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Endoscopic ultrasound-guided portal pressure gradient identifies patients with previously undiagnosed clinically significant portal hypertension

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Portal Hypertension & cirrhosis 2024年第2期3卷 67-74页

作者： Jerome c.Edelson Scott F.D.Edelson John g.Quiles cyrus V.Edelson Eric M.Montminy christian l.Horn John P.Magulick Don c.Rockey Department of gastroenterology and Hepatology Brooke Army Medical CenterFort Sam HoustonTexasUSA Department of Medicine Uniformed Services University of the Health SciencesBethesdaMarylandUSA Department of Medicine Brooke Army Medical CenterFort Sam HoustonTexasUSA John H.Stroger Jr.Hospital of cook county ChicagoIllinoisUSA Digestive Disease Research center Medical University of South CarolinaCharlestonSouth CarolinaUSA

Aims:Portal hypertension(PH)is a complication of cirrhosis that leads to hepatic *** the portal pressure gradient(PPg)provides valuable information for disease assessment,staging,and *** this study,we aimed to report the utilization of endoscopic ultrasound(EUS)-guided PPg(EUS-PPg)measurements in a real-world ***:This retrospective analysis included patients at a tertiary care center who underwent EUS-PPg between February 2021 and May *** most common indication was to establish or exclude the diagnosis of cirrhosis,followed by an assessment of surgical risk in the setting of suspected *** demographic and clinical data were collected,and statistical analysis was performed using the Student's t ***:Eighteen patients underwent *** success was achieved in 17 of the 18 *** complications were *** mean scores of child-Pugh,Model for End-Stage liver Disease-Sodium,and Fibrosis-4 scores were 5.1±0.5,9.0±3.0,and 3.7±4.5,*** the 18 patients,two presented with esophageal varices and six with portal hypertensive *** mean PPg was 5.8±4.5 mmHg,and five patients exhibited clinically significant PH(cSPH).Of the 18 patients,15 underwent concurrent EUS-liver biopsy,which was 100%successful and provided diagnostic histology for all *** PPg data led to changes in the clinical management of 17 ***:EUS-PPg is safe and technically *** child-Pugh score did not correlate well with the presence of cSPH;however,PPg measurements resulted in changes in the management of almost all *** studies correlating EUS-PPg with other assessments of liver diseases are required.

关键词： EUS portal hypertension portal pressure gradient

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Amplitude analysis of the decays D^(0)→π^(+)π^(−)π^(+)π^(−)and D^(0)→π^(+)π^(−)π^(0)π^(0)

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chinese Physics c 2024年第8期48卷 6-33页

作者： M.Ablikim M.N.Achasov P.Adlarson O.Afedulidis X.c.Ai R.Aliberti A.Amoroso Q.An Y.Bai O.Bakina i.Balossino Y.Ban H.-R.Bao V.Batozskaya K.Begzsuren N.Berger M.Berlowski M.Bertani D.Bettoni F.Bianchi E.Bianco A.Bortone i.Boyko R.A.Briere A.Brueggemann H.cai X.cai A.calcaterra g.F.cao N.cao S.A.cetin J.F.chang W.l.chang g.R.che g.chelkov c.chen c.H.chen chao chen g.chen H.S.chen M.l.chen S.J.chen S.l.chen S.M.chen T.chen X.R.chen X.T.chen Y.B.chen Y.Q.chen Z.J.chen Z.Y.chen S.K.choi X.chu g.cibinetto F.cossio J.J.cui H.l.Dai J.P.Dai A.Dbeyssi R.E.de Boer D.Dedovich c.Q.Deng Z.Y.Deng A.Denig i.Denysenko M.Destefanis F.De Mori B.Fang S.S.Fang W.X.Fang Y.Fang Y.Q.Fang R.Farinelli l.Fava F.Feldbauer g.Felici c.Q.Feng J.H.Feng Y.T.Feng K.Fischer M.Fritsch c.D.Fu J.l.Fu Y.W.Fu H.gao Y.N.gao Yang gao S.garbolino i.garzia P.T.ge Z.W.ge c.geng E.M.gersabeck B.Ding X.X.Ding Y.Ding Y.Ding J.Dong l.Y.Dong M.Y.Dong X.Dong M.c.Du S.X.Du Z.H.Duan P.Egorov Y.H.Fan J.Fang JA.gilman K.goetzen l.gong W.X.gong W.gradl S.gramigna M.greco M.H.gu Y.T.gu c.Y.guan Z.l.guan A.Q.guo l.B.guo M.J.guo R.P.guo Y.P.guo A.guskov J.gutierrez K.l.Han T.T.Han X.Q.Hao F.A.Harris K.K.He K.l.He F.H.Heinsius c.H.Heinz Y.K.Heng c.Herold T.Holtmann P.c.Hong g.Y.Hou X.T.Hou Y.R.Hou Z.l.Hou B.Y.Hu H.M.Hu J.F.Hu T.Hu Y.Hu g.S.Huang K.X.Huang l.Q.Huang X.T.Huang Y.P.Huang T.Hussain F.H\"olzken N.H\"usken N.in der Wiesche M.irshad J.Jackson S.Janchiv J.H.Jeong Q.Ji Q.P.Ji W.Ji X.B.Ji X.l.Ji Y.Y.Ji X.Q.Jia Z.K.Jia D.Jiang H.B.Jiang P.c.Jiang S.S.Jiang T.J.Jiang X.S.Jiang Y.Jiang J.B.Jiao J.K.Jiao Z.Jiao S.Jin Y.Jin M.Q.Jing X.M.Jing T.Johansson S.Kabana N.Kalantar-Nayestanaki X.l.Kang X.S.Kang M.Kavatsyuk B.c.Ke V.Khachatryan A.Khoukaz R.Kiuchi O.B.Kolcu B.Kopf M.Kuessner X.Kui A.Kupsc W.K\"uhn J.J.lane P.larin l.lavezzi T.T.lei Z.H.lei H.leithoff M.lellmann T.lenz c.li c.li c.H.li cheng li D.M.li F.li g.li H.li H.B.li H.J.li H.N.li Hui li J.R.li J.S.li K.li l.J.li l.K.li lei li M.H.li P.R.li Q.M.li Q.X.li R.li S.X.li T.li W.D.li W.g.li X.li X.H.li X.l.li X.Y.li Y institute of High Energy Physics Chinese Academy of SciencesBeijing 100049China Beihang University Beijing 100191China Bochum Ruhr-University D-44780 BochumGermany Budker institute of Nuclear Physics SB RAS(BiNP) Novosibirsk 630090Russia carnegie Mellon University PittsburghPennsylvania 15213USA central china Normal University Wuhan 430079China central South University Changsha 410083China china center of Advanced Science and Technology Beijing 100190China china University of geosciences Wuhan 430074China chung-Ang University Seoul06974Republic of Korea cOMSATS University islamabad Lahore CampusDefence RoadOff Raiwind Road54000 LahorePakistan Fudan University Shanghai 200433China gSi Helmholtzcentre for Heavy ion Research gmbH D-64291 DarmstadtGermany guangxi Normal University Guilin 541004China guangxi University Nanning 530004China Hangzhou Normal University Hangzhou 310036China Hebei University Baoding 071002China Helmholtz institute Mainz Staudinger Weg 18D-55099 MainzGermany Henan Normal University Xinxiang 453007China Henan University Kaifeng 475004China Henan University of Science and Technology Luoyang 471003China Henan University of Technology Zhengzhou 450001China Huangshan college Huangshan 245000China Hunan Normal University Changsha 410081China Hunan University Changsha 410082China indian institute of Technology Madras Chennai 600036India indiana University BloomingtonIndiana 47405USA iNFN laboratori Nazionali di Frascati INFN Laboratori Nazionali di FrascatiI-00044FrascatiItaly iNFN laboratori Nazionali di Frascati INFN Sezione di PerugiaI-06100PerugiaItaly iNFN laboratori Nazionali di Frascati University of PerugiaI-06100PerugiaItaly iNFN Sezione di Ferrara INFN Sezione di FerraraI-44122FerraraItaly iNFN Sezione di Ferrara University of FerraraI-44122FerraraItaly inner Mongolia University Hohhot 010021China institute of Modern Physics Lanzhou 730000China institute of Physics and Technology Peace Avenue 54BUlaanbaatar 13330Mongolia instituto de A

Using e^(+)e^(−)annihilation data corresponding to an integrated luminosity of 2.93 fb^(−1)taken at the center-of-mass energy√s=3.773 geV with the BESiii detector,a joint amplitude analysis is performed on the decays D^(0)→π^(+)π^(−)π^(+)π^(−)and D^(0)→π^(+)π^(−)π^(0)π^(0)(non-η).The fit fractions of individual components are obtained,and large interferences among the dominant components of the decays D^(0)→a_(1)(1260)π,D^(0)→π(1300)π,D^(0)→ρ(770)ρ(770),and D^(0)→2(ππ)_(S)are observed in both *** the obtained amplitude model,the cP-even fractions of D^(0)→π^(+)π^(−)π^(+)π^(−)and D^(0)→π^(+)π^(−)π^(0)π^(0)(non-η)are determined to be(75.2±1.1_(stat).±1.5_(syst.))%and(68.9±1.5_(stat).±2.4_(syst.))%,*** branching fractions of D^(0)→π^(+)π^(−)π^(+)π^(−)and D^(0)→π^(+)π^(−)π^(0)π^(0)(non-η)are measured to be(0.688±0.010_(stat.)±0.010_(syst.))%and(0.951±0.025_(stat.)±0.021_(syst.))%,*** amplitude analysis provides an important model for the binning strategy in measuring the strong phase parameters of D^(0)→4πwhen used to determine the cKM angleγ(ϕ_(3))via the B^(−)→DK^(−)decay.

关键词： BESiii D^(0)meson decays amplitude analysis cP-even fraction

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gRP7 phase separation as an interpreter of temperature cues

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Molecular Plant 2024年第6期17卷 842-844页

作者： Sunita Pathak lucia c.Strader Department of Biology Duke UniversityDurhamNCUSA

Plants are exposed to a range of daily and seasonal temperatures and thus are required to regulate their cellular processes under fluctuating temperature *** various temperature-responsive genes,glYciNE-RicH RNA BiNDiNg PROTEiN7(gRP7)encodes a glycine-rich RNA-binding protein that provides freezing tolerance to plants(carpenter et al.,1994;Kim et al.,2008)by acting as an RNA chaperone(Kwak et al.,2011).

关键词： conditions. separation

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Simultaneous removal of critical rare earth elements and chalcogen oxyanions by anaerobic granular sludge

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Rare Metals 2024年第9期43卷 4595-4611页

作者： chiara Belloni Mohanakrishnan logan Stefano Papirio Piet N.l.lens University of galway Department of civil Architectural and Environmental EngineeringUniversity of Naples Federico II

conventional mining of economically and strategically important critical rare earth elements(REEs)(such as neodymium, lanthanum and dysprosium), and chalcogens(such as selenium and tellurium) are associated with a huge economic and environmental cost. Therefore,the need to recover REEs as well as chalcogens from different waste streams including wastewaters is becoming urgent. Batch assays on synthetic chalcogen/REE-laden wastewater showed that the presence of REEs significantly improved the tellurite removal rate(> 80%) and enhanced selenate removal by 66% ± 10%. Three 3.9 l continuous upflow anaerobic granular sludge bed(UASB) reactors were operated at a hydraulic retention time of 24 h and30 °c. Selenate reduction was achieved with a removal efficiency of ～ 98% with an influent p H of 4.0 for more than 28 days. The effect of REEs on tellurite removal in the UASB bioreactor could not be clearly established since a soluble tellurium removal efficiency of more than 98%was observed already before the addition of REEs at elevated tellurite concentrations. The complete REE removal in both batch assays and UASB reactors at higher pH (7.0 ± 0.5) was attributed to precipitation, whereas chalcogen oxyanions removal was due to microbial reduction. However, at acidic p H, biosorption was responsible for REE's removal, and the Se-enriched sludge exhibited a superior REE's removal efficiency than the non-enriched and Te-enriched sludge.

关键词： Adsorption Bioreduction Rare earth elements Selenium Tellurium

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Metal-modulated epitaxy of Mg-doped Al_(0.80)in_(0.20)N-based layer for application as the electron blocking layer in deep ultraviolet light-emitting diodes

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Journal of Semiconductors 2024年第5期45卷 80-89页

作者： Horacio irán Solís-cisneros carlos Alberto Hernández-gutiérrez Enrique campos-gonzález Máximo lópez-lópez Optomechatronics group Tecnológico Nacional de México Campus Tuxtla Gutiérrezcarretera Panamericana 1080C.P.29050Tuxtla GutiérrezChiapasMéxico Departamento de Física Instituto Nacional de Investigaciones NuclearesCarretera México-Toluca s/nC.P.52750La Marquesa OcoyoacacMéxico Departamento de Física Centro de Investigación y estudios Avanzados del Instituto Politécnico NacionalAv.Instituto Politécnico Nacional 2508San Pedro ZacatencoGustavo A.Madero07360 Ciudad de MéxicoCDMXMéxico

This work reports the growth and characterization of p-AlinN layers doped with Mg by plasma-assisted molecular beam epitaxy(PAMBE).AlinN was grown with an Al molar fraction of 0.80 by metal-modulated epitaxy(MME)with a thickness of 180 nm on Si(111)substrates using AlN as buffer *** substrate temperatures were used to enhance the incorporation of indium atoms into the alloy without clustering,as confirmed by X-ray diffraction(XRD).cathodoluminescence measurements revealed ultraviolet(UV)range ***,Hall effect measurements indicated a maximum hole mobility of 146 cm^(2)/(V∙s),corresponding to a free hole concentration of 1.23×10^(19)cm^(−3).The samples were analyzed by X-ray photoelectron spectroscopy(XPS)estimating the alloy composition and extracting the Fermi level by valence band ***-doped AlinN layers were studied for use as the electron-blocking layer(EBl)in lED *** varied the Al composition in the EBl from 0.84 to 0.96 molar fraction to assess its theoretical effects on electroluminescence,carrier concentration,and electric field,using SilVAcO *** results from this study highlight the importance and capability of producing high-quality Mg-doped p-AlinN layers through *** simulations suggest that an Al content of 0.86 is optimal for achieving desired outcomes in electroluminescence,carrier concentration,and electric field.

关键词： metal-modulated epitaxy AlinN DUV-lED EBl simulation

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A Method for Evaluating the Maximum Bending Degree of Flexural Toppling Rock Masses Based on the Rock Tensile Strain-Softening Model

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Journal of Earth Science 2024年第4期35卷 1243-1253页

作者： Jiongchao Wang Jun Zheng Jichao guo Qing lü Jianhui Deng Department of civil Engineering Zhejiang UniversityHangzhou310058China center for Balance Architecture Zhejiang UniversityHangzhou310007China State Key laboratory of Hydraulics and Mountain River Engineering College of Water Resource and HydropowerSichuan UniversityChengdu610065China

Flexural toppling occurs when a series of layered rock masses bend towards their free *** is important to evaluate the maximum bending degree and the requirement of supports of flexural toppling rock mass to prevent rock mass cracking and even failure leading to a *** on the rock tensile strain-softening model,this study proposes a method for calculating the maximum curvature(c_(ppmax))of flexural toppling rock *** applying this method to calculate cppmax of 9 types of rock masses with different hardness and rock layer thickness,some conclusions are drawn:(1)the internal key factors affecting c_(ppmax)are E^(⋆)(E^(⋆)=E_(ss)/E_(0),where E_(0)and E_(ss)are the mean deformation moduli of the rock before and after reaching its peak tensile strength,respectively),the strainεt corresponding to the tensile strength of rock,and the thickness(h)of rock layers;(2)hard rock layers are more likely to develop into block toppling than soft rock layers;and(3)thin rock layers are more likely to remain in flexural toppling state than thick rock *** addition,it is found that c_(ppmax)for flexural toppling rock masses composed of bedded rocks such as gneiss is related to the tensile direction.

关键词： flexural toppling rock mass maximum bending degree strain-softening model curvature rock mechanics

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Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RiRSearch group study

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Asian Journal of Urology 2024年第1期11卷 80-85页

作者： Oktay Özman Hacı M.Akgül cem Başataç Önder Çınar Eyüp B.Sancak cenk M.Yazıcı Bülent Önal Haluk Akpınar gaziosmanpasa Training and Research Hospital Urology ClinicİstanbulTurkey TekirdağNamık Kemal University School of MedicineDepartment of UrologyTekirdağTurkey group Florence Nightingale Hospitals Department of UrologyİstanbulTurkey Zonguldak Bulent Ecevit University School of MedicineDepartment of UrologyZonguldakTurkey Çanakkale Onsekiz Mart University School of MedicineDepartment of UrologyÇanakkaleTurkey istanbul University-cerrahpaşa Cerrahpaşa Medical FacultyDepartment of UrologyİstanbulTurkey

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RiRS).Methods:Data from 568 patients undergoing RiRS for kidney or upper ureteral stones were retrospectively ***,patients were compared after 1:1 propensity score matching,according to UAS usage during RiRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 *** outcomes of the study were the success and complications of ***:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;pive complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[ci]1.314-10.162;OR 4.443,95%ci 1.350-14.552;OR 4.107,95%ci 1.366-12.344,respectively).conclusion:Use of UAS in RiRS may increase stone-free rates,which also increase with higher caliber *** usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

关键词： Stone Retrograde intrarenal surgery Ureteral access sheath Urolithiasis Kidney

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improved Analytical Methods for Determination of Residues of Nitrapyrin and 6-chloropicolinic Acid in Different crop Matrices by liquid chromatography-Tandem Mass Spectrometry

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Journal of Agricultural chemistry and Environment 2024年第3期13卷 263-281页

作者： Fabiola g. Zuno-Floriano Riza l. Reyes-Punongbayan Matt J. Hengel Department of Environmental Toxicology University of California Davis California USA

Novel analytical methods were developed for the determination of nitrapyrin and 6-chloropicolinic acid (6-cPA) residues in agricultural products. Nitrapyrin was extracted with hexane: toluene (1:1, v/v) and 6-cPA with 0.1 N sodium hydroxide (NaOH). For nitrapyrin, samples were cleaned with silica solid phase extraction (SPE) and for 6-cPA with c18 or carbon SPE. Analysis was performed by liquid chromatography-tandem mass spectroscopy (lc-MS/MS) with external calibration (0.010 to 0.0010 µg∙ml−1 for nitrapyrin and 0.0050 to 0.00025 µg∙ml−1 for 6-cPA). Recoveries for nitrapyrin and 6-cPA were 68% - 102% and 66% - 90%, respectively. Nitrapyrin was detected in celery and onion (−1) and 6-cPA in onion, mustard greens and lettuce (−1). lower level method validation (llMV) for nitrapyrin and 6-cPA was 0.020 µg∙g−1 and 0.050 µg∙g−1, respectively. The methods presented in this study are robust and were utilized for the registration of nitrapyrin on agricultural commodities in the United States.

关键词： Herbicide Agricultural Products External calibration lc-MS/MS Registration

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Boll weevils in dry bolls:is there a performance disadvantage?

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Journal of cotton Research 2024年第3期7卷 243-252页

作者： cOElHO Beatriz S. lEiTE Suzany A. SANTOS Mateus P.dos MATES Eloito c.de MORAES Beatriz M.l.de BASTOS cristina S. gUEDES Raul N.c. MOREiRA Aldenise A. cASTEllANi Maria A. Departamento de Fitotecnia e Zootecnia Universidade Estadual do Sudoeste da BahiaVitória da ConquistaBA 45031‑900Brazil Faculdade de Agronomia e Veterinária Universidade de BrasíliaBrasíliaDF 70910‑900Brazil Departamento de Entomologia Universidade Federal de ViçosaViçosaMG 36570‑900Brazil Pós‑graduacão em Agronomia(Fitotecnia) Universidade Estadual do Sudoeste da BahiaVitória da ConquistaBA 45031‑900Brazil

Background Anthonomus grandis grandis is the main cotton pest in the Americas,with the potential to become a pest in other *** insect uses the plant's reproductive organs for feeding,oviposition,and survival strategies in the off-season,sheltering in dry *** study aimed to know the reproductive potential,feeding,longevity,and morphometric characteristics of boll weevils from dry bolls,squares,and *** were obtained from infested squares,dry bolls,and traps installed in cotton fields and the caatinga *** weevil pairs were maintained in the laboratory to assess the oviposition,feeding holes,longevity,and morphometric measurements of the parental and F_(1) *** in the parental generation,boll weevils from traps(the caatinga area and cotton cultivation)showed greater reproductive *** weevils from squares and the caatinga area showed greater feeding activity compared with those from cotton *** rostrum length,thorax+abdomen length,and abdomen width were observed in boll weevils from cotton cultivation and dry *** origin of boll weevils parental generation did not affect progeny emergence *** F_(1) generation of boll weevils showed significant differences in average longevity depending on the origin of different ***,differences in rostrum lengths were observed,with the boll weevils coming from traps installed in cotton cultivation,the caatinga area,and dry bolls being the *** thorax+abdomen length and abdomen width,the highest values were observed in those from the caatinga area and cotton *** it was proven that dry bolls did not affect the reproductive,feeding,and longevity performance of boll weevils,enabling better insect fitness(reproduction and size)in relation to those coming from *** use of dry bolls as off-season shelter is an important survival strategy for the boll weevil.

关键词： Anthonomus grandis grandis gossypium hirsutum Off-season Survival

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leptin Modulates the Differentiation of Keratinocytes via Autophagy in Psoriasis Patients with Metabolic Syndrome

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international Journal of Dermatology and Venereology 2024年第3期7卷 121-130页

作者： Song c.-H. Wang R. Zhao Z.-K. Zhang Y. Sun J. Zhang X. Ding X.-Y. Bai J. liang X.-Q. Wei X.-J. liu X.-l. Yang T. liang X.-l. li c.-X. lin B.-W. Department of Dermatology PLA General Hospital Beijing 100853 China Department of clinical laboratory PLA General Hospital Beijing 100853 China Department of Dermatology Southern Medical University Guangdong Guangzhou 510515 China

Objective: Psoriasis is associated with a high prevalence of metabolic syndrome (MS), and patients with concomitant psoriasis and MS are more severely affected and less responsive to treatment. However, the molecular mechanisms behind these effects are unknown. Recent studies have shown that leptin may serve as a molecular link between psoriasis and MS, suggesting that high leptin concentrations may exacerbate psoriasis. However, the molecular mechanism of this effect is still unclear. We aimed to investigate the effect of leptin on autophagy in patients with psoriasis. Methods: From January 2021 to June 2022 in PlA general Hospital, we enrolled 51 patients with psoriasis, including 21 patients with MS and 30 without MS, and 30 healthy controls who had undergone nevus surgery. We measured the epidermal leptin, P62, and lc3B concentrations of patients by immunohistochemistry, and measured the serum leptin concentration by enzyme-linked immunosorbent assay. We then performed correlation analyses to compare these proteins' concentrations between patients with concomitant psoriasis and MS, patients with psoriasis alone, and healthy control groups. Additionally, we performed western blotting after in vitro culture of HacaT cells with different concentrations of leptin and measured the expression levels of the autophagy markers Beclin1, lc3B, and P62; the differentiation markers K10, K16, and K17; and Pi3K/AKT/mTOR signaling pathway-related proteins of Hacat cells. Next, we transfected ATg5 into HacaT cells to revert autophagy and used the specific Pi3K inhibitor lY294002 to block Pi3K/AKT/mTOR signaling. The expression levels of K10, K16, and K17 of Hacat cells were again measured. One-way analysis of variance was used for the comparison of means of multiple samples, and lSD-t post hoc test was used for comparison between the 2 groups. The counting data were analyzed by the chi-square test. correlations were evaluated by Pearson correlation analysis. Results: The serum l

关键词： autophagy keratinocyte differentiation leptin metabolic syndrome Pi3K/AKT/mTOR psoriasis signal pathway

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