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Early systemic anticoagulation reduces hospital readmission in acute necrotizing pancreatitis patients:A retrospective cohort study

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 77-82页

作者： Wen-Jian Mao Jing Zhou Guo-Fu Zhang Fa-Xi Chen Jing-Zhu Zhang Bai-Qiang Li Lu Ke Wei-Qin Li Department of Critical Care Medicine Jinling HospitalNanjing Medical UniversityNanjing 210002China Department of Critical Care Medicine Jinling HospitalMedical School of Nanjing UniversityNanjing 210002China National Institute of Healthcare Data Science Nanjing UniversityNanjing 210010China

Background:Early systemic anticoagulation(SAC)is a common practice in acute necrotizing pancreatitis(ANP),and its impact on in-hospital clinical outcomes had been assessed.However,whether it affects long-term outcomes is unknown.This study aimed to evaluate the effect of SAC on 90-day readmission and other long-term outcomes in ANP patients.Methods:During January 2013 and December 2018,ANP patients admitted within 7 days from the onset of abdominal pain were screened.The primary outcome was 90-day readmission after discharge.Cox proportional-hazards regression model and mediation analysis were used to define the relationship between early SAC and 90-day readmission.Results:A total of 241 ANP patients were enrolled,of whom 143 received early SAC during their hospitalization and 98 did not.Patients who received early SAC experienced a lower incidence of splanchnic venous thrombosis(SVT)[risk ratio(RR)=0.40,95%CI:0.26-0.60,P<0.01]and lower 90-day readmission with an RR of 0.61(95%CI:0.41-0.91,P=0.02)than those who did not.For the quality of life,patients who received early SAC had a significantly higher score in the subscale of vitality(P=0.03)while the other subscales were all comparable between the two groups.Multivariable Cox regression model showed that early SAC was an independent protective factor for 90-day readmission after adjusting for potential confounders with a hazard ratio of 0.57(95%CI:0.34-0.96,P=0.04).Mediation analysis showed that SVT mediated 37.0%of the early SAC-90-day readmission causality.Conclusions:The application of early SAC may reduce the risk of 90-day readmission in the survivors of ANP patients,and reduced SVT incidence might be the primary contributor.

关键词： Anticoagulation Splanchnic venous thrombosis Acute necrotizing pancreatitis Readmission Long-term outcomes

GNAS mutations suppress cell invasion by activating MEG3 in growth hormone–secreting pituitary adenoma

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Oncology Research 2024年第6期32卷 1079-1091页

作者： CHAO TANG CHUNYU ZHONG JUNHAO ZHU FENG YUAN JIN YANG YONG XU CHIYUAN MA Department of Neurosurgery Affiliated Jinling HospitalMedical School of Nanjing UniversityNanjing210002China Department of Neurosurgery Children’s Hospital of Nanjing Medical UniversityNanjing210019China Affiliated Eye hospital Nanjing Medical UniversityNanjing210029China Department of Neurosurgery Jinling HospitalSouthern Medical UniversityNanjing210002China Department of Neurosurgery Jinling HospitalNanjing Medical UniversityNanjing210002China

Approximately 30%–40%of growth hormone–secreting pituitary adenomas(GHPAs)harbor somatic activating mutations in GNAS(αsubunit of stimulatory G protein).Mutations in GNAS are associated with clinical features of smaller and less invasive tumors.However,the role of GNAS mutations in the invasiveness of GHPAs is unclear.GNAS mutations were detected in GHPAs using a standard polymerase chain reaction(PCR)sequencing procedure.The expression of mutation-associated maternally expressed gene 3(MEG3)was evaluated with RT-qPCR.MEG3 was manipulated in GH3 cells using a lentiviral expression system.Cell invasion ability was measured using a Transwell assay,and epithelial–mesenchymal transition(EMT)-associated proteins were quantified by immunofluorescence and western blotting.Finally,a tumor cell xenograft mouse model was used to verify the effect of MEG3 on tumor growth and invasiveness.The invasiveness of GHPAs was significantly decreased in mice with mutated GNAS compared with that in mice with wild-type GNAS.Consistently,the invasiveness of mutant GNASexpressing GH3 cells decreased.MEG3 is uniquely expressed at high levels in GHPAs harboring mutated GNAS.Accordingly,MEG3 upregulation inhibited tumor cell invasion,and conversely,MEG3 downregulation increased tumor cell invasion.Mechanistically,GNAS mutations inhibit EMT in GHPAs.MEG3 in mutated GNAS cells prevented cell invasion through the inactivation of the Wnt/β-catenin signaling pathway,which was further validated in vivo.Our data suggest that GNAS mutations may suppress cell invasion in GHPAs by regulating EMT through the activation of the MEG3/Wnt/β-catenin signaling pathway.

关键词： GHPAs GNAS mutation MEG3 β-catenin EMT

Fabrication of Core-Shell Hydrogel Bead Based on Sodium Alginate and Chitosan for Methylene Blue Adsorption

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Journal of Renewable Materials 2024年第4期12卷 815-826页

作者： Xiaoyu Chen School of Material Engineering Jinling Institute of TechnologyNanjing211169China

A novel core-shell hydrogel bead was fabricated for effective removal of methylene blue dye from aqueous solutions.The core,made of sodium alginate-g-polyacrylamide and attapulgite nanofibers,was cross-linked by Calcium ions(Ca^(2+)).The shell,composed of a chitosan/activated carbon mixture,was then coated onto the core.Fourier transform infrared spectroscopy confirmed the grafting polymerization of acrylamide onto sodium alginate.Scanning electron microscopy images showed the core-shell structure.The core exhibited a high water uptake ratio,facilitating the diffusion of methylene blue into the core.During the diffusion process,the methylene blue was first adsorbed by the shell and then further adsorbed by the core.Adsorption tests showed that the coreshell structure had a larger adsorption capacity than the core alone.The shell effectively enhanced the adsorption capacity to methylene blue compared to the single core.Methylene blue was adsorbed by activated carbon and chitosan in the shell,and the residual methylene blue diffused into the core and was further adsorbed.

关键词： Core-shell structure hydrogel bead attapulgite nanofiber sodium alginate polyacrylamide methylene blue adsorption material

Early prediction and prevention of infected pancreatic necrosis

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World Journal of Gastroenterology 2024年第9期30卷 1005-1010页

作者： Cheng Lv Zi-Xiong Zhang Lu Ke Department of Critical Care Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210000Jiangsu ProvinceChina Research Institute of Critical Care Medicine and Emergency Rescue Nanjing UniversityNanjing 210000Jiangsu ProvinceChina

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

关键词： Acute pancreatitis Infected pancreatic necrosis Biomarker Scoring system Nutrition therapy Selective digestive decontamination Probiotics Antibiotics Immune enhancement therapy

Light-modulated graphene-based φ_(0) Josephson junction and -φ_(0) to φ_(0) transition

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Chinese Physics B 2024年第2期33卷 476-481页

作者：程任翔于苗汪洪曹德亮李兴鳌戚凤华周兴飞 New Energy Technology Engineering Laboratory of Jiangsu Province School of ScienceNanjing University of Posts and TelecommunicationsNanjing 210023China School of Electronic and Information Engineering Jinling Institute of TechnologyNanjing 211169China School of Electronic Engineering Nanjing Xiaozhuang UniversityNanjing 211171China

We investigate the chiral edge states-induced Josephson current–phase relation in a graphene-based Josephson junction modulated by the off-resonant circularly polarized light and the staggered sublattice potential.By solving the Bogoliubov–de Gennes equation,a φ_(0) Josephson junction is induced in the coaction of the off-resonant circularly polarized light and the staggered sublattice potential,which arises from the fact that the center of-mass wave vector of Cooper pair becomes finite and the opposite center of-mass wave vector to compensate is lacking in the nonsuperconducting region.Interestingly,when the direction of polarization of light is changed,-φ_(0) to φ_(0) transition generates,which generalizes the concept of traditional 0–πtransition.Our findings provide a purely optical way to manipulate a phase-controllable Josephson device and guidelines for future experiments to confirm the presence of graphene-based φ_(0)Josephson junction.

关键词： graphene circularly polarized light staggered sublattice potential φ_(0)Josephson junction

Overexpression of low-density lipoprotein receptor prevents neurotoxic polarization of astrocytes via inhibiting NLRP3 inflammasome activation in experimental ischemic stroke

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Neural Regeneration Research 2025年第2期20卷 491-502页

作者： Shuai Feng Juanji Li Tingting Liu Shiqi Huang Xiangliang Chen Shen Liu Junshan Zhou Hongdong Zhao Ye Hong Department of Neurology Nanjing First HospitalNanjing Medical UniversityNanjingJiangsu ProvinceChina Department of Neurology Nanjing Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjingJiangsu ProvinceChina

Neurotoxic astrocytes are a promising therapeutic target for the attenuation of cerebral ischemia/reperfusion injury.Low-density lipoprotein receptor,a classic cholesterol regulatory receptor,has been found to inhibit NLR family pyrin domain containing protein 3(NLRP3)inflammasome activation in neurons following ischemic stroke and to suppress the activation of microglia and astrocytes in individuals with Alzheimer’s disease.However,little is known about the effects of low-density lipoprotein receptor on astrocytic activation in ischemic stroke.To address this issue in the present study,we examined the mechanisms by which low-density lipoprotein receptor regulates astrocytic polarization in ischemic stroke models.First,we examined low-density lipoprotein receptor expression in astrocytes via immunofluorescence staining and western blotting analysis.We observed significant downregulation of low-density lipoprotein receptor following middle cerebral artery occlusion reperfusion and oxygen-glucose deprivation/reoxygenation.Second,we induced the astrocyte-specific overexpression of low-density lipoprotein receptor using astrocyte-specific adeno-associated virus.Low-density lipoprotein receptor overexpression in astrocytes improved neurological outcomes in middle cerebral artery occlusion mice and reversed neurotoxic astrocytes to create a neuroprotective phenotype.Finally,we found that the overexpression of low-density lipoprotein receptor inhibited NLRP3 inflammasome activation in oxygen-glucose deprivation/reoxygenation injured astrocytes and that the addition of nigericin,an NLRP3 agonist,restored the neurotoxic astrocyte phenotype.These findings suggest that low-density lipoprotein receptor could inhibit the NLRP3-meidiated neurotoxic polarization of astrocytes and that increasing low-density lipoprotein receptor in astrocytes might represent a novel strategy for treating cerebral ischemic stroke.

关键词： inflammation ischemia/reperfusion injury ischemic stroke low-density lipoprotein receptor neuroprotective astrocytes neurotoxic astrocytes NLRP3 inflammasome polarization

Protective mechanism of quercetin in alleviating sepsis-related acute respiratory distress syndrome based on network pharmacology and in vitro experiments

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World Journal of Emergency Medicine 2024年第2期15卷 111-120页

作者： Weichao Ding Wei Zhang Juan Chen Mengmeng Wang Yi Ren Jing Feng Xiaoqin Han Xiaohang Ji Shinan Nie Zhaorui Sun Department of Emergency Medicine Jinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210002China Department of Emergency Medicine Jinling Clinical Medical College of Nanjing University of Chinese MedicineNanjing 210002China Department of Emergency Medicine the Affiliated Hospital of Xuzhou Medical UniversityXuzhou 221002China Department of Emergency Medicine Xuzhou Municipal Hospital Affiliated to Xuzhou Medical UniversityXuzhou 221000China

BACKGROUND:Sepsis-related acute respiratory distress syndrome(ARDS)has a high mortality rate,and no effective treatment is available currently.Quercetin is a natural plant product with many pharmacological activities,such as antioxidative,anti-apoptotic,and anti-inflammatory effects.This study aimed to elucidate the protective mechanism of quercetin against sepsis-related ARDS.METHODS:In this study,network pharmacology and in vitro experiments were used to investigate the underlying mechanisms of quercetin against sepsis-related ARDS.Core targets and signaling pathways of quercetin against sepsis-related ARDS were screened and were verified by in vitro experiments.RESULTS:A total of 4,230 targets of quercetin,360 disease targets of sepsis-related ARDS,and 211 intersection targets were obtained via database screening.Among the 211 intersection targets,interleukin-6(IL-6),tumor necrosis factor(TNF),albumin(ALB),AKT serine/threonine kinase 1(AKT1),and interleukin-1β(IL-1β)were identified as the core targets.A Gene Ontology(GO)enrichment analysis revealed 894 genes involved in the inflammatory response,apoptosis regulation,and response to hypoxia.Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis identified 106 pathways.After eliminating and generalizing,the hypoxia-inducible factor-1(HIF-1),TNF,nuclear factor-κB(NF-κB),and nucleotide-binding and oligomerization domain(NOD)-like receptor signaling pathways were identified.Molecular docking revealed that quercetin had good binding activity with the core targets.Moreover,quercetin blocked the HIF-1,TNF,NF-κB,and NODlike receptor signaling pathways in lipopolysaccharide(LPS)-induced murine alveolar macrophage(MH-S)cells.It also suppressed the inflammatory response,oxidative reactions,and cell apoptosis.CONCLUSION:Quercetin ameliorates sepsis-related ARDS by binding to its core targets and blocking the HIF-1,TNF,NF-κB,and NOD-like receptor signaling pathways to reduce inflammation,cell apoptosis,and oxidative stress.

关键词： Quercetin Sepsis-related acute respiratory distress syndrome Network pharmacology

E2E-MFERC:AMulti-Face Expression Recognition Model for Group Emotion Assessment

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Computers, Materials & Continua 2024年第4期79卷 1105-1135页

作者： Lin Wang Juan Zhao Hu Song Xiaolong Xu Jiangsu Key Laboratory of Big Data Security&Intelligent Processing Nanjing University of Posts and TelecommunicationsNanjing210042China School of Network Security Jinling Institute of TechnologyNanjing211169China State Grid Jiangsu Electric Power Company Limited Nanjing210000China School of Computer Science Nanjing University of Posts and TelecommunicationsNanjing210042China

In smart classrooms, conducting multi-face expression recognition based on existing hardware devices to assessstudents’ group emotions can provide educators with more comprehensive and intuitive classroom effect analysis,thereby continuouslypromotingthe improvementof teaching quality.However,most existingmulti-face expressionrecognition methods adopt a multi-stage approach, with an overall complex process, poor real-time performance,and insufficient generalization ability. In addition, the existing facial expression datasets are mostly single faceimages, which are of low quality and lack specificity, also restricting the development of this research. This paperaims to propose an end-to-end high-performance multi-face expression recognition algorithm model suitable forsmart classrooms, construct a high-quality multi-face expression dataset to support algorithm research, and applythe model to group emotion assessment to expand its application value. To this end, we propose an end-to-endmulti-face expression recognition algorithm model for smart classrooms (E2E-MFERC). In order to provide highqualityand highly targeted data support for model research, we constructed a multi-face expression dataset inreal classrooms (MFED), containing 2,385 images and a total of 18,712 expression labels, collected from smartclassrooms. In constructing E2E-MFERC, by introducing Re-parameterization visual geometry group (RepVGG)block and symmetric positive definite convolution (SPD-Conv) modules to enhance representational capability;combined with the cross stage partial network fusion module optimized by attention mechanism (C2f_Attention),it strengthens the ability to extract key information;adopts asymptotic feature pyramid network (AFPN) featurefusion tailored to classroomscenes and optimizes the head prediction output size;achieves high-performance endto-end multi-face expression detection. Finally, we apply the model to smart classroom group emotion assessmentand provide design references for classroom effect analysis evaluation

关键词： Multi-face expression recognition smart classroom end-to-end detection group emotion assessment

Systemic immune-inflammation index,neutrophilto-lymphocyte ratio,and platelet-to-lymphocyte ratio in patients with type 2 diabetes at different stages of diabetic retinopathy

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International Journal of Ophthalmology(English edition) 2024年第5期17卷 877-882页

作者： Ying Gao Rong-Xin Lu Yun Tang Xin-Yi Yang Hu Meng Chang-Lin Zhao Yi-Lu Chen Feng Yan Qian Cao Department of Ophthalmology Sir Run Run HospitalNanjing Medical UniversityNanjing 211112Jiangsu ProvinceChina Department of Ophthalmology Affiliated Jinling HospitalMedical School of Nanjing UniversityNanjing 210002Jiangsu ProvinceChina Department of Thoracic Surgery the First Affiliated Hospital with Nanjing Medical UniversityNanjing 210029Jiangsu ProvinceChina Medical School Nanjing UniversityNanjing 210093Jiangsu ProvinceChina Department of Ophthalmology Taikang Xianlin Drum Tower HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjing 210046Jiangsu ProvinceChina

AIM:To investigate systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),and plateletto-lymphocyte ratio(PLR)levels in patients with type 2 diabetes at different stages of diabetic retinopathy(DR).METHODS:This retrospective study included 141 patients with type 2 diabetes mellitus(DM):45 without diabetic retinopathy(NDR),47 with non-proliferative diabetic retinopathy(NPDR),and 49 with proliferative diabetic retinopathy(PDR).Complete blood counts were obtained,and NLR,PLR,and SII were calculated.The study analysed the ability of inflammatory markers to predict DR using receiver operating characteristic(ROC)curves.The relationships between DR stages and SII,PLR,and NLP were assessed using multivariate logistic regression.RESULTS:The average NLR,PLR,and SII were higher in the PDR group than in the NPDR group(P=0.011,0.043,0.009,respectively);higher in the NPDR group than in the NDR group(P<0.001 for all);and higher in the PDR group than in the NDR group(P<0.001 for all).In the ROC curve analysis,the NLR,PLR,and SII were significant predictors of DR(P<0.001 for all).The highest area under the curve(AUC)was for the PLR(0.929 for PLR,0.925 for SII,and 0.821 for NLR).Multivariate regression analysis indicated that NLR,PLR,and SII were statistically significantly positive and independent predictors for the DR stages in patients with DM[odds ratio(OR)=1.122,95%confidence interval(CI):0.200–2.043,P<0.05;OR=0.038,95%CI:0.018–0.058,P<0.05;OR=0.007,95%CI:0.001–0.01,P<0.05,respectively).CONCLUSION:The NLR,PLR,and SII may be used as predictors of DR.

关键词： diabetic retinopathy neutrophil-tolymphocyte ratio platelet-to-lymphocyte ratio systemic immune-inflammation index