Objective: Investigation on the quality control method of bacterial endotoxin in betahistine hydrochloride injection.
Methods: The method of bacterial endotoxin gel test of 23 batches of betahistine hydrochloride injection from 5 manufacturers was studied.
Results: The limit value of endotoxin in this product was 3 EU·mg^-1, which was suitable for the bacterial endotoxin test of China Pharmacopoeia 2020.
Conclusion: The quality of betahistine hydrochloride injection can be controlled by bacterial endotoxin test, and the limit of bacterial endotoxin can be set as follows: the content of endotoxin in every 1mg of betahistine hydrochloride should not exceed 3 EU.

ObjectiveTo determine the epidemiological characteristics and risk factors of a norovirus GII.17 outbreak in Minhang District of Shanghai in 2018， and provide evidence for prevention and control measures of norovirus infection. MethodsDescriptive epidemiological analysis was performed. In addition， a retrospective cohort study was conducted to determine the risk factors. ResultsFrom May 30^th to June 1^st of 2018， a total of 132 cases （126 clinical cases and 6 confirmed cases） were documented，with an attack rate of 29.20%（132/452）.All cases were children in a kindergarten， with the average age of 5 years and 43.9% being male. The cases were reported in all the classes， with no clustering by class or floor．The epidemic curve was characterized by a point source exposure， which was estimated to be probably between 7 AM on May 30^thand 0：30 AM on May 31^st. The retrospective cohort study showed that the attack rate significantly differed between the children who had taken and did not take the school lunch （RR=∞） on May 30^th，and those who had taken and did not take seafood noodles （RR=4.11， 95%CI：1.09-15.55） （P<0.05）. Among a total of 73 specimens， six specimens collected in child cases and one specimen in an asymptomatic chef tested positive for GII.17 type of norovirus. In addition， one retained food specimen of seafood noodles was positive for Aeromonas hydrophila. Viral shedding in the asymptomatic chef remained over 30 days. ConclusionThe outbreak was caused by seafood noodles contaminated by norovirus. It warrants enhancement in the regulation of food safety in canteens and regular examination of norovirus infection in catering industry employees.

Objective:To analyze the clinical characteristics of severe adenovirus pneumonia with bacterial infection in children, so as to provide clinical evidences for early diagnosis and reliable treatment.Methods:A total of 72 pediatric cases with severe adenovirus pneumonia admitted to Pediatric Intensive Care Unit at the First People′s Hospital of Chenzhou from January 2018 to August 2019 were included.The clinical features, laboratory and imaging data, efficacy of the treatments and prognosis were investigated retrospectively.Patients were divided into with bacterial infection group and without bacterial infection group.The clinical characteristics were analyzed.Results:Among the 72 children, there were 54 males and 18 females, aging from 3 months to 5 years, including 37cases with bacterial infection and 35 cases without bacterial infection.Compared with the group without bacterial infection, the group with bacterial infection had longer heat duration and hospital stay [12.0 (10.0, 18.5) days vs.10.0 (9.0, 12.0) days; 6.0(4.0, 7.0) days vs.11.0(6.5, 16.0) days, P<0.05], the incidences of diarrhea and hepatomegaly were higher[35.1% (13/37) vs.14.3%(5/35); 45.9%(17/37)vs.8.6%(3/35), P<0.05], the proportion of five lobes involved in lung imaging was higher [91.8% (34/37) vs. 57.1%(20/35), P<0.05]. The incidences of complications with respiratory failure, hemophagocytic lymphohistiocytosis, and bronchiolitis obliterans in the group with bacterial infection were significantly higher than those of without bacterial infection group ( P<0.05). Conclusion:For children under 2 years old age with severe adenovirus pneumonia, there are prolonged high fever and extensive pulmonary lesions.We should be highly alert to the combination of bacterial infection and timely anti-infection therapy.Children with severe adenovirus pneumonia with bacterial infection have severe clinical manifestations and many complications with respiratory failure, hemophagocytic lymphohistiocytosis, and bronchiolitis obliterans.

Objective:To investigate the relationship between serum matrix metalloproteinase-9 (MMP-9) level and the location and severity of bleeding in patients with cerebral microbleeds(CMBs).Methods:A total of 60 CMBs patients admitted to the Department of Neurology of the First Affiliated Hospital of the Xinxiang Medical University from January 2019 to August 2020 were selected as subjects as the CMBs group, and 60 healthy controls without nervous system diseases in outpatient physical examination during the same period were selected as the control group. The clinical data and biochemical indicators of the two groups were collected. Serum MMP-9 levels were measured by enzyme linked immunosorbent assay (ELISA). According to susceptibility weighted imaging (SWI), CMBs patients were divided into grade 1 group ( n=24), grade 2 group ( n=19) and grade 3 group ( n=17), and according to the micro analytical rating scale (MARS), the CMBs patients were divided into the lobar group ( n=19), the deep or infratentorial group ( n=17) and the mixed group ( n=24).The relationship between serum MMP-9 level and the location and severity of CMBs was analyzed. SPSS 19.0 software was used for data statistical analysis.One-way ANOVA, t-test and rank sum test were used for comparison. Logistic regression analysis was used to analyze the influencing factors. Pearson correlation analysis and Spearman correlation analysis were used for correlation analysis. Results:The level of MMP-9 in CMBs group was significantly higher than that in control group (208.13(142.25, 285.88) μg/L, 149.50(93.40, 186.51)μg/L), and the difference was statistically significant ( P<0.05). Serum MMP-9 level was a risk factor of CMBs ( β=1.322, OR=3.750, 95% CI=2.038-7.997, P=0.002). The difference of level of MMP-9 in different severity of CMBs was statistically significant (147.55(109.25, 266.47)μg/L, 242.12(147.55, 288.80)μg/L, 270.42(203.43, 364.27)μg/L, P=0.017). Serum MMP-9 level was positively correlated with the number of CMBs ( r=0.371, P=0.003). The difference of MMP-9 level of CMBs in different locations were statistically significant (249.77(158.43, 338.46)μg/L, 188.83(138.52, 243.15)μg/L, 210.65(144.25, 255.78)μg/L, P=0.013). The increased serum MMP-9 level was a risk factor for CMBs( β=0.401, OR=1.122, 95% CI=1.004-1.204, P=0.036). Conclusion:The increased level of serum MMP-9 may be a risk factor of CMBs, especially for CMBs in cerebral lobesand, and the level of MMP-9 is positively correlated with the severity of CMBs.

Objective:To retrospectively analyze the prevalence and genotype distribution of human papillomavirus (HPV) among women in mainland China from the introduction of cervical cancer vaccine to its marketing in China, so as to provide data for comparing HPV prevalence after the application and gradual promotion of HPV vaccine.Methods:Related articles published during 2006 to 2016 were retrieved from PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang databases. Data about HPV infection in women receiving physical examination or routine cervical cancer screening and female outpatients were collected and analyzed.Result:A total of 270 articles were retrieved, in which the sampled women were aged from 13 to 90 years old. Seventy-two articles were about HPV infection in women screened for cervical cancer with a sample size of 580 308 people. The overall results showed that during the 11 years, the five most common high-risk HPV genotypes were HPV52, 16, 58, 68 and 18, and the common low-risk HPV genotypes were HPV81, 43 and 6. The distribution of HPV genotypes varied in different regions, but HPV16, 52 and 58 were always the predominant genotypes. Among the 270 collected articles, 200 analyzed HPV infection in female outpatients with a total of 675 035 cases. The results showed that the top five high-risk HPV genotypes with high prevalence were HPV16, 52, 58, 18 and 33, and the common low-risk types were HPV6, 11 and 81. The analysis of HPV infection rate in seven geographical regions indicated that, although the distribution of the commonly circulating high-risk HPV genotypes varied in different regions, HPV16, 52 and 58 remained the predominant genotypes.Conclusions:The present study showed that the prevalence and genotype distribution of HPV infection varied by region, but HPV16, 52 and 58 were always the most common high-risk genotypes and HPV6 was the predominant low-risk genotype in both women screened for cervical cancer and female outpatients. Besides that, the infections of other high-risk genotypes, such as HPV53 and 68, should also be of concern.

Objective:To investigate the relationship between serum matrix metalloproteinase-9(MMP-9) level and vascular cognitive impairment with no dementia (VCIND) in patients with cerebral small vessel diseases (CSVD).Methods:A total of 374 patients with CSVD treated in the First Affiliated Hospital of Xinxiang Medical University from January 2016 to January 2020 were collected and 150 healthy subjects in the same period were used as general data of the control group. All subjects were detected for serum MMP-9 level using enzyme linked immunosorbent assay and received cognitive function scoring using Montreal cognitive assessment (MoCA). The 374 patients with CSVD were divided into the Group A(186 cases with vascular cognitive impairment with no dementia) and the Group B(188 cases without cognitive impairment). The general data, serum MMP-9 level and cognitive function score were compared among the three groups and the correlation between MMP-9 level and cognitive function was analyzed.Results:The MMP-9 levels of Groups A and B ( (335.10±105.10)μg/L, (261.62±80.32)μg/L) were higher than those of the control group ( (168.23±48.85)μg/L), and the MMP-9 level of Group A was higher than that of Group B ( P<0.05). The MoCA scores of Groups A and B ( (18.45±5.24), (28.31±1.52) ) were lower than those of the control group (29.49±0.90), and the MoCA scores of Group A were lower than those of Group B ( P<0.05). The serum MMP-9 level, a risk factor for VCIND in patients with CSVD ( β=1.505, OR=1.323, 95% CI=1.149-1.527, P<0.05), was negatively correlated with total score of MoCA scale, visual-spatial and executive function, naming, language, abstract thinking, delayed recall, and directive force factor score ( r=-0.299, r=-0.155, r=-0.383, r=-0.358, r=-0.192, r=-0.259, r=-0.246 respectively, all P<0.05). Conclusion:The increased level of MMP-9 may be a risk factor of VCIND in CSVD patients, and it is closely related to cognitive impairment.

Objective:To compare the prognostic efficacy of CRB-65 (Confusion, Uremia, Respiratory, BP, Age 65 Years) , BAP-65 (BUN, Altered Mental Status, Pulse, and Age 65 years) and DECAF (Extended MRC Dyspnea Score, Eosinopenia, Consolidation, Acidaemia, and Atrial Fibrillation) scoring systems in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) .Methods:Clinical data, CRB-65, BAP-65 and DECAF scoring rubrics of 181 AECOPD patients hospitalized in the Department of Respiratory Medicine, the First Affiliated Hospital of Zhengzhou University from January 2017 to December 2018 were retrospectively collected. According to the outcomes, the patients were divided into stable disease group (patients discharged, n=121) and critically ill group (patients transferred to ICU or died, n=60) . The clinical data and scores were compared between the two groups. The sensitivity, specificity and accuracy of CRB-65, BAP-65 and DECAF scoring systems in predicting the prognosis of the patients was calculated with the death and admission into ICU as the observation endpoints. The receiver operating characteristic curves (ROC) of the three scoring systems were drawn, and the area under the curve (AUC) was calculated to identify the best cut-off point in predicting the prognosis. Results:The acute exacerbation frequency, CRB-65 score, DECAF score, and BAP-65 score in the past year in the critically ill group were higher than those in the stable disease group ( t=-4.899, -31.748, -34.611, 7.227; P<0.001) . The best cutoff points of CRB-65 score, BAP-65 score and DECAF score for predicting the patients' outcome were ≥3, ≥Ⅲ, ≥3 (sensitivity=70.00%, 81.67%, 90.00%; specificity=61.16%, 77.69%, 83.47%; accuracy=64.09%, 79.00%, 85.63%) . The AUC of DECAF score, BAP-65 score and CRB-65 score for predicting the prognosis of AECOPD patients was 0.811 (95% CI: 0.845-0.948) , 0.774 (95% CI: 0.707-0.869) , and 0.669 (95% CI: 0.595-0.779) , and the AUC of DECAF score for predicting the prognosis of AECOPD patients was higher than those of BAP-65 score and CRB-65 score ( Z=3.891, 4.799; P=0.026, 0.005) . Conclusions:CRB-65, BAP-65 and DECAF scores are of certain clinical value in predicting the prognosis of AECOPD patients. Among them, DECAF has the highest predictive efficacy, while CRB-65 is faster and more convenient.

Objective:To explore the effects of professional nurse led multidisciplinary care team in extended nursing outside hospital among elderly diabetic patients.Methods:From January 2018 to December 2018, we selected 102 elderly patients with type 2 diabetes of Endocrinology Department in the First Affiliated Hospital of Zhengzhou University as subjects by convenience sampling. All of patients were randomly divided into control group and observation group, 51 cases in each group. Control group implemented the routine model management, while observation group carried out the professional nurse led multidisciplinary care team model management; the extended nursing outside hospital lasted for 6 months. We compared the fasting blood glucose (FBG) , glycosylated hemoglobin, readmission rate and the complication incidence between two groups.Results:After 6 months intervention, the FBG of control group was lower than that before intervention with a statistical difference ( P<0.05) ; there was no statistical difference in the glycosylated hemoglobin of control group before and after intervention ( P>0.05) . After 6 months intervention, the FBG and glycosylated hemoglobin of observation group were lower than those before intervention, and lower than those of control group with statistical differences ( P<0.05) . The readmission rate of observation group within 6 months was 15.69% (8/51) lower than that [37.25% (19/51) ]of control group with a statistical difference (χ 2=6.095, P=0.014) . The complication incidence of observation group within 6 months was 7.84% (4/51) lower than that [35.29% (18/51) ]of control group with a statistical difference (χ 2=11.359, P=0.001) . Conclusions:Extended nursing outside hospital with the professional nurse led multidisciplinary care team model can effectively improve the FBG and glycosylated hemoglobin of elderly diabetic patients, reduce the readmission rate and complication incidence which is worthy of clinical generalization.

Objective To evaluate the expression and role of serum CXC chemokine ligand 13 (CXCL13) in Primary hepatic carcinoma (PHC) patients and explore the clinical value of PHC diagnosis and prognosis . Methods Serum samples were collected from 80 patients with PHC ,80 patients with chronic hepatitis B (CHB) and 36 healthy controls (HC) .Serum levels of CXCL13 in patients were measured by enzyme-linked immunosorbent assay (ELISA) .The relationship between clinicopathological features and laboratory parame-ters was analyzed by statistical software .The correlation between CXCL13 level and prognosis of liver func-tion were tested by spearman correlation analysis ,the diagnostic value of CXCL13 and AFP to PHC were ana-lysed by ROC curve .Results The levels of serum CXCL13 in patients with PHC were significantly higher than those in CHB and HC groups .The levels of serum CXCL13 in patients with advanced PHC (Ⅲ - Ⅳ) were significantly higher than those in patients with early PHC (Ⅰ - Ⅱ) .Serum levels of CXCL13 in patients with tumor diameter more than 5cm were significantly higher than those tumor diameter less than or equal 5 cm .Patients that metastatic serum levels of CXCL13 were significantly higher than without tumor metastasis in patients .The level of serum CXCL13 in patients with ascites was significantly higher than that in patients without ascites ,all the data were statistically significant (P＜0 .05) .Serum levels of CXCL13 in patients with PHC were correlated with hemoglobin ,serum albumin ,cholinesterase ,and international normalized ratios . There was a positive correlation between serum CXCL13 concentration and Child-Pugh score in PHC patients (r＝ 0 .459 ,P＝ 0 .001) ,and negatively correlated with serum albumin and cholinesterase (r＝ -0 .319 ,-0 .259 ,P＝0 .004 ,0 .008) .CXOC13 and AFP combination of the ROC curve were 0 .938 .Sensitivity and spe-cificity were 82 .8% and 100 .0% .Conclusion High expression of serum CXCL13 in PHC is closely related to tumor grow th and metastasis ,and has important clinical value in the diagnosis ,treatment and prognosis evalu-ation .