画笔下 出寿星

<正>与画笔终生结下不解之缘的画家、雕塑家、邮票设计师、美术工艺师、时装设计师等,其寿命多高于常人。如元黄公望85岁,明董其昌81岁,清吴昌硕83岁,现代朱屺瞻105岁、齐白石94岁、何香凝94岁、黄宾虹90岁、刘海粟98岁、宋美龄106岁等。此外,如张大千、李苦禅、钱松岩、陈权亮、关山月、孙传哲、刘昌潮、王兰若等都寿高80以上,有的至今仍健在。     

2021年对本刊有突出贡献的审稿专家名单

审稿是保证期刊质量的重要环节。2021年,本刊总编、副总编.编委、通讯编委和审稿专家对于审稿工作付出了大量的时间和精力,在此,对辛勤付出的所有专家致以崇高的敬意和衷心的感谢!审稿数量超高10篇的专家包括(按照审稿数量的多少排序):冯波、窦京涛、李红(贵州)、高昕媛、肖建中、赵一鸣、李洪梅、关海霞、胡承、龚凤英、周健、李惠琴、张朝云、蔡晓凌、张军霞、吴红花、房辉、周洁、李健榕、徐向进、赵芳、滕晓春、李鸿、秦贵军、李成乾、黄凌宁、郭辉、杨少玲。     

本刊2013年特邀审稿人名单

除本刊编委外，2013年对稿件审核把关工作做出比较突出贡献的专家有（按姓名拼音排序）：曹筱佩、曾勇（心内科）、丛丽、邓华聪、董方田（眼科）、高洪伟、高政南、管阳太（神经科）、郭志新、韩学尧、何权瀛（呼吸）、侯为开、胡云、李连喜、梁华、刘靖（心内科）、刘彦君、刘煜、鲁红云、马晓伟、任伟、舒晓春、孙晓东（眼科）、王从容、王存川（普外科）、王广、王鹏华、王晓明、王颜刚、乌正赉（统计）、吴红花、武晓泓、肖和平（结核科）、许迅（眼科）、严孙杰、杨慧霞（妇产科）、杨兆军、袁伟杰（肾内科）、张广宇（结核科）、张丽娟、张淼、张涛（儿科）、张文健、郑成竹（普外科）、周嘉强、周健。在此特致衷心感谢!     

经营管理创新 科学技术创新 《中国卫生产业》征稿函

本刊欢迎有关医疗卫生经营管理理论研究与实践应用、临床医学、医院改革、思想工作。医德医风以及科室、质量、人事、科研、教学、护理、药事、病案、财务、设备、后勤和医院文化等与医院管理相关的各个方面文章。     

青海省青南高原棘球蚴病流行状况

青海省南部高原属“世界屋脊”——青藏高原的腹地,行政区域包括玉树、果洛、黄南3个藏族自治州的玉树、称多、杂多、治多、昂欠、曲麻莱、玛沁、达日、甘德、班玛、久治、玛多、同仁、尖扎、河南和泽库。这些县大部分海拔在3     

黄嘌呤氧化酶与糖代谢异常及尿酸水平的关系

目的探讨黄嘌呤氧化酶与糖代谢异常及尿酸水平的关系。 方法选取2009年6月至2010年6月浙江省湖州市第三人民医院同期收治的2型糖尿病及空腹血糖受损男性患者各50例（分别为2型糖尿病组及空腹血糖受损组）,另择同期体检健康者（血糖水平均正常）50例作为对照组。检测3组对象空腹血糖、糖化血红蛋白A1c（HbA1c）、空腹胰岛素、甘油三酯、LDL、尿素氮、血肌酐、血尿酸、ALT、AST、黄嘌呤氧化酶（xanthine oxidase,XOD）的水平。3组间所有参数先行单因素方差分析,然后再进一步行LSD分析。XOD与血尿酸、胰岛素抵抗指数（IRI）及空腹血糖的相关性采用Pearson相关分析,血尿酸与空腹血糖的相关性采用偏相关分析。 结果3组对象XOD、LDL、甘油三酯、空腹血糖、HbA1c、空腹胰岛素、血尿酸、血肌酐、尿素氮及IRI的差异均有统计学意义（F=53.803、5.476、4.957、42.596、52.477、10.582、20.014、8.883、13.138、14.947,均P<0.01）。与对照组比较,2型糖尿病组XOD及血肌酐均显著升高,差异有统计学意义（t=9.780、3.680,均P<0.01）;2型糖尿病组及空腹血糖受损组LDL、甘油三酯、空腹血糖、HbA1c、空腹胰岛素、血尿酸、尿素氮及IRI均明显升高,差异均有统计学意义（t=2.076、2.988、9.058、10.066、4.588、5.868、6.557、5.366,3.270、2.355、2.993、3.500、2.581、4.993、3.857、1.774;P<0.05或0.01）。与空腹血糖受损组比较,2型糖尿病组XOD、空腹血糖、HbA1c、空腹胰岛素、血肌酐、尿素氮及IRI均明显升高,差异均有统计学意义（t=7.866、6.065、6.636、2.007、3.621、2.236、3.592,P<0.05或0.01）。XOD与血尿酸、IRI、空腹血糖均呈显著正相关（r＝0.507、0.361、0.268,P<0.01或P=0.01）,血尿酸与空腹血糖呈明显正相关（r=0.17,P<0.05）。 结论XOD活性升高在增加尿酸代谢紊乱的同时可能加重糖代谢紊乱。     

《中国艾滋病性病》稿约

1 刊登范围《中国艾滋病性病》杂志（原《中国性病艾滋病防治》）是由卫生部主管、中国性病艾滋病防治协会主办的学术刊物,为中国科技核心期刊。刊登艾滋病、性病的流行病学、病原学、诊断、治疗、预防和心理学、社会学等研究的原始工作论文,介绍国内外研究进展的学术文章。辟有专报、论著、工作研究、短篇报道、综述、学术讨论、学术报告、病例分析、经验交流、管理、国内外信息等栏目。     

中国卫生产业杂志社征稿函

本刊欢迎有关医疗卫生经营管理理论研究与实践应用、临床医学、医院改革、思想工作、医德医风以及科室、质量、人事、科研、教学、护理、药事、病案、财务、设备、后勤和医院文化等与医院管理相关的各方面文章。     

中国卫生产业杂志社征稿函

本刊欢迎有关医疗卫生经营管理理论研究与实践应用、临床医学、医院改革、思想工作、医德医风以及科室、质量、人事、科研、教学、护理、药事、病案、财务、设备、后勤和医院文化等与医院管理相关的各方面文章。     

72例慢性乙型重型肝炎症状与舌脉象聚类分析

目的探讨慢性乙型重型肝炎（乙型慢重肝）的证候特点,确定其主要和次要证候,以指导临床应用。方法观察72例乙型慢重肝的症状表现,对症状进行频次、聚类分析。结果乙型慢重肝的症状和舌脉象经高频次分析后,提取出26个关键症状及31个舌脉象进行聚类分析。聚为5类为：第1类,滑脉、舌苔厚、舌苔腻、舌体嫩、舌苔干、舌尖红;第2类,肢体困重、纳差、乏力、少气懒言、头重、腹胀、呕吐、恶心、小便不利、头晕、大便干结、呃逆、矢气、厌食油腻、口渴喜饮、吞酸嗳腐、口苦、口干、便下不爽、口渴少饮、口粘腻、沉脉、两目干涩、弦脉、嘈杂、舌苔白、口淡、舌下脉络迂曲、舌下脉络青紫、舌苔黄、数脉、舌苔薄、舌体瘦;第3类,舌苔焦;第4类,灰黑苔、无苔;第5类,迟脉、疾脉、弱脉、实脉、微脉、呕酸水、尿黄、细脉、舌有齿痕、舌体胖、舌苔润、涩脉、舌质瘀点、舌质暗、舌质红。结论乙型慢重肝病因主要为湿邪,其病理关键是湿阻中焦,气机阻滞,升降失司。早期治疗上应以疏肝和胃、温阳祛湿为主。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

治疗高血压药物的经济学评价

重视高血压治疗中的经济学评价,对利用我国有限的卫生资源来遏制高血压对人民群众的危害有着重要的现实意义。药物经济学对于药物治疗的成本和治疗的结果给予同样的关注。因为治疗高血压的费用,不仅涉及药物价格,还包括患者的危险水平,降压疗效和对临床终点事件的影响,以及治疗的依从性和安全性。因此药物经济学更强调整体成本和价-效比。低危病人,若非药价低廉,治疗的价-效比不够理想。而在高危的患者,价-效比越小越经济而不是药费越便宜越好。     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.     

Morbidity of closure of colostomy

This study reviews 86 colostomy closures with 61.6 per cent of the cases resulting from trauma. The overall complication rate was 17.4 per cent which included 7 per cent wound infection, 3.5 per cent anastomotic leak with fecal fistula, 2.3 per cent partial bowel obstruction, and 1 per cent each of deep stitch abscess, wound dehiscence, incisional hernia, and death due to intra-abdominal sepsis. Age, sex, and underlying disease had no demonstrable influence on the outcome of the operation. Closure of colostomy after three months of construction, mechanical and antibiotic bowel preparation, intraperitoneal closure, end-to-end anastomosis, and seconary skin closure were factors that appeared to influence the morbidity of the operation.     

Results of treatment of fistula-in-ano

To evaluate the application of Parks' classification in the management of patients with fistula-in-ano, a study was undertaken to assess the outcome of surgery, especially with respect to the recurrence rate and alteration of continence. A retrospective analysis of 160 consecutive patients who were classified at the time of operation was conducted. The distribution of fistulas was as follows: intersphincteric, 41.9 percent, transsphincteric, 52.1 percent, suprasphincteric, 1.3 percent, extrasphincteric, 0. A horseshoe extension occurred in 8.8 percent of the fistulas and 3.8 percent did not exactly conform to the classification as they were either complex or combinations of more than one type of fistula. The sole immediate postoperative complication was bleeding, which occurred one week postoperatively and ceased spontaneously (0.7 percent). Alteration in continence occurred in 6 percent of patients with 2.6 percent experiencing temporary incontinence to flatus, 1.3 percent to liquid stool, and 0.7 percent to solid stool. Permanent loss of control for flatus occurred in one patient (0.7 percent) and for liquid stool in one patient (0.7 percent). No patients suffered loss of control for solid stool. Recurrence developed in 6.3 percent of patients, all between five and 25 months postoperatively. Classifcation was found to be a useful guide in the operative management of patients with fistula-in-ano. Read at the joint meeting of the American Society of Colon and Rectal Surgeons with the Section of Colo-Proctology, Royal Society of Medicine, and the Section of Colonic and Rectal Surgery, Royal Australasian College of Surgeons, New Orleans, Louisiana, May 6 to 11, 1984.     

Mechanisms of action of nitrates

Summary Glyceryl trinitrate, isosorbide dinitrate, and isosorbide-5-mononitrate are organic nitrate esters commonly used in the treatment of angina pectoris, myocardial infarction, and congestive heart failure. Organic nitrate esters have a direct relaxant effect on vascular smooth muscles, and the dilation of coronary vessels improves oxygen supply to the myocardium. The dilation of peripheral veins, and in higher doses peripheral arteries, reduces preload and after-load, and thereby lowers myocardial oxygen consumption. Inhibition of platelet aggregation is another effect that is probably of therapeutic value. Effects on the central nervous system and the myocardium have been shown but not scrutinized for therapeutic importance. Both the relaxing effect on vascular smooth muscle and the effect on platelets are considered to be due to a stimulation of soluble guanylate cyclase by nitric oxide derived from the organic nitrate ester molecule through metabolization catalyzed by enzymes such as glutathione S-transferase, cytochrome P-450, and possibly esterases. The cyclic GMP produced by the guanylate cyclase acts via cGMP-dependent protein kinase. Ultimately, through various processes, the protein kinase lowers intracellular calcium; an increased uptake to and a decreased release from intracellular stores seem to be particularly important.