Neonatal mortality amongst Scottish preterm singleton births (1985–1994)

Objective To provide a valid estimate of singleton neonatal mortality based on birthweight and gestational age at delivery.
Design Record linkage of maternity data and neonatal mortality data.
Setting Scotland, UK.
Population All singleton preterm deliveries from 24 to 36 weeks inclusive between 1985 and 1994.
Main outcome measure Neonatal death.
Results There were 625,646 liveborn singleton deliveries over the study period, of which 33,912 were preterm (5.4%). The overall neonatal mortality in the preterm group was 41/1000 and the data have been presented by both gestational age and birthweight. The neonatal mortality rate fell with advancing gestation from 795/1000 live births at 24 weeks to 9/1000 live births at 36 weeks and was higher at the extremes of birthweight for a given gestational age. There was a significant increase in the proportion of babies delivered iatrogenically over the study period (χ test for trend   P < 0.001  ).
Conclusion This is the largest recent series to consider neonatal mortality using both birthweight and gestational age. These figures will be of use in obstetric management when elective preterm delivery is considered, and for providing prognostic guidance following preterm delivery.     

医疗卫生服务价格改革方向初探

医疗卫生服务价格改革是要理顺价格构成成份之间量的关系，使每个构成成份的价格值都在供求关系的约束中，在政府的有效管制中，从而成为医疗卫生资源合理配置的有效工具。为此：①对生产要素分别定价；②对劳动定价；③对资本和自然资源定价；④确定医疗卫生机构内部管理时劳动价格；⑤价格中的所有构成成份价格都置于供给和需求关系约束下；⑥确定医疗卫生服务价格的理想传递方式。     

维甲酸改变人肝癌细胞表面N－糖链的结构及其酶学机制

用３Ｈ－甘露糖标记７７２１人肝癌细胞表面糖蛋白的Ｎ－糖链，经提取和去唾液酸后，用ＣｏｎＡ和ＤＳＡ亲和柱顺序层析将３Ｈ－标记的Ｎ－糖链分成４个类型和天线数不同的组分来研究维甲酸（ＲＡ）对细胞表面Ｎ－糖链的影响。结果：１０μｍｏｌ／ＬＲＡ处理细胞３～５ｄ后，可使Ｃ２Ｃ２二天线复杂型Ｎ－糖链增加，而高甘露糖型及三、四天线，特别是带有Ｃ２，６分支结构的复杂型Ｈ－糖链减少。用ＬＣＡ亲和柱还证明二天线糖链中的核心岩藻糖也减少。进一步发现上述改变的酶学机制是ＲＡ降低Ｎ－乙酰氨基萄葡糖转移酶Ｖ和α－１，６－核心岩藻糖转移酶的活力。结论：ＢＡ通过改变某些糖基转移酶活力而改变细胞表面糖链结构，这可能是ＲＡ使７７２１细胞诱导分化的机理之－。     

二氯胺基酚诱发的染色体畸变及染毒时间对畸变率的影响研究

２，４－二氯胺基酚（ＤＣＡＰ）是８３—１除草剂在哺乳动物体内的主要代谢产物。本研究以三种染毒计划观察了ＤＣＡＰ诱发Ｖ７９细胞的染色体畸变。结果表明：ＤＣＡＰ是一种染色体损伤剂，诱发的畸变主要为染色单体断裂和交换；３ｈ染毒和染毒后培养１７ｈ诱发的染色体畸变率最高，２０ｈ染毒观察不到染色体畸变，说明以高浓度短期染毒对高细胞毒性化合物的细胞遗传毒性研究可能是较好的染毒方案。     

冷冻食品中损伤大肠菌群的修复探讨

目的：为了准确测定冷冻食品中大肠菌群含量。避免对冷冻损伤大肠菌群的漏检。方法：应用营养物质丰富的营养肉汤，对冷冻损伤的大肠菌群在接触选择性培养基前在37℃孵育2h。结果：营养肉汤在37℃孵育冷冻损伤大肠菌群2h后，选择性平皿上菌落数与非选择性平皿上菌落数相当，细菌未发生显著繁殖；在实际样品应用试验中，提高了大肠菌群阳性样品的检出率。结论：应用营养肉汤37℃孵育冷冻损伤大肠菌群2h，可使其得到良好的修复，此修复过程是对常规检测大肠菌群方法的改进和完善。     

The change process in alcoholics: client motivation and denial in the treatment of alcoholism within the context of contemporary nursing

Despite being constantly cited as a critical intervening variable in the recovery from alcohol problems, there is a paucity of literature on client motivation. This paper reviews the current literature which impacts on motivation and its importance in treatment and develops in a stepwise manner the revised expectancy/motivation hypothesis, tentatively explaining both motivation and denial as a natural process in behavioural change. Because of the revised expectancy/motivation hypothesis' distinctly defined stages which closely relate to the process of nursing and the qualitative and quantitative measurement it entails which the nursing process demands, it offers a particularly appropriate model for treatment within nurse practice.     

高效液相色谱法测定肺癌患者尿中假尿嘧啶核苷和肌苷量比值

目的：通过检测肺癌患者尿液中假尿嘧啶核苷和肌苷量比值，探讨其在肺癌诊断中的应用价值。方法：肺癌患者、肺良性疾病及对照组各50例，分别收集其晨起空腹尿液，离心过滤后利用高效液相色谱法同时检测假嘧啶苷及肌苷，计算假尿嘧嘧与肌苷量比值。结果：肺癌患者中尿液中n（假尿嘧啶核苷/n（肌苷）比值有明显升高，与正常人比较差异有统计学意义，但肺良性疾病组与正常组和肺癌组比较，差异无统计学意义。结论：假尿嘧啶核苷对肺癌诊断并非特异性肿瘤标志物，但可以作为肺癌早期诊断的一种辅助指标。     

面对《医疗事故处理条例》的实施医院应采取的对策

为实施《医疗事故处理条例》,必须加强医院自身建设,规范管理。并从强化教育、严格准入制度、健全规章制度,规范病案与物证管理,尊重患者知情同意权,及时化解纠纷,分摊风险责任,维护合法权益等八个方面进行研讨提出对策。     

斑点膜型HBsAg和HIV抗体联合检测试剂盒的研制及评估

为了方便入出境人员，及时有效地防止传染病的传入和传出。我们研制了斑点膜型乙肝、艾滋病联合酶联免疫快速检测试剂盒(DsELISA)．该试剂盒用硝酸纤维素膜作固相载体，将抗-HBs单克隆抗体，艾滋病I型抗原和抗-鼠IgG多克隆抗体分别包被于其上，再用辣根过氧化物酶标记的抗-HBs单克隆抗体和抗人IgG单克隆抗体检测样本中的乙型肝炎表面抗原(HBsAg)和艾滋病病毒抗体(抗-HIV)．在检测中，HBsAg的最低可检出浓度要少于2ng／ml，而且全部检测过程在8分钟内即可完成，对于280份已确诊的血清样本的检测结果表明，HBsAg和抗-HIV的总符合率分别为99．7%和100%，我们认为，我们研制的DsELISA具有高度的精确性．敏感性，稳定性和特异性，方便了入出境人员，适合于口岸现场入出境的查验和传染病监测体检的要求.     

Risk of lung cancer among patients with head and neck cancer

A cohort of 5180 patients with head and neck cancer, who were part of the tumor registry of the Surveillance, Epidemiology, and End Results area of western Washington State, was followed up for as many as 15 years to determine the risk of lung cancer. A sample of 522 patients from this cohort was interviewed to determine smoking history. Lung cancer developed in 356 (6.9%) of the 5180 patients. The overall annual incidence of lung cancer remained relatively constant between approximately 1.0% and 2.0% during the 15 years of follow-up. Men had an increased risk of lung cancer compared with women (relative risk [RR] = 1.56; 95% confidence interval [CI] = 1.18 to 2.03). Compared with patients with oral cavity cancer (RR = 1.00), the relative risk of lung cancer developing by the site of the index tumor was 0.63 (95% CI = 0.40 to 0.98) for lip, 1.12 (95% CI = 0.81 to 1.56) for intrinsic larynx, 1.73 (95% CI = 1.21 to 2.47) for oropharynx, 1.84 (95% CI = 1.16 to 2.92) for hypopharynx, and 2.28 (95% CI = 1.60 to 3.24) for extrinsic larynx. Among the 522 patients who were interviewed, men smoked more than women ( p < 0.0001), and patients with laryngeal or pharyngeal cancer smoked more than patients with cancer of the lip or the oral cavity ( p < 0.05). Among patients with head and neck cancer, the risk of lung cancer is highest for men and for patients with cancer of the pharynx or extrinsic larynx. These findings may be explained by differences in smoking consumption. (Otolaryngol Head Neck Surg 1997;116:630-6.)