"医检互认"的法理审视

卫生部《关于医疗机构间医学检验、医学影像检查互认有关问题的通知》引起了社会的广泛关注。它固然存在降低医疗费用等进步之处,但不可否认也可能引起法律风险和争议,文章就此着重分析了医师的注意义务、医疗责任的划分等内容,并提出若干推进途径。     

论"医源性疾病"的法律责任

在医学界实施举证责任倒置及新的《医疗事故处理条例》后，应进一步明晰医源性疾病的法律责任问题，因为医源性疾病的定义本身就包容着承担民事法律责任的要件，鉴于医源性疾病的广袤性和它与法律关系的紧密性，对该病的研究应从缩小医源性疾病的界定范畴入手，把医与法结合起来，在加强我国卫生法制建设的同时，促进医学的进步。     

Drugs and firearm deaths in New York City, 1990–1998

Firearm deaths remain among the leading causes of mortality in the United States. Changing law enforcement activities, incarceration, drug use, and socioeconomic conditions may have played roles in the declining rates of firearm deaths during the 1990s. Using records from the Office of the Chief Medical Examiner, we analyzed the role of drugs in firearm deaths in New York City between 1990 and 1998. Positive drug toxicology was present in over half of all firearm death victims during this time. Cocaine, cannabis, opiates, and alcohol accounted for almost all of these deaths with drug-positive toxicology. There were decreases in cocaine- and alcohol-positive toxicology for firearm deaths in New York City starting in the early 1990s; there was a more gradual decrease in heroin-positive toxicology for firearm deaths. Cannabis-positive toxicology for firearm deaths increased in the early part of the 1990s and then decreased starting in the mid-1990s. Although the disparities between minority and white firearm death rates narrowed during this time, minorities remained about three times more likely to be victims of fatal firearm violence than whites in 1998. The highest firearm death rates were among African American and Latino male decedents, with a larger proportion of Latinos testing cocaine or opiate positive, while a larger proportion of African Americans tested cannabis positive. These results suggest a complex role of drugs in firearm-related deaths.     

Sentencing Problem Gamblers in New Zealand

Any recognition of the societal impact of problem gambling necessarily implies that there is an effect on the incidence of crime. However current New Zealand Department of Corrections statistics, which extensively chart drug and alcohol abuse in prisoners, lack any reference to the incidence of gambling addiction. The invisibility of gambling addition, as a mitigating factor in criminal sentencing, arises from a misunderstanding of agency in addiction which leads to drug and alcohol abuse being factored into sentence programmes while problem gambling is often viewed as a matter of choice. There is no principle of sentencing which distinguishes between these various addictions and the failure to factor gambling addiction in sentencing decreases the likelihood of rehabilitation and so increases the likelihood of re-offending.     

医学新技术的特点、应用现状与对策

文章分析了医学新技术的应用现状，指出要沿着造福于人类的根本方向正确使用新技术，就必须重视其伦理规范研究，应当与技术管理配套进行，同时要依法规范医务人员的医疗行为和经济行为。     

论医疗纠纷处理相关法律制度建设

针对医疗纠纷处理的热点与难点，在新的《医疗事故处理办法》尚未颁布之际，文章先分析了3种医疗纠纷处理的途径现状，继而提出了颁布《医疗事故处理法》，完善医疗事故处理模式、确立合理风险分担制度和赔偿制度3个方面的相关法律制度建设的建议。     

医疗纠纷中患者权利的法律救济

分析了医疗纠纷频发的根源和医患法律关系的性质，指出患者的基本医疗权利，并探讨患者权利的法律救济途径。     

Ultrastructural changes in muscle and motor end-plate of the dystrophic mouse

A comparative study of dystrophic mice (C57BL/6J-dy2J) and normal littermates, 6 to 9 months old, has revealed numerous ultrastructural changes in the dystrophic soleus. Vacuoles, swollen mitochondria, vesicular aggregates, membranous bodies, Z-line degradation, localized hypercontraction, myofibrillar disorientation, and focal necrosis were common. We report here new observations. Discontinuous, dense bands (240 A wide) were observed rarely between inner and outer membranes in some nuclei. Closely associated with infoldings of nuclear membrane were paracrystalline, vesicular structures, actin-like filaments, and autophagic vacuoles. With the degeneration of the nuclear membrane, actin-like filaments were observed within the nucleus. The primary synaptic clefts were widened and contained osmophilic-dense granules (diameter 0.2 to 0.7 micrometer). There was loss of secondary synaptic folds. Discontinuity of pre- and postsynaptic membranes could be observed, though rarely. Lysosome-like dense bodies were present among myofilaments. The myeloid bodies and autophagic vacuoles that were associated with nuclei, sarcoplasmic reticulum, and mitochondria gave a positive acid phosphatase reaction. Such degeneration changes were not observed in the normal soleus.     

从法学和医学双重角度看医疗纠纷与医学保护

在人类科技与文明进程以史无前例的速度推进的今天,人类对医学的认识和自身的健康生存状态有了更深刻的认识,但用法律手段来调整医疗纠纷的范围和程度还有待我们重新认识和定位.人们一方面渴求医疗救助,一方面又怕医疗事故的降临,在"又爱又恨"的心态下寻求着医学和法律的救济,人们要么单一的从法律角度看待医疗纠纷,要么单一的从医学角度看待医疗纠纷,但医学和法律都不是万能的,如何既考虑保护单个患者的合法权益,又考虑到作为特殊行业的医疗机构的公益性、医学的风险性、医疗技术的发展乃至全社会的共同利益,是今天法学界和医学界应该共同探讨的问题.不管怎么说,"无论法律多么有力以及我们多么希望法律不断强大,适可而止仍是法律的美德".     

Individual Differences in Phasic Cardiac Reactivity to Psychological Stress and the Law of Initial Value

The validity of the law of initial value (LIV), which predicts relationships between prestimulus level and phasic response, was evaluated for two cardiac measures, heart rate (HR) and electrocardiographic T-wave amplitude (TWA). HR acceleration and TWA attenuation were produced in undergraduates by the performance of the backward digit span task. The between-subjects correlations of prestimulus level with the magnitude of the phasic responses were significant, with signs opposite to that which would be predicted by the LIV. The within-subjects prestimulus level-phasic response correlations, however, were consistent with the LIV. It appears that individual differences in psychologically-elicited phasic cardiac reactivity negate LIV predictions. These results emphasize the importance of sharply distinguishing the between- vs. within-subjects formulations of the LIV, and are contrary to recent psychophysiology textbook accounts of the prestimulus level-phasic response relationship for cardiac variables.