Objective To analyze the reasons of cesarean section in primiparae without operation indications ,in order to provide foundation for reducing the rate of cesarean section .Methods 640 cases of primipara were randomly divided into cesarean section with no operation indications(observation group) and spontaneous labor group(control group) ,320 cases in each each .The general data was investigated and analyzed ,the scale of cesarean section causes ,scale of cesarean section and pregnancy knowledge were compared between the two groups .Results The average age of the observation group was significant higher than that of the control group ,the percentage of monthly income of over 2 000 yuan and the proportion of level of education for college or above was signifi-cant higher than that of the observation group(P<0 .05) .In terms of pain tolerance ,no confidence in the natural delivery ,timing production ,family members will ,elderly parturient women ,the observation group were significant higher than the control group (P<0 .05) .The pregnancy knowledge level of observation group was significant lower than the control group (P<0 .05) .Multi-fac-tor analysis showed that ,high education level ,no tolerence of pain ,no confidence in the natural delivery ,timing production ,elderly parturient women ,and low degree of knowledge during pregnancy were major cause of of cesarean section rate .Conclusion The ap-propriate analgesia and encourage should be adopted for pregnant women who can′t stand the pain ,without confidence in the natural delivery .Education should be strengthen for pregnant women who timing production ,elderly parturient women ,low degree of knowledge .

Objective To study the clinical and pathological manifestations of microsporidian encephalitis.Methods The clinical findings and the brain pathological features of a patient with microsporidian encephalitis hospitalized in 2004 were studied.Results The onset was subacute or chronic. The body temperature was usually normal or below 37.5℃,but it rose when patient's condition deteriorated and coma appeaxed.The patient had hypoimmunity but without human immunodeficiency virus infection. Multifocal lesions in the whole brain,signs of meningeal irritation and infective myelogram were observed. Rheumatoid factor increased in the early stage and indirect bilirubin,proteins in cerebrospinal fluid(CSF), and immunoglobulin IgG,IgA increased in the middle stage.Cytological examination of CSF showed lymphocyte reaction.Blood routine test showed normal eosinophil granulocyte count.The patient was found to have pleurisy,peritonitis and cystitis.Brain magnetic resonance image(MRI)manifested plaque-like isometric T1 weight image and long T2 weight image signal in white matter of bilateral cerebral hemisphere and cerebella where FLAIR sequence showed hyperintensity.No apparent mass was identified.Contrast- enhanced MRI scan showed patchy and ring-like intensification.The neural system impairments were permanent and not improved after treatment.The pathology of brain tissue showed neuronal degeneration, karyopycnosis and Derivasculitis.The infectious agents were observed in the cytoplasm of neurons.Wister rats had muhiple organ inflammatory reaction 2 weeks after intraperitoneal inoculation of the patient's CSF and a large quantity of pathogens were found in the peritoneal lavage fluid.Conclusions The patient was PAS staining method is useful for detecting the pathogen in neurons and the rate can be raised by animal intraperitoneal cultivation

Objective To investigate radioactive nuclide ²¹⁰Po content in the diet of residents and internal irradiation dose caused by them. Methods The major food distribution market is selected, more than 50 kinds of food samples such as meat, vegetables, fruits, aquatic products, cereals, milk are collected, the combined method ofwet ashingand metal deposition is used to measure ²¹⁰Po content of food samples, and analysis of monitoring data and estimationof irradiationexposure dose of residents caused by ²¹⁰Po and their relative contribution are made. Results In the food samples, the specific activity of ²¹⁰Po was 8.34 mBq/kg· fresh～16.9 Bq/kg· fresh, and the content of ²¹⁰Po in hairtail was higher, its value was16.9 Bq/kg· fresh, which was higher than other freshwater fish. According to the data, the annual intake of residents was 108 Bq/person, and the annual effective dose of adult caused by ²¹⁰Po was 129 μSv/a.The relatively large contribution were from flour (15.2%), eggs (22.0%), aquatic products (17.1%) and vegetable oil (18.1%). Conclusion The annual intake of ²¹⁰Po for residents is lower than the current limit for adults of which the value is 2 200 Bq.

Objective To investigate the distribution of gross α and gross β levels of centralized drinking-water of township in Beijing from 2018 to 2019, so as to carry out better monitoring and evaluating the radioactivity in water. Methods A total of 215 underground drinking water samples were collected from 12 districts of Beijing, then monitored and evaluated according to the Determination of gross alpha activity in water-thick source method EJ/T 1075—1998 and Determination of gross beta activity in water-evaporation method EJ/T 900—1994. Results The gross α level of centralized drinking water of township in Beijing was 0.050 (0.052) Bq/L, ranging from 0.001 to 0.210 Bq/L, and the gross β level was 0.048 (0.038) Bq/L, ranging from 0.002 to 0.261 Bq/L from 2018 to 2019. Gross α and gross β levels of all samples did not exceed the guidance value recommended by standards for drinking water quality. There was no significant difference in the distribution of gross α and gross β levels of samples of all districts from 2018 to 2019(P > 0.05), there were significant differences in the distribution of gross α and gross β levels of samples from different district in the same period (P < 0.05). And the levels of Miyun, Huairou and Shunyi in Chaobai River system were higher than other districts. Conclusion The distribution of radioactive background of centralized drinking-water of township in Beijing was mastered, which was in the normal range.

Objective:To explore the effects of adenoid hypertrophy on the growth and development of cranio-maxillofacial hard tis-sues in children at different growth stages.Methods:The cephalic lateral images of 232 children aged 4 to 16 years were measured and analyzed by Bjork-Jarabak cephalometric analysis.The patients were divided into 3 groups:CVM 1-2(A),CVM 3-4(B)and CVM 5-6(C)according to cervical vertebral maturation(CVM).Adenoid hypertrophy group and normal group were set up by Adenoi-dal-Nasopharyngeal Ratio(A/N Ratio)of 0.61.A,B and C groups included 28,55 and 23 cases in the subjects with adenoid hyper-trophy,and 12,65 and 49 cases in those of normal controls respectively.T-test was used to explore the difference of growth and devel-opment measurements among different subgroups of the same CVM stage and the change trend of the difference in different CVM sta-ges.Results:Hypertrophic adenoid children's S-Ar,N-Me and S-Ar/Ar-Go were significantly larger in CVM 1-2 subjects(P＜0.05);Ar-Go-Me,N-S-Ar and Ar-Go-N were significantly larger in CVM 5-6 subjects(P＜0.05),while S-Ar-Go decreased significantly(P＜0.05);S-N,Go-Me,S-Go,S-N/Go-Me and Ar-Go/N-Me had no significant differences in the whole stages(P＜0.05).Conclu-sion:Adenoid hypertrophy has great effect on the cranio-maxillofacial growth trend.It induces more posterior position of condyle,tilt-ing back of mandibular ramus,vertical growth and clockwise rotation of the mandible and incline to form class Ⅱ malocclusion.The effects are more prominant in early and late growth and development stages of the children.

Antipyretic-analgesics are currently one of the most prescribed drugs in children.The clinical application of antipyretic-analgesics for children in our country still have irrational phenomenon, which affects the therapeutic effect and even poses hidden dangers to the safety of children.In this paper, suggestions were put forward from the indications, dosage form/route, dosage suitability, pathophysiological characteristics of children with individual differences and drug interactions in the symptomatic treatment of febrile children, so as to provide reference for the general pharmacists when conducting prescription review.

Objegtive:To investigate the efficacy and safety of preemptive/salvage therapy with venetoclax (VEN) in patients with recurrence after allogeneic hematopoietic stem cell transplantation (allo-HSCT) .Methods:Retrospective analysis the clinical data of 25 patients with minimal residual disease (MRD) positive or morphological recurrence after allo-HSCT treated with VEN in the hematological Hospital of Chinese Academy of Medical Sciences from 2021.2 to 2021.11, there were 15 MRD positive patients (preemptive treatment group) and 10 morphological recurrence patients (salvage treatment group) . The dose of VEN in both groups was 400 mg/d, which was reduced to 100 mg/d when combined with azole antifungal drugs.Results:①In the preemptive group, there were 7 males and 8 females, with a median age of 32 (18-52) years; There were 13 cases of acute myeloid leukemia (AML) , 1 case of acute lymphoblastic leukemia (ALL) and 1 case of primary myelofibrosis (PMF) ; the median time from MRD positive to the application of VEN was 2.5 (0-12.5) months. The median course of treatment was 2 (1-4) . On the 7th day of the first course of treatment, the median concentration of VEN was 1945 (688-5383) μg/L. After one course of VEN treatment, MRD in 8 patients turned negative (major responses) , MRD in 4 patients decreased by 50% compared with that before treatment, 3 cases were ineffective, and the overall response rate (ORR) was 80% (12/15) . On the 7th day of treatment, 3 of the 9 patients with VEN blood concentration <1 000 μg/L or >3 000 μg/L turned negative for MRD (33.3%) , and 5 of the 6 patients with VEN blood concentration between 1000 and 3000 μg/L turned negative for MRD (83.3%) . Grade 3/4 neutropenia occurred in 5 patients (33%) and grade 3/4 thrombocytopenia occurred in 5 patients (33%) , there were no new cases of severe infection and death. ②In the salvage group, there were 7 males and 3 females, with a median age of 44 (28-59) years; there were 6 cases of AML, 2 cases of ALL, 1 case of atypical chronic myeloid leukemia (aCML) , 1 case of refractory hemopenia with multiline dysplasia (MDS-RCMD) ; the median time from relapse to application of VEN was 0 (0-1) months. The median treatment was 1 (1-2) course. The median concentration of VEN on the 7th day of the first course of treatment was 2 419 (1 200-6 155) μg/L. After one course of VEN treatment, 3 cases achieved complete remission (CR) (major responses) and 3 cases achieved partial remission (PR) , 4 cases were ineffective and the ORR was 60% (6/10) . On the 7th day of treatment, 1 of the 4 patients with VEN blood concentration >3 000 μg/L achieved CR (25%) , and 2 of the 6 patients with VEN blood concentration between 1 000 and 3 000 μg/L achieved CR (33.3%) . Grade 3/4 neutropenia and grade 3/4 thrombocytopenia occurred in 10 patients (100%) . One patient died of severe pulmonary infection. ③The median follow-up was 4.5 (1-8.5) months. The overall survival rate (OS) of the preemptive group and the salvage group were (70.2±12.7) % and (50.0± 15.8) %, respectively ( χ2=1.873, P=0.171) . The OS of patients with and without primary response to one course of VEN were (90.9±8.7) % and (36.2±14.7) % respectively ( χ2=6.843, P=0.009) . Three patients with TP53 mutation achieved the major responses after VEN treatment. Conclusion:Preemptive/salvage therapy with VEN after allo-HSCT in patients with hematological malignancies is effective and well tolerated, monitoring the concentration of VEN is expected to improve the curative effect. The prognosis of patients who fail to reach the major responses after one course of preemptive/salvage treatment with VEN is poor, so they need to switch to other treatment schemes as soon as possible.