Objective:To investigate the incidence and influencing factors of pneumothorax in elderly patients(aged ≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).Methods:A prospective cohort study was conducted, enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status, patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups, and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.Results:Among the 647 elderly patients who underwent PLB, 152 cases(23.5%, 152/647)developed pneumothorax, with 101 cases(15.6%)presenting with minor pneumothorax and 51 cases(7.9%)with major pneumothorax.Compared with the non-pneumothorax group, patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD), higher frailty proportion, smaller lesions, lesions located further from the chest wall, more frequent bronchial involvement, and a higher rate of puncture depth ≥5 cm(all P<0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax: COPD( OR=1.256, 95% CI: 1.014-1.558, P=0.033), lesion size ≤2 cm( OR=1.345, 95% CI: 1.075-1.659, P=0.022), lesion-to-chest-wall distance ≥2 cm( OR=1.372, 95% CI: 1.105-1.703, P=0.007), presence of pulmonary bullae or emphysema( OR=1.524, 95% CI: 1.223-1.899, P<0.001), ground-glass opacity density( OR=1.313, 95% CI: 1.072-1.839, P=0.014), bronchial involvement( OR=1.211, 95% CI: 1.047-1.694, P=0.038), and needle insertion depth ≥5 cm( OR=1.312, 95% CI: 1.024-1.749, P=0.038).For major pneumothorax, significant risk factors included age( OR=1.286, 95% CI: 1.021-1.819, P=0.041), COPD( OR=1.248, 95% CI: 1.098-1.753, P=0.035), heart failure( OR=1.312, 95% CI: 1.027-1.956, P=0.042), frailty( OR=1.301, 95% CI: 1.063-1.981, P=0.036), lesion size ≤2 cm( OR=1.345, 95% CI: 1.040-1.872, P=0.039), lesion-to-chest-wall distance ≥2 cm( OR=1.482, 95% CI: 1.116-1.738, P=0.032), presence of bullae or emphysema( OR=1.705, 95% CI: 1.316-2.431, P=0.024), and puncture depth ≥5 cm( OR=1.343, 95% CI: 1.058-1.763, P=0.037). Conclusions:Elderly patients undergoing CT-guided PLB have a high risk of pneumothorax.Personalized predictive strategies are necessary to reduce the risk of pneumothorax, particularly major pneumothorax.

Objective:To investigate the incidence and influencing factors of pneumothorax in elderly patients(aged ≥65 years)undergoing CT-guided percutaneous lung biopsy(PLB).Methods:A prospective cohort study was conducted, enrolling elderly patients who underwent CT-guided PLB at Beijing Hospital from January 2017 to December 2023.Pneumothorax occurrence was assessed through two CT scans performed immediately post-procedure and at 48 hours post-PLB.Based on pneumothorax status, patients were categorized into a pneumothorax group and a non-pneumothorax group.Baseline clinical and procedural data were compared between the two groups, and multivariate logistic regression analyses were conducted to identify factors associated with pneumothorax.Results:Among the 647 elderly patients who underwent PLB, 152 cases(23.5%, 152/647)developed pneumothorax, with 101 cases(15.6%)presenting with minor pneumothorax and 51 cases(7.9%)with major pneumothorax.Compared with the non-pneumothorax group, patients in the pneumothorax group had a higher incidence of chronic obstructive pulmonary disease(COPD), higher frailty proportion, smaller lesions, lesions located further from the chest wall, more frequent bronchial involvement, and a higher rate of puncture depth ≥5 cm(all P<0.05).Multivariate logistic regression analysis revealed the following as significant risk factors for minor pneumothorax: COPD( OR=1.256, 95% CI: 1.014-1.558, P=0.033), lesion size ≤2 cm( OR=1.345, 95% CI: 1.075-1.659, P=0.022), lesion-to-chest-wall distance ≥2 cm( OR=1.372, 95% CI: 1.105-1.703, P=0.007), presence of pulmonary bullae or emphysema( OR=1.524, 95% CI: 1.223-1.899, P<0.001), ground-glass opacity density( OR=1.313, 95% CI: 1.072-1.839, P=0.014), bronchial involvement( OR=1.211, 95% CI: 1.047-1.694, P=0.038), and needle insertion depth ≥5 cm( OR=1.312, 95% CI: 1.024-1.749, P=0.038).For major pneumothorax, significant risk factors included age( OR=1.286, 95% CI: 1.021-1.819, P=0.041), COPD( OR=1.248, 95% CI: 1.098-1.753, P=0.035), heart failure( OR=1.312, 95% CI: 1.027-1.956, P=0.042), frailty( OR=1.301, 95% CI: 1.063-1.981, P=0.036), lesion size ≤2 cm( OR=1.345, 95% CI: 1.040-1.872, P=0.039), lesion-to-chest-wall distance ≥2 cm( OR=1.482, 95% CI: 1.116-1.738, P=0.032), presence of bullae or emphysema( OR=1.705, 95% CI: 1.316-2.431, P=0.024), and puncture depth ≥5 cm( OR=1.343, 95% CI: 1.058-1.763, P=0.037). Conclusions:Elderly patients undergoing CT-guided PLB have a high risk of pneumothorax.Personalized predictive strategies are necessary to reduce the risk of pneumothorax, particularly major pneumothorax.

Background: Cervical cancer is still present a major public health problem, especially in developing countries. In International Federation of Gynaecology and Obstetrics 2018, allowing assessment of retroperitoneal lymph nodes by imaging and/or pathological findings and, if deemed metastatic, the case is designated as stage IIIC (with r and p notations). Patients with lymph node metastases have lower overall survival (OS), progression free survival (PFS), and survival after recurrence, especially those who have unresectable macroscopical positive lymph nodes. Retrospective analysis suggests that there may be a benefit to debulking macroscopic nodes that would be otherwise difficult to sterilize with standard doses of radiation therapy. However, there are no prospective study reporting that resecting macroscopic nodes before concurrent chemoradiation therapy (CCRT) would improve PFS or OS of cervical cancer and no guidelines for surgical resection of bulky lymph nodes. The CQGOG0103 study is a prospective, multicenter and randomized controlled trial (RCT) evaluating lymph node dissection on stage IIICr of cervical cancer. Methods Eligible patients are histologically confirmed cervical squamous cell carcinoma, adenocarcinoma, adeno-squamous cell carcinoma. Stage IIICr (confirmed by computed tomography [CT]/magnetic resonance imaging/positron emission tomography/CT) and the short diameter of image-positive lymph node ≥15 mm. 452 patients will be equally randomized to receive either CCRT (pelvic external-beam radiotherapy [EBRT]/extended-field EBRT + cisplatin [40 mg/m2] or carboplatin [the area under curve=2] every week for 5 cycles + brachytherapy) or open/minimally invasive pelvic and para-aortic lymph node dissection followed by CCRT. Randomization is stratified by status of para-aortic lymph node. The primary endpoint is PFS. Secondary endpoints are OS and surgical complications. A total of 452 patients will be enrolled from multiple hospitals in China within 4 years and followed up for 5 years.

Objective To verify the reliability of novel 3D classification of intertrochanteric fractures by comparing the consistency between conventional and novel classifications.Methods Included for the present study were the preoperative X-ray and CT images of 189 patients with intertrochanteric fracture who had been hospitalized at Department of Orthopaedics,Beijing Chao Yang Hospital,Capital Medical University from 1 January,2017 to 1 January,2019.The patients' intertrochanteric fractures were classified by 6 orthopedic surgeons independently using Evans classification,Jensen classification,AO classification and novel 3D classification,respectively.One month later,the original images of the 189 patients were renumbered and classified again in the same way.The Kappa values between observers and within observers were calculated for the classifications of intertrochanteric fractures based on X-ray and CT images.Results In Evans classification,Jensen classification,AO classification and novel 3D classification,the interobserver Kappa values of X-ray films were 0.54 ± 0.03,0.53 ± 0.03,0.45 ± 0.03 and 0.63 ± 0.02,respectively,and the interobserver Kappa values of the CT images were 0.49 ± 0.03,0.49 ± 0.03,0.44 ± 0.04 and 0.63 ± 0.03.The intraobserver Kappa values of the X-ray films were 0.53 ± 0.02,0.54 ± 0.03,0.44 ±0.04 and 0.65 ± 0.02,respectively,and the intraobserver Kappa values of the CT images were 0.52 ± 0.03,0.52 ±0.03,0.41 ±0.02 and 0.64 ±0.03.In the novel classification based on X-ray and CT images,the interobserver and intraobserver Kappa values were both significantly higher than those in Evans,Jensen and AO classifications (P ＜ 0.05).Conclusion The novel 3D classification of intertrochanteric fractures is more reliable than the conventional ones.

Objective:An automatic analysis system for radiotherapy planning was developed to realize the automatic analysis of dose parameters of radiotherapy planning through the intelligent analysis of the underlying data of Pinnacle 3 treatment planning system (TPS). Methods:The radiotherapy plans of 12 patients with esophagus cancer were analyzed. The automatic analysis system automatically retrieved the Pinnacle 3 TPS database, obtained the raw data of 12 cases of treatment plan, and automatically analyzed the underlying raw data, reconstructed contours, radiation fields, and dose parameters, and recalculated dose distribution and dose-volume histograms. The accuracy of the recalculation of the volume and dose data of the new system was evaluated by comparing with volume and dose data from the original plans of online TPS. Results:The automatic analysis system successfully parsed the underlying data of the treatment plan and reconstructed the parameters of the treatment plan. The volume deviation between the contour calculated by the new system and the original plans was ≤0.1%; Compared with the reference dose of the original plans, the deviations of dose parameters (D max, D mean, D 95, and D 50 for GTV, PGTV, CTV, and PTV) recalculated by the new analysis system were ≤1.0%; The deviations of D max and D mean of recalculated ROIs from the original plans were <5%. Conclusions:The automatic analysis system can directly analyze the underlying data of the Pinnacle 3 TPS treatment plan, reconstruct the treatment plan, calculate the contour volume and dose parameters, and the dose deviations from the original plans meet clinical requirements

Objective To investigate the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA)in elderly patients with early-stage lung cancer who were unable to underwent surgery,and to evaluate the risk factors for prognosis.Methods A total of 51 patients with early stage(stages Ⅰ and ⅡA)non-small cell lung cancer (NSCLC)who underwent MWA in Beijing hospital from January 2016 to December 2018 were collected as the MWA group.And 50 patients with similar age and gender receiving lobectomy surgery were collected as the control group.In a retrospective follow-up study,the clinical efficacy and safety of treatment were compared between the study(n=51)and control(n=50)groups.Kaplan-Meier survival analysis was used to assess the overall survival and local recurrence-free survival.COX analysis was used to evaluate the risk factors.Results Of the 101 patients,62 were male(61.4％),aged 60-85 years(average,72.3± 11.6 years).There was no significant difference in baseline characteristics,including age,gender,smoking,medical history,lung function,tumor size,pathological type and histological grading,tumor position and clinical stage between the two groups(P＞0.05).There were no serious complications in the MWA group during perioperative period,and 14 cases (27.5％)had a small amount of pneumothorax after operation,which were absorbed after special treatment.Five cases (9.8％)had a small amount of hemoptysis,7 cases(13.7％)had a small amount of pleural effusion,9 cases(17.6％)had low fever (＜ 38.5 ℃),and 9 cases (17.6 ％) had postoperative mild pain.There were no serious complications in the control group.The follow-up period was up to December 31,2018,and the median follow-up time was 11.7 months(4.5 20.3 months).During the follow-up,local recurrence occurred in 10 patients(9.9％),including 7 patients(13.7％)in the MWA group and 3 patients(6.0％)in the control group.There was no significant difference between the MWA group and the control group in the 1-year overall survival rate(92.2％ or 47 cases vs.96.0％ or 48 cases,P =0.313),tumor-specific survivalrate(100.0％ vs.100.0％,P=1.00),local recurrence free survival rate(86.3％ or 44 cases vs.94.0％ or 47 cases,P =0.156).Multivariate COX regression analysis showed age (HR =1.22,95 ％CI:1.06-1.38,P =0.004),tumor size (HR =1.75,95 ％ CI:1.14-2.36,P =0.005) and clinical stage of tumor(HR =1.53,95 ％ CI:1.17-1.89,P =0.001) were risk factors for the local recurrencefree survival.Conclusions MWA is an effective and safe treatment for elderly patients with early-stage lung cancer who are not suitable for surgery.Age,tumor diameter and clinical stage are risk factors for local recurrence-free survival.

Objective: The aim of this study was to compare the efficacy and safety of metformin/thiazolidinediones (TZDs) / glucagon-like peptide 1 (GLP-1) analogs (triple therapy) with conventional glucose-lowering therapy(conventional therapy) for patients with type 2 diabetes and metabolic syndrome. Methods: A prospective randomized-controlled 26-week study was carried out. A total of 82 patients with type 2 diabetes and metabolic syndrome were randomized to receive either triple therapy protocal or just conventional therapy, altogether with 41 cases in each group. Results: HbA_1C value was significantly reduced in triple therapy group versus the conventional therapy group [(2.23±1.75)% vs (1.48±1.59)%, P<0.05]. Values of body mass index, waist circumference, and visceral fat area were significantly reduced in triple therapy group as compared to those of conventional therapy group [(2.50±1.81 vs 0.92±1.82)kg/m², (6.75±4.92 vs 1.66±3.25)cm, (24.10±19.10 vs 10.02±20.10)cm², all P<0.01, respectively]. Control rates of HbA_1C and fasting plasma glucose for triple therapy were higher than those for conventional therapy (both P<0.05). No hypoglycemia occurred in triple therapy group. Subjects receiving triple therapy experienced more frequent gastrointestinal side effects than those in conventional therapy group (18.87% vs 3.92%, P<0.05). The most common side event was mild nausea (90%). Conclusion Combination therapy with metformin/TZDs/GLP-1 analogs had statistically significant advantages in the control of body weight, waist circumference, and visceral fat area in addition to the control of blood glucose over conventional glucose-lowering therapy in our patient cohort, it seems to be an optimized therapeutic regimen for patients with type 2 diabete and metabolic syndrome.

In the process of kidney acquisition and transplantation, the donor kidney undergoes hypoxia, ischemia and reperfusion, which inevitably leads to ischemia/reperfusion (I/R) injury of the donor kidney. Hypoxia-inducible factor-1α(HIF-1α) is a ubiquitous oxygen-sensitive transcription factor. It can be activated rapidly during I/R injury. Then preventing and reducing the I/R injury of donor kidney during kidney transplantation by mediating the adaptation of donor kidney to hypoxic stress through direct or indirect ways, and participating in the repair of injury, thereby improving the effect of kidney transplantation. This review describes the evidence of the role of HIF-1α in I/R injury of donor kidney during kidney transplantation, and provides a theoretical basis for further research.

Objective To study the association of NLRP3 gene polymorphism with primary hyper tension (PH) and carotid atherosclerosis (CA) in patients of Xinjiang Kazakh nationality.Methods Three hundred and fifty PH patients of Xinjiang Kazakh nationality were divided into CA group (n=150) and CA-free group (n=200) with 200 Xinjiang Kazakh nationality people undergoing physical examination served as a control group in this study.Their NLRP3 rs10754558 genotypes and alleles were detected using the Tapman probe method and their serum IL-1β level was measured by ELISA.Results The detection rate of rs10754558 genotypes and alleles was significantly higher in CA group than in control group (20.0％ vs 9.0％,43.0％ vs 34.8％,P＜0.05).No significant difference was found in NLRP3 gene types and G alleles between the two groups (P＞ 0.05).The serum IL-1β level was significantly higher in CA and CA-free groups than in control group (2.79±0.83 ng/L and 2.82±0.92 ng/L vs 2.21±0.91 ng/L,P＜0.05) and in GG gene type carriers of CA and CA-free groups than in those of control group (3.40±± 0.37 ng/L and 3.35±0.43 ng/L vs 2.21±0.90 ng/L,P＜0.05).Conclusion NLRP3 rs10754558 gene polymorphism is associated with genetic susceptibility to hypertension and carotid atherosclerosis in patients of Xinjiang Kazakh nationality.

Objective To investigate the mechanism of renal injury induced by changes in flow shear stress (FSS) during renal ischemia/reperfusion (I/R).Methods 1.In vitro,HUVECs were divided into 4 groups:(1) HUVECs were loaded with 12 dyn/cm2 force for 30,45,and 90 min by using plate fluid chamber system.(2) Cells were loaded with FSS for 2 h,and then cultured for 1,3,8 and 12 h respectively;(3) HUVECs were pretreated with 0,1,2,4 and 8 mmol metformin and cultured for 24 h.(4) HUVECs in control group were cultured normally.The expression of p-AMPK/AMPK protein was detected by Western blotting in each group.2.In vivo,16 SD rats with successful establishment of IR model were randomly divided into 4 groups (n =4 in each group):(1) static cold storage (CS) group:isolated kidneys were stored for 4 h;(2) hypothermia machine perfusion (HMP) group:isolated kidneys were continuously perfused with 0 ℃ lactated Ringer's solution for 4 h;(3)metformin treatment group (Met-CS):metformin was intraperitoneally injected 3 days before surgery,and the isolated kidneys were obtained after cold preservation for 4 h;(4)rat kidneys of control group were just subjected to thermal ischemia for 30 min.The injury of renal tissue in each group was observed by TUNEL and HE staining.The expression and distribution of p-AMPK protein in renal tissues were detected by immunohistochemistry.The correlation between FSS loss and AMPK expression in kidney tissue was analyzed.Results The expression of p-AMPK in HUVECs could be up-regulated by FSS,and the expression of p-AMPK protein increased with the prolongation of time.After stopping FSS,the expression of p-AMPK protein in HUVECs gradually decreased with time (P＜0.05).Metformin could activate AMPK activity in a concentration-dependent manner (P＜0.05).The content of p-AMPK in renal tissue of HMP group was significantly higher than that of CS group (P＜0.05).The expression of p-AMPK in renal tissue of HMP group mainly distributed in the renal tubules,and few in glomerular endothelial cells and blood vessels.The apoptosis rate of renal tissue in HMP group was significantly lower than that in CS group (P＜0.05).In the HMP group,the damage of the renal tissue was mild,there was no swelling,and the renal tubules were slightly expanded.In the CS group,the renal tissue was severely damaged and the renal tubules were markedly swollen.Conclusion During the course of renal IR in rats,changes in FSS may affect renal tissue damage through the AMPK pathway.