,P＜0.001;与P/F=100对应的S/F值为126.8,敏感度和特异性分别为78.3％和52.2％,ROC曲线下的面积为0.578.结论 对于中重度ARDS患者,S/F基本可以替代P/F评价疾病的严重程度并指导临床诊断治疗.

UED:在过去的一年当中,您比较关注哪些建筑界事件? 王昀:应该是中国美术馆的评选.这可以说是中国建筑界的一件大事,从投标到评选历时一年左右.我曾经说过,中国过去做过很多标志性的建筑,可以说,这些建筑的产生大致都与国家发展的节奏基本对应.例如当涌现出一批国贸等金融建筑时,国家正在努力要把经济建设搞好;之后做奥林匹克公园、鸟巢、水立方等体育建筑时,也对应着国家开始重视国民的身体素质;做媒体建筑,如中央电视台,体现出国家要发展媒体行业.而如今做美术馆等文化建筑,实际上也是与国家重视文化建设的决定相关的,所以,我想中国美术馆的评选应该是过去这一年当中,建筑界比较重要的事件.

<正>刚才听了魏春雨老师的演讲,发现魏老师对展览的每一个细节都研究得非常仔细和深入,可以说到了深刻的地步。而我实际上是做聚落研究的,特点就是乱七八糟什么都看,所以我给大家做的汇报也是聚落式的,什么都有,总之就是带大家走马观花地看一下这次双年展。"千回百转"方能到达中国馆这届威尼斯建筑双年展的展场大致可分两个区域。区域1是一个长条形的主题馆,主要是陈列主题性展示,参加的都是组委会特约的来自不同国家和地区的建筑师。中国国家馆和意大利国家馆等也

目的观察静脉注射艾司洛尔治疗急性心肌梗死并交感风暴临床效果。方法本组9例急性心梗并交感风暴患者,在常规治疗的同时,应用静脉注射艾司洛尔后,观察患者心率、血压及交感风暴发作情况。结果本组9例患者治疗后心率明显下降,血压轻度下降,均使交感风暴终止。结论对急性心梗并交感风暴,常规治疗的同时静脉注射艾司洛尔可获得良好的疗效。

<正>青岛这座城市,历史悠久、个性突出;青岛的建筑,因其独特的自然环境和城市风貌,呈现出独特的建筑整体性,成为基于原有城市基因创新的良好载体;青岛之腾远,十五年艰辛的创业历程在发展和传承上与这座日渐国际化、充斥着建筑设计实例的城市异曲同工且深深契合。这是刻意打造的平台,希望在中国城市发展建设的特色化需求不断增加,越来越多的地标性建筑如雨后春笋般出现,建筑再次成为展现城市独特魅力的第一窗口的背景之下,以实例为出发

<正>今天,我做的报告主题是《经验与设计》。我认为设计在大学期间是一门基础性的教学,它可以让你入门,而不是让你在大学四年内就会做设计。做设计需要更长的时间,它需要大学毕业之后几年甚至十年二十年的时间来丰富经验,这个经验不仅仅是我们所说的生活阅历,我们看到的任何一个东西都算是我们的

目的观察闭合复位加交锁髓内钉内固定治疗胫骨骨折的疗效。方法回顾性分析应用交锁髓内钉治疗的36例胫骨干骨折患者的临床资料。结果 36例均得到随访,随访时间6~46个月,平均28个月。33例骨折骨性愈合,愈合时间为3.2~5.9个月,平均4.3个月,无伤口感染及骨髓炎,无继发性筋膜间室综合征发生,无脂肪栓塞、交锁钉断钉及退钉现象,按照Johuer-wrush功能评价标准优25例,良9例,差2例,优良率94%。结论透视下闭合复位交锁髓内钉内固定治疗胫骨骨折损伤小、并发症少,是一种安全有效的方法。

目的观察神经妥乐平局部注射治疗肱骨外上髁炎的临床效果和安全性。方法 76例诊断为肱骨外上髁炎的患者,随机分为两组。实验组为神经妥乐平治疗组,给予局部痛点分层注射,3.6 U/次,1周2次,连续4周为1个疗程;对照组痛点给予醋酸泼尼松龙25 mg和0.5%利多卡因混合液2 ml。结果实验组治疗有效率为92.1%,明显高于对照组76.3%。结论神经妥乐平局部痛点注射治疗肱骨外上髁炎安全、有效,值得临床推广应用。

<正>WANG YUN:LOCALITY CANNOT BE MADE DELIBERATELY王昀:地域性不是刻意的这个房子处处开窗给我一种很"中国"的印象,就像是古代的园林。但是在它的设计中没有刻意用空间、色彩和材料等来体现所谓的中国性。我个人也觉得那是一种特别表面的做法。一个房子是否有中国性,是否承载着地域特征,是由设计师和沉淀在设计师心里的一种感觉性决定的。一个看上去很中国的房子,也许并没有刻意用到中国化的元素,但是里面每一个看起来很美的地方无意中

<正>UED:您的建筑传达的总是很纯净的空间,重要的一点就是您所用的白色。白涂料在您的手里出现了独特的语言,不但完美的表达了建筑空间,还与周边环境相互映衬。谈谈您是如何使用这种材料的?王昀:建筑材料很普遍,随处可见,但是如何将材料用在合适的地方,与建筑空间相辅相成,这个才是最重要。涂料也是如此,比如说:刷什么样的涂料,怎么样去刷都很讲究的。就以白涂料为例,如果说红的、黄的、绿的、