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Background and Objective: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has been widely applied in diagnosing mediastinal and hilar adenopathy. This study is further to evaluate value and safety of EBUS-TBNA in diagnosing intrathoracic metastasis from extrapulmonary malignancy., Methods: Prospectively analysis of 41 patients suspected intrathoracic metastasis from previous diagnosed/concurrent extrapulmonary malignancies in Shanghai Chest Hospital, with radiologic findings showing mediastinal/hilar lymph node enlargement or intrapulmonary lesion requiring EBUS-TBNA examination for pathological diagnosis., Results: 41 candidate patients enrolled, and 67 mediastinal/hilar lymph nodes and 5 intrapulmonary lesions were aspirated. 14 intrathoracic metastasis, 10 primary lung cancer, 9 reactive lymphadenitis, 4 sarcoid-like reactions, and 1 tuberculosis was diagnosed by EBUS-TBNA. Sensitivity and accuracy of EBUS-TBNA in diagnosing intrathoracic metastasis was 87.50% and 95.12%, respectively. Immunohistochemistry (IHC) was performed in 18 malignant tumors to obtain definite type or origin, twelve intrathoracic metastasis and 6 primary lung cancer were further confirmed., Conclusions: EBUS-TBNA is a safe, effective method for the diagnosis of intrathoracic metastasis from extrapulmonary malignancy. IHC can provide additional evidence for distinguishing extrapulmonary malignancy from primary lung cancer.

Objective: To investigate the clinical characteristics and analyze the proportions of adult hip fracture patients combined with other sites of fractures., Methods: Adult patients with hip fractures admitted to the Third Hospital of Hebei Medical University were retrospectively collected from January 2008 to December 2012. The proportions of patients combined with other fractures were calculated and the clinical features of gender, age and combined fracture sites were analyzed., Results: A total of 3 310 patients with hip fracture were included, and 328 patients of them were combined with other site fractures, therefore with the proportions of 9.91%, and 13.93% for males, 6.40% for females respectively. The patients aged ≥ 30 and < 40 years account for the highest (26.88%) proportion of combined fractures, with the single summit for incident age. The most amount of hip fracture patients with other site fractures were aged ≥ 70 and < 80 years (56 patients). Which were aged ≥ 30 and < 40 years, ≥ 40 and < 50 years for males (41 patients), while aged ≥ 80 years for females (32 patients). There were a total of 536 combined fracture sites with 1.63 sites per patient, and 1.73 sites per males, 1.45 sites per females. The highest of average sites per patient (2.22 sites/person) was occurred at age ≥ 16 and < 20 years. For youth or males patients, the most common combined fracture sites were diaphyseal femur fracture, tibia and fibula and ankle fractures, foot fractures. While for elderly or female patients, it were thoracolumbar fractures and distal radius and ulna fractures., Conclusions: The young or male patients have the most possibility to combine with other sites of fractures. For youth or males, the most common combined fracture sites are concentrated in the lower limbs. While for elderly or female patients, thoracolumbar fractures and distal radius and ulna fractures are more commonly.

Background and Objectives: The aim of this study is to determine the best reference values of the optimal evaluation indexes that identify different disease types. Disease identification was conducted using the YUV quantitative analysis of autofluorescence bronchoscopy (AFB) images in the target areas. Furthermore, this study discusses the significance of AFB in the diagnosis of the central-type lung cancer., Methods: A biopsy was conducted for cases that showed pathologic changes under either autofluorescence or white-light bronchoscopy. Moreover, MATLAB was used to carry out the quantitative analyses of lesion in multi-color spaces from AFB images. The cases were divided into different groups according to the pathological diagnosis of normal bronchial mucosa, inflammation, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and invasive cancer. SPSS 11.5 was used to process the data for statistical analysis., Results: The Y values were different and statistically different between invasive cancer and LGD (P<0.001) and invasive cancer and inflammation (P=0.040), respectively. The U values between invasive cancer and the other groups were statistically different (P<0.050). Similarly, the V values between invasive cancer and LGD and inflammation and normal bronchial mucosa were different. Lastly, the V values between normal bronchial mucosa and HGD and inflammation and normal bronchial mucosa were different., Conclusions: The YUV values in the AFB effectively identified benign and malignant diseases and were proven to be effective scientific bases for the accurate AFB diagnosis of lung cancer.

Objective: To analyze the gender, age, fracture classification and variation trend of adult intertrochanteric fractures treated in a single-center hospital in ten years., Methods: The data of adult (age ≥ 16 years) intertrochanteric fractures admitted to the Third Hospital of Hebei Medical University from January 2003 to December 2012 were collected retrospectively. All the fractures were acute and the pathological or periprosthetic fractures were excluded. The radiography of fracture were classified by same experienced orthopedic resident and verified by two orthopedic deans and one radiologist. The gender, age and fracture classification were analyzed and compared between January 2003 to December 2007 and January 2008 to December 2012., Results: A total of 3 201 cases were collected. The adult intertrochanteric fractures accounted for 2.97% of all adult fractures and 43.76% of adult proximal femoral fractures. Of all fractures 64.98% were elderly ( ≥ 60 years) and 35.02% were middle-aged (16-59 years). In elderly, female were common (57.78%) while in middle-aged were male commonly (79.13%). According to Evans classification, instable fractures were more common (68.92%). According to AO classification, the most common type was A2 (49.67%) and the least was A3 (15.93%). Comparing between January 2003 to December 2012 and January 2008 to December 2012, the proportion of intertrochanteric fracture of adult fracture was decreased by 0.31% (χ² = 9.29, P = 0.002)and the proportion of intertrochanteric fracture of adult proximal femoral fractures was decreased by 3.15% (χ² = 7.35, P = 0.007). The proportion of elderly patients, female and stable fractures was increased by 14.35% (χ² = 71.98, P < 0.01), 4.04% (χ² = 8.16, P = 0.004) and 5.62% (χ² = 11.7, P = 0.001), respectively. The proportion of AO classification was not significantly verified (χ² = 3.24, P = 0.198)., Conclusions: The intertrochanteric fractures are most common in elderly patients, A2-type of AO Classification and stable (Evans III, IV, V) in Evans classification. Compared with the previous five years, the proportions of female, elderly and stable (Evans I, II) fracture increase in last 5 years.

Objective: To explore the optimized methods to define and delineate supraclavicular lymph nodal target in postmastectomy radiotherapy for breast cancer patients., Methods: From September 2012 to August 2013, a total of 10 breast cancer patients at Sun Yan-sen University Cancer were selected for mastectomy plus postoperative radiotherapy. The clinical target volume (CTV) of every patient was delineated on CT-slices after computed tomography (CT) simulation by 6 radiation oncologists. Then the coverage discrepancy in anatomic lymphatic drainage subregions was analyzed among both CTVs by different oncologists and CTVs for patients with different clinical characters., Results: The average volume of SCLN-CTVs was 110 ± 28 cm(3). All SCLN, neck-IV and axilla III regions were covered in CTV, none of axillaIregion. The covergy rates of nonsurgery-axillaII, Rotter-LN, intraclavicular-LN, neck-Vb, scalenus gap, neck-III and surgery-axilla IIregions was 75%, 85%, 73%, 88%, 68%, 10%, 17% , respectively., Conclusion: SCLN, neck-IV and axilla III regions should be covered according to consensus. However, the opinions of nonsurgery-axillaII, Rotter-LN, intraclavicular-LN, neck-Vb, scalenus gap, neck-III and surgery-axilla IIremain divisive.

Background and Objective: The aim of this study is to evaluate diagnostic yield and the safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis ofbronchogenic carcinoma., Methods: Between July, 2009 and February, 2010, 95 patients with mediastinal/hilar lymphadenopathy and/or intrathoracic peritracheal or peribronchial masses previously detected with CT scan underwent EBUS-TBNA. No rapid onsite cytology was performed., Results: In all 95 patients, 60 cases were newly diagnosed lung cancer through the pathological examination and clinical follow-up certification. In 60 lung cancer cases, 112 samples were obtained from lymph nodes (LNs) and 11 samples were obtained from intrapulmonary lesions. Fifty-eight cases of patients were diagnosed, false negative in 2 cases. Sensitivity and specificity of EBUS-guided TBNA method in distinguishing benign from malignant LNs or thoracic masses were 96.67% and 100%, respectively. There was any major complication in this series, the procedure was uneventful., Conclusion: EBUSTBNA seemed a safe and effective technique in making bronchogenic carcinoma diagnosis for mediastinal/hilar LNs and intra-pulmonary masses.