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 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.

Forty rats were randomly divided into four groups and intraperitoneal injection of 1%lidocaine 400mg/kg (group Ⅰ)、1%lidocaine-?-cyclodextrin 400mg/kg (group Ⅱ)、1%alkalinized lidocaine 400mg/kg(group Ⅰ)and 1% alkalinized lidocaine-?-cyclodextrin 400mg/kg(group Ⅳ) respectively. The results showed that there was a significant difference of lethal time between group Ⅰ and Ⅱ, and no significant difference between gronp Ⅲ and Ⅳ; the times of toxic and lethal effects of group Ⅲ and Ⅳ were shortened markedly as compared to group Ⅰ and Ⅱ. It is concluded that ?-cyclodextrin can postpone the release and absorbance of lidocaine,and alkalizer can weaken this action of ?—cyclodextrin.

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: 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.

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.

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.