In conclusion, although the concept of a “very early” ICC based solely on tumor size is vague as it does not necessarily reflect an aggressive tumor biology, our proposed definition could serve as a basis for further studies evaluating the efficiency of either surgical resection or liver transplantation for this malignant disease.Intrahepatic cholangiocarcinoma (ICC) is a rare disease with poor outcome, despite advances in surgical and non-surgical treatment. Recently, studies have reported a favorable long-term outcome of “very early” ICC (based on tumor size and absence of extrahepatic disease) after hepatic resection and liver transplantation, respectively. However, the prognostic value of tumor size and a reliable definition of early disease remain a matter of debate. Patients undergoing resection of histologically confirmed ICC between February 1996 and January 2021 at our institution were reviewed for postoperative morbidity, mortality, and long-term outcome after being retrospectively assigned to two groups: “very early” (single tumor ≤ 3 cm) and “advanced” ICC . A total of 297 patients were included, with a median follow-up of 22.8 (0.1–301.7) months. Twenty-one (7.1%) patients underwent resection of “very early” ICC. Despite the small tumor size, major hepatectomies (defined as resection of ≥3 segments) were performed in 14 (66.7%) cases. Histopathological analyses revealed lymph node metastases in 5 (23.8%) patients. Patients displayed excellent postoperative outcome compared to patients with “advanced” disease: intrahospital mortality was not observed, and patients displayed superior long-term survival, with a 5-year survival rate of 58.2% (versus 24.3%) and a median postoperative survival of 62.1 months (versus 25.3 months;  Intrahepatic cholangiocarcinoma (ICC) is a highly malignant disease with poor prognosis and the second most common primary hepatic malignancy, responsible for 10–20% of all primary liver tumors [Recent epidemiological data revealed a rising incidence; however, ICC remains a rarity, especially compared to hepatocellular carcinoma . AlthougAs the incidence of patients with single tumors ≤2 cm is extremely low and data presented by Spolverato et al. demonstrated the prognostic value of a 3 cm tumor size cut-off as a predictor for vascular invasion and higher tumor grading in patients undergoing resection , while SWe retrospectively reviewed 297 patients undergoing resection of ICC in curative intent between February 1996 and January 2021 at the Department of General, Visceral and Transplant Surgery, Hannover Medical School, in Hannover, Germany, for postoperative morbidity, mortality, and long-term survival. Patients were included only if conclusive postoperative histology was available. Resections of combined hepatocellular–cholangiocarcinomas, perihilar cholangiocarcinomas, and gallbladder carcinomas were not included within the analyses. Patients undergoing surgery for tumor recurrence and patients under the age of 18 years were also excluded from this study. Patients were assigned to two groups on the basis of tumor size, multifocality, and extrahepatic disease: “very early” ICC was defined by the presence of a single tumor with a size ≤3 cm and the absence of extrahepatic disease. All other patients were assigned to the group of “advanced” ICC.Major hepatectomies were defined as resections of three or more liver segments, whereas extended hepatectomies were defined as resection of five or more segments. Vascular resections were defined as simultaneous resection of large vessels, such as the vena cava inferior or the portal vein. Multivisceral resections were defined as additional resections of extrahepatic tissue (excluding perihilar bile ducts and large vessels). Postoperative complications were graded according to the Clavien-Dindo classification system as follows: Grade 0 (no complications), grade I (minor deviations), grade II (requiring pharmacologic treatment), grade III (requiring interventions), grade IV (life-threatening), and grade V (death). Complications ≥grade III were defined as severe complications. In addition, the classification system of the International Study Group of Liver Surgery for common surgical complications post hepatic resection  was applied. The AJCC/UICC staging system (8th edition) was applied for tumor classification. The follow-up time was defined as time between hepatic resection and last contact or death. The last follow-up date was 17 May 2021. Survival times are reported as Kaplan–Meier median estimates throughout the text.p-value < 0.050 and is shown in bold (Tables) or marked with an asterisk . The collected data were implemented and analyzed using SPSS statistical software . The figure was created with GraphPad Prism .The distribution of categorical variables between the two groups was compared by the chi-squared and Fisher’s exact test. Differences in continuous data were analyzed with the Student’s t test in case of normal distribution and the Mann-Whitney U test. Kaplan–Meier analyses and log rank tests were applied to compare postoperative survival between the two groups. Statistical significance was set at a A total of 297 patients was included in the analyses, with a median follow-up of 22.8 (0.1–301.7) months. Twenty-one (7.1%) patients underwent surgical resection for “very early” ICC, whereas 276 (92.9%) patients were resected for “advanced” ICC. n = 135 (48.9%); p = 0.071). However, the extent of (hepatic) surgery, vascular and extrahepatic resections, and consequently operating times were inferior by trend when compared to that in patients undergoing resection of “advanced” ICC  patients underwent major hepatectomies, including 5 (23.8%) patients receiving simultaneous perihilar bile duct resection and 1 (4.8%) patient undergoing extended hepatectomy. Major resections despite a “very early” disease were performed due to a tumor location adjacent to either central vascular structures or bile ducts. One patient underwent left hemihepatectomy as a radical resection due to intraoperatively suspected nodal involvement. Although pedicle clamping during resection was performed in 16 (76.2%) patients, intraoperative transfusions were necessary in 6 (28.6%) cases . Of note, the rate of simultaneous lymphadenectomy was also similar in the two groups . Postoperative histopathological analyses revealed lymph node metastases in five (23.8%) cases, comparable to the rate of patients suffering from “advanced” ICC (n = 1 (4.8%) versus n = 66 (23.9%); p = 0.020), and none of the patients revealed a poorly differentiated carcinoma (versus n = 83 (30.1%); p = 0.005).Vascular invasion was identified less frequently for “very early” disease (p = 0.218). Furthermore, positive resection margins were observed in 1 patient (4.8%) only, as opposed to 45 (16.3%) patients undergoing resection for “advanced” ICC (n = 97 (35.1%); p = 0.156). None of the patients suffered from severe post-hepatectomy liver failure. Moreover, intrahospital, 30-day, or 90-day mortality was not observed in the case of “very early” disease, whereas 21  patients died within the primary hospital stay after undergoing resection of “advanced” disease. The main cause for intrahospital mortality was a postoperative liver failure with subsequent multiple organ failure, observed in nine (42.9%) cases. Six (28.6%) patients died due to septic complications . Three (14.3%) patients died after massive postoperative hemorrhage. Lethal myocardial infarction was observed in two (9.5%) patients, whereas mesenteric ischemia was determined as the cause of death in one (0.5%) patient. p = 0.013, Patients undergoing resection for “very early” ICC showed superior postoperative outcome, defined by morbidity and mortality. Severe complications were observed in four (19.0%) patients only  has been introduced, displaying excellent outcome after liver transplantation and resection ,12,13. TIn our cohort of 297 patients who underwent surgical resection at a tertiary referral center for hepatobiliary surgery over a course of 25 years, we identified 21 patients suffering from “very early” ICC. These patients displayed excellent postoperative outcome and long-term survival, with a 5-year survival rate 58.2%, which was significantly superior to that of patients with more advanced disease. Furthermore, we were able to confirm the aforementioned data from Spolverato et al. with significantly lower rates of vascular invasion and high-grade tumors. In the light of our own results and other work on the matter, we conclude that a 3 cm tumor size cut-off seems to be more appropriate for the definition of a “very early” ICC and could serve as a basis for further studies evaluating the efficiency of either surgical resection or liver transplantation and also for interventional approaches such as thermal ablation, as was recently reported by Kim et al., for this malignant disease .Nevertheless, the value of tumor size in general for long-term prognosis remains uncertain. Studies of the past failed to show a direct correlation between tumor size and survival. Consequently, the first ICC-specific classification according to the AJCC/UICC staging system (7th edition) did not include tumor size . More recently, Hyder et al. demonstrated an independent prognostic value of tumor size for survival after resection of ICC in a patient cohort of 514 patients [In response to the aforementioned reports, also including studies by Ali et al. and Doussot et al., the current 8th) edition of the AJCC/UICC staging system subdivides the T1 stage with regard to a maximum tumor size of more than 5 cm (a/b) th editio,18.As has been concluded by others, a larger tumor size is often associated with further pathologic features impairing the long-term outcome of patients, such as perforation of the visceral peritoneum and, thereby, even involvement of extrahepatic structures, which are also factors implemented within the 8th edition of the AJCC/UICC classification system, but also more oblique factors not part of the current staging systems, such as an obstruction of the biliary tree.Recently, inflammation-based biomarkers have been shown to have prognostic value in patients with ICC . AccordiIn the past years, the understanding of cancer biology has made significant progress, and mutation analyses of tumor tissue as well as modern biomarkers could prove more appropriate to predict prognosis and response to potential therapies in patients with ICC, although the available data are still scarce and partially conflicting. In two large studies, mutations in KRAS and TP53 were associated with inferior recurrence-free and overall survival ,22. FurtIn summary, we believe that, despite our encouraging results, the concept of a “very early” ICC merely defined by tumor size is vague, as it does not necessarily exclude an aggressive tumor biology and an advanced disease. Therefore, further studies evaluating the efficiency of either surgical resection or liver transplantation and also interventional approaches should be based on modern tumor biomarkers or mutation analyses in combination with inflammation-based biomarkers and traditional surgical risk factors, such as tumor size, to optimize the outcome of this lethal disease.Limitations of our study are the retrospective design as well as the long time period of more than two decades in which the included patients underwent surgical resection. Furthermore, the low incidence and therefore the small number of cases with “very early” ICC requires multicenter studies to address pending issues in the future.


Clinically relevant pancreatic fistula (CRPF) is a serious complication following laparoscopic pancreaticoduodenectomy (LPD). This study aimed to determine if C-reactive protein (CRP) and procalcitonin (PCT) serum levels could be used as early biomarkers to predict CRPF after LPD.In this retrospective study, we collected peri-operative data of patients who underwent LPD between January 2019 and November 2019. We compared serum levels of white blood cells (WBC), CRP, and PCT on post-operative days (POD) 1, 2, 3, 5, and 7 between the CRPF and non-CRPF groups and analyzed the predictive risk factors for CRPF.P < 0.001)].Among the 186 patients included in this study, 18 patients (9.7%) developed CRPF, including 15 and 3 patients with grade B and C fistulas, respectively. The mean WBC, CRP, and PCT levels were higher on most PODs in the CRPF group compared to the non-CRPF group. Receiver operating characteristic (ROC) analysis indicated that CRP levels on POD 2, 5, and 7 can predict CRPF development after LPD, with the area under the curve (AUC) value reaching the highest level on POD 2 (AUC 0.794). PCT levels on POD 2, 3, 5, and 7 were highly predictive of CRPF after LPD. The highest AUC value was achieved on POD 3 [PCT > 2.10 ng/ml (AUC 0.951; sensitivity 88.2%, specificity 92.9%, Both CRP and PCT levels can be used to predict CRPF development after LPD, with PCT having a higher predictive value. Laparoscopic pancreaticoduodenectomy (LPD) was first described in 1994 . Post-opWhite blood cell (WBC) counts, C-reactive protein (CRP), and procalcitonin (PCT) are the most commonly used markers of inflammation. Elevated blood levels of these markers are associated with inflammatory or infectious conditions. CRP and PCT have been widely used as early predictors of anastomotic leak and infection in colorectal surgery , gastroiThis was a retrospective analysis of data obtained from electronic medical records. Patients who underwent LPD between January 2019 and November 2019 in the Department of Hepatobiliary and Pancreatic Surgery at the First Hospital of Jilin University , a large tertiary grade A hospital and high-volume pancreatic surgical center, were included in this study. The study protocol was approved and informed consent was waived due to the retrospective nature of this study by the Ethical Committee of the First Hospital of Jilin University .All operations were performed by the same senior pancreatic surgeon with the help of a dedicated staff. There was no bias in the selection of patients. Exclusion criteria were as follows: (i) patients with symptoms and signs of active infection at the time of surgery, (ii) patients with autoimmune disorders or hematological malignancies, and (iii) incomplete clinical data.The patients were placed in a supine position with legs separated. A 12 mm camera port was inserted 3 cm below the umbilicus and pneumoperitoneum was established. The intra-abdominal pressure was maintained at 12–14 mmHg. The surgeon stood on the right side of the patient, the assistant stood on the left side, and the laparoscope holder stood between the legs of the patient. The operation was performed using the posterior colonic approach. The pancreatico-jejunal, bilio-enteric, and gastrojejunal anastomoses were performed laparoscopically as described previously . ReconstAll patients were transferred to the intensive care unit (ICU) for monitoring after surgery. Patients were transferred to general wards within 1–2 days once all vital parameters stabilized. All patients received prophylactic antibiotic treatment. According to the fast-track protocol, all patients had their nasogastric tubes removed on the first day after surgery, and liquid food was administered once flatus was passed. The drainage volume was closely observed after surgery. If the drainage volume was < 50 mL/d and the amylase level in the ascitic fluid was < 3000 IU/L, the abdominal drain was removed on the third day after surgery.The WBC count, CRP, and PCT levels were routinely measured on post-operative days (PODs) 1, 2, 3, 5, and 7 after LPD. We also collected data from pre-operative laboratory testing, intra-operative events, and post-operative outcomes.POPF was defined in this study using the International Study Group of Pancreatic Surgery (ISGPS) 2016 criteria  and clasP values < 0.05 were considered statistically significant.Continuous variables with non-normal distribution are represented as median (Q1–Q3) and compared using the Mann–Whitney U test. Categorical variables are represented as frequency (percentage) and compared using the Chi-square or Fisher’s exact test. Multivariate analysis was carried out using logistic regression analysis. The best cutoff points for the predictive variables of CRPF were identified using receiver operating characteristic (ROC) curves and the Youden index. The area under the curve (AUC) of the different ROC curves were compared using Delong’s test . All anaA total of 194 patients underwent LPD during the study period. Among these patients, 8 patients were excluded due to presence of active infection (n = 3), presence of autoimmune disorder (n = 1), presence of hematological malignancy (n = 1), and incomplete clinical data (n = 3). Finally, 186 patients were included in this study. There were 102 males and 84 females with a median age of 61 years (interquartile range (IQR), 52–67). No patient required conversion to open surgery. CRPF developed in 18 patients (grade B fistula in 15 patients and grade C fistula in 3 patients). The incidence of CRPF was 9.7%. Table differences between the two groups regarding pancreatic gland texture and pancreatic duct diameter. In addition, patients in the CRPF group had higher incidences of post-operative hemorrhage, longer hospital stays, and higher mortality rates.P < 0.001). Drain fluid amylase (DFA) on POD 3 was also significantly higher in the CRPF group (P < 0.001) . The highest AUC value for PCT was achieved on POD 3 [PCT > 2.10 ng/ml ]  and WBC counts  were independent predictive factors for CRPF after LPD  = 3.303, 95% confidence interval (CI) [1.902–5.736], CI 0.019–.115, P =Post-operative pancreatic fistula (POPF) is a life-threatening complication after LPD. Various methods have been reported to predict and prevent POPF after OPD. However, LPD is a technically more demanding procedure that is only performed at a select number of surgical centers. As such, there are limited reports on the prediction of POPF after LPD. The current study was conducted at a high-volume center with nearly 200 cases of LPD being performed per year. The results of this study showed that WBC, CRP, and PCT levels were higher among patients with CRPF compared to those without CRPF. WBC counts are affected by factors other than inflammation and infection, such as trauma, acute blood loss, and medications, making this a less reliable marker than CRP and PCT levels for predicting CRPF.CRP is the first acute reactant synthesized in the liver, with a half-life of 19 h. CRP levels rise above normal values within 6 h and peak at 48 h after stimulation . Serum CPCT is considered to be a marker of severe bacterial infections and has the potential to distinguish between infectious and non-infectious systemic inflammation . PCT canDrain fluid amylase content is superior for determining the presence of POPF because it directly reflects the leakage of pancreatic fluids. However, amylase concentration can be strongly influenced by the amount of exudative ascites fluid and the efficacy of drainage , indicatThe present study has some limitations, including small sample size and the retrospective nature of the study. Future larger prospective studies are required to assess the validity and reliability of the present data. In the future, we plan to design prospective controlled trials to compare the differences in post-operative inflammatory response between LPD and OPD and to assess the ability of inflammatory markers to predict other infectious complications after LPD.Both CRP and PCT levels can be used to predict CRPF development after LPD. PCT levels > 2.10 ng/ml on POD 3 after LPD are superior predictive markers of CRPF compared to CRP levels. Early recognition of CRPF after LPD using these parameters can help surgeons to intervene in the early stages and reduce post-operative morbidity and mortality.


Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature newborns. In this study, we aim to compare the reintubation rate in preterm babies with RDS who were extubated to Nasal Continuous Positive Airway Pressure (NCPAP) versus those extubated to Nasal Intermittent Positive Pressure Ventilation (NIPPV).n = 220) of ventilated preterm infants with gestational age ranging between 28 weeks 0 days and 36 weeks + 6 days gestation and extubated to non-invasive respiratory support  during the period from January 2016 to December 2017 were reviewed.This is a retrospective study conducted in the Neonatal Intensive Care Unit (NICU) of Women’s Wellness and Research Center (WWRC), Doha, Qatar. The medical files (n = 97 (44%) babies were extubated to CPAP, n = 77 (35%) were extubated to NIPPV, and n = 46 (21%) babies were extubated to Nasal Cannula (NC). Out of the n = 220 babies, 18 (8.2%) were reintubated within 1 week after extubation. 14 of the 18 (77.8%) were reintubated within 48 h of extubation. Eleven babies needed reintubation after being extubated to NCPAP (11.2%) and seven were reintubated after extubation to NIPPV (9.2%), none of those who were extubated to NC required reintubation (P = 0.203). The reintubation rate was not affected by extubation to any form of non-invasive ventilation (P = 0.625). The mode of ventilation before extubation does not affect the reintubation rate (P = 0.877). The presence of PDA and NEC was strongly associated with reintubation which increased by two and four-folds respectively in those morbidities. There is an increased risk of reintubation with babies suffering from NEC and BPD and this was associated with an increased risk of hospital stay with a P-value ranging (from 0.02–0.003). Using multivariate logistic regression, NEC the NEC  and the vaginal delivery  remained significantly associated with reintubation.From the study group of 220 babies, Reintubation rates were less with NIPPV when compared with NCPAP, however, this difference was not statistically significant. This study highlights the need for further research studies with a larger number of neonates in different gestational ages birth weight categories. Ascertaining this information will provide valuable data for the factors that contribute to re-intubation rates and influence the decision-making and management of RDS patients in the future. Respiratory Distress Syndrome (RDS) is a common cause of neonatal morbidity and mortality in premature infants. It is caused by a deficiency of surfactant in a premature lung. In preterm infants at-risk for or with established RDS, Nasal Continuous Positive Airway Pressure (NCPAP) is the initial preferred intervention to prevent alveolar collapse –3. It woFurthermore, Nasal Intermittent Positive Pressure Ventilation (NIPPV) is a delivery model of positive pressure ventilation that avoids the trauma of the endotracheal placement tube. It augments and promotes the effectiveness of NCPAP by delivering ventilator breaths via nasal prongs or mask . NIPPV IThe popularity of NIPPV is rising since its comparison to NCPAP has demonstrated a significant decrease in respiratory failure, re-intubation rates, and extubation failure , 9. A muThis retrospective study was conducted in the Neonatal Intensive Care Unit (NICU) of Women’s Wellness and Research Center (WWRC) in Hamad Medical Corporation (HMC), after obtaining ethical approval from the Medical Research Center (MRC-01-18-321) following the Declaration of Helsinki. WWRC is a large tertiary center in Doha, Qatar, with a delivery rate of over 18,000 per year. The medical files of 220 ventilated preterm infants who were born at the gestational age between 28 weeks 0 days and 36 weeks + 6 days gestation and extubated to non-invasive respiratory support in 2016 and 2017 were reviewed. In our unit, we use the Babylog VN500 Ventilator  to provide NCPAP and NIPPV for extubated infants. The available nasal interfaces in our institution are nasal masks and RAM cannula. All infants were extubated, following our NICU extubation criteria, if Fraction of Inspired Oxygen (FiO2) < 0.30, for a target oxygen saturation of more than 90%, and if a good consistent respiratory effort was present. After extubation, our babies were supported by adequate non-invasive respiratory support of NCPAP pressure of 5–7 cm H2O, or nasal intermittent positive pressure ventilation (NIPPV) PIP pressure of 18–24 cm H2O, or nasal cannula 2–4 Litres/minute. Infants were reintubated and connected to mechanical ventilation if they required high FiO2 of > 0.35–0.40, had frequent or persistent apnea or had respiratory acidosis with pH < 7.25 and PCO2 > 60 mmHg. We traced the rates of reintubation in babies extubated to NCPAP and those extubated to NIPPV. Our primary outcome is to compare the rate of reintubation in those two groups. We identified the need for reintubation by respiratory acidosis, increased oxygen requirement, or apnea that was frequent or severe, leading to the endotracheal tube being reinstated during the week post-extubation . For infOur secondary outcomes are to compare the characteristics of the two groups to try to identify predictive factors for reintubation and to compare the rate of complications from non-invasive ventilation in both groups.We designed a data collection sheet with maternal characteristics including nationality, Gestational Age (GA), mode of delivery, antenatal steroids, maternal chorioamnionitis, Premature Rupture of Membranes (PROM), Group B Streptococcus (GBS) status, and maternal comorbidities including Diabetes Mellitus (DM) and hypertensive disorders. Delivery and neonatal variables were also collected including Birth Weight (BW), sex, 1- and 5-min Apgar scores, need for Positive Pressure Ventilation (PPV)/intubation/resuscitation medication at delivery, surfactant therapy, need for a postnatal steroid, Patent Ductus Arteriosus (PDA), pre-extubation mode of ventilation, and duration of NCPAP/NIPPV.Other outcome measures included gastrointestinal perforation; Necrotizing Enterocolitis (NEC); pneumothorax, Bronchopulmonary Dysplasia, duration of mechanical ventilation, duration of hospitalization, and mortality. BPD was defined according to the definition of the National Institutes of Health Consensus . NEC wasp-value of < 0.05 was considered statistically significant. All statistics were computed using SPSS, version 22 .Descriptive statistics were used to summarize data related to demographic, clinical, laboratory, and other characteristics of the study sample. Continuous variables were analyzed using a t-test or a Mann Whitney U test, where applicable, and presented as mean ± standard deviation. Categorical variables were analyzed using a chi-square test or Fisher exact test, where applicable, and presented as frequencies and percentages. A logistic regression model was used to determine the predictors for reintubation. The results were presented as odds ratio and 95% confidence intervals. A receiver operating characteristic (ROC) curve was calculated to evaluate the predictive accuracy of possible predictors. A two-tailed We had 2335 NICU admissions in 2016, and 2411 in 2017. Of these 4746 NICU admissions, 220 infants were born between 28 weeks 0 days and 36 weeks + 6 days gestation and required mechanical ventilation. Most of the study sample were non-Qatari (58.6%) males (55.9%). The mean ± SD for the birth weight in our study population is 1655.4 ± 547.8 g while for the gestational age is 31.3 ± 2.7 weeks  were reintubated within 1 week after extubation. In our NICU, we use Pressure-Controlled, Assist-Controlled Ventilation with Volume Guarantee as (PC-AC + VG) the primary mode for mechanical ventilation in infants with RDS. Of those intubated babies, 198 were extubated from PC-AC + VG mode, 5 were extubated from Synchronized Intermittent Mandatory Ventilation (SIMV), and 5 were extubated from High-Frequency Oscillatory Ventilation (HFOV)  were reintubated within the first 1 to 2 days whereas the other 4 cases (21.2%) were reintubated on the 4th, 5th, 6th, and 7th days post-extubation, respectively.P = 0.203). Significant differences between the three modes involved the following parameters: air leak, need for PPV during resuscitation, surfactant administration, number of surfactant doses, PDA, HsPDA, BPD, birth weight, and gestational age  as shown in Table P = 0.959).PDA was present only in 22.2% (48/216) of the neonates in our study. Of those 27 56.3%) were having hemodynamically significant PDA (HsPDA) , 15. HsP% were haP = 0.583). Similarly, when compared sepsis status across three post-extubation groups showed insignificant difference   and non-reintubation 3.1% (6/192) groups (P = 0.115) (Table P = 0.495).One-way ANOVA indicated that the mean age at extubation in days was not significantly different across three post-extubation modes . Those 18 babies who required reintubation are 17 out of the 198 babies (8.6%) extubated from PC-AC + VG and 1 out of 4 (20%) extubated from SIMV. None of those who were extubated from High-Frequency Oscillatory Ventilation (HFOV) required reintubation. The mode of ventilation before extubation does not affect the reintubation rate (P = 0.877). Reintubation had multiple significantly different characteristics compared to the non-reintubation group including NEC, the method of delivery, BPD, and length of stay with a P-value ranging (from 0.02–0.003). NEC happened after reintubation in all cases. The presence of PDA and NEC was strongly associated with reintubation which increased by two and four-folds respectively in those morbidities  and the delivery by vaginal delivery  remained significantly associated with reintubation after controlling and adjusting for all other potential associated factors, confounders and predictors. The need for PPV during resuscitation was associated with reintubation but that association was statistically insignificant   = 0.68, 95% CI 0.52, 0.82)  infant holds the potential for several benefits for the infant, including a decrease in calorie consumption, decreased tracheal and laryngeal injury, decreased nosocomial pneumonia, and sepsis, and a decreased incidence and severity of bronchopulmonary dysplasia. Non-invasive Ventilation in neonates has mainly been used to maintain effective breathing after a period of extubation and to avoid extubation failure. There has also been a recent trend to use NIPPV as the primary mode of ventilation for the early management of Respiratory Distress Syndrome (RDS) as an alternative to intubation and ventilation, but evidence of its superiority over traditional CPAP and ventilation is still lacking .We conducted this study to compare the rate of reintubation after extubation to different non-invasive modes of ventilation.Our study reported an 8.2% reintubation rate within 1 week after extubation. This is lower than the 19.6% reintubation rate after 48 h of extubation reported in a study by Chico et al. . NecrotiThis study compared reintubation rates among preterm babies after extubation to either NCPAP or NIPPV. The findings showed no significant difference in reintubation rates between those extubated to NCPAP and those to NIPPV. This is in contrast to what four randomized controlled trials  using NIOur study also investigated the rates of gastrointestinal perforation, NEC, and air leak in both groups. There was also no difference concerning gastrointestinal perforation and NEC when comparing NIPPV, NCPAP, and NC. From our results, NEC is associated with reintubation, but it is not a complication of one mode of ventilation. Pneumothorax was significantly higher in those who were extubated to NC compared to those extubated to NCPAP and NIPPV. It might be related to the extra effort done by babies extubated to NC to maintain their Functional Residual Capacity (FRC).A meta-analysis that covered three clinical trials reported a statistically significant benefit for those extubated to NIPPV compared to NCPAP, regarding preventing extubation failure, along with the absence of gastrointestinal perforation . A systeThe association between extubation failure in preterm babies and the type of delivery was not clearly understood. Many researchers did not find any association between extubation failure and the type of delivery –26. TeixThe findings of this study can be attributed to a range of predictors and covariates including the nature of the current study, being retrospective which is the main limitation. Despite not, all have been reintubated, the relatively high number of intubated babies in the gestational age group of infants included in the study reflects the tendency of our NICU team to intubate those infants. Less Invasive Surfactant Administration (LISA) has been introduced recently to our clinical practice. With that, we expect a significant decrease in the number of intubated babies and subsequently the number of extubation failures –32. BesiReintubation rates were less with NIPPV when compared with NCPAP, however, this difference was not statistically significant. This study highlights the need for further research studies with a larger number of neonates in different gestational ages birth weight categories. Ascertaining this information will provide valuable data for the factors that contribute to re-intubation rates and influence the decision-making and management of RDS patients in the future.


Respiratory tract infections (RTIs) are ubiquitous among children in the community. A prospective observational study was performed to evaluate the diagnostic performance and quality of at-home parent-collected (PC) nasal and saliva swab samples, compared to nurse-collected (NC) swab samples, from children with RTI symptoms. Children with RTI symptoms were swabbed at home on the same day by a parent and a nurse. We compared the performance of PC swab samples as the test with NC swab samples as the reference for the detection of respiratory pathogen gene targets by reverse transcriptase PCR, with quality assessment using a human gene. PC and NC paired nasal and saliva swab samples were collected from 91 and 92 children, respectively. Performance and interrater agreement (Cohen’s κ) of PC versus NC nasal swab samples for viruses combined showed sensitivity of 91.6%  and κ of 0.84 , respectively; the respective values for bacteria combined were 91.4%  and κ of 0.85 . In saliva samples, viral and bacterial sensitivities were lower at 69.0%  and 78.1% , as were κ values at 0.64  and 0.70 , respectively. Quality assessment for human biological material (18S rRNA) indicated perfect interrater agreement. At-home PC nasal swab samples performed comparably to NC swab samples, whereas PC saliva swab samples lacked sensitivity for the detection of respiratory microbes.IMPORTANCE RTIs are ubiquitous among children. Diagnosis involves a swab sample being taken by a health professional, which places a considerable burden on community health care systems, given the number of cases involved. The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in the at-home self-collection of upper respiratory tract swab samples without the involvement of health professionals. It is advised that parents conduct or supervise swabbing of children. Surprisingly, few studies have addressed the quality of PC swab samples for subsequent identification of respiratory pathogens. We compared NC and PC nasal and saliva swab samples taken from the same child with RTI symptoms, for detection of respiratory pathogens. The PC nasal swab samples performed comparably to NC samples, whereas saliva swab samples lacked sensitivity for the detection of respiratory microbes. Collection of swab samples by parents would greatly reduce the burden on community nurses without reducing the effectiveness of diagnoses. The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in at-home self-collection of upper respiratory tract swab samples, which are then sent to the laboratory for clinical diagnostics .Traditionally, respiratory tract infection (RTI) diagnosis is made by HCW collection of an invasive and uncomfortable nasopharyngeal (NP) swab sample, which is considered to have high sensitivity for viral detection . Reverse7–Surprisingly, there are limited community-based studies demonstrating the performance of parent-collected (PC) swab samples obtained from children, compared to HCW-collected swab samples, for the detection of respiratory microbes –16. Many–10–n = 182) and 92 PC and NC saliva swab samples (n = 184) were analyzed for the detection of respiratory microbes . For the paired saliva swab samples, 88.67%  of PC swab samples, compared to 98.11%  of NC swab samples, were positive (P = 0.013). Thus, the RNase P gene demonstrated that PC nasal swab samples were better than NC nasal swab samples, whereas NC saliva swab samples were better than PC saliva swab samples. The complete agreement of PC and NC swab samples with regard to detection of the 18S rRNA gene indicates that parents can swab as effectively as nurses.To test whether parents could swab as effectively as nurses, we determined the percentage of paired swab samples that were RT-PCR positive for the detection of two control human gene targets, 18S rRNA and RNase P . There wFor further analyses, however, paired samples in which either or both samples were negative for the detection of RNase P were excluded . Such saInterrater reliability and sensitivity were used to assess the performance of the PC and NC swab samples using detection of the human 18S rRNA gene, an indication that the swab contained biological material. The PC nasal and saliva sample 18S rRNA gene results showed 100% sensitivity and specificity and a κ value of 1, indicating perfect agreement with the NC swab results .TC) values were analyzed. The TC value for the detection of 18S rRNA was significantly (P = 1.1 × 10−6) lower (higher expression) for PC nasal swab samples  than for NC swab samples   higher (lower expression) for PC swab samples  than for NC swab samples   . For pai 21.69]) . This inTC values were within the limits of agreement . In this study, the mean RNase P gene TC values were higher than the mean 18S rRNA TC values, indicating lower expression levels or lower assay sensitivity. Overall, the RNase P gene results were less reliable and were not trusted as a suitable control for this study  or who collected the specimen (PC swab samples versus NC swab samples), the majority of 18S rRNA is study .To compare the performance of PC swab samples with NC swab samples for the detection of microbes, only pairs of PC and NC swab samples in which both were positive for both human control genes were considered . In totaNeisseria meningitidis  and 97.57% , respectively; for bacteria, the sensitivity and specificity of the PC nasal swab samples were 91.47%  and 92.93% , respectively . The nasngitidis .Streptococcus pyogenes, and Fusobacterium necrophorum showed 100% sensitivity and specificity in PC swab samples, compared to NC swab samples  and 97.24% , respectively; for bacteria, they were 78.12%  and 93.26% , respectively . Salivar samples .N. meningitidis  and 0.85 , respectively . Perfectngitidis .S. pyogenes, and F. necrophorum  and 0.70 , respectively . Perfectrophorum .Moraxella catarrhalis  and rhinovirus 2 , whereas those in saliva swab samples were coagulase-negative staphylococci  and rhinovirus 2   .TC values for detection of the most prevalent viruses (rhinovirus and rhinovirus 2 combined data), bacterial pathobionts , and the human control gene (18S rRNA) in nasal swab samples , M. catarrhalis (P = 6.6 × 10−12), S. pneumoniae (P = 7 × 10−6), and rhinoviruses (P = 2.5 × 10−6) , M. catarrhalis (P = 0.06), S. pneumoniae (P = 0.14), and rhinoviruses (P = 0.82)  . PC and  = 0.82) . PC and We have demonstrated that PC nasal swab samples collected at home from children displaying RTI symptoms are comparable to NC swab samples for the detection of respiratory viruses and bacteria. Although PC saliva samples demonstrated high levels of specificity, they were insufficiently sensitive to substitute for NC samples.S. pneumoniae has been positively associated with the presence of H. influenzae, M. catarrhalis, rhinoviruses, and enteroviruses and negatively associated with the presence of Staphylococcus aureus  clinical validation sensitivity range of 89.1% to 100% . Consists aureus . Our stuaureus 9–, 16, 19.4 to 77% . In our Increasingly, saliva has been used for the clinical detection of respiratory pathogens during an RTI , 21. In TC values for PC and NC samples, indicating a difference in the amounts of biological material collected . This suggests that there was adequate sampling of the community to ensure performance validity between PC and NC swab samples, compared to other community-based studies in which 33 to 234 children were recruited and swabbed for the detection of respiratory pathogens 9–, 19, 25.To assess performance, we used the NC swab sample RT-PCR results as the reference standard against which the performance of PC swab samples was compared. A true reference standard is defined as “the best available method for establishing the presence or absence of the target condition” . TherefoIn our study, the RNase P gene generated a number of false-positive and false-negative results and, with a low expression level, it was not used as a control. There is no standard human housekeeping gene for performance assessment measures; therefore, judgement is required in each study. The endogenous human retrovirus gene (ERV3) was used previously to assess biological loads between nasal and NP swab samples, comparing swab collection by a parent and a HCW . Our resIn this study, two measures were used to compare the performance of PC and NC nasal and saliva swab samples. Cohen’s κ value is widely used but involves subjective interpretation. This interpretation, by Landis and Koch , categorGiven the widespread use of nasal sampling in the COVID-19 pandemic, 384 million lateral-flow at-home self-test kits are already being used throughout the United Kingdom, advocating the ease of nostril swabbing . COVID-1Recruitment, data collection, and demographic information for children were described previously . In brieParents were given written instructions on how to collect effective nasal swab and saliva swab samples . The swab home kits were provided by the nurses on the day they visited the family home, to allow parents ample time to read the swab collection instructions. PC nasal swab samples were collected with a sterile dry PurFlock nylon swab , placed just inside the nostril entrance and rotated three times. Saliva sponge Oracol swabs  were placed in the mouth under the tongue for at least 1 min, until approximately 1 ml of crevicular fluid soaked into the swab. PC samples were packaged into a first-class Royal Mail SafeBox and posted to the laboratory at ambient temperature. Nurses swabbed the children immediately after the parents had collected swab samples. The NC nasal swab was immersed in a vial containing 1 ml viral transport medium (VTM) and then both of the NC swab samples were placed on ice and delivered to the laboratory the same day.Upon laboratory receipt, nasal swab samples and saliva samples were stored at –80°C until required. Batches of samples for extraction were allowed to thaw at room temperature. The volume of saliva in the collection tubes was estimated. If necessary, low-volume specimens (<200 μl) were diluted with 200 μl phosphate-buffered saline. Dry nasal swab samples were prepared by adding 1 ml VTM from sterile Copan tubes and vortex-mixing briefly to agitate the swab. Then, 100 μl of each sample was extracted using the QIAsymphony DSP virus pathogen minikit (Qiagen) and the 60-μl elution protocol, including an internal process control containing bacteriophages T4 and MS2.TC value of <38 for any gene target was reported as a positive result. Samples were run in 9 batches and were amplified and analyzed using a Life Technologies Custom TaqMan low-density array system on an Applied Biosystems Life Technologies ViiA-7 real-time PCR system, as described elsewhere (To detect respiratory microbes (29 viruses and 13 bacteria), 2 exogenous extraction controls (T4 and MS2 bacteriophages), and 2 endogenous human control genes (18S rRNA and RNase P genes), a 42-microbe TAC  was used (see Table S1). The TAC was clinically validated at Southmead Hospital  . Upon colsewhere .The performance of PC samples relative to NC samples was assessed by calculating sensitivity, specificity, and interrater agreement using Cohen’s κ . The valTC values. A Bland-Altman plot  divided by the total number of tests for the microbe. McNemar’s test  was usedman plot  was creaTC value comparison plots, boxplots and statistics were performed in R via RStudio (version 3.3.2).MedCalc and GraphPad QuickCals software were used to calculate sensitivity, specificity, prevalence, and κ. To demonstrate equivalence between PC sample and NC sample


SNCA a critical gene in PD pathology have been reported involved in tumorigenesis recently. However, the role of SNCA in BLCA remains unclear. This study aimed to explore the potential value of SNCA as a prognostic diagnostic molecular biomarker in BLCA.The epidemiological investigation of different cancer types in the global population has reported a decreased risk of bladder cancer (BLCA) in Parkinson’s diseases (PD). SNCA in BLCA by GEPIA2, UALCAN, TCGA, GENT2, GEO and c-BioPortal database. Then, we used LinkedOmics database to obtain the co-expression genes of SNCA for further study by WGCNA. We further investigated the correlations between SNCA expression and six main types of immune cell infiltrations and immune signatures by TIMER. Finally, BLCA cell lines treated with 5-Aza-CdR were used to explore the correlation between increased methylation and downregulated mRNA expression.In this study, we explored the expression pattern, prognostic value and promoter methylation level of SNCA was downregulated in tumor tissues in TCGA-BLCA, GENT2 and GEO, which was validated in our cohort by qRT-PCR and immunohistochemistry. SNCA was confirmed as an independent predictor of poor overall survival (OS). LinkedOmics analysis suggested that SNCA regulates cell adhesion molecules, cytokine–cytokine receptor interaction, and complement and coagulation cascades. Twenty-two co-expression gene modules were constructed by WGCNA, and most of them were significantly associated with OS and disease-free survival (DFS). Six key genes  screened also significantly correlated with prognosis. There were significant correlations between SNCA expression and immune infiltrations, especially T cell, suggesting that immune infiltration was one of the reasons for the influence of SNCA on prognosis in BLCA. Analysis by ULACAN and c-BioPortal showed that the promoter methylation of SNCA negatively correlated with its mRNA level. Furthermore, BLCA cell treatment with 5-Aza-CdR revealed that SNCA expression levels were upregulated with decreased methylation.SNCA was downregulated in BLCA and negatively correlation with DNA methylation. High SNCA expression was confirmed as an independent risk for prognosis. SNCA probably plays an important role in the infiltration of immune cells, especially with T cells. Thus, SNCA may be a promising prognostic biomarker in BLCA patients.Our research showed that The online version contains supplementary material available at 10.1186/s12885-022-09411-9. SNCA, located on chromosome 4q22.1, encodes a 140-amino acid protein, namely alpha synuclein (α-Syn). α-Syn is a presynaptic neuronal protein, which plays a crucial role in the etiology of Parkinson’s disease (PD) and other synucleinopathies [SNCA were the first identified genetic causes of PD [es of PD .SNCA in the pathological processes underlying human cancers, including ovarian and breast cancer [SNCA methylation levels are significantly upregulated in colon cancer patients, and thus can be used as a biomarker for noninvasive detection [SNCA was significantly associated with multidrug resistance in ovarian cancer [SNCA is involved in the progression of breast cancer [SNCA can be used as a new diagnostic marker for medulloblastoma, and proved that SNCA may inhibit tumor growth by inducing apoptosis via activating the Akt/mTOR pathway [SNCA can be observed [SNCA promoter hypermethylation has been reported as an early diagnostic indicator of Hodgkin’s lymphoma [SNCA on tumorigenesis. The results revealed that melanoma and breast cancer were accelerated, but no effect on lung cancer was observed, indicating that SNCA may selectively accelerate cellular mechanisms leading to cancer [Recent studies have demonstrated the potential role of t cancer , colorect cancer , melanomt cancer , brain ct cancer  and lungt cancer . SNCA meetection . Throughn cancer . Other st cancer . Li et a pathway . In meduobserved . SNCA prlymphoma . Previouo cancer .2 = 88.3%, P < 0.001) [SNCA is key molecular link between PD and BLCA, and may serve as a novel biomarker for BLCA.Interestingly, an epidemiological investigation of different cancer types in the global population has reported a decreased risk of bladder cancer (BLCA) in PD patients  . However< 0.001) . Despite< 0.001) . To provSNCA and its impact on prognosis in patients with BLCA based on The Cancer Genome Atlas (TCGA) and various public databases. Using the LinkedOmics database, we obtained the genes co-expressed with SNCA and used WGCNA to further study their potential biological function. In addition, due to the key role of immune microenvironment in tumor development, we evaluated the potential correlation between SNCA and immune infiltration through TIMER database. Finally, analysis was performed for the methylation level of SNCA promoter with its mRNA and protein levels. The expression of SNCA in BLCA cell lines was studied by treatment with 5-Aza-CdR, a demethylating agent. Our results could potentially reveal SNCA as a new prognostic marker for BLCA.In this study, we first explored the expression of https://tcga-data.nci.nih.gov/tcga/), then we downloaded RNA expression and clinical data for BLCA from GEO database, including GSE13507, GSE3167, GSE32894 and GSE32548. Gene Expression database of Normal and Tumor tissues 2 (GENT2) is an updated version of GENT, which has provided a user-friendly search platform for gene expression patterns across different normal and tumor tissues compiled from public gene expression data sets [SNCA in GPL570 and GPL96 between normal and tumor tissues.Level 3 gene expression profile  and clinical data for BLCA patients were obtained from the TCGA data portal (ata sets . We obtahttp://gepia2.cancer-pku.cn/) is an updated and enhanced version, which provides insights with higher resolution and more functionalities. It features 198,619 isoforms and 84 cancer subtypes [SNCA expression between normal and tumor, and the survival map of OS.The GEPIA is an interactive web that provides experimental biologists and clinicians with a convenient tool to explore TCGA and GTEx datasets. GEPIA2  is a database that uses TCGA level 3 RNA sequencing and clinical data from 31 cancer types. It can analyze relative expression of a query gene(s) across tumor and normal samples, as well as in various tumor subgroups based on individual cancer stages, tumor grade, race, body weight, or other clinic-pathological features [SNCA expression and promotor methylation profile was tested in the UALCAN database based on patients’ individual cancer stages, age, gender, race, and smoking status.UALCAN  has multidimensional cancer genomics data sets [SNCA in BLCA was analyzed using the c-BioPortal tool. The scatter plot displays expression and methylation level per sample in SNCA.The cBio Cancer Genomics Portal  is a knowledge for systematic analysis of gene functions, linking genomic information with higher order functional information. The higher order functional information is stored in the PATHWAY database [q value less than 0.05 were considered significantly enriched.KEGG (Kyoto Encyclopedia of Gene and Genomes)  were created using “survival” R packages. For survival analysis, BLCA patients were categorized into the high group and the low group, according to the SNCA mRNA Optimal grouping threshold, which was estimated by R package “survminer”. The Log-Rank test was used to estimate the overall survival (OS) and recurrence-free survival (RFS) differences between groups with different expression levels of SNCA. P -value < 0.05 was selected as threshold.The Kaplan–Meier survival curves (http://www.linkedomics.org/login.php) is a multi-omics database that contains multi-omics data and clinical data for 32 cancer types and a total of 11,158 patients from the TCGA project [SNCA co-expression was analyzed statistically using Pearson correlation coefficient and presented in volcano plots and heat maps. Function modules to GO biological process (GO_BP) and KEGG enrichment were set by gene set enrichment analysis (GSEA). The rank criterion was false-discovery rate (FDR) < 0.05, and 1000 simulations were performed.The LinkedOmics database ( project . SNCA coSNCA from LinkedOmics database were selected based on a common threshold (FDR < 0.01). All selected genes were used to construct a weighted correlation network using the R package “WGCNA” [p values were calculated using log-rank test. Finally, the brown module in the WGCNA analysis significantly related to BLCA OS and DFS was further analyzed for GO and KEGG enrichment.Genes co-expressed with  “WGCNA” . The R fhttps://cistrome.shinyapps.io/timer/) is a comprehensive resource for the analysis of immune infiltrates and the differences in gene expression in different tumors from TCGA [SNCA expression in BLCA and the correlation of SNCA expression with the abundance of immune infiltrates, including B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages, and dendritic cells, as well as the tumor purity. Multivariate Cox analysis was used to evaluate how SNCA and these six types of immune cells together affected survival prognosis.TIMER  sore to quantify the enrichment level of immune signatures in a tumor. The tumor purity was estimated using ESTIMETE as previously described . Gene siTumor and adjacent non-tumorous tissues of 20 patients with BLCA, who underwent surgical treatment at the Department of Urology, the Second Affiliated Hospital of Kunming Medical University from January 2019 to February 2021 were collected . The concentration and quality of the RNA were determined by NanoPhotometer . Next, cDNA was generated from 2 μg total RNA using the iScript™ cDNA Synthesis Kit  in accordance with the manufacturer’s instructions. To detect mRNA levels of genes, qRT-PCR was performed using Eastep qPCR Master Mix  and a CFX96 Real-Time PCR Detection System . The primers’ sequences are listed in Supplementary Table Sp value less than 0.01 were regarded as key genes. The expression of key genes from BLCA patients was analyzed by qRT-PCR.We defined the top five genes in the 22 module networks as hub genes. A total of 20 genes among the hub genes that significantly correlated with OS and DFS were selected for further studies. The univariate Cox analysis was further conducted to screen potential prognostic genes for OS. Genes with a 2O2 to block endogenous peroxidase activity, the tissue microarrays were incubated with anti-SNCA antibody  overnight at 4 °C and then treated with secondary antibodies  for 1 h. Finally, they were stained with diaminobenzidine (DAB) until brown granules appeared. The slides were observed using a laser multicolor fluorescence scanning imager . Image-Pro Plus 6.0 soft was used to analyze the number of positive cells and total cells in tissue microarray. The final protein level were measured by histochemistry score (H-score), a semi quantitative method for IHC of tissues.IHC was performed as described previously . After a2. The cells were treated with 5 μM 5-Aza-CdR  for 72 h. Then, the cells were collected for RNA and protein extraction.The human BLCA cell lines T24 (RRID: CVCL_0554), EJ (RRID: CVCL_2893), 5637(RRID: CVCL_0126), and J82 (RRID: CVCL_0359) were purchased from ATCC . All the cells in the experiments were confirmed as free of mycoplasma. The cells were cultured in RPMI-1640  containing 10% fetal bovine serum  at 37 °C in a humidified atmosphere containing 5% COt test was used to estimate the significance of difference in protein expression levels between groups. * p < 0.05; ** p < 0.01.Western blotting was performed as described previously . The celt test was used to compare the two groups. P values less than 0.05 were considered statistically significant and marked as follows: * p < 0.05, ** p < 0.01, *** p < 0.001, **** p < 0.0001. The survival analysis was obtained using log-rank test, and the correlations of SNCA with immune infiltration and specific immune cell markers were evaluated using Spearman’s correlation.The Student’s SNCA transcription levels (TPM) of 404 BLCA tissue samples and 19 normal samples from TCGA and GTEx by setting the threshold log2|FC| = 1 and P-value = 1e-6 in GEPIA2 database, and found that the SNCA mRNA was significantly less expressed in BLCA tissues  was obtained from UALCAN database  group had significantly longer OS  compared with the high expression group in BLCA cohort  had significant negative correlation (FDR < 0.01). The detailed description of the co-expressed genes is provided in Supplementary Table SSNCA are shown by heat map in Fig. SNCA expression showed a strong positive relationship with the expression levels of KLHL5 , ARSJ  and PCDH7 , and strong negative associations with PLEKHH1 , ZNF823  and CFAP44 . Remarkably, the top 50 significantly positive genes showed a high probability of becoming high-risk markers in BLCA, in which 23/50 genes were with high hazard ratio  and while 16/50 genes were with low HR in the top fifty negatively significant genes  was moderate   Fig. C and D. 05) Fig. C and D. ion Fig. E. We theion Fig. F.SNCA expression correlated with the six main immune infiltration cells  in BLCA from TIMER database. The results showed that the expression level of SNCA correlated negatively with the tumor purity  and positively with CD8+ cell , CD4+ cells , macrophages , neutrophils , and dendritic cells   and 1.40 times higher risks on RFS (p = 0.054). In particular, T cell infiltration seemed to be a critical factor for SNCA to increase the risk of poor OS  , immune inhibitory or stimulatory, cytokine-related, cancer-testis antigen, and MHC genes. The analysis after the correlation adjustment by tumor purity, we showed that the expression level of SNCA in BLCA significantly correlated with 40.27% (611/1578) of the immune marker genes , ELVOL4 , DNAJC12 , RBMS3 , and HDAC9 . The top five markers negatively correlated with SNCA were S100A4 , TEKT5 , CEBPA , GATA2 (r = − 0.209 p = 5.26E- 05), and LYPD6B   and 1/33 (3.03%), respectively. In activated CD8+ T cells, SNCA highly correlated with protein MPZL1. Indeed, MPZL1 has been reported to promote tumor cell migration via the Src signaling pathway [SNCA significantly correlated with ETS1, which has been predicted to play an inhibitory role in cell migration in BLCA [In the previous section, we showed that T cell infiltration may be one of the key reasons for the prognostic value of NCA Fig. B. Theref pathway , 37. In  in BLCA , 39.TablSNCA expression in BLCA, we performed IHC staining on the tissue microarray containing samples from 63 cases of BLCA and paired adjacent nontumor tissues purchased from Outdo Biotech (Supplementary Table Sp < 0.01)    Table . The res1) Table .Table 3USNCA in BLCA may be related to DNA methylation. The promoter methylation level of SNCA in BLCA was investigated. As expected, the promoter methylation levels of SNCA were significantly higher in primary tumors than in normal tissues from UALCAN database . To investigate whether the promoter methylation may serve as a regulator of the transcription of SNCA in BLCA, we treated the BLCA cell lines with 5-Aza-CdR, a demethylating agent approved by the U.S. Food and Drug Administration, at a final concentration of 5 μM for 72 h. The results showed significantly increased mRNA  did not significantly correlate with these modules. However, most modules significantly affected OS and DFS. These results together suggest that SNCA expression positively correlated with the presence of CD8+ T cells (r = 0.353) and CD4+ T cells (r = 0.326) in the BLCA tissues. We further analyzed the cell markers of T cells, and obtained consistent results. Previous studies have reported that T lymphocyte infiltrates are present in parkinsonian brains and 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine mouse model of PD [SNCA expression was correlated with infiltrating may take part in PD. It is indicated that the tight relationship between SNCA and T cell marker genes is the potential epicenter of the immune response and one of the critical factors affecting the prognosis.Tumor-infiltrating immune cells have emerged as a key regulator of tumor growth and progression. They are a part of the complex tumor microenvironment and are associated with the biological behavior and patient survival in BLCA . In the el of PD , 49. SNCSNCA in BLCA through WGCNA analysis, the detailed mechanism linking SNCA expression and BLCA requires further biomedical experiments. Nevertheless, the current results are encouraging and noteworthy in the field of identifying promising prognostic biomarkers for BLCA.It is worth noting that this analysis inevitably had limitations. First, the results originate from retrospective data, and more prospective data will be needed to prove the clinical utility of our findings. Second, although we preliminarily explored the biological roles of SNCA is downregulated in BLCA and is negatively regulated by DNA methylation in BLCA. Low SNCA expression predicts favorable prognosis in BLCA patients. Moreover, SNCA expression potentially contributes to the regulation of T cells, B cells, macrophages, neutrophils, and dendritic cells. Hence, SNCA probably plays an important role in the infiltration of immune cells, and could act as a promising prognostic biomarker in BLCA patients.Additional file 1.Additional file 2.Additional file 3.Additional file 4.Additional file 5.Additional file 6.Additional file 7.Additional file 8.Additional file 9.Additional file 10.Additional file 11.


Rosaceae family, and both are important economic fruit trees worldwide. The emergence of many varieties in the market has been mostly domesticated from wild to cultivated and regulated by the differential expression of genes. However, the molecular process and pathways underlying this phenomenon remain unclear. Four typical wild and cultivar pear and apple trees at three developmental stages were used in our study to investigate the molecular process at the transcriptome level.Pears and apples are both perennial deciduous trees of the Physiological observations indicated the obvious differences of size, weight, sugar acid content and peel color in wild and cultivar fruit among each developmental stage. Using next-generation sequencing based RNA-seq expression profiling technology, we produced a transcriptome in procession of a large fraction of annotated pear and apple genes, and provided a molecular basis underlying the phenomenon of wild and cultivar fruit tree differences. 5921 and 5744 differential expression genes were identified in pear and apple at three developmental stages respectively. We performed temporal and spatial differential gene expression profiling in developing fruits. Several key pathways such as signal transduction, photosynthesis, translation and many metabolisms were identified as involved in the differentiation of wild and cultivar fruits.Rosaceae fruit trees. The results will be great influence to the improvement of cultivar species and the utilization of wild resources.In this study, we reported on the next-generation sequencing study of the temporal and spatial mRNA expression profiling of pear and apple fruit trees. Also, we demonstrated that the integrated analysis of pear and apple transcriptome, which strongly revealed the consistent process of domestication in The online version contains supplementary material available at 10.1186/s12870-021-03051-0. Malinae subtribe within Rosaceae (Pyrus) family [P. calleryana Dence) southwest China, which has a cultivation history of more than 3000 years in China [P. bretschneideri, P. pyrifolia, P. ussuriensis, P. sinkiangensis, and P. communis system [P. betulifolia Bunge), Chuan pear (P. pashia Buch), Shan pear (P. ussuriensis Maxim) and Ma pear (P. serrulata Rehd) [M. sieversii (Ledeb.) Roem [Pear and apple trees belong to the deciduous perennial trees of ) family . Both ofin China , 3. Cults system , while tta Rehd) . Wild apta Rehd) . Numbersb.) Roem , 7.miR172g, MdSWEET9b, MdSWEET15a and MYB have been identified in fruit trees [Fruit tree domestication is a process of adapting wild fruit trees to a new environment by changing their genetic characteristics . Generalit trees , 19. Desit trees –22, the Measurements of mRNA expression levels, clarity of the regulatory relationships between them are critical to understanding many pathways and biological systems. With the advent of second-generation sequencing-based technologies of RNA-seq, it is possible to measure a genome wide dynamic range of expression in an unbiased manner . RNA-seqP. calleryana Dence), wild apple ‘Xifuhaitang’  and the cultivar pear ‘Dangshansuli’ (P. bretschneideri Rehd), cultivar apple ‘Golden Delicious’ (M. domestica) were selected as typical materials for wild and cultivar fruit tree [In the present study, the wild pear ‘Douli’  were pooled to provide a broad gene library associated with fruit growth and finally sixteen libraries were generated including the fruits and leaves Fig. , Table 1To better understand the physiological variation among growth, transverse and longitudinal diameter, single fruit weight and sugar acid content from the developmental stages were observed Fig. , Table 3−1, and 20.66 −1 in wild, which showed that the total sugar content of cultivar pear was higher than that of wild. The content of fructose in cultivar pear was 26.24 −1 at maturity stage, about 13 times that of sucrose. The contents of glucose, fructose and sucrose increased with fruit development, and were positively correlated with total sugar content. There was a negative correlation between sorbitol and total sugar content. The content of citric acid in wild pear is higher than that of other acids. The content of organic acids in wild pear maturity stage is higher than that in cultivar.The soluble sugars in pear and apple mainly includes sorbitol, fructose, glucose and sucrose . The org−1, and wild apple reached 61.45 −1, which showed that the total sugar content in cultivar apple was significantly higher than in wild. The contents of glucose, fructose and sucrose increased during fruit development, and were positively correlated with total sugar content. The content of citric acid and malic acid were higher than the other acids. The highest acid content of wild apple at maturity was citric acid 8.18 −1, followed by malic acid content of 6.36 −1. In contrast to sugar content, the organic acid content decreased during fruit maturation. The total acid content in wild was higher than in cultivar apple.The fructose content was higher than other sugars and in cultivar apple at maturity was about 2.6 times of that in wild apple. The total sugar content at maturity of cultivar apple reached 131.23 P < 0.001 and |Fold change|> 2, the significant differential expressed transcripts were identified , 15 (239 genes), 12 (208 genes) and 11 (319 genes) were up-regulated, profile 0 (381 genes) and 3 (179 genes) were down-regulated and profile 14 (484 genes) was first up-regulated and then down-regulated  to analyze the expression trend in pear and apple respectively . It idenThere were 6 colored profiles are significantly at three stages of cultivar apple Fig. B1 and 3 P < 0.05 was significantly enriched to 855 and 533 terms  > 6 were further enriched to 36 biological pathways, 16 cell components and 18 molecular functions in pear different expression genes  > 6 in pear and apple different expression genes were enriched into 8 biological pathways, 4 cell components and 4 molecular functions  pathway can help to further determine biological functions and interactions of genes . Based oP < 0.05). Function classification indicated that yellow in WP_t1  associated with flavonoid biosynthetic process, response to cadmium ion etc.; red in WP_t3  response to transcription, high light intensity, heat, salt stress and abscisic acid; blue in CP_t1  associated with transcription, glycolytic process, photosynthesis; brown in CP_t2  also focuses on response to water deprivation, abscisic acid, cold and salt stress; green in CP_t3  focus on plant-type cell wall organization, malate metabolic process etc.  associated with flavonoid biosynthetic process, anthocyanin-containing compound biosynthetic process, response to stress; brown in WA_t3  associated with transcription, defense response, response to cold; pink in CA_t1  associated with response to light stimulus, ATP hydrolysis coupled proton transport; black in CA_t2  associated with response to response to water deprivation, photosynthesis, response to cytokinin; yellow in CA_t3  associated with translation, defense response, fatty acid biosynthetic process  approach with functional classification enabled identifying those mechanisms related to long periods of domestication between wild and cultivated materials . STEM, pP < 2.2e-16)  and apple   and cultivar pear ‘Dangshansuli’ (P. bretschneideri Rehd) were collected from the experimental farm of Nanjing Agricultural University. The wild apple ‘Xifuhaitang’  and cultivar apple ‘Golden Delicious’ (M. domestica) were collected from Zhenzhou Fruit Research Institute, Chinese Academy of Agricultural Sciences . Pear fruits were harvested on May 6th, June 30th and September 6th 2014; Apple Fruit were harvested on May 6th, June 6th and September 17th 2014, and which corresponded to the young fruit stage, expansion stage and maturity stage respectively  were collected for RNA preparation. Total RNA was extracted using a TRIzol reagent (Gibco BRL) following the manufacturer’s instructions and mRNA was purified from total RNA using poly-T oligo-attached magnetic beads. RNA concentration and purity were measured using NanoDrop 2000 . After fragmentation, first strand cDNA was synthesized using random hexamer primer and second strand cDNA synthesis was subsequently performed using DNA Polymerase I and RNase H. In order to select cDNA fragments of preferentially 240 bp in length, the library fragments were purified with AMPure XP system . After PCR amplification of the selected fragment, library quality was assessed on the Agilent Bioanalyzer 2100 system and then sequenced with Illumina platform and paired-end reads were generated. The raw data of the experiment are submitted to Sequence Read Archive (SRA) of NCBI under accession number SRR9291270, SRR9291271, SRR9891658 and SRR9891659.http://ccb.jhu.edu/software/tophat/index.shtml) [https://pachterlab.github.io/kallisto/).Raw reads of fastq format were firstly processed through in-house perl scripts. In this step, the adaptor sequences and low-quality sequence reads were removed from the data sets. Raw sequences were transformed into clean reads after data processing. These clean reads were then mapped to the pear and apple reference genome sequence respectively by Tophat tool soft (x.shtml) , 17. Onl2 value of reading segments from a particular transcript. It is assumed that the number of reads to a specific gene in two different samples is C1 and C2 respectively: M = log2C1 – log2C2, A = (log2C1 + log2C2)/2. P value < 0.001 and |Fold change|> 2 was set as the threshold for significantly differential expression.The differential expression transcripts and genes in fruits were analyzed by R-package DEGseq . DEGseq http://www.geneontology.org/). Kyoto Encyclopedia of Genes and Genomes (KEGG) a database resource for understanding high-level functions and utilities of the biological system, such as the cell, the organism and the ecosystem, from molecular-level information, especially large-scale molecular datasets generated by genome sequencing and other high-throughput experimental technologies (http://www.kegg.jp/). Gene Ontology and KEGG pathway enrichment analysis of the differential expression genes were implemented by R script based non-central hyper-geometric distribution with P value < 0.05 [Gene Ontology (GO) is an international web site for functional annotations of genes, providing a range of semantics for describing the characteristics of genes and gene products, including cellular components, molecular functions and biological pathways   is a sofr > 0.8 and P value < 0.05.The R package of WGCNA  is a common tool for weighted correlation network analysis . In thisAdditional file 1.Additional file 2.Additional file 3.


Clear cell renal cell carcinoma (ccRCC) is a common genitourinary cancer type with a high mortality rate. Due to a diverse range of biochemical alterations and a high level of tumor heterogeneity, it is crucial to select highly validated prognostic biomarkers to be able to identify subtypes of ccRCC early and apply precision medicine approaches.Transcriptome data of ccRCC and clinical traits of patients were obtained from the GSE126964 dataset of Gene Expression Omnibus and The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) database. Weighted gene co-expression network analysis (WGCNA) and differentially expressed gene (DEG) screening were applied to detect common differentially co-expressed genes. Gene Ontology, Kyoto Encyclopedia of Genes and Genomes analysis, survival analysis, prognostic model establishment, and gene set enrichment analysis were also performed. Immunohistochemical analysis results of the expression levels of prognostic genes were obtained from The Human Protein Atlas. Single-gene RNA sequencing data were obtained from the GSE131685 and GSE171306 datasets.ALDOB, EFHD1, and ESRRG were identified as significant prognostic factors in patients diagnosed with ccRCC. Single-gene RNA sequencing analysis revealed the expression profile of ALDOB, EFHD1, and ESRRG in different cell types of ccRCC.In the present study, a total of 2,492 DEGs identified between ccRCC and healthy controls were filtered, revealing 1,300 upregulated genes and 1,192 downregulated genes. Using WGCNA, the turquoise module was identified to be closely associated with ccRCC. Hub genes were identified using the maximal clique centrality algorithm. After having intersected the hub genes and the DEGs in GSE126964 and TCGA-KIRC dataset, and after performing univariate, least absolute shrinkage and selection operator, and multivariate Cox regression analyses, ALDOB, EFHD1, and ESRRG may act as potential targets for medical therapy and could serve as diagnostic biomarkers for ccRCC.The present results demonstrated that  Renal cell carcinoma (RCC) is one of the most common genitourinary cancer types worldwide, and it has a number of heterogeneous histological subtypes, with clear cell RCC (ccRCC) accounting for ~85% of all cases . In totaVHL) gene is located, is found in over 90% of ccRCC cases, and it is considered the critical genetic event  was developed by Horvath and Zhang in 2005 , 22.In the present study, a gene expression profile of ccRCC from the Gene Expression Omnibus (GEO) was downloaded. WGCNA and differentially expressed gene (DEG) screening were applied to detect common differentially co-expressed genes. Then, The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) data were used to establish the prognostic model of ccRCC. Single-cell RNA sequencing (RNA-seq) data from GEO were used to verify the expression profile of the prognostic genes in different cell types. This study aimed not only to understand ccRCC pathogenesis but also to determine its molecular mechanisms and provide insights into novel therapeutic targets for drugs.2 transformed in R (version 4.0.4) and RStudio (version 1.2.5033) if necessary. Principal component analysis (PCA) was performed, and the outliers of GSM3619137 and GSM3619152 were excluded .RNA-seq data of TCGA-KIRC and corresponding clinical information were obtained from TCGA (Single-cell RNA-seq data from GSE131685 and GSE171306 were downloaded through GEO website. R package “Seurat” (version 4.0.2) was used to process the data . Three h2fold change| of ≥2.0 were selected as the cutoff criteria. The volcano and heatmap plots were generated using ggplot2 (version 3.3.3) and pheatmap (version 1.0.12) packages, respectively. The DEGs of TCGA-KIRC dataset  were obtained via Gene Expression Profiling Interactive Analysis  (The “limma” software package (version 3.48.0)  was usedpku.cn/)  using thhttp://www.bioconductor.org/packages/release/bioc/html/clusterProfiler.html) (The “clusterProfiler” (version 3.18.1) R package was used for GO and KEGG enrichment analyses (er.html) . The thrThe “WGCNA” package (version 1.70-3) of R  was usedThe Cytoscape software v3.7.2 was used to visualize the co-expression network in the turquoise module . The datUnivariate Cox regression analysis was performed to screen the genes significantly associated with overall survival (OS) in the TCGA-KIRC dataset. The OS-related genes with p < 0.1 were included in the least absolute shrinkage and selection operator (LASSO) regression analysis by using the R package “glmnet” (version 4.1-2). Then, a multivariate Cox regression model analysis was performed to establish a Cox proportional hazards regression prognostic model. We used the following formula to calculate the risk score of each patient:β is coefficient and x is the expression level of each prognostic gene i. The samples were divided into a high-risk group and a low-risk group according to the median risk score of the training cohort from TCGA-KIRC. Receiver operating characteristic (ROC) analysis and Kaplan–Meier analysis were conducted between the high-risk group and the low-risk group.In this formula, https://www.proteinatlas.org/). We also verified the protein expression levels of the survival-related hub genes based on immunohistochemistry using the HPA database.The Human Protein Atlas (HPA) is a database that aims to map all the human proteins in cells, tissues, and organs using an integration of various omics technologies  was also used to detect the potential molecular mechanisms of the prognostic genes. Enriched terms predicted to be associated with the KEGG pathway in c2.cp.v7.2.symbols.gmt were screened by GSEA. Images were generated by “ggplot2” (version 3.3.3) package. The p-value of <0.05 was considered statistically significant.https://gtexportal.org/home/).The prognostic gene expression profiles were obtained from the GTEx Portal (2(fold-change)|>2.0 and adjusted p < 0.05. A total of 2,492 DEGs between ccRCC and normal control samples were filtered, revealing 1,300 upregulated genes and 1,192 downregulated genes .The “limma” package was utilized to analyze DEGs in the GSE126964 dataset, with the threshold of |logThe DEGs were mostly enriched in “T cell activation,” “leukocyte cell–cell adhesion,” “apical part of cell,” “external side of plasma membrane,” “collagen-containing extracellular matrix (ECM),” and “ion transmembrane transporter activity” in the GO analysis  and mean connectivity reached steady status   and module membership (MM) of the genes in the module turquoise was subsequently conducted. A high correlation coefficient of GS and MM was found in the turquoise module   and a testing cohort (N = 266). The univariate Cox regression analyses of 13 key genes with regard to OS of samples from the training cohort were performed  were included in LASSO analysis . Following the cross validation, seven genes achieved the minimum partial likelihood deviance. Then, we performed a multivariate Cox regression with these seven genes  as covariants. We finally got three genes, including ALDOB, ESRRG, and EFHD1 without collinearity, and each of them could be an independent prognostic marker for ccRCC (ALDOB + (-0.275676) * ESRRG + (-0.269554) * EFHD1.We randomly divided the patients in TCGA-KIRC into two cohorts, a training cohort  were significantly downregulated and associated with poor pathologic stages in the training cohort, testing cohort, or GSE126964 dataset  for ccRCC was established. ALDOB, EFHD1, and ESRRG were also identified as novel independent prognostic markers for ccRCC in different datasets via integrated bioinformatics analysis, including DEG analysis, WGCNA, and single-cell analysis.ccRCC is a common genitourinary cancer with a high mortality rate . There iVHL is considered to be closely associated with metabolic reprogramming in ccRCC  and protects ccRCC from oxidative stress –signal transducer and activator of transcription 3 (STAT3) signaling pathways  and PTH-related protein and plays a central role in calcium homeostasis , the National Natural Science Foundation of China , the Natural Science Foundation of Hunan, China (2021JJ40992), and the Fundamental Research Funds for the Central Universities of Central South University (2021zzts0078).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


To compare postoperative sexual dysfunction (SD) and quality of life (QOL) in Type A Aortic Dissection (AAD) Patients of Different Ages.From January 2018 to December 2019, 204 AAD postoperative survivors in Union Hospital of Fujian Medical University were selected and were divided into young group (less than 50 years old) and elderly group (more than 50 years old). We evaluated SD according to the male International Erectile Dysfunction Index (IIEF-5) and female sexual function index (FSFI). The Short Form 12 Health Survey Questionnaire (SF-12) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to investigate the QOL, Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR) and the Beck Depression Inventory-II (BDI-II) to investigate depressive symptoms.P = 0.03). Compared with non-SD patients, the total physical health of SD patients was significantly worse (P = 0.04), however, the mental health was not significantly worse (P = 0.77); the depressive symptoms did not expressed a significant difference between the SD and non-SD groups . Total physical health scores in the young SD group did not show significant better than elderly SD group (P = 0.24), however, total mental health scores showed significantly worse (P = 0.04), depressive symptoms scores were significantly higher .One hundred seventy-five patients completed all the questionnaire (85.8%). The total SD prevalence rate was 38.9% (68 cases), with 27.4% of the young (20 cases) and 47.1% of the elderly (48 cases). The age of non-SD and SD patients was 49.0 ± 11.5 and 56.9 ± 10.8 years, respectively (The postoperative AAD SD prevalence of elderly is higher than that of young, and the total physical health of SD patients is poorer than those without SD patients. The young SD patients did not show a significant higher physical health scores than the elderly SD patients, instead, the young SD patients were more psychologically affected than the elderly SD patients, whose mental health was worse, and depression symptoms were more obvious, suggesting that the factors affecting the QOL of postoperative SD patients are related to physical factors, but the young postoperative SD patients mainly affected by psychological factors.The online version contains supplementary material available at 10.1186/s13019-021-01468-0. Acute aortic dissection (AAD) is an age-dependent, life-threatening cardiovascular disease associated with high mortality due to various fatal complications –7. StudiWe totally distributed related questionnaires by mail or by outpatient appointments to 204 type A aortic dissection (AAD) survivors who successfully underwent “modified triple-branched stent graft implantation technique” surgery  in the UInclusion criteria: (1) Patients who survived more than 6 months after being discharged from the hospital after successful AAD surgery; (2) 18 to 70 years old; (3) Fixed sex partners; (4) No mental illness, no cognitive dysfunction in reading, writing and communicating, able to read and comprehend the contents of the questionnaire; (5) Informed consent to this study, volunteered to participate in the study; (6) People who had regular sex before surgery.Exclusion criteria: (1) Exclude those with mental illness, language communication barriers, dyslexia, and non-cooperation; (2) Exclude those with reproductive system diseases and organic diseases of other vital organs; (3) Exclude those with severe preoperative sexual dysfunction; (4) Exclude those who take drugs that seriously affect sexual function; (5) Exclude those who fail to fill in the questionnaire.We collected the following demographic and clinical variables from all effective subjects: age, gender, chronic disease, marital status and the sexual partners situation.We defined SD for men by using the International Index of Erectile Function-5 (IIEF-5): The International Index of Erectile Function (IIEF) was designed in 1997 by Rosen et al. , a doctoThe Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q)  were useWe used the Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR)  to assesP value was used if the variance between groups was uneven); the enumeration data was described by percentage, the comparison of rates between groups was by Chi-square test. P < 0.05 indicated that the difference was statistically significant.In this study, SPSS 20.0 statistical software was used to perform data statistical analysis. We performed normality test on measurement data firstly, and normally distributed data were expressed as mean ± standard deviation, analyzed with independent sample t test  and 102 cases in the elderly group ; 144 cases were married or had a fixed sexual partner (82.29%), 31 cases were unmarried or divorced but had a fixed sexual partner; 119 cases of smoking , 43 cases in the young group and 76 cases in the elderly group; of the total number of chronic diseases, 29 cases of diabetes, 143 cases of hypertension, 33 cases of dyslipidemia, 10 cases of coronary heart disease, 40 cases with renal dysfunction, 10 cases with COPD; 143 cases with medication . The demographic characteristics are shown in Table The total SD prevalence was 38.9% (68 cases), with the young prevalence of 27.4%  and the elderly prevalence of 47.1%  , including general health (P = 0.02), physical function (P = 0.04); However, the mental health of SD patients was not significantly worse than non-SD patients (P = 0.77), including vitality (P = 0.16), social function (P = 0.59), emotional role limitation (P = 0.59) and mental health (P = 0.75); the average depression score did not expressed a significant difference between the SD group and non-SD group  (Table P = 0.24) in the young SD group did not show a significant higher scores than the elderly SD group, including physical function (P = 0.43), role limitation physical (P = 0.50), pain (P = 0.71) and general health (P = 0.64), however, the scores of total mental health in the young group was significantly lower than that of the elderly group (P = 0.04), including emotional role limitation (P = 0.04) and mental health (P = 0.03), the average depression score was significantly higher than that of the elderly group  , and the prevalence of 47.1% in the elderly is significantly higher than 27.4% in the young. This may be because the majority of our research subjects are elderly people, most of whom are associated with chronic diseases. With age, the level of androgens in the body decreases. The decline of testosterone can reduce erectile response, sexual satisfaction and sexual frequency and also has a certain effect on ejaculation function . In addiOur results show that the AAD postoperative SD patients showed obvious impairment of QOL, and we found that the impaired QOL was mainly manifested in physical health items, associated without depressive symptoms or clinically measurable mental health, which is consistent with the trend of QOL changes after heart transplantation . The resIn addition to aging and other confounding factors such as drugs and lifestyle factors, studies have shown that poor mental health is also related to SD. For example, there was a strong relationship between depression and SD . Such paThe sample size included is relatively small, especially in the young group. It is difficult to obtain accurate preoperative data about sexual function and quality of life (QOL). Selection bias may have occurred as patients were not randomized and the majority of patients were enrolled from outpatient clinic follow-up appointments or investigated by mailing questionnaires. Therefore, we might missed data of who died, who did not respond to emails or did not return to the outpatient clinic for review, but this only accounts for a small part of the survey subjects and does not seriously affect our survey results. Recall bias can also affect results as the data was acquired retrospectively. Some patients might have been experiencing SD, although we only include patients who deny preoperative SD. It was also a limitation that questionnaires were subjective assessment. Objective measures, such as activity, strength and ejaculation levels, in association with SD have not been well studied in the postoperative AAD population. Also, sex in the general population has appeared to be correlated with SD in heart transplant recipients . This stThere is a considerable proportion of SD patiernts after AAD surgery, with higher ratio in elderly than young. SD seemed to linked to physical health rather than mental health of QOL. Interestingly, in contrast, young SD patients might experienced worse mental health rather than physical health of QOL.Additional file 1.