Objective To develop a kinetic chromogenic quantitative method for the determination of endotoxin content in intermediate of pertussis antigen,and to verify the method so as to better control the quality of diphtheria,tetanus,and pertussis vaccine(DTP vaccine).Methods A kinetic chromogenic assay[Limulus Amebocyte Lysate(LAL)]was developed to detect the endotoxin content in the intermediate products of pertussis antigens after detoxification,and verified for the linearity,specificity,accuracy,reproducibility and intermediate precision. The quantitative detection results of kinetic chromogenic assay were compared with those of gel method.Results The absolute value of the linear correlation coefficient（|r|）of the kinetic chromogenic assay was more than 0. 99;under the maximum effective multiple dilution,the interference test recovery of the intermediate was within 50% — 200%,and pertussis toxin(PT)diluted to 10,100 and 1 000 times,filamentous hemagglutinin(FHA)diluted to 3 000,5 000 and 10 000 times,and pertussis adhesin(PRN)diluted to 50,75 and 100 times had no interference effect on the experiment after detoxification;the accuracy verification recovery rates of PT,FHA and PRN were 125%,110% and 99% respectively;and the CVs of reproducibility verification were 7. 21%,8. 31% and 5. 84%,and the CVs of intermediate precision verification were 6. 04%,16. 29% and 12. 23%,respectively.The bacterial endotoxin content of the three batches of pertussis antigen intermediates detected by kinetic chromogenic assay was consistent with that verified by gel method,both of which were less than the limit of bacterial endotoxin in the intermediates of pertussis antigen after detoxification.Conclusion The developed kinetic chromogenic assay has good linearity,specificity,accuracy and precision with accurate detection results,which can be used to detect the endotoxin content in intermediate products of component pertussis antigen after detoxification.

Objective To analyse the economies of scale in public hospitals in Zhejiang Province. Methods One hundred and twenty-five public hospitals in Zhejiang Province with qualification no less than class two level two were selected as sample hospitals. Douglas production function was employed to analyse the relationship between investment and output in sample hospitals between 2004 to 2006, with two types of production models established by medical service and incomes in hospitals as dependent variables. Results From 2004 to 2006, the medical service and incomes of sample hospitals were in line with economies of scale. The production increase rate was higher than investment increase rate. The medical service, incomes, total assets and number of staff in class three hospitals were higher than those in class two hospitals (P =0.000). Conclusion Economies of scale is the ultimate incentive to continuous outstretch for hospitals. Hospitals should rationally control the scale so as to avoid problems in medical service caused by overstretch.

Objective: To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time.Methods: The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object.Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables.Logistic regression model was used to analyze the influencing factors.Results: The average age of the research object was 36.7 years, with mostly secondary education.The average accumulated residence time in Beijing was 8.4 years.The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%.The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization.Conclusion: The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower.It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization.This is because people with longer residence time have lower age-adjusted two-week prevalence rate.This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice.It does not mean people with longer residence time have lower utilization of medical service.The residence time variable plays the role of proxy variable.It can solve the problem of variables' endoge-neity.At the same time, it can reflect the influence to outpatient services utilization of some determinants,which are not included in the model but varies with residence time.

Angiogenidiseaseof the retinare the common reasonof several visual loss.Vasculaendothelial growth facto(VEGF) playan importanrole in pathologiangiogenesis.In recenyears,the developmenof anti-VEGF therapiehatransformed the prognosiof these conditions.The treatmenof angiogenidisease had entered an erof anti-VEGF therapy,especially in the treatmenof choroidal neovascularization (CNV) caused by age-related maculadegeneration (AMD).Abreakthrough,anti-VEGF therapy changethe photodynamitherapy (PDT) based weAMD (wAMD) treatmenmode.In thipaper,we describe thaeven though relegated to background,PDstill haclinical therapeutivalue fospecial circumstanceand certain type of CNV lesion,awell ain certain retindisease.

Objectives To explore the clinical effect of external fixator combined antibiotic-calcium sulfate packing medullary cavity, VSD continuous drain with negative pressure and local skin flap transposition for the treatment of postoperative infected nonunion after initial debridement. Methods 20 cases of traumatic osteomyelitis from August 2012 to August 2014 were selected and taken antibiotic-calcium sulfate to focal zone. The patients were taken first-stage bone grafting for small bone defects and osteotomy for lengthening for big bone defects. For patients with cutaneous injury, local skin flap transposition was taken. For other patients with partial flap necrosis and non healing wounds, VSD continuous drain with negative pressure was taken. Results Operative incisions of 12 cases were primary healing, two cases were healing by second intention, four cases of flap were survived after local skin flap transposition, and two cases of flap were partial necrosis and healed by second intention. 11 cases of immobilization with external fixator, bone healing was satisfactory in seven cases after osteotomy for lengthening and two cases of bone delayed union in osteotomy for lengthening and recovered after bone transplantation. All patients were followed up for average 19(6-32) months with permatoplasty survived; all the infection of wounds was controlled and relapse-free. The fracture healing period was eight(4-12) month without pin site infection, osteoporosis and deformed healing. But there were 1 cases of knee stiffness and two cases stiffness of ankle joint. Conclusion After initial debridement, taken external fixator and taken antibiotic-calcium sulfate to medullary cavity and fracture ends. The patients were taken first-stage bone grafting for small bone defects and osteotomy for lengthening for big bone defects. For the skin defect after local flap grafting, taken VSD continuous drain with negative pressure for partial necrosis of flap occurred and non healing wounds cases. The method obtained prominent curative effect, reduces the treatment cycle and reduce the complications in the treatment of postoperative infected nonunion.

There have appeared many new insulin analogues in recently years. Two of them are rapid-acting insulin analogues(aspart,lispro).The regions between the insulin analog molecules were modified,which have shorter time than regular human insulin in onset of action,peak,duration of acting,and are better in decreasing postprandial glucose and opportunity of hypoglycemia before next meal.The another insulin analogues were galargine and detemir.They were obtained from changing insulin isoelectric point and increasing molecular weight,which lengthen time for disintegration,absorption and action and have little absorption variation and no overt peak.They can simulate physiological base insulin excretion.

Resistant starch is not absorbed in the small intestine.But it can be fermented in the large bowel.Recent studies have confirmed the ability of resistant starch to decrease postprandial blood glucose levels,decrease serum cholesterol and triglyeride levels,and enhance the sensitivity of insulin.As such,resistant starch contributes to preventing and treating metabolic syndrome.

Dimethyltrilobine iodide (DMT) 1.5 M-M increased the contractile force of isolated guinea pig left atria. This positive inotropic action could not be an-tagonized by either propranolol, cimetidine or diphen-hydramine. DMT 1.5 nM also increased the contractile force of isolated guinea pig left atria exposed to low concentration of calcium or to verapamil.

Objective To explore the occurrence and prevention and the principle of management of chylous fistula after neck dissection. Methods Retrospective research on 1750 cases of neck dissection in Henan Tumor Hospital from January 1983 to January 2005. There were 48 cases chylous fistula and 1 case chylothorax. The incidence was 2.8 %. 5 cases on the right, 44 cases on the left. 18 cases had completed radiotherapy or chemotherapy before operation. Conservative methods and surgical methods were used in the treatment. Low fat food was supplied to the patients with chylous fistula. The conservative methods was local pressure, the surgical methods was applied while maximal production of chylous exceeding 500 ml a day. Results All the patients were cured finally. The conservative method was 12.6(5~34) days, the surgical method 7.5(3~10)day. Conclusion The key to prevent chylous fistula was to band the rupture of thoracis or lymphatic duct during operation. The conservative methods could be used in patients with slight and middle chylous, when the chylous exceed 500 ml a day or the conservative methods was unavailable, the surgical methods was appropriate, it could shorten the time of tube draw.

By means of the observation of acridine orange-stained lysosomes with fluorescence microscope, we studied the intracellular killing and digestive process after alveolar macrophage (AM) ingested living-yeast. Based on the morphological changes of the cells, we divided the process into three stages: the pre-phagosome-lysosome fusion stage, the phagosome-lysosome fusion and killing stage, and the digestive stage. The results revealed that all the values of phagocytic index, phagocytic rate, fusion index and fusion rate of the isolated AM of rabbits infected with living-BCG were higher than those of normal rabbits (P