Objective: To investigate the reciprocal causal relationships between periodontitis and hepatobiliary diseases through Mendelian randomization (MR) analyses, to provide evidence for joint prevention and clinical decision-making in patients with concurrent periodontitis and hepatobiliary diseases. Methods: Single nucleotide polymorphisms (SNPs) were extracted from the largest genome-wide association study on periodontitis (17 353 cases, 28 210 controls) and hepatobiliary diseases within the European ancestry and used as instrumental variables (IVs). The strength of the associations was examined by calculating the F-statistic. The SNPs significantly associated with the outcome were removed by scanning on Phenoscanner platform. Bidirectional causal associations between periodontitis and hepatobiliary diseases were estimated using inverse variance weighted (IVW), MR-Egger, and Weighted Median methods. The robustness of the findings was further verified through additional sensitive MR approaches, including Cochran’s Q statistic （IVW）, Rucker’s Q statistic （MR-Egger）, MR-PRESSO and Leave-one-out analysis. Further MR analyses, utilizing other available genome-wide association studies (GWAS) on hepatobiliary diseases, were conducted to validate the results. Results: The IVW method found that periodontitis had a causal impact on acalculous cholecystitis (odds ratio = 1.277, 95% CI 1.097-1.485, P=0.002), implying an increased risk of acalculous cholecystitis associated with periodontitis, while the MR-Egger regression and Weighted Median failed to observe significant causal effects of periodontitis on acalculous cholecystitis. However, no bidirectional causal associations between periodontitis and nonalcoholic fatty liver disease, cirrhosis or liver cancer were observed using IVW, MR-Egger regression and Weighted Median. The bidirectional causal relationships were deemed unlikely to be influenced by horizontal pleiotropy. Further, the validation analysis based on alternative GWAS data suggested parallel results. Conclusions The MR analyses suggest that periodontitis may elevate the risk of acalculous cholecystitis. Further investigations, including clinical studies and mechanistic explorations, are warranted to validate these findings. However, the MR analyses do not support bidirectional causal associations between periodontitis and nonalcoholic fatty liver disease, cirrhosis or liver cancer.

Objective To summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. Methods From January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. Results A total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. Conclusion Transcatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.

Objective:To investigate the impact of the interval period between biopsy and MR examination on tumor detection and extraprostatic extension (EPE) assessment for prostate cancer (PCa) using multi-parametric MRI (mpMRI).Methods:The study was cross-sectional and retrospectively included 130 patients with PCa who underwent RP and preoperative systematic biopsies followed by mpMRI between January 2021 and December 2022 in the First Medical Center of Chinese PLA General Hospital. Patients were divided into 3 groups according to interval following biopsy (group A,<3 weeks, 31 cases; group B, 3-6 weeks, 67 cases; group C,>6 weeks, 32 cases). The percentages of hemorrhage volume in the total prostate were drawn on T 1WI and calculated. The junior, senior and expert radiologists independently localized the index lesions and calculated the accuracy for tumor detection, in addition to assessing the probabilities of EPE according to EPE grade. The correlation between the hemorrhage extent and interval was analyzed using the Spearman correlation coefficient. The accuracy for tumor detection was compared using χ2 test among groups. The diagnostic performance of the radiologists for EPE prediction was assessed using the receiver operating characteristic curve, and the differences between the corresponding area under the curve (AUC) were compared using the DeLong test. Results:The percentage of hemorrhage was correlated with the interval between biopsy and MR examination ( r=-0.325, P<0.001). The detection accuracy of junior radiologist was 83.9% (26/31), 76.1% (51/67), and 78.1% (25/32) in group A, B and C, respectively; no differences were observed in the detection accuracy among three groups ( χ2=0.76, P=0.685). The detection accuracy of senior radiologist was 83.9% (26/31), 80.6% (54/67), and 71.9% (23/32) in 3 groups with no differences ( χ2=1.53, P=0.464). The detection accuracy of expert radiologist was 80.6% (25/31), 77.6% (52/67), and 93.8% (30/32) with no differences ( χ2=3.95, P=0.139). The AUC (95% CI) for predicting EPE were 0.830 (0.652-0.940), 0.704 (0.580-0.809), 0.800 (0.621-0.920) in the group A, B and C for junior radiologist; 0.876 (0.708-0.966), 0.768 (0.659-0.863), 0.896 (0.736-0.975) for senior radiologist; and 0.866 (0.695-0.961), 0.813 (0.699-0.895), 0.852 (0.682-0.952) for expert radiologist, respectively. No differences were observed among the subgroups in each radiologist ( P>0.05). Conclusion:The interval period does not significantly affect the detection accuracy and EPE assessment of PCa using mpMRI. There is probably no necessity for prolonged intervals following systematic biopsy to preserve the clarity of MRI interpretation for PCa.

Objective　To assess the diagnostic efficacy of the cell-free Mycobacterium tuberculosis DNA testing (CF-TB) in tuberculous pleurisy. Methods　A total of 71 patients diagnosed with tuberculous pleurisy and 35 patients with non-tuberculous pleurisy were selected from the Fifth People's Hospital of Wuxi between January to December 2022. The standard pleural puncture was conducted to collect pleural effusion, which was then utilized for Mycobacterium tuberculosis culture, GeneXpert Mycobacterium tuberculosis/rifampicin resistance (GeneXpert MTB/RIF), CF-TB, and adenosine deaminase (ADA) testing. Blood samples were subjected to tuberculosis infection T-cell spotting test (T-SPOT.TB) assay. The receiver operator characteristic curve (ROC) was applied to obtain the optimal cut-off value for pleural fluid CF-TB and to compare the diagnostic performance of CF-TB with other methods. Data analysis was conducted using SPSS 22.0 software, with statistical significance defined as P<0.05. Results　The ROC curve analysis determined that the optimal cycle threshold (Ct) value for diagnosing tuberculous pleurisy using CF-TB in pleural fluid was 38.489, with a sensitivity of 91.5% and specificity of 97.1%. In comparison, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T-SPOT.TB and pleural fluid ADA in diagnosing tuberculous pleurisy were 86.0%, 71.4%, 86.0%, 71.4%, 81.1%, and 55.0%, 91.4%, 92.9%, 50.8%, 67.0%, respectively, all of which were lower than the diagnostic efficiency of CF-TB. Furthermore, the specificity of pleural fluid CF-TB in diagnosing tuberculous pleurisy (97.1%) was not significantly different from GeneXpert MTB/RIF (100%) and Mycobacterium tuberculosis culture (100%), but its sensitivity (91.5%) was significantly higher than both GeneXpert MTB/RIF (19.7%) and Mycobacterium tuberculosis culture (28.2%), with a statistically significant difference (P<0.001). Conclusions　Compared to the conventional gold standard for diagnosing tuberculous pleurisy, CF-TB exhibits a higher sensitivity and its specificity is superior to that of tuberculosis immunological test. Consequently, CF-TB can serve as a valuable complement to other traditional detection methods in aiding the diagnosis of tuberculous pleurisy.

Objective:To explore the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) parameters in different regions of the kidney in distinguishing IgA nephropathy (IgAN) patients from healthy volunteers.Methods:This study was a cross-sectional study. Eighty-four patients diagnosed with IgAN (IgAN group) who underwent renal biopsy (lower pole of the left kidney) and were pathologically confirmed at the First Medical Center of PLA General Hospital from February 2022 to September 2023 and thirty-four healthy volunteers (control group) were included prospectively. The regions of interest were outlined in the right renal cortex, medulla, and parenchyma for all subjects, and the apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo-diffusion coefficient (D *), and perfusion fraction (f) were measured in the corresponding regions. The differences in IVIM-DWI parameters between the IgAN group and the control group were compared using the student′s t-test or the Mann-Whitney U test. Receiver operating characteristic curve analysis was performed on the parameters with statistically significant differences, and the area under the curve (AUC) was calculated. Results:There were statistically significant differences in renal cortical ADC, renal parenchymal ADC, renal cortical D, renal parenchymal D, and renal medullary f values between the IgAN group and the control group ( Z=-3.03, -2.21, -2.62, -2.03, -2.03; P=0.002, 0.027, 0.009, 0.043, 0.042). The AUCs (95% CI) for diagnosing IgAN using renal cortical ADC, renal parenchymal ADC, renal cortical D, renal parenchymal D, and renal medullary f values were 0.679 (0.586-0.762), 0.630 (0.537-0.717), 0.654 (0.535-0.774), 0.619 (0.497-0.742), and 0.620 (0.495-0.745), respectively. There were no statistically significant differences in renal medullary ADC, D, renal cortex, medulla and parenchyma D *, renal cortical and renal parenchymal f values between the two groups ( P>0.05). Conclusion:The quantitative parameters of renal IVIM-DWI are influenced by different measurement regions, among which the ADC, D of renal cortex and parenchyma, and f of renal medulla can be used for the initial diagnosis of IgAN.

Objective:To explore the value of quantitative parameters of enhanced MRI in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus.Methods:Sixty-seven patients with renal cell carcinoma and inferior vena cava tumor thrombus who underwent radical resection and inferior vena cava venography in First Medical Center, PLA General Hospital from May 2006 to January 2021 were included retrospectively. According to the results of inferior vena cava venography, the patients were divided into two groups: the well-established collateral circulation group ( n=41) and the poor-established collateral circulation group ( n=26). Quantitative parameters were measured on preoperative enhanced MRI images, including tumor size, the maximum diameter of bilateral lumbar veins, the length of tumor thrombus, and the long and short diameters of tumor thrombus. Student′s t test or Mann-Whitney U test was used for comparison between the two groups. The independent risk factors related to the establishment of collateral circulation were obtained by binary logistic regression analysis and the model was established. The receiver operating characteristic curve was employed to evaluate MRI quantitative parameters and the logistic model, and the area under the curve (AUC) was compared by the DeLong test. Results:Between the well-established collateral circulation group and the poor-established collateral circulation group, the maximum diameter of the right lumbar vein, the maximum diameter of the left lumbar vein, the length of the tumor thrombus, the long diameter of the tumor thrombus, and the short diameter of the tumor thrombus were different significantly ( P<0.05). There was no significant difference in the tumor size between the two groups ( t=0.30, P=0.766). The AUC of the maximum diameters of the right lumbar veins and left lumbar veins, length of tumor thrombus, long and short diameters of tumor thrombus in predicting the collateral circulation were 0.917 (95%CI 0.824-0.971), 0.869 (95%CI 0.764-0.939), 0.756 (95%CI 0.636-0.853), 0.886 (95%CI 0.785-0.951), and 0.906 (95%CI 0.809-0.963). The AUC of the maximum diameter of the right lumbar vein and the short diameter of the tumor thrombus were larger than those of the length of the tumor thrombus, and the differences were statistically significant ( Z=2.25, 2.04, P=0.025, 0.041), but the AUC between other parameters had no significant difference ( P>0.05). The maximum diameter of the right lumbar vein (OR 24.210, 95%CI 2.845-205.998), the maximum diameter of the left lumbar vein (OR 20.973, 95%CI 2.359-186.490), and the length of the tumor thrombus (OR 23.006, 95%CI 2.952-179.309) were independent risk factors for predicting the establishment of inferior vena cava collateral circulation. The AUC of logistic model was 0.969 (95%CI 0.931-1.000). Conclusion:Quantitative parameters of tumor thrombus and lumbar vein based on enhanced MRI have a good ability in predicting the establishment of inferior vena cava collateral circulation in patients with renal cell carcinoma and inferior vena cava tumor thrombus. The maximum diameter of bilateral lumbar veins and the length of the tumor thrombus were independent risk factors for inferior vena cava collateral circulation.

Objective:To investigate the intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the differential diagnosis of diabetic nephropathy (DN) and non-diabetic renal disease (NDRD) among patients with type 2 diabetes mellitus (T2DM).Methods:A diagnostic test. In this prospective study, patients with T2DM who underwent both IVIM-DWI and renal biopsy at the First Medical Center of Chinese PLA General Hospital between October 2017 and September 2021 were consecutively enrolled. IVIM-DWI parameters including perfusion fraction (f), pure diffusion coefficient (D), and pseudo-diffusion coefficient (D*) were measured in the renal cortex, medulla, and parenchyma. Patients were divided into the DN group and NDRD group based on the renal biopsy results. IVIM-DWI parameters, clinical information, and diabetes-related biochemical indicators between the two groups were compared using Student′s t-test or Mann-Whitney U test. The correlation of IVIM-DWI parameters with diabetic nephropathy histological scores were analyzed using Spearman′s correlation analyzes. The diagnostic efficiency of IVIM-DWI parameters for distinguishing between DN and NDRD were assessed using the receiver operating characteristic (ROC) curves. Results:A total of 27 DN patients and 23 NDRD patients were included in this study. The DN group comprised 19 male and 8 female patients, with an average age of 52±9 years. The NDRD group comprised 16 male and 7 female patients, with an average age of 49±10 years. The DN group had a higher D* value in the renal cortex and a lower f value in the renal medulla than the NDRD group (9.84×10 -3 mm 2/s vs. 7.35×10 -3 mm 2/s, Z=-3.65; 41.01% vs. 46.74%, Z=-2.29; all P<0.05). The renal medulla D* value was negatively correlated with DN grades, interstitial lesion score, and interstitial fibrosis and tubular atrophy (IFTA) score ( r=-0.571, -0.409, -0.409; all P<0.05) while the renal cortex f value was positively correlated with vascular sclerosis score ( r=0.413, P=0.032). The renal cortex D* value had the highest area under the curve (AUC) for discriminating between the DN and NDRD groups (AUC=0.802, sensitivity 91.3%, specificity 55.6%). Conclusion:IVIM-derived renal cortex D* value can be used non-invasively to differentiate DN from NDRD in patients with T2DM that can potentially facilitate individualized treatment planning for diabetic patients.

Sex reversal, representing extraordinary sexual plasticity during the life cycle, not only triggers reproduction in animals but also affects reproductive and endocrine system-related diseases and cancers in humans. Sex reversal has been broadly reported in animals; however, an integrated resource hub of sex reversal information is still lacking. Here, we constructed a comprehensive database named ASER (Animal Sex Reversal) by integrating sex reversal-related data of 18 species from teleostei to mammalia. We systematically collected 40,018 published papers and mined the sex reversal-associated genes (SRGs), including their regulatory networks, from 1611 core papers. We annotated homologous genes and computed conservation scores for whole genomes across the 18 species. Furthermore, we collected available RNA-seq datasets and investigated the expression dynamics of SRGs during sex reversal or sex determination processes. In addition, we manually annotated 550 in situ hybridization (ISH), fluorescence in situ hybridization (FISH), and im-munohistochemistry (IHC) images of SRGs from the literature and described their spatial expression in the gonads. Collectively, ASER provides a unique and integrated resource for researchers to query and reuse organized data to explore the mechanisms and applications of SRGs in animal breeding and human health. The ASER database is publicly available at http://aser.ihb.ac.cn/.