HighJump_Life Science_Case Studies

schooi life英语作文初一全文共6篇示例，供读者参考篇1School life is super duper fun! I'm a first-year junior high student now, and everything is so exciting and new. Let me tell you all about it!First of all, my school is huge! There are so many classrooms, and each one is decorated in a different way. Some have cool posters and drawings on the wall, while others have colorful maps and charts. My favorite classroom is the science lab because there are all kinds of cool gadgets and experiments to play with.My teachers are awesome too. They're all really nice and funny, and they always make learning fun. My English teacher, Mr. Smith, is the best. He tells the funniest jokes and makes even the hardest grammar rules easy to understand. And my math teacher, Mrs. Johnson, is like a math wizard. She can solve any problem in like two seconds flat!During break time, my friends and I love to hang out in the courtyard. We play tag, hopscotch, and jump rope. Sometimeswe sit under the big tree and share our snacks and secrets. It's the best time of the day!Of course, there are also tests and homework to do. But even that's not so bad. My friends and I always help each other out, and we make studying fun by turning it into a game. And when we do well on a test, we celebrate with a dance party in the classroom!I can't wait to see what other adventures and fun times await me in junior high. School life is the best!篇2School life in junior high school is so much fun! There are new teachers to meet, new subjects to learn, and new friends to make. It's like a whole new adventure every day!First of all, let me introduce you to our homeroom teacher, Mr. Smith. He's super cool and always makes us laugh with his jokes. He also helps us with any problems we might have, whether it's with our schoolwork or with our friends. He's like our school dad, always looking out for us.In junior high, we have so many new subjects to learn about. We have math, science, English, history, and even art and music.My favorite subject is science because I love doing experiments and learning about how things work. But English is pretty cool too because we get to read interesting stories and write our own essays.And of course, there are all our new friends to hang out with. We have lunch together, play sports after school, and even study together for big tests. It's so much fun getting to know everyone and making memories that we'll never forget.Overall, school life in junior high is the best! It's full of new experiences, new challenges, and new friendships. I can't wait to see what the rest of the year has in store for us. Junior high, here we come!篇3Title: My Life in Middle SchoolHey ev eryone! I’m so excited to tell you all about my life in middle school. It’s been such a cool and fun experience so far and I can’t wait to share it with you.First off, let me talk about my classes. I have different subjects like English, math, science, history, and even art. I have to admit that math can be a bit challenging for me, but I try mybest to pay attention in class and ask questions when I don’t understand something. English is my favorite subject because I love reading and writing stories. Science is really interesting too because we get to do experiments and learn about the world around us.Besides classes, I also have extracurricular activities like sports and clubs. I joined the soccer team and it’s so much fun running around and kicking the ball with my friends. I also joined the art club where we get to paint, draw, and create cool stuff. It’s a great way to relax and express myself creatively.One of the best things about middle school is making new friends. I’ve met so many awe some people who are all so friendly and kind. We eat lunch together, hang out during recess, and even study together sometimes. It’s nice to have a group of friends who support and encourage each other.Of course, there are also challenges in middle school. Sometimes I have tests and homework to do, but I try to manage my time wisely and ask for help when I need it. It’s important to stay organized and focused so that I can do my best in school.Overall, my life in middle school has been a blast. I’m learning new things, trying new activities, and making memories that will last a lifetime. I can’t wait to see what the rest of theschool year has in store for me. Stay tuned for more updates on my middle school adventures!That’s all for now. Thank s for reading, guys! Have an awesome day!篇4Title: My School Life in the First Year of Junior HighHello everyone, I want to share with you my school life in the first year of junior high. It’s been so exciting and fun!First of all, I have to wake up early in the morning to catch the school bus. The bus ride is always so noisy with everyone talking and laughing. It’s a great way to start the day!When I arrive at school, I have to go to my locker to get my books and then head to my first class. We have different subjects like math, English, science, and history. Sometimes it can be tough, but my teachers are really nice and always willing to help.During break time, I love hanging out with my friends in the cafeteria. We share snacks, talk about our classes, and play games. It’s the best part of the day!After school, I have extracurricular activities like basketball practice or drama cl ub. It’s a great way to relax and have fun with my classmates.One of my favorite things about school is the school events. We have sports day, talent show, and school dances. It’s so much fun to dress up and dance with my friends.Overall, my firs t year of junior high has been a blast. I’ve made new friends, learned new things, and had so much fun. I can’t wait to see what the next year will bring!篇5School LifeHey everyone! I'm so excited to share with you all about my school life as a first-year junior high student. It's been such a fun and interesting experience so far!First off, let me tell you about my cool teachers. My English teacher is super awesome and makes learning English really fun. She always has these cool games and activities that help us practice our English skills without even realizing it. And my math teacher is the best too! He's always patient and explains things in a way that makes it easier for us to understand.Next, let's talk about my friends. I've made so many new friends since starting junior high. We always have a blast together during break time, playing games or just hanging out and chatting. I feel really lucky to have such awesome friends who always have my back.Of course, school isn't just all fun and games. We also have to work hard and study to do well in our classes. I try my best to stay focused and pay attention in class, so I can understand everything and get good grades. It's not always easy, but I know that hard work pays off in the end.One of the best parts of school life is all the extracurricular activities we can participate in. I joined the soccer team and it's been so much fun practicing and playing matches with my teammates. I also joined the school choir and we get to perform at school events, which is really exciting.Overall, I'm really enjoying my school life as a first-year junior high student. I love learning new things, making new friends, and taking part in all the fun activities that school has to offer. I can't wait to see what the rest of the school year has in store for me!篇6School life in junior high school is so much fun! There are so many things to do and learn every day. Let me tell you all about it!First of all, we have different subjects like Math, English, Science, History, PE, Music, and Art. We have different teachers for each subject and they all have their own style of teaching. Some teachers are strict, some are funny, and some are super nice. But no matter what, we always try our best to pay attention and learn.We also have homework every day. Sometimes it can be a lot, but it's important to do it because it helps us understand the lessons better. And when we have tests, we study hard to get good grades. It can be stressful sometimes, but we always help each other out and study together.During break time, we play with our friends and have snacks. We talk about our favorite TV shows, sports, and games. Sometimes we even have group projects together. It's always so much fun working with our friends and coming up with creative ideas.And don't forget about school events like sports day, talent show, and field trips. We get to show off our skills and talents,cheer for our classmates, and explore new places. It's always exciting to try new things and make memories together.Overall, school life in junior high school is a mix of hard work and fun. We learn new things every day, make new friends, and create unforgettable moments. It may be challenging at times, but we always have each other's backs. I'm grateful for all the experiences and friendships I've made in school. Junior high school rocks!。

中小学教学楼建筑国外参考文献随着社会的快速发展,校园教学楼建设越来越受到重视。

校园教学楼是学生重要的活动场所,对于学生的生活、学习方面都是非常重要的部分,充分的利用建筑的空间变化能够更加丰富学生的生活,提高学习效率,因此进一步加强对其的研究非常有必要。

就目前的情况来看,对于现代建筑其主要是强调了建筑的交流空间,给人们能够提供一个交流的空间,从而更好的愉悦师生的心情,更好的投入到学习和工作中,因此在教育建筑中进行交流空间的设计非常重要,需要引起我们的重视。

参考文献一[1]Marlyne Sahakian,Gill Seyfang. A sustainable consumption teaching review: From building competencies to transformative learning[J]. Journal of Cleaner Production,2018,:.[2]Kendra C. Taylor. Teaching decision-making and building resilience in youth –A case study to reduce the supply of vulnerable youth to sex traffickers in Atlanta, Georgia[J]. European Journal of Operational Research,2018,268(3):.[3]Li Yang,Xiaodong Liu,Feng Qian,Shubo Du. Ventilation effect on different position of classrooms in “line”type teaching building[J]. Journal of Cleaner Production,2019,209:.[4]Noriyuki Inoue,Tadashi Asada,Natsumi Maeda,Shun Nakamura. Deconstructing teacher expertise for inquiry-based teaching: Looking into consensus building pedagogy in Japanese classrooms[J]. Teaching and Teacher Education,2019,77:.[5]Jonathan L. Mezrich. Innovative Teaching Methods in Radiology—Building on the Experiences of Other Disciplines[J]. Academic Radiology,2019,26(1):.[6]Michael P O'Leary,Reed I Ayabe,Christine E Dauphine,Danielle M Hari,Junko J Ozao-Choy. Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?[J]. The American Surgeon,2018,84(2):.[7]. Transplant Medicine - Liver Transplants; New Findings from National Taiwan University Describe Advances in Liver Transpls (Efficient undergraduate learning of liver transplant: building a framework for teaching subspecialties to medical students)[J]. Biotech Week,2018,:.[8]David Malone. New Life Science Building at University of Washington designed for the next generation of research and teaching[J]. Building Design & Construction,2018,:.[9]Jacob Peng,Ira Abdullah. Building a market simulation to teach business process analysis: effects of realism on engaged learning[J]. Accounting Education,2018,27(2):.[10]Burgard,Boucher,Johnston. Building Capacity and Changing Mental Models: The Impact of a Short-Term Overseas Teaching Experience on White Teacher Candidates from a Rural Midwestern College[J]. Action in Teacher Education,2018,40(1):.[11]Baize-Ward,Royer. Questioning the Influence of a Spiritual Lens on Teaching, Empathy Building, and Meaning Making in a Community College: ADuoethnography[J]. Community College Journal of Research and Practice,2018,42(7-8):.[12]Biggs,Bowers,Bartle Angus. University and Community College Partnership: Building Teaching Capacity to Increase Underserved Student Success[J]. Journal of College Reading and Learning,2018,48(3):.[13]Johnston,George. A tool for capacity building: teacher professional learning about teaching writing[J]. Teacher Development,2018,22(5):.[14]刘嫦娥,潘瑛,常学秀,孟祥怀,秦媛儒,段昌群. 基于教学–科研有机融合的环境类复合型人才培养模式探讨—以云南大学环境科学专业建设为例[J]. 教育进展,2018,08(02):.[15]孟凡云. 传统教学与慕课教学方式结合的课堂教学模式构建研究—以民族学专业《中国民族志》课程为例[J]. 社会科学前沿,2018,07(09):.[16]Melinda Hermanns,Danice B. Greer. Building God?s Kingdom Through Strengths-Based Teaching[J]. Journal of Christian Nursing,2018,35(4):.[17]O'leary Michael P,Ayabe Reed I,Dauphine Christine E,Hari Danielle M,Ozao-Choy Junko J. Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?[J]. The American surgeon,2018,84(2):.[18]Frew Emma,Platt Maia,Brown Heather,Goodman Allen,Seidler Elizabeth,Spetz Joanne,McIntyre Di. Building an international health economics teaching network.[J]. Health economics,2018,27(6):.[19]Carla Viviana Coleman Cordova,Nilanjan Banerjee. INTERDISCIPLINARYTEACHING STRATEGIES for Designing and Building Effective Smartphone Applications[J]. GetMobile: Mobile Computing and Communications,2018,22(1):.[20]McGreevy James M,O'Shea Jennie M. Building a Simulator with Life-like Realism for Teaching Abdominal Operations.[J]. Journal of surgical education,2018,:.。

schoollife英语作文初三全文共10篇示例，供读者参考篇1School LifeHi everyone! I am a student in grade 9 and today I want to tell you all about my school life. School life is so fun and exciting, but sometimes it can be a little bit stressful too.First, let's talk about classes. We have all kinds of classes like math, science, English, history, and more. My favorite subject is art because I love to be creative and make cool things. But sometimes, the classes can be a little boring, especially when the teacher talks for a long time.Next, let's talk about friends. I have so many awesome friends at school. We eat lunch together, play games together, and help each other with homework. My best friend is Lucy, we have so much fun together and share everything.Finally, let's talk about homework. Ugh, homework can be so annoying sometimes. I have to do math problems, write essays,and study for tests. But I know it's important to do my homework so I can learn and do well in school.Overall, my school life is pretty great. I learn new things, have fun with friends, and grow as a person. School may be tough sometimes, but it's all worth it in the end. I can't wait to see what the future holds for me in high school!篇2School life in middle school is so fun and exciting! There are so many things to do and learn every day. Let me tell you all about it!First of all, we have different classes like Math, English, Science, and History. My favorite subject is Science because we get to do experiments and learn about how things work. English is also fun because we get to read interesting stories and learn new vocabulary words.In addition to regular classes, we also have extracurricular activities like sports, art, and music. I love playing soccer with my friends during recess and practicing the piano after school. It's a great way to relax and have fun with my classmates.One of the best parts of school life is hanging out with my friends. We eat lunch together, play games during break time, and help each other with homework. It's so much fun to have friends who support and encourage me.Of course, there are also challenges in school life, like exams and projects. But with the help of my teachers and classmates, I know I can overcome them and succeed. School life may be busy and tiring at times, but it's also full of laughter, friendship, and opportunities to grow.Overall, school life in middle school is an unforgettable experience that shapes who we are and prepares us for the future. I'm grateful for all the memories and lessons I've learned so far, and I can't wait to see what the future holds.篇3School life is super duper fun! There are so many cool things happening every day at school. Like hanging out with friends, studying together, and of course, playing games during recess.First, let me tell you about my awesome friends. We do everything together, from sharing snacks at lunchtime to helping each other with homework. We also love to play games togetherduring break time. Sometimes, we play tag or hide and seek, and it's always a blast.Speaking of homework, it's not always fun, but it's important to do our best. I try to pay attention in class and ask my teachers for help when I don't understand something. Studying with my friends makes it more fun, and we can help each other out if we get stuck.And let's not forget about recess! It's the best part of the day. We get to run around and play games with our friends. Sometimes we play soccer, other times we jump rope or just chat and laugh together. It's a time to relax and have fun before getting back to class.Overall, school life is full of ups and downs, but I wouldn't trade it for anything. I love learning new things, spending time with my friends, and having fun during recess. School is where memories are made, and I'm making the most of every moment.篇4School life is so much fun! I'm in the 8th grade now and I want to tell you all about it.First of all, we have different subjects every day like Math, English, Science, and History. My favorite subject is Art because I love drawing and painting. Our Art teacher is really cool and she always has fun projects for us to do.We also have a lot of extracurricular activities at school. I'm on the school soccer team and I love playing with my friends. We have practice after school a few times a week and we have games on the weekends. It's so much fun to be part of a team and work together to win.Of course, school isn't all about fun and games. We have homework every night and tests to study for. Sometimes it can be tough to balance schoolwork with all of our other activities, but my teachers are always there to help me when I need it.One thing I really love about school is all of the friends I have made. We have so much fun together in and out of school. Whether we're hanging out at lunch, studying together for a test, or just chatting in between classes, my friends make school a great place to be.Overall, I love my school life and all of the opportunities that come with it. I can't wait to see what the rest of the school year has in store for me!篇5School life in junior high is super different from elementary school! It's like a whole new world with lots of new things to learn and do.First of all, we have different subjects now. In elementary, we mostly learned things like math and English. But now we have subjects like history, science, and even a foreign language like French or Spanish. It's so cool to learn about different things and expand our knowledge.Also, the teachers expect us to be more responsible and independent. In elementary, the teachers would remind us to do our homework and study for exams. But now, we need to manage our time and stay organized. It can be tough, but it's good practice for high school and beyond.Another big change is that we have more freedom during breaks. In elementary, we had to stick to a strict schedule for recess and lunch. But in junior high, we can hang out with friends, play sports, or just chill out in the cafeteria. It's nice to have some time to relax and socialize during the day.Of course, there are also challenges in junior high. The workload can be overwhelming at times, and there's morepressure to do well in exams and projects. But with hard work and support from teachers and parents, we can overcome any challenges that come our way.Overall, junior high school life is a mix of fun, learning, and growing up. It's a time to explore new opportunities and discover our passions. So let's make the most of it and enjoy the ride!篇6School life in junior high is super fun and also a bit tough. There's a lot of things happening all the time and it can be hard to keep track of everything. But that's what makes it so exciting!One of the best things about school life is all the friends you make. I have a group of friends that I hang out with every day and we have so much fun together. We play games during break time, share our snacks, and help each other out with homework. It's like having a little family at school.But school isn't just about hanging out with friends. We also have to study a lot and sometimes it can be really challenging. I have to stay up late to finish my homework or study for a test, but it's all worth it in the end. I know that if I work hard, I can get good grades and make my parents proud.There are also a lot of extracurricular activities to do at school. I joined the basketball team and it's been a blast. We practice every day after school and have games on the weekends. It's a great way to stay active and make new friends. Plus, it's fun to compete and represent our school.Overall, school life in junior high is a mix of fun and hard work. But I wouldn't trade it for anything. I love my friends, my teachers, and all the experiences I get to have. Junior high is a special time in my life and I'm going to enjoy every moment of it.篇7Title: My School Life in Grade 9Hey guys! I am so excited to share with you about my school life in Grade 9. It has been such a roller coaster ride with so many fun memories and unforgettable experiences.Firstly, let me tell you about my class. My classmates are the best! We have so much fun together, whether it's working on group projects, playing during breaks, or just chatting in class. We are like one big happy family, always supporting each other and having each other's backs.Our teachers are also really cool. They are super nice and always ready to help us with our studies. Even though they can be strict sometimes, we know it's because they care about us and want us to succeed. Plus, they come up with the most creative and fun ways to teach us, which makes learning so much more enjoyable.Apart from classes, we have so many extracurricular activities to choose from. I have joined the debate club and it's been so much fun! I get to improve my public speaking skills and make new friends at the same time. There are also sports teams, art clubs, and music groups for us to explore our interests and talents.Of course, let's not forget about the exams. Grade 9 is a crucial year for us as we prepare for the big high school entrance exams. It can be stressful at times, but with the support of my friends and teachers, I know I can do my best and achieve my goals.Overall, my school life in Grade 9 has been nothing short of amazing. I have grown so much as a person, made lifelong friends, and created wonderful memories that I will cherish forever. I can't wait to see what the future holds for me in high school!That's all for now, guys. Stay tuned for more updates on my school adventures. Bye!篇8School life in the third grade is super cool! We have lots of fun and make so many memories together. Let me tell you all about it!First of all, we have the best teachers ever. They are so nice and always help us with our work. They make learning fun by playing games with us and telling us interesting stories. We have different subjects like English, Math, Science, and History. My favorite subject is Art because I love to draw and paint.We also have so many activities at school. We have sports day where we compete in different games and races. We have music class where we learn to play instruments and sing songs. We have drama class where we act out plays and have so much fun pretending to be different characters.One of the best parts of school life is lunchtime! We get to eat with our friends and share our food with each other. My favorite lunch is pizza with chocolate milk. Yum!Sometimes we have tests and homework, but that's okay because we all help each other out. We study together and make sure we understand everything. It feels good when we get good grades and our teachers are proud of us.Overall, school life in the third grade is amazing. I have made so many friends and learned so many things. I can't wait to see what the rest of the year brings!篇9School life is super cool! I'm in grade three now and I want to tell you all about it!First of all, let me tell you about my teachers. They are all super nice and always try their best to make learning fun. My English teacher, Mrs. Johnson, always makes us play games to help us remember new words. She is always encouraging us to speak up in class and not be shy. My math teacher, Mr. Smith, is a bit strict but he really knows his stuff. He always helps me when I don't understand something and never gives up on me.Secondly, I have to talk about my friends. They are the best! We have so much fun in class and during recess. We play tag, jump rope, and sometimes just sit and chat. My best friend is Lily and we do everything together. We help each other withhomework, share our snacks, and even have sleepovers on the weekends.Lastly, I have to mention all the different activities we have at school. We have sports day, talent shows, and even field trips. Last month, we went to the zoo and it was so much fun. We got to see all the animals up close and even got to feed the giraffes! I can't wait for our next field trip.Overall, school life is the best. I learn new things every day, have amazing friends, and get to do fun activities. I love everything about it and can't wait to see what the rest of the year has in store for me. Thank you for reading about my school life!篇10School LifeHi everyone, I’m so excited to share with you about my school life in junior high school! It’s been such an amazing experience with lots of cool things happening every day.First of all, let me tell you about my classes. We have a ton of different subjects like math, science, history, English, and even music and art! My favorite class is definitely English because I love to read and write. Sometimes we have to do projects orpresentations, which can be a bit stressful, but it’s also really fun to work with my friends on them.Apart from classes, we also have extracurricular activities like sports and clubs. I joined the basketball team this year, and it has been so much fun. I’ve made a lot of new friends and learned a lot about teamwork and sportsmanship. I also joined the drama club, where I get to act and perform on stage –it’s a great way to express myself and build confidence.But it’s not all work and no play! We also have school events like sports day, talent shows, and field trips. I love these days because we get to have fun and bond with our classmates outside of the classroom. It’s a nic e break from the usual routine and a chance to make memories that will last a lifetime.Overall, my school life in junior high has been full of ups and downs, but I wouldn’t trade it for anything. I’ve grown so much as a person and made some amazing friends along the way. I can’t wait to see what the rest of the year has in store for us!。

《2024年1月浙江首考英语卷深度解析及变式训练》专题05 阅读理解D篇(解析+词汇+变式+技巧+模拟) 原卷版养成良好的答题习惯，是决定高考英语成败的决定性因素之一。

做题前，要认真阅读题目要求、题干和选项，并对答案内容作出合理预测;答题时，切忌跟着感觉走，最好按照题目序号来做，不会的或存在疑问的，要做好标记，要善于发现，找到题目的题眼所在，规范答题,书写工整;答题完毕时，要认真检查，查漏补缺，纠正错误。

关键词：说明文, 人与社会, 棉花糖测试, 心理测试, 信息轰炸, 抵御诱惑The Stanford marshmallow (棉花糖) test was originally conducted by psychologist Walter Mischel in the late 1960s. Children aged four to six at a nursery school were placed in a room. A single sugary treat, selected by the child, was placed on a table. Each child was told if they waited for 15 minutes before eating the treat, they would be given a second treat. Then they were left alone in the room. Follow-up studies with the children later in life showed a connect ion between an ability to wait long enough to obtain a second treat and various forms of success.As adults we face a version of the marshmallow test every day. We’ re not tempted (诱惑) by sugary treats, but by our computers, phones, and tablets — all the devices that connect us to the global delivery system for various types of information that do to us what marshmallows do to preschoolers.We are tempted by sugary treats because our ancestors lived in a calorie-poor world, and our brains developed a response mechanism to these treats that reflected their value —a feeling of reward and satisfaction. But as we’ve reshaped the world around us, dramatically reducing the cost and effort involved in obtaining calories, we still have the same brains we had thousands of years ago, and this mismatch is at the heart of why so many of us struggle to resist tempting foods that we know we shouldn’t eat.A similar process is at work in our response to information. Our formative environment as a species was information-poor, so our brains developed a mechanism that prized new information. But global connectivity has greatly changed our information environment. We are now ceaselessly bombarded (轰炸) with new information. Therefore, just as we need to be more thoughtful about our caloric consumption, we also need to be more thoughtful about our information consumption, resisting the temptation of the mental “junk food” in order to manage our time most effectively.32. What did the children need to do to get a second treat in Mischel’s test?A. Take an examination alone.B. Show respect for the researchers.C. Share their treats with others.D. Delay eating for fifteen minutes.33. According to paragraph 3, there is a mismatch between_______.A. the calorie-poor world and our good appetitesB. the shortage of sugar and our nutritional needsC. the rich food supply and our unchanged brainsD. the tempting foods and our efforts to keep fit34. What does the author suggest readers do?A. Absorb new information readily.B. Be selective information consumers.C. Use diverse information sources.D. Protect the information environment.35. Which of the following is the best title for the text?A. Eat Less, Read MoreB. The Bitter Truth about Early HumansC. The Later, the BetterD. The Marshmallow Test for Grownups一、高频单词1. originally ad.2. psychologist n.3. nursery n.4. treat n.5. follow-up a.6. version n.7. tempt vt.8. tablet n.9. device n.10. delivery n.11. preschooler n.12. ancestor n.13. calorie-poor a.14. mechanism n. 15. reflect vt.16. reward n.17. reshape vt.18. dramatically ad.19. calorie n.20. mismatch n.21. species n.22. information-poor a.23. prize vt.24. connectivity n.25. ceaselessly ad.26. thoughtful a.27. consumption n.28. resist vt.29. mental a.30. effectively ad.31. delay vt.32. appetite n.33. shortage n. 34. absorb vt.35. readily ad.36. selective a.37. diverse a.38. bitter a.二、高频词块1. in the late 1960s2. sugary treat3. leave sb alone4. be involved in5. at the heart of6. in response to7. show respect for8. delay doing三、长难句翻译1. We are tempted by sugary treats because our ancestors lived in a calorie-poor world, and our brains developed a response mechanism to these treats that reflected their value —a feeling of reward and satisfaction.我们被含糖食物所诱惑，因为我们的祖先生活在一个热量匮乏的世界里，我们的大脑对这些食物产生了反应机制，反映了它们的价值——一种奖励和满足感。

08 改善民生1.改善民生，提高生活质量Improving the people's well-being and raising quality of life2. 民谋利是治国理政的根本原则。

为人民谋福祉，是我们党坚持为公益服务、执政为民的重要内容。

Working for the people's wellbeing is an essential part of the Party's commitment to serving the public good and exercising governance for the people.3. 我们必须在发展中保障和改善民生，推动全体人民为实现对美好生活的向往而共同奋斗。

We must ensure and improve the people's well-being in the course of pursuing development and encourage everyone to work hard together to meet the people's aspirations for a better life.For many, moss(苔藓) is nothing but a humble tiny plant growing in some invisible corners, but for villagers in the mountainous town of Maoyang, it is 1 cash cow that has carried them out of poverty and on a path to further affluence.The remote town 2 (locate) in one of the least developed counties of East China's Zhejiang province, a major economic powerhouse and a pilot zone for 3 (achiev) common prosperity.Building on its distinctive 4 (nature) resources, the town has nurtured a burgeoning niche industry of breeding moss and selling related products such as potted plants, 5 are in rising demand in China as people's lives improve. Last year, the moss business generated over 17 million yuan (about $2.4 million) for the 6 (villager)."To make locals rich, you have 7 (foster) an industry. To grow bigger, the industry has to leverage local advantages," 8 (say) Lei Xiaohua, the town's Party chief and a delegate to the ongoing 20th National Congress of the Communist Party of China.Lei now has even 9 (strong) confidence in her town's future, as new arrangements have been made in a report to the congress to attain solid progress in promoting common prosperity10 the country's entire population.【答案】1.a 2．is located 3．achieving 4．natural 5．which6.villagers 7．to foster 8．said 9．stronger 10．forPassage1Measles(麻疹), which once killed 450 children each year and disabled even more, was nearly wiped out in the United States 14 years ago by the universal use of the MMR vaccine(疫苗). But the disease is making a comeback, caused by a growing anti-vaccine movement and misinformation that is spreading quickly. Already this year, 115 measles cases have been reported in the USA, compared with 189 for all of last year.The numbers might sound small, but they are the leading edge of a dangerous trend. When vaccination rates are very high, as they still are in the nation as a whole, everyone is protected. This is called “herd immunity”, which protects the people who get hurt easily, including those who can’t be vaccinated for medical reasons, babies too young to get vaccinated and people on whom the vaccine doesn’t work.But herd immunity works only when nearly the whole herd joins in. When some refuse vaccination and seek a free ride, immunity breaks down and everyone is in even bigger danger.That’s exactly what is happening in small neighborhoods around the country from Orange County, California, where 22 measles cases were reported this month, to Brooklyn, N.Y., where a 17-year-old caused an outbreak last year.The resistance to vaccine has continued for decades, and it is driven by a real but very small risk. Those who refuse to take that risk selfishly make others suffer.Making things worse are state laws that make it too easy to opt out(决定不参加) of what are supposed to be required vaccines for all children entering kindergarten. Seventeen states allow parents to get an exemption(豁免), sometimes just by signing a paper saying they personally object to a vaccine.Now, several states are moving to tighten laws by adding new regulations for opting out. But no one does enough to limit exemptions.Parents ought to be able to opt out only for limited medical or religious reasons. But personal opinions? Not good enough. Everyone enjoys the life-saving benefits vaccines provide, but they’ll exist only as long as everyone shares in the risks.1、The first two paragraphs suggest that ____________.A.a small number of measles cases can start a dangerous trendB.the outbreak of measles attracts the public attentionC.anti-vaccine movement has its medical reasonsrmation about measles spreads quickly2、Herd immunity works well when ____________.A.exemptions are allowedB.several vaccines are used togetherC.the whole neighborhood is involved inD.new regulations are added to the state laws3、What is the main reason for the comeback of measles?A.The overuse of vaccine.B.The lack of medical care.C.The features of measles itself.D.The vaccine opt-outs of some people.4、What is the purpose of the passage?A.T o introduce the idea of exemption.B.T o discuss methods to cure measles.C.T o stress the importance of vaccination.D.T o appeal for equal rights in medical treatment.Passage2If you are taking vitamin supplements to reduce your risk of heart disease or cancer, a group of health experts want you to know that those vitamins may actually increase your risk of cancer. The US Preventive Services T ask Force came to this conclusion after reviewing dozens of studies. Nearly half of adults in the US take at least one vitamin or mineral supplement on a regular basis. These pills are advertised as a way to promote general health. In some cases, manufacturers promote them as cancer fighters and heart protectors.Studies in animals and in laboratory dishes suggest that oxidative (氧化性的) stress contributes to diseases like cancer and heart disease. If so, there is a reason to believe that antioxidants—including beta-carotene, vitamins A, C, and E—could be useful as preventive medicines.But when the Task Force examined the medical evidence on vitamins, it found “inadequate(不充分的) evidence” to support the claims that vitamin and mineral supplements benefit healthy adults.“Cardiovascular (心血管的) disease and cancer have a significant health impact in America, and we all want to find ways to prevent these diseases,” Dr. Virginia Moyer, who heads the T ask Force, said in a statement. But so far, she added, the medical evidence does not show that taking vitamins is helpful in this regard.However, the T ask Force did find “ad equate ev idence” that people with a raised risk for lung cancer actually increase their risk further by taking beta-carotene, a precursor of vitamin A.The T ask Force recommendations of taking vitamins regularly apply to healthy adults aged 50 and older who don’t have “special nutritional needs”. The advice does not apply to children, women who are pregnant or may become pregnant, people with chronic illnesses, or people whohave to take supplements because they can’t get all their essential nutrients from their diet.5、Studies in animals and in laboratory dishes find out________.A.ample evidence that taking vitamins are helpful for treating lung cancerB.cardiovascular disease spreads very fast in AmericaC.oxidative stress can lead to heart disease and cancerD.people must take vitamins on a regular basis6、What can we conclude from T ask Force’s findings?A.Scientists want to control cardiovascular disease.B.In some regard, taking vitamins is not useful.C.Manufacturers cannot produce medical-use vitamins.D.Vitamins must be useful to prevent cancer and heart disease.7、Who can take vitamins regularly according to the advice of the T ask Force?A.A 60-year-old healthy worker.B.A 15-year-old boy with short-sightedness.C.A 34-year-old pregnant lady.D.A 40-year-old man who never eats vegetables or fruits.8、What’s the best title for the text?A.An Inside Look at VitaminsB.T ask Force: Ending to VitaminsC.Vitamins: T o Live or to KillD.T aking Vitamins to Prevent Cancer May FailPassage3In 2015, researchers from Australia's Deakin University published one of the first studies measuring food’s physical effect on the left hippocampus (海马体),a seahorse-shaped brain region crucial for memory, learning and decision making. It is also one of the first areas to shrink in people with dementia (痴呆). 252 people filled out diet surveys and then underwent scans that measured their brains. Four years later, they returned for another scan.The study found that the left hippocampus was heftier in the healthy eaters than in the unhealthy ones, regardless of age, sex, weight, exercise habits or general health. The average difference was 203 square millimeters, nearly one third of a square inch. Sounds small, but that's room for a lot of extra brain cells. And strong new evidence showed that eating the right food and skipping the wrong stuff could help protect against declines in thinking and memory that lead to dementia.“Plant-based diets may protect against memory decline and dementia,” says lead researcher Claire McEvoy, RD. How is the power food working with your brain cells? Animal and test-tube experiments suggest that vitamins and fatty acids found in the plant food help new cells make copies of DNA when they divide and multiply. Meanwhile, the high-fat and the high-sugarprocessed food harms brain cells by leaving brain tissue damaged by free radicals (自由基).This may hold back brain plasticity, making the processed food an especially big threat for the developing brains of kids.While food emerges as an important brain protector, experts say brain supplements(补充剂) aren’t all that effective. These pills and capsules may contai n many ingredients. But actually, studies show that they do not activate brain cells in a significantly positive way. “Let the buyer be aware of it,” says David Hogan? MD, a specialist at Calgary University.9、What does the underlined word “heftier” in par agraph 2 mean?A. Larger.B. Darker.C. Smaller.D. Cleverer.10、What is paragraph 3 mainly about?A. The health benefits of plants.B. The effects of food on the brain.C. The key components of healthy diet.D. The harm of the processed food to the brain.11、What should buyers be aware of according to David Hogan?A. Food is an important protector of the brain.B. Pills and capsules contain many ingredients.C. Brain supplements don't really benefit the brain.D. Supplements affect the brain in a significant way.12、What can be concluded from the text?A. Eating smart can benefit our brain.B. The animal-based diet damages free radicals.C. The high-fat food is the direct cause of dementia.D. A balanced diet contributes to kids’ learning ability.Passage4What did you eat for lunch today? Did you choose this dish because it was healthy, cheap or because it was just very delicious? Are you a selective eater or an adventurous foodie?I love exploring trends in food. Fusion cuisine is not for everybody. My Italian grandmother would turn her nose up at the thought of pizzas with mangoes topping but this marriage of tastes is perfectly fine in the 21st century. Chef and food writer Ching-He Huang, who presented a series on Chinese Food for the BBC, is a fan of fusion cuisine. She says: Fusion has been happening for centuries, for as long as people have travelled, but with the internet and global travel, the exchange of ideas makes the process much faster.”Wolfgang Puck is seen by many as one of the chefs who made fusion cuisine elegant. He opened his own restaurant in Los Angeles in the 1970s. This European devoted himself to Asian cuisine and became one of the first in a long line of celebrity chefs, because he adjusts the Asian cuisine to wes tern customers’ appetites by mixing different types of flavors. He said in aninterview with the Wall Street Journal that initially he got negative responses from traditional American-Chinese restaurant owners but he is not bitter. “Cooking is like paintin g or writing a song. Just as there are only so many notes or colors, there are only so many flavors—it’s how you combine them that distinguishes you.” he explains.My granny's cup of tea would be the Slow Food Movement. Founded by Carlo Petrini in the 1980s and still going strong, it seeks to preserve traditional cuisine and the use of ingredients that are grown locally. But Petrini thinks fusion cuisine is trendy.All these trends give us food for thought. We might be wasting an exciting opportunity to wake up our taste buds(味蕾) when we scoff (狼吞虎咽) a sandwich at our desks. Tomorrow, why not find an exotic(异国风味) restaurant and enjoy a feast?13、What does the underlined word in the second paragraph mean?A. combinationB. weddingC. relationshipD. divorce14、What has made fusion cuisine more popular?A. People from all over the world like to travel.B. People become well educated and like to try new things.C. Fusion has been happening for centuries.D. The internet and global travel increase the exchange of ideas.15、What can we conclude from the passage?A. My granny likes drinking a cup of tea.B. My granny likes pizzas with mangoes topping.C. The way a chef combines different flavors is what sets him apart.D. Puck is painful because of people's negative response to his restaurant.16、Which of the following best summarized the passage?A. Fusion cuisine is becoming more and more popular. Why not have a try?B. People attach great significance to Slow Food Movement. Why not call for it?C. Chefs are making fusion cuisine elegant. Why not preserve traditional cuisine?D. Fusion cuisine is criticized by many people. Why not avoid it?Passage5Consumers, as the manufacturers know well, are interested in avoiding fat because it causes heart problems and makes them fat.①_____ Fat-free cookies, chips and dairy products are all bestsellers. In fact, not eating fat seems to cause some health issues.②_____ Fruit and vegetables are obviously on the top of the list. Fruit and vegetables are usually low in calories and are packed with vitamins and minerals.Fat makes food taste good. With all the fat removed, some tasty food tends to taste like cardboard. ③_____ After all these additives like sugar, salt and artificial flavors are pumped in, the body is unable to process certain nutrients, and fat-free food can actually end up containing more calories than full-fat products.④_____ Fat helps regulate your nervous system, aids vitamin absorption and improves your immune system. Fat-free salad dressings can actually prevent your ability to process all the good-nutrients in that salad.When buying a fat-free product, you should take a second to examine the nutritional information on the package. If it's loaded with sugar, salt or artificial additives, put it back on the shelf. ⑤_____A. We know now that all fat is not bad.B. So the non-fat food is a dieter's dream!C. There is, of course, plenty of naturally fat-free food.D. Fat-free food actually has too much to recommend it.E. So, the manufacturers have to add in something to restore the flavor.F. When food manufacturers sell fat-free products, they will achieve great success.G. Sometimes, it is better to eat controlled full-fat products than fat-free junk.Even though it was only October, my students were already whispering about Christmas plans. With each passing day everyone became more 1 waiting for the final school bell. Upon its 2 everyone would run for their coats and go home, everyone except David.David was a small boy in ragged clothes. I had often 3 what kind of home life David had, and what kind of mother could send her son to school dressed so 4 for the cold winter months, without a coat, boots, or gloves. But something made David 5 . I can still remember he was always 6 a smile and willing to help. He always 7 after school to straighten chairs and mop the floor. W e never talked much. He 8 just smile and ask what else he could do, then thank me for letting him stay and slowly 9 home.W eeks passed and the 10 over the coming Christmas grew into restlessness until the last day of 11 before the holiday break. I smiled in 12 as the last of them hurried out the door. Turning around I saw David 13 standing by my desk.“I have something for you” he said and14 from behind his back a small box.15 it to me, he said anxiously. “Open it.” I took the box from h im, thanked him and slowly unwrapped it. I lift the lid and to my 16 I saw nothing. I looked at David’s smiling face add back into the box and said, “The box is nice, David, but it’s 17 ”.“Oh no it isn’t” said David “It’s full of love, my mum told me before she died that love was something you couldn’t see or touch unless you know it’s there”T ears filled my eyes 18 I looked at the proud dirty face that I had rarely given 19 to. After that Christmas, David and I became good friends and I never forgot the meaning 20 the little empty box set on my desk.18、A. anxious B. courageous C. serious D. cautious19、A. warning B. ringing C. calling D. yelling20、A. scolded B. wondered C. realized D. learned21、A. modestly B. naturally C. inaccurately D. inappropriately22、A. popular B. upset C. special D. funny23、A. expressing B. delivering C. wearing D. sharing24、A. practiced B. wandered C. studied D. stayed25、A. would B. should C. might D. could26、A. aim at B. turn to C. put off D. head for27、A. argument B. excitement C. movement D. program28、A. school B. year C. education D. program29、A. relief B. return C. vain D. control30、A. weakly B. sadly C. quietly D. helplessly31、A. searched B. found C. raised D. pulled32、A. Holding B. Handing C. Sending D. Leaving33、A. delight B. expectation C. appreciation D. surprise34、A. cheap B. empty C. useless D. improper35、A. as B. until C. because D. though36、A. advice B. support C. attention D. command37、A. from B. behind C. over D. towardsWolong National Nature Reserve is located in Sichuan Province. The soil types within Wolong are especially ①________(remark). Each mountain layer(层) contains a different type of soil, ②________ (range)from mountain black brown soil ③________ mountain brown soil. These soil types have stimulated the development of a rich biodiversity.About 4,000 plant species have been recorded in the various habitats of the reserve, such as evergreen forests and broadleaf forests. Altogether, 96 mammal(哺乳动物) species, 300 bird species ④________1,700 insect species live in Wolong, while 30 animal species ⑤________(be) under legal protection, including many endangered animals. The presence of the world's largest giant panda population was one of the main reasons why the reserve ⑥________(establish).While agriculture remains the major economic activity of local people, touristactivities are becoming a basic source of income(收入来源) However, ⑦________ construction of tourist facilities, as well as pressure from the large human population, is resulting in a number of negative ⑧________(impact). In addition, illegal firewood and medicinal plant collection presents challenges to local governments. Other challenges include the ⑨________(promote) of sustainable tourism and the development of other income opportunities. Research that was conducted within the reserve in the past has focused on the ecology and biology of the giant panda. Today, however, the ecosystem approach and the rehabilitation of bamboo and forest ecosystems are playing a(n) ⑩________ (increase) important role.Passage1上周日你班举办了以“亲近大自然”为主题的“秋游红叶谷”活动。

综述与专论 | Summarize and reviews1612020.23·0　引言为培养具备水产动植物增养殖科学基本理论、基本知识和基本技能，并能将所学运用到科学研究、教学、技术开发与推广、管理、生产经营等工作的高级应用型、复合型和外向型，特别是热爱“三农”的卓越农林人才，指导和带领学生参加学科竞赛是将理论运用于实践的重要教学环节[1]。

1　大学生生命科学竞赛全国大学生生命科学竞赛始于2017年，是在浙江省大学生生命科学竞赛的基础上由教育部高等学校大学生物学课程教学指导委员会、生物科学类专业教学指导委员会、生物技术与生物工程类专业教学指导委员会联合《高校生物学教学研究（电子版）》杂志共同倡议发起举办的。

在2007年，由浙江大学、浙江农林大学和浙江中医药大学首次发起的第1届浙江省大学生生物技能竞赛；至2009年，正式更名为浙江省大学生生命科学竞赛，每年举行1次。

全国大学生生命科学竞赛至今已经分别在浙江中医药大学（2017）、河南大学（2018）和陕西师范大学（2019）举办了3届[2]；因受新冠疫情影响，第4届预期延后至2020年11月决赛，形式和地点至今未定。

大学生生命科学竞赛为学生提供创新和实践的平台。

通过该实践环节，利于学生提高动手能力、提出问题和解决问题的能力。

在参赛过程中，通过产学研相结合，使学生了解产业的发展和瓶颈，可以极大增强学生学习和创新的积极性，形成良好的学风。

此外，竞赛还可反过来促进专业教学的改革和创新[3-4]。

2　水产动物寄生虫课教学内容和目标《水产动物病害学》课程主要以水产动物病原学和病理学、渔药的药物学及疾病防治学等为基础，使学生深刻理解水产动物疾病学的基础知识和基本原理，基本具备对水产动物疾病的分析、诊断、研究及防控的能力。

“水产动物寄生虫病”是上述课的重要章节，包括理论教学和实验，理论主要为寄生虫病原学、鱼类寄生原生动物疾病、鱼类寄生如虫病、鱼类寄生甲壳动物病、虾蟹类寄生虫病、贝类寄生虫病和其他水产动物寄生虫病；实验分别为水产动物寄生虫病的调查方法和操作、水产动物寄生虫病的常规检查与诊断、水产动物常基于大学生生命科学竞赛的水产动物寄生虫病教学尹飞（宁波大学海洋学院，宁波 315832）摘要：大学生生命科学竞赛逐渐成为相关学科培养创新人才的有效环节。

December2003:397–412 Lead Review ArticleEvaluation of Insulin Sensitivity in Clinical Practice and in Research SettingsLais U.Monzillo,M.D.,and Osama Hamdy,M.D.,Ph.D.Insulin resistance is the core metabolic abnormal-ity in type2diabetes.Its high prevalence and its association with dyslipidemia,hypertension,hy-perinsulinemia,and high coronary and cerebro-vascular mortality put it in the forefront as the plausible target for aggressive intervention.Mea-surements of insulin sensitivity provide clinicians and clinical researchers with invaluable instru-ments to objectively evaluate the efficiency of both current and potentially useful interventional tools.Although several methods had been devel-oped and validated to evaluate insulin sensitivity, none of these methods can be universally used in all patients.Nonetheless,a method suitable for use in clinical or basic research may not neces-sarily be a practical method for use in clinical practice or for epidemiologic research.We re-viewed the currently used methods for assess-ment of insulin sensitivity.For each method,we summarized its procedure,normal value,cut-off value for defining insulin resistance,advantages and limitations,validity,accuracy for each patient population,and suitability for use in clinical prac-tice and in research settings.The methods re-viewed include fasting plasma insulin,homeo-static model assessment,quantitative insulin sensitivity check index,glucose-to-insulin ratio, continuous infusion of glucose with model as-sessment,indices based on oral glucose toler-ance test,insulin tolerance test,and the so called “gold standard”methods,the hyperinsulinemic euglycemic clamp and the frequently sampled–intravenous glucose tolerance test.Key words:insulin resistance,insulin sensitivity, clinical practice©2003International Life Sciences Institutedoi:10.1301/nr.2003.dec.397–412IntroductionInsulin resistance is a state in which physiologic concen-trations of insulin produce a subnormal biologic re-sponse.1It underlies abnormalities of glucose,lipid,and blood pressure homeostasis.2This cluster of metabolic abnormalities is referred to as the insulin resistance syndrome,syndrome X,or the metabolic syndrome,and is related to type2diabetes,obesity,hypertension,and dyslipidemia.3–5In fact,insulin resistance is present long before the clinical manifestations of the individual com-ponents of the syndrome.6–8Epidemiologic evidence indicates that insulin resistance is directly related to the risk of developing atherosclerosis and cardiovascular disease.9–11To clinically identify patients with the metabolic syndrome,the National Cholesterol Education Program Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III,ATP III)suggested that individuals having three or more of the following criteria are defined as having the metabolic syndrome:121.Abdominal obesity:waist circumferenceϾ40inchesin men andϾ35inches in women;2.Hypertriglyceridemia:Ͼ150mg/dL(1.69mmol/L);3.Low high-density lipoprotein(HDL)cholesterol:Ͻ40mg/dL(1.04mmol/L)in men andϽ50mg/dL(1.29mmol/L)in women;4.High blood pressure:Ն130/85mmHg;5.High fasting plasma glucose:Ն110mg/dL(Ն6.1mmol/L).A recent epidemiologic study among adults above age20 showed that the age-adjusted prevalence of the metabolic syndrome in the United States is23.7%,with a higher prevalence among minority populations.13Several clinical trials have shown that lifestyle mod-ification delays the progression to type2diabetes among individuals with impaired glucose tolerance;14–17how-ever,none of these studies included quantitative evalu-ation of insulin sensitivity as an integral component of the study design.It is possible that an improvement in insulin sensitivity can be achieved either through life-style modification18–21or pharmacologically with met-Drs.Monzillo and Hamdy are with the Clinical Research Center,Joslin Diabetes Center;Department of Medicine,Harvard Medical School,Boston,MA 02215,USA.formin22,23or thiazolidinediones.24–26The Food and Drug Association(FDA)has not approved either of these pharmacologic compounds for treatment of insulin resis-tance in nondiabetic individuals;however,the diagnosis of type2diabetes,hypertension,and dyslipidemia man-dates aggressive appropriate treatment with antidiabetic, blood pressure–lowering,and lipid-lowering agents aimed at reducing cardiovascular morbidity and mortal-ity.The rapidly growing epidemic of obesity and con-sequent insulin resistance has increased the interest in finding quantitative,accurate,and easy methods to eval-uate insulin sensitivity in both clinical research and clinical practice.Such a tool is not only useful for early identification of insulin resistance but also to assess the degree of success in treating this syndrome and its consequences.This review will summarize our current knowledge of the available methods used to evaluate insulin sensitivity in humans.The components of each method,its indications,and its limitations are discussed. Fasting Plasma Insulin ConcentrationOne of the most practical ways to estimate insulin resis-tance from the clinical perspective is to measure plasma insulin concentration after an overnight fast.As it is inexpensive and easy to do,it has been used in several population-based studies.27–30Very high plasma insulin values reflect the presence of insulin resistance.Despite the relatively good correlation between fasting plasma insulin and insulin sensitivity derived from the hyperin-sulinemic euglycemic clamp,measures of fasting plasma insulin explain no more than5to50%of the variability in insulin action seen in nondiabetic subjects.31,32This is because plasma insulin levels depend not only on insulin sensitivity,but also on insulin secretion,distribution,and degradation.33Moreover,with the development of diabetes,fasting plasma insulin levels tend to decrease owing to beta cell dysfunction.Therefore,plasma insulin levels in diabetic patients are valid reflection of both target tissue insulin resistance and diminishing insulin production.34This explains why fasting plasma insulin levels may accu-rately predict insulin sensitivity among normoglycemic patients than among those with impaired glucose toler-ance(IGT)or type2diabetes.32,35,36Another limitation to using fasting plasma insulin to predict insulin resis-tance is cross-reactivity between insulin and proinsulin. Proinsulin levels are high among insulin-resistant sub-jects with type2diabetes and IGT,37,38but not in people who are insulin resistant and normoglycemic.39 The commonly used radioimmunoassay(RIA) method has a lower specificity and sensitivity,and a higher interassay coefficient of variation,when com-pared with the two-site monoclonal antibody-based in-sulin assay methods(immuno-radiometric[IRMA],im-muno-enzymometric[IEMA],and immuno-fluorimetric [IFMA])methods.40,41The presence of anti-insulin an-tibodies in type1and type2diabetic patients,who are treated with human or animal insulin,can interfere with both the RIA and two-site monoclonal assay,unless removal of anti-insulin antibodies and antibody-bound insulin is performed.41,42The normal range for insulin levels using RIA is3to 32mU/L.43,44However,there is no defined cut-off value indicating insulin resistance.This lack of consensus stems partly from the various means used to define abnormal.In a population-based study examining the association between insulin levels and cardiovascular risk,Lindahl et al.8defined insulin resistance as a plasma insulin levelϾ7.2mU/ing the hyperinsulinemic euglycemic clamp as the reference standard,McAuley et al.45found that a fasting insulinϾ12.2mU/L predicted insulin resistance among normoglycemic adults. Laakso,32also using the hyperinsulinemic clamp in nor-moglycemic adults,arrived at a cut-off of18mU/L. Finally,defining the abnormal range as the upper10% percentile,Ascaso et al.46defined insulin resistance in nondiabetic individuals when plasma insulin levels were equal or greater than16.7mU/l(Table1).While these variations illustrate how study designs influences what insulin level is determined to represent insulin resistance, the lack of established standards for insulin assay proce-dures further complicates the issue.47Another limitation for measurement of fasting plasma insulin is the pulsatile mode of insulin secretion (pulses with a periodicity of10–15minutes,and ultra-dian oscillations periods of1to3hours).The periodicity, amplitude,and ultradian oscillations of insulin pulsesparison of Fasting Plasma Insulin Values and Insulin Assays Used to Assess Insulin Sensitivity in Different StudiesStudy Year Population Insulin Assay Insulin Resist Value Lindahl et al.81993General population RIAϾ7.2mU/L McAuley et al.452001General population RIAϾ12.2mU/L Laakso et al.321992Normoglycemic RIAϾ18mU/L Ascaso et al.462001Normoglycemic RIAՆ16.7mU/L RIAϭradioimmunoassay.vary in the fasting state,and are altered in IGT and in type2diabetes.41Because of these limitations,fasting plasma insulin levels are of limited value for clinical purposes,but have some utility as a research tool in population-based studies.The Homeostasis Model Assessment(HOMA)Because fasting insulin per se does not provide an accu-rate measure of insulin sensitivity in diabetic patients, efforts have been made to incorporate fasting plasma glucose in a formula to arrive at a better estimate of insulin-sensitivity.HOMA was developed by Matthews et al.48as a method for estimating insulin sensitivity from fasting serum insulin(FI)and fasting plasma glu-cose(FG)using the following mathematic formula: HOMA Insulin Resistance(HOMA IR)ϭFIϫFG/22.5FI is measured in␮U/mL and FG is measured in mmol/L.Low HOMA IR indicates high insulin sensitiv-ity,whereas high HOMA IR indicates low insulin sensi-tivity.In their original report,Matthews et al.found HOMA IR ranges between1.21and1.45in normal sub-jects and between 2.61and 2.89in insulin-resistant diabetic subjects.48However,further epidemiologic studies performed in the general population reported higher HOMA IR values of2.1,442.7,31and3.8.46 Because fasting insulin is a major component of the HOMA IR calculation,all previously mentioned limita-tions should apply to this formula.Three samples for fasting plasma insulin should be drawn5minutes apart to avoid errors that may arise owing to the pulsatile nature of insulin secretion.However,most studies use only one basal insulin measurement to calculate HOMA IR.HOMA IR correlates well with the glucose disposal rate derived from the hyperinsulinemic euglycemic clamp.49–53In addition,two authors found a good cor-relation between the HOMA IR and the insulin sensitivity index(S i)derived from the frequently sampled intrave-nous glucose tolerance test(FSIVGT).54,55By contrast, Anderson et al.35failed to demonstrate a good correla-tion between the two.Furthermore,some of the studies that initially demonstrated significant correlation be-tween the HOMA IR and the clamp-derived insulin sen-sitivity used a low insulin infusion rate of20 mU⅐m2Ϫ1⅐minuteϪ1during the clamp,which might not have completely suppressed the hepatic glucose pro-duction and may have created an error in calculating theglucose uptake by peripheral tissues.51,52One of the limitations of HOMA IR is the model assumption that insulin sensitivity in the liver and pe-ripheral tissues are equivalent,whereas it is known that they can differ considerably in the same individual.50 Furthermore,some data suggest that the accuracy of HOMA IR is limited by hyperglycemia.Those studies that demonstrated good correlations between HOMA IR and the clamp-derived insulin sensitivity in diabetic patients tended to enroll patients without significant hyperglyce-mia.48–50,52,53Mari et al.56failed to show a significant correlation between HOMA IR and clamp in type2dia-betic patients with higher glucose levels(mean basal plasma glucose of205mg/dL).In addition,Anderson et al.35and Brun et al.57found that the correlation between HOMA IR and S i derived from the FSIVGT weakened as glycemia increased.These results suggest a non-linear relationship between S i and HOMA IR.The coefficient of variation(CV)for HOMA IR is as high as31%,48which limits its use in clinical practice and clinical research.47Optimizing sample size and in-sulin assay method reduceHOMA IR CV to8to12%.49,51 In conclusion,HOMA IR is mostly useful for the evaluation of insulin sensitivity in euglycemic individu-als and in persons with mild diabetes;however,this index appears to offer little or no advantage over the fasting insulin concentration alone.31,45,58In patients with severe hyperglycemia or in lean diabetic patients with beta cell dysfunction,the HOMA IR may not be accurate.Its usefulness should therefore be restricted to large population-based studies that require a simple method to assess insulin sensitivity.Quantitative Insulin Sensitivity Check Index (QUICKI)QUICKI is another mathematic model available to esti-mate insulin sensitivity.59QUICKIϭ1/[log(I0)ϩlog(G0)],where I0is the fasting plasma insulin level in␮U/mL, and G0is the fasting plasma glucose level in mg/dL.The mean QUICKI for lean,obese,and obese-diabetic sub-jects are0.382,0.331,and0.304,respectively.59Al-though other studies have found a similar range for a normal healthy population of0.372and0.366,60,61one study showed a wider range between0.265and0.518.62 The mathematic difference between the QUICKI and the HOMA IR is that the former uses the reciprocal of the logarithm of both glucose and insulin to account for the skewed distribution of fasting insulin values.As expected,there is very good correlation between QUICKI and HOMA IR,63especially when the HOMA IR is log-transformed.59,62,64,65Although two studies failed to demonstrate any real advantage of QUICKI when compared with log HOMA IR,62,65other studies argue that QUICKI has the advantage of being applied to wider ranges of insulin sensitivity.61,63,64QUICKI was also shown to correlate well with the FSIVGT66and the hyperinsulinemic eu-glycemic clamp.58However,the correlation is weakerwhen insulin levels were low,as seen in non-obese insulin-sensitive subjects and diabetic patients with di-minished insulin production;59,60,62,65,67,68this is be-cause low insulin levels lead to variability in determined insulin concentrations and because of the oscillatory pattern of insulin secretion in healthy individuals.Other limitations to this mathematic method include its limited applicability for type1diabetic patients owing to lack of endogenous insulin secretion,59and its inaccuracy if conducted following exercise training.67In conclusion,the QUICKI may be a useful and simple tool for assessing insulin sensitivity in epidemi-ologic settings;it may offer some advantage over the HOMA IR,especially in obese and diabetic individuals with relatively preserved beta cell function.However, the model needs validation in a wider range of subjects with different glucose tolerance patterns in order to confirm its reliability for use in clinical practice and in research settings.Fasting Plasma Glucose-to-Insulin Ratio(G/I)G/I is another mathematic method that uses fasting plasma insulin and fasting plasma glucose to estimate insulin sensitivity.The higher the ratio,the more insulin-resistant an individual is.The index generally correlates well with other indi-ces of insulin sensitivity.1,45,69–75It correlated with in-sulin sensitivity indices derived from the oral glucose tolerance test(OGTT,rϭ0.82,PϽ0.05),1,71and FSIVGT(rϭ0,76,PϽ0.001).1,69,72Vuguin et al.72 found that a fasting G/I ratioϽ7provided87%sensitiv-ity and89%specificity for identifying low insulin sen-sitivity in young girls with premature adrenarche.In another study of white nondiabetic women with polycys-tic ovarian syndrome(PCOS),Legro et al.69found the G/I ratio to be the best screening test for insulin resis-tance.The authors showed that a cut-offϽ4.5provided an87%positive predictive value and94%negative predictive value in screening for insulin resistance in PCOS.G/I ratio was found to correlate well with HOMA IR(rϭ0.83,PϽ0.01),fasting insulin(rϭ0.95, PϽ0.001),73and QUICKI(rϭ0.91,PϽ0.0001)74in healthy individuals.Data on the correlation between G/I ratio and insulin sensitivity derived from the euglycemic clamp procedure are inconsistent;whereas two studies found a significant correlation,1,45another did not.50 Adding to the previously mentioned problems that in-clude precision of insulin assay,pulsatile pattern of insulin secretion,and cross reactivity with proinsulin,the major problem with using the G/I ratio is its inaccuracy in diabetic patients owing to defects in insulin secretion and high plasma fasting glucose.1,50,70,76In subjects with normoglycemia,G/I ratio offered little advantage over the1/insulin measure76or fasting insulin.45Moreover,it provides indirect information on whole-body sensitivitybut not on the effect of insulin in peripheral tissues.1Inconclusion,this index,like the previously describedindices,should be limited to the nondiabetic population.For research purposes,its superiority over the fastinginsulin is questionable.Continuous Infusion of Glucose with Model Assessment(CIGMA)Because of the inaccuracy that may result from low basalinsulin concentrations,an alternative mathematic methodwas proposed.This method assesses insulin sensitivitythrough the evaluation of the near–steady state glucoseand insulin concentrations after a continuous infusion ofglucose with model assessment.77This procedure mim-ics postprandial glucose and insulin concentrations.CIGMA not only provides information about glucosetolerance and insulin sensitivity,but also about beta celling a mathematic model of glucose ho-meostasis,glucose and insulin values are compared withknown physiologic data of glucose and insulin kinetics inresponse to glucose infusion that are derived fromhealthy lean subjects with no family history of diabetes.The glucose and insulin values used for CIGMA areobtained during the last15minutes of the60-minutecontinuous glucose infusion(5mg glucose⅐kg idealbody weightϪ1⅐minuteϪ1).Samples are collected at five-minute intervals,to avoid the oscillatory variation ininsulin concentration.The average is then compared withpredicted values from the computer model.The medianvalue for normal subjects is1.35and for diabetic patientswith mild hyperglycemia is4.0.77Although CIGMA has been used in several studiesto evaluate insulin resistance,78–83few studies havecompared CIGMA with other insulin sensitivity indices.In elderly normoglycemic patients,CIGMA significantlycorrelated with mean fasting plasma insulin concentra-tions.84Hermans et al.55compared CIGMA,HOMA IR,FSIVGT,and the insulin tolerance test(ITT),in subjectswith glucose tolerance ranging from normal to frankdiabetes.They found that CIGMA and HOMA IR wereable to discriminate differences in insulin sensitivityamong subjects as well as the FSIVGT and better thanthe ITT.Among the four methods,CIGMA was the bestdiscriminatory test in precision analysis.It is worthmentioning that CIGMA in this study derived from a2-hour test(compared with the original1-hour CIGMA).Other studies have also reported data from2-hourCIGMA.85,86Data aiming to validate CIGMA against the clamp-derived insulin sensitivity index are scarce.In the orig-inal article,CIGMA was shown to correlate well with theeuglycemic hyperinsulinemic clamp(rϭ0.87,P Ͻ0.0001)77in normal subjects and in diabetic patientswith mild hyperglycemia.However,the relationship be-tween CIGMA and the clamp was nonlinear for diabetic patients with severe insulin resistance.Nijpels et al.70 studied90subjects,most of them with normal or im-paired glucose tolerance,and found a modest correlation between CIGMA and the clamp-derived insulin sensitiv-ity(rϭ0.66;PϽ0.05).The CV of CIGMA ranges between17%84and20%.77There are two main advantages of CIGMA over HOMA IR.First,the insulin values that are measured in CIGMA are much higher than those in HOMA IR owing to the glucose stimulus;therefore,the high insulin inter-assay CV(10–15%)41,47that is problematic at low insu-lin a concentration is avoided.55Second,higher insulin concentration in CIGMA stimulates peripheral glucose uptake producing a steady-state glucose concentration, which is a better reflection of the peripheral insulin sensitivity.Although CIGMA is more physiologic,practical, cheaper,and less invasive than the FSIVGT and clamp procedure,the model incorrectly assumes that levels of insulin resistance at the liver and peripheral tissues are equal.Furthermore,in insulin-deficient subjects,where the insulin response is insufficient to stimulate glucose uptake,the interpretation of CIGMA is difficult.33As CIGMA is a procedure and not a simple test such as fasting insulin or the HOMA IR,its use in clinical practice is limited.Moreover,due to insufficient data comparing CIGMA against the“gold standard”euglycemic hyper-insulinemic clamp,its use in research settings should also be viewed with caution.The Oral Glucose Tolerance Test(OGTT) Because oral glucose tolerance is in part determined by sensitivity of peripheral tissues to insulin,the OGTT has been used to evaluate insulin release and the sensitivity of the peripheral tissue to the insulin action.Being a less costly and less labor-intensive procedure compared with the FSIVGT and the euglycemic clamp,the OGTT has been considered a practical method for epidemiologic studies,58for population screening,and for large-scale intervention trials.50,63,87Several indices to estimate in-sulin sensitivity have been derived from the four samples of insulin and glucose(0,30,60,and120minutes)taken after ingestion of75grams of glucose(Table2). Insulin Sensitivity Indices Based on the OGTT Levine et al.88was one of thefirst authors to use the product of the area under the curve for glucose(AUC G) and the area under the curve for insulin(AUC I)during the OGTT to derive an estimate of insulin sensitivity. Later,AUC I was used alone as an estimate.31,36,89Cederholm and Wibell Index90SIϭM/G⅐log I,where Mϭglucose load/120ϩ(0-h plasma glucose concentration–2-h plasma glucose concentration)ϫ1.15ϫ180ϫ0.19ϫbody weight/120;where Gϭmean plasma glucose concentration,and Iϭmean serum insulin.A normal reference value is79Ϯ14.Gutt et al.Index91ISI0,120ϭMCR/log MSI(mean serum insulin),uses the fasting(0min)and120min post-load insulin and glucose concentrations,where MCR(metabolic clear-ance rate)is m/MPG(mean plasma glucose),where mϭ(75000mgϩ[0min glucose–120min glucose]ϫ0.19ϫbody weight)/120min.The reference range for lean controls was89Ϯ39,for obese58Ϯ23,for IGT 46Ϯ12,and for diabetic patients23Ϯ19.Avignon et al.Index92Sibϭ108/(IϫGϫVD)⅐(normal rangeϭ11.99Ϯ1.43)Si2hϭ108/(I2hϫG2hϫVD)⅐(normal rangeϭ1.79Ϯ0.33), where Iϭfasting insulin,Gϭfasting plasma glucose, G2h and I2hϭplasma glucose and insulin at the second hour of the OGTT,and VDϭvolume distribution(150 mL/kg of body weight).An additional insulin sensitivity index(S i M)was derived by the average of the2,after multiplying S i b by a correcting factor:SiMϭ[(0.137ϫSib)ϩSi2h]/2(normal rangeϭ1.71Ϯ0.24). Matsuda et al.Index50ISI(composite)ϭ10,000/͙(FPGϫFPI)ϫ(GϫI), where FPGϭfasting plasma glucose,FPIϭfasting plasma insulin,and Gϭmean plasma glucose,and Iϭmean plasma insulin concentration.Belfiore et al.Index93ISIϭ2/(INSpϫGLYp)ϩ1,where INSp and GLYp are the insulinemic and glycemic areas of the person under study recorded during OGTT. Reference value in normal controls was around1,butmarkedly reduced in the obese and obese-diabetic sub-groups.Stumvoll et al.Index94MCR est(OGTT)ϭ18.8Ϫ0.271BMIϪ0.0052ϫI120Ϫ0.27ϫG90, where MCR est stands for metabolic clearance rate estimate derived from the OGTT,BMIϭbody mass index,I120ϭplasma insulin at120minutes OGTT,and G90ϭplasma glucose at90minutes OGTT.Mari et al.Index56OGIS180ϭ[637106(G(120)Ϫ90)ϩ1]Cl ogtt, where OGIS180ϭoral glucose insulin sensitivity,G120ϭplasma glucose at2h OGTT,andCl ogttϭ289DoϪ104[G(180)ϪG(120)/60]G(120)ϩ14.0103G(0)440I(120)ϪI(0)ϩ270, where Clϭglucose clearance in mL⅐minϪ1⅐mϪ2, Doϭoral glucose dose in g/m2,G(120)ϭplasmaTable2.OGTT-derived Indices to Estimate Insulin Sensitivity and their Correlation with the Euglycemic Hyperinsulinemic Clamp or Frequently Sampled Intravenous Glucose Tolerance Test(FSIVGT)in Various PopulationsFormulae Subjects Correlation with 1.AUC I NGT Euglycemic clamp89rϭ0.61,Pϭ0.001IST31rϭ0.79,PϽ0.001AUC II30min I2hrG30min G2hr NGT,IGT ITT36rϭϪ0.51,PϽ0.001rϭϪ0.43,PϽ0.001rϭϪ0.39,PϽ0.001rϭϪ0.28,Pϭ0.01rϭϪ0.38,PϽ0.0012.SIϭMGϫlog INGT,IGT,DMEuglycemic clamp90rϭ0.62,PϽ0.00013.ISI0,120ϭMCR/log MSI NGT,IGT,DM Euglycemic clamp91rϭ0.63,PϽ0.001 4.Sibϭ108/(f Iϫf GϫVD)NGT,IGT,DM FSIVGT92Si2hϭ108(I2hϫG2hϫVD)rϭ0.90,PϽ0.0001 SiMϭ[(0.137ϫSib)ϩSi2h]/25.ISI(Comp)ϭ10,000͙(FPGϫFPI)ϫ(GϫI)NGT,IGT,DMEuglycemic clamp50rϭ0.73,PϽ0.00016.ISIϭ2(INSpϫGLYp)ϩ1NGT,O,ODMEuglycemic clamp93rϭ0.96,PϽ0.0017.MCRestϭ18.8Ϫ0.271BMIϪ0.0052ϫI120Ϫ0.27ϫG90NGT,IGT Euglycemic clamp94rϭ0.80;PϽ0.000058.OGIS180ϭ[637106(G{120}Ϫ90)ϩ1]Cl ogtt L,O,IGT,DM Euglycemic clamp56rϭ0.73;PϽ0.0001 AUC Iϭarea under the insulin curve,NGTϭnormal glucose tolerance,IGTϭimpaired glucose tolerance,I30minϭ30minutes post-load insulin,I2hrϭ2hours post-load insulin,G30minϭ30minutes post-load glucose,G2hrϭ2hour post-load glucose, ITTϭinsulin tolerance test,SIϭinsulin sensitivity,Mϭglucose uptake rate in mg⅐minϪ1,Gϭmean glucose concentration,Iϭmean insulin concentration,DMϭtype2diabetes,ISI0,120ϭindex of insulin sensitivity from fasting and120minutes post OGTT insulin and glucose concentrations,MCRϭmetabolic clearance rate,MSIϭmean serum insulin,Sibϭinsulin sensitivity in the basal state,Si2hϭinsulin sensitivity at the second hour,f Iϭfasting insulin concentration,f Gϭfasting glucose concentration,VDϭ150mL/kg of body weight,SiMϭinsulin sensitivity index,ISI(Comp)ϭcomposite whole-body insulin sensitivity index,FPGϭfasting plasma g glucose,FPIϭfasting plasma insulin,Gϭglucose,Iϭinsulin,ISIϭinsulin sensitivity index,INSpϭinsulinemic area,GLYpϭglycemic area,MCRestϭmetabolic clearance rate estimate,OGISϭoral glucose insulin sensitivity,Doϭoral dose glucose,Cl ogttϭglucose clearance.glucose at120minutes OGTT,G(180)ϭplasma glucose at180minutes OGTT,G(0)ϭfasting plasma glucose, I(120)ϭinsulin levels at120minutes,and I(0)ϭfasting insulin.Reference values in lean controls ranged300–600mL⅐minϪ1⅐mϪ2.As shown in Table2,the insulin sensitivity mea-sures derived from these formulas correlate well with insulin sensitivity determined by the euglycemic clamp50,89,90,93and FSIVGT.93However,the correlation was weaker in type2diabetic patients50,92,94and in the IGT group.36,58Belfiore et al.93advocate that their for-mula should not be used in type2diabetic patients with significant insulin deficiency.On the other hand,Mari et al.formula(OGIS),56showed a positive correlation with the clamp data in type2diabetic patients(rϭ0.49,P Ͻ0.002).In addition to the inadequacy of this method in insulin deficient states,other problems should be consid-ered.First,during the oral glucose tolerance test suppres-sion of hepatic glucose production is minimal,confound-ing interpretation of the plasma glucose level.Thus,it is impossible to differentiate among whole-body,periph-eral,or hepatic insulin sensitivity separately using data from the OGTT.49Second,the insulin level achieved in response to an oral glucose load involves gut hormones, neural stimulation,and of course the integrity of the pancreatic beta cells.68For example it has been shown that after75grams of glucose,obese subjects exhibit insulin hypersecretion,95while type2diabetes patients show a blunted response.96Third,glucose homeostasis in the postprandial state depends partly on the suppression of glucagon secretion and partly on the rate of entry of ingested glucose into the circulation.This rate is deter-mined by the rate of gastric emptying and splanchnic glucose uptake.60,61Fourth,the OGTT is poorly repro-ducible.Several studies show only about50to65% reproducibility of the results of an OGTT.63,97,98 Despite these limitations,the OGTT may be used in clinical settings to assess insulin action and in large-scale clinical and epidemiologic studies.However,the glucose and insulin excursions in the OGTT should be inter-preted with caution in populations with varying glucose tolerance.The Insulin Tolerance Test(ITT)ITT was one of thefirst methods developed to assess insulin sensitivity in vivo.99In this method,afixed bolus of regular insulin(0.1U/kg body weight)is given intra-venously after an8-to10-hour fast.The plasma glucose decrement over60minutes is then measured.The faster the decline in glucose concentration,the more insulin sensitive the subject is.The slope of the linear decline in plasma glucose(K ITT)can be calculated by dividing 0.693by the plasma glucose half-time(50%from base-line,Figure1).100K ITTϭ0.693/t1/2ϫ100,where t1/2represents the half-life of plasma glucose decrease.Normal K ITT isϾ2.0%/minute and values Ͻ1.5are considered abnormal.This method gives an indirect estimate of overall insulin sensitivity.It has been shown to correlate with the euglycemic clamp(rϭ0.811,PϽ0.001)101in several studies.101–104Some of the drawbacks of this method include the supraphysi-ologic insulin dose used,102and also the fact that the test does not differentiate peripheral versus hepatic insulin resistance.A major limitation of this test is the risk of hypo-glycemia,particularly in normoglycemic subjects and in elderly diabetic patients.Moreover,hypoglycemia trig-gers counterregulatory hormonal responses,which may interfere with insulin sensitivity.A lower insulin dose method of0.05units/kg,or shortening the test to15 minutes was suggested as an attempt to decrease the risk of hypoglycemia.105–107The lower dose ITT has also been shown to correlate well with the clamp.105How-ever,some studies failed to demonstrate reduction of the risk of hypoglycemia in insulin sensitive sub-jects.55,108,109They also showed a higher CV(16and 31%)in comparison to the conventional dose ITT(6–9% CV).101,103,104,110The shorter version101,103evolved from the notion that the counterregulatory hormone re-sponse occurs only after20minutes of the insulin infu-sion.111–113The short ITT yielded a good correlation with the euglycemic clamp101,103,105and has been used in most of the recent studies.114–117In conclusion,the ITT should be used with great caution in insulin sensitive individuals because of the increased risk of hypoglycemia,even when thesmallerFigure1.Calculation of the KITT(percentage decline in plasma glucose concentration per minute)in nondiabetic subjects.100 The time(t1⁄2)required for the plasma glucose concentration to decline by50%(i.e.,from90to45mg/dL)was25minutes.From the equation,KITTϭ0.693/t1⁄2ϫ100,the K rate was determined to be2.77%.。

（2019·山东菏泽）第二节书面表达（满分15分）假如你是李华，你的英国笔友Lisa来信说她最近正在学习汉语，在学习过程中遇到“程门立雪”（Chen Men Li Xue）这一成语，不解其意。

请根据下面图片提示，用英语给她回信，简要叙述这个成语故事，并谈谈自己的理解和感悟。

要求：1. 语言规范，语句通顺，可适当发挥；2. 字数：不少于100词；开头和结尾已给出，不计人总词数。

可能用到的词：idiom成语；during the Northern Song Dynasty北宋时期；Cheng Yi程颐；have a nap小憩；disturb打扰；moved感动的；respect尊敬Dear Lisa,I’m glad to hear from you. ______________________________________________________._______________________________________________________________________________Yours,Li HuaDear Lisa,I’m glad to hear from you.In you letter, you say you’re studying Chinese and you don’t understand the meaning of the Chinese idiom “Cheng Men Li Xue”. Now let me tell you some about it.During the Northern Song Dynasty, there lived a famous learned teacher called Chen Yi. At that time, many young people wanted to learn more knowledge from him. One day, there were two young men coming to Chen’s house, which of them was called Yang Shi. It was snowing heavily and Chen was having a nap. One of them said to Yang Shi, “Let’s come in and ask the teacher for help.” But Yangshi said, “No. The teacher is having a rest. We should wait outside to avoid disturbing him.”After some time, Chen woke up. When he found the two young men standing outside in such a snowy condition, immediately he asked them to come in. But, Yang Shi said, “I’m sorry to trouble you.”Now the idiom is used to describe a person who hopes to learn shows respect to a learned elder. It’s about the idiom “Cheng Men Li Xue”. I hop e it can help!Yours,Li Hua(2019浙江湖州) 八、书面表达(本题15分)5月18日是国际博物馆日，下图是你班同学参观博物馆的情况。

短肠综合征患者饮食行为特征及管理的质性研究沈如婷，罗娟，黄迎春，叶向红（东部战区总医院普通外科研究所，江苏南京 210002）摘要：目的 深入了解短肠综合征患者饮食行为特征及自我饮食管理方面的体验，以进一步指导和干预患者饮食管理，提高饮食管理依从性。

方法 运用质性研究中的现象学方法，对15例短肠综合征患者进行面对面、半结构式访谈，采用Colaizzi现象学资料分析法分析访谈资料。

结果 短肠综合征患者的饮食行为特征及管理中主要存在4个方面的体验：日常饮食结构改变、饮食指导信息获取与认知、自我饮食管理类型、饮食管理支持需求。

结论 医务人员应重视短肠综合征患者疾病和饮食知识认知的提高，可采用多模式饮食指导方式提高患者知识储备并通过制订科学量化的饮食方案提高饮食依从性。

同时，应关注患者家庭和社会支持，保障患者正常社交功能。

关键词：短肠综合征；饮食行为；饮食管理；质性研究Qualitative study on the characteristics of dietary behavior and managementof patients with short bowel syndromeSHEN Ruting, LUO Juan, HUANG Yingchun, YE Xianghong(Research Institute of General Surgery, Jinling Hospital, Nanjing 210002, Jiangsu) Abstract:Objective To deeply understand the dietary behavior characteristics and self dietary management experience of patients with short bowel syndrome, so as to further guide and intervene the dietary management of patients and improve the compliance of dietary management. Methods Face to face and semi-structured interviews were conducted in 15 patients with short bowel syndrome by using qualitative research phenomenological method. The interview data were analyzed by Colaizzi phenomenological data analysis method. Results There were four aspects of experience in the dietary behavior characteristics and management of patients with short bowel syndrome: daily dietary structure change, dietary guidance information acquisition and cognition, self dietary management types, dietary management support needs. Conclusion In the future work, medical staff should pay attention to the improvement of the cognition of disease and diet knowledge of patients with short bowel syndrome. Multi mode diet guidance can be used to improve the knowledge reserve of patients, and the diet compliance can be improved by making scientific and quantitative diet plan. At the same time, it should be pay attention to the family and social support of patients to ensure their normal social function.Key words: Short bowel syndrome; Dietary behavior; Dietary management; Qualitative research 短肠综合征（short bowel syndrome,SBS)是指因各种原因引起广泛小肠切除或旷置后肠[作者简介]沈如婷，本科，主管护师，E-mail：[通信作者]叶向红，本科，主任护师，E-mail：道有效吸收面积显著减少，出现以腹泻、水电解质紊乱以及各种营养物质吸收和代谢障碍为主的症候群[1]。

张晶晶等.叙事护理模式对首诊癌症化疗患者创伤后成长的影响分析2192组患者心理情绪结果显示，进行叙事护理模式干预后观察组患者心理情绪情况优于对照组，表示进行叙事护理模式干预后对改善首诊癌症化疗患者情绪有一定作用。

究其原因可能在于：进行叙事护理模式时，患者向干预人员讲述内心苦闷，而干预人员根据患者叙事内容引导患者发觉自身过往积极事件,并引导患者根据积极事件进行错误认知修正，进行新的行动规划，有助于患者负面情绪缓解。

孙妞妞等[⑸研究认为，进行叙事护理有助于患者负面情绪缓解，与本研究结果一致。

本研究结果还显示，干预后观察组生活质量高于同期对照组，说明进行叙事护理有利于首诊癌症化疗患者生活质量提升。

其原因可能与患者接受叙事护理后,改变原有的生活态度，愿意接受周围人的鼓励，有利于减轻患者负面情绪，故患者生活质量有所提高。

综上所述，叙事护理模式用于首诊癌症化疗患者中，可帮助患者创伤后成长，缓解患者癌性疲乏及负面心理情绪，并有助于患者生活质量提高。

参考文献[1]肖红英，蒋运兰，杨飞霞，等.癌症长期幸存者创伤后成长的心理调查[J].四川医学,2018,39(10)：1112-1115.[2]李玉梅，黄瑛，薛智颖，等.叙事护理对晚期肺癌患者心境与症状群管理的效果[J].解放军护理杂志,2018,35(21)：28-31,41-[3]佟俊萍，王宁，李静，等.腮腺肿瘤切除患者围术期个性化舒适护理与叙事护理干预模式的构建[J].中国医药导报,2018,15(14)：138-142.[4]张晓义，何红，吴爱娟•叙事医学教育模式对中高危糖尿病足患者足部知识水平及代谢指标的影响[J].中华现代护理杂志，2016,22(5)：639-642,643.[5]陈万青，郑荣寿,张思维，等.2011年中国恶性肿瘤发病和死亡分析[J]•中国肿瘤,2016,25(1):1-10.[6]郝素敏，郝素聪,贾海潮•心理痛苦分层管理模式对改善肿瘤门诊化疗患者负性情绪和社会支持状态的应用价值[J].癌症进展,2019,17(6)：731-735.[7]曾秋霞，何海燕,徐春美，等.急性心肌梗死患者创伤后成长特征及其与社会支持和应对方式的关系[J]•第三军医大学学报，2018,40(2)：176-182.[8]张凤玲，丁坍，韩丽沙.癌症疲乏量表中文版的信效度[J].中国心理卫生杂志,2011,25(11):16-19.[9]王建平，陈海勇，苏文亮，等.简式简明心境问卷在癌症病人应用中的信、效度[J].中国心理卫生杂志,2004,18(6)=404-407.[10]晁敏，梁丰，孙涛，等.不同强度抗阻训练对老年癌症生存者癌因性疲乏及生存质量的影响[J]•中国康复医学杂志,2015,30⑻：777-781. [1叮王义会，李颖，李文娟，等.叙事护理在自然分娩产妇中的应用效果[J]•护理研究,2019,33(7)：1247-1250.[12]张慧，刘桂霞.化疗期肺癌患者自我感受负担与疾病感知，乐观倾向及创伤后成长的相关性[J]•广东医学,2020,41(2)：169-173. [13]田琳琳，马丽莉,李艳萍•结构式团体心理干预对改良根治术后年轻乳腺癌病人创伤后成长的影响[J]•护理研究,2016,30 (27)：3384-3386.[14]王明，戴经纬,齐向秀，等•选择性心理干预对乳腺癌患者术后癌性疲乏及生存质量的影响[J]•河北医药,2018,40(2)=292-294,298.[15]孙妞妞，史素玲,李转珍，等•叙事护理对冠状动脉搭桥术患者焦虑抑郁干预效果的观察[J]・中国实用护理杂志,2019,35 (31)：2407-2411.(收稿日期：2020-11-30；修回日期：2021-03-12)参考文献著录格式文献尽量引用近5年登载论文作，内部资料和尚未发表者请勿列入。