Objective To evaluate the roles of telomerase,interferon-γ(IFN-γ),adenosine deaminase(ADA)and T cell spot test(T-SPOT.TB)in the diagnosis of tuberculous and malignant pleural effusion.Methods Forty patients with early tuberculous pleurisy(tuberculosis group)and 40 patients with malignant pleural effusion(tumor group)were enrolled.Pleural effusion and fasting blood were extracted before treatment.The activity of telomerase and the concentration of IFN-γ were detected by enzyme-linked immunosorbent assay.The activity of ADA was detected by colorimetric analysis.The positive rate of T-SPOT.TB was detected by Elispot spot counting.Results Telomerase activity in the tuberculosis group was significantly lower than that in the tumor group([1.46±0.73]×10-3 nmol/L vs.[3.34±1.72]×10-3 nmol/L,P<0.01).The concentration of IFN-γ was(137.44±38.93)U/L and(27.94±8.46)U/L in the tuberculosis group and tumor group,respectively;ADA content was(68.42±9.58)U/L and(15.39±4.43)U/L.There were significant differences in IFN-γ and ADA between the 2 group(P<0.01).IFN-γ concentration,ADA activity and the positive rate of T-SPOT.TB in the tuberculosis group were significantly higher than those in the tumor group(P<0.01).The sensitivity and specificity of combined detection of telomerase,IFN-γ,ADA and T-SPOT.TB in differentiating tuberculous and malignant pleural effusion were 0.974 and 0.974,respectively.Conclusion The combined detection of telomerase,IFN-γ,ADA and T-SPOT.TB has important value in differential diagnosis of tuberculosis and malignant pleural effusion.

Objective:To investigate the value of CT findings of childhood hepatoblastoma (HB) in predicting preoperative tumor risk stratification.Methods:Totally 46 children with HB confirmed by surgery and pathology were retrospectively enrolled from October 2010 to October 2019 in Shenzhen Children′s Hospital and Xuzhou Children′s Hospital. The preoperative abdominal plain CT and three-phasic contrast-enhanced CT with complete clinical files were evaluated. According to the clinical risk stratification established by the multidisciplinary diagnosis and treatment consensus for children with HB, the HB children were divided into high-risk group and non-high-risk group with 16 and 30 cases respectively. The maximum diameter of tumor, relative tumor volume index, cystic change or necrosis, bleeding, calcification, fibrous septations, tumor rupture, liver capsule retraction and subcapsular effusion were evaluated. Enhancement percentage and enhancement index on arterial, venous and delayed phases of each tumor were measured and calculated. Pearson′s χ 2 test or Fisher′s exact test were used to compare the differences in gender and lesion morphological characteristics between the high-risk group and the non-high-risk group. Two independent sample t test or Mann-Whitney U test were used to compare the differences in age, gestational age, birth weight, α-fetoprotein, platelets, maximum diameter of tumor, relative tumor volume index and CT parameters of the lesion between the two groups. Statistically significant features were included in the binary logistic regression analysis and independent predictors related to high-risk group were obtained. The ROC curve was used to determine the critical value of the high-risk group. Results:There were statistically significant differences in age, maximum diameter of tumor, relative tumor volume index and tumor rupture between the high-risk group and the non-high-risk group (all P<0.05). The logistic regression analysis showed that the maximum diameter of tumor (OR=1.906, P=0.004) and tumor rupture (OR=16.558, P=0.005) were risk factors of the high-risk group. Based on ROC curve, the optimum cut-off point of maximum diameter of tumor to predict high-risk group was 10.5 cm. Tumor rupture, maximum diameter of tumor and maximum diameter of tumor combined with tumor rupture for predicting the incidence of high-risk group resulted in the area under the curve of 0.744, 0.807 and 0.879, respectively. The sensitivity and specificity of maximum diameter of tumor combined with tumor rupture were 75.0% and 96.7%, respectively. Conclusion:The age of onset in high-risk group is relatively older. The maximum diameter of tumor greater than 10.5 cm accompanied by tumor rupture can be regarded as a high-risk sign.

Objective To investigate the value of combined 3D-constructive interference in steady state(3D-CISS) with phase-contrast MR(PC-MR) in diagnosis of hydrocephalus children.Methods We collected retrospectively 28 children with hydrocephalus who caused by obstructive membranes.They all underwent MR imaging examination with a 1.5 T consisting of 3D-CISS, conventional sequences and PC-MR.With the result of surgery and CT cisternography as gold standard,we analysised different sequence in the diagnosis of membranous obstruction.The results of obstructive were analysed by x2 test between 3D-CISS combined with PC-MR and conventional sequences.Results The study included 28 children, of whom 16 showed obstructive membranes in CSF pathways of ventricle and 12 displayed obstructive membranes in CSF pathways of cistern.Conventional sequences diagnosed obstructive membranes of 15 children, and obstructive membranes of 11 children were consistent with gold standard, and 4 cases were false positive.The 3D-CISS diagnosed obstructive membranes of 40, and 12 cases were false positive.There were significant difference between 3D-CISS combined with PC-MR and conventional sequence about obstructive membranes diagnosis of CSF pathways(x2=24.410, P=0.001).Conclusions Making use of jointing 3D-CISS sequence and PC-MR sequence successively, and we can diagnose the position of obstructive membrane for hydrocephalus, which can be helpful to select a perfect surgical approach.

Objective To study MRI manifestations of cerebral developmental venous anomaly (DVA)and to analyze the diagnos-tic value of different sequences.Methods Conventional MRI and contrast enhancement 3D-T1 WI were performed in all 10 patients who were collected in our hospital.Among the 10 cases,6 patients underwent MRA and 4 patients underwent MRV.The diaplay of the draining veins and medullary veins were assessed.Results All 10 cases were sporadic lesion,the lesions of 9 cases were located in supra tentorium and which of 1 case was located in infra tentorium.Abnormal signals without characteristics of draining veins in 6 cases and dilated medullary veins in 4 cases were found in conventional MRI,while 6 draining veins showed flow void signal on T2 WI and 3 of the 4 medullary veins showed hypointensity on T1 WI and hyperintensity on T2 WI.Contrast enhancement 3D-T1 WI displayed the markedly enhanced draining veins and dilated medullary veins in all 10 cases of DVA.Numerous medullary veins gath-ered together into large draining veins radially and flowed into superficial or deeper veins,so-called“caput medusae”appearance were found as the characteristics in all cases.MRA and MRV revealed draining veins only partially but no medullary veins.Conclusion MRI could diagnose DVA clearly,the sensitivity of detecting DVA on conventional MRI is low and there are no characteristics ap-pearances.Contrast enhancement 3D-T1 WI is the most accurate and sensitive method,MRA and MRV are not highly worthwhile for diagnosing DVA.

Objective To investigate the therapeutic effect of the sandwich method (medical glue +gelatin sponge+medical glue) in the repair of spinal dura mater to prevent the cerebrospinal fluid leakage.Methods From February 2007 to June 2011,54 patients with spinal subdural tumors underwent excision of tumor in our hospital.According to manner of repairing spinal dura mater,all patients were classified into two groups:routine group and sandwich group.There were 16 males and 7 females with an average age of 45.2±7.2 years in the routine group,while 19 males and 12 females with an average age of 44.2±6.4 years in sandwich group.In routine group,the spinal dura mater was repaired through running locked suture.In sandwich group,the spinal dura mater was repaired through running locked suture,painting medical glue around the dural incision,covering with gelatin sponge,and painting medical glue on the surface and margin of gelatin sponge successively.Results Compared with the routine group,the total volume of postoperative drainage in sandwich group decreased significantly on the very day,the first day,the second day,and the third day,and the incidence of cerebrospinal fluid leakage decreased significantly.Before discharge,hydrops happened in 3 cases in the routine group,and got well through aspiration,continuous pressure by sandbag,and prone position.Three months after operation,5 cases from the routine group got deep hydrops under the incision and no treatment was applied to them.There was no obvious abnormality in the sandwich group.Conclusion The sandwich method can improve the repair effect of spinal dura mater injury,reduce the volume of postoperative drainage,and decrease the incidence of cerebrospinal fluid leakage