Objective:To compare the effects of volume-controlled ventilation (VCV),pressure-controlled ventilation (PCV) and pressure controlled ventilation-volume guarantee (PCV-VG) on respiratory mechanics and respiratory function index in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods:Seventy-five patients who underwent EBUS-TBNA under general anesthesia during February to December in 2019 in Lishui City People's Hospital,China were included in this study.They were randomly assigned to undergo VCV (Group V),PCV (Group P) or PCV-VG (Group G),with 25 patients in each group during EBUS-TBNA.After exclusion because of different reasons,25,24 and 24 patients from the Groups V,P and G respectively were included in the final analysis.Peak airway pressure (P peak),pulmonary dynamic compliance (C dyn),the partial pressure of carbon dioxide in arterial blood (PaCO 2),and oxygenation index (OI) at baseline (T 0),at the time of EBUS-TBNA for 30 (T 1) and 60 min (T 2) and immediately after EBUS-TBNA (T 3). Results:At T 2 and T 3,P peak in the Group P was (22.5 ±5.2) cmH 2O and (16.2 ± 2.8) cmH 2O respectively,which was significantly lower than that in the Group V [(25.8 ± 3.5) cmH 2O,(18.2 ± 3.2) cmH 2O, q = 3.672,3.454, P = 0.031,0.045).At T 1,T 2 and T 3,C dyn in the Group P was (26.4 ± 5.0) mL/cmH 2O,(24.1 ± 4.5) mL/cmH 2O and (32.5 ± 4.2) mL/cmH 2O,respectively,which was significantly higher than that in the Group V [(23.0 ± 2.7) mL/cmH 2O,(19.9 ± 2.1) mL/cmH 2O,(28.5 ± 3.7) mL/cmH 2O, q = 3.732,4.795,4.118, P = 0.027,0.004,0.013).At T 2 and T 3,P peak in the Group G was (21.7 ± 4.3) cmH 2O,(15.6 ± 2.6) cmH 2O,respectively,which was significantly lower than that in the Group V [(25.8 ± 3.5) cmH 2O,(18.2 ± 3.2) cmH 2O, q = 4.493,4.332, P = 0.006,0.009]. At T 1,T 2,and T 3,C ydn in the Group G was (26.6 ± 5.6) mL/cmH 2O,(24.3 ± 5.6) mL/cmH 2O,(33.2 ± 6.3) mL/cmH 2O,which was higher than that in the Group V [(23.0 ± 2.7) mL/cmH 2O,(19.9 ± 2.1) mL/cmH 2O,(28.5 ± 3.7) mL/cmH 2O, q = 3.852,4.936,4.791, P = 0.022,0.002,0.003]. At T 2 and T 3,PaCO 2 in the Group G was (41.1 ± 3.8) mmHg,(38.4 ± 3.4) mmHg,respectively,which was significantly lower than that in the group V [(45.7 ± 3.4) mmHg,(41.0 ± 3.0) mmHg, q = 5.969,3.682, P = 0.000,0.030].At T 2,OI in the group G was significantly higher than that in the group V [(358.0 ± 32.8) mmHg vs.(326.6 ± 29.7) mmHg, q = 4.782, P = 0.030].There were no significant differences in indexes between groups P and G (all P>0.05). Conclusion:During EBUS-TBNA for>60 min,PCV combined with VG can not only reduce airway pressure and improve lung compliance,but also prevent respiratory acidosis and improve oxygenation.

BACKGROUNDAccurate detection of human epidermal growth factor receptor 2 (HER2) expression and gene amplification is crucial for the application of HER2-specific therapy and for evaluating the response of patients with breast cancer. A uniform and standard procedure of immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) needs to be established for evaluating the HER2 status in breast cancer tissues for the treatment of patients with real HER2-positive tumors. The present multicenter study was aimed to examine the HER2 status in breast cancer specimens from Chinese patients using both IHC and FISH methods.

METHODSA multicenter study was performed on the HER2 status in 3 149 breast cancer specimens from different ethnic populations and areas in China by IHC and FISH assays. The potential association of HER2 status with demographic and clinical characteristics was analyzed.

RESULTSThe positive rates for HER2 over-expression and HER2 amplification were 23.3% and 27.5% in this study, respectively. The concordance between IHC and FISH was 71.2% (κ = 0.494, P < 0.001). Furthermore, 72.9% of specimens with IHC 2+ were negative to FISH. The discordance rates among laboratories were from 5% to 28% for IHC and 1% to 16% for FISH. HER2 amplification was associated significantly with advanced tumor stage (III or IV, P = 0.002), large tumor size (>5 cm, P = 0.002), moderate and poor histological grades (P < 0.0001), post-menopause (P < 0.0001), ER-PR- (P = 0.002), and having ≥ 4 lymph nodes affected (P < 0.0001) in this population. The positive rates of HER2 amplification in specimens from Man and Hui Chinese were significantly higher than that in other Chinese populations. There are slightly higher positive rates of HER2 expression and amplification in Chinese patients with breast cancer.

CONCLUSIONThese findings may provide new insights into understanding the epidemiological features of HER2 expression and amplification, and may be valuable for clinical practice.

Biomarkers, Tumor ; analysis ; genetics ; metabolism ; Breast Neoplasms ; metabolism ; Female ; Humans ; Immunohistochemistry ; methods ; In Situ Hybridization, Fluorescence ; methods ; Middle Aged ; Receptor, ErbB-2 ; analysis ; genetics ; metabolism