Objective To investigate the relationship between the mechanism of gynecomastia and serum hormone levels ,as well as liver function in male patients with liver cirrhosis .Methods Forty‐six male patients with liver cirrhosis and gynecomastia were collected as gynecomastia group from March 2013 to March 2014 ,and at the same period seventy male patients with liver cirrhosis but without gynecomastia were studied as non‐gynecomastia group . The condition of mammogenesis and maximum of breast thickness were measured by bilateral breast ultrasound .Hormones including luteinizing hormone (LH) ,follicle‐stimulating hormone (FSH) , prolactin (PRL) ,estradiol (E2) ,progesterone (PRGE) ,and testosterone (T);liver function including alanine aminotransferase (ALT) ,aspartate aminotransferase (AST) ,total bilirubin (TBil) and serum albumin (Alb);blood coagulation function including prothrombin time (PT) ,platelet count (PLT) were examined and the Child‐Pugh scores were calculated .t‐test was performed for results comparison between gynecomastia group and non‐gynecomastia groups .Chi‐square test was used to compare the difference in drinking rate between two groups . The patients of gynecomastia group and non‐gynecomastia group were further divided into Child‐Pugh Grade A ,B and C subgroups according to Child‐Pugh scores and the patients of gynecomastia group were divided into subgroups according etiology such as posthepatitic cirrhosis ,alcoholic liver cirrhosis and posthepatitic cirrhosis combined with alcoholc cirrhosis .Single factor analysis of variance was applied to compare the laboratory findings between subgroups ,and least‐significant difference mothod was used to further compared the differences between two subgroups .Results Among forty‐six male patients with liver cirrhosis and gynecomastia ,the mean thickness of breast was (7 .56 ± 2 .84) mm .All the differences of TBil ,Alb ,PT and Child‐Pugh score of Child‐Pugh grade patient were statistically significant between gynecomastia group and no gynecomastia group ((96 .72 ± 75 .86)μmol /L vs (60 .57 ± 54 .00)μmol /L ,(29 .12 ± 4 .90) g/L vs (33 .86 ± 6 .86) g/L ,(19 .06 ± 4 .76) s vs (15 .54 ± 2 .57) s ,11 .54 ± 0 .91 vs 10 .33 ± 0 .57 ,respectively ,t=2 .79 ,-4 .33 ,4 .58 ,2 .22 ,all P<0 .05) . The alcoholic drinking rate of gynecomastia group (74% (34/46) vs 53% (37/70)) increased ,and the difference was statistically significant compared with that of non‐gynecomastia group (χ2 =5 .183 , P<0 .05) .There was no statistically significant difference in E2 levels between gynecomastia group and non‐gynecomastia group (P>0 .05) .PRL and E2/T ratio ((404 .49 ± 297 .26) mU/L and 68 .74 ± 46 .37) were higher than those of non‐gynecomastia group ((279 .77 ± 111 .57) mU/L and 13 .60 ± 11 .55) ,and T was lower than that of non‐gynecomastia group ((7 .15 ± 5 .74) nmol/L vs (15 .46 ± 8 .53) nmol/L) ,and the differences were statistically significant (t=2 .72 ,7 .90、-6 .27;all P<0 .05) .Among patients with gynecomastia ,breast of patients with alcoholic liver cirrhosis was significantly thicker than that of patients with posthepatitic liver cirrhosis ((9 .25 ± 3 .59) mm vs (6 .67 ± 2 .48) mm) ,while the level of PRGE was lower than that of patients with posthepatitic liver cirrhosis ((0 .61 ± 0 .51 ) nmol/L vs (1 .49 ± 1 .47 ) nmol/L ) , and the differences were statistically significant (F= 3 .634 and 2 .674 ,both P< 0 .05) .Along with the severity of liver injury ,E2 level of gynecomastia group gradually increased ,however there was non‐statistically significant difference compared with non‐gynecomastia group (P>0 .05) .T level of gynecomastia group gradually decreased ,and those of Child‐Pugh B ,C subgroup ((8 .20 ± 7 .58) nmol/L and (4 .18 ± 3 .76) nmol/L) were siginificantly lower than that of Child‐Pugh A subgroup of non‐gynecomastia group ((17 .64 ± 9 .04) nmol/L ,F=9 .37 ,P<0 .05) .The E2/T levels of gynecomastic group gradually increased .There was significant difference in E2/T level between Child‐Pugh C subgroup of gynecomastia group (105 .49 ± 94 .42) and Child‐Pugh A grade subgroup of non‐gynecomastia group (11 .38 ± 9 .60 ,F=12 .57 ,P<0 .05) .Conclusions There are different degrees of sex hormone disorder in the serum of male patients with liver cirrhosis and gynecomastia which is more significant in PRL ,T and E2/T .T and E2/T level are correlated with the degree of liver functional impairment .Gynecomastia in alcoholic liver cirrhosis is more severe than that of posthepatitic liver cirrhosis .

Objective To investigate the clinical effect of glassfiber post with all-ceramic-crown for incisors restoration, providing some references for our clinical application. Methods 82 patients (100 teeth defect) in our department from October,2008 to October, 2009 were divided into group A and group B with 50 incisors in each. Glassfiber post with all - ceramic - crown was used in group A, and metal post with porcelain-fused-to-metal in group B. After one year follow-up, we observed the clinical effect. Results 49 cases were effective and 1 case failed in group A. 42 cases were effective and 8 cases failed in group B.There was statistically significant difference between the two groups. Conclusions Glassfiber post with all-ceramic-crown is better in convenient handling and good colour for incisors compared to metal post with porcelain-fused-to-metal.

Objective To investigate the effect of scalp acupuncture on cerebral blood flow and gross motor function in children with spastic cerebral palsy. Methods From January to November, 2016, 79 children with spastic cerebral palsy were randomly divided into con-ventional group (n=40) and scalp acupuncture group (n=39). Both groups received conventional rehabilitation treatment, and the scalp acu-puncture group was given scalp acupuncture in addition, for five months. The systolic blood flow velocity (Vs), mean flow velocity of cere-bral artery (Vm) and vascular resistance index (RI) of anterior cerebral artery (ACA), middle cerebral artery (MCA) and posterior cerebral artery (PCA) before and after treatment were assessed with color transcranial Doppler ultrasound (TCD). The clinical effect was evaluated with the Gross Motor Function Classification System (GMFCS). Results Five cases dropped out during the follow-up, three cases in the con-ventional group and two cases in the scalp acupuncture group. There was no significant difference in all the indexes between two groups be-fore treatment (P>0.05). After treatment, the Vs and Vm of ACA, MCA and PCA improved (t>2.051, P<0.05), no improvement was found in the RI of ACA, MCA and PCA in the conventional group (t<1.1631, P>0.05), and they decreased in the scalp acupuncture group (t>2.659, P<0.05). After treatment, the Vs and Vm of ACA, MCA and PCA were higher in the scalp acupuncture group than in the conventional group (t>2.098, P<0.05), the RI of ACA was lower in the scalp acupuncture group than in the conventional group (t=2.375, P<0.05), and no signifi-cant difference was found in the RI of MCA and PCA between two groups (t<1.637, P>0.05). The total effective rate was higher in the scalp acupuncture group than in the conventional group (χ2=6.887, P<0.05). Conclusion Scalp acupuncture facilitates to increase the cerebral blood flow, decrease the vascular resistance, and improve gross motor function in children with spastic cerebral palsy.

Objective To evaluate the difference of Doumas′method and 15 commercial serum total protein ( TP ) methods based on EP9-A3.Methods Serum panels were quantified for TP with Doumas′method and measured in parallel with 15 commercial methods.The linear regression analyses were performed, followed by calculating relative deviation and 95%CI between commercial method and Doumas′method at three different medical decision levels (45 g/L, 60 g/L, 80 g/L).We also calculated relative deviation, 95% limit of agreement ( LoA ) and 95% CI based on classical and improved Bland-Altman method at three different medical decision levels.If both the relative deviation and 95%CI were within 5%, we conside red the commercial serum total protein method was comparable to Doumas′method.Results (1) All assays presented high correlation ( r>0.975, P<0.001) with the Doumas′method.All assays showed that the relative deviations and 95%CIs were within the biological total error goal (5%) at medical decision levels based on regression analysis.(2) Based on classical and improved Bland-Altman method, fourteen of 15 commercial methods showed that the relative deviations and 95%CIs were within +/-5%. Conclusions All commercial assays are comparable to Doumas′method at medical deviation levels.There is no difference between regression analysis and Bland-Altman method for comparison study.

Construction and application of immunization information system is an important part of health information, which is very useful to improve the quality, efficiency and safety of vaccination. The background, system architecture, functions and applications, working conditions and characteristics of Shandong province Immunization Information System (IIS) are introduced in this article. It is expected to provide experiences for the development of immunization information system of other provinces.

Construction and application of immunization information system is an important part of health information, which is very useful to improve the quality, efficiency and safety of vaccination. The background, system architecture, functions and applications, working conditions and characteristics of Shandong province Immunization Information System (IIS) are introduced in this article. It is expected to provide experiences for the development of immunization information system of other provinces.

Objective To evaluate the commutability of certified reference materials, external quality assessment program materials and calibrators for serum glucose measurements which were performed in 24 routine measurement procedures.Methods 35 fresh patient specimens and some reference materials were analyzed by isotope dilution liquid chromatography tandem mass spectrometry ( as the comparative method) and 24 routine measurement procedures (as the evaluated methods).The relationships between the results from the evaluated method and the comparative methods were evaluated to identify the commutability.Results It showed that 5 certified reference materials, 2 trueness verification materials, and 5 calibrators were commutable in all 24 routine measurement procedures.The other samples were displayed the presence of commutability issue in different degrees.Conclusion It is important to pay more attention to the problems brought by commutability of reference materials in clinical laboratory.

Objective To evaluate the analytical quality of different analytical systems in measuring seven kinds of sero-enzymes consisting of Alanine Aminotransferase(ALT), Aspartate Aminotransferase (AST),γ-Glutamyltransferase(GGT), Lactate Dehydrogenase(LDH), Creatine Kinase(CK), α-Amylase (AMY) and Alkaline Phosphatase(ALP).Methods Data from 2013 routine chemistry external quality assessment (EQA) and Enzymes Trueness Verification(ETV) were collected.1 450 and 165 participating laboratories were selected respectively for investigation.Analytical systems of participating laboratories were classified into 6 kinds,i.e.imported matching system(AI), domestic matching system(AH), systems consisting of imported reagents and corresponding calibrators(BI), systems consisting of domestic reagents and corresponding calibrators ( BH ) , unmatched systems using imported calibrators ( CI ) and unmatched systems using domestic calibrators ( CH ) .Total error, bias and coefficient of variation within laboratories ( CVI) were calculated from the data of 2013EQA and ETV The proportion of laboratories meeting the desirable and the optimal criteria derived from biology variation were analyzedby EXCEL2010 with coincidence rate (CR) above 85% as evaluation criterion.Results The AI and CI occupied more than 70%among six systems, CH occupied approximate 15% and the other systems were less than 10%.The
range of the average of ETV′s total errors , EQA′s total errors, absolute value of bias and CVI of seven kinds of sero-enzymes were 6.2%-27.8%, 4.0%-7.0%, 4.2%-25.1% and 3.6%-4.6% respectively. Accuracy, bias and within-laboratory imprecision were judged by CR of ETV′s total errors, ETV′s bias, CVI and EQA′s total errors respectively and comparability between different systems was evaluated.It turned out that the results of analytical systems of enzymes except ALP were comparable, the accuracy of systems of enzymes except AMY, ALP and GGT, LDH of AI, the within-laboratory imprecision of enzymes except LDH, AMY, ALP and AST of AI, CH could meet the desirable criteria.The bias of all systems of seven kinds of sero-enzymes were undesirable.Conclusions The analytical quality of routine testing of seven kinds of sero-enzymes could fulfill the clinical requirement generally in China.

Objective To prepare the serum reference materials for total thyroxine .Methods Individual blood samples were collected from 13 healthy donors (7 males and 6 females) aged from 20 to 50 years old, and the sera were separated and mixed into 4 serum pools according to the concentration of thyroxine.The materials were tested for homogeneity and stability using routine methods .The method of isotope dilution liquid chromatography tandem mass spectrometry ( ID-LC/MS/MS) was used to determine the concentration of thyroxine .The candidate reference materials were also measured by four conventional methods to analyze the commutability of the materials .Results It showed that the four candidate reference materials were homogeneous and commutable in four conventional methods and they were tested to be stable for at least 1 year at -70 ℃using the isochronous stability study .The certified values ( reference value ± expanded uncertainty ,nmol/L) were:75.9 ±1.8,105.3 ±2.2,114.7 ±2.1 and 187.4 ±2.9.Conclusions Certified reference materials for serum thyroxine have been prepared .These materials have been approved to be the Certificate Reference Materials of GBW 09127,GBW 09128,GBW 09129 and GBW 09130.

Objective Preparation of aqueous reference materials for cholesterol and glycerol.Methods Study on reference materials.The certified reference materials GBW09203b and GBW09149 were weighed accurately and dissolved into 20% of methyl cyclodextrin aqueous solution to prepare six kinds of candidate reference materials of cholesterol and glycerol according to the concentration.The materials were tested for homogeneity and stability using routine methods.The reference methods of isotope dilution liquid chromatography tandem mass spectrometry (ID-LC/MS/MS) were used to determine the concentration of cholesterol and glycerol to evaluate the accuracy of the certified values.Meanwhile, the blank verification test was carried out.The expanded uncertainty was the combination of standard uncertainty of measurement, unhomogeneity and instability.Results It showed that the six candidate reference materials were homogeneous and stable for at least 1 year at-70 ℃ and-20 ℃.The certified values (reference value ± expanded uncertainty,mmol/L) were as follows,for cholesterol:0.65±0.01,1.31 ±0.01,2.57±0.02,5.21±0.06,7.71±0.08,10.24±0.06;for glycerol:0.29±0.01,0.58±0.01,1.22±0.02,2.24±0.02,3.46±0.04,4.52 ±0.04.The results of reference methods were consistent with the certified values.Blank validation tests showed that the concentration of the analytes would not be affected by the reagent and the blank matrix.Conclusions Certified reference materials for cholesterol and glycerol in aqueous solution have been prepared successfully.These materials are homogeneous and stable, and the certified values are reliable.Therefore the materials have been approved to be the Certificate Reference Materials of GBW 09823, GBW 09824, GBW 09825, GBW09826, GBW09827 and GBW 09828.