Objective:To screen out high risk factors of cervical intraepithelial neoplasia (CIN) of grade Ⅱ or worse (CIN Ⅱ +) by analyzing related factors for CIN Ⅱ + detection in grade 1 abnormal colposcopic finding (G1) of cervix and provide reference for individual management of colposcopic performance. Methods:A retrospective study was performed on patients who were reffered to colposcopy for abnormal results of cervical cancer screening and only had G1 colposcopic findings of cervix at the First Affiliated Hospital of Nanjing Medical University, from April 2017 to January 2021. The factors influencing the detection of CIN Ⅱ + were analyzed by univariate and multivariate analysis. Results:(1) A total of 403 patients were included in this study whose median age was 38 years old (range: 22-67 years old), and utimately 108 had high-grade squamous intraepithelial lesion, 1 had adenocarcinoma in situ and 1 had adenocarcinoma. The overall detection rate of CIN Ⅱ + was 27.3% (110/403). (2) Univariate analysis showed that the detection rate of CIN Ⅱ +, in patients ≥50 years old was higher than that in patients <50 years old (38.3% vs 25.4%; χ2=4.328, P=0.037), and in HPV 16 positive cases was higher than that in non-HPV 16 positive cases (41.8% vs 21.8%; χ2=16.080, P<0.01); as the cytological severity ( χ2=6.775, P=0.009) and the number of involving quadrants ( χ2=31.117, P<0.01) increased, the risk of CIN Ⅱ + detection increased; but the types of colpolscopic signs were not related to detection of CIN Ⅱ +( χ2=0.323, P=0.851). Multivariable analysis showed that the age of ≥50 years old ( OR=2.504, 95% CI: 1.299-4.830, P=0.006), HPV 16 positive type ( OR=3.353, 95% CI: 2.004-5.608, P<0.01) and the increase of involving quadrants ( OR=1.899, 95% CI: 1.518-2.376, P<0.01) were independent risk factors. (3) The detection rate of CIN Ⅱ + was highest in the women with HPV 16 positive type and four quadrants of G1 (73.7%), while lowest in the women with non-HPV 16 positive type and one quadrant of G1 (10.4%). Conclusions:The age of ≥50 years old, HPV 16 positive type and the increase of involving quadrants are independent risk factors of detecting CIN Ⅱ + in G1 colposcopic findings. So the key point of the individual management of G1 groups with different risk stratification is to adequately biopsy in high-risk group to avoid miss diagnosis of CIN Ⅱ +.

Objective:To investigate the value and feasibility of early goal directed sedation (EGDS) in patients with acute brain injury.Methods:A total of 110 patients with acute brain injury who were admitted to intensive care unit (ICU) of the Third Medical Center of the Chinese People's Liberation Army General Hospital from January 2015 to March 2019 were included and randomly divided into EGDS group and standard sedation group (STD) using the random number table. Patients in the EGDS group were sedated by continuous intravenous infusion of dexmedetomidine (initial dose of 0.2 μg·kg -1·min -1) for 72 consecutive hours. Patients in the STD group received intravenous bolus of propofol as appropriate clinically. Richmond agitation-sedation score (RASS) and electroencephalogram bispectral index (BIS) were used to continuously monitor the level of sedation. All patients were given sufentanil for analgesia. Routine treatments such as dehydration and reduction of intracranial pressure with mannitol, hemostasis or antiplatelet therapy were given according to the patients' condition. Vital signs, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, Glasgow coma scale (GCS) score, BIS value, artery blood gas analysis, duration of mechanical ventilation, analgesic dosage and adverse events were recorded in two groups before and 24, 48, and 72 hours after sedation. Results:① Among the 110 patients, patients who received the second surgery due to cerebral hemorrhage, had worsening of cerebral hernia, withdrew during the course of the study, or whose family members abandoned treatment were excluded from the study. Finally, 105 patients were enrolled in the study, including 56 patients in the EGDS group and 49 in the STD group. There was no significant difference in gender, age, types of brain injury, baseline APACHEⅡ or GCS score or rate of mechanical ventilation between the two groups. ② Compared with before sedation, heart rate (HR) significantly decreased till 72 hours after sedation in both groups, and the decrease in the EGDS groups was more obvious as compared with the STD group (bpm: 70.49±7.53 vs. 79.83±9.48, P < 0.05). Besides HR, significant improvement was found in the APACHEⅡ and GCS scores in the STD group at 72 hours of sedation as compared with before sedation, and no significant difference was found in other indicators. Compared with before sedation, arterial partial pressure of carbon dioxide (PaCO 2) was significantly increased from the 24th hour of sedation, mean artery pressure (MAP) was decreased significantly and GCS score, BIS value were increased significantly from the 48th hour of sedation, till 72 hours, which were all improved significantly as compared with the STD group [72-hour PaCO 2 (mmHg, 1 mmHg = 0.133 kPa): 40.30±5.98 vs. 31.57±8.20, 72-hour MAP (mmHg): 85.01±8.26 vs. 89.54±9.41, 72-hour GCS score: 8.62±3.34 vs. 7.89±2.74, 72-hour BIS: 60.87±24.79 vs. 56.68±33.43, all P < 0.05]. APACHEⅡ score was significantly lower only at the 72nd hour of sedation as compared with before sedation in the EGDS group, and no significant difference was found as compared with the STD group (17.10±7.05 vs. 18.90±3.32, P > 0.05). Oxygenation index (PaO 2/FiO 2) was significantly increased only at the 24th hour of sedation in the EGDS group as compared with the STD group (mmHg: 261.05±118.45 vs. 226.45±96.54, P < 0.05). ③ The duration of mechanical ventilation was significantly shorter in the EGDS group than that in the STD group (hours: 20.56±9.03 vs. 27.75±11.23, P < 0.05), and the total administered dose of sufentanil was significantly lower in the EGDS group than that in the STD group (μg: 79.16±26.76 vs. 102.46±35.48, P < 0.05). ④ Compared with the STD group, the incidence of bradycardia in the EGDS group was increased significantly [10.71% (6/56) vs. 6.12% (3/49), P < 0.05], while the incidence of tachycardia was decreased significantly [14.29% (8/56) vs. 38.78% (19/49), P < 0.05], but no significant difference was found in the incidence of hypotension [5.36% (3/56) vs. 4.08% (2/49), P > 0.05]. The incidence of unexpected extubation in the STD group was 4.08% (2/49), which did not occurre in the EGDS group. Conclusion:EGDS can improve the GCS score and BIS value of patients with acute brain injury, suggesting that the EGDS is safe and feasible, which can help improve neurological function in patients with acute brain injury.

Objective:To explore the correlation between oxidative stress markers malondialdehyde(MDA), superoxide dismutase(SOD), magnetic resonance burden and vascular cognitive impairment in patients with ischemic cerebrovascular disease (CSVD).Methods:Totally 300 patients with ischemic cerebral small vessel diseases who were admitted to the Department of Neurology, North China University of Science and Technology Affiliated Hospital were selected as the research subjects, and 60 healthy outpatients in the same period were selected as the control group.According to the results of mini mental state examination(MMSE), patients with ischemic cerebral small vessel diseases were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases). The cognitive impairment group was further divided into mild cognitive impairment group (101 cases), moderate cognitive impairment group (58 cases ) and severe cognitive impairment group (35 cases) according to Montreal cognitive assessment (MoCA). MDA and SOD were determined by double antibody sandwich method and the results were compared and analyzed.Results:(1) Compared with the control group(MDA: (8.40±1.81)μmol/L, SOD: (112.73±83.48)U/ml), the level of MDA increased while the level of SOD decreased significantly in normal group(MDA: (8.46±2.05)μmol/L, SOD: (108.90±88.72)U/ml) and cognitive impairment group(MDA: (12.19±7.02)μmol/L, SOD: (62.64±20.34)U/ml). Compared with the cognitive normal group, the level of SOD decreased significantly and MDA increased significantly in cognitive impairment group, the differences were statistically significant (all P<0.05). Compared with the normal cognitive group (1.18±1.10), the cognitive impairment group (1.93±1.05) had a higher MRI burden score ( P<0.05). (2)Multivariate analysis showed that the decrease of plasma SOD level( β=-0.024, OR=0.977, 95% CI=0.961-0.992)and the increase of plasma MDA level( β=0.110, OR=1.117, 95% CI=1.005-1.241)and the MRI overall burden( β=0.453, OR=1.573, 95% CI=1.011-2.446)were independent protective factors of vascular cognitive impairment in patients with ischemic CSVD.(3) Compared with mild cognitive impairment group(MDA: (9.79±5.79)μmol/L, SOD: (81.64±58.09)U/ml, MRI overall burdern (1.69±0.99)), the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in moderate cognitive impairment group and severe cognitive impairment group(MDA: (7.95±2.44)μmol/L, SOD: (76.13±46.00)U/ml, MRI overall burden: (1.78±0.86)), (MDA: (11.16±6.68)μmol/L, SOD: (63.49±20.04)U/ml, MRI overall burden: (2.89±1.02). Compared with the moderate cognitive impairment group, the level of SOD decreased significantly and the level of MDA and the MRI overall burden increased significantly in the severe cognitive impairment group (all P<0.05). Conclusion:Increased plasma MDA level, MRI burden score and decreased SOD level in patients with CSVD are all risk factors for the occurrence of cognitive impairment.It is suggested that oxidative stress injury and cerebral small vessel lesions may be involved in the occurrence and development of cognitive impairment of CSVD from multiple aspects.

Objective To explore the diagnostic value of MRI in adnexal torsion.Methods A retrospective study was conducted on 32 patients with adnexal torsion confirmed by surgery and pathology.The MRI features were analyzed in combination with clinical data.Results Among the 32 cases of adnexal torsion,there were 12 cases of ovarian cyst,5 cases of cystic ovarian teratoma,4 cases of theca cell tumor,6 cases of ovarian cystadenoma,1 case of high-grade serous carcinoma,1 case of corpus luteum hematoma,1 case of simple ovarian torsion,1 case of ovarian goiter,1 case of fibrotheca cell tumor with serous cystadenoma;There were 13 cases on the left side and 19 cases on the right side;The torsion angle of adnexal was about 90 °-1 440 °.MRI showed that 13 of 32 patients were cystic masses and 19 were cystic solid masses;torsion pedicle can be seen near the mass,of which 13 cases showed"whirlpool sign",27 cases showed"T2WI dot low signal sign",10 cases showed"nodule sign",5 cases showed"triangle sign",and 9 cases had structural disorder around the mass.Enhancement showed no obvious enhancement in 12 cases,and mild enhancement in 20 cases.Thirty cases complicated with pelvic effusion;The uterus moved to the affected side in 9 cases,to the healthy side in 20 cases,and no obvious deviation in 3 cases.Conclusion The MRI imaging features of adnexal torsion are characteristic,which are cystic or cystic solid lesions.The torsion pedicle is characterized by"whirlpool sign"and"T2WI dot low signal sign",etc.The enhancement is mild or no enhancement.Combined with the clinical history,it is of great value for the preoperative diagnosis and treatment of adnexal torsion.