Improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection

Objective:To study the improving effect of sputum aspiration combined with bronchoalveolar lavage by fiber bronchoscope on the condition and inflammation in lung cancer patients with postoperative pulmonary infection.Methods:A total of 78 patients with lung cancer who received surgical treatment in our hospital between August 2013 and January 2015 and were with postoperative infection were selected as the research subjects and randomly divided into two groups, control group received mechanical ventilation therapy, observation group received bronchoalveolar lavage by bronchoscope combined with mechanical ventilation, and the inflammatory factor levels, RAAS system activity and respiratory mechanics indexes of two groups were determined after treatment.Results:3 d after treatment, serum hs-CRP, TNF-α, IL-8, PCT, renin, angiotensin II and aldosterone levels of observation group were lower than those of control group, and PIP, Raw and WOB values were lower than those of control group while Cdyn value was higher than that of control group.Conclusion:For lung cancer patients with postoperative pulmonary infection, bronchoalveolar lavage by bronchoscope combined with mechanical ventilation can optimize patients' condition, relieve systemic inflammatory response and improve respiratory function, and it has positive clinical significance.

Effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia

Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.

Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope

Objective In order to achieve immediate relief of central airway obstruction caused by malignant tumor after interventional therapy, we observed the efficacy and safety of cryorecanalization after cryosurgery via flexible bronchoscope.

Removal of metallic stents using flexible bronchoscope:report of 29 cases

Objective:Placement of self expanding metallic stents(SEMS) is invariably associated with complications and often necessitates their removal usually by rigid bronchoscope.There have been few reports published on use of flexible bronchoscope(FB) for the removal.This article summarizes the indications,methods and complications of SEMS removal by FB.Methods:We reviewed our experience with removal of SEMS using FB retrospectively.The clinical data on 29 patients with average age of(39.0±13.2) years was analyzed who underwent removal of SEMS using FB between April 2002 and August 2008.Results:Thirty-seven procedures were performed in 29 consecutive patients to remove 37 stents.The average duration of stent placement was(55± 94.7) d(0-472 d).Twenty-two procedures(59.4%) were performed under local anesthesia.The percentage of procedures under general anesthesia was 13%(3/24),67%(4/6) and 100%(7/7) for the short-term(≤30 d),medium-term(31-90 d) and long-term(>90 d) of stents placement,respectively.Indications for stents removal included migration in 15(40.6%),scar restenosis in 11(29.7%),airway shaping in 5(13.5%),stent fracture in 2(5.4%),stent incomplete expansion in 2(5.4%),improper size in 1(2.7%),mucus plugging with chest pain in 1(2.7%).And 85.7% of long-term stents were removed due to scar restenosis.The total success rate was 92%.There was no significant difference in success rate between the uncovered and covered group(82.3% and 100%,P>0.05).Complications were encountered in 13 patients,bleeding being the most common(53.8%).Conclusion:Operation by FB may be an alternative method to remove SEMS effectively and safely based on the proper anesthesia chosen.

Damage Mechanism of Ultra-thin Asphalt Overlay(UTAO) based on Discrete Element Method

Aiming to analyze the damage mechanism of UTAO from the perspective of meso-mechanical mechanism using discrete element method(DEM),we conducted study of diseases problems of UTAO in several provinces in China,and found that aggregate spalling was one of the main disease types of UTAO.A discrete element model of UTAO pavement structure was constructed to explore the meso-mechanical mechanism of UTAO damage under the influence of layer thickness,gradation,and bonding modulus.The experimental results show that,as the thickness of UTAO decreasing,the maximum value and the mean value of the contact force between all aggregate particles gradually increase,which leads to aggregates more prone to spalling.Compared with OGFC-5 UTAO,AC-5 UTAO presents smaller maximum and average values of all contact forces,and the loading pressure in AC-5 UTAO is fully diffused in the lateral direction.In addition,the increment of pavement modulus strengthens the overall force of aggregate particles inside UTAO,resulting in aggregate particles peeling off more easily.The increase of bonding modulus changes the position where the maximum value of the tangential force appears,whereas has no effect on the normal force.

Mild polarization electric field in ultra-thin BN-Fe-graphene sandwich structure for efficient nitrogen reduction

The electrocatalytic N_(2)reduction reaction(NRR)is expected to supersede the traditional Haber-Bosch technology for NH3 production under ambient conditions.The activity and selectivity of electrochemical NRR are restricted to a strong polarized electric field induced by the catalyst,correct electron transfer direction,and electron tunneling distance between bare electrode and active sites.By coupling the chemical vapor deposition method with the poly(methyl methacylate)-transfer method,an ultrathin sandwich catalyst,i.e.,Fe atoms(polarized electric field layer)sandwiched between ultrathin(within electron tunneling distance)BN(catalyst layer)and graphene film(conducting layer),is fabricated for electrocatalytic NRR.The sandwich catalyst not only controls the transfer of electrons to the BN surface in the correct direction under applied voltage but also suppresses hydrogen evolution reaction by constructing a neutral polarization electric field without metal exposure.The sandwich electrocatalyst NRR system achieve NH3 yield of 8.9μg h^(−1)cm^(−2)and Faradaic Efficiency of 21.7%.The N_(2)adsorption,activation,and polarization electric field changes of three sandwich catalysts(BN-Fe-G,BN-Fe-BN,and G-Fe-G)during the electrocatalytic NRR are investigated by experiments and density functional theory simulations.Driven by applied voltage,the neutral polarized electric field induced by BN-Fe-G leads to the high activity of electrocatalytic NRR.

Regulation of interlayer channels of graphene oxide nanosheets in ultra-thin Pebax mixed-matrix membranes for CO_(2) capture

For the application of carbon capture by membrane process,it is crucial to develop a highly permeable CO_(2)-selective membrane.In this work,we reported an ultra-thin polyether-block-amide(Pebax)mixedmatrix membranes(MMMs)incorporated by graphene oxide(GO),in which the interlayer channels were regulated to optimize the CO_(2)/N_(2) separation performance.Various membrane preparation conditions were systematically investigated on the influence of the membrane structure and separation performance,including the lateral size of GO nanosheets,GO loading,thermal reduction temperature,and time.The results demonstrated that the precisely regulated interlayer channel of GO nanosheets can rapidly provide CO_(2)-selective transport channels due to the synergetic effects of size sieving and preferential adsorption.The GO/Pebax ultra-thin MMMs exhibited CO_(2)/N_(2) selectivity of 72 and CO_(2) permeance of 400 GPU(1 GPU=106 cm^(3)(STP)·cm^(2)·s^(-1)·cmHg^(-1)),providing a promising candidate for CO_(2) capture.

Numerical Investigations on Fluid Flow and Heat Transfer Characteristics of an Ultra-Thin Heat Pipe with Separated Wick Structures

Thermal and fluid-flow characteristics were numerically analyzed for ultra-thin heat pipes.Many studies have been conducted for ultra-thin heat pipes with a centered wick structure,but this study focused on separated wick structures to increase the evaporation/condensation surface areas within the heat pipe and to reduce the concentration of heat flux within the wick structure.A mathematical heat-pipe model was made in the threedimensional coordinate system,and the model consisted of three regions:a vapor channel,liquid-wick,and container wall regions.The conservation equations for mass,momentum,and energy were solved numerically with boundary conditions by using a code developed by one of the authors.The numerical results with the separated wick structures were compared with those with the centered,which confirmed the effectiveness of the separation of the wick structure.However,the effectiveness of the separation was affected by the position of the separated wick structure.A simple equation was presented to determine the optimum position of the separated wick structures.Numerical analyses were also conducted when the width of the heat pipe was increased with the cooled section,which clarified that the increase in the cooled-section width with the addition of wick structures wasmore effective than the increase in the cooled-section length.A 44%reduction in the total temperature difference of the heat pipe was obtained under the present numerical conditions.Furthermore,a comparison wasmade between experimental results and numerical results.

Value of autofluorescence bronchoscope in diagnosis of central type lung cancer

Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010,29 patients (23 men,6 women,median age 62. 2 years,range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea,1 at

经电子支气管镜肺泡灌洗在肺部感染病原学诊断中的应用

目的探究肺部感染病原学诊断中经电子支气管镜肺泡灌洗的应用。方法筛选2023年7月至2023年12月120例肺部感染患者,全部病例均予以经电子支气管镜肺泡灌洗,结束上述操作后取适量灌洗液,行细菌培养、药敏试验,分析、判读结果并观察全部病例临床治疗效果。结果入组120例患者,分离出231病原菌株,具体分布情况如下:167株革兰氏阴性菌,占比72.29%;54株革兰氏阳性菌,占比23.38%;10株真菌,占比4.33%。药敏试验表明:阿米卡星和头孢吡肟对大肠埃希菌和肺炎克雷伯菌均表现出很高的灵敏性;多粘菌素和阿米卡星对铜绿假单胞菌和鲍曼不动杆菌表现出较高的灵敏性。全部患者治疗总有效率高达98.33%(118/120)。患者治疗后用力肺活量(FVC)、第1秒用力呼气容量(FEV1)、FEV1/FVC指标改善,与治疗前比较差异有统计学意义(P<0.05)。全部病例诊疗满意度高达97.50%(117/120)。结论基于支气管镜下,实施肺泡灌洗对肺部感染进行病原学鉴别是可行的,不仅可切实明确患者感染病原菌种类,还可基于其药物敏感性检测结果,合理选用相应的抗生素药物,改善患者肺部功能、提高其疾病疗效,保证患者对临床医疗服务的满意度。

改良式俯卧位通气联合支气管镜肺泡灌洗对ARDS患儿呼吸力学及血流动力学的影响及有效性评价

目的探讨改良式俯卧位通气联合支气管镜肺泡灌洗治疗对ARDS患儿呼吸力学和血流动力学影响以及临床治疗效果评价。方法选取2021年1月至2023年12月在昆明市儿童医院急诊重症监护病房的96例接受机械通气治疗的ARDS患儿为对象,按随机数字法分为A、B、C 3组。A组为传统俯卧位通气组(n=32)、B组改良式俯卧位通气组(n=32)、C组为改良式俯卧位通气联合支气管镜肺泡灌洗治疗组(n=32)。比较3组治疗前及治疗后以下参数的变化,氧合指标:动脉血氧分压(PaO_(2))、动脉氧合指数(PaO_(2)/FiO_(2));呼吸力学指标:肺顺应性、气道平均压、气道平台压、气道总阻力;血流动力学指标:心输出量、心指数、总外周阻力指数,平均动脉压;临床疗效指标:啰音消失时间,机械通气时间,住院时间;并发症发生率:心律失常、气道阻塞、压力性损伤、导管脱落总发生率、胃内容物反流。结果C组治疗后的氧合指标优于A组和B组(P<0.05)。C组治疗后的呼吸力学指标优于A组和B组(P<0.05)。血流动力学方面:C组治疗后心输出量、心指数、平均动脉压3项指标与A、B组比较,差异无统计学意义(P>0.05);C组治疗后总外周阻力指数指标优于A组和B组(P<0.05)。C组治疗后的临床疗效指标优于A组和B组(P<0.05)。C组治疗后的并发症发生率较A组、B组无明显差异(P>0.05)。结论改良式俯卧位通气联合支气管镜肺泡灌洗治疗方案较传统治疗方法有更好的治疗效果,对患儿氧合及呼吸力学指标及血流总外周阻力指数有较好改善,值得临床推广。

Fabrication and Simulation of an AlGaAs/GaAs Ultra-Thin Base NDR HBT

A novel mesa ultra-thin base AlGaAs/GaAs HBT is designed and fabricated with wet chemical selective etch technique and monitor electrode technique. It has a particular and obvious voltage-controlled NDR whose PVCR is larger than 120. By use of device simulation,the cause of NDR is that increasing collector voltage makes the ultrathin base reach through and the device transforms from a bipolar state to a bulk barrier state. In addition, the simulated cutoff frequency is about 60-80GHz.

Spontaneous Orientation Polarization of Anisotropic Equivalent Dipoles Harnessed by Entropy Engineering for Ultra‑Thin Electromagnetic Wave Absorber

The synthesis of carbon supporter/nanoscale high-entropy alloys(HEAs)electromagnetic response composites by carbothermal shock method has been identified as an advanced strategy for the collaborative competition engineering of conductive/dielectric genes.Electron migration modes within HEAs as manipulated by the electronegativity,valence electron configurations and molar proportions of constituent elements determine the steady state and efficiency of equivalent dipoles.Herein,enlightened by skin-like effect,a reformative carbothermal shock method using carbonized cellulose paper(CCP)as carbon supporter is used to preserve the oxygencontaining functional groups(O·)of carbonized cellulose fibers(CCF).Nucleation of HEAs and construction of emblematic shell-core CCF/HEAs heterointerfaces are inextricably linked to carbon metabolism induced by O·.Meanwhile,the electron migration mode of switchable electronrich sites promotes the orientation polarization of anisotropic equivalent dipoles.By virtue of the reinforcement strategy,CCP/HEAs composite prepared by 35%molar ratio of Mn element(CCP/HEAs-Mn_(2.15))achieves efficient electromagnetic wave(EMW)absorption of−51.35 dB at an ultra-thin thickness of 1.03 mm.The mechanisms of the resulting dielectric properties of HEAs-based EMW absorbing materials are elucidated by combining theoretical calculations with experimental characterizations,which provide theoretical bases and feasible strategies for the simulation and practical application of electromagnetic functional devices(e.g.,ultra-wideband bandpass filter).

支气管镜肺泡灌洗术联合阿奇霉素治疗儿童肺炎支原体肺炎合并肺实变的效果

目的:探究支气管镜肺泡灌洗术(BAL)联合阿奇霉素治疗儿童肺炎支原体肺炎(MPP)合并肺实变的效果及其对痰液中MP-DNA载量及C反应蛋白(CRP)、血清淀粉样蛋白A(SAA)、血小板反应蛋白(TSP-1)水平的影响。方法:选取江西省妇幼保健院2023年8月—2024年2月收治的150例MPP合并肺实变患儿,按抽签法将其分为对照组和研究组,每组75例。对照组使用阿奇霉素治疗,研究组在对照组基础上联合使用BAL。对两组治疗前后痰液MP-DNA载量及CRP、SAA、TSP-1水平,不良反应,疗效进行比较,观察研究组BAL相关并发症的发生率。结果:治疗后研究组痰液MP-DNA载量、CRP、SAA、TSP-1水平均低于对照组(P<0.05),两组不良反应发生率比较,差异无统计学意义(P>0.05),研究组治疗效果优于对照组,差异有统计学意义(P<0.05),研究组BAL术中术后的肺部出血、气管痉挛、心律不齐的发生率分别为2.67%、5.33%、2.67%。结论:对MPP合并肺实变的患儿,BAL联合阿奇霉素治疗提供了一种安全有效的新选择,可降低痰液中MP-DNA载量,有效地控制炎症反应。

纤维支气管镜肺泡灌洗辅助治疗对小儿重症支原体肺炎患儿炎性指标、免疫学指标的影响

目的研究纤维支气管镜肺泡灌洗作为辅助治疗手段,对小儿重症支原体肺炎患者的炎症标志物及免疫学参数的影响。方法选取莆田市第一医院收治的60例重症支原体肺炎患儿为对象,样本案例纳入时间范围为2021年5月至2023年6月,并根据纳入时间分组,2021年5月至2022年5月收治的30例为对照组,采用常规治疗。2022年6月至2023年6月收治的30例为研究组,在常规治疗手段的基础上,该组增加纤维支气管镜肺泡灌洗。对比两组临床疗效、炎性指标、免疫学指标、相关症状消退时间。结果研究组患儿临床治疗总有效率高于对照组(P<0.05)。与对照组相比,治疗后研究组患儿相关炎性指标均较低(P<0.05)。治疗后研究组CD3+、CD4+指标降低,而CD8+则有所升高(P<0.05)。且研究组相关症状消退时间较短(P<0.05)。结论采用纤维支气管镜肺泡灌洗作为辅助治疗手段,对于重症支原体肺炎的患儿而言,能够提升治疗效果,实现更为理想的治疗成果,可积极减轻患儿炎性反应,提升其免疫能力,利于早日获得康复,缩短相关治疗时间。

Research on the Influence of Cutting Condition on the Surface Microstruct ure of Ultra-thin Wall Parts in Ultrasonic Vibration Cutting

In many fields of high-tech industry the ultra-t hi n wall parts are employed. In this paper the experiments were carried out to dis cuss the surface microstructure of the camera’s guided drawtube by applying ult rasonic vibration cutting device to the traditional lathe. The influence rule of the cutting condition on the surface roughness was put forward, which was drawn by comparing the ultrasonic cutting with the common cutting by use of the cemen ted carbide tool and the polycrystalline diamond (PCD) tool. The test results sh owed that the ultrasonic cutting performs better than the common cutting in the same condition. According to the test results analyzing, the surface characteriz ation is influenced clearly by the rigidity of the acoustic system and the machi ne tool, as well the setting height of the tool tip. Otherwise, the dense regula r low frequency vibration ripples will be scraped on the machined surface. When the tool tip is set higher than the rotating center of the work piece by three t imes of the amplitude of ultrasonic vibration, the vibration ripples behave alig ht; they turn light and shade alternatively when the tool tip is lower than the rotating center of the work piece by three times of the amplitude of ultrasonic vibration. According to the test result analyzing, the following conclusions are put forward: 1) The surface roughness in ultrasonic cutting is better than that in common cutting. Under a one third critical cutting velocity, the value of th e surface roughness in ultrasonic cutting rise slightly along with the cutting v elocity, while in common cutting it decreases contrast to the cutting velocity; the curves of the surface roughness in ultrasonic cutting and common cutting see m to be alike, both increase along with the feed rate and the cutting depth, but the value in ultrasonic cutting is smaller in the same condition.2) The influen ce of the coolant on the surface roughness cannot be ignored. The kerosene can b e employed to improve the surface roughness in ultrasonic machining.3) In ultras onic cutting process of aluminum alloy ultra-thin wall work piece, the PCD tool performs better than the cemented carbide tools.4) The vibration ripples result from the not enough rigidity of the acoustic system and the improper setting he ight of the tool tip. The departure of the tool tip from the rotating center of the work piece to some extent causes the vibration ripples on the machined surfa ce.

High-efficiency ultra-thin Cu_(2)ZnSnS_(4) solar cells by double-pressure sputtering with spark plasma sintered quaternary target

In recent years,Cu_(2)ZnSnS_(4)(CZTS)semiconductor materials have received intensive attention in the field of thin-film solar cells owing to its non-toxic and low-cost elements.In this work,double-pressure sputtering technology is applied to obtain highly efficient and ultra-thin(-450 nm)pure Cu_(2)ZnSnS_(4)(CZTS)solar cell.Using mixed materials with sulfides and copper powder as a quaternary target via spark plasma sintering(SPS)method and adopting double-layer sputtering(high+low pressure),a highly adhesive and large-grained CZTS thin film is achieved.As a result,the damage to the surface of Mo contact is decreased so that the reflectivity of incident light can be improved.Moreover,the composition of CZTS film was more uniform and the secondary phase separation at the Mo interface was reduced.Therefore,the interface defect state and deep level defect density in corresponding device with double-pressure is reduced and the ratio of depletion thickness to absorption layer thickness can reached to 0.58,which promoted the collection of photogenerated carriers.Finally,an efficiency of 9.3%for ultra-thin(~450 nm)CZTS film solar cell is obtained.

Large energy-loss straggling of swift heavy ions in ultra-thin active silicon layers

Monte Carlo simulations reveal considerable straggling of energy loss by the same ions with the same energy in fully-depleted silicon-on-insulator （FDSOI） devices with ultra-thin sensitive silicon layers down to 2.5 rim. The absolute straggling of deposited energy decreases with decreasing thickness of the active silicon layer. While the relative straggling increases gradually with decreasing thickness of silicon films and exhibits a sharp rise as the thickness of the silicon film descends below a threshold value of 50 nm, with the dispersion of deposited energy ascending above ~10%. Ion species and energy dependence of the energy-loss straggling are also investigated. For a given beam, the dispersion of deposited energy results in large uncertainty on the actual linear energy transfer （LET） of incident ions, and thus single event effect （SEE） responses, which pose great challenges for traditional error rate prediction methods.

K_(x)C_(y) phase induced expanded interlayer in ultra-thin carbon toward full potassium-ion capacitors

Carbonaceous materials have been regarded as highly promising anode candidates for potassium storage with their cost-effectiveness and environmental benignity.However,low specific capacity and difficulty in large-scale synthesis largely hinder their further development.Herein,a thermal-induced potassium–carbon alloy phase(K_(x)C_(y))with the expanded interlayer spacing strategy is first put forward.Through in situ high-temperature X-ray diffraction,a K_(2)C_(2) phase is evoked by thermal energy during the in-situ carbonization process of carbon quantum dots intermediate derived from potassium-containing precursors,whereas no lithium or sodium–carbon alloy phase is observed from lithium/sodium-containing precursors.The asobtained ultra-thin carbon nanosheets achieve adjustable layer spacing,preparation in bulk,delivering reversible potassium storage of 403.4 mAh g^(−1) at 100 mA g^(−1) and 161.2 mAh g^(−1) even at 5.0 A g^(−1),which is one of the most impressive K-storage performances reported so far with great potential application.Furthermore,the assembled potassium-ion hybrid capacitor by combining the impressive CFMs-900 anode with the three-dimensional framework-activated carbon delivers a high energy-power density of 251.7 Wh kg^(−1) at 250Wkg^(−1) with long-term stability.This study opens a scalable avenue to realize the expanded interlayer spacing,which can be extended to other multicarboxyl potassium salts and can provide approach for the design of high-performance carbon anode materials for potassium storage.

Virtual bronchoscopic navigation without fluoroscopy guidance for peripheral pulmonary lesions in inexperienced pulmonologist

Objective:Fluoroscopy guidance is generally required for endobronchial ultrasonography with guide sheath(EBUS-GS)in peripheral pulmonary lesions(PPLs).Virtual bronchoscopic navigation(VBN)can guide the bronchoscope by creating virtual images of the bronchial route to the lesion.The diagnostic yield and safety profiles of VBN without fluoroscopy for PPLs have not been evaluated in inexperienced pulmonologist performing EBUS-GS.Methods:Between January 2016 and June 2017,consecutive patients with PPLs referred for EBUS-GS at a single cancer center were enrolled.The diagnostic yield as well as safety profiles was retrospectively analyzed,and our preliminary experience was shared.Results:A total of 109 patients with 109 lesions were included,99(90.8%)lesions were visible on EBUS imaging.According to the procedure time needed to locate the lesion on EBUS,24.8%(27/109)were deemed technically difficult procedures;however,no significant relationships were identified between candidate parameters and technically difficult procedures.The overall diagnosis yield was 74.3%(81/109),and the diagnostic yield of malignancy was 83.7%(77/92).Lesions larger than 20 mm[odds ratio(OR),2.758;95%confidence interval(95%CI),1.077-7.062;P=0.034]and probe of within type(OR,3.174;95%CI,1.151-8.757,P=0.026)were independent factors leading to a better diagnostic yield in multivariate analysis.About 30 practice procedures were needed to achieve a stable diagnostic yield,and the proportion of technically difficult procedures decreased and stabilized after 70 practice procedures.Regarding complications,one patient(0.9%)had intraoperative hemorrhage(100 mL)which was managed under endoscopy.Conclusions:VBN without fluoroscopy guidance is still useful and safe for PPLs diagnosis,especially for malignant diseases when performed by pulmonologist without previous experience of EBUS-GS.VBN may simplify the process of lesion positioning and further multi-center randomized studies are warranted.