ObjectiveTo investigate the mechanism of Xiezhuo Jiedu prescription in the treatment of ulcerative colitis （UC） by inhibiting ferroptosis and alleviating intestinal mucosal injury based on the nuclear factor E₂ related factor 2/solute carrier family 7 member/glutathione peroxidase 4 （Nrf2/SLC7A11/GPX4） signaling pathway. MethodsA total of 60 male SD rats were divided into a normal group， a model group， high- and low-dose Xiezhuo Jiedu prescription groups （26.64 and 13.32 g·kg^-1， respectively）， a ferroptosis inhibitor group （Ferrostatin-1， 0.005 g·kg^-1）， and a mesalazine group （0.27 g·kg^-1）， with 10 rats in each group. A UC rat model was established by intrarectal administration of trinitrobenzene sulfonic acid （TNBS）-ethanol. The normal group and the model group were intragastrically administered normal saline. The other groups were given intragastric administration according to the corresponding dosage for 7 d. The general condition， disease activity index （DAI） score， colon length， and mucosal injury index （CDMI） score were observed in each group. The pathological changes of colon tissue in each group were observed by hematoxylin-eosin （HE） staining. The intestinal mucosa and mitochondrial morphology in each group were observed by transmission electron microscopy. The expression levels of Occludin， Claudin-1， mucin 2 （MUC2）， and E-cadherin in intestinal tissue were detected by immunofluorescence （IF）. Enzyme-linked immunosorbent assay （ELISA） was used to detect the expression levels of serum tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6）， and interleukin-10 （IL-10） in each group， and a lactic acid assay kit or ELISA was employed to detect the expression levels of reactive oxygen species （ROS）， ferrous ions （Fe²⁺）， glutathione （GSH）， malondialdehyde （MDA）， 4-hydroxynonenal （4-HNE）， diamine oxidase （DAO）， and D-lactate （D-LA）. Real-time quantitative polymerase chain reaction （Real-time PCR） was applied to detect the mRNA expression levels of Nrf2， SLC7A11， GPX4， Occludin， Claudin-1， MUC2， and E-cadherin in each group， and Western blot was adopted to detect the protein expression levels of Nrf2， p-Nrf2， SLC7A11， and GPX4 in each group. ResultsCompared with the normal group， rats in the model group exhibited listlessness， sluggish response， and mucopurulent and bloody stools. The model group also showed significantly increased DAI score， colon length， CDMI score， and expression levels of TNF-α， IL-6， ROS， Fe²⁺， MDA， 4-HNE， DAO， and D-LA （P<0.01）. In addition， it presented significantly decreased IF values of Occludin， Claudin-1， MUC2， and E-cadherin and mRNA and protein expression levels of IL-10， GSH， Nrf2， p-Nrf2， SLC7A11， and GPX4 （P<0.01）. There were different degrees of improvement in each administration group after treatment， and the improvement was the most significant in the high-dose Xiezhuo Jiedu prescription group （P<0.01）. ConclusionXiezhuo Jiedu prescription may alleviate intestinal mucosal injury by inhibiting ferroptosis of intestinal epithelial cells via regulating the Nrf2/SLC7A11/GPX4 signaling pathway， thereby exhibiting efficacy in the treatment of UC.

Childhood primary renal tubular diseases are chronic kidney diseases characterized by impaired renal tubular reabsorption. Primary renal tubular disease has diverse clinical manifestations and lacks of specificity. Laboratory tests are limited，making it prone to missed diagnosis and misdiagnosis. Based on the current knowledge of renal tubular diseases，authors propose early warning signals of renal tubular diseases such as family history of primary tubular diseases，unexplained polyhydramnios during pregnancy，polydipsia，polyuria，delayed growth and development or rickets，decreased muscle strength and tone，unexplained electrolyte disturbance，hyperuricemia，acid-base disturbance，positive urine sugar test，renal tubular proteinuria，urinary imaging examination suggesting kidney stones，calcium deposition，renal cysts and early onset of eye，ear，joint and neuron injury.Meanwhile，some universal management strategies for primary renal tubular disease are proposed，emphasizing the importance of multidisciplinary collaboration，genetic testing and individualized intervention to improve the long-term prognosis of childhood primary renal tubular diseases.

Objective To investigate the distribution of traditional Chinese medicine(TCM)syndromes in chronic persistent immunoglobulin A nephropathy(IgAN)and to explore the relationship between TCM syndromes and prognosis based on real-world research.Methods From January 2018 to January 2024,a total of 80 patients with chronic persistent IgAN who were admitted to Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University were included.The clinical baseline data and prognosis-related information were collected.The main outcome indicators were defined as renal failure events of glomerular filtration rate(eGFR)decreased by＞50%,serum creatinine doubled or end-stage renal disease(ESRD).The distribution of TCM syndromes in chronic persistent IgAN and the relationship between different deficiency syndromes and prognosis were preliminarily discussed.Results(1)Among the 80 patients with chronic persistent IgAN,the syndrome manifestations with an occurrence frequency of more than 30%in descending order were foamy urine(75.00%),fatigue and lassitude(71.25%),waist ache(61.25%),dry mouth(31.25%),lower extremity edema(31.25%),aversion to cold and cold limbs(30.00%),and insomnia(30.00%).(2)The commonly-seen root-deficiency syndrome in patients with chronic persistent IgAN was qi and yin deficiency syndrome,with a total of 28 cases(35.00%).And other root-deficiency syndromes were spleen and kidney yang deficiency syndrome in 22 cases(27.50%),lung and spleen qi deficiency syndrome in 15 cases(18.75%),and liver and kidney yin deficiency syndrome in 15 cases(18.75%).The commonly-seen complicated syndrome was water-damp syndrome,with a total of 17 cases(21.25%).The other complicated syndromes were damp-heat syndrome in 15 cases(18.75%),blood-stasis syndrome in 9 cases(11.25%),phlegm-damp syndrome in 7 cases(8.75%),turbidity-toxin syndrome in 5 cases(6.25%),liver depression syndrome in 3 cases(3.75%),and cold-damp syndrome in 1 case(1.25%).(3)Among the 80 patients with chronic persistent IgAN,21 cases(26.25%)had renal failure events,and their syndrome types were lung and spleen qi deficiency syndrome in 9 cases(60.00%),qi and yin deficiency syndrome in 3 cases(10.71%),liver and kidney yin deficiency syndrome in 3 cases(20.00%),and spleen and kidney yang deficiency syndrome in 6 cases(27.27%).The incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in the other three syndrome types,and the chi-square test showed that the difference was statistically significant(P＜0.05).(4)Kaplan-Meier survival analysis showed that the cumulative incidence of 2-year and 5-year endpoint events in patients with lung and spleen qi deficiency syndrome was 23.10%and 46.20%,respectively,and the final incidence was 85.00%.The cumulative incidence of 2-year and 5-year endpoint events in patients with other deficiency syndromes was 4.50%and 19.70%,respectively,and the final incidence was 71.60%.The intergroup comparison(tested by Log-rank)showed that the incidence of renal failure events in patients with lung and spleen qi deficiency syndrome was significantly higher than that in patients with other root-deficiency syndromes,and the difference was statistically significant(P＜0.05).(5)COX proportional hazard regression analysis showed that lung and spleen qi deficiency syndrome(HR=7.755,95%CI 1.631-36.874,P＜0.05)and anemia(HR=8.205,95%CI 1.007-66.857,P＜0.05)were the independent risk factors for renal failure events in patients with chronic persistent IgAN.Conclusion Qi and yin deficiency syndrome is the most common syndrome in the patients with chronic persistent IgAN,and lung and spleen qi deficiency syndrome and anemia are the independent risk factors for renal failure events in IgAN.

ObjectiveThis study aims to explore the potential mechanism of the Xiezhuo Jiedu formula in regulating pyroptosis for the treatment of ulcerative colitis （UC） using bioinformatics and in vivo animal experiments. MethodsDifferentially expressed genes （DEGs） in colon tissues of UC patients were retrieved from the Gene Expression Omnibus （GEO） database. Pyroptosis-related genes were obtained from the GEO and GeneCards databases. The intersection of these datasets yielded pyroptosis-related DEGs （Pyro-DEGs）. Pyro-DEGs were subjected to Gene Ontology （GO） and Kyoto Encyclopedia of Genes and Genomes （KEGG） enrichment analysis using the Metascape database. A protein-protein interaction （PPI） network was constructed using the STRING database. Least absolute shrinkage and selection operator （LASSO） prediction model and receiver operating characteristic （ROC） analysis were conducted to identify core Pyro-DEGs with diagnostic and therapeutic potential. Immune infiltration analysis of the UC datasets was performed using the deconvolution method （CIBERSORT）， along with correlation analysis with core Pyro-DEGs. Sixty male Sprague-Dawley （SD） rats were randomly divided into a control group， a model group， high-， medium-， and low-dose groups of Xiezhuo Jiedu formula （26.64， 13.32， 6.66 g·kg^-1）， and a mesalazine group （0.27 g·kg^-1）， with 10 rats in each group. UC was established by intrarectal administration of 3，5-trinitrobenzenesulfonic acid （TNBS） dissolved in ethanol. The control and model groups were given distilled water by gavage， while the treatment groups were administered the corresponding drugs for 7 consecutive days. Hematoxylin-eosin （HE） staining was used to observe the colon histopathology. Enzyme-linked immunosorbent assay （ELISA） was used to detect the levels of inflammatory factors such as interleukin-1β （IL-1β）， IL-10， IL-18， and transforming growth factor-β （TGF-β）. Immunohistochemistry （IHC） and Western blot were applied to detect the expression of Caspase-1， gap junction alpha-1 protein （GJA1）， peroxisome proliferator-activated receptor gamma （PPARG）， and S100 calcium-binding protein A8 （S100A8）. Real-time quantitative polymerase chain reaction （Real-time PCR） was utilized to measure mRNA expression of Caspase-1， GJA1， PPARG， and S100A8. Western blot was performed to assess protein expression levels of Caspase-1， GJA1， PPARG， and S100A8. ResultsGEO datasets GSE87466 and GSE87473 yielded 64 Pyro-DEGs. KEGG analysis indicated that these genes were enriched in the NOD-like receptor signaling pathway， tumor necrosis factor （TNF） signaling pathway， and hypoxia-inducible factor 1 （HIF-1） signaling pathway. Four core Pyro-DEGs （Caspase-1， GJA1， PPARG， and S100A8） were identified. Immune infiltration analysis showed that expression of these genes was positively correlated with mast cells， neutrophils， M0 macrophages， M1 macrophages， and dendritic cells. Animal experimental results indicated that compared with the control group， the model group had significantly increased levels of IL-1β and IL-18， significantly decreased levels of IL-10 and TGF-β. The model group showed enhanced Caspase-1， GJA1， and S100A8 staining， and significantly increased mRNA and protein expression of Caspase-1， GJA1， and S100A8 （P<0.01）. In contrast， the expression of PPARG was reduced in the model group （P<0.01）. After treatment， all dosage groups showed varying degrees of improvement （P<0.05， P<0.01）， with the high-dose group showing the most significant improvement （P<0.01）. ConclusionCaspase-1， GJA1， PPARG， and S100A8 are core Pyro-DEGs closely associated with the pathogenesis of UC. These genes may collaborate with immune cells such as mast cells， neutrophils， and M0 macrophages to mediate disease development. The Xiezhuo Jiedu formula may regulate the expression of core Pyro-DEGs through the NOD-like receptor， TNF， and HIF-1 core signaling pathways， thereby modulating immune homeostasis in UC rats and effectively alleviating UC.

Objective To explore the mediating role of activities of daily living (ADL) in pain and depressive symptoms in the elderly in China. Methods Utilizing the data from 2020 China Health and Retirement Longitudinal Study, 4403 Chinese elderly individuals aged ≥ 60 years old were selected as the research subjects. Depression Scale (CES-D 10) of the Center for Epidemiological Survey and ADL scale were used in the study. The PROCESS4.1 macro was used to test the mediating effect of daily living activities between pain and depressive symptoms, and the Bootstrap method was applied for verification of the mediating variables. Results A total of 2368 cases of depressive symptoms were detected in the elderly in China, with a detection rate of 53.78%. Pain was positively correlated with depressive symptoms (r=0.27, P<0.01), and activities of daily living were negatively correlated with pain and depressive symptoms (r=-0.27, -0.337, P<0.01). The results showed that the total effect value of pain on depressive symptoms was 0.33, the direct effect value was 0.24, and the mediating effect value of daily living activities was 0.09, accounting for 27.27%. Conclusion Pain and activities of daily living are important factors influencing depressive symptoms in the elderly, and activities of daily living play a partial mediating role in the relationship between pain and depressive symptoms in the elderly.

Objective:To investigate the effects of galectin-3 (Gal-3) expression on lipopolysaccharide (LPS)-induced proliferation, migration, apoptosis, reactive oxygen species (ROS) and inflammatory cytokine production in human gingival fibroblasts (GF) as well as its mechanism, thus laying the foundation for an in-depth discussion of the regulatory role of Gal-3 in periodontitis and its mechanisms.Methods:Gingival tissues from 6 periodontally healthy subjects undergoing crown lengthening were collected at the Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University from December 2022 to December 2023. GFs were extracted and cultured by collagenase digestion. Lentivirals with multiplicity of infection (MOI) of 15, 20, 30, 40, 50, 60, 70, 80 were used to achieve knockdown and overexpression of Gal-3 gene in GFs, whose efficiencies of Gal-3 gene were detected by using immunofluorescence, real-time fluorescence quantitative PCR (RT-qPCR) and Western blotting. Negative control of knockdown (shNC)+LPS group, Gal-3 knockdown (shGal-3)+LPS group, negative control of overexpression (oeNC)+LPS group, and Gal-3 overexpression (oeGal-3)+LPS group were established, respectively. 5-Ethynyl-2′-deoxyuridine (EdU), Ki67 staining, scratch migration assay, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) technology, immunofluorescence assay and RT-qPCR were used to investigate the effects of Gal-3 on LPS-induced proliferation, migration, apoptosis, ROS, interleukin (IL)-6, IL-8 expression. The effects of Gal-3 knockdown on the expression of differential genes and the enrichment of signaling pathways in LPS-induced GFs were investigated by RNA sequencing (RNA-seq).Results:More than 80% of GFs were successfully transfected by shGal-3 MOI 40 and oeGal-3 MOI 70. Immunofluorescence results showed that the morphologies of GFs were normal after lentiviral transfection, and green fluorescence could be distributed in the cytoplasm, nucleus, and cell membrane. The results of RT-qPCR and Western blotting assay showed that the expressions of Gal-3 at the gene and protein levels in shGal-3 group (0.26±0.01, 0.26±0.03, respectively) were significantly lower than those in the shNC group (1.00±0.03, 1.00±0.09, respectively) ( P<0.001); the expressions of Gal-3 at the gene and protein levels in the oeGal-3 group (4.26±0.05, 3.94±0.34) were significantly higher than those in the oeNC group (1.00±0.00, 1.00±0.24, respectively) ( P<0.001). EdU, Ki67 experiments showed that the percentage of GFs proliferation was significantly lower in the shGal-3+LPS group [(16.99±1.79)%, (13.48±0.95)%, respectively] than in the shNC+LPS group [(33.86±3.84)%, (35.63±1.62)%, respectively] ( P<0.05), and the proliferation ratio of GFs was significantly increased in the oeGal-3+LPS group [(45.36±1.56)%, (45.83±1.50)%, respectively] compared to the oeNC+LPS group [(34.47±1.02)%, (33.66±3.14)%, respectively] ( P<0.05). The results of scratch migration assay showed that the migration ratio of GFs in shGal-3+LPS group significantly decreased compared to the shNC+LPS group [(25.07±0.01)% vs (57.84±0.00)%] ( P<0.001), whereas the oeGal-3+LPS group significantly facilitated the migration ratio of GFs compared to the oeNC+LPS group [(74.70±0.03)% vs (53.36±0.01)%] ( P<0.001). The results of TUNEL experiments showed that LPS stimulation with shGal-3 promoted apoptosis of GFs ( P<0.05), whereas oeGal-3 inhibited apoptosis of GFs ( P<0.001). Immunofluorescence experiments and RT-qPCR results showed that knockdown of Gal-3 significantly reduced ROS production, IL-6 and IL-8 expression levels at the gene level in GFs ( P<0.001), whereas overexpression of Gal-3 significantly increased the production of ROS and the expression of IL-6 and IL-8 at the gene level in GFs ( P<0.001). RNA-seq results showed that differential genes caused by Gal-3 knockdown under LPS conditions were significantly enriched in biological processes such as cellular response to type Ⅰinterferon in the Gene Ontology database and in the Kyoto Encyclopedia of Genes and Genomes database for NOD-like receptor, RIG-I like receptor and other signaling pathways. Conclusions:Gal-3 knockdown inhibited LPS-induced proliferation, migration, ROS, IL-6 and IL-8 production, and promoted apoptosis of GFs, while overexpression had the opposite effect. This process might be closely linked to the Janus kinase-signal transducer and activator of transcription pathway.

Objective:To clarify the morphological relationship between the upper airway and TMJ in patients with normal-angle skeletal Ⅱ and skeletal Ⅰ malocclusion.Methods:30 skeletal class Ⅰ and 22 skeletal class Ⅱ patients with normal-angle were included.CBCT examination was performed,and Mimics 21.0 software was used to conduct 3D reconstruction and measurements of the samples.Data was analyzed by using independent t-test and the Pearson correlation test.Results:12 measurements,including the sagittal diameter of nasopharyngeal segment,the sagittal,coronal diameter,minimum cross-sectional area,the volume of palato-pharyngeal segment and glossopharyngeum segment,the total volume of upper airway,posterior oblique slope of the articular eminence and the length of the condylar showed significant differences between skeletal Ⅱ and skeletal Ⅰ subjects with normal-angle(P＜0.05).The posterior oblique slope of the articular eminence showed a positive correlation with the sagittal diameter of the palatopharyngeal segment,volume and minimum cross-sectional area of glossopharyngeum lingual segment(P＜0.05).The liner ratio showed a negative correction with the coronal diameter of palatopharyngeal and glossapharyngeal segment as well as minimum cross-section area of glos-sapharyngeal segment(P＜0.05).Conclusion:The structure of upper airway is correlated with that of TMJ.Differences in the upper airway are statistically significant between skeletal Ⅱ and skeletal Ⅰ malocclusion with normal-angle(P＜0.05).

Objective:To investigate the effects of galectin-3 (Gal-3) expression on lipopolysaccharide (LPS)-induced proliferation, migration, apoptosis, reactive oxygen species (ROS) and inflammatory cytokine production in human gingival fibroblasts (GF) as well as its mechanism, thus laying the foundation for an in-depth discussion of the regulatory role of Gal-3 in periodontitis and its mechanisms.Methods:Gingival tissues from 6 periodontally healthy subjects undergoing crown lengthening were collected at the Department of Periodontology, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University from December 2022 to December 2023. GFs were extracted and cultured by collagenase digestion. Lentivirals with multiplicity of infection (MOI) of 15, 20, 30, 40, 50, 60, 70, 80 were used to achieve knockdown and overexpression of Gal-3 gene in GFs, whose efficiencies of Gal-3 gene were detected by using immunofluorescence, real-time fluorescence quantitative PCR (RT-qPCR) and Western blotting. Negative control of knockdown (shNC)+LPS group, Gal-3 knockdown (shGal-3)+LPS group, negative control of overexpression (oeNC)+LPS group, and Gal-3 overexpression (oeGal-3)+LPS group were established, respectively. 5-Ethynyl-2′-deoxyuridine (EdU), Ki67 staining, scratch migration assay, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) technology, immunofluorescence assay and RT-qPCR were used to investigate the effects of Gal-3 on LPS-induced proliferation, migration, apoptosis, ROS, interleukin (IL)-6, IL-8 expression. The effects of Gal-3 knockdown on the expression of differential genes and the enrichment of signaling pathways in LPS-induced GFs were investigated by RNA sequencing (RNA-seq).Results:More than 80% of GFs were successfully transfected by shGal-3 MOI 40 and oeGal-3 MOI 70. Immunofluorescence results showed that the morphologies of GFs were normal after lentiviral transfection, and green fluorescence could be distributed in the cytoplasm, nucleus, and cell membrane. The results of RT-qPCR and Western blotting assay showed that the expressions of Gal-3 at the gene and protein levels in shGal-3 group (0.26±0.01, 0.26±0.03, respectively) were significantly lower than those in the shNC group (1.00±0.03, 1.00±0.09, respectively) ( P<0.001); the expressions of Gal-3 at the gene and protein levels in the oeGal-3 group (4.26±0.05, 3.94±0.34) were significantly higher than those in the oeNC group (1.00±0.00, 1.00±0.24, respectively) ( P<0.001). EdU, Ki67 experiments showed that the percentage of GFs proliferation was significantly lower in the shGal-3+LPS group [(16.99±1.79)%, (13.48±0.95)%, respectively] than in the shNC+LPS group [(33.86±3.84)%, (35.63±1.62)%, respectively] ( P<0.05), and the proliferation ratio of GFs was significantly increased in the oeGal-3+LPS group [(45.36±1.56)%, (45.83±1.50)%, respectively] compared to the oeNC+LPS group [(34.47±1.02)%, (33.66±3.14)%, respectively] ( P<0.05). The results of scratch migration assay showed that the migration ratio of GFs in shGal-3+LPS group significantly decreased compared to the shNC+LPS group [(25.07±0.01)% vs (57.84±0.00)%] ( P<0.001), whereas the oeGal-3+LPS group significantly facilitated the migration ratio of GFs compared to the oeNC+LPS group [(74.70±0.03)% vs (53.36±0.01)%] ( P<0.001). The results of TUNEL experiments showed that LPS stimulation with shGal-3 promoted apoptosis of GFs ( P<0.05), whereas oeGal-3 inhibited apoptosis of GFs ( P<0.001). Immunofluorescence experiments and RT-qPCR results showed that knockdown of Gal-3 significantly reduced ROS production, IL-6 and IL-8 expression levels at the gene level in GFs ( P<0.001), whereas overexpression of Gal-3 significantly increased the production of ROS and the expression of IL-6 and IL-8 at the gene level in GFs ( P<0.001). RNA-seq results showed that differential genes caused by Gal-3 knockdown under LPS conditions were significantly enriched in biological processes such as cellular response to type Ⅰinterferon in the Gene Ontology database and in the Kyoto Encyclopedia of Genes and Genomes database for NOD-like receptor, RIG-I like receptor and other signaling pathways. Conclusions:Gal-3 knockdown inhibited LPS-induced proliferation, migration, ROS, IL-6 and IL-8 production, and promoted apoptosis of GFs, while overexpression had the opposite effect. This process might be closely linked to the Janus kinase-signal transducer and activator of transcription pathway.

Objective:To clarify the morphological relationship between the upper airway and TMJ in patients with normal-angle skeletal Ⅱ and skeletal Ⅰ malocclusion.Methods:30 skeletal class Ⅰ and 22 skeletal class Ⅱ patients with normal-angle were included.CBCT examination was performed,and Mimics 21.0 software was used to conduct 3D reconstruction and measurements of the samples.Data was analyzed by using independent t-test and the Pearson correlation test.Results:12 measurements,including the sagittal diameter of nasopharyngeal segment,the sagittal,coronal diameter,minimum cross-sectional area,the volume of palato-pharyngeal segment and glossopharyngeum segment,the total volume of upper airway,posterior oblique slope of the articular eminence and the length of the condylar showed significant differences between skeletal Ⅱ and skeletal Ⅰ subjects with normal-angle(P＜0.05).The posterior oblique slope of the articular eminence showed a positive correlation with the sagittal diameter of the palatopharyngeal segment,volume and minimum cross-sectional area of glossopharyngeum lingual segment(P＜0.05).The liner ratio showed a negative correction with the coronal diameter of palatopharyngeal and glossapharyngeal segment as well as minimum cross-section area of glos-sapharyngeal segment(P＜0.05).Conclusion:The structure of upper airway is correlated with that of TMJ.Differences in the upper airway are statistically significant between skeletal Ⅱ and skeletal Ⅰ malocclusion with normal-angle(P＜0.05).

Objectives:To investigate the clinical feasibility of three-dimensional(3D)high-resolution late gadolinium enhancement(LGE)MRI in accessing left atrial myocardial fibrosis in patients with atrial fibrillation(AF). Methods:A total of 34 AF patients referred for hybrid surgical ablation were retrospectively enrolled in this study.3D-LGE-MRI images were acquired by Siemens 3.0 T machine and analyzed by ADAS post-processing software by two experienced radiologists to obtain parameters such as the area and the area percentage of LGE.Regional analysis was performed by one of the two radiologists at ten left atrial segments.The Kappa test was used to assess the agreement for scoring image quality,and the interclass correlation coefficient(ICC)was used to evaluate the interobserver agreement of LGE parameters.The parameters of left atrial morphology,area(and area percentage)of LGE,and location of LGE were compared between patients with persistent AF and paroxysmal AF. Results:Images of all 34 patients were considered to have diagnostic value.The scores of the overall image quality and the clarity of the left atrial wall evaluated by two radiologists were(2.88±0.64)points and(3.26±0.75)points(radiologist 1),(2.97±0.58)points and(3.24±0.70)points(radiologist 2),respectively.The corresponding Kappa values were 0.724 and 0.859.Both the area and the area percentage of LGE showed good consistency among observers,and the ICCs were 0.969 and 0.950,respectively.The difference in the area of LGE and the area percentage of LGE between patients with paroxysmal and persistent atrial fibrillation was similar(both P＞0.05).Compared with patients with paroxysmal AF,patients with persistent AF had a higher Utah stage and more severe myocardial fibrosis in the right inferior pulmonary vein antrum and the left atrial septum(all P＜0.05). Conclusions:3D high-resolution LGE-MRI provides a non-invasive way to visualize and quantify left atrial myocardial fibrosis.The extent of left atrial fibrosis in patients with persistent AF is more severe than that in patients with paroxysmal AF,with a preferential distribution in the right inferior pulmonary vein antrum and the left atrial septum.