效益评价中指标筛选及其假设检验

西文介绍了综合效益评价中指标的逐步筛选及其假设检验方法，用该法选出的指标具有独立性强、代表性好的优点。同是分析处理了全国３４家县级医院的投入指标，从中筛选出５个指标参与评价。     

天津市煎炸油卫生状况评价

通过连续８小时的煎炸实验和对市，郊２９个煎炸点的现场卫生学调查及采用羰基值（ＣＯＶ），极性组分（ＰＣ）对所采样品的分析表明，天津煎炸油的总体的卫生质量基本符合国家卫生标准，参考极性组分的ＡＤＩ值并依据本次调查结果，估计天津大部分居民的煎炸食品摄入量安全水平，但对于偏爱煎炸食品者其安全系数明显下降。     

海南省妇幼保健机构现状与创等达标的对策

根据《妇幼保健机构等级评审标准》（下称《标准》）要求，对全省２０个妇幼保健机构现状进行了调查。结果显示：我省妇幼卫生工作基础薄弱，离《标准》要求差距较大；各机构间的发展极不平衡；县（市）级机构整体水平偏低，业务用房、人员、设备、床位等建设滞后；服务项目单一，二级专业分科不完善等矛盾较为突出。据此提出，在创等达标工作中，要依靠各级政府，努力争取各方面的支持，抓住机遇，迎接挑战，重点抓好软件建设，加强在职培训，积极引进人才，拓宽服务范围，规范自我，依法服务。     

Current practice in the pre-operative assessment of patients for elective repair of abdominal aortic aneurysmA survey of UK hospitals

A postal survey of 100 hospitals throughout the United Kingdom and Ireland was conducted to assess current practice in the pre-operative assessment and use of pulmonary artery catheters in patients undergoing elective abdominal aortic aneurysm repair. Seventy-four completed questionnaires were received. The survey revealed that 53% of respondents hold designated pre-operative assessment clinics, attended by anaesthetists in 54% and cardiologists in 26%. However, only 4% of respondents have a written protocol for stratifying patients and assessing peri-operative risk. By far the commonest investigation of choice for further cardiological assessment is transthoracic echocardiography (67%). Other investigations of choice are multiple update gated acquisition (MUGA) scan (13%), dipyridamole thallium imaging (9%), exercise ECG (6%), stress echocardiography (1%) and stress MUGA (1%). Two units (3%) never undertook further investigation. Pulmonary artery flotation catheters are used as a routine by 9% of respondents, dependent upon left ventricular ejection fraction by 65%, dependent on other factors by 7% and not used at all by 19%. The survey reveals widespread variation in pre-operative assessment of patients undergoing elective repair of abdominal aortic aneurysm.     

Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Soft tissue sarcomas (STS) tend to recur locally. In a series of 140 patients operated on during the past two decades with STS of the extremities and trunk, prognostic factors influencing local recurrence were determined. Statistical significance was evaluated for the quality of surgical resection (P<0.001), regional positive lymph nodes (P=0.03), and adjuvant radiotherapy (P=0.01) [for resection without wide margins (R1) and low-grade (G3) tumors]. In 1988, the surgical procedure was standardized. After 1987, local recurrence decreased significantly (P < 0.001). In subfascial tumors, local recurrence occurred far less in cases of compartmental resection than with wide excision. These data indicate that the course of patients with STS can be beneficially influenced by optimal therapy. Resection with wide margins in all three dimensions is the aim of sarcoma surgery. Postoperative radiation therapy is indicated in the case of R1 resection.

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Lokalrezidive von Weichteilsarkomen an Extremitäten und Rumpf

Zusammenfassung Weichteilsarkome neigen zur Ausbildung von Lokalrezidiven. In einer Studie von 140 Patienten der letzten 20 Jahre mit Sarkomen an Extremitäten und Rumpf wurde untersucht, welche Faktoren das Auftreten von Lokalrezidiven beeinflussen. Statistische Signifikanz ergab sick fur die Qualität der chirurgischen Re sektion (R) (p<0,001), den regionalen Lymphknotenstatus (p=0,03) sowie eine adjuvante Strahlentherapie (p=0,01) [bei marginal resezierten (RI), niedrig differenzierten (G3) Tumoren]. 1988 wurde das chirurgische Vorgehen standardisiert. In der Zeit danach traten signifikant weniger Rezidive auf als davor (p < 0,001). Bei subfaszialer Lage traten Rezidive nach Kompartmentresektion wesentlich seltener auf als nach weiter Resektion. Der Krankheitsverlauf von Weichteilsarkomen ist also durchaus therapeutisch beeinflußbar. Ein dreidimensional weiter Sicherheitsabstand ist das entscheidende Therapieziel, eine Bestrahlung in R1-Situationen indiziert.

     

Distinguishment of A 42 Capsomere Structure of Icosohedral Virion from A 32 One by Electron Microsco

ＤｉｓｔｉｎｇｕｉｓｈｍｅｎｔｏｆＡ４２ＣａｐｓｏｍｅｒｅＳｔｒｕｃｔｕｒｅｏｆＩｃｏｓｏｈｅｄｒａｌＶｉｒｉｏｎｆｒｏｍＡ３２ＯｎｅｂｙＥｌｅｃｔｒｏｎＭｉｃｒｏｓｃｏｐｅＣｎｅｎＢｉｎｇｙｉｎｇ（陈丙莺）；ＺｈｏｕＴｏｎｇ（周）（Ｄｅｐａｒｔｍｅ...     

磁共振胰胆管成像诊断胆系梗阻性疾病的临床评价

目的　探讨磁共振胰胆管成像 (MRCP)对胆道梗阻性疾病的临床诊断价值。方法　对 42例胆道梗阻患者进行MRCP检查 ,并经手术病理或 /和其它影像学和临床资料证实。结果　①本组MRCP定位诊断率为 10 0 % ,定性准确率为 83 % ;②扩张的胆道表现为枯枝状 2 3例、软藤状 15例、腊肠样 4例 ;③梗阻端呈倒杯口状 6例、截断状 5例、杵状 17例、鸟嘴状 9例、鼠尾状 5例。结论　MRCP对胆道梗阻性疾病定位诊断准确 ,结合MRI及源像对胆道梗阻性疾病的定性诊断也具有较高的特异性 ,是一种安全快捷、非创伤性的检查方法 ,能为胆道梗阻的诊治及术后评估提供可靠的依据。     

Sarcomas of head and neck — A 10 yrs experience

38 cases of sarcoma of head and neck region were analysed in a retrospective way in relation to age, anatomic location, histological, clinical profile, and surgical approaches. Compared to other types of head and neck neoplasms, such as squamous cell carcinoma, soft tissue sarcomas have low rates of regional metastases. However the biological behaviour of soft tissue sarcoma is more aggressive specially in paediatric age group. In the present series, CT scan was considered as the primary modality of investigation. Surgery generally has been recommended as the primary method of treatment for achieving local control, except in those high-grade tumours arising in sites not amenable to resection. 3-year and 5-year survival rates in this present series 50% and 31.6% respectively.     

农村公共卫生投融资机制存在的问题及对策

当前,农村公共卫生投融资规模不能适应农村居民的卫生服务需要,投融资结构不合理,致使投融资效果不佳,不利于农村卫生事业的发展。为此,需要从四个方面改革农村公共卫生投融资机制:一是要建立健全国家财政投资保障制度,发挥财政在农村公共卫生投资中的主体作用;二是要改革运行模式,拓宽融资渠道;三是要改善投资结构,优化资源配置;四是要创新管理体制,提高农村公共卫生服务能力。