Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective::To explore the risk factors and pregnancy outcomes in women with a history of cesarean section complicated by placenta accreta (PA).Methods::This case-control study included clinical data from singleton mothers with a history of cesarean section in 11 public tertiary hospitals in seven provinces of China between January 2017 and December 2017. According to the intraoperative findings after delivery, the study population was divided into PA and non-PA groups. We compared the pregnancy outcomes between the two groups, used multivariate logistic regression to analyze the risk factors for placental accreta.Results::For this study we included 11,074 pregnant women with a history of cesarean section; and of these, 869 cases were in the PA group and 10,205 cases were in the non-PA group. Compared with the non-PA group, the probability of postpartum hemorrhage (236/10,205, 2.31% vs. 283/869, 32.57%), severe postpartum hemorrhage (89/10,205, 0.87% vs. 186/869, 21.75%), diffuse intravascular coagulation (3/10,205, 0.03% vs. 4/869, 0.46%), puerperal infection (33/10,205, 0.32% vs. 12/869, 1.38%), intraoperative bladder injury (1/10,205, 0.01% vs. 16/869, 1.84%), hysterectomy (130/10,205, 1.27% vs. 59/869, 6.79%), and blood transfusion (328/10,205,3.21 % vs. 231/869,26.58%) was significantly increased in the PA group ( P < 0.05). At the same time, the neonatal birth weight (3250.00 (2950.00-3520.00) g vs. 2920.00 (2530.00-3250.00) g), the probability of neonatal comorbidities (245/10,205, 2.40% vs. 61/869, 7.02%), and the rate of neonatal intensive care unit admission (817/10,205, 8.01% vs. 210/869, 24.17%) also increased significantly ( P < 0.05). Weight (odds ratio ( OR)= 1.03, 95% confidence interval ( CI): 1.01-1.05)), parity ( OR= 1.18, 95% CI: 1.03-1.34), number of miscarriages ( OR= 1.31, 95% CI: 1.17-1.47), number of previous cesarean sections ( OR= 2.57, 95% CI: 2.02-3.26), history of premature rupture of membrane ( OR= 1.61, 95% CI: 1.32-1.96), previous cesarean-section transverse incisions ( OR= 1.38, 95% CI: 1.12-1.69), history of placenta previa ( OR= 2.44,95% CI: 1.50-3.96), and the combination of prenatal hemorrhage ( OR= 9.95,95% CI: 8.42-11.75) and placenta previa ( OR= 91.74, 95% CI: 74.11-113.56) were all independent risk factors for PA. Conclusion::There was an increased risk of adverse outcomes in pregnancies complicated by PA in women with a history of cesarean section, and this required close clinical attention. Weight before pregnancy, parity, number of miscarriages, number of previous cesarean sections, history of premature rupture of membranes, past transverse incisions in cesarean sections, a history of placenta previa, prenatal hemorrhage, and placenta previa were independent risk factors for pregnancies complicated with PA in women with a history of cesarean section. These independent risk factors showed a high value in predicting the risk for placentab accreta in pregnancies of women with a history of cesarean section.

Objective: To evaluate the value of Kirschner wire internal fixation in the treatment of sagittal mandibular condylar fractures. .Methods : From January 2019 to January 2020, 13 patients (19 sides) with mandibular condylar sagittal fracture treated by Kirschner wire internal fixation at the Stomatological Medical Center, Foshan Hospital of Traditional Chinese Medicine were retrospectively analyzed. After conventional surgical incision and exposure and reduction of the mandibular condyle, 2-4 Kirschner wires were used for fixation, and other maxillofacial fractures were treated simultaneously. The reduction accuracy and stability of the free mandibular condyle were evaluated by CBCT one week after the operation, and the occlusion relationship, opening degree and opening type were evaluated by clinical examination. Results: All patients had good fracture alignment and no twisting, breaking or loosening of the Kirschner wire. The occlusion relationship, opening degree and opening shape recovered well after the operation. Conclusion Kirschner wire is effective in treating sagittal fractures of mandibular condyles.

Objective : To explore the effect of negative pressure sealing drainage on the treatment of maxillofacial-neck-mediastinal infection in multiple spaces. Methods: Vacuum sealing drainage (VSD) was applied in five patients with maxillofacial-neck-mediastinal infection caused by odontogenic infection accompanied by diabetes or renal failure and other systemic diseases. After extensive debridement, a negative pressure drainage sponge was placed in the pus cavity and then the wound was closed. Continuous negative pressure drainage was continued after the operation. At the same time, multidisciplinary consultation was applied to control basic diseases and, strengthen anti-inflammatory responses, and nutrition and other systemic treatments were applied. Results: Four patients underwent continuous negative pressure drainage and successful removal of the negative pressure sponge after inflammatory symptoms subsided. One patient′s inflammatory symptoms became more serious after the operation, and we performed another operation to change the placement of the negative pressure sponge. All 5 patients underwent VSD with negative pressure sponge replacement ranging from 1 to 3 times during treatment. After multidisciplinary consultation, they were all cured and discharged from the hospital. Conclusion For infection of the mediastinum, maxillofacial region and neck, local treatment and systemic treatment are emphasized, as well as the treatment of infected lesions and basic diseases. Negative pressure closure and drainage technology promotes the alleviation of inflammation, and multidisciplinary combined treatment is beneficial for the control of basic diseases.

Objective The age and seasonal variation in children's serum 25-hydroxyvitamin D (25(OH) D] were analyzed retrospective and to provide some guides on clinical application.Methods The serum 25(OH) D level was detected by using enzyme-linked immunosorbent assay kit in 13 502 children that took health examination in Guangzhou Women and Children's Medical Center in February,march,September and October from 2009 to 2011.The cases were divided into five age groups.The average levels,deficiency and overdose of vitamin D (VD),were analyzed.Results The average 25(OH)D in serum was (80.81±42.39) nmol/L in 13 502 cases,(72.71 ± 33.47) nmol/L in Feb.and Mar.group,(89.91 ± 49.01) nmol/L in Sep.and Oct.group.There was statistically significant difference on serum 25 (OH)D level between seasons and between boys and girls for 6 years older groups.The serum 25 (OH) D levels significantly decreased with increasing age.There were statistically significant differences in serum 25 (OH) D levels and between the VD deficiency and the lack of number of cases in the 5 age groups of the two seasons.The number of VD deficiency was 482 cases (3.57％) whose 25 (OH) D ＜ 37.5 nmol/L,and 1850 cases (13.7％) whose 25 (OH) D ＜ 50.0 nmol/L.The VD deficiency in each age group was 8.19％,13.97％,37.72％,52.63％,57.92％ in Spring,and 2.38％,4.15％,10.36％,16.85％,27.47％ in Summer.The number of lack of VD was in 6 973 cases (51.64％);Excessive and poisoning of VD were 34 cases (0.25％) and 35 cases (0.26％).Conclusions Children had a relatively low level of VD in Guangzhou area,especially in the spring and school-age children with more severe VD deficiency.It is necessary to supplyVD timely in accordance with the age and season,and children were encouraged to spend more time outdoors.

Objective To develop a suitable forcep for reduction and internal fixation of sagittal fracture of mandibular condyle (SFMC) and evaluate its role in clinical practice.Methods Twenty patients with SFMC diagnosed by three-dimensional CT undergone open surgery were divided into experimental group and control group with 10 patients per group,according to the random number table.Patients in experimental group were reduced and fixed using the new reduction forcep,while in control group by the classical vascular clamp and nerve retractor.Operation time,three-dimensional CT before operation and 2 weeks after operation,and occlusion,maximum mouth opening (MMO),visual analogue scale (VAS),joint clicking as well as noise before operation and 1 and 6 months after operation were recorded.Results Operation time was obviously lower in experimental group than in control group [(0.90 ± O.11)hours vs (1.34 ±0.10)hours,t =-10.8,P ＜0.01].MMO in experimental group revealed significant improvements compared to control group at postoperative 1 month [(32.6 ± 1.6) mm vs (29.7 ±1.6)mm,t =-10.1,P＜0.01] and at postoperative 6 months [(34.3 ± 1.2)mm vs (33.3 ± 1.1)mm,t =3.4,P ＜0.01].VAS between experimental group and control group also differed significantly at postoperative 1 month [(3.6 ± 0.7) mm vs (5.1 ± 0.7) mm,t =-12.5,P ＜ 0.01] and at 6 months [(3.5±0.9) points vs (4.8±0.6) points,t=-3.3,P＜0.01].Conclusion The new reduction forcep can shorten operative time and improve mouth opening and pai for SFMC.

Objective To analyze the separation and displacement of bone fragments in sagittal fracture of the mandibular condyle (SFMC),understand the motion type and guide clinical treatment and development of related surgical instruments.Methods Forty-five patients (52 sides) with SFMC treated between October 2008 and October 2012 were enrolled; 32 patients (36 sides) were males and 13 patients (16 sides) were females.According to the Neff classification,there were 20 sides with type A,28 sides type B and 4 sides type M.All the patients underwent CT scan and were classified based on measurements of distance and angle of displaced bone fragments.Results Patients were categorized into type Ⅰ on 20 sides (type Ⅰ A on 14 sides and type Ⅰ B on 6 sides),type Ⅱ on 27 sides (type Ⅱ A on 11 sides and type ⅡB on 16 sides),type ⅢB in 1 side and type Ⅳ in4 sides.Mean displacement of bone fragments was 12 mm (range,4-16 mm) ; mean deviation angle was 34°(range,11°-43°) ; mean descending distance was 13 mm (range,6-18 mm).Conclusion CT analysis results show that,mast bone fragments in SFMC move slightly.

AIM:To establish a microthrombus model by carrageenan (Ca)/ lipopolysaccharides (LPS) intraperitoneal injection in rats with hyperhomocysteinemia (HHcy) and endothelial dysfunction induced by L-methionine intake. METHODS: ① Male Sprague Dawley rats were randomly divided into 2 groups: control and endothelial dysfunction (HHcy) groups. L-methionine was administered by gavage in HHcy group for total 4 weeks. Purified water was administered by gavage in control rats. Plasma Hcy, NO and vWF were examined and the thoracic aorta were excised after 4 weeks of L-methionine treatment to evaluate endothelial function. ② Male Sprague Dawley rats were randomly divided into 3 groups to establish a microthrombus formation model with Ca/ LPS: control, microthrombus formation (Ca/LPS) and endothelial dysfunction plus mitoarothrombus formation (HHcy+Ca/LPS) groups. Control rats were injected with normal saline (NS). Ca/LPS rats were intraperitoneally injected with carrageenan (Ca) and followed by lipopolysaccharides (LPS) 16 h later. HHcy+Ca/LPS rats were intragastric gavaged by L-methionine for total 4 weeks, and then were injected with Ca/LPS in the same way as Ca/LPS group. Cruor parameters and platelet count were detected at 20 h after LPS or NS injection and the mesentery microcirculation was monitored. Plasma NO and vWF were also detected at 24 h after LPS or NS injection. RESULTS: ① Plasma Hcy concentrations and vWF level were significantly increased in HHcy group, while plasma NO content was significantly decreased compared with that in control group. Endothelial dependent relaxation (EDR) of aortic rings was significantly decreased in HHcy group, suggesting endothelial damage/dysfunction was induced by HHcy. ② Mesentery capillary was obviously blocked by microthrombus in Ca/LPS rats and was blocked more seriously in HHcy+Ca/LPS rats. Cruor parameter results suggested that Ca/LPS rats were in hypercoagulable phase and HHcy+Ca/LPS rats were in hypocoagulable phase at 20 h after LPS injection. Platelet count and plasma NO content in HHcy+Ca/LPS group were significantly decreased, while plasma vWF level was significantly increased compared with Ca/LPS group. CONCLUSION: L-methionine intake induces severe HHcy and causes endothelial dysfunction in rats. Microcirculation dysfunction and microthrombosis can be caused by Ca/LPS intraperitoneal injection and may be aggravated by endothelial dysfunction.