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 determine the value of 18F-FDG PET-CT in detecting the primary origin of cancer of unknown primary (CUP).Methods A total of 48 patients (age range 41-82 years,mean age of 57±16 years, 20 females) were retrospectively selected. All patients were diagnosed as CUP and were examined by 18F-FDG PET-CT scan.The patients were divided into cervical lymph node metastasis group (28 cases) and extra-cervical lymph node metastasis group (20 cases) according to different metastasis site.Sensitivity of 18F-FDG PET-CT to detect primary tumor site was compared between these two groups.Results 18F-FDG PET-CT detected primary tumors in 32 of 48 patients (66.7 ％), the cervical lymph node metastasis tumors in 22 of 28 patients (78.6 ％), and extra-cervical lymph node metastasis tumors in 10 of 20 patients (50.0 ％).There was significant difference between cervical lymph node metastasis group and extra-cervical lymph node metastasis group (x2 =4.286,P ＜ 0.05).Conclusion 18F-FDG PET-CT has a high sensitivity to detect primary origin of CUP,especially for patients with cervical lymph node metastasis.

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 establish the evaluation system and explore the possible impact factors for public interest nature in public hospitals. Methods One hundred and twenty-five public hospitals in Zhejiang Province were served as sample hospitals, and related data of year 2004 to year 2006 were collected. The Delphi expert investigation method, variation coefficient method and TOPSIS method were employed to screen the impact factors for public interest nature and build up the evaluation system for public hospitals, and stepwise regression analysis was conducted for possible impact factors of public interest nature. Results The evaluation system mainly included five aspects of quantity, quality, efficiency, mean charge of medical service and social satisfaction to public hospitals. The two most important factors that influenced the public interest nature were the number of beds and the number of equipments valued above 10 000 RMB. Conclusion The hospital scale is the most important impact factor for the nature of public interest in public hospitals. Therefore, the scale of public hospitals should be properly designed so as to ensure the public interest nature in public hospitals.

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.

Diabetic cardiovascular autonomic neuropathy is the most common and troublesome complication of diabetes mellitus.Diabetic cardiovascular autonomic neuropathy contributes greatly to the morbidity,mortality.Factors in the pathogenesis of these complications are altered metabolism,vascular insufficiency,loss of growth factor trophism,and autoimmune destruction of nerves in a visceral and cutaneous distribution.There are studies in progress that suggest cardiovascular autonomic nerves can be induced to regenerate,and the future for patients with diabetic cardiovascular autonomic neuropathy is brighter.

Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes.NF-?B can be triggered by oxidative stress and controls several programs of gene expression,the majority of which participate in the host inflammation and immune response.Evidence has accumulated that NF-?B is involved in the development of diabetic retinopathy.NF-?B activation induced by diabetes is associated with the apoptosis found in the pericyte,leukocyte-endothelial interaction,capillary basement membrane thickening,neovascularization and formation of epiretinal membranes.Inhibition of(NF-?B) activation has been suggested as a treatment strategy in diabetic retinopathy.

Subcutaneous insulin resistance is a condition in which glucose is insensitive to insulin from the subcutaneous tissue,but sensitive to that by intravenous injection.The mechanism of subcutaneous insulin resistance is mainly associated with skin obstruction or delayed entry of insulin into blood circulation.The treatment of the problem involves Aprotinin,anticoagulant and intramuscular injection of insulin.This paper offers an overview of the advances in the researches of subcutaneous insulin resistance.

Objective: Thyroid nodules are common clinical thyroid disorders.The purpose of this study was to investigate the diagnostic value of the clinical characteristics and various parameters of malignant thyroid nodules and the sensitive indexes for their differentiation so as to improve the diagnosis of malignant thyroid nodules and avoid unnecessary procedures or operations.Methods: We retrospectively studied 600 cases of thyroid nodules treated by surgery from 2001 to 2008,divided them into a benign and a malignant group according to the pathological results,and analyzed by multivariate logistic regression the correlation between the nature of thyroid nodules and various factors.Results: Of the 600 cases of thyroid nodules,519(83.47%) were benign and 81(16.53%) were malignant.Clinical symptoms and signs,ultrasonography and CT were all useful in indicating malignancy,especially ultrasonography,whose specificity and diagnostic accuracy were 93.3% and 84.2%,respectively.Multivariate logistic regression analysis revealed a higher rate of malignancy in younger patients with solid or hard nodules,or accompanied with calcification or painless adenophyma in the neck.Conclusion: Clinical symptoms and signs,ultrosonography and CT are of significant value in the diagnosis of malignant thyroid nodules.

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.