Objective To investigate the clinical value of thinprep cytology test(TCT) combined with colposcopy in diagnosis of cervical lesion. Methods Retrospective analysis was conducted in 174 females with abnormal cervical smear. All the patients underwent colposcopy to screen the cervical lesions. According to the pathological results,the clinical value of TCT and colposcopy was analyzed and compared. Results In the 174 cases with abnormal cervical smear,the positive rate of atypical squamous cells(ASC) was 27. 0% (47/174). There were 92 low grade squamous intraepithelial lesion (LSIL) (52. 9%) ,33 high grade squamous intraepithelial lesion (HSIL) (19. 0%) and 2 squamous cell cancinoma (SCC) (1. 1%) . According to the diagnosis by biopsy and pathology,the positive rate of benign cervical cell(BCC) was 16. 1% (28/174) .cervical intraepithelial neoplnsia (CIN) I 42. 0% (73/174), CIN II 18.4% (32/174), CIN ffl 21. 8% (38/174) and SCC 1. 7% (3/174) . The coincidence rate of TCT and pathology was 83. 9% (146/174). Conclusions TCT and colposcopy are a practical approach for detecting cervical lesion. TCT combined with colposcopy is the optimal screening approach for cervical lesion, which can enhance the sensitivity and specificity of the diagnosis of cervical lesions.

BACKGROUND:Studies on the tip position of the conus medullaris in a population have been limited to autopsy and long ago. Therefore, it is necessary to dynamically study the position of conus medullaris (CM) in the Chinese population by magnetic resonance imaging (MRI).OBJECTIVE: To observe the variation in position of the CM in a living population without spinal deformity through MRI. DESIGN: A controlled observation.SETTING: Qingdao Municipal Hospital.PARTICIPANTS: Totally 1199 patients who complained of low back pain and underwent MRI examination in the Department of Radiology of Qingdao Municipal Hospital between October 1993 and December 2006 were recruited in this study. The involved patients, including 765 males and 434 females, were averaged (46±14)years ranging from 5 to 85 years old. Among them, 276 patients suffered from metastatic tumor on spinal vertebrae or trauma of spinal column. Patients with scoliosis or congenital diseases of spinal cord and spinal column were rejected. Another 30 volunteers were recruited via advertisement checked up in the Department of Radiology of Qingdao Municipal Hospital.All the volunteers, including 15 males and 15 females, were averaged (32±8)years, ranging from 19 to 52 years.Written informed consents of detected items were obtained from all the subjects.METHODS: Totally 1199 patients underwent lumbar vertebra MRI scanning by a GE Signa 1.5T supraconduction MRI machine. The tip position of the conus medullaris was observed by spin echo T1 weighted and median sagittal imaging.The MRI machine was located according to its corresponding relationship with vertebral body and intervertebral disc. All the volunteers were given the dynamic research conceming the tip of CM in middle, hyperflexion and hyperextension position.MAIN OUTCOME MEASURES: Dynamic observation of the location of tip of CM in the healthy volunteers and the patients who complained of low back pain.RESULTS: The above 1199 patients who complained of low back pain and 30 healthy volunteers participated in the final analysis. ①The mean conus position of the patients who complained of low back pain was the lower third of L1 (range: middle third of T12 to upper third of L3). The variation in conus positions followed a normal distribution. The conus position in female patients was significantly lower than that of male counterparts (t =18.127,P ＜ 0.01). No significant difference in conus position was seen with increasing age (F =0.530, P ＞ 0.05). ②The tip of the CM did not change in relation to the posterior edge of vertebrae when the spine was in hyperflexion or hyperextension position.However, it got close slightly to the posterior edge of vertebrae when in hyperflexion, and got away slightly from it when in hyperextension.CONCLUSION: The location of tip of CM of our group of population ranges from the middle third of T12 to the upper third of L3, and female population have a much lower conus position than that of male ones.

Objective To evaluate cause,treatment and prevention of esophageal fistula caused by anterior cervical spine surgery.Methods Between January 2004 and December 2011,2348 patients underwent anterior cervical spine surgery.Among them,5 patients suffered from esophageal fistula owing to operation,including 3 males and 2 females,with an average age of 34 years (range,14 to 48 years).The diagnosis of these patients included 3 cases of cervi(c)al injury,1 case of cervical spondylosis and 1 case of cervical tuberculosis.There was 1 patient whose esophageal injury was founded during the surgery,and that was directly repaired.For another 4 patients,esophageal fistulas were founded after operation; one case underwent debridement and orificium fistulae repair; one case only underwent debridement; one case underwent debridement and second-stage removal of hardware; and one case underwent debridement and second-stage removal of hardware and esophageal repair with sternocleidomastoid flap.Postoperative treatment included esophageal rest,enteral nutrition,wound drainage,and antibiotic administration.Methylene blue was used to evaluate status of orificium fistulae.Results All patients with esophageal fistula were cured 9 to 61 weeks after treatment,and oral intake was achieved.They were followed up for 6-48 months.There was no recurrence of esophageal fistula,cervical instability and infectious spondylitis in any ease.All patients were satisfied with swallowing function and outcome of cervical spine diseases.The Frankel grade was improved averagely one grade in patients with cervical injury,and the JOA score was improved from preoperative 9 points to postoperative 15 points in patients with cervical spondylosis.Conclusion Successful management of esophageal fistula caused by anterior cervical spinal surgery depends on primary closure of the perforation with or without muscle flaps,surgical drainage,esophageal rest and nutrition support,and removal of hardware if necessary.Prevention consists of the careful operation and gentle tissue handling.

Objective This paper aims to find a best position of ephedrine hydrochloride nasal drops by comparing earache occurred in hyperbaric oxygen(HBO )therapy while using ephedrine hydrochloride nasal drops in two positions: laying in lateral position of 45°with head leaning back; laying down flat, so as to supply reference for prevention of earache. Methods We selected 300 cases of HBO patients who were firstly treated by HBO and randomly divided into the observation group and the control group with 150 cases in each group. All these patients were treated by large medical hyperbaric oxygen tank. On the first to third day, ephedrine hydrochloride nasal drops were put into the patients before they were sent into the oxygen tank. Patients in the observation group lay in lateral position of 45°with their head leaning back, and those in the control group were in horizontal position. We put three drops of 1% of ephedrine hydrochloride nasal drops respectively into their nasal cavity. When they came out of the oxygen tank, we asked them if they felt earache and checked their tympanic membrane so as to make a comparison. Results It was found that earache, rate of tympanic membrane injury and the extent of such injury in the observation group was obviously less than that in the control group, there was difference in statistics between these two groups. Conclusions Before HBO treatment, ephedrine hydrochloride nasal drops that put in lateral position of 45°with patients head leaning back can reduce the possibilities of earache occurred in HBO. It was also observed that such position was an ideal one which had anatomical characteristics of Eustachian tube and was safer than laying down flat, so such position is more practical.

Objective To compare the effectiveness of hyperbaric oxygen (HBO) therapy and normal pressure oxygen inhalation for lung infection in patients with severe brain injury and tracheotomy.Methods Sixty lung infection patients with severe brain injury and tracheotomy were stratified by age and Glasgow coma scale (GCS) score into an HBO group (30) and a conventional therapy group (30).Both groups were given treatments to reduce intracranial hypertension and protect the brain,surgery,antibiotics,and symptomatic and support therapy.In the conventional group the patients received oxygen therapy at normal oxygen pressure by tracheal cannula.In the HBO group,the patients received HBO therapy through self-made oxygen devices by the authors.The body temperature,cough and expectoration,respiratory sounds and white blood cell (WBC) count were compared between the groups.Results There were statistically significant differences in body temperature,cough and expectoration,respiratory sounds and the normalized time for the count and classification of WBC between the groups.Conclusion HBO had good treatment effectiveness for excretion and expectorant in lung infection patients with severe brain injury and tracheotomy.

Objective:To investigate the effect of levothyroxine sodium tablets on homocysteine (Hcy), antithyroid peroxidase antibody (TPO-Ab), thyroid function, folic acid and vitamin B 12 levels and pregnancy outcome in patients with subclinical hypothyroidism (SCH) during pregnancy. Methods:From January 2018 to August 2019, 120 cases of pregnant SCH patients in Shaoxing Central Hospital were selected and divided into control group and observation group according to the random digital table method, with 60 cases in each group.The observation group was given levothyroxine sodium tablet intervention, while the control group was not given any drug intervention.The changes of Hcy, TPO-Ab, thyroid function, folate level and pregnancy outcome were compared before and after treatment.Results:The serum levels of Hcy[(7.79±0.64)μmol/L]and TPO-Ab[(26.59±2.76)U/L] in the observation group were lower than those in the control group[(8.49±0.87)μmol/L and (30.49±3.25)U/L]( t=5.020, 7.085, all P<0.05). The serum TSH level[(2.25±0.48) mIU /L] in the observation group was lower than that in the control group[(3.49±0.70)mIU/L]( t=11.317, P<0.05). The levels of folate[(12.17±1.08)μg/L]and vitamin B 12[(487.23±26.23)ng/L] in the observation group were lower than those in the control group[(10.80±1.29)μg/L and (442.81±31.56)ng/L]( t=6.308, 8.385, all P<0.05). The incidence of adverse pregnancy outcome in the observation group (10.00%) was lower than that in the control group (28.33%) (χ 2=6.508, P<0.05). Conclusion:Levothyroxine sodium tablets can reduce Hcy and TPO-Ab levels, increase TSH, folate and vitamin B 12 levels, and reduce adverse pregnancy outcomes.

Objective To discuss the clinical characteristics and prognosis of lipoprotein glomerulopathy (LPG) in chil-dren. Method Clinical data of one pediatric LPG patient were retrospectively analyzed. The clinical features and prognosis of childhood LPG were summarized based on literature review. Results A nine years old girl presented with frequent urination. The ifrst urine test revealed hematuria and proteinuria. After one week anti-infection treatment, the hematuria and proteinuria were continued. The serum albumin was slightly reduced. The hyperlipidemia and mild anemia were emerged. Kidney biopsy showed that enlarged glomeruli, with dilated capillary loops and weak eosinophilic lipoprotein thrombi in the capillary lumina under the light microscope;layered or tuftedemboluscontaining particulated lipid vacuoles under electron microscope. Gene sequencing identified APOE Tokyo (Leu141-Lys143→0). The diagnosis of LPG was confirmed. The lipid-lowering therapy was administrated and the disease was alleviated. Conclusion LPG is a rare disease in children. The level of blood lipid was signiifcantly increased, and the hormone therapy was ineffective. Kidney biopsy is the main basis for diagnosis. The genetic testing can prompt the genetic background. Lipid lowering therapy can relieve the progress of the disease.

Objective To investigate the levels of literacy and numeracy in type 2 diabetes patients with poor glycemic status in communities of Shanghai,China,and to evaluate their associations with blood glucose level.Methods A total of 800 type 2 diabetes patients with recent HbA1c≥7.5％ or fasting plasma glucose level ≥10 mmol/L were recruited from 8 communities in Minhang district and Changning district of Shanghai,China,and were interviewed using a structured questionnaire during February 2015 and March 2016.Literacy and numeracy levels of all patients were evaluated using the validated Health Literacy Management Scale (HeLMS) and the 5-item version Diabetes Numeracy Test (DNT-5),respectively.Results The patients included in this study were observed to have higher levels of health literacy,with a median score of HeLMS being 116 [interquartile range (IQR),108-120] and a median correct rate of DNT-5 of 80％ (IQR,60％-100％).Age,educational level and occupation were significantly related with health literacy levels and numeracy.Sex and income were closely related with health literacy levels.HeLMS score was not significantly associated with HbA1c level (P =0.383),while the lower correct rate of DNT-5 was linked with a higher level of HbA1c.The median HbA1c level was 8.3％ (IQR 7.7％-9.4％) in the patients with the lowest tertile of DNT-5 correct rate,significantly higher than 8.2％ (IQR:7.5％-9.2％) in the medium and 8.0％ (IQR:7.5 ％-8.8 ％) in the highest tertile group (P =0.009).Conclusions Diabetes patients with poor glycemic status in communities of Shanghai have high levels of health literacy,which was significantly related with age,sex,educational level,occupation and income.Ability in numeracy may be a more important influence factor than health literacy for glycemic status of diabetes patients.

Objective: To investigate the clinical characteristics and treatment strategies of diabetic hyperosmolar hyperglycemia (HHS) with rhabdomyolysis (RM). Methods: The clinical data of 40 patients with HHS treated in the General Hospital of Shenyang Military Command from November 2013 to November 2017 were retrospectively analyzed.According to the serum levels of creatine phosphokinase and myoglobin, they were divided into RM group (12 cases) and non-RM group (28 cases). The clinical characteristics and treatment results of the two groups were compared. Results: There were 12 cases in the RM group, 6 cases were diagnosed RM at the time of consultation, and 6 cases developed RM during the course of treatment.Compared with the non-RM group, RM group had lower systolic pressure[(98.3±17.8)mmHg vs.(128.0±18.1)mmHg, t=4.823, P=0.000], higher blood glucose level[(44.4±14.0)mmol/L vs.(32.6±8.1)mmol/L, t=2.717, P=0.016], and more acidosis, mainly manifested by lower pH[(7.16±0.15)vs.(7.32±0.13), t=3.355, P=0.002], lower bicarbonate[(12.92±5.23)mmol/L vs.(19.07±6.80)mmol/L, t=2.792, P=0.008], higher blood D-3 hydroxybutyric acid [(5.84±2.98)mmol/L vs.(2.55±2.13)mmol/L, t=4.012, P=0.000], and renal function was worse[creatinine (257.1±149.8)μmol/L vs.(148.1±85.3)μmol/L, t=2.925, P=0.006]. Individualized rehydration and low dose insulin were given to control blood sugar, and increasing blood pressure, kidney protection, correction of electrolyte disturbance, anti-infection and inhibition of gland secretion were given to the complications.Hydration and alkalization were given to 7 cases of RM, and continuous renal replacement therapy (CRRT) was given to 5 cases.In 10 cases of HHS with RM, creatine kinase decreased, renal function recovered, and 2 patients died. Conclusion It is very important to improve the understanding of RM in HHS patients, routinely monitor the dynamic changes of muscle enzymes, make a good early diagnosis and prevention of RM.Urine hydration and alkalization should be given in time after RM occurs, and CRRT treatment as early as possible can improve the survival rate of diabetic patients.

Objective To evaluate the clinical efficacy of anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach in the treatment of Denis type B thoracolumbar burst fractures.Methods A retrospective case series study was made on 26 cases (14 males and 12 females,mean age of 48.5 years) of Denis type B thoracolumbar burst fractures treated by anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach from January 2007 to June 2009.Age was 18-68 years (mean,48.5 years).The fractured vertebrae included T1 in three cases,L1 in 18 and L2 in five.The neurological status was Grade C in eight cases,Grade D in 12 cases and Grade E in six cases according to American Spinal Injury Association (ASIA) classification.The operation duration,blood loss and incision length were recorded.The neurological function,lower back pain were evaluated by visual analogue score (VAS),correction of kyphosis and restoration of the fractured vertebral body height followed and documented at 3,6 and 9 months and annually after surgery.The healing of the graft was assessed using Brantigan method based on 3-dimensional computed tomography at final follow-up.Results All patients were successfully managed with this approach.The operation duration was (214.6 ± 30.5)min,and the intraoperative blood loss was (389.7 ± 57.1) ml.The length of incision was (8.5 ± 1.3) cm.All patients were followed up for (6.3 ± 0.4) years.At final follow-up,the neurological functions of all patients with incomplete neurological deficit were improved for at least one grade.The VAS of lower back pain was improved from preoperative (7.8-± 1.6) points to (2.1 ± 0.8) points at final follow-up (P ＜ 0.05).The height of the intervertebral body was restored from preoperative (29.8 ± 5.3) mm to (35.2 ± 2.4) mm at final follow-up (P ＜ 0.05).The kyphosis was corrected from preoperative (20.4 ± 11.7) ° to (11.3 ± 5.5) ° at final follow-up (P ＜ 0.05).Bone fusion was achieved in all patients,with no looseness,breakage or displacement of internal fixation at follow-up.Conclusions Anterior single segmental decompression and instrumentation through Endoring self-support retractor-assisted minimally invasive small incision approach can reduce the surgical trauma,achieve complete spinal canal decompression,adjust kyphosis,fix segment,obtain high rate of bone graft fusion and hence is a safe and effective method with minimal invasion for Denis type B thoracolumbar burst fractures.