Objective:To analyze the changes of preterm birth rate and proportion of multipara in 10 years, and to explore the possibility of multipara as a risk factor for preterm birth.Methods:This study was a cohort study. The general clinical data and pregnancy outcomes of 53 979 parturients delivered in Peking University First Hospital from January 2013 to December 2022 were collected, and the changes of preterm birth rate and proportion of multipara in the past 10 years were analyzed retrospectively. Single factor and multivariate logistic regression analysis were used to explore the risk factors of spontaneous preterm birth and the influence of multipara on pregnancy outcome.Results:(1) The total preterm birth rate of 53 979 parturients was 8.3%(4 478/53 979), and the overall preterm birth rate showed an upward trend in the past 10 years, among which the preterm birth rate was higher in 2017 and 2018, which were 8.9% and 9.2% respectively. The proportion of multipara was 24.9% (13 440/53 979), which showed a trend of rising first, then declining and then stabilizing. In 2017 and 2018, the proportion of multipara was the highest, accounting for 35.0%. (2) Multivariate logistic regression analysis showed that multipara was a risk factor for spontaneous preterm birth before 37 weeks of pregnancy ( OR=1.678, 95% CI: 1.523-1.850; P<0.001), which was also a risk factor for spontaneous preterm birth before 34 weeks of pregnancy ( OR=1.937, 95% CI: 1.632-2.301; P<0.001). The high risk factors of spontaneous preterm birth also include multiple pregnancies, hyperglycemia during pregnancy, abnormal amniotic fluid volume, premature rupture of membranes, intrauterine infection, cervical incompetence, history of cervical surgery and abnormal uterine development. (3) Compared with primiparas, multiparas was older, had earlier delivery weeks, higher premature delivery rate, higher birth weight and fewer multiple pregnancies. Among pregnancy complications, the incidence of gestational diabetes mellitus, placenta previa, placenta implantation, urgent delivery and macrosomia was higher, while the incidence of pregnancy-induced hypertension, pre-eclampsia, intrahepatic cholestasis of pregnancy, oligohydramnios, fetal growth restriction, premature rupture of membranes, intrauterine infection and postpartum hemorrhage was lower, and the differences were statistically significant ( P<0.05). Conclusions:In recent 10 years, the overall rate of preterm birth is on the rise, and the risk factors of preterm birth are basically similar to those in previous studies. Multipara is a high-risk group of spontaneous preterm birth, and the risk of various pregnancy complications increases, which should be paid attention to in pregnancy care.

Objective: To analyze the clinical characteristics and imaging features of occupational pulmonary thesaurosis induced by dust of iron and its compounds (OPTIDIC). Methods: A total of 230 cases of occupational welder's pneumoconiosis (OWP) patients or observation subjects were selected as the research subjects using the retrospective analysis method. They were diagnosed in four occupational disease diagnosis institutions in Shandong Province from 2010 to 2017. The high kV X-ray chest radiography or chest digital radiograph (hereinafter referred to as X-ray) were re-read to screen OPTIDIC patients. The clinical data of OPTIDIC patients were collected and analyzed. Results: Among the 230 cases, 56 cases were diagnosed as OPTIDIC, accounting for 24.3%. The clinical symptoms of the 56 patients with OPTIDIC were cough, sputum, chest tightness, shortness of breath, and difficulty breathing, while their physical signs were low or coarse breath sounds in lungs and others. Most of the X-ray results showed p shadows or q shadows, accounted for 98.2%, of which p/p shadow and q/q shadow accounted for 62.5%. The result of chest computed tomography (CT) showed diffuse point/round shadow and diffuse glass shadow in OPTIDIC patients. The result of fibro-bronchoscopy showed that a large amount of iron lutein particles was accumulated in macrophages and biopsy of lung showed idiopathic pulmonary hemosiderosis in OPTIDIC patients. Conclusion: The clinical characteristics of OPTIDIC patients showed no different from OWP. However, the result of X-ray of OPTIDIC patients mainly showed small circular shadows, and their CT images mainly showed diffuse point/round shadows or grinding glass shadow, which could be used to the differential diagnosis of OPTIDIC and OWP.

Objective:To evaluate the clinical efficacy of the Chinese herbal medicine compound Kangliu Pill combined with conventional Western medicine therapy in the treatment of patients with malignant glioma after surgery.Methods:A total of 100 patients with malignant glioma (grade Ⅲ-Ⅳ), who met the inclusion criteria and underwent surgery from January 2017 to November 2019, were divided into the treatment group of 48 patients and the control group of 52, according to the treatment method. The control group was treated with conventional surgery plus radiotherapy, and the treatment group was treated with Kangliu Pill on the basis of the control group. The patients were followed up for 1 to 2 years, and the survival rate, progression-free survival and median survival were recorded. The Karnofsky functional status score (KPS) and quality of life score (QOL) were used to evaluate the patients' survival and quality of life, and the adverse reactions during the treatment period were observed.Results:After treatment, the 1-year survival rates [97.92% (47/48) vs. 80.77% (42/52); χ2=5.847, P=0.016] and 2-year survival rates [89.47% (33/48) vs. 42.31% (22/52); χ2=7.051, P=0.008] in the treatment group were significantly higher than those in the control group. After treatment, the progression-free survival [(23.94±13.12) months vs. (15.82±8.65) months; t=3.63, P<0.01] in the treatment group was significantly higher than that of the control group. After treatment, the survival analysis using the life table method yielded a median survival of 21.13 months in the treatment group and 12.00 months in the control group, with statistically significant differences in median survival and cumulative survival rates between two groups ( P=0.001). The KPS and QOL scores in the treatment group were higher than those in the control group, but the differences between the groups were not statistically significant ( P>0.05). There was no serious adverse events occurred during the treatment period in both groups. Conclusion:Adjuvant therapy with Kangliu Pill can improve survival rate, prolong progression-free survival, median survival, improve quality of life, and enhance the efficacy of patients with malignant glioma after surgery.

Objective: To explore the clinical effect of bulk-fill composite resin combined with transparent preformed crowns for aesthetic restoration of deciduous incisor of children. Methods: A predesigned clinical prospective randomized controlled research method was used to select 90 patients (123 teeth). The random number table method was divided into three groups: A, B, and C. Group A was treated with a bulk-fill composite resin of SF (SonicFill) combined with a transparent preformed crown (41 teeth in 30 cases), and group B was treated with a large block of Tetric N-Ceram Bulk Fill Composite resin combined with transparent preformed crowns (39 teeth in 29 cases). Group C was treated with 3M Z350 XT universal nano resin combined with transparent preformed crowns (43 teeth in 31 cases). The visual analog scale (VAS) and the modified USPHS standard were used to evaluate the completeness, marginal steps, marginal discoloration, surface condition, secondary caries and satisfaction of the parents with prostheses after 12 months. Results : Twelve months after the operation, the evaluation indexes of group A were better than those of group B and group C, and the differences were statistically significant, including edge integrity (χ2=10.847, P=0.028), edge step (χ2=7.799, P=0.020), edge discoloration (χ2=10.391, P=0.034), surface state (χ2=11.476, P=0.021), and secondary caries (χ2=10.447, P=0.034). The satisfaction of parents in group A on the overall contour (χ2=10.238, P=0.037), shape and texture (χ2=11.521, P=0.021) were better than those in group B and group C, and the differences were statistically significant. There was no significant difference in the evaluation of color satisfaction among the three groups (χ2=0.990, P=0.610). Conclusion SonicFill bulk-fill composite resin combined with transparent preformed crown is good for short-term aesthetic restoration of deciduous incisor, and parental satisfaction is high.

OBJECTIVE：To est ablish the working mode of the first pharmaceutical ward rounds of clinical pharmacists in our hospital，in order to provide a useful reference for establishing a national standardized pharmaceutical ward rounds model. METHODS：By sharing the clinical cases of the first pharmaceutical ward rounds ，the work content and process of the first pharmaceutical ward rounds in our hospital were introduced. RESULTS & CONCLUSIONS ：The clinical pharmacist ’s first pharmaceutical ward round in our hospital mainly includes self introduction of clinical pharmacists ，diagnosis of patients ’condition under the guidance of doctors ，collection and evaluation of patients ’previous medication information （including previous medication varieties ，usage methods ，efficacy and safety evaluation ），assistance for doctors in formulating initial treatment plan ， carrying out initial medication and diet education ，and intensive communication and cooperation with nurses. The development of first pharmaceutical ward rounds promotes the rational use of drugs in clinic ，elevates the hospitalization satisfaction of patients and improves the professional quality of clinical pharmacists.

Objective:To quantitatively assess the degree of bone resorption following cranial bone remodeling for children and adolescent congenital cranial deformity cases in Crouzon syndrome.Methods:A total of 14 congenital cranial deformity patients (mean age 7.7 years) who underwent cranial bone remodeling between Mar. 2014 and Dec. 2018 were selected from Shanghai Ninth People’s Hospital, and retrospectively reviewed. They were treated with modified monobloc osteotomy and distraction osteogenesis. Craniectomy and cranial bone remodeling were performed, and the follow-up period was one week(t1) and one year(t2). The patients were scanned by spiral CT at the two following time points. Then data were imported into Mimics to acquire the three-dimensional model of skull. Bone volume was measured with Mimics Research 18.0 after three-dimensional CT reconstruction. The resorption rate was calculated as (V t1-V t2)/V t1×100%(V t1 represented bone volume before distraction osteogenesis, V t2 represented bone volume after distraction osteogenesis), followed by statistical analysis. Results:Among the 14 patients, bone resorption occurred in 11 patients and the resorption rate after 1 year was 3.482%. There was no significant difference between bone volumes at 1 week and 1 year after surgery( t=0.851, P=0.410). Conclusions:Bone resorption following cranial bone remodeling for children and adolescents with congenital cranial deformity did exist, however, it was acceptable. Therefore, the surgical treatment of cranial remodeling and distraction osteogenesis is advisable for children and youth with congenital cranial deformities over 1 year old.

Objective:To quantitatively assess the degree of bone resorption following cranial bone remodeling for children and adolescent congenital cranial deformity cases in Crouzon syndrome.Methods:A total of 14 congenital cranial deformity patients (mean age 7.7 years) who underwent cranial bone remodeling between Mar. 2014 and Dec. 2018 were selected from Shanghai Ninth People’s Hospital, and retrospectively reviewed. They were treated with modified monobloc osteotomy and distraction osteogenesis. Craniectomy and cranial bone remodeling were performed, and the follow-up period was one week(t1) and one year(t2). The patients were scanned by spiral CT at the two following time points. Then data were imported into Mimics to acquire the three-dimensional model of skull. Bone volume was measured with Mimics Research 18.0 after three-dimensional CT reconstruction. The resorption rate was calculated as (V t1-V t2)/V t1×100%(V t1 represented bone volume before distraction osteogenesis, V t2 represented bone volume after distraction osteogenesis), followed by statistical analysis. Results:Among the 14 patients, bone resorption occurred in 11 patients and the resorption rate after 1 year was 3.482%. There was no significant difference between bone volumes at 1 week and 1 year after surgery( t=0.851, P=0.410). Conclusions:Bone resorption following cranial bone remodeling for children and adolescents with congenital cranial deformity did exist, however, it was acceptable. Therefore, the surgical treatment of cranial remodeling and distraction osteogenesis is advisable for children and youth with congenital cranial deformities over 1 year old.

Objective:To retrospect the treatment and clinical effect of craniometaphyseal dysplasia(CMD), and summarize the experience of cranial reconstruction and nasal deformity correction in the management of this case.Methods:From June 2004 to June 2018, three male CMD patients of Shanghai Ninth People’s Hospital who received treatment. One patient was 1 year-old child who received drug therapy. A 5 year-old boy was treated with nasal cavity expansion and orbital hypertelorism for plastic and reconstructive surgery. The 7 year-old patient received cranial reconstruction and nasal deformity correction. Moreover, surgical treatments from 1967 to 2017 in the literatures on CMD were reviewed.Results:Indicators (Ca, ATP, PTH) in the laboratory of the first child returned to normal after medication treatment, and there was no obvious abnormality in the following 2 months. Nasal cavity of the second case was enlarged and function of the nose was improved, and interorbital distance was reduced by 16-17 mm. However, cranial facial deformation was not ameliorated obviously. For the third patient, scaphocephaly deformity was significantly improved. Skull thickness decreased from 3cm to 1-2 cm, the anteroposterior diameter of the skull was shortened up to 6 cm. The immediate review of dd dimer was 4.25 mg/L, FDP was 20.6 μg/ml, which was significantly higher than preoperative tests (dd dimer 0.98 mg/L, FDP 7.24 μg/ml). Two weeks after surgery, the patient received skull debridement due to ineffective anti-infective treatment. Ten months later, the child was admitted to the hospital because of infection. CT scan showed bone resorption, and we treated him with skull debridement and cranioplasty. Following 16 months, the patient was in a stable condition without complications until now.Conclusions:Drug therapy has a potential role in CMD treatment. However, surgery is the only effective management of it, although there will be a high risk and many complications, and the patients need repeated operations.

Objective:To retrospect the treatment and clinical effect of craniometaphyseal dysplasia(CMD), and summarize the experience of cranial reconstruction and nasal deformity correction in the management of this case.Methods:From June 2004 to June 2018, three male CMD patients of Shanghai Ninth People’s Hospital who received treatment. One patient was 1 year-old child who received drug therapy. A 5 year-old boy was treated with nasal cavity expansion and orbital hypertelorism for plastic and reconstructive surgery. The 7 year-old patient received cranial reconstruction and nasal deformity correction. Moreover, surgical treatments from 1967 to 2017 in the literatures on CMD were reviewed.Results:Indicators (Ca, ATP, PTH) in the laboratory of the first child returned to normal after medication treatment, and there was no obvious abnormality in the following 2 months. Nasal cavity of the second case was enlarged and function of the nose was improved, and interorbital distance was reduced by 16-17 mm. However, cranial facial deformation was not ameliorated obviously. For the third patient, scaphocephaly deformity was significantly improved. Skull thickness decreased from 3cm to 1-2 cm, the anteroposterior diameter of the skull was shortened up to 6 cm. The immediate review of dd dimer was 4.25 mg/L, FDP was 20.6 μg/ml, which was significantly higher than preoperative tests (dd dimer 0.98 mg/L, FDP 7.24 μg/ml). Two weeks after surgery, the patient received skull debridement due to ineffective anti-infective treatment. Ten months later, the child was admitted to the hospital because of infection. CT scan showed bone resorption, and we treated him with skull debridement and cranioplasty. Following 16 months, the patient was in a stable condition without complications until now.Conclusions:Drug therapy has a potential role in CMD treatment. However, surgery is the only effective management of it, although there will be a high risk and many complications, and the patients need repeated operations.

Objective: To observe the influence of lower wide pedicle frontal periosteum flap on frontal bone absorption rate after cranioplasty. Methods: From February 2016 to July 2017, the lower wide pedicle frontal periosteum flap was produced in 12 patients of Shanghai Ninth People′s Hospital (7 males/5 females, aged 5-9 years, 10 hypertelorism, 2 Crouzon syndrome), who accepted intro-cranio-route plastic surgery, to cover the frontal bone window. A spiral CT scans were applied one week (t1) and one year (t2) after surgery. DICOM data was imported into Mimics software to reconstruct the 3D model of skull. The bone window covered the frontal bone was selected and the bone volume was calculated. The absorption rate was calculated as (Vt₁-Vt₂)/Vt₁×100%. As a control group, the CT data of 20 patients (from January 2010 to December 2015, 11 males/9 females, 7 hypertelorism, 12 Crouzon syndrome, 1 Pfeiffer syndrome) were analyzed retrospectively in the same way, and compared to the experimental group. Results: The average bone absorption rate in experimental group was 8.65%±2.56% (n=12), while in control group it was 26.51%±5.23% (n=20). Significant statistical difference was observed. No further cranial defect was observed in one-year follow-up in both two groups. Conclusions The lower wide pedicle frontal periosteum flap reduces the bone absorption rate after intro-cranio-route plastic surgery. It could also help to repair the anterior cranial base defect during the surgery. This technique was recommend as a regular step in craniofacial surgeries.