我国治理医疗领域商业贿赂的法律规制

2006年，随着打击力度的加大，“商业贿赂”被频频曝光．医疗领域的反商业贿赂行为更是倍受舆论媒体关注。其实，在长期的反商业贿赂进程中，我国已在民事、行政、刑事等方面制定了一系列的法律法规对医疗领域的商业行为进行规范，构建了一套相对完善的反商业贿赂法律体系。这些医疗领域商业行为的禁止性法律规定，对打击违法犯罪行为、治理商业贿赂起到了十分重要的作用。     

防止医疗领域的商业贿赂治本措施探讨

本文通过分析医疗领域商业贿赂的涵义、表现形式;医疗领域涉及商业贿赂的相关利害群体和医疗领域商业贿赂产生的促成环境因素.提出防止医疗领域的商业贿赂治本措施,包括健全和完善有关法律、政策,并提高其执行力,同时加强宣传教育;限定医院的医疗服务项目或医疗商品的价格;规范医疗机构和医务人员使用医疗商品行为;公开有关信息,引入合法的市场竞争,并接受社会多方监督.     

我国治理医疗领域商业贿赂的法律规制

2006年,随着打击力度的加大,“商业贿赂”被频频曝光,医疗领域的反商业贿赂行为更是倍受舆论媒体关注。其实,在长期的反商业贿赂进程中,我国已在民事、行政、刑事等方面制定了一系列的法律法规对医疗领域的商业行为进行规范,构建了一套相对完善的反商业贿赂法律体系。这些医疗领域商业行为的禁止性法律规定,对打击违法犯罪行为、治理商业贿赂起到了十分重要的作用。     

医药购销领域商业贿赂分析及对策

当前,医疗费用居高不下,医疗纠纷不断增多,其中医药购销领域的商业贿赂是很重要的原因之一。商业贿赂行为不仅严重扰乱正常的经济秩序,而且扰乱了正常的医疗秩序,给广大人民群众的就医带来更加沉重的费用负担。本着以维护公平竞争的医疗市场秩序为目的,以医药购销领域的商业贿赂为视角,从商业贿赂的现状及原因入手,探讨治理医药购销领域商业贿赂的对策。     

医药领域中的商业贿赂及伦理思考

2006年年初，中共中央办公厅、国务院办公厅共同印发《（关于开展治理商业贿赂专项工作的意见）的通知》，将治理商业贿赂定为今年反腐重点，医药卫生领域成为专项治理的重点。一直以来，在医药领域就存在有形形色色的“回扣”、“赞助”、“提成”等行为，甚至成为“潜规则”；这些行为在相当程度上破坏了药品市场的正常流通秩序，造成药价虚高现象。而在医疗行业内部，有不少异议，认为“回扣”、“提成”“红包”等行为只是违纪，算不上商业贿赂。那么医药领域“回扣”、“赞助”、“红包”是不是的商业贿赂？它与一般的商业贿赂的有什么区别？它的主要表现形式及原因是什么？它有哪些危害及带来哪些生命伦理问题呢？笔者就这些问题作一些伦理思考。     

如何防范医药购销中商业贿赂行为

近几年来，医药购销领域的贿赂犯罪案件屡屡发生，针对此问题，我国各级卫生行政部门和医疗卫生机构纠正医药购销和医疗服务中的不正之风，查处收受药品和医疗器械回扣等商业贿赂案件，取得了一些成效。但是，医药购销领域的商业贿赂问题仍是纠而复生，打而不绝。     

医药购销领域商业贿赂的成因与治理

商业贿赂是一种腐败现象。在我国经济体制转轨过程中，由于法律法规不完善，市场秩序不规范，商业贿赂问题也渗透到医药购销领域。《关于开展治理医药购销领域商业贿赂专项工作的宣传提纲》中列举了此次专项治理的5个重点。应该说，它们也是当前医药购销领域商业贿赂最基本的5种形式。医药购销领域商业贿赂在一些地区不断滋生繁衍，影响面越来越宽，败坏了党风、政风和社会风气，严重损害了社会主义和谐社会的构建，对我国政治、经济、社会生活均带来很大的负面影响。它不由得不引起人们的反思，探求建立健全治理医药购销领域商业贿赂的长效机制。     

当医疗潜规则遭遇反商业贿赂

无论对政府意志、还是社会舆情而言,作为商业贿赂的重灾区,医疗医药界眼下已成为众矢之的。 3月28日,卫生部部长高强在全国卫生系统治理医药购销领域商业贿赂专项工作会议上,痛批医药购销领域的商业贿赂形式多样、危害严重,并列举了医药购销商业贿赂的三大罪状。高强     

红包、回扣,离商业贿赂有多远

四川全省医疗卫生系统在专项反商业贿赂行动中,包括全省各地的36名医院院长、副院长在内的128人因商业贿赂被依法查处。在上述被查处的医疗人士中,有的确因行贿、受贿受到查处,有的则是因为红包、回扣而被查处。与此同时,我国其它省市地区的医疗卫生系统也发生多起商业贿赂事件。因此,医疗行业掀起了一场如何定性商业贿赂的大讨论,收受红包、回扣、赠与以及学术赞助的行为如何定性?是应该直接定性为商业贿赂?还是应该加以区分对待?理由又有哪些?就以上问题,本刊特约业内专家进行了探讨。     

关于医疗商业贿赂的伦理学审视

医药贿赂是发生在医药领域中的一种非正当交易。其发生有个体道德弱化、医院管理伦理失范以及社会监督不健：套等方面的原因。为治理医药领域中的商业贿赂，解决“看病难、看病贵”问题，需要加强医务人员的职业道德教育，完善医者的人格；规范医院管理伦理建设；深化卫生体制改革，注重社会道德和法制建设。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.