BACKGROUND:Studies have demonstrated that postmenopausal osteoporosis is related to female reproductive characteristics and exercise diets,but few studies have demonstrated whether female reproductive characteristics and exercise diets have an effect on vitamin D in postmenopausal women. OBJECTIVE:To investigate the relationship of vitamin D levels with female reproductive characteristics and exercise diets and their influencing factors in postmenopausal women in Beijing. METHODS:Totally 727 postmenopausal women with an age range of 46-75 years old who received on-site questionnaires in 17 communities of Beijing from September 2017 to May 2018 were selected as the study subjects,and the questionnaires included the subjects'basic information and history of menstruation,menopause,pregnancy,and exercise diet.An electrochemiluminescence immunoassay analyzer and its auxiliary reagents were used to determine 25-(OH)D levels.Bone mineral density and T values of the lumbar spine(L1-L4,whole)and both hips(femoral neck,whole)were determined using a dual-energy X-ray bone mineral density detector.The correlation of vitamin D with reproductive characteristics and exercise diet was observed,as well as the influencing factors of vitamin D were analyzed. RESULTS AND CONCLUSION:There were 136 cases(18.7%)in the vitamin D normal group,389 cases(53.5%)in the vitamin D insufficient group,and 202 cases(27.8%)in the vitamin D deficient group.The mean vitamin D level was(15.60±5.85)ng/mL.With the increase of vitamin D level,the bone mineral density value and T value of different parts of the body also increased.Vitamin D level was positively correlated with age at menarche,days of menstrual duration,stage of menopause,activity,diet type,and dietary preference(P<0.05);was negatively correlated with menstrual cycle,age at menopause,and number of childbearing(P<0.05);and had no correlation with age at first conception and number of pregnancies(P>0.05).The results of multifactorial ordered Logistic regression analyses showed that there was a positive correlation between the frequency of drinking dairy products and vitamin D level(P<0.05),and dairy products were a protective factor for vitamin D level.To conclude,vitamin D levels are generally insufficient and bone mineral density values are generally low in postmenopausal women in Beijing.Vitamin D levels are correlated with some reproductive characteristics and exercise diets,and drinking dairy products is a protective factor.Therefore,it is possible to intervene in the dietary situation of postmenopausal women by means of health education about osteoporosis and by increasing vitamin D levels in order to increase bone density values and reduce the prevalence of osteoporosis in the postmenopausal period.

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Objective To investigate the correlation between muscle strength level and bone mineral density and bone metabolism indexes in postmenopausal women in Beijing.Methods Postmenopausal women who were investi-gated by on-site questionnaires and followed by bone mineral density examination in Beijing from September 2017 to May 2018 were recruited as study subjects.They were divided into early menopausal group,middle menopausal group,late menopausal group,and twilight menopausal group according to the years of menopause.Changes in grip strength,5 times sit-to-stand test(FTSST)with bone mineral density(BMD)and bone metabolism indexes were observed in the four groups and their correlations were analyzed.Results A total of 815 cases of postmenopausal women were included.At different menopausal stages,muscle strength was all found to decrease with the increase of menopausal years(P＜0.05),there was non-significance of different bone metabolism indexes among the four groups(P＞0.05);Femoral neck and lumbar spine BMD decreased with the increase of menopausal years(P＜0.05).Maximum grip strength was positively correlated with both femoral neck and lumbar spine BMD(R=0.158,P＜0.05;R=0.130,P＜0.05).There was no correlation between muscle strength and bone metabo-lism indexes(P＜0.05).Conclusions Different bone metabolism indexes are not associated with muscle strength in menopausal women.Maximum grip strength is positively correlated with bone mineral density,which can be used as an auxiliary screening tool for osteoporosis(OP)in women.The FTSST suggests that the lower limb muscle strength of menopausal women decreases with age,which can be used as one of the indicators for predicting the risk of falls in menopausal women.

Objective:To summarize the clinical characteristics and efficacy of hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy.Methods:Eleven patients with hemorrhage resulted from cortical venous infarction with seizure as the first symptom after craniotomy admitted to Neurosurgical Center, 988 th Hospital of PLA Joint Logistic Support Force from June 2011 to September 2019 were chosen in our study; primary diseases included meningioma in 7 patients, contusion and laceration of frontal lobe in 2, hypertensive cerebral hemorrhage in 1, and obsessive-compulsive disorder in 1 patient. Epilepsy was the first symptom after craniotomy. Clinical characteristics and efficacy of these patients were analyzed retrospectively; seizure control efficacy was evaluated by Engel grading. Results:First seizure occurred 4 h-7 d after craniotomy in these 11 patients, including 2 with focal sensory retention seizure, 3 with focal bilateral tonic-clonic seizure, and 6 with general tonic-clonic seizure. Follow-up cranial CT revealed hematoma in surgical region, adjacent cortex or subcortex in 9 patients (hematoma volume: 15-50 mL); emergency craniotomy (hematoma clearance) and decompressive craniectomy was performed in 5 patients; only emergency craniotomy (hematoma clearance) was performed in 3 patients; conservative treatment was performed in 1 patient. A small amount of diffuse bleeding with severe cerebral edema in the surgical region appeared in 2 patients, and the transient limb paralysis gradually recovered after 2 months of conservative treatment. Follow-up was performed for (4.5±1.7) years ([2.3-7.0] years). During the last follow-up, 4 patients were normal, 5 patients had mild to moderate hemiplegia, 1 had mild decreased vision in the right eye, and 1 had long-term coma. Epileptic control efficacy analysis indicated that 8 had Engel grading I and 3 grading II.Conclusion:Complete removal of hematoma and inactivated brain tissues can effectively control seizures and rebleeding in patients with hemorrhage resulted from cortical venous infarction.

Objective:To investigate the imaging and electrophysiological characteristics, surgical methods and efficacies of preschoolers with refractory temporal lobe epilepsy.Methods:A retrospective data study was conducted on 27 patients with refractory temporal lobe epilepsy accepted surgical treatment in our hospital from June 2014 to January 2019. By combined with clinical manifestations, preoperative epileptogenic zones were evaluated by imaging data, such as MR imaging, MR spectroscopy and positron emission tomography-CT, and interictal and ictal video-electroencephalogram (VEEG) data. During the surgery, cortical electroencephalography (ECoG) and deep electrode monitoring were used to monitor and locate the abnormal discharge areas to guide the surgical excision of epileptic zone. Engel grading was used to evaluate the efficacy after surgery.Results:All children had typical clinical manifestations of temporal lobe epilepsy; abnormal signal images were found in one side of the temporal lobe and the hippocampus in MR imaging; epileptic discharges were originated from one side frontotemporal region in interictal and ictal VEEG. Obviously persistent or paroxysmal spike waves, spike waves and slow spikes and spike composite waves were intraoperatively discovered by ECoG and depth electrode electroencephalography in the temporal lobe. All patients accepted standard anterior temporal lobectomy+lesion resection+peripheral abnormal discharge resection of the temporal lobe cortex; partial insular lobe was excised and frontal cortex was performed low power thermal coagulation in two patients. Follow-up was performed for 6 months; Engel grading I was reported in 22 patients (81.5%), Engel grading II in 3 patients (11.1%), and Engel grading III in 2 patients (7.4%).Conclusion:Early surgery and moderate extension of resection under intraoperative ECoG and deep electrode monitoring are the key factors to improve the surgical efficacy of preschoolers with refractory temporal lobe epilepsy.

Objective To investigate the effectiveness and safety of carbapenem antimicrobial management programs (ASP). Methods 671 patients who were discharged from the emergency department of the hospital from January 2017 to April 2018 were enrolled. These patients were subject to before-and-after self-control studies, using such intervention measures as MDT proactive management-feedback-training. January-September of 2017 was set as the pre-intervention stage, and September 2017-April 2018 as the post-intervention stage. The two stages were compared in such indicators as the monthly antibacterial use, quality of care and hospital acquired infection. Results Thanks to the ASP measure against antibiotics like carbapenems, the use rate of carbapenems at the emergency department ward fell from 36.7% to 18.6% , the defined drug doses (DDDs) of carbapenems fell from 211.92 to 82.22, and the antibiotics use density (AUD) of carbapenems fell from 29. 18 DDDs/100 day/patient to 11. 56. The pathogen detected rate increased significantly (0.61 ± 0.08 versus 0.78 ± 0.16), with a difference of statistical significance (P=0.020). On the other hand, the mean days of stay, average cost per hospitalization, proportion of antibiotics use, incidence of hospital acquired infections, and the infection/colonization rate of carbapenem-resistant organisms ( CROs ) present no significant changes. There was a moderate positive correlation between carbapenem DDDs and mean days of stay ( P=0.034), and also a moderate positive correlation between hospital acquired infection incidence and CROs infection/colonization rate ( r = 0.545, P = 0.029 ). Conclusions The carbapenem ASP at the hospital proves safe and effective. CROs infection/colonization may be the cause of hospital acquired infection. Prevention and control against multi-drug resistant bacteria on the basis of ASP may add to the effect of ASP.

Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.

Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST,presepsin) combined with national early warning score (NEWS) for predicting the prognosis of emergency patients with sepsis.Methods To select 119 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study.The serum samples were collected immediately as they came,the presepsin was measured,and the NEWS scorescalculated.Patients were divided into survival group (81 cases) and death group (38 cases) according to the 30-day prognosis,and the value of the presepsin,NEWS score and presepsin + NEWS score in the assessment of prognosis were compared.Results Presepsin and NEWS scores both were higher in the death group than the survival group.Presepsin and NEWS were the independent risk factors of the 30-day mortality of patients with sepsis.Under the ROC curve area (AUC) of presepsin and NEWS were 0.842 and 0.823;the combination of Presepsin and NEWS was 0.906.When presepsin ＞ 927.5 pg / mL and NEWS ＞ 6.5 points,it can significantly improve the efficacy of predicting prognosis.Conclusions Serum presepsin is a good indicator to judge the prognosis of patients with sepsis,and the combination with NEWS can improve the ability to predict the risk of septic death.

Purpose To explore whether potassium perchlorate shall be taken orally to occlude gastric mucosa before taking 99Tcm-3PRGD2 SPECT/CT gastric image,and to provide theoretical evidence for clinical application.Material and Methods Eighteen adult male Wistar rats were divided into three groups randomly:low dose group of potassium perchlorate (36 mg/kg),high dose group (72 mg/kg) and normal saline control group,with six rats in each group.All rats were conducted with gavage of 1 ml/100 g respectively and,one hour later,injected with 99Tcm-3PRGD2 intravenously to rat tail.Then 99Tcm-3PRGD2 gastric image was taken two hours later.The same film reader carried out audio analysis of the image and then gastric and radioactivity ratio (T/N) on the lung of the same side were analyzed.Results Preparation of 99Tcm-3PRGD2 was simple and radiochemical purity of final products was (98.90±0.70)％.Rat weights in high dose group of potassium perchlorate,low dose group and control group were (479.7t21.5) g,(481.0± 17.6) g and (478.5± 16.5) g,respectively.The differences were of no statistical significance (F=0.027,P＞0.05).T/N values in rat stomach area were 1.2219±0.0165,1.2204±0.0167 and 1.2186±0.0175,respectively.The differences were of no statistical significance (F=0.055,P＞0.05).Conclusion Preparation of 99Tcm-3PRGD2 is simple and radiochemical purity is high.There is great possibility of no need to take potassium perchlorate orally to occlude gastric mucosa when taking 99Tcm-3PRGD2 SPECT/CT image (especially when the radiochemical purity of final products is over 98％),making it convenient in clinical promotion and utilization.

Objective To evaluate the influence of SOCS3 conditional ablation in macrophage polarization and functional recovery after spinal cord injury in mice.Methods The Socs3fVfl Nes cre mice were used to obtain nervous-system-restricted SOCS3 deletion models as experimental group (n=40),and littermate Socs3fl as control group (n=40).Mice (n=35) in each group were underwent T10 spinal cord compressing injury (the left 5 were as sham-operated controls);on the third,7th and 14th d of injury,injured tissues from 15 mice of each group were harvested;immunofluorescence was performed to detect the changes of M2a and M2c phenotypic marker Arginase1 and M1 and M2b phenotypic marker CD86;on the first,third,7th and 14th d of injury,injured tissues from the left 20 mice from each group were harvested;fluorescent quantitative real time-PCR was used to detect the macrophage phenotypic markers (Arginasel,CD206,iNOS and CD32),SOCS3 and STAT3 gene expressions;the above data from the sham-operated controls were used as base data.BMS scale was used to evaluate the motor functions of posterior limbs and bodies on the first,third,7th and 14th d of injury.Results The behavioral assessments of the experimental group were superior on the third,7th and 14th d of injury as compared with those of control group (P＜0.05).Immunofluorescence showed that as compared with the controls,the Socs3fVfl Nes cre mice had a predominance in distribution and population of Arginasel-positive macrophages in spinal cords on the third,7th and 14th d of injury;in contrast,the control group showed superiority of CD86 expression on the 7th and 14th d,with significant differences (P＜0.05).Similarly,fluorescent quantitative real time-PCR analysis demonstrated that gene expression of A rginase I on the 7th d of injury,that of CD206 on the 7th and 14th d of injury,and that of STAT3 on the third,7th,and 14th d of injury were significantly increased,whereas that of CD32 on the 14th d of injury and SOCS3 on the first and third d of injury were significantly reduced in the experimental group,as compared with those in the control group (P＜0.05).Conclusion SOCS3 conditional knockout can promote the formation of M2 macrophage,as well as good functional recovery after spinal cord injury in mice.