也谈医疗“红包”的成因

在我们全力治理医药购销领域商业贿赂行为、纠正行业不正之风的同时,“红包”也是我们需要治理的工作内容之一。学术专家及社会媒体对“红包”的成因从不同的角度有不同的分析。作者作为医院纪检监察工作者,从患方及我国的国情、“红包”的历史角度出发分析了“红包”的成因。以期全社会能够全面、客观、公正的分析和对待“红包”,以助于对“红包”的有效治理。     

"以德治国"方略的重要意义

江泽民同志最近阐述了在治理国家 ,发展社会主义市场经济过程中 ,必须坚持“以德治国”的重要思想。他指出 :“要坚持不懈地加强社会主义法制建设 ,依法治国 ,同时也要坚持不懈地加强社会主义道德建设 ,以德治国 ,对于一个国家的治理来说 ,法治与德治 ,从来都是相辅相成相互促进的。二者缺一不可 ,也不可偏废”。“以德治国”就是以社会主义思想道德来治理国家 ,即以马列主义、毛泽东思想、邓小平理论为指导 ,积极建立适应社会主义市场经济发展的社会主义思想道德体系 ,发展社会主义精神文明。这个体系 ,以为人民服务为核心 ,以集体主义为原…     

都市化对健康的影响

都市化是由农业社会向工业社会发展的结果，是世界经济发展的必然趋势，也是社会分工发展到一定历史阶段必定会产生的一种社会现象，任何国家都会或早或迟、程度不同地以各种形式表现出来。然而，都市化的结果使大量农田逐渐为工业交通用地所取代，农民纷纷涌向城市，城市人口急剧增长。城市以其经济聚集、经济辐射、科技创新的独特功能大大地推动了社会经济发展，为人类社会带来空前的繁荣。可是，城市是在破坏自然、损伤自然中建立和发展起来的，城市的人口爆炸、人类活动及其产生的废弃物正在不断地侵袭和破坏着千万年来人们业已习惯的生…     

新形势下加强高校师德建设的重要性及对策--深入贯彻"以德治国"方略

江泽民同志最近阐述了在治理国家、发展社会主义市场经济的过程中 ,必须坚持“以德治国”的重要思想。他指出 :“要坚持不懈地加强社会主义法制建设 ,依法治国 ,同时也要坚持不懈地加强社会主义道德建设 ,以德治国。对于一个国家的治理来说 ,法治与德治 ,从来都是相辅相成 ,相互促进的 ,缺一不可 ,也不可偏废。将“以德治国”提到了治国方略的高度来认识 ,这在我党的历史上还是第一次 ,这一理论对指导教育工作具有特殊重要的意义。重视“德治”和“以德治国” ,必须重视道德建设及道德教育 ,高校作为培养新世纪人才的基地 ,在全社会道德教育…     

利益均衡与社区治理问题的理论探讨

我国已进入城市化快速发展阶段，社区的发展关系到城市的发展进程和城市居民的日常生活，进而关系到城市社会的和谐。探求适合我国国情的社区治理模式，无论在实践上还是在理论上都有着非常积极的意义。目前，我国城市社区治理主体呈多元化发展趋势，但各主体间的利益实现却呈现失衡状态。本文基于利益均衡原理以及治理的理念，秉持“四轮驱动、并驾齐驱”的社区治理模式，从理论层面来探讨如何均衡各治理主体的利益诉求。     

临床路径概念的提出及发展

1957年,美国杜邦公司将“路径”一词应用于工业领域,其目的是为了提高企业产品质量。20世纪70年代,面临医疗费用高涨的压力,美国医疗护理界的有识之士意识到工业领域中为了提高产品质量的“关键路径”也可应用于医疗。1985年,美国波士顿新英格兰医疗中心医院（Boston New England Medical Center Hospital,NEMC）首次将临床路径用于临床,并取得成功。此后,临床路径逐渐在世界范围内得到应用。1996年,第四军医大学报道了临床路径在美国的应用。1998年,四川华西医院开始试行临床路径。自此,临床路径在中国逐渐得到应用和发展。     

黄幸纾副教授获美国扬特奖

本校农药毒理研究室主任黄幸纾副教授应美国工业卫生学会主席史密斯教授邀请,于今年5月下旬赴美国费城参加美国工业卫生1983年年会,接受“扬特奖”,并在会上作了学术报告——题目为“预防生殖细胞受化学物损伤”。“扬特奖”是1964年为纪念美国工业卫生     

新加坡刮起博士伦旋风

最近从新加坡卫生部传出的消息引发了一场博士伦旋风。新加坡和中国香港、澳门已暂停销售美国博士伦的“润明全护理液”,中国内地也有部分城市在不声不响地把“润明全护理液”从柜台上撤下来。原因是这种用于维护隐形眼镜的护理液被怀疑会造成使用者感染真菌性角膜炎。新加坡真     

民营科技企业公司治理机制研究

高科技企业在创建、成长、成熟和衰退不同的生命周期有不同的权力结构和不同的治理机制要求,如何根据发展的不同阶段处理好人力资本和非人力资本的治理和激励关系显得至关重要。目前民营科技企业存在诸如：管理制度的建设落后于发展速度、集权式的治理结构和家族式经营管理、核心技术人员跳槽而引发业务危机的潜在风险等等问题。企业内部治理结构及其质量问题,已经成为我国民营科技企业实现进一步发展的主要瓶颈。民营科技企业管理模式必须从创业时期的“人治”转变为制度化、专业化的“法治”管理模式,即要建立有效的公司治理机制。     

复杂性视角下中医药治理体系优化研究

中医药发展历史、文化、制度的复杂性深刻影响着中医药事业的传承、创新和发展。从复杂性视角出发,基于“情景-理论-工具”框架分析了中医药治理的复杂性和当前的困境。中医药治理的复杂性要求治理体系不断作出调适,一方面,政府治理体系优化要厘清权责关系,激发地方政府内生动力;另一方面,要利用“协同治理”理念实现中医药治理横向结构中不同主体的资源整合和功能协同,提升联合行动能力。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.