Objective To investigate the causal relationship between gut microbiota and idiopathic pulmonary fibrosis (IPF). Methods Genome-wide association studies (GWAS) data of gut microbiota and IPF were obtained from MiBioGen and IEU OpenGWAS, respectively. Instrumental variables were screened by means of significance, linkage disequilibrium, weak instrumental variable screening, and removal of confounding factors (genetics, smoking, host characteristics). Inverse variance weighted (IVW) was used as the main Mendelian randomization (MR) analysis method, and the weighted median, simple mode, MR-Egger, and weighted mode were used to perform MR to reveal the causal effect of gut microbiota and IPF. The Cochrane's Q, leave-one-out, MR-Egger-intercept, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) and Steiger tests were used to analyze the heterogeneity, horizontal pleiotropy, outliers, and directionality, respectively. Results IVW analysis results showed that Actinobacteria [OR=1.773, 95%CI (1.323, 2.377), P<0.001], Erysipelatoclostridium [OR=2.077, 95%CI (1.107, 3.896), P=0.023], and Streptococcus [OR=1.35, 95%CI (1.100, 1.657), P=0.004] could increase the risk of IPF. Bifidobacterium [OR=0.668, 95%CI (0.620, 0.720), P<0.001], Ruminococcus [OR=0.434, 95%CI (0.222, 0.848), P=0.015], and Tyzzerella [OR=0.479, 95%CI (0.304, 0.755), P=0.001] could reduce the risk of IPF. No significant heterogeneity, horizontal pleiotropy, outliers, and reverse causality were found. Conclusion Actinobacteria, Erysipelatoclostridium and Streptococcus may increase the risk of IPF, while Bifidobacterium, Ruminococcus and Tyzzerella may reduce the risk of IPF. Regulation of the above gut microbiota may become a new direction in the study of the pathogenesis of IPF.

OBJECTIVE To evaluate the therapeutic efficacy and safety of vonoprazan-based triple therapy in treatment-naive patients with Helicobacter pylori （Hp） infection. METHODS From March 2022 to August 2023， 198 treatment-naive patients with Hp infection treated at the outpatient service of department of gastroenterology in our hospital were assigned to the vonoprazan- based triple therapy group （VAC group， n＝98） and the bismuth-based quadruple therapy group （BQT group， n＝100） using the random number table method. Patients in VAC group were given Vonoprazan fumarate tablets （20 mg） + Amoxicillin capsules （1 g） + Clarithromycin tablets （0.5 g）， all twice daily. Patients in BQT group were given Esomeprazole magnesium enteric-coated tablets （20 mg， twice daily） + Metronidazole tablets （0.4 g， four times daily） + Tetracycline tablets （0.5 g， three times daily） + Bismuth potassium citrate capsules （0.6 g， twice daily）. The treatment course for both groups was 14 days. The Hp eradication rates were compared between the two groups in intention-to-treat （ITT）， modified intention-to-treat （MITT）， and per-protocol （PP） analysis sets， while adverse reaction occurrence and medication compliance of two groups were recorded. RESULTS In the ITT， MITT and PP analyses sets， the Hp eradication rates in VAC group were non-inferior to those in BQT group. The incidences of grades 1-2 nausea， vomiting， and loss of appetite in VAC group were significantly lower than in BQT group， and the proportion of patients with good compliance was significantly higher in VAC group （P＜0.05）. Regardless of whether the body mass index （BMI） ≤25 kg/m2 or ＞25 kg/m2， no statistically significant difference was observed in the Hp eradication rates between the two groups （P＞0.05）. CONCLUSIONS Vonoprazan-based triple therapy is non-inferior to bismuth-based quadruple therapy in the treatment of treatment-naive patients with Hp infection， with higher safety and good patient medication compliance. BMI has no significant impact on the Hp eradication rate.

Objective:To compare the pregnancy and perinatal outcomes following cleavage-stage embryo transfer and blastocyst-stage embryo transfer, and to explore the best strategy of embryo transfer for infertile patients.Methods:In this retrospective cohort study, data of patients who underwent in vitro fertilization/intracytoplasmic sperm injection from January 2021 to December 2022 in Reproductive Medicine Department of the Fifth Hospital and the First Hospital of Shanxi Medical University and Jinzhong Yingtai Women's and Children's Hospital were collected. Patients were divided into cleavage-stage embryo transfer group (named D3 group, n=2 827) and blastocyst-stage embryo transfer group (named D5 group, n=1 253). The main observation indicators were large for gestational age (LGA) and preterm birth (PTB). The secondary observation indicators were multiple pregnancy, gestational age, birth weight and newborn gender. Univariate and multivariate logistic regression were applied to analyze the correlation between embryo transfer type and adverse outcomes. Results:Clinical pregnancy rate [64.5% (808/1 253)], live birth rate [55.5% (696/1 253)], implantation rate [46.0% (1 026/2 230)], multiple pregnancy rate [22.6% (183/808)], male newborn rate [58.6% (515/879)], single LGA rate [19.8% (103/520)] and single PTB rate [21.7% (113/520)] in D5 group were significantly higher than those in D3 group [54.3% (1 535/2 827), P<0.001; 48.2% (1 362/2 827), P<0.001; 36.7% (1 962/5 346), P<0.001; 19.0% (291/1 535), P=0.026; 49.7% (822/1 653), P=0.001; 7.5% (80/1 071), P<0.001; 17.2% (184/1 071), P=0.029]. LGA rate [24.8% (72/290)] in the single frozen-embryo transfer and LGA rate [13.5% (31/230)] in the single fresh-embryo transfer of D5 group were significantly higher than those of D3 group [8.8% (36/409), P<0.001; 6.6% (44/662), P=0.002]. LGA in male newborns [24.8% (82/330)] and female newborns [11.1% (21/190)] of D5 group were significantly higher than those of D3 group [9.1% (54/592), a OR=2.95, 95% CI: 2.01-4.33, P<0.001; 5.4% (26/479), a OR=2.04, 95% CI: 1.10-3.77, P=0.024]. Conclusion:The risk of LGA and premature birth in blastocyst-stage embryo transfer is higher than that in cleavage-stage embryo transfer. In clinical practice, embryo transfer methods should be selected based on the condition of patient and embryo.

Objective:To investigate the efficacy and characteristics of levonorgestrel intrauterine system in in vitro fertilization (IVF) assisted pregnancy for infertility patients with atypical endometrial hyperplasia and adenomyosis. Methods:The clinical characteristics of 3 infertility patients with atypical endometrial hyperplasia and adenomyosis admitted to the Reproductive Medicine Center, the Fifth Clinical Medical College of Shanxi Medical University from 2019 to 2021 were retrospectively analyzed. All patients underwent IVF as soon as possible after the successful treatment of levonorgestrel intrauterine system. Using progestin-primed ovarian stimulation protocol and gonadotropin-releasing hormone antagonist protocol, the ring was removed before frozen-thawed transfer.Results:Two cases of atypical endometrial hyperplasia were completely relieved, one case received healthy singleton fetus, and one case received biochemical pregnancy. One case had complete remission of adenomyosis and received healthy singleton fetus.Conclusion:Levonorgestrel intrauterine system in the treatment of infertility caused by atypical endometrial hyperplasia and adenomyosis can not only achieve better therapeutic effect but also effectively improve endometrial receptivity.

Objective:To compare the pregnancy and perinatal outcomes following cleavage-stage embryo transfer and blastocyst-stage embryo transfer, and to explore the best strategy of embryo transfer for infertile patients.Methods:In this retrospective cohort study, data of patients who underwent in vitro fertilization/intracytoplasmic sperm injection from January 2021 to December 2022 in Reproductive Medicine Department of the Fifth Hospital and the First Hospital of Shanxi Medical University and Jinzhong Yingtai Women's and Children's Hospital were collected. Patients were divided into cleavage-stage embryo transfer group (named D3 group, n=2 827) and blastocyst-stage embryo transfer group (named D5 group, n=1 253). The main observation indicators were large for gestational age (LGA) and preterm birth (PTB). The secondary observation indicators were multiple pregnancy, gestational age, birth weight and newborn gender. Univariate and multivariate logistic regression were applied to analyze the correlation between embryo transfer type and adverse outcomes. Results:Clinical pregnancy rate [64.5% (808/1 253)], live birth rate [55.5% (696/1 253)], implantation rate [46.0% (1 026/2 230)], multiple pregnancy rate [22.6% (183/808)], male newborn rate [58.6% (515/879)], single LGA rate [19.8% (103/520)] and single PTB rate [21.7% (113/520)] in D5 group were significantly higher than those in D3 group [54.3% (1 535/2 827), P<0.001; 48.2% (1 362/2 827), P<0.001; 36.7% (1 962/5 346), P<0.001; 19.0% (291/1 535), P=0.026; 49.7% (822/1 653), P=0.001; 7.5% (80/1 071), P<0.001; 17.2% (184/1 071), P=0.029]. LGA rate [24.8% (72/290)] in the single frozen-embryo transfer and LGA rate [13.5% (31/230)] in the single fresh-embryo transfer of D5 group were significantly higher than those of D3 group [8.8% (36/409), P<0.001; 6.6% (44/662), P=0.002]. LGA in male newborns [24.8% (82/330)] and female newborns [11.1% (21/190)] of D5 group were significantly higher than those of D3 group [9.1% (54/592), a OR=2.95, 95% CI: 2.01-4.33, P<0.001; 5.4% (26/479), a OR=2.04, 95% CI: 1.10-3.77, P=0.024]. Conclusion:The risk of LGA and premature birth in blastocyst-stage embryo transfer is higher than that in cleavage-stage embryo transfer. In clinical practice, embryo transfer methods should be selected based on the condition of patient and embryo.

Objective:To investigate the efficacy and characteristics of levonorgestrel intrauterine system in in vitro fertilization (IVF) assisted pregnancy for infertility patients with atypical endometrial hyperplasia and adenomyosis. Methods:The clinical characteristics of 3 infertility patients with atypical endometrial hyperplasia and adenomyosis admitted to the Reproductive Medicine Center, the Fifth Clinical Medical College of Shanxi Medical University from 2019 to 2021 were retrospectively analyzed. All patients underwent IVF as soon as possible after the successful treatment of levonorgestrel intrauterine system. Using progestin-primed ovarian stimulation protocol and gonadotropin-releasing hormone antagonist protocol, the ring was removed before frozen-thawed transfer.Results:Two cases of atypical endometrial hyperplasia were completely relieved, one case received healthy singleton fetus, and one case received biochemical pregnancy. One case had complete remission of adenomyosis and received healthy singleton fetus.Conclusion:Levonorgestrel intrauterine system in the treatment of infertility caused by atypical endometrial hyperplasia and adenomyosis can not only achieve better therapeutic effect but also effectively improve endometrial receptivity.

Objective:The clinical features, laboratory indices, and imaging data of patients with Pneumocystis jirovecii pneumonia (PJP) were described and analyzed, aiming to provide helpful information for the diagnosis and treatment of PJP. Methods:A retrospective study were conducted with data from 154 PJP patients who visited China-Japan Friendship Hospital from May 2017 to August 2020. Their clinical characteristics, laboratory and imaging data, and clinical outcomes were collected for analysis. The patients were further divided into the death group (51 cases) and the survival group(103 cases). The differences between the groups were compared by using t-test, nonparametric test, and chi-square test. Results:Of the 154 PJP patients, there were 89 males and 65 females, with a mean age of (53.7±14.8) years. Among them, 85.7% (132/154) were on immunosuppressive/glucocorticoids agents within the past month. Besides, 27.9% (43/154) and 33.1% (51/154) had kidney diseases and connective tissue diseases, respectively. The major clinical manifestations in these patients involved fever 82.9% (126/154), cough 59.7% (92/154), and dyspnea 52.6% (81/154). For the laboratory data, the lactate dehydrogenase (LDH) was 561.0 (434.3, 749.0) IU/L and the value increased in 91.3% (95/104) of the patients. The CD4+T-cell lymphocytes in 88.0% (95/108) and 57.4% (62/108) of patients were lower than 400/μl and 200/μl, respectively. Furthermore, (1, 3)-β-D glucan (BG) increased in 74.4% (67/90) of PJP patients (≥100.0 ng/L). For the imaging results, chest computed tomography (CT) showed diffuse ground-glass shadows/grid shadows in 90% (117/130) patients. Compared with the survival group, higher LDH [690.5 (528.8, 932.3) IU/L vs 502.5 (381.8, 657.0) IU/L, Z=-3.375, P=0.001], white blood cell count (WBC) [9.8 (5.8, 12.6) ×10 9/L vs 7.3 (5.0, 10.1) ×10 9/L, Z=-2.392, P=0.017], and age [(69.8±14.5) years vs (50.6±14.0) years, t=-3.756, P=0.001] were found in the death group. Lower lymphocyte ratio [5.3 (3.2, 9.3) % vs 9.6 (5.6, 17.2) %, Z=?3.262, P=0.001] and oxygen partial pressure (PaO 2) levels [(73.2±20.5) mmHg vs (64.8±17.7) mmHg (1 mmHg=0.133 kPa), t=2.345, P=0.021] were also observed in the death group. Furthermore, in the death group, the bacterial and fungal infection rate was higher than the rates in the survival group [55.1% (27/51) vs 21.5% (22/103), χ 2=15.372, P=0.001]. Conclusions:Long-term use of immunosuppressive agents or glucocorticoids predispose to PJP. CD4+T-lymphocytes, LDH, and BG might be used as important auxiliary examinations for PJP patients. Age, LDH, WBC, lymphocyte ratio, PaO 2 and possible combinations with bacterial or fungal infections are more closely related to the prognostic of PJP patients.

We proposed a new stitching method based on sift features to obtain an enlarged view of transmission electron microscopic (TEM) images with a high resolution. The sift features were extracted from the images, which were then combined with fitted polynomial correction field to correct the images, followed by image alignment based on the sift features. The image seams at the junction were finally removed by Poisson image editing to achieve seamless stitching, which was validated on 60 local glomerular TEM images with an image alignment error of 62.5 to 187.5 nm. Compared with 3 other stitching methods, the proposed method could effectively reduce image deformation and avoid artifacts to facilitate renal biopsy pathological diagnosis.
Algorithms ; Artifacts ; Humans ; Image Processing, Computer-Assisted ; methods ; Kidney Glomerulus ; ultrastructure ; Microscopy, Electron, Transmission ; methods

We proposed a new stitching method based on sift features to obtain an enlarged view of transmission electron microscopic (TEM) images with a high resolution. The sift features were extracted from the images, which were then combined with fitted polynomial correction field to correct the images, followed by image alignment based on the sift features. The image seams at the junction were finally removed by Poisson image editing to achieve seamless stitching, which was validated on 60 local glomerular TEM images with an image alignment error of 62.5 to 187.5 nm. Compared with 3 other stitching methods, the proposed method could effectively reduce image deformation and avoid artifacts to facilitate renal biopsy pathological diagnosis.

We proposed a new stitching method based on sift features to obtain an enlarged view of transmission electron microscopic (TEM) images with a high resolution. The sift features were extracted from the images, which were then combined with fitted polynomial correction field to correct the images, followed by image alignment based on the sift features. The image seams at the junction were finally removed by Poisson image editing to achieve seamless stitching, which was validated on 60 local glomerular TEM images with an image alignment error of 62.5 to 187.5 nm. Compared with 3 other stitching methods, the proposed method could effectively reduce image deformation and avoid artifacts to facilitate renal biopsy pathological diagnosis.