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.     

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。     

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.     

Occurrence and social structure of Baird's beaked whales,Berardius bairdii,in the Commander Islands,Russia

The social structure of Baird's beaked whales is completely unstudied, and it is unknown if either females or males form long‐term social associations or occur in stable groups. In this paper we summarize our observations of individually identified animals over the span of 6 yr to provide insight on their long‐term social structure. We have identified 122 whales, with 28 of them encountered three times or more and thus included in the analysis of social structure. We found that the whales exhibited nonrandom patterns of social associations with some individuals preferentially associating with each other. Whales with more scarred skin had higher maximum association coefficients, which indicates that older animals and/or males were more inclined to form stable associations. Cluster analysis with a modularity test for gregariousness divided the whales into four clusters. Whales from the same clusters did not always occur together, but some individuals retained stable associations over several years. The strength of social relationships decayed over periods of months, with between‐year relationships showing little deviation from what would be expected if association was random. Generally these findings do not correspond to a stable society with fixed groups but instead suggest a fission‐fusion society with some stable alliances.     

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。     

县级医院医务人员稳定性与影响因素实证研究

目的 分析县级医院医务人员的稳定性以及影响因素,以促进县级医院人才队伍的稳定性建设。方法 通过对我国4个省12家县级医院的在职医务人员进行现场调查,运用描述性与卡方检验的方法进行统计学分析。结果 有51.9%的县级医院医务人员都表示曾经想过离开本单位,而且高层次人才具有较高的离职倾向。工作条件中的业务活动经费不足和加班太多,以及工作困扰中的没有合作团队、工作不受重视和人际关系不和谐会显著影响县级医院医务人员的稳定性。结论 通过各种途径稳定人才队伍是县级医院得到长效发展的关键。     

我国与典型发达国家数字化医疗技术体系的对比研究

目的 对比研究我国与典型发达国家的数字化医疗技术,指导建立我国数字化医疗技术体系框架。方法 调研欧美发达国家和我国的数字化医疗现状和发展趋势,对数字化医疗所涉及的工程技术进行研究。结果 欧美发达国家已经建立了符合本国卫生政策的国家级数字化医疗工程项目,并开展了技术支撑研究。结论 我国医院信息化发展迅速,但是缺乏顶层统筹设计,技术支撑滞后,需要建立我国数字化医疗技术体系基本框架,以期对各地卫生信息化建设相关工作起到指导作用。     

医学检验服务支撑平台在区域医联体中的作用

自2013年以来,北京地区构建了多个区域医联体。在中日友好医院医联体运行的半年多时间里,针对遇到的问题,医联体内各医疗机构采取了许多相应的措施。针对医学检验信息互通,结果互认,样本转运等方面的问题,中日友好医院联合医联体内各成员单位引入医学检验服务支撑平台,探索一种“互助式”的新型医学检验服务模式,力求达到“六统一”的要求,实现医联体的优势互补、资源优化配置作用。     

Ephemeroptera,Plecoptera, and Trichoptera on Isle Royale National Park,USA, compared to mainland species pool and size distribution

Extensive sampling for aquatic insects was conducted in the orders Ephemeroptera (mayflies), Plecoptera (stoneflies), and Trichoptera (caddisflies) (EPT) of Isle Royale National Park (ISRO), Michigan, United States of America, during summer 2013. The island was ice covered until 8,000 to 10,000 years ago and is isolated by 22–70 km distance from the mainland. Two hypotheses were examined: that ISRO EPT richness would be much reduced from the mainland, and that the species colonizing ISRO would be of smaller size than mainland, adults presumably using updrafts to bridge the distance from mainland sources. Data sets were developed for known mainland EPT species and size for those species. The first hypothesis was confirmed with the mainland species pool consisting of 417 EPT, while ISRO is known to support 73 species. Richness of EPT is directly related to the number of specimens examined. Small streams supported five EPT species, while 15–25 species were found in larger streams. Lakeshores had intermediate diversity. The second hypothesis was substantiated for stoneflies, but not for mayflies or caddisflies. Stoneflies apparently are poorer fliers than either of the other two orders.