Objective To compare the diagnostic significance of pleural SLPI,IFN-γ and ADA for differenti-ating TPE from pleural effusions with the other etiologies. Methods Pleural effusion samples were obtained from 93 patients who were divided into the following groups: tuberculous pleural effusion,malignant pleural effusion, bacterial pleural effusion and transudative pleural effusion. The pleural effusion and/or serum levels of SLPI , IFN-γand ADA were determined. Results 1.The concentrations of SLPI, IFN-γand ADA in tuberculous pleural effusion was higher than that in malignant group, bacterial group and transudative group. 2. The diagnostic value of SLPI, IFN-γor ADA for the diagnosis of tuberculous PE is high respectively. The combinations of SLPI, IFN-γand/or ADA gained the more valuable diagnostic performance. Conclusion Pleural SLPI, IFN-γand ADA may be helpful for the differential diagnosis of tuberculous pleural effusion and the other pleural effusion. The combinations of SLPI or/and IFN-γor/and ADA further increased diagnostic value.

Objective To discuss the expression and significance of neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) in peripheral blood in patients with chronic obstructive pulmonary disease(COPD).Methods One hundred and fifty cases COPD patients who were treated in Respiratory Departments of Hai'an People′s Hospital Affiliated to Nantong University from January to December 2015 were selected and divided into stable period group with 60 cases and acute exacerbation period group with 90 cases,and 50 healthy subjects were selected as control group.Clinical data were collected and white blood cell count(WBC),neutrophil count(NC),lymphocyte count(LC),platelet(PLT),NLR,PLR,forced expiratory volume in one second(FEV1%) predicted and C reactive protein(CRP) were tested.Results NLR,PLR and CRP values were significantly higher in patients in acute exacerbation period group than in stable period group and control group(NLR:(10.30±9.93) vs.(6.76±5.90) vs.(5.85±3.67);PLR:(335.88±164.94) vs.(286.80±118.98) vs.(194.11±88.14);CRP: (42.18±24.89) mg/L vs.(23.27±13.59) mg/L vs.(22.49±13.47) mg/L,F=6.637,6.808,11.007,P<0.05),but FEV1% predicted was no difference in stable period group and acute exacerbation period group((58.85±16.83)% vs.(57.47±17.76)%;t=0.228,P>0.05).There was a significant positive correlation between NLR,PLR and CRP in acute exacerbation period group(r=0.374,0.379,P<0.01),there was a positive correlation between NLR and PLR(r=0.482,P<0.01),there was a negative correlation between NLR,PLR and FEV1(r=-0.297,-0.299,P<0.05).There was a significant positive correlation between NLR,PLR and CRP in table period group(r=0.593,0.433,P<0.01),NLR and PLR were also positively correlated(r=0.618,P<0.01),NLR,PLR and FEV1 accounted for the expected value of the negative correlation(r=-0.324,-0.342,P<0.05).Conclusion Both NLR and PLR are inflammatory markers,furthermore they show a significant negative correlation to airflow limitation in patients with COPD.

Objective:To explore the changes of peripheral blood Th17/Treg and serum cytokines in AECOPD patients with secondary pulmonary fungal infection.Methods:Selected the clinical data of 27 AECOPD patients who were admitted between January 2018 to March 2020 in the Department of Respiratory Medicine, Hai'an People's Hospital Affiliated to Nantong University with fungal infection (fungal infection group), and 58 AECOPD patients without fungal infection (non-fungal infection group) who received treatment in the hospital during the same period. Compared the general clinical data, peripheral blood Th17 and Treg cell levels, Th17/Treg ratio, interleukin-17 (IL-17), interleukin-23 (IL-23), interferon-γ (interferon-γ, IFN-γ), and transforming growth factor-β (TGF-β) levels. Meanwhile, compared the levels of Th17 and Treg cells in peripheral blood, the ratio of Th17/Treg and serum cytokines in patients with different infection severity in fungal infection group. The measurement data with normal distribution were compared by independent samplet t-test between the two groups, one-way ANOVA between multiple groups, LSD-t test for pairwise comparision, and χ 2 test for counting data. Results:In the 27 AECOPD patients with fungal infection group, the pathogen distribution was 65.52% (19/27) of candida albicans, 10.34% (3/27) of candida tropicalis,10.34% (3/27) of candida albicans, and 6.90% (2/27) of Aspergillus. The level of Th17 [(16.18±3.15) % and (12.34±2.64) %, t=5.87, P<0.001)], the ratio of Th17/Treg [(4.70±0.85) and (2.41±0.51), t=22.87, P<0.001] in Patients with fungal infection group were higher than those in the non-fungal group. The level of Treg [(3.42±0.42) % and (5.13±0.51) %, t=20.77, P<0.001] in Patients with fungal infection group was lower than those in the non-fungal group. The levels of IL-17 [(85.67±21.51) μg/L and (53.64±14.36) μg/L, t= 8.12, P<0.001], and IL-23 [(61.38±16.58) μg/L and (38.29±12.60) μg/L, t=7.10, P<0.001] in Patients with fungal infection group were higher than those in non-fungal infection group, but the levels of IFN-γ ((47.75±17.72) μg/L and (62.37±19.06) μg/L, t=3.37, P=0.001) and TGF-β ((110.34±26.03) μg/L and (131.40±35.03) μg/L, t=2.87, P=0.007) were lower than those in non-fungal infection group, and the differences were statistically significant. There were statistically significant differences in the ratio of Th17/Treg, and the levels of Th17, Treg cells and cytokine among patients with different infection severity in the fungal infection group. With the increase of infection severity, the levels of Th17 ((13.06±1.98)%, (15.94±2.11)%, (17.75±2.20)%, F=10.19, P<0.001), the ratios of Th17/Treg ((5.01±0.60), (5.66±0.69), (6.52±0.65), F=10.77, P<0.001), the levels of IL-17 ((63.39±11.64) μg/L,(78.66±12.82) μg/L, F=9.01, P=0.001), and IL-23 ((42.52±13.11) μg/L, (59.97±15.25) μg/L, (69.75±14.30) μg/L, F=7.41, P=0.003) were increase, the levels of Treg ((4.33±0.39)%, (3.32±0.42)%, (2.50±0.35)%, F=44.42, P<0.001), IFN-γ ((57.78±10.52) μg/L, (48.82±10.39) μg/L, (38.90±10.56) μg/L, F=6.50, P=0.006), TGF-β ((126.62±18.94) μg/L, (115.34±13.66) μg/L, (102.52±17.73) μg/L, F=4.25, P=0.026) were significantly decreased. Conclusion:The imbalance of Th17/Treg ratio and related serum cytokines play an important role in the process of lung fungal infection in AECOPD patients, and their imbalance is related to the severity of fungal infection. Therefore, the levels of Th17/Treg and serum cytokines should be closely monitored in AECOPD patients.

Objective To explore the prevalence and epidemiological characteristics of bronchial asthma in people over 40 years old in Hai'an. Methods The stratified random sampling method was used in this study. A questionnaire survey was conducted and pulmonary function measurement was performed among the residents over 40 years old in Hai'an, ​Jiangsu Province to analyze the prevalence and epidemiological characteristics of asthma. Results A total of 2 237 valid questionnaires were collected in the survey, and 116 patients with bronchial asthma were found, with an incidence rate of 5.19%. The prevalence of asthma was related to gender, age, family history, active and passive smoking, occupational exposure, childhood history of lung disease, history of respiratory allergies, and exposure to cooking fumes (P<0.05). Multivariate logistic regression analysis showed that being male (OR=0.637, 95%CI: 0.499~0.691) was a protective factor for asthma, while advanced age (OR=1.438, 95%CI: 1.207~1.972), active smoking (OR=1.795, 95%CI: 1.423~2.399), passive smoking (OR=2.098, 95%CI: 1.423~2.399), occupational exposure (OR=3.446, 95% CI: 2.175~6.290), childhood history of lung disease (OR=2.228, 95%CI: 1.337~4.491), history of respiratory allergies (OR=2.287, 95%CI: 1.535~5.219) were risk factors for asthma (P<0.05). Conclusion The prevalence rate of bronchial asthma in people over 40 years old in Hai'an was high. Advanced age, active and passive smoking, occupational exposure, a history of lung disease in childhood, and a history of respiratory allergies were related to asthma development. It is necessary to strengthen the prevention and treatment of asthma among high-risk population in clinical practice to reduce the incidence of asthma.

Objective: To evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) in robot-assisted laparoscopic pyeloplasty in pediatric patients. Methods: Sixty pediatric patients of both sexes with hydronephrosis, aged 3-12 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing robot-assisted laparoscopic pyeloplasty from March 2018 to April 2019, were divided into 2 groups using a random number table method: control group (group C, n=28) and ERAS group (n=32). In ERAS group, preoperative ERAS education was carried out, the time of preoperative food and water deprivation was shortened, pediatric patients drank glucose water at 2 h before surgery, anesthetic regimen was optimized, lung protective ventilation and target-directed fluid therapy were performed, and intraoperative warming and multi-mode antiemetic measures were carried out during operation, and multi-mode analgesic measures were taken after operation, and pediatric patients received water and food intake early through the mouth and got out of bed as soon as possible after operation.In group C, the traditional concept was adopted for perioperative management.Immediately after tracheal intubation, at 30 min and 1 and 2 h after establishing pneumoperitoneum, at 5 min after the end of pneumoperitoneum and at 5 min after extubation, the airway peak pressure and tidal volume were recorded, and blood gas analysis was performed.The occurrence of cardiovascular events was recorded during surgery.The postoperative time of extubation, time of first intake, the first postoperative off-bed time, the first flatus time, time of pulling out the ureter and drainage tube, and length of hospital stay were recorded.The Pediatric Anesthesia Emergence Delirium scale was used to assess the agitation during the recovery period.The Faces Pain Scale-Revised scale was used to assess the degree of pain within 72 h after surgery.When Faces Pain Scale-Revised scale score ≥4, fentanyl 0.25 μg/kg was intravenously injected as rescue analgesic.The requirement for rescue analgesia was recorded.The overall complications were evaluated by using Clavin-Dindo grading, and postoperative complications included nausea and vomiting, abdominal distension, abdominal pain, incision infection, abdominal infection, anastomotic leakage, fever, etc. Results: Compared with group C, the preoperative food and water deprivation time was significantly shortened, the time of postoperative extubation was prolonged, the postoperative length of hospital stay, time of first intake, the first postoperative off-bed time, the first flatus time, and time of pulling out the ureter were shortened, airway peak pressure was decreased at 1 and 2 h of pneumoperitoneum, arterial blood lactate concentrations were decreased at each time point of pneumoperitoneum (P<0.05 or 0.01), and no significant change was found in the incidence of postoperative agitation, nausea and vomiting, incision infection, abdominal infection or fever in group ERAS (P>0.05). No intraoperative adverse cardiovascular events were found, and no pediatric patients required rescue analgesia after operation in two groups. Conclusion ERAS can be safely and effectively used for the pediatric patients undergoing robot-assisted laparoscopic pyeloplast.