Objective To investigate the value of adenosine deaminase( ADA) for the diagnosis of tubercu-lous pleural effusion.Methods A retrospective analysis was made of 324 cases of tuberculous pleural effusion patients which were effective treated and 68 cases were diagnosed of malignant pleural effusion.By drawing receiver operating characteristic curve, the best threshold of diagnosing of tuberculous pleural effusion was determined,and the distribution characteristics of ADA in tuberculous pleural effusion were analyzed.Results When the ADA was set at 19.5U/L it was good for identifying tuberculous empyema and tuberculous pleurisy.The activity of ADA in group of different gender did not have significant difference(Z=-0.572,P=0.283).The activity of ADA had significant difference between tuberculous empyema with tuberculous pleurisy patients(Z=-2.317,P=0.01),and the same as in group of different ages between less than or equal to 45 years old with the others(Z=-2.387,P=0.008).The activity of ADA had significant difference between tuberculous empyema and tuberculous pleurisy patients of younger than 45 years old(Z=-2.740,P=0.003),but not in the group of less than or equal to 45 years old (Z=-0.267, P=0.390).Conclusion The activity of ADA is good for identifying diagnosis of tuberculous pleural effusion and malignant pleural effusion, especially in tuberculous empyema and less than or equal to 45 years old patients.The standard of diagnosis and the nature of the tuberculous pleural effusion may affect the cut-off value of ADA.

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.

Objective To investigate the diagnostic value of bronchoscopy in smear negative pulmonary tuberculosis.Methods 65 cases with cavernous and 35 non -cavernous negative smear pulmonary tuberculosis were examined by bronchoscopy.Results The positive rates of sputum examination in the empty group,the non empty group and the total sputum examination were 49.2%,17.1% and 38%,respectively.There was statistically signifi-cant difference in sputum positive rate between empty group and non empty group (χ2 =9.942,P =0.002).The posi-tive rate of sputum was 28%.The positive rate of sputum negative and sputum positive rate was 10% after operation. Microscopically visible tracheal and bronchial abnormalities,tracheal inflammatory change rates of empty group and non empty group were 52.3%,40.0%,the difference between the two groups had no statistically significant difference (χ2 =1.381,P =0.240).The tracheal stenosis rates of hole group and non empty group were 9.0% and 11.4%,the difference between the two groups had no statistically significant difference (χ2 =0.122,P =0.727).The overall trachea abnormal changes rate was 58.0%,including inflammatory change rate 48.0% and 10.0% stenosis rate. Conclusion Bronchoscopy has significant clinical value in smear negative pulmonary tuberculosis,especially with cavernous.The positive rate will be promoted after bronchoscopy,and can find abnormal changes of tube.

ObjectiveTo explore the correlation between the degree of liver damage and clinical manifestations in patients with pulmonary tuberculosis after chemotherapy. MethodsThis study included 3620 new smear-positive pulmonary tuberculosis patients treated with first-line anti-tuberculosis drug in the Second Central Hospital of Baoding from January 2008 to January 2014, and the follow-up study was carried out to observe medication use and side effects of anti-tuberculosis drug treatment. Comparison of categorical data was made by chisquare test. ResultsA total of 1225 patients (33.8%) exhibited clinical manifestations related to liver injury. The most common clinical manifestation was nausea and vomiting (72.9%), followed by fatigue (37.8%), rash (31.5%), abdominal distension and diarrhea (281%), fever (14.2%), anorexia (3.8%), and other manifestations (2.0%). The nausea and vomiting usually first appeared and were followed by abdominal distension and diarrhea. Of all patients, 243 cases (6.7%) suffered from liver damage and 109 cases (3.0%) had moderate to severe liver damage. Of the patients with clinical manifestations, 171 cases (14.0%) had liver damage and 74 cases(60%) suffered from moderate to severe liver damage. Compared with the patients without clinical manifestations, the relative risks of liver damage and moderate to severe liver damage were 4.643 ［95% confidence interval (CI)=3.035-4.856］ and 4.134 (95% CI=2.817-4.351), respectively, in the patients with clinical manifestations. The patients with fatigue, nausea and vomiting, rash, abdominal distension and diarrhea, anorexia, and other manifestations had higher risk of liver damage and moderate to severe liver damage than those without clinical manifestations (P＜0.05) and the patients with anorexia showed the highest risk. ConclusionOne third of patients with pulmonary tuberculosis have liver injury-related clinical manifestations after chemotherapy. Patients with fatigue, nausea and vomiting, rash, abdominal distension and diarrhea, anorexia, and other manifestations are more susceptible to liver damage and moderate to severe liver damage.

Objective:To explore the differences in tumor-specific growth factors, cellular immune function and efficacy of olaparib and platinum-containing regimen for treatment of platinum-sensitive relapsed ovarian cancer patients with BRCA mutation.Methods:A retrospective cohort study was conducted. A total of 100 platinum-sensitive relapsed BRCA-mutant ovarian cancer patients in Baoding Second Central Hospital from September 2017 to March 2020 were retrospectively selected. The clinical data of the patients were analyzed, and they were divided into the olaparib group (treated with olaparib tablets) and the platinum-containing regimen group (treated with paclitaxel and platinum drugs for 6 cycles, followed by olaparib tablets maintenance therapy), with 50 patients in each group. The clinical efficacy, tumor specific growth factor [carbohydrate antigen (CA) 125, CA199, human epididymal protein 4 (HE4)] levels, cellular immune function-related indicators [T-cell subsets (proportions of CD3 + cells and CD4 + cells), CD4 + cells/CD8 + cells ratio (CD4 +/CD8 +)], and quality of life scores before treatment and after 2, 4 and 6 cycles of treatment of the two groups were compared, as well as the safety of the two groups. The data of three years of follow-up were obtained, Kaplan-Meier method was used to analyze the progression-free survival (PFS) of patients in the two groups, and log-rank test was used for comparison between groups. Results:The age of patients in the olaparib and platinum-containing regimen groups was (53±7) years old and (56±7) years old, respectively. The differences in compositions of patients with different age, body mass index, Eastern Cooperative Oncology Group (ECOG) performance status score, primary tumor location, lesion size, pathological stage, pathological type, germline BRCA mutation, and previous chemotherapy response between the two groups were not statistically significant (all P > 0.05). The objective response rate (ORR) [58.0% (29/50) vs. 38.0% (19/50)] and disease control rate (DCR) [80.0% (40/50) vs. 56.0% (28/50)] of the olaparib group after treatment were higher than those of the platinum-containing regimen group, and the differences were statistically significant (both P < 0.05). Serum CA125, CA199 and HE4 levels were gradually decreased in both groups before treatment and after 2, 4 and 6 cycles of treatment (all P < 0.05); serum CA125, CA199 and HE4 levels in the olaparib group after 2, 4 and 6 cycles of treatment were lower than those in the platinum-containing regimen group, and the differences were statistically significant (all P < 0.05). The CD3 + cells ratio, CD4 + cell ratio and CD4 +/CD8 + in the olaparib group gradually increased before treatment and after 2, 4 and 6 cycles of treatment (all P < 0.05), while those in the platinum-containing regimen group all gradually decreased (all P < 0.05); the CD3 + cells ratio, CD4 + cells ratio and CD4 +/CD8 + in the olaparib group were higher than those in the platinum-containing regimen group after 2, 4 and 6 cycles of treatment, and the differences were statistically significant (all P < 0.05). The quality of life scores of both groups increased before treatment and after 2, 4 and 6 cycles of treatment (all P < 0.05), and the quality of life scores of the olaparib group were higher than those of the platinum-containing regimen group after 2, 4 and 6 cycles of treatment, and the differences were statistically significant (all P < 0.05). The incidence of nausea, fatigue and malaise, vomiting, anemia, and diarrhea at all levels in the olaparib group was lower than those in the platinum-containing regimen group (all P < 0.05). By follow-up for 3 years, there was no statistically significant difference in PFS between the olaparib group and the platinum-containing regimen group ( P > 0.05). Conclusions:The efficacy of olaparib treatment in platinum-sensitive relapsed ovarian cancer patients with BRCA mutation is superior to platinum-containing regimen, and it can increase the level of T cells, inhibit the expression of tumor-specific growth factors, improve the quality of life, and have a positive effect on improving the safety of treatment.

Objective To investigate the prevalence of autism spectrum disorders (ASD) of children aged 4-6 years in public kindergartens in Shanghai.Methods Songjiang district and Xuhui district were selected randomly as the representative sample.By means of "Clancy Autism Behavior Scale","Social Communication Questionnaire" and "high-functioning Autism Spectrum Screening Questionnaire",all of the 33 public kindergartens in chosen area,which contained 10 385 children aged 4-6 years,were surveyed.Those who were screened as suspected cases would be further diagnosed by "Autism Diagnostic Interview-Revised" and "Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition".Results Among 9 665 valid questionnaires,9 children were diagnosed with ASD.The ratio of male to female was 8:1,the point prevalence rate was 0.93‰.The results of ADI-R corresponded with that of DSM-5.There were two children who never had medical records.For others,"language" problem was the most likely reason for their parents to seek medical help,while "deficits in social communication" was the main symptom of patients.Conclusion The prevalence of ASD was lower than those recorded in literature,home and abroad which might be related to some patients not going to public kindergartens.