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.

Objective:To explore the potential of thrombus-targeted nanoprobes for ultrasound/near-infrared bimodal imaging and their synergistic therapeutic effects on thrombosis in vitro.Methods:Nanoprobes loaded with arginine-glycine-aspartate peptide (RGD), perfluoropentane (PFP) and indocyanine green (ICG) were prepared by ultrasonic vibration and carbodiimide method with mesoporous silica nanoparticle (MSN) as the carrier. The probe morphology was observed by scanning and transmission electron microscopy. The loading of RGD and ICG was detected by Bicinchoninic Acid Assay (BCA) and UV-Visible-NIR spectroscopy respectively. The imaging performance and photothermal response of the nanoprobe under near infrared light (NIR) irradiation were studied in vitro. Its biological safety was tested by cytotoxicity test and hemolysis test. The phase transformation was studied under ultrasound and NIR irradiation. The nanoprobe was incubated with fresh arterial thrombus, and its target-seeking ability was observed by frozen section. Ultrasound and NIR irradiation were used to evaluate its thrombolytic ability by the weight changes of thrombus before and after irradiation.Results:The prepared nanoprobe had regular morphology and uniform size. The particle diameter was (156.83±5.05)nm, and the surface potential was (11.47±0.25)mV. The RGD coupling rate was (77.67±4.50)%, which could mediate the targeting of nanoprobe to fresh extracorporeal arterial thrombus. UV-Visible-NIR spectroscopy confirmed the successful loading of ICG, and its encapsulation rate was (80.47±0.05)%. After ultrasound and NIR irradiation, the nanoprobe could undergo acoustically induced phase transition, thermally induced phase transition and enhance the ultrasonic development effect. With the increase of the concentration of the nanoprobe solution, the NIR signal gradually increased, and the temperature rose in a concentration-dependent and intensity-dependent manner after NIR irradiation. The cytotoxicity test and hemolysis test showed that the nanoprobe had good biological safety, and it could play a thrombolytic role under the combined irradiation of ultrasound and NIR, and the weight of thrombus was significantly reduced after the treatment ( P<0.01). Conclusions:In this study, the nanoprobe (RGD/ICG/PFP@MSN) were successfully prepared possesses excellent dual mode imaging capabilities of ultrasound and NIR, excellent phase transition ability and photothermal conversion efficiency, as well as efficient targeted penetration and therapeutic effects against thrombosis. This study provides strong in vitro experimental evidence and new strategies for the integration of diagnosis and treatment of thrombotic diseases under the cooperation of ultrasound and NIR.

Anemia, Aplastic ; diagnosis ; pathology ; Humans ; Severity of Illness Index

Objective To detect the difference of cerebral gray matter change in children with different karyotype Turner Syndrome (TS) by using voxel-based morphometry (VBM).Methods Nineteen children with 45XO karyotype TS,21 children with heterozygous TS and 20 age-matched control girls were recruited in this study.Wechsler intelligence scale for children was used to obtain their intelligence quotients (IQ).High-resolution magnetic MR imaging was performed in TS children and control girls to collect the whole brain structural data.The data was analyzed by VBM based on SPM8 to compare the volume of gray matter among the monosomy TS children,heterozygous TS children and normal controls by using covariance analysis.Alphasim method in the software of analysis of functional neuroimages(AFNI) was used for clusterlevel multiple comparison.Results The IQ was 89 ± 16 for the monosomy TS children,and it was 91 ± 13 for heterozygous TS children and 109 ± 15 for the controls.Statistical analysis revealed significant difference of IQ among them (F =10.75,P ＜ 0.05).Compared with normal controls,both monosomy TS children and heterozygous TS children showed significantly decreased volume (voxel numbers in clusters were 4117,1392,1085,t =5.75,5.33 and 5.02 for monosomy TS; voxel numbers in clusters were 4501,2437,591,t =5.40,5.11 and 4.95 for heterozygous TS respectively,P ＜ 0.01,FWE-corrected) in the gray matter of bilateral precuneus lobule,postcentral gyrus,and cingulum cortex.However,the volume of the orbitofrontal lobe,parahippocampal gyrus,cerebellum,temporal pole,corpus striatum and posterior midbrain were increased in the monosomy and heterozygous TS children compared to the controls (voxel numbers in clusters were 1444,1188,791,725,695,431,386,t =5.01,5.96,5.67,5.23,4.85,4.43,4.94 for monosomy TS; voxel numbers in clusters were 6988,2709,2510,2380,1987,1709,1185,t =6.50,7.06,7.26,5.27,5.71,6.02,4.56 for heterozygous TS,P ＜ 0.01,FWE-corrected).Compared with monosomy TS,heterozygous TS showed increased gray matter volume in the left parahippocampal gyrus and corpus striatum (voxel numbers were 1014 and 496,t =4.75,4.53,P ＜0.01,FWE-eorreeted),while they had decreased gray matter volume in the right supramarginal gyrus (voxel number was 350,t =4.28,P ＜ 0.01,FWE-corrected).Conclusions Both monosomy and heterozygous TS show brain atrophy in the parietooccipital lobe,indicating similar abnormality of gray matter development.However,heterozygous TS shows more increased gray matter volume in the prefrontal lobes and the cerebellum than monosomy TS,which may be the compensatory mechanism in this condition.