Objective To evaluate the diagnostic value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and conventional-transbronchial needle aspiration (C-TBNA) in mediastinal and lung hilar lesions. Method 301 cases of lung hilar and mediastinal lesions were selected from 2010 to 2016. Among them, 183 cases underwent TBNA, and the other 118 cases received EBUS-TBNA technology. During the research, the associations of diagnostic positive rate and complications were analyzed in order to explore the advantage and the value of EBUS-TBNA. Results The positive rates of EBUS-TBNA in central groups (2R, 4L, 4R, 7) were higher than in the peripheral groups (10R, 10L, 11R, 11L) (P < 0.05). When studying the lymph node group 2R, 4R and 7R, the positive rate of EBUS-TBNA is much more significant than conventional TBNA (P < 0.05); When biopsying at the lymph node group R4 and group 7, one needle positive rate of EBUS-TBNA were much more superior than TBNA (P < 0.05), the three needles cumulative positive rate of EBUS-TBNA almost reach the total positive rate(P > 0.05), an approving effect of puncture can be acquired; The accuracy and sensitivity of EBUS-TBNA in the diagnosis of lung hilar and mediastinal lesions were much better than conventional TBNA (P < 0.05), especially the diagnostic positive rate of EBUS-TBNA in benign diseases was higher (P < 0.05); The complications rates in both two technologies were not significantly different (P > 0.05), there were no severe complications during the operations in all cases. Conclusion EBUS-TBNA is useful in diagnosis of mediastinal and hilar lesions of unknown reason, and significant in diagnosis of bronchial and extrabronchial diseases. It is an efficiency and safe operation while further application studies are needed.

Objective To evaluate the value of bronchoscope-guaided different combined interventions in the treatment of patients with malignant severe central airway stenosis.Methods A total of 48 patients with malignant severe central airway stenosis were selected and divided into group A treated with combined interventions including high-frequency electrotome + argon plasma coagulation (APC) + freezing (n =31),while another 17 with combined interventions including high-frequency electrotome + APC + freezing + tracheal stent implantation were designed as group B.The response rate (RR) after initial interventional treatment and the middle-and short-term clinical efficacy after 6-month follow up were observed,and corresponding complications and adverse events were recorded.Results The RR of all patients was 100％,in which group B was significantly better in the increase of airway diameter and increase rate of cross sectional area (CSA) (P ＜ 0.05),but was significantly lower in polypnea index than group A (P ＜ 0.05),but there was no significant difference between two groups in forced expiratory volume in one second (FEV1) in the expected value (FEV1％)(P ＞0.05).During 6-month follow-up,there were significant differences in the average monthly interventional therapeutic frequency and average remission period between two groups (P ＜0.05).No patients had complications immediately after interventional process.During the 6-month follow-up,4 8 patients had different-degree chest pain,hemoptysis and retention of secretes.Conclusion Bronchoscope-guided different combined interventions have excellent efficacy in the treatment of patients with malignant severe central airway stenosis.

Objective To evaluate the value of bronchoscope-guaided different combined interventions in the treatment of patients with malignant severe central airway stenosis.Methods A total of 48 patients with malignant severe central airway stenosis were selected and divided into group A treated with combined interventions including high-frequency electrotome + argon plasma coagulation (APC) + freezing (n =31),while another 17 with combined interventions including high-frequency electrotome + APC + freezing + tracheal stent implantation were designed as group B.The response rate (RR) after initial interventional treatment and the middle-and short-term clinical efficacy after 6-month follow up were observed,and corresponding complications and adverse events were recorded.Results The RR of all patients was 100％,in which group B was significantly better in the increase of airway diameter and increase rate of cross sectional area (CSA) (P ＜ 0.05),but was significantly lower in polypnea index than group A (P ＜ 0.05),but there was no significant difference between two groups in forced expiratory volume in one second (FEV1) in the expected value (FEV1％)(P ＞0.05).During 6-month follow-up,there were significant differences in the average monthly interventional therapeutic frequency and average remission period between two groups (P ＜0.05).No patients had complications immediately after interventional process.During the 6-month follow-up,4 8 patients had different-degree chest pain,hemoptysis and retention of secretes.Conclusion Bronchoscope-guided different combined interventions have excellent efficacy in the treatment of patients with malignant severe central airway stenosis.

Objective To investigate early diagnosis and treatment of Paget disease of breast. Methods The clinicopathological data of 26 cases of breast Paget disease in the First Affiliated Hospital of Wenzhou Medical University from January 1995 to June 2018 was analyzed. Results The main clinical manifestation of 26 patients was eczema like papillae in 19 cases (73.1%), and associated with nipple discharge in 9 cases (34.6% ) and breast mass in 6 cases (23.1% ). The diagnosis of this disease was based on curettage cytology in 4 cases (15.4% ), biopsy in 8 cases (30.8% ), and needle aspiration cytology or post resection pathological examination in 14 cases (53.8% ). Paget disease consisted of simple papillary Paget disease in 3 cases (11.5%), ductal carcinoma in 18 cases (69.2%) and invasive ductal carcinoma in 5 cases (19.2%). Pathological TNM staging was 0 stage in 19 cases (73.1%), stageⅠin 3 cases (11.5%), stageⅡin 2 cases (7.7%), stageⅢin 2 cases (7.7%) and no stage inⅣcase. In this group, 2 cases underwent radical mastectomy, 18 cases underwent modified radical mastectomy, 4 cases underwent simple mastectomy, and 2 cases underwent mastectomy combined with low axillary lymph node dissection and intraoperative rapid frozen examination. Fourteen patients received adjuvant chemotherapy with CEF(cyclophosphamide + pharmorubicin + tegafur)/EC (pharmorubicin + cyclophosphamide) + T(docetaxel) or TP(docetaxel + cis- platinum)regiment after operation, 2 cases were treated with trastuzumab targeted therapy and 5 cases with adjuvant radiotherapy. Twenty-five of 26 patients were followed up for 8-108 months except one patient lost in follow-up. The 5-year survival rate was 96.0% (24/25), and the 10-year survival rate was 52.0% (13/25). Conclusions The diagnosis of Paget disease of the breast depends on cytology or pathology, and multidisciplinary treatment based on surgery is judged of by tumor stage and coincident other types of breast cancer and axillary lymph node involvement.

OBJECTIVEThe purposes of our study were to investigate the association between maternal urinary phthalate metabolites and the levels of inhibin B (INHB) and insulin-like factor 3 (INSL3) in the cord blood in a Chinese pregnant population.

METHODSMaternal urine samples in the third trimester of pregnancy of 69 participants were collected and stored, and the samples of cord blood (10 ml) were collected at delivery between June 2011 and September 2012 in a comprehensive hospital of gynecology and obstetrics in Tianjin, China.Four phthalate metabolites, monomethyl phthalate (MMP), monoethyl phthalate (MEP), monobutyl phthalate (MBP), and mono-2-ethylhexyl phthalate (MEHP) were measured in the urine samples using liquid chromatography-tandem mass spectrometry. The levels of INHB, INSL3 in the cord blood were tested by ELISA. Associations of phthalate exposure with INHB and INSL3 levels were determined by spearman correlation and multiple regression model analysis.

RESULTSThe median concentrations of observed metabolites in descending order were 49.74 µg/L for MMP, 24.96 µg/L for MEHP, 19.52 µg/L for MEP and 17.73 µg/L for MBP. The median concentrations of INHB and INSL3 were 89.09 and 106.21 ng/L.Significant negative associations between INHB and MMP(β' = -0.252), MEP(β' = -0.363) or the sum value (∑PAEs) (β' = -0.346) were found by the multiple regression model analysis. For INSL3, only the sum value (β' = -0.313) was inversely significantly associated with the levels of INSL3 in the cord blood.

CONCLUSIONSMaternal urinary phthalate metabolites were associated with INHB and INSL3 in the cord blood in a Chinese population.

Adult ; Diethylhexyl Phthalate ; analogs & derivatives ; urine ; Female ; Fetal Blood ; chemistry ; Humans ; Infant, Newborn ; Inhibin-beta Subunits ; blood ; Insulin ; blood ; Male ; Maternal Exposure ; Phthalic Acids ; urine ; Pregnancy ; Proteins ; Testicular Hormones ; blood ; Young Adult

There is a high risk of myelosuppression in pelvic malignant tumors during concurrent chemoradiotherapy. The dose-volume relationship of pelvic exposed bone marrow( bone) is related to acute hematological toxicity during radiotherapy and chemotherapy,but lacks recognized parameters in this respect. The hematopoietic capacity of the bone marrow(bone)in different parts of the pelvic cavity is heterogeneous,and the pelvic bone marrow near the central axis has the strongest hematopoietic capacity,namely functional bone marrow. The relationship between dose-volume parameters of pelvic functional bone marrow and acute hematologic toxicity during chemoradiotherapy of pelvic malignant tumors may be the future direction.