四川省卫生总费用的结构变动及预测研究

目的 分析2008—2019年四川省卫生总费用结构变动及影响因素和预测研究,为助力“健康四川”建言献策。方法 使用四川省卫生统计年鉴的相关卫生总费用数据,在描述性分析的基础上,使用结构变动度分析卫生总费用的结构变动,灰色关联法研究卫生总费用的影响因素并进行GM(1,1)预测。结果 2008—2019年卫生总费用持续增加,政府、社会和个人卫生支出结构逐步合理;人均卫生费用水平排名靠后,社会卫生支出成为卫生总费用的主要构成单元;千人口床位、常住人口和农村居民人均可支配收入是影响卫生总费用的主要因素;预测发现,2020—2025年卫生总费用仍呈增加趋势,个人卫生支出占比进一步下降。结论 四川省卫生总费用结构渐趋合理,医疗服务水平得到大幅度改善;但仍需重点关注人均卫生费用等相对性指标。     

The Development of a Predictive Method for the Estimation of Flux Through Polydimethylsiloxane Membranes. IV. Application to a Series of Substituted Quinolines

The steady-state flux of 33 substituted quinoline derivatives was determined in polydimethylsiloxane membranes using isopropyl alcohol as the receiver solvent. These diffusants constituted a diverse group of compounds possessing a wide range of hydrophobic, steric, and electronic characteristics. Various parameters representing these physicochemical properties such as cyclohexane–water fragmental constants, molar refractivity, Hammett's constants, intramolecular hydrogen bonding ability, melting point, and mole fraction solubility were employed to develop empirical models capable of relating the rate of diffusion to these characteristics of either the substituent on the quinoline ring or the compound itself.     

Ca2+ channel actions of the non-dihydropyridine Ca2+ channel antagonist Ro 40-5967 in vascular muscle cells cultured from dog coronary and saphenous arteries

Summary We studied the membrane effects of (1S,2S)-2-(2-[[3-2(benzimidazolyl) propyllmethylamino]ethyl)-6-fluoro-1,2,3,4-tetrahydro-l-isopropyl-2-naphthyl-methoxy-acetate dihydrochloride, Ro 40-5967, a new non-dihydropyridine (DHP) Ca²⁺ channel antagonist, on dog coronary and saphenous arterial vascular muscle cells using the whole-cell patch-clamp method. Long-lasting (L-type) inward currents in 20 mM Ba²⁺ were measured over a range of test potentials (300 ms) from –50 mV to + 90 mV from a holding potential of –80 mV in the presence of 1 M Bay k8644 (a DHP Ca²⁺ agonist). Ro 40-5967 caused a concentration-dependent suppression of Ca²⁺ channel currents in muscle cells from both arteries, with greater potency on coronary than saphenous arterial cells. The concentration of Ro 40-5967 which inhibited the magnitude of peak inward currents by 50% (IC₅₀) was estimated to be 1 M (n = 5) in muscle cells from coronary artery and 10 M (n = 4) in saphenous artery. Ro 40-5967 (1 M) decreased the amplitude of the activation current-voltage relationship for coronary L-type Ca²⁺ channel currents over a wider range of membrane potentials than verapamil, diltiazem, or nifedipine. In contrast, block of Ca²⁺ channel currents in saphenous artery cells by 1 M Ro 40-5967 was only observed at command potentials positive to 0 mV. Ro 40-5967 (1 M) significantly shifted the voltage-inactivation curve downward by 40% in coronary (n = 4), but only by 18% in saphenous arterial muscle cells (n = 3). The non-parallel shift of the coronary artery inactivation curve suggests that pronounced resting channel block is a notable feature of Ro 40-5967. The marked inhibition of Ba²⁺ current by 1 M Ro 40-5967 in the inactivation protocol in coronary arterial muscle cells was found over the entire range of membrane holding potentials tested, while inhibition in the saphenous artery inactivation curve occurred only from holding potentials more positive than –40 mV. Therefore, Ro 40-5967 is unique: 1) in acting over a wider range of voltages, on both instantaneous and resting Ca²⁺ currents, than other Ca²⁺ antagonists; 2) in producing more significant resting state block; and 3) in acting with selectivity for coronary over saphenous arteries.This research was supported by National Institutes of Health grants HL38537, HL38645, and by F. Hoffmann-La Roche, Basel, Switzerland     

Erworbene Bauchhöhlenmuskelstörungen

Zusammenfassung Die Bauchhöhle hat ein Faszienskelett, das durch ihren permanenten veränderhchen Ruhetonus verspannt gehalten wird. Zur Bauchhöhle gehören mit der seitlichen Bauchmuskulatur auch das Zwerchfell und der Beckenboden. Willkürliche und reflektorische Tonusänderungen bedingen ihre Verformung und ihren Verschluß oder ihre Eröffnung. Am Versuchstier haben wir diesen Ruhetonus schon in der Schwanzmuskulatur nachgewiesen, von der der Beckenboden des Menschen stammesgeschichtlich abstammt. Der Beckenboden bildet mit den Sphinkteren das anorektale Kontinenzorgan. Es ist, phylogenetisch erklärbar, bei der Frau viel schwächer entwickelt als beim Mann. Diese unterschiedliche Mächtigkeit ist his zu den Kernen des Rückenmarks, die diese Muskulatur steuern, zu verfolgen. Diese Asthenie des weiblichen Kontinenzorgans wird durch das Gebären und die Obstipation noch zusätzlich belastet. Das gleiche gilt für die Bauchdecke der Frau, die, wie hier nachgewiesen wird, nach einer Gravidität die gleichen, bleibenden Denervationserscheinungen ihrer Muskulatur erkennen läß t. Es sind die gleichen Schäden, die der Beckenboden mit den Sphinkteren erleidet. In schwereren Fällen ist neben der Inkontinenz also auch ein Schlotterbauch die Folge dieser Belastungen. Der ruhetonisierte Beckenboden kann das spastische Beckenbodensyndrom, die kontinente Obstipation, zur Folge haben. Sic kann psychotherapeutisch geheilt werden. Davon muß die inkontinente Obstipation unterschieden werden, die manchmal mit einem Mastdarmvorfall einhergeht. Bei ihr liegt das Hindernis im Darm. Sic kann in schweren Fällen durch eine Sigmaresektion gebessert werden. Die Denervationsinkontinenz ist am besten durch das operative Engerstellen des ganzen Levatortrichters zu bessern. Voraussetzung ist: Der gelähmte Beckenboden muß noch eine Restruheaktivität aufweisen.

---

Acquired disturbances of muscles of the peritoneal cavity

The peritoneal cavity has a fascial skeleton that is kept under tension by permanent variable resting tone maintained by the abdominal muscles. The lateral abdominal muscles, the diaphragm and the pelvic floor are all components of this fasciomuscular support system. Voluntary and reflective changes in muscle tension allow the entry and exit of matter into and out of the spherical abdominal cavity by opening and closing of specialized wall segments called sphincters. We have previously demonstrated the existence of a resting tone in the tail muscles of mammals from which the human pelvic floor muscles are derived. The pelvic floor and its integrated sphincters form the anorectal organ of continence. This organ is much weaker in females than in males. The spinal centers that govern continence, contain in the female significantly fewer ganglion cells than the corresponding centers in the male. Childbirth and a commonly found tendency to develop constipation are additional stressors for the congenitally weaker female organ of continence. We explain in this paper why the abdominal wall and the pelvic floor may suffer stretch-induced denervation injuries during pregnancy and delivery. Such damage may persist in later life and can give rise to incontinence and flabby abdomen. Based on our work in this field, we found a new differentiation between continent and incontinent constipation. Continent constipation is caused by spasticity of the pelvic floor characterized by abnormally high sphincter activity. This spastic pelvic floor syndrome can be treated successfully by psychotherapeutic techniques. Incontinent constipation, in contrast, is always associated with subnormal activity of the sphincters and may be a cause of rectal prolapse. It can be treated successfully by anterior rectosigmoid resection. Incontinent constipation will also require operative approximation of the levators in many cases. Improvement cannot be expected to result from this procedure, however, unless the pelvic floor shows some residual resting activity.

Korrespondenz an: em. Prof. Dr. Dr. h. c. mult. F. Stelzner     

人体胆结石高能震波碎石的动物实验

目的　研究人体 3种胆结石在一定能量下 ,冲击次数和能量的关系 ,确定不损伤胆囊和小肠内膜的能量安全阈值 .方法　犬胆囊和小肠内放入固醇石、混合石和色素石 ,在不同的输出电压下 ,放电碎石 .结果　固醇石、混合石和色素石破碎所需的能量不同 ,在同样电压下 ,固醇石所需的次数最少 ,混合石次之 ,色素石最多 ;病理检查表明 ,在电压 <15 k V时 ,胆囊和小肠粘膜处 ,细胞膜轻度充血 ,出现小出血点 .当电压 >15 k V后 ,粘膜有脱落 ,膜下组织水肿 .结论　电压具有依赖性 ;该仪器临床应用的冲击电压应小于 15 k V     

缓激肽对缺血-再灌注兔心肌能量代谢的延迟性作用

目的　通过在体兔心肌缺血再灌注模型探讨缓激肽(BK)对缺血再灌注心肌能量代谢的延迟性影响 .方法　 36只健康新西兰兔 ,随机分为 3组 . 组 (对照组 ) :建立动物模型后关胸 ,2 4h后心肌缺血 40 m in,再灌注 6 0 m in. 组 (BK组 ) :建立动物模型后给予 BK左室内灌注 5 0 μg· (kg·min) - 1 ,共 10 m in,其余同 组 . 组 (HOE140组 )第 1日建立模型后输注 BK时给予 BK B2 受体拮抗剂 HOE140 iv10μg· kg- 1 ,其余同 组 .分别测定各组缺血 2 0 min,40 m in及再灌注后心肌 ATP、磷酸肌酸、糖原及乳酸含量 .结果　 BK组在缺血 2 0 min时 ATP、磷酸肌酸、糖原含量明显高于对照组 ,乳酸含量低于对照组 ;缺血 40 m in BK组 ATP、磷酸肌酸、糖原及乳酸与对照组相比无明显差异 ;再灌注后 ATP、磷酸肌酸、糖原含量再次明显高于对照组 ,乳酸含量与对照组相比则明显降低 .而 HOE140组各项指标同对照组相比无明显差异 .结论　 BK能够延迟性改善兔心肌缺血再灌注的能量代谢     

基于大家系设计的静息心率与常见慢性病双表型遗传度估计

目的 基于福建省南靖县土楼地区大家系,探索静息心率和常见慢性病(高血压、糖尿病、血脂异常)的单表型遗传度和双表型遗传度。方法 研究对象来源于2015年8月至2017年12月福建省漳州市南靖县土楼地区塔下村、曲江村、南欧村募集的张姓居民及其亲属,以及草坂村、图美村、背岭村募集的陈姓居民及其亲属。研究共纳入了来自452个大家系的1 563名研究对象。家系关系确定依据为家系信息登记及家谱。采用方差组分模型估计连续性变量的单表型、双表型遗传度,采用易患性-阈值模型估计二分类变量的单表型、双表型遗传度。结果 家系重建纳入了1个七代家系,2个五代家系,23个四代家系,186个三代家系和240个二代家系。研究对象的平均年龄为57.2岁,男性占39.4%。研究对象的高血压、糖尿病、血脂异常患病率分别为49.2%、10.0%、45.2%。单表型遗传度估计显示,静息心率遗传度为0.263(95%CI: 0.120~0.407),高血压遗传度为0.404(95%CI: 0.135~0.673), 血脂异常遗传度为0.799(95%CI: 0.590~1)。收缩压、舒张压、血糖、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白的遗传度分别为0.379、0.306、0.393、0.452、0.568、0.852、0.387。双表型遗传度分析显示,静息心率与高血压、糖尿病、舒张压、血糖、甘油三酯存在表型相关性。双表型遗传度显示,静息心率与血糖(遗传相关性0.485,95%CI: 0.120~1,P<0.05)和糖尿病(遗传相关性0.795,95%CI: 0.181~0.788,P<0.05)具有较强的遗传相关性。结论 静息心率是一个可遗传性状,其与常见慢性病及其相关指标存在相关性。静息心率与糖尿病和血糖值具有较强的遗传相关性,提示静息心率与糖尿病和血糖之间可能存在共同的遗传基础。     

彩色多普勒能量图对不孕症妇女子宫动脉血流变化的观察

利用彩色多普勒能量图测定子宫的血流 ,即血流的脉冲指数 (pulsative index,PI)及阻力指数 (resistantindex,RI)来探索不同原因的女性不孕症。 6 7例不孕症妇女经腹腔镜诊断确诊不孕原因后 ,于月经周期第 2 0～ 2 3d作腹部 B超彩色多普勒能量图 (CDE)检查。其结果两侧子宫动脉 PI、RI可因各种不孕原因不分侧别平均 PI、RI均高于正常组 (P<0 .0 1) ,而且不受病情轻、中、重所影响。反映了子宫周围血管阻力较高所致子宫动脉血流灌注不足是引起不孕症的基础 ,可能也干扰孕卵着床而致不孕。