Objective To investigate factors and neonatal outcomes associated with histologic chorioamnionitis(HCA) after preterm premature rupture of membranes (PPROM).Methods From January 2008 to January 2013,103 women with PPROM at 28-33+6 weeks of gestation undergoing deliveries were studied retrospectively.According to placental histopathologic findings,those patients were categorized into two groups,including 68 cases in histologic chorioamnionitis (HCA group) and 35 cases in non-chorioamnionitis (control group).Age,parity,gestational age of PPROM and delivery,latency period,oligohydramnios,white blood cell (WBC) count and serum C reactive protein (CRP) level at admission and before delivery,and the neonatal outcomes were compared between two groups.The risk factors were analyzed by multivariable Logistic regression analysis.Results The incidence of HCA was 66.0％ (68/103) in all cases with PPROM.The occurring ruptured membrane gestation in HCA group was (28.2 ± 1.2) weeks,which were significantly earlier than (32.3 ± 1.4) weeks in control group (P ＜ 0.05).The level of CRP of (8.3 ± 4.7) mg/L before dehvery in HCA group was significantly higher than (5.4 ± 3.2) mg/L in control group (P ＜ 0.05).The rates of oligohydramnios and cesarean sections were significantly higher than those in control group (P ＜0.01 or ＜0.05).Using multivariable Logistic regression analysis,oligohydramnios,gestational age of PPROM ＜ 32 weeks,serum CRP level ＞ 8 mg/L before delivery and latency period 48-168 h were significantly associated with HCA (P ＜ 0.01 or ＜ 0.05).The gestational age of delivery and birth weight of HCA group were significantly lower than those of control group (P ＜ 0.05).The incidence of Apgar ＜ 7 scores,abnormal brain ultrasonography findings,neonatal pneumonia,bronchopulmonary dysplasia,early-onset neonatal sepsis and mortality in HCA group were significantly higher than those in control group (P ＜ 0.05).Conclusions HCA has significantly correlated with lower gestational age of PPROM,higher serum CRP level before delivery,prolonged latency period and oligohydramnios in PPROM.HCA could increase the neonatal morbidity and mortality.

Objective To improve the diagnosis and treatment of primary adrenocortical carcinoma. Methods Retrospective analysis was performed in clinical data of 16 patients with primary adrenocortical carcinoma. The diagnosis was based on clinical presentations,hormonal studies and imaging. Surgical treatment was underwent on 13 cases. All patients were followed up for 3 to 62 months. Results Of 16 cases,functional tumors were in 8,including Cushing′s syndrome in 5,combination of Cushing′s syndrome and virilization in 2,and hyperaldosteronism in 1. Imaging studies revealed the tumors were 4.8 to 19.5 cm in diameter,average in 7.8 cm. Distant metastasis occurred in 3 cases. Radical surgery was done in 13 cases without distant metastasis,including radical adrenalectomy in 8,adrenalectomy plus nephrectomy in 2,adrenalectomy plus surgical extirpation of intracaval tumor thrombus in 2,and partial resection of the wall of inferior vena cava in 1. Pathologic stages were stage Ⅰ in 2 cases,stage Ⅱ in 8,stage Ⅲ in 3,stage Ⅳ in 3. Among the 11 cases who were treated over 2 years after operation,6 cases were still survival,while 1 case had pulmonary and 1 case had bone metastasis. The other 5 cases survive in average of 26 months. Conclusions Prognosis of primary adrenocortical carcinoma is poor. The keys to early diagnosis are clinical manifestations plus imaging. Surgical treatment is the only effective therapy for the disease.

Objective To retrospectively analyze the effect of two kinds of biological agents in volume -re-duced bullae .Methods 11 patients who suffered from bullae were operated under large C-arm locating ,and infused two kinds of biological agents through micro catheter of fibreoptic bronchoscopy .All of them were randomly divided into the two groups .The biological agents in group A were fibrinogen and diluent thrombin , and that of group B was Porcine Fibrin Sealant Kit .In group A,the micro catheter with diameter of micro thread less than 1.2mm was placed in bullae through fibreoptic bronchoscope ,and then the 2mL lidocaine,5 ml fibrinogen,and double of 500u diluent thrombin were inproperorder injected through micro catheter .In group B,the Porcine Fibrin Sealant Kit was injected at the same method,and then the suspension fluid was exacted .The operation time was recorded ,and then the clinical efficacy and incidence rate of complications were compared .Results The operation time of group A was 5-15 minutes, and that of group B was 6-20 minutes.For all the patients ,4 cases were totally effective ,2 cases were significantly effective,and 2 cases were totally non-effective.The total effective rate was 81.82%(9/11).The incidence rates of common complications in group A and B were 52.38%(22/42),58.33%(14/24),respectively,the difference was not significant (χ2 =0.22,P>0.05).Moreover,there were no serious complications in all cases .Conclusion The security and effect of two kinds of biological agents might be well enough ,but in view of less cases ,they were worth to further popularized and applied in clinical practice .

Objective To retrospectively analyze of clinical application of BF-XP60 micro-bronchoscopy.Methods 135 clinical data of patients who adopted ultrafine micro-bronchoscopy and intervention were collected and analyzed for the complications.Results The frequency of local rhinomusoca damaging and errhysis was in 3 cases,the mucous of the glottis damaging and errhysis was in 2 cases,local mucous of the tracheal bronchus errhysis was in 3 cases.After intervention,the frequency of fever was in 13 cases,massive haemorrhage was in 1 case,pneumothorax was in 1 case,chest pain was in 2 cases,part fiber of inner untrafine micro-bronchoscopy broken was in 2 cases,check failure due to ultrafine micro-bronchoscopy broken in trachea was in 4 cases,and arrhythmia,asphyxia,and death were in 0 case.The overall incidence of side effects was 22.9％ (31/135).Conclusion Application of ultrafine micro-bronchoscopy was contributed to find the lesions within the bronchioles and around the lungs,moreover,it could evaluate the distal bronchus of airway obstruction which was planned to adopt intervention.The topic that how to reduce the incidence of the side effects of the micro-brohchoscopy and improve the success rate and safety of inspection and intervention was worth to be concerned.

Objective To preliminaryly explore the effect and adverse reaction of Marine Injection combined therapy through local spray in benign tracheobronchial stenosis.Methods 19 cases of bronchial tuberculosis were collected in our department.By assessing cough,shortness of breath and other symptoms,chest high -resolution CT (HRCT)of three -dimensional reconstruction,and length were observed by ultrafine bronchial stenosis.According to the pathogeny and types of stenosis,combined multiple intervention were sequentially adopted,and then Marine Injec-tion was sprayed through one -off endoscopic spray tube.All the subjects were divided into the two groups,the higher concentration Marine injection (1 200 mg/mL)group was chosen with the condition of serious inflammation,edema, ulcer and necrosis,obvious local granulation tissue hyperplasia,severe scar stenosis,and the length of stenosis greater than 2 cm or the sectional area of stenosis less than 50% of the normal sectional area,otherwise the low concentration (600 mg/mL)group was chosen.The subjects were reexamined by clinical symptoms,high -resolution CT (HRCT) of three -dimensional reconstruction,and ultrafine bronchoscopy a week after the surgery to dynamically observe the local changes.Depending on the situation,the injection was sprayed once a week,adding up to 2 -4 times.Follow -up visit lasted for 3 months,cough,expectoration or hemoptysis,and dyspnea were observed.Results 11 cases were effective fully,17 cases were effective substantially,7 cases were ineffective,the total effective rate was 80% (28 /35).The overall complication rate was 42.8% (15 /35),no deaths occurred.No complications related to local spra-ying of Marine were seen.Conclusion Local spray of Marine Injection may have preferable effect that inhibits scar formationand prevention airway restenosis.It is worth further study with a high security,precise clinic effect,easy oper-ation and etc.

Objective To explore the security and its influencing factors on benign airway stenosis treated with interventional of high pressure balloon expansion catheter.Methods Clinial data of 39 cases of inpatients suffered from benign airway stenosis were chosen.17 cases were male,and 22 cases were female.The ages of them ranged from 15 to 83 years old.According to the clinical symptoms,HRCT 3D reconstruction,and the results of bron-choscope,all patients were treated with balloon expansion catheter at different criterions.The balloon catheter with size that slightly smaller than the targeted normal bronchial tube was chosen,expansion for average 1 -4 times,single balloon expansion time ranged from 0.5 to 4 min,the pressures were kept at 3 -6 atmosphere,and the highest pres-sure did not exceed 8 atmospheric pressure.The efficacy and complications were retrospectively analyzed.Results 19 cases were completely effective,14 cases were basically effective,6 cases were completely ineffective,and the total effective rate was 84.6% (33 /39 ),the incidence of complications was 35.8% (14 /39 ),moreover,no deaths occurred.Conclusion High pressure balloon catheter expansion is one of commonly used technology in breathing interventional treatment;it has the characteristics of easy operation,and immediate curative effect,and so on.But if the improper operation,incorrect selection of the case,or inaccurate evaluation of the stenosis during operation,serious complications and unnecessary iatrogenic injury can be occurred.Therefore,it is worthy of attention and further summarizing by breathing interventional physicians.

Objective To summanrize the operative method and follow-up data of total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta (Sun's procedure) for acute Stanford type A aortic dissection.Methods Between August 2004 and March 2012,73 patients with acute type A aortic dissection underwent this procedure.60 males and 13 females ranging in age from 26 to 79 years (mean age,49,6 years).Right axillary or femoral artery cannulation was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by bilatero-antegrade or selected hrain perfusion.The stented elephant trunk was implanted throuugh the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10cmlong self expandable graft.Patent false lumina were evaluated using computed tomography 3 months and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Results Mean cardiopulmonary bypass time was (248.1±69.8)min,and selected cerebral perfusion time was (38.2±10.5)min.Hospital morality was 6.85 ％ (5/73).Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 9 1.7％ of the aortic dissections 3 months postoperatively.The mean follow-up time was(36.4 ± 31.6)months (range,2 to91 months).Survival at 1,5,7 years was 97％,87％ and 81％,respectively.Conclusion Total aortic arch replacement combined with transaortic stented paft implantation into the descending aorta is an effective treatment and n more promising choice for acute type A aortic dissection.

Objective To evaluate the value of endoscopic ultrasonography ( EUS) combined with conventional endoscopy for prediction of invasion depth of early gastric cancer and its therapeutic decision-making. Methods Patients with biopsy-proven gastric cancer underwent EUS and conventional endoscopy from July 2011 to January 2018 in Ningbo No. 2 Hospital. A total of 129 patients with early gastric cancer confirmed by postoperative pathology were enrolled in the study. The sensitivity, specificity, positive predictive value, negative predictive value, consistency ( the value of Kappa ) and area under receiver operating characteristic curve ( AUC) of EUS, conventional endoscopy and combination of two methods to assess the accuracy of tumor infiltration depth were analyzed. The accuracy of therapeutic decision-making based on the EUS, conventional endoscopy and combination of two methods were assessed. Results In intramucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 75. 00％, 82. 22％, 88. 73％, 63. 79％, 0. 536 and 0. 797, respectively, and for conventional endoscopy, these statistical values were 61. 9％, 93. 33％, 94. 55％, 56. 76％, 0. 481, and 0. 801, respectively. For the combination of two methods, these statistical values were 85. 71％, 82. 22％, 90. 00％, 75. 51％, 0. 666 and 0. 850, respectively. In submucosal cancer, the sensitivity, specificity, positive predictive value, negative predictive value, the value of Kappa and AUC of EUS were 51. 11％, 86. 91％, 67. 65％, 76. 84％, 0. 403 and 0. 697, respectively, and for conventional endoscopy, these statistical values were 57. 78％, 73. 81％, 54. 17％, 76. 54％, 0. 311 and 0. 678, respectively. For the combination of two methods, these statistical values were 71. 11％, 90. 48％, 80. 00％, 85. 39％, 0. 632 and 0. 817, respectively. The accuracies of therapeutic decision-making of EUS, conventional endoscopy and the combination of two methods were 83. 72％, 68. 22％ and 92. 25％, respectively. Conclusion Patients who are diagnosed as intramucosal caner by conventional endoscopy should not be recommended to undergo EUS. For those whose invasion depth is unclear, or diagnosed as submucosal cancer or deeper by conventional endoscopy, EUS should be performed for reassessment. The combination of two methods can improve the accuracy of distinguishing intramucosal and submucosal caners and therapeutic decision-making. Trial registration Chinese Clinical Trial Registry, ChiCTR-DDT-13003299.

Objective To explore the effect of carbon monoxide (CO) and ozone (O3) in the air on the myocardial infarction mortality in Ningbo,Zhejiang province,from 2011 to 2015.Methods The data of daily air quality surveillance and the causes of deaths in Ningbo from January 1,2011 to December 31,2015 were collected and the time series study using a generalized additive model was conducted to evaluate the relationship between the mortality of myocardial infarction and the air pollutants after adjustment for the long-term trend of death,weather conditions,"days of the week" and other confounding factors.Results The daily average concentrations of CO and O3 in Ningbo during 2011-2015 were 0.90 (0.02-3.31) mg/m3 and 82.78 (4-236) μg/m3,respectively.A total of 5 388 myocardial infarction deaths occurred,with a daily average of 3 deaths.In single-pollutant model,an increase of 0.1 mg/m3 in average concentration of CO could increase the risk of myocardial infarction mortality by 1.06％ (95％ CI:0.29％-1.93％) in general population,and by 1.26％ (95％ CI:0.28％-2.24％) in aged people aged ≥65 years in lagged 6 days,but the influence was not significant in people aged ＜65 years.The influence had no significant difference in males,but it increased the risk of myocardial infarction mortality by 1.77％ in females (95％ CI:0.44％-3.13％).In multipollutant model,CO did remain robust after adjusting for other co-pollutants.Whereas the effect of O3 had no significant influence.Conclusion These findings suggested that the increased risk of daily myocardial infarction mortality was associated with the increase of CO concentration,but no such association was found for O3 in Ningbo.

Objective:To analyze the influential factors of hypoalbuminemia in patients with preeclampsia and observe the pregnancy outcomes.Methods:The clinical data of 237 pregnant women with preeclampsia who received treatment in The Sixth Affiliated Hospital of Guangzhou Medical University (Qingyuan People's Hospital) from July 2018 to December 2020 were retrospectively collected and analyzed. These patients were divided into hypoproteinemia (observation group) and no hypoproteinemia (control group) groups according to whether they had hypoproteinemia. The general situation, clinical data, and adverse maternal and infant outcomes were statistically analyzed. Risk factors of hypoalbuminemia were analyzed using a logistic regression model. The predictive efficacy was evaluated using the receiver operating characteristic curve.Results:There were no significant differences in general data between the two groups (all P > 0.05). Multivariate analysis showed that D-dimer ( OR = 1.25, P = 0.004), 24-hour urinary protein ( OR = 1.29, P < 0.001), and total bile acid ( OR = 1.08, P = 0.010) were the independent risk factors for hypoproteinemia in preeclampsia. The predictive efficacy of these three indicators (area under the receiver operating characteristic curve = 0.855, P < 0.001) was greater than that of a single indicator. The incidences of adverse maternal and infant outcomes including placental abruption (9.4%, P = 0.019), liver and kidney dysfunction (34.4%, P < 0.001), pleural and ascitic fluid (28.1%, P = 0.001), fetal intrauterine growth restriction (50.0%, P = 0.001), fundus lesions (6.2%, P = 0.018), HELLP syndrome (9.4%, P = 0.019), mild neonatal asphyxia (15.6%, P = 0.022), severe asphyxia (6.2%, P = 0.049), metabolic acidosis (12.5%, P = 0.001), intrauterine infection (12.5%, P = 0.004), and neonatal hospitalization for more than 20 days (37.5%, P < 0.001) were greater in the observation group compared with the control group. There were no significant differences in postpartum hemorrhage, eclampsia, respiratory distress syndrome, fetal loss, and neonatal death between the two groups (all P > 0.05). Conclusion:D-dimer, 24-hour urinary protein, and total bile acid are independent risk factors for hypoproteinemia in preeclampsia. Patients with preeclampsia complicated by hypoproteinemia have a high risk of adverse maternal and infant outcomes.