Thematic review series: Adipocyte Biology. Lipodystrophies: windows on adipose biology and metabolism

The lipodystrophies are characterized by loss of adipose tissue in some anatomical sites, frequently with fat accumulation in nonatrophic depots and ectopic sites such as liver and muscle. Molecularly characterized forms include Dunnigan-type familial partial lipodystrophy (FPLD), partial lipodystrophy with mandibuloacral dysplasia (MAD), Berardinelli-Seip congenital generalized lipodystrophy (CGL), and some cases with Barraquer-Simons acquired partial lipodystrophy (APL). The associated mutant gene products include 1) nuclear lamin A in FPLD type 2 and MAD type A; 2) nuclear lamin B2 in APL; 3) nuclear hormone receptor peroxisome proliferator-activated receptor gamma in FPLD type 3; 4) lipid biosynthetic enzyme 1-acylglycerol-3-phosphate O-acyltransferase 2 in CGL type 1; 5) integral endoplasmic reticulum membrane protein seipin in CGL type 2; and 6) metalloproteinase ZMPSTE24 in MAD type B. An unresolved question is whether metabolic disturbances are secondary to adipose repartitioning or result from a direct effect of the mutant gene product. Careful analysis of clinical, biochemical, and imaging phenotypes, using an approach called "phenomics," reveals differences between genetically stratified subtypes that can be used to guide basic experiments and to improve our understanding of common clinical entities, such as metabolic syndrome or the partial lipodystrophy syndrome associated with human immunodeficiency virus infection.     

Data-Mining Discovery of Pattern and Process in Ecological Systems

ABSTRACT Most ecologists use statistical methods as their main analytical tools when analyzing data to identify relationships between a response and a set of predictors; thus, they treat all analyses as hypothesis tests or exercises in parameter estimation. However, little or no prior knowledge about a system can lead to creation of a statistical model or models that do not accurately describe major sources of variation in the response variable. We suggest that under such circumstances data mining is more appropriate for analysis. In this paper we 1) present the distinctions between data-mining (usually exploratory) analyses and parametric statistical (confirmatory) analyses, 2) illustrate 3 strengths of data-mining tools for generating hypotheses from data, and 3) suggest useful ways in which data mining and statistical analyses can be integrated into a thorough analysis of data to facilitate rapid creation of accurate models and to guide further research.     

探索病理学教学改革,培养高素质医学人才

病理学是医学院校的重要基础课,高质量的病理学教学是培养高素质医学人才的必要基础。从更新教学内容,科学运用新的教学方法及多种现代化教学手段等方面探讨了当代病理学教学改革。     

Environmental decision support systems: A new approach to support the operation and maintenance of horizontal subsurface flow constructed wetlands

This paper describes the development and operation of an Environmental Decision Support System (EDSS) to improve the operation and maintenance of horizontal subsurface-flow constructed wetlands (EDSS-maintenance). Constructed wetlands (CWs) allow wastewater treatment in a sustainable manner since they involve low energy consumption, low construction and functioning costs and low environmental impact. However, operation and maintenance activities are essential to guarantee reliability in CWs performance. The definition of operation and maintenance protocols depends on several quantitative and qualitative aspects such as wastewater treatment plant configuration, CW design, influent characteristics, sensitivity of the receiving media, etc. Bearing this in mind and considering the limited technical knowledge about CWs, the need for a new tool to support CW performance is clear. In this sense, EDSSs offer a new approach because they can tackle problems of complex and uncertain systems. The EDSS-maintenance provides operation and maintenance manuals specifically defined for every CW. To achieve it, the required knowledge was implemented within a rule-based system, which forms the backbone of the EDSS. Several features presented in this paper demonstrate how the EDSS-maintenance provides a proper platform to support the necessary collaborative work in the ecological engineering problem of horizontal subsurface flow CWs operation and maintenance.     

The therapeutic exception: abortion, sterilization and medical necessity in Costa Rica

Based on the case of Rosa, a nine-year-old girl who was denied a therapeutic abortion, this article analyzes the role played by the social in medical practice. For that purpose, it compares the different application of two similar pieces of legislation in Costa Rica, where both the practice of abortion and sterilization are restricted to the protection of health and life by the Penal Code. As a concept subject to interpretation, a broad conception of medical necessity could enable an ample use of the therapeutic exception and a liberal use of both surgeries. The practice of therapeutic sterilization has been generalized in Costa Rica and has become the legitimate way to distribute contraceptive sterilization. In contrast, therapeutic abortion is very rarely practiced. The analysis carried out proposes that it is the difference in social acceptance of abortion and sterilization that explains the different use that doctors, as gatekeepers of social morality, make of medical necessity.     

Honeybees Use Celestial and/or Terrestrial Compass Cues for Inter‐Patch Navigation

Foraging honeybees (Apis mellifera) are well known to fly straight from the hive, their primary hub, to distal goals as well as between familiar feeding sites. More recently, it was shown that a distal feeding site may be used as a secondary hub. If not fully satiated, the foraging bee may decide to depart the first feeding site in a new compass direction straight to one of many other feeding sites (inter‐patch foraging). Using a recently developed recording method, we discovered that the chosen departure direction at a secondary hub can be guided exclusively by either celestial or terrestrial compass cues. Given our data, we draw two theoretical inferences. First, the bees must be capable of learning and remembering multiple, spatially distinct, navigation vectors between the hive and among multiple feeding sites. Second, this documented and useful representation of multiple navigation vectors between multiple, identified target locations logically implies composite place‐vector mapping, stored in long‐term memory.     

A generalist brood parasite modifies use of a host in response to reproductive success

Avian obligate brood parasites, which rely solely on hosts to raise their young, should choose the highest quality hosts to maximize reproductive output. Brown-headed cowbirds (Molothrus ater) are extreme host generalists, yet female cowbirds could use information based on past reproductive outcomes to make egg-laying decisions thus minimizing fitness costs associated with parasitizing low-quality hosts. We use a long-term (21 years) nest-box study of a single host, the prothonotary warbler (Protonotaria citrea), to show that local cowbird reproductive success, but not host reproductive success, was positively correlated with the probability of parasitism the following year. Experimental manipulations of cowbird success corroborated that female cowbirds make future decisions about which hosts to use based on information pertaining to past cowbird success, both within and between years. The within-year pattern, in particular, points to local cowbird females selecting hosts based on past reproductive outcomes. This, coupled with high site fidelity of female cowbirds between years, points to information use, rather than cowbird natal returns alone, increasing parasitism rates on highly productive sites between years.     

医疗保险预付费方式控制医疗费用的机制研究

医疗保险以控制医疗费用为重要职能,以预付费方式为主要手段。医疗保险预付费方式实际上是一种“定额”付费方式,以“超支自负和结余归己”的固定结算制度为控费机制。目前,部分地区的医保机构对医疗机构采取“超支分担、结余奖励”的弹性结算制度,部分地区对医疗机构采取“超支自负、结余归人”或“超支分担、结余归己”的半固定半弹性结算制度。这些结算制度不是“定额”付费方式,而且“限额”付费方式,原本是为了既控制医疗费用又防范医疗风险,结果是既不能控制医疗费用又不能防范医疗风险。     

依托六大平台 实施医疗质量与安全精准化监管

运用信息化手段实施精准化的医疗质量与安全监管正在被越来越多的医院管理者所重视和接受。通过建立授权管理平台、环节质控平台、指标监测平台、医疗安全管理平台、电子病历质控平台和信息交互平台,对临床信息进行收集、统计、分析,为医院决策和医疗管理提供数据支撑,并及时反馈应用到临床医疗服务中,形成戴明环（PDCA循环）管理机制,切实打造医疗质量和安全精准化监管系统。